1. Timing:

1. One should plan the timing of transplant if transplant is planned. Transplant process requires in hospital stay for 4-5 weeks and after discharge patient will need to attend the outpatient department two to three times a week, during the immediate period following discharge. Outpatient follow up period can last from 3-4 months and varies from patient to patient. Most of the patients return back to their routine activity by six months of period.
2. If transplant is urgent then follow the decision of BMT Physician.
3. Preparation at home depends on the type of transplant planned.
4. Child care
5. Restricting your social activity
6. Help at home when you are discharged
7. Work Holiday for full time employed patients for at least six months post-transplant
8. All of these considerations are an important part of your psychological preparation for the transplant and are particular to you.

2. Fertility: There are high chances of having infertility with high dose chemotherapy, but it is not 100% inevitable that all patients will be infertile. The techniques for preserving fertility are changing and doctor can discuss current treatments with patient & family prior to any fertility damaging therapy.

It is technically easier and quicker to obtain semen from male patients, than it is to obtain eggs from female patients.

Male Patients

Before starting transplant process one should discuss the option of semen preservation for use later on.

• Donating semen is a simple procedure.
• Prior to donating semen some general questions you should know
• Consent for viral testing.
• There is possibility that your sperm may already have been damaged
• The quality and sperm count is checked when you donate.

Female Patients

The following pages advise about the fertility treatments available at present. There are currently four options to consider:

• Using own eggs following embryo storage
• Using donor eggs
• Using own eggs following egg storage
• Ovarian Tissue

Early Menopause: High dose chemotherapy and/or radiotherapy that you will receive before your transplant is likely to damage your ovaries. This damage frequently leads to premature menopause.

3. Clean diet

4. Losing hair and growing it back again!

ANY QUESTIONS?

We are here to help you get reliable, easy-to-understand information from planning your travel to India for Bone Marrow Transplant procedure, treatment through recovery. CONTACT US anytime on Phone/ Whats App +91 7015677759 or email us at drvikas.bmt@gmail.com.nCall or email us for confidential, one-on-one support from caring experts. We'll listen and help you find answers.

BMT Clinic team can help you and your family plan for transplant. We can answer your questions and provide support and education to help you navigate your transplant journey by guiding you at each step.

• Doctors. Doctors who specialize in oncology, hematology, immunology, and bone marrow transplantation.
• Bone marrow transplant nurse coordinator. A nurse who organizes all aspects of care provided before and after the transplant. The nurse coordinator will provide patient education, and coordinates the diagnostic testing and follow-up care.
• Social workers. Professionals who will help your family deal with many issues that may arise, including lodging and transportation, finances, and legal issues.
• Dietitians. Professionals who will help you meet your nutritional needs before and after the transplant. They will work closely with you and your family.
• Physical therapists. Professionals who will help you become strong and independent with movement and endurance after the transplantation.
• Pastoral care. Chaplains who provide spiritual care and support.
• Other team members. Several other team members will evaluate you before transplantation and will provide follow-up care as needed. These include, but are not limited to, the following:

• Pharmacists
• Respiratory therapists
• Lab technicians
• Infectious disease specialists
• Dermatologists
• Gastroenterologists
• Psychologists

An extensive evaluation is completed by the bone marrow transplant team. The decision for you to undergo a bone marrow transplant will be based on many factors, including the following:

• Your age, overall health, and medical history
• Extent of the disease
• Availability of a donor
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Expectations for the course of the transplant
• Your opinion or preference

ANY QUESTIONS?

We are here to help you get reliable, easy-to-understand information from planning your travel to India for Bone Marrow Transplant procedure, treatment through recovery. CONTACT US anytime on Phone/ Whats App +91 7015677759 or email us at drvikas.bmt@gmail.com.nCall or email us for confidential, one-on-one support from caring experts. We'll listen and help you find answers.

BMT Clinic team can help you and your family plan for transplant. We can answer your questions and provide support and education to help you navigate your transplant journey by guiding you at each step.

