Tag Archives: sally stap

Acoustic Neuroma – How I Face My Face

I’m hard on myself, always pushing for progress. Critical of myself and always falling short of my own expectations. Not acknowledging that perhaps some things are beyond my control. One simple example being facial paralysis. I consistently fuss over of how much I have not healed – or ever will – rather than how far I’ve come.

Facial paralysis is hard. The first few months were the worst. It’s hard to watch nothing happen. It’s painful to wait for a healing rate of 1 mm per day. I was told that it would be at least seven to eight months before I could expect any healing and much longer before I’d know my “final” healing rate. At the beginning of that seven months it could have been twenty years.

However, I was given hope. I know that many people have to swallow the tough news that their facial nerve was completely severed and there will be no healing. There are possible surgical options in those cases, but that is a different path than I traveled.

Since the initial trauma during brain surgery, I’ve had a lot of improvement. People tell me they can’t tell, which is an emotional dilemma of its own. I fully accept their perception and appreciate their encouragement but am screaming internally that it is NOT ME! I wonder if they are truly looking at my face because it still looks incredibly abnormal to me. It’s such a contrast to process the difference between what I see in the mirror versus what I’m told by others. I recognize that they are seeing a face in motion that frequently smiles where I am studying a motionless direct glare of disappointment. I do appreciate that each person in my life does not stare at my face in a medical analysis mode.

Regardless of my frustration, I see improvement if I consistently focus on small changes. Improvement that some people would dance in the streets with delight about – and others see and are reminded of their more advanced outcome.

I have learned more about facial paralysis than I even thought possible. I am not a medical professional but as a person living it, I’d like to share a bit of what I’ve learned. I am just a girl, standing in front of a mirror, wishing I had my old smile back. (yes, that was a corny reword from the movie Notting Hill but I think you’ll get it and maybe smile a bit.)

First, while you are waiting for the facial nerve to heal from the brain at, prior to healing showing, here are some things that may be helpful:

– Regular use of a heating pad on the effected side of your face on a daily basis helps blood flowing for optimal healing.
– Gently brushing your cheeks with your fingers reminds your brain that your face is still there.

As healing begins what I didn’t know is that my muscles seized as the nerve healed. So, I had the characteristic look of a raised lip – my cheek muscles were pulling up as they seized. Through facial therapy, I learned that there was a lot of stretching that would help.

However, my fingers got tired and I couldn’t stretch things well inside my mouth. So, I experimented a bit and discovered the value of using a baby teether. This tool helped me significantly. (If traveling without, a spoon will do if you are gentle with yourself.)

In hindsight, I should have been stretching immediately after surgery. I know that many before and after me have found their own methods, but here’s my “wish” list:

1 – trail fingers on cheek
2 – pull cheeks together with mouth open
3 – push bottom of nose up. (like a pig – very attractive)
4 – Press between eye and nose
5 – massage cheek vertically and horizontally.
6 – pinch along jawline

I was told somewhere that a stretch doesn’t count if not held for 30 seconds and have strived to honor that minimum. I believe it does help your body parts relax and release into the stretch.
If a spot on my face hurts I hold that position until it stops hurting. I don’t know how to describe this so let me know if you’ve experienced it. After holding a painful spot (spasm) there is almost an instant – very short – where it hurts amore than then releases. It’s almost like the muscle is making one last attempt to hang on before giving up.

If you’ve had a Charlie horse – or cramp – in your leg, you know it hurts. Did you know that a facial muscle spasm is the same? Your leg muscles are connected to bone, so the pain is immediate and intense. You immediately stand to release it and it typically releases and feels better.

Facial muscles are not attached to bone, so we don’t have the same intense pain. The down side is that we then aren’t aware of the cramping and think its paralysis. Since you can’t stand to release,  you must turn to other methods.

I continue to work with my face. To me, it still looks strange. Partly because I’m not 21 anymore (grin). But if I follow my routine, it does make a difference in looks and comfort.

I know I’m not alone in this journey…

Pictures that may help are below.  PLEASE NOTE that if your face is really tight you will say this is impossible. However, with continued stretching, you will be able to.

 

 

 

 

 

This is “the lip” before stretching

This is “the lip” after stretching. I am able to close my lips.

