Vacating

Dear Patients and Caregivers,

This message is being sent as a notice of my upcoming family vacation:

***I will be away from Saturday February 19, 2022 until Sunday February 27, 2022***

No patient visits will be performed that week, although phones will continue to be monitored regularly during our office hours of Monday thru Wednesday, 8:30am – 3:30pm as our amazing staff, Trish (Clinical Manager) and Lisa (Administrator) will continue working in my absence. THE OFFICE WILL BE FULLY CLOSED THURSDAY 2/24 and FRIDAY 2/25.

PLEASE AVOID USING EMAIL to reach out for medical questions or concerns. You will receive much more timely attention by calling our Office Line at (774) 318-4205 and leaving a voicemail if there is no answer.

Medical coverage will be provided by a respected colleague whose contact information will be posted in our Office Voicemail during that week. For serious matters of urgent priority, it is strongly advisable to be evaluated promptly in an Urgent Care Center or Emergency Department.

Please stay safe and warm!

Sincerely,
Dr M 🙂

Mary A. Medeiros, MD, MPH
Thrive Adult Primary Care
835 W Central St, Ste 4 | Franklin, MA 02038
Phone: 774-318-4205
Email: mary.medeiros@thriveapc.com
Web: http://www.thriveapc.org

The Anatomic Mind-Body Connection

I have often wondered why we talk about a “mind-body connection” as if it were some vague, ethereal, spiritual thing. Last I checked, everyone’s head is attached to their torso. And the wiring is rather specific, too. Allow me to show you.

Exposed! –A Doc’s Perspective

The ‘fun’ has once again begun, and between the barrage of exposures, possible exposures, questionable symptoms, and doubts and fears around vaccination, I am being repeatedly asked for advice. It only seems apropos to make a basic statement perhaps lending insight to the most common situations surrounding COVID-19 these days.

Before you read the following, please allow me to be ABSOLUTELY CLEAR about something: “There is one thing that we know, which is that we know nothing.” All statements I make are based on SOUND REASON in keeping with my medical background, which, beyond medical school, includes 5 years of post-graduate training, and nearly 15 years of independent practice in multiple settings which not only include private practice Primary Care but also tertiary hospitals, community hospitals, urgent care, group practice, home care, and congregate/communal settings (correctional health). But we are learning new information with every passing day– every passing minute, even, thanks to the 24hr news cycle, “citizen reporting”, social media and the like. What we “know” now indeed has the chance to be debunked tomorrow. The notion of “doing research” is losing meaning. There is far more value — although far less reliable calibration — in being WISE.

With all due respect, my physician colleagues and I “read the internet” very differently from how folks without similar background and training do. I am only posting the following because multiple people are asking for *my feedback* on whether or not to get tested, or how and when to get tested now that we are getting through the holidays. For this reason, I am not adding any specific references. Heaven knows the public has decided to seek their own sources, for better or for worse. If you can read this, you can read 1000 other articles or (God forbid) Facebook posts and the like. At the end of the day, you are still going to make your own choice.

Please only continue reading if you plan to respect my opinion. I have no crystal ball predicting who will read this, so I am clearly not here to prove ‘you’ wrong, whoever you might be. Just stating my own case. Thank you kindly in advance for all mutual respect shown.


There are fundamentally two reasons to get tested for COVID as an outpatient:


1. To minimize risk of passing along the infection

Anyone who believes he/she is at risk for being COVID(+) but is capable of strictly quarantining should simply proceed with quarantine if at all possible. Recommended duration of quarantine has varied greatly over the past 2 years, but at this time if someone is fully vaccinated/boosted and remains fully asymptomatic for 5 days after a suspected exposure, quarantine for that individual can be stopped at that point.

For someone whose vaccination status is not in keeping with the CDC/WHO recommendations, it is important to bear in mind that risk of transmissibility and/or severe disease is understood to be elevated. Outcomes in such regards are FAR FROM BLACK-AND-WHITE. But given the evidence we have access to thus far, it is advisable to quarantine more strictly if you are not fully vaccinated/boosted compared with those who are, in the range of 7-10 days.

If a negative swab of respiratory secretions can be obtained NO SOONER than 48hrs after the suspected exposure AND an individual remains asymptomatic, then quarantine can be stopped. It is still advisable to socially distance and stay masked for at least what would have been the duration of recommended quarantine, to help support public health and safety.

If there is an upcoming interpersonal encounter with a high-risk person that cannot be avoided within a 10-14 day time frame following a suspected exposure, a negative test result should be obtained before proceeding with the encounter.

