Summer is a busy time. It’s easy to let the planning go, eat at the concession stands or run to the drive-thru. And friends and clients tell me that pre-packed sandwiches get boring. I know; I’m right there with you.

Here are some ideas to keep you healthy and away from the concession stand this summer:

• Make your sandwiches different.  Use wraps, tortillas, bagels, sandwich thins or pita pockets for bread. Add toppings like hummus, broccoli slaw, roasted red peppers and laughing cow light cheese wedges. Open a can of sliced olives or diced jalapenos too add for an interesting kick. If you’re using bread, cut your kids sandwiches into shapes or use a tool to make them crust-less. Pampered Chef sells a great version, or find a similar option at a local cooking materials store.

• Or, ditch the sandwich all together! Fix a chicken, tuna or salmon salad with low-fat mayonnaise or flavorings such as buffalo wing or hot sauce, lemon or lime juice.  Add seasonings like chopped dill or parsley, tarragon or ground black pepper. Taste before seasoning. Then, pack a snack bag of whole grain crackers or pita chips to dip. Remember, one serving is one ounce (16 wheat thins or a handful of pita chips). Weigh them sometime to check yourself. Or, pack a made-from-home salad with lots of color and fresh veggies. Add a little container of vinaigrette or yogurt based dressing like the ones from Bolthouse Farms.

• You don’t need a four course meal! Pack healthy snacks, and put them together for a well rounded meal. Pair one ounce of nuts (about 20 almonds), one low fat string cheese, a medium piece of fruit and granola bar with protein for a meal that includes carbohydrate, protein and healthy fats.

• If you have a lunch bag, pack a few reusable containers with cottage cheese, yogurt and hummus. Throw in nuts, like pistachios, to add later for crunch. Add a bowl of fruit and some plastic skewers or toothpicks to make it fun for little ones. Pack a serving of pretzels for extra satisfaction.

Don’t forget plastic spoons, forks, skewers, wipes and napkins. Visit the concession stand for those things, if you forget!

And if you must indulge in the concessions, make the best choice you can and aim for a snack that will satisfy you until you have access to better choices. Some of the less damaging options might include peanuts, sunflower seeds, fresh fruit and my personal favorite, soft pretzels (no dip!).

If you’re at a college or professional game, many ballparks have options that might be hidden in another section but aren’t available at every stand. Make the rounds, then make your choice. There are often grilled chicken sandwiches, salads and smoothies or frozen yogurt available.

Summertime is full of fun, and it can be hard to be on-the-go and healthy at the same time. Make a little room in your schedule to pack meals and snacks … You’ll be glad you did!

So what’s number two? Women commonly complain about how their partner intimately touches — more specifically, the use of grabby hands.

Grabby hands are like a left-hand turn on Dodge Street; you may think it’ll get quick results, but it’s more annoying and frustrating to others.

One of my female patients describes grabby hands by comparing it to her toddler:  He reaches his arms up, wiggles his fingers and pouts.

Another patient says her partner, “zones in for her chest like he’s checking fruit at the grocery store.”

Both women say the grabby hands technique prevents them from getting turned on and sometimes leads them to decline sex out of frustration, even if they are interested.

Here are a few sensual touch suggestions, which will hopefully lead to better results with your partner:

Go slow. It’s common for women to need additional time to acclimate to intimacy.

You’re less likely to be rejected if you ease into intimacy and allow her the opportunity to become desirous and aroused. Often times, women reject sexual advances because they just aren’t interested … YET.

Warm up first. Start off with soothing caresses on non-sexual anatomy like arms, shoulders and legs.

If your hands are shaped like you’re holding a grapefruit, relax your fingers. Focus on temperature and softness rather than grabbing. Touch with light, soft strokes.

Don’t advance to sexual anatomical parts (chest and pelvic area) until she seems aroused and ready.

Request feedback. The only way you’ll learn what is effective and what’s not, is by asking.

Communication about wants and desires can be difficult since it’s not a common dialogue. If your partner is struggling to communicate what she likes and dislikes, pay attention to her reactions and responses to your touch.

Look for goose bumps, tense muscles, smiling or even laughing at a tickling sensation. These reactions can help you determine what to continue doing and what needs tweaking.

If you need additional help, visit a certified sex therapist to assist with a better dialogue about needs and wants. An expert can also make suggestions regarding sensual touch exercises.

