ࡱ>  @ .bjbjPP 2::EEE8ED"F [i:H:H:H:H:H:HTH `HhiiiiiiQkRmni|J:H:H|J|Ji:H:HiLLL|JX:H:HhvL|JhLL[|L]:H.H &lEJXP\4^T +i0[ib\n,KBn$L]L]n`]hHLH6LH,IfhHhHhHii7;$ nLX;Fax your answers to 979-776-6280 In the last year, I have experienced following problems. Your truthful answers will help me understand the state your body and brain are in. Please circle each that applies to you. I have low or no energy through the day. I lack desire for activity, projects or challenging things. I want to but cannot go on with exercise. I have low concentration and attention. I sleep too much. I have problems waking up in the morning. I have low sexual desire and drive I use caffeine, chocolate, diet pills, Red Bulls, energy drinks to keep awake. I use methamphetamines, Cocaine or use stimulants (Medicines like Ritalin, Adderall, Concerta, Vyvance, Provigil, Nuvigil) to keep awake. I am a pessimist. I have lot of thoughts that I am a failure. I blame my self for small little things that others can ignore. I have low self-esteem. I do not have self-confidence. I have absurd thoughts or images that bother me. (e.g. Unwanted sexual, aggressive thoughts or images) I get moody and depressed in fall or winter, as day light becomes shorter. My family has history of seasonal affective disorder. I am irritable, and easily angered. I am impatient. I am a perfectionist. I am socially shy and get anxious when in group of people. I am fearful of going out of my safe zone like my house or family. I have fear of heights, crowds, or flying. I have fear of speaking in public. I feel anxious or have panic attacks (feeling of doom) I have PMS (premenstrual syndrome) with moodiness, cravings, breast tenderness, swelling and bloating before my period. I have problems falling asleep. I wake up in the middle of the night and have trouble getting back to sleep. I wake up too early in the morning. I crave sweets or starchy carbs like bread and pasta. I feel good when I exercise. I have muscle aches, jaw pain, and fibromyalgia. My family members have benefited from Prozac, Zoloft or similar medications. I am nervous and cannot relax. I feel frequently feel overworked or pressured. I stress out easily. I ma easily overwhelmed. My muscles get tense and uptight. Frequently I have a knot in my stomach. I sometimes feel weak and shaky. Loud noises, lights, or excess activity by others bother me. I am nervous without food. I use sugar, alcohol, or drugs to relax. I must make lists so I dont forget things. I cant do math in my head. I cant remember what I was just talking about. I cannot soak in the new information. I cant follow story plots. I misplace common things like keys and cell phones. I have trouble focusing during lectures and meetings. I feel dull in my brain. Food Table: Please comment below on your food habits Note how frequently in a week you eat the listed items. Itemonce or twice a week3-5 time week4-5 times a week or moreMeat Dairy Fats (margarine, butter, packed food)Veggies (2-3 cupful)Fruits (2-3 cupful)Alcohol  In the last year, I have experienced following problems. Check 0 (No problems) to 3 (severe problems) Problem0123Work inside home or officeLack exposure to sunshineUsing sunscreen frequentlyWeakness in muscles (sore)My bones hurtMy mind does not feel sharpI am losing short term memoryMy diet lacks in small-fatty-fish like mackerel, herring, sardine etcFrequent InfectionsArthritisMy skin colorLightBronzeBrownDarkAge in years>30>40>50>60 In the last year, I have experienced following problems. Check 0 (No problems) to 3 (severe problems) Problem0123Brittle, thin, peeling nailsNails have ridges and spotsSkin rashes and eczemaAcneI dont heal well, if cutAllergies that have not improvedI am losing my hair prematurelyFrequent DandruffFrequent DiarrheaMy town supplies hard waterI dont eat seaweed, kelp, fish, or lambI eat beans & pumpkin seedsI eat ginger rootI take water pills -diureticsI cannot smell or taste well In the last year, I have experienced following problems. Check 0 (No problems) to 3 (severe problems) Problem0123Cold sensitivity is highMy hands and feet stay coldI feel cold in summerDry, rough skinMy nails are thick and not shinyI am losing eyebrowsI am tired and fatiguedLow blood pressureI was told I have low heart rateI cant lose weightI am in depressed dull MoodI lack of drive to do thingsMy memory is going downI am losing my sex driveI retain water in my body My hands and feet are swollen in the morningMy doctor says that have PMS or PMDD (for females)I have heavy periods  Before After     MAHESH R. DAVE, M.D.P.A 1201 D Briarcrest Drive Bryan, TX 77802 979-776-5600 !"Z[  ` j Ͼ}lXGX3&hJ hm5CJOJQJ\^JaJ h[5CJOJQJ\^JaJ&hJ h[5CJOJQJ\^JaJ h,5CJOJQJ\^JaJ/h]+Qh,56>*CJOJQJ\]^JaJ/h]+QhJ 56>*CJOJQJ\]^JaJ h a5CJOJQJ\^JaJ hJ 5CJOJQJ\^JaJ&hJ h,5CJOJQJ\^JaJ h$N5CJOJQJ\^JaJh$Nh$N5>*CJ !"[\ @ j B J b 3 i  & Fgd r_gd,dgd$N-j  * 4 6 A B e i s J ` p g i m y ؎؎z؎f&hJ hWz5CJOJQJ\^JaJ&hJ hE{5CJOJQJ\^JaJ&hJ hfm5CJOJQJ\^JaJ&hJ hk5CJOJQJ\^JaJ h r_5CJOJQJ\^JaJ hk5CJOJQJ\^JaJ&hJ hm5CJOJQJ\^JaJ&hJ hb5CJOJQJ\^JaJ( 5 ` 2RG3[|)Eu & Fgd r_ ) 3 ; U _ ` o 2A58F)3[|()DEtu!9ذ؜؜؜؜؜؜؈؈؈؈؈؈&hJ h t5CJOJQJ\^JaJ&hJ hN85CJOJQJ\^JaJ&hJ h 5CJOJQJ\^JaJ&hJ hE{5CJOJQJ\^JaJ&hJ hm5CJOJQJ\^JaJ&hJ hWz5CJOJQJ\^JaJ3!:<=IJs$Ifl$Ifgdp#lgdJ  & Fgd r_ 9:=HIJ/BPUV\opq޹uudP<&h[hm5CJOJQJ\^JaJ&h[hm5CJOJQJ\^JaJ hk5CJOJQJ\^JaJ h]+Q5CJOJQJ\^JaJ h,5CJOJQJ\^JaJ hp#5CJOJQJ\^JaJ hp#5CJOJQJ\^JaJ&hp#hp#5CJOJQJ\^JaJ h]+Q5CJOJQJ\^JaJ hJ 5CJOJQJ\^JaJ hm5CJOJQJ\^JaJttt$IfgdZl$Iflgkd$$Ifl ! t0644 la^NNNNN$IflkdI$$Ifl\#j GHGH t0644 la^NNNNN$IflTkd$$Ifl\#j GHGH t0644 la+,-.