If AT ANY TIME someone develops symptoms potentially suspicious for COVID and is capable of strictly quarantining and is not sick enough to need hospital admission, the advice is to simply proceed with quarantine until 48hrs of having no fever without medications to reduce fever (such as Tylenol or ibuprofen), AS LONG AS symptoms are resolved.

If someone has no fever but continues to have other respiratory symptoms, show courtesy and common sense by keeping your secretions as far away from other people as you can.

Testing requirements for specific situations like travel, access to events, elective medical procedures and so forth are SPECIFIC to the agency or entity. As a Primary Care Physician, I in no way can predict what the specific requirements are, whether in regard to timing of obtaining a test, selecting a type of test (e.g., rapid or PCR or… etc), producing a finalized test result, and so on and so forth. In order to help providing appropriate testing/results for an individual, I NEED TO READ THE POLICY that an individual is trying to adhere to. I am terribly sorry, but a verbal description of what is thought to be required is not enough for me to be helpful.


2. To justify treatment for a COVID infection

Outpatient medical therapy for an active COVID infection, thus far, remains highly difficult to access and involves jumping through multiple specific hoops. At my office, we have tried to assist some patients with obtaining an outpatient monoclonal antibody infusion but have been unsuccessful mostly due to limited supply and appointments. As a result, I am holding off on advising it for my patients until it seems more realistically available.

I feel it is riskier to send mildly/moderately ill patients to a closed infusion suite that contains confirmed COVID cases, not to mention requiring patients to leave their homes multiple times trying to obtain an approved confirmatory test, when compared with staying home and engaging optimal self-care (that is, resting and hydrating like it is your job, and if you are sick with COVID, this IS your job).

In other words, because treatment options for mild/moderate cases are extremely limited, essentially no change in approach would be advised regardless of whether a test is positive or negative. So if someone can quarantine and maintain the right level of supportive care (again: hydration and rest), there is no reason to test. COVID-POSITIVE STATUS SHOULD BE ASSUMED. Remain quarantined until essentially asymptomatic for 48hrs. Stay masked when in the presence of others thereafter. USE. COMMON. SENSE.

The primary indicator to seek hospital-level care would be respiratory distress. Other indicators would be high fevers (>103’F) or listlessness (prolonged deep sleep very difficult to arouse).

If AT ANY TIME someone contracts significant respiratory or infectious symptoms of any nature that seem severe enough to warrant a hospital admission, that person should proceed to the closest hospital Emergency Department without delay. Testing and any appropriate treatment would be rendered there.


Navigating the transition between a Pandemic and a Post-Pandemic World is tough on everyone. Let’s please all try to stay mindful of this.

We all wish the world were a better place. Many of us want to actively contribute to the world becoming a better place. If you have the bandwidth for that, wonderful! What you can offer is authentically needed.

But in sooooooo many cases, the most important contribution someone can make is to simply take care of him/herself without disproportionately draining the limited resources around. Please don’t pour out from an empty cup only to become the next vortex of need.

Stay well, seek wisdom, and be kind.

Part of Me

Still warming up to the vlogging, I sheepishly present my first original song on YouTube with absolutely awful sound quality. But I did it!

Since the audio turned out so poorly, in case you’re curious about lyrics, feel free to click the link below.

Otherwise, I’ll keep tweaking and bring this back around some other time. For now… peace!

Maiden Voyage with Vlogging – What is KNX?

I have been dreaming about doing something like this for a long time.

In fact, after I lost my brother in 2015, I had a host of ideas play out in my head regarding ways to publicly honor his memory. For someone like me, who more or less grew up on a stage, it’s hard for me not to do that. But then… I found myself consumed (again… see previous blog posts for reference) by the same thing that took him.

DEPRESSION. What is it, though, really? Well, on my prior blog posts I’ve endeavored to address it both clinically and personally. But my life’s purpose has been consumed with this at so many levels, that I’ll never be satisfied sharing what I’ve come to understand only through an essentially invisible blog.

I want to… I need to… touch the future in such a way that reduces the prevalence of depression in the generation of my children (known popularly as Gen Z), and perhaps in the generation that precedes them (Millenials). Unfortunately, for most members of my Generation (Gen X) and those who precede me (Boomers), it may already be too late. {=-< But if anyone in those brackets is touched by what I do, I am happy to count it a win.

