Tag Archives: Bell’s Palsy

Lyme Disease, John Kerry and My Face

Lyme disease effects and facial palsy

 

I was not going to write again about Lyme disease or my recovery from facial palsy, but recent news just begs for comment.

I have written about my facial palsy as a result of Lyme disease in the past. Here are some of those posts.

 https://tavmd.com/2013/07/26/facial-nerve-injury-and-lymes-disease/

https://tavmd.com/2013/07/12/facial-nerve-injury-without-facelfit-surgery/

Lyme disease tick photo

Lyme disease in the news

Since then, the CDC has come out with a new and startling report. The cases of Lyme disease in the US have been seriously underreported. Instead of 30,000 people a year getting Lyme, the number seems to be at least 300,000, and even that is probably an underestimate! Of course, having a larger number of people around the country having a disease decreases the personal sympathy factor, but that’s OK. What is not OK is the huge number of people who are walking about with complaints of fatigue and lack of energy who have been misdiagnosed or not diagnosed at all, let alone treated for Lyme disease.

The greater the awareness, the less chance that patients will develop “chronic” Lyme disease and whatever that may entail.

 

My facial palsy

I was lucky in a sense that the combination of a rash and my facial palsy led to a high degree of suspicion about Lyme disease, which was confirmed by a blood test. Had I not had the facial palsy, I would have thought the fatigue was just due to getting older, the rash just a sunburn or allergy. The paralysis of my face has improved significantly.  At rest, I look like I always did. When I grin, though, there is still a weakness on my right side. I also cannot sneer on the right, nor wink : not two facial expressions I use anyway. My eye’s tearing on the right has stopped but I still cannot force a closure as tightly as before.


John Kerry before photoJohn Kerry after photo

John Kerry’s palsy?

Today I saw a report that showed that Secretary of State John Kerry looks different than usual. Here are his recent photos, and  yes, he sure does look different! The spokesperson said he was very tired and stressed. Some have said he has had Botox and others that he has developed a… Bell’s palsy. I do not think the poor man has time to potter around his garden and get bitten by a tick, so I doubt the cause is Lyme disease, but still, a facial palsy is no fun. Stress is a well known cause of Bell’s palsy. We are learning now that stress can cause and/or uncover many of the immune-system-modulated reactions that lead to disease.

 

I shall be scouring the internet to see if I can find a video of him, with facial movement or otherwise. The chubby look could also be a reaction to steroids that he may have been placed on to reduce the effects of the Bell’s palsy.

 

All of you healthy readers: “For there you go by the grace of god…” Take care of yourselves and learn how to de-stress.

 

Morad Tavallali, M.D., FACS

Facial Nerve Injury and Lyme Disease

Facial nerve injury due to Lyme disease

 

For those of you who read this blog regularly, you will be familiar with my tribulations and fallen face. I thought initially that the acute facial paralysis I developed one morning upon awakening was due to a condition called Bell’s palsy. See below for more information on the facial nerve and its injury.

https://tavmd.com/2013/07/06/facelift-surgery-and-nerve-injury/

https://tavmd.com/2013/07/12/facial-nerve-injury-without-facelfit-surgery/

 

A few days after writing that post, I saw that I had developed a strange oval-shaped rash on my belly. Facial nerve paralysis + rash + living in the northeastern United States = Lyme disease. I am under treatment with antibiotics now.

The facial palsy has improved, though slowly. Here are my photos at a month’s difference. You can compare them with what I looked like in the earlier post above.

1 month post paraylsis at rest

after paralysis at rest

smiling with facial paralysis photo

 

The most annoying part of this ordeal has not been the disfigurement; after all, as a cosmetic plastic surgeon, I am hard-wired for dealing with that. Rather, the annoyances have been a tearing up from my right eye, which cannot close properly and is prone to tearing. That is very annoying.

Also, the loss of taste on one half of my tongue is much more of a handicap than I would have thought. I am no glutton, but loss of taste means there is no enjoyment in eating. I have forgone my second helpings and just eat less because it’s no fun; I have lost 13 pounds, though some of that may be due to the Lyme disease.

 

Lyme disease

 

Lyme disease is a tick-borne infection common in the northeastern US. The tick is carried around by deer and jumps onto plants and then onto humans who brush against a blade of grass or a plant. The tick bites us and we become infected by a form of bacteria the tick carries, which leads to infection.

Lyme disease shows many varied symptoms and the diagnosis is sometimes difficult.

