Waiting for Engraftment

There are other considerations with protective isolation. Visitor Isolation does not mean no human contact. The number of visitors you have at one time should be kept to two. The rooms are usually relatively small, and seeing many people can increase the risk of the spread of infections. Visits from anyone in contact with an infection are strictly out of the question until they are clear of the incubation period or they are ‘infection-free’. If in doubt, please ask our medical staff. Your visitors will be advised not to mix with other patients since this can increase your risk of catching infections..

Any visitors who have been in contact with any infectious diseases should not visit until they have received advice from our medical staff. If they have been in contact with, or have been suffering from, chickenpox, measles, flu, coughs or colds, or are in any doubt at all; they should contact the nursing staff before visiting.

Almost everyone who has had a transplant will experience changes in their mouths and gut. This happens because the chemotherapy drugs that are used attack and damage cells that divide quickly. This includes cancer cells, but also bone marrow cells, hair cells and those cells that line the mouth and the gut. This damage usually begins a couple of days after your transplant but can start earlier.

These changes to your mouth and gut are called mucositis and are caused by your conditioning therapy. Mucositis can also be caused by the treatment you may receive to suppress your immune system. The severity of your symptoms can depend on the type of conditioning therapy you receive and the type of transplant you are having; the stronger and more intense the treatment, the greater your chance of developing mucositis.

As a rough guide, mucositis tends to be mild to moderate in people who have transplants using their own stem cells or bone marrow (autologous transplants), or where conditioning therapy is given in lower doses (reduced-intensity conditioning). It is moderate to severe in people receiving higher doses of conditioning therapy (myeloablative conditioning) before a donor (allogeneic) transplant, or those receiving TBI (Total Body Irradiation).

When mucositis develops, your mouth may look whiter and feel rougher than usual. Your saliva may become thicker, less manageable, and more difficult to swallow. When it starts to become painful to swallow your saliva or fluid, make sure you inform our doctors, as they can offer pain relief. As your mouth continues to change, the surface may become red and inflamed; sometimes, painful ulcers can develop. The areas of your mouth that are usually affected include the insides of your cheeks, the sides and underneath of the tongue, and the back of the throat. Your throat may also become very sore, and you might find it difficult to swallow.

Mucositis in your oesophagus (the canal that connects the throat to the stomach, also called the gullet or foodpipe), in your digestive tract and bowel, can cause you discomfort, indigestion, pain and sometimes diarrhoea. Should this happen, please discuss your symptoms with your doctor so that you can receive medication. It is important to remember that your mouth pain is temporary, and it will heal once the effects of the conditioning therapy have gone, and your stem cells begin to work. However, it can be some time before your mouth feels ‘normal’ again.

Mouth care is essential and helps to make you feel more comfortable, reduces your risk of infection, and may help your mouth to heal more quickly.

VOD is a problem with the liver. It is a specific disease where the blood flow through the small veins of the liver is partly blocked. VOD can be life-threatening if severe. It can cause symptoms such as yellowing of the eyes and skin (jaundice), swelling of the stomach (abdomen) and a build-up of fluid. VOD can be caused by the high doses of conditioning therapy that you have before the transplant. The stronger the chemotherapy, the higher the risk of VOD.

While it aids in preparing for your transplant, chemotherapy can damage otherwise healthy tissues. When the liver is damaged, this can lead to VOD. It can happen at any time from after the start of the conditioning therapy, to the third week after your transplant; in very few cases, it can happen even later. VOD is more common in people having myeloablative conditioned donor transplants than in those receiving reduced-intensity conditioned transplants. It is usually very mild, disappears quickly, and often you may not even be aware of it. However, VOD can be a severe problem, and your treatment is aimed at minimising its effects. Your recovery is helped by your liver’s incredible ability to improve and restore itself from the effects of diseases like this.

Your kidneys perform many essential functions, such as:

• Producing urine
  
• Fluid balance
• Regulating your blood pressure
• Removing waste from your body
• Processing medication

To function normally, your kidneys also depend on your other organs working normally. Following a stem cell transplant, mild kidney problems are not unusual.

Our doctor will monitor your kidney function through:

• Blood tests
• Checking your urine output and quality
• Daily weight checks

Such monitoring will help your doctors understand how well your kidneys are working. These problems are generally treated aggressively with fluid, or by reducing your intake of any medicines that make your kidneys work hard. Careful monitoring is essential. Treatment usually resolves these problems, and your kidney function will return to normal.

Fatigue is a prevalent problem during this stage. People often find it difficult to concentrate on reading a book, watching television or even holding a conversation. This is normal, and it is crucial that you set yourself realistic goals and reasonable expectations of your abilities at this time. A balance of rest and light exercise is often helpful.

There are several reasons why you can feel tired. You are still having a lot of treatment, you may be anaemic, your sleep may be disturbed, and you may still be feeling anxious about your treatment. You may find that activities such as showering or bathing are exhausting. Try to conserve your energy by doing things for a shorter period, and then rest. A good night’s sleep is vital to prepare yourself for the day ahead.

Getting to sleep at night can be difficult while you are in hospital. You may find that earplugs and an eye-mask help to block out any sounds or overhead lighting that may stop you from getting a good night’s sleep. Remember the things that you do at home that help you to go to sleep – for example, reading, listening to the radio, warm and milky drinks. Try to recreate the same atmosphere while you’re in the hospital.

Please talk to our nurse or doctor if you’re having problems with sleeping.

Mobility is the ability to move freely and easily. You may experience issues associated with your mobility if you have had a long period of bed rest and illness.

Daily light exercise help:

• Improve fatigue
• Maintain muscle strength
• Reduce muscle loss, which can happen with long periods of bed rest
• Maintain balance and coordination
• Boost feelings of wellbeing
• Improve physical comfort
• Prevent chest infections and blood clots (thrombosis), which are associated with long periods of bed rest.

During recovery, there will be some days that are better and easier than others. Where possible, take advantage of these good days by getting up and moving around more.