Dr. Cranquis' Mumbled Gripes

Brandi submitted:

I belive I may have hypothermia, since my body temperature has been varying from 96-94 the past 2 weeks, but my parents don’t belive me and don’t want to take me to the doctor. What should I do? 

First of all, Chilled Brandi, I wouldn’t freak out. Temperatures between 90-95 degrees F are considered “mild” hypothermia, and very rarely cause any problems.

Second, I’d make sure you have a working thermometer. If it’s battery-powered, get fresh batteries. Make sure you’re following the instructions on using it. If it’s an oral thermometer, don’t eat/drink anything just cold before using it.

Third, be aware that your body’s temp varies throughout the 24-hour daily “circadian” cycle, so if you’re only checking your temp at one particular time of day/night, you may just be catching the lowest readings. If you really want to get some accurate data, check it at least 3 different times during the day (and write them down for reference).

Fourth, if your carefully-collected data indicates that your average temps are consistently running low, I would then recommend seeing a doctor sometime. (You can lay out your carefully collected data for your parents, along with this post, for them to consider). There are many possible causes for mild hypothermia; the first that comes to my mind would be a hypothyroid condition, which has other signs and symptoms (and lab findings) for which your doctor could test you, among other conditions.

Good luck!

If you really want to spend a long time at the Urgent Care, while the doctor does a “Fever of Unknown Origin” workup on your child, including urine test, strep test, flu test, and chest xray (which takes about an hour to get all the results)…

Don’t tell the doctor about your other child’s recent illness (even after the doc specifically asks you, “Is anyone else sick around this child lately?”)…

Instead, wait until this child’s influenza test comes back Positive, and the doctor starts to discuss prophylactic Tamiflu prescriptions for the other children in the home, then blurt out, “Oh that’s ok, the other child is already on that medicine after she was positive for influenza at the ER yesterday!”

Ok, parents of the 3-month-old girl with a high fever and diarrhea — let me get this straight:

• You all just returned from 3 weeks visiting family in Mexico.
• While in Mexico, little Ayeli had “a cough and runny nose, no fever” and you took her to a doctor who gave her a shot of penicillin (yay, modern Mexican medicine!) plus 3 days of oral penicillin. She “got all better in 3 days” (wow, big surprise, a cold getting better in less than a week!).
• Now she’s had “black watery diarrhea” for 3 days, and a fever since last night (although, of course, you have no idea what temperature it was because you don’t own a thermometer). Here in my clinic, her temp is 101.5 degrees.
• Her flu and strep tests are negative here, her chest x-ray looks fine to me, her ears are fine, her lungs sound fine, her throat looks fine, there’s no rash.

Ok, all that being said: you absolutely refuse to let me get a catheterized urine specimen to check for a bladder infection. “Is that really necessary?” you ask. “The doctor in Mexico didn’t do that!” you exclaim. “We don’t want to cause her any pain!” you wail. “Would you do that to your own child?” you challenge. (To which I answered, “Yes, in this situation at this age, yes, I would.”)

Oops, you’re absolutely right! I was just gonna have my nurse stick a tube up your child’s urethra for the pure giggles of it!! You caught me — I’m a sadist! And obviously that doctor in Mexico is the world’s expert on diagnosing Fever of Unknown Origin, since he pre-emptively put her on antibiotics before a fever even BEGAN! I’m certain that the injected penicillin hurt much less than a 30-second catheterization, too! I quiver in the presence of your genius! Here, take this prescription pad and go get her something nice at the pharmacy!!!! It would also be really nice if you’d condescend to doing these stool tests I’m ordering to see if she’s bleeding internally from some yummy enteric pathogen — but if that’s too gross for you or something, don’t fret about it — seriously, who dies from diarrhea nowadays?! Oh and when her fever doesn’t go away by tomorrow, don’t come back to my clinic, because the first thing I’ll do it stick a catheter in your child’s urethra while praying that she doesn’t have a bladder infection headed for her kidneys and All Points West!

I walked out of that exam room and told my nurse: “My new motto is: You can lead a horse to water, but you can’t make it think.” I’m pretty proud of being able to come up with that from within my cloud of blinding rage at that moment.

