I. Infection
Since all immunosuppressive drugs alter the immune system to reduce the body’s ability to recognize and respond to bacteria and viruses, transplant recipients are at risk of developing infections. The normal response to infection is an increase in white blood cells, which are responsible for fighting the invading microorganisms. Mycophenolate, azathioprine and rapamycin can all cause leukopenia and therefore increase the risk of infection. It is important to monitor the white blood cell count and adjust the treatment regimen based on its results.
During the 3-6 months after transplantation, when immunosuppressive drug concentrations are maintained at their highest levels, infection prevention therapy is applied in many centers. Ganciclovir is applied to prevent cytomegalovirus (CMV) infection, acycloguanosine to control herpesvirus infection, cotrimoxazole (SMZ-CO) to prevent Pneumocystis carinii pneumonia and urinary tract infections, and fluconazole to prevent mycobacterial infections.
Recommendations.
1. good hand washing habits are recommended; for children, it is recommended that they be taught how to wash their hands first.
2.Avoid cleaning animal waste.
3.Avoid contact with patients.
4.Maintain instructions on immunization methods and the timing of the onset of influenza.
5.Use antibiotics when performing dental treatment to prevent infection.
6.Avoid digging up dirt with bare hands.
7. reporting to the physician as soon as signs or symptoms of infection appear, e.g. sore throat, fatigue, altered urination, swollen lymph nodes, cough, fever
8. Any puncture wounds, large cuts or wounds should be reported to the physician immediately.
II. Acne
Acne is caused by increased oil production in the skin. Acne is associated with cyclosporine, hormones and rapamycin.
Suggestions:
1. Wash the affected area gently several times a day, taking care not to rub the affected area.
2.Wash with soap to remove excess oil, taking care not to make the skin feel dry.
3, topical application of an ointment containing 5-10% benzyl peroxide to the affected area.
4. when choosing a shampoo for daily use: avoid baby shampoo products.
5. Avoid hand contact with the face, while not squeezing acne or piercing it with the hands.
6, Dermatologists will give some topical antibiotics or capsules, such as: Vitamin A acid, etc.
Third, emotional instability
Hormones are the most common cause of emotional instability in patients.
Suggestions.
1. discuss with your doctor about your problems, feelings and behaviors once such problems occur.
2. participate in organizations or community activities, such as; a liver club.
3. if necessary, seek professional treatment from a professional psychiatrist.
4. consulting with some patients to raise awareness about these out-of-control behaviors.
5.Read some professional books.
IV. Insomnia
Hormones are the most common cause of insomnia in patients.
Suggestions.
1.Avoid beverages containing caffeine and alcohol, and quit smoking.
2.Perform some relaxation activities before going to bed: bathing, reading, listening to music.
3. not going to bed until you feel like sleeping.
4. getting up on time every day.
5, if persistent insomnia causes a lot of trouble, you can take some sedatives, such as: Benadryl, under the guidance of a doctor.
V. Weight gain
Patients taking hormones and have increased appetite, or uncontrolled diet, are the reasons for weight gain.
Suggestions.
1.Eating low-salt, low-fat and low-calorie food.
2.Control the amount of food eaten.
3. choosing low-calorie snacks, e.g. fresh vegetables.
4, exercise.
VI. Excessive hair growth
Cyclosporine is the most common cause of excessive hair growth in patients. However, hormones and rapamycin can also cause excessive hair growth in patients.
Suggestions.
1, hair removal creams can be used, but due to the long-term use of hormones, the patient’s skin becomes thinner, so products for sensitive skin need to be chosen carefully.
2, Bleaching, shaving, hair removal with wax.
3, application of laser to remove hair.
5.Electrolysis cap removal method and plucking hair with tweezers can also be applied, but this increases the risk of infection.
VII. Excessive gingival hyperplasia
It has been found that: cyclosporine not only causes gingival overgrowth, but also increases the tendency of gingival bleeding. Calcium channel blockers and phenytoin have also been associated with gingival hyperplasia in patients.
1. brushing with a lint toothbrush twice a day.
2. daily use of a gingival stimulator or finger massage of the gums.
3. avoiding contact of cyclosporine with the gums
4. use of over-the-counter dental rinses.
5. use of antibiotics, e.g. azithromycin
6. receiving 2-4 oral examinations per year
7.Avoid smoking.
8, avoid breathing through the mouth.
