(Yes, those cookies have nothing to do with cancer. Did you seriously think I was going to put a picture of cancer up there? I just wanted an image to put at the top of the blog, and I like cookies. Side note: do not ever, ever, ever Google “cancer cookies”.)
To be clear: I do not have cancer. Or at least, I am 99% sure I don’t.
For the past couple of weeks, that number has been quite a bit lower. I’m not normally the kind of person to start freaking out about this kind of thing – I come from a family of doctors, and am inclined to wait for an actual medical professional to pass judgement before I start panicking. But when a dental professional peers into your mouth and starts saying things like “Not a good sign” and “Oral surgeon” and “Pathologist” and “Biopsy”, it’s very hard not to start imagining the worst, even when there’s no good reason to do so.
Let me backtrack. In July, my wife and I went down to Portland, to do things like drink beer and wander around huge Japanese gardens and visit the best bookstore on the planet, so I could sign stock and write my name on their signature pillar, next to Neil Gaiman and Robin Hobb (yay!). While we were down there, I noticed a very tiny apthous ulcer on the tip of my tongue.
You’ve probably had these before. They’re those little open spots you get on the inside of your mouth, green ringed with red. They are annoying and sore, but usually go away after a while. I’d had plenty on my lower lip, but never one on my tongue. All the same, I didn’t give it much thought. I figured it was just one of those things.
Except, it didn’t go away. Over the next two weeks, it mutated, going from a tiny green dot to a smooth, fire-engine-red wound the size of a shirt button. It was alternately tender and painful, and completely numb. As I packed for a trip to the UK, I tried to calm myself down. I’d injured it somehow, irritated the area. It would fix itself. But over the next few days, it just got worse. And whenever I drunk whiskey, the wound would sting like a motherfucker.
Halfway through the trip, I caved, and went to see a dentist – an Egyptian guy in Baker Street with an impenetrable accent and a receptionist who had great taste in hip-hop. He asked if I ground my teeth at night. I told him I did, and that although I had a mouthguard, I was a little bit forgetful when it came to using it. He told me that the most likely cause was that I was biting my tongue while I slept. Use the mouthguard, he said (or at least, I think he said – he really did have a serious accent) and it should heal in a few days.
He was, it must be said, extremely thorough. He checked for lumps. He did a full nose-around in my gums and throat. None found. But when he got to the base of my neck, he paused. “Your thyroid is very swollen,” he said.
“Is it?” I replied. Up until that point, I hadn’t even known that I had a thyroid.
“Yes. You must get that looked at by your GP.”
I wore the guard. I cleaned my mouth thrice daily with antiseptic mouthwash. I tried Bonjela, which covered the wound in a horrid-tasting liquid plaster. Nothing worked. If anything, it got worse: more inflamed, a little more angry. What was this thing? Why the hell had it taken up residence in my mouth?
I have, you may not be entirely surprised to hear, an overactive imagination. And now, it started to grind itself into action. Was my throat tighter, or was I just imagining it? My saliva felt a little thicker, swallowing more noticeable. True, the doc hadn’t found any lumps, but what if…
You’re probably smirking by now. And trust me, I cringed just writing that. But that’s the thing about worst case scenarios. They have a way of taking hold, and being very difficult to dislodge.
My mom, a former GP (now an ass-kicking physical rehab specialist), did her own examination and managed to calm the waters for a little. But the wound didn’t get better. Back in Vancouver, I hustled to my own dentist, hoping once and for all to find out what this thing was, and how I could kill it. I’d already been to get my blood tested, hoping to track down the source of my overactive thyroid, and although it would be a few days before I got the results, I was still mighty keen to get rid of my bloody little passenger.
Which is where I was told I might need a biopsy, and that I’d need to see an oral surgeon. Also, that there was significant tissue loss in the area, including total loss of taste buds. They took photos, they shone ultraviolet light on it, and I was given a stern lecture not to eat anything acidic, or drink any alcohol.
By now, my tongue had developed a gnarly white coating – another symptom to add to the growing list. “It’s plaque,” the dentist said. “You need to brush your tongue with toothpaste.”
I did, I assured her. Always had.
“Are you drinking enough water?”
That too. I am far too obsessive about drinking water, constantly refilling a bottle on my desk. It’s the kind of thing that, were I fool enough to work in an actual office, would get me roundly mocked.
“It’s probably nothing,” she said. But she looked worried. And let me just tell you, hearing a medical person say “It’s probably nothing” while looking nervous is right up there with “You can still live a normal life” and “You’ll get used to it over time” in the absolutely-not-reassuring-at-all stakes.
