TendrTummy/Christine
Moderators: Rosie, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
TendrTummy/Christine
5/31/2005 Tuesday
Breakfast (5am): 1/2 cup applesauce
Symptoms: pain, gassiness, crampiness this morning
snacks: rice cereal
lunch (1:45): salad - lettuce, fresh tomato, mushrooms, pieces of ham, and sunflower seeds topped with french dressing (no-no).
4:10pm: intense diarrhea/pain in lower abdomen followed by a feeling of "poop urgency" but no poop.
dinner (6pm): corn dog bites (I know, NOT a great idea), organic fries
BMs:
8:31am BM - solid consistency, foul smell, "norman"
2:05pm BM - solid but tissuey consistency, foul smell, looked like "norman" but definitely didn't FEEL like "norman" - painful!
4:30pm: BM, diarrhea, painful
OVERALL SYMPTOMS:
Right Elbow/Arm pain today
lower abdominal pain/gassy-crampiness
low back pain
neck pain
Breakfast (5am): 1/2 cup applesauce
Symptoms: pain, gassiness, crampiness this morning
snacks: rice cereal
lunch (1:45): salad - lettuce, fresh tomato, mushrooms, pieces of ham, and sunflower seeds topped with french dressing (no-no).
4:10pm: intense diarrhea/pain in lower abdomen followed by a feeling of "poop urgency" but no poop.
dinner (6pm): corn dog bites (I know, NOT a great idea), organic fries
BMs:
8:31am BM - solid consistency, foul smell, "norman"
2:05pm BM - solid but tissuey consistency, foul smell, looked like "norman" but definitely didn't FEEL like "norman" - painful!
4:30pm: BM, diarrhea, painful
OVERALL SYMPTOMS:
Right Elbow/Arm pain today
lower abdominal pain/gassy-crampiness
low back pain
neck pain
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
WEEKLY SELF-SURVEY
CONSTITUTIONAL
_4_ Fatigue (sluggish, tired) - TIRED ALL THE TIME
_0_ Hyperactive (nervous energy)
_1__ Restless (can’t relax/sit still) - RESTLESS LEGS
_1_ Sleepiness During Day
_0_ Insomnia at Night
_6__ TOTAL (0-20)
EMOTIONAL/MENTAL
_2_ Depression (feelings of
hopelessness)
_0_ Anxiety (vague fears,
uneasiness)
_1_ Mood Swings (rapid
distinct changes)
_1_ Irritability
_2_ Forgetfulness
_2_ Lack of concentration/focus
__8_ TOTAL (0-24)
HEAD/EARS
__4_ Headache (any kind)
__2_ Earache
__0_ Ear Infection
__1_ Ringing in Ear
__2_ Itchy Ears
__1_ Discharge From Ears
__10 TOTAL (0-24)
SKIN
__4_ Blemishes, Acne
__0_ Rashes, Hives
__0_ Eczema
__0_ “Rosy” Cheeks
__4_ TOTAL (0-16)
NASAL/SINUS
__4_ Post Nasal Drip
__1_ Sinus Pain
__2_ Runny Nose
__2_ Stuffy Nose
__2_ Sneezing
__11 TOTAL (0-20)
MOUTH/THROAT
_2__ Sore Throat
_0__ Swollen Throat
_0__ Swelling of Lips/Tongue
_1_ Gagging/Throat Clearing
_0_ Lesions ("Canker Sores")
_3___ TOTAL (0-20)
LUNGS
__0_ Wheezing" (Asthma or
Asthma-like Symptoms)
__0_ Chest Congestion
__0_ Non-Productive Coughing
__2_ Productive Coughing
__2_ TOTAL (0-20)
EYES
__0__ Red or Swollen Eyes
__2__ Watery Eyes
__3__ Itchy Eyes
__1__ Dark Circles" or "Baggy"
__6__ TOTAL (0-16)
GENITOURINARY
__0__ Increased Urinary
Frequency
__0__ Painful Urination
__0__ TOTAL (0-8)
MUSCULOSKELETAL
