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Subj: # 1 Survey 8-2000-(Please fill out if you haven't done so yet)

Date: 9/8/00 7:06:09 AM Pacific Daylight Time

From: Robbin40@...

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JRA-listegroups

This is a survey for this group

to see if jre any comparison

if so we can check into it deeper

Where the name is put the Email address

We dont want the REAL name

Please take it you would be amazed

at what this could do :-)

To take it you Copy and Paste

And send back

We can compare

Robbin

Name: WELSMOYEDS@...

City & State:Perkasie. PA

Age: 9

Illness: JRA_Pauci

When Did It Start: diagnosed age 4-started about 2.5 - 3 years old

Were There Any Symptoms Prior To Onset: Fevers-rashes

Medication On Now: None-Allergy meds

What side effects does the child have on medication: She had none- except

bleeding from NASD's

What color hair does child have: Blonde

What color eyes: Brown

Child Up To Date On Immunizations: Yes

Has the child had any childhood diseases: Chicken pox, hand, foot mouth

(Which)

Is your child allergic to any immunization shot: No

Is your child allergic to anything: Dogs, dustmites and penicillin

Has child been exposed to anything or has had:

Flu: NO-gets flu shots

Chicken Pox: yes

Menigitis: no

Add any to this:

Child full term or premature: Full term

Weight of child at birth:6.6 pd.

Height of child at birth:19.6 inches

Any complications during birth: MAny=fetal distress- emergency C-section

What was the stay of the child at the hospital at birth: 5 days

What hospital was child born: North Penn Hospital- Lansdale PA

What percentile is the child in height and weight: 75 hieght-50- weight

What age did the child crawl:

What age did the child walk: 1 year

What age did the child start talking:

Did you drink during pregnacy:No

Did you smoke during pregnancy: No

Did you take anything to get pregnant: I don't think so-Tylenol??

Did you use birth control: NO really Only a few years in my teens

(if so what kind)BC. Pills months

Was this a happy pregnancy: ecstatic-I was an infertility patient

Which line is this child first born 2 3 4th Last: first

Does the child have any more health problems other than JRA?

( if so please list) Scolliosis, Iritis, Alergies. Hematusria.

vonWillebrands. recurent strep infections

How is the child doing now: Good

walking: good_great-except occasional joint pain

Talking: Great

Motor skills:Great

Hand eye cooranation: Great

Family History

Does Grandfather, Grandmother, Father, Mother, Brother, Sister, Aunts, Uncles

or Cousins have or had any or the following ( put the person who has it next

to it)

Arthritis: mother, great grandmother

Asthma: sister, mother

JRA:

Diabetes:

Gout:

TB:

Shingles:

Stomach Problems:

ADHD: step brother

Osteroarthritis: grandmother

Eye Problems: Mother, grandmother

Metabolic Problems: Mother, great aunts(s)

Sickle Cell:

Thrombosis:

Heart Trouble:mother

Emphysema: Great-grandfather

Lung Problems

Kidney Trouble:

Add any if it aint listed: Lupus-aunt

Has the child had any broken bones:NO

Has the child had any sprains: Always

Has the child had any hard bruises: yes

Was the child breast fed: yes

Was the child bottle fed: yes

If bottle fed what was the formula: Soy based and nutramagin

What age did the child start eating baby food: 6 months

What kind of food did they eat: everything that the pediatrician said

Has the child had ear infections:many

How often: at least 4 and year-as she gets older the decrease. They where

constant in infancy

Has the child had urinary tract infections: NO

How many:

Has the child had the croup: Yes

Has the child had any other infections: Pneumonia, eye

if so what was the antibiotic ALL of them at some point

Can you list all medications the child took before onset of symptoms to

JRA:ventalin,

All antibiotics, pediacare, tylenol

(if you use a pharmacy they may keep a list)

How often was the child seen in a E R before onset of JRA: Not at all

What was diagnosis: Paucitarticular

How often was the child seen in the doctors office before onset of JRA: 50

times

Was or is the child at any day care centers: Yes

Is the child's environment Big City, Small Town, Rural, or Country: Rural

(suburb)

