Back pain? Spine practitioner aims to get patients best possible treatment


Denise Karsten is someone you might not expect to find in the office of a neurosurgical practice, but she’s an important part of the Upstate Brain and Spine Center team. Karsten, a chiropractor and registered nurse, is a primary spine practitioner who this year began working alongside the neurosurgeons.

Her role is like that of a primary care provider, whose focus is on the spine. Most of her patients suffer from back and neck pain.

Karsten cites studies showing that seeing a primary spine practitioner can decrease a patient’s chances of an episode of back pain becoming a chronic, disabling condition.

“It’s all about how fast we act and delivering appropriate care at the first visit with the most appropriate provider,” she explains. The first visit with Karsten usually takes more than an hour. She asks dozens of questions about the pain, such as when it began, what it feels like, its location and what provokes it. She performs a neurological and orthopedic examination and reviews any imaging tests with the patient. This can help identify the cause of the back or neck pain.

It’s Karsten’s job to either give the patient tools to help alleviate or manage their pain, or to help them find an intervention that will help. This might include acupuncture, massage therapy, weight loss, physical therapy, chiropractic care, psychological support or surgery.

To make an appointment, call the center at 315-464-6386.

health-winter-2017cvr This article appears in the winter 2017 issue of Upstate Health magazine. Hear a radio interview/podcast about spine care with Karsten from Upstate’s “HealthLink on Air.”

Posted in bones/joints/orthopedics, brain/spine/neurosurgery, disability, health care, HealthLink on Air, physical therapy/rehabilitation, surgery | Tagged , , ,

Got a couple hours to help save lives? Donate platelets

Scott Goodrich prepares equipment for a platelet donation at the Red Cross Center in Liverpool, NY. Photo by Susan Keeter.

Scott Goodrich prepares equipment for a platelet donation at the Red Cross’ Liverpool Blood Donation Center. Goodrich is a phlebotomist, someone trained to draw blood from patients. (PHOTO BY SUSAN KEETER)


“What if you could do one thing on Monday that might save a cancer patient’s life on Wednesday?” That’s the message from a Red Cross video encouraging platelet donation.

I’ve donated blood since high school but learned about platelet donation just a few weeks ago when I got an email appeal from the American Red Cross. Platelets are the cells that help form blood clots and control bleeding. They’re clear, and a bag of them is caramel-colored. For years, my mother-in-law needed platelets for treatment of myelodysplastic syndrome, a condition that can occur when the blood-forming cells in bone marrow are damaged.

What I didn’t know then was that I could have donated platelets that would have helped her or someone else with a blood disorder, cancer or an organ transplant.

A bag of freshly donated platelets.

A bag of freshly donated platelets.

Donating platelets takes longer than a standard whole-blood donation (about two hours for the donation, plus the time for registration, etc.) and usually requires needles in both arms, which restricts movement. But, when I donated platelets, I was relaxing on a recliner, covered in a blanket, watching a movie. The 2½ to three hours needed for a platelet donation seems time well spent, given that every 30 seconds someone in the United States needs platelets. Platelets are delicate and must be used within five days, but individuals can donate them every seven days.

It’s an impressive process. At the Red Cross’ Liverpool Blood Donation Center on Oswego Road, three walls of a warehouse-sized room are lined with reclining chairs, and an apheresis machine sits between each set of chairs. The donor’s blood goes into the machine in tubes and is spun by a centrifuge to separate the red and white cells, platelets and plasma. The platelets go into a pint bag for donation, and the red blood cells go back into the donor’s veins.

Of course, whole-blood donation is a lifesaving gift, as well, and Upstate University Hospital makes it easy to donate. Upstate offers blood drives as many as eight times a year at both its downtown and Community campuses, and several times at other sites, including the Upstate Bone and Joint Center.

With a whole-blood donation, a pint of blood is collected, and the components — red and white cells, platelets and plasma — are separated afterward for use. Individuals can donate whole blood every 56 days.

Check out Upstate’s schedule of blood drives. If none of those dates works for you, go to the Red Cross website, type in your ZIP code and search for blood drives that are convenient for you. Blood drives are held throughout the community at places like schools, churches, shopping malls and hospitals, including Upstate. You can also use the Red Cross site for details on scheduling a platelet donation.

