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Tooth removed today POST radiation

wifeforlife
Posts: 189
Joined: Feb 2010

ok... so I went to the superthread! (which is AWESOME!!!) but i couldn't find a link for what I need.
My husband is post treatment. He has recieved 20 HBO treatments and will now have a tooth pulled. Then he will receive 10 more HBO treatments. What should I watch for? How will I know if he isn't going to heal?
Thanks for your continued support and dedication.
Wife

Hondo's picture
Hondo
Posts: 5927
Joined: Apr 2009

I am looking at doing the same thing and real soon so I will follow your port and see what happens.

All the best to you both
Hondo

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

You are right that is something good to add to the Superthread. I have not been through it so I cannot really answer your question. I may have to have one pulled without the HBO. :( Just the thought makes me sick. From the limited discussion I had with my dentist you should heal up fine with having HBO treatments.

I will be watching for answers here as well.

wifeforlife
Posts: 189
Joined: Feb 2010

I will share a few details because this could affect many.
It bagan with a root canal many years ago. The tooth has recently become infected. We went to a specialist to have another root canal on the tooth, it couldn't be done. He is not in pain at this time but there is still infection under the tooth. The infection can cause Osteonecrosis of the Jaw the same as removal of the tooth can ... so it is really a no win here... except by removing the tooth you will clear up the infection if all goes well. We then went to an oral surgeon who agreed with the others and we scheduled a meeting with the Pulminary Dr. (this is who orders the HBO treatments) He took 20 HBO treatments (two hours a day) had the tooth removed today (that was easy ) and will begin taking 10 more HBO treatments tomorrow.
We also touched base with the Radiation Oncologist (just because my husband likes him so much!)

A few notes:
The fact that he has been dealing with an ongoing infection and hasn't developed any lesions is a good sign that he won't have a problem.

The HBO treatments degrease his chances of having a problem

The newer readiation technics lower the risk of a problem.

We have dont everything we can to get a positive outcome... now we just wait. and PRAY.

Clean mouth is important: brush and rinse after intake of anything.

I'll post updates.
Wife

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

18 months ago I had to have two teeth removed. I was treated for 30 days with anti biotic and had a special rinse they gave me with a couple small surringes to rinse the two pot holes out. I was told to rinse with water after any food as this would be the most important. The risk if the infection did not go away was Osteonecrosis of the Jaw. If that happened they would have to remove the jaw bone area and replace.

Healing is extremely slow. At 15 months my pot holes were still not healed over the exposed jaw bone. They keep reminding me the healing is slow but good news is they is no infection and is not very tender. About 10 months ago I purchased a water pic for rinsing and cleaning since most of the soreness was gone. This has been the best addition to my many times a day teeth rotine.

Keep all your teeth clean all the time and rinse the the potholes after any foods.

The only way you will know if the healing is going well is by your oral surgeon review and your dentist observation.

Good luck to everyone with post radiation teeth extractions.

John

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sweetblood22
Posts: 3230
Joined: Jan 2010

You did not have HBO treatments? I have no insurance and I would not be able to have them.

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

No I did not!

My doctors back in 96 were so against HBO because they felt it stimulated any cancer that might be hanging out. My history was clean for 12 years until I had infection on my pharnyx and had to have HBO 40 treatments. Prior to treatments we(doctor team, wife and I)discussed this and almost argued. Well what was said is I had to take the risk to get the reward. 5 months later we found a spot on tongue, gee I wonder why. Surgery to remove and have had no problems with any other we can find, that was two years early Feb.

I am not in favor at all with HBO. In my case the risk was worth the reward of vocal cords.

John

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

Thank you for the quick response, John. I have heard people talk about the increased risk of cancer and HBO treatments. I don't know enough about it all to have an opinion. Definitely need to read up on all this. Thanks again.

Hondo's picture
Hondo
Posts: 5927
Joined: Apr 2009

That is remarkable that you had teeth pulled with no HBO. I am looking at having to do this but think I will question my Dr about it first, my big problem is that I had Radiation twice to the head and might not heal even with the HBO.