Acceptance

 

I am not happy about the brain surgery I had. I tolerated it. I’ve dealt with lingering post-issues. However, have I accepted any of it?  I was recently told that the path to dealing with life events, failure, and disappointment is acceptance. What does that mean?  I recently dug into the dictionary of Google and found myself stuck between tolerance and acceptance. I learned a new perspective.

I drilled down through layers of web pages and definitions. I dug from high-level headlines to a detailed analysis of terms and descriptive words. Acceptance comes from the word accept which means that you consent to receive, believe or recognize. Yea, okay. Consent is not implying that I welcome, without trying to rewrite. I’ve often recited the obvious — you can’t have highs without lows, but I haven’t been past tolerance with the lows. I pondered as I looked out the window at trees and life.

We all quickly accept things that go our way in life. We accept without questioning desirable life events such as passing a test, enjoying a day with family, or finding a new pleasure in the form of food, book, or activity. We don’t obsess about decisions that we made that went well regarding career choice, friends made, or journeys traveled. However, when things are bad, which they factually are at times, we ask why?  We do not want to recognize or accept that life can be really rough.

I pondered that something can be tolerated but not accepted. However, one cannot accept without tolerance. After thinking really hard, and digging further, I started to understand the difference. Acceptance is moving our hearts and minds toward being okay with something.

Tinnitus is ringing in the ear. If you don’t have tinnitus, it probably sounds pretty benign. However, if you have it you know what crazy is. It doesn’t go away. It gets worse in some settings, but it’s always there. My tinnitus roars at times after being in a noisy setting. It changes with the movement of my eyes. However, if I don’t think about it, I tune it out. I forget about it for a while, even though it is still making the same sound to my brain. I know that there is nothing I can do about it, so I have accepted it.

Single-sided deafness is odd. It can range from unnoticeable in a quiet setting to frustrating when a grandson whispers something in my deaf ear. Shortly after becoming deaf in one ear, I was still adjusting. I was at a hotel and picked up the phone to call the front desk. I was holding the phone to my deaf ear. All I heard was silence. I hung up, looked at the phone, and tried again. Nothing. After three tries, I recognized I had been holding the phone to the wrong ear.

I switched ears and called a confused front desk person. At that moment, I could have been frustrated and depressed. However, for some reason, I chose acceptance. I laughed and apologized to the confused lady on the phone, explaining I had recently lost my hearing. I believe this was an example of acceptance – not just tolerance. It is a fact that I am totally deaf on one side. All frustrations aside, it is a funny story.

I haven’t been as gracious to myself about other things I should accept. I still question why I have not been able to will my body to heal faster or more fully. I am still limited in cognitive and physical stamina. I continually tolerate those limitations but haven’t fully accepted them. I get stuck between giving up and moving forward between tolerating with frustration and accepting by making new plans. I want to blame myself when I should accept that this is the journey I am on. I am not going to wake up one day to a different reality.

I’ve tried in spurts. I confidently find a new direction in life in my continual attempt at adding value to the world. However, when things don’t go as envisioned, I find myself pouting about how hard life is. I find myself bemoaning the old days. I don’t accept that I won’t get an honor badge for tolerating brain surgery. I won’t get a free pass for future endeavors. In fact, I’ll frequently pay a higher price to play in life. I don’t like that. But can I accept rather than tolerate? Am I missing new opportunities that may be very rewarding because I’m too busy looking back?

I’ve lived in many houses throughout my life in several different towns. I accept that I lived in one house as a child and a different one now – with many more in between. Sometimes the movement from house to house was my choice, and other times not. However, the moves happened, and my daily view was different. While I miss the view from previous houses, I love the view I have now of trees and space. Even when the trees are bare and brown in the winter, I know they’ll be green again in spring.

I can rearrange my current living room. However, it’s futile to try to fit things into a room in my house exactly as they fit into a previous house. I need to focus on the house I am currently living in. Maybe now I will try to view my mind and body similarly.

I constantly chaff at the changes in my life post-craniotomy. However, maybe if I focus more on what has happened rather than on what could have been I would feel more at peace with where I am in life. If – scratch that — WHEN we encounter a valley in life, the only way to get back on top of the mountain is to climb it. The pursuit of a full life is through trial and error, accepting that success isn’t guaranteed. Bumps and switchbacks are part of the journey. Can we embrace acceptance?

