Survey Page Three

V. Non-Traditional Treatments - Continued

41. - 54.  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        
Homeopathy Use Effect on Bleeding Effect on Platelets Side Effects
41 Enter name here:
Diet Use Effect on Bleeding Effect on Platelets Side Effects
42 Macrobiotic
43 Eat Right For You Type
44 Zone Diet
45 Atkin Diet
46 Other Diet -  Enter name here:
Spiritual/Emotional Use Effect on Bleeding Effect on Platelets Side Effects
47 Prayer
48 Meditation
49 Visualization
50 Psychotherapy Emotional Guidance
51 Positive Thinking
52 Other Spiritual -  Enter name here:
53 Other Therapy -  Enter name here:
54 Other Therapy -  Enter name here:
Spiritual/Emotional Use Effect on Bleeding Effect on Platelets Side Effects

VI. Approach

55. I've told my hematologist about the non-traditional therapies I have tried.

  Don't use non-traditional therapies Yes  No

      Is your hematologist supportive of the non-traditional therapies you have tried?

  Don't use non-traditional therapies      Don't know  Yes   No

56. Check all that apply

I've given up on traditional therapies working

I've given up on non-traditional therapies working

I've decided to live with my current counts

I am willing to keep trying other traditional therapies

I am willing to keep trying other non-traditional therapies

I am satisfied with the success of my traditional therapies

I am satisfied with the success of my non-traditional therapies

57. I'd like to add the following comments about my therapies (limit 256 characters) :

This is the end of the survey. Check your answers on this page before clicking on the Submit Survey button below.  Once you click on that button, you do not have access to your answers to change them.