Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Mononucleosis

Episode Date: January 24, 2023

Have you ever been interrupted on a college campus by someone asking about your latest incident of intimate kissing? That's because they were trying to track the spread of a common infection called mononucleosis, or mono. Dr. Sydnee goes over the history of how the virus that caused mono was tracked down, and how it's tested for now.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books! One, two, one, Saul Bones, Marital Tour of Miscited Medicine. for the mouth. Wow. Hello everybody, welcome to Saul Bones, Marital Tour of Misguided Medicine.

I'm your co-host, Justin McRoy. And I'm Sydney McRoy. Some times I take a look at the notes you send over and I kind of think, oh, that's interesting. I'll have some thoughts about it. Like, oh, I should work out some fun jokes about that. Yeah. And I don't know what this word means.

I don't know what this word means. You know what this is, because you have a joke and I was gonna let you get it out of the way early in the podcast. Oh, right. In the podcast. Cause I know I already know. You use the long version, mono nucleosis.

Not just mono. not just mono. That's funny. That's funny. Funny story about mono. I once thought I had mono for an entire month and it turns out I was just really washed. There we go. There it is.

I knew I wanted to give you space to make that joke like right away. It's a. Do you think you'll have to make it again? Like do I need to? It's not so much a joke as it is a reenactment of Wayne's World, a scene in Wayne's World, one of the binnets for Wayne's World.

It's not a, it's not Ha Ha Funny. Like much of Mr. Myers' work, it's not Ha Ha Funny, but in a vacuum, in this specific context, I think it's very, very funny. Now, how old about How old were you when you first saw Wayne's World? 12.

Okay, so you say it's not Ha Ha funny, but would 12-year-old Justin... Oh, I was busted not. Yeah, okay. No question about it. 12-year-old Justin would disagree. I wanted to talk about mono Justin because I was sick recently. You had mono? Well, I don't think that mono.

The kissing disease. But I honestly, I entertain the thought because I felt so lousy. Did it turn out to be? Have you ever actually had mono? Not to my knowledge. Really? Yeah.

I thought that I had mono. No, no, no, no, stop. I bet you if we tested you for the antibodies you have. That's kind of like really judgmental of you. Well, just statistically, the vast majority of adults have. That's kind of like really judgmental of you. Well, I just statistically, the vast majority of adults have. Okay. Because it is it's contagious and for a lot of people, you don't have symptoms, so you don't know that you came in contact with the virus. Okay. If you're like me, you did know. So I had mono, here's my mono story. Okay. I was on spring break in college, my freshman year of college.

This is very, this is like a 90's story. I was at the beach, totally MTV spring break. It was not MTV spring break, but I was at the beach for spring break with my boyfriend at the time. And some friends. And towards the end of the week, my throat was so sore. And I kept thinking, maybe this coronal will fix it. I don't know. No, it doesn't.

It doesn't fix it. No, but I had such a sore throat, probably had a fever, but I can tell you none of us had thermometers. And I remember the drive back from the beach because I was just in so much pain, my throat. And then we got back. I told I was like, in tears, told mom and dad, they took me to the urgent care. I got diagnosed with mono. Well, no one else would have suffered this way.

I wanted to come and doctor and I'll cure mono. I never happened to anyone ever again. That wasn't it, but it's not. this way I want to become a doctor and I'm I'm on a care mono. It's never happened to anyone ever again. That wasn't it, but it's not and I was tired. A lot of people when they get mono get tired for quite a while. It was a rough, it was rough few weeks of college. Sounds rough.

Yeah, but anyway, recently I had a sore throat again. I talked, I think we talked about it on the show and some swollen lymph nodes and a fever. And then Riley did Yes, I do remember that yeah, and and I started thinking like gosh it feels like it's it dragged on so long Because when Riley told me I was like oh wonder if you have mono Ha ha you've been kissing somebody because you're a doctor. I'm also her older sister though So I'm supposed to say that like ha ha, are you kissing somebody? That's what I'm like legally supposed to say. But then I thought like, well heck, did I have mono again?

Like it's not likely, but did mono reactivate? Did I come in contact with it? Like did I get mono again? So I couldn't believe we've never talked about the kissing disease as it is colloquially, colloquially, colloquially. I hate that word. Colloquially, colloquially. Colloquially. I hate that word. Colloquially, colloquially. It's a tough word.

