First do no harm (Hippocrates, c.460 - c.370 BCE)

In the previous post, I told you that Mrs. RWP (the lovely Ellie) had suffered several episodes of the rigors (shivering, teeth chattering, etc.) and that having her gall bladder removed had not stopped them. Rachel remarked in a comment that gall bladder removal and teeth chattering and shivering sounded like a strange combination to her. I said I would explain in my next post.

Here we are at my next post and I will give it the old college try. Please keep in mind, though, that I am not a doctor, I am not an expert, and mainly I don't know what I'm talking about. I just read a lot and that is always dangerous.

During one of Ellie's hospitalizations, one of the doctors mentioned "rigors" -- no one else had used that term -- and I looked it up. It did describe what she had experienced (shivering, trembling, teeth chattering) and that a likely or possible cause (I don't remember the exact wording) was the portion of the brain called the hypothalamus, which is the body's thermostat. Sometimes, for reasons not clear, the hypothalamus decides to change the body's 'set-point' temperature, and it can (and often does) result in rigors as the body attempts to adapt to the change, This is my very unscientific summary of what the article said.

It rang a bell with me because ever since I met Ellie 63 years ago she has told me and nurses and doctors that her normal temperature is 97.6°F instead of 98.6°F (37°C). In the last couple of years it seems to have dropped even lower, the thermometer often reading 96.5 (35.8) and even 96.0 (35.5) on occasion. I have concealed my alarm by teasing that she must be part reptile; she gets my point but remains unconcerned. In July, the episodes of rigors began occurring about once every three weeks, the latest and most severe being this past Monday night. We do know for sure that her gall bladder is not the reason because she hasn't had one since mid-September. Perhaps I should say "not the only reason" as the surgeon remarked that the gall bladder he removed was "very angry".

Our PCP did give a referral to an endocrinologist for further testing but we are currently on hold with that as this particular endicrinologist only treats patients with thyroid problems or diabetes, neither of which has been indicated.

Another possibile cause (or aggravator) for Ellie's rigors is dietary choices. We are learning the hard way that without a gall bladder a person should prefer low-fat foods almost exclusively and scrupulouy avoid egg yolks, mayonnaise, seafood salad, and the like.

I hope this post is helpful and does not lead people to reach erroneous conclusions. You should always check with your physician about any questions or personal issues you may have about your health.

Your trivia factoid for today is that the words "do no harm" do not appear in the Hippocratic oath. Hippocrates did include them, however, in another of his works entitled Of The Epidemics.