The Good, the Bad and the Downright Frustrating
As Seen Thru the Eyes of a Patient and His Spouse
Introduction
I want to start this recollection by saying that as I understand it, everyone�s experience is different among same type transplants and certainly among different types of transplants.� So, this is not meant to be a manual of exactly how to handle a transplant.� Mine was no piece of cake (keep in mind that I had two organs transplanted at the same time) and I understand that others sail right through the process, but statistically it is a rough road, be it short or long, for everyone.� I just thought it would be helpful to someone that is pre-transplant to hear how my expectations were the same and different from my actual experience and to know how I handled some situations (sometimes not well) and how I might have handled some differently.� For those of you post-transplant, this might provide some comfort that you are not alone as I am sure some of the things I experienced were similar to those you experienced.� And, of course, not to forget everyone else from family and friends of the transplant patient to the curious, this should give you some insight into my experience.� Maybe it will encourage organ donation.� Maybe it will set aside some of the talk that transplants are an easy fix for some poor lifestyle choices.� At a minimum, I hope it will be enlightening.
Fair warning � I don�t pull many punches and if you are looking for a pep talk on how easy transplants are, this is probably not for you.� If you are looking for an honest account of one person�s experience, I hope this helps you in your search for information.� Another point is that I have no medical training whatsoever other than instructions and answers to questions from health care professionals (although I felt like I knew more than some of the professionals after the transplant) and you should not take any conclusions or advice as that of a doctor or health care professional.� Always seek competent advise from someone who is qualified to give it.� This is simply my opinion based on my personal experience.� Finally, please do not rely solely on my words.� Seek many people who went thru the experience and many sources of information.� I will say this many times � the more information you have going into this, I believe the better the experience and the better the outcome.
Our Writing Style
We really feel like this is an experience shared by many, not just the patient.� We will jog back and forth between the patient and spouse to give a feel for what both of us were going through at the time.� To try and keep the confusion to a minimum, we will indicate �patient� where the patient is giving their take on things and �spouse� where she is recollecting the event.� That way if you wanted to read this book strictly from the patient�s or spouse�s perspective, you could do so.� However, we highly recommend taking in the whole experience all at once.� That is definitely the way it happened in real life.
For Those of You More Curious�
I have included in the back of this book some web sites, books, medication and supplements summaries and a glossary of terms (with some fun facts added).� I highly encourage you to read these.� It will not tell you all the medications and terms you will encounter if you are a transplant patient, but you will have a major step ahead of the game.� I have also included some of my own experiences with the drugs and terms so you can relate them to my case and maybe take away a tip or two that the doctors and scholars that never had a transplant would not think to tell you.
Our Story
Who am I (Patient)?
By way of background, as of this writing, I am a 41-year-old male who was a diabetic for about 30 years.� For you diabetics, I would consider my average control of my disease over my lifetime to be quit poor.� This goes especially for my youth due in part to the technology of the time but mostly due to my arrogance thinking that complications just couldn�t happen to me.� Hindsight is always better than foresight, but it is staggering to think what I put my body through especially in college just to keep from seeming as if I was different.� Even later, my laziness governed my actions and my blood sugar control.� I have had complications such as high blood pressure, high cholesterol, retinopathy, neuropathy, and, of course, renal failure.�
About 8 years ago, two weeks after our daughter was born, I wised up and purchased an insulin pump in an attempt to get better control of my disease.� I highly recommend this for all diabetics requiring insulin.� I have been told that even children benefit from this device.� Unfortunately, shortly after I went on the insulin pump, it was identified that my kidneys were slowly failing (the 2 events, of course, were not related).� Call it denial or continued arrogance, but even when I was told my kidneys would eventually fail, I didn�t believe it and I didn�t do any research or seek information of any kind on the subject.� All of my information seeking throughout my life as a diabetic was to try and find a �miracle cure.�� I know now that was a huge mistake.
I have learned the impact that the day-to-day stresses of life can have on the human body.� I say this because looking back on my career, I can see how stress effected my health.� At the time of my transplant, I had been a COO of a commercial real estate firm.� Although this opportunity was a great experience, some of the stresses that probably could have been prevented expedited the deterioration of my health. �As I tell my story, you will see the pattern.
Becoming Educated
Fast-forward about 6 years and we come to the point where my kidneys could no longer support me.� I immediately started interviewing surgeons (yes, I finally started seeking information) knowing that I would need a new kidney unless I wanted to stay on dialysis the rest of my life, which was not an option in my mind given my limited information at the time.� I knew I wanted to talk to at least 3 surgeons so that I could get some diversity of opinion.� Two of the surgeons were kidney specialists with one of them having the ability to transplant a pancreas if desired.� The third specialized in kidney/pancreas transplants, which intrigued me.� The thought of no longer being a diabetic was very attractive to me (remember the �miracle cure�) even though this type of surgery was relatively young.� It also had some logic.� If you put a new kidney in a diabetic, you have a higher risk of losing the new kidney over time than putting it in a non-diabetic.� Coincidentally, I met this surgeon about 3 years prior to this when I asked to talk to a vascular surgeon to assess any damage my diabetes may have done to my vascular system.� This was the first time I was introduced to the reality that I could have a pancreas transplant and potentially be free from my diabetes.� When I met him this second time, he had his transplant department fully operational at the hospital where I would eventually have my surgery.
I was leaning very heavily towards the kidney/pancreas surgeon, but I wanted to talk to someone who had the surgery.� The transplant team was happy to oblige and put me in contact with a dentist who had the surgery 3 months earlier.� Both he and his wife talked on the phone with my wife and me.� I could not have a higher endorsement of the procedure or the surgeon.� This transplant recipient talked for almost 2 hours about how amazing the surgery and the surgeon were, how happy he was with the procedure, and how ecstatic he is with the outcome.� This man loved life and loved it even more now that he was free from his diabetes.� I later learned that his enthusiasm for life was due in part that he almost lost his life a couple of times during his recovery.� He had many complications that I only learned about or at least learned the severity of them after my surgery.� Here is some more advice.� If you do not ask the right questions, you do not get useful answers.� It would not have changed my decision, but I wish I had educated myself more to ask the right questions and not be caught up in the emotions and allure of not having to take insulin any more.� I also wish that I had talked to this person and others on multiple occasions so that I caught them on a bad day when I could experience the flip side of their enthusiasm.
Dialysis Options
In the process of interviewing surgeons, I was also talking to my kidney doctor about dialysis options.� Again, I wanted to talk to people on both types of dialysis to see which was preferable.� My options were hemodialysis, which is taking your blood, circulating it thru a machine to remove waste and excess water and then returning it to your body.� This involves large needles and sitting in a chair 3 times per week for 3 hours each.� Day surgery must be performed to create a fistula, a procedure that enlarges a vein to in order to accept the needle.� The other option was peritoneal dialysis that involves filling a cavity in your mid section (the peritoneum) with a solution that pulls waste and excess water across a natural membrane.� This also involves day surgery to place a tube (catheter, not to be confused with a hemodialysis catheter) in your abdomen to get the solution in and out.�
While I was in the initial phase of testing for the transplant (a series of tests required to qualify you for transplant), I was told that there is a dye injected into your body during the angiogram (one of the tests to look at the vascular system around the heart) that can be toxic to the kidneys (nephrotoxic � learn this word!) thus creating a possibility that the kidneys would fail more quickly.� Therefore, I was advised by my kidney doctor at the time that the best course of action would be to get the fistula surgery done for hemodialysis so the vein could begin to mature and if I wanted to do peritoneal dialysis, the fistula would still be there as a backup.� This was probably �safe� advice and I took it having the day surgery performed by the transplant doctor I chose.� He created the fistula in my right arm.� As it turns out, although this was the �safe� decision, it was not the best one.� Soon thereafter, I decided to use peritoneal dialysis (great decision!) so I had the day surgery for that also.�
Problems arose later from the first procedure (fistula) when blood samples and IV access were needed pre and post-surgery.� No one will touch the enlarged vein for these purposes rendering my right arm almost useless (although I found out later that when they have no choice, they are happy to use that arm).� This means my left arm took quite a beating.� I didn�t learn until later that there are other ways to gain hemodialysis access on an emergency basis which you can imagine was very aggravating.� The fistula surgery was unnecessary.� Again, lack of information got the best of me.� It is very easy to be caught up in the idea that the doctor is the expert and you should follow whatever he/she says.� You have the absolute right to ask questions, refuse treatment, get a second opinion, and certainly change doctors if you do not feel comfortable. �Just make sure that delays in treatment don�t end up hurting you.� If anything, I was too enthusiastic to get treatment because I wanted to feel better.� I changed my kidney doctor for this and other reasons.
A very important aspect of dialysis is the dialysis staff.� I will also make this point later about the transplant team.� Although I did not choose hemodialysis, I was not impressed at all with the hemodialysis staff as I observed them every time I went for my peritoneal dialysis checkups.� I could be completely off base as I never experienced them first hand, but they seemed like a bunch of zombies simply going through the motions and didn�t seem to be patient-oriented at all handling many patients at a time.� On the other hand, the peritoneal dialysis nurse works one-on-one with the patient and I found her to be extremely interested in my well-being.� When you work with someone like that, you are much more likely to comply with the treatment and want to please him or her, which in turn helps you.
The Transplant Staff
This is probably as good a time as any to talk about the transplant staff.� I cannot stress how important it is at this stage and especially immediately pre and post transplant to have a great transplant team.� You, of course, want the best surgeon you can find, but that is only part of the equation.� Probably the most important person on the team for your comfort, ease of mind and ultimate success is the transplant coordinator.� He or she will be your best advocate, your sounding board, one of your best sources of information and the person who can best guide you through a complicated system.� I would not recommend choosing any surgeon until you have met at least with the transplant coordinator and ideally several members of the transplant team.� Even if you really like the surgeon, I would think twice about choosing him or her if you do not get a GREAT feeling about the transplant coordinator and team.� Just like the dialysis team, if you get along with the transplant team, you are much more likely to want to please them, which is greatly to your benefit.� Taken to the extreme, it could be life or death.� I have heard some horror stories about patients who defy the transplant team and ended up losing their new organ(s).� I would recommend the following considerations:
1.� Keep in mind also that it could be quite some time before you actually have your surgery if you are not using a living donor.� This means you will need to make sure the people you met originally are still with the team and if not, meet with any new person/people and make sure you still have that great feeling.�
2. Look for an enthusiasm from the team.� They should be excited about what they do and have confidence about how they do it�NOT just a good personality.�
3. The team should have a sincere admiration about the surgeon they work for and be complimentary about the doctor�s success.�
4. Ask for patient references.� Make sure to ask patients how they feel about the team.�
You will have to work intimately with these people for the first three months or more (much more in my case) after your transplant and will be working with them periodically for the rest of your life.� You don�t want to be stuck with people that will make your life miserable.� You want people that have a genuine interest in your comfort and successful outcome.
Once My Decision was made�
Once I made the decision to go with my transplant surgeon, many wheels were put in motion.� I had to be thoroughly tested to make sure I was healthy enough to endure this type of surgery (later I would find out exactly what �endure� meant).� Blood work, heart tests, x-rays, a bladder test (very uncomfortable), etc. were performed for this purpose.� Some of these were done as an office visit and others were done on an outpatient basis, so you can imagine how extensive the tests were.� The carrot for all this was that all these tests were necessary to be presented to committee so that I could be put on the list for a cadaver (non-living donor) pancreas and kidney.� Unfortunately, a living person cannot donate their pancreas.�
Once I was put on the list, it was just a waiting game from there.� Some periodic blood tests were required and after a year, I understand that some of the initial tests have to be repeated.� However, I didn�t make it that far because I was only on the list nine months before my transplant was performed.� I am told some people wait as long as three years for a kidney.� Apparently when the kidney is paired with the pancreas, the waiting time is significantly shorter because the demand for pancreases are not as high and if they gave both kidneys away, they would waste the pancreas unless they had a recipient that only wanted the pancreas which I am told is rare.�
I was presented with the option of using a living donor for the kidney and getting a cadaver pancreas later.� Although the statistics are better for the organ�s survival from a living donor, the thought of putting a loved one through that and doing two surgeries was not appealing at all.� In hindsight, this was a great decision because the last thing I want to do is go through that surgery again.� Unfortunately, statistics say I will have to at some point in my life.
Finally, I am on the list!
After completing all of the qualifying medical tests, meeting the financial commitments, and having my �file� reviewed by the transplant committee, on September 18, 2001, I was put on the UNOS (United Network for Organ Sharing) list.� UNOS regulates and governs the distribution of donated organs.� This was exciting because it meant that I could finally start the clock ticking until the time I received my new organs.�
On January 1, approximately 3 months later, my insurance changed.� This was some minor drama because if my new insurance carrier did not approve me quickly, they would have to put me on a hold status on the UNOS list.� Putting me on hold status could make me skip right over the next organ, however, this proved not to be a problem.�
When my insurance changed, I also learned I was at the top of the kidney/pancreas list.� This was particularly exciting and scary at the same time because I didn�t expect it was possible to have the surgery this soon.� I was not mentally prepared and certainly was not prepared in my business or personal life to have the surgery this soon.�
I should also mention that it was my transplant coordinator that called me about the concerns with my insurance change.� She expedited the insurance approval process to make sure the transition was smooth and not disruptive to my status on the UNOS list.� This is one of many examples where I knew I made the right decision choosing this transplant team.�
�The Calls� Begin
The weekend before Valentine�s Day, I received my first call.� It was a Saturday night about 10 p.m.� I had to wait until 6 a.m. the following morning to learn if this was the call that would put me in the hospital.� By 7 a.m., we learned that it was a false alarm.� My wife was on pins and needles during this time.� I was relatively calm and didn�t want to panic until I was sure it was going to happen.�
The next call came approximately one month later during mid-March.� It was a Sunday afternoon.� I found myself having to keep busy with my family as I waited to learn if I would be in surgery in a few hours.� Again, I was calm as we waited almost 5 hours before we found out it was another false alarm.� As I understand it, the pancreas is a very hard organ to harvest and not every one is viable.� This was the situation in both of these cases.�
After the second false alarm, I really started thinking about loose ends to tie up at work, the status of my living will, things I needed to do in my personal life, etc.� Even though I didn�t get another call for some time, I began to feverishly prepare for it.� The more I prepared, the more I found I needed to do.� I finally gave in to the reality that I would never be prepared.� The best I could do is to put things in a state where my absence was as little a burden as possible on the people around me.� This is pretty good advice because when the time comes to go to the hospital, there will be plenty of things to think about without having to worry about the things you didn�t do.� When it came time for the real call, I was totally focused on the moment when I went to the hospital and was very glad that I did enough preparation where I didn�t have to worry about things outside the hospital.� It�s sort of like preparing to have a baby.� Except, in this case, you could have to go to the hospital at any time over the next few years and the chance of �false alarms� is fairly high.
They say that the peak time for organ transplants is during the holiday seasons.� This meant that with Memorial Day weekend and the 4th of July being around the corner, I may be getting another call.� Boy was I fooled.� I didn�t hear anything from the transplant department during this time.� In fact, many months passed and I was getting very frustrated that I had not heard anything.� I learned that the transplant center had not performed a kidney transplant in over 4 months.� This eased my mind somewhat.� Then, August 22 about 10 a.m., I finally got the call.� I was at work and I had a feeling that this was not a false alarm.� I began to panic and get excited all at the same time.� The transplant coordinator said she would call me by 2 p.m. and let me know if this was �it.�� Although I spent months trying to prepare, I still wasn�t ready emotionally, physically, personally or in my business life for this.� I was warned that I would never be ready for this moment and boy were they right.
I told all the key people at work that I might have to rush out and told them what they needed to do to take over in my absence.� I had also prepared a list of proposed reassignment of duties that I reminded everyone to follow.� At 2 p.m., as promised, I received the confirmation that �the� call was �THE� call.� This started a whirlwind of activity.� I didn�t even have time to take my car home.� I was told to come straight to the hospital.� I arrived at approximately 2:15 p.m. (my work location was very close to the hospital).� When I arrived, they drew blood, gave me a full physical exam, took x-rays, and asked me what seemed like a million questions to make sure my health status had not changed.� While all this was going on, my wife was pulling my daughter out of school and making her way to the hospital as well.� In retrospect, I was being a little dramatic, but I felt like I wanted all my close family with me one last time in case something went wrong.
At the Hospital
My wife and daughter arrived by 3 p.m.� My daughter did her 2nd grade homework as a distraction amongst the activity.� Ironically, the assignment consisted of a reading assignment about human body organs.� A diagram of the human body was on her worksheet.� After she completed her assignment, we discussed it and I was able to show her on the human body diagram approximately where my new kidney and pancreas were going to be.�
Once the initial blood work and other medical testing was over and my family arrived, they checked me into a semi-private room with a big family on the other side.� The man in the other bed had just returned from surgery.� His wife and daughter were there trying to comfort him as he moaned and groaned in his sleep.� It was disturbing as I wondered if I would be in the same shape when I returned from surgery.� This is when everything really hit me.� I was about to undertake major surgery and start on what would be a long and difficult recovery (little did I know).� This was also the time for me to say goodbye to my daughter for several weeks (or more if something went wrong).� This was hard enough under normal circumstances, but it was even harder with so many people around.� Neither of us really knew how to handle it.� She really didn�t understand what was going on (she was only 7) and I didn�t know how to communicate it.� Both of us had a good cry.� I was crying because I was going to miss her and didn�t know what to expect and she was crying because I was crying.� We felt rushed because the nurses learned my daughter was under the age of 12 and not allowed in the room.� I really didn�t care and my daughter and I watched TV in the bed until they had to take me to surgery.� My wife and I were much more prepared for this moment and I knew I would be seeing her as soon as I got out of surgery.� During the wait, we were really in the dark as to what was happening and all we heard were little tidbits like the organs have arrived and that �it wouldn�t be very long.�� Around 7:30 p.m., almost 5 hours since I had arrived, they wheeled me back to a preoperative holding area.� Apparently, the longest wait was to see if my blood was reactive with the new organs.� If there had been a reaction, the whole thing would have been called off.� Fortunately, everything was fine and we moved ahead.
Pre-Operative Preparation
They wheeled me into a holding area where the anesthesiologist could get an IV started.� Every time I was handed off to another person, they asked the same questions to make sure I was in the right place and I knew why I was there.� For the most part, everyone was very nice and reassuring.� Despite that, I was nervous beyond description.� It seemed like forever before the anesthesiologist came in and asked me a bunch of questions.� In the course of the questions, I made sure he was aware of my drug allergies and that I become violently ill when I come out of general anesthesia.� I had been told that I would get an epidural similar to those given to mothers in labor.� After the IV was started, (I always ask for lidocaine, a numbing agent, because it makes the IV insertion almost painless) and some drugs were given to relax me, they started the epidural.� Later this proved to be great because I really didn�t ever feel any significant pain and if I did, they gave me a button I could press to administer more drugs into the epidural line.� This basically numbed the lower half of my body.� This was especially great when they had to give me multiple shots in my stomach.� When they took the epidural out and I had to get these shots, I really appreciated the epidural!� I guess this is what they mean when they say better living thru chemistry.� Little did I know just how much chemistry I would be getting over the next couple of years.� The last thing I remember was being wheeled towards the operating room.
Intensive Care
Apparently, I woke up several times after surgery in intensive care.� I don�t remember this at all.� When I started to become aware of my surroundings, I really had no comprehension of what was going on.� The first thing I became aware of was a nasal-gastric (�NG�) tube that was snaked down my nose into my stomach to remove any stomach fluids.� This is definitely something someone, somewhere in the process should have told me!� Apparently, during surgery, my intestines are so jostled around that they shut down so they cannot process normal digestive fluids so the fluids have to be removed until my intestines �wake up.�� I am told that normally with only a kidney transplant, this is not necessary.� It has to do with the placement of the pancreas.� When only a kidney is transplanted, they put the organ nearer to the skin surface so the operation is not very invasive.� When a kidney and pancreas is transplanted, the pancreas has to be attached to the large intestines to allow for drainage of unused fluids produced by the organ and both organs are placed low and behind the intestines making it necessary to probe much deeper into the body and thus the intestines have to be lifted and pushed aside to get access to the area.
The more I woke up, the more concerned and agitated I became.� Part of this was due to the enormous amount of drugs being pumped into an IV that had been started in the operating room that was placed in my neck.� This was something else that was not discussed and came as quite a surprise!� Especially the steroids heightened my senses when I was awake to the point that I could swear I heard the fluids being pumped into the IV in my neck.� You might have seen movies where athletes abuse steroids and become very aggressive.� Trust me that this is very accurate.� Suppressing this aggression proved to be one of my biggest challenges.� Part of my agitation was due to my personality.� I am not very good at being passive.� I want to know everything that is going on and why (several times this would prove to be valuable).� Last, but by no means least, part of my concern and agitation and in some cases anger was due to the personalities of the staff.� Some of the staff were fantastic at dealing with my concerns and fears and some were horrific to the point of being afraid for my life (probably an over-reaction brought on by the medications, but it was very real at the time).� Much later I learned that there is actually a psychosis that is very common in intensive care that could account for a large part of my paranoia.� Just know that it is a possibility and maybe knowing will be preparation for you that I did not receive.
When I finally got around to looking at all the equipment that was hooked up to me, there were probably 6 IV pumps with 10 or so IV bags pushing all kinds of fluids and medicine into me.� My NG tube was hooked into a vacuum pump and had to be flushed periodically to make sure it wasn�t clogged.� This was disturbing because they take a syringe of saline and push everything into your stomach and then let the vacuum sucks it back out.� It is cold and uncomfortable.� The tube irritated the back of my throat and it was very uncomfortable every time I swallowed.� The drugs induce paranoia about all this equipment and everything that is going on around you.� I also realized that my left hand was completely numb except for a tingling in my palm.� I also realized that my scrotum was enormous!� I am told that this is because of all the blood that is lost from the pancreas causing the scrotum to swell to the size of a large cantaloupe.� I don�t know what effect the surgery has on women, but it would be a good idea to ask.� This is all balanced to a degree because the drugs make you semi-conscious so I was constantly sleeping and waking up.� When I was asleep or barely awake, I didn�t worry too much about what was going on around me, but when I was awake, my imagination ran wild.� I found two great drugs that got me thru most of my hospital stay.� I learned the timing of when I could take them and when it was ok to ask for them.� The first is Zofran for nausea.� The other is Adavan for anxiety.� I can�t count the number of doses I was given of these, but I can tell you my stay would have been miserable without them.
Was I Really Prepared?
I don�t know if it was ego or just a confidence in my ability to heal myself that left me unprepared for the degree of difficulty I experienced following surgery.� Yes, I was told that this is major surgery.� I was also told that a kidney/pancreas transplant was much more involved than just a kidney transplant.� However, I wish someone had really sat me down and put a little healthy fear in me and explained in much more detail what was going to happen along with the fact that something unplanned always happens.� It is great that all the people in the transplant program have such a passion for what they do.� I read incorrectly into that confidence that the whole experience would be much easier than it was.� Again, I hope this recount of my experience in some way puts that healthy amount of fear along with all the information I can give into your brain so you can process it to fit your own experience.
One particular night early in my ICU experience, I really felt the effects of the medication.� My blood pressure was very high; I was full of fear and anxiety and was in and out of sleep all night.� Well, mostly out of sleep more than in sleep.� Adding to my anxiety was the �scary� nurse.� I asked my wife to stay around until she was off duty because I didn�t trust her at all.� Any time I spoke, she came back very aggressively and offensively.� It was without question the worst night of my stay.� This anger and anxiety lingered the entire night causing it to also be the longest night of my stay.� In retrospect, I should have immediately asked for this nurse to be reassigned.� At the time, I was so paranoid, I thought she might retaliate.
Strong Drugs, Strong Reaction
I should probably not tell you about a particular event because it may not apply to you and even if it does, it does not mean it will happen to you.� One morning, after the night I described above, awakened several times by ICU nurses and even more by the uncomfortable tube in my nose, I felt I had to talk to the doctor immediately about my NG tube.� I asked a nurse for a phone to call the doctor and they said I could not do that and the doctor would be around shortly.� I asked to call my wife so she could page the doctor and I was told that was not allowed either.� Unmedicated I have a hard time taking no for an answer and with the combination of drugs and a restless night I was determined to do something about what I was sure was something wrong with my NG tube and sitting around waiting for the doctor was not one of the options.� So, I started fiddling with the tube and I could swear that the tube had worked its way out to the point that it was barely up my nose.� In my mind, all I needed to do was take the tape off and I was rid of the annoying thing. �I couldn�t have been more wrong.� I took the tape off and pulled the tube about an inch.� Then I pulled another inch.� Panicking, I realized that I started something that I had to finish and pulled what seemed like 2 feet of tubing out of me.� That�s when the ICU went crazy.
A particular nurse that had been very nice to my wife and me switched personalities and began yelling at me at the top of her lungs telling me what a horrible thing I had done, how bad I was for doing it and that I was in big trouble.� This went on for what seemed like an eternity.� I felt bad enough without a nurse getting in my face telling me what a horrible person I was.� The only thing that kept me from jumping back at her, ironically, was the nurse that had told me earlier that I could not contact the doctor.� He befriended me and told me that everything was going to be all right.� So, I just nodded my head as if to agree hoping she would get out of my face before I snapped.� It is amazing when you are in such a vulnerable position how dramatically harsh or kind words can effect you.� Later the doctor and transplant coordinator told me that this is not the first time this has happened to a patient and that even though they may have to put the tube back in, I was not a freak and everything was going to be just fine.� As it turned out, they didn�t have to put it back in and it was probably good I got it out to prevent any more damage to the back of my throat.� It took almost a month for the damage to heal as it was.
Importance of the Patient/Staff Relationship
I cannot stress enough how patient/nurse relationships can make or break a hospital experience.� Recovering from major surgery is rough enough without dealing with unpleasant personalities.� My worst experience was in the ICU with the nurse I briefly described above when I described my worst night.� She would argue with every comment and every request to the point of being angry.� The last thing you want is someone angry that has your life in his or her hands.� No matter how much I tried to sugar coat my request and show her that I respected her as a nurse (I was faking, of course), she would become agitated to the point of making me snap at her which, of course, made the situation worse.� This is where a partner in your recovery really comes in handy.� In this case, my wife stayed with me the whole time I was in the hospital and helped develop the relationships that made my stay much easier.� Don�t get me wrong, most of the nurses were very competent and some were down right exceptional.� I guess in the interest of letting someone know who is thinking about having a transplant there are some real pitfalls that I wish I had been prepared for and in retrospect, I should have asked that a couple of the nurses be reassigned.� At the time, I thought word would get out that I was an unreasonable or uncooperative patient and I was very focused on making everyone that was regularly treating me very happy with me and keeping them interested in my well-being.
Hindsight about the ICU
Backtracking a bit, there are a few things that I believe would have made my ICU experience somewhat more comfortable in hindsight.� As I noted above, taking the nurses that were not as patient or patient oriented out of the equation would have made a huge difference.� I don�t believe my emotions would have escalated as much if not for the one nurse that scared me to death.� My wife or I should have made a complaint earlier in that relationship.� My wife did request that I be assigned nurses that could work with my need to know details and she requested that the nurse that caused the problems not be assigned to me again.� A much more detailed preparation for the conditions and feelings I would feel in the ICU would have also helped.� Again, even without this preparation, a kind voice and explanation after the fact would have helped as well.� Many of the nurses were great at this; it was the one�s that were not so good that aggravated the problem.�
I found out later that music is a great calmer of the �savage beast.�� Many of you may not find music calming, but I bet there is a large population that does.� I am a big classic rock fan, but my wife found a light jazz station that really calmed me in my hospital room when the drugs were really trying to make me crazy.� It was especially helpful to get me to sleep.� I am sure if music had been brought into the ICU, it would have made a huge impact.� Obviously, a combination of all these things would have made a very scary and aggravating experience much less so.� Keep in mind amongst the fear that you may have right now that I made it thru this period just fine.� I don�t believe it compromised my health at all.� I give you all these details in the hopes that you can use some of them to make your experience more comfortable.� Remember this is a relative statement.� This is not a comfortable time.� You will need to keep your wits about you and you will need to want to recover.� I am sure you have been in plenty of uncomfortable situations in your life that you have handled just fine.� This will just be another one of those situations.
Freed from the ICU Jail
Even though I was still very weak and on many IV drugs, I was very excited to get out of the ICU and away from that whole experience.� It was interesting getting into a wheelchair with my huge scrotum!� They took me to a private room on the transplant floor and with my experience in ICU; I was understandably leery about the nurses.� I was pleasantly surprised.� Although there was a little too much gossip for my taste, I found these nurses to be much less mechanical about what they did and much more interested in patient comfort.� Amazingly, the better I felt and could carry on a conversation with them and remember their names, the better the relationships were.� My wife again was invaluable in developing relationships with the nurses.� This made information flow much easier and they seemed more willing to answer what may have seemed at times like silly questions.
Oddly enough, the ICU stay seemed fairly short, but the rest of the stay seemed to drag on forever.� They were constantly checking vital signs at all hours of the day and night, alarms on the IV�s were going off all the time and it was quite an ordeal to drag the IV pole into the bathroom once they took away the convenience of the Foley catheter (a tube that is inserted into the urethra and on into the bladder) that allowed me to urinate without moving a muscle.� By the way, you would think the removal of the catheter would be a major event, but it was no big deal.� It was time to let me start urinating on my own.� The catheter pulled right out with a minimum of discomfort.�
My hand numbness was getting a little better, but I wanted to know why it was not gone after all this time.� I was told that it was probably a pinched nerve from the awkward position of my arm during surgery.� My patience at this point was much better, so I decided to just wait and see if it got better.� I think the reason the rest of my stay seemed so long was that I was feeling better and was awake much more.� As you know, when you are fully or partially asleep, time passes much quicker.� In addition, I was ready to get home to see my daughter and get some good food.
Just like in the ICU, my surgeon and transplant coordinator were fantastic.� I saw them twice a day and we discussed my progress.� Yes, I said discussed.� I was treated like an intelligent patient and everything that was going on was explained along with the theory behind it.� All of my questions and concerns were entertained and given consideration.� Not only my statistics were taken into consideration, but also my feedback about the way I felt.� My wife was an integral part of the discussions and she was given the same respect and consideration.� I stressed before that these two people could make or break your transplant experience and I was ecstatic that I had chosen them.� Many changes were made in my therapy and being the control freak that I am, I wanted to understand in detail the reason and effect of each one.
Things seemed to progress well once I was out of ICU.� They gradually removed IV drugs until I was down to fluids and some supplements.� I started very slowly on soft foods and worked my way to more substantial foods.� Nausea came and went, but I weaned myself off the Zofran and was content to eat slowly and eat crackers before I took oral medication.� I was very particular about what sounded good to me and the hospital tried to accommodate me as best they could (even though the food overall stunk!).� For some reason I craved grilled cheese sandwiches (I ate a lot of them!).� As I became stronger and was able to walk some distance in the halls (although difficult because my scrotum made walking uncomfortable), we talked about going home.� I was determined to show everyone that I was strong enough and I was also determined to start my strength training as soon as possible.� This sounds ominous, but it really consisted of pushing an IV pole around the floor for as long as I could.� After some training on taking medications and how to organize the many pills I would take at home, I was released to go home.� After all the anticipation, it was somewhat anticlimactic to be released, but I was still very happy.� Other than being very weak, having a very sore throat, and loose stools, I was ready to leave the hospital.
At Last � Home, But Not for Long�
It was great to arrive home, see my daughter, and reassure her that I was doing ok.� My family and neighbors had taken care of the house while my wife and I were gone and it looked like I never left.� I am eternally grateful for that help because it freed my wife and me to concentrate on my health instead of worrying about the house.� A close second to the importance of a healing partner, the support of friends and family are invaluable.� If you don�t have a strong support group, I suggest that you simply ask someone to put things in order so you don�t have the pressure of cleaning, organizing, etc. when you come home.�
Things went pretty well for the first couple of days.� I was warned to drink lots of water and I did my best even though it was very painful to swallow.� I had many problems with low blood pressure.� In retrospect, it was partly due to the lack of water.� The other problem was that I was developing an infection.� My temperature climbed over the next few days and the doctor put me on an oral antibiotic.� It really didn�t help much.� I was asked to go to the transplant clinic almost every day even on the weekends because I was not getting substantially better.� Small consolation � my scrotum was back to normal!� Every time I went in, I was told if I didn�t get more fluids they would have to start an IV and give me fluids that way.� My temperature continued to climb and I was so dehydrated that I couldn�t function.� They immediately readmitted me to the hospital.� I learned later that something always goes wrong post-transplant.� I was very discouraged, but was relieved that we were aggressively handling the problem and felt much better in about an hour after they pushed fluids into me.� In retrospect, I don�t think there is much I could have done to keep from being readmitted.� However, talking to other patients, drinking lots of water is still very important because dehydration seems to be the number one reason for readmission.� I have also heard that some patients are told not to drink too much water because their kidney is not functioning fully.� I guess I am back to advising that you ask questions and see what your doctor wants you to do.� In my case, drinking lots of water was the right thing to do.
Adding another Doctor to the Mix
I was introduced to and was followed by an infectious disease (�id�) specialist from that point on.� His job was to find out why I was running the fever and to see what medications I needed to eliminate the problem.� This proved to be quite a task.� I had already been scheduled to have a CT scan so the doctors could establish a baseline view of the transplanted organs.� I had to drink a fowl tasting lemon concoction called a contrast before they did the scan.� I was placed at the center of a gigantic donut hole of a machine and an IV was hooked up to me that had some further contrast in it.� I was asked to hold my breath as the machine scanned the area they wanted to view.� It was really no big deal and there was no pain involved.
I continued to feel better and started eating some soft foods.� The results of the CT scan came back with no unusual results.� The kidney looked very healthy.� The pancreas as it was described to me months before is a very �bloody� organ and tends to leak when transplanted.� They found a little fluid and some postoperative blood surrounding the organ.� The surgeon was not concerned about this at all.� The id doctor was much more concerned and he talked about sticking a needle into the fluid if it did not clear up quickly.� This really made me nervous and sounded very painful.� He started me on what he called �gorilla antibiotics� by IV.� Over time, this slowly reduced my fever, but caused some diarrhea.
Slow Progress and the Discovery of the �PICC�
My progress was much slower than any of us liked or expected.� The id doctor came in every day and gave me a list of possible paths we could take and some of them were pretty scary.� I felt like telling him to only tell me what he was going to do, not what he might do.� My curiosity kept me from telling him this.� He kept bringing up the idea of sticking a needle into the fluid surrounding my pancreas and seeing if they could grow the infection so they would know what specific antibiotic to use.� Even though my progress was slow, the doctors wanted to send me home.� In order to do that, I would have to administer the IV antibiotics myself.� Since typical IV access only lasts 3 days, they opted to put in a PICC line.� I found out later this stands for peripherally inserted central catheter.� Had I known this before hand, I would not have been so surprised when they took out a two-foot catheter that they said they were going to snake down close to my heart starting under my armpit.� This seemed dangerous, but it really didn�t end up being any more painful or much more invasive than a regular IV.� The great thing was it could stay in so I didn�t have to be stuck every 3 days and they could take blood from it so it eliminated that stick also.� I was worried that this would aggravate my hand numbness because it was continuing to get better, but I was told it would not affect it.� I grew to be very fond of my PICC line and fought having it taken out in case they needed IV access for some other purpose.� I was also very fond of not having to be stuck every time they needed blood.
At this point, I thought I was going home when they sprang a last minute change on me.� They wanted to do another CT scan and if they found anything, they wanted to use a needle to get a sample of it.� I flipped.� The only thing that kept me reasonable calm was the possibility that they might not find anything.� Well, as Murphy would have it, they found the same thing they did last time.� I started shaking with fear and was prepared for the worst.� Then they gave me some wonderful drugs thru my PICC line that made me care less what they were doing.� They gave me lidocaine (remember the numbing agent?), the whole procedure was done, and I didn�t feel a thing.� What a relief.� They took a sample of the fluid and put a drain tube into the residual blood.� Other than the inconvenience of a plastic bulb outside of a bandage to catch any drainage, (there was none), the procedure was no big deal.� Needless to say, I did not go home right away and that was a big disappointment.
A Day Pass to Keep my Sanity
The next couple of days were a wait and see game.� I was ready to go home, but the doctors were wary that I would end up back in the hospital if they let me go home.� The strong antibiotics seemed to be doing the trick because my fever continued to go down.� The odd thing is that no one could tell me why.� The fluid they took from my pancreas showed no sign of infection.� When they pulled the drain from the postoperative blood around my new pancreas, it was exactly as they expected and nothing had drained in the two days I had the tube in the area of concern.� I was really pressuring the doctors and the nurses to let me go home, so they did � for a day.� They gave me a day pass to go home for a while to see how I would do on my own and it was wonderful to see my daughter again and eat some home cooked food.� Then it was back to the hospital.�
The next day they decided it was o.k. to let me go home.� I received some further training on how to administer my IV antibiotics at home which was really easy to do.� Last, but not least, I was given charts to fill out each day I administered the antibiotics and when I received test results.� Each day I take my blood pressure in the morning and evening, my weight, my temperature and my blood sugar (probably only applicable to diabetics) and charted each of these statistics.� When I get my Creatinine and Prograf level results, I chart them along with the date of my next lab draw. �Then I was released.� After giving hugs to all the nurses and telling them no offense, but I didn�t want to see them again under these circumstances, I went home for the third time.
Home Again, Home Again�
I felt really energetic when I got home.� I immediately started emailing my office and getting my brain back into work.� Although I had done some exercise the first time I came home, I was really determined to exercise and make progress doing it.� The oral and IV medications were an inconvenience, but really didn�t slow me down much.� I realized the importance of taking everything correctly and on time so I diligently did it.� Because my phosphates were dangerously low, I had to concentrate on eating a lot of foods like beans and milk to get the numbers up.� I didn�t make much progress in this area early on, but persistence paid off.� I was really excited when I made it a mile walking.� I was also taking whirlpool baths in the hopes of stimulating the absorption of the fluid around my pancreas and to ease the neuropathy (pain) in my legs left over from my pre-transplant days.� It was probably the slowest mile in history, but it was a major milestone in my mind.� I continued to go to the transplant clinic three times a week to do blood work and see the staff.� The encouragement I received especially from the transplant coordinator was really helpful in making me push myself and increase my strength and energy level.� My statistics continued to look better and better.
Even though I was feeling better and things were really looking like I was over the hump, I was still second-guessing myself for having the double organ transplant instead of just the kidney.� In a weird way, the recipient of the other kidney from the same donor broke me out of my doubts.� We met in the clinic and his mother told my wife and me all about the problems he had.� He had been through much more than I had including a complete shut down of his new kidney and the need to remove one of his old kidneys.� I saw that my circumstances could have been much worse even with a single organ.� It just goes to show that we are all individuals and we all react differently under similar circumstances.� The great news is that he is doing much better and seemed to be catching up to my level of energy.� With a fully functioning kidney and pancreas, I felt very lucky and was more committed than ever to increase my stamina and achieving the strength I needed to face any more obstacles that might present themselves.
The New Nemesis - CMV
The next possible obstacle was CMV.� This is a virus that I am told about 50% of the population carries with them.� A normal immune system keeps the virus in check and the person that has it feels no symptoms as a result.� I was told that pre-transplant, I did not have the virus.� However, my donor did have the virus.� I was also told that all double organ transplant patients get the virus.� Taking immunosuppressive drugs and with my donor having the virus, I was at high risk of getting it.� As Murphy rears his ugly head again, the test for the virus started turning positive.� At this point, the reading was very low and I was not showing any symptoms.� The doctor was not optimistic that the tests would get better, but for a while, the level stayed low and constant.� Consequently, they decided to keep my PICC line in so they could administer IV drugs for the virus if necessary.� That was great with me because it was great not to be stuck to take blood and if I needed another CT scan, they would not have to get IV access to give me the IV contrast.
For about a week, I noticed that the small tremors I had been suppressing in my hands had worsened.� In addition, my heart rate was rising and I was breathing harder.� The symptoms seemed to lessen overnight and worsen as the day progressed.� The initial diagnosis was I was weak because of all that I had endured over the past weeks.� They said, as I got stronger the effect would lessen.� This didn�t make sense to me because I was up to 1.75 miles on the treadmill and felt like my stamina was getting better.� Well, since they couldn�t find any other explanation, they decided to pull my PICC line just in case it was the cause.� Back to the needles to take blood and if my CMV got worse, they would have to put it back in which is no fun.� It always amazes me that medicine seems to be just as much a process of elimination as a diagnosis and treatment.� I had a feeling I would miss my PICC line and I was right.
My Medicine Cabinet Overflowith�
This is probably as good a time as any to talk about the medications I am/was taking.� The first three months is the critical time to make sure your body does not reject your new organ(s).� Consequently, the drugs I was on are strong.� I was taking three drugs specifically designed to prevent rejection.� Other drugs are meant to lessen the side effects of the rejections drugs, prevent infection and to lessen the effects or prevent CMV presenting symptoms.� The side effects I had that I was told are normal were an elevated temperature, tremors in my hands, weakness in my body especially in my legs, headaches and high/low blood pressure and its associated symptoms.� For me, the side effects really hampered taking control of my healing process.� It�s easy to just �let� your body heal and there are certainly times to do this.� However, I have a hard time just �letting� anything happen.� I knew that my stamina and strength were a fraction of what they were before the surgery and increasing my stamina and strength was a key to my recovery.�
Normally it�s hard to get yourself to work out and follow any kind of regime to make yourself healthier.� When you have tremors and you are weak which, of course, affects your balance it makes it much harder to motivate yourself to overcome these side effects and then work out.� Even though I was only walking on a treadmill, it was still an effort.� I cannot stress how important this is as part of your healing process both physically and mentally.� This was stressed by all my health care professionals.� One of the strongest side effects is from the steroids.� Although the doses after I left the hospital were much lower, and later in the three month period, the dosage was reduced further, this is the drug that all the athletes are warned not to take (well, anabolic steroids and therapeutic steroids are different, but I guess it�s my way of stressing the point).� I have heard of much more severe side effects than I experienced, but I found myself feeling very aggressive at times and very emotional at others.� My hair thickened and I believe the steroids brought some of my fatigue on.� Many nights I had a hard time getting to sleep because of the anxiety that steroids cause.� The anti-rejection drugs most likely caused the tremors and I am always aware that strong drugs are at work in my body.
Well, back to the chronology.� As Murphy rears his ugly head again, I learned that I needed another CT scan to see if the fluid and blood around my pancreas had cleared.� I knew the minute they took out the PICC line that they would probably do this.� You see, with the PICC line in, they have a way to administer the IV contrast.� Without it, they have to get IV access, which means all that discomfort for a 15-minute procedure.
The Good and Bad of Getting Better
Up to this time, I really felt like I was the transplant team�s highest priority.� I lost that feeling around this time with my surgeon.� Also around this time, I lost that feeling with the transplant team.� This is not necessarily bad.� If you are a high priority for them, it probably means there is a reason for it.� When I stopped seeing my surgeon on a regular basis, I was told that there is no reason for him to see me when I am doing that good.� That made me feel great!� Before the transplant team lost focus on me, a LOT of attention was paid to the details.� Now, everyone was more focused on the big picture.� The infectious disease doctor announced that he didn�t need to see me weekly any more and my nephrologist was seeing me about every week and a half when he could fit me in.� Let me stress again, this is not a bad thing.� It is the next step in getting me away from the hospital/doctors/transplant team and gets me out on my own.� In this same vain, I was given a work release to work 16 hours a week from home.� The truth is, I already was, but now it was official.� The next obvious question was, �can I only come into the transplant clinic two times per week instead of three?�� The answer was a resounding �yes.�� Yet another encouraging step.
It�s Therapeutic to Help
My wife and I had our first opportunity to provide some encouragement to a fellow transplant patient.� A man who had a kidney transplant about three weeks prior to us meeting him was going through a pretty rough and doubtful time.� Like me, he was having a hard time keeping hydrated following his release from the hospital.� I stressed how important this is, because I had to be readmitted because of it.� It was good for him to see my energy level after 6 weeks because I think it gave him hope that he would indeed feel better.� He was also frustrated at the side effects of the medication.� I didn�t have much hope to give him except to reassure him that what he was feeling was normal.� It was a great feeling to take my trying experience and use it for good.
The �Shaky� Medication
Around this time, I was really complaining about the tremors in my hands that had now spread to my legs.� I also had an unusually fast heartbeat and I was out of breath at rest.� Before, they told me it was the medication and that my strength was much less than pre-transplant.� This time they dropped a bomb on me saying that the tremors would never go away.� They would get better as doses were reduced, but they would never go away.� I pictured myself in business meetings with everyone looking at my shaky hands and their confidence in me getting shaky as well.� Once again, thoughts of doubt enveloped me.� Should I have just stuck with the dialysis?� Even though my energy level was getting lower every day before the surgery, I didn�t have all the drug risks and these tremors.� I decided that what was done was done and I would form my opinion well after my 3-month risk period.
Insight on Doctors
This is probably a good time to talk about different types of doctors and the maze of instructions and opinions you will have to wade through.� Every doctor has his own agenda and priorities.� This goes for his staff as well.� I guess it stems from the different training they receive when they go into their particular specialty.� The surgeon is concerned with the success of his surgery.� In my case, he was/is focused on the survival of the organs.� Consequently, he leans towards high doses of anti-rejection drugs and conservative therapy for the organs arguably sometimes to the detriment to the overall patient.� An infectious disease doctor is much less concerned with the survival of the organs as than the health of the overall patient.� They lean towards fewer immunosuppressants so the immune system has a fighting chance to ward off infection and viruses.� The nephrologist is the proverbial �Switzerland� of the two.� He wants everything to be optimized.� Consequently, he or she tends to look at the details wanting all of the laboratory statistics to be normalized.� The surgeon looks at certain labs to make sure the body isn�t rejecting the organ(s), the infectious disease doctor looks at other labs to make sure infection or viruses are not invading the body and the nephrologist looks at everything.� As human nature would have it, they all think they have the right approach, which I can only imagine (because the patient is never privy to these discussions), the spirited debates that go on behind closed doors.�
When I met with each of these doctors individually, it would not be abnormal to get slightly different instruction, opinions, or �facts� from each one.� I think they realize their differences because they would frequently explain the other�s philosophy on a particular subject and then explain their own as if, almost, to solicit my opinion as to which one is right.� Of course, before I offered one, they would tell me what they wanted me to do.� It is very important that you relay each and every conversation to each and every doctor.� They are so overwhelmed with other patients that a lot of instructions slip through the cracks and all of the doctors are not necessarily told change(s) that other doctors have made.� Even opinions are important to relay, because it is a great opportunity to get another opinion on the same subject.� Sometimes you will get a flat out disagreement between doctors and you will need to form your own opinion as to who is right.�
Remember I said earlier that sometimes I believe medicine is as much a process of elimination as it is rendering diagnoses.� The same goes for you and processing information.� Sometimes you have to eliminate some opinions to get closer to the facts.� Just like I did, by continuous inquiry, you will find out things (some good and some bad) that you were not told up front, but are extremely important for your therapy and quality of life.� For example, I was told by my previous nephrologist that when I received my new kidney, all of lab statistic would return to normal and I would lead a normal life except that I would have to take anti-rejection drugs.� This could not be farther from the truth, as I know it now.� I want to point out that none of the current team made this representation, but had I stayed with that nephrologist, I would have been completely misled and it would be up to me to find out the truth.
