The first question I ask patients when they come into my office for the first time is, ‘Do you know how to do a self breast exam?’ Most women don’t, but self exams are so important. While they don’t change the mortality of breast cancer, they can change the morbidity – meaning that if you catch it earlier, you need less treatment. Even younger women, who aren’t as at risk for developing breast cancer, should get familiar with your breasts. Start early.
The second thing we really emphasize in the practice is healthy lifestyle choices. Plant-based nutrition, exercise, and stress management are all important.. More and more studies are developing data linking these lifestyle factors with breast health.
It’s super simple: you’re looking for the pit in the cherry pie. Soft changes or soft areas in the breast are normal. You’re looking for anything firm that feels like a pit, a seed, a cherry or a marble. These are the things that you always need to bring to the attention of your physician or healthcare provider.
When self-examining, you don’t want to miss any areas of the breast. Lightly use your fingertips to move in a circumferential fashion around the breast. Go up into the axillary region – or the region of the armpit – because that's where lymph nodes are located and accessory breast tissue can be. Examine the breast in a circumferential fashion and don’t forget to go up into the armpit. The shower is a great location for your self-exam, because the water increases the tactile sense of your fingers.
The timing and frequency of the exam is also super important. You want to do it in the first five to seven days of your period, because that’s when hormone levels are at their lowest. For women who still have their periods, I recommend day one of your cycle. For my post-menopausal women, I recommend the first day of each month. You don’t want to do an exam too frequently, because your mind will start playing tricks on you. Did I feel this yesterday? Did I not feel this?
You want to examine your breasts once a month, at the same time and location each month, making sure to examine all the areas, and you’re just looking for that pit in the cherry pie.
Fear is a normal reaction when going for a mammogram or self exam, but I try to telegraph to women that the earlier you find something abnormal, the more likely it is to be treatable and curable. You want to know your body; to understand your body. The discovery of early cancers or even pre-cancers can save you from developing an invasive cancer. If you find it early, it's potentially curable. You could save yourself a lot of years of longevity by doing these exams, instead of waiting for your doctor to find something later on.
The main block I hear from women when it comes to self-exams is: ‘I don’t really know what I’m looking for and I’m scared.’ I always recommend doing a breast exam with your physician, to go over the process in detail and learn what normal feels like. Then, you go home, and do a self-exam that same night. Get to know your breasts, because this is a normal, healthy exam for you.
Mass is the most common finding for a malignancy, but it’s important to remember that you can palpate solid masses or cysts that are completely benign. It’s important to have a healthcare provider who is engaged with you. You need to be able to pick up the phone that day and speak to them, to get evaluated quickly. Any mass or abnormality in the breast should be brought to their attention – including skin changes, dimpling of the skin or any changes in the nipple.
Breast pain is a little more elusive. A lot of women have cyclical, breast pain with each normal period, particularly during the second half of you cycle.. We typically don't think of breast pain as being an indicator of a malignancy, however, it can be. Any different or unusual pain for a woman should also be brought to the attention of her health care provider.
I always listen to that. Women are so in tune with their bodies. They know when something is off, when something is unusual, when something is not right. I take that very seriously. If my patient does not feel right, or their energy is off, those are really concerning complaints to me. These signals are sometimes hard to pin-point, but they always need to be taken seriously.
Sensuality is being connected to your body, respecting your body, enjoying your body. That appreciation for your body can be functional – my joints don’t hurt today – but it can also be a joyful, dynamic fascination of the body.
I started out as an engineer before switching to medicine. A lot of these engineering principles inform my practice. We know the body is a systemized machine – the hip bone is connected to the thigh bone – but we don’t always think of it as a system in medicine. When we medically deconstruct the body, we often think one system at a time. In engineering, you can’t do that, because if you only pay attention to one system, you’ll have the wrong reaction three steps down. Everything is connected. This knowledge has shaped my holistic approach to medicine.
But engineering also taught me that humans can’t engineer the human body. It’s a beautiful harmony beyond our man-made technologies. You see that in surgery. When we operate on a body, we rely on this beautiful machine to put itself back together. As a physician, my sensuality is rooted in a deep respect for that.
We need to take care of our bodies. You don’t leave a vintage car out in the rain to rust. You change the oil regularly. You get it tuned up. It’s amazing to me that a lot of individuals take better care of their cars than their bodies, when cars are replaceable. The body is not. To take joy in your body, to respect your body, comes with a deep desire for longevity. I wake up every morning fascinated by the human body and committed to caring for it.
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