1 Can you imagine going to bed one night and being fine, just to wake up with half of your face paralyzed? Consequently, patients with Bell’s palsy frequently present to the ED before seeing any other health care professional. I’m female in generally good health but was dealing with a tremendous amount of stress at home at the time (coupled with Christmas/holiday stress). It all started the morning after Christmas in 2010. In rare cases, it may affect both sides. The probable sequence of events is viral reactivation, multiplication, and axonal spread causing facial nerve inflammation, demyelination, and ultimately palsy. Men and women are equally at risk of getting Bell’s palsy.
As I was losing the feeling in my face on this Sunday morning, I felt similar twitches traveling around my cheek, my eyebrows, my forehead and lips. This association remains speculative. Naturally, as this was going on I was freaking out, should I call an ambulance? Is this life threatening? It’s really good to know you don’t have herpes, dormant or otherwise. I immediately ran to my computer and googled “right side of face paralyzed.” What I found is that I wasn’t having a stroke, but had a condition called Bell’s Palsy which can be caused by many factors. We retrospectively analyzed the medical charts of 13 patients who were diagnosed with either Bell’s palsy or Ramsay Hunt syndrome from 1995 to 2004 and their MRI scan upon the diagnosis.
This patient was assigned to the control group and the level of recovery attained was not reported. A simple test of taste should be performed. My right eye wouldn’t close and the right side of my face looked dead. I ran down to my nearest Urgent Care office, and they confirmed that yes, I was experiencing Bell’s Palsy. Experimental data support a hypothesis of low temperatures in the pathogenesis of BP [15-18]. I requested to see a doctor and with much resistance they went and fetched the in-house doctor. She told me that there was no real way at this point for them to tell me what was causing the Bell’s Palsy, and that I should just take some valacyclovir and prednisone and “hope for the best.” I was very dismayed at this and demanded to know why this was happening to me!?!?
The doctor told me all we can do is wait and if it persists, THEN we will do more investigating. She told me, “something has decided to attack you’re facial nerve and we’re not sure why it happens.” With all the crazy feelings and emotions I was experiencing, this was not what I wanted to hear. Most people have chickenpox at some stage (usually as a child) and many people have cold sores. Not only are you dealing with the physical issues, lessened eyesight, a general dull pain on the nerve, an inability to eat properly, severe ear pain, and having to hold up the lower eyelid with your FINGER so your eye won’t dry out (eye patch didn’t work for me), but the emotional issues that came along were also severe. Call me vain, but I’m a young female and figured I had many years before getting the usual wrinkles and age spots. The goal of the nutritional support would be to decrease inflammation, control any swelling and add nutrients known to speed the healing of nerves. Also, you’re dealing with neurological issues – losing control of something you’ve had control of since in the womb can bring on great depression.
I absolutely could not get out of bed and cried daily for at least a week. I really feel for anyone who’s put in this position. Yes, there are much worse things that can happen and I just tried to keep reminding myself of that. I wasn’t dying, but the whole uncertainty of the whole thing (what caused it? Will it get better?) was really messing with my mind. If you have no feeling and little saliva on one side of your tongue, food may get stuck there, leading to gum disease or tooth decay. A few people are left with some permanent facial weakness after recovering from Bell’s palsy, though.
The process can take years! As I spent the next two weeks in bed, I had to remove my contact out of my right eye because it was so dry since the lower eyelid was drooping. My nearsightedness (which was WORSE now) limited my vision to a few feet in front of me. An affected ear may lead to sensitivity to sound (hyperacusis). So what could I do? Well, I put my smartphone about six inches in front of my face so I could see it, and researched everything I possibly could about Bell’s Palsy on my Blackberry. High-dose steroids (>120 mg/d of prednisone) have been safely used to treat Bell’s palsy in patients with diabetes;[29, 30] however, optimal dosing has not been established.
As I searched I came up with more questions than answers. What I found through internet searches is that the condition can be caused by SO many things – anything that causes damage or trauma to the facial nerve, ranging from cancerous tumors, to Lyme Disease to even rough housing with your dog and sustaining injury! All comments are moderated and will not appear until approved. Side effects There is a low risk of side effects (~ 1-4%) even from a short (one week) course of oral prednisolone. I’ve never had an STD and quickly dismissed this as being a possibility for causing my Bell’s Palsy (have had same partner for 7 years). Another cause I found is Ramsay Hunt Syndrome 2, but I dismissed that as well since it referenced the herpes virus. About 10 days into it I noticed my ears popping a lot, accompanied with sharp pains in the right ear.
I also had a very slight ringing and my ear generally felt very stopped up. I still had no improvement in my muscles and had absolutely ZERO movement on the right side of face. I had been taking a lot of prednisone as well as acyclovir and felt feverish like my body was fighting something. Also, for some reason my body was craving insane quantities of garlic (bless my boyfriend at the time for cooking constantly). In all patients, edema and swelling was observed in the labyrinthine segment of the facial nerve. At two weeks with no improvement the depression was really getting to me. But then a miracle happened.
