Back in December and January, while my oncologist was restaging my myeloma and we were discussing courses of treatment, he suddenly said, “And I want you to go see your dentist and ask him whether he sees you having any major dental work done in the next year.”

The calcium levels in my blood were rising. My oncologist intended to start me on a bisphosphonate, such as Aredia ^[1] (pamidronate) or Zometa ^[2](zoledronic acid), as soon as possible to supplement the calcium that was leaching out of my bone. The treatment would be a monthly intravenous infusion. He wanted my dentist’s green light because of the “possibility” of bone loss in the jaw (osteonecrosis of the jawbone).

I saw my dentist a few days later and after checking my mouth and reviewing some x-rays, he said, “I want you to see an endodontist and have a root canal on that back right molar.”

Great.

[A couple of personal dental notes: First, I had a really, really incompetent dentist throughout my childhood and adolescence, so the interior of my mouth is subprime to begin with. Second, because I had such a horrific dentist and had to have the interior of my mouth overhauled when I was young adult, I have really, really good dental hygiene. Still, since the onset of the myeloma, I have had to have several extractions, a situation my dentist suspects is a result of my childhood dentist’s damage and the increased stresses on my body with the advent of the myeloma and its accompanying treatments.]

Three days later I was tilted back in a chair while the endodontist did his job, neatly and professionally. Afterwards, he and I talked about the sudden necessity for a root canal. I explained about my oncologist’s desire to start bisphosphonate treatments as soon as possible.

The endodontist frowned. “Tell me more.”

I gave him a thumbnail overview of my medical back story: the myeloma, the relapse, the increased calcium levels in my blood. He listened and then proceeded to ask me a few questions.

“Have you had any fractures or breaks that are considered the result of the myeloma?”

No.

“Are you showing signs of lesions?”

No.

“When was your last skeletal survey?

Just last month and it came out fine.

“Are there any other extraordinary factors, including hereditary issues, that put you at high risk for bone damage?”

No.

He shook his head.

“If I were you, I would ask the oncologist to postpone the treatment for as long as possible, preferably until it is absolutely medically necessary. I get that oncologists use bisphosphonates for good reasons. But to those of us in the dental world, they are the scourge of the earth.”

To him, osteonecrosis of the jawbone is more than “possible.” In the case of a root canal, he assured me, he has not seen it often. In the case of an extraction, he has seen it often. He said he even had a few patients who had no invasive dental work done and “the bisphosphonate treatments are causing them to lose their jawbones.” His concern with these drugs is the fact that they could impact the jawbone long after the treatment stopped.

The endodontist studied my x-rays, then pointed to the tooth next to the one he had just worked on. “That’s the area I would be worried about in the next year or so. So talk to your oncologist about this stuff.”

When I saw my dentist for a follow-up visit and to get the root canal capped, he and I talked about the bis­phos­phonate issue in more depth. He echoed the sentiments of the endodontist, adding that researchers are still trying to understand why these drugs affect the jawbone. (Indeed, if you Google “bisphosphonates and “osteonecrosis of the jaw,” you will see links to journal articles puzzling over that very issue.)

I asked the question that was at the back of my mind. “So, let’s say that I get the treatment and I start losing my jawbone due to osteonecrosis. Do I just go through the rest of my life with no jawbone?”

Apparently not. My dentist proceeded to describe a patient of his who was currently having his jaw reconstructed at Ohio State University Hospital. He described inserting a steel plate, then grafting bone onto that, and then …

I don’t know what came next. I stopped listening at “insert a steel plate.”

I saw my oncologist at the end of February, after finishing my first course of Revlimid ^[3] (lenalidomide). I was ready to raise the issue of the bisphosphonate infusion, as I was scheduled for one that day immediately following the exam. I was going to refuse treatment, something I do not do lightly.

Luckily, I never had to cross that bridge. My labs showed a marked improvement across the board after the first course of Revlimid, and my calcium levels were back in the normal range. My oncologist looked at the numbers and said, “We’re not going ahead with the bisphosphonate infusion then.” I replied without filtering. “Good, because I wasn’t going to take it anyway.”

(An aside: Yes, I got solid lab results with the first round of Revlimid. But I also got mediocre quality of life results. Or, as my oncologist put it, “So you’re getting good results biologically, but not so great results physically.” I am in the middle of round 2 right now, with a lower dosage and a longer break between round 1 and round 2.)

I missed the infusion, or at least a detailed debate of the “necessity” of the infusion, by the skin of my teeth.

And that’s close enough for me.