This Won't Hurt A Bit

Full episode transcript -


way gonna get this thing done and we're gonna do this. We're gonna do it. Why? We're gonna do it. Three biscuits


was this bit. So, Dave, tell us what was going on with our niece. My lad. Talk about that. Talk about it. Okay? Tell me what was happening.


So ah, phone call late at night. Niece was having a fever. Wonder if she should go to the e r. Ah, The fever, I think, was 102. You earned 100 to sing like that, and we got into a big discussion about why are we taking people to the e r. For a fever, right? And so I started, Like, pulling some friends. So you or a loved one or one of your kids gets a fever in the middle of the night? They take him to the e r.

You're sitting there. You're hoping the e r. Does what? Ah, bring down the fever. And without a doubt, most people said yes. We are going to the e r. So that the fever could be reduced so no one gets brain damage. So does fever cause brain damage? This is a legitimate concern of your family members I viva and friends from an infection is going to cause brain damage. So you go to the hospital so just has a special solution or an injection or a bomb. Or I think the ice bath bring down burning brain damage. Very


interested. And, you know, it wasn't just our family members because we're having dinner with our friends the other night and they had We asked them the same questions. Concerns, you know, why would you bring your daughter to the E. R? And they had the same exact answer off. The fever gets too high brain


damage. Okay, got it. Alright, understand?


And it raises a lot more questions and things for us to talk about. I think first kind of figuring out what a fever is, right? And then we can talk about what we do in the e. R. When someone comes in with a fever and what we're worried about.


What is a fever? Why is a fever? Who


is a favor? Win is a fever.


Where how is a fever fever? We're gonna explain and explore it'll, so let's do it.


He's burning up. Running A temperature will melt your brain.


My brain is on fire. I'm dying. What is a fever? Just what is the definition that you would use as a physician?


So I'll tell you the textbook definition of a fever, at least the cut off that we use, which is a hard cut off, which in itself is sort of bizarre. Why should there be one specific cut off, but the number that we use You wanna guess? Dave? What number? Tell me in


Fahrenheit. It's a magic number below your fun. You have a fever. It's a cut off


film. Okay, well,


hard cut up. I'm gonna say 101


Not bad. You're pretty close. The answer is in Fahrenheit 100.4 and in Celsius. That's 38 degrees Celsius. So any temperature at or above that number is considered a fever. Is that weird?


It is. But we had to have this particular cut off. But this comes from you. Take a whole bunch of normal people. You think they're normal and you take all of their temperatures, and then you do some statistical analysis and you say, Well, let's do a cut off under which almost everybody lives. That is normal. That's not sick. That doesn't have cancer or something else going on. And that will be our cut off for fever. And that cut off his bringing, determined to be 100.4 Fahrenheit, or 38 degrees Celsius. So now when a person comes to the doctor, the nurse Webber,

and you'd get a temperature. If they're above that cut off 100.4 Fahrenheit, 38 degrees Celsius, then you can say there's a really high likelihood that that's a fever that's abnormal. There's something going on because we know because we looked at lots and lots of normal people just walking around, doing their normal stuff and the overwhelming majority. I have a temperature that is less than that cut off. But it is kind of silly, because if you're 37.95 no fever, 38.5 fever. That sort of brings up the Christian world. Why do you get a fever? Why don't I get a fever when I'm infecting? The answer. That is probably that the enzymes and the cells that are in your body that they had a fight the infection work a little better when your temperature comes up and the bacterian, the viruses that are in your body don't work so well when the temperature goes up. So your body has worked out of a time through the wonders of evolution that if I raised my temperature, then I can kill these bugs a little bit of so the fever is actually probably useful, too.


So like activating the the military to go for It's like everyone join forces. Let's kill this virus. Let's crank up the temperature and will fight better. So yeah, it's not just the temperature alone where the virus is just melting.


Eso are friends that we're going to go to the I think they did. I'm going to the e r. Um, What is the temperature they should be worried about? What is the temperature where brain damage can occur? Or does it occur?


Well, let me say this. I would never First of all, I would never tell a parent. If you're worried about your kid, don't bring him to the e. R like I would just never say, you know, like if you're worried and you don't know what exactly to be worried about, that is why we're here. Bring them on in. We'll take a look at him. We'll evaluate them. But in general, what we look for when a parent brings their kid to the E. R because they have a fever is we're not concerned about the number about the temperature we're looking at. Why?

That's where our mind immediately causing the fear. Why do you have a fever? Not Oh, my God. You have a fever. But, like, why did you have a fever? Do you have pneumonia? Do you have back to re mia or urinary tract infection or meningitis or something? Something serious, like, you know, like meningitis. We don't want to miss that, but that's not determined. Necessarily by a number,


fever itself could make you feel a little bit. But if you look really sick, then I'm worried about what caused the fever. Yeah, not so much that the fever is gonna cause brain damage. I have never walked into the


room going Oh, my goodness.


This child is a favor. My brain is melting. That is never a concern of a doctor of somebody who's having a fever from a virus. Now they may have an infection in the brain causing. If even that's gonna be a problem, right? Favor


itself. I'm not working. Fevers are controlled by your hypothalamus in your brain. It's sort of the thermostat of the brain, and your brain is not going to auto destruct. In general, it's not gonna be like keep getting hotter and hotter and then it's going to melt. That's not gonna happen.


We'd have a big problem with evolution if that happened.


Yes, and keep in mind that this is different than hypothermia, So in hypothermia you have a high temperature. But that's not because your hypothalamus said give this person a fever. It's because you were trapped in a hot car or stranded in the Mojave Desert. I don't know something else that externally makes your body temperature very, very high, and that's dangerous. And we cool you with things like ice packs and cold I V fluids and things like that. So that's definitely not what we're talking about right now. Actually, we talked about that last season in our episode on Extreme Heat. What is the hottest temperature you've seen in a person? Let's exclude, like the hypothermic people just fevers. What's the hottest one


remember. I think like 106107 comes to mind for a little kid that's pretty toasty. And at that level, it starts to make your bit


anxious like their brain


is going to melt. Yeah, And the kid did phone you get Mottola and they came running round.


Numbers like that worry me.


It seems to be the generally accepted number. That 107 is the official freak out point. But, um, the official freak out point for parents is significantly lower the bet. But for most pediatricians, like over one of five, I start to get word. Even at that level, there's no good evidence that just that fever that your body created to foot the bacteria whatever is gonna do you any harm.


I very rarely have seen a fever that hits 100 and six or higher. And if I see a temperature that hot, the first thing I think Is there something else going on here where you know it is this hypothermia? Is this a drug reaction? Is there some other cause of a fever this hot? Because this isn't consistent with most fevers to go


that hot? Yes. So let me back up instead, that again I've sort of already passed out those patients where there was something else going. If I'm thinking just a kid with a virus or a little bacteria and a really high fever, no, but I have seen temperatures much higher than that. The person who got trapped in a car. The person was running sick on a hot day, the person who had a drug reaction and their temperature skyrocket. And then they do melt their brain that it really melt there. Brian. They just get breakdown. But not from just. I got a cold and Mike's body exploded. Well, but not explainable have said they've had 100 8 fever like I have friends that says, Oh, that one time I got really sick and I went to the doctor and I had 100 8 fever, and it's like you get a gold star for having the highest


of this group. They probably had 100.8 for starters, or if it was 100 and eight than they were probably delirious, and they can't remember what temperature they really


had. So they had a moment of abnormality. Well, they're lying or they're


exaggerating with


the 100 for that in court. The decimal point Exactly.


That's most likely


the highest temperature that I know about. A friend of mine is a pediatric moons, a physician. So she see lots of kids all the time. And I asked her, What's the highest temperature? The patient or parent of Isa said that their child is and she goes, Oh, I know this one so well, 450 degrees. What? Uh, yeah, this mum came in and said, Oh my gosh, you've gotta look after my little kid Here they have a temperature of 40 and 50 degrees. What?

What? Why do you say it's 150 degrees? Goes while I was cooking in the oven, it forward and 50 degrees and I put my hand on the oven and I put my hand on the kid and they were identical. And you've got to get this temperature. I think. What a waste of bio thermometer.


So do be. Answer your question. Can a fever cause brain


damage, right? Yes.


