Fever-approach and insight for commons

Fever is a common problem which we experience in our day to day life.Many times you get confused,what to do.For better understanding I am trying to simplify the things.

How do you know that you have fever?You feel yourself that something has changed or wrong in your body.You tell your family or friend,they touch your forehead or hand and say”oh my god! You have fever….”They try to make themselves sure by applying thermometer in your mouth or in your axilla(under your arm firmly pressed between arm and the side of your trunk) and check the temperature reading.”If it is 100 degree Fahrenheit or more,they get confirm that you have fever.

Now the important thing you must understand that fever is an important symptoms of many different diseases.From trivial to risky. My approach here to provide you some insights which will help you in addressing fever at odd time,odd situation when you don’t have access to a qualified doctor or you cannot visit him for monetary constraints.

Following points can help you when you or your relative have fever.

1.Be sure that it is really fever.Assessing fever by touch,is often misleading.Suppose you manipulated the ice container from your refrigerator or have handled ice or some cold substance with your hand and returned in bedroom to wake up your kid who is sleeping under blanket cover,you touch his forehead, “Oh god he has fever!”.You may be wrong.Or you touch someone who has just come from a hot environment and you happen to touch his body,you may be mistaken for fever.

So the best thing you should do is to confirm it by thermometer.Many of you are worried with the definition of fever.Don’t bother,just keep in your mind,if the temperature is greater than or equal to 100 degree F(Fahrenheit), it is fever.mercury in glass thermometer You may ask how long should I keep the thermometer in mouth or under arm?If you are using mercury thermometer, you should keep it for two minutes.For digital thermometers, there would be a beep sound to indicate.One more thing to note,you should ideally take temperature from axilla.Tip of the thermometer constantly touching the skin in axillary fold for two minutes in mercury thermometer.Taking axillary temperature Take care to clean the thermometer tip with small cotton with antiseptic.Follow the standard operating procedure of the thermometer you are using.

2.If you are sure,you have fever what should you do.Everyone knows that paracetamol 500 mg tab can relieve ones fever for adult,and for kids paracetamol 125 mg syrup or 250 mg syrup can be used.Dose adjustment for body weight is essential when you are giving that syrup for kids.The most important thing,patient who have jaundice or liver disease should not take this medicine.Pregnant and nursing mother should not take it without medical advice.Oh! Really difficult to take medicines without doctor’s advice!You have alternatives apart from medicine.Take a bath,wear light cotton clothes, sleep in air conditioned room,apply ice or do cold  sponging. It is interesting to note that a type of fever which is triggered by extremely hot atmosphere cannot be resolved by medicines,the only solution is application of cold in any one of my previously explained alternatives.High temperature of your body can damage the brain.It is good to keep ice packs on forehead.How long should you do such cooling effort?

You should do cooling up to 100 degree Fahrenheit.When the reading of thermometer goes below 100,stop the cooling process.

Now work is over!your temperature reduced the work is over! No.. Not necessarily! You have to find out the reason behind your fever.Check, whether the person having fever, has any wound  on skin which is causing pain or oozing pus.If it is so,thoroughly clean the wound with antiseptic,drain the pus and apply framycetin or any antiseptic ointment,cover with gauze,then apply cotton and dress it.bandage on woundTry to change dressing whenever it gets dirty,wet or every alternate day.Apart from it amoxicillin+dicloxacillin combination adjusted for body weight may be taken.If you are allergic to penicillin,you can take azithromycin or roxithromycin.Warning!antibiotics should be taken only under guidance of qualified medical practitioner. Is there any alternative? Yes,you can use one to two teaspoonful turmeric powder in a glass of boiled milk twice daily.Raw garlic if possible to be sandwiched in your bread can improve your healing power.
If you don’t have any wound in your body,is there any burning sensation in urine?If yes your fever might be due to urinary tract infection for which you can refer to my earlier post for urinary tract infection.
3.If you have no wound in your body and no burning sensation in urine then what else?Do you have cough with sputum coming out?If yes,Check its color,whether it is yellow or blood stained.If it is yellow,greenish or blood stained,go to your nearest clinical lab and get yourself checked,sputum for culture and sensitivity and sputum for AFB.After giving your sample you can start amoxycillin +diocloxacillin capsule 500 mg thrice daily for five to seven days for adults.For kids dose should be adjusted for body weight.warning!Antibiotics should be used under guidance of qualified medical practitioner only..

