Three Tooth Tuesday.

My New England forebears had the good sense to be farmers and not whalers, but I have heard the term “Nantucket Sleighride”. The metaphor of being in a small boat being dragged at overwhelming speed across the open ocean by a powerful force, doing everything in one’s power to hold on until such time as you can prevail, came to mind this morning. The harpoon has been sunk, and we are off!

Yesterday afternoon I had a session at Seattle Special Care Dentistry, the local hot-spot for hip head-and-neck cancer patients about to get radiation. As we learned years ago when we visited MD Anderson for a consultation on my 2004 cancer, radiation to the jaw raises a host of issues.

Most of us don’t quite get how the jaw and the teeth are living tissues, with blood flowing through them, and growing cells and everything. There is an elaborate system of micro-vessels and cellular interaction going on all the time that keeps things healthy. Radiation does very, very bad things to that.

Radiation will damage the blood flow through the bone, so that any future wounds, like if you needed to extract a tooth, may not heal. Also, while I am proud of my big vocabulary, I really would prefer to not have encountered the word “osteoradionecrosis”, basically the bone dying as a result of the radiation. Ick. To make a long story short, before they zap you, they need to look skeptically at any of your teeth that may need treatment for decay in the future, and if any look too bad, they need to come out while your body still has time and ability to heal from the wound.

For me, there were three. One on the lower left, where a previous crown had broken off and given me the excuse to have a dentist take a look at the sore spot in the back of my mouth (which is when we officially discovered the cancer.) The other two are the rear molars on the right side top and bottom, which will be directly in the beam. (As it turns out, I don’t use those teeth much anyway, since the 2004 surgery left that part of my mouth numb, and I don’t chew much on that side.)

I have never liked going to the dentist. My early dental experiences were as a child in the 60s, when my dentist, Dr. Milton, was an old man who had been and was still my father’s dentist. God knows when his training had been, but let’s just say it’s a good thing dentistry has evolved rapidly since Dr. Milton’s day. By the time I was an adult in Seattle, I was able to find an office with a staff and dentist I really like, who use state-of-the-art equipment and techniques.

Still, I don’t like having people working inside my mouth. And consciously knowing that the Special Care Dentistry people are Seattle’s top choice for this kind of work was only a small consolation. I was really afraid of yesterday’s procedure. I knew I was going to be sedated, but not completely out, and it was unclear to me how awake I was going to be, and how much pain or conscious participation was going to be called for.

In the end, all went well. In the waiting room, after being of sound mind to sign the consent form, I dissolved two pills under my tongue. 20 minutes later they were kicking in, and I was able to walk to the chair and get settled, and they gave me a nasal cannula with nitrous oxide. I remember them injecting anesthetic into my gums, and a few parts of the process later on, mostly them telling me to take more deep breaths of the nitrous, and it was done. I’m happy to say it was far less traumatic than I had feared.

Still, I did just have three teeth pulled. There was a fair amount of bloody gauze involved and I have an ice pack on my cheek as I type this. I’ve dialed up the pain meds. And, I do remember all the instructions about monitoring for infection or other post-surgical complications, which they carefully gave me before I was allowed to take my pills in the waiting room. So far, though, so good.

Which means I should be in good shape for this afternoon’s adventure, the PICC line insertion!


The “Just The Facts, Ma’am” Post.

Kimberly and I have been working on well-written and highly informative blog posts to bring you up to date. But they are just not coming together, and given the fact that the weather in Seattle this weekend is amazingly beautiful, they likely won’t be ready soon. But we’ve gone way, way too long without an update, so here’s a quick and dirty summary of the news since the last post.

Kimberly’s father, Tom McKittrick, died. So we’ve both spent time in Houston dealing with that.

When we got back, we had the appointments with med-onc and rad-onc. I also had a PET scan. The PET scan showed that we have three cats and six chickens. (Sorry, couldn’t resist.) Actually, the PET results were that the only active cancer in my body is the stuff we know about in the oral cavity. No need to worry about my lungs and/or any lymph nodes in my neck.

My case was discussed at the UWMC Tumor Board, and the plan is to treat me with a combination of modern, high-tech, computer-guided radiation and chemotherapy, which, while grueling, will have less chance of leaving me with further permanent impairment in speech and swallowing. (I say permanent, because I’ll be getting a feeding tube, because the rads and the chemo will temporarily trash my mucous tissues in my mouth. I did say grueling, right?)

Treatment will last 8 weeks, with a weekly dose of drug and doses of radiation 5 days a week. Before we can begin, there will need to be multiple appointments to do advance dental work including likely extractions, to place the feeding tube, and to get the PICC line that they’ll use for the injections. (The aluminum-foil lining (not quite silver) is that we’ll be able to go on the quick trip to NYC I was hoping to make this month, before I’m too deep into the battle.)

More details and descriptions to follow, but not right away.

Yesterday was such a gorgeous and perfect day in Seattle that it almost made me cry. We have really needed a break, and we were given one. Kimberly and I had lunch outdoors at the Fisherman’s Terminal, and went for a long walk through the neighborhood, and drank delicious limonadas on the patio of our local Cuban-influenced café next to the bookstore. This is the kind of weather that makes me happy to be outside giving the chicken coop its spring cleaning. I am quite consciously and enthusiastically enjoying the gift of these days, storing them up to balance the very crappy ones I know are just a few weeks down the road.