The purpose of the Healing Circle at Love Heals Cancer and ZenOnco.io is to give a safe space to cancer patients, survivors, and caregivers, to share their feelings or experiences. This circle is built on the foundation of kindness and respect. It is a sacred space where everyone listens with compassion and treat each other with honor. All the stories are held confidential, and we believe that we have guidance we need within us, and we rely on the power of silence to access it.
Dr (Brig.) A K Dhar is an experienced Oncologist specialized in Bone Marrow Transplants and Acute Promyelocytic Leukemia. Dr Dhar has over 40 years of rich experience and has treated more than thirty thousand patients. He pioneered the technique of Autologous Transplant in India and has to his credit more than seventy Bone Marrow Transplants. Dr Dhar is currently the Director at the Department of Medical Oncology in Fortis Memorial Research Hospital in Gurgaon and has an illustrious career serving in Army Hospitals, including being the Head of Oncology Division at Army Hospital (R&R), Delhi Cantonment.
In this week's Healing Circle, Dr (Brig.) A K Dhar shares his life experiences and how he shifted his career focus to bone marrow transplantation. He shares his knowledgeable insights on Bone Marrow Transplantation through the real-life stories he has seen in his 40 years of rich experience. He believes that real stories inspire people and make them understand everything quickly.
I began my career after completing my post-graduation in Internal medicine. As a specialist, I joined the Army way back in 1993. After a few years, I was selected for super-specialty training for medical oncology and bone marrow transplantation at Tata Memorial Hospital, Mumbai. Not many people used to study oncology those days, so I was initially lost when I joined the hospital because it was new for me. Army officials told me that after returning from super-specialty training, I had to establish an oncology center in the Armed forces. It was October 1992; we got a patient from Kashmir, Shrinagar. She was a doctor herself, and her husband also was a doctor. She was paralyzed and bedridden. She reached us, and when we examined her, we found that she had multiple myeloma. We started the treatment, and after 2-3 months of treatment, the lady started walking. She went back home and continued her treatment at Shrinagar. She came back to us again on 12th March 1993, when the Mumbai blast happened. She came to Dr Advani, and he told me that the only chance of prolonging her life was through bone marrow transplantation. He asked me to do a bone marrow transplantation. But we were not aware of bone marrow transplantation at that time. Dr Advani had his chamber full of patients, so we came out of the chamber, and the lady started crying; she thought it was the end of her life. As the lady and I were both Kashmiri, I decided to take her home to my wife because my wife could console her and somehow help her mentally prepare for the bone marrow transplantation by counseling her in the native language. I hired a taxi and took her to my home. My wife counseled her, and she had dinner with us and then left the place. After that, Dr Advani did not tell me what was to be done. We were residents there, and we were studying how bone marrow transplantation was to be done. We did the bone marrow transplantation in August 1993. Later only we realized that it was the first Autologous Bone Marrow Transplantation for multiple myeloma in India. After six months, the patient recovered and went back home. The doctor called me and wrote me a letter in which he wrote that When death was everywhere in Mumbai, we were talking about life. That lady survived 17 years after bone marrow transplantation. She settled with her children and passed away in 2009. Later, I shifted my career focus to bone marrow transplantation. After I returned to the Army, I told people that I could do bone marrow transplantation, but they laughed at me because people were not even aware of bone marrow transplantation. It took me seven years to convince them, and in 1999, we established a bone marrow transplant unit in Delhi and Pune.Dr (Brig.) A K Dhar answers some questions on cancer
In 2005, I was in Army hospital, Delhi, and around 5 pm, I got a call. I remember the caller had a good voice, and he said, Doctor, my wife got a swelling in the abdomen, and I have started the treatment; I am speaking from Allahabad and will be reaching the Army hospital tomorrow morning, so kindly see us. It was a surprising call for me, so I asked him to introduce himself and then told him that I would be seeing him the next morning. When that couple came to my office, the lady was barely able to walk. She was sick, her abdomen was filled with fluid, and she was in respiratory distress. Her husband itself was treating her. I told him that she has got cancer, and she should be admitted immediately. We did her biopsy, and she was diagnosed with breast and Ovarian Cancer. We treated her; she became alright and then had a daughter. Breast cancer and Ovarian Cancer are likely to go to the offspring, so I asked the couple to get their daughter timely investigated. I kept on reminding them, they kept on postponing it, and in 2015, the lady expired. I had left Army by that time, and in 2017, when I was sitting in my office, the same person walked, and he said, My daughter has got Breast Cancer. The purpose of telling this story is that she might not have undergone such a painful experience if she was detected early. So I always say that early diagnosis is very important. In stage one cancer, the chances of recovery is at around 90-95%; at stage two, it comes to 80%, at stage three 50-60%, and at stage four, it comes to 25-30%.
