Nutritional Considerations for Lymphedema

Posted April 19th, 2012 in Breast Cancer, Cancer Surgery, Recipes by Rebecca Lane

The function of a healthy lymphatic system is to collect
excess fluid, proteins, fats, inorganics and organics from the tissues, filter
it and return it to the bloodstream. Through its capacity as a filter, it protects
our body against disease and illness.

With lymphedema, excess protein-rich fluid leaks from the
lymph causing swelling, which decreases the oxygenation of tissues and
interferes with normal cell function. If the lymph stagnates, there is
potential for infection to occur (since the lymph contains bacteria) and excess
protein which remains in the tissues can begin to align and cause fibrosis.

Nutritional considerations for lymphedema include the
following key factors:

CALCIUM

The healthy flow of lymph is dependent on the presence of free calcium for good peristaltic action of the smooth muscles.  We have a tendency to look to milk as a good source of calcium (Ca), however milk contains too much protein to be an adequate supply of Ca. In fact, one of the key factors influencing Ca loss is high protein intake since protein creates an acidic environment in the body (the body constantly seeks to maintain blood pH at about 7.35). When the blood becomes too acidic it takes calcium from the bones and pulls it into the bloodstream where it acts to restore the proper balance.

Good food sources:

  • Green vegetables – spinach, collard greens, swiss chard, kale, romaine lettuce,
    celery, broccoli, cabbage, green beans, Brussels sprouts, asparagus
  • Citrus fruits
  • Herbs – basil, cinnamon, rosemary, garlic, mustard seeds
  • Nuts and seeds – steel cut oats, sesame seeds, almond
  • Sea vegetables

PROTEIN

Lymphedema is associated with the accumulation of protein in
the interstitial spaces. At the same time, protein is essential for repairing
and replacing tissues and muscles and building hormones, chemical messengers
and antibodies (to name only a few roles) in your body. Your body requires
protein with every meal.

Consider:

  • Choose healthy lean meat and fish protein – just one serving per day.
  • Use nuts, seeds, and legumes as alternative protein sources. Add them to
    salads, whole grains and steamed veggies for new taste options.

WATER

Water is an important component of lymph and is the
transport medium of the lymph system. It is very important to stay well
hydrated when dealing with lymphedema. Cutting back on fluid intake in an
effort to reduce the swelling can actually increase the swelling.

Consider:

  • Here’s a good rule of thumb to determine proper hydration levels: Drink enough water to turn your urine
    a light-coloured yellow
    – no odour and very little colour!
  • Avoid caffeine and alcohol which are mild diuretics. You can enjoy 1 to 2 cups
    of green tea which is full of antioxidants and anti-inflammatory
    compounds.

FATS

Since the lymph is also responsible for removing fats from the tissues and bloodstream, it is important to choose your fats wisely. Reduce the amount of saturated fat (from animal
protein), polyunsaturated fats and completely eliminate hydrogenated and trans fats from your diet (found in margarine and fried foods).

Choose good fats:

  • All of the hype about omega-3 fatty acids is completely valid. You need these
    essential oils for healthy cell membranes and brain health. They are found
    in fish oils, flax oil, hemp oil, walnut oil. I supplement my fish intake
    with EPA/DHA capsules, then use the nut and seed oils as dressing for
    salads, and steamed vegetables. They cannot be heated without going
    rancid.
  • For low heat cooking (less than 350 degrees F) you can use olive oil combined
    with vegetable or chicken stock to keep it cool – for steaming vegetables
    and light sautéing. For higher heat cooking used small amounts of coconut
    oil or butter.

SODIUM

Excess salt intake can increase the swelling of lymphedema as well as cause other health issues within the
body. High intake of sodium can lead to dehydration and is linked to high blood
pressure and heart disease. At the same time, sodium is an important mineral
necessary for the regulation of blood pressure and fluid volume to name just a
few of its roles.

Consider:

  • Consume no more than 1,500 milligrams of salt per day.
  • Take the salt shaker off the table, instead flavour with herbs, spices, seaweed
    and lemon juice
  • Limit the amount of processed foods you eat. When you do, read food labels
    carefully to determine the amounts of sodium and learn to recognize
    ingredients that contain sodium: a food with salt, soy sauce, salt brine,
    or any ingredient with sodium, such as monosodium glutamate, or baking
    soda (sodium bicarbonate).
  • In reading menus, look for words that signal a high sodium content, such as
    barbecued, broth, marinated, pickled, smoked and tomato base.
  • Fresh vegetables and fruits are a good source of appropriate amounts of sodium.

