The Power of Snow: a Haiku

The coughs and the colds

and all the runny noses

cured by winter's snow.

Happiness among Women Victims of Intimate Partner Violence

Happiness among Poor Women Victims of Intimate Partner Violence in Nicaragua.

The article analyzes various aspects of overall happiness expressed by 136 women in poverty who are victims of intimate partner violence (IPV) in Nicaragua.

Results showed that despite the hardships, one half of the women in poverty who are victims of IPV say they are happy, and the vast majority are optimistic about their future.

The main sources of happiness among the interviewees were in areas outside their economic life and are mainly associated with social relations.



Soc Work Public Health. 2014 Oct 15;:1-12

A Courageous Look at Disease

We all will face health challenges at some point in our life. Although some people will pass away quickly, many of us will undergo a more gradual process. The disease that kills us may take only a few days, or it may take years in the process. Chronic disease starting at a very young age, sometimes back to the moment of conception, afflicts many of us. So it is a worthwhile task to examine how you will react to disease, how you will look at disease. Will we face it with courage, or will it overwhelm our spirit? In order to prepare yourself to act courageously in the face of disease, it can be helpful to look at Stiliyan Petrov, the Aston Villa captain midfielder, after he was diagnosed with acute leukemia.

Petrov was in peak condition, an active, professional footballer. The popular, consistent player had made 30 appearances for his team that season. Then after a game against Arsenal, he wasn't feeling well and made an appointment to see the doctor. He got some tests, which discovered that he had acute leukemia. Within one week. Petrov announced his retirement from football so he could devote his attention to the leukemia.

But then what did he do? He didn't hide from the public nor did he wallow in his new diagnosis. Instead, the very next day after his retirement announcement, he went to his team's game against Chelsea. He cheered them on and gave his team his support, knowing that they would support him back.

One important thing that Petrov did was to share his situation with his closest friends. As a public figure, he made the decision to also share it with all of his fans. By doing this, he was strengthened, and encouraged to give his all to overcome the disease. He shared what was going on with his family and friends, and got strength from their support.

Another important action that Petrov took was to take some of the focus off of himself. Of course, he needed to concentrate on fighting the leukemia, that's why he retired. Yet, in spite of the sudden serious diagnosis, he nevertheless still showed a genuine interest in, and concern for, his teammates. Through his outward, positive encouragement of others, he demonstrated for them his courage in the face of disease.

How will each of us respond to disease? When it comes upon us, will we look at disease with courage, or with fear? By building up courage today, perhaps through the regular practice of courage builders, we can help ensure a courageous response.

Published by Tom Heston MD 4/10/2012

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.

Courage and Hope

"If you lose hope, somehow you lose the vitality that keeps life moving, you lose that courage to be, that quality that helps you go on in spite of it all. And so today I still have a dream." 

Martin Luther King Jr.

Dr. Martin Luther King was an inspiration leader of the civil rights movement in the 1950's and 1960's. He was perhaps best known for his powerful speeches, and his commitment to nonviolent means to bring about social change. The power of Martin Luther King Jr.'s dream was that behind his dream, he had great hope. A dream often can seem so far off, so unbelievable, that we fail to act. If it is just a fantasy, why work hard at it? Without hope, despair, but with hope, courage. With a great, burning desire and overwhelming hope, your dream seems possible. It is a real possibility, not just a whimsy or a fantasy. It is the hope that builds consistent, courageous action. That hope is what Dr. King gave us, to build up our courage to do the right thing. To respect each other. When disagreements occur, resolve them with nonviolence.

To build up your hope, listen to some of Martin Luther King, Jr.'s speeches. Learn about his life, and his struggles. Ask yourself, what gave King such courage? What gave him hope? Certainly, the conditions in the deep south during his life were unjust and highly segregated. Separate seating, separate facilities, separate treatment. In spite of this, something remarkable happened. The courage, strength, and hope of good people responded to King's calls for change. Nonviolence worked. Hope kept him going to the very end, which for him tragically ended in an assassination in 1968 at the hands of James Earl Ray. Yet his dream, his hope still inspires us today, almost a half century later.

Build hope through an optimistic outlook. In the movie Dumb and Dumber, Mary and Lloyd were speaking. Lloyd asks Mary what his chances are with her. Mary responds not good, perhaps one in a million. In response to Mary's one in a million odds, Lloyd replies, "so you're telling me there's a chance. Yeah!" Lloyd has an optimism outlook. He just doesn't seem to understand that he can't do something. What makes the movie endearing is the purity of the characters. Lloyd and Harry constantly have hope. They are too "dumb" to understand the long odds of their success. Yet, somehow they accomplish their objectives nonetheless, and they are happy.

Martin Luther King Jr.'s dream, powered by unshakable hope, changed the world. You can change your world, and that of everyone you touch, by having a great hope that fuels your dreams.

Regularly practice these courage strengthening behaviors:

1. Listen to inspirational music

2. Speak up in a firm yet kind and humble manner

3. Be hopeful

RESOURCE: Martin Luther King, Jr. A call to action: the landmark speeches of Dr. Martin Luther King, Jr. eBook, B000Q9IN8G.

Published by Tom Heston MD 4/2/2012

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.  

The Courage Reboot

Sometimes, the brain can build up excessive recurrent thoughts, some good, but also some that are harmful. As discussed in the Wake-up Call of Courage, the intentional development of good habits is a key component of developing and strengthening your courage. But what is also needed is to eliminate and reduce the impact of negative thought memes, also known as thought viruses . The best way I've found to reboot the brain is by going through the following exercise, based upon a system by John Reese.

