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How to Tell If You Have Influenza/H1N1 or a Bad Cold

How to Tell If You Have Influenza/H1N1 or a Bad Cold
August 11, 2009 Patrick Nemechek, D.O.

Even as an Internist with 20 years experience, I find it somewhat difficult to tell if a person has a common viral cold or sinus infection from Influenza (aka, The Flu).

So many respiratory illnesses cause head congestion, coughing, fever, headache, sore throat, muscle aches, nausea or diarrhea – how do you tell what is what and what difference does it make?

Well, many common colds and sinus infections will resolve without treatment but the typical Influenza and H1N1 (‘Swine Flu’) can be easily transmitted to your friends and family, can cause some individuals to become so sick they require hospitalization and some may even die.

Another important point is that the medical treatment for Influenza and H1N1 must be started within 48 hours of the onset of symptoms to be effective.

This raises a questions: 1.How do I know if I or a family member have influenza and how can I get seen within 48 hours to start therapy?

The defining difference in symptoms between a cold/sinus infection and Influenza is the rapidity in which the symptoms come on. Colds and sinus infections tend to progress from feeling fine to feeling ill in the matter of a few days.Ā  Influenza and H1N1 tend to progress from fine to miserable in a matter of hours.Ā  You go to work feeling fine and by noon everyone in the office is asking you if you feeling alright because y0u’re so sick.

The reason for the difference is that Influenza and H1N1 cause pneumonia and the natural clinical course of pneumonia is associated with a rapid onset.Ā  In spite of have a cough, fever, congestion, etc, if the symptoms didn’t come on very rapidly they patient probably isn’t sick from pneumonia.Ā  Patients often describe it like being hit by a truck in that the symptoms come on so fast and they feel so sick so quickly.

Now there is a rapid diagnosis test for Influenza that can be done once you get into the office but this test will not detect H1N1.Ā  So that leaves clinicians like me with the difficult task of just uses our old-fashioned clinical skills to determine if someone may have Influenza and then treat them.

Getting in to see a doctor within 48 hours of developing symptoms is another difficult task.Ā  There are a few ways to deal with this. Some medical practices such as mine (Nemechek Health Renewal) have same day appointments or there own urgent care clinics and can get patients in and started on medication in time.Ā  If that is unavailable, consider going to one of the Nurse Practitioner clinics at the local pharmacy (TakeCare Clinic at Walgreen’s and Minute Clinic at CVS).Ā  I’ve found the Nurse Practitioners at these clinics very capable to handle these kind of illness.Ā  Lastly, one might go to the emergency room especially if extremely ill.

And one final comment, newsreports make it sounds like H1N1 is ‘coming’, as if its not here already.Ā  Well it never left the U.S. since arriving this past Spring and an estimated 10% of the country has already been infected. Ā  I see patients everyday or so who I suspect have H1N1 but most have waited too long at home to get treated.Ā  H1N1 is here but its just going to become much more prevalent in the next 1-2 months.

So remember, Influenza and H1N1 hit hard and fast and you need to get treatment started within 48 hours for the treatments to be effective.


  1. Sarah Brant 2 years ago

    Hi Dr N,

    The two little boys that I wrote to you about above have some flu symptoms that began today and they have an appointment tomorrow with our family Dr. Iā€™m in one of the Nemechek Protocol Facebook groups and thereā€™s some debate in the group over wether or not tamiflu should be used on the protocol. I wanted to see if I could get your opinion on this matter. I truly appreciate any feedback.

    • Author
      Patrick Nemechek, D.O. 2 years ago

      I would use Tamiflu if the doctor recommends it.

  2. Sarah 2 years ago

    Dr Nemechek, two of my kiddos who are on your protocol have recently been diagnosed with bicuspid aortic valve. One of those two kids has red flags for autism that have improved significantly since starting the protocol. I had planned to avoid any vaccines for a year die this child to give him time to heal. However now I am being told that people with BAV should always get the flu shot because of the risk of damaging the valves. Iā€™m not sure if this risk is associated with the flu or if itā€™s more of a concern with secondary infection, but in any case Iā€™m not comfortable with the flu shot. I was hoping you could give me your opinion in light of our recent diagnosis of BAV. Thanks for any help.

    • Author
      Patrick Nemechek, D.O. 2 years ago

      I’m not aware how influenza can damage the heart valves.

      I would ask the cardiologist if this is considered a high priority issue to protect the heart valves.

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