Anticholinergic medications may be linked to increased dementia risk

“Avoiding anticholinergic medications over the counter is a smart choice with this information. The list of common anticholinergic drugs is listed here in Wikipedia. . It surprised me.” Bill Chesnut, MD

To go back to New Health News:

Anticholinergic medications may be linked to increased dementia risk

ABC World News Tonight (4/18, story 10, 0:20, Muir) reported that “certain medications may increase the risk of dementia,” a new study warns. Medicines, “including tablets for cold and flu, allergies and heartburn,” appear to be linked to “memory problems.”

According to CNN (4/18, Tinker), the study “offers the most definite proof yet of what scientists have known for at least a decade: that anticholinergic” medications are associated with “cognitive impairment and an increased risk of dementia.” Such medicines “are sold over the counter and by prescription as sleep aids and for chronic diseases including hypertension, cardiovascular disease and chronic obstructive pulmonary disease.”

TIME (4/18, Oaklander) points out that researchers “analyzed already existing data from 451 people around ages 70-75 who had normal brains,” then “examined the results of memory tests, MRI brain scans and other neuroimaging data – all while paying particular attention to people who said they took anticholinergic” medications. Seniors “who regularly took at least one anticholinergic drug showed poorer cognition, lower brain volumes and less glucose metabolism in the whole brain and the temporal lobe” than seniors who did not. The study was published online in JAMA Neurology.


Change your brain pathways for the better pathways. Be Better.

“The advances in functional MRI and SPECT scans of the brain are leading to better correlations between personality, mood and mental disorders with anatomic sections fo the brain. The SPECT scan shows hypoperfusion and hyperperfusion of areas of the brain. Depression, bipolar disorder and similar dysfunctions are associated with hypoperfusion is brain areas. The Cleveland Clinic advice has more science behind it now than ten years ago. The proof is in the pudding. Try it and you will see that your brain assumptions and reflex reactions change.” Bill Chesnut, MD

To go back to New Health News:

April 26, 2016 Cleveland Clinic Wellness Newsletter

Harness the power of positive thinking…for your health!

Pollyanna gets a bad rap. What if it turns out that her relentless optimism wasn’t naiveté, but wisdom? Considering that negative thinking contributes to chronic stress and a host of health problems, Polly may have known exactly what she was doing. Advances in neuropsychology have shown that returning to the same thought over and over creates a real neural pathway in the brain, just like taking the same path through a field day after day creates a visible trail. Once the “thought pathway” is there, you’re more likely to follow it. Take these three steps to set yourself up for good health by increasing positive thinking and interrupting negative thinking before it gets entrenched. Happy trails!

Get perspective. If you notice that you’re having a negative thought, step outside yourself (figuratively!) and take stock. This probably isn’t the worst day ever, and everyone is not, in fact, out to get you. Your brain is just in a mental rut. Really. It’s that simple.

Sit and be still. A regular meditation practice can help steer you away from negative thought pathways and lead to lasting, beneficial changes in your brain. Sitting quietly, paying attention to your breath, and noticing your thoughts and emotions without judging them (all hallmarks of meditation) will help you to cultivate a more positive frame of mind.

Revel in the good stuff. Reinforce positive pathways by basking in enjoyable experiences, like the scent of fresh lilacs, a laughing fit with your best friend, or the natural high you feel after a bike ride. Keep a “joy journal” or a “gratitude register” to record the high points. And if people start calling you Polly, take it as a compliment!

A morning meal may lead to more exercise.

“The research about breakfast is so good if you eat the right breakfast that it is hard to find good negative articles. Add to breakfast doing several one minute strengthening exercises at the beginning of the day and a better day is guaranteed.” Bill Chesnut, MD
Breakfast bonus! A morning meal may lead to more exercise.

To go back to New Health News:

Cleveland Clinic Wellness newsletter_March 13, 2016
“One thing leads to another” is more than a catchy song from an ’80s band (okay, we’ll give it to you: Pet Shop Boys). It’s a fact of life — and health. And sometimes the connections surprise you. Case in point: a compelling benefit of breakfast. No, your morning meal does not lead to immortality or hundred-dollar bills falling from the sky (sorry!), but research suggests that if you’re trying to be more active, eating breakfast may help. In a randomized, clinical trial studying people with obesity, researchers found that those who ate breakfast were more physically active during the day than those who fasted until lunch. Earlier research found similar benefits in people of normal weight. That’s a big deal, given the marked disadvantages of being sedentary. The study didn’t track what people ate, but that matters, too, of course. (In a nutshell, skip the sweet stuff and stripped carbs, and aim for whole foods, including protein.) You’ll probably notice more spring in your step! The possibilities are endless, and staying active is one of the pillars of good health.


Personal relationships with receiving and giving support are good for your health

“ Personal relationships with receiving and giving support are good for your health. They change your life experiences in great ways you cannot anticipate.” Bill Chesnut, MD

To go back to New Health News:

Cleveland Clinic Wellness Newsletter.      March 12, 2016
Reach out and text someone? When you’re offering support, face-to-face contact can’t be beat.
Whether you view the Days Before Texting as the dark ages or as the good old days probably depends on your age. Teens and twentysomethings are mystified at how people socialized in the analog days (“Mom, did you ‘call and make plans,’ as you put it, before or after being chased by a saber-toothed tiger?”). But people of all ages are sliding along technology’s slippery slope. For instance, a national survey of texting behaviors in adults ages 50 to 64 found that they averaged more than 11 texts a day, but fewer than 9 calls. And overall, U.S. smartphone users are sending and receiving five times as many texts compared with the number of phone calls each day.

There are a lot of benefits to digital communication, from streamlining logistics to staying in touch with children and grandchildren, nieces and nephews, and far-flung friends. When reaching out to a friend in need, though, kick it old school if you can. Face-to-face support is much more effective than digital support, suggests new research. Alas, we are still social animals. You’ll never be able to order up Friend 6.0 from the tech store! Remember that the next time you need someone to lean on. Instead of seeking support via social media or texting, plan to meet a friend at a café for good old-fashioned face-to-face time (and not FaceTime!).

Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.

“ This research is a heads-up for hard working people. If you must, want to or just enjoy working more than 45 hours a week, counteract the risk factor by exercise, good consistent diet habits, stress control, good interpersonal relationships, mindfulness, good sleep habits and a regular lifestyle, not having wild variations in your weeks. This risk applies to most physicians in patient care; it is unavoidable. Their skills and knowledge are so needed, they have a strong reason to work excessively.” Bill Chesnut, MD.

