Have you suffered from interstitial cystitis (debilitating chronic pain characterized by urinary urgency, frequency, urination at night and bladder pain)?
Never had it / don't know
Probably, but now resolved
Diagnosed, but now resolved
Current minor problem
Current major problem
562.
Have you had a bladder infection? Symptoms are similar to those of interstitial cystitis except that it is much more common, of shorter duration and generally resolves by itself or with treatment.
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SYMPTOMS: FEMALE Some of the questions below are very personal in nature. If you would prefer not to answer a question, simply skip it by leaving the default "don't know" response. The accuracy of your evaluation will be only slightly affected.
578.
Do you have silicone (not saline) breast implants?
Never had them / don't know
Removed after being in place for less than 5 years
Removed, in place for over 5 years
Still in, have had them less than 5 years
Still in, had them more than 5 years
579.
On an average day, for how long do you wear a bra? Only answer this question if time is spent wearing a bra that restricts motion greatly or leaves significant impressions in your skin when taken off.
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SYMPTOMS: REPRODUCTIVE Some of the questions below are very personal in nature. If you are unwilling to answer a question, skip it by leaving the default "don't know" response. The accuracy of your evaluation will be only slightly affected.
585.
At what age did you become sexually active?
Not applicable / never active
Before age 15
15 to 19
20 to 25
Over 25
586.
What is the approximate number of sexual partners that you have had during your lifetime?
Unwilling to answer / don't know
One or fewer
2 to 5
6 to 20
Over 20
587.
Is your sexual desire (libido)...?
Totally absent
Reduced
Normal / don't know
Increased
Very strong
588.
Frequency of sexual contact with another person.
Under once per month / don't know
Once per week or less
About 2 times per week
3-4 times per week
5 or more times per week
589.
Frequency of any sexual stimulation that results in orgasm.
Under once per month / don't know
Once per week or less
About 2 times per week
3-4 times per week
5 or more times per week
590.
Do you have difficulty achieving an orgasm? Please answer this regardless of the method used to try and achieve one.
Cervical Dysplasia. Have irregular, but non-cancerous, cells been found on a PAP smear? (Class 1 = Slightly abnormal, Class 2 = Abnormal, Class 3 = Severely abnormal. Class 4 would be cancer.)
Not applicable / cervix removed / don't know
No
Abnormal cells in the past only, currently normal
Current abnormal cells - class 1 or 2
Current very abnormal cells - class 3
595.
When you have tried, how difficult in general has it been for you to conceive children?
Not applicable / I have not tried / don't know
It has not been difficult
There was some difficulty
It was very difficult
I am infertile / unable to have children
596.
Is there a chance of your becoming pregnant within the next six months?
Don't know
No, definitely not
Yes, a fair chance
Yes, a good chance (I am trying)
597.
Have you ever been pregnant, now or in the past?
Don't know
No
Yes, but not currently pregnant More questions later...
Currently pregnant with first child More questions later...
Pregnant now but this is not my first time More questions later...
Current menstrual status? If unsure, answer Premenopausal if under 45 or Perimenopausal if 45-52. Only answer Postmenopausal if you have successfully passed through menopause. Answering 'Don't know' will present all menstrual questions.
Don't know More questions later...
Premenopausal / Ovaries still present More questions later...
Perimenopausal More questions later...
Menopausal - having menopausal symptoms More questions later...
Postmenopausal OR both ovaries removed More questions later...
Other than AIDS, have you had any form of sexually-transmitted disease (STD)? This includes herpes, chlamydia, HPV, syphills and gonorrhea as examples. Candida is not a STD.
Don't know
No
Yes / probably More questions later...
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Please mention the question number(s) if possible.
SYMPTOMS: RESPIRATORY
610.
Do you have a cough that produces mucous?
Don't know
No
Recent problem for less than a month
Problem for over a month but less than a year
Problem for more than a year
611.
Do you have a cough that does not produce mucous?
Don't know
No
Recent problem for less than a month
Problem for over a month but less than a year
Problem for more than a year
612.
Do you feel worse when in moldy or musty places?
