Health Decision Guides

We're sorry you have pain in the neck.

Please take a few minutes to answer some questions and this guide will provide some of the more likely causes and provide some helpful information. The guide is not intended to replace a face-to-face evaluation with your doctor.

Neck pain may be a symptom of a serious or even dangerous condition that requires prompt evaluation. The first question is designed to identify these rare cases.

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Do you have one or more of the following:

• Weakness or inability to move one or both hands, arms, or legs

• Numbness or tingling in one or both hands, arms or legs

• Severe neck pain that moves from the neck down one or both arms

• Neck pain that moves into the jaw, shoulder or chest associated with exertion

• Fever

• Difficulty swallowing

• Difficulty breathing

• Incontinence of urine or stool

• Marked pain when pressing on one area of the neck

• Neck pain that followed significant trauma, such as car accident or sports injury?

Yes, I have one or more of these symptoms.

No, I do not have any of these symptoms.

Welcome to our Decision Guide.

The purpose of this guide is to provide understanding and advice to women who are concerned because they have never started menstruating. The absence of menstrual periods is called amenorrhea. If a woman has never had any menstrual blood flow by the age of 16, doctors call this primary amenorrhea.

Through a series of questions, you will learn about the more common possibilities to explain your personal situation. The guide should be used as a complement to the care you receive from a health professional. It is not intended to replace direct interaction with your doctor.

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A women's first menstrual period, called menarche, happens around 12 years of age. However, it can start as early as age ten or as late as age 16 years.

Are you older than 16?

Yes, I am at least 16 years of age.

No, I am not 16 yet.

Many women experience crampy pain around the time of menstrual periods. Painful menstrual cramps, also called "dysmenorrhea," usually involves the area around the lower abdomen or pelvis, but can be felt in other areas such as the lower back, hips or upper thighs.

Menstrual cramps can be mild to moderately severe, usually lasting one to three days. About ten percent of women with painful periods have such severe pain that they cannot work, exercise or play for several hours to several days each month. Fortunately, most women find relief or control of their symptoms with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.

For many women, painful menstrual cramps have been a part of their lives for years.

This Decision Guide is designed to help women who have more recent onset of painful menstrual cramps or whose cramps have become worse in the last several months. The guide consists of a series of questions. You answers will lead to information pertinent to your menstrual cramps and tips on how to manage your cramps.

Please note that this guide should be used for informational purposes and is not intended to replace the evaluation and advice of your health care provider.

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If your menstrual cramps have developed recently this may indicate a new medical problem or a change in your hormones. For example, painful cramps that have had their start within the past six weeks may be caused by infection or pregnancy. Cramps that started more than six weeks ago are less likely to be from one of these problems.

Did your cramps begin within the last six weeks?

Yes, my cramps started less than six weeks ago.

No, my cramps started more than six weeks ago.

Painful or frequent urination is a common problem, especially in older men. Urinary tract infections, kidney stones and prostate problems can all produce these symptoms. Frequent urination without pain also can be a side effect of certain medications, or a symptom of diabetes.

Most men who experience new problems with painful or frequent urination should see their doctor. This guide is intended to provide helpful information while you are awaiting further evaluation, or can add to what you may have already learned after your visit with a doctor.

Please keep in mind that this information cannot replace a face-to-face evaluation with your own health care provider.

Pain or burning during urination and frequent urination can be caused by the same medical condition. However, it's helpful to focus on one symptom or the other.

Choose which symptom is presently bothering you the most.

I have frequent urination.

I have pain or burning with urination.

Pain or burning can be a sign of a several different medical conditions, including

• a urinary tract infection

• a prostate problem, such as a prostate infection

• a sexually transmitted disease

• kidney stones.

Have you noticed a discharge from the tip of your penis?

Yes, I've noticed a discharge from my penis.

No, I have not noticed a discharge.

Welcome to our guide on eye pain.

This guide will offer helpful information while you are awaiting further evaluation, or to supplement what you may have already learned after evaluation by your doctor. Please keep in mind that this guide cannot replace a face-to-face evaluation with your own health care provider.

First, we will try to determine if what you have is conjunctivitis (pinkeye). Conjunctivitis can feel uncomfortable. The surface of the eye may be itchy or irritated and the white part of the eye often turns red. Actual pain is not common with simple conjunctivitis.

My eye is

Painful

Irritated or itchy but not painful

If one or both of your eyes are irritated or itchy and red, then you may have conjunctivitis. Conjunctivitis is most commonly caused by a viral infection or allergy. Chemical exposure and bacterial infection are also possible.

Bacterial conjunctivitis needs treatment with antibiotics. Viral conjunctivitis will usually get better without specific therapy. However, it can be difficult to determine whether the infection is bacterial or viral without an examination by a health professional. Avoid touching the eye because viral conjunctivitis can be contagious.

