Can’t blink, can’t wink, can’t smile or cringe! International singer Justin Bieber’s predicament of a partial facial paralysis only seems too familiar to me. I was in the same boat in 2020, trying to make sense of a condition I had barely heard about until it struck me. When people the world over were trying to escape the wrath of the Covid-19 pandemic, I ended up with the horrors of the Ramsay Hunt Syndrome.
It was a usual morning, with an unusual reflection in the bathroom mirror. The simple yawn seemed off, the smile incomplete. Only one of the two nostrils could be moved. One eye couldn’t completely shut. It was mind-boggling. My first instinct was that it could be a stroke.
So, I headed to the emergency wing of a nearby hospital, and was advised to meet a neurologist. “It seems like a case of Ramsay Hunt Syndrome,” the expert said.
In the most layman medical terms, she explained, “It is the result of an inflammation or viral infection that affects the seventh cranial nerve that controls the muscles of facial expressions.”
As much as I wanted to raise my eyebrows in further curiosity, I couldn’t even do that with my partial stone-face. But I asked the expert, Dr Khushboo Goel, Neurologist, Manipal Hospital, Dwarka, New Delhi, “What causes Ramsay Hunt Syndrome?”.
While she said it was hard to pin-point the exact cause, she explained, “Well, this virus, called a varicella zoster virus (VZV), is generally there in the nerves because of a previous infection. It can get reactivated later due to any reason.”
According to Dr Goel, weak immunity, spurred by conditions such as thyroid, diabetes, pregnancy, kidney problems, can cause the virus to get renewed energy. What happens as a result is a nerve issue, causing facial weakness.
Stress or dietary changes also could be likely causes, pointed out some other neurologists whom I had consulted for second and third opinions. Like any paranoid patient would do, I was just trying my best to set my face right.
At the age of 32, one could easily put the blame on stress, but that wasn’t for me. Prolonged ignorance towards health and fitness, maybe. While the reason for my tryst with Ramsay Hunt Syndrome still remains a mystery, it was important to rule out any serious neurological impact. For that, the doctor advised an MRI scan. To my advantage, it was an all-clear!
The other good news that the doctor gave was that the condition was reversible, especially since it was noticed early on. It could take a month or a few months, but I was almost assured my dimpled smile would be back.
Before I tell you more, let me share Justin Bieber’s post on Ramsay Hunt Syndrome.
Listen to your body! Isn’t that what most health experts tell you? I can vouch for it from my own experience of battling Ramsay Hunt Syndrome.
I could feel the pain, going from temple to ear to jawline on one side of the face, a day in advance. A certain redness also developed. But as we tend to do with minor pains and aches, I relied on a simple balm. Who knew what I was going to face the next morning.
Dr Goel shared the following symptoms of Ramsay Hunt Syndrome:
* Painful rash around the ear
* Pain around ear, or in the inner or outer canal of the ear
* Pain or discomfort in the mouth
For me, the initial few days were tough. One eye was watery, and one felt dry. I couldn’t suck water from my sipper, or eat food from one side of my mouth. Brushing my teeth was becoming a task because I was unable to gargle well. There were multiple problems, but I held on to the power of patience that can move mountains in the world.
As far as some common after-effects of the condition are concerned, Dr Goel explained that you can face:
* Facial deviation
* Drooping eyelid
* Difficulty in closing one eye
* Difficulty in closing the mouth
* You may drool saliva
* Inabiliy to chew food properly
* Water may not get retained in your mouth
* Your smile may not be the same (temporarily, till you get better)
* Ear pain
* Ringing in the ears (tinnitus)
* Intolerance to loud sound
* Dry eyes
This syndrome can be identified by a clinical diagnosis. A physical exam would typically involve the doctor checking for obvious symptoms including inflammation and facial palsy. Depending on the severity, they would advise a sample saliva test or an MRI scan.
“Early diagnosis is important to treat the patient in time. Doctors can often identify Ramsay Hunt syndrome based on medical history, a physical exam, and the signs and symptoms of this issue,” Dr Goel said.
Well, I was put on a dose of steroids and anti-virus medication, apart from physical rehabilitation or physiotherapy to return to normalcy.
It hit harder because this phase was preceded by two months of determined efforts by me to lose weight – with healthy eating and a daily hour of walking. Alas, the steroids brought the weight and more back to where it seemingly belonged! Like I joke about it in hindsight, for all that my face lost in that brief period of life, it also gained a feature – a double chin!
But all’s well that ends well. Let me share what all helped me recover:
A set of face yoga exercises were assigned by my physiotherapist to reactivate and retrain my nerves. I would stretch, pinching and massage certain key points to stimulate the muscles, skin and improve blood circulation. Eyebrow, lips, nose, eyes, neck and chin – I was required to target all these areas to breathe life into the lifeless (well, almost!) half of my face.
Deep breathing exercises helped me not just to calm my nerves and help me stay patient. They also enabled both my nostrils to work in tandem to do what they are meant to do.
Electrical stimulation is used to treat facial weakness in Ramsay Hunt Syndrome and Bell’s Palsy, to improve facial movement.
I was quite intrigued by this special, therapeutic tape. My therapist informed me that it helps to relieve pain and also improves lymphatic drainage by providing a lift to the skin. The tape was cut into multiple parts to lift each dropping part of the face.
A large part of my 100 percent recovery, which happened over a month and a half, was due to my diligence in following my physiotherapist’s instructions. Some of the simplest exercises that I was asked to do involved “pouting like Kareena Kapoor Khan and Karan Johar”! That was my therapist’s way of making recovery a little fun, apart from asking me to chew gum, blow balloons and recite the vowels AEIOU out loud at least 5 times each, twice a day.
In your tough times, it always helps to know that there will always be a circle of people to lean upon for emotional support. My family-like friends and friends-like family went out of the way to ensure I was my usual high-spirited self. My food intake, medicines, my exercises, my physiotherapy sessions were all under close supervision and watch of my loved ones. They wanted to do it all to see the smile back in full force.
Going back to such basics as reciting vowels or blowing my cheeks was emotional to say the least considering I never anticipated a day in my life when I wouldn’t be able to say ‘O’ and ‘U’ as I have all my life. So, when Justin Bieber says “This is really serious”, I know it is. He’s a singer after all – and giving voice to words is his power.
But what I really want to underline is how as humans, we take so many of our body’s powers for granted. And how it could sometimes take just a moment for everything to change. So, hey, it’s great if you take a wee bit of stress to plan for a secure and better future, but don’t forget living for and in the moment.
With half my smile, I learnt how to look at the glass half full.
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