I had taken a very long nap and when I woke up I went to the bathroom to see if there were any changes. I had read online to NOT go overboard with trying to force your muscles to move, because you can actually re-train your brain to move them too much and when they heal they will be contorted. The mean value of each meteorological parameter recorded from all days of each cluster was calculated so as to provide a realistic overall estimate of the corresponding weather type (Table ). The rest of my face was still dead, but I felt a slight bit of hope for the first time. Since that moment, things improved at a torturously SLOW, but steady rate. At the three-week mark I stopped taking steroids as they don’t recommend you stay on them too long due to bad side effects. As the next few weeks progressed I noticed a little improvement in my mouth, then cheek, then eye movement.
Finally at about the one month mark my eye began to close without my finger holding it. Three months into the ordeal, my forehead and chin began to improve, but my “kissy face” still was crooked. My smile was still at about 75% of what it used to be on the right side (same goes for raising my eyebrows), but I knew there was some time to go as the doctor’s told me it’s a 6-month to a year or more healing process. Around the two-month mark I started to notice a NEW symptom. It’s rare I get acne, but I broke out with an especially-nasty spread of pimples covering about 3 inches near my right temple, spreading down to my ear. I thought perhaps it was attributed to some massage lotion I used to massage my face during the first month, and told myself I would never use that product again on my skin. But the pimples then popped up on my lower right cheek, jaw, and seemed to be travelling slowly down, leaving destruction in its path!
Not trying to be gross, but the pimples were especially painful and difficult to remove or pop (not that I recommend this). While this did suck bigtime, it was the factor that revealed WHY THIS HAPPENED TO ME! One night, around the 5 or 6 month mark, I still had nasty acne on the right side of my face and now forehead and was beginning to think it odd that a massage lotion would create such long-term effects on my skin. I asked my doctor if the prednisone could have caused this long-term acne, and he was adamant that it would have been gone by now. He was baffled but told me to ask an ear-nose-throat specialist. I also was experiencing CONSTANT ear-popping which had happened since 10-days into it, accompanied by ear pain. I called an entirely new ENT and the doctor who had never seen me before actually spoke with me on the phone!
I told him what was going on. Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches are also effective. Well, I hear “herpetic” and think, I don’t have herpes! I started to research this term, and the words “Ramsay Hunt Syndrome Type 2” kept appearing on my web searches. Turns out, this condition is caused by the reactivation of the varicella-zoster virus. While entirely different from herpes simplex which causes the STD known as genital herpes, it is a part of the herpes family, which come in many forms. How did I contract this?
Well, it all began in preschool, when I came down with the chicken pox (in 1984!!). Turns out, when somebody contracts this virus, they get chicken pox. Then, the virus lies dormant in a bundle of nerves near your ear. As the years go by, your immune system can change and stress, illness or other factors can cause the virus to “become alive again” or reactivate. But instead of getting another case of the chicken pox, the virus returns in the form of something called SHINGLES – first on the nerve bundle where the facial nerve is (disabling it and causing Bell’s Palsy), then travels along the nerve paths out to the nerve endings which is actually what the acne was on my face. Gross! Figuring this out at the six-month mark was pretty relieving and as my face regained its movement, I started to feel better like I on the road to recovery.
The same doctor that told me I had post-herpetic neuralgia also diagnosed me with TMJ, which is a muscle spasm which could have been caused by the Bell’s Palsy that causes ear pain and popping. After being treated for TMJ (and with a mental effort to stop “popping” my ears), I did notice considerable improvement in the pain factor. Now at the one-year mark, I still have several effects that remain. I’m left with a slight woman-moustache presumably from taking the prednisone, and I have to epilate now. I still have about 5% permanent damage to the muscle movement of my face. No one notices this but me. Also, my eyesight was permanently damaged in my right eye but only slightly as I wear a -7.5 now instead of -7.0 contact.
The shingles left me with slight scarring on my face, similar to miniature “pock marks”. Another thing I notice is when I smile or wrinkle my forehead I see a tiny bulge of vein on the right side that wasn’t there before. I think this comes with aging anyways but it wasn’t there before and it’s only on the right side, so I think I have some slight atrophy. Also in photos I notice my eyes are a slightly different size. But overall I think my face is about 95% back to what it used to be. Details on my treatment – I started taking valcyclovir and prednisone within about 6 hours of onset (but the sooner the better). I took B12 and a B complex for two months.
I had constant bedrest for two weeks. I ate a ton of fruit, vegetables and garlic. I smoked medical marijuana every day for pain relief (improves my life and doesn’t bring me down – most people can’t relate but please don’t judge me). I massaged my face several times a day with a high quality pain relieving massage oil. I used Neosporin on the shingles and did try to pop them (several unsuccessfully which cause probable scarring but I did successfully remove about 50% of them which really helped). Something that I think really helped was to take INSANE amounts of B12 vitamin plus a B complex! These are essential to nerve regeneration – some people even get shots.
After the shingles disappeared I purchased an expensive face cream called strivectin which I think minimized the scarring. Don’t take Flonase or any other nasal sprays!!! At the six month mark I visited the doctor for the ear-popping, and she suggested I take Flonase to “clear up the passages.” Turns out Flonase lowers your immune system. I got the shakes and shivers and the existing pimples/shingles flared up and seemed to almost start spreading! I immediately got back on valcyclovir and it got better.