“God cannot alter the past, though historians can.” -Samuel Butler

TASK AT HAND: This week I’m thinking about revisionist history. This is a more complex topic than it seems. On the one hand, you cannot go back and revise history to fit your viewpoint. You can have an opinion on historical accounting but factual history must remain honest. Contrasting, our personal history displays more variance and offers us vast opportunity for accountability and ownership.

Let me illustrate the above point with an example. Go back and, sometime in the last five years, identify something you quit. Now, uncover the reasons why you quit that activity, pursuit or hobby.

Would the reasons why you would quit today be the same as they were when it happened?

What has changed?

When you start this self-reflection exercise you see that views change. The reasons for choices in the past evolve over time; sometimes into species that barely resemble their original proforma. Not surprisingly, we change. Consequently, our views evolve.

The goal of this exercise is to become a scientist with our history. Nikola Tesla stated, “The history of science shows that theories are perishable. With every new truth that is revealed we get a better understanding of Nature and our conceptions and views are modified.” We need to develop the skill to revisit strategies from the past and evaluate them under the light of who we are today. To forge new considerations so that we avoid previous pitfalls and can succeed when opportunities present themselves.

How can we apply this for improved decision making and strategy?

Use this exercise of reflecting on previous choices as a means to review your history. This can be of significant utility when you are faced with similar conflicts. Don’t simply apply the same strategy as in the past. Look to the past strategy, revise it with who you are today, and see if it still applies. Usually it does not. Revise your strategy and apply an improved framework.

 

MEDICINE & MACULA: This is a case of idiopathic intermediate uveitis, also known as pars planitis, showing peripheral inflammatory snowbanking.

Intermediate uveitis involves inflammation of the posterior part of the ciliary body and peripheral retina (pars planitis). It consists of mostly vitreous inflammation (“snowballs”) and may associated with inflammatory cells on the pars plana (“snowbanks”). In pure intermediate uveitis, there is usually no retinal findings, although patients may have a mild iritis.

In total, approximately 80-90% of intermediate uveitis cases are idiopathic pars planitis. Other causes include sarcoid, syphilis, inflammatory bowel disease, multiple sclerosis, lyme, tuberculosis, Behcet disease, Whipple disease and lymphoma.

 

GRATIS: “History repeats itself, first as tragedy, second as farce.” -Karl Marx

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“I draw from the absurd three consequences, which are my revolt, my freedom, and my passion.” –Albert Camus

 

TASK AT HAND: This week I’m thinking about consequences; specifically, our personal consequences. The way you live has consequences. For Camus, he emphasized revolt, freedom and passion. For many years I have esteemed this quote as a reminder that struggling with the consequences of our actions is a worthwhile and rewarding duty. The concepts that Camus brings forth – revolt, freedom, and passion – are requisites for review here on today’s Sunday Surgical Scrub.

REVOLT How do you effectively express revolt? In my opinion, there is no better approach than the constant unyielding pursuit of independent thought. The struggle to hold back the convenience of conformity is a revolt we must pursue each day. Don’t let an hour go by where you don’t question dogma and doctrine. We have discussed this multiple of times here on the Sunday Surgical Scrub because this is something YOU NEED TO DO! Whether it’s fake news, peer pressure or groupthink, you need to revolt with independent thought.

FREEDOM From the bastion of independent though comes the freedom for independent action; the latter is not possible without the former. Necessity for autonomy, and the liberty to act independent without discrimination is, unfortunately, another consequence that cannot be forgotten for any lapse of time. Look at the daily news and you will see numerous examples of this consequence.

PASSION Finally, with passion, we surge the courage to pursue our desires. From the inception of independent thought, to the freedom of independent action, the final culmination is the courage to pursue these desires in our daily lives. The courage to pursue our desires – driven by passion – is perhaps the greatest of effects on the consequences we are capable of.

So, the call to action with today’s Sunday Surgical Scrub is to look carefully at our thoughts, actions and desires and ensure they are part of the pursuit of worthwhile consequences.

 

MEDICINE & MACULA: Here is a case of severe recurrent acanthamoeba infection presenting initially as keratitis, followed by sclerokeratitis and histolopathology-confirmed endophthalmitis.

For the first time, we document acanthamoeba involvement in all ocular layers. This severe case demonstrates that despite persistent medical and surgical intervention, eradication of organisms may not be possible.

