Stress reduction

Rapid Eye Movement Meditation/progressive muscle relaxation


Weight Loss

Good sleep hygeine

Building self-esteem

Improving money "function"

Building better relationships

Excellent teaching/parenting

Lots of exercise, bicycling and running

Avoiding the common poisons,

Appropriate health screening and treatment

In my current philosophy for robust health, each element is a prerequisite for the next. Without adequate sleep, it is hard to have good self-esteem. With this, get your money and relationship woes figured out and stop poisonous bad habits and exercise persistently. Without exercise it is impossible to maintain reduced weight on a proper diet. Without all these things, you can't expect even the best medical testing and medicines to magically save you.

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Everybody is under a certain amount of stress. A certain amount makes one productive, but more can sicken or kill. Oh, great, you say, that is all I need. The ancient, pre-vertebrate nervous system that runs our heart rate, blood pressure and bowels can give us trouble but it is simply responding to our sometimes-uncontrolled emotions. The good news is that we can control our response to the various stressors in our lives, and limit our sympathetic nervous system's fight or flight response. If someone hits us, we are necessarily angry, but we can let angry words flow right by us and maintain a level head.

For stress reduction: Try this rapid relaxation response: focus on the resolution of the conflict, saying to yourself, "I can get through this," then focus on your own breathing [you can think "breathe, breathe..."], positive self-talk and relaxation, "I am relaxing, I am doing well, I am a good person." Reevaluate the situation by putting it in perspective: "is this worth dying for? If so, why?" Modifying your stress response is even more important than exercise,because an elite athlete can die from a heart attack being angry. Put down the burden of your anger. Use its energy to resolve the conflict in a constructive, healthful, unhurtful way. Ask, "how can I change this situation from a threat or a challenge to an opportunity?" Refresh yourself with the knowledge that you can do this, you are in control of your body and emotions. Check your body for tensed posture, gritted teeth, white knuckles and relax them. See the book Prescription for Anger, by Gary Hankins. It may be that we have the same fear and anger in our dreams, and this is why more people die in their sleep from 3 to 6 A.M. I tell my children they can tell the monsters in their dreams, "you have no power over me," and can control their dreams.

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Rapid Eye Movement Meditation/progressive muscle relaxation: This is thought to emulate the refreshing aspects of dreaming, or REM sleep. Give yourself at least ten minutes in a comfortable chair. Imagine a comfortable scene; look back and forth at it with eyes closed. Breath slowly and rhythmically (or concentrate on slowing your heart rate if you'd rather). While still moving your eyes and breathing slowly, tense and then relax each muscle group successively for a few seconds each: the feet and calves, thighs, buttocks, back, stomach, shoulders, biceps, hands, neck, and finally the face (frown and squeeze your eyes shut). Relax. Continue your rhythmic breathing, eye movement and imagery. Feel how relaxed all of your muscles are in turn. If necessary, repeat the whole process. Be sure to come out of this slowly after at least ten minutes; you owe it to yourself to do this as often as necessary to minimize your stress levels. Twice daily really breaks the cycle of stress; people find themselves able to accomplish more in less time and feel less fatigued after; this is the origin of the coffee break and of late, the power nap. Massage and a daily five minute hug with your significant other adds to your sense of well being.

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Exercise: start with 10 minutes six days per week of low impact aerobics like walking, and build by 5-10min per episode per week to 30-45min 6 times a week such that you sustain a heart rate of 200 minus your age. Consult me if you are over 40 years old. Be sure to start with 30 second stretches of all exercised muscle groups. Remember a 5 minute warm up and cool down. Tylenol can help initial achiness. Stop and report severe pains. Exercise should be thrilling. Do it with Chariots of Fire playing on the stereo.

More on exercise!

Counseling. Sometimes normal life stressors are overwhelming and an interactive resource like a professional counselor is essential; relatives aren't trained or obligated to help or cannot help in an unbiased way, and books are often not enough. Probably every adult could benefit from weekly counseling for a year or two to sort out trouble arising from their family of origin. Those who immediately defend their family and social history as perfect are defending a harmful family myth. Nobody is perfect, but some get sick trying to be.

Weight Loss: Less weight means less stress on your bones. It is fatiguing carrying around extra weight. Obesity kills 300,000 people a year, more than die from alcohol, fewer than from smoking, usually those over 120 percent of ideal body weight. It is important to feel good about your physical shape now rather than despising yourself: I invite you to give up shame over over anything forever. Everyone would like to lose weight and this best accomplished slowly with consistent exercise, positive attitude and a low calorie diet.

Sex: This is a good stress reducer if it is not part of a power struggle. All sorts of feel-good chemicals are released by the brain during attentive foreplay and orgasm. It has recently been reported in the medical literature as a cure for headache. Attention Teens: your mom asked me to ask you not to try this at home.

On the job: A healthy work environment is important to productivity, sanity and job turn over rates. Employees should make suggestions and these should be considered carefully. Job descriptions should be clear and good job performance rewarded, noise levels minimized, light and ventilation made adequate. Are there adequate measures for conflict resolution or do things simmer and explode? Is there sexual harassment? Is there flexibility in the schedule; is there child care? If not, can you work somewhere else? Why work if it kills you? See the money section.

Smoking, alcohol, drugs, violence: these don't help reduce stress. Avoid them.

References: Getting the Love You WantKeeping the Love You Find, for couples, and singles respectively, both by Harville Hendricks. Couple's Skills by McKaye, which has anecdotes of all orientations. Credit, Cash and Codependency, Yvonne Kaye. The Male Couple's Guide Eric Marcus. Healing the Child Within, by Whitfield. The Road Less Traveled, A World Waiting to be Born, Civility Rediscovered, on remaking the workplace into a civil, healthful place, both by Scott Peck. Women who Run with the Wolves, on female empowerment, Clarissa Estes. Fried Green Tomatoes, the movie.

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Sleep Hygiene: Good sleep habits are the first element prerequisite for excellent health. Americans chronically sleep too little. As a doctor in training, I frequently went with little or no sleep and I was too tired to feel good about myself. I was a zombie medical maven plowing through admission after admission to the hospital. When I finally got to sleep in my own bed every night, I felt like a new person, patients could feel that new energy and my medical practice took off. What I wish I had known as a student was that if you change your bedtime or waking time as little as 15 minutes, there is a decrease in cognitive ability, specifically in math test scores in students in a sleep lab. This is probably generalizable to learning, writing and other performance skills. Even if it is not, we all need our best math skills every day. Know that you have a right to enough sleep and the elements that follow, because you have a right to good health. It is part of our "pursuit of happiness." You should minimize caffeine, don't smoke or drink at all, and do not eat a large meal or drink much before bed. Never argue in bed; it should be a safe place for the "child within." Keep the same bedtime ritual, read a little, put your worries away, make sure it is quiet and dark, roll over the same way. If you wake up and are awake 30 minutes, you may read for 20 minutes in bed, skip the TV [I don't think there should be one in the bed room], and then go back to sleep. You should be in the sack long enough to arise refreshed, and again, keep the same hours of sleep 7 days a week. The last 3 hours of an 8 hour slumber are especially important because we start the night sleeping soundly [stage 4] and rise almost to waking for brief dreams, but by the end of the night we dream for up to 90 minutes. So sleeping 6.5 rather than 8 hours results in a devastating loss of REM sleep time. Soldiers shoot their own men on 4 hours of sleep. You can accomplish in 8 hours after 8 hours of sleep what you can do in 16 hours after 4 hours of sleep. Do not skimp! It's a losing proposition. 100 years ago, people worked 14 hours a day and slept 9. The Land of Nod was their only vacation. Why work hard, lose sleep, earn money only to spend it getting jet lag on the plane to the tropics?

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Self Esteem When I began practice, I put a symbol on my desk. It was a vase of wheat that reminded me, "we reap what we sow." A farmer must believe he can weed, irrigate and harvest before he can believe it useful to plant. This is an allegory for life. Self-esteem is always less than perfect, and it drives what we do and do not do, and how we approach tasks. So, many people get stuck in one of many ruts in life. They donÕt believe they can go on or go farther, usually a parent said they couldn't, long ago. As children we often heard, "sit down, be quiet, who asked you?" As adults, it is more subtle, "why vote? That is not fashionable, that is cheap." What if we consciously chose our values on a logical basis? Just as our life is continuous, so is our consciousness. Really - - nature abhors a vacuum; a lot accumulates in our heads. Our perception, responses, emotions are all influenced strongly by our development since conception: in utero and ex utero in the big world. This development includes maternal habits like smoking and drinking during pregnancy, the milieu of our family of origin, the resources of our extended family, our schooling, our insight and introspection about our existence, the emotional support, even the touch and smell of loved ones, the good and bad events that happen, and the good and bad ways we learn to cope with them. The good news is we can get out of a rut and learn conscious constructive coping strategies. The best news is we can get off the cycle of fear, anger and ego defense and just be ourselves, fully conscious and able to listen, learn and grow, able to feel and think at the same time without being overwhelmed or exhausted. I am asking people to give up acting or not acting from shame or fear. Shame means feeling devalued for doing or failing to do something, and all creatures know fear. Why feel ashamed when each of us is a unique, sacred expression of the universe seeking to become aware of itself? Why be fearful or lonely? Every breath connects us to the world, we come from it and return to it. Read A Brief History of Time, by Steven Hawkins.

