Bone Marrow Transplant in Older Adults: Reduced-Intensity Conditioning and What Age Changes

A 72-year-old retired schoolteacher sits across from her hematologist with a notebook open. Her acute myeloid leukemia has gone into remission, and the word ‘transplant’ has just entered the conversation. Her first question is not about donors or hospital rooms. It is simpler: ‘Aren’t I too old for that?’

Twenty years ago, the answer would often have been yes. A bone marrow transplant for older adults was rare, because the chemotherapy needed to wipe out diseased marrow was too harsh for aging kidneys, hearts and lungs. That calculus has shifted. Gentler preparation regimens, better supportive care and more careful ways of measuring fitness have changed who gets offered a transplant and how the process is planned.

This explainer walks through what actually happens, what ‘reduced-intensity’ means in practice, how teams judge readiness, and what the weeks and months afterward tend to look like for someone in their 60s or 70s. Every decision, though, sits with the treating team.

What a bone marrow transplant in older adults actually involves

Strip away the jargon and a bone marrow transplant is a replacement of the body’s blood-making factory. Bone marrow is the spongy tissue inside large bones where blood stem cells live; stem cells are immature cells that grow into red cells, white cells and platelets. When a blood cancer or marrow failure disorder corrupts that factory, a transplant aims to shut it down and restart it with healthy stem cells.

The process has three broad phases. First comes conditioning: chemotherapy, sometimes with radiation, given over several days to suppress the existing marrow and immune system. Second is the infusion itself, which looks surprisingly ordinary. The stem cells arrive in a bag and run through a central line, a soft tube placed in a large vein near the heart, over an hour or two. Third comes the wait for engraftment, the point at which the new cells settle in the marrow and begin producing blood counts on their own.

Most transplants today use stem cells collected from the bloodstream rather than drawn directly from the hip bone, which is why the phrases ‘stem cell transplant’ and ‘bone marrow transplant’ are used interchangeably by the NHS and other mainstream sources.

For older adults, the mechanics are identical to those for younger patients. What changes is the intensity of the conditioning, the depth of the fitness assessment beforehand, and the amount of attention paid to recovery of strength, nutrition and independence afterward. A 30-year-old and a 70-year-old may receive the same bag of cells; the road that gets each of them to that moment, and away from it, is planned quite differently.

Can a 70 year old get a bone marrow transplant, and is there an age limit?

Yes, people in their 70s receive transplants, and the idea of a fixed stem cell transplant age limit has largely given way to an assessment of biological rather than chronological age. The Mayo Clinic and the Cleveland Clinic both describe eligibility in terms of overall health, organ function and disease status rather than a number on a driver’s license.

Who is usually considered a candidate? Broadly, someone whose blood cancer is likely to return or progress without transplant, whose disease is in a controlled state at the time of planning, and whose heart, lungs, liver and kidneys can tolerate conditioning and the infections and inflammation that follow. Independence in daily activities, the ability to walk reasonable distances, and a support person at home all weigh heavily.

Who is usually asked to wait, or steered toward other options? People whose disease is not yet under control, since transplanting into active leukemia carries higher risk. People with an uncontrolled infection. People whose organ function tests fall below thresholds the team has set. People recovering from a recent stroke, heart attack or major surgery, who may be reassessed after a period of rehabilitation. And people who, after honest discussion, decide the intensity of the process does not match what they want from the coming years.

Age still matters in the background. Comorbidities accumulate with time, marrow reserve shrinks, and recovery from any insult slows. That is precisely why reduced-intensity approaches were developed. The practical message for a 70-year-old is not ‘you qualify’ or ‘you don’t’, but ‘you will be assessed thoroughly, and the plan will be shaped around what that assessment finds’.

What reduced-intensity conditioning means in plain language

Conditioning is the preparation phase, and its intensity is the single biggest variable that changed transplant medicine for older adults. Traditional, or myeloablative, conditioning uses chemotherapy doses high enough to permanently destroy the patient’s own marrow; ‘ablative’ simply means destroying. It is effective at killing residual cancer cells but is hard on every organ system, and the risk of death from the treatment itself rises steeply with age and comorbidity.

Reduced-intensity conditioning, often shortened to RIC, deliberately pulls back. It uses lower chemotherapy exposure, sometimes combined with a lower dose of total body radiation than the standard approach, or with no radiation at all. Common building blocks described in the medical literature include purine analogue chemotherapy such as fludarabine, alkylating agents such as busulfan or melphalan, and in some protocols an antibody that depletes lymphocytes. These are mentioned here only to explain the concept; the choice and combination belong entirely to the transplant physician.

The trade-off is real and worth understanding. Because RIC does not fully eradicate the patient’s marrow or disease, it leans on a different mechanism: the graft-versus-tumor effect. Donor immune cells, once engrafted, recognize remaining cancer cells as foreign and attack them. In other words, the transplant becomes less of a chemotherapy event and more of an immunotherapy event.

That shift has consequences. Relapse risk tends to be somewhat higher than after full-intensity conditioning, because fewer cancer cells are destroyed up front. Treatment-related toxicity tends to be lower, which is the whole point for someone whose body cannot absorb the harsher regimen. Nonmyeloablative conditioning sits one step gentler still, using regimens that barely suppress the patient’s own marrow at all. Teams weigh disease biology against patient fitness to choose where on that spectrum a given person should sit.

Reduced intensity conditioning transplant vs full-intensity: a side-by-side view

People often ask for a simple comparison, and a table helps here because the differences are about emphasis rather than absolutes. Individual protocols vary widely, so treat this as a conceptual map, not a menu.

Feature	Myeloablative (full intensity)	Reduced-intensity (RIC)	Nonmyeloablative
Goal of conditioning	Destroy marrow and as much disease as possible	Suppress marrow enough for donor cells to engraft; partial disease reduction	Suppress immune system only; marrow largely spared
Main anti-cancer mechanism	Chemotherapy and radiation	Mix of chemotherapy and donor immune effect	Mostly donor immune effect
Organ toxicity	Highest	Intermediate	Lowest
Relapse risk	Generally lowest	Intermediate	Generally highest
Typical patient profile	Younger, fit, few comorbidities	Older adults or those with comorbidities	Frailest candidates or specific disease types
Speed of marrow suppression	Rapid and profound	Moderate	Gradual; mixed patient-donor cells for a time

A few things the table cannot show. First, the boundaries between categories are blurry, and some regimens are described as ‘reduced toxicity’ rather than reduced intensity, meaning they aim for full marrow destruction with drugs chosen to spare specific organs. Second, the relapse and toxicity rows describe tendencies across large groups; an individual’s outcome depends on disease genetics, remission depth, donor match and luck. Third, RIC did not make transplant risk-free. Graft-versus-host disease, infection and organ complications still occur, sometimes at similar rates to full-intensity approaches, because they arise mainly from the donor immune system rather than the chemotherapy itself. The NHS lists these risks in detail.

How transplant teams measure fitness rather than age

The most important appointment in the whole journey may be the one where nobody gets a treatment. Pretransplant assessment is where the team decides whether the body can carry the load, and for older adults it goes well beyond a routine physical.

Organ function comes first. An echocardiogram measures how well the heart pumps. Pulmonary function tests measure lung capacity and gas exchange. Blood tests estimate kidney filtration and liver health. Each has thresholds below which conditioning becomes hazardous.

Comorbidity scoring comes next. The most widely used tool is the Hematopoietic Cell Transplantation-specific Comorbidity Index, or HCT-CI, developed and published in Blood in 2005. It assigns points to conditions such as diabetes, heart disease, prior cancers, lung impairment and psychiatric illness, producing a score that correlates with the risk of dying from the transplant process rather than the disease. Teams use it to frame conversations, not to issue verdicts.

Geriatric assessment is the newer layer, and arguably the one that matters most for people over 65. It looks at things a blood test cannot: how fast a person walks, whether they can rise from a chair without using their arms, how many medications they take, whether memory and attention are intact, whether they live alone, how their mood is, and how nutritionally robust they are. Frailty, a state of reduced physiological reserve, predicts complications more reliably than age does, and it is at least partly modifiable. Some centers offer ‘prehabilitation’, a period of supervised exercise and nutrition support before transplant, with the aim of building reserve the body will draw on afterward.

The result of all this is a picture, not a pass-fail grade. A 74-year-old who gardens daily and takes two medications may look very different on paper from a 62-year-old with diabetes, heart failure and a recent fall.

