What guidance to you give your transplant patients about pets, yardwork, swimming, sun exposure, piercing and tattoos when initially returning home?

How sterile does the home need to be upon return?

In terms of going back home, right. When the patient goes back home, the house doesn't need to be sterilized. Right? If you think about it, the place where you were staying, either if you did your transplant in the hospital. Right. The hospital is not a clean place, right? There are many, like, nasty bacteria that out of the air, that remains in the floors or in the walls or equipment, even though those are clean.

I think if you are doing this outpatient, you probably are staying at a hotel. You're probably staying. I know that apartment that you rent or something like that. Right. So those places are also not like, bacteria free. These are not, like, completely sterile areas.

So when you go home, basically, what we will tell the patients is just a regular good spring cleaning, right? That's enough, for the patient itself in terms of, like, what they can do. I tell them once they are home, they have the energy to do it. They will do like the cleaning stuff. Right?

What is the cleaning stuff? Like, for example, taking their clothes out from the dryer. Right. Taking the plates from the washer. Once they are clean, those kind of things. Right a small stuff he they feel doing that right. They have their stamina, they have recovered and they want to do the dusting around like cleaning areas are looked at.

There is more around, mowing the lawn and along those things I want to say no, at least until the day night they when they start getting their immunizations. Not that that's going to prevent many of those things, but they need to, be mindful about they are at a higher risk at those times for, potentially their life fungal pneumonia or other things.

That's why we, we talk to the patients about like, having a caregiver, at least for the first 30 days. Right. It's got to give it it's going to do those things that the patient is not allowed to do. And it's also going to supervise, you know, medications if they are eating and drinking, bringing them to the clinic and so on, so forth.

I think it is good to have a clean home in a home environment, but I don't think patients necessarily need to stay away from their house, plant and so on. We do tell them to be careful. They try not to clean out the attic. Try not to clean out the basement if you're going to be out weeding things out where there's a lot of fungus and so on, that you might want to be careful and wear a mask and take common sense precautions.

Can transplant patients have pets in their home when they initially return home?

When it comes to pets, there's certain pets that we ask them to remove from their house and those in that first initial period. And those are usually birds. Exotic animals, things like that that pose an additional risk. But when it comes to cats and dogs, we want them to have their loved pets in their environment as long as they engage in safe practices.

So usually we ask them not pick up after the pets scrupulous hand hygiene if they're rubbing their pets, to not to allow the pets to kiss them in the face and lick their face. In that period. But the pets don't have to be removed from the home. We try to have those things that are important to patients in their lives, present. As long as we can mitigate and minimize those risks.

Now, obviously, institutional practices can vary from place to place, but that's our practice at Moffitt. The answers are somewhat operator dependent. Different physicians feel a little bit differently about this. I was one of those physicians that used to feel that post-transplant patients to stay away from their pets for three months at a time. And, I don't necessarily feel that way now, but I do feel certain basic guidelines are important.

For instance, I would suggest to patients that it is important not to clean up kitty litter or to take the dog out for a walk. I would tell them to be careful about being scratched by animals. I don't necessarily feel strongly that patients have to house their pet somewhere else post-transplant, I. I feel that during the transplant period, it's most important to be safe and keep distance from anything that might be a focus of infection.

But with respect to animals, I think the paradigm is changing over time and people are becoming more liberal about how patients can interact with their pets. Still, it's important to be careful, stay away from litter, stay away from poop. You should manage to stay safe in that setting. The patient could still pat their dog or cat and then wash your hands. Right.

We also, advise the patients not to sleep in the same bed with the with their pets. Right. But it can be in the same room, potentially, but in their own place. Right.

And then, there are certain, pets that are more exotic, right? Like parrots, like turtles, iguanas. Those kind of carry a specific bacterias under the patients may be more susceptible. So those ones will prefer the patients living at home maybe more than someone else, but a regular cat or a dog, which should be okay to be with it.

What guidance is given on houseplants, gardening and yard work.

When it comes to houseplants and gardening, our recommendations are they can have plants inside their home, but not to engage in digging in the soil or liberating the soil in any way, because the theory is that that might liberate things into the air, into the atmosphere, that they could breathe in and put them at risk.

