Who Gets In and Why

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I read a well-written book on the present, crazy state of competitive college admissions, called “Who Gets In and Why,” by Jeffery Selingo. There’s been constant media coverage over the years about how the college admissions process and final decisions seem stressful, overwhelming, and arbitrary and the book definitely brings some insight into this. See below for my list of takeaways from the book.

College admissions appears to have become a huge, imperfect, delicate matching monstrosity. On the one hand, colleges struggle to find students to meet various institutional needs (i.e. athletics, diversity of gender, race, socioeconomic background, legacy, finances, academics, etc.)  And even if the perfect balance of students to meet these needs are admitted, the actual yield (the number of accepted students who actually enroll) is another step that may throw everything off balance. 

On the other hand, students, in an unbelievably competitive environment, have to identify and apply to colleges where they will find the best financial, academic, and social fit. . . and be lucky enough to apply to schools that just happen to be needing students like them. 

Who Gets In and Why

Main Points

I wish I’d taken better notes while reading it, as I’m struggling to remember the details on some of my takeaways. Before I forget even more, here they are, however abbreviated: 

  • Your high school curriculum and grades are heavily considered. Based on what’s available to you at your school, the more rigorous, the better.
  • For a student, certain aspects can give you an edge (see below) for getting in (all other things being fairly similar).
  • Athletics – Colleges need to fill large rosters of a variety of sports, including many niche sports like fencing, water polo, or rowing. In most schools, there are more of these spots and needs available than in other activities such as theater or music. While the chances of an athletic scholarship are slim, the value of athletics is in the admissions part. It might give you access to an elite school that you can’t get into academically. 
  • Money matters. “Even at need-blind schools. . . colleges control how much they spend on financial aid by recruiting heavily in rich high schools and admitting in early decision a significant proportion of students who tend to be wealthier.”  Need- aware colleges will take into account how much financial aid the student needs as they have limited financial aid available for students. “They think it’s fairer to reject a student rather than accept them” and strap them with tuition bills they can’t afford. My takeaway is that strong students who can pay full price may have better odds than strong students who will need a lot of financial aid.
  • Legacy gives you an edge. While it’s not a guarantee for admissions, the acceptance rate for legacies at very select schools like Harvard, have been shown to range 30-40% vs 6% for the regular student body.
  • Siblings –  Admissions may consider where an applicant’s sibling goes to school in assessing the likelihood of whether the applicant would accept an offer.
  • First generation college students are favored and given extra notice in admissions.
  • High school makes a difference in the sense that admissions offices often know certain high schools and their curriculum pretty well. In terms of getting into a selective college, studies have shown that you’re better off being a big fish in a small pond. 
  • Male is preferred to female because there are fewer male applicants
  • Students can end up at colleges that are above their academic level. Selingo calls this, “overmatching,” and writes that it tends to occur with wealthy students who are accepted because of their families ability to pay full price. “Undermatching” is when you don’t end up somewhere that matches your academic or intellectual level or ambitions.
  • Early decision – Colleges benefit because early decisions allow them to lock in a certain yield early on. The acceptance rate for ED is on average about 10 percentage points higher than for regular admission (e.g. Duke’s rates – 18% ED, 6% regular decision)
  • For some schools, it is helpful to demonstrate interest so they feel that you will likely accept their offer if given one.
  • See if you can figure out what the school’s critical needs might be. If you fit one of those needs, you have a better chance of acceptance.
  • Some of the factors that I thought might help give a student an edge in consideration were not listed, such as: language, leadership, music, and other extra-curricular activities. I’m guessing that you have to really be a standout in these activities for it to give a student that extra edge.
Who Gets In and Why
Sample pages from “Who Gets In and Why”

The World Cup and the End of Soccer Headers

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“Use your head!!” yell some parents from the sidelines. Our coach winces at my son’s high kick to bring down the soccer ball – he shouts at my 11 year old son and motions to his head, an instruction for my son to use his head the next time. My son glances at me from across the field. 

What the other parents and my son’s coach don’t know is that my son is not allowed to do headers in soccer. That’s our deal. If he wants to continue playing the game, he’s not to use his head; otherwise, I won’t let him play anymore. You might say if I wasn’t going to let him play the game fully, why did I ever get him into the sport in the first place? Well, prior to letting him start, I was pretty ignorant about the sport and its physical nature. Another one of those things I wish I knew before. . .

Unfortunately, with World Cup 2022 mania sweeping the globe and my household, I can see that headers are still very much a part of the game.  Will disallowing headers ever be possible? Would it “ruin” the sport?  Soccer is a highly physical contact sport and headers are certainly not the only source of major injury, but header rules are perhaps the most straightforward thing to change about the sport to reduce the risks of head injury and long term brain damage. 

Mom, what a buzzkill, right? Seriously, first, no screen time, and now, we can’t even play soccer like we’re supposed to? And, like with the France vs. Argentina final coming up, nobody wants to hear about that now! Surprisingly, I did find some recent research and media commentary suggesting that a ban on headers may be in the future.

Soccer Football – FIFA World Cup Qatar 2022 – Quarter Final – England v France – Al Bayt Stadium, Al Khor, Qatar – December 10, 2022 England’s Harry Maguire in action with France’s Olivier Giroud REUTERS/Hamad I Mohammed

What’s the Danger of Headers in Soccer?

First, there is increasing evidence to support my anxiety. Cognitive impairment can result from just a single training session involving the practice of headers. Whether that impairment is just short term or long term is yet unknown (but we could take an educated guess on what the research will likely find). Plus, do any of us knowingly want that impairment even if it’s just for a day? Don’t practice headers before your math test? 

Long term, it’s suspected that soccer players may eventually suffer from CTE (chronic traumatic encephalopathy – a degenerative brain disease) as has been the case with MLS players, Scott Vermillon (confirmed CTE), Bruce Murray (suspected CTE, early dementia in his 50’s), former England international, Jeff Astle (confirmed CTE), and many players in American football. CTE is caused not only by repeated concussions, but it’s also suspected that small, repetitive hits to the head have the same damaging effects.

Will Headers Ever Be Banned from Soccer?

Soccer organizations in England and Scotland have already responded to the growing research on the dangers of headers by putting guidelines on heading practice in adult games. In both the US and England, soccer authorities have delayed the introduction of headers in youth soccer. 

With the World Cup in Qatar going on, I’ve caught a few articles covering soccer that discussed the end of headers, including a New York Times piece projecting that with increasing evidence, it’s just a matter of “when,” and not “if” headers will eventually be banned.

The more studies that come out to show the risks of headers and the more educated parents become on the dangers of letting their kids beat their heads with a high velocity ball, the harder it will be to knowingly endanger the long term health and safety of all the athletes and our kids.  

Resources

A sampling of the media attention to the dangers of headers and the possibility of ending them:

Soccer players with dementia or CTE:

In the US, moms’ organized to delay (or eliminate) the use of headers in youth soccer:

Ruining the sport if we ban headers – the comments at the end of this article highlight the perspective of those who feel the sport should be left alone:

Storelli tries to sell some head gear by pointing out that headers are not the only cause of concussions (although they are the cause of CTE and dementia):

Changing Jobs? Check the Impact to Your Medical Benefits

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changing jobs, HSA, FSA, health benefits, job benefits
Image credit: events.ibx.com

Updated as of 2/22/22

If you’re changing jobs, don’t forget to think about how to coordinate your benefits between the two jobs, so that:

  1. you’re not without coverage between the two 
  2. you maximize your benefits
  3. you minimize any forfeits in FSAs
  4. you coordinate your HSA contributions and providers

(If you’re wanting to compare plans at your new job, check this post on health insurance plan comparison spreadsheets.)

Below are the main things that I’ve learned to check during job changes:

Fill the insurance gap between jobs

  • If you and your partner are each insured through different employers, then whoever is losing insurance is considered to be having a qualifying event – which means the remaining insured partner will be able to enroll you into their insurance plan regardless of the time of year.
  • When leaving your job, make sure you know how long your benefits will last. Check if all benefits will extend through the end of the month or if they cease immediately on resignation. Apparently, this can vary by employer. 
  • If you are ending a job and starting another job in the same month, you may not have any gap in coverage. Confirm with the benefits providers in each job about the termination date of the coverage in the current job with the effective date of your benefits coverage in your new job.
  • If there is a coverage gap of any amount of days, it’s always safest to buy some sort of coverage for those days. You will have to do a cost risk analysis on your own situation. You have 3 main options:
    • COBRA insurance, which is pretty much an extension of your current coverage except that your employer no long pays for any of it, so it is usually very expensive. 
    • Short term insurance – which can vary in cost but is usually the cheapest option, because it is essentially catastrophic insurance, to minimize the financial impact if you were to unexpectedly have any major medical costs during your gap days. Remember to always review the insurance terms in detail as these plans all have different levels of coverage, too.
    • Standard health insurance, including Affordable Care Act (ACA) plans – the cost of these plans are usually less than COBRA costs, but more than short term plans. However, you should always check all the costs before selecting. 

Your age, your family size, your medical needs, your risk threshold, and expected duration of time between jobs will determine the best choice for you. 

Maximize Your Benefits

Timing of routine, preventative services 

If you will have any sort of gap between coverage, it’s always safest to take advantage of any preventative doctor or dental visits before your coverage ends. This minimizes the likelihood of your needing to pay out of pocket for routine checks. 

Timing of non-covered benefits 

Conversely, if you are close to changing plans and haven’t met your deductible, then you may be better off delaying (if possible) costs that could contribute to your new deductible rather than your old one which you most likely won’t meet at the end of your current coverage. 

Timing of benefits that are capped

If you have any benefits where only a certain amount is covered per plan or plan year, then you may want to use them before switching. For example, vision plans often cover $150 per year in contact lenses or glasses. Even if you don’t need the contact/glasses yet, you should stock up or you would just be losing $150. In your new job, you may have a new plan that provides another $150 to use – essentially giving you a $300 contacts/glasses benefit for that one year. 

Check the latest FSA and HSA rules

Finally, doublecheck the rules on your FSA and HSA – there are often updates to these rules. It’s no wonder that the FSA and HSA are often under-utilized by people because they can be such a pain to track. Always recheck the rules each time you change jobs to make sure you know the latest. In 2022, here are some things to know about the FSA and HSA when changing jobs.

Regular FSA during job change

Your FSA must be used up – they don’t transfer to the next employer, so you should spend it all before you leave. However, the medical FSA plan limit is per employer and not per year, so even if you maxed out with your first employer, you are eligible for the maximum amount again with your new employer ($2850 in 2022). 

HSA during job change

Your HSA funds are not impacted by changing jobs. Whatever you have is yours to keep and use as needed for qualified medical expenses. You can roll it over to another HSA provider or continue to use it through your existing provider. 

However, you do have to be careful about how much you contribute. The annual maximum amount per individual or family has to be pro-rated for each month that you are eligible to contribute (e.g. that you are enrolled in a high-deductible, HSA eligible plan). Therefore, if your new job provides HSA eligibility or no longer provides it, you will have to adjust your monthly contributions accordingly. This PDF from Benefit Strategies, LLC and this post on the Finance Buff provide helpful information on mid-year changes and HSA eligibility and contributions.

Also note that some employers contribute towards your HSA – these amounts count towards your annual HSA limits. Don’t forget to account for employer contributions when calculating how much you will contribute while still not exceeding the limit.

Limited-purpose FSA (LPFSA) during job change

This is the FSA that you’re allowed to have if you also elect the HSA and is only usable towards vision and dental expenses. Like the regular FSA, it must be used up when changing jobs – they don’t transfer to the next employer, so you should spend it all before you leave unless you feel like gifting your employer. However, again as with the medical FSA, your plan limit is per employer and not per year, so even if you maxed out with your first employer, you are eligible for the maximum amount again with your new employer ($2850 in 2022).

Dependent Care FSA during job change

Dependent care FSA – I found some conflicting answers on this one and basically, it is up to your employer. Some employers allow you to use your funds through the end of the plan year. Others will require that you use it up or forfeit it upon departure. You will have to check with your employer. In 2020-21, there were COVID-related changes to the dependent care FSA that you should definitely check on with your employer. In fact, after doing this research, I’ve decided to check these specific terms with any new employers, so I know what I’m getting into when I sign up for the dependent care FSA. By the way, don’t forget that dependent care FSA expenses can include after school care, summer camps, as well as family members who babysit for you!

Do you have other tips to share? Email me at wishiknewbefore20@gmail.com or add them to the comments below!

Resources

Filling in the gap

Maximizing benefits in all categories

HSA and mid-year changes

LPFSA

Dependent care FSA

Lowest Price for EpiPens

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Updated as of 11/4/22

We have food allergies and we need to carry around EpiPens. But we also have a high-deductible HSA-eligible health insurance that doesn’t cover very much, so below is a rundown of the options I went through to find the best price for EpiPens. My takeaway is that if you can’t get an EpiPen or EpiPen alternative for free, you should only pay up to the low $100s in the U.S. See the rundown of options below.

(This fall of 2022, I had to fill our EpiPen RX at Walgreens for $109 with a GoodRX coupon. The GoodRX price is only if you don’t use insurance. In prior years, I bought Auvi-Q which was available at $25 for those with poor insurance coverage, but that Auvi-Q price went up to $125 in October 2022. All of this is ridiculous, isn’t it?)

EpiPen size comparison
In case you’re curious, an EpiPen size comparison: (L to R) Auvi-Q, Adrenaclick, Mylan/generic EpiPen

#1 Health Insurance EpiPen Cost

When we had excellent health insurance, I was able to buy a pack of two generic EpiPens for as little as $30. I’ve also seen online that some people have health insurance that can bring the cost down to $0-$5. 

