The Not-So-Gentle Answer: 5. Commensals

Lately, when people ask me “how are you?” I have to choose between being polite and being accurate. Most people get the polite answer “I’ve been better”. It turns out I may have been too gentle.

Commensal, n.,  An organism participating in a symbiotic relationship in which one species derives some benefit while the other is unaffected.

The human body is full of, and covered in, commensal bacteria, viruses and fungi.  Our gut flora, which digests our food for us, is one example.  We actually accept their waste products into our blood as our source of energy and building materials.  If that sounds bad, just remember that the ethanol in all the beer, wine and spirits we drink is yeast piss.

Sepsis, broadly speaking, means an infection in the blood stream.  If an infection becomes septic, it means the infection has escaped the initial focus and has entered the blood stream.

Neutropenic sepsis is when, due to a lack of neutrophils, a commensal enters your blood stream.  In my case, almost certainly bowel flora.

On Wednesday, I woke up with a fever of 40C, barely able to stand, and not terribly coherent. I was admitted to hospital at 6:30am.  There is a fixed protocol for patents presenting as febrile and neutropenic, and I was put on a standard cocktail of three IV antibiotics.  After 24 hours, I was responding well, the fever was way down, and I was starting to feel normal, or at least more normal than Wednesday.  It was another four days before I could  write some software.

As I began to feel better, the pain in my arse began to feel worse and worse.  Probably it was actually remaining constant, just the improvement everywhere else made me perceive it as relatively worse.  The microbiology specialist was pleased to be able to assign a focus to the infection.  It turns out that there is a large abscess in my groin.  Well it would be an abscess, except that I don’t have enough neutrophils to die bravely in service of their nation (me) and then decompose to make pus. Treatment consists of yet more IV antibiotics.  The silver lining is that no pus also means no pimples.

I am confident in my oncologist and I am confident the treatment will work.  I accept this gift.

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You may be interested in reading the other Not-So-Gentle episodes: (1) Introduction, (2) CLL, (3) Neutropenia, (4) Platelets, (5) this post, (6) Infections, (7) Migraine.