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):

Favorite Audiobooks for Kids

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 

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:

How to Be a Happier Parent

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

  • 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.

How to Raise Good Eaters

Updated 9/2/2021

Feeding our children in this day and age is challenging – unhealthy food is too readily available and social norms of accommodating children can cultivate picky eaters. As parents, we’re met with a plethora of feedback from grandparents, pediatricians, parenting books, media, peers, societal norms, and social pressures and expectations.  

My kids, ages and 7 and 9, are good eaters, in the sense that they eat a wide variety of foods (meats, vegetables, grains), and will try new foods. Some of this may be luck, but it’s also due to habits. There are constant “turning points” in their eating career, and we can’t take their eating habits for granted at all. Their tastes and behavior continue to evolve and I’ve sometimes had to double down on some habits that wane easily. Below are our top 10 habits (10+ actually) to raising healthy eaters.

Today’s array of food options are endless

#1 Limit Snacks

Start with limiting snacks in quantity and frequency. This is very subjective – we’ve had friends who say they are limiting snacks but I see that their “limits” are quite different than ours. The basic idea though is that snacks, whether in the morning or afternoon, reduced my kids’ appetites for regular meals. 

Not over-snacking is fundamentally important to being a good eater at mealtime.  It’s totally fine and good for kids to be a little hungry or thirsty. The effectiveness of any other tactics that we use at mealtimes is very dependent on this habit of limiting snacks. I have seen a friend give his child a cupcake 30 minutes before dinner, and then fight with his son to have him finish a pasta dish. My friend didn’t realize that he himself had sabotaged his son’s appetite for that dinner. 

#2 Eat Only in Designated Areas 

We only allow eating in the kitchen and dining room, never in any other area of the house. First, it reduces ant and sticky toy problems. Secondly, it takes away the temptation to extend snacking and meal times and distract from the eating process itself – eating is not to be multi-tasked. Originally, we started this habit from when they were mobile because we didn’t want to be chasing them, or cleaning up after them all over the house. Then, I saw other kids running around their homes after taking a few bites, and coming back to the table for now cold food, and fighting with their parents about finishing their food. I realized we had conveniently sidestepped this battle. 

#3 Try Everything At Least 10 Times (not during the same meal)

I once read from one of those child nutritionist guides that people need to try something at least ten times to determine if they like that particular food or taste. Whether this is true or not, I have actually used that rule of thumb to great success. My children have expressed dislike for a lot of foods at one point or another. I tell them the rule and continue to put the foods that they dislike on their plates. My only requirement is that they have at least one bite of the food that they dislike and they can discard the rest. Over time, they surprisingly just started eating more of that food.

One of my kids hated mushrooms with a passion. Over the course of a year of seeing them on his plate regularly, he suddenly started eating them. So don’t give up. Keep making the food a part of their meals whether they eat it or not. Foods come in and out of “favor,” especially the vegetables, so if I remove them from the lineup altogether, I’ll never know when they’re coming back into favor!

# 4 Don’t Offer Alternative Foods During a Struggle

There have been times when my kids didn’t like the meal we had prepared for them, and basically looked like they were going to be missing a meal. Their grandparents have then suggested that I heat up some leftover pasta or other food that they knew the children liked. First, missing a meal here and there is okay. Second, try not to give in during those moments. All it takes is your doing this a few times, for your child to see your potential as a short order cook. 

#5 Prepare a “Reliable” Food

I might sound like a mean mom, but I don’t like my kids to go hungry either. To be proactive about avoiding a struggle, try to always have one aspect of the meal that is “reliable.” Reliable as in reliably eaten. That could be something as basic as rice, pasta or bread. If you’re introducing a new grain, then try to make sure either the meat or vegetable portion is “reliable.” That way, even if they’re not fully satisfied, they won’t “starve.” Or I might even heat up the “backup leftover food” and offer it as a side dish in advance, so long as they don’t think I got up specifically to go make a special dish that only they like to eat.

# 6 Offer Yucky Foods in a Variety of Ways

We prepare the “yucky” foods in different ways: different shapes, different spices, and different sizes. Our kids hated red bell peppers. Then I chopped them up and put them in chili (which has a pretty overwhelming flavor on it’s own). They noticed them, but couldn’t taste them. Gradually, I put the chopped bell peppers in less overwhelming dishes and before I knew it, they were eating large pieces without complaint (although still without love). 

#7 Have One Bite and Don’t Force Finish

We have a one bite rule. It doesn’t matter if they spit it out. The important thing is that they put it in their mouth. And the important thing is that they try it every time it’s offered. 

On the flip side, we never encourage the kids to finish their meal either. We encourage them to stop eating when they feel full even if it means leaving a lot of food on the plate. We don’t say just “a few more bites.” However, we also have limited snacks and don’t prepare special meals outside of meal times (unless someone is sick), so there’s no gaming the system for extra snack food.

