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
As we went through Grandpa’s belongings after his passing one of the things we came upon were some carefully labeled but expired medicines. And I don’t mean a couple of months expired; generally they had expired a decade or so ago. Grandpa was always a frugal guy – cutting the mold off the cheese and eating the rest or grabbing and consuming the two-week-old casserole with a questionable odor before we could get it to the disposal. So what about these expired meds? Had his frugality in keeping these old prescriptions for later use posed any threat to him? My bet is that almost all of us keep and take a few meds past their expiration date. So just how risky is that?
In 1979 a law was passed requiring drug manufacturers to put an expiration date on their meds. Up to this date the manufacturer guarantees the potency and safety of the medication. So far so good, but how quickly do medicines lose their safety and efficacy after these expiration dates have passed? Some years back, the Food and Drug Administration carried out a study to answer that question at the request of the military. The military had a large and expensive stockpile of drugs which they hated to just discard and replace every few years. The study was carried out on over 100 drugs, including both prescription and over-the-counter meds. They found that more than 90% were both safe and effective even 15 years after their expiration date.
Ok, so for many medicines passing the expiration date doesn’t really mean the medication is no longer effective or is unsafe to use. But are there exceptions to this? One important exception is the EpiPen. They have been in the news recently because of how crazy expensive they can be so there is a temptation to not refill them after the expiration date has passed. Unfortunately a study done several years back found that the pens do in fact lose potency soon after passing their expiration date. That means you really do need to keep your EpiPens up to date. By the way, if somehow you find yourself treating a severe allergic reaction with an EpiPen and notice it’s expired, give it anyways (as long as it isn’t discolored and you can’t see particles in the fluid) since some potency is better than nothing. But do this as you dial 911 or get immediate emergency care. Other important exceptions would be nitroglycerin, insulin, liquid antibiotics, and aspirin. Tetracycline may also be an exception although there is still debate about it.
So you’ll have to decide whether to take Grandpa’s approach and save almost everything or the other extreme of tossing everything the moment it hits its expiration date or some place in between. For most meds, a little laxity with that stamped on expiration date is pretty reasonable. Hey, Grandpa lived a healthy 90 years with his approach.
Andrew Smith, MD is board-certified in Family Medicine and manages the Trinity Medical Associates office at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835. He is accepting new patients with commercial insurance in a typical fee-for-service model and those without insurance or with Medicare in a Direct Primary Care model.
Over prescribing of ADD and ADHD stimulant medications, especially in adults, is a rapidly exploding issue. Inappropriate use is common at many universities and high pressure jobs. However, there remains a considerable number of patients who have legitimate need and should be cared for within the healthcare community.
Addressing a patient’s need for stimulant medications requires a careful and thoughtful approach. For many disorders, Trinity uses our multifaceted approach to therapy which so often improves, reverses, or even cures the common maladies of modern humankind. We address the three main pillars of health that are required for any person to be remain healthy: good nutrition, good exercise, and good sleep.
Nutritionally, studies have demonstrated that a lower carbohydrate dietary plan improves ADD/ADHD symptoms over other dietary interventions. Omega-3 fatty acids found in fish oil (or actually eating more fish) is one of the few supplements that improves ADD/ADHD symptoms. Vigorous aerobic activity consistently demonstrates improved symptom control especially if challenging tasks are performed within the 90 minute golden window following exercise. Finally, sleep is a critical element to good focus and concentration. Disorders such as sleep apnea, excessive screen time, as well as burning the candle at both ends severely limits the brain’s ability to concentrate for weeks and months on end.
Trinity has adopted the widely published guidelines from the American Academy of Pediatrics and the American Academy of Family Practice concerning the prescribing of stimulant medications These guidelines include such things as the following:
-Stimulants will only be prescribed after an appropriate history and physical is performed which supports the diagnosis
-Secondary causes for the symptoms including poor nutrition, poor exercise, and poor sleep have been fully addressed
-Follow up is required in person on a monthly basis until stable then every three months thereafter
-Medication changes are done in person only
-Regular use of Tennessee’s Controlled Substance Monitoring Database
-Refills are done on time. They are not filled early, after hours, or for long term supplies.
-Urine drug screens are required at random intervals to confirm the use of the prescribed medication as well as the absence of inappropriate chemicals.
-Long term prescribing of medications is not guaranteed and referral to a mental health specialist will be made if the situation warrants.
We feel that with our approach and the use of these guidelines we will continue to provide high quality care for individuals in need and limit the inappropriate use of these medications.