The End of Illness: Personal Health Inventory Questionnaire

Jan. 17, 2012— -- 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.

Nails: These dead tissues can actually tell you a lot. Have they changed in appearance or color lately? Discolored nails can signal certain conditions, from a simple infection to diabetes. If your nails have a yellowish hue to them, it's time for a diabetes check. Nails can also indicate iron levels. Look for a whitish crescent C at the base of your nails, which indicates good iron levels.

Fingers: Do your joints ache after using them? If you're a woman, is your ring finger longer than your index finger? If so, you may be twice as likely to suffer from osteoarthritis. That's according to a 2008 study in the journal Arthritis & Rheumatism, which discovered this odd connection and hypothesized that longer ring fingers are linked to higher levels of testosterone exposure in the womb. Higher prenatal levels of testosterone lower the concentration of estrogen, which is critical to bone development. If you're a man whose index finger is longer than your ring finger, your risk of prostate cancer drops by a third.

Joints: Do they hurt? More in the morning when you get up, or after a long day? What makes the aching joints better?

Appetite: Is it the same as it used to be? Stronger? Weaker? Do you have serious cravings? If so, for what?

Breasts: If you're a woman, do you see or feel any lumps, bumps, or dimples when you perform a breast exam?

Digestion: Any feelings of discomfort to report? Do you have to use any over-the-counter medications for your digestion/stomach on a regular basis (e.g., Tums, Pepto-Bismol, Tagamet, Zantac, Prevacid, laxatives, and the like)? If you have symptoms, are they better or worse after eating a meal? Do you experience an intolerance, sensitivity, or allergy to certain foods?

Headaches: Do you experience headaches regularly? Migraines? Do you know the triggers for such headaches? Do you find yourself taking over-the-counter painkillers consistently (e.g., Advil, Aleve, Tylenol, Excedrin, aspirin, and the like)?

Allergies: Do you have any? Have your allergies changed over the years? How so?

Sleep: Do you sleep well? Do you resort to sleep aids on occasion? Do you wake up feeling rested most of the time? How consistent are your bedtimes and wake times? Does your bed partner say that you snore? (Sleep apnea, which is often characterized by snoring, is incredibly common today and is a known risk factor for a heart attack. Luckily, sleep apnea can be treated pretty successfully.)

Pain: Is there any area where you feel discomfort or pain?

Passing colds and flus: Do you get sick a lot? How many fevers have you had this past year? When you get sick, does it seem to take you longer than your friends or family members to get better? Did you get a flu shot this year?

Mood: How stable is your mood? Do you have feelings of depression?

Hormonal cycle: If you're a woman, is your cycle regular? Are you in perimenopause or menopause?

Previous diagnoses: What have you previously been diagnosed with? Is there anything that you deal with chronically?

Stress level: On a scale of 1 to 10, how bad is it? Is it chronic or just once in a while? Does the stress affect your lifestyle? If your stress is work-related, do you love or hate your job? (Turns out that if you love your job despite the stress, you're much better off than if you hate your job and it causes you stress!)

Weight: Are you happy with it? Have you tried to change it? What happened when you did? Do you have a paunch that you cannot get rid of?

Medications (prescription and nonprescription): What do you take, for what conditions, and for how long have you been taking them? This includes all vitamins, supplements, additives, and occasional medications (such as a few Tylenol or Advil for a headache).

Health-care prevention: Are you up-to-date with things like routine exams/wellness checkups, vaccines, screenings (e.g., Pap smear, colonoscopy, etc.), and blood tests? Do you know what foods you're supposed to be eating given your underlying disease risk factors?

Overall satisfaction: If you had to rank how you felt about yourself in general, on a scale of 1 to 10, what would your number be? What kind of report card would you give yourself? What do you want to change in your life?