I have had two liver transplants at Mayo Rochester. I am also a Physical Therapist with a specialty certification in Aquatic Physical Therapy. I have found from professional and work experience, that gentle aquatic aerobic exercise in therapy pools (warmer than lap pools) is very comfortable for patients and there are very few health risks. Something to consider before seeking this out is if you have an open wounds, ostomy sites or issues with fecal/urinary incontinence. Don’t worry about not being able to get into and out off the pool because most Therapy pools have a lift or a walk in/out ramp to make it easier. Often times for patients with extreme muscle wasting, this is a great way to ease back into exercise without stressing the joints too much and is often very relaxing. Plus, I may be biased here, Aquatic PTs are super friendly and fun! The goal with this is to refer you to a community based exercise program. Many hospitals have this integrated into their Rehabilitarion program in some way, shape or form.

I could not swim after either transplant because I had a rather large wound to heal, but what I did in the hospital was request a PT consult and started walking right away. It comfortable at the first, but the more you walk the better you will feel. I learned that the hard way after my first transplant where I refused to get out of bed and sat and pushed my PCA button whenever I had increased pain.The second time around I was walking a mile post op day 1 and had the PT bring in a little bedside bike pedal to use whenever I was sitting up and watching tv or reading. And depending on your platelets post op, you can begin gentle upper extremity stretching in a variety of positions which helps with healing, swelling, and mobility. I always tried to adhere to what is common referred to as “Sternal precautions.” This is a basic set of guidelines given to patients who have had open heart surgery but came somewhat apply to lost liver transplant patient with some modifications. Briefly, they are:

1. Protect your sternum. Hug a pillow to your chest or cross your arms over your chest when you laugh, sneeze, or cough.

2. Be careful when you get into or out of a chair or bed. Hug a pillow or cross your arms when you stand or sit. Do not twist as you move. Use only your legs to sit and stand. You may need to use a raised toilet seat if you have trouble standing up without using your arms. Your healthcare provider may teach you to use your elbow for support as you move from lying to sitting.

3. Ask when you may take a bath or shower. You may need to use a bath chair if you have trouble getting into or out of the tub. Do not use a grab bar. Depending on where you are transplanted at, they may have different protocols for when you can shower after surgery.

4.Do not lift or carry anything heavier than 5 pounds. For example, a gallon of milk weighs 8 lbs.

5. Try to use both arms and hands for any reaching or grabbing of objects around you. Do not let anyone pull your arms to help you move or dress.

6. Do not push or pull anything. Examples include a car door or a vacuum cleaner.

7. Do not drive while you are healing. Your surgeon will tell you when it is safe for you to start driving again.

Depending on how you heal, you age and previous strength and flexibility prior to transplant, the PT can modify these to fit your particular needs.

After two liver transplants I have learned that physical fitness and diet are keys to living a long healthy life after transplant. Whenever I don’t want to go swim my 2 miles in the pool or eat my greens, I always remember that I am not just doing this for me, but for the person and the family who gave a part of their life so that I might live a little long!

Be well,

Teresa H.