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 FEMALE QUESTIONNAIRE - PAGE 5 

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SYMPTOMS: MIND: EMOTIONAL
427.  How large and available is your social support group - the circle of close friends / family that you can confide in and turn to for support?
Don't know
Nonexistent
Small and/or rarely available
Average
Large and easily available
428.  Does being emotionally upset result in exhaustion?
No / don't know
Sometimes
Yes
429.  Overall, how stressful is your lifestyle?
Don't know
Not stressful / I live a slow-paced life
About average / moderately stressful
Very stressful / I lead a fast-paced life
Extremely stressful / I can't really cope
430.  Do you have trouble working under pressure?
Not a problem / don't know
Mild problem, completely manageable
Moderate problem, causes stress
Serious problem, causes severe stress
Severe problem - completely unable to function
431.  Do you collapse or go into shock from too much stress?
Not a problem / don't know
Occasionally, when under severe stress
It is a major problem, even with moderate stress
432.  Have you had a problem with panic attacks?
Never had one / don't know
Probably had one/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem
433.  Worry / anxiety. Do you tend to be...?
Always care-free
Generally care-free
Average I suppose / don't know
Generally anxious/nervous
Always anxious/nervous
434.  Are you experiencing any form of anguish, grief, or heartbreak?
No / don't know
Mild
Moderate
Serious
Severe - devastating
435.  Have you had suicide thoughts or attempts?
Never / don't know
I seriously considered it
I tried it over 5 years ago
I tried it within the past 5 years
Tried in past year / several times in past 5 years
436.  Have you recently endured the death of a loved one?
No / over 2 years ago / don't know
Within the past 2 years
Within the past year
Within the past 6 months
Within the past 3 months
437.  Do you have fears or phobias?
No, I'm afraid of (almost) nothing
Minimal
Average / don't know
Moderate phobia / some fears, somewhat irrational
Severe phobia / many fears, irrational
438.  Do you have difficult memories of traumatic experiences? Do not include rape or sexual / physical abuse as these will be covered separately.
No / don't know
Minor
Moderate
Serious - I avoid certain people/places/things
Severe - flashbacks, intrusive re-experiencing
439.  Did you suffer rape after the age of 18?
No / don't know
Probably, but it is no longer a significant issue
Yes, but I feel it is as resolved as it can be
Yes, it is still an unresolved issue for me
Yes, still a traumatic unresolved issue for me
440.  Do you cry or become teary / sad for no reason?
No / don't know
Occasionally
Often
441.  Postpartum depression. Have you experienced depression after childbirth?
No / not applicable / don't know
Mild
Moderate
Serious
Severe
442.  As far as you know, has depression or a depressive tendency been a problem for you? This includes seasonal or recurring episodes but not depression associated specific events such as (for women) menstrual periods or giving birth.
Don't know
No
Yes    More questions later...
443.  Approximately how often do you have feelings of insecurity? Examples include worrying about what people think of you, or wondering if you are working hard enough.
Never / don't know
Rarely - under once per month
Occasionally (under once per week) and moderate
Occasionally severe or often moderate
Often (once per week or more) and severe
444.  How would you rate your irritability or usual level of irritation?
I rarely get irritated, never severely
I occasionally get mildly irritated
I suppose I am average / don't know
I sometimes get very irritated
I frequently get very irritated
445.  Disposition. Are you...?
Always calm / not easily ruffled/patient/agreeable
Mostly calm / not easily ruffled/patient/agreeable
Average / don't know
Sometimes tense / easily angered/impatient/hostile
Often tense / easily angered/impatient/hostile
446.  Are you generally moody and somewhat emotional by nature?
No / don't know
Somewhat
Yes, very
447.  How would you rate your emotional stability?
My emotions are stable / controlled
My emotions tend to be stable / controlled
I'm about average / don't know
I occasionally have emotion/mood swings
I often have significant emotion/mood swings
448.  Have you had any nervous breakdowns?
Never had one / don't know
Probably had one/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem

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SYMPTOMS: GLANDULAR
449.  Do you have diabetes?
Don't know
No, it has been ruled out within the past 6 months
Yes    More questions later...
450.  Do you suffer from Hypoglycemia (abnormally low blood glucose level)?
Never had it / don't know
Probably had it/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem
451.  Hyperthyroidism
Never had it / don't know
Probably had it/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem
452.  Hypothyroidism
Never had it / don't know
Probably had it/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem, confirmed
Current major problem, confirmed
453.  Do you have a swelling at the front of your neck?
Don't know
Definitely not
Possibly - I'm not sure
Yes, minor
Yes, major / pronounced
454.  Adrenal Insufficiency
Uncertain / don't know
No, lab tests have confirmed normal function
It is a suspected problem
Yes, a lab test has confirmed it
I have confirmed Addison's Disease
455.  Have you had any swollen, tender or painful lymph nodes within the past year? They appear as small, smooth lumps under the skin. If in doubt, click on the link to read more about them.
Don't know
No
Yes    More questions later...