Take care
Hondo

backachedp
Posts: 124
Joined: Oct 2009

Hey I know you have not had any HBO treatments and said you may need a tooth pulled...Bob had 4 teeth extracted about 4 weeks ago with any HBO treatments...he went in on Monday and he is healing, but slowly...Monday the 25th he will have 3 more extracted one just wiggled out last night...;( so he will only have 3 more pulled. He is doing very well with this and I was so worried about him not having HBO treatments. He didn't have to take any Antibiotics eighter. I just thought I would let you know how well he is doing. Hopefully by the end of May he will have his Paritials done and put in, but I am sad he has to go without front teeth for so long, but I have upper Dentures and thought maybe we could run around without our teeth together...just to make him feel better lol...

sportsman
Posts: 98
Joined: Feb 2010

Sweet: I had a crown today and my dentist was having a hard time putting in the crown because he said I had a tooth that had dropped and was in the way of the crown being put in. He said that this tooth that was giving him the problem was not really serving me a purpose so far as to make a contact to bite. He said it probably should be pulled but decided to do a little grinding on it inorder to make the new crown on another tooth work. I have read so much on here about not healing when having a tooth pulled that it scares me to death. He advised that the area could not possibly heal and cause you to lose part of your jaw bone. He is trying to keep me in a position where I will not lose a tooth. He did advise that if this happened he would refer me to a oral surgeon who is more familar in handling cases associated with the radiation of head and neck cancer. My radiation treatment ended now just over four years ago. I have had several crowns and several fillings. In reading your postings on here it appears you are having many of the same problems I am having with teeth. I personally neglected mine for a number of years when I was very young but had them in decent shape before radiation. With all the other terrible side effects from radiation that has happened to me it wold be devastating to lose my teeth. I would appreciate your reply and your thoughts or any others on here. God Bless

abbimom's picture
abbimom
Posts: 81
Joined: Sep 2010

Went through the same thing this summer. I had my wisdom teeth removed. I had to go back and see the dentist every couple of weeks so he could see the progress or if there were any problems. Mine healed but I have pockets where my teeth used to be. Just stay on top of it and if you feel there is something wrong go see the dentist. One tooth took longer to heal than the others but it eventually did. I do not miss HBO treatments. So expensive and time consuming. Thank God insurance made a mistake on mine in my favor.
Good luck
Linda

Kent Cass's picture
Kent Cass
Posts: 1747
Joined: Nov 2009

Had an experience like this a couple months after my last rad. Dentist sent me an extraction place to get a tooth pulled. Was in the chair when the Surgeon called my rad Dr. She nixed it! Said that because of the chemo and rads I could have problems with it developing infection, or Dry Socket. Rad Dr. then called my Dentist and chewed him out for not finding the problem in the pre-treatment exam! Ended-up getting a root canal, which was a treat- but a better treat than Dry Socket would be. Please be advised.

kcass

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

When dealing with teeth you should have Dentist and oral surgeons who have had a lot of experience with Radiation and Chemo.

To me this is a must. Check out Dental schools as most will have this experience.

John

wifeforlife
Posts: 189
Joined: Feb 2010

we did not have the option of a root canal. Our only option was removal of tooth. These decisions are so scary... we felt that the HBO treatments were our best option. We spoke with our ENT, Rad Dr., Dentist, entodontist, and oral surgeon all agreed this was the best option... If cancer comes back I can't feel that this was the wrong decision... we made the decision we had to in order to keep his jaw.
We are praying for healing.
Wife

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

Absolutely. Sometimes this crap is enough to make you crazy. I am glad you guys are comfortable with your decisions. That is so important.

I will pray for healing for him too.

wifeforlife
Posts: 189
Joined: Feb 2010

Well the tooth is gone. Dr looked at it today and so far the cavity (hole)is pink .... that is good... on antibiotics, anti-inflamatory. and mouth rinse... swelling is looking better today.. that's about it so far. Continuing to pray for healing.

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

Love the news that the pot hole is pink.

Not to be a nag but keep it clean as often as possible! If you think it is clean clean again.

