Catra -

I understand and appreciate that you have done (and are doing) all you can do. Clearly, your neurologist doesn't think that there is anything seriously wrong with you: I can't imagine that you would not have been admitted through the ER by now if that was the case. And the fact that your new PM is in apparent agreement with this course of action makes both if us more comfortable!

But just out of curiosity, I wonder if there is a similar waiting list at the Cleveland Clinic? (Probably so.)

But the one thing I still don't get is the mild fever where, if anything, acetaminophen (Tylenol) has significant if limited antipyretic (fever reducing) effects in both children and adults, as I had thought. See, e.g., Acetaminophen has limited antipyretic activity in critically ill patients, Greenberg RS, Chen H, Hasday JD, J Crit Care 2010 Jun;25(2):363.e1-7. Epub 2009 Sep 24:

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore VA Medical Center, Baltimore, MD 21201, USA.

Abstract
PURPOSE: Fever occurs commonly in the critically ill patients and may adversely affect outcome. Acetaminophen is one of the most commonly used antipyretic agents in the intensive care unit; however, there is little evidence that it is effective in this population. The objective of this study was to analyze the antipyretic activity of acetaminophen in critically ill patients.

MATERIALS AND METHODS: We performed a retrospective study of medical intensive care unit and surgical intensive care unit patients with systemic inflammatory response syndrome and compared the resolution of fever in the presence and absence of acetaminophen treatment by comparing the absolute reduction in body temperature and the rate of cooling over comparable time frames in fevers that were untreated and those treated with acetaminophen.

RESULTS: We analyzed 166 febrile episodes (body temperature, >38 degrees C) in 59 patients with systemic inflammatory response syndrome without cancer, neurologic disease, or liver disease. Acetaminophen was administered for 88 of 166 fevers. Febrile episodes in which other antipyretic drugs or external cooling were administered were excluded. The response to acetaminophen was variable, but the absolute temperature reduction was slightly higher (mean, 0.86 versus 0.56 degrees C; P = .0362), and the cooling rate was slightly more rapid (mean, 0.20 versus 0.13 degrees C per hour; P = .0152) in acetaminophen-treated versus untreated fevers. There were no obvious differences between the most and least responsive patients.

CONCLUSIONS: We conclude that acetaminophen has significant albeit modest antipyretic activity in critically ill patients.

PMID: 19781895 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/19781895

AND

Fever and Antipyretic Use in Children, The Section on Clinical Pharmacology and Therapeutics; Committee on Drugs, Pediatrics 2011 Mar;127(3):580-587. Epub 2011 Feb 28:

Abstract
Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a "normal" temperature. Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child's overall comfort rather than focus on the normalization of body temperature. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized. Current evidence suggests that there is no substantial difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever. There is evidence that combining these 2 products is more effective than the use of a single agent alone; however, there are concerns that combined treatment may be more complicated and contribute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices.

PMID: 21357332 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/21357332

And there are scores if not hundreds of articles just like this, most of them comparing the relative efficacy of Tylenol, Advil, or any number of combinations of the two in reducing fever.

As such, I'm not sure where your neuro was coming from with "...that it is normal to have the low grade fevers with the tylenol..."

be good,
Mike