Dental hygienist recalls father's bout with oral cancer

Back in the 1970s I was a student at the Balboa Canal Zone College, Canal Zone, Panama. I wanted to become a medical technologist.

Dental Hygienist Reflects On Experience With Father

BY CARMEN S. TORRES, RDH

“Tremendous things happen to the believer. So believe the answer will come. It will.”
— Norman Vincent Peale

Back in the 1970s I was a student at the Balboa Canal Zone College, Canal Zone, Panama. I wanted to become a medical technologist. My dad was in the Air Force, and we were constantly traveling. Toward the end of my first year of college, we moved back home to Puerto Rico shortly after my father’s retirement. I then transferred to the Catholic University of Ponce, P.R., to continue my premed years before going to medical technology school.

I loved medical technology, but after two years, I realized that I couldn’t visualize myself in a lab all day without any patient contact. I wasn’t sure what to do until I received a letter from one of my friends in Panama who had gone into dental hygiene school. This started me thinking about changing my career and becoming a dental hygienist. As I thought more and more about it, dental hygiene became my goal, but I didn’t know how to tell my parents. My father always wanted to get me started in my medical technology career by setting up a lab for me when I graduated. But I was determined to switch my career to dental hygiene. My parents were upset and couldn’t understand my sudden change. To be honest, in a way I didn’t understand it either.

I had to move fast and applied to dental hygiene school at the University of P.R. Medical Sciences Campus. I had heard it was hard to get accepted, but I figured I had nothing to lose by applying. Out of 30 applicants only 20 would make it, and guess what? I did! Out of the 20 who were chosen, only 12 of us made it to the end.

Before I graduated, I already had a job at a small community diagnosis and treatment center in my hometown. During the next 23 years, I got married, had three beautiful kids, and worked in private practice with general dentists and periodontists.

In 1998, my dad told me one day that he was feeling something on the lateral border of his tongue. Prior to that, I had told him he needed to get new partials, since the ones he had were very old and I knew they might begin to cause problems. I thought this was the case — old partials not fitting properly anymore and causing friction on the tongue, probably triggering a canker sore. At the time I was working in my hometown with a private practice dentist and friend of mine since childhood. I told my dad I would take a look at his tongue and bring him some meds that would soothe his discomfort after I got off work.

It was close to 6 p.m. and beginning to get dark when I got to my parents’ house. I took a look at what my father claimed was a sore, and I felt a shooting cold stream coming from my stomach all the way up to my throat. I did not like what I saw. I asked my mother to get a flashlight since it was a bit dark and I wanted to take a good look, hoping I was not seeing what I thought I was seeing. I did not want my parents to worry because I wasn’t sure of the diagnosis, but I certainly knew that it did not look good when I checked the “sore” with the flashlight. I told Dad that the medicine I had brought him was not going to solve the problem; that I would discuss it with my boss.

As soon as I got out of the house, I called my boss and described what I had seen. He advised me to tell my father to be at the office first thing in the morning. That cold feeling was back again. I couldn’t believe what I had seen and still hoped it was not what I thought it was.

I called my mom and told her to take Dad to the dental office the next morning so we could get a better look at his mouth. The next day, the doctor examined him and took a panoramic radiograph. The initial diagnosis was possible squamous cell carcinoma.

There were several specialty dentists at the clinic, but the maxillofacial surgeon was not there. We called him at his other office and he said to take Dad to his office in San Juan that afternoon. The oral surgeon wanted to take a biopsy but couldn’t do it at the office because my dad was diabetic and not in the best of health. All of this happened on a Wednesday.

By Friday of the same week, Dad had his biopsy done at the medical center by the maxillofacial surgeon. By Tuesday, we had the final diagnosis — squamous cell carcinoma on the lateral border of the tongue. The tumor board got together and decided that my dad was unable to go through surgery at that time because of his health issues, and they decided to do radiotherapy and chemotherapy simultaneously. Within a week, we prepared Dad for his treatment. He had a full dental exam, necessary restorations were completed (he didn’t have many because his oral hygiene was always good), and I did the prophylaxis. Next, fluoride trays were prepared.

My dad was in his 60s then. He is such a wonderful human being with a great sense of humor. He is a very stubborn retired veteran, proud to have served his country and very patriotic. He kept saying that there was nothing wrong. He took things as a joke and never accepted the diagnosis. My father did very well during his therapy and always joked around with the other patients, making their day brighter. He had positive thoughts and acted like he was just humoring us.

During therapy, he became very sore. My mother brought a small cooler with cold, crushed aloe vera to put on his face after each radiotherapy. The aloe vera kept him from having radiotherapy burns; however, he developed xerostomia and mucositis. The doctor gave him some meds for the mucositis.

Meanwhile, I researched his condition on the Internet, trying to find ways to treat the condition and lessen the side effects of therapy. I read about Biotene toothpaste and rinse for patients with xerostomia, but I couldn’t find it at the local pharmacies. I ordered some products on the Internet and took them to a pharmacist at the Walgreens close to our house. I explained the use of these products, and ever since, Walgreens and other pharmacies have stocked these products. Believe me, the Biotene helped!