Did they give you a surringe to help clean the pot hole? I hope so.

Another I recall is to use luke warm water. Cold is sensitive and Warm is sensitive.

Prayers going out!

backachedp
Posts: 124
Joined: Oct 2009

I am glad I found this thread. Bob is going to the U of Mn Dental School as I and he do not like our Dentist..I belive he should have detected Bob's Cancer, but that's another story...Bob has to get 11 teeth extracted soon. He was seen last week and the week before he was schedueled to have the teeth extracted tomorrow. They had not even taken impressions. I called on Monday and spoke to the Student who was to do the extractions and asked him had he sent paper's to the Rad Dr...or had they spoken..??? He called back later Monday and told Bob she would not allow a Student to do the extractions. I am glad for that even though they are supervised by a Dentist...I had read many month;s ago about the HBO treatments and Bob's Dr's did not think it was nessasary. His teeth are literally loose and he is having much trouble still eating, esp. with the teeth issues and swallowing. I can't find the Superthread can anyone help me out on how to find it??? Also with Bob having to have so many teeth taken I am now worried when I read about the healing...I hope we made a good decsion on where he is having this done, but his Dr's are all at the University of MN and the Dental School is right there. Any help or info about healing or anything would be much appreaciated....and help me get to the Superthread...
Thanks to everyone here you all have been so kind and caring I wish I could do something in return...I do try and post when I think I can be of help to someone. Prayers to all for continued healing and for all who are just starting this journey.

Deb

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

Deb
my thought first and foremost is there is no way I would have an inexperienced person remove the teeth. I would suggest only an oral surgeon with radiation treatment experience.

Also if your looking at doing HBO I thought they do the treatments of 20 before extractions and 10 after.

Up to you but a dentist and oral surgeon should be working on Bob.

God luck

John

backachedp
Posts: 124
Joined: Oct 2009

I agree...time is limited so we will have to figure this out quickly as his teeth are so bad they are so loose he said he could almost pull them out himself;( He has been getting Vicodin, but it just is not cutting the pain...it's so frustrating as he has enough trouble ating and after his last Apt. he said they hammered on all of his teeth and has only been able to eat soup's and oatmeal...when he was at the ENT yesterday he was in the room waiting for the Dr and a Woman came in and said "Hi I am a speech Therapist"..they told me you were drooling when you came in! He said lady I have lost my saliva glands I wish I could DROOL!..this Cancer just keep's on giving...but thankfully it is GONE. The after effect's are different for everyone and Bob has so much trouble eating..choking..they scope him and say all is well. He did loose his swallow during Treatment, so it is so important not to loose your swallow as I belive some of all the issues of eating etc are because of tgis..maybe I am wrong. He is working 20 hours a week now and it is kicking his Butt, but it is a start after not working for 18 months. Everyone here is so kind and helpful I so appreaciate that...it makes a person know they are not alone and so many have been thru the smae thing.

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

Bob definitely wants to have only an experienced oral surgeon or maybe dentist pull those teeth. My dentist had me go outside his hospital to some one he knew was the best when I had the ones pulled before radiation. The person he referred me to, my insurance would not cover it. I paid out of pocket because I knew if Dr. Halupa said that was where he felt I should go, and not his colleague in his own hospital, then that was a no brainer for me. Dr. Halupa is the only one who touches my teeth except for the lady who cleans them. He always comes in and checks them even when it's just a cleaning. He is the only one to drill them. He allows the ladies to fill them, but then he always checks their work. He has asked me if I would allow students to observe and learn because of all my issues. He does all the work. He was also the dentist on my tumor board.

I don't have any info about the teeth pulling after rads yet. It will be a while. I guess I got my first cold in over two years. I feel like crud.