Conversely, I’m somewhat put off when a patient who comes to see me looking like they just rolled out of bed or came in from digging a ditch. Recently, a man in his mid-forties showed up to his inaugural cardiology appointment wearing a sleeveless t-shirt, ragged jeans and sandals. He didn’t smell particularly good, either.

Young people are the worst offenders. I can’t tell you how many patients under the age of 25 I’ve seen in frayed sweatpants, flip-flops and hoodies. In their minds, a trip to the doctor’s office holds as much formality as a stroll to Starbucks or, for that matter, a trip to the bathroom. I shouldn’t be too offended, though, since they’d probably adopt the same dress standard for a court appearance, morning in the church pews, or trip down the aisle of a wedding chapel. One young woman recently graced our exam room sporting a t-shirt that said, “Do I look like a ******* people person?” Her shirt, however, sported no asterisks.

For the smokers among you, wearing a shirt or jacket that hasn’t been laundered in months leaves behind such a stench of stale tobacco that the nurses have to quarantine the exam room. And for younger people: Please try to recognize that you reached legal adulthood at age 18. In the grown-up world, people don’t attend professional matters wearing pajamas or jeans low enough that your underwear is visible.

My older patients do considerably better despite the fact that their fixed-income pocketbooks are thinner. In particular, I admire my Greatest Generation ladies who don their well-worn dresses. Their hair is done, their make-up perfect. It’s clear that their trip to the cardiologist is the highlight of the day. Their male counterparts – long retired – go to the trouble to dust off a business suit and tie for their 15 minute interaction with me.

By now you must think I’m some sort of sartorial snoot by confessing my biases about patient fashion, but I’m not asking for tuxedos or Vera Wang evening gowns. Most people in my practice are among the 99-percenters, and I’ve observed over the years that a respectful personal appearance and one’s tax bracket don’t necessarily correlate. Some of my poorest patients put in the greatest effort to come to my office in presentable attire.

Why should it matter? When we sit down to discuss your heart health, we’re engaging in a business transaction in all its formality. I show you respect by being receptive, courteous, punctual, professional. The way I dress for a day at the office should show these values and signal to you that I think higher of you than just “casual formality.”

In return, all I ask is that you come having bathed or showered in the last 72 hours and wear clothing that is, at a minimum, relatively clean. Simple grooming – hair, teeth, deodorant – is optional, but clearly a bonus.

Now, all that said, I want to thank  my patients who come for an appointment dressed for the occasion. I believe it’s human nature for caregivers to take your concerns more seriously, treat you with greater respect and converse on a more mature level if you’re wearing clean clothing and don’t look like you just woke up from a teen slumber party … or have been sucking down Jack Daniels in a biker bar.

“Protein” bars have become a common go-to snack, but what makes up a balanced protein bar? With hundreds of flavors and brands, how do you decide which one is right for you?

First, ask yourself what you’re using the bar for. Is it a meal replacement? If so, look for a bar with at least 200 calories.

Look at the nutrient facts label. Does the bar have fat, carbohydrate, fiber and protein?

Now, go a little deeper. And remember the number three. Does the bar have 3 grams or less of saturated fat? Does it contain three or more grams of fiber? Are there at least 3 grams of protein?

If the bar is a mid-afternoon snack, look for one with more protein. More is relative though, and it doesn’t mean you have to buy the bars with twenty plus grams of protein. Protein helps slow the body’s response to blood sugar. It provides a more even energy release, and more studies are pointing to the long term satisfaction that protein offers. In other words, staying full longer.

Another major difference between protein bars is the amount of sugar they contain. Try to purchase a bar not void of carbs, but lower in sugar. Looks for single digit sugar grams. A highly trained active person or athlete who actually needs sugar following a workout is an exception.

Many athletes, especially on the collegiate level, ask me what kind of bar they should eat after a workout.

Going back to the basics of sports nutrition, we know that the body has a window of opportunity following a workout. In regards to recovery, the sooner a person ingests carbohydrates, the better. Adding protein will assist the muscle in recovery as well, potentially allowing repair and growth of the muscle to happen more effectively.

So, how much? A person needs about thirty grams of carbohydrate and eight to ten grams of protein per hour of exercise, immediately following exercise. That’s a minimum, and some people need more, based on size, exercise type and intensity, gender, body composition and goals.

Take a look at many bars out there. You’ll see that the manufacturers know that we know how much to eat. Many of them contain around those amounts of carbs and protein.

