Hi Lori,

Thank you ever so much for your detailed response. The best thing I learned is that immunosuppressive drugs do not kill off good bacteria; they are NOT antibiotics. Good to know! I need to read more about the other points you made. I can tell you this. I have been taking very good care of myself for a long time. I know good nutrition, do the treadmill for 45 minutes every day, and my family is very careful about Covid, masking up with an N 95, etc!

My mother was taking steroid (?) injections for shoulder pain before she died at the ripe ol' age of 99. She had been told her bones were like ice cream cones. The doctor who injected her was truthful enough to tell her the injections would help her pain, at first, but the effect wouldn't last and the pain would be worse in the end as a result of taking the injection. This proved to be true but she was in so much pain at the time she was willing to do anything for even short-term relief.

I inherited osteoarthritis but have been able to control it with diet, exercise, and thyroid dosage. One question would be: Can one protect one's bones through diet, cardio, and weight-bearing exercise after going on immunosuppressive drugs, or is one automatically prescribed (bone) drugs?

Also, I recently had shingles. The shingles virus lays dormant in one's spine and once triggered through stress, emerges to affect one side of the body's nervous system. I was given antivirals and my symptoms cleared up within a couple of weeks. But, the shingles virus is always going to be in my body. If my immunity is always going to be down due to the immunosuppressant drugs, isn't the shingles virus going to be continually triggered due to my lowered immunity? Or will taking a shingles vaccine prior to transplant avoid that? I wonder if the shingles virus rears its ugly head due to lowered immunity, and I am given another antiviral, it may help for a while but, before long, my lowered immunity will put me back where I started. Having shingles is nasty. I'm sure the doctors will be able to answer this question for me but it would be interesting to know if anyone else has had to deal with this problem.

You provided so much good information - I need to go over it again. It's good to know immunosuppressive drugs do NOT destroy the good bacteria in our gut, but I'm still not clear on the process which does cause the gut issues and associated comorbidities. Is it that they were already there prior to transplant and the immunosuppressive drugs made them worse, or are the immunosuppressive drugs responsible for creating them?

Are you able to recommend any research or medical article on this subject? Suggesting some keywords to do a search on would be helpful too. Which medical sites do you recommend?

Thank you so much for your input. It helped a lot.