What are some signs and symptoms of infection? What should myeloma patients know about fevers?

What are some signs and symptoms of infection? What should myeloma patients know about fevers? When should they go to the E.R.?

What would be the symptom of infections?

So I guess the first thing is fevers. Anything above 100.4 is considered a real fever and you need to just pay attention to that. But some people, they don't have a fever and they only have chills, sweating, fatigue more than usual, lack of appetite all of a sudden, And then all the urination issues such as a pain or discomfort, a cough may come, so you’ll have to just consider all of these would be the sign of infection from a different part of your body.

So when you should contact with your doctor, I would say the fever would be the first thing. Like, if you have a 100.4, definitely contact, especially if the neutrophil is low, that would be dangerous to stay home and ignoring it. Some facilities, they have an acute care unit, that you don't need to even go to the E.R. with it. And then the doctor can just kind of arrange some tests for you in acute care. But if it's not available, I would say if you have a fever and your neutrophil counts are low and you know it, you should go to the E.R. right away.

What are the signs and symptoms of infection and how should we proceed forward when we're concerned about that?

So, the first thing is fever. Any fever, especially if you're on one of these immunosuppressive immunotherapies, it is something definitely to let your doctor know about. The most common infections that we often see that can become serious are lower respiratory tract infections, so upper respiratory tract infections, things like nasal congestion, runny nose, mild cough. When it moves lower into the lungs, it can cause pneumonia or shortness of breath. And certainly if you start to have those symptoms, certainly call your doctor. But if feeling, short of breath, that would be a reason to go to the E.R. and be evaluated.

Other types of infections that we may see are gastrointestinal infections. So things like nausea, vomiting or diarrhea, skin and soft tissue infections can happen. So if you notice redness in the skin or pain in one area that wasn't there before, definitely all things to bring to your doctor’s attention.

But, you know, sometimes when your neutrophil count is low, there may not be much sign or manifestation of infection, besides fever or just not feeling well, just feeling kind of generally weak or general malaise and, you know, you know your body and if you feel out of the ordinary, it's never wrong to call your team and let them know so that they can get a little bit more information and help you make a decision about how to proceed forward. But certainly, if feeling really weak, really lightheaded, short of breath, high fever, those are all reasons to be evaluated in the emergency department.

Generally speaking, a temperature over 101 is definitely concerning. You often tell patients if they have a temperature in the kind of 100 to 101 range, but they're otherwise feeling well, you know, they can recheck it in an hour and see if it kind of goes away on its own, but if it stays there, it's going higher, especially in the context of what treatment they're currently receiving. You know, that kind of matters too, knowing, you know, what therapy they're on, what are your recent blood counts? Those are all kind of factors as into whether this is something that could potentially be managed at home versus whether you'll need to come in to the hospital for further evaluation.

What should patients know about the use of Tylenol and fever?

So Tylenol is definitely- can mask fever. And so I encourage patients if they're on a therapy where I'm concerned an infection may develop and a fever may develop, there's nothing wrong with taking Tylenol to help with the symptom of fever, but trying to avoid taking a lot of Tylenol for other aches and pains that might mask that fever is important, because we certainly want to know if there is fever or sign of infection.

Other things that can mask fever that are often use for like arthritis would be NSAIDs or non-steroidal anti-inflammatory drugs. So things like ibuprofen or Advil, Motrin, Celebrex, all kind of different names that do the same thing that can mask fever. It's just that if you're on those types of things for arthritis, have a conversation with your doctor because it may be appropriate to try to switch to something else, to avoid masking those fevers on certain therapies.

We would recommend pretty limited use of NSAIDs, not chronic daily use. Although, for some patients who've had really bad osteoarthritis and that's what they found helpful, you know every medication decision is a risk benefit. But generally speaking, long term use of NSAIDs can irritate the lining of the stomach. And we could potentially be concerned about ulcers. And it can also potentially impact blood flow to the kidney and kidney related function. Things we can watch pretty closely. But if other options are available, we do try to avoid daily use of NSAIDs.