Donor type and transplant type: what changes for someone in their 60s or 70s

There are two fundamentally different transplants, and older adults may be offered either depending on the disease. An autologous transplant uses the patient’s own stem cells, collected earlier and frozen, then returned after high-dose chemotherapy. It is standard for many people with multiple myeloma and some lymphomas, and because there is no donor immune system involved, there is no graft-versus-host disease. Its limits are age-related too: the chemotherapy before an autologous transplant is intensive, and teams assess fitness carefully.

An allogeneic transplant uses cells from another person. This is the setting where reduced-intensity conditioning matters most, because the donor immune system does much of the anticancer work. It is the usual choice for acute leukemias, myelodysplastic syndromes and several other marrow disorders.

Where do the cells come from? Historically a matched sibling was the preferred donor, but siblings of a 70-year-old are themselves often in their 60s and 70s, and donor age influences cell quality and recipient outcomes. Many teams now consider a younger unrelated donor from a registry, or a half-matched relative such as an adult child in what is called a haploidentical transplant. Advances in preventing graft-versus-host disease after haploidentical transplants have widened this option considerably, and for older adults it can mean a healthy 40-year-old son or daughter becomes the donor.

Umbilical cord blood is another source, though the smaller number of cells and slower engraftment make it less common in adults. The MedlinePlus overview describes each source in neutral terms. The choice involves matching of tissue markers called HLA, donor age and health, urgency, and the specific disease, and it is made by the transplant team in consultation with the patient.

How long is the bone marrow transplant hospital stay for older patients?

Hospital time varies with the type of transplant, the conditioning intensity and how smoothly engraftment goes. The MedlinePlus encyclopedia describes a typical inpatient stay of around 4 to 6 weeks for a bone marrow transplant, and the NHS similarly frames the stay in terms of weeks rather than days.

What fills those weeks? The first several days are conditioning. Then comes the infusion, referred to as ‘day zero’. The days after that are the nadir period, when blood counts fall to their lowest and the body has almost no ability to fight infection or clot blood. Patients are typically in a single room with air filtration, on a low-microbe diet, receiving transfusions of red cells and platelets as needed, and taking preventive antimicrobials. Mouth soreness, nausea, diarrhea and fatigue are common and are managed with supportive medication.

Reduced-intensity conditioning can shorten this arc. Because the marrow is suppressed less profoundly, the nadir may be shallower and shorter, and some programs perform parts of the process on an outpatient or ‘day hospital’ basis with the patient staying nearby and attending daily. Whether that is appropriate depends on the individual’s stability, their caregiver situation and the center’s setup.

Older adults sometimes stay longer, not because engraftment is slower but because the complications that prolong stays, such as infection, delirium, kidney strain and loss of mobility, are more common. Physical therapists often begin working with patients within days of admission to counteract deconditioning; a week of bed rest can cost a 70-year-old a meaningful share of leg strength that a 30-year-old would recover quickly. Walking the corridor, however slowly, is treated as medicine rather than optional.

The first weeks after infusion: engraftment, infection and graft-versus-host disease

Engraftment is the milestone everyone watches for. The MedlinePlus encyclopedia notes it can take 2 weeks or more for the new stem cells to begin producing blood cells, and teams track the daily neutrophil count, a type of infection-fighting white cell, waiting for it to climb past a set threshold on consecutive days. Platelets often recover more slowly. After reduced-intensity conditioning, there may be a period of ‘mixed chimerism’, where blood tests show both patient and donor cells coexisting before donor cells gradually take over.

Infection is the dominant early risk. With no functioning white cells, bacteria from the gut or skin can cause fever within hours. Fungal and viral infections become concerns as weeks pass, and reactivation of cytomegalovirus, a common virus most adults carry silently, is monitored with regular blood tests. Older adults may show infection differently, with confusion or a fall rather than a high temperature, so families and nurses are taught to treat any change as potentially significant.

Acute graft-versus-host disease, or GVHD, is the other major early complication in allogeneic transplants. The donor immune cells that attack cancer can also attack the patient’s skin, gut and liver. Early signs include a rash, diarrhea or rising liver tests, typically appearing in the weeks after engraftment. Preventive immunosuppressive medication is started around the time of transplant and adjusted by the team; the NHS describes these risks plainly.