Phrases that my patients utter with a straight face, and which make me want to poke my pen into my eyeball:

• “I don’t believe in vaccines/the flu shot”
• “98.6 degrees is a fever for me” (or the anti-thesis: “Well I don’t have a thermometer, so I don’t know if Junior had a fever.”
• “I just want to nip this [infection] in the bud”
• “No offense, but I hate doctors”
• “I’ve never been this sick… but I haven’t tried doing anything about it yet”
• “Oh, by the way, Doc…”
• “I brought it in so you could see what color it was…”

(Yes, this is the internet equivalent of a “Best Of The Simpsons” rerun… but I’ve been on vacation all week, so I don’t have a lot of brand new medical stories to share right now. Enjoy!)

Dr. Cranquis is gonna kill the next patient who tells me that “I don’t get fevers when I’m sick, nobody in my family does.”

(STOP claiming this as if it makes you a medical mystery who should be given antibiotics every time you get a runny nose, “just in case it’s really a bacterial infection.” If you really truly NEVER get a fever when you are sick, your immune system doesn’t work — why don’t we do some HIV testing today?!?)

What patient says: “Oh, I don’t get fevers.”

What patient means: “I want you, the physician, to believe that I am a medical mystery who gets infections which REQUIRE antibiotics but which don’t give me a fever.”

What doctor hears: “I’ve never been truly sick a day in my life. I go to the doctor because my throat feels scratchy and my nose is stuffy for 24 hours, and assume that the doctor will congratulate me on my complete lack of any effort to deal with these Common Cold symptoms on my own, and then reward me with a buttload of antibiotics (and maybe a note for a week off work too!).

Good evening, children, and welcome to…. Tales of the Thermometer!

I am your host, Dr. Cranquis. Tonight, two tales which will chill your blood with their feverish inanity.

First, the adult flower-child woman who presented for complaint of “Check if I really have a fever.” Yes, children, good money being spent to confirm what a home thermometer had already told her: she had an elevated temperature of 100.5 degrees Farenheit, even though she felt fine. Whose good money? Well, since the patient was covered by state health insurance — YOUR money! Moo-ahahahaha! Say goodbye to your social security, children!

Second, a woman who recently returned from a trip to Europe. Her story, a vague mishmash of “my body started hurting” and “sometimes I would cough but sometimes I wouldn’t” and “everybody else on the trip got sick too.” Yet when asked whether a fever had been part of her symptoms, listen with quivering ears, my children, to her insightful reply — “I don’t know, I was out of the country!” No, children, it did not help to rephrase the question and ask if she had FELT feverish, for her reply remained as unchanging as a child’s underwear at summer camp — “I don’t know if I felt feverish, I was out of the country!” Oh despair! Despair!

(This week’s Tales of the Thermometer was brought to you by Nyquil. Nyquil, the nighttime sniffling sneezing coughing aching stuffy head fever so you can rest medicine — tastes great served on the rocks with a splash of lemon!)

The average human body temperature is 98.6 degrees farenheit — basic fact you learned in health class, right?

Well, yes and no: that number doesn’t account for the route of measurement (oral/mouth vs. tympanic/ear vs. temporal/forehead vs. axillary/armpit vs. rectal/eww).

My 1st rule of thumb: the deeper you had to plunge the thermometer, the higher your body temperature is going to read on your thermometer.

My 2nd rule of thumb: don’t use your thumb to verify the 1st rule of thumb.

So, I say all that to explain this frustration — I ask people, “Have you had a fever?” and they reply, “Oh yes, my temperature was 98.6, which IS a fever for ME, because I always run at 96.6 degrees, so I’m 2 degrees lower than average, so a temp of 98.6 if really 100.6 for me, and also I have cloven hooves and a forked tail and sometimes my belly-button smells like pickles” (which is just the most eye-ball-rolling pointless spiel, and I think I tend to tune out around the time they start talking about cloven hooves.)

Really? You’ve checked your temperature every day at the same time in the same weather in the same clothing with the same thermometer in the same area/orifice for a statistically-significant amount of time? Or (more likely), you don’t even OWN a thermometer, and the last 2 times your doctor’s office checked your temperature, it was 96.SOMETHING and so you’ve magically extrapolated your life-long average body temperature from this. And now you’re using this infallible tidbit of personal data to conclude that (a) you have a “fever” and (2) you need to be on antibiotics because obviously your sniffles of the past 22 hours and your “fever” are signs of bacterial pneumonia!

(then I apply one of every type of thermometer in every possible location in your body — just not in the correct locations)