The World Cup and the End of Soccer Headers

“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):

Prevent Foot, Knee, and Heel Pain from Soccer Cleats 

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:

Best Chinese Medicines

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

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:

Lowest Price for EpiPens

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

Free Printable Eye Charts

Since I started trying to reverse my myopia and control my child’s myopia progression, I’ve found eye charts to be handy. During the pandemic with distance learning and increase in computer use, I have used eye charts as a way to check my kids’ vision regularly. However, I’ve also found that those sneaky kids have memorized the eye charts so it’s harder for me to check their vision accurately! So below I’ve included links to the best free printable eye charts that I found online as well as links to some eye charts that I can customize

Standard charts typically come in two formats, one designed for 10 feet viewing distance and one for 20 feet (6 meters) viewing distance. The 10 feet (3 meters) chart is useful when you don’t have enough space for a 20 feet check. 

Best, free standard eye charts

These were the best, free eye charts that I could find online:

20 feet, 6 meter – free standard eye chart in PDF format

10 feet, 3 meter – free standard eye chart in PDF format

Free, customizable eye charts 

I also made my own, so I could occasionally change the lettering. To customize either of the charts below, log in to your Google account while you are accessing the Google document. Select “make a copy” and modify the letters and spacing however you want in your copy. (Be sure to print them on default settings and not “custom scale” or “fit to page,” etc. as it will throw off the size of the printed letters.)

20 feet 6 meters customizable eye chart – 1

10 feet 3 meters customizable eye chart – 1

Eye Massage and Eye Acupressure Points for Myopia

I reviewed some online literature on eye massage to add to my repertoire of things to try for slowing / reversing myopia. As an acupressure layman, I found the acupressure points and techniques seemed to vary just enough from site to site to confuse me initially. Finally, I cobbled together some basics. 

(Note: there are also eye exercises and acupressure points on other parts of the body that directly affect the eyes. I think I will have to review those thoroughly another time.)

My basic takeaway

  • The theory is that eye massage improves the blood circulation to the eyes and relaxes the eye muscles. Tight eye muscles are understood to eventually contribute to myopia. 
  • Eye acupressure is practiced regularly in schools in China, but studies haven’t been conclusive about their benefits on myopia and I’m not sure that any studies could ever be conclusive. After all, how could they really know if the kids were doing the massage correctly? Plus, there are so many other factors that may also affect myopia progression. 
  • You have to be able to do this pretty regularly for some duration to judge whether there is any benefit to you. 
  • I don’t get the feeling that eye massage could slow myopia down significantly on its own but perhaps it would be helpful as a supplement to other methods like myopia control.

Acupressure points for myopia

I cross-checked the acupressure points that children were taught to use in some of the myopia and acupressure studies with some other articles that I found about acupressure for improving vision and eye health. Below are the points (and diagram of what) I found. I listed all the variations in naming that I came across:

  • BL2 / Zan Zhu / Cuanzhu / 攢竹 – located on the inner end of the eyebrow
  • EX-HN5 / Tai Yang / 太阳 – located on the flat sides of the temple
  • BL1 / Jing Ming / 睛明 – located in the inner corner of your eyes
  • ST1 / Cheng Qi / 承泣 – located directly below the pupil between the eyeball and the intraorbital ridge. A questionable source, Dr. Deborah Banker identified this as the access point for the ciliary muscle. Although her credibility is unclear, the ST1 point is indeed frequently mentioned as an important acupressure point. 
  • ST2 / Si Bai / 四白 – located on the depression of the infraorbital foramen below ST1, about where the nostrils begin
  • Tianying / Ashi – I could only find mention of this point twice, but I included it because it was mentioned in articles that were specifically dealing with myopia.  It seems to be located vertically between BL2 and BL1. It is also the first point referred to in this video by Dr. Grace Tan, whose credentials seemed legit (if you are open to TCM). The Dr. Banker article stated that this point could manipulate the superior oblique muscle which is a muscle that can cause the eye shape to change.
  • Series of points covered by scraping along the eyebrow and just below the lower lash line, points which were included in both of the studies of Chinese students and also an easy to follow video of Dr. Grace Tan performing the massage
    • ST1 (see above)
    • TE-23 /Sizhukong / 丝竹空 – located on the outer end of the eyebrow
    • BL2 (see above)
    • EX-HN4 / Yuyao / 鱼腰 – located in the middle of the eyebrow in the hollow, directly above the pupil
    • GB1 / Tongziliao / 瞳子髎 – located on the outer corner of the eye
Eye acupressure points for myopia
Eye acupressure points for myopia

