Bell’s palsy—another immune system problem

The other day, I was sitting in a room at the doctor’s office, waiting for a surgeon to remove a couple of skin cancers from my face. Before I saw the doctor, his assistant came in to give me a heads up: last November the doctor was stricken with Bell’s palsy, a condition that temporarily paralyzes half the face (but, she assured me, doesn’t affect his hands or brain).

I wasn’t worried. I already knew about Bell’s palsy because my mother had had it—in fact she’d had it twice. The first time was when she was a child, living in near poverty in a small town near Mobile Alabama. Hers was an immigrant family, so their understanding of English was spotty.  Actually, her mother spoke no English. At any rate, Mother woke up one morning to discover that she couldn’t feel or move half her face. She thought it was funny, but her mother was distraught enough to decide that they’d walk the five miles into town and see a doctor—a first for my mother. 

The doctor prescribed a medicine, which was a grainy white powder to be mixed with water. When she got home, Mother prepared the medicine and ate it, even though it was so salty she had to gargle with water in between swallows. Mother was fine the next morning. It wasn’t until later that mother’s older brother looked at the label and explained the meaning of “apply locally.” I told my surgeon (who did look a bit lopsided) “maybe you should try eating Epsom salts.”

No one knows for sure what causes Bell’s palsy. The prevailing theory is that it develops after a viral infection, which activates the immune system. Once activated, the thinking goes, the immune system attacks a nerve. The condition usually affects only one side of the face, causing drooping on one side. No one knows the reason for this either. Some think that Bell’s palsy is related to the herpes simplex virus. But because the condition is helped by taking prednisone, but not by anti-viral agents, the current thinking is that the real culprit is the immune system and not the virus itself. The disease affects about 40,000 Americans a year.

Most people recover within three months, although sometimes the symptoms last longer. In rare cases the palsy never completely disappears. Angelina Jolie, George Clooney and other celebrities have had Bell’s palsy. Of course, I couldn’t find a photo of them with drooping faces, more’s the pity. Angelina Jolie believes that acupuncture helped with her case. As far as I know, no one else has tried eating Epsom salts.

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Chronic pain may be an autoimmune problem

Dr. Anne Louise Oaklander, a neurologist at Massachusetts General Hospital, may have figured out the cause of many people’s unexplained pain: an over-active immune system. One of her patients, Leslie Levine, had to quit her job as Harvard University’s chief patent attorney because “I was in such pain and could hardly walk. It was like my legs were dipped in boiling oil 24/7.” Oaklander treated Levine with intravenous immunoglobulin (IVIg), and Levine’s pain disappeared within five days.

The IVIg treatment works, Oaklander says, because it “bamboozles the immune system,” overwhelming it with harmless proteins to distract it from attacking the nerves. If the condition goes untreated, continued attacks can leave permanent damage. On the other hand, Oaklander has found that about 16 percent of the patients were able to be weaned off of IVIg without their symptoms returning.

The painful condition is a small-fiber neuropathy and is rather common, especially among people who have diabetes or have suffered the effects of chemotherapy or other toxins. (The condition can also include numbness and itching.) But there are plenty of people with small fiber neuropathy for whom doctors cannot find a cause and which may in fact be an over-active immune system. (The same tiny nerves also line the gut, so people with this condition can also have gastrointestinal symptoms, such as nausea or vomiting when they try to eat.)

So far, there have been no large-scale clinical trials for the treatment. Because of this, other doctors are reluctant to try the therapy. Moreover, the treatment costs $10,000 per monthly dose (each dose contains purified proteins from 5,000 to 8,000 blood donors who have been screened for infectious disease). Of course, insurance companies are reluctant to pay, although after four years they began paying for Ms. Levine’s treatment when they discovered it was cheaper than paying for her hospital stays that resulted from the side effects of steroids—a treatment she’d resorted to when insurance wouldn’t cover the IVIg.

If insurance won’t pay for IVIg, there are always opioid painkillers. On second thought…..

