What Is a Breast Self-Exam?

The breast self-exam is a way that you can check your breasts for changes (such as lumps or thickenings). It includes looking at and feeling your breast. Any unusual changes should be reported to your doctor. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved.

How Do I Perform a Breast Self-Exam?

If you choose to do self-breast exam, follow the steps described below.

In the mirror:

1. Stand undressed from the waist up in front of a large mirror in a well-lit room. Look at your breasts. Don’t be alarmed if they do not look equal in size or shape. Most women’s breasts aren’t. With your arms relaxed by your sides, look for any changes in size, shape, or position, or any changes to the skin of the breasts. Look for any skin puckering, dimpling, sores, or discoloration. Inspect your nipples and look for any sores, peeling, or change in the direction of the nipples.
2. Next, place your hands on your hips and press down firmly to tighten the chest muscles beneath your breasts. Turn from side to side so you can inspect the outer part of your breasts.
3. Then bend forward toward the mirror. Roll your shoulders and elbows forward to tighten your chest muscles. Your breasts will fall forward. Look for any changes in the shape or contour of your breasts.
4. Now, clasp your hands behind your head and press your hands forward. Again, turn from side to side to inspect your breasts’ outer portions. Remember to inspect the border underneath your breasts. You may need to lift your breasts with your hand to see this area.
5. Check your nipples for discharge (fluid). Place your thumb and forefinger on the tissue surrounding the nipple and pull outward toward the end of the nipple. Look for any discharge. Repeat on your other breast.In the shower:
6. Now, it’s time to feel for changes in the breast. It is helpful to have your hands slippery with soap and water. Check for any lumps or thickening in your underarm area. Place your left hand on your hip and reach with your right hand to feel in the left armpit. Repeat on the other side.
7. Check both sides for lumps or thickenings above and below your collarbone.
8. With hands soapy, raise one arm behind your head to spread out the breast tissue. Use the flat part of your fingers from the other hand to press gently into the breast. Follow an up-and-down pattern along the breast, moving from bra line to collarbone. Continue the pattern until you have covered the entire breast. Repeat on the other side.Lying down:
9. Next, lie down and place a small pillow or folded towel under your right shoulder. Put your right hand behind your head. Place your left hand on the upper portion of your right breast with fingers together and flat. Body lotion may help to make this part of the exam easier.
10. Think of your breast as a face on a clock. Start at 12 o’clock and move toward 1 o’clock in small circular motions. Continue around the entire circle until you reach 12 o’clock again. Keep your fingers flat and in constant contact with your breast. When the circle is complete, move in one inch toward the nipple and complete another circle around the clock. Continue in this pattern until you’ve felt the entire breast. Make sure to feel the upper outer areas that extend into your armpit.
11. Place your fingers flat and directly on top of your nipple. Feel beneath the nipple for any changes. Gently press your nipple inward. It should move easily.Repeat steps 9, 10, and 11 on your other breast.

What Should I Do If I Find a Lump?

See your health care provider if you discover any new breast changes. Conditions that should be checked by a doctor include:

• An area that is distinctly different from any other area on either breast.
• A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
• A change in the size, shape, or contour of the breast.
• A mass or lump, which may feel as small as a pea.
• A marble-like area under the skin.
• A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed).
• Bloody or clear fluid discharge from the nipples.
• Redness of the skin on the breast or nipple.

I will probably not blame the patients for visiting Dr Titi’s clinic and partaking in her brews and concoctions or even religiously doing the daily instructed rituals believing beyond reasonable doubt that their illness will be cured, as they must have some form of trust in Dr Titi’s methods or we, the conventional doctors, must have failed them at some point in time.

With no doubt there must be an increasing number of people seeking this alternative treatment as the posters have become numerous .To crown it all, there are some who even print out fliers and thus it must be a lucrative business, but does it work?
Do they truly rid people of these ailments and if they do how? Does it mean the science of medicine we learn at school was not enough? It makes me hurt when I think about it, but I disagree that Dr Titi’s methods work.

I had the privilege of attending to one of Dr Titis’s clients a few years back. I met him in the operating theaters; he had been admitted as an emergency with acute abdomen. He was a hypertensive newly diagnosed who opted for one of Dr Titi’s treatment after being informed that he would be on a small yellow pill for the rest of his life and that he had to diet and exercise.
This was too extensive in comparison to a week’s treatment of some powder dissolved in water twice a day for a week followed by a sacrifice of a red cock. This treatment was cheaper too, it however cost him a section of his stomach which we had to cut off as it was corroded. He vowed never to repeat but the damage had already been done. It is true what they say cheap is always expensive in the long run.

