Posted in Super Momma

Toning up after giving birth: When &How?

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5 ft 4 inc 115lbs pre pregnancy
Most pregnant moms (99%!!!) cannot wait to get back to pre-pregnancy size; a smaller waist and firmer butt & thighs after giving birth. We lose a lot of strength in our core due to the over stretching of our abdominals and we lose core stability. Even though a new mom loses about 10- 15 pounds after delivery, the million dollar question remains to be “when can I start working out again?”

Once you are discharged home, the first week you will be very busy with your newborn especially if you’re a first-time mom. Healing time frames differ for vaginal delivery versus cesarean section. If you had a vaginal delivery, you feel very sore on your bottom for about 3 weeks. If you had a C-section, you feel pain on your incision site. I am sorry to say this but after a C-section, most activities will be achy. Every time you try to sit up, get in/out of bed, reach for something etc., you will have some aches/pain that will last for about 4-6 weeks.A vaginal delivery helping time is 6 weeks where a C-section is 8 weeks. Since many women experience abdominal separation, it is advised to wait out 6-8 weeks before you start any abdominal exercises. Best exercises to focus on initially are the ones that are going to keep you up right first.

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Still 5 ft 4 inc 155 lbs at 32 weeks
You can first start working on your mid back, shoulder stabilizers and your gluteals. These muscle groups will help you with proximal strengthening. What does that mean? These muscles will keep you upright, resist the pull of gravity and reverse the adverse effects of bad posture(s). Some shoulder exercises to perform are shoulders squeezes, wall slides, airplanes, angels and horizontal adductions. Some gluteal strengthening exercises you can do at home are clamshells, side lying straight leg kicks, squats (form is important for proper activation), butt busters and fire hydrants.

You can start in your core stabilization exercises with transversus abdominus activation(TrA). Very important ladies!! TrA is a deep stabilizer in your core that needs to be active to support a healthy good posture and protect your spine from any injury or simply prevent back pain. Waiting about six weeks on average after vaginal delivery is optimal before you start with any aggressive abdominal training that can include sit ups, crunches, reverse crunches, straight leg lowering etc. If you had a C-section, that time frame stretches to eight weeks to ensure soft tissue healing.

What exercises helped you the most to recover and get fit? Which exercises you liked? Which exercises you hated? Please comment below and let me know!

Stay awesome!

 

 

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Posted in Super Momma

Lactation circle: how is it important?

Why join a lactation Circle? Thats what I asked myself since I did not see the value in it in the beginning. Later on my views totally changed. Once awhile, it is good to be wrong!

Before being discharged home, I had the nurse as well as a lactation counselor teach me to how to express milk, educate me on how to position the baby, latching him on and the feeding schedule. The following morning, I had one more nurse and lactation counselor go over the same information. A breast feeding booklet was included with my discharge paper in case I needed to review the information. So, I felt pretty okay going home, even though, I didn’t know exactly what I was doing. They made it seem somewhat simple, my baby seemed to be latching on and feeding. It also had to come naturally, right? Yeah, right!!!

Shortly after we got home, things didn’t go as planned. My newborn was not latching properly and he was crying all night long because he was hungry. I was afraid I was gonna lose my milk supply so I kept on pumping to spoon feed him. Even then, he kept losing weight. It was on our second pediatrician visit when she realized he had a tongue tie and, he had to have the release when he was 10 days old. Our pediatrician wanted us to do lactation sessions with her right after tongue-tie procedure. She also said she didn’t accept insurance for one hour lactation service fee of $295. We were ready to do everything in our power to get him to feed properly but the money was a bit of an issue. I was on my maternity leave so we were trying to survive on one persons’s salary for over a month already. Our budget was tight and we were going to have to do multiple lactation sessions.

img_7042-jpgI decided to work with someone that I trusted if I was going to pay that much cash. What did I do? I turned to my midwives. During my first postpartum visit, I recalled my midwife telling me about their lactation circle that run twice a week. Giving their office a call, I found out it was a free service and no appointments were necessary. So, I started lactation circle an hour after his tongue tie release. Not the midwives, but a doula- Britt Sando- was running the circle. She welcomed me to the group right away. Not only she helped me with latching my baby on, we also weigh him before and after breastfeeding to see how many ounces he gained. She kept in touch with my pediatrician giving her updates on baby’s weight gain. It was not too long before I realized our lactation circle was more than just showing moms how to latch their babies on.

