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Is it a cold or the flu ?
flu Half the people with respiratory complaints are safer if they do not see a doctor!

If the truth were known, there is nothing substantive a doctor can do for typical cold symptoms and even minor flu symptoms. Prescription medications for flu symptoms are often no more effective than over-the-counters (OTCs).

Last year’s cold and flu season could have been much worse. There could have been a true influenza epidemic such as the 1917 swine flu epidemic that struck down and killed millions of people worldwide. However, that did not happen. There could have been an avian flu (bird flu) epidemic if the virus had “jumped” species and become a truly human infection that spread just like influenza but with deadlier consequences. However, that did not happen either.

Nonetheless, as in seasons past, doctors’ offices, outpatient clinics and emergency departments throughout the country were inundated with people with respiratory problems, all the way from the sniffles to pneumonia. It’s always a difficult time for patients who have long waits in crowded waiting rooms, seated on uncomfortable chairs, not feeling well, with little more to do than blow their noses and rub their sore tushes. It is even worse for the parents of young children who rub snotty noses, rock tiny bodies, and worry.

The irony is that about half of the people who show up in waiting rooms with respiratory problems should not be there. In fact, sitting for hours in a crowded waiting room, sharing viruses with one another with every cough and sneeze may be the last place you should be. If the truth were known, there is nothing substantive a doctor can do for typical cold symptoms and even minor flu symptoms. Prescription medications for flu symptoms are often no more effective than over-the-counters (OTCs). Antiviral medications such as Tamiflu generally have marginal effect, and antibiotics are not only ineffective for viruses, but they expose people to side effects and promote antibiotic resistance The fact is that half the people with respiratory complaints are safer if they do not see a doctor!

How do you decide when the benefits of getting medical care outweigh the risks? First, you need to know the difference between the symptoms of a simple cold or mild case of the flu from serious symptoms, which do require medical intervention.

Symptoms of the “common cold”
Every child gets about six common cold viruses a year and most adolescents and adults get two to three. However, when a child is running a high fever or an adult feels miserable, it is natural to think, “This has to be something worse!” However, think again. Typical cold symptoms include runny nose, stuffy nose, a dry cough, and a scratchy throat. Adults may also feel achy and run down, but usually are not so sick they cannot plod on with their lives. They seldom run a fever, and, if they do, it’s “low-grade,” (a degree or so above normal 99° to 101° F). Adolescents tend to react more dramatically to colds, with all the same symptoms but with an extra punch. They have more trouble plodding along with their lives (especially if their itinerary includes a history test they didn’t study for) and are more likely than adults to run a low-grade fever.

Children also have all the same symptoms as adolescents and adults but they often also run fevers and may have tummy aches, diarrhea, and loss of appetite. Children with simple colds can often have very thick nasal drainage (medical scientists call it “purulent rhinorhea; I call it “the snot monster.”) Unlike with adolescents and adults, a child’s fever may be frightening high, but it usually responds readily to acetaminophen or ibuprofen and general cooling measures. As the fever responds, a wilted, whiny child will often start scurrying around the house again as if nothing were amiss.

When a cold is not “just a cold.”
If you are still coughing, sneezing, and sniffling after about a week to ten days, it is time to see your doctor. You may have developed a sinus infection or bronchitis. Both of these conditions require additional treatment, often including antibiotics and sometimes steroids. Even in the days before antibiotics, most folks eventually got over these infections, but it often took many weeks, and they sometimes developed complications that are more serious. Bronchitis can sometimes lead to pneumonia; sinus infections can rarely spread to adjacent areas of the skull and even to the brain.

In addition, except for a sore throat, a typical cold seldom causes pain. Therefore, if you or your child has chest pain, earache, face pain, neck pain or severe sore throat or headache, it is time to see your doctor. Sometimes those annoying cold symptoms that just won’t go away are not a cold at all: the problem could be allergies, a condition for which there are several potential treatments.