You need to have approximately one hour to complete a reboot of your brain. Make sure you are in a quite place where you won't be interrupted. Have available your favorite writing tools, perhaps a pen and paper or an online, private journal.

First, write down everything that you need to do. Some people call this a brain dump, others call it the to-do expedition. Your task is to make the list complete. Keep going until you cannot think of anything else. Concentrate on this task for at least 10 minutes before moving on to the next step. This is your to-do list. When you are done, put your list aside and take a short break of 5 minutes.

Now, write down all of your dreams, wants, and desires. Write these down regardless of the financial costs. For now, don't worry about how much effort it will take, or how likely you think it is possible for you to achieve. Just get these desires out of your brain. Write down your perfect life as you picture it. Write down the physical things, and also the metaphysical things. These are the physical and spiritual things that you really, really want. Completely empty your thoughts on this topic. This is your goal list. Keep going for at least 10 minutes, then take a short break.

The third step is to confront your fears in writing. Put all of your fears down on paper. It doesn't matter how small, how large, how real, or how imagined. The important thing is to put it all down. This is your list of fears. Again, keep working on this for at least 10 minutes then take a 5 minute break.

Now it is time to read out loud all of your entries from each of your three lists: a) your to-do list, b) your goals, and c) your list of fears. Read them aloud in the order you wrote them down. When doing this, if any new thoughts occur to you, write these down on the appropriate list.

Closely examine your fears, and while doing so, think about solutions that could help you overcome these fears, or decrease the fear. If you think of a complete solution, then add this to your to-do list and strike the fear off of your fear list. For example, maybe you are afraid of premature death. You come up with the idea that by walking for 20 minutes a day, you will greatly diminish this fear because you know you are taking active steps to improve your health. Write down "walk for 20 minutes a day, more days than not" on your to-do list.

Next it is time to closely examine your goal list. Think of possible solutions. Also check to see if you have any fears associated with any particular goal. As your ideas come forth, write them down on either the to-do list or the list of fears.

Finally, prioritize and begin work on your to-do list. This is the final step in your brain reboot. This completes the process, because now you can relax knowing that you have begun definite action steps to move you towards your goals and away from your fears. This builds up your courage by helping you become a person of action, not just words or thoughts. After performing a brain reboot once, it becomes much faster the second time. Do this on a regular basis as part of your personal improvement system, and watch your courage grow as your fears and anxieties decrease.

REFERENCE: Lofland D. Thought viruses. 1997.

Published by Tom Heston MD 4/2/2012

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.  

The Wake-Up Call of Courage

"Moral excellence comes about as a result of habit." 

Aristotle

Start out your day on a courageous note by consciously and intentionally waking up with a strong, healthy, and optimistic attitude. This initial direction to the day makes a big difference! By starting out on the right foot, the rest of the day is much more likely to fall in place. So make the commitment to begin every day with a Wake-Up Call of Courage.

The first attitude to have when waking up is gratitude. Be grateful for having another day. Be thankful for having another opportunity to help and serve others. Even when facing great challenges, find something to be grateful for.

To turn this attitude of gratitude into a strong habit, connect this pattern of thinking with a specific action that you take every morning. Many people find that a good trigger for this is the action of placing your feet flat on the ground for the first time when getting out of bed. Connect putting your feet solidly on the ground with the thought pattern of giving thanks. Do it intentionally every morning, right when you put your feet flat on the ground. After a short time, this will soon become a powerful and self reinforcing habit. To make it a strong habit faster, pause for a few moments and dwell upon your feeling of gratitude as you get up. Think of the things you are thankful for, and internalize a strong feeling of gratitude. Emotionalize your thoughts. Let your gratitude completely fill you up.

Now, as you get fully up out of bed, summon up your courage. Think of your goals and your dreams. Visualize your goals from the perspective of a courageous person. Your goals are not simply fantasy and pipe dreams. No. Your goals are real. Your goals are achievable. Your courageous actions will cause you to achieve your goals!

Your strongest, most motivating goals will be ones that bring about the greatest benefit to others. This will result in the deep personal satisfaction that comes from helping others. Goals that are selfish or small do not inspire courage. Have big goals, that serve a grand purpose. Have goals that you enjoy pursuing and that you find deeply satisfying. These are the thoughts that nourish and strengthen your courage.

You will find that as you go about the rest of your morning routine, thoughts of gratitude and courage will continue to grow and strengthen. Encourage this growth. Reinforce positive thoughts and ideas. Just as watering plants makes them grow and thrive, nourishing these thoughts will cause gratitude and courage to become stronger.

The wake-up call technique can help you build up and strengthen your courage. Although the technique is simple and straightforward, it has real power.

SUMMARY: THE WAKE-UP CALL OF COURAGE

1. As you wake-up, think of the things and the people for which you are grateful. Emotionalize and internalize this feeling.

2. Anchor this feeling with a specific action you take every morning, such as putting your feet flat on the floor as you get out of bed.

3. Now, summon up your courage. Feel the strength and the boldness fill you up.

4. When your courage is strong, visualize your goals and your dreams. Have the attitude that your goals and dreams are 100% realistic, and that through your courageous actions, you will achieve these goals.

