These two potentially most dangerous health problems are in fact the most vigorous defence measures we have. Unless they become harmful, our focus should be on managing rather than suppressing them .
Inflammation and fever
When we are threatened with toxic or infectious agents our bodies can muster a fearsome fightback. At a local level this is inflammation; when the threat is on a wider level, eg the bloodstream, the result is a fever.
Inflammation
This was classically seen to move through 4 stages after the initial injury or intrusion, named from the ancient Greek observations. Rubor or redness marks the increased flow of blood into the area. This brings in more neurophils and other white blood cells (see Part 1). Calor refers to the heat that is generated by this increased blood flow. Tumor is the swelling that follows the blood congestion and Dolor is the pain the accompanies the release of histamine and other ‘cytokines’ that are engaged in the battle to deal with the threat. All these ‘acute’ stages are signs of a healthy response and if the measures are effective the inflammation subsides. However, if the intrusion overwhelms or resists these defences the inflammation persists and becomes ‘chronic’.
Chronic inflammation often is termed by a word ending in ‘itis’: cystitis, bronchitis, gastritis, arthritis, hepatitis and so on. However, we now know that a great many diseases and longterm conditions can include significant levels of chronic inflammation. These include some surprises: heart and cardiovascular disease, diabetes, depression, chronic fatigue syndrome, bipolar disorder, dementias, all autoimmune diseases (see Part 4). Chronic inflammation can also be a major feature in cancer.
The usual approach to a chronic inflammatory condition is to use anti-inflammatories like steroids or NSAIDs (eg ibuprofen). These suppress the inflammation but do not remove the cause. Another option (that can also be used alongside anti-inflammatories, is to find ways of diminishing the threat. This will be the focus of these posts and courses. As we go through each form of chronic inflammation we will be suggesting the most effective approaches we know to respond to the body’s call for help in fending off trouble.
Fever
is a similar call to action involving the body as a whole. Infectious organisms unwittingly drop off chemicals that provoke our inner thermostat to increase our temperature. When the thermostat setting is higher than the actual body temperature we feel cold. At this point we wrap up, take a hot bath and drinks, and shiver (muscle contractions produce heat). When the body temperature duly rises, at a a few degrees above normal this leads to a very much increased neutrophil and other defensive activities. If all goes well and these fired up defenders get rid of the pathogen, the internal thermostat goes down. When the thermostat is lower than the body temperature, we feel hot: we throw off our bedclothes, and splash with and drink cold water. The fever ‘breaks’.
Fever management does need care and responsible attention to the situation. Do not do this if you feel anxious or unsure of your ability here. Also seek help with a child who has asthma or anyone with another seriouis medical condition.
However most fevers do not become dangerous and the usual rewponse if you call an emergency number or check a medical website (eg the NHS for children and adults) is to provide water and rest and use paracetemol (tylenol) or ibuprofen preparations if needed. Here are things you can safely do in in fevers to make the event more productive.
First you need a thermometer. Normal body temperature is usually between 97.6-99.6 degrees Fahrenheit (36.4-37.6 degrees Celsius). A temperature up to 100.3 F (37.9 C) is considered to mark a low-grade fever. 100 F is actually the sweet spot to aim for in fever management. At this temperature the relevant white blood cells and innate immune system are firing at much higher levels than usual. If the temperature is higher then we aim to bring it down; if persistently lower or dropping lower even though other symptoms point to continuing trouble, we bring it back up!
Temperatures up to 104 F (40 C) can mostly be managed at home. However call for help if it goes higher, there are any symptoms that worry you, or if you spot any of the following:
- Seizures.
- Bad headache.
- Stiff neck.
- A slow pulse (pulse rates should increase with body temperature)
- Confusion or extreme irritability.
- Extended vomiting or diarrhoea.
From what was said earlier fever management involves learning that when we feel cold our body temperature is rising, and when we feel hot it is going back down in the right direction. During chills, the aim is to maintain a comfortable outer temperature, with blankets and especially avoidance of draughts. Excellent herbal teas to support the system when the temperature is rising and bring comfort include yarrow, elderflower, or hawthorn leaf.
If the chills persist but the body temperature is not rising, or if the fever seems to go back and forth without resolution, then one can increase warmth (and firepower) with cinnamon or ginger teas. Always check the body temperature to keep close to the 100-degree sweet spot.
If the temperature looks like heading too high, start with cool wet flannels on the face and neck and plenty of cool drinks. Teas to help here include the three (yarrow etc) above, or if needed more bitter ones like dandelion root, feverfew (good name!) or even wormwood. (Bitter remedies were always associated with cooling fevers.) If still uncontrolled seek further help.
If all goes well there will be a second stage when there is a new equilibrium, neither too hot nor cold. Keep hydrated, gentle foods like soups for nourishment and lots of rest. This might go on for hours or days. Do not rush this: now is the time when most of the work is being done. When the fired-up defences have done the job the fever ‘breaks’. Then one starts feeling too hot, starts sweating, throwing off the bed covers. At this point the danger has passed and the focus is on keeping comfortable without exposing to the risk of a secondary chill (again avoid draights!). Keep drinking and eat at will.
Then take time to rest and recover. One should not rush back to work or school. A poorly repaired fever job will let you down in the future. Proper repair will set you up forever!
For further reading on the role of inflammation and fever look through the following
Cavaillon JM. (2021) Once upon a time, inflammation. J Venom Anim Toxins Incl Trop Dis. 27:e20200147
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