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For those interested, here are my discharge instructions from MD Anderson. As you can see, they are quite extensive and getting released from the hospital is just the start... - Dave
Autologous Discharge Instructions
Most patients will be able to go home when you:
Have an ANC (absolute neutrophil
count) over 1.0
Have no fever for 72 hours
Are able to drink 8 to 10 glasses of
liquid a day
Can take all medication/pills without
difficulty
Are able to eat small amounts at each
meal
Can walk without help
Perform simple tasks, such as dressing
yourself and going to the bathroom
Have a caregiver and a local place to
stay
Self care issues and when to return to normal activities
Plan to stay in Houston until Day +30 after your transplant.
Have someone with you when you come to the clinic for your appointments. Always have a
caregiver available to you.
Avoid crowds and limit contact with plants, pets, and children below the age of 12.
Wear your mask when in crowded areas or coming into the hospital; gloves should not be
worn. Wash your hands before taking the mask off. The mask should be worn for the first
month after your transplant. Your family or caregiver does not need to wear a mask around
you as long, as they are healthy. Your visitors should not have any symptoms of a cold such
as a cough, runny nose, sore throat or fever.
No raw fresh fruits and vegetables until you have engrafted after transplant and your ANC
(absolute neutrophil counter) is over 1.5. Your doctor or APN will tell you when you may
begin adding those to your diet. Wash all fruits and vegetables before eating.
Limit sun exposure. If you go outdoors, or your skin is exposed to sunlight, you should wear
a sunscreen with SPF 30.
Keep active. Fatigue is one of the most common side effects after transplant. Balance your
activity with rest breaks and dont overdo it.
Take your temperature at least twice a day, and as needed.
Wash your hands frequently, especially before eating and after using the bathroom.
Drink plenty of fluid such as water, Gatorade, milk, juices, or lemonade. You should try to
drink 1.5 to 2 liters of fluid each day. Limit your caffeinated beverages such as coffee, soda,
energy drinks, and tea. Supplements such as Boost or Ensure may cause diarrhea in some
patients, therefore check with your APN before adding these to your diet.
Some patients have questions about when they can return to their place of work. Your clinic
doctor will determine when it is safe for you to go back to work and will discuss this with
you closer to day +30.
Activity
It is important that you stay active! However, all activities should be done in "moderation."
It is very important that you stay out of bed and move around as much as possible. This will
help keep your muscles and lungs in good shape.
Perform as much of your own self care activities such as bathing, and dressing as safely
possible.
You may start doing most of your normal activities, but be aware that you will get tired
easily. Increase your daily activity slowly and remember to take rest periods between
activities.
Ask your advanced practice nurse or doctor when you may return to water activities such as
swimming or water aerobics.
Skin Care
Chemotherapy may cause your skin to become more sensitive to the sun. Limit your time
out in the sun to no more than 30 minutes daily. Apply sunscreen of SPF 30 to all areas of
exposed skin at all times when in the sun or during long car rides.
Continue to shower daily. Use an antibacterial soap with moisturizer, if your skin is
unusually dry. You may shampoo your hair daily but use a cream conditioner, since your hair
may tend to be dry and brittle. Apply moisturizer to dry skin after bathing.
Infection
It is important to remember that even though your body is producing white blood cells, you will
continue to be at a greater than normal risk of infection for up to one year.
Take your temperature at least twice a day, once in the morning and once in the evening. If
you feel warm at any other time, check your temperature then as well.
If your temperature is equal to or higher than 100.5ฐF (38.0ฐC), go to the Emergency Center.
Do not take aspirin, Ibuprofenฎ or Tylenolฎ
because it will be difficult to tell if you have a
fever. A fever is a warning sign of infection.
It is important to continue to wash your hands after using the bathroom and before eating.
Watch for any sign of infection, such as:
− Fever
− Flushed appearance of your skin
− Chills
− Sweating
− Cough
− Runny nose
− Sore throat
− Shortness of breath
− Chest discomfort
− Painful or frequent urination, cloudy
urine
− Unusual or smelly vaginal discharge P
− Skin rash or infected cuts
− Any pain, swelling, drainage, or
redness at your catheter site
Wear a mask when you are coming to the clinic or going to crowded public areas. You may
go out in public and socialize with your friends, but stay away from crowds in enclosed
areas.