Defining the flu
The “flu” that we are referring to is properly referred to as influenza. Although there is some overlap with cold symptoms, the culprit viruses tend to cause more serious illness and they can lead to complications that are more serious.

Influenza can give you all the symptoms of a cold and then some; it is a cold on steroids. While cold symptoms tend to sneak up on you, flu symptoms can knock you flat in a matter of a few hours. In addition, influenza usually causes a fever, profound exhaustion known medically as “prostration” or “obtundation,” a dry, sometimes painful and persistent cough, and loss of appetite. Sometimes the flu itself can settle in the lungs, causing a viral pneumonia with associated shortness of breath, wheezing, and chest congestion. Worse still, damage to the airways and lungs from the infection can allow secondary bacterial pneumonia to set in. Historically and globally, this form of pneumonia has caused the most flu-related deaths in previous epidemics.

Anyone with a serious chronic illnesses or a suppressed immune system, especially children between the ages of 6 months and 2 years of age, and adults over age 65, are at high risk. We usually don’t think of young children lining up to get a flu shot, but, because their immune systems aren’t fully developed, they can get seriously ill from influenza…or worse.

Who should be vaccinated?
Because there is no magic bullet that can shoot down the flu, an ounce of prevention is worth a ton of cure. Clearly, anyone who falls into the “high risk” group should receive the vaccine yearly, ideally in October or November before the flu season builds up. The high risk group includes people with diabetes, emphysema or other debilitating diseases and nursing home residents. Health care workers or adults who take care of infants less than six months old or people from the high-risk group should take the vaccine so they do not spread the disease. Children between two years and eighteen years of age who take aspirin regularly (for example, children with juvenile rheumatoid arthritis) should also take the vaccine. Contrary to popular belief, pregnant women should not avoid taking a flu shot; in fact, it is encouraged. The flu shot does not harm unborn children, but a serious case of influenza in the mother-to-be can. Healthy people between the ages of five and fifty may be able to opt for the nasal spray form of the vaccine, which is a kinder, gentler way of immunizing the needle-phobics among us.

Other precautions
First, bolster your immunity to infections in general by getting at least seven hours a day of uninterrupted sleep (sorry, but for you Type A’s out there, four short hours with a power nap is not enough), a well-balanced diet (a six-pack of diet cola in each hand isn’t what I mean by well-balanced), and enough exercise to stay fit, but not so much you exhaust yourself. Second, do not share eating utensils, cups, or eat or drink from of a common container. Fondue is definitely OUT during the flu season. If you must be near someone with the flu, avoid kissing, and wash your hands immediately before and after you care for them.

flu Use a combination of fluids, bed rest, and OTC medications for head and chest congestion. If a cough and fever are making you uncomfortable, the best advice is to get further advice. Contact your doctor’s office or check with your health plan’s advice nurse and find out if you need medical attention. If you have a high fever, shortness of breath, chest pain, and/or productive cough, do not wait for advice: head to the nearest emergency facility. If you or a family member have a high fever, trouble breathing, seem disoriented, distressed, or confused...call 911.

The take-home message is this: for your own health’s sake, you need to know the difference between a viral respiratory infection and an illness that requires medical evaluation and treatment. If you are at high risk for a serious case of influenza and its complications, be sure to get the flu vaccine every year. In any case, whether you have been vaccinated or not, if you get really sick, seek medical advice if you have questions about the nature or seriousness of your illness. On the other hand, if you are confident that you have nothing more than a common cold or a mild case of the flu, you are probably better off caring for yourself at home and avoiding people-packed and virus-laden waiting rooms. The person sitting next to you might have a contagious illness much worse than yours, something you would be much better off not sharing. Sometimes, having a generous neighbor like that can be hazardous to your health!

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"Is it a cold or the flu ?"
   authored by:
Dr. Anne Phelan-Adams is a board-certified family physician with experience in a variety of practice settings ranging from occupational health and urgent care to traditional family medicine. When not busy working or caring for her four children, thr...

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