Ten Health Care Tips for Travel

While you are making vacation plans, take a few minutes to think about your health needs and what you might do if an unexpected medical problem occurs. 

1. Confirm you have a current health insurance card with you. Many insurers offer mobile apps now so you can pull up your card whenever you need it. Contact your insurance company or HR department to order one if necessary. 
2. Make sure you understand your medical insurance coverage. Do you have coverage outside of a preferred provider network? How are emergency room visits treated?
3. Download your medical plan's provider locator app on your smartphone. If you don't have access to a smartphone, print out a list of participating providers near your travel destination from your carrier's internet site.
4. Pack enough prescription medication to last your entire trip and be sure to keep it in your carry on if you're flying. Contact your insurer a couple of weeks before your trip to arrange coverage for additional amounts of any prescription drug that you'll need. This is sometimes called a "vacation override request." Pack a list of your prescription medications in case of a medical emergency or to make replacing them a little easier if they get lost. 
5. If you take over-the-counter drugs regularly, include those as well. Consider packing something to treat traveler's diarrhea like Imodium. Depending on your destination and the type of activities you have planned, you may want to pack a first-aid kit and insect repellent. (Those blister band-aids can save the day if you plan to do a lot of walking.) And, of course, don't forget the sunscreen. 
6. If you have a medical condition that could cause problems, ask your doctor to provide a letter that contains information about your illness and the treatments you are receiving. 
7. If you experience a non-life threatening medical problem, consider calling your insurance company's nurseline for advice. Convenience care clinics and urgent care centers are often time and cost saving alternatives to an emergency room visit. 

Running of the Bulls in Pamplona
Image: The Boston Globe via filmapia.com

If you plan to travel abroad:

1. Find out if your health insurance plan covers treatment outside of the United States. You will probably have to pay for services in advance and submit for reimbursement if they do. Find out if you have coverage for medical evacuation. International medical insurance coverage is available if you do not think your normal coverage is adequate. It's reasonably priced and can be purchased by the day. I recently purchased a policy from International Medical Group for my son who will be traveling through Europe this summer.  
2. Consider seeing a Doctor who specializes in travel medicine before you leave home. Travel doctors keep current on the health issues and immunizations needed in countries worldwide. Travel doctors will tailor their recommendations to your individual health needs and may prescribe medications and/or vaccines for your trip. 

If you will be traveling alone:

1. Consider purchasing a Road ID. Road IDs are frequently worn by triathletes and cyclists. They offer a few different styles and give you space to include emergency contact information and highlight medical conditions. 

See this post for some tips to help you stay healthy when you travel --  Building Your Immunity Arsenal for Travel. 

Bon Voyage!

Build Your Immunity Arsenal for Travel

Our organization holds an annual convention for 10,000+ members the week before Thanksgiving. About 100 staff travel to host the convention. We usually fly and then wind-up working 14 hours a day in a convention center. Inevitably, some of us get sick. It's usually just a cold, but it's no fun. I asked Dave Foreman if he had some tips for staying healthy when you travel. Dave's a pharmacist and a Naturopathic Doctor. We partnered with Dave on a heart health initiative earlier this year. This is what Dave shared with me.

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Whether or not it is cold/flu season or you just don’t want to get sick, here are a few tips to support yourself naturally.

Avoid Sugar - (this includes other “white” foods like pasta, bread, cake, etc. and honey) I like to say that sugar/refined foods make your immune cells stupid. I read years ago that 7 teaspoons of sugar will decrease your immune function by 50% for up to 8 hours.  While you immune cells aren’t functioning properly, bacteria and viruses can wreak havoc on your body. Stay ahead of the game and avoid those refined foods.

Wash your hands - Goodness knows what all you have on your hands. I like grapefruit seed extract as my hand sanitizer.  If you want something more traditional, there are a few great choices at your local health food store.

Supplement - I use a supplement daily (Host Defense) to support my immune system. By using a support supplement, I can use it daily for months on end. Other products I like are: Advanced Immune Support (MD Select), Immune Support Formula (Weil Nutritional Formulas) and Immuneactive (Futurebiotics). Consult with a store health enthusiast to find the right formula for you.

