Text Size: A A A

 

The Quick Lyme Checklist:

.

This was the initial checklist that began to lead to my Lyme diagnosis. It is based on the Burrascano "Guidelines". Keep a tally of the "yes" responses. Although many of these symptoms are common or indicative of other things, a number of them may suggest the need for further evaluation. (My own count was 18 out of 46.)

As part of your symptoms, have you had any of the following?

   
Yes
No
1. Tick Bite (deer tick or dog tick?)
Y
N
2. Rash at bite site
Y
N
3. Rashes at other sites
Y
N
4. Joint/muscle pain in feet
Y
N
5. Swelling in toes, balls of feet
Y
N
6. Ankle pain
Y
N
7. Burning in feet
Y
N
8. Shin splints
Y
N
9. Unexplained fevers, sweats, chills
Y
N
10. Unexplained weight change (loss or gain)
Y
N
11. Fatigue, tiredness
Y
N
12. Unexplained hair loss
Y
N
13. Swollen glands
Y
N
14. Sore throat
Y
N
15. Testicular pain / pelvic pain
Y
N
16. Unexplained menstrual irregularity
Y
N
17. Unexplained milk production (lactation)
Y
N
18. Irritable bladder or bladder dysfunction
Y
N
19. Sexual dysfunction or loss of libido
Y
N
20. Upset stomach
Y
N
21. Change in bowel function (constipation, diarrhea)
Y
N
22. Chest pain or rib soreness
Y
N
23. Shortness of breath, cough
Y
N
24.

Heart palpitations, pulse skips, heart block

Y
N
25. Joint pain or swelling
Y
N
26. Stiffness of the joints, neck or back
Y
N
27. Muscle pain or cramps
Y
N
28. Twitching of the face or other muscles
Y
N
29. Headache
Y
N
30. Neck creaks and cracks, neck stiffness
Y
N
31. Tingling, numbness, burning or stabbing sensations
Y
N
32. Facial paralysis (Bell's Palsy)
Y
N
33. Eyes/vision: double, blurry, pain, increased floaters
Y
N
34. Ears/hearing: buzzing, ringing, ear pain
Y
N
35. Dizziness, poor balance, increased motion sickness
Y
N
36. Lightheadedness, wooziness, difficulty walking
Y
N
37. Tremor
Y
N
38. Confusion, difficulty in thinking
Y
N
39. Difficulty with concentration or reading
Y
N
40. Forgetfulness, poor short term memory
Y
N
41. Disorientation: getting lost, going to wrong places
Y
N
42. Difficulty with speech
Y
N
43. Mood swings, irritability, depression
Y
N
44. Disturbed sleep: too much, too little, early awakening
Y
N
45. Exaggerated symptoms or worse hangover from alcohol
Y
N
46. Any history of heart murmur or valve prolapse?
Y
N