Maybe we can blame the social economic status for his case, maybe still the doctor who told him of his medical condition. Many a time doctors just dump news of a chronic illness to patients without proper education and counseling on the new diagnosis. This leaves patients in a panic mode and without hope, which can lead them in to the hands of the like of Dr. Titi, who almost always declare they can cure about any condition. They instill Hope, something the patients really need at the time, which the Conventional doctors took away!

It’s not surprising that the elite and the educated attend these clinics too. I recently attended to one dignified client who confessed to drinking liters and liters of some herbal mix, intended to cleanse him of his HIV infection. He confessed to have felt much better immediately after wards and for the subsequent 4years, he was well. He however got a persistent cough recently and was told he had tuberculosis, a sort of reality check that his immunity had waned.

You have probably heard about Loliondo, haven’t you?  The retired pastor has been quite busy lately, what with the long queues lining up for magic cup? There has been lots of speculation onto whether the cup truly works or not, but this is not my objective. My advice is that you can take the cup, but still keep taking your regular medicines.

The crown jewel was a story of a herbalist from Bungoma county (my inspiration for writing this article actually). A client walked in to my office and told me her 9 year old daughter was using herbs which he purchases from Bungoma to cure her Sickle Cell disease and her “doctor” (herbalist) had requested for lab tests to see how she is doing and he handed me this piece of paper written Peripharal blood film (PBF) and Hemoglobin electrophoresis, believe or not, I was speechless.
These are the same tests we conventional doctors use to assess severity and response to treatment of the said disease! Do they teach this in herbalist school? Does it also take five years of reading volumes and volumes of books to be a herbalist? Or is this a MD turned rogue and decided to do it the traditional way? Too many questions and no answer. Attempts to change his mind about the herbs were obviously futile so for his sake and my sanity I ordered for the test …. I cannot wait to see the results.

As it is obviously clear Dr Titi’s clients are widely spread and many and hence we should not be surprised if we see the increase in the posters, who knows soon they might have a certified training institution, and this may be the way to go.
For we need the government to protect its citizenry from rogue and unscrupulous businessmen/women from exploitation. It is true that most modern medicines come from plants and herbs that we traditionally used for treating various ailments before the whites came to purify them. It is the practitioners of this trade we need protected and regulated, as we seek ways of standardizing herbal use and practice.

In my opinion the same government that is giving these traditional healers license to practice, since apparently they require one, should also make it illegal for them to administer any form of medicament that does not bear the “diamond mark of quality” from our dear trusted K.B.S as it is clear the market is bound to grow. Always remember that Dr. Titi’s clients are us, our relatives, our friends and our neighbors, and maybe if this was done we would avoid complications as highlighted above.

by Dr. T. Sarro

I know some very passionate young men and women who hold Bill Gates or Oprah Winfrey in high esteem. But mostly it’s because of their money and fame, rather than their business genius and ideology.
I may have seen Mr. Kofi Annan’s or Mr. Ocampo’s images around, probably because of their international eminence. Or is it because of the sensationalism of their subject matter? Or maybe some in their helplessness see them as their avengers in an unjust society….

What about musicians with serious criminal record? Ubiquitous is the word. Even the ‘Mamluki’ claimed their place in the Kenyan youth’s psyche. Have these guys worked for their great achievements? Of course, they have. But their success has been chequered by serious trouble with the law. Probably not the kind of guys you are looking for to model your teenage daughter.
It would be naive to say they have nothing to offer our young people. After all as they say, even a faulty clock is always right twice every day. But at least our youth should have choices on who to emulate. Of course the trajectory anybody’s life takes is dependent on the choices they make. And the choice of the people to look up to is one’s responsibility.
But then, mentorship is much more than just choosing a figure head to look up to. Furthermore you and I were once teenagers. The right choice even on the most basic issues isn’t always obvious.

Naturally, young people tend to be drawn to people with a dramatic sensational life story, whether good or bad. Few people are moved by the exploits of the boys in the British royal family for example. Do we expect anything less? What about the story of our very own Wangari Maathai. Her life has been far from trendy. But it is inspirational. Yet there’s no paucity of these men and women in our society. They are just unsung. We don’t glorify their values and achievements. We especially tend not to look up to accomplished professional leaders. Probably because the professionals are not available to mentor the youth. One way or another, this vacuum must be filled and guess who’s available? Yes, the media backed by all the ICT at the disposal of our youth is more than willing to feed these young minds with sometimes unthinkable material.

