Archive for February 2014

Bell’s Palsy

​What are you supposed to think when you wake up and half of your face isn’t working? That was the question one of my patients recently had to ask herself. When she smiled in the mirror, only the left side of her mouth went up. When she tried to close her eyes, only the left eye closed. And when she tried to lift her eyebrows, only the left eyebrow worked, and only the left forehead wrinkled. She brushed her teeth and tried to swish out her mouth and the water went spilling out of the weak side of her mouth. Stroke? Fortunately not, although when in doubt it’s always best to get immediately to the ER.

​One clue that this was Bell’s palsy and not stroke was the lack of movement of the right forehead. When a stroke is the cause, the forehead is usually spared and still moves (wrinkles) on both sides – we won’t get into the whole reason for that – but with Bell’s palsy it doesn’t.

​So what is this stroke-mimicker that affects only the face? Bell’s palsy is an acute affliction of the facial nerve. It results in rapid paralysis or weakness of the facial muscles on one side of the face, usually progressing over up to 48 hours. The cause still isn’t definitively known. It can happen at any age, but its peak prevalence is in 40-49 year olds.

​Along with the one-sided facial paralysis, there may be altered taste and loss of tear production on the affected side. There also may be pain around the ear and sometimes vision is blurred on the affected side.

​Treatment involves first making sure it’s Bell’s palsy and not a stroke. If the symptoms aren’t clear-cut, a cat scan or MRI of the head is sometimes done to rule out tumor or stroke. Steroids are the preferred treatment and antiviral agents may sometimes improve outcomes slightly as well. ​

​The good news is that in 80-90% of cases, the symptoms slowly clear over a few months’ time. In the meantime, the affected eye needs to be protected with frequent lubrication, and sometimes taped shut overnight to avoid drying out and damaging the cornea. Facial physical therapy is sometimes used but hasn’t really proved to make a notable difference in the rate of recovery. Various surgical procedures are used only rarely to aid eye closure in those cases where the paralysis proves permanent.

​So, while Bell’s palsy certainly beats a stroke, it’s no picnic and can be very slow to resolve, or rarely, may not resolve fully. And as we said at the beginning, always best to get to the ER immediately with any sudden paralysis or loss of function.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835


Recipe Review- Chicken Pizzaiola


Chicken Pizzaiola
My hunny originally made this with a side of spaghetti squash for Valentines day and it was SO yummy! We made it again last week with a side of asparagus. He chopped up onions and peppers before and sautéed them in coconut oil on the stove before adding them as toppings! We had leftovers and it reheated well for lunch the next day! Who said chicken has to be boring?!
Serves: 4
  • 3 cups tomato sauce (one 24-26 oz jar or homemade)
  • 4 boneless, skinless chicken breast (6-8 oz each), trimmed (we cut ours in half to bake)
  • Salt and Pepper
  • 2 oz Parmesan cheese, grated (1 cup)
  • 4 oz mozzarella, shredded (1 cup)
  • 2 oz pepperoni (preferably nitrite/ preservative free)
  • *optional: sausage, peppers, onions, mushrooms, other pizza toppings of your choosing
  1. Adjust an oven rack to the middle position and preheat oven to 450 degrees. Spread the tomato sauce in a 9x 13 baking dish.
  2. Pat the chicken dry with paper towels and season with salt and pepper. Spread the Parmesan in a shallow dish, then coat the chicken with Parmesan. Lay the chicken on top of the tomato sauce and bake for 15 minutes.
  3. Sprinkle the mozzarella, pepperoni and other desired toppings over the chicken. Increase the oven temperature to 475 and continue to bake (~5 minutes) until the cheese melts and the chicken is 160 degrees on an instant- read thermometer (can purchase online or at a local grocery or anywhere with kitchen supplies)


School Lunch Box





This is what my girls got for lunch today:

  • Apple and Natural Peanut Butter sandwich ( we want nut or seed butters to be the nut or seed and possibly salt only. No sugar or extra oils)
  • “Carbmaster” Yogurt from Kroger
  • Turkey Pepperonis (beef ok too! Prefer nitrite/ preservative free)
  • Baby Carrots
  • Ranch dressing
  • Cheese cubes (for one. The other doesn’t like cheese)
  • Water bottle

Do you pack your kid’s lunches or yours? What “real food” items do you send?

P.S. I love my containers! They come in packages of two. You can get them online here  or I bought mine at our local grocery. They are leak proof, easy to open for my girls,  and easy to wash!! And they save on cost and waste from so many plastic baggies!




Antibiotics: When and Why?

This is part three of my question and answer session for the A Musing Maralee blog.  Today I focus on antibiotic use and touch on overprescribing.

The original article can be found here.  Andy Smith, MD wrote a related article on antibiotics found here.

When do we need antibiotics? Are they over prescribed? What should a parent do if they are concerned they are being unnecessarily prescribed antibiotics for their child?

Antibiotics are a powerful class of medications designed to kill off bacteria that have invaded the body. They are useful medications that can rapidly change the tide of a worsening infection. In the strictest sense, antibiotics are only used when the invading bacteria are not being sufficiently killed off by the body’s typical defense mechanisms thereby causing significant risk to the individual’s health.

This indication for using antibiotics is not as simple as some would like to think. For instance, ear infections in children may commonly be a bacterial infection that would dramatically improve with antibiotics. Different countries and cultures have different levels at which their healthcare community typically prescribes antibiotic help. In the United States, we have a low threshold for pain and suffering in our children and the standard for treatment is much sooner than the Northern European countries. The trade off is more antibiotic use but less complications from untreated infections.

The advice I give my patients is that I use antibiotics only when I feel they have a bacterial infection that their body cannot clear adequately enough on its own. Sometimes the evidence is very clear and sometimes it becomes a decision based on experience.

It’s important to note that there is a difference between an antibiotic and an antiviral medication. Antibiotics only attack bacteria and they do so largely by killing them. After a day or two of antibiotics there are fewer bacteria. The reduction is rather dramatic, honestly. Antiviral medications don’t work that way. They tend to stop the virus from replicating itself within the body. So if there are 100,000 copies of the virus present when the antiviral medication is started that number begins to stagnate. It only declines when the body begins to appropriately process and attack the infection. This is why antibiotics often have impressive effects in the first 48hrs while antivirals don’t.

I think antibiotics get over prescribed because physicians often assume the worst and patients often expect the best. Patients expect to heal more quickly than they really will and when that doesn’t happen they come in asking for something to make it better. Physicians are all too eager to help because as a group we want to “do something” to help our patients. If more antibiotics had annoying (but not harmful) side effects like turning your hair purple fewer people would over prescribe them. Even today a parent said to me about their child “But she can’t be sick, we’re going to be out of town in three days. Can’t you do something?” There is great pressure from many sides to over prescribe.

Parents who think they are being prescribed antibiotics unnecessarily should ask a few simple questions. Where, specifically, is the infection? Which bacteria is likely causing the infection? What do we gain by starting the antibiotic today? What do we risk by waiting to start the antibiotic? I would welcome any parent asking me these questions because they are the ones going through my mind each time I write out my prescription therapy. I need to be able to answer them well before deciding on the best course.