Pay me later: You know the old saying, “pay me now or pay me later”. What if it is too late and you are now getting sick? Look for products that boost or stimulate your immune system into action. In my family, we use Esberitox (Enzymatic Therapy). Other great products such as; Seasonal Support (MD Select), Umcka Cold and Flu (Nature’s Way), Immuboost Blend Sp-21 (Solaray) and Wellness Formula (Source Naturals) along with a bunch more I can’t list can be found in the immune support section of your local health food store.

Getting ready to send your child to college? Complete this health related check list before you wave good-bye.

Getting ready to send your child off to college? Take a few moments to think about how their health care needs will be met while they are away.

Ian 2008

Thanks to the ACA, children can stay on a parent's health care plan until they reach the age of 26. If you're covering your child on your plan, do a quick search to find in-network providers near where he or she will be attending school. If you don't find any, call your insurance company and ask if they have any affiliate networks available where you child will be attending school. If you have no in-network options, find out if you have an out-of-network benefit. It may have a separate deductible that needs to be met. This deductible may be high, but if your child can seek routine care at home and use the school's health clinic for primary care when they're away, it may serve as sort of catastrophic coverage if needed. If your child is uninsured, see the articles at the end of this post for some options.

The school's health clinic can be a good source of primary care for your student. If you're child seeks care at the student health clinic, it is likely that the visit will be covered free of charge. Well, not exactly free, there is probably a fee to support the student health clinic tacked onto the tuition bill or included as part of a comprehensive fee. Many schools will bill your insurance for lab work and any prescriptions your child might need. Keep in mind that the healthcare provided by the school is not a replacement for health insurance. It typically won't cover procedures, tests, prescriptions or any type of inpatient care.

If your child takes any maintenance medications, renew the prescriptions and set up mail order delivery at the school. You may need to call the school to confirm that they'll be able to accept delivery of prescriptions if you child is assigned a P.O. box.

Schedule any routine visits while your child is at home. You'll probably need to complete a pre-entrance health form and provide proof of vaccinations, so request this information from the doctor's office if you don't have records at home. It's also good to get in a routine of scheduling dental visits in December and June when your child is more likely to be home. Remember teeth cleanings generally have to be six months apart to be covered under your preventive care benefit.

Identify which hospitals are in-network and then pull up the city or town where your child will be and see which hospitals earned the highest scores for safety on Hospital Safety Score. If you don't find any in-network options, the ACA specifies out-of-network emergency services must be covered as follows:

if a group health plan or health insurance coverage provides any benefits for emergency services in an emergency department of a hospital, the plan or issuer must cover emergency services without regard to whether a particular health care provider is an in-network provider with respect to the services, and generally cannot impose any copayment or coinsurance that is greater than what would be imposed if services were provided in network. At the same time, the statute does not require plans or issuers to cover amounts that out-of-network providers may "balance bill"

If your child decides to travel abroad, consider purchasing international medical insurance for the time he or she will be out of the country. You can learn more in this post -- 10 Health Care Tips for Travel.

Your child's school should provide all the information you need on its' website, but this list should give you a head start. If you think of anything I overlooked, please leave a note in the comment section below.

Health Care Essentials -- 
A check list for college students.

Connor 2013

• Complete any required pre-entrance health forms. This is likely to require providing proof of immunizations (see list below), but not necessarily a physical for most students. Student athletes will probably be required to have a physical and complete additional paperwork. 
• Find in-network medical providers near the school. If none are available, find out if you have any out-of-network benefits.
• Make sure routine dental care is up-to-date.
• Refill any prescriptions and arrange to have maintenance medications delivered by mail-order to the school address or transfer prescriptions to the student health clinic.
• Make sure your child has these items in his/her wallet.
• Insurance card
• Student ID Card
• List of medications taken routinely
• List of any medications he/she is allergic to
• Primary care physician's contact information
• Confirm your child has these apps on his/her phone.
• Your health insurance companies' app. If you're with UnitedHealthcare, it's Health4Me. Make sure your student has the login information
• Hospital Safety Score to find the safest hospital whenever and wherever they need it.
• ADA - Your Health Guide- searching health topics by symptom
• Put together a first aid kit (see list below.)
• If you student wears contact lenses, it's a good idea to have a back up pair of eyeglasses and pack a copy of his or her current prescriptions.
• Contact the student health center to notify the school of any serious pre-existing conditions your student has including any mental health issues. 
• Pack a copy of important medical records. 
• Pack an EpiPen if prescribed and an updated prescription for additional medication if needed.
• Students that are diabetic should have adequate quantities of supplies for glucose monitoring and insulin administration. Check with the student health center to find out about disposal of needles and syringes.
• If your student will be using a bicycle, be sure to pack a helmet.

