Showing posts with label What Happens. Show all posts
Showing posts with label What Happens. Show all posts

Stem cell and bone marrow transplants - What Happens

What happens-Stem cell and bone marrow transplants




A stem cell or bone marrow transplant is a long and complicated process that involves 5 main stages.
These stages are:
  1. Tests and examinations – to assess your general level of health.
  2. Harvesting – the process of obtaining the stem cells to be used in the transplant, either from you or a donor.
  3. Conditioning – treatment to prepare your body for the transplant.
  4. Transplanting the stem cells.
  5. Recovery – you'll need to stay in hospital for at least a few weeks until the transplant starts to take effect.
The stages are described in more detail below.

Tests and examinations

Before a stem cell transplant can be carried out, you'll need a series of tests and examinations to ensure you're healthy enough for the procedure to be carried out.
Transplants tend to be more successful in people who are in good general health, despite their underlying condition.
The tests you might have include:
If you have cancer, you may also need to have a biopsy. This is where a small sample of cancerous cells is removed and analysed. It can show whether your cancer is under control (in remission) and whether there's a high risk of it returning after your transplant.

Harvesting stem cells

After you've had tests to check your general health, the stem cells that will be used for the transplant will need to be removed and stored.
There are 3 main ways stem cells can be harvested, these are:
  • from blood – where the stem cells are removed from your blood using a special machine (see below)
  • from bone marrow – where a procedure is carried out to remove a sample of bone marrow from the hip bone (see below)
  • from cord blood – where donated blood from the placenta and umbilical cord of a newborn baby is used as the source of stem cells (find out more from the NHS Cord Blood Bank)
It may be possible to remove stem cells from your own blood or bone marrow and transplant them later after any damaged or cancerous cells have been removed.
If this isn't possible, stem cells from a donor's blood or bone marrow will usually be used.

Removing stem cells from blood

The most common way to harvest stem cells involves temporarily removing blood from the body, separating out the stem cells, and then returning the blood to the body.
To boost the number of stem cells in the blood, medication that stimulates their production will be given for about 4 days beforehand. On the fifth day, a blood test will be carried out to check there are enough circulating stem cells.
If there are enough cells, veins in each arm will be connected by tubes to a cell-separator machine. Blood is removed from one arm and passed through a filter, before being returned to the body through the other arm.
This procedure isn't painful and is done while you're awake. It takes around 3 hours and may need to be repeated the next day if not enough cells are removed the first time.

Removing a bone marrow sample

An alternative method of collecting stem cells is to remove around a litre of bone marrow from your hip bone using a needle and syringe.
The needle may need to be inserted into several parts of your hip to ensure enough bone marrow is obtained. This is done under a general anaesthetic, so you'll be asleep and won't feel any pain while it's carried out.
However, the area where the needle is inserted may be painful afterwards and you'll have marks on your skin where the needles were inserted (usually one on each side).

Conditioning treatment

Treatment with high doses of chemotherapy and sometimes radiotherapy will be needed before the stem cells can be transplanted to:
  • destroy existing bone marrow cells – this is to make room for the transplanted tissue
  • destroy any existing cancer cells
  • stop your immune system working – this reduces the risk of the transplant being rejected
As part of the conditioning treatment, you'll be given a range of medicines, so a tube called a central line will usually be inserted into a large vein near your heart. This means medication can be passed into your body without the need for lots of injections.
The conditioning process usually lasts up to a week. You'll probably need to stay in hospital throughout the treatment.
Conditioning can cause a number of unpleasant side effects, such as sickness, hair loss and tiredness. These are usually temporary. Your treatment team will discuss the risks of treatment with you beforehand.
Read more about the risks of stem cell transplants.

The transplant

The transplant will usually be carried out a day or 2 after conditioning has finished.
The stem cells will be passed slowly into your body through the central line. This process often takes around a couple of hours.
The transplant won't be painful and you'll be awake throughout.

