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Survivors' Guide for Bone Marrow/Stem Cell Transplant
What to Expect and How to Get Through It

Caring for Yourself During the Hospital Stay

Following the conditioning treatment and the transplant, your immune system will be compromised and thus you will be at risk for infections. In order to minimize risk of infection, good hygiene, mouth care and exercise are all recommended.

Good Hygiene
The most effective way to minimize infection is to wash your hands and to require that all visitors and staff entering the room wash their hands. Diseases are most commonly spread through hand contact and the importance of hand washing in minimizing the spread of infection cannot be stressed enough. As a patient, you should wash your hands regularly throughout the day, before meals, before taking your pills and after using the bathroom. Daily bathing is also highly recommended, as it will help to reduce skin bacteria.

Dental Care
One of the best things you can do for yourself during the transplant to reduce discomfort and infections is to take meticulous care of your mouth. The conditioning regimens of chemotherapy and radiation often cause the tissues inside the mouth to become thinner and more delicate, leading to irritation and ulceration (mucositis). By maintaining good oral hygiene during the transplant, you may reduce oral infection and bleeding gums.

Remember, optimal mouth care entails frequent mouth rinses throughout the day. You should also brush your teeth regularly with a soft nylon bristle toothbrush or a sponge toothbrush if the regular toothbrush hurts. While brushing, you should thoroughly rinse your mouth several times so as to remove bacteria and debris. Brush or rinse your mouth after taking any food as this will help minimize infection and pain. If you are good at flossing and are able to do so without injuring your gums, continue to do so.

Exercise
During days that you will feel weak and sick, it will be particularly tempting to curl up in bed and not move. However, exercising and moving is going to be your ticket to doing many of the things you will want to do when you are discharged. Exercising will mean more energy to carry out daily activities and is also likely to lower your risk of injury from falling or twisting an ankle. You do not need to be in top fitness to exercise. Many exercises and stretches can even be done in bed. The benefits of exercise are manifold:

• Exercising promotes good circulation and encourages the continued normal functioning of your body.
• Exercise prevents or minimizes muscle atrophy from prolonged bedrest and steroid treatment.
• Exercise is associated with improved nutritional status as it promotes protein assimilation and decreases body fat.
• Exercising and deep breathing help prevent the accumulation of fluids in the lungs which can often lead to pneumonia.
• Exercise is known to combat depression and promote feelings of wellbeing as well as to enhance physical comfort.
• Exercise facilitates cardiac function and circulation.

During your time at the hospital and also as an outpatient, you may have visits from a physical therapist who will work with you in maintaining your strength and endurance and working on particularly important things like ankle strength and chest expansion. If you feel you need more information on exercises and stretches, make your needs known and have a physical therapist visit you more often:

I was told that doing exercise would lower my chance of getting a lung infection—so I was on my exercycle almost everyday. I’d turn up the music, face the window and start pedaling.

Nutrition
Often the treatment will affect one’s appetite and ability to eat and digest food. Eating may be difficult for some people because of changes in taste and smell, nausea, general dryness of the mouth or difficulty swallowing. If you are having difficulty eating, you will be fed intravenously through your central line so that your basic caloric and nutritional needs will be met. To the extent possible, it is recommended that you continue eating so that your digestive system continues to function and pass food. Depending on the center you are being treated at, there may different food guidelines during the period of immuno-suppression, with some centers allowing fresh fruits and vegetables and others disallowing them. Good nutrition is particularly important post-transplant as your body will require additional calories, protein, vitamins and minerals to heal and recover.

Eating was really difficult for me. It took forever to chew food that normally would take minutes to consume. Some days I just couldn’t eat anything at all.

Eating Tips
Although your nutritional requirements will be met through intravenous feeding, it is highly recommended that you try to continue eating, at least small amounts, throughout the period of the transplant. By eating and keeping your digestive tract active, the muscle tone and function of your digestive tract will be better maintained, thus making it easier for you to eat post-transplant. During this period, your dietitian can serve as an important resource in helping you find ways to meet your nutritional needs.

A helpful suggestion is to begin increasing your oral intake with small meals and snacks every few hours. Nutritious beverages are often well-tolerated and can be an excellent source of vitamins, minerals and calories.

In order to aid digestion and prevent heartburn, eat and drink slowly. Sitting up rather than lying down after meals can also help. If you are not experiencing much nausea, light exercise such as walking can promote digestion and may help you feel more comfortable.

Although there are no hard fast rules with regard to which foods to eat, a large number of people find that moist, bland, low fat soups, casseroles or noodle dishes are relatively easy to digest as compared to fried foods, meats and some raw fruits and vegetables. The best rule of thumb is to eat the foods that are most appealing to you. If there are particular foods you crave that are not on the hospital menu, see if they can be made available for you.

Finally, in order to reduce the probability of food-borne illness, wash your hands prior to eating meals and follow the food safety guidelines that are recommended by your dietitian.

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