Working long hours may be linked to higher risk of heart disease, study suggests

The New York Times (3/10, Bakalar) “Well” blog reports that research suggests “the more hours you work, the greater your risk for heart disease.” Investigators “found that for each additional hour of work per week over ten years, there was a 1 percent increase in the risk for heart disease.” The findings were published in the Journal of Occupational and Environmental Medicine. _________________Ama 3.10.1

Journal of Occupational & Environmental Medicine: ____March 2016 – Volume 58 – Issue 3 – p 221–226


Dose–Response Relation Between Work Hours and Cardiovascular Disease Risk: Findings From the Panel Study of Income Dynamics                 Conway, Sadie H. PhD; Pompeii, Lisa A. PhD; Roberts, Robert E. PhD; Follis, Jack L. PhD; Gimeno, David PhD

Objectives: The aim of this study was to examine the presence of a dose–response relationship between work hours and incident cardiovascular disease (CVD) in a representative sample of U.S. workers.

Methods: A retrospective cohort study of 1926 individuals from the Panel Study of Income Dynamics (1986 to 2011) employed for at least 10 years. Restricted cubic spline regression was used to estimate the dose–response relationship of work hours with CVD.

Results: A dose–response relationship was observed in which an average workweek of 46 hours or more for at least 10 years was associated with an increased risk of CVD. Compared with working 45 hours per week, working an additional 10 hours per week or more for at least 10 years increased CVD risk by at least 16%.

Conclusion: Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.


Immediate release opioids for pain control are a poorer choice than extended release

“I want to share my understanding of better ways to control pain with opioids. My comment here is not putting the post below in perspective, but a chance to share what I learned controlling acute and chronic pain by prescribing opioid medications. My comments are not research, just experience.

Immediate release (IR) opioids for pain control are the poorer choice when extended release (ER) forms of the same medication exist. The extended release drugs have a lower and slower rise in maximum blood level, do not have a trough of inadequate dose level and do not have frequency and severity of personality impairments seen with immediate-release medications. The lack of personality changes is with ER medications prescribed at drug levels controlling the pain adequately. The same degree of pain control with an IR drug can have personality changes. The personality side effects are especially concerning in co-morbidities such as depression. Ten percent of Americans studied have depression, often don’t get treatment, and are at risk for depressive exacerbations on pain control medication.

 Examples of ER medications that have been approved and used extensively are tramadol, both IR and ER, hydrocodone, both IR and ER, oxycodone IR and ER. The costs of the ER form is higher than IR of the same drug. Buprenorphine, Butrans, is available in an extended release patch that lasts a week.

 There are two factors that have delayed the more common use of ER opioids. First is the first formulations of ER drugs could be altered and injected by drug abusers. The new ER formulations are much harder to inject. They cannot be crushed by common methods using. They don’t dissolve to inject the drug intravenously and similar. The second factor is that the prescriber must create and submit a “prior authorization” form before you can get the ER medication. There are free software that makes obtaining the “prior auth” a matter of only a few keyboard clicks, if your provider uses them. I find using the software for prior authorizations and the software to look up your insurance drug formulary is efficient. It’s more work and time to get the ER form of an opioid than prescribing the IR form of the same drug.“ Bill Chesnut, MD.

To go back to New Health News:

 Leading the News  AMA Morning Rounds 3.23.2016.    FDA to update warning for immediate-release opioids

The Washington Post (3/22, Bernstein) reports in “To Your Health” that the Food and Drug Administration announced that “it will require new warnings about the risk of addiction, abuse, overdose and death for short-acting opioid pain medications.” The boxed warning for immediate-release opioids “also will warn of the danger that chronic use of the drugs by pregnant women can result in…Neonatal Opioid Withdrawal Syndrome” in newborns. The new warnings “will emphasize that immediate-release opioids should be a last resort for severe pain.”

The New York Times (3/22, A13, Tavernise, Subscription Publication) reports that “the new labels also include ‘clearer instructions’ for directions like initial drug dose and dose changes during therapy.”



Postmenopausal bone loss is a major concern for orthopedic surgeons.

“Postmenopausal bone loss is a major concern for orthopedic surgeons. We know that 25% of a woman’s total bone mass before menopause is lost by age 65. There are a high emphasis and research trying to deliver methods to restore that bone loss or stop further loss. Some women have striking amounts of bone loss and pathological fractures. Fractures occurring from a standing height are called a “fragility fractures” whether it is the wrist, kneecap, hip or spine. A fragility fracture is an alarm to begin studies of bone mass and metabolism. The odds are high of another fragility fracture occurring without medical intervention.

 Developing methods to restore bone loss years after menopause is the late side of this problem. The early smart approach in medicine is to prevent the bone loss by methods in peri-menopausal women. Many studies were done relating to the safety of using some form of estrogen early in menopause. There are increased risks starting estrogen five years after menopause. These may be lessened by using Estriol, the weakest form of estrogen and avoiding giving the medication orally. By avoiding the oral administration, you avoid the “first pass” metabolism that affects the hormone.  Using estriol intravaginally has increasing research experience to show it does not cause hyperplasia of the endometrium. The data is increasing that it decreases urinary incontinence by its effect on the urethra and vaginal tissue. There have not been extensive studies of estriol vaginally yet. There is a reason to combine testosterone with the estriol vaginally for muscle strength and the bone strengthening result of getting more physical activity.

 Many practitioners are not aware of the most recent developments in my experience. My bigger concern is that so many people I have seen as patients were not aware they need to research safe hormone replacement early in menopause. I posted 14 articles related to postmenopausal hormone deprivation as a “category of posts” on the homepage.” Bill Chesnut, MD.  

To go back to New Health News:

 Anti-Mullerian Hormone and Prediction of Trans-Menopausal Bone Loss                              The Endocrine Society 1016 meeting _ a presentation.  Friday, April 1, 2016          

Arun S Karlamangla*1, Albert Shieh1, Sherri-Ann M Burnett-Bowie2, Elaine W. Yu2, Gail A Greendale1, Patrick M. Sluss2, Deborah Martin3and Joel S Finkelstein2
1University of California, Los Angeles, CA, 2Massachusetts General Hospital, Boston, MA, 3University of Pittsburgh, Pittsburgh, PA

