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I have Bell’s Palsy: Part 1, I become a patient

December 11, 2010

This is what my face feels like.

I woke up a bit distressed and I think the experience might be valuable to document. It’s not often that we as doctors are patients – and we make bad patients – so I thought I’d chronicle (what is hopefully) my recovery. Baring my personal course will also help lend some transparency to the process of medicine, I hope.

My own doctor’s office is closed on the weekends. The only walk-in open on a Saturday is the clinic that I work in daily. I thought it would be weird to check in as a patient since I work there. Plus, patients with this usually go to the ER so the ER docs are probably more up to date on treatment strategies. I was embarrassed to take up their time, was pretty sure of what I had, but didn’t want to self-doctor. Plus, I needed someone to look in my ear (I’ll explain this aspect later).

(as it probably appears on my chart:)

ID: 25 year old female, resident physician, previously healthy

HPI: Noticed numbness in L tip of tongue yesterday. Last PM, had difficulty sleeping last night due to “funny” sensation in eyes. Awoke several times. At 0800 noticed dry L eye and not able to close it, L facial weakness, slurred speech, loss of forehead wrinkles, and some decreased sensation on L side. No diplopia or change in visual acuity.

Healthy until this week. Sore L neck this week secondary to fall at hockey, L sided occipital headache/migraine not resolved with usual Rx (Axert). Works in Family Practice office and was exposed to VZV (Chicken Pox) this week. Had same as a kid. No hx HSV.

Med Hx: Migraines x 12 yrs
Surg Hx: Tonsillectomy 2007
All: No known drug allergies.

Rx: Axert (a triptan – anti-migraine medication) 12.5 mg PO PRN, Oral Contraceptives

On Exam: Looks well, no distress. Slurred speech. No obvious droop
loss of forehead wrinkles on L, unable to shut L eye,
sl decreases sensation to light touch in L V1-V3
Cranial Nerves: EOM full, visual fields normal, PERLA
Cerebellar normal

Assessment: Bell’s Palsy

Plan:
Prednisone 50mg PO daily x 10 days
Valtrex 1000mg PO TID x 7 days
Follow-up with ENT (ear nose and throat doctor, aka otolaryngologist)
Return if diplopia (double vision), other visual changes, worsening headache, nausea, etc.

(photos, my thoughts, what is Bell’s Palsy, prognosis, etc in the next posts)

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14 Comments leave one →
  1. December 11, 2010 3:35 pm

    Sounds like an awful experience, but I appreciate you sharing what it feels like as a physician to become a patient.

    Take good care of yourself (perhaps a few less calls?) until you are well again…and I’m sure that you are much more attractive than that blue guy in your post!

    • December 12, 2010 3:50 pm

      Thanks ! I’m lucky in that I don’t have any more call – just 1 week of work then I’m off for 2 weeks.

      Too bad this happened exactly 1 week before my birthday and 2 weeks before Christmas. Well, Twoface (from Batman) is pretty gross but when it’s your own face, it does kind of feel that bad, even though it’s probably not very noticeable to others.

  2. December 11, 2010 5:07 pm

    STATworkUP (version 1.2.0 – runs universal on iPad as well as iPhone or iPod Touch with iOS 4.2)

    DX – Search:

    Bell Palsy – Cranial Nerve VII Dysfunction

    Drill down to detail view:

    Idiopathic unilateral facial nerve paralysis
    –[commonest acute mononeuropathy]
    Inability to control facial muscles
    –[on the affected side]

    (Associations)
    Acoustic Neuroma
    Brain Tumor
    Brainstem Infarction
    Compression within stylomastoid foramen
    Guillain-Barre Syndrome
    Hypertension
    Lyme Disease
    Otitis Externa
    Otitis Media
    Parotid Gland Tumor
    Relapsing Fever
    Ramsey Hunt Syndrome
    –[Herpes zoster]
    —-[geniculate ganglion]
    Sarcoidosis
    Stroke
    Vincristine adversity

    (Prognosis)
    Usually self-limited
    –[85% recover within 3 weeks]
    —-[without treatment]
    –[remaining 15% improve by 6 months]
    —-[12% have a moderate recovery]
    —-[4% have a poor recovery]
    Incomplete palsies almost always resolve
    –[within 1 month]

    (Complications)
    Chronic Ageusia
    Corneal Damage
    –[inability to close eyelids]
    —-[dry eye]
    impaired vision

    Correlate: (Button above tab bar in the detail Info View for Bell Palsy pops up panel of others)

    Problems
    Tests
    Remedies

    Problems: (For Bell Palsy – any or all may be found – if so toggle check mark green into Findings)

    STATworkUP calculates the Differential Diagnoses array likelihood based upon total finding weights.

