SYMPTOMS OF LYME DISEASE QUESTIONNAIRE -  to print out for self analysis 

The Canadian Lyme Disease Foundation published a diagnostic questionnaire that they say will help guide a person to see if they have LD. Twenty (20) YES answers out of the seventy five (75) questions gives a strong indication.   

The Tick Bite 
(fewer than 50% recall a tick bite or get/see the rash) 

1.  Rash at site of bite 
2.  Rashes on other parts of your  body 
3.  Rash basically circular and spreading out (or generalized) 
4.  Raised rash, disappearing and recurring 

Head, Face, Neck 
5.  Unexplained hair loss 
6.  Headache, mild or severe, Seizures 
7.  Pressure in Head, White Matter Lesions in Head (MRI) 
8.  Twitching of facial or other muscles 
9.  Facial paralysis (Bell's Palsy) 
10. Tingling of nose, (tip of) tongue, cheek or facial flushing 
11. Stiff or painful neck 
12. Jaw pain or stiffness 
13. Dental problems (unexplained) 
14. Sore throat, clearing throat a lot, phlegm ( flem ), hoarseness, runny nose 

15. Double or blurry vision 
16. Increased floating spots 
17. Pain in eyes, or swelling around eyes 
18. Over-sensitivity to light 
19. Flashing lights/Peripheral waves/ phantom images in corner of eyes 

20. Decreased hearing in one or both ears, plugged ears 
21. Buzzing in ears 
22. Pain in ears, over-sensitivity to sounds 
23. Ringing in one or both ears 

Digestive and Excretory Systems 
24. Diarrhea 
25. Constipation 
26. Irritable bladder (trouble starting, stopping) or Interstitial cystitis 
27. Upset stomach (nausea or pain) or GERD (gastroesophageal reflux disease) 

Musculoskeletal System 
28. Bone pain, joint pain or swelling carpal tunnel syndrome 
29. Stiffness of joints, back, neck, tennis elbow 
30. Muscle pain or cramps, (Fibromyalgia) 

Respiratory and Circulatory Systems 
31. Shortness of breath, can't get full/satisfying breath, cough 
32. Chest pain or rib soreness 
33. Night sweats or unexplained chills 
34. Heart palpitations or extra beats Endocarditis, Heart blockage 

Neurologic System 
35. Tremors or unexplained shaking 
36. Burning or stabbing sensations in the body 
37. Fatigue, Chronic Fatigue Syndrome, Weakness, peripheral neuropathy or partial paralysis 
38. Pressure in the head 
39. Numbness in body, tingling, pinpricks 
40. Poor balance, dizziness, difficulty walking 
41. Increased motion sickness 
42. Lightheadedness, wooziness 
43. Psychological well-being 
44. Mood swings, irritability, bi-polar disorder 
45. Unusual depression 
46. Disorientation (getting or feeling lost) 
47. Feeling as if you are losing your mind 
48. Over-emotional reactions, crying easily 
49. Too much sleep, or insomnia 
50. Difficulty falling or staying asleep 
51. Narcolepsy, sleep apnea 
52. Panic attacks, anxiety 

Mental Capability 
53. Memory loss (short or long term) 
54. Confusion, difficulty in thinking 
55. Difficulty with concentration or reading 
56. Going to the wrong place 
57. Speech difficulty (slurred or slow) 
58. Stammering speech 
59. Forgetting how to perform simple tasks 

Reproduction and Sexuality 
60. Loss of sex drive 
61. Sexual dysfunction 
62. Unexplained menstral pain, irregularity 
63. Unexplained breast pain, discharge 
64. Testicular or pelvic pain 

General Well-being 
65. Unexplained weight gain, loss 
66. Extreme fatigue 
67. Swollen glands/lymph nodes 
68. Unexplained fevers (high or low grade) 
69. Continual infections (sinus, kidney, eye, etc.) 
70. Symptoms seem to change, come and go 
71. Pain migrates (moves) to different body parts 
72. Early on, experienced a "flu-like" illness, after which you have not since felt well. 
73. Low body temperature 
74. Allergies/Chemical sensitivities 
75. Increased affect from alcohol and possible worse hangover 
 ***Many Lyme patients were firstly diagnosed with other illnesses such as:

Juvenile Arthritis, Rheumatoid Arthritis, Reactive Arthritis, Infectious Arthritis, Osteoarthritis, ibromyalgia, Raynaud's Syndrome, Chronic Fatigue Syndrome, Interstitial Cystis, Gastroesophageal Reflux Disease, Fifth Disease, Multiple Sclerosis, scleroderma, lupus, early ALS, early Alzheimers Disease, crohn's disease, ménières syndrome, reynaud's syndrome, sjogren's syndrome, irritable bowel syndrome, colitis, prostatitis, psychiatric disorders (bipolar, depression, etc.), encephalitis, sleep disorders, thyroid disease and various other illnesses. 

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