No, we have


not yet answered that. There's no good data that


shows it does. There's there's there's not


Unless It's an external


temperature, right? That's frying. Exactly. And then yes. Absolutely. You can get hypothermic.


Boring. It would be frying.


Yeah, it's more baking.


Is there anything you can do to bring down the fever? Like the ice Beth thing? Okay, Island. All right. Doesn't Tylenol bring down the fever?


Okay, okay. Good questions. Good questions. Eso first, let's talk about external cooling, right? Should you do that's what ice bath you're recommending were asking about a nice bath. Is that something that we should D'oh, Um, for a fever that's caused by your own body. Your hypothalamus is generating an increased body temperature. Uh, not so much. Here's why you take a kid and you dunk him in an ice bath right there. Hot fever. Want to cool him?

You don't come in an ice bath. What is that kid gonna d'oh! The kid is gonna shiver, right? Because it's uncomfortable and freezing. Who wants being a nice bath? So they're gonna shiver, and then this is gonna increase their basal metabolic rate. They're gonna be working extra hard just to warm themselves up from the ice bath you've dunked them in. So it's not necessarily helpful to cool them that way. Part two of your question was, Should we give them anti pirate IX? That's that's medicines that treat fever. Anti pirate ICS are acetaminophen, which is Tylenol and ibuprofen, which you know it's Motrin and things like that. So those were the really common ones. There's other ones, but those are the really common


ones. The pirate. It is something on fire. So it's something to stop you being on fire tunnels for when you're on fire. Just following the logic


of that word. Here's some tunnel. No, I'm on full. Forget


the extinguisher to my tile it off. Tell it'll be fun. It's an anti paralytic.


Yep. Eso Should we give that child an anti piratical Tylenol or ibuprofen? And Mel, why don't you? D'oh! The answer


is I would give the kid the Tylenol of the Motrin or whatever you want to treat the fever because hands up, those people have had a favor in the shrimp. That's three hand. Do you take a terminal when you've got a fever? Do you take


a Motrin when you got a fever? I do


make me feel better. Ideo I don't know. Hey, the Tylenol to make the fever go away because I'm worried that the fever is going to hurt me. I take it because I'm feeling crappy and part of feeling crappy is the fever. No, you might argue it might be actually worse to treat the fever than not treated. But I don't know of any studies that have compared


Well, there are sort of some studies that try to address this question. The problem is that they're mostly retrospectives. They're mostly looking back at things that already happened, and you can't really prove causation from them. But because of some, I'm gonna call it weak evidence. There are some people that believe that anti prior antics are not helpful, that they impede the immune system. But that's not the best evidence. I have to say that I generally do treat fevers, though, and part of that's treating the parents. I mean, they brought their kid in for a favor, So I'm going to give him something effective for the fever and the kids. Grumpy.

They got a fever. It feels awful. And also as many parents, no kid gets a fever. Kid feels awful. Kid doesn't want to eat and drink and then they get dehydrated. It becomes a bigger problem. So if you just treat the fever, maybe they'll feel well enough. We'll drink some fluids. Well,


yeah, I agree with you there. Reason to treat it because you feel bad. And again, I just sort of make common sense. Like when you get a fever. Do you take Tylenol? Do you take goodbye? Preference? Um, yet, because it makes you feel better. So it's not like treating the fever is going to cause the death and destruction of millions of Children. There's not, you know, ambulance runs, too.

Oh, my gosh, you gave somebody Tylenol and you killed this chump. It's the network, so it might be a little less effective. Your body might be a little less effective at treating the infection, but it's not like it's not effective at all. So I think most of us end up treating people cause they just want to make him feel better. It's called symptomatic treatment.


You want to know a fun fact. Okay, so a lot of time parents come in and they're like, I've been giving my kid ibuprofen. I keep doing it, I'm doing it every six hours or four hours, whatever. And I cannot break


the fever, breaking


the fever break in the fever. Okay, so then I give them medicine and then the fever goes away. And then the parents are like You have magic, ibuprofen or magic? Tylenol. How did


you do that? Well, I would guess that its industrial strength, if it's coming from the hospital


industrials, what does that mean? Industrial,


you know, like commercials. It's not like what


I get. A. Yes, you have


to have a stronger stash the night.