__2_ Joint Pains/Aching - LEFT HIP, RIGHT ELBOW
__1_ Stiff Joints
__1_ Muscle Aches
_0_ Stiff Muscles
__4__ TOTAL (0-20)
CARDIOVASCULAR
__0_ Irregular Heartbeat
__0_ High Blood Pressure _0___ TOTAL (0-8)
DIGESTIVE
__1_ Heartburn/Esoph.Reflux
__4_ Stomach Pains/Cramps
__4_ Intestinal Pains/Cramps
__0_ Constipation
__3_ Diarrhea
__4_ Bloating Sensation
__4_ Gas (of Any Kind)
__2_ Nausea, Vomiting
__4_ Painful Elimination
_26__ TOTAL (0-36)
WEIGHT MANAGEMENT
_106# Record Actual Weight
_5'1"_ Height
__1_ Fluctuating Weight
__0_ Food Cravings
__0_ Water Retention
__0_ Binge Eating or Drinking
__0_ Purging (all methods)
__1_ TOTAL (0-20)
Patient Name:_Christine Neutgens_ Date:_ 5/31/2005_____
SYMPTOM SURVEY
Instructions: The way to fill out the form is simple. Start with the first symptom and ask yourself, "Lately, have I experienced this symptom?" If you answer no or almost not at all, then write a "0" in the corresponding field. If the answer is yes, then ask yourself if you experience the symptom occasionally (less than 2 times in a week) or frequently (2 or more times in a week). After you have decided on the frequency, then ask yourself if the symptom is "Severe" or "Not Severe". Using the SCALE OF SYMPTOM POINTS listed below, write the appropriate score in the corresponding field for EVERY symptom listed. Total the points for each category and add all category totals to come up with the Grand Total. After completion, turn in this form to your health care provider.
SCALE OF SYMPTOM POINTS:
0 = Do Not Suffer From This Ever or Almost Ever
1 = Suffer OCCASSIONALLY (less than 2 times per week), is not severe
2 = Suffer FREQUENTLY (2 or more times per week), is not severe
3 = Suffer OCCASSIONALLY and is severe
4 = Suffer FREQUENTLY and is severe _____ INITIAL REPORT (or)
_____ FOLLOW-UP (circle)
1 2 3 4 5 6 7 Grand Total:
_4_ Fatigue (sluggish, tired) - TIRED ALL THE TIME
_0_ Hyperactive (nervous energy)
_1__ Restless (can’t relax/sit still) - RESTLESS LEGS
_1_ Sleepiness During Day
_0_ Insomnia at Night
_6__ TOTAL (0-20)
EMOTIONAL/MENTAL
_2_ Depression (feelings of
hopelessness)
_0_ Anxiety (vague fears,
uneasiness)
_1_ Mood Swings (rapid
distinct changes)
_1_ Irritability
_2_ Forgetfulness
_2_ Lack of concentration/focus
__8_ TOTAL (0-24)
HEAD/EARS
__4_ Headache (any kind)
__2_ Earache
__0_ Ear Infection
__1_ Ringing in Ear
__2_ Itchy Ears
__1_ Discharge From Ears
__10 TOTAL (0-24)
SKIN
__4_ Blemishes, Acne
__0_ Rashes, Hives
__0_ Eczema
__0_ “Rosy” Cheeks
__4_ TOTAL (0-16)
NASAL/SINUS
__4_ Post Nasal Drip
__1_ Sinus Pain
__2_ Runny Nose
__2_ Stuffy Nose
__2_ Sneezing
__11 TOTAL (0-20)
MOUTH/THROAT
_2__ Sore Throat
_0__ Swollen Throat
_0__ Swelling of Lips/Tongue
_1_ Gagging/Throat Clearing
_0_ Lesions ("Canker Sores")
_3___ TOTAL (0-20)
LUNGS
__0_ Wheezing" (Asthma or
Asthma-like Symptoms)
__0_ Chest Congestion
__0_ Non-Productive Coughing
__2_ Productive Coughing
__2_ TOTAL (0-20)
EYES
