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Sore Mouth or Throat
Mouth sores, tender gums, and a sore throat or esophagus often result from radiation therapy, chemotherapy, or infection. If you have a sore mouth or gums, see your healthcare provider to make sure the soreness is a treatment side effect and not an unrelated dental problem. Your healthcare provider may be able to give you medicine that will control mouth and throat pain.
Your dentist can also give you tips for the care of your mouth. Certain foods will irritate an already tender mouth and make chewing and swallowing difficult. By carefully choosing the foods you eat and by taking good care of your mouth, teeth, and gums, you can usually make eating easier.
You might want to try soft foods that are easy to chew and swallow, such as:
- Bananas, applesauce, and other soft fruits
- Peach, pear, and apricot nectars
- Cottage cheese
- Mashed potatoes
- Macaroni and cheese
- Custards, puddings, and gelatin
- Scrambled eggs
- Oatmeal or other cooked cereals
- Pureed or mashed vegetables, such as peas and carrots
- Pureed meats.
It's also important to avoid foods or liquids that can irritate your mouth. For some people, these include:
- Oranges, grapefruits, lemons, or other citrus fruits or juices
- Tomato sauces or juice
- Spicy or salty foods
- Raw vegetables, granola, toast, crackers, or other rough, coarse, or dry foods
- Commercial mouthwashes that contain alcohol.
Other ideas for taking care of a sore mouth or throat include the following:
- Cook foods until they are soft and tender
- Cut foods into small pieces
- Use a blender or food processor to puree your food
- Mix food with butter, margarine, thin gravy, or sauce to make it easier to swallow
- Use a straw to drink liquids
- Use a smaller-than-usual spoon, such as a baby spoon
- Try foods cold or at room temperature -- hot foods can irritate a tender mouth and throat
- Try drinking warm bouillon or salty broth; it can soothe throat pain
- Try sucking on ice chips
- If swallowing is hard, tilting your head back or moving it forward may help
- If your teeth and gums are sore, your dentist may be able to recommend a special product for cleaning your teeth
- Rinse your mouth often with water to remove food and bacteria and promote healing
- Ask your doctor about anesthetic lozenges and sprays that can numb your mouth and throat long enough for you to eat meals.
Chemotherapy and radiation therapy can reduce the flow of saliva and cause dry mouth. When this happens, foods are harder to chew and swallow. Dry mouth can also change the way foods taste. Some of the ideas for taking care of a sore mouth and throat may be helpful. The following suggestions may also help you deal with dry mouth:
- Have a sip of water every few minutes to help you swallow and talk more easily. Consider carrying a water bottle with you so you always have some handy.
- Try very sweet or tart foods and beverages, such as lemonade. These foods may help your mouth produce more saliva (do not try this if you also have a tender mouth or sore throat and the sweet or tart foods make it worse).
- Suck on hard candy or Popsicles, or chew gum. These can help make more saliva.
- Eat soft and pureed foods, which may be easier to swallow.
- Keep your lips moist with lip salves.
- Moisten food with sauces, gravies, and salad dressings to make it easier to swallow.
- If your dry mouth is severe, ask your healthcare provider or dentist about products that coat, protect, and moisten your mouth and throat. These are sometimes called "artificial saliva."
Dental and Gum Problems
Colon cancer treatment can cause tooth decay and other problems for your teeth and gums. Changes in eating habits may also add to the problem. Your healthcare provider and dentist should work closely together to fix any problems with your teeth before you start treatment.
If you eat frequently or eat a lot of sweets, you may need to brush your teeth more often. Brushing after each meal or snack is a good idea. Here are some other ideas for preventing dental problems:
- Be sure to let your healthcare provider know about any dental problems you are having.
- Be sure to see your dentist regularly. People who are receiving treatment that affects the mouth -- for example, radiation to the head and neck -- may need to see the dentist more often than usual.
- Use a soft toothbrush. Ask your doctor, nurse, or dentist to suggest a special kind of toothbrush and/or toothpaste if your gums are sensitive.
- Rinse your mouth with warm water when your gums and mouth are sore.
- If you are eating foods high in sugar or foods that stick to your teeth, be sure to brush or rinse your mouth afterward so that the sugar won't damage your teeth. Or, try using sugar-free varieties. Sorbitol, a sugar substitute that is contained in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of these products.