CT � Again and an IV Revelation
I had my third CT scan.� Every other CT scan had clearly said on the instructions that I would receive oral contrast only.� Each time the radiologist added IV contrast to the order.� Before this was not a problem because I already had IV access.� Since they removed the PICC line, it was a concern this time.� I really didn�t want to get a painful IV line for a 15-minute procedure.� So, when they told me to come back and get my IV put in I pitched a fit.� I was fortunate to get a nurse who explained the importance of the IV contrast and the importance of using an IV set (typical IV with a needle that inserts a small, flexible tube) as opposed to a butterfly needle (much smaller needle with �wings� that hold it steady, but the metal needle stays in).� I had requested (demanded) a butterfly needle because it is smaller and does not hurt or traumatize the vein as much.� They explained that the contrast is injected very quickly at 200 psi and if the cannula (small, flexible tube) on an IV set is not used, it can blow out the vein.� This made sense to me so I agreed.� By the way, this sounds scary, but you can�t feel the injection of the contrast.� The nurse explained that she had a painless way of getting IV access.� I told her that the last 10 nurses told me the same thing and it hurt like hell.� She explained that she was going to use a smaller (20-guage) IV set and was going to insert it where my blood was taken at the crease where my arm bends.� Wow!� This was the first painless insertion of an IV in my life!� I understand that this could not be used if the IV were to be left in for some time, but it was great for this purpose!� Again, it shows that a lot of the information you receive is left up to luck and in some cases, tactfully disagreeing or questioning people if you do not think things are going the right way is a good idea.� Usually I end up doing things their way, but like in this case, I learn new things and they may modify the way they are doing a procedure to make me more comfortable.
More Story Swapping
I had the opportunity to visit in person with the transplant patient that I had originally talked to before my operation.� Once again, I found out more about things that had happened to him in the course of his surgery.� Again, I don�t think this would have changed my decision, but I keep being reminded how much more information is out there that I am not asking the right questions to obtain.� He was still in great spirits and we had a great conversation with him and his wife in the transplant clinic and over lunch.� He put my mind at ease about some symptoms I was feeling and with his optimism gave me more hope that I was almost out of the woods.� The question that he raised was if I was ever going to be rid of the constant side effects, complications, and doctor involvement.� Part of the answer I knew and it was that I would never be rid of doctor involvement.� He had so many further complications like an esophageal tear, reflux, two cases of CMV, and a toe amputation that I told myself that it was comparing red and green apples (hope you get the analogy).� Then again, I learned that day that the CT scan revealed that the fluid around my pancreas was much better, but they discovered a hiatal hernia that might be the cause of some minor reflux I was experiencing.� It was not a big deal, but it was just one more thing to add to the pile.� I am not sure if the whirlpool baths helped with the fluid absorption, but if you have this resource, I highly recommend it.� Of course, get your doctor�s approval and restrictions (such as keeping your PICC line dry) before you jump in.
Stay Positive!
I want to jump out of my chronology again and talk about something I observed as I talked to many transplant patients in the transplant clinic.� The observation is attitude.� There was no scientific sampling, but I observed a direct correlation between a positive attitude and a positive outcome.� Those that seemed to love life and took complications and setbacks in stride seemed to be in much better shape sooner than those that had a bad attitude bordering on depression.� I happen to be a Christian.� I draw a lot of my attitude from my faith and conversations with God.� If you have your own faith or even if you don�t, you might be able to draw some strength and positive attitude from the two things that helped me both pre-transplant and post.� Before my surgery, I did a lot of praying asking that my body be prepared for the surgery and to prepare my body to accept the new organs it was about to receive.� I also believe very strongly in the body�s ability to heal itself and a strong role that the brain plays in this healing.� Consequently, I had a lot of conversations with my body and myself (sounds mental, but I am quite sane) to prepare for the surgery and the new organs.� Likewise, after the surgery I thanked God for the progress I made even when I had setbacks.� My faith in God�s plan for me got me through some rough times.� Again, I also talked with myself (that�s real easy to do on all the drugs I was taking) and convinced my body that the new organs were not foreign and that they were good for me and would make me healthy.� If this sounds �out there�, find your own way of keeping a positive attitude and convincing yourself that all of this, even the rough stuff, is good for you and you will be so much better off when things settle down.� Then keep up the positive attitude when things do get better.
Not Quite there, but Getting Close
At this point, I was doing almost everything I was doing before the surgery.� My stamina was still a little low partly from general weakness and partly from the medications.� By doing projects like painting doors and general repairs around the house and continuing my treadmill routine, my strength was increasing every day.� My wife really didn�t want me to go back to work because I was getting so much done around the house, but I was ready to get back into a routine that kept me busy all day.� My office was also pressuring me something fierce to return to work.� So, I started pressuring the doctors and transplant staff.� My main question was exposure to potentially sick people.� I heard one of the people in the office went home with strep throat.� Going back into the hospital was an event I wanted to avoid at all cost.�
I was also cleared to reduce my visits to the transplant clinic to two times per week.� This was great because my arms were really getting beat up from all the blood samples they were taking.� Along these lines, just expect mistakes to be made where they have to take blood twice on the same day.� It is very frustrating, but remember, the people on your transplant team are human, and they are going to make mistakes.� If this happens more than a couple of times, you need to talk to someone because this goes beyond human error and they need to figure out how to prevent this unnecessary discomfort.� If I haven�t said it enough, your communication with your transplant team is essential for your success.� Don�t be afraid to communicate complaints, just be sure to use respect and tact and you should get a positive, cooperative reaction.� If not, you may have a bigger problem on your hands and unfortunately, I can�t give you any personal accounts of how to handle this.
Work?
I was getting a lot of pressure to go back to work so I asked if it is ok.� The transplant coordinator was not in favor of this.� The nephrologist didn�t have a problem with it.� It took a couple of days to get a letter giving me authorization and parameters for returning to work.� While I waited, I talked with people at work to see if there were any sick people that were still coming in.� Apparently there were, so this made me nervous.� As I said before, I want to avoid going back in the hospital at all costs.� In an attempt to minimize this risk, I sent an email to everyone I might see and asked them to let me know if they think they are coming down with something and we will do business by phone.� They were very understanding.� Keep in mind that I am still on the same doses of immunosuppressants that I was on when I left the hospital with the exception of a slight reduction in my steroids.� This means my immune system is still very weak and a simple virus could send me back to the hospital.�
For personal reasons, I felt like I needed to get back to work, preserve Family Leave time (if you don�t know what this is, you can ask a human resources specialist at your workplace and they will explain it to you) and start accruing time off in the event that I did have to go into the hospital again.� I am sure your situation is different from mine and you have to make judgment calls along with the advice of your transplant team.
Work was tougher than I thought.� I work behind a desk most of the day and the first couple of days I felt like I had worked on a road crew.� I can�t imagine how someone who actually worked on a road crew would get back to work.� I imagine it would take a lot longer than it took me.� I found that stress and emotion took its toll similar to physical activity.� For the most part, people were respectful of my wish to avoid anyone who might be sick.� It seemed to work because other than general fatigue, I didn�t show any symptoms of illness.� I don�t know about your situation, but I had to be firm about my need to ease back into work.� People assumed that since I was back at work, I must be 100%.� People tend to equate you with themselves and most people don�t come to work unless they are fully able.� I got a lot of disapproving stares when I came in late and left early, but I didn�t care.� There was no way I was going to work full days and end up back in the hospital.
CMV Rears its Ugly Head
I was doing great as my ability to work longer hours came easier after about 2 months from my surgery.� I went from going to the transplant clinic 3 times to 2 times to 1 time per week to eventually every other week.� My labs were very consistent and very close to normal.� That is, until about 2 � months out.� My CMV antigen (a measure of the presence of the virus) jumped from 10 to 140.� I was told some time before that the doctors become concerned around 150.� I didn�t wait.� I had not seen the infectious disease doctor in quite some time but I made an appointment immediately.� Sometimes it seems like great progress is tempered with setbacks.� My CMV test came back at 544, well over the �concerned� level.� The doctor said I should start IV therapy immediately.� There are other oral medications that can be used, but apparently, they are toxic to the kidney, so I was all too happy to get a PICC line put in again to avoid possible damage to my new kidney.� Besides, I can start taking blood out of the PICC line instead of being stuck although this time it is not quite as good a benefit considering I was only getting blood taken every other week.
Some Insight into PICC Lines
I want to take a moment to give you my opinion on PICC lines inserted by the nursing staff versus a radiology doctor.� The first time I received the line in the hospital by a PICC nurse, I had no idea what to expect and despite that, it was not a bad experience.� No worse than getting a regular IV inserted.� However, the experience the second time with a radiology doctor was much more comfortable.� I believe the difference is in the local anesthesia.� The nurse gave me topical (on top of the skin) anesthesia until she had the skin punctured and then she gave me the local injection.� The doctor gave me the injection before any skin was punctured.� A big difference!� The difference is between feeling some pain and feeling no pain.�
The apparatus they use is slightly different also.� The nurse used a method that depends on the elasticity of the skin to hold the catheter in place and the doctor placed 2 stitches attaching the base to the skin.� The nurse that changes my dressing says she likes the stitch attachment better because sometimes when the other method is used; the extra catheter can stick to the tape and be accidentally pulled out of the skin necessitating a �fix.�� The downside of the stitches is that there are more punctures that can become infected and that would make it necessary to treat or abandon the PICC line.� Another issue is the placement of the catheter.� The tube is inserted under the arm near the armpit (at least mine was) and the catheter is threaded thru the vein down towards the heart.� The nurse takes measurements and makes an educated guess how far they should thread the catheter before hitting the heart.� Soon thereafter, they take an x-ray to confirm the placement and pull or push the catheter in place if needed.� Mine was inserted too far, my heart raced, and I felt chest pressure until it was pulled back.� The doctor uses a fluoroscope to watch in real time as he inserts the guide wire to the exact spot it should be.� This was very comforting to me.� Last, but not least, the doctor�s environment was much more sterile than the hospital room where I received the first line.� As you can tell, I am a fan of insertion by a radiologist, but you may prefer the lower key insertion by a PICC nurse.� Neither is bad, but this is just my opinion.
More Self-Administered Drugs
Like the IV antibiotics, the IV Cytovene (same as the pill you are/will be taking) I gave to myself thru a Redimed device.� It is essentially a plastic pod with a rubber bulb in the middle of it, which is filled with the appropriate prescription, and when the clamp is released, it forces the medicine thru the tube and into your vein.� There is a disc in the line that regulates the flow.� The antibiotics I took previously were done in about 20 minutes.� The IV Cytovene is much slower infused over an hour period.� It is not painful although if you forget to take the Redimed out of the refrigerator about an hour ahead of time, the cold solution can be uncomfortable.� When I forgot, I put the device in my pocket for about 30 minutes and this seemed to do the trick.
Whether it was the virus or the medications, I got severe diarrhea.� I didn�t develop any other symptoms except a light case of nausea.� Hopefully this was because they caught it early.� I talked to another patient who did not report his symptoms early and he said he almost died because of it.� I went back into the infectious disease doctor to figure out the cause of the diarrhea before I became dehydrated again because I wanted to stay out of the hospital if possible.� Once again I was reminded how inexact medicine can be.� The doctor threw out a list of possible paths as if I was supposed to decide.� We decided instead of taking drastic measures, we would talk to the nephrologist and see if he would agree to a reduction in immunosupression.� This was scary because this was risking rejection.� It seems that doctors tend to favor a near term remedy over long term adverse effects.� Of course, they try to balance the two, but I think the �squeaky wheel� still tends to get more attention.� Also, doctors (as I pointed out before) tend to protect the parts of the body related to their specialty.� I felt like I was the subject of negotiation when the nephrologist was on the phone with the infectious disease doctor.� Indeed, they reached a compromise on my treatment opting for a minor reduction in immunosupression with tests to follow in a couple of days to reassess treatment.� One of the courses of treatment was to change my IV treatment to a drug that is nephrotoxic (remember this important word?).� I was very resistant to this.
Sometimes Drugs Don�t Work � Enter Plan �B�
The results of the subsequent test were not good.� My CMV antigens were well over 1,000 causing me to consult with the id doctor immediately.� Murphy�s Law would not go away and I was determined to break this law.� Again, I was presented with all the options including going off immunosuppressants and letting my new organs fail (ridiculous to even give me this option).� This was on a Friday and to avoid being admitted to the hospital to receive the drug we decided upon, I would have to wait until Monday to receive the drug.� This was not consistent with my game plan to be aggressive at every phase of my recovery.� I was admitted that day to receive an IV in my PICC line of a human CMV antibody.� In addition, my IV Cytovene would be almost doubled when I went home.� The treatment only took about 3 hours after about a 2-hour wait (typical for the hospital) and then I went home.� I was next door to a kidney transplant patient who was one month post-transplant whose bladder still did not work.� His catheter had been in for a month!� Once again, it made my setback seem miniscule in comparison.�
I started getting cold in the hospital and as I went home, I felt much worse.� I felt like I had the flu and ran a moderate fever with moderate nausea.� The doctor suggested I take Compazine and Tylenol to control the symptoms.� This helped me to get to sleep and in the morning, I felt much better.� Over the next couple of days, I felt run down, but not too badly.
Back to the Hospital
A problem that I had ever since leaving the hospital the first time was diarrhea.� It would go away for a little while, come back, get better and worse, but I never seemed to completely get rid of it.� A couple of the drugs and supplements you will take can cause this.� After I was admitted to the hospital most recently, the diarrhea was uncontrollable.� It was so severe that 3 days later I was dehydrated and had to be admitted again to receive IV fluids and find out what was causing the diarrhea.� The suspicion was the CMV was residing in my colon.� To determine this definitively, they wanted to do a colonoscopy and take a biopsy of my colon.� As sore as my rear end was, this was something I fought and made sure that all possible other causes were explored before we did this test.� At my age, I needed to start having regular colonoscopies anyway, but I really didn�t want to start under these conditions.� But, of course, because all of my non-invasive tests came back negative, they decided to do the colonoscopy and take a biopsy.�
Like a lot of the procedures I dreaded before, this one was no big deal also.� They gave me some Versed, which apparently is a sedative that usually doesn�t leave you with any memory of the event.� They used this on me when they did my dialysis access, needle aspiration, and before I went into surgery and it did as it claimed.� I have no recollection of the procedure.� It is a great drug!� However, apparently, they did not give me nearly as much on this one because I vividly remember watching the camera as they did the procedure.� However, my transplant surgeon came in to visit me later and asked me if I remember him being there and talking to him during the procedure and I didn�t have any recollection of that at all.� The gastroenterologist (digestive tract doctor) who did the procedure did not find anything that concerned him although he took biopsies to make sure.� He was relatively sure that I had a form of colitis and gave me antibiotics to try to clear it up.
As things had been going, the antibiotic had not made any progress to clear up the diarrhea after a day of taking it.� If you are admitted over holidays, just expect everything to take longer.� In my case, it was getting my biopsy back.� Because nothing else worked, the biopsy became increasingly important to me, but it didn�t seem to be important to anyone else.� They tried another drug for inflamed bowels and all that seemed to do was make me physically ill.� I was once again reassured that sometimes medicine is an art, not a science.� It really didn�t comfort me at all; in fact, it irritated me to think that a statement like this should comfort me.
Hospital vs. Home
This is good time to talk about hospital procedures versus home procedures.� When I was admitted, I was insistent that I administer my own regular medications.� I saw the bills from prior admissions and I think it is criminal the mark-up they put on these medications.� I realize they have costs such as labor and facilities, but come on, mark-ups like 1500% are just pure greed.� The problem with administering your own drugs (you have to have the doctor�s agreement to do this) is that there is a different schedule in the hospital and in my case, they didn�t remind me of this so everyone got bent out of shape that the doctor didn�t have lab results when he was suppose to.� You also need to keep up with all the medications they are giving you.� I stressed this once before, but it bears a mention again.� Take note of strengths, timing, and volume of pills, IV�s, and any others.�
One of the most disturbing things I noted this trip was the lack by some nurses of aseptic (minimizing germs) procedures.� For example, it was drilled into me that you MUST use alcohol every time you connect an IV.� I saw everything from great technique to the complete lack of technique.� Don�t be afraid to speak up and say, �Are you going to put some alcohol on that before you connect it?�� Better yet, ask if a box of alcohol can be put in the room and just swab everything yourself.� It may irritate some nurses, but it is your health, not their ego that is at stake here.� My id doctor�s nurse takes a great deal of time and attention to sterility when she changed my PICC line dressing.� The nurse in the hospital didn�t wear a mask, was not concerned at all about sterility and was done in a matter of about a minute.� Which way do you think is best?
Home Again � Self Medicated, Not for Long
I was released to go home with home IV therapy in the way of IV fluids.� This consisted of a back pack with a battery operated IV pump and a liter bag of saline and other nutrients.� I still had very bad diarrhea and was going to the bathroom losing valuable fluids, electrolytes, and nutrients.� I tried to keep active, but it was increasingly difficult.� I could tell that the amount of fluid I was putting in by IV was not keeping up with the amount I was losing in the bathroom.� About a week later I had to go to the doctor�s office and get a rapid infusion of IV fluids because I was so depleted I could barely walk.� That helped temporarily, but 2 mornings after that I ran a 103-degree fever and they put me back in the hospital thinking that it was possibly a PICC line infection.
I arrived in the ER around 4:00 a.m. on a Saturday and was greeted by my id doctor.� I convinced him to take a more liberal approach, leave the PICC line, and treat with antibiotics.� I was admitted as soon as possible (slow by my standards) and we quickly saw that my fever was not going down, so he decided to remove the PICC line.� This, of course, meant I had to get a peripheral IV, which, against my better judgment, I allowed the nurse to insert without any numbing agent.� As usual, it hurt like hell!� Making matters worse, it took her two tries!� I was not a happy customer.
A Risky Protocol
The doctors were still clueless about why they could not abate the diarrhea.� So, they removed all of my anti-rejection drugs except the steroids to see if my own body defenses would take over and cure the problem.� In the meantime, the id doctor was trying to get an experimental drug used on AIDS patients with Cryptosporidium (which is the only thing they could positively identify in my stool).� I then got the news that they had to add another electrolyte to my IV that was not compatible with the others; therefore, I needed another peripheral line.� This was on a Sunday and I was going to get another PICC line the next day so I threw a fit to try to get it postponed with no success.� Fortunately, I refused to have the IV unless they used a numbing agent on me.� I asked for the subcutaneous (shot), but all they would give me is the topical cream.� I gave in and it wasn�t too bad.
I went for my PICC line the next day and found out that the old PICC line had done some damage to the vein and they could not put one back in the same place.� They decided to place it under my right collar bone in my jugular vein (subclavical).� This placement wasn�t quite as comfortable as under the armpit.� He had to do a lot of tugging and manipulating to get it just right.� A big mistake they made was forgetting to shave my chest.� The adhesive drape and first dressing change were quite painful as they ripped the hair at the site.� After that, it performed well and was very comfortable.� Two questions I wished I had asked were: 1. If you are already putting in a double lumen (2 catheters) line, why not go ahead and put 3 in just in case?� In addition, 2.� Why not put 2 large catheters in instead of one large and one small?� The small catheter did not give blood very well, confused the nurses, and could not handle large volumes of fluid.� If they will allow it, have them put a 3 lumen with all 3 being of the large variety.
This seemed like the longest stay in the hospital even though it wasn�t.� I didn�t feel too bad except that I was getting weaker and thinner by the day.� You see, when you have this form of diarrhea and this severe, your body does not absorb nutrients.� They gave me Tincture of Opium (yes, I said opium) which is a powerful agent to slow bowel movement.� This did not work on its own so they supplemented it with Sandostatin injections, which do the same as the opium.� This slowed the bowel movements to about 10 in a 24 hour period, but I was still not absorbing nutrients.� Nutrients are the proteins, fats, and carbohydrates that are turned to glucose to fuel the body.� Proteins are important because they are the building blocks of life and the most notable affect of a lack of proteins is the loss of muscle mass, thus the weakness.� Nutrients are not to be confused with vitamins, minerals, and electrolytes.� They can easily replace these through the IV.� Apparently, the IV can give nutrients, but it presents a list of problems that I didn�t have to learn, because I never needed them.�
As before, the IV pole was a big pain to wheel around to the bathroom, down the hall, etc.� I felt very imprisoned this time because they were not making any progress with the ailments.� Then we finally received approval to use the experimental drug NTZ.� Actually, I found out it was FDA approved and ready to be marketed, but there was such a small demand for it, the drug company couldn�t afford to market it.
My high hopes for the drug were soon crushed as a week went by with no indication of any improvement.� Then an ever so small sign appeared.� My need for IV supplements was going down.� This meant that I must have been absorbing some nutrients through the food I was eating.� My appetite was enormous because everything went through me at lightening speed.� Even though the diarrhea was no better, something was getting better.� Soon, the number and complexity of supplements they were putting in my IV seemed manageable at home, so I launched a campaign to get myself home.� I was successful getting a day pass so I could spend Christmas at home.� I took home a portable IV with 2 pumps and had to carry about 4 liters of fluid in 2 bags on my shoulder.� It was extremely tiring, but worth every ounce of effort to get out of the hospital long enough to be with my family on that special day.� You see, I had to spend my Thanksgiving in the hospital and was not about to do that at Christmas.� The food and company at Christmas time were a thousand percent step up from that at Thanksgiving!
My next campaign was to get another day pass for New Year�s Day.� I guess I did a good job because they released me on New Year�s Eve from the hospital.� Some day I need to apologize to the transplant surgeon and the transplant coordinator because I was so frustrated that I raised my voice to them.� I hope they understood.
Home Again � Self-Medicated Again
Being home was great, but I was still getting weaker and having to lug around the IV fluids 24 hours a day.� The NTZ was making extremely slow progress.� I was also getting extremely nervous going without my anti-rejection drugs for so long.� Fortunately, there were no signs of rejection, but that could change with the next blood test.� My frustration was coming out in my conversations with my id doctor and his nurse.� The only side benefit was that my CMV tests were indicating that my immune system had eliminated the need for treatment at the time, so that was a positive.� As things started to improve, I weaned myself from my IV fluids, which were down to very basic supplements.� I was down to only hooking myself up at night.� The PICC line was performing fantastically.� This made the blood they took 2-3 times per week a breeze.� Unfortunately, another complication surfaced in the form of blood clots in my left arm.� Apparently, this was from the three central IV lines, taking multiple blood samples and the PICC line that had been in my left arm.� This trauma caused several non-vital veins to close off and it was quite painful as my body processed this problem and tried to reroute my blood supply.�
They immediately started my on Lovenox injections to thin my blood and try to dissolve the clots.� The shots were not very comfortable because they came in pre-filled syringes and I guess the drug company was not too concerned with patient comfort.� Very soon afterwards, I was switched to Coumadin, which is a powerful blood thinner.� Frequent blood tests were performed to make sure I did not take too much as this drug can cause you to bleed for seemingly no reason in some cases so they are very careful with it.
The Good News Just Keeps Coming
As if this wasn�t enough, some time before the clots appeared my liver function indicators jumped in the wrong direction.� So, they did several ultrasound tests that showed my bile duct was enlarged except I didn�t have any symptoms that should go with those indications.� So, after a lot of deliberation and my diarrhea still as watery as ever, they decided to perform an endoscopy and colonoscopy.� The former is threading a small camera through the mouth, down the esophagus, through the stomach and into the upper intestines including a look at the bile duct.� The latter is the same as I did before threading a camera up the lower intestines and looking for abnormalities.� The test was fairly uneventful as they gave me Versed again and knocked me out somewhat.� To add to my frustrations, the test was inconclusive stating that everything looked normal with the exception of some swelling.� The doctors were really stumped now.� All they could conclude is that my intestines still had some healing to do and the diarrhea would go away soon.� The biopsies they took didn�t show anything either, so the doctors finally agreed to put me back on my immunosuppressive drugs.� At least that mental burden was taken from me.
Odd Things that will Excite You
You have heard the saying, �Doctor heal thyself!�� I propose a new saying, �Patient heal thyself.�� One morning I forgot to take all of my medications.� I noticed that even without the Sandostatin or Tincture of Opium I didn�t need to go to the bathroom.� When I finally took my meds that evening, there was a dramatic change in the consistency of my stool!� Now you are probably thinking what a weird event to make everyone excited, but I told everyone and the excitement was amazing!� After over two months of dealing with this, it was a major event in my life.� Well the doctors started speculating which drug might be the cause when I was positive it was the NTZ so against doctor�s advice, I did an experiment of my own and after my stool turned back to water, I stopped the NTZ the next morning.� Again, things firmed up, the evidence was conclusive, and the id doctor agreed to stop the drug.� After that, I started gaining weight and was less and less dependent on my IV fluids.� I guess this shows you need to pay attention to the details because sometimes the patient can diagnose better than the doctor!
As if my body could not leave well enough alone, I started running a fever.� Blood cultures revealed that I had a minor infection and as they had done every time before, they suspected the source was the PICC line.� They said it had to come out which meant going cold turkey on the IV fluids.� I was ready.� Other than having to be stuck to get blood tests, my life could return to normal.� As they monitored my blood cultures, they could not grow any infections from it in the lab, so it seems this time they were right and it was the PICC line to blame.
Life Tries to Get Back to Normal
Things continued to get better.� I was retaining more fluids, absorbing more nutrition and gaining weight.� Best of all, I was regular!� Every day I felt better and better.� My main concern at this point was my stamina and loss of muscle tone. �In fact, my legs and arms were mere sticks from where they were before the transplant when I weighed around 210.� I lost almost 40 pounds.�� The pounds were coming on slowly, but I really didn�t feel like exercising yet which meant every pound went straight to fat.� The enthusiasm I had soon after surgery to exercise and get back to my former self was not there after the beating I took over this last setback.� To add to matters, my employer went from supportive to concern to pressuring to threatening.
Your Employer, Your Health Providers, Your Insurance Company and Looking Out for Yourself
This is a good time to talk about transplants and your employer.� It is important if you are the sole wage earner and insurance provider to get back to work.� It is also important to do everything you are supposed to in order to preserve all your rights at work and under your insurance.� Take notes well before, during, and after your medical leave.� I am not an attorney, but my experience is that during these times, everyone tends to be out for themselves and you should be too.� You should be honest with your employer about your status and take notes including details, the date, time, and anything else you think is relevant such as your employer�s reaction to the discussion.� You or your significant other should take notes after surgery not only because you will get a lot of information that you need to understand, but also because not all caregivers are working in your best interest (although a vast majority are) and your doctor or (hopefully not) your lawyer need to know this.� You may think that the notes the insurance company take every time you talk are plenty � NO WAY!� They are looking out for their company, not you.� They will couch their notes to soot themselves.�
You need to take notes to make sure you follow instructions.� Not following instructions may void your insurance!� Since you will be a MAJOR claim for the insurance company, you will be very prominent on their radar screen and if they can find a way not to pay, they are saving a ton of money.� All of this is not meant to make you paranoid, just cautious.� It would be great if you could just sit back and let everything happen, but few things in life work this way and transplants are no exception.
Hindsight is 20/20
Getting back to progress, the doctor�s were very hesitant to put me on a full dose of immunosuppressive drugs for fear that I would develop another infection, virus, or parasite that my body could not fight.� This was very concerning to me because I was most afraid of going thru another transplant and lowering my immunosuppressive drugs made me more susceptible to rejection.� I guess rejection is much better than death, which is how my doctors put it to me.� At this point, I was feeling much better although I was being very cautious not to over do it at work (despite the anger and pressure of my employer).� I was impressed that my new organs did not show any signs of rejection while I was completely off my anti-rejection drugs so I went along with the doctors who only gave me a minimal dose of Prograf and Prednisone to ward off rejection.� Life was really good because I was putting in full, productive days at work and able to catch up on a lot of �honey do� items at the house.
I continued on my blood thinner for the clots that had formed in my left arm.� By this time, the doctor concluded that the clots had shut off the veins and my body would probably absorb them.� This is not a big deal.� I was still giving a blood sample every week to monitor how thin my blood was, checking for CMV, and monitoring the function of my pancreas and kidney.� After a couple of months, we noticed that my Creatinine was going up.� When it took a jump of .4, the doctors became concerned and sent me for an ultrasound of my kidney and pancreas.� Although this test did not discover anything alarming, a repeat of my blood test disclosed another .2 rise in Creatinine.� They immediately admitted me to the hospital for a biopsy of my kidney.� The biopsy would consist of inserting a biopsy needle into my new kidney and taking a few small pieces.�
When I arrived, I had a slight fever, so they were almost sure it was rejection.� My Creatinine had not increased from the previous day so the doctor was confused about starting rejection therapy immediately or waiting for the biopsy results.� A lot of things went thru my mind.� What if I had pushed for more Prograf?� What if I had insisted that we start the Cellcept again?� Was this caused by the couple of times I took my medication late?� All of these questions are valid, but were not very helpful at the time.� I guess equally as frustrating as second-guessing myself was the indecision of my nephrologist.� Since he did not mention that my temperature was elevated when he saw me that morning, I later thought he might not have considered this in deciding my therapy.� Repeated attempts to contact him by the transplant coordinator failed.� I have said several times that hospitals are a frustrating place and this is another example of why.
A Word about Support Staff
This is a good time to say a quick note about support staff/companies.� Under my definition, these people are much lower on the totem pole and take their instructions from people several layers below the doctors.� For example, a �support� person takes the blood pressure/temperature readings and a support person or company takes blood.� I have a lot more patience with these people because their job is fairly mechanical and they have no latitude on how they do their job.� Or do they?� Just like other health care professionals, they need to know your particular needs such as an arm that will not register blood pressures correctly (in my case, on my fistula arm) or a reason that blood cannot be taken in a particular place (in my case, where veins are clotted).�
As I have said repeatedly, it is your body and you are the boss when someone wants to fiddle with it.� If a doctor, nurse or transplant coordinator has given you instruction that are contrary to what a support person wants to do, make them aware of it before they do it.� I have had several cases where this person got argumentative with me and I simply told them that unless they received clearance from the appropriate person to do what they were about to do, they could not do it.� Usually this angers them because you have thrown them off schedule, but who cares!� Admittedly, sometimes I have been wrong and I have apologized and you should too.� However, it is worth some extra time on their part and a possible apology on yours to make sure what they are doing is right.� When someone draws blood, do you ask what tests they are drawing?� Do you know what these tests are for?� When blood pressure or any other reading is taken on you, do you know what it means?� YOU DEFINITELY SHOULD. �I can�t count the number extra tests I have avoided by simply knowing what is suppose to be done and what time the next one should be done.� You will be amazed at how many times wires can be crossed between shifts, due to lack of communication, etc. that caused you to have to be stuck unnecessarily or another test taken too frequently.� My favorite is when they do not take enough blood to run the tests and they have to come back, stick you again and draw 1 more tube of blood.� This happened frequently before I learned the trick of going over what they are going to draw before they stick the needle in.
Your Bill of Rights
Now I am really going to get off track and talk about something we have in Texas called �The Patient Bill of Rights,�� This was obviously created by complaints lodged by unhappy patients over the years and legislators forced hospitals to make patients aware of things they entitled to by law.� Your state may have something similar or nothing at all, but here are the Texas rights:
- Patients with communication challenges (i.e. speech, language, hearing, etc.) should make their need for assistance known.
- The facility must comply with the federal Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) by removing barriers for people with disabilities.� This includes architecture, attitudes, employment, and other barriers.� You should make a complaint in writing to someone in authority if you feel your rights have been violated.
- A patient cannot be denied appropriate treatment based on race, national origin, color, age, sex, religion, disability, or source of payment.
- The hospital must make a reasonable response to the request of a patient for services.
- Considerate and respectful care should be expected.� This is a tough one for some people to assert, but done tactfully as I have discussed previously, can make your stay a whole lot better.
- Patients are involved in all aspects of their care.� This is what I have been trying to drill into your mind.� In Texas, it is a right by law.� It is an ethical right everywhere.� They go on to talk about information on pain management and that the staff is committed to and responds quickly to reports of pain.
- The care of the dying patient shall be optimized for comfort and dignity.
- The patient will receive information necessary to give informed consent prior to the start of any procedure and/or treatment.� I find this to be one of the weakest areas of the hospital.� In my experience, the person asking me to sign consent usually is not able to answer any questions except to reiterate the words on the paper.� I usually just say, �I have been told I need this procedure, are you saying if I don�t sign this paper I cannot have the procedure?�� They usually say �yes� so if I understand that I have to have the procedure, I sign the paper.� I know this seems contrary to many things I have said, but this is just my personality.� I do not have patience to go thru a long dissertation by someone who really does not know what they are talking about to get a procedure done that I know I have to have.� Also if the procedure has a bad outcome on my health, I believe the facility or person should be responsible and you cannot sign that responsibility away even though that is what they are trying to do with all the paperwork (better get an attorney�s opinion on that one, this is certainly not legal advice).
- The patient will be allowed to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of such actions.
- Every consideration of the patient�s security and privacy will be given.
- Expect all communications and records pertaining to his/her care should be treated as confidential.
- The patient has the right to obtain information to the existence of any professional relationships among any individuals, by name, who is treating him/her.
- Shall be advised if the hospital proposes to engage in or perform human experimentation affecting his/her care or treatment.� Patient has right to refuse to participate.
- Access protective services.� I have no idea what this means.
- This one talks about withholding resuscitative services or withdrawing life-sustaining treatment.� It says procedures are in place, but does not tell what the patient�s rights are regarding it.� Personally, I have a living will that spells out who can make these decisions if I am not able.
- This is important so I will type it verbatim.� Expect reasonable continuity of care.� He/she has the right to know in advance what appointment times and physicians are available and where.� The patient has the right to expect that the hospital will provide a mechanism whereby he/she is informed by his/her physician or delegate of the physician of the patient�s continuing health care requirements following discharge.� I read this to mean that your doctor should be available and you should always know how to get him.� Sometimes I get frustrated with the timeliness of their compliance with this.
- You have the right to make an Advance Directive (see 15 above) and expect that it will be followed.� The Hospital cannot discriminate in your care based on this Advance Directive or whether one has been executed.
- They reiterate 17 above and add that the Advance Directive will be kept in the file and reviewed periodically with the patient or their designate.
- The patient has the right to examine and receive an explanation of his/her bill regardless of source of payment.� The patient has the right to timely notice prior to termination of eligibility for reimbursement by any third party payer for the cost of care. �It is important for you to examine your bill whether you or an insurance company is paying for it.� Hospitals are notorious for charging or overcharging you for items and services not received.
- You should be informed about these rights, what conduct they expect from you and the mechanism for dispute resolution.
- Staff educated about patient rights and their role in supporting those rights should care for you.
- Receive care appropriate to age, developmental, and psychosocial level.� I don�t know what this means??
- Receive are in a secure, non-threatening environment.� Wow, they blew this on in the ICU for me!
- Have all interests/business relationships between my health care providers, the hospital, or educational institutions, which might affect my care, explained to me.� Personally, I do not think they know all these relationships, so how are they going to explain them to the patient?
- The patient or patient�s designee has the right to all information concerning the patients care and should be told where and from whom to obtain that information.
- The patient or designee has the right to participate in the consideration of ethical issues.� They can tell the health care provider to consult the Ethics Committee for resolution of conflicts.
- The patient�s legally authorized representative shall exercise the patient�s rights if the patient is unable to do so.
- The patient or their family has the right to present complaint(s) to the department manager and they are entitled to a response upon reasonable investigation.� Presentation of a complaint shall not compromise a patient�s future care.� I have a hard time believing that filing a complaint against someone will not bias their attitude or care.� Even though I have the right, I made sure I picked my battles well and did not get a reputation as a complainer.
- If the patient is 55 or older, the message from Medicare outlining their rights will be provided will be provided.
They go on to outline the responsibilities of the patient, guardian or legally authorized representative:
- To provide to the best of their knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters related to health.
- To report unexpected changes in their condition.
- To ask about pain and pain management.� To ask for relief when pain first happens and to help the doctor and nurse measure your pain.� Tell them if the pain is not relieved.
- To participate in and follow the treatment plan that was developed.
- To follow hospital rules and regulations.
- To be responsible for his/her actions if they do not follow practitioners instructions.
- To be considerate of the rights of others by assisting in the control of noise, smoking and number of visitors.
- To participate in the educational and discharge planning.
- To fulfill the financial obligations of his/her health care.
- To provide the hospital a copy of his/her advance directive, if they have one.
A lot of this is paraphrased and you should not rely on my interpretation.� Get a copy of whatever is provided in your state and read it carefully especially if you have a special need.
The Ultimate Rejection Test
Getting back to the biopsy, they could not do it until my blood was able to clot well.� The blood thinner (Coumadin) could cause major bleeding if they did the biopsy while my blood was too thin.� To take the biopsy, they gave me a mild sedative (Versed), a general pain killer (Phentanol) and a local anesthesia (Lidocaine).� A needle was used to take four small pieces of my kidney for a pathologist to analyze for rejection.� With the anesthetic, it did not hurt at all.� I was sedated enough that even the pop of the biopsy tool did not upset me.� Actually, after waiting for over a day to get this done, I was happy to have it over and was anxious to get the results.
As luck would have it, even though the biopsy was taken on a Friday and I was promised results the next day, I did not get the results until Monday.� It seems there was a problem getting the sample to the right place, which delayed the results.� By that time, I had been released from the hospital and had gone into the emergency room to get my final treatment of steroids.� Let�s sidetrack for a moment.� I convinced my doctor that it was ridiculous for me to stay in the hospital until Monday just to receive one more dose of steroids (I am sure my insurance company thanks me) and it was agreed that I would be released on Saturday and go into the emergency room to receive my final dose.� The nurse came in to remove my IV access and I flipped.� She said it was policy that I could not leave with peripheral IV access.� I stopped her and called the doctor.� I told him it was ridiculous to remove the access when they would just have to reinsert it the next day for a 30-minute dose of medicine.� It was especially ridiculous given that I had multiple clots in my left arm from all the puncture wounds from previous IV access.� He went through channels and got the hospital to agree to let me go with it still in.� Again, it goes to show you that not everything is set in stone if there is a good reason for doing otherwise.
Sometimes it is Frustrating beyond Comprehension
I went to the emergency room and as I have experienced several times before, they had no clue what to do with me.� I tried to call ahead to have the medicine prepared so I didn�t have to wait and was rudely told that it was not possible.� I tried to get them to call my doctor and they wouldn�t until I arrived.� When they finally called him, of course, he authorized the medicine, which took an hour to prepare.� In the meantime, I had to have blood drawn.� Again, I had to explain to yet another person why I could not have blood drawn out of my left arm and that it was ok to draw from the arm that had my dialysis access in it.� A man came to draw the blood with a setup that I had not seen before.� Fortunately, it included a butterfly needle that I would have insisted upon because of its small size.� He proceeded to take the syringe that he was going to use to draw the blood, took the top off and he put it under a pillow!� I asked him if he was going to use that syringe and he said yes.� I replied, �No you are not!�� After he gave me his nursing history, I explained that only sterile objects are going to be used to take my blood.� He agreed obviously offended.� As you can imagine, he was not gentle.� I asked if he was drawing enough blood for all my tests and he barked that he was.� Of course, he didn�t.� Another lab technician had to come and draw more blood because I refused to have him do it again.
Back to the biopsy.� I received word that I had indeed started to reject my kidney and although no tests were done, I assume I was starting to reject my pancreas as well.� Tests concluded that the steroids seemed to have arrested the process and further tests showed an improvement in kidney function.� They said that I had mild tubular damage and the doctor said that the damage would repair itself over time.� This is deemed an acute rejection as opposed to a chronic rejection.� An acute rejection can be reversed, a chronic one means you will eventually lose the kidney.
They continued to test my blood every other day to make sure the rejection was reversed.� To be consistent with how things had gone for me so far, the test results reversed and my kidney function started getting worse.� The test they watch is the blood Creatinine.� A normal kidney usually reads 1.0.� Mine was as high as 2.3 when they decided to do the biopsy and it jumped back to 2.3 again after the steroid treatment after going as low as 1.9.� My theory was that I did some heavy muscular work before it jumped up.� Creatinine is a byproduct of muscle activity and I thought that with a compromised kidney, it would be especially sensitive to an increase in activity.� We were all ready to admit me again, do another biopsy, and start �gorilla� antirejection drugs along with another drug to try to prevent a recurrence of CMV because these drugs would knock out my immune system again.� Fortunately, whether my theory was right or not, my Creatinine slowly started to come down by .1 every other day.� I was really glad I dodged that bullet.� I was sure if I had to go in the hospital again, my boss would have been at his wits end and fired me.
More Hospital, More Needles
Did you really think I got off that easily?� Of course not!� My Creatinine went up .1 and the doctor said thru the transplant coordinator to get into the hospital and get another biopsy.� I was not happy.� In fact, I was quite angry.� I thought this was a knee jerk reaction to a minor movement in my stats.� I could not get the doctor on the phone and was suppose to go in the next morning.� Finally, that evening I had enough and called everyone I thought could get me out of this procedure.� I started with the transplant coordinator that I liked so much, but the problem was that she was on maternity leave and was on strict bed rest.� I felt bad calling her, but she did give me her home number and said to call if I had any problem I could not get solved.� I respected her opinion and she was very helpful.� She basically had the same thoughts I did and felt it was a bad idea to disturb the kidney unnecessarily.� However, she wanted to defer to the surgeon that put the kidney in to me.� She was gracious enough to contact him.� Normally this would be a little touchy because it looks like I don�t trust my nephrologist, but given the fact that my nephrologist was not calling me back and I had been dealing with complications for almost 8 months, we decided to do it anyway.
The surgeon called me and explained that he felt the biopsy was the right course to take.� He said that I should still be having a downward trend in my Creatinine and the fact that it was stable and had actually gone up slightly was a bad sign.� At one time I had been as low as 1.0 and 2.0 just seemed too high.� His theory is that there still might be some rejection going on and if we could eliminate the remainder, the kidney function might improve (lower Creatinine).� There is that art over science thing again.� Everyone agreed that I should probably get another Creatinine done before the biopsy on the outside chance that it would be drastically lower and we could delay the biopsy on the hopes the trend would continue.� Another transplant coordinator agreed to meet me early in the morning and draw the blood and let me wait in the clinic for the results before I checked into the hospital.� About that time, the nephrologist called and agreed with the plan.� I found out that he and the surgeon had talked earlier in the week and already had this plan in mind.� I have said many times that communication is key and often poor among the health care professionals and between the health care professionals and the patient.� Knowing about the conversation between the doctors might have avoided all my calling around.� All I was looking for is another opinion that this was the right course of action.
The next morning we executed the plan and of course, the Creatinine only went down .1 so everyone agreed that we needed to do the biopsy.� I checked into the hospital, greeted all the nurses that I knew on the hospital floor so everyone knew that I was there again, and rekindled the relationships that I fostered the many times I had been there before.� I went down to Radiology and to my pleasant surprise; my favorite radiologist was going to do the procedure.� He was very accommodating with both general and local anesthetics.� The procedure went extremely well.� They even seemed to have the transportation of the biopsy problem solved.� I was taken back to my room and went thru the same drill again of not being able to move for 4 hours and having a sand bag on the biopsy site to help prevent bleeding.� By this time, I was very hungry and I ordered a late lunch tray.� Now, everyone knew that I was not able to move for 4 hours and what do you think they brought me to eat?� Cottage cheese and a fruit plate including prunes!� There is that great communication thing again.� Needless to say, I did not eat much of it and was so frustrated that I was not hungry any more.� They took blood test to see if there were chemical signs of bleed and they came back clear so I was released to come home that afternoon.
Still Rejecting
The next day I received word that I was still rejecting and that it was urgent that I get in right away to start Thymoglobulin therapy that day.� Thymoglobulin is the same aggressive immunosuppressant that I had been given immediately following my transplant.� It really knocks out your immune system so I was apprehensive about receiving it given all the problems I had in the past due to my compromised immune system.� However, because everyone had agreed in advance that this was the right course to take I was ready for it and did as I was told.� I was not too clear on how I was to receive the therapy, but I had been told that I would spend 2 days in the hospital and I would be able to get my last course of treatment on an outpatient basis as it was going to be Easter that day.� I was also told that for some reason they wanted to use my fistula (old dialysis access) to administer the drug.� The fiasco was about to begin.
A Comedy of Errors that was not Funny
I arrived at the hospital and after being admitted and checking in with the floor nurses it seemed odd that no one really knew what was suppose to happen with me.� Sure, they knew what drug I was suppose to get, but they didn�t know how I was going to get it.� Seems that normally this drug must be given via a central IV line like a PICC line, however, everyone was nervous about putting a PICC line in me because of the clotting I had from the PICC lines and other IV access in my left arm.� This drug can damage small low flowing veins where a peripheral IV is placed.� I thought this was a good idea, but no one had communicated this to me and the nurse was very confused about how they were going to accomplish this because the floor nurses were prohibited from doing anything with a fistula.� The idea was to get a dialysis nurse to place the line; however, no one had arranged for this to happen.� In other words, the transplant coordinator did not follow the process all the way through to make sure everyone knew what to do.� It appeared she dropped it in the charge nurse�s lap and assumed she would handle it.�
Once again, I was very angry at the poor communication and lack of follow thru.� Once again, I started making calls.� I paged the nephrologist twice because I was under the impression that the transplant coordinator was not available that evening and went and got something to eat.� When I returned I was told that they could not start the treatment that evening because there was no one to start the IV line.� I was furious!� I put another page into the nephrologist and told the transplant clinic operator to page the transplant coordinator.� When she called, I found out that she had talked to the doctor and they had been trying to orchestrate getting my treatment for hours!� I was amazed that no one had called me to let me know this.� When I hung up with her after telling her how frustrating this lack of communication with me was, the doctor called and said I should just go home and he would meet me in the morning and personally handle getting the treatment administered.� So, 6 hours after I was told to get into the hospital immediately, I went home. �I won�t further bore you with how complicated it was to get the hospital to let me go home knowing I would be back in first thing in the morning.
Let�s Try Again
The next morning I was there on time and the doctor was about an hour late.� Get used to this.� Doctors tend to run late.� I don�t know if this is planned so they don�t have to wait or if they just always run behind, but this seems to be consistent wherever I go.� The plan was to have me go to the dialysis ward and have a butterfly needle inserted into my fistula to administer the Thymoglobulin.� I then learned that they would also be giving me a large dose of steroids at the same time.� I don�t like steroids because they make you gain weight, get puffy and get very aggressive, but if this is what it took to keep my kidney, I was willing to do it.� At this point there still was not a clear plan how to get my 3 treatments done.� The doctor asked, �What do you mean 3 treatments?�� I told him that is what I was told by the transplant coordinator.� He said I would have up to 10 treatments!� Again, I was angry at the poor communication.� He was very protective of the transplant coordinator saying that it was probably his fault.� You will see a lot of this.� The medical profession is very much a �good �ol boys club� and they are all very protective of each other.� Since there was confusion about that, I made sure that the doctor told the dialysis unit that they should not use a dialysis needle.� A dialysis needle is several times the size of the small needle necessary to administer an IV.� He said he would.� It seemed ridiculous to go to the dialysis ward to get this done, but if this was the only way for me to get my medicine, I was up for the inconvenience.
