Mucositis: Symptoms and Coping Methods
Mucositis is a common side effect of chemotherapy. According to
Cancer Supportive Care Programs, this side effect occurs in approximately
20 to 40 percent of patients that are treated with chemotherapy.
It also occurs in approximately 50 percent of cancer patients who
undergo both chemotherapy and radiation. Mucositis is the result
of the chemotherapy treatment causing a low white blood cell count
in the immune system. If radiation is used in conjunction with chemotherapy,
it causes the cells in the mucosal linings to die off leaving the
linings exposed.
There are several consequences that may occur due to the development
of mucositis. These include:
• Hypovolemia or a decrease in blood volume
• Electrolyte abnormalities
• Malnutrition
These consequences have the potential to be fatal if the patient
is not treated and depending on the severity of the condition.
Chemotherapy often causes nausea and vomiting. This complicates
the situation because the mucous linings in the mouth are particularly
sensitive and prone to infection and ulceration with mucositis.
Vomiting can cause the lining of the mouth and the digestive tract
to become irritated. Because cells are damaged in these mucous linings,
they are unable to heal properly and vomiting can cause complications
in the mucous lining of the mouth. Research also suggests that patients
with head and neck cancer tend to be more prone to severe mucositis
because the treatment is targeting these sensitive mucous linings
and severe damage may be caused to those cells.
Another consequence of this condition is taste loss. The amount
of taste that is lost increases in proportion to the strength and
aggressiveness of the chemotherapy treatment that the patient is
receiving. Because the mouth is already sore, eating is already
difficult. It is even more difficult for those patients who are
unable to taste their food. If a patient is unable to eat, they
begin to lose weight, muscle mass and strength. They are also unable
to have a strong immune system due to the lack of energy the body
is receiving. Adequate nutrition during cancer treatment is very
important and can be difficult without side effects such as mucositis
because the chemotherapy treatment already has a side effect of
appetite loss on its own. Mucositis only adds to the severity of
this side effect.
Coping with Taste Loss and Taste Aversion
Taste loss and taste perception is common in those people who
are receiving cancer treatments that target the head and neck area.
This condition is temporary and occurs due to the effect that the
treatment has on the taste buds of the tongue. Many patients complain
that their food tastes too bitter, sweet or even metallic. This
makes it hard for patients to eat. Time and healing often solves
the problem, however patients must learn to cope with these side
effects during their treatment. Doctors suggest that patients avoid
eating their favorite foods the day that they receive chemotherapy
so that they do not develop a taste aversion that may cause them
not to be able to eat those foods again.
If foods taste too bitter, you may try adding sweet fruits to the
meal, adding honey or a sweetener, eating meat cold or at room temperature
or marinating foods to add to their flavor. Patients can also eat
bland chicken or fish, mild cheeses, eggs or tofu instead of red
meat. These foods often taste better when they are prepared in a
casserole style and mixed with other flavors. At the same time,
be sure to brush your teeth regularly and use a mouth rinse. Patients
may also mix salt with water or use hydrogen peroxide to upset the
bacteria living in the mouth that may be causing foods to taste
bitter.
If foods taste too sweet, patients can use a product called Gymnema
Sylvestra. This is an herbal tea that deadens the taste buds to
sweets for about 20 minutes. This product should be held in the
mouth for about 5 minutes prior to eating a meal. Adding items such
as wine, beer, mayonnaise, and sour cream to soups or sauces also
helps to disguise the taste of foods that may taste badly. Breads,
potatoes, rice and plain pasta should also not have a sweet taste
and be easy to eat. Do not add butter or fats to these starches
as it will cause these foods to taste sweet. Eat bland foods, as
they are likely to taste normal instead of sweet.
Other tips for coping with taste abnormalities include eating in
a relaxed and pleasant area. This can help you relax and may reduce
taste issues. Flavorings and seasonings may also help disguise odd
tasting goods. Remember that citrus and acidic foods tend to stimulate
taste buds and can help you to overcome these taste problems. However,
the acid may irritate some patient’s mouths and you don’t
want to aggravate this problem. If you are having problems eating
properly, be sure that you are receiving adequate protein and take
supplements if necessary to ensure you are receiving proper nutrition.
A sore mouth can often be healed quickly if the patient is able
to eat properly and receive proper nutrition. When the body does
not receive nutrients the body is unable to recover as quickly.
This is also important because anorexia is also a common side effect
of chemotherapy and nutrition is important in fending off this condition
as well. Of course, mucositis makes it very difficult to eat and
may contribute to weight loss. Treatment of ulceration of the mouth
is largely supportive. It is important that you tell your doctor
about the extent of your mucositis because you want to ensure that
you receive the proper treatment for this condition. The severity
of it may be mild to severe and if left untreated it may become
very serious. It takes approximately 7 to 14 days for the cells
of the ulcerated mouth to heal. Ulceration may occur anywhere from
three to ten days after chemotherapy.
To deal with a sore, ulcerative mouth patients may use lozenges,
anesthetic gels or Chloraseptic spray to numb the mouth and ease
the pain. Frequent use of a gentle mouthwash, such as baking soda
and water can also ease pain in the mouth. Oral pain relievers such
as Advil and Tylenol are also helpful.
Importance of Dental Hygiene
While the mouth is ulcerated it is necessary to take extra care
in oral hygiene. Patients need to keep their mouths free of infection.
A good oral hygiene program should include dental cleaning, scaling,
daily brushing, and careful flossing. Patients should brush three
to four times per day with a soft toothbrush. They should take care
not to cut the gums with floss. They should also rinse their mouth
regularly with salt water or baking soda after chemotherapy. Before
the dentist performs any work, patients will want to have their
blood counts checked to be sure that the mouth could heal should
it become infected.
If brushing is painful for the painful, patients may try softening
their toothbrush by soaking it in warm water. Baking soda is also
often easier to brush with, as it does not irritate the mouth as
much as commercial toothpaste. Biotene toothpaste is also non-irritating
can help to control bacteria through natural salivary enzymes. Patients
should also avoid commercial mouthwashes. Alternatives to toothbrushes
include cotton swabs or Q-tips. Toothetes are also helpful as they
are sponge tips containing toothpaste.
Steer Clear of Infections
A patient’s main goal with mucositis is to stay clear of
developing infections. The body already has a low white blood cell
count due to the treatment they are receiving and healing takes
considerably longer than it would in a healthy individual. Many
patients often vomit and are nauseous during chemotherapy
treatment, which makes it even more difficult for the patient
to eat and provide the body with the energy that it needs. The combination
of low nutrition and low white blood counts means that the body
is hindered in its ability to heal itself. This means that it is
imperative for the patient suffering mucositis to avoid any and
all infectious contacts.
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