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Here is some of the information I put btogether for making data

> > base. I am

> > > not a data base person. Need more input and some one to set up

> > data base.

> > > Need some one that doesn't have brain fog. Lab questions. Is it

> > easy for the

> > > lab to draw your blood? Do they have you make a fist to draw

> > blood? Slap you

> > > where they are trying to get the blood from. Draw blood with the

> > tourniquet

> > > on. have to stick you more then once? Poke around to try to hit

> > the vein.

> > >

> > > >

> > >

> > > >

> > >

> > > Question on fatigue. How far can you walk? How

> > >

> > > > > > > > > fast can you walk

> > >

> > > > > > > > > > > > > > > > for how long? How much weight can you

> > carry and

> > > how

> > >

> > > > > > > > > far? Does a gallon

> > >

> > > > > > > > > > > > > > > > > > of milk sometimes feel heavy.

> > >

> > > > > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > I think I will send the questions and the others

> > can

> > > provide

> > >

> > > > > > > > > the choices that they think we should have. I will

> > review. For

> > > example

> > >

> > > > > > > > > > > > Now we will ask some questions about your

> > kidneys. click

> > > on

> > >

> > > > > > > > > the ? if you want to know why we are asking this.

> > >

> > > > > > > > > > > > Questions about peeing at night (nocturia).

> > >

> > > > > > > > > > > > Were you a bed wetter as a child? Y/N

> > >

> > > > > > > > > > > > At what age did it stop? XX years

> > >

> > > > > > > > > > > > What did your Drs think was causing the problem?

> > bed

> > > wetter/

> > >

> > > > > > > > > bladder infections/other descirbe free text.

> > >

> > > > > > > > > > > > Do you get up at night to pee before it is time

> > to get up?

> > > Y/N

> > >

> > > > > > > > > > > > If yes how many times on the average? XX or XX

> > to XX Do

> > > you

> > >

> > > > > > > > > pass more water at night than during the day? Yes/No/

> > Don/t know

> > >

> > > > > > > > > > > > Have you ever had a saline infusion or salt

> > infussion

> > > test? Y/

> > >

> > > > > > > > > N/?

> > >

> > > > > > > > > > > > How many times did you pee during the 4 hours? I

> > did not

> > > have

> > >

> > > > > > > > > to pee till the end of the infusion or enter number of

> > times.

> > >

> > > > > > > > > > > > Would you say you passed a lot? How many cups/

> > ccs/pints do

> > > you

> > >

> > > > > > > > > think you passed?

> > >

> > > > > > > > > > > > Did they actually measure the urine? Y/N/? How

> > much was

> > > it?

> > >

> > > > > > > > > XXX cups/quarts/ml/liters.

> > >

> > > > > > > > > > > > If you ever have a saltine test be sure to ask

> > them to

> > > measure

> > >

> > > > > > > > > how much you pass during and at the end.

> > >

> > > > > > > > > > > > The volume of urine you pass is a Grim Quickie

> > test of PA

> > > yeas

> > >

> > > > > > > > > or no. Pass more than 1 L and prob have it, 2 L and you

> > > certainly

> > >

> > > > > > > > > have it.

> > >

> > > > > > > > > > > > Have you ever had blood in your urine that you

> > could see?

> > > that

> > >

> > > > > > > > > a Dr told you about?

> > >

> > > > > > > > > > > > Have you ever been told you had protein in your

> > urine? Ask

> > >

> > >

> > > > > > > > > your Dr how much and record here.

> > >

> > > > > > > > > > > > Have you ever fainted when peeing?

> > >

> > > > > > > > > > > > Have you ever had an episode of severe

> > hypertension after

> > >

> > > > > > > > > peeing?

> > >

> > > > > > > > > > > > Have you ever been injured in the kidnys in a

> > work, auto

> > > or

> > >

> > > > > > > > > sporting accident? Did you pass blood after this for a

> > time?

> > >

> > > > > > > > > > > > Have you ever been told one kidney was smaller

> > than the

> > > other?

> > >

> > > > > > > > > > > > Have you ever been told you had cysts on your

> > kidney?

> > >

> > > > > > > > > > > > Have you ever been told you had a tumor on your

> > kidney?

> > > Did

> > >

> > > > > > > > > they operate? What did they call it? Did they take out

> > the

> > > adrenal

> > >

> > > > > > > > > at the same time.

