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3. ¿Ha expulsado usted algún coágulo de sangre durante las últimas 24 horas?
No
Sí
4. En las últimas 24 horas, ¿cuántas toallas sanitarias utilizadas quedaron SATURADAS? (Favor de no incluir mini-toallas ni protectores de ropa interior).
_________toallas sanitarias (si no usó ninguna, anote 0)
5. En las últimas 24 horas, ¿cuántos tampones utilizados quedaron SATURADOS?
_________tampones (si no usó ninguno, anote 0)
6. ¿Cómo calificaría los CALAMBRES MENSTRUALES que sintió en las últimas 24 horas?
7. ¿Cómo calificaría cualquier DOLOR EN LA PARTE INFERIOR DE LA ESPALDA relacionado con el fibroma que usted haya sentido en las últimas 24 horas?
Ningún dolor en la parte inferior de la espalda
Dolor leve en la parte inferior de la espalda
Dolor moderado en la parte inferior de la espalda
Dolor severo en la parte inferior de la espalda
Dolor extremadamente severo en la parte inferior de la espalda
8. ¿Cómo calificaría cualquier DOLOR ABDOMINAL relacionado con el fibroma que usted haya sentido en las últimas 24 horas?
Translation - Spanish Daily log of bleeding and symptoms of the uterine fibroma (fibroid tumor)
For each question, please choose the response that describes your experience DURING THE LAST 24 HOURS.
1. Have you experienced any menstrual bleeding OR spotting in the last 24 hours?
No
Yes
2. How would you classify your MENSTRUAL BLEEDING in the last 24 hours?
Spotting
Light flow bleeding
Moderate flow bleeding
Heavy flow bleeding
Extremely heavy flow bleeding
3. Have you passed any blood clots in the last 24 hours?
No
Yes
4. In the last 24 hours, how many of the feminine pads that you used became SATURATED? (please do not include mini pads or panty liners)
__________ feminine pads (if you did not use any, put 0)
5. In the last 24 hours, how many of the tampons that you used became SATURATED?
__________ tampons (if you did not use any, put 0)
6. How would you classify the MENSTRUAL CRAMPS you felt in the past 24 hours?
No cramps
Mild cramps
Moderate cramps
Severe cramps
Extremely severe cramps
7. How would you classify any PAIN IN YOUR LOWER BACK that you felt in the last 24 hours, that is related to the fibroma?
No pain in the lower back
Mild pain in the lower back
Moderate pain in the lower back
Severe pain in the lower back
Extremely severe pain in the lower back
8. How would you classify any ABDOMINAL PAIN you felt in the last 24 hours that is related to the fibroma?
No abdominal pain
Mild abdominal pain
Moderate abdominal pain
Severe abdominal pain
Extremely severe abdominal pain
9. How would you classify any PAIN you felt DURING SEXUAL RELATIONS in the last 24 hours that is related to the fibroma?
I did not have sexual relations
No pain
Mild pain
Moderate pain
Severe pain
Extremely severe pain
Counseling will be needed for any answer of “I did not have sexual relations”.
10. How would you classify any PHYSICAL FATIGUE you felt in the last 24 hours that is related to the fibroma?
No physical fatigue
Mild physical fatigue
Moderate physical fatigue
Severe physical fatigue
Extremely severe physical fatigue
11. How would you classify any SWELLING you had in the last 24 hours that is related to the fibroma?
No swelling
Mild swelling
Moderate swelling
Severe swelling
Extremely severe swelling
I am a 37 year old wife and mother of 4. I was born and raised in the United States and English is my primary language. My husband was born and raised in Mexico and Spanish is his primary language. We are both bilingual and college educated in English and Spanish. I currently interpret and translate for the Upper Cumberland Region Health Departments and for Tennessee Early Intervention. I have worked in the dental field for over 10 years, and I am very knowledgeable when it comes to the medical/dental/insurance fields. We also own a tax preparation business and, on a regular basis, we work with the hispanic community here in Tennessee.
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