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HTML Rev: Sept. 19, 1999
Created: June 1998
and/or given you comfort
during those difficult nights,
we hope that you will become
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Diane Manhatten
Jill Osborne
IC Self Assessment Quiz
Any chronically ill patient can, over time, develop some unhelpful patterns, such as not being fully honest with their physician or isolating themselves. We developed this quiz for patients to take a step back and look at their self care. Veteran IC patients may have one of those "How come I didn't figure that out?" moments as they go through the questions. Newly diagnosed patients can gain valuable perspective on their self care. Family members and/or friends may be surprised to learn many of the issues that IC patients consistently deal with. We encourage support groups to take the test as a group exercise.Your Doctors
1. Do you have
a medical care provider who believes in IC?
(yes) or (no)
2. Do you feel
comfortable talking with your doctor?
(yes)
or (no) If not, why?
3. Do you ever
hold anything back from your doctors?
(yes) or (no)
. If no, what do you hold back?
4. Are you ever
unsure of when to call the doctor?
Answer:
5. Is your doctor
up to date on IC treatments?
Answer:
6. Does s/he
encourage you to try new treatments?
Answer:
7. When you
try a new treatment, how do you keep track of your progress?
Answer:
8. Have you
ever given up on a treatment and wondered if you stopped to soon?
Answer:
Patient Organization
9. Do you have
a file where you keep your IC information?
Answer:
10. Do you have
written instructions down for your family to use and/or a list of
medications if you ever need to be hospitalized for your IC?
Answer:
11. Does your
family know what doctors you see and how to contact them?
Answer:
12. How do you
keep track of your IC symptoms? A voiding diary? Written notes?
Answer:
Support & Family
13. Have you
deliberately talked with your family (spouse, siblings and/or children)
and explained what IC is?
Answer: If so,
how do you describe IC?:
14. Do you give
yourself permission to say "no" to family events if you are in too
much discomfort to participate comfortably?
Answer:
15. Does your
family have any hidden fears or worries about your IC? (i.e. children
who might think that you are dying because they don't know what IC
is?) If so, what do they fear?
Answer:
Self Help
16. Do you know
where to gather information on IC? Where do you go?
Answer:
17. When you
find new information, how do you verify it?
Answer:
18. What are
your most common IC triggers?
Answer:
19. Are you
getting enough sleep at night? How much sleep do you need to make
it through the next day comfortably?
Answer:
20. Can you
have comfortable sexual relations with your partner?
Answer:
21. Do you ever
have sex even though you are in pain?
Answer:
22. Does your
sexual partner clearly understand that when you say "No" to sex, that
you still love your partner and that IC will not change that love?
Answer:
23. Is travelling
comfortable? If no, how long can you drive or fly comfortably before
your symptoms begin to bother you?
Answer:
24. Has exercise
ever bothered your IC? If so, what type of exercise caused the problem?
Answer:
25. Has soap,
clothing or bubble bath ever bothered your IC?
If yes, what?
Answer:
26. Do you ever
worry that you will be denied access to a restroom or won't be able
to find one?
Answer:
27. Do you
keep in touch with your non IC friends? If not, why?
Answer:
28. Do you have
other IC patients that you talk with?
Answer:
29. On those
days when you may feel frustrated, isolated or depressed, how do you
care for yourself?
Answer:
30. What brings
you daily comfort and joy in your life?
Answer: