PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 01 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** CHIEF COMPLAINTS The patient has food allergies. Allergy to food may be mediated by a number of immune mechanisms. The most recognized by the medical com- munity is immediate or atopic. This particular form is mediated by IgE, an histamine release mechanism. These immunoglobulins are aligned on special receptors along the cell membranes of eosinophils and basophils. When an antigen comes in contact with two adjoining IgE molecules, the resulting tension on the surface membrane of the WBC causes the release of histamine. A more common but less recognized allergy which has a wider systemic effect is delayed or hypersensitivity reactions. These reactions are mediated by IgM, IgG, immune complexes, and complement fixation. The target site in the body is varied and usually occurs at a site of recent or ongoing inflammation. The symptoms for this type of allergy is multiple depending on the organ or organ system it involves. An important cue to this malady is slow healing or a chronic pain or dysfunction with no other physical or functional account for the symptoms. CLINICAL CONSIDERATIONS: Order serum IgE blood test. Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Patient complains of headaches. This common complaint can occur from so many different causes that its proper evaluation may be difficult. The intensity, quality, site of pain, duration and associated neuro- logical symptoms will assist in identifying the underlying cause. The onset of severe headaches in a previously well patient is more likely due to an intracranial disorder (ie. tumor, subarachnoid hemorrhage, or meningitis). Also, headaches that disturb sleep, excertional headaches, and late onset paroxysmal headaches as well as headaches accompanied by neurological signs of seizures, drowsiness, visual disturbances, limb dysfunction, or altered mental status may be due to an underlying structural lesion. Chronic headaches are commonly due to migraine, tension, depression, head injury, cervical spondylosis, dental or ocular disease, TMJ dys- function, sinusitis, or hypertension. CLINICAL CONSIDERATIONS: PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 02 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** CHIEF COMPLAINTS (cont.) Examine head and neck Order radiographic studies of the cervical spine Oral contraceptive use should be discontinued Consider ordering Cerebrovascular doppler study. Order SMAC, CBC w/diff, T7, serum ferritin, ESR and serum magnesium Conduct complete physical examination Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Has stomach and/or gall bladder problems. The symptoms of indiges- tion, nausea, or abdominal pain maybe due to a wide variety of organ pathologies. A detailed history should assist the clinician in identifying the functional problems associated with this serious but sometimes vague complaint. Question dietary habits, pain associated or relieved by eating, the onset of nausea and/or indigestion. History of medication or drug use is extremely important. Differential diagnosis should include: Gastritis, Peptic ulcer, Duodenal ulcer, Jejunal ulcer, Gastrinoma (Zollinger-Ellison syndrome) and Carcinoma of the stomach. Diseases of the gall bladder include: Cholelithiasis, Acute and Chronic Cholecystitis, Cystic Duct Syndromes, Choledocholithiasis, and Biliary Stricture. Radiographs of the abdomen may reveal calcified stones within the gall bladder. Physical examination of the abdomen should include palpation and auscultation in all quadrants. Lab work performed. CLINICAL CONSIDERATIONS: Conduct complete physical examination Order SMAC, CBC w/diff, T7, serum ferritin, ESR and serum magnesium Review historical record of past and present medications Conduct stool guaiac test for occult bleeding Has a neck or spinal disorder. A thorough history will direct the clinician to the proper examinating procedures which will benefit him in making the proper diagnosis. Onset, site of pain, history of trauma, pain relieved by rest, age, medication, will aide the doctor PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 03 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** in eliminating the vast number of differentials which must be considered for this anatomic region. Orthopaedic/neurologic tests coupled with radiographs will be extremely beneficial in the diagnosis and treatment of spinal dis- orders. Diagnosis