We met in person on Tuesdays but we could reach out to one another all the time. I was added to private Facebook lactation circle that already had 40+ moms sharing experiences, talking about good products to purchase, posting questions and helping one another. Whoever could make it to Tuesday sessions showed up, on average four to six people, but rest of the group met online. Many times I thought I was the only one going through a struggle, or when I was not sure what I was going was right or wrong, I would post on our Facebook group. Other moms would come to my help, comforting me by letting me know that their little ones experienced similar symptoms, behaved same way and what to do about it, how to resolve the problem. It was all OKAY, our struggles would pass. My lactation circle became my support group.

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When ege was born, 7 lb 15 oz
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Right after tongue tie procedure, he was about 6 lb 9 oz
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After extensive breastfeeding, he was almost 13 lbs in this picture

 

 

 

 

 

 

 

 

 

Having my son go through tongue-tied release was very hard; there was no anesthesia given since he was too young, I was asked to hold his head still as I watched the doctor approach him with a pair of scissors following his mouth filling with blood. As my mom says, every crisis has a blessing in it and this one led me to our lactation group. My advice to all the new moms is to find your local lactation circle which, is most likely to be a free service, and to join. You have nothing to lose but a lot to gain. When women support one another, incredible things happen!

I want to hear about your experiences. Please comment below and let me know what your thoughts and feelings are!

Posted in pregnancy, Super Momma

Switching providers during your prenatal care

https://www.tuftsmedicalcenter.org/-/media/Images/Slideshows/TuftsMC/640x357/Doctor_with_patient_6_640x357.ashxDuring the first 5 months of my pregnancy I was under the care of an OBGYN. When I found out that I was pregnant, I called my insurance company and inquired about a list of in-network providers in my area. After some research, I chose an OBGYN due to his 22 five out of five stars reviews online so I made my first appointment. The staff was great, he was a great doctor but I decided to switch to midwifery care when I was 5 months pregnant. Let me explain to you why…

My doctor was great; he had great credentials, great reviews and he was very professional with an awesome demeanor. He was also a medicine man. What does that mean? He wanted to rule out any possible disease or condition by ordering bunch of tests every time I had an appointment. His approach was “lets find out whats is wrong with your pregnancy” instead of “Everything appears to be normal and there is no reason why we need to predict otherwise.” His suspicion may be due to just to be on the safe side, that may be just the way he practices or just in case something went wrong, he would be covered since he would have the test results in my file.

http://www.npobgyn.com/assets/images/iStock_000016387993XSmall.jpgOur first two appointments went great. During later visits, he did not seem to engage in much conversation other than telling me what tests we needed to run next. He was very professional but I feel like I was another patient for him, I did not feel a connection. This loss of connection may be due to males do not like to talk too much and/or I was having a normal pregnancy so there was not much to discuss.

The biggest reason why I switched to midwifery care was when I told him that I wanted to do a natural birth, he was certain that I would need an epidural and a possible C-section. His argument was that since the medicine has come far, why was I going to suffer from pain while I could be pain-free?

850d12e2ff165f05135772cda1bbc8d4I wanted to be in more control of my labor experience and I did not 100% agree with hospital regulations. As females, we know what we want, we are strong headed and independent until it comes to giving birth. We give up all control and let someone else be in charge of our birthing experience. I wanted to give my best shot by trusting my body that it is capable of doing what it is supposed to do, and not let anyone tell me that I could not move and had to lie down and stay still, or I needed pitocin because I was taking too long to dilate or I needed some epidural for pain because I was screaming too much. Do not get me wrong, there are situation where medication is indicated due to dangers of complications however I did not want to expect the worst going into labor.

Every woman is different; everyone’s goals are different, every female’s medical history and health status is different. I am not telling you what you need to do or who to trust. My advise to you is interview your provider before you finalize your decision. Do your research, there is a ton of information on the internet, on the books and talk to other mothers to learn from their experiences. Be in charge of your own care and make educated decisions.

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I would like to hear about your perspective. What do you think? Please comment and let me know!

 

Images retrieved from:

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Posted in pregnancy, Super Momma

Travel regulations for pregnant women

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Do you have a trip coming up and are you aware of the regulations that you need to meet?