BODY WEIGHT

Excess body mass creates more work for the lymphatic system,
further with excess weight can come limited mobility, which reduces the
movement of the lymph and leads to stagnation and more swelling.

Consider:

  • Maintain a healthy, active body weight
  • Eat a balanced, healthy diet.  We strongly
    recommend eating 6 to 9 cups of vegetables and fruits per day, one to two
    servings of whole grains, and only one serving of animal protein per day –
    make that fish two to three times each week.
  • Make exercise an important part of your everyday routine. Whether walking,
    dancing, visiting the gym or enjoying fitness classes – find time to move
    and sweat every day.

Herbal Salt Substitute Recipe

Source: http://www.tasteofhome.com/Recipes/Herbal-Salt-Substitute

1 tablespoon dried basil

1 tablespoon dried thyme

1 tablespoon ground coriander

2 teaspoons onion powder

2 teaspoons dried parsley flakes

2 teaspoons ground cumin

1 teaspoon garlic powder

1 teaspoon ground mustard

1 teaspoon cayenne pepper (I use less – my family finds this a little too picante!)

1 teaspoon paprika

In a small bowl, combine all ingredients. Store in an airtight container in a cool
dry place for up to 1 year. Yield: 1/2 cup.

I also use Dulse or Kelp flakes instead of salt – or add large pieces of seaweed (Nori) to cooking water of soups, stews, and to flavour
pasta and rice.

 

Thanks to the following resources:

http://www.nhlbi.nih.gov/hbp/prevent/sodium/tips.htm

http://lymphalexa.com/2011/03/08/nutrition-lymphedema/

http://whfoods.org

The Encyclopedia of Healing Foods by Michael Murray, ND pp. 27-28

Lymphedema: Finding the Holistic Approach by Phillip J. Pollot, LMT

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Cancer Surgery – What you need to know ahead of time

Posted May 31st, 2011 in Angiogenesis, Breast Cancer, Cancer Surgery by Rebecca Lane

My view as I write this!

Yesterday I was flipping through my binder of cancer articles that I have collected, intending to read when I have the chance, and came across this article written by Dr. Steven Nemeroff, Oncology Health Advisor to Life Extension Foundation. Click here for the full article.

I am not a doctor, but I can give a ‘Coles Notes’ version of this article so that you can decide whether or not it contains information you would be interested in researching further and discussing treatment options with your MD, ND and oncologist. Knowledge is power!

As you probably know, the surgical removal of the primary tumor is the first treatment option for many cancers. The reason behind surgically removing the tumor is that once the tumor has been removed, then the body can be returned to health. Unfortunately this approach doesn’t take into account the reality that, in many instances, after surgery the cancer frequently metastasizes (spreads to another organ). This metastasis can be more serious than the original tumor – and can often prove fatal.

Metastasis of the tumor may occur after surgery as a result of cancer cells splitting off from the tumor and dispersing into the bloodstream or seeding directly into the chest or abdomen. To form a new tumor, that cell must first adhere to the lining of the blood vessel where it secretes powerful enzymes that break down the epithelial lining and basement lining of the blood vessel and allow the cell to burrow through the surrounding connective tissue and arrive at the organ that is its final destination. Here the cancer cell can multiply and form a new colony.

Given this information, what can individuals undergoing surgery to removal a tumor do to protect themselves against an increased risk of metastasis?

Cancer cell adhesion

Cancer cells that have broken away from the primary tumor utilize adhesion molecules – called galectin-3 – to adhere to clump together and thereby form colonies. These molecules are present on the surface of cancer cells and work like Velcro to allow free-standing cancer cells to stick together. Galectin-3 is also used by cancer cells circulating in the bloodstream to latch onto the lining of the blood vessels. This adhesion is a critical step in the tumor forming process.

According to Dr. Nemeroff, a natural supplement called modified citrus pectin (MCP) can inhibit cancer cell adhesion by binding to the galectin-3 adhesion molecules on the surface of cancer cells, thereby preventing cancer cells from sticking together and forming a cluster. MCP can also inhibit circulating tumor cells from adhering to blood vessel linings. There’s a lot of research that has been done to determine the efficacy of MCP and it’s available in this article. Most trial dosages have been 14.4 grams/day for one year.

