If you are performing breast self-exams, try to do them once a month. The best time to do this is about one week after the end of your period. This is when your breasts are least tender and lumpy. During your period, your breasts can be lumpy because of hormone fluctuations.  If you don’t have regular periods, do the self-exam on the same say every month. If you don’t want to do it monthly, you can do an exam less often. It just depends on what you are comfortable with. One way to look for issues with your breasts is to look for changes in their appearance. Stand in front of a mirror without your shirt and bra. Place your hands on your hips. Press firmly down on your hips to engage the muscles, which will help you notice changes. Take note of any redness or scaling of the skin and nipples, any changes to the size, contour, or shape, and any dimpling or puckering to the area.  Check under your breasts as well. Turn side to side, lifting your breasts up so you can see underneath and on the side of them. Also look under your arm, holding your arm only part of the way up. This will prevent the muscles in your underarm from contracting too much, which will distort your perception of the area. The best position to perform a physical self-exam is lying down. This is due to the way the breast tissue flattens out evenly over your chest, making the tissues easier to examine. Lie down on your bed or couch with your right arm lifted above your head. Some experts suggest doing the examination while standing, or doing one standing in addition to lying down in order to make sure each layer of tissue is examined thoroughly. This can easily be done in or after a shower. You can choose which works best for you. Using your left hand, feel around your right breast. Start under your right armpit and press down gently but firmly at first. This will help you feel the first layer of tissue under your breast. Make small circles with your three middle fingers using the pads of your fingers, not your fingertips. Move your finger circles up and down the breast tissue, kind of like a pattern you make mowing a lawn, until you cover the whole breast and underarm area. Once you have moved over your whole breast, move in the same pattern again, making sure to press harder this time. This will reach further into your tissue and examine the under layers of tissue. It is normal to feel your ribs as you do this. Once you have finished cataloging the breasts, you need to check your nipples for any irregularities. Using light but firm pressure, squeeze your nipple between your thumb and forefinger. Note any lumps or if it expels any discharge. Once you have made your way across your entire right breast and nipple, repeat the procedure from start to finish on your left breast. Switch the arms behind your head and use your right hand to examine your left breast. The same procedure can be used to perform an examination while standing. If you feel any lumps, feel for the texture of them. Abnormal lumps of concern tend to feel firm or gritty, have irregular edges, and can feel as if they are stuck to your chest. If you feel anything that feels like this, call you doctor for an appointment as soon as you can to have it checked.  Many people have a hard time knowing which lumps in a breast are normal and which ones aren’t. One purpose of regular breast self exams is to get an understanding of which lumps are normal and which are new. If you are having trouble figuring it out, ask your doctor to show you what is normal and what isn’t. Your doctor may have a model that demonstrates this in their office. If the lump is small and doesn’t feel this way, you still should contact your doctor to make sure there is nothing wrong. There is no need to panic. Eight out of ten lumps are not cancerous.

Summary: Perform the test monthly. Perform a visual exam. Get into position. Start the examination. Repeat with more force. Check your nipple. Switch to the other breast. Contact your doctor.


Vitamin D3 (as opposed to D2) is recommended most often because it is the naturally occurring version of vitamin D in your body. D2 is poorly absorbed. Other possible names for vitamin D supplements include: Alfacalcidol, Calcifediol, Calcipotriene, Calcipotriol, Calcitriol, Colecalciferol, Dihydrotachysterol, and Paricalcitol. Vitamin D is a fat-soluble nutrient, which means that you need to have eaten a little bit of fat in order for the nutrient to be absorbed efficiently by your body. Fat-soluble nutrients (the other ones are A, E and K) take a long time to be absorbed and eliminated by your body because they are stored in your fatty tissues and liver.  Always take your vitamin D supplements with or right after you have eaten a meal. The food in your system will help your body to process this nutrient. It doesn’t seem to matter what meal you take your supplement with. The time of day does not appear to affect your body’s ability to absorb vitamin D. Certain medications interact with the absorption of vitamin D supplements and prevent healthy absorption. These medications include: Antacids, Lipitor, Dovonex, Lanoxin, Cardizem, Dilacor, Tiazac, Cytochrome P450 3A4 (CYP 3A4) substrates, Verapamil and water pills. Cofactors are nutrients that work together to help the body absorb as much of the nutrients as possible. For example, magnesium is known to be a co-factor of vitamin D. This means that eating foods that are rich in magnesium, or taking magnesium supplements, may help your body to absorb vitamin D more efficiently. Other nutrients that are thought to help your body absorb vitamin D include:  Boron. Foods that are rich in boron include almonds, apples, hazelnuts, dates, and avocados. Vitamin K. Foods that are rich in vitamin K include basil, kale, spinach, scallions, Brussels sprouts, and asparagus. Zinc. Foods that are rich in zinc include oysters, crab, beef chuck, fortified breakfast cereal, lobsters and baked beans. Vitamin A. Foods that are rich in vitamin A include sweet potatoes, carrots, kale, butternut squash, dried apricots, and romaine lettuce. People who are overweight tend to have low levels of vitamin D. This is because the fat cells in their body extract the vitamin D from their blood (vitamin D is fat-soluble after all) and thus vitamin D is kept from the circulation through their bodies. If you are obese, losing some weight may help you to better absorb vitamin D and increase your vitamin D levels. To lose weight:   Try to eat a healthy, balanced diet. The key to reaching a healthy weight is to make healthy choices when you eat.  Exercise regularly. In addition to eating healthy, you need to get your body moving in order to tone your muscles and burn off excess fat. As mentioned in the previous section, there are some medical conditions that can affect how your body activates vitamin D. In particular, weak kidneys can limit your body’s ability to activate the vitamin D that you consume (either through sun, food, or supplement). Talk to your doctor about options for treatment.
Summary: Choose the correct vitamin D supplement. Take your vitamin D supplement with the largest meal of the day. Examine your medications before taking vitamin D supplements. Consider increasing your intake of other nutrients that are cofactors of vitamin D. Lose some weight. Work with your doctor to try to treat underlying medical conditions that could be affecting your body’s ability to absorb vitamin D.