The menopause transition (MT) in women is a period of bone loss, with the most rapid declines occurring in a 3-year period bracketing the final menstrual period (FMP). This period of rapid bone loss has been called the trans-menopause, and the rate of BMD decline over this period varies substantially between women (1).  Circulating levels of Anti-Mullerian Hormone (AMH) made by ovarian granulosa cells also decline as women progress through the MT (2). We hypothesized that serum levels of AMH in women early in the MT will predict the rate of bone loss over the trans-menopause. We tested this hypothesis using data from The Study of Women’s Health Across the Nation, a 7-site, multi-ethnic study of the MT. At baseline, participants had to be 42 to 52 years old, pre- or early peri-menopausal, have an intact uterus with 1 or 2 ovaries, and not be taking exogenous sex steroid hormones. Enrollment began in 1996 and women were asked to return annually.  At each visit, blood was collected between 8:00 and 10:00 AM after a 12-hour fast, during the early follicular phase (cycle days 2–5) whenever possible, and serum was stored at -80F.  In all women who had a natural (non-surgical) MT and a dateable FMP, serum level of AMH was measured from frozen blood samples using a new high-sensitivity monoclonal ELISA with a detection limit of 2 pg/mL (Pico AMH, Ansh Labs, Webster, TX). BMD [bone mass density] in the lumbar spine and femoral neck was measured annually in 5 of the 7 study sites.  In 474 women who had AMH and BMD measurements between 2 and 4 years before the FMP, had a 2nd BMD measurement 3-4 years later, and had not taken any medications that affect bone prior to the 2nd BMD measurement, we examined the ability of AMH level to predict the annualized rate of BMD decline between the two visits (% decline per year). AMH inter-quartile range was [11,146] pg/mL. Median rate of BMD decline was 1.3% per year in the spine and 1.0% per year in the femoral neck. Adjusted for age, BMI, smoking, race/ethnicity, and study site, in multivariable linear regression, each 75% (or four-fold) decrement in AMH level was associated with 0.15% per year faster decline in spine BMD (p<0.001) and 0.13% per year faster decline in femoral neck BMD (p=0.005).  These associations persisted even after additional adjustment for time from FMP and serum levels of estradiol and FSH. In multivariable logistic regression, adjusted for age, BMI, smoking, race/ethnicity, and study site, each four-fold decrement in AMH level was also associated with 18% increase in the odds of faster-than-median decline in spine BMD (p=0.02) and 17% increase in the odds of faster-than-median decline in femoral neck BMD (p=0.02). These findings suggest that serum levels of AMH in women going through the MT can indeed predict the rate of trans-menopausal bone loss, and help identify the women at risk of most loss.  AMH levels appear to provide information about the rate of bone loss beyond that provided by serum levels of estradiol and FSH.

(1) Greendale GA et al., JBMR 2012; 27: 111-8. (2) Sowers MFR et al., JCEM 2008; 93: 3478-83.


Why Exercise Can Help Make You Happier

“The value of exercise as a treatment has been increasing documented in the last three decades. This information is timely because of the increasing rate of injury by using prescription opioid pain medications. Controlling depression decreases pain.” Bill Chesnut, MD

Why Exercise Can Help Make You Happier   by Mladen Golubic, M.D., Ph. D. Cleveland Clinic Wellness newsletter 2.24.16

Lifestyle factors — like food choices, physical activity and stress — have a profound effect on your mood and strongly influence whether or not you may develop anxiety and depression. Here’s a fact you may not know: Depression is projected to be a leading social and economic burden worldwide by 2020, second only to coronary artery disease! In fact, about 10 percent of the U.S. population suffers from depression at any point in time. Why so much depression? It is suspected that continuously increasing levels of stress are contributing to the rapid rise in depression. Increased stress hormones not only damage nerve cells, but also prevent growth of new ones in parts of the brain responsible for positive mood states. While there are effective treatments for depression, for example psychotherapy and antidepressant medications, only about a third of depression sufferers actually receive these treatments. What can be done for the remaining two-thirds? A lot.

Physical activity has been identified as an effective alternative treatment, either alone or in combination with standard therapies. In fact, the American Psychiatric Association now includes exercise in their treatment recommendations. It’s easy to understand why: Data from randomized clinical trials provide solid evidence about the benefits of both aerobic (walking, running, biking) and resistance (strength) training for those afflicted with depression. The recommended amount? Three to five exercise sessions per week, of 45 to 60 minutes each. Here’s more great news: People with depressive symptoms may experience improvements within four weeks of starting an exercise routine. And if that’s not enough to convince you of the mental health benefits of exercise, consider this: While stress decreases the growth of new nerve cells that can boost your mood, exercise does the opposite. Exercise grows the brain!

While there is no doubt about the effectiveness of exercise in reducing symptoms of depression, it does take real effort to begin and maintain an exercise routine. To be successful, find an exercise that you love to do. Many people enjoy walking, which has several health benefits if you reach 10,000 steps a day. If you begin to lose interest in your routine, change it up. Take a new fitness class, start dancing, begin a yoga practice or take bike rides with friends or family. And if you’re pressed for time, you may want to look into short, high-intensity workouts that do not require any equipment but use only body weight. They can be performed anywhere and can be done in as little as seven minutes a day. But high-intensity workouts are not for everyone, so please discuss this idea with your doctor before attempting it on your own. Even if your exercise frequency, intensity and duration are below the current recommendation, do not despair. Engaging in at least some physical activity may still be beneficial for patients with depression, according to the authors of the report.

If you’re not suffering from depression, you should know that exercise has numerous other health benefits, too. Regular physical activity can lower your blood pressure, improve your cholesterol profile, help control blood sugar, and reduce your risk of heart disease, diabetes and common cancers. And of course, it will help you achieve or maintain a healthy weight. What medication can do all that? Yes, you’re right. None. Such a pill does not exist and probably will not for generations to come. If it is ever created, it won’t be cheap. Exercise is free and readily available. So just do it.



To combat loneliness, sign up for a class and schedule nights out with friends.

“Friends make life better, longer and happier. Having good friendships is a topic priority for good health.” Bill Chesnut, MD

Having a tough time adjusting to an empty nest? To combat loneliness, sign up for a class and schedule nights out with friends.   

by Cleveland Clinic Wellness Editors February 2016.

Sending your kids off to college signals the end of an era. Alongside those feelings of excitement and pride, it’s perfectly normal to also experience a sense of loss and loneliness. Those first few years that they’re gone can be the toughest to adjust to, so be proactive. Make plans to keep yourself busy and entertained. Schedule nights out with friends, sign up for classes, get involved with a community volunteer organization, or join a knitting circle or book club. Also, take brisk daily walks; fresh air and exercise will help buoy your mood.


Why positive emotions may be the next big predictor of health

“Dr. Stellar presented by video her research about the effect of emotions on inflammation  markers in our saliva at TELMED 2015. That video is not publicly available. Do a search for her and you will find other presentations she makes. Worth a look.” Bill Chesnut, MD

 Why positive emotions may be the next big predictor of health

 What if joy or amusement could improve your health—would you smile more today? That’s precisely the question psychology researcher, Jennifer Stellar, PhD, has explored in her work. The University of Toronto postdoctoral fellow recently presented her research at TEDMED 2015. Learn about her evidence-based approach to exploring human emotions and why our feelings may have a greater impact on our well-being than we expect.