#8 Offer a Variety of Foods Early On and Repeatedly

It’s now commonly encouraged for parents to introduce babies to a diverse diet as a way of limiting the likelihood of developing allergies. However, this advice has multiple benefits. It helps develop a diverse palate early on. The ability to eat a variety of foods early on makes it easier for kids to get the different vitamins and minerals that their growing bodies need. To avoid FOMO, even junk food, snacks, and desserts are all sampled – just in limited quantities! The important thing is to keep offering the variety even as it is rejected. . . possibly over and over again. 

#9 Control Meal Portions

Controlling how much food your children eat is contrary to most of the advice I found in baby-led weaning books, parenting books, and from our own pediatrician. All these sources advised that babies and young children know how to self-regulate and will stop eating when full. This ranks among some of the most incorrect advice I ever heard from “official” sources. Maybe this was true for breast-feeding, but absolutely wrong for milk and solids. Or perhaps this may have been true for humans prior to a world of processed foods, fiber-free food where eating bite after bite was not so easy. 

Yet given the ubiquitous advice, I tried this many times, and watched as my babies, and later, children absolutely did not know their limits over and over again when eating a food they liked (usually something fried, sweet, or a processed snack). In fact, adults often don’t know their limits either when it comes to snacking or foods they like in particular, and we somehow expect children to? Allowing kids to stretch their stomachs too much on a regular basis sets them up for a cycle of overeating and getting more than their bodies need. Try to limit meals to reasonable quantities until you’ve taught your kids to reliably know how to stop eating. 

#10 Educate About the Foods They’re Eating

Don’t underestimate the ability of your children to want to do right by their bodies. In past societies, food education may not have been so important, but with all the choices of foods these days, teaching kids how to navigate the food world is just as important as teaching them how to navigate cyberspace. 

I wasn’t very aware about food growing up, but the trends towards understanding what we put in our bodies and our babies has really heightened my awareness around food and its impact on our health. Talk to them often about what your family is eating and why it’s good for you. Or when you’re having junk food, talk about why it’s not good for you and why you shouldn’t eat too much of it. Talk about cultural differences in foods and diets and the relative healthiness of each. Talk about the evolution of food. Talk about it all repeatedly. Eventually, it will resonate. 

For example, you can explain in a way kids can understand more easily. An 8/18/21 study published in Nature Food, framed eating a hot dog to be akin to losing 36 minutes of healthy life! Eating nuts, on the other hand, added 25 healthy life minutes. That news gave my children pause!

#11  Educate About Junk Food, Peers, and Society

When we joined the food world through organized sports and school, our kids became inundated with birthday party pizza and cake, sport practices that included brown bags filled with a variety of processed/healthy/sugary snacks, and classmates who got to eat candies and chocolate milk regularly at school lunchtime. We had to teach our kids about how food and snacks are thought about differently by each family and why they might not get to eat as much of the snacks and sweets as their friends. Holding off the peer pressure to eat like their friends can be one of the toughest things to do, but it gets easier the longer you do it.

#12  Model Food Behavior

Finally, what if you’re a junk food junkie and / or a picky eater yourself? It’s extra, extra tough to raise your kids to eat differently than you do, so I had to model the food behavior I wanted them to have. 

I found myself learning to be a better eater by following the habits that I was trying to model for my kids. Interestingly, my appetite for junk (formerly quite strong), waned when I removed a lot of the items from my shopping list. After I learned to pay attention to labels and ingredients, the rational side of me was put off by many of the ingredients in a lot of packaged foods that I used to eat. 

Similarly, I hated lamb meat, eggplant, and brussel sprouts growing up, but in an effort to diversify and follow the behavior I was trying to encourage in my kids, we introduced it in meals periodically. Roasted brussel sprouts and spicy garlic eggplant are now in my list of favorite vegetable dishes. I’m still working on the lamb meat, one bite per meal. . .

My Favorite Free Printables

Since the pandemic began, I’ve been supplementing home learning for the kids here and there. I’ve found a few free printables that we really like – because they print well, and have an interface that is easy to use.

(There are a lot of interactive sites that can supplement learning as well, but with all the Zoom and other digital resources that the schools are requiring the children to use, I’m trying to dial it back and reduce screen time for the kids.

Here’s a running list in the various categories of what I’ve found and used:

Favorite Free Math Printables

Both of the math sites listed here provide a lot of different printable worksheets that go up to at least 5th grade. I see calculus topics on Math Aids, and if I remember correctly – that would be high school!

