Triple Mix To Relieve Pain of Mouth Sores After Chemotherapy

Triple Mix for Mucositis from Chemotherapy

Mouth sores, medically referred to as mucositis or stomatitis, are a very common side effect of chemotherapy. Yet, while sores in the mouth would seem to be a minor concern relative to some of the potential problems, they can be one of the more annoying symptoms. Fortunately there are treatments that can may both reduce the risk of mouth sores and relieve the discomfort they cause. Since discussion of mouth sores often takes back seat to discussing nausea and low white counts for starters, let's talk about how you can reduce your risk, what do do if mouth sores are bothering you, and when you should be concerned and make a call.

Young woman rinsing mouth, leaning over sink
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Mucositis (Mouth Sores) from Chemotherapy

Chemotherapy causes several side effects, one of which is mucositis, or, in plain English, mouth sores. While good oral hygiene, avoiding hot and spicy foods, saline mouth rinses, and ice chips may provide some comfort, many people desire something more potent to relieve their pain until the mucositis resolves.

You may have heard people talk about a simple mix which dramatically reduced the pain they had from mouth sores. Let's learn about triple mix—a common remedy for mucositis caused by chemotherapy

What is Mucositis (Mouth Sores)?

Mucositis is an inflammation of the mucous membranes, which start at your mouth (oral mucositis) and goes down your esophagus (esophageal mucositis) and through your digestive system (intestinal mucositis). It can feel like a sunburn inside your body. Other features of mucositis include:

  • Redness in your mouth
  • Open sores in your mouth with ulcerations

Mucositis often begins shortly after starting chemotherapy. Pain relief until the mucositis resolves—which can be anywhere from two to four weeks after completing treatment—is important for a person's comfort and quality of life. In addition, pain control is important for a person's nutritional status. Your body is already going through enough during chemotherapy without adding inadequate nutrition due to mouth sores to the mix.

What is Triple Mix for Chemotherapy-Related Mouth Sores?:

Triple Mix is a combination of three liquids that treat and soothe oral and esophageal mucositis. The recipe can vary, and some of the ingredients are available by prescription only. The usual mix contains drugs that will stop pain, reduce inflammation, and sometimes treat a bacterial or fungal infection.

Your healthcare provider must prescribe this drug for you, and your pharmacist will need time to create it. Triple Mix must be compounded when it is ordered—meaning it has to be made at the pharmacy and does not come already mixed.

Triple mix often contains:

  • Maalox (to coat and sooth sores) or sometimes Kaopectate
  • Lidocaine (a topical anesthetic to numb the sores, similar to the numbing solution used for babies who are teething)
  • Benadryl (diphenhydramine, an antihistamine)

Other ingredients may include:

  • Nystatin (an antifungal medication which is used to treat thrush)
  • Hurricane gel or liquid (to numb pain)

There are several variations on this mix, and your oncologist is probably familiar with which mix seems to work best. Make sure to talk to her, preferably before you begin chemotherapy and develop mouth sores.

You may hear of solutions with names other than Triple mix. These include:

  • Triple Solution
  • Velvet Glove
  • Magic Mouthwash
  • GI (Gastrointestinal) Cocktail

How You Use Triple Mix

There are two ways to use Triple Mix. You can either use it as an oral rinse, swishing a dose around inside your mouth to coat all the sores and other tissues. In this case, don't swallow the Triple Mix, just spit it out.

If your mucositis is severe and extensive, you may use it as an oral rinse first, and then swallow it to get relief from pain and inflammation in your esophagus and digestive system. Wait at least 30 minutes after using Triple Mix before you eat or drink anything.

Complications of Mouth Sores

You may think of mucositis as a nuisance, but it can more than just a pain. If you are suffering from pain related to your cancer treatment, mouth sores are one more straw to add to the camel's back. Most concerning, however, is that mouth sores can interfere with your ability to eat, and eating healthy is very important to maintain your strength during cancer treatment. Other symptoms, such as a loss of appetite, nausea, or taste changes (metal mouth) can compound the problem.

If you are losing weight due to a decreased ability to eat, make sure to talk to your oncologist. We are learning that the syndrome of cancer cachexia, a combination of unintentional weight loss and muscle wasting, may be the direct cause of death in up to 20 percent of people with cancer. Catching a decreased ability to eat before it gets to that point is critical.

Oral thrush during chemotherapy is a complication which is commonly related to the steroids used but can also be a complication of mucositis. This infection, caused by the fungus Candida albicans, usually causes white plaque to develop on the tongue and the insides of the cheeks (and can resemble yogurt or cottage cheese in your mouth.) Thrush can cause burning which adds to the pain from mouth sores as well. It is usually treated with a topical cream such as nystatin, or oral Diflucan (fluconazole.)

Managing Mouth Sores from Chemotherapy

Triple mix can be helpful—enough so that many people have coined it the "miracle mix" but there are other things you can do to increase your comfort. Take a moment to learn about what to eat and other secrets for reducing pain from chemotherapy-related mouth sores

For Severe Mucositis

The use of Triple Mix and dietary modifications are often sufficient to control symptoms, yet some people require treatments that go beyond these measures. There seems to be a general thought that nothing else can be done, but that is far from the truth. Other treatments, such as cryotherapy, can be very effective in treating even the most severe mouth sores. You may be hesitant to call your healthcare provider, but do. You don't need to wait for a life-threatening emergency. If you're still hesitate please realize that practitioners would be on the phone with their oncologist asking these questions and requesting help.

Final Thoughts From Verywell

If you are suffering from chemotherapy-induced mucositis, please speak with your healthcare provider about strategies for pain relief. For those who like the "holistic" approach of Triple Mix, talk to your oncologist about recent studies which suggest that eating honey may be very effective for helping people cope with mouth sores as well. (Yet, if your white blood cell count is very low, honey is not recommended due to the theoretical risk of botulism). In addition, treatments such as cryotherapy may be used in a preventive fashion as well.

Far too often, people with cancer don't want to "bother" their oncologist with "minor" concerns. They think about all of the life-threatening conditions oncologists must be dealing with, and feel like a hypochondriac. But your oncologist truly wants to know if you are uncomfortable. Your quality of life during cancer treatment is very important. Speak up. We've reached a point at which more people survive from cancer than succumb to cancer, and it's important that we all begin to focus on the journey, and making it as comfortable as possible along the way.

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