36 = Formal Others left this blank

45 = Female 4 = Male

21 - 25 = Two 26 -35 = Six 36 - 45 = Twenty Four

46 - 55 = Twelve 55+ = Six

47 = Yes 3 = No

5 : Anyone else in family diagnosed

18 = Yes 32 = No

6 : Suffer abuse before symptoms

30 = Yes 21 = No

7 : What kind of abuse

17 = Physical 5 = Sexual 21 = Emotional

2 = Surgical 1 = Fall

8 : Childhood illnesses

27 = Chicken Pox 2 = Mononucleosis 10 = Tonsillitis

2 = Whooping Cough 1 = Malnutrition 1 = Cystis

1 = Endometriosis 2 = Scarlet Fever 15 = Mumps

1 = Red Measles 1 = Meningitis 1 = Pink Eye

19 = German Measles 1 = Cold Sores 1 = Yellow Jaundice

1 = Hepatitis A 2 = Thrush 1 = Growing Pains

7 = Ear Infections 3 = Strep Throat 1 = Apnoea

4 = Asthma 4 = Pneumonia 1 = Rosasha

3 = Appendicitis 3 = Anaemia 2 = Scoliosis

1 = ENT Infections 3 = Bronchitis 1 = Seasonal Allergies

1 = Eczema 1 = Beta Thalassaemia 1 - Varicella

9 : Sleepy as a child

33 = Yes 17 = No

10 : Weight range as a child

18 = Underweight 23 = Normal 5 = Overweight 4 = Fluctuating

11 : Allergies

1 = Adhesives 1 = Amoxil 1 = Ampicillin 1 = Apples 2 = ASA

1 = Aspirin 1 = Bactrim 1 = Bananas 1 = Benadryl 1 = Bees

1 = Blue berries 1 = Broccoli 1 = Buscopan 6 = Cats 1 = Ceclor

1 = Ceftin 1 -1 Celebrex 1 = Chemicals 1 = Chicken 1 = Cockroaches

1 = Coconuts 4 = Codeine 1 = Contrast dyes 1 = Corn 1 = Cortisone

1 = Cows 3 = Dermerol 4 = Dogs 11 = Dust 2 = Eggs

2 = Erythromycin 3 = Feathers 2 = Flowers 1 = Food dyes 1 = Fruit

1 = Ginger 3 = Grasses 1 = Green beans 3 = Hayfever 1 = Hornets

1 = Indocid 3 = Iodine 1 = Lactos 1 = Leviquin 1 = Mildew

2 = Milk 1 = Mollusks 1 = Monocryl 3 = Morphine 11 = Mould

1 = Myacin 1 = Narcotics 1 = Oranges 2 = Peanuts 8 = Penicillin

1 = Perfume 7 = Pollen 1= Pork 3 = Ragweed 3 = Seafood

5 = Seasonal 2 = Smoke 1 = Soy 1 = Stemitil 3 = Sulpha

2 = Sulpha drugs 2 = Talwin 2 = Tetracyclene 1 = Tomatoes 3 = Trees

2 = Tree nuts 1 = Tricyclic drugs 1 = Trumpet vines 1 = Tylonol 1 = Ultram

1 = Ultracaria 1 = Vicodin 2 = Wool

12 : Blood disorder

23 = Yes 27 = No

13 : Injection for blood disorder

9 = Yes 4 = No

14 : B12 injection

5 = Yes 45 = No

15 : Learning difficult

36 = Yes 14 = No

16 : Trauma before symptoms

31 = Yes 19 = No

17 : Depression before symptoms

27 = Yes 14 = No 9 = Don't know

18 : Miss school as a child

17 = Yes 26 = No 7 = Don't know

19 : Penmanship difficult

24 = Yes 26 = No

21 : Symptoms before or after diagnosis

Acalculia = 22 Anomia = 27

Auditory verbal memory = 19 Blurry vision = 3

Difficulty inputting, encoding and retrieving information = 22

Difficulty maintining attention = 27 Directional problems = 9

Dyslexic like symptoms = 20 Fogginess = 37

Forgetfulness = 37 Impaired judgement = 19

Pain = 38 Photosensitive = 32

Sleeping problems = 37 Severe headaches = 40

Sound distractions = 29 Visual spatial problems = 3