^K;;;$Ifl$IfgdEmlkd_$$Ifl\#j GHGH t0644 la./8EFGH^KK;;;$Ifl$IfgdEml\kd$$Ifl\#j GHGH t0644 laHIQ^_`a^KK;;;$Ifl\$IfgdEml\kdu$$Ifl\#j GHGH t0644 laabjklmn^NNNNN$Ifl\kd$$Ifl\#j GHGH t0644 lanopqrstuvwx^\\\\\\\\\kd$$Ifl\#j GHGH t0644 la xyz{|}~$Iflkl .4=CPQVW]^cdhjذziizziziziziziz hr>5CJOJQJ\^JaJ h5CJOJQJ\^JaJ h%BL5CJOJQJ\^JaJ&hp#hX5CJOJQJ\^JaJ&hp#h%BL5CJOJQJ\^JaJ&hp#hX5CJOJQJ\^JaJ&hp#h%BL5CJOJQJ\^JaJ&hp#hK5CJOJQJ\^JaJ#J:::::$Iflkd$$Ifl4rpN,"! t0644 la45678J:::::$Ifl\kd$$Ifl4rpN,"! t0644 la89TUVWXJ:::::$Iflkd&$$Ifl4rpN,"! t0644 laXYtuvwxJ:::::$Iflkd$$Ifl4rpN,"! t0644 laxyJ:::::$Iflkd6$$Ifl4rpN,"! t0644 laJ:::::$IflTkd$$Ifl4rpN,"! t0644 laJ:::::$IflkdF$$Ifl4rpN,"! t0644 laJ:::::$Iflkd$$Ifl4rpN,"! t0644 la/0123J:::::$Ifl\kdV$$Ifl4rpN,"! t0644 la34>?@ABJ:::::$Iflkd$$Ifl4rpN,"! t0644 laBCQW^diJ77777$Ifgd_lkdf $$Ifl4rpN,"! t0644 laijw{J77777$Ifgd_lkd $$Ifl4rpN,"! t0644 laJHCH3$IflgdXkdv $$Ifl4rpN,"! t0644 la#>DZ`78Ӿ|||g|VB1 hV5CJOJQJ\^JaJ&hp#h35CJOJQJ\^JaJ hJ 5CJOJQJ\^JaJ)h35B*CJOJQJ\^JaJph)h=i[5B*CJOJQJ\^JaJph)hX5B*CJOJQJ\^JaJph/hp#hX5B*CJOJQJ\^JaJph)h,K5B*CJOJQJ\^JaJph&h&fhX5CJOJQJ\^JaJ/h[hm5B*CJOJQJ\^JaJph;kd $$IflroD"0 t0644 la$Ifl !"#;kd $$IflroD"0 t0644 la$Ifl#?@ABCD;kd@ $$IflroD"0 t0644 la$IflD[\]^_`;kd $$IflroD"0 t0644 la$Ifl`efghi$Ifl\$IfgdZlijK8(($IflT$IfgdZlkd $$IflroD"0 t0644 la;+$Iflkd#$$IflroD"0 t0644 la$IflT;kd$$IflroD"0 t0644 la$Ifl;kde$$IflroD"0 t0644 la$Ifl;kd$$IflroD"0 t0644 la$Ifl;kd$$IflroD"0 t0644 la$Ifl !"#;kdH$$IflroD"0 t0644 la$Ifl#LMNOPQ;kd$$IflroD"0 t0644 la$Ifl\Qmnopqr;kd$$IflroD"0 t0644 la$IflTr;kd+$$IflroD"0 t0644 la$Ifl;kd$$IflroD"0 t0644 la$Ifl$Ifl$IfgdZl78@KFFD1$IfgdZlgd3kdm$$IflroD"0 t0644 la@BDFHI8kd$$IflroD"0 t0644 la$IfgdZl8H pvҽҽҽҽҽҬs[SOSOSOSOEh$Nh0w'5CJh+^jh+^U/h[hm5B*CJOJQJ\^JaJph&h[hm5CJOJQJ\^JaJ&h[hV5CJOJQJ\^JaJ hV5CJOJQJ\^JaJ hm5CJOJQJ\^JaJ)hg5B*CJOJQJ\^JaJph)hV5B*CJOJQJ\^JaJph/hp#hV5B*CJOJQJ\^JaJphIbcdefg8kd$$IflroD"0 t0644 la$IfgdZlg8kdP$$IflroD"0 t0644 la$IfgdZl8kd$$IflroD"0 t0644 la$IfgdZl$IfgdZl\$IfgdZlK8%%$IfgdZlT$IfgdZlkd$$IflroD"0 t0644 la8%$IfgdZlkd3$$IflroD"0 t0644 la$IfgdZlT8kd$$IflroD"0 t0644 la$IfgdZlT8kdu$$IflroD"0 t0644 la$IfgdZl()*+,-8kd$$IflroD"0 t0644 la$IfgdZl-NOPQRS8kd$$IflroD"0 t0644 la$IfgdZlSghijkl6kdX$$IflroD"0 t0644 la$IfgdZll8kd$$IflroD"0 t0644 la$IfgdZl8kd$$IflroD"0 t0644 la$IfgdZl\8kd?$$IflroD"0 t0644 la$IfgdZlT8kd$$IflroD"0 t0644 la$IfgdZl  8kd$$IflroD"0 t0644 la$IfgdZl 789:;$IfgdZl$IfgdZl;<qrsK8%%$IfgdZl$IfgdZlkd"$$IflroD"0 t0644 lastuv8%$IfgdZlkd$$IflroD"0 t0644 la$IfgdZl86kdd $$IflroD"0 t0644 la$IfgdZl*+,-. !dgdkgdm+,-./h[hm5B*CJOJQJ\^JaJphh+^h0w' h0w'KH h0w'5CJ000P:pm/ =!"#$%`G$$If!vh5!#v!:Vl t65!$$If!vh5G5H5G5H#vG#vH#vG#vH:Vl t65G5H5G5H$$If!vh5G5H5G5H#vG#vH#vG#vH:Vl t65G5H5G5H$$If!vh5G5H5G5H#vG#vH#vG#vH:Vl t65G5H5G5H$$If!vh5G5H5G5H#vG#vH#vG#vH:Vl t65G5H5G5H$$If!vh5G5H5G5H#vG#vH#vG#vH:Vl t65G5H5G5H$$If!vh5G5H5G5H#vG#vH#vG#vH:Vl t65G5H5G5H$$If!vh5G5H5G5H#vG#vH#vG#vH:Vl t65G5H5G5H$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh5!5555#v!#v#v:Vl4 t65!55$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555$$If!vh505555#v0#v#v#v#v:Vl t6505555X@X Normal1$5$7$8$H$ KHOJQJ^J_HmH sH tH V@V r_ Heading 1$<@&5CJ KH OJQJ\aJ DAD Default Paragraph FontRi@R 0 Table Normal4 l4a (k( 0No List z@z m Table Grid7:V01$5$7$8$H$HC@H r_Body Text Indenthx^h>@> r_ Normal Indent ^2B@"2 r_ Body Textx<O2< $Nc7$d5$a$ CJKHaJDBD $N Balloon TextCJOJQJaJ4@R4 kHeader  !4 @b4 kFooter  !.!"[\@jBJb3i5`2RG3[|) E u ! : < = I J s      + , - . / 8 E F G H I Q ^ _ ` a b j k l m n o p q r s t u v w x y z { | } ~        4 5 6 7 8 9 T U V W X Y t u v w x y       / 0 1 2 3 4 > ? @ A B C Q W ^ d i j w {   !"#?@ABCD[\]^_`efghij !"#LMNOPQmnopqr78@BDFHIbcdefg()*+,-NOPQRSghijkl  789:;<qrstuv*+,/000000000 0 0 0 0 0 0 0 0 0 0  0  0  0  0  0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0  0! 0" 0# 0$ 0% 0& 0' 0( 0) 0* 0+ 0, 0- 0. 0/ 00 010000000 0 0 0 0 0 0 00 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0x0x 0x 0x 0x 0| 0x0x 0x 0x 0x 0| 00 0 0 0 0 0000000000000000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00000x@0;00@0;00@0;00@0;00@0@0@0x@0@0@0@0@0@0;00!   + E H I ^ a b 3 4 B C i j CD_`eHIfg,-RSkl  ;<quv/{00{00г{00  {00 d.{00 d.{00{00 @M{00 {00{00{00p ԷbFX6 {00{00p TF7 @ {0 0{00D {0 0{00D {00D{00D {00D{00D ;00L {008 ;008{008 {008 {008 {00 ѶF6<$ ;00 : {008 ;00{008 {008 ;0$0{00{00{00 {00 {00 {00 {00{00{008 {008 {0 0 {00 {008 {00 {00 {00 {00 {00 {00 {00 {00 {00 {00 {00{00 {00{00 {00{00 {00 {00{00{008 ;0C0hp {0!0 {008 {0!0{00 {008 {00  @0T6  0{00 0 ]]j 98.-AW .Hanx8Xx3Bi#D`i#Qr@Ig-Sl ;s. !"#$%&'()*+,./0123456789:;<=>?@BCDEFGHIJKLMNOPQRSTUV- OLE_LINK1q / /mO#nOP#oO#pO"qOv //;*urn:schemas-microsoft-com:office:smarttagsaddress:*urn:schemas-microsoft-com:office:smarttagsStreet>*urn:schemas-microsoft-com:office:smarttags PostalCode9*urn:schemas-microsoft-com:office:smarttagsState8*urn:schemas-microsoft-com:office:smarttagsCity ,/,/"= J / q   #Djr8g-Sl*,/,/ |(t!H=JKѬO[` ytX ^`o(hH. ^`hH.  L ^ `LhH.   ^ `hH. xx^x`hH. HLH^H`LhH. ^`hH. ^`hH. L^`LhH. ``^``o(hH. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH. hh^h`o(hH. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH. ^`hH. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH. hh^h`o(hH. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.h hh^h`hH. 88^8`hH. L^`LhH.   ^ `hH.   ^ `hH. xLx^x`LhH. HH^H`hH. ^`hH. L^`LhH.ytJK O[HF         Bl        F                  F                  D/.J 3hVK0w' (,r>,K%BL$N]+Q=i[+^ r_&ffmmEm t_uWzE{k| amq+3[vZN8bk_ XzN8 8p#gCJ      + , - . / E F G H I ^ _ ` a b k l m n o       4 5 6 7 8 9 T U V W X Y t u v w x y       / 0 1 2 3 4 > ? @ A B C Q W ^ d i j w {   !"#?@ABCD[\]^_`efghij !"#LMNOPQmnopqr8@BDFHIbcdefg()*+,-NOPQRSghijkl  789:;<qrstuv/ColorPos(SColorSet4SStylePos@SStyleSetLS-1-1-1-1@.@@UnknownGz Times New Roman5Symbol3& z Arial7&  VerdanaGBemboMS MinchoQ Bembo-BoldMS Mincho7&{ @Calibri5& zaTahoma"(h+f ! !c!xxd 2Q$PmDA Arpit M. Dave Arpit M. Davemaguna$      Oh+'0`   ( 4@HPXDAArpit M. DaveNormalArpit M. Dave7Microsoft Word 10.0@~@=b@՜.+,0 hp|  !  DA Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXZ[\]^_`abcdefghiklmnopqrstuvwxyz{|}~Root Entry FData Y!1Tablej5nWordDocument2SummaryInformation(DocumentSummaryInformation8CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q