It's like, Monos caused by a Herbie's virus called the Epstein Bar virus, usually EBV is how it's, you know, shortened. It's largely spread through saliva. So there you go, the kissing thing. It has an incubation period of four to eight weeks, so it can be hard sometimes to know exactly, well, depending on how much kissing you're doing, when you were exposed, and you can stay infectious for quite a while, like months.

Oh, really? Which is why I already said the vast majority of adults have had it, whether you know it or not, if you're grown up, and whether you feel like it or not, if you're legally a grown up, you probably have the antibodies to mono in your body. We could find EBV antibodies in there. I read old journal articles about mono and when they talk about the mode of transmission, like back in the 50s, it's really fun. There was one legal does hey kissing in the 50s.

Right. You can print that as a legal. It's not just, it's just so, and maybe you know what, this doesn't change because like some of the journal articles for more recent years are similarly like, it's like a very buttoned up sciencey way of talking about making out.

And they're like, it was like one article from the 50s said it is only spread by deep kissing. Ew. That's in a journal article. That's a worse way of saying. A scientist wrote that deep kissing. The episode of deep kissing. There's one from 2015 where they call it intimate oral contact among teenagers and young adults. That's it. it intimate oral contact among teenagers and young adults. That's right.

Intimate oral contact. Also bad. There's another one intimate oral contact of such a nature as to permit direct transfer of saliva. Oh no. These are like people just write like you know, just a kissing. Just a kissing. Or French and.

French and no. Or I believe our British friends would say snogging. Snogging? No, I've always wondered that about snogging. Is snogging just like you kissed or is that like, making out? It's a make-out sense. I think making out is snogging.

Yeah, okay. This is my understanding. I don't know. I'm, you know what? Do not email us. No, you can email us. Email Sid. We got so many emails about Asafetida.

Yeah. Yeah. Should I mention that by the way, thank you for the recipes. Thank you for sharing your experiences. I loved reading all those emails, and also we did get some. Yeah, we got some, so we'll try it. And it, but we can already attest to the fact

that you do not have to warm it up to smell it. Yeah, it's right there. It's right there. It's free to enjoy. As soon as we opened it. Yep. Yep. I think it smells a little like wild onions. It would be like if a human onion had be.

Yeah. That like it's a punge. A human onion. Like if a onion was a human the had be. Like onion from the cartoon. It's like onion, like intensity onion. It's like what's up? I'm onion.

I think attacking you. It is, it is's up? I'm onion. It's like attacking you. It is, it is, it reminded me specifically though of like wild onions that grow out in the yard that we pull up. I always used to find those and pull those and smell them and I like that, except that to a degree where it's like, no, too much, too much, too much. I didn't hate it. It's like kind of powerful as like impactful. I felt something. Yeah. We have not cooked yet with it, But I'm excited to try it. Anyway, it was thought that for a while that sex may increase the risk of transmission. But then they did a study that showed here was their conclusion. Deep kissing with or without coitus had the same risk of primary

EBV infection throughout their undergraduate years. Deep kissing, I still can't quite get it. Deep kissing with or without coitus. That's what it says I'm looking for on my tender profile. I'm after deep kissing. What's there without coitus? There's also things like they spend a lot of time trying to figure out like because they wanted to figure out this there is this long occupation period, right? So part of when you're studying a virus and stuff or studying an illness and you're trying to figure out like how long is it between when you get it and when you show symptoms That helps us figure out how it's transmitted and who gave it to who and whatnot are not you have to ask questions to figure out The time from kissing episode to onset of symptoms or time from an incident of intimate kissing

Deep kissing did you have an incident of intimate kissing. Deep kissing. Did you have an incident of intimate kissing recently? These would have been the surveys. Can you imagine you're on your college campus, you're like walking from your dorm to class. It's early, maybe you're a little hungover. You're like rushing so that you're not late for whatever. Someone's flagged again. And like some guy with a clipboard stops you

and is like, excuse me, when would you say was your last incident of intimate kissing? Ooh, let me think. It's a tough one. And you're like, I'm not going to answer these questions. And then they're like, we'll give you a free t-shirt. Ooh. And you're like, oh, hey.