differentials include: Osteoarthritis, compression fractures, ankylosing spondylitis, Reiters Syndrome, osteogenesis imperfecta, Pott's Disease (TB of the spine), cervicobrachial syn- dromes, low back pain syndrome, disc protrusions, and thoracic outlet syndrome, psoriatic arthritis, spondylosis, Etc. Back pain that is not responsive to treatment may be complicated by delayed food allergies. Eliminating these allergies is vital. CLINICAL CONSIDERATIONS: Allergies or hypersensitivity disorders may present as systemic or localized reactions in any organ system of the body. The reactions may be acute, subacute, delayed or immediate. Allergies in general are classified by 4 different immunological mechanisms. 1) Anaphylactic or immediate: Mediated by IgE. 2) Cytotoxic: Mediated by IgG & IgM which activates complement. 3) Immune complex: Mediated by IgG & IgM by forming Ag-Ab complexes. 4) Cell Mediated: Delayed reaction mediated by sensitized T-Cells. CLINICAL CONSIDERATIONS: Free Amino Acids Order serum IgE blood test. Order SAGE Test or IgG,A,M RAST tests for possible food allergy. GENERAL Patient rarely exercises. Educating the patient on the benefits of excercise in the prevention of health problems, the effect on current disease processes, and the psychological outlook is needed. Regular physical excercise can have a dramatic effect on a number of pathological conditions including: 1) Hypertension. 2) Heart disease. 3) Lung disease. PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 04 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** 4) Obesity. 5) Psycological disorders. It is important for the clinician to assist the patient in developing an excercise regiment personalized to address their health problems at a level constant with their physical conditioning. CLINICAL CONSIDERATIONS: Assist patient in developing aerobic excercise routine Order ECG, PFT, and phoncardiograph Order SMAC, CBC, and ESR GENERAL Drinks less than an adequate amount of water. CLINICAL CONSIDERATIONS: Opt. oz. water intake/day = 1/2 body weight X 0.8. EYES Patient is near sighted. CLINICAL CONSIDERATIONS: Chromium with GTF Mucopolysaccharides EYES Blood shot eyes is the most common symptom of ocular disease. Hyperemia can result from infection, irritation, inflammation, tumors, trauma, allergy, and an increase in intraocular pressure. CLINICAL CONSIDERATIONS: Conduct opthalmic examination Increase in tearing or watery discharge is usually the result of bacterial or viral infection. A purulent discharge results from bacterial infections, where viral infections produces a watery discharge accompanied by redness and itching. Allergic conjunctivitis is correlated with recurring symptoms during PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 05 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** a particular time of the year. The signs and symptoms are similar to those of viral infection. Lacrimal drainage obstruction may cause excess tearing. CLINICAL CONSIDERATIONS: Conduct opthalmic examination EARS AND HEARING Recurrent ear infections (chronic otitis media) is due to reoccurring acute ear infections. Signs and symptoms of any ear infection is a purulent discharge, pain, external ear itching, and foul odor. The tympanic membrane will probably be perforated or show signs of bulging with fluid being observed within the middle ear. Delayed hypersensitivities to foods may have an underlying effect in the development of this recurrent problem. These foods should be identified and eliminated from the diet. Complication to poorly controlled middle ear infection may result in mastoiditis and loss of hearing. CLINICAL CONSIDERATIONS: Possible milk allergy. Conduct otoscopic examination Order SAGE Test or IgG,A,M RAST tests for possible food allergy. MOUTH AND THROAT Aphthous stomatitis is the most common form of ulcerative stomatitis. Morphologically lesions are 1-2 cm in diameter (but can be sub- stantially larger; upto 10 cm) occurring on the gingiva or buccal mucosa. They appear as a grey oval lesion with a fibrinoid center. The cause is unknown. Differential diagnosis should include: 1) Herpetic lesions 2) Syphilis 3) Tuberculosis 4) Histoplasmosis 5) Blastomycosis 6) Vincent's Infection (trench mouth) 7) Erythema multiform PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 06 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** 8) Pemphigus 9) Lupus erythematosus 10) Lichen Planus 11) Carcinoma CLINICAL CONSIDERATIONS: Lactic Acid Yeast Acidophilus Yeast Conduct oral examination Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Consider ANA, ESR, CRP, and rheumatoid factor RESPIRATORY Sinusitis occurs as a result of a undrained collection of pus within sinus cavities. Diseases that cause swelling of the nasal mucosa are the underlying cause. They include allergic rhinitis and upper respiratory infections. Symptoms include fever, headache, pain over infected sinuses, and purulent nasal discharge. Objective findings include pain and pressure over the affected sinuses to palpation, opacity on transillumination of frontal or maxillary sinuses, and opaque areas over the paranasal sinuses on radiographic examination. NOTE: Dental infections may cause sinusitis and should not be over- looked. The role of delayed hypersensitivity immune reactions should not be discounted in the pathogenesis of chronic sinusitis. CLINICAL CONSIDERATIONS: Order serum IgE blood test. Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Order pulmonary function test. Conduct oral examination Transilluminate paranasal sinuses Consider radiographs of paranasal sinuses Inspect nasal cavity Allergic rhinitis will display similar symptoms to viral rhinitis but are usually more persistant and seasonal. If one is familiar with the plants pollinating at the time symptoms develop, desensitization PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 07 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** program can be instituted. Air filters which eliminates dust mites and mold along with pollens may be helpful. Synthetic bedding may assist in the symptomatic patient. The elimination of foods from the diet which the patient may be sensitive too is often beneficial to hay fever sufferers. CLINICAL CONSIDERATIONS: Germanium Order serum IgE blood test. Examine head and neck Institute sublingual desensitization therapy Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Order IgE RAST for weeds, grasses and pollens. Sneezing is a reflexive response initiated from centers in the upper respiratory tract. Severe or repetitive sneezing is a sign and symptom of atopic allergy most likely due to seasonal allergy. IgE allergy rast test should be ordered to assist in identifing offending agents. Installing air filters in the home may help these patients better cope within their environment. Also, synthetic bedding may be beneficial. As with all allergy sufferers, elimination of all foods from the diet which they are sensitive will be helpful in the management of these patients. CLINICAL CONSIDERATIONS: Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Order serum IgE blood test. Order IgE RAST for weeds, grasses and pollens. Examine head and neck Institute sublingual desensitization therapy A sign and symptom of delayed hypersensitivity reactions and atopic allergy is commonly associated with a constant "stuffy nose". A history of onset, seasonal occurrence, exacerbations and remissions will assist the doctor in distinguishing these two forms of allergy. Order IgE rast test to identify weeds, grasses and pollens which are in bloom for the region that may initiate the immune response. Also, PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 08 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** order blood work to identify delayed allergies to foods in the diet. Perform an in depth physical examination including the head and neck, thoracic cavity, abdomen and pelvic region. CLINICAL CONSIDERATIONS: Order serum IgE blood test. Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Order IgE RAST for weeds, grasses and pollens. Inspect nasal cavity Transilluminate paranasal sinuses Consider radiographs of paranasal sinuses Institute sublingual desensitization therapy CARDIOVASCULAR In adults hypotension is defined as a systolic pressure less than 90 mmhg. Areas of consideration are heart, adrenocortical disorders, renal, shock, hypothermia, hepatic ischemia, dehydration and medication. Ragland's postural blood pressure test may reveal signs of adreno- cortical insufficiency. Electrocardiogram will identify any ischemic related defect with cardiac circulation. A complete blood count will reveal anemic states associated with blood loss and shock. Ordering a urinalysis can identify renal disease. A multichannel blood profile will assist in diagnosing any liver pathology that may contribute to low blood pressure. Medications that may lead to low blood pressure are