The Superthread should be on the first page. It says:

HNC Superthread. A COLLECTION OF HELPFUL LINKS ONLY. (please post only informative links here) Help for some FAQ

backachedp
Posts: 124
Joined: Oct 2009

Thanks for all the info and help you have given me..and all you other kind and caring people here...I am going to discuss all of this with the U of MN Monday...I will NOT let them touch Bob unless we mostly I am comfortable with all of this..it's alot to think about. I am worried about loss of bone and healing...and Infection...I did find the Superthread thanks so much hope everyone has a great weekend and Sweetblood hope you feel better SOON. 2 years without a cold is great, but I am sure you feel like crap...fluids and rest..but you know that be well ;)
Deb

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

Thanks for the well wishes, Deb. :) Yes, the possibility with what can happen after those teeth are pulled warrants plenty of research and working with the people who know best. Don't be afraid to wait to find them.

ljoy's picture
ljoy
Posts: 90
Joined: Dec 2007

I had a tooth come loose this time last year. Thankfully had an oral surgeon who new the damage caused from radiation for tonsil cancer. Went to Hennepin county Medical Center for 40 HBO treatments before extraction of two teeth. It was definately worth the time to make sure the bone and tissue would heal after surgery. Since you mentioned you were at the U of MN I thought you might want to check out Hennnepin County Medical Center.

The teeth came loose because the blood supply is not suffient to keep the teeth alive. The bone is also damaged and needs to be debrieded (sp) in order to heal properly.

Hope all turns out well for you.

wifeforlife
Posts: 189
Joined: Feb 2010

an interesting piece of information... the "pre" HBO treatments last a life time. If he needs any further invasive procedure he will only need to take the "post" HBO treatments.

As of today we do not have any throbbing pain and he is off pain meds. Which means we do not have a dry socket. He is using his rinse with syringe everytime he puts anything in his mouth (except water)
I check it with a light twice a day..he can't see it because it was a back tooth and his jaw doesn't open as wide as it use to ...

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

Keep on keeping it clean. Great job and good news about the lack of pain.

Thanks for the update.

John

wifeforlife
Posts: 189
Joined: Feb 2010

I really feel like you should see someone who knows what they are dealing with. To simply make sure that ALL of those teeth need to be removed. The removal of the teeth is not the problem, that is easy takes 1 min per tooth... it is the damage that the radiation has done to the bone that is the issue and when you pull the teeth it exposes the bone and healing is an issue. It is called Osteonecrosis of the Jaw or you can get inforomation on it online under BOT (this is actually caused by something else...but it is the same thing.) The condition is almost like Gangrene only of the bone instead of the flesh. If this occurs the bone needs to be removed.
I understand that he is in pain... but please see someone informed
Wife

wifeforlife
Posts: 189
Joined: Feb 2010

well the pain is gone... gums are still pink... the cavity where the tooth was is still bleeding at times... 6 more HBO treatments...
He is back to eating just about everything as before except some meats.

wifeforlife
Posts: 189
Joined: Feb 2010

We thought we were going to get through all the HBO treatments without any of side effects they tell you about.
But... his eyes are being affected.Interesting enough... he no longer needs reading glasses...but everything past that is really blurry... difficult fo rhim to see tv or drive. They tell him this is temporary, aparently the preasure of the chamber changes the shape of your eyes but they will go back.
Other than that all is still going well. tooth still bleeding off and on. He has 5 treatments left.

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

Yep some have their eye sight change. It will come back to what it was.

So good to hear that treatments are going well and wow only five left.

Love the good news.

John

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

Wife, wanted to thank you for the updates. I have been trying to find articles all day on tooth extractions for HNC patients post rads with no HBOT. Not finding anything useful. I found one paper that looked very promising, but it was restricted. I did come across some good articles on necrosis and dental protocol for HNC patients that I will update the Superthread with.

If anyone else has info or experience with getting a tooth pulled after rads, with no HBOT I would love for you to share that with me.