I hope you can view it as good news that we are responsible for our actions, and that each person must generate his/her own happiness, health and wisdom. These cannot be generated by a spouse, or praise, or accomplishment, or me. People can be happy in a Tibetan hut or sad in a Hollywood mansion. These responsibilities can be a threat, a challenge or an opportunity. I used to think, sure, learning all of medicine shouldn't be a threat, but it must be a challenge. I now know that it was an opportunity, just as it is a great honor to treat patients, and that to make it a challenge was to make it harder than it needed to be. I used up some energy on the mind set "it's challenging," rather than using it all on pure learning.

When we hear we must claim the right to enough sleep, work on a permanent positive mind set, stop the poisons, start exercising, lose weight, and accept the invitation to medical therapies and screenings, we can respond by 1] denying the validity of these ideas or running away because it is threatening [this is also called resistance to therapy], or 2] we can convince ourselves changes are so challenging we cannot be persistent and so collapse into old habits, or 3] looking at it as the opportunity these lifestyle changes represent, we can stop waiting for someone to fix it with a pill; we can give up our fear of failure, we can admit imperfection and stop making excuses so we can make progress. It is possible to seek the truth without judging ourselves, or being judged. This may not be possible from your current perspective, and you may have gotten hung up on any part of what I just wrote.

Most responses to important, truthful statements are what I call ego defenses. For example, every other smoker dies of smoking. "I'll think about stopping smoking after exams." Obesity kills 300,000 people per year. "I will never be able to get this weight off." "If I just were not so hungry all the time." "I love food." Increasing amounts of exercise have increasing benefits. "I try hard to exercise, then I get so sore that I quit." We defend the status quo. We convince ourselves it is OK to stay the same even when the truth is, it is dangerous, or rapidly fatal. "Look, doc, when it's my time, I will go." Our lives are sacred, but it is hard to view them as such in our murky mirror of introspection. We are defending a wounded ego.

Many high achievers and professionals did not get enough positive input as children and they base their current self-value on what they can provide for others. I used to say, if I had a stroke and could not provide for my family, "just shoot me." I started exercising because I knew I would not live to see my grandchildren given my family's bad history of heart disease if I remained sedentary. I had just begun to believe I would not get run over in short order bicycling to work, that "grace happens." As I became healthier while exercising, and escaped the sleep deprivation of residency and moonlighting, I realized that I treated my patients as precious; even if I could not provide for others I was still a priceless, sacred human, like them. I realized it was OK to develop long-latent non-medical interests again. In facing the American Board of Internal Medicine exam in 1995, I could abandon all of the negative transference I had had against my entire education and simply take the opportunity to study and pass the two-day exam. I was the sixth person out of the room each of four sessions; I thought either I was a flunking fool [attitude check!] or those other 350 people were agonizing over answers they did not know. They were. I did well not because of my intellectual ability, [which is ample - it is OK to say that], but rather because I changed a potentially threatening process into a growthful opportunity. The point is, we are all capable of doing more if we don't fritter away time and energy worrying whether we can really do something.

What I did not know even then, in 1995, was how interdependent fear, anger and defensiveness are; I had been able to consider each and deal with each on an intellectual basis, but not recognize how they cycle perpetually and destructively at an emotional level. When we defend ourselves in an argument, we put up a mental shield that reflects the heat of the opponent&'s verbal onslaught, just making it hotter; we also launch barbed comments that push the buttons of the opponent, especially a loved one. This is also like putting out fire with gasoline. I realized if I did not defend my ego, the anger and fear would go, leaving only peace and consciousness. If I could listen, people would not have to shout. An image flashed to mind from Little Buddha where Buddha is sitting serenely beneath a tree and the devil is trying to frighten him with a storm and fire. Buddha remains calm, so the devil gives up and Buddha pops into a higher plane of existence. I have earned that calmness. It used to bother me that Jesus said, "turn the other cheek." "Why not sock [shoot, stab, bomb] him one?" is the response in all parts of the globe. Of course, Mohandas Gandhi and Martin Luther King, Jr. had been successful evoking social change with just such peaceful approaches, but I had not linked anger with defense in a personal sense: if your ego-shield reflects or contains anger, it cannot dissipate. I found a great relief in no longer spending energy on self-defense; it could all go into listening, learning, caring, loving, and growing.

