Dr. Ashok Kumar Srivastava
Otolaryngology (E.N.T)
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Patient's Query
Hi doctor,
I was just diagnosed with Ramsay Hunt ( like Bell's palsy but due to varicella) last week after having the shingles two weeks before. I have moderate facial paralysis. About twenty-five years ago, I had Bell's palsy on the same side, treated successfully then. I am otherwise a healthy person with no significant past medical history. For the Ramsay Hunt, I was placed on oral Prednisone 60 mg for three days, 40 mg for two days, 20 mg for two days, 10 mg for two days, and 5 mg for three days. My question is about the amount of steroid. Please let me know whether the dosage is correct or little high or low. I am also taking Acyclovir. About five to six days after my facial weakness appeared, I noticed that it was getting slightly worse (for example, I could shut my eye before, but by the weekend, I was unable to close) despite being on steroids. Now I feel it has plateaued hopefully. I would be glad to hear any of your thoughts and suggestions. For example, would you suggest facial massages or even acupuncture, and if so, when would these be typically started? I have done standard CBC, metabolic profile, varicella IgG, and everything was normal except a high WBC count of 15, and varicella IgG was greater than 4000. Varicella IgM was positive, as expected, and the STD panel was negative. Thank you.
Hi,
Welcome to icliniq.com.
I understand your concern. I have gone through your previous history of the disease and the available investigations, I think you are getting the correct treatment. As far as steroids are concerned, they are used in loading dose at the beginning to reduce edema (swelling) of the nerve, and then tapering off the dose is recommended to avoid the withdrawal symptoms. Here I would like to suggest you for active facial exercises for better recovery. For this, you have to consult a good physiotherapist. I hope you will feel recovery soon, and about four to six weeks is required for complete healing. Thanks for consulting us.
Patient's Query
Hi doctor,
Thank you for writing back so soon. But I wanted to know whether the dosage of steroids that my Neurologist put me on was acceptable for Bell's palsy or insufficient.
Hi,
Welcome back to icliniq.com.
The dose of steroids depends on the severity of the involvement of the nerve. This is a clinical assessment, so I cannot comment on that issue. The second important fact is that steroids have a role in the disease's initial phase, hence there is no need to repeat the steroids. Please wait; you will get the response. Thanks for consulting us.
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Otolaryngology (E.N.T)
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