INTRODUCTION

My name is Rudy de Bruin, 41 years of age, married and father of two children.
In August 2000 I was struck by Bell's palsy. The Internet is loaded with information on this phenomenon, but only a few experiences can be found. Even though there are different levels of facial paralysis and the duration may vary I have decided to log the progress in this diary, resulting in a source of information for myself and for all of those who somehow find themselves confronted with this, in most cases, temporary paralysis of the facial nerve.

Day 1: Saturday, August 5 2000
On our way back from our vacation in France I noticed that my tongue felt a little numb. I did not taste things like I used to and it felt like I had been numbed by my dentist and not yet fully recovered. Since I was used to having problems with my mouth, caused by an allergy for certain types of fruit (apples, pears, apricots, plums, peaches, etc.) as part of a hay-fever-allergy, I thought I had eaten something, which might have caused this effect. I decided to stay away from the cookies with apricot-jelly. Didn't pay to much attention to it that day and we safely arrived back home in Holland at the end of the day.

Day 2: Sunday, August 6
Everything still tastes differently on this last day of a two week vacation. No improvement noticeable. The tongue still feels strange. It's just like the left part of the tongue refuses to join in. It feels like the numbness spreads out a little into the cheek. I did not eat any fruit, because of a possible allergic reaction, which may have caused the problem.

Day 3: Monday, August 7
The problem remains unchanged. I vaguely have the idea that I have less power in the muscles at the left side of my face. Perhaps I'm just imagining things. I'll just continue to pay close attention. A busy day at work, where time flies. No time to think about it. In the evening I notice that I am not able to close my left eye fully, in comparison with my right eye. Strange.

Day 4: Tuesday, August 8
After getting up in the morning I'm sure. I have less power in the muscles of my left eye. No problems with vision, but only with the ability to close the eye. I try to whistle, but that doesn't work either. Standing in front of a mirror I notice my mouth moving to the right when trying to whistle. Also pressing my lips together results in a asymmetric face. Everything pulls to the right, where the muscles are as strong as ever. Pulling up my nose and eyebrows is limited to the right side of my face. I am starting to worry, because I have no idea what my problem is and because it appears to be getting worse. Where will it stop ? Face, arm, leg ? My wife makes a doctor's appointment for the following day.

Day 5: Wednesday, August 9
This afternoon I went to see the doctor. The situation has deteriorated. My eye is moving less and less. It hardly blinks any more. Also talking becomes more difficult.
I showed the doctor the things I noticed (ref. Day 4) and she had me do some additional tests.
- When closing my eyes full force (as far as this was possible) the left eye could be opened just like that in contradiction to my right eye.
- Lifting my eyebrows does not really work symmetrically.
- Smiling same thing (one side only)
- Reflex test by touching the cornea with cotton-wool. The left eye did not blink, the right one did.
- I had to fill my cheeks with air (pressure). To my astonishment this wasn't possible. The air escaped through the left side of my lips.
I was diagnosed having Bell's palsy. Additional information provided eased my mind a little, since it appeared to be the "best" paralyses one could have. Recovery is mostly a matter of time. I am prescribed eye-drops and an eye patch in order to prevent my eye sustaining damage due to dehydration or abrasion. Little appears to be known about how to cure Bell's palsy. I am not to enthusiastic to use steroids (Prednison), especially when the results are questionable. Now that I know what the problem is,  the question which remains to be answered is what caused it. For a second opinion I made an appointment with a neurologist next week. Because this won't take place until Thursday, my doctor insists on seeing me back on Friday. As soon as I got home, I dug my way into the Internet, looking for experiences of other people and medical information on the subject of Bell's Palsy . Lots of it was available and there was plenty of recognition, which actually eases one's mind.
Administered eye-drops and slept with the eye-patch.

Day 6: Thursday,  August 10
Everything appears to have worsened. No more movement is noticeable, when blinking my eyes. Administered eye-fluid 6 to 8 times today and protected it with the eye-patch. My eye was very sensitive and lots of crocodile-tears were shed. The position of my mouth is not too bad yet, but the open eye and the speech which becomes worse do not lead to abundant joy. Worked until about 13.30, after which I was exhausted, especially because of my eye. Hard to focus, troubled vision with the left eye.

