I just posted to say that I am not one to give med’s unecessarily myself and that I did not mean to imply that you have any kind of anti medication stance.  Obviously not with a CAH child---and you must be doing ok.  I also didn’t want people to think that I think the CAH immune system is not fully functional either.  There is of course nothing wrong with a CAH’ers immune system.  What I was trying to convey is that the immune system is dependant upon the endocrine system where it comes to erradicating any illness, virus and toxins from the body. 

I don’t think that there could be any dispute that when we are ill, our temp rises and cortisol levels rise in response and in doing so the blood pressure and blood volume increase.  These are all part of the bodies defense mechanism against whatever bacteria or virus is invading it.  As we all know hormones are chemical messengers and changes within the endocrine affect the immune system and vice versa.  I think that these things happen within seconds literally sometimes.  One thing sets of a chain of events and exactly how long does it take for blood to circulate the entire body?  That is the time it could possibly take for a message to reach its target destination and need a response with either increased immune system response and cells to deal with the invader or raised cortisol levels to make the conditions more effective for whatever has to happen.    I don’t just think it is a case of the blood increasing for the cells to get to the places they are needed, but immune cells need oxygen and increased nutrients to sometimes increase in their number also.    

See snippet below:

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As mentioned above, the process of swallowing of microbes by the phagocytes is known as phagocytosis. After the invading microbe has been swallowed, the next task for the phagocyte is to kill the microbe. This is achieved in two main ways.

• Aerobically, i.e. using oxygen. The phagocytes produce oxygen based chemicals that are highly disruptive to the swallowed microbe. Oxygen is highly chemically reactive, and these oxygen based chemicals "tear" the microbe apart. This process is known as the oxidative burst, or the respiratory burst.
• Anaerobically, i.e. without using oxygen. One way to kill the microbe without oxygen is by using a chemical that deprives the microbe of iron, thus preventing it from metabolising. Another way is to increase the acidity of the internal environment of the phagocyte.

When these tasks are complete, the Macrophages have one further task to complete. They return to the lymph nodes, displaying the remnants of the destroyed invader on their surface. This has the effect of stimulating the cells of the Acquired immunity system into action."

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So what I meant to say was that in illness cortisol levels I felt would raise in order to increase blood pressure to pump these chemical messengers around faster, excrete waste faster, get nutrients and oxygen to where it needs to be much faster.   We read so much about how taking zinc and certain vitamins like vitamin c can help with illness because they enhance the immune system by increasing the number of cells that can fight a virus or cold, but without the increase in blood volume and excretion rate as such, it would not go very far surely?  In illness cortisol levels need to be raised where it concerns infection most definately, as that is the normal anti inflammatory response as you will probably know. 

 There have been studies connecting poor immune response in people that have elevated cortisol, but I am not really sure it means elevated cortisol in illness---just a prolonged raised levels of cortisol as that can cause adrenal exhaustion.  I always associated this type of poor immune system response with someone that is perhaps so stressed that their cortisol levels were raised more than they would otherwise be which then suppressed the immune system response when it was needed.  The last time Ashley was ill in hospital I was arguing with a nurse to get his cortisol levels raised and she was back and forth between us and the Doctor.  he was on 75mg per day and it was not even touching the illness.  We wanted the dose raised to 100mg and for that to be distributed over four doses and she said that too much would suppress his immune system.  She would not listen to me and did not seem to realise that in actual fact if he did not have adrenal insufficiency, right at that moment his body would probably have been making much higher levels of cortisol and that because it wasn not, he was indeed having some trouble dealing with it and consequently every time each dose came around, (8 hourly at that point) he was nauseous and vomiting again---and yet after a high dose he was fine.  Who would not be with 30mg cortisol for an hour or so???  Of course when it wears off and there is extemely low levels and the infection is still there--this is what then causes the problem.  Adrenal crisis, when a child is really ill these kids can need up to 100mg immediately and more after that on a constant level to help their bodies cope with whatever it is that is causing the problem. 