Measuring positive emotions and health

To determine whether emotions impact health, Stellar launched two studies in which she measured students’ levels of proinflammatory cytokines, which if chronically elevated for long periods of time, can have harmful health effects contributing to diabetes, cardiovascular disease and depression.

In her research, Steller specifically measured students’ levels of Interluken-6 (IL-6), a common proinflammatory cytokine, based on the emotions they exhibited.

Stellar noted that she and her research staff had an important hypothesis to test. “Our idea was that people who experience more positive emotions will have lower levels of IL-6 circulating in their body,” she said. “Why did we think this? Certain negative emotions have been associated with increases in IL-6, so we thought perhaps positive emotions would have an opposite effect leading to lower levels of this damaging biomarker.”

Stellar had students come to a lab where she measured how many positive emotions they experienced in the previous month, then collected a saliva sample to measure each student’s level of IL-6. “It turns out, our hypothesis was correct. Positive emotions predicted lower levels of proinflammatory cytokines in our student population.”

How Stellar challenged her own research, explored new emotions

This was a great discovery, but Stellar still felt compelled to approach her hypothesis differently. Not only did she want to confirm that human emotions impact IL-6 levels but she also wanted to know which specific emotions were key drivers to higher IL-6 levels, so she launched an additional survey that measured the frequency and intensity in which students experienced a core set of emotions.

The survey measured seven key emotions: amusement, awe, contentment, compassion, pride, love and joy. Stellar found that four specific emotions—joy, pride, contentment and awe—predicted lower levels of IL-6.

Interestingly, awe had the strongest negative relationship to IL-6, even when researchers controlled for the other six positive emotions, personality measures and a third method of measuring emotions.

An awe-inspiring discovery

Awe is such a powerful emotion because it signifies wonder and amazement in the world, and you don’t have to travel abroad or pursue a daring adventure to find it. “In fact, participants report feeling awe about twice a week on average, making it a more common emotion than we might expect,” she said, noting that everyday experiences— glancing up at the stars or watching athletes achieve a seemingly impossible physical feat—can inspire awe.

While researchers don’t entirely know why awe topped the list of emotions as a positive predictor of health, Stellar said she’s certain that her own studies have changed her way of thinking about awe in the world.

“I used to see a walk in nature or a trip to the museum as a luxury I could barely afford in my busy life. Now I see it as essential to my mental and physician health.”

She said her studies also remind her that as a field, psychology is transforming, and her colleagues are shifting how they think about positive emotions. “We now recognize that they’re not simply the absence of negative emotions but that they’re colorful and varied in their own right …. We still have a lot to learn about the emotion of awe, but it’s fascinating to think that in seeking out the beauty, mystery and vastness our world has to offer, we might actually find the key to our physical health.”

Interested in more TEDMED?
AMA members have complimentary virtual access to the stage program for TEDMED 2015, which brings together the global community dedicated to shaping a healthier world.

Thought leaders and change agents will share compelling personal stories as this year’s theme, “Breaking Through,” focuses on shattering the status quo and fostering a shift in our daily mindset to change established routines and habits to shape a healthier nation.


How to beat burnout: 7 signs physicians should know

“I include this article from the AMA News for its insights which apply to many types of work and workers. It may help patients to understand their communications with some providers.” Bill Chesnut, MD.

How to beat burnout: 7 signs physicians should know

AMA News_3/4/2015, 2:36 PM

If constant stress has you feeling exhausted, detached from patients, or cynical, take notice. You may be in danger of burnout, which studies show is more prevalent among physicians than other professionals. But how can you avoid it? Learn the signs of physician burnout and what you can do to stay motivated on the job.

Mark Linzer, MD, Director of the Division of General Internal Medicine at Hennepin County Medical Center in Minneapolis, has studied physician burnout since 1996. He said he understands why many physicians eventually feel exhausted practicing medicine, but this problem is avoidable.

“Burnout doesn’t have to be highly expensive to fix,” Dr. Linzer said. “The problem is that no one is listening. People always want to say that physician wellness and performance measures will cost a lot of money, but preventing burnout can actually save money in the long run on recruiting and training new practice staff.”

If physicians want to keep burnout at bay, Dr. Linzer said there are some serious signs they should never ignore. Here are seven ways to know if your practice is getting the best of you—and when to finally do something about it:

  1. You have a high tolerance to stress.  
    Stress consistently ranks as the number one predictor for burnout among physicians, Dr. Linzer said. “Please don’t ignore the stress, even if you can take it,” he said. Physicians who consistently operate under high stress are at least 15 times more likely to burn out, according to his research.
  2. Your practice is exceptionally chaotic.  
    A quick glance around your practice will let you know if you or your colleagues may cave to stress. “People tend to think it’s the patients that always stress doctors out, but actually, it’s the opposite,” Dr. Linzer said. “Caring for patients keeps doctors motivated. What burns them out is caring for patients in a high-stress environment. Change the environment and you’ll change the overall quality of care.”
  3. You don’t agree with your boss’ values or leadership.  
    This one is particularly tricky to identify but “necessary to prevent burnout,” Dr. Linzer said. Whether at a large hospital or private practice, physicians need to feel as if the people leading them also share their values for medicine and patient care. Otherwise, their motivation can slowly wane.
  4. You’re the emotional buffer.  
    Working with patients requires more than medical expertise. “Often, the doctor acts as an emotional buffer,” Dr. Linzer said. “We will buffer the patient from our own stressful environment until we can’t take it anymore.”
  5. Your job constantly interferes with family events.  
    Spending quality time with loved ones helps physicians perform better. “When they can’t do those things, it’s all they think about during the day and the patient suffers,” Dr. Linzer said, citing work-life interference as one of the most common predictors for burnout among physicians in his studies.
  6. You lack control over your work schedule and free time.  
    When work demands increase, but control over your schedule doesn’t, stress can kick in and spark burnout. That’s why Dr. Linzer often tells practices, “If you standardize, customize”— a medical mantra to suggest that if physicians must work a long standardized set of hours each week, practices should at least customize their schedules to flexibly fit changes or needs in their daily lives.
  7. You don’t take care of yourself. 
    When was the last time you enjoyed a nice bubble bath or morning run? If you continually neglect yourself, you may neglect your patients, too. “As physicians, we want to be altruistic but one of the keys to altruism is self-care,” Dr. Linzer said.


Birth order appears not to influence any of the “big five” personality traits

“This study of 20,000 subjects’ data sets to compare people not only within their families but also with other sibling sets.” Bill Chesnut, MD

 Birth order appears not to influence any of the “big five” personality traits

TIME (10/20, Basu) reports that a study published Oct. 19 in PNAS has found little evidence to back up “oft-repeated stereotypes about birth order and personality.” Researchers arrived at that conclusion after having reviewed “data sets that include 5,240 Americans, 4,489 British people, and 10,457 Germans because they wanted to compare people not only within their families but also with other sibling sets.”

