Cervical Stenosis Diary: Pain and Symptom Tracker, Guided Record Book, Daily Discomfort Assessment Journal, Mood, Sleep, Activity, Medication Logbook, Chronic Autoimmune Disease Management Gifts, 6x9

Triggers/Concerns, Symptoms and Pain

Triggers/Concerns - check one of the prelisted triggers

Symptoms - check one of the pre-listed symptoms (options include swallowing, difficulty walking, balance, fatigue, lack of coordination, muscle spasms, sciatica, neck pain, bowel/bladder issues, hand/arm/foot/leg function and more)

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

What Helped?

Medications

Medications - check box to indicate 'Usual Daily Medications' and/or 'Usual Daily Supplements'.

List additional medications with reason, time, dose and whether it helped.

Daily Assessments, Mood, Statistics

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

Blood Pressure, Heartrate, Oxygen(O2), Sleep hours

Weather - rain, dry, snow, wind?

Mood

Issue Tracker, Activities, Notes, Meals & Snacks

Issue Tracker - when weakness, pain or discomfort comes sporadically during the day you can enter the symptom here along with when it happened/how long it happened, and rate the severity by circling a number.

Activities - select from prelisted options (walking, self-care, socializing, hobbies, employment, house/yard work, childcare, commute) and enter time. Check box to indicate if you were able to exercise.

Notes - insights, comments, questions, additional activities

Meals & Snacks - list and check applicable box to indicate if meal contained salt, red meat, dairy, gluten, sugar, fats

Example of Completed Sections

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

Issue Tracker - balance issue marked with a severity of 5 and lasted for 3 hours necessitating use of a cane.

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.

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.

Tests/Results and Medical Appointments

To Avoid, Exercise Log and Blood Pressure Log

Left Page

Right Page