BYU vs. Utep Comments

http://en.wikipedia.org/wiki/Infectious_mononucleosis

Wiki states that strep often accompanies strep. So it is highly possible the strep test came back positive. But when the antibiotics didn't help and the rash appeared the doctors then looked for mono. Which they then found and began treating.



http://www.drgreene.com/21_1144.html

Time table appears to be 2 to 4 weeks.

bball wrote:
Indeed, how does a doctor mis-diagnose strep? You take a swab, send it to the lab, and it's either strep or it's something else. Doctor's, like officials, often call what they think is going to happen, not what actually happens. I think the doctor thought it looked like strep, and that was the diagnosis--not real smart.

That may be exactly what they did, but lab results aren't instantaneous and in the meantime I'm sure they wrote a script for an antibiotic. 99% of the time, this is what any primary care physician would do.



I have heard nothing that any physician had done in this case that wasn't par for the course.



What makes no sense here, is that if Jimmer indeed has mono (which seems to be the case), then nothing the physicians did would have mattered anyhow (so why the backlash on the docs?). It's not the reaction to the antibiotic that kept him out of games, it's the mono. The only definitive diagnostic test for mono is bloodwork and that's almost always a result of failure to improve from an initial diagnosis (like strep, etc)



There is no magic pill for mono. It's rest, fluids, healthy diet and more rest.



Jimmer might have been a little more judicious who he swapped saliva with after celebrating the Arizona game though ;)

craigoscarson wrote:
Jimmer might have been a little more judicious who he swapped saliva with after celebrating the Arizona game though ;)

John Beck had mono in the 7th grade, before he ever kissed someone...

Mars wrote:

Jimmer might have been a little more judicious who he swapped saliva with after celebrating the Arizona game though ;)

John Beck had mono in the 7th grade, before he ever kissed someone...

It was a joke (I have no idea how he celebrated the Arizona game); by the time adults are 30-35 yrs old, 95% of them have already been exposed to EBV (mono) one way or another.

Craigo,way to circle the wagons brotha.here's the deal,if you see my daughter,who is soph. at BYU and one gorgeous chicky,and she presents with fever and sore throat,and you do strept test and it's positive,and you give her Amoxil,and then she says "oh by the way I'm really tired",it's reasonable for you and you have my permission to pat her on the hand and tell her,"it'll be okay sweety".but what if you're treating Ochocinco,and he tells you same

thing with his positive RST.you're telling me you don't look a little further,esp. after the rash?I have personal knowledge that good practice dictates that you ask about antibiotic allergies before you hand out the Amoxil(or whatever he got,but likely that).therefore,when the rash shows up you can discount that possibility.I know you live in Midwest,and as such don't know timeline.to those out here,we heard Jimmer's got strept,then SEVERAL days later he's got a rash,we don't know why,then finally he's got mono.as I said in a different thread it's curious that the timeline was what it was,that's all.as to the assertion that it makes NO difference cuz ther's NO treatment except rest and fluids,while that is typically true(and prob would be with my daughter)are you saying you don't offer Ochocinco,or perhaps the Jammer,an anti viral like Valtrex?I would,and I have ANECDOTAL evidence itspeeds return to competition in serious athletes.and there is absolutely no contraindication,other than cost.even a pregnant woman can take the antivirals safely,I know because I was involved with the clinical trials looking at this with Acyclovir.

l



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clemdiggitydog1 wrote:
Craigo,way to circle the wagons brotha.here's the deal,if you see my daughter,who is soph. at BYU and one gorgeous chicky,and she presents with fever and sore throat,and you do strept test and it's positive,and you give her Amoxil,and then she says "oh by the way I'm really tired",it's reasonable for you and you have my permission to pat her on the hand and tell her,"it'll be okay sweety".but what if you're treating Ochocinco,and he tells you same