This is the first case reported with confirmed choroidal involvement (histology shown above) and we have previously published this in a work entitled, Acanthamoeba Endophthalmitis After Recurrent Keratitis And Nodular Scleritis (Zaid Mammo, David RP Almeida, Matthew A Cunningham, Eric K Chin & Vinit B Mahajan), in the journal Retinal Cases and Brief Reports.

You can find the complete study here.

 

GRATIS: “Nobody ever did, or ever will, escape the consequences of his choices.” -Alfred A. Montapert

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“In this world, nothing can be said to be certain, except death and taxes.” -Benjamin Franklin

 

TASK AT HAND: This week I’m thinking about death and taxes. Let me digress for a few sentences. This past week, on Thursday November 2nd, Republican lawmakers unveiled a sweeping revision of the tax code. Don’t worry, we are in no way going to get into the tax bill here on the Sunday Surgical Scrub. However, as I reviewed the proposal, it reminded me about the famous Benjamin Franklin quote above and the search for absolutes.

Today’s Sunday Surgical Scrub is about absolutes and our longing to grasp onto these as a means to reduce the anxiety of life and its transitions. We look for absolutes to reduce the inherent entropy of life. There is an overwhelming desire to find order and sense in the events that shape our days. But – and this should be apparent to anyone one of us who have attempted to exert control over extraneous circumstances that we cannot dictate – this is an anxious futile state. Instead, as we discussed on last week’s Sunday Surgical Scrub (you can find it here)you are not in control! As you master your ability to let go of this need for control, you find the peace it brings.

What does this have to do with death and taxes?

You can use death and taxes as reminders of absolutes. Everyone will die. Everyone has to pay taxes. If you are looking to grab onto absolutes, here are two that should make you relaxed that everything else is transient and you need not worry about it. In fact, you can argue that the paying of taxes is a somewhat negotiable and varied, albeit with consequences. I like this rationalization because it means that there is only one absolute.

Death is guaranteed.

This is not simply for macabre effect. This is actually a wonderful liberation that we should use our talents and energy to effect genuine meaning in our lives and those we come in contact with. The anxiety and worry surrounding most items is not necessary and often hinders our duty in the latter regard.

 

MEDICINE & MACULA: Here is a color fundus photograph of a patient with intraocular inflammation secondary to sarcoidosis. Sarcoidosis is a chronic systemic granulomatous disease from an exaggerated cellular immune response to a variety of self antigens or non-self antigens.

Characteristic funduscopic findings in posterior segment involvement include periphlebitis, sheathing of vessels, perivenous exudates and multiple small round chorioretinal lesions.

 

GRATIS: “The only difference between death and taxes is that death doesn’t get worse every time Congress meets.” -Will Rogers

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“We should always be asking ourselves: Is this something that is, or is not, in my control?”– Epictetus (Enchiridion)

 

TASK AT HAND: This week I’m thinking about the illusion of control. This powerful mirage commonly creates a façade we believe to be actually present. While the desire for control may be real, in actuality, control is an illusion that can impair our judgement and create anguish and anxiety that does not exist.

How can we give up on the illusion of control?

The first step is to realize – you are not in control! You are not in control of the weather. You are not in control of what others think of you. You are not control of any external events. So, as the Stoics accepted long ago, you too must accept this as a means to fulfillment. All you can control is your reaction. Be honest, caring and genuine in the acts you put forth into the world but, beyond that, realize you do not have control.

The second step, which follows logically from the point above is, if you are not in control, then to worry is pointless. That flight delay, the toddler screaming from the next table, the insult from a disgruntled coworker – all inconsequential. By choosing to not worry about it, and to rather embrace that all you can control is your reaction to events, will liberate you from most of life’s torments.

The final step, in the process of letting go of this desire for control, is to come to terms that this process is not an apathetic one. Quite contrary – events may cut deep and personally injury you. This is ok. However, they need not consume you with resentment, fear and regret. The call to action is to be compassionate and honest in what you curate and create; however, beyond this, there is no need for control.

 

MEDICINE & MACULA: Thanks to everyone who regularly emails and contacts this forum with opinions, suggestions and criticisms. In response to recent comments, I will continue with regular postings of interesting patients similar to the images last week of Vogt-Koyanagi-Harada (VKH) disease.

Here is a color fundus photograph of a severely immunocompromised patient with viral retinitis. This shows the condition known as Progressive Outer Retinal Necrosis (PORN) secondary to herpetic virus infection.

