Chills

WHEN TO SEE YOUR DOCTOR

* A child who has chills and is also irritable or lethargic should see a doctor immediately—this could be a medical emergency.

* Your chills are so severe that your teeth are chattering.

* You have severe chills for more than an hour or the chills are recurring.

* You also have pain or discomfort anywhere.

* You have a heart valve abnormality and recently had either dental work done or an infection.

* You have a condition that compromises your immune system, such as diabetes.

* You have been taking oral steroids or are being treated for cancer.

What Your Symptom Is Telling You

When you dash out into a frosty winter morning in your pajamas to fetch the newspaper, a quick shiver is your body's natural response. A home thermostat set too low might produce the same reaction: Brrrrr, I'm cold!

Other than when you're simply chilly, a chill is most likely to be your body's signal that a fever is on the way. When viruses or bacteria invade, your trusty white blood cells release proteins that send a message to your brain's temperature control center. To fight off the infection, this control center begins to raise your temperature by constricting your blood vessels and making you shiver. As you shiver, the increased muscle activity produces heat, and the blood vessels in your skin contract to prevent heat loss.

When you have a chill, your skin may feel colder, but as blood is diverted from the skin to deeper inside your body, the temperature at the core of your body is actually on the rise. Most chills last for no more than 15 minutes before the fever becomes truly obvious, doctors say.

The flu bug or some other virus most often cues your chills, but any infection is a possibility—from pelvic or urinary tract infections to pneumonia. If your chills are bad enough that you feel like you're shaking all over, suspect an infection that has spread throughout your bloodstream. And if you've recently traveled in the tropics, it could be malaria.

Symptom Relief

When you shake, rattle and roll and there's no music playing, here's comfort and cure.

Treat the fever. The over-the-counter medicines you normally use for fever will also blunt the chill response, says Harry Greene, M.D., chief of general medicine at the University of Arizona College of Medicine in Tucson. Acetaminophen and ibuprofen are both effective. (For a complete discussion of how to deal with a fever, see page 182.)

Hydrate and rest. The basics of virus care are the same for chills, Dr. Greene says. Be sure to increase your intake of liquids and get plenty of rest, he advises.

Use comfort strategies. Try these steps when a chill hits, suggests John C. Rogers, M.D., M.P.H., vice chairman of the Department of Family Medicine at Baylor College of Medicine in Houston. "During the chill, pile on the blankets. In a while, you'll get a fever," he says. "Then take your Tylenol and sit in a tub of body-temperature water. Use a washcloth to rub your skin, which will dilate blood vessels, and as the water slowly evaporates, you'll cool off."

Avoid alcohol rubdowns. Don't use alcohol as a body rub, Dr. Rogers says. Rubbing alcohol on your skin will evaporate quickly but add to your discomfort. "You don't need to bring your temperature down that quickly, and if you're having chills, your skin will feel even colder," he says.

Dismiss the Saint Bernard. You may feel like reaching for the brandy when a chill hits, but don't, says Dr. Rogers. "Alcohol will affect your mental abilities and may mask more dangerous symptoms you need to be alert for," he says. "When the fever comes, alcohol may also cause fainting and a fall in the tub."

See the doctor. When chills and fever are really persistent, your doctor will need to evaluate any other symptoms you may have, such as pain or a cough. If you have respiratory symptoms, he may want a sample of your sputum to test for bacteria that may be responsible. If a treatable infection is diagnosed, your doctor will prescribe antibiotics, says Dr. Greene. In the unlikely event that you have malaria, a variety of antimalarial drugs is available.