Unfortunately, now that we have health insurance with a very high deductible, those generic Epipens would cost me $476. I detest anything associated with health insurance these days, so even if I could afford $476 for epipens, I would do my best to avoid this option.

#2 EpiPen Manufacturer Discount

On the Mylan brand name EpiPen website, you can get a savings card for up to $300 on brand name Epipen, and a savings card of $25 on generic EpiPens. However, you’re only eligible for these savings cards if you also have commercial health insurance:  

“The Epipen Savings Card® helps eligible patients who have commercial health insurance save on out-of-pocket costs.”  

– Mylan website

And in fine, fine print, Massachusetts or California residents are not eligible. At any rate, if I were eligible for the savings card of $25, my generic EpiPens would now cost $451 instead of $476. The search continues. . .

(FYI, the brand name Mylan EpiPen and the generic EpiPen look and work exactly the same. The EpiPen alternatives operate a little differently.) 

#3 EpiPen Alternatives

There are a few other EpiPen alternatives. You would need to get your doctor to write you an RX specifically for one of these alternatives. 

  • Adrenaclick – about 6 years ago, this was the wonderboy of EpiPen alternatives because CVS offered them for as little as $10 (I don’t remember the fine print of this offer). However, without insurance, it’s now offered at a retail price of ~$110 at Target/CVS pharmacies. You can also print out a $10 savings card that should bring you to ~$100. 
  • Auvi-Q – our allergist suggested trying Auvi-Q. This is the EpiPen alternative that talks you through the process. It has a retail price of $4500 that nobody actually pays. I called the Auvi-Q customer service number and learned that they have contracted with a direct delivery pharmacy called ASPN Pharmacies. To start the process for direct delivery service, call them or complete this direct delivery enrollment form. The pharmacy itself has mixed reviews. (My personal experience was that it took me about 2.5 weeks and two followup phone calls to get the EpiPens.) However, the ASPN representative told me the following:
    • If you have commercial health insurance AND YOUR INSURANCE COVERS the Auvi-Q, then the cost will be $0, even if you have a high insurance deductible.
    • If you have commercial health insurance AND YOUR INSURANCE DOES NOT COVER the Auvi-Q, then the cost will be $125. (In October 2022, this cost increased from $25 in prior years to $125 this fall!)
    • If you need more than one pack of 2, you can order a second one for the same price after a 30 day waiting period.
    • For those without insurance, they offer a patient assistance option if you complete this patient assistance form. If you don’t qualify for financial assistance, they say that the most anyone should have to pay for Auvi-Q is capped at $360. At that price, you would be better off with a Adrenaclick or the generic EpiPen options through GoodRx and the like (see #4 below).
  • Symjepi – I’m not familiar at all with this option, but I saw it listed on the GoodRX website as an Epipen alternative. Pricewise, I didn’t see any quotes that made it a better deal than the Adrenaclick or Auvi-q. I’m not sure there is any point to considering this option seriously.

#4 Prescription Cost Saving Websites for EpiPen

There are a lot of prescription cost saving websites out there now that can offer prices in the low $100s. To get these discounts, you search the name of the drug and the website returns an out of pocket cost comparison of the Rx’s cost at local pharmacies, along with a coupon that you can use at the pharmacy. These are the costs of the EpiPen if you pay without using insurance.

Here are a few of the sites I looked at. The costs below are based on my local zip code, so may be different for you. This is what I found for 1 pack of 2 generic epinephrine auto-injectors: 

#5 Your Allergic Friend with Good Health Insurance 

It also crossed my mind to ask if any of my allergic buddies with good health insurance wouldn’t mind just calling in a refill for me to pick up. I figure that would be about $30 and without the kids in school, I really don’t need an RX in their names. Just throwing this idea out there. . .

#6 Expired Epipens

You either already have expired Epipens or you have friends that do. I think I’ve never felt that comfortable with expired Epipens, knowing that I carry them around in all sort of temperatures that could lead to its degradation in performance. However, if they’ve been stored safely, they could very well be perfectly useful, so you may keep that in consideration in terms of how many new Epipens you may want to buy. A study in 2019 showed that even Epipens that were 30 months past their expiration date were still effective. (See here if you’re trying to figure out how to dispose of them.)

Resources

Articles summarizing EpiPen costs:

Auvi-Q

Epipen

Adrenaclick

Best Allergy Medications for Kids

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The pediatric allergists who we’ve seen have said that all the allergy medications being used to treat children’s allergies are “very safe these days.” However, I like to double-check everything, including what the doctors say. Plus, to me, there’s a range of “safe” which I like to call risk reduction. Here’s what I found: there are in fact, nuances to the common allergy medications that are prescribed like Zyrtec and Benadryl, that are worth considering when deciding which to use and when. (If you want to try and reduce allergies without medications, see my posts on physically reducing allergens in your environment and also natural ways to minimize or treat your allergies.)

Best anti-histamine for kids: Zyrtec

Best anti-histamine for kids, best allergy medicine for kids
Zyrtec is the most popular anti-histamine for kids

For regular environmental allergies, Zyrtec seems to be the anti-histamine of choice. It’s the second fastest-acting (20 minutes – 1 hour) and lasts 24 hours. Benadryl apparently works the fastest, but its main ingredient has been linked to increasing risk of dementia. Many allergists no longer recommend Benadryl for kids at all. The Stanford clinical trials on OIT for peanut allergies used to require children to dose daily with Benadryl. When the studies came out about its link to dementia risk, they switched over to Zyrtec immediately.

Claritin takes longer to work (3 hours). Allegra, another popular choice, is shorter-acting and apparently less effective. 

Anecdotally, on a Facebook group for children with allergies, some parents noted increased aggressive behavior and acting out during their child’s regular use of Zyrtec. They felt that symptoms resolved with the use of Allegra. I searched this briefly and found that allergy meds are sometimes linked to negative effect on behavior, although no one particular anti-histamine is blamed. It appears to depend on the child.

Our own pediatric allergist also recommended Zyrtec during our food allergy treatment, but did not have any particular reason for not recommending the others. If you’re looking for the quickest relief possible (and for one-off use) such as reaction to a food allergen, etc. then Benadryl might be your top choice. Also, according to our pediatric allergists, if you need the medication to get into your system faster, then choose liquid over tablet form.  However, if your child needs the medication daily, then Zyrtec sounds like a safer choice.

Best nasal spray for kids: Flonase Children’s Sensimist

Best nasal spray for kids, best allergy medicine for kids
Flonase Sensimist is the most popular nasal spray for kids

Two of our pediatric allergists recommended Children’s Flonase Sensimist (different formulation from the adult version). One pediatric allergist called it “super safe.” It appears to have the least amount of systemic absorption – which is what you want since you are mainly trying to treat nasal symptoms and want the drug to work locally. We were also warned to be sure and spray away from the nasal septum as spraying directly can damage the septum and cause nosebleeds. 

Even with Flonase, it seems that the less you need to use it, the better. Studies have found that inhaled corticosteroids, like Flonase, can stunt a child’s growth.

Resources

One pediatric allergist’s ranking of allergy meds for children

Side effects of common children’s medications

Negative effect of anti-histamines on behavior

Corticosteroids can stunt growth

Ice or Heat for Injuries?

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Updated as of 5/11/23

My child sprained an ankle and immediately, every well-meaning person around us kept at us with ice, and more ice. The day after the injury, our sporty, super-fit friends quizzed me, double-checking that we were continuing to ice the ankle. All this emphasis on ice gave me pause, because in traditional Chinese medicine (whose philosophy I have followed growing up), ice is never used for an injury. These opposing views sent me running to Google.  

It turns out that recent research suggests icing an injury may not be the best way to heal an injury. In fact, a new March 2021 study found that ice may be more than just unhelpful, but may actually slow healing!

Don't ice injuries
There’s a little-known, but good case for avoiding ice with injuries

My findings

The bullet points below summarize the basic arguments against using ice:

  • For years, ice has been widely practiced as the standard treatment for sprains and sore muscles. However, recent research has determined that both ice and too much rest may actually delay healing. In fact, Dr. Gabe Mirkin, the doctor who coined the term RICE,  Rest, Ice, Compression, and Elevate in 1978, wrote an article in 2015 stating that he now believed this method actually delayed, rather than helped healing.
  • A review of 22 research papers found little evidence that ice and compression helped healing over the use of compression alone, so there is actually scant scientific proof that ice helps
  • Controlled blood flow and inflammation is needed for the body part to heal and ice (as well as anti-inflammatories like ibuprofen, and other pain reducers) work against them, by shutting or slowing down blood flow to the area and turning off your body’s natural immune response of inflammation
  • If ice is used at all, it should just be used briefly and is only for the benefit of pain relief. You should use ice in those instances, but be aware that it may slow your recovery.
  • Instead of ice and rest, do movements (gently as needed) but as soon as possible. According to renowned physical therapists, Dr. Jim and Phil Wharton, “inactivity shuts the muscle down. Blood flow is restricted and tissue atrophy follows. In contrast, activity improves blood flow, which brings oxygen and removes metabolic waste.”
  • Icing may slow healing. It may be disrupting the body’s natural cell process in a way that actually delays muscle recovery according to a March 2021 study done on mice. Apparently, there are enough similarities between animal and human muscle to suggest that the body’s muscles may know how to heal itself better without the ice.

Ice vs. no ice is still widely debated and you will find professional, medical voices on both sides. However, if you do a search, you will find most articles by orthopedists, physical therapists, physicians alike advising you to use ice. It seems the idea of ice not always being helpful or necessary is either not well-known or perhaps not acceptable to most people in this field where the idea of using ice for injuries has been ingrained for some time. I found that our own orthopedist at a well-known sports medicine clinic prescribes ice. 

My takeaway

This turned out to be a much more controversial topic that I expected it to be. It definitely reinforced my propensity to question conventional medical wisdom (5 Reasons Not to Rely on Doctors). Arguably, I found the evidence to back my personal bias towards of not using ice. There are other ways to address injuries that may also be better at preventing recurrence. I saw arguments ranging from ice is harmful, to neutral, to helpful. I think at the very least, I saw that ice is not necessarily helpful nor necessary, (and I won’t have to feel like I wronged my child by not giving ice). 

Resources

The case for ice: 

The case against ice:

Links about the ongoing debate of ice versus heat:

Traditional Chinese Medicine (TCM) rationale against ice:

Minimalist, Athletic Shoes for Kids

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In another post, I wrote about how I decided to lean towards minimalist footwear for my kids and for myself. Well, I didn’t realize that finding children’s minimalist, athletic footwear (and there are definitely degrees of minimalism here) would be so difficult! In fact, most popular brands had very thick soles and were heavy. Others were too rigid and narrow, particularly in the toebox, and even others also had positive inclines, so much that I was effectively putting my child in a slight heel. None of those made any sense to me and yet those were the majority that I found.

Below is what I eventually found (some of which I ended up buying, others which I considered). Zappos and Amazon are my go to sites for buying shoes due to their easy buy and return policy. Buying shoes isn’t like buying t-shirts – easy return policies are so key!

Photo credit: zappos.com

Tsukihoshi Mako – These are my personal favorite. They’re flexible, some sole, zero drop heel, very washable. Lots of color options (compared to some others) and athletic-looking enough that my kids didn’t feel too different from their Adidas, Under Armor-clad peers. Velcro closure for fast in and out! Plus, this model has been around for many seasons. Around $55 & up.

Tsukihoshi Kaz – These are another favorite, but don’t come in some of the larger “Little Kid” sizes. Same pros and cons as the Tsukihoshi Mako. Around $50 & up.

Photo credit: zappos.com

Merrell Kids Trail Glove – I just noticed these recently (2021) on Zappos and will have my boys try them out. They’re very lightweight and have a barefoot feel. The sole is minimal with very light cushion, but it’s still sturdy with with a lot of traction on the bottom. The toe box is pretty wide, but doesn’t seem quite as wide as I’ve seen on Vivo, Xero, or Altra models. Advertised as being good for cross-training, available in sizes for toddlers through big kids. Listed at $50.

Photo credit: zappos.com

Altra Kids’ Athletic Shoes – Altra’s running shoes for kids have a large toebox for toe splay. Last I checked, there were two models, Kokiri and Lone Peak – my kids found both models to be comfortable. They are flexible and lightweight. They are zero drop, and though the soles look thick, they are actually much less cushioned than your typical running shoe. We love these shoes, but we did find that the traction on both models wore down pretty quickly. $60-$70.

Photo credit: zappos.com
Altra Youth Lone Peak trail shoe
Photo credit: altra.com

Prio – I’ve been eyeing this model for my kids to try maybe in the future. They’re not available on Zappos or Amazon, so ordering is a little more “work.” Also on the pricier side, $70. Check their website for more info and pics.

Nike Free RN (pictured below, left) and Nike Flex (pictured below, right) for kids – some of the versions of the Flex and Free RN are pretty lightweight and very flexible. They tend to have thick, wide soles. Maybe that’s for stability? At any rate, I couldn’t discern much of any incline despite the thick sole on some of these models. Look carefully for what’s important to you though because there’s variation even within the models and from season to season. My kids found them super comfortable in general and said they felt like slippers. $40 – $70, depending on the model – plus these go on sale frequently when the newer versions come out.

PLAE – I don’t have a particular model in mind and we don’t own any of this brand, but almost all their shoes seemed to be zero-drop. We’ve definitely tried some of their models on a couple of times, too, but I find them a bit stiff and heavy though for a minimalist shoe. They look like a good fit for wider feet and toebox and the bottoms feel robust, for those wanting a sturdier sole. $50 & up. 

