Neutropenia

A couple of definitions are in order, courtesy a medical dictionary at Teens Living With Cancer:

Neutropenia: Less than the normal number of neutrophils (leukocytes) or "polys" in the circulating blood.

Polys (neutrophils or granulocytes): The group of white cells that is important to your ability to resist bacterial infection. A "poly" count of less than 1,000 indicates less than normal protection and considerable risk of infection.

We're getting technical, though, learning new words all the time. This isn't just throwing all the medicine available at me hoping some of it sticks. There is science involved, here, culled from decades of research. That's why we notice when things change. It's not an obvious shift, but it does mark a difference in how we'll need to approach my treatment. Details matter. Precision matters.

We're all about numbers these days, watching the steady drop of so many different counts. We watch my polys closely. They're a leading indicator. When they dropped low enough, they announced that I'd become neutropenic. A colored sign was placed outside my door -- probably red -- to remind everybody coming in that they would need to take extra precautions. It's a simple thing: when I'm neutropenic, my body will not be able to fight infections by itself. I'll need lots of help to keep any infections at bay in the first place, but even more help, in case I happen to get an infection somewhere, to actually get rid of it.

So it makes sense that I've been getting fevers. They arrive out of nowhere, though, with increasing frequency and strength. They are very mysterious. Very sneaky. We don't now where they're coming from, but it makes perfect sense that I'd be getting them. It makes even more sense when you know that I'm not "just" neutropenic anymore. Those extra seven days of chemotherapy did a serious number on my internals. Whatever straggling polys I had left were quickly eradicated by the chemo. I've bottomed out. My poly count is a big fat zero. I've got nothing.

Every return fever, then, is cause for concern. It's why I'm hooked up to so many different antibiotics, why Cindy and Anne and Mary and every other nurse on the floor spend so much time in my room. They're constantly swapping out meds, monitoring my temp, trying to head things off before they get bad.

Things change when your immune system has stopped working.

We're more aggressive, now, about finding out what's been causing all of my fevers. They can't just show up on their own. They're symptomatic of something else: one or more infections, somewhere, kicking me when I'm already down. But where? Nothing is obvious. We've kept my Hickman clean; there are no festering sores or oozing puss around the entry site. When I take two deep breaths with a cold stethoscope on my chest, then two more with the stethoscope on my back (one more, please, deep again, deep breath, please) my lungs are clean and clear. We've started scheduling multiple x-rays to validate that there are no infections in my lungs.

I should expect these fevers, right, with the neutropenia and all, but while it's okay to expect them, my doctors absolutely will not tolerate them. Unless I'm able to magically stop them on my own (which I can't), then everybody will continue to search relentlessly for the source. It's not good enough to just keep on keeping on. Demoral helps, almost instantaneously, with my convulsive chills. Tylenol manages to ease my throbbing headaches and lower my high temps. Together, they form an effective one-two punch against my fevers, but they don't do anything about eliminating the source.

That's what my doctors are after. That's the mystery they want to solve.