Day 7: Friday,  August 11
Every day things continue to get a little worse. The main question is when it will stabilize.
The 3 to 5 days, during which a Bell's palsy develops to its maximum according to many sources have passed. Movement is reduced to zero. Today I worked until 14.00 hours. Went to see the doctor later in the afternoon who had contacted a neurologist regarding the ways of treating Bell's palsy. The association of bell's with the Herpes Simplex-virus (just like cold sore) was brought up, which I had indeed read about on the Internet. This virus is present with the majority of the people and it can manifest itself in different ways. I agreed on taking Aciclovir 800 mg, 5 x per day over a period of 1 week. There's no harm in it and it may do the trick. Bloodpressure was measured. No problem. 100/70
We agreed that I would contact the doctor on Monday, should my eye become red and irritated over the weekend. At 18.00 hours I started taking the prescribed medicine. (2 x 800mg Aciclovir that day) Administered eye-drops and slept with the eye-patch.

Day 8: Saturday, August 12
Situation remains unchanged. The eye is giving me lots of discomfort. Combined the use of the eyepatch with the use of sunglasses in the daytime. Every day I wake up and find myself trying to whistle and hope that improvements have occurred overnight. Spread out over the day I took 5 x 800mg Aciclovir. Administered eye-drops and slept with the eye-patch.

Day 9: Sunday, August 13
Did not use the eye-patch in the daytime. Important not to overstress the right eye. Only used the patch when taking a nap in the car on the way back from my parents. My mother recognized my story, because years ago she appeared to have had the same experience. In her situation it manifested itself suddenly and not gradually as is the case in my situation.
She had a sudden pain, followed by the palsy. In several weeks she had almost fully recovered. The thing I don't like is that things continue to worsen. The left side of my head feels sensitive, especially behind my ear and around my temple. I have a headache. Used a microwave heat-pack to keep the area warm for some time. I have decide to do this daily.
I noticed that my eye started to shed tears when I administered heat or when I massaged the painful spots. Looked around the Internet some more. Also noticed that my neck muscles (left) do not function any more. After reading two diaries of Bell's palsy - victims I have decided to keep a diary as well.

http://www.jimpowers.com/other1.htm

http://www.asisna.com/users/brishsew/bells.html

Spread out over the day I took 5 x 800mg Aciclovir. Administered eye-drops and slept with the eye-patch.

Day 10: Monday, August 14
I had another week vacation coming and decided to take it anyway, even though I did not feel like going anywhere. Perhaps that rest will do some good. We decided to stay home. My mouth is drooping a little more, from which I derive that the deterioration has not stopped after 9 days. My speech is getting worse as well. Lack of control over mouth and tongue make it difficult to eat things which get lost in the left cheek. This had been a problem over the last few days. Shedding many tears, especially when eating. The left side of my head remains sensitive. Made a start with the diary and the web-page design. Kinda like Droopy, even before Bell's hit me. Sent out some emails and got some replies from people who had gone through the same experience. Spread out over the day I took 5 x 800mg Aciclovir.
Administered eye-drops and slept with the eye-patch.

Day 11: Tuesday, August 15
For the first time I have the feeling that the condition has not deteriorated any further. Anyway, less motion at the leftside of the face is hardly possible. With lots of effort I can still succeed in moving the corner of my mouth a fraction. The jawmuscles are not affected, so that opening and closing the mouth does not lead to any problems. It's inconvenient that I have to move my lip out of the way manually in order to prevent that I bite on it. Did not use the eyepatch during the day. Around the ear and temple the area remains sensitive.
Spread out over the day I took 5 x 800mg Aciclovir. Administered eye-drops and slept with the eye-patch.

