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I have Bell’s Palsy: Part 5, New Video, being treated “specially” and the struggle to Take Care

December 15, 2010

Between ER nurses, the ER doctor (who’s been a preceptor), the Pharmacist (who I work with weekly), the Otolaryngologist (Ear Nose and Throat = ENT surgeon), and my own  (super-dedicated to Family Practice) GP, I’ve had some durn’d nice treatment.  Being a resident doc and being already friendly with these professionals has certainly made my experience different than it might be for another patient. The general process of being “ill” – do I really feel sick though? – is also strange as one who, usually as an outsider, deals with illness all the time.

I often close a chat with a patient by saying something like “Do take care of yourself! Return if you have any concerns” or “Remember to take care.”  I don’t know if they ever really hear me when I say it. It is a statement easily brushed off. It’s tough advice to follow. What does it even mean? I’m struggling now to decide how much I need to temporarily give-up in order to be ‘taking care.’ I usually thrive on busyness so I guess I’m afraid that giving up parts of my routine will make me feel less well. Or perhaps this is the pathological thinking of a Type-A “gotta be doing stuff” junkie – an apt description for most physicians I know, including myself.

I probably should have discussed my doc’s advice with my parents (since he suggested I travel the 2 hrs to their place so they can look after me). But I had just talked to them and they’ll hear sooner or later (right M + P?!)

Anyway, the next video instalment is here. I thought I fixed the sound-delay but YouTube compression maybe re-jangled it.

———————-

Watching myself reminds me that I used more jargon than I should have; in the office I usually draw pictures and try and explain it carefully, checking in with the patient that it makes sense. Talking at my computer, I wasn’t as conscious of the fancy words:

Schadenfreude = pleasure taken in witnessing the misfortune of others [my reference to this is a joke, by the way, in case it wasn’t clear]
“Loveseat”  = mini couch with 2 seats (is this a Canadian term only?), I slept here because it was in the room furthest from the noise
location of the geniculate ganglion= (for pedants,) this convergence of nerve fibres that form the facial nerve is technically in the facial canal not inside the cranium proper

GP = Family Doctor aka General Practitioner – possibly called Primary Care Provider (PCP) in the good ‘ole US of A
ENT = Otolaryngologist also known as Ear Nose and Throat = ENT surgeon
MRI = Magnetic Resonance Imaging – a non-radiating imaging modality, especially good for looking at brain stuff, like the nerves that control our face
Prednisone = a steroid medication meant to suppress inflammation; read more about it here

14 Comments leave one →
  1. December 15, 2010 10:42 am

    Hi Jessica,

    Observation:

    The latest video reveals a more prominent nasal alar crease and better lid closure upon downward gaze and less lisp.

    Good signs!

    Hang in there …

    Steve

    BTW in my estimate you must be the oldest or only kid
    Let yourself be a human patient and Doc too.
    Givers and saviors have the right to receive as well.

    • December 15, 2010 11:38 pm

      Hahah! Well I’ll be 26 on Saturday. This has been my birthday present to myself, I guess!

      thanks for the observations, seems most agree. Not sure how much of the lid movement in CN III vs VII but any change is good with me!

      Oh and who knows about this clinical prediction/grading scale. Just gotta wait it outand try and remember to not half-ass it on the self-care bit.

  2. December 15, 2010 10:59 am

    Clinical Predictions:

    A clinical prediction rule is type of medical research study in which researchers try to identify the best combination of medical sign, symptoms, and other findings in predicting the probability of a specific disease or outcome.

    Physicians have difficulty in estimated risks of diseases; frequently erring towards overestimation[2], perhaps due to cognitive biases such as base rate fallacy in which the risk of an adverse outcome is exaggerated.

    In a prediction rule study, investigators identify a consecutive group of patients who are suspected of a having a specific disease or outcome. The investigators then compare the value of clinical findings available to the physician versus the results of more intensive testing or the results of delayed clinical follow up.

    These have had the consequences of their usage by physicians quantified.

    When studied, the impact of providing the information alone (for example, providing the calculated probability of disease) has been negative.

    However, when the prediction rule is implemented as part of a critical pathway, so that a hospital or clinic has procedures and policies established for how to manage patients identified as high or low risk of disease, the prediction rule has more impact on clinical outcomes.

    The more intensively the prediction rule is implemented the more benefit will occur.

    It is hoped that the use of STATworkUP may help to influence inclusion of prediction rules in practice. It is designed to correlate selected findings with a set of likelihood likely diagnoses based upon the probability settings.

    Where clinical prediction rules exist these are included in constructing the relationship between findings and diagnoses.

  3. Nico permalink
    December 15, 2010 12:48 pm

    HEY. i see improvement. Seriously. Much more than the last vid!

    ( really honestly, major difference.)

    • December 15, 2010 11:39 pm

      thanks Nico. They eye seems to almost close when I look down which is kind of handy. Definitely less uncomfortable. I’ll test it out at work tomorrow since I’m gonna do an afternoon 🙂

  4. Richard permalink
    December 15, 2010 5:32 pm

    I think that your eye is moving a whole lot more than it was in the previous video. It sounds horrible, but if you DID have a tumor, you would be one of the people who needed the MRI, so if it’s a concern that they want to exclude, you’re not being treated specially.

    Sure, the ER doc calling you at home and the pharmacist filling your prescription quickly are professional courtesies – possibly in an attempt to reward a doctor for not self-diagnosing? To make sure that you follow through with the treatment, etc.