No / don't know
Somewhat
Very much
613.
Do you sigh frequently, or have 'air hunger' or shortness of breath that is not associated with significant exertion?
Don't know
No
Mildly / occasionally
Moderately / often
Serious sudden unexplained onset
614.
How easily do you become short of breath?
Don't know
Only with great exertion, for example sprinting
With moderate exertion such as jogging
Even with mild activity, such as walking
Always/often - even when not active
615.
Do you wheeze? If you are using respiratory medication (e.g. for asthma), tell us if you wheeze when you are not using it.
Don't know
No, not at all
Only after exercise
Occasionally / slightly
Much of the time / severely
616.
Sore throat / tonsillitis. How many times per year do you suffer from this?
Never / rarely
About once a year / average / don't know
2-3 times, mildly
2-3 times severely or more than 3 times mildly
More than 3 times, severely
617.
Have you had a problem with laryngitis?
Don't know
No
Yes, but in the past only
Current problem but can talk
Completely lost my voice
618.
Have you been diagnosed with any lung related problems not metioned already? Examples would include asthma, tuberculosis, pneumonia, COPD, acutebronchitis, etc..
Don't know
No
Yes More questions later...
619.
Have you experienced any kind of chest pain, burning, tightness, pressure or discomfort or difficulty breathing within the last year?
Don't know
No
Yes More questions later...
Enter any additional information here for the questions above:
Please mention the question number(s) if possible.
SYMPTOMS: SLEEP
620.
How often do you take a nap outside of normal sleeping hours?
Never / don't know
Once a month or less
Once a week or less
A few times per week
Daily or almost daily
621.
Drowsiness. Not including after meals, do you find yourself often falling asleep in situations such as boring meetings, watching TV or while driving?
Never / don't know
Once a month or less
Once a week or less
A few times per week
At least daily
622.
Do you generally become sleepy after eating?
Rarely / don't know
No
Occasionally
Often
623.
Do you have difficulty staying awake after midnight?
Yes, always
Usually / I only stay up for special occasions
Sometimes / I'm about average / don't know
No, I regularly stay up into the small hours
Not at all, I'm a real "night person"
624.
How is your quality of sleep when you are able to sleep without interruption or pain?
Usually broken up / difficult
Sometimes broken up / difficult
Average/sound / don't know
Generally deep
Always deep
625.
Sleep. On average, how many hours of sleep do you get per night?
Fewer than 6
6 to 7
8 / don't know
9
10 or more
626.
Do you sweat at night? Only include sweating that is not the result of an overly warm environment or too many bed covers.
Don't know
No
Only slightly
Moderately, sheets are moist
Profusely, sheets are soaked
627.
If you suffer from night sweats (severe/drenching sweating that is not due to heat or humidity), for how long has it been a problem?
Not applicable / don't know
Recent onset only - less than 2 weeks' duration
2 weeks to 2 months
2 to 6 months
Longer than 6 months
628.
Do you experience bizarre, vivid or nightmarish dreams?
Don't know
Never / rarely
Occasionally
Quite often, quite bad
Often and awful/recurring nightmares
629.
Do you remember your dreams when you wake up?
I almost always remember my dreams clearly
Average - sometimes I remember / don't know
I almost always forget them quickly
630.
Do you have any other sleeping problems? Examples include insomnia, restless legs, snoring, apnea, grogginess and sleep disorders.
Don't know
No
Yes More questions later...
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Have you had an enlarged artery called an aneurysm or experienced a ruptured aneurysm? Sometimes cerebral aneurysms are the cause of a stroke, although most strokes are caused by clotting rather than by a rupturing aneurysm.
Don't know
No
Possible enlargement being watched for progression
Yes, may require surgery
Yes, ruptured or required surgery
634.
Do you have Raynaud's phenomenon (extreme loss of circulation to fingers and/or toes)?
Do you suffer from occasional and unusual pain that may be in your chest, upper left arm or left side of neck?
Don't know
No
Occasionally / moderate
Often / severe
638.
Does your heart sometimes race or palpitate such that you can feel it beating?
No / don't know
Occasionally / moderately
Often / severely
639.
Have you had any kind of heart problem not mentioned above? Examples include heart attack, valve damage, enlargement, weakness, inflammation, failure, pain, etc.
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GLOSSARY
Acute: An illness or symptom of sudden onset, which generally has a short duration.
AIDS: Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.
Anemia: A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Asthma: A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress.
Atherosclerosis: Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.
Bronchitis: Inflammation of the mucous membrane of the bronchial tubes, frequently accompanied by cough, hypersecretion of mucus, and expectoration of sputum. Acute bronchitis is usually caused by an infectious agent and of short duration. Chronic bronchitis, generally the result of smoking, may also be known as Chronic Obstructive Pulmonary Disease (COPD) or Emphysema.
Cancer: Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Candidiasis: Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.
Cervical Dysplasia: Abnormal cells on the surface of the cervix, classified as either mild (70% of cases fall into this category; the cells regress on their own), moderate, or severe, or as class 1, 2 or 3. While dysplasia itself does not cause health problems, it is considered to be a precancerous condition. Left untreated, dysplasia sometimes progresses to an early form of cancer known as cervical carcinoma in situ, and eventually to invasive cervical cancer.
Chlamydia: A sexually-transmitted disease that is often without symptoms. Some females experience a white vaginal discharge that resembles cottage cheese, a burning sensation when urinating, itching, and painful intercourse. A clear watery urethral discharge in the male probably is a chlamydia infection.
Chronic: Usually Chronic illness: Illness extending over a long period of time.
Chronic Renal Failure: (CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.
Cysts: A closed pocket or pouch of tissue; a cyst may form within any tissue in the body and can be filled with air, fluid, pus, or other material. Cysts within the lung generally are air filled, while cysts involving the lymph system or kidneys are fluid filled. Cysts under the skin are benign, extremely common, movable lumps. These may develop as a result of infection, clogging of sebaceous glands, developmental abnormalities or around foreign bodies.
Endometriosis: A condition whereby endometrial tissue builds up in parts of the uterus where it does not belong or areas outside of the uterus, forming 'ectopic implants'. Unlike the normal tissue lining the uterus, ectopic tissue has no place to shed in response to a decline in estrogen and progesterone. This results in debris and blood accumulating at the site of the implant leading to inflammation, scarring and adhesions that ultimately cause symptoms and complications. Symptoms typically occur in a cyclic fashion with menstrual periods, the most common being pelvic pain and cramping before and during periods; pain during intercourse; inability to conceive; fatigue; painful urination during periods; gastrointestinal symptoms such as diarrhea, constipation, and nausea.
Galactorrhea: Galactorrhea is inappropriate lactation in the woman who is not pregnant or has not recently given birth. It can be unilateral or bilateral.
Gonorrhea: A sexually-transmitted disease that is often without symptoms. If there are symptoms in the female, they include frequent and painful urination, cloudy vaginal discharge, vaginal itching, inflammation of the pelvic area, and abnormal uterine bleeding. If the male has a purulent (pus-like) urethral discharge, he should assume he has gonorrhea until proven otherwise.
HIV: Abbreviation for human immunodeficiency virus, a retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).
Hysterectomy: Surgical removal of the uterus, by way of either an abdominal or vaginal incision. Removal might include removal of the cervix (total hysterectomy) or not (subtotal / partial hysterectomy). A radical hysterectomy involves surgical removal of the uterus, upper vagina, tissues adjacent to the uterus and possibly the ovaries; usually undertaken for carcinoma of the uterus. A hysterectomy with oophorectomy involves the removal of the uterus and one ovary (unilateral oophorectomy) or both ovaries (bilateral oophorectomy).
Interstitial Cystitis: A chronic bladder problem involving a bladder wall that is inflamed and irritated. Symptoms include an urgent need to urinate, both daytime and nighttime; pressure, pain and tenderness around the bladder, pelvis and perineum (the area between the anus and vagina or the anus and scrotum) which may increase as the bladder fills and decrease as it empties during urination; a bladder that won't hold as much urine as it did before; pain during sexual intercourse; in men, discomfort or pain in the penis or scrotum. In many women, the symptoms get worse before their menstrual period. Stress may also make the symptoms worse, but it does not cause them.
