Do you have less hair or a bald patch on the front/side area of your lower leg(s)?
No / don't know
Yes
697.
Have you had a recent change in body hair quantity?
Much recent loss
Some recent loss
No / don't know
Some recent gain
Much recent gain
698.
Do you have an urge or habit of pulling or plucking hairs from your body beyond the removal of selected hairs for cosmetic reasons?
Don't know
No
Yes, from time to time
Yes, I habitually pull hairs out
Yes, I habitually pull hairs out and eat them
699.
Do you have less pubic or underarm hair growth than previously?
I can't tell / don't know
No, quantity is at least as much as before
Yes, the quantity has decreased somewhat
Yes, the quantity has decreased substantially
700.
Is your head (scalp) hair generally thinning/falling out? Do not include male pattern baldness.
Normal loss / not applicable / don't know
Moderate loss
Much loss
701.
Do you have male pattern hair loss? Male pattern hair loss (MPHL) is a common condition in which men - and sometimes women - experience a receding hairline and/or balding on the top of the head.
No / don't know
Mildly / frontal loss only
Moderately / partial loss on top only
Moderately / complete loss on top only
Severely / nearly or totally bald
702.
If you suffer from male pattern hair loss (balding), at approximately what age did it start progressing significantly?
Not applicable / don't know
25 or under
26 to 35
36 to 45
Over 45
703.
How oily is your hair?
Dry
Average / not applicable / don't know
Oily
704.
Apart from graying, what color tone is or was the hair on your head?
Very light
Light
Average / not applicable / don't know
Dark
Very dark
705.
If you have gray hair, choose the answer that best describes the graying process in your case. Hair graying is both genetic and age-related.
I have no hair / no gray hair / don't know
It retained its natural color longer than expected
How fast does your head (scalp) hair grow? Hair normally grows about 1/2 inch (1.25cm) per month or 6 inches (15cm) per year.
Very slowly
Slowly
Average / don't know
Quickly
Very quickly
710.
How wavy is your hair naturally?
It is straight
"Average" / don't know
It is wavy / curly
Add any additional information here for the questions above:
Please mention the question number(s) if possible.
SYMPTOMS: NAILS
711.
Do your fingernails have white spots on them that are not due to nail trauma/injury?
No / don't know
A few
Several
712.
Do you have any white areas (not spots) on your fingernails that are not due to nail injury/trauma?
No / don't know
Pink at the base, turning white towards the ends
80% or more of nail beds are white, including base
White lines from side to side, do not move
White lines from side to side, move as nails grow
713.
Are (parts of) your fingernails any unusual color other than white?
No / don't know
Green
Blue and brown
Black / somewhat brown
714.
Do you experience inflamed cuticles (the skin over the base of your nails)?
No / don't know
Occasionally / moderately
Often / severely
715.
Do you suffer from hangnails/agnails (painful swelling around the fingernails or toenails) or ragged cuticles (occurring when cuticle or skin surrounding the nail is damaged or torn)?
No / don't know
Occasionally / moderate
Often / severe
716.
Are your fingernails brittle - do they chip, peel or break easily?
Don't know
No
Somewhat
Very
717.
Do your fingernails have ridges or grooves going from side to side, across the direction of growth?
No / don't know
A few / minor
Many / pronounced
718.
Do your fingernails curve backward like little spoons?
Don't know
No
A little
Definitely
719.
Are your toenails distorted/deformed?
No / don't know
Probably/minor episode now resolved
Major episode now resolved
Current minor problem
Current major problem
720.
How fast do your fingernails grow? Normal growth is 0.8 inches (2cm) per year but this can be hard to estimate.
Very slowly
Slowly
Average / don't know
Quickly
Very quickly
Add any additional information here for the questions above:
Please mention the question number(s) if possible.
SUPPLEMENT, MEDICATION AND DRUG USE
740.
Multiple vitamin supplement. Only include broad-spectrum preparations, not individual nutrients or specialty combinations such as B-vitamins. "One-a-Day" types are usually of low potency; high potency products involve taking several tablets per day.
Whether you use aspirin or not, is it an effective pain reliever for you?
Not applicable / don't know
No
Somewhat
Definitely
744.
Have you ever used steroids, in the form of eye drops, by mouth, injections or creams?
Don't know
No, definitely not
Minor - used for less than 2 weeks
Moderate - used for up to 3 months
Major - used for more than 3 months
745.
Have you taken other dietary or nutritional supplements within the past year? These include vitamins, minerals, nutraceuticals and others (except hormones) generally found in a health food store, not a pharmacy.