__0__ Red or Swollen Eyes
__2__ Watery Eyes
__3__ Itchy Eyes
__1__ Dark Circles" or "Baggy"
__6__ TOTAL (0-16)
GENITOURINARY
__0__ Increased Urinary
Frequency
__0__ Painful Urination
__0__ TOTAL (0-8)
MUSCULOSKELETAL
__2_ Joint Pains/Aching - LEFT HIP, RIGHT ELBOW
__1_ Stiff Joints
__1_ Muscle Aches
_0_ Stiff Muscles
__4__ TOTAL (0-20)
CARDIOVASCULAR
__0_ Irregular Heartbeat
__0_ High Blood Pressure _0___ TOTAL (0-8)
DIGESTIVE
__1_ Heartburn/Esoph.Reflux
__4_ Stomach Pains/Cramps
__4_ Intestinal Pains/Cramps
__0_ Constipation
__3_ Diarrhea
__4_ Bloating Sensation
__4_ Gas (of Any Kind)
__2_ Nausea, Vomiting
__4_ Painful Elimination
_26__ TOTAL (0-36)
WEIGHT MANAGEMENT
_106# Record Actual Weight
_5'1"_ Height
__1_ Fluctuating Weight
__0_ Food Cravings
__0_ Water Retention
__0_ Binge Eating or Drinking
__0_ Purging (all methods)
__1_ TOTAL (0-20)
Patient Name:_Christine Neutgens_ Date:_ 5/31/2005_____
SYMPTOM SURVEY
Instructions: The way to fill out the form is simple. Start with the first symptom and ask yourself, "Lately, have I experienced this symptom?" If you answer no or almost not at all, then write a "0" in the corresponding field. If the answer is yes, then ask yourself if you experience the symptom occasionally (less than 2 times in a week) or frequently (2 or more times in a week). After you have decided on the frequency, then ask yourself if the symptom is "Severe" or "Not Severe". Using the SCALE OF SYMPTOM POINTS listed below, write the appropriate score in the corresponding field for EVERY symptom listed. Total the points for each category and add all category totals to come up with the Grand Total. After completion, turn in this form to your health care provider.
SCALE OF SYMPTOM POINTS:
0 = Do Not Suffer From This Ever or Almost Ever
1 = Suffer OCCASSIONALLY (less than 2 times per week), is not severe
2 = Suffer FREQUENTLY (2 or more times per week), is not severe
3 = Suffer OCCASSIONALLY and is severe
4 = Suffer FREQUENTLY and is severe _____ INITIAL REPORT (or)
_____ FOLLOW-UP (circle)
1 2 3 4 5 6 7 Grand Total:
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
6/01/2005 Wednesday
6/01/2005 Wednesday
breakfast (5am): 1/2 cup applesauce
snacks: rice cereal
lunch: none. This does NOT ordinarily happen. Just didn't have TIME.
result: SHARP pains in my mid-right abdomen as well as VERY lightheaded and feeling of "butterflies" in stomach.
dinner (6:30pm): plain hamburger with a little ketchup and corn.
**NOTE** no BMs today!!! STRANGE.
OVERALL SYMPTOMS TODAY:
Right elbow pain has progressed to shoulder and wrist
neck pain
back pain
sharp lower abdominal pains
nausea, lightheadedness this morning
breakfast (5am): 1/2 cup applesauce
snacks: rice cereal
lunch: none. This does NOT ordinarily happen. Just didn't have TIME.
result: SHARP pains in my mid-right abdomen as well as VERY lightheaded and feeling of "butterflies" in stomach.
dinner (6:30pm): plain hamburger with a little ketchup and corn.