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SYMPTOMS: METABOLIC
456.  Are you hyperactive? In other words, do you always feel the need to be active?
Don't know
No
Somewhat
Yes, very
457.  If you are hyperactive, are you also generally exhausted?
No / does not apply / don't know
Moderately
Severely
458.  Do you suffer from the incurable genetic lung disease known as cystic fibrosis?
Don't know
No
Yes
459.  How would you rate your physical stamina (ability to undertake prolonged exercise)?
I have poor endurance
I'm about average / don't know
I have strong endurance
460.  Do you ever feel cold for no apparent reason?
Don't know
No
Occasionally
Frequently, mildly to moderately
Frequently and severely
461.  Do you experience inappropriate / excessive sweating during the day? Only include sweating that is not explained by a hot / humid climate, exertion or dressing too warmly.
Don't know
No
Occasionally
Frequently, mild to moderate
Frequently and severe
462.  Do your feet tend to have a strong odor and/or sweat a lot?
No / not particularly / don't know
Slight sweating, no significant odor
Slight sweating, significant odor
Significant sweating, no significant odor
Significant sweating and odor
463.  Do you suffer from edema (swelling/puffiness caused by fluid retention) anywhere on your body?
Don't know
No
Yes / probably    More questions later...
464.  Do you find that flu / influenza stays longer and hits harder than for other people?
No / don't know
Moderately
Severely - they knock me out for a long time
465.  Do you have frequent colds or flus?
No / don't know
2-3 per year
More than 3 per year
466.  Do you currently have a fever? If you do, try to rate your average temperature.
Don't know
No
Mild, 99-100°F (37.2-37.8°C)
Moderate, 100.1-103°F (37.8-39.4°C)
High, usually over 103°F (39.4°C)
467.  How often do you get unexplained fevers?
Never / rarely / don't know
Occasionally - one or two per year
Frequently - several per year
468.  If you suffer from unexplained recurring fever, how would you rate its average severity?
Not applicable / don't know
Very mild
Mild
High
Very high - I'm bedridden
469.  Do you sometimes experience 'chills' (sensations of cold accompanied by shivering) that can not be explained by your environment?
Don't know
No
Occasionally
Often - more than once a month
I am experiencing chills due to a current illness
470.  Have headaches been a problem for you?
Don't know
No
Yes, but in the past only
Yes    More questions later...
471.  Have you experienced any unusual headaches within the past month?
Not applicable / don't know
No
Yes, one/some that have now resolved
Yes, I am having mild to moderate headaches
Yes, I am having severe headaches
472.  Do you feel shaky, headachy, tired, faint or nauseated when meals are delayed?
No / don't know
Occasionally / moderately
Often / severely
473.  Do you experience inner trembling?
No / don't know
Occasional / moderate
Often / severe
474.  Have you suffered from pancreatitis?
Never had it / don't know
Probably had it/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem
475.  Does your body temperature, during the day and under normal conditions, sometimes measure below 98.0°F (36.7°C)? Only answer this if you are confident that your answer is accurate.
Uncertain / don't know
Definitely not
Occasionally a little lower
Often a little lower or occasionally much lower
Regularly much lower
476.  What is your approximate percentage body fat?
Don't know
14-20% / very low
21-24% / low
25-31% / average
Over 32% / high
477.  Do you have any problems with your weight? This includes being under/overweight, difficulty maintaining weight, a history of serious weight gains and losses, recent unexplained weight changes, etc.
Don't know
No
Yes    More questions later...