Your sputum culture and sensitivity report arrived and reports says positive results.Check for the name of antibiotics which shows the greatest number of + signs for example,it is written ++++ against levofloxacin,you can choose anyone with greater number of + for your respiratory tract infection.You should take that antibiotic at least seven days according to the prescribed daily dose according to your body weight.For example an adult weighing sixty kg can take levofloxacin 500 mg tab, one tab daily for at least 7days if he has ++++against levofloxacin in his sputum culture and sensitivity report.Or he may take roxithromycin 150 mg tab every twelve hour for seven days,if the same report says ++++ against roxithromycin. OR he may take OFLOXACIN 200 mg twelve hourly for seven days,if the report says ++++against OFLOXACIN.

The dose in children should be adjusted for their body weight.Suppose your sputum for culture and sensitivity report is negative.Check for sputum for AFB report,if it is positive,then you should go to government run hospital or primary health center,they would provide you free medicines for tuberculosis after doing some confirmatory tests from their sides.This medicine for tuberculosis should be taken for complete six months.Take care not to miss the course.

If your sputum for culture and sensitivity and sputum for AFB are negative,then you should continue amoxycillin +diocloxacillin as I have stated earlier for five days.If you see improvement in your cough,you should extend it up to seven days and if no improvement till five days of amoxycillin +dicloxacillin, then you should go for x-ray chest PA view under advice of a qualified doctor.

If your sputum for AFB is negative and your chest x- ray doesnot show any abnormal sign and you still have fever for more than five days despite taking amoxycillin and diocloxacin for five days,you should  get tested for malaria and typhoid.For malaria MP test and for typhoid widal test.(note:if you are living in area where malaria is common,and you have fever;you should get your blood tested for malaria earliest and you should give it  priority.)

For malaria test the result may be positive for falciparum or vivax.Your doctor would provide you exact line of treatment.Don’t try self medication at all.For typhoid widal test,if give you positive results,be careful to interpret it correctly,it should be positive for 1:160 dilution or greater to be significant.If you are sure of widal positive.Adults can take Ciprofloxacin of some reputed brand 500 mg twice daily for two weeks.Their  fever can be controlled by paracetamol 500 mg,cold sponging.Here it is important to note that paracetamol is just used to relieve the symptom of fever and it should not be repeated before 8 hours.Further for typhoid fever,requirement of paracetamol ends after five days of ciprofloxacin therapy.Beyond that you should complete your ciprofloxacin course of two weeks even if you have no fever after five days.

If you have fever and associated skin rash or eruptions,your fever might be due to viral infection.It is wise to consult your primary healthcare providers in such cases.In developing countries the myth is prevalent for such disease as wrath of Mata and there is no treatment for this.There are some antiviral drugs which can help you,but your doctor only can diagnose and decide about it.But you should keep one thing in your mind,you can boost your disease resisting capacity by use of vitamin-c.

If you are a welder or working in an industries where furnace being operated for metallurgy, you may experience fever with chills.Such fever is often confused with malaria.This fever is metal fume fever and can be relieved by paracetamol.,

If your little kid is wrapped in blanket for long,his body temperature may appear high on touching,so it is a better idea to confirm the fever with thermometer.A kid can generate more heat due to brown fat cells containing numerous mitochondria.Whenever your kid has high body temperature that is 100 degree Fahrenheit or more,you should not cover his body with blanket.It is better to keep them in light color cotton clothes till their temperature is 100 degree F or more.High temperature can damage the kid’s brain and make them unconscious.

Twenty six years ago,when I had not joined my medical college and I had no idea about medicines,I heard a cry in my neighborhood that a two year kid got unconscious.His grandma was crying and shouting.The kid had fever.The family members had kept him in warm woolen clothes.I rushed for auto for his transportation and went along with them to a child specialist.The smart doctor just removed all woolen clothes and did cold sponging and miraculously the kid opened his eyes.Further he prescribed some medicines and advised  to keep his body open for cooling.

Many kids get convulsions when they have high fever due to the bad effect of excess heat on brain.If you encounter any kid who has fever and convulsion,do cold sponging and put ice packs on forehead.

Brain is very sensitive organ,it can withstand cold but it cannot tolerate hot.If you have habit to take bath with warm water,keep in mind,never pour hot water on your head.

Thank you for patient reading…….










Approach for infertility,what you should know

    Infertility is a common problem now a days with huge psychosocial impact in a couple’s life.In majority of cases the lack of awareness regarding normal physiology of reproductive organs, is the cause of infertility.This post is dedicated for the desirous couple who need some insights.There are few noteworthy points which they should understand to solve their problems..

    1.Three basic requisites for conception are A.adequate healthy sperm count in semen(semen is a fluid comes out from male Sex organ at the time of orgasm.The process of release of semen is called ejaculation.Semen contains millions of sperms per millilitre of semen.Sperm fuses with egg in females’ fallopian tube to form embryo which develops into baby in womb in approximately nine months.)