In addition to modified citrus pectin, studies using Cimetidine (common name is Tagamet, an over the counter medication for heartburn) have shown that it inhibits cancer cell adhesion by blocking the expression of an adhesion molecule – called E-selectin – on the surface of cells lining blood vessels. This blocks the ability of cancer cells to latch on to the blood vessel walls.

The combined data suggests that at least five days prior to surgery, to ingest 800 mg of cimetidine daily and at least 14 grams of modified citrus pectin daily. According to Dr. Nemeroff, this regimen can be followed for a year or longer to reduce metastatic risk.

Preventing Surgery-induced Immune Suppression

The immune system plays an essential role in healing cancer. An important white blood cell to be aware of is the Natural Killer cells (NK). It’s role is to seek out and destroy cancer cells. However, surgery itself reduces NK activity! So without question, it is critical to actively strengthen the immune function by enhancing NK cell activity in the period before surgery.

One prominent natural supplement that can increase NK cell activity is PSK, a specially prepared extract from the Coriolus mushroom. Other supplements that have been documented to increase NK cell activity are garlic, glutamine, IP6 (inositol hexaphosphate), AHCC (active hexose correlated compound) and lactoferrin.

Pharmaceuticals used to increase NK cell activity include interferon-alpha and granulocyte-macrophage colony stimulating factor, as well as interleukin.

At least five days prior to surgery, institute a natural killer cell enhancing program involving PSK, lactoferrin, glutamine, garlic, IP6, and AHCC.

Cancer Vaccines

Produced from a person’s own cancer cells removed during surgery, these highly individualized cancer vaccines greatly amplify the ability of the immune system to identify and target any residual cancer cells present in the body. Cancer vaccines provide the immune system with the specific identifying markers of the cancer that can then be used to mount a successful attack against metastatic cancer cells.

Angiogenesis

Angiogenesis is the process by which new blood vessels are formed from pre-existing blood vessels. Cancer cells use this normal and necessary wound healing process in order to increase blood supply (and thereby oxygen and nutrients) to the tumor. The formation of a blood supply allows tumors to grow beyond the size of a pinhead – without angiogenesis they must remain 1-2mm.

The presence of the primary tumor serves to inhibit the growth of metastatic cancer elsewhere in the body. The primary tumor produces anti-angiogenic factors which restricts the growth of metastases. Surgical removal of the primary cancer results in the removal of these anti-angiogenic factors, and the growth of metastasis is no longer inhibited.

In fact, after surgery levels of factors that increase angiogenesis (to heal the wound) – called vascular endothelial growth factor (VEGF) – are significantly elevated. This can result in an increased formation of new blood vessels supplying areas of metastatic cancer – whether from newly formed colonies or from the activation of dormant micrometastases (those pinhead sized tumors that were before angiogenesis unable to be nourished by a blood supply).

Various nutrients have been shown to inhibit VEGF. These include soy isoflavones (genistein), silibinin (a component of milk thistle), chrysin, green tea (EGCG), and curcumin (also see other posts about angiogenesis).

Five days prior to surgery, the patient may consider supplementing with standardized green tea extract, curcumin, soy genistein extract and silibinin.

Surgical Anesthesia can influence Metastasis

The conventional medical approach to surgical anesthesia has been to use general anesthesia during surgery followed by intravenous morphine after surgery for pain control. The may not be the optimal approach.

Morphine weakens the immune system by diminishing NK activity. Studies on mice actually found that morphine increased angiogenesis and stimulated the growth of breast cancer.

One new approach is the use of conventional general anesthesia combined with regional anesthesia (only affects a specific part of the body). The use of regional anesthesia reduces the amount of general anesthesia required during surgery as well as decreasing the amount of morphine needed after surgery for pain control – especially for nausea and vomiting.

Those requiring morphine for pain control post surgery can consider asking for Tramadol instead. Unlike morphine, tramadol does not suppress immune function and has actually been shown to stimulate NK cell activity.

Less Invasive Surgery

Surgery places an enormous physical stress on the body. Surgeries that are less invasive, therefore less traumatic and less stressful, pose less risk of metastasis, compared to more invasive. An example of a less traumatic surgery for the abdomen, and pelvis is laparascopic surgery – where small incisions rather than large, are used.

For lung cancer, video-assisted thoracic surgery (VATS) is a minimally invasive surgery that you might want to consider.

