This next section is in two parts. The first part everyone should do regularly themselves. The second part includes those details that need to be done by a doctor.

Breast examination
The size and consistency of women's breasts vary. Some women have very soft breasts others have lumpier feel. Each woman needs to know how her own breasts feel, so she can be aware of any changes. Even though most lumps are not cancer, they should be reported to the doctor urgently.  top of page link

Breast examination is only a little more than happens every time a women washes herself. Breast examination consists of two stages - looking for changes and feeling for changes. To start, stand or sit in front of a mirror and compare the outline of each breast. Do this first with your hands by your side, then on your hips and finally above your head. This gives three different profiles of the breasts. Look for any irregularities in the outline that might indicate a lump. 

The second stage is feeling for changes. You can do this standing, sitting, in the bath, lying in bed or however you are comfortable. Use the flat of your fingers and hand. If you pick up your breast with your fingers you may be able to feel any number of 'lumps' and you will be feeling the edge of the breast tissue. Make sure you feel all over. It takes a little while to get used to examining your breasts and learning how your breasts feel. Your GPs practice nurse will be happy to go through breast examination with you. .  top of page link

Testicular Examination
Testicular cancer is the commonest cancer of young men. If it is noticed before it has spread, 98% of men survive. It is better to visit your doctor with numerous false alarms than to miss a significant lump.

After a warm bath or shower, feel both testes in the palm of your hand. One testes may be lower than the other, this is normal. Feel each testes individually. Gently roll the testes between your fingers. It should feel smooth and slightly compressible. At the back of the testes, there is a softer part. This is the epididymis, where sperm is stored. It is attached to the spermatic cord (vas deferens) which transfers sperm to the urethra prior to ejaculation. Both testes should feel the same. It is important to be familiar with how your testes feel so that if there is any change is easily noted.

If you notice a lump, an increase in size of a testes or even just a heavy feeling in the scrotum, report this urgently to your own doctor.   top of page link

Lymph glands
The body has numerous lymph glands. These are places where the body produces white cells that fight off infection. Whenever there is an infection, lymph glands in the area increase in size to produce armies of cells and can then be felt. If someone has a sore throat, the glands in their neck become swollen. After an infection, the glands gradually reduce in size until they disappear or remain the size of a large raisin.

Every now and again it is worth checking to make sure you do not have any lumps. Feel your neck down each side, under the jaw line, and above the collar bone. Also feel under your arms and in your groins. Most people have one or two 'raisin' glands - (known as 'shotty' in the trade).

Most lumps are not serious, however if you do find a lump, check it with a doctor as soon as is convenient. In all cases, it worth being familiar with your own body so that you are aware of any changes. .  top of page link

Lumps elsewhere in the body  
There are numerous causes for lumps under or in the skin, including sebaceous cysts and lipomas. As with all changes, a single visit to the GP can provide the necessary diagnosis and an indication whether they need any further treatment. .  top of p age link

Moles  
Most people, especially those with fair skin, have a large number of moles. If a mole changes in any way, it is important that someone with particular experience has a look at it. If there is any doubt at all, the mole should be removed as soon as possible.

Significant changes include the following

a) change in colour, especially darkening

            b) increase in size

            c) redness around the edge

            d) itching

            e) bleeding .  top of page link

Pulse rate
The pulse rate varies considerably over the day, increasing during periods of stress or exercise and slowing during times of rest and relaxation. The pulse rate at rest is a generally an  indication of fitness, world class athletes will have resting pulse rate as low as 48 or 50, which might rise to 180 during exercise. For most people their pulse rate will vary between 60 and 150, it should be regular, mostly people will be unaware of their heart beating.

The pulse can be felt at the wrist, in the neck or in the groin or anywhere a large artery lies close to the skin. To feel the pulse at your wrist: Turn your left hand upwards. Gently place your fingers over the outside (thumb side), upper surface of your wrist. Relax for a few seconds and be aware of a pulsation beneath your finger.

To feel the pulse in your neck. Gently place your fingers in the angle between your jaw and your neck. Do not press. Relax for a few moments and be aware of a pulsation beneath your fingers. To count your pulse, find a clock or watch with a second hand. Count the pulsations over 15 secondsand multiply the number by 4.