At any rate, bear with me. I’m brand-spanking-new to this, but if I don’t start then it will never happen, and in my incessant mind, that isn’t an option. What I endeavor to do here is just as much part of my ongoing personal journey as I hope it to become part of yours. Or part of the journey for someone you care about who needs this.

I will be telling stories. Some will be about folks who have given permission or for whom details will be altered to protect their privacy. Some will be personal stories, but they will all be shared in the name of exploring ideas and truths — please don’t walk away with some false idea that you know everything about me based on what I decide to share. My personal business is going to stay personal, make no mistake.

I will delve deeply into theoretical concepts of neuroscience, social biology and even metaphysics without insisting on adherence or belief — these are just MY ideas waiting to be beta-tested and vetted. It wouldn’t surprise me at all to be completely debunked over the course of this explorative process, but for those who have not studied a scientific discipline, here is some news… truth cannot be found without giving air to possibilities that are eventually found erroneous. However, it is essential to remain open to probing and critique with every claim that is proposed, rather than stating unproven theories as if they are facts. I hope to contribute to this philosophical approach, which is desperately lacking in society today.

I will share music and poetry not because I expect acclaim, but because in my soul it begs to be shared, whether you like it or not (LOL)! And because the essence of depression and its variants simply can NOT be encompassed exclusively in scientific data-mining. In fact, the clearest descriptions of psychiatric illness are inarguably depicted in art.

In short, after churning and churning for years, I am reaching out to see what KNX.

If it works for you, I look forward to you joining me. If it doesn’t work for you, please feel more than welcome to just move on and find your own path. I won’t step on yours if you don’t step on mine, deal?

Depression is more than just a state of mind – Part III: Success is not a destination

(Originally posted August 28, 2018; reposted with edits)

As a brief prequel to this post, I feel compelled to clarify that the purpose of the previous one was not to draw sympathy to my situation but to create a picture of depression that is both real and precise.  We all go through stuff.  What I have learned from my “stuff” is that we probably all have more in common than we realize, and I am hoping to pass along a similar realization.

Please also allow me to clarify that while relaying the story of my own journey, I disclaim any implication that your journey is supposed to follow the same path. Not at all. Instead, I have again included subtitles to paint a bigger picture relative to what I see as a legitimately clinical (albeit, nonmedical) “treatment plan” to a legitimately clinical problem (as indicated by subtitles in the previous post).

My objective here is to illustrate that anyone’s individual path towards redemption, while remaining unique, also contains certain critical elements, towards a whole/sound/healthy/insert-wellbeing-related-term-here life, that are FUNDAMENTALLY HUMAN.

Sure, people live without such elements, but I propose that without them, a life is closer to mere existence. And I propose that existing without living is tantamount to seeing one’s own life as not worth living. Which can progress to a desire to stop existing. And this is a state of mind to which we as a society have illustriously applied the term: “Depression.”

I propose that fullness of life … that is, THRIVING … necessitates all of the following subtitles.

My story is here merely an illustration, not a map or an example or a pattern to be followed. The best way to come away from this story is to develop determination, in some form or fashion, to seek whatever path feels like the “rightest” fit for you to discover and fulfill VALUE.

At the end of this, I hope you will be inspired to find that fit for yourself. Then find it again. And again. Because as long as there is breath in your body, the journey keeps rollin’ on. And on. And on.

For now, let’s just get on with the story.

* * * * *

Physical exertion

My husband Keith started going to CrossFit® around 2009 when our first son was an infant, and my scorn for it was thinly veiled.  Not only did he frequently come home from workouts vomiting, but the lingo of “WOD”s and “AMRAP”s annoyed me.  Meanwhile my job at the time was to admit patients to the hospital where “CrossFit Rhabdo” became a well-known entity.  This is a situation where otherwise healthy individuals had pushed themselves too hard at the gym, resulting in uncontrolled breakdown of muscle tissue called rhabdomyolysis, flooding the bloodstream with proteins which can potentially clog the kidneys in critical fashion if left alone.  As such, they require admission to the medical service for IV fluids and close monitoring.  Thankfully, this never happened to Keith, but amidst all this I swore off the program for myself.

We moved in 2013, Keith found a new gym, and I continued to scoff.  But he wasn’t vomiting anymore.  In fact, many things were drastically different.  It was hard to pinpoint, other than that he typically came home from workouts… happy.  Fulfilled.  And …inspired?  He was bursting at the seams to share what seemed to be a regular ration of new skills with ridiculous names: “clean”, “jerk”, “snatch”.  The new place was clearly more systematic than where he had gone previously, but the benefit was greater than mere organization.