Word blocking = 28 Word transposition = 28

22 : Medication

41 = Yes 5 = No

Advair = 1 Adipex = 1 Advil = 1

Albuteral = 1 Alodorm = 1 Altace = 2

Aspirin = 1 Atacand = 1 Avinza = 1

Baclofen = 2 Beta blocker = 1 Buspar = 1

Calcium = 1 Celebrex = 1 Celex = 1

Codeine Phosphate = 1 Cyclobenzaprine = 1 Dalmane = 1

Darvocet = 2 Dexedrine = 1 Diazepam = 1

Dicetel = 1 Dihydrocodeine = 1 Dioxygen

Doxepin = 2 Duragesic = 1 Effexor = 8

Efflor = 1 Esterol = 1 Estraderm = 1

Evaril = 1 Fentanyl = 1 Fiorinal = 1

Flexeril = 3 Flonase = 1 Fortis = 1

Fosamax = 1 Gabapentin = 1 H C T Z = 4

H pylori = 1 Hydrocodone = 1 Hyoscyamine = 1

Ibubrofen = 1 Imitrex = 1 Imodium = 1

Inderal = 1 Indocin = 1 Klonipin = 4

Lasic = 1 Lexapro = 1 Librax = 2

Lisinporil = 2 Lomotil = 1 Lopressor = 1

Lovastatin = 1 Macrocrystal = 1 Mepergan = 1

Morphine = 1 Neurotin = 2 Nexium = 1

Nitrofurantoin = 1 Nortriptyline = 3 Norvasc = 3

Oxazapam = 1 Oxycontin = 3 Paxcil = 1

Percocet = 2 Plavix = 1 Potassium = 2

Premarin = 1 Prevacid = 2 Prozac = 7

Ranitidine = 2 Restasis = 1 Restoril = 1

Robaxin = 1 Singulair = 1 Skelaxin = 1

Soma = 1 Synthroid = 2 Thyroxin = 1

Topamax = 2 Topral = 1 Tramadol = 3

Trazadone = 6 Tritace = 1 Tylenol = 2

Ultracet = 3 Ultram = 1 Vicodine = 3

Vioxx = 1 Xanax = 1 Zanaflex = 1

Zantac = 1 Zelnorm = 2 Zestoretic = 1

Zoloft = 4 Zomig = 1 Zyrtec = 1

23 : How much medication

24 : Does medication improve symptoms

11 = Yes 16 = No 22 = Sometimes

Advil = 2 Avinza = 1 Baclofen = 2

Celebrex = 1 Clonipin = 1 Dexedrine = 1

Diazepam = 1 Dihydrocodeine = 1 Doxepin = 2

Effexor = 4 Efflor = 1 Fentanyl = 1

Flexeril = 2 Hydrocodone = 1 Hyoscyamine = 1

Imitrex = 1 Klonopin = 1 Morphine = 1

Neurotin = 2 Nortriptyline = 2 Oxycontin = 1

Percocet = 1 Prozac = 4 Soma = 1

Tramadol = 3 Trazadone = 4 Ultracet = 3

Ultram = 1 Vicodin = 2 Zoloft = 1

Zomig = 1

25 : Would you like to have more medication options

44 = Yes 6 = No

26 : Do you have a good relationship with your doctor

27 = Yes 9 = No 14 = Sometimes

27 : Do you use mechanical aids

13 = Yes 37 = No

28 : Did pregnancy affect symptoms

13 = Yes 2 = No 31 = Not applicable

1 = Don't know 12 = Made symptoms worse 2 = Made

symptoms better

29 : Have you used natural health products

24 = Yes 11 = No

30 : When did you use them

10 = Before 6 = After 8 = Both

31 : What products were used

Avlimil (energy) Biotin

Calcium (leg pain) Co Enzyme Q-10

Digestive enzymes Dong Quai (sleep)

Fish oil (Feel better internally) Flaxseed oil (hair & skin)

Folic acid Glucosamine chondroitin

Kelp (immune system) l-glutamine

Magnesium Melatonin (sleep)

Metamucil Multi vitamin/mineral

Omega 3 - 6 - 9 Probiotic

Salon pas pain patches Valerian (sleep)

Vitamin B6 Vitamin B12

Vitamin C Vitamin D

Vitamin E Vitamin K

Zinc (immune system)