VIII. Diarrhea
Mycophenolate is the most common cause of this distress. Before treating diarrhea, it is recommended that you rule out other causes, such as: lactose intolerance, etc.
Suggestions.
1. taking 1-2 Tum between meals and just before bedtime.
2. avoiding the use of magnesium-based acid preparations.
3. avoid foods that cause diarrhea, such as: prunes, wheat bran and fava beans.
4. adding the following foods to the recipe: bananas, rice, apple juice and tea.
5. taking Pulcolax and mycophenolate 2-4 hours apart.
6. taking the above-mentioned drugs with meals or 1 hour after meals
7.Take half amount of Metamucil diluted solution.
IX. Elevated blood sugar
Both hormones and Pulcolax are associated with this side effect. The mechanism of action of both drugs is to produce a barrier to prevent insulin from entering the cells, thus increasing the need for insulin.
Recommendations.
1. weight control to reduce insulin requirements.
2. Exercise – 20 minutes of slow exercise per day. May be extended by 5 minutes as appropriate to improve tolerance.
3.Have a dietitian develop a nutrition plan for you.
4.Take oral hypoglycemic drugs, such as glibenclamide, etc.
X. Skin cancer
Although azathioprine is the drug most associated with the occurrence of skin cancer, it has been shown that: receiving any immunosuppressive therapy increases the risk of cancer. Patients are instructed to check their skin frequently and note any changes, which may include: dry patches, moles, lumps and non-healing ulcers on the skin.
Recommendations.
1. wearing protective clothing in the sun.
2. using a sunscreen with an SPF > 15 that also isolates UVB and UVA.
3. reapply sunscreen if exposed to the sun for more than 80 minutes.
4. avoiding sunbathing, especially between the hours of 10 a.m. and 3 p.m.
5.Buy a new sunscreen every year, while taking care to check its expiration date.
XI. Hair loss
Any immunosuppressive treatment can cause hair loss because these drugs can rapidly affect cell division and thinning of hair fibers. Usually Azathioprine and Pulcolax will have such side effects.
1. Use hair softeners (in cream form) to avoid tangling of hair.
2. Use only a wide tooth comb to gently comb the hair.
3. Avoid straightening, bleaching, coloring and perming hair, as these can damage the hair.
4. Avoid ponytails and other hair styles that pull hair tight.
5, limit sun exposure and contact with chlorinated substances.
XII. Tremor
Pulcoflor and cyclosporine are the most important causes of tremor. The nuisance of tremor has been found to be particularly prominent in patients with high blood levels of the drug. Electrolyte imbalance is also a cause. Tremor can occur in the extremities, especially the hands, and may be accompanied by numbness. Patients need to be examined by a neurologist to rule out any other causes of tremor.
1. Monitor the drug concentration and use the lowest blood level to achieve immunosuppression.
2. dividing 2 oral doses per day into 3-4 oral doses per day.
3. switching to other immunosuppressive treatments.
4. performing simple stretching exercises.
5.Monitor blood electrolytes, blood phosphorus, blood magnesium and blood calcium levels, and treat if necessary.
XIII. Headache
Cyclosporine and Pulcolax are the most common causes of this side effect. Other causes are: infections, exercise, high blood pressure, allergic reactions, mental stress, caffeine in food, high tyramine content in food, such as cheese; also alcohol consumption can cause headaches. Since a variety of factors can cause headaches, it is important to inform the patient to be aware of identifying which activities cause headaches to occur. Document the foods, activities, and treatment options associated with the headache at the onset of the headache.
Recommendations.
1. switching from Proscar or cyclosporine to 3-4 daily doses.
2. stop ingesting the food causing the headache.
3. gradual adaptation of exercise to avoid the occurrence of post-exercise headache.
4. avoiding the occurrence of hypoglycemia
5. apply paracetamol for pain relief in the absence of liver disease, but limit the dose to 140/90 mmHg. If the patient takes diuretics, a blood pressure >135/85 mmHg is considered hypertensive. Since this is a silent lesion, it can easily be overlooked.
Recommendations.
1. weight control.
2. Quit smoking.
3. consulting with a dietitian to change to a low salt, low fat and low sugar diet and limiting caffeine intake.
4.Monitor blood pressure daily if the patient takes antihypertensive medication; even if not taking antihypertensive medication, then test blood pressure regularly every month.
5.If the doctor gives blood pressure lowering treatment, should adhere to the medication on time.