Vaccinations:

My youngest son attends UVA and this is what they require. I think it's fairly typical. Medical and nursing students will likely have additional requirements. You should get a list of what's required at your child's school during orientation. You should also be able to look it up on the school's website. Look for a student health section. 



• Measles/Mumps/Rubella (required)
• Meningococcal Disease (required)
• Tetanus/Diphtheria (required)
• Tuberculosis Screening/PPD (required)
• Hepatitis B (required)
• Polio vaccine series (required)
• Chickenpox (Varicella) (recommended)
• Hepatitis A (recommended)
• Hepatitis A and B combination vaccine (recommended)
• Influenza (Flu) (recommended)

My sons always give me a hard time about getting a flu shot, but I do my best to drag them to the CVS Minute Clinic for a flu vaccine. Having the flu when you're in college is particularly miserable. Especially if you live in a dorm. The school health clinic may offer the flu vaccine. You can also check with your health insurer to see where the vaccine is covered near your child's school.


First aid kit for college students:

I felt better sending our sons off with a first aid kit. My oldest son sent his home fully intact after college (expired soup cans and all.) At least, I bought myself some piece of mind.



• Adhesive bandages (assorted sizes)
• Adhesive tape (1" wide)
• Antacids
• Antibiotic ointment
• Antihistamine (diphenhydramine hydrochloride - generic for Benadryl)
• Antiseptic wipes
• Can or two of chicken noodle soup (pull top or be sure to include a can opener)
• Cold Pack (disposable)
• Cough drops
• Cotton roll and balls
• Cotton-tipped swabs
• Decongestant (pseudoephedrine hydrochloride - generic for Sudafed)
• Digital thermometer
• Elastic bandage (3" wide) (Ace wrap)
• Flashlight (and extra batteries)
• Gauze pads
• Pain relief medicine (aspirin, acetaminophen, ibuprofen)
• Scissors
• Tissues
• Sunscreen
• Hydrocortisone cream

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Learn More:

• FAQ: A Young Adult's Guide To New Health Insurance Choices
• Health Insurance for College Students: Take Note of These Tips
• Off to College? Put a Doctor in Your Student’s Pocket

Foam Rollers -- A Quick Fix for Aching Muscles

In 2005, Gabrielle Reece interviewed Oakland Athletics pitcher Barry Zito on Fit TV's Insider Training. They showed Barry Zito using a foam roller for recovery and I wanted to give it a try, so I asked my family for a foam roller for Christmas. I was hooked immediately. A few minutes with my foam roller was better than a trip to the chiropractor for relieving an aching back. I used that first foam roller until it was crushed into the shape of a V. I upgraded to a firmer foam roller. Well, not exactly just one, I have one next to my bed, one in the living room, one in the family room, one in my car, one under my desk at the office, and a smaller packable version for travel.

I stocked our exercise room with foam rollers and I have encouraged our instructors to incorporate them in our classes so people know how to use them. In 2010, we held a myofascial release clinic to introduce more staff to foam rolling and other self-massage techniques. It was well attended and well received. I've been meaning to write this post ever since. Matt Hirn, one of the trainers we were working with at the time, even helped me create this little instructional video.  

The benefits of foam rolling include:

1. Release tight muscles. 
2. Relieve pain associated with working at a computer for long stretches of time.
3. Improve circulation which aids in muscle performance and recovery.
4. Improve the range of motion in your spine.
5. Reduce the appearance of cellulite. (This last point is somewhat debatable, but it can't hurt to try.)

Some people find foam rolling a little painful initially, but you can easily control the amount of pressure you use. I'd put it in a "hurts so good" category. You use your body weight to roll specific muscles to mimic a deep, gliding massage and pause on any trigger points until they release. Matt will introduce you to a few things you can try to get started, but you can get at most major muscles if you contort yourself into the right position.
  

