I am hoping to get some advice from our Palliative Medicine expert readers on a problem that seems really vexing. Over the past year or so, we have admitted a number of patients on our inpatient service with chemotherapy (or XRT) related mucositis-- A very painful inflammation of the mucous membranes in the mouth and throat.
I can only imagine how awful this must be. When I have had small localized apthous ulcers (canker sores), I have found them to be difficult and painful---more distressing than one would expect from somthing all the textbooks call a very common benign problem. I can't imagine what it must feel like to have the equivalent of one of these ulcers over the whole mouth and throat. The patients I have seen with mucositis are miserable. They are in pain, and it hurts just to talk or eat. In fact, it seems many develop additional complications because the pain prevents them from eating and drinking.
I have not found our treatments for mucositis to work very well. It seems patients suffer a great deal till the episode runs its course. So my question for our Palliative Care experts:
How do you treat chemotherapy related mucosits? Do you have any remedies that you have found successful and helps your patients through these episodes?
by: [ken covinsky]
I can only imagine how awful this must be. When I have had small localized apthous ulcers (canker sores), I have found them to be difficult and painful---more distressing than one would expect from somthing all the textbooks call a very common benign problem. I can't imagine what it must feel like to have the equivalent of one of these ulcers over the whole mouth and throat. The patients I have seen with mucositis are miserable. They are in pain, and it hurts just to talk or eat. In fact, it seems many develop additional complications because the pain prevents them from eating and drinking.
I have not found our treatments for mucositis to work very well. It seems patients suffer a great deal till the episode runs its course. So my question for our Palliative Care experts:
How do you treat chemotherapy related mucosits? Do you have any remedies that you have found successful and helps your patients through these episodes?
by: [ken covinsky]
Comments
There is some data on prevention (tho there is most for prevention pre-radiation)
I have also used oral morphine solutions with some success.
Sorry I do not have more
I also use probiotics, but have no idea if they help (have not seen evidence).
Meg Wallhagen
Rx Magic Mouthwash
1) Nystatin 60 cc
2) Viscous Xylocaine 60 cc
3) Maalox 60 cc
4) Benadryl sol'n 60 cc
Total volume = 240 cc
sig 5 cc PO (swish) q2 hrs prn.
Tetracycline is used in older recipes but has fallen into disfavor.
Try it & best of luck!
Robert Killeen MD
I found the following OTC lifesavers and have written up an article detailing them at http://azam.org/archives/chemo.html. Please read and share.
In brief, I found great relief from:
*Gelclair (oral mucositis)
*Slippery Elm Bark Lozenges (oral mucositis)
*Carafate (gastritis)
*Aloe Vera Juice (colitis)
*Belladonna (colitis)
Most of the inpatients I've met with chemo-induced mucositis did not care for the benadryl-maalox-xylocaine mixture we used.
We often try prophylactic NS with baking soda both for moisture and pH alteration.
Laura Hertz, NP-C, OCN
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