Eating out when your white cell count is low

Call 911 or go to an emergency department if you have trouble breathing while resting or while doing simple tasks, or you are too weak to stand. MedlinePlus lists both among the symptoms to report while your immune system is recovering, and NCI warns that infections during cancer treatment can be life threatening and require urgent medical attention.

Ring your care team without delay if you develop a fever of 100.4 °F (38 °C) or higher, chills or sweats, severe nausea or vomiting, or diarrhoea that does not go away. CDC gives that temperature as the point to call your health care team, and MedlinePlus lists fever, chills or sweats, severe nausea and vomiting, and diarrhoea that will not settle among the reasons to contact your provider after a transplant. Do not wait until morning.

MedlinePlus guidance for people recovering from a bone marrow transplant says: "Be careful when you eat out. Do not eat raw vegetables, meat, fish, or anything else you are not sure is safe."

That is the whole restaurant rule as federal guidance states it, and it is worth noticing what it does not say. It does not say stay home. It does not name types of restaurant to avoid. It draws its line around raw food, and around anything you cannot be sure of.

Cooking kills a lot of what can make people ill. When your neutrophils — the white cells that fight infection — are low, your body has less capacity to deal with anything that gets through, so the margin for error narrows.

MedlinePlus makes the wider version of the point too: do not eat or drink anything that may be undercooked or spoiled.

NCI's infection guidance runs along the same lines: "Follow food safety guidelines; make sure the meat, fish, and eggs you eat are well cooked. Keep hot foods hot and cold foods cold."

In a restaurant, order things cooked through. That single habit does most of the work.

Thinking through a typical menu, the items that fall foul of raw and undercooked are fairly predictable:

• Salads and raw garnishes.
• Sushi, sashimi, ceviche and other raw fish.
• Rare or pink meat.
• Runny or soft-set eggs, and dressings built on raw egg.
• Anything served cold that was assembled well before it reached you.

Fully cooked hot dishes, served hot, are the easy end of the menu.

The hot-food-hot, cold-food-cold instruction is about what happens after cooking. Food that has been sitting at room temperature for a long stretch has had time for problems to develop, regardless of how well it was cooked originally.

That is why buffets, long lunch spreads, and food left out at gatherings are worth thinking about. If you cannot tell how long something has been sitting there, you cannot really apply the rule.

NCI notes that you may be advised to eat only fruits and vegetables that can be peeled, or to wash all raw fruits and vegetables very well.

Both of those are things you can do in your own kitchen and cannot do in a restaurant kitchen. It is one of the honest reasons why eating at home is simpler during the low-count period — not because restaurants are dangerous places, but because you have no visibility into the preparation.

The guidance quoted here is general. Your team may give you something stricter, particularly for the days after treatment when counts fall.

Worth asking: which days are my counts likely to be lowest, do you want me eating differently during those days, and when do the rules relax again. Having specific dates makes this much easier to live with than a permanent vague sense of caution.