Mentorship should begin at home, because children are most impressionable before age seven. The opportunity to positively influence their behavior should not be missed, and they should be exposed to good models to establish a moral standard for the models that come later in life.
The choice therefore of who looks after your child at that age is critical. Once they hit teenage many have a hard time communicating with their parents and people in positions of authority like teachers. Even though you may not have absolute control over whom they learn from, there are ways of guiding, there are ways of guiding your teen seek good models. Encourage him or her to take part in extracurricular activities led by good leaders e.g. religious youth groups, sports, volunteer community service etc. Occasionaly get involved in group activities with their friends. Besides knowing what kind of friends they keep, you could help another teenager in the group.

Have you found out who’s modeling your teenager? For the last three years I have been talking with many of them in school health education programs and the fact is that some teenagers are very impressive in their philosophy while others need serious guidance.

What is it that you can offer the youth in your home, neighborhood, at work or in a school of your interest? You think about that today…

Dr. P. Ndunda

The mobile phone companies have cashed in on this a developed the so called hands free devices.

One wonders what the main problem is. Is it holding the phone while driving and hence the need for a hands free device or is it the conversation on the phone that is distracting to the driver?

Well, many studies have been carried out in this regard and the results are very interesting as I will share with you.

A study carried out the Canadian Automobile Association found the overall relative risk (RR) of having an accident for cell phone users when compared to non-cell phone users averaged 1.38 across all groups. They also found that increased cell phone use correlated with an increase in RR that is RR of 0.78 for those making less than 1 call/day and 2.27 for those with more than 7 calls/day. (Claire, 2003)

The risk was much higher in women than men contrary to popular belief of multitasking.

In 2009 in the U.S. there was a reported 5,474 people killed by distracted drivers. Of those 995 were considered to be killed by drivers distracted by cell phones.

In a study comparing the effect of alcohol and the effect of driving while on the phone, it was noted that those driving within the normal blood alcohol limits exhibited less impairment compared to those using the cell phones. (Strayer et al 2003)
Other studies have also concluded that driving while using hands free is not any safer than using a hand held cell phone. This is because it is the increased “cognitive workload” involved in holding a conversation, not the use of hands, causes the increased risk (Redelmeier 1997).

The effects of sending a text message have also been noted to be more detrimental than retrieving one it has been found that drivers typically take their eyes off the road for an average of four out of six seconds when texting.

There you have it don’t drink and drive and now don’t phone and drive

References

Laberge-Nadeau, Claire (September 2003). “Wireless telephones and the risk of road crashes”. Accident Analysis & Prevention 35 (5): 649–660.

Strayer, David; Drews, Frank; Crouch, Dennis (2003). “Fatal Distraction? A Comparison of the Cell-Phone Driver and the Drunk Driver” University of Utah Department of Psychology.

Redelmeier, Donald; Tibshirani, Robers (February 1300, 1997). “Association between Cellular-Telephone Calls and Motor Vehicle Collisions” (PDF). The New England Journal of Medicine 336 (7): 453–458.

Dr Michuki Maina

The connection between sleep and general health is definite, though scientific research is yet to define how exactly so as involves various body processes. We have all more or less experienced that if we do not get enough sleep on a particular night we will probably wake up the next day mentally and physically fatigued, and probably go throughout the day feeling irritable and moody.
We will probably not be as productive as after having a good night’s sleep. The biggest function of sleep is to ‘rest and repair’ the body from the normal exposures of day to day life, including ultraviolet radiation. More proteins are made by the body during sleep than at any other time, proteins that form the building blocks of our body’s cells.

A short-lived bout of insomnia should generally not cause any panic. The bigger concern is with chronic sleep loss which can contribute to health problems such as a weakened immune system, weight gain, high blood pressure, increased risk of type 2 diabetes, reduced cognitive function and general anxiousness, to name but a few.

Conversely, the health benefits of a consistent good night’s sleep include improved learning and memory (maybe a possible factor as to why children learn and retain new information better and faster than adults), better concentration, less somnolence during the daytime, and better functioning of the body’s organs, including vital organs such as the heart.

FACT: Heart attacks and strokes are more common in the early morning hours.

Other benefits of adequate nighttime sleep include reduced risk of certain cancers, such as breast cancer and colon cancer, thought to be associated with increased production of the protective substance melatonin in the dark; for the same reason it is recommended to switch off lights and objects that radiate energy where you sleep (such as LED lights of mobile phone and computer screens), as this interrupts the body’s production of melatonin.