How to do acupressure on the eye points

For each of the points, there were different recommendations for what to do – it seems that you could do either a circular massage or a press and release: 

  • Circular motion – This is a circular kneading motion on the point with your fingers. Apply gentle pressure at the same time as kneading.
  • Press and release – Press at a 90 degree angle for 10-30 seconds and slowly release. Do this for a couple of minutes for each point. If you prefer a more precise time prescription, you’ll just have to make it up as I found a range in my review of the literature. 
  • Scraping – Apply light pressure and sweep your fingers along your brow line and below your bottom lash line. This encompasses stimulation of multiple points around the eyes.

Resources

Research on whether eye exercise or massage can be helpful:

Identifies different eye acupressure points and talks about the specific eye problems that they may address:

Explains how to do the acupressure:

Videos that show how to do eye acupressure:

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

Simple Dang Gui Soup or Tea Recipe

As I mentioned before, dang gui (angelica sinensis, 当归) soup is my go-to Chinese herbal tonic for whenever I have any issues that I suspect may be remotely related to blood, circulation, or hormones. Men can benefit from this tonic in the same way, too. Whenever I drink it, I feel revitalized and relaxed at the same time, helping my sleep and energy. I swear by it, and so do 2,200+ years of traditional Chinese medicine.

(Whenever I think about how Western medicine would never suggest this as a simple remedy because it’s not evidence-based, I’m frustrated by how many people could benefit, but are missing out!)

Although the dang gui herb comes in extract, capsule, or powder, I have only had the tea form. Having tried taking other Chinese herbs in capsule form, I think that the brewed method is far superior in feeling immediate benefit.

There are two basic recipes either sweet with dates or savory with chicken drumsticks, that you can use to prepare the soup/tea. Personally, I LOVE the bitter and sweet flavor of the sweet tea. I asked my mom to write me the recipe as she always prepares it for me and I haven’t ever done it myself. Now I’ve written down the surprisingly simple recipe here for myself (and you!) and have no excuse not to be able to prepare it for myself.

Ingredients:

  • About 5 slices of dang gui (當歸)
  • About 8 red dates aka jujubes (红 枣 or 大枣) or more if you like it sweeter
  • Substitute the red dates with 2 chicken drumsticks if you prefer savory
dang gui slices for recipe
These dang gui slices are about 1.5-2 inches in length.
red dates for recipe
Dried red dates/jujubes above – they can be eaten as a dried fruit snack, too.  Terrible photo, I know, but the tea is delicious!

The number of dang gui slices and red dates are really more about the taste/effect that you prefer. The more dates you add, the sweeter the tea will be. Likewise, the more dang gui you add, the stronger the tea.

I get the dang gui from a local Chinese herbal store and recently have been able to find organic jujubes online at luckyvitamin.com.

Directions:

  1. Rinse both ingredients, then put them into a pot of water (about 6 rice bowls of water – that’s how my mom measures things, haha).
  2. Cook on medium high heat for about 20-30 minutes.
  3. Then turn to medium low heat until the soup is ready (stop brewing when the liquid is equivalent to about 2 rice bowls of soup/tea).
  4. If you prepared the savory version, you can salt to taste.

Lessons Learned in the Time of Coronavirus

I’m home with my family this morning, following guidelines for self-isolation and social distancing. It is so surreal, but here are the actionable items that I’ve learned so far from living in the time of coronavirus. Most of us will survive the coronavirus, and this is why these learnings are important to me.

Photo credit: forbes.com

#1 Respond at the first hint of trouble, not at panic time

Determining what constitutes as “the first hint of trouble” is open to debate, but I will say that I responded somewhere in the middle between “the first hint of trouble” and “panic time.” 

I went to Costco two weeks ago and decided to purchase some stocking supplies. It was more crowded than usual and I could see a number of carts filled with an irregular amount of certain supplies. However, it was still a manageable crowd. I should have thought of precautionary preparation when the first case of coronavirus was diagnosed, rather than when I actually did. After all, there’s no downside to acting earlier.

