Article by Chase Sanborn & Bell’s Palsy
When I asked for information on Bell’s Palsy it is because I suddenly find myself afflicted with this nerve disorder. I want to thank those who have offered information and support, and encourage anyone else with information to send it to me. I hope to make this a learning experience and help others who find themselves similarly afflicted.
Last Wednesday night I felt great and played a lot. On Thursday morning my chops were un-responsive, which I attributed to too much playing the night before, I put the horn away until the gig that night. At that point, to my amusement and horror, I could not play above a G on the top of the staff without the embouchure collapsing. There were no other symptoms, so it was very puzzling. I got through the gig taking things down one, and in some cases, two octaves.
Friday morning things felt much the same, but throughout the day I started to develop a numbness on one side of my face. By the end of the day I was convinced that something quite unusual was happening and I headed to the doctor first thing Saturday morning.
It took her ten seconds to diagnose Bell’s Palsy. As I have since learned, this is a disorder affecting the 7th cranial nerve. The effect is partial paralysis of the face, In more severe cases, the entire face can droop, resulting in an eye that won’t close, difficulty chewing or smiling on one side, constant drooling and other unsavory conditions. I consider myself lucky in that I don’t have most of these problems, except for the eye, and that is minor. On the other hand, it has left my embouchure numb and one side cannot contain the air from leaking out, therefore playing is impossible.
Some general information: The condition is temporary, it will go away on its own, with or without treatment. The use of steroids to treat the inflammation and anti-viral drugs to combat the virus are controversial, but I am trying both. There can be permanent damage related to the disorder. (Because my case is mild, I am optimistic for full recovery.) Re-occurrence can happen but is not common.
The medical profession is somewhat in the dark on this. There is a theory that it is viral, but that is not proven. The causes are generally unknown. Recuperation can be a matter of weeks, months or years, and there seems to be no real predicting. Some well-known brass players have experienced it and have come back full strength. My current plan of action is taking steroids and anti-viral meds (despite the aforementioned controversy), daily electro-physiotherapy to stimulate the muscles of the face, and regular exercise of the facial muscles including exaggerated expressions and lip-fluttering. If I hold the lips down on one side to block the escape of air I can get a buzz on the mouthpiece, so I am doing that as well. The key is to try to maintain muscle tone in the absence of nerve stimulation, especially for those that depend on our facial muscles for our livelihoods. Though shocked by the overnight turn-of-events, I remain optimistic and determined to see it through. After the passing of the palsy, of course, I will have some chop-rebuilding to do. I don’t mind that so much, maybe I’ll learn to play correctly this time! (I might have to read my own books.)
Tuesday Today I went for a second round of physiotherapy. They hook up electrodes to my face and stimulate muscle contractions in the absence of nerve impulses. This is in the hope of keeping some muscle tone while I’m waiting for the nerve to repair itself. I exercise my face with exaggerated facial movements throughout the day. I find that I can get a buzz on the mouthpiece if I stop the air from leaking out on the weak side by holding my finger against my lips. It is a pathetic sight, but there is a real psychological benefit to actually hearing a sound come out. I put on the headphones and buzz along. (Today was Fred Mills and Das Rennquintett. You should hear me buzz your cadenza on the Haydn, Fred!) I will be a very happy guy on the day that I can put the mouthpiece to my lips normally and play a long tone! When I try this buzzing approach on the horn the sound is rather unpleasant, to say the least, but at least it’s a sound. I have a solid 1 octave range with this approach, but no free hand to operate the valves. Unfortunately the range is in the low end, so I don’t have the chops to recreate the famous clarini solos on the natural trumpet. I might be able to play some Beethoven 3rd trumpet parts with an elementary school band. Anybody need a ringer in your band, somebody who can read flyspecks, as long as they are C and G?
I also tried acupuncture today. I have not had this before, and was curious. I could feel the needles stimulating muscles and nerves deep inside the face and can still feel it aching tonight. While this procedure probably would help if I continue, it did not result in any noticeable change today, so I am reluctant to continue with this relatively costly approach. (She wants me to have treatments 3-5 times a week. The physio is every day, and is covered by the government health plan, a consideration as I face an uncertain period of layoff from gainful employment.) A side effect of Bell’s Palsy is that the eye does not close properly. To protect it from wind on my motorcycle, I wear a patch covered by a mean looking pair of wrap-around shades. I call it my Bell’s Angels outfit.
