Questionnaire - Page 7 of 9 (1077 maximum possible questions)

Last updated: May 12, 2008

SYMPTOMS: IMMUNE SYSTEM
720.	Have you suffered from boils, abscesses or carbuncles?	Never had one / don't know Probably had one/minor episode(s) now resolved Major episode(s) now resolved Current minor problem Current major problem
721.	Have you ever been diagnosed with cytomegalovirus (CMV)?	Don't know It was ruled out Yes
722.	Have you ever been diagnosed with Epstein-Barr virus (EBV)?	Don't know No, tests were negative Yes, doctor suggested it but no testing was done Yes, tests confirmed previous infection only Yes, tests confirmed current active infection
723.	Have you had vaginal yeast infections? Symptoms may include itching, burning or a "cottage cheese" discharge.	Don't know No In the past, but none for at least a year Currently 1 to 3 per year Chronic problem / more than 3 per year
724.	Have you had vaginal infections which were not caused by yeast? Symptoms, if any, may include discharge, irritation and itching.	Don't know No In the past, but none for at least a year Currently 1 to 3 per year Chronic problem / more than 3 per year
725.	Have you had fungal or yeast infections (such as Candida) anywhere, other than vaginal?	No / don't know Minor in the past only, now resolved Major in the past only, now resolved Current minor problem Current major problem
726.	Have you had Coccidioidomycosis (Valley Fever)?	Don't know No, tested negative In the past only Current problem, only lungs involved Current problem, disseminated
727.	Do you have a history of infections, for example skin, ear, bladder, respiratory etc.?	No / almost never Average - occasionally / don't know Often - one or two per year Very often - more than two per year
728.	Have you ever been diagnosed with Lupus (SLE, Systemic Lupus Erythromatosis)?	Don't know No, it has been ruled out Past episodes, now resolved Current minor problem Current major problem
729.	Have you ever been diagnosed with Lyme disease?	Don't know Tests for Lyme were negative Past episode now resolved Current minor problem Current major problem
730.	Do you have Multiple Sclerosis? Details can be entered into box below.	Never had it / don't know Probably had it/minor episode now in remission Significant problem in remission for some time Current problem Current major problem
731.	Have you been diagnosed with ALS (amyotrophic lateral sclerosis)?	Don't know No, doctors don't think I have it. Has been suggested as a possibility Yes, onset less than 3 years ago Yes, onset less over 3 years ago
732.	Do you generally have poor wound healing?	No / don't know Moderate - healing takes longer than it should Severe - healing takes weeks/months
733.	Have you suffered from Postviral Syndrome - a viral infection where symptoms persist for a long time?	Never had it / don't know Probably/minor episode now resolved Major episode now resolved Current minor problem Current major problem
734.	Do you have Sarcoidosis?	Don't know No Yes, but now symptom free Yes, a single organ problem Yes, a multiple organ problem
735.	Have you been diagnosed with scleroderma?	Never had it / don't know Probably/minor episode now resolved Major episode now resolved Current minor problem Current major problem
736.	Have you had Shingles, also known as Varicella Zoster?	Never had it / don't know Probably/minor episode now resolved Major episode now resolved Current minor problem Current major problem
737.	Have you been diagnosed with Sjogrens?	Don't know No Past only / It is suspected Mild / moderate case Severe case
738.	Have you had inflammation of the thyroid gland - Thyroiditis? This means elevation of antithyroid antibodies like TBII, anti-Tg or anti-TPO (antithyroid peroxidase / antimicrosomal antibody).	Never had it / don't know Probably/minor episode now resolved Major episode now resolved Current minor problem Current major problem
739.	Have you had tumors that were benign, or non-ovarian cysts?	Never had any / don't know Probably/minor episode now resolved Major episode now resolved Current minor problem Current major problem
740.	Have you ever had from any form of cancer?	No / don't know Yes, a past problem only More questions later... Yes, a current problem More questions later...
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SYMPTOMS: SKIN: GENERAL
741.	Do you have calluses on your heels and, if so, are they cracked?	No / don't know Light callus without significant cracking Light callus with cracking Thick callus without significant cracking Thick callus, cracked
742.	Do you have a problem with cracking skin, typically on the fingers, toes or in skin creases? Do not include cracked heel calluses.	No / don't know Occasionally / moderate Often / severe
743.	Do you have small bumps on the backs of your arms?	No / don't know Yes, some/minor Diagnosed with keratosis pilaris Yes, many/definite
744.	What is your skin color prior to suntan, compared to others of your race, or family members?	Significantly lighter/paler A little lighter/paler Average / don't know A little darker/redder Significantly darker/redder
745.	What is your facial coloring prior to suntan, compared to others of your race, or family members?	Noticeably pale Slightly pale Average / don't know Slightly dark Noticeably dark, pink, flushed or ruddy
746.	Not counting blushing during embarrassing situations, do you experience facial blushing, flushing or redness more frequently or intensely than would be considered normal?	Don't know / I think I'm average No, definitely not Mild / occasionally Moderate / sometimes Major / often
747.	Does your skin seem to have a more yellowish (jaundiced) tone than previously? It may help to look at untanned areas.	Don't know No Probably Definitely
748.	Skin moistness. Without moisturizer, is your skin...?	Very dry A bit dry Average / don't know A bit oily/moist Definitely oily/moist
749.	Does your skin tend to itch often, perhaps worse at night?	No / don't know Moderately Severely
750.	Do you have a burning sensation on your skin?	Don't know No, definitely not Mildly / occasional Moderately / sometimes Severely / frequently
751.	Do you have a sensation of bugs crawling under or on top of your skin?	Don't know No Mildly / occasionally Moderately / sometimes Definitely / frequently
752.	Do you perspire/sweat...?	Very little / not easily Less than average About average / don't know More than average Lots / easily
753.	Do your palms sweat excessively?	No / don't know Moderate problem of less than 1 year Moderate problem of more than 1 year Major problem of less than 1 year Major problem of more than 1 year
754.	Does your perspiration/sweat have a strong odor?	Don't know No Somewhat Definitely
755.	Do you bruise easily?	No / don't know Mildly Moderately Seriously Severely - I usually have bruises somewhere
756.	Do you have palms and fingertips that are more red than average?	No / don't know Somewhat Definitely
757.	Is your skin temperature . . . ?	Very cold Colder than average Average / don't know Warmer than average Very warm
758.	Is your skin thickness . . . ?	Very thin / fragile Thinner than average Average / don't know Thicker than average Very thick / tough
759.	Is your skin yellow-tinged?	No / don't know Somewhat Definitely
760.	Beyond the questions already asked, do you have ANY skin problems? This would include diagnosed conditions like acne, eczema, psoriasis, dandruff, polyps, spots, rashes, infections, MRSA, etc..	Don't know No Yes    More questions later...
