Fungal Assessment

A Symptom Questionnaire

The following questionnaire is designed to aid you in measuring how much you have been exposed to fungi and their mycotoxins. Physicians may also use this questionnaire to assess their patients’ histories.

Because the degree of exposure varies from incident to incident, and because consumption of natural, antifungal nutrients can often neutralize a portion of such exposure, we are unable to provide a meaningful index to which you might map your final score. However, a high number of positive answers would suggest that your condition has been caused by fungi and their mycotoxins. If a couple of weeks on the Kaufmann Antifungal Program improves your health, vey likely a fungus does lie at the root of your problem.

Have you ever taken repeated or prolonged rounds of antibiotics? If so, how long ago, and for what conditions?
Have you taken repeated or prolonged courses of steroids or cortisone-based pills? If so, how long ago, and for what reason?
Have you been diagnosed with fibromyalgia?
Do you have, or have you ever had asthma?
Have you been diagnosed with arthritis?
Do you have diabetes? Type 1 or Type 2?
At any time in your life, have you been treated for worms or other parasites?
Have you traveled to less developed countries? When and where?
Have you ever been diagnosed with cancer? If so, were you treated with chemotherapy or radiation?
Do you have, or have you had, ringworm, fingernail or toenail fungus, or jock itch?
Have you ever been diagnosed with attention-deficit disorder?
1. If so, are you currently taking medications for your condition?
2. Name the medication(s).
If you are currently ill, were you in and around areas such as construction sites at the time you became sick?
Do you suffer from fatigue? Based on a 1-10 scale, with 10 representing the worst, how bad has your fatigue been the past few weeks?
Do you suffer from irritability, frequent memory loss, or a feeling of constantly being ‘spaced out?’
Do your muscles, bones, or joints bother you? Would you describe them as aching, weak, stiff, or swollen?
Do you get headaches?
1. How long have you suffered with headaches?
2. How many days per month do you have headaches?
3. Do you think your headaches may be hormonally driven?
4. What medication do you take for these headaches?
Do you have itching, tingling or burning skin?
Do you have hives, psoriasis, dandruff, or chronic skin rashes?
Do you have acne?
Are you on medications for the skin problems listed in questions 17, 18 and 19? Name the medication(s).
Have you experienced hair loss, itching in you inner ear, or vision problems?
Do you have high blood pressure, low blood pressure, high cholesterol or triglycerides? If so, are you on medications for these problems? How long have you taken these medications?
Do you have prolapsed mitral valve or heart symptoms, i.e., racing pulse or uncontrolled heart beat? If so, are you on medications for this condition? How long have you taken these mediations?
Have ever been diagnosed with an autoimmune disease?
Are you bothered by recurrent digestive problems, including bloating, belching, gas, constipation, diarrhea, abdominal pain, indigestion, or reflux? If so, are on medication for these problems? How long have you been taking these medications?
Do you have chronic infections for which your doctor keeps prescribing antibiotics? If so, what are these infections, and how long have they been recurring?
Does your condition worsen in response to the heat from taking a shower or a bath? Does very hot weather make it worse?
Do your symptoms worsen on damp days or in musty, moldy environments?
On days when the mold/pollen count is elevated, do you feel worse?
Do you often feel “blue” or depressed?
1. Are you presently seeing a therapist for depression?
2. Are you on medication for depression?
3. If so, how long have taken these medications?
Do you drink alcohol? If so, how often, how much, and for how long have you been doing so?
Do you smoke? If so, how often, how much, and for how many years have you been smoking?
Do you often crave sugar?
Do you tend to eat a lot of corn and peanuts?
Have you ever spent a lot of time on a farm?
Have you experienced mold-related problems in your home or office? Has your home or office ever flooded?
Are you allergic to pollens, molds, animal dander, dust, mites, perfumes, chemicals, smoke, or fabric store odors? Do you presently take allergy shots?
Are you allergic to any foods? Have you had food allergy tests run? Were these skin tests or blood tests?

For Women Only

Have you ever taken birth control pills? If so, have you ever experienced complications as a result? Describe your reaction.
Have you ever been bothered by vaginal or urinary tract problems?
Are your ovaries, thyroid gland, adrenals, and pancreas functioning as they should? Have you experienced symptoms possibly indicating hormonal disturbances, such as PMS, menstrual irregularities, loss of libido, infertility, sugar cravings, weight problems, or feeling inappropriately hot or cold? If so, are you on medications for these problems? How long have you taken these medications?

For Men Only

Have you ever felt pain in your testicles unrelated to injury?
Have you ever been bothered with prostate problems?
Are your testicles, thyroid gland, adrenals, and pancreas functioning as they should? Have you experienced symptoms possibly indicating hormonal disturbances, such as loss of libido, infertility, impotence, sugar cravings, weight problems, or feeling constantly hot or cold? If so, are you on medications for these problems? How long have you taken these medications?

Summary

A high yes/no ratio may mean the degree to which you are exposed to fungi puts you at risk for disease. If you suspect you are at risk, or that you may have already contracted a fungal infection, you should consider making some immediate changes to your lifestyle. Try the Initial Phase Diet, exercise under supervision of a healthcare professional, and get on some strong, natural antifungals for a time. Once again, please do so under the supervision of your healthcare professional. If your health improves, or if it worsens for a period of a few days or weeks before returning to normal, quite likely a fungus lay at the root of your problem. Keep a close watch on your symptoms, returning to the Initial Phase diet from time to time as necessary.

This document is copied with permission from Doug Kaufmann, August 2010

BioActive Nutrients • 1300 Roundhouse Road Spooner, WI 54801, USA • Toll Free: 800-879-6504

Fungal Assessment

A Symptom Questionnaire

For Women Only

For Men Only

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