The years went by and things seemed to be stable. My father went in for a checkup every three months. In 2001, during one of the office visits, the doctor palpated a very small lump and decided to do another biopsy that ended up being positive. By this time, my dad’s health was stable, so we decided to take him to Sloan-Kettering Hospital in New York for his surgery. He had a hemiglossectomy, saving the tip to help with speech, and a radical neck dissection to avoid possible metastasis. I became friends with the surgeon who let me participate in the postcare of my dad with oral irrigations, etc.

My parents went home, my dad began his speech therapy, and things seemed to be going OK. Dad continued to have his regular checkups and cleanings every three months.

About three years ago, he began to have recurrent episodes of mucositis and pain in the mandible area. He was hospitalized with osteomyelitis. He was developing osteoradionecrosis of the jaw due to the excess radiation he had received during his cancer treatments. We took him to the University of Tennessee Hospital for mandible surgery, where doctors resected his mandible and replaced the resected mandible portion with a titanium plate.

After surgery, Dad seemed to be doing great. He joked with the nurses and wanted to leave the hospital right away. After a two-night stay at the hospital, he was released and we took him back to the hotel. I did postcare the following day, but late that night he began hemorrhaging. His tissues had torn away from the sutures. I called the doctor who told me to take Dad to the ER right away if I could not stop the bleeding. After a half hour, the bleeding stopped and I was relieved.

We took Dad to the doctor’s office the next day. He told me that Dad’s tissues were like gelatin due to the previous radiation exposure, and the sutures seemed to be too tight. The oral surgeon didn’t want to do sutures again, but then he decided to try to do them loose this time ... and it worked.

After a few days, I brought my parents to my home in Washington, D.C., where they stayed until my dad was fully recovered. They flew back to Puerto Rico, but after three months, Dad was still in extreme pain. He’s not a complainer, but this time he kept saying that it felt like a dog was biting his jaw. I felt so bad for him and thought that the healing was taking too long.

At one of his appointments, he was in the cafeteria trying to eat when he felt something dripping down his chest. He felt a small hole under his neck right at the jaw line. He had developed a dehiscence. He was hospitalized for a week, at which time I flew down to take care of him at the hospital. We had to fly back to U.T. Hospital to have the metal plate removed. This time, they did not do any surgical intervention inside his mouth; they just opened up under the mandible. We flew back to Washington, and my parents once again stayed with me during Dad’s recovery.

Ever since then, things have not been the same. It is very hard for Dad to eat. His mandible goes all over the place, and eating has become an ordeal. He chokes on food because the radiation caused the tendons and muscles in his neck to lose elasticity, and the valve in his esophagus doesn’t close properly. He has had to learn to deal with these things.

My mother is an excellent caregiver. She prepares Dad’s food so he can eat healthily and varies his food so he doesn’t get bored with eating the same things. Sometimes he refuses to eat pureed food and wants to eat like a normal person, which takes him almost an hour to accomplish. He gets tired and stops eating, resulting in weight loss.

My parents flew up to Washington so my father could go to the hospital where I work, which treats wounded soldiers. The doctors did a magnificent job constructing a partial that enables him to chew his food better. It took almost two months to get the proper fit since he doesn’t have a stable bite. Two years in a row, he has made the trip to D.C. to have his partial replaced and adjusted.

Meanwhile, my father developed prostate cancer. Thank God it’s encapsulated, but now he has to deal with that too. By the way, my dad was never a smoker. Cancer has changed his life and the lives of those around him. He is a fighter — my hero — and I will be there for him, helping him fight this terrible condition.

My dad tries to be like he was before, but things will never be the same. He is finally adjusting to his reality and is still standing tall. Life is tough. It’s a matter of falling yet trying to stand up again and move on. This is what he has done, and he is still alive! I am glad we caught the lesion in an early stage. He has been an inspiration in my life and the lives of many people who have witnessed his life these past 14 years.

One day I said to my dad, “Daddy, do you remember when you were upset because I changed my career from a medical technologist to a dental hygienist?” He was quiet and just looked at me. I knew what he was thinking. We just hugged. There is a purpose for us in life that sometimes only God knows.

I currently work at Walter Reed National Military Medical Center in Bethesda, Md. I am proud to see our patients, have contact with them, and treat our wounded soldiers, making a difference in their lives. I always do cancer screenings as part of my routine. My dad is “the wind beneath my wings.” My name is Carmen S. Torres, and I am very proud to be a dental hygienist. RDH

CARMEN TORRES graduated from University of P.R., Medical Sciences Campus School of Dentistry, as a registered dental hygienist in 1975. She has been practicing for more than 30 years. She currently resides in Washington, D.C., and works as a health-care provider in Walter Reed National Military Medical Center in Bethesda, Md., in the Primary Care Dentistry Department for the past six years. Dental hygiene has become her passion and she is constantly doing volunteer work, research, and assisting conferences and dental conventions to offer her patients excellent care. One of Carmen’s favorite quotes: “Nobody can go back and start a new beginning, but anyone can start today and make a new ending.” (Maria Robinson)

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