 

GRATIS: “I can control my destiny, but not my fate. Destiny means there are opportunities to turn right or left, but fate is a one-way street. I believe we all have the choice as to whether we fulfil our destiny, but our fate is sealed.” -Paulo Coelho

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Body language is a very powerful tool. We had body language before we had speech” -Deborah Bull

TASK AT HAND: This week I’m thinking about the body-words disconnect. The concordance, or lack thereof, between words and actions is a powerful revealer of motive. Congruence between what someone is telling you and how their body relays those messages speaks volumes to the truth, emphasis and purpose of the message. “Reading between the lines” and “it’s not what someone says, it’s how they say it” are popular clichés that remind us of the importance of the connection between words and mannerisms.

“The concordance, or lack thereof, between words and actions is a powerful revealer of motive.”

The first step in understanding the body-words disconnect is carefully listening to what people tell you. The words serve as the message. If you don’t carefully listen to the message, any further interpretation will be lost. You need to be cognizant of what someone is telling you. Next, survey their body language. This requires visual and auditory engagement in the conversation. Visual input (facial expressions, body movement and position) is as crucial to auditory input (words, volume, inflection).

“The first step in understanding the body-words disconnect is carefully listening to what people tell you – the words serve as the message!”

The simplest – and extremely useful – aspect of the body-words disconnect is as follows: listen to the words people tell you and, if the words don’t match their body language, consider an alternative meaning or motive. For example, comments “welcoming” of your opinion expressed with a closed body posture (e.g., arms crossed) would indicate a defensive stance.

“Congruence between what someone is telling you and how their body relays those messages speaks volumes to the truth, emphasis and purpose of the message.”

Another common example involves words evoking positive emotions, like joy or happiness, with incongruous facial expressions like frowning of the brow. A few years ago, Gill and coworkers presented an excellent summary of the strategy of many common facial expressions (D Gill, OB Garrod, RE Jack & PG Schyns, Facial movements strategically camouflage involuntary social signals of face morphology. Psychological Science 2014;25(5):1079-1086. doi:10.1177/0956797614522274). Here are a few key illustrations:

·       High dominance—wrinkling the nose and snarling the lips

·       Low dominance—raising and lowering the brows, showing dimples, stretching the lips, and lowering the chin

·       High trustworthiness—raising the brows, deepening the lines between the nose and mouth, and smiling

·       Low trustworthiness—narrowing the eyes, wrinkling the nose, dilating the nostrils, frowning, and parting the lips

·       High attractiveness—raising and lowering the brows, smiling and pulling the lips back in a slight smile

·       Low attractiveness—tightening the eyelids, wrinkling the nose, and pulling the lips open and back

The purpose of today’s Sunday Surgical Scrub is not make you an expert in decoding body language. Although this is an interesting skill set, it is obviously beyond a single post. However, the call to action is for you to be cognizant of the body-words disconnect and, when these two spheres do not align, look for alternative motives for the communication in question.

 

MEDICINE & MACULA: Here is a fundus color photo of a patient I saw recently with Vogt-Koyanagi-Harada (VKH) disease. VKH is a severe inflammatory condition with a myriad of ocular and systemic effects. The fundus photo shows circumscribed retinal edema with multiple serous retinal detachments.

 

The optical coherence tomograph (OCT) shows serous subretinal inflammatory infiltrates.

 

GRATIS: “Language is a more recent technology. Your body language, your eyes, your energy will come through to your audience before you even start speaking.” -Peter Guber

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Everything that we see is a shadow cast by that which we do not see.” -Martin Luther King, Jr.

 

TASK AT HAND: This week I’m thinking about cooperation and lengthening the shadow of the future. Let me explain what this means.

In game theory, the prisoner’s dilemma – commonly evoked in strategy development – is an example of a scenario where rational individuals would do better if they did not cooperate even though it appears that it is in their best interests to work together.

The prisoner’s dilemma is as follows:

–       Two criminals from the same syndicate are arrested.

–       Each criminal is in solitary confinement with no ability to communicate with the other.

–       Prosecutors do not have enough evidence to convict either criminal on a major charge but hope to charge each with a lesser crime with a punishment of 1 year in jail.