A few days ago, I went back to Costco for some allergy medicine and it was panic time. The parking lot was almost full before the store even opened. The allergy medicine I wanted was out of stock, as were all of the panic items (paper towels, toilet paper, rice, pasta, disinfecting wipes, rubbing alcohol). Shoppers were elbow to elbow (great for our minimum 6ft social distancing requirement) and I am now hearing online reports from our neighbors of the continual crowds at all the local grocery stores.

#2 Always have 3 months worth on hand

Why 3 months worth? Well, I’m not sure that’s the correct number, but basically you want to be self-sufficient for some period in the event that you become isolated (due to say coronavirus, store closures, insufficient stock, or a major disaster renders everything unavailable to you except for your home (don’t forget to pack your emergency bag for when your home isn’t an option either). 

Here’s what I should have had 3 months worth of:

  • Food (that we would actually eat – not random cheap stuff for emergencies)
  • Household supplies (paper products, cleaning, and disinfecting supplies)
  • Toiletries (soap, shampoo, toothpaste, etc.)
  • Medications (common OTC items like cold and allergy medicines and prescriptions) 
  • Protection supplies (disposable gloves, garbage bags, plastic bags, N95 masks, face masks )

I wasn’t able to get some of these items during the current panic time. What I should have done is just gradually amassed 3 months worth of the above items like a regular consumer in the months/years prior and thereafter, just replenish stress-free any items that dipped below the 3-month threshold. 

If you don’t have enough room where you live, stockpile whatever amount is realistically maintainable in your available space. If organized purchasing is not your strong suit, use an inventory list – there are many online options to help.

#3 Don’t rely on doctors or the government

 . . . ever.  Assess your own risk. 

My elderly mom lives with us. One of my kids has asthma, as does their father. Initial government and public health/medical guidance was not enough for us. After a few days of discussion and wondering what we were waiting for, we pulled our kids out of public school. The next day, the public schools announced a 4 week closure. Given our high risk family members, I have already decided we will not go back in just 4 weeks even if that date holds true. 

If we don’t get the coronavirus soon (assuming my kids didn’t just contract it at school last Thursday), I will consider ourselves lucky this time. I already know a couple of families with members who have COVID-19-like symptoms. We were late to make the right decision for ourselves. Next time, I will trust my gut and not be afraid to seem overly cautious.

As far as how to treat COVID-19 if you do contract it, Western doctors are not likely to have the best approach. Western medicine is limited by evidence-based treatment, and there has not been time for this to emerge. A more holistic approach, merging Western and traditional Chinese medicine (TCM) may currently be the best option we have. For those who may be open to TCM or are familiar with it, there are clear TCM treatment plans for COVID-19 in China. These have already been used in conjunction with modern medicine for many patients in China – which certainly has experience by now. If you’re in a Western country, you’ll likely have to pull this treatment together on your own, because most Western doctors will dismiss TCM approaches completely.

#4 Change mindsets, lifestyles, and habits now

This is not likely going to be the last time that we or our children will experience pandemics or global crises in our lifetimes. I won’t miss this opportunity to make lasting changes to my own lifestyle and habits and to truly instill the same into my children so they won’t even have to think about these habits when they’re older. It will serve them well throughout their lives in any context.

Learn now 

  • Not to touch your face. I’ve toyed with the idea of wearing gloves or taping a Kleenex to my face to make me realize when I’m touching my face. Send me your suggestions!
  • To wash hands properly and automatically – we think we do, but oh, we do not. . .  

Protect and boost your immune system 

Recognize how decisions and actions you think that you are making for just yourself actually affects other people. This applies to so many things in our lives. The earlier our children learn this, and to act on this, the better our world will be.

There’s nothing groundbreaking here, but at my age, I’ve developed some unhelpful habits and sustaining change isn’t easy. But perhaps the threat of coronavirus to those I love can give me the motivation to sustain change. Plus, I’m not elderly now, but I most certainly will be someday. Hopefully, we’ll be better prepared then to handle anything life gives us.

Got Body Odor? And Will Your Child, Too?

I’d been sniffing the hair on my children’s heads – yes, moms do that. And found that they smell very different. I can’t even describe the smell though – one like vanilla soup and the other like citrus tea. That got me wondering what they might smell like as teenagers and then adults. Would my deliciously smelling kids become stinky people with various body odors? Would I need to arm them with deodorants? Was I going to need to do a 3 week research project on finding the best, non-toxic deodorants? 

