Allergy basics: Kid focused seasonal and food related

Dust, cats, peanuts, cockroaches. An odd grouping, but one with a common thread: allergies — a major cause of illness in the United States. Up to 50 million Americans, including millions of kids, have some type of allergy. In fact, allergies account for the loss of an estimated 2 million schooldays per year.

About Allergies

An allergy is an overreaction of the immune system to a substance that's harmless to most people. But in someone with an allergy, the body's immune system treats the substance (called an allergen) as an invader and reacts inappropriately, resulting in symptoms that can be anywhere from annoying to possibly harmful to the person.

In an attempt to protect the body, the immune system of the allergic person produces antibodies called immunoglobulin E (IgE). Those antibodies then cause mast cells and basophils (allergy cells in the body) to release chemicals, including histamine, into the bloodstream to defend against the allergen "invader."

It's the release of these chemicals that causes allergic reactions, affecting a person's eyes, nose, throat, lungs, skin, or gastrointestinal tract as the body attempts to rid itself of the invading allergen. Future exposure to that same allergen (things like nuts or pollen that you can be allergic to) will trigger this allergic response again. This means every time the person eats that particular food or is exposed to that particular allergen, he or she will have an allergic reaction.

Who Gets Allergies?

The tendency to develop allergies is often hereditary, which means it can be passed down through your genes. However, just because you, your partner, or one of your children might have allergies doesn't mean that all of your kids will definitely get them, too. And someone usually doesn't inherit a particular allergy, just the likelihood of having allergies.

But a few kids have allergies even if no family member is allergic. A child who is allergic to one substance is likely to be allergic to others as well

Common Airborne Allergens


Some of the most common things people are allergic to are airborne (carried through the air):

•Dust mites are one of the most common causes of allergies. These microscopic insects live all around us and feed on the millions of dead skin cells that fall off our bodies every day. Dust mites are the main allergic component of house dust, which is made up of many particles and can contain things such as fabric fibers and bacteria, as well as microscopic animal allergens. Dust mites are present year-round in most parts of the United States (although they don't live at high altitudes), and live in bedding, upholstery, and carpets.

•Pollen is another major cause of allergies (most people know pollen allergy as hay fever or rose fever). Trees, weeds, and grasses release these tiny particles into the air to fertilize other plants. Pollen allergies are seasonal, and the type of pollen a child is allergic to determines when symptoms will occur. For example, in the mid-Atlantic states, tree pollination begins in February and lasts through May, grass from May through June, and ragweed from August through October; so people with these allergies are likely to experience increased symptoms during those times.

Pollen counts measure how much pollen is in the air and can help people with allergies determine how bad their symptoms might be on any given day. Pollen counts are usually higher in the morning and on warm, dry, breezy days, whereas they're lowest when it's chilly and wet. Although not always exact, the local weather report's pollen count can be helpful when planning outside activities.

•Molds, another common allergen, are fungi that thrive both indoors and out in warm, moist environments. Outdoors, molds may be found in poor drainage areas, such as in piles of rotting leaves or compost piles. Indoors, molds thrive in dark, poorly ventilated places such as bathrooms and damp basements, and in clothes hampers or under kitchen sinks. A musty odor suggests mold growth. Although molds tend to be seasonal, many can grow year-round, especially those indoors.

•Pet allergens from warm-blooded animals can cause problems for kids and parents alike. When the animal — often a household pet — licks itself, the saliva gets on its fur or feathers. As the saliva dries, protein particles become airborne and work their way into fabrics in the home. Cats are the worst offenders because the protein from their saliva is extremely tiny and they tend to lick themselves more than other animals as part of grooming. Pet allergens are also present in dander, hair, and urine.

•Cockroaches are also a major household allergen, especially in inner cities. Exposure to cockroach-infested buildings may be a major cause of the high rates of asthma in inner-city kids
 
Common Food Allergens


The American Academy of Allergy, Asthma, and Immunology estimates that up to 2 million, or 8%, of kids in the United States are affected by food allergies, and that eight foods account for most of those food allergy reactions in kids: eggs, fish, milk, peanuts, shellfish, soy, tree nuts, and wheat.