–       At the same time, prosecutors offer each criminal a deal: testify against the other criminal and get off while the other gets convicted on a major charge and faces 2 years in jail. Or, cooperate with the other criminal, stay silent, and get 1 year in jail on the lesser charge.

 

Here are the possible outcomes:

–       If both betray each other, each of them serves 2 years in jail, on a major charge.

–       If both cooperate and remain silent, each serve 1 year in jail, on a lesser charge.

–       If one betrays the other but the other remains silent, one would get off free, and the other would serve 2 years.

 

It would seem, looking at the possible outcomes, that the rational strategy would be for both to remain silent and serve the 1 year in jail on a lesser charge. However, this is not the best strategy. Game theory purports that it is clearly in the best interests of the criminal to betray the other for the possibility of no jail time. Since betrayal always results in a better payoff than cooperation – irrespective of the other person’s choice – it is the dominant theory. Because you cannot assure that the other criminal will stay silent, your only choice is to betray. In fact, in the prisoner’s dilemma, mutual betrayal is the only strong outcome.

Where is the dilemma?

The dilemma occurs because mutual cooperation would provide a better outcome (only 1 year for both on a lesser charge) than mutual betrayal. But, this is not the rational outcome because, if you assume individuals act to maximize their self-interest, the choice to betray is preferred over cooperation.

So, what does this have to do with lengthening the future?

Shadow of the future is another basic game theory concept which states that we behave differently when we expect to interact with others repeatedly over time. At the prospect of having to interact multiple times, our behavior changes since we can now be punished or rewarded for previous choices. Our choices today are shadows on future interactions. If those criminals are loyal to their crime syndicate and expect to interact with that individual again, remaining silent becomes a significantly better strategy, albeit not entirely rational. This is a form of conditional retaliation strategy and favors cooperation.

How can we use this for our decisions, choices and strategies?

There is nothing wrong with working towards optimizing our self-interests; notwithstanding, be careful to not interpret the prisoner’s dilemma as always needing to solely pursue your best interests at one particular point in time. Assess the relationships in your decision and look for opportunities to lengthen the shadow of the future – look to cooperate and maximize value to others and support their interests as future prospects.

 

MEDICINE & MACULA: Many thanks to Clinical Ophthalmology for recently publishing our study, Epiretinal membrane and cystoid macular edema as predictive factors of recurrent proliferative vitreoretinopathy (Kunyong Xu, Eric K Chin, D Wilkin Parke 3rd & David RP Almeida).

You can find our study in the October 2017 issue here.

In it, we describe epiretinal membrane and cystoid macular edema as potential predictive factors for recurrent proliferative vitreoretinopathy. Early recognition and treatment of these conditions may be critical to prevent dreaded recurrent postoperative scarring and improve visual outcomes.

 

GRATIS: “We cast a shadow on something wherever we stand.” -E. M. Forster

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“A mind cannot be independent of culture.” -Lev Vygotsky

TASK AT HAND: This week I’m thinking about the interplay between culture and strategy. What would you prefer – advantages in culture or a superior strategy? This a question that comes up frequently when looking at organizational design and strategic plans. There are two considerations we need to discuss when contemplating this answer.

1. Culture Trumps Strategy. A superior culture has definite advantages over strategy development. Organizational excellence is akin to having a built-in mechanism for effective strategy. To be part of an organization that is grounded in metrics and principles of development is always preferred because there is an inherent advantage to set processes and practices. An example I commonly use is a take a football team. A superior culture is analogous to a strong playbook whereas a superior strategy can be compared to one dominant play. You can use that one play successfully but, in the long run, developing a playbook that is composed of plays for a myriad of situations that may be encountered is best.

2. Strategy Shapes Culture. The main reason why one cannot simply rest on laurels of culture is because, culture alone, is not enough for long-term growth and improvement. There is a necessity to continue to develop strategies for the challenges encountered. It is in these circumstances where well-constructed strategy has the benefits of providing you with an approach to a problem. Moreover, at the same time, this strategy allows you to shape culture. Contrastingly, fragmented strategy that lacks cohesiveness, can harm cultural identity.

When I surmise the idea of culture and strategy, I feel the need to stress the importance of culture over strategy. However, effective strategy is a powerful influence on culture. The final point that should come to light, and one I discuss in my book in several chapters, is that strategy does not exist in a vacuum. Thus, aligning strategy with culture is an excellent path to achieving goals and objectives.