It used to make me angry to have to say "under God" during the Pledge of Allegiance in school, even raised as a Methodist. Yahweh first watched over people as a vengeful sky god, and this is an unfortunate history. Now I prefer to think that Grace is all around and is protective and comforting, not a omnipotent version of my father - when I was little, he loomed over me like a thundercloud with lightning in his eyes. It used to make me angry to sing Amazing Grace in church. I did not have to fear God or my dad; I would stand up and take the licks that came my way. I was sure I was fearless. I was cool. Every hair was in place. I wore the right clothes. No one could successfully criticize. I was no wretch! That'd be awful. I couldn't be. I had my wits about me. I was strong, persevering, intelligent, caring. But each characteristic I was so sure about was an ego defense for a little child who was at times so afraid or so lonely or so angry that he stopped recording the unconscionable situation at hand. I gradually learned to acknowledge that my imperfection, past pain and unconscious responses kept me feeling wretched. It was liberating to know admit that I had been wretched and no longer needed to be. Now these words sing out from my heart and my flute or bagpipes:

Amazing grace, how sweet the sound
That saved a wretch like me;
I once was lost lost but now am found
Was blind, but now I see.
Twas grace that taught this heart to fear
And grace my fears relieved;
How precious did that grace appear
The hour I first believed.
Through many dangers, toils and snares
I have already come;
Tis grace hath brought me safe thus far
And grace will lead me home.
And when weÕve been there ten thousand years
Bright shining as the sun,
We'll have no less days to sing God's praise
Than when we first begun.

There are other verses in other versions, of course; it was originally written by John Newton [1725-1807]. I prefer to think we don't have to wait to get to heaven to be shining bright with happiness and health and learning, rather, we shine as soon as we set ourselves free from the shackles of self-doubt, the injury of critics, the fear and the anger. We need to become continuously aware of our emotions and be able to quickly set down the burden of anger, fear and sadness. Then, anything is possible. Then, we can live. If we do not, know that even elite athletes can have MIs getting angry and shouting.

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Money A patient recommended Verblen's Theory of the Leisure Class, 1899, when she she heard some of my views. He originated the phrase, "conspicious consumption." I, too, have benefitted from being able to examine our culture somewhat "from the outside looking in," as she said. Everyone thinks they need money, but 80 percent of people in the world survive on less than a dollar a year. Even 50 years ago salaries included hogs, garden space, corn and milk on the farm. This was not taxed. It only became legal to tax dollar income this century by constitutional amendment. At this time, people often bartered for goods and services. But the government began to equate prosperity with "a car in every garage and a chicken in every pot." Americans believed this wholeheartedly. We were asked to idolize the nuclear family - - the Waltons were out. Then, every couple needed their own house, yard, lawnmower. Diamonds became a girl's best friend. To keep up with the Joneses, we had to "get on the [electric] grid," buy [rather than raise] chickens, buy pots, cars, garages, houses, refridgerators, washers, dryers, stoves, phones, TVs, child care, elder care, beeper, personal communications service, Internet access, body sculpting. We obeyed advertizers and let our lives be filled with more and more products that our grandparents had done without. It is our national religion. We became productized, captive subjects of the products we thought we had to buy. This is even true for food: buy a pound of tomatoes for a dollar. 30 cents beyond that already went for taxes. So much to own the car to drive to the store. Gas to get there. Insurance. Maintenance. Farmers and middlemen add their land and transportation costs into what you pay for the tomato. Drive home. Look, your big lawn needs mowing or the neighbors will complain. Get out the weedwhacker. The mower. The rideon mower. The blower. The vacuum attachment. What if we grew our own tomatoes on that land from seed we saved? I invest time, common sense, muscle, water, aged manure and profit with knowlegde, self reliance, better spiritual and physical health for my self and my children. Someone looked at my garden once and said, "It is big. I bet you have no free time because of it. You ought to be keeping grocers employed or you will destroy the economy." Imagine someone running their life by those rules, and asking me to do so. No surprise. I am here to destroy the old economy, to permit the further evolution of the human species.

