Quality of Life Assistant How to Make Written Log Entries

Quality of Life Assistant

How to Make Written Log Entries

One of the most important things you can do with your Quality of Life Assistant is to track and analyse the things that trigger episodes of weakness, paralysis or other symptoms. You start by logging events or activities you think may be triggers, plus all your symptoms as you have them. The mind is a wonderfully tricky and adaptive organ and will “forget” or minimize painful events when it can. So, pick a logbook size that you can have with you all day, and use it as you go.

Look at your logbook page, We have included three different full-page log forms in the QLA. The folks at At-A-Glance paper products also make a nice preprinted T0-Do List form that works well. The 3¾ by 6¾ inch size is part number E-404. For more information go to www.ataglance.com or to your local office supply store. Lined school paper or a small notebook will do fine. On your page, you will see three columns. Use these three columns to:

Write down the type of item you are logging,
Log the details about the event, and
Record the time

Start by dating the page. Then, using the column on the left, write a single letter to identify the type of entry. For example, you can use “T” for triggers, “S” for symptoms or “A” for attack, “F” for food and “M” for medication. In the beginning, the two most important items to log may be triggers and symptoms. In the center column, write a brief but detailed description of the event. In the far right column, enter the time. For example:

To-do or Blank Log Form
Letter	Details	Time
		01 Jan 2005
S	Woke up stiff, sore and mentally foggy.	8:00 AM
F	Breakfast, Pancakes. Probably a mistake.	8:30 AM
T	Helped my brother move furniture.	10:00 AM
S	Legs very weak, then arms went all floppy.	11:45 AM
S	When it got hard to breath, my brother took me to ER.	12:15 PM

Do not use abbreviations when describing your problems. If you need to look back at your log from a year ago, you may not remember that you used to write RLP for “right leg paralyzed.” Also, your doctor may ask to see your log and he will understand it faster if you spell out the details. An alternative format, shown below, is for people familiar with using an appointment book. Enter the time, followed by the initial, then the details.

Appointment Style Log Format
Jan 01 2005
8:00 AM	S Woke up stiff, sore and mental foggy.
8:30 AM	F Breakfast, Pancakes. Probably a mistake.
10:00 AM	T Helped my brother move furniture.
11:45 AM	S Legs very weak, then arms went all floppy
12:15 PM	Hard to breath. To ER.

Chart your Triggers and Symptoms

After you have been logging for two weeks or more, you MAY notice a trend or feel a pattern begin to emerge. It pays to be sure. You can use:

Pareto Charts,
Frequency Plots, and
Scatter Plots.

The names may sound unfamiliar of intimidating at first, but the charts are easy to make. Use “Pareto charts” to find your most common triggers and symptoms. “Frequency Plots” will tell you the worst time of day and help sort out which symptoms may go with which triggers. You can use “Scatter Plots” to test, validate or disprove a correlation between your triggers and symptoms. These plots or charts are easy to do. They are especially helpful for quickly and convincingly proving information to you and your doctor. You are saying in effect, “Here is the data, here is the correlation. What can we do to improve this?” Here goes.

Pareto Charts for Triggers and Symptoms

To find your most common triggers you need:

Your log book,
Pencil or pen,
One piece of lined paper, and
One piece of graph paper.

With tools in hand, the following list outlines the next steps.

List your triggers from your log book,
Group similar triggers into categories,
Count the number in each trigger category,
Make a bar chart with the triggers in order, most frequent on the left to least frequent on the right.

Look through your logbook. On the lined paper, make a list of all your triggers. For example, write down: poor sleep, heat, work stress, exercise, moving furniture, home stress. Then count the number of each type of trigger. For example: work stress and home stress might be counted twice under “stress”. You might put both moving and exercise down twice as “exercise”. Then count the number of triggers under each category.

You might see that in the last two weeks, you wrote exercise as a trigger seven times, stress four times, sodium twice and high carbohydrate and heat once each. Now make a bar chart, also called a Pareto chart or a Stratified Frequency Plot. Along the left side, draw a vertical line with at least 5 steps in it. Along the bottom, draw a horizontal line and write in your triggers from most common to least common. It would look like the chart below.

8
7
6
5
4
3
2
1
No. of Triggers	Exercise	Stress	Sodium	High Carb High Potassium	Heat/Cold

Use the same process to find your most common symptoms.

List your symptoms from your log book,
Group similar symptoms into categories,
Count the number in each trigger category,
Make a bar chart with the triggers in order, most frequent on the left to least frequent on the right.

Look through your log and write down all your symptoms, categorize them and list them in order from most common to least common, then turn the data into a bar chart with the most common symptoms on the left.

With these Pareto Charts, you now know the face of the enemy. When you know your most common triggers, you can begin to avoid them. When you know your most common symptoms they become much less frightening and you can prioritize your treatment plan.

Correlating Triggers and Symptoms

Sometimes, you may find it useful to look directly at symptoms and triggers to see if they correlate to the time of day or days of the month. This is when you use frequency plots. You will need your logbook, graph paper and pencil.

Draw a vertical line on the lift side of the paper and label this “Symptoms”.
Along the bottom of the page, draw a horizontal line and label this “Hours of the day”.
Go back through your log and every time you see a symptom, put an “X” in the box above that hour.