By now, I was vacillating between indignation and outright, bone-gripping panic. Indignation, because getting any kind of mouth cancer would be the the most crushing kind of unfair: I’d never smoked (short of a few joints and the odd cigar, spaced over a period of about fifteen years), and I was hardly what you’d call a heavy drinker. Panic, because I knew what mouth cancer could do.
That’s the problem with living with the Internet. Stephen King, in 11/22/63, quoted an old proverb from somewhere: “Look not through a knothole, lest ye be vexed.” I might have resisted self-diagnosis, but I still looked through that knothole, because I’m an imbecile, and what I found scared the bejesus out of me. Lost speech. Lost salivary glands. Inability to eat solid foods. Inability to swallow at all. Radiation and chemo, turning the mouth into one giant burn site, making it impossible to ever eat spicy food or drink alcohol ever again. I consoled myself with the fact that if I did have mouth cancer, I might just lose the tip of my tongue.
Yeah, I know. I shouldn’t have panicked. But I’m a writer, an introverted worrier, so it came with the territory.
And by the way, you have no idea how much you miss acid in your food until it’s taken away from you. Lemon. Pepper. Spices. Chilli. Tomato. Fresh fruit. Vinegar. Orange juice. Honey. Ketchup. Soy sauce. I adore food, and cooking, and to have these snatched away was a blow. I scrambled, hunting down recipes, obsessing over pH levels, already missing the bitter tang of a cold beer and the hot hit of whiskey, munching on plain yoghurt and jacking every one of my meals with as many herbs as I could.
I am not, by the way, bitching about this. It sucked, but I was and still am keenly aware that I was receiving excellent medical care, far more than most people on this planet could ever hope for. Moreover, I was in the position of being able to shop, to pick and choose my meals. It could have been a hell of a lot worse. All the same, the thought that kept running through my head was: Please don’t let this be a preview of what’s coming down the pike.
I could still – thank the Pope and Buddha and Luke Skywalker – drink coffee, as long as it was polluted with enough milk to raise the pH to acceptable levels.
As my date with the oral surgeon drew near, I found myself in gritted-teeth mode, no pun intended, blocking out everything else. I was fine. I was normal. I would get through this. And everyday, I’d look at the insult to my tongue. I had no idea if the no-acid diet was helping, and the more I looked, the glummer I got.
The oral surgeon was in North Vancouver, a motherly Iranian woman – and by the way, why is it that all dentists in this city are from Iran? My regular dentist, her assistant, the other doctor in her practice, and now this oral surgeon. Was there some kind of mass dental exodus from the country? Were there, even now, people wandering the streets of Tehran, nursing toothaches that would never heal? I’m not complaining, you understand; I’m just curious*. These were the thoughts I tried to calm myself down with as I sat in her chair, waiting to see what she’d find.
She quickly established three things:
- It was almost certainly not cancer. Tongue cancer, she said, almost always occurred on the sides of the tongue, and there were no indications of that anywhere, or lumps in my neck and jaw. She did a basic dye test, which added to this hypothesis: there was no sign of cancerous cells. I wouldn’t 100% know without a biopsy, but it was highly unlikely.
- My teeth were very rough from grinding – including the bottom teeth, which weren’t shielded at night by a gum guard. I had almost certainly been abrading my tongue against them – a fact backed up when she pointed out a pattern of small abrasions along the sides of my tongue.
- I needed a new mouth guard (my current one was quite old) and I needed to get my teeth sanded down.
She also said that I could start eating and drinking as I usually did. A quick call to the blood lab got my thyroid test results back, which were approximately normal. I still don’t know why my thyroid is enlarged, but it looked like I was (mostly) in the clear
I walked out of there on legs that were a good deal shakier than they should have been, finally sitting down on a bench in the building lobby. Jesus fucking Christ.
In hindsight, it was laughable. If it looks like a duck, and quacks like a duck, then chances are it’s a duck that’s been rubbing its tongue against the inside of its rough, sandpapery beak. A regular ulcer had been continually aggravated over time, not allowed to heal properly, and I’d been going crazy over nothing. The rough bottom teeth were the missing piece of the puzzle.
The first pull of beer, an hour later, felt like Beyonce was dancing on my tastebuds.
There’s still a slight chance that it’s cancer, but it’s very, very minimal. A new guard and some sanding down of the gnashers should heal it. I’ll report back, but in the meantime, a big thank you to the numerous dentists who peered inside my mouth – Doctors Habib, Mansuripur, and Taleghani – even the unnamed hygienist who forbade me from eating food that tasted good (she is unnamed because she never introduced herself, not ‘cos I’m bitter). And by the way, if you grind your teeth, go and get a damn mouthguard fitted. Unlike me, remember to wear it. Doing otherwise is just not worth the aggravation.
* By the way, here’s the answer about Iranian dentists.