Is there any truth to this?

[Nurse SMS]

I sometimes have people insist they are feverish when they aren't based on what they state their baseline temp is. "Well, I usually am 96.5 so YOU may not think 98.6 is a fever but for me it is". I have only ever had females make this type of statement and to be honest it has always been a patient who is difficult to care for in other ways. I do not want to dismiss it out off hand but my gut reaction is pretty much an inward eye roll. Is there any basis for this claim that anyone knows of?

[IrishIzCPNP, MSN, RN, APRN, NP]

I see an SBP of 90 as dramatically more acceptable than one of 70.

I have been lower than 90 even. I used to run scarey low but I was healthy. I'm now unhealthy but have a "normal" bp.

[brillohead, ADN, RN]

You have people who's bp is 70/50 all the time? Walking around with no radial pulse?

I spent a good part of the 1990s like that. Lowest recorded blood pressure, taken with a manual cuff, was 56/"48-I think" (nurse's words, not mine). Even now, morbidly obese, I'm lucky to get anything over 100/80.

I'm also hypothyroid, and prior to treatment I regularly had a temperature in the 96-range (and even a 95.8 once). These were recorded at more than one doctor's office during appointments -- not a one-time thing, not a first-thing-in-the-morning basal temp, not a faulty thermometer at my house, not "eye-rolling-worthy wishful thinking" on my part.

If you are at all interested, do some REAL research into hypothyroidism. It is often under-diagnosed (no, a normal TSH range is not what most labs claim it is!), it affects more women than men, and it can result in very low body temperatures and blood pressures, among other symptoms.

We're not crazy and we're not looking for special attention -- we're COLD!!!!

[Penelope_Pitstop, BSN, RN]

I am one of those people who rigor @ 100; however, I've hit that number a whopping twice in my adult life, once at 28 and once at 19. When I was 19, I had "walking pneumonia" and mono, when I was 28 had the flu. I took Tylenol the second time to finish my shift but rode it out the rest of the illness.

I personally believe in the healing powers of a slight fever in an otherwise healthy patient, so I only give Tylenol or Motrin if the patient really wants it. For some reason, a lot of my coworkers wig once the temp hits anything above 37. (Yet they crank the room temps up to 85 and have the really bright lights on for hours at a time.)

[applewhitern, BSN, RN]

My blood pressure and heart rate run very low, also. I have had a nurse call the doctor into the room because my heart rate was 38. My pet peeve is when a baby/child actually has a fever, like 102, and the parents have them bundled up in thick coat, hat, etc. The first thing we do is start yanking all those clothes off! Hard to convince a parent that their child needs to cool off.

[Jory, MSN, APRN, CNM]

FWIW, I happen to be one of those annoying people who normally runs a low temp. I'm healthy as a horse, rarely get sick, certainly don't complain about it if I am, and would rather stay at home and quietly bleed to death than ever be admitted to a hospital, so I'm not some whiny hypochondriac. However, my temp v. rarely fluctuates unless/until I'm really sick, and a temp of 99.1 actually does represent a significant elevation for me (a fever). Feel free to roll your eyes ...

I recently went through an illness where I had horrible, horrible chills. I couldn't be any more cold if I were outside in the snow.

My fever never broke the 100 mark. I too, run a low normal temp.

[Jenni811, RN]

No. Temperatures fluctuate throughout the day, especially in females (time of month has something to do with it too). Anyway, people don't get that it fluctuates.

I get that line frequently too and i just explain "Well, it is common for our bodies to fluctuate temperature from time to time. We really don't get too concerned unless it is over 100. That is the bodies way of telling us something is wrong." Keep it simple, they don't understand what fevers are and why we get them. So someone who is normally 96 something and has a temp of 98, is not running a fever.

[wooh, BSN, RN]

So someone who normally runs a heart rate of 45 and is now 90 resting, you aren't going to worry? After all, pulses fluctuate throughout the day.