    B.Ovulation(release of egg from women’s ovary)

    C.opportunity of the sperm to meet with ovum in the fallopian tube.(after sexual intercourse the sperm from the semen released from male into female’s vagina goes into her uterus which has two tubes attached on each side.Both the tubes have finger like projections which are close to the respective side of the ovary.One egg comes per month from any one side of the ovary.That egg via finger like projection of fallopian tube are taken up, as soon as released from ovary and if sperms reaches that tube at that time,the egg gets fertilized.)

    2.To know the sperm count,you can simply go to your local clinical lab and ask for seminal analysis.You can see your sperm count against the normal range of the same in your seminal analysis report obtained from the lab.

    If this is normal,your second issue is ovulation in your female partners ovary.For this you should know that on the day of ovulation her temperature rises.If you do daily check the temperature of your wife just before getting up from the bed early morning and make a record of it from the day one of the menstrual cycle,you can find her body temperature increased on fourteenth day if she has 28day menstrual cycle.If her menstrual cycle is of more than 28 days,you simply subtract 14from that figure.For example,suppose her period comes every 35days.You subtract 14 from 35..It comes 21.So she would ovulate on 21st day(assuming first day of bleeding is day one of the menstrual cycle.So in such case woman is likely to conceive on 21st day.So desirous couple should make effort on 21st day in above example.Here one important thing to note is,sperm can survive for1-2days after ejaculation and egg upto 3-4days of ovulation So two days before to four days after ovulation a woman has better chance to conceive.So in above example the couple can make effort from 19th day to 25th day. One important tip is that,the male should keep abstinence during other period for better results.Further the female should take folic acid tablets from two to three weeks prior to their efforts and should continue it.Apart from this both partners should take vitamin E supplements 400mg  every alternate day or 15days every month.Apart from this,they should get treatment of any Sexually transmitted disease they have.

    If you have taken care of above things and still your wife did not become pregnant.There may be technical problem in intercourse.No chemical,lubricants or oil should be used.After intercourse and ejaculation the female should remain in lying position for at least three hours Preferably the foot side of bed should be raised.

    Best approach to summarize, Male should abstain from Sex from the first day of his wife’s menstrual cycle.(even he should not masturbate).He should know the duration of her menstrual cycle by reviewing her last three period onset dates.Whatever the average duration of menstrual cycle comes  by assesing last three period onset dates,just take a note of that.Subtract furteen from average duration.The number which comes after subtraction is the day on which her egg will come or ovulation date.On that very day have Sex with her if possible twice or thrice and keep her in lying position on the bed whose foot end is raised for three hours.

    Once more I need to elaborate the calculation of ovulation date(date on which a female’s egg released from ovary and taken up in the fallopian tube of her uterus.)Take following steps:

    Step-1.Mark in your calendar when your bleeding starts in a new cycle.The marked day is day1. Similarly in the next two cycles mark the bleeding start day in your calendar. Suppose in march month your bleeding had started on 25 March 2015.So day1 of the new cycle which had started in march was 25 March 2015.That bleeding persisted for 5 to 7 days and finished.Again in April,your bleeding had started on 27th,then the day1 of this second cycle would be marked in calendar on 27th April 2015.Again in May the bleeding started on 21 so it day1 of third cycle would be marked as 21st May.Again in June. Suppose it came on 20th June,so the day1 of the fourth cycle should be marked on 20th June.

    Now you have got day1 of the four consecutive cycles:

    1.        25 March 2015

    2.         27 April 2015

    3.          21 May 2015

    4.           20 June 2015

    Step-2.    You can count the days between day1 of the first and the day1 of the  second cycle, between 25 March and 27 April. ……….. 33 days(first menstrual cycle duration)

    Similarly between day1 of second and day1 of third cycle,

    between 27 April and 21 May………………..24 days(second menstrual cycle duration)

    Similarly,between 21 May and 20 June…………29 days(third menstrual cycle duration)

    Step 3-Add all the three consecutive cycle duration and divide the resulting number with three.

    In above case 33+24+29=86

    86/3=27 approx.

    So this is the average of your three consecutive cycle duration.

    Step-4. Date of ovulation=Average menstrual cycle duration Minus 14

    So in above case it is 27-14=13

    So in this case ovulation day is 13 th day.

    So this female would be most likely to be pregnant,if sexual inter course would be done on 13th day from 20th June.

    If the dates are regular in a female then you are not required to do such calculation.Ask what is her expected date of coming period and do Sex 14 days before that expected date.

    If you have addressed the above points and still not being pregnant,then go for ultrasonography for pelvic organs and tubal patency test.If they are also normal.Get Yourself tested for VDRL, HIV,TORCH TEST,MICROFILARIA TEST,HORMONAL ASSESSMENT.

    But that part would better in consultation with your gynaecologist.