Paul's Heart

Life As A Dad, And A Survivor

When You Are Prepared For The Unexpected

I have a very exciting weekend planned. But somewhere in the cards or the universe, there were other plans. In my life, at least the last four decades or so, that is the way it has gone anyway. So I got a visit from “Mr. Murphy” last evening. You know Mr. Murphy, who states his law that “if something can go wrong it will?”

I had just completed packing for a visit to my daughters this weekend. I was relaxing before turning in for the night, enjoying a light snack of some Edy’s vanilla ice cream. About half-way through with my tasty treat, I felt a small “nugget” of some sort, that I thought might have just been a crystalized piece of the ice cream as I keep my freezer a bit colder than many. As my treat swished from one side of my mouth to the other, my teeth hit that “nugget” again. Clearly, it should have been thawed out, and softer. I know I was eating plain vanilla so it could not be a nut or a chocolate chip, which can be a disaster for teeth when frozen. It did not make sense to me. And then it hit me.

Being careful not to swallow the portion currently in my mouth, I began to sweep my upper jaw with my tongue from left to right. Nothing. I lowered my tongue to the bottom jaw, and began to sweep from right to left. Instinctively, or perhaps in apprehension of what I felt I was about to discover, the pace of the lower sweep was much slower, as if I could prevent what I was about to discover. Half way around the lower jaw, so far so good. Only about seven more teeth to go, then I would spit out what was in my mouth to see what foreign object was in my ice cream. Six, five, four, three… nothing yet, maybe my mind had tricked me into thinking the worst… two, DAMMIT!!!!!!!

Not the first time that I have ever broken a tooth (a reason that I will get into shortly), I knew what had happened, though I could not figure how, as I was only eating ice cream. This particular tooth and I have a long history with each other (an explanation that I will also get into shortly). With this trip coming up tomorrow, I did not have time to waste. I needed to get the tooth dealt with before I got on my plane. I had to get an appointment today. There was no other choice.

As I said, this is not the first time that I have ever broken a tooth. In fact, it is quite common for me, being a long term cancer survivor of thirty-three years, an issue created by the treatments for my Hodgkin’s Lymphoma. The first time occurred back in 2008 soon after I had my emergency bypass surgery. One of the first things brought up to any heart patient, not just a cancer survivor cardiac patient, is the need to prevent this type of situation to develop an infection. It is very common for heart disease to be discovered by a dentist, as bacteria being dealt with during cleanings, can all too easily enter the blood stream and go right for the heart. So, with that, I learned that when this situation would occur, it was urgent that I prevent any opportunity for infection, and get the tooth dealt with right away. Unfortunately, dental bills are expensive enough when you do not have dental insurance, so really anything more than a cleaning or cavity being filled was going to be out of my price range. The recommendation by the dentist, was a procedure called a “crown,” simply a replica replacement of the tooth. This option however was way out of my budget. The only other certain choice, was to pull the tooth, which I did not want to happen. After a lengthy discussion, my dentist had one more thought. She offered no guarantee that it would even work, let alone last. But she was willing to give it a try, if I was willing to allow it. She would restore the tooth, damaged probably up to 85% using filling material. The only remnant left of the original tooth, would be the outer wall of enamel, and the inside wall of enamel. Her hopes would be that it would last at minimum, maybe two or three years.

To the surprise of my dentist with each subsequent visit, the tooth still held for almost fifteen years. That’s right, this tooth finally decided it could not last any longer, the inside wall of enamel had broken off from the filling, yesterday.

Having already had the doomsday conversation with my dentist about this dreadful day, I already knew there would be only one option available, extraction, pulling what was left of the tooth. With my flight leaving tomorrow, and several factors to consider, a rather important one of being on blood thinners, and needing time to stop taking the blood thinner and needing the tooth pulled, I had only a small window to get this done, this morning.

As I said, this is not the first time that I am dealing with a tooth having to come out. This is actually my fifth tooth, fortunately, all unseen to anyone not going spellunking (cave exploring) directly into my mouth. More importantly, because of my complicated health history, this type of procedure needed to be done by someone with knowledge and experience of radiation and chemotherapy damage, or, be willing to to listen to the information I had for them about my health.

The above three photos are from a file on potential late side effects for various treatments as compiled by oncologists of the Childrens Oncology Group, who created these Survivorship Guidelines. This document is nearly 300 pages long, so all I needed to do, was pull the pages that pertained to my current crisis and bring them with me. I did this only for the first visit. He knew what to do with me every other time this happened.

But there was one more step in the procedure he needs to perform while doing an extraction on me, and it is vital for my jaw to heal. Because radiation has caused the damage that it has, the jaw was likely to have difficulty healing. For many, hyperbaric treatments may be prescribed to increase oxygen to enhance healing. That is a problem for some cancer survivors, like me. Having received the drug Bleomycin with my chemo, I cannot have hyperbaric treatments, due to something called “bleotoxicity,” a different discussion on a separate post. The surgeon explained a procedure available called “PRP”, protein rich plasma being injected into the empty space where the tooth once was, prior to closing up the hole. Blood is drawn, and spun in a centrifuge, leaving the plasma. I have now gone through this several times, all successful, and with no complications in healing. An antibiotic mouthwash for the next two weeks, and I will be good to go.

I knew what had to be done, that it could be done, and I had no time for anything else. There was one problem, the surgeon. Dentists do not like pulling teeth if they do not have to for multiple reasons. But he is a surgeon, not a dentist. Realizing I have lost a number of teeth (common for us long term survivors), he felt this was one time, I should consider fixing the tooth, with a crown. If I do say so, he offered multiple risks to dissuade my decision . I explained the history of this tooth to him, and that my dentist said, the tooth would not be fixable once the filling no longer held. With the Novacaine working, the surgeon went to work. In the end, everything went as expected with a final comment from the good doctor. “In hindsight, this was the right call. The tooth just crumbled with each attempt to extract it. A crown would not have been possible.” Had I listened to him, I would be stuck with this until I returned home.

And so, I packed before my appointment, all I needed to do, was chill the rest of today, then head to the airport tomorrow. The bleeding has stopped and the pain is lessening, and I can look forward to a wonderful weekend with my daughters. My diet will not be as it normally would be, unable to chew anything hard or chewy so I do not risk the stitches. But all the better excuse to have more ice cream. Did I just end this post that way?

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