'Cathvt' was kind enough to share this list to prepare for your doctor's visit: "This checklist is a collection of general symptoms that I got from a friend who does a lot of research into his health. I have no idea where he got it, but I know that others have used it and their doctors have been impressed by how helpful it was. It is general in nature, so you may wish to add additional symptoms that you may be experiencing. These are only suggestions designed to help you preplan for your doctor visits."

Report of symptoms for your doctor: fill this out in advance of your appointment.

• GENERAL
  • ____ Fatigue, made worse by physical exertion or stress
  • ____ Activity level decreased to less than 50% of pre-illness activity level
  • ____ Recurrent flu-like illness
  • ____ Sore throat
  • ____ Hoarseness
  • ____ Tender or swollen lymph nodes (glands), especially in neck and underarms
  • ____ Shortness of breath (air hunger) with little or no exertion
  • ____ Frequent sighing
  • ____ Tremor or trembling
  • ____ Severe nasal allergies (new allergies or worsening of previous allergies)
  • ____ Cough
  • ____ Night sweats
  • ____ Low-grade fevers
  • ____ Feeling cold often
  • ____ Feeling hot often
  • ____ Cold extremities (hands and feet)
  • ____ Low body temperature (below 97.6)
  • ____ Low blood pressure (below 110/70)
  • ____ Heart palpitations
  • ____ Dryness of eyes and/or mouth
  • ____ Increased thirst
  • ____ Symptoms worsened by temperature changes
  • ____ Symptoms worsened by air travel
  • ____ Symptoms worsened by stress
• PAIN
  • ____ Headache
  • ____ Tender points or trigger points
  • ____ Muscle pain
  • ____ Muscle twitching
  • ____ Muscle weakness
  • ____ Paralysis or severe weakness of an arm or leg
  • ____ Joint pain
  • ____ TMJ syndrome-problems that affect the jaw joint and the muscles that are used to chew.
  • ____ Chest pain
• GENERAL NEUROLOGICAL
  • ____ Lightheadedness; feeling "spaced out"
  • ____ Inability to think clearly ("brain fog")
  • ____ Seizures
  • ____ Seizure-like episodes
  • ____ Syncope (fainting) or blackouts
  • ____ Sensation that you might faint
  • ____ Vertigo or dizziness
  • ____ Numbness or tingling sensations
  • ____ Tinnitus (ringing in one or both ears)
  • ____ Photophobia (sensitivity to light)
  • ____ Noise intolerance
• EQUILIBRIUM/PERCEPTION
  • ____ Feeling spatially disoriented
  • ____ Dysequilibrium (balance difficulty)
  • ____ Staggering gait (clumsy walking; bumping into things)
  • ____ Dropping things frequently
  • ____ Difficulty judging distances (e.g. when driving; placing objects on surfaces)
  • ____ "Not quite seeing" what you are looking at
• SLEEP
  • ____ Hypersomnia (excessive sleeping)
  • ____ Sleep disturbance: unrefreshing or non-restorative sleep
  • ____ Sleep disturbance: difficulty falling asleep
  • ____ Sleep disturbance: difficulty staying asleep (frequent awakenings)
  • ____ Sleep disturbance: vivid or disturbing dreams or nightmares
  • ____ Altered sleep/wake schedule (alertness/energy best late at night)
• MOOD/EMOTIONS
  • ____ Depressed mood
  • ____ Suicidal thoughts
  • ____ Suicide attempts
  • ____ Feeling worthless
  • ____ Frequent crying
  • ____ Feeling helpless and/or hopeless
  • ____ Inability to enjoy previously enjoyed activities
  • ____ Increased appetite
  • ____ Decreased appetite
  • ____ Anxiety or fear when there is no obvious cause
  • ____ Panic attacks
  • ____ Irritability; overreaction
  • ____ Rage attacks: anger outbursts with little or no cause
  • ____ Abrupt, unpredictable mood swings
  • ____ Phobias (irrational fears)
  • ____ Personality changes
• EYES AND VISION
  • ____ Eye pain
  • ____ Changes in visual acuity (frequent changes in ability to see well)
  • ____ Difficulty with accommodation (switching focus from one thing to another)
  • ____ Blind spots in vision
• SENSITIVITIES
  • ____ Sensitivities to medications (unable to tolerate "normal" dosage)
  • ____ Sensitivities to odors (e.g., cleaning products, exhaust fumes, colognes, hair sprays)
  • ____ Sensitivities to foods
  • ____ Alcohol intolerance
  • ____ Alteration of taste, smell, and/or hearing
• UROGENITAL
  • ____ Frequent urination
  • ____ Painful urination or bladder pain
  • ____ Prostate pain
  • ____ Impotence
  • ____ Endometriosis
  • ____ Worsening of premenstrual syndrome (PMS)
  • ____ Decreased libido (sex drive)
• GASTROINTESTINAL
  • ____ Stomach ache; abdominal cramps
  • ____ Nausea
  • ____ Vomiting
  • ____ Esophageal reflux (heartburn)
  • ____ Frequent diarrhea
  • ____ Frequent constipation
  • ____ Bloating; intestinal gas
  • ____ Decreased appetite
  • ____ Increased appetite
  • ____ Food cravings
  • ____ Weight gain (____ lbs)
  • ____ Weight loss (____ lbs)
• SKIN
  • ____ Rashes or sores
  • ____ Eczema or psoriasis
• OTHER
  • ____ Hair loss
  • ____ Mitral valve prolapse (MVP) heart murmurer- When the mitral heart valve doesn't open and close properly, the flaps may "billow" backward slightly into the upper chamber during the heart's contraction. As a result of MVP, a clicking sound can often be heard by the doctor listening to the heart sounds with a stethoscope.
  • ____ Cancer
  • ____ Dental problems
  • ____ Periodontal (gum) disease
  • ____ Aphthous ulcers (canker sores)
• COGNITIVE
  • ____ Difficulty with simple calculations (e.g., balancing checkbook)
  • ____ Word-finding difficulty
  • ____ Using the wrong word
  • ____ Difficulty expressing ideas in words
  • ____ Difficulty moving your mouth to speak
  • ____ Slowed speech
  • ____ Stuttering; stammering
  • ____ Impaired ability to concentrate
  • ____ Easily distracted during a task
  • ____ Difficulty paying attention
  • ____ Difficulty following a conversation when background noise is present
  • ____ Losing your train of thought in the middle of a sentence
  • ____ Difficulty putting tasks or things in proper sequence
  • ____ Losing track in the middle of a task (remembering what to do next)
  • ____ Difficulty with short-term memory
  • ____ Difficulty with long-term memory
  • ____ Forgetting how to do routine things
  • ____ Difficulty understanding what you read
  • ____ Switching left and right
  • ____ Transposition (reversal) of numbers, words and/or letters when you speak
  • ____ Transposition (reversal) of numbers, words and/or letters when you write
  • ____ Difficulty remembering names of objects
  • ____ Difficulty remembering names of people
  • ____ Difficulty recognizing faces
  • ____ Difficulty following simple written instructions
  • ____ Difficulty following complicated written instructions
  • ____ Difficulty following simple oral (spoken) instructions
  • ____ Difficulty following complicated oral (spoken) instructions
  • ____ Poor judgment
  • ____ Difficulty making decisions
  • ____ Difficulty integrating information (putting ideas together to form a complete picture or concept)
  • ____ Difficulty following directions while driving
  • ____ Becoming lost in familiar locations when driving
  • ____ Feeling too disoriented to drive