Kidney Stone: A stone (concretion) in the kidney. If the stone is large enough to block the tube (ureter) and stop the flow of urine from the kidney, it must be removed by surgery or other methods. Also called Renal Calculus. Symptoms usually begin with intense waves of pain as a stone moves in the urinary tract. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin. The pain may continue if the stone is too large to pass; blood may appear in the urine and there may be the need to urinate more often or a burning sensation during urination. If fever and chills accompany any of these symptoms, an infection may be present and a doctor should be seen immediately.
Menopause: The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Ovarian Cysts: These occur in two forms, namely "functional" and "organic". may not be present but can include pressure or pain in the abdomen, problems with urine flow or pain during sexual intercourse. Rarely, a very large cyst can become twisted and stop its own blood supply, possibly causing nausea, fever or severe abdominal pain. Functional ovarian cysts form part of the normal functioning of the ovary and are always benign. They may be either "follicular cysts", produced by all menstruating women every month and reaching up to 2-3cm in diameter before they rupture at ovulation, or "corpus luteum cysts", which appear after ovulation and may grow to produce "hemorrhagic cysts" if ovulation does not occur or is delayed. Rupture of such a cyst can sometimes cause painful ovulation or bleeding, which is often moderate and resolves by itself. Organic ovarian cysts may be benign or malignant and are not linked to the functioning of the ovary. They occur as either "dermoid cysts", which are benign tumors that may nevertheless recur on either ovary and contain elements derived from the skin (hairs, sebum, teeth), or other organic cysts.
Pap Test: Papanicolaou test. Microscopic examination of cells collected from the vagina and cervix to test for uterine cancer or dysplasia.
Perimenopause: A transition time during which menstrual periods can become irregular and symptoms of menopause may be experienced prior to menopause. On average, the onset of perimenopause occurs around age 47 and the average duration is 4-5 years. It is increasingly seen in women even up to 12-15 years before menopause. An array of physical, mental and emotional symptoms can occur during this time.
Perineum: The area between the anus and the posterior part of the external genitalia.
Phlebitis: Inflammation of a vein. Symptoms of superficial phlebitis include pain, swelling, redness, and warmth around the affected vein. The vein feels hard to the touch because of the clotted blood.
Postmenopause: The postmenopausal phase of a woman's life begins when 12 full months have passed since the last menstrual period and any menopausal symptoms have become milder and/or less frequent.
Premenopause: The period when women of childbearing age experience relatively normal reproductive function (including regular periods).
Raynaud's Phenomenon: Raynaud's disease or syndrome is a disorder of blood circulation, mainly in the fingers and toes. It is of unknown cause and characterized by changes of the skin that are aggravated by exposure to cold: first, becoming white with numbness and pain as a result of inadequate oxygenation of the blood, then red/purple with a burning sensation. The sudden constriction of blood vessels causes decreased blood flow to the extremities and can, in extreme cases, lead to gangrene. Also called "white finger", "wax finger" or "dead finger".
Stroke: A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Thrombophlebitis: Venous inflammation with formation of clots. It can occur without any symptoms until the clot reaches the lungs. However, in about half of cases, there are warning symptoms including swelling, pain and warmth in the entire calf, ankle, foot, or thigh (depending on where the involved vein is located).
Tuberculosis: Also known as TB, Consumption or "The White Plague", tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis, usually affecting the lungs but possibly also the brain, kidneys and bones. Patients may at first be symptom-free or experience a flu-like illness. In the secondary stage, there might be a slight fever, night sweats, weight loss, fatigue and various other symptoms, depending on the part of the body affected. Tuberculosis of the lung is usually associated with a dry cough that eventually leads to a productive cough with blood-stained sputum. There might also be chest pain and shortness of breath.
Urethral Discharge: A discharge from the urethra (the narrow tube that transports urine from the bladder to the outside of the body) that may be a cloudy, yellow-green mucous, white (like 'cottage cheese'),
More questions later...