GENERAL 1. Activity level decreased to less than 50% of pre-illness activity level 2. Cold hands and feet (extremities) 3. Cough 4. Craving carbohydrates 5. Delayed reaction to physical activity or stressful events 6. Dryness of eyes and/or mouth 7. Edema 8. Family member(s) with Fibromyalgia 9. Fatigue, made worse by physical exertion or stress 10. Feeling cold often 11. Feeling hot often 12. Frequent sighing 13. Heart palpitations 14. Hoarseness 15. Hypoglycemia (blood sugar falls or low) 16. Increased thirst 17. Low blood pressure (below 110/70) 18. Low body temperature (below 97.6) 19. Low-grade fevers 20. Night sweats 21. Noisy joints – with or without pain 22. Poor circulation in hands/feet 23. Profuse sweating 24. Recurrent flu-like illness 25. Shortness of breath with little or no exertion 26. Severe nasal allergies (new or worsening allergies) 27. Sore throat 28. Subjective swelling of extremities – (feels swollen Bu can’t find anything) 29. Sweats 30. Symptoms worsened by air travel 31. Symptoms worsened by stress 32. Symptoms worsened by temperature changes 33. Tender or swollen lymph nodes, especially in neck and underarms 34. Tremor or trembling 35. Unexplained weight gain or loss
PAIN 36. Abdominal wall pain 37. Bad hip pain 38. Burning Nerve Pain 39. Chest pain 40. Collarbone pain 41. Diffuse swelling 42. Elbow pain 43. Exacerbated Plantar arch or heel pain 44. “Growing” pains that don’t go away once you are done growing 45. Headache – tension or migraine 46. Inflamed Rib Cartilage 47. Joint pain 48. Lumpy, tender breasts 49. Morning stiffness 50. Muscle pain 51. Muscle spasms 52. Muscle twitching 53. Muscle weakness 54. Pain that ranges from moderate to severe 55. Pain that moves around the body 56. Paralysis or severe weakness of an arm or leg 57. Restless Leg Syndrome 58. Rib Pain 59. Scalp Pain (like hair being pulled out) 60. Sciatica-like pain 61. Tender points or trigger points 62. TMJ syndrome 63. “Voodoo Doll” Poking Sensation in random places
NEUROLOGICAL 64. Blackouts 65. Brain fog 66. Carpal Tunnel 67. Feeling spaced out 68. Hallucinating smells 69. Inability to think clearly 70. Lightheadedness 71. Noise intolerance 72. Numbness or tingling sensations 73. Photophobia (sensitivity to light) 74. Seizures 75. Seizure-like episodes 76. Sensation that you might faint 77. Syncope (fainting) 78. Tinnitus (ringing in one or both ears) 79. Vertigo or dizziness
EQUILIBRIUM/PERCEPTION 80. Bumping into things 81. Clumsy Walking 82. Difficulty balancing 83. Difficulty judging distances (when driving, etc.) 84. Directional disorientation 85. Dropping things frequently 86. Feeling spatially disoriented 87. Frequent tripping or stumbling 88. Not seeing what you’re looking at 89. Poor balance and coordination 90. Staggering gait
SLEEP 91. Alertness/energy best late at night 92. Altered sleep/wake schedule 93. Awakening frequently 94. Difficulty falling asleep 95. Difficulty staying asleep 96. Excessive sleeping 97. Extreme alertness or energy levels late at night 98. Falling asleep at random and sometimes dangerous moments 99. Fatigue 100. Light or broken sleep pattern 101. Muscle spasms/twitches at night 102. Narcolepsy 103. Sleep disturbances 104. Sleep starts or falling sensations 105. Teeth grinding 106. Tossing and turning 107. Un-refreshing or non-restorative sleep 108. Vivid or disturbing dreams/nightmares
EYES/VISION 109. Blind spots in vision 110. Eye pain 111. Difficulty switching focus from one thing to another 112. Frequent changes in ability to see well 113. Night driving difficulty 114. Occasional Blurry vision 115. Poor night vision 116. Rapidly worsening vision 117. Vision changes
