Medication and Nursing Care for Mucositis

Treatment of mucositis

There are various (also prophylactic) measures that can be taken to support the etheric forces in the area of the mucous membrane when they are weakened by cytotoxic treatment, with the resulting ulcerations.

• Mucositis prophylaxis during radiation therapy or chemotherapy:
  Calendula ex herba D3 amp. WALA, 1 amp. per os or 10–15 drops 3x/d
  and Ratanhia comp. Mouthwash WELEDA (also available as Ratanhia Mundwasser),
  use diluted several times a day
  
  
• If mucositis is present:
  Basic therapy: Calendula ex herba D3 amp. WALA, 1 amp. per os daily or 10–15 drops 3x/d
  and
  Mouth Balm mixture WALA (also available as Mundbalsam flüssig), 1 pipette full in approx. 20 ml water, several times daily
  
  Rinse the mouth with 1:20 diluted Calendula tincture for external use WALA (also available as Calendula essence,  Calendula-Essenz WALA, WELEDA) and 1 tablespoon honey several times a day. 
  
  Mare’s milk (can also be given with ice cubes)   
  
  Sea buckthorn fruit pulp oil (be careful—it stains badly!)
  
  Linseed water (gruel) boiled up and drained off
  
  Marshmallow root tea covers the oral mucosa with a mucilaginous extract
  
  Propolis drops soluble in water: add approx. 15–20 drops to a glass of water and rinse out the oral cavity.
  
  Helago® Pflege-Oel (skin-care oil with chamomile and sage) apply, e.g., with cotton swabs or a finger in the mouth
  
  
• For lesions or aphthae:
  Calendula tea
  
  
• In case of irradiation of the mouth and throat as well as the mediastinum (esophageal exposure):
  a significant, almost indispensable effect on the reduction of side effects can be gained from
  
  1 tablespoon honey before and after irradiation.
  
  Possible additional rinsing of the oral cavity with 1:20 diluted Calendula tincture WALA, WELEDA (available as Calendula-Essenz WALA, WELEDA)
  or
  Sage mouthwash (available as Salbei-Mundspülung WALA MED). 
  
  Honey supports upbuilding, formative forces and has a healing effect on wounds in the areas of the skin and mucous membranes. At the same time, it has a broad antibacterial spectrum that has not yet developed any resistance.
  Note: In a study by Montallebnejad, et al. (1), 20 ml of honey was given 15 min. before, 15 min. after and 6 hrs after radiation therapy, resulting in a highly significant reduction of side effects. In another study with a simplified setting, 20 ml honey was administered 15 min before and 15 min after oropharyngeal irradiation. Mucositides WHO 3° occurred in the honey group only in 18% of those surveyed, compared to 44% in the control group, who had received mouth rinses with benzydamine (Tantum verde®). Grade 4 mucositides occurred only in 4% compared to 22% (2). In practice (as practiced, for example, at the Mayo-Clinic) also smaller quantities of honey have proven effective.
  
  Causticum D12, 5–7 drops or pill. 2x/d, can also be given preventatively.
  
  
• The following organ preparations are suitable for severe complaints:
  Pharynx, Larynx and Oesophagus Gl D15 WALA, 1 amp. s.c. 1x/d to 3x weekly.
  often combined with
  Apis ex animale Gl D15 WALA amp. (for hot feeling, swelling, pain)
  or
  Argentum nitricum D12 WELEDA amp. (in case of sharp, splintering pain),
  possibly augmented with
  Mercurius vivus D6 WELEDA, 1–3 tabs. dissolved in water. 
  
  
• In case of edema and possibly pain:
  Solum Injekt 10 ml amp. WALA i.v. 
  Note: If mucositis is pronounced, consider the possibility of oral thrush and treat it if necessary. The intramuscular administration of immunoglobulins can help with very pronounced symptoms (see technical information on Beriglobin®, which is approved for this indication).
  

  Stimulation of salivary secretion in dry mouth (xerostomia)
  

  Here it is important to consider the effect of food on the senses in an individually appropriate way: by seasoning the food vigorously and including sour foods, the patient’s perception of taste can be enhanced, saliva production stimulated and appetite improved, provided there is no mucositis. Sour foods and tastes draw in the soul body and stimulate it to action. This, in turn, stimulates the production of saliva.
  
  Sour ice cubes to suck, made from a mixture of blackthorn elixir and water
  
  Frozen pineapple pieces to suck
  The enzyme bromelain has a wound healing effect, the enzyme ananase has a cleansing effect on the oral mucosa, which often has unpleasant coatings.
  
  Encourage the patient to chew by offering bread crusts, dried fruits, gummy bears,
  chewing gum.
  
  Mouthwashes with sage tea stimulate saliva production.
  
  Always have something to drink by the bed.