**NOTE** no BMs today!!! STRANGE.
OVERALL SYMPTOMS TODAY:
Right elbow pain has progressed to shoulder and wrist
neck pain
back pain
sharp lower abdominal pains
nausea, lightheadedness this morning
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
Thursday 6/02/2005
Thursday, 6/02/2005
breakfast (5am): 6 mini carrots - changing it up a little!
snacks: rice cereal
snack (9:30): honey glazed peanuts
lunch (1pm): oriental style chicken and rice dish. MIGHT have soy in the sauce but I really didn't have time for anything else..
dinner (7pm): taco salad - lettuce, tomato, taco meat (beef with light coating of salt and taco spices), gluten and vinegar free french dressing
No BMs today - 2nd day in a row (ODD)
OVERALL SYMPTOMS TODAY:
right elbow pain is still present altho less today
extreme stomach pain and overall malaise today
feeling VERY fatigued, weak, sleepy, tired
took a walk tonite and did some stretching - right leg pain (extreme) late at night, kept me up until midnight or so..
breakfast (5am): 6 mini carrots - changing it up a little!
snacks: rice cereal
snack (9:30): honey glazed peanuts
lunch (1pm): oriental style chicken and rice dish. MIGHT have soy in the sauce but I really didn't have time for anything else..
dinner (7pm): taco salad - lettuce, tomato, taco meat (beef with light coating of salt and taco spices), gluten and vinegar free french dressing
No BMs today - 2nd day in a row (ODD)
OVERALL SYMPTOMS TODAY:
right elbow pain is still present altho less today
extreme stomach pain and overall malaise today
feeling VERY fatigued, weak, sleepy, tired
took a walk tonite and did some stretching - right leg pain (extreme) late at night, kept me up until midnight or so..
-
- Rockhopper Penguin
- Posts: 706
- Joined: Wed May 25, 2005 6:16 am
- Location: South Carolina
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
peanuts
Well, I left my peanut can at home, but all ingredients are safe.... in fact, I was SHOCKED at how FEW ingredients are in honey roasted peanuts!! It's basically peanuts, honey, sugar, and salt.. I'll double-check the EXACT ingredients tonite but they were all on my safe list, and peanuts are a good source of protein for those of us who can't have eggs, and a good source of fat for those of us who can't have milk..
Christine
Christine
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
Friday (thank GOD), 6/03/2005
Friday (THANK GOD), 6/03/2005
breakfast (5am): 1/2 cup applesauce
snack: honey roasted peanuts
lunch (1pm): leftover taco salad - lettuce, tomatoes, taco meat, french dressing
dinner (6:30pm): corn dog bites (I know, BAD), organic fries, and peas.
snack (9pm): banana with Hershey syrup on it :)
BMs:
8:20am: semi-diarrhea BM - gassy, crampy, painful now.. note, corn from 2 nights ago appeared.. so we're talking about a 1 & 1/2 day turnover rate here..
OVERALL SYMPTOMS TODAY:
elbow pain is somewhat better today :)
back pain
stomach pain
neck pain
small amount of leftover right leg pain
foot cramps this morning
breakfast (5am): 1/2 cup applesauce
snack: honey roasted peanuts
lunch (1pm): leftover taco salad - lettuce, tomatoes, taco meat, french dressing
dinner (6:30pm): corn dog bites (I know, BAD), organic fries, and peas.
snack (9pm): banana with Hershey syrup on it :)
BMs:
8:20am: semi-diarrhea BM - gassy, crampy, painful now.. note, corn from 2 nights ago appeared.. so we're talking about a 1 & 1/2 day turnover rate here..
OVERALL SYMPTOMS TODAY:
elbow pain is somewhat better today :)
back pain
stomach pain
neck pain
small amount of leftover right leg pain
foot cramps this morning
-
- Rockhopper Penguin
- Posts: 706
- Joined: Wed May 25, 2005 6:16 am
- Location: South Carolina
Good Morning, Christine
It's interesting about the honey roated peanuts. I would like to be able to eat them - used to love that flavor. I'm not sure why I think I can't eat them.
What kind of sugar do you think is in them? I wouldn't be surprised if it is corn syrup. Are you corn intolerant? How do you feel after you've had the nuts for a snack? Do you notice any increased rumbling or gas?
