When Half Your Face Stops Working: Bell's Palsy Early Treatment and Recovery

Hello, I'm your host, Dr. Valda Crowder, also known as Dr. V, board certified emergency room physician committed to empowering you with life-saving health information. Please make sure to subscribe to my channels on YouTube. Follow me on all social media. Today we are going to talk about a very important topic, which is Bell's palsy and when your face will not cooperate. We've got two guests we're gonna actually bring in. These are listeners that have actually experienced this. But before we get to that, I'm gonna I want to talk a little bit about Bell's palsy and what it is. So, you know, this can happen when you wake up and you look in the mirror and one side of your face just isn't listening to you anymore. It may be that you have a crooked smile, a droopy face, maybe your eye won't close. And it can be really, really terrifying. Um, a lot of people actually wonder if they're having a stroke. So this scenario actually just played out in the headlines when an NBA all-star player was diagnosed with Bell's palsy. And this is why we decided to actually talk about this today, because it really sort of spotlights this condition and it sends thousands of people, rightfully so, to the emergency department every year, often in panic and with good reason. So today we're talking about Bell's palsy, what it is, and what the recovery really looks like from people that have actually actually had this diagnosis. So let's start off with what it is. Bell's palsy is a sudden temporary weakness or paralysis of the muscles on one side of your face. Um and it is often caused by inflammation or swelling of your seventh cranial nerve. And the seventh cranial nerve is the cranial nerve that actually controls all of the muscles in your face that are responsible for your facial expressions. Whether or not you're laughing or crying or opening up your mouth or closing your mouth, the seventh cranial nerve is the nerve that is actually responsible for that. It is the most common cause of facial paralysis, and while it can look alarming, most cases are not dangerous, and often they um improve over time. What is important about Bell's palsy is that it mimics stroke. You cannot assume or tell the difference between a stroke and Bell's palsy. Um and so um I tell people all the time do not take any chances, do not try to diagnose and determine whether or not you're having a stroke or Bell's palsy. Instead, just go to the emergency department and have them perform that evaluation. But when you look at it, facial drooping is actually part of what we call the fast screening. And fast screening is for a stroke, and it's fast F-A-S-T, because you need to go to the emergency department fast if you have any of these symptoms. And so the F stands for facial drooping, the A stands for arm weakness, the S stands for speech difficulty, and T stands for Time to Call 911 if you have any of these symptoms. And that's really, really important because there's a lot of treatments for a stroke now that we can only actually treat people if they actually get to the emergency department within the correct amount of time. Um, and usually that time window is pretty narrow, it's in the four to five hour range. Um, and so it can be very, very uh narrow. Um, so let's talk a little bit more about um Bell's palsy. Um so uh if you go to the emergency department, they determine that you do not have a stroke and they diagnose you with Bell's palsy. What does that actually look like? So again, the signs and symptoms are very similar to a stroke. You can get sudden weakness and paralysis of one side of your face, it can happen suddenly, it can happen over hours. Um there can be drooping of the mouth and eyebrow. Sometimes you may have difficulty closing your eyelids. Some people actually experience drooling or change in taste or increased sensitivity to sound on the affected side. Um people also have pain around their jaw or ear, um, which can actually precede the facial uh weakness. Um and uh both sides of the in rare cases, both sides of the face can be affected. Uh so why does this actually happen? So the facial nerve in your face actually travels through a very narrow bony canal on its way to innervating the the muscles of your face. And when that nerve becomes inflamed, it can become inflamed related to a viral infection, it swells, and it gets compressed inside of that narrow bony canal. That compression then interrupts the electrical signals traveling to the brain and to the facial muscles, which is why you actually then get the weakness. Because the nerve isn't severed, just compressed and irritated, the signal often returns as the swelling goes down, which is why many people actually regain the function of their face. So Bell's palsy uh affects about 40 out of every 100,000 people every year in the United States, making it one of the most common causes of facial paralysis. Um resolve completely without any treatment at all. Um, some people do require uh steroids or antiviral treatments, and that helps to actually improve the odds of recovery. About 10% of the cases actually have some lasting facial weakness, um, and that sometimes occurs when people don't get treatment or get delayed treatment. You're more likely to get recovery of your facial weakness the earlier you actually get treatment. Pregnant women, particularly in their third trimester, are also uh prone to this. So this condition uh is most common uh in uh all sorts of ages, but uh 15 to 45, with a slightly higher uh rate with folks that are over 65 years old. Again, the treatment is usually steroids within 72 hours, um, as well as possibly an antiviral. Alrighty, so we are going to go on to news you can use, but before that, to hear about today's topics or any topics that you have may have missed on this show. All of these shows are actually uploaded to our podcast. The podcast is called What the Health Is Happening. What the Health is Happening is available on all streaming platforms Apple Podcasts, Podbean, Audible. Wherever you listen to your audiobooks or podcast, you will find What the Health Is Happening, which is a rebroadcast of all of these shows. So you can get all of the information and the inside scoop on all sorts of health matters and life-changing medical updates. Also, if you want to cruise with Dr. V, we are going on the Norwegian Gym from February 28th to January 4th. If you'd like to join us, please email us at info at asdrv.us. That's info at askdrv.us. All right, news you can use. NBA All-Star Joel Embred, he was the one who was diagnosed with Bell's palsy, and it drew widespread attention, prompting physicians nationwide to field a surge of questions about facial paralysis. Family medicine doctors, neurologists have used the moment to remind the public that sudden facial weakness needs prompt medical evaluation, since it is sometimes a stroke, but it can also be Bell's palsy. And in order to tell the difference, it is really, really important that you call 911 and get into the emergency department. The other news you can use that I think uh people are really hearing about, and I believe it's now beginning to hit Washington, D.C. and the metropolitan area is cyclosporosis. This is the parasitic infection that is causing explosive diarrhea. People have actually tagged it to Taco Bell, but let me tell you, it's not just Taco Bell. It can be any restaurant. It can be in your home, right? So it is primarily with fresh lettuce, basil, cilantro, any sort of fresh greens that you are eating that are not cooked. You really want to make sure during this period of time that you give everything an extra wash. This actually leads to an explosive diarrhea that actually lasts for days. So you want to keep you and your family uh safe from that. All right. I want to introduce our guest. Um, these are two uh listeners that emailed me, and um I want to thank them for joining us today. We're gonna talk to Linda first. Linda, are you on the line? Yes, I am. Alrighty. Thank you for sharing your story today, because I think this is really important for people to realize sort of what happens and and what this looks like. So, what happened with you?

