Fever | Shaking chills

Temperature Control: Fever

First rule: If you have a fever, call your doctor! Here's why:

Fevers and Infection

Infections are a big deal when you have cancer. Chemotherapy wreaks havoc on your healthy cells as well as the cancer cells. In particular, your white blood count is very low after chemo (neutropenia).

You are very susceptible to infection without the protection of your white cells. If you do get an infection, your ability to fight it is diminished. You're hit with a double whammy - easy to get an infection and hard to fight it!

Fevers are the most common sign of infection. If you have a fever over 100.5 F or 38 C, you must call your doctor immediately. You will probably be started on antibiotics and may need to stay in the hospital until your fever comes down. Don't be surprised if your doctor is very strict about this.

What causes a fever?

Ever wonder what causes a fever when you have an infection? In a nutshell, here's what happens:

When foreign substances (like germs) enter your system, something called cytokines are released which re-set your body's thermostat. It's like adjusting the thermostat in a room when you want it warmer. Your body knows it needs more heat to fight the intruding germ - your immune system works better at a higher temperature.

Your body's first response is to tighten up or constrict your blood vessels. This reduces the amount of heat lost through your skin and raises your temperature a little.

The surface air feels cooler as your body temperature begins to rise. Even if you put on more clothes (adding warmth), you may begin to shiver. This causes your muscles to contract, producing more heat . Before you know it, you have a fever.

Once again, a double whammy - you shiver because you're cold but the shivers cause a fever which makes you feel sick. Like we said, first you're cold, then you're hot, then you need to get cool again.

Actually, a fever is your body's way of protecting itself. Fevers are good things - in a way. A natural defense mechanism.

When the infection goes away (with antibiotics), your body no longer needs as much heat. You may hear the expression, "Your fever is breaking". You begin to sweat, so you have to take off all the extra covers and clothes in order to cool off. Hot - cold.

Treating the fever

• Your doctor may recommend you take acetaminophen (Tylenol). This will not cure the infection but it will take care of some of the uncomfortable symptoms: fever, body aches, etc. Don't take Tylenol or any other drugs without your medical team's knowledge. Drugs can mask a fever and keep you from getting treatment for the infection that caused the fever in the first place.


• Don't take aspirin or ibuprofen (Motrin, Advil). These may promote bleeding, which is not good if your platelets are low.


• If you are chilly or shaking, stay warm. Cover up with blankets. You could also try a heating pad.


• If you get too hot, cover yourself with a light sheet. Have someone (your trusted caregiver!) place cool washcloths on your forehead. Ahhh….


• Drink plenty of fluids. Your body uses lots of fluids during a fever, so keep drinking.

To help prevent infections

• Avoid other people who are sick - even with a cold. Don't take any chances.


• Wash your hands often, especially after going to the bathroom, before eating, or if you've been in a public place where there might be germs on door handles, railings, etc.


• Tell others to wash their hands carefully before coming in contact with you.


• Be careful not to get any cuts or scrapes. Bacteria can enter an open wound very easily. If you do get cut, wash it well with soap and water and cover the area with a bandage. Use lotions and moisturizers to prevent drying, chapping, and cracking.


• Have good oral hygiene: brush your teeth often, replace your toothbrush at least every three months or after a mouth infection, visit the dentist when your counts are normal.


• Be careful what you eat. Make sure your food has been prepared properly.


• Make sure you use sterile procedures when changing your central line dressing and when flushing your lines. This is a common source of infection.


• Avoid large, indoor crowds when your counts are low. As an example, if you go to a movie, see an afternoon matinee when the crowds are smaller. Large rock concerts where people are piled on top of each other - not a good idea for lots of reasons!