Photo credit: zappos.com

Martial arts and wrestling shoes – Most shoes used in these sports tend to be zero-drop. Their flexibility varies. Asics makes a wrestling/martial arts shoe, so it is a high cut shoe, but aside from the ankle support, the rest of the shoe is very flexible, zero drop, with varying degrees of width. Puma, Adidas, Asics also have martial arts shoes that are zero drop, somewhat flexible, but sometimes a bit narrow in the toebox, and the leather (faux?) can make the shoe a little stiffer to begin with.

Indoor soccer shoes (not the grass cleats!) – Indoor soccer shoes are typically zero drop, so we got that requirement out of the way quickly. They also have the “cool” factor, so my kids are always excited to see these. After that, you have to sift through the brands and models for the ones that suit your child’s feet. Nike has the most models that felt flexible and lightweight. Alot of them look good, but have rigid soles and for whatever reason, soccer shoes tend to run narrow though, and are all lace-ups. Around $35 & up. 

Photo credit: zappos.com

Thoughts? More info? Better info? I’m all ears. Email me at:  wishiknewbefore20@gmail.com or leave a comment below.

Can You Control or Reverse Your Myopia?

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In my quest to quell my child’s myopia, I discovered the myopia reversal community online. It seems there are many adults who are trying to improve their vision naturally. Yet while the medical eyecare community has not reached the point where they will even consider that myopia reversal is possible, myopia control for children is a growing sub-specialty and reaching mainstream eyecare practices in the US. In Asian countries where myopia is unusually high, myopia control is already a common practice. Considering that myopia control didn’t exist when I was growing up, (and yet here it is), I’m wary of dismissing the possibility of myopia reversal too quickly.

My takeaway

Researching and comparing these two “fields” was helpful for me in deciding how to manage my child’s myopia and also in convincing me that it was worth trying to reverse some of my own myopia. Below are some of the similar ideas that I found between the two areas .

Single vision lenses (SVL) will likely progress your myopia – This is not yet a commonly known fact, especially among adults. On the plus side, as I mentioned earlier, myopia control is definitely a growing sub-specialty and I think it’s only a matter of time before it will become common practice:

  • Myopia control view: Optometrists who provide myopia control options to children know that the traditional single vision glass lenses or contact lenses will mostly likely cause your prescription to get worse and worse. (Yes, that’s the lenses that you and I grew up wearing.) The current thought is that myopia stabilizes in adulthood, but the eye is particularly susceptible to growth in childhood and teenage years since those are “growing” years for the body. SVL are known to cause peripheral light to focus behind the retina, which is thought to stimulate the axial growth of the eye and therefore increase myopia.
  • Myopia reversal view:  In the philosophy of two popular myopia reversal methods, Jake Steiner’s endmyopia.org and Todd Becker’s gettingstronger.com, it is also believed that the cycle of progressively stronger RXes are due to wearing SVL that perfectly correct or overcorrect your vision. If your myopia is worsening as an adult, it seems that perfectly corrected or overcorrected SVL could also be a contributing factor. They call it “lens-induced” myopia

Reducing near work strain is important in treating myopia – Giving your eyes a break from reading a book or the computer screen is common wisdom (that many of us probably have trouble following). However, myopia treatment takes this a step further.

  • Myopia control view – Multifocal or bifocal glasses and multifocals contacts give the child different corrections for distance viewing and near viewing. The theory here is that the near viewing through an add power reduces the strain of close work. Although studies haven’t found much clinical benefit from bifocal glasses as from the multifocal contacts, researchers think it may be due to children not being able to use the bifocal lenses correctly (looking thru the right part for the particular activity at hand).
  • Myopia reversal view – Similarly, many myopia reversal methods also include wearing either a reduced RX or plus lenses for near work to reduce strain. 

Outdoor time affects myopia – Spending time outdoors is believed to play a central role in vision.

  • Myopia control view – Research in myopia control is full of studies on the possible link between myopia and time spent outdoors. It is believed that spending more time outdoors (3 hours/day) can help prevent myopia in children (although studies find that it’s not helpful once myopia has begun). Although there are many theories (i.e., the eye needs vitamin D, outdoor time replaces screen/reading time, being outdoors skews the eyes towards using distance vision, etc.), it’s also not clear why the outdoor time may prevent the eye from growing too much.
  • Myopia reversal view – Jake Steiner’s endmyopia.org frequently posts about the importance of incorporating outdoor time into part of the rehabilitation. While myopia control researchers still don’t feel that they have found the reason that outdoor time is beneficial, Mr. Steiner believes that outdoor time spent actively trying to see things more clearly is the reason that outdoor time can improve vision.

The effects of both treatments are variable in individuals – both research and anecdotal evidence show that neither myopia control nor reversal methods are guaranteed to work. Researchers don’t know why myopia control works for some children but not so much in others. I haven’t found any formal myopia reversal studies on adults – perhaps I just haven’t logged enough hours in the search. Nevertheless, the treatments do seem to work  for many adults anecdotally and definitely for many children.

Resources

This Medium post by an Australian optometrist describes how the traditional approach of glasses for children is becoming outdated and that myopia is becoming recognized as a condition that can be treated:

Two of the most popular myopia reversal techniques seem to be Jake Steiner’s endmyopia.org and Todd Becker’s gettingstronger.org:

Lens-induced myopia was reversible in a study of chicks

Thoughts? More info? Better info? I’m all ears. Email me at:  wishiknewbefore20@gmail.com or leave a comment below.

10+ Things to Know About OIT for Food Allergies

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Recently, we decided to have our children try oral immunotherapy (OIT) for nuts. OIT is just one of many treatment options emerging. This was a huge, agonizing decision for us and we went back and forth several times for months before we finally committed. Read this post, “Stopping OIT at One Nut,” for where we are with OIT today.

My takeaway

This post is a summary of the key information (but a long list, nevertheless) that I found helpful in making our decision and knowing what to expect once we started OIT. I gathered it through reading online resources, quizzing OIT providers, and lurking on Facebook private practice OIT groups.

  1. OIT for food involves ingesting increasingly larger amounts (often referred to as “doses”) of the allergen until you reach your target amount of desensitization. You decide what you want your target to be.
    • Some people just want to be “bite-proof” which is being able to accidentally ingest the equivalent of say, a few nuts, and not have a reaction. Others want to be able to eat a lot of the allergen.
    • Desensitization is not a cure – OIT desensitizes your body to the allergen so that you don’t react, but you are still allergic and you may still have reactions (more likely to be minor, but reactions nonetheless) to the allergen.
    • There is about an 80 something percent success rate in clinical trials. OIT providers say that success rate is more like 90+ percent because of private practice’s ability to tailor the treatment to the patient. In clinical studies, participants may have to drop out if they can’t keep up with the trial’s dosing schedule, etc.
    • Doing OIT is often referred to as a program of X number of months, after which you graduate and go into the “maintenance phase.”
  2. The length of the program is determined by the patient’s goal, how well the patient tolerates the doses and the gradual increase, your own scheduling availability for increasing your dose (aka “updosing”)  at the OIT office, and your OIT doctor’s protocol. 
  3. The maintenance phase, at this point in time of medical knowledge, is basically the rest of your life! Once you stop increasing your doses at the OIT provider’s office, you go into maintenance phase. If you ended your program at a dose level of say, 3 peanuts, then you are supposed to eat the equivalent of 3 peanuts a day for the rest of your life. After being in maintenance phase for a couple years (time varies by patient), you may be able to reduce your dosing to twice a week (like Mondays and Thursdays) or every other week, etc, but it all depends on the patient.  
  4. If you don’t finish OIT or quit during maintenance, you may lose whatever desensitization that you have gained, but in theory, you don’t become more allergic because you tried OIT. 
  5. OIT in practice looks roughly like this:
    • First dose appointment – Your initial dose day may involve taking very, very small amounts of the dose up to a pre-determined total dose or until there is a reaction, known as an eliciting dose. This depends on your provider’s protocol. The amount that you stop at is the amount that you will be ingesting daily at home until your next appointment. 
    • Dosing at home – you take the dose amount of the allergen daily at home, with applesauce (applesauce may be best if you experience problems with other foods) or any foods you like (to either hide the taste, or ensure you get the entire dose). Prior to the dose, you should have a meal or a high carb snack. Apparently, this helps to minimize reactions. 
    • Updose appointment – you return to the doctor’s office after a minimum of 1-2 weeks on your dose (or more depending on scheduling and how the dosing goes). You do this until you reach your target dose and enter the maintenance phase.
    • Rest period – for 2 hours after each dose, you should not exercise, shower, or do anything that may raise your body temperature which is currently believed to increase your chances of a reaction. One well-known OIT provider explained the idea that an elevated heart rate increases your blood circulation (which may have histamines from the dose) and therefore spread your body’s reaction. Nevertheless, reactions can still occur after the rest period and also during maintenance.
    • Vacations/sick/exceptions – you’re not supposed to dose or fully dose when you are sick (more likely to have reaction due to increased inflammation levels in the body or higher body temperature due to fever), traveling (elevation, far from hospital, time changes), or doing things that may make it difficult to follow the rest period. After these exceptions, you contact your doctor to get instructions for slowly building back up to the dose you were on.
  6. The protocol and guidelines you follow will vary depending on the OIT provider you choose as well as on the patient’s needs and progress. There is no standard protocol and if you consult a few OIT providers, you will find that each doctor’s protocol varies slightly. These are some of the differences that I found: 
    • Dosing schedule – number of doses per day seems to range from 1 to 2 doses per day. Increasing the dose can also vary from one increase per week to every two or three weeks. Some providers say you should only dose in the mornings as there seems to be an increased likelihood of having a reaction to an evening dose (rising cortisol levels, etc.). The schedule may also be modified due to the patient’s progress. 
    • Rest period: in addition to the 2 hour rest period, some providers say you should not exercise for 1 hour before your dose. Some providers have reduced the required rest period from 2 hours to 1 hour.
    • OIT is available for most of the top allergens (milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybean), but depends on your provider.
    • Multi-allergen vs. one allergen OIT: You can do OIT for multiple allergens at once. Some providers recommend it, others don’t. I preferred not doing multi-allergen OIT because I didn’t like not knowing which allergen the body was reacting to.
    • Zyrtec vs no Zyrtec: some providers require that Zyrtec or some anti-histamine is used prior to dosing. Others say it is optional. Some doctors require it for updosing and some doctors ask that you don’t use it on updose days. Pretty confusing. After some inquiry, I understood that the anti-histamine was mainly for the patient’s comfort and to avoid experiencing mild reactions. It wouldn’t prevent the chances of you having anaphylaxis if you took it nor would it make you physically any less desensitized to the allergen in the long run. One provider also explained that routine Zyrtec is highly recommended for the pre-teen ages 7-12 because they can generally be more anxious about OIT and having minor reactions can cause them to develop more anxiety over the allergen.
    • Other medications during OIT: Antacids, asthma medications are the most popular other drugs that you may find are needed during the course of OIT. Apparently, it’s important to keep asthma under control during OIT as uncontrolled asthma increases the likelihood of anaphylactic reactions. Even asthma that is exercise-induced or environmental allergy-induced may be very subtle (and never a problem for you or your child previously) is a red flag for OIT providers. If there are some warning symptoms such as needing albuterol or corticosteroids during colds or having persistent coughs, etc. during allergy season, OIT providers will likely put you on an asthma medication such as Qvar, Flovent, or Singulair. We had a bad reaction to Qvar and ended up treating through TCM with some success.
    • Xolair (an anti-IGE medication) is sometimes recommended for highly allergic, high risk individuals. One provider said that she would not normally start considering it unless the patient’s IGE levels were >100. If used, you would need to start it two months before you begin OIT. To take effect, Xolair would need to be given at 1 shot/month for 3 months. Xolair is currently only approved for chronic hives, so unless you have been diagnosed with chronic hives, you would likely need to pay out of pocket for the shot at ~$1300/shot. However, you would be able increase your dosing much more quickly than you would without Xolair. I’ve read a post that talked about providers who provide the drug for free in order to get through treatment faster – interesting post that hints of the provider drama behind OIT.
    • Note: the medications come with side effects. All of the medications listed above (anti-histamines, asthma medications, Xolair, etc.) seem well-tolerated by many, but all come with some troubling side effects related to emotions and behaviors that seem to affect a significant number of users. These are often reported on the Facebook OIT parents groups.
  7. Anyone is a candidate for OIT and potentially treatable.
    • However, it’s believed that the younger you are when you are treated, the better chance you have of becoming not-allergic as opposed to just desensitized. This is because the young immune system is still developing and capable of resetting. Think the preschool set. One OIT practitioner told me that even 6 year olds appear much less likely to reach “no longer allergic” status.
    • At the same time, I’ve heard from some moms that their kids (who started OIT around 10-12 years old) are not allergic anymore and can eat as much as they like of the allergen. 
  8. Maintenance phase doesn’t mean that you are home free:
    • Some OIT graduates have reported reactions during maintenance if they don’t follow the rest period
    • People do experience reactions (even anaphylactic ones) after they have reached maintenance (EVEN if they have followed the rest period!) and even some with very low IGE numbers
    • Hormonal changes (during puberty or periods) can sometimes cause reactions
  9. The only current way to know if you are no longer allergic is by having low enough IGE levels and negative skin prick test and passing a food challenge. This seems unreliable to me, however. In the same way that some people may develop allergies later in life, it seems to me that even if you no longer clinically present as allergic at one point in time, you could always redevelop the allergy. My conclusion is treated patients will always want to have the Epipen handy and you will always want to be careful of what you eat and how you feel. 
  10. Costs with and without insurance 
    • With some insurances, your coverage can be up to 100%, minus co-pays. The providers typically bill your visits as specialist office visits and food challenge visits (like any other allergy provider would). If your insurance covers regular allergist visits, then they would probably cover OIT because they don’t register it as anything different.
    • If you don’t have insurance coverage, or your provider doesn’t take insurance, it seems like out of pocket costs could be $10K – $25K per allergen/year, depending on your goals and personal allergy situation. I got this cost range from a Facebook group for families doing OIT and one of the providers we visited.
    • There are often clinical trials available for certain allergens, but the cons seemed pretty significant. In some trials, you don’t know if you are the control group and in others, you have to keep up with the trial’s schedule of increasing doses or whatever other parameters they are testing for. Otherwise, you could be dropped from the trial if you cannot keep up with the dosing schedule, and so on. However, trials are free for the patient.
    • There is a new allergy “drug” called Palforzia, which has been FDA-approved and they may start to change (probably increase) the cost structure of OIT treatments. The drug is essentially pre-measured peanut flour in the form of a pill, so you don’t have to do it yourself and which I guess is supposed to help standardize the dosing protocol of OIT providers.
  11. Much is still unknown about how the body responds to OIT over time and I think that is reflected in the variability of protocols from one OIT doctor to another. This is also the reason that many allergists don’t feel that OIT is ready for private practice. 
  12. There are a range of things that could be reactions (other than anaphylaxis) and the problem is that you will often be unsure whether it’s a reaction or just something else that you might get in everyday life. Range of reactions:
    • Itchy mouth or throat
    • Runny nose
    • Stomach ache
    • Hives
    • Rash
    • Vomiting
    • Coughing
    • Feeling something in the throat
    • Eosinophilic esophagitis (EoE) 
  13. OIT is introducing a new habit into your life and family lifestyle – like brushing your teeth and flossing, dosing is something you will have to remember to do everyday or on some schedule. 

