It Might Get Messy

The human skeletal system is a multitasking monster. Think about it. It fights gravity for you as a passively functional infrastructure. It anchors your muscles so you can breathe, play chess, and when you were younger, hammer a dynamite topspin backhand with that tightly strung T3000. It also massively vascularized—packed with blood vessels. So much so that if it is impossible for some reason to get an intravenous drip into your peripheral circulatory system, next option is intraosseous, pumping whatever you need into the circulatory system via your bones. Your skeletal marrow manufactures the red blood cells on which your entire aerobic physiology depends, does the quality analysis on the older cells, and swaps them out as needed. 


The latter function means your marrow is intensely metabolically active. Which, as we discussed last year when I being hammered by the twice daily radiation makes it especially vulnerable. 


To get the particle beams focused on my tumor, one vector was through my left lower jaw. That’s why they pulled so many teeth before starting my treatment—weak teeth die in place and rot away when they’re radiation poisoned. It turns out a very similar process of osteonecrosis (bone death) can occur in the jawbone itself. 


And that’s where I found myself this week. That persistent pain “under my tongue” isn’t really in my tongue at all. It’s at the base of my mandible. A wide swath of the jaw in that vicinity was severely damaged by the radiation. That damage accrued to both the covering soft tissue and the metabolically active bone itself—the blood vessels and marrow. What that damage means is that there’s no good way for my immune system to protect that area—no way to get white blood cells, antimicrobial proteins, and inflammatory responses in place without a functional circulatory component. So now I have a nasty, nasty infection in my jawbone.


Last week, the dentist looked at the exposed bone, diagnosed the infection, and put me on both a systemic and a topical antibiotic. A couple days later, a piece of my jaw bone broke free from its decomposing moorings and rolled around in my mouth. I retrieved it and stuck it in a jar. Photo below.

After the hunk of bone broke off, I noticed increased pain in that quadrant. I started calling the oncology dentist, who is at the moment between offices. Got no call back on Post-Bone Chunk Day 1. By mid-day Day 2, I REALLY hurt and decided it was more than a dental question in any case. I called poor Dr. H, oncology surgeon, and he set up to see me late in the afternoon on a day’s he’s not scheduled at the hospital. I felt bad about dragging him in on a day off, but wasn’t sure what else to do.


He poked around and said the infection was pretty bad and that it was likely I would accidently break the bone and at that point it would have to be removed.  He chuckled at the Actinomycin the dentist had me on, and put me on something much stronger. As he pointed out, it would kill everything that moves that isn’t part of me, and likely some moving parts—like my liver—that ARE me. And he said he wants me on it for the foreseeable future. If I managed to not break the bone, Dr. H thought we would try some hyperbaric oxygen therapy. They stick me in a pressurized chamber with a high-oxygen atmosphere and hope the banging on the circulatory system leaks a little oxygen and immune function into the infected bone. But he said he wanted to talk to the dentist.


The dentist had finally returned my call, and I had an appointment with him the next morning. When he saw me, he said it was a good thing the chunk of bone broke off—it was the most infected piece and needed to go. Wish he’d told me that earlier. He also said it looked like I was actively healing and might not need hyperbaric oxygen. Well damn! That was certainly a crack of daylight in the darkness!


So now I’m taking this enormous 300 milligram antibiotic tablet every 6 hours, rinsing my mouth with a harsh medicinal topical antibiotic, and regressed to tube feeding for a while so the swelling can go down and the infection can be controlled. 


For all that, I’m not bad. It’s a painful and fussy setback. But the jaw’s not broken yet. With a little luck, I’ll be able to keep it. We’ll see! Thanks for checkin’ in everybody. I love you all. You’re keeping me on the road to recovery. And I sure as hell need the help staying on that track!