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SYMPTOMS: HAIR
761.	What is your body hair quantity? This question refers to 'normal' female hair patterns i.e. underarm, pubic or leg hair but not chest or upper lip.	Don't know Little / none Less than average Average Abundant, more than average
762.	Do you have any hair growth pattern that is usually seen in males? This means increased hair on the chest/nipples, above the pubic area toward the navel, or on the chin or upper lip.	Don't know No Very minor Somewhat / one or two areas Very noticeable / in several areas
763.	Have you had a recent change in body hair quantity?	Much recent loss Some recent loss No / don't know Some recent gain Much recent gain
764.	Do you have an urge or habit of pulling or plucking hairs from your body beyond the removal of selected hairs for cosmetic reasons?	Don't know No Yes, from time to time Yes, I habitually pull hairs out Yes, I habitually pull hairs out and eat them
765.	Do you have less pubic or underarm hair growth than previously?	I can't tell / don't know No, quantity is the same Yes, the quantity has decreased somewhat Yes, the quantity has decreased substantially
766.	Do you have male pattern hair loss? Male pattern hair loss (MPHL) is a common condition in which men, and sometimes women, experience a receding hairline and/or balding on the top of the head.	No / don't know Mildly / frontal loss only Moderately / partial loss on top only Moderately / complete loss on top only Severely / nearly or totally bald
767.	Is your scalp hair falling out?	Don't know Normal loss History of heavy loss / alopecia areota Moderate loss Much loss
768.	How oily is your hair?	Dry Average / not applicable / don't know Oily
769.	Apart from graying, what color tone is or was the hair on your head?	Very light Light Average / not applicable / don't know Dark Very dark
770.	If you have gray hair, choose the answer that best describes the graying process in your case. Hair graying is both genetic and age-related.	I have no hair / no gray hair / don't know It retained its natural color longer than expected It has grayed normally for my age and race Somewhat prematurely (over half gray before 45) Very prematurely (over half gray before 35)
771.	How dense is the hair on your head?	Very sparse Somewhat sparse Average / not applicable / don't know Dense/abundant
772.	How strong are individual hairs from your head?	Brittle / break easily Somewhat brittle Normal / durable / don't know
773.	How thick are individual hairs on your head?	Thin / fine Average / don't know Thick
774.	How fast does your scalp hair grow? Hair normally grows about 1/2 inch (1.25cm) per month or 6 inches (15cm) per year.	Very slowly Slowly Average / don't know Quickly Very quickly
775.	How wavy is your hair naturally?	It is straight "Average" / don't know It is wavy / curly
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SYMPTOMS: NAILS
776.	Do your fingernails have white spots on them that are not due to nail trauma/injury?	No / don't know A few Several
777.	Do you have any white areas (not spots) on your nails that are not due to nail injury/trauma?	No / don't know Pink at the base, turning white towards the ends 80% or more of nail beds are white, including base White lines from side to side, do not move White lines from side to side, move as nails grow
778.	Are (parts of) your nails any unusual color other than white?	No / don't know Green Blue and brown Black / somewhat brown
779.	Do you experience inflamed cuticles (the skin over the base of your nails)?	No / don't know Occasionally / moderately Often / severely
780.	Do you suffer from hangnails/agnails (painful swelling around the fingernails or toenails) or ragged cuticles (occurring when cuticle or skin surrounding the nail is damaged or torn)?	No / don't know Occasionally / moderate Often / severe
781.	Are your fingernails brittle - do they chip, peel or break easily?	Don't know No Somewhat Very
782.	Do your fingernails have ridges or grooves across them (from side to side)?	No / don't know A few / minor Many / pronounced
783.	Do your fingernails curve backward like little spoons?	Don't know No A little Definitely
784.	Do you have increased roundness of finger and toe tips and nails that look like upside down spoons? This is called clubbing and can be seen here.	Don't know No Possibly Definitely with some digits Definitely, both fingers and toes
785.	How fast do your fingernails grow? Normal growth is 0.8 inches (2cm) per year but this can be hard to estimate.	Very slowly Slowly Average / don't know Quickly Very quickly
786.	Are your toenails distorted/deformed?	No / don't know Probably/minor episode now resolved Major episode now resolved Current minor problem Current major problem
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