Candida Abdicans Self Screening
Name:
Instructions
Section A pertains to factors in your medical historywhich may promote the imbalanced growth of candida.
Sectiond B and C are concerned with symptoms which are commonly seen in individuals with yeast-connected illnesses
Follow the instructions provided in each section
Then move on to sections B and C
Section A: History
For each statement that applies to you, enter an 'X' in the grey box on the left of it.
Then move on to sections B and C.
Have you taken tetracyclines (Sumycin, Panmycin, Vibramycin, Minocin, etc.) or other antibiotics for acne for 1 month or longer?
Have you, at any time in your life, taken other "broad spectrum" antibiotics (Ampicillin, Amoxicillin, Ceclor, Bactrim, Septra, Keflex, etc.) for respiratory, urinary or other infections (for 2 months or longer, or in shorter course 4 or more times in a 1-year period)?
Have you taken a broad spectrum antibiotic drug, even a single course?
Have you at any time in your life, been bothered by persistent prostatitis, vaginitis or other problems affecting your reproductive organs?
Have you been pregnant 2 or more times?
Have you been pregnant 1 time?
Have you taken birth control pills for more than 2 years?
Have you taken birth control pills for 2 weeks or less?
Have you taken Prednisone, Decadron or other cortisone-type drugs for more than 2 weeks?
Have you taken Prednisone, Decadron or other cortisone-type drugs for 2 weeks or less?
Does exposure to perfumes, insecticides, fabric shop odors and other chemicals provoke moderate or severe symptoms?
Does exposure to perfumes, insecticides, fabric shop odors and other chemicals provoke mild symptoms?
Are symptoms worse on damp, muggy days or in moldy places?
Have you had severe or persistent athlete's foot, ringworm, "jock itch" or other chronic fungus infections of the skin or nails?
Do you crave sugar?
Do you crave breads?
Do you crave alcoholic beverages?
Does tobacco smoke really bother you?
Section B: Major Symptoms
for each of your symptoms enter the appropriate number in the column on the left
If the sympton is occasional or miled then score 3 points
If the symptom is frequent and/or moderately severe, score 6 points
If the sypmtom is severe and/or disabling, score 9 points
Abdominal pain
Bloating
Constipation
Cramps and/or other mentrual irregularities
Depression
Diarrhea
Endometriosis
Erratic vision
Fatigue or lethargy
Feeling "spacy" or "unreal"
Impotence
Loss of sexual desire
Muscle aches
Muscle weakness or paralysis
Numbness, burning or tingling
Pain and/or swelling in joints
Persistent vaginal burning or itching
Poor memory
Premenstrual tension (PMS)
Prostatitis
Spots in front of eyes
Troublesome vaginal discharge
Section C: Other Symptoms
for each of your symptoms enter the appropriate number in the column on the left
If the sympton is occasional or miled then score 1 points
If the symptom is frequent and/or moderately severe, score 2 points
If the sypmtom is severe and/or disabling, score 3 points
Drowsiness
Irritability or jitteriness
Uncoordination
Inability to concentrate
Frequent mood swings
Headache
Dizziness/loss of balance
Pressure above ears; feeling of head swelling or tingling
Itching
Other rashes
Heartburn
Indigestion
Belching and intestinal gas
Mucous in stools
Hemorrhoids
Dry mouth
Rash or blisters in mouth
Bad breath
Joint swelling or arthritis
Nasal congestion or post nasal drip
Nasal itching
Sore or dry throat
Cough
Pain or tightness in chest
Wheezing or shortness of breath
Urgency or urinary frequency
Burning on urination
Failing vision
Burning or tearing of eyes
Recurrent infections or fluid in ears
Ear pain or deafness
