Scleroderma Journal: Guided Assessment Record Book to log Symptoms, Triggers, Medication, Mood, Pain, for Autoimmune Disease management

Triggers, Symptoms and Pain

Triggers - select from options including trauma, infection, chemicals/solvents, foods, medications, stress and more.

Symptoms - select from options including scaled/hardened skin, discolored skin, rash/itching, sores/lesions, under skin nodules, irregular heartrate, swollen/painful joint, muscle weakness, breathlessness, and more.

Pain description and location on images

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

Mood

* See sample completed sections further on

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. * See sample completed sections further on

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

Sample Completed Section

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

Issue Tracker - note that there was a wheezing episode on that train that lasted for an hour with a severity of 5. Rash and itching with a severity of 4 occurred between 2 - 4 pm.

Personal Information and Healthcare Team

Offers ability to record insurance information along with provider details.

Can also record emergency contact, allergies, alerts and medical conditions.

Daily Medications and Changes to Daily Medications

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 & Medical Appointments

To Avoid, Exercise Log, Blood Pressure Log

List foods, medications, activities, exercises to avoid.

Blood Pressure Log also provides space to track O2 level and heartrate.

Left Page

Right Page

Notes and Daily Summary