Gambling and shopping can be an addiction just like food, tobacco or alcohol. Most of us are not out on that end of the spectrum, but money worries still have a huge impact. Half of marital arguments are about money; one partner imagines living without spending anything, and sees the other's spending as flagrantly wasteful, while the first is accused of asceticism; or one partner has reasonable budget expectations and the other really is a binge buyer who may hide the goods around the house to avoid detection. People on different points on this spectrum seek each other out, she, liking his responsible nature, he, liking her joi de vivre. When the honeymoon is over, though, the distance between financial attitudes can become a chronic grinding tension. People get bent out of shape for the holidays because they feel that must buy an even more impressive gift than last year for the Mother in Law. I have sympathy for the patient who complains of headache, heartburn, palpitations, shortness of breath and in the course of examining him, he says, "if I could just get caught up on bills."

I have been through the financial wringer too. During college I had 1200 bucks to last me indefinitely for books, rent utilities and food. I ate food that cost less than a dollar a pound, usually less than 50 cents, e.g. grains, beans, chicken liver, jack mackerel and vegetables. I made the money last ten months; half went for rent. I accumulated free things like crazy. People moved and gave me their furniture. Medical school brought a debt of 55K, less than average, and residency netted 1200 a month. The older doctors only pointed out, "in the days of giants, we were proud to pay to go to our residencies."

It was only in 1995, 2.5 years into successful solo practice (after borrowing no small chunk of change to get started), and after hearing Yvonne Kaye speak at the annual Medical and Chirurgical Society Meeting on money dysfunction that I was able to really let go of the stuff in the basement that I was storing but not using. Her book is Credit, Cash and Co-dependency. The book points out the futility of trying to buy a persons love or approval with expensive gifts. In addition, it is full of good advice on how to get off the treadmill of debt, overspending and overworking. I think many will click with her anecdotes. After reading the book, I sat down with the kids and told them, "I have participated in a lie, and I want to tell you the truth. Santa is not watching your behavior. You are watching your behavior, and the eyes of truth are upon you. Santa will bring what he can, and he will not pay for your good behavior with bigger presents. You are wonderful, priceless people and your value has nothing to do with what you get for Christmas." Coal and switches for the "bad" kids, and a car on the sixteenth birthday for the good kids, relates personal value so closely with possessions that there's bound to a crisis later in life. Being poor, or even just sticking to a budget until you are out of debt, can be a threat, a challenge or an opportunity. Buddhist monks revel in poverty; the simple living helps the spirit grow. Medicine, unfortunately, is a priesthood of the opposite kind; it runs on money. I have rejected that aspect as much as I can, but I am paying on student loans through the year 2007. My spirit is lifted as I sail by cars on my bicycle or now on my own two feet; drivers are stuck in a metal box and stuck with a car payment; I am getting my exercise. When I get wet in the rain, I figure I am made mostly of water anyway. It is fascinating to note that I left the medical meeting that day on my bicycle in front of a doctor driving a Maserati.

People bring a set of coping methods to adult life, usually survival strategies learned in their family of origin. Spending money that you donÕt have is a destructive habit that feels good until the bill comes. Then people feel guilty that they are not earning enough. Self-esteem comes from inside, and cannot be bought with money. Feeling good about spending within a budget, and planning to dig yourself out of debt, is a personal wealth that grows and grows. I believe that self-help books are good, but that most, if not all adults, can benefit from good personal or financial counseling at one time or another. You can take on your money situation in assertive ways. Have your name taken off catalog mailing lists. Screen calls during dinner - you want to be developing family relationships, not to be buying something you donÕt need - or even wasting time hearing about it. Then, once you are out of debt, if you do not spend it, you do not have to earn it.

Imagine this: there was not and there will not be poverty without the concomitant existence of money. Lack of money is almost always used to define poverty. If every person realized he was surrounded by the real necessities of life, no one could be poor. America must awaken from this financial lotus-eating to fund a permanent presence in space. Carl Sagan died not understanding this, fussing over the cost and arguing that we had to get off planet for the species to survive meteor impacts [The Pale Blue Dot, Cosmos, Contact]. In March 1998, a report was issued that said a mile-sized meteor might strike the Earth in 2028. The next day the conclusion was that it would miss by half a million kilometers. When, though, will meteors have a big impact on our health? WouldnÕt the economy be healthier after opening the high frontier?