No / don't know
Yes More questions later...
746.
Have you used antacids or drugs to prevent acid reflux during the past 2 years?
Don't know
No
Yes, but is no longer used More questions later...
Yes, currently using More questions later...
747.
Have you used prescription antibiotics within the past 5 years? This includes antiviral, antifungal and antiparasitic medications.
Don't know
No
Yes More questions later...
748.
Have you used tranquilizers, sedatives or psychotropic (perception, emotion or behavior-altering) prescription drugs within the past 2 years for conditions such as anxiety, depression, mania, OCD?
Have you ever used recreational ("illegal") drugs? Include those that were used for medicinal purposes.
No / I would prefer not to say / don't know
Yes More questions later...
761.
Have you taken any other prescription or over-the-counter medications that we have not covered so far? Examples include stimulants, blood thinners, decongestants, anti-nausea drugs...
Don't know
No
Yes More questions later...
Add any additional information here for the questions above:
Please mention the question number(s) if possible.
PAST MEDICAL PROCEDURES
This section deals with invasive, manipulative or reparative physical procedures that have been carried out on your body. You may list any other procedures below.
762.
Have you received any blood transfusions?
No / don't know
Yes, one
Yes, several
763.
Have you ever had any type of surgery?
Don't know
No
Yes More questions later...
Add any additional information here for the questions above:
Please mention the question number(s) if possible.
LABORATORY VALUES - COMMONLY KNOWN
These values - if known - will help to confirm or rule out certain conditions. Skip questions you are uncertain of and older tests that are no longer valid. At the end you may provide further information.
764.
Blood Pressure. What is your usual blood pressure without medication? [Top number, systolic]
Don't know
Under 110 (low)
110 to 129 (normal)
130 to 150 (elevated)
Over 150 (very elevated)
765.
Blood Pressure. What is your usual blood pressure without medication? [Bottom number, diastolic]
Don't know
Under 70 (low)
70 to 89 (normal)
90 to 100 (elevated)
Over 100 (very elevated)
766.
If you have hypertension (elevated blood pressure), how long has it been elevated? Don't include periods where it was normalized by medication or other means.
Not applicable / don't know
Less than two years
2 to 6 years
6 to 10 years
More than 10 years
767.
Pulse rate - What is your resting pulse rate?
Don't know
Less than 60
60 to 70
71 to 80
Over 80
768.
Blood Type. Only answer if you are certain what it is.
Don't know
Type O
Type A
Type B
Type AB
769.
Have you had any diagnostic/lab tests performed in the past year? Examples are blood, urine, stool, hair or saliva analysis; X-rays; scans; biopsies, etc. NOTE: We do not require this information, but it can help to confirm or rule out certain things.
Don't know
No tests within the past year
Yes, I have had tests within the past year More questions later...
Add any additional information here for the questions above:
Please mention the question number(s) if possible.
GLOSSARY
Antacid (Antacids) Neutralizes acid in the stomach, esophagus, or first part of the duodenum.
Antifungal (Antifungals) An agent that kills or inhibits fungi, or a compound that inhibits either a dermatomycosis like ringworm or athlete's foot, or one that inhibits Candida albicans either externally as a douche or internally as a systemic antifungal. Examples: Nystatin, griseofulvin, Tabebuia.
Anti-inflammatory (Antiinflammatory) Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Antiviral Any of a number of herbs, drugs or agents capable of destroying viruses or inhibiting their growth or multiplication until the body is capable of destroying the virus itself. Most antiviral agents are members of the antimetabolite family.
Anxiety Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Asthma (Asthmatic) A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress. Extrinsic Asthma is triggered by pollen, chemicals or some other external agent; Intrinsic Asthma is triggered by boggy membranes, congested tissues, or other native causes… even adrenalin stress or exertion.
Ayurvedic (Ayurveda) Type of alternative medicine in which diet and therapies, such as herbal inhalation and massage, are dictated by individual's body type; 4,000 year-old traditional Indian system believed to be helpful to those suffering insomnia, hypertension and digestive problems.
Bulk Laxative (Bulk Laxatives) These products increase fecal (bowel content) volume in order to stimulate its movement. Bulk-forming laxatives provide the closest approximation to the natural process of increasing fecal volume, and are normally the first line recommendation for functional constipation. They contain natural or semi-synthetic polysaccharides or cellulose derivatives that pass through the gastrointestinal tract undigested. Examples include wheat bran, psyllium, flax, methylcellulose, ispaghula husk, and Sterculia urens.