Thoughts after starting OIT

For us, OIT is turning an “unknown” into “slightly more known.” Choosing to do OIT is not a “no-brainer” and is a very personal decision. OIT takes more time and energy than simply nut avoidance, especially as it appears that patients continue to be at risk for reaction even after “successfully” completing immunotherapy. Unlike some who have extensive allergies, our nut allergies were not affecting our lives significantly and we wondered if we were bringing more risk, concerns, and health issues into our lives. On Facebook groups, you will see other families wondering the same thing.

However, I will say that on the first day of dosing, after I saw that my kids were actually able to ingest very small amounts of their allergens, I realized that I was getting some answers. I had never known how allergic they might be. I hadn’t known whether they could even touch a nut. We had always worried that if we kissed our kids after eating nuts that we might cause a reaction. We knew nothing about their reactions – it was just this big question mark. Now we’re beginning to know a little.

Resources

I read a lot of articles and studies about OIT and included some of them here.

Informative OIT starting points – helpful for understanding what it is about and what doing OIT entails (the top 10 myths section in particular has become much more detailed since I first came across it in early 2019, so if you haven’t reviewed that page in awhile, check it out again):

Articles about OIT

Determining thresholds for OIT

Facebook groups for OIT patients or parents of OIT patients (just a couple here, but there seem to be lots of these, so worth checking them out and finding one helpful to you):

Personal stories about OIT experiences (below are just a few – you can find many online):

Articles with some skepticism around OIT:

People don’t maintain the same level of desensitization when they stop OIT, proving that maintenance is needed for most people:

Interesting article on SoCal Food Allergy Institute, a well-known food allergy treatment center that uses a more customized, yet similar approach to OIT:

Reversing Myopia: Getting Started

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Once you become myopic, is it possible for your vision to improve? Ophthalmologists and optometrists say NO, and rather emphatically so. However, welcome Internet research, pseudoscience, and anecdotal evidence. Even the burgeoning science found in myopia control methods has many theories in common with the myopia reversal movement. After a lot of reading, it seems like it may be possible to reverse some myopia and that it’s worth giving it a try.

(As of 8/16/20: My one year progress update.)

 

My takeaway: the basic method of reversing myopia

The basic method of reversing myopia looks like this:

  • Reduce your glasses or contact RX by a small amount at a time, 0.25 to 0.50 diopters (some people do more, but it seems like you may end up reducing so much that your eyes cannot focus enough to improve).
  • When wearing your reduced RX, routinely spend time focusing on slightly blurry things and trying to make them clear. When you can see 20/20 or 20/25 with the reduction, then reduce the RX some more. This could take weeks or months – each person’s eyes are different. Reduce each eye enough so that both eyes see about the same. Sometimes you will reduce more in one eye than the other.
  • Wear an even lower RX when doing near work (computer, reading, task work). Some methods say that this lower RX should just be enough so that you can see well enough to do your near work. This reduces the focusing and strain that your eyes go through in order to switch from distance focus to a near focus. It also reduces the strain of near work. This has some similarity to the concept of wearing plus lenses or multifocal lenses in myopia control for children. Another method suggests that this lower RX should be low enough so that print (whether on your computer screen or book) can have a slight blur so that you can work on trying to clear the blur.
  • Make lifestyle changes: 

Some amount of improvement, around 1.00 to 2.00 diopters, anecdotally seems very possible. In a variety of YouTube videos and online comments/blogs, many individuals seem to have been able to achieve at least this amount of improvement. I list them in Resources below.

My myopia reversal experience so far

I’ve been nearsighted since I was 8 years old, becoming highly myopic by high school. I figure I have nothing to lose by trying out the myopia reversal methods.

I started out with a glasses RX of -8.00 (R) and -6.25 (L), with -0.50 astigmatism in both eyes for most of my adult life. In June 2019, I began wearing glasses with a slightly reduced RX of -6.00 and -7.25, with -0.50 astigmatism in both eyes. I purchased glasses with this self-customized RX on http://www.zennioptical.com. (BTW, if you don’t have a complicated RX, I’ve discovered that getting glasses from your optometrist’s eye shop can be the biggest waste of your money ever! But that will have to be a topic of another post.) I determined my starting RX by purchasing a test lens kit and checking my vision with these free, online eye chart printables. I wanted to make sure that I would be seeing about the same out of each eye with my modified RX. I did get a lower RX for near work but I didn’t end up using it as I found it cumbersome to remember to switch glasses.

I found almost right away that I could see 20/25 with the reduced RX. This made me suspect that I had originally been over-corrected. I made the lifestyle changes as best I could, although getting adequate sleep or taking screen breaks during “crunch time” work was probably not always at ideal levels. I tried to look at slightly blurry words and seeing if they could become clear by focusing on them just a bit longer. This was usually street signs, etc. while I was out driving or waiting in lines or doctors’ offices.

At the end of September 2019, I saw the optometrist for a regular eye exam. He found that the astigmatism in my right eye had gone away. He also said that I could see 20/10 with my original RX. When I asked him to adjust my glasses RX to see just 20/20, he gave me this new glasses RX: -7.5 (R), no astigmatism correction; -5.75 (L), -.5 (CYL), 180 (AXIS). 

My contacts RX was adjusted from R: -7.50, L: -6.50 to R: -7.00, L-6.00. When I checked the eyechart wearing this new contact RX, I actually couldn’t see any difference with my stronger, previous RX.

Prior to this recent myopia research, I’d never paid much attention to daily visual strength changes. By paying attention to what I can see on an eye chart, I’ve learned that eyesight can have minor changes daily and from hour to hour sometimes just based on what I’ve been doing. This leads me to realize that even the optometrist’s measurements can not be perfectly accurate so I am taking my recent optometrist prescription with a grain of salt.

However, it does seem that “the disappearance” of my astigmatism in the right eye is significant and the fact that I can see 20/20 with -0.50 diopters less in both eyes seems like a big improvement over my RX of just 4 months ago. I still suspect original over-correction may have had something to do with my new RX, so I will have to see how the next year goes.

As of 8/16/20: My one year progress update.

Resources (updated 11/17/22):

I found these two sources to be the most helpful sites in outlining straightforward methods for reversing myopia:

There are two other sources that are “well known” (pop up high on search results) and also worth reading through for theory and techniques. They also have a lot more detail on their methods and the rationale behind them:

Forums where vision improvement is discussed – you’re not alone!!!:

Anecdotal evidence of eye changes/improvement:

On reddit, there are some good arguments against trying to reverse your myopia or against whether it can work at all. The link below on blur adaptation seemed interesting, plausible to me. However, the fact that my son’s optometrist had actual data points of axial length reduction is also encouraging:

Where to buy inexpensive glasses with your own customized prescription:

Where to buy contact lenses with your own customized prescription (unfortunately, as of January 2023, this is no longer an option for US customers):

If you are in the US and want to buy contacts of your own modified RX, you may need to rely on the 8 hour prescription verification rule and hope that the optometrist office you list for verification does not respond before the 8 hour waiting period!

Free eye charts to check your vision:

Thoughts? More info? Better info? I’m all ears. Email me at:  wishiknewbefore20@gmail.com or leave a comment below.

Proper Oral Hygiene for Children

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Updated as of 10/9/21

I was wondering how important it was to personally brush my kids’ teeth, especially since they have the black stain problem, but also because I HATE brushing their teeth, and the process of yelling at them to come to the bathroom, and getting them to stand still, so I can brush their teeth. I was really hoping to find out that I don’t need to brush my kids teeth anymore. Instead, I just found way more than I had planned to know. 

How to take care of your kids teeth
Photo credit: http://www.nhs.uk

#1 Up to what age should you help brush your child’s teeth?

My own dentist claims that I need to be brushing and flossing my kids’ teeth until they are 9-10 years old. He says kids just don’t have the finger dexterity to get in between the teeth properly and brush all the sides that they need to. I presume each child is different, so you will need to observe your child as they brush themselves to determine when they are capable of brushing independently. So do I need to brush their teeth, night and day? My pediatric dentist tells me that he lets his kids brush their own teeth in the morning and he brushes it for them at night.

#2 How often should we brush our teeth? 

2x/day is the general consensus, although 3x/day seems to be the ideal.  It’s actually possible to brush your teeth too much or too hard which eventually wears down tooth enamel. Tooth enamel is precious and doesn’t really re-form although some products claim to help with that. If you brush your teeth too much or too hard, you also may wear out your tooth brush quickly and have to replace them more frequently. I learned that the buildup of plaque that causes gum disease takes at least 24 hours to develop. To me that means it’s ok for me to let the kids try brushing their teeth in the mornings as long as I brush thoroughly in the evening.

#3 When should we brush our teeth? 

I’ve always thought that we should brush after we eat (after breakfast, and say, before bed?), but after a round on the Internet, I’m not so sure. Apparently, eating sugary, acidic, and processed foods leaves tiny food particles that can wear away at your enamel if you brush directly after eating. Experts recommend taking a break before you brush after eating, a break ranging from 15-40 min, depending on the expert you consult!

The reasoning is that despite brushing before bed, plaque grows in your mouth overnight, and the sugars in your breakfast feed the plaque to make it worse for your teeth. This post describes the process in easy to understand detail. The conclusion is that brushing before breakfast is best if you can only do one of the two. Otherwise, brushing before breakfast and brushing again after some break would be ideal.

#4 What kind of toothpaste should I use?

You don’t need a lot of toothpaste. Just a pea-sized amount for both children and adults. Toothpaste manufacturers sell more toothpaste by convincing you that you need a whole ribbon on your large toothbrush. In fact, too much toothpaste can erode your enamel.

You can buy toothpaste with or without fluoride, or without Sodium Lauryl Sulfate (SLS). You should avoid toothpaste with SLS as it apparently can cause recurrence of canker sores. There are a number of arguments for or against having these things in your toothpaste. However, it seems that none of these toothpaste additives are harmful if you are truly just using a pea-sized amount.

#5 Rinse or spit?

The jury is out. I think this depends on what kind of toothpaste you use and whether or not you’re comfortable with swallowing a very small amount of these ingredients. Fluoride in high amounts in your body isn’t good for you. However, leaving fluoride on your teeth creates fluorapatite on your teeth which apparently helps prevent tooth decay. If you tend to get cavities easily, maybe it’s worth leaving more fluoride on your teeth.

#6 And the floss, what about the floss? 

As if brushing teeth wasn’t hard enough, but our dentists have always recommended flossing for kids, too. Both our adult dentist and pediatric dentist recommend that we begin to floss our kids teeth when there is no longer a gap between them. That happened quite early for us – our kids’ teeth seemed all snugly lined up against each other as soon as they came in!

However, the benefits of flossing are unproven according to a 2016 Associated Press investigation, so there was a media flurry suggesting that flossing wasn’t needed. My own oral hygiene experience, along with many dentists, is that despite the lack of proven benefit, flossing, if done correctly, removes many of the food particles that brushing alone can’t do. 

We should do this like we brush 3x/day ideally, 1x/day realistically (before bed).