• Make a list of important phone numbers. Share the list with the entire family. Include names and numbers of your health care team and caregivers.
• Write down important information about finances.
• Plan how your bills will be paid while patient is in the hospital and during recovery.

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• Ask your doctor how long patient might need to stay in the hospital and how long attendant & patient needs to stay near the hospital.
• Make a packing list. Bring clothes for different temperatures and seasons, if appropriate. Include some family photos or posters to brighten your hospital room or temporary living space.
• Get phone numbers, email addresses and mailing addresses of people you want to stay in touch with.
• Think about how bills will be paid. When possible, pay ahead.

• Make plans with your employer for being away from work.

• Set up a time to talk with your family about what each of you believe. Consider talking about what gives you comfort and strength.
• Arrange to keep in touch with your faith community. Community members could send cards, organize a prayer chain or give encouragement in another way.
• You might ask your faith leader to offer special prayers, anointing services or other healing rituals for you and your family.
• Find out if there is a local contact for your faith community in the city where your transplant will take place.
• Keep track of the out-of-pocket costs related to your transplant.
• Consider assigning someone to handle your finances temporarily. If you do not share a joint checking or credit account, talk with your bank to find out how to give someone temporary access to your accounts.

• Ask your transplant center social worker about lodging resources near the transplant center. Ask for costs and whether you need to put your name on a waiting list.
• Make arrangements for traveling to your transplant center.

Checklists for Parents

Prepare your child

• Talk honestly with your child in words he or she will understand. You might use books, videos or pictures to help tell the story. If you want help talking with your child, contact your hospital social worker or child life specialist. Talk about:
  • Who will be at the hospital, and who will care for brothers, sisters or pets at home.
  • What will happen at the hospital and what the schedule might be like.
• Reassure your child that Mom, Dad or another caregiver will be available to help with whatever he or she needs.
• Help your child make a list of items he or she would like to take along.
• Talk with your child’s teachers and principal about the plan for schoolwork while your child will be away.
• Talk about ways to keep your child connected with school and friends.

Prepare brothers & sisters

• Talk with your children to tell them what will be happening within the family while their sibling is going through a transplant.
• If children are staying home, talk with them about who will take care of them. Reassure them they will be taken care of during this time and that you love them.
• If you are a single parent with more than one child, think about who will care for your other children if you must travel for your child’s treatment. For example, who can consent for your children’s medical care or contact the school while you are away. Talk about this with your child’s doctor, teachers and family.
• Talk with your other children about any planned family visits to the transplant center.

ANY QUESTIONS?

We are here to help you get reliable, easy-to-understand information from planning your travel to India for Bone Marrow Transplant procedure, treatment through recovery. CONTACT US anytime on Phone/ Whats App +91 7015677759 or email us at drvikas.bmt@gmail.com.nCall or email us for confidential, one-on-one support from caring experts. We'll listen and help you find answers.

BMT Clinic team can help you and your family plan for transplant. We can answer your questions and provide support and education to help you navigate your transplant journey by guiding you at each step.

Transplant patients have very low immunity to fight bacterial, viral and fungal infections and therefore need to be isolated into CLEAN ROOMS which will protect them from infections.

What Are Clean Rooms and How Do They Protect Against Infections?

Our BMT Unit has been made as per class 1000 clean room standards prescribed internationally. Our Hospital is the only hospital of India which has made its BMT Unit as per class 1000 clean rooms standards, prescribed internationally, which are as under:-