  • https://www.math-aids.com/  – I use Math Aids quite a lot to give my kids the practice with basic addition, subtraction, multiplication, and division that they don’t get with common core at school. I think it helps them to understand the common core approaches better. There are a wide range of math topics on the site though that we haven’t reached at my kids’ age.
  • https://www.math-salamanders.com/ – I’ve used Math Salamanders less than Math Aids but I liked the mental math problems and it has a similar interface to Math Aids. A large variety of worksheets in a large range of math topics are available.
  • I used the blank multiplication chart on https://www.memory-improvement-tips.com/  to teach my kids their times tables. There are a variety of well laid out charts to choose from. The site also seems to have other cool brain games and memory improving techniques that I hope to explore more someday.
mathaids
math-aids.com Division section

Favorite Free Geography and Map Printables

https://online.seterra.com/ – We just started some geography and I found this awesome site called Seterra, for free, professional-looking blank maps for the seven continents to teach the kids all the countries of the world. The printables were just a minor part of the site. The site is an extensive free resource of games and resources on world geography.

Seterra

Favorite Free Comic Book Template Printables

http://allfreeprintable.com/blank-comic-book-template – My kids’ latest passions are in graphic novels and comic books, so of course they wanted to write their own books, too.

ComicBook
Just one of a variety of comic book templates from http://allfreeprintable.com/blank-comic-book-template

Favorite Free Chinese Learning Printables

Since extracurriculars have been cut down so much with the pandemic, we’ve been doing more Chinese lessons at home and these two printables are wonderful.

  • http://chineseprintables.com/  – This straightforward site called Chinese Printables allows you to print grid paper or practice paper in a variety of styles
  • http://chineseworksheetgenerator.org/ – I love, love, love this Chinese Worksheet Generator. You input any characters that you want and it will generate great looking practice worksheets, along with options for stroke order, etc.. This is especially useful for us because it’s curriculum agnostic and allows us to customize the worksheets for our kids to suit whatever we are learning or need to practice more.
ChineseWorksheetGeneratorBorder
Sample worksheet generated by chineseworksheetgenerator.org

 

Favorite Free Eye Chart Printables

If you’ve read my posts on myopia, you know that eye health is a biggie for me. To help with some of the myopia reversal techniques and also regularly check everyone’s vision, I use free eye chart printables. Since my kids’ tend to memorize the chart, I’ve even made my own customizable 10 feet and 20 feet eye charts.

eyechart
Read the message that I wrote for my kids with https://www.homemade-gifts-made-easy.com/eye-chart-maker.html

Other Favorite Free Teaching Printables

I found this site to have a lot of free teaching printables to help supplement home learning. It’s regularly updated by different sources, so it provides a bit of inspiration even if you don’t find exactly what you’re looking for. It’s UK-based, but many materials are still applicable for us. I’m sure there’s a US equivalent, but I just haven’t come across it yet.

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

Reduce Your Allergies Naturally

phytocort asthma allergies
From left, Vitamin C, a bottle of liquid extract of Chinese medicine, Phytocort

Maybe Zyrtec doesn’t work for you lately or perhaps you don’t like its side effects. Personally, I fear that we don’t know much about the long-term use of these “safe” OTC antihistamines for allergy relief. Instead, I’m hoping to treat my sneezing family as naturally as possible. Below are some of the things that I’ve been reading about (and in some cases, trying out):

1. Avoid Antibiotics as Much as Possible

Scientists are increasingly looking at an imbalance in the microbiome as the root cause of many of the problems we have with our immune systems not working properly. These problems include both food and environmental allergies, asthma, and dermatitis.

It’s not too far of a stretch to see the problem with taking antibiotics, since antibiotics essentially kill all the bacteria you have, both the good and the bad.

I really wish I knew this before, both for myself and the rest of my family. Apparently, some of the good bacteria don’t come back. Antibiotic overuse has also been linked to people suddenly developing serious allergies later in life. It should also be noted that antibiotics can be found in our food and water supplies, so even if you’ve managed to avoid antibiotics for infections, you’ll probably still have some low level of exposure to it. (This topic deserves it’s own blog post.) But basically, avoid antibiotics as much as you’re able!

2. Try Traditional Chinese Medicine to Address the Root Cause

Perhaps strengthening your body in other ways can still help to address your immune system gone awry. I don’t want to be lugging an air purifier around for the rest of my life! Traditional Chinese Medicine (TCM) practitioners often claim that acupuncture and herbal medicine can alleviate symptoms as well as address the root cause of hay fever.

Since TCM is tailored to the individual’s constitution, I didn’t find any obvious herbal formulas to try for adults. Generally speaking, I found these herbs commonly listed in formulas to address the root cause of allergies: ginseng, huang qi (astragalus root), bai zhu, gancao. I’ve also read about PhytoCort which some people find to treat asthma and reduce allergies.

For children, I’ve been looking for ways to address what seems to be cough-variant asthma in one of my kids. A TCM practitioner recommended a combination of liquid extract formulas from “Gentle Warriors”, a line of children’s herbal formulas. The formulas were selected based on my child’s constitution and the presenting symptoms. I’m skeptical, but also hopeful. We’re trying it out for 1-2 months and I’ll be sure to update this post with our results.

