Questionnaire - Page 1(a) of 9
(1014 maximum possible questions)		 Last updated: May 05, 2008

THE ANALYST TM
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There are often risk factors associated with conditions that your close relatives (grandparents, parents, brothers or sisters) have or have had... please answer to the best of your knowledge.
75.  Allergies in close family members?
None / don't know
Minor in one parent
Minor in two parents or significant in one
Significant in two parents
Severe in two parents
76.  Alzheimer's Disease in close family members?
None / don't know
Probably in one family member
Probably in more than one family member
Yes, in one family member
Yes, in more than one family member
77.  Chronic Fatigue in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
78.  Colitis (inflammation of the colon) or ulcerative colitis in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
79.  Depression in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
80.  Diabetes in either distant or close relatives?
None / don't know
Yes, in a distant relative
Yes, in 1 direct or 2 distant relatives
Yes, in 2 direct relatives
Yes, in more than 2 direct relatives
81.  If your father ever suffered heart attack(s), at approximately what age did they start?
Never / don't know
Over 60
51-60
41-50
40 or younger
82.  If your mother ever suffered heart attack(s), at approximately what age did they start?
Never / don't know
Over 80
71-80
61-70
60 or younger
83.  Aside from heart attacks, has there been any heart disease in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
84.  Has any family member had Huntington's Disease?
Don't know
No
Grandparent
Parent
85.  Did either of your parents suffer from hypertension?
None / don't know
Mild in one parent
Both parents mild or one parent moderate
Both parents moderate or one parent high
Both parents high or one parent severe
86.  Hyperthyroidism in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
87.  Hypothyroidism in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
88.  Macular Degeneration in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
89.  Muscle pains in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
90.  Multiple Sclerosis in close family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member
91.  Schizophrenia in close family members?
None / don't know
Yes, in one distant relative
Yes, in one direct relative or 2 distant relatives
Yes, in 2 direct relatives
Yes, in more than 2 direct relatives
92.  Stroke in close family members?
None / don't know
Yes, in one distant relative
Yes, in more than one distant relative
Yes, in one direct relative
Yes, in more than one direct relative
93.  Tuberculosis in family members?
None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one or more family members
Yes, in more than one generation of family members

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GLOSSARY

Allergy:  Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Alzheimer's Disease:  A progressive disease of the middle-aged and elderly, characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions such as memory and learning. Alzheimer's disease is the most common cause of dementia.

Chronic Fatigue Syndrome:  CFS (Chronic Fatigue Syndrome) is a disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.

Close Family Members:  For medical purposes this would include your parents, grandparents, and nonadopted siblings (brothers and sisters). In some cases it could include your children as well.

Colitis:  Inflammation of the colon.

Colon:  The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Hypertension:  High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.

Hyperthyroidism:  An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.

Hypothyroidism:  Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.

Macular Degeneration:  Increasingly poor eyesight often accompanied by light sensitivity, distorted vision and a blank or dark patch in the center of vision.

Multiple Sclerosis:  Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.

Schizophrenia:  Any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and defects of the frontal lobe and is caused by genetic, other biological, and psychosocial factors.

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.

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.

Ulcerative Colitis:  (Colitis ulcerosa): Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.



 


Your attitude determines your outcome. Successful people embrace this truth, whether it is a doctor going into surgery, a pastor preparing a sermon or a business-person launching a new venture. Confidence increases your chance of success every time. When you approach a task, especially one you do not relish, fix your mind on the facts, not your feelings. That will put your attitude on the right track.