Thanks,

Sweet

ratface's picture
ratface
Posts: 1254
Joined: Aug 2009

Hi Sweet, I mentioned it to you prior to the procedure beginning and was reluctant to say anything further because both my dentist and I weren't really sure it was going to work. He had only read about it. It also took three appointments to set everything up and weekly appointments thereafter to monitor progress. You have to weigh this with daily HBO treatments. Anyway my dentist has a wire spring gizmo hooked up to an adjacent tooth which is attached in an arc to the tooth being pulled. Attached to this there is an orthodontic rubber band attached pulling up in a constant state of tension. I'm on week three now and the tooth is very slowly moving up and I can feel it loosenning. It rose to the point where he had to shave off the top on my last visit to keep the bite correctly alighned. The jury is still out and this could take from 5-6 weeks to work. Hoping it does. I 'll update when the tooth is out.

wifeforlife
Posts: 189
Joined: Feb 2010

Sweet.. I wish I could help you.. :(
Ratface... I sure hope this works for you...very interesting.. keep us updated!!!!
UPDATE:
One HBO tratment left... bleeding has stopped and dare I say the hole looks to be getting smaller.... eyes are still bad... but all seems to be going well!
We get a CT on the 24th.. (one yr!!!!) we will see if this has created any other issues!
Wife

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sweetblood22
Posts: 3230
Joined: Jan 2010

Thank you, Rick. HBOT aren't an option for me unless my Medicaid, which kicks in July I believe, would pay for it. There is no way I could afford it. In my research I think I came across that denistd's Medicaid paid for HBOT so I may PM him to find out about that. I am still getting restoration work done on my teeth and he did fix up 19 for me, and knock wood, so far so good. Hope it hold out. My detist told me that the HBOT wouldn't be something to do for just one tooth, that he would do the rest of the restoration and see if there are any other issues. Hope there aren't.

Thanks for keeping me updated. I really appreciate it. Hope this works for you.

wifeforlife
Posts: 189
Joined: Feb 2010

Husband gum has a small white spot on it where the tooth use to be ... the rest is still pink. Not worried about this yet, just wanted all to know what was happening.

Sweet, most of the people taking the HBO treatments with my husband (they have more than one chamber) are either on medicare or medicaid. The pulmanary DR. is the one that orders it, your dentist will send you there, it is considered medical not dental. The Pulmanary DR told us it is now considered standard treatment for Head and Neck Cancer issues. Wasn't a problem getting it approved at all.
Wife

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

I would can the white spot an unknown and call the oral surgeon for some input.

I would also rinse out and then look again. Use the suringe to rinse.

My best guess this is nothing to worry about and part of the extremely slow healing.

John

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

HBOT with Medicaid or Medicare.

Well, if that is the case, then I am feeling a little less panic about possibly loosing that tooth. I haven't got a clue how Medicaid works or what it will pay for when I get it. It won't kick in until July for me. Right now I am on an uncompensated care program through my hospital and my necessary health care is covered.

My dental is not considered necessary, so I am basically draining what little savings I had left.

Glenna M's picture
Glenna M
Posts: 1580
Joined: May 2009

Your Medicaid coverage depends on your income. I am on a spenddown program, before I started receiving my disability I had a $600 per month spenddown. Now that I am getting my disability each month my spenddown went up to $2048 per month. It's really a confusing program but it's better than not having anything. What this means is I have to have $2048 in medical bills before they pay. When I was in treatment this was all well and good, now that I am only seeing my ENT every 2 months and a scan every 3 months I am paying a lot more on my medical bills.

Like you, I have no dental insurance and don't know what I'll do if I need dental work. Money is super tight right now as I am on payment plans with all of my doctors and can't afford to add dentist's bills.

Somehow we will survive, we always do :)

Stay well,
Glenna

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

Spend down? Good grief. I have no clue about any of this. I am going to have to try and read about this stuff again. I just don't understand it. I will apply for the hospital program again, I think I can. Its up in May, hopefully I can get approved again.

wifeforlife
Posts: 189
Joined: Feb 2010

the meicaid spend down is kind of complicated... it's based on your income and expenses... they can tell you at the medicaid office.
Sweet. Keep in mind the HBO will be medical not dental. I know that isn't perfect but at least it is something.

