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Alert Number 73

Oral Sores Can Get Pretty Ugly

Date: January 30, 2005

The other day I spent 4 hours in the infusion room as my husband got his Rituxan therapy, part of his annual RHK protocol (Rituxan + Neulasta + EGCG with the new addition of omega-3 rich fish oil). I spent the time to chat with the nurses, they have a lot of practical information that is often hard to come by.

I noticed that the nurse handed out frozen popsicles (flavor of your choice, but sugar free) well before she started up the chemo infusion for several women who were there, breast cancer patients. The infusion room had a refrigerator that was stocked with a dozen boxes of popsicles, and the nurse made sure a new one was available to suck on, as soon as the patient finished the prior one. She had the patients working on the popsicles well before she even had them hooked up to the IV. I asked her why she did this. The answer was startlingly simple: oral mucositis, fancy name for severe mouth sores from hell.

Most chemotherapy drugs target rapidly growing cells, such as cancer cells but unfortunately also cells lining the inside of your mouth, GI tract etc. A very significant majority of patients undergoing chemotherapy end up with lesions in the membranes on the inside of their mouth, as a result of the chemotherapy. These breaks in the protective lining of the mouth are immediately colonized by the huge variety of pathogens in your mouth. You are not alone in this, we all have flourishing colonies of bacteria in our mouths and GI tract, that is just the normal state of affairs. The problem is that in the case of cancer patients, we are talking about people with suppressed immune systems, especially during and immediately after therapy. The combination of mucosal lining of the mouth coming under attack due to chemotherapy, plus a ready supply of pathogens present in the mouth, plus an immune system that is not up to the job of clearing out the infections, all this adds up to severe mouth sores.

These are often not your average "cold sore" or "fever blister" that does little more than crimp your social life. These are mouth sores from hell, sores that hurt, that may make it hard for you to eat or drink, even smile. When they get serious enough, they may interfere with sticking to the delivery of chemotherapy on schedule, they cause excessive weight loss, and surely excessive loss of quality of life.

How does sucking on popsicles work? The ice-cold popsicle cools down the inside of the mouth, which in turn causes the capillaries to shrink and the blood flow to the inside of your mouth reduce drastically. Less blood flow means less drug delivery to the mucous membrane on the inside of your mouth, less damage to the cells lining the inside of the mouth, less lesions due to chemotherapy, less mouth sores. So simple, so easy, so useful! The nurse told me that almost none of her chemotherapy patients ever develop serious oral sores and she could not imagine why all infusion centers to do not follow this simple procedure. Suggest this to your oncology nurse, the next time you are in for therapy. If this simple and yet important preventive measure is not practiced in your doctor's office, you might want to think about taking in a little cooler with sugar-free popsicles for your own use.

We discussed oral mucositis and its dangers in a recent article on the website, here is a link to read it: A Real Pain in the Mouth.

Be well.


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