I figured I could quiet his insistence for me to try it by doing the introductory classes.  I had found a Groupon anyway, so what the heck?  After the intro classes I felt I had done my duty and had no intention of going back.  This was right around the beginning of September 2015.

One month later, broken and swimming in a sea of emotion after the loss of my brother, I decided to throw some weight around and showed up for my first “WOD” (Workout Of the Day).  Exerting myself like that was a first, and I was quite sure my whole body would explode before the workout was over.  But I survived!  And I will never forget the sense of release afterwards, like nothing I have ever experienced before.

To this day, Keith and I both know the surest antidote to bad moods – for both of us – is a strenuous workout.  It certainly isn’t as easy as popping a pill might be.  But it eff-ing works, and the only side effect (as long as it is approached with wise supervision, especially when new to it) is becoming physically stronger.  There are worse things.

Real food

There was far more than one instance, though I couldn’t tell you quite how many, when I twisted my face in confusion as Keith would talk to me about “real food” as opposed to “processed food.”  I honestly was mystified.  My deeply seated impression was that if you eat something and it doesn’t immediately kill you or at least make you sick, it was food and that was that.

You see, having completed nearly all my higher education in institutions of the Seventh-Day Adventist Church with its embedded Health Message consisting largely of vegetarianism also eliminating alcohol and coffee (I’d say “caffeine,” although I’m pretty sure there was Coke or Pepsi in the soda fountains), I was well acquainted with a variety of meat substitutes which I took as healthy simply because they contained no animal products, although it clearly takes pretty advanced processing to get vegetable proteins to resemble meat in any way.  I had a friend from medical school wildly entertain my husband by declaring my nutrition during that phase of life consisted of “veggie meat out of a can.”

Having long lived according to a mantra of “eat to live, not live to eat,” I considered food a necessary evil to be overcome day-to-day, which might occasionally provide enjoyment in the form of chocolate or cookies.  Since most “foods” didn’t immediately render death or severe illness to myself or my kids, I easily took for granted that dino nuggets, 3-minute mac-n-cheese and yogurt squeeze tubes were adequate staples.  Our erratic work and life schedules lent to mealtimes that were all over the place, too, so we rarely ate dinner together, and we rarely ate the same thing for dinner.

To my dismay, Keith began to insist that we sit together for dinner and teach the kids to eat the same thing as us… which was to include a simply prepared meat with some vegetables on the side (along the lines of a “paleo” diet).  Period.

I did not take kindly to this at all.

It seemed like a hopeless venture to adjust the eating habits of a toddler and a fussy kindergartner but little by little, we discovered small victories here and there – lettuce with blue cheese dressing for one, carrot sticks for the other, etc. – and worked these into every meal.  We taught them to try new things.  I never really minded eating anything in particular; I was just a nervous wreck in the kitchen.  That came with time and effort, too.  My chopping skills have come a long way, and I even know how to “toss” in a pan while sauteeing… it’s all in the wrist!

The greatest shift occurred, though, in early 2016 when I agreed to partner with my husband in a 6-week “clean” diet challenge through our CrossFit gym that also encouraged hydration, exercise and mobility.  I detailed this experience rather extensively at the time in another series within this blog called “Confessions of a Carbaholic” so I’ll keep my message simple here.  I started out angry and starving, but week #3 of diligence yielded a shocking payoff.  I can best summarize it as wellness like I never knew existed.  I felt energetic, clear-headed, optimistic.  Even the quality of my sleep improved.  It was a whole different version of being “healthy” that I think most Americans haven’t ever had the benefit of experiencing because of the toxins that we treat as basic rations even before birth (that is, relative to mom’s diet during pregnancy — which, as a mom myself, I now realize all too well).

Bottom line: changing dietary habits does not happen overnight, and every single snack and meal is a new opportunity to make a choice for better or for worse.

Also, there is no such thing as a “perfect” diet.  Food still accomplishes various objectives in the human body.  Achieving a balance between physical nutrition and emotional enjoyment through eating is a lifelong endeavor.  There will be ups and downs.  Try to embrace the journey and learn about what you put in your body.  It REALLY MATTERS.

Mindfulness/Meditation

I have come to realize, when it comes to grief, that the first anniversary is the hardest.  It may or may not get easier after that, but whatever coping mechanisms a survivor of a lost loved one may have constructed over the course of a year all come crashing down when the air feels familiar, certain holidays resurface, and myriad other reminders arise that someone who had once been there is definitively gone.

