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Article by Chase Sanborn & Bell’s Palsy
I am a professional trumpet player. In June of the year 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 not a life-threatening condition, Bell’s Palsy is disruptive, particularly so for a brass player. With one side of the face substantially weakened, it is impossible to form an embouchure and buzz the lips. Even once recovery is underway, the fine muscle control needed to control the embouchure returns very slowly.
While most people recover completely from Bell’s Palsy, and my prognosis was good since we caught it early, there can be permanent lingering after effects that could effectively end the career of a brass player. The possibility of this filled me with anxiety. I struggled daily to find signs of progress, an agonizingly slow process that consisted of two steps backwards for every three forwards. Over the period of a year I kept a log, daily at first then expanding to weeks or months as the condition subsided. What follows is a summary of the log.
In the years that have passed, I’ve shared this story with many others that have found themselves similarly afflicted. It is important to know that almost everyone I’ve been in contact with eventually recovered completely, as I did. Any musician that overcomes an obstacle due to illness or injury will tell you the same thing: you learn from the experience and come back stronger for it.
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 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.
During the course of the next day my jaw started to ache when I chewed. At first I suspected TMJ. After dinner, numbness set in on the right side of my face and I could not fully close my right eye. I should have gone to the hospital immediately, but waited until the following morning to see my own doctor. Ironically, before I went to the doctor I went to see a friend who was in the final stages of cancer. I remember sitting in his kitchen, knowing he had weeks to live, and feeling terribly guilty for worrying about something as comparatively unimportant as my chops.
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 searched the Internet for medical information where I encountered horror stories of protracted and sometimes permanent disabilities. Thoughts of the end of my career bombarded my head.
Though things were predicted to get worse in the coming days before they got better, it didn’t progress that way. There was little to 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. Brushing my teeth was a comically messy affair. My right eye only closed halfway when blinking—I had to use my fingers to help it shut—but I could close both eyes for sleeping. Many Bell’s Palsy victims 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.
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 electric shock. After a session, I felt like I had really worked the muscles, in a way that simulated playing to a certain degree. 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; more’s the pity). I also used a mirror to perform a variety 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. When people asked what they could do to help, I suggested buying a CD. Bells Palsy was a rather drastic way to stimulate CD sales, but it remains to this day my most successful sales campaign.
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 weak side, clamping the lips together and plugging the air leak. It was a pathetic sound but at least it was a sound. I could cover about one octave in this fashion. I could sustain a 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, which contained the air leak inside the larger cup. I found the tuba mouthpiece fit in the large end of a trumpet lead pipe, turning it into a tuba buzz-aid. I dubbed it my ‘recuperator’.
Though there was encouraging improvement in the general condition by the start of the second week, it felt like no progress at all was being made on the embouchure. 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.
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, but only 20% recovered as a player. It was all too easy to imagine that it would never feel the same again.
I could get a pretty big sound up to 3rd space C, but it thinned out 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. With limited chops and endurance, I was forced to find music in the bottom octave of the horn. If I played too long the cheek gave way, forcing me to edit my phrases. Chet Baker was my musical inspiration.
Teaching without demonstrating was 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 a comeback!
During the fourth week I went to a cottage in the mountains, hoping the clean air and water 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.
Though I could see improvement, I found myself demoralized by the slow pace of recovery, and still harbored fears that I would never get back to my former ability. 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.
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.
During this week my range continued to improve. I could produce decent sound up to high C, but the embouchure would collapse if I pushed too hard. I was encouraged by the fact that the sensations felt less foreign and that endurance was improving. 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.”
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 jazz festival 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 gig. 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 trumpet 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 gigs.
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, and as a general embouchure strengthening tool.
Edit: Today I would make good use of the P.E.T.E. as a way to work and strengthen the embouchure.
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 shook 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.
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:
“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!”
“The sound is much clearer and I am starting to feel more confident. It is finally starting to feel normal.”
“In the last week or so, 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.”
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.”
Well! Could we custom craft a disorder that more directly impacts on a brass player? While Bell’s Palsy is a horrifying experience, particularly for a brass player, for most it will be a temporary blip on the map. The key is to learn from the experience. As they say, ‘what doesn’t kill us makes us stronger.’
With the benefit of hindsight, I would not spend so much time worrying about my non-functioning trumpet embouchure and devote the time normally spent practicing to other musical pursuits. That would have been a more efficient way to spend the time and would have helped deal with the psychological aspects. Hopefully I’ll never have to put this to the test.
One thing I learned is that bad news travels fast; good news much slower. It seemed that everyone knew almost immediately that something had happened to me. Years afterwards, people I didn’t see often would come to me with concern in their voice asking “How are you?” (I’ll never know how many calls did not come in because people assumed I was still not playing.) Although writing my blog and posting it on the internet was cathartic and generated an outpouring of support, those blog posts made their way onto websites around the world, reading years later as if it was happening now. I had to track websites down and ask them to replace the posts with this summation. As I said at the outset, reading this story has given many people encouragement to overcome their obstacles, and for that I feel grateful.