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Relationships! Everybody is in them, or has been. Having healthy, communicative, growthful relationships is what makes or breaks your health. My heart goes out to the patient who complains of headache, heartburn, palpitations, shortness of breath and in the course of examining him, he says, "Oh, and I'm going through an acrimonious divorce." I hope that every patient is in their best and last relationship, because people in long-lasting mutually monogamous relationships are healthier, happier, live longer and have less sexually transmitted diseases than those who do not. It is also true that when a person dies, their elderly spouse is likely to follow in 6 to 12 months. But there are problems. Our popular music has done quite a job lately of describing dysfunctional relationships, i.e., "if you don't love me I'll kill myself,&" "I am a loser baby, so why don't you kill me," "if she keeps it up, I might just tell her so." [Pete Droge, Beck, Offspring, respectively. Who?.]. Country music probably offers better examples, but I can't give quotes, because I only listen to it by accident. The problem is these songs are played endlessly, just as they are in relationships, with no solutions given.

If you are willing to sleep with a person, you have invested much [time, trust, energy and money], and your relationship is worth the work to keep it together. And it will slide into stagnation, apathy or separation without ongoing work. No relationship is perfect, both people bring a set of coping methods to the relationship, a stated and unstated agenda, and issues of their family of origin. Those coping methods can be destructive [drinking when sad] or constructive [putting the energy of one's anger into solving a problem], and no one got a course in high school or college to learn better ones. I believe that self-help books are good, but that most, if not all adults, can benefit from good personal or marital counseling at one time or another. Various churches efforts to do premarital counseling is a great idea, but the effectiveness may vary and people do not always avail themselves of it. This is too bad, because it might lower the divorce rate of more than half. Doctors cannot cast any stones, because their divorce and suicide rates are higher than the general public, e.g., all the surgical residents at Johns Hopkins were divorcing when I was an intern. Now they reputedly have excellent psychiatric services for their professionals.

People tend to interact in aggressive, passive and assertive ways. The latter is best, and it is a learnable skill. If both partners can be assertive, they tend to get their needs met much better, and they will no longer suffer in silence. People can learn to negotiate with their partner in succinct, clear ways that end the bickering and yelling.

I'm trying to be thoroughly communicative in this doctor-patient relationship, so do your part and bring me your personal and marital problems so I can help you. By the laws of Maryland and my oath as a physician I cannot release information about personal, marital, psychiatric, alcohol or drug problems, so share with me to get on a happier healthier path! Please see the stress section for references, counseling numbers. Also see Couple' Skills by McKaye et al.

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Teaching/Parenting If you live as I have described earlier, you will likely be a good helper, teacher, partner, parent, or grandparent to those you love. If we can do a better job parenting than our parents did, then the world will be a better place. At least, it will be better for those we love. If we choose not to have children, we can still imbue our perspective on all those who will listen through our writing, actions and words. This is our gift to the world. Everybody has seen the bumper sticker and books, "Practice random acts of kindness and senseless acts of beauty." To be random is confusing, and we do not have time to be senseless. The author felt a little uneasy with kindness and beauty, hence the flippant attitude. Rather, practice consistent acts of kindness and purposeful acts of beauty. We hopefully create beautiful children purposefully and treat them kindly consistently. We can be kind with our students too. Our teaching can be beautiful art that explodes into their imagination. Their very brains are "purposeful acts of beauty," more beautiful than any flower. They will do the same for their charges.

Of course, we should seek physical, mental and spiritual health for our own sake. It is all the more important when people around us can benefit from our guidance. First, we must not beat our children. Even though this works quickly to end the bad behavior, unless it is our only attention to the child, it sets up the standard that violence is an appropriate sanction. It teaches that injury is part of the love they receive. They will tend to grow up violent and seeking abusive partners. It is going to be hard for them to avoid being drawn into riots and wars. It teaches that it is appropriate to remain out of control emotionally. An example is, "do not do that or you will make me mad," as if the child were responsible for how the adult felt. Of course, unless the adult is being struck or bitten, he has the power to decide how to feel. Even if bitten, he has a duty not to injure the child in response. It is time to have a peaceful future and end our five thousand year history of wars.