It was a busy time at work. I was working 20 hours a day, and I felt my eye start to twitch in an uncontrollable way. That was on uh Wednesday in December, and then it kept twitching, and then it seemed to spread. But I have to say the whole time I never identified it as paralysis. I never felt any pain. I always imagined paralysis had some pain associated with it. I just didn't recognize it as paralysis. And then it spread.

So so that's actually really that's actually a really good distinction, yeah. So so when we say paralysis, we're talking about like the loss of function, like something going limp. So did the side of your so paralysis usually is not associated with pain. So did the side of your face go limp?

Yes. Yes. Um my eye and when it spread, so first it started kind of blinking uncontrollably, and then it went limp, and then it just spread, and it by the time I finally went to seek um treatment, my eye was limp and my mouth was limp. The whole side of my face was limp.

The whole side of your face was limp. Okay, alrighty. And so you went to go seek treatment, and then did you go to the emergency department, or where did you go?

Well, at first I was playing tennis with you. Yes, that's true.

That's true. And I was like And I was like, just to so that everybody knows, I was like, what is going on over there? I know I played tennis well, but I shouldn't play. I don't think I hit the ball hard enough to make your face crooked.

And so I felt like if I was playing tennis, it couldn't be too bad. And I was doing my the rest of my workout, so I thought it couldn't be too bad. Um, but then you and some other people convinced me to see treatment. You in particular, when you said that there was the 72-hour rule that you know is optimal for um recovery, and that if I um waited too long, uh that because I kept thinking this'll this uh I you know I should be able to recover on my own. I'm not in pain. It should be okay. Um and then finally I went to um Georgetown emergency room where they were wonderful.

Good, good. And did you actually uh were you placed on uh steroids and the the typical treatment for uh Bell's palsy?

Yes. They were actually it was very fast. I went in there and they, like you said, they started the stroke protocol. Mm-hmm. And uh the I I ended up seeing a remote doctor first because he was the fastest one, I think, who could see me. And um and the remote doctor went through a checklist and said, yes, it's bell's palsy, but then I saw I think four other doctors.

Right.