Stress and physical exercise increases the pulse rate as the heart pumps faster to supply the muscles with oxygen. This may be in response to adrenaline (the 'fight or flight response') or during exercise in order to pump more oxygen to the muscles. Relaxation reduces the pulse rate.  

If your pulse rate is irregular or has frequent 'odd beats', this may indicate a problem with the heart or may be a result of too much caffeine, or alcohol or simply stress. It is advisable to check with a doctor who can organise an electrical recording of the heart (ECG) and if necessary for a 24 hour recording..  top of page link

Blood pressure
Average blood pressure is around 120/80. It can be as low as 90/70 in young people and increases to about 140/90 by the age of 70. During and after exercise blood pressure will increase significantly to levels of up 180 or 190 /100. For the rest of the time the lower the better.

It is important to have your blood pressure checked regularly (every year)  over the age of 40. This can be done at a GP's surgery. It is also possible to buy your own blood pressure monitor. This is probably only worthwhile there has been some concern about your blood pressure or you are on tablets for blood pressure. They are available from most large chemists and cost between £60 and £200. .  top of page link

Heart examination
Every child should have their heart ausculated on at least three occaions by a doctor as part of routine medical examinations. This will pick up almost all abnormalities. It is extremely rare to find a heart murmur for the first time in an adult. If you are fit and well, then there is very unlikely to be anything wrong with your heart.

The heart is on the left side of the chest and makes a 'lubdub ..lubdub' sound. A structural change to the heart changes the sound that the heart makes, this is known as a heart murmur. This would include abnormalities such a 'hole in the heart'. Most heart murmurs do not cause a problem, they should all be checked out with a doctor. It is possible to listen to someone's heart by using a tube of paper, with one end against the chest and the other to your ear. This was the original stethoscope..  top of page link

Lung examination
Both sides of the chest should move equally on taking a big breath in. Lung diseases such as TB, severe asthma and emphysema reduce the amount the chest can expand. Tapping or 'percussing' the chest shows whether there is any fluid in the chest, which might indicate a chest infection.

Listening to the chest (auscaltating) with a stethoscope at different points over the chest, allows the sound of the air moving through the lungs to be heard. (again, a tube of paper can substitute). These sounds are called the breath sounds. If there is a lung infection, asthma attack or other problem in the chest, then the breath sounds change accordingly. Sometimes with a bad chest infection or asthma attack it is possible to hear the wheezes as one breathes. .  top of page link

Abdomen

Normally the abdomen is soft and not tender to gentle palpation. By gently feeling each part of the abdomen, the state of the liver (upper right), stomach (upper middle), bowels (lower left and centre),  kidneys (back just below the ribs) bladder (lower midline) and ovaries (lower left and right) can be checked. .  top of page link

Brain and Nerves
Doctors rarely explain why they look into peoples eyes with a curious black and white baton called an opthalmoscope. There are two main reasons. Because of the clear structure of the eye, at the back of the eye it is possible to see blood vessels directly. (elsewhere blood vessels are covered by skin). The state of the vessels in the eye can indicate the state of the circulation generally. If someone has high blood pressures or diabetes, the blood vessels may be affected. In addition, at the back of the eye, there is a structure called the optic disc. This is the site where nerves from the eye go back towards the brain. The state of this disc reflects the pressure around the brain within the skull.

Thus when a doctor looks into the back of someone's eyes they are checking the state of their blood vessels and the state of their optic disc. This is particularly important for people with diabetes, high blood pressure and headaches.

People almost always know if there is something wrong with their nerves or muscles. These are a couple of quick checks you can do to reassure yourself. (It is safer do this with someone watching). Put your arms straight out in front of you, stand on one leg and close your eyes for a few seconds. It should be possible to maintain this position without falling over or moving your arms. Repeat for the other leg. If you can walk on your heels and on your toes, there is unlikely to be anything wrong with the muscles or nerves to your legs. 

Checking muscle reflexes with a patella hammer indicates whether there is any nerve damage. It is useful when there is a suspected ruptured disc that may be pressing on a nerve (sciatica). .  top of page link

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