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I am a trumpet player. In June of
2000 I contracted Bell's Palsy, a viral infection causing inflammation
of the 7th cranial nerve, producing weakness or paralysis of
the facial muscles. While it is a non-life threatening condition, Bell's
Palsy is particularly disruptive for a brass player. It becomes impossible
to form an embouchure, let alone buzz the lips. Once recovery is underway,
the fine muscle control needed to control the embouchure returns very slowly.
I was fortunate to have recovered completely, but it was a slow process, and the experience taught me many lessons. I have spoken to other musicians who at one point temporarily lost the ability to play due to accident or illness. They all agree that they came back as better players than they were before. I feel the same way.
Despite a generally optimistic outlook that this would be the case, I was fraught with anxiety during the time. While most people recover completely from Bell's Palsy, there can be permanent lingering aftereffects that could effectively end the career of a brass player. My recovery period seemed agonizingly long: six weeks until I played my first gig, six months until I felt I could play as well as before, and a year before I shook the feeling that something was still `different'.
While some people advised me to simply take an extended vacation while waiting for the palsy to subside, this is not my nature and I spent many hours each day struggling to regain the sensations of playing. I kept a daily log of my recovery to help me chart my progress. What follows is a summary of those daily logs.
Week 1 (June 5, 2000)
Several days before any other symptoms were observed I noticed a slight numbness and taste desensitization on my tongue, as if it had been scalded lightly with hot coffee. I thought nothing of it at the time, but I have since learned that this is a common early warning sign of Bell's Palsy.
On the first day of symptoms my chops felt stiff and unresponsive during the daily practice sessions. I attributed it to a heavy playing schedule and I felt confident that they would improve by the evening. When I went to work that night, I found I could barely play a G on the top of the staff (an octave below my normal range.) As the night progressed my range dropped another fifth. If I attempted to play any higher all of the air leaked from the corner of my mouth. It was disconcerting, but also kind of humorous. I thought perhaps I had strained a muscle. Fortunately the band was so loud nobody noticed I was taking the parts down two octaves! The only other symptom at this point was a slight twitch in my eye. I didn't connect the two, but now know that I should have.
When I woke up the next day my chops felt the same, but still no other symptoms were present. During the course of the day my jaw started to ache when I chewed. At first I suspected TMJ, a problem with the jaw. After dinner a numbness set in on the right side of my face and I could not close my right eye. I should have gone to the hospital immediately, but waited until the following morning to see my own doctor.
It took my doctor about 10 seconds to identify Bell's Palsy. She prescribed steroids (Prednisone) and anti-viral medication (Acyclovir) and scheduled me for physiotherapy. She told me I could be facing up to a year to recover, and might be left with a permanent droop on the side of my mouth. As the gravity of the situation sunk in I panicked. My wife Diane and I searched the Internet for medical information. The first pages we found were horror stories of protracted and sometimes permanent disabilities. Thoughts of the end of my career bombarded my head and I sank into a deep depression.
Though things were predicted to get worse in the coming days before they got better, it didn't progress that way. There was no distortion of the face, and I had control of most of the muscles on the right side, though to a markedly lesser degree than on the left. My right eye only closed halfway when blinking, but I could close both eyes for sleeping. Many Bell's Palsy victims must wear an eye patch and protective gel to avoid damaging the open eye while sleeping. To protect the eye from wind on my motorcycle, I wore a patch covered by a pair of wrap-around sunglasses. I called it my Bell's Angels outfit. As always, I found that a sense of humor helps any situation.
The physiotherapist explained that the nerve inflammation would eventually subside on its own, and the muscle control would return. In the meantime it was important to keep the muscles exercised. Electrodes were attached to my face to stimulate muscle contraction. I was scheduled for a half-hour treatment each day. Eventually I rented one of the stimulators so I could use it at home. Over the next few days I refined my technique. The electrodes stimulate the muscles for about 20 seconds, then provide a rest period. When the current was on I formed a firm embouchure and blew air through the middle of the lips. As the current subsided, I could feel the muscles in the right side of my mouth give way, like a car running out of gas. It was depressing to feel them collapse each time. I became somewhat addicted to my sessions. It's amazing that one can develop a fondness for an electric shock! After a session, I felt like I had really worked the muscles, in a way that simulated playing as much as possible. I did this 30-minute routine three times a day.
