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How well are you coping with IBD

Whether you_ve had Crohn_s disease or ulcerative colitis for years or you_re newly diagnosed, you know staying on top of symptoms can help you feel your best. Make copies of this worksheet, fill it out when symptoms strike, then share it with your healthcare provider. Spotting trends and patterns can help him determine your best route to relief.

Provided by HealthMonitor

Check the answer that applies.
''" Very low "'" Low
''" Normal "'" High
Abdominal pain and cramping:
''" None "'" Mild
''" Moderate "'" Severe
''" None "'" Number of times
Other symptoms:
''" Blood in stool
''" Vomiting
''" Fever
''" Joint pain

''" Eye pain
''" Flaky, scaly
skin or rash
Morning: "''''''''''''''''''''''''''''''''''''
Afternoon:'''''''''''''''''''''''''''''''''''" Evening: "'''''''''''''''''''''''''''''''''''''

Vital statistics
Current weight:
Weight changes: "''None
'''Gained "''lbs "''Lost "''lbs

How I'm feeling
Stress level: "''''''''''''''''''''''''''''''''"
(Rate on a scale of 0 = no stress, 10 = severe stress)
Energy level: "''''''''''''''''''''''''''''''''"
(Rate on a scale of 0 = no energy, 10 = high energy)
Other notes: "''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Medication (Rx and OTC) Dose Times per day When to take it

Crohn's Disease Arthralgia Blood In Stool Emesis Eye Pain Fever Joint Aches Joint Pain Muscle Cramps Pain Pain, Joint Puking Stress Vomiting Joint Pain Fatigue

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