Much to my delight, someone in the dialysis unit realized how ridiculous it was for me to come down there and came to my hospital room to get the IV started.� This was so much easier than a typical peripheral IV that I was amazed at all the fuss and confusion.� It was something I probably could have done myself with my experience with my insulin pump catheter sets.� The IV would go in over 5 hours and the first couple of hours were very rough.� I was short of breath, had extreme heartburn, nausea and all this was topped off with a fever and severe chills.� After that, it settled down and other than being dizzy, it was not bad.� A really great nurse got the kitchen to send me a grilled cheese sandwich, which was great comfort food.� I was done for the day.� Something I forgot to mention was that the id doctor prescribed Valcyte, which is similar to Cytovene to protect me against a recurrence of CMV, which was likely given that I was going to be highly immunosupressed.� There were not too many lingering effects except a little diarrhea and some imbalance.
The remainders of my treatments were done in the Clinical Decision Unit (CDU), which is an extension of the Emergency Room (ER) and is usually where they take patients after they have been to the ER to decide if they will be admitted into the hospital on a longer-term basis.� As a favor to the Transplant Department, they agreed to let me come in every day for the next week to receive my IV therapy.� I went to the dialysis unit to get the IV started every day with a 23-gauge butterfly needle that was so much better than a typical IV that I didn�t mind at all.� These treatments were very easy.� They premedicated me with Benadryl and Tylenol (forgot to mention that) so I don�t have an allergic reaction and the treatment can cause headaches and muscle aches.� This seemed to be a very efficient way to take care of the fiasco that had been created before trying to get my treatment to me.� As always, and as I have mentioned many times, know what they are suppose to give you, when and how.� I noticed on the second day that the IV line was missing a filter that was on all the other treatments.� I was right.� This was an important device as apparently there is some sediment in the preparation that you don�t want going into you.
The Internet
Let�s talk about another great tool in your treatment � the Internet.� Doctors and nurses do their best to keep up on the latest treatments and problems with current treatments, but let�s face it; there are only so many hours in the day.� You need to help.� You will find some doctors that are irritated with your research and others are truly appreciative that you have an interest.� I don�t have to tell you which doctor you should you need to be using.� Be careful with your research.� Make sure it is from a reliable source and is of a current date.� There is a ton of outdated information out there and it is definitely irritating to constantly ask questions about information that is outdated.� There are a few web sites listed below, but your best bet is to use a search engine and simply type in what you want to find.� There are a few of these below as well.� I picked up the information about the filter that was supposed to be on my IV and the premedication from my research and I am glad I asked about it.� Some of these things might not make any difference, but why chance it?� Do your research and ask questions.� Do your research and ask questions.� Are you starting to get it?
Drawing Blood
Here is a note about drawing blood.� There are lots of ways the nurse or lab technician can get blood from you.� If you have a PICC line, you have the best way.� They simply hook a syringe to it and pull the saline or Heparin from the line and discard the first syringe.� They then take another syringe and draw enough blood to fill the vials they need.� When that is done, they flush the line with saline if you are going to be immediately connected to an IV or with saline and Heparin if the line will not be used for a while.� If you have an IV in a fistula the procedure is pretty much the same but they will never leave it unused.� Most of you will simply be stuck with a needle.� The key is to be stuck as few times as possible.� Remember that nurses and lab techs are human.� The WILL make mistakes.� You should always make sure they are drawing all the blood they need.� Nothing is more frustrating than having to be stuck again because they forgot to draw a vial.� You will not always know what tests are supposed to be drawn, but try to find out beforehand.� It might save you a needle stick.�
Why is this important?� Take me for example.� I was stuck with needles, IV�s, and PICC lines so much in my left arm that it clotted.� If I was more careful, I could have avoided about 10% of that trauma to my arm (sounds worse than it is).� If you think there is a better way or a way to save another needle stick, don�t be afraid to fight a little to try to get it done that way.� Sometimes you will win and sometimes you won�t.� It never hurts (no pun intended) to be your own advocate.� Also, know your needle sizes.� Usually a �butterfly� needle means a smaller needle than the typical one used to draw blood.� However, even butterfly needles come in different sizes.� The difference between a 23 gauge and a 21 gauge may not sound like much, but they do different damage to the skin and underlying vein it punctures.� By the way, the larger the number, the smaller the needle � pretty important point.�
A pediatric syringe needle can be as small as 30 gauge, but you cannot take blood with something this small.� When talking about IV�s, generally the faster they need to put medicine into you, the bigger the needle or IV set must be.� They used a 23-gauge needle to infuse my Thymoglobulin because it went in very slow.� The used a 21 gauge needle when I needed IV fluids because the needed to get about 10 times the amount of fluid into me.� I think the smallest IV set they make is 22 gauge, but they will only use that if they know they will not need to infuse a large volume.� By the way, the 22-gauge IV set is MUCH more comfortable going in than other sizes if you can convince them to do it.
Back to my rejection.� I was very frustrated at this point because I had 7 Thymoglobulin treatments and my Creatinine was not going down, it was creeping up!� They decided to give me one more treatment to see if that would do the trick.� I was told that with a week or so delay, I could expect to see some improvement in my Creatinine values.� I seemed to stabilize in the 2.0 to 2.2 range, which would mean that I lost a significant amount of kidney function due to the rejection.� I was told it was not the end of the world and it was not unusual to see someone stabilize in this range after rejection.� As always, I was hoping for better.
At Least the Outcome was Consistent
Well, as with most of my �events�, I did not stabilize at 2.0, in fact, due to the aggressive immunosupression, the CMV reared its ugly head again and my Creatinines were running in the 2.4 range.� Since I was not symptomatic, the doctor decided to discontinue the Valcyte and see if this might be causing the rise in Creatinine.� As luck would have it, I became symptomatic with flu-like symptoms.� We started the Valcyte again along with Tylenol, but delayed starting IV therapy.� This seemed to reduce the symptoms where I could go about my daily life, not for long anyway.� The fever and chills came back and we decided it was time to visit my home away from home � the hospital.
Back to the Hospital - Again
We immediately started the IV therapy of choice � Gancyclovir.� Into that night, my fever reached 103.1 and I was thinking this is the last straw.� When is it going to end?� Then I thought back to a message I saw posted on the National Kidney Foundation website.� It said you can expect a multitude of major complications in the first year.� Warped comfort as it was, at least I was part of the average.� For some reason, my white blood count dove into the concerning range.� First, they tried antibiotics thinking it might be an infection.� They gave me Neupogen, which is a white blood cell stimulant.� My red blood cell count also went down so they gave me Procrit, which is stimulant for production of those cells.� The good news is that one or all of these drugs made me feel much better the next morning.� The bad news is that my white blood cell count was still excessively low.� They decided to move me to a floor where they take anti-bacterial precautions.� It was a cold, sterile and loud (because of the special ventilation system) room.� This was very depressing and made me feel like my situation was more critical.
A New Sensation
Then I got even more disturbing news that they wanted to do a bone marrow biopsy.� White (and red) blood cells are produced in the bone marrow and they wanted to see exactly what was causing their production to be reduced.� I was told that this is a somewhat painful procedure, but with enough drugs, it would probably not be any worse than my kidney biopsy.� Wrong!!� I was given essentially the same drugs as previous biopsies (Versed, Phentanol and Lidocaine).� The sample is taken from the highest part of the rear of the hip.� The initial puncture was painless.� Then he takes a boring tool (it was anything but �boring�) to create a path thru the hard bone for the needle to extract the marrow.� This was painful, but tolerable.� It is disturbing, however, because there is some force used.� Imagine taking a tool and manually making a hole in a hard piece of wood.� That was the force he used.� The next step sent me into orbit!� They put a needle into the hole they created and there must be a lot of nerves in there because it was very painful.� Then the marrow is sucked out with the syringe.� The hole is plugged and pressure is used to stop the bleeding.� Understand that I did not see any of this, but this is what I felt and what I understood these feelings represented.
The results came back the next
day and I was relieved to hear that it was not cancer or a major infection.�
The doctor explained that there were plenty of red and white blood cells
stacked up ready to go into the blood stream, but one of my drugs (we suspected
earlier that it was Cellcept, so we stopped it) was keeping them from fully
maturing and doing their job.� He suspected that we would see a positive trend
now that the
Cellcept was stopped and indeed, we did.� In the meantime, my red blood cell
count went so low, they had to give me a transfusion of red blood cells.� This
was weird because I never liked it when blood would back up in my IV, now the
IV bag, the line and the IV was full of blood!� I really didn�t feel anything,
so it was ok after the initial shock.� My stats continued to slowly improve.
Dealing with the Docs
Let�s talk a little about dealing with doctors.� For the most part, I get along well with doctors, my personality clashes are mostly with nurses which makes sense because I deal with more of a variety of them.� However, keep in mind that doctors are very proud and have worked very hard to attain their status.� Most expect everyone including the people that pay them (patients) and especially everyone on staff who is not a doctor to acknowledge this.� Their number one mantra is �my time is more important than yours.�� In a sense, it is more important than yours because you need the doctor, he doesn�t necessarily need you.� Obviously if doctors kept dropping patients, they would not have any due to their reputation.� Don�t be surprised if you frequently have to wait on the doctor and the one time you ask him to wait on you he doesn�t.� That is just how the game is played.� You just have to figure out if the doctor is good enough to put up with the inconvenience.� The fact is, good doctors tend to be less aware of their patients time because they don�t have to.� Make your own decision, but be aware of the possible consequences.
Back to the latest hospital stay.� The hardest thing to do is stay calm and cooperative when you feel great, but your doctor will not let you go home.� This was my case.� With the exception of some back pain, I was ready to go.� By the way, I got some Demurral for the first time and it was great when I got it, but it was miserable the next day.� I was told later that they should have given me some anti-nausea medicine at the same time and first thing the next day.� Anyway, my stats slowly improved and eventually I was released to go home.
A Little More IV Info
A quick word about peripheral IV�s.� I said before to be aware of the gauge they use and the gauge that is needed.� Last time I was in the hospital, I was told that I would get blood just before they changed the IV.� I caught them putting back in the 22-gauge set and stopped them.� If they had continued, they would have had to remove it a put a bigger gauge in for the blood transfusion.� So, I insisted on a Latocaine injection and a bigger gauge IV.� Also, watch the IV site closely and tell the nurse immediately if the site is red or the IV medicine is painful.� Some types of medicine are uncomfortable, but not many.� It is important to get an infected IV our early to prevent a permanent clot or other injury.
As my luck continues to get better, but still not good, I found out that a urine test they performed while I was in the hospital showed positive for the BK virus.� I don�t know what �BK� stands for, but I understand that it is fairly rare and can be very damaging to the kidney if that is where it is originating.� With my Creatinine not getting any better, they decided to do another biopsy on my kidney to confirm if the virus is there and perhaps to see if I still had some rejection going on.� They didn�t seem to think it was too urgent as the biopsy was scheduled around when the pathologist that my nephrologist likes got back from vacation.� This was in a weird way comforting because the virus could not have been too threatening or they would have arranged to get the biopsy done immediately.� I insisted on my favorite radiologist to do the procedure and as sometimes things work out, he was not on duty that day.� So, I insisted that I not have the radiologist that had performed procedures in the past with discomfort or poor results.� I also insisted that they use a butterfly needle to take blood and administer IV medicine for pain.� I was running out of good veins and it seems like every time I have a plastic IV used, there are negative consequences.� On the other hand, I had 8 successive IV treatments using a butterfly needle with no problems.� The only down side is you cannot keep a butterfly needle in over night.� That was ok because the biopsy is a 4-6 hour procedure between taking the sample and sitting with a sand bag on the site to make sure the site properly clotted.
The biopsy went great.� There must be a correlation between the number of samples they take and the amount of bruising and knotting.� The first time they took 4 (of course this time I was on Coumadin), second time 3 and this time 2 and this time you could barely tell they did anything.� The results came back the next day with good and bad news.� There were no signs of any virus, but I was still showing �mild rejection.�� My nephrologist�s associate immediately increased my Prednisone 5x to 40mg to try to curb the rejection and to tide me over until we could get a game plan with my regular nephrologist.� My Creatinine came down from 2.5 to 2.2, which was encouraging, but still had bad implications long term.� Although, surgeons usually turn the case over to the nephrologist after 3 months, I have kept my surgeon in the loop given all of my problems.� He has done a tremendous amount of research and is extremely experienced in most situations that can arise.� Besides, a second or consulting opinion is not a bad idea.
My Hindsight is Still Good
My surgeon did not have my data for the past few months so he requested (since I like to do these types of things) that I create a graph showing my Creatinine, Prograf dose and Prograf level to see the trend over time.� This is what I produced for him:
Hindsight is always much clearer than foresight, but you can see the trend after I dealt with Cryptosporidium that led to my rejection that was continuing at this point.� The low dose of Prograf to help my immune system deal with the parasite had the adverse effect of allowing my immune system to attack the kidney.� It is obviously a fine line to walk for the doctor and patient.� In hindsight, I should have pushed much sooner to increase the Prograf at the risk of inviting the Cryptosporidium back.� Other than that, it is hard to see any clear trends or cause and effect in this graph.� The main reasons for continuing to treat the rejection are the biopsies and the constantly elevated Creatinine.
Change of Game Plan �C??�
The doctors discussed my case and decided that a change of immunosupression was in order at this point.� They wanted to change from Prograf to Rapamune.� The theory is that Rapamune is processed in the liver, excreted in the bowels, and is not as toxic to the kidney.� If the kidney toxicity is reduced, maybe it will survive and function better long term.� The remainder of the side effects are the same with a couple added.� It tends to reduce the platelet count that helps blood to clot and it inhibits healing.� These are the two main reasons my nephrologist was hesitant to start me on this drug before now.� There is also the unknown of a relatively new drug (developed for 20 years, but only FDA approved in 1999) and what effects it may have down the road.
The transition involves a �loading dose� of Rapamune, which simply means they gave me a high dose for 3 days while still taking Prograf.� This is a little scary because combined with the high dose of Prednisone; my immune system will be hit pretty hard.� Another noteworthy point is that this is not the typical regime for Rapamune.� Typically, Rapamune is combined with Prednisone and Prograf or Cyclosporine.� Again, the reason my regime is atypical is to get away from the kidney toxicity.� I should also note that despite the rejection and the reduced kidney function, I felt great.� I was afraid to change anything for fear that I would start feeling bad, but I understood and agreed with the reasoning.
If Your Doctor Doesn�t Know�
Question:� What do you do when your doctor freely admits they don�t know much about the drug they have prescribed for you?� I suspected it, but was very concerned when my doctor admitted that she does not know much about Rapamune.� I asked several questions about symptoms I was having (they were minor, but I wanted to make sure none of them were red flags) and she either couldn�t answer them or she speculated.� With my regular doctor out having bypass surgery I had a decision to make.� Do I go and find someone who knows more about the drug or do I just wait for my regular doctor to come back.� To complicate things, I suspected that my regular doctor didn�t know much about the drug either.� I chose to wait for my regular doctor.� I would just have to see if it was a good idea.
There are Usually Other Options
Question:� What do you do if you find out that a test that you have had several times has an alternative that is less damaging to your kidneys?� I complained of headaches after I was switched to Rapamune.� My doctor scheduled an MRI of my head to see if there were any problems.� This is prudent because people on immunosupression are more susceptible to cancer and I was definitely in favor of discovering any problems early.� I was concerned because of the damage that had been done to my kidney during the rejection and asked if the IV contrast they use is toxic to the kidney like the contrast used in a CT scan.� She said �no.�� Then I asked if a CT scan was better to see organs than an MRI.� Again, she said �no.�� Then I asked the obvious question �if a CT scan is no better and the contrast does more damage to the kidney, why use it?�� The answer is that it is cheaper and/or some doctors are just used to using this test.� Obviously if the need arose again, I would insist on the MRI.
Go With the Obvious
Question:� What do you do when you find out from a credible source that after a change of the transplant coordinators and surgeon that there has been a noticeable increase in the number of rejections at the clinic?� Remember when I said how important the surgeon and transplant coordinator are to the success of your transplant?� This is certainly confirmation of this assertion.� I don�t know if the coordinator did or didn�t do something or my nephrologist did or didn�t do something or if I just have a body that is ripe for these issues, but I added to their rejection statistics.
I Might be the Exception
I keep on telling you about all these seemingly tragic situations that just seem like they would discourage anyone from getting a transplant.� I will tell you that to a certain extent I may be the exception.� There are several people that I have talked to who that have had a very easy time after their kidney transplant.� Everyone that has had a kidney/pancreas seems to have a rough time the first year.� From that perspective, I lean towards the norm.� At this point I was feeling great with the exception that my stamina was not up to par, so I was thrilled.� Even transplant patients that have a hard time during their first year seem to say how great they are doing after that time.� This always provides me encouragement.� Even at the risk of finding someone who was emotionally damaged by the event, I try to talk to everyone I can and compare notes.
Magnesium Works Miracles for Me
A word about magnesium for you sufferers of diabetic retinopathy.� About ten years before my transplant, I started having symptoms of this complication that presented itself as black �floaters� in my field of vision.� I was told this is because the walls of the capillaries in my eyes were weak and they were leaking blood into my eyeballs.� The treatment for this is photocoagulation, which is using a laser to �seal� the breaks in the capillaries.� I had probably 300 or so pulses/treatments.� I call a treatment every time the laser goes off.� I probably sat in the chair for the treatments around 20 times.� Then I read something about taking high doses of magnesium to curtail the need for treatment.� Apparently, magnesium strengthens the vein walls making it harder for them to leak.� I started doing this about 4 years ago and I have only had 1 sitting since then.� I also notice when I have floaters if I am more diligent about taking the magnesium, they seem to go away, and I get a clean checkup from the eye doctor.� This may be coincidence and you certainly need to consult with your doctor before taking this vitamin, but it seems to work for me.�
For you kidney transplant patients, keeping your magnesium levels up are especially challenging, as I understand most kidney recipients have to take high doses of magnesium to obtain normal levels and increased doses of magnesium tends to cause diarrhea.� It has been a balancing act, but I am still diligent about taking as much as I can of this vitamin because I really believe it has played a part in preserving my sight.
Felt Good, but Stats Looked Bad
Even though I was feeling great, my blood stats were not reflecting a healthy trend.� My Creatinine kept rising and falling with a rising trend.� No one seemed very concerned when I was in the low 2�s.� The change from Prograf to Rapamune occurred when I hit the mid 2�s in the hope that the lower toxicity of the Rapamune would improve my Creatinine readings.� It did not help.� My Creatinine over the next month or so eased into the high 2�s.� About this time, my nephrologist was back from bypass surgery and he was very concerned about the trend.� He did some research and some studies showed promise using Neoral (Cyclosporine) along with Rapamune to reduce Creatinine levels.� The theory was that with my �minor� rejection still occurring, increased immunosupression might knock out that last bit of rejection and return some function to my kidney.� The down side is that Neoral is toxic to the kidneys so I was somewhat back where I started.� Like Prograf, Neoral tends to raise Creatinine levels.� The hope was that the rise in Creatinine would be offset by arresting the rejection and might even cause it to fall if the kidney was allowed to repair itself.� The hope of getting anywhere near the levels I had immediately after the transplant were unrealistic.
I know I have not given you very many time references, but this is a good time to give you one.� At this point it had been 1 year since my transplant.� For most, this is a time for celebration and as I understand it, most people have good reason to celebrate because the doctors can start thinking about reducing medications and most have been free from post-transplant complications for many months.� Unfortunately, I did not fit that category.� I was sweating this �last ditch� therapy to try and curb my rejection.� I saw the look of defeat in the eyes of my nephrologist and I gleaned from our conversation that if this did not work, at best case, I would be back on dialysis in a year.� I talked to several people that were on their 2nd or 3rd transplant and at the time, I could not conceive that I would be one of these people.� My celebration would either come when this therapy is successful or 1 year after my next transplant.
Confirming the Bad News
My nephrologist�s statement was confirmed by a 24 hour Creatinine clearance test.� The result was 25.1, which meant that I had roughly 25% of my kidney function left.� Once again I contacted my surgeon to get his opinion about how to proceed and to confirm my kidney�s fate.� If the conclusion was that I would be on dialysis soon, I had a decision to make.� I could either choose to be on dialysis the rest of my life while still having to take immunosuppressive drugs to preserve my pancreas, or have another transplant.� Given the past year, I was leaning towards eternal dialysis.
Don�t Cheat!
A word about cheating on tests.� It dawned on me that I had �cheated� on my 24 hour Creatinine clearance test.� I forgot to take the receptacle to work, so I just added that time to my time at home and fill the container accordingly.� I asked one of the transplant coordinators if that mattered.� They said, �Of course it does!�� So, we retook the test.� The results were a little better.� It indicated that I had roughly 1/3 of my function left, which, if stabilized, could sustain me indefinitely.� Now we had a whole new ballgame.� Of course, my nephrologist dampened my excitement when he said that these tests are not too accurate.� This, coupled with my Creatinine creeping into the 3�s, still made me wary of my future.
I found out after getting a Creatinine reading of 3.1, that my Neoral level was way too high.� They wanted to see it in the 180-200 range and it was 268, so that gave me some hope, because this is a level toxic to the kidney, that reducing the level would reduce the Creatinine.� Unfortunately this did not hold true.� My Creatinine went up to 3.6 on my next test.� After this, we found out that my Rapamune level was too high also.� They wanted it to stay in the 8-10 range and it was 15.6.� I was very frustrated because the doctor knows (or should have known) that putting me on Verapamil for my blood pressure enhances the effect of these two drugs and no adjustment was made for this.� Again, this stresses the need for the patient to know these types of things and press the doctor and transplant coordinator for information and to take action.� It also highlighted the fact that the transplant clinic was not operating as efficiently or effectively as once before.� In my current coordinator�s defense, management should not have put her in a position coming from a dialysis unit with very little training in the transplant clinic of being on her own.� In hindsight, I should have been more insistent that someone with more experience be assigned to me.
Make Sure Your Doctor Knows Your Case
A small adjustment was made by a new nephrologist to the practice.� I felt strongly that she was just trying to be conservative and not put the senior doctor�s patient in jeopardy.� So, I took matters into my own hands and increased the reduction.� I CANNOT RECOMMEND THIS TYPE OF ACTION FOR YOU.� This was a personal choice and could have been a dangerous one.� However, I felt like my kidney had been thru too much trauma lately and I needed to get my levels down to the recommended range as soon as possible.� I also shortened the time until my next blood test, so, if I had made a bad decision and the level was too low, I could increase it and not jeopardize another rejection episode.� As it turns out, it was still too high.� I immediately called the senior doctor and told him I wanted an additional decrease.� The next test was on the high side of the range and I was happy with that.� As you can imagine, I received quite a lecture from my doctor saying that I was �lucky� and not to do that again.� I told him I would not if he made a commitment to be more aggressive in my treatment.� He agreed.
The Situation Will Change Periodically
We also discussed that his practice was going to a �team� approach and that was what I was trying to get away from when I chose him.� I wanted a one-to-one relationship with my nephrologist, not a team-to-one.� We also discussed that I felt the transplant clinic (that I told everyone was so great) had degraded in its decisions and attention to patients to the point that I wanted to leave it and these two factors might mean that I would have to leave him.� He agreed to see me personally out of his office and arrange for me to get blood drawn from a draw station close to my home.� If you don�t know, a draw station is a local office for one of the big labs that is usually close to a medical area.� There happened to be one on my way to work which was fine with me as long as the lab technicians (phlebotomists as they are called) were good.� I was finding that it was very hard to get in to see the best nephrologists, so this arrangement on an interim basis was fine with me.� I know in life things have to change.� Some change for the better and some for the worse, but I was very sad to have to leave the transplant clinic and the great arrangement with my nephrologist and lab technician.� I was also very scared about what I would do if I had to have another transplant because I definitely would not use the new surgeon or his transplant clinic again.
As I hoped, my Creatinine went down eventually to 2.8.� I was very depressed because this seemed to be about as good as it was going to get.� I happened to talk to my former transplant coordinator and she gave me some great news.� Apparently she had patients that varied between 2.2 and 2.9 and still had their kidney after 10 years.� Wow!� This was great news.� Now, I didn�t get too excited because I was going between 2.8 and 3.6, but the kidney is a very slow healing organ and I needed to give it time to heal after all the medical assaults it had endured over the past year.� It is amazing what one short conversation can do for your outlook on life.� I guess if you want to take away something from my learning experience on the subject is to stay positive even in the face of bad news.� Do some research and if the news is really bad, focus your energy on how to deal with it, not how bad it is.� I don�t want to sound like Dr. Phil, but that is what I took from the ordeal.
The Next Issue
I noticed a huge blister on the outside of my right leg above the ankle.� When you take steroids, especially in the doses that I took them when I was rejecting the kidney, you get used to what is called steroid induced acne.� I was vigilant about washing and using Bactriban cream to keep the little critters at bay and I did a great job of it on my face.� However, the rest of my body had little acne blisters that I was constantly medicating.� This big one I decided to lance and drain.� Yes, I know, I should have had a doctor do it.� The odd thing was that more cropped up around it.� Again (against my better judgment) I lanced and drained these as well, but they just kept coming.� So I finally had my nephrologist look at it on my next visit.� Of course, this is not his specialty and he simply said watch it and if it doesn�t get better, to go see the infectious disease doctor.
It didn�t get better, so I went to the id doctor.� He couldn�t identify it for sure, but he thought it was a viral infection probably in the herpes family.� He put me on a drug called Acyclovir which is an oral medication.� I know your next question is, �is this toxic to the kidney?�� You guessed it, of course it is!� So, he had me take a reduced dose and test my Creatinine a few days after I started it.� You ask, �Did it make your Creatinine go up?�� Of course it did!� I was thinking I must be a magnet for drugs that strain my kidney.� Well, to make a long story short, the blisters cleared up (and actually a lot of what I thought was steroid induced) and I stopped taking the drug quickly (upon the advice of my doctor, of course) and hoped that my Creatinine would come down quickly as well.
My Creatinine came down slightly and seemed to stabilize.� I was not happy that it stayed in the very high 2�s, but I was happy that it seemed to stop going up.� Even though I made arrangements with my nephrologist to see me individually and away from the transplant clinic, I wanted to cover my bets and start looking for a backup in case this didn�t work out.� My surprise was how difficult it was to see the better nephrologists in town.� Even with recommendations from my surgeon and another general practitioner, I was not able to get in to see another doctor.� I found out very quickly how spoiled I was at the transplant clinic.� My original transplant coordinator set such a high expectation of quality of care that no one was able to match it.� Consequently, even though the subsequent transplant coordinator that did my follow up was not nearly as good, in some ways, she was still better than the private practice nurse that I was now seeing.� I think it is partly due to people focusing their energy on those that need them most.� Now that I was somewhat stabilized, I was a lower priority.
Don�t Forget Insurance
About this time I was asked by my disability insurance company to give them a written update on how I was doing.� I presume this was an attempt to see if they could wean me off of insurance.� My nephrologist had to fill out the paperwork and it was shocking to see all the ailments that I had put in one place.� I knew all these things were going on with my body, but I guess I had become somewhat numb to dealing with them.� In fact, I could probably have dealt with them better if I didn�t have constant reminders that something was wrong.� Blood tests, exams, other tests and now an insurance questionnaire.� At least in the normal course of daily life, I only focused on whatever was at the top of the list of ailments and tended to put the others in the back of my mind.� But there is was in black and white, a stunning compilation of things that were still wrong.� I had to quickly catch my breath and think of how much worse things could have been if I was still on dialysis and taking insulin.� It just goes to show you that everything is relative and most gifts come with a price.
I Finally Got a Common Illness�
I was really amazed that up to this point I contracted odd, even bizarre illnesses, but nothing common.� Sure I had the occasional sneeze, cough or runny nose probably associated with allergies, but no common cold or flu.� What made this even more puzzling was that I was around a LOT of sick people.� When I was sitting in the lab waiting area, at the hospital, at work and at home I was exposed to plenty of opportunities to get something that would test my common immune response.
I finally got the chance to �test my mettle� and contracted some kind of virus.� I don�t know were I picked it up and don�t really care.� Even though I took the flu shot (as all transplant recipients should with their doctor�s advice), I still got the bug.� At first it was no big deal.� It started as a sore throat and cough that I treated with over-the-counter cough medicine.� Then I started with a little fever.� I was nothing to get excited about at around 99.5 degrees.� Then I felt some nausea.� This caused me to eat and drink less.� I am sure you know the cycle.� Let me just say that even more important than people who don�t have a transplant (and it is important for them too), force feed yourself liquids at all times!� I have said this several times before, but it is even more important when your body is resisting liquids.� The doctors tell me that water or Sprite is ok, but the best liquid you can give yourself is Pedialyte.� I started doing this too late.
As my nausea increased so did my fever and my fluid intake decreased.� Between my fever sweats and my incessant urination, I became dehydrated.� My doctor says to always call him if my fever gets above 100.5 and it certainly was at this point.� He wanted me to go to the emergency room immediately.� After resisting a little in my weakened state, I finally agreed.� Good thing, because it took me almost an hour to get around and muster up the strength to get in the car.� I remembered the weak feeling because it was exactly the same as just after I got home from the hospital the first time and had to go back due to severe dehydration.� Dehydration is hard on your kidneys and with all the trauma mine had been thru, I didn�t want a common virus to be the thing that caused me to loose it.
When we arrived, I was up to 102.9 degrees and could hardly lift my head.� My wife had to get a little aggressive and make them understand that even though the ER was full, I was a transplant patient with a high fever and they finally understood that was a priority so I was rushed in right away.� Another word you need to memorize is �immunocompromized.�� This simply means you have a weak immune system and shouldn�t be around sick people � it is a one way ticket to the head of the line.� After a quick pre-admission work-up, they put me in a private room and gave me IV fluids.� I started feeling better right away just like the time before.� You should also know that immunocompromized gets you a one way ticket to a private room and there is not a whole lot your insurance company can say about it!
To make a long story short, I was in the hospital for 2 days, my temperature peaked at 104.2 and I was given an anti-viral medication and IV antibiotics because they never definitively found out what it was.� The point I want to make with all this is to take every illness very seriously.� Don�t be �macho� (even if you are a female) and think you can wait it out as you did before transplant.� Seek medical help when that temperature gets up there and reduce the possibility it will damage the organ you worked so hard to get and keep.� I would rather �cry wolf� a couple of times than loose my organs.� I think the doctors respect you much more for letting them know early on than coming into the ER on your death bed.
Some Positive Words from a Real Skeptic
What a blessing this whole transplant process is (never thought you would hear me say that did you?).� I don�t have to take insulin by shot or pump and I don�t have to do any type of dialysis.� Yes, the process was rough and I will be immunosupressed the rest of my transplanted life.� Yes, managing the medicine cabinet will consume more brain power than most people have to endure.� Yes, I will get sick more than most people and will probably see the inside of hospitals more than anyone would like.� Yes, I was dealt a life card that I have to handle, but I am alive. �I am with my family and hopefully I will get to see my daughter grow up and be an influence on her life along with my wonderful wife.� Life is tough, but who said it was suppose to be easy?
A natural reaction to this recollection of my transplant experience is to be very scared.� To be honest, even if I painted a rosy picture of the process you would be scared.� After all, no matter how you describe the event, it is major surgery!� I think the value in reading my experience is that I had so much go on for so long that you will probably be able to pick up pieces of my experience and have a little insight as to what I did that may help you with how you handle it.� In the same breath, I must say that as much as I dealt with, you will probably have different experiences worthy of writing your own recollection.� Have a healthy amount of fear and caution, but make your own decisions based on your own life and your own goals for your health.�
A lot of great things came out of my experience.� I have a better understanding of how to use the health care system to better my quality of life.� My relationship with my wife and child are stronger and I appreciate them more than I ever thought I could.� I was truly enlightened to see the breadth and depth of friends our family has.� I also found a new and renewed relationship with God who helped me through many dark, lonely nights when I thought I couldn�t take any more.� So, even though this sounds like a nightmare, I look back the same way I would any other life-changing event such as going to college, getting a job, getting married, having a child, etc.
Some Final Words
As you can gather from this account, getting a transplant is a complicated, emotional, trying, and life-changing event.� The result is truly a miracle of modern medicine.� Those of you who ask a lot of questions and go into it with your eyes wide open will find many fewer surprises that those who do not.� Do your research, make life plans, find support from health providers, family, and friends, and make this experience your own � in control.
This recollection is not meant to be a manual for the transplant recipient.� That would take volumes.� I hope you got a flavor for the process thru my eyes and I sincerely hope your experience is void of surprises and full of positive events that make your life better.
Date: 9/4/02���������������� Creatinine: 1.5������������� Blood Prograf:� 15.7��� Prograf Dose: 3.5 mg
Date: 9/4/02���������������� Creatinine: 1.5������������� Blood Prograf:� 15.7��� Prograf Dose: 3.5 mg
Date: 9/6/02���������������� Creatinine: 1.7������������� Blood Prograf:� 35.6��� Prograf Dose: 2.5 mg
Date: 9/7/02���������������� Creatinine: 1.8������������� Blood Prograf:� 15.8��� Prograf Dose: 2.5 mg
Date: 9/9/02���������������� Creatinine: 1.7������������� Blood Prograf:� 12.7��� Prograf Dose: 3.0 mg
Date: 9/16/02�������������� Creatinine: 1.4������������� Blood Prograf:� 15.7��� Prograf Dose: 3.5 mg
Date: 9/20/02�������������� Creatinine: 1.7������������� Blood Prograf:� 20.8��� Prograf Dose: 2.0 mg
Date: 9/23/02�������������� Creatinine: 1.6������������� Blood Prograf:� 18.3��� Prograf Dose: 1.5 mg
Date: 9/25/02�������������� Creatinine: 1.5������������� Blood Prograf:� 16.5��� Prograf Dose: 1.5 mg
Date: 9/27/02�������������� Creatinine: 1.7������������� Blood Prograf:� 15.7��� Prograf Dose: 1.5 mg
Date: 9/30/02�������������� Creatinine: 1.5������������� Blood Prograf:� 14.7��� Prograf Dose: 1.5 mg
Date: 10/2/02�������������� Creatinine: 1.5������������� Blood Prograf:� 8.4����� Prograf Dose: 2.0 mg
Date: 10/4/02�������������� Creatinine: 1.5������������� Blood Prograf:� 10.2��� Prograf Dose: 2.0 mg
Date: 10/7/02�������������� Creatinine: 1.3������������� Blood Prograf:� 8.4����� Prograf Dose: 2.5 mg
Date: 10/9/02�������������� Creatinine: 1.3������������� Blood Prograf:� 9.3����� Prograf Dose: 3.0 mg
Date: 10/11/02������������ Creatinine: 1.4������������� Blood Prograf:� 23.1��� Prograf Dose: 3.0 mg
Date: 10/14/02������������ Creatinine: 1.3������������� Blood Prograf:� 21.9��� Prograf Dose: 3.0 mg
Laboratory Results
I found that one of the more important pieces of knowledge I picked up through my many years of health issues was understanding lab results.� As I have said several times, I am not a doctor and I do not understand lab tests and results a fraction as well as a doctor, but doctors look at a LOT of these numbers every day and your understanding even on a superficial level of your test results can help your doctor.
Lab results are yours and your doctor�s barometer of how well you are doing and what course of action should be taken if you are not doing so well.� Single tests are important, but multiple tests at the same time and multiple tests over time tell an important story.� You should always insist that you receive a copy of your test results.� You are entitled to these results and with so many numbers, it is impossible to remember all of them.� I keep a file and review my test results periodically to help spot trends and ask questions when I have the opportunity.
Below are some selected definitions of lab results and an attempt at explanations of their importance.� You should definitely learn about tests that pertain to your particular situation because, as I have said before, health professionals are human and they will make mistakes.� If you are educated about your condition and lab results, you might be the one to catch the mistake and save yourself some inconvenience or even a dangerous situation.
Creatinine Level:
If you or someone you know is on a waiting list to receive an organ, you probably know that it is a long and troublesome wait.� It is longer and more troublesome for some than others.� My wait was fairly short and although the dialysis was not comfortable or convenient, I have talked to many recipients that had a much rougher road.� Every day, according to my latest information, 17 people die waiting for an organ.� Can you imagine being in a hospital bed, feeling terrible (if you are even conscious) and knowing that your life is in the hands of the laws of probability?
You can help these people!� The first thing you can do is to become an organ donor.� Believe it or not, I am an organ donor.� Yes, even transplant recipients can donate their organs.� The only organ they will definitely not take is the transplanted one.� Think about it.� The person who receives my organs will be on the same medication that I am on.� It makes perfect sense.� Did you know that you can donate even if you are HIV positive?� In this case, the recipient will have to be HIV positive as well.� The point I am trying to make is that ANYONE can be an organ donor.� Whether upon your death they will be able to use your organs is a different story, but EVERYONE can offer to donate them.
I understand that every state is a little different, but the process for donation is very simple.� LET EVERYONE AROUND YOU KNOW THAT YOU WANT TO DONATE YOUR ORGANS.� The most important people to let your wishes known are those that might be in a position upon your death to talk to the doctor about this subject.� Donor cards and driver�s licenses are irrelevant (at least in Texas).� A family member can override these documents and prevent your organs from being donated.� You can also legally designate someone to make health decisions on your behalf in the event you are unable to do so.� In this case, make sure that person knows you want to donate your organs.
Most people don�t think about this subject, but for the 80,000 people on the waiting list (at last count), someone�s lack of consideration about this subject could cost them their life.� Once you have made your decision (either way, although I hope you donate), talk to others and ask if they have made their decision.� Here are some statistics that will show you how important you are in the process of organ donation awareness:
� 2 million people die each year in this country
� only 1% or 20,000 are eligible for organ donation (organs are viable, etc.)
� 5,000 are ruled out for medical reasons (cancer, etc.)
� 3-4,000 are prematurely disconnected from ventilators before the family is even approached about organ donation
� of the remainder, only about 6,000 consent to donation
It�s easy to see why so many people die waiting for organs.� If there are 80,000 on the waiting list, and only 6,000 donate, the problem is far from being solved.� Now, this doesn�t take into account that one donor can affect many lives, but it also doesn�t account for people who go on the list as others are taken off.� You can make a difference!
Separating the Facts from the Myths
If you find a passion for this subject as I have, you will encounter all sorts of myths, questions and objections.� Here are some questions, answers and myths straight from the Southwest Transplant Alliance Volunteer Program.
Who can be a donor?
Anyone, regardless of age, race or gender can become an organ and tissue donor. Medical suitability of organs is determined after the donor�s death.� Organs and tissues that cannot be used for transplants due to advanced age or disease can often be used to help scientists find cures for serious illnesses.
How do I become a donor?
Tell your family.� Consent from next-of-kin is required for donation to occur.
What organs and tissues can be donated?
One donor can benefit many other people.� Organs and tissues that can be transplanted include:� the kidneys, corneas, heart, lungs, liver, pancreas, heart valves, bone, skin and other tissues.
Is there a conflict between using my organs/tissues and saving my life?
No.� Donation is not considered until all possible efforts to save a patient�s life have failed and death has been declared.� The transplant team has no involvement in the patient�s care prior to death and is notified only after death.
Is there any cost or payment for donation?
No.� Donor families are never charged and will not receive any payment or compensation for the donation.� The organ procurement agency picks up all the costs associated with the donation and those costs are passed on to the recipient and his or her insurance agency. �If there are costs that went unpaid at the end of the year, Medicare zeros out the procurement agency.
How are organ/tissue recipients selected?
The National Transplant Act of 1984 established full and equal access to donated organs and tissues for all potential recipients.� A national computer system matches gifts to receivers on the basis of need and availability.
Do religious groups support organ and tissue donation?
Yes.� Religious leaders the world over favor organ and tissue donation as the highest humanitarian ideal.� If you have questions concerning your religion�s position regarding organ and tissue donation, consult your religious leader.
Does donation affect funeral and burial arrangements?
No.� A traditional, open casket funeral is still possible.� Although there is no cost to the family for donating organs or tissues, the estate is still responsible for all costs associated with the funeral and burial.
Don�t only the rich, famous and well-connected get organs?
Anyone can become an organ or tissue recipient.� Almost 20,000 receive organ transplants each year.� People with no connections at all get transplants every day when other people choose to donate.
How does organ allocation work?
All allocation issues boil down to not having enough organs.� The key is to get more organs donated so that we won�t ever have to make decisions affecting who lives and dies.
The 60 Minutes question� Are donors really dead?
Yes.� Donation does not take place until all life-saving efforts have failed and death has been pronounced by physicians having nothing to do with the transplant process.
Hospital bill questions?
Sometimes, due to hospital billing procedures, donor families will get bills that include some charges relating to the donation.� Procurement agencies tell their donor families not to pay those bills until the agencies have had a chance to review them and pay their charges.� Then the agencies have the hospitals re-bill the families for any charges that were not relate to the donation.
Why does my family have the final say?� What about me?
Although there are laws in place that allow procurement agencies to recover organs and tissues without family consent, in practice, this is not done.� This is because the family lives on and must be at peace with the situation.� This respect for the families involved helps maintain public trust in the donation system.� Tell your family you want to donate.
Can transplant recipients be donors?
Yes.� The drugs that they take will be the same drugs that their recipients would take.� It all depends on the viability of their organs at the time of their death, just as with other donors.� The only medical rule outs for donation are metastatic cancer.
What about the kidney rumor?
There is not a licensed medical professional that would transplant a kidney that does not come complete with medical/social history and detailed identification through a federally-designated organ procurement agency.
�The doctor will let my loved one die in order to get the organs.�
False.� You need not be concerned about the issue of saving your life versus recovering your organs.� In order for organs to be recovered, the patient must be declared dead.� Brain death is pronounced only after several tests have been performed and repeated with the same results.� After brain death, respiratory and circulatory functions would cease immediately without mechanical support.
�I can�t have a normal funeral if I am an organ donor.�
False.� Organ and tissue donation will not interfere with normal funeral arrangements.� An open casket service can be held unless the donor was severely injured in a head-on collision, for example.
�I can�t get into heaven unless I�m whole.� My religion doesn�t allow donation.�
False.� There are no major religions opposed to organ and tissue donation or transplantation.� In fact, may religions believe a person�s soul passes into a new life, so the body is only matter and will �return to ashes.�
�Organ donation is expensive.� We can�t afford it.�
False.� The donor family will not have to pay for any charges related to the recovery.� All costs involved in organ and tissue recovery are assumed by the organ and tissue recovery agency.
�My family can receive payment for donation.�
False.� Transplantation ethics and laws do not allow for the sale of human organs.
�I am too old to become an organ donor.�
False.� As the national waiting list of an organ transplant has grown through the years, limits on donor age have been relaxed.� Because people are taking better care of themselves, organs are often transplantable for more years than they have been in the past.� While hearts still have pretty stringent age limits, other organs may be able to be used for transplant well past the age of 60.
�As long as I sign and carry my donor card, I will be a donor.�
Not necessarily true.� Upon declaration of brain death, medical professionals will search for the next of kin to consent for donation.� Key to having your wishes to become a donor honored is to make your decision known to your family.
Parts as Gifts
When you think about it, the ability to give the gift of life is an amazing thing.� Some people say, �Isn�t that playing God?�� I don�t see organ donation as any different that any other medical intervention.� We replace bones with stainless steel, use antibiotics to supplement the body�s immune system, use radiation to destroy tumor cells when the body can�t and the list goes on for miles.� Take a look at the gifts you can give to someone:
Here are some facts about how these organs are put to use:
|
Organ/Tissue |
Function |
Application |
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Bone |
Structural support of the body, protects vital organs such as kidneys and liver |
Facial reconstruction, limb salvage, correction of birth defects, cancer treatments, spinal and oral surgery |
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Bone Marrow |
Soft bone tissue concerned with production of blood cells and hemoglobin |
Life saving treatment for patients with immune deficiencies |
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Cartilage |
Connective tissue that serves as structural support in some areas |
Facial and other reconstructive surgery |
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Eyes/Corneas |
Allow light to enter the eye |
Restore vision to the blind |
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Fascia |
Fibrous membrane which covers, supports and separates the muscle |
Restores support, limb and soft tissue repair |
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Heart |
Pumps blood to the body |
Life saving replacement for patients whose hearts no longer work |
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Kidneys |
Extract wastes and excess water from the blood, produces hormones that help regulate blood pressure |
Life enhancing/life saving replacement for the patient with kidney failure |
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Liver |
Instrumental in energy regulation, breaking down proteins, removes waste from the blood |
Life saving replacement of non-functional livers |
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Lungs |
Organs of respiration |
Life saving lung replacement for patients with cystic fibrosis, emphysema or other end-stage lung disease |
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Pancreas |
Secretes enzymes necessary for digestion; secretes insulin that regulates blood sugar |
Life enhancing/life saving replacement of diseased pancreas; in diabetics, eliminates need for insulin injections |
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Skin |
The body�s first barrier against dehydration, injury, infection and loss of body heat |
Life saving for burn victims, decreases pain, infection, heat loss, fluid loss and infection |
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Small Intestine |
The upper end of the digestive tract from the stomach to the ileum, provides for absorption of the products of digestion |
Life saving for patients suffering from short bowel syndrome, restores the nutritional balance of the body |
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Tendons |
Attaches muscle to bone, allows for joint movement while keeping the joint together |
Utilized to restore mobility in patients who have damaged tendons or joint injuries |
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Veins |
Blood vessels which carry blood toward the heart |
Utilized in vascular reconstruction to restore blood flow to various parts of the body |
What a way to add meaning to your life!� You could save some child�s mommy or daddy, a wife or husband�s spouse or there have been cases where the donor has directly affected their own family by their gift.� There are other ways to give as well.
Whole Body Donation
Because most people will not die in a way that they will be eligible for organ donation, another way you can affect people�s lives is to donate your entire body.� This is something you must do in advance of your death.� You can contact your local medical school and if they need bodies for research or teaching at the time of your death, they will often pick up the body and cremate it at no cost to the family.� Then if the family would like the ashes, they will often provide them at a fraction of the cost of a traditional cremation.� Total body donation does not exclude you from organ donation.� If your organs are viable, you can do both.� But remember, for the organ donation part of this; make your wishes known to your significant others.
Living Donation
A tremendous way to reduce the burden on the organ procurement system is to be a living donor.� It is fairly widely know that you can donate one of your kidneys while you are living.� Did you know that now you can donate part of your liver?� People are donating the small lobe of their liver to a child in need with amazing success.� Your liver actually regenerates itself (unlike the kidney) to make up for the loss.� Less successful is the donation of the large lobe, but it is being done as well.
You frequently hear of a family member donating their kidney to a loved one so they don�t have to go thru the agony of waiting on �the list.�� Have you heard the increasing trend of complete strangers donating their kidney?� There are many stories like a family member who�s kidney is not a match for their loved one and they decide to donate their kidney anyway to help get others off the list.� I hear increasingly about complete strangers who hear a heartfelt story of someone in need and deciding to make this precious gift because they are so thankful that they are healthy and they want to give this gift to someone else.
Donation of Your Time and/or Money
When I heard the statistic mentioned above I was shocked at how few people qualify to be organ donors upon their death.� My first thought was that the chance of me making a difference with so few possibilities for donation was miniscule.� Then I came to the realization that even if I helped for an entire year and only caused one eligible person to donate and it only saved one life (although you can see from the diagram that it would help many), it would be more than worth my time, effort and money.� There are many Organ Procurement Organizations (�OPO�) across the country that would be thrilled to have your help and support.� You can contact the Southwest Transplant Alliance at 800-788-8058 and they can help you find your local OPO.
Although your contributions would be greatly appreciated by many organizations, my bias is towards those individuals who cannot afford to have a transplant.� Doctors and hospitals rarely if ever work for free and there are many people who cannot afford to have a transplant and/or do not have insurance or if they have insurance it does not cover transplants.� Although the OPO�s cannot deny a person an organ based on their financial status, as a practical matter, someone who does not have the ability to pay for the surgery will probably not get the transplant.� These surgeries can cost well in excess of $100,000 and very few of us can afford this without insurance.� Even some with insurance cannot afford their deductibles and co-payments.� There are too many organizations that specialize in helping these people to list here.� A great starting place is the National Kidney Foundation at 800-622-9010.� They will, of course, encourage you to give to them, but they can also give you contact information for other organizations that may benefit people needing other organs or where the funds are not spread among different areas, but are targeted to those in need of financial assistance.
One More Time�
Let�s take a look at one more set of statistics to emblazon this need upon your brain.
As of December 31, 2003, these are the statistics for people waiting for organs nationally:
� Kidneys� ������������������������������������������� 56,641
� Liver������������������������������������������������� 17,398��������������������������
� Pancreas��������������������������������������������� 1,526��������������
� Kidney/Pancreas��������������������������������� 2,432
� Heart��������������������������������������������������� 3,557
� Lung���������������������������������������������������� 3,951
� Heart/Lung��������������������������������������������� 190
� Intestine�������������������������������������������������� 175
��������������������������������������������������������������������������������� 83,840
I�m Glad You�re Not Dead � A Liver Transplant Story
By Elizabeth Parr, PhD.
A mostly positive book with the authors blunt opinion about a few things negative she encountered.� A couple of short accounts of other recipients she knows.� Not very technical or instructional.� Great if you are in the mood for a very positive outcome.
Web Sites
Web Sites Related to Transplantation
http://hepatitis-c.de/txlinks.htm
American Liver Foundation
American Society of Transplant Surgeons (ASTS)
Anatomy Gifts Registry
Liver Study Unit of the University of Chicago Hospitals
The Living Bank
Medicine Assistance Program
Medline Plus Health Information (Kidney Diseases)
www.nlm.nih.gov/medlineplus/kidneydiseasesgeneral.html
National Institute of Diabetes and Digestive and Kidney Diseases
www.niddk.nih.govhealth/kidney/kidney.htm
National Kidney Foundation
National Transplant Assistance Fund (NTAF)
Novartis Transplant
www.novartis-transplant.com/home.html
Secretary�s Donation Initiative
Transweb
Transplant Awareness Inc.
Transplant Patient Partnering Program
Transplant Recipients International Organization (TRIO)
Transplantation Society Journal
U.S. Department of Health and Human Services
United Network for Organ Sharing (UNOS)
WebMD
Search Engines
Yahoo
MSN
From WebMD.com
You should not rely solely on these summaries.� Your pharmacist has additional information about these substances written for health professionals that you may read.� Also, your doctor may advise your differently than either of these sources.
Comments have been added to describe how these were used in my case.� This may not necessarily be the same for you.
Pronunciation: a see ta MIH no fen
Brand Names: Anacin-3 Maximum Strength, Childrens Tylenol, Tylenol, Tylenol Caplet, . . . more
What is the most important information I should know about acetaminophen?
Use acetaminophen for up to 3 days for fever or up to 10 days for pain (or up to 5 days to treat a child's pain). If the symptoms do not improve, or if they get worse, stop using acetaminophen and see a doctor.
Avoid alcohol during treatment with acetaminophen. Together, alcohol and acetaminophen can be damaging to the liver.
Be aware of the acetaminophen content of other over-the-counter and prescription products. Care should be taken to avoid taking more than the recommended amount of acetaminophen per dose or per day.
What is acetaminophen?
Acetaminophen is a pain reliever and a fever reducer.
Acetaminophen is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers.
Acetaminophen may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking acetaminophen?
Do not take acetaminophen without first talking to your doctor if you drink more than three alcoholic beverages per day or if you have had alcoholic liver disease. You may not be able to take acetaminophen, or you may require a lower dose or special monitoring.
Before taking acetaminophen, tell your doctor if you have kidney or liver disease. You may not be able to take acetaminophen, or you may require a dosage adjustment or special monitoring during treatment if you have either of these conditions.
Acetaminophen is in the FDA pregnancy category B. This means that it is unlikely to be harmful to an unborn baby. Do not take acetaminophen without first talking to your doctor if you are pregnant.
Acetaminophen passes into breast milk. It appears to be safe for use during breast-feeding but should be avoided if possible. Talk to your doctor before taking acetaminophen if you are breast-feeding a baby.
If you are treating a child, read the package carefully and use a pediatric form of the medication if possible. Talk to a doctor first if the child is younger than 2 years of age.
How should I take acetaminophen?
Take acetaminophen exactly as directed by your doctor or follow the instructions on the package. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each oral dose with a full glass of water.
Acetaminophen can be taken with or without food.
Wash your hands before and after using the rectal suppositories. Run the suppository under cold water or put it in the refrigerator for a few minutes before using it. Remove any wrapping from the suppository and moisten the suppository with cold water. Squat, stand, or lie down with one leg straight and the other bent, in a comfortable position that allows access to the rectal area. Use your finger, or the applicator if one is provided, to deposit the suppository as far as it will comfortably go into the rectum. Insert the narrow end first. Close your legs and lie still for a few minutes. If the applicator will be reused, take it apart and wash it with warm water and mild soap, then dry it completely. Avoid having a bowel movement for at least 1 hour after inserting the suppository.
To ensure that you get a correct dose, measure the liquid forms of acetaminophen with a special dose-measuring spoon or cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one. Shake the liquid well before measuring.
Never take more acetaminophen than is directed. The maximum amounts for adults are 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Taking more acetaminophen could be damaging to the liver. If you drink more than three alcoholic beverages per day, talk to your doctor before taking acetaminophen.
Use acetaminophen for up to 3 days for fever or up to 10 days for pain (or up to 5 days to treat a child's pain). If the symptoms do not improve, or if they get worse, stop using acetaminophen and see a doctor.
If you are treating a child, read the package carefully and use a pediatric form of the medication if possible. Talk to a doctor first if the child is younger than 2 years of age.
Store acetaminophen at room temperature away from heat, moisture, and the reach of children. The rectal suppositories can be stored at room temperature or in the refrigerator.
What happens if I miss a dose?
If you are taking acetaminophen on a regular schedule, take the missed dose as soon as you remember. Wait the prescribed amount of time or as directed in the package labeling before taking another dose. Do not take a double dose.
If you are taking acetaminophen on an as-needed basis, missing a dose is not usually a problem. Take the dose as soon as you remember, and do not take another dose for the amount of time prescribed or as directed in the package labeling.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of an acetaminophen overdose include nausea, vomiting, diarrhea, abdominal pain, sweating, seizures, confusion, and an irregular heartbeat.
What should I avoid while taking acetaminophen?
Avoid alcohol during treatment with acetaminophen. Together, alcohol and acetaminophen can be damaging to the liver.
Be aware of the acetaminophen content of other over-the-counter and prescription products. Care should be taken to avoid taking more than the recommended amount of acetaminophen per dose or per day.
What are the possible side effects of acetaminophen?
If you experience any of the following rare but serious side effects, stop taking acetaminophen and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue);
- blood problems (easy or unusual bleeding or bruising).
Other, less serious side effects are not known to occur.
Side effects other than those listed here may occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect acetaminophen?
Be aware of the acetaminophen content of other over-the-counter and prescription products. Care should be taken to avoid taking more than the recommended amount of acetaminophen per dose or per day.
Acetaminophen may cause false urine glucose test results. Talk to your doctor if you have diabetes and you notice changes in your glucose levels while taking acetaminophen.
Other medications may interact with acetaminophen. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products while taking acetaminophen.
Brand Names:
Anacin-3 Maximum Strength
Childrens Tylenol
Tylenol
Tylenol Caplet
Tylenol Caplet Extra Strength
Tylenol Extended Release
Tylenol Extra Strength
Tylenol Gelcap Extra Strength
Tylenol Suspension
My Experience:� I was told that Tylenol is one of the few over the counter pain relievers that do not have an effect on a transplant patient�s body taken in moderation.� I didn�t use it much because there was typically some prescription drug for any pain I might have.� I did use it when I had a fever and the nurses gave it (usually with Benadryl) as a pre-medication for some drug to avoid or reduce reactions.
Acyclovir (oral)
Pronunciation: ay SYE kloe veer
Brand Name: Zovirax
What is the most important information I should know about acyclovir?
Take all of the acyclovir that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
Treatment with acyclovir should be started as soon as possible after the first appearance of symptoms (e.g. tingling, burning, blisters).
Herpes infections are contagious and you can infect other people, even during treatment. Avoid letting infected areas come into contact with other people. Wash your hands frequently to prevent transmission.
What is acyclovir?
Acyclovir is an antiviral drug. It slows the growth and spread of the herpes virus so that the body can fight off the infection. Acyclovir lessens the symptoms of these infections and shortens the length of time you are sick.
Acyclovir is used to treat infections caused by herpes viruses. Illnesses caused by herpes viruses include genital herpes, cold sores, shingles, and chicken pox.
Acyclovir may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking acyclovir?
Do not take acyclovir without first talking to your doctor if you are allergic to valacyclovir (Valtrex).
Before taking this medication, tell your doctor if you have kidney disease. You may need a dosage adjustment or special monitoring during treatment.
Acyclovir is in the FDA pregnancy category B. This means that acyclovir is not likely to harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.
Acyclovir passes into breast milk and may affect a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
How should I take acyclovir?
Take acyclovir exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Treatment with acyclovir should be started as soon as possible after the first appearance of symptoms (e.g. tingling, burning, blisters).
Take each dose with a full glass of water.
Acyclovir can be taken with or without food. Taking acyclovir with food may decrease stomach upset.
Shake the suspension well before measuring a dose. To ensure that you get a correct dose, measure the suspension with a special dose-measuring spoon or cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
Take all of the acyclovir that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
Lesions caused by herpes viruses should be kept as clean and dry as possible. Wearing loose clothing may help to prevent irritation of the lesions.
Store acyclovir at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take a double dose of this medication unless otherwise directed by your doctor.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of an acyclovir overdose include seizures, hallucinations, and kidney damage (decreased urine production).
What should I avoid while taking acyclovir?
Herpes infections are contagious and you can infect other people, even during treatment. Avoid letting infected areas come into contact with other people. Wash your hands frequently to prevent transmission.
Acyclovir will not prevent the spread of genital herpes. Avoid sexual intercourse or use a latex condom to prevent spreading the virus to others.
What are the possible side effects of acyclovir?
Stop taking acyclovir and seek emergency medical attention or contact your doctor immediately if you experience any of the following serious side effects:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- little or no urine production; or
- unusual bleeding or bruising.
Other, less serious side effects may be more likely to occur. Continue to take acyclovir and talk to your doctor if you experience
- nausea, vomiting, diarrhea, decreased appetite, or abdominal pain;
- a headache or lightheadedness; or
- joint pain.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect acyclovir?
Probenecid (Benemid) may increase the effects of acyclovir and lead to dangerous side effects. You may need a dosage adjustment or special monitoring during treatment if you are taking probenecid.
Drugs other than those listed here may also interact with acyclovir. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
Brand Names:
Zovirax
My Experience:� This drug was used when I had pustules pop up that the infectious disease doctor thought may be akin to the herpes virus.� It had some positive effect, but because it can negatively affect the kidney, I was monitored closely and, in fact, my creatinine went up and we stopped the drug.� The pustules went away eventually, but I cannot say if it was the Acyclovir that did it.
Alina (see Nitazoxanide)
Atorvastatin
Pronunciation: a TORE va sta tin
Brand Name: Lipitor
What is the most important information I should know about atorvastatin?
Do not take atorvastatin without first talking to your doctor if you have liver disease.
Alcohol and atorvastatin can both damage your liver. Discuss with your doctor the amount of alcohol that you drink so that it can be determined if atorvastatin is the best choice for lowering your cholesterol.
Do not take atorvastatin if you are pregnant, if you are planning a pregnancy, or if you are breast-feeding a baby.
Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness, especially if it is accompanied by a fever or flulike symptoms or yellowing of your skin or eyes.
What is atorvastatin?
Atorvastatin blocks the production of cholesterol (a type of fat) in your body.
Atorvastatin is used to reduce the amounts of LDL (bad) cholesterol, total cholesterol, triglycerides (another type of fat), and apolipoprotein B (a protein needed to make cholesterol) in your blood. Atorvastatin is also used to increase the level of HDL (good) cholesterol in your blood. These actions are important in reducing the risk of hardening of the arteries, which can lead to heart attacks, stroke, and peripheral vascular disease.
Atorvastatin may also be used for purposes other than those listed in this medication guide.
Who should not take atorvastatin?
Do not take atorvastatin without first talking to your doctor if you have liver disease.
Before taking atorvastatin, tell your doctor if you
- drink alcoholic beverages,
- have a chronic muscular disease,
- require major surgery, or
- have a blood disorder.
You may not be able to take atorvastatin, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Atorvastatin is in the FDA pregnancy category X. This means that atorvastatin will cause birth defects if it is taken during pregnancy. Cholesterol is very important for the proper development of a baby. Do not take atorvastatin if you are pregnant or are planning a pregnancy.
It is not known whether atorvastatin passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
How should I take atorvastatin?
Take atorvastatin exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Atorvastatin can be taken with or without food.
Atorvastatin is usually taken once a day. Try to take your dose at the same time each day. Follow your doctor's instructions.
Your doctor may want to monitor your liver function with blood tests before starting treatment with atorvastatin, at twelve weeks after both the start of your treatment and any increase in dose, and periodically (every 6 months) thereafter. Depending on the results of these tests, your doctor can determine how much monitoring you will require.
Grapefruit and grapefruit juice may interact with atorvastatin. The interaction could lead to potentially dangerous effects. Discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
Eat a low-fat, low-cholesterol diet. To realize beneficial effects from atorvastatin, avoid fatty, high-cholesterol foods.
Do not stop taking atorvastatin without first talking to your doctor. It may be weeks or months before beneficial effects are seen from this medication.
Store atorvastatin at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
The symptoms of an overdose of atorvastatin are not known.
�
What should I avoid while taking atorvastatin?
Alcohol and atorvastatin can both damage your liver. Discuss with your doctor the amount of alcohol that you drink so that it can be determined if atorvastatin is the best choice for lowering your cholesterol.
Grapefruit and grapefruit juice may interact with atorvastatin. The interaction could lead to potentially dangerous effects. Discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
�
What are the possible side effects of atorvastatin?
If you experience any of the following serious side effects, stop taking atorvastatin and seek emergency medical attention or call your doctor immediately:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- muscle aches, pain, or weakness;
- "flu-like" symptoms;
- decreased urine or rust-colored urine;
- blurred vision; or
- yellowing of your skin or eyes.
Other, less serious side effects may be more likely to occur. Continue to take atorvastatin and talk to your doctor if you experience
- headache;
- upset stomach or flatulence; or
- a rash.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
�
What other drugs will affect atorvastatin?
Do not take atorvastatin without first talking to your doctor if you are taking any of the following medicines:
- cyclosporine (Sandimmune, Neoral);
- gemfibrozil (Lopid);
- niacin (Nicolar, Nicobid, Nicotinex, others);
- clarithromycin (Biaxin);
- erythromycin (E-Mycin, E.E.S., Ery-Tab, Ilotycin, Eryc, PCE, Ilosone, others); or
- fluconazole (Diflucan), itraconazole (Sporanox), or ketoconazole (Nizoral).
The medications listed above interact with atorvastatin and may cause damage your muscles.
Before taking atorvastatin, tell your doctor if you are taking any of the following medicines:
other cholesterol-lowering drugs such as cholestyramine (Questran) or colestipol (Colestid); or
digoxin (Lanoxin, Lanoxicaps).
You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with atorvastatin. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Brand Names:
Lipitor
My Experience:� Lipitor was added because my cholesterol was running around 315.� I took Lipitor before the transplant because my cholesterol was high then also which I am told is typical for a diabetic.� Immediately following the transplant my lipids were fine, but several drugs that I started I am told have the effect of raising cholesterol.� I experienced some muscle weakness which I am told is a side effect of the drug, so when it did not significantly bring my cholesterol down, my doctor added Zetia.� This had a profound effect and brought me down to around 180.� I was kept on Lipitor regardless because I was told that this type of drug has been shown to protect the heart and that outweighed the muscle weakness.
Bactrim (see Sulfamethoxazole)
Bactroban (see Mupirocin)
Benadryl (see Diphenhydramine)
Calcitriol (oral)
Pronunciation: kal si TRYE all
Brand Name: Rocaltrol
What is the most important information I should know about calcitriol?
Do not take antacids or vitamin or mineral supplements except under the supervision of your doctor.
Contact your doctor if you experience weakness, headache, nausea and vomiting, dry mouth, constipation, a metallic taste in your mouth, muscle or bone pain, increased thirst and / or urination, increased nighttime urination, itching, or decreased appetite. These may be signs of too much calcium in your body.
What is calcitriol?
Calcitriol is a synthetic (man-made) form of vitamin D. Vitamin D is important for the absorption of calcium from the stomach and for the functioning of calcium in the body.
Calcitriol is used in the treatment of low levels of calcium in the body of patients on chronic renal dialysis and patients with hypoparathyroidism. Calcitriol is also used to treat secondary hyperparathyroidism and resultant metabolic bone disease in patients with kidney failure who are not yet receiving dialysis.
Calcitriol may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking calcitriol?
You cannot take calcitriol if you have high levels of vitamin D or calcium in your body.
Before taking this medication, tell your doctor if you
- take digoxin (Lanoxin, Lanoxicaps); or
- take magnesium-containing antacids.
You may not be able to take calcitriol, or you may require a dosage adjustment or special monitoring during treatment if you take either of the medications listed above.
Calcitriol is in the FDA pregnancy category C. This means that it is not known whether calcitriol will harm an unborn baby. Do not take calcitriol without first talking to your doctor if you are pregnant.
It is also not known whether calcitriol passes into breast milk. However, it is believed that calcitriol could harm a baby. Do not take calcitriol if you are breast-feeding a baby.
How should I take calcitriol?
Take calcitriol exactly as directed by your doctor. If you do not understand the directions on your prescription bottle, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Swallow the capsules whole. Do not chew or bite them.
To ensure that you get the correct dose, measure the liquid form of calcitriol with the dose-measuring device provided, not with a regular table spoon. If you do not have a dose-measuring spoon, cup, or dropper, ask your pharmacist for one.
Your doctor may also prescribe a calcium supplement while taking calcitriol. Follow your doctor's instructions.
Store calcitriol capsules and solution at room temperature away from moisture, light, and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a calcitriol overdose are not known but may include irregular heartbeats, abdominal pain, nausea, vomiting, dry mouth, decreased appetite, constipation, weakness, headache, or a metallic taste in the mouth.
What should I avoid while taking calcitriol?
Do not take antacids or vitamin or mineral supplements except under the supervision of your doctor.
What are the possible side effects of calcitriol?
If you experience any of the following serious side effects, stop taking calcitriol and seek emergency medical attention:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- an irregular heartbeat; or
- abdominal pain.
Other side effects may be signs of too much calcium in your body. Contact your doctor if you experience
- weakness;
- headache;
- nausea and vomiting;
- dry mouth;
- constipation;
- a metallic taste in your mouth;
- muscle or bone pain;
- increased thirst and / or urination;
- increased nighttime urination;
- itching; or
- decreased appetite.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect calcitriol?
Before taking calcitriol, tell your doctor if you are taking any of the following medicines:
- digoxin (Lanoxin, Lanoxicaps);
- a magnesium-containing antacid;
- cholestyramine (Questran, Prevalite);
- orlistat (Xenical);
- a thiazide diuretic including hydrochlorothiazide (Esidrix, Hydrodiuril, Microzide, Oretic), chlorothiazide (Diuril), chlorthalidone (Hygroton, Thalitone), indapamide (Lozol), metolazone (Mykrox, Zaroxolyn), bendroflumethiazide (Naturetin), hydroflumethiazide (Diucardin, Saluron), methyclothiazide (Enduron, Aquatensen), polythiazide (Renese), and trichlormethiazide (Naqua); or
- mineral oil.
You may not be able to take calcitriol, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with calcitriol. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines.
Brand Names:
Rocaltrol
My Experience:� Rocaltrol was used when I was on dialysis.� It was started when my calcium levels started to drop.� It was stopped immediately following my transplant.
Ceftin (see Cefuroxime)
|
Pronunciation: sef yur OX eem Brand Name: Ceftin What is the most important information I should know about cefuroxime? Take all of the cefuroxime that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated. Cefuroxime can be taken on an empty stomach or with food or milk if it causes stomach upset.
What is cefuroxime? Cefuroxime is an antibiotic in a class of drugs called cephalosporins. Cefuroxime fights bacteria in the body. Cefuroxime is used to treat many different types of bacterial infections such as bronchitis, sinusitis, tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract infections. Cefuroxime may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking cefuroxime? Do not take cefuroxime if you have ever had an allergic reaction to another cephalosporin or to a penicillin unless your doctor is aware of the allergy and monitors your therapy. Before taking cefuroxime, tell your doctor if you have
You may not be able to take cefuroxime, or you may require a dosage adjustment or special monitoring during treatment if you have either of the conditions listed above. The cefuroxime (Ceftin) suspension contains sucrose. Individuals with diabetes may need to be aware of the sucrose contained in this suspension. Cefuroxime is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not, however, take cefuroxime without first talking to your doctor if you are pregnant or could become pregnant during treatment. Cefuroxime passes into breast milk and may affect a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
How should I take cefuroxime? Take this medication exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. Take each dose with a full glass of water. Cefuroxime can be taken on an empty stomach or with food or milk if it causes stomach upset. To ensure that you get the correct dose, measure the liquid form of cefuroxime with a dose-measuring spoon or cup, not a regular table spoon,. If you do not have a dose-measuring device, ask your pharmacist where you can get one. Shake the suspension well before measuring a dose. Take cefuroxime at evenly spaced intervals to keep a constant level of drug in the body. It is important to take cefuroxime regularly to get the most benefit. Take all of the cefuroxime that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated. Do not take cefuroxime at the same time as antacids (e.g., Tums, Maalox, Rolaids, others) or other medications taken to reduce stomach acid such as cimetidine (Tagamet, Tagamet HB, others), famotidine (Pepcid, Pepcid AC, Pepcid RPD, others), ranitidine (Zantac, others), or nizatidine (Axid, others) unless otherwise directed by your doctor. Antacids and stomach acid reducers may reduce the effects of cefuroxime. Store the tablets at room temperature away from moisture and heat. The suspension can be stored at room temperature or in the refrigerator. Throw away any unused medication after 10 days.
What happens if I miss a dose? Take the missed dose as soon as you remember, then try to evenly space the rest of the doses for that day until you can return to a normal schedule. Do not take a double dose of this medication unless otherwise directed by your doctor.
What happens if I overdose? Seek emergency medical attention if an overdose is suspected. Symptoms of a cefuroxime overdose may include nausea, vomiting, diarrhea, abdominal cramps, and seizures.
What should I avoid while taking cefuroxime? Do not take cefuroxime at the same time as antacids (e.g., Tums, Maalox, Rolaids, others) or other medications taken to reduce stomach acid such as cimetidine (Tagamet, Tagamet HB, others), famotidine (Pepcid, Pepcid AC, Pepcid RPD, others), ranitidine (Zantac, others), or nizatidine (Axid, others) unless otherwise directed by your doctor. Antacids and stomach acid reducers may reduce the effects of cefuroxime.
What are the possible side effects of cefuroxime? If you experience any of the following serious side effects, stop taking cefuroxime and seek emergency medical attention or contact your doctor immediately:
Other, less serious side effects may also occur. Continue to take the medication and talk to your doctor if you experience
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect cefuroxime? Do not take cefuroxime at the same time as antacids (e.g., Tums, Maalox, Rolaids, others) or other medications taken to reduce stomach acid such as cimetidine (Tagamet, Tagamet HB, others), famotidine (Pepcid, Pepcid AC, Pepcid RPD, others), ranitidine (Zantac, others), or nizatidine (Axid, others) unless otherwise directed by your doctor. Antacids and stomach acid reducers may reduce the effects of cefuroxime. Before taking cefuroxime, tell your doctor if you are taking any of the following medicines
You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above. Drugs other than those listed here may also interact with cefuroxime. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.
Brand Names: Ceftin
My Experience:� This was given to me well after my transplant when I had severe flu symptoms and all tests were non-conclusive.� My temperature reached 104.2 and it was initially given to me as an IV antibiotic in the hospital.� I then took the pill form home to continue the therapy.� I think the infectious disease doctor was trying to cover all bases because none of the test could tell him exactly what was causing the high fever and other symptoms. |
Clotrimazole
Pronunciation: kloe TRIM a zole
Brand Name: Mycelex Troche
What is the most important information I should know about clotrimazole?
Take all of the clotrimazole that has been prescribed for you even if you begin to feel better. Your symptoms may begin to improve before the infection is completely treated.
What is clotrimazole?
Clotrimazole is an antifungal medication. It is like an antibiotic but is used to treat yeast (fungal) infections.
Oral clotrimazole is used to treat and prevent yeast infections of the mouth and throat.
Clotrimazole may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking clotrimazole?
Before taking this medication, tell your doctor if you have liver disease. You may not be able to take clotrimazole, or you may need a lower dose or special monitoring during treatment.
Clotrimazole is not absorbed through your stomach. It will not treat fungal infections in any part of your body other than your mouth and throat. Talk to your doctor if you have another type of fungal infection such as athlete's foot, jock itch, ringworm, or a vaginal yeast infection.
Oral clotrimazole is in the FDA pregnancy category C. This means that it is not known whether clotrimazole will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.
It is not known whether clotrimazole will harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
The safety and effectiveness of clotrimazole have not been established for children younger than 3 years of age.
How should I take clotrimazole?
Take clotrimazole exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
The troches should be allowed to dissolve slowly in your mouth. Suck on one troche at a time until it is completely dissolved, usually 30 minutes.
Do not chew or swallow the troches whole.
The troches are usually used five times a day. Follow your doctor's instructions.
Store clotrimazole at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a clotrimazole overdose are unknown.
What should I avoid while taking clotrimazole?
There are no restrictions on foods, beverages, or activities during treatment with clotrimazole unless your doctor directs otherwise.
What are the possible side effects of clotrimazole?
Stop taking clotrimazole and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives).
Side effects are not likely to occur with clotrimazole. Continue to take clotrimazole and talk to your doctor if you experience
- nausea or stomach upset,
- vomiting,
- itching, or
- an unpleasant sensation in the mouth.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect clotrimazole?
Since clotrimazole is not absorbed by your body, drug interactions are not expected. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines.
Brand Names:
Mycelex Troche
My Experience:� Mycelex was given to me when I went home from the hospital.� I took it 4 times per day.� Apparently transplant patients are prone to fungus of the mouth called �Thrush.� After taking it for about 6 months continuously, I only took it when I say a white coating on my tongue.� It is important not to chew the tablet.� You suck it like a lifesaver.
Compazine (see Prochlorperazine)
Coumadin (see Warfarin)
Cyclosporine
Pronunciation: sye kloe SPOE rin
Brand Names: Neoral, Sandimmune
What is the most important information I should know about cyclosporine?
Notify your doctor immediately if you develop fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These symptoms could be early signs of dangerous side effects.
Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.
Although Sandimmune and Neoral are both brands of cyclosporine, they do not provide equivalent doses. Do not switch brands of this medication without first talking to your doctor. A dosage adjustment is necessary when you switch brands.
Do not consume grapefruit or grapefruit juice during treatment with cyclosporine unless specifically directed otherwise by your doctor. Cyclosporine can interact with grapefruit and grapefruit juice and the interaction may have dangerous effects. You should discuss the use of grapefruit and grapefruit juice with your doctor.
What is cyclosporine?
Cyclosporine is an immunosuppressant. Immunosuppressants decrease the effects of your body's immune system.
Cyclosporine is used to prevent your body from rejecting a kidney, liver, or heart transplant. Cyclosporine may be used in combination with another immunosuppressant and a steroid medication. Some brands of cyclosporine (e.g. Neoral) are also used to treat severe rheumatoid arthritis and severe psoriasis.
Cyclosporine may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking cyclosporine?
Before taking cyclosporine, tell your doctor if you have
- liver disease;
- kidney disease;
- cancer;
- high blood pressure;
- a viral, bacterial, or fungal infection;
- undergone treatment with PUVA, UVB, methotrexate (Rheumatrex, Immunex), coal tar, radiation, or other immunosuppressants; or
- any other serious or chronic medical condition.
You may not be able to take cyclosporine, or you may require a lower dose or special monitoring if you have any of the conditions listed above.
Cyclosporine is in the FDA pregnancy category C. This means that it is not known whether cyclosporine will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or become pregnant Dur ring treatment.
Cyclosporine passes into breast milk and may harm a nursing infant. Cyclosporine is not recommended for use during breast-feeding. Do not take cyclosporine without first talking to your doctor if you are breast-feeding a baby.
How should I take cyclosporine?
Take cyclosporine exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.
Take each dose with a full glass of water.
Take cyclosporine at the same time(s) each day and in the same relation to meals. For example, take your medication always with a meal, always 1 hour before a meal, or always 1 hour after a meal. Food can alter the amount of cyclosporine that gets absorbed into your body, and it is important to keep your routine as consistent as possible.
The Sandimmune oral solution can be mixed with milk, chocolate milk, or orange juice at room temperature. The Neoral oral solution can be mixed with apple or orange juice at room temperature; it should not be mixed with milk. Do not mix Sandimmune or Neoral with grapefruit juice. To regulate your doses, try to mix your medication with the same beverage as often as possible. Measure the required amount with the syringe provided, then transfer it to the beverage. Use a glass container, not a plastic one, to hold the mixture. Stir well, then drink the mixture immediately. Do not allow it to stand. Put some more of the beverage into the same glass, swirl it around, and drink this too. This process will ensure that you get all of the cyclosporine that is prescribed for you.
To ensure that you get a correct dose, measure the liquid form of cyclosporine with the syringe provided. Do not rinse the syringe before or after use. Even the smallest bit of water will alter the dose of cyclosporine that you measure, and variations in the dose could become dangerous. If the syringe needs to be rinsed, be sure that it is completely dried before measuring a dose.
Do not consume grapefruit or grapefruit juice during treatment with cyclosporine unless specifically directed otherwise by your doctor. Cyclosporine can interact with grapefruit and grapefruit juice and the interaction may have dangerous effects. You should discuss the use of grapefruit and grapefruit juice with your doctor.
Your doctor will probably want you to have regularly scheduled blood tests and other medical evaluations during treatment with cyclosporine to monitor progress and side effects.
Although Sandimmune and Neoral are both brands of cyclosporine, they do not provide equivalent doses. Do not switch brands of this medication without first talking to your doctor. A dosage adjustment is necessary when you switch brands.
Store cyclosporine at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the dose you missed, and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor. Notify your doctor if you miss a dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a cyclosporine overdose are not known.
What should I avoid while taking cyclosporine?
Do not consume grapefruit or grapefruit juice during treatment with cyclosporine unless specifically directed otherwise by your doctor. Cyclosporine can interact with grapefruit and grapefruit juice and the interaction may have dangerous effects. You should discuss the use of grapefruit and grapefruit juice with your doctor.
Cyclosporine can lower the activity of the immune system making you more susceptible to infection. Avoid contact with people who have colds, the flu, or other contagious illnesses. In addition, do not receive vaccines that contain a live strain of the virus (e.g., live oral polio vaccine) and avoid contact with individuals who have recently been vaccinated with a live virus. Notify your doctor at the first sign of fever, chills, or a sore throat
Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.
Although Sandimmune and Neoral are both brands of cyclosporine, they do not provide equivalent doses. Do not switch brands of this medication without first talking to your doctor. A dosage adjustment is necessary when you switch brands.
What are the possible side effects of cyclosporine?
Notify your doctor immediately if you develop fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These symptoms could be early signs of dangerous side effects.
If you experience any of the following serious side effects, stop taking cyclosporine and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- unusual tiredness or weakness;
- cough or hoarseness, fever, or chills;
- painful or difficult urination;
- severe nausea, vomiting, or diarrhea;
- unusual bleeding or bruising;
- seizures; or
- a sudden unusual feeling of discomfort or illness.
Other, less serious side effects may also occur. Continue to take cyclosporine and notify your doctor if you experience
- tremor (shaking);
- increased bodily hair growth;
- gum problems;
- high blood pressure;
- numbness or tingling; or
- decreased appetite.
Immunosuppressant drugs such as cyclosporine increase your risk of certain types of cancer, such as lymphomas or skin cancer. Ask you doctor about the risks and benefits of cyclosporine in your treatment.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect cyclosporine?
There are many drug / drug interactions with cyclosporine and you should tell your doctor of any drugs you are on and any new drugs, including herbal products, you start. The interactions could alter cyclosporine levels causing a decrease in effectiveness or an increase in side effects. The side effects or effectiveness of the other drugs may also be altered.
The following are some examples of medications that may result in a drug / drug interaction when taken with cyclosporine:
- trimethoprim with sulfamethoxazole (Bactrim, Septra, Sulfatrim, others), gentamicin (Garamycin, others), and vancomycin (Vancocin);
- ibuprofen (Advil, Motrin, Nuprin, others), naproxen (Naprosyn, Anaprox, Aleve, others), diclofenac (Voltaren, Cataflam), etodolac (Lodine), flurbiprofen (Ansaid), fenoprofen (Nalfon), indomethacin (Indocin), ketorolac (Toradol), ketoprofen (Orudis KT, Orudis, Oruvail), nabumetone (Relafen), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), and tolmetin (Tolectin);
- amphotericin B (Fungizone) and ketoconazole (Nizoral);
- tacrolimus (Prograf);
- melphalan (Alkeran);
- cimetidine (Tagamet, Tagamet HB) and ranitidine (Zantac, Zantac 75);
- diltiazem (Cardizem, Dilacor XR, Tiazac), nicardipine (Cardene), amiodarone (Cordarone, Pacerone) and verapamil (Calan, Verelan);
- ketoconazole (Nizoral), itraconazole (Sporanox), and fluconazole (Diflucan);
- danazol (Danocrine) and methylprednisolone (Medrol, others);
- erythromycin (Ery-Tab, E-Mycin, E.E.S., P.C.E., others), clarithromycin (Biaxin);
- bromocriptine (Parlodel);
- colchicine and allopurinol (Aloprim, Lopurin, Zyloprim);
- indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), lopinavir-ritonavir(Kaletra) and saquinavir (Fortovase, Invirase);
- metoclopramide (Reglan);
- prednisolone (Prelone, Pediapred, others);
- digoxin (Lanoxin, Lanoxicaps);
- lovastatin (Mevacor), fluvastatin (Lescol), pravastatin (Pravachol), simvastatin (Zocor), or atorvastatin (Lipitor);
- PUVA or UVB therapy; and
- potassium-sparing diuretics (water pills) such as amiloride (Midamor), spironolactone (Aldactone, Spironol), or triamterene (Dyrenium); and
- any type of vaccination.
Brand Names:
Neoral
Sandimmune
My Experience:� I was not put on this immunosuppressant immediately following surgery.� The protocol this transplant clinic used was a combination of Prograf, CellCept and Prednisone to suppress the immune system.� After eliminating CellCept due to a white blood cell deficiency caused by the drug and organ rejection that would not go away, I was switched to Rapamune and Neoral.� Cyclosporine was one of the first immunosuppressants used, but like Prograf, it is toxic to the kidneys so it is a real balancing act to keep rejection away while keeping the kidney healthy.
Cytovene (see Ganciclovir)
Demerol (see Meperidine)
Diphenhydramine
Pronunciation: dye fen HYE dra meen
Brand Names: 40 Winks, Aler-Dryl, Banophen, Benadryl, Calm-Aid, Compoz Nighttime Sleep Aid, Diphedryl, Diphen, . . . more
What is the most important information I should know about diphenhydramine?
Use caution when driving, operating machinery, or performing other hazardous activities. Diphenhydramine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking diphenhydramine.
What is diphenhydramine?
Diphenhydramine is an antihistamine. Diphenhydramine blocks the effects of the naturally occurring chemical histamine in the body.
Diphenhydramine is used to treat sneezing; runny nose; itching, watery eyes; hives; rashes; itching; and other symptoms of allergies and the common cold.
Diphenhydramine is also used to suppress coughs, to treat motion sickness, to induce sleep, and to treat mild forms of Parkinson's disease.
Diphenhydramine may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking diphenhydramine?
Do not take diphenhydramine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. A very dangerous drug interaction could occur, leading to serious side effects.
Before taking this medication, tell your doctor if you have
- glaucoma or increased pressure in the eye;
- a stomach ulcer;
- an enlarged prostate, bladder problems or difficulty urinating;
- an overactive thyroid (hyperthyroidism);
- hypertension or any type of heart problems; or
- asthma.
You may not be able to take diphenhydramine, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.
Diphenhydramine is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not take diphenhydramine without first talking to your doctor if you are pregnant.
Infants are especially sensitive to the effects of antihistamines, and side effects could occur in a breast-feeding baby. Do not take diphenhydramine without first talking to your doctor if you are nursing a baby.
If you are over 60 years of age, you may be more likely to experience side effects from diphenhydramine. You may require a lower dose of this medication.
How should I take diphenhydramine?
Take diphenhydramine exactly as directed on the package or as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Diphenhydramine can be taken with or without food.
For motion sickness, a dose is usually taken 30 minutes before motion, then with meals and at bedtime for the duration of exposure.
As a sleep aid, diphenhydramine should be taken approximately 30 minutes before bedtime.
To ensure that you get a correct dose, measure the liquid forms of diphenhydramine with a special dose-measuring spoon or cup, not with a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
Never take more of this medication than is prescribed for you. The maximum amount of diphenhydramine that you should take in any 24-hour period is 300 mg.
Store diphenhydramine at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
What happens if I overdose?
Seek emergency medical attention if an overdose is suspected.
Symptoms of a diphenhydramine overdose include extreme sleepiness, confusion, weakness, ringing in the ears, blurred vision, large pupils, dry mouth, flushing, fever, shaking, insomnia, hallucinations, and possibly seizures.
What should I avoid while taking diphenhydramine?
Use caution when driving, operating machinery, or performing other hazardous activities. Diphenhydramine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking diphenhydramine.
What are the possible side effects of diphenhydramine?
Stop taking diphenhydramine and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives).
Other, less serious side effects may be more likely to occur. Continue to take diphenhydramine and talk to your doctor if you experience
- sleepiness, fatigue, or dizziness;
- headache;
- dry mouth; or
- difficulty urinating or an enlarged prostate.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect diphenhydramine?
Do not take diphenhydramine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. A very dangerous drug interaction could occur, leading to serious side effects.
Talk to your pharmacist before taking other over-the-counter cough, cold, allergy, or insomnia medications. These products may contain medicines similar to diphenhydramine, which could lead to an antihistamine overdose.
Before taking this medication, tell your doctor if you are taking any of the following medicines:
- anxiety or sleep medicines such as alprazolam (Xanax), diazepam (Valium), chlordiazepoxide (Librium), temazepam (Restoril), or triazolam (Halcion);
- medications for depression such as amitriptyline (Elavil), doxepin (Sinequan), nortriptyline (Pamelor), fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil); or
- any other medications that make you feel drowsy, sleepy, or relaxed.
Drugs other than those listed here may also interact with diphenhydramine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.
Brand Names:
40 Winks
Aler-Dryl
Banophen
Benadryl
Calm-Aid
Compoz Nighttime Sleep Aid
Diphedryl
Diphen
Genahist
Hydramine
Nu-Med
Nytol Caplet
Quenalin
Scot-Tussin Allergy Relief Formula
Sleep
Sleepinal
Sominex
Twilite
Unisom Sleepgels Maximum Strength
My Experience:� Benadryl was only used periodically on me to lessen the side effects of certain drugs.� The only drug I recall using Benadryl before was Thymoglobulin, but I know there were others.
Epogen (see Epoetin)
Epoetin alfa
Pronunciation: ee poe EE tin AL fa
Brand Names: Epogen, Procrit
What is the most important information I should know about epoetin alfa?
Do not give yourself an injection if you are not sure how to inject yourself, how much to inject, and how often to inject your medication. Call your doctor, nurse, or pharmacist for help with the instructions.
During the first 3 months of treatment with epoetin alfa, use caution when driving, operating machinery, or performing other hazardous activities. Epoetin alfa has been reported to cause seizures in patients on dialysis, although this side effect is uncommon. If seizures occur, they generally do so during the first 90 days of treatment.
What is epoetin alfa?
Epoetin alfa is a man-made form of a naturally occurring protein called erythropoietin. Erythropoietin is produced in the kidney and stimulates the production of red blood cells. The amount of erythropoietin in the body may be diminished when the kidneys are damaged. Medications may also decrease the number of red blood cells.
Epoetin alfa is used to treat anemia by stimulating red blood cell production.
Epoetin alfa may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before using epoetin alfa?
Before using this medication, tell your doctor if you have
- high blood pressure;
- heart disease;
- cancer; or
- epilepsy or another seizure disorder.
You may not be able to use epoetin alfa, or you may require a lower dose or special monitoring if you have any of the conditions listed above.
Epoetin alfa is in the FDA pregnancy category C. This means that it is not known whether epoetin alfa will harm an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant.
It is also not known whether epoetin alfa passes into breast milk. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.
How should I use epoetin alfa?
Use epoetin alfa exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Epoetin alfa may be injected subcutaneously (under the skin) or intravenously (into a vein). Your doctor, nurse, or pharmacist will give you specific instructions on how and where to inject your medication. Do not give yourself an injection if you are not sure how to inject yourself, how much to inject, or how often to inject your medication. Call your doctor, nurse, or pharmacist for help with the instructions.
Allow the medication to reach room temperature before measuring a dose.
Do not shake the vial of epoetin alfa. Vigorous shaking can ruin the medication.
Properly store and discard all syringes and needles.
Store epoetin alfa in the refrigerator at 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit) away from light, moisture, and the reach of children.
What happens if I miss a dose?
Contact your doctor if you miss a dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of an epoetin alfa overdose are not known.
What should I avoid while using epoetin alfa?
During the first 3 months of treatment with epoetin alfa, use caution when driving, operating machinery, or performing other hazardous activities. Epoetin alfa has been reported to cause seizures in patients on dialysis, although this side effect is uncommon. If seizures occur, they generally do so during the first 90 days of treatment.
What are the possible side effects of epoetin alfa?
If you experience any of the following serious side effects, stop using epoetin alfa and seek emergency medical treatment:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives); or
- seizures.
Other, less serious side effects may be more likely to occur. Continue to use epoetin alfa and talk to your doctor if you experience
- increased blood pressure;
- headache;
- a "flulike" feeling;
- increased heart rate;
- nausea, vomiting, or diarrhea;
- numbness or tingling;
- tiredness;
- muscle aches;
- a rash; or
- injection site discomfort.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect epoetin alfa?
It is not known whether epoetin alfa will interact with other medicines. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Brand Names:
Epogen
Procrit
My Experience:� I have used Epogen and Procrit extensively just prior to dialysis and following my transplant rejection.� This drug is a man-made form of a hormone your kidney produces called erythropoietin.� This hormone stimulates your bone marrow to produce red blood cells.� When your kidneys fail, not enough of this hormone is produced.� You or a nurse has to give this by injection.� A tip I found is to always get the 2cc vial.� I was told that it is the preservative that stings when you inject it.� In the 2cc vial, the preservative is apparently distributed over a larger volume so it does not sting much at all.
Pronunciation: e sew MEH pra zol
Brand Name: Nexium
What is the most important information I should know about esomeprazole?
Do not stop taking esomeprazole even if you begin to feel better. Your symptoms may improve before the condition is fully treated.
Do not break or chew the capsules. Swallow them whole. They are specially formulated to release slowly in the body.
What is esomeprazole?
Esomeprazole decreases the amount of acid produced in the stomach.
Esomeprazole is used to treat ulcers, gastroesophageal reflux disease (GERD or heartburn), erosive esophagitis, and other conditions involving excessive stomach acid production.
Esomeprazole may also be used for purposes other than those listed in this medication guide.
Who should not take esomeprazole?
Before taking esomeprazole, tell your doctor if you have ever had any type of liver disease. You may not be able to take esomeprazole, or you may require a dosage adjustment or special monitoring.
Esomeprazole is in the FDA pregnancy category B. This means that it is unlikely to harm an unborn baby. Do not take esomeprazole without first talking to your doctor if you are pregnant.
It is not known whether esomeprazole passes into breast milk. Do not take esomeprazole without first talking to your doctor if you are breast-feeding a baby.
How should I take esomeprazole?
Take esomeprazole exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass (8 ounces) of water.
Esomeprazole should be taken at least one hour before a meal. Follow your doctor's instructions.
Do not break or chew the capsules. Swallow them whole. They are specially formulated to release slowly in the body.
If you have difficulty swallowing the capsules, one tablespoon of applesauce can be added to an empty bowl and the esomeprazole capsule can be opened, and the pellets inside the capsule carefully emptied onto the applesauce. The pellets should be mixed with the applesauce and then swallowed immediately. The applesauce should not be hot and should be soft enough to be swallowed without chewing. The pellets should not be chewed or crushed. The pellet / applesauce mixture should not be stored for later use.
Do not stop taking esomeprazole even if you begin to feel better. Your symptoms may improve before the condition is fully treated.
Store esomeprazole at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of an esomeprazole overdose include drowsiness, shortness of breath, tremor, loss of coordination, and seizures.
What should I avoid while taking esomeprazole?
There are no restrictions on food, beverages, or activities while taking esomeprazole, unless otherwise directed by your doctor.
What are the possible side effects of esomeprazole?
If you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives), stop taking esomeprazole and seek emergency medical attention.
Other, less serious side effects may be more likely to occur. Continue to take esomeprazole and talk to your doctor if you experience
- headache;
- diarrhea;
- nausea, flatulence, abdominal pain, or constipation; or
- dry mouth.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect esomeprazole?
Before taking esomeprazole, tell your doctor if you are taking any of the following medicines:
- digoxin (Lanoxin, Lanoxicaps);
- itraconazole (Sporanox) or ketoconazole (Nizoral); or
- iron (Feosol, Mol-Iron, Fergon, Femiron, others).
You may not be able to take esomeprazole, or you may require a dosage adjustment or special
Drugs other than those listed here may also interact with esomeprazole. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Brand Names:
Nexium
My Experience:� This makes my day much more tolerable.� Some time after the transplant I started having reflux/heartburn.� My doctor started me on an over the counter medication and the heartburn quickly became worse.� I was to the point where I was up all night pacing the floor to get relief.� Many times I wanted to stick my finger down my throat because the pain was so bad and I thought this might bring relief � but I didn�t.� The only relief I found was Nexium in the morning and at night.� When I forget my dose, which is not often, I get a quick reminder!
Pronunciation: eh ZEH teh mib
Brand Name: Zetia
What is the most important information I should know about ezetimibe?
Do not stop taking ezetimibe unless directed to do so by your doctor. It may be weeks or months before beneficial effects are seen from this medication.
What is ezetimibe?
Ezetimibe reduces the amount of cholesterol absorbed by the body.
Ezetimibe is used to reduce the amount of total cholesterol, LDL (bad) cholesterol, and apolipoprotein B (a protein needed to make cholesterol) in the blood. Ezetimibe is used with a low cholesterol diet and, in some cases, other cholesterol lowering medications.
Ezetimibe may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking ezetimibe?
Before taking ezetimibe, tell your doctor if you
- have liver disease;
- are taking another cholesterol-lowering medication; or
- have unexplained muscle pain, tenderness, or weakness.
You may not be able to take ezetimibe, or you may require a dosage adjustment or special monitoring during treatment.
Ezetimibe is in the FDA pregnancy category C. This means that it is not known whether ezetimibe will be harmful to an unborn baby. Do not take ezetimibe without first talking to your doctor if you are pregnant or could become pregnant during treatment.
It is not known whether ezetimibe passes into breast milk. Do not take ezetimibe without first talking to your doctor if you are breast-feeding a baby.
How should I take ezetimibe?
Take ezetimibe exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Take ezetimibe once a day with or without food. It may be easier to remember to take the medication if you take it at the same time every day.
Ezetimibe should be taken 2 hours before or 4 hours after a bile acid sequestrant such as cholestyramine (Locholest, Prevalite, Questran), colestipol (Colestid), or colesevelam (Welchol).
Eat a low-fat, low-cholesterol diet. To see beneficial effects from ezetimibe avoid fatty, high-cholesterol foods.
Your doctor may want to monitor cholesterol levels, liver function, or other factors with blood tests before starting and during treatment with ezetimibe. Depending on the results of these tests, your doctor can determine how much monitoring you will require.
Do not stop taking ezetimibe unless directed to do so by your doctor. It may be weeks or months before beneficial effects are seen from this medication.
Store ezetimibe at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of the medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of an ezetimibe overdose are not known.
What should I avoid while taking ezetimibe?
Eat a low-fat, low-cholesterol diet. To see beneficial effects from ezetimibe avoid fatty, high-cholesterol foods.
What are the possible side effects of ezetimibe?
If you experience an uncommon allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives), stop taking ezetimibe and seek emergency medical attention.
Other, less serious side effects have also been reported, although uncommon. Continue to take ezetimibe and talk to your doctor if you experience
- abdominal pain;
- diarrhea; or
- tiredness.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect ezetimibe?
Before taking ezetimibe, tell your doctor if you are taking:
another medicine to lower cholesterol such as gemfibrozil (Lopid), fenofibrate (Tricor), clofibrate (Atromid-S), atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altocor, Mevacor), pravastatin (Pravachol), or simvastatin (Zocor).
cyclosporine (Sandimmune, Neoral, Gengraf).
You may not be able to take ezetimibe, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medications listed above.
Ezetimibe should be taken 2 hours before or 4 hours after a bile acid sequestrant such as cholestyramine (Locholest, Prevalite, Questran), colestipol (Colestid), or colesevelam (Welchol).
Drugs other than those listed here may also interact with cholestyramine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
Brand Names:
Zetia
My Experience:� This is an amazing drug that lowers blood cholesterol.� I am on Lipitor for the same purpose, but it did not affect me much and caused some muscle weakness.� In lieu of increasing the Lipitor, we tried this relatively new drug and boy did it work!� Also, there seems to be no side effects.� I am still on the Lipitor because I am told that this class of drugs has been proven to lower the risk of heart problems.� Diabetics, dialysis patients and transplant patient are in an extremely high risk group for heart problems.
Pronunciation: fill GRASS tim
Brand Name: Neupogen
What is the most important information I should know about filgrastim?
Do not give yourself an injection if you are unsure how to inject yourself, how much to inject, or how often to inject the medication. Contact your doctor, nurse, or pharmacist to go over the instructions with you.
Contact your doctor if you develop a fever; chills; sore throat; congestion; diarrhea; or redness, pain, or swelling around a wound or sore while using filgrastim.
What is filgrastim?
Filgrastim is a protein that stimulates the production of white blood cells. White blood cells are important for protecting the body from infection.
Filgrastim is used to increase white blood cells, and to decrease the risk of infection, in conditions such as cancer; bone marrow transplant; pre-chemotherapy blood cell collection; and severe chronic neutropenia including congenital neutropenia, cyclic neutropenia, and idiopathic neutropenia.
Filgrastim may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before using filgrastim?
Do not use filgrastim if you have an allergy to the bacterium E. coli. You may also be allergic to filgrastim.
Before using this medication, tell your doctor if you
- are undergoing radiation or chemotherapy;
- have myeloid (bone marrow) cancer;
- have kidney disease; or
- have liver disease.
You may not be able to uses filgrastim or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Filgrastim is in the FDA pregnancy category C. This means that it is not known whether filgrastim will be harmful to an unborn baby. Do not use filgrastim without first talking to your doctor if you are pregnant or could become pregnant during treatment.
It is not known whether filgrastim will be harmful to a nursing baby. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.
How should I use filgrastim?
Use filgrastim exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Filgrastim can be used subcutaneously (SC) or intravenously (IV). If you are injecting the medication at home, your doctor, nurse, or pharmacist will give you specific instructions on how and where to inject your medication. Do not give yourself an injection if you are unsure how to inject yourself, how much to inject, or how often to inject the medication. Contact your doctor, nurse, or pharmacist to go over the instructions with you.
Try to receive the injections at the same time each day.
It is important to use filgrastim regularly to get the most benefit.
Rotate injection sites as directed and inject the medication slowly.
Do not shake any vial of filgrastim. It can be gently swirled if mixing is needed. Do not use any medication that is discolored or that particles in it.
Use each vial filgrastim for only one dose then throw away any remaining solution. Do not re-enter the vial with the same or another needle.
The vial of medication can be allowed to reach room temperature by leaving it out of the refrigerator for about 30 minutes before injecting a dose. Do not leave the vial in direct sunlight. Neupogen can remain at room temperature for up to 24 hours. If it is unrefrigerated for longer than 24 hours, throw the vial away.
Properly store and discard all syringes and needles.
Your doctor may want you to have blood tests or other medical evaluations during treatment with filgrastim to monitor progress and side effects.
Store this medication in the refrigerator between 2 and 8 degrees Celsius (36 to 46 degrees Fahrenheit) away from light, moisture, and the reach of children. Do not allow it to freeze. If a vial of medication is accidentally frozen, it can be thawed in the refrigerator and used at a later time. If the vial is frozen a second time, do not use it at all. Discard all unused medication on the expiration date.
What happens if I miss a dose?
Contact your doctor if you miss a dose of this medication by more than a few hours.
What happens if I overdose?
Seek emergency medical attention if an overdose is suspected.
Symptoms of a filgrastim overdose are not known.
What should I avoid while using filgrastim?
There are no restrictions regarding foods, beverages, or activities during treatment with a filgrastim unless your doctor directs otherwise.
What are the possible side effects of filgrastim?
If you experience any of the following serious side effects, stop using filgrastim and seek emergency medical treatment or notify your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- a fever (over 100.5 degrees Fahrenheit or 38 degrees Celsius); or
- signs of infection such as chills; sore throat; congestion; diarrhea; or redness, pain, or swelling around a wound or sore
- Other, less serious side effects may be more likely to occur. Continue to use filgrastim and talk to your doctor if you experience:
- bone pain;
- nausea; or
- swelling, redness, or pain at the injection site.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect filgrastim?
Before using this medication, tell your doctor if you
- are taking lithium (Eskalith, Lithobid, Lithane, others); or
- are undergoing radiation or chemotherapy.
You may not be able to use filgrastim or you may require special monitoring if you are taking any of the medications listed above.
Drugs other than those listed here may also interact with filgrastim. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.
Brand Names:
My Experience:� I took Neupogen periodically when my white blood cell count was low.� White blood cells are critical for fighting infection and as you can imagine, even more important in a transplant patient�s case where their immune system has been chemically weakened.� This is an injection that you or your nurse can give and was relative painless as injections go.
Foscarnate (Foscavir)
Furosemide
Pronunciation: fur OH seh mide
Brand Names: Lasix, Lo-Aqua
What is the most important information I should know about furosemide?
To reduce nighttime urination, take furosemide early in the day unless otherwise directed by your doctor.
Promptly report any muscle weakness or cramps to your doctor.
What is furosemide?
Furosemide is in a class of drugs called loop diuretics (water pills). It decreases the amount of fluid in the body by increasing the amount of salt and water lost in the urine.
Furosemide is used to reduce swelling in the body caused by congestive heart failure, liver disease, or kidney disease.
Furosemide may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking furosemide?
Before taking this medication, tell your doctor if you have
- an allergy to sulfa medicines such as sulfa-based antibiotics,
- kidney disease,
- liver disease,
- diabetes mellitus,
- gout, or
- systemic lupus erythematosus.
You may not be able to take furosemide, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Furosemide is in the FDA pregnancy category C. This means that it is not known whether furosemide will be harmful to an unborn baby. Do not take furosemide without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Furosemide passes into breast milk and may affect a nursing infant. Do not take furosemide without first talking to your doctor if you are breast-feeding a baby.
How should I take furosemide?
Take furosemide exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
To reduce nighttime urination, take furosemide early in the day unless otherwise directed by your doctor.
It is important to take furosemide regularly to get the most benefit.
Do not stop taking furosemide suddenly even if you feel better. Stopping suddenly could make your condition worse.
Store furosemide at room temperature away from moisture and heat.
What happens if I miss a dose?
If you take one dose daily, take the missed dose as soon as you remember within 12 hours. If more than 12 hours have passed, skip the dose you missed and take only the next regularly scheduled dose. Do not take a double dose of this medication.
If you take more than one dose daily, take the missed dose up to 2 hours late. If more than 2 hours have passed, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention if an overdose is suspected.
Symptoms of a furosemide overdose include weakness, muscle cramps, fatigue, dizziness, fainting, confusion, irregular pulse, nausea, and vomiting.
What should I avoid while taking furosemide?
Use alcohol cautiously. Alcohol may increase the side effects of furosemide.
What are the possible side effects of furosemide
If you experience any of the following serious side effects, stop taking furosemide and seek emergency medical attention or call your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- muscle cramps or weakness;
- an irregular heartbeat;
- abdominal pain or diarrhea;
- low blood pressure (weakness, dizziness, fatigue); or
- decreased hearing.
Other, less serious side effects may be more likely to occur. Continue to take furosemide and talk to your doctor if you experience
- dry mouth or increased thirst;
- headache, dizziness, or lightheadedness;
- constipation;
- increased sensitivity to sunlight;
- a rash;
- jaundice (yellow skin or eyes);
- ringing in the ears;
- nausea;
- easy bleeding or bruising; or
- numbness in the hands or feet.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect furosemide?
Before taking furosemide tell your doctor if you are taking any of the following medications:
- lithium (Lithobid, Eskalith, others);
- probenecid (Benemid);
- a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil, Nuprin), naproxen (Naprosyn, Anaprox, Aleve), ketoprofen (Orudis, Orudis KT, Oruvail), indomethacin (Indocin), diclofenac (Cataflam, Voltaren), etodolac (Lodine), nabumetone (Relafen), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin), fenoprofen (Nalfon), ketorolac (Toradol), or flurbiprofen (Ansaid); or
- a diabetes medication such as glipizide (Glucotrol), glyburide (Micronase, Glynase, Diabeta), chlorpropamide (Diabinese), tolazamide (Tolinase), tolbutamide (Orinase), and others.
You may not be able to take furosemide, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medications listed above.
Also, before taking furosemide, tell your doctor if you are taking any other medicine to treat high blood pressure, water retention, heart problems, prostate problems, or another condition. Some medicines used to treat these conditions may interact with furosemide and the effects on your heart may be increased.
Drugs other than those listed here may also interact with furosemide. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.
Brand Names:
Lasix
Lo-Aqua
My Experience:� Lasix was given to me periodically when I retained water or my blood pressure was high.� I was on Lasix almost continuously just prior to dialysis to stimulate my weakened kidneys to extract and evacuate water.� Too much water makes you feel bloated and can raise your blood pressure.� I frequently found that I would get leg cramps when I took Lasix.� Eating bananas and/or taking a potassium supplement usually stopped the cramps.
Pronunciation: ga bah PEN tin
Brand Name: Neurontin
What is the most important information I should know about gabapentin?
If you are taking gabapentin for seizures, do not stop taking gabapentin even if you feel better. It is important to continue taking the medication to prevent seizures from recurring.
Carry or wear a medical identification tag to let others know that you are taking this medicine in the case of an emergency.
Use caution when driving, operating machinery, or performing other hazardous activities. Gabapentin may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
What is gabapentin?
Gabapentin affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. The exact way that it works is unknown.
Gabapentin is used with other drugs in the treatment of some types of seizures and for the management of postherpetic neuralgia (nerve pain caused by the herpes virus or shingles).
Gabapentin may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking gabapentin?
Before taking this medication, tell your doctor if you have any other medical conditions, especially kidney, liver, or heart disease. Also discuss any medicines that you take, including over-the-counter preparations.
Gabapentin is in the FDA pregnancy category C. This means that it is not known whether gabapentin will be harmful to an unborn baby. Do not take gabapentin without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Gabapentin passes into breast milk. Do not take gabapentin without first talking to your doctor if you are breast-feeding a baby.
How should I take gabapentin?
Take gabapentin exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose of gabapentin with a full glass of water.
Gabapentin can be taken with or without food.
To ensure you get the correct dose, measure the gabapentin oral solution with a dose-measuring cup or spoon, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
Carry or wear a medical identification tag to let others know that you are taking this medicine in the case of an emergency.
Do not stop taking gabapentin without talking to your doctor. Suddenly stopping gabapentin may cause side effects.
If you are taking gabapentin for seizures, do not stop taking gabapentin even if you feel better. It is important to continue taking the medication to prevent seizures from recurring.
Store gabapentin tablets and capsules at room temperature away from moisture and heat.
Store the gabapentin oral solution in the refrigerator.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if several hours have passed and it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of the medication to catch up.
What happens if I overdose?
Seek emergency medical treatment.
Symptoms of a gabapentin overdose include double vision, drowsiness, slurred speech, diarrhea, poor coordination, and difficulty breathing.
What should I avoid while taking gabapentin?
Use caution when driving, operating machinery, or performing other hazardous activities. Gabapentin may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
Avoid alcohol during treatment with gabapentin. Alcohol may increase the risk of having side effects while taking gabapentin.
What are the possible side effects of gabapentin?
If you experience any of the following serious side effects, stop taking gabapentin and seek medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives).
- Other, less serious side effects may be more likely to occur. Continue to take gabapentin and talk to your doctor if you experience
- dizziness, poor coordination, or drowsiness;
- blurred or double vision;
- irregular back-and- forth movements of the eyes;
- nausea and vomiting; or
- tremor.
If children 3 to 12 years of age experience any of the following serious side effects, contact your doctor immediately
- emotional liability (anxiety, behavior problems, crying, false sense of well-being, mental depression, reacting too quickly, too emotionally, or overreacting, rapidly changing moods);
- hostility (aggressive behavior, suspiciousness, or distrust);
- restlessness, hyperactivity or increase in body movements;
- amnesia (loss of memory); or
- thought disorders (concentration problems and change in school performance).
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect gabapentin?
Gabapentin does not interact with other commonly used antiseizure medications.
Antacids will decrease the amount of gabapentin that is absorbed in the stomach. Do not take gabapentin for at least 2 hours after a dose of antacid.
Gabapentin may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants.
Drugs other than those listed here may also interact with gabapentin or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
Brand Names:
Neurontin
My Experience:� This is an interesting drug because as you can see from the above summary, it is typically used for seizures.� In my case, after using Tylenol with no effect for my neuropathy, I tried this and it worked.� Neuropathy can occur in diabetics and kidney patients that usually show in the form of leg pain when at rest.� In my case, the pain was also in my arms and it also caused my ejaculate to retrograde into my bladder.� This drug does not reverse neuropathy, it merely relieves the pain.� Be very cautious if you go on this drug.� When you first take it you will feel very �drunk� until you get used to it.� I walked into a couple of walls the first few times I took it and wisely decided not to drive for a while.
Ganciclovir (oral and injectable)
Pronunciation: gan SYE kloe veer
Brand Name: Cytovene
What is the most important information I should know about ganciclovir?
Serious side effects affecting the blood have been reported with the use of ganciclovir. Decreased levels of blood cells (white blood cells, red blood cells, and platelets) have occurred. Your doctor may monitor your blood with blood tests.
Ganciclovir has caused birth defects in animals, and it is generally not recommended for use during pregnancy. Women should use an effective form of birth control during treatment with ganciclovir. Also, men should use a form of barrier contraception (e.g., condom) during and for at least 90 days following treatment with ganciclovir.
Take all of the ganciclovir that has been prescribed, even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
Take oral ganciclovir with food to increase its absorption by the body.
What is ganciclovir?
Ganciclovir is an antiviral drug. It slows the growth and spread of the cytomegalovirus.
Ganciclovir is used to treat and prevent infections caused by cytomegalovirus. This infection usually occurs in patients who have suppressed immune systems such as patients with AIDS and organ transplant patients.
Ganciclovir may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking ganciclovir?
Before taking ganciclovir, tell your doctor if you have
- had an allergic reaction to ganciclovir or acyclovir (Zovirax);
- kidney disease; or
- blood problems or low blood counts.
You may not be able to take ganciclovir, or you may need a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Ganciclovir is in the FDA pregnancy category C. This means that it is not known whether ganciclovir will be harmful to an unborn baby. Ganciclovir has caused birth defects in animals, and it is generally not recommended for use during pregnancy. Women should use an effective form of birth control during treatment with ganciclovir. Also, men should use a form of barrier contraception (e.g., condom) during and for at least 90 days following treatment with ganciclovir.
It is not known whether ganciclovir passes into breast milk. Generally, breast-feeding should be avoided during treatment with ganciclovir. Do not take ganciclovir without first talking to your doctor if you are breast-feeding a baby.
How should I take ganciclovir?
Take ganciclovir exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each oral dose with a full glass of water.
Take each oral dose with food to increase the absorption of the drug in your body.
Your healthcare provider will administer injectable ganciclovir as an intravenous (into a vein) infusion.
Take all of the ganciclovir that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
Your doctor may want you to have blood tests, eye exams, or other evaluations during treatment with ganciclovir to monitor progress and side effects.
Store ganciclovir at room temperature away from moisture and heat.
What happens if I miss a dose?
If a dose of oral ganciclovir is missed, take the missed dose as soon as you remember. If it is almost time for the next dose, skip that dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.
Contact your healthcare provider if you miss a dose of injectable ganciclovir.
What happens if I overdose?
Seek emergency medical attention if an overdose is suspected.
Symptoms of a ganciclovir overdose include seizures, diarrhea, kidney damage (decreased urine production), liver damage (yellowing of the skin or eyes, abdominal pain), and bone marrow damage (paleness, increased chance of infection, fever and chills).
What should I avoid while taking ganciclovir?
There are no restrictions on food, beverages, or activity during treatment with ganciclovir unless otherwise directed by your doctor.
What are the possible side effects of ganciclovir?
Serious side effects affecting the blood have been reported with the use of ganciclovir. Decreased levels of blood cells (white blood cells, red blood cells, and platelets) have occurred. Your doctor may monitor your blood with blood tests.
Stop taking ganciclovir and seek emergency medical attention if you experience any of the following serious side effects:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- paleness and fatigue that may be signs of anemia (a low level of red blood cells);
- unusual bleeding or bruising;
- fever or signs of infection; or
- numbness or tingling in a part of your body.
Other, less serious side effects may be more likely to occur. Continue to take ganciclovir and talk to your doctor if you experience
- nausea, vomiting, diarrhea, or decreased appetite;
- increased sweating;
- itching; or
- decreased sperm production or infertility.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect ganciclovir?
Before taking ganciclovir, tell your doctor if you are taking any of the following drugs:
- zidovudine (Retrovir, AZT);
- didanosine (Videx);
- probenecid (Benemid); or
- imipenem-cilastatin (Primaxin).
You may not be able to take ganciclovir, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with ganciclovir. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
Brand Names:
Cytovene
My Experience:� This is an antiviral drug used to fight CMV.� As you can read in the glossary, CMV is a nasty virus that lies dormant in about 50% of the population.� My donor had CMV and I got it with the transplant which I am told is common.� With a good immune system, it usually does not become symptomatic.� In transplant patients, it can become life threatening if left unchecked.� I was put on oral Cytovene upon leaving the hospital in very large doses.� It keep the CMV at bay for a while.� When I showed symptoms and my CMV antigens (an indicator of active CMV) rose, I was given IV Ganciclovir.� Both of these are not good for your kidneys but far better than some of the other drugs I was given to fight CMV as you will see in these summaries.
Humatin (see Paromomycin)
Pronunciation: HEP ah rin
What is the most important information I should know about heparin?
Notify your doctor immediately if you develop a nosebleed; black, bloody, or tarry stools; prolonged bleeding; or unexplained bruising or bleeding.
Do not inject this medication intramuscularly (into the muscle).
Do not take aspirin, ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis KT, Orudis, Oruvail), naproxen (Aleve, Naprosyn, Anaprox, others), indomethacin (Indocin), or any other nonsteroidal anti-inflammatory medication. These medicines may lead to bleeding when taken with heparin. Ask your pharmacist or doctor before taking any prescription or over-the-counter medication.
What is heparin?
Heparin is an anticoagulant (blood thinner). Heparin prevents the formation of blood clots.
Heparin is used to treat and prevent blood clot formation in patients with active blood clots in an artery, vein, or lung; prior to surgery if the risk of a blood clot is high; in patients with atrial fibrillation (irregular heartbeats); and in patients with chronic blood clotting disorders.
Heparin may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before using heparin?
You cannot use this medication if you have a very low level of platelets in your blood, if you have uncontrolled bleeding, or if accurate blood testing cannot be done prior to and during dosing.
Before using this medication, tell your doctor if you
- have bacterial endocarditis,
- high blood pressure that is not being controlled,
- need to have major surgery,
- have hemophilia or another blood disorder,
- have a stomach ulcer, or
- have liver disease.
You may not be able to use heparin, or you may require a lower dose or special monitoring during therapy if you have any of the conditions listed above.
Heparin is in the FDA pregnancy category C. This means that it is not known whether heparin will harm an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant.
Heparin does not pass into breast milk. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.
Heparin may be more effective in females patients over 60 years of age. A lower dose may be needed to prevent side effects.
How should I use heparin?
Use heparin exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.
Heparin must be used as an injection, either intravenously (into a vein) or subcutaneously (under the skin). Heparin is not effective if given by mouth.
Do not inject this medication intramuscularly (into the muscle).
Your doctor or nurse will give you detailed instructions on how to inject heparin. Do not inject this medication if you do not understand these instructions.
Do not use this medication if it is very discolored or if it has particles in it.
Do not stop using this medication without first talking to your doctor.
Store heparin at room temperature away from moisture and heat.
What happens if I miss a dose?
Use the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and use only your next regularly scheduled dose. Do not use a double dose of this medication.
Notify your doctor if you miss a dose of heparin.
What happens if I overdose?
Seek emergency medical attention.
The main symptom of a heparin overdose is bleeding: nosebleeds; black, bloody, or tarry stools; blood in the urine; and easy or unexplained bruising or bleeding.
What should I avoid while using heparin?
Do not take aspirin, ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis KT, Orudis, Oruvail), naproxen (Aleve, Naprosyn, Anaprox, other), indomethacin (Indocin), or any other nonsteroidal anti-inflammatory medication. These medicines may lead to bleeding when taken with heparin. Ask your pharmacist or doctor before taking any prescription or over-the-counter medication.
What are the possible side effects of heparin?
If you experience any of the following serious side effects, stop using heparin and seek emergency medical attention:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- any prolonged or unexplained bleeding; or
- pain, warmth, or redness in an arm or leg, or difficulty breathing, which could indicate a blood clot.
Other less serious side effects may be more likely to occur. Continue to use heparin and talk to your doctor if you experience
- mild pain, redness, warmth, or ulceration at the injection site;
- hair loss;
- prolonged, painful erection; or
- osteoporosis (following long-term use).
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect heparin?
Do not take any of the following medicines during treatment with heparin:
- aspirin or choline salicylate and magnesium salicylate (Trilisate, Tricosal, Doan's, Bayer Select Backache Pain Formula, Magan, Arthropan, others);
- salsalate (Disalcid, Salflex, Salsitab, others); or
- ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis KT, Orudis, Oruvail), naproxen (Aleve, Naprosyn, Anaprox, others), indomethacin (Indocin), diclofenac (Cataflam, Voltaren), etodolac (Lodine), fenoprofen (Nalfon), flurbiprofen (Ansaid), ketorolac (Toradol), nabumetone (Relafen), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), or tolmetin (Tolectin).
The medicines listed above may lead to bleeding when taken with heparin. Ask your pharmacist or doctor before taking any prescription or over-the-counter medication.
Before taking this medication, tell your doctor if you are taking any of the following medicines:
- warfarin (Coumadin);
- ticlopidine (Ticlid) or clopidogrel (Plavix);
- dipyridamole (Persantine);
- digoxin (Lanoxin, Lanoxicaps);
- a tetracycline antibiotic such as tetracycline (Sumycin, others), minocycline (Minocin), or doxycycline (Vibramycin, Doryx);
- an antihistamine such as diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton, others), brompheniramine (Dimetapp, others), and others; or
- nicotine (in tobacco products and nicotine withdrawal products.
The drugs listed above may increase or decrease the effects of heparin, both of which could become dangerous.
Drugs other than those listed here may also interact with heparin. Talk to your doctor and pharmacist before using any prescription or over-the-counter medicines.
My Experience:� Heparin was used in my case to keep tubes and catheters from clogging.� When I was on peritoneal dialysis, it was very important to keep the tube that ran from outside my body to my peritoneum (belly) free-flowing.� At best, a clogged tube would make filling and emptying my peritoneum slow.� At worst, it would prevent the flow and the tube would have to be replace probably causing me to have to do hemodialysis while the new tube entry site heals.
It was also used when I had my PICC line.� For the same reason as my dialysis catheter, the line must remain unclogged.� It was a little more complicated because there were two lumens (catheters) to fill and keep unclogged.� Many times in the hospital, I had to ask for Heparin to be used because I did not want to have to have another PICC line inserted because someone forgot to use Heparin.
Humalog (see Insulin)
Pronunciation: IN suh lin LISS pro
Brand Name: Humalog
What is the most important information I should know about insulin lispro?
Know the signs and symptoms of low blood sugar (hypoglycemia), which include headache, drowsiness, weakness, dizziness, fast heartbeat, sweating, tremor, and nausea. Carry a piece of hard candy or glucose tablets with you to treat episodes of low blood sugar.
Insulin lispro should be given within 15 minutes before or immediately after a meal because it begins to work very soon after injecting a dose and hypoglycemia (low blood sugar) may occur if eating is delayed.
Follow any diet and exercise plan that you have developed with your doctor or nurse. Changes in what you eat or how much you exercise can change the amount of insulin that you need to control your blood sugar levels.
Ask your doctor or nurse what to do if you are sick with a cold, flu, or fever. These illnesses may change your insulin requirements.
Do not change the brand of insulin lispro or syringe that you are using without first talking to your doctor or pharmacist. Some brands of insulin lispro and syringes are interchangeable, while others are not. Your doctor and / or pharmacist know which brands can be substituted for one another.
What is insulin lispro?
Insulin is a hormone naturally produced by your pancreas. Insulin enables your body to use the sugar in food as a source of energy. When the body does not produce enough insulin, or when the insulin produced by the body is not effective enough, the condition is called diabetes mellitus. This condition allows sugar levels in the blood to become very high. Diabetics must use man-made insulin or insulin that comes from pigs (which is very similar to human insulin) to lower these high blood sugar levels.
There are three types of insulin, which differ in how soon they begin to work and how long their effects last. Insulin lispro starts to work in 15 minutes and its effects last for 3 to 5 hours.
Insulin lispro may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before using insulin lispro?
Do not use insulin lispro if you are allergic to insulin or if you have an intolerance of a certain insulin lispro product.
Insulin lispro can be used during pregnancy and breast-feeding. Insulin lispro is not expected to harm a baby. In fact, it is very important to control blood sugar levels during pregnancy. Insulin is the best treatment option for pregnant or breast-feeding women.
How should I use insulin lispro?
Use insulin lispro exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, nurse, or pharmacist to explain them to you.
Insulin lispro should be given within 15 minutes before or immediately after a meal because it begins to work very soon after injecting a dose and hypoglycemia (low blood sugar) may occur if eating is delayed.
If you have stored your insulin lispro in the refrigerator, warm it to room temperature before using it.
If you are mixing different types of insulins in the same syringe, follow your doctor's directions and always draw up the different insulins in the same order (usually the clear insulin first). This may prevent a dosage error.
Change your injection sites exactly as directed by your doctor. Usually, you should not inject within 1 inch of the same site within 1 month.
Never reuse a needle or syringe. Dispose of all needles and syringes in an appropriate, puncture-resistant disposal container.
Do not change the insulin strength (e.g., U-100) or insulin type (e.g., lispro) unless your doctor approves a change for you.
Do not change the brand of insulin lispro or syringe that you are using without first talking to your doctor or pharmacist. Some brands of insulin lispro and syringes are interchangeable, while others are not. Your doctor and / or pharmacist know which brands can be substituted for one another.
Follow any diet and exercise plan that you have developed with your doctor or nurse. Changes in what you eat or how much you exercise can change the amount of insulin that you need to control your blood sugar levels.
Ask your doctor or nurse what to do if you are sick with a cold, flu, or fever. These illnesses may change your insulin requirements.
Wear some type of medical identification bracelet, necklace, or other alert tag to inform others that you have diabetes and that you require insulin in the case of an emergency.
To adequately control diabetes, proper foot care, eye care, dental care, and overall proper health care are necessary. Visit your doctor, dentist, eye doctor, and other heath care practitioners as recommended by your doctor.
Do not use any insulin that is discolored, looks thick, has particles in it, or looks different from your previous bottles, cartridges, or pens of insulin lispro.
Keep the bottle, pen, or cartridge that you are using at room temperature in the original carton, if possible, protected from direct sunlight and extreme heat or cold.
The Humalog vials, cartridges, and pens can be kept unrefrigerated for 28 days, as long as they are kept as cool as possible (at temperatures not greater than 30 degrees Celsius or 86 degrees Fahrenheit). Unrefrigerated vials, cartridges, and pens must be used within this time period or discarded.
Store unused bottles, cartridges, and pens of insulin lispro in the refrigerator in the original carton. Most insulin lispro is good for up to 1 year if it is stored unopened in the refrigerator. Throw away any expired insulin lispro.
What happens if I miss a dose?
Follow your doctor's directions if you miss a dose of insulin. To prevent missed doses, be sure to always have enough insulin on hand, especially if you are going on vacation.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of an insulin overdose reflect very low blood sugar levels and include headache, irregular heartbeat, increased heart rate or pulse, sweating, tremor, nausea, increased hunger, and anxiety.
What should I avoid while using insulin lispro?
Do not use alcohol without first talking to your doctor. It lowers blood sugar, and you may experience dangerously low blood sugar levels.
Follow any diet and exercise plan that you have developed with your doctor or nurse. Changes in what you eat or how much you exercise can change the amount of insulin you need to control your blood sugar levels.
What are the possible side effects of insulin lispro?
Rarely, people have allergic reactions to insulin. Seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives).
The side effects of insulin therapy result mostly from blood sugar levels that are either too high or too low. You should be familiar with the symptoms of both high and low blood sugar levels and know how to treat both conditions. Also, be sure your family and close friends know how to help you in an emergency.
Low blood sugar may occur when too much insulin is used; when meals are missed or delayed; if you exercise more than usual; during illness, especially with vomiting or diarrhea; if you take other medications; after drinking alcohol; and in other situations.
Hypoglycemia, or low blood sugar, has the following symptoms: shaking, headache, cold sweats, pale, cool skin, anxiety, and difficulty concentrating.
Keep hard, sugary candy; chocolate; fruit juice; or glucose tablets on hand to treat episodes of low blood sugar.
Increased blood sugar may occur if not enough insulin is used, if you eat significantly more food then usual, if you exercise less than usual, if you take other medications, if you have a fever or other illness, and in other situations.
Hyperglycemia, or high blood sugar, has the following symptoms: increased thirst, increased hunger, and increased urination.
Monitor your blood sugar levels and ask your doctor how to adjust your insulin doses if your blood sugar levels are too high.
Side effects may also occur at the site of injection. If the area becomes thickened, hard, or pitted, talk to your doctor before injecting at that site again.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect insulin lispro?
Many drugs can interact with insulin or affect your blood sugar levels. Do not take any other medicines, including prescription products or over-the-counter medicines or supplements without first talking to your doctor or pharmacist during treatment with insulin.
Brand Names:
Humalog
My Experience:� This is the life giving hormone for diabetics.� It is a man-make replacement for the hormone most people naturally produce.� It is a real juggling act for diabetic to balance food intake with insulin intake and timing.� Too much insulin or too little food can cause an insulin reaction from low blood sugar which is not comfortable.� It makes you sweat, shake, weak and dizzy. �The symptoms come on very quickly and necessitate eating sugar in some form.� Most of the time, I overreacted and ate too much sugar and caused a �rebound effect� that sent my blood sugar too high.� I experienced hundreds over my diabetic tenure.� The extreme form of this is insulin shock and possible death, neither of which I thankfully experienced.
Likewise, too little insulin or too much food can cause the blood sugar to be too high.� These symptoms come on much slower, sometimes over the course of a couple of days.� You feel lightheaded, weak, very thirsty and urinate frequently.� Yes, the same symptoms that probably indicated diabetes in the first place.� The hidden danger of this condition is long-term complications like my kidney failure, my retinopathy, my neuropathy and others I did not contract.� The immediate danger is ketoacidosis which is a by-product of your body trying to get nutrition by using you fat for energy.� This can lead to coma and possible death.� I experienced many high blood sugar episodes, but did not experience coma.� The other damage from this condition is the subject of this book and hopefully is a harsh lesson for all diabetics out there.
Lasix (see Furosemide)
[need definition]
Pronunciation: LYE doe cane
Brand Names: Anestacon, Bactine, Dermaflex, Ela-Max, Ela-Max 5, Ela-Max Plus, Lida Mantle, Lidocaine Viscous, . . . more
What is the most important information I should know about lidocaine topical?
Do not use lidocaine topical more often or for longer than is directed. Talk to your healthcare provider if your symptoms do not improve or if they worsen.
What is lidocaine topical?
Lidocaine causes loss of feeling (numbness) of skin and mucous membranes.
Lidocaine topical is used to relieve pain associated with sunburn; insect bites; poison ivy; poison oak; poison sumac; minor cuts; scratches; and burns; sores in the mouth; dental procedures; hemorrhoids; and shingles (herpes infection).
Lidocaine topical may also be used for purposes other than those listed here.
What should I discuss with my healthcare provider before using lidocaine topical?
Before using lidocaine topical, talk to your healthcare provider if you have
- liver problems;
- other serious medical conditions; or
- broken, inflamed, or damaged skin (lidocaine patches).
You may not be able to use lidocaine topical, or you may require a dosage adjustment or special monitoring during treatment.
Lidocaine topical is in the FDA pregnancy category B. This means that it is unlikely to be harmful to an unborn baby. Do not use lidocaine topical without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Lidocaine topical passes into breast milk and may affect a nursing baby. Do not use lidocaine topical without first talking to your doctor if you are breast-feeding.
How should I use lidocaine topical?
Use lidocaine topical exactly as directed. If you do not understand these instructions, ask your doctor, nurse, or pharmacist to explain them to you.
Lidocaine topical is intended for external use on the skin only. Do not swallow the medication (unless specifically directed to do so by your doctor if treating a throat condition).
Lidocaine topical may be applied using the finger tips or a cotton swab. Apply the medication as directed by your healthcare provider.
Lidocaine oral cavity patches are applied to the gums by a dentist or a dental assistant before a dental procedure.
Lidocaine solution can be swished around the mouth or gargled, and then spat out. Use a dose-measuring spoon or cup to measure the solution. Ask your pharmacist if you do not have one.
Shake the oral spray well before use. Do not inhale the spray.
Apply the lidocaine patches as directed by your doctor. Make sure the skin does not have any open sores or rashes. You may apply up to 3 patches at one time. Leave the patches on for only 12 hours during a 24-hour period. Patches may be cut into smaller sizes with scissors before removing the adhesive liner. Clothing may be worn over the patches. If irritation or burning occurs due to the patch, remove it and do not reapply until the irritation subsides. Dispose of used lidocaine topical patches where they cannot be reached by children or pets.
Do not use lidocaine topical more often or for longer than is directed. Talk to your healthcare provider if your symptoms do not improve or if they worsen.
Store lidocaine topical at room temperature away from moisture and heat, out of the reach of children and pets.
What happens if I miss a dose?
Apply the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the next regularly scheduled dose as directed. Do not apply a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention if an overdose is suspected or if the medication has been ingested.
Symptoms of a lidocaine topical overdose may include dizziness, drowsiness, confusion, nervousness, ringing in the ears, blurred or double vision, sensation of heat or cold, numbness, twitching, seizures, unconsciousness, decreased breathing, and heart attack.
What should I avoid while using lidocaine topical?
Do not use lidocaine topical more often or for longer than is directed. Talk to your healthcare provider if your symptoms do not improve or if they worsen.
Since there will be decreased sensation of the skin where lidocaine topical is applied, use caution to avoid injury of the area during treatment.
What are the possible side effects of lidocaine topical?
Stop using lidocaine topical and seek emergency medical attention or contact your doctor immediately if you experience any of the following rare but serious side effects:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);;
- chest pain or irregular heartbeats;
- dizziness or drowsiness;
- nausea or vomiting;
- trembling, shaking, or seizures (convulsions); or
- blurred or double vision.
Other less serious side effects may be more likely to occur. Continue to use lidocaine topical and talk to your healthcare provider if you experience
- mild irritation, redness, or swelling at the application site.
Side effects other than those listed here may also occur. Continue to use lidocaine topical and talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect lidocaine topical?
Although lidocaine topical is unlikely to affect medicines taken by mouth, talk to your doctor before using lidocaine topical if you are taking digoxin (Lanoxin) or any medicine to control irregular heartbeats. You may not be able to use lidocaine topical, or you may require a dosage adjustment or special monitoring.
Avoid using other topical medications on the affected area without first talking to your doctor.
Drugs other than those listed here may also interact with lidocaine topical. Talk to your doctor and pharmacist before taking or using any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.
Brand Names:
Anestacon
Bactine
Dermaflex
Ela-Max
Ela-Max 5
Ela-Max Plus
Lida Mantle
Lidocaine Viscous
Lidoderm
Lidomar
Medi-Quik Spray
Protech First Aid Stik
Solarcaine
Xylocaine 10% Oral
Xylocaine Jelly
Xylocaine Topical
Xylocaine Viscous
Zilactin-L
My Experience:� The only time I recall using this drug is just before I had a peripheral IV inserted into my arm or hand.� This was usually after my best efforts to get a subcutaneous (below the skin) shot of the drug.� I did not find the topical (on top of the skin) use to be very effective.� It takes about 15 minutes to take effect and if they cannot hit the vein in that area, I found very few that were willing to wait another 15 minutes to try again.� At that point, I usually was so exasperated that I gave the go-ahead despite the pain.
Lipitor (see Atorvastatin)
Lisinopril
Pronunciation: lye SIH no pril
Brand Name:� Prinivil, Zestril
What is the most important information I should know about lisinopril?
Do not take lisinopril if you are pregnant or planning a pregnancy. When used during the second and third trimesters of pregnancy, lisinopril can cause injury and even death to the developing fetus. Notify your doctor immediately if you think you might be pregnant.
Lisinopril may increase the risk of dangerous allergic reactions. Before taking lisinopril, tell your doctor if you have ever had an allergic reaction that involved swelling of your lips, face, tongue, or throat or difficulty breathing. Seek emergency medical attention if you develop any of these symptoms while taking lisinopril.
Heavy sweating, vomiting, diarrhea, or other causes of fluid loss may lead to very low blood pressure, dizziness, and fainting during therapy with lisinopril. Maintain proper fluid intake to prevent dehydration and related side effects.
What is lisinopril?
Lisinopril is in a class of drugs called angiotensin-converting-enzyme (ACE) inhibitors.
Lisinopril is used to lower blood pressure, to treat congestive heart failure, and to improve the survival rate after a heart attack.
Lisinopril may also be used for purposes other than those listed in this medication guide.
Who should not take lisinopril?
Lisinopril may increase the risk of dangerous allergic reactions. Before taking lisinopril, tell your doctor if you have ever had an allergic reaction that involved swelling of your lips, face, tongue, or throat or difficulty breathing. Seek emergency medical attention if you develop any of these symptoms while taking lisinopril.
Before taking lisinopril, tell your doctor if you
- have kidney disease;
- are on a salt-restricted diet or have high levels of potassium in your blood;
- are taking salt substitutes, potassium supplements (e.g., K-Dur, Klor-Con), or potassium-sparing diuretics such as amiloride (Midamor), triamterene (Dyrenium, Dyazide, Maxzide), or spironolactone (Aldactone); or
- have diabetes.
You may not be able to take lisinopril, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Lisinopril is in the FDA pregnancy category D. This means that lisinopril is known to harm an unborn baby. When used during the second and third trimesters of pregnancy, lisinopril can cause injury and even death to the developing fetus.� Do not take lisinopril if you are pregnant.
It is not known whether lisinopril passes into breast milk, and its effects on a nursing baby are not known. Do not take lisinopril without first talking to your doctor if you are breast-feeding a baby.
How should I take lisinopril?
Take lisinopril exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Lisinopril can be taken with or without food.
Do not stop taking lisinopril without first talking to your doctor. If you stop taking this medication suddenly, your condition could become worse.
Store lisinopril at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a lisinopril overdose include extreme dizziness, weakness, fainting, and fatigue.
What should I avoid while taking lisinopril?
Use caution when driving, operating machinery, or performing other hazardous activities. Lisinopril may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities and notify your doctor. Also use caution when rising from a sitting or lying position.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking lisinopril. Alcohol may further lower blood pressure and increase drowsiness and dizziness when you are taking lisinopril.
Do not use salt substitutes or potassium supplements while taking lisinopril except under the supervision of your doctor.
Heavy sweating, vomiting, diarrhea, or other causes of fluid loss may lead to very low blood pressure, dizziness, and fainting during therapy with lisinopril. Maintain proper fluid intake to prevent dehydration and related side effects.
What are the possible side effects of lisinopril?
If you experience any of the following serious side effects, stop taking lisinopril and call your doctor immediately or seek emergency medical treatment:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- difficulty breathing;
- little or no urine;
- an irregular heartbeat or changes in your heartbeat;
- chest pain;
- severe dizziness or fainting; or
- signs of an infection including a sore throat or a fever.
Other, less serious side effects may be more likely to occur. Continue to take lisinopril and talk to your doctor if you experience
- mild dizziness or lightheadedness;
- headache;
- unusual fatigue or weakness;
- dry, tickling cough;
- muscle cramps;
- numbness or tingling in the hands, feet, arms, or legs;
- nausea, vomiting, or diarrhea;
- a rash; or
- impotence.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
�
What other drugs will affect lisinopril?
Before taking lisinopril, tell your doctor if you are taking any of the following drugs:
- a potassium supplement such as K-Dur, Klor-Con, and others;
- salt substitutes that contain potassium;
- any of the diuretics (water pills) triamterene (Dyrenium, Maxzide, Dyazide), spironolactone (Aldactone), or amiloride (Midamor);
- any other diuretic (water pill) such as hydrochlorothiazide (HCTZ, HydroDiuril, others), furosemide (Lasix), bumetanide (Bumex), indapamide (Lozol), and others;
- lithium (Lithobid, Eskalith, others); or
- indomethacin (Indocin).
You may not be able to take lisinopril, or you may require a dosage adjustment or special monitoring during your treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with lisinopril or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Brand Names:
Prinivil
Zestril
My Experience:� If you have a failing kidney, you need to ask you doctor about putting you on this medicine immediately if you are not already taking it.� When your kidneys fail, they lose their ability to regulate your blood pressure and it will go up.� This drug helps to reduce your blood pressure.� In addition, it has been shown to have protective properties that may prolong your kidney function.� The only side effect I experienced with this drug was low blood pressure.� This can be somewhat debilitating and come on fairly quickly.� I would eat something salty and drink a lot of water while lying down with my feet elevated.� It usually goes away quickly.� This mostly happened to me when I would exert myself and especially if it caused sweating.
Lopressor (see Metoprolol)
Pronunciation: me PER i deen
Brand Name: Demerol HCl
What is the most important information I should know about meperidine?
Meperidine may be habit forming. Physical and / or psychological dependence can occur, and withdrawal effects are possible if the medication is stopped suddenly after prolonged or high-dose treatment. Do not stop taking meperidine suddenly without first talking to your doctor if you have been taking it continuously for more than 5 to 7 days. Your doctor may want to gradually reduce the dose.
Meperidine may increase the effects of other drugs that cause drowsiness, including other pain relievers, alcohol, antihistamines, sedatives (used to treat insomnia), antidepressants, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine without first talking to your doctor.
Meperidine may cause constipation. Drink plenty of water (six to eight full glasses a day) to lessen this side effect. Increasing the amount of fiber in the diet can also help to alleviate constipation.
Never take more meperidine than is prescribed. If the pain is not being adequately treated, talk to your doctor.
What is meperidine?
Meperidine is in a class of drugs called narcotic analgesics. It relieves pain.
Meperidine is used to treat moderate-to-severe pain.
Meperidine may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking meperidine?
Meperidine may be habit forming and should only be used under close supervision if there is a history of alcohol or drug addiction.
Before taking this medication, tell your doctor if you have
- kidney disease;
- liver disease;
- asthma;
- urinary retention;
- an enlarged prostate;
- hypothyroidism;
- seizures or epilepsy;
- gallbladder disease;
- a head injury; or
- Addison's disease.
You may not be able to take meperidine, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Meperidine may cause addiction and withdrawal symptoms as well as other harmful effects in an unborn baby. Do not take meperidine without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Meperidine may also cause addiction and withdrawal symptoms in a nursing infant. Do not take meperidine without first talking to your doctor if you are breast-feeding a baby.
How should I take meperidine?
Take meperidine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Take meperidine with food or milk if it causes stomach upset.
To ensure that you get a correct dose, measure the syrup with a special dose-measuring spoon or cup, not with a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
Meperidine is also available as an injection. Your healthcare provider will administer injectable meperidine. If you are using injectable meperidine at home, your healthcare provider will give you detailed instructions regarding preparation, administration, and storage of the medication.
Never take more meperidine than is prescribed. If the pain is not being adequately treated, talk to your doctor.
Meperidine may be habit forming. Physical and / or psychological dependence can occur, and withdrawal effects are possible if the medication is stopped suddenly after prolonged or high-dose treatment. Do not stop taking meperidine suddenly without first talking to your doctor if you have been taking it continuously for more than 5 to 7 days. Your doctor may want to gradually reduce the dose.
Meperidine may cause constipation. Drink plenty of water (six to eight full glasses a day) to lessen this side effect. Increasing the amount of fiber in the diet can also help to alleviate constipation.
Do not share this medication with anyone else.
Store meperidine at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Do not take a double dose of this medication. Wait the prescribed amount of time before taking the next dose.
What happens if I overdose?
Seek emergency medical attention if an overdose is suspected.
Symptoms of a meperidine overdose include slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, confusion, tiredness, cold and clammy skin, and small pupils.
What should I avoid while taking meperidine?
Use caution when driving, operating machinery, or performing other hazardous activities. Meperidine may cause drowsiness. If you experience drowsiness, avoid these activities.
Avoid alcohol while taking meperidine. Alcohol may increase the drowsiness and dizziness caused by meperidine and could be dangerous.
Meperidine may increase the effects of other drugs that cause drowsiness, including other pain relievers, alcohol, antihistamines, sedatives (used to treat insomnia), antidepressants, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine without first talking to your doctor.
What are the possible side effects of meperidine?
If you experience any of the following serious side effects, stop taking meperidine and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- slow, weak breathing;
- seizures;
- cold, clammy skin;
- severe weakness or dizziness; or
- unconsciousness.
Other, less serious side effects may be more likely to occur. Continue to take meperidine and talk to your doctor if you experience
- constipation;
- dry mouth, nausea, vomiting, or decreased appetite;
- dizziness, tiredness, or lightheadedness;
- muscle twitches;
- sweating;
- itching;
- decreased urination; or
- decreased sex drive.
Meperidine may be habit forming. Physical and / or psychological dependence can occur, and withdrawal effects are possible if the medication is stopped suddenly after prolonged or high-dose treatment. Do not stop taking meperidine suddenly without first talking to your doctor if you have been taking it continuously for more than 5 to 7 days. Your doctor may want to gradually reduce the dose.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect meperidine?
Do not take meperidine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. Dangerous side effects could result.
Meperidine may increase the effects of other drugs that cause drowsiness, including other pain relievers, alcohol, antihistamines, sedatives (used to treat insomnia), antidepressants, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine without first talking to your doctor.
Drugs other than those listed here may also interact with meperidine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.
Brand Names:
Demerol HCl
Methylprednisolone
Pronunciation: meh thill pred NIH sew lone
Brand Names: Duralone, Medipred, Medralone, Medrol, Predacorten, Solu-Medrol
What is the most important information I should know about methylprednisolone?
Do not stop taking methylprednisolone suddenly if you have been taking it for a few weeks. You may need a gradual reduction in dosage before you stop taking this medication.
Take oral methylprednisolone with food or milk to lessen stomach upset.
Carry some type of medical identification that will let others know you are taking methylprednisolone in the case of an emergency.
What is methylprednisolone?
Methylprednisolone is in a class of drugs called steroids. Methylprednisolone reduces swelling and decreases the body's immune response.
Methylprednisolone is used to treat many different conditions. It is used to treat endocrine (hormonal) disorders when the body does not produce enough of its own steroids. It is also used to treat many immune and allergic disorders, such as arthritis, lupus, psoriasis, asthma, ulcerative colitis, and Crohn's disease.
Methylprednisolone may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking methylprednisolone?
Do not take methylprednisolone if you have a serious bacterial, viral, or fungal infection. Methylprednisolone weakens the body's immune response and thus its ability to fight infection.
Before taking this medication, tell your doctor if you have
- kidney disease,
- liver disease,
- high blood pressure or heart disease,
- ulcerative colitis, diverticulitis, or stomach ulcers,
- hypothyroidism,
- a psychiatric condition,
- osteoporosis,
- myasthenia gravis,
- diabetes mellitus, or
- any other medical conditions.
You may not be able to take methylprednisolone, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Methylprednisolone is in the FDA pregnancy category C. This means that it is not known whether methylprednisolone will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Methylprednisolone passes into breast milk and may affect a nursing baby. Do not take methylprednisolone without first talking to your doctor if you are breast-feeding a baby.
How should I take methylprednisolone?
Take methylprednisolone exactly as directed by your doctor. Do not take more or less than is prescribed for you. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each oral dose with a full glass of water.
Take oral methylprednisolone with food or milk to lessen stomach upset.
Methylprednisolone is also available as an injection. Your healthcare provider will administer injectable methylprednisolone. If you are using injectable methylprednisolone at home, your healthcare provider will give you detailed instructions regarding preparation, administration, and storage of the medication.
If you are taking one dose daily, take that dose before 9 a.m. if possible, to follow the body's natural cycle. If you take more than one dose daily, space the doses evenly throughout the day as directed by your doctor.
Do not stop taking methylprednisolone suddenly if you have been taking it for a few weeks. You may need a gradual reduction in dosage before you stop taking this medication.
Carry some type of medical identification that will let others know you are taking methylprednisolone in the case of an accident.
Store methylprednisolone at room temperature away from moisture and heat.
What happens if I miss a dose?
If you take one dose daily, take the missed dose as soon as you remember. However, if you don't remember until the next day, skip the dose you missed and take only the regular daily dose.
If you take more than one dose daily, you can either take the missed dose as soon as you remember, or you can take two doses (the one you missed plus your regularly scheduled dose) when it is time for the next dose.
If you take one dose every other day, take the missed dose as soon as you remember, then go back to your regular every-other-day schedule.
What happens if I overdose?
Seek emergency medical attention. A single large dose of this medication is unlikely to cause symptoms or death. An overdose is more likely to be caused by a chronic overdose--large doses taken over a period of time.
Symptoms of an overdose include obesity (especially around the stomach); a round face; increased hair growth (especially around the face); acne; bruising; increased blood pressure; swollen hands, feet, or ankles (fluid retention); and sore or weak muscles.
What should I avoid while taking methylprednisolone?
Use alcohol cautiously. Together, alcohol and oral methylprednisolone can be damaging to the stomach.
Avoid sources of infection. Wash the hands frequently and keep them away from the mouth and eyes. The immune system may be weakened while taking methylprednisolone.
Do not receive any immunizations during treatment with methylprednisolone without first talking to your doctor.
What are the possible side effects of methylprednisolone?
If you experience any of the following serious side effects, stop taking methylprednisolone and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- increased blood pressure (severe headache or blurred vision); or
- sudden weight gain (more than 5 pounds in a day or two).
Other, less serious side effects may be more likely to occur. Continue to take methylprednisolone and talk to your doctor if you experience
- insomnia;
- nausea, vomiting, or stomach upset;
- fatigue or dizziness;
- muscle weakness or joint pain;
- problems with diabetes control; or
- increased hunger or thirst.
Other side effects that occur only rarely, usually with high doses of methylprednisolone, may include
- acne,
- increased hair growth,
- thinning of the skin,
- cataracts,
- glaucoma,
- osteoporosis,
- roundness of the face, and
- changes in behavior.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect methylprednisolone?
Do not take any other over-the-counter or prescription medications, including herbal products, during treatment with methylprednisolone without first talking to your doctor. Many other medicines can interact with methylprednisolone resulting in side effects or altered effectiveness of the medications.
Brand Names:
Duralone
Medipred
Medralone
Medrol
Predacorten
Solu-Medrol
[need definition]
Pronunciation: me TOE proe lole
Brand Names: Lopressor, Toprol XL
What is the most important information I should know about metoprolol?
Do not stop taking metoprolol without first talking to your doctor. Stopping metoprolol abruptly may cause your condition to become worse.
Call your doctor immediately if you experience shortness of breath.
Use caution when driving, operating machinery, or performing other hazardous activities. Metoprolol may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
What is metoprolol?
Metoprolol is in a class of drugs called beta-blockers. Beta-blockers affect the heart and circulatory system.
Metoprolol is used to reduce hypertension (high blood pressure), to treat chest pain (angina), to treat heart failure, and to reduce the risk that a heart attack will recur.
Metoprolol may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking metoprolol?
Before taking metoprolol, tell your doctor if you have
- asthma;
- a heart problem such as low blood pressure, a slow heart rate, heart block, sick sinus syndrome, a pacemaker, heart failure, and others;
- diabetes;
- depression;
- thyroid disease;
- kidney disease;
- liver disease; or
- any type of circulatory disease.
You may not be able to take metoprolol, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Metoprolol is in the FDA pregnancy category C. This means that it is not known whether metoprolol will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Metoprolol passes into breast milk in small amounts and may affect a nursing baby. Do not take metoprolol without first talking to your doctor if you are breast-feeding a baby.
How should I take metoprolol?
Take metoprolol exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Take metoprolol with food or immediately following a meal.
Do not crush or chew the extended-release tablets and capsules (e.g., Toprol XL). The tablets can be divided in half if prescribed by your doctor and the half tablet should be swallowed whole, without crushing or chewing. These tablets are specially formulated to release the medication slowly in the body.
It is important to take metoprolol regularly to get the most benefit.
Do not stop taking metoprolol without first talking to your doctor. Stopping metoprolol abruptly may cause your condition to become worse.
Your doctor may want you to have blood pressure monitoring or other medical evaluations during treatment with metoprolol to monitor progress and side effects.
Store this medication at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for the next dose however, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention if an overdose is suspected.
Symptoms of a metoprolol overdose include a slow heart beat, shortness of breath, fainting, dizziness, weakness, confusion, nausea, and vomiting.
What should I avoid while taking metoprolol?
Use caution when driving, operating machinery, or performing other hazardous activities. Metoprolol may cause drowsiness, dizziness, and blood pressure changes. If you experience drowsiness or dizziness, avoid these activities.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking this medication.
Tell your doctor and dentist that you are taking this medication before having surgery.
What are the possible side effects of metoprolol?
If you experience any of the following serious side effects, stop taking metoprolol and contact your doctor immediately or seek emergency medical treatment:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; hives);
- wheezing or shortness of breath;
- an unusually slow or irregular heartbeat;
- swelling of the feet and lower legs;
- leg pain or cramping;
- sudden weight gain (more than 2 pounds in one day or 5 pounds in one week);
- chest (heart) pain;
- unusually cold or blue feet and hands; or
- skin rash.
If you experience any of the following less serious side effects, continue taking metoprolol and talk to your doctor:
- fatigue or confusion;
- headache or dizziness;
- weak pulse or mildly slow heart rate;
- diarrhea, constipation, gas, nausea, or vomiting;
- depression; or
- nightmares.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect metoprolol?
Before taking metoprolol, tell your doctor if you are taking
- a heart medication such as nifedipine (Procardia, Adalat), reserpine (Serpasil), verapamil (Calan, Verelan, Isoptin), diltiazem (Cardizem, Dilacor XR), clonidine (Catapres), digoxin (Lanoxin), doxazosin (Cardura), guanadrel (Hylorel), prazosin (Minipress), or terazosin (Hytrin);
- a diabetes medication such as insulin, glyburide (Diabeta, Micronase, Glynase), glipizide (Glucotrol), chlorpropamide (Diabinese), or metformin (Glucophage);
- a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil, others), naproxen (Aleve, Anaprox, Naprosyn, others), ketoprofen (Orudis, Orudis KT, Oruvail), and others;
- a respiratory medication such as albuterol (Ventolin, Proventil, Volmax, others), bitolterol (Tornalate), metaproterenol (Alupent, Metaprel), pirbuterol (Maxair), terbutaline (Brethaire, Brethine, Bricanyl), or theophylline (Theo-Dur, Theochron, Theolair, others), and others;
- the stomach medication cimetidine (Tagamet, Tagamet HB); or
- prescription or over-the-counter cough medicines, cold medicines, or diet pills.
You may not be able to take metoprolol, or you may require a dosage adjustment or special monitoring during treatment.
Drugs other than those listed here may also interact with metoprolol or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.
Brand Names:
Lopressor
Toprol XL
[need definition]
Pronunciation: myoo PEER oh sin
Brand Name: Bactroban
What is the most important information I should know about mupirocin topical?
Use this medication for the full amount of time prescribed by your doctor or as recommended in the package even if you begin to feel better. Your symptoms may improve before the infection is completely healed.
Avoid your eyes, nose, mouth, and lips when applying mupirocin topical. If medication gets in any of these areas, wash with water.
Watch for signs of improvement in 3 to 5 days. If your condition gets worse or does not improve, see your doctor.
What is mupirocin topical?
Mupirocin is an antibiotic. Mupirocin topical prevents bacteria from growing on your skin.
Mupirocin topical is used to treat infections of the skin such as impetigo.
Mupirocin topical may also be used for purposes other than those listed in this medication guide.
Who should not use mupirocin topical?
Do not use mupirocin topical if you have ever had an allergic reaction to it.
You may not be able to use mupirocin topical if you have a very large open wound. This medication contains polyethylene glycol, which may cause damage to your kidneys if too much drug is absorbed through your skin.
Mupirocin topical is in the FDA pregnancy category B. This means that it is unlikely to harm an unborn baby. Do not use mupirocin topical without first talking to your doctor if you are pregnant.
Mupirocin topical passes into breast milk and may affect a nursing infant. Do not use mupirocin topical without first talking to your doctor if you are breast-feeding a baby.
How should I use mupirocin topical?
Use mupirocin topical exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Wash your hands before and after using this medication.
Clean and dry the affected area. Apply a small amount of the ointment as directed.
Use this medication for the full amount of time prescribed by your doctor or as recommended in the package even if you begin to feel better. Your symptoms may improve before the infection is completely healed.
You should notice improvement in 3 to 5 days. If the infection gets worse or does not improve, consult your doctor.
Do not use bandages that do not allow air circulation over the affected area unless otherwise directed by your doctor. A light, cotton-gauze dressing may be used to protect clothing.
Avoid getting this medication in your eyes, nose, or mouth or in large, open wounds.
Store mupirocin topical at room temperature away from moisture and heat.
What happens if I miss a dose?
Apply the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and apply only the regular amount of mupirocin topical. Do not use a double dose of this medication unless otherwise directed by your doctor.
What happens if I overdose?
An overdose of mupirocin topical is rare. Consult a doctor if you suspect an overdose. No symptoms of an overdose are known.
If mupirocin topical gets in your eyes or mouth, rinse with water.
If mupirocin topical is ingested, consult a poison control center.
What should I avoid while using mupirocin topical?
Avoid using other topical preparations on the same area at the same time unless directed to do so by your doctor.
What are the possible side effects of mupirocin topical?
Serious side effects are not expected to occur with mupirocin topical therapy. Stop using mupirocin topical and see your doctor if you experience unusual blistering, itching, redness, peeling, dryness, or irritation of the skin.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect mupirocin topical?
Other topical medications may change the way that your skin absorbs mupirocin topical. Avoid using other products on the same area at the same time unless directed to do so by your doctor.
Brand Names:
Bactroban
Mycelex (see Clotrimazole)
Mycophenolate mofetil (oral)
Pronunciation: my koe PHEH no late MAH feh till
Brand Name: CellCept
What is the most important information I should know about mycophenolate mofetil?
Therapy with mycophenolate mofetil may increase your risk of infection and the development of lymphoma and other types of cancer. Notify your doctor immediately if you develop fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These symptoms could be early signs of dangerous side effects.
Mycophenolate mofetil has caused birth defects in animals, and therefore is not recommended for use during pregnancy. Your doctor may ask that you have a pregnancy test with negative results within 1 week of starting therapy with mycophenolate mofetil. Birth control must be used before starting treatment, during treatment, and for six weeks following treatment with mycophenolate mofetil, unless abstinence is the chosen method or if you have had a hysterectomy. Do not take this medication without first talking to your doctor if you are pregnant or if you are thinking about becoming pregnant.
Do not open the capsules or crush or chew the tablets. Do not inhale the powder, or allow the powder or suspension to come in contact with your skin, eyes, or mucous membranes. If contact with the skin, eyes or mucous membranes occurs, wash your skin with soap and water and rinse your eyes with plain water.
Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.
Mycophenolate mofetil may increase the risk of developing skin cancer. Limit exposure to sunlight and UV light by wearing protective clothing and using a sunscreen with a high protection factor (SPF).
What is mycophenolate mofetil?
Mycophenolate mofetil is an immunosuppressant. Immunosuppressants decrease the actions of your body's immune system.
Mycophenolate mofetil is used to prevent your body from rejecting a kidney, liver, or heart transplant. It is usually combined with cyclosporine (Sandimmune, Neoral) and a steroid medication.
Mycophenolate mofetil may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking mycophenolate mofetil?
Before taking mycophenolate mofetil, tell your doctor if you have
- a stomach ulcer or other stomach disease;
- a viral, bacterial, or fungal infection; or
- a rare hereditary deficiency of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) such as Lesch-Nyhan and Kelley-Seegmiller syndrome.
You may not be able to take mycophenolate mofetil, or you may require a lower dose or special monitoring if you have any of the conditions listed above.
Before taking the CellCept Oral Suspension, tell your doctor if you have phenylketonuria. This product contains aspartame, which is a source of phenylalanine.
Mycophenolate mofetil is in the FDA pregnancy category C. This means that it is not known whether mycophenolate mofetil will harm an unborn baby. Mycophenolate mofetil has caused birth defects in animals, and therefore is not recommended for use during pregnancy. Your doctor may ask that you have a pregnancy test with negative results within 1 week of starting therapy with mycophenolate mofetil. Birth control must be used before starting treatment, during treatment, and for six weeks following treatment with mycophenolate mofetil, unless abstinence is the chosen method or if you have had a hysterectomy. Do not take this medication without first talking to your doctor if you are pregnant or if you are thinking about becoming pregnant.
It is not known whether mycophenolate mofetil passes into breast milk. Do not take mycophenolate mofetil without first talking to your doctor if you are breast-feeding a baby.
How should I take mycophenolate mofetil?
Take mycophenolate mofetil exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.
Take each dose with a full glass of water.
Take mycophenolate mofetil on an empty stomach, 1 hour before or 2 hours after a meal unless otherwise directed by your doctor.
Mycophenolate mofetil is usually taken twice a day. Follow your doctor's instructions.
Shake the suspension well before measuring a dose. Use the dose-measuring device supplied by your pharmacist to measure a dose of the suspension.
Do not open the capsules or crush or chew the tablets. Do not inhale the powder, or allow the powder or suspension to come in contact with your skin, eyes, or mucous membranes. If contact with the skin, eyes or mucous membranes occurs, wash your skin with soap and water and rinse your eyes with plain water.
Therapy with mycophenolate mofetil may increase your risk of infection and the development of lymphoma and other types of cancer. Notify your doctor immediately if you develop fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These symptoms could be early signs of dangerous side effects.
Store mycophenolate mofetil at room temperature away from moisture and heat. The suspension can be stored in the refrigerator, however this is not necessary. Do not allow the suspension to freeze. Throw away any unused suspension after 60 days.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed, and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
Notify your doctor if you miss a dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a mycophenolate mofetil overdose include nausea, vomiting, diarrhea, and unusual bleeding or bruising.
What should I avoid while taking mycophenolate mofetil?
Avoid sources of infection. Mycophenolate mofetil decreases your body's immune system, and you are more susceptible to infection. Notify your doctor at the first sign of fever, chills, or a sore throat.
Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.
Mycophenolate mofetil may increase the risk of developing skin cancer. Limit exposure to sunlight and UV light by wearing protective clothing and using a sunscreen with a high protection factor (SPF).
What are the possible side effects of mycophenolate mofetil?
If you experience any of the following serious side effects, stop taking mycophenolate mofetil and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- unusual tiredness or weakness;
- cough, hoarseness, a sore throat, fever, or chills;
- painful or difficult urination;
- severe nausea, vomiting, or diarrhea;
- abdominal pain;
- pale stools or darkened urine;
- unusual bleeding or bruising; or
- a sudden unusual feeling of discomfort or illness.
Other, less serious side effects may also occur. Continue to take mycophenolate mofetil and notify your doctor if you experience
- upset stomach, nausea, or vomiting;
- diarrhea or constipation;
- mild weakness;
- tremor or dizziness;
- headache;
- insomnia;
- swelling of the feet or lower legs; or
- a skin rash.
Treatment with mycophenolate mofetil increases the risk of cancer of the immune system.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect mycophenolate mofetil?
Before taking mycophenolate mofetil, tell your doctor if you are taking any of the following medicines:
- another immunosuppressant medicine such as azathioprine (Immoral), tacrolimus (Prograf), or daclizumab (Zenapax);
- cholestyramine (Questran);
- an antacid (prescription or over the counter);
- acyclovir (Zovirax) or ganciclovir (Cytovene);
- probenecid (Benemid);
- phenytoin (Dilantin);
- theophylline (Theo-Dur, Theochron, Theolair, others); or
- any type of vaccination.
You may not be able to take mycophenolate mofetil, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with mycophenolate mofetil. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Brand Names:
CellCept
Neoral (see Cyclosporine)
Neupogen (see Filgrastim)
Neurontin (see Gabapentin)
Nexium (see Esomeprazole)
Nitazoxanide
Pronunciation: nye tah ZOX ah nide
Brand Name: Alinia
What is the most important information I should know about nitazoxanide?
Take nitazoxanide with food.
Talk to your doctor before taking other prescription or over-the-counter medications, including herbal products, during treatment with nitazoxanide.
What is nitazoxanide?
Nitazoxanide is an antiprotozoal agent.
Nitazoxanide is used to treat diarrhea in children caused by the protozoa Cryptosporidium parvum and Giardia lamblia.
Nitazoxanide may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking nitazoxanide?
Talk to your doctor before taking nitazoxanide if you have
- liver disease;
- kidney disease; or
- HIV infection or problems with your immune system.
You may not be able to take nitazoxanide, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
The nitazoxanide oral suspension contains 1.48 grams of sucrose per 5 mL (teaspoon). Individuals with diabetes may need to monitor their intake of sucrose.
Nitazoxanide is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Since nitazoxanide is only indicated for use by children, it should not be taken by a pregnant woman. Do not take nitazoxanide without first talking to your doctor if you are pregnant or could become pregnant during treatment.
It is not known whether nitazoxanide passes into breast milk. Since nitazoxanide is only indicated for use by children, it should not be taken by a woman who is breast-feeding. Do not take nitazoxanide without first talking to your doctor if you are breast-feeding a baby.
How should I take nitazoxanide?
Take nitazoxanide exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take nitazoxanide with food.
Shake the suspension well before measuring a dose. To ensure that you get the correct dose, measure the suspension with a dose-measuring spoon, dropper, or cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
Store the suspension at room temperature. The suspension may be stored for 7 days, after which any unused portion must be discarded.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If you do not remember until it is time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of the medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a nitazoxanide overdose are not known.
What should I avoid while taking nitazoxanide?
There are no restrictions on food, beverages, or activity during treatment with nitazoxanide unless otherwise directed by your doctor.
What are the possible side effects of nitazoxanide?
Stop taking nitazoxanide and seek emergency medical attention if you experience a rare allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives).
Other, less serious side effects may be more likely to occur. Continue to take the medication if you experience
- abdominal pain;
- diarrhea;
- vomiting; or
- headache.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect nitazoxanide?
Talk to your doctor before taking other prescription or over-the-counter medications, including herbal products, during treatment with nitazoxanide.
Brand Names:
Alinia
Pronunciation: ock TREE oh tide
Brand Names: Sandostatin, Sandostatin LAR Depot
What is the most important information I should know about octreotide?
Octreotide solution may be allowed to come to room temperature prior to administration by removal from the refrigerator. Do not warm the medication in any way other than removing it from the refrigerator.
What is octreotide?
Octreotide is a synthetic (man-made) protein that is similar to the naturally-occurring hormone called somatostatin. Octreotide decreases the production of many substances in the body such as insulin and glucagon (involved in regulating blood sugar), growth hormone, and chemicals that affect digestion.
Octreotide is used in the treatment of acromegaly. Octreotide is also used to reduce flushing and watery diarrhea caused by metastatic cancerous tumors (carcinoid syndrome) or tumors called vasoactive intestinal peptide tumors (VIPomas).
Octreotide may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before using octreotide?
Before using octreotide, talk to your doctor if you have
- diabetes;
- gallbladder disease;
- heart disease;
- thyroid problems;
- pancreatitis;
- kidney disease; or
- liver disease.
You may not be able to use octreotide, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Octreotide is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not use octreotide without first talking to your doctor if you are pregnant or could become pregnant during treatment.
It is not known whether octreotide passes into breast milk. Do not use octreotide without first talking to your doctor if you are breast-feeding a baby.
How should I use octreotide?
Use octreotide exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.
Octreotide (Sandostatin) can be injected subcutaneously (into the fat) or intravenously (into a vein). A depot formulation of octreotide called Sandostatin LAR is injected into the muscle and is intended for use every four weeks. Your healthcare provider may administer octreotide or will give you detailed instructions on how to administer the medication at home.
Do not inject any octreotide product that is discolored or has particles in it.
Octreotide solution may be allowed to come to room temperature prior to administration by removal from the refrigerator. Do not warm the medication in any way other than removing it from the refrigerator.
After initial use from a multiple-dose vial, octreotide should be used within 14 days and any remaining medication should be discarded.
The Sandostatin LAR Depot product kit should be kept at room temperature for 30 to 60 minutes before mixing the suspension. After mixing the suspension, it should be administered immediately.
Rotate injection sites as directed by your healthcare provider.
Never reuse a needle or syringe. Dispose of all needles and syringes in an appropriate, puncture resistant disposal container.
It is important to use octreotide regularly to get the most benefit.
Your doctor may want you to have regularly scheduled blood tests or other medical evaluations during treatment with octreotide to monitor progress and side effects.
Store unopened vials and ampules of octreotide (Sandostatin, Sandostatin LAR Depot) in the refrigerator between 36 and 46 degrees Fahrenheit (2 and 8 degrees Celsius), protected from light. Do not allow the medication to freeze.
Octreotide (Sandostatin) solution may be stored at room temperature, protected from light, for up to 14 days.
What happens if I miss a dose?
Contact your doctor if you miss a dose of octreotide.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a octreotide overdose have not been reported. An overdose of octreotide is unlikely to threaten life.
What should I avoid while using octreotide?
There are no restrictions on food, beverages, or activity during treatment with octreotide unless otherwise directed by your doctor.
What are the possible side effects of octreotide?
If you experience any of the following serious side effects, seek medical attention or notify your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- irregular heartbeats or changes in heart rate;
- gallbladder problems (abdominal pain);
- thyroid problems (may be detected by blood tests);
- low blood sugar (symptoms may include chills; cool, pale skin or cold sweats; drowsiness or fatigue; extreme hunger; fast heartbeat; headache; nausea; nervousness or anxiety; shakiness or trembling; unsteadiness; or weakness); or
- high blood sugar (symptoms may include frequent urination; unusual thirst; flushed or dry skin; drowsiness).
- Other side effects may also occur. Notify your doctor if you experience
- nausea or vomiting;
- diarrhea;
- stomach pain or gas;
- constipation; or
- pain, redness, or irritation at the injection site.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect octreotide?
Octreotide should not be used at the same time as cyclosporine (Neoral, Sandimmune, Gengraf). Talk to your doctor before using octreotide if you are using cyclosporine.
Before using octreotide, tell your doctor if you are taking any of the following medicines:
- a diabetes medication such as insulin, glipizide (Glucotrol), glyburide (Diabeta, Micronase), tolbutamide (Orinase), metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and others;
- a medicine for heart disease or high blood pressure; or
- a diuretic or water pill.
You may not be able to use octreotide, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with octreotide. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
Brand Names:
Sandostatin
Sandostatin LAR Depot
Pronunciation: on DAN se tron
Brand Name: Zofran
What is the most important information I should know about ondansetron?
The ondansetron orally disintegrating tablets (Zofran ODT) can be taken with or without water. Do not remove the tablet from the blister until immediately before taking a dose. Do not try to push the tablet through the foil backing, the tablet may break. With dry hands, peel back the foil backing of one blister and gently remove the tablet. Immediately place the tablet on your tongue where it will dissolve in seconds, then swallow with saliva. Administration with water is not necessary.
What is ondansetron?
Ondansetron blocks the actions of chemicals in the body that may cause nausea and vomiting.
Ondansetron is used to prevent nausea and vomiting associated with cancer chemotherapy, radiation therapy, and surgery.
Ondansetron may also be used for purposes other than those listed in this medication guide.
Who should not take ondansetron?
Before taking ondansetron, tell your doctor if you have liver disease. You may require a dosage adjustment or special monitoring during treatment.
The Zofran ODT (orally disintegrating tablets) contain phenylalanine. Phenylketonuric patients should be aware that both the 4 mg and 8 mg tablets contain less than 0.03 mg of phenylalanine.
Ondansetron is in the FDA pregnancy category B. This means that it is not likely to harm an unborn baby. Do not take ondansetron without first talking to your doctor if you are pregnant or if you are planning a pregnancy.
It is also not known whether ondansetron passes into breast milk. Do not take ondansetron without first talking to your doctor if you are breast-feeding a baby.
How should I take ondansetron?
Take ondansetron exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each regular tablet with a full glass of water.
The ondansetron orally disintegrating tablets (Zofran ODT) can be taken with or without water. Do not remove the tablet from the blister until immediately before taking a dose. Do not try to push the tablet through the foil backing, the tablet may break. With dry hands, peel back the foil backing of one blister and gently remove the tablet. Immediately place the tablet on your tongue where it will dissolve in seconds, then swallow with saliva. Administration with water is not necessary.
To ensure that you get a correct dose, measure the liquid form of ondansetron with a special dose-measuring spoon or cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
Ondansetron can be taken with or without food.
Store ondansetron at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a ondansetron overdose are not well known but might include headache, temporary blindness, constipation, faintness, and heart problems.
What should I avoid while taking ondansetron?
There are no restrictions on foods, beverages, or activities during treatment with ondansetron unless otherwise directed by your doctor.
What are the possible side effects of ondansetron?
If you experience any of the following uncommon but serious side effects, stop taking ondansetron and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- irregular heartbeats; or
- muscle cramps or uncontrollable movements.
Other, less serious side effects may be more likely to occur. Continue to take ondansetron and talk to your doctor if you experience:
- headache;
- fatigue, drowsiness, or dizziness;
- anxiety or agitation; or
- diarrhea or constipation.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect ondansetron?
Ondansetron has not been reported to interact with other medicines. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines during treatment with ondansetron.
Brand Names:
Zofran
Opium, tincture
[need definition]
Paromomycin
Pronunciation: pair oh moe MY sin
Brand Name: Humatin
What is the most important information I should know about paromomycin?
Use caution when driving, operating machinery, or performing other hazardous activities. Paromomycin may cause dizziness. If you experience dizziness, avoid these activities and contact your doctor.
What is paromomycin?
Paromomycin is an antibiotic.
Paromomycin is used in the treatment of various intestinal infections. Paromomycin is also used in the treatment of certain liver problems.
Paromomycin may also be used for purposes other than those listed here.
What should I discuss with my healthcare provider before taking paromomycin?
Before taking paromomycin, tell your doctor if you have
- stomach or intestinal problems such as stomach ulcer, inflammatory bowel disease, or intestinal blockage (obstruction);
- kidney disease; or
- liver disease.
You may not be able to take paromomycin, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Do not take paromomycin without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Do not take paromomycin without first talking to your doctor if you are breast-feeding a baby.
How should I take paromomycin?
Take paromomycin exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, nurse, or pharmacist to explain them to you.
Take each dose with a full glass of water.
Take paromomycin with food.
It is important to take paromomycin regularly to get the most benefit.
Store paromomycin at room temperature away from moisture, heat, and direct light.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose. Do not take a double dose unless otherwise directed by your doctor.
What happens if I overdose?
Seek emergency medical attention if an overdose is suspected.
Symptoms of a paromomycin overdose are not known.
What should I avoid while taking paromomycin?
Use caution when driving, operating machinery, or performing other hazardous activities. Paromomycin may cause dizziness. If you experience dizziness, avoid these activities and contact your doctor.
What are the possible side effects of paromomycin?
If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- decreased hearing or ringing in the ears;
- little or no urine production; or
- dizziness.
Other less serious side effects may be more likely to occur. Continue to take paromomycin and talk to your doctor if you experience
- nausea or vomiting;
- diarrhea; or
- itching.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or especially bothersome.
What other drugs will affect paromomycin?
Talk to your doctor before taking any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, during treatment with paromomycin.
Brand Names:
Humatin
[need definition]
Potassium
[need definition]
Pronunciation: PRED ni sone
Brand Names: Deltasone, Liquid Pred, Meticorten, Orasone, Prednicen-M, Sterapred, Sterapred DS
What is the most important information I should know about prednisone?
Do not stop taking prednisone suddenly if you have been taking it for a few weeks. You may need a gradual reduction in dosage before you stop taking this medication.
Take prednisone with food or milk to lessen stomach upset.
Carry some type of medical identification that will let others know you are taking prednisone in the case of an emergency.
What is prednisone?
Prednisone is in a class of drugs called steroids. Prednisone reduces swelling and decreases the body's ability to fight infections.
Prednisone is used to treat many different conditions. It is used to treat endocrine (hormonal) disorders when the body does not produce enough of its own steroids. It is also used to treat many disorders such as arthritis, lupus, severe psoriasis, severe asthma, ulcerative colitis, and Crohn's disease.
Prednisone may also be used for purposes other than those listed in this medication guide.
Who should not take prednisone?
Do not take prednisone if you have a serious bacterial, viral, or fungal infection. Prednisone weakens the body's immune response and thus its ability to fight infection.
Before taking this medication, tell your doctor if you have
- kidney disease,
- liver disease,
- high blood pressure or heart disease,
- ulcerative colitis, diverticulitis, or stomach ulcers,
- hypothyroidism,
- a psychiatric condition,
- osteoporosis,
- myasthenia gravis,
- diabetes mellitus, or
- any other medical conditions.
You may not be able to take prednisone, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Prednisone is in the FDA pregnancy category C. This means that it is not known whether prednisone will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.
Prednisone passes into breast milk. Do not take prednisone without first talking to your doctor if you are breast-feeding a baby.
How should I take prednisone?
Take prednisone exactly as directed by your doctor. Do not take more or less than is prescribed for you. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Take prednisone with food or milk to lessen stomach upset.
Measure the liquid with the dropper provided or with a special dose-measuring spoon or cup. Ask your pharmacist for a dose-measuring spoon or cup if you do not have one.
If you are taking one dose daily, take that dose before 9 a.m. if possible, to follow the body's natural cycle. If you take more than one dose daily, space the doses evenly throughout the day as directed by your doctor.
Do not stop taking prednisone suddenly if you have been taking it for a few weeks. You may need a gradual reduction in dosage before you stop taking this medication.
Carry some type of medical identification that will let others know you are taking prednisone in the case of an emergency.
Store prednisone at room temperature away from moisture and heat.
What happens if I miss a dose?
If you take one dose daily, take the missed dose as soon as you remember. However, if you don't remember until the next day, skip the dose you missed and take only your regular daily dose.
If you take more than one dose daily, you can either take the missed dose as soon as you remember, or you can take two doses at the next dose time.
If you take one dose every other day, take the missed dose as soon as you remember, then go back to your regular every-other-day schedule.
What happens if I overdose?
Seek emergency medical attention. A single large dose of this medication is unlikely to cause symptoms or death. An overdose is more likely to be caused by a chronic overdose--large doses taken over a period of time.
Symptoms of an overdose include obesity (especially around the stomach); a round face; increased hair growth (especially around the face); acne; bruising; increased blood pressure; swollen hands, feet, or ankles (fluid retention); and sore or weak muscles.
What should I avoid while taking prednisone?
Avoid alcohol. Acting together, alcohol and prednisone can be damaging to the stomach.
Avoid sources of infection. Wash your hands frequently and keep them away from the mouth and eyes. Your immune system may be weakened while taking prednisone.
Do not receive any immunizations during treatment with prednisone without first talking to your doctor.
What are the possible side effects of prednisone?
If you experience any of the following serious side effects, stop taking prednisone and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- increased blood pressure (severe headache or blurred vision); or
- sudden weight gain (more than 5 pounds in a day or two).
- Other, less serious side effects may be more likely to occur. Continue to take prednisone and talk to your doctor if you experience
- insomnia;
- nausea, vomiting, or stomach upset;
- fatigue or dizziness;
- muscle weakness or joint pain;
- problems with diabetes control; or
- increased hunger or thirst.
Other side effects that occur only rarely, usually with high doses of prednisone, include
- acne,
- increased hair growth,
- thinning of the skin,
- cataracts,
- glaucoma,
- osteoporosis,
- roundness of the face, and
- changes in behavior.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect prednisone?
Do not take any other over-the-counter or prescription medications, including herbal products, during treatment with prednisone without first talking to your doctor. Many other medicines can interact with prednisone resulting in side effects or altered effectiveness of the medications.
Brand Names:
Deltasone
Liquid Pred
Meticorten
Orasone
Prednicen-M
Sterapred
Sterapred DS
Prinivil (see Lisinopril)
Prochlorperazine
Pronunciation: pro klor PER a zeen
Brand Names: Compazine, Compazine Spansule
What is the most important information I should know about prochlorperazine?
Call your doctor immediately if you have uncontrollable movements of the mouth, tongue, cheeks, jaw, arms, or legs.
Use caution when driving, operating machinery, or performing other hazardous activities. Prochlorperazine may cause dizziness, drowsiness, or blurred vision. If you experience dizziness, drowsiness or blurred vision, avoid these activities.
Dizziness is likely to occur when you are rising from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking prochlorperazine.
Do not crush, break, or chew any sustained-release capsules or tablets. Swallow them whole.
Do not let the liquid form of prochlorperazine touch your skin or clothes.
Do not mix the liquid form with coffee, cola, tea, grape, or apple juice.
What is prochlorperazine?
Prochlorperazine is in a class of drugs called phenothiazines.
Prochlorperazine is most commonly used to treat nausea and vomiting. It is also sometimes used to treat psychotic disorders and anxiety.
Prochlorperazine may also be used for purposes other than those listed in this medication guide.
Who should not take prochlorperazine?
Before taking this medication, tell your doctor if you have
- a bone marrow disease,
- glaucoma,
- seizures,
- Parkinson's disease,
- kidney disease,
- liver disease, or
- an enlarged prostate.
You may not be able to take prochlorperazine, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.
It is not known whether prochlorperazine will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.
It is not known whether prochlorperazine will harm a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
If you are over 60 years of age, you may be more likely to experience side effects from prochlorperazine. You may require a lower dose of this medication.
How should I take prochlorperazine?
Take prochlorperazine exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass (8 ounces) of water.
Prochlorperazine can be taken with or without food or milk.
Do not crush, break, or chew the sustained-release capsules. Swallow them whole. They are specially formulated to release slowly in your body.
Mix the concentrate with 2 to 4 ounces of water, soda, juice, milk, or semisolid food such as applesauce or pudding.
Shake the liquid form of prochlorperazine well before measuring a dose. To ensure that you get a correct dose, measure the suspension with a special dose-measuring spoon or cup, not with a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
Do not let the liquid form of prochlorperazine touch your skin or clothes.
Do not mix the liquid with coffee, tea, cola, grape, or apple juice.
The suppositories are for rectal use only. Ask your doctor, nurse, or pharmacist to explain how to use a suppository if you do not know how.
Store the tablets and capsules at room temperature away from moisture and heat. Store the liquid in a light-resistant container at room temperature.
What happens if I miss a dose?
If you are taking prochlorperazine as needed for nausea and vomiting, take the missed dose as soon as possible, if it is needed, and then wait at least 4 hours before taking another dose.
If you are taking prochlorperazine once a day for any other condition, take the missed dose as soon as you remember, then go back to your regular schedule the next day. If you do not remember until the next day, skip the dose you missed and take only the dose regularly scheduled for that day. Do not take a double dose of this medication.
If you are taking prochlorperazine several times a day for a condition other than nausea and vomiting, take the missed dose within 1 hour of its regular time. If more than 1 hour has passed, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose.
What happens if I overdose?
Seek emergency medical treatment.
Symptoms of a prochlorperazine overdose include uncontrollable movements, agitation, seizures, severe dizziness or fainting, coma, deep sleep, irregular heartbeats, and high or low body temperature.
What should I avoid while taking prochlorperazine?
Use caution when driving, operating machinery, or performing other hazardous activities. Prochlorperazine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
Dizziness is likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking prochlorperazine.
Avoid prolonged exposure to sunlight. Prochlorperazine may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.
What are the possible side effects of prochlorperazine?
If you experience any of the following serious side effects, stop taking prochlorperazine and seek emergency medical treatment:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- uncontrollable movements of the tongue, face, lips, arms, or legs;
- muscle spasms of the face or neck;
- severe restlessness or tremor;
- severe drowsiness or fainting; or
- a rash.
Other, less serious side effects may be more likely to occur. Continue to take prochlorperazine and talk to your doctor if you experience
- decreased sweating;
- dry mouth and stuffy nose;
- constipation;
- blurred vision;
- mild restlessness, weakness, or tremor;
- difficult urination or dark urine;
- decreased sex drive;
- dizziness; or
- increased appetite.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect prochlorperazine?
Before taking this medication, tell your doctor if you are taking any of the following medicines:
antacids (take antacids at least 2 hours before or 2 hours after taking a dose of prochlorperazine; otherwise they will decrease the effectiveness of your medication);
alcohol; over-the-counter cough, cold, or allergy medications; sleep aids; antidepressants; muscle relaxants; barbiturates; or seizure medications. (these drugs will increase the side of effects of prochlorperazine, especially drowsiness and dizziness);
blood pressure medications such as propranolol (Inderal), methyldopa (Aldomet), and clonidine (Catapres) (these medicines may cause dizziness and fainting if used with prochlorperazine);
anticoagulants such as warfarin (Coumadin) (these medicines may have decreased effects, which could lead to blood clotting); and
phenytoin (Dilantin) (prochlorperazine may increase the effects of phenytoin and lead to side effects; you may need a lower dose of phenytoin).
Drugs other than those listed here may also interact with prochlorperazine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Brand Names:
Compazine
Compazine Spansule
Procrit (see Epoetin)
Prograf (see Tacrolimus)
Rapamune (see Sirolimus)
Rocaltrol (see Calcitriol)
Sandimmune (see Cyclosporine)
Sandostatin (see Octreotide)
[need definition]
Pronunciation: sih ROW lih mus
Brand Name: Rapamune
What is the most important information I should know about sirolimus?
Do not consume grapefruit or grapefruit juice during treatment with sirolimus unless your doctor specifically directs otherwise. Sirolimus can interact with grapefruit and grapefruit juice, and the interaction may have dangerous effects.
Increased susceptibility to infection and the possible development of lymphoma (cancer of the immune system) and other forms of cancer may result from the use of an immunosuppressant such as sirolimus. Discuss these risks with your doctor and avoid sources of infection.
Notify your doctor immediately if you develop a cough, sore throat, fever, chills, or swelling of glands. These symptoms could be early signs of an infection.
Tell your doctor and dentist that you are taking this medication before having surgery, starting any other medicines, or receiving any vaccinations.
What is sirolimus?
Sirolimus is an immunosuppressant. Immunosuppressants decrease the effects of the body's immune system.
Sirolimus is used to prevent your body from rejecting a transplanted kidney. It is usually combined with a steroid medication (e.g., prednisone) and cyclosporine (Neoral, Sandimmune).
Sirolimus may also be used for purposes other than those listed in this medication guide.
Who should not take sirolimus?
Before taking sirolimus, tell your doctor if you have
- liver disease;
- a viral, bacterial, or fungal infection;
- high blood cholesterol or triglycerides; or
- any other serious or chronic medical condition.
You may not be able to take sirolimus, or you may require a dosage adjustment or special monitoring if you have any of the conditions listed above.
Sirolimus is in the FDA pregnancy category C. This means that it is not known whether sirolimus will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. For women who could become pregnant, effective contraception is recommended before the start of treatment with sirolimus, during treatment with sirolimus, and for 12 weeks after sirolimus therapy has been stopped.
It is not known whether sirolimus passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
Sirolimus is not approved for use by children younger than 13 years of age.
How should I take sirolimus?
Take sirolimus exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.
Take the oral tablets with a full glass of water.
To use the oral solution from a bottle:
Upon first use, open the solution bottle and insert the adapter assembly (plastic tube with stopper) tightly into the bottle until it is even with the top of the bottle. Do not remove the adapter assembly from the bottle once inserted. For each use, fully depress the plunger of one of the amber syringes, then insert it tightly into the opening of the adaptor.
Withdraw the prescribed amount of sirolimus solution by gently pulling out the plunger of the syringe until the bottom of the black line of the plunger is even with the appropriate mark on the syringe. Always keep the bottle in an upright position. If bubbles form in the syringe, empty the syringe into the bottle and repeat the procedure. If it is necessary to carry a filled syringe, place a cap securely on the syringe (the cap should snap into place) then place the capped syringe into the enclosed carrying case. Sirolimus solution can be kept in the syringe for a maximum of 24 hours at room temperature up to 25 degrees Celsius (77 degrees Fahrenheit) or refrigerated between 2 and 8 degrees Celsius (36 to 46 degrees Fahrenheit).
Empty the prescribed amount of sirolimus from the syringe into only a glass or plastic container holding at least 2 ounces (one-quarter cup, 60 mL) of water or orange juice. No other liquids should be used to dilute the solution. Stir vigorously for one minute and drink at once. Refill the container with at least 4 ounces (one-half cup, 120 mL) more of water or orange juice, stir vigorously, and drink at once. Discard each syringe and cap after one use.
If it is necessary to wipe clean the mouth of the bottle before returning the product to the refrigerator, wipe with a dry cloth to avoid introducing water, or any other liquid, into the bottle.
The sirolimus solution may develop a slight haze when refrigerated. If this occurs, allow the solution to stand at room temperature and shake gently until the haze disappears. The presence of this haze does not affect the quality of the product.
To use the oral solution from the pouches:
Before opening a pouch, squeeze the pouch from the neck area to push the contents into the lower part of the pouch. Fold the pouch along the marked line, then use scissors to cut along the marked line.
Squeeze the entire contents of the pouch, into only a glass or plastic container holding at least 2 ounces (one-quarter cup, 60 mL) of water or orange juice. No other liquids should be used to dilute the solution. Stir vigorously for one minute and drink at once. Refill the container with at least 4 ounces (one-half cup, 120 mL) more of water or orange juice, stir vigorously, and drink at once.
Sirolimus is usually taken once a day. It is recommended that sirolimus be taken 4 hours after taking cyclosporine (Neoral, Sandimmune). Follow your doctor's instructions
Sirolimus can be taken either with or without food, but it is very important to take every dose of sirolimus in the same relation to food. For example, if you take sirolimus with food, you should take every dose with food. If you take sirolimus on an empty stomach, you should take every dose on an empty stomach.
Do not consume grapefruit or grapefruit juice during treatment with sirolimus unless your doctor specifically directs otherwise. Sirolimus can interact with grapefruit and grapefruit juice, and the interaction may have dangerous effects.
Your doctor may want you to have regularly scheduled blood tests while taking sirolimus.
If sirolimus comes into direct contact with skin or mucous membranes, wash thoroughly with soap and water. If sirolimus comes into contact with the eyes, rinse the eyes with plain water.
Store sirolimus oral tablets at room temperature. Store sirolimus bottles or pouches of oral solution in the refrigerator between 2 and 8 degrees Celsius (36 to 46 degrees Fahrenheit). Once a bottle is opened, use the contents within one month. If necessary, the pouches and bottles can be stored at room temperature up to 25 degrees Celsius (77 degrees Fahrenheit) for several days, but not longer than 30 days.
What happens if I miss a dose?
Notify your doctor if you miss a dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a sirolimus overdose are not known.
What should I avoid while taking sirolimus?
Increased susceptibility to infection and the possible development of lymphoma (cancer of the immune system) and other types of cancer may result from the use of an immunosuppressant such as sirolimus. Discuss these risks with your doctor and avoid sources of infection.
Do not consume grapefruit or grapefruit juice during treatment with sirolimus unless your doctor specifically directs otherwise. Sirolimus can interact with grapefruit and grapefruit juice, and the interaction may have dangerous effects.
Tell your doctor and dentist that you are taking this medication before having surgery, starting any other medicines, or receiving any vaccinations.
Sirolimus may increase the risk of skin cancer. Avoid prolonged exposure to sunlight or UV light and wear protective clothing and use a sunscreen with a high sun protection factor (SPF) when sun exposure is unavoidable.
What are the possible side effects of sirolimus?
If you experience any of the following serious side effects, stop taking sirolimus and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives); or
- cough, sore throat, fever, chills, or swelling of glands.
Increased susceptibility to infection and the possible development of lymphoma (cancer of the immune system) or other types of cancer may result from the use of sirolimus.
Other, less serious side effects may also occur. Continue to take sirolimus and notify your doctor if you experience
- upset stomach, abdominal pain, nausea, or vomiting;
- diarrhea or constipation;
- headache;
- increased blood pressure;
- increased cholesterol or triglyceride levels;
- water retention or swelling;
- insomnia;
- tremor;
- sore or weak muscles or joints;
- a rash;
- upper respiratory or urinary tract infections; or
- acne.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect sirolimus?
Do not take sirolimus without first talking to your doctor if you are taking any other medicines, especially any of the following:
- a seizure medicine including carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), or phenytoin (Dilantin);
- an antifungal medicine including ketoconazole (Nizoral), itraconazole (Sporanox), or fluconazole (Diflucan);
- a calcium channel blocker (heart medicine) including verapamil (Calan, Verelan), diltiazem (Cardizem, Dilacor XR, Tiazac), or nicardipine (Cardene);
- erythromycin (Ery-Tab, E-Mycin, E.E.S., others), clarithromycin (Biaxin), or troleandomycin (TAO);
- an HIV-protease inhibitor including ritonavir (Norvir), indinavir (Crixivan), and others;
- bromocriptine (Parlodel);
- cimetidine (Tagamet, Tagamet HB);
- cisapride (Propulsid);
- danazol (Danocrine);
- metoclopramide (Reglan);
- rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), or rifapentine (Priftin); or
- any type of vaccination.
You may not be able to take sirolimus, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with sirolimus. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Brand Names:
Rapamune
Solu-Medrol (see Methylprednisolone)
Sulfamethoxazole and trimethoprim
Pronunciation: sul fa meth OX a zole and trye METH oh prim
Brand Names: Bactrim, Bactrim DS, Bactrim Pediatric, Bethaprim, Bethaprim Pediatric, Cotrim, Cotrim DS, . . . more
What is the most important information I should know about sulfamethoxazole and trimethoprim?
Take all of the sulfamethoxazole and trimethoprim that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
What is sulfamethoxazole and trimethoprim?
Sulfamethoxazole and trimethoprim are both antibiotics that treat different types of bacterial infections. Sulfamethoxazole and trimethoprim fight bacteria in your body.
Sulfamethoxazole and trimethoprim is used to treat infections such as urinary tract infections, bronchitis, ear infections (otitis), traveler's diarrhea, and Pneumocystis carinii pneumonia.
Sulfamethoxazole and trimethoprim may also be used for purposes other than those listed in this medication guide.
Who should not take sulfamethoxazole and trimethoprim?
Before taking this medication, tell your doctor if you have
- kidney or liver disease, or
- a glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency).
You may not be able to take sulfamethoxazole and trimethoprim, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.
Sulfamethoxazole and trimethoprim is in the FDA pregnancy category C. This means that it is not known whether sulfamethoxazole and trimethoprim will harm an unborn baby. This medication affects folic acid in your body, which is necessary for the normal development of a baby. Do not take sulfamethoxazole and trimethoprim without first talking to your doctor if you are pregnant.
Sulfamethoxazole and trimethoprim passes into breast milk and may harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
Sulfamethoxazole and trimethoprim is not approved for use in children younger than 2 months of age.
How should I take sulfamethoxazole and trimethoprim?
Take this drug exactly as directed by your physician. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Take sulfamethoxazole and trimethoprim with food or milk if it upsets your stomach.
You may crush the tablets and put them in water or a soft food like applesauce or pudding if you cannot swallow them whole.
To ensure that you get a correct dose, measure the liquid form of sulfamethoxazole and trimethoprim with a special dose-measuring spoon or cup, not with a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one. Shake the suspension well before measuring a dose.
Take all of the sulfamethoxazole and trimethoprim that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infections is completely treated.
Store the tablets and liquid at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
If you have only missed one dose, you can take the rest of your scheduled doses for that day at evenly spaced intervals.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a sulfamethoxazole and trimethoprim overdose include nausea, vomiting, decreased appetite, diarrhea, headache, yellowing of the skin or eyes, decreased urine production, bloody urine, and coma.
What should I avoid while taking sulfamethoxazole and trimethoprim?
Avoid prolonged exposure to sunlight. Sulfamethoxazole and trimethoprim may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.
What are the possible side effects of sulfamethoxazole and trimethoprim?
Stop taking sulfamethoxazole and trimethoprim and seek emergency medical attention if you experience any of the following serious side effects:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- unusual bleeding or bruising; or
- yellow skin or eyes.
Other, less serious side effects may be more likely to occur. Continue to take your medication and talk to your doctor if you experience
- headache, fatigue, or dizziness;
- nausea, vomiting, decreased appetite, or diarrhea;
- weakness; or
- increased sensitivity to the sun.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect sulfamethoxazole and trimethoprim?
Sulfamethoxazole and trimethoprim may increase the effects of oral anticoagulants such as warfarin (Coumadin) and lead to bleeding. Tell your doctor if you are taking a blood thinner.
Sulfamethoxazole and trimethoprim may also increase the effects of drugs used to treat diabetes, such as glipizide (Glucotrol), glyburide (Glynase, Micronase, Diabeta), chlorpropamide (Diabinese), tolbutamide (Orinase), and tolazamide (Tolinase). Very low blood sugar levels may result. Watch for changes in your blood sugar if you are a diabetic.
Sulfamethoxazole and trimethoprim may increase the effects of phenytoin (Dilantin) and lead to dangerous side effects. Watch for unusual side effects during treatment.
Drugs other than those listed here may also interact with sulfamethoxazole and trimethoprim. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Where can I get more information?
Your pharmacist has additional information about sulfamethoxazole and trimethoprim written for health professionals that you may read.
Brand Names:
Bactrim
Bactrim DS
Bactrim Pediatric
Bethaprim
Bethaprim Pediatric
Cotrim
Cotrim DS
Cotrim Pediatric
Septra
Septra DS
Sulfatrim
Sulfatrim Pediatric
Sulfatrim Suspension
Uroplus
Uroplus DS
Pronunciation: ta CRAW lih mus
Brand Name: Prograf
What is the most important information I should know about tacrolimus?
Do not consume grapefruit or grapefruit juice during treatment with tacrolimus unless your doctor specifically directs otherwise. Tacrolimus can interact with grapefruit and grapefruit juice, and the interaction may have dangerous effects.
Increased susceptibility to infection and the possible development of lymphoma (cancer of the immune system) may result from the use of an immunosuppressant such as tacrolimus. Discuss these risks with your doctor and avoid sources of infection.
Notify your doctor immediately if you develop frequent urination, increased thirst or hunger, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, darkened urine, a cough, sore throat, fever, chills, or swelling of glands. These symptoms could be early signs of dangerous side effects.
Tell your doctor and dentist that you are taking this medication before having surgery, starting any other medicines, or receiving any vaccinations.
What is tacrolimus?
Tacrolimus is an immunosuppressant. Immunosuppressants decrease the effects of your body's immune system.
Tacrolimus is used to prevent your body from rejecting a liver or kidney transplant. It is usually combined with a steroid medication.
Tacrolimus may also be used for purposes other than those listed in this medication guide.
Who should not take tacrolimus?
Before taking tacrolimus, tell your doctor if you
- have kidney disease;
- have liver disease;
- have a viral, bacterial, or fungal infection;
- have epilepsy or another seizure disorder;
- have diabetes;
- have high blood pressure;
- have any other serious or chronic medical condition; or
- are taking potassium supplements (e.g., K-Dur, Klor-Con) or potassium-sparing diuretics such as amiloride (Midamor), spironolactone (Aldactone), or triamterene (Dyrenium, Dyazide, Maxzide).
You may not be able to take tacrolimus, or you may require a dosage adjustment or special monitoring if you have any of the conditions listed above.
Tacrolimus is in the FDA pregnancy category C. This means that it is not known whether tacrolimus will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.
Tacrolimus passes into breast milk and may affect a nursing infant. Tacrolimus is not recommended for use during breast-feeding. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
How should I take tacrolimus?
Take tacrolimus exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.
Take each dose with a full glass of water.
Tacrolimus is usually taken twice a day. Follow your doctor's instructions.
Do not consume grapefruit or grapefruit juice during treatment with tacrolimus unless your doctor specifically directs otherwise. Tacrolimus can interact with grapefruit and grapefruit juice, and the interaction may have dangerous effects.
Your doctor may want you to have regularly scheduled blood tests while taking tacrolimus.
Store tacrolimus at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the dose you missed, and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
Notify your doctor if you miss a dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a tacrolimus overdose are not known.
What should I avoid while taking tacrolimus?
Increased susceptibility to infection and the possible development of lymphoma (cancer of the immune system) may result from the use of an immunosuppressant such as tacrolimus. Discuss these risks with your doctor and avoid sources of infection.
Do not consume grapefruit or grapefruit juice during treatment with tacrolimus unless your doctor specifically directs otherwise. Tacrolimus can interact with grapefruit and grapefruit juice, and the interaction may have dangerous effects.
Tell your doctor and dentist that you are taking this medication before having surgery, starting any other medicines, or receiving any vaccinations.
What are the possible side effects of tacrolimus?
If you experience any of the following serious side effects, stop taking tacrolimus and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- unusual tiredness or weakness;
- cough, sore throat, fever, chills, or swelling of glands;
- pain in the lower back or side;
- painful or difficult urination;
- a sudden unusual feeling of discomfort or illness; or
- frequent urination or increased thirst or hunger.
- Increased susceptibility to infection and the possible development of lymphoma (cancer of the immune system) may result from the use of an immunosuppressant such as tacrolimus. Discuss these risks with your doctor and avoid sources of infection.
Other, less serious side effects may also occur. Continue to take tacrolimus and notify your doctor if you experience
- tremor;
- headache;
- diarrhea or constipation;
- increased blood pressure;
- insomnia;
- numbness or tingling;
- upset stomach, abdominal pain, nausea, vomiting, or loss of appetite;
- swelling of the feet or lower legs; or
- itching or a rash.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect tacrolimus?
Before taking tacrolimus, tell your doctor if you are taking or need to take any of the following medicines:
- potassium supplements (e.g., K-Dur, Klor-Con, others);
- potassium-sparing diuretics, including amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium, Dyazide, Maxzide);
- other drugs that affect the kidneys, such as gentamicin (Garamycin), amikacin (Amikin), amphotericin B(Fungizone), cisplatin (Platinol), or cyclosporine (Neoral, Sandimmune);
- the seizure medicines carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin);
- antifungal medicines such as ketoconazole (Nizoral), itraconazole (Sporanox), and fluconazole (Diflucan);
- calcium channel blockers (heart medicines) such as verapamil (Calan, Verelan), diltiazem (Cardizem, Dilacor XR, Tiazac), nifedipine (Adalat, Procardia), and nicardipine (Cardene);
- erythromycin (Ery-Tab, E-Mycin, E.E.S., others), clarithromycin (Biaxin), or troleandomycin (TAO);
- the AIDS medicines ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), and saquinavir (Invirase);
- bromocriptine (Parlodel);
- cimetidine (Tagamet, Tagamet HB);
- cisapride (Propulsid);
- danazol (Danocrine);
- metoclopramide (Reglan);
- methylprednisolone (Medrol, others);
- rifabutin (Mycobutin);
- rifampin (Rifadin, Rimactane); or
- any type of vaccination.
You may not be able to take tacrolimus, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with tacrolimus. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Brand Names:
Prograf
[need definition]
Toprol (see Metoprolol)
Tylenol (Acetaminophen)
Valcyte (see Valganciclovir)
Pronunciation: val gan SYE kloe veer
Brand Name: Valcyte
What is the most important information I should know about valganciclovir?
Take all of the valganciclovir that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
Take valganciclovir with food to increase its absorption by the body.
Valganciclovir may cause serious birth defects in children of both men and women. Women must use an effective form of birth control, and men must wear a condom during sexual intercourse to prevent pregnancy. Men should continue to use condoms for at least 90 days following treatment to prevent pregnancy.
Treatment with valganciclovir has been associated with severely low levels of red and white blood cells and platelets. Your doctor may want to monitor your blood with blood tests during treatment. Notify your doctor immediately if you experience paleness, fatigue, unusual bruising or bleeding, or fever or other signs of infection.
Valganciclovir has been associated with dizziness, confusion, weakness, and seizures. Use caution when driving, operating machinery, or performing other hazardous activities. If you experience any of these side effects, avoid these activities.
What is valganciclovir?
Valganciclovir is an antiviral drug. After taking valganciclovir, it is converted in the body to ganciclovir. Ganciclovir (also available as Cytovene) slows the growth and spread of the cytomegalovirus.
Valganciclovir is used to treat and prevent infections caused by cytomegalovirus in patients with acquired immunodeficiency syndrome (AIDS).
Valganciclovir may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking valganciclovir?
Before taking this medication, tell your doctor if you have kidney disease. You may need a dosage adjustment or special monitoring during treatment with valganciclovir.
Valganciclovir is in the FDA pregnancy category C. This means that it is not known whether valganciclovir will be harmful to an unborn baby. Valganciclovir has caused birth defects in animals, and it is generally not recommended for use during pregnancy. Both men and women must use birth control while taking valganciclovir. Men should continue to use condoms for at least 90 days following treatment to prevent pregnancy.
It is not known whether valganciclovir passes into breast milk. Generally, breast-feeding should be avoided during and immediately following treatment with valganciclovir. Do not take valganciclovir without first talking to your doctor if you are breast-feeding a baby.
How should I take valganciclovir?
Take valganciclovir exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Take each dose with food to increase the absorption of the drug by the body.
Take all of the valganciclovir that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
Strictly follow the dosage prescribed by your doctor. Valganciclovir tablets cannot be substituted for ganciclovir (Cytovene) capsules on a one-to one basis.
Valganciclovir tablets should not be broken or crushed. Since valganciclovir may cause cancer, avoid direct contact of broken or crushed tablets with skin or mucous membranes. If skin contact occurs, thoroughly wash with soap and water and rinse the eyes thoroughly with plain water.
Store valganciclovir at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember up to 2 hours late. If more than 2 hours have passed since the missed dose, skip that dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a valganciclovir overdose include tremors, convulsions, seizures, diarrhea, kidney damage (decreased urine production, blood in the urine), liver damage (yellowing of the skin or eyes, abdominal pain), and bone marrow damage (paleness, increased chance of infection, fever and chills).
What should I avoid while taking valganciclovir?
If you have AIDS, follow your doctor's instructions with respect to high-risk activities such as unprotected sex and the sharing of needles.
Valganciclovir may cause serious birth defects in children of both men and women. Women must use an effective form of birth control, and men must wear a condom during sexual intercourse to prevent pregnancy. Men should continue to use condoms for at least 90 days following treatment to prevent pregnancy.
Valganciclovir has been associated with dizziness, confusion, weakness, and seizures. Use caution when driving, operating machinery, or performing other hazardous activities. If you experience any of these side effects, avoid these activities.
What are the possible side effects of valganciclovir?
Stop taking valganciclovir and seek emergency medical attention or contact your doctor immediately if you experience any of the following serious side effects:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- numbness or tingling in a part of the body;
- seizures; or
- hallucinations, confusion, or agitation.
Treatment with valganciclovir has been associated with severely low levels of red and white blood cells and platelets. Your doctor may want to monitor your blood with blood tests during treatment. Notify your doctor immediately if you experience paleness, fatigue, unusual bruising or bleeding, or fever or other signs of infection.
Other, less serious side effects may be more likely to occur. Continue to take valganciclovir and talk to your doctor if you experience
- nausea, vomiting, or abdominal pain;
- diarrhea;
- dizziness;
- weakness;
- headache; or
- insomnia.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect valganciclovir?
The use of zidovudine (Retrovir, AZT) or didanosine (Videx) at the same time as valganciclovir may affect the blood. Your doctor will want to monitor this combination of medicines.
Probenecid (Benemid) may increase the effects of valganciclovir and lead to dangerous side effects. You may need a lower dose of valganciclovir if you are taking probenecid.
Drugs other than those listed here may also interact with valganciclovir. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
Brand Names:
Valcyte
Verapamil (oral)
Pronunciation: ver AH pa mill
Brand Names: Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM
What is the most important information I should know about verapamil?
Do not stop taking this medication without first talking to your doctor. If you stop taking the medication, your condition could become worse.
Do not crush, chew, or break extended-release forms of verapamil such as generic Covera-HS and Verelan PM. Swallow them whole. Generic verapamil SR, Isoptin SR, and Calan SR may be divided in half but should not be crushed or chewed.
What is verapamil?
Verapamil is in a class of drugs called calcium channel blockers. Verapamil relaxes (widens) blood vessels (veins and arteries), which makes it easier for the heart to pump and reduces its workload.
Verapamil is used to treat hypertension (high blood pressure), to treat angina (chest pain), and to control some types of irregular heartbeats.
Verapamil may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking verapamil?
Before taking this medication, tell your doctor if you have
- kidney or liver disease;
- other diseases of the heart or blood vessels such as sick sinus syndrome, aortic stenosis, heart failure, heart block, Wolff-Parkinson-White syndrome, coronary artery disease, or low blood pressure; or
- muscular dystrophy.
You may not be able to take verapamil, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Verapamil is in the FDA pregnancy category C. This means that it is not known whether verapamil will be harmful to an unborn baby. Do not take verapamil without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Verapamil passes into breast milk and may harm a nursing infant. Do not take verapamil without first talking to your doctor if you are breast-feeding a baby.
How should I take verapamil?
Take verapamil exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Verelan, Verelan PM, Calan, Isoptin, Covera-HS, and generic forms of regular-release verapamil can be taken with or without food. Taking the medication with food may reduce stomach upset if it occurs.
Calan SR, Isoptin SR, and generic sustained-release verapamil (verapamil SR) may be more likely to cause stomach upset and should be taken with food to reduce this side effect.
Take Covera-HS and Verelan PM at bedtime.
If you have trouble swallowing the Verelan pellet-filled capsules, they can be opened and the contents can be sprinkled onto cold, soft food such as applesauce. This mixture must be swallowed without chewing. Use the mixture immediately. Do not save it for later use. (Do not use this procedure for the Verelan PM capsules.)
Do not crush, chew, or break extended-release forms of verapamil such as Covera-HS and Verelan PM. Swallow them whole. Generic verapamil SR, Isoptin SR, and Calan SR may be divided in half if the tablets are scored, but should not be crushed or chewed.
If you are taking Covera-HS, do not be concerned if you find what looks like an undissolved tablet in your stool. This medication is formulated with an outer shell that does not dissolve. This shell allows the medicine to be released slowly into your body before it is passed out in the stool.
It is important to take verapamil regularly to get the most benefit.
Do not stop taking this medication without first talking to your doctor. If you stop taking the medication, your condition could become worse.
Grapefruit and grapefruit juice may interact with verapamil. The interaction could lead to potentially dangerous effects. Discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
Your doctor may want you to have blood tests, blood pressure monitoring, or other medical evaluations during treatment with verapamil to monitor progress and side effects.
Store verapamil at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a verapamil overdose include dizziness, weakness, chest pain, shortness of breath, fainting, an unusually fast or slow heartbeat, coma, slurred speech, and confusion.
What should I avoid while taking verapamil?
Grapefruit and grapefruit juice may interact with verapamil. The interaction could lead to potentially dangerous effects. Discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
Avoid the use alcohol. Alcohol may further lower blood pressure and increase drowsiness and dizziness while taking verapamil.
Follow any recommendations your doctor makes about diet or exercise.
What are the possible side effects of verapamil?
If you experience any of the following serious side effects, stop taking verapamil and contact your doctor immediately or seek emergency medical treatment:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- an unusually fast or slow heartbeat;
- shortness of breath (heart failure);
- fainting;
- abnormal behavior or psychosis;
- jaundice (yellowing of the skin or eyes); or
- swelling of the legs or ankles.
Other, less serious side effects may be more likely to occur. Continue to take verapamil and talk to your doctor if you experience
- unusual headache, fatigue, or tiredness;
- insomnia or trouble sleeping;
- vivid dreams;
- hair loss;
- nausea or diarrhea; or
- increased urination.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect verapamil?
Before taking this medication, tell your doctor if you are taking any of the following drugs:
- cyclosporine (Sandimmune, Neoral);
- cimetidine (Tagamet, Tagamet HB);
- carbamazepine (Tegretol, Carbatrol);
- lithium (Lithobid, Eskalith, others);
- theophylline (Theo-Dur, Theochron, Theolair, Theobid, Elixophyllin, Slo-Phyllin, others);
- rifampin (Rifadin, Rimactane);
- phenobarbital (Luminal, Solfoton);
- an HMG CoA reductase inhibitor such as atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor), and others; or
- another heart medication such as propranolol (Inderal), metoprolol (Lopressor, Toprol XL), atenolol (Tenormin), digoxin (Lanoxin), quinidine (Quinora, Quinidex, Quinaglute), flecainide (Tambocor), disopyramide (Norpace), captopril (Capoten), enalapril (Vasotec), and others.
You may not be able to take verapamil, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with verapamil or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.
Brand Names:
Calan
Calan SR
Covera-HS
Isoptin
Isoptin SR
Verelan
Verelan PM
Pronunciation: WAR far in
Brand Name: Coumadin
What is the most important information I should know about warfarin?
Never take a double dose of this medication.
Do not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Aleve, Anaprox), and others while taking warfarin, except under the direction of your doctor. These medicines increase the risk of bleeding.
Avoid sudden changes in your diet. Vitamin K decreases the effects of warfarin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, and green leafy vegetables (e.g., spinach, Swiss chard, coriander, collards, cabbage). Do not change the amount of these foods in your diet without first talking to your doctor.
It will be necessary to regularly monitor your therapy with a blood test called a "PT" or an "INR." These tests help to determine the amount of warfarin that you need to take.
Contact your doctor if you experience any unusual bruises or heavily bleeding wounds, diarrhea, infection, or fever during treatment with warfarin.
What is warfarin?
Warfarin is an anticoagulant (blood thinner).
Warfarin reduces the formation of blood clots, which is important in the prevention of heart attacks, strokes, and blockage of major veins and arteries.
Warfarin may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking warfarin?
Do not take warfarin if you:
- recently had surgery;
- have a stomach ulcer or bleeding in the stomach;
- have had a certain type of stroke caused by bleeding in the brain;
- have had an aneurysm;
- recently had a spinal puncture or lumbar block anesthesia; or
- have bacterial endocarditis (infection of the heart), pericarditis (swelling of tissue around the heart), or pericardial effusion (build-up of fluid around the heart).
Before taking warfarin, tell your doctor if you:
- have kidney disease;
- have liver disease;
- have high blood pressure;
- have a hereditary protein C or protein S deficiency;
- are diabetic;
- have polycythemia vera;
- have vasculitis;
- have congestive heart failure;
- have a collagen vascular disorder such as systemic lupus erythematosus;
- have thyroid disease;
- have high cholesterol;
- have cancer;
- have a vitamin K deficiency;
- are considering having surgery; or
- are taking antibiotics to treat an infection.
You may not be able to take warfarin, or you may need a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Warfarin is in the FDA pregnancy category X. This means that warfarin is known to cause birth defects in an unborn baby and must not be taken during pregnancy. Do not take warfarin if you are pregnant or could become pregnant during treatment. Consult your doctor immediately if you become pregnant while taking warfarin.
Warfarin has not been detected in human breast milk. Talk to your doctor before taking warfarin if you are breast-feeding a baby.
How should I take warfarin?
Take warfarin exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
It is important to take warfarin at the same time every day. Warfarin can be taken with or without food.
It is important to take warfarin regularly to get the most benefit.
Never take a double dose of this medication.
Do not stop taking warfarin without first talking to your doctor.
It will be necessary to regularly monitor your therapy with a blood test called a "PT" or an "INR." These tests help to determine the amount of warfarin that you need to take. Your doctor may also want you to have other blood tests or medical evaluations during treatment with warfarin to monitor progress and side effects.
Do not take any more or less of this drug than is prescribed for you.
Avoid sudden changes in your diet. Vitamin K decreases the effects of warfarin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, and green leafy vegetables (e.g., spinach, Swiss chard, coriander, collards, cabbage). Do not change the amount of these foods in your diet without first talking to your doctor.
Contact your doctor if you experience any unusual bruises or heavily bleeding wounds, diarrhea, infection, or fever during treatment with warfarin.
Store this medication at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember, on the same day. If the missed dose is not remembered until the next day, skip that dose and take only the next regularly scheduled dose.� Never take a double dose of this medication.
What happens if I overdose?
Seek emergency medical treatment.
Symptoms of a warfarin overdose include bruising; small, broken blood vessels under the skin; excessive bleeding from cuts or wounds; bleeding from the gums; blood in the stools, urine, or vomit; and excessive menstrual bleeding in women.
What should I avoid while taking warfarin?
Avoid sudden changes in your diet. Vitamin K decreases the effects of warfarin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, and green leafy vegetables (e.g., spinach, Swiss chard, coriander, collards, cabbage). Do not change the amount of these foods in your diet without first talking to your doctor.
Do not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Aleve, Anaprox) and others while taking warfarin, except under the direction of your doctor. These medicines increase the risk of bleeding.
Tell your doctor (or dentist) that you are taking warfarin before taking an antibiotic or before having surgery.
Do not start or stop taking any other medications during treatment with warfarin without first talking to your doctor.
Avoid hazardous activities and sports that may cause injuries. Bleeding and bruising may be a problem, especially at the start of therapy. Watch for excessive bleeding and bruising and report any unusual bruises or heavily bleeding wounds to your doctor.
Avoid the use of alcohol and tobacco products. These products can alter the effects of warfarin and cause problems with your therapy. Discuss the use of alcohol and tobacco with your doctor.
What are the possible side effects of warfarin?
If you experience any of the following serious side effects from warfarin, stop taking the medication and seek emergency medical attention or contact your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- black, bloody, or tarry stools;
- blood in urine or vomit;
- coughing up blood;
- bleeding gums or sores in the mouth;
- decreased urine production;
- yellowing of the skin or eyes;
- severe dizziness or headache;
- easy bleeding or bruising under the skin;
- purple discoloration of the toes or fingers;
- sudden leg or foot pain; or
- unusually heavy menstrual periods.
Other, less serious side effects may be more likely to occur. Talk to your doctor if you experience
- excessive gas or bloating;
- diarrhea, nausea, or vomiting;
- hair loss; or
- decreased appetite or weight.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect warfarin?
Warfarin interacts with many other drugs, and these interactions can be dangerous, even fatal. Before starting treatment with warfarin, tell your doctor and pharmacist about all medicines you take including prescription medicines, over-the-counter products, vitamins, minerals, and herbal products. Talk to your doctor and pharmacist before taking any other medication during treatment with warfarin.
Brand Names:
Coumadin
Zetia (see Ezetimibe)
Zofran (see Ondansetron)
Zovirax (see Acyclovir)
GLOSSARY
From MedicineNet.com
Comments are added to try to relate to the situations described herein.
Irrelevant parts of the definition are retained for entertainment and curiosity value.
ADA (American Diabetes Association): The American Diabetes Association (ADA) provides the following introduction:
"The American Diabetes Association is the nation's leading nonprofit health organization providing diabetes research, information and advocacy. Founded in 1940, it was reorganized in 1969 to increase its ability to serve the public. Today, offices in more than 800 communities conduct programs in all 50 states and the District of Columbia.
"The mission of the organization is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes. To fulfill this mission, the American Diabetes Association funds research, publishes scientific findings, and provides information and other services to people with diabetes, their families, health care professionals and the public."
The statement quoted (above) comes from the ADA Internet site (www.diabetes.org) which contains useful and reliable information concerning many facets of diabetes.
Advance directives: These directives pertain to treatment preferences and the designation of a surrogate decision-maker in the event that a person should become unable to make medical decisions on their own behalf. Advance directives generally fall into three categories: living will, power of attorney and health care proxy.
LIVING WILL: This is a written document that specifies what types of medical treatment are desired. A living will can be very specific or very general.
The most common statement in a living will is to the effect that: If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.
More specific living wills may include information regarding an individual's desire for such services such as analgesia (pain relief), antibiotics, hydration, feeding, and the use of ventilators or cardiopulmonary resuscitation.
HEALTH CARE PROXY: This is a legal document in which an individual designates another person to make health care decisions if he or she is rendered incapable of making their wishes known. The health care proxy has, in essence, the same rights to request or refuse treatment that the individual would have if capable of making and communicating decisions.
DURABLE POWER OF ATTORNEY: This is the third type of advance directive. Individuals may draft legal documents providing power of attorney to others in the case of incapacitating medical condition. The durable power of attorney allows an individual to make bank transactions, sign Social Security checks, apply for disability, or simply write checks to pay the utility bill while an individual is medically incapacitated.
AIDS: Disease due to infection with the human immunodeficiency virus (HIV). AIDS is an acronym for Acquired Immunodeficiency Syndrome.
Alcohol: An organic chemical in which one or more hydroxyl (OH) groups are attached to carbon (C) atoms in place of hydrogen (H) atoms. Common alcohols include ethyl alcohol or ethanol (found in alcoholic beverages), methyl alcohol or methanol (can cause blindness) and propyl alcohol or propanol (used as a solvent and antiseptic). Rubbing alcohol is a mixture of acetone, methyl isobutyl ketone, and ethyl alcohol. In everyday talk, alcohol usually refers to ethanol as, for example, in wine, beer, and liquor. It can cause changes in behavior and be addictive.
Anesthesiologist: An anesthesiologist is a physician or, less often, a dentist who is specialized in the practice of anesthesiology, the branch of medicine specializing in the use of drugs or other agents that cause insensibility to pain.
There is a major distinction between an anesthesiologist and an anesthetist. An anesthesiologist has a doctorate whereas an anesthetist does not. An anesthetist is a nurse or technician trained to administer anesthetics.
Anesthetic: A substance that causes lack of feeling or awareness. A local anesthetic causes loss of feeling in a part of the body. A general anesthetic puts the person to sleep.
Angiogram: An x-ray of blood vessels which can be seen because the patient receives an injection of dye to outline the vessels on the x-ray.
Angiography, coronary: The most accurate method (the "gold standard") for evaluating and defining coronary artery disease (CAD). Coronary angiography is used to identify the exact location and severity of CAD.
During coronary angiography, a small catheter (a thin hollow tube with a diameter of 2-3 mm) is inserted through the skin into an artery in the groin or the arm. Guided with the assistance of a fluoroscope (a special x-ray viewing instrument), the catheter is then advanced to the opening of the coronary arteries, the blood vessels supplying blood to the heart. Next, a small amount of radiographic contrast (a solution containing iodine, which is easily visualized with x-ray images) is injected into each coronary artery. The images that are produced are called the angiogram. Angiographic images accurately reveal the extent and severity of all coronary arterial blockages.
Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not terribly uncomfortable. The procedure takes approximately 20-30 minutes. After the procedure, the catheter is removed and the artery in the leg or arm is sutured, "sealed," or treated with manual compression to prevent bleeding. There is a small risk of serious complications from coronary angiography, as it is an "invasive" test, but in the hands of an experienced physician, this risk is quite small (well below one per cent).
In patients for whom the test is appropriate, the therapeutic information learned from the coronary angiogram is far more valuable than the relatively small risk of the procedure. For patients with severe angina or myocardial infarction, or those who have markedly abnormal noninvasive tests for CAD, the angiogram also helps the doctor select the optimal treatment, which may include medications, balloon angioplasty, coronary stenting, atherectomy ("roto-rooter"), or coronary bypass surgery.
The coronary angiogram is the only test which allows the precise quantification of the extent and severity of CAD to optimally make these treatment decisions.
Antibacterial: Anything that destroys bacteria or suppresses their growth or their ability to reproduce. Heat, chemicals (chlorine), and antibiotic drugs all have antibacterial properties.
Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. Originally, an antibiotic was a substance produced by one microorganism that selectively inhibits the growth of another. Synthetic antibiotics, usually chemically related to natural antibiotics, have since been produced that accomplish comparable tasks.
In 1926, Alexander Fleming discovered penicillin, a substance produced by fungi that appeared able to inhibit bacterial growth. In 1939, Edward Chain and Howard Florey further studied penicillin and later carried out trials of penicillin on humans (with what were deemed fatal bacterial infections). Fleming, Florey and Chain shared the Nobel Prize in 1945 for their work which ushered in the era of antibiotics.
Another antibiotic, for example, is tetracycline (brand names: Achromycin and Sumycin), a broad-spectrum agent effective against a wide variety of bacteria including Hemophilus influenzae, Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Neisseria gonorrhoea, and many others. The first drug of the tetracycline family, chlortetracycline, was introduced in 1948.
Antigen: A substance that is capable of causing the production of an antibody.
Antigens may or may not lead to an allergic reaction. Allergens are antigens that cause an allergic reaction and the production of IgE.
Antibody: An immunoglobulin, a specialized immune protein, produced because of the introduction of an antigen into the body, and which possesses the remarkable ability to combine with the very antigen that triggered its production.
The production of antibodies is a major function of the immune system and is carried out by a type of white blood cell called a B cell (B lymphocyte). Antibodies can be triggered by and directed at foreign proteins, microorganisms, or toxins. Some antibodies are autoantibodies and home in against our own tissues.
The term "antibody" dates to 1901. Prior to that time, an "antibody" referred to any of a host of different substances that served as "bodies" (foot soldiers) in the fight against infection and its ill effects.
Aseptic: The absence of microorganisms. By contrast, something that just discourages the growth of microorganisms is antiseptic.
Bile duct, common: The duct that carries bile from the gallbladder and liver into the duodenum (the upper part of the small intestine). The common bile duct is formed by the junction of the cystic duct that comes from the gallbladder and the common hepatic duct that comes from the liver.
Biopsy: The removal of a sample of tissue for examination under a microscope to check for cancer cells.
The physical exam, imaging, endoscopy, and lab tests can show that something abnormal is present, but a biopsy is the only sure way to know whether the problem is cancer. In a biopsy, the doctor removes a sample of tissue from the abnormal area or may remove the whole tumor. A specialist trained to examine such tissues is called a pathologist. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually tell what kind of cancer it is and may be able to judge whether the cells are likely to grow slowly or quickly.
Bone marrow biopsy: The removal of a sample of bone marrow and a small amount of bone (usually from the hip) through a large needle. Two samples are taken. The first is bone marrow by aspiration (suction with a syringe). The second sample is a core biopsy to obtain bone marrow together with bone fibers. After the needle is removed, this solid sample is pushed out of the needle with a wire. Both samples are examined under a microscope to see the cells and architecture of the bone marrow.
Cadaver: A dead human body that may be used by physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Students in medical schools study and dissect cadavers as part of their education.
Catheter: A thin, flexible tube. For example, a catheter placed in a vein provides a pathway for giving drugs, nutrients, fluids, or blood products. Samples of blood can also be withdrawn through the catheter.
Catheter, Foley: A flexible plastic tube (a catheter) inserted into the bladder to provide continuous urinary drainage.
The "Foley" has a balloon on the bladder end. After the catheter is inserted in the bladder, the balloon is inflated (with air or fluid) so that the catheter cannot pull out but is retained in the bladder as an "indwelling" catheter. Removal is accomplished simply by deflating the balloon and slipping the catheter out.
Catheter, hemodialysis: A venous catheter used for hemodialysis (dialysis of the blood). A hemodialysis catheter is a type of central venous catheter. It may be inserted into the subclavian, internal jugular, or femoral veins. Subclavian catheters generally may be used for 2 to 6 weeks. Hemodialysis catheters are often for relatively short-term use because of an acute need for dialysis or because chronic dialysis is just starting.
Long-term access for hemodialysis may be provided by subcutaneous arteriovenous fistulas in which an artery (the radial artery) is surgically anastomosed (connected) to a vein (the cephalic vein). However, after this procedure is done, it takes 6 to 8 weeks for the forearm veins to dilate and arterialize to be suitable for repeated puncture and hence for long-term hemodialysis.
Catheterization, venous: The insertion of a tiny tube (a catheter) into a peripheral or central vein to deliver fluids or medication. This is the most frequently used method for the administration of intravenous (IV) fluids and IV meds (medications).
The most common complications of venous catheterization are infiltration of fluid around the catheter, failure of the line to stay open, and infection somewhere along the length of the catheter (catheter sepsis).
Central line: A catheter (tube) that is passed through a vein to end up in the thoracic (chest) portion of the vena cava (the large vein returning blood to the heart) or in the right atrium of the heart.
Central lines have a number of different uses. A central line allows concentrated solutions to be infused with less risk of complications. It permits monitoring of special blood pressures including the central venous pressure, the pulmonary artery pressure, and the pulmonary capillary wedge pressures. The central line can be used for the estimation of cardiac output and vascular resistance. The near end of the catheter may also be connected to a chamber for injections given over periods of months. A central line saves having to have frequent small injections or "drips" placed in the arms. A central line may also allow a patient to have medicine or fluids at home instead of in the hospital.
The central line may be inserted for the short term or long term. There are two types of long term central lines: the cuffed or tunnelled line and the reservoir long line that ends in a rubber bulb or reservoir.
The possible complications of a central line include air in the chest (pneumothorax) due to a punctured lung, bleeding in the chest (hemothorax), fluid in the chest (hydrothorax), ble4eding into or under the skin (hematoma) and infection. If the line becomes disconnected, air may enter the blood and cause problems with breathing or a stroke.
A central line is also called a central venous line or a central venous catheter (CVC).
Circulatory: Having to do with the circulation, the movement of fluid in a regular or circuitous course. Although the adjective "circulatory" need not necessarily refer to the circulation of the blood, for all practical purposes today it does. A circulatory problem is taken usually to be a problem with the blood circulation, for example with heart failure.
CMV (cytomegalovirus): A virus that infects 50-85% of adults in the US by age 40 and is also the virus most frequently transmitted to a child before birth. Persons with symptoms have a mononucleosis-like syndrome with prolonged fever and mild hepatitis. Once a person becomes infected, the virus remains alive and usually dormant within that person's body for life. Recurrent disease rarely occurs unless the person's immune system is suppressed due to therapeutic drugs or disease. CMV infection is therefore a concern because of the risk of infection to the unborn baby, people who work with children, and immunodeficient people such as transplant recipients and those with HIV.
CMV is a member of the herpesvirus group, which also includes herpes simplex virus, varicella-zoster virus (which causes chickenpox) and Epstein-Barr virus (which causes infectious mononucleosis). These viruses share a characteristic ability to remain dormant within the body over a long period. Initial CMV infection, which may have few symptoms, is always followed by a prolonged, inapparent infection during which the virus resides in cells without causing detectable damage or clinical illness. Severe impairment of the body's immune system by medication or disease consistently reactivates the virus from the latent or dormant state.
Infectious CMV may be shed in the bodily fluids of any previously infected person, and thus may be found in urine, saliva, blood, tears, semen, and breast milk. The shedding of virus may take place intermittently, without any detectable signs, and without causing symptoms.
Spread of CMV is from person to person. Infection requires close contact with a person excreting the virus in their saliva, urine, or other bodily fluids. CMV can be sexually transmitted. It can also be transmitted via breast milk, transplanted organs and, rarely, blood transfusions. Although the virus is not highly contagious, it has been shown to spread in households and among young children in day care centers.
Transmission of the virus is often preventable because it is most often transmitted through infected bodily fluids that come in contact with hands and then are absorbed through the nose or mouth of a susceptible person. Therefore, care should be taken when handling children and items like diapers. Simple hand washing with soap and water is effective in removing the virus from the hands.
CMV infection without symptoms is common in infants and young children; therefore, it is unjustified and unnecessary to exclude from school or an institution a child known to be infected. Similarly, hospitalized patients do not need separate or elaborate isolation precautions.
During pregnancy when a woman becomes infected with CMV, there is a risk that the infant may be born with CMV and have CMV-related complications. On the other hand, infants and children who acquire CMV after birth have few, if any, symptoms or complications.
CMV is the most important cause of congenital viral infection in the US. For infants who are infected by their mothers before birth, two potential pictures exist:
- Generalized infection may occur in the infant, and symptoms may range from moderate enlargement of the liver and spleen (with jaundice) to fatal illness. With supportive treatment, most infants with CMV disease survive. However, from 80% to 90% have complications within the first few years of life that may include hearing loss, vision impairment, and varying degrees of mental retardation.
- Another 5% to 10% of infants who are infected have no symptoms at birth but subsequently have varying degrees of hearing and mental or coordination problems.
Most healthy people working with infants and children face no special risk from CMV infection. However, for women of child-bearing age who previously have not been infected with CMV, there is a potential risk to the developing unborn child (the risk is described above in the Pregnancy section). Contact with children who are in day care, where CMV infection is commonly transmitted among young children (particularly toddlers), may be a source of exposure to CMV. Since CMV is transmitted through contact with infected body fluids, including urine and saliva, child care providers (meaning day care workers, special education teachers, therapists, as well as mothers) should be educated about the risks of CMV infection and the precautions they can take. Day care workers appear to be at a greater risk than hospital and other health care providers, and this may be due in part to the increased emphasis on personal hygiene in the health care setting.
Primary (or the initial) CMV infection in the immunocompromised patient can cause serious disease. However, the more common problem is the reactivation of the dormant virus. Infection with CMV is a major cause of disease and death in immunocompromised patients, including organ transplant recipients, patients undergoing hemodialysis, patients with cancer, patients receiving immunosuppressive drugs, and HIV-infected patients. Pneumonia, retinitis (an infection of the eyes), and gastrointestinal disease are the common manifestations of disease. Because of this risk, exposing immunosuppressed patients to outside sources of CMV should be minimized. Whenever possible, patients without CMV infection should be given organs and/or blood products that are free of the virus.
Most infections with CMV are not diagnosed because the virus usually produces few, if any, symptoms and tends to reactivate intermittently without symptoms. However, persons who have been infected with CMV develop antibodies to the virus, and these antibodies persist in the body for the lifetime of that individual. A number of laboratory tests that detect these antibodies to CMV have been developed to determine if infection has occurred and are widely available. In addition, the virus can be cultured from specimens obtained from urine, throat swabs, and tissue samples to detect active infection.
Co-payment: A payment made by an individual who has health insurance, usually at the time a service is received, to offset some of the cost of care. Co-payments are a common feature of HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) health plans in the US. Co-payment size may vary depending on the service, generally with low copayments required for visits to a regular medical provider and higher payments for services received in the emergency room, the latter intended to discourage insured persons from using the emergency room unless it is absolutely necessary. Also called co-insurance.
Colitis, universal:� Ulcerative colitis that involves the entire colon (the large intestine).
Ulcerative colitis itself is a relatively common disease involving inflammation of the large intestine (the colon). The cause is unknown. It is a form of inflammatory bowel disease and has some similarity to a related disorder, Crohn's disease.
The lower end of the colon (the rectum) is always involved in ulcerative colitis. When the inflammation is limited to the rectum, it is called ulcerative proctitis.
In ulcerative colitis, the inflammation may extend to varying degrees up into the upper parts of the colon. When the entire colon is involved, the terms pancolitis or universal colitis are used.
The symptoms of ulcerative colitis include crampy abdominal pain, diarrhea, and intermittent rectal bleeding. Ulcerative colitis characteristically waxes and wanes. Many patients experience long remissions, even without medication. Ulcerative colitis may mysteriously resolve ("burn out") after a long history of symptoms.
Direct visualization (sigmoidoscopy or colonoscopy) with sampling of the lining of the bowel is the most accurate diagnostic test. Especially in new cases, infections and other diseases that can mimic ulcerative colitis have to be considered and excluded.
Long-standing ulcerative colitis increases the risk for colon cancer. Ulcerative colitis can also be associated with inflammation in joints, spine, skin, eyes, the liver and its bile ducts.
The treatment of ulcerative colitis involves medications and/or surgery. Since inflammatory bowel disease is currently an area of active and productive research, new treatments are anticipated which, it is hoped, will be of value in ulcerative colitis.