During the physiotherapy it was helpful to use a mirror. I compressed the left (unaffected) side while waiting for the current to start, then tried to balance the muscular contraction of the two sides in the mirror. It still looked a little cockeyed (a jolt of electricity running into my cheek does not form a perfect embouchure after all; more's the pity). I also used a mirror to do a slew of facial exercises each day to try and regain some muscle control.
I booked subs for all my gigs in the following weeks. Rumors quickly spread about my condition, and mis-information abounded. I decided to be proactive and sent out an email explaining what was happening, assuring everybody (with perhaps more confidence than I actually felt) that it was a temporary condition. That email started traveling the Internet and I was soon inundated with messages of support and condolence from around the world! For several days I sat at the computer answering emails; they came quicker than I could type. Though it was overwhelming at times I was humbled and buoyed by this outpouring of empathy. People suggested many alternate forms of medicine including acupuncture, shiatsu, chiropractors, Rikki, sacro-cranial massage, herbal remedies and the like. I did make a few exploratory visits, but decided to stick with the path of steroids and daily physiotherapy. I also resolved to fight to regain my ability on the instrument.
Initially, playing was impossible. I could not hold the muscles of the embouchure in place and all the air leaked out the side of the mouth. My face was numb, as if I'd had a shot of Novocain. Toward the end of the first week I found that I could get a weak buzz on the mouthpiece if I held my fingers against the week side, clamping the lips together and plugging the air leak. It was a pathetic sight, and the sound was rather unpleasant, but at least it was a sound. I could cover about one octave in this fashion. I could sustain a weak buzz on the mouthpiece without holding the lips together, but only for a few seconds and with a lot of air leakage.
I also tried buzzing on a tuba mouthpiece. Though the buzz was in a different place on my lips, at least it was contained within the mouthpiece, rather than escaping out the side of my mouth. I found the tuba mouthpiece fit in the large end of a trumpet lead pipe, turning it into a tuba buzz-aid. With the trumpet mouthpiece in one end and the tuba mouthpiece in the other, I dubbed it my `recuperator'.
Week 2
Though there was encouraging improvement in the general condition by the start of the second week, the embouchure didn't seem to be recovering; it felt like there was no progress. The physiotherapist said it was possible that a breakthrough day could occur, though more often it is a slow gradual process of reacquiring muscle control. Whatever progress I made in the course of a day seemed to evaporate overnight and I generally woke up with the numb sensation that would gradually wear off during the day. I realized that I would have to chart my progress in weeks, not days.
During the course of the second week my range expanded on the mouthpiece from a pedal F to the top of the staff, still holding the corner with my fingers. By the end of the week I could hold a steady tone on the trumpet for about 5-10 seconds. I had to rest about a minute before I could do it again, but I repeated this (short) long-tone over and over.
Week 3
By the start of the 3rd week the general symptoms had largely abated. The morning numbness was mostly gone, my eye closed almost completely and was less irritated, and control of the facial muscles was returning. In one way this created frustration: as I started to feel normal in general it was maddening to pick up the instrument and still not have any chops. I felt 80% recovered in general, but only 20% recovered as a player. It was all too easy to imagine that it would never feel the same again.
I had enough strength to put a solid core of air into the sound and fill it out for a short time. I could get a pretty big sound up to 3rd space C, but it thinned out a lot after that and air leaked out noisily (sounding like Porky Pig). I could, however, feel the gradual return of playing sensations and my endurance was improving. I could play for longer periods before the mouth corner would give way. In discussing whether I would be OK to teach at an upcoming jazz camp I told the director that I might have to change my clinic topic from `Double High C in Two Minutes' to `Building the Low Register with Short Phrases'.
