Winter Doldrums

By Dr. Jim Ferguson

C.S. Lewis begins his wondrous little book, “The Great Divorce,” by describing a “long mean street” shrouded in semi-darkness and drizzling rain. I feel much the same about cold and dreary February, whose only redeeming aspect is its shortness. I don’t like winter and after the Holidays, and perhaps a snow or two, I’m ready for spring. People holler about global warming. I say bring it on.

I wasn’t encouraged when I heard that Punxsutawney Phil saw his shadow on February 2nd and predicted six more weeks of winter. However, I have about as much faith in a Pennsylvania groundhog’s ability to predict the arrival of spring as I do of politically motivated scientists who deign to predict the weather ten years from now based on computer models.

Nature and winter are hard on animals in the wild such as the birds at my birdfeeder. Only the hardiest survive. Humans are more compassionate of their own and provide shelter, food and treatment for those who will have it. We have a significant “homeless” population in Knoxville just like New York, Los Angeles and Sarasota Florida. Unfortunately, so many of those who choose to live on the streets have lost a centering spirituality, and are driven by drugs, alcoholism and mental illness. It is tragic that so many reach for a hand out more than a hand up.

I’ve been watching the CDC website which reports influenza activity in the various states. Over the last several weeks the reports of influenza activity in Tennessee have gone from “low” to “high.” So if you haven’t gotten a flu shot, get one!

Becky and I are finally recovering from what I have called the Thistle flu, named after our small Thistle Farm. Typically influenza is associated with a sudden high fever of 101°F or more, and aches and pains analogous to being beaten with a stick. Headache and cough are also prominent symptoms as well as watery eyes which doctors call coryza. I had a patient who once told me he knew he had influenza because he felt so bad he was afraid wouldn’t die. Hyperbole? Yes, but quite descriptive and diagnostic with influenza in the neighborhood.

Like good citizens Becky and I had our flu shots. There are many viruses which circulate in the human herd this time of the year, and our misery didn’t fit the classical picture of influenza. “Colds” primarily affect the upper respiratory tract with head congestion, drainage and sometimes low grade temperature. The term “flu” is a nonspecific term for a viral syndrome more than a simple cold and less dramatic than influenza.

Retrospectively, Becky and I probably had a nonspecific viral flu-like illness rather than influenza. Flu shots are not perfect, but are helpful and can prevent or lessen the impact of influenza in two-thirds of those vaccinated. Perhaps our persistent post-flu fatigue is consistent with resolving influenza, now being diagnosed in Knoxville along with generic flu. They’ve even shut down schools in Knox, Blount and Hawkins county due to illness in students, teachers and bus drivers!

The doldrums is a colloquial expression of torpidity which derives from maritime usage. It refers to areas in the Atlantic and Pacific Ocean where capricious winds can suddenly abate and becalm a ship. Perhaps my post flu asthenia is why I seem to have lost the wind in my sails.

Quarantine is a therapeutic measure to isolate creatures who are sick from others in the herd. It is a very effective strategy. Our best advice during the flu season is to stay out of crowds, religiously use hand sanitizers and cough or sneeze into your sleeve rather than tissue paper. Thankfully, few people use a handkerchief anymore. Spring will eventually save us by driving us all outside and away from close contact with each other. Only then will viral infections of all types decline.

I am impressed with a mother’s ability to diagnose a fever in her child. And by observing my daughter and my wife’s hands-on method of diagnosing fever in my grandkids (aka the cute ones), I have become better at this time honored diagnostic tool of touch.

Being a scientist I still prefer a thermometer to touch, and believe a quantitative reading is better than a subjective one. I often ask patients who call whether they’re running a fever. Surprisingly, few have measured their temperature, though it remains a simple and important diagnostic tool. The old moonshiner, Rafe Hollister on the Andy Griffith show eschewed measuring his temperature. He maintained that when he was sick he was either “hot, dang hot or dead.” We can do better.

Many years ago a sentinel study was reported from a family practice clinic. By analyzing fever in more than 3000 patients, across ages from infants to the geriatric population, it was discovered that a fever of 101° F in patients more than 65 years old predicted serious or life threatening illness with a 90% probability. This level of temperature did not hold such dire predictions in youngsters who I’ve jokingly said can walk across the street and run a fever. Of course, this is also hyperbole, but you get the message: a high fever in older folks should be evaluated by a doctor sooner than later.

You might ask why you run a temperature when you’re sick. Shivering is produced by contractions in the tiny muscles of your body and generates friction and heat. This is driven by your brainstem to elevate your basal temperature set point. But why are we designed this way?  Apparently, there is a survival benefit from an elevated temperature in infection. An elevated temperature suppresses the release of iron stored in your tissues. This deprives bacteria that might be in the bloodstream of iron necessary for their metabolism and proliferation.

Some might find these arcane aspects of medicine tiresome or boring. I find them wondrous and behold the hand of God. The Psalmist proclaimed, “We are fearfully and wonderfully made” (#139). He is right. I see similar majesty when I look into the heavens and contemplate my place in the Creation (Psalm #8). You should read these musings of wonder and wisdom from 3000 years ago.  Somethings never change.

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