Arachnoiditis Tracking Log: Record Pain and Location, Symptoms, Meals, Hydration, Medications, Mood, Activities for Meningitis, Chronic Pain

Triggers/Concerns and Symptoms

Triggers/Concerns - check from prelisted issues.

Symptoms - select from prelisted symptoms including formication, twitching, morning stiffness, difficulty sleeping, reduced range of motion, difficulty sitting, leg weakness, pelvic pain and more

Pain location and description - mark on the image (both front and back are available)

Pain Description

What Helped & Medications

Medications - check box to indicate 'Usual Daily Medications' and/or 'Usual Daily Supplements'. List additional medications along with whether they helped.

What Helped? - reference for future

Activities and Meals and Snacks

Exercises - check box to say whether you were able to exercise, and list them.

Activities - select from prelisted options and indicte time. Options include walking, self-care, socializing, hobbies, employment, house/yard work, childcare, commute.

Meals & Snacks - there are checkboxes available you can mark to indicate if the meal included salt, red meat, dairy, gluten, sugar or fats.

Hydration - mark how much you have had to drink

Daily Assessments, Weather, Mood

Daily Assessments - circle applicable arrow to indicate 'Increased, Same, Decreased' Pain, Stress, Energy, Mental Clarity, Activity, General Mood, Sleep Quality.

Blood Pressure, Heartrate, Oxygen level

Sleep - enter number of hours at night/during day

Mood

Sample Completed Sections

Note that stress, fatigue and sleep quality are marked as increased, pain, mental clarity are the same/consistent, while energy, activity and general mood are decreased.

Sample completed Section

Personal Information and Healthcare Contacts

Introductory page has space for personal info including allergies and medical alerts.

Enter doctor and contact info.

Enter pharmacy and contact info.

Enter insurance information.

Tests/Results & Medical Appointments

Tests, date performed, and the results.

Upcoming appointments

To Avoid & Exercise Log

Medications and Changes

Page for current medications / supplements along with reason and refill due date.

Page for CHANGES to medications and supplements with reason for the change, new dose, and date effective.

Blood Pressure Log

Right Page