*Fever Reducers- Medical Mischief- This piece was inspired by the rapidly spreading Swine Flu virus and the awareness that most victims will reach for a fever reducer (NSAID) at the first sign of illness. Hopefully this article will make them think twice.

 

*Note: On febrile seizure: Researchers have found that prolonged hyperthermia (elevated body temperature) does "open" the blood brain barrier BBB), which is an intricate system of cells designed to protect the brain from the invasion of certain substances and organisms. Febrile seizures could then be caused from the virus that is inducing the fever or as a consequence of the increased flow of substances across the the BBB into the brain. (Read the rest below).

 

*Important Links- Here are some links that support the idea that fever is an important component of our immunity and that our routine suppression of fever does significant harm.

 

 

 

 

 

Fever Reducers- Medical Mischief

by Dogtor J

 

This piece was inspired by the rapidly spreading Swine Flu virus and the awareness that most victims will reach for a fever reducer (NSAID) at the first sign of illness. Hopefully this article will make them think twice.

 

“Hi, this is Mrs. Jones. My child, Amy, is a patient of Dr. Smith. She came home from daycare this afternoon with a temperature of 101.5 and I am wondering what to do.”  How many calls like this one go out to pediatrician offices every single day, especially in the fall and spring when the seasonal “bugs” start getting passed around?

A registered nurse brought her pet into the office the other day and we were discussing the variation in body temperature among the different species of animals and the role this played in zoonotic diseases (those transmitted from one species to another). She was fascinated by the idea that dogs and cats didn’t get our viral diseases partly because their body temperature (100-102 degrees F.) was so much higher than ours (97.5- 98.8 degrees F., according to Mayo) while humans were often subject to viral diseases from animals (e.g. Avian Flu, Swine Flu, West Nile Virus, Equine Encephalitis) for the same reason. I reminded her that the average human body temperature of 98.6 F. is a protective temperature against most human viruses, which generally prefer a subnormal temperature in order to invade the host.

This fact helps to explain the old “get a chill, catch a cold” idea, which is only true if there is a virus afoot to take advantage of the individual’s weakened state. It also sheds light on the origins of the “cold and flu season”, typically beginning when the ambient temperatures drop in fall and early winter. If we don’t take appropriate measure when this happens (e.g. dress warmly), our body temperature can drop, opening the door to the next available virus. “But what about summer colds?” some ask. Two words: Air conditioning. (Of course, the immune status of an individual is much more involved than their ability to maintain a proper temperature but persistent subnormal body temps have been linked to a number of disease conditions.)

So, because viruses enter and thrive in a body experiencing a subnormal temperature, a virus from a higher temperature animal jumping into a lower temperature human makes much more sense than the other way around. After all, what virus “in its right mind” would want to jump into an individual with a fever? Which brings up another point: Our normal body temperature is designed to help protect us against most viruses. A fever is even more so, helping to ward off other viruses trying to invade the individual in their weakened state. If this weren’t the case, the term “double pneumonia” (which classically means both lungs are involved) could take on a whole new meaning (more than one virus or bacteria involved).

As our discussion progressed, I sensed that this veteran nurse had actually seen the importance of the fever for the very first time. All of this talk of viruses and normal versus subnormal body temperatures had awakened her common sense.  So, I asked her the question: “Well let me ask you: If I was the father of child who had just come home with a fever from some daycare plague and I called 100 pediatrician offices in our city today, how many nurses would answer by saying ‘Give her a little Tylenol, monitor her temperature, and if her temperature gets above a certain level or these particular symptoms arise, then give us a call back or come in’.”  She quickly answered, “All of them! That’s what I say all of the time!” I then asked, “And what was the first thing the parent is told- kill the fever with Tylenol, right?” She gasped, “Oh, my gosh! I’ve been doing this for 18 years. No telling how many people I’ve told that to!” She was genuinely repentant, having finally seen the truth: Our body knows exactly what it is doing.

But as the fog from her formal training was lifting, she had a few more questions. “What about when the fever gets too high? Can’t it do brain damage?  What about febrile seizures?” I started by asking her if she thought our immune system knew what it was doing. She agreed that it did. So I inquired “Why then do we think the fever causes the seizure rather than the virus itself, which caused the fever?” She agreed that made more sense.