If you are traveling with a car or train, there is no clearance needed. However, if you are traveling with a plane, then there are some flying restrictions you need to be mindful of. You can always check with your airline when you purchase your ticket. I traveled when I was 29 weeks pregnant, and here are the regulations I had to meet during my travel:

  • No health report is necessary until the end of the 27th week of pregnancy.
  • Pregnant women expecting one baby can fly with a doctors report that states that they are for to fly by air carriage between 28-35 weeks. Past 35 weeks, you cannot fly even with medical clearance.
  • Pregnant women expecting twins or more can fly with a doctors report that states that they are for to fly by air carriage between 28-31 weeks. Past 31 weeks, they cannot fly even with medical clearance.
  • Medical clearance must be dated maximum 7 days prior to the flight.
  • Report must include doctors full name, license number and signature.

I would like to hear about your perspective. What do you think? Please comment and let me know!

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Posted in pregnancy, Super Momma

Weight gain during pregnancy

The first trimester is the toughest when it comes to eating and controlling your weight. You all know what I am talking about. You feel sick all day long, you cannot eat, even if you eat you may not be able to keep it in, and heightened sense of smell does not even let you look at some food groups. Controlling yourself in the first trimester is very hard and you are likely if you can eat some food then keep it actually in.

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During my first trimester I could only eat bagel with cream cheese, pizza, pasta with cheese and any citrus fruit. I could not stand garlic, hummus or anything green including salad spinach etc. I knew not eating would make me weaker and also I had to go to work so I would have a bagel in the morning, some fruit in the afternoon, then pizza and some soup in the evening. I knew I was not in taking nutritious food, but that’s what I managed to eat at that time. I was not too concerned either because I knew this period was transient and I was going to get some supplementation from prenatal vitamins. I was able to take control of my food intake, make healthier food choices and control my cravings as well as portion sizes better once my nausea settled.

http://www.babyyourbaby.org/images/pregweightdiagram.gifThe recommended amount of weight gain is 11-33 lb during pregnancy. If you are gaining less than 11lbs then your baby may be underweight and premature. If you gain more than 33 lbs, it will be harder for you to move around with all that extra weight, you may set yourself for gestational diabetes and/or high blood pressure, and it will be harder to lose all that extra weight post pregnancy. I know people who gained 50-70 lbs during pregnancy and unfortunately, it was really hard for them to get back to their pre-pregnancy weight since it took months and a big commitment and lots of sacrifice.

Tips to avoid excessive weight gain during pregnancy

woman-eating-two-burgersPeople will try to convince to eat whatever you want in large amounts because you are eating for two.

Learn to say no. Remember your baby only needs 300 calories on average a day so there is no need to double up your portions. All the extra calories are unnecessary and will be stored in your body.

P-portionControl-enHD-AR1Stop eating once you get full.

As your uterus keeps expanding into your abdominal cavity, there is will be less and less room so overeating will create a lot more discomfort for you. Pace your self and remember portion control.

fresh-produceAdd more fresh produce to your diet; keep them available in your fridge.

If you like to snack, have fresh produce and healthy snack ready in your kitchen. If you have good food choices such as hummus, yogurt, edemame, veggies or fruit in your fridge you are more likely to snack on those before you open a package of cookies.

e64cc62a2a20a84d7ad6404bdb80b760Drink water, keep hydrated!

Remember you may not be hungry, you may be thirsty. There is not really a recommended amount of water intake you need to reach. However, still ensure that you are drinking water not soda, coffee or all other zero calorie carbonated drinks. Remember nothing will replace water. If you do not like the taste of plain water, then try adding some fresh cucumber, lemon, mint, and/or strawberries for some flavor. You know what works best to make yourself drink more water.

Sweet tooth challenge 

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If you have a sweet tooth and it is hard for you to give up on cookies, cake, ice cream then definitely try portion control. During my first trimester, magnum brand double chocolate caramel ice cream bar would relieve my nausea. Weird right?! I would crave for it right before bed between 9-10 pm. After I put on 8lbs during my second month of being pregnant, I knew that habit had to stop. I started eating only half and saving the other half for the following night. Cut your portion size in half, eat slower for a prolonged satisfaction period and avoid from eating in front of TV since you can indulge a lot more without realizing.

Avoid packaged products and baked goods and take control of your cravings.