One of the easiest ways to be a better parent is to turn off the TV and spend more time with each child. Read to them every day even once you have taught them to read, play number games, encourage them to sing, dance, and play musical instruments, by doing these things for them and with them. This is a chance for you to read the literature you wished youÕd read [hey, the book is better than the movie], and play. If you do not know how to dance, it is time to learn, give up longstanding inhibitions and teach them to be free. Bring back the nine muses: Calliope (epic poetry), Clio (history), Erato (lyric poetry), Euterpe (music), Melpomene (tragedy), Polyhymnia (hymns), Terpsichore (dance), Thalia (comedy), Urania (astronomy). These are better than Teletubbies. Teach mythology, etymology (word origins), other languages. Dance, sing, laugh, cry, play, act, wonder. Give your charges detailed feedback, not just "that is nice." They beam with pride when you tell them you think their painting is composition is interesting, the colors varied and subtle, that it really tells a story. Ask them questions. Give them a chance to answer.

When my children get up, we urge them to "EBDBIER." This stands for Eat, Brush, Dress, make your Bed, Inspect your room, be sure to Exercise and Read today. We went over these elements until they were second nature and we made them proud to accomplish these things, rather than punish if they were not done. We would explain they might injure themselves tripping over toys on their floor, or have trouble with cavities if they did not brush their teeth. Ask them how their school day was. Do not be satisfied with "OK." Try to relate what they are studying to the work of the real world. Eat dinner together, play soft music. They love candles and a special atmosphere. Hug them often, take your time about it, stroke their hair, give them a massage. Have the same bedtime ritual. We have bath, a story, the lullaby, and a 15 minute reading period that they earned by promising they would only read quietly, not play. It is lights out at 8:15, and "snuggles" for each child by each parent. I lay down on their bed and hug them, saying,

I want you to sleep well;
go to dream land and wake up happy, healthy, refreshed
and ready to exercise and learn.
You are precious and worthy of self-love
and self-respect, and loving, respectful behavior towards others,
behavior that's calm and polite and helpful and non-violent;
the sun and moon and stars shine for you,
the mountains and forests protect you
and Earth holds you up. I love you.
Sleep well. Good night. Any questions?

So, they hear in a soothing way what I want for them again and again. Violence is part of the human unconscious natural state; I hope I am helping them out of that state. Cliff asks, "when can I have my own business like you?" [oh, my] Sean usually asks me something like, "how do you turn wood into paper?" or"why are leaves green?" Morgana asks, "how can the moon set when the sun is rising?" I am writing diaries for them until they can write their own entries. This documents where they are in their cognitive, verbal and physical development. It can also help document the need for gifted and talented resources at school. Regarding this, know that you are the child's best resource, and it is better to spend time teaching your child than wasting too much steam arguing for the expenditure of few extra dollars for him/her at school.

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EXERCISE. Walking is good. Exercycle is OK if you cannot walk for 20 minutes at a time. Swim if you have no exercycle; do floor or bed exercises lacking a pool or good weather. I got achy and discouraged by choosing a rapid pace for 30 minutes of exercycling in 1992. Please choose an exercise and start with a pace that you think is too slow and stop as soon as you are tired. Then do this twice daily and add a minute a day towards 20 minutes twice daily, then work on your speed. Exercising regularly is the most important thing you can do for your health if you do not smoke. It's a rush and makes you feel and sleep better. It makes you more creative. If you still smoke, exercising will not save you, but it will help avoid weight gain as you quit. [See the smoking info]. In fact, if I could put every patient on just one therapy, it would be exercise 20 to 30 minutes twice a day. This is because many of the benefits of exercise last for 12 hours. For example, at about 3.5 mph walking or 12 mph on a bicycle for at least 20 minutes, exercise thins the blood for 12 hours after each episode, helps avoid heart attacks and stroke, lowers the bad cholesterol [the LDL that winds up narrowing arteries], raises the good scavenger cholesterol [HDL], lowers the blood pressure and raises the metabolism. So it is the critical component in losing weight and keeping it off. Don't bother to fail another diet! Exercise and eat sensibly [see the diet info].