Wednesday Welcome to the continuing saga of the BP kid! I started the day again with physiotherapy, with the electrodes on my face to stimulate muscle contraction. While the voltage goes in, I try to form an embouchure and blow air out the center. (Without the electrical stimulation all the air leaks out the corner.) I now have one of the stimulators at home, so I can use it throughout the day, and try it with a rim-visualizer to better focus the muscles of the embouchure. My wife is worried that the bad side of my face will come out stronger than the good side! (To those who council me to take it easy and not overdo it, I concur, and use plenty of rest. It stresses me out more, however, to sit back and do nothing and just wait for time to take care of things. I need to be proactive to remain positive.) Also, on the second-hand advice of Doc Severinsen, I am buzzing on a tuba mouthpiece. Though the buzz is in a different place on my lips, at least it is contained within the mouthpiece, rather than escaping out the side of my mouth. I have a range between a half-step and a whole-step. (This is about what I would have on a tuba mouthpiece with or without Bell’s Palsy.)
This technique helps me at least imagine when I’ll be able to once again buzz the trumpet mouthpiece. One of my own credos is that the first step to accomplishing anything is to be able to picture yourself doing it. In the last few days it has been hard to even imagine doing again what I’ve been doing naturally for 35 years or so, it feels so foreign. (Somebody called me for a last-minute gig last night. My first reaction was to say “I don’t know how to play the trumpet!” Fortunately I just said I was busy.) So progress continues ever so slowly, but continues none-the-less. I struggle with the necessary patience, but feel hope. Thanks for the continued good wishes from everybody!
Chase Sanborn Chase@brasstactics.netwww.brasstactics.net ========
Bell’s Palsy: Monday, Day 11 On Saturday, while Gary showed me his state-of-the-art equipment and computer design programs, I kept buzzing and found for the first time that I could sustain a weak buzz on the mouthpiece without holding the lips together with my hand. I could only hold it for a few seconds and then had to rest, and some air still leaked out the side, but this is a step I’ve been looking for and was strongly encouraged.
On Sunday I woke up to a very numb mouth, but by the afternoon I was able to repeat the buzzing before climbing on the plane for home. Monday, this morning, I got an idea and headed to my repair shop for a leadpipe. I’ve been buzzing the trumpet mouthpiece all day in the leadpipe, a la Bill Adam. This is fantastic, and I’ve made progress through the day on this, to the point that with the leadpipe I can now direct all the air into the mouthpiece without any leakage out the side. The buzz is week, but this is major improvement physically and psychologically. I also found that the tuba mouthpiece fits perfectly into the other end of the leadpipe, and allows me to buzz that much more effectively. Tuba players take note: a reversed trumpet leadpipe makes a perfect buzz-aid for you!
I buzz the trumpet mouthpiece until I can no longer hold the cheek in, then buzz the tuba mouthpiece down two octaves to flap and rest the lips. It’s a great looking piece of apparatus and I’ve dubbed it the Recuperator. When I put the mouthpiece into the trumpet the cheek still gives way quickly, but I can get out a lame scale from low C up to G, albeit with a lot of air leakage. Small steps, but improvement none-the-less.
Wednesday, Day 12 Some definite improvement today. Late last night (2:00-4:00 am-the steroids are making me jittery and are interfering with my sleep) I found that I could hold a steady tone on trumpet (not leadpipe!) for about 5-10 seconds. I then had to rest about a minute before I could do it again, but I must have repeated this (short) long-tone 50 times. During the day today I kept picking up the instrument and running a scale from low C up to G. After about 15 seconds the cheek puffs and the air leaks out, but the sound is improving. I now have enough strength in the corner to put a solid core of air into the sound and fill it out for a short time. This is a pale reflection of my former self, but is HUGE improvement from a week ago when I could not even form an embouchure, let alone get it to buzz.
