Bone Marrow Transplant

WHAT YOU SHOULD KNOW

Risks

Conditioning before the Transplant

• Coughing or trouble breathing
• Weakness
• Achy feeling
• Chills
• Red, swollen skin
• Sores, swelling, or redness in your mouth
• Pain when you urinate

• Wash your hands often, especially after you go to the bathroom.
• Shower every day making sure to wash between folds of skin. If you are feeling dizzy, take a bath or use a shower chair. Use an electric shaver to keep from nicking your skin when shaving.
• Use a deodorant instead of an antiperspirant, which can cause an infection.
• If you wear false teeth, change the water in your denture cup every day.
• Change the water daily in respiratory equipment such as humidifiers.
• Clean the area between your legs each time you go to the bathroom.
• Do not give yourself an enema, take your temperature rectally, or put anything including medicine into your rectum.
• Avoid crowds and stay away from people who have colds or the "flu."

• See blood in your urine, stool, or vomit
• Bruise more easily than usual
• Get frequent nosebleeds
• Bleed from your gums (Using a soft toothbrush can relieve this problem)

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
• Chest X-ray: The doctor will check this picture of your lungs and heart to make certain you can handle the procedure.
• Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
• Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.

During The Bone Marrow Transplant:

• Shortness of breath
• Skin rash
• Chills
• Feverish feeling
• Dizziness
• Chest pain

After The Bone Marrow Transplant:

• Activity: You may need to rest in bed for a while. But even if you are confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
• Blood Transfusion: Before the new, blood-cell-producing marrow takes hold, you may need a transfusion. Although you might be worried about catching AIDS or hepatitis from tainted blood, the risks posed by going without a transfusion are actually much greater. Your chance of receiving infected blood is about 1 in a million; severe blood loss, on the other hand, can be fatal.
• Fluid: Especially if vomiting becomes a problem, you should try to drink 6 to 8 large glasses of liquid each day.
• Daily Weight: To monitor the amount of fluid in your body, you'll probably be weighed on a regular basis, at about the same time each day. Excessive fluid loss can cause dehydration. Retaining too much body fluid can lead to breathing problems and swollen ankles.
• Strict Intake/Output: As another check on your fluid level, your doctor may keep records of the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an "I&O."
• Medicines:
• Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
• Antifungal Medicine: These drugs kill fungal infections. They can be given by IV, by mouth, or as a cream.
• Antiviral Drugs: Because viral infections are also a danger, you may be given drugs that help to combat them.
• Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
• Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
• Diuretics (DI-u-REH-tiks): Often called "water pills," these drugs rid the body and lungs of extra fluid, allowing you to breath more easily. They work by increasing the amount of urine you produce. They can be given as a pill or in your IV.
• Fever Medicine: Doctors often prescribe medicine such as acetaminophen or ibuprofen to help lower fever.
• Hematopoietic (HE-mah-toe-po-EH-tik) Growth Factors: This medicine encourages growth of new blood cells. It may be given as a shot or in your IV.
• Reverse Isolation: Because of your vulnerability to infection, you will be given a private room. Medical staff and visitors may be required to wear gloves, a face mask, and a gown to protect you from their germs.

After You Leave

• Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• If you are taking pain medicine, especially as a shot or IV, ask you doctor to show you and your family how to give it. Take enough medicine to stay comfortable. Do not worry about becoming addicted to the drugs.
• Do NOT take any medicine that contains aspirin or ibuprofen-like ingredients. Ask your doctor before taking any over-the-counter medication.
• While the transplant is taking hold, you'll continue to be vulnerable to infection. Observe the same precautions recommended during the conditioning program.
• Your skin may become red and sore after the transplant. Do not rub it. Protect it from the heat and cold. Avoid going out in the sun. If you must go outdoors, use sunscreens with an SPF (sun protection factor) of at least 15 to prevent sunburn.
• The skin inside your mouth and throat may become swollen and sore and may develop a white coating. This could be an infection called thrush or a mouth irritation called stomatitis. Other symptoms include bleeding sores and a thickening of the saliva, making it difficult to talk and eat. Your doctor can prescribe medication to treat these conditions.
• You'll be shown ways of cleaning your teeth and mouth without making your gums bleed. Rinse your mouth with water 2 to 3 times every day, preferably after meals. If your mouth is sore, you may rinse with salt water or a prescription mouthwash. Do not use over-the-counter mouthwash or any other liquids that contain alcohol. See your dentist for regular check-ups. Your dentist may need to speak to your doctor before an exam.
• To combat the nausea that often lingers after a marrow transplant, try following these guidelines:
• • Don't lie down for 2 hours after eating. Lying down sooner can make both nausea and heartburn worse. Rest quietly while leaning back in a comfortable chair. Put a cool, damp washcloth over your forehead, face, or neck.
  • Take medicines with a glass of milk or a snack.
  • Try eating small meals 5 or 6 times a day instead of 3 large meals. Suck on ice chips or sip small amounts of clear, unsweetened liquids such as apple juice. Then try crackers or dry toast.
  • If you have trouble swallowing, eat soft foods and liquids.
  • Remember that sweets and fried or high-fat food can make nausea worse. Spicy foods and alcohol can aggravate heartburn.
  • To help prevent nausea from returning after you vomit, brush your teeth or rinse your mouth as soon as possible.
  • If food seems bland and unappealing, try tart foods like cherries, use extra seasoning, try new recipes, and select bright colored fruits and vegetables.
• Continue drinking 6 to 8 large glasses of liquid each day, particularly if vomiting remains a problem.
• If constipation develops, follow these tips. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
• The transplant procedure will result in a temporary loss of all hair, including eyebrows and pubic hair. Wash your head gently with a mild shampoo. To slow down hair loss, do not brush or comb your hair any more than necessary, and use a mild shampoo. You may want to use hats, scarves, and wigs to cover your head.
• You will probably need more rest. Match your activity to your energy level. Nap a couple of times during the day. Going to bed early and getting up late may also help.
• Sex can be resumed as soon as your doctor gives the OK. Stop if it causes pain or bleeding. Female transplant patients should use birth control, since radiation and chemotherapy can cause birth defects in the event of pregnancy. If you have problems, remember these tips:
• • Taking a nap before sex can help reduce fatigue.
  • If nausea interferes, take your anti-nausea medicine in advance.
  • Because your immune system will still be weak, do not engage in oral or anal sex until your blood count returns to normal.

Call Your Doctor If...

• Your temperature rises.
• You develop sores, swelling, white patches, or redness in your mouth.
• You have any change in bowel habits.
• You notice redness, swelling, or pain anywhere on your skin.
• Urination causes pain or burning or the urine smells bad.

Seek Care Immediately If...

• You develop sudden chest pain or trouble breathing. You could have a blood clot in your lung or may be having a reaction to one of your medications.
• You cannot think clearly.
• You develop a headache or stiff neck.
• You develop a high fever.
• You become so depressed you feel you can no longer cope.