Update as of 1/6/2021: After we tried these formulas last year, my child’s cough-variant asthma seems to have disappeared! After having this asthma cough for over 1 year, it’s now been gone for 5 months! We’ve managed to keep off of Qvar and Singulair, oral steroids that had bad side effects for us.

3. Eat a Diet Rich in Natural Antihistamines

If you’re in the midst of having allergic symptoms, this approach isn’t going to help you right away. However, over a couple weeks, it sounds like a person with mild allergies could benefit. Common foods with natural antihistamines include: bell peppers, citrus fruits, pineapples, broccoli, cauliflower, berries, apples, tomatoes, black/green tea, ginger.

My family has pretty good eating habits and many foods on this list are already a regular part of the diet. Yet we still have allergic symptoms so I’ll have to say this doesn’t get rid of all your allergies, although I guess they could always be worse.  Anecdotally, as a data point, I’ve noticed that my two kids who rate equally on the allergy scale, have different levels of allergic symptoms. The one who happens to eat a lot more fruits (2-3x more than the normal serving that everyone else eats), also happens to experience less allergic symptoms. Then I read this study about how a Mediterranean diet rich in fruit and vegetables was found to be associated with less allergy symptoms, which further boosted my small finding.

4. Take Natural Supplements to Boost the Immune System

The amount of natural antihistamines found in foods may not be enough for some allergies. Higher dosages in capsule or powder form enable higher intake to replicate the dosages given in scientific studies. These supplements include:

Vitamin C – I found Vitamin C at the top of many lists. Apparently, vitamin C both inhibits the release of histamine from anti-inflammatory cells as well as helps to break down histamine after it has been released. However, the current recommended daily allowances (RDAs) for children (25mg-45mg) and adults (65mg-90mg) may be too low to create the expected allergic relief. The current RDAs were in fact calculated as the amount needed to prevent scurvy and not other ailments. According to the ODS, the highest daily intake likely to pose no risks is:

  • 400 mg for infants aged 1–3 years
  • 650 mg for children aged 4–8 years
  • 1,200 mg for children aged 9–13 years
  • 1,800 mg for teenagers aged 14–18 years
  • 1,800 mg in pregnant or breastfeeding teenagers aged 14–18 years
  • 2000 mg for adults

For my kids, I decided to trial 400-500mg dose. We are only 1 week into it, so I will have to update this post when I have more observations.

Quercetin – this is an antioxidant also regularly included in everyone’s list. It’s high in leafy greens, apples, grapes, and onions to name a few. I saw a range of dosage recommendations for taking it as a supplement. For adults, I saw a range from 500mg daily to 1000mg 2x/day. For children, Dr. Weil says 200mg daily 2x/day for hay fever.

N-acetyl-cysteine (NAC) – this is an antioxidant that some websites report is stronger than Vitamin C. It’s touted as being able to break down mucous, and reduce allergy symptoms. While it can be found naturally in protein-rich foods that you might eat, like turkey, eggs, etc., a much higher dose is needed for therapeutic effect. I read that NAC caused stomach pain in high doses for some users, so I would proceed with caution. I saw recommended dosages of 300mg 2-3x daily.

Probiotics – Probiotics are the supplements that contain the good bacteria that your gut needs for a healthy immune response. Whether probiotics are effective in putting the good bacteria in your gut is still being studied. However, this doesn’t stop a lot of people from trying. There have been quite a few studies that suggest taking probiotics may result in less hay fever symptoms.

What has worked for you? If there is something that has really worked for you, I would love to know about it!

Email me at:  wishiknewbefore20@gmail.com or leave a comment below.

 

Resources

Natural allergy relief in general

On Traditional Chinese Medicine for children

https://www.craneherb.com/shared/articles/28_Gentle_Warriors.aspx

On Vitamin C

On quercetin

On NAC

On probiotics

On antibiotic use and allergies

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

7 Ways to Reduce Physical Exposure to Environmental Allergens

I try to avoid the use of allergy medications as much as possible, so I’ve tested out a variety of non-medical ways to reduce my family’s environmental allergic reactions to tree pollens, grass pollens, and dust mites. Here are the things that we do that seem to have helped in order of suspected effectiveness.

1) Run the air purifier

We have serious dust mite allergies, so I run an air purifier on high in my children’s carpeted bedroom about 1 hour before their bedtime, then I switch it to low for the remainder of the night. We’ve been told to run it 24/7, but that seems excessive. Apparently, it takes approximately 1 hour for the air in the bedroom to be completely filtered. I also run it about 1 hour after I vacuum. Our vacuum doesn’t have a HEPA filter, and I’ve also read that even if it does have a HEPA filter, the sheer act of vacuuming kicks up enough dust (mites) that then need to be filtered. There seem to be a lot of fancy, pretty models on the market these days. We have a pretty old Honeywell one that looks like this model. It seems to do the job, so my thought is, you may not necessarily need a fancy medical grade one.

