Michael’s Medical Journal: Neutropenic Diet

I wrote this before I was admitted to Queen Mary Hospital for my transplant.

At the start of this journey, I was given multiple pamphlets, dietary discussions with nurses, and the strict guidelines of what I can and cannot eat.

The Neutropenic Diet is primarily for patents with low neutrophil counts (below 1.o) and undergoing chemotherapy and/or immunocompromised patients. It focuses on eliminating bacterial or microbial items to minimize any risk of infection. These patients need to avoid any food that might contain bacteria or pathogens, and assure that all food consumed is well-cooked, pasteurized, or processed.

I’ve learned there are some differences if you look up Neutropenic Diet for the USA, UK, or Asia. So some items and small guidelines may vary, but since we live in and are getting treated in Hong Kong, we follow the local Hospital Authority (HA) Guidelines from Hematology & Department of Dietetics. So the local key aspects of a neutropenic diet are as follows: 

• Only shelf stable foods (non refrigerated), pre-packaged (canned foods, or individually packaged items).
• No leftovers, or opened containers or packaging longer than 2 Hours. Eat only freshly prepared or opened foods.
• No breads, anything with yeast.
• Fruits and Vegetables: No thin skinned fruits or veggies, only canned fruit or boiled veggies. No damaged, overripe, or bruised fruits/veggies. No dried fruits, or prepackaged fruit cuts, or unpeeled fruits.
• Meat and Eggs (I exclude seafood or fish, as we are not big seafood eaters, because Heather is severely allergic to any type of shrimp and shellfish and many fish sauce/oil/spices contain these). Only canned or fully cooked meat, no medium rare meats. Nothing not fully cooked, and no runny eggs.
• No Dairy products: only UHT (ultra high temperature processing), plant based milk (oat, soy, almond, etc.), and ultra pasteurized cheeses.
• Soups are ok, if canned or shelf stable/pre-packaged soups or stews — anything chilled from refrigerated section is not allowed.
• no nuts, or dried fruit, no uncooked spices (i.e. table salt or pepper), no fermented food.

So for the past six months, I’ve lived off whatever I could tolerate from the hospital food with my amazing wife supplementing that by bringing food to me in the hospital. After 2-3 months of being okay eating hospital food, chemotherapy affected my taste and tolerance for the food and I was unable to stomach it anymore. So Heather was absolutely my savior after February.

For Breakfast, I would typically have a small, single serving breakfast cereals (eaten dry out of the box), and a protein supplement drink.

For Lunch, Heather would bring me some oatmeal in a thermos (the hospital’s version of “oatmeal” was a runny watery beige oatmeal soup.

For Dinner, Heather would bring me a canned stew, heated up and brought in a thermos.

At home, we could branch out a little more: For breakfast, typically oatmeal and sometimes (if my white blood cells were up) some chopped bananas in the oatmeal (not bruised).

For lunch, either some scrambled eggs, with frozen hash brown cooked and chopped in with the eggs, and some pasteurized cheese mixed in. Or sometimes some a single serving package of microwaved jasmine rice, with canned stew or curry (chicken, beef, or lamb) poured over the rice.

For dinner Heather would make an amazing Michael-friendly meal which the whole family could eat, or I would alternate with another rice and stew meal.

Before the transplant, I was home for 7-8 weeks. I got a lot of my strength and appetite back. I would make both Heather and my breakfast every morning, with coffee. Then for lunch I would alternate making scrambled eggs with avocado and processed cheese. And for dinner, we tried to work on a schedule where Heather would cook one night, and make enough for the boys and her to have leftovers, but then on leftover nights, I would have the rice and canned stew mix (because I’m not allowed to reheat food/leftovers).

My small pleasure at the end of each day is making myself some microwave popcorn as a treat. Heather was able to order online a large stash of Amish microwave popcorn.

It was, and will continue to be a challenge. Queen Mary Hospital’s food menu is slightly different but just as restrictive. Heather is not allowed to bring in any home cooked food at all. Only sealed, commercial, approved individual products that the staff on the transplant ward can heat up to boiling for me. There is actually a menu that I can choose from each day here. The food is still not great, but at least you have a small choice. However, right now I’m dealing with many radiation, chemotherapy, and transplant side effects, so I am nauseated all the time with no appetite.

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