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Keep a record of your symptoms

By using this form you can keep a record about your symptoms. You can print out the page and you have a record of your current symptoms.

SUDS (Subjective Units of Disturbance Scale, a psychological term) is a scale of "0-10". "10" is very severe symptoms. "1" is barely any.  After you mark your answers, print out the screen. Keep it for your records. Then you can check your progress periodically. Unless you keep a good record, you can get discouraged if your progress is slow. It can take months to really notice a major improvement.

Today's Date: 
How long have you had CFS? :
Symptoms of CFS
1. Do you have abdominal pain? SUDS
2. Do you have alcohol intolerance? SUDS
3. Do you have allergies? Are you sensitive to medicines, inhalants, odors, and foods? SUDS
4. Do you have altered taste, smell, hearing? SUDS
5. Do you experience anxiety/panic attacks or seizures? SUDS
6. Do you experience aphasia (inability to find the right word, saying the wrong word) and/or dyscalculia (difficulty with numbers)? SUDS
7. Do you have a balance disturbance? SUDS
8. Do you have a bitter or metallic taste in your mouth? SUDS
9. Do you have bladder/prostate problems, frequent urination? Do you experience burning during urination? Do you experience incontinence? SUDS
10. Do you experience bloating after meals? SUDS
11. Do you have blurred vision, are your eyes scratchy? SUDS
12. Do you have bouts of diarrhea or constipation? SUDS
13. Do you bruise easily? SUDS
14. Is your thyroid inflamed? SUDS
15. Do you have a white coated tongue? SUDS
16. Do you have carpal tunnel syndrome? SUDS
17. Do you have chemical sensitivities? SUDS
18. Do you have chest pain or even serious cardiac rhythm disturbances? SUDS
19. Are you cold most of the time? SUDS
20. Do you have a chronic sore throat? SUDS
21. Are you clumsy? SUDS
22. Do you have problems concentrating or thinking clearly, feel spacey? SUDS
23. Do you have a cough? SUDS
24. Do you crave sugar or carbs? SUDS
25. Do you have a decreased libido? SUDS
26. Are you depressed? SUDS
27. Do you have difficulty swallowing? SUDS
28. Do you experience disequilibrium, spatial disorientation, dizziness, vertigo? SUDS
29. Do you have double vision or see "floaters"? SUDS
30. Are your mouth and/or eyes too dry? SUDS
31. Do you have frequent earaches? SUDS
32. Do you have endometriosis? SUDS
33. Do you experience episodic hyperventilation or do you get short of breath easily? SUDS
34. Do you have eye pain? SUDS
35. Do you have fainting spells or blackout? SUDS
36. Do you have extreme fatigue that alternates with periods of normalcy? SUDS
37. Do you experience fatigue, often accompanied by nonrestorative sleep, generally worsened by exertion? SUDS
38. Do you have fevers/chills/sweats/feeling hot often? SUDS
39. Do you have a flushing rash of the face and cheeks? SUDS
40. Do you have frequent canker sores? SUDS
41. Do you have a fungal infection of skin and nails? SUDS
42. Have you experience unusual hair loss? SUDS
43. Do you have hallucinations? SUDS
44. Do you get headaches? SUDS
45. Has your hearing changed? SUDS
46. Do you experience heart palpitations? SUDS
47. Do you have a heat/cold intolerance? SUDS
48. Do you have hypoglycemia or hypoglycemia-like symptoms? SUDS
49. Are you impotent? SUDS
50. Do you have tinnitus? (ringing in the ears) SUDS
51. Do you have increased/severe PMS (premenstrual syndrome)? SUDS
52. Do you suffer from insomnia? SUDS
53. Do you have sinus pain? SUDS
54. Do you have irritable bowel syndrome (diarrhea, nausea, gas, abdominal pain)? SUDS
55. Do you have isolative tendencies? SUDS
56. Do you have joint, neck, or muscle pain? SUDS
57. Do you have low blood pressure? SUDS
58. Do you have lymph node pain? SUDS
59. Do you feel like you have the flu? SUDS
60. Do you have short term memory problems? SUDS
61. Do you have mitral valve prolapse? SUDS
62. Do you experience mood swings, excessive irritability, overreaction? SUDS
63. Do you experience muscle twitching, involuntary movements? SUDS
64. Do you experience muscle weakness? SUDS
65. Do you experience nausea or vomiting? SUDS
66. Do you have night sweats? SUDS
67. Do you have numbness and/or tingling in extremities? SUDS
68. Do you have pain in teeth, loose teeth, and endodontal problems, periodontal (gum) disease? SUDS
69. Has your personality changed? SUDS
70. Are you sensitive to light? SUDS
71. Do you feel pressure at base of skull? SUDS
72. Do you have a pressure sensation behind eyes? SUDS
73. Do you have pyriform muscle syndrome, causing sciatica? SUDS
74. Have you lost/gained weight without trying? SUDS
75. Do you have TMJ syndrome (jaw pain or locking)? SUDS
76. Have you experienced swelling of nasal passages, swelling of the extremities or eyelids, swollen lymph glands, any swelling, fluid retention? SUDS
77. Do you have a systemic yeast/fungal infection? SUDS
78. Do you experience temporary paralysis after sleeping? SUDS
79. Do you have a subnormal body temperature? SUDS
80. Other symptom       SUDS
81. Other symptom       SUDS
82. Other symptom       SUDS
What do you think caused your CFS?
83. Toxic exposure     No Yes
84. Toxic emotions    No Yes
85. Lack of life goal   No Yes
86. No idea No Yes
87. SAD diet      No Yes
What have you tried?
88. Spit test for fungus overgrowth No Yes
89. Cut sugar out of diet No Yes
90. Cut processed foods out of diet No Yes
91. Don't eat soy No Yes
92. Avoid chemicals in diet including artificial sweeteners No Yes
93. Don't eat flour or wheat products No Yes
94. Raw food diet No Yes
95. Drug therapy          No Yes
96. Vitamin therapy No Yes
97. Mineral supplements No Yes
98. Drink live/fresh spring water No Yes
99. Eat superfoods      No Yes
100. Been tested for food allergies No Yes
101. Used alternative treatments such as zapper    No Yes
102. Used colloidal silver, caprilic acid, or other health food store product      No Yes
103. Water cure No Yes
104. Oxygen therapies No Yes
105. Emotional freedom technique No Yes
106. Spiritual growth No Yes
107. Positive thinking No Yes
108. Do something that brings me joy frequently No Yes
109. Listen to happy, pleasant music No Yes
110. Get out in nature frequently No Yes
111. Growing a garden as Anastasia in Ringing Cedars of Russia recommends No Yes
112. Other                    No Yes