4. Inflammation and fever – shock and awe!

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 .

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 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 involves learning that when we feel cold our body temperature is rising and when we feel hot it is going down and heading in the right direction. Additional measures may be needed more when we still feel cold.  Handling a fever does call for many precautions and safeguards and will feature in detail in a another edition of this gazette.