Resources

Reversing cavities, alternative medicine:

What happens if you only brush once a day:

Mistakes we make when we brush our teeth:

Rinse or spit

Flossing:

When you should brush:

Informative dental resource website:

 

Safe, Less White Sunscreens According to EWG

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Safer sunscreens

I’ve always hated the aesthetic of white sunscreens, but now that my family and I are frequently outdoors, I’ve been on an ongoing hunt for the safest sunscreen with the least white cast that I can find. The following sunscreen reviews are based only on what we have tried. I usually start with EWG ratings and then go to Amazon or Target to see what is easy and relatively affordable to buy. I hope to keep this post updated as we try new safe sunscreens. I’m sorry to say that there always seems to be some tradeoff among price, white cast, ease of application, and safety. Ugh. On to the current list, in order of favorites to least liked: 

ThinkSport Safe Sunscreen SPF 30: EWG Rating 1, Price on Amazon

This lotion is my reliable favorite because the white cast is relatively low. It smells mildly of vanilla orange and it seems to protect fine. The skin tone in our family ranges from pink white to yellowish white and we have never had any burns when using this lotion. Price is typically average in sunscreens of its class: not the cheapest, but not the most expensive either.

Banana Boat Kids Sport Sunscreen Stick, SPF 50, EWG Rating 2, Price on Amazon

This is a chemical sunscreen – it does contain avobenzone and homosalate, but I guess they’re not the worst chemicals and EWG gives it a 2 rating. It has no white cast, goes on pretty easily but in stick form, is probably only good for face, neck and arms. It’s clear, so you have to go by the greasy feel to know if you’ve missed any areas. It’s not messy at all, and easy to carry around for backup. 

ThinkSport Safe Sunscreen Stick SPF 30: EWG Rating 1, Price on Amazon

Similar to the lotion version in orange vanilla scent. The stick is sometimes a little stiff to rub on in colder temperatures. I see that the current price on Amazon is a little high (5/10/23). It’s better value at the $8-$10 range. Brands offering similarly safe products in stick form include Blue Lizard, BabyGanics, and Babo.

All Good Kid’s Sunscreen Body Stick, SPF 50, EWG Rating 2, Price on Amazon

This is the pink stick (the blue sport version gets a EWG Rating 1), but I found the pink stick to be creamier and somewhat easier to apply. The best thing about this sunscreen is that the stick is big enough to use all over the body. The drawback is that it has more white cast than lotions and tends to be stiff in cooler temperatures, making it hard to spread. Overall, not as multipurpose as a lotion can be, but less messy.

All Good Face Sunstick Coconut, 30, EWG Rating 1,  Price on Amazon

I had high hopes for the coconut marketing bit, but it doesn’t really smell like coconut. It’s stiff, hard to spread, and small. We won’t buy this one again.

Babo Super Shield Sport Stick SPF 50, EWG Rating 2,  Price on Amazon 

My kids didn’t like the smell of this one, but this one is similar in usability to the ThinkSport Stick.

Babo Tinted Moisturizing Face Mineral Stick Sunscreen, SPF 50, EWG Rating 3, Price on Amazon

I liked the idea of a tinted one and it goes on fine without white cast – yay! What hadn’t occurred to me before I bought this, is that the tint can stain your clothes if you sweat or your face accidentally comes in contact with clothes or fabric.

What is your favorite safe sunscreen? I would love any tips. Email me at:  wishiknewbefore20@gmail.com or leave a comment below.

Resources

Filling Out Form 709 for Superfunding 529 Contributions

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I decided to superfund my kids’ 529 accounts because I was late to the game. Then I learned that I needed to fill out the IRS Form 709 for taxes. I superfunded over 2 years which made it slightly more complicated. I found Form 709 (and many other tax forms for that matter!) hard to understand how to complete correctly. You wouldn’t believe how much time I exhausted trying to figure out how to fill out a few boxes. Eventually, I got help from the following resources, which were lifesavers. Hope they help you, too!

Picture of completed Form 709

Samples of completed Form 709 and related help

My sample of completed Form 709 for superfunding 529s

Through a variety of the resources I found, I think I got the gist of it and cobbled together a sample of completing a Form 709 for superfunding (across two years), and the Form 709’s attached explanation text. Not 100% sure though, so take it all with a grain of salt! To use any of the template versions below, log in to your Google account while you are accessing the file, then you will be able to select “make a copy” and modify it however you want in your Google Drive.

Favorite Audiobooks for Kids

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There have been a few standout audiobooks that my kids have really enjoyed so far over their elementary and early middle school years.  For the most part, the books themselves are well known and already wonderful, but the particular readers have made these audiobook stories even better! The way these narrators know how to perform the dialogue, pausing, enunciating, emphasizing, applying different tones and voices, can really transform the story experience. 

You can find these audiobooks free at the library and at many of the audiobook apps such as Hoopla, Overdrive, and the like. I hope you enjoy these as much as we did!

Here is the list of what we have loved so far:

Roald Dahl Books

In the Roald Dahl audiobook collections, look for these versions:

The Whipping Boy

 by Sid Fleischman, read by Spike McClure – funny adventurous tale of two boys, one a prince and the other a poor commoner, and the relationship that grows between them

Henry Huggins 

by Beverly Clearly, read by actor and Broadway star Neil Patrick Harris – tales of trivial everyday childhood experiences that Clearly writes with such hilarious insight and Harris reads with such perfection.

A Cricket in Times Square

by actor Tony Shalhoub, famous, I believe, from the TV show, Monk, and The Marvelous Miss Maisel – a heartwarming story of a special little cricket and his animal friends.

A Series of Unfortunate Events (Books 1-13)

by Lemony Snicket and narrated by Lemony Snicket (the author himself) or Britsh actor, Tim Curry – this series about unfortunate orphans trying to escape a terrible villain had us both laughing and sitting at the edge of our seats in suspense. The readers really made the characters come alive.

The Westing Game 

by Ellen Raskin, performed by Jeff Woodman – this classic mystery is really one of the all-time best mysteries for children in the way it unravels from character to character.

96 Miles

by J.L. Esplin, narrated by Robbie Daymond – Two brothers must travel 96 miles through the hot Nevada roads without barely any food or water. This book may be more interesting for ages 9 and up. The narrator really makes this story worth listening. He reads the entire book with such emotion, possibly surpassing the imagination that would have come with silent reading.

Have you heard some superbly narrated audiobooks for kids? I would love to hear about them! Please share below or email me at wishiknewbefore20@gmail.com

Prevent Foot, Knee, and Heel Pain from Soccer Cleats 

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The standard fit of soccer cleats doesn’t make any orthopedic sense (see this article on podiatrists whose patients play soccer) and yet, it’s the norm. If you play soccer in cleats, you probably know they can be pretty uncomfortable. However, when I was a new soccer mom, the first time I went shopping for cleats for my kids, I was stunned by the stiffness and narrow shape of the shoe. The uppers were stiff, synthetic leather and the sole plate was hard plastic with a thin, flat insole. I sucked it up and after twisting many a pair, I settled on some Nike cleats that I generally find are the least stiff of all the brands. Fast forward through 5 years of soccer playing, and my kids started complaining of knee and heel pain, enough to knock them out of sports for weeks at a time. 

I wish I had paid more attention to the cleat fit issue from the beginning because now I realize what I should have done from the start to help the cleats fit better. It should be standard soccer education along with “what is a shin guard?” Here is a list of the things I learned to do to help the cleat fit as much as possible:

Replace Insoles with OTC Orthotic Inserts

Far and away, the best thing you can do to make your cleats fit more comfortably is to replace the soccer cleat insoles with orthotics. Out of the box insoles on cleats are minimal drop with minimal padding. If you follow some principles behind minimalist footwear, it would seem like this is a good thing. However, the stiffness of the shoe and rigidity of the soleplate probably negates this. 

Instead, the insole should provide some of the shock absorption and protection that you will need from both the impacts and the rigidity of the cleat. There are a couple of OTC orthotic inserts that are often mentioned as fitting well in cleats: Currex CleatPros and Superfeet Carbon. We tried a couple of different Superfeet and found the Everyday Superfeet Insole (Green) to have the deepest heel cup and the most cushion for shock absorption. 

  • Tip #1: Orthotics and insoles are FSA/HSA eligible. (They can feel expensive, but then again, the visits to the orthopedists or podiatrists cost even more. We’re skipping those type of doctor visits in the future. Plus, they will just tell you to buy orthotics, too!)
  • Tip #2: When selecting orthotics, pay attention to:
    • the level of arch support, 
    • depth of heel cup, and 
    • the thickness of the insole to determine if it’s the right orthotic for you.
  • Tip #3: it’s easier to try orthotics in your cleats if it comes with a removable insole. However, it’s also possible to scrape out any glued on, out of the box insoles and slide in your orthotic inserts. See pic below.
soccer cleat insoles removed for orthotics
Glued on insoles removed from Firm Ground Nike Cleats

Stretch and Soften the Uppers

Stuff a compression or regular tennis ball or shoe-tree as far into the shoe as it can go. We were able to get into the lower toe area and leave it in for awhile. This can help resolve the squished pinky toe feeling to some degree and give a little more room in the toe box. This is player preference, but there’s a balance to be had between ball feel and painful toes.

Add Heel Lift or Heel Cup

Sometimes the orthotic insert isn’t enough shock absorption particularly on the heel. You can add a gel heel lift which increases the drop on the cleat, which is usually zero drop (i.e. completely flat). Sever’s and plantar fasciitis are common heel injuries that occur with cleat-wearing athletes. In both diagnoses, contributing factors include tight calf muscles, irritated heel pad, or muscles that just haven’t caught up in growth with the bones. A heel lift reduces the stretch on the calf muscle and heel cups can provide more shock absorption and support for the heel strike during activity. We ended up with the heel lift which I stuck to the shoe underneath the insert. Heel cups can sometimes be hard to get used to – my kids kept feeling like the cup was going to come out of the shoe, but they are also a popular option. 

Wear Cushioned Soccer Socks

Some soccer socks don’t come with extra cushioning, but many do. Cushioned socks just add that one more layer of shock absorption and some protection against blistering in cleats. 

Twist Before First Wear

I’m sure the boot guy does it for the pros. By that I mean, break in soccer shoes for fit and comfort.  On an episode of Amazon’s All or Nothing: Manchester United, the camera shows the boot room for the team and there’s an equipment guy giving all kinds of TLC to each of the players’ cleats. Wow, until my son turns pro, it’ll have to be his poor mom. Wring the cleat multiple times and knead the uppers until the shoes feel like they give more easily. Yeah, you could also let your kid break them in on the field, but then they may have a blister or two – depends on how much of a helicopter parent you are! 

Resources

Podiatrists weigh in on the problem with soccer cleats and offer advice:

Products we’ve used:

Common pains from soccer:

Reversing Myopia: Update #2

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My last update about my experience trying to reverse my myopia was about 20+ months ago. For previous posts about my experience, please see: my first post and my first update. Today my 2nd update, in short, is that my vision still seems to be improving, but the improvement is quite slow when averaged out over 3.5 years – a 1.50 diopter improvement total in each eye when measured by my contact lens RX. See below for an updated chart and further notes about my experience:


Eye Exam Date		Glasses RX (from optometrist)Contact Lens RX (from optometrist)My Reduced Glasses RX for reversing myopia during this time
October 2018Corrected to see 20/15:
R: -8.00 w -0.50 astigmatism
L: -6.25 w -0.50 astigmatism		Corrected to see 20/20:
R: -7.50
L: -6.50		I first started wearing reduced lens June 2019:
R: -7.25 w -0.50 astigmatism
L: -6.00 w -0.50 astigmatism
End of Sept 2019Corrected to see 20/15:
R: -8.00, no more astigmatism
L: -6.25 w -0.50 astigmatism

Corrected to see just up to 20/20:
R: -7.5, no more astigmatism
L: -5.75 w -0.50 astigmatism		Corrected to 20/20:
R: -7.00
L: -6.00		In October 2019, I started wearing:
R: -7.25 
L: -6.00 
Early August 2020Corrected to see 20/15:
R: -7.5
L: -5.75 w -0.50 astigmatism

Corrected to see just up to 20/20:
R: -7
L: -5.75 (no astigmatism correction)		Corrected to 20/20:
R: -6.50
L: -5.25		In March 2020, I started wearing:R: -7.00 L: -5.75 
Nov 2021Corrected to see 20/20
R: -6.75 w -0.25 astigmatism
L: -5.75 		Corrected to 20/20:
R: -6.25
L: -5:25
In December 2021, I started wearing glasses:
R: -6.50
L: -5.25
Contacts:
R: -6.00
L: -5.00
July 2022 (haven’t visited optometrist yetNot available yetSeeing 20/20 with:
R: -6.00
L: -5.00

Notes on My Recent Experience with Reversing Myopia:

  • As I continue to reduce my glasses and contact RXs, my close vision seems to benefit so I still have no major need for bifocals or readers while most people my age are starting to have more trouble with small print.
  • I think I had trouble improving my right eye in years 2020 to 2021 because contact lenses above -6.00 don’t come in increments of -0.25, and so my left eye was always doing the heavy lifting. Finally, I tried reducing my left eye to match the blur in my right eye. I first started wearing contacts at the reduced lens of -6 and -5 in December 2021, seeing about 20/40. Things were slightly blurrier than I would like then, so I actually wore glasses with a -.25  lens for driving at night. Although that felt silly, it allowed me to wear contacts and get through the transition while my eyes slowly improved which took about 3-4 months to seeing 20/20 in daylight. I still don’t see 20/20 in dim lighting nor at nighttime. I haven’t measured it, but signs and people’s faces over 20 ft away are just slightly blurrier.
  • I haven’t done print pushing (Todd Becker method) or active focus (Jake Steiner method) consciously. My computer screen sits over 90cm from my eyes when I am working and when I’m outside, I make a conscious effort to constantly check how well I can read signs or see activities taking place at a distance. Maybe someone could improve faster with a more concerted effort, but at the moment I’m satisfied with the slow change with seemingly little effort.
  • Interesting comment from my optometrist: He said that young people tend to want to see super clear and their young eyes are able to do so. As a result, during a manual refraction, they will tend to pick the higher powers – this tends to lead to overcorrection in prescriptions.

