From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: What Causes Fever and Aches during a Cold?
Date: Fri, 14 Nov 1997
Newsgroups: sci.med

In <346ACC27.E9192C5F@emory.edu> Andrew Chung <achung@emory.edu>
writes:

>Mark Nowak wrote:
>
>> Hi,
>>
>> Can anyone tell me how the human body raises its temperature when you
>> have a fever?
>>
>> Also, what cause the acheyness of muscles when you have a cold or the
>> flu?
>
>The cells of the immune system make and release substances especially
>the interferons which will cause all these symptoms including fever.
>These substances activate the body's defenses against viral infection.
>For bacterial infections, cell wall proteins from the bacteria are often
>pyogenic (fever inducing).


And the fever is actually generated by the muscle "shakes" (rigors)
during the shaking chills.  Which is why temp goes up right after
these.  If you get into a hot tub or shower when they come on, and
raise your temp that way, you won't be nearly so uncomfortable.  The
higher temps may help your immune response, also.

                                      Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: a simple question!!
Date: Tue, 25 Nov 1997
Newsgroups: sci.med

In <65ddmb$kre1@athserv.otenet.gr> ". Picolas" <pikolas@hiway.gr>
writes:

>what are the physiological reasons for the fact that  we are more
>susceptible to illness when it is cold?


Nobody knows, but chilling to even a couple of degrees below normal
body temp profoundly depresses immune response in rodents, and probably
also in people.  There's probably a good reason you run fevers when
infected.

Of course, some of the stuff about catching nasty viruses when very
chilled may be old wives' tales, though it's hard to prove this
"negative" for sure, since it would involve running people's body temps
down farther, and giving them viruses more pathologic, than you could
get permission from a human subjects review panel to do <g>.  There is
also the probability that in cold weather, people tend to stay cooped
up indoors where they tend to infect each other more.

                                 Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: Cholesterol causes heart disease
Date: 6 May 1998 03:19:16 GMT

In <Pine.SOL.3.96.980505101507.3192B-100000@ascc.artsci.wustl.edu> Alex
Brands <abbrands@artsci.wustl.edu> writes:

>Let's consider other body responses that people like to defeat.
For example, if you twist your ankle, it swells up, and for some
reason, people like to ice such a thing "to keep the swelling down".
Now, it's not clear to me exactly why you would want to keep the
swelling down, if that's what your body thinks is the right thing to do
(does it have to do with circulation?) but nonetheless, that's what
doctors recommend.<

   Only if your skin isn't broken.  If it is, the swelling will be
helping you fight infection (which is what your body is assuming is the
next thing to happen after injury).  And even then, your body doesn't
"know" about antibiotics, so it's quite common that your inflammatory
response to injury is more vigorous than needed (if the antibiotics are
working).  Meningitis is the perfect example: to get best results you
immunosuppress(!).  Best results in closed head injuries and anoxic
brain damage are turning out also to be surprisingly like icing your
ankle.  Cool the injured brain for a day by 5-10 F, and you get a LOT
less injury.  Your body's fighting an infection that isn't there, on a
scale you were never meant to survive from anyway.


>How about fever?  Fever is one way the body responds to infection,
ostensibly as part of the fight against the infection.  Now, I
understand that long lasting, very high fever can cause brain damage,
but a lot of people are anxious to bring their fever down.  I guess
it's because you feel better without a fever.<

   Sometimes.  Sometimes you feel chilly.  I tell my patients NOT to
take aspirin or Tylenol, and get in the hot shower or tub when they
feel that chill which tells them their body wants to be warmer than it
is.  If that gives them a fever of 103 F, so what?  Unless you're a
child capable of running a fever high enough to cause brain damage, or
you have bad heart disease, the higher temp's probably good for you.

   Hey, they used to cure syphilus that way, long before antibiotics.
Put you in a hot box for a day.  I think this won somebody or other a
Nobel, even.