Upstate University Hospital, downtown campus, will host blood drives on Thurs., Jan. 19, 8:30 a.m. to 5 p.m., and Fri., Jan. 20, 7 a.m. to 1 p.m., in the second floor cafeteria, 750 East Adams St., Syracuse. The public is welcome to donate. Email to register. Photo ID required to enter hospital. Photo by Robert Mescavage.

Upstate University Hospital’s downtown campus will host blood drives 8:30 a.m. to 5 p.m. Jan. 19 and 7 a.m. to 1 p.m. Jan. 20 in the second floor cafeteria of the hospital, 750 E. Adams St., Syracuse. Walk-ins are accepted, or email to register. A photo ID is required to enter the hospital. (PHOTO BY ROBERT MESCAVAGE)


Posted in cancer, community, health care, illness, organ donation/transplant, patient story, surgery, technology, volunteers | Tagged , , , ,

Navigating through a cancer diagnosis

Holly Briere is a nurse navigator who helps patients with cancers of the liver, gallbladder and pancreas. The Upstate Cancer Center also has nurse navigators who specialize in other types of cancer. (PHOTO BY ROBERT MESCAVAGE)


While each person’s cancer journey is unique, patients are likely to encounter similar  services and treatment options along the way.

Holly Briere, a nurse navigator specializing in cancers of the liver, gallbladder and pancreas, guides us through what the experience may entail. The Upstate Cancer Center offers nurse navigators who specialize in various types of cancers.

STEP ONE: Initial referral to a cancer doctor

A patient’s primary care doctor may refer him or her to a physician at the Upstate Cancer Center for assistance in diagnosing cancer, or for expert care after a cancer diagnosis. Depending on the situation, the first appointment could be with a medical oncologist, a surgeon or a radiation oncologist.

STEP TWO: Meeting the nurse navigator

A nurse navigator becomes the point of contact for patients at the Upstate Cancer Center. The navigator helps coordinate appointments, answer any questions and arrange for services that go beyond standard medical care. “I’m somebody they can always count on,” says Briere.

STEP THREE: Creating a personalized care plan

The patient’s cancer center physician discusses his or her case with a team of doctors, nurses, technicians and other caregivers during weekly multidisciplinary meetings. Each team member can contribute expertise toward the best care plan for the patient, which may include one or more of the therapies listed below in step four:

STEP FOUR: Treatment

— Medical oncology: Chemotherapy refers to any of a variety of medications that are used separately or in combination, in specific dosages and over particular time spans as a method of treating cancer. Sometimes chemotherapy is prescribed as the only treatment. Sometimes it precedes other treatments. It may also be used at the conclusion of primary treatment, to help lower the risk of recurrence.

Among the radiation oncology technology available at Upstate is the Vero, a sophisticated machine that allows tumors to be pinpointed and radiation delivered with precision.

— Radiation oncology: A variety of external beam radiation therapies is available to help shrink tumors before surgery or eliminate microscopic cancer cells after surgery. Today’s advanced radiotherapy machines deliver radiation with unprecedented precision. Brachytherapy is also an option, for tumors that are likely to respond to the temporary placement of tiny radioactive sources.

— Surgery: A surgical team may operate to remove a tumor from a patient with cancer. Surgeons are also involved in the installation of ports to ease chemotherapy administration.

— Palliative care: Depending on the patient’s wishes, a palliative care plan may be crafted to focus on relief from the symptoms and stress of cancer.


STEP FIVE: Survivorship

A patient’s basic health needs changed after a cancer diagnosis. The survivor wellness team at Upstate works with existing health care providers to ensure comprehensive communication and a personalized plan for post-treatment life.