COGNITIVE 118. Becoming lost in familiar locations when driving 119. Confusion 120. Difficulty expressing ideas in words 121. Difficulty following conversation (especially if background noise present) 122. Difficulty following directions while driving 123. Difficulty following oral instructions 124. Difficulty following written instructions 125. Difficulty making decisions 126. Difficulty moving your mouth to speak 127. Difficulty paying attention 128. Difficulty putting ideas together to form a complete picture 129. Difficulty putting tasks or things in proper sequence 130. Difficulty recognizing faces 131. Difficulty speaking known words 132. Difficulty remembering names of objects 133. Difficulty remembering names of people 134. Difficulty understanding what you read 135. Difficulty with long-term memory 136. Difficulty with simple calculations 137. Difficulty with short-term memory 138. Easily distracted during a task 139. Dyslexia-type symptoms occasionally 140. Feeling too disoriented to drive 141. Forgetting how to do routine things 142. Impaired ability to concentrate 143. Inability to recognize familiar surroundings 144. Losing track in the middle of a task (remembering what to do next) 145. Losing your train of thought in the middle of a sentence 146. Loss of ability to distinguish some colors 147. Poor judgment 148. Short term memory impairment 149. Slowed speech 150. Staring into space trying to think 151. Stuttering; stammering 152. Switching left and right 153. Transposition (reversal) of numbers, words and/or letters when you speak 154. Transposition (reversal) of numbers, words and/or letters when you write 155. Trouble concentrating 156. Using the wrong word 157. Word-finding difficulty
EMOTIONAL 158. Abrupt and/or unpredictable mood swings 159. Anger outbursts 160. Anxiety or fear when there is no obvious cause 161. Attacks of uncontrollable rage 162. Decreased appetite 163. Depressed mood 164. Feeling helpless and/or hopeless 165. Fear of someone knocking on the door 166. Fear of telephone ringing 167. Feeling worthless 168. Frequent crying 169. Heightened awareness – of symptoms 170. Inability to enjoy previously enjoyed activities 171. Irrational fears 172. Irritability 173. Overreaction 174. Panic attacks 175. Personality changes –usually a worsening of pervious condition 176. Phobias 177. Suicide attempts 178. Suicidal thoughts 179. Tendency to cry easily
GASTROINTESTINAL 180. Abdominal cramps 181. Bloating 182. Decreased appetite 183. Food cravings 184. Frequent constipation 185. Frequent diarrhea 186. Gerd-like Symptoms 187. Heartburn 188. Increased appetite 189. Intestinal gas 190. Irritable bladder 191. Irritable bowel syndrome 192. Nausea 193. Regurgitation 194. Stomachache 195. Vomiting 196. Weight gain 197. Weight loss
UROGENITAL 198. Decreased libido (sex drive) 199. Endometriosis 200. Frequent urination 201. Impotence 202. Menstrual problems 203. Painful urination or bladder pain 204. Pelvic pain 205. Prostate pain 206. Worsening of (or severe) premenstrual syndrome (PMS)
SENSITIVITIES 207. Alcohol intolerance 208. Allodynia (hypersensitive to touch) 209. Alteration of taste, smell, and/or hearing 210. Sensitivity to chemicals in cleaning products, perfumes, etc. 211. Sensitivities to foods 212. Sensitivity to light 213. Sensitivity to mold 214. Sensitivity to noise 215. Sensitivity to odors 216. Sensitivity to yeast (getting yeast infections frequently on skin, etc.) 217. Sensory overload 218. Sensitivity to pressure & humidity changes 219. Sensitivity to extreme temperature changes 220. Vulvodynia
SKIN 221. Able to “write” on skin with finger 222. Bruising easily 223. Bumps and lumps 224. Eczema or psoriasis 225. Hot/dry skin 226. Ingrown hairs 227. Itchy/Irritable skin 228. Mottled skin 229. Rashes or sores 230. Scarring easily 231. Sensitivity to the sun 232. Skin suddenly turns bright red
Cardiovascular (Heart) 233. “Click-murmur” sounds through stethoscope 234. Fluttery heartbeat 235. Heart palpitations 236. Irregular heartbeat 237. Loud pulse in ear 238. Pain that mimics heart attack 239. Rapid heartbeat
HAIR/NAILS 240. Dull, listless hair 241. Heavy and splitting cuticles 242. Irritated nail beds 243. Nails that curve under 244. Pronounced nail ridges 245. Temporary hair loss
OTHER 246. Canker sores 247. Dental problems 248. Disk Degeneration 249. Hemorrhoids 250. Nose bleeds 251. Periodontal (gum) disease |