Day 12: Wednesday, August 16
No developments worth mentioning. Didn't sleep that well. Leftside of my face remains sensitive. Moments of fatigue. Tomorrow I have the appointment with the neurologist. Anxious to find out what he has to say. Took medication and treated my eye regularly.

Day 13: Thursday, August 17
Went to see the neurologist this morning. After several tests he confirmed the first diagnoses that Bell palsy was my problem. There was no reason to think about a stroke. I mentioned the word abces as a possible cause, but he explained the rarity of the occurence and told me that the way it had developed in my situation did not point into that direction.
He had some second thoughts about the Aciclovir, because more and more specialists are convinced that, should BP be caused by a viral infection, it concerns a different variant. Nevertheless, an alternative at the moment was not available. It's all guessing.
The use of Prednison was not promoted by him.
Based upon his findings he had to conclude that my problem was a next to full paralysis of the 7th facial nerve. The fact that the muscles in the left side of my neck were not reacting made him look up. As expected, nothing sensible could be said about the the amount and timeframe of recovery. In general it is proven that the more complete a paralysis is, the less likely the chances are for full recovery. I guess I'm on the wrong side.
Blood-samples were taken for lab-tests. (e.g. bitten by a tick ?). A new appointment was made for September 12, to undergo an EMG-test, during which the conductancy is measured between nerves and  mucsles. From this progress can be monitored in the long run.
During the day I felt some tintling (chin) and had a headache in the afternoon. Sometimes I felt my lip and eyelid vibrate a little. Pretty exhausted in the afternoon. Having problems speaking intensively. Took my medication. I was prescribed some watch-glass eye-dressings, especially for during the night. Some invention! I'm curious how this will work.

Day 14: Friday, August 18
A day with little developments. At certain moments my eye-lid started trembling, just like my lip/cheek. I used to have that before Bell's hit me as well, especially when I got tired. When I talk for several minutes, my mouth gets very tired and appears to become weaker and thicker. Not a good idea. Sleeping with the watch-glass eye-dressing proved a success. It remained in place much better than the eye-patch, but changed my appearance from pirate to alien. It also ensured that the moisture could not evaporate. My environment (family and work) worry that I'll pick where I left off too quickly. I still struggle with the question whether or not the intensity of work has an influence. My body tells me however that I should not do the things I would like to do. Still I'm convinced that the tide will change. Took the last Aciclovir-tablets and took treated my eye regularly.

Day 15: Saturday, August 19
Took it real easy today. I got tired very quickly. Slept bad last night. I am under the impression that I am able to move the corner of my mouth a little more. It is however difficult to determine which movement is caused by the facial nerve /muscle or by some nerve / muscle which is unaffected. Whether or not this is part of the healing-process or just an increased command over other muscles remains a question for now. Talking is something I can only do very shortly.  After a period of rest my mouth feels relatively normal, but after I say just a few sentences my speech deteriorates very quickly. The leftside of my mouth and cheek actually swell and my mouth starts drooping. My wife can visually see the deterioration, the minute I start to talk. Now that we are aware of that we have decided to reduce talking to an absolute minimum. Tomorrow I won't be going to a birthday, because everyone would be interested to hear how I am doing and what it is that I have. Physically I am not capable to answer these questions, without ot having a noticable negative impact on my recovery.

Day 16: Sunday, August 20
Did not talk much today in order to give the muscles in my mouth as much rest as possible. I notice it does my whole body well. Slowly I get more control over the corner of my mouth and my cheek. My lips, eye-brow, eye, neck and nose on the left side still do not cooperate.

Day 17: Monday, August 21
It was necessary to talk some more today (about 1 hour, spread out through the day). As a result my mouth swelled up again and I got very tired. I'm under the impression that I have  more control over my mouth and cheek than yesterday. I can also press my lips together more tightly, although not enough to prevent air under pressure from escaping. Just like yesterday no changes in other parts of my face. The eye requires frequent attention.