5. Remember that your goals that serve a greater purpose other than just yourself have the greatest power. Go for your goals that will bring you the greatest satisfaction while at the same time bring about the greatest good.

Published by Tom Heston MD 3/26/2012

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.  

The Blue Cup

Mary likes the blue cup. It's her favorite color. The size of the cup is just right for her morning coffee, and the design, well it's a peaceful, relaxing combination of an abstract drawing in black on a background of charcoal speckled blue. It's Mary's cup.

So when we get up together, after walking the dogs, I make the coffee and get her cup. Any random cup for me is fine as long as the coffee is strong, but Mary is more artistic. To her, what makes good coffee is pleasant company, a relaxed conversation, a warm home, and of course, the tranquility of the blue cup.

The Sea of Tranquility is a basaltic basin on the moon that appears relatively black, juxtaposed against the predominantly white moon. The early astronomers Grimaldi and Riccioli thought these dark areas were actual seas, and in 1651 named one the Sea of Tranquility and another the Sea of Serenity.

The Sea of Tranquility was where the first man ever walked on the moon. When looking at the Sea of Tranquility on a clear night with a full moon, there often appears to be a touch of blue luminescence radiating out from the moon. The sea itself also gives off a bluish shade because of the relatively higher metal content in the area.

When gazing upon the Sea of Tranquility and its neighbor, the Sea of Serenity, a comfortable quiet and sense of wonder is experienced. Is it any surprise the early astronomer's used "tranquility" and "serenity" to describe these great wonders of nature so far away, on the moon?

Today as I write this, I am alone, and missing Mary. She is out of town for work and I've been feeling a bit lonely. Twenty five years together is a lot, but I selfishly want more. Although I am enthralled by the evening sky, and find the moon to be an amazing beauty of nature, Mary is my Sea of Tranquility, and my Sea of Serenity. As I rush to get my strong coffee in a jelly jar if necessary, she will take the time to find her blue cup. As I am already thinking of the business day ahead, she will turn the conversation around to deeper, more meaningful issues. From her comes this infinite, indescribable, yet clear sense of tranquility and serenity. Though we often only get a few minutes to talk, she doesn't ever just give a raindrop of tranquility, or a pond of serenity. She gives an entire sea of both.

So this morning, while waiting for Mary's return, the day starts as usual. Get up. Walk the dogs. Eat breakfast and make the coffee. But when the coffee was ready, I grabbed the blue cup. A small, trivial thing. A cup is just a cup. But then... patience... then peace.

Tranquil and serene.

The blue cup

. 

Published by Tom Heston MD 3/24/2012

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.

The Courage Walk

"All serious daring starts from within." 

Harriet Beecher Stowe

To build your courage, start from within. An excellent way to begin doing this is the courage walk.

You can build up your courage from within by regularly going on Courage Walks. The courage walk helps build up your inner strength in three important ways. First of all, it involves going on a walk. This perfect exercise tones your body, cleans your lungs, and strengthens your heart. It is a perfect exercise for many of us because it can be done anywhere, for your entire life.

Secondly, the Courage Walk clears away the clutter in your brain. In effect, it serves to perform a brain reboot. Sometimes, a computer can build up an excessive number of programs in its RAM. This memory is for short-term, temporary use. It is not used for long- term memory, which is stored on the hard drive. This RAM can get overwhelmed by running too many programs all at once, and cause your computer to crash. When this happens, a simple reboot of the computer will clear the RAM, and the computer will function normally once again. In a similar fashion, your brain also benefits from clearing out the clutter of random, petty, miscellaneous thoughts. The Courage Walk helps you performs this vital function, allowing you to reset and re-calibrate your brain.

Finally, the Courage Walk strengthens your spirit. It makes your thoughts, and your soul, more resilient. It helps your creativity. The Courage Walk makes you stronger in body, mind, and spirit. Here's how the Courage Walk is performed.

First, go on a walk. On your walk, clear your thoughts by focusing on your breathing. You can focus on your breathing in many different ways. One simple way is to breathe in for 4 steps, hold your breath for 4 steps, then breath out for 4 steps. Another method to help you focus on your breathing is to talk a deep, deep breath. Hold it. then let it out slowly. The main thing is just to focus on your breathing.

Now, imagine breathing in healthy energy and letting it fill up your entire body. Imagine taking the energy in when you inhale. As you inhale, imagine your body becoming full of positive, beautiful colors. Many people imagine themselves becoming more full of a bright, warm light. The molecules of your body resonate with harmonious, positive life. Your aura builds up a stronger glow. Now exhale, and imagine negative energy leaving you through the palms of your hands and the soles of your feet. The toxins are being released. Negativity flows out easily as you exhale.

Let your aura, your inner light become so strong that absolutely nothing can diminish it, harm it, or overcome it. Your aura is so powerful, it reaches out to others, affecting them in a positive, healthy way. This light is your (good) force, helping you, helping others, and strengthening the universe.

Now, let all of the color leave your body. Every time you inhale, every time you exhale, the glow grows less and less until finally nothing is left. Imagine your body as completely invisible, completely gone.... yet your spirit remains. You are greater than your body. Your spirit is something greater than the physical world, and therefore nothing in the physical world can diminish, harm, or destroy your spirit.

Continue to meditate on filling your body with a brilliant light, then releasing all of the light. Imagine building up the spirit within your body, and then imagine your spirit as greater than just your body. Fill your body full of healthy energy, yet realize that while your body is temporary, your spirit is something greater.

