Quick Lyme Checklist

The Quick Lyme Checklist:

This was the initial checklist that led 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.) If you prefer a printed working copy, click here.

 

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

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

Heart palpitations, pulse skips, heart block
Yes
No
25. Joint pain or swelling
Yes
No
26. Stiffness of the joints, neck or back
Yes
No
27. Muscle pain or cramps
Yes
No
28. Twitching of the face or other muscles
Yes
No
29. Headache
Yes
No
30. Neck creaks and cracks, neck stiffness
Yes
No
31. Tingling, numbness, burning or stabbing sensations
Yes
No
32. Facial paralysis (Bell’s Palsy)
Yes
No
33. Eyes/vision: double, blurry, pain, increased floaters
Yes
No
34. Ears/hearing: buzzing, ringing, ear pain
Yes
No
35. Dizziness, poor balance, increased motion sickness
Yes
No
36. Lightheadedness, wooziness, difficulty walking
Yes
No
37. Tremor
Yes
No
38. Confusion, difficulty in thinking
Yes
No
39. Difficulty with concentration or reading
Yes
No
40. Forgetfulness, poor short term memory
Yes
No
41. Disorientation: getting lost, going to wrong places
Yes
No
42. Difficulty with speech
Yes
No
43. Mood swings, irritability, depression
Yes
No
44. Disturbed sleep: too much, too little, early awakening
Yes
No
45. Exaggerated symptoms or worse hangover from alcohol
Yes
No
46. Any history of heart murmur or valve prolapse?
Yes
No
TOTAL SCORE:  
  
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