Does the child live near any Factories, Plants, Airports: No

If so how close:

Does the child drink City water, Well Water or Bottled water: Well

(or has in the past)

Does the child eat any packaged meats: Wampler Longacre

(frozen at the store already if so which brand)

Does the child eat canned veggies: No

if so what brands)

Does the child eat more fried foods: NO

Does the child eat more boiled or broiled foods: Yes

What other foods does the child eat: We don't eat a lot of processed foods

(What brand)

Does the child live in Air Condition: NO

Does the Child have Carpet or Hard wood flooring: Hard Wood

Electric or Gas stove: Gas

Does the child eat foods Microwave: Sometimes

Now This Is For ALL

What cleaning products do you use in the house: Bleach

's oils soap, pledge, favor, Lysol, Windex. scoots wood oil, vinegar

Have you cleaned your carpets or do you have a company do it: Only have

carpets on starer

Has the child been exposed to LEAD or paints with lead in it: NO

Has the child been Exposed to Abestos: NO

Does the child take or has taken vitamins: yes-varies

(If so what brand)

How often does the child eat junk foods: OCCASIONALLY

( Sweets, Potato Chips, ETC...)

What do you wash the clothes in: varies

(Brand)

What kinds of chemicals are around the house:

When you took the child to the doctor for this problem what was the doctors

reaction: It was urgent bring her to the hospital and they would meet us there

Was the child promptly examined: I called my DR, to move up her well check,

They called me back and directed us to the local hospital where they did

x-rays and labs.

What did the Doctor say it was the first time: A chronic rheumatoid disorder

What were the first blood tests given to check: Ana. Ra aso CBC, DIFF SMA,

SEDRATE

What is the chills tests now: sed rate cbc/diff

What was the chills tests at onset: same as first blood tests ordered

You can give the tests done and the number here onset and now:

How long are the flare ups: years-

Does weather play a role with flare ups: yes

How long are the remissions: been 3 years, until her eyes flared

Do you use self remedys:No

Has your child used or using a wheelchair: NO

Has your child used braces or using them now: NO

What other assistants does your child use: NO

What is the pain rate for your child most days:1

( 1 - 10 10 being worse)

How is your child in the mornings with stiffenss:good now- terrible during

the flare

Is there a time of day that's worse for your child: it was all day during

flares

Does it seem like your child gets sicker more than other kids: YES

How long did it take to get a diagnosis: One week to be confirmed, but a year

before we noticed the joint swelling, She was bed wetting and had blood in

her urine-She could not get out if the bet to go to the bathroom in the

morning

Does the Doctor seem compassionate with your concerns: My Drs. are wonderful

Does your child see a physical therapist: Used too

(if so how long seeing the P T)

Does your child see an Occupational Therapist: NO

(if so how long seeing O T)

Do you feel you are getting the best treatment for your child: Absolutely

How far do you have to travel for visits to the Rhuemy Doctor:1 -2.5 hours

How far do you travel to see the P T or O T: 45- 1 hr when we went

How often are each trip:

Do you get questioned from school personnel due to school absents: NO

Do you have a good school staff that understand: NO

Do you have a school nurse at your child's school: Yes

Do you feel the school is helping you and your child: NO

Does your child ride a school bus or do you take the child to school: yes

How often is the child out of school for Doctor visits:average 8-10x per year

How often is the child out of school due to illness: 5 X per year

(Explain cold Or JAR ET... ) Cold- Strep, Her Jr. has been quit so we really

do not miss school from it

How often is child out of school total in a school year:15 X

Does your child participate in P E: Yes

If i have forgot anything that you want to add please add it here

feel free to: I knew something was wrong when my daughter started bed

wetting, But I never dreamed that it was from JRA. Hide sight is 20/20. We

took her to CHOP inPhila, at the diagnostic center to see why she was bed

wetting and had blood in her urine- I guess they never checked her joints.

For links to websites with JRA info visit:

http://www.geocities.com/Heartland/Village/8414/Links.html

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Subject: # 1 Survey 8-2000-(Please fill out if you havent done so yet)

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