Fatigue during this stretch is profound and often underestimated. Appetite is poor, taste is altered, and sleep is fragmented by observations and medications. Dietitians, pharmacists and physical therapists are as much part of the team as physicians during these weeks.

What happens 100 days after a bone marrow transplant?

Day 100 is a traditional checkpoint rather than a finish line. The Mayo Clinic describes the first 100 days as the period of highest risk for acute complications, which is why so many programs organize follow-up around it and why patients are often asked to stay within a short travel distance of the center until then.

Around this point, several things typically happen. A bone marrow biopsy and blood tests check whether donor cells have fully taken over and whether any disease is detectable. Immunosuppressive medication may begin a gradual taper if there is no significant GVHD, a process that is stretched over months and paused at any sign of flare. Some restrictions on food, crowds and travel begin to relax, though the immune system remains far from normal.

The character of risk also shifts. Acute GVHD gives way to the possibility of chronic GVHD, which can affect skin, eyes, mouth, joints and lungs and may appear months later. Infection risk persists, particularly from viruses and encapsulated bacteria, and revaccination schedules usually begin somewhere in the months after transplant, because prior immunity is largely erased. The Cleveland Clinic notes that full immune recovery can take a year or longer, and it is often slower in older recipients.

For a 70-year-old, day 100 often feels like a mixed moment. Strength and stamina are usually well below baseline, weight may be down, and the emotional weight of months of vigilance can surface as low mood or anxiety. None of that means something has gone wrong. Recovery after transplant is measured in seasons, and the team will say so. What day 100 does offer is data, and a chance to reset expectations with the people who know the case best.

Risks that change with age: heart, kidneys, mind and muscle

Reduced-intensity conditioning lowered the risk of dying from the transplant itself, but it did not remove the ways an older body is more vulnerable. Understanding them helps families know what the team is watching.

Cardiac reserve matters because fluid shifts, transfusions, infection and certain chemotherapy agents all stress the heart. Someone with mild heart failure or an arrhythmia before transplant may see it worsen under that load, which is why echocardiograms and cardiology input are routine.

Kidneys are exposed to antimicrobials, immunosuppressants and dehydration from diarrhea and poor intake. Age-related decline in kidney filtration means less margin before medication levels become toxic, and pharmacists adjust regimens closely to blood levels.

Delirium, an acute state of confusion with fluctuating attention, is common in hospitalized older adults and more so after transplant, where sleep disruption, infection, medications and isolation all contribute. It is distressing for families, usually reversible, and is managed by treating causes, restoring day-night rhythm and keeping familiar faces present.

Deconditioning and falls form the fourth cluster. Muscle loss during weeks of low activity is faster in older adults, and low platelets make any fall more dangerous. Rehabilitation is not an add-on after discharge; it begins in the transplant unit.

Chronic GVHD and secondary cancers are longer-horizon risks that apply at any age but carry more weight when combined with existing conditions. The NHS outlines these clearly. What the evidence supports is careful patient selection, thorough pretransplant optimization and early rehabilitation, rather than exclusion by age alone.

Alternatives when transplant is not the right path

Not every older adult with a transplant-eligible disease chooses transplant, and not every one is offered it. That is not failure; it is a different branch of a decision tree, and it deserves as much clarity as the transplant branch does.

For acute myeloid leukemia in older adults, lower-intensity chemotherapy regimens, sometimes combined with targeted medicines that block specific cancer-cell survival pathways, are established options that can control disease for a period without the risks of transplant. For myelodysplastic syndromes, medicines that alter how genes are switched on and off in marrow cells are commonly used. For multiple myeloma, combinations of newer drug classes have made it possible for some older patients to defer or forgo autologous transplant. Which approach is appropriate depends on disease genetics, prior treatment and the person’s own goals, and those are conversations for the hematologist.

Clinical trials are another route. Many trials specifically enroll older adults to test gentler conditioning, novel GVHD prevention or maintenance therapies after transplant. Asking whether a trial is available is reasonable at any center.

Supportive and palliative care run alongside every option, not instead of them. Palliative care is specialist attention to symptoms, function and decision-making, and involving it early is associated in mainstream guidance with better symptom control and clearer goals, whether or not transplant proceeds.