•Cow's milk (or cow's milk protein). Between 1% and 7.5% of infants are allergic to the proteins found in cow's milk and cow's milk-based formulas. About 80% of formulas on the market are cow's milk-based. Cow's milk protein allergy (also called formula protein allergy) means that the infant (or child or adult) has an abnormal immune system reaction to proteins found in the cow's milk used to make standard baby formulas, cheeses, and other milk products. Milk proteins can also be a hidden ingredient in many prepared foods.

•Eggs. One of the most common food allergies in infants and young children, egg allergy can pose many challenges for parents. Because eggs are used in many of the foods kids eat — and in many cases they're "hidden" ingredients — an egg allergy is hard to diagnose. An egg allergy usually begins when kids are very young, but most outgrow the allergy by age 5. Most kids with an egg allergy are allergic to the proteins in egg whites, but some can't tolerate proteins in the yolk.

•Seafood and shellfish. The proteins in seafood can cause a number of different types of allergic reactions. Seafood allergy is one of the more common adult food allergies and one that you don't always grow out of.

•Peanuts and tree nuts. Peanuts are one of the most severe food allergens, often causing life-threatening reactions. About 1.5 million people in the United States are allergic to peanuts. (Peanuts are not a true nut, but a legume — in the same family as peas and lentils, although people with peanut allergy don’t usually have cross-reactions to other legumes). Half of those allergic to peanuts are also allergic to tree nuts, such as almonds, walnuts, pecans, cashews, and often sunflower and sesame seeds. Like seafood allergy, peanut allergy is one you don't always grow out of.

•Soy. Like peanuts, soybeans are legumes. Soy allergy is more prevalent among babies than older children; about 30% to 40% of infants who are allergic to cow's milk are also allergic to the protein in soy formulas. Soy proteins, such as soya, are often a hidden ingredient in prepared foods.

•Wheat. Wheat proteins are found in many of the foods we eat — some are more obvious than others. As with any allergy, an allergy to wheat can happen in different ways and to different degrees. Although wheat allergy is often confused with celiac disease, there is a difference. Celiac disease is caused by a sensitivity to gluten, which is found in wheat, oat, rye, and barley. It typically develops between 6 months and 2 years of age and the sensitivity causes damage to the small intestine in a different way to the usual allergic reaction
 
Other Common Allergens


•Insect stings. For most kids, being stung by an insect means swelling, redness, and itching at the site of the bite. But for those with insect venom allergy, an insect bite can cause more severe symptoms. Although some doctors and parents have believed that most kids eventually outgrow insect venom allergy, a recent study found that insect venom allergies often persist into adulthood. An allergy evaluation is needed if wheezing and other signs of anaphylaxis are present after an insect sting or bite.

•Medicines. Antibiotics — medications used to treat infections — are the most common types of medicines that cause allergic reactions. Many other medicines, including over-the-counter medications, can also cause allergic reactions. If you suspect a medicine allergy, talk to your doctor first before assuming a reaction is a sign of allergy.

•Chemicals. Some cosmetics or laundry detergents can cause people to break out in an itchy rash. Usually, this is because someone has a reaction to the chemicals in these products. Dyes, household cleaners, and pesticides used on lawns or plants can also cause allergic reactions in some people.

Some kids also have what are called cross-reactions. For example, kids who are allergic to birch pollen might have reactions when they eat an apple because that apple is made up of a protein similar to one in the pollen. Another example is that kids who are allergic to latex (as in gloves or certain types of hospital equipment) are more likely to be allergic to kiwifruit, water chestnuts, or bananas

Signs and Symptoms


The type and severity of allergy symptoms vary from allergy to allergy and child to child. Allergies may show up as itchy eyes or an itchy nose, sneezing, nasal congestion, throat tightness, trouble breathing, and even shock (faintness or passing out).

Symptoms can range from minor or major seasonal annoyances (for example, from pollen or certain molds) to year-round problems (from allergens like dust mites or food). Allergies to dust mites are common to the eastern parts of the United States, but not in areas of high-altitude and low humidity (for example, like Colorado).
Because different allergens are more prevalent in different parts of the country and the world, allergy symptoms can also vary, depending on where you live. For example, peanut allergy is unknown in Scandinavia, where they don't eat peanuts, but is common in the United States, where peanuts are not only a popular food, but are also found in many of the things we eat.

Airborne Allergy Symptoms

Airborne allergens can cause something known as allergic rhinitis, which occurs in about 15% to 20% of Americans. It develops by 10 years of age and reaches its peak in the early twenties, with symptoms often disappearing between the ages of 40 and 60.

Symptoms can include:

•sneezing

•itchy nose and/or throat

•nasal congestion

•coughing

These symptoms are often accompanied by itchy, watery, and/or red eyes, which is called allergic conjunctivitis. (When dark circles are present around the eyes, they're called allergic "shiners.") Those who react to airborne allergens usually have allergic rhinitis and/or allergic conjunctivitis. If a person has wheezing and shortness of breath, the allergy may have progressed to become asthma.

Food Allergy Symptoms

The severity of food allergy symptoms and when they develop depends on:

•how much of the food is eaten

•the person's sensitivity to the food

Symptoms of food allergies can include:

•itchy mouth and throat when food is swallowed (some kids have only this symptom — called "oral allergy syndrome")

•hives (raised, red, itchy bumps)

•eczematous rash

•runny, itchy nose

•abdominal cramps accompanied by nausea and vomiting or diarrhea (as the body attempts to flush out the food allergen)

•difficulty breathing

•shock

Insect Venom Allergy Symptoms

Being stung by an insect that a child is allergic to may cause some of these symptoms:

•throat swelling

•hives over the entire body

•difficulty breathing

•nausea

•diarrhea

•shock
 
About Anaphylaxis


In rare instances, if the sensitivity to an allergen is extreme, a child may experience anaphylaxis (or anaphylactic shock) — a sudden, severe allergic reaction involving various systems in the body (such as the skin, respiratory tract, gastrointestinal tract, and cardiovascular system).

Severe symptoms or reactions to any allergen, from certain foods to insect bites, require immediate medical attention and can include:

•difficulty breathing

•swelling (particularly of the face, throat, lips, and tongue in cases of food allergies)

•rapid drop in blood pressure

•dizziness

•unconsciousness

•hives

•tightness of the throat

•hoarse voice

•lightheadedness

Anaphylaxis can happen just seconds after being exposed to a triggering substance or can be delayed for up to 2 hours if the reaction is from a food. It can involve various areas of the body.

Fortunately, though, severe or life-threatening allergies occur in only a small group of kids. In fact, the annual incidence of anaphylactic reactions is small — about 30 per 100,000 people — although those with asthma, eczema, or hay fever are at greater risk of experiencing them. Most anaphylactic reactions — up to 80% — are caused by peanuts or tree nuts

Diagnosing Allergies


Some allergies are fairly easy to identify because the pattern of symptoms following exposure to certain allergens can be hard to miss. But other allergies are less obvious because they can masquerade as other conditions.

If your child has cold-like symptoms lasting longer than a week or two or develops a "cold" at the same time every year, consult your doctor, who will likely ask questions about the symptoms and when they appear. Based on the answers to these questions and a physical exam, the doctor may be able to make a diagnosis and prescribe medications or may refer you to an allergist for allergy skin tests and more extensive therapy.

To determine the cause of an allergy, allergists usually perform skin tests for the most common environmental and food allergens. These tests can be done in infants, but they're more reliable in kids over 2 years old.

A skin test can work in one of two ways:

1.A drop of a purified liquid form of the allergen is dropped onto the skin and the area is pricked with a small pricking device.

2.A small amount of allergen is injected just under the skin. This test stings a little but isn't extremely painful. After about 15 minutes, if a lump surrounded by a reddish area appears (like a mosquito bite) at the injection site, the test is positive.

If reactions to a food or other allergen are severe, a blood test may be used to diagnose the allergy so as to avoid exposure to the offending allergen. Skin tests are less expensive and more sensitive than blood tests for allergies. But blood tests may be required in children with skin conditions or those who are extremely sensitive to a particular allergen.
Even if a skin test and/or a blood test shows an allergy, a child must also have symptoms to be definitively diagnosed with an allergy. For example, a toddler who has a positive test for dust mites and sneezes frequently while playing on the floor would be considered allergic to dust mites

Treating Allergies


There is no real cure for allergies, but it is possible to relieve symptoms. The only real way to cope with them is to reduce or eliminate exposure to allergens. That means that parents must educate their kids early and often, not only about the allergy itself, but also about what reaction they will have if they consume or come into contact with the allergen.

Informing any and all caregivers (childcare personnel, teachers, extended family members, parents of your child's friends, etc.) about your child's allergy is equally important.

If reducing exposure isn't possible or is ineffective, medications may be prescribed, including antihistamines (which you can also buy over the counter) and inhaled or nasal spray steroids.
In some cases, an allergist may recommend immunotherapy (allergy shots) to help desensitize your child. However, allergy shots are only helpful for allergens such as dust, mold, pollens, animals, and insect stings. They're not used for food allergies, and someone with food allergies must avoid that food.

Here are some things that can help kids avoid airborne allergens:

•Keep family pets out of certain rooms, like your child's bedroom, and bathe them if necessary.

•Remove carpets or rugs from your child's room (hard floor surfaces don't collect dust as much as carpets do).

•Don't hang heavy drapes and get rid of other items that allow dust to accumulate.

•Clean frequently.

•Use special covers to seal pillows and mattresses if your child is allergic to dust mites.

•For kids allergic to pollen, keep the windows closed when the pollen season is at its peak, change their clothing after they've been outdoors, and don't let them mow the lawn.

•Keep kids who are allergic to mold away from damp areas, such as basements, and keep bathrooms and other mold-prone areas clean and dry
 
Injectable Epinephrine


Food allergies usually aren't lifelong (although those to peanuts, tree nuts, and seafood can be). Avoiding the food is the only way to avoid symptoms while the sensitivity persists.

Doctors often recommend that caregivers of kids who are extremely sensitive to a particular food, have asthma in addition to the food allergy, or are allergic to insect venom carry injectable epinephrine (adrenaline) to counteract any allergic reactions.

Available in an easy-to-carry container that looks like a pen, injectable epinephrine is carried by millions of parents (and older kids) everywhere they go. With one injection into the thigh, the device administers epinephrine to ease the allergic reaction.

An injectable epinephrine prescription usually includes two auto-injectors and a "trainer" that contains no needle or epinephrine, but allows you and your child (if he or she is old enough) to practice using the device. It's vital that you familiarize yourself with the procedure by practicing with the trainer. Your doctor also can provide instructions on how to use and store injectable epinephrine.

Make sure kids 12 years or older keep injectable epinephrine readily available at all times. If your child is younger than 12, talk to the school nurse, teachers, and your childcare provider about keeping injectable epinephrine on hand in case of an emergency.

It's also important to ensure that injectable epinephrine devices are available in your home and in the homes of friends and family members if your child spends time there. Your doctor may also encourage your child to wear a medical alert bracelet. It's also wise to carry an over-the-counter antihistamine, which can help alleviate allergy symptoms in some people. But antihistamines should not be used as a replacement for the epinephrine pen.

Kids who have had to take injectable epinephrine should go immediately to a medical facility or hospital emergency department, where additional treatment can be given if needed. Up to one third of anaphylactic reactions can have a second wave of symptoms several hours following the initial attack, so these kids might need to be observed in a clinic or hospital for 4 to 8 hours following the reaction even though they seem well.

The good news is that only a very small group of kids will experience severe or life-threatening allergies. With proper diagnosis, preventive measures, and treatment, most kids can keep their allergies in check and live happy, healthy lives

Children and Discipline:

After much reading and research, the following is the preferred method of parenting and dealing with behavioral issues (I use she but replace with he as needed):

Learning self-discipline
Learning self-discipline and respect for others is an absolutely vital part of growing up. Children need adults to be firm, clear and calm with them so they learn right from wrong and how to get along with others.It's important to set an example to your child. If she sees you shouting, losing control or lashing out she's more likely to do the same. Children learn by copying adults.

Communication
Communication is a huge part of good discipline. Right from the start it's important to talk with your child and to listen to her, too. Make sure she understands what sort of behavior you want from her and praise her whenever she does something well.
Children often find it hard to explain their feelings and may behave badly because they are upset or angry. If something goes wrong, encourage your child to talk about how it felt "you must have felt mad when Sam interrupted " and help her to deal with those feelings so she can handle the situation better next time.

Attention-seeking and positive discipline
Attention-seeking is often a cause of bad behavior. Children, especially when they are young, will do almost anything to get your attention and it can be maddening.
Positive discipline can work at home as well as at school. When it's safe to do so, ignore tantrums, whining and other attention-seeking behavior. Instead, encourage and reward good behavior with lots of attention.
Do be specific when you praise your child, too: describe what she did so she knows exactly what was so good. 'You're a good girl for helping your brother off with his coat without being asked' is clearer than 'Good girl for being so helpful'.

Sticker charts
You may find it helpful to try other positive discipline techniques, too. Using a sticker chart and be effective.
Make a chart which divides each day into manageable chunks. Award a sticker for each part of the day when your child behaves well. Give lots of praise and encourage her to keep going, especially if bad behaviour starts to appear.
A full day needs to be celebrated with lots of praise. A set number of stickers can lead to a small reward, such as a favorite film or a trip. The set number might range from two days to a week, depending on your child's needs. Make sure she is absolutely clear about the time frame. If rewards seem too far away the whole thing can feel impossible, but too many rewards can devalue the idea.

Sanctions or punishments
If you do need to use sanctions, they don't need to be severe. They just need to be explained in advance and to be consistent. So, if your child keeps doing something, tell her what she's doing wrong and explain what will happen if she carries on.
If she does carry on, make sure you follow through with exactly what you said you'd do, calmly explaining as you go why you're doing it. Do stay as calm and quiet as possible.
'Time out' can work well at home as well as at school, and can give you some space to calm down too. Tell your child to sit on the stairs or in a room for a short, set period of time. The room should be boring (no TV!) but safe. Carry her there if you need to and start timing. If she moves, simply put her back, explaining what you're doing, and start timing again.
At the end of the time, give her a hug and let her go back to what she was doing. If you need to, reinforce in a positive way what you expect her to do. At this point, though, the punishment is over: don't start telling her off now. If she begins to behave badly again, just repeat the whole process. She should get the message pretty quickly.

Distraction
Distracting your child if she begins to get tired or naughty can also work well, If children are starting to fight or misbehave, suggest another activity, such as a game, a toy, an activity or a change of scene. This can help to diffuse a scene before it gets going.

Shouting
Do try to avoid shouting and laying down the law. Too many rules can make a child feel confused or even defiant. A few clear, simple ones are much easier to stick to. Shouting may frighten a child into good behavior at first, but it won't help her to understand what she did wrong. It will also create drama. This may well encourage her to shout back or to shout at others to get her own way.

Lastly, do try to keep your sense of humor! Laughter can often diffuse a situation before it gets serious. It's also important to make time for yourself, too, so you can keep a sense of perspective. Bringing up children is stressful and you deserve a break from time to time!

Strep Throat: It is here in DFW

The signs of strep throat are far from subtle. A very sore throat will be your first sign. If you have the infection, it's pretty easy for your doctor to diagnose. A simple strep throat test or throat culture will be able to determine if you're infected.
Strep throat occurs when the Group A Streptococcus bacteria infects the throat and tonsils. This type of infection can happen to anyone, though it is most common in children and teens.

Strep Throat Symptoms

A sore throat is the most obvious symptom of strep throat. You're throat will feel very dry and scratchy. The soreness may make it painful to swallow food or drink.

A fever that comes on suddenly can be a symptom of strep throat. The fever can be severe or mild, but it will come on quickly.

Nausea can be a symptom of strep throat. The nausea may be mild or severe. If severe, you may also experience a loss of appetite. The nausea may also induce vomiting and general stomach pains.

A red throat, often with little white or yellow patches on the tonsils can be a symptom of strep throat. There may also be tiny red spots at the back of your mouth.

Swollen lymph nodes can be a symptom of strep throat. These nodes are located of both sides of your neck, below the jaw line. If touching this area is painful, the nodes are likely swollen.

A rash can be a symptom of strep throat. The rash will begin at the neck and spread towards the chest. If left untreated, the rash can spread over the entire body.

Strep Throat Treatment

Most strep throat infections only last about a week, but treatment is available. If you're diagnosed with strep throat shortly after the symptoms began, your doctor will most likely prescribe antibiotics to help fight the infection. However, if you wait too long to visit your doctor, the antibiotics will not help. You will have to just deal with the infection until it clears up on its own.

Cancer causing MYTHs

http://www.cancer.gov/newscenter/tip-sheet-cancer-myths

Myth: Antiperspirants or deodorants can cause breast cancer.


Fact: There's no conclusive evidence linking the use of underarm antiperspirants or deodorants with breast cancer, according to the National Cancer Institute.
Some reports have suggested that these products contain harmful substances such as aluminum compounds and parabens that can be absorbed through the skin or enter the body through nicks caused by shaving. No clinical studies have yet given a definitive answer to the question of whether these products cause breast cancer. But the evidence to date suggests these products don't cause cancer.
If you're still concerned that your underarm antiperspirant or deodorant could increase your risk of cancer, choose products that don't contain chemicals that worry you.

Myth: Microwaving plastic containers and wraps releases harmful, cancer-causing substances into food.

Fact: Microwave-safe plastic containers and wraps don't leak chemicals into your food.
But the Food and Drug Administration (FDA) says plastic containers not intended for use in the microwave could melt and potentially leak chemicals into your food. So avoid microwaving containers that were never intended for the microwave, such as margarine tubs or whipped topping containers.
Check to see that any container you use in the microwave is labeled as microwave-safe.

Myth: People with cancer shouldn't eat sugar, since it can cause cancer to grow faster.


Fact: Sugar doesn't make cancer grow faster. All cells, including cancer cells, depend on blood sugar (glucose) for energy. But giving more sugar to cancer cells doesn't speed their growth. Likewise, depriving cancer cells of sugar doesn't slow their growth.
This misconception may be based in part on a misunderstanding of positron emission tomography (PET) scans, which use a small amount of radioactive tracer — typically a form of glucose. All tissues in your body absorb some of this tracer, but tissues that are using more energy — including cancer cells — absorb greater amounts. For this reason, some people have concluded that cancer cells grow faster on sugar. But this isn't true.

Myth: Good people don't get cancer.

Fact: In ancient times illness was often viewed as punishment for bad actions or thoughts. In some cultures that view is still held. If this were true, though, how would you explain the 6-month-old or the newborn who gets cancer? These little ones haven't been bad. There's absolutely no evidence that you get cancer because you deserve it.

Myth: Cancer is contagious.

Fact: There's no need to avoid someone who has cancer. You can't catch it. It's OK to touch and spend time with someone who has cancer. In fact, your support may never be more valuable.
Though cancer itself isn't contagious, sometimes viruses, which are contagious, can lead to the development of cancer. Examples of viruses that can cause cancer include:

■Human papillomavirus (HPV) — a sexually transmitted disease — that can cause cervical cancer and other forms of cancer

■Hepatitis C — a virus transmitted through sexual intercourse or use of infected intravenous (IV) needles — that can cause liver cancer

Talk to your doctor about ways to protect yourself from these viruses.

Please visit this site for up to date information from the authorities: http://www.cancer.gov/newscenter/tip-sheet-cancer-myths

Lose weight/ not breast size:

It is Difficult but Not Impossible to Lose Weight without Losing Boobs

You can lose weight without losing boobs if you are specifically planning your workouts to target building muscle in your chest. Some equipment that might be useful to do this is an exercise ball, weight bench or loose dumbbells. If you belong to a gym you can find this equipment plus a dip machine there to use for this purpose. You might also want to speak to a trainer there and let them know your goal; they can make sure you are doing the exercises correctly.

Strength Training to Lose Weight without Losing Boobs

•Lift weights – For weight lifting, keep in mind that the heavier the weight is the more muscle it will build in your chest to maintain your boobs. Pick a weight that you can do about 8 repetitions of. Only complete 2 to 3 sets of repetitions a day for about 3 to 4 days each week.

•Chest flies – For this exercise you lay on your back on an exercise bench, weight bench or an exercise ball. Holding weights in your hands you will lift your hands above your to meet above your chest. Hold your arms in line with your shoulders while doing this lift. Once the weights meet you will then lower them back down until your arms are even with your shoulders again.

•Chest Presses – Lay flat on your exercise ball or bench holding weights above your shoulders with your elbows bent. Press the weights up and out over your chest and then slowly lower them back to the starting position.

•Pushups are great for building muscle in the chest. If you are not able to do the standard version on your hands and toes, you can get the same result on your hands and knees.

•If you have access to a Dip Machine perform dips to help increase your pectoral muscles and lose weight without losing boobs.

Low Repetitions to Lose Weight without Losing Boobs

When doing exercises that target your pectoral muscles you want to keep the repetitions low. Do a variety of exercises with minimal repetitions, unless you want to look like a body builder. Your goal is to build the muscle just under the breasts while you are losing weight so that the loss of fat is replaced with muscle and firmer tissue. This may be tedious, but all good things take work. Good Luck!