To reinforce this idea, I told her about heat stroke in dogs, the tragic result of leaving a pet in a hot car, in which we do attempt to resolve their hyperthermia as quickly as possible. Some of these pets have temperatures that are literally off the scale. We slip a thermometer into them and it pegs at 107 in two seconds. Only God knows how hot some of these poor dogs are. And yet, I have never had one seize and those that managed to recover did not show overt signs of permanent brain damage. Those that died usually passed away from consequences related to their internal organs being horribly over-heated by that unusually hot car interior, often reaching 110-140+ degrees F. (which can happen on a 75 degree day).  But this sort of dramatically elevated core temperature is not something that is going to occur with a typical viral or bacterial infection. After this example, it seemed clear to both of us that the conventional seizure-fever connection was a bit backwards: The seizure is more likely to be a sign that a virus has entered the brain- and a therapeutic step to contain it.

We talked a little more about the viruses and bacteria that can affect the central nervous system and how the fevers that accompany meningitis and encephalitis were usually some of the highest body temperatures we experienced (e.g. West Nile Virus). Yes, the more critical infections generally create the highest temperatures, once again underscoring the importance of fever. I sometimes wonder how many people who died from West Nile Virus infection might have survived had they not artificially reduced the initial fever.

In order to help defend her new pro-fever philosophy, I suggested that she might want to go home and Google “fever” or “physiology of fever” for a refresher course on the cascade of events that occurs in our body following the rise in body temperature and the proven benefits of fever, including increased proliferation of white blood cells, increased mobility of and pathogen consumption by those cells, suppressed bacterial toxin production, and increased interferon production. Interferons are proteins (glycoproteins called cytokines) produced by cells that signal other cells of the immune system to get involved in viral, bacterial, or parasitic infections- activating killer cell and other white blood cells and helping to make host cells more resistant to the invasion. A little technical for some but I throw out the “med-speak” because I firmly believe that people need to get a feel for the intricacy of our body’s functions and see that it knows exactly what it is doing when it comes to generating a fever.

But when the reader does do their homework, they will find some articles that continue to state the benefits of fever as being “controversial”. To whom, I would like to know, are these proven benefits controversial…the drug companies, perhaps? There should be no controversy among health care professionals and, yet, they are the ones who are blindly disseminating this misinformation. Hey, I used to do the same thing so I cannot throw stones here. Not only was I the first to take my NSAID-of-choice at the first sign of a virus but we as veterinarians were supplied with an injectable form (dipyrone) to give to pets running fevers. This idea of killing fevers was instilled into us all- laypeople and doctors alike- years and years ago. How did that happen?

What happened to the days of yore when an unfortunate soul in the wagon train became stricken with “the rheumatism” and was wrapped in blankets and sat down by the fire to sweat it out? Yes, they encouraged the fever, which is exactly what we do instinctively. I don’t know anyone whose instinct tells them to jump into a tub of ice water when that fever hits. No, we jump into bed- often fully clothed because the chills are so bad- and pile as many blankets on top of us as we can muster to avoid being overwhelmed by the violent shakes (designed to raise the temperature) that accompany the onset of that fever.

And yet, as I was listening to a popular TV personality interviewing a recent victim of the Swine Flu, I heard the unfortunate college student tell of his faithful roommates who kept him iced down during the worst parts of his fever. The interviewer enthusiastically asked how high the fever had gotten. When the student said “102”, the host said something like “Wow! Man, you really have some dedicated friends there.”  I wonder how many people listening had the reaction I did, shouting “No, no! Don’t be telling people with swine flu to kill their fever!!!”

I meet people all of the time who, when asked how they are, they reply, “I’m OK, but I’ve been fighting this bug for weeks now. I can’t seem to shake it.” I’ll then bait them by asking, “Well, are you taking something for it?” When they give the typical response that includes the use of fever-reducers, I look ‘em dead in the eye and say “Stop doing that!” Then they get the lecture. For those in the advanced class, I tell them about the root word of “pharmacy”, which is pharmakeia. What does pharmakeia mean? Magic. Yep- now you feel it, now you don’t.

When did we exchange common sense for magic?

 

Dogtor J

(Romans 1:25)

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