[Ruth Cuadra]

Hi, Steven.

Your father should probably be using either salted water or hydrogen peroxide instead of any commerical mouthwash. Even if you choose a brand that doesn't contain alcohol, most mouthwashes contain flavorings and other ingredients that can aggravate a sore mouth. He might also try Biotene or Closys mouth rinses, which help patients with dry and/or inflamed mouths. I prefer the Closys because it just tastes like water but is very effective when my mouth gvhd flares up.

If he can, he might be able to staunch the bleeding by applying pressure to his gums with an ice-cold cloth or taking ice-cold drinks.

You're right to be concerned about monitoring your father's kidneys (via creatinine levels) while he's on cyclosporine. The doctor is undoubtedly doing this through his regular blood tests. Since every patient is different, there is no set timetable for scaling back the dosage. It's a balancing act between maintaining blood production and kidney (or other) toxicity. If possible, the process of tapering off cyclosporine should be done very slowly--some patients take a year or more to reduce their dosages--in order to maintain marrow function.

Regards,
Ruth