While I don’t like to depend on bars for meals, they are a nice substitute in the interest of time and balanced nutrition. I took a stroll through the fitness bar aisle at the grocery store, and here are some of my favorite finds:

• Post-intense cardio workout:

Power Bar Harvest Energy (Double chocolate crisp):  250 calories, 5 grams fat (2.5 saturated), 42 grams carbohydrate, 5 grams fiber, 21 grams sugar, 10 grams protein

• Great balanced snack:

Clif Mojo (Trail Mix Peanut Butter):  200 calories, 11 grams fat (1.5 saturated), 18 grams carb, 2 grams fiber, 9 grams sugar, 9 grams protein

• Filling snack on the go:

Pure Protein (Chocolate Peanut Butter):  200 calories, 5 grams fat (3 saturated), 18 grams carb, 1 gram fiber, 3 grams sugar, 20 grams protein.  This bar also contains sugar alcohols, which act like fiber in the body.

• Meal replacement:

Think Thin (chocolate fudge):  230 calories, 8 grams fat (3 saturated), 25 grams carb, 1 gram fiber, 0 grams sugar, 20 grams protein

• Snack to get you through until dinner

Nature Valley Protein (Peanut Butter Dark Chocolate):  190 calories, 12 grams fat (3.5 saturated), 14 grams carbohydrate, 5 grams fiber, 6 grams sugar, 10 grams protein

• Filling, gluten-free snack:

KIND, Cranberry Almond:  190 calories, 13 grams fat (1.5 saturated), 20 grams carbohydrate, 3 grams fiber, 12 grams sugar, 3 grams protein

“Now, you two have support, right?” The doctor asked. “Yes, we have a lot of family and friends eager for Baby P’s arrival.”

“That’s good. Babies require a lot of stuff, and you’ll need help acclimating to all the new things in your home,” the doctor said.

My mind wondered back to the night before — I had completely reorganized our living room. Ross walked through the door and stopped among the disordered array of living room furniture.

“What’s all this?”

“I’m rearranging. Bored with this set-up.” Huffing with exertion, I shoved our over-sized couch across the room.

“Do you need some help with that?” Ross smirked as he sat his work bag down.

A couple of hours later, having finally assembled the furniture into a configuration I felt economical yet stylish, I fell into a nearby chair. Ross kissed my forehead, plopping down next to me.

“I think they call this nesting. You know, before the baby comes you want everything just so,” I said.

“And how exactly is that any different from how you are when not pregnant?”

“I’m a woman who knows how she likes things. And if I didn’t constantly rearrange the house, I’d get bored with it.” I playfully slapped his arm.

Coming back to the present, I assured my OB we had a pretty good idea of how we want things arranged, even once the baby comes.

“Good, but someone will have to help you reorient to all the new stuff in your home,” she said.

She was referring to the things we’d buy and stock in our home: Diapers, bottles, etc.

Moments like these make me pause and wonder how best to respond. A conversation like this may seem insignificant if you’re not blind, but when you frequently deal with questions about how to accomplish simple, everyday things, you grow weary.

I know what I’m capable of. To assume you know my abilities seems presumptuous and awfully bold, even if you meant well. All people need help at times, regardless of disability or not, including new and veteran parents. A disability doesn’t automatically render one incapable of a task or make that task too overwhelming without outside help.

I buy new things for my home all the time. I’m constantly rearranging and redecorating. Sometimes I ask for assistance from someone I trust to help carry out my vision; sometimes I do it alone.

What I don’t do is lose my “orientation” around the house, have no clue where items are or require help “acclimating” to my living environment, especially when I’m the one organizing my space. A seeing person would never be advised to seek help adjusting to their own living space.

Ross and I don’t scoff when assistance is offered, and we ask for help when necessary. We appreciate the concern and desire to be helpful, but the reasoning is flawed nonetheless. It makes us feel childish, inadequate.

That said, don’t be afraid to ask questions. We all wonder about things, and having only been blind for eight years, I too have questions at times about how blind people do things.

As it turns out in life, very little is impossible, even for the blind. Treat me like anyone else, and I’ll let you know if something isn’t working or if I need help.

Now, to update readers on the pregnancy: I am 22 weeks along and still going strong. I had a slight bump in the road with dehydration and fluctuating glucose levels, though this is normal in a diabetic pregnancy.

Baby P. doesn’t seem phased by anything. He’s moving around so much that he’s taken to kicking the ultrasound device when checking his heart rate! Thanks to all the supporters out there, and keep reading.

