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Waking Up to Bell’s Palsy
May 1, 2024
By Kisha Davis, M.D., M.P.H., FAAFP
AAFP Board Member
I often tell patients who are experiencing the physical or mental manifestations of stress that they need to sit down voluntarily before the universe forces them to sit down. It took my own health wake-up call to learn that lesson for myself.
Hearing the news that NBA All-Star Joel Embiid recently was diagnosed with Bell’s palsy prompted me to reflect on my own experience with the condition. Although it occurred nearly nine years ago, I still have residual effects from it today.
Thirty-eight weeks into my pregnancy, I woke up and found it difficult to spit while brushing my teeth. I also tried to pluck my eyebrows, but I repeatedly poked myself in the eye instead.
When I took the time to really look at myself in the mirror, I realized that my face was crooked. I panicked and quickly turned to Up to Date to review the signs of a stroke versus Bell’s palsy. I was reassured that this was “just” Bell’s palsy, and not a stroke, because my forehead, eye and mouth were all affected on the same side of my face.
Bell’s palsy can make it difficult for a person to express what they are feeling. After the birth of my son, I wanted to smile but couldn’t.
I called my doctor, who reminded me that this can happen in pregnancy, a medical fact I’m sure I learned at some point in my training but had since forgotten. Diabetes, obesity and hypertension also are risk factors for this idiopathic nerve palsy that results in facial weakness, or paralysis, which can manifest as trouble closing the eyelid, difficulty with facial expression, loss of taste, drooling, tearing and hypersensitivity to sound.
Eight years out of residency, I called in sick for the first time in my career.
The next few weeks were a whirlwind. I had planned to work right up until my due date. However, I wrapped up seeing patients earlier than expected. Trying to care for them with my eye patched and face paralyzed drew too much sympathy and attention from them, making it difficult to focus on their health needs. I continued to go to work because the practice was going through a strategic planning process. As a recently promoted medical director, I felt like I had to be there to help direct the process. I also was filling a gap after one of our busiest physicians departed the practice.
During the next several days, the right side of my face continued to weaken. My mother-in-law asked if I had lost taste in my tongue, and I responded that I definitely had not. But then I tried a piece of hard candy, finding it remarkable that it had flavor just on one side, the other side tasting like a marble. I had, in fact, lost taste on half of my tongue.
I was excited to welcome my third son into the world and I tried to smile, but pictures from that time show my face looking flat. Pushing through labor with my eye open because it couldn’t close was a strange feeling.
During my first six weeks postpartum, which included the final weeks of summer for my two other boys, then 4 and 8, I kept a busy schedule. I traveled to the AAFP Congress of Delegates in Denver (with my parents along to help watch the baby). I went to Durham, N.C., for the final weekend of my integrative medicine leadership fellowship. We drove to Ohio for a family reunion and had the pleasure of introducing the new baby to a 104-year-old aunt.
I knew that time would be busy, but I figured the second six weeks of my 12-week maternity leave would be calmer. My older boys would be back in school and I could just sit and relax with the baby.
I was wrong.
Well-being Resources
Family physicians devote their careers to caring for others, but what about your own well-being? The AAFP has resources and programs that can help.
Physician Health and Well-being Conference: Refresh, recharge and earn up to 20.5 AAFP Prescribed credits May 6-8 in Scottsdale, Ariz.
Power in Your Personal Narrative: The Academy will offer a free webinar on physician well-being at 6:30 p.m. CT on May 22.
Leading Physician Well-being: The application period for this AAFP certificate program closes May 31. LPW helps family physicians develop the leadership skills needed to lead change in their practices and health care organizations.
Breaking Down Professional Stigma: This on-demand CME activity focused on reducing the stigma surrounding mental health is free.
Seventy percent of Bell’s palsy cases resolve without treatment, and the addition of corticosteroids increases the likelihood of recovery. Just 10% of cases have long-lasting residual effects. At my six-week postpartum check-up, my doctor raised grave concerns that my symptoms had not resolved. That triggered a whirlwind of interventions, MRIs, specialist referrals, acupuncture treatments and physical therapy, which I tried to squeeze in around nap times and breastfeeding.
By this point my support system (a husband and two grandmas who all worked for the school system) had gone back to work. Like many new parents returning to work after paternity leave, I was tired and stressed but also determined to make it all work.
About a year after I developed Bell’s palsy, I served as a lecturer for the AAFP’s physician wellness initiative. I had to confront my own superwoman complex. It wasn’t until I was teaching other physicians about the importance of our own well-being that I started to explore the possibility that my Bell’s palsy may have been caused not just by pregnancy, but also by stress.
We as physicians are taught to just keep going. Those of my generation (and the ones before us) all have stories of colleagues who continued to work while sick. Doctors often feel obligated to work through pain, fatigue, physical and mental illness. I recall an attending who insisted on coming in to round while in a wheelchair and with a NG tube after being in a car accident that fractured her pelvis.
I am encouraged by the new generation of doctors that won’t tolerate that type of self-abuse.
What I often heard in the old days was, “You are amazing, how do you do it all?” or, “It’s so great that you are here even with everything you have going on.” That mindset fed into a fallacy that I was OK and managing everything just fine. If I felt OK and was still able to show up for everything and people thought I was doing a good job, then I must be OK.
What I actually needed to hear was, “It’s great that you are here, but you don’t need to be.” And, “Don’t worry, we’ve got this. You can go now.”
As physicians, we are so determined to keep going that we often need permission to do less. It wasn’t until I started to slow down that I started to see some improvements. About a year after the baby was born, an opportunity opened to serve as a consultant for Family Medicine for America’s Health, which gave me more flexibility. I stepped down as medical director. I focused my work in the office on just patient care and I focused more on my own health.
Some will look at me and say, “Umm, Kisha, you are still doing a lot.” That is true, but now I understand, and strive to live within my limits. My Bell’s has not completely resolved, and I still can’t quite trust that my facial expressions are conveying what I feel. However, my Bell’s palsy does serve as an early warning for when things are getting to be too much. When I’m tired, dehydrated or stressed, my tongue starts to tingle and my face gets tight. I prioritize sleep, I preschedule massages, I take walks in the evening, I spend time with friends, I don’t sweat the small stuff.
And when I don’t heed that warning, my body reminds me to sit down voluntarily before the universe sits me down.
Disclaimer
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