September 2016 came and went.  I suppose I expected things would get easier after that, especially since there was mercifully little ongoing onslaught of new drama.  My family was well, work was miserable but this was no change (haha), and my own physical health was in a better place than ever in the past because I was eating, hydrating, and exercising with some distinct regularity.  But I felt awful, deep in a hole and couldn’t drag myself out.

Off I went to my therapist, who I hadn’t seen in close to a year (of course there had been a bolus of visits after Abe’s suicide the year before).  My big question was, “What is wrong with me?”  Overall, I wanted for nothing in life: healthy kids, caring husband, good household income.  What more did I want or expect?

She pondered my conundrum, and told me simply: “You need mindfulness.”

I almost fell off the couch.  Good ol’ Hubby had been talking to me about mindfulness meditation for the better part of TWO YEARS by that point.  I had repeatedly responded to him with “I’m already mindful!” and would promptly return to my flitting activity of motherhood and doctorhood.  Again, I had been annoyed with the soothing monotones of guided meditation voices, somewhat resentful over being left to handle all manner of household and parenting duties while Keith laid in respite, listening and breathing.  He offered to switch places multiple times over, but I just couldn’t be bothered.

Albeit irritated about taking a stance of “you were right” relative to my husband, I was fascinated that this was being offered by my deeply trusted therapist as real advice, rather than mere spousal harassment.  I asked for a distinct recommendation for something structured, an “app” I could use.  She told me there were many but upon my insistence she mentioned “Headspace.

Much like cleaning up my diet, the first two weeks of sifting through my mind were awful, abject torture.  I loyally popped in earbuds and spent 10 minutes a day sitting upright but relaxed, eyes closed, and soon became ragingly aware of the chaos inside.  I discovered the content of my thoughts was almost exclusively self-deprecating.  For example, while driving down the road to my house one day, I attempted mindful awareness of my surroundings, cast my gaze upon a neighbor’s front lawn, and caught myself thinking, “My lawn looks terrible compared to theirs.  I never make time to take care of my home and property, because I’m a terrible homeowner, not to mention a terrible wife and a terrible mother…”  This was a typical reaction for me.  I had just never paid attention to it before.  Every single thing I looked upon seemed to be a reason to berate myself.  I could never keep up at work, and my overflowing inboxes reminded me of this.  I could never keep up at home, and the clutter from corner-to-corner in the house constantly reminded me of this.

Not that more details are needed, but I also discuss my journey with mindfulness in a previous blog post.  Suffice it to say, success in this endeavor also came only with time and persistence.  The most poignant lesson I have personally drawn from mindfulness is self-compassion – learning to observe without judgment.  Evaluation and decision-making have their place, but the ability to calmly take note of something without creating internal stories about it is a skill that in and of itself is impactful and universal.  Entire books – libraries by now – have been written about it, so I don’t pretend to be able to explain all the benefits in this single blog post.  It’s simply life-changing, I’ll leave it at that.

Tribe

I’m a bit of a lone wolf; I got used to this early on, being raised to believe my religion “set me apart from the world.”  Being different and separate was a badge of honor, of sorts.  Also, pride was a big deal in my Asian family — we were to be beholden to no one.  Leaning on others is just not my style.

Turns out the human organism is not meant to subsist independently.  We joke about whether someone “was never held as a child” but legitimate development of certain fundamental neural channels depends on interactive contact with others.  Rugged independence is often regarded as strength, but the strength required to conquer the toughest obstacles can only be generated through interdependence.

I would say the first time this hit home to me was with my CrossFit experience, at the ripe old age of 38.  From my very first Intro Class, through Foundations training and my first few real “WODs”, I remained flabbergasted at the steady stream of warm, fuzzy remarks from people I barely knew, who were eons more physically fit than I: “Great job!”, “Way to go!”, “You got this!”  It felt essentially impossible to not keep going.  Everyone else was finishing the grueling workout… including people who appeared less physically fit than I.  So clearly I should, too.  It was an oddly refreshing, new form of peer pressure.

Go figure, this is a phenomenon I’ve blogged about before as well.  But I have grown in so many more ways than what is alluded to in prior posts, on account of actually becoming a part of the tribe, as opposed to just being present in the setting.  There is a reason people thrive in religious communities, where going to church or temple or coming together for worship in one forum or the next is so successful at yielding happy people.  At the risk of sounding blasphemous, although I find it a widely proven truth: this is far less a product of the dogma, or beliefs, than of the community that happens to revolve around a common set of beliefs.