In 1996, I was in Pune when a small 11-year-old girl came to me from a nearby town. She was diagnosed with Acute Lymphoblastic Leukemia, and she underwent Chemotherapy and bone marrow transplantation. After that, she completed her education and got married, and presently she has three children. Like her case, on most occasions, the menstrual cycle becomes natural after some time. Meanwhile, women should carry on with their routine activity.
I am working on cutting down the price of treatment. Firstly, we have to rely on generic. It is the doctor's duty to practice generic. Secondly, we should save five rupees per for ourselves, and everyone should take some insurance. I am also trying to get lower-cost treatment for cancer patients.
It's a natural thing that blood count go down after Chemotherapy. It a good thing because the old cancer cells are going away, and the new cells are coming into the body. If the counts are going down, and if the patient does not have any complications, then he/she should not bother much about this thing; he/she should take it in a positive way that the medicines are working. There are various ways to keep the blood count steady. There are some medicines and injections that are called growth factors, which help in controlling blood counts. The patient should take a high protein diet and avoid raw things and outside food.
All cancer patients do not need bone marrow transplantation. The majority of solid tumors do not require bone marrow transplantation; only patients of lymphoma, leukemia, multiple myeloma, aplastic anemia, thalassemia, and sickle cell anemia need bone marrow transplantation. Patients with bone marrow disorders whose bone marrow does not function also need bone marrow transplantation. An essential thing in bone marrow transplantation is the availability of the donor. Though the donor is not required for an autologous transplant, we need a donor for an allogeneic transplant.
For Thalassemia, the survival rate after transplant is 95%; for leukemia, it depends on the kind of leukemia; if it is Acute Lymphoblastic Leukemia, then the chances of survival are good, but if it is Acute Myeloid Leukemia, then the chances are relatively less.
Usually, bone marrow transplantation is not done after 60 years of age, but there are certain diseases like multiple myeloma, for which we do transplants until 70 years of age. It depends on the type of transplantation; if it is not a very aggressive transplant, you have to see the organ function of the patient; if the organs are fit, then the bone marrow transplantation can be done after 60-65 of age too, but after 70 years of age, it does become difficult.
The patient should not take raw food items; certain fruits like apple and grapes are forbidden. Eat fruits that have thick skin and follow a high protein diet. The fruit should be taken after warming properly; fruit juices should be avoided except Tetra Pak because they are safe.
Not all, but in certain cancers, bone marrow transplantation is required upfront. In other cancers, when the disease comes back, then only bone marrow transplantation is needed.
It's a prevalent problem. We make sure that when a patient is alone in the isolation room, all the entertainment modes such as TV, games, etc. are there. We allow one attendant to the patient so that the patient can talk to the attendant. The patient should see a glimpse of sunlight; there should be a kind of arrangement that, through a hazy glass, the patient should see the sunlight.
When we plan a bone marrow transplant unit, we always make arrangements and try to give the patient close to the nature-life look. The doctor and nursing staff should know how to keep the patient cheerful throughout the period.
Firstly, the most important thing is that the patient should not get an infection. Secondly, nobody who is sick should visit the patient at home. A crowded environment should be avoided, and a healthy diet and cheerful atmosphere should be there.
One of the most significant factors is fitness, and we have to see the patient's age, the performance status, status of his teeth, whether there is some infection or not, and then the organ functions. After that, we see whether the patient will be able to tolerate the transplantation because it is a very aggressive procedure. There are fixed guidelines for bone marrow transplantation by ICMR in which it is clearly mentioned that bone marrow transplantation will only be done for patients of hematolymphoid malignancies.
Nowadays, we do not take bone marrow; we take stem cells from the blood. So it is just like taking platelets, and hence there are no significant precautions. The only thing is that the donor should be well-nourished, the diet should be okay, he/she should be fit to donate stem cells, and the age should not be more than 55 years.
If they are in remission and they are free of disease, then they can donate blood.
The doctors should talk in a way that the patient should not lose hope, by highlighting more positivity, while at the same time, everything should be told to the caregivers.
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