Journey from Hopeless to Hope

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At times, I feel hopeless. Does acknowledging disappointment mean that I’ve given up?  Does it mean I’m a realist or a defeatist? When dealing with life as it is presented, is there a recommended ratio of hope to realism? Of optimism to acceptance? For me, I’ve found that changing expectations allows for an increase in hope that leads in new and realistic directions.

Hope is a feeling of expectation and desire for something to happen. It can be a short term hope – “I hope the weather is good,” or a long term hope – “I hope my chronic pain goes away.” Hope for things we know are not possible in this broken world can bring depression, which brings isolation and fatigue. It leads to hopelessness.

To be hopeless is to feel despair and disappointment that something hasn’t happened: an emotion frequently labeled pessimistic or defeatist. When our bodies fail, should we hope?  Or cope? I hate the word cope. I know that hating a simple word is rather severe.  However, I’ve heard the word cope too many times while living with head pain. I cheerfully and kiddingly correct anyone using the word cope by advising that adapting is the preferred word – for me. Coping is treading water while adapting is finding a way to move forward.

Futile is a word that pops up when I find myself hoping for things that are not probable. Yes, I know that God is capable of touching and healing. However, He is also capable of nurturing a deeper faith as we learn to accept and not fight.  Sometimes, I feel overwhelmed and torn between deliberate optimism and honest feelings that demand to be acknowledged.  I don’t know how to reconcile my public mask of “positive, strong, and resilient; pleasant, miserable person” with one who opens up vulnerably to connect with the people in my life.  I worry I’ll make people uncomfortable with something they can’t fix. It can’t be talked through.  My head pain can’t be overcome.  It demands perseverance when I don’t really want to be a strong, persevering person. What’s important to share?  What is rambling? I’ve always had a desire to be concise – fix it and move on. However, life has brought me unfixable challenges following brain surgery. At least so far. . .

At times, I can’t breathe.  I feel stifled by life.  I start in one direction and stall.  I start in another direction but stall again. Feeling stuck and immobilized, I can’t move.  Pain.  Constant pain.  Recurring pain.  Exhausting pain.  Inescapable pain.  Pain that doctors have given up on but I live with every day, in every moment.

Given the hopelessness and futility of wishing for life to be different, I still feel surges of hope urging me forward.  I see little – and big – miracles in life that bring joy. I experience things that make me want to get up for another day.

Despite being deaf in one ear, the other one delights in the song of my grandsons’ laughter. They’re just too darn cute.  To hear them say “Grandma” melts my heart, and I have to suppress laughter at their young declarations of independence, “Don’t want to!”.

Although my vision is far from perfect due to genetically poor vision, a dry eye from facial paralysis and skewed vision from nerve damage, I love to take in our world’s vast horizon with spectacular sunrises and sunsets. I see beauty in nature that allows me to forget my head pain for a moment. The world that challenges me also calms me.

I love the feel of working with melted wax to create encaustic paintings. I lose myself as I focus on getting a detail right. I smell the heated wax and feel stickiness as the wax cools and takes shape.  Sometimes smooth, and other times textured by objects that I embed in the wax – all to create unique pictures.

Writing provides a way to express what I’m living in a way that connects with other hurting people. When I take a break from writing, which I need to do at times, I always feel liberated when words start to flow again.  I find myself smiling, even if crooked, at the feedback that I helped even one person’s day.

Each of these respite diverts my focus bringing me back to experiencing joy. I feel gently led from hopelessness to hope.  I become filled with hope for living and finding a way through the brambles of life.

Acoustic Neuroma – Depression and Timelines

 

Depression and Acoustic Neuromas are definitely linked – in my non-professional, experiential opinion. The same sentiment has been expressed by many others throughout the acoustic neuroma world. I don’t know if it’s because our brains have been invaded or because our lives are too often turned upside down. Regardless of the reason, I can state that depression for our world, and the world of anyone recovering from a major medical crisis, is real.

When I was in the hospital, my family and I learned that “hospital time” is often very different from “clock time.”  Frequently, the time given for appointments, procedures, and hospital releases are truly more of an estimate or recommendation than an actual time that is met.

In defense of the medical profession, there are valid reasons for delays. Critical cases pop up. Our bodies heal slower than we (and the professionals) predicted. And when a doctor spends some extra time answering my questions, I always appreciate it and think about that when delayed – perhaps someone really needed an answer and I’m happy to think my doctor took the time to answer rather than abruptly leave the room in order to be punctual.

