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Management Of Acute Fevers - A Real Challenge



(Article published in HomeoBuzz, published by http://www.bjain.com/)

Introduction:

A rise in the body temperature above the normal level is considered as fever. Fever is not a disease but a clinical manifestation seen in many diseases and conditions. In other words, it is a reaction of the body towards some external agents or stimuli. For a remedial diagnosis, Homoeopathy gives more importance to the individual features of the patient than the name of the disease. However, doing a correct disease diagnosis is very essential for the case management and plan of treatment, and it is also a must owing to some medico-legal reasons. Diagnosing a particular case as “fever” has no meaning whereas the pathological reason for fever is the nosological diagnosis in most cases. In majority of cases, a local or generalized infection is responsible for the increase in temperature. If the fever continues for more than three weeks with no diagnosis even after one week of hospitalization, it is considered as pyrexia of unknown origin (PUO).


When a patient comes to us with fever , the main demand from him is the quick diminution of temperature by any means because he wants to continue his routine work without any interruption. At the onset of fever, most of the patients may not be bothered about the ill-effects of suppression of fever such as shifting of sickness to the other organs or affection of generals such as loss of appetite, prolonged weakness, aggravation of respiratory symptoms etc. Those patients who are unaware of these facts judge the ability of the doctor or the efficacy of the system of medicine only on the basis of sudden relief of temperature. Hence, a good number of the public are under a wrong impression that Modern medicine is the effective mode of treatment to tackle fevers, and they demand some injections or bitter tabs even while consulting a practitioner of alternative systems. And those physicians who hesitate to use another system of medicine for this purpose, search for a tool in our own system. Here comes the use (or misuse) of specifics, tinctures, combinations, patent preparations etc. in order to bring the temperature to the normal level. At least a few among us relay on these methods as a last attempt before referring the case to a higher center. On the other hand, if the doctor intents to utilize genuine homoeopathy for his patient, it will definitely provide maximum benefit to the patient. But the selection of the most suitable drug in suitable potency and dose is a real challenge for the doctor.

Before we administer medicine to the patient, we should educate that fever is not a bad sign and the rise of body temperature is a natural mechanism of the body to make an unfavorable environment for the pathogenic organisms. The defense mechanism of the body gets activated during the episode of fever. True that high fever can be dangerous for the brain if the temperature rises beyond certain level, but fever is not a 'devil' as wrongly understood by many. There are some myths regarding the treatment of fever like the belief that if there is any infection, antibiotic is a must. It is quite surprising to note that even for viral diseases, tons of antibiotics are prescribed. It is also reported that during an acute viral infection, if the children take drugs like aspirin, acetaminophen, salicylates, it can lead to a fatal condition called Reye's syndrome. A few months back, a person from India (a relative of my friend) visited a European country. Immediately after reaching the destination, he suffered from fever and consulted a doctor. The doctor prescribed only a single tablet and asked him to take one-fourth only if the fever is persisting. This patient was shocked to see the minimum dose given by the modern medical doctor in Europe, because, under such situations, he used to get tons of tabs, capsules, syrups and injections from his family doctor!


A case of fever:

At the onset of the last monsoon, a boy named Akhil Raj, 11 years, hailing from a poor family, consulted me for fever persisting for a few days. His mother said that the fever started after falling from a small tree. Initially he took allopathic treatment. The temperature subsided immediately with sweating but he was getting weak along with some respiratory troubles. Hence his mother decided to try homoeopathy and discontinued the allopathic tablets, and then the fever reappeared. When they consulted me, the boy was looking weak with high temperature. His mother said that after the onset of fever, he is very much irritable. The tongue was coated and he refused food because of bitter taste. He also had constipation since the allopathic treatment. Also there was chest pain while coughing. The boy also got a smothered feeling whenever his father smoked near him. The same feeling was there even before the beginning of fever. He had pain all over the body which was getting worse by touch and motion. Appetite was poor but thirst was more. He had primary complex before a few years and took allopathy. His father, a chronic chain smoker, was also having tuberculosis. Though the fever was continuing, till then they had not done any investigations. I decided to prescribe first and do the investigation only when the condition was not improving.