Allergic conjunctivitis can be treated with non-prescription antihistamine eye drops or oral antihistamine pills.

Mild eye discomfort can be treated at home by resting your eyes and avoiding bright lights.

Welcome to our Decision Health Guide on Persistent Cough. This guide is designed for people who have been coughing for at least 3 weeks.

Anyone with a persistent cough should be evaluated by a health care provider.

This guide will provide you with the likely possibilities for your persistent cough. You can use this guide either before or after you have been evaluated by a health care professional.

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Most people are not concerned about a cough when it first begins, since it is so common to have a cough from a cold or viral bronchitis. At the start of your cough, you may also have had a dripping or congested nose, sore throat, fever, muscle aches, nausea, ear pain, or pink eye. Sometimes bronchitis or other upper respiratory infections result in a long-lasting cough.

When your cough began, did you have any other symptoms that suggest that you had a cold, bronchitis or a viral illness?

Yes, I had some or all of these symptoms.

No, I didn't have any symptoms like that.

Welcome to this Decision Guide about persistent knee swelling. We're sorry to hear you have this problem!

The goal of this guide is to provide information while awaiting evaluation with your doctor for persistent knee swelling or for additional information after you have seen him or her. Please keep in mind that this guide is not intended to replace a face-to-face evaluation with your doctor.

First, some background information about this guide and about knee swelling:

Knee swelling may develop for a number of reasons. If you have new, unexplained knee swelling that followed a significant injury or you have fever, this guide is not the best place to start! See your doctor first. Ligament tears, cartilage damage and fracture can follow trauma and may require urgent treatment; this is particularly true if you are unable to bear weight.

This decision guide will focus on persistent knee swelling -- that is, knee swelling lasting more than two or three weeks.

You'll be asked a series of questions and depending on your answers, information will be provided and additional questions asked until the conclusion.

So, let's get started.

Would you like to get information related to your own situation? Or would you rather start with some general information about knee swelling?

General information about knee swelling

Information specific to my situation

In general, one or both knees may be swollen due to

• increased joint fluid

• blood in the joint

• enlargement of the bones near the knee joint

• swelling near the knee joint (without an actual joint problem)--for example, bursitis can cause swelling directly on top of the kneecap

• fluid behind the knee, called a Baker's cyst.

Each of these will be briefly reviewed. There are other, rarer, causes that will not be covered here.

Let's start with Increased Joint Fluid:

Normally, there is a tiny amount of fluid in the knee which serves as a lubricant and to deliver nutrition to the cartilage that lines the joint. When there is any type of arthritis present, fluid may accumulate in the joint. This is sometimes called "water on the knee." In addition to arthritis, structural problems in the knee (such as torn cartilage or ligament injury) may stimulate extra fluid formation.

Your doctor may recommend a procedure (called arthrocentesis, or joint aspiration) in which a sample of fluid is removed from the knee and analyzed for the presence of white blood cells, red blood cells, infection, or crystals.

This is helpful because certain diseases can be suggested or even proven by the results of this analysis:

• high white blood cell count in joint fluid suggests the presence of marked inflammation (making infection a larger concern).

• a large number of red blood cells suggests there's been bleeding into the joint.

• many common bacterial joint infections can be identified by analysis of the fluid.

• gout or pseudogout, the most common forms of "crystal-induced" arthritis, can be proven by seeing the appropriate crystal (uric acid crystals in gout; calcium crystals in pseudogout).

Would you like to continue learning about other causes of joint swelling (next up: blood in the joint) or would you prefer to move on to questions about your particular situation?

Blood in the joint

Information specific to my situation

Welcome to the Positive ANA Decision Guide.

This decision guide is designed for persons with a positive antinuclear antibody (ANA) who would like to find out more about this test and what the test result may mean.

The goal of this guide is to provide information while awaiting evaluation with your doctor, or for additional information after you have seen him or her. Please keep in mind that this guide is not intended to replace a face-to-face evaluation with your doctor. The diagnoses provided are among the most common that could explain your test results, but the list is not exhaustive and there are many other possibilities. In addition, more than one condition may be present at the same time.

Would you like more information about the ANA test in general, or would you rather proceed directly to what your ANA may mean?

I'd first rather get more general information about the ANA.

I'd like to learn more specific information about my ANA now.

Nearly all people with systemic lupus erythematosus (SLE) have a positive (abnormal) ANA -- that is, the sensitivity of the ANA for SLE is quite high. That also means that it is very rare to have lupus with a negative (normal) ANA. If you or your doctors are concerned you may have SLE, a negative ANA should be quite reassuring. However, there are other arthritic, autoimmune and rheumatic conditions that have a negative ANA.

Not everyone with a positive ANA has a disease. In fact, specificity is low, meaning that many healthy people have a positive result.