To support the view that raised cortisol levels are not tied with poor immune system all the time, and need to be there when we are ill--but if not ebcourage prolonged illness I read that there have also been studies into people with CFS (Chronic Fatigue Syndrome) and they have been found to have low cortisol levels and low immune system response.  So I feel that the two are harmonious with eachother.  Perhaps when your making the stuff too much as in stressed mode for a prolonged period of time, when it comes to the crunch, the adrenal glands are so exhausted they cannot do the biz when it is really needed, i.e. infection, high temp illness?

You hear many people say feed a cold but starve a fever/virus.  To exactly what level you should starve one is the question?  Obviously extra fluid and rest is a good thing as it helps to flush out the virus and also keeps all the energy reserves to fight it.    One would have to look at what exactly a virus needs to thrive exactly to know what to starve it of.  But then in starving that, wouldn’t you be starving the body of the nutrients it needs to do what it needs to also? 

Also if raised temperature is something that slows a virus or kills it, in a normal healthy child that may be all for the good.  However, they have no problem producing all the right hormones that their bodies require to deal, and should the need arise at anytime, their cortisol levels will raise if an infection ensues as a result.  I guess in that case giving tylenol would be prolonging such, though small babies and toddlers can be quite miserable and really with adrenal insufficiency, distress is another thing you need to avoid for a CAH child besides a high temp.  A lack of cortisol I feel would be breeding ground for bacteria and infection.  What might start as a virus would wind up as infection in that scenario and how can you determine how long a CAH child has had the illness and the lowered cortisol levels--well a baby anyhow?  Older children usually tell you if they are sick.  babies usually get cranky and whiny and you usually can pick up a high temp before it gets too high.  

 There have been studies into that and it is said that early morning physical training is not really a good idea because it lowers the cortisol levels and raises body temp.  Levels of cortisol need to be high in the morning and when lowered every morning in this way, apparently from the study that they did in people who have morning training, the incidences of infection are increased.  So we can definately derive from that that lowered cortisol levels is good for bacteria to thrive and a temp is a good indication that this is the case before a crisis often.  Even if the temp is not up, it is absolutely no indication that the illness is not worthy of raised cortisol, because when we have accidents and stress, this does not involve havving a high temp.  Cortisol levels raise independantly of temperature therefore and so we know that there are situations where a child can be injured or ill and still need raised cortisol levels.  Exactly what is causing Natalie’s problem is related to her fluctuating temp obviously. 

I think there is a difference between a raised temp in a non-critically ill child and a critically ill child and that is perhaps where the importance and emphasis should lie herein?  At the end of this there is a link to a web page which covers a great deal about temperature in children and what exactly intervention is where it concerns a temp.  But that revolves around studies done in non-cristically ill children and critically ill children (which is basically someone with adrenal insuffuciency of CAH and a very high temp for whatever reason) are to be treated differently from my understanding. 

In non cah individuals the action of lowering the body temp would possibly have an effect of lowering the cortisol levels.  I get the impression that this would happen as in lowering the temp possibly this would be sensed as someone recovering.  Not as much stress on the body etc.  So perhaps in children with normal functioning adrenals by lowering the temp, they lower also the normal endocrine response also as I said earlier.  But in a CAH child because we increase the cortisol at the same time we attempt to lower the temp, we are doing something completely different--and that is where I feel the whole thing is to their advantage once we act immediately and increase.  No one is saying either that we should strictly increase in doubles and triples either.  i guess in some situations there are mild illness that could get away with increasing a little less than double.  On the other hand I have had to increase the total daily dose up to x5 and then split that over four doses for a mere viral infection come head injury the other month--25mg per dose--and that was scary but the point is--we can decide what we do either way.   It all depends on the severity of the stress to the body with illness or injury I guess.  I never did think that things were black or white but all kinds of grey shades inbetween.  If you increase a little above their normal needs though--(not too much) surely they get the best of both worlds happening for them?  I have never had an illness prolonged yet because I gave too much.  on the other hand I have had many prolonged because we didn;t double quick enough or for long enough or did not give triple or enough full stop. Honestly ;)  

Well I have heard many parents comment on how their CAH children often seem to recover much more quickly from illness than their other children.  I assume that this is the reason why.  here is that link: 

http://www.curtin.edu.au/curtin/dept/planstats/wacebnm/review/finalreport.html