How often should I check my temperature after my bone marrow transplant?

Knowing how many times a day to take your temperature, for what duration and when to call your healthcare provider can help catch an illness or infection early in its course. Using a thermometer to monitor your temperature can help you manage an illness. A rise in your temperature is usually caused by an illness or infection and is usually one of the first signs of a potential problem.

Autologous transplant patients: Check your temperature twice a day while you have central line and for two weeks after discharge.

Allogeneic transplant patients: Check your temperature twice a day while you are taking immunosuppressive medicines and while you have a central line.

When to call your health care provider?

For allogeneic bone marrow transplant patients, page your nurse coordinator if you have a temperature of 100.0 degrees Fahrenheit or higher. For autologous bone marrow transplant patients, page your nurse coordinator if you have a temperature of 100.5 degrees Fahrenheit or higher. This could be a sign of infection and should be treated right away.

If you have a fever and any of these other signs, call your healthcare provider right away:

  • Severe headache
  • Stiff neck
  • Severe swelling of your throat
  • Mental confusion

Although bone marrow transplantation offers hope for many patients, going through the BMT process is a difficult experience for patients and their families. Treatment is physically and emotionally challenging.

Dealing with changes and loss of control

Facing the reality of a serious illness, fearing what is involved in bone marrow transplantation, dealing with complex and unfamiliar medical information, and facing separation from family and friends can be overwhelming and difficult to endure. You and your family might experience anxiety regarding the uncertainty of what lies ahead.

You will experience changes and might not be as independent as you want to be. People will experience some changes and role losses that are temporary, and some longer-term changes in lifestyle might occur. While going through transplantation, common role changes might involve employment or work, parenting and family responsibilities, and physical activity. People who are used to being independent and like to feel in control might find such changes very frustrating and might find it difficult to cope.

A person’s ability to cope is strongly influenced by his or her perceptions of a situation. If you believe challenges facing you are insurmountable, you might feel helpless or hopeless. Obtaining more information, asking about how other people have coped, and turning to others for support are helpful coping strategies and might change the way you view your situation.

Give yourself permission to have bad days. You are only human and will have times when you feel discouraged or are in a bad mood. Just guard yourself against getting stuck in negative thinking and feelings.

Helpful coping strategies

Review what has been helpful and not helpful to you in the past when dealing with stressful or difficult situations. Focus on building on your strengths, and stay open to new ideas and strategies. Here are some positive coping strategies:

  • Utilize your support network of friends and family: having loved ones or friends visit or call you can be very comforting. Discuss your feelings about what is happening with your friends and family. Allow family and friends to help you sort through the information you receive.
  • Talk with other patients and families about bone marrow transplantation: talk with your social worker. Make use of resources and support services —these include resources at Cleveland Clinic and in the community.
  • Actively participate in your treatment plan: you are a valuable and key person in your treatment plan. Stay informed and communicate your questions and ideas to the medical team. Do not be afraid to ask your doctor, nurse, or other health care provider to repeat any instructions or medical terms you don’t understand. Your Bone Marrow Transplant Team is always available to answer your questions and address your concerns.
  • Focus on things you can influence: let go of things you can't change or control, and focus on doing things that will help your situation.
  • Focus on what needs to be done here and now: it is easy to get overwhelmed if you think about everything you might eventually have to deal with. Focus on what you are currently dealing with and can work on now.
  • Accept your reactions and your natural pace: accept how you feel about events, and give yourself time to adjust and process thoughts and feelings about what is happening.
  • Give yourself things to look forward to: your energy has been focused on treatment, but there are still things you can enjoy, and you need to plan simple pleasures to which you can look forward.
  • Focus on what you have: try to focus on what you still have and have gained rather than what you have lost or haven't accomplished yet.
  • Accept the unexpected: accept that there are events you cannot control. Few things will happen exactly as expected. Plan for delays, setbacks, and surprises.
  • Reduce stress: when you are facing BMT, stress can build up and affect how you feel about life. Prolonged stress can lead to frustration, anger, hopelessness and, at times, depression.

Here are some tips for reducing stress:

  • Be assertive instead of aggressive. "Assert" your feelings, opinions, or beliefs instead of becoming angry, combative, or passive.
  • Learn to relax.
  • Exercise as often as you can.
  • Eat well-balanced meals.
  • Rest and sleep. Your body needs time to recover from stressful events.

Learn to Relax

There are a number of exercises you can do to relax. These exercises include breathing, muscle and mind relaxation, relaxation to music, and biofeedback. A few for you to try are listed below. First, be sure you have a quiet, distraction-free location. Try to find a comfortable body position. Sit or recline on a chair or sofa. Also, have a good state of mind. Try to block out worries and troubling thoughts.

Two-minute relaxation

Switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped. Loosen up these areas, letting go of as much tension as you can. Rotate your head in a smooth, circular motion once or twice. (If any movement causes pain, stop immediately.) Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should feel relaxed.