IGE and Oral Immunotherapy (OIT): Sample Size of 2

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I’ve received many questions about what the kids’ IGE numbers have been since they began oral immunotherapy. I was definitely curious when I was researching OIT and I like to see numbers too, so I’ve posted them below. Basically, the numbers trend downwards since OIT. Unfortunately, the numbers were already down from their peak before they began OIT (2019), so I won’t ever know if the continued downward trend is due to OIT or if they were on their way to becoming less allergic anyway. Below I list the raw data, and then graphed. I don’t have 2022 numbers, so check back after this summer for those.

Peanuts and IGE

YearTotal IGE (IU/mL)Peanut IGE (kU/L)Ara h 2 IGE (kU/L)F447-IGE Ara 6 IGE (kU/L)
20213588.358.884.51
202041317.314.8no data
(numbers right before OIT start) 201927918.717.3no data
2018420no data41no data
2017no datano data31.1no data
201689.211.623.7no data
20151195.19no datano data

Pistachios, Cashews, and IGE

YearTotal IGEPistachioCashew Component (F202)Cashew Component (F443-IGE Ana o 3)
20212971.211.260.91
20204482.512.631.85
(numbers right before OIT start) 20193263.412.841.9
20183652.182.251.56
2017no data4.353.62no data
20162681.921.45no data
2015no data3.673.08no data

 

What You Need to Know About a Health Savings Account (HSA)

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Updated 6/1/23

Everywhere on the Internet, you will easily find the basics on health savings accounts (HSAs) about who is eligible, what the rules are, etc. However, as they say, “the devil is in the details,” both good and bad.

Is an HSA right for you?

Using an HSA is, in fact, a big pain in the ass. It’s not easy to manage and use it efficiently and a certain amount of administration is required. While financially beneficial, I have to view it as getting paid a decent amount of money to do some low-level administrative work. 

Opening an HSA

Below are the things I “wish I knew before” I got started with the HSA:

#1 Start Saving in an HSA as Early as You Can

If you’re going to set up an HSA, the younger you are, the more money you can “make” with it! If you are eligible, see how your HSA with high-deductible plan compares with your other health insurance options in my other post, “Health Insurance Plan Comparison Spreadsheets.”

It’s one of the best retirement account options out there, without actually being limited to retirement. It’s pre-tax money going into an investment account and tax-free withdrawals (for qualified medical expenses). There’s no other investment account like that. It’s essentially tax-free income that you can use before retirement. As much as I hate the administrative side of the HSA, I think it’s the financially savvy thing to do, and I’m going to teach my kids to set up an HSA (and a Roth IRA) account as soon as they can. 

#2 Watch Out for Employer Contributions and Contribution Limits to the HSA

If your employer contributes to your HSA, make sure that you account for that in your overall contribution limit and set up your contributions accordingly. We didn’t pay attention to that and over-contributed last year. You may pay a penalty for excess contributions. Fortunately, you can typically rectify it online and with the IRS before the tax filing deadline, but it’s more admin work for you!

#3 Set Up a Stable HSA Provider Outside of Your Employer’s Provider

HSA providers can change even if you don’t change jobs. Set up an HSA provider account that is separate from your employer. Even if you don’t change employers, your employer may often change the HSA provider from year to year or even mid-year. It gets complicated to manage funds in multiple accounts. Ideally, we would have kept it to two.  Additionally, some of the employer’s HSA providers charge fees for the investment portion of the account. 

I followed the Finance Buff’s recommendations and opened an account at Fidelity which is fee-free. (Seriously, the Finance Buff author is like the financially savvy uncle I always wish I had!) It seemed like a no brainer when compared to HSA providers that do charge a fee to invest your HSA funds.  

#4 Avoid Investing With the HSA Provider That Your Company Uses 

Why? Because when your company decides to change providers, you have usually have to liquidate all investments or roll over to another provider. When you are forced to rollover your investments, you have to liquidate your investments and find equivalents in the new account, regardless of market timing. To keep it simple, keep cash funds in the employer account and only make investments with your own provider. Many employer HSA providers also charge fees for investment accounts – all the more reason to choose your own provider that doesn’t charge fees.

#5 Create a Physical and/or Virtual Home for Medical Expense Receipts

Create a physical home (a file folder, envelope, box, sock, whatever!) for the expense receipts as well as a file folder on your computer. Separate that into two piles –  reimbursed and not yet reimbursed. Creating the structure before you begin accruing medical expenses increases the likelihood of your staying organized and getting the most or anything out of your HSA! This sounds so basic, yet you would be surprised how critical it is to not hating your HSA. Just ask my husband for which paperwork is the all-time enemy of mankind. Even if you only reimburse yourself once a year or every 5 years (theoretically, there is no time limit), having the organization structure is what makes this manageable.

#6 Avoid Using the HSA Debit Card

I’ve found that reimbursing myself later gives me much more flexibility and time to think about which HSA I want to draw from and when I want to withdraw it. It also potentially allows your money to grow in the meantime. The flexibility offsets the inconvenience of having to manually reimburse.

Another reason to avoid using your debit card is that some people have the debit cards that draw from both your HSA and your LPFSA (the FSA account that you are allowed to have in conjunction with an HSA).  Watch the debits carefully because a technical error may draw from the HSA instead of the LPFSA (it happened to me!) Why is this a problem? Your LPFSA is “use it or lose it” for vision and dental expenses in the calendar year, while your HSA is not. You should always use up your LPFSA first, so you have to monitor the debits carefully to make sure there are no technical errors (which sadly, are quite likely) and time-consuming to fix.

#7 Plan How You Want to Use Your HSA Funds

It’s no use for you if you never use the money in the account, so have a plan for what medical expense you would like to use the money on. The longer you wait, the “less” the medical purchase will cost, assuming growth in your savings. A prudent way to manage the funds is to leave a portion uninvested so you can access it immediately if needed, and invest the remainder. Ideally, you should not draw from the invested funds when the market is particularly down. 

#8 Review the Complete HSA Eligibility List

Make sure you know what is considered an HSA-eligible expense to get the most out of your HSA. Medical bills and services with conventional medical providers are usually obvious HSA-eligible expenses. However, depending on what the balance of your medical and financial needs are, you should know that there are a lot of day to day items that are HSA-eligible items now, particularly after the CARES Act of 2020. (This post calls the items out about half-way down the page.) 

The website, HSA store, seems to have the most current and comprehensive eligibility list. Familiarize yourself with the list, so you can save those receipts to reimburse yourself as needed. Some of the less obvious, but commonly purchased items that I found useful here are many items of common use: OTC pain relief, allergy meds, face masks, Covid tests, sunscreen, orthotic insoles (OTC or custom), sports wraps and bandages, and first aid products. 

#9 Watch Out for State Taxes on HSA Investment Income If You Live in CA or NJ!

HSA investment income is currently federal and state tax-free everywhere except California and New Jersey. It doesn’t mean that HSA is not beneficial in those states. It just means that if you live in either CA or NJ, your HSA investment earnings are subject to state tax (they are still federal tax-free). Again, my “uncle” at the Finance Buff has a very helpful post on this called, “California and New Jersey HSA Tax Return Special Considerations.” 

#10 Pay Attention to How Much Each Medical Service Costs

You can ignore the costs and just know that you are saving money overall, or you can be like me, and start to realize that it makes very little sense to pay $300 for your doctor’s wrong opinion. Having an HSA means you have a really high deductible. So, if you don’t plan to meet your deductible, then every appointment and small procedure affects how much money you will be saving.

Using an HSA can be a lot of work – think about whether you can do the job. It can save and earn you a lot of money, but you have to use it correctly to maximize the financial benefits.

Do you have extra tips? I’m still learning, so would love to hear more ideas! Email me at wishiknewbefore20@gmail.com. 

Resources

Best HSA provider:

Over contributing:

CA and NY state tax considerations

Comprehensive list of HSA eligible expenses

Where to Dispose of Expired Epipens

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Updated as of 10/18/22

I discovered that it was unbelievably difficult to properly dispose of expired and/or used Epipens, injectors, and medications. Here’s a summary of the first 50 Internet search results: “Take expired EpiPens to a doctor’s office, hospital, or pharmacy for disposal.”

NOT!!! Our local Walgreens wouldn’t take them. Our doctor’s office wouldn’t take them. Our local police station would only take old medications. Even our allergist’s office said no. I carried around a bag of our expired Epipens for a couple of years, trying to get these “drop-off locations” to take them. Our collection of expired Epipens and injectors was growing into a very large pile.

photo credit: Med-Project

How to Dispose of Expired or Used EpiPens

I eventually found a couple, more reliable resources:

#1 Med-Project, an organization that provides you with the packaging and an address to mail your disposal. Better than schlepping your expired EpiPens, back and forth across town. Depending on your location, they also provide a local list of mail back or drop off kiosks for other products like expired medications and inhalers.

Enter your zipcode on their site to see what your area’s options are:

https://med-project.org/

#2 Safe Needle Disposal, this resource for disposing of medical sharps would include your expired/used EpiPens):

https://safeneedledisposal.org/

Best Chinese Medicines

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Traditional Chinese medicine (TCM) has been a part of my American upbringing because my parents grew up under TCM principles and philosophies. Our family healthcare approach has evolved to be a mix of both Western and Chinese medicine along with some skepticism for each of them (see “5 Reasons Not to Rely on Doctors“). However, through generations of family trial and error, we’ve come to find a few Chinese herbal remedies that are popular, commonplace, and often more effective than Western options. Here are the top Chinese herbal remedies that sit in our medicine cabinet:

Best Chinese Medicine for Strains, Sprains, Bruising, and Soft Tissue Trauma: Yunnan Baiyao

Best Chinese Medicine for Strains, Sprains, Bruising, and Soft Tissue Trauma: Yunnan Baiyao
Yunnan Baiyao in powder form, photo credit: tiensproduct.com

Yunnan Baiyao is an ancient Chinese remedy for severe bleeding, trauma, bruises, sprains, strains, and pain and a whole lot more. A lot of Chinese herbal medicine is slow-acting, so it’s not easy to tell if and when they start to help. This is definitely not that kind of medicine – Yunnan Baiyao effects are almost immediate. It’s available in powder, capsule, and patch form. As I understand it, it keeps blood circulating (and not stagnating) through the applied area and also provides some pain relief. We’ve used this regularly for severe bruises, sprains, and fractures, but have not tried it for post-surgery recovery. With it, we’ve had significant swelling and sprains disappear in 1-2 days. We’ve also used the patch version for chronic, recurring pain – with about 80% success rate. There’s an interesting story behind this medicine that you can read about here. We would reach for this before any ice pack and are now using an integrative approach to speed up healing.

Best Chinese Medicine for Allergies and Sinus Infections: Bi Yan Pian

Chinese medicine Plum Flower brand, Bi Yan Pian works as well as Zyrtec
Plum Flower brand, Bi Yan Pian

I came across this Chinese formula for allergies called Bi Yan Pian, when I was browsing this book, Between Heaven and Earth: A Guide to Chinese Medicine. It’s similar to this pediatric liquid extract herbal formula called Windbreaker which I had originally been giving my child. However, this has worked way, way better and faster. It seems to work even better than Zyrtec for both me and my child. The dosing instructions for the Plum Flower brand are 4 pills, 3x a day. However, I only need 4 pills once a day and my 8 year old takes 2 pills once a day whenever we experience symptoms. During our last allergy season, we would take them only after we started having hay fever symptoms, and the pills seemed to halt the symptoms within the hour. Zyrtec often doesn’t work for us after our symptoms have already started.

Best Chinese Medicine for UTIs: Ba Zheng Tang

Ba Zheng San or Tang seems to be the most effective remedy (in both Western and Eastern spheres) for UTIs
Ba Zheng Tang, liquid formula

Ba Zheng (Eight Rectification) San or Tang seems to be the most effective remedy (in both Western and Eastern spheres) for UTIs in our experience. I wish I had known about Ba Zheng (Eight Rectification) from the beginning when my mom first started having UTIs. The UTIs became chronic after regular antibiotic use. After years of trying tons of Western remedies (D-Mannose, premarin, antibiotics, garlic pills, oregano, cranberry, you name it), I saw this formula mentioned quite a lot in my research on Chinese medicine for UTIs. It seems to be a formula that specifically targets urinary symptoms and is used for acute UTIs. After 10 years of recurring UTIs every 4-6 months, my mother stopped her last two UTIs with this formula and hasn’t needed antibiotics in 2 years! It almost seems too good to be true. I’m guessing that overcoming the last two infections without antibiotics helped to stop the cycle of antibiotics to recurrent UTI. Berkeley Community Acupuncture has helpful information on how long and how often it could be taken. It’s not meant to be taken long term. If you can’t stand pills, I also found Ba Zheng in liquid formula.

Best Chinese Medicine for All Things Female: Dang Gui

Best Chinese Medicine for All Things Female: Dang Gui
Sliced dang gui root, photo credit: tcmwiki.com

Also known as Chinese Angelica Root, dong quai, or Angelicae Sinensis Radix. This is popular as the go-to herb for any female issues. It’s apparently beneficial for men’s health as well. We’ve used it for improving regularity of menses and reducing the side effects of hormonal imbalance that women naturally go through. Don’t take during menses (only in-between periods). 

