Q: I AM 68 years old and diabetic, but I have avoided the flu jab since 2014, when, exactly two weeks after having the vaccination, I developed Bell’s palsy. It was terrifying – could it happen again?
JF
A: Bell’s palsy is when the nerve that controls facial movement becomes suddenly paralysed. It affects one side of the face, causing the eyebrow to sag and the mouth to droop.
Named after Sir Charles Bell, who identified this nerve in the early 1800s, the effect is dramatic and disfiguring and, as you found, it can be a terrifying experience. Much of the anxiety is driven by the fact that not all people recover fully, which can be devastating.
While Bell’s palsy is responsible for more than half of all cases of facial paralysis, other causes include shingles, where the same virus that causes chicken pox affects the nerves, and otitis media, a middle-ear infection which can press on the facial nerve as it passes through the middle ear to the brain, as well as Lyme disease, tumour and stroke.
Between 15 and 30 in every 100,000 people develop Bell’s palsy each year and, while the exact mechanism is unknown, it tends to happen when people are ‘run down’ or under stress. Indeed, research has found that the herpes simplex virus – which causes cold sores and which reactivates when the immune system is overloaded – often affects the facial nerve.
People with diabetes are advised to have the annual flu jab because you are more at risk, and flu might affect you more severely, as well as affecting blood sugar levels.
As for whether the vaccine is linked to Bell’s, there was a report in 2004 describing a series of 46 cases of Bell’s palsy following the use of a certain flu vaccine delivered nasally and used only in Switzerland. But there are no reports of any association between Bell’s palsy and the flu jabs used here in the UK, and it is most likely that the onset in your case was coincidental.
Given the lack of evidence of any link, and the well proven benefits of the flu vaccine, particularly in people of your age and with a known diagnosis of diabetes, I urge you to have one when the jabs become available this month.
Q: I HAVE had erectile problems over the past six months, but numerous blood tests have come back OK. I have also noticed that my penis has a bend in it on erection. I am 57.
B.
A: IT SOUNDS like you have Peyronie’s disease, a disorder of the tough membrane that surrounds the spongy tissue of the penis. It occurs when fibrous plaques – like spontaneous scar tissue – form within the membrane.
This scar tissue is rigid and inelastic, affecting erectile function and causing the distortion you have experienced. It’s not known why it happens, but there is suspicion that micro-injury sets up uncontrolled inflammation, which escalates into this spontaneous scarring.
Pain can occur in the early stages, but ceases after a year or two when the acute inflammatory phase ends. After this, the deformity gets no worse, but usually no better, either – the condition resolves itself in only 12 per cent of men.
A survey of 8,000 suggested 3 per cent of men have this condition and 20 to 50 per cent of those also have erectile dysfunction.
I would ask your GP to refer you to a urologist. The first line of treatment is the drug pentoxifylline, with a dose of 400mg taken three times daily. This acts on a growth factor involved in scar tissue forming – studies show that pentoxifylline slows the rate at which the curvature progresses, but early treatment (and it sounds like you are just in time) gives better outcomes.
Vitamin E, a powerful antioxidant, may also be prescribed. It’s thought to reduce collagen deposits, the material that creates the plaques.
The specialist may also suggest injecting collagenase, an enzyme that, in theory, softens collagen and so reduces plaque formation. One study has shown this produced an average 34 per cent improvement in the curvature.
If the deformity persists, there are surgical options to correct it – a surgeon will recommend the best.
Long term outcomes are good, with return to sexual activity for more than 80 per cent of people who have surgery.
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