Recovery

Once the transplant is finished, you'll need to stay in hospital for a few weeks while you wait for the stem cells to settle in your bone marrow and start producing new blood cells.
During this period you may:
  • feel weak, and you may experience vomiting, diarrhoea and/or a loss of appetite
  • be given fluids by mouth or through a tube running from your nose to your stomach (a nasogastric tube) to prevent malnutrition
  • have regular blood transfusions, as you'll have a low number of red blood cells
  • have regular platelet transfusions, as you'll have a low number of platelets
  • stay in a special germ-free room, and visitors may need to wear protective clothing to prevent infections, as you'll have a low number of infection-fighting white blood cells
Many people are well enough to leave hospital between 1 and 3 months after the transplant. However, if you develop complications such as an infection, you may not be able to leave hospital for longer.
Even after going home, you'll still be at risk of infections for potentially a year or 2 because it can take a while for your immune system to return to full strength.
If donated stem cells were transplanted, you'll also usually need to take medicines that stop your immune system from working so strongly, to reduce the risk of your body attacking the transplanted cells (immunosuppressants), or to reduce the risk of the transplanted cells attacking other cells in your body.
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Radiotherapy - What Happens

What happens-Radiotherapy




Radiotherapy can be carried out in many different ways, depending on your circumstances.
This page covers what happens before treatment starts, how radiotherapy is given and issues to be aware of during treatment.

Before treatment starts

Deciding to have treatment

If you're diagnosed with cancer, you'll be cared for by a team of specialists. Your team will recommend radiotherapy if they think it's the best option for you, but the final decision is yours.
Making this decision can be difficult. You may find it useful to write a list of questions to ask your care team.
For example, you may want to find out:
  • what the aim of treatment is – for example, is it being used to cure your cancer, relieve your symptoms or make other treatments more effective?
  • about possible side effects and what can be done to prevent or relieve them
  • how effective radiotherapy is likely to be
  • whether any other treatments could be tried instead
If you agree with your team's recommendation, they'll start to plan your treatment once you've given your consent to treatment.

Planning your treatment

Your treatment will be carefully planned to ensure the highest possible dose is delivered to the cancer, while avoiding damage to nearby healthy cells as much as possible.
You will probably have a computerised tomography (CT) scanto work out exactly where your cancer is and how big it is.
After the scan, some very small but permanent ink marks may be made on your skin to ensure the right area is targeted accurately each time.
If you're having radiotherapy to your head or neck, a plastic mask will be made for you to wear during treatment. The ink marks will be made on the mask.

Your treatment course

Radiotherapy is usually given as a number of treatments where a small dose of radiation is given daily over several weeks.
Before treatment starts, your care team will draw up a plan that outlines:
  • the type of radiotherapy you'll have
  • how many treatment sessions you'll need
  • how often you'll need treatment
Most people have five treatments a week (one treatment a day from Monday to Friday, with a break at the weekend). But sometimes treatment may be given more than once a day or over the weekend.
Your doctor may call each dose a "fraction", although the term "attendance" is sometimes used to indicate how many hospitals visits you'll need to make during treatment.
Want to know more?

How radiotherapy is given

Radiotherapy is usually given in one of two ways:
  • external radiotherapy – where a machine directs beams of radiation at the cancer
  • internal radiotherapy – where a radioactive implant is placed inside your body near the cancer, or a radioactive liquid is swallowed or injected
The main types of radiotherapy are outlined below.

Radiotherapy given using a machine (external radiotherapy)

During external radiotherapy, you lie down on a table and a machine is used to direct beams of radiation at the cancer.
The machine is operated from outside the room, but you'll be watched through a window or a camera. There will be an intercom if you need to speak to the person treating you.
You need to keep as still as possible throughout the treatment. It usually only takes a few minutes and is completely painless. You can normally go home soon after it has finished.
Sometimes a slightly different technique may be used, such as:
  • intensity-modulated radiation therapy (IMRT) – where the shape and strength of the radiation beams are varied to closely fit the area of the cancer
  • image-guided radiation therapy (IGRT) – where scans are done before and during each treatment session to ensure the cancer is targeted accurately
  • stereotactic radiosurgery (SRS) – where lots of tiny beams of radiation are aimed at the cancer very precisely, so a high dose can be given at once (usually in a single treatment)
  • stereotactic body radiation therapy (SBRT) – where several beams of radiation are directed at the cancer from several directions
You can ask your doctor about the technique being used for your treatment.