thing with his positive RST.you're telling me you don't look a little further,esp. after the rash?I have personal knowledge that good practice dictates that you ask about antibiotic allergies before you hand out the Amoxil(or whatever he got,but likely that).therefore,when the rash shows up you can discount that possibility.I know you live in Midwest,and as such don't know timeline.to those out here,we heard Jimmer's got strept,then SEVERAL days later he's got a rash,we don't know why,then finally he's got mono.as I said in a different thread it's curious that the timeline was what it was,that's all.as to the assertion that it makes NO difference cuz ther's NO treatment except rest and fluids,while that is typically true(and prob would be with my daughter)are you saying you don't offer Ochocinco,or perhaps the Jammer,an anti viral like Valtrex?I would,and I have ANECDOTAL evidence itspeeds return to competition in serious athletes.and there is absolutely no contraindication,other than cost.even a pregnant woman can take the antivirals safely,I know because I was involved with the clinical trials looking at this with Acyclovir.

l



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From a primary care doc who sees strep all the time:



First off, someone with strep is going to be "Oh by the way I'm tired". It goes right along with strep throat. If the rapid strep test is positive (takes 5 mins) and the symptoms fit, you give an antibiotic, because unlike mono, strep throat can have serious additional manifestations if left untreated (ie rheumatic fever). So with or without your permission, your adult daughter gets offered antibiotics and definitely is not told "It'll be okay sweety".



Second, I haven't heard enough about "The rash" to say for sure, but if it came on after the antibiotics it was likely a typical reaction to antibiotics that patients with mono get. Sometimes that's how you suspect mono because of the rash from antibiotics. It is not a typical allergic reaction and would likely occur even if the person was never allergic to any antibiotics before.



Third, Valtrex is not typically given for mono, and anecdotal evidence is not the best way to practice medicine, but you're right, if the docs thought it might help they probably gave it to him . . . Not sure how you know he didn't get it.



Other things with mono, the monospot test is often negative early on in the course of illness and even after 2 wks the test is only positive 50% of the time, so a lot of the diagnosis of mono is done clinically and with other labwork. Strep and mono present to the clinic pretty similarly a lot of the time. As I mentioned above, it is much more important to treat strep early vs mono.

Let me clarify,sorry I'm obviously not being clear.the antibiotics are of course a must,as a primary care physician myself I meant with 'the pat on the hand 'only after the script was given,the fatigue with EBV or acute infectious mono,for those out there who are snoozing due to this technical discussion I apologize,is in my 20 plus years clinical experience more profound than that with strept.that said everything was done correctly,it just seems that given the development of the RASH it seems that yes,the clinical diagnosis,of mono should have been suspicioned earlier.you are absolutely right,he may have eventually received Valtrex.obviously,these are the drugs used for herpes viruses,the only ones we have,and mono is after all a herpetic virus.again no downside to treat except cost.

anecdotal evidence is why we choose most things in practice,a good reason why we need more evidence based trials.but if I'm the Jammer and I get back on the court faster with it,I'm there.



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Sounds good, hope Jimmer gets back soon. I may be a little annoyed by those second guessing the medical staff when we don't have the entire picture. I have confidence the medical staff did what was in the best interest of Jimmer.

Sometimes physicians criticize each other too much,sometimes they cover for each other too much.neither extreme is good.the original post on this subject was to the effect that it seemed to take a while for the clinical diagnosis of mono to be made.obviously none of the people who have contributed to this discussion,thus far,were his treating physician,so we may never know wether valuable time was lost getting Jimmer back on the court.I'm not sure wether anyone need apologize for asking the question,given the circumstances.



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From the Wikipedia link posted earlier

Patients with infectious mononucleosis are sometimes misdiagnosed with a streptococcal pharyngitis (because of the classical clinical triad of fever, pharyngitis and adenopathy) and are given antibiotics such as ampicillin or amoxicillin as treatment. Some studies indicate that approximately 80-90% of patients with acute Epstein Barr virus infection treated with such antibiotics develop a red, diffuse rash.[12]

this is actually the exact point i made several days ago, which began this now ponderous discussion.