And by the way, the t-shirt says deep kissing. What do you think? Now for those that do develop symptoms, there's a range, as I said, it can range from fatigue, swollen lymph nodes, fever, sore throat for a couple of weeks to months. They can go on for months that you feel really exhausted, really fatigued, not just like the normal, you know, if you have a viral syndrome, if you get the flu or something like it, you know, you're tired. You sleep more. If you had COVID, probably slept more. But you can go on for a lot longer, intense fatigue, intense body aches. One other thing that we specifically watch when patients have mono is that your spleen can get enlarged. And that doesn't, you probably wouldn't notice that. So it's not like that's causing you a problem inherently,

but what it can lead to is that if you then are like involved in a contact sport or some sort of accident, or I don't know, you're gonna fight, your spleen can rupture. And that is a big deal, because if your spleen starts bleeding and it doesn't stop, well, generally, any bleeding doesn't stop. Yeah, any bleeding that doesn't stop in the body

from organs and stuff is all bad stuff. Is a bad thing. So, and generally, it's gonna resolve on its own. Like, the spleen is gonna go back to its normal size, all by itself. But for a while, you have to limit things like that. So, because of the age group that can get this, teenagers and young adults, this is relevant,

because like, as an almost 40 year old, I don't engage in a lot of contact sports regularly. I'm not a professional athlete, so why would I? But for younger people who are playing contact sports, who are in high school sports or college sports, or that kind of thing, this could be a much bigger deal. Even really heavy lifting can be discouraged. So that is something that I remember them telling me

that don't play any contact sports. I was like, I'm a biology major. So I'm good at front. I'm self-selected for not getting head injuries. They'd ask me in high school, I'm in show choir. Does that count? No, that's not true. I played soccer. That C-socker, that would have been bad. There are rare serious complications that is true for a lot of viruses like this, but for most people who have had it, you were like really tired and you were achy for a while and you couldn't play a sport.

I told Riley when I thought it was possible she had it, like she was like, well, do I need to know? And I said, well, honestly, right now there's not a huge value in you knowing one way or the other, you know. But don't engage in contact sports and try not to get punched or kicked in the stomach. And she said, Sydney, I live my entire life trying not to get punched or kicked in the stomach. Yeah. And she said, Sydney, I live my entire life trying not to get punched or kicked in the stuff. That's fair. The first description of mono going way way back was written in 1887. That's how long we met about the syndrome, not the virus yet.

We didn't know about what caused it, but we knew there was something that we that we would eventually call mono. It was written by a Russian doctor who's who's also known as like the founder of Russian pediatrics, Neil Filatov. And he wrote about the condition after observing it in patients, and it was called Filatov's disease for a while before it was called mono. He didn't call it that. Yeah, maybe he doesn't want a disease. Other people called it. He called it idiopathic adnitis. So that wasn't going to catch on. Yeah, big lymph nodes't want a disease. Other people call it. He called it idiopathic adnitis. So, that wasn't going to catch on.

Yeah, big lymph nodes don't know why. That's how I would interpret idiopathic adnitis. Big lymph nodes don't know why. That's what that means. Okay, I got it. I'm translating. No, it's not a different language, right? Medicine?

I guess so. Medicine is a different language, right? Medicine? I guess so. Medicine is a different language. And that's part of what I do is I translate. Big lymph nodes don't know why. Yeah, that's what idiopathic means we don't know why. Yet, that was just me. That was just me saying yet. I don't know, I'm hopeful.

Other people named it after him. I don't know why I'm defending him. He, I mean, he was arrogant. I don't know if he was arrogant or not. But like, as far as I know, he just called it that and then other people named it after him. I don't know why I'm defending him. He, I mean, he, he was arrogant. I don't know if he was arrogant or not, but like as far as I know, he just called it that and then other people were like, filetops disease. But that didn't stick.

I think that's a mixed bag, man. I just, I don't know. I wouldn't want it. I don't need that to be my legacy. Everybody's like, oh, I got filetops again. Oh, hate this. Hate that guy. Whoever that guy is.

I know he's long dead, but I have bad feelings towards him. That's what's... I would love for something to be named after me. I don't really care what it is or why. Or, you know, I mean, well, the why is probably, hopefully, I would have something to do with it in a positive way. Now, I don't want something named after me. If it's like, I don't know, I accidentally created it or something.