1. Air Handling Unit (AHU) Each room of the 4 room BMT Unit has its own dedicated Air Handling Unit (AHU) to provide 10-15 Hepafiltered fresh air changes per hour. This means the fresh air entering the patients room is first treated through special filters. Treated fresh air then passes through 0.3 Micron High Efficiency particulate Air Filter (HEPA). Hepa removes all the bacteria, viruses and fungus. This hepafiltered air passes through a laminar floor to reach the patient’s room at the desired humidity and temperature, which is comfortable for the patient.
2. Automatic and Selective Control System Automatic and selective control system provides positive air pressure in the BMT room compared to ante room and the BMT corridor. This has been done to ensure that, on opening the door of the BMT Room or the ante room, no outside air from BMT Corridor can enter the patient’s room. Air pressure in Anteroom is 10-15 pascal higher than the BMT corridor and air pressure in BMT room is 10-15 pascal higher than the ante room. Ante room is a small room between the corridor and the BMT room for maintaining positive air pressure, special hand washing (scrubbing) and wearing a sterile gown before entering the BMT room.
3. Stainless Steel Doors, Vinyl Flooring and Cladding of Walls Stainless steel doors and vinyl surfaces are most practical to clean with disinfectants to maintain and protect patients from infections.

Precautions before Entering in the BMT Unit

• Do not carry any valuables e.g. jewellery, cash etc. to the BMT room
• Ring the bell outside the BMT unit, so that the nurse can decide, whether to let you in or not.
• If allowed, keep your cell phone, toys, games, pictures etc. in the pass box fitted with ultraviolet light to kill bacteria (germs).
• Enter the change room
• Change shoes
• Change into sterile clothes, wear cap and mask.
• Wash your hands with soap and water by following 6 step hand wash instructions, written on the wall of the sink, called scrubbing of hands.
• Use all the three disinfectants (placed above the sink) one by one. Dry your hands
• Enter the BMT corridor.
• Enter the Anteroom, scrub again as mentioned above, wear a sterile gown and then enter the BMT room.

Precautions inside the BMT Room

Attendants– No attendants are allowed except with children and very sick patients with the doctor’s permission.

Toilets- Attached toilet is exclusively meant for the patient. Only treated water should be used for patient. Attendants should use change room toilet only and not the patient toilet.

Food

• No outside food is allowed inside the BMT room
• Patients will be served prescribed; pressure cooked and microwaved food inside the BMT room.
• Attendants will be served food in the BMT pantry as per their order

Note:

• BMT Nurse will explain all the above in detail to the patient and the family for their full cooperation.

Equipment, Furniture and Furnishing of the BMT Unit and Room

BMT Unit is equipped with a dedicated X-ray machine, ultrasound machine, dialysis machine and a ventilator. In other words patients requiring these equipment, need not be sent to X-ray dept./ICU/Dialysis Unit etc.

Furniture and furnishing of BMT room

• Centralized oxygen, suction system with double outlets
• State-of-art, six parameter monitors, for monitoring heart rate, breathing rate, blood pressure, oxygen saturation, Central Venous Pressure and ECG
• Infusion pumps
• Syringe pumps
• C.C.TV monitoring system for 24x7 vigilance of the patient
• Television
• Telephone
• Patient bed, bedside locker and desk.
• Attendant bed
• Two trolleys for medicines/ dressing etc.

Instructions given to Hospital Staff and Attendants

1. Step Down Isolation Once transplanted bone marrow starts to grow, or engraft, the white blood cell count will rise. Once the part of the white blood cell count called the NEUTROPHILS has stayed above '500' for 3 days, strict protective isolation measures can be somewhat relaxed. This phase of transplant is called step down isolation. In step down isolation, parents or relatives will still have to wash their hands before visiting the patient.

2. Nutrition Guidelines During bone marrow transplantation, the bone marrow is destroyed by high doses of chemotherapy. This leaves the patient at risk for developing infection, what we call ImmunoSuppresed. When Patients are admitted in the isolation room, they are placed on a low bacteria diet. Most foods contain certain types and amount of bacteria. The purpose of the low bacteria diet is to reduce the total bacterial content of foods and to keep the patient away from eating potentially harmful foods. A low bacteria diet is not complicated, but it does restrict the use of some specific food.

• Home prepared foods are NOT allowed.
• Commercially packaged items are ONLY allowed after they have been approved by the dietician or nurse.
• Food should NOT be left at room temperature for longer than one hour. Eating well is very important- it keeps the body healthy and helps the new marrow grow. Patient should eat and drink, even if it in small amount. To assess the nutrient intake, we will place the patient on daily calorie counts. Please tell the nurse or the dietician what you would prefer to eat within the choices provided.

