Symptom Survey

Use the free Symptom Survey below (PDF download) to track your ups and downs.  By tracking, you can often see patterns that you wouldn’t otherwise notice.  Here’s the Survey below.  Just right click and “Save Target As” or “Save Link As”.

Lyme Disease Symptom Survey

Here’s my record (of just the monthly totals).  The lower the score, the better (fewer symptoms).

Symptom Survey Score on 11/12/08 – 93
Symptom Survey Score on 12/12/08 – 81
Symptom Survey Score on 1/12/09 – 60
Symptom Survey Score on 2/15/09 – 52
Symptom Survey Score on 3/15/09 – 47
Symptom Survey Score on 4/15/09 – 47
Symptom Survey Score on 5/17/09 – 37
Symptom Survey Score on 6/14/09 – 49
Symptom Survey Score on 7/13/09 – 66 (mostly increase in neurological symptoms)
Symptom Survey Score on 7/25/09 – 41 (week of taking Lyrica)
Symptom Survey Score on 8/18/09 – 31 (after taking Gabapentin for a couple weeks)
Symptom Survey Score on 9/13/09 – 30
Symptom Survey Score on 10/16/09 – 44
Symptom Survey Score on 11/13/09 – 58
Symptom Survey Score on 12/13/09 – 71 (increase in neurological and abdominal)
Symptom Survey Score on 1/16/10 – 63
Symptom Survey Score on 2/15/10 – 67 (increased neurological, decreased abdominal)
Symptom Survey Score on 3/23/10 – 60
Symptom Survey Score on 4/15/10 – 57
Symptom Survey Score on 5/16/10 – 91 (while on Alinia – harsh stuff, yucky)
Symptom Survey Score on 6/15/10 – 65
Symptom Survey Score on 7/15/10 – 47
Symptom Survey Score on 8/15/10 – 38
Symptom Survey Score on 9/15/10 – 35
Symptom Survey Score on 10/14/10 – 28
Symptom Survey Score on 11/17/10 – 25 (still making improvement..!!)
Symptom Survey Score on 12/14/10 – 23
Symptom Survey Score on 1/14/11 – 25
Symptom Survey Score on 2/14/11 – 30 (back pain, increased stomach pain)
Symptom Survey Score on 3/14/11 – 22
Symptom Survey Score on 4/14/11 – 19
Symptom Survey Score on 5/14/11 – 20 (Nearly all fatigue and abdominal pain)
Symptom Survey Score on 6/14/11 – 20 (Nearly all fatigue and abdominal pain)
Symptom Survey Score on 7/14/11 – 18 (Nearly all fatigue and abdominal pain)
Symptom Survey Score on 8/14/11 – 18
Symptom Survey Score on 9/14/11 – 15 (New Low!)
Symptom Survey Score on 10/14/11 – 13 (slightly more energy – no joint pain at all).
Symptom Survey Score on 11/14/11  - 21 (some joint pain – knees)
Symptom Survey Score on 12/14/11  - 17
Symptom Survey Score on 1/15/12  - 27 (more abdominal pain)
Symptom Survey Score on 2/15/12  - 22 (still abdominal pain and fatigue)
Symptom Survey Score on 3/15/12  - 17
Symptom Survey Score on 4/15/12  - 24
Symptom Survey Score on 5/14/12  - 32 (increase in abdominal and joint pain)

You are able to see progress over time, and often can link improvement to specific treatments or dietary changes.  I typically take it once a month.

The survey has different categories for gastrointestinal complaints, skin conditions, and neurological symptoms (among others).  These categories are useful because even if your score stays the same, maybe your stomach pain decreased, but your mood swings and fatigue went up.  This can be helpful to know, and can help you see what’s working and what’s not.

Please leave comments below on other ways you track progress.  If you have any suggestions about the symptom survey and how to use it, please enter those also.  We can help each other so much.