Avoid people with known infections, especially children with upper respiratory infections
like colds, rashes, or the flu after discharge from the hospital. You may go out to public areas
such as shopping, church or movie theaters during off-peak hours.
Immunizations may be dangerous for people who have had a transplant. Avoid being
immunized for such things as measles, mumps, rubella, polio, or yellow fever. If you have
children or grandchildren who may have recently received their immunizations, please tell
your advanced practice nurse or doctor. They will tell you about any precautions that need to
be taken. You should discuss a re-immunization schedule with your doctor.
Dental Care
Dental hygiene is very important. You should follow the instructions given to you by your
dentist about tooth brushing and flossing.
Sexual Activity
After your transplant, you should be able to engage in normal sexual activity, such as kissing,
hugging, touching and sexual intercourse.
You may resume intercourse with your partner as soon as your platelet count reaches 50,000
(50) and your absolute neutrophil count (ANC) is 2,000 (2).
A water-soluble lubricant such as K-Yฎ Jelly should be used to reduce friction.
Cleanliness and safe-sex practices (a monogamous relationship, condom use), are important
and recommended.
Female patients may have decreased or absent menstrual flow and decreased vaginal
secretions. Males may notice a temporary decrease in sexual desire and function. Talk to
your doctor if these problems persist. Hormone replacement may be needed.
Pets
Although it is safe to be around household pets, limit the amount of close contact you have
with them. In other words, do not let your pet lick your face, sleep in bed with you, and avoid
contact with any urine and stool for at least six months after you leave the hospital.
Do not handle pet litter boxes and birdcages.
Plants
You may have plants or fresh flowers in your home after you are discharged. Do not repot
your plants or work in the garden for six months after your transplant.
Tobacco
You should avoid using tobacco or tobacco products. It can increase the risk of pneumonia,
infection with fungus and lung scarring.
Blood Products
If you ever need a blood transfusion at another hospital, be sure that all blood products are
irradiated (external beam radiation). This is very important to prevent serious reactions.
Nutrition after Transplant
Diet
Raw or fresh fruits and vegetables are okay to eat once the patient has engrafted after transplant.
Your hospital doctor or advanced practice nurse (APN) will let you know when you can add
these foods back into your diet.
You are asked to avoid the following:
Raw and undercooked oysters, fish, meat and eggs such as rare or medium meats or
sunny-side up eggs.
Open salad bars or open buffets.
Drinking alcohol is discouraged. Check with your doctor if you have questions.
Food Safety
No raw, rare, or undercooked seafood, meat, or eggs. This includes sushi.
All meats should be cooked completely. Use a meat thermometer to make sure the meat is
cooked at an adequate temperature.
Reheat foods to at least 165ฐF or until boiling if liquid.
Leftovers should be refrigerated or frozen within 2 hours of cooking. Refrigerated leftovers
should be used in less than 5 days or thrown away. Frozen leftovers can be safely stored for
several months. But, changes in taste, flavor, texture, and eating quality may occur with
extended freezing.
Defrost frozen foods in the microwave or in the refrigerator only.
Use dishes, utensils, glasses and cutting equipment that have been properly cleaned,
especially during food handling.
Always wash your hands before food preparation and between handling raw and cooked
foods.
Refrigerate foods promptly after shopping or cooking.
Eat only at clean, reputable restaurants.
Do not eat at self-service buffets.
Do not eat bulk foods (i.e., items purchased from bulk food bins, like candy, nuts, and dried
fruit).
Maintain Your Weight
Weigh yourself at least once a week; your goal is to maintain your current weight.
Eat five to six small meals each day.
Protein builds and repairs tissues. Eat at least one serving of high protein food with each
meal or snack (i.e. meat, eggs, beans, dairy products, cheese and peanut butter).
Calories provide energy and help you maintain your weight.