If you think I'm nosy, you're right
I eat peanuts on occasion and I don't have any problems that I know of in relation to the peanuts themselves.
It's interesting about the absence of BMs you've experienced the last few days. How about today? It could be a sign that you are having good luck with your most recent diet changes. With your good attitude I have no doubt you'll get your symptoms under control very soon.
Love,
Karen
It's interesting about the honey roated peanuts. I would like to be able to eat them - used to love that flavor. I'm not sure why I think I can't eat them.
What kind of sugar do you think is in them? I wouldn't be surprised if it is corn syrup. Are you corn intolerant? How do you feel after you've had the nuts for a snack? Do you notice any increased rumbling or gas?
If you think I'm nosy, you're right
I eat peanuts on occasion and I don't have any problems that I know of in relation to the peanuts themselves.
It's interesting about the absence of BMs you've experienced the last few days. How about today? It could be a sign that you are having good luck with your most recent diet changes. With your good attitude I have no doubt you'll get your symptoms under control very soon.
Love,
Karen
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
LOL
LOL good attitude, that's a funny one I think I have the worst attitude of most the people I've met.. yeah, I try to be all cheery on the board, but I spent like an hour lying awake last night in fear for my son's life just because he has a DOORKNOB for a father LOL I worry too much!!! Probably contributes to my symptoms..
I dunno about what kinda sugar is in it. I'm going to have to check when I get home and post to you then.. usually get home around 5:30 or 6..
I haven't noticed anything STRANGE after eating them except for increase in heartburn, which I rarely have anymore. Much as I HATE heartburn, those nuts are a lowfat source of protein and my body needs it!!! I'm not corn intolerant that I KNOW of.. but I've suspected it and had previously eliminated it from my diet. I'm TRYING to test out all of my current dietary restrictions for awhile and see if this affects anything/improves all of my symptoms after a given time period.. then, if I'm still having probs, I guess I'll try eliminating it again..
Christine
I dunno about what kinda sugar is in it. I'm going to have to check when I get home and post to you then.. usually get home around 5:30 or 6..
I haven't noticed anything STRANGE after eating them except for increase in heartburn, which I rarely have anymore. Much as I HATE heartburn, those nuts are a lowfat source of protein and my body needs it!!! I'm not corn intolerant that I KNOW of.. but I've suspected it and had previously eliminated it from my diet. I'm TRYING to test out all of my current dietary restrictions for awhile and see if this affects anything/improves all of my symptoms after a given time period.. then, if I'm still having probs, I guess I'll try eliminating it again..
Christine
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
Saturday, 6/03/2005
Saturday, 6/03/2005
breakfast (9am): half a banana, 1 cup rice cereal
lunch (noon): chicken, potato, corn, part of a brownie (I cheated)
dinner (5pm): Chuck E Cheese! Salad with french dressing
OVERALL SYMPTOMS TODAY:
arm is somewhat better but I haven't been using it :)
stomach pain is there but not horrible
back pain is the same
breakfast (9am): half a banana, 1 cup rice cereal
lunch (noon): chicken, potato, corn, part of a brownie (I cheated)
dinner (5pm): Chuck E Cheese! Salad with french dressing
OVERALL SYMPTOMS TODAY:
arm is somewhat better but I haven't been using it :)
stomach pain is there but not horrible
back pain is the same
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
Sunday, 6/05/2005
Sunday, 6/05/2005
breakfast (8am): 1/2 banana
BM (8:30am): complete diarrhea, horrible gas, painful
lunch (noon - 3pm): snacks, beef jerky, potato chips, peanuts, summer sausage and shrimp.
dinner (6pm): steak, hot potato salad, and beans.
OVERALL SYMPTOMS:
arm is doing quite a bit better
stomach pain is horrible today
breakfast (8am): 1/2 banana
BM (8:30am): complete diarrhea, horrible gas, painful
lunch (noon - 3pm): snacks, beef jerky, potato chips, peanuts, summer sausage and shrimp.
dinner (6pm): steak, hot potato salad, and beans.
