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Tick bite .....................................................Y or N
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Rash at bite site
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Rashes at other sites
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Fever, chills, sweats
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Weight change (loss or gain)
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Fatigue, tiredness
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Unexplained hair loss
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Swollen glands
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Sore throat
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Testicular pain or pelvic pain
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Unexplained menstrual irregularity
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Irritable bladder or bladder dysfunction
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Sexual dysfunction or loss of libido
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Upset stomach
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Change in bowel function, constipation
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Chest pain or rib soreness
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Shortness of breath, cough
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Heart palpitations, pulse skips, heart block
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Joint pain or swelling
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Muscle pain or cramps
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Twitching of the face or other muscles
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Headache
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Neck creaks and cracks, neck stiffness
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Stiffness of the joints or back
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Tingling, numbness, burning or a stabbing
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Facial paralysis (mouth is crooked on one side when you talk in front of a mirror-Bell's Palsy)
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Eyes/vision: double, blurry, pain, increased floaters (specks in front of vision)
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Ears/hearing: ringing, buzzing, ear pain
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Dizziness, poor balance, increased motion sickness
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Light-headedness, wooziness, difficulty walking, clumsy bumping into objects
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Tremor
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Confusion, difficulty in thinking, difficulty in concentrating, difficulty with sticking with a task
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Difficulty with concentration or reading
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Decreased short term memory
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Disorientation: driving past your turn, getting lost, going to wrong place
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Difficulty with speech
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Mood swings, irritability, depression
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Disturbed sleep: too much, too little, early awakening- goes through cycles sometimes too much
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Exaggerated symptoms or worse hangover from alcohol
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Slowed pulse
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Testicular enlargement
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Nodules on earlobes
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Stomach distension
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Breathing with mouth open
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Eye lesions
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Nasal stuffiness /restriction
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Shortness of breath
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Hypersensitive olfactory organ (sensitive to the slightest odors / smells)
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Feeling drunk without drinking
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No desire to do anything- including favorite hobbies
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Too slow a pulse when resting
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Rapid pulse with slightest exertion
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Perfuse sweating- soaking wet if you go snow skiing
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Muscle pains, cramps or charley horse
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Pains switching from one side of the body to the other
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Enlarged lymph glands
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Stiff aching neck
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Changes in vision
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Generalized acheyness
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Limbs- especially arms feel heavier than normal.
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Diminished or absent reflexes
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Brain fog
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Poor coordination/ataxia
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Continual infections
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Poor concentration
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Decreased ability to spell correctly
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GI distress/abdominal pain
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Poor word retrieval/aphasia
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Anxiety
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Difficulty swallowing
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Nausea/vomiting
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Anorexia
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Vasculitis
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Loss of muscle tone
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Changes in taste or smell
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Obsessive-compulsive symptoms
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Panic attacks
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Changes in cerebral blood flow/brain waves
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Number reversal
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Light sensitivity
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Trigeminal neuralgia (TMJ)
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Dilated cardiomyopathy
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Loss of temperature control