Drink plenty of fluid every day (1.5 to 2 liters per day).
Autologous Discharge Instructions
Most patients will be able to go home when you:
Have an ANC (absolute neutrophil
count) over 1.0
Have no fever for 72 hours
Are able to drink 8 to 10 glasses of
liquid a day
Can take all medication/pills without
difficulty
Are able to eat small amounts at each
meal
Can walk without help
Perform simple tasks, such as dressing
yourself and going to the bathroom
Have a caregiver and a local place to
stay
Self care issues and when to return to normal activities
Plan to stay in Houston until Day +30 after your transplant.
Have someone with you when you come to the clinic for your appointments. Always have a
caregiver available to you.
Avoid crowds and limit contact with plants, pets, and children below the age of 12.
Wear your mask when in crowded areas or coming into the hospital; gloves should not be
worn. Wash your hands before taking the mask off. The mask should be worn for the first
month after your transplant. Your family or caregiver does not need to wear a mask around
you as long, as they are healthy. Your visitors should not have any symptoms of a cold such
as a cough, runny nose, sore throat or fever.
No raw fresh fruits and vegetables until you have engrafted after transplant and your ANC
(absolute neutrophil counter) is over 1.5. Your doctor or APN will tell you when you may
begin adding those to your diet. Wash all fruits and vegetables before eating.
Limit sun exposure. If you go outdoors, or your skin is exposed to sunlight, you should wear
a sunscreen with SPF 30.
Keep active. Fatigue is one of the most common side effects after transplant. Balance your
activity with rest breaks and dont overdo it.
Take your temperature at least twice a day, and as needed.
Wash your hands frequently, especially before eating and after using the bathroom.
Drink plenty of fluid such as water, Gatorade, milk, juices, or lemonade. You should try to
drink 1.5 to 2 liters of fluid each day. Limit your caffeinated beverages such as coffee, soda,
energy drinks, and tea. Supplements such as Boost or Ensure may cause diarrhea in some
patients, therefore check with your APN before adding these to your diet.
Some patients have questions about when they can return to their place of work. Your clinic
doctor will determine when it is safe for you to go back to work and will discuss this with
you closer to day +30.
Activity
It is important that you stay active! However, all activities should be done in "moderation."
It is very important that you stay out of bed and move around as much as possible. This will
help keep your muscles and lungs in good shape.
Perform as much of your own self care activities such as bathing, and dressing as safely
possible.
You may start doing most of your normal activities, but be aware that you will get tired
easily. Increase your daily activity slowly and remember to take rest periods between
activities.
Ask your advanced practice nurse or doctor when you may return to water activities such as
swimming or water aerobics.
Skin Care
Chemotherapy may cause your skin to become more sensitive to the sun. Limit your time
out in the sun to no more than 30 minutes daily. Apply sunscreen of SPF 30 to all areas of
exposed skin at all times when in the sun or during long car rides.
Continue to shower daily. Use an antibacterial soap with moisturizer, if your skin is
unusually dry. You may shampoo your hair daily but use a cream conditioner, since your hair
may tend to be dry and brittle. Apply moisturizer to dry skin after bathing.
Infection
It is important to remember that even though your body is producing white blood cells, you will
continue to be at a greater than normal risk of infection for up to one year.
Take your temperature at least twice a day, once in the morning and once in the evening. If
you feel warm at any other time, check your temperature then as well.
If your temperature is equal to or higher than 100.5ฐF (38.0ฐC), go to the Emergency Center.
Do not take aspirin, Ibuprofenฎ or Tylenolฎ
because it will be difficult to tell if you have a
fever. A fever is a warning sign of infection.
It is important to continue to wash your hands after using the bathroom and before eating.
Watch for any sign of infection, such as:
− Fever
− Flushed appearance of your skin
− Chills
− Sweating
− Cough
− Runny nose
− Sore throat
− Shortness of breath
− Chest discomfort
− Painful or frequent urination, cloudy
urine
− Unusual or smelly vaginal discharge P
− Skin rash or infected cuts
− Any pain, swelling, drainage, or
redness at your catheter site
Wear a mask when you are coming to the clinic or going to crowded public areas. You may
go out in public and socialize with your friends, but stay away from crowds in enclosed
areas.
