Gastroparesis Journal: Pain, Symptom and Trigger Record Book, Guided Tracker for Daily Assessments, Meals, Medications and Gastro Issue Management

Triggers, Symptoms and Pain

Triggers - select from prelisted options that include spicy foods, soda, fatty/fried foods, stress, alcohol, whole grains and more.

Symptoms - select from pre-listed symptoms that include sore throat, regurgitation, shortness of breath, difficulty swallowing, chronic cough, chest pain, nausea, fatigue, bloating and more.

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

Pain Overall - enter a number ranking, and check one of the pre-listed available.

Daily Assessments, Mood, Weather

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

Exercise, Activities, Meals & Snacks

Exercise - check box for doing Recommended Exercises. Add additional exercises/activities with time and how you felt.

Activities - select from prelisted options (walking, self-care, socializing, hobbies, employment, house/yard work, childcare, commute) and enter time.

Notes - insights, reminders, questions

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 completed sections

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

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.

Tests/Results and Medical Appointments

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

Tests, date performed, and the results.

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.

Additional logs

Blood Pressure Log

Left page

Right page