Inflammation

Cancer surgery causes an increased production of inflammatory chemicals. These chemicals increase the activity of cyclooxygenase-2 (COX-2), a highly potent inflammatory enzyme which plays a pivotal role in promoting cancer growth and metastatis. It fuels cancer growth by stimulating the formation of new blood vessels feeding the tumor, by increasing cancer cell adhesion to the blood vessel walls, and enhances the ability of the cancer cells to metastasize.

Initially, COX-2 inhibitor drugs were designed to alleviate inflammatory conditions such as arthritis, but they have been shown to possess powerful anti-cancer activity.

A number of nutritional and herbal supplements are known to inhibit COX-2. These include curcumin, resveratrol, vitamin E, soy isoflavones (genistein), green tea (EGCG), quercetin, fish oil, feverfew, and silymarin (milk thistle).

Pharmaceutical COX-2 inhibitors include Celebrex and NSAIDS, such as aspirin and ibuprofen.

Conclusion

Since cancer-related death is most commonly the result of metastatic disease, it is crucial to minimize this facilitation. Therefore it is essential to be informed and employ preventative interventions during this critical time in order to minimize recurrence and metastatic spread.

I hope that you have found the key points of this article as interesting and important as I did. If you have any questions, please discuss this article with your MD, ND, oncologist – or give me a call and I can point you in the direction of answers.

Click here to link to the Life Extension Cancer Surgery Special Report with supplement guidelines.

 

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Going braless

Posted March 12th, 2011 in Breast Cancer by Rebecca Lane

My teenage daughter is absolutely appalled that I would even consider writing about this, but I have to let you in on an experiment that I’ve been doing.

I have always had large breasts, and have always worn very supportive underwire bras. I put it on first thing in the morning and take it off last thing at night. And my breasts have always hurt – sore, heavy and uncomfortable – especially around the time of my period.

After completing the Healthy Breast program I decided that I was going to try something different. For one month, I would spend time going braless. On days when I’m not going anywhere, I decided to spend the day braless. When going out, I bound up the girls and went on my way, but when I returned home I let them out for some air! And you know what, they really feel great!

They don’t hurt constantly anymore. I don’t have the soreness under my arms that I now realized was caused by a blocked lymphatic drainage system. I just finished a period during which my breasts did not hurt! I never realized how much that has affected me all my life.

So I urge every one of you to take off your bras whenever you can and let the body’s natural drainage systems work without any constrictions or blockages. The first couple of days are a little uncomfortable, but after that your breasts will feel much better.

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Eat your vegetables!

Posted March 9th, 2011 in Angiogenesis, Breast Cancer by Rebecca Lane

Your mother always told you to “eat your vegetables” and its no surprise that she was right. Interestingly enough, the compounds in fruits and vegetables (called polyphenols) that give them their beautiful colours, flavours and taste are the same compounds that have incredible healing properties.

Foods with high levels of healing polyphenols include soybeans, cauliflower, broccoli, cabbage, green tea, fava beans, kale, grapes and the spice turmeric.

Sipping approximately three cups of green tea has been shown to reverse breast cancer in laboratory mice by suppressing the gene that triggers the disease. A daily cup of broccoli sprouts, which has sulforaphane as an active compound, has been shown to reduce the risk of developing many cancers.

The full review is published in the journal Clinical Epigenetics and research more about angiogenesis and epigenetics to discover more about the healing properties of polyphenols.

Photo from http://therawendeavor.com/?p=122 – Yummy Kale Salad recipe!

Bromine Toxicity and Hyperthyroidism

Posted February 14th, 2011 in Breast Cancer, Bromine, Hormone Disrupting Chemicals HDCs, Vitamins by Rebecca Lane

Dr. David Brownstein – whose blogs I follow – posted this information today. I’ve just added in some nutritional information for your health!

Recently, the U.S. EPA reported that common chemicals (polybrominated diphenyl ethers– PBDE’s) found in nearly all our homes are contributing to a rash of thyroid problems. This class of chemicals is mainly used as a fire-retardant. PBDE’s are also found in a variety of household items including computers, televisions, carpeting, furniture and mattresses. PBDE’s are made from bromine. Bromine is also used to keep swimming pools and hot tubs clean. It is used as a pesticide, as well as in brominated vegetable oil which is used as an emulsifier in many citrus flavoured soft-drinks. (Source: http://en.wikipedia.org/wiki/Bromine)

Bromine is from the family of halides. This chemical family contains iodine, fluoride and chlorine as well. The reason we are seeing such a high prevalence of iodine deficiency and thyroid disorders in humans is due, in large part, to the excess exposure of bromine from our modern conveniences. Bromine exposure causes our bodies to excrete iodine. If we don’t supplement with extra iodine, bromine will bind to receptors in the body that are supposed to be binding with iodine. In effect, bromine will replace iodine throughout the body.