>Allergies are another example.  Of course it is a GOOD thing to have
an immune system.  But it is a BAD thing to die from a peanut allergy.
How smart does the body look then?<


   Yep.  The body's smart about minor things, really dumb about major
ones.  You're not supposed to survive major injury and disease anyway.
Also, the body's really dumb about most things that happen as a result
of aging.  You're not supposed to survive that long-- there's no
program for it.  It would probably help older people a lot if they
could RUN a decent fever.  Too many of them cannot.

                                       Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Basic question about fevers
Date: 13 Feb 1999 03:04:02 GMT

In <36C4B02D.C0BBE03C@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>Carl Mueller wrote:
>>
>> Hi.
>>
>> I've been nursing a fever that has climbed as high as 103 since last
>> Monday night.  The problem is, the fever just seems to continue to
>> climb unless I do something about it (take aspirin or ibuprofen,
>> icepack, etc.).  But I thought the idea behind a fever is that your
>> body raises the temp. as to make it an inhospitable environment for
>> the germ, so that it dies.  So if I don't let the fever go, am i just
>> stretching this thing out?  It shows no signs of getting any better,
>> and I can't make a doctor's appt. until Monday now, so I'd appreciate
>> some advice over what I might do this weekend to improve things a bit.
>
>I'm not a doctor, but I did nearly die from a fever once.  (I had
>pneumonia)  If the fever goes too high, it can kill you.  So keeping
>it under control is certainly a good idea in some circumstances.
>
>I don't know about low-grade fevers, but my sons' doc always said
>just to give acetaminophen to reduce the fever.  My impression from
>doctors has been that fever really isn't that important for responding
>to an infection.
>
>BTW, I believe that the lethal level for a fever is above 105-106
>degrees, and children can handle a higher fever than adults can.
>(But the temperature range is based on my recollection, not a
>definitive source.)


   Fever does activate the immune system, and these days most docs are
advising patients to run as high a fever as they can tolerate.  It's
more comfortable anyway.  The shaking chills are just your body's way
of getting your temp up, and if help by getting into a hot shower or
tub, they go away.  Fever, per se is usually not that uncomfortable,
and if it is, it can always be brought down a *little*.

   The main thing to remember about fever is that its clinical meaning
is age dependent.  In a child a fever of 102 F may mean a cold or ear
infection.  It's a yawner if the child does have evidence of a cold or
ear infection.  In an 80 year-old, a fever that high almost always
means some kind of nasty bacterial infection (spreading sepsis from a
urinary infection, or pneumonia, or a ruptured diverticulum or
appendix), and one that has not a small chance of hospitalizing or
killing the person if the cause is not found pronto.  In fact, any kind
of temp over 99 F is worrysome in geriatrics.  Even a temp of 98.6 F in
a person who normally runs 97.6 F (as not a few older folks do).

   So-- it's not how high the fever is, but who has it.  You look at
the patient, not the thermometer.

                                         Steve Harris, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Basic question about fevers
Date: Sat, 13 Feb 1999 16:19:32 GMT

On 13 Feb 1999 03:04:02 GMT, sbharris@ix.netcom.com(Steven B. Harris)
wrote:

>   Fever does activate the immune system, and these days most docs are
>advising patients to run as high a fever as they can tolerate.  It's
>more comfortable anyway.  The shaking chills are just your body's way
>of getting your temp up, and if help by getting into a hot shower or
>tub, they go away.  Fever, per se is usually not that uncomfortable,
>and if it is, it can always be brought down a *little*.

Allowing the fever to run may be tolerable for adults, but children --
especially toddlers -- tend to be extremely irritable and fussy when
febrile.  Antipyretics usually calm them down.  And I know I
personally feel better when I get my own fever down, and I sleep
better.

As far as I know, there is still no resolution to the question of
whether maintaining your fever actually affects your disease course
significantly, for a typical viral infection.  Even if this were the
case, supposing that the flu would last 5 days if the fever were
active and 6 days if suppressed, I would much rather have the flu for
6 days if I kept my fever and muscle aches suppressed than be
absolutely miserable for 5 days!