At CrossFit, we congregate around fitness.  The fitness is great.  But to me, the true primary benefit is that we congregate.  This has been by far and away the most efficacious antidepressant I have come across.  I would go so far as to say interactions in the form of friendship, community and romantic love are what flood the brain with serotonin: manifesting as happiness that feels substantial, lasting.  But my natural inclination is still to gravitate away from it and be a stubborn individual.  Old habits die hard.

It is not just about being ‘around people’, by the way.  I personally find there is no worse emotion in the world than being in a crowd of people but feeling entirely alone.  It is about connecting with people who are likeminded to you.  That is the essence of having a tribe, or community.  This is what has set CrossFit apart from other “workout classes” where you can walk in and walk out without anyone noticing, which is easier up front but far less healing and also far easier to quit.

A tribe that suits you is rarely easy to find, often follows lots of trial and error, then entails overcoming a long, steep hurdle of integration that typically takes – again – weeks to months of persistence through initial discomfort (notice a common theme here?).  Most of the time, successful community experiences are thrust upon us through motivators that have nothing to do with “seeking a community” – e.g., growing up in a church, joining the military, sports teams, college majors or other intensive training experiences.  In these scenarios, people come together for a common objective, and the togetherness happens by necessity then provides them with more meaning than ever sought or imagined.  Worth writing books and movies about.  Over and over, again and again.  This is the essence of being human.

There is something powerful about being part of something bigger than oneself.  Sharing experiences with others – and sharing in others’ experiences through conversation, storytelling, reading, teaching and learning – is truly expansive for an individual.  When we feel closed in, shut out, locked down, trapped… what we need is each other.  It can sound very cliché, but that’s only because it’s that important, that repeatable, that life-essential.

Actually, I think the best way to summarize the fundamental human attribute here is: What we need is to belong.

Personal Achievement

Much like Maslow’s Hierarchy of Needs, being able to fully realize one’s own potential is more of a pinnacle attainment as opposed to fulfillment of a day-to-day need.  However, there is something to be said about a sense of accomplishment even in little things, that provides us with shots of dopamine: manifesting as thrills that feel great but are fleeting.

I love this about CrossFit.  Every single impossible-seeming movement done by the beastly, superhuman-appearing competitive athletes has a countless array of corresponding “scaled” movements that engage similar muscle groups but can be completed by “the rest of us.”  Can’t climb a rope?  Lie on the ground and pull yourself up by the rope for a few grabs then lower yourself back down.  Can’t do a handstand push-up?  Do a regular push-up with your knees on the ground, or lift small dumbbells overhead.  Can’t lift 225lb overhead?  Start with a PVC pipe.  Embarrassed because you can’t do what the competitors do?  Let it go and revel in the fact that you are there doing it.  My CrossFit mantra is: “I show up, I win.”

You don’t ever walk away from a CrossFit class without having done your body a huge favor.  Ever.  Unless you overdo it or do it unskillfully.  Good coaches will prevent that.  And there are LOTS of great gyms with amazing coaches, not to mention dozens of people who have bought into the culture of cheering you on even if they’ve never met you before.

Regardless of your level, you grow every single time you are there.  It’s built into the programming.  All you have to do is keep showing up.  I wish life were so well plotted out.

But in life, showing up takes on a different form.  No matter the task, there are scaled versions of it, too.  The key is to proceed without wasting time and energy on critique of self or others.  Judgment that isn’t constructive is the best way to create a setback, and is the essence of depression – it’s a relentless feedback loop on a theme that carries you nowhere, like getting stuck in a hamster wheel.  If something didn’t go well, let it go and take a slightly different path.  But keep showing up.

The following is quoted from the end of the televised 2018 CrossFit Games® in celebration of the athletes who competed:

“To be worthy representatives of us all, they must know defeat and humble themselves to its teachings.

“Continuously, they test and test and test again, for in the testing lies the answer to the question: ‘How will you be better tomorrow?’

“Only those who repeatedly ask and accept the answer, who continue to recognize missteps as opportunity will realize their true potential.  Fear and ego will stop many as they mistake failure for weakness.  It is through their efforts that we come to understand how our own limitations will be tried, that we come to understand what’s possible, that we come to understand what we can choose to be:

“Better.”

That’s all it is.  Just be better today than yesterday.  Or if today is really bad, make the better decision to let it go so you can get back on your way more quickly than you would while ruminating on the perceived failure.

And because there is always a way to be better, there is no goal, no final destination: only new platforms for the next leg of the trip.  Just stick to the journey.  Wherever you find yourself, count it a win because you are there.