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Sugar is the #1 substance that 99% of the population is addicted to. There is sugar in everything especially in packaged products. More sugar you eat, more you will crave for it. During my pregnancy, I would crave for dates right before bed after I had my ice cream bar. I would tend to eat about 12-14 of them in one sitting and I know it a big sugar load for my system. I would try to hold off on that to have it when I wake up in the morning. More you expose yourself to late night snacking, more your body will store. If you can hold off on your cravings and eat in the morning, you are more likely to burn that off throughout the day.

If you are struggling with nutrition and weight gain, see a professional.

I am not a nutritionist or a dietitian and all the information that I offer on my website is drawn from my personal experience as a new mother. If you are really struggling with what to eat, want to learn more about different food groups and how they affect your body, also has weight issues, I advise you to see a professional who can guide and help you. You can definitely talk to your OBGYN, see a nutritionist or dietitian.

During my pregnancy, I really enjoyed reading and learning more from Mark Sisson’s Primal Blue Print book, and Primal Blue Print Cookbook as well as Quick and Easy recipe book. If you want to learn more about nutrition, making better food choices and how to make healthy food in seconds, these books are treasures that are definitely worth checking out.

I would like to hear about your perspective. What do you think? Please comment and let me know!

Images retrieved from:

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Posted in pregnancy, Super Momma

Essential exercises of the second trimester

good-pregnant-posture-Due to your growing baby and increased amount of relaxin in your system, your posture, your laxity and the way you move will start changing. You all have heard of Newtons third law: for every action, there is an equal and opposite reaction. When you are carrying a baby in your belly, the weight of the baby will change the way your spine is. You arch will get exaggerated, your core stabilizers will be inhibited, then your hamstrings will tighen up to put the “breaks on” to stop that forward pull. These are just some of the changes in your lower half.

Even though, we refer to our spine as neck, mid back and low back, in reality, our spine is made up of 33 bones that are interconnected via ligaments, muscles, and fascia. The point is if your curvature in your low back changes, it will eventually change your alignment in your neck. That is one of the reasons why pregnant women tend to suffer a forward head posture that also accompanies rounded shoulders and tight chest. As the weight you are carrying in the front increases, you can imagine the increased stress on your joints and muscles.

Following a program that consists of both stretching and strengthening is essential especially during your second trimester since your body is going under more stress as your baby keeps growing inside of you. If you have not started with a workout routine, this is the time for it! Do it asap.

If you can spare 20-30 minutes daily, performing couple stretches and strengthening exercises will be helpful during your pregnancy, labor as well as postpartum. You can either alternate your days as upper and lower half, or you can dedicate stretches to one day and leave strengthening exercises for the next day.

Upper half

Some stretches to focus on should be for your neck and chest. Doorway stretches are really good for your neck while seated stretches for both right and the left side of your neck will alleviate muscle tightness and spasms. After stretching what is tight, the next step is to strengthen what is weak. My favorite muscle groups to focus on are your triceps and upper back. You can either use weights or an elastic band for both exercises. Another choice is simply using your body weight. Tricep dips on the edge of a couch, modified push ups or regular push ups if you are able to, and/or planks will help you strengthen your upper back.

 

Lower half

When it comes to stretching, keeping your hips mobile and unrestricted will aid your low back pain and prepare you for labor. Hip flexors, adductors, hamstrings and calves are the muscle groups that need to be stretched. Holding 30-60 seconds shall be adequate hence it will allow muscle to start relaxing. Strengthening your abs is out of the question and crunches make it to the top of the exercises that you need to avoid while pregnant. Whet you can do instead is focusing on your deep pelvic muscles and gluteals. Kegel exercises, double leg bridges that you can advance to single leg later on, clamshells and again planks are great exercises. As the exercises get easier, you can also add 5-10 seconds holds for each rep.

deep-breath.jpgAn important tip to keep in mind to avoid holding your breath during exercising since it can also affect your blood pressure. You cannot vocalize, without taking a breath so  easiest trick is to count out loud while you are exercising.

I would like to hear about your perspective. What do you think? Please comment and let me know!

Tune in for more information and instructions on detailed exercise programs, until then stay awesome!

 

 

Images retrieved from:

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Posted in pregnancy

How to battle back pain during pregnancy

Hello everyone!

