By Penelope A. Domogo, MD
In the 1980s when I was fresh from medical school, fever was one of those necessary occurrences of childhood. It was part of growing up. Parents and caregivers didn’t really mind it and we, doctors, were not worried either. We had reason not to be concerned because in those days, the fever is usually not so high, the baby/child is still breastfeeding and in a few days, the baby/child would be well.
Fast forward to 2010 and beyond. When a child or anybody in the Cordillera has fever, people get worried and immediately take measures to bring down the fever. We have become so afraid of fever because we have come to associate it with serious diseases like dengue hemorrhagic fever and covid. Take note, I said dengue hemorrhagic fever (DHF), not simple dengue fever. And this season, we are seeing dengue fever patients. Well, not all fevers are dengue fever.
What is fever?
Our body normally maintains a certain body temperature range, thanks to a built-in thermostat in the brain. So even if we are walking in a very warm place like Tabuk or go climbing cool Mt. Pulag, our body maintains a temperature of 35.5-37 degrees Centigrade (taken in the armpit) or 96-99 degrees Fahrenheit. Above that body temperature is fever. In medical practice, fever is a body temperature of 37.5 degrees and above. (We can also get body temperature under the tongue and in the anus and the figures would vary.)
Body temperature can increase with physical activity, strong emotions, eating, heavy clothing, some medications, high room temperature and high humidity. Temperatures of women go up by 1 degree or more during ovulation. But these are not considered fever.
Fever is an important part of our body’s defense mechanism. Why? Many bacteria and viruses or germs that cause disease thrive best at around 37 degrees centigrade. Above that they are killed or immobilized. Think of your own reaction. In a very hot environment, you would just want to sit down, that means you are immobilized. Moreover, studies show that during fever the other components of the immune system, like the white blood cells, work faster.
What causes the fever? There are internal and external causes of fever. Most often, the cause is external like bacteria and viruses. Internal causes are autoimmune diseases like systemic lupus erythematosus wherein the body can’t recognize itself anymore.
In eastern medicine, fever is also a survival mechanism because it is one of the body’s way of discharging excessive expansive energies. If these excesses are not discharged, then they will get stuck and accumulate in the body and lead to more serious diseases later in life. Germs thrive in a sugary environment so if you are fond of sugar and milk/chocolate and fruit (or any food that has those), then your sweet blood would be fertile ground for bacteria and viruses. Notice how children in remote barrios whose parents seldom buy sugar or milk also seldom have fevers. And notice, further, that if they have fever, this will not be so high and will surely go away without any medication after a day or two.
Fever, then, is just a symptom or a sign that something is wrong with the person. Just like a car that will overheat because there is no more water in the tank. Fever is not the disease. The characteristic of the fever will also give a clue as to what is causing it. Classical dengue fever, which is a viral infection, has a saddle-back fever – meaning the temperature is immediately very high on the first day, goes down about the 2nd or 3rd day then shoots up again the next days. Classical typhoid fever, which is a bacterial infection, starts with a low grade fever going higher as the days go by- a step-ladder fever. But then there are a lot of variations in these fever patterns.
Elderly people and very young babies may not have fever and might even have lower than normal temperature in very serious infections because of their poor immune systems.
What then do we do when somebody has fever? Because it is a defense mechanism and a symptom, fever should not be lowered unless the person is very uncomfortable or has other symptoms like vomiting, severe headache, irritability, convulsion or high fever (41 degrees and above)
It is important, though, to drink plenty of fluids – water, plain and thin vegetable or bean soup. You may put lemon grass in the soup. Safeng – the fermented drink of Bontoc- is okay. Don’t give anything sweet or processed. If there’s no appetite, don’t force eating. There’s no appetite because the body wants to concentrate its energies on fighting the invading germs. Digesting food will require additional energy. Meat or eggs are not recommended as these produce heat and require much energy to be digested.
Remove excess clothing or blankets. Room should be comfortable, not too hot, not too cool. If fever is high, you can give lukewarm sponge bath. Not ice or alcohol rubs as these will cause rebound fever.
If necessary, you may give paracetamol every 4-6 hours or ibufrofen every 6-8 hours. But don’t awaken the person just to give the paracetamol. If there is still high fever, wait for the patient to wake up then give the paracetamol. Remember, though, these anti-fever medicines can damage the liver and kidneys at high doses so give only when there is a reason. If there is no more fever or the person can tolerate the fever, then stop the paracetamol or any anti-fever medicine. Consult your health worker if there are symptoms other than fever like cough or if the patient has poor unbalanced diet or you are not sure what to do.
Somebody wrote, “although fever signals that a battle might be going on in the body, the fever is fighting for the person, not against it.” We should not, then, be afraid of fever. But let us be concerned why there is fever and let us take steps to remove its causes. Choosing to eat the right foods would be the first major step. ***
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“A gentle answer turns away wrath, but harsh words stir up anger.” Proverbs 15:1