The most important development was that I was starting to practice again, though in a very limited way. Psychologically, this was very significant. For the first two weeks I felt in limbo, just trying to get any kind of sound at all. Now it felt like I was starting to make some progress. I looked forward to the rebuilding process and woke up several days in a row dreaming about simply practicing. I practiced softly, with lots of rest. I utilized breath attacks, lip buzzing, mouthpiece buzzing, pedal tones, slow flexibilities, note bending and long tones.
I tried playing some jazz for the first time. This was interesting, as I'd recently been developing a style of playing that involved less high, loud and fast notes, in the style of Chet Baker. At this point I had no choice but to play in that style! With limited chops and endurance, I was forced to find music in the bottom octave of the horn. Also, if I played too long the cheek gave way, forcing me to edit my phrases.
Teaching without demonstrating was also a new experience. I found that my students played more than they normally would in the course of a lesson, and had to rely on themselves to hear any improvement, I couldn't hand it to them by playing the phrase in question. (Some students reveled in their ability to outplay me, but I vowed to make them pay! :>)
Week Four
During the fourth week I went to our family cottage in the Adirondack Mountains, hoping the clean air and water and a lifetime of fond memories would help the healing process. I would take the boat out to an island early each morning and do some mouthpiece and leadpipe buzzing. During the day I would put in 3-4 practice sessions on the horn. I managed to get up to high C with a very thin sound, certainly not usable on a gig.
Though I could see improvement, I found myself demoralized by the slow pace of recovery, and still harbored dark fears that my career was over. I was subject to severe mood swings. I took some inspiration from reading stories of various players who had come back after illness or injury. One piece of advice that I took to heart was that things might never be exactly the same, and perhaps that wasn't even the goal. Rather than hoping each day for the return of familiar sensations I decided to work with what I had, and if that meant finding a new way to play, so be it. Though I had been clinging to the hopes of a quick recovery (3-4 weeks) I now reconciled myself to the fact that it seemed certain to be at least several months before I felt back to normal.
I experimented with the placement of the mouthpiece, finding that I could stem the leakage somewhat if I moved it over towards the weaker side. I started each note with a very relaxed embouchure, and tried to `blow' the lips into place, letting them find whatever position produced the best sound. While resting I did a lot of fingering of scales while tonguing on the air stream. This helped a lot to balance the tension between the two sides of the mouth, and kept my fingers and tongue working.
Week Five
During this week my range continued to improve, and I got up to a weak high G. My useable range increased to high C, but even that would give way if I played too hard. I was encouraged by the fact that my embouchure felt less foreign and by my increasing endurance. I returned home from the cottage buoyed with optimism and determination and was very reflective about what I had been through and what was to come. I wrote:
"I am wrestling with the reality that I probably should return to work soon. This is a tough hurdle as I have not played outside of the practice room for over a month, and I am very aware that my capabilities are diminished. Physically and mentally, however, I think it is probably a good idea to `get back on the horse'. I will have to be careful about what gigs I accept, because I am definitely not in any shape to do a hard-blowing gig."
Week Six
During the course of this week my response improved. I could play two-octave sirens on the mouthpiece without encountering gaps in the vibrating response. I was also able to hold high E's and F's with a pure, albeit quiet tone. Prior to this week there was a fair bit of break-up in the sound as I couldn't quite control the vibrations.
Most importantly, this week brought my first gigs. I played a 75-minute concert with my quartet. It went very well; many people commented that they would not have known anything was different. I replied that if we had played just one more tune they would have! From the day I contracted Bell's Palsy this concert had been a landmark goal for me. While not fully recovered yet, as I had hoped I would have been by this time, I was very pleased that I was able to perform, and my appearance was met with enthusiastic response from the musicians and the audience.
