<p>Severe cases are not new. DH got mono shortly before spring break of his first year in med school in the 70s. Couldn’t finish the year. Was in bed until late June. Repeated his entire first year. Despite kissing (and sleeping with) him (we were married!) I never got it.</p>
<p>I would strongly encourage your daughter not to rush things. It is important to take time to heal, or relapses can happen. DD got bad case of mono, I think near end of sophomore year. We went and picked her up and brought her home, after she got so dehydrated from night sweats, she was worried about passing out getting down from her loft bed. She stayed home and slept and relaxed until she felt well enough to return. She took a lot of incompletes and finished them during the summer. Are you sure it’s the "I"s that remain on the transcript? Usually it is the other way around. The “incompletes” are replaced by grades as soon as the class is completed, while the “W
s” stay on the transcript because the student withdraws from the class and no grade is ever given.</p>
<p>anxiousmom brought up a very point. When D1 had mono, the biggest challenge was to get someone to take care of her when she was in school. All of those kids had their own activities, it was hard to count on them to get what D1 needed - sometimes she was too tired to get out of the bed for water or food. I would make sure your daughter is not too tired to take care of herself before she goes back to school.</p>
<p>In responding to all the advice, you indicate that you have been in touch with the academic dean or provost. That is the level at which medically based withdrawals on most campuses are adjudicated. The course-by-course, professor-by-professor strategy is a messier way through this scenario. Most colleges offer medical withdrawals with pro-rated tuition refunds. They require a doctor’s letter to do this. At my university, you can also request a medical withdrawal after the fact: if your daughter were at my university, she could try to complete classes successfully and then if she ended up messing up her gpa and realizing that she should not have attempted to come back, she could ask for a medical withdrawal that would erase the bad grades and replace them with Ws. It typically is all courses - you can’t keep the one B and ditch the Ds. And you can’t get a tuition refund because the whole semester is over. I recommend talking with the academic dean about what policies are in place if your daughter attempts a return and then realizes it was a mistake. You should ask when the door on the medical withdrawal closes (our provost once signed off on a medical withdrawal three years after the semester in question). Incompletes are sometimes completely inappropriate for a particular type of course and most schools limit them at the undergraduate level to work left incomplete due to illness in the last six weeks of the semester. At the Junior level and with the need for a gpa to be strong, and with challenging classes, from my perspective as a professor, I would lean toward the medical withdrawal at this point if I were advising our daughter. The academic dean can sit down with your daughter and you and talk through the options (on the phone or in person).</p>
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<p>I think just a perception issue. I had it late 70’s as a college soph and was moderately sick (a course of Prednisone saved my spring semester finals but I was on activity restriction for the summer), a cousin had it a year or two earlier and was out for a semester of HS, several other friends in HS and College had it with incredibly variable symptoms (week of fever/ST/OK in a week to bedridden for 3 months and still recovering strength 6-12 months later). It’s one of those conversation starters and it seems everybody has their story – some sad, some pretty funny. My Med School professors would relate stories from their school days (30-50’s) of friends and family with remarkably similar stories though making the diagnosis is certainly easier now. </p>
<p>The interesting thing is that Mono as we know it seems to be mostly a First World illness and the more severe cases seem to hit Teens and Young Adults. In 2nd/3rd world countries the diagnosis in that age group is far less common though antibody testing seems to indicate that a large majority of adults have been exposed. This would seem to indicate that the younger kids got the virus (less clean environment, more people living in smaller living quarters, less clean water for hygiene, etc) and likely were less ill so were never diagnosed. Mono may be like many viruses (Coxsackie, Mumps, Measles, Chickenpox, Parvovirus) in that it had more severe symptoms in older patients and particularly after Puberty – our Immune systems actually overreact leading to more inflammatory symptoms.</p>
<p>To be honest, if it were all up to me, I’d keep her here at least another week, but that could be overly conservative. The doctor says that current practice philosophy is to encourage people to go back to their routines and balance rest with their routines once they are feeling up to it. D says she feels ready, and that even with some waves of fatigue, she’s feeling much better overall. She’s not all that tough when she’s feeling lousy, so that is a good sign. And really, with a couple of exceptions, one of which could have been a side effect of discontinuing the course of prednisone, she’s been on the upswing for almost a week. Tonight she’s feeling energetic again. </p>
<p>anxiousmom, They definitely said that "I"s stay on the transcript, W’s can be petitioned to be wiped off, but D will double check.</p>
<p>libartsmom, Thank you for your post - that was valuable info. We are currently going through the dean’s office and D needs to provide the documentation you mention. Meeting with individual teachers is more for determining which classes may be more conducive than others to continuing with success. Your point about what happens if it turns out this was the wrong move and the question of what the window of notification is for medical withdrawal is also our big concern. My take is that the school has the ability to make any allowances and accomodations they want, but you don’t necessarily know that this will be granted ahead of time.</p>
<p>duncanidaho, I have read all that as well - very interesting. D’s doctor also says that severity of initial acute phase has little to do with subsequent length of the illness. Ditto the level of antibodies - D was off the charts, but that apparently doesn’t correlate with length of recovery, which can vary considerably from person to person, as you say. </p>
<p>Years ago, they routinely isolated patients with a mono diagnosis and kept them on bed rest for at least a month - that is not done anymore, since 1) most people have been exposed to the virus in childhood and 2) it’s not all that contagious. Meanwhile, D had never had it and catching it is no picnic at all, so I’m not sure I totally agree with that logic!</p>
<p>I’ve never seen anything written on how to predict severity or duration. As you mention antibody levels alone don’t correlate well, but a lot of theories about other immune system co-factors – cytokines, leukotrienes and prostaglandin level, complement factors, and non Immunuglobin factors, general genetic factors and on and on.</p>
<p>The contagiousness seems rather odd as well – I’ve seen or heard of sports teammates, boyfriend/GF, inseparable friends with constant contact and random friends with only short exposures catch it, but very strange that I’ve rarely rarely come across Siblings living at home with nonstop exposure before/after symptoms actually coming down with the virus within 4-6 weeks. </p>
<p>My wise old Physician/Mentor patted me on the head as a quite jaundiced 20yo with a liver and spleen the size of a small collie while I was lamenting (whining Why Me, Why Now) that finals were next week and whispered something on the order of – “Son, sometimes luck IS the answer. Don’t ever discount random chance when you are trying to figure out Human Biology. It’s why Hard Science people (chemistry, physics) who expect the same experiment to always have the same result usually hate Biology, but it’s what makes it such a lifelong fascination and interest to Us” </p>
<p>2 days into a 7 day course Prednisone made me feel remarkably better and got me through the week – i became a big fan of steroids at this point in life. I think I had 18 hrs that semester including Physiology, Org Chem 2, American Lit, and Physics 2 from M-Sat. Luckily the finals were spaced well so I could finish one, sleep for 10hours, study a bit b/w extra naps, take the next test, and repeat. After the last test I think I went to the apartment Sat around Noon and woke up Sunday night for dinner.</p>