Dec. 9, 2005

Sometimes you may hear someone say that they are so tired they feel as if they have mono. Mononucleosis (or "mono" as it is sometimes referred to) is a clinical syndrome caused by the Epstein Barr Virus, and is especially common in adolescents and children. Studies have shown that most people who get mono are between the ages of fifteen and twenty-five. One study reports six to eight cases of mono per 1,000 persons in this population over a year. The condition is most commonly found in young adults, such as college students. Presently no data exists to show that highly trained athletes, such as hockey players, are more or less susceptible to contracting mono, However, special care must be taken when treating the athlete with mono who is engaged in a contact or collision sport such as ice hockey.

Mono is contagious to those individuals who have not had the disease before. It can be easily spread to people by contact with saliva. Examples of this are kissing, improper use of water bottles (allowing bottle to contact the mouth), coughing (while not covering the mouth), sharing straws or eating food from the same plate. Once an individual contracts mono, they are contagious for about six weeks.

The symptoms of mono are very much like the flu. People who contract mono usually feel very, very tired. A sore throat is quite common along with swollen lymph nodes (infection-fighting glands that are located on the back of the neck). Patients may also have other symptoms such as a fever, sore muscles, and a headache. The duration of these symptoms can vary, but they are usually at their worst during the first five to fifteen days from when the symptoms of mono begin.

Another symptom of mono includes the potential for an enlarged spleen. The spleen is an organ that is located on the left side of the body, under the ribs, and is important because it filters blood and helps to fight infections. Spleen enlargement happens in about half of people who have mono and when the spleen is enlarged, it is susceptible to rupture. Although rare, the potential for rupture and life threatening hemorrhage is significant and dramatic.

The only way to be able to determine for sure if someone has mono for is to be evaluated by a physician. The doctor will examine the patient and draw blood for various tests. One of these tests is called a Monospot test, which is the most widely used test to diagnose mono. Although it provides quick results, a negative finding on the Monospot may not be accurate and it may have to be repeated. A complete blood count is often more accurate and will show a high amount of atypical white blood cells in the patient with mono.

Treatment for mono in the athletic population is the same as with the non-athletic patient: REST. Proper hydration during recovery is also recommended. The patient will have to avoid playing contact sports for at least three to four weeks. For athletes, especially those involved in collision sports like hockey, the most important consideration is the possibility of spleen rupture with severe hemorrhage. Symptoms of a splenic rupture are a sudden onset of left upper quadrant pain that spreads to the top of the left shoulder. The risk of splenic rupture is very low and estimated to be 0.1 percent, but it is important for the patient to call his/her doctor or go to the local emergency room right away if they experience these symptoms. Studies show that almost all ruptures occur in the first three weeks of illness. Thus it is particularly important to avoid contact as well as aggressive workouts that might involve trunk twisting during the first three weeks. Also, the patient must be especially alert for symptoms during this time.

Studies of spleen rupture indicate that all spleens that rupture are enlarged and possibly correlate with liver inflammation. Therefore it is important that there is a complete physical examination prior to the athlete returning to play. After physical exam, the physician may choose to ultrasound the patient's spleen. There must be no sign of spleen enlargement before the return to play.

In the majority of instances, mono resolves in about one month. Rest from hockey as well as other activities for the first three weeks, followed by a gradual return to aerobic activity and strength training will help to ensure a safe return to sport. However, some patients may have more prolonged symptoms and require longer periods of relative rest.