 The Clarinet BBoard
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Author: elmo lewis
Date: 2005-04-07 01:39
A student came in today with part of the left side of his face paralyzed. ¿Has anyone had any experience with this, such as how long it takes to recover and if recovery is total or partial?
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Author: Mark Charette
Date: 2005-04-07 01:48
Boy, considering it could be absolutely anything that caused the problem ... no one online could know.
When I had my wisdom teeth out some 30 odd years back I had partial paralysis (extensive numbness) for over 3 months.
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Author: avincel
Date: 2005-04-07 02:49
There is a condition known as "Bell's Palsy", etiology unknown, that results in unilateral facial paralysis. It usually resolves itself within 6 months.
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Author: Merlin
Date: 2005-04-07 03:51
I know a couple of saxophonists who've had Bell's Palsy. One got it in his 70's and recovered, and is still playing well at 85.
Former Canadian Prime Minister Jean Chretien has Bell's Palsy - that accounts for his distinctive look.
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Author: Karel
Date: 2005-04-07 05:46
Bell's Palsy usually recovers within 6-10 weeks, as a rule without residual weakness. One problem to look out for is damage to the cornea by drying, since the eyelids may not be able to close completely.
Karel.
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Author: mnorswor
Date: 2005-04-07 06:35
I've had this before as has Joe Rabbai of the Met. Your student should see a neurologist IMMEDIATELY. They treat it with anti-viral drugs and high dosage steroids. Facial massage/physical therapy is usually also recommended as are other non-western treatments such as accupuncture.
For me, the drugs didn't help, except to stop the progression of it because I caught it early. What did help the most was accupuncture and accupressure massage combined with Chinese herbs. After each treatment (I had 5 in total) I had a noticeable improvement over the control of the muscles in my face. All total, I was sick for 3 months.
It's imperative that you not try to play during this healing period because you end up straining other muscles in the area of the face and neck to compensate for the loss of control. This can be very harmful. My physical therapist recommended that I do something to keep up the dexterity in my hands so I did lots of finger practicing and went out a bought a GameCube on her recommendation. This helped a lot and gave me something to pass the time with.
Info is available on www.webmd.com and if your student decides on accupuncture, be sure it's with someone you trust. There are many quacks out there and accupuncture can be dangerous if done by someone who doesn't know what they're doing. Recovery times vary with the severity of the illness and usually range from 6 weeks to 6 months.
Best of luck and feel free to email me if you have any other questions about what I did to recover.
Best,
Michael Norsworthy
m.norsworthy@comcast.net
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Author: Mark Charette
Date: 2005-04-07 10:50
mnorswor wrote:
> student should see a neurologist IMMEDIATELY.
That's really the only advice anyone here can give. Without an exam one cannot be sure WHAT is causing the problem, never mind any treatment options.
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Author: bawa
Date: 2005-04-07 11:16
Dear Elmo,
Am not giving advice on treatment but your student should see his GP immediately who will refer him to a specialist.
I had this condition (whole right of the face paralysed, eyelid that would not close, mouth that could not swallow properly as half tongue and half the lips couldn't move etc). This was when I was 14-15. It has to be treated immediately; in my case, I noticed it in the morning at school but didn't call home and only when I went home in the afternoon my mother saw it, and then Panic! The family GP said even those hours were crucial to it being detained in time from getting worse. Cause was never clear, but it is the nerve on the face that gets seized up due to ...have your guess. In my case they said from sitting in front of a direct draft of cold air for a long time, although that also wasn't clear when and for how long. It is also associated with Epstein-Barr virus I think.
At the time I had to take steroid drugs, but as they weren't proving that effective, it was combined with electric shock therapy to reactivate the nerves and muscles of the face. Besides that, a lot of facial exercises prescribed by the physiotherapist. It is true that one should not read as the eye does not blink and anything visual (reading/tv) caused strain and watering (thats when I fell in love with the radio!). I also acquired the strange habit (to this day) of sleeping with a pillow ON my head as well as under (rather like a sandwich), mainly to keep the eye closed while I slept. Once I was allowed out, I had to wear an eyepatch because the eye could not blink to protect itself from dust etc.
It took about 4 months to get completely cured, but that can vary according to age and each persons individual body response. The important thing is to get medical treament straight away, as the longer you leave it, the worse it is likely to get and the harder to get it back. Any physical consequences I have are really too minute, but while one is affected one also loses a certain amount of strength in the corresponding limb (at least to me, although maybe it was all in my mind).
Also not to lose heart, as at the beginning progress maybe slow, and in my case I put a lot of weight because the steroids gave me a huge appetite! Afterwards I took up tennis and lost it all again.
Local lore also said to avoid eating fods classified in my country as "coolants" to the body (rice, yoghurt, etc.) and eat the warmants (meat, fish, eggs, dry fruits). In my case, too many warmants give me nose-bleed, so I remember my mother treading this thin line.
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Author: elmo lewis
Date: 2005-04-07 23:51
Thanks to all for the info. The student has been receiving treatment so I was not looking for medical advice, I wanted info from a clarinetist who had experienced this problem.
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Author: ken
Date: 2005-04-08 03:04
I contracted Bell's Palsy in 1984 on the right side of my face and struggled for 13 months to beat it and win back my health. I was abruptly off my horn the whole time and it was an extremely agonizing and confusing experience. As I recall it just hit me one morning when waking up. The entire right side of my face from my forehead to the bottom of my chin was as if I had received a shot of novocain. My face "felt" and appeared like it blew a fuse and was melting and/or dropping down off my skull. My right cheek, ear, eyebrow and eyelid were paralyzed nor could I wink or blink. To move the right side of my mouth and lips I had to stick my fingers in my mouth and pry them open. I was also unsuccessful at making any funny faces or scrunch my face. Breakfast was a bewildering sight and sensation as I had to use the spoon to open my mouth to shove my cereal in and even then, I couldn't chew on the bad side. I also had this bizarre and unexplainable metallic taste in my mouth.