HealthDay (10/20, Thompson) reports that the study concluded that “birth order does not influence any of the ‘big five’ personality traits – extroversion, emotional stability, agreeableness, conscientiousness or openness to experience.”

AMA Wire newsletter_10.20.15

A dazzling way to be a kinder person.

“The power of feeling the “awe” emotion does change a mood. Recently published studies of human interleukin 6 levels show feeling “awe” lowers our level of a harmful inflammatory compound. Do an internet search for “interleukin 6 and stress for significant associations with heart disease, Alzheimer’s Disease, obesity, and mood disturbance, to name a few.

Take mood control and manipulation for better emotional states seriously!” Bill Chesnut, MD.

Some kind of wonderful: Experience awe-inspiring moments to become more benevolent.     Cleveland Clinic Wellness newsletter September 9, 2015.

When was the last time you were dazzled and amazed? If it has been a while, add a trip to the woods, beach, symphony, or art museum to your calendar. You’re not the only one who will benefit; the people around you will too. Besides making you feel relaxed and happy, the awe-inspiring wonders found in nature, music and art make you a kinder person. Feelings of awe tend to make people more generous, helpful and cooperative, according to numerous studies. Exactly how sequoia trees and Picasso make you a kinder person is unknown, but it may be that being surrounded by greatness and beauty — something bigger than yourself — helps you transcend self-centered forces within. Your own awe-inspiring moments don’t have to be at Yosemite or the Cleveland Orchestra. Surround yourself with whatever beauty you can, and change things up: hiking trails, botanical gardens, museums, and the classical music station will all leave you wonderstruck. Get the whole family involved, and let the good vibes roll.

Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age

“This is a pressing report of 5,034 children. The authors address childhood experiences that are associated with mental and behavioral health problems as your adults. Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services.  This deserves wide dissemination.” Bill Chesnut, MD

 Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age

Andre Sourander, MD, PhD1,2; David Gyllenberg, MD, PhD1; Anat Brunstein Klomek, PhD3,4; Lauri Sillanmäki, Stud SocSc1; Anna-Marja Ilola, MD1; Kirsti Kumpulainen, MD, PhD5

JAMA Psychiatry. 2016;73(2):159-165. doi:10.1001/jamapsychiatry.2015.2419.

 Importance. Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear.

Objective.  To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age.

Design, Setting, and Participants.  Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015.

Main Outcomes and Measures.  Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment.

Results.  Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms.

Conclusions and RelevanceExposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.


“Tune out” to stay sharp!

“My experience strongly recommends turning off the screens to be happy and interesting. Ophthalmologists now describe “flat eyeballs” from looking at a screen too many hours a day. Look it up. It’s true.” Bill Chesnut, MD

Tune out to stay sharp! Replace screen time with brain-building activities.

Cleveland Clinic_November 3, 2015
Screen time spawns plenty of hand wringing among parents, but the less-is-more wisdom applies to people well beyond the Sesame Street set. Recent research found that young adults who watched four or more hours of television daily scored lower on cognitive tests in middle age, which can set the stage for conditions such as Alzheimer’s down the road. It may be less of a “this is your brain on screens” effect, and more about what you’re not doing. Whatever your age, staying active — both above the shoulders and below — is critical for brain health. Try crowding out your usual screen time with activities — emphasis on active — that get your neurons firing: a morning walk, a family hike, a good laugh with an old friend, or a dance class with someone you love. And beware of bedtime screen seduction. (It’s never as good as the real thing anyway!) Quality sleep is critical for your brain; it essentially detoxifies your noggin while you snooze!
You may also want to know:

9 ways to boost your brain health 

Get moving for a healthy memory

Stay sharp with 20% off our brain health products 


Surprising Do’s and Don’ts for a Healthier Heart

“I am sharing information from the Cleveland Clinic Wellness Clinic, international experts in good health. You may not agree with everything but it’s a good thing to know, that thing you don’t agree with. I strongly agree with Don’t be a Pessimist.” Bill Chesnut, MD

Surprising Do’s and Don’ts for a Healthier Heart

By Cleveland Clinic Wellness Editors 
Published 10/16/15

You’ve probably heard (most likely from us!) that a healthy diet, regular exercise and a good handle on stress is the best prescription for a healthy heart. But we’ll bet you haven’t heard these tips about heart health. Here, 10 surprising do’s and don’ts for keeping your heart healthy.

Do Get Plastic Smart

Bisphenol-A (BPA), a common plastic additive that has been suspected of contributing to hormonal disruptions and neural development issues in children, has now been linked to heart disease. Recent studies have begun to look at the health effects of BPA in adults — in 2009, researchers at the University of Exeter in the United Kingdom found that adults with high levels of BPA in their urine had a significantly higher risk of developing heart disease and suffering from impaired liver function. Despite these dangers, more than 90 percent of the American population has detectable levels of BPA in their bloodstreams. To minimize your exposure, avoid plastic water bottles, discard any plastic containers that have scratches, and don’t microwave or place hot liquids or food in plastic containers. Because BPA is also found in the lining of cans, consider cooking with dried beans and frozen vegetables instead of their canned counterparts.

Do Get Up From Your Desk

Most of us lead a very sedentary lifestyle. Even if we work out regularly, all this downtime takes a toll on our health. Turns out, people who sit on their duff all day without taking breaks are at greater risk of a slew of health issues than those who get up and walk around regularly. Sitting for prolonged periods of time is linked to larger waistlines, higher blood pressure, lower levels of “good” HDL cholesterol, increased levels of triglycerides, and higher levels of inflammation. And that even goes for gym rats. According to the study’s researchers, 30 to 60 minutes of activity a day can’t undo the effects of sitting for eight to 12 hours at a time. But standing up and walking around periodically throughout the day can help. They recommend standing during phone calls and meetings, walking over to a person’s desk instead of e-mailing them and making frequent visits to the watercooler and bathroom.

Do Avoid Secondhand Smoke

Too polite to ask someone to stop smoking? You won’t be after you learn this: According to a study in Circulation: Journal of the American Heart Association, being exposed to 15 to 30 minutes of secondhand smoke a week increases the risk of stroke by 56 percent and peripheral artery disease by 67 percent over the course of two years. Another study found that one-third of nonsmokers with a high exposure to secondhand smoke had early signs of lung damage, representing very mild forms of emphysema.