FOOD FOR THOUGHT: Doctors, nurses and other health care workers who work night shifts as part of their regular work routine are thought to be at a higher risk of developing cancer due to interrupted production of melatonin with increased exposure to light in the dark!

Further, sleep also reduces inflammation in the body (linked to various conditions including cancers and irritable bowel syndrome); and is important in combating the ultimate of all stresses – stress itself.

Now comes the shocker! Adequate sleep for the average adult ranges from 7 to 9 hours per night. Getting less than 6 hours per night of sleep over a long period of time predisposes one to all
the risks of chronic sleep deprivation. Furthermore, daytime napping (for a period of 15 to 20 minutes, and definitely not more than 30minutes) seems to provide added benefits – a study of 24,000 adults in Greece showed that those who napped several times a week, as opposed to taking a caffeine or sugary foods break, had increased energy levels for the rest of the day and had lower levels of stress and related conditions (such as heart disease).Early morning exercise versus late afternoon or evening exercise, as well as the oft repeated healthy balanced diet, have also shown to reduce the frequency of insomnia. Smoking is your enemy in your search for adequate sleep.

So, draw the blinds, turn out the lights, and sleep your way to better health!

… By Dr. Jackie Mavuti

Do we need two ministries running the sector sometimes with overlapping mandate?
Shouldn’t we have a requirement that the chief executives of ministries be accomplished technocrats in their respective fields?

I believe the new constitution will see more professionals becoming cabinet secretaries, but I think we’ll need a law to prescribe the qualifications of these leaders. If there are qualified health professionals who can lead the ministry of health in this country, why appoint a civil engineer? Let him or her run the ministry of works, we need professional leadership there too.

We need to embrace more ICT application in the health sector. It’s good for the patient, the health care providers and the system as a whole, but that’s a story for another day. There’s need for the government and the private sector to support homegrown innovators in this field, some of whom have very exciting ideas.

Training of health care professionals needs to respond to the needs of the market. Should we standardize the training curricula for health care professionals countrywide at the expense of institutional autonomy and diversity? Should we relook into the role of some cadres like the clinical officer? Should we expand their roles, re-define their roles or scrape the whole cadre?
I was particularly intrigued by the suggestion of a respectable Gynecologist and researcher. He believes surgery is a skill and some less complicated operations like Caesarian Sections, which are a preserve of doctors, should even be widely done by well trained Clinical officers in rural areas.
Well, food for thought. There’s need to incorporate structured in-service training programs to upgrade the lower cadres and build capacity among health professionals. AMREF’s e-learning program in selected centers for upgrading enrolled community nurses to registered nurses is particularly impressive. The government should pick this cue and roll out the program to more centers and include more cadres.

As a country we need more clinical specialists. The number of specialists trained in the three Universities is not enough. We need to learn from the American Graduate Medical Education model where good private Hospitals are given incentives to begin Medical post-graduate programs without necessarily being affiliated to a University.
We have many hospitals that would offer good training in Kenya.

Corruption has for long been our Achille’s tendon. It has become so rampant I think it should be declared a national disaster. The fight can probably be modeled on president Moi’s approach to HIV/AIDS. Create ‘Corruption Control Units’ in the ministries and departments, staffed by the Kenya Anti-Corruption Commission, with the mandate to promote integrity, prevent and control corruption and undertake periodic audits in the departments. But this sanitization must begin at the very top. Next year we must elect a president and a legislature that have demonstrated the will to fight this national scourge.

Then there’s the National social insurance scheme that never saw light of day. They said we couldn’t afford it. What we can’t afford is failure to provide basic health care to our people. We will probably be hearing about that from our politicians next year as they seek our votes. Let’s find out if they have a plan for our health. If they don’t, let’s give them one.

Before next year however, there’s a lot we can do at a personal level. What percentage of motor vehicles is insured in Kenya? It’s nearly 100%. How about health insurance? Less than 4% of Kenyans have health insurance. How is it then that we don’t insure ourselves against an obvious risk? All of us at some point will get sick. Very sick. We just don’t know when. The cost of quality health care has become prohibitive in Kenya.
The good hospitals will require anything from sixty to hundred thousand shillings as deposit even before one gets admitted to hospital.
If you need ICU admission this deposit can go as high as half a million Kenya Shillings. In three days one can spend three hundred thousand in hospital bills for a simple ailment. Ten times what you could pay in annual insurance premiums. Failure to plan for that day that we need those emergency services can easily lead to either an unnecessary loss of life or a devastating financial catastrophe on individuals or families.
It does not matter what insurance provider you take, just get yourself and your loved ones into a health scheme that responds to your needs and that you can afford. There are many providers with plans for the different income groups. If you are reading this article, there is a scheme somewhere you can afford.

By Dr. P. Ndunda

A decade ago, critics of herbal medicine needed not point out the hard issue surrounding alternative medicine, namely; the credibility of the evidence supporting its use. The ingredients in the herbs were largely unknown let alone whether they worked, side effects, drug interactions etc). How would you quantify the active ingredients in the herbal mixture? They asked. When you get a bunch of roots to boil then you take a glass of the concoction three times per day, just how much of the ‘drug’ is in there?           There are many factors that determine how much substance gets dissolved in a solution after boiling a tuber.

But we now know the active ingredients in some herbal medicines. There are even tablets, capsules and syrups some with specific strengths of the ingredients in there. So what’s the big deal? The big deal is all about evidence. Understanding how a disease happens or how a drug works is important in guiding the choice of treatment, but evidence that the treatment works and is safe, rules. You see, I’d rather use 10Ml three times daily of pure honey to treat HIV without knowing how it works, If there’s credible evidence that it’s safe and it works better than the good old ARVs for which we’ve such a big body of knowledge. Just for the record, no such evidence exists.

Fact; there’s no evidence on what most herbs do. Fact; there’s poor understanding of how most herbs work. Fact; the herbal practice in Africa is largely unregulated. Any practice that touches on public safety must be backed by credible evidence and must be well regulated to protect unsuspecting clients. The consequences of taking a substance that’s untested are many. First, it might just work fine. Just might. Second, it may cause direct bodily harm. Third, even though it may not have any toxic effects, but it may not work and therefore delay much needed treatment and therefore worsen the disease outcome. Fourth, taking herbal preparations with drugs may have adverse interactions. Fifth, the financial burden of using ineffective treatments has major negative effects not only on individual clients but also on our health care system that is already cash strapped.

So, are we saying that herbal medicine has no role in health care? No. Just have the right information for you to make an informed choice. The internet, to which most of us turn to for information is awash with articles that are inaccurate in their content. I personally look for an authority in their field when I search information about anything on the internet. I recommend these links to the National Institutes of Health website for credible information on specific herbal ingredients and dietary supplements; http://nccam.nih.gov/health/herbsataglance.htm and http://ods.od.nih.gov/factsheets/list-all/. You may just be surprised what you find.

The proponents of alternative medicine have long campaigned for the incorporation of herbal practice in conventional health care centers. The bottom line here is; let us have the evidence on specific herbal products and we’ll use them to help our clients lead healthier quality lives, because that is what we live for.

….by Dr P. Ndunda

Chronic dehydration is probably the most common cause of a lot of our health ailments. There are two main reasons so many people are dehydrated these days. We eat less vegetables and fruits (which are water-dense) and more processed foods than we should. And we drink lots of caffeinated beverages instead of water. Caffeinated beverages and alcohol are diuretics. They force more water out of our bodies.
If a person is dehydrated their body compensates by retaining excess water as a protective measure. This alone is responsible for some excess weight. As well, a dehydrated person’s metabolism is significantly lower than a normally hydrated person.

Dehydration is responsible for many people’s feelings of fatigue. Many people have lost their sense of thirst and mistake it for hunger. Drinking a glass of water will usually greatly reduce any false hunger pangs.

So the solution to losing at least a few extra pounds sounds easy. Start with two glasses of room temperature water first thing in the morning. That’s before you drink coffee or eat your breakfast. Try to drink some water regularly during the day. And eat more water dense foods such as vegetables, fruits and even legumes.

I’ll get right on it. And I’d be keen to hear any feedback from people who’ve recently tried this for losing weight.

Everyone should bear in mind that cold temperature is a risk factor (for heart attack and stroke)

People especially at risk include those with high blood pressure, also known as hypertension, and patients with health conditions that require strict blood-pressure maintenance, such as diabetes and chronic kidney disease. But even comparatively healthy people aren’t entirely immune, he said.
Patients with hypertension should be very careful when they go out (in the cold).But normal people should take precautions as well.

Original Recipe Yield 2 cups

Ingredients

* 1 (8 ounce) package cream cheese, softened
* 1 (14 ounce) can sweetened condensed milk
* 1 teaspoon fresh lemon juice

Directions

1. In a medium bowl, blend cream cheese, sweetened condensed milk and lemon juice. Cover and chill in the refrigerator at least 3 hours before serving.