The End of Illness: Personal Health Inventory Questionnaire

PHOTO: The End of Illness by David B. Agus, MD
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The following Personal Health Inventory Questionnaire is adapted from The End of Illness by Dr. David B. Agus. Find out more about The End of Illness at the ABC News special section.

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This questionnaire was originally designed to help you prepare for a checkup with your doctor, giving you clues to discuss during your visit. However, while piecing this book together, I realized that the same questionnaire should be filled out before even reading the book, which will help you to know yourself better before embarking on this adventure. I also know that you want to be told what to do as soon as possible, and even though you'll find lots of "health rules" to consider throughout this book, many of which will be called out at the ends of chapters, at least the following questions will equip you with concepts to think about as you read further and incorporate my advice into your life. This questionnaire is also downloadable online at www.The End of Illness.com/questionnaire, where you'll find a version that you can respond to directly on the page to print for your records and/or take to your doctor.

Overall feeling: How do you feel? It's arguably the most important question to ask of yourself. You might feel great today, but how about yesterday? When do you have your low moments? Is there a pattern? Is it hard for you to get out of bed in the morning?

Energy levels: How would you rank your energy level on a scale of 1 to 10? How has it changed in the last year?

Schedule: How regular is your schedule of when you eat, exercise, and sleep? Is every day the same or different?

Breathing: Anything abnormal to report? Do you hear or feel rattles when you breathe? Does it hurt to breathe deeply? Do you cough when you take a deep breath? Answer these questions when you are at rest and after exercise.

Exercise tolerance: How much can you comfortably tolerate? How does this amount of physical activity compare with how you felt and how hard you moved your body last year? Does anything hurt or feel funny when you move or exercise?

Walking: Are you walking the same way you always have? Do you lean to one side and never did before? Do you hunch over more? Is it hard to walk fully upright?

Sensations: Anything unusual or out of the ordinary to report in any part of your body? For example, how is your sense of smell? Is it as strong as ever? Weak?

Skin: When you scan your skin for any strange marks, growths, or bumps while naked in front of the mirror, do you find anything? Has anything changed since the last time you examined your skin? Do your socks leave indentation marks on your ankles/legs? (If so, this could indicate that your heart isn't working properly and fluid is getting stagnant in areas, increasing your risk for a blood clot.)

Hair: Has your hair changed at all in terms of thickness, texture, growth/loss, and so on? Have you lost hair around your ankles? This could be a sign of a circulatory problem, especially noticeable in men. Conversely, do you have hair growing in odd places, such as your arms and face? This could signal hormonal changes, especially in women.

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