Brief Answer:
Continue the current regimen for at least 6 more months

Detailed Answer:
Dear Sir,

I did review your concern and I am sorry to hear about your father's health. MDS-RAEB-2 is a intermediate to high risk MDS and requires special treatment including low dose methyltransferase inhibitors which your father is definitely getting. The response however is variable in different individuals. Stem cell transplant is an option but is rarely performed in people above 60 years since the risks associated with transplant at this age are much more than at younger age.

My recommendations would be-
1) Continue the current regimen for atleast 6 more months and get a regular hemogram and see the pattern in hemoglobin.
2) Give regular red blood cell transfusion to maintain hemoglobin atleast above 7gm/dl and give platelets if you see any petechiae on his body and platelet count is less than 50,000/cumm.
3)Always eat well cooked food and diet rich in green leafy vegetables and a well balanced diet that should include good amount of proteins from animal or plant sources like eggs, daals etc.
4) Encourage him to walk everyday (even if for little distances) and keep himself active.
5)Consult your doctor immediately if he has spiking fever attacks or experiences burning micturiton or shortness of breath more than everyday.
6) Try to keep his surrounding clean and keep a handwash sanitizer (alchohol based) at the entrance of his room, so that anybody who visits him should apply before meeting him. Also encourage him to use it before and after eating food and going out or meeting someone.
7) Discourage people from bringing flowers or fruits and vegetables near him. All these measures are important for him to prevent infections.
8) Also consult your doctor regarding influenza and pneumococcal vaccines (killed type) as that will immunize him against these common agents that can cause infection in immunocompromised hosts.
9) Encourage him to take part in Yoga or tai-chi like relaxation regimens. You can learn and show him from internet sites like you tube and accompany him. Trust me these exercises help a lot in keeping the body and mind in alignement for patients with any chronic illness.
10) Above all keep a cheerful environment in the house and around him. Happiness is the best medicine and it works miracles.

Apart from that medically I reviewed the treatment he is getting and he is getting all the things he needs as of now. Also do not forget to get his regular bone marrow checks and hemograms for monitoring the blast count, hemoglobin and platelets.

I hope this helps.
Let me know if you have any more questions or concerns sir.
Wish you and your family all the best!
Sincerely,
Dr Parth Desai.

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Brief Answer:
Hi I would recommend the following.

Detailed Answer:
Dear Mr Fatania,

Thank you for your reply email sir.

As far as transplant option is considered it is indeed not very advisable after 60 years of age.

MDS is a progressive condition but medications like azacytidine does prolong the survival significantly especially with the help of support therapy. The main risk is however development of Acute myeloid leukemia which is poor prognosis especially at this age. But we can all strive together and do our best to keep him healthy and happy.

Regarding the Ayurvedic treatment, most of them contains steroids which weakens immunity and can cause more problems. However, I am not an expert in that field and hence I would not really advice it before know what are its chemical constituents.

You can definitely ask me questions anytime on this platform and I would be more than happy to answer all your questions sir. I generally do not use whattsapp.

I can definitely understand your problem and it indeed must be very difficult for you managing everything and I must congratulate you for whatever you are doing for your father is commendable and praiseworthy. We all wish for his happy and healthy life ahead.

I hope this helps.
Let me know if you have any more questions or concerns sir.
Wish you and your family all the best!
Sincerely,
Dr Parth Desai.

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Brief Answer:
Please do let me know the followup regarding your father's health.

Detailed Answer:
Dear Mr Fatania,
WIsh you all the very very best.
stay happy stay positive!!

Let me know if you have any more questions or concerns sir.
Wish you and your family all the best!
Sincerely,
Dr Parth Desai.

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