There is a lot of additional information available online. I like these posts:

• Self-myofascial release: no doctor required
• Using Foam Rollers
• Foam Rolling -- The Basics from USAT
• 3 Ways a Foam Roller Can Help Triathletes

Enjoy Breakfast! -- Guest Post by Kelly Velasquez

30 Day Mediterranean Lifestyle Challenge

Kelly Velasquez is our Associate Director of Credentialing - Research & Quality Management. (Believe it or not, Kelly is not even in the running for the longest job title in the office.) Kelly has been a big supporter of our wellness efforts and is a long standing member of our wellness advisory team. Kelly is a swimmer and a triathlete. She is married to Eduardo who also works for ASHA and has two beautiful little girls. As you can imagine, what she doesn't have is spare time. Yet she never skips the most important meal of the day.

Like Kelly, I'm a big breakfast fan. On a good day, I might even eat two breakfasts. I can't resist this opportunity to share two of my favorite weekday breakfast recipes. (1) Cottage cheese pancakes -- these are great to make on the weekend, so you can just grab one or two before a morning workout. This is also my go to pre-race breakfast. They're great with some berries. (2) Blueberry-Coconut Baked Steel Cut Oatmeal. My friend Lee Baumgartner shared this recipe with me when I started planning this challenge. Make a 9x13 pan on Sundays and just heat a scoop up in the microwave all week. (I leave out the Stevia, skip the sauce and use plain almond milk. I like to top it with some slivered almonds and chia seeds.)

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As an avid breakfast lover, I jumped at the opportunity to write about how you

can adapt your breakfast (or start eating breakfast) the Sonoma/Mediterranean way…whether you love eggs or not.  As it so happens, I love eggs, but the idea of making a frittata, or mini-muffins of eggs and veggies, or following any recipe at all, left me less than enthused. I am not typically a recipe girl, but with this diet I have followed almost all of the recipes in the Sonoma book,

Sonoma Breakfast Day One –
2 scrambled eggs with chives,
4 grape tomatoes, ½ c blueberries,
½ c spinach, 1 slice Ezekiel toast
(yes, I know, it is the one with raisins,
which I since learned we are not
supposed to have in Wave 1 –
so switch to the Sprouted or
whole grain variety)

which means that sometimes we are eating dinner at 9:30pm. Breakfast, on the other hand, has been a breeze, possibly because I plan ahead and make it at work (ideally, after taking ASHA’s Functional Training fitness class or putting in some miles outside or on the treadmill). And, while I know that you should eat something before you work out, I have to admit that years of getting up at 4:30am to swim have left my body trained to NOT eat early in the morning. So I typically wait to eat until after my workout is done, which means my breakfast can be as late as 9:00 or 10:00am – just motivates me to get showered, dressed, and ready faster!

The benefits of starting your day off with a nutritious, well-planned breakfast are well-documented and - while somewhat controversial in their presentation of ‘data’ this is alsoa pretty good read. But what do you do when you are short on time, and just trying to race out of your house to get to work? The morning rush makes it kind of hard to whip up a frittata on the stove prior to dashing out of your house. Here are some of my tips to make sure you eat a Mediterranean breakfast each day.

First off, find what works for you – timing wise, and meal-wise. You may prefer to eat at home vs at work. Or you may be a creature of habit and prefer to have the same breakfast every morning. I tend to find 2-3 breakfasts that I like and alternate them (cereal, some form of eggs, and oatmeal).  I keep a bowl

Sonoma breakfast staple –
Kashi Go Lean Crunch
(Honey Almond Flax) –
9g protein and
8g fiber per serving;
3/4 c skim milk;
½ c blueberries

and spoon in my desk, along with a box of Kashi cereal (I like the Go Lean! Crunch Honey Almond Flax flavor, while my husband prefers the Go Lean! Crisp Cinnamon Crumble one – both appear to meet the Sonoma diet guidelines as they serve up 8g fiber per serving and are whole grain). So at least once per week I only need to bring in a cup of fat-free milk in my travel mug and some fruit. I prefer blueberries which are quite tasty right now, and as you can see in the picture below. My other favorite option is eggs (sometimes I use the egg beaters, just check to see that they have omega-3s). I’ll pack up the leftover veggies from the night before in a Tupperware container (onions, mushrooms, cauliflower, zucchini, asparagus, etc), bring 2 eggs, and scramble them in the microwave at work. Halfway through the cooking time I may add a diced tomato, and then some shredded parmesan at the end. That with a piece of whole grain toast or with some turkey bacon (also microwaveable) makes for a great meal.

