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Having fever. Blood work done. Taken anti immune pills. Prescribed Zoloft. Developed tooth cavity. Suggestions?

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General & Family Physician
Practicing since : 2009
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I have had a low grade fever for the past 2-3 weeks. Ranging from normal 98 (36.8) to 100(37.6C) degrees. I've had blood work done, and taken anti immune pills. Doctor really didn't say much more and gave me zoloft.

2 months prior to all this I was very sick and vomiting in the mornings every 3 days where only bile came up. I went to urgent care and they told me they think it is something with my gallbladder but couldnt tell me for sure because of no ultrasound. I finally met a digestive care physician and they did an endoscopy, followed by ultrasound and everything came back normal. They did a blood test as well as bacterial test during the endoscopy which came back normal. The illness lasted for 2 months and finally went away, but now I am stuck with the low grade fever and headaches which have gotten better after the root canal. The doctor thinks it was a viral infection which cannot be detected by blood.

During the illness I started developing a tooth cavity that wasn't too painful, but because of the vomiting it wasn't a priority. After I healed up from that illness it dawned on me that it was maybe this tooth that was causing it. I went to dentist and a root canal was performed. For 2 days I felt a lot better. The headaches/pains were gone and no fever. Now the fever is back at 37.4C and it goes away quick as well (within 30 mins).
Posted Mon, 15 Jul 2013 in Liver and Gall Bladder
Answered by Dr. Luchuo Engelbert Bain 2 hours later
Hi and thanks for the query,

It is already very good that endoscopy and an ultrasound ruled out gall bladder disease. Association of the low grade fever with the tooth cavity manifestations could imply the symptoms were associated with some bacterial infection within the system. This is however not very conclusive for the fever was actually too low grade.

It would be important to know if you have recently gone through any specific stressful situation or psychological trauma. This could justify the doctor's prescription of Zoflot, which is an anti depressant or used in treating mood disorders. It really does not have anything in managing the fever.

A body temperature of between 37.5 to 37.6, if the individual is not on anti pyretic drugs or thermometer which shows a temperature of greater than 37.7.

A think an active search to exclude a bacterial infection should be done. Measuring acute phase reactants, indicators of infectious inflammation like C reactive protein can be of great help. A complete blood count could indicate raised white blood cells pointing towards an infection, either viral or bacterial depending on the given raised blood sub types. A blood culture at this point, should be done to grow and bacteria that could be causing these symptoms. Foci of these low grade fevers like the heart should be sought. In the case of infectious endocarditis, low grade fever can occur as such and is usually common in tooth infections. A careful cardiac examination is mandatory to exclude any signs of infectious endocarditis that could present as such.

I strongly support the idea that these symptoms could be of viral origin. However, a bacterial infection must formerly be excluded before jumping to such a conclusion. Viral infections would generally be accompanied with lymph node enlargement and may be enlargement of the spleen. I would advice you do an HIV screening, in case of any exposures or unprotected sexual relations lately.

There exist what is called fevers of unknown origin. these are fevers that persist despite active search to know the real causes. Conditions like sarcoidosis, systemic diseases, lymphomas, Tuberculosis could be causing these, but they are rare and should always be kept in the back of the mind.

I strongly recommend you consult an internist for a proper clinical review and follow up. Thanks and hope this helps. Do not hesitate asking any further questions if you need some clarification. Wishing you good health and kind regards.

Bain LE, MD.
Above answer was peer-reviewed by
Follow-up: Having fever. Blood work done. Taken anti immune pills. Prescribed Zoloft. Developed tooth cavity. Suggestions? 44 hours later
My mother today told me that she has thyroid problems and had similar symptoms. Today I woke up with a very low temperature of 35.6C and later went up to 37.4C in the evening.

The doctor gave me zoloft because he thinks it is stress related, but I know I don't feel well and I've been through a lot more stress before without the problems I have.

Do you think I may have a thyroid problem as well? I've been feeling lethargic and varying temperatures for the past few weeks.

What is the best way to tell the doctor that more testing is required? I feel if he gave me zoloft that he thinks it is all mental, but I really don't think it is mental.
Answered by Dr. Luchuo Engelbert Bain 3 hours later
Hi and thanks for your query,

You are very right to feel that way, and its true thyroid disease usually has more symptoms associated which are of course very classical. however, it is not excluded that you might have thyroid disease, though it would be exceptional. Considering the family history therefore, I think we should take it into consideration too.

Fluctuation of temperature from 35.6 to 37.4 within the course of the day to me is not a call for concern. what is instead pre occupying is the subjective feeling you actually feel. It s high time I suppose to do an in depth investigation before ascribing your symptoms to stress. From what you describe, I feel something underlying must be identified first.

It can be difficult and frustrating at times to convince doctors you need further testing. Its a challenging situation at times. You have to tel the physician you need more testing for its your utmost right as a patient to get maximum in depth testing, especially when you are not exposed to any significant side effects from the procedure.

I strongly feel you deserve to book an appointment with an INTERNIST. The doctor should always give you time during the consultation session to express your feelings and get your views about the management of the health condition. This could be a moment to express what you want. I am happy you were so keen to ask about thyroid disease, which honestly think, with the prevailing family history and vague clinical symptoms, should be given close attention in your case. Other conditions earlier mentioned should be systematically screened for too.

Thanks and hope this helps as I wish you the best, and good health. Kind regards.

Bain LE, MD.

Above answer was peer-reviewed by
Follow-up: Having fever. Blood work done. Taken anti immune pills. Prescribed Zoloft. Developed tooth cavity. Suggestions? 34 hours later
I talked to the doctor and asked him about the thyroid issues and he told me that men never get thyroid disease that it is almost exclusively a female disease. He also said that he tested for it and that my blood results were all good. I asked if I could have more testing done and he told me he ran all the tests he could and that everything was normal. He tested for thyroid, kidney, liver, etc. and everything was normal. He said that the zoloft takes a few weeks to really kick in and that once it does I will feel normal.

I really do not think this is a mental condition as I have been a lot more stressed in my life in other occasions without any of the problems I am having now. I feel like I cannot function and everything is hazy.

What can I do? Should I look for another doctor? Is there a certain specialist I should see?
Answered by Dr. Luchuo Engelbert Bain 3 hours later
Hi and thanks for the query,

It s nice he did testing. But I am sorry thyroid disease is not an exclusively female disease. It s true its relatively more common in females. But men really do get it. It s true the possibility is a bit not very high in your case, but its a possibility to be considered with caution. I would not really love to disagree so much with him with respect to the place and action of Zoloft. I honestly think a serious second opinion should be considered.

I advise you book an appointment with an INTERNIST. This shall be of utmost good and importance. Thanks and hope this helps as I wish you good health. Will be glad responding in case you got more specific concerns.

Thanks and kind regards,

Bain LE, MD.
Above answer was peer-reviewed by
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