Your Courage Walk is now over. Your brain has been rebooted. Your heart, your lungs, and your muscles all have been re- energized. Your inner glow, your aura has grown in strength and brilliance, just like a fire that has just been stoked. Finally, you have reaffirmed that your spirit is greater than your body, that life is much more than just the physical world.

SUMMARY: BUILD COURAGE WITH THE COURAGE WALK

* Go on a walk and focus on your breathing

* Breathe in positive energy and exhale negative energy

* Imaging your aura so bright and strong that nothing can diminish its glow

* Now, imagine your spirit and your entire being as invisible to the world, and unaffected by earthly concerns

Published by Tom Heston MD 3/13/2012

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.

Music and Your Success

Music and the rest of the arts are an essential component of a successful life. Experiencing the depth of emotion expressed in great works of art and music enriches our life and strengthens our soul. The fine arts have powerful effects upon the brain, helping integrate knowledge between diverse subjects.

Music can be particularly helpful when you are trying to learn a great deal of information. It can help you learn faster and better if you occasionally take a break from your studies, relax, and listen to some music. This process allows the brain to find and make connections between the individual facts you are studying. The result is a greater understanding of the subject, and ultimately, a depth of knowledge and wisdom that you could not have acquired any other way.

Listening to music, either on an iPod or just singing something silently in your head, can help you perform better physically. Take a look at the professional athletes as they are preparing to compete. Frequently they will be listening to some music to help them get mentally psyched up, and help their body get in the rhythm of the sport.

Art and music also bring greater meaning to your life. Any knowledge you gain needs to be applied wisely. This requires that you develop not only your intellect, but also your spirit. The arts are what help develop your soul, so you can become a person of wisdom, help more people, and enjoy life more fully.

Does any art accomplish this goal? No. To get the most from music, it is important to listen to a wide range of styles. Listen to some pop music, listen to rock, listen to Mozart. A wide exposure to the masters of music will enrich your life, help you enjoy life more, and help you get the most out of life.

My personal music program consists of practice, performance, and listening. I practice the piano to help develop my discipline, give my hands flexibility, and to free my mind if only for a short time from its day-to-day thoughts. I perform, even if only for myself, to help develop and deepen my emotions. I try to get to the heart of the song, to forget myself and get wrapped up in the music. This helps develop my emotional strength and stability. It does not make me unemotional, rather gives me emotional depth. Finally, I listen to a wide range of music. For me, it is important to listen to the great symphonies and classical masterpieces because their depth of beauty and emotion greatly exceeds what can be experienced in the few minutes of a typical pop song, yet I also enjoy contemporary pop, country, and rock music.

A similar program can be established for the visual or literary arts. You may prefer the culinary arts, or even physical art expressed through sports or ballet. Sports such as the x-games go beyond the physical, and can become great works of art. What is important is to experience the beauty and the great emotion that art brings into your life. Life would indeed be a drudgery without art. And life would be shallow and have little meaning without experiencing the great works of art, whether it be Shakespeare, Mozart, or Van Gogh.

Commit to practicing, performing, and experiencing art on a regular basis.

Perhaps you are a software programmer. How can you make this an art? The people at Wordpress have made their slogan "code is poetry." Can you view your code this way? Practice the fundamentals of programming, write a complete program or routine that expresses the poetry (a performance), and finally, look in-depth at a wide variety of programs, so you can experience the poetry written by other people. Look for the beauty in the code, look beyond the numbers and beyond the fundamentals and find the art in the programming.

Perhaps you perform freestyle sports as art. Then practice the fundamentals. Put together a routine and perform it, even if only for yourself. Finally, look at what others are doing and don't just analyze their freestyle, try to also experience the art, beauty, and joy behind their performance.

Live to the fullest. Art helps you do this.

Published by Tom Heston MD - Featured Contributor in Health & Wellness

Tom Heston MD earned his MD at St. Louis University and completed post-grad training at Duke, Oregon Health Sciences, University of Washington, and Johns Hopkins Hospital.

Overcome Fear and Strengthen Your Courage

Have you been in a life or death situation that required you to summon up great courage? Many of us have not. Although we have been in situations that test our resolve, usually it is not life or death. Frequently, our courage is called upon during everyday life, when performing seemingly routine activities.

Modern life has protected us from many dangers that were quite common in generations past. For example, no longer do we all need guns in our homes to protect us from grizzly bears, mountain lions, or other wild animals. We do not need to weather the elements with raw materials. In the current day and age people have electricity, running water, and adequate housing. Instead of hunting, we only need go to the supermarket. And instead of braving the elements, we can often get from home to work and back without even going outside. So why is it that when we think of courage, we only think of someone who overcame great odds or a life or death situation?

Sometimes when thinking of courage, we only think it applies to rare and uncommon situations. Yet can our ordinary life also be full of courage, even if we are not facing the end of a gun, a wild animal, or a vicious criminal? Can we fill our routine days with courage?

One definition of courage is the ability to overcome one's fears, and we can all overcome at least some of our fears. It is in this manner that every one, on a daily basis, can build up their courage.

The process is simple but challenging. First, select one of your fears. Figure out a plan to overcome it. Then follow your plan. In this way, courage grows and strengthens.

The first step is to write down your fears. Don't run away from your fears, don't avoid them. Face them head on.

Then, write down several specific actions that you can take in order to overcome those fears. Make up a master list of ACTION STEPS that will lead to overcoming your fear, or at least greatly decrease the fear.