Finally – oatmeal. I pour one serving of rolled oats into a Tupperware container, cover it with half skim-milk and half water, and pack it in the fridge.

Sonoma frittata – using leftover
roasted veggies (onion, squash,
cauliflower, asparagus), grape
tomatoes, ½ c blueberries

Next morning at work, I microwave it to warm it up, and add chopped walnuts and dates and a diced apple (I particularly like Gala apples). Sometimes I add cinnamon; other times I may add raisins (but not in Wave 1 of the Sonoma Diet). Then I have 3 go-to meals ready for the week. Also, I make a frittata on Sunday, and have 2 extra servings in Tupperware for the week ahead (the Sonoma book has several frittata variations, all good – and don’t worry if your eggs don’t exactly set, as I think it is almost better tasting when it is messier).  And if all else fails, the Mediterranean Café has breakfast!

NOTE: If you are not much of an egg fan, some other options are here. 

Enjoy breakfast – truly the most important meal of MY day!

Additional Resources/Recipe Ideas/Articles -

• Breakfast is King
• Mediterranean Diet: 5 Tasty Breakfast Ideas
• Mediterranean Breakfast Pitas Recipe
• Breakfast on the Sonoma Diet
• Mediterranean Diet Breakfast Food

Infusing Herbs and Spices -- Guest Post by Pam Leppin

30 Day Mediterranean Lifestyle Challenge

Pam Leppin is ASHA's Advertising Sales Director. She is an avid cook and she produced and sells a really nice herb chart. When I started thinking about spicing up our meals during the challenge, I went straight to Pam and asked her to write a post for us. Pam has her own blog Artistic Feast. 

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Pam and Kurt's wedding on Pink Gin
Beach in Grenada

My husband and I got married on Pink Gin Beach in Grenada, the Island of Spice. The island is one of the largest producers of nutmeg in the world. We had three glorious days to explore this beautiful island while we obtained residency so we could get married there. During our fun-filled days, we visited a nutmeg plantation. We discovered that all parts of the nutmeg are used in cooking. The fruit surrounding the nut, nutmeg apple, is used to make jams and syrup. The nut shell is wrapped in red tendril fingers of the spice Mace and inside the shell is the nutmeg meat itself.

In Grenada, nutmeg is used in practically everything they cook, savory and sweet alike. It's not just for pumpkin pie folks. At breakfast one morning, I asked the server what the eggs were seasoned with, the answer nutmeg. I’ve since become a big fan of nutmeg. It tastes great on spinach, broccoli, carrots, cauliflower, a variety of fruits, lamb, pasta, eggs,

The layers of nutmeg. Photo by Joshua Yetman.

raisins, squash, and of course, pumpkin. A word of warning…nutmeg should be used in moderation. It has a strong flavor that can overwhelm your dish and ingesting large quantities can be a health hazard causing hallucinations and even death. You’re not likely to overdose on nutmeg. You’d have to eat one or more whole nuts and by then your food would be so overwhelmed with flavor you probably wouldn’t want to eat it anyway. 

Nutmeg drying. Photo by Pam Leppin.

Speaking of whole nuts, you should always use fresh, whole nutmeg, rather than pre-ground. It only requires a little bit of extra effort and the flavor difference is enormous. Roll the nutmeg with the palm of your hand on the counter top, cracking the hard outer shell and swipe the nut inside across on a mini grater a few times on top of your eggs instead of salt. Amazing. 

I don't want to have to count calories or follow a point plan to lose weight. I believe the Mediterranean Lifestyle Challenge is presenting me with the solution I've been seeking. I love that it is about mindful eating, breaking the sugar addiction, and sharing meals with those you love. I'm an avid cook and I love feeding people. Nothing gives me quite the same pleasure as filling my home with friends and family, sharing a bottle of wine (or two) and watching them devourer what I have lovingly made for them. It fills my heart with immense joy. Long before visiting the Island of Spice, I was a big fan of using herbs and spices. I’ve had an herb garden, of one sort or another, at every house I’ve lived in since I was 10. Herbs and spices can add a complex depth of flavor without adding extra salt and butter. It is all in the layering. So many herbs complement one another. Most folks know from classic Italian cuisine that garlic, basil, and oregano blend well together with tomato, but did you know that basil and dill are a wonderful combination as well? Both herbs taste great with one another on carrots, yellow squash, eggs, shellfish, lamb, and cucumber. 

