[dianaiad]

When is a fever a fever?

by dianaiad on Sun Jun 01, 2014 11:26 pm

It is commonly known that elderly patients may have pneumonia or other infections and not 'present' with a fever. I'm beginning to find out that this may be because the elderly commonly have lower body temperatures than young folks do, which means that what MAY be happening is that there may well be a rise in body temperature equal, in number of increased degrees, than that of the young folk, but since the old folk START lower in the first place, their three degree rise might not get them to that magic 100.5 degrees that people start worrying about.

For example, a 25 year old has an average body temperature of 98,6, or thereabouts. His body temperature rises to 100.5, and voila' he's running a fever and everybody begins to be concerned. This represents a slightly less than 1 degree rise in body temperature.

The old guy, though ... his normal body temperature is around 97 to 97.5 because his body can't keep his temperature up to where everybody thinks it ought to be; he wears sweaters in the summer. ANYway ... if his temperature rises a degree, it goes all the way up to ... 98.6. Perfectly normal, right?

Except of course HE is feeling all the symptoms of a low-grade fever; lack of appetite, fatigue, that 'crawly' feeling ... but he is brushed off because he's not 'runnning a fever."

So ... he begins to actually run a fever of 100 to 100.4. For HIM, that's a rise in temperature of, not one degree that the 25 year old has, but three. Three degrees. By that time he's feeling pretty darned miserable, but since it hasn't reached the magic 100.5, he's told not to worry about it.

In the meantime, the 25 year old who experiences a 3 degree increase in body temperature is now running a fever of ... wait for it ... nearly 103 degrees. Everybody starts getting very concerned.

So, could someone explain this to me? Since, obviously, it IS possible to be very ill without 'running a fever,' especially in the over sixty-five crowd, why is the level for 'running a temperature' set the same for everybody? Shouldn't it be based on what one's normal temperature is? If not, why not? If not, then why is it almost standard for people to consider that the elderly can get pneumonia...and not run a fever? I have a suspicion that they are, in fact, running one. It's just discounted because of a standard that may not, after all, be all that applicable.

This is important to me, actually, because I'm one of those 'low normal body temperature' folks, running at a fairly constant 96.8 to 97.5, and right now I can't get my temp below 99, (but it never quite reaches the magic 100.5 that my oncologist considers to be a problem; stops right short at 100.4).

I'm frustrated, and can't find any research/information about this issue. So the questions are:

Why is the cut-off for 'low-grade' temperature set where it is, and does it really not matter what a person starts at?

[dnalex]

Re: When is a fever a fever?

by dnalex on Mon Jun 02, 2014 12:10 am

Here is what a Harvard Health Publication says

http://www.health.harvard.edu/press_releases/normal_body_temperature

Essentially ... know your baseline, and go from there.

[Wayne K]

Re: When is a fever a fever?

by Wayne K on Mon Jun 02, 2014 1:06 pm

Good question. I had a hard time recovering from my SCT because of undiagnosed pneumonia. My temperature runs around 97 + or - and the only symptom that was noticeable was temp. I never reached the 102 that was given as the threshold, but often ran 100+.
When they put me back in the hospital they picked up the pneumonia on an Xray and after treating it I gain back my health rapidly. This was 6 weeks after my SCT.

[Dr. Jason Valent]

Re: When is a fever a fever?

by Dr. Jason Valent on Mon Jun 02, 2014 5:46 pm

We use the 100.4 fahrenheit cut off or 38 celsius.

However, other signs or symptoms of serious infection should also be taken into con­sider­a­tion as to when emergent attention is needed for infection in a potentially immuno­com­pro­mised person. Such as ... shaking chills, altered mental status, passing out (syncope), ex­treme fatigue or lethargy, or respiratory distress.

So you are correct to say that fever does not always tell the whole story.

[NStewart]

Re: When is a fever a fever?

by NStewart on Wed Jun 04, 2014 8:11 pm

I guess that I'm fortunate because my primary and my oncologist do pay attention to what I have to say about how I am feeling and look for signs of infection in addition to looking at my temperature. I have always had a baseline temperature that varies between 96+ to 97+. I have been extremely ill with respiratory infections with temperatures in the 98-99 range. Because I had all of the symptoms of a serious illness except for the temperature, I have been treated as if I did have a high temp.

You need to be really insistent with your doctors if they are only looking at your temperature. Have you talked to them about your concerns?

Nancy in Phila

[dianaiad]

Re: When is a fever a fever?

by dianaiad on Wed Jun 04, 2014 9:41 pm

I'm trying...I just wish it wasn't so hard to 'get heard!'

The doc had me go in for blood tests today, and said that he'd 'call me as soon as [he got] the results.' He hasn't called me yet...

And right this minute my temp is 100. I THINK he'd pay more attention if I had any other symptoms (like coughing or a sore throat or chest pains or whatever), but I don't. Just the fever.

And a case of the 'annoyed because I'm being patted on the head again." You'd think I was the patient who called in for everything from a stubbed toe to a bad hair day, and I don't do that. I don't think the man even knows who I am from month to month!