My dental adventure

Two weeks ago I had to make a return visit to the dentist. Going to the dentist when you have cancer is a complicated business – the visit has to take place 1-4 days before a chemotherapy session, and must be preceded by blood tests at Sloan-Kettering, both requirements presumably meant to insure that my immune system and general health are up to having dental work done. I’d done all that a few weeks earlier, because of a pain somewhere in my upper right molars. That visit produced a possible quick fix: a filling fell out with a little nudge from the dentist, so she put it back in with fresh cement or glue. But she told me that the tooth with the loose filling was one back from the tooth I’d thought was the most painful – so I knew I might need to return.

After a few days, the pain in my upper right molars returned. It wasn’t very bad, but it was there. So I did the pre-dentist steps again and returned to the dentist for another look. I went back on a Tuesday, the day before my scheduled Wednesday chemotherapy. This time the dentist concluded, perhaps with the aid of a new x-ray, that the problem was in a tooth that long ago had been the object of root canal work. So she sent me off to a root canal specialist. I left my dentist’s office at about 8:15 AM and walked about a mile and a half north to the root-canal specialist, who (amazingly) had given me an appointment at 8:45.

The root canal specialist gave me another x-ray. This one I’d never had before – it was a stereoscopic view of my jaw. The technology was interesting, but the results weren’t good: it turned out I had a quite substantial infection in the tooth with the old root-canal, and that the tooth itself appeared to have cracked. That meant that a root canal wouldn’t work because the tooth was likely to disintegrate. And that meant I needed to have the tooth pulled. They referred me on to an oral surgeon, who gave me an appointment for 11:30 that morning. They also charged me only the amount my insurance would pay for the visit – another courtesy.

I walked back south about half a mile to the oral surgeon’s office. I was way early for my 11:30 appointment, but while I waited I called my oncologist’s office to tell them what was happening. As it turned out, I was called in to the oral surgeon early, a little before 11. The oral surgeon was ready to go. My recollection (rather a lot happened quickly, so I may not be recalling perfectly, but this is what I think happened) is that he understood I was a cancer patient, and so he called the oncologist’s office too. He came back and said that they’d said he could go ahead as long as I wasn’t on blood thinners. But I am on a blood thinner, Xarelto, so I told him that, and he called the oncologist again. This time he came back and said that based on his conversation with the office we could go ahead; he himself didn’t feel Xarelto posed a big problem.

And so we started. He gave me two injections of anesthetic. At that point my cellphone began to buzz. It was in my shirt pocket and, though I felt it was a bit improper, I decided to check who it was – and it was Sloan-Kettering. I answered the phone and the nurse from the oncologist’s office was on the line; she told me that I needed to be off the Xarelto for two days before having my tooth removed. (Pulling a tooth involves bleeding; Xarelto increases the risk of uncontrolled bleeding.) I said that that was the opposite of what the oral surgeon had understood, and gave the phone to him. He and the nurse then talked, and the result was that my tooth stayed in that day.

By this time I was upset. Looking back I think I was somewhat unnerved by the quick escalation I’d already experienced, from a visit to my regular dentist to a trip to the root-canal specialist and then on to the oral surgeon. But I was also unhappy about the fact that the oral surgeon had already started anesthetizing me when the nurse called me. So then I called the oncologist’s office again, from the oral surgeon’s chair, and insisted on getting entirely clear what was going to happen next. The nurse called back and told me they could move my chemo appointment from the following day, Wednesday, to Friday. This last-minute adjustment, which I appreciated, meant that I could stop taking the Xarelto and be off it for two days before the oral surgeon pulled the tooth on Thursday (and that’s what we did; at their instruction I also consulted the Sloan-Kettering physician who deals with my blood thinner prescription, who confirmed that two days off Xarelto was what I needed). In the process I spoke sharply to the nurse about not having been called back more quickly earlier that morning, and she spoke sharply to me in return; in hindsight I wasn’t pleased with either of our reactions – and I hope I didn’t make them feel I’m a “bad patient.”

Anyway, on the Thursday I had my tooth pulled. (I’d never had a tooth pulled before, and I thought it was all pretty alarming – lots of drilling and pulling, though no pain at all – but it really went fine. And in yet another courtesy, the oral surgeon’s office charged me only what insurance would cover.) Then on Friday morning I had chemo; the oncologist’s office had arranged for the appointment to start at 7 AM at my request, so that I’d be done in time for what I had scheduled for Friday afternoon. Chemotherapy went quickly and smoothly, and I was at New York Law School by early afternoon. There I was part of the opening session of a conference I’d been working on for most of the school year. The conference continued through Saturday and half of Sunday, and I was there, sometimes chairing or facilitating sessions, throughout. So now I know that I have the strength for dental surgery, chemo and a 2-3 day conference all in a row – actually a happy ending to my dental adventure.