Years ago I was searching for a resource that would easily tell me what herbs tasted good with what food and with what other herbs I could combo together to add depth. I could find a variety of resources to tell me one or the other but not both. So I researched, experimented, ate and ultimately developed a culinary herb chart that would give me a cross reference at a glance. The result hangs inside my spice cabinet door and gets used on a regular basis. The chart covers 13 different herbs, cross referencing which herbs work with each other, and with what foods. If you work at ASHA, you can stop by my desk and pick one up for $10 or visit my website/blog and have one shipped to you for a little bit more. While you're there, check out my blog post on making preserved lemons and chimichurri. Here are some handy online resources for using culinary herbs and spices including The Epicentre's encyclopedia of spices, Spice Advice's online chart, About.com's herb and spice chart, and Epicurious' visual guide to fresh herbs. 

A few hints I've discovered over the years... 

Dried herbs have a more intense flavor than fresh. So if a recipe calls for dried herbs and you're using fresh, use more. A good rule of thumb for every 1t dried = 1T fresh. 

Some herbs and spices are strong and can overwhelm a dish. A number of these are sage, cumin, nutmeg, rosemary, cardamon, cloves, allspice, and cinnamon. They should be used in moderation. 

Don't discount parsley and relegate it to being only a garnish. Parsley combines well with most herbs and foods, as it adds flavor and depth to your dish. Fresh parsley can brighten heavy dishes. It is a must for bouquet garni when making stock or soup. To create your bouquet garni, tie together a bundle of fresh herbs with cotton twine or wrap dried/fresh herbs in cheesecloth and drop into your pot. Most bundles include parsley, bay leaves, thyme, but can also include rosemary, tarragon, chervil, savory, and peppercorns depending on what you're making. Remove the bundle before serving. 

Heat and spices don't get along. If you store your spices over the stove, oven, or dishwasher the rising heat makes them lose their flavor and potency rapidly. Pick a spot away from heat sources and moisture. Store them in air tight containers. Go through your spice cabinet and replace the bottles that have been lingering. The bottle of paprika that you bought for a recipe five years ago, has probably gone over and won't taste like it should. McCormick has some great information on the recommended shelf life including a Fresh Tester tool that allows you to put in the code from the bottom of your McCormick spice bottle and will tell you the age of that spice. Ground spices usually last 2-3 years with dried herbs having a shorter shelf life at 1-3 years. If you think it has been around too long, dump the spice and keep the bottle. 

Many spices travel great distances, from far away exotic places, and can be quite costly. Ever looked at the price per pound when buying the little bottles in the grocery store? Marjoram is $255/lb, bay leaves are a whopping $834/lb. Ouch! Find your local natural market, many like the Common Market in Frederick, that sells bulk herbs and spices at a much cheaper price per pound and you can buy as much or as little as you need. I buy a big bag of marjoram, as it tastes wonderful on most vegetables. A little bottle of marjoram in the grocery store will set me back $6.19 but I can buy in bulk, refill an old, well-washed, spice bottle for pennies comparatively. 

Want fresh herbs? Try your hand at growing them yourself. Many herbs are like weeds, they will grow in the worst of soils, as long as they have plenty of sun and water. So pick a sunny spot and give it whirl. There is nothing quite like running your hand over a rosemary bush and then putting your palm to your face and inhaling. The rich earthly scent fills your nose and according to research, can improve your memory and mood, as well as flavor your dinner. Health Diaries' Eat this! notes 16 health benefits of this wonderful Mediterranean herb. 

I’m not going to delve too deeply into the health benefits of herbs, although there are many and much research to support the benefits. Check out the Huffington Post article on the 25 healthy herbs. ASHA's health care provider, United Healthcare has an article on the healing powers of a handful of herbs as well. On a personal note, I use turmeric to reduce inflammation. To find more information on the benefits of turmeric, try looking at Dr. Weil's website. In an effort to not turn everything I cook bright yellow, I take a 1,000 mg capsule of turmeric every day. If I don't take it for a couple days, I notice a big difference in how my knee joints feel. Being overweight can increase inflammation throughout your body...another good reason to drop the extra pounds and to add turmeric to your diet. 

Want to learn more about using herbs and spices in your cooking adventures? Check out this blog post. It has some great information. 