The hepatobiliary team cares for patients with diseases of the liver, gallbladder and pancreas and is one of the multidisciplinary teams at the Upstate Cancer Center. From left are Ajoy Roy, MD, gastroenterologist; Savio John, MD, gastroenterologist; Holly Briere, nurse navigator; Steve Landas, MD, pathologist; Nuri Ozden, MD, gastroenterologist; Rahul Seth, DO, medical oncologist; Dilip Kittur, MD, surgeon; Anna Shapiro, MD, radiation oncologist; Ajay Jain, MD, surgeon; Muhammad Naqvi, MD, medical oncologist; and Olivia King, nurse practitioner. (PHOTO BY SUSAN KAHN)

Other appointments 

Nurse navigators can help patients and their loved ones arrange for:

— spiritual care

— genetic counseling

— nutritional advice

— assistance from a social worker

— financial counseling and insurance coverage

— assistance with legal matters

— help conducting library research

— integrative medicine consultations

— psychological counseling

— support group information

— rehabilitation therapy

— fitness counseling

— smoking cessation help

— fertility counseling

— lodging in the Syracuse area during treatment

This article appears in the fall 2016 issue of Cancer Care magazine.



Posted in cancer, digestive/gastrointestinal, drugs/medications/pharmacy, health care, illness, liver/ gallbladder/ pancreas, medical imaging/radiology, pancreas/liver/gallbladder/bile ducts, surgery, technology | Tagged , , , , , , , , , , , ,

Personal plan: Her team crafted the best way to fight her pancreatic cancer

Gail Brehm with her surgeon, Ajay Jain, MD, associate chief of liver and pancreatic surgery at Upstate. Her coordinated plan showed good results. (PHOTO BY ROBERT MESCAVAGE)

Gail Brehm with her surgeon, Ajay Jain, MD, associate chief of liver and pancreatic surgery at Upstate. Her coordinated plan showed good results. (PHOTO BY ROBERT MESCAVAGE)


A tumor quietly growing in Gail Brehm’s pancreas invaded her stomach and surrounding soft tissues. Eventually the mass began pressing on a nerve.

Brehm, 63, a retired postal worker in Auburn, felt that pain in her lower left side. She thought she had pulled a muscle.

When the pain didn’t get better, her family doctor told her she might have a kidney stone and scheduled an imaging scan. Before she went for that appointment, Brehm says the pain became unbearable. She went to Upstate University Hospital’s emergency department in late October 2015.

“I’ll never forget it. The doctor came back in the room and said she had very unexpected results,” Brehm recalls. The scan had revealed a large tumor that appeared to be malignant.

Brehm had already survived breast cancer. Treated in 2011, she was found to have inherited a gene mutation linked to breast cancer. It was likely the new tumor was related. She was afraid.

Ajay Jain, MD, associate chief of liver and pancreatic surgery at Upstate, met with Brehm. Her biopsy revealed cancer, and he wanted to operate.

Her imaging scan, however, suggested that the tumor was very large and invading her stomach and blood vessels that feed other organs.

He decided to present her case to a team of doctors, nurses and technicians at Upstate who specialize in cancers of the liver, gallbladder and pancreas. At this weekly meeting, every cancer patient’s case is reviewed individually to come up with a personalized treatment plan. What works for one person may not be the recommended treatment for another.

Given the extensive spread of Brehm’s cancer, her team agreed surgery would be feasible only if the tumor could first be reduced.

“The goal of surgery is to cut it out and not leave cancer behind,” Jain explains. Chemotherapy, radiation therapy or a combination are sometimes key parts of the strategy. Another key aspect for patients at the Upstate Cancer Center is a nurse navigator.

Nurse Holly Briere summarizes how she serves patients with cancers of the liver, pancreas or gallbladder: “I’m somebody they can always count on.” She helps schedule medical appointments, answer questions and field requests for any sort of assistance.

For Brehm’s care, oncologist Muhammad Naqvi, MD, oversaw six rounds of chemotherapy designed to help shrink the tumor. He also prescribed medicine to quell the unrelenting nausea that caused Brehm to rapidly lose 20 pounds.

“After that very first chemotherapy treatment, the pain started to go away,” Brehm recalls. “I knew that tumor was shrinking. I just knew it.”

It was shrinking.

But not enough for surgery.



While Brehm was hospitalized over the Christmas holiday, Jain and his senior partner, Dilip Kittur, MD, chief of liver and pancreatic surgery at Upstate, stopped in to see her and consult on her care.