Anecdotally, a friend of ours tested extremely anemic to the point that she was recommended to go through iron IV infusion. Before doing the IV, she decided to take iron pills (known to have poor absorption by the body) and dang gui for a few months first to see if she could get the numbers up without IV infusion (which can have some side effects). When she retested, she was no longer anemic and the hematologist said she could hardly believe the results as iron numbers don’t typically go up that fast through oral intake of iron pills. This is a strong- acting herb. It comes in pill form, but we have only ever used the dried root form brewed in soup. Here’s the basic recipe we use: Simple Dang Gui Soup or Tea Recipe.

Best Chinese Medicine for Immune System and Energy: Ginseng

Best Chinese Medicine for Immune System and Energy: Ginseng
Ginseng roots, photo credit: superfoodevolution.com

There’s American or Asian ginseng. We’ve only tried the Asian ginseng. I see it suggested for use in a variety of ailments, but in our family we take it for primarily overall vitality, energy, and immune system strength. In our family sample size, we’ve linked it to improved asthma and allergy reactions and general sense of well-being in both the kids and adults. Depending on your body’s constitution, some may find it too strong, akin to taking a dose of caffeine. As with dang gui, it is one of the stronger herbs and and it’s important to check the contraindications for it, as it really depends on your body type and needs. Definitely read the literature on it before taking, to see if it’s a good fit for your body’s needs. This also comes in natural dried root form, and in pill and extract forms. 

Best Chinese Medicine for Eye Health and Clearing Inflammation: Chrysanthemum

Best Chinese Medicine for Eye Health and Clearing Inflammation: Chrysanthemum
Dried white chrysanthemum flowers, photo credit: amazon.com

We take chrysanthemum flower in tea form, steeping the dried flower in hot water. To feel any benefits, you have to take it regularly for long periods of time. It’s indicated for clearing heat and inflammation in the body. There’s white or yellow chrysanthemum and they have different indications. White is mostly taken for eye health (dry eye, etc.) and visual acuity. Yellow for common cold-related symptoms. The most obvious benefit we’ve ever had from it was relief from dry eye and allergy-caused eye irritation. Here’s the basic recipe we use: Chrysanthemum and Goji Berries Tea Recipe for the Eyes

Best Chinese Medicine for Mouth Sores: Watermelon Frost

Best Chinese Medicine for Mouth Sores: Watermelon Frost
Watermelon frost, photos credit: suanie.net

Watermelon frost is available in spray or powder form and is indicated for canker sores and sore throats. We’ve only used it topically for sores in the mouth and it seems to reliably heal the sore quickly. I see many TCM/naturopathic practitioners recommending it for sore throats, so I may try that someday. 

Resources

Yunnan Paiyao

Other TCM for injuries (sprains, strains, bruising)

Bi Yan Pian

Ba Zheng

Dang Gui

Ginseng

Chrysanthemum

Watermelon Frost

Heal Fast and Prevent Recurring Pain

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With two kids in contact sports and my own, easily injured, aging self, I’ve looked into ways to heal the body faster and avoid recurring pain and injury. This means doing more than just ice and rest to reduce recovery time. Below I’ve combined emerging practices from Western sports medicine and Traditional Chinese Medicine (TCM) to heal soft tissue injuries. 

heal injuries fast
Heal an ankle sprain fast!
(photo credit: Vittori Foot and Ankle Specialist)

Don’t Use Ice on an Injury

Immediately after the injury, do not apply ice. In fact, do not apply ice at any point. Instead, apply some compression and massage to help ease the pain. Most Western sports medicine recommendations are to RICE (Rest, Ice, Compress, Elevate) and even many practitioners of TCM, acupuncturists, etc. will still recommend ice in the very first moments of an injury. 

However, in reviewing the literature, the use case for any healing benefits with ice is murky. In TCM, cold is an enemy to the body’s natural healing reaction and invasive to the body. Even in Western studies, there is recent research that suggests ice actually damages muscle fibers as highlighted in this New York Times article, “Ice for Sore Muscles? Think again.” Furthermore, even the original coiner of the term RICE (Rest, Ice, Compression, Elevation), has recently come out against using ice at all in the healing process – except to numb the area and relieve initial pain. If there is so little benefit to using ice, and some possible damage – why bother at all with the ice?  

Integrative Treatment for Soft Tissue Injuries

In all stages of recovery, the guiding principle involves keeping the blood circulating properly and quickly through the area of injury as blood flow is the key to healing the area.  Certain tissues in the body have different levels of blood flow and that is why some tissues, like muscle, heal much faster than ligaments or cartilage. (Here again, ice would only serve to slow this process.)

TCM offers external application of herbal medicines as well as herbal medicines to be taken internally – all with the aim of circulating more blood through the injury. Emerging Western sports therapy recommends that patients work on continuing to move the area of injury almost immediately – they call this method, METH (Movement, Elevation, Traction, Heat). 

For the first few days to weeks, depending on the severity of the injury:

  • Apply an external TCM. We apply the Yunnan Baiyao patch or spray continuously for the first few days. If there is an open wound in the area that makes the patch or dit da jow sting or uncomfortable, you can cover that small area with a nonstick pad or Tegaderm which will allow you to apply the spray, patch or medicinal wine to the non-open areas of the injury. If the area is not painful to massage, then in between applications of the Yunnan Baiyao, we also massage with a Chinese herbal liniment, dit da jow (though there are many types and brands to choose from), which purportedly also improves the circulation to that area. We taper off external application after the first 1-2 weeks. Towards the middle to end of recovery, we typically just do daily massage with dit da jow to the area. I did this diligently with a recent, moderate grade ankle sprain, and surprisingly did not go through the bruising stages.  
  • Take a Chinese herbal medicine that helps with improving blood flow throughout the body. In this category, I am only familiar with Yunnan Baiyao capsules or The Great Mender Tea Pills, although I have seen other products mentioned online. The product dosing typically recommends taking these medicines for just a few days to a week at a time, so in the initial stages of the injury. When ingesting Chinese herbal medicines, you should be cautious or check with a practitioner if you know one. Some can have contraindications and depending on dosage, may be too strong for your constitution. 
  • Keep the injured area moving and stretching as much as you are able without inducing pain. Elevate the area as appropriate to keep too much blood from stagnating / pooling at the injury. If you rest the injury too long, stiffness can settle in and make it more difficult to retain or regain mobility as the tissues heal. Google the METH method or MOVE method for guidance in this area. 
  • Apply a warm compress to the area, which can help with pain relief, and again, encourage blood flow to the injury. 

Integrative Treatment for Chronic Pain Avoidance 

Post-injury, not having a thorough recovery can lead to chronic problems in the area of the original injury. Towards the final days/weeks of recovery, I’ll feel that my injury is more or less recovered and I don’t want to mind it so much anymore. Just because you don’t feel pain anymore doesn’t mean your injury is fully healed. In fact, that final phase could be going on for quite some time.

I’ve learned that this phase is critical and long in terms of making sure the injury is thoroughly healed to avoid developing some chronic weaknesses, aches, pains, or arthritis in that injured area as we grow older or continue to be active. I suspect this phase could be as long as months or even years for many people, but that complete healing is possible.

Even though you may feel healed from your injury, it would be ideal to do the following:

  • Try to avoid allowing recent injured areas to be cold – even if it feels fine to you.
  • Massage with dit da jow on days where you might feel achy or if you used the formerly injured area a lot that day. 
  • Apply warm compress, keep the area warm as much as possible. People who tend to have cold hands / feet (which means poorer blood circulation to formerly injured extremities), keeping those areas warm in the last recovery stages can be particularly important.
  • Keep the area moving and stretching as much as possible as long as there is no pain. Protect or enhance your strength and range of mobility in that area. For example, some therapists recommend wearing a protective brace during exercise and doing preventative exercise for up to a year post ankle sprain. This probably feels like overkill when your injury feels healed, but it would likely prevent chronic pain long term.

Resources

Time it takes for different tissues to heal:

Stop the ice (study shows that ice can cause damage to the muscle fibers and could delay healing):

Western sports medicine starting to recommend METH or MOVE, over RICE as an approach for speedy and thorough recovery:

Posts on how to heal injuries quickly with TCM:

Posts on getting through the chronic stage with TCM or Western sports medicine:

TCM products for soft tissue injuries:

5 Tips for Reversing Myopia

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In my experience so far with reversing myopia, I’ve learned a few things that have made a big difference for me. They’re mostly related to ways you can make this journey easier for yourself. If you’re still experimenting with reversing myopia, below are some tips you can consider, too. 

Tips for reversing myopia
Tips for reversing myopia

#1 Use the Eye Chart Regularly

Put up one or two eye charts in places that will be easy for you to use to check your vision casually and without much effort. (Get free printable eyecharts here.) This tip is actually CRITICAL because it keeps the idea of vision improvement in your mind and incorporates it into your daily routine without adding extra work. Without a convenient and well-placed eye chart, I think I would forget about checking my vision and give up. 

I put one up near my work space (directly behind my computer monitor), so that whenever I looked up from my work/screen, I could see how well I was seeing. The distance doesn’t matter so much as long as you have something of varying font sizes and an easy way to remember how well you are able to see certain sizes (20/40, 20/50, etc) from day to day, and time to time. With this method, you will almost effortlessly start to notice how your vision changes based on the close up work that you do: reading a book versus reading on your phone versus working on your computer. Glance at the chart before you even start working – I found that my vision is often better after I’ve been outside driving or playing racket sports. 

#2 Pay Attention to How Well You Are Seeing

Pay attention to your vision everyday or as often as you can. If your vision is getting worse, you’ll catch this sooner and have a better opportunity to adjust habits that may be contributing to the deterioration. Small +/- changes in vision seem not to be always permanent initially. Conversely, if your vision is improving, then consider what might be helping. 

Check your eyes separately. Pay attention to how your vision in each eye differs. Pay attention to whether words become more clear if you focus your eye on it longer. Or if you see a word clearly and slowly back away from it, does it stay clear? And for how long? People’s eyes work together in different ways. I have one eye that seems to always improve faster than the other one. When your vision varies, think about what factors may have changed it. More sleep or less sleep? Less screen time? Reading more or less or for a long period of time? Or even the sequence of wearing contacts first, followed by wearing your glasses later during the day. Interestingly, I have found that I can see noticeably better in reduced RX glasses if I wore contact lenses (at a higher relative RX) during the daytime.

#3 Use a Computer Monitor

Use a monitor instead of a laptop screen and place it as far as is realistic for you and your screen size. This could also reduce eye strain, not to mention the superior ergonomics of the position. With a monitor so far, I think I may be doing some light variation of print pushing (a method articulated by a fellow named Todd Becker) without realizing it. I currently have a 27” screen that is placed about 90cm, 3ft from my eyes. I’m not the first person to have thought of this, and I recently came across this article on endmyopia.org which is a popular reversing myopia website.  My husband thinks I’m nuts, but I used the same set up for my kids through the Zoom school pandemic and while it looked stupid, at least their eyes didn’t become more myopic during that period. (Luck of the draw or careful attention to eye breaks and screen time/distance, we’ll never know!)

#4 You Can Reverse Myopia While Wearing Contacts

You can continue to wear contacts regularly and still use the reduced RX method to “work” on vision improvement. I got tired of wearing my glasses so often (I’m quite myopic, my glasses were heavy, and it was hard to play sports). I learned that I could buy contacts without an RX on https://www.visiondirect.co.uk/no-prescription-needed, so I didn’t necessarily need an optometrist exam every time I wanted to adjust my RX. Then I bought one pair of inexpensive glasses with a mild -0.25 RX (from zennioptical.com), so I could see better for driving or for any other time when you would like to see a bit more clearly.  

#5 Have Patience

Maybe you’ll be lucky and be one of those people I’ve read about online who seem to experience drastic, quick improvements. In general, though, you really need to adopt the mindset that this process will take place over a long period of time. If you’re the impatient type, trying to reverse your myopia or at least with the reduced lens method, is probably not for you! My experience feels painstakingly slow. I recently wore a reduced RX for almost a year without seeing any change and then out of the blue, I started seeing 20/15 periodically and now almost daily. I’m guessing that will amount to just -.50 improvement this recent year. 

Overall, the more convenient you make the process for yourself and the more you incorporate mindful vision habits, the easier it will become for you to continue trying to improve your vision!

How to Be a Happier Parent

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When I saw the title, “How to Be a Happier Parent” at my local library, I was curious. It certainly wouldn’t hurt to be happier! Written by KJ Dell’Antonia who is a former editor of a New York Times parenting column, the book has chapters on dealing with pain points, called: Mornings, Chores, Siblings, Sports and Activities, Homework, Screentime, Discipline, etc.  

Even though it’s not the main or only message of the book, my biggest takeaway from this book is that taking care of myself will make me a happier parent. I used to poo-poo this idea when my children were younger, and in road warrior-fashion, I made sure that my kids should always come first. However, I’m a little older now, worse for wear, panting to keep up with the kids, and finally starting to realize that even if I want to put my kids first all the time – that actually means that I need to be my best self – first. So, how to do this?

“How to Be a Happier Parent” by KJ Dell’Antonia

Sleep

Duh. Getting enough sleep seems like a no-brainer, but I don’t think sleep makes it to many parents’ priority list as much as it should, mine included. Dell’Antonia brings sleep up in relation to mornings which are rushed and chaotic because so much can be out of our control at that time. However, she declares that there’s one thing that for many people is more controllable about those mornings – and that’s SLEEP.  (Incidentally, I struggle with RBP, revenge bedtime procrastination. If you’ve never heard of RBP, but you often stay up later than you should, check to see if you have RBP too!) 