Um all making sure that I did have bell palsy. And I have to say the wonderful thing that you did was uh at one point the one of the doctors asked if we wanted to proceed with the stroke protocol, and my friend who was with me said yes, she was wonderful. And I said, I think this is a payment question, and so we decided to contact you, and you said, absolutely this is a payment question. If several doctors have told you you have bell palsy, there is no way your insurance is gonna pay for it. So do not continue with the stroke protocol. That usually bankrupts people. Um it seems like everyone's convinced it's bell's palsy. Proceed with the bell's palsy. So they put me on steroids and an antiviral for 10 days, and then I proceeded to go get additional treatment.

And did your face fully recover?

Actually, it was really interesting. Um, it's about ninety-five percent now. I'm I'm still within the six-month window, but it's it's about ninety-five percent. When I get tired, um the eye that first started to flicker sometimes that will, and basically I had a cold and that seemed to affect my recovery, delay it a little bit um in that period. Um, and they told me to wear a mask as much as possible so I would not get a cold.

Good.

Um lymphatic drainage massages helped, and uh yoga, face yoga, and acupuncture as as you recommended. Electro uh acupuncture also helped.

Good.

Good. All right, so I'm glad you're like 95% of the way uh to recovery. Now now, Leanne, I I wanted you to actually come on the show as well because you have had Bell's palsy more than once, correct?

That's correct, Albert. Yeah.

Yes, and so you have how many times have you had Bell's palsy?

I've had it three times uh in 2020, in 2023, and again in 2026.

Okay, and then did you um uh go to the emergency department right away or did you delay like Linda? Tell us a little bit about what happened when the when you woke up and saw that you had some paralysis on your face.

Yeah, the first time I was going to bed and I noticed my eye was swollen. But when I woke up the following morning, it was drooping and the face had started to droop. So I immediately went to the ER. I called the on-call doctor and of course got the clearance, and I went to uh George Washington ER where they did a stroke event uh protocol because of they just needed to rule it out. But once they had ruled out stroke, they began to treat me for Bell's palsy. Um that was on the right side of my face, and then three years later I had similar symptoms on the left side of my face, so I knew what to look for, and again I called in. I got to the ER at Sibley, and they immediately began. Um, they ruled out the stroke, of course, but then they began to treat me with steroids and antivirals. The third time I was at a dentist appointment, my dentist said that she noticed facial drooping. I did not see or feel anything, but because she was so insistent, and also contacting my on call, checking in with you, I went to the nearest emergency department, got the stroke evaluation. They said, no, this is not stroke. We think this is spells again.

Right.

And it was on the other side again, on the right side. And so I did the run of both antivirals and steroids for the 10-day period.

Now, l now Linda talked about the fact that uh she was working a lot, um, and stress is one of the things that can really bring Bell's palsy on. Um, were you under any particular stress?

Oh, absolutely. Um, the first two times I was working, well, the first time I was working in the government, the second time I was working in a uh global nonprofit, the third time I was laid off from the nonprofit, so I was under the stress of trying to find new work. So, yes, there was heavy stress going on in addition to other family medical problems that I was dealing with as well.

Yeah, and I think that's really that's really important for people to actually realize that you know, stress, whether or not it's work or family or personal, um, can really uh bring on uh Bell's palsy. Now, what about your recovery? What sort of things did you do to actually recover and did you recover completely?

Yeah, I was very fortunate because I was able to get extensive outpatient treatment um with specialists who only do facial paralysis work. So I had, in addition to the medication, had things like ultrasound to map the muscle functions, radiotherapy, laser therapy, and um a lot of manual work. Plus, they trained me for exercises and facial um recovery that I could do at home. So in the first two instances, I worked with them for several months. And in the third instance, my recovery was so um immediate that the referring physician said that he did not see a need for additional um PT beyond the run of the medication. So I'm like 99% recovered.

Wow, so so that's interesting. So the last episode, which is probably the episode where we caught it the earliest, you caught it the earliest, that one was the one where you had your quickest recovery.

Yes, exactly.

Right.

And I think that because I was able to get to an emergency department within an hour, it was less than an hour from where I live, that I was very fortunate because I had notified the people I had worked with before. They said go to the emergency room. And I had such amazing treatment because they were able to rule out the stroke right away.

Yeah, that's really um that's really important. Now, Linda, how long did your symptoms last for? I know you were a little bit more delayed in getting the um diagnosis. Um, how long did your symptoms last for before you had uh recovery? I guess they're still there since you're 95%, but how long before you couldn't you couldn't actually, you know, you could go out in public and not really notice it?

