*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.
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.
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?
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.
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.)
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).
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.
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.
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.
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.
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.
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?
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.
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!!!”
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?
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.
Considering that most children and adults do not have seizures as
the result of a fever, we would have to ask whether those individuals who do are prone to seizures in general,
especially if the current viral infection itself was not deemed the culprit. In discussing the history of epilepsy with
mothers of afflicted children, I have heard about a number of those children with febrile seizures as younger children
developing various forms of epilepsy or autism as they got older. Certainly, not all children who have a febrile seizure go
on to become long-term epileptics or develop learning disabilities. Statistically, the vast majority do not unless
they meet certain criteria (from Epilepsy.com)
But by examining these criteria, I think my point is made for me. They make a specific point of qualifying
their statistics by saying "The vast majority of children with febrile seizures do not have seizures without fever
after age 5." They then discuss various risk factors that suggest the febrile seizures were either caused by a significant
viral infection of the brain or were related to familial epilepsy.
What I am suggesting is that we not be so concerned that a seizure might accompany
a fever that we routinely bring down elevated temperatures with fever reducers. Again, the overwhelming majority
of fevers do not result in seizures. But when they do, I contend that the seizure serves a purpose,
just like any other symptom, acting both as a warning sign and a therapeutic measure. When we look a little deeper,
we may very well see that the seizure is warning us that the individual is prone to seizures and that we need to
be looking into possible predisposing factors, such as food intolerance (e.g. celiac disease), food additive sensitivities, or environmental factors.
Remember: Our body frequently offers us numerous warnings of impending illness (e.g. migraines,
heartburn, IBS, allergies, pain, insomnia, etc.) and I believe that seizures are no exception. In the case of febrile
seizures, they may be telling us that the individual may need their diet and environment examined more closely.
*Important Links- Here are
some links that support the idea that fevers are an important component of our immunity and that our routine suppression
of fever does significant harm.