My husband was and still can be a rather picky eater. When we first met, the only salad green he would consume was iceberg lettuce. On the same weddingmoon trip to the Grenadines, we were having lunch on a secluded beach. They served us shrimp salad on a bed of baby spinach leaves with a mango dressing. After inhaling the entire plate full of food, he asked "what were those green leaves?" I laughed out loud. I’m happy to report that he now eats a wide variety of greens. His mom is amazed at what he'll eat nowadays. I’m still trying to recreate the mango dressing. Now that I think about it, I bet there was nutmeg in it…shrimp, mango, spinach…all yummy with nutmeg. Hmmm, perhaps that has been the missing ingredient all along. 

Happy Cooking...and eating!

Long Commutes Take a Toll on Our Wallets and Our Waistlines

People in the Washington, D.C. Metropolitan Area have the worst commutes in the Nation according to a report that was released earlier this year. That came as no surprise to me. I live in Reston, Virginia and work in Rockville, Maryland. The 27 mile commute should take 32 minutes. Ha!

The cost of commuting has been in the news a lot in the DC area lately. Last week, I heard that Maryland congestion costs drivers $2,195 a year. If you use the ICC to commute in Maryland, it will cost you an additional $8.00 per day. If you take the Dulles Toll Road in Virginia, it costs $5.50 per day. (Tolls will increase to $7.00 a day January first of next year.) I probably shouldn't even get started on the new HOT Lanes. 

Commuting is not just hard on our wallets. Studies show that long commutes take a toll on health. CBC News reported, "People who drove longer distances to work reported less frequent participation in moderate to vigorous physical activity and decreased cardiovascular fitness, and had greater body mass index, waist circumference, and blood pressure." A Gallup Poll from a few years ago also showed that wellbeing is lower among workers with long commutes. 

What can employers do to improve the situation?

1. Offer flextime to your employees so that they can chose to commute when traffic is not at its' peak.
2. Offer on-site fitness classes and encourage employees to balance out some of the time they spend sitting with physical activity. 
3. Provide options for employees to work from home. (Help your supervisors manage these situations so things don't get out of hand like they did at Yahoo and Best Buy.)
4. Provide locker rooms with showers for your employees. 
5. Encourage employees to take public transportation by offering transit benefits. 
6. Advocate for improved public transportation in your area. 
7. Advocate for bike lanes in your community and provide a safe place for employees to lock up their bikes while they're working. Research has shown that people that commute by bike are the happiest. 

What can you do to make your commute more bearable? (I'm assuming walking, biking and public transportation aren't reasonable alternatives here.)

1. Check the traffic while you still have time to take an alternate route. I listen to WTOP or check the Traffic.com app on my iPhone. 
2. Go into work early or stay late to exercise and avoid commuting during the heaviest traffic. 
3. Listen to audio books. I use the Audible app on my iPhone and have a subscription that provides two credits (two books) per month for $22.95. I'm also a fan of quite a few Podcasts. 
4. Be a connected commuter. A recent study has found that people who use crowdsourced traffic apps and services that connect them to other commuters tend to find their commutes less stressful. I use Waze. 
5. If you have clean air tags in Virginia, you can use the HOV lane on the Dulles Toll Road and drive on 66 during the restricted hours. That's one of the many reasons I love my Prius! The rules are confusing though, so check them out carefully. 
6. If you're going to use your cell phone, make sure you have a good hands free set-up. I can hear well through the bluetooth in my car, but people can hear me better if I use the standard issue Apple headphones. 
7. A long commute can eat up a lot of your day, but if you're using it as an excuse to eat poorly, it's just that -- an excuse. If you tell yourself you don't have time to eat well and exercise, it becomes a self-fulfilling prophecy. Start telling yourself a new story and pack an apple for the ride home. 
8. The other things that come to mind seem painfully obvious -- carpool if you can, use an E-Z Pass if you travel on a toll road, and make sure you pee before hitting the road. 

If you think I've missed something that could be helpful, please share your thoughts in the comment section below. 

Related articles:

• Shopping Around Can Help Save on E-Z Passes
• People with long commutes have a 40% higher risk of separating from their spouses
• How Americans Get To Work, In 2 Graphs which I first saw on Steve Boese's post Getting reacquainted with the nightmare that is commuting

Five Big Ideas from the World Health Care Congress #WHCC15

I had the good fortune to attend the World Health CareCongress. The event pulls together some of the most respected leaders in healthcare and shares the issues of the day from diverse perspectives. I walked away with pages and pages of tweets and notes. Way too much to summarize session by session. I decided to let it sit for a while and then come back to it and share the ideas I continue to think about. 

