Male Questionnaire
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SYMPTOMS: RESPIRATORY

Q472

Do you have a cough that produces mucus (a 'productive cough')?
  • Don't know
  • No
  • Yes, for less than a month
  • Yes, for over a month but less than a year
  • Yes, for more than a year

Q473

Do you have a cough that does not produce mucus (a 'dry cough')?
  • Don't know
  • No
  • Yes, for less than a month
  • Yes, for over a month but less than a year
  • Yes, for more than a year

Q474

Do you feel worse when in moldy or musty places?
  • No / don't know
  • Somewhat
  • Very much

Q475

Roughly how many times per year do you suffer from a sore throat?
  • Never / rarely
  • About once a year / average / don't know
  • 2-3 times, mildly
  • 2-3 times severely or more than 3 times mildly
  • More than 3 times, severely

Q476

Do you have a sore throat now?
  • Don't know
  • No
  • Yes, somewhat sore
  • Yes, very sore and painful to swallow

Q477

Have you suffered from Asthma?
  • 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

Q478

Have you had Pneumonia?
  • Never had it / don't know
  • Probably/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q479

Do you have a history of Acute Infectious Bronchitis? Symptoms may include chest pain on coughing, difficulty breathing, mild fever and a cough with mucus. It usually lasts from a few days to weeks.
  • Don't know
  • No
  • Recurrent problem, but no symptoms now
  • Recurrent problem with current symptoms
  • It is not a recurring problem, but I have it now

Q480

How easily do you become short of breath?
  • Never / don't know
  • Only with great exertion, for example running fast
  • With moderate exertion such as jogging
  • Even with mild activity, such as walking
  • Very easily - even when I am not active

Q481

Are you currently experiencing any type of breathing problems? For example, easily becoming short of breath, difficulty breathing in or out, wheezing, rapid breathing, or medical conditions such as COPD, Emphysema or Bronchitis.
  • No / don't know
  • Yes*
* more questions will be asked later

Q482

Have you experienced any kind of chest pain, burning, tightness, pressure or discomfort within the past year?
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: SLEEP

Q483

How often do you take a nap outside of normal sleeping hours?
  • Never / don't know
  • Once a month or less
  • Once a week or less
  • A few times per week
  • Daily or almost daily

Q484

Roughly how often do you yawn, on average?
  • Never / a few times per year perhaps
  • I'd say less than average
  • Average / a few times per day / don't know
  • Many times during the day
  • Several times every hour

Q485

How often do you become very tired within 1-3 hours of eating a meal?
  • Never / rarely / don't know
  • Once a month or less
  • Once a week or less
  • A few times per week
  • At least daily

Q486

General drowsiness. Roughly how often do you find yourself falling asleep in situations such as boring meetings, watching TV or while driving? Do not include drowsiness that occurs 1-3 hours after eating a meal.
  • Never / rarely / only after a meal / don't know
  • Once a month or less
  • Once a week or less
  • A few times per week
  • At least daily

Q487

Do you have difficulty staying awake after midnight?
  • Yes, always
  • Usually / I only stay up for special occasions
  • Sometimes / I'm about average / don't know
  • No, I regularly stay up into the small hours
  • Not at all, I'm a real "night person"

Q488

How is your quality of sleep generally, when you are able to sleep without interruption or pain?
  • Usually broken up / disturbed
  • Sometimes broken up / disturbed
  • Average/sound / don't know
  • Generally deep
  • Always deep

Q489

Sleep. On average, how many hours of sleep do you get each night?
  • Under 5 hours / much less than I should
  • 5-6 hours / less than I should
  • 6-8 hours / don't know
  • 8-9 hours / more than necessary
  • Over 9 hours / much more than necessary

Q490

Night Sweats. Do you sweat at night? Only include sweating that is not due to an overly warm environment or too many bed covers.
  • Don't know
  • No
  • Only slightly
  • Moderately, sheets are damp or moist
  • Profusely, sheets are soaked

Q491

If you suffer from Night Sweats, for how long has it been a problem?
  • Not applicable / don't know
  • Recent onset only - less than 2 weeks' duration
  • 2 weeks to 2 months
  • 2 to 6 months
  • Longer than 6 months

Q492

How often and severely do you experience bad dreams? A nightmare is more intense than a bad dream, waking you up and causing significant emotional distress.
  • Never / don't know
  • Bad dreams under once a month / rarely nightmares
  • Monthly bad dreams / nightmares under once a month
  • Weekly bad dreams / monthly nightmares
  • Weekly/nightly/recurring nightmares

