Bell’s palsy: Facing up to uncertainty

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By BEATRICE NAKIBUUKA

Due to a stressful work environment, Tony Glencross, the managing director Nation Media Group-Uganda developed Bell’s palsy, a sudden, temporary weakness in the facial muscles that makes half of the face appear to droop.

He had had a stressful year and started noticing the first symptoms on December 18, 2018. “As I gave a speech at a party, I noticed my speech was slurry yet I had not taken alcohol. This worried me,” he recalls.

For Hellen Nakate, a social worker, the condition was kick-started by an outburst of anger after an argument with a friend.
“I had a heated argument with a friend but even though there was no physical fight, I felt exhausted. A few days later, I suffered general body malaise. My speech got slurry and I could not move my lips easily,” she says. After three days, her mouth drooped and the jaws became immobile.

“My speech was disoriented; mouth was droopy, teeth misaligned and had numbness around the left jaw. Eating became a problem. I would bite inside my mouth whenever I chewed. I could not close my mouth but there was no pain,” Nakate recalls.
She adds that she visited Rubaga hospital, where after several tests, the neurologist gave her medication and the symptoms disappeared after two months.

Bell’s palsy affects both men and women equally but is more common in those aged between 15 and 60 years. It is often mistaken for a stroke but according to Dr Kaddu Mukasa, a neuro physician at Kiruddu General Hospital, the condition causes a temporary partial paralysis of the muscles in the face only.

Symptoms
Dr Mukasa says Bell’s palsy symptoms can develop a few weeks after you experience a stressful situation, trauma, viral infection, or eye infection. They are usually abrupt but noticeable when you try to eat or drink or when you look at yourself in the mirror.

They can include uncontrollable drooling, difficulty chewing and drinking, inability to make facial expressions such as smiling or frowning, facial weakness and muscle twitches in the face.

Others include eyes watering more than usual, inability to close your eyelid or blink, decreased sense of taste and pain or numbness behind your ear. It is important to see a doctor if you have these symptoms. Never self-diagnosis for Bell’s palsy because its symptoms can be similar to those of other serious conditions such as a stroke or brain tumour.

Risk factors
Children who suffer meningitis are very likely to suffer from Bell’s palsy according to Dr Kaddu. Bell’s palsy can also be kick-started by viral infections which cause inflammation to the nerve. It is also been associated with headaches, chronic middle ear infections, trauma, herpes, high blood pressure, brain infections, lung infection, pregnancy, diabetes, and tumors.

Diagnosis
The doctor will first perform a physical examination to determine the extent of the weakness in your facial muscles by asking questions about your symptoms, when they occurred or when you first noticed them. You may also need an MRI or CT scan to check the nerves in your face.

Glencross says, “I suspected it would be Bell’s palsy because when we were young, a friend got the same condition so I knew the symptoms.” However, Bell’s palsy symptoms and those of a stroke are usually the same so he went to a doctor who recommended a CT scan.
“I went to Nakasero Hospital, did the scan and took the results to a surgeon. He also tested the strength in my left hand and leg to rule out stroke,” he recalls.

If it was a stroke, the paralysis affects the whole side of the body but in his case, the paralysis was only on the left side of the face. At the time of diagnosis, the paralysis was too bad that you would not notice that he was laughing if you looked at him from the left. I needed an eye patch be able to sleep.

Treatment
As soon as diagnosis is done, one must start treatment immediately because complete reversal of the symptoms is possible with early diagnosis.

Treatment for Bell’s palsy includes steroids which reduce inflammation, painkillers to relieve pain or eye drops for the affected eye. Prescription depends on your age and degree of severity of the condition.

“I took steroids for about two weeks. I had pain next to the left ear so I got diclofenac tablets and by January, the pain had disappeared,” Glencross says. He adds that he also had to change his lifestyle by slowing down at work to ease the stress, walking in the evenings, and engaging in breathing exercises.

Every day his Bell’s palsy gets better but he still cannot blink or close the left eye. “When I want to shower, I put my hand over the eye then wash my face,” he says.

“I went for physiotherapy where I got electric shock on the face for the first six weeks to stimulate the muscles to keep them active. I also do facial exercises such as moving my nose, eyes, smiling, and saying certain words,” he says, adding that he also went for acupuncture treatment from Dr Wang Yingjue, a Chinese doctor in Kampala.

Complications
“Until now, when I smile, one side of my face does not bring out the expression and I cannot blink in the left eye,” says Glencross.
“It is not a permanent disability but an illness of inconvenience. I still play golf every week; do my work normally although there is a little slow down,” he adds.

How can you care for yourself at home?

• Facial exercises. As the nerve in your face begins to work again, doing simple exercise such as tightening and relaxing your facial muscles may make those muscles stronger and help you recover more quickly. Massaging your forehead, cheeks, and lips with oil or cream may also help.
• Eye care. If you cannot blink or close your eye fully, your eye may become dry. A dry eye can lead to sores and serious vision problems. To help protect the eye and keep it moist:
• Use your finger to close and open your eyelid often throughout the day.
• Wear an eye patch while you sleep, and wear glasses or goggles the rest of the time.
Mouth care. 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. Brush and floss your teeth often. To prevent swallowing problems, eat slowly and chew your food well. Eating soft, smooth foods, such as yoghurt, may also help.

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