Life is absolutely fantastic after my transplant.
It has never been better. My energy level has gone
way up. I mean, I'm doing things now that I was doing when I was 25.
I run 4 miles a day, I can swim a mile in the pool,
I started playing squash a couple of months ago. I'm out walking. I'm out running. I'm
out-doing everybody, and
I'll be 69 this year. I've managed to continue my sports at a very high
level and
fitness-wise I'm in tremendous shape. Now I'm back to 100 percent and
probably better than that. It feels wonderful.
There's nothing more rewarding than seeing our transplant patients do well after
their surgery.
And part of those success stories that we see day in and day out in the transplant
program
is when patients take responsibility for their health. For patients and their
families there is a lot of information that they need to take in what they need to know
about.
Not only about caring for their organ, but also for being on guard for
signs and symptoms of potential dangers, potential complications, following
transplantation process.
Narrator: The risk of infection is a complication faced by
every transplant patient. The purpose of this video
is to help you understand exactly what infection is,
and what that might mean to you. It means
perhaps new medication, it may mean a change in routine, it may mean a decrease in health
for a period of time.
The key is - the sooner we can identify these issues,
the sooner the transplant team can find out about them the sooner we can treat them
and the better the outcome is in the long run.
During the first year transplantation is the most susceptible time to infection,
and that's why they need to be aware of all the signs and symptoms of
infection and to call transplant team
as soon as there's any sign and symptom. General signs and symptoms of infection
include a temperature greater than 37.5,
flu-like symptoms, possibly diarrhea, nausea and vomiting,
and just general feeling of malaise. Patients should be checking their
temperature at home at least once a day. And, if it's
37.5 degrees celsius are greater for several hours they should notify the
transplant team.
At first it's a little bit scary when you hear that
you have infections and you realize that your immune system is
quite heavily suppressed at that point. It started with a fever
and it wasn't that high but we came in just in case, because I've been so close
the transplant we are still some nervous
about a lot of things, and then
the fever just got higher and higher. They realized
after the scan that I appeared to have
about three different infections on the go at that point.
I've had a couple of different weird infections that
normal, everyday, walking around person wouldn't get
and all, but because I'm immune suppressed, I get them. Narrator: all transplant patients
are prescribed drugs that affect their immune system. The immune system
is your body's natural defense against invasion from cold and flu viruses,
bacteria, and other foreign bodies, including your new organ.
The immune system operates through the bloodstream.
Here, specific types of cells, called t-cells,
are on constant lookout for foreign invaders. When they recognize something
that doesn't belong,
for example, a cold virus, they send out a signal,
bringing in whole armies of other t- cells to kill off the invader.
Your prescribed medications affect this defense system
and protect your new organ. However, they also lower your resistance to other
health complications.
It is therefore very important to take your medications
exactly as prescribed, monitor the results very closely,
and report any signs or symptoms as soon as you notice them.
I'm on 13 medications and I take them
very conscientiously, every day at the same time.
It might take a bit of getting used to at the beginning,
maybe for the first couple months, because you want to make sure that you don't
miss
taking your medication. But, after a while,
it's nothing, it's just automatic. Respiratory tract infections,
which are one of several common types of infections which transplant patients may
experience,
are most likely during the winter months, when cold and flu viruses are quite
common.
If the patient was experiencing an upper respiratory infection they need to
call their transplant coordinator and let them know the symptoms.
Those symptoms may be watch for 24 hours
or the patient may be brought in to see the physician and
possibly get started on antibiotics. Viruses typically are not treated with
antibiotics
so there may be times when we have to just really watch the patient carefully
and see whether it progresses into the chest. Infection was always a concern for me
because
we knew what the risks were when we were getting involved with the whole process,
because infection is a major problem with transplantation, especially with
these
patients with cystic fibrosis because we have infection in our system
all the time,
and even after transplant it's still an issue. About two days after the
transplant they realized that I had an infection.
An the infection that I had was because of my cystic fibrosis. It was one of the
complications that is related to that kind of a transplant with
my type of disease. Narrator: another common type of infection
is urinary tract infection caused by bacteria entering the urinary system.
It might not accompany a temperature of greater than 37.5, but you will note that
there will be a lot of problems urinating.
The signs and symptoms of urinary tract infection would be
burning when the patient
urinates, they may have frequency and when they actually go to the washroom they
only may
pass dribbles of urine - they may not have a lot urine but it's really
irritating
the inside of the bladder. They can't wait to empty their bladder.
Again, they may have a fever, the urine may be foul-smelling,
and if they look at it may look cloudy as well.
If you are a kidney transplant, this type of infection should be looked after
right away,
as, for obvious reasons, it could very well
affect the transplanted kidney. Urinary track infection can be treated very
simply by
antibiotics by mouth, and once it's treated it
will subside. Narrator: wound infection is another common complication after transplant.
It may occur along the incision line after surgery,
where the skin has been secured with staples or clips. Or, with any wound
acquired after surgery that doesn't heal well.
If there are problems with the incision, it may be required to be
opened up just a little bit, and a little packing put in place.