Radiotherapy implants (brachytherapy)

Radioactive implants (metal wires, seeds or tubes) may be used to treat cancer in areas of the body where they can be placed inside the body without surgery (such as the vagina).
Sometimes surgery is used to place an implant near the cancer.
The length of time the implant is left in your body varies. It could be a few minutes or a few days. In some cases, tiny implants may be left inside the body permanently.
The radiation from the implants is painless, but it could be harmful to others so you may need to stay in hospital for a few days until the implant is removed.
Permanent implants aren't a risk to others because they produce a very small amount of radiation that gradually decreases over time.

Radiotherapy injections, capsules or drinks (radioisotope therapy)

Some types of cancer, including thyroid cancer and some prostate cancers, can be treated with radioactive liquid that's swallowed or injected.
You may be radioactive for a few days after treatment is given, so you'll probably need to stay in hospital as a precaution until the amount of radiation has fallen to a safe level.
Your treatment team may give you some advice to follow for a few days when you get home to avoid putting other people at risk.
Want to know more?

Issues during treatment

During radiotherapy treatment, there are a number of important things to bear in mind.

Pregnancy and contraception

Women should avoid becoming pregnant while having radiotherapy, as the treatment could harm your baby.
Use an effective method of contraception, such as a condom, and contact your care team immediately if you think you may be pregnant.
Men having radiotherapy may sometimes be advised to use contraception during treatment and possibly for several months afterwards.
Macmillan has more information about sex life and radiotherapy.

Side effects

Radiotherapy can cause a range of side effects.

Deciding to stop treatment

Some people decide that the benefits of radiotherapy aren't worth the poor quality of life, due to the side effects.
If you're struggling with the treatment and are having doubts about whether to continue, it's a good idea to speak to your care team.
Your team can give you advice about the likely benefits of continuing with treatment, but the final decision to continue or stop is yours.
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Pancreas transplant - What Happens

What happens-Pancreas transplant




Pancreas transplants are carried out under general anaesthetic. This means you'll be asleep and will not feel anything during the procedure.
  • A cut will be made in your tummy, from just below your breastbone to below your belly button.
  • The donor pancreas is usually placed in the right side of your tummy and is connected to the blood vessels that carry blood down to your leg.
  • A small portion of the donor's small intestine will be attached either to your small intestine or your bladder to allow digestive juices to drain from the donor pancreas.
  • If you're having a combined pancreas and kidney transplant, the kidney will be placed low down on the left side of your tummy.
  • The old pancreas will not be removed as it'll continue to produce digestive juices while the donor pancreas produces insulin.
A pancreas transplant operation can take 4 to 5 hours to complete.
If you also need a kidney transplant at the same time, the operation can take around 6 to 8 hours.
Your new pancreas should start to produce insulin straight away.

Islet transplantation

A small number of people with type 1 diabetes may have a slightly different procedure, where only the cells that produce insulin (islet cells) are transplanted from a donor pancreas into the liver.
This is called islet transplantation and is usually carried out under local anaesthetic, which means you're awake but the area being operated on is numbed.
A thin, flexible tube (catheter) is inserted through your tummy and liver into the vein that supplies the liver with blood. The donor islet cells are then injected into it.
If the operation is successful, the donor cells will start making insulin. This can help people who experience severe episodes of a dangerously low blood sugar level that occur without warning.
Insulin treatment is often still needed after the operation, but the episodes of low blood sugar should be easier to control.
As with a conventional pancreas transplant, you'll need to take medicine to suppress your immune system for the rest of your life.