 

MEDICINE & MACULA: Yesterday, Saturday October 7th, Dr Ed Ryan presented one of our recent studies at the 50th Annual Retina Society Meeting at the Fairmont Copley Plaza Hotel in Boston, MA.

Our study, Outcomes of Current Techniques for Repair of Moderately Complex Phakic Rhegmatogenous Retinal Detachment, compares scleral buckle, vitrectomy and combined scleral buckle and vitrectomy surgical techniques in retinal re-attachment rates in phakic patients.

 

GRATIS: Last Sunday, October 1st, I had the once in a lifetime chance to share the court with Mr Karim Abdel Gawad for a squash event hosted by Boast Squash here in MN! Gawad is a professional squash player from Egypt who reached World No. 1 in May 2017.

It was humbling and an honor to share the court with a fierce talent like Gawad. I had a blast and thankful to Gawad for having some fun with us amateurs!

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Life is without meaning. You bring the meaning to it. The meaning of life is whatever you ascribe it to be. Being alive is the meaning.” -Joseph Campbell

TASK AT HAND: This week I’m thinking about the concept of “the meaning of life”. All discussions, thoughts and contemplations are essentially about the meaning of life. At the very core, discourse on any meaningful topic is by virtue an introspective survey of that which holds some meaning in our lives. Consider, “is there one meaning of life” or “is all life about meaning”?

Here is my answer: there are 3 meanings of life that should be pursued and need to be satisfied.

1) Meaningful Health. We need meaningful health. Without meaningful health, the pursuit of all other goals is hindered. There are two key components to this aspect. First, meaningful health is not perfect health. We all know many able body people with excellent physical health who have stalled in life. Contrastingly, we know individuals with serious physical limitations who live energizing and impressive lives. Second, meaningful health requires commitment to psychological and physical facets. Diet, sleep, reflection, exercise, recovery, stretching, etc. are all elements of meaningful health that require attention.

2) Meaningful Work. We require meaningful work. Purpose is the manifestation of meaningful work. We need work constructs that provide benefit to ourselves and others. This is one of the reasons why youth unemployment is a tragic economic problem. Individuals need the ability to purse interesting and valuable skills. Following, there is a real need for economic opportunity and societal activism to ensure we can contribute in a meaningful way to the growth of culture in both local and global senses.

3) Meaningful Relationships. All life is about relationships. Living is about family. Meaningful relationships, perhaps more than any other component discussed here, contribute most significantly to finding meaning in the lives we mold. Meaningful relationships – founded on trust, empathy, and selflessness – provide us with insight and opportunity for growth. Work towards meaningful health, contribute to mankind by means of meaningful work but, most importantly of all, seek out meaningful relationships to enlighten you.

 

MEDICINE & MACULA: Earlier this year we published a photo essay on intraocular foreign bodies in the Canadian Medical Association Journal (CMAJ). Entitled, Five things to know about intraocular foreign bodies (Kunyong Xu MD MHSc & David RP Almeida MD MBA PhD), here is a quick summary:

1. Risk of intraocular foreign body is associated with mechanism of injury.

2. Ophthalmic examination should include dilation of the pupil.

3. Imaging should be conducted promptly to diagnose and localize intraocular foreign bodies.

4. Antibiotics should be prescribed early to prevent endophthalmitis.

5. Patients with an intraocular foreign body require urgent referral to an ophthalmologist.

You can find the study here.

 

GRATIS: “Each man must look to himself to teach him the meaning of life. It is not something discovered: it is something molded.” -Antoine de Saint-Exupery

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Even a happy life cannot be without a measure of darkness, and the word happy would lose its meaning if it were not balanced by sadness. It is far better take things as they come along with patience and equanimity.” Carl Jung

TASK AT HAND: This week I’m thinking about equanimity. Let me preface, without writing another sentence, that the secret anxiolytic elixir of life is equanimity. I don’t usually bestow such praise on any one quality but – in the case of equanimity – it is warranted.

What is equanimity?

Equanimity is not a virtue or emotion but instead a skill. Equanimity is the ability to remain stable and composed when under stress. Equanimity is the skill to exercise calmness in the midst of a storm; the faculty to remain balanced in a state of disequilibrium. Equanimity comes and goes but, as you will see below, is a competence worth cultivating because it is essential for navigating the choppy waters that we are sure to encounter. Without equanimity, there is a propensity to slide into reaction without strategy.

