Candida Questionnaire and Score Sheet - Yeast Connection

1 2003 Professional Books, Inc. PO Box 3246, Jackson, TN 38303info@yeastconnection com www YeastConnection com 800-241-8645 Candida Questionnaire and Score SheetIf you d like to know if your health problems are yeastconnected, takethis comprehensive in Section A focus on your medical history factors thatpromote the growth of Candida albicans and that frequently are found inpeople with Yeast -related health Section B you ll find a list of 23 symptoms that are often present inpatients with Yeast -related health problems. Section C consists of 33 othersymptoms that are sometimes seen in people with Yeast -relatedproblems yet they also may be found in people with other out and scoring this Questionnaire should help you and yourphysician evaluate the possible role Candida albicans contributes to yourhealth problems. Yet, it will not provide an automatic yes or no A: History_____Point Score_____1. Have you taken tetracyclines or other antibiotics for acne for 1 month (or longer)?

2 35_____2. Have you at any time in your life taken broadspectrum antibiotics or other antibacterial medication for respiratory, urinary or other infections for two months or longer, or in shorter courses four or more times in a one-year period? 35_____3. Have you taken a broad-spectrum antibiotic drug even in a single dose? 6_____4. Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis or other problems affecting your reproductive organs? 25_____5. Are you bothered by memory or concentration problems do you sometimes feel spaced out? 20_____ 2003 Professional Books, Inc. PO Box 3246, Jackson, TN 38303info@yeastconnection com www YeastConnection com 800-241-8645_____ Point Score_____6. Do you feel sick all over yet, in spite of visits to many different physicians, the causes haven t been found? 20_____7.

3 Have you been Two or more times? 5 One time? 3_____8. Have you taken birth control For more than two years? 15 For six months to two years? 8_____9. Have you taken steroids orally, by injection or inhalation? For more than two weeks? 15 For two weeks or less? 6_____10. Does exposure to perfumes, insecticides, fabric shop odors and other chemicals provoke .. 20 Moderate to severe symptoms? 5 Mild symptoms?_____11. Does tobacco smoke really bother you? 10_____12. Are your symptoms worse on damp, muggy days or in moldy places? 20_____13. Have you had athlete s foot, ring worm, jock itch or other chronic fungous infections of the skin or nails? Have such infections Severe or persistent? 20 Mild to moderate? 10_____14. Do you crave sugar? 10_____TOTAL Score , Section A_____ 2003 Professional Books, Inc. PO Box 3246, Jackson, TN 38303info@yeastconnection com www YeastConnection com 800-241-8645 Section B: Major SymptomsFor each of your symptoms, enter the appropriate figure in the Point Scorecolumn:If a symptom is occasional or mild.

4 3 pointsIf a symptom is frequent and/or moderately severe .. 6 pointsIf a symptom is severe and/or disabling .. 9 pointsAdd total Score and record it at the end of this Score_____1. Fatigue or lethargy_____2. Feeling of being drained _____3. Depression or manic depression_____ 4. Numbness, burning or tingling_____5. Headache_____ 6. Muscle aches_____7. Muscle weakness or paralysis_____8. Pain and/or swelling in joints_____9. Abdominal pain_____10. Constipation and/or diarrhea_____11. Bloating, belching or intestinal gas_____12. Troublesome vaginal burning, itching or discharge_____13. Prostatitis_____14. Impotence 2003 Professional Books, Inc. PO Box 3246, Jackson, TN 38303info@yeastconnection com www YeastConnection com 800-241-8645_____Point Score_____15. Loss of sexual desire or feeling_____16. Endometriosis or infertility_____17. Cramps and/or other menstrual irregularities_____18. Premenstrual tension_____19.

5 Attacks of anxiety or crying_____20. Cold hands or feet, low body temperature_____21. Hypothyroidism_____22. Shaking or irritable when hungry_____23. Cystitis or interstitial cystitis_____ TOTAL Score , Section B_____Section C: Other SymptomsFor each of your symptoms, enter the appropriate figure in the Point Scorecolumn:If a symptom is occasional or mild .. 1 pointIf a symptom is frequent and/or moderately severe .. 2 pointsIf a symptom is severe and/or disabling .. 3 points Add total Score and record it at the end of this Drowsiness, including inappropriate drowsiness_____2. Irritability_____ 2003 Professional Books, Inc. PO Box 3246, Jackson, TN 38303info@yeastconnection com www YeastConnection com 800-241-8645_____Point Score_____3. Incoordination_____4. Frequent mood swings_____5. Insomnia_____6. Dizziness/loss of balance_____7. Pressure above ears .. feeling of head swelling_____8. Sinus problems.

6 Tenderness of cheekbones or forehead_____9. Tendency to bruise easily_____10. Eczema, itching eyes_____11. Psoriasis_____12. Chronic hives (urticaria)_____13. Indigestion or heartburn_____14. Sensitivity to milk, wheat, corn or other common foods_____15. Mucus in stools_____16. Rectal itching_____17. Dry mouth or throat_____18. Mouth rashes, including white tongue_____19. Bad breath_____20. Foot, hair or body odor not relieved by washing_____21. Nasal congestion or postnasal drip 2003 Professional Books, Inc. PO Box 3246, Jackson, TN 38303info@yeastconnection com www YeastConnection com 800-241-8645_____ Point Score_____22. Nasal itching_____23. Sore throat_____24. Laryngitis, loss of voice_____25. Cough or recurrent bronchitis_____26. Pain or tightness in chest_____27. Wheezing or shortness of breath_____28. Urinary frequency or urgency_____29. Burning on urination_____30. Spots in front of eyes or erratic vision_____31.

7 Burning or tearing eyes_____32. Recurrent infections or fluid in ears_____33. Ear pain or deafness_____TOTAL Score , Section C_____Total Score , Section A_____Total Score , Section B_____GRAND TOTAL SCORE_____The Grand Total Score will help you and your physician decide if your healthproblems are Yeast -connected. Scores in women will run higher, as seven itemsin the Questionnaire apply exclusively to women, while only two applyexclusively to men. 2003 Professional Books, Inc. PO Box 3246, Jackson, TN 38303info@yeastconnection com www YeastConnection com 800-241-8645 Yeast -connected health problems are almost certainly present in women withscores more than 180, and in men with scores more than health problems are probably present in women with scoresmore than 120, and in men with scores more than health problems are possibly present in women with scoresmore than 60, and in men with scores more than scores of less than 60 in women and 40 in men, yeasts are less apt tocause health problems.