Do Drink Beer

You’ve probably heard that drinking red wine in moderation can help reduce the risk of cardiovascular disease. (Moderation is no more than one serving of alcohol per day for women and two for men.) Beer has these same beneficial effects. According to research, the antioxidants in beer significantly improve the capacity for an artery to dilate, which just could have a positive impact on cardiovascular and heart health. Beer, along with tea, coffee and cocoa, provides antioxidants (specifically phenolic compounds) that reduce damaging free radicals in the body. One great benefit? Beer and other spirits can help raise HDL (healthy cholesterol) levels. But beer (much like red wine) can also prevent LDL (lousy cholesterol) levels from becoming even worse.

Do Have More Sex

You can boost your health without even getting out of bed — by having more sex! Studies show frequent sex promotes longer life and fewer heart attacks. Not only does a good roll in the hay reduce stress, studies also show that people who have sex frequently (generally twice a week, although individual studies vary) live longer, have lower blood pressure and are less likely to suffer heart attacks. So grab your main squeeze and get busy tonight.

Do Watch Your Mouth

Several studies have linked gum disease to heart disease. While the connection is not totally understood, preliminary research suggests the more bacteria crowding your mouth, the higher your chances of developing heart disease. The thinking is that because people with gum disease have higher amounts of harmful bacteria in their mouth that adhere to the gingival lining (pockets just inside the gums), the bacteria can get into the bloodstream and cause inflammation in arteries that results in arterial disease. A new study that analyzed the oral hygiene habits of 11,000 people found that people who didn’t brush their teeth regularly had a 70 percent greater risk of heart disease than people who brushed twice a day. And that was after accounting for other risk factors like smoking, obesity and family history. Reduce bacteria’s head count by brushing twice a day, flossing regularly, and using ADA-approved antimicrobial mouthwash with fluoride.

Don’t Be a Pessimist

A study in Circulation: Journal of the American Heart Association found that optimistic women had lower rates of high blood pressure, coronary heart disease, diabetes and death than pessimistic women. Researchers aren’t sure whether a positive outlook motivates us to take better care of ourselves or if it has direct health benefits. Either way, being upbeat has upsides for your health. If you tend to see the glass as half empty, try this: Once a week for a month or more, list three things you’re grateful for and spend time contemplating what makes them possible, suggests Thomas Morledge, MD, of the Center for Integrative Medicine at the Cleveland Clinic. Thankful for your health? Think about what keeps you healthy. Thankful for a strong relationship? Think about how you manage that. Evidence suggests that this simple act to cultivate gratitude can be a powerful antidote for anxiety and depression.

Don’t Overdo Sweets

The added sugars (glucose, sucrose, fructose) in soft drinks, candy, cookies and muffins can cause a low grade of inflammation in your body, which can affect your blood vessels. Research over the past decade has pointed toward inflammation as being the trigger that causes most forms of coronary heart disease. Americans consume an average of 22 teaspoons of added sugar a day; the American Heart Association recommends a maximum of six teaspoons for women and nine for men. Drink club soda instead of a 12-ounce cola and you eliminate eight teaspoons right there. (And a bonus: You get a big sodium savings!)

Don’t Be a Couch Potato

Every hour spent watching TV is associated with an 18 percent increase in death from heart disease! That’s no joke. According to a study in Circulation: Journal of the American Heart Association, the more time you spend in front of the TV, the higher your risk of dying from heart disease. The real shocker? Whether you’re overweight or not doesn’t matter. Sitting for long periods of time can have a negative impact on blood sugar and lipids. Exercise, on the other hand, has an antiaging effect, all the way down to the cellular level. If you can’t seem to part with your favorite shows, find a fitness routine you can do while watching or during commercials.

Don’t Be Mean

Got a mean streak? Time to learn how to play nice. People who are overly aggressive or competitive may be at greater risk of heart attacks or strokes, according to a study in Hypertension: Journal of the American Heart Association. As we age, the lining of our arterial walls starts to thicken, which has correlated with a greater risk of heart disease. The more antagonistic a person is, the thicker their arteries tend to be — even at a young age. If you blow your fuse often, consider a course in anger management. Losing weight, quitting smoking and engaging in regular physical activity can be beneficial and decrease the rate of arterial thickening. Physical exercise is also great for stress reduction.

Prioritize Sleep!

“ This is so important for brain health and personality growth.” Bill Chesnut, MD

Cleveland Clinic Wellness newsletter_September 24, 2015

Total recall: Boost your brainpower by prioritizing sleep.
Get a good night’s sleep before, say, a family reunion and your second cousins’ names will be flowing from your tongue like water from a fountain. Sound slumber, known to protect long-term memory, also makes memories easier to access. On the flip side, poor sleep makes it harder to learn, to make decisions, and even to distinguish between friendly and unfriendly faces. Stay sharp by treating sleep like the health essential it is. Three steps to get started: 

Say hellooo to sunshine. Get out in the morning sun to normalize your circadian rhythm, which makes you alert during the day and sleepy at night (what a concept!). 

Exercise, but not too late. Evening exercise can rev you up just when you want to feel sleepy. But physical activity during the day helps you sleep longer and more deeply. 

Dim your devices at night. Blue wavelength light from electronic devices suppresses melatonin, your brain’s natural sleep-beckoning hormone. Stick with good old-fashioned paper books, or — even better — turn off the lights and practice meditation. 

You may also want to know:

Let Go of the Day to Enjoy Restful Sleep 

How’s your sleep hygiene

Stay sharp with 20% off our brain health products 


Could Chronic Stress Increase Your Risk of Getting Cancer?

“Recent reports show changes in Interleukin in human saliva change with stress levels. Interleukin is bad. See reference below.” Bill Chesnut, MD

 Could Chronic Stress Increase Your Risk of Getting Cancer?   by Mladen Golubic, M.D., Ph. D.   Cleveland Clinic Wellness

Chronic stress has been associated with increased risk of cancer. How could stress impact your risk of getting cancer? Here’s how it works: Stress leads to hyper activation of the sympathetic nervous system – otherwise known as the “fight or flight response” – and the release of stress hormones, such as epinephrine, norepinephrine, cortisol and neuropeptide Y (NPY). In test tube experiments, norepinephrine and epinephrine may contribute to cancer progression by preventing cancer cell death. And in recent studies, NPY was shown to stimulate cell division (needed for cancer growth) and cell motility (needed for cancer spread) of human breast cancer cells. Cancer survivors who practice relaxation techniques like meditation or yoga, show a decrease in stress response, have less anxiety and better mood and quality of life. To what degree these desirable and beneficial effects are related to modulation of stress hormones remains to be examined. Regardless of the mechanisms involved, low-tech but highly beneficial interventions like yoga and meditation can be practiced by any cancer survivor. Needless to say, such practices do not interfere at all with any cancer treatment modality. Having good social support (friends, friends, friends) and being physically active are other ways to diminish the negative effects of chronic stress.