> > >

> > > > > > > > > > > > Have you ever had a ultrasound test of your

> > belly? Find

> > > the

> > >

> > > > > > > > > report and record the size of the right and left

> > kidney R length

> > > R

> > >

> > > > > > > > > width, Left lenght, Right Width. Other abnormalities.

> > >

> > > > > > > > > > > > What was the size of your aorta if done? Was

> > there an

> > > aortic

> > >

> > > > > > > > > aneurysm? How big XXX by XXX. Have you ever had a CT

> > of your

> > > belly?

> > >

> > > > > > > > > repeat questions about kidney size

> > >

> > > > > > > > > > > > What did the adrenals show?

> > >

> > > > > > > > > > > > Was there any calcium seen in the blood vessels?

> > >

> > > > > > > > > > > > Did the liver have cysts in it?

> > >

> > > > > > > > > > > > Was your gallbladder OK? Y/stones/sludge/other

> > text.

> > >

> > > > > > > > > > > > Men: Have you ever been Dxed with a prostate

> > problem? Y/N

> > > what

> > >

> > > > > > > > > was the DX: BPH, prostatis, cancer, other text

> > >

> > > > > > > > > > > > PSA level? Have you ever had a kidney stone? Y/

> > N. What

> > > type

> > >

> > > > > > > > > was it? Calcium, uric acid.don't know.

> > >

> > > > > > > > > > > > Same for bladder stone?

> > >

> > > > > > > > > > > > Erectile dysfunction questions. to be developed.

> > >

> > > > > > > > > > > > Any other kidney or bladder problems? text.

> > >

> > > > > > > > > > > > GYN questions.

> > >

> > > > > > > > > > > > At what age did you begin menses

> > >

> > > > > > > > > > > > How many pregnancis have you had?

> > >

> > > > > > > > > > > > What happened to your BP during prenancy? I had

> > HBP before

> > >

> > >

> > > > > > > > > Preg, Always normal, went up early in pregnancy, went

> > up More

> > > later

> > >

> > > > > > > > > but you get the idea.

> > >

> > > > > > > > > > > > CEG Clarence E. Grim, BS, MS, MD

> > >

> > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > > BEGIN DATA

> > >

> > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > > Date: 100309

> > >

> > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > > To the member completing the form:

> > >

> > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > > The goal of collecting this information is

> > to get as

> > >

> > >

> > > > > > > > > much detailed

> > >

> > > > > > > > > > > > > > > medically relevant information as we can

> > about your

> > >

> > > > > > > > > history of high

> > >

> > > > > > > > > > > > > > > blood pressure. Only then will be best

> > equipped to

> > >

> > > > > > > > > assess the best

> > >

> > > > > > > > > > > > > > > way(s) to control your BP

> > >

> > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > > This history will give us possible clues

> > to the

> > > cause(s)

> > >

> > > > > > > > > of your

> > >

> > > > > > > > > > > > > > high

> > >

> > > > > > > > > > > > > > > blood pressure also called hypertension

> > (HTN). It

> > > will

> > >

> > > > > > > > > alert us to

> > >

> > > > > > > > > > > > > > the

> > >

> > > > > > > > > > > > > > > need for further testing to elucidate the

> > cause(s)

> > > of

> > >

> > > > > > > > > your HTN.

> > >

> > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > >Maybe should ask if they know how much

> > sodium the

> > > eat.

> > >

> > > > > > > > > > > >

> > >

> > > > > > > > > > > > > > > SALT: You might be one of the many who can

> > lower

> > > their

> > >

> > > > > > > > > BP to safer,

> > >

> > > > > > > > > > > > > > > healthier levels by simply changing how

> > you eat-

> > >

> > > > > > > > > especially by

> > >

> > > > > > > > > > > > > > lowering

> > >

> > > > > > > > > > > > > > > the amount of salt you consume. If

> > lowering your

> > > salt intake lowers

> > >

> > > your BP you are called salt sensitive (SS). The beauty

> > >

> > > of being SS

> > >

> > > is

> > >

> > > that you can lower your BP within 2 weeks by lowering your salt

> > >

> > > (NaCl)

> > >

> > > intake.

> > >

> > > DASH: You might be one who can lower your BP to

> > >

> > > healthier levels by

> > >

> > > using the mulipronged, best proven, eating plan called

> > >

> > > the Dietary

> > >

> > > Approaches to Stopping Hypertension (DASH) diet. The

> > >

> > > beauty of being

> > >

> > > DASH sensitive (DS) is that you can reduce you blood

> > >

> > > pressure to

> > >

> > > normal in 15 days by following the DASH eating plan.

