Archive for January 2017

Bell’s Palsy

Patty relates her story: “So I’m out for a nice dinner with my husband and it’s so embarrassing — as I’m drinking my water, it keeps dribbling out of the corner of my mouth.  At first I think I’m just being spastic and hope he didn’t notice.  But it keeps happening and I laugh and tell him my mouth doesn’t seem to be working right.  So he looks at me, and instead of laughing he suddenly looks scared and says, ‘C’mon we’ve got to get you to the hospital.’  What I didn’t know is that when I laughed, one side of my face moved normally and the other barely moved at all.  Of course he’s thinking, stroke!”

This account turned out, happily, to not be a stroke, but rather a condition called Bell’s palsy.  Of course, when in doubt it’s always best to get immediately to the ER and make sure it isn’t a stroke.  Bell’s palsy involves a loss of function of the facial nerve.  This is the nerve that triggers most of the movements of the muscles of the face.  So Bell’s palsy 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 hasn’t been totally nailed down.  It can happen at any age, but its peak prevalence is in 40-49 year olds.

When Bell’s palsy first strikes, it can be tough to distinguish from a stroke.  One clue is that with Bell’s palsy the forehead muscles on the paralyzed side don’t move.  So if you ask the person to raise their eyebrows or wrinkle their forehead, nothing happens on the paralyzed side.  On the other hand, when a stroke is the cause, the forehead muscles are usually spared and still move (wrinkle) on both sides – we won’t get into the whole reason for that, but it’s one way to help distinguish the two.

Along with the one-sided facial paralysis, Bell’s palsy may cause 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 may be done immediately since successful stroke treatment is often dependent on the timely use of clot-busting meds. If Bell’s palsy is diagnosed, 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 much of a 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, having Bell’s palsy certainly beats having a stroke, but it’s still no picnic.  It can sometimes be very slow to resolve, or rarely, may not ever fully recover.  If it strikes you or someone you love, and you’re not sure what it is, get to an ER and let them make sure it’s not a stroke.  Once you’re sure it’s Bell’s palsy they can help you to protect your eyes and give you meds that maximize your chances for a full recovery.

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






Reignite Liberty’s torch

The American dream for healthcare needs strong medicine.

The inscription on the Statue of Liberty which is taken from the poem New Colossus written by Emma Lazarus says in part,

Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!

Over the last several decades the medical economic model has encouraged physicians to seek out otherwise well and healthy patients.  It was inadvertently done and without any malicious intent but the pressures were real.  The system requires such enormous documentation and coding that it has encouraged patients to conform to the box in which they are placed.  It discourages individualism in favor of protocols.  It celebrates documentation of such things as smoking rates yet hinders the affordability of medication to stop smoking.  The system wants to categorize and number patients and let them be a resource to run through it’s machine.  When patients want to be individuals, freely making their own healthcare decisions, then the system runs poorly.  Those individuals with complex and personal needs become burdensome to the system and often are subtlety shunned.

From it’s foundation Trinity has been principled in seeking to serve those who need care.  These are “the tired, the poor and the huddled masses” to whom Ms. Liberty proclaims refuge.  In this week of political celebration or protest (depending on your viewpoint), we want to again reiterate our stance on seeking to serve those who are sick and hurting.  We stand ready to care for all patients of all conditions.

We do this in several ways.  First our walk in clinic serves the community six days a week in a personal and compassionate manner.  Our charges for services are some of the lowest in the area.  We dumped the double standard charge model years ago where the uninsured paid substantially more than the insured.  Today, anyone who is cared for in our practice will pay the same amount regardless of insurance status.  For anyone who pays in full at the time of service, they will receive the same discount that has been negotiated by the the insurance companies.  Everyone pays the same.

Second, our depth of resources for our patients to truly become healthy are unparalleled across the country let alone Knoxville.  We offer a full range of experts to help patients treat, reverse, and cure their chronic illness with nutrition changes, exercise programs, wellness plans, stress management, sleep improvement, and Biblical counseling.  We have seen patients reap large rewards of weight loss, medication reduction, and reclaiming their lives as they progress through the programs.

Lastly, our Direct Primary Care program is offering discounts to new patients with chronic conditions.  Any new patient that completes their first member appointment with the Direct Primary Care program by the end of Inauguration Day and has one of the three biggest chronic, pre-existing conditions of diabetes, high blood pressure, or high cholesterol for which they are receiving at least one prescribed medication  will have their registration fee of $125 waived.

