"Bell's Palsy? What's that?" I asked the emergency room doctor a couple of weeks ago, after being transported via ambulance with the sure signs of having had a stroke. Left side paralysis of face, arm and tingling in leg - chest pain - headache - dizziness - blurred vision. I really thought I was having a stroke. Here is what I learned on my journey into understanding this disease. I would like to share it with you now.

DEFINITION

Bell's Palsy is a condition that causes the facial muscles to weaken or become paralyzed (as in my case). It's caused by a trauma to the 7th cranial nerve (either by infection, stress or physical trauma - like hitting) and is not permanent¹. The condition was named for Sir Charles Bell, a Scottish surgeon who studied the nerve and its innervation of the facial muscles 200 years ago. Bell's Palsy is not as uncommon as one might think. Worldwide statistics set the frequency at just over .02% of the population (with geographical variations). In human terms this is 1 of every 5000 people over the course of a lifetime and 40,000 Americans every year. Diabetics are more than 4 times more likely to develop Bell's Palsy than the general population and the last trimester² of pregnancy is considered to be a time of increased risk for Bell's Palsy.

Symptoms of Bell's Palsy onset very quickly, most often people awake to find they have it or the symptoms such as dry eye or tingling around the lips and cheek that will progress to classic Bell's Palsy that same day. Occasionally symptoms may take a few days to be recognizable, but the degree of paralysis should peak within several days of onset - never longer than 2 weeks. A warning sign might be neck pain or pain in or behind the ear. This is usually not recognized in first-time cases. Regardless of the trigger, Bell's Palsy is best described as an event - trauma to the nerve. As with any other injury, healing follows. The quality and duration of recovery is dependant on the severity of the initial injury - any where between 6 weeks and 6 months. The possibility of recurrence had been thought to be as high as 10% - 20%. These figures have been lowered as more has been learned about the conditions that are now diagnosed as other types of facial palsies - 5% - 9%.

CAUSES

• Herpes Simplex 1
• Stress
• Lack of sleep
• Upper Respiratory Infection
• Rubella
• Mumps
• HIV/Aids
• Lyme Disease
• Otitis Media
• Bilateral Palsy
• Melkersson-Rosenthal Syndrome

SYMPTOMS

• Muscle weakness or paralysis
• Forehead wrinkles disappear³
• Overall droopy appearance
• Lower eyelid droop
• Brow droop
• Nose runs
• Nose is constantly stuffed
• Difficulty speaking, eating and drinking
• Sensitivity to sound
• Excess or reduced salivation
• Sensitivity to light
• Facial swelling
• Diminished or distorted taste
• Pain in or around the ear
• Drooling
• Eye closure difficult or impossible
• Lack of tears or excessive tearing
• Tears fails to coat cornea
• Impossible or difficult to blink

IN GENERAL

The first priority in treating Bell's Palsy or an type of facial paralysis is to eliminate the source of the damage to the nerve as quickly as possible. A physician might prescribe a steroid or antiviral medication for this purpose, however this is dependant upon the view of the individual physician. Some doctors believe that this will decrease the time of healing, while others do not. Should your physician believe that these medications are helpful, they should be administered as early as the first 24-hours of onset of symptoms and no longer than 7 days.

Rest is important. Bell's Palsy is an injury and you will heal more efficiently with enough rest to maintain strength and immunity at peak levels. You may feel more tired than usual during recovery, and that's normal. If you choose to work or exercise immediately after onset, be smart about it - when your body tells you it needs a break, indulge it if you have that option.

Take extra care in oral hygiene. Because your mouth can not chew properly on the affected side, food particles can lodge between the gum and cheek and cause discomfort or even infection.

If sounds appear painfully loud, don't hesitate to ask people to speak a bit softer. Exaggerated perception of volume isn't a symptom that most are likely aware of so you may need to explain that it's a symptom associated with Bell's Palsy. An earplug might help, although not suggested if you've had a history of inner or middle ear problems or have had surgery in the affected ear. Check with your doctor first.

For pain or discomfort, moist heat can help. You can purchase gel packs and thera-bead paks that can be heated in a microwave for fast, easy and portable help with the soreness. You can also use ordinary rice in a sock and heat it in the microwave. Try using an herbal heating pack at night (that's what I've used). Not only does it help with soreness, but the vapours help you sleep. Doctors aren't all aware that significant pain can be part of this ordeal. If you need medication, ask for it. If the doctor doubts the pain is real, refer him to the recently published "The Facial Nerve, 2nd Edition"for documentation.

EYE CARE

Eye care is the most important concern in the early days of Bell's Palsy. Maintenance of moisture and protection from debris are important functions that are frequently disrupted with 7th nerve damage. Permanent damage to the cornea is a risk if care is not taken to protect the eye.

HELPING WITH DRY EYES

Manually blink your eye using the back of your finger at regular intervals, and especially when it feels dry. Maintain moisture during the day with artificial tears. Look for a brand that is labeled "for sensitive eyes", "non-allergenic", or "preservative free". Use at least 4-5 times a day, or as you feel your eye becoming dry. For additional moisture retention, as well as protection from wind and debris, try a patch. For nighttime protection if your eye will not close, lubricants (gel or ointment) or lubricants combined with a patch are a good solution. Gels are thicker than artificial tears due to the addition of mineral oil. But they can make the vision blurry, so you won't want to use them during the daytime. By adding the "pirate's patch" (my son calls it), you not only add protection from debris and injury, you also keep light out and may find it easier to fall asleep. If you use the patch, try adding a bit of plastic wrap to help keep the patch from shifting around during the night. You can also tape your eye shut during the night, but a word of caution - it is too often that you can incorrectly tape the lid shut and the eyelid can pop open during the night exposing the eye to more damage than without the tape. If you experience any burning or stinging with the gels or drops, see your opthalmologist for further help.

RECOVERY

Most people who develop Bell's Palsy will recover completely and spontaneously ⁴ within 3 months. Residual effects can include eye problems (decreased lid closure/increased lid closure, dryness/excessive watering/watering during eating [crocodile tears⁵]), nasal problems (runny nose, dryness, collapsed nostril) and others. Generally the long the recovery takes beyond the initial three months, the more severe the residual effects. There are exercises that you can do that might decrease your recovery time, but as with any exercise ritual please speak with your doctor first before doing any of them.