From that perspective, we asked them not engage in gardening in the first 90 days after they have their transplant, because, again, for the same reason, digging around in the soil is potentially going to liberate moles and things that we don't want them breathing in.

I think that house plants, a little bit of, you know, like collecting your tomatoes from the garden and things like that is probably fine. Anything where you're really in the soil, digging a lot in the soil, where you're at risk of cutting your skin and injuring yourself is something that it's probably better to avoid. For a few months after transplant.

What guidance is given on when it is safe to mow the lawn.

I will satellite, you know, once your energy is back and then, you, protect yourself, right? Like, because mowing the lawn sometimes, you know, like, will remove spores. Like fungal spores. Right? I will say, like, way, at least for the first 90 days. Once you want to engage on doing some of those things, but protect yourself out. Well.

What guidance is given on swimming in hot tubs?

In terms of like swimming in the pool. Right. What I tell my patients is if, if it's the pool in your house that you clean, you don't share it with a lot of people, right? Is it, it's well maintained. Then my rule is like, as follow. They cannot go to the pool at least until ten days after their line was removed. Right. Because we want the area to be, well, heal.

When we talk about the ocean, ICL they should wait at least after their they teddy and at least two weeks from their line removal. The similar precautions in terms of, of the sun right to have either wear long sleeve or, you know, those, a special clothing with UV filters and such, or wearing, like, a sunscreen.

I also try to avoid telling them, okay, go in, they can go to the beach, you know, like just going into the water a little bit, but you know, like maybe as trainers like, swimming in to the right with the rays of potentially swallowing water, you know, placing a risk for probably some GI effects or something like that. Right. So I also they will be feeling very tired. So I doubt many patients will go into the beach to swim right, they might like they used to do before. Right. So that would probably be complicated to do.

Hot tubs. Also kind of the same similar, scenario like like the pool. If it's at your house, you know, it's clean. And those things. Sure. After the day 30, it probably should be. Okay. If this is a public, sharing, there's a different situation, right? For those things, I would say, like, way until the day 90, when you start your immunizations, you will be, not necessarily fully immune reconstituted, but, you can will be more stable. We will know exactly. You have no neutropenic anymore you have a sense of whether you feel that the pool is maintained well.

Some people really do enjoy going to the pool. And I often suggest that they, they just call and they ask, you know, what time of day is it is it much less crowded? I think that, it makes sense if you know your pool. Not necessarily because of the pool itself, but because of the changing rooms. And the areas around the pool can sometimes be really packed, and you perhaps want to have a little bit more breathing room around you.

What should transplant patients know about sun exposure after transplant?

After patients are exposed to high dose chemotherapy, in this case melphalan, right. Like they are all going to be more sensitive to develop other cancers down the road. We have discussed above for example, leukemia myelodysplastic syndrome. But at the same time there are some other like non hematological cancers that become more frequent. Right. And those that are specifically talking about like skin cancers. Right.

So a good advice for patients after transplant is to keep a dermatology appointment for that full, like a skin at least once a year. Patients who already have damage in this, it's sun damage in their skin. Right. They are particularly more susceptible to develop these basal cellular carcinoma sort of squamous cell carcinomas. Fortunately, most of those cancers, are going to be handled by your dermatologist.

So if you keep a regular appointment within at least once a year, they will be able to detect these solutions very early on. Provide therapy for them. Right? They either come for the those lesions, they could probably shave it off to sort of like also have tissue to prove what type of cancer it is in the skin or whether or not this is like a pre-cancerous lesion that they are addressing early on.

What guidance is given on piercings and tattoos?

I would say piercings also will weigh me at least 30 days. Need to make sure, you know, your counts are fully right, your platelets, because you don't want to be bleeding from the area where they are doing the piercing. Right. They've your, neutrophil count is completely normal. Right. And, then, you know, like, also figured it out. Where are you going to do this procedure? Right. Don't go to, you know, the first place it grows, your, your way to do it, right? Do some research, see how clean they are. Those kind of things. Right.

Tattoos those I will say I will way at least after the first 90 days. Because it's a more involved process. Right. That those are not ongoing in one single day. They require like, you know, the markings they, continue to stain the area. Right. And there is a higher risk for, for infections. Right? So, also find the right place to do it.