Hi has anyone else on the forum experienced excessive saliva following radiotherapy?
I finished my radiotherapy on 31 March and suffered with the usual as described stringy saliva issue. However from the start of March I have been producing excessive amounts of saliva. For some reason I cant swallow it and seem to be constantly spitting out and wiping my mouth on a tissue. I go everywhere with a big box of tissues and get through a box and a half a day.
The oncologist suggested it was the ulcer on the side of my tongue causing my mouth to water, the ENT specialist said it wash it down with water. The dentist shaved my teeth around the ulcer but the problem persists. My GP prescribed Mucodyne but that didnt help either. It really doesnt seem to be getting any better with time. It does stop me from doing things like going out to the shops and I am at the stage I really should be doing a bit more. Someone suggested I should try Hyoscine (used for travel sickness) as this would dry my mouth.
Has anyone else experienced this, most people on here seem to have a dry mouth. Why am I different? The only time my mouth is dry is when I have been asleep and laying on my side.

This message has been edited. Last edited by: Dr Vinod K Joshi,

Hello gd

The increase in saliva could be due to stimulation of saliva production by the ulcer aggravated by an inability to swallow it. Speak to your doctor about medications that can reduce salivation like Atropine. Meanwhile, you might have to carry a small container that you can spit into.

Let us know how you get on.

Best wishes
Vinod

Thank you for your advice Dr Joshi I will book in to see my GP this week and will let you know how I get on. It would be really good to get something to help I have my brothers wedding in two weeks and would love to be able to wear some lippy instead of wiping my mouth every ten minutes. Even if the meds only helped for a few hours a day it would make a big difference. Thanks again

Hello there,
Just thought I would let you know you aren't alone on this one! ALl the other patients I met also had a dry mouth but I had excessive saliva. The doctors explained to me that the radiotherapy had inadvertently zapped some of my saliva glands on the way to my tongue and had therefore caused an imbalance of the perfect saliva cocktail most people have. Apparently it didn't zap them enough to cause a dry mouth. I was going to try Hyoscine but was quite fearful I would go from having some moisture to having a dry mouth and I think both are unpleasant in different ways. My speech therapist taught me a technique to swallow the excess saliva before I speak and this improved as healing took place in my throat after radiotherapy finished. I tried Mucodyne at one point when the saliva was very thick and stringy but it did nothing for me. All I can say is, it does get better. I finished radiotherapy in December 2006 and it has gradually improved as the months and years have passed. Hang in there and enjoy the wedding!

Thank you for your reply Susana,
I went to the GP and was prescribed Hyoscine which you can buy over the counter as they are travel sickness pills. They could be taken as and when needed and the GP advised me to take one in the evening to see how i got on with them. I took one and felt as if i had just had a bottle or two of wine and then fell asleep.
I also asked about the Atropine as advised by Dr Joshi, but he said he didnt want me to take this as the side effects were not good.
I really do not know why i cannot swallow it and i am very self concious about constantly wiping my mouth. I have started going out a lot more now but take a box of tissues with me hidden in my huge handbag, but at times the saliva issue has been so bad it has actually started making me retch although it does calm down after a few minutes.
Im ok at nights and do not have the excess saliva when i am laying on my side. I finished radiotherapy on 31 march and at times i have felt it has got better but then when i look to see how many tissues i have got through in a day i can see its just the same.
I was interested to see the speech therapist taught you a technique to swallow, i feel that this is a muscular problem and maybe also partly habit perhaps i should ask to be referred to a speech therapist who may be able to help.

The wedding was good i managed to stay till 9pm, but had to go home after that as i was so tired, but was so pleased to have been able to go out and enjoy the day.

Hi gd,

My husband had the same response following radiation for tongue cancer (tons of stringy saliva and phlegm instead of the seemingly more typical symptoms of dry mouth, or xerostomia [ZEER-oh-STOH-mee-ah]). It did take several months to abate, which is difficult to get one's head around, but hang in there. (Stephen's first joke during his long recuperation process following maximum-strength radiation: "Another day, another box of Kleenex..!")

I finally came to understand that the stringy saliva and excess phlegm is the initial phase of dry mouth -- the damaged saliva glands are still working but are not able to produce the lighter type of saliva, thus only the thicker type remains. This awareness was very helpful to me, because it seemed most people kept talking about the stinging of dry mouth and not having enough saliva, a problem that did arise later for Stephen, after the initial response of excess phlegm.