2) Avoid being outside between 5am to 10am

I only recently learned about this, but according to multiple online sources, pollen counts are highest between 5am-10am and after sunset. Close your windows before dark! I realized how true it was when one of my kids started having a runny nose every time we tried to do a 7am walk during shelter-in-place, but had zero issues when out in the afternoon. So much for trying to become an early morning exercise person.  On the other hand, now I feel a lot better about sleeping in.

3) Wear a face mask

ReduceEnvironmentalAllergens
I’ve got a lot of face masks around the house these days.

If you do have to be outside in the early morning, then try a face mask. This made a HUGE difference for my massive grass allergy when I was outdoors recently – it wasn’t even a PM 2.5 or N95 mask. Just a simple, single layer fabric mask seemed to do the trick. Fortunately, it’s become normal to wear masks these days, so my grass allergy symptoms have significantly improved.  I also suspect I have a temperature sensitivity allergy that is sensitive to the change from the warmth of my bed and being suddenly cooler. I swear it’s real, and putting on a mask immediately after getting out of bed seemed to help!

4) Vacuum regularly

By this, I mean once every 1-2 weeks. That may seem like a lot or very little to you. To me, it feels like a lot and so we have an iRobot that we set loose in the bedroom. It really helps, especially with getting under the bed and not making it seem like such a chore. Again, we have a very old model (older than this, so it’s not a true HEPA filter and doesn’t filter dust mites), but I still see a very full dust container at the end of each run. I run it twice for good measure. We run the air purifier to get rid of the resulting airborne dust mites (in theory).

5) Use a nasal spray / Neti Pot / eye wash

I keep a few canisters of regular saline spray by our home’s entrances. If it seems like a high allergen day, I have the kids do a thorough spray in each nostril and blow, when they’ve been outside. We’ve tried this Arm & Hammer brand and the Little Remedies brand with similar results. Arm & Hammer is available at our local Costco for a much better price. Ideally, I could teach them to use the Neti Pot, but it’s a little too involved.

My mom and kids seem to also have a strong reaction to allergens in the eyes and frequently have very red or itchy eyes after being outside. We have used allergy eye drops, but I don’t find them very effective. Instead, briefly washing the eyes out with a few artificial eye drops or eye wash seems to help clear or prevent the red. The sooner you do it after being outside, the better it works. We use these single use Refresh vials the most.

6) Use dust mite covers

These alone, didn’t seem enough to make an actual difference. My kids were still getting congested at night when we had these. I think the air purifier made the most difference. But now we have the dust mite covers for all their pillows, mattresses, and duvets, and I’m not about to remove them to test. All covers are not equal though, so I researched a bit and ended up using this website’s reviews to help with the selection and considerations.

7) Run pillows and comforters through the dryer on high heat

High heat is supposed to kill or at least reduce dust mites, so I run the kids’ pillows and comforters on high heat in the dryer for 20-30 minutes every month. Since I only do this about once a month, it’s hard for me to tell if this is a necessary step or if changing sheets along with the use of dust mite covers is enough.

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

Revisiting “13 Things Mentally Strong Parents Don’t Do”

During this time of “shelter in place,” I’m tempted to give myself a bigger break than usual when it comes to parenting. Then I remember two things: one, we don’t know how long we’re going to be dealing with this, if this is, in fact, the “new normal,” and two, if I relax my parenting now, I might be giving myself more work for later to fix habits I’ve undone in a couple of weeks (screen time, anyone?).

So to help me stay “strong,” I’m falling back on some great guidance I once found in “13 Things Mentally Strong Parents Don’t Do” by Amy Morin, a foster parent, therapist, and social worker. I’ve read a few parenting books and Amy Morin’s book definitely falls into the authoritative parenting category (as opposed to permissive or disciplinarian). I’m not always a mentally strong parent, but I certainly aspire to be!

The best thing about her book is that it’s practical and usefully laid out. For each “thing” that mentally strong parents shouldn’t do, she lists examples of ways we actually do what we shouldn’t do – without even realizing it. You will almost always find yourself in some of her examples. She shares a detailed story highlighting that “thing” parents shouldn’t do and then provides a variety of tips and guidance for what you should do instead. First, if you just want to read her list, see below. But the list doesn’t mean much without the context she provides in each of the chapters. She really brings each of these “Don’t Do’s” to life with lots of example situations and personal experience. 