During the physiotherapy today I brought in a mirror. I should have done this before. I can compress the left (good) side while waiting for the electricity to flow into the right (it cycles on and off), then try to balance the muscular contraction of the two sides in the mirror. It still looks a little cockeyed (a jolt of electricity running into my cheek does not form a perfect embouchure after all; more’s the pity) but the mirror really helps me to balance the two sets of muscles. I’ve been using a mirror at home to do a bunch of facial exercises, and it is logical to do it during the physiotherapy as well. It may be that until now I didn’t have enough control to balance anything, as I was just trying to get any muscle contraction at all. I am considerably uplifted by the day’s developments. My experience so far is that I make strides one day, and not so much the next, so I am ready for anything tomorrow, but I see a light at the end of the tunnel. (Let’s hope it’s not a train.)
Day 14 Nothing but good news, folks. In the last couple of days my face has made remarkable progress. The morning numbness is gone, the eye closes better and is less irritable, and control of the muscles is returning slowly but surely. On the horn things still feel pretty weird, but it is getting there. I can play from a weak pedal C up to a weak 3rd space C (consistency is important), and for increasingly longer periods. The tone in that register is actually fairly decent. (Kind of sounds like Chet Baker with a lot less chops.) In discussing an upcoming jazz camp I said to the director that I fully expect to be at the camp, but might have to change my ‘Double High C in Two Minutes’ clinic to ‘Building the Low Register with Short Phrases’. Most importantly, I can feel the sensation of playing returning, even though the muscles are weak. This leads to its own frustration, that of picking up the horn and expecting chops-of-old, since other aspects of the face are returning to near-normal sensations. That’s OK, I prefer that to complete demoralization. All this means that I finally feel I am starting to practice again, in a very limited way, rather than just trying to get any kind of buzz happening. Psychologically this is huge. For the first two weeks I felt in limbo. I could barely conceive how it felt to play anymore, and I was completely in the dark as to the if and when of my recovery. Now I feel I can take small steps every day, and have every confidence that it will return in a relatively short period of time. I’m looking forward to the rebuilding process. (For a number of days last week I woke up every morning dreaming about simply practicing. I’m looking forward to going back to dreams about flying and winning the lottery!)
Chase Sanborn Email: firstname.lastname@example.orgWebsite: http://www.brasstactics.net =====
Monday, Day 18
Baby steps improvement. I practiced my limited routine twice today, produced a tiny high C and am able to get a G on top of the staff with less air leakage.
Wednesday, Day 20 Yesterday and today I added a fair bit of lip buzzing (no mouthpiece) to the routine. This is a technique I hove not used in the past, but it feels like I am really concentrating attention on the compression in the corner of the mouth, where I am still weak. I am buzzing fairly low pitches to avoid excess tension. I can do this anywhere those in earshot will not be annoyed. (My family is used to just about any strange sound or sight these days.)
Thursday, Day 20 During the nine-hour drive to Lake George, I kept my tuba mouthpiece with buzz-aid (trumpet leadpipe) in hand and buzzed on and off the entire trip.
Friday, Day 21 I’ll be doing all my practicing while here with the Silent Brass electronic practice mute system. While not ideal (I’d rather hear the open horn) I believe it will still allow me to hear and feel exactly what is going on with the chops. What I hear and feel today is depressing. If there is improvement, it is very slight. I can play to high C or D but it is very weak. E is impossible. At the current rate, I’m afraid it is going to be a long time before I can play like I used to. The right side remains noticeably weaker, and I can feel air leaking. I’m experimenting with altering placement over to the right to help stem the air leakage, but am leery about changing my setting very much.
I put in a couple of hours today in three sessions, practicing pedal tones, flexibilities, breath attacks/long tones/note bending, and scales. In between I did a lot of fingering of scales while double tonguing. Double tonguing on the airstream without buzzing allows me to keep the corners firm, and it is easier to balance the compression on the two sides.
