I have read much about a neutropenic diet, nadir and infection in the past several days. My mom is currently classified as a severe neutropenic, which means she is at high risk of infection. Some definitions below.NeutropenicSomeone who is neutropenic has low levels of neutrophils. Neutrophils are the most dominant type of white blood cells. Levels of neutropenia are classified by the number of Absolute Neutrophil Count (ANC). The ANC is measured in cells/microliter of blood. Below are the classifications from Wikipedia:
- Mild neutropenia (1000 ≤ ANC < 1500) — minimal risk of infection
- Moderate neutropenia (500 ≤ ANC < 1000) — moderate risk of infection
- Severe neutropenia (ANC < 500) — severe risk of infection.
My mom is currently at severe neutropenia, with ANC < 400. Using different units, sometimes this is also referred to as 0.4, instead of 400. Where WBC count is 0.4, so the neutrophil count is even less than that!NadirNadir simply means the lowest point of something. In Chemotherapy, the red blood cells, white blood cells and platelets all have their own nadir periods. The white blood cell nadir period is critical because this is when the body is most prone to infection. My mom is current in her nadir period and it may last for another 10 days. We are on Day 10 of Chemotherapy. Her white blood cell count may not get back up to acceptable until Day 20. During nadir, we must be extra cautious. This means keeping a watchful eye on what she eats and making sure her nurses understand this as well. Surprisingly, not all of my mom's nurses are aware of her severe neutropenic state. This is quite unfortunate.Infections and SepsisNeutropenia and nadir simply means that she is at great risk for infection. Infection can lead to sepsis. We have to keep an eye on her temperature, blood pressure and urination frequency in the next 10 days. Basically, her body's army is gone and we home no little terrors come along during this time! We can only do as much as we can to keep infection out of the room and away from her. One of the ways to keep infection away is to stay on a strict neutropenic diet. This basically means avoiding any fresh foods of any kinds. This includes fresh fruits, veggies, nuts, raw spices, soft serve and anything that might foster bacteria of any kind. Here is a pretty good chart from a surviving Leukemia blog with foods that we should allow and avoid. The Leukemia and Lymphoma website also has a succinct description of foods we should avoid:
- Avoid all uncooked vegetables and most uncooked fruits. You may eat fruit that you can peel a thick skin off of, such as a banana or an orange. Cooked vegetables and canned fruits and juices are safe to eat.
- Avoid raw or rare meat and fish and uncooked or undercooked eggs. Cook meat until it's well-done. Thoroughly cook eggs (no runny yolks).
- Avoid salad bars and deli counters. Buy vacuum-packed lunch meats instead of freshly sliced meats.
- Consume only pasteurized milk, yogurt, cheese and other dairy products.
- Avoid soft mold-ripened and blue-veined cheeses such as Brie, Camembert, Roquefort, Stilton, Gorgonzola and Bleu.
- Avoid well water or boil it for one minute before drinking. At home, it's okay to drink tap water or bottled water.
So here's to the next 10 HEALTHY, INFECTION-FREE days! Go Team Mama Pham!