Last time, I promised we'd take a look at the latest information regarding Bell's Palsy. So, here it is. Most of us know that this malady effects one of our facial nerves, in fact, the facial nerve. The tell-tale finding is that of weakness on the involved side of the face, with difficulty closing the eye and a marked drooping of the corner of the mouth. There is seldom any warning of its onset, and it seems to come out of the clear blue. Most authorities believe this is caused by a herpes virus infection, although others think an inflammatory or vascular abnormality is to blame.

Regardless of the cause, the onset of this "palsy" is very disconcerting, due to the disfigurement caused by the facial drooping. Most people will quickly seek help, thinking they may have had a stroke. Once they are reassured this is not the case, their focus turns to correcting this drooping and getting back to normal. Here is the rub. This is a relatively common problem (we will see 20-25 people in our clinic each year with Bell's Palsy) and the majority of those afflicted will have a full recovery. However, as many as 30% of these people will have some degree of residual facial weakness. This may be a slight, almost imperceptible weakness in the muscles that close the eye, or it could be complete laxity of the muscles on one side of the face. That's what we want to prevent, if we can.

Fortunately, we have a medication that will help here. It's prednisone, a familiar and inexpensive drug that has been used with success for this problem for many years. The key is to start this medicine as soon as possible. The evidence clearly indicates that the sooner, the better. We mentioned that up to 30% of sufferers will have some sort of residual weakness. If prednisone is started early, one large study showed that almost 95% of patients will have a full recovery by 9 months (New England Journal of Medicine 2007;357). Interestingly, no other medications were proven to be of any additional benefit, including the commonly prescribed anti-viral drug, acyclovir. So, if you or a "significant other" develops these symptoms, get some help quickly, and ask for some prednisone.

Now, let's consider something near and dear to our hearts. In fact, the topic is anxiety and the incidence of heart disease and stroke. The Archives of General Psychiatry (2007;64) published a study that looked at the association between these diseases and panic attacks. Most of us are familiar with these attacks, and with what they feel and look like. Maybe you experience them yourself. Maybe you feel that they represent some sort of weakness on your part and you've never talked to anyone about them. Maybe you just suffer through them, waiting for the rapid heart beat, rapid breathing, and sense of doom to pass. It can't be too serious, right? Just a simple "panic attack"? Not so, according to the authors of this study. They looked at 3369 generally healthy postmenopausal women (age 51-83 years) and what they found is really pretty bothersome. Their data indicated that women with at least one full-blown panic attack during the previous 6 months were 4 times as likely to have a heart attack or stroke than those not experiencing panic attacks. That's a big number, higher than the risk from high blood pressure or an elevated cholesterol.

So, what are we to do with this information? We've talked here before about the increased risk of heart disease with stress, depression, and anger. This is something new to worry about. Oh, and with "worry". I forgot about that one. Anyway, this is deserving of our attention. It has been my experience that a lot of people are reluctant to discuss this with their family physician. That's especially true for men. Again, it's the "weakness" thing, I suppose. The reality here is that there are effective treatments for this problem, including professional counseling and appropriately selected medication. Not only can a person's quality of life be improved, but now there is evidence that we can help prevent heart disease and stroke by treating this common problem. Again, if you or a "significant other" think you may be suffering from significant anxiety and especially panic attacks, talk with your doctor. And make sure he or she listens.