QUESTIONNAIRES
Use of Standard Questionnaires
- Use of standard questionnaires provides:
Time saving for the doctor/health provider
A broader range of information gathering to avoid missing important medical facts
Asking questions in a consistent, scientific valid manner
Mailing the questionnaire in advance and asking the patient to bring it in completed allows them time to answer all questions more accurately.
- Selecting questions which are scientifically valid. One means of doing this is using question wording that was demonstrated in scientific studies to distinguish factors the doctor/health provider needs to know.
On the Health and Environment History (which may be downloaded) items from medically published research include questions:
1, 4, 6, and 12: Johns Hopkins/Dr. Davidoff research that distinguished between groups of chemically ill persons and healthy controls.
5: Dr. Claudia Miller’s evaluation instrument which distinguished severity and body location of chemical illness effects.
“Supplemental Health History”: Robert Wood Johnson Medical College of New Jersey/Dr. Kipen which distinguished specific exposures that exacerbated/symptoms in persons with chemical illness but not healthy controls.
Another scientifically valid means is using clearly worded questions which investigate what is known about chemical illness. This helps medical care decisions. Examples include questions:
11: A change in frequency of neurologic symptoms after exposure.
14-22: A change in ability to conduct usual daily activities.
26-37: Symptoms of prophyrin disturbance (see Dr. Ziem’sEnvironmental Health Perspectives article, this website.
45-59: Environmental exposures which can cause/aggravate chemical illness.
39-43: Dietary information to evaluate nutritional factors needed for healing.
- Follow-Up Questionnaire
This can be done periodically (eg, every 6-12 months) or some items asked more often. The Follow-Up and Environment History Questionnaire on this website can be downloaded and tailored to meet the needs of the specific patient care situation. For example, question:
7 can be used with a “symptom star” on the doctor/health providers records to follow symptom severity at a glance.
5 can be used to get more detailed information on symptom type, frequency
6 follows dietary progress.
8-12 follow disability progress.
26 (and other symptom questions follow progress on the Neural Protocol.
13-24 follow progress in environmental factors.
28, 29 let patients list problems and needs.
Interpreting Questionnaire Responses
Burning/raw/irritation is common in chemical injury; itchy nose/eyes and sneezing are likely allergy. New onset or worsened allergy is common with chemical immune activation.
Respiratory, GI, neurologic, fatigue and widespread aching are common in more severe injury.
Extreme thirst is common, often with omega 3 deficiency (from free radical damage).
Autonomic neuropathy can cause cardiac rhythm changes, blood pressure changes, white/blue fingers/toes and/or flushing skin, often worse with exposure.
Symptom ‘Star’
Question 5 and 7 on Initial and Follow-up Questionnaire, respectively can be easily diagrammed into a symptom star that tells you at a glance the organ location and general severity of symptoms. This has been validated by research of Dr. Claudia Miller. A symptom ‘star’ can be used to compare progress.