They reviewed new imaging scans. Jain had to disappoint Brehm. “You’re still not ready,” he told her. “The purpose of surgery is to get it all out. If I operate and leave it behind, it’s not going to help.”

Brehm’s team recommended additional chemotherapy, with a plan to consider radiation therapy if necessary.

Jain ultimately performed surgery in April, six months after Brehm’s diagnosis. He removed the back half of her pancreas, some of her stomach and soft tissue adjacent to the aorta and other major blood vessels supplying the rest of the bowel.

The pathology report showed no evidence of active disease, no cancer cells along the borders, or margins, of where the surgeon cut. “That does not mean there’s no risk of the cancer coming back,” Jain explains. “It means she had a very good response to her treatment. Given that she has no tumor at the margins, she has the best chance she could have of reducing her risk of recurrence.”

Brehm remembers the news she received after her surgery. “They told me the results couldn’t have been better. The tumor was big, and the fact that it hadn’t spread to my liver was just a miracle.”

Now the team recommends that Brehm follow up with imaging scans every three months for the next couple of years. She’s also taking a different type of chemotherapy, which Naqvi says has been shown to extend survival. Radiation may be recommended afterward.

Brehm is grateful for how well things turned out.

She had such a good outcome because of the coordination of the care she received, Jain says. Pancreatic cancer is aggressive. While chemotherapy or radiation alone may have extended Brehm’s life, they would not have offered the possibility of cure.

With the carefully orchestrated care plan Brehm’s team crafted for her – measured chemotherapy and precision radiation followed by exacting surgery — she received the best possible chance of remaining cancer free.

Bream with her oncologist, Muhammad Naqvi, MD. (PHOTO BY ROBERT MESCAVAGE)

Bream with her oncologist, Muhammad Naqvi, MD. (PHOTO BY ROBERT MESCAVAGE)

Hospital gets recognition for pancreas treatment

Upstate this fall became one of four institutions in New York and the only one outside of New York City to be designated as a National Pancreas Foundation Center for the treatment and care of patients with pancreatic cancer.

The designation, which highlights Upstate’s multidisciplinary treatment of pancreatic cancer and the array of treatment options available, required an extensive audit. To gain the designation, an institution must have expert physician specialists in oncology, gastroenterology, pancreas surgery, clinical trials, palliative care and interventional radiology, plus patient programs including pain management services and psychosocial support.

Upstate last March earned the designation of an NPF Center for Care and Treatment of Pancreas Disease.

This article appears in the fall 2016 issue of Cancer Care magazine. Hear Jain talk about surgical techniques to fight cancer and other diseases of the pancreas, gallbladder and liver in a radio interview/podcast. Hear a separate  radio interview/podcast with interventional gastroenterologist Nuri Ozden, MD, and Jane Cross, chair of the New York State Chapter of the National Pancreas Foundation, about pancreatic functions and diseases and Upstate’s recognition for its multidisciplinary treatment of pancreatic diseases.

Posted in cancer, genetics, health care, HealthLink on Air, illness, liver/ gallbladder/ pancreas, medical imaging/radiology, pancreas/liver/gallbladder/bile ducts, patient story, surgery | Tagged , , , , , , , , ,

How much do existing medical problems impact lung cancer?



When people are diagnosed with lung cancer, they usually ask about survival odds.

Doctors have used calculation methods that take into account the patient’s other diseases, known as comorbidities.

A cancer expert at Upstate suggests those calculations may be outdated.

Ajeet Gajra, MD

Ajeet Gajra, MD

Ajeet Gajra, MD, writes in the Journal of Geriatric Oncology that some diseases have a greater impact than others on the treatment for and survivability of lung cancer.

He cites one analysis that compared lung cancer patients who had multiple health problems with those who did not. The two groups of patients survived for similar lengths of time. In another analysis, patients with severe comorbidities reported a poorer health-related quality of life — but their conditions did not deteriorate significantly more than patients with fewer health problems.

Considering a patient’s other diseases is important, Gajra says, but due to the complexities of various diseases on physical function and physiologic organ function, that should be part of a full evaluation.

He shares three better predictors of a lung cancer patient’s survival: whether he or she is 1.) a cigarette smoker, 2.} age 80 or older or 3.) in poor general health.