In my previous post I talked about why we develop back pain during pregnancy and in this post, we will talk about how to tackle the pain. Pre-pregnancy, I worked out 3 times a week  that consisted of cardio and lifting. When I stopped working out in my first trimester, I lost some of my muscle mass. That was not a good outcome for my body since I started developing some back, neck and pelvic pain. Four factors that can create back pain during pregnancy are losing muscle mass, postural changes, developing baby and hormones. Here are four ways how you can tackle back pain during pregnancy.

#1 Avoid standing or sitting for too long 

use-support-pillows-while-sitting-during-pregnancyAs you move along your pregnancy, your activity tolerance will change. As nausea and fatigue slow you down in your first trimester,  your growing belly will limit your activity tolerance in your last trimester.  Today, we all are used multi tasking where we go non-stop all day long. My advice to you is take it easy and take breaks to make it more manageable and less painful for your body. Avoid prolonged activity such as sitting or standing for too long. Being in a position for an extended period of time will increase the stiffness in your back. If you are sitting for an hour, getting up may be harder. If you are standing for an hour, you may start getting radiating pains from your back to your legs. Remember to give yourself adequate rest breaks.

mh5m455i7it6hzhj_oxn-wqA low back pillow such as OPTP lumbar support can also prolong your sitting tolerance. You can purchase it on Ebay or Amazon for under $20. This hot dog shaped pillow fits in the curvature of your back and supports your spine during sitting in front of TV, while you are at the dinner table or even while driving. You can take it with you anywhere. A little support for your back, will make it also complain less.

#2 Stick to your exercise program

Following an exercise program that consists of both stretching and strengthening is very important. Stretching will prevent over tightening of your muscles, while strengthening will keep your muscles active and engaged that will give the support for your growing baby and changing body.  20-30 minutes of daily exercising will be helpful during your pregnancy, labor as well as postpartum. When it comes to your upper back, the key is to stretch the front of your chest and strengthen your upper back. When it comes to your lower back, the key is to stretching your hamstrings, calves and hip flexors, while you strengthen you gluteals and deep core stabilizers.

Pilates and yoga are also great tools to use while pregnant. Pilates focus on core stabilization and hip strengthening while yoga focuses on improving overall flexibility, and strength by using your own body weight.

 

#3 Use a belt of support

If your back pain is hard to manage, then it is ok to get a little external support. I have a small frame and during my second trimester, I started getting some back and pelvic pain where I could not stand more than 10 minutes. When I was registering for my registry, I came across Medela Maternity support. Thinking to myself, “it is under $20 so can’t hurt to try”, I am glad I made the purchase. This belt provided gentle support for my low back which eased my pain. I was able to stand for longer periods of time which allowed me to attend some house chores. It is made of stretchy material so it did not dig into my belly as it gently lifted and supported my stomach. This belt attaches in the front via velcro system so it was easy to put on, adjust and take off. Hassle free! Definitely recommended!

 

#4 See a professional

pregnant-ptSeeing a health care professional throughout your pregnancy is a great idea. Even though, your ongoing aches and pains will stop once you give birth, alleviating those symptoms can be as simple as seeing a physical therapist or chiropractor as little as once a week, regularly. A health care professional can address any misalignments in your body, can use manual techniques to decrease muscle spasms, correct misalignments, and unlock aching joints. They can use tape to support your growing belly to alleviate your pelvic and back pain, give you tips on which exercises to perform to keep your musculoskeletal system as strong and efficient as possible.

I would like to hear about your perspective. What do you think? Please comment and let me know!

Do not miss my next post on essential exercises of your second trimester!

Stay tuned in, stay awesome!

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Posted in pregnancy

Drinking alcohol while pregnant

pregnant-women-red-wine-avoid-new-survey-514778Once of the most discussed topic of pregnancy is whether or not you can drink while pregnant. I think most people agree on the harms of excessive drinking, however the amount remains unsettling for many. But what is excessive? Is one cup a day excessive? Is one cup a month okay? Should you not risk anything and not drink at all?

Here is my take on this topic…

Whatever you put in your body, you are also sharing it with your baby. Even with the advancements in the medicine today, we still do not know how much alcohol your baby would be exposed to and the affects of the alcohol on your baby’s development when you drink. Also, each drink has a different amount of alcohol in it. A glass of long island tea contains way more alcohol than a bottle of miller light. So, I have a little conservative take on this topic but I am not for banning alcohol fully either.