32 : How many consecutive hours sleep do you have

1-2hr = 1 2hr = 2 2hr-3 = 3

3hr = 3 3-4hr = 2 4hr = 2

4-5hr = 1 4-6hr = 1 5hr = 3

5-6hr = 1 6hr = 6 6 - 7 = 1

7hr = 2 8hr = 2 8-10hr = 1

10-12hr = 1 Not sure = 1

33 : Do you use a sleep aid

14 = Yes 11 = No 9 = Sometimes

Ambien = 3 Dong Quai = 1 Doxepin = 2

Elavil = 1 Sominex = 1 Lavender oil = 2

Soma = 1 Sound machine = 1 Traxadone = 5

Valerian = 2 Xanax = 1

34 : Do you have mostly broken sleep

33 = Yes 1 = No

35 : What affects your sleeping patterns

Bloating = 1 Body temperature = 4 Caffine = 1

Cramps = 1 Daily activity = 2 Depression = 1

Exercise = 4 Headaches = 2 Light = 1

Medication = 4 Muscle spasms = 3 Noise = 2

Pain = 20 Palpatations = 2 Room temperature = 2

Stress = 8

36 : Do you have nightmares

16 = Yes 18 = No

37 : How do you feel when you wake up

Angry = 1 Clumsy = 2 Cold = 1

Confused = 2 Disorientated = 9 Dizzy = 2

Exhausted = 15 Frustrated = 1 Headache = 2

Head congested = 1 Irritated easily = 2 Pain = 16

Scared = 1 Sometimes great = 1 Stiff = 13

Swollen = 2 Tired = 12 Weak limbs = 2

Fed up waking up feeling so bad day after day = 2

38 : Do symptoms improve with movements

9 = Yes 6 = No 19 = Sometimes

Depends on how bad muscle spasms are = 1 Depends

on activities the day before = 2

Depends on amount of sleep = 2 Depends on weather = 2

Only if not in a flare = 1 Stiffness goes but not the pain = 2

Stiffness works through but doesn't completly go = 1

39 : How do moods affect your symptoms

Feeling down means less energy = 1 Get mad or scared means more pain = 1

In a good mood means less pain = 1 More stress means worse symptoms = 21

Not much = 2 Not sure they do = 1

Sad means pain = 3

40 : Do you exercise

Don't exercise = 5 Occasionally = 15

Rarely = 6 Regulary = 8

A little helps = 2 Makes it worse = 6

More often helps = 1 Too much makes it worse = 5

41 : Do you do yoga

4 = Yes 31 = No

42 : Do you smoke

13 = Yes 20 = No

43 : Do you drink

3 = Yes 22 = No 9 = Sometimes

44 : Foods

Healthy = 22 Too much junk = 5 Mixture = 6

45 : Do you binge

19 = Yes 15 = No

46 : Foods that affect your symptoms

13 = Yes 19 = No

Alcohol Caffine = 1

Bacon = 1 (gives energy) Carbohydrates = 1

Coke = 1 Cottage cheese = 1

Fiber = 1 Milk = 1

Orange juice = 1 Red meat = 1

Salads = 2 Sugar = 3

Sweets = 2

47 : Have you had physical therapy

18 = Yes 16 = No

48 : How did it affect you

A little bit helps = 2 Hard to tell = 2 Mixed = 2

Pool therapy helped = 1 Made much worse = 10

49 : Have you tried aromatherapy

8 = Yes 26 = No

50 : Which ones used, did they work.

Lavender Oil Eucalyptus Oil Fresh Rosemary

Mint

51 : Do you work

Full time = 10 Part time = 11 Not at all = 13

52 : What kind of work

Admin assistant = 2 Cashier C N A = 1

Computer analyst = 1 H R Manager = 1 House mum = 2

Meat wrapper = 1 Nail technician = 1 Nurse = 4

Receptionist = 1 L P N = 1 Run day care = 2

Stylist = 1 Systems analyst = 1

53 : Does your employer help

Less stressful duties = 2 Limited hours = 2 Not at all = 3

Special equipment = 1 Time off for doctor appointments

 1

54 : Does seasons affect symptoms

Best in warm dry weather = 3 Cold = 17 Damp = 5

Heat = 10 Humid = 5 Rain = 10

Storms = 4 Windy = 2

55 : Methods to relieve

Avoid stress = 3 Chiropractor = 1 Dencoerub ice = 1

Diflam gel = 1 Do something positive each day Heat

pads = 7

Hot showers = 5 Hot water bottles = 3 Massage = 7

Meditation = 4 Naps = 6 Pain relief = 4

Positive thinking = 2 Salon pas pain patches = 1 Soak in bath = 9

Sticking to routines = 1 Stretching = 6 Swimming = 1

Take frequent breaks = 7 Tramadol = 1 Walk a little = 2

56 : Does it need to be publicized more

Everyone said yes

57 : Does your doctor validate you

20 = Yes 14 = No

58 : Do you do sports

3 = Yes 32 = No

59 : What do you do to relax

Boating Crafs

Don't be fooled into a miracle cure

 Don't deny it

Don't feel guilty if unable to do things

 Don't give up

Don't push too hard

Don't think you will get every symptom

Exercise with care

 Explain to family and friends

Find a support group

 Fishing

Garden Get a good doctor

Learn as much as possible about the condition

Make sure doctor validates your condition

Pace yourself

Read

Remember it is not fatal

 Remember it is not in your head

Spend time alone

 Stretch

Water therapy

60: Tips and advice

Avoid stress

Get a computer

Faith Good friends

Hobbies

 Lie down on heating pads

Listen to happy music

 Movies

Nap

Read

Sit in the sun

 Soak in the bath

Start an inside herbal garden

 Take short walks

Trust your body

 Use luggage cart to take heavy things around

Watch funny video