For example, perhaps you are afraid of dying prematurely from a heart attack. First, you would write down your fear, then you would write up a plan of action designed to overcome the fear. One plan might be to exercise more, or perhaps improve your diet. By doing these things, your fear will decrease because you know you are doing your very best.

So today ask yourself: What would a person of courage do? Courage is a primal force that can be summoned up by thinking and planning, but it only becomes a part of your life when you take action.

To strengthen your courage, follow these steps:

1. Recognize your fears.

2. Write down a plan of action that will cause you to overcome or at least lessen these fears.

3. Make up a task list, and prioritize it.

4. Take action immediately.

Published by Tom Heston MD 3/6/2012

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest. 

Speaking Up for Courage

Want to build up your courage, today? Then speak up for the things you know to be right. Stand tall. Speak up.

A fool speaks of trivial things without thinking, but it takes inner strength to talk about our most important thoughts in a respectful and courteous manner. Standing up for what is right by putting into words our most important thoughts takes courage.

"Moral cowardice that keeps us from speaking our minds is as dangerous to this country as irresponsible talk." - Margaret Chase Smith.

Margaret Chase Smith knows what she is talking about. She was the first woman to represent Maine in the U.S. House and first in the U.S. Senate. She was the first woman to serve in both houses of the United States Congress. In 1964, she became the first woman to ever be placed in nomination for the U.S. Presidency by one of the major political parties. What was her secret to achieving groundbreaking success? Most certainly, one reason she was so successful was her courage to speak up for what she believed to be true and right.

Do you know anyone who is afraid to say "I love you" but always has the latest neighborhood gossip? It's possible that this person is afraid to make a real connection with you, and instead prefer to keep the relationship at a distant, superficial level. Usually, their fear of rejection -- not lack of love -- prevents them from ever sharing their deepest thoughts.Without the courage to speak up, their relationships remain shallow, and likewise their contribution to society remains shallow.

Perhaps you know people who will never say "I'm sorry." Why won't they ever say they are sorry? This usually is because they are afraid to admit they were wrong. They are afraid to show that they are human and capable of making mistakes. They are afraid to show weakness. Yet by not sharing our vulnerabilities, we create an emotional wall around ourselves. We become unable to build strong friendships. Everyone suffers.

So, do you want to become more courageous, today? Start right now by speaking up and sharing with others your most important feelings, and your most important thoughts.

Talk in a kind, and respectful manner, so others will respond positively. When we are rude or abrupt, others frequently stop listening, and our words then become meaningless. A good way to learn how to effectively speak up is by following the principles set forth by Toastmaster's International. Many communities have a local club that helps members improve their speaking. The goal is to speak effectively. Thoughtless speech cannot help others. People are going to be much more receptive to listening when we speak firmly, but in a kind, gentle, and respectful manner.

Finally, is there really such a thing as "quiet courage"? Although this concept has been romanticized in books, the concept is very misleading. Certainly, the courageous are quiet when it comes to complaining or criticizing. They don't seek out publicity for publicity's sake. But this doesn't mean courage is "quiet." Not at all. Courage comes from deep inside of us, and it grows only through sharing. We need to speak up in order to share our innermost feelings.

Follow these three principles to become more courageous, today.

1. Speak up with confidence. You can become a more courageous person, today, by sharing with others your most important feelings and thoughts.

2. Speak up about your beliefs. Moral courage requires us to stand up for what we believe in.

3. Speak up with respect. People are more receptive to your message when you speak up in a firm but kind and respectful manner.

The Fundamentals of Courage

"You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the thing which you think you cannot do." - Eleanor Roosevelt

Eleanor Roosevelt faced many challenges during her life. She married Franklin Delano Roosevelt at age 20, then around age 30 she discovered that FDR was having an affair with her own secretary. Shortly thereafter, FDR became paralyzed, and her campaigning on his behalf played a huge role in him winning election to the Presidency of the U.S. Through her fearless and direct actions, she was able to make the most of things, and ultimately became one of the ten most widely admired people of the 20th century according a poll of the American people. She knew that positive thinking was not courage. Talking to her friends about plans for the future is not courage. Courage is an action.

It takes action to overcome a fear, and only through taking action does one become more bold and courageous.Through action directed at fear, the fear is overcome and courage is strengthened. So, in order to become more courageous, it is necessary to embrace the first fundamental element of courage- action.

"Conscience is the root of all true courage; if a man would be brave let him obey his conscience." - James Freeman Clarke

James Clarke was an early 19th century theologian and author. A graduate of Harvard College in 1829, he then became a minister for the Unitarian church in Louisville, Kentucky. At the time, Kentucky was a slave state, but James Clark stood up against his state's government and advocated strongly for the abolition of slavery. This strength of conviction, coupled with action, made Clarke a courageous person others could follow and respect. Courage comes from this strength to follow one's conscience, even if it goes against popular opinion or as in the case of Clarke, the government. This is the second fundamental principle of courage. When actions become aligned with the conscience, courage grows and is strengthened.

Taking positive action that is in alignment with the conscience is a simple concept. To strengthen courage, one must act upon the things known to be true, just, and right.

Is there something the community needs to be improved? What can be done to help? Is there something in the family that can improve? What are some simple actions that will help make things better? Is there something that should be confronted, but fear is getting in the way of acting?

