Sewing With Nancy

Perhaps the question that most of you would like to ask me but are a little afraid to do so has nothing to do with fabric and thread. The topic - my face! Obviously, I'm not symmetrical. My eye and mouth on my right side have a partial paralysis called Bell's Palsy. It happened when I was just a baby, about one year old. Being a public figure with a facial paralysis has prompted many of you to write to me and ask questions when a friend or perhaps a loved one is stricken with a comparable paralysis. To address your curiosity and also answer some of those questions I've invited a special guest. I'd like you to meet Dr. Justin Sattin. Dr. Justin Sattin is a Neurologist and Medical Director of the University of Wisconsin Health Comprehensive Stroke Program. Thank you for being my guest. Thanks for having me. I doubt when you graduated from medical school you thought you would be on a sewing program! I never thought I would. So, we're here to address the facial paralysis because I get comments and people are wondering about this. Just as a summary, tell us the areas that often cause facial paralysis. Well, the most important thing in the occurrence of abrupt onset of facial weakness is to consider a stroke, so that's a medical emergency and folks should seek emergency medical attention and not try to diagnose a Bell's Palsy or anything else themselves. Sure. That's important because stroke has very specific treatments that are time sensitive and have to be given right away. Once that has been excluded there are several other conditions that can cause facial weakness. Some of them are a concerning, like a brain tumor and some are a little bit less concerning like an inner ear infection as is likely when it occurs in a young child. That is what caused the onset of mine. Lyme disease is a known cause of facial weakness and Wisconsin, of course is an endemic area for Lyme disease. Then when other causes have been excluded and we don't know what the cause is then it is called Bell's Palsy which is by definition a facial nerve weakness of uncertain cause. I happen to know that it's the 7th cranial nerve. That's correct, it's the 7th cranial nerve. So, the treatment... If someone would have an onset of facial paralysis is as follows. Well, there is now evidence, unlike 50 years ago that there are treatments that can affect the course of this illness. The one for which there's the most evidence is steroids like Prednisone. This is because Bell's Palsy is probably caused by some inflammation of that 7th nerve. That inflammation may or may not be caused by a viral infection. That's still rather controversial but irrespective of that it appears that giving steroids to reduce the inflammation in the nerve is beneficial for preventing a more serious long-term paralysis. In addition to the steroids we sometimes add some anti-viral medication because there's a theory that Bell's Palsy may be caused by reactivation of a viral infection in the nerve. That's a little bit more controversial but the steroids are pretty well accepted as a treatment. So, if your physician says, "Go home and it will go away" get a second opinion. I would recommend that. Again, because there is some evidence that treating early with the steroids can really affect the course of the disease. And also because there are other things that can mimic Bell's Palsy and it is important to exclude them. Now, there is a very positive recovery rate. Yes, the prognosis is excellent from Bell's Palsy. In most cases about 70% of the people make a full recovery or near-full recovery. About 15% of the people make a partial recovery and then about 15% are left with more severe weakness. The folks who have complete paralysis to begin with unfortunately are the ones who are more likely to have some residual weakness of the face. The people whose facial weakness is only fairly mild to begin with have a very good prognosis. And over 90% of those folks make a full recovery. Well, that's encouraging. It is encouraging that it is being treated with aggression rather than passivity, as it was many years ago. A brain tumor could be perhaps a cause of this. That's an important consideration to think about when the face becomes weak because there is a tumor that you may have heard of that is called acoustic neuroma the more technical term is vestibular schwannoma but these are tumors that involve the lining if you will, of the cranial nerves usually the 8th cranial nerve, so it would cause hearing loss and balance disturbance. But, if such a tumor were to grow long enough or large enough that it compresses the adjacent 7th cranial nerve it could cause facial weakness or less commonly the tumor itself can arise from that nerve. So, that's an important consideration. Well, Dr. Sattin, thank you so much for being with us. Thank you for joining us and perhaps having some of your curiosity answered. If you'd like to go to sewingwithnancy.com and "Nancy's Corner" you can find out more when you click on Dr. Sattin's name. Thanks for joining me, bye for now.