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Mouth Sore


Don Wood

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Lucie had the first part of her second chemo cycle this week -- Navelbine and Gemzar. She has since developed soreness in her throat and mouth. She did not have this when she took Navelbine alone, so it may be the Gemzar.

If anyone has info on either Gemzar or Navelbine as far as mouth and throat soreness, would appreciate the info, especially specific treatments to ease. Right now, I'm giving her the old-fashioned salt water gargle and, of course, the great stand-by, ice cream! Thanks. Don

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I had some mouth sores from Carbo and Taxol and can sympathize with Lucie. I had cisplatin and Gemzar the second time I had chemo (2/05 - 6/05)and didn't have any mouth sores. The cisplatin made me really sick, but my reaction to the Gemzar (every other time I received only Gemzar)was very mild. By the way, fudge sauce on the ice cream might be good for Lucie, too. How many more treatments?

Muriel K

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Hi Don & Lucie, Here's some info I found. Hope this helps some.

Mouth Sores due to Chemotherapy

Other terms: mucositis, stomatitis, esophagitis, sore mouth

What is mucositis (mouth sores) and what is its relationship to chemotherapy, radiation, and other cancer treatments?

Mucositis is an inflammatory reaction of the mucous lining of the upper gastrointestinal tract from mouth to stomach (mouth, lips, throat) and surrounding soft tissues.

Stomatitis refers to inflammation in the mouth.

Esophagitis refers to inflammation of esophagus.

Mucositis refers to all mucous linings.

This response is due to certain chemotherapeutic drugs, biologic response modifiers, radiation therapy, and/or surgery. This reaction may progress to painful ulcers and infection, interfering with eating, talking, taste, chewing or swallowing and often lasting a few days.

Mucositis is a self-limiting condition, currently there is no agent available to consistently prevent or treat this condition. The goal is to decrease the severity and duration of mucositis and to provide relief of discomfort, and prevent or treat infection until recovery.

Things you can do to manage oral problems and bad mouth sores from chemotherapy:

*Keep mouth and lips moist:

*Rinse mouth with water frequently (every 2 hrs while awake & when awake during the night). May add salt or baking soda (1/2 to 1 teaspoon in 8 ounces of water).

*Use saliva substitute (commercially available) if needed.

*Apply lip moisturizer often (i.e. chap stick).Suck on hard candies.

*Keep mouth & teeth clean.

*Use soft-bristle toothbrush (can soften even more by placing brush in very warm water), cotton swabs, mouth swabs (popsicle stick covered with gauze) to clean teeth after each meal and at bedtime.

*Clean dentures and/or bridge after eating. Leave out dentures if experiencing any discomfort.

*Floss gently with unwaxed floss (if platelet count adequate).

*May use Water-Pik.

Avoid:

*Mouthwash containing alcohol.

*Lemon glycerin swabs.

Treat the discomfort/pain.

*Use topical or local agents such as Orajel, or Zilactin-B apply generously.

*Combination mouth wash can be made (ingredients may require prescription).

Use equal parts: xylocaine viscous solution, Zovirax® (alcohol-free), and Maalox®, or Mylanta®.

Take 2 teaspoons every 2-4 hours as needed (swish around mouth and spit out).

*May be advised by healthcare provider to swallow if experiencing discomfort while swallowing.

For severe pain:

*oral or intravenous pain medication* may be required in addition to topical medication .

(* prescribed by healthcare provider).

Enhance healing:

*Apply Orabase®, Ulcerase®, etc. to irritated areas in mouth or on lips.

*Apply Vitamin E (puncture cap 400IU and squeeze onto swab. Gently place swab on open area(s).

*Take an antacid 1/2-1 ounce every 3-4 hours as needed to decrease burning sensation.

*Maintain good nutrition focusing on high protein and high calorie foodswhich are soft and/or semi liquid (i.e. scrambled eggs, puddings, blenderized or pureed foods).

*May use liquid supplements (i.e Carnation Instant Breakfast®, Ensure®, Boost®, etc.).

Avoid:

*Hot, spicy, coarse or rough textured foods.

*Very hot or cold beverages and foods.

*Citric juices or foods containing citric acid (tomatoes, oranges, lemon, etc.).

*Alcoholic beverages or tobacco products.

*Liquid medication containing alcohol (i.e. some cough medicine) if not essential.

Drugs that may be prescribed by your doctor to treat bad mouth sores resulting from chemotherapy, radiation, or other cancer treatments:

To treat or prevent infection the following may be used:

Antifungals: Such as nystatin,clotrimizole, fluconozole

Antibacterials: Mouthwash antiseptic, rinses are the basis of the oral decontamination regimen.

Chlorhexidine gluconate (Peridex®, PerioGard®).

Brush and floss teeth, and completely rinse toothpaste from mouth, before using rinse.

Antivirals: Such as acyclovir (Zovirax®) or famciclovir (Famvir®)

To protect Gastrointestinal (GI) tract from irritants:

Gastrointestinal agents: Sucralfate (Carafate®), comes in a liquid suspension form, protects the lining of the mouth to the stomach from irritants.

Analgesics for pain control

If you feel your chemo, radiation, or other cancer treatments have resulted in bad mouth sores or other oral issues, the following guidelines suggest when to call your doctor or healthcare professional:

*Temperature greater than 100.5 F (38 C).

*Sores or ulcers in mouth or on lips that interfere with eating, drinking or sleeping.

*Pain or any sign of infection ( i.e tongue heavily coated).

*Symptoms increasing in severity despite above recommendations.

*Always inform your health care provider if you experience any unusual symptoms.

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My oncologist prescribed this for me when I had difficulty eating post

chemo and radiation:

The pharmacist made it up for me.

Directions: swish and spit about 1 spoonful (fifteen mls) every 30 minutes as needed, esp before

eating. (You can swallow a teeny bit)

Mouth rinse:

25 cc of liquid Benadryl, 25 mg/cc stock solution

25 cc of Maalox

25 cc of lidocaine, viscous, 2% solution

25 cc of nystatin liquid.

-----------------------------------------

There is also a premix similar to the above available in the Wash DC

area by prescription called Gel-claire, but the nurse had no firsthand

knowledge of it.

Hope this helps!

XOXOX

MaryAnn

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Don, glad to hear that Lucie is feeling better. I am assuming the prescription you got may have been for the "Magic Mouthwash" that others have mentioned. Our oncologist prescribed this for Dennis and I can tell you that I know why they call this stuff magic. It really worked like a charm for him.

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I used the standard remedy of baking soda and salt mixed with water after every meal or snack (and in between) Also the onc nurse gave me some samples of UlcerEase mouth rinse that worked very well. I'm not sure if this is an RX or OTC though. Even Cepacol Throat Lozenges worked fairly well. I couldn't stand using the "Magic Mouthwash". It made my mouth and throat so numb I felt like I was choking to death and I would get panicky! Sometimes I'm such a wimp. And as others have mentioned, popsicles, ice cream and jello feel really good.

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Don....I was just organizing some of Bob's paperwork and stopped and reread notes from the mutritionist. She says vitamin E helps mouth sores. The only ones that Bob had were from acid reflux during radiation and his dentist gave him a perscription...Hope Lucy has found some relief. Diane

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