Below is a symptom check-list. If you have one or two of these, or have several occasionally, it may not be a problem. We all have some of this when in normal health. However, if there is a collection of several symptoms that occur with some frequency or severity, you may want to get checked for Lyme disease. (See IGeneX lab).
(This was taken from another website - it is not my own. There are better check-lists out there. Look on some of the websites I list in on the Reference page. I will try to update with a better one soon.)
LYME SYMPTOM CHECKLIST
NAME_________________________________ DATE_______________
RISK PROFILE (PLEASE CHECK)
Tick infested area ____ Frequent outdoor activities ____ Hiking ____
Fishing ____ Camping ____ Gardening ____ Hunting ___ Ticks noted on pets ____
Do you remember being bitten by a tick? No ____ Yes ___ When?_________________
Do you remember having the "bulls eye rash"? No ____ Yes ___ Any other rash? No ___ Yes ___
Have you had any of the following? CHECK ALL YES ANSWER
1. Unexplained skin changes: Fevers
Sweats Chills Flushing
2. Unexplained weight change: Weight loss Weight gain
3. Fatigue Tiredness
4. Unexplained hair loss
5. Swollen glands
6. Sore throat
7. Testicular pain Pelvic pain
8. Unexplained menstrual irregularity
9. Unexplained milk production
Unexplained breast pain
10. Urinary problems: Irritable bladder
Bladder dysfunction
11. Sexual difficulties: Sexual dysfunction
Loss of libido (desire)
12. Upset stomach
13. Change in bowel function: Constipation Diarrhea
14. Chest pain Rib soreness
15. Shortness of breath Cough
16. Heart palpitations Pulse skips
Heart block
17. Any history of a heart murmur or valve prolapse? Yes No
18. Joint pain or swelling? Yes No List joints:
19. Stiffness: Joints Neck Back
20. Muscle pain Cramps
21. Twitching: Face Other muscles
22. Headache
23. Neck creaks Neck cracks
Neck stiffness
24. Tingling Numbness Burning
Stabbing sensations
25. Facial paralysis (Bell's Palsy)
26. Eyes/Vision: Double vision Blurry
Pain Increased floaters
27. Ears/Hearing: Buzzing Ringing
Ear pain
28. Increased motion sickness Vertigo
29. Lightheadedness Wooziness
Poor balance Difficulty walking
30. Tremor
31. Confusion Difficulty in thinking
32. Difficulty with concentration
Difficulty reading
33. Forgetfulness Poor short term memory
34. Disorientation: Getting lost
Going to wrong places
35. Difficulty with speech
Difficulty writing
36. Mood swings Irritability Depression
37. Disturbed sleep: Too much Too little Early awakening
38. Exaggerated symptoms or worse hangover from alcohol