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SYMPTOMS: URINARY
478.  Have you suffered from interstitial cystitis (debilitating chronic pain characterized by urinary urgency, frequency, urination at night and bladder pain)?
Never had it / don't know
Probably, but now resolved
Diagnosed, but now resolved
Current minor problem
Current major problem
479.  Have you had a bladder infection? Symptoms are similar to those of interstitial cystitis except that it is much more common, of shorter duration and generally resolves by itself or with treatment.
Never had one / don't know
In the past only, no longer a problem
Yes, but culture usually negative
Current minor problem
Current major problem
480.  Have you suffered from kidney stones?
Never had one / don't know
Probably had one/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem
481.  Do you have any degree of chronic renal insufficiency or kidney failure?
Don't know
No, definitely not (confirmed)
Chronic Renal Insufficiency
Chronic Renal Failure - not on dialysis yet
End-Stage Renal Disease - on dialysis
482.  Do you have a problem with urine leakage (incontinence)?
Don't know
No
Minor occasional problem
Occurs with physical stress only (cough, jumping)
A continual problem / use absorptive pads
483.  Do you have internal pain or discomfort in the inguinal (groin) area?
Never / don't know
Occasional moderate discomfort
Frequent moderate discomfort
Occasional severe pain
Frequent severe pain
484.  How difficult or easy is it for you to urinate? In other words, how forceful is your urine stream?
Very weak stream / great difficulty urinating
Weak stream / some difficulty
Don't know
Average / normal compared to past characteristics
Strong stream, rapid emptying
485.  Urination. On average, how many times do you get up to urinate during your sleeping hours?
None / don't know
Once
Twice
Three times
Four or more times
486.  Urination. On average, how many times do you urinate during waking hours?
Under 2 times
2 or 3 times
About 4 to 5 times / don't know
6 to 7 times
8 or more times
487.  Do you feel a frequent need to urinate, even when your bladder is empty?
Don't know
No, definitely not
Yes, sometimes
Yes, often
488.  What is the usual color of your urine, ignoring supplement (B-vitamin) yellowing, medications you are taking or other obvious factors?
Don't know
Colorless
Light Yellow
Dark Yellow
Very dark or black
489.  Is your urine cloudy?
Don't know
No, it is clear
Occasionally slightly cloudy
Often slightly cloudy / occasionally very cloudy
Often very cloudy - as if a little milk was added
490.  Do you ever see blood in your urine?
No / don't know
Yes, once or twice recently
Yes, occasionally
Yes, regularly
491.  When you urinate, is foam produced in the toilet? This is known as 'foamy urine'.
Don't know
No / extremely rarely
Occasionally foamy
Frequently foamy OR occasionally very foamy
Always very foamy
492.  Do you suffer pain or burning while urinating?
No / don't know
Mild
Moderate
Serious
Severe - excruciating
493.  Do you have any form of unusual urethral discharge?
No / don't know
Minor, in the past only
Major, in the past only
Current minor problem
Current major problem
494.  Does your urine usually have a strong odor?
No / don't know
Fairly strong
Very strong

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SYMPTOMS: FEMALE

Some of the questions below are personal in nature. If you would prefer not to answer a question, simply skip it by leaving the default "don't know" response.
495.  Do you have silicone (not saline) breast implants?
Never had them / don't know
Removed after being in place for less than 5 years
Removed, in place for over 5 years
Yes, for under 5 years
Yes, for over 5 years
496.  On an average day, for how long do you wear a bra?
Don't know
Never / very rarely
Less than 10 hours per day
10 to 16 hours per day
Over 16 hours per day (I sleep with it on)
497.  Cysts in breasts
Never had one / don't know
Probably had one/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem
498.  Are you currently experiencing breast tenderness, soreness or swelling that is not associated with your menstrual cycle? If it is related to your cycle, answer the question that comes later.
Don't know / it is related to my cycle
No
Yes, slight, for under 1 month
Yes, severe, for under 1 month
Yes, for over 1 month
499.  Do you have a tendency towards male characteristics (build, breast development)?
No / don't know
Moderately
Definitely

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GLOSSARY

Adrenal Insufficiency (Adrenal Exhaustion, Low Adrenal Function)
A condition in which the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.

Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.

Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.

Chronic Renal Failure (Chronic Renal Insufficiency, Kidney Failure, Renal Insufficiency)
(CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.

Cystic Fibrosis
(CF) An incurable genetic disease involving a sticky buildup of mucus in the lungs (which makes breathing difficult and leads to infections), as well as pancreatic insufficiency (which leads to digestive problems). Symptoms include chronic cough producing thick mucus, excessive appetite combined with weight loss, intestinal disorders, salty sweat/skin and pneumonia. Lung-related problems are the most frequent cause of death. CF is a recessive disease, occurring only when a person inherits two mutated copies of the CF gene - one from each parent. Individuals with CF generally have a life expectancy of about 30 years.

