Home > Cancer and Treatments > BMT Overview > Patient Guide
Before the transplant process begins, we must make sure your heart, lungs, kidneys and liver are
strong enough to tolerate the side effects of chemotherapy, as well as other medications that may
be used during the procedure. Before the transplant you will have a variety of tests — performed
as an outpatient — to determine your current state of health. Listed below are possible tests you
may undergo depending on your disease, your transplant protocol and whether you have had these tests
previously. Some of them may be repeated throughout the transplantation process to monitor for changes.
Each test will be explained to you in advance. If you have any questions about these tests, please ask your
physician or nurse. Some of the tests you may have include:
- Chest X-ray
To check your lungs for disease
- Bone marrow aspiration
To check your bone marrow for and biopsy disease and genetic information and to monitor
engraftment after transplant
- Lumbar puncture
To check the fluid surrounding your brain and spinal cord for disease or infection and to
administer chemotherapy
- Blood tests
To check your blood counts, as well as liver, kidney and immune function
- Audiology
To monitor your hearing
- CAT scan/skeletal survey
Special X-rays to look carefully at your chest, abdomen, head or bones to monitor for disease
- Pulmonary function test
To determine how well your lungs are performing
- ECHO/EKG/MUGA
Each is a different test to determine how your heart is functioning
- Urine tests
To check your kidney function
Central Catheter Placement
Prior to beginning the transplant, a long-term intravenous catheter will be inserted if you do not already have one.
This IV is a special catheter inserted by a doctor into a large vein in your chest. You will be given a sedative and
local anesthesia to numb the area.
The catheter is very similar to a regular IV and is made of plastic
tubing. It has several ports so it can be used for drawing blood and infusing chemotherapy, antibiotics, blood
products and other medications. The catheter will remain in place for the duration of your transplant and for
as long as it continues to be needed after your discharge.
The complications of placing this catheter
and its care will be reviewed with you prior to its insertion. If you have any questions, please ask your doctor or
nurse.
Patient Education Meeting
You must attend a patient education meeting prior to your transplant admission. This meeting is open to your
family and friends as well. We will review what you can expect during your transplant experience, answer any
questions you have and take you on a tour of the unit. Please contact the BMT office at (734) 936-8785 for the
meeting schedule and to confirm your attendance date.
Dental Exam
The mouth and teeth can be a source of infection. Before coming for your transplant you should have any necessary
dental work done, including teeth cleaning, X-rays and a routine exam. If any major dental work needs to be done,
your dentist should call the transplant office immediately at (734) 936-8785. A summary of your dental health will
be needed when you come for your transplant.
Nutrition/Exercise
Prior to the transplant, it is important to maintain your nutritional intake by eating a well-balanced diet
adequate in calories and protein. No food restricions are needed unless you have a health problem that requires a
special diet. Eating a variety of foods is recommended so you get the nutrients you need. If you are experiencing
eating problems, the nutrition specialist is available by contacting the transplant office.
You should remain active. Walking can be a good way to build your strength and increase your circulation. Remember
not to overdo — this can be more harmful than no activity at all. You should not be in pain during or after
your exercise. If you have questions related to your current nutrition or exercise level, call the transplant office
and speak with the nutrition specialist or your nursing coordinator.
Smoking
If you smoke, you must quit immediately. This is necessary to prevent lung infections and lung damage, which may
be increased by smoking. You should also make every effort to avoid second-hand smoke, as this is also detrimental
to your lungs’ health. Please talk to your physician or nurse coordinator if you need assistance with this
process.
Lodging
Prior to admission, the transplant social worker will contact you to make necessary arrangements and assist with
any lodging problems or concerns you may have. If you are receiving an allogeneic transplant and live more than
50 miles from the hospital, you will need to reside in the Ann Arbor area for several months after discharge
from the hospital. A variety of housing options are available to you and your family. The BMT social worker
will help you locate the appropriate lodging depending on your specific requests or needs. Lodging expenses
are generally not covered by medical insurance plans.
Transportation
The Medical Center is conveniently located near major expressways and Detroit Metropolitan Airport.
The Medical Center is on the city’s bus route and is a short taxi cab ride from most locations in
Ann Arbor. A map of the Ann Arbor area is located in the pocket of this handbook.
Insurance
Understanding the costs and insurance benefits for transplant services can be difficult. The Medical Center
can provide you with the background information you need to plan effectively for meeting the costs of the
transplant services. You will receive a Patient Accounts packet. Please use this information as a reference
guide to direct you to resources within the Medical Center if problems regarding your insurance or medical
bills arise.
Prior to transplant, a Patient Accounts representative is assigned to you. This
person will contact your insurance provider and confirm:
- inpatient hospital benefits
- coverage for outpatient services and physician fees
- prescription coverage
- insurance “prior authorization” requirements for payment of transplant services
during the inpatient stay
After your Patient Accounts representative has gathered this information, you will receive two copies
of your transplant insurance confirmation. Please carefully read the information provided.
Sign the “Guarantee of Account” section of the form and return one copy to Patient
Accounts as soon as possible.
Emotional Concerns
Most people cope better when they have information and know what to expect. The transplant team encourages you
to gather the information you need and ask questions.
It is important to identify and acknowledge
the stress of the transplant experience. It is also important to focus on the strengths that you and your
family have. Our staff will help you recognize these and help you develop your physical, social, emotional
and spiritual strengths. It is important to talk about your concerns and feelings with those close to you.
Although each family’s emotional response to the transplant process is unique, many share similar reactions.
Your family will understandably experience some of the following feelings:
Stress
The first few weeks at the University of Michigan Medical Center can be difficult. You will be dealing with the
stress of living in a new area, adjusting to the hospital routine and, more importantly, establishing trust in
a new health care team. At the same time, you may learn more technical details regarding the transplant than
you anticipated. In a short time our transplant team will attempt to make you very well-informed. It is the
philosophy of our bone marrow transplant team to be honest and “truth telling.” We believe this
will assist you in building trust in us and will prevent you from “guessing” what is happening
to you. Honesty can also lead to stress, as you will know at all times what is happening and what we are
planning. If you have any questions or don’t understand what has been said, please ask for clarification.
This will decrease some of the stress you will be experiencing.
Most people remember only a portion of what is said the first time the transplant is discussed. Our approach
is to frequently repeat medical and patient education information. Please feel free to ask your physician,
nurse, social worker or any member of the transplant team if you have questions or would like information repeated.
A tape recorder can be useful in recording information sessions for play back at a later date.
Fear
Fear is an overwhelming emotion that patients and families experience before, during and even after the
transplant procedure. These fears often include fear for the well-being of your family, fear of discomfort,
fear of what your future holds and fear of dying. Although a transplant unit is a place of hope, it is
important to realize that patients can die during the course of transplantation. Sometimes family members
and patients may not talk about their fears of death as a way of trying to protect one another. These
fears are very real and sharing them with family and staff usually helps.
Anger
Anger is another common reaction to illness. Some patients may be angry at God; others direct their
anger at their family or the health care team. Relatives may be angry at the patient for getting sick
and disrupting their lives. Anger is a normal reaction to the stress a family feels during a transplant.
It is important to find an outlet (for example, talking to someone) to relieve the tension. This is a
time when both patients and families need mutual support.
Guilt
Many families talk about feeling guilty. Parents may feel guilty because their child has cancer,
while adult patients may feel guilty for being a burden to their family. These feelings are common
human emotions and coping with them can be difficult.
Any and all of these reactions are perfectly normal. You and your family should not hesitate to
use the experience, understanding and support of the transplant team and unit staff to help you deal
with these emotions.
Sometimes talking with a patient who has gone through transplant is
helpful and can be arranged if desired. Former patients are often eager to help.
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