Classic bruschetta uses tomatoes, basil and balsamic vinegar. This sweet take on the Italian classic opts for some healthy swaps. Mascarpone, an Italian cream cheese, is part of the luxury, yet it contains half the fat of regular butter.  You could also use a light, low-fat cream cheese for this recipe.

Strawberry Bruschetta

4 thick slices of bakery whole wheat bread

6 tbsp light brown sugar

1 tsp grated lemon zest

2 tsp lemon juice

3 cups slices or diced, hulled strawberries

4 tbsp mascarpone (Italian cream cheese)

Preparation:

Toast the bread.

1. Meanwhile, heat a large skillet over high heat. Add sugar, lemon zest and lemon juice. Cook, stirring, until the sugar melts and the mixture begins to bubble – 30 seconds to a minute.  Add strawberries, and stir until juices begin to exude and the berries are heated through, 30 seconds to a minute more.
2. Spread 1 Tbsp of mascarpone on each piece of toast.  Top with the warm berries.
3. To make ahead:  Prepare the sauce (step 2), cover and refrigerate for up to two days or freeze for up to a month.  To reheat, microwave on high for about one minute (defrost first, if necessary).

Makes 4 servings.  Nutrition facts per serving:  202 calories; 5 grams fat (2 grams saturated fat); 38 grams carbohydrate; 4 grams fiber; 5 grams protein; 137 mg sodium.

Nutrition bonus:  Vitamin C (109% daily value).

Source:  Adapted from Eating Well, Inc.

The information is not intended as medical advice.  Please consult a medical professional for individual advice.

IBS affects as much as 20 percent of the adult population, and one diet is getting more attention for helping relieve the symptoms: the low-FODMAP diet.

Originated in Melbourne, Australia, FODMAP stands for fermentable oligo-, di-, and mono- saccarides and polyols (a group of short-chain carbohydrates).  A person with IBS can’t properly digest and absorb these carbs like some without the condition. This is what leads to gas, bloating, diarrhea or constipation.

Luckily, the majority of IBS suffers can benefit from the following low-FODMAP diet.

Eliminate the following:

Lactose – found in milk, ice cream

Free fructose – found in apples, pears, honey, watermelon

Fructans – found in wheat, onions, garlic, and insulin

Galacto-oligosaccharides – found in legumes (including soy)

Polyols – found in sugar-free gum, mints, prunes

Note:  These are just some examples, this is not an all-inclusive list of foods to avoid.

All of these foods have a cumulative impact on gastrointestinal symptoms. An individual with IBS may be able to tolerate small amounts of some of these, but may experience symptoms if they consume more than what their body can handle.

This diet is pretty restrictive, and many clients need to consult a dietitian to ensure they’re getting adequate nutrients and fiber.

Source:  Today’s Dietitian, March 2012

It’s virtually impossible to count calories on a trip, and it really isn’t necessary. Focusing on behaviors is much more reasonable. If you put a system into action before you go on vacation, you can still splurge and maintain, even lose, weight. There are some catches though, so read carefully! It might seem detailed, but the process is (relatively) fun, and it forces mindfulness.

To avoid gaining weight or to continue your quest to lose weight, follow a point system, in which you earn and lose points for various activities.

Each day, survey your behaviors. Throughout the day, mentally add and subtract points according to your actions.

• +1  Eat a meal in this order:  water, veggies, water, protein, water, starch.  Stop before you’re full.
• +1  Avoid tempting sugary or high fat snacks
• +1  Drink an extra bottle of water instead of a having a snack
• +1  Eat a small, healthy handful snack such as fruit, nuts or a skinny latte.
• +1  Leave half of the starch on your plate at a meal
• +1  Do cardio exercise for 30 minutes—do more and it counts double (60 minutes = 2 points)
• +1  Do strength exercises for 30 minutes—this includes body weight resistance such as pushups.

• -1  Order a pasta based dish
• -1  Eat past the point of fullness (defined by a slight pressure in your abdomen)
• -1  Eat the airplane-provided snack (except maybe the healthy first class offerings!)
• -1  Eat fried food
• -1  Give in to a sugary or high fat snack
• -1  Drink regular soda or juice
• -1  Drink alcohol (-1 more point per drink if you have over one drink (ladies) or more than two drinks (men)
• -1  Clean your plate

Average Daily Point Goal for weight loss over the time of your trip:  >5

Average Daily Point Goal for weight maintenance over the time of your trip:  3

Average Daily Points for which you will have to “make up” upon your return:  <3

If you want to lose weight on vacation, I suggest adding up your points each day.  Start over at zero at the beginning of each day.  This means you can make up for an off day!  If you lose points, have better behaviors tomorrow and you’ll end up with a good average!