Q493

Roughly how often do you experience very strange dreams? Do not include scary dreams (nightmares).
  • Don't know / I (usually) don't remember my dreams
  • Never / rarely / less than once a year
  • Occasionally, less than once a month
  • Regularly, more than once a month
  • Frequently, more than once a week

Q494

Do you have a hard time waking up and getting started with your day?
  • Don't know
  • No, I usually wake up refreshed and ready to go
  • Occasionally / moderate
  • Often / severe - I often oversleep, ignore alarm

Q495

Do you remember your dreams when you wake up?
  • I almost always remember my dreams clearly
  • Average - sometimes I remember / don't know
  • I almost always forget them quickly

Q496

Do you have other sleep problems? Examples include snoring, teeth grinding, Insomnia, Sleep Apnea, Narcolepsy, Sleep Paralysis, other sleep disorders, or symptoms when you wake up, such as a dry mouth, dry eyes, choking, gasping for air, or acid in mouth.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: CARDIOVASCULAR

Q497

Have you had an irregular heartbeat (arrhythmia)?
  • No / don't know
  • In the past only, seems resolved
  • Occasionally / somewhat
  • Often / very much so

Q498

Does your heart sometimes race or palpitate such that you can feel it beating?
  • No / don't know
  • Occasionally / moderately
  • Often / severely

Q499

Do you suffer from occasional and unusual pain that is in your chest, upper left arm, or left side of neck?
  • No / don't know
  • Occasionally / moderate
  • Often / severe

Q500

Do you have varicose veins?
  • No / don't know
  • Minor - first signs
  • Moderate - a few, small instances
  • Serious - many minor instances or a few major
  • Severe - many major instances

Q501

Do you have Raynaud's Phenomenon (extreme loss of circulation to fingers and/or toes)?
  • No / don't know
  • Probably had it / minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q502

Have you been diagnosed with any other cardiovascular problems? For example, Stroke, Angina, Congestive Heart Failure, Heart Attack, Atherosclerosis, Aneurysm, Vasculitis, (Thrombo)phlebitis, Enlarged Heart, MVP, Heart Murmur, Cardiomyopathy, Myocarditis.
  • Don't know
  • No
  • Yes / probably*
* more questions will be asked later

Q503

Have you had any kind of anemia?
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: IMMUNE SYSTEM

Q504

Have you suffered from boils, abscesses or carbuncles?
  • Never had one / don't know
  • Probably had one/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor/occasional problem
  • Current major/frequent problem

Q505

Have you been diagnosed with Candida Yeast Infection anywhere in your body?
  • 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

Q506

Coccidioidomycosis (Valley Fever). Have you ever been diagnosed with this condition? It is a serious fungal disease of the lungs and other tissues.
  • No / don't know
  • I tested negative
  • In the past only
  • Current problem, only lungs involved
  • Current problem, disseminated

Q507

Lyme Disease. Have you ever been diagnosed with this condition? It is a tick-borne disease characterized by circular rash, headache, fever, chills and, later, by possible arthritis and neurological and cardiac disorders.
  • No / don't know
  • Minor episode now resolved
  • Major episode now resolved
  • Current minor problem
  • Current major problem

Q508

How often do you get bacterial, viral, or fungal infections? For example, skin, ear, gastrointestinal, chest/respiratory, mouth, genitourinary. Symptoms usually include fever, pain, swelling, redness, pus, runny nose, sore throat, or swollen lymph nodes.
  • Once a year or less / almost never
  • 1-2 per year / less than average
  • 2-3 per year / about average / don't know
  • 4-6 per year / regularly
  • More than 6 per year / I usually/always have one

Q509

Have you ever been diagnosed with Lupus (SLE, Systemic Lupus Erythematosus)?
  • No / don't know
  • Minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q510

Wound healing. Do your wounds (any breaks in the skin) seem to take longer to heal than they would in other people? Small wounds normally take 3 days to 3 weeks to heal (grow new skin over the injury).
  • No / wounds heal quickly / don't know
  • Moderately - healing takes longer than it should
  • Severely - healing takes months (or even years)

Q511

Blood clotting problems. When you start to bleed, does it take a long time to stop?
  • Don't know
  • No, bleeding stops quickly (normal)
  • It takes quite a long time
  • Yes, definitely
  • I have von Willebrand disease or Hemophilia

Q512

Scleroderma. Have you ever been diagnosed with this condition? This disease causes skin to thicken and tighten.
  • Never had it / don't know
  • Probably/minor episode now resolved
  • Major episode now resolved
  • Current minor problem
  • Current major problem

Q513

Shingles (Varicella Zoster). Have you ever been diagnosed with this condition? Symptoms include rash, blisters for 1-14 days, burning/shooting pain and tingling/itching usually on one side of the body or face.
  • Never had it / don't know
  • Probably/minor episode now resolved
  • Major episode now resolved
  • Current minor problem
  • Current major problem

Q514

Chronic Thyroiditis (Hashimoto's Disease). Have you ever been diagnosed with this condition?
  • Never had it / don't know
  • Probably/minor episode now resolved
  • Major episode now resolved
  • Current minor problem
  • Current major problem

Q515

Have you had any cysts? Some can be felt as abnormal lumps under the skin, but others are only detected using X-ray, ultrasound, CT scan or MRI.
  • Never had any / don't know
  • Probably/minor episode now resolved
  • Major episode now resolved (required treatment)
  • Ongoing minor problem (no treatment necessary)
  • Current major problem (requires treatment)

Q516

Multiple Sclerosis? Have you ever been diagnosed with this condition?
  • Never had it / don't know
  • Probably had it/minor episode now in remission
  • Significant problem in remission for some time
  • Current problem
  • Current major problem

Q517

Have you ever had from any form of cancer?
  • No / don't know
  • Yes*
* more questions will be asked later

SYMPTOMS: SKIN: GENERAL

Q518

Do you have calluses on your heels and, if so, are they cracked?
  • No / don't know
  • Light callus without significant cracking
  • Light callus with cracking
  • Thick callus without significant cracking
  • Thick callus with cracking

Q519

Do you have a problem with cracked skin, typically on the fingers, toes or in skin creases? Do not include cracked heel calluses.
  • No / don't know
  • Occasionally / moderate
  • Often / severe

Q520

Do you have small bumps on the backs of your arms?
  • No / don't know
  • Yes, some/minor
  • Yes, many/definite

Q521

What is your skin color prior to suntan, compared to others of your race, or family members?
  • Significantly lighter/paler
  • A little lighter/paler
  • Average / don't know
  • A little darker/redder
  • Significantly darker/redder

Q522

What is your facial coloring prior to suntan, compared to others of your race, or family members?
  • Noticeably pale
  • Slightly pale
  • Average / don't know
  • Slightly dark
  • Noticeably dark, pink, flushed or ruddy

Q523

Do you experience facial blushing, flushing or redness more frequently or intensely than would be considered normal? Do not count blushing during embarrassing situations.
  • Don't know / I think I'm average
  • No, definitely not
  • Mild / occasionally
  • Moderate / sometimes
  • Major / often

Q524

Does your skin seem to have a more yellowish (jaundiced) tone than previously? It may help to look at untanned areas.
  • Don't know
  • No
  • Probably / somewhat
  • Definitely

Q525

Skin moistness. Without moisturizer, how dry or moist is your skin?
  • Very dry
  • A bit dry
  • Average / don't know
  • A bit oily/moist
  • Definitely oily/moist

Q526

Is your skin scaly or flaky in areas other than the top of your head (scalp)?
  • Don't know
  • Definitely not
  • Yes, somewhat
  • Yes, significantly

Q527

Does your skin tend to itch often, perhaps worse at night?
  • No / don't know
  • Moderately
  • Severely

Q528

How much do you perspire/sweat?
  • Very little / not easily
  • Less than average
  • About average / don't know
  • More than average
  • Lots / easily / often and profusely for no reason

Q529

Do the palms of your hands sweat excessively?
  • No / don't know
  • Slight problem for less than 1 year
  • Slight problem for more than 1 year
  • Major problem for less than 1 year
  • Major problem for more than 1 year

Q530

Body odor. Does your perspiration (sweat) cause a strong odor? This applies mainly to the armpits and feet.
  • No / not really / don't know
  • Somewhat, but it is manageable
  • Definitely, it is a serious problem for me

Q531

Do you bruise easily?
  • No / about average / don't know
  • Yes, a little more easily than other people
  • Yes, even a little bump will leave a bruise
  • Yes, very easily - I often/always have bruises

Q532

Do you have palms and fingertips that are more red than average?
  • No / don't know
  • Somewhat
  • Definitely