24. - 40. Select the most appropriate response from the drop down menus below for those treatments that you have tried or are currently using. If you do not make any selection, the default is the displayed response (Never Used, No Effect, None). Therefore, NO ACTION is required for those treatments you have NOT tried and NEVER used.
If you have tried a non-traditional treatment that is not on the list and you are not sure in which category it belongs, place the name at the end of the list in the "Other Therapy" category.
Describe your use of each treatment or practice Never used - Never a part of your treatment
Tried to use - Used in the past but have discontinued use
Currently using - Currently a part of your treatment
Effect on your bleeding symptoms (select one if applicable)
No effect - Didn't reduce bleeding Some - Had some positive effect
Normal - Bleeding returned to normal
Effect on your platelet counts (check one if applicable) No effect Didn't raise counts Moderate effect had a moderate or short lived positive effect Sustained effect - had a long term positive effect on counts
Side Effects (check one if applicable) None - No difficult side effects Mild - Minor and temporary side effects Moderate - Difficult side effects Severe - Extreme side effects
Treatment
Physical Therapies
Use
Effect on Bleeding
Effect on Platelets
Side Effects
24
Acupressure (shiatsu)
25
Acupuncture
26
Other physical therapy - Enter name here:
Vitamins
Use
Effect on Bleeding
Effect on Platelets
Side Effects
27
Vitamin C
28
Vitamin K
29
Other Vitamins - Enter name here:
Supplements
Use
Effect on Bleeding
Effect on Platelets
Side Effects
30
Moducare Sterinol
31
Collostrum
32
Chlorophyll
33
Other Supplements Enter name here:
Energy Treatments
Use
Effect on Bleeding
Effect on Platelets
Side Effects
34
Reiki
35
Magnets
36
Healing or therapeutic touch
37
Other Energy Treatments - Enter name here:
Herbs
Use
Effect on Bleeding
Effect on Platelets
Side Effects
38
Chinese herbs - Enter name here:
39
Ayurvedic herbs - Enter name here:
40
Other herbs - Enter name here:
Herbs
Use
Effect on Bleeding
Effect on Platelets
Side Effects
This is the end of page two. Check your answers on this page before you click on the continue button below. Once you click on that button, you do not have access to your answers to change them.