CCSVI Tracking Project
Posted: Thu Aug 26, 2010 9:00 am
CCSVI TRACKING [08/26/2010]
MS HISTORY
Peg:
Male/Female: F
Age: 59
Date(s) & type of neurological diagnosis (RRMS, SPMS, PPMS, CIS, or other):
Lesion locations (most affected side, if known), number:
MS treatments:
MS symptoms before stenosis intervention:
Number of relapses before intervention (if applicable):
EDSS before CCSVI intervention (self-assessed or physician-assessed?):
[To review EDSS rating, click the following link: http://www.mult-sclerosis.org/expandedd ... scale.html ]
FSS before CCSVI intervention:
[To calculate FSS rating, click the following link: http://www.mult-sclerosis.org/fatigueseverityscale.html ]
MSIS before CCSVI intervention:
[To calculate MSIS rating , click the following link: http://healingpowernow.com/msis.htm ]
Are you using Inclined Bed Therapy I.B.T? Yes
Have you had testing (and possibly procedure) for blockage yet: (Y/N)
[Some patients may wish to start with a baseline report, if Y, continue with next section]
STENOSIS PROCEDURE HISTORY
Date/location of testing/procedure: My appointment is October 5, 2010 in Albany, NY
Type of venographic study: (MRV, Doppler)
Diagnosis:
Type of procedure:
Procedure/drug related symptoms:
[Repeat this section if there have been more than one procedure]
Number of relapses since first CCSVI intervention:
Impact on your MS symptoms in words (include date in brackets if there have been multiple updates):
EDSS as of this update (self-assessed or physician-assessed?)
FSS as of this update:
MSIS as of this update:
MS HISTORY
Peg:
Male/Female: F
Age: 59
Date(s) & type of neurological diagnosis (RRMS, SPMS, PPMS, CIS, or other):
Lesion locations (most affected side, if known), number:
MS treatments:
MS symptoms before stenosis intervention:
Number of relapses before intervention (if applicable):
EDSS before CCSVI intervention (self-assessed or physician-assessed?):
[To review EDSS rating, click the following link: http://www.mult-sclerosis.org/expandedd ... scale.html ]
FSS before CCSVI intervention:
[To calculate FSS rating, click the following link: http://www.mult-sclerosis.org/fatigueseverityscale.html ]
MSIS before CCSVI intervention:
[To calculate MSIS rating , click the following link: http://healingpowernow.com/msis.htm ]
Are you using Inclined Bed Therapy I.B.T? Yes
Have you had testing (and possibly procedure) for blockage yet: (Y/N)
[Some patients may wish to start with a baseline report, if Y, continue with next section]
STENOSIS PROCEDURE HISTORY
Date/location of testing/procedure: My appointment is October 5, 2010 in Albany, NY
Type of venographic study: (MRV, Doppler)
Diagnosis:
Type of procedure:
Procedure/drug related symptoms:
[Repeat this section if there have been more than one procedure]
Number of relapses since first CCSVI intervention:
Impact on your MS symptoms in words (include date in brackets if there have been multiple updates):
EDSS as of this update (self-assessed or physician-assessed?)
FSS as of this update:
MSIS as of this update: