The first 100 days post-transplant are the most critical days. Physiologically, is the time when the patient's immune system is most suppressed and the patient is most week. Emotionally and mentally, this is when the patient is quite vulnerable, trying to slowly get life back together. The first 30 days are spent in the hospital where doctors check-in daily, nurses monitor 24/7 for irregularities, patients are fed through IV if they can't eat, and someone is always there to make sure the right meds are taken. Once the patient is discharged, it is critical that the patient continues to take very careful care to make all the right medications, eat properly, maintain a clean home and constantly be on alert of irregularities in bodily functions. Fever is the most important sign to watch.Taking the right medication at the right time is very critical to maintain the correct chemical balance to fight off infection, prevent off Graft vs. Host disease but allow the body enough strength to fight off any lingering Leukemia blasts. This is where we trust the team of doctors and pharmacists to know the right drugs to combine for the best possible outcome. So glad chemistry is in the medical curriculum! Below are a sample set of some of her current medications:
- Tacrolimis - immunosuppresent to help prevent Graft vs. Host disease, adjusted based on Complete Blood Count every few days
- Sirolimus - immunosuppresent to help prevent Graft vs. Host disease, adjusted based on Complete Blood Count every few days
- Acyclovir - antiviral
- Sulfamethoxazole - antibacterial
- Magnesium - Other medications cause a magnesium deficiency
- Zofran - nausea
- Protonix - acid reflux
- Ursodiol - potential gall stones, help with liver
- Baraclude - preventive measure for Hepatitis B because this is a common liver condition among Asians who have not been vaccinated. Since my mom's immune system is suppressed, it is critical that we prevent Hep B
- Voriconazole - antifungal
With so many different, changing medications, we need to constantly check to make sure her chemical levels are good and that the drugs do not negatively interact. One example is that we want to keep the Tacrolimus and Sirolimus level at the perfect balance so that graft vs. host disease (GVHD) does not happen. However, the two drugs suppress the immune system, which means they inhibit the body's ability to fight off evil things (like Leukemia blasts). We eventually need to lower this dosage or stop completely so the body can get stronger. There are risks when suppressing the immune system too much, but also risks when not suppressing it enough!