antidepressants, opiates, and hypertensives. An extensive system review and complete exam is needed to identify any of the underlying causes of hypotension. CLINICAL CONSIDERATIONS: Order Ragland's postural blood pressure test. Order Six hour Glucose Tolerance Test. Order CBC and serum iron for possible anemia. Order Electrocardiographic examination. Conduct complete physical examination Review historical record of past and present medications Cold lower extremity is most commonly associated with poor circulation PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 09 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** to the lower limbs. Suspect arteriosclerotic disease, arterial occlusive disease, and compartmental syndromes. Associated symptoms include pain, dependent rubor, numbness and tingling. High lipids in the blood and platelets may lead to blood clots. Smoking and poorly controlled diabetes may also predispose patients to arterial disease. A thorough vascular examination including arterial doppler and pulse volume recording is required. Blood samples investigating hyper- lipidemia and hyperglycemic states is also warrented. CLINICAL CONSIDERATIONS: Order Plethysmographic and Doppler studies. Omega 3 Marine Oil Gamma Linoleic Acid Niacin Conduct complete physical examination Order SMAC, CBC, and ESR Oral contraceptive use should be discontinued Eliminate all use of tobacco products Consider ordering hyperemic compression test GASTROINTESTINAL Diarrhea in a clinical sense is a increase in frequency or increased fluidity of bowel movements in a given individual. Pathophysiological terms, diarrhea results from the passage of stools containing excess water. Causes of diarrhea includes: 1) Infection or infectious materials: parasites, viral, bacterial, or bacterial toxins. 2) Intestinal factors: Fecal impaction, lactase deficiency, inflam- matory bowel disease, carcinoma, gastrocolic fistula, heavy metal toxicity, antibiotic therapy. 3) Choleostatic syndromes: Hepatitis, bile duct obstruction. 4) Malabsorption states: Celiac sprue, diverticula. 5) Pancreatic disease: Diabetes mellitus, pancreatic insufficiency and pancreatic tumors. 6) Neurologic disease: Tabes dorsalis, diabetic neuropathy. 7) Hyperthyroidism. 8) IgA deficiencies. 9) Malnutrition: Kwashikor, marasmus. 10) Food allergy: atopic and delayed hypersensitivity. PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 10 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** 11) Excesses: Laxatives, fiber, fruit, etc. CLINICAL CONSIDERATIONS: Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Order Urinary Indican. Possible milk allergy. Order serum IgE blood test. Order SMAC, CBC, and ESR Obtain stool sample Order thyroid panel (T7, TSH, Free T4) Obtain hair biopsy Review historical record of past and present medications NEUROMUSCULAR Neck pain can originate from articular and extra-articular sites. Pain can be localized to the area or radiate along any affected nerve roots. Proper diagnosis is usually difficult due to the complexity of the region and no one syndrome has specific signs and symptoms but rather a myriad of overlapping symptoms. In neck pain with poor re- sponse to care, the examiner should investigate delayed food allergy. Considerations include: 1) Acute or chronic musculotendinous strain: Pain, decreased mobility, paraspinal muscle spasms, trigger points, etc. A history of trauma, either mechanical or overuse is essential to diagnose. 2) Herniated nucleus pulposus: Usually at the C6-C7 level, hallmark symptoms include radiation of pain along the nerve root down the peripheral nerve and exacerbated with an increase in intrathecal pressure, decrease in the bicep and tricep reflex, tactile sensation, and muscle weakness of the hand and forearm. 3) Arthritic disorders: Degenerative arthritis, rheumatoid arthritis, 4) Compression fracture. 5) Other considerations include neoplastic disease, osteoporosis, osteomyelitis, etc. CLINICAL CONSIDERATIONS: Examine cervical spine Order radiographic studies of the cervical spine Thoracic spine discomfort can be attributed to articular or extra- PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 11 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** articular causes: Articular causes include: 1) Osteoporosis. 2) Degenerative arthritis. 3) Compression fractures. 