It's funny the way you phrase that, but essentially, that's true because I'm giving a weight based dose. So if you go to the pharmacy and over the counter, you buy a box of kids. I have a profiler kids, Tylenol. It is like for aged, you know, 2 to 3 give You know, this many teaspoons Well, that's not science. That's just like a couple teaspoons.


You know its way. It will be the granular size of that. He's right. It has to be. Wait, wait. Not like


yes, And they'd rather underestimate because they don't want to kill the kid than ever. I can weigh the child and then give the exact number of milligrams per kilogram for that child. And so I'm giving Ah higher dose. I'm giving an industrial strength Tylenol.


I'm hearing a $1,000,000 idea for a nap. Right now it's cold. A calculator?


What's the formula? Um, so it's in milligrams per kilogram. So if you're doing, like what is it? 20 milligrams were killing around 15 milligrams per kilogram. Then you had to wait the child. Cassidy.


The dose and app would be so much easier during a Seinfeld episode where he talked about medicines. Um, when he's sick, he basically said, I want the chemists, the pharmacist, the doctors to find out the maximal dose of this that will kill you and back it off just a little. Yes, that's when you gotta called ahead, stuffing favor like I want the strong. I'm going to the medicine camera like


I want the strongest thing you've given the strongest thing.


It'll kill me and then back off right now, giving the maximum strength it may the maximum allowable human dosage figure out what will kill May and then back it off a little bit. How exactly are temperatures being taken? Because I would assume if you're gonna take temperatures from the Arctic and temperatures at the equator. I guess if you're taking a skin temperature that would that would be dramatic. But so there must be another in a better way. You guys take temperatures than just the little is little strips on the head or the back of the hand. Mama's hand. How do you have you take the temperature? What's a good way of taking temperature? So that's a really good question. There is lots of different ways you can take temperature, and many of them are really inaccurate. So that skin temperature where you put it on your skin, they're incredibly inaccurate. Um, so they're useless pretty much,

but they're quick and they look cool, so they're good for marketing, but they're really actually useless. So you're right. So if you're really hot out and, uh, it's the equator and you put that thing on there, you probably have a favor. And if it's minus 60 into the winds blowing, it's gonna be so. Skin temperatures useless. Another one, as people put ah thermometer like under the egg Zillah,


because then you don't have to put an armpit.


Thank you you're welcome. Um, that's also really inaccurate. They're accurate. Way to get temperature is are released. They put it in your mouth on your tongue and closure. Math. That's pretty accurate. Fairly reproducible. But you know the best way to take a temperature. Well, one of the best way to take a temperatures day. You take a thumb over there and you stick it. Where in your but not my. But you're well, if you want your temperature, we can't state in my but we're gonna have to put it in your butt.

Okay, So it's actually a very good way to do it is to put it the moment in you. But why are y more than the mouth? Why the but more than mouth because you're breathing through your mouth internal. I guess if you've got an enormous amount of Flavius, this could be a


problem with the latest


his guests in general, you know, in the buttocks. But if you really want a super duper accurate temperature, you actually put in a cell for geo probe down into your Suffolk us, or you get a rectal probe that's really long and shove it way up there.


So the idea is like if if you if we're trying to check internal temperature, we care about the body's temperature at the body's core. So we call this a core temperature. Like if I were toe, cut your forearm off and stick a thermometer in the middle of your forearm. That body temperature is gonna be different than if I stick a thermometer in your spleen. You know, like you're gonna be warmer in your core. You should be than in your extremities. And so what? That's actually what we really care about is the core temperature, and the closest orifice that we can put a thermometer in a person to give us a core temperature


is usually short. Short of stabbing somebody. Yeah, I'm over. Yeah, he's at the moment I stepped into your liver. That's a very accurate. So does blood is Can you take the temperature of blood is bloody good, like marker for 10 core temperature. Oh, I'm sure it's great, but I don't know how to do that


right With formal blood from the blood, the mobile you've also seen as you would draw the blood would immediately cool. So anyway, we still it seems archaic, But yes, we're still putting thermometers


and people. But so in general, when you come to the not everybody's going to get at the moment of the big, but they were gonna take an oral temperature that's good enough for most people. But if you got a really sick person, or if they I got some other issues, then we might put a thermometer in there. But we might have to leave it in there with this probe that gives the continuous reading because we want to see that that temperatures coming in. But that's not really for somebody with a fever way. Do that for somebody who's got an external temperature elevation. So you've been in a hot car, you've got hypothermia. That's the type of fever we really worry about. It's not really a fever. That's hypothermia, and that's a big difference. What's a low grade fever? I've heard low grade


before. A low grade fever is a term made up by parents


very official. Then what's the definition on urban dictionary? Right?