Understanding Prescription Drug Pricing and Safety

According to the CDC almost half of Americans have taken at least one prescription drug in the past 30 days. Until recently, information wasn't readily available to consumers to compare the cost of prescription drugs from one pharmacy to another and to allow consumers to compare treatment options with various drugs, but those things have become much more transparent.

Lisa Roy and Eugenia Perna joined us from UnitedHealthCare to discuss prescription drug pricing, safety and the tools available to help us manage both.

Drug pricing is complicated and drug prices fluctuate like the price of gas. The same way gas may cost more on a heavily traveled holiday weekend the price of allergy medicines may be increased during allergy season. One factor in the pricing of drugs is ease of use. When drugs are going off patent, manufactures will create an extended release version or a combination drug to keep a patent. 

Azor is an example. It is a combination pill for blood pressure -- essentially two pills in one. You pay for the convenience of only needing to swallow one pill. Azore runs $280 per month. You could achieve the same effect by taking two generic pills. One at $24 per month and the other at $5 a month for a savings of $251 a month. 

Lipitor recently came off patent. In the first six months, the new generic, atorvastatin, had exclusivity. That typically means it's cheaper for consumers if they're only responsible for a copay; but three, four or maybe even five times more expensive than the brand during this time period. To make matters even more complicated Pfizer, the manufacturer of Lipitor, made a deal to provide rebates to insurers and pharmacy benefit managers (PBMs) to eliminate a lot of the cost advantage of atorvastatin. Just like many Facebook relationships, "it's complicated."

Medical advances often come in terms of new drug treatments and new treatments are often costly. We talked about Sovaldi as an example. It is a new treatment for Hepatitis C. It costs about $1,000 per pill and more than $84,000 for a course of treatment. It represents a cure for a chronic and often fatal condition, so most employers are including it in their coverage, but the cost has an impact.

Let's think safety first though. Mistakes are routinely made when dispensing medications. When you pick up a prescription, talk to the pharmacist or look up a picture of the medication to confirm you received what you expected. 

In the book, Where does it hurt? by Jonathan Bush, there is an example of a woman who had been fainting. It turned out that she had been prescribed twenty-seven different medicines by eleven different doctors, most of them specialists. Seven of these were for hypertension alone -- four of them were the exact some drug. This example is less surprising than it is appalling. Unfortunately, we can't trust the system to manage our health. Keep a record of all the medications and supplements you take and discuss possible interactions with your doctors and pharmacist. 

If you're insured with UnitedHealthCare, you have some good tools at your disposal. To use them, log into myuhc.com and select "manage my prescriptions." From there you can look up drug information which includes a picture of the pill and see what each drug will cost at a retail pharmacy and through mail order. You can see possible lower cost alternatives to a medication. You can even print out a report to show to your doctor to faciliate your discussion. See the flier below for more details. 

To save money, you may consider using a pharmacy that offers a generic discount program. Pharmacies like Target and Walmart often offer very low prices on a select list of generic drugs used to treat common conditions like diabetes, mental health, high blood pressure and infections. Their prices may be less than your copays and are likely to be less than what you would pay out-of-pocket with a high deductible plan. If you use one of these programs, the cost will not track toward your deductible though.

If you're not in our health plan, Good RX is helpful for pricing medications. Costco, Walmart and Target are generally cheaper than pharmacies like CVS and Walgreens. You may be able to negotiate with a convenient pharmacy to match a price if you find a drug cheaper at another place nearby. Giant will typically do this. It certainly doesn't hurt to ask.  

And, since were in vacation season, if you're traveling and forget your meds, go to a pharmacy and request a vacation override. Show the pharmacist your card and he or she will call UHC to obtain the override for you. You might also be interested in this post -- 10 Health Care Tips for Travel.

  Managing Your Prescriptions Online

Learn More:

• The Soaring Cost of a Simple Breath ~New York Times
• FOX 5 Investigates: Medication mistakes that can kill ~Fox News
• ‘Real Money’: Save Money on Prescription Drugs ~ABC News
• Prescription Drug Pricing ~KJRHTV video