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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18436
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have a 26 year old daughter getting regular high temperatures

Resolved Question:

I have a 26 year old daughter getting regular high temperatures and constant debilitating headaches. She is rarely out of bed and is regularly rushed to hospital with a temperature over 38degrees that only IV fluids and morpheme can correct. Once out of hospital the headaches return along with the temperatures and sweating/chills. When out of bed (which is rare)she is dizzy and regularly falls over. She has had mental health issues including a broken jaw that was not diagnosed, head, neck and jaw pain from this break since it happened at the age of nine, an attempt at suicide 18months ago and persistent plans to follow through on this, failure to succeed at university, drink issues and an abusive boyfriend in the past. She has been in critical mental care several times but discharged as she will not co-operate with therapy. She has been taking strong headache medications for several years and is always on one type of medication or another. She has now been in bed so long that her heels are sore from bed pressure. She has given permission for me to speak about her case at the GP surgery but has also told them that I have been abusive to her so I do not think they trust me. They may be trying to protect her hence their reluctantance to speak to me without her being there but when she goes they now make her see a medical assistant and she has ended up arguing with a couple of people at the surgery so they seem to me to avoid dealing with her. When I ask for an appointment to talk about her they will not book an appointment of longer than 10 minutes. I love my daughter very much and am very scared that she is dying in front of me and nobody cares.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.

I am sorry that your daughter is having so many problems.

What is the highest that her temperature gets?
Can you provide details of what evaluation has been done thus far for these symptoms?
What medicines is she currently taking?
Customer: replied 1 year ago.
A few days ago she was hospitalised with a temperature of 38.9. In the last year she has been hospitalised 4/5 times. They always take bloods, test her urine, she has had chest X-rays, head X-rays, and a lumbar puncture. She has had a brain scan and an upper body MRI all coming back clear. They suspected bacterial meningitis the time before last that she was admitted with a temperature of 40 but this was not bourne out by tests so she was discharged after a few days with not treatment plan and no follow up by the GP.
Expert:  Dr. D. Love replied 1 year ago.
Do you know the result of her white blood count?
Did they check tests of inflammation, such as a sed rate or C-reactive protein?
What specialists has she seen?
What medicines is she currently taking?
Customer: replied 1 year ago.
She was told following the last admittance and tests last week that her blood count and white blood cells are low but the discharge doctor did not explain this to me when I collected her following discharge. She is currently taking what I think is an antibiotic called trimethoprim 200mg twice daily as she also has a urine infection picked up during the last hospital visit and 1 tablet of effervescent Co-codomol 500mg every 4 hours to control the headaches with no effect. She is barely eating.
Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information.

There are several issues to consider in this situation.

The first concern with recurrent fevers and headache would be an infectious process, but it sounds like she has had an extensive evaluation for the common infections that would be a concern in this situation. The only other evaluation that would be appropriate, if not already done, would be to perform blood cultures during acute episodes, consideration of an echocardiogram, and consultation with an Infectious Disease specialist.

The other major concern in this situation would be whether there is an inflammatory disease affecting the blood vessels to the head and brain, called a vasculitis. This inflammation will typically not be apparent on MRI or other imaging studies. Blood tests of inflammation, such as a sed rate or C-reactive protein, are usually elevated. However, it also may be necessary to perform a biopsy to assess for inflammation of blood vessels. A consultation with a Rheumatologist may also be helpful.

In addition to further evaluation to identify the underlying cause of the symptoms, there are some other considerations that may help with symptoms from many different causes. It may help to use medicines that prevent headaches, such as certain anticonvulsants or certain antidepressants. With her history of mental health symptoms, one of the antidepressants may be better, such as amitriptyline, nortriptyline, or duloxetine.

If I can provide any further information, please let me know.
Customer: replied 1 year ago.
Thank you very much. Amytriptyline was tried several years ago for her headaches but these made her drowsy. I will ask some more questions of the GP based on your replies. It's so difficult to get information and the GPs just seem to think these issues are mental but there has got to be more Than a mental health explanation for the physical symptoms that have plagued her young life for so long. Don't understand why she is just left to cope? I am a single mum working hard to maintain the home and can't be with her to nurse her and can't afford to pay someone else to do this. What could possible be the cause of a low blood count? Can you explain this to me?
Expert:  Dr. D. Love replied 1 year ago.
It is very unusual to get a fever to the range that she is experiencing solely from a mental health problem.

A mildly low bood count is usually normal. A significantly low blood count is not specific and can occur in many different infectious or inflammatory conditions, so does not narrow down the cause of a fever. The same conditions are in the differential diagnosis as would be considered for the fever and headaches.
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