I’ve decided that I need to do whatever I can to stem the air leakage, even if it involves changing my embouchure placement. I am taking my own advice to students, and following the sound, placing the mouthpiece where the sound is the best and the air leakage is contained. To assist the lips in finding the most efficient position, I am placing lightly on a relaxed embouchure, and focusing on drawing the corners in and sealing the right side. The resulting placement is moved to the right (which is actually closer to the center, relative to my normal placement, which is left of center.) The range is not improved; I’m still stuck at a weak D-Eb (and not for very long), but the sound is slightly better and I can stop the leaking this way.
As of today I can play an E at the end of the flexibility exercises (Phase 8) or at the end of Clarke #5. It is not very centered or strong, but I can get it and hold it for reasonable duration. It would certainly not be useable on a gig. My endurance has improved over the week. When I first arrived at the cottage I was pretty wasted after a half-hour of routine work. While I am still doing half-hour sessions, I am feeling stronger at the end of each session. I’m doing 4-6 sessions a day. The biggest change over the week, I guess, is the basic feel of the embouchure, which has become less foreign, at least in the low and mid-register. I think it is all related to the compression and air leakage on the right side. As I slowly (very slowly!) regain strength the feel of the embouchure starts to feel more normal. My placement is drifting back to the normal spot.
Tomorrow begins month two.Chase Sanborn Email: email@example.comWebsite: http://www.brasstactics.net =======
Day 35 The high range continues to be unresponsive; I have to force everything from high C up. While this is frustrating and prevents a return to my regular work schedule, I am happy with the fact that it is becoming more enjoyable to put the horn to the face and play, even with limited range. I’m working hard at it, trying to push the chops a bit each day. One positive improvement over a week ago is seen with the mouthpiece buzzing. I buzz two octave arpeggios, then start at the top and gliss down and back up, like a siren. A week ago there were gaps in the response, spots where the lips stopped vibrating, particularly going back up. Today I am getting a smooth gliss all the way. Soon I may try three octaves, which is what I did previously, starting down in the pedal register. My concert is tomorrow. I feel ready and am looking forward to it.
Sunday, Day 37 I played my concert yesterday (the rain held off just long enough) and I’m very happy to report that it went extremely 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! We played tunes from both CD’s, and the band sounded great. There was great love and support coming from them, because they’ve known all along that it was dicey whether I would be able to play with them or not at this concert. They are not only stupendous musicians, but really stellar individuals as well. I’m three times blessed to have them making me sound good.
Monday, Day 38 Another good-news update today. Last 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 (F’s and F#’s) that I’ve not been able to play yet in the practice room. They were not huge notes, but were solid and well centered. I was quite surprised when they came out. It was probably due to familiarity with the charts, having played those notes in those places many times in the past. In the practice room today I am unable to duplicate the ease with which I played them, but never mind, the main thing is that I banished for the first time this weekend any lingering doubts that I might never be the same again. I also convinced myself that I can, in fact, return to some jobs. I’m not ready to play a hard lead book (if I ever was) and am leery of jingles where the difficulty of the part is unknown, but I am confident that I can play the trumpet again.
Of great interest to me was the arrival today of a facial exerciser sent to me by Julie, who I met a few weeks ago. Called the Facial Flex Ultra, 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 can vary the resistance by using heavier rubber bands. I am starting with the lightest and after a few minutes of use, I can really feel it in my corner muscles. This may be just what the doctor ordered, as it really targets exactly the muscles I am weak in. Julie said that she found this device to be more useful than the electrodes, and I agree that at this stage it is more efficient. (The electrodes work even if you have no muscle control at all, and are very beneficial in the early stages.) I have fallen off of the use of my electro-stimulator, as it is inconvenient to use and you really need a private spot, since it looks so weird. The Facial-Flex can be used in front of the computer, or while driving (though they caution against this.)
Tuesday, Day 46 My range is still hovering around a useable D, though I hit a couple of G’s in the last couple of days. I wouldn’t want to guarantee them, however. I did a day of recording yesterday for a cartoon series and I was happy to dive for the 3rd trumpet chair. They did keep me afterwards to record a bunch of solo trumpet sound effects. That would have filled me with dread a couple of weeks ago. Fortunately, it went well.