Trinity Medical Associates is reigniting Liberty’s torch for all people to receive the highest quality medical care.  Call today for an appointment and come be part of the new American healthcare dream.


Pre-existing conditions don’t scare us.

Trinity’s Direct Primary Care program is about finding better ways of taking care of patients.  It isn’t about insurance companies or government policy.  It is about caring for patients without outside influence.  We don’t base our standard of care on who is in the White House or who controls congress.  We focus on our patients.

So in light of all the anxiety provoking discussion concerning repealing and/or replacing Obamacare and the effect it might have on patients with pre-existing conditions, we want to show you what DPC is all about.  We going to give patients with any of the three biggest pre-existing conditions a discount.  That’s right.  We are going to actually make it cheaper for patients with chronic illness receive healthcare because that is what we do.  Trinity Direct Primary Care focuses on our patients first.

Here are the details: Any new patient who joins as a member and has their first appointment this week who has either diabetes, high blood pressure, or high cholesterol for which they are taking at least one daily prescribed medication will have their $125 registration fee waived.  Monthly membership billing will start at the end of the first month at the usual rates of $30 a month for children 22 years of age and younger, $60 a month for adults through 64 years of age, and seniors 65 years of age or older.

Sign up now and call one of the DPC offices for your appointment.  This offer expires when the last appointment this week is taken.


In Health, Silence Isn’t Always Golden

Most of us have heard the expression, “Silence is golden.”  The poet Thomas Carlyle, observed, “Silence is the element in which great things fashion themselves together; that at length they may emerge, full-formed… Silence is golden.”  But when it comes to our health, if those “great things fashion(ing) themselves” in silence to later “emerge, full-formed” are diseases, then silence isn’t so golden at all.  Why?  Because silent (asymptomatic) disease processes allow bad maladies to quietly sneak up on us without much warning.

            Let’s be more specific.  About two thirds of all deaths in the U.S. are attributed to just five causes: heart disease, cancer, chronic respiratory disease, accidents, and stroke. Most of these are the end result of silent processes that we don’t recognize until it’s too late.  The number one cause of death, heart disease, involves atherosclerosis, where plaque blocks the arteries that supply the heart.  When complete blockage of one of these occurs a heart attack often results.  That same process of atherosclerosis and artery blockage, when it involves arteries up in the brain, causes most strokes (the #5 cause of death) as well.  But until a heart attack or stroke hits, the process of blocking arteries is often silent, producing few or no symptoms.

            To go back a step further in the process, the factors that produce atherosclerosis, such as high blood pressure, elevated cholesterol, artery inflammation, and even early diabetes, also may bring little or no symptoms.  In fact, I occasionally wish some of these factors were routinely painful so that folks would be more motivated to treat them aggressively.

            What about cancer, the #2 cause of death?  Many types of cancer can grow for quite some time before any symptoms occur.  So screening tests, such as the wildly popular colonoscopy or mammograms or Pap smears are ways to discover cancers and pre-cancers while they are still curable.

            Even chronic lung disease (COPD, etc.), which is the #3 cause of death, can be mostly silent for a long time.  Because God builds a lot of reserve into lungs, folks can lose a substantial amount of lung function before they actually notice shortness of breath.  That’s where a simple in-office pulmonary function test can give a heads up before someone gets to a critical stage.  Sometimes that kind of information can help discover and define an otherwise stealthy process that, usually with the help of cigarette smoking, is slowly robbing breath from a person.

            I love it when my patients are aggressive with prevention; I would so much rather them be aggressive with preventing heart disease than with having to be aggressive in getting bypass surgery after a blockage finally shows itself with crushing chest pain. I’d rather they were aggressive in stroke prevention rather than having to be aggressive with rehab to try to be able to walk or speak again after a stroke.

            So what we’re saying is, so much of health is (often with the help of a trusted physician) discovering and controlling the silent processes that are going on inside us in order to prevent the big disasters.  If we wait until we can feel a problem, we’ve often waited too long.  So if it’s been a while, get a check-up that looks for and identifies these silent processes, because when it comes to our long term health, silence isn’t always golden.

Andrew Smith, MD is board-certified in Family Medicine and manages the Maryville office of Trinity Medical Associates located at 1503 East Lamar Alexander Parkway, Maryville.  He is accepting new patients with most commercial insurances and participates in Trinity’s Direct Primary Care program for patients who are without insurance, who belong to a cost sharing program, or who are Medicare beneficiaries.   Contact him at 982-0835