Sunday, November 1, 2009

Bell's Palsy or Stroke?

The pizza arrived at 7:30 P.M. on the Wednesday before last. I relaxed, watching TV and sipping water until I had an urge for a box of vanilla milk shortly after midnight.

But the left side of my mouth couldn't close around the straw.

I started to freak. Had I had a stroke?

I checked myself to see what else was different and prayed, "Lord, did I have a stroke? What do I do? What is it?"

The answer came back, "Bell's Palsy," in that still, small voice within my spirit.

Wanting to make sure it wasn't a stroke, I got on the Internet. Everything I read at the Mayo Clinic, MedlinePlus, the Merck Manual, WebMD, and other sites Google gave me said to go to an emergency room immediately. Feeling a check in my spirit for that course of action, I continued to study the pages and was gradually reassured.

Men are the usual victims. I have no family history of stroke or heart disease. I'm younger than the typical age range of those women who did have a stroke. I've never been diagnosed with hypertension. Most of all, stroke affects the lower left part of the face and is usually accompanied by the left arm and/or left leg being affected as well, while Bell's Palsy affects an entire side of the face, only, from forehead down, and from nose to ear.

Wondering what might have caused it, I checked the web sites for Bell's Palsy before calling my chiropractor for an adjustment. Everything fit.

However, my D.C., said there wasn't anything he could adjust to fix Bell's Palsy and he wasn't about to adjust my neck, anyway, because he didn't know that it wasn't a stroke and didn't want to make it worse, if it was.

Fair enough.

On Monday, I called my regular M.D. for an appointment to get an official diagnosis for Bell's Palsy. However, because of him taking time off, his appointment book is full until Nov. 10. The nurse asked a series of questions and relayed them to the doctor. When his answer came back, it was that he'll see me on Nov. 10th and if I wanted to get checked out sooner, I may go to the walk-in clinic he named.

Off like a shot, I arrived at the walk-in clinic and was given a five-page intake form to complete that inconsiderate, partial idiots must have designed. For example, instead of allergies to medicines being filled in on page 1 where doctors like it for quick reference so they don't prescribe something that'll kill their patients, allergies were to be listed on page 2...and page 4.

What the...?!

Yes, allergies were to be listed on page 2 and listed again on page 4 with the reactions. If I had been smart, I would have reviewed all five pages before starting to complete the form so I could list them on page 4 that wanted more information about the allergies and enter "See page 4" on page 2. But I didn't have that foresight.

Returning the clipboard to the receptionist, she reviewed my pages. "You didn't do this section," she said about the two-inch square box I had left blank.

I didn't appreciate her tone of voice. Was she copping an attitude with me?

"I didn't understand it," I replied.

"It's your Family History." She read, "Father/Mother/Grandparents/ Brother/Sister..."

Yup, she had an attitude.

"I know that," I sniped back. "It's all those initials that I didn't understand."

"Oh!" She went on to interpret:

Heart disease.





(That must be the "CA" that I saw; the others still didn't make any sense to me.)

"You didn't sign this," she said in a better tone of voice, pointing to a signature block on the last page.

"Sorry, I don't sign for things I haven't received," I said.

She handed me a privacy policy statement and I signed, acknowledging receipt.

Sitting back down to wait, I couldn't get into "Judge Alex" on the TV although the case sounded really funny. What would Jesus do about this twit of a receptionist and the stupidly designed intake form? There are people who definitely should not be interfacing with the public and I don't subscribe to the "Turn the other cheek" philosophy because it's for a conquered people of which I am definitely not a member. Him raging in righteous anger seems more like it except flinging the receptionist's papers about and driving her out with a whip of cords (John 2:15) would be drastic overkill as well as get me arrested for assault.

One of my college professors who taught computer programming also functioned as a group therapist after hours. We had gotten close enough for her to invite me to Christmas dinner and one year she advised, "I can be angry and you can be angry, but it's a lot better for me if you're the one who's angry," as a way to deal with aggravating people.

Thinking about her advice, maybe I should have put the monkey on their backs by filling the Family History block with "NTIKOBIDUTFLAADKFWYL" ("None That I Know Of Because I Don't Understand The Freaky Little Abbreviations And Don't Know For What You're Looking") and let them sort it out.

Before I could calm down, the nurse called me in and took my blood pressure: 208/103.

The doctor saw me immediately.