13 Things Mentally Strong Parents Don’t Do, according to Amy Morin:

  1. They don’t condone a victim mentality
  2. They don’t parent out of guilt
  3. They don’t make their child the center of the universe
  4. They don’t allow fear to dictate their choices
  5. They don’t give their child power over them
  6. They don’t expect perfection
  7. They don’t let their child avoid responsibility
  8. They don’t shield their child from pain
  9. They don’t feel responsible for their child’s emotions
  10. They don’t prevent their child from making mistakes
  11. They don’t confuse discipline with punishment
  12. They don’t take shortcuts to avoid discomfort
  13. They don’t lose sight of their values

I’m dissecting my own behavior around this list as a form of parenting self-analysis. Starting with the #1 Thing that I should try not to do too often. . .

#1 They Don’t Condone a Victim Mentality

My kids will moan and complain that it’s their worst day ever. That it’s everyone else’s fault but their own that they weren’t focused during a basketball game. That their math book is stupid and that’s why they’re frustrated. Or they’ll let their sibling push their buttons until they explode while their sibling sits smugly and happily in the other room. 

Morin calls a victim mentality a learned behavior that can be learned from parents unfortunately. Some things that I’ve been guilty of as a parent:

  • Making excuses for my kids’ failures or shortcomings (yes, I’ve blamed their terrible tempers on their father and their negativity on genes from my pessimistic mom)
  • Thinking that my children are helpless sometimes

Instead of giving time to these thoughts, I should be helping my child focus on what he can control in his life. For example, being trapped more or less in our home now, I’m trying to empower them with how not to be fearful of coronavirus. I’m telling them that we have to train ourselves to wash hands automatically, not touch our faces, and to be mindful of space and contact with others at all times. If the kids get into fights with each other, I can ask them to think of what they can do to make themselves feel better and not expect me to solve it or punish the other child. 

I’ve had lots of opportunity to work on my parenting these last few days, and without getting too ahead of myself, I want to say that I’ve noticed more independent behavior. I’ll be sure to have another post on “#2 They don’t parent out of guilt” which I already know will give me some cringe-worthy self-reflection. . .

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.

Stopping OIT at One Nut

I have to take my mind off coronavirus somehow, so I thought I would provide the latest update on our experience with oral immunotherapy for food allergies

We’re done for now

We have stopped oral immunotherapy updosing, after having reached a dose of 1 whole nut for each child (see why in the section below, “New information since we started OIT”). So now we are entering maintenance phase at a daily peanut for one child and a daily cashew for the other. Our allergist said that after about 3 months on the 1 nut dose, they would be protected from accidental ingestion of up to 2-3 times their dose – which would be about 2-3 nuts.

It’s the weight that matters, but seeing my nut-allergic kids eat an entire nut of these sizes was a little unnerving

Time involved

It took us 7 months, updosing on a schedule target of every 2 weeks, to go from roughly 2.5mg of nut flour to 1 of an actual, decent-sized nut. We had a few updoses with 2.5 to 3 weeks in between due to illness, scheduling availability, and travel. 

We’re only 30 minutes away from our food allergist. Each appointment was 1.5 hours long. I got used to measuring out the nut flours everyday. All in all, in retrospect (now that it’s over!), the time invested didn’t seem so bad.

Reactions during updosing

Overall, we had a pretty smooth experience with updosing. We did not have any anaphylactic reactions. We followed most of the guidelines: 

  • We usually dosed in the evenings around 7 to 7:30pm. Our kids go to bed around 9pm. We did occasionally dose late around 8pm.
  • We skipped dosing on particularly hectic/exciting days like Halloween.
  • We did shower after the dose a few times, but we kept it particularly short and not too hot and did not have reactions.
  • We dosed with Zyrtec on updose days and for 2-3 days after based on initial recommendations of our allergist.
  • Both my kids had occasional tummy aches, but I could never be certain if it was related to dosing. I suspect that some were and some weren’t. 
  • Twice, one child had the feeling of something in the throat. Both resolved with Zyrtec.
  • My peanut-allergic child had coughing reactions on 5-6 occasions within the two hour window of dosing that were resolved with Zyrtec. 
  • It was recommended that we treat our peanut-allergic child with Qvar or other asthma control medication because there were also environmental allergies that presented with allergy-induced asthma symptoms (periods of recurrent, mild coughing and more coughing symptoms during colds). Ultimately, we stopped the Qvar because of some behavioral changes that accompanied its use

New considerations since we started OIT

Our allergist basically recommended that we stop at 1 nut. This is a change in thinking since the time we began OIT last year. Originally, our provider thought that OIT would continue up to about 3-4 nuts. Here are the recent learnings that resulted in the change of their decision:

  • Clinically, our provider saw that patients in maintenance were having more reactions at 3-4 nuts versus patients who were doing very well on just 1 nut, while conferring a strong level of protection of up to 3 nuts. (Incidentally, for what it’s worth, I learned that a maintenance dose of 8-10 nuts is around the level of what is considered “free eating.”)
  • This supported my own anxiety-inducing findings on Facebook OIT groups where it seemed that many parents shared that their kids were having reactions, even anaphylactic ones on maintenance doses of 3-4 nuts or more
  • Palforzia, the “drug” containing pre-measured doses of peanut flour will also only go up to 300mg (1 peanut), so this falls in line with what is now considered “safe” and FDA-approved.
  • I also came across this 2018 Palforzia aka AR101 study that showed only 67.2% of patients who had been on a maintenance dose of 300mg peanut flour were able to pass an exit challenge of 600mg without dose-limiting symptoms. This made me less comfortable about the 2-3 nut protection level mentioned by our allergist. If you’re data-inclined, here’s the appendix for even more details (including the OIT dose schedule, patient characteristics, etc.) on the study.

