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History |
Point Score |
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1. |
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Have you ever taken tetracycline or other antibiotics for acne for one month or longer? |
25 |
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2. |
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Have you ever taken other "broad-spectrum" antibiotics for respiratory, urinary, or other infections for two months or longer, or in short courses four or more times in one year? |
20 |
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3. |
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Have you ever taken a "broad-spectrum" antibiotic (even a single course)? |
6 |
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4. |
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Have you ever been bothered by persistent prostatitis, vaginitis or other problems affecting your reproductive organs? |
25 |
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5. |
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Have you been pregnant... |
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One time? |
3 |
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Two or more times? |
5 |
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6. |
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Have you taken birth control pills... |
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For six months to two years? |
8 |
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For more than two years? |
15 |
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7. |
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Have you taken prednisone or other cortisone type drugs... |
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For two weeks or less? |
6 |
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For more than two weeks? |
15 |
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8. |
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Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals provoke... |
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Mild symptoms? |
5 |
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Moderate to severe symptoms? |
20 |
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9. |
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Are your symptoms worse on damp, muggy days or in moldy places? |
20 |
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10. |
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Have you had athlete's foot, ringworm, "jock itch," or other chronic infections of the skin or nails? |
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Mild to moderate? |
10 |
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Severe to persistent? |
20 |
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11. |
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Do you crave sugar? |
10 |
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12. |
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Do you crave breads? |
10 |
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13. |
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Do you crave alcoholic beverages? |
10 |
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14. |
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Does tobacco smoke really bother you? |
10 |
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Total Score For This Section |
_______ |
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Major Symptoms |
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For each of your symptoms, enter the appopriate figure in the Point Score column. |
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If symptom is occasional or mild |
score 3 points |
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If symptom is frequent and/or moderately severe |
score 6 points |
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If symptom is severe and/or disabling |
score 9 points |
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1. |
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Fatigue or lethargy |
_______ |
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2. |
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Feeling of being drained |
_______ |
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3. |
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Poor memory |
_______ |
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4. |
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Feeling "spacey" or "unreal" |
_______ |
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5. |
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Depression |
_______ |
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6. |
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Numbness, burning, or tingling |
_______ |
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7. |
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Muscle aches |
_______ |
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8. |
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Muscle weakness or paralysis |
_______ |
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9. |
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Pain and/or swelling in joints |
_______ |
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10. |
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Abdominal pain |
_______ |
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11. |
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Constipation |
_______ |
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12. |
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Diarrhea |
_______ |
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13. |
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Bloating |
_______ |
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14. |
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Persistent vaginal itch |
_______ |
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15. |
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Persistent vaginal burning |
_______ |
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16. |
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Prostatitis |
_______ |
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17. |
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Impotence |
_______ |
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18. |
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Loss of sexual desire |
_______ |
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19. |
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Endometriosis |
_______ |
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20. |
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Cramping and other menstrual irregularities |
_______ |
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21. |
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Premenstrual tension |
_______ |
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22. |
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Spots in front of eyes |
_______ |
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23. |
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Erratic vision |
_______ |
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Total Score For This Section |
_______ |
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Other Symptoms |
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For each of your symptoms, enter the appopriate figure in the Point Score column. |
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If symptom is occasional or mild |
score 1 points |
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If symptom is frequent and/or moderately severe |
score 2 points |
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If symptom is severe and/or disabling |
score 3 points |
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1. |
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Drowsiness |
_______ |
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2. |
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Irritability |
_______ |
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3. |
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Lack of coordination |
_______ |
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4. |
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Inability to concentrate |
_______ |
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5. |
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Frequent mood swings |
_______ |
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6. |
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Headache |
_______ |
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7. |
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Dizziness/loss of balance |
_______ |
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8. |
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Pressure above ears, feeling of head swelling and tingling |
_______ |
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9. |
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Itching |
_______ |
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10. |
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Other rashes |
_______ |
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11. |
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Heartburn |
_______ |
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12. |
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Indigestion |
_______ |
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13. |
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Belching and intestinal gas |
_______ |
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14. |
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Mucus in stool |
_______ |
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15. |
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Hemorrhoids |
_______ |
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16. |
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Dry mouth |
_______ |
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17. |
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Rash or blisters in mouth |
_______ |
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18. |
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Bad breath |
_______ |
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19. |
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Joint swelling or arthritis |
_______ |
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20. |
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Nasal congestion or discharge |
_______ |
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21. |
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Postnasal drip |
_______ |
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22. |
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Nasal itching |
_______ |
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23. |
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Sore or dry throat |
_______ |
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24. |
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Cough |
_______ |
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25. |
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Pain or tightness in chest |
_______ |
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26. |
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Wheezing or shortness of breath |
_______ |
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27. |
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Urinary urgency or frequency |
_______ |
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28. |
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Burning on urination |
_______ |
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29. |
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Failing vision |
_______ |
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30. |
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Burning or tearing of eyes |
_______ |
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31. |
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Recurrent infections or fluid in ears |
_______ |
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32. |
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Ear pain of deafness |
_______ |
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Total Score For This Section |
_______ |
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Point Score Totals |
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Total from section one |
_______ |
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Total from section two |
_______ |
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Total from section three |
_______ |
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Total All Sections |
_______ |
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Results |
Women |
Men |
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Yeast-connected health problems are almost certainly present |
>180 |
>140 |
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Yeast-connected health problems are probably present |
120-180 |
90-140 |
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Yeast-connected health problems are possibly present |
60-119 |
40-89 |
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Yeast-connected health problems are less likely to be present |
<60 |
<40 |
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