Avoid people with known infections, especially children with upper respiratory infections
like colds, rashes, or the flu after discharge from the hospital. You may go out to public areas
such as shopping, church or movie theaters during off-peak hours.
Immunizations may be dangerous for people who have had a transplant. Avoid being
immunized for such things as measles, mumps, rubella, polio, or yellow fever. If you have
children or grandchildren who may have recently received their immunizations, please tell
your advanced practice nurse or doctor. They will tell you about any precautions that need to
be taken. You should discuss a re-immunization schedule with your doctor.
Dental Care
Dental hygiene is very important. You should follow the instructions given to you by your
dentist about tooth brushing and flossing.
Sexual Activity
After your transplant, you should be able to engage in normal sexual activity, such as kissing,
hugging, touching and sexual intercourse.
You may resume intercourse with your partner as soon as your platelet count reaches 50,000
(50) and your absolute neutrophil count (ANC) is 2,000 (2).
A water-soluble lubricant such as K-Yฎ Jelly should be used to reduce friction.
Cleanliness and safe-sex practices (a monogamous relationship, condom use), are important
and recommended.
Female patients may have decreased or absent menstrual flow and decreased vaginal
secretions. Males may notice a temporary decrease in sexual desire and function. Talk to
your doctor if these problems persist. Hormone replacement may be needed.
Pets
Although it is safe to be around household pets, limit the amount of close contact you have
with them. In other words, do not let your pet lick your face, sleep in bed with you, and avoid
contact with any urine and stool for at least six months after you leave the hospital.
Do not handle pet litter boxes and birdcages.
Plants
You may have plants or fresh flowers in your home after you are discharged. Do not repot
your plants or work in the garden for six months after your transplant.
Tobacco
You should avoid using tobacco or tobacco products. It can increase the risk of pneumonia,
infection with fungus and lung scarring.
Blood Products
If you ever need a blood transfusion at another hospital, be sure that all blood products are
irradiated (external beam radiation). This is very important to prevent serious reactions.
Nutrition after Transplant
Diet
Raw or fresh fruits and vegetables are okay to eat once the patient has engrafted after transplant.
Your hospital doctor or advanced practice nurse (APN) will let you know when you can add
these foods back into your diet.
You are asked to avoid the following:
Raw and undercooked oysters, fish, meat and eggs such as rare or medium meats or
sunny-side up eggs.
Open salad bars or open buffets.
Drinking alcohol is discouraged. Check with your doctor if you have questions.
Food Safety
No raw, rare, or undercooked seafood, meat, or eggs. This includes sushi.
All meats should be cooked completely. Use a meat thermometer to make sure the meat is
cooked at an adequate temperature.
Reheat foods to at least 165ฐF or until boiling if liquid.
Leftovers should be refrigerated or frozen within 2 hours of cooking. Refrigerated leftovers
should be used in less than 5 days or thrown away. Frozen leftovers can be safely stored for
several months. But, changes in taste, flavor, texture, and eating quality may occur with
extended freezing.
Defrost frozen foods in the microwave or in the refrigerator only.
Use dishes, utensils, glasses and cutting equipment that have been properly cleaned,
especially during food handling.
Always wash your hands before food preparation and between handling raw and cooked
foods.
Refrigerate foods promptly after shopping or cooking.
Eat only at clean, reputable restaurants.
Do not eat at self-service buffets.
Do not eat bulk foods (i.e., items purchased from bulk food bins, like candy, nuts, and dried
fruit).
Maintain Your Weight
Weigh yourself at least once a week; your goal is to maintain your current weight.
Eat five to six small meals each day.
Protein builds and repairs tissues. Eat at least one serving of high protein food with each
meal or snack (i.e. meat, eggs, beans, dairy products, cheese and peanut butter).
Calories provide energy and help you maintain your weight.
Drink plenty of fluid every day (1.5 to 2 liters per day).