Next Steps

All in all, our provider suggested that we stop at one nut for now and reassess in 3 months whether we would like to continue, given the recent findings and after we see how our kids fare on their 1 nut maintenance. Our provider also said that we would need to be completely reaction-free for the next 3 months to even consider updosing to reach 3-4 nuts (which is about 3-4 more updose appointments). 

Our peanut-allergic child with suspected underlying asthma conditions would not be recommended to continue past 1 nut due to the risk associated with the conditions, unless we resumed asthma control medications. We’ll have to think hard about that one because the behavioral changes were very unsettling. 

Our other cashew/pistachio-allergic child could be allowed to continue if there are zero reactions in the next 3 months. However, in that case, we would do a pistachio challenge of some sort. When we began OIT, we were told that desensitizing to cashew results in desensitizing to pistachio (due to the cross-reactivity) in about 80% of the cases. Our allergist now says that this is actually the case in 90%+ of the allergies, and after 3 months on the 1 cashew maintenance dose, they would recommend a challenge of eating 3 pistachios in the clinic to see if my child has desensitized to the pistachio as well (1 cashew = 2.5 pistachios).

In the meantime, I’ve been following the continuing developments linking food allergies to the gut and am hopeful that a cure, not just a treatment is in our future.

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. 

 

How Much Outdoor Light Do You Need to Prevent Myopia?

Updated 12/7/22

If you’ve been reading about the latest findings on why we’re all becoming so nearsighted, then you know that researchers have found a strong link between myopia and outdoor light. They think that outdoor light (possibly even more so than near work) may have the strongest impact on protecting against myopia. However, the simple recommendation of spending more time outdoors is a little ambiguous and not enough information to decide whether following this recommendation was feasible or worthwhile.  As much as I would like to spend my entire day at the beach, in a time-constrained world, I wondered how much and what kind of outdoor light do we need for it to make a difference?

Looking into the distance may also be part of the reason outdoor time prevents myopia
Looking into the distance may also be part of the reason outdoor time prevents myopia

Why outdoor light matters

Why outdoor light matters is still unclear to researchers. There are a few candidate theories, but if the reason is unclear, that means the kind of outdoor light you need is, well, unfortunately, another educated guess. Here are the theories so far:

  • The dopamine theory: Outdoor light triggers retinal dopamine. Animal studies show that when the eye has low levels of dopamine, its’ axial length increases.
  • UV exposure: Being exposed to UV light in the range of 360 nm to 400 nm light may be the part that helps control myopia
  • Vitamin D levels: Vitamin D is believed to help proper eye growth and the body can only produce adequate amounts of Vitamin D levels through physical exposure to the sun’s UVB rays. One study found a correlation between low vitamin D levels and myopia in children.
  • More distance viewing: Being outside causes more frequent distance viewing, as opposed to near work and the closer viewing environment that we have when indoors.
  • Brighter, outdoor light: The higher light levels that are outside are thought to be key – this doesn’t necessarily negate the other theories above. 

How much light and how bright?

Based on the theories above, here are the study recommendations:

  • There was a range of “how much light” recommendations from the studies. On the lower end, I saw that 14 hours outdoors/week could lower the chances of myopia by ⅓. On the higher end, Dr. Ian Morgan, a researcher who specializes in myopia and the environment, has concluded that children need to spend at least 3 hours/day in light levels of at least 10,000 lux to be protected
  • 10,000 lux is described as “the level experienced by someone under a shady tree, wearing sunglasses, on a bright summer day.” For comparison, average indoor lighting is about 500 lux. Consequently, sitting by the window with natural outdoor lighting is probably more protective than being indoors without natural light.
  • Despite the fact that the UV exposure may play a role against myopia, it is still recommended that we wear UV protective eyewear and clothing. Since it’s unclear if and how much UV exposure is needed, doctors still recommend protecting against the damaging effects of UV light. However, since many contacts and glasses nowadays include UV protection, they are continuing to investigate the possibility that a different balance may be needed between UV protection and myopia protection. 
  • To get adequate levels of vitamin D (30 ng/mL or more), some experts recommend about 10-15 minutes of sun exposure on your arms and legs without sunscreen between 10a-3pm each day. However, you need to tailor this recommendation for yourself by factoring in sunscreen (which blocks UVB), your skin pigmentation (darker skin needs longer exposure), and where you live in the world. For example, if you live at latitudes 37 degrees north of the equator, there is less UVB exposure resulting in less if any vitamin D production. You may also look into adding more vitamin D rich foods or supplements to your diet.