What are the consequences of excess bromine levels?
The consequences are severe; increased rate of cancer of the breast, thyroid, ovaries, uterus and prostate are due, in part, to bromine toxicity. Also, we are seeing dramatically increased rates of autoimmune illnesses including autoimmune thyroid disorders. People with a serious illness have markedly elevated bromine levels.

So, what can you do?
The main treatment for excess bromine is to avoid bromine exposure.  Eat foods that do not contain bromine such as organic fruits and vegetables. Avoid bread, pasta and cereal that contain brominated flour and citrus-flavoured soft drinks like Mountain Dew. Next, supplement with enough iodine to allow your body to detox from bromine – excellent food sources of iodine include sea vegetables (sea vegetables like dulse, kombu, kelp can be added to your cooking water, and soups and stews, and you can sprinkle it on top of food to replace salt – for more recipes, visit http://www.whfoods.com).

Finally, supplement with antioxidants like Beta Carotene, vitamins C and E, selenium and zinc that help your detoxification system function optimally.  It’s easy to recognize foods rich in antioxidants because they have the brightest colours. Enjoying a spectrum of different coloured foods will allow you to enjoy the benefits of a spectrum of antioxidants.

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Dr. William Li – Antiangiogenic Foods

Posted February 8th, 2011 in Angiogenesis, Breast Cancer by Rebecca Lane


Recently (September 2010), Dr. Oz interviewed Dr. William Li about his antiangiogenic research. Angiogenesis is the term used to describe the body’s ability to create new blood vessels and capillaries to heal damage to the body. While this is important to maintain homeostasis, there is another time when angiogenesis occurs – and thats when cancer tumors send out angiogenic enzymes and new capillaries are formed to feed the tumor. Not good – because this allows cancer cells to grow and divide at a much faster rate.Dr. William Li has developed several antiangiogenic drug therapies to stop angiogenesis to cancer tumors, but while doing his research he discovered that there are several foods that inhibit angiogenesis.How You Can Eat (and Drink) to Defeat Cancer Eating to defeat cancer can be accomplished simply by adding a few anti-angiogenic foods to your meals each day. Our diet is all about making choices. Since we all eat every day, why not choose foods that can reduce your risk of disease? Listed below are some food facts, supported by scientific research, to help you get the most cancer fighting benefits from your diet. 

  • Be picky. Red Delicious and Granny Smith apples have twice as many cancer fighters as Fuji or Golden Delicious apples. The San Marzano tomato contains more cancer fighters than any other variety. Wine grapes grown in cooler climates have more cancer fighters than grapes grown in warmer climates.
  • Eat Your Sprouts. Broccoli sprouts can contain more cancer-fighting properties than regular broccoli.
  • Dunk Your Teabag. Dunking a green tea bag up and down releases more cancer-fighting molecules than letting the bag just sit in the cup.
  • Cook Your Tomatoes. Raw tomatoes are good, but cooking them in olive oil is better. Tomatoes contain the phytonutrient lycopene which, when combined with olive oil, has very strong antiangiogenic capabilities.
  • Chew Your Greens. Chewing leafy greens helps to release enzymes that activate cancer-fighting molecules embedded deep in the leaves.
  • Go Soy. Fermented soy, like the kind used in miso soup, and tempeh, contains four times more cancer fighters than regular soybeans.
  • Choose one cancer fighting food for each meal. We eat at least 3 meals each day, that adds up to more than a thousand of cancer fighting food opportunites each year.
  • Foods from the brassica family are antiangiogenic – brassicas include broccoli, cabbage, cauliflower, bok choy, kale, Brussels sprouts, rapini.
  • Berries, like raspberres and strawberries, contain ellagic acid in their seeds. Ellagic acid is both an antioxidant and antiangiogenic.
  • Omega 3 EFAs – found in white fish like flounder and flax seed oil – are antiangiogenic.

There’s lots more of Dr. William Li’s research available at http://www.angio.org/.  Also, there’s another video of his lecture at TED that’s very interesting and informative.

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Breast Cancer – Intro and Stats

Posted February 3rd, 2011 in Breast Cancer by Rebecca Lane

Our entire body is composed of cells which contain their own DNA (genetic blueprint). In a healthy body, cells divide at a controlled rate and are used for growth and tissue repair and replacement.

If cells keep multiplying when new ones are not needed, a mass of tissue cells develops causing a growth or tumour. These tumours can form anywhere in the body and can be either benign (non-cancerous) or malignant (cancerous).

A malignant tumour that forms in breast tissue is called breast cancer. Malignant tumours grow uncontrollably and interfere with normal organ and metabolic functioning and have the ability to metastasize (spread to other parts of the body) and invade other organs or tissues. Breast cancer spreads principally through the lymph system and metastases are frequently found in the lungs, liver, brain and bone.

There are several different types of breast cancers, depending on where the tumours develop, with different doubling times and levels of metastases. Most often cancer cells start within the ducts (ductal carcinoma) or within the glands (lobular carcinoma). Ductal carcinoma is the most common type of breast cancer. (Canadian Cancer Society)

While a diagnosis of cancer can be frightening, the tumour itself is a symptom of a systemic underlying problem or combination of issues. When the immune system is healthy, it can kill off cells that have mutated and are not working properly. So the tumour is a symptom of an impaired immune system. There are many factors causing abnormal cell growth (more on this to follow), including damage from free radicals and imbalanced hormones.

Breast cancer is the most frequently diagnosed cancer in women, with more than one million cases occurring worldwide annually and is the second leading cause of cancer death in women, exceeded only by lung cancer.  The lifetime risk of developing breast cancer for Canadian women is one in nine. In 2010, it is estimated that 23,200 women will be diagnosed with breast cancer (only 180 men) and 5,300 will die from it (50 men). The 5-year survival rate is about 87 percent for women (84% for men). (Canadian Cancer Society)

The Hormone Diet – FREE E-class

Posted February 1st, 2011 in Breast Cancer, Hormone Disrupting Chemicals HDCs, Hormone Therapy by Rebecca Lane
Was just going through Facebook and found out that the Health Lady has organized a FREE e-class with Dr. Natasha Turner. To sign up – go to http://www.facebook.com/notes/health-lady/free-teleclass-the-hormone-diet-with-dr-natasha-turner/10150094687461450Date: February 10 , 2010Starts: 5:00 pm PDT / 8:00 pm EDTEnd: 9:00 pm EasternThis will be a great introduction to hormone health for those who are just learning about our wonderful endocrine system!

Raw Foods Witch

Posted February 1st, 2011 in Breast Cancer, Meatless, Raw Foods by Rebecca Lane
Today I found a wonderful voice on the web – the Raw Foods Witch. Her site is fun, informative and really does take the scary out of raw food. Further, she has taken her passion for food and made a fabulous, interactive, versatile site for everyone to use. You can input your recipes and it will “magically” make a grocery list for you. Even more, she has some great posts that really bring the whole in holistic to mind. When you get a chance, go visit her site, and stop by this great post: http://rawfoodswitch.com/alternative-health/breast-cancer-emotional-reactions-glimmer-hope/. Make sure that you sign up for her Cues – you’ll find yourself waiting for Wednesdays!Way to go Nathalie – great job! Thanks for providing valuable information without being militant about it.

Breast Self-Examinations

Posted January 24th, 2011 in Breast Cancer by Rebecca Lane

I’ve just added several breast self-examination video links to the resource section. Here’s what I’ve learned so far.There are two types of breast exams that are best done monthly so that you become familiar with your breasts and can recognize any changes. The first is a visual exam of the breast which includes looking at your breasts a. with your hands on your hips, b. with your hands above your head, c. with your hands behind your head, d. with your hands in front of your head, palms together and e. with your upper torso bent forward and hanging. With the visual exam, you are watchful for any changes to the breasts including dimpling, puckering, bulging, irregularities or changes in size. Also look for any changes to the nipples.The second type of breast exam is a palpation exam of which there are three different techniques: Spiral (move the 3 middle fingers from the outside of the breast toward the nipple in a circular motion), clockwise (move the 3 middle fingers toward the nipple then back out again through each of the time zones) or zig zag (move the 3 middle fingers from the underarm area from above the breast to below the breast moving slowly up and down until the whole breast has been examined). Choose the method that feels the most comfortable for you.  Regardless of the method that you choose, your objectives are to 1. Examine the entire breast; 2. Observe any abnormal changes; 3. Check under the arm and above the breast areas too. It is important to do it the same way every single time and create a breast map (I’ll be adding a pdf of a breast map for you to use) so that you can recognize when there are any changes.