> > >

> > > Have you been over weight most of your life. How much

> > >

> > > weight gain in past 5

> > >

> > > years. Do you retain fulid.

> > >

> > > WEIGHT: You might be one of the many who can lower their BP to

> > >

> > > healthier levels by losing weight. We call these folks

> > >

> > > weight

> > >

> > > sensitive (WS). Most of this effect will be seen with

> > >

> > > the loss of

> > >

> > > only

> > >

> > > 10 pounds.

> > >

> > > ALCOHOL: You might be one of those who can lower their

> > >

> > > BP by

> > >

> > > deceasing

> > >

> > > your alcohol consumption. We call these folks alcohol sensitive

> > >

> > > (AS).

> > >

> > > STRESS: You might be one who can lower your BP by

> > >

> > > reducing your

> > >

> > > stress. We call these folks stress sensitive (STS).

> > >

> > > Any reason you feel you shouldn't exercise. Do you get

> > >

> > > short of breath,

> > >

> > > Dizzy, raceing heart.

> > >

> > > EXERCISE: You might be one who can lower your BP by

> > >

> > > increasing your

> > >

> > > exercise. We call these folks exercise sensitive (ETS).

> > >

> > > MORE than ONE of these. In some more than one of the

> > >

> > > items above may

> > >

> > > help your BP. You are unique in the world. Only you and

> > >

> > > your health

> > >

> > > care team can find out which of one(s) of these will get

> > >

> > > your BP to

> > >

> > > goal. When these methods fail they you will and your

> > >

> > > health care

> > >

> > > team

> > >

> > > need to discuss which medication(s) should be used to get you to

> > >

> > > goal. Some will require medications that attack the specific

> > >

> > > problem(s)

> > >

> > > that

> > >

> > > are causing

> > >

> > > You can download and print out a copy of this form to

> > >

> > > take to your

> > >

> > > health care team so you can get better control your BP.

> > >

> > > Please give us the year you were born: ____. We know

> > >

> > > that blood

> > >

> > > pressure goes up with age in societies that eat too much

> > >

> > > salt. The

> > >

> > > causes of high blood pressure differ in different age

> > >

> > > groups.

> > >

> > > Different medications work better in the young than in

> > >

> > > the old.

> > >

> > > Gender ___. Women tend to have lower BP than men till

> > >

> > > menopause.

> > >

> > > Ethnicity (race)_____ different ethnic groups tend to

> > >

> > > have different

> > >

> > > BP problems. For example those descended from the

> > >

> > > African Diaspora

> > >

> > > tend to be more SS and respond better to drugs called

> > >

> > > diuretics.

> > >

> > > Those of Chinese descent tend to metabolize beta

> > >

> > > blockers (BB)

> > >

> > > slower.

> > >

> > > As we learn more about human genetics we will be better

> > >

> > > able to

> > >

> > > think

> > >

> > > about what is causing your high blood pressure and what

> > >

> > > are the best

> > >

> > > life style changes/drugs we need to get your BP to goal.

> > >

> > > Where were you born: List

> > >

> > > Where were you raised: List + text

> > >

> > > How far in school did you go (years)?

> > >

> > > What is your degree in?

> > >

> > > This enables me to be sure I don't talk up or down to you.

> > >

> > > What are the last 3 jobs you had: 1, for X years 2 for X

> > >

> > > years, 3

> > >

> > > for X years

> > >

> > > This may tell me how to relate your

> > >

> > > What are your hobbies? Three choices from list

> > >

> > > Living situation: living alone (single), married live

> > >

> > > together,

> > >

> > > divorced, living with another person. How many in

> > >

> > > household now: XX

> > >

> > > Who cooks at your house?

> > >

> > > Do you currently follow a specific diet? No yes list

> > >

> > > types.

> > >

> > > If you cook how many do you cook for?

> > >

> > > When was the last time you bought a box of salt?

> > >

> > > How old were you when you were first noted to have HTN?

> > >

> > > Age

> > >

> > > How was your HTN picked up?

> > >

> > > I was in emergency room for XXX

> > >

> > > At a routine check up

> > >

> > > I was pregnant

> > >

> > > I went to the Dr for the symptom(s) listed below.

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