Continue a running tally while you’re gone, and average the days’ numbers together. After you calculate your daily average, subtract one point for every two days you didn’t do any exercise.  For example, on a six-day trip without any workouts, you would subtract three points from your calculated average.

This might seem tedious – like it would take a lot of focus. The point will remind you to be mindful, make good choices when possible and stay active while out of town. If you don’t want to keep track with the math, just try to remember some of the good behaviors and avoid those that set you back.

Vacations are sometimes used as a time to “reward” or “let loose.” Don’t let your desire to have fun turn reckless, or it will hurt you in the long run. No one wants to come home to clothes that are tight and the hopeless feeling of being off track. Relaxed and rejuvenated is the goal of a vacation, right?

Specifically, women become frustrated with juvenile advances and demanding requests for sex.

Juvenile advances, for example, are those you remember from high school: yawning to place your arm around your girlfriend or immaturely asking, “Do you wanna make out?”

Unfortunately, this approach is all too common as it’s often role modeled. Joey on the TV show “Friends” was known for smiling at women and saying, “How you doin’?” And as Ron Burgundy on the movie “Anchorman” simply put it:  “I want to be on you.”

These attempts appear humorous on the big screen but won’t get you far in the bedroom after a while.

Women attribute these funny yet juvenile attempts to a lack of confidence, which itself can be a turnoff. I also hear women say they feel like a mom when their partner acts sexually immature.

But what’s worse than prompting your partner to feel like a parent? Demanding sex from her.

If sex becomes a demand it will lack meaning, connection and a desire to be together. These are important aspects to intimacy that both partners usually crave in a relationship.

Guys: Consider the last five times you asked your partner to be intimate.

· What specifically did you say?

· If sex is routine, how did it start? Pointing to the clock? Or offering a massage?

· Did you immaturely give “the look” that represents you’re turned on?

Next, evaluate what happened. Did she seem intrigued or annoyed and/or obligated? Based on your answer, try a new technique, or better yet, ask her how she’d like to be approached.

Acknowledge that you understand men and women become sexually aroused differently, and you want to cater to her unique needs. If the two of you can begin a conversation about your sexual interests, better sex will often follow.

Check back next Tuesday when I address the second most annoying thing men do in the bedroom.

Not that I win any of these, mind you.  I’ve always been a fairly mediocre runner, but while I haven’t obtained blistering speed from my 25 years of running, I’ve gained wisdom.

For example, I’ve learned that you can never tell who the fast runners are by their outward appearance. Sure, it’s easy to pick out the gazelles that will finish in the top five: 25-35 years old, 110-135 pounds, average height,  long legs and not a scrap of fat to be found.  But past that point, it’s impossible to guess a runner’s performance by pre-race appearance alone.

I remember one particular old guy (“old” being relative—he was probably about the age I am now) who warmed up with a slow shuffling gait and a slight limp. His upper torso tilted to one side, as if one leg were longer than the other.  It took me no more than a second to discount him as a challenger.

The gun went off, and I sprinted out. It was a 10K, and I made the mistake of trying to run at a pace better suited for a shorter course. By the time I reached mile five, I’d begun to drag. Just as the finish line was in sight I noticed a shuffling, limping figure out of the corner of my eye.  The old man had picked up his pace and calmly sailed by as I struggled with burned-out legs and aching lungs.  He became the first of many men and women with atrocious gaits and less-than-svelte profiles to beat me over the next two decades.

The great thing about competing in these races is that you’re never really competing with the person next to you. The average person ends up racing mainly against themselves. You compete against your own previous race times, aging body, desire to slow down and walk the last few miles and everyone who thinks you’re wasting time pounding the pavement early in the mornings.  And no matter if you finish the race at the front or back of the pack, you’ve scored a victory by just showing up.

So make it a goal to run a race this year. Start by walking around the block if you have to. Talk to other runners, and let their excitement for the sport motivate you. On the day of the race, take a moment before the start gun goes off to just soak up the energy of the event. Be sure to give yourself a hearty pat on the back when you cross the finish line knowing that you accomplished what you set out to do.

And if you happen to see an old guy with a shuffling, limping gait finishing somewhere in the middle of the pack, come say hi to me.

Check out LiveWellNebraska’s list of local walks, runs and races.