Common ‘comorbidities’

The vast majority of Americans 65 and older have multiple health issues that could impact lung cancer treatment, including:

— High blood pressure, 73%

— Chronic obstructive pulmonary disease, 57%

— Ischemic heart disease, 53%

— Diabetes, 32%

— Congestive cardiac failure, 31%

— Chronic kidney disease, 30%

— Depression, 21%

This article appears in the fall 2016 issue of Cancer Care magazine.






Posted in aging/geriatrics, cancer, death/dying, health care, illness, research, Smoking Cessation | Tagged , , , , ,

Where cancer patients can find advice for eating right

Maria Erdman

Maria Erdman

Upstate registered dietitian nutritionist Maria Erdman recommends these resources for help eating well during and after cancer treatment. She also sees patients who are referred by physicians. Reach her at 315-464-3607.
— The National Cancer Institute makes the booklet “Eating Hints: Before, During and After Cancer Treatment” available free of charge by calling 800-4-CANCER or online.

— The book “Nutrition for the Person With Cancer During Treatment” by the American Cancer Society is available by calling 800-227-2345 or online.

— For more information on cancer research and foods that fight cancer, see the websites of the American Institute for Cancer Research or the Academy of Nutrition and Dietetics’ oncology nutrition practice group.

— “A Consumer’s Guide to Food Safety Risks” is available at, the website of the International Food Information Council Foundation.

This article appears in the fall 2016 issue of Cancer Care magazine.

Posted in cancer, diet/nutrition, digestive/gastrointestinal, health care, illness, recipe, research | Tagged , , ,

What might $50,000 help discover?

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Scientists think big, and long term. They measure progress incrementally, knowing that solutions are often years, decades, centuries in the making.

Such dedication can bring society closer to finding cures for cancer, ways to prevent the disease or extend survival.

To that end, the Carol M. Baldwin Breast Cancer Research Fund of CNY awarded grants of $50,000 each to five research projects at Upstate that just might help find:

A way to identify fracture risks

Breast cancer patients whose disease spreads to bone are at risk for disabling fractures. If there were a reliable method of predicting which bones were most likely to break, surgery could be done to reduce the risk. Orthopedic surgery professors Timothy Damron, MD, and Kenneth Mann, PhD, are testing a way of identifying fracture risks using computerized tomography and a structural stress analysis. The Baldwin grant money will allow them to further verify the sensitivity and specificity of this method.

A means of stemming the spread of breast cancer

Breast cancer becomes deadly when it spreads, so some researchers are focused on impeding tumor cell migration. Assistant professor of urology Dimitra Bourboulia, PhD, explains that tumor cells migrate once a group of enzymes called matrix metalloproteinases degrade structural protein barriers. She’s looking at natural inhibitors to these enzymes, hoping to understand their impact on tumor cell invasion – and come up with a new treatment strategy for metastatic breast cancer.

A route to targeted therapy

Most human cancers evolve from genetic mutations that occur due to gene damage during a person’s life. One form of damage is chromosomal DNA strand breakage, which cancer cells exploit to rearrange the genome and adopt abnormal behaviors. Wenyi Feng, PhD, an assistant professor of biochemistry and molecular biology, maps chromosome breaks in breast cancer cell lines using a novel technology called Break-seq. If proven sensitive enough, the technique could ultimately be used to help doctors prescribe targeted therapy.

A deeper understanding of cell division

Heidi Hehnly, PhD, an assistant professor of cell and developmental biology, studies mitotic cell division, in which a cell splits into two genetically identical “daughter” cells. This process relies heavily on an enzyme to segregate the chromosomes into the two cells. Defects in this process lead to the progression of cancers. Hehnly’s lab is working to understand exactly how.

A safer way to deliver medication

Not all medications have the ability to cross into the brain from the bloodstream, but a cancer drug called cabazitaxel does. It was developed for use when other drugs stop working, so it holds promise for treating cancers and brain metastases, such as breast cancer that has spread to the brain. The problem is, the drug harms other organs with which it comes into contact. That’s why Juntao Luo, PhD, an assistant professor of pharmacology, and Vivian Gahtan, MD, the division chief of vascular surgery and endovascular services, will study whether a nanocarrier delivery system developed in their lab can safely transport cabazitaxel into the brain to treat breast cancer brain metastases, while sparing healthy tissue.

