This is from about 2006
The Canadian Lyme Disease
Foundation published a diagnostic
questionnaire that they say will help
guide a person to see if they have LD.
Twenty (20) YES answers out of the
seventy five (75) questions gives a
strong indication. Circle the ones that
apply and count the YESs.
Symptoms of Lyme Disease
The Tick Bite
(fewer than 50% recall a
tick bite or get/see the rash)
1. Rash at site of bite
2. Rashes on other parts of your body
3. Rash basically circular and spreading
out (or generalized)
4. Raised rash, disappearing and
recurring
Head, Face, Neck
5. Unexplained hair loss
6. Headache, mild or severe, Seizures
7. Pressure in Head, White Matter
Lesions in Head (MRI)
8. Twitching of facial or other muscles
9. Facial paralysis (Bell's Palsy)
10. Tingling of nose, (tip of) tongue,
cheek or facial flushing
11. Stiff or painful neck
12. Jaw pain or stiffness
13. Dental problems (unexplained)
14. Sore throat, clearing throat a lot,
phlegm ( flem ), hoarseness, runny
nose
Eyes/Vision
15. Double or blurry vision
16. Increased floating spots
17. Pain in eyes, or swelling around
eyes
18. Over-sensitivity to light
19. Flashing lights/Peripheral waves/
phantom images in corner of eyes
Ears/Hearing
20. Decreased hearing in one or both
ears, plugged ears
21. Buzzing in ears
22. Pain in ears, over-sensitivity to
sounds
23. Ringing in one or both ears
Digestive and Excretory Systems
24. Diarrhea
25. Constipation
26. Irritable bladder (trouble starting,
stopping) or Interstitial cystitis
27. Upset stomach (nausea or pain) or
GERD (gastroesophageal reflux
disease)
Musculoskeletal System
28. Bone pain, joint pain or swelling
carpal tunnel syndrome
29. Stiffness of joints, back, neck,
tennis elbow
30. Muscle pain or cramps,
(Fibromyalgia)
Respiratory and Circulatory Systems
31. Shortness of breath, can't get
full/satisfying breath, cough
32. Chest pain or rib soreness
33. Night sweats or unexplained chills
34. Heart palpitations or extra beats
Endocarditis, Heart blockage
Neurologic System
35. Tremors or unexplained shaking
36. Burning or stabbing sensations in
the body
37. Fatigue, Chronic Fatigue Syndrome,
Weakness, peripheral neuropathy
or partial paralysis
38. Pressure in the head
39. Numbness in body, tingling,
pinpricks
40. Poor balance, dizziness, difficulty
walking
41. Increased motion sickness
42. Lightheadedness, wooziness
43. Psychological well-being
44. Mood swings, irritability, bi-polar
disorder
45. Unusual depression
46. Disorientation (getting or feeling
lost)
47. Feeling as if you are losing your
mind
48. Over-emotional reactions, crying
easily
49. Too much sleep, or insomnia
50. Difficulty falling or staying asleep
51. Narcolepsy, sleep apnea
52. Panic attacks, anxiety
Mental Capability
53. Memory loss (short or long term)
54. Confusion, difficulty in thinking
55. Difficulty with concentration or
reading
56. Going to the wrong place
57. Speech difficulty (slurred or slow)
58. Stammering speech
59. Forgetting how to perform simple
tasks
Reproduction and Sexuality
60. Loss of sex drive
61. Sexual dysfunction
62. Unexplained menstral pain,
irregularity
63. Unexplained breast pain,
discharge
64. Testicular or pelvic pain
General Well-being
65. Unexplained weight gain, loss
66. Extreme fatigue
67. Swollen glands/lymph nodes
68. Unexplained fevers (high or low
grade)
69. Continual infections (sinus,
kidney, eye, etc.)
70. Symptoms seem to change,
come and go
71. Pain migrates (moves) to different
body parts
72. Early on, experienced a "flu-like"
illness, after which you have not
since felt well.
73. Low body temperature
74. Allergies/Chemical sensitivities
75. Increased affect from alcohol and
possible worse hangover
Count the number you have circled.