I just today found some text I'd noted a while back to post on the forum about phlegm, and am not sure I ever did - your issues are likely not as extreme as Stephen's were (the rays were focused on the back of his throat, which damaged his epiglottis, so he is still not able to swallow without aspiration). You will likely have success swallowing your saliva without a problem as the saliva becomes thinner -- which it should and most likely will, as the less damaged saliva glands take over. You may still want to have a small bottle of Biotene with you for rinsing and moistening the inside of your mouth from time to time. (Stephen also uses seltzer water to rinse his mouth – I think he found it helped in rinsing out the phlegm as well. We always had a bottle with us for a while, but he no longer needs it.)

So, see below for some tips for dealing with the phlegm…. (Lip balm that you may find helpful after wiping your lips so much: Aquaphor Healing Ointment by Eucerin - comes in a small 0.35oz/10g tube now.)

As things become dryer, you'll likely relate to the problems mentioned by others about dry mouth in the morning (lips sticking to gums, etc.) -- a quick rinse with seltzer or Biotene can help take care of the problem. Also running an ultrasonic warm-mist humidifier (heats the water before dispensing) on high all night is a wonderful help. I use tap water but clean ours out every couple of nights by soaking the heating element in vinegar for a couple of hours, to keep it working efficiently and to be sure the water is clean. Apparently there are microbes that can even survive in boiling water...! Antimicrobial Cleaning Cartridges are also available. I used to keep an extra humidifier in the trunk for traveling – easily carried inside unobtrusively along with travel bags.

Tips re phlegm:

~Taking 400mg of Guaifenesin two-four times a day (with plenty of water – at least 8 oz. for each dose) makes it easier to get rid of the thick ropey saliva. (Be sure to note this on your medication list for your doctor.)

~Gargling with Baking Soda Rinse (1 teaspoon baking soda in 1 cup water) may be helpful.

~Also rinsing with diluted Biotene mouthwash can be helpful and soothing (undiluted may be too stingy in early stages of healing).

~Seltzer water can be a helpful and cooling rinse throughout the day as well.


For EXTREME issues of phlegm, when it is so thick as to being stuck in one’s throat and causing vomiting:

~Gargling with diluted papaya puree very helpful – very little sting and seems to immediately have an effect on separating stringy saliva from throat (saved my husband from having a lot of dry heaves and or tossing up of food) and allows the clumps of stringy saliva to be coughed up and out more easily or sucked out by a suction machine. (Its taste is not pleasant, but the benefits certainly outweigh the negatives.)

Note: Papaya juice found in grocery stores is often mixed with apple or other juice. That was all we found at first and it can work but it stings a bit and is not as effective as milder papaya puree diluted with water (about half puree and half water seems to work well – a little goes a long way).

~Gargling with Baking Soda Rinse (1 teaspoon baking soda in 1 cup water) is helpful as a follow up and then a rinse with diluted Biotene mouthwash as a “palate cleanser” is good for the final step.

~A prescription is needed for a suction machine – if you are having serious phlegm issues, it is well worth it to ask your doctor for one and to give it a try (there is a specific type of wand that works for this purpose, which the supply companies are familiar with). The rental fee is not at all exorbitant and in our case insurance covers most of the cost. (Our cost was about $40 per month.)

[As always, additional commentary by Dr. Joshi on these issues is most welcome.]

All the best to you, gd. Things will get better.

Susan

Hi I just wanted to say thank you to all who replied to my query and i thought i would just post an update.
Dr Joshi had advised me to try atropine and I was at the stage where i would try anything, I wanted to go out but was all too aware of people looking at me as i wiped my mouth time and time again. I wanted to drive myself places but couldnt as i tried a few times and had to pull over to retch as the saliva was thick and choking the back of my throat. My GP would not prescribe atropine saying the side effects were not very good.
Im not sure how it happened and my husband only commented today how fast the issue resolved itself, but I had a bit of a craving for some salted cashew nuts, being softer than peanuts i was able to eat them, afterwards my mouth seemed to dry up and stayed like that for the next few hours.
For the next few days everytime my mouth started to fill up i ate a handful of cashews. Ten days later i dont eat the cashews anymore but I dont need to spit out or continually dry my mouth with my tissues and i was getting through a big box each day!!.I dont know if it was the salt or the oil in the cashews or if its just coincidence and my throat/mouth had healed further but its made a big difference. I feel so much more confident and i am able to go out by myself and drive myself places.
I am not saying this will work for everyone but when you are as desperate as i was you will try anything!!

Thank you again to everyone who took the time to reply.

Wonderful news -- so glad to hear of this breakthrough for you. Very cool about the benefits of cashews!