Changed Sense of Taste or Smell
Your sense of taste or smell may change during your illness or treatment. Foods, especially meat or other high-protein foods, can begin to have a bitter or metallic taste. Many foods will have less taste. Chemotherapy, radiation therapy, or the colon cancer itself may cause these problems. Dental problems can also change the way foods taste. For most people, changes in taste and smell go away when their treatment is finished.
There is no foolproof way to prevent changes to your sense of taste or smell because each person is affected differently by illness and treatments. However, the following tips should help if you have this problem (If you also have a sore mouth, sore gums, or a sore throat, talk to your doctor, nurse, or registered dietitian; they can suggest ways to help you without hurting the sore areas).
Choose and prepare foods that look and smell good to you. Here are some suggestions:
- If red meat, such as beef, tastes or smells strange, try chicken, turkey, eggs, dairy products, or mild-tasting fish instead.
- Help the flavor of meat, chicken, or fish by marinating it in sweet fruit juices, sweet wine, Italian dressing, or sweet-and-sour sauce.
- Try using small amounts of flavorful seasonings, such as basil, oregano, or rosemary.
- Try tart foods, such as oranges or lemonade, that may have more taste. A tart lemon custard might taste good and will also provide needed protein and calories. (If you have a sore mouth or throat, tart or citrus foods might cause pain or discomfort.)
- If smells bother you, try serving foods at room temperature, turning on a kitchen fan, covering foods when cooking, and cooking outdoors in good weather.
- Try using bacon, ham, or onion to add flavor to vegetables.
- Visit your dentist to rule out dental problems that may affect the taste or smell of food.
- Ask your dentist or healthcare provider about special mouthwashes and good mouth care.
Nausea, with or without vomiting, is a common side effect of surgery, chemotherapy, and radiation therapy. The disease itself, or other conditions unrelated to your colon cancer or treatment, may also cause nausea.
Some people have nausea or vomiting right after treatment; others don't have it until two or three days later. Many people never experience nausea. For those who do, nausea often goes away once the treatment is completed. There are now drugs that can effectively control this side effect. These medications, called antiemetics, are often given at the beginning of a chemotherapy session to prevent nausea.
Whatever the cause, nausea can keep you from getting enough food and needed nutrients. Here are some ideas that can help:
- Ask your healthcare provider about antiemetics that might help you control nausea and vomiting.
- Try foods that are easy on your stomach, such as:
- Toast, crackers, and pretzels
- Angel food cake
- Cream of Wheat®, rice, or oatmeal
- Boiled potatoes, rice, or noodles
- Skinless chicken that is baked or broiled, not fried
- Canned peaches or other soft, bland fruits and vegetables
- Clear liquids
- Ice chips
- Carbonated drinks.
- Avoid foods that:
- Are fatty, greasy, or fried
- Are very sweet, such as candy, cookies, or cake
- Are spicy or hot
- Have strong odors.
- Eat small amounts, often and slowly. Eat before you get hungry, because hunger can make feelings of nausea stronger.
- If nausea makes certain foods unappealing, eat more of the foods you find easier to handle.
- Avoid eating in a room that's stuffy, too warm, or has cooking odors that might disagree with you.
- Drink fewer liquids with meals. Drinking liquids can cause a full, bloated feeling.
- Slowly drink or sip liquids throughout the day. A straw may help.
- Have foods and drinks at room temperature or cooler; hot foods may add to nausea.
- Don't force yourself to eat favorite foods when you feel nauseated. This may cause a permanent dislike for those foods.
- Rest after meals because activity may slow digestion. It's best to rest sitting up for about an hour after meals.
- If nausea is a problem in the morning, try eating dry toast or crackers before getting up.
- Wear loose-fitting clothes.
- If nausea occurs during radiation therapy or chemotherapy, avoid eating for one to two hours before treatment.
- Try to keep track of when your nausea occurs and what causes it (specific foods, events, surroundings). If possible, and if it helps, change your diet or schedule. Share the information with your doctor or nurse.
Vomiting may follow nausea and may be brought on by treatment, food odors, gas in the stomach or bowel, or motion. In some people, certain associations or surroundings, such as the hospital, may cause vomiting. As with nausea, some people have vomiting right after treatment, while others don't experience it until a day or more after treatment.
If vomiting is severe or lasts for more than a day or two, contact your healthcare provider. He or she may give you an antiemetic medication to control nausea and vomiting.