Mervin Dictionary definition. No, I mean, that's not really there's not really any such thing as a low grade fever, adds a low grade fever is one that it has not quite met. The definition. The cut off of 100.4 Fahrenheit. But it's still above normal. So if you had, like 100.2, Uh, yeah, I guess colloquial Lee. You could say that's a low grade fever, but that's not really a thing. You know, it's a


hard cut off. I use that term a little time for myself. So you got a little virus and you're feeling warm and you're sweating a little bit and you take your temperature. And it's not above the magic threshold of a fever 38. But you know that you're getting a year of 37.85 You're like, Yeah, let's get a little low grade fever. It's low grade. It's not an actual real medical term, but it's a spectrum. We talked about the fact that favors the spectrum from 38 to 48. What what Senate Fahrenheit again 100. 100 for her. Before That doesn't seem like much 100.4 from, like what? We 98 point Something


all the time? Isn't that amazing? The bodies just so tightly regulated like it's just


so it's so, like better than a nest. A nest? Um, hot the film. This is the next them instead of you. But I don't have, like, a vacation mode. And you like an ico vacation, Kevin away mode? Nah, nothing. So So one thing some people pointed to when I asked this question was, uh, hallucinations. If you're having a hallucination with a fever, it means brain damage is occurring.


That explains a lot about me, because I definitely hallucinated with fevers. Is


a guy who say it all the time. Yeah, that's not the case. Yeah, okay. Yeah, for fevers had really bad hallucinations. Really bad. Yeah. So that's really common with fever. And my sister used to have an old time. Remembers kid being in sharing a room with her and she could get a favor, and she'd start to people coming in on the


walls and stuff like what the hell's going on?


That's not brain damage. That's just there was a little brain dysfunction that does make you a little anxious is neon looks like, but it's really common. High fevers, particularly in kids, makes them sort of see things weird and and get sort of hallucinations bring the temperature down and they start to get better. So but it's so common. Those people don't go on and have brain damage because look at you two, right? Well, you're here with us now. I don't know if that's a good example. And on top of the people talking about concerns about hallucinations, another thing people pointed to was the fever might cause seizures. Is that true? Can a fever if it gets too high, Kat is cause


a seizure. Why, yes, there is an entity called febrile seizures, and that's something that happens in little kids. And in general, if it's just a seizure from the fever and it's just one, and it's not otherwise like complex with other things going on, we don't worry too much about that. It's fairly common, and it's pretty benign. But, uh, again, that's why we're here in the e. R. For you to make that figure out that that one's benign, and that's not like the dangerous


kind. It's kind of scary for the parent that you can imagine. Ugo, you're wonderful little one year old and they get a fever, and then they have a full on tonic chronic seizures. So their arms and their legs, they're jerking and they're having a seizure. They come to the ear and the doctor's good history exam and doesn't find anything wrong. And you say, Well, uh, here's some tunnel. You can go home now The prince, like What do you told her? Happiest are melting, but it's really common in kids. Does that predict them going on to having seizures later in life? Mostly, no.


You've got a little


bit more risk of having seizures later on in life. If you had a febrile seizure as a kid,


but not much, just a little


tiny bit high risk that you'll have epilepsy later on.


There are a couple of special populations that we get more worried about when there's a fever is the 1st 1 is kids that are not vaccinated?


