mono symptoms

[© Jpcprod |] Most mono infections occur in teens and young adults, and most adults have had mono whether they remember it or not.

Q: How do I get mono?
Mono is caused by the Epstein-Barr virus and is transmitted through saliva. While you can get mono through kissing, you can also become infected by sharing utensils or from a cough or a sneeze.

Q: What are the symptoms?
Symptoms usually develop four-to-six weeks after exposure and may consist of mild to no symptoms in some younger patients to the more typical symptoms in adolescents and young adults. These symptoms may include fatigue, general discomfort, sore throat, fever, swollen lymph nodes in the neck or arm pit, swollen tonsils, a headache and possibly an enlarged spleen or liver.

Q: How do you test for mono?
The diagnosis is based on patient history, physical exam and blood work. The blood work may include a monospot test (that detects a type of antibody during certain infections) and can be negative in some cases. A more specific test can be ordered which measures antibodies to the Epstein-Barr virus.

Q: Can I get mono more than once?
In most cases, a person will get mono only once. Once someone is exposed, they develop antibodies and are unlikely to become infected again. However, in some rare cases, symptoms may reappear months or even years later. If you have had mono before and start to experience symptoms again, contact your physician as some mono symptoms can mimic other conditions.

Q: How is mono treated?
There is no specific treatment for the virus that causes mono. Treatment with medications may help symptoms and control fever and pain. Some people may develop a secondary bacterial infection and require antibiotics other than Amoxicillin which often causes a rash in people with mono. If tonsil and lymph node swelling is severe, steroids may be given to decrease inflammation.

Q: Is mono more common in children or adults?
Most adults have had mono whether they remember it or not. More than 90 percent of adults have antibodies to the Epstein-Barr virus and are immune. Most infections occur in teens and young adults.

Q: Does having mono predispose me for any other complications?
Mono can result in severe complications, although they are uncommon. These can include liver problems, such as hepatitis and jaundice; an enlarged spleen, which in rare cases may rupture; blood problems with low blood counts; or neurologic complications.

If you suspect you have mono, contact your primary care physician for an evaluation, blood tests, if indicated, and treatment based on your individual symptoms. While mono is very common, it is usually a self-limiting disease that resolves without significant complications.

Sharon Silverman, M.D., is an internal medicine physician in Columbia. Call for an appointment, 410-964-5311.

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meningitis symptoms

[© Obencem |] Many cases of viral meningitis improve without treatment while bacterial cases can be life-threatening and require urgent antibiotic treatment. A sudden high fever is a common meningitis symptom.

With flu season approaching, it is important to know about meningitis, which shares many similar early symptoms with flu and can be mistaken for the flu. According to the Centers for Disease Control and Prevention (CDC), meningitis symptoms and signs of meningitis can begin to develop anywhere from several hours to several days from infection and may include:

  • sudden high fever
  • stiff neck
  • confusion
  • vomiting or nausea with headache
  • severe headache
  • seizures
  • light sensitivity

Symptoms for newborns are slightly different and include: constant crying, extreme sleeping, high fever, inactivity and lack of interest in eating.

Meningitis stems from a variety of causes, though most common are viral or bacterial. It is important to know the specific cause of the meningitis, as it determines the treatment and severity of each case, warns the CDC. Many cases of viral meningitis improve without treatment while bacterial cases can be life-threatening and require urgent antibiotic treatment.

Bacterial vs. Viral Meningitis
With bacterial meningitis, the earlier you get treatment, the better the chance of preventing serious complications. This form typically develops when bacteria enters the bloodstream and makes its way to the brain and spinal cord. Meningococcal bacterial meningitis is very contagious – particularly in crowded living conditions such as dormitories or close contact situations such as sports – escalates quickly and can be deadly. That is why we immunize children at age 11 when they tend to start being exposed to these types of environments. Children who are medically or genetically at a higher risk can be vaccinated as young as two months of age. This includes those with diabetes, sickle cell disease, immune deficiency or who are of Native American descent. A booster dose is typically given in the late teens before children head off to college. Infant vaccines (PCV13 and Hib) also protect against other forms of bacterial meningitis.

Viral meningitis is a more common form, occurring as a result of a virus such as measles, mumps, enterovirus, herpes and West Nile among others. This form of meningitis is milder than bacterial and evolves more slowly.

Viral meningitis doesn’t respond to antibiotics and should resolve on its own. However, as with any disease, trust your gut. If your child is lethargic and not responsive, and/or is refusing to eat or drink, take them to their pediatrician. If they have a terrible headache, fever and neck pain – especially down the middle of the neck – go to the emergency room.

Lindsay Fitch, M.D., is a pediatrician with Klebanow & Associates in Columbia. Call for an appointment, 410-997-6400.

