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Professional Courtesy Thomas Giacobbi, DDS, FAGD; Editorial Director, Dentaltown Magazine

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Farewell Angelfish


Thomas Giacobbi, DDS, FAGD
Editorial Director,
Dentaltown Magazine		 Health-care providers of all types are often the worst patients. Not only do we squirm and flinch more than the average person, but we also tend to skip regular care for long periods of time. I am embarrassed to say how long I have postponed my annual physical (let’s just say the Summer Olympics occur more frequently). This month I want to share a special story from our community that reinforces the need to take care of ourselves as we so carefully tend to the needs of our patients. I also suggest that you take a few moments to read the special article written by Dr. Mark Fleming on page 20 as his present experiences adhere to this important message.

Dr. Joseph L. Francis was a dentist in Illinois who had participated on Dentaltown.com for more than six years. He was known to fellow Townies by his screen name “Angelfish.” This past July, at the age of 59, he died from complications during treatment of an advanced squamous cell carcinoma. I think his story serves as a reminder of our mortality and a word of warning that significant health problems can strike at any time.

This month I want to share with you a few excerpts from Angelfish’s final posts on Dentaltown.com as he describes the challenges he faced from discovering a lump to seeking a definitive diagnosis and treatment. Ever the highly motivated dentist, Dr. Francis continued to post to the Dentaltown message boards, even after he could not continue working at his practice. To find the entire thread, search for “Dreaded News” in the Dentaltown Search box.

I Got The Dreaded News
angelfish
Posted: 4/30/2009, 8:37 a.m.
I got the call a week ago Tuesday, “Joe, you have squamous cell carcinoma. We don’t know the primary site yet. This is going to get expensive in a hurry and you’re going to be sick. I think you’ll be able to return to practice – I hope so.”

Then he dropped the bomb, saying he needed 25K now to continue with the case, or that I could call the closest teaching hospital and try to get into a study. I told him I could give him a 10K retainer that very day, and he said his fee needed to be paid up front since I dropped my medical insurance about 10 years ago when the premiums got ridiculous (I know, stupid in light of recent happenings).

So right now I am proceeding with more diagnostic procedures with some doctors who are more interested in providing care than in paying for the upkeep on their twin-engine airplane, and once I get a diagnosis I can try to get into a clinical trial. I’ll continue later, not for pity, but as sharing info so some of you can hopefully avoid the journey I am poised to begin.

Cordially, Joe

angelfish
Posted: 4/30/2009, 10:19 a.m.
I appreciate all the good vibes.

It just started as a swollen lymph node on the center of my left sternocleidomastoid. I noticed it when I was shaving one day. The next day it was still there, and gradually got larger and oval shaped, broad based, regular edges and relatively hard to palpation.

I thought, “Oh, I’ve got a root canal going bad,” and snapped some PAs and a new pano – all looked fine intraorally.

I took some amoxicillin for 10 days and convinced myself it was regressing – but it wasn’t. I went to one ENT who looked at it and said, “We’ll get you into the surgery center and get that lymph node out.” When I asked about a biopsy he said it would be a total excisional biopsy. That didn’t set well with me so I made another appointment with someone else, which got cancelled at the last minute by that office when the doc had a schedule change.

So I scheduled with a third ENT who got me in within five days and did a fine needle aspiration of the node, looked at my nose and throat with fiber optic (they have a neat device for delivering atomized zylocaine to the area that we need for dentistry) and ordered a CT with contrast, which I stuck around that day to have done in the hospital.

A few days later I got a call saying the CT was non-diagnostic, that I had too much dental work to get any info. Then the call about the results of the aspiration and the fishing expedition to see if I could come up with $25K for that doc to continue with me.

To be continued.

angelfish
Posted: 5/29/2009, 12:36 a.m.
So on June 22 I will have a surgical procedure to remove the cancer areas, using a gamma knife, and also a modified radical neck dissection. There is a 95 percent probability that I will not need radiation or chemo. The surgeon says these last modalities have lifelong complications and are almost never needed for this cancer in his hands.

He further told me that the squamous cell CA can be either keratinized or non-keratinized [remember learning about this in school?]. Interestingly enough, non-k squamous is often viral in origin, 75 percent of the time being due to the HPV virus!

He was also very happy no one had biopsied the node, as it would have seeded the area, as stated in a previous entry.

I feel fine, although I have lost about nine pounds as food is not the most important thing in my agenda these days.

Many of my patients are aware of my situation, and the response has been very gratifying, including prayers, cards, vitamins and religious medallions. There are a lot of really good people out there, and it’s also amazing how many people have had some sort of cancer in their personal history.

It looks like the surgery and hospital bills will be in the neighborhood of 100K, but it’s just money and I can work to pay it off. The main thing is surviving, for myself and for my family and friends.

One of my dental classmates is sending me many jokes and amusing photos every day; another had me out to his lake for “fishing therapy.” Most people don’t know there is a problem, as I look fine and I haven’t broadcast the info except here on Dentaltown. After the surgery I hope to resume a normal life, except I guess I’ll look like I was in a sword duel. I’ll gladly take that in return for a few more years, say another 25 or so.

Cordially, Joe

Above was Joe’s last post in this particular thread. On Wednesday, July 8, 2009, Dr. Joseph Francis passed away. Below is a post from Aaron, Joe’s son.

Passing of Joe Francis
To all Townies:
This is Joe’s son Aaron
Thank you all for the kind words. He was my father, best friend, and hero. I’m thankful that he was able to touch so many people’s lives. As a dentist, as a friend, as a colleague, he wanted nothing more than to help people anyway he could, even giving them the shirt off his back if they needed it. His whole life was his work and his family. I miss him so much as I know all of you do too. Thank you all, just keep doing your thing helping those in need and loving your family and friends as he did, wholeheartedly!

Dr. Joseph L. Francis (Daddio) 9/29/1949 – 7/8/2009
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