Well, you don't want to fall. I don't, again, like you, there's a disease, like like Lou Gehrig's, if you're just a faint, if you're just a faint, that's not a great, what to say. Well, obviously that is not what one would desire. Yes, like you don't want to be like such a notable occurrence of this that it is named after you either.

I don't think anyway wants that. I am talking from a scientific, like from the medical community perspective. Unless it's like McArois huge muscleitis, like if you have some sort of strength based illness that makes you too strong. I don't think there's any chance of a huge muscleitis ever being called macaroid's huge muscleitis. But it's a disease. I get it.

Like from any of us. But it's pathogenic. That would be the whole point. Is that it's pathogenic, you know what I mean? So you get it. It's a disease you get. It's not just you naturally have huge muscles. You catch macaroid's huge muscleitis

and then you do have huge muscles. And it's contained. I love that you think that if I name something after myself or if I get something named after me, it's going to be macaroid something. That was me. I was naming it. It's going to be Sydney. Sydney? If it's the same macaroni, something there, you're going to think I have something to do

with you. So it's going to have to be named Sydney. Bad news. Nobody knows my maiden name. Well guys, the research is done. I finally discovered it. Hepatitis Doug. It's my maiden name. Well, guys, the research is done. I finally discovered it. Hepatitis Doug. It's my own new brand.

There's a, at the university, we both went to at Marshall. A lot of the buildings are named after people. The science building is just named the science building. Yeah. And that's been a goal of mine. Is that that's going to be the Sydney building. So your goal of yours is to donate tens of millions of dollars to a university, right? Because like, what if I just do something so great that they name it up?

I don't want to give them that much money. I just want to name it the Sydney building. Well, yeah, you that's how it works. You do something so great that people give you tens of millions of dollars and then you give it to the university. That's how they honor you. Sydney building coming soon. Sydney building. Yeah. Okay. Sydney building. Sydney Building coming soon. Sydney Building? Yeah. Okay. Sydney Building. I like my first name. Anyway, we have to get to the point that it is infectious modern nucleosis caused by the FC Bar virus. We're about to get there, but first we got to go to the building department. Let's go. Since that escalate my car for the mouth.

Dear reading glasses, it's been years since I've been able to read. I missed it so much that I had no idea where to start. I felt so overwhelmed. But thanks to your show, now I'm back to enjoying books again and feeling like a reader. Love, Sarah. Yeah, that's an email we actually answered. Okay, maybe not that email specifically, but one just like it because most of our listeners are named Sarah.

We're reading glasses and we're here to solve all your reader problems. We give advice, help you find books you love and discuss reading without making you feel pressured. No matter what you read or how you read it, we'll help you do it better. Reading glasses every week on Maximum Fun. Ah, elephants right-handed.

What's the middleest size in the universe? What is the history of fan fiction? Let's find out together on our show, let's learn everything. Where we learn anything and everything interesting. My name is Caroline and I studied biodiversity and conservation. My name is Tom and I studied computer science and cognitive, then. Mmm, did you?

And my name is Ella and I studied STEM cells and regenerative medicine. On our show, we do as much research as you would for a class, but we don't get in trouble for making each other laugh. And we get to so f*****! Maybe not in the trailer. Subscribe to Let's Learn Everything every other Thursday on Maximum Fun. Okay, I'm ready to transform. So at this point, it's 1920. At the Filatov's disease is the syndrome that is called mono. There were two other researchers in 1920 that observed this infectious disease that caused

fever and these big lymph nodes and a really bad sore throat and specifically that looking on a blood film, so looking at a smear of your blood under a microscope. Sometimes we do that, right? Like a lot of things labs are automated, they just put some blood in a machine and it counts the cells and counts different components of the blood and gives us a list of numbers, right? Sometimes we actually need a pathologist to look at the slide. Smear some blood on the slide in a certain way with certain stains and then look at it and tell us what's in there. Back then, of course, that's what you would have done.

You weren't using machines. Anyway, they looked and they noticed that there were atypical lymphocytes. Lymphocytes are a certain part of your white blood cells, a certain type of white blood cells. They were large and the nucleus of them look different. And so they call them atypical. So they saw a lot of these. And these kinds of lymphocytes resembled another kind of white blood cell called monocyte. So as a result, mononucleosis. Got it. Yes. What an origin story. Is where the name is?

