So, Yeah, I Think I'm So Smart.....

I was diagnosed with Multiple Myeloma a little over nine years ago.  My prognosis was not awesome.  My MM sub-type was IgA, which at the time was known to be less responsive to the drug therapies for MM overall.  Most MM cases were IgG, only 20% or so were IgA.  The IgG patients got better and longer lasting results from chemo and transplants.  At first, I didn't really consider what that could mean.  I was much younger than the average patient.  I had no co-morbidities.  I had good health insurance.  I was in Boston, the center of the known universe!  So, I would take some pills, have a transplant and be on my way.

But of course, that's not what happened.  I am refractory.  That means it's harder to push me into remission and I don't stay as long.  There is no cure for anyone with MM.  Sure people might get long remissions, but no one is cured.  Eventually, if you don't die of something else along the way, it always comes back.  I had one remission after my 2011 stem cell transplant that lasted 21 months or so.  And I may be in one right now.  But the only way to confirm it is a long drawn out test and I have other things rolling.  This test is way down on my "To-Do" list.  Mostly because it's academic.  If I am in remission, Dr. Miller isn't going to let me stop chemo.  I'm already on the lowest possible dose of Pomalyst and it's not good to jump on and off.  And if I'm not in remission, this dose keeps my numbers in control.  So, I want to know, but I don't *need* to know.

So, why am I talking about all this stuff now?  Well, pretty much every decision I have made in the last nine years and three months has been based on this diagnosis, this treatment, doctor's appointments, etc.  And I am a reactionary person.  Some people see their future a few steps ahead.  I never really did.  Consequently, I am always reacting to stuff instead of getting ahead of *it*.  Cause I never see *it* coming.  As the logic goes elsewhere, I am always fighting the last war.

One of those decisions was about what I would spend on myself.  What was worth it, so to speak.  I was always really big on the dentist.  My parents raised me to think it was important.  I had frequent dental care, braces, retainers, etc.  As an adult I remember spending more than a thousand dollars for a root canal, crown and a few fillings in less than three months.  But you want to keep your teeth forever!  My Dad is 83 and has all his own teeth.  I wanted to be like that.  And preparation for the transplant meant a few dental visits.  Not the least of which was a visit where they tested my ability to make saliva, lol.  Chewing wax and drooling in a cup.  I was diagnosed as having "dry mouth" which makes you more susceptible to cavities.

Anyway, one of the bad habits I acquired after diagnosis was clenching my jaw and grinding my teeth in my sleep.  Then one broke.  Then another.  I didn't have dental coverage and I remembered how much I had spent on that root canal and crown.  So I put off doing anything.  There was always something or someone else to spend that money on.  How ridiculous would it be for someone with such a poor prognosis to pour good money into her teeth?  So I just rolled along.

Of course now I know that Dr. Miller and his team are so good, and God was going to let me stick around to meet my grandson.  So now I am way past the five year mark.

And because I was so smart not pouring that money into my mouth, I now have a mess on my hands!  If I had gone to a dentist when the first one broke, I would have learned what I found out a few months ago - I can't have root canals.  One of the elements of my treatment plan is a two hour (give or take) infusion of pamidronate every other month.  One of the risks of treating with pamidronate is osteonecrosis of the jaw.  That's where the bone dies and the treatment for that is removal of the bone.

They. Cut. Out. The. Diseased. Part. Of. The. Jaw. Like amputating a leg before the gangrene spreads.  Like William Holden had to in "The Horse Soldiers" while John Wayne lost his mind.

This risk increases if you have; cancer - check; treat with chemo - check; treat with steroids - check; and require removal of a tooth, you know....like in a root canal.

So, I learned all that right after my diagnosis when I was in "Research mode" studying everything about Multiple Myeloma.  And I dismissed it from my "here-in-the-moment" front part if my brain.  I tucked it away in a little box in my mind and put it in storage so to speak.

The only reason I finally went to the dentist was the thing that always gets me off my ass - pain.  One broken tooth became infected and I hustled on in to Tufts Dental School around the corner from all my other Tufts/NEMC peeps.  If something causes pain with all the other stuff I am popping, you better believe I am "on the run with a burger on a bun" as the saying goes.

Part of the reason so many decisions are driven by my diagnosis is because my diagnosis impacts so many parts of my life.  When I tell people I have Multiple Myeloma, they generally have one of two reactions - 1) "What's that?" or 2) "Oh." followed by looking at the floor.  But sometimes it's even better and "Oh" is followed by a hasty retreat.  That's what I got when I got my butt into the first chair on this dental journey I am on.  I sit down, fold up my glasses and say "By the way, I have Multiple Myeloma.  It's an auto-immune blood cancer.".  The dental student (Tuft's Dental School, so students, but that's who treated me before the transplant and it's all heavily supervised) says "Oh." and gets up and leaves.  She comes back with the supervising dentist who is clearly trying to calm the student.  The supervising dentist repeats my diagnosis back to me and asks "What about bisphosphonates?"  So I'm like "Yeah, at least every other month since December 31, 2008."  I remember that clearly because my first bisphosphonate was Zometa and I had a bad reaction and it was New Year's Eve.

And typing that just now makes me laugh and cry because it was Frankie who found me and helped me and made me laugh about it.

So, anyway, they leave and talk to people in the hall.  I could hear some of it.  Basically they decided they could do nothing for me.  I was already on anti-biotics from the oncologist and the infection was nearly gone.  The got me an appointment to have it pulled with "Oral Surgery" the next day.

I went back the next day and met the oral surgeon and basically replayed the previous day.  Once they found out about the Multiple Myeloma and the pamidronate they tell me that they can't pull my tooth.  Everyone is going to have to conference.  Who is my oncologist?  What kind of bisphosphonate?  Who is my primary?  Where?  How often?  And then they say the word that opens up a little box of information in my oh so smart brain....way down in the back.....and I freak the fuck out!  Osteonecrosis.  I know exactly what that is.  And how it's treated and I have seen pictures and they are exploding like fireworks in my brain.  Mind you I am not showing this or saying anything except - "Ok."  "Ok."  They are telling me that I will need to see endodontics.  "Ok."  They are going to call someone right now.  "Ok."  Meanwhile I am putting up the arm on the chair and getting my bag and my glasses because I have to get the hell out of there.

Eventually I calmed down.  It took days, lol.  But the one thing I am smart about is who my friends are - The other half of Team M and My Marine kept me from jumping off a cliff.  It's all being handled.  It's all going to be great and I am not going to have to wear a burqa to cover up the fact that I am missing part of my jaw.  Sometimes it's hard to have positive thoughts.  But I have friends.  And I have Little Frankie.  Nothing distracts like a three and half year old shouting "Look at me Grandma!" 50 times.  And Emma.  Nothing comforts like holding a one year old fresh out of her bath in her jammies.

And finally, if you are reading this - go to the dentist!