REFERENCES

Gallup News Service. Mother Teresa Voted by American People as Most Admired Person of the Century. 31-Dec-1999. Retrieved 24-Feb-2012.Eleanor Roosevelt was #9 on this list.

Heston T (ed). Courage Builder. Internet Medical Association, Las Vegas, 2011.

Published by Tom Heston MD 2/24/2012

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest. 

Out of the Box Holiday Gifts: 5 Tips for the Techno Nerd

Some people don't like to leave their gaming console to go shopping for holiday gifts. It's cold outside, warm inside. You need shoes to go out, only socks if staying in. But don't miss out on the holiday giftgiving spirit! Here are some out of the box gift ideas that you can get right from home for that special you-know-who.

1. Give a fruit of the month club membership. This will send some healthy fruits to your gift recipient every month. Most people could benefit from more healthy fruit in their diet, so with this gift you could also be giving your friend the side-effect of better health. You can stay with your energy drinks and your potato chips. At least they will be getting fruit.

2. Give the gift of making your grandfather his very own domain. Giver him a cool domain name and good content. If you build a multi-page website, you may want to put in some Easter eggs to surprise him when he checks it out. Plus, be sure to put some of your own links on the site, to remind grand dad that the gift came from you.

3. Do you have a grandmother that you want to give something to? How about you dedicate to your grandmother her very own Sim City. Make the city unique to her, giving it some of her personality, but also some of yours. Then show it to her explaining all of the cool details you put in place.

4. Go out to lunch with your friend to that neighborhood health cafe. Order special food dedicated to your enjoyment and your health. Celebrate life, your friendship, and the divine. Good food, good friendship, good laughter. Even tech nerds need off-line friends. Make the most of them.

5. Electronic books are great out-of-the-box gifts that you can give to anyone with a computer, a notepad, or hand held smart phone. They no longer need a special reader, anyone can read them with just about any digital device. If you are not sure what the latest hot books are, just check out an online list of the digital book best sellers Be sure to check out the free electronic books. These free books often contain the greatest works in human history. Check out some Shakespeare, or Newton, or Socrates. These books are almost always free, so if you are on a tight budget, why not give a free book of one of the worlds greatest works of literature?

Holiday gift giving can frequently pose a major challenge for the techno nerd. These out of the box gifts can show your friends and family that you care about them, and that you were thoughtful in the selection of their gift. Sometimes the most meaningful gifts are out-of-the-box.

Published by Tom Heston MD 12/6/2011

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest. 

Christmas and Your Health - A Doctor Clarence Story

I wandered back and forth in the small clinic, looking busy. As the town physician, my duties were important. But I was acting overinflated, as if I was even more important than my duties. A preposterous thought. Of course not. Besides, I wasn't good at much else. But the nervousness was definite. Something was up. It was time to give up the pretenses and finally admit it. The problem was me.

It was only two weeks until Christmas but I was still trying to meet last year's resolutions. A doctor is supposed to set a good example. And furthermore, my resolutions were made as a father, and a husband. My New Year's Resolutions: made, but not kept.

And now the year was nearly out. It was time to stop sitting around and get going. I had gained too much weight once moving back to the city, and needed to cut down on my eating. And all that time in the tavern, talking about the latest news, it was just too much. And yes, today would be an excellent time to start working on those cabinets I promised to make.

More like past time, I thought. Much past time.

But back to reality. I shook off my thoughts and shook off my boots and got going. No time for regrets. It was time to be going home. It wasn't fair to let my sour, defeatist mood spread to others in the clinic.

"Good night, Doc Clarence!" the nurse said cheerily. But I just brushed by, saying hardly anything, and not fully realizing why. The fact was, it was time to leave.

So I opened the door to the boardwalk, and headed towards my horse. But with the sudden exit, came sudden shock, a slap on the cheek and a gasp of a cry. Oh my land, was it ever cold! Absolutely freezing. Really, really cold.

Well, I told myself, that's what happens in winter. So with a huff, I looked down and began my walk to my horse. And then it happened.

A gust of wind lifted my eyes, and with them, lifted up everything else. Look, there is the constellation Orion's Belt. And over there is the Big Dipper. I pondered briefly on their ancient history. Then they spoke. It sounds strange, even fantastical, but they really, truly, spoke to me. 

Here is what they said:

"You are to have only one serving of dessert from now on."

"Starting today go on a vigorous walk. Repeat regularly."

"And would it hurt you to smile some more! "

Well, what could I say to this. O.K. fine. The winter air reminded me that it was time to get moving home. So when I got to my horse I quickly jumped on the filly. "Giddy up, Ginny. We'll be home soon."

And so we began the trip back home. I hope my wife put chili on for dinner. It's really cold tonight. 

Published by Tom Heston MD 11/29/2011

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.

A Hell of a Week

Tired and dirty, I was ready for hell week to end. It wasn't that new sugar coated "inspiration week." Not to me. This was the good old fashioned hell week. So I wasn't inspired. No, back then it was just, well, just what it was: hell week at the fraternity house.

Then on the following Sunday morning, right after the week ended, things were different. Inspirational even.

Perhaps because it was Sunday, or perhaps because we were all still so tired, we actually sat quietly as some pastor gave us a talk. Well really, he just told a couple of jokes.

Then, this pastor started passing out a mountain, yes a true mountain of business cards. These business cards had a number of various short and trite sayings on them, such as "go get 'em" or "rah rah you can do it".

