Mono Common, But Often Misdiagnosed

When R. Geordie Hyland '98 arrived at Harvard, he was excited to play hockey. But in mid-October, he started feeling tired all the time.

It took three visits to the University Health Services (UHS) for Hyland to discover that he had mononucleosis, or mono.

"I wasn't happy with that," he says. "[At first] they just thought it was a [flu] virus."

Hyland went home for a week to recuperate, missed three weeks of classes and dropped a class; a month later, his liver and spleen are still not back to normal.

In many ways, Hyland's is a common case at Harvard.

UHS "probably sees documented mono three or four times a month," says Dr. David S. Rosenthal, Director of UHS. "Sometimes it's up to 10 [cases per month]."

Like Hyland, many students who have had mono complain of UHS diagnosis procedures. Several undergraduates say they did not get mono tests until they demanded them.

For those students who are diagnosed with the disease, it often means weeks in bed and the loss of class, extracurricular and work time.

Hyland, for instance, has so far been unable to play with his team.

"For me, the biggest thing was not being able to play hockey," he says. "I'm a freshman, and I was real excited about playing."

Common Ailment

Mono is more common in close living communities like Harvard, where people are in constant contact, Rosenthal says.

"You always hear about [mono cases] more because of close living, with people having more contact," he says.

The disease is generally transmitted through oral contact or saliva exchange, which is the source of its nickname, "the kissing disease." But kissing is far from the only way to get the disease.

"You can actually cough in someone's face [and spread mono]," Rosenthal says.

Matt B. Botein '95 had mono during his sophomore year.

"My roommates quarantined all the food items I touched," he says.

The stress of life at high-pressure colleges like Harvard also leads to mono for overworked students. Unhealthy living styles aggravate students' mononucleosis, Rosenthal says.

"There's no question that if they're burning the candle at both ends, they're more susceptible," he says.

Lisa L. Ritter '97 says she was not surprised to learn she had mono.

"I was stupid. I only got about three hours of sleep a night for about a month," she says. "There's an attitude at college that you should be doing work--that if you are getting sleep, something is wrong with you."

She's changed her ways now, however.

"I learned my lesson," she says. "I got eight hours [per night for] the rest of the year."

Weeks in Bed

For those who do get the disease, weeks in bed are the norm. The most common symptoms are a sore throat, swollen glands and general exhaustion. Most sufferers from the disease, which is caused by the Epstein-Barr virus, get a fever. Two-thirds have an enlarged spleen.

Many patients' livers are affected, and one-third of mono sufferers have strep throat as well, according to Rosenthal.

"Mono is very variable, due to liver involvement," Rosenthal says. "If there are liver problems, that causes the most fatigue."

Ruth S. Raskas '96 developed a severe case of mono last January and February. She was diagnosed by her home doctor over intersession. He told her she was going to have to take the semester off.

"I had terribly swollen glands," she says. "I couldn't swallow, couldn't eat, I don't remember ever being so sick."

Despite her doctor's advice, Raskas missed only three weeks of school. "I didn't do very many extracurriculars, and slept a lot," she says.

While a mild case might only last three weeks, mono can linger for three to six months in some people. Most students are back to their activities in six to eight weeks, Rosenthal says.

Jessica I. Levin '95 had mono as a first-year for about six weeks, including over final exams.

"I had a quick, really intense case," she says. "It could have been the summer, so I was relatively lucky."

Her case was easy to diagnose, she says.

"I had a high, high temperature, and an enlarged spleen. I was sick as a dog," she says. "It was very obvious what I had."

Levin, who lives in Massachusetts, went home to recuperate, only coming back to Harvard for exams.

"I was beyond fatigue," Levin says. "I just sat in bed except to go take finals and then I'd go back to bed."

There is no specific therapy for mono, and bed rest is the best prescription. Botein also says: "[UHS] tells you not to drink alcohol until the liver count comes down."

Anne Harkavy '95 was sick for nearly eight months. She stayed in bed all summer, giving up a Washington, D.C. internship.

"It was horrible," she says. "I just sat in my bed, watching O.J. and complaining to whichever friends called me."

The months in bed disrupt many students' plans.

"The worst thing about it was my parents stuck around when they found out I was sick," Ritter says. "They made me stay in their hotel room, and it was when everyone was finding out about the housing lottery.

"They were breathing down my neck so much I thought I was going to go insane."

