SYMPTOMS OF LYME DISEASE

    BITE
    o  Do you remember an attached tick? (Only 50% of
       patents remember a tick bite)                      __Yes

    o  Do you remember a bite of an insect which
       resulted in infecton?                              __Yes

       Deer Fly__        Horse Fly__         Bot Fly  __
       Flea    __        Mosquito __         Other    __

    RASHES
    o  Have you had an erythema migrans (EM) rash,
       commonly called bull's-eye rash, with:

    i) red border with central clearing                   __Yes
       This rash may enlarge in a circular pattern from a
       diameter of 1 cm to a diameter of 70 cm, and appear
       4-90 days after a tick bite.  Duration of this EM rash
       averages 27 days (range is 4-100 days); however,
       ones have lasted 2 years.  Sometimes it is warm to the
       touch.

    ii) centrally darker                                 __ Yes

    iii) homogeneous, erythematous
       (uniform reddish colour throughout)               __ Yes

    o  Other skin lesions can occur:

    i. Multiple blotchy, round, annular
       skin lesions                                      __ Yes
    ii. Scaly (eczema-like) rash                         __ Yes
    iii. A rash like "hives"                             __ Yes
    iv. Malar rash - looks like
       "flushed cheeks"                                  __ Yes
    v. Bluish-red swelling or nodule on ear
       lobe of children, or on the
       nipple/areola of breast.                          __ Yes
    vi. A greyish-tan coloured, "scar-like" tissue with bluish-
       red discoloration denoting arteries/veins which can
       occur mainly on the back surface of hand and feet,
       on legs or buftocks, and progress over many months
       or years. (1-17 year duration recorded)
       (ACA rash)                                        __ Yes
    vii. An acne-like rash                               __ Yes
    viii. Measles-like rash                              __ Yes
    ix. A blistering rash                                __ Yes
    x. Any suspicious rash                               __ Yes

    o  LATE SYMPTOMS
    Any combination of these symptoms may develop after
    infection occurs.  They may arise within a few days, or
    years later.

    NOT WELL
    o  Loss of sustained energy                          __ Yes
    o  Re-occurring "flu-like" symptoms                  __ Yes
    o  Overwhelming fatigue                              __ Yes
    o  Fevers, chills, sweats                            __ Yes
    o  Intolerance to cold/heat                          __ Yes
    o  Excessive thirst, frequent urination              __ Yes
    o  Symptoms that wax and wane                        __ Yes

    MUSCULOSKELETAL
    o  Muscle ache, backache                             __ Yes
    o  Muscles pulled into uncontrollable "knots"        __ Yes
    o  Muscle spasm, twitching                           __ Yes
    o  "Heavy" feeling in legs                           __ Yes
    o  Joint ache, joint pain                            __ Yes
    o  Stiff joints, stiff creaking neck                 __ Yes
    o  Swollen joints, swollen hands or feet             __ Yes
    o  Migratory joint/muscle ache & pain                __ Yes

    GASTROINTESTINAL
    o  Vomiting, nausea, diarrhea                        __ Yes
    o  Abdominal discomfort, decrease in appetite        __ Yes
    o  Itchy anus                                        __ Yes
    o  Weight loss/gain                                  __ Yes

    SKIN
    o  Itching                                           __ Yes
    o  Formications
       (feels like an insect crawling on skin)           __ Yes
    o  Peripheral neuropathies, paresthesia              __ Yes
    o  Burning pain                                      __ Yes

    NEUROLOGICAL
    o  Headaches, head pressure                          __ Yes
    o  Lightheadedness, dizziness                        __ Yes
    o  Loss of balance (ataxia)                          __ Yes
    o  Vertigo (whirling in head)                        __ Yes
    o  Twitching inside head                             __ Yes
    o  "Heavy" head, brain "fog"
       (like it is filled with cotton batting)           __ Yes
    o  "Spaced-out" feeling                              __ Yes
    o  Tremors, seizures, "insides" shake                __ Yes
    o  Tingling sensations                               __ Yes
    o  Bell's palsy (face droops on one side)            __ Yes
    o  Sensation of "pinched nerve" with pain
       or numbness running down a limb                   __ Yes
    o  Disturbed sleep                                   __ Yes
    o  Dementia                                          __ Yes
    NEUROPSYCHIATRIC MANIFESTATIONS
    o  More moody and irritable                          __ Yes
    o  Depression, anxiety                               __ Yes
    o  Feeling less able to cope                         __ Yes
    o  Feeling I'm going "crazy"                         __ Yes

    COGNITIVE FUNCTION PROBLEMS
    o  Loss of concentration                             __ Yes
    o  Short-term memory loss                            __ Yes
    o  Inability to concentrate & comprehend             __ Yes
    o  Letter/word reversal                              __ Yes
    o  Difficulty with synthesis of new information      __ Yes
    o  Calculation difficulties                          __ Yes
    o  Disorientation, confusion, forgetfulness          __ Yes

    CARDIAC
    o  Heart palpitation                                 __ Yes
    o  Heart block, cardiac arrest                       __ Yes
    o  Rapid & irregular heartbeat                       __ Yes

    RESPIRATORY
    o  Sore throat                                       __ Yes
    o  Persistent cough, non-productve cough             __ Yes
    o  Rapid respiration                                 __ Yes

    REPRODUCTIVE
    o  Unexplained menstrual irregularity                __ Yes
    o  Vulva & vaginal soreness                          __ Yes
    o  Sore breasts, infection &/or discharge            __ Yes
    o  Testcular/pelvic pain                             __ Yes
    o  Loss of libido                                    __ Yes
    o  Newborn - birth defects                           __ Yes

    EYES
    o  Conjunctivitis                                    __ Yes
    o  Difficulty focusing                               __ Yes
    o  Blurred vision, double vision                     __ Yes
    o  Sensitivity to bright &/or fluorescent light      __ Yes
    o  "Lazy Eye"                                        __ Yes
    o  Wandering eyeball                                 __ Yes
    o  Prickly or itchy sensations, optic neuritis       __ Yes
    o  Dry eyes                                          __ Yes
    o  Difficulty reading                                __ Yes
    o  Blindness                                         __ Yes

    EARS
    o  Ear pain; ringing in ears                         __ Yes
    o  Hypersensitivity to loud noise                    __ Yes

    OTHER SYMPTOMS
    c  Pain in chest                                     __ Yes
    o  Rib soreness                                      __ Yes
    o  Swollen/sore lymph nodes                          __ Yes
    c  Bladder infection                                 __ Yes

Symptom sheet provided courtesy of:

Lyme Disease Association of Ontario
365 St. David Street South
Fergus, Ontario N1M 2L7
(519) 843-3646 Fax (519) 843-6550