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Meeting Dr. Herx -- 46? Under Water Sometimes A Panic Attack Is Much More Than Anxiety

Posted Sep 12 2008 10:59am

By Virginia T. Sherr, MD

“What could have happened?” Conrad’s shaky, urgent voice demanded answers. “What is happening to me?” His phone call to this psychiatrist from Florida sounded desperate. An experienced diver, he had been 46 feet down – a mere recreational depth that was usually easy for him, when, with the suddenness of a blow, bizarre sensations and ideas burst into his mind and body – he felt totally disoriented and disconnected from himself. He was flooded with terror. Trembling, he hurriedly checked hoses and gauges. The fact that everything, including his oxygen supply, was in perfect order did not reassure him. He suddenly felt no self-assurance as the idea occurred to him that he had always been totally inept.

Something disastrous was happening to him, and he couldn’t figure it out or control his rising panic. The day’s status was “Blue,” the water depth 70 feet and calm, the equipment in perfect working order, he had not been worried--yet he suddenly lost all confidence. He needed to surface, which he managed to do correctly with the help of his diving buddy, and now he needed advice. He felt so weird he was sure that he was having a break with reality – thus, the urgent call to me.

Conrad knew me because he previously had sought help for a self-diagnosed depression. Actually, I had never been sure that he was “depressed-depressed” or whether he was just lonely-depressed. He was working on a maritime project that had him away from his beloved Boston, where his good friends and family hoped for his quick return. A young marine biologist, he had always been at home in the water. But not that day--now the sea was filled with dread and doom, sensations that he had never experienced before.

I urged him to come back to my office to be tested for tick-borne diseases, since what he was experiencing sounded for all the world like an oxygen-prompted Jarisch-Herxheimer [cytokine] excessive immune system reaction to a kill-off of toxic spirochetes—the bacterial cause of Lyme disease. Drs. Jarisch and Herxheimer were scientists who discovered the J-H phenomenon while working with spirochetal infections at the start of the last century. Lyme disease is a tick-borne illness that, if not recognized and treated promptly, can result in serious nervous system infection and chronic, sub-acute encephalitis.

Prior to Conrad’s vacation in Florida, something unusual had occurred. While he was not aware of any tick-bite, he had developed a generalized rash. Referred to his family doctor, he had been told it was “non-specific”, and was given a Med-Pack of gradually descending doses of prednisone designed to eliminate the itching and spots. I had suggested then that he first undergo testing for tick-borne diseases, but his family doctor had brushed aside any such considerations because there had been neither the popularly expected “bull’s eye rash” nor flu-like symptoms. These are now known to be present in only perhaps 50% of Lyme victims.

The location of Conrad’s home address had alerted me at the onset to consider Lyme disease as another possible cause of his depression. This was because some of the most serious cases of previously unsuspected Lyme encephalopathy that I have ever seen came to me from his geographic area north of Philadelphia, Pennsylvania, USA. Reviewing my intake notes at the time of his rash, I had found Conrad related no physical complaints other than an old “football injury” that gave him a knee ache without joint swelling from time to time. With his lack of physical symptoms, I had relaxed about the possibility of his depression being caused by tick-borne diseases. It had seemed to me then that neuro-Lyme disease was only a remote possibility what with his assurances that he felt physically well and was “only depressed.”

Re-interested in considering all options he hurriedly returned from Florida and I tested him for the antibodies and DNA of tick-borne diseases. Results showed considerable evidence of Lyme disease but not the full CDC diagnostic number of “bands” on the Western Blot antibody test. Retesting his blood shortly after initiation of antibiotics clearly substantiated the clinical diagnosis of Lyme disease, however. This timing may have allowed the effectiveness of antibiotics to jump-start his immune system and for the formation of antibodies.

Unfortunately, Conrad’s status continued to deteriorate rapidly. This bright young man was struggling to keep up at work, could barely hold on to one task or one thought at a time (loss of short-term memory), and was actually grinding to a halt cognitively. A SPECT brain scan done at Columbia University in NYC revealed “global heterogeneous hypoperfusion” revealing vascular inflammation in a pattern typical of the cerebral Lyme disease that was impairing blood flow to his brain tissues.

Informed of the facts, Conrad was at once relieved to know the source of his problems and chagrined that he hadn’t told me before about such symptoms of extreme fatigue and migrating muscle and joint pains—symptoms that he considered “signs of weakness.” “It was embarrassing enough to tell someone I was depressed,” he said. He has cooperated with his antibiotic and herbal treatment regime offered by a physician skilled in the treatment of TBD’s and is slowly recovering. His employer has been uniquely considerate of his health problems and has redesigned his job, making it compatible with his overwhelming but temporary disabilities.

Knowledgeable Lyme patients are known to make arrangements for carefully managed scuba diving excursions to reduce their spirochetal burden—air (providing oxygen) under pressure is lethal to the bacteria.

The likelihood of disorienting panic attacks while submerged is predicted to people prior to the dive and therefore reactions are much less frightening. Patients often prefer this therapy to the Hyperbaric Oxygen (HBO) dives that stimulate similar therapeutic experiences. The emotional phenomena that occurred to Conrad and that bears the Herxheimer name bears a strong resemblance to what D. Prater wrote concerning the plight of the poet, R. Marie Rilke in another context:

“In a sudden onset, the hitherto vague feeling of unease had developed into a brutal shock felt to his very marrow, so powerful that he was terrified. He could not explain this covert onslaught but somehow it had sapped the inner confidence, which, even at his worst moments, had always seemed unshakable, and whose absolute and evermore integrated unity with the body had been the wellspring of his art. He felt then a nameless fear that the defection of this body might destroy that unity, that a rift in his nature had been opened which might never be repaired.”

That Conrad will continue to work in marine biology is not in question. But whether he will come to see diving as an ancillary therapeutic tool in his treatment is problematic. At present, he is not ready to chance another underwater meeting with Dr. Herxheimer.

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