There may be times when Patients may not feel well enough to eat. To maintain the nutrition, TPN (Total Parenteral Nutrition) may be started. TPN is a mixture of protein, fat, sugar, vitamins and minerals that is delivered through central line into the blood stream.

3. Low bacteria diet guidelines

• No restaurant food, take out, cafeteria food or vendor food is allowed.
• All foods must be cooked thoroughly. Avoid rare to medium cooked meats and fish.
• Herbs, spices and pepper should not be added to food after it is cooked, but are allowed when cooked into the food.
• Avoid raw fruits and vegetables including salads, garnishes, stir-fried vegetables, egg rolls and any food items where vegetables are not completely cooked.
• Avoid foil- sealed plastic cups of juices because they do not have best before date.
• Avoid food containing raw eggs including soft cooked eggs.
• Dried fruits, nuts and seeds, are not allowed unless cooked in a food item.

4. Central venous lines (CVL)

If you do not have a double lumen central venous catheter, you need one for the transplant period. The double lumen catheter is a flexible catheter, or small tube, that is inserted through the skin and tissue in the chest into a major vein. The tube, called a central venous line or CVL, is inserted about 1-2 weeks before the patient has a blood or marrow transplant. The placement of the CVL requires minor surgery under sedation and local anesthetic.

This CVL remains in place for the entire transplant period. It may be used to give intravenous (IV) fluids, chemotherapy, medication, blood and platelet transfusion and nutritional fluid. It will also be used for drawing blood for daily tests. Sometime the CVL will remain in place for a while after you go home. You may need to visit our clinic weekly or more frequently for blood product transfusion. Before you leave the hospital, one of the BMT nurse will teach you how to care for the central venous line at home.

When the transplant doctor decides that the line is no longer needed, it will be removed in the operating room. Usually, this is a day- surgery procedure, so no overnight stay is needed. The major risk of a CVL is that it can become infected. If this happens, the transplant physician will decide whether the CVL needs to be removed.

ANY QUESTIONS?

We are here to help you get reliable, easy-to-understand information from planning your travel to India for Bone Marrow Transplant procedure, treatment through recovery. CONTACT US anytime on Phone/ Whats App +91 7015677759 or email us at drvikas.bmt@gmail.com.nCall or email us for confidential, one-on-one support from caring experts. We'll listen and help you find answers.

BMT Clinic team can help you and your family plan for transplant. We can answer your questions and provide support and education to help you navigate your transplant journey by guiding you at each step.

• Stem Cell Donation procedure
• Complete BMT procedure & care of the patient
• 1 month hospital room stay of patient with 1 attendant, Room tariff (for the specified period)
• Medicines during the procedure
• Surgeon's fees
• O.T. charges
• Anaesthesia charges
• Investigations related to the surgery
• Food and Beverage for the patient and 1 attendant during stay at Hospital.
• The Hospital also provides Complimentary two way airport transfers.
• In case of ICU admission, stay for one companion would be arranged in ICU Lounge

Exclusions

• All expenses for stay beyond the package period
• Additional charges in case of inter-disciplinary consultations
• Additional procedure costs
• Use of special drugs/ consumables/ blood components (Specific to the treatment)

Payment Details

• Payment can be done in installments before starting the procedure via wire transfer from your country or once the patient is admitted in the hospital. Although the whole payment must be done before the discharge of the patient.
• Payments can be done either via cash, credit card or Wire Transfer.

ANY QUESTIONS?

We are here to help you get reliable, easy-to-understand information from planning your travel to India for Bone Marrow Transplant procedure, treatment through recovery. CONTACT US anytime on Phone/ Whats App +91 7015677759 or email us at drvikas.bmt@gmail.com.nCall or email us for confidential, one-on-one support from caring experts. We'll listen and help you find answers.

BMT Clinic team can help you and your family plan for transplant. We can answer your questions and provide support and education to help you navigate your transplant journey by guiding you at each step.