I never stopped going out in public. Matter of fact, I thought I could live with it until a little girl did one of those mommy, what's wrong with her face? I was like, no, I guess not.

Wait, so you thought it was mild until a child told you that it was not.

Yes. No, the child was frightened. That's what I realized. I was like, oh my God. Okay. Um I would say the antiviral and the probably the steroid, really. The steroids worked immediately. Um so I started to see relief within days of uh you know, my ten day period of taking a lot of medication. And then within the first month, other people couldn't really tell. But then uh later on in the day when I got tired, uh you could kind of you could kind of tell. It was weird. It like I definitely needed to go to bed early and get a lot of sleep.

Right, right, right. So uh a quick question, did either of you adjust your lifestyle or your work schedule or how you manage stress as a result of this?

I recognize that I definitely had to get more sleep and more regular sleep, and also to kind of recognize when I was having a reaction to stress or excessive demands on my time, so I just had to start saying no a lot more.

What about you, Linda? Did you change uh your your lifestyle or your schedule at all?

Oh yes. I a matter of fact, I uh I ended up um uh making sure I'm a nine hour a night sleeper. I made sure that I was getting at least seven. Um but I really tried on the weekends to get nine. And then uh I cut back on almost everything.

When you say almost everything, you mean work hours?

Work hours, uh workouts, um anything that I thought could stress my body, I um pulled back on a lot of and I did the more like more of a relaxation kind of uh workout. So, you know, more meditating, more yoga, right yoga, especially, stuff like that. Um, more massages, um, lymphatic drainage massages.

So so let me ask you this. When you all told family members that you had Bell's palsy, did they know what it was? Or what were some of the reactions you got?

None of my people knew what was going on.

None of you none of your folks, Leah, knew what was going on.

Well, actually, one, so in my Buddhist network, I have been doing my daily practice for many years. There were actually three people who had also had Bell's palsy within the last couple of years. So those were the people that actually supported me and knew what was going on. But family and other friends, they thought, oh, did you have a stroke?

Right, right. That is the most common thing that you think about. Yes, absolutely. What about you, Linda?

Um, my mother had diagnosed early on that I had Bell's palsy. So she she knew and then she would call me every day with like, you should do face yoga, you should do this. Um, yeah, she she was the one uh who had a lot of ideas about she knows how I feel about medication and um you know, kind of not uh having a lot of it. My niece and nephew were probably the funniest. Um they both wanted to FaceTime me constantly and were like, Do you look more like Justin Beaver or Angelina Jolie? And I was like, no, think Picasso, self-portrait, uneven eyes, uneven face, you know. Right. Right. We kind of joked about it in the end.

Right. Now now you've mentioned face yoga a couple of times. Can you explain to people what that is?

Uh, you know, it's funny. I uh all I've done yoga for a long, long time since I've been a child for decades, and I had never done face yoga before, so I wasn't quite sure how that would be different than a massage. But it actually is. You try to um stretch and um contract your facial muscles, and because it had been in my eye, the a acupuncturist that I'd gone to, she basically said she described it and a friend of mine who had been told by an optometrist um no, which one's the medical doctor? I can't believe I said ophthalmologist. Ophthalmologist. Yes. Yeah, ophthalmologist. Optometrist does glasses. Yes. So she'd been told by an ophthalmologist to do the uh closure eye shot, you know, so close your eye shot really um hard and then open them bright. So I had done that drill constantly trying to exercise my eye muscles. And sometimes you kind of put a finger to where your nose bridge is to take a little of the slack around your eye so that it's a real must muscular exercise. And then there's some other things you do with your cheek, like you kind of blow out air in kind of almost like babies do, like kind of a uh, you know, uh if you say a lot of R, like kind of like that. Right. So there were various exercises for the same thing.

That gives us that gives us a great idea. That gives us a great idea. So I want to really thank you guys for actually joining us today because a lot of people haven't heard of Bell's palsy, they don't know what it is. I think it is really important the take-home messages. You need to actually, you don't know if you're having a stroke or not, get to the emergency department, see the physicians there, and allow them to actually really take a look at you and really uh decide. I want to thank you guys for joining me today. We're really committed to answering your most pressing questions here on the Ask Dr. V show. If you want to email me or be a part of the show, send me an email at info at asdrv.us, info at askdrv.us. We will talk to you next week. Thank you.