KAREN L. HERBST, PHD, MD - Home Page for Karen L. Herbst ...
Monthly Symptom tracker Start Date: ___________________________ Name: ___________________________________________1. Use any of the filled in signs and symptoms or delete them and write in words that fit your life and experience.Symptom or Sign MTWThFSaSuMTWThFSaSuMTWThFSaSuMTWThFSaSuDate→AppetiteBloatingBrain fogFat tissue painFatigueLeg heavinessJoint painMuscle painSleep timeNumbnessFluid excessShort of breathMuscle stiffnessItchingSwellingSkin lesions2. Rate each sign or symptoms on a scale of 0-10, with 10 being the worst ever and 0 being none or not ever except for sleep: list the time. Pick one sign or symptom that is very important to you and write it in the lined space below. Highlight the “o” that corresponds to your rating for each day. M T W T F S S M T W T F S S M T W T F S S M T W T F S S 10……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 9……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 8……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 7……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 6……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 5……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 4……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 3……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 2……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o 1……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o______________________0……..o…..o….o…….o…..o…..o…..o……….o…..o…..o…..o……o….o…….o……….o…..o…..o…..o……o…..o……o………..o….o……o……o…..o…..o…..o.Sign or Symptom ................
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