After the operation

Once the transplant is complete, you'll usually be moved to an intensive care unit (ICU) or a high dependency unit (HDU).
You'll be very closely looked after, and various tubes and machines that help monitor your health and support the functions of your body will be attached to you.
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Miscarriage - What Happens

What happens-Miscarriage




If there's no pregnancy tissue left in your womb, no treatment is required.
However, if there's still some pregnancy tissue in your womb, your options are:
  • expectant management – wait for the tissue to pass out of your womb naturally
  • medical management – take medication that causes the tissue to pass out of your womb
  • surgical management – have the tissue surgically removed
The risk of complications is very small for all these options. It's important to discuss them all with the doctor in charge of your care.

Expectant management

If you have a miscarriage in your first trimester, you may choose to wait 7 to 14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management.
If the pain and bleeding have lessened or stopped completely during this time, this usually means the miscarriage has finished. You should be advised to take a home pregnancy testafter 3 weeks.
If the test shows you're still pregnant, you may need to have further tests.
If the pain and bleeding haven't started within 7 to 14 days or are continuing or getting worse, this could mean the miscarriage hasn't begun or hasn't finished. In this case, you should be offered another scan.
After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.
Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever) or you experience severe pain.

Medication

You may choose to have medication to remove the tissue if you don't want to wait, or if it doesn't pass out naturally within 2 weeks. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out.
In most cases, you'll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve.
The tablets usually begin to work within a few hours. You'll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to 3 weeks.
In most units, you'll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.
You should be advised to take a home pregnancy test 3 weeks after taking this medication. If the pregnancy test shows you're still pregnant, you may need to have further tests.
You may be advised to contact your healthcare professional to discuss your options if bleeding hasn't started within 24 hours of taking the medication.

Surgery

In some cases, surgery is used to remove any remaining pregnancy tissue. You may be advised to have immediate surgery if:
  • you experience continuous heavy bleeding
  • there's evidence the pregnancy tissue has become infected
  • medication or waiting for the tissue to pass out naturally has been unsuccessful
Surgery involves removing any remaining tissue in your womb with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.

After a miscarriage

A miscarriage can be very upsetting, and you and your partner may need counselling or support. You may also have questions about trying for another baby and what happens to the miscarried foetus.
For more information, read what happens after a miscarriage.
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Kidney transplant - What Happens

What happens-Kidney transplant




When a suitable donor kidney is found, the transplant centre will contact you. Staff at the centre will check you don't have any new medical problems and then ask you to go to the centre.
When you hear from the transplant centre:
  • don't eat or drink anything
  • take all current medicines with you
  • take a bag of clothes and essential items for your hospital stay
When you arrive at the transplant centre, you'll be quickly assessed. Some of the tests you had at your initial assessment may be repeated to ensure no new medical conditions have developed. Tests will also be done to ensure the donor kidney is suitable for you.
The transplant procedure must be carried out as quickly as possible for the transplant to have the best chance of success. After the medical team has confirmed the kidney is in good condition and is suitable, you'll be given the general anaesthetic and taken to the operating theatre.

The operation

The kidney transplant procedure involves 3 main stages:
  • First, an incision (cut) is made in your lower abdomen (tummy), through which the donated kidney is put into place. Your own kidneys will usually be left where they are, unless they're causing problems such as pain or infection.
  • Second, nearby blood vessels are attached to the blood vessels of the donated kidney. This is to provide the donated kidney with the blood supply it needs to function properly.
  • Finally, the ureter (the tube that carries urine from the kidney to the bladder) of the donated kidney is connected to your bladder.
A small plastic tube called a stent may be inserted into the ureter to help ensure a good flow of urine initially. This will usually be removed about 6 to 12 weeks later during a minor procedure called a cystoscopy.
When the kidney is properly in place, the incision in your abdomen will be closed with surgical staples, stitches or surgical glue.
Although the procedure may sound relatively straightforward, it's very demanding and complex surgery that usually takes around 3 hours to complete.