    • December 15, 2010 11:42 pm

      yah I’m not sure if it’s the numbness in my tongue/lack of salivations etc. that is concerning as those branches aren’t necessarily involved in your average Bell’s patient. I will take the MRI. It would have been a good learning experience so I could tell patients about what it’s like to have MRIs if I hadn’t already EXPLICITLY had a functionalMRI (2 yrs ago) in order to have that experience.

      I’ll look at the courtesy your way. I wouldn’t really want to be in their shoes, treating a doctor, either, to be honest. They really stepped up and it makes me warm and fuzzy to know that they were trying really hard. I’m so lucky that the people I work with DO treat all their patients with such degree of care.

  5. December 15, 2010 7:30 pm

    Thanks for the update. I’ve been looking forward to your posts to hear how you are doing.

    As far as going to work or staying home, here’s something to consider: you are a role model to your patients. How you take care of yourself demonstrates your values about self-care. Objectively (as you can be), how would you advise a patient who was in your situation? Perhaps if that is your guide, you will find the decision a little easier.

    On a more personal note, you are going through an experience which is not only challenging your physically, but I imagine must also be difficult emotionally as well. Taking care of yourself emotionally and spiritually is important too.

    I find your observations from the patient’s perspective (and how you think it will influence your practice) really interesting.
    One question I have is regarding prednisone, what are some of the risks? How might being on prednisone affect your ability to provide patient care?

    BTW…I didn’t know that a loveseat was a Canadianism…Chesterfield, definitely, but isn’t loveseat universal?

    • December 16, 2010 12:11 am

      Hi Penelope

      Glad you are still reading 😀

      I have been trying to listen to the doctors, honestly. My GP is the kind of guy who has probably never taken a day off in his life. Although I trust him, because he is a Family Practice ‘machine,’ he models behaviour different than that which he instructed me to undertake.

      There are only a handful of ‘harcore-ers’ around me who I expect would suck it up if they were in my shoes, and that’s only because they came from the old, masochistic medical culture. The other 99% I know are genuine in reminding me to be nice to myself and would do the same if in my shoes.

      As far as prednisone, it’s just caused me insomnia/fatigue (secondary to not sleeping more likely), increased appetite, and sore stomach [pukey this AM], etc. Mood swings and brain fog are common but in my case I’m not sure that these are from the meds and not just from being sick/tired/etc. It seemed that my physician was concerned that I would experience more profound psych effects, or if I was experiencing them, that I wouldn’t maybe have the insight to notice. Many get a bit… ragey, but this hasn’t been a problem for me. Maybe because I don’t snap easily anyway? I’ve also been limiting my time away from my apartment. Depression, mania, psychosis/delirium, confusion, and trouble making decisions do all appear on the pharmacy handout that comes with the drug and I’ve seen some of these cases in the ER or psych ward.

      To be honest I was a bit scattered at work. Forgetting simple things – like not billing for one patient, having trouble remembering what blood tests to do for hyperthyroidism even though it’s really easy- but I assumed it was just ‘being sick.’ Can’t be more dangerous than being mandated to do 36 hour shifts eh (I would never do those now but didn’t know I had a choice in med school)? There are TONNES of longterm issues but I’ll only be on it for 10 days so many of them don’t apply to me. Only 5 more days of drug to go!

      This is all nothing compared to the uphill battle it sounds like you are facing. It must be so much scarier to not know what you have. I hope you have a healthy holiday season and get to start the new year feeling great!


      I don’t know about “loveseat” “chesterfield” etc. They all sound funny when you spend too much time thinking about the terms, don’t they?

    • December 16, 2010 12:28 am

      I can’t believe anyone could make a rational decision after 36 hours! I’m glad to hear that is starting to change. You medical people can be very hard on yourselves…

      Just wanted to share one more quick reflection with you – one of the most powerful moments in my recovery from PPD after my miscarriage was when my doctor shared with me that he had taken a year off work to recover from back surgery.

      I was feeling crummy about being off work for a few months (worked with a serious type A group). Trusting my doctor and knowing that he had allowed himself time to heal *and had obviously returned to work successfully* allowed me to be easier on myself.

      It sounds like you have a lot of supportive people around you and a great family to share the holidays with. I’m sure you will be looking and feeling like your regular self very soon. 🙂

  6. December 16, 2010 10:35 pm

    Serious improvement doc. Right away I’ve noticed that you’re speaking better (though it could be a function of getting used to it?), eyelid movements and eyebrows too. Progress!

    I’ve had doctors call me at home sometimes as well, both doctors and dentists, especially after something unusual and they’re just wanting to make sure that stitches are staying in and/or medication has kicked in (when it’s supposed to). It may be part professional courtesy in your case, but it’s also possible that they’re genuinely concerned for you as Bell’s is one of those “whoa this is kind of freaky” things that may have an impact on your emotional health as well?

    Either way, yay for the improvements!

    I’m enjoying the videos – you’ve got a really unique perspective here, and you’re really good at using the medical terminologies and providing explanations/definitions too.

  7. December 20, 2010 12:57 pm

    Oh! Oh!

    You must must must take the best care of yourself. MUST.
    You are my friend and I am now going to read all the rest
    of the things you have written so I can further understand
    how you are doing.

    Much love and good energy for you
    Be well!

    You are naturally full of well-being and so I am sure
    that the well-being will come out on top.

    Oh! ❤

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