But sleep is critical to more than just the morning. I find that being a better and therefore, happier parent, HINGES ALMOST ENTIRELY on getting enough sleep! If I just wasn’t so sleep-deprived and tired all the time, then I would have more energy to do all the hard things like setting limits, following up on chores, and disciplining consistently. Everything is so much easier to handle when you’re not sleep-deprived and not dragging every afternoon. 

Find Your Own Thing

In the book’s chapter on Sports and Activities, I also particularly valued the author’s idea of “finding your own thing.” It’s tempting to lose myself in doing everything in the name of my children’s advancement. But one day, they’ll look at me, and wonder, why should I listen to her? What does Mom do for her own improvement?

More loosely, finding your own thing is really about having time to do your own thing or to develop yourself. This can seem like a luxury – but I think we can try to more consciously incorporate this into our lives by using time differently: 

  • Think about your work differently and ways you can gain more skills or knowledge at your job, no matter how small the activity – while you are at work
  • Work on a skill or activity during your kids’ activities – if you have just an hour to kill, use some of the time to exercise, read, or practice, etc.
  • If you’re with the kids, try to learn whatever it is that they’re learning – the exercise of pushing your own cognitive development is important
  • When you have child-free time, try to avoid household chores, administrative tasks, and family errands. Use most of that time for self-improvement and self-care.

While reflecting on “finding your own thing,” I concluded that I have to protect and value my own learning and growth as a person – whether for my career or personal development. This serves multiple purposes: 

  • I improve as a person.
  • I teach my children that they are not the center of the universe.
  • I model for them how a person can continually learn and try to better themselves. They can learn from seeing how I practice and put hard work into what I’m interested in doing. 
  • The better I feel about how my own life and interests are progressing, the more patience, strength, and energy I will have in helping my children with their challenges.  

Of course, my willpower and ability to do any of this is greatly enhanced by getting enough SLEEP. See how everything spawns from sleep?  Since reading this book, I’ve been working deliberately on both sleep and self-development and I’d like to say that I’ve been calmer, more productive, and more purposeful. . . maybe even happier.

Raising Your Child to Be a Champion

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  • Cultivate Interest – Less is More
  • Hold Your Ground as a Parent
  • Nurture a Second Passion 

The title of my recent read is a bit misleading for its true value – bold letters state “Raising Your Child to be a Champion” and in smaller letters, “in Athletics, Arts, and Academics.” This seemingly trite, short, and simple parenting book is authored by Wayne Bryan, the father of the Bryan twins, who grew up to be world doubles champions in men’s tennis. There’s not much scientific evidence backed strategies, but instead, refreshingly straightforward, actionable ideas from a dad who found success with his approach and philosophy. I liked a lot of his practical advice, and I find myself considering three of his ideas (below) in particular.

Cultivate Interest - Less is More Hold Your Ground as a Parent Nurture a Second Passion 
Raising Your Child to Be a Champion by Wayne Bryan

1) Cultivate Interest – Less is More

Bryan reminds us about keeping it fun and using games or related fun activities to cultivate interest or passion in a child. This is pretty common knowledge. It was his idea that less is more that was intriguing to me. Bryan suggests spending just enough time on an activity that leaves them wanting more. For example, he would stop tennis practice early for his kids, leaving them hungry for more opportunities to play another time. 

It’s not intuitive, yet I think it works to some degree, even when they don’t have that intrinsic interest. Sometimes, there’s a subject matter or skill that you might feel is valuable for your child to learn, but they’re not interested. I only “let” my kids practice piano for 15 minutes a day (they don’t love the piano), but it seems to keep them from being over saturated with it. For the kids who do have a passion, a tempered approach would help to keep them from mentally or physically burning out early.

2) Hold Your Ground as a Parent

Bryan has a story about how his twins wanted to play video games like their friends so badly that they proposed a one year plan of doing daily chores in return for getting to play video games for 1 hour every Friday night. He was against the idea of any easily accessible video games or TV, but incredibly, the kids accomplished their one year goal and Bryan got them a game. Behind their father’s back, they broke their 1 hour/week promise within the month and started to prioritize game playing over sports, academics, and music. When Bryan realized, he got rid of the games forever. Sounds a bit extreme on both ends, but when I feel badgered and too tired to hold out on my kids’ constant requests, I actually think of his story to help me dig my heels in and say no to the kids. (I feel comforted that I’m not the only parent to hold off screen time and video games, ha.) For us right now, it’s NO to new toys, extra snacks, video games, more screen time, etc. I’m sure there’s a plethora of other things on which I’ll need to stand my ground as the kids get older.

3) Nurture a Second Passion 

Being intentional with fostering a second passion wasn’t something that I had really thought about, but Bryan writes that it can be very valuable to a child’s development. Kids can be interested in a lot of different things and so while we may support them in all of these interests, it may actually be even better if we consciously help them to build a second passion as well (more than just an interest). 

Bryan views this second passion as something a person can fall back to when things aren’t working out well in their first passion – a second passion is something that counterbalances the first passion, and maybe strengthens the other side of their brain. When his twins had a tough time with tennis, they could go to their music. He writes that the famous actress, Kaley Cuoco (known for The Big Bang Theory)  would fall back to competitive tennis during difficult periods in her early acting career. 

While I’m not raising any elite athletes, I definitely see the benefits of how being skilled or knowledgeable in more than one thing supports my children’s self-confidence and takes the edge off of disappointments or injuries in other sports and activities. 

All in all, I’ve got these takeaways in mind as we emerge from the pandemic and are faced again with modern day’s multitude of activities to choose for the kids. It’s an opportunity to rethink as well as become more intentional with my choices and my parenting.

Chinese Herbal Medicine for UTIs

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You may have tried a lot of different things to treat UTIs by now (e.g. D-mannose, garlic, cranberry, oregano, etc.). We certainly have, and have battled UTIs for 10 years without lasting success. In yet another bid to avoid antibiotics which cause all kinds of issues, I’ve looked into how Chinese herbal medicine (CHM) might help. Since both my kids seemed to resolve their problems (cough-variant asthma and clammy/sweaty hands respectively) with a tailored course of CHM, we decided to try Chinese herbal medicine to treat UTIs as well. In this post, I share a list of formulas I found and share our experience with taking some of them successfully!

Why Chinese Herbal Medicine Could Treat UTIs

In Traditional Chinese Medicine (TCM) theory, people may present with similar UTI symptoms, while the causes for the symptoms are often different for each person. Sometimes they are a constellation of causes. For a UTI, you could even think of the overgrowth of the bacteria (E. coli or proteus mirabilis) as one of the symptoms rather than the cause itself. For people without UTIs, they are exposed to those UTI-causing bacteria all the time, too, however, their bodies just don’t allow the bacteria to take root or multiply enough to cause an infection.

In this context, a Chinese herbal formula, (which may or may not have some antibacterial or anti-inflammatory properties) also tries to address the weaknesses that allow the bacteria to flourish. These weaknesses vary from person to person. They can be a weakened immune system, an imbalance of hormones, lack of estrogen, a weak liver function, or a weak kidney function. TCM typically sees UTI symptoms as damp heat in the lower body. Damp heat is a distinctly TCM term, but just think of it as the state of a physical environment that’s conducive to the growth of mold, other allergens or bacteria – except in this case, that physical environment is in your body. 

Common TCM Formulas that Treat UTIs

I found the formulas (listed in this section) to appear most frequently on various TCM practitioners’ or TCM-related websites when I searched for Chinese herbal medicines to treat UTIs. Most of these herbal medicines appear to be targeted towards clearing damp heat in the lower body. Some are targeted more towards hormonal/menstrual regulation, and others help to reduce inflammation. Some seem to address an endless variety of symptoms. 

Chinese herbal formulas for UTIs, from L to R: Zhi Bai Di Huang, Ba Zheng Wan, Long Dan Xie Gan Tang, Ba Zheng Tang

Here are the formulas that I came across most often:

  • Ba Zheng (Eight Rectification) – I saw this formula mentioned quite a lot and seems to be a formula that specifically targets urinary symptoms and is used for acute UTIs. We tried this and it worked! Unfortunately, while the UTI symptoms disappeared, it also caused a lot of diarrhea in my sample size of one (an elderly female). However, my data point also happens to have a sensitive digestive system, so you may not have the same experience. Berkeley Community Acupuncture had helpful information on how long and how often it could be taken. It’s not meant to be taken long term. If you can’t stand pills, I also found Ba Zheng in liquid formula.
  • Er Xian  (Two Immortals) – this formula seems more commonly used for menopausal symptoms. However, some research indicated that it was also recommended by some TCM practitioners for preventing recurring UTIs.
  • Long Dan Xie Gan (Gentiana) – this formula is targeted at liver health and seems to be recommended for acute UTIs with pain.
  • Zhi Bai Di Huang (Anemarrhena, Phellodendron and Rehmannia Formula) – this formula is known to address menopausal symptoms and boost kidney function. It can be taken long term, and was listed as a formula suitable for chronic UTI sufferers.
  • San Jin Pian (Three Gold Tablets) –  this was mentioned in some of the clinical studies and seemed to have good potential for effectiveness. On a separate UTI occurrence, we tried this one too. It didn’t seem to work for us, but did cause diarrhea.

Final Notes to Keep in Mind When Trying a Formula

Formula name conventions – note that when searching for a formula, each formula name ends with either a Pian/Wan/Tang/San. These are Chinese terms for the form that the formula comes in and corresponds, in order, to tablets/teapills/decoctions/granules.

Best used immediately – Through my reading, as well as witnessing the experiences of an elderly female, I think that TCM formulas are best used immediately at the first sign of symptoms or in conjunction with antibiotics. It seems that after a certain amount of time, too much bacterial growth or inflammation has occurred for TCM formulas alone to overcome. While some formulas are anti-bacterial in nature, I don’t know if any would be as strong and sweeping as an antibiotic. Some research has found that simultaneous use of CHM and antibiotics to significantly reduce the rate of recurring UTIs. This suggests that while CHM may not be able to overcome a raging infection, it can balance your body’s internal environment to make it less conducive to bacterial growth afterwards.

Finding the right formula  for you may largely depend on accurately diagnosing your own individual causes for the UTI.  A good TCM practitioner can probably help you with that and can also modify these well-known formulas to even more specifically tailor them to your particular needs. However, seeing a practitioner can cost upwards of $200, not including follow up visits, etc., which may or may not be covered by health insurance. I don’t have any great ideas for addressing that cost because even after researching a lot of the material online, I didn’t have enough experience with the herbs or diagnosing a person’s health from a TCM perspective to feel confident in my assessments.

Nevertheless, we tried to skip working with a TCM practitioner, and did some trial and error. Then we tried a TCM practitioner who couldn’t seem to diagnose accurately enough. Finally, after the Ba Zheng Wan caused diarrhea while simultaneously curing the UTI, I felt that it would be worth trying yet another TCM practitioner to get a more customized formula that was easier on the digestive system. Additionally, we were interested in finding a suitable, long-term formula for addressing the body’s imbalances since we suspected that these imbalances were at the root of the recurring UTIs. 

As of this post’s date, we have managed to avoid antibiotics for 6 months, while addressing two flare-ups with CHM instead. If you’re a fellow UTI sufferer, you know how that feels! Fingers crossed!! 

Resources

This research suggests that Chinese herbal medicine (CHM) can help reduce the rate of recurring UTIs and has a role in treating UTI symptoms:

A review of clinical studies on CHM and UTIs:

A TCM practitioner recommendations for UTI treatment (primarily recommended San Jin Wan and Ba Zheng Wan):

Online Chinese herbal medicine storefront with nice write up explaining TCM view of UTIs and different types of formulas that might work:

Online post about UTI and treatments including TCM:

Goji Berry Chocolate Muffins

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This is a muffin that is like a chocolate cupcake, mixed with some goji berries and whole wheat that make you feel like it’s slightly healthier. Goji berries are a bittersweet berry that are supposedly a superfood.  We normally snack on them or put them in chrysanthemum tea, but I wanted to give the kids a little variety in how we get this superfood, so I made Goji Berry Chocolate Muffins.

Goji Berry Chocolate Muffins
Goji Berry Chocolate Muffins

Ingredients

Makes 12 muffins / cupcakes

  • 1 ¼  cup all-purpose flour
  • ¼ cup whole wheat flour
  • ½ cup cacao powder
  • 2 tbsp cornstarch (optional – I added this to make it more “cake-like,” but you’d be fine without)
  • ½ tsp salt
  • ½ tsp baking soda
  • 2 eggs
  • ½ cup of sweetener (Really, any sweetener like sugar, maple syrup, brown sugar, etc. We generally find commercial sweets to be too sweet for our palates. If you do too, then use ½ cup of sweetener. If you prefer things sweeter, then use 1 cup.)
  • ½ cup vegetable oil
  • 1 cup sour cream 
  • ½ tsp vanilla extract
  • 1 cup of hydrated goji berries (These usually come dried, so hydrate them for 5 minutes in hot water and drain.)
  • ¼ cup – ½ cup of chocolate chips (your sweet tooth preference!)

Directions

  1. Mix the flours, cacao powder, cornstarch, salt, and baking soda in one bowl. 
  2. In a larger bowl, stir together the eggs, sugar, oil, and vanilla. 
  3. Mix in the dry ingredients. 
  4. Gradually stir in the sour cream until mixed. 
  5. Stir in the goji berries and chocolate chips.
  6. Spoon batter into a lined muffin tin. (Batter should be thick enough to use an ice cream scooper, which makes this part easier and faster!)
  7. Bake at 400 degrees F for 20 minutes.