It may look like this:


	X										X
	X										X
	X	X			X						X										X
X	X	X			X			X		X	X	X									X
X	X	X		X	X			X		X	X	X		X							X
6	7	8	9	10	11	MD	1	2	3	4	5	6	7	8	9	10	11	MN	1	2	3	4	5

As you can see, there were several bad spells around 7:00 in the morning, 11:00 in the morning, and 5:00 in the afternoon. It may be that all these symptoms have the same trigger, but maybe not. If in your log, you notice the most common problems are fatigue or weakness, pain and paralysis, you can break that information our and look at the whole picture as a “stratified frequency plot".

Stratified Frequency Plot

Fatigue and Weakness

	X										X
	X										X
	X	X			X						X
X	X	X			X					X	X	X
X	X	X			X					X	X	X
6	7	8	9	10	11	MD	1	2	3	4	5	6	7	8	9	10	11	MN	1	2	3	4	5

Pain




								X
				X				X						X
6	7	8	9	10	11	MD	1	2	3	4	5	6	7	8	9	10	11	MN	1	2	3	4	5

Paralysis



																					X
																					X
																					X
6	7	8	9	10	11	MD	1	2	3	4	5	6	7	8	9	10	11	MN	1	2	3	4	5

Now a different set of patterns emerges. Fatigue and weakness before meals. pain only after meals and paralysis only in the middle of the might. A pattern like this almost certainly points to three different triggers causing the different symptoms. Your intuition and experience from logging might tell you these patters could be weakness and fatigue from getting over hungry between meals, pain from eating too much sodium at meals and paralysis from the stillness of sleep or a bedroom that is too cold. You are begriming to find information you can test and use to improve your life.

Beyond the basics your your type of PP, you don't want to make too many lifestyle of behavior changes until you are fairly sure the changes will be improvements. That is why you need to be sure there is a correlation between your triggers and symptoms. This is where “scatter plots come in. Scatter plots can also be useful in obtaining a diagnosis, as you will see shortly.

The imaginary person using the stratified frequency plots, above, might want to examine a possible link between how many hours since their last meal, and the number of symptoms they have. Again you will need your log, pencil and graph paper. Scatter plots only work with symptoms and triggers that vary in number. They won't work with yes-no god-day-bad-day data. Many people with PP report multiple symptoms with attacks so “number of symptoms” may be a good indicator of the intensity of the attack. Someone who has few different symptoms but frequent full-body paralysis could use “minutes paralysed” or “percent of body paralyzed” as a gage to the severity of the attack.

Draw a vertical line on the left and label it “Hours since last meal”.
Make the line tall enough to chart six or seven hours with one hour per each box.
Draw a horizontal line along the bottom of the page and label this one “Number of Symptoms”.
Male the line long enough to account for your worst symptom day with one box for each time you have symptoms.
Now go to your log.
Rate the severity of the attack by counting the number of symptoms logged for that attack (say it is 5).
Then count over from left to right along the horizontal line and shade in the box that matches the number of symptoms (in this case 5).
Next, count back from the time of that attack till your last meal (say it was 6 hours ago).
Count up the vertical line to the 6^th hour and shade that horizontal strip.
Where the lines intersect, put an “X”.

In the example below, this first comparison is shown grayed out. Other comparisons are also graphed. You'll notice a series of X's that slope up and right. This indicates a strong correlation between the hours since the last meal and the number of symptoms in an attack.

Scatter Plot for Hours Between Meal and Symptoms
Hours
7
6
5
4
3
2
1
Number of Symptoms	1	2	3	4	5	6	7	8	9

Another example would be looking for a correlation between sodium and potassium intake and symptoms. You can actually use the same graph to chart two similar triggers. This time, the vertical axis is labeled “Milligrams of Sodium and Potassium”. The horizontal axis remains “Number of Symptoms”. You will chart correlations between symptoms and potassium with the letter “P” and with sodium by entering the letter “S”.

Of course, your log will have to include symptoms, plus milligrams of sodium and potassium consumed per day. This information is usually available from labels of foods, or from published nutrition guides. The amount of potassium in foods is often left off the labels. If there is nothing noted, that might be a an indication there isn’t much potassium in the food. People who are diagnosed with Hypokalemic Periodic Paralysis might just log their prescription potassium. Remember that 25 mEqs to potassium is the same as 1,000 mg of potassium.

Scatter Plot for Sodium and Potassium
mg
7,000
6,000
5,000
4,000
3,000
2,000
1,000
Number of Symptoms	1	2	3	4	5	6	7	8	9

In this case, there is a strong positive correlation between potassium and symptoms. More potassium means more symptoms. However, there is no clear relationship between sodium and symptoms. A chart like this probably indicates this imaginary person has the hyperkalemic form of periodic paralysis and is (fortunately) not sensitive to sodium.

Summary

So now you know how to make a simple triggers and symptoms log. You know how to use a Pareto chart to find your most common triggers and symptoms. You can use the frequency plot and the stratified frequency plot to find related symptoms and triggers. Finally, you can use scatter plots to see relationships between triggers and symptoms. The logs and charts in the Quality of Life Assistant are some of the most powerful tools you can use to reduce your symptoms and improve your life. Your lifestyle choices, what you eat, when you eat, what you do how much you do, are so powerful that these activities can overpower the strongest drugs. Certainly, drug therapy is a major management key for many patients; however, reducing triggers is also a very powerful tool to reduce symptoms. Good luck.

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