Y O U R K E Y T O L I F E L O N G H E A L T H A N D V I T A L I T Y iMMunizatiOn
Did you have any of the following reactions?
Please give approximate date if you don’t have specific. “Bowel” means any bowel symptom such as diarrhea, “Swelling” means
Diphtheria-pertussis-tetanus DPT 1 DPT 2 DPT 3 DPT 4 DPT 5 Adult Diphtheria-Tetanus Pediatric Diphtheria- Tetanus h influenza type B Hib 1 Hib 2 Hib 3 Hib 4 Oral pOliO Vaccine OPV 1 OPV 2 OPV 3 OPV 4 OPV 5 Polio Vaccine Injection Polio Vaccine Injection 1 Polio Vaccine Injection 2 Polio Vaccine Injection 3 Polio Vaccine Injection 4 Polio Vaccine Injection 5 Measles-MuMps-ruBella MMR 1 xxx MMR 2 hepatitis-B Vaccine HBV 1 HBV 2 HBV 3 HBV 4 MiscellaneOus Varivax (Chicken Pox) Tine Test Other: MeDicatiOn Or suppleMent Please check all that apply. suBstances affectinG central nerVOus systeM Clozaril (clozapine) Haldol Prolixin Risperdal Seroquel Stelazine Thorazine Zyprexa Antihistamine Clonidine Cogentin Deanol (deaner, DMAE) Dextromethorphan Lithium Naltrexone St John’s wort Anafranil Depakene for behavior Depakene for seizures Depakote for behavior Depakote for seizures Dilantin Felbatol Gabitril Keppra Klonopin Lamictal Luvox Mysoline Neurontin Paxil Phenobarbital Tegretol Topamax Trileptal Valium Zarontin Zonegran Adderal Prozac Zoloft Amphetamine MeDicatiOn Or suppleMent (cOntinueD) suBstances affectinG
Cylert Dexedrine, Dextroamphetamine Fenfluramine Focalin Ritalin Buspar Chloral hydrate Valium Desipramine Mellaril Tofranil antiBiOtics Bactrim (Septra) Biochoice Bismuth Colostrum Diflucan DiGestiVe flOra Humatin Lamisil
Yodoxin Bethanecol DIGESTION Digestive enzymes Pepsid Peptidase Enzymes Probiotics DetOXificatiOn DMPS DMSA (succimer, Chemet) Reduced glutathione (transderm) Reduced glutathione IV Reduced glutathione oral B6 & Magnesium Brain child supplements Folic Acid Melatonin Multivitamin high potency Multivitamin regular potency MeDicatiOn Or suppleMent (cOntinueD) suBstances affectinG nutritiOn anD MetaBOlisM Super Nu Thera Ultra Clear Sustain Vitamin B3 (Niacin) Vitamin B6 5 HPT Alpha Keto Glutarate Amino Acid Mix Deanol Dimethylglycine (DMG) DMG Glutamine SAMe (SAM, Samyr) TMG Tryptophan Tyrosine Calcium Magnesium Manganese Selenium Zinc Human Growth Factor IV Immune Globulin Kutapressin Oral Immune globulin Secretin IV Secretin transdermal Steroids TTFD DHA rich oils EPA rich oils Omega 6 rich oils Omega brite Cod liver oil Flax Oil Alka Gold Carbatrol Tranxene Famvir Valtrex Zovirax Actos syMptOM scOre sheet For monitoring progress: Record the main problems in the Symptom column. Enter the date and rank
according to ratings below. Put a “P” for problems that were present only in the past. Put an “L” to mark
lab tests of importance. I will paste these symptoms, and a distil ation of the x’d in the laboratory data
questionnaire on next page, into the record we will use to track progress.
Rank = (0= Absent, 3= mild, 6= Moderate, 9=severe, 12= incapacitating.)past /lab laBOratOry Data eValuatiOn/test
24 hour urine amino acidsAmino acid screenBlood chemistry screenBlood countBlood test for fatty acidsBlood test for food allergiesCAT scanColonoscopyDMSA loading studyEEGFolic acidFragile X chromosome studyHair elementsImmune profileIntestinal permeabilityLiver Detoxification profileMRIOrganic acids quantitative – fungal/bacterial metabolitesOrganic acids quantitative – metabolismOrganic acids screenPET scanPinworm prepPlasma amino acidsPlasma or serum zincRBC elementsSerum Ferritin (iron stores)Serum methylmalonic acidSerum Vitamin ASmall bowel biopsyStool cultureStool parasitesThyroid ProfileUric acid test (blood or urine)Urinary PeptidesUrine elementsUrine Kryptopyrrole
past anD present prOfessiOnals
Who made the initial diagnosis of autism/other disorder? _____________________________________________ When? ______________________
Bankart Repair Post-Op Instructions Missouri Orthopaedic Institute Bankart Repair Post-Operative Instructions Seth L. Sherman, M.D. Tamara L Young, ATC, OTC, M.Ed Department of Sports Medicine Ø Anesthetic drugs used during surgery may cause nausea for the first 24 hours. If nausea is encountered, drink only clear liquids and light food (jello, soups, dry crackers, toast).
CHAPTER 12 NUISANCES (a) MISCELLANEOUS PROVISIONS (b) ABATEMENT PROCEDURES (c) SPECIAL PROVISIONS RELATING TO JUNK (d) VIOLATIONS Nebraska Statutes For statutory provisions authorizing cities to declare and abate nuisances, see R.R.S. §§ 16-230, 18-1720. (a) GENERAL PROVISIONS 12-1-1. Definitions. As used in this chapter, the following terms shall have the followi