I was on the edge of my seat for that one. Mono comes from, so the two researchers, Sprunt and Evans, renamed it mononucleosis in 1920, because it's the same syndrome. But specifically, if you look on a blood film, you see that. And this could be a diagnostic criteria, right? Because a lot of things can cause fever, a sore throat, you see that. And this could be a diagnostic criteria, right? Cause a lot of things can cause fever, a sore throat, some lymph nodes. Like a lot of things could cause these other symptoms.

But then also if you look on a blood film and see this, now you have diagnosed it. I'm glad they went with mononucleosis though, because can you imagine? So it's like, don't kiss me. I've got sprints. The sprints would be a rough one. I've got sprints. Don't kiss me, I've got sprunts. Sprunts would be a rough one. I've got sprunts, don't kiss, keep your distance.

I'm just riddled with sprunts. That is sprunts is rough. I got to sprunt something fierce. The virus that shoots four times a day, these sprunts are so. Who's sprunt sprunts for see this for a spring it's not sprunts fault I mean I can't my maiden name is

smurl and I don't know that it's yards better than sprunts so we're in the same boat buddy Epstein bar virus was discovered um one of the researchers was Epstein, as you can imagine. In 1964, using electron microscopy, so now we could, we had the technology at this point to look more closely, right? Like that's what a lot of,

when we talk about sort of understanding microorganisms and infectious disease and contagions and everything as our ability to look at things that are smaller Advanced we better microscopes. I can see better. Yeah, we can see smaller things and so now first, you know That's great. We can see that the cells are different. Well, those are larger so you don't have to have an electron microscope to look at You know white blood cells But you do when you're looking at viruses. So we get to a point in 1964 where we can use an electron microscope and we can look at specifically in a kind of cancer, Burkets, lymphomas, a specific kind of cancer.

And they found this virus in these cancer cells. And it's interesting because the story, and this is not tied to mono yet. They haven't yet attached it to mono. They're just discovering the virus that we would also understand causes mono. Epstein found this, but he, like a good scientist, thought that somebody else should repeat it. Because then that's good. You need to be, you know, it has to be something that you repeatable. Yeah, so he had reached out to other British Viralogist to look at it and nobody wanted to work with him. They were like now We're just not interested in this. This is not something that I don't know. We want to spend time on maybe they had like

Disputes, I don't know what the issues were so he was having trouble finding somebody to repeat these findings so that he could see if they were valid So he sent some of the cells to a clouse humler in Philadelphia, who they had just had like a sabbatical together. So they were like buds and he was like, hey, will you look at these cells and see if you can also find this virus in these cells? And then we can say like we both did independently.

And it's, you know, we know that this virus is connected to this type of cancer. Now the problem is humler. And I don't know that this virus is connected to this type of cancer. Now the problem is, Humler, and I don't know if this was because he was just on this sabbatical, but he had lost all his funds, and so his laboratory had been completely dismantled, so he didn't have anything to look at it with.

He was like, this is really cool, and I'm very good at this. I don't have a microscope though, and nobody's that good. To see that in microscope. Yeah, nobody's that good. You can't see virus without a microscope. So he took the cells to different laboratory

in Philadelphia, Henley's laboratory. And he was like, hey, would it be cool with you if we like had a little collabo and you looked at these cells? One thing you bring to this, what I bring to it is that I'm very good at science and everything. What you bring to it is very cool. You have a microscope. It's like the one friend who had a zone car in high school, right? So you got to hang out that guy. Got to hang

out there on these guys on car. Well, but Henley brought more to the table because also scientists. It's two microscopes. Well, also scientists also can find it. It's interesting because, you know, and we've talked about a lot of different scientific discoveries where a lot of people are finding the same thing at the same time. And there's always an inherent competition between all of these people, usually dudes, not always dudes, but a lot of dudes.

There's usually an inherent competition because if you're the one that finds it, you get your name on it, have seen. And so to go to someone else's lab and be like, I am on the verge of a monumental discovery and I need your lab equipment because I don't have any, is a big deal. It shouldn't be, right? All of science should be collaborative, but it's not. And part of that is because you can make money off stuff, but that's not really in this case.

Part of it's just because people want to, they want a legacy, they want to be famous, they want, they want to be known for the virus they saw. Yeah. So they, they characterized this new, it was in the Herpes virus category, and they find this new, this new virus, the Epstein bar virus at this point.