This article appears in the fall 2016 issue of Cancer Care magazine.

Posted in bones/joints/orthopedics, cancer, drugs/medications/pharmacy, genetics, health care, illness, medical imaging/radiology, research, surgery, technology, urology, women's health/gynecology | Tagged , , ,

Art from adversity: Students transform radiation masks into artistic décor

Mask sculpture by Amina GIngold. (PHOTO BY WILLIAM MUELLER)

Mask sculpture by Amina GIngold. (PHOTO BY WILLIAM MUELLER)


“Everything will be OK. I’ll be in a better place. I love you.”

Amina Gingold’s mother spoke these words to her while dying of colon cancer.

Gingold paid tribute to her mother by embellishing these phrases with paint and flowers as a way to transform suffering into beauty.

Gingold and six other Manlius Pebble Hill School students in the advanced studio art class created art out of radiation masks used to treat head and neck cancer as part of Beneath the SurFACE, a project organized by the Upstate Cancer Center. Eight schools and 25 professional artists from Central New York participated in the project, which also educated the artists about these cancers.

Gingold lost her mother, Naomi Chernoff, in fifth grade.

“I wanted it to be something meaningful for the cause,” said Gingold, who graduated last June. “I thought I would make an ode to her.”

Gingold painted her mask white with tears flowing from its closed eyes. Clustered in the blue are vibrant flowers, representing beauty growing out of pain.

Creating beautiful art from unimaginable ordeals was no simple task, however. Teresa Henderson, chair of the visual art and design department and class instructor, described the difficulty of doing justice to a cancer patient’s experiences through the masks.

“Because it’s such a big topic and it’s such a real topic,” Henderson said, “the topic has to be treated with a level of respect, but it also needs to have the balance of the artistic voice as well.”

Six MPH masks, including Gingold’s, were auctioned off at the Upstate Cancer Center in April. The auction raised more than $6,000 for the center’s head and neck cancer patient fund. Upstate also produced a documentary about the project designed to serve as an educational tool for cancer prevention. MPH students were interviewed for the film.

Going forward, Henderson hopes the masks will be informative tools in the community. “Art isn’t something that just hangs on the wall,” she said. “Art is something that has the ability to engage, it has the ability to advocate, and it has the ability to bring more information and more awareness.”

This story by Lily Grenis, a student at MPH, first appeared in her school publication, the Pebble, and was reprinted in the fall 2016 issue of Cancer Care magazine.


Posted in adolescents, cancer, death/dying, fundraising, grief/loss, illness, medical imaging/radiology | Tagged , , , , ,

Upstate med student had a hand in PBS cancer documentary

Images from the documentary "Cancer: the Emperor of All Maladies."

Images from the documentary “Cancer: the Emperor of All Maladies.”


When Raghib Siddiqui was in his junior year of studying neurosciences and English at SUNY Stony Brook University on Long Island, he looked for work that would nurture his twin interests of science and writing.

He came across an internship opportunity he describes as “an interesting confluence of the two.” His background in biology and his college writing samples helped get him hired.

Raghib Siddiqui is a first-year medical student at Upstate. (PHOTO BY SUSAN KEETER)

His job was to research and tell the complete story of cancer, from prehistory to the present, and make it easily understandable to the crew of a film production company. The crew was making the documentary “Cancer: The Emperor of All Maladies,” based on the Pulitzer Prize-winning book by Siddhartha Mukherjee, MD, PhD. The six-hour film premiered on PBS in 2015.

Siddiqui, 26, now a first-year medical student at Upstate, worked on the project for 15 to 20 hours a week in New York City, continuing for about a year after his 2012 graduation.

“We were trying to catalog the history of cancer from the earliest recorded history, from Hammurabi and ancient prehistory, trace it down through the advent of chemotherapy, surgical procedures to remove tumors, down to the present day — a millennium of living with the disease,” he says. “My job was to look at trends in cancer all across the world, so we could break it down into key terms,” he says.

