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Doctor Nash
Doctor Nash, Professor of Medicine (MD)
Category: Health
Satisfied Customers: 616
Experience:  I've been teaching and practicing medicine for more than 40 years.
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I have extreme chills with no fever

Customer Question

This has been going on for months. Many different types of tests, blood work, MRI, EEG and so on. Still no reason for the chills. These are not minor chills, but wrap up in a blanket and still shivering chills to the point I wake my husband. It can be 90+ degrees out doors and still I am chilled. This happens on and off all day. It feels like ice water in my viens. Then when I do get warm, I get hot, like boiling water, but not like a hot flash.
Submitted: 7 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 7 years ago.

Hello,

Were your thyroid function tests done?

Are you on any medications?

Customer: replied 7 years ago.
Yes and they were negative. I was taken off Lyrica, as the Dr. thought that might be part of the problem, but nothing has changed. I take the following medications and have for over a year:
Metformin 1000 mg a day
Glimepiride 2 mg a day
Vytorin 10/20 tabs 1 a day
Actos 45 mg a day
Vicodin as needed 7.5/750
Lisinopril 20 mg a day
Potassium 99 mg a day
Calcium 500 mg a day
Magnesium 250 mg a day
Black Cohos Root 300 mg a day

The Dr. went over all the medications again last week with me.
Expert:  Dr. Arun Phophalia replied 7 years ago.

Hello,

Two of the commonest causes of chills without fever are abnormal thyroid functions and medications. I am sending you a link where you can read all other common causes for this like anemia, hypoglycemia, uncontrolled blood sugar etc. We physician if are unable to find anything wrong anywhere than would blame your diabetes and medications for it. You can visit this link:

http://health.msn.com/womenshealth/articlepage.aspx?cp-documentid=100159027

Usually the approach for this is to get serial blood tests, chest x-ray and sonography done at 2-3 moths interval. Sometimes, initially all the things are normal but later on a small abnormality may be detected by these regular investigation. This clue can then be further investigated.

I don't know how much this has helped. If not, I would opt out and let my fellow experts take over.

Customer: replied 7 years ago.
My thyroid test came back normal. Medications my Dr. don't feel are the issue as nothing has changed with them. The diabetes is well under controll and no hypoglycemia in about a year. I have had extensive blood tests done, but everything still seems to be normal. The blood tests have been done over weeks and started about three months ago. The chills are so severe at times that they wake my husband.
Does anyone have any other ideas? This can't be totally uncommon, something has to be making this happen.
Expert:  Dr. Arun Phophalia replied 7 years ago.
I think, I'll opt out and let some other expert take over.
Customer: replied 7 years ago.
Thank you.
Expert:  Dr. Arun Phophalia replied 7 years ago.
Welcome.
Expert:  Doctor Nash replied 7 years ago.
I've been asked to look in and see if I can help?

In most cases, a shaking chill is a mechanism to raise body temperature by increasing the activity of muscle cells. As they contract, do work, the cells generate heat, much as an automobile engine generates heat as it does work.

So, what is putting out a call for help by raising the body temperature? Usually this is the presence in the body of a foreign protein such as bacteria, their toxins, or viruses. Unusually, it is another type of invader that we generally do not test for. The purpose for the increase in body temperature is that the higher temperatures help the immune system inactivate and kill them.

I would not look first at the shaking, I would consider your problem a fever of unknown origin (FUO). The muscle contraction is only a means to an end. Why do you need to have an increase in body temperature?

The following is copied from this source:
  • Although infections are the most common causes of elevated body temperature, fevers have a long list of other causes, including toxins, cancers, and autoimmune diseases.
Please go to the linked page. You will see elaboration of what I have told you, with a long list of possible causes that should be investigated for you.

I recommend that you see a good internal medicine doctor with experience in infectious and autoimmune diseases, who knows how to deal with FUOs. I doubt that a family practitioner would deal with this often. Also, ask him to see if he can shorten your mediation list.

Tell me where you live in North Carolina so that I can help you find a specialist if necessary. If you are close to any of the excellent academic medical centers in NC, that may be your best bet.

