Outpatient Visits after Autologous or Allogeneic Transplant

• Temperature over 100.5 degrees Fahrenheit or 38 degrees Celsius
• Chills, sweating
• Redness, swelling, pain or discharge around the central line
• Bleeding
• Coughing, shortness of breath or chest pain
• Persistent nausea or vomiting
• Frequent or painful urination, blood in the urine
• Weight loss greater than 5 pounds
• Painful blisters on the skin
• Skin rash, diarrhea, abdominal cramping or pain, yellowing of skin or whites of eyes
• Inability to keep medications or fluids down due to nausea

Your risk of infection will remain higher than normal for at least three months after your transplant even though your body is again producing white blood cells. The highest risk is within the first month of leaving the hospital and during this period you should spend most of your time at home and away from people. You should not go to the supermarket, church, movie theater or any place where there may be large crowds of people. You may have visitors, but people who are ill should not visit. If there are family members or household members, including kids, who are ill, you must do your best to keep away from them, either by staying in separate rooms or keeping them at a distance. To help prevent infection, do the following:

• Stay away from anyone that is ill or is coughing
• Wash your hands often
• If you feel you may have a fever, take your temperature and if you have a fever, call the clinic or after 5 pm, call 315-464-5540 and ask for the transplant doctor on call.
• Do not have any immunizations until one year after BMT and avoid children who have been immunized with live virus vaccines for four to six weeks
• Wash your hands carefully after handling pets, and do not clean up animal feces. This includes cat litter boxes, your dog's excrement in the yard, etc.
• Avoid swimming in lakes, rivers, public swimming pools or hot tubs
• Avoid flossing your teeth until your platelet count is over 50,000. Use a soft toothbrush to clean your teeth.
• When near a construction site, wear a mask. Avoid them if possible.
• Avoid activities with exposure to dust or dirt that may be a source of infection
• Contact lenses can be worn only after your counts have returned to normal
• Do not smoke

Your platelet count may not be back to normal levels when you are discharged. If it is low, take the following precautions:

• Use an electric razor instead of a straight edge razor
• Do not blow your nose forcefully
• If you tend to be constipated, use a stool softener so that you will not have to strain when having a bowel movement
• Do not use rectal thermometers or suppositories, enemas, tampons or douches
• Avoid strenuous forms of exercise or activities which have potential for injury
• No aspirin or aspirin products until your platelets are greater than 100,000.

If you have an injury which bleeds, apply pressure over the injured area. Keep applying pressure until the bleeding stops, which may take several minutes. If the bleeding does not stop, apply ice, maintain the pressure and call your clinic doctor or go to the emergency center.

Your appetite may not have returned by the time you leave the hospital, so you may have to try harder to get the calories you need. Your dietician can help you to plan for meals before you are discharged. The guidelines listed below may help you to maintain or improve your nutritional status.

• Eat small snacks and five or six small meals a day instead of three large meals
• Eat high-calorie, high-protein snacks such as milk shakes, cheese and crackers, nuts, high-calorie supplements, etc. Add gravies and margarine to foods you already eat
• Drink eight large glasses of fluid daily. Try to include fluids with calories (instant breakfast, sports drinks, etc.) and avoid excessive amounts of caffeine (i.e. colas, coffee, tea)
• Avoid alcoholic beverages, as they can interact with medications and may injure your liver
• Do not eat from salad bars or buy foods from bulk containers in the grocery store, as the food may contain bacteria that can cause infection
• Do not eat raw meat or raw seafood (including raw oysters, fish or sushi)
• Do not eat raw fruits or vegetables until your neutrophil count is over 1000, then wash them thoroughly
• Watch for stomach cramps, diarrhea or gas after eating or drinking milk or milk products, which could indicate an inability to digest lactose

Your skin will be drier than usual after treatment. Use a soap that contains a moisturizer and also use a moisturizing lotion, especially after bathing or showering. Use a creme rinse or conditioner after shampooing to moisturize your hair and scalp. Wear a hat, long sleeves and long pants when outdoors during the day whenever possible. Always apply sunscreen (SPF 15 or higher) and limit the amount of time spent in the sun.

You may have questions regarding issues of intimacy and sexual activity after transplant and should feel free to ask your doctor or nurse. Your partner also may have questions and want to be involved in any discussion.

You may feel free to hold, kiss, hug and sleep in the same bed as your partner unless your partner is ill. You may resume intercourse once your platelet count and neutrophil counts are high enough, such as a platelet count of about 50,000 and neutrophil count of about 1500.

Many people notice a change in desire or interest in sexual activity, which is usually related to hormonal changes as a result of the chemotherapy. This is a temporary situation and not a reflection of a change in your feelings of love or need for closeness.

The American Cancer Society (ACS) has a booklet called "Sexuality and Cancer" (one for men and his partner and one for women and her partner) which may be helpful and can be obtained.

Sperm or egg banking should be done well before admission for transplantation if this is a concern.

• CNY Fertility

An interruption in the menstrual cycle is common in women. However, fertility may be preserved occur in a small percentage of both men and women. You should discuss hormone replacement with your family doctor or gynecologist. Contraception should be used to protect against unwanted pregnancy.

The appropriate time to return to work varies from patient to patient. Check with your doctor about your expected return to work.

You may continue your follow-up and care here or you can return to your referring physician once you have recovered from your transplant. At three months you will likely have an evaluation of your cancer. This may include X-rays, CAT scans, PET scans, blood tests, urine tests and possibly a bone marrow biopsy. You will be scheduled to start vaccines at one year, just like a newborn child. You may never have the live herpes vaccine. Although you will be followed by your local doctor, you will always be able to contact us any time after transplant.