I am 15 days into my first chemo. My immune system is down to near zero, making me pregnable to infectious agents (bacteria, viruses, fungi). If they take root, they have been known to end lives in a matter of a few hours. Being without an immune system is not a widely shared experience, and it is 10X as neurotic as Corona’s defence. This post covers how I design and execute my infection defence. A general reader will know how to manage a future pandemic much worse than Covid. Please show this blog to your doctor before adopting rules from it.
The Five Holes
The body is well wrapped up and does not present entry points to invaders easily. Evolution made 5 holes so that material from outside can come in and vice versa. It is with this material flow into and from the body that infectious agents can get in. Diminishing this flow of harmful agents into our holes is the central principle underlying this blog. The holes are Mouth, Nose, Ears, Anus, and the Engineer Hole. For men, the Engineer hole combines urination and sensory pleasure into one and is a tribute to evolution. If you cut yourself during chemo, that’s a sixth hole requiring vigorous defense. Get material flow into holes as safe as you can, and you’ll cut infection risk dramatically, making chemo easier. Sanitize your hands with alcohol before and after you use any hole — that has to become an instinct.
The mouth comes first. Eat and drink will go in here. Our stomachs have a defense unless it has been eradicated by antibiotics. The bad news is that food is complex in the type of infectious agents it can introduce. Two small rules help. The first is to ensure you eat only cooked food heated to high temperatures (80c) during cooking. Out goes the Sushi, the skinned apple, kale salad from your favorite bar, and the yogurt that’s sitting in a supply chain for 2 months before it comes to your plate. The second rule is to eat foods that your gut is used to — now is not the time for experimentation. Disregard new diets you’re unused to like keto, carnivore, paleolithic, Atkins, intermittent fasting, etc., for your first chemotherapy experiences. The creators of these diets produced benefits for humanity, but chemonauts weren’t on their minds.
One final addendum: minimize processed food. It is designed to sell by appealing to taste but is usually not nutritious (capitalism!), made in a factory under bulk cooking conditions, and sits in supply chains for weeks. This rule is hard, and I break it every day by indulging in Dark Chocolate.
For the nose, wear a clean medical-grade mask. Do not interact with maskless people and keep social distance, even with primary relatives. For now, assume you do it 24 hours in the day. We will relax this rule later in the article. Do not clean your nose by hand — use medical cotton and sanitizing liquids as needed.
Heat can be used as a defense for the mouth and nose. Hot water with salt can be drunk and steamed water can be inhaled. Critters are sensitive to heat, which is why our bodies have evolved fever to make a temporary heat shield. Use that shield — the times call for it.
There’s less to be done for ears. Cover them with clothing or buds when you go out. Do not itch or play with them with your hands. Itches and discomfort in the ears need to be referred to your doctor.
Solid excretion is a high-risk activity — you’re usually sharing a seat that multiple other people use, and their bacteria can quickly enter. You will manically clean everything that will come in touch with any region near your body part — back of the seat, the weight support, etc. Invest in high-quality cleaning paper both for equipment cleaning as well as your body part.
Liquid excretion behaves differently for different sexes. For those who urinate the same way as they defecate, all precautions are duplicated. As a man, I do something gross: urinate in a standing position and clean the seat for other users. I am avoiding bringing my orifice near dirty places unless necessary — the times call for it.
Finally, let’s discuss the pleasure orifice =). Chemo will be stressful. We lose physical cuddles and other displays of affection for months on end. Self-stimulation might be the only thing we do. I’ll dedicate a blog to this because men and women are pretty different. Overall, you want to sanitize your hands before and after, and dispose of resulting secretions carefully. Do not let the secretions become a nutrition source for critters right outside your pleasure hole! Sanitize places where secretions had lain.
Did you open up the sixth hole by cutting yourself? Show to the doctor immediately. The situation is out of your control.
The Sanctum
I am sure readers realize the difficulty of following all these rules all the time. I break them by scratching my nose, eating food from outside the plate, forgetting to wipe the toilet seat, etc. Adapting to discipline takes time.
Hence, a second major hack: Define your clean Sanctum. It is a small space in your home (for home-chemo) or around your bed in the hospital. The Sanctum contains all you need for 95% of your activities — rest, meals, exercise, relaxation, connection, and work. You, and your caregivers, make an effort to keep the Sanctum clean. Sheets are changed every day, floors and surfaces wiped down, possessions sanitized etc. The Sanctum also contains a nearby (ideally single-user) toilet and bath. The highest hygiene standards are applied to those. This sacred place is meant only for the chemonaut — mask-bearing family members come in to help with the cleaning but leave quickly. The Sanctum is your temple/church, and you are the Priest.
When the Sanctum is immaculately kept, risks arising from you breaking some earlier rules reduce. Did you pick your nose in the Sanctum? Undesirable, but might be okay: your hand was touching something else in the Sanctum, and that other thing is clean. Did you pick food off the plate in the Sanctum? Not good, but the Sanctum provides you some additional protection. See the logic?
Critically, you can be without a mask in this place. Everyone else wears a mask and gloves to enter the Sanctum, but you’re exempt. We need this freedom to keep ourselves sane.
Venturing out of the Sanctum
Chemonauts will venture out of their Sanctum to gardens, lakes, trails, and other comforting locations. These ventures are necessary and will be designed for. The critical mental image: venture out dressed as tanks in the outside world. Medical grade masks, gloves, correct eyeglasses, sanitary ear covers, clean underwear, a scarf, full clothing covering every part of skin below the neck, stable shoes, warm socks, and warm overwear are worn. Chemonauts may not look cool. They realize they are on the path to be cancer survivors, one of the sturdier breeds of people in the Western World. Coolness is a sacrifice they find easy to make.
There is an implication — a chemonaut requires a protocol to wear external clothes without contaminating the Sanctum on onward journey. In return, they need a different protocol to ensure critters stuck on outer clothing do not enter the Sanctum. Let’s call the first the tanking procedure and the second the de-tanking procedure.
Tanking must be performed either at the edge or just outside the Sanctum. Sanitize your hands, wear gloves, remove sanctum clothing while storing it properly, and then put on each piece of clothing for the external venture. Once tanked, there is no fleeting return to the Sanctum, for instance, to collect a mobile. Remember: Agents on outer clothes are to be kept away from the Sanctum.
De-tanking is the opposite. Just outside the Sanctum, every piece of external clothing is taken off, gloves last, a quick shower is taken, and fresh clothes are worn for the Sanctum. Outer garments are then either stored for later use or washed depending on the duration and location of the venture.
That’s the lifestyle I am getting used to ward off infections. I am a beginner. I am wondering about questions such as:
- How can a mobile road vehicle be built with an inner Sanctum so that people with compromised immune systems can travel?
- Can tanking and de-tanking be simplified? Can we augment personal transport vehicles, like cycles or electric boards, with bio-containment capabilities to make them Sanctum-like?
Until next time chemonauts!