  • A tell-tale “bulls eye rash” may or may not be present ( I had just a big red rash)
  • Fatigue
  • Runny nose
  • Muscle and joint pain
  • Headaches
  • Acute facial paralysis

These are some of the symptoms of Lyme disease.

A diagnosis is confirmed by drawing a blood test for the body’s reaction to the bacteria; it often comes back equivocal.

Treatment is with a 3-6 week course of antibiotics, typically Doxycyclin. Recently, a new form of “Lyme” has been identified that is caused by a different bacteria that is not sensitive to Doxycyclin. As for my facial palsy, it will hopefully get better by itself in the next few weeks. There is little to do but treat the Lyme disease and wait for the facial nerve to come back. I exercise the muscles daily to keep them from atrophying.

No treatment can lead to debilitating conditions that essentially make the patient bed-ridden.

The rule is: if you suspect you have Lyme, see a doctor and get treated.

 

Morad Tavallali, M.D., FACS

 

Facial Nerve Injury without Face lift Surgery

My facial nerve injury

In the previous blog I wrote about the anatomy of the facial nerve. Here is the link in case you missed it.

https://www.tavmd.com/2013/07/06/face-lift-and-facial-nerve-injury/

 

facial nerve photo

Botox or botulinum toxin injections can also lead to facial nerve paralysis in specific areas. See below.

https://tavmd.com/2012/04/26/why-do-i-have-a-droopy-eyelid-after-botox-injection/

https://tavmd.com/2012/05/01/treatment-of-droopy-brows-and-eyelids-after-botox/

 

Effects of facial nerve injury

Facial nerve injury has many causes, including:

  1. Trauma – getting the facial skin cut
  2. Surgery – facelift surgery or skin cancer surgery
  3. Tumors – brain or Parotid gland tumors or cysts putting pressure on a nerve
  4. TMJ – tempro-mandibular joint inflammation
  5. Bell’s palsy – unknown cause for loss of facial nerve function

 

Why a sudden interest in facelift nerve injuries?

Well, I just woke up with an acute partial facial nerve paralysis. It happens relatively commonly, and in most cases has an unknown cause called Bell’s palsy. In my case, I think it may be due to a TMJ problem that causes swelling around the facial nerve and decreases its function.

Damage to facial nerve functions and results respectively lead to:
  • Chorda tympani – inability to taste with one side of the tongue

  – Decrease in amount of saliva production leads to dry mouth

  • Temporal – inability to wrinkle brow; brow will droop
  • Zygomatic – inability to tightly close eye; eye will tear up

     – Unable to blink reflexively

  • Buccal – inability to puff out cheeks and purse lips
  • Marginal mandibular – inability to show lower teeth

 

Symptoms of facial nerve injury?

 

  • Inability to close my right eye and tearing

I have patched my eye to prevent damage to my cornea

 

  • Unable to chew or drink properly

Just like when you have come back from the dentist after anesthesia, I cannot purse my lips and drinking from a cup; it is… messy.

 

  • Unable to smile

I look grumpy and when I do try to smile I look like a pirate

 

  • Mouth feels dry

Only some of my salivary glands are working

 

  • Lack of taste

Perhaps the most interesting of the symptoms is an almost total lack of taste on one side of the tongue. Technically, it’s the front two thirds that have no sensation, but it feels like the whole side. Of course, the ability to sense a bitter taste is intact in the whole tongue.

Surprisingly I can feel all foods. All food feels alike, from a piece of bread to salami to an olive. They all feel slimy like an oyster! None have any taste at all! This is the worst sensation of all, in my opinion, since I have long suffered from the vice of gluttony, which I am now denied.

 

Since I am someone who usually has a very animated face and uses many facial expressions when talking, the lack of muscle function on one side is even more noticeable.

 

Treatment of facial nerve trauma (nerve palsy)

If the facial nerve is damaged during facelift surgery, it should be repaired immediately by the cosmetic plastic surgeon.

Facelift surgery that has damaged a facial nerve but is discovered later may need complicated cross-face nerve grafts in the future.

If palsy is due to known causes like tumors or cancers, these causes must obviously be addressed and treated first.

Facial nerve injury due to other causes requires treatment with steroids to decrease the swelling around the nerve, exercises to keep the muscles of the face working and taught and… a lot of prayer.

Facial nerve palsy usually improves within three weeks to six months, but some may be left with a remnant decrease in function.

Morad Tavallali, M.D., FACS