What is Mononucleosis?
Mononucleosis is referred to as “Mono” and is caused by a virus. It usually presents as a bad sore throat.
Photo Credit: : Blausen.com staff. “Blausen gallery 2014”. Wikiversity Journal of Medicine.
Quickcare or ER?
A few RED FLAGS that will send you to the ER
- Severe abdominal pain. Mono can make the spleen become very large and weak
- Difficulty swallowing and breathing.
- Dehydration from lack of drinking fluids
What will your Doctor Ask?
Your doctor will want to know your symptoms. Remember, a symptom is your description of your condition. It is your story.
Your story will be much clearer after answering these questions:
How long have you been sick?
- Do you have a sore throat?
- What makes is better?
- What makes it worse?
- Are you able to swallow and breath ok?
- Have you been exposed to others with similar symptoms?
- Do you feel tired and weak?
The unique thing about Mono is the achiness and fatigue. Most patients , when asked how they feel, almost always say the same thing, ” I feel like sh-t”
What will your Doctor look for?
Your doctor will look for signs. Remember, a sign is an objective finding seen by your doctor
Your doctor will first make sure that the airway is intact. That is, no difficulty breathing or speaking. This is key.
The 3 classic things that are found with Mono are fever, sore throat and swollen glands (lymphadenopathy).
A few key points. A doctor will feel for the glands at the back of the neck (lymph nodes). This is a very unique finding specific for mononucleosis
A doctor will feel the size of the spleen which is in the abdomen. Why? Mono can make the spleen big and tender.
What is your doctor thinking?
Your doctor will make a mental list of possible reasons for your signs and symptoms. This list is called a Differential Diagnosis.
One possibility for a sore throat is the common cold
Another is strep throat? Strep throat symptoms are very similar to Mono symptoms
There are a couple of things to check.
First is a strep test. This is a simple bedside test using a cotton swab
Second is a Monospot test. This can be done at the bedside also.
What is the treatment of Mononucleosis?
Mono should be treated “symptomatically.” What does that mean? It means there is no cure.
It means, if you have a fever, take Tylenol.
If you have aches, take Motrin. If it hurts, don’t do it.
Your physician may be cautious and use an antibiotic.
Keep in mind, the antibiotic called ampicillin will cause a rash when given to Mono patients.
How long will you be sick?
A patient with mono may be symptomatic for 2 weeks but with have fatigue for months.
Key point: The spleen can get big and weak. That is why a patient with mono should not engage in contact sports for at least 4 weeks. If you look to the drawing on the right, #8 is the spleen
Let Me Tell you a Story
As an ER doctor, I rarely get calls on my cell phone. Once the shift is over, I am done. No phones. No overhead pages.
So it was a huge surprise when my massage therapist, Maria, called me in panic. “David. Please call me. You are the only one that I trust with this.” Sometimes being a doctor is like being a priest during confession.
“Ah. Ah. Let’s see. Ok. I will give it to you straight. I started seeing this guy named Abdul. We were just friends at first. But, you know. Well you know how hot I am. Anyway, now he is sick.” The first thing to think about is Venereal Disease-VD-The Clap.
She went on to say, “At first the doctors thought he had just a cold. Then he got sicker and he went to the ER…They told him he had Mono (Mononucleosis)”
It turns out Abdul had cough, runny nose, sore throat, general body aches.
I explained to her that there is not much to do about it. So why the tears? She let out another burst, “And then they said I could have given it to him.” Ahhhh. Guilt.
” He just started at Tesla and was supposed to fly off to the new battery-plant site…..Did I cause him to get sick?” asked Maria
Abdul, feeling a little dehydrated, eventually went to the ER. Was that necessary?
The next thing Maria knew, the ER nurse started an IV on Abdul and a $3,000 bill soon followed. That was a lot of time and money spent to be told to take Tylenol and Motrin.
I hope this helps
David Reyes MD
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