[SeeMel]

I understand that we have a tendency to read our patients based on monitors and vital signs sometimes in filtering what we are hearing. I became septic and nearly died after an outpatient procedure (biopsy) that sent me straight to the ICU instead of home, my temp was NORMAL and remained borderline low normal, however my heart rate crept to 130-140 and stayed there for 37 days fighting for my life, I was told by my surgeon that I couldn't breathe well because "you aren't walking in the hall enough" basically dismissing all of my complaints and fears, refusing my request for ID consult and wound care with purulent drainage seeping out around my chest tube and visible within the chest tube he suggested it was lymph, I am forever an advocate and with passion try to educate everyone in my various circles, due to this, I believe that surviving this will only help others - this is not meant to offend but in this very personal experience I learned: an informed and aware patient isn't really what Dr's and other clinicians ALWAYS really want despite what is written in the hospital mission statement and professional creeds. Thank you for raising this question, we all grow through sharing and you never know how many lives may be saved by people reading these comments!!! Bless you!

[texasmum]

Addressing the BP: it can run low in "normal" adults. The females on my mother's side all typically run low. I have had three nurses take my BP then have the doc do it because "that can't be right." Years ago when I was in paramedic school the instructors used to love to use me in trauma mock-ups as an example of reading your patient, not your equipment (i.e. patient obviously not in shock).

[theantichick]

My mother is ill if her BP gets over 90. She will very frequently get a resting BP reading of 80/50. She also gets dizzy if she stands up too fast. That's been her norm my entire life.

All the women in my family run to low thyroid (and that's a WHOLE 'nother rant) and we typically have low temperatures no matter what time of day. My temp is typically in the mid 97 range all day, and during a period when I was tracking basal to try and prove to a doc who wouldn't listen that I was hypo, it would be in the low 96's before I got out of bed. Now, I don't try to tell anyone that 98.6 is a fever for me, but at 98.6 I start making note of my other symptoms and if I run 99 I'm sick. I am also of the school of thought to let a fever do its job unless it's getting too high, so I typically don't take anything for just the fever until I'm pushing 101. However, way before that point I'm usually sick enough that I'm taking cold/flu meds which have tylenol or ibuprofen in them... so I've VERY rarely seen 101. Of course, this also means that both I and my daughter (who has the same situation) have been at school/work more times than I can count while we were contagious because everyone gets tied up with the "normal" numbers.

I listen very carefully to my patients who can tell me what their norms are. That means either they've had issues in the past that caused them to have to pay attention to certain numbers, or that they are a patient who involves themselves and educates themselves about their health care. Yes, some of them tend to hypochondria, but even hypochondriacs get real illnesses, and I don't want to be the nurse that ignored a patient's real issue because I knew them to be a whiney butt.

And here's where I have to keep this from becoming a rant. In my opinion the medical community gets too tied up in the lab values and what the books say and forget that their patients are individuals and may not conform to those text book standards. I fought a doc for over 5 years telling her I had physical symptoms, but because I'd had to be treated for post-partum depression a decade before, she decided that I was just depressed. Turned out after I fired her and got another doc, I had sleep apnea and probably had it for years. Over the years I've had reactions to medications, only to have the docs poo-poo my report and try to strongarm me into taking meds that were making me ill. The absolute icing on the cake was when I had an adverse reaction to a med last year and ended up with 41 PVC's a minute - very symptomatic - in bigeminy most of the time with salvos of 3-5 PVC's at a time, and had no less than 4 docs & NP's tell me (including 2 cardiologists) that PVC's are normal and I shouldn't worry about them. Turned out I had developed 3 lesions in my ventricle that had to be ablated. Could have died one particular day driving myself to work after the doc said I didn't need to get a work from home note (I was a computer programmer at the time) and almost passed out at the wheel.

I'll stop here before I really go off. Just know that some of us "whiners" have real issues, and we actually *do* know what's going on with our bodies and not everyone is "text book".

ETA: And yes, I'm very aware that there's probably a warning flag on my chart at my doc's office that says "DIFFICULT PATIENT". I'm OK with that. And amazingly, after the PVC thing my doc is all of a sudden very intent on making sure my concerns are heard and addressed.

[morte, LPN, LVN]

NURSE THE PATIENT, NOT THE NUMBER. 98.6 is a MEAN, not "normal".

[bethjor]

This is the best answer on this whole post....

"So if someone tells you that 98.6 is a fever for her, you'd be well-advised to listen to her...and to maintain a higher level of suspicion for other indicators of infection (look for left shifts in the diff, for example). Doing otherwise is acting from a position of ignorance."