Here is a partial list of common rheumatic and non-rheumatic diseases associated with a positive ANA. Because many of these conditions are relatively rare, many -- perhaps most-people with a positive ANA have none of them and have no disease or condition related to this test result.

ANA in rheumatic disease: SLE , drug-induced lupus erythematosus, Sjogren's syndrome, mixed connective tissue disease, progressive systemic sclerosis (scleroderma)

ANA in non-rheumatic disease: autoimmune hepatitis, primary biliary cirrhosis, Graves' disease, Hashimoto's thyroiditis, hepatitis C, HIV infection

Finally, some specific details about the ANA are important. The ANA is reported as a ratio, as in 1:80 or 1:640. In general, the more abnormal result, (that is, the higher the second number), the more likely it is to be meaningful; however, exceptions are common. In addition, there are several types of ANAs and, when necessary, additional testing can identify the specific type of ANA (also called subtype). Among the most helpful are the anti-Sm and anti-ds-DNA, because when positive, they strongly suggest SLE.

Remember: just because you have a positive ANA does not mean you have lupus or other specific rheumatologic disease. It all depends on your symptoms, your physical examination, other routine test results and why the ANA was checked in the first place.

I'd like to learn more specific information about my ANA now.

Welcome to the Positive Rheumatoid Factor (RF) Guide.

This decision Guide is designed for persons with a positive rheumatoid factor (RF) who would like to find out more about this test and what the result may mean.

The goal of this guide is to provide information while awaiting evaluation with your doctor, or for additional information after you have seen him or her. Please keep in mind that this guide is not intended to replace a face-to-face evaluation with your doctor. The diagnoses provided are among the most common that could explain your symptoms, but the list is not exhaustive and there are many other possibilities. In addition, more than one condition may be present at the same time.

The first thing to say is this: don't panic! The test is not so accurate that its result clearly means anything at all! Depending on your symptoms and the reason the test was ordered, the importance (or lack of importance) of your test result can usually be determined.

Would you like more information about the RF test in general, or would you rather proceed directly to what your RF may mean?

I'd first rather get more general information about RF.

I'd like more specific information about my RF.

The RF is an antibody detectable in the blood in about 70 percent of persons with rheumatoid arthritis but can often be found in other people as well. In fact, healthy people with no arthritis and no medical problems at all make tiny amounts of this antibody. In 90-95 percent of young, healthy persons, the amount of RF present in the blood is so low that it is considered absent from the blood and the test is considered negative (the "normal" result).

The number of healthy people having a positive RF rises somewhat with age, although sicker elderly people tend to have a positive RF more often than the healthy elderly. Also, when the RF is positive without disease present, it is usually only slightly positive, while higher levels are more likely to indicate "true" disease of one sort or another. See below for conditions other than rheumatoid arthritis associated with a positive RF.

Other conditions associated with arthritis may result in a positive rheumatoid factor: Sjogren's syndrome and systemic lupus erythematosus are good examples, but these conditions usually cause other symptoms and blood test abnormalities that provide clues to the diagnosis.

Certain infections, including endocarditis, viral infections, and others may trigger RF production by the body's immune system. Once the infection passes, repeat RF testing usually reveals negative results. Hepatitis C, a viral infection of the liver, is one of the more common ones, especially when a protein called "cryoglobulin" is present. This infection can be chronic (long-standing) so the RF may remain positive.

Three other situationsdeserve mention:

• People who tend to make one "autoantibody" (an antibody created against a part of one's own organs or tissues) may make others; so if you have an "autoimmune" condition, such as certain thyroid diseases or even type 1 diabetes, you may be more likely to make RF even without an associated disease.

• People with a family history of rheumatoid arthritis (or other RF-associated disorder) are more likely to have relatives with a positive RF, even if no disease is present.

People "destined" to develop rheumatoid arthritis may have a positive RF detected years before they develop symptoms or signs of the disease. However, of all people with a positive RF and no joint symptoms, the vast majority are thought to remain free of RF-associated disease over time.

Click below to continue with the guide:

I'd like more specific information about my RF.

Welcome to this Guide about problems with vision. We're sorry you're having this problem!

Please keep in mind that this information cannot replace a face-to-face evaluation with your own health care provider. It is meant to provide helpful information while you are awaiting further evaluation or to supplement what you may have already learned after evaluation with your doctors.

Are you having any eye pain or eye discharge?

Yes, I have one of these symptoms.

No, I have no eye pain or discharge.

Before you are asked a series of questions about the details of your symptoms, it is important to determine whether you have a condition that warrants immediate, urgent or emergency care. For example, a sudden loss of or change in vision deserves prompt evaluation by your doctor.

Have you noticed the sudden onset of any of these symptoms:

• vision loss

• seeing double (or double vision)

• the feeling of a shade over the eye

• lights are surrounded by halos

• light sensitivity?

Yes, I am experiencing one or more of these symptoms.

No, I have not noticed any of those symptoms.