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Dithering about organic farming

My hat’s off to organic farmers. In the ‘70s we had a farm in Michigan where I planted 500 peach trees. It was an organic operation with sub-optimal results (actually, below sub-optimal). My trees were beset with rose chafers—small beetles that gnawed on the fruit. Organic Farming and Gardening magazine said you could keep these critters away by picking them off the fruit, then pureeing them in the blender with water to make a spray. I did this (just ask my grossed-out kids). The spray was supposed to scare the beetles away, but it had no effect whatsoever.

The trees also suffered from lack of fertilizer. Because the soil on our farm was practically nutrient-free, I tried mulching them with a variety of organic matter—mostly a type of seaweed that grew on ponds in the area. People would remove the weeds and put them in piles that I then forked into the back of my pickup truck, hauled to the trees, and spread underneath them. Again, no luck with that. (Of course, it would take years for that organic matter to break down and make its way into the soil.) I’m sure that the trees would have perked up with a big dose of fertilizer I could buy in a store.

Now I’m rather two-faced about organic gardening. On the one hand, I think organic farms should be supported and am concerned about the effect of chemicals on farm workers. On the other hand, I don’t make it a point to buy organic food, mostly because I’m not a worrier. I’m also a user of store-bought fertilizer and of Roundup, the world’s most widely-used herbicide. We have areas around our current home where there are great swaths dense with weeds—way too much territory for me to weed by hand, or even with a hoe.

There is a lot of controversy about the safety of Roundup and similar herbicides. Its active ingredient is glyphosate, a compound that specifically inhibits protein synthesis in a pathway that is unique to plants. Plenty of research has been performed on glyphosate, and the conclusion, in the words of one scientist, is “The data are overwhelmingly in agreement that glyphosate by itself is relatively nontoxic.” But glyphosate is just one ingredient in the formulation, which contains a variety of other chemicals, such as surfactants that help the product cling to leaves and stems. Herbicide producers are not required to make public these “inert” ingredients. As one scientist remarked, “You can have an active ingredient that is nontoxic, but that does not mean that the commercial formulation is also nontoxic.” Another adds, “The effects are going to be subtle and accumulative over years of exposure.” As of now, nobody really knows that long-term effects of these chemicals—either on the environment or in our bodies.

 I’m very careful when I use Roundup, and only use it once a year and only in places that are prohibitive for me to weed by hand. Does it help that I feel a little guilty each time I use it?

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How’s your gait?

I think mine’s not so great. In high school, friends told me I walked like a duck. I suppose I still do. According to the authorities, by the age of seven you have already developed your unique life-long walking style. Sometimes, if I’m feeling stiff or if my hips or legs hurt, I catch myself walking more like a penguin, listing from side to side. I hate that!

I think that walking correctly is important for your overall structural health. In her book, 8 Steps to a Pain-Free Back, Esther Gokhale, the posture lady, provides detailed instructions on how to walk properly. She garnered this information by studying how people walk in non-industrialized cultures (picture the women walking long distances with bundles on their heads).

Gokhale learning to walk.

Gokhale calls the proper walking style “glidewalking,” as opposed to walking with a heavy tread that jams the hip joint, as well as every other weight-bearing joint. The problem is, the instructions in the book are too complicated and consist of 11 different steps: put foot here, move this, shift that, relax this, tighten that…you become sort of paralyzed. Recognizing that problem, Gokhale says to learn the samba to get a feel for it.

For me, the simplest way to approach glidewalking is to think about just two things: 1) swinging one leg forward (relaxed at the hip) and 2) contracting your butt muscle (gluteus medius) on the other side to propel you forward. “Walking,” Gokhale writes, “is a series of forward propulsions, not falls.” As the gluteus muscle at your back leg contracts to move you forward, your foot on that side remains on the ground for a bit, an action that stretches the psoas muscle that runs from the front of the lumbar spine to the upper inside of the thigh bone—a good thing to do. On the forward foot, your heel lands first, but only barely before the rest of the foot. Walk on a line, with the inner edge of each heel touching the line, and the front of the foot angled slightly outward. Also, keep the pelvis stationary.

OK. It’s not that easy, but worth the effort if you want to avoid the penguin walk.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.