Is a fever a friend or foe? Drug makers will market anything
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Is a fever a friend or foe? Drug makers will market anything
LuisLomeliMD
3 min - Mar 2, 2008
Is a fever a friend or a foe? A person with pneumonia and no associated fever is in serious trouble. The combination of a disease process and no fever usually warns of a poor prognosis. Once we used to treat AIDS patients by putting them in ovens in order to elevate their body temperature in our effort to help them fight off the offending virus. The fever profile may suggest specific disease patterns, as in Malaria. Normalizing a fever may cause more harm than benefit. Drugs like Ibuprofen (Advil/Motrin) harm thousands upon thousands of patients throughout the world annually. A fever rarely causes harm. An elderly person with a serious infection or occult pneumonia may present as confused but afebrile (no fever). Parents may reduce a high fever to 102.5, but I rarely recommend for them to normalize it. If a patient has meningitis with associated fever, it is the meningitis that may cause harm, not the fever. Why does our body desperately tries to maintain an elevated temperature during a viral or bacterial infection? Throughout the world, when patients become ill and febrile (with fever), they try to cover themselves under the blankets. Why? The body will shiver (which requires energy/work) in order to maintain an elevated temperature. In doing so, the body is using up precious caloric resources. For this reason, I suspect, patients innately try to cover themselves with blankets so that the work associated with shivering is reduced and energy is saved. The higher the temperature the more it suggests a serious infection, except in the case of Roseola Infantum. If the temperature needs to be reduced, I only prescribe, besides cooling measures, Acetaminophen (the inexpensive active product in Tylenol). (*When patients say to me that their child had no temperature, I know that they implied that their child had no fever.)
Nature developed the cough reflex to protect us from invading particles, toxins, allergens and infectious agents. A patient with pulmonary tuberculosis may cough in order to remove the bacteria from the lungs. Bacteria (as in Mycobacteria tuberculosis) that are swallowed are destroyed by our hydrochloric acid. Before using the Nexium or the purple pill to reduce our gastric acid, you may want to consider why it was that nature developed the proton pump in our gut. For instance, I encourage patients with respiratory infections to cough and swallow their secretions. When coughing, they should cover their mouth in order to avoid infecting others, especially in the case of Tuberculosis. Recently, a singer asked me for a medication for his cough that was due to allergy related disease (irritable airways). In his case, I simply prescribed him fluids, Dextromethorphan (over-the-counter), and I gave him a single corticosteroid dose four hours before his performance.
It is common for patients with bronchial asthma to cough and vomit in order to clear their airways. It is a life saving reflex. Sadly, this type of vomiting is often confused by doctors who commonly prescribe the dangerous drug Promethazine DM (Phenergan DM or with Codeine). Sedating an asthmatic with a drug like Promethazine may cause death.
This intriguing topic, and others will be continued.
Beta project, unfinished and unedited.
Luis Lomeli M.D.
Never belittle a patient because of the manner in which he expresses himself. Einstein had a miserable accent that made his English hard to understand. If a patient says my gut or my belly or my stomach hurts, so be it, let it be. It's all just semantics that is irrelevant to a person's actual insight or intelligence. If you listen carefully to a patient, he will usually give all you the information you need to make the appropriate diagnosis.
Regarding a live debate I had with a top U.S. medical student regarding people having to wait months to get a CAT-scan (CT-Scan) in England. If we allow each individual practitioner to freely order any test at will without a formal design via algorithms, the system becomes unusually inefficient and costly. Over 90 percent of us experience intermittent headaches, were we to order CT-Scans for all headache sufferers, it would not only be absurd, it would be costly. If we allow each individual provider to randomly evaluate a woman for secondary amenorrhea, the evaluation becomes costly and is determined by the provider's financial incentives, knowledge and is limited by his logic. If infertile couples randomly access our health care system, the evaluation can be in the tens of thousands or just a few hundred dollars. We can no longer allow individual practitioners to freely evaluate patient without some external monitoring. Reimbursement must be based on intelligence not random stupidity or greed.