20 minutes of brisk walking 3 times a week reduces the risk of heart attack and of not surviving a heart attack, because it protects against ventricular fibrillation, which causes most sudden cardiac deaths [SCD], [50% of heart attacks start with SCD]. 30 to 45 minutes 4 to 5 times a week cuts the incidence of adult diabetes in half, a disease that is mostly due to obesity on top of genetic susceptibility. Diabetes kills and disables with strokes, heart attacks, kidney failure, blindness and limb loss. Exercise is free except for the time you need to find to do it; it saves us from untold suffering and literally billions of dollars in extra medical costs. Even if we sleep 56 hours, commute 4 and work 40 hours, we still have 68 hours a week to exercise! Some studies suggest that 4 hours a week in women of childbearing women cuts breast cancer risk by as much as 58 percent, others don't, but it could help and couldn't hurt. Cycling regularly reduces prostate cancer risk by 88 percent. Exercise is the strongest anticancer treatment there is. People are working on whether various vitamins and even phenols in French wine are protective for heart disease and cancer, and they want to bottle and sell them. Do not buy more than a good pair shoes, and get walking! Take joy in every step - you are worth it and know that you will probably prevent the fatal diagnosis that you would have acquired by staying sedentary. It is obvious that you should not step in front of an oncoming truck, but not passively awaiting death and disease on the couch in front of the TV is even more important because it kills more Americans: 300,000 a year. Exercise helps maintain bone density. Exercisers have fewer falls, and fewer injuries if there is an accident. Surgeons can tell if the tissue and bone they are working with belongs to exerciser. Avid exercisers are up and going again much sooner than they expect after any given operation. The exercise I recommend needs little or no equipment: low impact walking or bicycling [with a helmet and gloves], I did the latter for 4 years before trying running with good shoes on a well-lit route. You can start with 10 minutes daily and build up to 30 minutes over a month, walking 6 days a week [leave out your busiest weekday] as fast and as far as you can. To obtain the maximum benefit, enjoy 12 episodes a week. I commuted on a 12 mile circuit between the 3 hospitals, home and the office this much at an 18 mph average, and I lost 15 pounds in 2 years and 3500 miles without any caloric restrictions. I continued to build muscle working to exhaustion in my garden and hefting children, but I can put on fat easily, so I began running in 12/96. To avoid trouble, my brother, Gary, and I read Running, Injury-Free, by Joe Ellis. We do each of his stretches 30 seconds a day [ideally]. We amazed ourselves by getting to 3.75 miles at a 7:15/mile pace by March. We have run up to 10 miles a day and 30 miles a week. Dr. Ellis recommends not running more than 16 miles per week. My record for the 2.9 miles from my Lutherville home to GBMC's door is 21:19.

Dear Sun Editor, From 1993 - this did not get published.

Spring is here. As a physician, I would like to recommend commuter bicycling to your readers. I rode all through high school and college. I weighed 155 pounds and looked like a stick. Then I gained 40 pounds over 12 years of education. Two of my sweetest elderly patients said I really looked good: I had "really fattened up." That was it. I also had a history of early heart attacks in my family. My diet was already good. I avoided fried foods, butter, margarine, and eggs. I ate plenty of broccoli, carrots, salads without dressing, oatmeal and bran, skim milk and a limited amount of skinless chicken and fish. I will cast no stones about dietary sins, however, having an occasional weakness for Brie cheese and chocolate.

I decided to begin a structured exercise program. Aerobic exercise is exercising with a sustained heart rate of about 200 minus one's age. This type of exercise lowers the blood pressure up to 10 points for 12 hours, conditions the heart if done at least 20 minutes three times a week, reduces fat mass. I tried a stationary cycle and found it boring. So I had my bicycle repaired.

Bicycle riding accomplishes many goals at once; it is low risk if one follows rules of the road, wears a helmet and gloves, and invests in adequate safety lights and reflectors. Bicycling takes you from here to there as quickly as a car if the trip is less than 2 miles and nearly as fast for 5 mile rides given time to find parking and then walk in to the work site. I travel 6 miles from Union Memorial to GBMC in 23 minutes. Bicycling produces only a tiny amount of carbon dioxide compared to cars (25 mpg city) which spew a pound (one cubic yard of pure gas) in 3 miles; this is warming the atmosphere. Bicycling produces no road kill, no carbon monoxide, no carcinogenic fumes, no oil spills, no noise. Bicycling requires no gas, and calorie for calorie, the human body would get about 500,000 mpg if it could use gasoline. Bicycling requires no license, no insurance, and causes no traffic jams. As I pedal by I looked sadly at all the single occupants of idling vehicles; I notice a pair in about every seventh vehicle. Bicycles can be ridden to a light rail or bus stop and parked there more easily than a car, for free. Commuter bicycling is a great way to fit into our busy schedules the exercise we should be doing to save our hearts and waistlines. In early spring you can smell the sap rising in the trees, hear the birds singing and see the whole blue sky... but not while strapped inside a car.

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back to front page, A Healing Continuum s the exercise we should be doing to save our hearts and waistlines. In early spring you can smell the sap rising in the trees, hear the birds singing and see the whole blue sky... but not while strapped inside a car.

inging and see the whole blue sky... but not while strapped inside a car.

GardeningI get my upper