Symptom Questionnaire

1.Is dry skin, eyes, and/or mucus membranes a frequent symptom?
2.Symptoms include history of or current problems with nonhealing cracks/fissures at the corners of the lips (cheilitis).
3.Symptoms include history of or current problems with overall skin dryness and/or pruritus - peeling skin on the palms and soles, and fingertip fissuring.
4.Symptoms include history of or current problems with thinning hair and/or hair loss without scarring (Telogen effluvium).
5.Symptoms include bone spurs, calcinosis (calcium deposits in the skin and subcutaneous tissue), and/or hypercalcemia. Over the long term osteoporosis and hip fractures may be a concern.
6.Symptoms may include headache, nausea, and vomiting.
7.Symptoms of increased pressure around the brain may be a cause of severe headaches and/or may affect vision, narrowing of the field of view, (pseudotumor cerebri syndrome).
8.Symptoms include hypothyroidism, or intermittent problems with thyroid function. Undiagnosed issues of low thyroid function might include thinning hair, feeling cold easily, depression, apathy, gaining excess weight easily, feeling very tired easily, constipation.
9.Symptoms include hypertriglyceridemia and other blood lipid changes.
10.Symptoms include a history or current problem of acute hemorrhagic pancreatitis.
11.Symptoms include history of or current renal/kidney dysfunction.
12.Symptoms include history of or current problems of elevated serum transaminases, or chronically with liver damage leading to fibrosis and hepatic stellate cell activation.
13.Symptoms include mental confusion, irritability, anxiety, depression, and/or suicidal ideation, and/or more extreme psychosis or suicide attempts.
14.Symptoms include mitochondrial dysfunction and/or oxidative stress (symptoms might include fatigue, muscle cramps, fibromyalgia).
15.Symptoms include increased β-amyloid1-40 peptide (the protein tangles that may be elevated in the brain of patients with Alzheimer's dementia or sometimes in autism).
16.Symptoms include dopamine imbalance and may include low dopamine: "tremor, stiffness, slowness of spontaneous movement, poor balance, and poor coordination"; and/or elevated dopamine: "high libido (sex drive), anxiety, difficulty sleeping, increased energy, mania, stress, and improved ability to focus and learn" and muscle twitches may occur.
17.I (or the patient) have had a history of psychiatric or other medication use.
18.Akathisia symptoms have been a problem (repetitive motions, largely uncontrollable, may also have mental symptoms of anxiety or agitation).
19.Mast Cell Activation Syndrome or histamine excess has been a problem (seasonal allergy or allergy like symptoms and food intolerances somewhat frequently).
20.I (or the patient) have had a history of an adverse vaccine reaction.
21.Has there been a history of a viral or other type of infection with chronic stages such as Lyme's Disease, Epstein Barr virus, or SARS-CoV-2 (COVID19)?
22.Meals and snacks include meats, poultry, fish, milk and other dairy products.
23.Meals and snacks include carrots, tomato products (fresh, or tomato sauce, ketchup, or salsa), sweet potatoes, winter squash or pumpkin, dark green leafy vegetables, cantaloupe, apricots, mango, papaya, peaches, nectarines.
24.Vitamin A and/or Beta-carotene is taken as a supplement singly or in one-a-day vitamins daily.
25.Retinoid toxicity - excess of the active form of vitamin A - has been identified with retinoid medication treatment. Stopping retinoid medication use helps. Theoretically liver injury may cause an increase in vitamin A being activated in the liver & lead to toxicity symptoms also. Reducing vitamin A in the diet or supplements may be needed. Whether that is true and how to heal the liver so less vitamin A is activated would be a question for more research. Thanks for participating in this early stage of information gathering.
26.Demographic information: What is your genetic sex (or the patient's)?
27.What is your gender (or the patient's)?
28.What is your age (or the patient's age)?
29.What is your (or the patient's) race or ethnicity?
30.This survey is being completed about your own symptoms or on behalf of someone else? Thank you very much for participating in this survey.
Current Progress,
0 of 30 answered