how did lyme disease affect you? survey

8/13/2019 How Did Lyme Disease Affect You? Survey

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How Did Lyme disease Affect You?

My name is Morgan Long and I am a 22-year-old female with Chronic Lyme disease. I appreciate

your participation in this survey. Feel free to remain anonymous. I encourage you to answer as

many questions as you can and to reply in as much detail as you can. Of course, you do not have

to answer all of them. Thank you again for your contribution. After you have completed this

survey, you may post it on my tumblr page or you may e-mail it to me [email protected]

you have any questions or would like to explain things to me in further detail than you feel this

space permits, you may call me at (336) 782-4085 or e-mail me at the address above. Thank you

again.

1. What is your name?2. How old are you?3. What is your gender?4. How old were your when you suffered from the disease? How long did you suffer? Are

you still suffering?

5. In which state/area were you in when you contracted the disease?6. How many doctors did you see prior to your diagnosis? What types of doctors were

they?

7. Did you receive other diagnoses? What were they?

8. In which area of the U.S./state did you visit doctors and/or receive medical treatment?

9. What were your initial symptoms?
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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10.Did you experience a rash/Erythema Migrans?

11.What symptoms do you still experience?

12.What were/are your most debilitating symptoms?

13.How were your treated for Lyme disease?

14.Did your symptoms interfere with your daily life? Did you end up having to leave yourjob or school?

15.What procedures/testing did you undergo?

16.Were you treated with pain medication? What kind? Was this treatment effective foryou?

17.Did you, at any point, suffer from anxiety, depression, or paranoia?


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18.Did you try other forms of treatment (therapy, massage, aromatherapy, acupuncture,supplements, diet, etc.)? Did any of this work for you? Which ones?

19.Which type of doctor finally diagnosed and treated you?

20. I would like to allow this space for you to add anything else you feel is significant(personal anecdotes, testimonies, or anything I mayve left out above).

21.Please fill out the chart below.


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SYMPTOMS MILD/MODERATE/SEVERE STAGE (BEGINNING,

THROUGHOUT, LATE,

PERSISTANT)

Nausea

Ear issues

Tongue issues

Muscle fasciculations

Tremors

Bells Palsy

Extreme fatigueHeadaches

Rash (E.M.)

Numbness

Paralysis

Pain

Vision issues

Arthritis/stiffness

Fibromyalgia

Brain fog

Heart issues

If there are symptoms that you experienced that are not in the chart above, please feel

free to list and describe them below.

how did lyme disease affect you? survey

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