After I explained what happened the week before and finished with what my doctor said that morning, the young East Indian doctor said, "You can't diagnose Bell's Palsy over the phone and with your high blood pressure, I'm concerned you may have had a stroke. I'm going to send you over to the county hospital emergency room and they'll do CT scans and an MRI..."

"To diagnose a stroke," I interjected having learned that from my research. You can't treat a stroke by yourself because it may be caused by either bleeding or a clot and incorrectly treating one will accelerate the other that actually caused the stroke and make things worse.

"No, to diagnose Bell's Palsy," she lied, not knowing that I already knew how Bell's Palsy is diagnosed.

I kept silent. I don't know what her background is, but she was sounding a lot like a couple of doctors who left the Canadian health care system to practice here in the U.S. who did nothing but prolong my pain some years ago. The first was a French Canadian orthopedic surgeon who ordered chest(!) X-rays when my hands suffered from carpal tunnel syndrome, a worker's comp case. I switched to another doctor, an American Chinese, as soon as I could.

The second was a few years after that, an English Canadian HMO (spit!) family practitioner who ordered three MRIs with a prescription for a narcotic when all I needed was a $35 chiropractic adjustment that I finally went and got for myself out of the network. After that, I immediately submitted paperwork to change to an American Hispanic doctor whom I'm still with although I'm no longer in an HMO.

The walk-in clinic doctor continued, "I'll call over so they'll expect you and we'll get an ambulance to take you there."

An ambulance to go two blocks? I don't think so! The one time I needed an ambulance, it cost me $400 and my PPO insurance didn't pay any of it.

"The problem with an ambulance is that I'll be over there and my car will be over here," I hedged.

"Do you have a friend that can get it for you?"

"No," I lied back at her. Bad form, I know, but expedient since I wasn't going to discuss my finances with her nor let her argue with me.

She had me sign a waiver for the ambulance and sent me on my way after making me promise to go straight to the emergency room. On my charge sheet, she had written "N/C" for no charge and "Bell's Palsy" for the diagnosis.

So, diagnosing Bell's Palsy needs CT scans and an MRI?

No, she had manipulated me because, my guess is, she didn't want me stroking out in her little clinic. At least, I didn't have to pay anything. I never did mention the receptionist nor the form.

At the hospital's triage station, I was relieved to see that their form was done right. Allergies to medicines right in front, up top. For complaint, I entered, "Referred by [name of walk-in clinic]: Bell's Palsy or stroke? High blood pressure."

I was seen right away. Blood pressure: 156/106.

After the doctor had me wrinkle my forehead and nose, smile and frown, check my eyes and ears, etc., he diagnosed Bell's Palsy, gave me a prescription, and instructed me to keep my appointment with my regular doctor on Nov. 10 for follow-up. No CT scans. No MRI.

Hah! Evidently, Bell's Palsy CAN be diagnosed over the phone if the right questions are asked.

About my blood pressure going over 200? "The 156 isn't alarming and blood pressure fluctuates, but you should discuss it with your doctor if you're worried about it," he said.

While waiting to get my prescription filled at Wal-Mart, I used the blood pressure check station that's next to the pharmacy: 149/85.

After I was done shopping, I checked again: 117/96.


As far as the Bell's Palsy goes, the cause is unknown. The facial nerve (Cranial nerve VII) passes through a tiny channel (facial canal) through the facial bone. The nerve gets inflamed which pinches it and causes paralysis on the side of the face where it is located. Most people recover spontaneously within a few days to six months. Some recover in a year. A few never recover. Corticosteroids such as Prednisone are believed to speed recovery.

The major concern is that without a full blink and not being able to close my eye (other people may not be able to open the affected eye), it may dehydrate and sustain permanent damage. My Rx included over-the-counter (OTC) eye drops for the day and an OTC ointment for while I sleep to ensure protection and hydration.

Living with it is inconvenient and awkward, but bearable as long as I don't have to talk too much since I can't enunciate as clearly as before.

The doctor also prescribed an eye patch to keep my eye closed while I sleep. The nurse recommended using paper tape instead. The nurse was right. The eye patch doesn't keep my eye closed although it does protect my eye from dust and other flying objects since I can't blink or close my eye to protect it while I'm out and about.

The moral of this story? At this point, I'm not really sure. All I can say is that I'm getting more prejudiced against non-American doctors who are practicing in the U.S. and know only that God doesn't lie.

Of that, I'm utterly convinced.

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