Mind Relaxation

Close your eyes. Breathe normally through your nose. As you exhale, silently say to yourself the word "one," a short word such as "peaceful," or a short phrase such as "I feel quiet." Continue for 10 minutes. If your mind wanders, gently remind yourself to think about your breathing and your chosen word or phrase. Let your breathing become slow and steady.

Deep breathing relaxation

Imagine a spot just below your navel. Breathe into that spot and fill your stomach with air. Let the air fill you from the stomach up, then let it out, like deflating a balloon. With every long, slow breath out, you should feel more relaxed.

Good nutrition is a very important part of your recovery. It helps your body resist infection and repair tissue damage caused by chemotherapy and/or radiation therapy.

Losing interest in food after a long illness is to be expected. Some of the side effects you might have experienced while in the hospital may continue even after you go home. These side effects may include nausea, vomiting, loss of appetite, taste changes, and a sore or dry mouth. With these symptoms, it may be difficult for you to imagine eating high-calorie, nutrient-rich meals.

Nutrition After Blood & Marrow Transplant

Nutrition supplements

When you are unable to eat a well-balanced diet, we recommend you try over-the-counter nutrition supplements to meet your nutritional needs, unless otherwise instructed. However, it is important to check the labels for the specific vitamin, mineral or nutrient levels. They can vary from different manufacturers. Examples of nutrition supplements are Ensure®, Boost®, Resource®, Carnation Instant Breakfast®, Boost® bars and Boost® puddings. If you have diabetes, Glucerna® and Boost® Glucose Control are options.

Several discount stores and drug stores have nutritional supplements packaged under their private label. Please check with the dietician to determine if the particular product will meet your needs.

Multivitamins

We recommend you take a daily multivitamin, after you are discharged. You can take children's chewable multivitamins twice a day if better tolerated. Excess doses of some vitamins and minerals might be unsafe at this time. For instance, it is important to choose vitamins that do not contain iron or herbs. Also, due to your numerous red blood cell transfusions, additional iron supplementation is unnecessary. Your body does not eliminate iron. If you have questions regarding your preferred multivitamin, bring your labeled vitamin bottle to your appointment for your doctor's approval.

Follow food safety guidelines when choosing any of the following foods:

Calcium and Phosphorus

Some of your medicines might deplete calcium, which is important for maintaining bone strength. When the staff reviews your medications and labs, they will inform you if this is likely to be a problem. Phosphorus is a mineral that helps to strengthen bones. Some transplant patients often need additional phosphorus. Unless you are following a special diet, we recommended you eat a diet high in calcium and phosphorus.

Your doctor might recommend calcium supplements such as Tums®, Oscal +D®, or Caltrate®. Calcium supplements with vitamin D are essential for those who require long-term steroid therapy, such as prednisone. Steroids cause bone loss, called osteoporosis. Taking these supplements, as well as exercising, can help minimize bone loss and prevent fractures. An appointment with a rheumatologist may be advised to monitor your bone density.

Potassium and magnesium

Antibiotics, diarrhea, and vomiting can cause electrolyte (mineral) imbalances. Even after your hospital discharge, it is common to require potassium and magnesium supplementation, which can be given by pill or intravenous infusion.

Potassium is an electrolyte (mineral) that maintains normal fluid balance, supports cell integrity, facilitates the making of protein, and assists in the transmission of nerve impulses and the contraction of the heart and other muscles.

Magnesium is also an electrolyte (mineral) that is involved in bone mineralization, building of protein, transmission of nerve impulses, and normal muscular contraction.

Sodium

Sodium is an electrolyte essential for water regulation and electrical activities of the body, such as nerve impulse transmission and muscular contraction. Our diets rarely lack sodium.

A healthy person requires about 200 mg of sodium daily, but the average sodium intake is estimated to be 6,000 to 18,000 mg daily. Excessive sodium intake can lead to high blood pressure (hypertension) and fluid retention. Reduce your sodium intake to less than 2,300 mg each day.

Since allogeneic transplant recipients might already be experiencing hypertension or fluid retention/swelling (edema) caused by steroids —such as prednisone, tacrolimus (Prograf®), or cyclosporine (Neoral®) — it is crucial to avoid a diet high in sodium.

Alcohol

After your bone marrow transplant, you might have decreased liver function due to the effects of high-dose chemotherapy, graft-versus-host disease (GvHD), or metabolism of medicines. Since the liver metabolizes alcohol, avoid all alcoholic beverages. Alcohol can cause malnutrition by attacking the stomach lining, leading to malabsorption and excretion of many nutrients. Before drinking beer, wine, or other alcoholic beverages, ask your BMT doctor.

Sun Exposure After Bone Marrow Transplant

Ultraviolet (UV) ray sun exposure can be harmful to the skin, causing sunburns and/or skin cancers. More importantly, sun exposure to those who have had an allogeneic bone marrow transplant can trigger or worsen skin graft-versus-host-disease (GVHD). Wear a hat, long sleeves, long pants, and sunscreen with an SPF of at least 30 if you are outside in the sun. However, avoiding sun exposure is the best prevention. Please note that even on cloudy days, skin exposure to UV rays still occurs; therefore, take precautions.

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