I’ve noticed that men and women and folks of different ethnicities also seem to have different body odors. I’m of Asian descent and have never used deodorant in my life and have probably rarely needed it (although I suppose I should get some second opinions about that). My husband of European descent can have more distinctive scent, but many of my male Asian friends have claimed that showering after the gym is utterly unnecessary from a body odor standpoint.

I got searching. Researching trivial things is a guilty pleasure of mine.

Image credit: Lucas C. on somethingdrawn.com

The answer first

Here’s the bottom line on whether you and/or your child will be stinky: 

  • It’s linked to a gene! A gene called ABCC11 affects how much of a certain protein called MRP8 is secreted in the sweat from your apocrine glands (the sweat glands in your armpits). This MRP8 protein is “responsible for secreting odorous chemicals in a person’s armpit—chemicals which are converted into body odor by bacteria on the skin.”  
  • A mutated, non-functioning ABCC11 which results in lower secretion of MRP8 has been found in approximately 80-95% of East Asians (Chinese, Korean, Japanese, etc.) 
  • In the rest of the world, this gene mutation exists in only 0-3% of people of European and African ancestry, and 30-50% of people from South Asia, the Pacific Islands, Central Asia, and indigenous Americans. Those with a mutated ABCC11 aren’t completely immune from body odor, just that they will probably have a lot less of it and maybe indetectably so.
  • This gene incidentally also determines the type of earwax you have.  A non-functioning ABCC11 gene results in dry ear wax, whereas a normal expression of the ABCC11 gene results in wet ear wax. Therefore, the type of earwax you have (at any age) can help determine your levels of body odor.

What makes the actual body odor?

The main source of our body odor comes from our body’s sweat glands in combination with the bacteria on our skin. At birth we have eccrine sweat glands all over our body which excrete water and salt mostly, but at puberty we develop apocrine sweat glands in the armpit and groin regions. Apocrine sweat glands secrete proteins (including the odor causing MRP8 protein) and lipids and when they mix with the bacteria on your skin, body odor is created. 

What’s the connection to ear wax?

The ABCC11 gene that determines your body odor also determines your ear wax type. It’s expressed in humans as two alleles resulting in either sticky brown cerumen also known as “wet ear wax” or dry flaky cerumen aka “dry ear wax.”

The dominant allele, let’s call it “W,” produces wet ear wax and body odor. The recessive allele , say “D” (also referred to as the mutated version of the gene) results in dry ear wax and less of the odor causing protein. If you have two recessive alleles, DD, then you have dry ear wax. If you have wet ear wax then you either have WW or WD. For a refresher on genetic traits and to see how this will be passed down in your family, see here and here

Check your ears and your child’s ears if you’re curious. For evolutionary reasons still unclear, dry ear wax is found predominately in East Asian populations (as mentioned above).

Why don’t we all smell the same?

Aside from the genetics mentioned above, the bacteria we have on our skin also varies from one person to another and depends on a variety of factors, such as diet, environment, and lifestyle. Mix it with the goods from your apocrine sweat glands and you’ve got your own signature scent!

Things in your diet such as spicy, pungent foods in high quantities can come through your skin. Stress can increase the production of your apocrine sweat glands, and the breathability of your clothes can either trap in your sweat or allow it to evaporate. How often and when you shower (like post-workout) can also determine how much bacteria is on your skin and available to turn sweat into odor. 

Bacteria and surroundings nothwithstanding, your scent may also change with age due to a couple major factors.  Babies and pre-teens don’t have the apocrine sweat glands that produce the odor-causing proteins. For older people, scientists have discovered that people over the age of 40 emit an odor compound called 2-nonenal that occurs when chemicals breakdown in our bodies as we age. It appears to be linked to the muskier smell that people associate with older people. 

So I checked the type of earwax in my kiddos and I’ve got one wet and one dry. Looks like I might have some future Google research on deodorants after all.

Resources

The science behind body odor

Factors causing body odor

Why body odor varies

Some people don’t have much body odor. 

 

To Ice or Not to Ice Injuries?

Updated as of 11/2/2021

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 traditional Chinese medicine (of not using ice). 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: