Candida Questionnaire

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Candida Questionnaire The total score will help you and your physician decide if your health problems are yeast connected. Scores in women will run higher, as seven items in the questionnaire apply exclusively to women, while only two apply exclusively to men. SECTION A: HISTORY For each of your symptoms, circle the number in the point score column. Add total score and record it at the end of this section. 1 Have you ever taken a broad spectrum antibiotic drug (even one course)? 6 2 Have you taken tetracyclines or other antibiotics for acne for 1 month (or longer)? 25 3 Have you taken other broad spectrum antibiotics (for 2 months or longer, or in shorter courses 4 or more times in a 1 year period)? 4 Have you, at a your life, been bothered by persistent prostatitis, vaginitis, or other problems affecting your reproductive organs? 20 25 5 Have you been pregnant 2 or more times? 5 6 Have you been pregnant 1 time? 3 7 Have you taken birth control pills for 6 months to 2 years? 6 8 Have you taken birth control pills for more than 2 years? 15 9 Have you taken prednisone or cortisone containing medication for more than 2 years 15 10 Have you taken predisone or cortisone containing medication for more than 6 months? 6 11 Have you taken prednisone or other cortisone type drugs for more than 2 weeks? 15 12 Have you taken prednisone or other cortisone type drugs for less than 2 weeks? 6 13 Does exposure to perfumes, insecticides, and other chemicals provoke mild symptoms 5 13a moderate to severe symptoms? 20 14 Are your symptoms worse on damp/muggy days or in mouldy places? 20 15 Have you had athlete's foot, ringworm, or other chronic fungal infections of the skin or nails? Y N 15a Have the infections been severe to persistent? 20 16 Are your symptoms worse on damp/muggy days or in mouldy places? 20

16 a Mild to moderate? 10 17 Do you crave sugar? 10 18 Do you crave breads? 10 19 Do you crave alcoholic beverages? 10 20 Does tobacco smoke really bother you? 10 TOTAL SCORE SECTION A = SECTION B: MAJOR S For each of your symptoms, enter the appropriate number in the point score column: if a symptom is occasional or mild 3 points if a symptom is frequent and/or moderately severe 6 points if a symptom is severe and/or disabling 9 points 1 Fatigue or lethargy 2 Feeling of being drained 3 Poor memory 4 Feeling spacey or unreal 5 Depression 6 Numbness burning or tingling 7 Muscle aches 8 Muscle weakness or paralysis 9 Pain and/or swelling in joints 10 Abdominal pain 11 Constipation 12 Diarrhea 13 Bloating 14 Troublesome vaginal discharge (quantity, frequency, odor etc)

15 Persistent vaginal itching or burning 16 (Male) Prostatitis 17 Impotence 18 Loss of sexual drive 19 Endometriosis 20 Cramps and/or other menstrual irregularities 21 Premenstrual tension 22 Spots in front of eyes 23 Erratic Vision (blurry for a few days or weeks then subsides) TOTAL SCORE SECTION B = SECTION C: OTHER S For each of your symptoms, enter the appropriate number in the point score column: if a symptom is occasional or mild 3 points if a symptom is frequent and/or moderately severe 6 points if a symptom is severe and/or disabling 9 points 1 Drowsiness 2 Irritability or Jitteriness 3 Lack of co ordination 4 Inability to Concentrate 5 Frequent Mood Swings 6 Headache 7 Dizziness (Loss of Balance) 8 Recurrent Ear Infections or Fluid in Ears 9 Ear Pain or Deafness 10 Pressure Above Ears/Feeling of Head

11 Pain or Tightness in Chest 12 Wheezing or Shortness of Breath 13 Dry Mouth 14 Rash or Blisters in Mouth 15 Bad Breath 16 Joint Swelling or Arthritis 17 Nasal Congestion or Discharge 18 Postnasal Drip 19 Nasal Itching 20 Sore or Dry Mouth 21 Cough 22 Urgency or Urinary Frequency 23 Burning on Urination 24 Failing Vision 25 Burning or Tearing of Eyes 26 Swelling and Tingling 27 Itching 28 Other Rashes 29 Indigestion 30 Belching and Intestinal Gas 31 Mucous in Stools 32 Hemorrhoids TOTAL SCORE SECTION C = TOTAL SCORE SECTION A = TOTAL SCORE SECTION B = Interpretation TOTAL SCORE (A + B + C) =

SCORE WOMEN MEN Yeast is less apt to be the cause of health problems. 60 or less 40 or less Yeast connected health problems are possibly present 60 and more 40 and more Yeast connected health problems are almost certainly present 140 and more 130 and more IMPORTANT please read Candida (yeast) can be persistent and lead to further gut microbial imbalance as well as parasites, leaky gut, damage to the gut wall, food sensitivities, liver overload, chronic inflammation, hormone imbalances including fertility issues. Testing Options: Vaginal yeast can be tested at the office as well as in culture in a lab. Lab Tests are for determining the exact microbial imbalance in your intestine will provide a breakdown of the pathogenic microbes and the presence of worms (in all life stages), for more pathogen specific treatments. For more information contact Dr. Chitale ND.

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