The next night, more as an experiment than anything else, I played a five-hour wedding reception. I expected that my chops would cave in at some point, but quite the opposite, I remained relatively solid to the end of the gig. I even hit a few high notes that I couldn't play confidently yet in the practice room. I was quite surprised and delighted when they came out!
These two jobs finally banished any lingering doubts that I might never be the same again. I wasn't ready to play a hard lead book and was leery of recording sessions where the difficulty of the part was unknown, but I became confident that I could play the trumpet again and decided to start accepting calls.
At about this time a friend sent me a facial exerciser called the Facial-Flex. This little device consists of two curved plastic pieces that fit in the corners of the mouth. Steel rods and a rubber band connect them, so that you are working against the resistance when you bring your corners in towards the center. You vary the resistance by using heavier rubber bands. Sold primarily as a beauty aid, the Facial-Flex is perfect for Bell's Palsy victims. It also seems perfect for trumpet players in general and 10 months later I am still using it every day to strengthen the embouchure.
Week Seven
My useable range was hovering around a high D at this point. I had played a few good high G's, but I couldn't guarantee them. I played my first recording session, and gladly jumped into the 3rd trumpet chair. They did, however, keep me afterwards to record some solo trumpet. That prospect would have filled me with dread only a few weeks earlier. Thankfully, it went well.
I continued to hear the comment from people that it sounded like everything was back to normal. While I was glad it sounded that way, I knew inside that it still did not feel exactly the same. That continued to shake my confidence, though I tried not to show it outwardly.
I practiced slowly and carefully all the exercises I normally practice but reduced the range, volume or intervallic spread of the exercise as needed in order to maintain control of the vibrations on each note. When I heard distortion or an uncontrolled buzz on a note I stopped and worked on that note. I had to pay attention to the limitations of my body, but I worked the muscles, pushing them a little harder each day.
Week Eight
A breakthrough occurred during this week. While playing arpeggios I tried to play a high G. Prior to this point when I tried for this note my chops often jammed and nothing came out. Well suddenly, out it came, loud and clear. As I held it I could feel the muscle strength start to sap, but I was sure that would strengthen with time. This was a happy day.
At this point, eight weeks after the onset of symptoms, I felt mostly recovered and stopped writing the daily log, adding entries only occasionally. I knew the rest of my recovery would be largely internal, evident to me but not to others. As so often happens, the home stretch was the longest. The final entries in my log tell the tale:
Week 13
"For the last four weeks or so I've been on a plateau; what I describe as 90% recovered. I can do pretty much everything I could before, but the chops still fight me. It's like every day is a `bad day'. I can't pick up the horn and assume that things will work correctly. I'm yearning for just one day where everything feels easy!"
Week 16
"The sound is much clearer and I am starting
to feel more confident. It is finally starting to feel normal."
Week 22
"In the last week or so, however, I've finally started calling it 100%. I've had a couple of nights where I know I've never been stronger, and I've shaken that `every day is a bad day' feeling. Still, there is a change, both mentally and physically. I have told myself that I would not close the book on this thing until I have the benefit of full hindsight. I suspect that is months away yet."
Week 52
It has been a year, and I can finally
honestly say that it is all in the past. I play better than I did a year
ago, and I've learned a lot since then. I'm stronger, more efficient, can
produce a wider range with better control, and enjoy trumpet playing fully
once again. In addition, I have a renewed appreciation for the fragility
of the art of buzzing my lips into a brass tube, and give thanks for each
morning that I wake up to a blessedly `normal' day.
"You function on a brass instrument based on the 7th cranial nerve, which is the motor nerve that comes from the brain. At the region of the lips it is carrying a signal and the lip reacts as a reflex to that signal from the brain." (Arnold Jacobs)
Well! Could we custom craft a disorder that more directly impacts on a brass player? While Bell's Palsy is a horrifying experience, I do believe that I play better today than if it had never happened. As they say, what doesn't kill us makes us stronger, or in my case, smarter.
Here is the best medical info I found on Bell's Palsy: