Preserving Your Fertility Before Transplant

For young men and women who have cancer and are planning to undergo a transplant, a common question they ask is, how will this affect my fertility? If the ability to have children naturally is something that is important to you, have this conversation early on with your healthcare team. They will be able to outline options with you help you get connected with Weill Cornell Medicine’s fertility specialists.

Cancer treatments can impair fertility in women in a number of ways. For example, some chemotherapy can destroy eggs, which could lead to infertility after treatment. This loss of eggs in the ovaries can actually “age” the ovaries, reducing the chance of pregnancy. There have been some cases where women go into early menopause after treatment as well. Women have many options when it comes to preserving their fertility. One option is to take hormones for approximately 10-14 days and collecting eggs. In order to create embryos, the eggs may be fertilized with sperm. Then, the embryos or eggs are frozen and stored.

There are many factors that need to be considered to determine success rate in having a baby using frozen eggs or embryos. These include age at the time of egg retrieval, current ovarian reserve and the number of mature eggs obtained from the procedure. Every egg that is collected will not become a baby. Women under 35 years of age generally have a higher chance of success. If you are interested in an appointment to learn more about your fertility preservation options, contact Cornell’s dedicated Fertility Preservation Program Specialist at 646-962-5450 or visit www.ivf.org for more information.

Many cancer treatments can cause damage to the cells that grow into sperm as well. Men who can no longer produce sperm will be infertile, meaning they will not be able to have a biologic child. It’s possible the cells can recover, but there’s a chance they may not. It is never certain how treatment will affect a man’s future fertility. Men who want to preserve their fertility have the option of sperm banking. Through this process, men collect, freeze and store sperm. In order to complete the process, three collections are needed. Sperm banking is typically done at a licensed laboratory or fertility clinic and these are available nationwide. For male fertility preservation, please contact the Manhattan Cryobank at 212-396-2796 or ReproLab at 212-779-3988 for sperm cryopreservation information.

Patients with cancer have a lot to consider and fertility should be addressed early on, before treatment. It can be difficult to make a decision about fertility preservation because there are many unknowns. It is important to understand that you do not have the make this decision alone. Your healthcare team will assist you in making an informed decision.

Diet: What Foods to Eat and Avoid After Transplant

After receiving your transplant, eating a nutritious diet is important so you can get your strength back. You may not feel as much of an appetite as you did before and that is normal. To increase your energy intake, you can try nutritional drinks, such as Ensure or Boost. It’s important to eat healthy foods and avoid certain foods since you are prone to infection.

Doctors recommend eating a low-microbial diet, which will lower your risk of getting sick while your immune system is weak. For the first 100 days after your transplant (autologous) or while remaining on immunosuppressant medications (allogeneic), it is recommended you follow this diet, but it’s important you speak with your healthcare team before you make any drastic changes to your diet.

About Microbes in Food

Microbes consist of small living things such as bacteria, viruses, yeast and molds. These can get into the food by infecting the animal the food comes from. Additionally, when food is being processed or prepared, microbes can get into the food. Without proper preparation, these microbes can cause infection. It’s not always easy to tell where microbes have attached themselves to. Examples of food products where microbes are hard to see or smell include milk and cheese that haven’t been refrigerated, undercooked and raw eggs, certain fruits and vegetables and undercooked or raw meat.

How to Determine if Food is Safe

Some helpful guidelines you should follow while at the grocery store include: avoid tasting free samples, only buy eggs that are refrigerated, don’t buy canned foods if the can has dents or is swollen, and most importantly, check containers for the expiration date. Be sure to buy and use food before that date. Another good tip is to not buy foods from self-service bulk containers or bins and try to avoid buffet-style served foods.

For a detailed list of what food items you may eat and which to avoid, please refer to the patient handbook found on the right side of the homepage.

An example of a low-microbial diet recipe is below.

Broccoli with Hazelnuts

Serves:  6
Per Serving:  59 calories, 7g carbs, 2g protein, 3g fat, 3g fiber, 99mg sodium

NOTE:  All ingredients, except soy sauce, must be well-cooked in order for this recipe to be okay for those on a low microbial diet.

Ingredients:

• 2 scallions, thinly sliced
• 2 tsp lite soy sauce
• Boiling water
• 1 lb broccoli, stems peeled and sliced thin, and florets separated
• 2 tsp sesame oil
• 2 garlic cloves, finely minced
• 2-3 Tbsp coarsely chopped hazelnuts

Cooking Directions:

In a small skillet, toast the hazelnuts over medium-high heat for 3-4 minutes, until the nuts are lightly browned.  Set aside.

In a large pot of boiling water, add the broccoli and blanch for 4 minutes.  Rinse it with cold water and drain.

In a large bowl, combine the oil, scallions, garlic and soy sauce.  Add the broccoli and toss well.  Top with hazelnuts. Serve hot or at room temperature.

Recipe from: American Institute for Cancer Research

Managing Oral Hygiene Before, During and After Transplant

We grow up learning certain truths regarding the need to brush-our teeth at least twice-a-day and visit the dentist on a regular basis, but during cancer treatment including transplant our mouth needs can change and there are additional precautions that need to take place.

After your transplant, your immune system is compromised and because of that, you’re at an increased risk of bacterial, viral and fungal infections including your mouth. Any dental work, which could cause further infection, should either be done well before the transplant or, if advised by your physician and dentist, after you’re fully recovered from your transplant.

Another reason dental work should be delayed until after you’ve recovered is because as a transplant patient, you are likely taking one or more medications that affect dental treatment. It is possible that immunosuppressive drugs can cause overgrowth of your gums, infections and general poor healing and could interact with commonly prescribed medications. Additionally, anticoagulant medications may contribute to excessive bleeding problems. Your physician may want to adjust these medications several days before an invasive dental procedure.

As a general rule of thumb, you should take care of any dental work once your transplant has stabilized, which typically occurs within three to six months after the transplant. If you need dental work, you, your physician and dentist should discuss your treatment and will then clear you for dental work at the appropriate time.

At Weill Cornell Medicine and NewYork-Presbyterian, we provide supportive oral care before, during and after cancer treatment. To make an appointment with a dentist at our center who specializes in treating cancer patients, please call Dr. Heidi Hansen at 212-746-5115.

How to Prevent Infections Post-Transplant

After your transplant, your immune system is weaker and you are at risk for infection. Although your white blood cell count might be considered normal, it’s important to remember your immune system is still in recovery mode. Some medications that you are taking make that risk increase even more. Infections are more common in patients who have received an allogeneic transplant, particularly those with graft-versus-host-disease, versus an autologous transplant. The causes of these infections include, bacteria, fungi, and viruses. You should take steps to check if you have an infection. One of the easiest ways to do this is by taking your temperature twice a day and recording your numbers.

There are a number of ways you can try and prevent infection. The first way is to make sure you don’t submerge your central venous catheter under water while you’re taking a shower or bathing. To avoid getting bacteria on your skin, be sure to cleanse with soap and water every day.

Personal hygiene such as frequent hand washing is crucial after your transplant, especially if you are taking immunosuppressive medicines. If you are traveling or outside of your home, it is recommended you use hand sanitizer. Handwashing is recommended throughout the day and especially during the following activities: before and after making food, before eating, after touching pets, after being outside, after coughing, sneezing or blowing your nose, before and after adjusting your central venous catheter, and before taking oral medications.

Oral hygiene is another important factor to consider after your transplant. Daily oral care is necessary to decrease chance of infection and gum bleeding. It is recommended that you use a soft toothbrush or sponge to care for your teeth and gums. Speak with your doctor about the appropriate type of mouth wash, rinse and toothpaste you should use.

While being outdoors is recommended, there are certain outdoor activities that you should avoid when recovering after transplant. Gardening, raking, mulching, farming, and any activities involving direct contact with soil and plants may increase exposure to potential pathogens, which are substances that can cause disease. These activities should be put on hold until your immune system is back to its strength. In addition, swimming is another activity that is not recommended since you are more likely to get infections in pools and hot tubs. Cleaning in areas that have dust and mold should be avoided after your transplant. You will want to avoid all areas that are prone to mold.

Preventing respiratory infections is important since your immune system will be weak. It will be more difficult to fight off illnesses, so it is recommended you take steps to avoid contact with people, especially children, who have a cough or a cold. Any public area where you are required to be in close contact with others, such as a movie theater, a concert should be avoided in the early days after transplant. You may wear a face mask when you are in public if you feel more comfortable, but it is not required. We do recommend that you wear a face-mask while in hospital or clinic waiting rooms.

Most importantly, report to your doctor any change that you notice or any fever promptly so that early evaluation can be done. Many infections that we test for at the transplant clinic cannot be easily tested or detected in regular offices and specialized transplant clinics have access to tests that your local physician’s office may not.

Five Ways to get the Most out of Your Support Group

Whether attending a support group meeting for the type of cancer you have or related to receiving a bone marrow and stem cell transplant, you want to be sure you’re getting the most out of it. Here are 5 tips to make sure you have a positive experience.

1. Find the Right Support Group

The most important step is finding the group that is best for you based on your personal experience. The best way to find the right support group is by trying different ones to see which ones you like. There is no rule that says you have to commit to a group after attending only one session. You may even want to go to a few support groups simultaneously to get alternate perspectives.

Weill Cornell Medicine and NewYork-Presbyterian provide many different support groups with different topics and speakers each month. To learn more about our different support groups visit our events calendar found here. You may also view NewYork-Presbyterian’s cancer-specific support groups.

2. Attend the Meetings Regularly

After you’ve committed to a support group or groups, you should start attending the meetings on a regular basis. Only going occasionally will not provide you with the ultimate benefit of getting to know those in the group. Building relationships with the group leader and participants will be helpful and will offer the opportunity to connect with people even outside the group if that is something in which you are interested. Knowing others who are going through a similar experience can bring you comfort and support.

3. Speak Up

You may not feel comfortable speaking publicly during the support group right away but over time, you will get the most of your experience if you tell your story. Being open and honest can be a great tool during your diagnosis and treatment. Sometimes telling your story out loud can be restorative and healing.

4. Keep an Open Mind

You may have preconceived thoughts and opinions before going to support group meetings. However, it’s important to keep an open mind and try not to close yourself off to solutions and guidance that is offered during the meetings. Remember that you’re going to these meetings to get an alternative perspective and you may even learn about new methods of treatment. If you hear of a new treatment that you want to learn more about, speak with your doctor.

5. Include Your Caregiver

Most of the time, support groups will allow you to bring your caregiver or family member with you. Weill Cornell Medicine and NewYork-Presbyterian have support groups for family members on the unit. We hold a General Oncology Caregiver Support Group on Thursday afternoons at 2:00PM. Patients should reach out to their social worker for additional information on these groups. The reason this is helpful is because so much information is shared and it’s better to have two minds remembering all the information as opposed to just one. The process of going through a stem cell transplant is also taxing for a caregiver, so they can also benefit from a support group.  If you’d prefer to attend alone, it’s a good idea to share what you learned with your caregiver or family member. Since they are your primary caretaker, they should be aware of any new treatments or resources that could be available to you. They can then provide assistance in figuring out ways to integrate those resources into your life.