>   The main thing to remember about fever is that it's clinical meaning
>is age dependent.  In a child a fever of 102 F may mean a cold or ear
>infection.  It's a yawner if the child does have evidence of a cold or
>ear infection.  In an 80 year-old, a fever that high almost always
>means some kind of nasty bacterial infection (spreading sepsis from a
>urinary infection, or pneumonia, or a ruptured diverticulum or
>appendix), and one that has not a small chance of hospitalizing or
>killing the person if the cause is not found pronto.  In fact, any kind
>of temp over 99 F is worrysome in geriatrics.  Even a temp of 98.6 F in
>a person who normally runs 97.6 F (as not a few older folks do).
>
>   So-- it's not how high the fever is, but who has it.  You look at
>the patient, not the thermometer.

Infants under one month of age are in the same category -- any fever
carries such a high risk of potentially deadly bacterial infection
that they are hospitalized immediately.

--
Jonathan R. Fox, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Basic question about fevers
Date: 14 Feb 1999 02:57:51 GMT

In <36c6c3e7.14185304@news2.brokersys.com> dsterner1@yahoo.com (Don
Sterner) writes:

>>I've been nursing a fever that has climbed as high as 103 since last
>>Monday night.  The problem is, the fever just seems to continue to
>>climb unless I do something about it (take aspirin or ibuprofen,
>>icepack, etc.).  But I thought the idea behind a fever is that your
>>body raises the temp. as to make it an inhospitable environment for
>>the germ, so that it dies.  So if I don't let the fever go, am i just
>>stretching this thing out?  It shows no signs of getting any better,
>>and I can't make a doctor's appt. until Monday now, so I'd appreciate
>>some advice over what I might do this weekend to improve things a bit.
>
>
>My doctors have suggested that I do nothing if a fever is below
>102.5 to 103Ff. Above that point I should take aspirin or
>acetaminophen - or both, if necessary. If the temp rises to 104
>or higher and can't be controlled, I should go to the doctor or
>ER ASAP. Likewise, I should see the doctor if the fever continues
>for more than 3 days.


    How old are you?  If more than 40, your doctors are idiots.

    Lemme guess.  It's not really your doctors, the nice triage nurse
at your HMO.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Basic question about fevers
Date: 16 Feb 1999 08:32:32 GMT

In <36C84900.36A0@enterprise.bidmc.harvard.edu> David Rind
<rind@enterprise.bidmc.harvard.edu> writes:

>Steven B. Harris wrote:
>>     How old are you?  If more than 40, your doctors are idiots.
>
>I can't tell whether the original post for how to deal with
>fevers was general advice, or around a specific illness.  I'd
>have to say that the past couple of weeks in Massachusetts, as
>we've been clobbered by influenza, I would not be getting that
>excited about a temp of 102.5 in a 45 year old with classic flu
>symptoms.  When not in the middle of a flu epidemic, I get more
>worried by fevers that high.


    I will have to agree that true influenza generates by far the
highest viral fevers in older folks.  But the older they get, the more
dangerous is the flu also.  I think I would get exited about a 45 year
old man running 102.5 F for days, in flu season, even with "classic flu
symptoms" (which as you well know, are not very specific).  Such a
person needs to be seen.  No, I can't tell you how soon.  But if they
feel really bad (ie-- not too sure they want to be driving) they
probably ought to be seen in an ER or Urgent Care (obviously
transported by somebody else), and not wait another day to see the
clinic doc.  You never know what you're going to find in a middle aged
or older person with a fever that high.  Heck, even pediatricians
worry (a little) about meningitis in those circumstances.  But in the
older adult, the risk of some kind of serious infectious process is far
worse than the tiny risk of meningitis in a kid with a temp of 102.5
for a couple of days.  That kind of temp in an 80 year-old, means, in
my experience, that they'd better be seen by a doctor somewhere in a
few hours, unless they are hospice and comfort-care folks.  Fail to
learn that in geriatrics, and you're in for a *nasty* surprise,
eventually.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Basic question about fevers
Date: 16 Feb 1999 08:37:50 GMT

