Chronic Pancreatitis Journal: Record Triggers, Pain and Symptoms, Meals, Activities, Mood, Sleep, and Medications as you manage the disease, your pancreas, and identify patterns

Triggers, Pain & Symptoms

Triggers/Concerns - select from prelisted options that include gallstones, rapid weight loss, fatty/fried foods, trauma, alcohol, stress and more.

Pain Description - select from prelisted options, rate pain on scale of 1-10, mark location of pain on images.

Symptoms - select from prelisted options that include jaundice, floating/fatty stools, shortness of breath, abdominal discomfort, fever, nausea, fatigue, bloating and more.

Daily Assessments

Circle applicable arrow to indicate 'Increased, Same, Decreased' for Pain, Stress, Fatigue, Energy, Activity, Mental Clarity, Activity Level, General Mood, Sleep Quality

Enter - Blood Pressure, Heartrate, Oxygen level

Sleep hours - both night and day

Mood - select from prelisted options

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

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.

Sample sections

Daily Assessments - note that pain, stress are increased, energy and mental clarity are decreased while fatigue, activity, general mood and sleep quality are the same or consistent.

Issue Tracker - note that there was an episode of vomiting after lunch with a severity of 5. There were also palpitations at 7pm with a severity of 3.

Personal Information and Healthcare Team

Introductory page has space for personal info including emergency contact, allergies, medical alerts and health conditions.

Enter name, address, phone # for physician, specialists, pharmacy as well as 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

Upcoming medical appointments - with whom? for what reason, and date

Tests, date performed, and the results.

Additional Logs

Left Page

Right Page