Years ago now, when I was an undergraduate, I shared an apartment with four medical students. The guys and I would play Ping-Pong a couple of nights a week, with whoever wasn't holding a paddle calling out questions for the endless exams they had to take. By the last game I was inevitably convinced I had the disease of the night—bubonic plague, check; diabetes, check; Still's disease, check plus. If you had any kind of imagination (and as an English lit major I liked to think I had plenty), you could see yourself as a candidate for the direst diagnosis, because symptoms are often mundane to the point of ubiquitousness. What woman doesn't occasionally have "muscle and joint pain," "fever," "headache," and a "rash"? (That's classic dengue fever, by the way.) And so I joined cynicism about an individual's ability to self-diagnose accurately with an innate preference for denial, and spent the next 20 or so years pretty much ignoring whatever messages my body was trying to deliver. The one exception to this ostrich approach happened on a beautiful late August night at a party. My then husband brought me a glass of white wine, and as I lifted it to my lips, a wave of revulsion washed over me. "The wine is off," I whispered to him. He took a sip and said it seemed fine to him, but he would get me some red and see if I liked that better. Same story with the red—a few centimeters from my lips, the smell revolted me and I put the glass down. Minutes later, a little voice in my head said, "You're pregnant," and it was right, I was, so early into the pregnancy that it would be weeks before the home test confirmed what my body knew. After that news blast, however, I went back to completely ignoring the mind-body continuum, finding it hard even to say with any accuracy if I was tired or hungry.
The wake-up call came in the dentist's office a month ago, when I happened to read a report about the "silent killer"—ovarian cancer. The article, in a nursing magazine, noted that a study of almost 2,000 women who had been diagnosed with ovarian cancer found that virtually all of them had had symptoms, many for as long as a year before diagnosis. I was stunned, and while I realized that the symptoms (bloating, pelvic pain, etc.) perfectly fit my "mundane to the point of universal" theory, I was shaken that patient and doctor alike could have failed to heed so many warnings. People tell stories all the time about being saved by their gut: I heard one recently about a woman who dreamed she was in a prison camp, pressed up against the barbed wire. She was unnerved by the dream, and when it kept recurring, she had a premonition that she knew what it meant; she went to her family physician and asked to be tested for colon cancer. Her doctor resisted—a colonoscopy is an invasive procedure, the woman was young and in seemingly excellent health, there was no family history of cancer. He said no, she pushed, they danced back and forth until her determination won out and he scheduled the test. As you'll have guessed by now, the dream was right—she was in the early, symptom-free stages of colon cancer.
But the predicament of the women with ovarian cancer was different—they didn't need a supernatural prompt; they had hard evidence tapping on the glass wall of their consciousness day after day after day. I trust my gut, but I don't trust my ability to heed that polite little tap on the brain. The magazine story ended with a call to women to Listen to Our Bodies. It was advice I'd read many times before, but it occurred to me that I'd no idea what it meant. How do you listen to your body? Where do you start if, like me, you've spent decades ignoring it? Can you listen too intently and topple over into hypochondria as I did all those years ago around the Ping-Pong table?
