Update: The MRI

Lori is doing much better the past couple days; her facial paralysis hasn't improved but she is feeling much less tired and run down. Earlier in the week she was having a lot of ear pain, so she went to see Dr. McMaster our local ENT, who was quite worried about the degree of paralysis she has, and recommended that she have an MRI of the brain to rule out other causes, such as tumors, etc. The MRI was normal except for a significant amount of inflammation along the facial nerve as it courses through the temporal bone. Here is a picture of what Bell's looks like on MRI. Of course, this example is on the left, and Lori's is right-sided.

And here is an MRI picture of Lori's brain in side view.


Just kidding! On the serious side, Bell's is graded on a 0-6 scale, with 0 being normal and and 6 being complete paralysis. Lori's case is a 6, and Dr. McMaster feels like, because of the severity of her paralysis, she is probably looking at several months, rather than weeks, before function returns to her face. So, that is discouraging, but she is getting used to the idea and hunkering down for the long haul with this crummy illness.

Here are a couple more pictures I found on the Internet that show the neuroanatomy relevant to Bell's palsy.


Thanks to all who have called, expressed support, brought food, flowers, and generally loved us through this. Understandably, it has knocked Lori back on her heels, and having such great friends and family is a wonderful thing for us. We love and appreciate you all!

Update: The Temporary Tarsorrhaphy

Lori woke up this morning with severe pain in her eye, definitely worse than it had been. She's pretty sure her eye patch came loose during the night, so her eye was probably open for some time. Luckily, I had most of the day off, so I got her in to see my ophthalmologist friend, Dr. Fullmer. He took a good look at her eye and could see that there were some very small ulcerations on the cornea, probably from excessive dryness, and that was what was causing the pain. We talked about options, and we eventually decided on a procedure called a "temporary tarsorrhaphy." Translated, that meant he would sew her eyelids together for a little while until the lid regains strength. Here she is after he instilled the local anesthetic. She looked like Hitch when he had the allergic reaction.Here it is tonight. The little white things are pieces of rubber used to bolster the stitch that holds the eyelid together, so that it doesn't cut through the skin like a cheese slicer. The eyelid isn't all the way sewn shut; it needs to be partially open to allow oxygen to get to the eye, and to provide a means to examine it and instill antibiotics. She is already a lot more comfortable. It will probably stay in for about 2 weeks.Thanks to all of you who have written encouraging comments, called, brought food, prayed, or otherwise shown such great support. She has literally been showered with friendship since this came on, and the outpouring of generosity and well wishes has been overwhelming and gratifying for her, and for me. I will continue to post updates on her progress.

Lori: Feeling a Little 'Down in the Mouth'

Lori called me at work Thursday with an odd question: "What does it mean if, when I smile, only half of my face moves?" She had been struggling with a touch of the flu for a few days, and, knowing that, my heart sank. I have seen a few cases of Bell's palsy in my practice; it is not a fun condition at all and it is often preceded by a viral illness like the one she had.Sure enough, when I got home that night Lori described how she had felt a little weird in that side of her face all day, and then had developed actual weakness on the right side. She had also noticed that she was having a hard time tasting anything at all, and that she had a vague pain in and behind her right ear. By the next morning, she couldn't take a drink without half of it running out that side, and she couldn't shut her right eyelid all the way.