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pain relievers

Acetaminophen or aspirin are safer alternatives to manage pain than relying on ones like ibuprofen and naproxen, which can increase the risk of heart attack or stroke. [© Monkey Business Images |]

The U.S. Food and Drug Administration (FDA) recently announced it is “strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)­—including ibuprofen, naproxen, diclofenac, and celecoxib as well as others—increase the chance of heart attack or stroke. The risk of heart attack and stroke with NSAIDs, both of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of prescription drug labels.”

We knew that long-term use of NSAIDs increased the risk of heart disease and stroke, but this new study discovered that short-term use could also pose a significant threat. This warning is especially important for high-risk groups that include males over age 50, females over age 60 and those who have high-risk factors of developing coronary artery disease such as diabetes, high blood pressure, high cholesterol, smoking or obesity.

For my patients with diagnosed coronary artery disease, a stent, history of a heart attack or bypass surgery who are suffering from a headache, arthritis or backache, I recommend that they take NSAIDs for no more than a few days. If you are a high-risk cardiac patient, but have not had a cardiac event, you can take NSAIDs for a few weeks but no longer.

If you want to avoid the risks associated with NSAIDs, Tylenol (acetaminophen) or aspirin are safer alternatives to manage pain. If you have concerns, you should call your doctor to discuss your risk of taking NSAIDs versus the benefit they may have in treating your pain.

If you are taking NSAIDs and experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of your body or slurred speech, call 911.


According to the FDA, new prescription NSAID labels will be revised to reflect the following information:

  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID.
  • The risk may increase with longer use of the NSAID. The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.
Keith Freidman, M.D., is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

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breastfeeding tips

Dr. Natalia Colón Guzmán is an OB/GYN on staff at Howard County General Hospital. Also a mother of two, she shares her struggles with breastfeeding and the reasons she persisted until breastfeeding became a success. (Dr. Colón Guzmán with husband Eduardo Guzmán and daughters Susana and Ana Lucía.)

Breastfeeding may require some hard work, but it’s worth the effort says this OB/GYN and breastfeeding mom

In addition to being a mom of two, I am an obstetrician. So, I know how beneficial breastfeeding is to both mother and baby. When I had my firstborn, I was determined to breastfeed. Although it was more difficult than I expected, with assistance, I was able to be successful. If I can do it, anyone can.

Breastfeeding has long proven to be quite beneficial for both mother and infant. There is good evidence that it can influence many aspects of an infant’s life, including overall health, risk of infections, risk of obesity in the future and many others. Breast milk helps strengthen infants’ immune systems, which is why infants who are exclusively breastfed have fewer visits to doctors and hospitals for illnesses. Some studies even suggest that the longer a baby is breastfeed, the higher the child’s IQ could be later in life.

There are also many benefits to the mother, including helping to achieve a quicker recovery from delivery and reducing her levels of stress. It can enhance weight loss for many mothers and can be a method of birth control, although not quite perfect. Breastfeeding can reduce the risks of maternal ovarian and breast cancer and it is also good for the household economy as it is free (it is estimated it can save $1,000 in one year).

While it has many benefits, breastfeeding can, unfortunately, be challenging for many mothers. Sometimes the infant has issues, such as a tongue tie or congenital deformities, and sometimes the mother can have problems, such as flat nipples and low milk supply. Some women have to work very hard to achieve their breastfeeding goals.

When I had my first child, my milk came in a bit later than expected and the baby was not gaining as much weight as the pediatrician wanted. It was very hard work for me; I had to pump and supplement feedings with my own milk, but perseverance is one of my personality traits and I sought support and was able to pull through. Now I am breastfeeding my second child, and it is so natural to me that it feels as if I have been doing it my whole life.

In order to be successful at breastfeeding, I think it is important to take care of yourself. Eat well, stay hydrated by drinking lots of fluids/water, take your vitamins, and rest as much as you can. It is important to be persistent, even if the breastfeeding is not going as planned. In my practice, I find many women give up easily. I know how they feel…I almost gave up myself. But, a good lactation consultant, pediatrician and/or a lactation support group, will help women pull through and allow them many months of successful breastfeeding.

Howard County General Hospital hosts a Breastfeeding Support Group every Wednesday, 12:30-2:30 p.m. in our Wellness Center. No appointment is needed.

Natalia Colón Guzmán, M.D., FACOG, is an OB/GYN on staff at Howard County General Hospital. She and her husband, Eduardo Guzmán, are the proud parents of two little girls, Susana and Ana Lucía.

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Before deep brain stimulation, Howard County resident Andrea Freeman suffered from Parkinson’s disease. “I could barely walk…trips to the mall with my daughters were filled with worry that I wouldn’t get back to the car. I was totally hopeless.” Now she’s back to hiking and biking again, completing a 20-mile ride this past spring.