Misdiagnosis

Many students say, however, that their biggest problem with mono was getting a diagnosis from UHS. Mono is diagnosed by a blood test, called a mono spot test.

Harkavy says she literally had to give UHS an ultimatum to get a test.

"I told the people at UHS that I wasn't going to leave until they gave me a mono test," she says. "So they did."

Several months earlier, Harkavy tested negative for mono at the UHS night clinic, but her symptoms persisted. She had a sore throat with white spots and thought she might have had mono. But when she came back, she was not given the mono blood test again.

"For some reason, the people at UHS couldn't put it all together, that I had mono, even though my friends all told me I did," Harkavy says. "The nurse practitioners kept thinking I had strep throat. I told [them] I did not have strep. I had a million strep tests, but [they] didn't give me mono tests."

The test results confirmed that she had mononucleosis.

Harkavy says some of her problems with diagnosis may have stemmed from the fact that she never actually saw a doctor.

"I saw nurse practitioners who didn't really have time for me," she says, "so I didn't get diagnosed when I should have been."

Harkavy is not the only student who has had problems with mono diagnosis at UHS. A sophomore woman, who asked not to be named, missed 10 days of school last April because of mono.

She was not given the mono blood test at UHS, she says.

"They took a throat culture," she says. "They like doing those."

"They told me I didn't have mono, that it was all in my mind, that I was overstressed, that it was just colds going around, that they hadn't heard of anyone having mono," she says. "They just wouldn't believe me. They thought I was crazy."

So the woman went to an outside doctor who administered the test and confirmed that she had mono.

"Go to UHS first, but if you don't get what you want, go somewhere else," she says.

Rosenthal says students are only given the mono test if they have developed symptoms other than a sore throat.

"We don't do a mono spot test on everyone with a sore throat," he says. "People come in early with no swollen glands."

If a student's illness gets worse, or if it gets better and then returns, he or she will get a mono test, he says.

"We may be seeing an individual at different clinical stages of the disease," Rosenthal says. "I've seen people with just a sore throat. We say 'keep us informed' and a week later they say 'I still feel lousy.' Now they have a palpable spleen and swollen glands [and we give the spot test]."

"It's really the follow-up," he adds. "We can't tell you where you are on the [mono] continuum."

Some students come in the first day they feel sick, before developing symptoms, while others go to UHS with obvious mono symptoms after feeling ill for a month, Rosenthal says.

He says the mono spot test is "sensitive but not exactly specific." The test result can be positive due to very similar viruses, which cause mono like symptoms and are treated in the same way.

Rosenthal says testing for strep throat is actually the proper first step, as nearly one out of three mono sufferers also have strep throat.

But according to students who say they spent extra weeks or months sick because a nurse refused a mono test, the "proper procedure" should be changed. "I just wanted to find out what I had," Harkavy says. "I was sick all the time."CrimsonAnne- Maire L. TaberANNE HARKAVY '95 was sick for nearly eight months with mono.

"You can actually cough in someone's face [and spread mono]," Rosenthal says.

Matt B. Botein '95 had mono during his sophomore year.

"My roommates quarantined all the food items I touched," he says.

The stress of life at high-pressure colleges like Harvard also leads to mono for overworked students. Unhealthy living styles aggravate students' mononucleosis, Rosenthal says.

"There's no question that if they're burning the candle at both ends, they're more susceptible," he says.

Lisa L. Ritter '97 says she was not surprised to learn she had mono.

"I was stupid. I only got about three hours of sleep a night for about a month," she says. "There's an attitude at college that you should be doing work--that if you are getting sleep, something is wrong with you."

She's changed her ways now, however.

"I learned my lesson," she says. "I got eight hours [per night for] the rest of the year."

Weeks in Bed

For those who do get the disease, weeks in bed are the norm. The most common symptoms are a sore throat, swollen glands and general exhaustion. Most sufferers from the disease, which is caused by the Epstein-Barr virus, get a fever. Two-thirds have an enlarged spleen.

Many patients' livers are affected, and one-third of mono sufferers have strep throat as well, according to Rosenthal.

"Mono is very variable, due to liver involvement," Rosenthal says. "If there are liver problems, that causes the most fatigue."

Ruth S. Raskas '96 developed a severe case of mono last January and February. She was diagnosed by her home doctor over intersession. He told her she was going to have to take the semester off.

"I had terribly swollen glands," she says. "I couldn't swallow, couldn't eat, I don't remember ever being so sick."