Lisa-NasalPharynx
Posts: 9
Joined: Mar 2011

I surely wasn't prepared for all these AFTER side effects. Do you mean that for the rest of my life I will have issues with my jawbone and teeth? I consulted with my dentist before starting radiation, and he did fix a couple small problems I had, and prescribed the fluoride treatments, but I didn't know about that bone necrosis stuff. And this lasts forever now that I've had radiation?

Geez - - - I went into this with my head in the sand, I guess. When you're first diagnosed, you just want to start treatment and stop the cancer. Bing! Bang! Boom! But, even if I had known these things, I'd still have gone for the treatment. What alternative do you really have?

Larrykins
Posts: 38
Joined: Jan 2012

Everyday I brush my teeth I wish I had voiced the thought in the dentists chair before treatment 'should I get the 2 wisdom teeth on my left side out?' They are partially buried in the flesh of my cheek and every now and again I poke something sharp in there to see if any food is caught. I have constant low-level pain that side (always have) and am just waiting for the day that something rots the teeth out. I don't know how to clean properly in there.

Thing is I thought this would delay my treatment and that was something I didn't want to do.
Still, you can't put etc etc back in the donkey they say.

On the other side of it though, I fought hard against docs advice to insert the peg and am glad now I didn't.

You win some, you win some in a different way.

P.S. while I'm on the subject, what's the verdict on mouthwash. Some say essential, some say causes cancer?? Confused of Europe...

sweetblood22's picture
sweetblood22
Posts: 3230
Joined: Jan 2010

Mouthwash is fine, just cannot have any alcohol in it.

Larrykins
Posts: 38
Joined: Jan 2012

No beer and now no mouthwash. It'll be no communion wine next!

titalie
Posts: 3
Joined: Nov 2012

Since after radiation you will have this horrible damage to your jaw bone that will risk you to Necrosis for life if you have any teeth extracted I believe rad Drs should require a WRITTEN report from dentist stating they have performed all that can be done (changing bridges for implants, adding all crowns needed, extracting all teeth neee=ded at present as well as future etc). Of course since teeth change as we get older you will eventually have to face this problem but when that time come you need to be in the hands of a very competent maxillofacial surgeon and dentist with cancer and radiation experience.

titalie
Posts: 3
Joined: Nov 2012

Since after radiation you will have this horrible damage to your jaw bone that will risk you to Necrosis for life if you have any teeth extracted I believe rad Drs should require a WRITTEN report from dentist stating they have performed all that can be done (changing bridges for implants, adding all crowns needed, extracting all teeth neee=ded at present as well as future etc). Of course since teeth change as we get older you will eventually have to face this problem but when that time come you need to be in the hands of a very competent maxillofacial surgeon and dentist with cancer and radiation experience.

Rick2924's picture
Rick2924
Posts: 22
Joined: Jan 2010

I had a molar extracted 12 months ago. 30 HBO's first followed by 10. I previously had 7500 cgy's in 35 treatments to that mandible. I experienced no problems and healed quickly.
Rick

wifeforlife
Posts: 189
Joined: Feb 2010

Last treatment was yesterday. His eye sight should improve in about 7 days. He is most excited about being able to drink coffee in the morning, wear his tape when he needs it, and put deoderant on after his shower!... He's glad it's done.
the small white spot is gone... and he seems to be doing very well!

fisrpotpe's picture
fisrpotpe
Posts: 1344
Joined: Aug 2010

Great news the spot is gone. Good for him that he can get back to some kind of norm. thanks for the update.

wifeforlife
Posts: 189
Joined: Feb 2010

appointment with the oral surgeon today. He said the spot couldn't be healing better. There is a thin film of skin forming over the cavity where the tooth was, which means the bone isn't exposed anymore. (YEAH!) NOTE: if he had not had radiation this cavity would have been completely healed by now. The Dr. told him to continue to be gentle with that side of his mouth, not to eat over there... etc. continue to keep it clean!.. and he doesn't anticipate any problems. He said it should be almost completley healed in the next 4-8 wks.
As to the vision side effect he was having from the HBO: they told him the vision change was temporary and should last about 7 days... he is still having the issue after 2 wks.

I will keep this updated for the information on the thread!
Wife

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