Therefore, it shouldn’t be a surprise to us that we each have our own “acoustic neuroma recovery” timeline. Each tumor grows at a different rate – though all within a somewhat common range. Each tumor causes different symptoms – all within a family of symptoms. And each recovery from treatment takes a unique path – somewhat within the guidelines (not strict rules) of the acoustic neuroma rules of nature.

Depression is one of those paths that each person takes – ranging from mildly set-back to debilitating and clinical. We are depressed that we got a brain tumor – but grateful to be alive. We are depressed to lose our old selves and each take our own time to return to ourselves – or more commonly come to terms and acceptance of a new self. One with different limitations wrapped into an old self who remembers.

Depression is not just a feeling, but a chemical imbalance in the brain that we need to really work at to change. Again, each person has their own path – some use therapy or pharmaceuticals. Others use natural holistic approaches. It is not often that we can just think our way out of depression. It’s like getting out of a well pit without a ladder – kind of hard to impossible on our own. One misconception about depression is that we want to stay there. We really don’t.

What is helpful from those around us is acceptance and grounding. Acceptance that we are going through a rough process that nobody can shortcut for us. Acceptance that we are still the same inside but fighting a new dragon. Grounding that we aren’t being judged for having our own path. Grounding that those who surround us are walking beside us.

It took time for the brain tumor to grow. It took time for our bodies to heal and adapt. It will definitely take time for our emotions and brain chemistry to adjust. Most importantly, it sometimes takes a long time to adjust our sense of value to the world and to redefine our individual comfort zones.

Announcing!

yippeeI’ve gotten great feedback on my blog and have put together a kindle book containing many of my posts, categorized by topic – such as diagnosis, single-sided deafness, eye care, etc.

It’s all in one place as a resource for anyone who’s struggling with AN recovery or wants to better understand our journey.


 

Disability and the Stages of Grief

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stones in the sand

I’ve talked to several people who have gone from an active full time career/life to long term disability due to acoustic neuroma or other medical reasons. Through those discussions, I’ve noticed a consistent pattern. It is grief – and I’ll get to that in a minute.

Becoming fully disabled feels like giving up. It feels like failure. We accept too much responsibility and blame our “selves” for physical weakness and brokenness.

I am here to tell you that disability is not for the weak. Strength is required for acknowledgement of real limitations and to speak up for what we know we need. Perseverance is called upon to fight a tougher battle than “before.” It takes tenacity to continue to fight for goodness in life and a grateful attitude when we face long term adversity.

Disability:

  • Is not death. Disability frequently stirs a desire for ability, life, and not giving up.
  • Is a process that doesn’t end often enough with a return to ability.
  • Requires bouncing between pushing our bodies to function as fully as possible while documenting our physical limitations.
  • Brings a new appreciation for life and relationships.

Living life with a disability brings a continuing cycle of grief. Everyone has a different timetable. The actual disability and grief are not cookie-cutter experiences but bond those who live it.  Each stage takes varying lengths of time as it is repeated in various forms.

Triggers can quickly springboard us from progressing to stepping back into grief. Perhaps we inadvertently are reminded of something we used to love to do that is no longer possible. Other times we may get a glimpse, through memories, how relationships have been affected by changes in health.

I decided to “map” the well documented generic grief process to disability, and here’s my take:

 Stage One: Denial and Isolation, or “this is not happening”

  • “I just need a little more time, and I’ll beat this.  Enough already – please.”
  • “I’m embarrassed and really can’t face the world. How will I ever be in a social setting?”
  • “If I just think good thoughts a little harder my body will heal.”

Stage Two: Anger, or “stomping my foot”

  • “This is not fair!  I don’t deserve this. Stupid (fill in the blank)”
  • “I’m not comfortable with vulnerability.  I do not want to ask anyone for help!”
  • “The world is continuing without me in my prior role. I wasn’t indispensable. Really?”

Stage Three: Bargaining, or as I affectionately call it – “If Only” stage

  • “If only I ate better, my body would recover.”
  • “If only there was something I could do to make this go away.”
  • “It must be my fault, and I will be stronger from now on.”
  • “The medical world can cure anything, can’t they?  Isn’t it a science that understands everything about our bodies? If only I could find a doctor who understood my case.”