After the operation

Once you've recovered from the effects of the anaesthetic, it's likely you will feel some pain at the site of the incision. Painkillers will be provided, if necessary.
After the operation, you'll immediately begin treatment with medication designed to prevent your immune system from rejecting your new kidney. See living with a kidney transplant for more information on this.
Most transplanted kidneys will start working immediately, particularly if they come from a living donor, although sometimes they may take a few days or weeks to work properly. If this is the case, you'll need to have dialysis during this time.
Most people can leave hospital in about a week, but you'll need to attend frequent appointments at the transplant centre, so your kidney function can be assessed and tests can be carried out to check how well your medications are working.
For the first month after surgery, you may need to have 2 to 3 appointments a week. However, over time, your appointments will become less frequent. After a year, as long as you do not have any serious problems, you should only have to attend the centre once every 3 to 6 months.
After kidney surgery, you should be able to return to work and normal activities within a few months, provided you make good progress.
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IVF - What Happens

What happens-IVF




What happens during IVF may differ slightly from clinic to clinic, but a typical treatment follows the main steps below.

For women

Step 1: suppressing the natural menstrual cycle

You're given a medication that will suppress your natural menstrual cycle. This can make the medicines used in the next stage of treatment more effective.
This medication is given either as a daily injection that you'll be taught to give yourself, or as a nasal spray. You continue this for about 2 weeks.

Step 2: boosting the egg supply

Once your natural cycle is suppressed, you take a fertility hormone called follicle stimulating hormone (FSH). This is another daily injection you give yourself, usually for about 10 to 12 days.
FSH increases the number of eggs your ovaries produce. This means more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.

Step 3: checking progress

The clinic will keep an eye on you throughout the treatment. You'll have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests.
About 34 to 38 hours before your eggs are due to be collected, you'll have a final hormone injection that helps your eggs to mature.

Step 4: collecting the eggs

You'll be sedated and your eggs will be collected using a needle that's passed through the vagina and into each ovary under ultrasound guidance. 
This is a minor procedure that takes about 15 to 20 minutes.
Some women experience cramps or a small amount of vaginal bleeding after this procedure.

Step 5: fertilising the eggs

The collected eggs are mixed with your partner's or the donor's sperm in a laboratory. After 16 to 20 hours, they're checked to see if any have been fertilised.
In some cases, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI. The Human Fertilisation and Embryology Authority (HFEA) has more information about ICSI.
The fertilised eggs (embryos) continue to grow in the laboratory for up to 6 days before being transferred into the womb. The best 1 or 2 embryos will be chosen for transfer.
After egg collection, you'll be given hormone medicines to help prepare the lining of the womb to receive the embryo. This is usually given either as a pessary placed inside the vagina, an injection, or a gel.

Step 6: embryo transfer

A few days after the eggs are collected, the embryos are transferred into the womb. This is done using a thin tube called a catheter that's passed into the vagina.
This procedure is simpler than egg collection and similar to having a cervical screening test, so you won't normally need to be sedated.
The number of embryos that will be transferred should be discussed before treatment starts.
It usually depends on your age:
  • Women under 37 in their first IVF cycle should only have a single embryo transfer. In their second IVF cycle, they should have a single embryo transfer if one or more top-quality embryos are available. Doctors should only consider using 2 embryos if no top-quality embryos are available. In the third IVF cycle, no more than 2 embryos should be transferred.
  • Women aged 37 to 39 years in the first and second full IVF cycles should also have single embryo transfer if there are 1 or more top-quality embryos, and double embryo transfer should only be considered if there are no top-quality embryos. In the third cycle, no more than 2 embryos should be transferred.
  • Women aged 40 to 42 years may have a double embryo transfer.
If any suitable embryos are left over, they may be frozen for future IVF attempts.
The HFEA has more about decisions to make about your embryos.

For men

Around the time your partner's eggs are collected, you'll be asked to produce a fresh sperm sample.
The sperm are washed and spun at a high speed so the healthiest and most active sperm can be selected.
If you're using donated sperm, it's thawed before being prepared in the same way.