4) Ankylosing spondylitis: Occurs usually in the lumbar spine and progressively moves headword. High ESR, HLA-B27 usually positive with negative rheumatoid factor. Extra-Articular causes: 1) Pancreatic disease: Cancer of the head, acute pancreatitis, etc. 2) Gall bladder disease: Cholecystitis, choledocholithiasis. 3) Lung disease: Cancer, infection, etc. Historical investigation of signs and symptoms associated with the above listed disease will assist in directing the proper diagnostic course. Radiographs, blood tests, and spirometric analysis will help differentiate the many causes of thoracicalgia. CLINICAL CONSIDERATIONS: Order radiographic studies on the thoracic spine Order SMAC, CBC, and ESR Consider ordering sputum cytology study Order pulmonary function test. Low back pain can be associated with a myriad of causes and becuase it is so common and the potential economic affect so devastating, the examiner should institute a comprehensive and detailed history. In almost all cases, X-rays should be ordered. Negative radiological differentials should include: Musculotendinous sprain/strain, hern- iated disc, early ankylosing spondylitis, abdominal aneurysm, and visceral disorders (ie. pancreatic, prostate, renal or gyno disease). Positive X-ray considerations should include: Osteoarthritis, spondy- losis, spondylolysis, spondylolisthesis, facet tropism, compression fractures, scoliosis, spinal curvatures, and osteoporosis. lumbalgia with or without radiographic signs with continued discomfort or in patients with failed surgical syndrome, the examiner should suspect delayed allergies to food and possible vitamin/mineral def- eciencies as an underlying cause. CLINICAL CONSIDERATIONS: Ascorbates Zinc Manganese PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 12 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** NEUROMUSCULAR (cont.) Bromelain Order radiographic studies on the lumbar spine Order complete urinalysis. Do a digital examination of the prostate in the male. Order HLA-B27 Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Obtain hair biopsy The history is the most useful tool available to the examiner in making the proper diagnosis. Important points to be covered include: 1) Location of the headache: Unilateral or bilateral; if unilateral does the headache migrate from side to side, frontal to occipital, or radiate to the neck or eyes. 2) Character of headache: Throbbing or pounding, bandlike, expanding, or exacerbated by light,noise or position. 3) Profile: Abruptness of onset, rate of spread, duration; if recur- rent, age of onset, frequency, time of day (morning, afternoon), or awakens from sleep. 4) Associated symptoms: Aura, numbness, visual disturbances, aphasia, nausea and vomiting, muscle tension, fever, stiff neck, pain on chewing, diplopia, progressive neurologic deficit, memory loss, poor coordination. 5) Precipitating factors: Food or drink (caffeine, alcohol, MSG), menstruation, tension, stress, oversleeping, excercise, sex, trauma. 6) Medical history: Drugs, diagnostic tests, hospitalizations. 7) Women: Birth control pills, estrogen therapy, pregnancy, menses. 8) Personality, life stresses, and response to headache. CLINICAL CONSIDERATIONS: Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Order radiographic studies of the cervical spine Examine head and neck Conduct opthalmic examination Review historical record of past and present medications Oral contraceptive use should be discontinued PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 13 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** NEUROMUSCULAR (cont.) Conduct otoscopic examination The habit of nail biting is almost always a emotional disorder. The examiner should look for other associated symptoms of emotional stress. Stress management techniques may need to be addressed. CLINICAL CONSIDERATIONS: Assist patient in developing aerobic excercise routine Counsel patient on reducing stress. Order Hoffer-Osmond Psychological screen. SKIN Acne vulgaris is the most common of all skin conditions. On exam, pimples are noted over the face, back, and shoulders. The onset of disease is marked by puberty. Complications can arise from cyst formation resulting in slow resolution and scarring. Differentially these pubertal lesions needs to be distinguished from acneiform lesions caused by bromides, iodides, steroids, and contact with chlorinated napthalenes and diphenyls. Patient should be advised to avoid oils and greases as well as greasy ointments, creams, and other cosmetics. The elimination of all reactive foods is of vital importance to help prevent cyst formation and scarring. CLINICAL CONSIDERATIONS: Order SAGE Test or IgG,A,M RAST tests for possible food allergy. Beta Carotene Zinc Acidophilus Yeast ENDOCRINE Urinary frequency is common in inflammatory disorders of the urinary tract. Severe infection produces a constant urge to urinate. Also, increase frequency or increase urge to urinate may be due to bladder PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 14 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** disease or a condition where the bladder cannot be emptied completely. Differential diagnosis consist of: 1) Urinary tract infections. 