Very often, if you can control nausea, you can prevent vomiting. At times, though, you may not be able to prevent either. Relaxation exercises or meditation may help. These usually involve deep rhythmic breathing and quiet concentration, and can be done almost anywhere. If vomiting does occur, try these suggestions to help prevent further episodes:
- Do not eat or drink anything until you have the vomiting under control.
- Once the vomiting is under control, try small amounts of clear liquids, such as water or bouillon (see Table 2: Examples of Clear Liquids) Begin with one teaspoonful every 10 minutes, gradually increasing the amount to one tablespoon every 20 minutes. Finally, try two tablespoons every 30 minutes.
- When you are able to keep down clear liquids, try a full-liquid diet or a soft diet (see Table 3 for examples of full-liquid foods). Continue taking small amounts as often as you can keep them down. If you feel okay, gradually work up to your regular diet. If you have a difficult time digesting milk, you may want to try a soft diet instead of a full-liquid diet, because a full-liquid diet includes a lot of milk products. Ask a registered dietitian for information about a soft diet.
Diarrhea may have several causes, including:
- Radiation therapy to the abdomen (stomach)
- Food sensitivities
- Emotional upset.
Work with your healthcare provider to identify the cause of your diarrhea so that it can be successfully treated.
During diarrhea, food passes quickly through the bowel before your body has a chance to absorb enough vitamins, minerals, and water. This may cause dehydration, which means that your body does not have enough water to work well. Long-term or severe diarrhea may cause problems, so contact your healthcare provider if the diarrhea is severe or lasts for more than a couple of days.
Here are some ideas for coping with diarrhea:
- Drink plenty of fluids to replenish what you lose with the diarrhea (see Table 2 and Table 3 for examples of fluids to try).
- Eat small amounts of food throughout the day instead of three large meals.
- Eat plenty of foods and liquids that contain sodium and potassium, two important minerals that help your body work properly. These minerals are often lost during diarrhea. Good high-sodium liquids include bouillon or fat-free broth. Foods high in potassium that don't cause diarrhea include bananas, peach and apricot nectar, and boiled or mashed potatoes. Sports drinks contain both sodium and potassium and have forms of carbohydrates that are easily absorbed.
- Try these foods:
- Yogurt or cottage cheese
- Rice, noodles, or potatoes
- Farina or Cream of Wheat
- Eggs (cooked until the whites are solid -- not fried)
- Smooth peanut butter
- White bread
- Canned, peeled fruits and well-cooked vegetables
- Skinless chicken or turkey, lean beef, or fish (broiled or baked -- not fried).
- Greasy, fatty, or fried foods if they make your diarrhea worse
- Raw vegetables and the skins, seeds, and stringy fibers of unpeeled fruits
- High-fiber vegetables, such as broccoli, corn, dried beans, cabbage, peas, and cauliflower.
- Also avoid very hot or cold food or beverages. Drink liquids that are at room temperature.
- Limit foods and beverages that contain caffeine, such as coffee, some sodas, and chocolate.
- If you have a sudden, short-term attack of diarrhea, try having nothing but clear liquids for the next 12 to 14 hours. This lets your bowel rest and replaces the important fluids lost during the diarrhea. Make sure your doctor or nurse knows about this problem.
- Be careful when using milk and milk products. The lactose they contain can make diarrhea worse. Most people, though, can handle small amounts (about 1½ cups) of milk or milk products.
Lactose intolerance means that your body can't digest or absorb the milk sugar called lactose. Milk, other milk-based dairy products (such as cheese and ice cream), and foods to which milk has been added (such as pudding) may contain lactose.
Lactose intolerance may occur after treatment with some antibiotics, with radiation to the stomach, or with any treatment that affects the digestive tract. The part of your intestines that digests lactose may not work properly during treatment. For some people, the symptoms of lactose intolerance (such as gas, cramps, and diarrhea) disappear a few weeks or months after the treatments end, or when the intestine heals. For others, a permanent change in eating habits may be needed.
If you experience this problem, your healthcare provider may advise you to follow a diet that is low in foods that contain lactose. Talk to a registered dietitian to get advice and specific tips about how to follow a low-lactose diet. Your supermarket should carry milk and other products that have been modified to reduce or eliminate the lactose. You can also make your own low-lactose or lactose-free foods.
(Click Colon Cancer Recipes to see a simple recipe for lactose-free double chocolate pudding.)