Body Talk Handout - Dr. Michelle Robin€¦ · The Body Talk form helps you pause long enough to see all the different ways your body is or has been talking to you and then listen

BODY TALKMetabolic Assessment Form

7410 Switzer, Shawnee, KS 66203 | Tel: (913) 962-7408 | Fax: (913) 961-7416 | www.DrMichelleRobin.com

Your body talks to you. Are you listening? Do you know how? There are so many ways your body talks to you—through your skin, mucus, sleep, energy, hair, bowel movements, digestion and many other ways.

The Body Talk form helps you pause long enough to see all the different ways your body is or has been talking to you and then listen to it and capture what it is saying. This Body Talk form and tips can be a tool to spur discussions with your health care practitioners and help you identify and apply small changes you can make. Return to this assessment after you’ve made changes and notice if and how your scores change. It is all about making progress on your wellness journey.

How to Use:Take a few minutes to think about your health goals, then write down your top 2 or 3 in order of priority.

Next, go through each section of the Body Talk form, answering the questions about the frequency of the symptoms listed. Use this rating scale:

0 = never 1 = rarely 2 = occasionally 3 = frequently or always

As you go through each section, add up your total points. Sections with many 2s and 3s are areas of concern. If your score is higher than the following numbers for any of the areas, you will probably want to make changes in those areas.

Digestion: 0-10 mild concern, 11-25 moderate concern, 26+ severe concern Blood Sugar: 0-8 mild concern, 9-17 moderate concern, 18+ severe concern Nervous System: 0-14 mild concern, 15-20 moderate concern, 21+ severe concern Hormones: 0-10 mild concern, 11-25 moderate concern, 26+ severe concern Female Hormones: 0-10 mild concern, 11-20 moderate concern, 21+ severe concernMale Hormones: 0-8 mild concern, 9-17 moderate concern, 18+ severe concern

Reference the Body Talk Tips for suggestions of changes you can make to shift your well- being in the areas of most concern. Be mindful of how your body responds. If your 2s and 3s don’t improve after you implement changes, you should consult your physician.

© 2015 Dr. Michelle Robin. Updated Feb 23rd, 2015.


Instructions

Name: Current Date: Reassess Date:


Please list 3 major health goals in order of priority:1.

2.

3.

Please circle the appropriate number 0-3 on all questions below. 0 as the least/never to 3 as the most/always:


Name:

Alternating constipation and diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Coated tongue or “fuzzy” debris on tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Frequent use of laxatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stomach pain, burning or aching 1-4 hours after eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Feeling hungry an hour or two after eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Temporary relief from antacids, food, milk, carbonated beverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bitter metallic taste in mouth, especially in the morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unexplained itchy skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stool color alternates from clay colored to normal brown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Excessive belching, burping or bloating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Difficulty digesting fruits/vegs; undigested foods found in stools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Roughage and fiber cause constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Frequent urination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Increased thirst and appetite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . History of gallbladder attacks or stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Have you had your gallbladder removed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 3

yes no

DIGESTION

Have difficulty falling asleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Have difficulty staying asleep; wake tired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Get ill often . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Numbness and/or tingling in hands or feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Frequent Headaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Multiple car accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Limited flexibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . History of severe falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Have poor concentration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Wake up with pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Go to bed with pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Take over-the-counter pain medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Take prescription pain medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Have a condition that is unidentified by my medical doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 3

NERVOUS SYSTEM

Crave sweets during the day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Irritable if meals are missed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Depend on coffee to keep yourself going or started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eating relives fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agitated, easily upset, nervous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Poor memory, forgetful . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blurred vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Must have sweets after meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 3

BLOOD SUGAR

Current Date: Reassess Date:

Body Talk



Cannot stay asleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Crave salt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dizziness when standing up quickly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Headaches with exertion or stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Weak nails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tired, sluggish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 3

HORMONES

Pain and cramping during periods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Breast pain and swelling during menses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Irritable and depressed during menses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pelvic pain during menses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Acne break outs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hot flashes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mental fogginess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disinterest in sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mood swings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Facial hair growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Feel cold – hands, feet, all over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Depression, lack of motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Outer third of eyebrow thins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thinning hair on scalp, face or genitals or excessive hair falling out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mental sluggishness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cannot fall asleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Perspire easily . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Excessive perspiration or perspiration with little or no activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Heart palpations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inward trembling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Increased pulse even at rest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Under high amounts of stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 3

0 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 3

FEMALE HORMONES

Urination difficulty or dribbling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Frequent urination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Feeling of incomplete bowel evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Leg nervousness at night . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Decrease in libido . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Decrease in fullness of erections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Spells of mental fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Increase in fat distribution - chest and hips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 3

MALE HORMONES

I don't enjoy food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I have negative thoughts about my body image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I don't eat with people I care about . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I don't eat slowly and mindfully . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I am concerned with my memory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I am not committed to making changes in my well being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I am concerned about my alcohol intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I am concerned about taking medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 30 1 2 3

OTHER

SCORING

- Mostly 2’s and 3’s: You need to stop, make a course correction and take action in that area - Mostly 1’s and 2’s: You need to use caution, pay attention and start making changes in that area - Mostly 0’s and 1’s: You’re doing good in that area, keep moving

Think of it as if you are driving across country with a GPS. The more often you stop, pull off the road or take a detour (red), the more the GPS has to reroute itself. When the GPS is having to constantly recalculate and reroute, more energy is used, and your journey can become complicated. You need to make a course correction and take action to stay on the clearest route to wellness.



Body Talk Tips

Name: Current Date: Reassess Date:

Digestion• Chew you food (20-30 times per bite)• Drink 1⁄2 your body weight in ounces of water each day • Increase your veggies and fruits (unprocessed fiber)• Make time for restroom habits• Limit dairy products• Breathe deeply

Blood Sugar• Start your day with 20 ounces of water• Eat a good breakfast• Eat before drinking any caffeine or alcohol • Eat 3-5 times a day• Limit processed food• Get cardiovascular exercise

Nervous System• Establish a healthy bedtime routine; try to get 8 hours of sleep a night • Sleep on your back or side• Stretch 15 minutes a day &/or use a foam roller• Don’t smoke• Limit alcohol consumption• Find an outlet for your stress

Hormones• Get plenty of Vitamin D• Eat healthy fats (walnuts, olive oil, coconut oil, etc.)• Limit the amount of soy in your diet. Soy is used as a filler in many products; it is even used in plastic water bottles; soy increases the estrogen in your body• Limit artificial sweeteners• Do yoga• Limit the amount of gluten in your diet• Develop a great sleep routine

Body Talk Handout - Dr. Michelle Robin€¦ · The Body Talk form helps you pause long enough to see all the different ways your body is or has been talking to you and then listen

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