Now that you have your transplant, regular exercise is one of the keys to putting you on the road to good health. It is important to have a daily exercise routine, to build up muscles weakened by a long period of illness. The exercise programme should be aiming to slowly increase the level of exercise. Walking is a good way to start exercising and hobbies such as tennis and jogging can be taken up, as early as three months, after your transplant. However, contact sports should be avoided.
Exercise has a positive effect on blood pressure, cholesterol levels, and the functioning of the heart and lungs, even if you don't lose weight. Exercise can also improve your psychological health and can be achieved with low to moderate levels of physical activity.
The Irish Kidney Association promotes an active year-round sports programme, for transplant recipients and people on dialysis. The programme is open to all levels of ability and interest, with an emphasis on participation and enjoyment. Regular open sessions are held, with family and friends always welcome. The Association organises national teams for events such as the World Transplant Games (biennial – odd years) and the European Transplant & Dialysis Games (biennial – even years). The team is open to all abilities as the Transplant & Dialysis Games experience is worthwhile and about so much more than sport! Why not contact the IKA to find out more and get involved in a new wonderful family?
The Irish Kidney Association also encourages the use of a free online exercise and lifestyle management app called Kidney Beam. There are recorded and live sessions available on the app. This can be done in your own home and at your own pace. You can access the app by scanning this QR code – we will add link
It is common to experience changes in your vision, for the first few weeks, after your transplant. It is recommended that you wait about six months for your vision to stabilise before considering a change in your glasses. Your transplant medications may increase your risk of developing cataracts, glaucoma and eye infections. Do visit an ophthalmologist at least once a year. Be certain to inform them that you are taking immunosuppressive medications.
If you were employed up to the time of your transplant, you should be able to return to work, within three months, after your surgery. It really depends upon you and your job — how well you feel, and what are the physical demands of your work. If your job requires heavy lifting, it may require more time. If your job is not physically difficult, it can be sooner. The important thing is to be realistic. Pushing yourself too soon, can lead to problems that would delay your return to a full work schedule. If you have not worked for some time, due to your illness, do speak to your transplant nurse or patient care co-ordinator, as there may be training or employment opportunities for you in your community.
Good mouth and dental care are essential to prevent infections after your transplant. It is best to wait about three months after your transplant, or if you have recently been treated for a rejection episode, before you have a routine dental check-up, including cleaning. Brush and floss your teeth twice a day. Be gentle when flossing, as this can irritate your gums and cause bleeding. A waxed floss slides more easily between the teeth. Use fluoride toothpaste and a soft nylon or electric toothbrush. You should see a dentist every six months. Be certain that your dentist knows that you are a transplant patient and taking immunosuppressive drugs. You will need to have antibiotics prescribed before any dental work is done, including cleanings.
Smoking tobacco, marijuana or using any unprescribed drugs is harmful to everyone but especially so for transplant patients. Smoking damages the lungs and puts you at greater risks of contracting lung infections and cancer. Your transplant team will assist you to give up smoking. Any form of so-called ‘recreational drugs’, such as cocaine, speed or ecstasy can have a serious negative effect on your body and mind. These drugs can also interfere with your medication If you have normal liver function, moderate amounts of alcohol should not cause you any problems. Some of your medications can reduce liver function so it is best to limit the amount of alcohol you drink. Alcohol can also cause dehydration and depression.
Some people may think — “You got a transplant, a new lease on life. Be happy. Don't worry!” But, in reality, the time after transplantation can be emotionally difficult for many patients. First of all, some of the medications can cause mood swings, sleep disturbances, or even depression. These kinds of problems are even more troubling because you cannot understand why you feel the way you do. If you experience any of these effects, talk to your doctor or transplant nurse. And, remember, never change your dose of medications without permission from your doctor. Very Important!! If you are feeling depressed, do not take any medications or herbal preparations without medical advice. St. John's Wort, for example, is known to interact with immunosuppressive medications. Transplant patients often have concerns about changes in relationships, work, finances, staying healthy, side-effects of medication, and the possibility of rejection, which may cause stress, anxiety, fear or sadness. Your transplant team is there to help you. Talk to them. Tell them when you have a problem. You can also avail of the renal nurse counselling service available at Beaumont Hospital.
STAYING HEALTHY CHECK LIST
Many transplant recipients ask how they might acknowledge the gift of their new donor organ. There is no right or wrong time, and no right or wrong way to say ‘thank you’ to your donor family.
Some ways that patients may express their thanks include writing:
Donor families receive a letter from the transplant co-ordinators, within a month of their loved-one's death, thanking them for consenting to organ donation. Donor families are not given any information which may identify you. We recommend that you allow some time to elapse, after your discharge, before expressing your thanks to the donor family. Your 'thank you' may be written, at any time, after your transplant. It will always be greatly appreciated by your donor family. The letter should not identify you. It is preferable that you do not date the letter or card as it may be some time before it may be forwarded to the family. Please do not seal the envelope as the Transplant Co-ordinators will need to check the letter, for confidentiality purposes, before passing it on.