The honest framing is that transplant offers the possibility of long-term disease control at the cost of a hard year and meaningful risk, while nontransplant approaches usually offer less durable control with lower up-front risk. Where a given person lands on that trade depends on the disease’s expected behavior, the body’s reserve and what that person wants the next few years to hold. The Mayo Clinic and the treating team can help lay out both branches.

What people often get wrong about bone marrow transplant in older adults

‘There is a hard cutoff at 65 or 70.’ Many programs have moved away from fixed age limits and instead assess organ function, comorbidity scores and frailty. Some people in their late 70s proceed; some in their early 60s are advised against it. Age is one input among many.

‘Reduced intensity means low risk.’ It means lower risk from the conditioning chemotherapy. Graft-versus-host disease, infection and relapse remain serious possibilities, and the NHS lists them without softening. The transplant is still one of the most demanding treatments in medicine.

‘The transplant is the surgery.’ There is no operation. The infusion resembles a blood transfusion. The hard part is everything around it: the conditioning, the weeks of low counts, and the months of immune recovery.

‘Once engrafted, you are back to normal.’ Engraftment restores blood counts, not immunity or stamina. The Cleveland Clinic describes immune recovery taking a year or more, and older recipients often need longer to rebuild strength.

‘A sibling is always the best donor.’ Donor age matters. A younger, well-matched unrelated donor or a half-matched adult child may be preferred over an older sibling.

‘Feeling fine before transplant means the assessment is a formality.’ Pretransplant tests routinely find silent heart, lung or kidney limitations that change the plan. Skipping or rushing them is where avoidable harm hides.

‘If the doctor recommends waiting, the door is closed.’ Waiting often means treating an infection, improving disease control or completing rehabilitation, with reassessment afterward. It is a pause, not a verdict.

Questions to ask your care team before deciding

Bring a notebook, bring a second set of ears, and do not worry about asking something twice. These questions are the ones transplant teams say they wish more patients asked.

• What is my disease likely to do without a transplant, and how confident are you in that estimate for someone with my specific genetics and remission status?
• Which conditioning intensity are you proposing for me, and what in my assessment led you there?
• What did my HCT-CI score and geriatric assessment show, and is any of it something I can improve before transplant?
• Who would my donor be, how well matched, and how does donor age factor into your recommendation?
• How long do you expect me to be in hospital, and how far from the center will I need to stay during the first 100 days?
• What would make you stop or delay the transplant once we have started planning?
• What does graft-versus-host disease look like in practice, and how will you prevent and monitor it?
• Who is on my team besides the transplant physician, and how do I reach someone at three in the morning?
• What will my caregiver need to do, and what support exists for them?
• What are the nontransplant options for my disease, and how do they compare in what they ask of me and what they offer?
• Are there clinical trials for people my age with my diagnosis?
• If things go badly, what does that look like, and how will you help me and my family navigate it?

It is reasonable to ask for time between the consultation and the decision, and to ask for a second opinion. A good team welcomes both. The Mayo Clinic overview is a useful primer to read beforehand so the appointment can go deeper.

When to call your doctor: red-flag signs after transplant

After discharge, the transplant team will give a direct phone number and a low threshold for using it. Older adults and their caregivers should treat that number as the first call, not the last, because early complications can move fast and can present subtly in people over 65.

Seek urgent care or call the team immediately for a fever of 100.4°F (38°C) or higher, or for chills and shaking even without a measured fever. Call for any new confusion, unusual drowsiness or a fall, since infection in older adults often appears this way before a temperature rises. Call for shortness of breath, chest pain, a fast or irregular heartbeat, or a new cough. Call for diarrhea that is frequent, watery or bloody, for persistent vomiting, or for being unable to keep fluids down, because dehydration strains the kidneys and alters medication levels.

A new rash, especially on the palms, soles, ears or neck, or yellowing of the skin or eyes, may signal graft-versus-host disease and should be reported the same day. Bleeding that does not stop, blood in urine or stool, widespread bruising or a severe headache can indicate low platelets. Pain, redness or discharge at the central line site, or a line that will not flush, needs same-day assessment. Sudden vision changes, severe abdominal pain, or an inability to pass urine are emergencies.

The Mayo Clinic and MedlinePlus both emphasize that infection after transplant can become life-threatening within hours. If in doubt, call. Nobody on a transplant team has ever been annoyed by a patient who phoned about a fever that turned out to be nothing. Every decision about medication changes, hospital return or investigation rests with the treating team.