In <36c8957c.15035082@news2.brokersys.com> dsterner1@yahoo.com (Don
Sterner) writes:

>> >>I've been nursing a fever that has climbed as high as 103 since last
>> >>Monday night.  The problem is, the fever just seems to continue to
>> >>climb unless I do something about it (take aspirin or ibuprofen,
>> >>icepack, etc.).
>>
>> >> But I thought the idea behind a fever is that your
>> >>body raises the temp. as to make it an inhospitable environment for
>> >>the germ, so that it dies.
>>
>>
>> >My doctors have suggested that I do nothing if a fever is below
>> >102.5 to 103Ff. Above that point I should take aspirin or
>> >acetaminophen - or both, if necessary. If the temp rises to 104
>> >or higher and can't be controlled, I should go to the doctor or
>> >ER ASAP. Likewise, I should see the doctor if the fever continues
>> >for more than 3 days.
>>
>>     How old are you?  If more than 40, your doctors are idiots.
>>
>>     Lemme guess.  It's not really your doctors, the nice triage nurse
>> at your HMO.
>
>Looks like Mr. Harris's post was canceled from my server so I
>never saw it until reading other responses.
>
>Yes, I am over 40 - 58, actually.
>
>Guess again re: the triage nurse. Actually, the services are not
>through an HMO at all. The physicians making the recommendations
>are my surgeon, a medical oncologist and a gastroenterologist,
>all employed by the M. D. Anderson Cancer Institute in Houston.
>Since these people pulled me though both Lymphoma and major
>pancreatic surgery involving considerable complications, I tend
>to think they are more than just "competent". My own primary
>family physician agrees with the philosophy. Obviously, other
>symptoms presented along with the fever could dictate an earlier
>visit, but I assumed that people like Harris would understand
>that.  Guess I was wrong.



   Yep.  I think that at age 58 you should have been seen by a doctor
for a couple of days of fever that high (103 F), no matter WHAT your
other symptoms.  But I don't claim to be infallible.

                                       Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,misc.education.medical
Subject: Re: Heart Rate
Date: 21 Feb 1999 16:09:21 GMT

In <36CE18B5.A699CE62@imap.pitt.edu> Dr & Mrs Smigrodzki
<srafal@imap.pitt.edu> writes:

>> the heart rate.  Heart rate rises an average of 6-7 beats/min for every
>> degree of fever.  Stress causes release of adrenalin in the body, which
>> causes increase of heart rate.
>
>       I am curious.  When one has a fever, I would guess that the
>diameter of blood vessels would enlarge in reaction to the temperature
>increase. This should make blood pressure decrease.  Would heart rates
>rise to increase the blood flow which is reduced by a blood pressure
>decrease?  I am ignoring the effects of the adrenalin kick-in.  What does
>anyone think?
>
>      Only a Doctor's wife.
>      Karen


    It would, but the adrenalin (or at least sympathetic) drive is
always stronger.  At least in people with good hearts, and in people
whose infections haven't gone so far that their capillaries and nitric
oxide systems are all out of control, and they are in septic shock.

    To see something of the way the system works in stages without
infection, you can look at excercise.  If you're in good shape, when
you start to run your muscle vessels open up, and you blood pressure
actually falls a bit because of it.  Your heart and sympathetic system
quickly takes up the slack, however, as you continue the load.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,misc.education.medical
Subject: Re: Heart Rate
Date: 21 Feb 1999 18:27:10 GMT

In <clw-1902991921430001@i48-03-10.pdx.du.teleport.com>
clw@teleport.com writes:

