Back on 8/10 I posted a brief questionnaire at the suggestion
of Sayward. I have completed tallying the data from the 43
folks that responded. If you misplaced the original questionnaire,
are new or just didn't have time at that time I'm posting it again
below. Thanks for your help from all fellow TMers.
__________________________________________________
I will collate this data and I will not release any of it on any
individual unless given permission. The geography questions
are related to MS research. I would ask that everyone, visitors,
just readers, helpers etc., to complete the questionnaire if it
applies to you, family members or friends with a Dx of
Transverse Myelitis. Hopefully we can make a difference.
1. NAME: (optional)
GENDER:
2. DATE OF Dx: LOCATION: (City,State)
3. AGE AT dx: LOCATION: (City, State)
4. CURRENT AGE: LOCATION: (City, State)
5. BIRTH LOCATION: (City, State)
6. UNUSUAL CIRCUMSTANCES: (Lived in one place, Dx'd in
another location. There were a few subscribers who were on
vacation or business).
7. CURRENT MEDICATIONS: (Please List)
8. MEDICATIONS TRIED BUT DID NOT WORK FOR YOU (Please list)
9. IF YOU FEEL THAT YOUR PHYSICIAN/NEUROLOGIST IS
EXPERIENCED WITH TM (or atleast willing to learn) PLEASE
LIST HIM AS SOMEONE YOU WOULD RECOMMEND TO OTHERS:
NAME:
SPECIALTY:
HOSPITAL AFFILIATION:
CITY, STATE:
TELEPHONE:
10. IF YOU HAVE BEEN TREATED BY A PHYSICIAN/NEUROLOGIST
THAT SHOULD BE AVOIDED AT ALL COSTS BY THOSE WITH TM.
NAME:
SPECIALTY:
HOSPITAL AFFILIATION:
CITY, STATE:
TELEPHONE:
I hope this information will aide many.
Doc