OVERALL SYMPTOMS:
arm is doing quite a bit better
stomach pain is horrible today
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
Monday, 6/06/2005
Monday 6/06/2005 Personal Survey
CONSTITUTIONAL
_4_fatigue (sluggish, tired)
_0_Hyperactive(nervous energy)
_0_ Restless (can’t relax/sit still)
_3_ Sleepiness During Day
_0_ Insomnia at Night
_7__ TOTAL (0-20)
EMOTIONAL/MENTAL
_3_ Depression (feelings of
hopelessness)
_0_ Anxiety (vague fears,
uneasiness)
_1_ Mood Swings (rapid
distinct changes)
_1_ Irritability
_1_ Forgetfulness
_0 Lack of concentration/focus
__6_ TOTAL (0-24)
HEAD/EARS
_2__ Headache (any kind)
_0__ Earache
_0__ Ear Infection
_0__ Ringing in Ear
_1__ Itchy Ears
_1__ Discharge From Ears
_4__ TOTAL (0-24)
SKIN
_3__ Blemishes, Acne
_0__ Rashes, Hives
_0__ Eczema
_0__ “Rosy” Cheeks
_3__ TOTAL (0-16)
NASAL/SINUS
_2__ Post Nasal Drip
_0__ Sinus Pain
_1__ Runny Nose
_1__ Stuffy Nose
_1__ Sneezing
_5__ TOTAL (0-20)
MOUTH/THROAT
_0__ Sore Throat
_0__ Swollen Throat
_0__ Swelling of Lips/Tongue
_0_ Gagging/Throat Clearing
_0_ Lesions ("Canker Sores")
_0__ TOTAL (0-20)
LUNGS
_0__ Wheezing" (Asthma or
Asthma-like Symptoms)
_0__ Chest Congestion
_0__ Non-Productive Coughing
_0__ Productive Coughing
_0_ TOTAL (0-20)
EYES
_0___ Red or Swollen Eyes
_2___ Watery Eyes
_2___ Itchy Eyes
_0___ Dark Circles" or "Baggy"
_4___ TOTAL (0-16)
GENITOURINARY
__0__ Increased Urinary
Frequency
__0__ Painful Urination
__0__ TOTAL (0-8)
MUSCULOSKELETAL
_4_ Joint Pains/Aching
_4__ Stiff Joints
_3_ Muscle Aches
_0 Stiff Muscles
_11_ TOTAL (0-20)
CARDIOVASCULAR
__0_ Irregular Heartbeat
__0_ High Blood Pressure
__0 TOTAL (0-8)
DIGESTIVE
__3_ Heartburn/Esoph.Reflux
__4_ Stomach Pains/Cramps
__4 Intestinal Pains/Cramps
__0_ Constipation
__3_ Diarrhea
__4_ Bloating Sensation
__4_ Gas (of Any Kind)
__3_ Nausea, Vomiting
__3_ Painful Elimination
__28_TOTAL (0-36)
WEIGHT MANAGEMENT
_106 Record Actual Weight
_5'1" Height
__0_ Fluctuating Weight
__0_ Food Cravings
__0 Water Retention
__0_ Binge Eating or Drinking
__0_ Purging (all methods)
__0_ TOTAL (0-20)
Patient Name:__ ___Christine Neutgens______ Date:_ _6/06/2005_____
SYMPTOM SURVEY
Instructions: The way to fill out the form is simple. Start with the first symptom and ask yourself, "Lately, have I experienced this symptom?" If you answer no or almost not at all, then write a "0" in the corresponding field. If the answer is yes, then ask yourself if you experience the symptom occasionally (less than 2 times in a week) or frequently (2 or more times in a week). After you have decided on the frequency, then ask yourself if the symptom is "Severe" or "Not Severe". Using the SCALE OF SYMPTOM POINTS listed below, write the appropriate score in the corresponding field for EVERY symptom listed. Total the points for each category and add all category totals to come up with the Grand Total. After completion, turn in this form to your health care provider.