>In article <36CE12A9.7A798F74@apex.net>, thehydes@apex.net wrote:
>
>> the heart rate response with fever is an attempt by the body to better
>> cool itself.  By circulating the blood faster, more of it reaches the
>> surface quicker, allowing excess heat to leave the body.  This effect is
>> almost always present, in my experience, except in cases of shock.
>
>No.  The heart rate response to increased body temperature is to deliver
>more oxygen.  Hyperthermia (and conversely hypothermia) increases body
>oxygen demand.  The reflex "cooling" mechanism is increased flow to the
>skin in order to increase radiant, conductive and evaporative heat loss.
>Onbe can see this effect in the vasodilation that occurs in the
>hyperthermic state.  conversely in the hypothermic state, the cutaneous
>vessels are constricted to prevent heat loss.
>
>Before one open ones mouth and expounds on basic physiology, one should
>consult a physiology text book.


Comment:

    Actually, this may be a chicken and egg thing, and I'm not at all
sure anyone knows the complete answer.  To run a fever you usually have
rigors (the shivers) which are muscle movements to generate more heat
and increased temperature.  That happens first, and this certainly does
take up lots of oxygen, and do it immediately.  And heart rate and
breathing are certainly driven by the vasorelaxation and increased
venous return in exercising muscle, which is what shivering is.  So
heart rate does go up before temperature does, and then it goes up a
lot.  Except for when it doesn't go up much, which happens occasionally
in certain infections like typhoid fever, to the consternation of
physiologists, and just to make them humble.

   As for the skin vasodilation-- who knows?  People at the peak of a
febrile spike will sweat, and that is certainly in other situations a
reflex response to a temperature which some part of the body's central
thermoregulatory system now thinks is too high.  Cutaneous vasodilation
is on par with sweating.  All this leads to the defervescence phase,
where the temperature drops.  Or, again, it may be more complicated.
Is it all a reflex to a high temp, or in an infection is the
defervescence ordered at some level of the brain, for reasons unknown?
The fact that fevers vary greatly in magnitude and duration, according
to patient and problem, certainly suggests that the defervescence
symptoms, including vasodilation, are more than just reflexes.

   And something else odd: This is anecdotal, but I remember that the
mother of the siamese twin girls in LIFE magazine recently (the ones
joined so closely they look a bit like one girl with two heads, instead
of two girls with one body), remarked that when they were young, one
girl would get infected and be cold with shaking chills, and the other
girl (other half of the body) would be hot and sweaty.  We've suggested
that vasodilation is not just an automatic thing-- it's under very
tight central control.   The body is doing here exactly what the
brain/hypothalamous "wants", and what it wants is carefully programmed
by your evolutionary response to whatever your tissues are feeling at
the moment.  And that's not all due to bad humors circulating in the
blood (IL-1 and other interleukins, etc) or else Siamese twins with
common blood systems but different hypothalami could certainly never
mount different skin responses to fever (if we may trust this story).
If true, it isn't just the afferent (outgoing from the brain) skin
response to febrile infection that is neurally mediated-- if this
mother is right, some of the efferent (incoming TO the brain) response
is neural, also.  The blood is all the same temperature and carries the
same IL-1, but the brain reacts differently for some reason, in a body
that has infected tissue (sore throat or ear infection).  And the
nerves TO the brain are the only thing that could possibly be that
specific.

                                      Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.physics
Subject: Re: Ceramic fan heater uses less electricity ?
Date: 23 Jun 1999 10:17:17 GMT

In <7kp2u3$afr@news-central.tiac.net> conover@tiac.net (Harry H
Conover) writes:

>R.f. energy tends to induce an artificial fever in the human body,
>a characteristic that was exploited in diathermy therapy for many
>years (although today it's somewhat out of vogue).  Most broadcast
>technicians that have worked in close proximity to high r.f. energy
>concentrations have experienced the effect. (Because of this, my
>r.f. eposure limit for adjusting the phasers and antenna tuners
>on a 10-Kw four-tower antenna array was about 4-5 hours, beyond
>which point I often got chills that prevented me from taking down
>notes and a fever of nearly 102.)
>
>Like any method that heats the body tissue and not the surrounding
>air, the bottom line is that you feel cold and generally experience
>chills.  Same as with a normal fever.