Colonoscopy: A procedure in which a long flexible viewing tube (a colonoscope) is threaded up through the rectum for the purpose of inspecting the entire colon and rectum and, if there is an abnormality, taking a biopsy of it or removing it. The procedure requires a thorough bowel cleansing to assure a clear view of the lining. Called also coloscopy.
Creatinine: A chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Approximately 2% of the body's creatine is converted to creatinine every day. Creatinine is transported through the bloodstream to the kidneys. The kidneys filter out most of the creatinine and dispose of it in the urine.
Although it is a waste, creatinine serves a vital diagnostic function. Creatinine has been found to be a fairly reliable indicator of kidney function. As the kidneys become impaired the creatinine will rise. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys, sometimes even before a patient reports any symptoms. It is for this reason that standard blood and urine tests routinely check the amount of creatinine in the blood.
Normal levels of creatinine in the blood are approximately 0.6 to 1.2 milligrams (mg) per deciliter (dl) in adult males and 0.5 to 1.1 milligrams per deciliter in adult females. (In the metric system, a milligram is a unit of weight equal to one-thousandth of a gram, and a deciliter is a unit of volume equal to one-tenth of a liter.) Muscular young or middle-aged adults may have more creatinine in their blood than the norm for the general population. Elderly persons, on the other hand, may have less creatinine in their blood than the norm. Infants have normal levels of about 0.2 or more, depending on their muscle development. A person with only one kidney may have a normal level of about 1.8 or 1.9. Creatinine levels that reach 2.0 or more in babies and 10.0 or more in adults may indicate the need for a dialysis machine to remove wastes from the blood.
Creatinine clearance test: A test that helps determine whether the kidneys are functioning normally. Specifically, the creatinine-clearance test gauges the rate at which a waste, creatinine, is "cleared" from the blood by the kidneys. Creatinine is produced from the metabolism of protein as when muscles burn energy. Most creatinine is then filtered out of the blood by the kidneys and excreted in urine.
The rate of creatinine clearance is measured by first noting the volume of urine excreted in a given time period, such as 24 hours. Then the amount of creatinine in the excreted urine is measured and compared with the amount of creatinine circulating in the blood. If the kidneys are not removing enough creatinine, the level of creatinine in the urine will fall. And consequently the level of creatinine in the blood will rise.
When the kidneys fail to clear enough creatinine and other wastes from the blood, the wastes build up in the bloodstream. Symptoms of kidney disease -- including swelling (edema), nausea, and high blood pressure -- may develop.
However, the creatinine-clearance test can usually detect waste buildup in the blood before it threatens the body. Doctors can then have an opportunity to eliminate the cause of the buildup and restore blood creatinine to normal levels. A creatinine-clearance test, thus, plays a key role in preventive medicine as well as in diagnostic and therapeutic medicine.
Calculating creatinine levels requires the following information:
A. The average volume in milliliters of urine excreted in one minute. (A milliliter is a metric unit equal to one-thousandth of a liter.)
B. The average amount of creatinine in milligrams in one liter of excreted urine. (A milligram is a metric unit equal to one-thousandth of a gram.)
C. The average amount of creatinine in milligrams in one deciliter of blood. (A deciliter is a metric unit equal to one-tenth of a liter.)
The creatinine-clearance rate is arrived at by first multiplying A by B, then dividing the result (product) by C.
The rate is expressed in milliliters per minute. Normal values for adult males range from about 110 to 120 milliliters per minute. Normal values for adult females range from about 100 to 110 milliters per minute.
"Creatinine" is derived from the Greek word "kreas," meaning "flesh." The suffix "-ine" denotes a chemical substance.
CT scan: Pictures of structures within the body created by a computer that takes the data from multiple X-ray images and turns them into pictures on a screen. CT stands for computerized tomography.
The CT scan can reveal some soft-tissue and other structures that cannot even be seen in conventional X-rays. Using the same dosage of radiation as that of an ordinary X-ray machine, an entire slice of the body can be made visible with about 100 times more clarity with the CT scan.
The tomograms ("cuts") for CT are usually made 5 or 10 mm apart. The CT machine rotates 180 degrees around the patient's body. The machine sends out a thin X-ray beam at 160 different points. Crystals positioned at the opposite points of the beam pick up and record the absorption rates of the varying thicknesses of tissue and bone. The data are then relayed to a computer that turns the information into a 2-dimensional cross-sectional image.
Cystic fibrosis: One of the most common grave genetic (inherited) diseases, CF affects the exocrine glands and is characterized by the production of abnormal secretions, leading to mucous build-up.
This accumulation of mucus can impair the pancreas and, secondarily, the intestine. Mucous build-up in lungs tends progressively to impair respiration. Without treatment, CF results in death for 95% of affected children before age 5. However, with diligent medical care patients with CF are surviving even beyond middle age.
Early diagnosis of CF is of great importance. Early and continuing treatment of CF is essential for long-term survival. However, as more people with CF survive childhood, new problems are emerging. For example, 68% of 75 adult women with CF reported leakage of urine within the past year. Coughing, sneezing, laughing and airway clearance provoked the leakage, which was worse when their chest disease was most severe.
CF is inherited in an autosomal recessive manner and affects both boys and girls. One in 400 white couples is at risk for having children with CF and their risk with each pregnancy is 1 in 4, so (multiplying 1 in 400 times 1 in 4) the overall risk that their child will have CF is 1 in 1600. Note that once a couple has had a CF child, the risk that each of their subsequent children will have CF drops to 1 in 4 (25%).
The treatment of CF includes physical therapy to loosen the mucus in the lungs, pancreatic enzymes, and medications to fight dangerous infections of the lungs.
CF is caused by mutations in a gene called CFTR (for the cystic fibrosis conductance regulator), which is located on chromosome 7
Dehydration: Excessive loss of body water. Diseases of the gastrointestinal tract that cause vomiting or diarrhea may, for example, lead to dehydration. There are a number of other causes of dehydration including heat exposure, prolonged vigorous exercise (e.g., in a marathon), kidney disease, and medications (diuretics).
One clue to dehydration is a rapid drop in weight. A loss of over 10% (15 pounds in a person weighing 150 pounds) is considered severe.
Symptoms and signs of dehydration include increasing thirst, dry mouth, weakness or lightheadedness (particularly if worse on standing), and a darkening of the urine or a decrease in urination. Severe dehydration can lead to changes in the body�s chemistry, kidney failure, and become life-threatening.
Dehydration due to diarrhea is a major cause of morbidity (disease) and mortality (death) in children. The young child has a more rapid turnover of body fluids than an adult. In rehydrating a child, there is less margin for error than for an adult. The younger the child, the more careful the rehydration must be. Cases that demand particular attention to detail are those in which organ function (especially skin, heart, brain, or kidney) is critically compromised. Overhydration may be as serious as severe dehydration in children; the rehydration should therefore be done under medical supervision.
The best way to treat dehydration is to prevent it from occurring. If one suspects fluid loss is excessive, notify a physician. Intravenous or oral fluid replacement may be needed.
Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus. Diabetes mellitus and diabetes insipidus share the name "diabetes" because they are both conditions characterized by excessive urination (polyuria).
The word "diabetes" is borrowed from the Greek word meaning "a siphon." The 2nd-century A.D. Greek physician, Aretus the Cappadocian, named the condition "diabetes." He explained that patients with it had polyuria and "passed water like a siphon."
When "diabetes" is used alone, it refers to diabetes mellitus. The two main types of diabetes mellitus -- insulin-requiring type 1 diabetes and adult-onset type 2 diabetes -- are distinct and different diseases in themselves.
Diarrhea: A familiar phenomenon with unusually frequent or unusually liquid bowel movements, excessive watery evacuations of fecal material. The opposite of constipation. The word "diarrhea" with its odd spelling is a near steal from the Greek "diarrhoia" meaning "a flowing through." Plato and Aristotle may have had diarrhoia while today we have diarrhea. There are myriad infectious and noninfectious causes of diarrhea.
Persistent diarrhea is both uncomfortable and dangerous to the health, as it can indicate an underlying infection. It may also mean that the body is not able to absorb some nutrients due to a problem in the bowels. Treatment includes drinking plenty of fluids to prevent dehydration, over-the-counter remedies in most cases, and medical examination if diarrhea persists for more than a couple of days, particularly in small children or elderly people.
Dialysis: The process of cleansing the blood by passing it through a special machine. Dialysis is necessary when the kidneys are not able to filter the blood. Dialysis allows patients with kidney failure a chance to live productive lives. There are two types of dialysis: hemodialysis and peritoneal dialysis. Each type of dialysis has advantages and disadvantages. Patients can often choose the type of long term dialysis that best matches their needs.
Electrolyte: An electrolyte is a substance that will dissociate into ions in solution and acquire the capacity to conduct electricity. The electrolytes include sodium, potassium, chloride, calcium and phosphate. Informally, called lytes. (The clue to the word electrolyte is in the lyte which comes from the Greek lytos meaning that may be dissolved.)
Emergency department (ER): The department of a hospital responsible for the provision of medical and surgical care to patients arriving at the hospital in need of immediate care. Emergency department personnel may also respond to certain situations within the hospital such cardiac arrests.
The emergency department is also called the emergency room or ER.
Emphysema: 1) A lung condition featuring an abnormal accumulation of air in the lung's many tiny air sacs, a tissue called alveoli. As air continues to collect in these sacs, they become enlarged, and may break, or be damaged and form scar tissue. Emphysema is strongly associated with smoking cigarettes, a practice that causes lung irritation. It can also be associated with or worsened by repeated infection of the lungs, such as is seen in chronic bronchitis. The best response to the early warning signs of emphysema is prevention: stop smoking and get immediate treatment for incipient lung infections. Curing established emphysema is not yet possible. Because patients don't have an adequate amount of space in the lungs to breathe, they gasp for breath, and may not be able to obtain enough oxygen. Those with severe emphysema usually end up using an oxygen machine to breathe. In some cases, medication may be helpful to ease symptoms or to treat infection in already-damaged lungs.
2) The escape of air into other body tissues, as may occur during surgery. This is called surgical emphysema.
Epidural anesthetic: An anesthetic injected into the epidural space surrounding the fluid-filled sac (the dura) around the spine which partially numbs the abdomen and legs.
Esophagus: The tube that connects the pharynx (throat) with the stomach. The esophagus lies between the trachea (windpipe) and the spine. It passes down the neck, pierces the diaphragm just to the left of the midline, and joins the cardiac (upper) end of the stomach. In an adult, the esophagus is about 25 centimeters (10 inches) long. When a person swallows, the muscular walls of the esophagus contract to push food down into the stomach. Glands in the lining of the esophagus produce mucus, which keeps the passageway moist and facilitates swallowing. Also known as the gullet or swallowing tube.
Fistula:� see Catheter, hemodialysis
FDA: The FDA is the Food and Drug Administration, an agency within the U.S. Public Health Service, which is a part of the Department of Health and Human Services.
Background: The FDA regulates over $1 trillion worth of products, which account for 25 cents of every dollar spent annually by American consumers and touches the lives of virtually every American every day. It is FDA's job to see that food is safe and wholesome, cosmetics won't hurt people, the medicines and medical devices are safe and effective, and that radiation-emitting products such as microwave ovens won't do harm. Feed and drugs for pets and farm animals also come under FDA scrutiny. FDA ensures that all of these products are labeled truthfully with the information that people need to use them properly.
Approval of new drugs: The FDA requires that drugs--both prescription and over-the-counter--be proven safe and effective. In deciding whether to approve new drugs, FDA does not itself do research, but rather examines the results of studies done by the manufacturer. The FDA must determine that the new drug produces the benefits it's supposed to without causing side effects that would outweigh those benefits.
Safety of food products: FDA tests food samples to see if any substances, such as pesticide residues, are present in unacceptable amounts. If contaminants are identified, FDA takes corrective action. FDA also sets labeling standards to help consumers know what is in the foods they buy.
Feed and drugs for pets and farm animals: FDA also is responsible that medicated feeds and other drugs given to pets and animals raised for food are not threatening to health.
Safety of the blood supply: FDA investigators examine blood bank operations, from record-keeping to testing for contaminants.
Safety of biologicals: FDA also ensures the purity and effectiveness of biologicals (medical preparations made from living organisms and their products), such as insulin and vaccines.
Safety of medical devices: These are classified and regulated by FDA according to their degree of risk to the public. Devices that are life-supporting, life-sustaining or implanted, such as pacemakers, must receive agency approval before they can be marketed.
Cosmetic, dyes and additive safety: FDA can have unsafe cosmetics removed from the market. The dyes and other additives used in drugs, foods and cosmetics also are subject to FDA scrutiny. The agency must review and approve these chemicals before they can be used.
Inspections and legal sanctions: FDA investigators and inspectors collect domestic and imported product samples for scientific examination and for label checks. If a company is found violating a law that FDA enforces, FDA can encourage the firm to voluntarily correct the problem or to recall a faulty product from the market. When a company can't (or won't) correct a public health problem with one of its products voluntarily, FDA has legal sanctions it can bring to bear. FDA can go to court to force a company to stop selling a product and to have items already produced seized and destroyed. When warranted, criminal penalties--including prison sentences--are sought against manufacturers and distributors.
Product recalls: About 3,000 products a year are found to be unfit for consumers and are withdrawn from the marketplace, either by voluntary recall or by court-ordered seizure. In addition, about 30,000 import shipments a year are detained at the port of entry because the goods appear unacceptable.
Scientific expertise: Evidence to back up FDA legal cases is prepared by FDA laboratory scientists. Some analyze samples to see, for example, if products are contaminated with illegal substances. Other scientists review test results submitted by companies seeking agency approval for drugs, vaccines, food additives, coloring agents and medical devices.
This information was condensed from a Statement on Jan. 11, 1999 (Publication No. BG99-1) by the FDA.
Gastroenterologist: A doctor who specializes in diagnosing and treating diseases of the digestive system.
GERD: Stands for GastroEsophageal Reflux Disease, a disorder in which there is recurrent return of stomach contents back up into the esophagus, frequently causing heartburn, a symptom of irritation of the esophagus by stomach acid. This can lead to scarring and stricture of the esophagus, which can require stretching (dilating).
10% of patients with GERD develop Barrett�s esophagus which increases the risk of cancer of the esophagus. 80% of patients with GERD also have a hiatal hernia.
Hemodialysis: A medical procedure that uses a special machine (a dialysis machine) to filter waste products from the blood and to restore normal constituents to it. This shuffling of multiple substances is accomplished by virtue of the differences in the rates of their diffusion through a semipermeable membrane (a dialysis membrane).
Although hemodialysis may be done for acute kidney failure, it is more often employed for chronic renal disease. Hemodialysis is frequently done to treat end-stage kidney disease. Under such circumstances, kidney dialysis is typically administered using a fixed schedule of three times per week.
There are other types of dialysis as, for example, peritoneal dialysis.
ICU: Intensive Care Unit.
Immune system: A complex system that is responsible for distinguishing us from everything foreign to us, and for protecting us against infections and foreign substances. The immune system works to seek and kill invaders.
If a person is born with a severely defective immune system, death from infection by a virus bacterium, fungus or parasite may occur. In severe combined immunodeficiency, lack of an enzyme means that toxic waste builds up inside immune system cells, killing them and thus devastating the immune system. A lack of immune system cells is also the basis for DiGeorge syndrome: improper development of the thymus gland means that T cell production is diminished.
Other immune disorders result from either an excessive immune response or an 'autoimmune attack'. Asthma, familial Mediterranean fever and Crohn disease (inflammatory bowel disease) all result from an over-reaction of the immune system, while autoimmune polyglandular syndrome and some facets of diabetes are due to the immune system attacking 'self' cells and molecules.
A key part of the immune system's role is to differentiate between invaders and the body's own cells - when it fails to make this distinction, a reaction against 'self' cells and molecules causes autoimmune disease.
Immunosuppressant: An agent that can suppress or prevent the immune response. Immunosuppressants are used to prevent rejection of a transplanted organ and to treat autoimmune diseases such as psoriasis, rheumatoid arthritis, and Crohn's disease. Some treatments for cancer act as immunosuppressants. Also called an immunodepressant.
Immunosuppression: Suppression of the immune system. Immunosuppression may result from certain diseases such as AIDS or lymphoma or from certain drugs such as some of those used to treat cancer. Immunosuppression may also be deliberately induced with drugs, as in preparation for bone marrow or other organ transplantation to prevent the rejection of the transplant.
Insulin: A natural hormone made by the pancreas that controls the level of the sugar glucose in the blood. Insulin permits cells to use glucose for energy. Cells cannot utilize glucose without insulin.
Intravenous (IV): 1) Into a vein. Intravenous (IV) antibiotics are a solution containing antibiotics that is administered directly into the venous circulation via a syringe or intravenous catheter (tube). 2) The actual solution that is administered intravenously. 3) The device used to administer an intravenous solution, such as the familiar IV drip used to slowly drip a bag of electrolyte solution into a dehydrated patient through a tiny plastic tube inserted directly into a vein.
HIV: Acronym for the Human Immunodeficiency Virus, the cause of AIDS (acquired immunodeficiency syndrome). HIV has also been called the human lymphotropic virus type III, the lymphadenopathy-associated virus and the lymphadenopathy virus. No matter what name is applied, it is a retrovirus. (A retrovirus has an RNA genome and a reverse transcriptase enzyme. Using the reverse transcriptase, the virus uses its RNA as a template for making complementary DNA which can integrate into the DNA of the host organism).
Although the American research Robert Gallo at the National Institutes of Health (NIH) believed he was the first to find HIV, it is now generally accepted that the French physician Luc Montagnier (1932-) and his team at the Pasteur Institute discovered HIV in 1983-84.
Irritable bowel syndrome (IBS): A common gastrointestinal disorder involving an abnormal condition of gut contractions (motility) characterized by abdominal pain, bloating, mucous in stools, and irregular bowel habits with alternating diarrhea and constipation, symptoms that tend to be chronic and to wax and wane over the years. Although IBS can cause chronic recurrent discomfort, it does not lead to any serious organ problems.
Making the diagnosis usually involves excluding other illnesses. Treatment is directed toward relief of symptoms and includes changes in diet (eating high fiber and avoiding caffeine, milk products and sweeteners), exercise, relaxation techniques, and medications.
Also called spastic colitis, mucus colitis, nervous colon syndrome
Jugular: The principal vein in the front of either side of the neck. The word comes from the Latin jugulum meaning throat. The jugular is "the vein of the throat" or in ancient times "the sacrificial vein."
Kidney: One of a pair of organs located in the right and left side of the abdomen which clear "poisons" from the blood, regulate acid concentration and maintain water balance in the body by excreting urine. The kidneys are part of the urinary tract. The urine then passes through connecting tubes called "ureters" into the bladder. The bladder stores the urine until it is released during urination.
The kidneys remove waste products from the blood and produce urine. As blood flows through the kidneys, they filter waste products, chemicals, and unneeded water from the blood. Urine collects in the middle of each kidney, an area called the renal pelvis. Urine then drains from the kidney through a long tube, the ureter, to the bladder, where it is stored.
The kidneys also make substances that help control blood pressure and regulate the formation of red blood cells.
Kidney transplant: Replacement of a diseased, damaged, or missing kidney with a donor kidney. Also called a renal transplant.
Patients with end-stage renal failure are candidates for transplantation. A successful transplant frees the patient from dialysis and provides the kidney's other metabolic functions.
The survival rate a year after a transplant from a living related donor is over 95%. The survival rate a year after a transplant from a cadaver is about 90%. The principal problems in kidney transplantation are immunologic, avoiding rejection of the transplanted kidney by the recipient's immune system.
The first kidney transplant was done in Boston by surgeon Joseph E. Murray in 1954. (This was the first successful human organ transplant.) Murray removed a kidney from Ronald Herrick and transplanted it to his identical twin, Richard Herrick (and thereby skirted the immunologic problems). In 1990, Murray shared the Nobel Prize in Physiology or Medicine with E. Donnall Thomas "for their discoveries concerning organ and cell transplantation in the treatment of human disease."
Lumen: A luminous term referring to the channel within a tube such as a blood vessel or to the cavity within a hollow organ such as the intestine. Lumen is a luminous term because it is Latin for light, including the light that comes through a window. When a hollow organ is cut across, you can see light through the space that has been opened. So the word "lumen" came to mean this space.
For example, in arteriosclerosis, fat deposits narrow the lumen of the artery. For another example, cells called enetrocytes within the intestinal wall help transport water from the lumen of the intestine into the bloodstream.
Medicare: The United States government�s health insurance program for older people and some who are younger but are disabled. Medicare is funded by the Social Security Administration. with a budget equal to about 10% of the entire US budget.
Medicare is currently available to about 40 million people: those who are 65 and older and to people with certain disabilities. Medicare Part A covers inpatient hospital stays while Medicare Part B covers physician and outpatient services.
In 1965, President Lyndon B. Johnson signed the Medicare bill into law in the presence of former President Harry S. Truman in Independence , Missouri. Truman described the event as "a profound personal experience for me." During his presidency, Truman had attempted in vain to get a national health insurance program through Congress.
In 1966 the first Medicare card was issued by LBJ to Truman. The second card was given to the former First Lady, Bess Truman.
MRA:� The magnetic resonance angiogram, or MRA, is a noninvasive test that has demonstrated usefulness in defining the anatomy of blood vessels of certain size in the head and neck. MRA serves as a complement to traditional MRI scanning in evaluation of the brain and neck.
Conventional angiograms, whereby contrast material is injected through a catheter into the blood vessels of the head and neck, are the gold standard (most accurate) for determining the anatomy of these vessels. The advantages of MRA is that it is faster and easier (it does not involve the catheters, contrast material, and risks of angiograms). Another advantage is that MRA also gives an image of the tissue of the brain.
MRA is a general term that refers to various imaging techniques that are used to visualize the blood vessels by using magnetic resonance (MR) signal changes that are affected by changes in the flow of blood caused by changes in the shape of the blood vessels.
MRA can be used to detect small ballooning of the blood vessels (aneurysms) as small as 4 millimeters in diameter. Smaller aneurysms can require an angiogram for detection. The sensitivity of MRA in detecting aneurysms can be affected by bleeding within the brain and the location of the aneurysms within the brain.
MRA can also detect abnormal design (malformations), and atherosclerosis of blood vessels within the brain. Atherosclerosis of the carotid arteries of the neck can be visualized with MRA.
MRA does not have significant application for the detection or definition of cancer of the brain.
MRI: Abbreviation and commonly used nickname for magnetic resonance imaging. A procedure using a magnet connected to a computer to create images of internal structures of the body, especially the soft tissues. An MRI uses the influence of a large magnet to polarize hydrogen atoms in the tissues and then monitor the summation of the spinning energies within living cells. MRI images, particularly with soft tissue, brain and spinal cord, abdomen and joints, are clear and can be superior to the usual X-ray image.
NG tube: An NG (nasogastric) tube is one that is passed through the nose (via the nasopharynx and esophagus) down into the stomach.
An NG tube is a flexible tube made of rubber or plastic and has bidirectional potential. A nasogastric tube can thus be used to remove the contents of the stomach including air (to decompress the stomach) and small solid objects and fluid (e.g., to evacuate poison from the stomach). A nasogastric tube can also be used to instill liquids into the stomach (e.g., to feed the person).
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): One of the National Institutes of Health in the U.S., the NIDDK has a multisystem name and a comparably broad mission, namely, to "conduct and support basic and applied research and provide leadership for a national program in diabetes, endocrinology, and metabolic diseases; digestive diseases and nutrition; and kidney, urologic, and hematologic diseases. Several of these diseases are among the leading causes of disability and death; all seriously affect the quality of life of those who have them."
Nephrologist: A medical specialist in nephrology (the study of the kidney or "kidney-ology").
Pancreas: A fish-shaped spongy grayish-pink organ
about 6 inches (15 cm) long that stretches across the back of the abdomen,
behind the stomach. The head of the pancreas is on the right side of the
abdomen and is connected to the duodenum (the first section of the small
intestine). The narrow end of the pancreas, called the tail, extends to the
left side of the body. 
The pancreas makes pancreatic juices and hormones, including insulin.
The pancreatic juices are enzymes that help digest food in the small intestine.
Insulin
controls the amount of sugar in the blood.
As pancreatic juices are made, they flow into the main pancreatic duct. This duct joins the common bile duct, which connects the pancreas to the liver and the gallbladder. The common bile duct, which carries bile (a fluid that helps digest fat), connects to the small intestine near the stomach.
The pancreas is thus a compound gland. It is "compound" in the sense that it is composed of both exocrine and endocrine tissues. The exocrine function of the pancreas involves the synthesis and secretion of pancreatic juices. The endocrine function resides in the million or so cellular islands (the islets of Langerhans) embedded between the exocrine units of the pancreas. Beta cells of the islands secrete insulin, which helps control carbohydrate metabolism. Alpha cells of the islets secrete glucagon that counters the action of insulin
NIH: The National Institutes of Health. The NIH is an important U.S. health agency. It is devoted to medical research. Administratively under the Department of Health and Human Services (HHS), the NIH consists of 20-some separate Institutes and Centers. NIH's program activities are represented by these Institutes and Centers. They are, along with a brief overview of their essential missions, as follows:
- National Cancer Institute (NCI) - mission is to "lead a national effort to reduce the burden of cancer morbidity and mortality and ultimately to prevent the disease. Through basic and clinical biomedical research and training, NCI conducts and supports programs to understand the causes of cancer; prevent, detect, diagnose, treat, and control cancer; and disseminate information to the practitioner, patient, and public."
- National Center for Research Resources (NCRR) - mission is to "advance biomedical research and improves human health through research projects and shared resources that create, develop, and provide a comprehensive range of human, annual, technological, and other resources. NCRR's support is concentrated in four areas: biomedical technology, clinical research, comparative medicine, and research infrastructure."
- National Eye Institute (NEI) - mission is to "conduct and support research, training, health information dissemination, and other programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight, and the special health problems and requirements of the blind."
- National Heart, Lung, and Blood Institute (NHLBI) - mission is to "provide leadership for a national research program in diseases of the heart, blood vessels, lungs, and blood and in transfusion medicine through support of innovative basic, clinical, and population-based and health education research."
- National Human Genome Research Institute (NHGRI) - mission is to "support the NIH component of the Human Genome Project, a worldwide research effort designed to analyze the structure of human DNA and determine the location of the estimated 100,000 human genes. The NHGRI Intramural Research Program develops and implements technology for understanding, diagnosing, and treating genetic diseases."
- National Institute of Allergy and Infectious Diseases (NIAID) - mission is "to support and conduct research and research training (that) strives to understand, treat, and ultimately prevent the myriad infectious, immunologic, and allergic diseases that threaten millions of human lives."
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) - mission is to "conduct and support a broad spectrum of research on normal structure and function of bones, muscles, and skin, as well as the numerous and disparate diseases that affect these tissues. NIAMS also conducts research training and epidemiologic studies and disseminates information."
- National Institute of Child Health and Human Development (NICHD) - mission is to support and conduct "research on fertility, pregnancy, growth, development, and medical rehabilitation strives to ensure that every child is born healthy and wanted and grows up free from disease and disability."
- National Institute of Dental and Craniofacial Research (NIDCR), formerly the National Institute of Dental Research (NIDR) - mission is to "provide leadership for a national research program designed to understand, treat, and ultimately prevent the infectious and inherited craniofacial-oral-dental diseases and disorders that compromise millions of human lives."
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) - mission is to "conduct and support basic and applied research and provide leadership for a national program in diabetes, endocrinology, and metabolic diseases; digestive diseases and nutrition; and kidney, urologic, and hematologic diseases. Several of these diseases are among the leading causes of disability and death; all seriously affect the quality of life of those who have them."
- National Institute of Environmental Health Sciences (NIEHS) - mission is to "reduce the burden of human illness and dysfunction from environmental causes by defining how environmental exposures, genetic susceptibility, and age interact to affect an individual's health."
- National Institute of General Medical Sciences (NIGMS) - mission is to "support basic biomedical research that is not targeted to specific diseases or disorders. Among the most significant results of this research has been the development of recombinant DNA technology, which forms the basis for the biotechnology industry."
- National Institute of Mental Health (NIMH) - mission is to "provide national leadership dedicated to understanding, treating, and preventing mental illnesses through basic research on the brain and behavior, and through clinical, epidemiological, and services research."
- National Institute of Neurological Disorders and Stroke (NINDS) - mission is to "support and conduct research and research training on the normal structure and function of the nervous system and on the causes, prevention, diagnosis, and treatment of more than 600 nervous system disorders including stroke, epilepsy, multiple sclerosis, Parkinson's disease, head and spinal cord injury, Alzheimer's disease, and brain tumors."
- National Institute of Nursing Research (NINR) - mission is to "sponsor research that focuses on the clinical care of individuals and on their responses to actual or potential health problems. Through its broad mandate, NINR-supported scientists seek to understand and mitigate the effects of acute and chronic illness and disability, promote healthy behaviors and prevent the onset or worsening of disease and improve the environment in which care is administered."
- �� National Institute on Aging (NIA) - mission is to "lead a national program of research on the biomedical, social, and behavioral aspects of the aging process; the prevention of age- related diseases and disabilities; and the promotion of a better quality of life for all older Americans."
- �� National Institute on Alcohol Abuse and Alcoholism (NIAAA) - mission is to "conduct research focused on improving the treatment and prevention of alcoholism and alcohol-related problems to reduce the enormous health, social, and economic consequences of this disease."
- �� National Institute on Deafness and Other Communication Disorders (NIDCD) - mission is to "conduct and support biomedical research and research training on normal mechanisms as well as diseases and disorders of hearing, balance, smell, taste, voice, speech, and language that affect 46 million Americans."
- �� National Institute on Drug Abuse (NIDA) - mission is to "lead the nation in bringing the power of science to bear on drug abuse and addiction through support and conduct of research across a broad range of disciplines and rapid and effective dissemination of results of that research to improve drug abuse and addiction prevention, treatment, and policy."
- �� National Library of Medicine (NLM) - mission is to "collect, organize, and make available biomedical science information to investigators, educators, and practitioners and carry out programs designed to strengthen medical library services in the United States. Its electronic data bases, including MEDLINE, are used extensively throughout the world."
- �� Center for Information Technology (CIT, formerly DCRT, OIRM, TCB) mission is to "incorporate the power of modern computers into the biomedical programs and administrative procedures of the NIH by focusing on three primary activities: conducting-computational biosciences research, developing computer systems, and providing computer facilities."
- �� Center for Scientific Review (CSR) - mission is to serve as "the focal point at NIH for the conduct of initial peer review, the foundation of the NIH grant and award process. The Center carries out peer review of the majority of research and research training applications submitted to the NIH. In addition, the Center serves as the central receipt point for all such Public Health Service (PHS) applications and makes referrals to scientific review groups for scientific and technical merit review of applications and to funding components for potential award. To this end, the Center develops and implements innovative, flexible ways to conduct referral and review for all aspects of science."
- �� National Center for Complementary and Alternative Medicine (NCCAM) - this center "identifies and evaluates unconventional health care practices; and supports, coordinates and conducts research and research training on these practices and disseminates information."
- �� Fogarty International Center (FIC) - mission is to "lead the NIH's efforts to advance the health of the American public, and citizens of all nations, through international cooperation on global health threats."
- �� Warren Grant Magnuson Clinical Center (CC) - mission is to "provide the patient care, services, and environment needed to initiate and support the highest quality conduct of and training in clinical research."
The value of the NIH to medical research not only in the USA but in the world as a whole cannot be overestimated.
Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope.
Pediatric: Pertaining to children.
Peripherally Inserted Central Catheter (PICC):� see Catheterization, venous
Peritoneal dialysis: Technique that uses the patient�s own body tissues inside of the belly (abdominal cavity) to act as a filter. The intestines lie in the abdominal cavity, the space between the abdominal wall and the spine. A plastic tube called a "dialysis catheter" is placed through the abdominal wall into the abdominal cavity. A special fluid is then flushed into the abdominal cavity and washes around the intestines. The intestinal walls act as a filter between this fluid and the blood stream. By using different types of solutions, waste products and excess water can be removed from the body through this process.
Phlebotomist: A person who draws blood.
Psychosis, ICU: A disorder in which patients in an intensive care unit (ICU) or a similar hospital setting may experience anxiety, become paranoid, hear voices, see things that are not there, become severely disoriented in time and place, become very agitated, even violent, etc. The condition has been formally defined as "acute brain syndrome involving impaired intellectual functioning which occurs in patients who are being treated within a critical care unit." ICU psychosis is a form of delirium, or acute brain failure. Organic factors including dehydration, hypoxia (low blood oxygen), heart failure (inadequate cardiac output), infection and drugs can cause or contribute to delirium.
The treatment of ICU psychosis depends on the cause(s). Family members, familiar objects and calm words may help. Dehydration should call for fluids. Heart failure needs treatment with digitalis. Infections must be diagnosed and treated. Sedation with anti- psychotics agents may help.
To prevent ICU psychosis, many critical care units now have instituted visiting hours, they try to minimize shift changes in the nursing staff caring for a patient, the lighting is coordinated with the normal day-night cycle, etc. ICU psychosis usually goes away when the patient leaves the ICU.
One patient in every 3 who spends more than 5 days in an ICU experiences some form of psychotic reaction, according to current estimates. As the number of intensive care units and the number of people in them grow, ICU psychosis is perforce increasing as a problem.
What causes ICU psychosis is not fully known. Something about the ICU causes some people, who are already experiencing great debility, stress and pain, to "lose their minds." Among the factors which are believed to play into ICU psychosis are:
- Sensory deprivation (being put in a room often without windows, away from family, friends and all that is familiar),
- Sensory overload (being tethered to noisy machines day and night),
- Pain (which may not be adequately controlled in an ICU),
- Sleep deprivation,
- Disruption of the normal day-night rhythm, or simply
- The loss of control over their lives that patients often feel in an ICU.
ICU psychosis often goes away with the coming of morning or sleep. Although it may linger through the day, severe agitation usually occurs only at night. (This phenomenon, called sundowning, is common in nursing homes).
Here is an example of ICU psychosis:
Once when we went to visit my father-in-law in an ICU, we found him disoriented and very depressed. He couldn't hear or see well. It was like being in a medically induced whiteout. His room was windowless. He was unable to listen to a radio, watch television or talk on the telephone. He had virtually no human contact other than brief visits by medical staff because he was in isolation with an infection and those people he did see were in mask and gown and all looked alike. He felt cut off from human contact. He was sure he was going to die (which he didn't). He had ICU psychosis.
It turned out that my father-in-law's customized hearing aid left lying on the nightstand had disappeared. It had apparently fallen into the waste basket and then been thrown out with the trash. To safeguard his glasses, a well-meaning nurse had then suggested that his glasses be taken home. Hence he could not hear or see much. Restoration of his hearing aid and glasses largely relieved his ICU psychosis.
Radiation: 1. Rays of energy. Gamma rays and X-rays are two of the types of energy waves often used in medicine. 2. The use of energy waves to diagnose or treat disease. See also: Irradiation.
Radiologist: A physician specialized in radiology, the branch of medicine that uses ionizing and nonionizing radiation for the diagnosis and treatment of disease.
Like other physicians, a radiologist must have graduated from an accredited medical school or school of osteopathy, passed a licensing examination, and completed at least 4 years of graduate medical or osteopathic education (residency). Radiologists are usually board certified, that is, they have taken and passed an examination and thus are approved to practice in the field of radiology by either the American Board of Radiology (for a medical doctor) or the American Osteopathic Board of Radiology (for an osteopathic doctor).
A radiologist can also subspecialize. Subspecialties in radiology listed by the American College of Radiology give a idea of the breadth of the field:
- Radiologist - Breast imaging. The subspecialty within diagnostic radiology devoted to the diagnosis and treatment of breast diseases and conditions unique to women.
- Radiologist - Cardiovascular. The subspecialty of radiology concerned with diagnosis and treatment of diseases of the heart and vascular (blood vessel) system.
- Radiologist - Chest. The subspecialty concerned with the diagnostic radiology of diseases of the thorax, especially the heart or lungs.
- Radiologist - Computed Tomography (CT). The subspecialty concerned with diagnostic radiology using computerized tomography (CT), radiologic equipment that demonstrates both bone and soft tissues, including organs, muscles, and tumors.
- Radiologist - Diagnostic Radiology. The subspecialty concerned with or aiding in diagnosis using radiology.
- Radiologist - Emergency. The subspecialty concerned with the diagnostic imaging of emergency trauma or non-traumatic emergency conditions.
- Radiologist - Gastrointestinal. The subspecialty concerned with diagnostic radiology of the gastrointestinal tract (including the stomach and intestines).
- Radiologist - Genitourinary. The subspecialty relating to the radiology of the genitourinary tract: the organs of the reproductive and urinary tracts.
- Radiologist - Head and Neck. The subspecialty concerned with the diagnostic radiology of diseases of the head and neck.
- Radiologist - Interventional. The subspecialty that uses fluoroscopy, CT, and ultrasound to guide passage through the skin by needle puncture, including introduction of wires and catheters for performing procedures such as biopsies, draining fluids, inserting catheters, or dilating or stenting narrowed ducts or vessels.
- Radiologist - Magnetic Resonance Imaging (MRI). The subspecialty relating to magnetic resonance imaging (MRI), a diagnostic radiological modality using nuclear magnetic resonance technology. MRI uses radio waves and a strong magnetic field rather than x-rays to provide clear and detailed pictures of internal organs and tissues.
- Radiologist - Musculoskeletal. The subspecialty concerned with the diagnostic radiology of diseases of the muscles and the skeleton.
- Radiologist - Neuroradiology. The subspecialty concerned with the diagnostic radiology of diseases of the central nervous system, head, and neck.
- Radiologist - Nuclear Medicine. The subspecialty concerned with the diagnostic and therapeutic uses of radionuclides, excluding the therapeutic use of sealed radiation sources.
- Radiologist - Pediatric Radiology. The subspecialty concerned with children's radiology and the radiological manifestations of diseases of children.
- Radiological Physicist. The subspecialty relating to the therapeutic, diagnostic and safe use of applications of x-rays, gamma rays, electron and charged particle beams, neutrons and radiations from sealed radionuclide sources; relating to the equipment associated with their production, use, measurement and evaluation and instrumentation required to perform appropriate radiation surveys; relating to the quality of images resulting from their production and use; and relating to medical health physics.
- Radiologist � Radiobiology. The branch of radiology or pathology concerned with the effects of radiation on cells and tissues.
- Radiologist - Ultrasound. The subspecialty concerned with the use of ultrasound (high frequency sound waves) and other techniques for medical diagnosis.
- Radiation Oncologist - Radiation Oncology. The medical specialty of radiation oncology, the use of radiation for the therapy of neoplasms (tumors).
Red blood cell: The blood cell that carries oxygen. Red cells contain hemoglobin and it is the hemoglobin which permits them to transport oxygen (and carbon dioxide). Hemoglobin, aside from being a transport molecule, is a pigment. It gives the cell its red color (and name).
The mature red blood cell (RBC) is a non-nucleated biconcave disk. Thanks to this unusual shape and its hemoglobin content, the RBC is superbly suited to the transport of oxygen.
A red blood cell is sometimes simply referred to as a red cell. It is also called an erythrocyte or, rarely today, a red blood corpuscle.
Reflux: The term used when liquid backs up into the esophagus from the stomach.
Rejection: In transplantation biology, the refusal by the body to accept transplanted cells, tissues or organs. For example, a kidney transplanted may be rejected.
Respiratory: Having to do with respiration, the exchange of oxygen and carbon dioxide. From the Latin re- (again) + spirare (to breathe) = to breathe again.
Retinopathy: Any disease of the retina, the light-sensitive membrane at the back of the eye. The type of retinopathy is often specified. Arteriosclerotic retinopathy is retinal disease due to arteriosclerosis ("hardening of the arteries"). Diabetic retinopathy is retinal disease associated with diabetes. Hypertensive retinopathy is retinal disease due to high blood pressure. Etc.
Steroid: A large group of chemical substances related in structure to one another and each containing the same chemical skeleton (a tetracyclic cyclopenta[a]phenanthrene skeleton).
Many hormones, body constituents, and drugs are steroids. Thus, the term steroid may carry many meanings. For example, steroids may refer to the corticosteroid drugs such as prednisone used to reduce swelling, pain, and other symptoms of inflammation. Vitamin D is a steroid, too, one that is necessary to normal health. The male hormone testosterone and its derivatives are steroids with anabolic effects that can be used medically (or illicitly) to build up muscle mass.
Stool: The solid matter discharged in a bowel movement.
Subcutaneous: Under the skin. "Subcutaneous" implies just under the skin.
With a subcutaneous injection, a needle is inserted just under the skin. A drug (for example, insulin) can then be delivered into the subcutaneous tissues. After the injection, the drug moves into small blood vessels and the bloodstream. The subcutaneous route is used with many protein and polypeptide drugs such as insulin which, if given by mouth, would be broken down and digested in the intestinal tract.
Topical: Pertaining to a particular surface area. A topical agent is applied to a certain area of the skin and is intended to affect only the area to which it is applied. Whether its effects are indeed limited to that area depends upon whether the agent stays where it is put or is absorbed into the blood stream.
Transfusion: The transfer of blood or blood products from one person (the donor) into another person (the recipient's) bloodstream. In most situations, this is done as a lifesaving maneuver to replace blood cells or blood products lost through severe bleeding. Transfusion of your own blood (autologous) is the safest method but requires planning ahead and not all patients are eligible. Directed donor blood allows the patient to receive blood from known donors. Volunteer donor blood is usually most readily available and, when properly tested has a low incidence of adverse events.
Blood transfusion and blood conservation are complementary activities that constitute the clinical arena of transfusion medicine. A review of transfusion medicine in The New England Journal of Medicine further concludes that:
- The use of blood transfusion has declined, largely because of concern about the safety of the blood supply.
- The presence now of a very safe blood supply suggests that outcomes need to be monitored to identify patients in whom transfusion may be underused (as well as overused).
- No given level of hemoglobin can, it seems, be used as a universal threshold for transfusion.
- Strategies to avoid blood transfusion will no longer be driven by the known risks, since they are now so low that no alternative is currently as safe as a blood transfusion.
- Instead, blood conservation will be driven more by issues related to the costs and inventory of blood.
Transplant: The grafting of a tissue from one place to another, just as in botany a bud from one plant might be grafted onto the stem of another. The transplanting of tissue can be from one part of the patient to another (autologous transplantation), as in the case of a skin graft using the patient's own skin; or from one patient to another (allogenic transplantation), as in the case of transplanting a donor kidney into a recipient.
Trauma: Any injury, whether physically or emotionally inflicted. "Trauma" has both a medical and a psychiatric definition. Medically, "trauma" refers to a serious or critical bodily injury, wound, or shock. This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. Psychiatrically, "trauma" has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects.
Traumatology is the branch of surgery which deals with trauma patients and their injuries.
"Trauma" is the Greek word for "a wound" (and for "damage or defeat").
Tremor: Any abnormal repetitive shaking movement of the body. Tremors have many causes and can be inherited, be related to illnesses such as thyroid disease, or caused by fever, hypothermia, drugs or fear.
United Network for Organ Sharing (UNOS): The nationwide umbrella for transplantation organ sharing in the U.S.
UNOS states that it is "a private, not-for-profit, membership corporation qualified as a charitable organization under section 501 (c)(3) of the IRC. UNOS administers the national Organ Procurement and Transplantation Network (OPTN) and the U.S. Scientific Registry on Organ Transplantation under contracts with the U.S. Department of Health and Human Services. The U.S. Scientific Registry is the most complete medical database in the world, tracking all solid organ transplants since October 1, 1987.
"Through the UNOS Organ Center, organ donors are matched to waiting recipients 24 hours a day, 365 days a year. Through its policies, UNOS ensures that all patients have a fair chance at receiving the organ they need - regardless of age, sex, race, lifestyle, religion, financial or social status. UNOS members include every transplant program, organ procurement organization and tissue typing laboratory in the United States. Policies governing the transplant community are developed by the UNOS membership through a series of regional meetings, deliberations at the national committee level and final approval by a 40 member board of directors, comprised of medical professionals, transplant recipients and donor family members."
Vascular: Relating to the blood vessels of the body. The blood vessels of the body, as a group, are referred to as the vascular system.
The blood vessels are composed of arteries, veins and capillaries -- arteries that pass oxygen-rich blood to the tissues of the body; veins which return oxygen-depleted blood from the tissues to the lungs for oxygen; and the capillaries that are the tiniest vessels and are between the arteries and veins.
Vein: A blood vessel that carries blood low in oxygen content from the body back to the heart. The deoxygenated form of hemoglobin (deoxyhemoglobin) in venous blood makes it appear dark. Veins are part of the afferent wing of the circulatory system which returns blood to the heart.
By contrast, an artery is a vessel that carries blood high in oxygen away from the heart to the body. The oxygenated form of hemoglobin (oxyhemoglobin) in arterial blood makes it look bright red. Arteries are part of the efferent wing of the circulatory system which carries blood away from the heart.
Ventilator: A ventilator is a machine which mechanically assists patients in the exchange of oxygen and carbon dioxide (sometimes referred to as artificial respiration).
White blood cell: One of the cells the body makes to help fight infections. There are several types of white blood cells (leukocytes). The two most common types are the lymphocytes and neutrophils (also called polymorphonuclear leukocytes, PMNs, or "polys").
Lymphocytes are made in lymphoid tissue in the spleen, lymph nodes, and thymus gland. There are different kinds of lymphocytes. Lymphocytes identify foreign substances from germs (bacteria or viruses) in the body and produce antibodies and cells that specifically target them. It takes from several days to weeks for lymphocytes to recognize and attack a new foreign substance.
Neutrophils are also major players in the body's defense against bacterial infections. Neutrophils are made in the bone marrow and circulate in the bloodstream. Neutrophils move out of the blood vessels into the infected tissue to attack the bacteria. The pus in a boil (an abscess) is made up largely of neutrophils. Normally a serious bacterial infection causes the body to produce an increased number of neutrophils, resulting in a higher than normal white blood cell count (WBC). When the WBC is low, there may not be enough neutrophils to defend against bacterial infections.
The white blood cell count is done by counting the number of white blood cells in a sample of blood. A normal WBC is in the range of 4,000 to 11,000 cells per microliter. A low WBC is called leukopenia. A high WBC is termed leukocytosis.
A normal absolute neutrophil count (ANC) is in the range of 1,500 to 8,000 cells per microliter. If the ANC is below 500 for an extended period of time, the risk of serious bacterial infection may increase significantly. A low neutrophil count is called neutropenia.
X-ray: 1. High-energy radiation with waves shorter than those of visible light. X-rays possess the properties of penetrating most substances (to varying extents), of acting on a photographic film or plate (permitting radiography), and of causing a fluorescent screen to give off light (permitting fluoroscopy). In low doses X-rays are used for making images that help to diagnose disease, and in high doses to treat cancer. Formerly called a Roentgen ray. 2. An image obtained by means of X-rays.