mononucleosis ?????????

[Shary]

My very healthy,busy 16 yr.old daughter with heavy 7-8 long day periods, and a below normal 36.5 C body temp complained about being tired most of last summer and was thinning down and losing her hair.
Once she was back to school and skating in the fall she got completely tired out. I took her to our GP and he did routine blood work that showed she was anemic. He perscribed ferrous sulfate 300mg 3x per day,3months and suggested the pill for her periods. I declined the pill till I was satisfied that the anemia was in check.
November she started getting an upset stomach, and was still extremely tired, thin for her bone structure, and began missing 2-3 days of school every few weeks. I returned to the doctor and he checked her feritin levels, they were coming up and there were no other life threatening symptoms so he recommended that I see the local pediatric doctor.
She has not been well enough to attend school since January 2004, thats when we finally have our appt with the ped. The doctor had a battery of tests done(note his writings hard to read) Isa trans glutimas, abs blood sugar,amylase,ggt,ldu,helicobactor,stool blood and wbc, and abdominal ultra sound. They found round worms in her stool and the ultra sound detected an enlarged liver and spleen suggesting mono.Every thing eles was negitive. We treated for the worms with combantrin twice and the last stool test was negitive. I had a mono spot test done in feb. that came back negitive. Which was expected.
She constantly has and upset stomach and no energy or concentration abilities. She can not tollerate our hard water, dairy products, sugar products and certain meats.So she is aware of what bothers her, we purchase bottled water and she drinks a fair bit daily. Her face is constantly  very flushed, she has begun to put weight back on but her low energy levels and upset stomach are unsettling. We have tried numerous different antacids with no relief. Some make it worse. For the last month she has been taking bonamine anti nausia every day. Last week the skating club had its year end carnival and she insisted in participating in the practises and a very small part last week. She has been on the couch ever since and is beginning to be very tired and upset with her condition.
If this is mono are there any other tests that may indicate she truly has it other than an enlarged liver and spleen on the ultra sound in jan?
Could there be more parasites maybe in her blood or organs that would not have been effected by the round worm treatment?
How long can mono go on?
She is not well, doesn't look well and is missing friends and a semester at school. I am not sure whether I should take her to an ER in a large city on the mainland or what I should be doing, asking for, or looking for. She eats well, there is no diareha or vomitting, no fever. As my gp says no life threatening symptoms. Improvement is so slow I wonder if its mono at all.
Do you have any suggestions. Thank you very much.

[Kevin Pho, MD]

To answer your questions:
1) There are some causes where mononucleosis is present with a negative monospot test.  IgG and IgM VCA and EBNA antibodies should be measured if this is suspected.  If negative, then infectious mononucleosis can be more definitively ruled out.  

2) To confirm whether there is evidence of parasites in the blood, special blood cultures can be considered to see if it has been appropriately eradicated.

3) Acute symptoms of mono can abate within weeks, but systemic complaints - such as fatigue and poor functional status can last months.  

Regarding the upset stomach, you may want to consider an upper endoscopy for further evaluation.  This is a comprehensive test to evaluate possible causes in the upper digestive tract.  A GI referral can be considered to discuss this test.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[Shary]

Thank you for your info, Due to the maximum length of characters I did not mention that an upper gi has been ordered by the pediatric doctor, but due to patient demand we will not be getting a consultation till mid may. Will see what the surgeon recomends my gp figured it probley will not show anything.humm

[Shelbie]

Hello, I am a 16 year old girl that does typical 16 year old things. I am pretty active - ride horses, ride my bike, go to school, out with friends, etc. But ever since a few months ago, I have been feeling very tired. Just this past week, I woke up with a 102deg. fever, I was EXTREMELY tired, and was so sore I could hardly move - mostly on my lower back, legs and hips. About 4 days after that, I still had all of those symptoms, but I woke up in the middle of the night with patches of rashes on my ankles, legs and back of my arms. It was a red, elevated, itchy rash.. The next day, I had more rashes all over my body, but they weren't so elevated. They were more like bright red "webbing" and circles. (I still did have a few lumps on my arms, but not as much as the webbing)... Since I have been looking info up on the internet, the most relative thing I can find would me mononucleosis. I'm not sure if it is or not, and I don't know if you can get this sort of rash from mono. It is very itchy, seems to go away with anti-itch creams, but then they pop up in different places, still in patches, mainly on my feet, ankles, arms, shoulders, face and neck. My friend told me that if it is mono I should take antibiotics to get rid of it, because it takes a long time to get rid of anyways. I have some Keflex (Cephalexin) 500mg. that I can take, but I wanted to get another opinion first - I know you probably can't tell me what to and what not to take, but please let me know if you think it would be a good idea for me to take the Keflex or not. If anyone has any helpful advice, please let me know by replying to this thread, or if you could e-mail me at  jezz_33***@****  that would be great... Thanks!

[tina123]

HI Shaire,

Did you doctor check for thyroid problems? What about ANA antibodies? Have you looked inoto Chronic Fatigue Syndrome? Just some sugegestions. I have a daughter with Chronic Fatigue Syndrome and doctors don't always consider this.

Good luck.

[RSFG]

Shelbie - you don't take antibiotics for mono (as it is not a bacteria, but a virus). You also do not take antibiotics without a prescription. Different things need different antibiotics and a doctor goes to med school to figure that out for you. Throw them away and see a doctor.

[tina123]

Hello again,

I don't know if you checked my response. I know how awful it is to have a sick teen. I would insist on a complete thyroid workup. My daughter has Cronic Fatigue Syndrome and she had low feritin levels. Are you sure the iron is not bothering her stomach? Do some research on Chronic Fatige syndrome in teens. My daughter is also a skater. It is so hard on them when they can't do what they are use to doing. Hope this helps you.

[Shary]

Thank you for your response, and I am sorry I never checked back to the site sooner. My daughter began to improve energy wise by May,unfortunately her stomach still bothers her a great deal and she has to be so carefull as to what she eats. No dairy, soy, greases/fats, spices, lemonade,pop,to name a few. Just fruits veggies and water. We saw a surgeon that will be preforming an endoscopy the first week in august. They are looking for
h-phylori. As for the mono I do not doubt she had that, and it is taking a long time to work out of her system, she got back to school full time in may and manged to get caught up and passed the subjects she had left, still doing to much leaves her sometimes really pooped out. We were hoping we did not have to do this surgical procedure but the stomach upset( nausea) has not seemed to go away. Thankyou once again for your response and sorry I never checked back sooner.