Despite her doctor's advice, Raskas missed only three weeks of school. "I didn't do very many extracurriculars, and slept a lot," she says.

While a mild case might only last three weeks, mono can linger for three to six months in some people. Most students are back to their activities in six to eight weeks, Rosenthal says.

Jessica I. Levin '95 had mono as a first-year for about six weeks, including over final exams.

"I had a quick, really intense case," she says. "It could have been the summer, so I was relatively lucky."

Her case was easy to diagnose, she says.

"I had a high, high temperature, and an enlarged spleen. I was sick as a dog," she says. "It was very obvious what I had."

Levin, who lives in Massachusetts, went home to recuperate, only coming back to Harvard for exams.

"I was beyond fatigue," Levin says. "I just sat in bed except to go take finals and then I'd go back to bed."

There is no specific therapy for mono, and bed rest is the best prescription. Botein also says: "[UHS] tells you not to drink alcohol until the liver count comes down."

Anne Harkavy '95 was sick for nearly eight months. She stayed in bed all summer, giving up a Washington, D.C. internship.

"It was horrible," she says. "I just sat in my bed, watching O.J. and complaining to whichever friends called me."

The months in bed disrupt many students' plans.

"The worst thing about it was my parents stuck around when they found out I was sick," Ritter says. "They made me stay in their hotel room, and it was when everyone was finding out about the housing lottery.

"They were breathing down my neck so much I thought I was going to go insane."

Misdiagnosis

Many students say, however, that their biggest problem with mono was getting a diagnosis from UHS. Mono is diagnosed by a blood test, called a mono spot test.

Harkavy says she literally had to give UHS an ultimatum to get a test.

"I told the people at UHS that I wasn't going to leave until they gave me a mono test," she says. "So they did."

Several months earlier, Harkavy tested negative for mono at the UHS night clinic, but her symptoms persisted. She had a sore throat with white spots and thought she might have had mono. But when she came back, she was not given the mono blood test again.

"For some reason, the people at UHS couldn't put it all together, that I had mono, even though my friends all told me I did," Harkavy says. "The nurse practitioners kept thinking I had strep throat. I told [them] I did not have strep. I had a million strep tests, but [they] didn't give me mono tests."

The test results confirmed that she had mononucleosis.

Harkavy says some of her problems with diagnosis may have stemmed from the fact that she never actually saw a doctor.

"I saw nurse practitioners who didn't really have time for me," she says, "so I didn't get diagnosed when I should have been."

Harkavy is not the only student who has had problems with mono diagnosis at UHS. A sophomore woman, who asked not to be named, missed 10 days of school last April because of mono.

She was not given the mono blood test at UHS, she says.

"They took a throat culture," she says. "They like doing those."

"They told me I didn't have mono, that it was all in my mind, that I was overstressed, that it was just colds going around, that they hadn't heard of anyone having mono," she says. "They just wouldn't believe me. They thought I was crazy."

So the woman went to an outside doctor who administered the test and confirmed that she had mono.

"Go to UHS first, but if you don't get what you want, go somewhere else," she says.

Rosenthal says students are only given the mono test if they have developed symptoms other than a sore throat.

"We don't do a mono spot test on everyone with a sore throat," he says. "People come in early with no swollen glands."

If a student's illness gets worse, or if it gets better and then returns, he or she will get a mono test, he says.

"We may be seeing an individual at different clinical stages of the disease," Rosenthal says. "I've seen people with just a sore throat. We say 'keep us informed' and a week later they say 'I still feel lousy.' Now they have a palpable spleen and swollen glands [and we give the spot test]."

"It's really the follow-up," he adds. "We can't tell you where you are on the [mono] continuum."

Some students come in the first day they feel sick, before developing symptoms, while others go to UHS with obvious mono symptoms after feeling ill for a month, Rosenthal says.

He says the mono spot test is "sensitive but not exactly specific." The test result can be positive due to very similar viruses, which cause mono like symptoms and are treated in the same way.

Rosenthal says testing for strep throat is actually the proper first step, as nearly one out of three mono sufferers also have strep throat.

But according to students who say they spent extra weeks or months sick because a nurse refused a mono test, the "proper procedure" should be changed. "I just wanted to find out what I had," Harkavy says. "I was sick all the time."CrimsonAnne- Maire L. TaberANNE HARKAVY '95 was sick for nearly eight months with mono.