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Discharge Instructions
Activity
The only restriction on activity is to avoid heavy lifting (maximum
of 10 lbs.) or other activities which involve abdominal muscles. You
should do only light activities at first, until your energy and
endurance increases. It is better to perform many short activities
with rest periods, rather than long, exhausting ones. At three
months post operatively, you may begin a more active exercise
program if you wish, and begin to play light sports.
Nutrition
“Diet as tolerated” – meaning no real restrictions. Patients are
requested to try not to gain too much weight post-transplant as it
is more work for the body to function and maintain their transplant.
Some weight gain is usually desired as patients are often thin owing
to the nature of their liver disease prior to transplant. Fluid
accumulation or “water” which is also related to liver disease can
make a person seem heavier pre-operatively. You need to follow good
nutrition after transplant to regain normal body mass. A dietician’s
consult can be helpful in mapping out a healthy diet.
Sun
Exposure
Immunosuppressive drugs increase your skins’ sensitivity to the sun
and thereby increases the incidence of skin cancer. We recommend you
decrease this risk by using sun screens. These lotions come in a
variety of strengths. Everyone should use products with Factor 15 –
this means you can stay in the sun 15 times longer than usual
without exposing your skin to dangerous ultra violet (UV) rays.
*A tan doesn’t
protect you, it just means that you have exposed yourself to the
risks.
Intercourse
Sexual activity may resume after your incision heals. This is often
at time of discharge from hospital, or as soon as you feel able. Use
your own comfort level as a guide. If you have concerns, do not
hesitate to discuss them with your doctor or nurse.
If impotency has been a problem, it often resolves post transplant.
If it does not, let the doctor know as it may caused by high blood
pressure medications – which can be altered. Other treatment options
are available.
Birth
Control
Birth control must be carefully practiced. Birth control pills are
contraindicated as they promote hormonal changes, decreased
hemoglobin, high blood pressure and interact adversely with
cyclosporine. The IUD may be eventually considered, however it
increases the risk of infection, especially in immunosuppressed
patients.
In conclusion, barrier methods of birth control are the best methods
of contraception. Probably the most reliable choice would be the
combination of contraceptive foam and condoms.
Having
Children
Birth defect risk in immunosuppressed patients has not been well
explored. To quote a limited study conducted by Sandoz (manufacturer
of cyclosporine): “There is no evidence of teratogenic effect of
cyclosporine in man. However, primarily as a result of
transplantation per se, the complications of pregnancy and hazards
to the offspring are increased in this patient group.”
Considering the stress of pregnancy on the body, there could be risk
to the transplant mother. Therefore family planning should be
discussed with the physicians. The chance of birth defects to the
child is the only risk for a transplant father.
Dental
Work
There is a risk of infection after tooth extraction, cleaning, etc.
for immunosuppressed patients. There is a protocol for antibiotic
coverage to begin before dental procedures. You are advised to let
the transplant coordinator know when you have a dental appointment
and a prescription can be obtained from the doctors or your dentist.
To further reduce risk, you are advised to have dental work done
prior to transplant.
Regular
Gynecology Check-ups
It is important to have gynecology check-ups with annual PAP tests.
Immunosuppressive drugs increase the risk of cervical cancer.
Regular check-ups will detect any changes if they happen.
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