Stage Four: Depression, or “I’ll just be under this rock over here if you need me, but I’m guessing you won’t”

  • “I’m exhausted. I’ve tried everything. It’s a lost cause. Why even try to be happy?”
  • “Why continue to look for answers in the medical community to mitigate pain, tinnitus, or limitations.”

Stage Five: Acceptance, or “inhale, exhale”

  • Life sucks but I have things to do. I’ll manage my disability so that I am still aware of the joys of life.
  • “I love life and will squeeze every bit out of it that I can. I will pay to play.”

As time goes on, we appreciate being in the acceptance phase and learn to recognize it.  We’ve learned not to just cope by treading water but have adapted to living life beyond breathing.  We will have triggers that pull us back into earlier stages of the grieving process but learn to claw back to acceptance again — as quickly as we can

Disability is not giving up but the beginning of a new journey.

 

 

What’s In a Smile?

cheesecake

Recently, I was dining in a buffet setting. People were coming and going between all the food options. The dessert table was particularly busy. As I approached, I saw what appeared to be a bit of a commotion. Not a fight or a brawl. What I saw was joy. I experienced a man living in the moment.

An employee serving cheesecake had facial palsy that immobilized one side of his face. Something that I would not have noticed or understood in the past. However, knowing what I know about living without the full use of facial muscle, I tuned into the picture before me.

I was captivated because he showed no sign of being self-conscious. He was not feeling sorry for himself. His infectious smile took over his face. His eyes, laugh, and broad “half” smile were pulling customers in.

On each side of him, servers dished up other desserts. The servers were pleasant (and the desserts too), but I don’t remember them as individuals. They weren’t pulling people in with a contagious enthusiasm for one particular dessert. Their smiles paled in comparison to his.

People responded to this one man. They chose his dessert over others – not for a lack of choices but due to his inviting nature. He was delighted to interact with each person and proudly dished out what I would define as oversized portions. It wasn’t about whatever he had gone through to become facially paralyzed. It was about the moment he lived in and the joy of interaction.

I won’t soon forget the power of one man’s smile.

Brains That Share Space With Brain Tumors

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So many reasons to live, so we do. So many reasons to give up, but we don’t. Sharing space in your head with a brain tumor – even if it’s been removed – changes who we are.

Getting the diagnosis that there is an alien inside what we perceived as an solid body part that’s already filled to capacity begins the change. Living through treatment that penetrates that impenetrable cranium tests our will to live in ways that we never imagined. Living through treatment is what is implied – living and not dying.

Recovering from treatment tests our longevity and patience. There are no quick answers. Healing may be stunted by limitations of our bodies to regenerate parts that were not meant to regenerate. Parts that were slowly damaged, unknown to us, by that selfish alien. A tumor that doesn’t care what it pushes around or damages to find space as it grows – until it demands to be recognized.

Fatigue can be overwhelming. Our minds are foggy until the sleep that our brains demand is paid in ransom – regardless of how we wanted to spend a day. Fatigue helps us prioritize and give effort to only what is important.

Depression can come – and go – in an instant. As suddenly as a balloon flying high and free and then popped, deflated and fallen to earth. The culprit could be a new diagnosis, a new drug that doesn’t work, or a hope that is dashed. When depression lets up, even for a short time, joy is more joyful and fun is more fun.

Balance is a challenge. While the opposite side typically takes over, it requires more time to catch our bodies when tilted or turned. Balance teaches us to know our body and be deliberate in our movements.

Pain may be constant, unrelenting. Not a welcome giggly friend, but a constant companion. The lack of pain can provide a gleeful relief that is recognized and savored.

Single-sided deafness is puzzling. How can noisy settings be louder when only one ear works? Single sided deafness – good ear down – shuts out the world for a period of time leaving only the frustrating yet fascinating sounds of tinnitus.

Facial paralysis is something we learn is a journey, not a point in time when it ends. As we learn to accept our inability to express ourselves, our faces either stay flaccid or morph and feel pain. Facial paralysis is something that teaches us the value of relationships and the value of what’s inside.

With the miracles of today’s medical science, it slowly dawns on us that while we look for a fix, the medical world can only search for a band aid to cover ongoing, long-term issues. With the miracles of today’s medical science, we recognize we are alive and survived.

