FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

READER'S "SHAKING" PROBABLY JUST A CASE OF THE "SHIVERS"

Question: While quietly writing some letters the other evening I suddenly felt very cold. Before I could stand up to turn up the heat, I began shaking uncontrollably. I was shaking so much that I had trouble getting to the other room to get a blanket. I took two aspirin and in about 10 minutes the shaking stopped. I've never had this before or since. What would have caused it?

Answer: The "shaking" you experienced was probably just a sudden and vigorous episode of shivering. This is likely since you also felt cold at the start of it and have had no subsequent episodes. I suspect that the sudden onset and severity of the shivering is what has led you to label it as "shaking" and, therefore, think that it has an unusual cause.

Shivering is an important part of the body's temperature regulating mechanism. This involuntary muscle movement occurs when the brain determines that the temperature in the core of the body is dropping lower than it should. The muscles are then stimulated in a way that produces the uncontrolled "shaking" that we have all experienced as shivering. This muscle activity causes an increase in body core temperature just as any other vigorous physical activity does. As the body temperature increases, the shivering subsides. I think this is why your "shaking" lasted about 10 minutes. It took that long to get you warm.

In addition to simply being cold, there are also other causes of shivering. We have all had this experience as a consequence of fever. Shivering can also be an undesirable side effect of certain medicines, and -- more rarely -- it is sometimes a symptom of a brain tumor. However, from what you've told me, I suspect that your shivering was just the garden variety type induced by cold temperatures.

An important follow-up question to yours is why did you start shivering while quietly writing a letter? Well, writing a letter doesn't usually involve much muscle activity. Consequently, your body wasn't generating much heat. Whether you get cold doing quiet activity depends upon the temperature in the room, how drafty it is and upon the warmth of the clothing you are wearing. As an example, my office has a ventilator that produces a near gale force wind. I get chilled whenever the thermometer drops below 75 degrees. That is why I keep a sweater here.

Under most situations the body's greatest heat loss is from the head, neck and shoulders. My grandmother knew this. She kept a shawl at her easy chair. When the day wore down to evening, she would put on her shawl and "sit for a spell." This is still a good idea.

Infants and the elderly are more susceptible to chilling. This is also a concern for those who are quite thin. I'd suggest that you keep your home at least 65 degrees to reduce the likelihood of cold-related health problems. And when you're sitting quietly, slip on an extra sweater or try grandmother's shawl. You may start a new fashion trend that'll actually be an old-fashioned and practical one.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.