Stability Under Stress. Composure Amidst Concern. How do we go about cultivating equanimity? How do we strengthen ourselves to remain stable under stress? How do we exert control to remain composed amidst anxiety and concern?

The strategy I have found to yield the most benefit towards a state of equanimity is summed up as follows: “analysis without judgment”. Take any situation, especially those that cause you to have unpleasant feelings, and you will see that the negativity arises from the emotions we placate on situations. This is happening because, during our analysis of a situation, we judge. Consequently, when we judge, we attribute qualifiers like “good”, “bad”, “terrible” that ultimately spawn anxiety and fear.

Alternatively, exercise the skill of analysis without judgment as follows:

1. Analyze the situation or conflict.

2. Assess the relative consequences possible.

3. Decipher the relative impact of different strategies to a satisfactory resolution.

No need for anxiety, fear or pain in any part of this process. By taking away judgment, you remain with analytic faculties to work out a solution. You will notice that this allows you to remain composed despite chaos and disaster. There is a wonderful Tori Amos quote that I believe sums up this strategy well and I paraphrase to: “It’s okay when everything is not okay.”

 

MEDICINE & MACULA: Today, Sunday September 24, I have the privilege of walking with my wife Jasmine and my children Max, Leo and Paloma as part of the VitreoRetinal Surgery, PA (VRS) team for the Foundation Fighting Blindness VisionWalk.

Today is the 11th Annual Twin Cities VisionWalk to be held at the Lake Harriet Bandshell in Minneapolis MN. The VisionWalk Mission – Changing Lives One Step at a Time – speaks to the fact that since its inception in the Spring of 2006, VisionWalk has raised over $45 million to fund sight-saving research.

Great time walking with my family and the VRS team for a wonderful cause! Many thanks for everyone who participated!

 

GRATIS: “Never let the future disturb you. You will meet it, if you have to, with the same weapons of reason which today arm you against the present.” Marcus Aurelius (Meditations)

 

My best to you,

David Almeida

david@davidalmeidamd.com

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 “Your first ritual that you do during the day is the highest leveraged ritual, by far, because it has the effect of setting your mind, and setting the context, for the rest of your day.” –Eben Pagan

 

TASK AT HAND: This week I’m thinking about the concept of a morning ritual. The morning ritual is the practice of having some set approach to the commencement of the day. The morning ritual is a strategy that will support a composed and successful mindset for the day. Despite the challenges, surprises and shortcomings that lie ahead, the morning ritual allows for preparation. From innovators to iconoclasts, found in teachers and thinkers alike, almost all individuals of genuine merit prescribe to some sort of morning ritual.

“Despite the challenges, surprises and shortcomings that lie ahead, the morning ritual allows for preparation.”

What is the morning ritual?

The morning ritual can take many forms: meditation, exercise, reading, journaling, nature walks, stretching, thought exercises are just a few examples. The overarching purpose of the morning ritual is to allow you a few moments of honest self-reflection. In reality, it actually doesn’t matter what your morning ritual is or how you do it; the focus is to have one that allows you to connect with yourself in a genuine manner. Over time, you can hone the morning ritual as a barometer of your willingness and preparedness for the uncertainties that await you.

“The overarching purpose of the morning ritual is to allow you a few moments of honest self-reflection.”

Now, it is important to note that this genuine willingness to look at yourself has much less to do with catering to emotional whims but rather, it is about curating strength in your ability to be ready for what lies ahead. The goal is to be poised and prepared for the traps and trickery that suffocate modern life. Bias, rationalizations, lack of self-control can rob you of effectiveness and leave you to act as a reactionary animal. Use your morning ritual for a measure of peace as you align strategy with execution.

“Use your morning ritual for a measure of peace as you align strategy with execution.”

 

MEDICINE & MACULA: Last week, I was a guest on the Cognified Marketing & Selling podcast with Joel Gaslin. If you haven’t heard of this podcast before, it focuses on marketing and selling by blending multiple strategies and techniques. I had a great time discussing some of my decision diagnosis strategies as applied to marketing and selling. No matter what your background is, I think you wil find this episode insightful and intriguing.

You can find the entire interview here via the iTunes link.

For other episodes, transcripts and other information, check out the homepage here.

 

GRATIS: “Every morning we are born again. What we do today is what matters most.” – Buddha

 

My best to you,

David Almeida

david@davidalmeidamd.com

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