Why am I having surgery, you ask? Welp, I found out in August that I have a patch of oral squamous cell cancer on my lower left gum. Let me say first that it is eminently treatable, I have a top rate team taking care of me, I have an excellent prognosis of recovery, and nobody should be freaking about about this. I’ve got it handled.
The Background:
In 2001 my dentist put a crown on a molar in my lower left jaw (Molar 19 if you grok dentistspeak) that had been root canal-ed in Sweden. Shortly after the crown was installed a small patch of inflammation appeared on the gum directly under the crown. The dentist checked it, didn’t see anything concerning, told me to use salt water rinses, and said that he would monitor it.
The inflammation continued over the next twenty years, never really hurting or anything, just there. In July 2021 I had the bicuspid next to the molar crowned. The inflammation began to get a bit puffy. I was supposed to have it biopsied but the periodontist I was sent to … let’s just say that he didn’t inspire confidence. Fast forward to this spring’s dental cleaning when my dentist said, “This is growing. You really need to get this biopsied—I’m making an appointment for you with an oral surgeon.” The OS turned out to be the same one who took out Ramón’s wisdom teeth so I knew he was good.
I went there, he looked at the inflammation and opined that I was having some kind of reaction to the dental cement in the crowns, but that we’d take samples and send them off to pathology anyway just to confirm. He numbed me up, snipped out five bits of gum, and sent me on my way.
A week later, he called. To his shock, it was oral squamous cell cancer, the most common form of oral cancer. Since I don’t smoke at all or use any tobacco products he really didn’t expect this diagnosis. But it needed to come out tout de suite so my August and September suddenly became filled with medical visits.
The Medical Visits:
The Oncology Surgeon: Doctor E (nice guy, very competent) x-rayed my jaw, palpated my neck (nobody, by the way, has been able to feel any swollen lymph nodes, nothing has ever shown up on my blood tests, and all the x-rays of my teeth including the ones taken at my dentist show no sign of cancer in the bone), scoped my nose and throat, and laid out a surgical plan. He would surgically remove the two molars and two bicuspids on my lower left jaw, remove the cancerous gum tissue and a strip of jawbone to make sure nothing had gotten in there, do some reconstruction on my jawbone, then wrap everything up by doing a biopsy on the lymph nodes under that side of the jaw. Everything would be sent off to pathology, at which point it would be decided whether or not I needed radiation, chemo, both, or neither. In about six months or so I could be fitted with a partial denture or implants, depending on how well the jawbone healed.
Pre-surgery physical: That was done at my GP’s office and was a standard physical with an additional EKG and chest x-ray. Everything came back okay (I have a little bit of opacity at the bottom of my lungs, but so do 90% of people in the United States who had COVID so…) and I was cleared for surgery.
The Radiation Oncologist: Dr. D (very nice guy, also extremely competent, with a great scheduler and nurse) took my history, palpated my neck, and felt around in my mouth. He told me I would most likely need radiation and what I could expect from it. Treatment would take six weeks; every week day I would drive to their office where I’d lie on a table and a mask that had been fitted to my face would hold me in place while I got hit with radiation. I could expect loss of taste, a drop in saliva production, and increased soreness and pain in my jaw and throat as the treatments proceeded. It would become painful to swallow during the second half of the treatments and I’d probably go on liquids, at which point I would need to make sure that I was taking in 2000 calories a day as the pain and lack of taste would affect my interest in eating. That being said, they have good painkillers that are very effective for this sort of thing, and I have a Ninja blender that could turn a brick into soup.
Long term effects would be a permanent drop in my saliva production (he said I’d probably need to have a water bottle next to my bed, which I already do), but it wouldn’t affect my ability to swallow or speak, and my sense of taste would eventually come back. I can live with that.
The Chemotherapy Oncologist: Dr. T (also a very nice guy—really, everyone I met at the cancer center was a doll) had spent a rotation at the University of Chicago Medical Center so we commiserated on Chicago winters. He didn’t think that I would need chemo, but it would depend on the PET scan and the path results of the excised tissue. We talked a little bit about the effects of chemo and what I could expect from that. He also asked me when I was supposed to get the PET scan. When I said it was two weeks out he said, “That’s unacceptable,” made some calls, and got it for me the next morning.
The PET-CT scan: I showed up after not eating anything since midnight, got a shot of radioactive glucose, waited for an hour for it to make the rounds of my body, then spent a half hour with my arms over my head while the scanner did its thing. A PET scan finds areas of high metabolic activity, which can include cancer, incisions, infections, and recent bone breaks. Unsurprisingly, it picked up on some low-level activity in my jaw, more apparent on the side with the cancer and much spottier on the other side. The doctor who wrote the report said that the other side might be due to an infection; since I had an URI/sinus infection complete with sore throat, coughing, etc. at the time, that could explain it. Oh, and apparently I have a large mass on my right ovary, but it didn’t react to the tracer so it’s either a cyst or a fibroid. Quelle surprise, said the woman with PCOS. I’ll get that dealt with once the jaw is done.
The Surgery:
The surgery was scheduled to happen on last Monday but there was a scheduling miscommunication between my surgeon’s office and the hospital so the event has been moved to 7:30 AM on Monday, October 9. Once I’m out of surgery I’ll spend between 2-5 days in the hospital (I’m hoping for two but it’ll be whatever they recommend), then go home to recuperate and heal for 2-3 weeks before they start the radiation and/or chemo.
Pretty much every medical professional I have spoken to has gone out of their way to reassure me that they can handle this and I have an excellent prognosis. I choose to believe them, so I’ve been doing my best not to panic. I probably won’t be bringing my laptop to the hospital but I’ll load my login details into my phone and hopefully I can update you tomorrow. Think good thoughts for me, please, and if you would like to support me in a more material way you can always join my Patreon. The most basic tier gets a free short story from me every month for $3, plus updates on my work and sneak peeks at the current WIP. Higher tiers will get bonus material, a free ebook, print book, or hardcover book, and all proceeds will go towards paying off my medical bills. And if you can’t swing that, totally cool—I will be happy with prayers, healing vibes, and any good thoughts you can shoot my way.
So I just got back from an appointment with my chemo oncologist. According to the path results my squamous cell cancer is Stage Two and the surgeon got everything. There is no evidence of cancer in the jawbone, nerves, or lymph nodes; apparently the tumor was wide (35mm) but only 2mm deep, so it was pretty much surface only. Dr. T says I don’t need chemo and he strongly doubts I need radiation, either, but I need to confirm that with my radiation oncologist next week.
Which is good because I need to start hauling ass on High Tide since we’ll be on the road Saturday which knocks out one writing day, and I have an unavoidable event next week that will knock out at least one other writing day as well, boo. But I’m past the 1/3 point and on my way to the halfway point, so we’ll just have to see what we can see. And yeah, ignore that deadline—it was set before I knew we’d be coming on this trip. I’m aiming to finish the first draft by 10/20/23 or so, with a release on 11/21/23.
So my first ZoeBub/Stuff Your Kindle/eReader event is done, and I had over 8,800 copies of Crystal Shard downloaded, plus a significant handful of Empress of Storms.
Nicola Cameron Writes 