It is your turn to be the doctor. Here is our case of the week. I’m presenting it to you because we have had more than our usual cases of this particular malady this school year. See if you can figure out what is wrong with this fake patient before I give you the answer.
Simon is a 20-year-old sophomore from Las Cruces, majoring in communication. He has a steady girlfriend, lives off campus and works at a fast-food restaurant. He doesn’t smoke and has no chronic health problems. He takes no medications. He comes in to the clinic with the following story.
He was fine until five days ago, when he started feeling really tired and achy. His throat is sore, he has been sweating at night and he has no appetite; in fact he feels nauseated. Mostly he is just exhausted. He could easily go back to bed in the morning and sleep all day. His girlfriend has not had this illness, nor has anyone he knows of in his classes or at work.
When you examine him, you note that his temperature is 101. Normal is 98.6. His heart rate is 100. Normal is closer to 60. His throat is red, and his neck has tender lumps along the back side. His heart sounds normal except for the increased heart rate. His lungs are clear. His abdomen is a little tender under the left ribcage.
You send him to the lab for a blood test and the result comes back two hours later, positive for the disease you were suspecting.
What is it?
If you guessed mono, you get Armchair Doctor of the Week award. There seems to be an upsurge of this illness at UNM recently. By this time last school year we had 19 positive tests for mono. This year we have had 50. This hardly qualifies as the Great Mono Epidemic of 2013, but it is interesting, to us medical nerds at least. Many infectious diseases come in clusters and waves, due to often unknown and unpredictable factors. For whatever reason, mono seems to be riding a breaker this year.
Mono is short for mononucleosis, which literally means an excess (-osis) of a certain type of white blood cell (monocyte) in your bloodstream. It is usually caused by an infection with Epstein Barr virus. There are rare cases caused by other viruses, but the clinical picture is essentially the same. It is passed from person to person by droplet spread.
Some people still call it “the kissing disease” as if you had to kiss someone to get it, but in fact most people have stories similar to Simon’s, where their close contacts don’t have it, or at least don’t show symptoms. Chances are Simon got exposed to it at work, where he is in contact with plenty of Joe and Jane Q. Germy Public.
Mono can cause a wide range of symptoms, from mild to severe. Most people fall somewhere in between. Simon’s sore throat is typically the most common complaint, but this year we are seeing lots of cases of mono with no sore throat. We are seeing more people with nausea and lack of appetite. Fatigue is the most common denominator, with leaden limbs, droopy eyelids, and a desire to stay in bed the rest of your life.
This infection tends to settle in the spleen, which is why Simon was tender on the left side of his abdomen. The spleen is tucked under the ribcage on that side, and can get swollen and inflamed when it is infected. A swollen spleen is at risk for rupture if it gets hit really hard, so we recommend that mono patients stay away from contact sports until they are better.
Mono can also take up residence in the liver, which is on the other side of the abdomen, under the right ribcage edge. If this happens, it is called secondary hepatitis, and can cause jaundice or yellowing of the eyes and skin due to overproduction of bilirubin from the inflamed liver. If you get this complication, we recommend you stay away from alcohol until you are better.
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Most people with mono have no desire to play football or go partying anyway. But again, there is a range of symptoms. Some people never even knew they had it. Others end up in the hospital, usually because they are so nauseated they can’t keep anything down and they get dehydrated. Some people take a long time to recover, and we have even had students need to drop out for the rest of a semester. Many people feel weary for weeks even after the acute phase has resolved.
We treat mono with supportive measures and symptomatic relief.
That is a fancy way of saying we can’t kill it. The Epstein Barr virus will be eliminated from the body by a normal immune system, which is your amazing body at work. Usually all you need to do is rest, get plenty of liquids to replace the sweat you lose with fever and your body will do the rest. We can help with medications to help relieve symptoms like nausea if needed.
This bug is contagious, so if you have it, protect your friends and family by keeping your secretions to yourself. Don’t share drinks, utensils or food. Keep your hands off your face and wash your hands often. You know, the usual precautions. Tincture of time is sometimes the best medicine.
Most people who get mono only get it once in their life, but unfortunately that is not guaranteed. You can get it again, and a few folks have some kind of chronic issue with it, either very delayed recovery or recurring flare-ups.
If you think you might have mono, we can do a quick and easy blood test for it at SHAC. Call 277-3136 for an appointment.
Dr. Peggy Spencer is a physician at Student Health and Counseling. She is also co-author of the book “50 Ways to Leave Your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous.
