Do one more examfor your patients and yourself
I'm trying to figure out why I have been given the gift of oral cancer, but I believe it is so I can change the world.
by Lawrence A. Hamburg, DDS
I'm trying to figure out why I have been given the gift of oral cancer, but I believe it is so I can change the world. My hero, Lou Gehrig, said he considered himself the luckiest man on the face of the earth. I know what that feels like now, or at least on the 10th floor of Beth Israel’s Head and Neck Cancer Center. It seems like everyone else had more extensive surgery than I did. I only had radiation implant therapy on my base of tongue tumor (sparing my tongue and vocal cords), and my affected lymph node removed (along with 15 to 20 other nodes that were checked for cancer — all were negative, thank God). Outside of a nasty scar on my neck (I tell people it's from protecting my wife in a bar fight) and the loss of my taste buds and salivary gland function (so far) and some neuropathy (numbness in my fingers and toes), I'm fine. And, although I can't sing any better than before, I can speak! Most of my hospital brethren can't say that.
How it all began
Briefly, my story is not unique. About eight months ago, I went to button the top button on my dress shirt before putting on my tie, and I realized my collar was too tight to button. I assumed I was getting fatter or older or possibly both, but then upon further examination, I noticed a swollen gland to the right of my Adam’s apple. My diagnosis was unilateral lymphadenopathy, and I figured I was fighting some sort of infection. I forgot about it.
In spite of playing tennis every Tuesday with a physician friend, and having many patients who are doctors, and staff members who could have checked my neck for me, I ignored it. You see, I have missed one day of work in 24 years of dentistry. Like my dentist-father before me, I thought, There can’t be anything really wrong with me — not Lawrence A. Hamburg, DDS.
Besides, we always see things on our body, or feel something beneath the surface that we’re afraid might be cancer these days, and we can’t go running to our doctors every time we suspect something might be wrong. I finally asked my hygienist what she thought during my three-month prophy, and she suggested I get it checked right away. But I still didn’t go to the doctor.
When I took my nine-year-old son in for a routine exam, I asked his doctor (and my friend) to just check the lump on my neck. She couldn’t help giving me “the look,” and immediately recommended a CAT scan, during which a radiologist friend discovered two masses and stated I had some type of lymphoma. I was told I had a base of the tongue tumor about the size of a super ball and a secondary tumor in my lymph node about the size of a baseball. “At least it’s not squamous cell,” he said, and I agreed. See, when I got out of school in 1983, that was the oral cancer you were taught had the worst outcome. I still believed it was a six-month death sentence.
My worst fears had come true
The next day the node was biopsied, and the following day I found myself at the oncologist. It was Stage IV (the worst) metastatic squamous cell carcinoma ... the very cancer I was most afraid of for the last 25 years! Needless to say, I fell on the floor hysterically crying, and swearing to my wife I was ready to die if that was God’s plan, but not to leave my two boys. I have been accused of being obsessed with them since their birth. I was also not ready to leave my young, beautiful wife and friends and family. Of course, I was devastated.
The next week or so I was in a daze. Every day was another doctor, and another test. At one point we went to a doctor’s office and everyone seemed to know me, much to my dismay. Upon questioning my wife, she informed me this was the third time at this office in the last two weeks. I honestly didn’t remember being there before. At some point in this confusion, I saw six of my “kids from camp” (I was their camp counselor many years ago). They’re now in their late 30s and early 40s and some of my closest friends, and they created “Doc’s cheat sheet.” It was a listing of six institutions — the best in the country — for me to consider treatment. It was one of the most precious gifts I have ever received.
After several consultations, and with the help of some local doctors/brothers, we decided on surgery in New York City, but staying local for the four months of chemo, with 33 daily radiation sessions toward the end, and then the surgery at Beth Israel. I’m not sure why, but compared to what I read in Lance Armstrong’s book, I sailed through the treatments. I believe it was the many prayers I had supporting me in houses of worship of all denominations, including the Vatican, the Wailing Wall, and monks in monasteries — not to mention some really great doctors, nurses, holistic therapists, and the daily love and support of my family.
Probably the most difficult thing I have ever had to do was to tell my kids about the diagnosis. I first told my boys I was very sick, but I was going to be OK, and left it at that. But after their overhearing many very serious phone calls, and many uncontrollable crying episodes, I decided to talk to each of the boys independently. Jamie (my oldest at age 11) and I went for a walk first. I asked him if he had any questions about my illness. He said, “Well, it’s not like you have cancer or anything, right, Dad?” I said, “Yes, Jamie, it is cancer.” I never expected what happened next. He immediately hugged me for just a few seconds, and then went into this lengthy explanation of why cancer isn’t something to be so afraid of anymore ... that there have been so many advancements in treatment, and many people live very long and healthy lives after their diagnosis.
I will never forget how brave he was, and how inspiring. Ryan was similarly positive and supportive. Before that, all I could think of was the 22 percent five-year survival rate I read about on the Internet. After that, I chose to just remember what my son said.
Seeing the challenge as a gift
Today, almost seven months later, I have chosen to see this challenge as a gift. I will beat this thing. I will change the world. I will dedicate myself to reaching out to all of you, my fellow dentists. I implore you to take better care of yourselves. You owe it to your patients, your loved ones, and yourselves. And more important, your first responsibility as a medical care provider is to check for life-threatening disease. Why would you worry more about finding a cavity than cancer? Or as they say in the ad: “You know how good it feels to save a tooth. ... Imagine how good it feels to save a life.”
Every day the literature points more and more toward how important we as dentists are to finding disease in the oral cavity before anyone else. We have many different ways of finding not just cancerous lesions, but precancerous lesions with the Oral CDX BrushTest, Zila’s ViziLite Plus, LED Medical’s VELscope, and scalpel biopsies. How can we justify motivating patients to have a crown done, but not referring them for a “suspicious area” or not even looking for ourselves?
My hope is that I can motivate just one more dentist, one more hygienist, to look closer than they did yesterday when they did an oral cancer screening. Literature suggests only 20 percent to 50 percent of us do a screening in the first place. Is it because insurance doesn’t pay a specific fee for the most important thing you can do in the course of your day? Actually, many insurance companies do pay for this procedure and, with the help of my many new friends, I plan on doing everything I can to get more insurance companies to see the light. You see, my treatment has cost my insurance company about $250,000 so far. They could pay for a lot of oral cancer screenings if they reduced their payout by just one cancer patient! And, if you only look at the financial aspect, dentists can actually make more money by doing these screenings on patients.
I hope to write many articles in the future, and give many seminars on oral cancer (which I will also include in my seminars on porcelain veneers), so please do your oral cancer screenings. Get the necessary armamentarium to find those lesions earlier and take better care of yourself. You and I have the power to change the world, one patient at a time. Please help me give meaning to this fight. Do one more exam for your patients, and for yourself. Please.
Lawrence A. Hamburg, DDS, is a member of the ADA, AACD, and AGD. He is the founder of Hudson Valley Dental Arts, P.C., and is president of the MMA study group. He has held positions at Vassar Bros. Hospital and NYUCD, and is currently a research associate at Tufts. Contact him via www.hvdentalarts.com.