I finally saw Renee Ivens at Washington University for facial physical therapy last Wednesday.
She is very pleasant and nice. We spent some time talking about my history (five year history of left-side hemifacial spasm and wakiing up with facial paralysis after microvascular decompression surgery) and also my feelings about the facial paralysis (I miss my big smile). I told her about meeting Jackie Diehls in Chicago. Renee says she is familiar with Jackie's work and has referred patients to her and had nice things to say about Jackie's specialization in facial issues. She asked if I would like to see Jackie, I told her yes, but I wanted to go through the channels of working with her first as she is in-network and much closer. If she and I feel in the future that I would benefit from a trip to Wisconsin, then I can apply for out-of-network coverage then. She was amenable to that approach. Then I asked what the difference is between neuromuscular retraining and physical therapy. She said it's basically terminology, all physical therapy is neuromuscular retraining.
Next she had me go through a range of facial expressions to see where I am in recovery and how much synkensis I have. She prescribed facial massage and four different exercises, two for the lips and two for the eyes.
Then she asked if I have any questions. My first was how often I would need to see her. She responded that for facial cases, and for out-of-town patients, she schedules appointments every 3-4 weeks, and the interval will lengthen as time goes on. Then I asked her how much improvement I can expect with diligent exercise. She said she did not want to give me false hope of regaining my smile the way it used to be, but that there is room for improvement, though of course she cannot guarantee how much. She added that even as a PT she thinks my appearance at rest is very good and that I have had good recovery in my smile. I told her that a lot of people consider me to be fully recovered, but I feel there is still much room for improvement. Renee said that her experience has taught her not to concentrate on the smile, even though that it what everyone wants back. Her focus is on getting the facial muscles more balanced and an improved smile comes about through that.
It has really surprised me this week as I have worked on the massage and exercise just how tight my cheek muscle is right by the nasolabial fold. It is hard and painful when I start the massage. I can see where the other muscles have a hard time trying to overcome that pull. On the other hand, it has not surprised me how difficult it is to isolate facial muscles. I was anticipating that. One thing I have discovered is that it is better to do the exercises at my computer using my webcam instead of in front of the bathroom mirror. It's impossible to look at my eyes using the webcam, so it is easier to concentrate on the muscles in my lips, cheek and under my eyes.
My next appointment is May 12.
ßara
