I took a lot of biology in high school, undergraduate and graduate school, but I had never heard of Natural Killer cells or their deficiency. Actually there have been several doctors who aren’t familiar with it either. When Jake finally got a diagnosis in 2012, it was a let down. Dr. N. explained it the best he could. “Natural killer cells are like the moat around the castle. They are your first line of defense. They ‘shoot first’ and ask questions later…” “Jake has a deficiency or a glitch. He has NK cells, but they don’t turn on like they should. That is why he gets sicker than normal. The rest of the immune system has to come in and do their work plus more. It shouldn’t cause problems; it will be a nuisance but not life threatening.” “There are no treatments; there is nothing we can do…” This did not bode well with me. I found a little when I Google searched, but nothing concerning treatment. (There is more now, but I don’t advise looking it up.) We didn’t see Dr. N. again until 2014. What I’ve realized in the meantime is that it is very rare, or maybe not identified in patients. There are different degrees. It is said to be inherited, but it could also be a gene mutation in utero. I think Dr. N. thought Jake would be ok because he had lived this long (2012) without a major complication. The cases he had seen were younger kids who presented with lethal cases of herpatic meningitis or Epstein Barr. Jake’s deficiency must have not been as serious or he probably would have already died. It is viruses that cause lethal infections in these patients. Healthy people with healthy NK cells fight the viruses. Looking back, Jake should have started Acyclovir, a viral medication, to help protect him. Warts are caused by the HPV virus. I had unwittingly had my kids vaccinated with the HPV vaccine. Genital warts are rampant, and I wasn’t going to pretend that teenagers not only have sex, but they may have multiple partners who have had multiple partners. Turns out, that was the right call. The vaccination is recommended for NK cell deficiency. The warts that had developed on Jake’s feet were also caused by HPV (not the sexually transmitted type). This was a strong indicator of his NK cell deficiency, but no one ever seemed to connect it. The other day I was surprised that Dr. N. wanted to see Jake’s feet. His warts have disappeared. Dr. N. was surprised and at a loss of explanation. I assumed he went back over Jake’s notes from our first meeting. Hindsight is 20/20. The 3 symptoms of Jake’s deficiency are chronic ear infections, warts and chronic respiratory infections. Serious complications can occur from viruses like HPV and herpes. Most people only think of sexually transmitted diseases, but chicken pox, shingles, and Epstein Barr virus are 3 of the 8 types of herpes virus that can infect humans. Most of us can fight and live with these viruses, but they can be deadly for a NK cell deficient patient. Knowing what I know now, I definitely count my blessings.