As it turns out, the eye symptoms are the worst part of the whole illness. The affected eye dries out quickly and has to be lubricated constantly. The irritation and burning are driving her to distraction, and the eyelid on that side is inflamed from all the various tapes and patches she has been trying to keep the darn thing shut. This seems to be the most comfortable method she has found so far; unfortunately, it isn't exactly inconspicuous!As long as she isn't trying to move her face, she looks pretty normal.
But, when she tries to smile, or talk, or eat, or drink, the right side of her face won't move. The left side gets pulled over to the left, since there isn't anything to oppose the contractions of the muscles on that side. When she blinks, her eye rolls back in her head, but the eyelid doesn't close, so that looks kind of creepy.Medically, Bell's palsy is interesting because it helps teach the neuroanatomy of the facial nerve. When the nerve signals are interrupted after they leave the brain, the entire side of the face is affected, including the forehead; if the nerve fibers are interrupted inside the brain (such as with a brain tumor or certain strokes, the forehead often works normally because the signals from the other side of the brain compensate for the loss of signal to that area. Here is an illustration of how that works.The second diagram here shows which types of nerve fibers run through the facial nerve. This explains why she can't taste things very well, and why she has to use lubricating drops in the eye even when she has it constantly patched and closed; the tear glands don't work well when denervated. Some people get dry mouth because the salivary glands are affected. She hasn't had that symptom, thank goodness. There is a muscle in the ear called the "stapedius." This muscle helps dampen loud noises, and it gets taken out of commission by the palsy. This explains why everything sounds loud to Lori right now.Bell's palsy is almost always temporary, but the time it takes for the damaged facial nerve to regain function is variable; it can return in 2 weeks, or it can take up to 6 months. My ENT friend says that, in most cases, even severe ones, most function has returned within 2 months. We're certainly hoping for a quick recovery, and our family had a special fast today for her. This is no fun for her and we feel bad! She is a trooper, though, and besides, if she cries it is only out of one eye anyway, so what would be the point of that? We all think she is beautiful no matter what!

The (New & Improved) Rexburg Medical Center

My medical office has undergone a major renovation/expansion over the past year and a half or so, which was finally completed in November. The building was completely redesigned for efficiency, and to maximize our space usage.The first thing we did was convert our record-keeping system to electronic. We have been using a system called eClinicalWorks for 2 years now. It was an expensive changeover, but well worth it, I believe. It has created a lot of efficiencies for us in our day-to-day processes, and the usable space we gained by getting rid of our paper records more than pays its expenses.We added some new space, most of which has been leased to a group of Physical Therapists and to a local General Surgeon, Dr. Coray.

The PT group has a whole suite for kids downstairs, and they have this cool climbing wall with a mural of the Tetons painted on it. This would be the coolest part of the building, except...This is our new 350 gallon saltwater fish tank. Granted, it doesn't look like much yet, but it is a work in progress; soon it will be teeming with sea life of all kinds, including fish, of course, but it will also have corals, starfish, anemones, sea snails, and other kinds of aquatic wonders, sort of like this similar tank at our local hospital.

Anyway, having a saltwater tank in my place of employment has given me the "SCUBA bug" all over again. I'm going to need to spend some time underwater in the near future, somehow.

Now we have all our exam rooms in one place, in a sort of oval configuration, with the nurses' work station in the middle. Check in and check out are in a totally different place, and redesigned to provide more privacy for patients. The only place in the whole building that is in the same place is xray; we kept them in the same location because all of the lead-lined walls are really expensive to move. All in all, this has been a much more efficient way of doing things.We have also added a separate suite for "DermaChic," which is our skin care clinic that does laser hair removal, Botox injections, and that sort of thing. And, our latest addition is the "RMC Wellness Center," where we provide medically supervised weight loss and other preventic health care services. We have some additional space to rent, and a dermatologist has recently signed a lease for that space, so we'll be all full again.
I think the floor coverings, paint colors, and all the other trimmings are very well done and really add a new touch of class to the office. Most of our patients seem to think so too, although I did get one comment recently from a patient who really misses the "homey" atmosphere we had before. (Personally, I think if your doctor's office feels "homey" to you, you might want to try to spend less time there. Just a thought.) And, of course, we have always had the best staff anywhere, so that isn't any different at all!I am really appreciative to Dr. Zollinger and Mary for all of the blood, sweat, and tears they have invested in the new and improved Medical Center. They really stuck their necks out, and I hope it pays off for them; I think it will.

As for me, I am still really excited every time I go to work there, and think it is a great place to build a strong and stable medical practice for many years to come.