Day 18: Tuesday, August 22
Considerable improvement !  Talking goes much easier and is less tiring. My mouth is more powerful and I am able to move the corner of my mouth and cheek more and more. There is even some movement possible with my eyebrow. At the end of the day I was even able to close my eyelid a little bit. It's still not possible to squeeze my eye closed yet, but we should not  wish for too much at a time. No improvement yet in nose and neck. Still a sore neck and headaches, but we are definitely on the right track ! The expression on my face is returning. Looking forward to tomorrow !

Day 19: Wednesday, August 23
Optimism ! Yesterday's improvements seem to continue. This morning I was able to WHISTLE ! (once, because it is rather strenuous) I can build up more pressure with my lips and my face looks more "in line". Through the day I managed to whistle a few more times. I notice that talking goes much easier as well and that it is less tiring. I am able to raise my cheek more and more and that I'm able to grin.  Also eating and drinking cause less problems. Stopped by at work to show the improvements. I had never expected that the improvements would come so quickly after a practically full paralyses. Because I notice that different parts of my face improve at different rates, I will update a graph every now nd then, which will be available on my website.  (http://home.hccnet.nl/rde.bruin). All in all a memorable day!

Day 20: Thursday, August 24
Also today started off very well. After a good night sleep I had more strength in my mouth / lips. Again I was able to whistle, just like yesterday. Talking and closing my eye was possible to the same extent as yesterday. Muscle control over my mouth and lips has improved a little again. Curling the left side of my lip is not possible yet and showing my teeth is not yet possible either. I received some nice and warm reactions from the rest of the world, which makes one feel good. Visited the company-doctor this afternoon. He mentioned that it was quite possible that the rapid recovery might have been due to the Aciclovir. Even though the opinions vary, it is remarkable.  However, we'll never know if that did the trick, but the most important thing is that the situation has improved ! I was urged to take it easy some more in order to ensure a further recovery. Every night I still use my micro-wave "Bed Buddy" and hold it against my ear / left side of my face.

Day 21, Friday, August 25
Again a little overall progress, except for neck and nose. These areas still show little improvement. For the first time  I was able to curl the left side of my lip, so that my teeth were a litlle visible. I made a follow up appointment with my doctor for next Wednesday.

Day 22: Saturday, August 26
Little improvement, compared to yesterday. The speed with which the improvements have taken place in the last few days seems to slow down a little, but recovery is now at a level that someone, who is not aware of the story, would not suspect anything wrong with me. Headaches continue to bother me and in the morning I feel better than later in the day.

Day 23: Sunday, August 27
Gradually things continue to get better. More or less the same story as yesterday. I'm really pleased with the progress I've made in such a short time. It remains hard to believe. I'm not complaining. Able to show some more teeth !

Day 24: Monday, August 28
Today a sore head and neck. I'm not sure if it has anything to do the recovery-process, however. Furthermore a similar story compared to yesterday. The situation itself remains good. In the morning things are better than later in the day. Fatigue still shows in my face. My eyelid continues to tremble regularly. Last night I did not use eyeprotection for the first time, since I noticed that the eye closes sufficiently. Sometimes I see less clear with my left eye. Focusing is difficult then. I still use eyedrops a few times a day.

Day 25: Tuesday, August 29
A better day compared to yesterday. My neck gives me less problems, only my head continues to bother me. I feel I can handle the days better.

Day 26: Wednesday, August 30
Recovery has reached the stage that daily improvements are relatively small. It contributes very little to report any longer on a daily base. As from today I will limit myself to mentioning of major changes, for the better or the worse. For the time being I will continue to use a heatpack every night. I have stopped using eye-drops. My eye still quivers quite a bit, but that will go away as well. On September 12 I still have an appointment with the neurologist, which will probably not contribute anything, because of the recovery which has taken place.

I would like to thank everyone who has shown support in the last four weeks, which have been a learning experience in itself, but one of which I'm glad that it was only a temporary condition.
I wish everyone who is struck by this temporary Bell's palsy lots of strength during the recovery. From my own experience I can state that there is no reason for despair, no matter how complete the palsy is. Remain positive, but take the situation seriously. Take care of your eye and make sure to take things easy. Recovery is a matter of time.

Rudy