Definitely an amusing collection of old and tired quotes. But then it caught my attention. The one saying that would so profoundly affect my life. This one card humbly caught my eye. What did it mean? I was no longer tired, no longer waking up. I was awake. My full curiosity was aroused.

The card simply said, I'm third.

The pastor saw my puzzlement and explained: God first, my fellow man second, and I'm third.That was it. He said nothing more to me, he just moved on to speak to one of my fraternity brothers.

My thoughts remained with the card. Yes. This explains things. This explains life.

By putting God first, the focus is on doing good things with my life, acting good, and doing good things. Really good things.

Putting my fellow man second, well isn't that what a fraternity is all about? The laughter, the shared memories. Through fellowship, together we are doing even more good. Awesome. This clicked.

Finally, I'm third. The words on the card. The two words that summarized the entire philosophy of a good life. I'm third. Out of all the priorities in life, one would always be in the third position. Take care of yourself. Regular exercise, a good diet, and a strong spirit are necessary if we are to make the most of our life. Not I'm last, but I'm third.

Now that several decades have passed, this is the saying that inspires me most: I'm third.

Out of hell came a beautiful lesson, thanks to that pastor and his mountain of business cards.

Top 10 Courage Builders

Want to increase and strengthen your courage? These top 10 courage building exercises can help.

#1: Listen to music.

"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." - Henry David Thoreau

Music helps balance your inner rhythm with your outward actions. Listen to music specifically designed to uplift and strengthen the spirit.

#2: Speak your mind gracefully

"Moral cowardice that keeps us from speaking our minds is as dangerous to this country as irresponsible talk. The right way is not always the popular and easy way. Standing for right when it is unpopular is a true test of moral character." - Margaret Chase Smith

"Grace under pressure." - Hemingway's response when asked to define having guts.

When a wrong exists, someone must speak up against it. This may be difficult, but by overcoming the difficulty you build up your courage. The most effective speech is when you are considerate of others while clearly stating your case.

#3: Be Hopeful.

"If you lose hope, somehow you lose the vitality that keeps life moving, you lose that courage to be, that quality that helps you go on in spite of it all. And so today I still have a dream." - Martin Luther King Jr.

#4: Develop Good Habits

"Watch your thoughts; they become words. Watch your words; they become actions. Watch your actions; they become habits. Watch your habits; they become character. Watch your character; it becomes your destiny". - Anonymous

#5: Meditation

Meditation clarifies our thoughts and strengthens our resolve. It increases our resolve and focus. Regular meditation also helps the physical body repair and regulate itself. Most people meditate through prayer although there are many, many different ways to meditate. One good way is by practicing the relaxation response as explained in detail by Herbert Benson and Miriam Klipper.

#6: Take bold action

Overcome fear by doing those things you know to be just and right. Courage is action over fear. Stand up for your beliefs and take action.

#7: Exercise

In Toughness Training for Life, James E. Loehr recommends regular situps to build up a core of toughness. Everyone can do some form of exercise. Give it your all and watch your courage grow.

#8: Eat right

Maximize your physical potential by eating right. This means for many people a diet full of vegetables, fruits, and grains while light on the red meat. When great courage is needed, you will be ready.

#9: Study

Courageous action is smart action. Adopt a respect for education, including math and science. Become as well educated in your line of work as you can be. This will make you more effective, and when your courage is called upon, you will act in an efficient and effective manner.

#10: Be generous

Give of yourself in a cheerful and uplifting way. Consistently think of nice and thoughtful things you can do for others. Make a difference in people's lives through your generosity.

A Stay-at-Home Mom Haiku Tribute

The stay-at-home mom
Never received a paycheck
No recognition.

Friends in the workforce
Got awards and bonuses
While she cleaned the house.

Alone with the kids and her résumé empty. A great sacrifice.

But courage and strength gave blossom to the loving that filled up her home.

Never worked a day? Ha! She worked all day and night. Raising our children.

The Affairs of Older Men: Lessons Learned from the Bobby Petrino and Jessica Dorrell Saga

Some people age gracefully, some don't. A good example of one of those that don't is Bobby Petrino. He was a highly successful, and highly paid head football coach at Arkansas University. In many ways, he could be considered at the peak of his football coaching career. Earning several millions of dollars a year as a major university football coach is a dream only a very few achieve. But that wasn't enough. He had an affair with a woman, Jessica Dorrell, who was less than half of his age. He paid her tens of thousands of dollars. He gave her a peach of a job. These were the type of actions Petrino knew would get him fired if he got caught. So why did he take such high risks? One clue is his age: 51 years old.

In their 40s and 50s, people frequently experience a midlife crisis. During this age, individuals are starting to come to terms with their own mortality. If death is close anyway, why not take some risks and live a little? There is this search for a deeper meaning to life. And with the midlife crisis comes a new source of stress that must be relieved.

Many people will engage in new adventures, reaching out in their search for answers. Often, this will result in great satisfaction and a more meaningful life. A change in career may do this, or travel, or learning a new language can all become positive expressions of a midlife crisis. But others will take a more dangerous, and ultimately empty road. Instead of searching for meaning, there is a search for a quick fix, a mindless release of stress. Take for example the middle aged man who has a high risk affair with a woman less than half his age. The illicit affair may bring a thrill, and the physical contact may relieve stress, but the result is disaster. Instead of finding meaning, the result is a painful emptiness.