    Ageusia – Loss of Taste Sensation of Tongue
    Clumsiness – Gross Motor Acquisition Delay (Incoordination)
    Corneal Reflex Loss – Ocular Disorder of the Eye
    Dysphagia – Difficulty Swallowing
    Facial Drooping – Lax Facial Muscles
    Facial Hemiplegia – Unilateral Facial Neuropathy (Motor Weakness)
    Hyperacusis – Hypersensitivity to Sounds
    Imbalance – Dizziness or Vertigo – Dysequilibrium
    Onset (Sudden) – Symptoms Begin Abruptly
    Otalgia – Earache – Painful Ear
    Pain Jaw – Mandibular Region Pain
    Paralysis – Muscle Atonia
    Paresthesia – Numbness & Tingling

    Return to the detail Info View for Bell Palsy by tapping the Info Breadcrumb on the Navigation Bar

    Tap the Correlate button again and when Pop up panel of buttons opens select…

    Tests: (For Bell Palsy – any or all may be appropriate)

    House-Brackmann Score – Facial Nerve Damage Test
    Scratch & Sniff Tests – Study to Detect Anosmia

    Return to the detail Info View again for Bell Palsy by tapping the Navigation Bar Info Breadcrumb

    Tap the Correlate button again and when Pop up panel of buttons opens select…

    Remedies: (For Bell Palsy – any or all may be possible)

    Corticosteroids
    Prednisone

    (You can expand the assessment for any of the Problems above by doing similar correlation on them.)

    For any Sx, Lab, Dx, or Rx you can also tap the (i) button in the Navigation Bar of the Detail Info view for any item selected from a table to get a list of web linked pages for further information if connected to the internet by WiFi, MiFi or 3G etc.

    For instance in the Info view the Bell Palsy, tapping the Nav Bar (i) button opens a list of links:, the

    Bell’s Palsy – Wikipedia, the free encyclopedia

    Tapping the link opens the web view…

    When done browsing that, tap the Nav Bar Blue Done button to return to where you were in the app.

    In table views of cells with Sx, Lab, Dx or Rx you can tap the button named Findings.

    Tap the Findings button to see a list of the Sx you have designated as Findings.

    (That button is above the tab bar.)

    In that view you can clear any finding by back swiping the cell then tapping the delete button.

    Or you can clear all findings of the workup by tapping the Navigation bar Clear button in that view.

    If you quit the app while doing a workup and return to the workup again the findings will be saved if you select the Continue button at the the alert prompt “Prior Workup in Progress”

    It will discard the findings if you decide to choose the Delete button at the Alert.

    There is also a button named:

    Differential

    Adjacent to the Findings button

    Tap it to see the Differential of Diagnoses based upon the Findings selected.

    The Findings view also has a Differential button at the bottom of the View.

    The Differential view has a sliding control to adjust the likelihood higher or lower to adjust how well findings fit to the listed Diagnoses.

    And the list can be built with Priority on or off (in the latter case the list is alphabetized.

    Get well soon Doc O.

    Steve

    Differential at low likelihood setting with all possible symptoms selected for Bell Palsy includes:

    Facial Nerve Palsy
    Fibromuscular Dysplasia
    Pneumonitis
    Migraine
    Ramsey-Hunt Syndrome
    Diphtheria
    etc…

    Good Luck!

    • December 12, 2010 3:51 pm

      thanks. I don’t think StatRef is gonna help me in this circumstance though.

  3. December 11, 2010 6:37 pm

    Oh man, sorry to hear this Jess. Hope you recover fast.

  4. December 12, 2010 3:16 pm

    Figure it was the fall in hockey? Our friend came down with Bell Palsy a few days after getting beaned in the head during quarterstaff practise (yes, Jaime and I are former medieval reenactors).

    Hope it passes as quickly and painless as possible. Take it easy, eh?

    • December 12, 2010 3:53 pm

      Yeah I didn’t sustain a direct blow to the facial nerve origin, so I don’t know. But I am slightly suspicious of that as my neck was really bothersome all week. That said, inflammation of the nerve (secondary to a virus) can cause pain behind the ear. Could have been coincidental timing, but I don’t know.

      Either way, the prednisone is the way to go! Thanks for the kind wishes.

  5. PhebeAnn Wolframe permalink
    January 3, 2011 8:54 pm

    Isn’t Valtrex a viral suppressant? Why would it be used for Bell’s Palsy?

    • January 3, 2011 11:34 pm

      Yah Valtrex is an anti-viral, used for Varicella Zoster (VZV = chicken pox, shingles) and Herpes Zoster 1 & 2 (HSV 1 and 2 = cold sores and genital rash). Statistically it is more likely that it is HSV that caused my Bell’s Palsy although I was definitely exposed to VZV about 4 days prior to developing symptoms. I have never had manifestations of HSV1 or HSV2 but the majority of the population are asymptomatic carriers of HSV1 so it is a distinct possibility also.

      There is mixed evidence as to whether Valtrex or other antivirals speed the recovery process. Since there are few side-effects associated with the medication (other than wallet weight loss) it was worth a go for me.

  6. PhebeAnn Wolframe permalink
    January 3, 2011 8:56 pm

    Oh, wait, I think I just figured it out. They gave you the Valrex in case it is from Chicken Pox.

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