    But that's NOT what a "normal fever" does!  There's a great deal of
misconception about this, it seems.  When you get infected you feel the
"chill" when your hypothalamus suddenly decides that your body temp is
too low (even though it's 98.6 F or so).  This is a result of your
thermostat resetting.  You ONLY feel cold when your temp is normal, or
rising.  Signals are then sent to your body to warm itself, and the
"shaking and rigors" are your muscles doing that.  They (shakes,
shivers, rigors) CAUSE the fever, not the other way around.  You can
abort them by getting into a hot shower or tub (which I often advise
patients to do).  When your body gets to the temp your brain thinks it
should be at, you're a lot more comfortable, and no longer feel cold.
You may feel perfectly normal.  Or your hypothalamus may reset again in
response to some outside stress (internleukins, bacterial endotoxins,
etc), you discover you're suddenly too hot, in which case you break out
in a sweat, and cool.

   Things that heat you internally make you feel hot internally, not
chilled.  I have no idea what the cause of your RF experience was, but
in RF diathermy fields (generally these are electric, though RF
induction is also seen), the subject feels overwarm, not cold.  I can
vouch for this myself, having worked around diathermy machines quite a
bit.

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: sci.med
Subject: Re: TWO DAY COLD & FLU CURE
Date: 23 Oct 2004 17:43:31 -0700
Message-ID: <79cf0a8.0410231643.6d1f1b6@posting.google.com>

milkywhy@wmconnect.com (MilkyWhy) wrote in message
news:<20041023024237.08561.00000590@mb-m22.wmconnect.com>...

> Could you give me some examples of foods we SHOULD eat or drink?
>
> How bout Tea or chicken soup?
>
> If you knew you were coming down with flu, what would you eat and drink?


COMMENT:

Chicken soup can't hurt, though I'm waiting to see that one verified
by a group of non-Jewish doctors.

Keeping hydrated is always important, and if you drink fluids it might
as well be fruit juice for all the good electrolytes and vitamin C. If
probably doesn't matter if you eat or not. If you don't feel like
eating, then don't.

Probably less important than what you should eat is what you shouldn't
do. Aspirin, tylenol, and other fever reducers probably should be
avoided. Fever is good and it activates the immune system. We don't
have any really good randomized studies of fever threatment for the
flu, but there's a lot of other data suggesting allowing fever to run,
makes sense.  And fever per se is not really uncomfortable-- most of
the discomfort associated with fever is not from the high temp per se,
but some from the rigors and chills which accompany the body trying to
GET to a high temp. But if you climb into your shower or 104 F hot tub
and assist that process, a fever's not bad at all.

If you're lucky enough to score a dose of FluMist this year, it's
especially important not to treat any fever which accompanies
infection with the attenuated virus. Those viruses are bred to be
temperature sensitive, and they can't take temps over 102 F or so
(even above 99 F for one of the strains). So fever does an even worse
job on them than the wild virus. Not that you're likely to run a high
fever with the FluMist, but at least it's nice to know that if you do,
you're really shutting the stuff down.

If you have true influenza, of course, there are now several classes
of active antiviral drugs. You might have trouble getting Tamiflu,
especially this year. And ribavirin's hard to find in capsule form
even in Mexico.  But if you have influenza A, you can still take
amatadine or flumantadine and get some effect.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: Bacterial flu dementia in elderly ?
Date: 26 Jan 2005 18:56:23 -0800
Message-ID: <1106794583.801611.129740@z14g2000cwz.googlegroups.com>

Pretty common. Mild dementia is very commonly aggrivated by fever. And
a really severe infection can make even non-demented people completely
confused. The general rule is all these mental status changes are
entirely reversible (provided the infection is not actually in the
brain), if the infection is cured.