Ann N Y Acad Sci. 2012 Jul;1261:88-96. doi: 10.1111/j.1749-6632.2012.06634.x.

Role of interleukin-6 in stress, sleep, and fatigue..

Rohleder N1Aringer MBoentert M.

Chronic low-grade inflammation, in particular increased concentrations of proinflammatory cytokines such as interleukin (IL)-6 in the circulation, is observed with increasing age, but it is also as a consequence of various medical and psychological conditions, as well as life-style choices. Since molecules such as IL-6 have pleiotropic effects, consequences are wide ranging. This short review summarizes the evidence showing how IL-6 elevations in the context of inflammatory disease affect the organism, with a focus on sleep-related symptoms and fatigue; and conversely, how alterations in sleep duration and quality stimulate increased concentrations of IL-6 in the circulation. Research showing that acute as well as chronic psychological stress also increase concentrations of IL-6 supports the notion of a close link between an organism’s response to physiological and psychological perturbations. The findings summarized here further underscore the particular importance of IL-6 as a messenger molecule that connects peripheral regulatory processes with the CNS. (emphasis mine. BC.)

© 2012 New York Academy of Sciences.



Words spoke aloud change mood.

“Want your happiness to grow? Think as a gardener. Words spoken aloud change mood, proven fact. Try it!” Bill Chesnut, MD. 

Happiness is creatable every day. Words spoke out loud, exercises, appreciation, mindfulness all work with a little practice.

Cleveland Clinic Wellness newsletter_November 15, 2015
Instead of the casino approach to happiness, which relies on Lady Luck — try the gardener’s methods.

Cultivate your soil. Just as plants need nourishing soil to grown in, so too does happiness. Think of your daily habits as your “soil.” Too much work and stress, and not enough sleep and exercise, deplete it. Nourish your soil with nutritious foods, daily exercise, relaxation, quality sleep, and time for friends — a pro-happiness environment.

Plant the right seeds. “Planting seeds of happiness takes intention, but it works,” says Jane Ehrman, Med, Cleveland Clinic behavioral health specialist. When something positive happens — anything from noticing a beautiful sunset to being offered a job you want — bask in the feeling for 20 to 30 seconds. That’s how long it takes to start to rewire your brain — or plant more seeds. “When you’re faced with something difficult, deal with it, but then focus on the positive facts within the situation,” Ehrman says.

Water and sun. Daily meditation and a few morning sun salutations will help your happiness garden thrive. Get plenty of actual sunshine and water, too!


Having social support is critical for good health.

“Having social support is critical for good health. Think of how few healthy people you know who have no social support.” Bill Chesnut, MD

Loneliness: How to Give It the Old Heave-Ho

Set Your Intentions
1. At the start of your day, sit quietly and center yourself with your breath. 
2. Choose the qualities you will live out today. For example: Being open-minded, courageous or friendly, or being a compassionate leader or team player.
3. Privately state your intention for the day. For example: “I bring the best in me to all whom I encounter and to all my efforts.” Now, imagine engaging with others and notice how it feels. 
4. Check in with yourself throughout the day; write a word or two on a sticky note to remind you of your intentions. 

How will you approach the day? Remember that what we think, we become. What we repeatedly say to ourselves becomes a self-fulfilling prophecy.

Cleveland Clinic Wellness newsletter.

Awareness and Compassion are essential daily attitudes for a good life.

“Awareness and compassion are essentials of daily living and for daily enjoying being a healthcare provider.”    Bill Chesnut, MD

Cleveland Clinic Wellness, November 21, 2015
Upgrade your stress relief! Two key qualities can help you nix habits that may add to your anxiety.
Feeling stressed? Time to turn up the A-C. No, we’re not referring to your cooling system — it’s November, after all. We’re talking about Awareness and Compassion.

Awareness: You may be attempting to relieve your stress with habits that do more harm than good. Seeing your automatic habits through a nonjudgmental, just-the-facts-ma’am lens can help you trade them in for effective stress relief. The next time you find yourself heading for the vending machine after a stressful meeting, trading exercise for Netflix, or doing whatever your personal automatic response to stress is, step back and notice. Instead of the quick fix that causes collateral damage, go for a win-win: a walk, some deep breathing, or a heart-to-heart with a close friend.

Compassion: Call it a design flaw, call it the modern world, but we’re very good at exhausting ourselves and not so good at replenishing ourselves. “We shortchange ourselves every day,” says Jennifer Hunter, LISW-S, Cleveland Clinic’s wellness director. A hearty dose of unconditional love — for yourself! — will help you shift the balance. “When you come from a place of compassion, you begin to prioritize how you’re going to keep yourself healthy and centered throughout the day.” And you won’t just feel better — you’ll get more done, too.


What patients really want–and why it’s important for their health

“What patients really want–and why it’s important for their health.” Bill Chesnut, MD.

12/3/2015, 12:00 PM

Getting patients to make healthy lifestyle choices ranks high on every physician’s professional wish list. But realistically accomplishing this goal, especially in a fast-paced health care setting, requires care teams to zero in on what really matters to patients.

Thomas Lee, MD explained at TEDMED 2015 that the best place for physicians to start is building a shared sense of trust and empathy with their patients. Here’s why Dr. Lee says a clear understanding of “patient suffering” can help improve care delivery and unlock the key to successful relationships.

Meeting patient needs in a complex health system
As the chief medical officer for Press Ganey, a health company that consults more than 20,000 health care organizations on strategies to improve patient care, Dr. Lee understands the strenuous juggling act physicians must perform to manage high patient demands, deliver quality care and meet expectations for patient satisfaction in fast-paced health settings.

Increased pressures in practice can lead to missed opportunities for coordinating care, shaky handoffs or forgotten follow up with patients about questions they asked. These missteps attest to “the superficial chaos that’s arrived in health care as a result of advancements in medicine,” Dr. Lee said.

This same chaos often infiltrates daily interactions between physicians, patients and care teams, and erodes patients’ trust in the health care system, Dr. Lee said.

To counter this trend, he urges physicians to instill confidence in their patients by focusing on ways to reduce their suffering. In ideal clinical situations, Dr. Lee said his research has shown that patients often simply want four things: “Good clinicians, communication, teamwork and empathy.”

Empathy helps spur patient action

When exploring new ways to foster patient participation and improve quality care, Dr. Lee urges physicians to shift how they think about patient suffering. This will help physicians build stronger patient relationships, which also can encourage patients to more actively partner with their physicians when making decisions to improve their health.

“There’s avoidable suffering, and there’s unavoidable suffering,” Dr. Lee said. “Unavoidable suffering is driven by the patient’s disease and treatment. It includes the pain, side effects and fear of where the disease is going to go.”