Most of this research is around outdoor light and its impact on children’s myopia, but it’s probably meaningful to adults who have progressing myopia, too. All in all, 2-3 hours outdoors daily can be a tall order for over-scheduled, over-worked lives – both kids and adults, especially in winter! 

How much time do you and/or your family get to spend outdoors on average? If you’re already fighting myopia in your family, see my other posts on our experiences with myopia control for children and reversing myopia as an adult.

 Resources

How much outdoor light is needed – some different viewpoints

UV light is blocked in contacts and in glasses

Sun protection can still be used outdoors for myopia prevention

Vitamin D, myopia, and sun exposure

Best Allergy Medications for Kids

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

6 Treatments for Food Allergies

Having children with severe food allergies can be very difficult on the parent as well as the child. However, other than plain avoidance, there are now actually a number of different options for families to consider. 

If you have a child under 5, you have a particularly good chance of using some of these options (particularly OIT), to cure (not just desensitize!) your child’s food allergies. Researchers have found that the younger kids have much more lasting benefits of immunotherapy – meaning they could actually be cured(!) rather than just desensitized. My kids were unfortunately past that age when I learned that information – talk about some serious “wish I knew before!!!” Below is a list of treatment options that you can now consider.

#1 Oral immunotherapy (OIT)

Oral immunotherapy involves giving your allergic child increasingly larger amounts (over a long period like a year, etc) so that they gradually become desensitized to the allergen. OIT for peanuts and other nuts is the most studied, but it is available for other food allergens as well. This is known to have about 80% efficacy rate, but there are challenges with it. Patients regularly have mild reactions and sometimes anaphylactic reactions. It has the lowest safety profile of all the treatments so far, but is the most effective. We are trying this one! Read my OIT post to get the key details to help you decide if it’s right for your family.

Currently, you or your allergist will measure out your own daily doses of this allergen, but for those allergic to peanuts,  AR101 also known as “Palforzia” is a “drug” coming out that is essentially pre-measured capsules of peanut protein.

Photo: AR101 also known as “Palforzia” from snacksafely.com )

#2 Sublingual immunotherapy (SLIT) 

These are liquid drops that appear to have a higher safety profile (less side effects), but generally less efficacy than OIT. It’s also much easier than eating doses of your allergen each day. It involves putting small drops of liquified allergen underneath the tongue and holding it for a couple minutes – this also has to be done for 1+ years. Like OIT, it’s unclear how long the benefits of the therapy can last without regular dosing. Some OIT practitioners offer SLIT, but not many yet. SLIT is also available for environmental allergens. The most recent research out on SLIT found the efficacy rate to be about the same as OIT. If the research continues to be promising, this option may emerge as the option that most allergists will be comfortable with due to its safety profile. 

Photo: Patient undergoing SLIT from snacksafely.com

#3 Peanut patch

This is a patch that you place on the skin that releases small amounts of peanut protein that mixes with your sweat to get into your skin. So far, the research says it’s not as effective as OIT or SLIT, but does offer some modest protection. 

Photo: peanut patch by DBV Technologies

#4 Food Allergy Herbal Formula (FAHF-2)

This is a Chinese herbal medicine formula even less available than OIT or SLIT. As far as I could tell, only one group led by Dr. Xiu Min Li (Western medicine – validated doctor, for those who have a lot of doubts about Chinese herbal medicine) is investigating this, but they have had hopeful results. This medicine works by altering the patient’s immune system response and involves taking up to 30 herbal pills/day for an undetermined amount of time until lab results show bloodwork low enough to warrant food challenges. The patient doesn’t ingest any of the allergen until lab results indicate the body is ready. There is a Facebook group called “Chinese Herbs for Allergies” and people from all over the world (Australia, UK, etc.)  work with her office for in-person or tele-consultations

#5 Allergy release technique (ART)

This one is less well known than the ones mentioned above. I have not had a chance to read much about this method, but appears to be a homeopathic approach to strengthen the immune and digestive system first (through probiotics) and then gradual ingestion of the allergen (that part sounds like OIT). I found some news coverage and well-known chef Ming Tsai has a son who was cured of his allergies with this method and spoke about at on this episode of Dr. Oz

#6 Peanut allergy vaccines and antibodies

These are fairly new and I haven’t gotten around to reading enough about them, but they sound promising and I wouldn’t rule out trying them even after having completed OIT. They seem only available in clinical trials for the near-term. 

Resources

OIT

SLIT

Peanut patch

FAFH-2

ART

Immune system injections

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:

Minimalist, Athletic Shoes for Kids

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

PrioI’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?

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

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: