Transplant part 3 (getting the call, Transplant meds, and instructions to take them)

(I got this information for all 5 of these blogs from the Cleveland Clinic's website regarding their transplant program.)

Getting the call
When a lung has been identified for you, a transplant coordinator will contact you by telephone or pager. Remember, this could be any time of the day or night.

As soon as you receive the call, do not eat or drink anything (not even water).

Your stomach must be empty before surgery.

It is normal to feel both excited and scared. Because of the natural confusion caused by the need to get to the hospital quickly, you may feel rushed and confused. You’ll be glad you planned ahead to get to the hospital with minimal delay, knowing you have left your home in order.

Getting to the hospital
As soon as you receive the call, bring your suitcase that you’ve packed ahead of time and come directly to The Cleveland Clinic. Even though the donor lung receives special handling, there is a time limit.

If you live more than 1½ hours away from the hospital, the transplant coordinator will arrange transportation for you and one family member. If you live less than 1½ hours away, you must have someone drive you quickly but carefully to the hospital.

When you arrive at the hospital, go to Desk G-50 where you will be admitted.

What happens before surgery?
You will wait in the Transplant Unit until the final results of the crossmatch are determined. If the crossmatch results are negative (or compatible), you will be prepared for surgery (generally within a few hours of your admission).

Just before surgery, you will be asked questions, and tests will be ordered to make sure you are in the best possible physical and emotional condition for the transplant.

If you have a cold, sore throat, fever or any type of infection, it is very important to tell the nursing staff. It also is very important to tell the staff about any other problems you may have.

A complete physical, chest X-ray, blood tests and an electrocardiogram (EKG) will be completed, and the results will be reviewed by your doctor.

While you are being prepared for surgery, one of The Cleveland Clinic transplant surgeons will remove and prepare the donor lung.

If you have a significant medical problem or any signs of infection, or if the donor lung is determined to be unacceptable, the surgery will be canceled. It is better to wait until another lung becomes available than to risk a transplant when you are not physically ready.

Before you go to the operating room, you will be asked to:

•Wear a hospital gown
•Empty your bladder
•Remove your dentures or partial plate
•Remove your eyeglasses or contact lenses
•Remove jewelry, makeup, nail polish and hair pins
To prepare you for the transplant surgery, the incision area will be shaved (from your chest to your knees) to prevent infection. You also will have an intravenous tube (IV) inserted in your arm to deliver fluids and medication. Before going to the operating room, you will be given a sedative to help you relax and make you sleepy.

What happens during surgery?
An anesthesiologist will inject general anesthesia (pain-relieving medication) through your IV, which will make you go to sleep. After you are asleep:

•A central venous catheter is inserted into a vein in your neck or groin. This type of catheter is used to deliver fluids, nutrition solutions, antibiotics or blood products directly into your bloodstream without frequently having to insert a needle into your vein.
•A tube is placed in your mouth that goes down your throat and into your windpipe (trachea) to help you breathe. The tube is attached to a ventilator that will expand your lungs mechanically.
•You are placed on a heart/lung machine to allow surgeons to bypass the blood flow to the heart and lungs. The machine pumps blood This information is not intended to replace the medical through the body, removing carbon dioxide (a waste product) and replacing it with oxygen needed by body tissues.
•A nasogastric tube is inserted through your nose into your stomach. This tube drains secretions from your stomach.
•A tube called a catheter is placed in your bladder to drain urine.
•The surgeon carefully removes your lung and replaces it with the donor lung.
Where can my family wait?
Family members and friends are invited to wait for you in the Family Waiting Lounge until the surgery is completed. This waiting area has a play room for small children, a television, reading materials and comfortable chairs.

The surgery lasts 6 to 12 hours. The Cleveland Clinic has several cafeterias and restaurants, a gift shop and a Health Information Desk that may be of interest. We ask visitors to sign in and out of the waiting area, and provide a phone number so we can contact them if necessary.

A member of the transplant team will meet with your family in the Lounge to keep them updated on your condition. Your family will be notified when the surgery is complete.
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Transplant Medications
The most important step in maintaining your health after your transplant is to take your medications exactly as prescribed. These drugs help prevent rejection and infection, and must be taken for the rest of your life.

•What will I need to know about taking my medications?
•Will the drugs I’m taking cause any side effects?
•Does it really matter if I miss a dose?
•What if I forget to take my medications at the scheduled time?
•Dose changes
•Other medications
•Can I get financial assistance to help pay my medication expenses?
•Will any new medications be available?
•General Medication Guidelines
•Questions to Ask about your Medication

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Click here to view a video about your medications.

What will I need to know about taking my medications?
Before any medication is prescribed, your physician will ask you:

•If you are allergic to any medications
•If you are currently taking any other medications (including over-the-counter medications)
•If you have problems taking any medications
The type of medications, the dosage and side effects may be different for each patient. While you are in the hospital, the Lung Transplant Team will teach you about your medications and give you information sheets describing each drug and how to take it. Before you go home, the Transplant Team will make sure that you know:

•The name of the drugs prescribed and their action
•Please note: All medications have two names—the generic or chemical name (such as furosemide) and the brand name (such as Lasix). The Transplant Team will tell you both names of the medications.
•The dosages, when (the time of day) and how to take the medications
•The side effects and how you can treat or prevent them
Your family members are also encouraged to learn about your medications.

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Will the drugs I’m taking cause any side effects?
Some of the drugs you are prescribed may cause unwanted side effects such as weight gain, acne or excess hair growth. Despite these side effects, never change the dose or stop taking your medications without first checking with your physician.

Many of the side effects can be controlled. Your doctor may adjust your dosage or offer other suggestions for managing the side effects. Keep all appointments with your doctor and the laboratory so your response to the drug can be monitored.

The individual drug information sheets contained in this notebook describe the common side effects of each drug and how to manage them.

Call your doctor or transplant coordinator if you become sick and vomit soon after taking your medication. Do not take a second dose without first talking to your health care provider. If you have diarrhea for more than one day, c

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all your doctor or transplant coordinator. Also call if you have any other symptoms that are persistent or severe.

Does it really matter if I miss a dose?
Yes. It is very important to always follow the instructions for your medications every day to prevent rejection. The third major cause of transplant failure results from not taking anti-rejection medications as prescribed.

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What if I forget to take my medications at the scheduled time?
If you miss a dose of your medication at the scheduled time, don’t panic. Take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and return to your regular medication schedule.

As you begin to feel well, it may be easy to forget to take your medications, but always remember that your body never stops requiring the transplant medications. By taking your medications consistently and following-up with your physician routinely, you are assuming the most important job after your transplant.

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Dose changes
Your physician will periodically change the dose of your medications. The dose may be changed because you are having uncomfortable side effects or because blood test results indicate a different dose is needed.

You will receive a medication dosage record to write down your medications and dosages. Every time your physician tells you to change the dose of your medication, cross out the previous dose and write in the new dose. (Use ink, not pencil, and do not erase previous information so you have a record of your earlier doses.)

Remember, never change the dose of your medication unless your physician has told you to.

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Other medications
Never take other medications without first talking to your physician. This includes over-the-counter drugs (those you can buy without a prescription). Some over-the-counter drugs include aspirin, ibuprofen (Advil, Nuprin), vitamins, cold medicine, antihistamines, antacids, laxatives and sleeping pills. Some over-the-counter medications may decrease the effectiveness of your transplant medications and can cause unwanted side effects.

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Can I get financial assistance to help pay my medication expenses?
Yes. Your health care providers realize your medications are expensive, especially since you must take them for the rest of your life. There are several government and state programs that offer financial assistance for medication expenses.

Please ask your health care provider what programs are available for you. You also can ask to see a financial counselor who can answer questions about insurance coverage and Medicare benefits related to your medication expenses.

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Will any new medications be available?
Exciting developments in drug research are creating new immunosuppressive medications. The Cleveland Clinic Lung Transplant Program participates in new drug studies on a continuous basis. You may be asked to take part in one of these programs after your transplant. All programs are strictly voluntary and have no influence on your transplant status.

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General Medical Guidelines
Note: These are general guidelines. Be sure to ask your doctor or pharmacist for guidelines specific to your medication.

•Keep a list of all your medications and their dosages with you.
•Take your medications exactly as prescribed by your doctor.
•Do not stop taking your medications unless you talk to your doctor first. Stopping your medication too early can cause the illness to return or make it more difficult to treat.
•Do not double the dose of your medication.
•If you miss a dose of your medication at the scheduled time, don’t panic. Take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and return to your regular medication schedule.
•Do not keep outdated medication or medication that is no longer needed. Throw away old medicines.
•Store medications in a dry area away from moisture (unless your doctor or pharmacist tells you the medicine needs to be refrigerated).
•Always keep medications out of the reach of children.
•Contact your doctor immediately if you experience any unusual side effects after taking your medication.
•Do not share your medications with others.
•If you store your medications in a container, label it with the medication name, dose, frequency and expiration date.
•Keep your medications in your carry-on luggage when you travel. Do not pack your medications in a suitcase that is checked, in case the suitcase is lost.
•Take extra medication with you when you travel in case your flight is delayed and you
need to stay away longer than planned.
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Questions to Ask about your Medication
Be sure you know the answers to these questions before you start taking any new medication:

•What is the name of the medication?
•Why do I need to take it?
•How often should I take it?
•What time of day should I take it?
•Should I take it on an empty stomach or with meals?
•Where should I store the medication?
•What should I do if I forget to take a dose?
•How long should I expect to take the medication?
•How will I know it is working?
•What side effects should I expect?
•Will the medication interfere with driving, working or other activities?
•Does the medication interact with any foods, alcohol or other medications (including over-the-counter medications)?
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