[For this case, I did not use the computer to repertorise. The reason is, this patient consulted me at my other clinic, where I do not use the computer. After using the computer for a long time, I felt that I was loosing my touch with the pages of Meteria medicas and Repertories. To avoid that, I preferred to read the books and prescribe, and use the computer only at my main clinic]

I was confused between many drugs, though the case was pointing towards Bryonia. Needless to tell you that in any case of fever with cough, we can see a few common symptoms of Bryonia. Apart from that, Arnica, the synonym of injury, also came to my mind. To avoid a prescription by giving an over importance to causation (sometimes the causation can be a coincidence)or a prejudiced approach, I decided to consider other drugs also. This case had no strong characteristic symptoms but the following drugs were considered.

Arnica: Complaints started after injury; tongue coated; bitter taste; body painful to touch.

Nux vom: Irritability; complaints after allopathic medicines; constipation; bitter taste; loss of appetite; coated tongue.

Rhustox: Complaints after injury; monsoon season; fever with pains.

Tuberculinum: History of primary complex; family history of TB; a remedy to be considered when fever is not controlled.

Sulphur: Remedy to start the treatment; to make the symptoms more clear etc.

Bryonia: Irritable; bitter taste; coated tongue; increased thirst; body painful; fever with respiratory complaints; complaints during change of season; cough with chest pain; constipation; <touch and motion.

I prescribed Bryonia 30 three doses only, to be taken TID, along with one dram of pills as placebo. I advised the mother to increase the frequency of pills in case of high temperature. A frequent repetition of placebo is enough for the panic stricken parents, or else they would use Paracetamol (Now Paracetamol is almost like a home remedy) and the story will be repeated again. The next day his mother reported improvement of generals with slight fever still persisting. After two days, the patient was brought to me and I noticed well marked improvement. I prescribed placebo and decided to consider Tuberculinum next time, in case of any recurrence. But when the boy came back with his father, I could notice that Bryonia did the job well by making him alright, and hence Tuberculinum was not given. Again I continued placebo for a few more days. I also didn't forget to give a very strong advice to his father to stop smoking, since his child was getting affected by passive smoking.


Commonly used drugs:

The use of terms such as common drug, useful drug, best remedy etc. is actually against the concept of homoeopathy. Though we all are known as homoeopaths, our style of practice varies from person to person. There are single remedy prescribers, multiple drug prescribers, and those who prescribe homoeopathic drugs on the basis of allopathy. Drugs like Aconite, Bell, Bry, Rhustox, Eupatorium, Gelsemium, Euphrasia, Ferrum phos, Kali mur, Nux.v, Baptisia, Ars alb, Verat virid, Sulph, China, Nat.mur, Apis, Pyrog, Lachesis etc. are some of the routinely prescribed drugs. In the case of fever, some of these drugs are prescribed even in specific potencies, for example: Ferrum phos 6x, kali mur 6x, Baptisia Q, Bell 3x, Bry 3x etc. There is a section of practitioners who select a drug from a group of favorite drugs such as Bell, Bry, Rhus tox, and they try one drug after the other till the patient gets some sort of relief. There is another group of doctors who use a secret combination of different remedies for fever. These are different kinds of practice developed as a result of experience. Another type of prescription is by giving the indicated drug along with a mother tincture, biochemic tissue salt and a high potency of a deep acting drug. These are all the prescriptions of homoeopathic medicines, but not homoeopathic prescriptions in the real sense. It is true that giving a partially similar drug may give some relief but the frequent repetition of the same drug can be more dangerous than a dissimilar drug, and can even spoil the case. Hence the administration of the minimum dose of the similimum is best to achieve a rapid, gentle and permanent cure.


Nowadays the trend of classical homoeopathy is getting more acceptance. Even young doctors are now able to give a minimum dose with cent percent confidence. Of course, the credit goes to our pioneers and some of the contemporary homoeopaths. Majority of homoeopaths now prefer to take the case in detail and select the similimum in minimum dose. The cure of fever with the homoeopathic similimum can be a great experience because the patient will have good appetite, activeness, alertness and no respiratory complaints like prolonged cough and joint pains. Now look at those Chikungunya patients who were treated with strong doses of allopathic drugs for immediate results but now having continuous joint pains and difficulty in performing their day to day activities. A good number of such patients are now benefited by homoeopathy but their treatment would have been much easier if they had consulted a homoeopath at the beginning.