SCALE OF SYMPTOM POINTS:
0 = Do Not Suffer From This Ever or Almost Ever
1 = Suffer OCCASSIONALLY (less than 2 times per week), is not severe
2 = Suffer FREQUENTLY (2 or more times per week), is not severe
3 = Suffer OCCASSIONALLY and is severe
4 = Suffer FREQUENTLY and is severe _____ INITIAL REPORT (or)
_____ FOLLOW-UP (circle)
1 2 3 4 5 6 7 Grand Total:
CONSTITUTIONAL
_4_fatigue (sluggish, tired)
_0_Hyperactive(nervous energy)
_0_ Restless (can’t relax/sit still)
_3_ Sleepiness During Day
_0_ Insomnia at Night
_7__ TOTAL (0-20)
EMOTIONAL/MENTAL
_3_ Depression (feelings of
hopelessness)
_0_ Anxiety (vague fears,
uneasiness)
_1_ Mood Swings (rapid
distinct changes)
_1_ Irritability
_1_ Forgetfulness
_0 Lack of concentration/focus
__6_ TOTAL (0-24)
HEAD/EARS
_2__ Headache (any kind)
_0__ Earache
_0__ Ear Infection
_0__ Ringing in Ear
_1__ Itchy Ears
_1__ Discharge From Ears
_4__ TOTAL (0-24)
SKIN
_3__ Blemishes, Acne
_0__ Rashes, Hives
_0__ Eczema
_0__ “Rosy” Cheeks
_3__ TOTAL (0-16)
NASAL/SINUS
_2__ Post Nasal Drip
_0__ Sinus Pain
_1__ Runny Nose
_1__ Stuffy Nose
_1__ Sneezing
_5__ TOTAL (0-20)
MOUTH/THROAT
_0__ Sore Throat
_0__ Swollen Throat
_0__ Swelling of Lips/Tongue
_0_ Gagging/Throat Clearing
_0_ Lesions ("Canker Sores")
_0__ TOTAL (0-20)
LUNGS
_0__ Wheezing" (Asthma or
Asthma-like Symptoms)
_0__ Chest Congestion
_0__ Non-Productive Coughing
_0__ Productive Coughing
_0_ TOTAL (0-20)
EYES
_0___ Red or Swollen Eyes
_2___ Watery Eyes
_2___ Itchy Eyes
_0___ Dark Circles" or "Baggy"
_4___ TOTAL (0-16)
GENITOURINARY
__0__ Increased Urinary
Frequency
__0__ Painful Urination
__0__ TOTAL (0-8)
MUSCULOSKELETAL
_4_ Joint Pains/Aching
_4__ Stiff Joints
_3_ Muscle Aches
_0 Stiff Muscles
_11_ TOTAL (0-20)
CARDIOVASCULAR
__0_ Irregular Heartbeat
__0_ High Blood Pressure
__0 TOTAL (0-8)
DIGESTIVE
__3_ Heartburn/Esoph.Reflux
__4_ Stomach Pains/Cramps
__4 Intestinal Pains/Cramps
__0_ Constipation
__3_ Diarrhea
__4_ Bloating Sensation
__4_ Gas (of Any Kind)
__3_ Nausea, Vomiting
__3_ Painful Elimination
__28_TOTAL (0-36)
WEIGHT MANAGEMENT
_106 Record Actual Weight
_5'1" Height
__0_ Fluctuating Weight
__0_ Food Cravings
__0 Water Retention
__0_ Binge Eating or Drinking
__0_ Purging (all methods)
__0_ TOTAL (0-20)
Patient Name:__ ___Christine Neutgens______ Date:_ _6/06/2005_____
SYMPTOM SURVEY
Instructions: The way to fill out the form is simple. Start with the first symptom and ask yourself, "Lately, have I experienced this symptom?" If you answer no or almost not at all, then write a "0" in the corresponding field. If the answer is yes, then ask yourself if you experience the symptom occasionally (less than 2 times in a week) or frequently (2 or more times in a week). After you have decided on the frequency, then ask yourself if the symptom is "Severe" or "Not Severe". Using the SCALE OF SYMPTOM POINTS listed below, write the appropriate score in the corresponding field for EVERY symptom listed. Total the points for each category and add all category totals to come up with the Grand Total. After completion, turn in this form to your health care provider.
