1. State you reside in. Pennsylvania
2. Inner City? Suburb? Country? Suburb
3. Do you live on a lake, by the ocean or pond? Theres a pond a few miles away
4. Do you have city or well water? City
5. Do you live in a heavily treed area?Some what
6. Age at onset 37
7. Number of years affected 2 months, but started feeling tickling at night maybe a year or more ago.
8. Any other family members affected?No not yet
9. Your occupation at onset?Customer Service
10. Do you own pets? Cat? Dog? Other?No
11. Have/had you traveled to California, Florida or Texas? Europe? Other? Florida, Gulf side
12. Do you/have you garden, hike, camp or spend allot of time outdoors? Only to do yard work. Occaisional trip outdoors with family.
13. List your activities and hobbies.Karate, Working Out
14. Have you used a public whirlpool or pool? Public Pool
15. Please provide your medical history (i.e.: do you or have you had any other diseases? Cancer, Lyme, Thyroid, AIDS, other?).No other diseases that I know of.
16. Do you smoke?No. Quit 8 years ago.
17. Any medications you have taken or are taking? Ambien
18. Do you drink more than 8 cups of coffee a day?Used to. Only drink a max of 1 cup a day since the on set of symptoms.
19. As far as lesions, have you had more than 10 at a given time?No
20. What part of your body did the lesions start?
21. Is there any area that they are most prevalent? If so, where? Face, Nose, ears, groin, waist and ankles.
22. Is one side of your body/face more affected than the other (i.e.: left vs. right)? Maybe a little more on my left.
23. Please list your current symptoms (brain fog? vision disturbances? fatigue? nausea? weight loss/gain etc?) Itching/ tickling on face in nose and ears. Groin area and waist also affected. Floaters in eyes. And make other people itch around me. Have lost about 15 Lbs, but I attribute that to my change in diet. (alkaline). Bouts with depression.
24. What did other doctors diagnose you with (i.e.: folleculitis? Scabies? DOP - delusional parasitosis)?Have only seen my GP. Did not receive a diagnosis other then given a script for lexapro. He was hinting that I might need to seek Psychological help.  |