Siddiqui focused on the history of chemotherapy, which from its earliest days, about a century ago, competed with the long-established cancer treatment of surgery. “Eventually, chemotherapy proponents and surgeons worked together in a clear analogue of what we have today,” he explains.

Siddiqui got a master’s degree in biomedical sciences from Tufts University before coming to Upstate. He says with his penchant for carpentry and building things, he is leaning toward a surgical career, probably in pediatrics.

See the film

Visit to watch the documentary “Cancer: The Emperor of All Maladies.” It’s also available for purchase at

This article appears in the fall 2016 issue of Cancer Care magazine.


Posted in cancer, drugs/medications/pharmacy, entertainment, health care, history, illness, international health care, medical student, research, surgery | Tagged , ,

Coping with mouth sores from cancer treatment


People with mouth sores can use a rinse made from 12 ounces of warm water, ¼ teaspoon baking soda and ½ teaspoon salt.


What they are:

Mouth sores that develop during chemotherapy and/or radiation treatment are called “oral mucositis.” They look like burns. Often they appear on the inside lining of the mouth or lips. You may notice them on your gums, tongue or the roof or floor of your mouth. They may also appear on the esophagus, the tube your food travels into the stomach.

Whether they form depends on the type and dose of chemotherapy you are taking, or the area and dose of radiation delivered if you are taking radiotherapy.

How they form:

Many cancer treatments are designed to kill rapidly growing cells. Cancer cells grow rapidly, but so do the cells that line the inside of your mouth. When these healthy cells are damaged, mouth sores may develop. This can range from a minor inconvenience to a severe complication that could impede eating, talking, swallowing and even breathing.

Why they matter:

Untreated, mouth sores can lead to infection, painful ulcers or the inability to eat and drink, and cancer treatment can be affected.

How they’re treated:

Doctors can prescribe medications that coat the entire lining of the mouth, so the sores are protected and the pain is lessened. Topical painkillers may be used for numbing.

What you can do:

  • Make sure your dentist is aware you will be undergoing chemotherapy or radiation therapy and ask about taking care of any unresolved dental issues such as gum disease, cavities or teeth that need to be pulled.
  • Tell your doctor if you have a history of mouth sores. Antiviral medicines are sometimes prescribed for people who get frequent mouth sores from the herpes simplex virus.
  • Floss with caution. If you have dentures, clean them at least once a day, wear them only when necessary and make sure they fit properly.
  • Rinse your mouth frequently while awake and if you awaken during the night. Use a solution of 12 ounces of warm water, ¼ teaspoon baking soda and ½ teaspoon salt.
  • Brush your teeth with a soft-bristle brush after every meal, using a non-irritating toothpaste as recommended by your dentist.
  • Check your mouth three or four times a day for sores or any changes – and keep your doctor posted.
  • Keep your lips and mouth moist. Drink 1 to 2 liters of fluid per day. Use a lip moisturizer. Suck on sugar-free candy or chew gum. Popsicles or ice can help decrease swelling and reduce pain. Consider using a saliva substitute.
  • Liquid Tylenol or Advil may help relieve mouth pain. Your doctor or nurse can recommend prescription options if necessary.
  • Maintain good nutrition, eating foods and liquids that are easy to swallow. Cut your food into small pieces. Or, you may need to use a blender to mix your food with a liquid.
  • Foods high in protein are the best choice. You may also include daily servings of liquid supplements such as Ensure, Boost or Carnation Instant Breakfast. Seek a referral to a nutritionist if you would like help.

What you should not do:

  • Do not assume you can crush medication if you are having trouble swallowing. Speak to your pharmacist first.
  • Do not use alcohol-based mouthwashes, which can dry out your mouth.
  • Do not use alcohol, caffeine and tobacco, as these can cause your mouth to dry out.
  • Do not eat extremely hot or cold foods or fluids, and avoid foods that are spicy or contain citric acid to avoid mouth irritation.
  • Do not eat foods that are hard, crunchy or chewy because they can irritate your mouth.

This article appears in the fall 2016 issue of Cancer Care magazine.


Posted in cancer, diet/nutrition, health care, illness | Tagged , , , , , , , ,