At first I was in total denial and tried to ignore it by going to work and my morning rehearsal. But, when I screwed my clarinet together, expelled into the mpc and "not a discouraging word" or sound came out I realized something was horribly wrong. I was shocked and pissed at the proposition the right side of my face was totally useless. I excused myself and got to a phone to make a doctor's appointment. After describing my symptoms the nurse told me to come in immediately.
My Doc intently listened to my symptoms, examined my face then told me to have a seat at his desk. He reached for and grabbed a reference text off his shelf. He flipped to a page, slid the book under my nose and said, "read here, this is what you have". I read in disbelief as it listed the different types, strains and causes of a facial nerve disease (or virus in my case) called Bell's Palsy. It also briefly described the medical history of the person it was named for. My particular virus attacked the primary or largest nerve controlling the right portion of my face. The Doc said the cause was undetermined, but likely due to a combination of a weakened immune system and acute stress syndrome. I told him if it was stress it had to be all the damn Sousa marches I've been forced to play or one too many performances of "Selections from Annie"...![[rotate]](http://test.woodwind.org/clarinet/BBoard/smileys/smiley25.gif)
Back in 1984 there were no treatments just supportive care --- the disease had to run its course and I was told it was a 50-50 chance of regaining at most, 80% feeling and normal use of my face again. Worse, my odds of ever playing ANY wind instrument was zilch%. Everyday for 6 hours and at bedtime, I had to tape down my eyelid, and as there was no involuntary blinking reflex my cornea was constantly at risk of drying out.
All in all, I was indeed fortunate. I beat the odds regaining over 95% of the feeling in my face and recuperated enough to once again earn a living at playing music. In retrospect, it served as valuable "character building" with the biggest challenge of getting back in shape and re-capturing time --- it was even like learning how to walk or run again. My tonguing is still not as fast or accurate it once was but I ain't complaining! v/r Ken
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Author: mnorswor
Date: 2005-04-08 05:16
Ken,
Thanks for sharing your story. It's things like this that really helped me when I had Bell's Palsy.
All of a sudden, I found myself with 6-8 extra hours of time on my hands because I couldn't practice, thoughts filled my head of alternate careers and I asked myself what I would ever do if I couldn't play again. This was terribly difficult for me and fortunately I've got a great support network up here in Boston. My teacher, Richard Stoltzman, was of immeasurable help, calling every day to check on me, asking me if I'd done my finger practicing and if I was studying scores and reading. To be honest, this was the last thing I wanted to do because it bothered me so very much no to play. He kept on me though and really made me believe that it was only temporary. Later I realized that all he wanted me to do was to use the time wisely and to believe in myself and my ability to get back on the horse. I still thank him to this day as I don't know what I would've done without him.
My doc also thought this was brought on by a lot of stress, though they're still not sure of the absolute cause. I had just got done playing a 6 concert week with the most difficult program of my life at the very end. It included Grisey's Vortex Temporum, a 40 minute long spectral piece that took every ounce of strength that I had to play after playing 2 other pieces beforehand totalling about 40 minutes. So, I had 80 minutes of straight, difficult new music playing on multiple instruments, playing double lipped and standing for two of them.
To this day I have to admit I cringe whenever someone mentions this Grisey piece and I have to do it a whole bunch of times next year. I've requested that this be the only thing on the program for me because I don't want a re-occurrence. Perhaps it was this concert, perhaps it was the whole week of concerts or perhaps I was just so stressed out that my body said slow down NOW!
I was fortunate to have what many considered a mild case as I didn't have any problems with my eye and it cleared up in 3 months. I've since learned to take better care of myself and not to book so many things in a row with different programs and literature every night. I still wake up every morning though and look in the mirror to make sure that nothing has come back and probably will do so for quite a while.
The good news is, this time off gave me some time to think about what I do, why I do it and I came to a lot of conclusions that affected my professional life in many good ways. In addition, my house looked like a MUSEUM for about 3 months because all I could do was clean!! It gave me the time I needed to figure some things out, to better my teaching, to really focus on some things that I had neglected for a while and to receive the comfort that comes from wonderful friendships and the ability to make music.
--Michael
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Author: bawa
Date: 2005-04-08 09:31
Well, the info form other users has been useful, lots of clarinet advice for Elmo's student.
Ken, you said back in 84 there was no treatment, so I sat down and calculated and came to the conclusion that I came down with it 1977-78, when treatment definitely existed (oral and physio, both electric and massage/exercises), so I was puzzled. And I was living in what was then a relatively small city in India.
It must have been doubly-hard for you, as I was under treatment and young (and incurably optimistic), and I could see the slow but visible difference every few days, especially after the physiotherapy started.
I can only imagine what you must have gone through if you had no actual treatment and it took that long to get better.
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Author: ken
Date: 2005-04-09 05:13
bawa wrote: "when treatment definitely existed (oral and physio, both electric and massage/exercises), so I was puzzled."
--to be honest it's been 20 years and I've subconsciously blocked out a lot of that time --- many depressing monthly trips to the doctor (a Navy Specialist at the old Philly Naval Hospital). I think I recall some massage therapy, a hand-held vibrator or similar. I was also given daily face exercises to do but can't recall exactly what they were --- just thankful it's over. v/r Ken
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Author: Clarino20
Date: 2005-04-09 20:16
See a neurologist, after that if there are more problems send in a comment to the Institute of Human Health and Performance, they are a very innovative group dedicated to creating products and therapies that aid in the recovery and prevention of musical injuries (not that this is one but they could tell you maybe how to prevent it).
Corey
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