Deep brain stimulation gives Howard County resident new life after Parkinson’s diagnosis

In 2005, at age 34, Andrea Freeman, a longtime Howard County resident, found herself off-balance –literally. An avid hiker, she began tripping and falling frequently. She went from feeling energetic and active with her family to a state of utter exhaustion. Her most strange symptom was a slight shake in her little finger.

“For four years I sought answers and was tested for fibromyalgia and Lyme disease among other conditions and diseases,” recalls Andrea. “But the doctors couldn’t determine what was causing these strange symptoms in someone so young.”

Throughout those four years, Andrea continued to deteriorate. Andrea remembers “shaking a lot and dragging my right leg. My right arm and hand were rigid and stuck, and I started having a blank look on my face. “

In 2009, she started seeing Howard County General Hospital neurologist Joseph Savitt, M.D. who finally gave Andrea the answer she was looking for—a diagnosis: Parkinson’s disease.

Dr. Savitt started Andrea on a regimen of medications. “Many of the medicines had side effects that you take different medicines to counteract,” says Andrea. “I would get dyskinesia (twisting of my limbs) but at least I wasn’t shaking. Holding a job was no longer possible.”

By 2014, Andrea found herself withdrawn and overwhelmed by her symptoms. “I couldn’t take any more medicine—it made me tired, and I was already chronically exhausted but I couldn’t sleep,” she remembers. “I could barely walk—my leg would twist—and I would fall a lot. I would go for a walk in the woods and panic I wouldn’t get out. Trips to the mall with my daughters were filled with worry that I wouldn’t get back to the car. I was totally hopeless. I had reached the point that nothing else could be done for me except deep brain stimulation.”

Andrea began the process of being evaluated and was approved as a candidate for the surgery.

According to The Johns Hopkins Deep Brain Stimulation (DBS) Center, DBS is an FDA-approved neurosurgical procedure where electrodes are implanted in the brain to send mild electrical signals to the area that controls movement. These electrodes are connected to a stimulator (implantable pulse generator) that is implanted under the collar bone, similar to a pace maker.

“In November of 2014, my brain was turned back on,” says Andrea. “I am so grateful that I have my life back. I can cook, rollover in bed and smile again. I can put my feet on the ground, get out of bed and dress myself. The rigidity released immediately in my arm. It was like a switch was turned on. I am still building back my muscle, but this winter I did a six-mile hike up a mountain in Western Maryland. In the spring, I completed a 20-mile bike ride—it was hard and I went slowly—but I did it.

“You just can’t imagine the things that I couldn’t do that were simple tasks and the ability to be able to do those again—I can’t put into words. Not being able to work was the worst feeling. I was literally wasting away mentally, emotionally and physically. Now I am back at work full-time and have a purpose again. I start every day with complete gratitude.”

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It’s summertime which means cookout season is in full swing! Whether you are hosting or attending a cookout, it is always difficult to stick to your diet or a healthy eating plan with all the delicious temptations surrounding you. Just keep in mind there are a variety of alternatives to add a healthier menu to your cookout which go beyond the traditional hot dogs and hamburgers!

Healthy tips for your next cookout:


  • Ditch the Chips – Substitute potato chips and French onion dip for raw veggies accompanied by hummus, salsa or guacamole. These snacks are not only better for you, they taste great and keep you full! Still crave that crunch? Try kale chips or a pickle! [© Jenifoto406 |]
  • Grill Outside the Box – Trade your regular ground beef burger for a lean meat such as chicken, sirloin, fish, pork or skinless turkey breast. Other popular, tasty options are salmon (or any fish!), black bean, portobello or veggie burgers. Don’t limit yourself to meat. Pineapple, peaches and vegetables are great grillers, too! Or fill a skewer with mushrooms, peppers, tomatoes, zucchini, squash and tomatoes. [© stockcreations |]
  • Talking Turkey (Dogs) – Switch your regular frank for a turkey dog to get that great hot dog flavor at a fraction of the calories and fat. If you are on a reduced sodium diet, read the label. [© Trudywilkerson |]
  • Calorie Counting – Using 100 percent whole grain sandwich thins is an easy way to cut down the calories. Go even lighter by ditching the bun altogether or prepare meat that doesn't require a bun. You can also say no to mayo in your salads by using a lighter alternative such as Greek yogurt or vinegar. [© Cardiae |]
  • Be Fruitful – Dessert doesn’t have to be a sugary sweet. Replace cookies and cakes with a naturally sweet fruit or fruit salad. [© Photodeti |]
  • Sweet Drinks – Trade your sugary beverages for water and add flavor by infusing with lemons, fresh strawberries or other fruit, mint, ginger or cucumbers! Low sugar lemonade or teas are also great options. [© Evgenyb |]

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