Talk Cancer

Question:

Two months ago, our son, who is away at college in another state, was diagnosed (by a student health nurse) with mono.  He has never seen a doctor.  We just visited him and his lymph nodes are still visibly swollen, but, much smaller than they were originally, he says.  The nurse told him they may be permanently swollen.  When I spoke with the nurse by telephone, she assured me that he does not have lymphoma.  He will be home for about 48 hours in a couple of weeks and he is satisfied with the nurse’s diagnosis.  Should I accept this or should I pressure him to see our MD?  Thanks for any input you can offer. Darlene

Response:

When our son was in college, he developed a swollen lymph node in the area of his collarbone and our doctor was really concerned and had the lump biopsied.  He found multiple swollen glands in that area, but they were normal lymph tissue.  I understood that the location of the problem, near the collarbone, was what set off the alarm.  G.S.

Response:

Two months ago, our son, who is away at college in another state, was diagnosed (by a student health nurse) with mono.  He has never seen a doctor.  We just visited him and his lymph nodes are still visibly swollen, but, much smaller than they were originally, he says.  The nurse told him they may be permanently swollen.  When I spoke with the nurse by telephone, she assured me that he does not have lymphoma.  He will be home for about 48 hours in a couple of weeks and he is satisfied with the nurse’s diagnosis.  Should I accept this or should I pressure him to see our MD?  Thanks for any input you can offer. Darlene

Dear Darlene, I understand your concern about the situation.  It is very likely that your son has mononucleosis based on his age and the swollen lymph nodes.  The questions to ask are the folowing:How is your son doing clinically? Is he really sick and needs hospitalization? Has he lost some weights? Patient with "mono" can be very sick and needs immediate hospitalization.  He can appear jaundice and has high fever and night sweats.  The symptoms of "mono’ and lymphoma can be hard to distinguish clinically, but patient with "mono" usually has a sudden onset of these symptoms and the patient with lymphoma has a more gradual course.  The change is high that he has "mono" rather than l lymphoma. Based on the current health care system it is unlikely that the college health service is going to do the labaratory studies to prove that he has "mono".  However, your peace of mind and his response to his condition are also important.  If you cannot accept the high possibility that he only has mono, you can have a blood test. If that is inconclusive, you can ask for lymoh node biopsy which in almost in very case can rule out a lympoma. PS: It is extremely crucial that he doesn’t play any physical sports for several months in the case of mono.  The risk of rupturing his spleen is very high, and it is fatal!!! William, Advocate for Information on Medicine  

Response:

Dear Darlene, No reason to worry too much but he HAS to see a doctor (specializing in internal medicine or a hematologist). He will have to undergo blood tests, and depending on the results scans, a biopsy, what have you. Far to early to speculate on a diagnosis. Good luck, bye, Rob. – Hide quoted text — Show quoted text -Two months ago, our son, who is away at college in another state, was diagnosed (by a student health nurse) with mono.  He has never seen a doctor.  We just visited him and his lymph nodes are still visibly swollen, but, much smaller than they were originally, he says.  The nurse told him they may be permanently swollen.  When I spoke with the nurse by telephone, she assured me that he does not have lymphoma.  He will be home for about 48 hours in a couple of weeks and he is satisfied with the nurse’s diagnosis.  Should I accept this or should I pressure him to see our MD?  Thanks for any input you can offer. Darlene

Response:

    Your letter brought back a whole flood of memories for me, my nephew was away at college and was diagnosed, as having mono with swollen lymph nodes. He continued to feel poorly so when he came home for break, he went to see a doctor at the hospital where I worked and had a CT Scan….he was diagnosed with Hodgkins Disease after a biopsy was performed. I was also diagnosed 6 months later with swollen lymph nodes in my clavicle area and after a biopsy the verdict was the same. Luckily we both had our diseases caught in time and after chemo we are both doing great!!!!!! Please have your son think about getting another opinion just to be safe Good Luck Moose

Response:

: : Two months ago, our son, who is away at college in another state, was : diagnosed (by a student health nurse) with mono.  He has never seen a : doctor.  We just visited him and his lymph nodes are still visibly : swollen, but, much smaller than they were originally, he says.  The nurse : told him they may be permanently swollen.  When I spoke with the nurse by : telephone, she assured me that he does not have lymphoma.  He will be home : for about 48 hours in a couple of weeks and he is satisfied with the : nurse’s diagnosis.  Should I accept this or should I pressure him to see : our MD?  Thanks for any input you can offer. : : Darlene : Dear Darlene, : I understand your concern about the situation.  It is very likely that : your son has mononucleosis based on his age and the swollen lymph : nodes.  The questions to ask are the folowing:How is your son doing : clinically? Is he really sick and needs hospitalization? Has he lost : some weights? Patient with "mono" can be very sick and needs immediate : hospitalization.  He can appear jaundice and has high fever and night : sweats.  The symptoms of "mono’ and lymphoma can be hard to : distinguish clinically, but patient with "mono" usually has a sudden : onset of these symptoms and the patient with lymphoma has a more : gradual course.  The change is high that he has "mono" rather than l : lymphoma. Based on the current health care system it is unlikely that : the college health service is going to do the labaratory studies to : prove that he has "mono".  However, your peace of mind and his : response to his condition are also important.  If you cannot accept : the high possibility that he only has mono, you can have a blood test. : If that is inconclusive, you can ask for lymoh node biopsy which in : almost in very case can rule out a lympoma. : : PS: It is extremely crucial that he doesn’t play any physical sports : for several months in the case of mono.  The risk of rupturing his : spleen is very high, and it is fatal!!! : : William, : Advocate for Information on Medicine   : Hmmm, having had throat cancer myself and having, when I was a military physician, treated lots young adults who suffered from mono, I’d urge you to not stand pat, but go on in to see a physician, preferrably one who’s experianced in adolescent medicine. Bill mentioned the very real possibility of splenic rupture but let me tell you an equally catastrophic one that happens probably more often. What if your son’s having an episode of mono or other virus but there is a coexisting infection with the type of strep which causes scarletina (rheumatic fever)? Suppose that some of the students at a college get mono and some get strep? Nope, a few get both diseases, and the strep needs to be treated before it causes damage to the heart and kidneys. Georgie

Response:

I also advise taking him to see a regular Doctor and having this "checked out"..what I thought was a case of upper respiratory infection, followed by swollen lymph nodes, sweats and weight loss was Hodgkin’s Disease-Stage IV..I have been, Thank God, 4 years in remission, but getting there earlier may have been much better! Good Luck Rick

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