Welcome

"We get by with a little help from our friends"*

St. Mary's/Good Samaritan Hospital-Centralia Campus

400 N. Pleasant

Centralia, IL 62801

(618)436-8000

*Special Guest Speakers *Information/brochures *Open discussions *Refreshments/snacks

Meeting Room # 1

Every 3rd Saturday of the month

2 p.m.

- Get Directions Here -

St. Mary's Good Samaritan Hospital-Mt. Vernon Campus Meetings Coming Soon!

Call Spencer @204-8084 for more info.

* Credits to The Beatles, John Lennon-Paul McCartney-George Harrison-Ringo Starr <3

Email us or give us a call and we can help
 you find a doctor, testing
and more!


 

Questionnaire Note: The information provided to us in this form will be kept confidential.  By filling out this survey you are helping us to determine where we need to focus our research, education and support groups. How did you hear about Illinois LDN?

Search engine From a friend Banner ad Magazine ad From another Lyme Group

Which disease do you have or request information about?

Lyme Disease Babesia Rocky Mt. Spotted Fever Bartonella Ehrlichiosis (Granulocytic/Monocytic) Masters Disease (STARI) Tularemia Q- Fever Mycoplasma Relapsing Fever Anaplasmosis Morgellons Other

Please tell us your story, no word limit.  If you would like to be contacted, leave your phone# or email addy.

Tell us your story. If you would like to remain anonymous, it's quite alright.

Have you been misdiagnosed? No Yes

If so, what was you diagnosis? Alzheimer's Disease ADD/ADHD Lou Gehrig's disease (ALS) Chronic Fatigue Depression Fibromyalgia Guillain-Barre Syndrome Juvenile Rheumatoid Arthritis Rheumatoid Arthritis Multiple Sclerosis Systemic Lupus Thyroid Disease Other In what city, state or county did you most likely contract Lyme disease? Where (on your body) did you get bitten or do you remember a bite? What Illinois County do you live in? Tell us your symptoms in the text box below. What are some of your symptoms?  Unexplained fevers, sweats, chills, or flushing  Unexplained weight change  Fatigue, tiredness, poor stamina  Unexplained hair loss  Swollen glands Sore throat Testicular pain/pelvic pain Unexplained menstrual irregularity or menopause at early age Unexplained milk production; breast pain Irritable bladder or bladder dysfunction Sexual dysfunction or loss of libido Upset stomach or abdominal pain Change in bowel function (constipation, diarrhea) Chest pain or rib soreness Shortness of breath, cough Heart palpitations, pulse skips, heart block Any history of a heart murmur or valve prolapse? Joint pain or swelling      Stiffness of the joints or back Muscle pain or cramps Twitching of the face or other muscles Headache Neck creaks and cracks, neck stiffness, neck pain Tingling, numbness, burning or stabbing sensations, shooting pains Facial paralysis (Bell's Palsy) Eyes/Vision: double, blurry, increased floaters, light sensitivity Ears/Hearing: buzzing, ringing, ear pain, sound sensitivity Increased motion sickness, vertigo, poor balance Lightheadedness, wooziness, unavoidable need to sit or lie down Tremors Confusion, difficulty in thinking Difficulty with concentration, reading Forgetfulness, poor short term memory/attention Disorientation: getting lost, going to wrong places Difficulty with speech or writing; word or name block Mood swings, irritability, depression Disturbed sleep — too much, too little, fractionated, early awakening Exaggerated symptoms or worse hangover from alcohol List your symptoms here. Do you believe a family member could be infected? Yes No Maybe Have you gone to a area doctor? What did they say? What did they tell you? Would you be willing to serve as a volunteer for the Illinois Lyme Disease Network? Distribute brochures to Hospitals, Drs Offices, etc. Give Lyme disease education talks at schools Help staff booths at fairs (health care, state, 4H, craft) Assist with lobbying efforts in Springfield Seek local media coverage of Lyme related issues Submit my personal Lyme story to magazines, newspapers, television I would like to help arrange speakers for support group meetings I can help with fundraising projects Canvas door to door with Brochures Would you consider having a support group in your area? Yes No Would consider The information provided to us in this form will always be kept confidential.  By filling out this survey you are helping us to determine where our focus needs to be on research, education or support groups. We will never share your information with anyone.

Disclaimer: The information submitted to Illinois Lyme Disease Network is used for research and education purposes ONLY, as we are not medical doctors or any medical affiliation.

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