Frequently asked questions

Can a 70 year old get a bone marrow transplant?

Yes, people aged 70 and older receive bone marrow transplants when their disease warrants it and their assessment supports it. Teams look at heart, lung, kidney and liver function, comorbidity scores, walking speed, cognition and home support rather than age alone. Reduced-intensity conditioning was developed specifically to make transplant tolerable for this group. The final decision rests with the transplant team after a full evaluation.

Is there a stem cell transplant age limit?

Most programs have replaced fixed age limits with fitness-based criteria. Chronological age still correlates with comorbidity and reduced reserve, so it informs the conversation, but it is not a cutoff in itself. Some individuals in their late 70s proceed with reduced-intensity regimens, while some younger people with significant heart or kidney disease are advised toward other treatments. Each center sets its own assessment process and thresholds.

What is a reduced intensity conditioning transplant?

It is an allogeneic transplant in which the preparatory chemotherapy, and any radiation, is given at lower intensity than the traditional myeloablative approach. The aim is to suppress the patient’s marrow and immune system enough for donor cells to engraft, while relying on the donor immune system to attack remaining cancer cells. It reduces organ toxicity, which matters for older adults, but does not eliminate infection, graft-versus-host disease or relapse risk.

How long in hospital for bone marrow transplant?

MedlinePlus describes a typical stay of around 4 to 6 weeks, covering conditioning, the infusion and the wait for engraftment. Reduced-intensity regimens may shorten this, and some centers run parts of the process as day-hospital care with the patient lodging nearby. Older adults sometimes stay longer if infection, delirium, kidney strain or loss of mobility develops. The team will give a personalized estimate based on the plan.

What happens 100 days after a bone marrow transplant?

Day 100 is a checkpoint marking the end of the highest-risk period for acute complications. Blood tests and often a marrow biopsy check donor cell takeover and disease status, immunosuppressant tapering may begin if graft-versus-host disease is absent, and some restrictions relax. Immune function remains far from normal, revaccination is planned over the following months, and chronic graft-versus-host disease becomes the main long-term concern.

Can you live a normal life after a bone marrow transplant?

Many people return to independent, active lives, though the path is long and the definition of normal often shifts. Fatigue and reduced stamina commonly persist for months, immune recovery can take a year or more, and chronic graft-versus-host disease or late effects may require ongoing care. Older adults typically need structured rehabilitation to regain strength. Long-term follow-up continues indefinitely, but many describe a good quality of life afterward.

Why is a younger donor sometimes chosen over a sibling for an older patient?

Donor age affects the quality of stem cells and the behavior of the donor immune system, and studies have linked younger donors with better recipient outcomes. Siblings of a 70-year-old are usually themselves older. A well-matched younger unrelated donor or a half-matched adult child, used in a haploidentical transplant, may therefore be preferred. Matching quality, urgency and donor health all enter the decision made by the team.

Does reduced-intensity conditioning increase the chance of relapse?

Across large groups, relapse tends to be somewhat higher after reduced-intensity than after full-intensity conditioning, because less disease is destroyed up front and more depends on the donor immune effect. Treatment-related mortality is generally lower, which is why the trade is accepted for older or less fit patients. For any individual, disease genetics, depth of remission and donor match matter as much as the regimen chosen.

What is frailty and why does it matter more than age for transplant?

Frailty is a state of reduced physiological reserve in which relatively small stresses cause disproportionate decline. It is measured by things like walking speed, grip strength, unintentional weight loss, exhaustion and low activity. Frail patients experience more complications and slower recovery after transplant regardless of age, while a robust 75-year-old may tolerate it better than a frail 62-year-old. Prehabilitation programs aim to reduce frailty before transplant.

What are the alternatives if the team advises against transplant?

Options depend on the disease. Lower-intensity chemotherapy combined with targeted medicines is established for older adults with acute myeloid leukemia; epigenetic therapies are used for myelodysplastic syndromes; drug combinations may defer transplant in myeloma. Clinical trials designed for older patients are another route, and palliative care specialists support symptoms and decisions alongside any of these. The hematologist will explain which apply.

References

• MedlinePlus Medical Encyclopedia: Bone marrow transplant
• NHS: Stem cell and bone marrow transplants
• NHS: Stem cell and bone marrow transplants, Risks

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.