Post Transplant Healthy Hints

Over time, your routine will start to return to normal. However, it is important to remember that your immune system will always be somewhat suppressed. We've tried to include some healthy hints for you as a new transplant recipient. These guidelines are simply common sense, so don't be paranoid about what you can and cannot do - just be careful. If you ever have any doubts about an activity, you know what to do - right? Call your transplant team first.

As a recipient you will be reminded to eat, in moderation, and correctly ("You are what you eat") and to walk or exercise the equivalent of up to 6 miles per day. You will be instructed to avoid contact with people who are ill, in your home, place of work, or elsewhere. To put it bluntly, avoid those who are sneezing and/or coughing. Your immune system is compromised, and always will be. The "common cold" can cause you a fairly serious medical problem. The main point here is to remain alert and aware, and don't be afraid to ask. And don't be afraid to avoid ill people if you have a question. One recipient left his place of employment for several days after his boss, who was old enough to know better, came to work with chicken pox, and wouldn't go home.

• Buy and wear a Medic-Alert (or similar) necklace or bracelet. Carry a card in your wallet or purse stating that you are a transplant recipient and list all of your daily meds, as well as any known drug allergies.
• All programs recommend that you always use a high SPF rated sun lotion. Immunosuppressive drugs can make you vulnerable to sunburn and increase your risk of developing skin cancer. Cover up, use a sunscreen of at least SPF30 and limit your exposure to the sun. Ratings of up to SPF55 have been quoted to particular individuals as a protection against skin cancer. You now have a healthy organ or tissue. Protect it! Your post transplant medications cause you to be supersensitive to sunlight. Stay out of the sun - use a sunscreen! wear a hat or cap! wear long sleeved shirts and pants while out in the sun! Avoid going out in the mid-day sun when reasonably possible to do so.

• Buy anti-bacterial soap and put it everywhere. Wash your hands often and make sure your family does too. Buy some anti-bacterial wipes and keep them handy for times when you are away from the house.
• Replace your normal household cleaning products with a brand that disinfects as well as cleans (e.g., Lysol).

• Be very careful around diapers. Better yet, have someone else change the kids/grandkids.
• Travel tips. These are important enough to repeat here!
• NEVER pack your meds - carry them with you at all times. You should also take an extra two weeks supply. That should be enough to cover most emergencies.
• Carry a copy of your medical history, doctors' names and phones and a copy of your prescriptions with you.

• Recipients who travel should be very much aware of water safety. Do not drink local water if there is any question. Bad water that causes others a severe case of cramps or diarrhea can be downright deadly to the recipient on immunosuppressive drugs. When traveling, many drink coffee or any drink that requires boiling of the water. Commercial fountain sodas and other bottled drinks are oftentimes made from local water. Some patients carry a portable filter obtained from camping stores. These cost anywhere from $140 to $300 and also require replacement of a filter cartridge.
• Enjoy food - but do so in moderation. Remember, it is much easier to gain weight than to lose it later. If you have questions about weight management, see a nutrition expert, such as a registered dietitian. You may also call the National Center for Nutrition and Dietetics at (800) 366-1655 for answers to any nutrition related questions or to locate a registered dietitian in your area.
• Food safety is important:
• Wash your hands before and after handling food, and consider using latex gloves when handling raw meat.
• Wash all fruits and vegetables. One drop of a mild soap in water will wash away most pesticides and germs.
• NEVER, EVER eat raw seafood or meat.
• Never eat an egg unless it has been cooked solid. Avoid food made with raw eggs such as Caesar salad, homemade ice cream, Hollandaise sauce and eggnog.
• In restaurants, avoid salad bars and buffet tables where food may be kept at inadequate temperatures.
• Order your meats cooked "well-done".
• Exercise regularly. Begin with short, easy workouts with an activity you enjoy and progress at your own pace. Talk to your doctor before starting any new vigorous exercise routine.
• Consider using bottled water or a water filter for drinking water and ice. If you use a filter, make sure it meets ANSI/NSF standard 53 for filtering out Cryptosporidum, etc. Also see note under travel tips, above. For a list of products that are certified to NSF standard 53, write to: 
  NSF International 
  P.O. Box 130140 
  Ann Arbor, MI 48113-0140 
  800-NSF-MARK / 800-673-6275

• Pets are OK too, BUT use caution: 
  Especially with cats and litter boxes; cat feces can carry toxoplasmosis. 
  Dogs are OK, but stay away from the feces. Dogs also like to eat cat feces, so keep an eye on Fido. 
  Birds carry many parasites and bacteria - use caution. (Lung transplants - stay away!) 
  Stay away from hamsters, gerbils, mice and rats - bites can be a problem. 
  Iguanas and turtles can carry salmonella.

• All programs recommend the annual flu shot, and most also strongly recommend any vaccinations that were missed when you were a candidate. Caution: Avoid live virus vaccinations.

• Calcium For bone loss, as a side effect of prednisone.
• Magnesium For bone loss, assists absorption of calcium.
• Zinc Boosts immune system, for memory loss.
• Garlic Boosts immune system, lowers blood pressure.
• Vitamin B-6 For tremors as a side effect of Prograf, also helps teeth and gums.
• Vitamin C Boosts immune system, also helps bones and teeth.
• Vitamin D Enhances absorption of calcium.
• Vitamin E Boosts immune system, helps heart and skeletal muscles.

Before taking any vitamin or mineral supplement, discuss it with your transplant team. Your prescribed medications will affect their recommendations. Some transplant coordinators leave these decisions entirely to the individual recipient's discretion because of cost considerations.

All programs, however, agree that patients on prednisone need calcium in their diet and/or mineral supplements. At least one program recommends TUMS as a source of calcium.

The Cost Containment Research Institute has published a booklet entitled "A Guide to Vitamins and Minerals." Provides information about the effects and benefits of most vitamins and minerals. To receive a copy send $5.00 to cover postage and handling to: The Institute, Booklet #MV907, 611 Pennsylvania Ave. SE, Suite 1010, Washington, DC, 20003-4303. 202-637-0038, http://www.institute-dc.org/