SCALE OF SYMPTOM POINTS:
0 = Do Not Suffer From This Ever or Almost Ever
1 = Suffer OCCASSIONALLY (less than 2 times per week), is not severe
2 = Suffer FREQUENTLY (2 or more times per week), is not severe
3 = Suffer OCCASSIONALLY and is severe
4 = Suffer FREQUENTLY and is severe _____ INITIAL REPORT (or)
_____ FOLLOW-UP (circle)
1 2 3 4 5 6 7 Grand Total:
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
Monday, 6/06/2005
Monday, 6/06/2005
breakfast (5am): 6 baby carrots
BM (5am): semi-formed, diarrhea in nature.
lunch (12:30pm): salad AGAIN: lettuce, onion, mushrooms, chunks o turkey and lowfat french dressing
BM (2:30pm): diarrhea - the kind that comes out with some #1 - I HATE THOSE.
dinner (6:30pm): plain hamburger, some ketchup, organic fries, corn
OVERALL SYMPTOMS TODAY:
stomach pain is VERY bad, and focused in one area - uterine area (note, had sex last night)
arm pain is pretty good today, altho still present
back pain is very lower back
feeling of heartburn in throat - "cold" feeling
breakfast (5am): 6 baby carrots
BM (5am): semi-formed, diarrhea in nature.
lunch (12:30pm): salad AGAIN: lettuce, onion, mushrooms, chunks o turkey and lowfat french dressing
BM (2:30pm): diarrhea - the kind that comes out with some #1 - I HATE THOSE.
dinner (6:30pm): plain hamburger, some ketchup, organic fries, corn
OVERALL SYMPTOMS TODAY:
stomach pain is VERY bad, and focused in one area - uterine area (note, had sex last night)
arm pain is pretty good today, altho still present
back pain is very lower back
feeling of heartburn in throat - "cold" feeling
- TendrTummy
- Gentoo Penguin
- Posts: 466
- Joined: Thu May 26, 2005 5:51 am
- Location: Waconia, MN, USA
- Contact:
Tuesday, 6/07/2005
Tuesday, 6/07/2005
breakfast (5am): 1/2 cup applesauce
BM (6am): diarrhea, painful
lunch (2pm): salad (sigh, AGAIN) - lettuce, mushrooms, onion, sunflower seeds, turkey chunks, bacon, tomato, french dressing.
dinner (6pm): hot dog, tater tots, peas
snack: viactiv!!! (crap, can't take it anymore - it has soy and a bit of dairy)
OVERALL SYMPTOMS TODAY:
elbow pain was horrible last night but is not bad this morning
stomach pain and cramping, I feel absolutely horrible this morning: nausea, crampy, gassy.
breakfast (5am): 1/2 cup applesauce
BM (6am): diarrhea, painful
lunch (2pm): salad (sigh, AGAIN) - lettuce, mushrooms, onion, sunflower seeds, turkey chunks, bacon, tomato, french dressing.
dinner (6pm): hot dog, tater tots, peas
snack: viactiv!!! (crap, can't take it anymore - it has soy and a bit of dairy)
OVERALL SYMPTOMS TODAY:
elbow pain was horrible last night but is not bad this morning
stomach pain and cramping, I feel absolutely horrible this morning: nausea, crampy, gassy.
Christine,
Sorry to see you're not doing well. The salads, salad dressings, and applesause would cause me to have nausea, bloating, gas, and uncontrollable diarrhea. Also, are you sure you're not corn intolerant?
Tex
Sorry to see you're not doing well. The salads, salad dressings, and applesause would cause me to have nausea, bloating, gas, and uncontrollable diarrhea. Also, are you sure you're not corn intolerant?
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.