Cysts (Cyst)
A closed pocket or pouch of tissue; a cyst may form within any tissue in the body and can be filled with air, fluid, pus, or other material. Cysts within the lung generally are air-filled, while cysts involving the lymph system or kidneys are fluid filled. Cysts under the skin are benign, extremely common, movable lumps. These may develop as a result of infection, clogging of sebaceous glands, developmental abnormalities or around foreign bodies.

Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Edema
Abnormal accumulation of fluids within tissues resulting in swelling.

Glandular (Glandulars, Raw Glandulars)
Either referring to a gland, OR glands and organs from animals specially processed at temperatures not exceeding body heat and put into supplement form.

Glucose
A sugar that is the simplest form of carbohydrate. It is commonly referred to as blood sugar. The body breaks down carbohydrates in foods into glucose, which serves as the primary fuel for the muscles and the brain.

Hyperthyroidism (Hyperthyroid)
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.

Hypoglycemia
A condition characterized by an abnormally low blood glucose level. Severe hypoglycemia is rare and dangerous. It can be caused by medications such as insulin (diabetics are prone to hypoglycemia), severe physical exhaustion, and some illnesses.

Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.

Incontinence (Incontinent)
The inability to retain urine in the bladder for a reasonable length of time. It is can be caused by urethral irritation, loss of tone to the basement muscle of the bladder (the trigone), scarification or growths on the urethral lining, nerve damage, or emotional stress.

Inguinal
Pertaining to the region of the groin. Generally, the lowest lateral regions of the abdomen just above either side of the genitals.

Interstitial Cystitis
A chronic bladder problem involving a bladder wall that is inflamed and irritated. Symptoms include an urgent need to urinate, both daytime and nighttime; pressure, pain and tenderness around the bladder, pelvis and perineum (the area between the anus and vagina or the anus and scrotum) which may increase as the bladder fills and decrease as it empties during urination; a bladder that won't hold as much urine as it did before; pain during sexual intercourse; in men, discomfort or pain in the penis or scrotum. In many women, the symptoms get worse before their menstrual period. Stress may also make the symptoms worse, but it does not cause them.

Kidney Stone (Kidney Gravel, Kidney Stones)
A stone (concretion) in the kidney. If the stone is large enough to block the tube (ureter) and stop the flow of urine from the kidney, it must be removed by surgery or other methods. Also called Renal Calculus. Symptoms usually begin with intense waves of pain as a stone moves in the urinary tract. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin. The pain may continue if the stone is too large to pass; blood may appear in the urine and there may be the need to urinate more often or a burning sensation during urination. If fever and chills accompany any of these symptoms, an infection may be present and a doctor should be seen immediately.

Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.

Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.

Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.

Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.

Nervous Breakdown (Nervous Breakdowns)
This is an unofficial term for an event experienced by someone when anxiety or depression escalates to the degree that they find themselves suddenly unable to perform normal functions.

Pancreatitis
Inflammation of the pancreas. Symptoms begin as those of acute pancreatitis: a gradual or sudden severe pain in the center part of the upper abdomen goes through to the back, perhaps becoming worse when eating and building to a persistent pain; nausea and vomiting; fever; jaundice (yellowing of the skin); shock; weight loss; symptoms of diabetes mellitus. Chronic pancreatitis occurs when the symptoms of acute pancreatitis continue to recur.

Panic Attack (Panic Attacks)
A brief, irrational episode of fear that is perceived as so real that an individual may be driven to escape from the place or situation where it occurs. The attack is sudden and increases in severity until it leaves, usually within ten minutes. Panic attack symptoms are numerous and involve both mental and physical signs and symptoms. A panic attack can occur in other anxiety states such as agoraphobia and with certain activities and places. It may occur spontaneously without an apparent cause.

Postpartum Depression
The "baby blues" are a very frequent and completely normal consequence of childbirth, usually wearing off soon afterwards as hormonal and psychological systems get back to normal. Postpartum depression is a less common but severe depression that begins in the weeks following delivery. It impairs the ability of the mother to care for the child and fall in love with it. This makes her feel even more depressed and inadequate thinking that she can not be a good mother. At the extreme, postpartum depression may lead to dangerous delusions (for example, thinking the baby is in some way deformed or cursed) or hallucinations (that may command violent acts). This can occasionally result in a tragic episode of suicide and/or infanticide.

Urethral Discharge
A discharge from the urethra (the narrow tube that transports urine from the bladder to the outside of the body) that may be a cloudy, yellow-green mucous, white (like 'cottage cheese'), either watery or thick, odorless or malodorous.





























 

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