Dr. Akash Mehta is an Emergency Medicine board-certified specialist, health and fitness consultant, and Concierge Medicine physician based out of Los Angeles. After finishing medical school at the Touro College of Medicine in Manhattan, Dr. Mehta completed his Emergency Medicine residency at Mount Sinai Medical Center in Miami Beach. Then Dr. Mehta joined Kaiser Permanente as an Emergency Medicine attending physician in West Los Angeles. After years of obtaining intricate knowledge of the healthcare system, he decided to branch on his own and create Nyla Health. He continues to work with various Emergency Medicine groups in and around Los Angeles, and most notably had extensive experience in the frontline during the COVID-19 pandemic.
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You have an extremely important presentation coming up in two days. A top client from Japan will be arriving, and your boss put you up to the task for the presentation since the project is "your baby." (Finally, Steve can't do anything but keep his pompous and derogatory comments to himself.) This is your time to shine! You, unfortunately, have been skipping meals, drinking excess caffeine, and sleeping four hours a night the last couple of days to prepare. You finally "crash" later, around midnight, and your alarm wakes you up at 4:30 am. You notice your pillow is wet; you then touch your face and notice you're drooling. You rush to the mirror and half your face is drooping!
Not only does it look like you might be having a stroke, but it is also extremely painful! You notice a clearly evident rash on your face that looks just like when your grandma had shingles. What is going on? How could this happen now?
Although Ramsay-Hunt syndrome is not life-threatening, it can greatly affect the daily lives of many due to the severe alteration of one's appearance. It is a combination of 2 diseases; shingles (the rash) and Bell's Palsy (unilateral paralysis of the face). The disease has an incidence of about 5 per 100,000 people per year; however, Bell's Palsy itself has an incidence of 15-30 per 100,000 people per year.
In fact, at the beginning of June this year, heart stopper musician Justin Bieber, unfortunately, brought Ramsay-Hunt syndrome to the forefront of the media as he shared a video of his facial paralysis from having just acquired the disease. While fans continued to send Bieber their prayers, medical professionals were on the frontline. Through the grapevine, Haute MD expert Dr. Akash Mehta, based in Los Angles, CA., had first-hand knowledge of Bieber showing slow signs of recovery and improvements. And now, based on Bieber's live performance at the Lucca Summer Festival on July 31st, he is officially back in the spotlight!
Though Bieber is showing to be recovered, his episode of Ramsy-Hunt syndrome concerned many worldwide, understandably. Seeing the clear red flags, we at Haute Beauty sat down with Dr. Mehta to discuss the disease and why it's essential to be aware of it. Here's what was discussed:
What is Ramsay-Hunt syndrome?
As alluded to earlier, Ramsay-Hunt syndrome is a viral infection characterized by paralysis of the facial nerve and a painful rash in the ear of the affected side (only affects one side of your face/head). It's caused by the varicella-zoster virus (VZV), which causes shingles and chickenpox. Once someone has had chickenpox, that virus may lay dormant in the nervous system and can re-emerge as shingles when one's immunity is compromised. (We hope shingles, and thus Ramsay-Hunt syndrome, will be less prevalent as time goes on because most children in the United States have been vaccinated with the VZV vaccine after it debuted in 1995). Shingles (a painful rash affecting a certain unilateral nerve distribution) can be reactivated in almost any part of the body; you may have known an elderly family member to have been affected by this on their torso or legs. When it affects the facial nerve, however, it can cause facial weakness along with a rash.
What is the cause of Ramsay-Hunt syndrome?
The cause of Ramsay-Hunt syndrome and shingles is a decrease in immunity. When the body does not have its "disease-fighting" system running optimally, viruses such as VZV can re-emerge. Conditions such as HIV, diabetes, and simply elder age lower immunity. However, physical and emotional stress can play a role. I have seen fellow physician friends and colleagues be afflicted by this in their 20s due to lack of sleep and the severe stress of our medical training!
Is Ramsay-Hunt syndrome treatable?
Luckily, Ramsay-Hunt syndrome is treatable, and most do recover in three to four months. However, there is no magic cure. Often we can treat the syndrome with steroids and specific antiviral medicine, which can help stop the progression of the disease. Still, the body will likely need to reverse any facial weakness over time. The key is early treatment! These medicines may not have much effect on the condition more than 72 hours after onset. Bieber also performed facial exercises, which have shown to help in facial paralysis recovery in general.
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Can Ramsay-Hunt syndrome be prevented?
The prevention of Ramsay-Hunt syndrome and shingles is primarily through obtaining the VZV vaccine for those who have not had chickenpox. For the rest of you, keep your immunity strong. Continue good eating, sleeping, and exercise habits to avoid diabetes and simply the temporary decrease in immunity due to stress.
What should you do if you experience the side effects of Ramsay-Hunt syndrome?
I recommend immediately visiting an emergency department (ED) if you develop one-sided facial weakness, tingling, or numbness. Conditions such as Bell's Palsy and Ramsay-Hunt syndrome are only considered once a trained medical professional can rule out emergent neurological or cerebral conditions, such as a stroke, bleeding in the brain, brain tumor, etc. This should also lead to early treatment of Ramsay-Hunt syndrome and Bell's Palsy if those are determined to be the final diagnoses.
The Summary
Ramsay-Hunt syndrome is characterized by a painful ear (and sometimes facial) rash and paralysis of one side of the face. It is caused by VZV and occurs in those who have had chickenpox already. VZV re-emerges because of a decrease in immunity, which can occur from several medical conditions, including diabetes and HIV, and bad lifestyle habits such as a lack of sleep. Treatment focuses on the early intake of steroids and antiviral medicines. Lastly, please visit your nearest ED if you develop one-sided facial numbness, tingling, or weakness to ensure a more dangerous medical condition is not occurring.
To my readers, the temperatures are a record high this summer in the United States. Keep yourself hydrated well, have ample rest, and continue a fun & healthy summer. Don't lower your immunity in exchange for a bit more temporary fun. Viruses such as COVID-19 and VZV are waiting around the corner to ruin the rest of the season!
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