Alexa Fleckenstein M.D.

This is the question I am asked most often around this time of a year. How can one discern between the one and the other. Not that the treatment is very different – they are both viral and respond to similar measures. Only the flu lasts longer, and can lead to more complications. Sometimes, it it hard to tell which is which - but here are some guidelines. A cold and the flu - both make you feel lousy. The flu makes you feel even lousier, but that is hard to figure out when you are in bed with something, your nose is stuffed, you can’t breathe right, your head hurts, and you are miserable. Whereas a cold often starts slowly, with a little scratching in the throat over several days or bouts of sneezing, a flu often starts with a bang: One moment you feel fine – and an hour later you realize you are coming down with something really bad. Sometimes it even starts with queasiness in your belly, and you wonder what you are hatching. But very soon, all your limbs hurt, your muscles hurt, your skin hurts, your scalp hurts, your head hurts, and you develop a fever (most of the time): That’s the flu. Complications of a cold include sinusitis (especially if you reach for over-the-counter cold medicine that tends to dry out the nasal mucosa and clog the system, instead of letting the phlegm flow out), and earaches. A flu does often not present as an enormously running nose; a flu might have some stuffiness that doesn’t go away. Fever is rare in a cold, and prominent in the flu: When the fever mounts, you feel chills and want to be covered with a dozen duvets; when the fever falls, you are soaked in sweat and have to change pajamas and sheets. A flu differs in that you are usually much more incapacitated. Sinus headaches in a cold can be bad, but flu headache feel like a minor meningitis – and it is just that: the virus is affecting your meninges (the outer lining of your brain): It hurts to move your eyes, it hurts to move your head, and light that shines into your eyes bothers you (photophobia). And a flu leaves you weak and seemingly unable to recover. A flu may make it impossible to get out of bed for a week or two, sometimes even three – you feel like you will never recover. In a flu, all your strength seems to be sapped out of you, and you feel unable to do exercise. While you are still bedridden, it is not a good idea to push through because this is the time your heart can be affected too – and you need rest, not tough determination to get it over with. And let me say this out loud: This is not a time for cold showers or other heroic measures. Just lie back in your cushions and rest. A cold never leads to this kind of utter exhaustion. I say rest because you might not be able to sleep – that has to do with the irritation of meninges, too. On the other hand, some people do nothing but sleep. Both is fine, and part of the picture. What is not part of the picture: If you get delirious, if you get bronchitis and/or pneumonia, if your fever lasts longer than three, four days, maximally a week - then it is time to consult a physician. Because nearly nobody dies of a cold, but many people – especially the elderly and diseased – die of flu and its consequences every year. The most common cause for cough is phlegm that comes down from the sinus and tickles your throat. The best way to deal with it is to rinse your nose with saltwater (which I have described somewhere here – look it up in the index). The cough of bronchitis comes from deep within the lungs, sounds like trumpeting, and your chest might hurt severely – that is a sign you should see your doctor. Read More