2) Cystitis. 3) Urethral obstruction: Scarring, stones, etc. 4) Prostate disease: Benign prostatic hypertrophy, prostatitis, cancer. Diagnostic considerations should include SMAC, CBC w/diff, ESR, and urinalysis. In the male patient, close investigation of the prostate is needed. This includes digital examination of the prostate and possibly tumor markers (prostate specific antigen, prostatic acid phosphatase). Becuase of the vast causes of water loss, a person complaining of excessive thirst requires a thorough examination into these many causes. CLINICAL CONSIDERATIONS: Order complete urinalysis. Diuretic methylene blue formula Conduct complete physical examination Order SMAC, CBC w/diff, T7, serum ferritin, ESR and serum magnesium The complaint of chronic fatigue is a very serious symptom of systemic disease. The causes are vast and include reinfectious states involving CMG and EBV viruses, adrenal failure, heart failure, fibrositis syndrome, myasthenia gravis, myelodysplastic syndromes, as well as lung disorders, collagen vascular disease, and thyroid disease An in depth laboratory workup is warrented including SMAC, CBC w/diff, EBV and CMG panels, T7, ESR, CRP, serum ferritin, ANA, RH factor, ECG, and PFT. A complete physical should be performed. CLINICAL CONSIDERATIONS: Magnesium aspartate Potassium aspartate L-Glutamine Coenzyme Q Order SMAC, CBC w/diff, T7, serum ferritin, ESR and serum magnesium Order Epstein-Barr panel Consider ANA, ESR, CRP, and rheumatoid factor PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 15 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** ENDOCRINE (cont.) Order ECG, PFT, and phoncardiograph Order Ragland's postural blood pressure test. Consider ordering ACTH challenge Nervousness is commonly associated with emotional disorders or hyperthyroidism. In the latter, associated complaints of heat intolerance, weight loss, palpitations, and fatigue should be identified. Common causes of hyperthyroidism is Grave's disease and toxic multinodular goiter. Physical attention should be placed on examination of the thyroid including palpation, T7, and free T4. CLINICAL CONSIDERATIONS: Order Hoffer-Osmond Psychological screen. Order thyroid panel (T7, TSH, Free T4) BEHAVORIAL Patient has insomnia. Transient psychophysiological insomnia occurs in the setting of situational stress, environmental disturbances, acute medical illness, or simple "jet lag". The diagnosis is made by the conjunction of insomnia and stress. Insomnia occurs commonly during the use or withdrawal from many phar- macological agents. These include stimulants, diet pills, and corti- costeroids. Also, insomnia may result from chronic use of sedatives or hypnotics. Insomnia is also related to shift work, chronic medical disorders, or no definable pathology. CLINICAL CONSIDERATIONS: Inositol Valerian Root herbal Hypothalamus Glandular Ascorbates Bi-calcium formula matched to patient's urine pH. Order Hoffer-Osmond Psychological screen. Difficulty in staying asleep is a form of insomnia. It may be related to stress or other physiological manifestations (ie. sleep apnea). PATIENT DIAGNOSTIC QUESTIONNAIRE HISTORY Copyright 1987, BALANCE, Inc., Dr. R. M. Cessna All Rights Reserved BALANCE Software, Inc. REPORT 6056 N. Oracle Road Tucson, Arizona 85704-5310 Date: 10/31/00 Page: 16 Patient: John Doe Sex: Male Age: 29 *********************************************************************** * THIS ANALYSIS IS NOT INTENDED TO DIAGNOSE OR TREAT ANY DISEASE * * OR CONDITION. IT IS IMPERATIVE THE PHYSICIAN SUPPORT THESE * * FINDINGS WITH ADDITIONAL LABORATORY DATA AND/OR CLINICAL PROCEDURES * *********************************************************************** CLINICAL CONSIDERATIONS: Inositol Valerian Root herbal Hypothalamus Glandular Ascorbates Bi-calcium formula matched to patient's urine pH. Order Hoffer-Osmond Psychological screen.