Finding out if you're pregnant

Once the embryos have been transferred into the womb, you'll be advised to wait around 2 weeks before having a pregnancy testto see if the treatment has worked.
Some clinics may suggest carrying out a normal urine pregnancy test at home and letting them know the result, while others may want you to come into the clinic for a more accurate blood test.
This 2-week wait can be a very difficult period because of the anxiety of not knowing whether the treatment has worked. Some people find it the hardest part of the treatment process.
During this period, you may find it useful to speak to a counsellor through the fertility clinic, or to contact other people in a similar situation to you through the HealthUnlocked IVF community.
If you do become pregnant, ultrasound scans will be carried out during the following weeks to check things are progressing as expected.
You'll then be offered the normal antenatal care given to all pregnant women.
Unfortunately, IVF is unsuccessful in many cases and you should try to prepare yourself for this possibility.
You may be able to try again if treatment doesn't work, although you shouldn't rush straight into it.
You may find counselling or fertility support groups helpful during this difficult time. 
Read more about the support available during IVF.
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Hysteroscopy - What Happens

What happens-Hysteroscopy




A hysteroscopy is a simple procedure usually carried out on an outpatient or day-case basis. This means you won't normally need to stay in hospital overnight.

Preparing for a hysteroscopy

In the days and weeks before a hysteroscopy, you may be advised to:
  • have tests to check whether you can have the procedure, such as blood tests and a pregnancy test – these may be done at an appointment about a week before your hysteroscopy
  • use contraception – a hysteroscopy cannot be carried out if you're pregnant
  • stop smoking – if you're due to have a general anaesthetic and you smoke, stopping smoking in the lead-up to the procedure can help reduce your risk of complications from the anaesthetic
If you're going to have fibroids removed, you may be given medicine to help shrink them beforehand.

Choice of anaesthetic

A hysteroscopy is not usually carried out under anaesthetic, as it's a relatively quick procedure and does not involve making cuts (incisions) in your skin.
Taking painkillers such as ibuprofen or paracetamol about an hour beforehand can help reduce discomfort after the procedure.
Occasionally, a local anaesthetic may be used to numb your cervix (entrance to the womb) during the procedure.
Longer or more complicated procedures, such as the removal of fibroids, may be done under general anaesthetic. This means you'll be asleep while the operation is carried out.

On the day of your hysteroscopy

If you're having a general anaesthetic, you'll need to avoid eating or drinking for a few hours before the procedure. Your appointment letter will mention whether this applies to you.
If you're having no anaesthetic or just a local anaesthetic, you can eat and drink as normal.
It's a good idea to wear loose, comfortable clothes when you arrive for your appointment, as you'll be asked to remove any clothes from below your waist and change into a hospital gown for the procedure.
You can bring a friend or relative with you for support, although they may not be allowed in the room during your hysteroscopy.

The hysteroscopy procedure

A hysteroscopy usually takes between 5 and 30 minutes. During the procedure:
  • you lie on a couch with your legs held in supports, and a sheet is used to cover your lower half
  • an instrument called a speculum may be inserted into your vagina to hold it open (the same instrument used for a cervical screening test), although this is not always needed
  • the vagina and cervix are cleaned with an antiseptic solution
  • a hysteroscope (long, thin tube containing a light and camera) is passed into your womb – you may experience some cramping and discomfort as it passes through your cervix
  • fluid is gently pumped into the womb to make it easier for your doctor to see inside
  • the camera sends pictures to a monitor so your doctor or specialist nurse can spot any abnormalities
If at any point you are finding the procedure too uncomfortable, tell the doctor or nurse. They can stop at any time.
In some cases, a small sample of tissue from the womb lining may be removed for further testing. This is known as an endometrial biopsy.
If you're having a hysteroscopy to treat a condition such as fibroids or polyps, fine surgical instruments can be passed along the hysteroscope. These are used to cut or burn away the abnormal tissue.

After a hysteroscopy

You should be able to go home soon after a hysteroscopy, although you may need to stay in hospital for a few hours if you had a general anaesthetic.
Your doctor or nurse will discuss their findings with you before you leave, although it may take a few weeks to get the results of a biopsy.
You can usually return to your normal activities later the same day or the following day if no anaesthetic or just a local anaesthetic was used. If you had a general anaesthetic, you may need to take things easy for a day or 2.
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