Dear Dr. Roach: I came down with Bell’s palsy this summer, and it lasted about six weeks. The left side of my face was paralyzed, and I experienced extreme fatigue. Three months later, I went to my pharmacy to get a COVID booster and a flu shot. When I told the pharmacist I recently had Bell’s palsy, she strongly suggested that I don’t get either vaccine for a while, since Bell’s palsy is caused by a virus and the shots might make me sicker.
What is your opinion on this, and when can I get the vaccines?
L.L.R.
Bell’s palsy is an inflammation of the facial nerve on one side. It is thought that most cases are due to reactivation of a herpes virus. Vaccines are suspected triggers for inflammation, so that is probably why your pharmacist was cautious.
An old nasal flu vaccine, since withdrawn from the market, was associated with Bell’s palsy. In one study comparing people who got a COVID vaccine compared to people who got a placebo, just one person out of 10,000 was diagnosed with Bell’s palsy. Other studies have shown no increase in risk following vaccination.
However, large studies have shown that COVID infection is a much bigger risk for developing Bell’s palsy, so overall, there may be a benefit in getting the vaccination, just from the standpoint of Bell’s palsy.
Recurrence of Bell’s palsy is uncommon, and I could not find any evidence to suggest that getting any vaccine after a case of Bell’s palsy increases the risk of a recurrence.
Dear Dr. Roach: My companion of 10 years has developed a severe case of osteoporosis that is causing her shoulders to move forward and put pressure on her heart. I assume this is what causes her to start coughing.
During any movement, and usually during mealtimes, this occurs very strenuously. She almost always retreats to the bathroom for 10 minutes until the coughing stops. The doctors say that they cannot do anything further.
It is very disheartening having to sit by and not find a solution or comfort her. Is there anything you can suggest to help her?
Anon.
Kyphosis (strictly speaking, “hyperkyphosis”) is the condition that older people sometimes get when they have untreated osteoporosis, leading to a “hunched forward” position. It can be especially bad when there are compression fractures of the bones in the neck and upper spine. When severe, this can cause many symptoms; however, it would be exceedingly unusual, if not impossible, for the spine to interact with the heart.
What I think may be happening is that she is not swallowing properly, which is very well-reported in people with hyperkyphosis. The fact that the cough often worsens with eating is highly suggestive that the problem is in the gastrointestinal system, not the cardiovascular system. The lungs can sometimes be affected with a decrease in lung volumes and airflow.
Her doctors probably feel that it’s unwise to consider an operation, which is a very risky procedure that is only considered in extreme circumstances. However, that does not mean there aren’t any treatments that might help relieve symptoms and comfort her.
A gastroenterologist or speech language pathologist can be a big help in determining whether it’s a gastrointestinal problem, such as abnormal swallowing, acid reflux or a hiatal hernia. Treatment will then depend on the findings.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