But then, there’s “avoidable suffering, which has nothing to do with the patient’s treatment and everything to do with how we work together,” Dr. Lee said, stressing the importance of coordinating care and reducing patient confusion caused by poor communication.

“We have to put patients in the middle and organize around meeting their needs and reducing suffering. To do that, we need technical excellence and empathy. We have to be great at both,” Dr. Lee said. “You can’t have truly excellent care without empathy.”

Journal of the American Medical Association. January 2016.


Eleven Ways to Strengthen the Relationships That Will Lead You to Success.

“Our personality are from our deeply held values. Our deeply held values often flourish by being good friends.” Bill Chesnut, MD.

11 Ways to Strengthen the Relationships That Will Lead You to Success. Inc. January 26, 2016.

Our leadership may come from within, but its foundation lies in relationships.

The most significant things we achieve are generally done in relationship with others. Here are 11 ways to bring the right significance to the relationships you are working to build or maintain:

  1. Make time.Cultivating deeper, stronger relationships takes time and effort. That means setting time aside to spend with those who are important to you. It means discovering their strengths and gifts and perspectives and accepting their imperfections. Think of relationships as investments that become more valuable over time.
  2. Call people by name.As Dale Carnegie used to say, a person’s name is to that person the sweetest and most important sound in any language. If you want to cultivate deeper, stronger relationships, you must remember people’s names correctly. No matter how bad your memory is, it’s possible to train yourself. And people will assume they’re important to you if you just remember them by name.
  3. Start the conversation.Don’t wait for someone else to speak first, and don’t sit with your face buried in your phone. The best way to learn about others is by striking up a conversation. Ask genuine questions and then focus in and listen on the answers.
  4. Be respectful and empathetic when you have to tell bad news.Keep your communications respectful and appropriate if you have to deliver bad news. Be direct but tactful, and communicate face-to-face in a private setting.
  5. Appreciate the value of diversity.Your leadership and your entire organization will be strengthened if you can open up to and truly accept people with different backgrounds, viewpoints, and beliefs. The more perspectives you have access to, the better your ability to do excellent work–no matter what you do.
  6. Look for and build on other people’s strengths.Everyone has something to contribute–and the better you know the people around you, the better you can leverage their strengths by delegating the right task to the right person. Give people assignments that let them excel and grow.
  7. Share the credit.As the old saying goes, there is no limit to the good you can do if you don’t care who gets the credit. Acknowledge those who assisted and those who collaborated, because the more credit you give away, the more will come back to you. The more you shine the light on others, the brighter everything looks.
  8. Lift others up.Everyone rises when you build a culture where people lift each other up. When you see someone having a tough go of it, be quick to offer words of encouragement and look for ways to help. When someone messes up, don’t put them down (or allow anyone else to) but help them make things right and learn from the experience.
  9. Ban gossip.It’s human nature to talk about others, but as the leader, you need to set the example. There is no value in gossip. Refuse to take part, and make your disapproval clear.
  10. Own your errors.Since everybody makes mistakes from time to time, you can empower those around you by letting them see how you respond when you get it wrong. Set an example by holding yourself accountable, fixing what can be fixed, and moving on.
  11. Build trust.The one ingredient that’s crucial to any relationship is trust. Trust is built on integrity, consistency, confidence, and concern. When people are treated with honesty, kindness, faithfulness, and gentleness–when they are in an environment of trust–they respond in kind. There’s no greater force you can create within an organization than a team with high levels of commitment and trust.

At the end of the day, there is no relationship without communication; no leadership without respect; no team without trust; no venture without value; no business without respect. Make sure you keep what is important up close and personal.

Editor’s note: “The First 90 Days” is a series about how to make 2016 a year of breakout growth for your business. Let us know how you’re making the first 90 days count by joining the conversation on social media with the hashtag #Inc90Days. Published by Inc. 

“Feel the power of the light when skies are gray.”

“Feel the power of the light when skies are gray.”Bill Chesnut, MD

Cleveland Clinic Wellness, January 17, 2016

Shine on! If winter is getting you down, try these surefire mood boosters.
There’s nothing like the sunshine, warmth and ease of summer. But that doesn’t mean winter has to be the opposite. While you can’t wiggle your nose like Samantha on Bewitched to change the season, you can cultivate internal sunshine. Light — lots of it — is the best medicine for the winter blues. Open your blinds, get outside for walks even on cold days, and consider investing in a therapeutic light box. “Light therapy is the most successful intervention I’ve witnessed,” says Cleveland Clinic psychologist Scott Bea, PsyD. Seek out a light that supplies at least 10,000 lux, and plan to bask in it for half an hour every day, ideally in the morning (by 8 a.m.). Then, plan to stick with it all winter, says Bea. Be sure to get regular cardio exercise, too — 35 minutes a day has been shown to ease depression — and plan frequent outings with close friends and family. When you do end up stuck inside, let the music play: Upbeat music — not gloomy tunes — can be veritable mood magic.



“Enjoy yourself” said Guy Lombardo and Doris Day.

“Enjoy yourself, it’s later than you think. Enjoy yourself while you’re still in the pink.” Tip of the hat to Guy Lombardo, 1950.  Bill Chesnut, MD  January 14, 2016
R&R Rx! Be still this winter and enjoy some rest and reflection
In winter, when nature is dormant, you might find yourself naturally drawn to sit by the fireplace and quietly stare at the flames. Go ahead, says Jane P. Ehrman, M.Ed., Behavioral Health Specialist at the Cleveland Clinic Center for Lifestyle Medicine. Use the stillness of the season to allow yourself some rest and reflection. Here, a few ideas for enjoying winter to the fullest:

  1. Put down the remote and the smartphone, and curl up by the fire with a good book. Research shows that reading, whether a suspense-filled thriller, a biography or self-help book, stimulates the imagination, improves mood, expands vocabulary, increases focus and concentration, reduces stress and slows memory loss.
  2. Sit and thoughtfully consider what is going well in your life. Let yourself soak in the positive feelings associated with your blessings. Gratitude elevates mood and energizes us.
  3. Begin a meditation practice. Take just five to ten minutes and sit quietly. For your meditation focus, try one of these:
    • Gaze out a window and observe the positive qualities of nature, whatever the weather.
    • Sit by the fire and experience the glow and dance of the flames, the coziness of the heat, etc.
    • Gently close your eyes and be present to your breath, heartbeat and body resting in a quiet place.

Whatever you choose, you are helping your body and mind take a break from all the analysis, judgment, worry, and planning that tends to distract us from the present moment, says Ehrman. While it may feel as though you are doing nothing, the truth is you are releasing stress and tension from your body. Enjoy the feelings of calm and peace.