So they know, by the way, and that's another thing about this, this is really focused on mono, the illness, but Epstein bar virus can also cause this lymphoma, this specific kind of cancer. So it is a virus that can do different things. Now what's really interesting is that there was a technologist who was working in Henley's laboratory. So, this is kind of like serendipity, right? Like, Epstein couldn't find anybody to confirm these findings in England.

He had to send them all the way to Philadelphia to a guy whose lab was dismantled, who had to then take it to another guy's lab and ask, can you help me? And there's a tech working in that lab who regularly, they started doing these experiments with Epstein-Barr virus, and who didn't have any antibodies. They looked in a lot of people's blood to see, do they have antibodies against this new virus we found? And as I said, a lot of people had them, right?

Because they're adults, and a lot of adults have been exposed. Well, this tech was unique in that they did not have any antibodies against Epstein Bar virus, right? So that they could donate some lymphocytes to do experiments with, which is something we don't really do much in labs today. Like ask our lab techs also, can we take blood from you and use your blood cells in the experiments that we're doing and that you're helping us with? We don't do that as often these days.

But back then that would have been more, I guess more standard. But it was interesting because so one, she could donate that she didn't have these antibodies they knew. And two, the cells would only grow for so long in culture and then they would die. They didn't continue to grow forever, which is not strange.

However, in August of 1967, she missed work because she was sick. So she ended up missing five days of work. Initially, her doctor thought she had Rubella, which is sometimes called German measles, and we've done a show on that. Yeah, yeah. But he also considered, there's this thing called mono.

Whoa. And you might have that thing called mono. So they checked her for rebella antibodies. Okay. She didn't have them. Good. And so then they checked her for a different kind of antibody. There's just specific antibody called a heterofile antibody, which the important thing to know

about it is that it's closely related to infection with mono. It's the thing that they were looking for, like if you had a mono test, they're looking for this specific kind of antibody to see, is it possible you've had mono. So, and the laboratory that she was helping work in is what established this is the test. So anyway. So they do the test test and it's positive. She has the antibody now. Great. No one kissed. And also when they took some of her lymphocytes

and tried to grow them in culture, they just kept growing continuously, which was interesting. And they were positive for Epstein bar virus antig. So here, now we have somebody who has the syndrome of mono, who we know for a fact didn't have this antibody before, because she was donating cells, and now moving forward does have this antibody. Wow. It's just a very lucky coincidental thing that sort of proved, like mono is caused by this virus that we have this antibody against,

and there's the antibody that you can test for, and there's the antigens that prove the virus is there. And there's the syndrome of the fever and the sore throat and all the stuff. You know, so and so this was a huge yeah, it's a it's a huge lucky break that shows that Epstein var virus was responsible for this, you know, very common infection called mononucleosis. They did other, obviously, they wanted to replicate that as well. Can you help me understand something very quickly, the distinction between a virus and an infection? So how has Epstein-Bar virus caused mononucleot? What's the difference? Well, so you've got to think about the fact that

You can get exposed to a virus so like the virus gets into your system, right? However through saliva or blood or whatever it is and your body Mounts in a response, right? Like we've talked about how the immune system works Something's going to detect an invader and take it and try to check it out and see what it is and see like, do we already have attack? Do we have antibodies against this already? Do we have a way to attack this? Whatever. And your body is going to mount an immune response to remove that invader. Sometimes that happens so quickly that you get exposed

to something. You create these antibodies against it, right? But you never actually get sick. Versus it establishing an infection where you get symptoms, you become ill, you're probably contagious. And then the symptoms usually have a name like the viral syndrome, the disease, the illness that is caused by the virus. Think about right now, COVID-19 is the disease, the illness, the sickness that is caused by a novel coronavirus. The virus itself is different from the disease COVID-19. Okay. That makes sense. Yes. And so the reason that's really important, especially looking back from a historical perspective, we had to have pretty regimened ways of saying conclusively, okay, well, I examined you and did studies on you and can diagnose you with this disease process.

But what is causing it? It was harder, right? Because we couldn't look at viruses. Once we had the ability to find viruses, then I needed a really regimented way to say, okay, you have this. Let's figure out what it's caused by by looking in your blood, seeing what we can find and comparing it to other people who have the same syndrome and what's in their blood. And then we can conclusively say that constellation of symptoms, that collection of illness is caused by this.