During my pregnancy, I stayed away from hard alcohol. I was not a big drinker to start with so giving up on hard alcohol such as vodka, tequila, whiskey, rum etc, was not a big deal. I only craved for beer and/or wine occasionally. Whenever we went out to get burgers and fries, I would also crave for beer. Since I did not want to have an alcoholic beer, I would ask the bartender for a non alcoholic beer. I have to admit it did not taste the same but hey! I was still having a beer with my burger.

Some non-alcoholic beer options are

 

The list goes on and on and you got the point. There are non alcoholic beer options available if you like. On occasion, I also craved for wine. We all know that drinking one cup of red wine is actually healthy for your heart. Since it was good for your health, I did not bother with non-alcoholic version, which would be sparkling wine. Instead I consumed in very very little amounts. I had wine in three or four occasions during my pregnancy and each time I took 2-3 sips only, not gulps ,which was less than ¼ of a cup. Since my alcohol tolerance was already lowered, I got buzzed after I took two sips so I stopped.

When it comes to making a decision on how much drinking is too much, it is all up to you. You will hear a lot of opinions on this matter and some will be conservative, while some will be more courageous for you to drink. Listen to all, do your research, then come to a conclusion.

I would like to hear about your perspective. What do you think? Please comment and let me know!

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Posted in pregnancy

Myth of eating for two while pregnant

0404mathsIn this case, 1+2 is not equal 2. In many cultures, pregnant women are encouraged to eat more since there is a baby growing inside of them. 1+1= 2 right? So many people believe when you are pregnant, you need to be eating twice as much since you need to gain weight and also supply for your baby.

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The recommended amount of weight gain is 11-33 lb during pregnancy. If you are gaining less than 11lbs then your baby may be underweight and premature. If you gain more than 33 lbs, it will be harder for you to move around with all that extra weight, you may set yourself for gestational diabetes and/or high blood pressure, and it will be harder to lose all that extra weight post pregnancy. I know people who gained 50-70 lbs during pregnancy and unfortunately, it was really hard for them to get back to their pre-pregnancy weight since it took months and a big commitment and lots of sacrifice.

The truth is eating for two means your baby also gets some of whatever you eat, it does not mean you need to uptake twice as much calories. Your baby needs about 300 calories a day. If you count your calories or into reading food labels, then you know 300 calories can be a small portion meal or just a snack. Refrain from overeating and packing up extra weight.

I would like to hear about your perspective. What do you think? Please comment and let me know!

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Posted in pregnancy

Is my baby kicking?

During first trimester, morning sickness onsets due to change in hormone levels in your blood which is super important for babies growth and placenta formation. Sensitive stomach and heightened sense of smell is a primitive tool to keep you away from bad food. Majority of the women experience some sort of morning sickness and the duration varies.

2d792aea0f016e7f0aa3824450ac078eMany people gave me a positive perspective on being sick; my hormones were working, and my body was doing what it supposed to do so it was a good thing. Around 3.5 months, when the nausea stopped and I was pretty much back to feeling normal; I did not feel pregnant at all. First, you tell yourself not to be crazy, and you are ok. At the time, one of family friends had to go for a surgical abortion at 3 months because her baby’s heart stopped. You can imagine then I started fearing what if something happened to my baby? Early in the pregnancy, my plan was to not get ultrasound at every doctor visit. Once I entered second trimester, I could not wait for the ultrasound just to see my baby. When we went for our 4 months follow up visit, I was relieved to know he was ok.

11055916_843521119074265_2014033821_nFeeling the first kick or move is very exciting for both parents. I did not start feeling him kick or move until 4.5 months. It is different for every mother. Also feeling your baby move has to do with the position of your baby in relationship to the placenta. If your baby is lying on top the placenta then your baby is directly under your belly, making the barrier between you two less. If placenta is between your stomach and the baby, it will be harder for you to feel all the punching and the kicking that may be going on.

77308d530b3a2b7dc9507d21a1d56cdeThe period between the nausea stopping and baby starting to kick, maybe a little unnerving but do not worry. I was not thrilled at all regarding ongoing sickness during my first trimester, however when the nausea stopped and fatigue subsided, I started feeling not pregnant. Do not worry and panic! Your little one is probably safe and just hanging out which will be confirmed at your next follow up visit.

 

I would like to hear about your perspective. What do you think? Please comment and let me know!

 

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