Fit, healthy people are often completely floored by the flu. It can be much worse if we have MS. The aches, pains, sniffles, coughs and sneezes of the flu, whilst unpleasant, are bearable. It’s the fever that often goes with it, that makes life very difficult for people with MS (PWMS). I had been dreading this moment for good reason. My temperature peaked at 39.4 °C. Suddenly I couldn’t walk, sit up straight for any length of time, or even roll over in bed unaided. I needed help, like a baby, with almost everything. The tingling and numbness in my hands which I had found so aggravating for the last three years suddenly felt about a hundred times more intense than before. It was by far my worst experience of MS to date. So what is the drum on MS and fever?
Our body temperature varies during the day, and is different when measured at different points of the body, but 37 °C is considered normal. In practice, temperatures between 36.1 °C and 37.5 °C are all considered normal. Anything above 37.5 °C is therefore a fever, with temperatures around 38 °C classed as a low grade fever, and temperatures at or above 39 °C being classed as a high grade fever.
If fever accompanies a cold or flu, it’s likely that it is just a symptom of the body dealing with the virus or associated bacterial infection. The white blood cells that are battling the foreign invaders are sending chemical messengers to recruit more T Cells, and to signal the brain to increase body temperature to make life uncomfortable for the virus or bacterium, many of which can only survive in a narrow temperature range. It may be tempting in this case to let the fever run its course without intervention. However, heat stress can have unpredictable results for PWMS. Having gone through this very frightening experience with MS and fever, my strategy next time would be to try and keep the fever as close to 37.5 °C as possible.
A fever makes us feel horrible. We become listless, lose interest in doing things that normally give us pleasure, and become very interested in lying down somewhere warm, and sleeping much of the time. This is just what we need to be doing to give our bodies the best chance at healing, so here are my tips for riding out a cold or flu related fever if you have MS:
- Try and keep the temperature comfortable all of the time. Avoid extremes, such as going from a warm bedroom to a cold bathroom for example, and risk a bout of shivering that will encourage you to seek extra warmth that may lead to overheating.
- If you start to shiver, warm yourself gradually. Don’t be encouraged by a bout of shivering into turning on an electric blanket, adding blankets to the pile, or cuddling a hot water bottle or two, that may cause you to overshoot what your body needs, and send your temperature soaring.
- Dress warmly in pyjamas, and bed socks in bed, and a dressing gown and slippers when you have to be up and about.
- Take as much bed rest and sleep as you need.
- Take plenty of fluids. This is one time that fizzy drinks can really help. Ginger beer/Ginger ale, lemonade or plain soda water can be very soothing.
- Eat frozen popsicles or fruit juice ‘ice-creams’.
- Keep layers of blankets on the bed, and peel them back or flip them back onto you as necessary. Use the lightest amount you can. It’s a balancing act. You don’t want to add fuel to the fever and send it soaring, but you don’t want to get so cold that you begin to shiver.
- If your temperature starts to spike above the range you have decided is safe for your damaged nervous system, take a lukewarm shower, have someone massage you with rubbing alcohol, or use a cool, damp cloth to bathe your face, neck and shoulders.
- You may have already decided to manage your fever by taking medications. Certainly, if trying to cool yourself naturally isn’t working, then paracetamol can help to reduce the fever. You may also talk to your GP or chemist about non-specific anti-inflammatory drugs or aspirin as an alternative to paracetamol, as well as the appropriate dosage rates.
- Monitor (or have someone monitor) your temperature regularly and take appropriate action to bring it down. The biggest potential risk is falling asleep with a low grade fever and waking up with a high grade fever.
You can monitor your temperature with a good quality thermometer. It’s handy to have at least two around the house, because they seem to go wrong or get dropped with monotonous regularity. The electronic types that you pop in your mouth seem easier to use and give more reliable readings than the ones you have to manoeuvre into your ear.
If your temperature spikes above 40 °C, or if you have been running a high grade fever for more than three days without signs of it abating, or the fever is accompanied by severe diarrhoea, rashes, severe headache, stiff neck, confusion, problems staying awake, or any other signs of serious illness, seek medical attention.
Most PWMS are familiar with pseudo exacerbations, where an increase in body temperature, even by as little as half a degree, can cause the nerves to conduct in a disorganised, inefficient way. This can bring about a return of old MS symptoms or an increase in the severity of existing symptoms. With a pseudo exacerbation, once the body is given an opportunity to cool down, or to recover from the fever, symptoms should return to ‘normal’ baseline activity. However, there is something else happening during fever, that isn’t only about raised temperature affecting nerve conductivity. Cells function best at normal body temperature. When they get too hot, things can go awry.
In my case, the fever disappeared after a few days, and I was able to roll over in bed, get in and out of bed unaided, and to walk again, but my walking was not at the same level as before the pseudo exacerbation. It could best be described as a ‘zombie shuffle’. After discussions with my MS Nurse, I went to my local hospital and was given a short course of oral steroids and a referral to the hospital’s physiotherapy department to get some help with rebuilding my walking capacity again. When discussing why my symptoms had not returned to base level as the fever eased, the doctor at the hospital explained to me that the body’s proteins are denatured during high fever, and this may result in a genuine exacerbation of MS symptoms instead of a simple heat related pseudo exacerbation.
I could find little advice on the web for managing fever in MS. This is surprising, since it poses such an obvious and unpleasant risk of severe pseudo exacerbation and relapse. In a perfect world, we would simply avoid fevers, but it simply isn’t possible to avoid catching the flu, no matter how hard we try. However, the pros and cons of taking flu shots can be discussed with your GP as a preventative measure. Antibiotics can also be discussed for any bacterial infections that are associated with a cold or flu virus. Otherwise it’s a question of riding out a fever and dealing with any long term consequences as best we can. As always, seek independent medical advice, however, I hope the tips above help. Stay cool and good luck!