Okay, that makes sense. Does that make sense? Yeah. Okay, so that's what they had to do next, right? Because they found it in this one lab tech, but that doesn't mean it's conclusive. You know, it could be coincidence. We've talked about the guy who thought

syphilis and gonorrhea were the same thing. Right, this will come at the same time a lot. Yes, and because he accidentally infected himself with both, it's that medical science back like a hundred years. Anyway. So they they had a bunch of serum from six students already at this lab. So they had a lot of pre and post illness samples. And so they started looking for the virus for the antibodies, putting it together

with like descriptions of the symptoms that the students have. And at the end, they were antibodies, putting it together with like descriptions of the symptoms that the students have and at the end they were like, we figured it out. Done. Epstein-bar virus causes infectious mononucleosis, and you can do a heterofile antibody test, look for this antibody and that tells us that you haven't. Boom.

And that is how we pieced it all together back in the 60s. There still are, we still use antibody testing, specific serology to look for patterns to tell you. It's not as simple as one test per se. If you ever get a test for mono, they're going to usually do this Epstein-Barr virus panel of antibodies. And it's several things we're looking at to see, do you have it now?

Or did you have it in the past? And that pattern of antibodies helps us know, like, is this because so many people have been exposed to it that just testing you to see, do you have the antibody? Well, I mean, I do. So tell you very much. Yeah, you probably do. So we need a certain pattern to tell us, are you acutely ill with it or did you just have it and you got something else now? The treatment for it is pretty much supportive. It's a viral syndrome.

It'll go away on its own. Just going to get you through it. Yeah. So away from kissing. Yeah, you are contagious. So yes, stay away from kissing or anything that would share saliva. So like, you know, I don't know food and drink depending on what you're doing. I guess.

What do you mean? It's like full of backwash. Ew, gross. That's so worth it. We can only talk about like deep kissing and intimate oral contacts. Yeah, there's a lot of unpleasant sounds in this episode. Are we almost done? It's a virus that will run its course, fluids, rest, avoid anything that's going to rupture

your spleen. Again, good role for life. Yeah, and then, of course, treatment for the sore throat because the sore throat can be, I will say having had it when I was younger, it was really bad. I mean, I could still swallow a bit of hurt. I could only hold down liquids. It's rough. So treatment for that.

One interesting thing is that because the sore throat is such a big feature, it is often misdiagnosed as... Strap. Strap. Yes. Ah, yes. And if people don't, which we often won't, do like a test for strep. We'll just look at you and based on a set of clinical

criteria, say, yeah, we think you have strep throat. Here's some amoxicillin. If you do that, there's a characteristic rash that you'll get. If you accidentally mistreat mono with amoxicillin. You're delighted that fact was a dorm. Well, I think it's, if you're in medical school, you will probably get asked this question at some point. You will have a patient that you will think has shrimp throat in the question. In the question, they will say you treated them with a moxasillin, and then they came back a few days later and they're covered in a red's body rash, and they said, I think I'm allergic to the moxasillin.

And what you're supposed to know, it was probably mono all along. I screwed up. I'm a doofus. I'm a bad doctor. I missed it. Well, no, I was so careful. Sydney, how could this happen? So anyway, that's that's the that's mono.

I don't know. You're supposed to, some of those people only ever get it once in their life, but the virus, I mean, it can live with you forever in your B lymphocytes. And so it is possible for it to reactivate. It is possible to come in contact and get like some mild symptoms again. It is, all these things are possible.

It is not the most common. So I don't know, I do wonder. I still have a sore throat. I know. It's been over a month. And then I just, for completeness, there are a lot of other things associated with Epstein bar viruses I mentioned, including things like chronic fatigue syndrome, which you kind of get into when you start talking about, mono reactivating stuff like that. But that's a whole other issue. And that's much, it would take us a whole other episode to cover all

that. And we don't have a whole episode because it's the end of this one. Thanks so much for listening. Thanks to the taxpayers for using their song, Medicines is the intro and outro program. Thanks to Max Fun for having us as part of their extended podcasting family. And thanks to you for for for listening. We really appreciate it. That's going to do it for us for this week. Until next time, my name is Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole. Come here, you're gonna have to do it.

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Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Come on, you're gonna have to do it. Alright!