A better path to resolving the midlife crisis is to take it head-on with deep, personal reflection. Recognize it when it arrives. Accept it. Embrace it. Then intentionally funnel that renewed energy, that desire to take some risks, into a positive direction. Learn a new skill, take on a more satisfying job, or travel somewhere exotic.

Petrino didn't have the insight to understand he was going through a midlife crisis. Instead of recognizing it, he simply released his stress through physical intimacy. No insight. No personal growth. Rather, his response to the crisis was psychological regression and cheap physical thrills which destroyed his career. Maybe now the newly unemployed Bobby will take time to examine his life, and find some answers. I'm sure he will find this search to be infinitely more exciting than a reckless college fling.

4/17/2012

Fruits and Vegetables During Childhood Promote Lifelong Health

Can a good diet as a child prevent heart disease as an adult? New research from Finland suggests that the answer is yes.

Atherosclerosis is the primary cause of premature death from coronary heart disease. Previous research has demonstrated that in adults, a diet high in fruit and vegetables reduces the risk of cardiovascular disease. Up to this point, however, there has been no good long term research studies showing a direct link between childhood nutrition to the development of cardiovascular risk factors as an adult. 

In the Young Finns Study researchers wanted to know the impact of childhood nutrition upon adult heart disease. In 1980, the scientists looked at the dietary habits of over 4000 children from 3 to 18 years of age. They then did follow-up assessments of the children 6 years, 21 years, and 27 years later.

Several important components of childhood nutrition were predictive of increased cardiovascular risk factors as an adult. Boys who were breast fed, compared to given baby formula, when they grew up tended to have improved functioning of endothelial cells, the cells which line the inside of blood vessels. A childhood diet high in fruits and vegetables was associated with improved flexibility of the arteries during adulthood. In women, consumption of sugar sweetened soft drinks was linked to increased obesity as an adult.

There were two basic dietary patterns identified in the children: a traditional diet and a health conscious diet. The traditional diet of rye, potatoes, milk, butter, sausages and coffee was associated with the development of multiple cardiovascular risk factors as an adult. On the other hand, a health conscious diet which emphasized fruits and vegetables was associated with beneficial outcomes, including decreased cholesterol plaque buildup in the carotid arteries as an adult.

This research strongly suggests that dietary habits and patterns established during childhood continue into adulthood. Eating behaviors and food choices while a child tend to be linked with adult nutritional choices. This has profound implications for parents and schools. 

Encouraging children to make wise food choices almost certainly will lead to better lifelong health and a decreased risk of premature death from heart disease. Furthermore, the research simplifies the dietary goals for children. We simply need to increase fruit and vegetable consumption in our children, and the likely outcome is a much healthier child who grows into a much healthier adult.

Reference: Kaikkonen JE et al. Does childhood nutrition influence adult cardiovasculardisease risk?-Insights from the Young Finns Study. Annals of Medicine, 2012 April 12.

Published by Tom Heston MD

Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.

4/20/2012

A New Cure for Breast Cancer - Early Detection

Breast cancer is the 2nd deadliest cancer in women, so it was interesting to come across a research article claiming to have found a cure. Was it a new pill, a new chemotherapy, or new surgical technique? It turns out to be none of the above, but rather the simple, but challenging principle of early detection. 

In very early breast cancer, usually the best treatment is surgical excision, but when the cancer has spread, chemotherapy and sometimes radiation therapy or additional surgery is necessary. This latest research study, published April 25, 2012 in the peer-reviewed journal Breast Cancer, looked at women who had early metastatic spread of the disease to the lymph nodes, bones , the liver, or other organs. And guess what? They found what essentially is a cure, meaning a relapse-free survival of over a decade. 

The researchers theorized that since only about 2% of women with metastatic disease survive relapse-free for 10 years or more, that looking at these 2% who are long-term survivors might provide some clues into what works. They therefore looked at 75 women with early metastatic disease, defined asoligometastatic breast cancer. These women in general were treated with systemic chemotherapy and as appropriate, surgical or radiation therapy. 

Chemotherapy lead to either a complete or partial response in nearly all of the 68 patients studied (an overall response rate of 95.6%). Response rates were better in women where the breast cancer had spread to only a single organ. Local therapy, such as additional surgery or radiation therapy, was associated with improved overall survival and relapse-free survival. 

The conclusion of this study is that aggressive treatment of oligometastatic breast cancer seems to lead to improved outcomes. If the cancer can be caught very early in the breast, it can be cut out and survival is excellent. If the cancer has already spread, but only to one or two organs such as to the bones or the liver, then aggressive treatment including additional surgical or radiation therapy seems to make a big difference. Catching the disease early can means a survival rate of over 50% at 10 years, but if the metastatic spread isn't caught until later, the relapse-free survival rate at 10 years is under 5%. 

This is very encouraging news, because it identifies a group of women with metastatic breast cancer that have a very good chance of long-term, relapse-free survival. It also is encouraging because it suggests that for patients, chemotherapy is worth it, and the additional radiation and surgical therapies also seem to make a big difference. 

Like just about everyone, I have several good friends with breast cancer, because after all, the disease affects about 1 out of every 8 women. It can be deadly, but even people with advanced spread of the disease can experience survival rates of over 50% at 20 years after diagnosis-- but only if the metastatic disease is caught early, when it is still oligometastatic. As a physician, the take-home message is that early detection of metastatic disease may greatly increase the chances of long-term survival. If metastatic disease is detected early, then there is great hope for beating the disease and living healthy for two decades and longer.

5/4/2012