Lease. That's another show. Oh,


sure, I'm gonna say one thing about it. I'm gonna say if you have ah, baby and you don't vaccinate your kid and they get a fever, that kid is getting a full workup. It's very invasive. There's blood cultures and urine and spinal taps and all these things that have to happen because they're at such a higher risk for serious bacterial infection. And so we have to do a very invasive workup. So that's one special population, and the other special population is little babies newborns, and I'm not gonna get into the exact number of days old because that's controversial. But if they are a newborn with a fever, that's another very serious, potentially serious problem where you have a higher risk that something really bad is going


on. And you can imagine why little babies they're just starting to get out of the world on their immune system isn't quite ready yet. So that's why it's really still sort of the recommendation when you've got a tight little newborn. Not to be Randa the rest of the kids coughing and sneezing and getting all these infections because even if it turns out that it's nothing if you come to see Jess with your two week old who's got a fever, just has to do lots of blood cultures and spinal taps and give antibiotics and watch you in the hospital so you don't want that. So don't hop on an airplane with screaming Children with lots of infections when you've got a little time you bought and given a chance, given my month or two before they really get out into the world. So what does it mean to break a fever? Because everyone really seems to be concerned about getting on top of it and breaking it as if it's gonna just skyrocket out of control if it's unchecked. And that's sort of being perpetuated by movies. So you know, the heroine or hero is lying in bed and they're dying and they're sweating and the doctor magically comes in and the fever breaks got a fever and then they're fine, and I get for a 12 mile joke fund this letter. Will they go fight the bad guy for? There's the movie, so breaking a fever is it's a sort of a made up term. We don't we're not there to break.

The fever were there to treat the infection, and sometimes when you treat the infection, the fever goes away. But what can happen with high fevers is this thing called riders and chills. So you'll see. No, you've probably experienced when your fever's really high. It doesn't just stay high, but it actually cycles up and down so your temperature your body says I need to raise the temperature. Your body says I need to go to one or two. I want to fight this infection, but you're only at 98. So you get these chills in the chills. Start all the old muscles Thio contract on that a minute


workout, Yeah. Ah, it's like a shake weight on,


then, reasons that I'm not really clear of. Then it cycles. Danning is like, Well, I should get one, too. We better drop it down back to 98. So then you feel incredibly hot, and that's often where people think the fever's broken so your temperature comes down. You put you at the moment, are in there, and it's like 98. But you're sweating and you just you have to get rid of all this heat because your body says I now need to be a 98. So that's when the fever is broken.


So we've talked about ibuprofen. We've talked about Tylenol, but Dave Mel, do you know what the real treatment for a fever is? I think we're done.


Yeah, fevers. They're actually okay. I mean, assuming it's not from some external force not being caused by something evil thing underlining building. But generally it's like a good sterilization for the body.


Fevers air fine, except when they're not


right. We don't really care about the fever itself. We care about why the fever's there. And there is this thing called fever phobia. We've become so obsessed with fevers and all the medications to bring it down, but most the time fever is fine. Take Tylenol or be proven if you're not feeling good, but you don't really need to treat. Most fevers just cost there a fever. There's no such thing as low grade, and there's no such thing is breaking. Yes, but if you're ever concerned, as always, if you're worried, go see your doctor. Go see the year of people because,

you know, if you're worried, that's what they're there for. To help you guys there. Anyways, do something. Just stand around. Thanks to just Mason, Dave Mason and I'm no Herbert. This one heard of it is a production of Pool Abou Incorporated, produced by CC. Haven't Bill Connor. The information you here on this one hood of it should not be taken as actual medical advice. If you have actual medical questions about actual medical things, you should see an actual medical practitioner even though we are actually, doctors were not your actual doctor. So be sensible and keep it real. And this this, this this this this viscous says this is the


business. We're in a bit.


Okay, So my gut feeling is that your your body wouldn't let you get so hot that you cook yourself or that would be like a big problem. So I would like to think at some point during evolution, we sort of worked that out, and now we consort of regulate our temperature to a point. So maybe it's true. Maybe it used to be, um, back in the day that you got of arse a cold bars and your body went crazy and took you to 800 degrees and you exploded and died. You couldn't reproduce. And so that Gene wasn't passed on and the people who got fevers who didn't spontaneously combust on the humans you see today that's a definite possibility. I think that's that's evolutionarily. Really.


That's how evolution way we've weeded out spontaneous human combustion.

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