We are like leaves. Some of us are strong and survive growing, blowing, and falling from trees. Some even stay pristine as fall leaves being walked on. We absorb whatever life throws at us. Others are brittle and crumble despite all attempts to hang on. We don’t know what type of leaf we are until we fall or get blown down.

Life is life and we cherish it. Each day when we touch nature or another person emotionally, or with a big hug – it is another day we live, love, and breathe. Even as brains share space with the unknown, our hearts share living.

 

Acoustic Neuroma – Common misconceptions about facial paralysis

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I will start with a disclaimer. Some people recover fully from short term facial paralysis and return to a fully functioning face. However, there are many of “us” who continue to have issues. This is for us.

I thought I’d spend some time addressing common misconceptions about facial paralysis.

“Facial Paralysis Goes Away” – it doesn’t in many cases. There is some improvement at times, but not always. There are degrees of improvement and each person is different.

“Healing is a one-time thing” – Faces that have some recovery commonly continue to change for years.

“Facial Therapy is like lifting weights” – No. It isn’t. Facial therapy focuses on tiny movements. You can “bully” your biceps into being bigger by lifting weights, but there is no such thing with the face. Trying to smile when your face is paralyzed is not going to help. (Although it won’t stop us from trying when we look in the mirror)  What is good is to focus on how the normal side feels and try to emulate that feeling and movement. (focus on what is working rather than what is not)

“It just comes back” – well, that is true for some people, and that is wonderful. However, for many it either doesn’t return to normal or returns partially with abnormalities (see next point)

“When it comes back, it will be back to the good old days” – No. While the brain is doing everything possible to get the face to move, commonly the fibers heal wrong. That causes Synkinesis, which is the result of mis-wiring. Picture a cable with many wires in it. If you cut it and then put it back together, think about how difficult it would be to line up each wire perfectly and match it with its prior other half. The odds are not good.

“Botox paralyses muscles, why would you do that to what little has healed?” – Botox can be very helpful to those with Synkinesis. Full paralysis of the face is more relaxed because there is no communication between the brain and the facial muscles. However, as the face begins to heal – the result of regeneration of the nerve from the point of injury to the ends – the brain is confused by Synkinesis. Spasms, tightness, and improper movements can be quite uncomfortable. (Heat also helps)

“Botox is a crutch” – for me, Botox was a reward of relief after months and months – years – of working through everything possible to figure out what was working, what was tightened in spasm, and what truly wasn’t working.

“Botox will retrain the brain” – Botox can do one of three things to your brain (or a combination).

1 – Allow the brain to take a break and forget improper movements. Ideally, it forgets and when the Botox wears off, the face is functioning more normally. (that is a lucky person).

2 – The brain is given a break, and over time will forget some improper movements because they haven’t been happening while deadened. (it does happen).

3 – I believe most commonly, (my opinion and experience) Botox will become a normal part of life. The location of each shot (many at a time) will change over time, but will continue to make significant improvement and relief.

“Anyone can do your Botox” – Botox should be done by a professional who is well trained in facial paralysis issues. It is not a beauty treatment. The goal is not to immobilize the good side of the face to match the placid side. It is to help the damaged side gain a balance between using what has healed correctly and minimizing what has healed incorrectly.

“At least you have no pain” – facial paralysis frequently included tightness, spasms, facial pain, and increased head pain.

“We don’t want pictures!”  We do want to participate in capturing life’s precious moments. However, we want advance warning so we can position our face to avoid very odd snapshots that do happen.

I’ve gotten used to my crooked smile. No, I don’t like it, but it has helped me prioritize what is important in life. Because our faces typically move minimally in normal life, it isn’t always as noticeable as we see in our minds. The exception to that is the exaggerated huge smile that everyone has in pictures that we can no longer do. And that’s ok. Life is imperfect, right?  Everyone has something. Facial paralysis just happens to be one of the more emotionally and socially difficult.

Go crooked smiles. . . and remember. . . When we smile internally, the beam is noticeable on the outside – Twinkling eyes, happy body language, half a smile that draws the eye. Facial paralysis is sometimes about what is working instead of what’s not.

Synkinesis is the result from miswiring of nerves after trauma. This result is manifested through involuntary muscular movements accompanying voluntary movements. For example, voluntary smiling will induce an involuntary contraction of the eye muscles causing the eye to squint when the subject smiles. (https://en.wikipedia.org/wiki/Synkinesis)