Centimeter (Centimeters, cm) A metric unit of length equaling one hundredth of a meter, or ten millimeters. There are 2.54 millimeters in one inch.
DHEA (DHEA-S) Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Diastolic Pertaining to the relaxation phase of the heartbeat, or period when the heart muscle is resting and filling with blood. When used in blood pressure readings (for example 120/80), it refers to the second/lower number.
Diuretic (Diuretics) An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
EDTA Ethylene Diamine Tetraacetic Acid. An organic molecule used in chelation therapy.
Fecal Lubricant (Fecal Lubricants) An example of such a laxative is liquid paraffin, which is indigestible and absorbed only to a small extent. It penetrates and softens the feces, and coats the surface with an oil film, which facilitates its passage through the intestine. It is considered to have a usefulness as an occasional laxative in situations where straining at the stool must be avoided, but it has several drawbacks which make it unsuitable for regular use.
Fecal Softener (Fecal Softeners) These act by lowering the surface tension of the intestinal contents, allowing fluid and fat to penetrate, emulsify and soften fecal material for easier elimination. The feces are kept soft, and evacuation is achieved without straining. An example is docusate sodium, an anionic surfactant that also exerts a stimulant laxative effect similar to that of the anthraquinones.
Hormone-altering Drugs Drugs that act by influencing your naturally-occurring hormone levels. Examples include Metformin, which affects insulin levels; Tamoxifen and Arimidex which affect estrogen levels; LHRH agonists which affect testosterone levels; and propylthiouracil (PTU) and methimazole(MTZ) which affect thyroid levels.
Hormones (Hormone) Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypertension High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Laxative (Laxatives) A substance (food, herb, chemical) that stimulates evacuation of the bowels. Examples include cascara sagrada, senna, castor oil, aloe vera, bisacodyl, phenolphthalein and many others.
Male Pattern Baldness The most common type of hair loss in men. It usually follows a typical "horseshoe" pattern of receding hairline and hair thinning on the top of the head, and is caused by hormones and genetic predisposition.
Melatonin The only hormone secreted into the bloodstream by the pineal gland. The hormone appears to inhibit numerous endocrine functions, including the gonadotropic hormones. Research exists on the efficacy of melatonin in treating jet lag and certain sleep disorders. Dosages greater than l milligram have been associated with drowsiness, headaches, disturbances in sleep/wake cycles and is contraindicated in those who are on antidepressive medication. It also negatively influences insulin utilization.
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.
Mineral (Minerals) Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Obsessive-Compulsive Disorder (Obsessive Compulsive, Obsessive-Compulsive, OCD) Those suffering from OCD have obsessions and/or compulsions. Obsessions refer to recurrent and persistent thoughts, impulses, or images that are intrusive and cause severe anxiety or distress. Compulsions refer to repetitive behaviors and rituals (such as hand washing, hoarding, ordering, checking) or mental acts (like counting, repeating words silently, avoiding). These obsessions and compulsions significantly interfere with normal routine, functioning, social activities and relationships.
Osmotic Laxative (Osmotic Laxatives) Osmotic laxatives exert a laxative effect by drawing water into the colon and retaining fluid in the bowel or by changing the pattern of water distribution in the feces. Unlike stimulant laxatives, they are safer and non-habit-forming. The most commonly used osmotic laxatives include magnesium hydroxide ("Milk of Magnesia"), magnesium citrate, magnesium sulfate (Epsom salts), sodium potassium tartrate, lactulose, glycerol and polyethylene glycol. Some are administered orally and others by enema.
Progesterone This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Saliva (Salivary) The watery mixture of secretions from the salivary and oral mucous glands that lubricates chewed food and moistens the oral walls.
Steroid (Steroids) Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Stimulant Laxative (Stimulant Laxatives) Stimulant laxatives are believed to stimulate nerve endings in the nerve plexuses of the bowel wall, increasing the movement of its content via several mechanisms. The most common active ingredients include the Anthraquinones (Senna, Aloin, Frangula, Cascara and Powdered rhubarb) and the Diphenylmethane derivatives (Bisacodyl, Sodium picosulfate, Phenolphthalein). Traditionally-used castor oil has fallen into disuse because of its 'drastic' action and unpleasant taste.
Systolic Pertaining to the contraction phase of the heartbeat, or the pressure in the arterial system caused by the heart as blood is being pumped out. When used in blood pressure readings (for example 120/80), it refers to the first/upper number.
Thyroid (Thyroid Gland) The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
X-rays (X-ray) High-energy radiation used to take pictures of areas inside the body.
More questions later...