Points to be considered:

1.Always try to treat the individual having fever, and not the case of fever.
2.Detailed clinical examination is very essential and come to a provisional diagnosis.
3.Give the indicated medicine in minimum dose.
4.SBR (second best remedy, as told by Kent) should be given frequently to make the patients and care givers comfortable.
5.Frequent change of medicines can cause more difficulty in case management. This is more common when homoeopaths treat their family members, wherein we go on changing the medicines one after the other. In such situations, it is better to consult your colleague.
6.Always educate the patients about the science behind fever and importance of general symptoms in assessing the effect of treatment.
7.If the fever and other symptoms are getting worse, do the necessary investigations and co relate with the clinical findings and come to a disease diagnosis.
8.Always tell the patients to come directly for the consultation, because the father or any other family member may not be able to give the PQRS. If we do not get the real picture of the individual, we will have to give either a climatic remedy or specifics in alternation or even a patent. The medicine selected by guessing may not always hit the target. But, a failure will definitely “hit” the doctor's reputation.
9.When you treat the children with history of febrile convulsions, a few doses of drugs like Cicuta, Belladonna, Stramonium or any other drug as per the indications can be given.
10.Sponging the armpits, forehead and trunk with water may be useful.
11.Gruel is the best food that can be given during fever. In Naturopathy, they manage fever with fasting and consuming liquids like tender coconut water. We need not go in to that extend, but we should suggest a diet that is nutritious and easily digestible.
12.Physical and mental rest is very essential, however patient need not be in bed throughout.
13.Personal hygiene should be maintained. Bathing in lukewarm water is beneficial, but application of oil on the scalp should be avoided.


Conclusion:

By doing a statistical analysis of the cases of fever treated so far, I have noticed best results in cases treated with a minimum dose of the indicated remedy. On the other hand, cases treated with frequent repetition and/or alternation of drugs or patents give bad results or a prolonged course of treatment. When the condition of the patient is not improving, we should take the opinion of our colleagues or seniors, and in most cases, the second opinion works. Even after second opinion, if the case is not improving, we should not hesitate to refer the case to a higher center (with a detailed treatment history) for further investigation and management. In my experience, it is better to refer the patients directly before they go themselves.


Views: 3381

Comment by sajjadakram on March 10, 2010 at 6:37am
The prescription was correct and was based on physicals only.
sajjad.
Comment by Dr Muhammed Rafeeque on March 10, 2010 at 6:54am
Bry was given on the basis of acute totality: Irritable, bitter taste, coated tongue, increased thirst, body painful, fever with respiratory complaints, complaints during change of season, cough with chest pain, constipation,
Comment by sajjadakram on March 10, 2010 at 7:00am
This is the best protocol. Following this technique homeopath can achieve success in every acute case. I am sure.Well done.
sajjad.
Comment by Jonathan Shore MD on March 10, 2010 at 3:38pm
An excellent article Dr.
Comprehensive and covers all the bases.
Much of what you say is confirmed in my own experience.

I can only add a little about the administration of the remedy.
In such acute cases I let them put some of the pellets in about 2oz of water and succuss 10x against the palm of the hand before each dose - about 1tsp.

If the parents/patient is reliable and not too anxious the instruction is to see if there is an amelioration. If so, if the symptoms return they can repeat the dose.

As long as there is amelioration after any dose, it can be repeated if the symptoms return.
I think this is helpful especially in cases where the remedy is close enough to push the case in the right direction, but maybe not exact.
Comment by Dr Muhammed Rafeeque on March 10, 2010 at 11:34pm
Thanks for your comments.

The globules and sugar of milk tabs contain starch, gum, whitener etc. Moreover, some homeopaths dispense the medicines in blister packs, wherein the medicine is heated. How can we trust these methods? Why should we imitate modern medicine? Hence I feel, the best method is to administer the medicine in water in divided doses. Of course, we can use tabs, globules and blister packs to give placebo.
Comment by Dr Ajay Yadav on March 11, 2010 at 12:16am
hi rafeeque
really good article .in last three years i had treated so many cases of fever.
i had seen in all acute case its important to get ailment from and you get your remedy .
i had seen in many acse ACONITE is remedy wher onset is sudden and getting no ailment from .GELS 1m IS ANATHER good remedy for fever i had seen with master result
dr ajay
Comment by Dr Muhammed Rafeeque on March 11, 2010 at 5:17am
Thanks for the comment.

Have you tried Vijaykar's acute chart method?
Comment by Dr Ajay Yadav on March 11, 2010 at 5:54am
yes i had followed dr vijaykar ,its good and wonderfull in acute
Comment by Dr Muhammed Rafeeque on March 11, 2010 at 6:49am
After attending his lectures, i started with his method. But, gradually I came back to my own style, though the result with his method was quite satisfactory.

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