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Dr. Chip
Dr. Chip, Doctor (MD)
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Experience:  Over 20 yrs of Family Practice
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I would like to ask a question a fluctuating fever that my

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I would like to ask a question a fluctuating fever that my 87 year old mother has. I have written to you about her before. There is not enough room in this space to put down all the information. Please write back so I can give you all the information I can.

Please be sure to read the details noted for "optional information".  In addition to that, I would like to add

that in November of 2002 she was diagnosed with L.Y.P.
(LYMPHOMATOID PAPULOSIS).  It was originally suspected that she had skin lymphoma.  A cancer specialist at the University of Michigan Medical Center changed the diagnosis to the LyP.  Periodically, she gets skin outbreaks.  She is not having one now.  He did say that having LyP put her at a higher risk for lymphoma.

Also, my mother says that she gets the frequent urination when she lies down regardless of the time of day.  Could body position exert some kind of pressure which would cause the frequent urination?

Hi--sorry for the delay in getting back to you. Even without any typical symptoms, has she had a recent urinalysis?
Customer: replied 4 years ago.

No. She has not.

OK--and since the fever thing has been going on, are you saying there has been something different about her--something in the way of a particular symptom?
Customer: replied 4 years ago.

Not really. The frequent urination at night (or when lying down) has been going on for a long time. That has not changed with the fever, according to her. She mentioned it to her GP a couple of months ago. He suggested body position. What we had was three or four days of pretty widely fluctuating fever (96.5 to 100.5 on the first day, then smaller fluctuations), then she was okay for about two weeks, and now she seems to have the fever again. It was 98.2 a little while ago - that's still elevated for her. She says that she thinks she might have a sore throat. I have heard her sneezing a couple of times, but this is not unusual for her as she has allergies. She head a headache this morning. Again, this is not unusual. I think that she gets dehydrated. She doesn't have any unusual back pain. I mean, she always has lower back pain because of arthritis. She says that she knows that she strained her shoulders by reaching for something, She attributes that pain to straining.

when the fever is its highest, no difference from any other times as to symptoms?
Customer: replied 4 years ago.

No. No difference. Of course, she says that she feels the effect of the fever in a general malaise kind of way. Not much of an appetite. Tired. But she has had disturbed sleep because of the frequent urination. That would explain the tiredness also. And there have been times when she has felt that way and taken her temperature and it has been low. We have used several different thermometers. They are consistent with each other.

OK--and has she had a recent CBC?
Customer: replied 4 years ago.

Blood work? She has them, I think, a couple of times a year. Not very recently, though. Her GP gave her a referral for one two days ago. She hasn't gone yet. Also, she seems to be under the impression that she's not supposed to have that done when she is unwell. That doesn't make sense to me, but that's what she says.

OK. First off, we aren't talking in general about a true fever since basically that's considered 100 or higher and most times she doesn't reach that, even if her usual temp is lower than the average 98.6. Certainly, if we were talking about the fever of unknown origin that sometimes signals an occult malignancy or something like tuberculosis or another serious infection, the temp should be 101 or higher. At this point, despite the lack of symptoms, I'd go for a urinary tract infection and I would get the urinalysis
Customer: replied 4 years ago.

Okay. I'll tell her go for the blood work and a urine test tomorrow morning. Is there any reason why she should not have a blood test as she thinks?

Thank you for your assistance. Just that last question: Is it okay for her to have the blood test when she is unwell?

Sorry for the delay--the site was down. Yes, she needs the blood work especially when unwell and even if her doctor is unimpressed with the story and the symptoms she needs the CBC and the urinalysis. Let me know how it goes.
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Customer: replied 4 years ago.

Dr. Chip -

I just wanted to let you know that you were right. She has a UTI. The blood work was okay ("stable"). Now we know to look for a new symptom (fluctuating fever) for UTI. Thanks for your help.

My pleasure as always
Customer: replied 4 years ago.

Dr. Chip -

I spoke too soon about the UTI. Here is an update. I wonder if you could offer any insight. I wrote to you last Monday (see above) after speaking to a nurse at my mother's GP's office. She said that my mother's blood results were stable. She also said that the preliminary (quickie) urine test was positive for a UTI. She went on that it had been sent on for a culture so that they would know what antibiotic should be prescribed. I don't think that I could have misunderstood her as there was quite a bit of detail. Today, the GP's office called. They said that the culture shows that my mother does NOT have a UTI. How could this happen? Is it possible that the initial quick test gave a false positive because it was contaminated? Is it possible that she has a low grade infection that the doctor doesn't think is worth treating? I would love to ask her doctor, but my mother does not want me to call. Also, is "stable" a normal expression to use in regard to blood test results.

We're not too concerned because this 2nd bout of fluctuating fever passed after about four days the same way the first one did about two weeks before. My mother is back to her normal very low temperatures and she feel better. But we're worried that it will all happen again. When my mother asked the nurse who called with the test results whether old age could cause a fluctuating fever, the nurse responded that it might. I've been googling "fluctuating fever in elderly woman" for a couple of weeks now, and I've yet to see anything saying that this just happens in the elderly. I guess my questions are:

A) Could the sample have tested positive for infection because it was contaminated but then showed negative with the culture? Can you think of any other reason for the two results?

B) Does the word "stable" imply anything to be concerned about with the blood results?

Thanks very much.

Do you know if the sample was dip sticked in the doctor's office and not looked at under the microscope?
Customer: replied 4 years ago.

It did not happen at the doctor's office, but at the lab. I know that they had the first result on the same day (Monday). They contacted the doctor's office, and the nurse called us and said that it was positive. I don't know how they would have gotten that result - maybe the speed involved might tell you something?

Well the standard urinalysis in a lab is the dip stick to look for nitrates from leukocytes, traces of red blood cells, protein, and then a microscopic exam to look directly for red and white cells and bacteria. I would assume the microscopic report was consistent with a UTI and I'm not sure what was seen in the culture--unless there was a preponderance of an infective bacteria it would be reported as negative but that wouldn't necessarily mean there is no UTI, especially if there were white cells in the microscopic. As for "stable" blood lab results, that doesn't mean anything unless there were expected to be a change, like if one were a bit anemic and the next test showed no drop in the hemoglobin.
Customer: replied 4 years ago.

Would you consider it normal to not prescribe an antibiotic if the microscopic report was consistent with a UTI. The last time my mother had a UTI, they had her on three different antibiotics for a month. They make her feel sick, so we're happy if she doesn't need them. But I wouldn't like to think that something that could have been nipped in the bud early will develop into something that's really hard to shake.

Well UTI's in the elderly shouldn't be brushed off so, yes, I would have put her on an antibiotic--maybe just amoxicillin for three days.
Customer: replied 4 years ago.

Thank you for your help. We'll be calling the doctor's office tomorrow.

Always my pleasure but keep me posted as usual
Customer: replied 4 years ago.

My my mother is always concerned about offending her doctors. Naturally, I would be diplomatic. But I would like to know if that first result was based on a microscopic analysis. It's her decision to call, though. She's thinking about it.

There's nothing wrong with asking a doctor questions and in this case she should just ask what was in the first test that indicated a UTI
Customer: replied 4 years ago.

I'll tell her that you said so. Thank you very much.

Keep in touch but we need to close this page with a rating again and you can get back to me on a new question page
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