There is another possibility you may explore, although it would take longer and is my second choice. You can have your doctor look at the list of causes in the link and arrange for appropriate tests for all, and send samples drawn under your normal circumstance, during a chill, and when your body temerature has risen, for blood cultures to the Center for Disease Control and Prevention (CDC) in Atlanta, GA, to test for rarely seen entities.

This is the protocol at my university medical centerl; we have excellent clinical and research laboratories, but there are tests that are so infrequently needed that, unless one of us has set up to do them beause of a special clinical and research interest, we send them out.

Let me know if you want to discuss this. I teach medicine, so I am not available at all times. However, I do check this site throughout the day. Please be patient; I will reply.
Customer: replied 7 years ago.
Thanks for the information. I seen an endrocronologist (sp) every three months. Is that the specialist you are speaking of? I have been taking my temp whenever this happens and it's between 96 and 98 degrees.

The only way I can describe this is, ice water running through my veins. Sometimes my hands and feet will feel cold to the touch but not always.

I live in Hendersonville, NC.
Expert:  Doctor Nash replied 7 years ago.
Are the numbers you gave during the chill or when you feel (naturally) warm after the chill?

Although I was notthinking of an endocrinologist, he had to have been a very good internist or he would not have been accepted for a fellowship in endocrinoligy. Have you discussed this problem with him/her?
Customer: replied 7 years ago.
I go back to her in a few weeks. The numbers are taken during a chill, which I'll be honest, are getting to be more and more often. They last from about 5 mins up to about 30, and most all day long. Have been waking up around 3 - 4 each morning shivering so bad it wakes me and my husband. BP has been really good. Hands and feet are usually cold to the touch now.
Expert:  Doctor Nash replied 7 years ago.
The next time you chill, take your temperaature during it and then after it when you feel warm.

Those numbers may allow me to eliminate some possibilities.
Customer: replied 7 years ago.
Starting to feel cold 95.0 - shivers 96.1
back to chilly 95.4 then very hot 95.6
Expert:  Doctor Nash replied 6 years ago.
What do I do now?

I will be talking with an infectious disease guy tomorrow about two other JA clients. If you don't mind, I'll bring you into the discussion.
Customer: replied 6 years ago.
Please do and thank you. Any insight will be greatly appreciated.
Customer: replied 6 years ago.
Dr. Nash,

What was the outcome of you talk with the infectious disease person?
Expert:  Doctor Nash replied 6 years ago.
Brief telephone exchange to set up lunch on Monday.

He's thinking. I emailed this thread to him.

Frank Nash
Expert:  Doctor Nash replied 6 years ago.
My colleague is a befuddled as your doctors and I am.

Do you sweat during the chill and/or after. I have been thinking of two possibilities, but they are usually accomained by flushing of the skin and excessive sweating.
Customer: replied 6 years ago.
Sometimes I sweat after, not always. Usually have a flushed appearance about 85% of the time, even before this started.
Customer: replied 6 years ago.
Reply was sent 10/10 - not sure if you saw it or not.

What are the possibilities that you were thinking of? Is it something that a test would prove?
Expert:  Doctor Nash replied 6 years ago.
Now we have some things to look for. The sweating and flushing are clues to something neuroendocrine.

It is now up to the endocrinologst to have a high index of suspicion for:
or more rarely
Pheochromocytomas are the more common of the two, and I have dealt with a fair number of them. Carcinoid is quite rare, but I have seen three cases here at JA in the past 18 months, which is striking because I probably did not see more than that in my career.

Suggest these to your endocrinologist. If the next appointment is very far down the road, you'll do well to try for an earlier one.

And do continue to keep me informed.




Doctor Nash, Professor of Medicine (MD)
Category: Health
Satisfied Customers: 616
Experience: I've been teaching and practicing medicine for more than 40 years.
Doctor Nash and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Thank you. My next appointment is on Tuesday and I'll mention these to her.

I will keep you informed. Thanks for the lead.
Expert:  Doctor Nash replied 6 years ago.
You are very welcome.

Please continue to keep me informed.

Frank Nash

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