DEAR DR. DONOHUE: I suddenly got Bell’s palsy. No one knows how a person gets it or what to do for it. Any information will be very welcomed. – C.M.

ANSWER: Everyone stricken with Bell’s palsy gets it suddenly. The usual story is that a person goes to bed and wakes up with it. It’s a weakness or outright paralysis of facial muscles on one side of the face.

The eye on the affected side won’t close. The corner of the mouth on that side sags and, when eating, food and drink dribble out of that corner of the mouth. The lips cannot be brought back into a smile. Affected people might complain of ear pain on the paralyzed side of the face, and they often say that a normal sound level is much too loud.

Most authorities believe that Bell’s palsy comes from a herpes-1 virus infection of the nerve serving the facial muscles. It’s the cold sore virus that stays in the body for life, and most people harbor it. What causes it to suddenly spring into action is something that remains a puzzle.

Sometimes Bell’s palsy is seen in conjunction with another illness, like Lyme disease. Infrequently, it results from a tumor pressing on the facial nerve.

Many doctors feel that prescribing a cortisone drug like prednisone at the onset of the illness shortens the duration of the paralysis. Others prescribe both prednisone and an antiviral drug like acyclovir. Some believe time is the best treatment. When the muscle weakness is profound, consideration is given to enlarging the bony tunnel that the inflamed and swollen nerve passes through on its journey to the face.

With or without treatment, most make a full recovery, and usually do so in a matter of weeks to months. About 15 percent are left with residual facial weakness, and a small number has to contend with permanent weakness of facial muscles.

DEAR DR. DONOHUE: Until recently, my husband was an active, healthy 60-year-old. About five months ago, I noticed that his gait was odd. He said his legs felt a little tired. Now he feels unsteady on his feet and is somewhat uncoordinated. He feels “blah” most of the time. We have an appointment with an orthopedist and a neurologist. In the meantime, he’s beginning to suspect MS or Lou Gehrig’s disease. What’s your assessment? – T.M.

ANSWER: Multiple sclerosis can appear at any age, but it most often occurs between the ages of 20 and 40. Symptoms depend on where in the brain and spinal cord the scars (sclerosis) are located. In addition to fatigue, early symptoms are a decrease of vision in one eye or double vision. Initial symptoms disappear and are replaced by new ones. I don’t think your husband has MS.

Lou Gehrig’s disease, amyotrophic lateral sclerosis, has an onset between 40 and 70. Fatigue is a common early symptom in it too. In the first stages, muscle cramps are frequent. Then the muscles weaken. People drop things from their hands and stumble when they walk. Chewing and swallowing are often impaired. The symptoms worsen as more and more muscles are involved. Your husband doesn’t fit the picture of Lou Gehrig’s disease very well either.

I don’t know what he has. A one-on-one examination by a neurologist should provide the definite answer. If you have the time, will you let me know the final diagnosis? Readers will also be interested in learning it.

DEAR DR. DONOHUE: Third request. My husband generates a lot of mucus, and he spits it into the sink where food preparation takes place. It turns my stomach, but he says it all washes down the drain. What do you say? – R.M.

ANSWER: It turns my stomach too. But I suppose he’s right. If he flushes it down the drain with water, then the chances of contaminating food with germs are slight, but he ought to respect our disgust. Tell him to use a tissue when he feels the need to spit. It’s the civilized thing to do.

DEAR DR. DONOHUE: How can one prevent a dowager’s hump? Is it hereditary? My mother, now 80, had one for years. I have one sister in her 50s who is very thin but doesn’t have one. I have another sister, 49, who is somewhat heavy, and she is developing a hump. I take some calcium and am in great shape. I exercise every day. Can I stop one from developing? I am 42. Recently someone noticed I have a tiny hump starting. – W.S.

ANSWER: A dowager’s hump is a bulge in an older woman’s upper back. Vertebrae (backbones) have collapsed due to osteoporosis. The bones have become so fragile that they cannot support body weight. The front of the bone caves in, and the back of the bone projects outward. These are compression fractures, and they are very common throughout the spine. They can be most painful.

You are only 42. You have no other signs of osteoporosis, do you? It’s unlikely you have a dowager’s hump.

As they do for just about everything, genes influence osteoporosis. So does calcium. Make sure you’re getting 1,200 to 1,500 mg a day. Women younger than 50 need 200 IU of vitamin D a day; those between 51 and 70, 400 IU; and those older than 70, 600 IU. Many believe 800 IU is a more reasonable dose. Continue your exercise program and add some weightlifting exercises for the upper back and upper arms.

If a doctor believes you are developing a dowager’s hump, then you need a DEXA test to determine the density of your bones. If the test indicates your bones are in the danger zone, then the doctor can prescribe appropriate osteoporosis medicines. I would be most surprised if your bones are osteoporotic.

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