Dysautonomia/ CFS, M.E. Potential Symptoms
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Name: (This will be kept confidential, but is required to reassure the ethics committee that you are a “real” person):
email address:
Where do you live? (state or country if not in U.S. is fine)
How many years ago you were “triggered” to go downhill? (or state if you’ve always been sick)
Please place a “1” in each box that pertains to you, even if the symptom is listed more than once.
Yes, this has happened
Almost Never / Never
I Don’t Know
“Allergy prone”
Do you see “dancing” lines; “spiders”, insects
“Terry’s nails”: nails lose their moons, flatten, redish at tips with tiny white dots 1mm away
Abnormal lipid profiles
ADHD
Agitation
An eye turns in, or double vision when looking far right or far left
Anaphylaxis
Anti-phospholipid Syndrome
Bipolar presentation (euphoria and/or dysphoria — depression/suicide ideation)
Blood pressure drops when standing
Bradycardia or tachycardia
Breast fibrosis
Candida or thrush (may include a white tongue)
Cataplexy
Change in sense of smell; smell “hallucinations”
Change in sense of taste
Changes in voice
Changes in your visual field
Chewing food is difficult
Clear fluid comes out your nose when leaning forward
Coma or cataplexy; stupor: times of staring off into space, unaware
Confusion
Conjunctivitis (“pink eye” for unknown reason)
Constipation
Delayed gross motor skills (walking, crawling, etc)
Delayed speech as a child
Depression
Dermatographia (skin turns red, white, or welts with a scratch)
Difficulty breathing
Difficulty concentrating
Diminished bowel movement; constipation
Disorientation
Dizziness
Double vision
Change in depth perception when looking right or left
Dry eyes
Dry mouth
Dry mouth (xerostomia) and possible increase in number of cavities
Dry, sore throat (due to decreased mucous production)
Dysarthria (difficulty speaking)
Dysphagia (difficulty swallowing)
Low pancreatic enzymes
Ear-aches
Easily motion sick
Easily startled (“jumpy”)
Eczema
Environmental sensitivities
Epilepsy; seizures
Extreme fatigue
Fast heart rate (tachycardia)
Feeling “bipolar” or having episodes of anger or rage
Feeling of pressure or fullness in your head
Flushing
Frozen shoulders
Gastroparesis
GERD
Gingivitis
Hallucinated presence of people not actually there
Headache – migraine, tension, cluster or unknown type
Headache at back base of your skull, radiating down your neck to the tops of your shoulders
Hearing loss
Hearing “whooshing” in your hears, Ringing in your ears
Heart attack
Heart palpitations
High Ig E
High serum tryptase
High urine methyl-histamine
IBS
Illogical thinking
Inability to concentrate; ADHD; loss of “executive function”
Incoherent speech
Increased body temperature
Irritability
Left ventricular diastolic dysfunction
Lifelike objects — unable to distinguish them from reality
Light sensitivity (photophobia)
Little or no fever when sick
Liver enzymes “off” or liver fibrosis
Loss of balance; frequent falls
Loss of coordination (ataxia)
Loss of gag reflex
Low ACTH
Low cortisol
Low gall bladder ejection fraction
Low immune system (may include candida, frequent UTI’s, high viral Ab titers)
Low level anxiety
Low muscle tone
Low sex drive; heightened sex drive
Lung fibrosis
Macular degeneration
Memory problems
Mental confusion (brain fog)
Metabolic Syndrome
Multiple sclerosis
Narcolepsy (without the gene for narcolepsy)
Nausea
Neurogenic shock — unable to move or speak when on your back
O.C.D. tendencies
One (or both) lid(s) droop, esp in the morning
One (or both) pupils are too large, esp in the morning
One side of your face is “weaker” than the other (a crooked smile, for example)
Osteopenia
Osteoporosis
Pain or weakness of neck or upper shoulders
Panic attacks
Perspiration stops
Poor healing
POTS — heart rate increases by at least 30 bpm from lying down to standing still for 10 min.
“Pusatile vision” – your vision brightens and dims with your heart beat (often in the a.m. only)
Pupils are dilated; difficulty in focusing up close
Rashes
Restlessness
Rheumatoid arthritis
Seeing periodic flashes of light
Sensitivity to any stress (good or bad)
Sensitivity to light
Sensitivity to movement around you
Sensitivity to noise
Sensitivity to sudden sounds
Shaking
Shift in sexual preference
Skin peeling for no reason
Snoring
Straining makes you feel worse (Valsalva), such as blowing up a balloon
Stroke
Tendency to over-achieve
Textured surfaces bother you, visually
tongue seems too big; difficulty making some sounds, like “s”
Tremor
Tunnel vision
Type 2 Diabetes or insulin resistance
Unexplained facial pain
Unexplained sinus pain
Urinary retention
Urticaria pigmentosa — skin spots, hives
Vertigo (your surroundings move)
Visual “snow”
Voice weakens or quivers or becomes hoarse
Wakeful myoclonic jerking; twitching of fingers or other extremities
Wandering thoughts; inability to sustain a train of thought
Warping or waving of surfaces and edges
Weight loss for no apparent reason
Thoracic outlet syndrome or “frozen shoulder”
Interstitial cystitis