What can the patient look for? Well, they can look for about five different things:
temperature, redness, swelling,
pain, and discharge. And number one is always
temperature. They can take their temperature with their own thermometer,
and the temperatures about 37.5, that might tell us that there's a
bit of a problem with infection coming up. Or, they can feel their
incision line and if the incision line feels hot.
then that can tell us that infection could be there just underneath the
skin.
Redness is something they should look for. So, if the incision is
reddened or swollen that gives us more information
too, and if its new pain,
that hasn't been there before. Also,
discharge - if there's a change in the
drainage from the wound, and it the discharge
increases in quantity, or the color changes, for example, if it turns green -
green needs to be seen. A wound infection could also be
a cut that you've recently had or perhaps
a bite or a scrape. If that becomes
swollen, inflamed, sore, or has some drainage,
we'd like to know about it so it can be dealt with appropriately.
Wound infection needs to be
dealt with quickly. We need to know about it
and if we don't know about it, we can't help,
but if we know about it we can deal with it with either
the dressing or appropriate medication. Narrator: another common infection
is known as cytomegalovirus or CMV.
It's a very common virus that is in the same group of viruses that cause
mono and that cause chicken pox. Your risk of getting a serious infection due to CMV
is quite different depending on what type a transplant you have,
types of immunosuppression you have, whether you've had problems with
rejection or not.
The important thing to remember is that CMV is very treatable virus.
CMV is a flu-like virus that presents
with chills and fever, it can present with shortness of breath, nausea,
vomitting, diarrhea. Anything really that you would associate with the flu or
a cold.
It's a very manageable problem, in that we have
very good therapy to prevent it, we have good therapy for treatment
of the disease, and we have good diagnostic tests that can tell us when
patients have the disease.
It can be very serious if it's left untreated.
We want patients to know that it's an illness that we can expect at some point,
that we know that they could be possibly exposed to,
but that we want to identify it early, we want to treat it early,
and it shouldn't cause further problems for them.
The patient's role with respect to CMV disease is really looking out for
the symptoms
and contacting their physician or the transplant coordinator, or coming to
hospital at
the first sign of symptoms.
I was a routine opthamologist examination, and the opthamologiest noticed
a difference in my eye, and he said, "did you pick up anything in the
hospital?"
And I relayed that to the transplant team and they said,
"better check for CMV," and they did the test and sure enough
it was there. Prior to transplant I had been tested
and it had been determined that I had been exposed to CMV somewhere
in my younger years. As had my donor. My donor had also been tested and had
tested positive for CMV. Basically it was transmitted
through my sister was a donor, and she had that
virus in her system. Theoretically, with both of us testing positive,
I should not have had a CMV problem, but with the rejection problem and the fact that
a lot
of suppression was given to me to
deal with rejection problems, CMV managed to come back.
The second time it arose, I was already back at work and I was able to work my
work schedule around it such that I could
get in the morning a bit late to work, come home a bit early
to get in the evening - that sort of thing. The only other thing about it was that
you tend to feel kind of dragged out and tired on these drugs.
If anyone feels like they have any symptoms, or
anything else that might show infection,
the best thing to do is to notify your transplant team immediately.
You will be getting advice like is there any burning on urination?
Do you have a cough? Is there any sputum production? Are there any sores in your
mouth?
And generally, describe how you're feeling exactly. You may have to come
down to the hospital for further tests. You may need blood tests
chest X-rays, and you may need to be admitted to the hospital for IV
antibiotics.
If you're really worried about how you're feeling then you should come down to the
emergency room and get it checked out.
When it comes to infection,
I think the key to it is to find out
as soon as possible when you're becoming infected. And the way to do that is to follow
the procedures that your transplant coordinator and doctors and nurses
tell you what you should do after transplant. At the beginning that can
make you a little bit paranoid, or a lot paranoid,
because you're really looking for things, but as time goes by you
have an idea that this is okay but this isn't. It is very important
that you are able to recognize the warning signs of infection.
Again, they are: a fever of 37.5 degrees Celsius or higher;
flu-like symptoms; problems breathing;
discomfort; pain or redness around incisions;
and changes or problems urinating. Remember,
the risk of infection is a complication faced by every transplant patient.
Your transplant team has the information you need to know.
The transplant team works with the patient and their family to make sure
that the patient has adequate information, adequate knowledge, to make
sure they can monitor their ongoing health status and notify us as soon as
there's any small problem.
The transplant team is committed to making sure that our patients receive
the best quality of life,
the best quality health they can possibly have after transplant.
When you read about these things prior to your transplant,
it's pretty scary stuff. It's all laid out for you in
no uncertain terms, and certainly it's
it's a very serious situation. But, again, it's something that
can be dealt with. The team that
is behind you is the greatest.
The doctors, nurses, and coordinators -
you'd be surprised - the don't miss anything. They're incredibly supportive people.
And, things that might seem ssometimes overwhelming or
daunting,
they make everything feel okay and that you're going to be just fine.
If something starts to feel not quite right,
I call my coordinator,
and she takes it from there.
Really, it's your own responsibility to make sure that you stay on top of things.
If you have any suspicion at all, give them a call.
It's a piece a cake. They'll make sure to check it out and make sure that
you're fine.