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Regular Checkups for Moms

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Depletion starts at the molecular level in your body, and it can go a long way before becoming really obvious. To stay healthy, you've got to catch little things before they get big: putting off checkups until you're ill is like searching the stable for clues after the horse has run away. For instance, Margie brought her two-year-old to the pediatrician and mentioned, only in passing, that she was four months' pregnant but had not yet seen her obstetrician (Ricki) because she had been unable to "organize" the appointment. Margie lost her train of thought a few times, but she reassured the doctor that she was only tired, due to still getting up at night with her daughter. Nonetheless, he was concerned about Margie, and he prodded her to see her obstetrician within the week. Based on Margie's fatigue, sluggish reflexes, and swelling in the skin other lower legs, Ricki ordered blood tests for thyroid, which showed dangerously low levels. Margie immediately began taking a thyroid supplement; within eight weeks she felt fine, and at twelve weeks, follow-up testing showed normal amounts of thyroid.

In another case, Carolyn came to see Jan for help with her nutrition. Flustered about arriving twenty minutes late to her first appointment, she made an offhand remark about feeling like there's no insulation anymore on the wiring in my brain. She had previously managed a high-powered career with aplomb, working as a senior editor on a major newspaper. But now, small hassles looked huge, and she always felt both tense and exhausted. In addition to receiving a routine physical from her family doctor, Carolyn had seen a knowledgeable endocrinologist, but that assessment had found no problems with Carolyn's hormones. Jan suggested testing her amino acids, and indeed, two important ones - tyrosine and taurine - had become seriously depleted. Jan arranged for Carolyn to get a balanced amino acid formula, and she began feeling much better after a couple of weeks. Looking back on what had happened, she said: I don't think I would have let things go so far before I had Chianna. You're coping with something new every day, and you're so tired that you just hold on and figure it'll get better. But, you know, I think I also sort of expected to feel not-great, so when I started feeling worse and worse, I thought it was normal for moms, or at least this one. If I had it to do all over again, I'd seek help for my health much sooner.

Most mothers see a physician for themselves just once a year, if at all, during their annual appointment with a gynecologist. And lab studies other than pap smears are not routinely done unless you mention a problem, something of concern is found during the exam*, or if you had health problems during a recent pregnancy. So it is important to take a moment before a doctor's appointment to reflect on how you are feeling, especially if you have changed providers since your last checkup. No one likes to complain. But health care providers can figure out what is going on and lend a helping hand only if they know how you are doing. So here are some suggestions for getting the most out of an appointment with your gynecologist, or another doctor.

Keep a personal health file. If you're concerned about a symptom or possible health condition, try to make a brief note about it in a daily diary. You could describe what you felt, the severity, how it changed during the day, and what seemed to make it better or worse (e.g., your menstrual cycle, supplements or medications, diet, stress). This information will be clarifying to your doctor or other health professionals, and it will also help you make sense out of how you're feeling. We aren't suggesting that you catalog every ache, pain, or blue moment. But it's important not to downplay physical or emotional problems.

In addition, keep copies of laboratory test results, notes from previous office visits, patient handouts, and so on together in a secure place. Along with your symptom diary, these will give you a highly useful personal health file. Be organized for the appointment. Bring your personal health file and a list of questions you want to address. Take notes during the appointment (or right afterward), so you can be sure about key points later on.

Be brave. Acknowledging the problems or sense of frailty you're experiencing can take courage. But your doctor can't know that you, let's say, are losing urine with coughing and sneezing unless you mention it. Similarly, if you feel worn out but it doesn't seem serious enough to mention, please remember that it really is, since fatigue is a symptom of many illnesses; be clear with the nurse or attendant when he or she interviews you that this is an important item to address with the doctor.

Tell your doctor about your history and any risk factors. For example, a family history of problems with the reproductive, endocrine, gastrointesrinal, or nervous systems increases your risk for depletion. Heavy and frequent menstruation may drain iron or suggest an imbalance in your hormones. Difficult pregnancies or miscarriages challenge a woman's body. A postpartum depression triples the risk of another one, and it may indicate underlying instabilities in the endocrine system. Past experiences of clinical depression, anxiety, trauma, or drug or alcohol abuse can suggest a vulnerability to the stresses of motherhood.

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From Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships by Rick Hansen, Jan Hansen, and Ricki Pollycove. Copyright © 2002 by Rick Hanson. Jan Hanson, and Ricki Pollycove. Used by arrangement with Viking Penguin, a member of Penguin Group (USA) Inc.

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