The starting point is easy enough: Get a grasp of what's natural and usual for you and what isn't; you don't have to meditate on how you're feeling—you just have to raise your general level of self-awareness. As the saying goes, the first step is admitting you have a problem. If you have a headache, for example, don't immediately brush it off with an excuse like "I'm just tired." What you need to note with any symptom is, first, is it new (I'm bleeding heavily each month and didn't in the past); then, is it recurring (the fourth headache of the week?); and is it exacerbated (I used to be bloated a day or two a month, but now it's all the time). Leah Millheiser, MD, who is an instructor of obstetrics and gynecology at Stanford University School of Medicine (and a women's reproductive health research scholar for the National Institutes of Health), says we all have our own doctor inside of us, and that's what we need to tune in to. She has found in her practice that more and more women are doing so, especially younger women, who are likely to have grown up in a climate of dialogue with their physician rather than the Doctor Knows Best tropes of the past. "Television shows such as House and Grey's Anatomy have helped educate the audience that mundane-seeming symptoms can be hugely important," Millheiser says. "Listening to your internal voice—which we all have, telling us when something is out of whack somehow—should make us all self-diagnosers. It's good to be an advocate for yourself and say, 'I think these symptoms might mean I have this condition.'" Obviously the Web has also played an important role in increasing patient advocacy, as has mass marketing by drug companies. (I can't be the only one who wishes we didn't have to hear about constipation or erectile dysfunction every night at dinnertime.) Consciousness, as we might describe listening to our bodies, is prompted by the current free flow of information. Indeed, a 2006 Consumer Reports questionnaire elicited responses from 25,184 readers about how they gathered information about a medical condition: Fifty-nine percent said they read books or articles, and 39 percent went to the Internet. Those are impressive numbers—the doctor within each of us is an increasingly well-educated specialist.
Where things get trickier, says Millheiser, is when we leap from self-diagnosis to self-treatment. "Here's an example," she says. "A woman who has chronic yeast infections might think, It's no big deal—I work out a lot, and take yogurt for its acidophilus, or grab an over-the-counter medication. But the symptom could indicate diabetes, or an autoimmune condition, or, very worst-case scenario, HIV. So anything that's chronic or recurring or increasing in frequency needs to be brought to the attention of a physician."
Of course, breaking the "it's no big deal" cycle is more psychologically fraught than it might at first appear. When I asked a friend, who happens to be an immensely smart woman who works many hours a week, raises a child, and multitasks like the rest of us, whether she felt she listened to her body, she replied earnestly, "Oh, yes. I hear it loud and clear—a new ache, the start of a fever—I hear it all, and then I yell at that little inner voice, 'Shut up, shut up, I don't have time to deal with this now!'" Avoidance is a factor Millheiser is well aware of: "This is the opposite of hypochondria," she notes. "Hypochondria is taking normal responses and turning them into symptoms of disease. But avoidance also plays negatively into a healthy awareness of your body, and what I try to stress is perspective. Say, for example, a woman is resisting a test such as a mammogram—she's too busy, it's too painful—I suggest she ask herself, Is this avoidance reasonable; is the test or the bringing of a symptom to a doctor's attention truly worse than the consequences of the potential disease?"
As Andrew Weil, MD, has pointed out for decades, the consequences of not listening to your body are profound: "Unless you learn to notice and be bothered by the early, subtle stages of illness," he warns in Health and Healing, "[you] will find yourself more and more dependent on...the costly interventions of modern hospital medicine." Unfortunately, once you are effectively listening to your body, the next challenge can be getting your doctor to listen as well as you do. Most of us have been brushed off at least once by our doctor: My personal low point was when I mentioned to a leading Manhattan internist that I felt tired all the time, and he looked me up and down and said, "You've put on weight; it's probably that." (I switched doctors shortly thereafter when it dawned on me that he had not wondered why I'd put on weight; an autoimmune condition turned out to be the culprit, and once that was under control, the pounds and exhaustion went away.) Millheiser advises, "If you tell a doctor a problem you're having and he says, 'It's nothing; just change your diet, add a little fiber,' do what you're advised, change your diet, avoid triggers, but if after a week to ten days there's no improvement, you have to go back and say, 'It's not nothing.' If need be, ask for a second opinion. You're not there to please the physician; you're there to stand up for yourself. You have to be the number one advocate for yourself."
Neil Shulman, MD, who uses the term body-illiterate for those, like me, who know less about our body than a good driver knows about her car, sees huge benefits to becoming literate: No other preventive measure would allow us to save more lives in America and prevent more disability than if people knew what their individual red light warning signals were. That's probably the bottom line of why even laggards like me should get in the habit of respecting the doctor inside our own body enough to pay attention—if I don't listen, who will?
Frequent contributor Elaina Richardson splits her time between Saratoga Springs, New York, and New York City.