The letter normally starts with “Dear Donor Family” or “Dear Friends”. You may like to include details such as:
Most people describe how their lifestyle was prior to the transplant, and describe their contrasting quality of life since receiving their transplant. Everyone expresses their thanks to donor families in their own way. In nearly all cases, transplant patients say it is the most difficult letter that they have ever written and that they had to rewrite it, many times, before getting it right.
You can give this letter or card to your transplant nurse or transplant co-ordinators.
This service is hosted every year, in the autumn, by the Irish Kidney Association (IKA). Many kidney transplant recipients and, indeed, other organ recipients, join with donor families, at this service, to remember the donors. It is a special way of expressing gratitude in an anonymous manner. Do view the IKA SUPPORT magazine for more details.
One of the things that many patients look forward to after transplant is the freedom to travel. Patients should advise their doctor if they intend travelling abroad. It is important to consider your destination as some exotic locations may have higher risks, including impure water or insect bites. If you require any vaccinations, you must consult your doctor. Always pack enough medications for the entire journey and a little extra in case of delays. Ensure that your medications are not exposed to extreme heat or cold. If you fly, keep your medication with you in your hand luggage. Carry your Renal Transplant Passport with you. Pack plenty of sunblock and use it! On long journeys, get up and walk around at least every two hours, and ensure you drink plenty of water. On long distance flights, it is recommended that you wear flight stockings. In warm weather, ensure that you keep yourself well hydrated.
Exotic destinations may include potential exposure to infections that are rare in your country of origin or that you have never been exposed to before. When considering foreign travel, it is worth assessing your potential destination with regard to water supply, general standard of hygiene and access to medical services.
If you are planning foreign travel you should consult with a travel medical specialist, in good time, before you plan to travel. You should also comply with vaccines and medications that are prescribed for you. You should also ensure that you have adequate supplies of medication and adequate health insurance cover. Many travel insurance packages do not cover existing illnesses - check before you buy a policy.
Vaccination is a highly effective way of preventing disease. Most vaccines take some time before they are fully effective, so you should ensure consultation with doctor and actual vaccination, weeks before you plan to travel.
You should ensure your vaccination schedule is up-to date. Additional vaccines may be prescribed, depending on the area of travel and any special risks you may encounter. If you are travelling to a malaria endemic area you should also take appropriate malaria medication and precautions.
The NHS website www.fitfortravel.nhs.uk is a very useful resource that lists specific vaccines needed for each country.
Please discuss with your transplant team if you have any queries about routine or travel vaccinations.
There are many factors that influence sexuality after transplantation – how you feel physically and how you feel about yourself. Sexual intimacy can begin any time after surgery, as long as you have the interest and feel well. However, wait 4-6 weeks to have sexual intercourse. This will allow time for your incision to heal. Communication is the most important factor in any relationship. Wherever there is a problem share your feelings and fears with your partner. Nursing and medical staff recognise that you may have difficulties, in sexual relationships, and will gladly talk to you and your partner. Professional guidance can help — all that may be needed is a little reassurance.
Difficulty with sexual function, for men, is not uncommon after kidney transplantation as the body gets used to being healthy again. Much of the time this is a psychological difficulty rather than any specific physical problem.
Diabetes, or some blood pressure medication, can cause impotency. If this happens discuss it with your doctor, as there are now very effective medications which can resolve these issues. As men get older the prostate gland may become enlarged resulting in difficulty passing urine, with poor flow or having to get up at night. Again, there are very effective medications or a small operation may be needed which can deal with these problems if you discuss them with your doctor.
Most women usually stop menstruating while on dialysis. Following kidney transplantation, many women find that their periods return within a couple of months. However, sometimes they will be irregular for the first few months. If you persist being very irregular let your doctors know and they may arrange for you to see a gynaecologist.
It is important to be aware that you may become pregnant at any stage post-transplant if you are sexually active and do not take precautions. We advise that you do not become pregnant for 2 years after kidney transplantation. If you plan to become pregnant discuss it with your doctor before you stop any contraceptive measures.
All transplanted women, who are sexually active, need to have a smear test annually.
When you have a kidney transplant you need to discuss your contraceptive requirements carefully with your transplant nurse or doctor. Generally, the pill is not suitable for transplant patients because of the risks of blood clots and blood pressure. The most suitable forms of contraception are either for the man to wear condoms or for women to use the Progesterone only pill or the DepoProvero contraception injection. The Mirena coil can also be considered. It is advised to use barrier protection such as condoms to help prevent against acquiring sexually transmitted disease.
If you are planning to conceive both male and female patients need to discuss this with their transplant team as some medications that you may be taking it is advised not to conceive whilst taking them.
If your transplant is functioning well and your blood pressure is well controlled, and you do not have much protein in the urine, then you may well be able to safely have a baby. There have been thousands of babies successfully born to transplant patients across the world. However, you should not plan to become pregnant until two years after transplant. Many of the medications that you are on may interfere with a baby's growth and, so, your doctor should switch these around prior to you becoming pregnant. It is also important to take vitamins, like iron and folic acid, prior to becoming pregnant.
Breast cancer is no more common after a kidney transplant than in the general population. It is none the less, common in women in general. The best way to treat breast cancer is to diagnose it early. Mammography is available for women between the ages of 50 and 65. If you are offered a free mammogram you should keep the appointment.
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