Humour In Hospital

Humour In Hospital 1 – Mary Johnson.

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Hospitals are boring. 

When you’re in there for months at a time, unable to see your friends, go to school or uni or work or even, at times, move for a while, it becomes agonising. 

There are ways to occupy yourself, sure. But you can’t FaceBook or YouTube all day, not for a few weeks in a row in any case. You can’t read forever. You may not always physically be able to do assignments or answer calls for work. Being stuck in a room or building for a long time is never easy. 

It’s what our prison system is based on. 

But there are moments which stand out from the blur of hospital staff, time-pass and treatment. Moments which keep it all interesting. 

And they’re almost always funny. 

Humour is really important for a lot of patients. It not only gets them away from boredom, but also cheers them up when life seems rough, especially kids. It can be powerful in doing those things. And the great thing is, it can come from literally anywhere – doctors, nurses, random occurrences in the hospital, or the patient can create it for themselves.

This series will be about some of the funniest, most memorable things that have happened to me while in hospital. 

Here’s the first one.

It started off an ordinary night. I was recovering from a dose of chemotherapy. Not many people know this, but most chemos don’t hurt or have too many immediate side effects as they’re injected into the veins. When it really begins to take effect, the week or so after that, is when it gets hard.

One the common side-effects, one I was experiencing, about 2 weeks after the chemotherapies had been infused was low blood counts. For me that night, platelets were especially low, so I was getting a bag transfused at around 6pm.

My nurse for that shift came and began making sure it was actually me the platelets were for, engaging in idle banter with my mother and I as she did so. They always check with another nurse as well to make sure that there wouldn’t be a mix-up. Once she was done, she put the bag up and let it run as usual. 

“Wait a second, you’re Mary Johnson right?” she exclaimed as she was about to leave the room. We all laughed as she walked out, attending to another patient. She was one of the funnier nurses in the ward.

I’d had at least a hundred of these transfusions before (I’m not even exaggerating), so it was all pretty much routine for me. But 15 minutes in, my lips began feeling… heavy. It seemed like they were growing bigger, minute by minute. Soon I couldn’t even close them. 

I pressed the panic button. Something was up. 

Nurses came rushing in, and soon enough, doctors were surrounding my bed. I was in anaphylactic shock – I’d had a severe reaction to the platelets. My face had swollen to twice it’s normal size, I was itchy, everywhere, and my throat was beginning to swell, slowly constricting my air ways. 

I was lucky though. The nurses were fabulous at keeping me calm in such a scary situation, and the doctors were doing their job well too. Within an hour and a few shots of hydrocortisone, anti-histamines and a hit of adrenaline, I pulled out of it fine. A few days later, I was perfectly fine. 

It wasn’t the nurse’s fault. I’d had a reaction to the preservatives in the platelets, or the antibodies in them or something else in the bag. It’s not like they weren’t matched to me. It was only fate which made her joke seem tasteless. She stayed back almost 2 hours past her shift, helping in my recovery and keeping an eye on me after it had all settled down, visibly trembling with worry. 

The next morning, when both dad and mum were in the room with me, she peeped through the door during her shift to check up on me, even though I wasn’t her patient at the time. Even though we knew it wasn’t her fault, and though she knew that we didn’t blame her, she was pale with guilt. 

“Morning, Mary Johnson,” said Dad before bursting into maniacal laughter.

The horrified look on her face, the laughter of my parents and the reluctant chuckle she broke into after a few moments will stay with me forever. 

From that moment onwards, I knew that whenever I saw her, or whenever I’d be getting another bag of platelets – even whenever I’d be administering them, I’d think back to that night. 

But I wouldn’t be thinking about the excruciating pain of adrenalin as it forced blood too rapidly through the tiny vessels in my head, or the insatiable itching all over my body or the drowning feeling as my airways were constricted by the swelling of its own tissues. 

I’d instead be thinking about the newly dubbed Mary Johnson. I’d remember the shock on her face. I’d remember my father’s laughter and my mother’s chiding look as he howled on for nearly a minute. I’d remember the looks of glee on the faces of the other nurses as we told them about her new nickname for work. 

And I’m glad that I can see it that way. 

All it took was 1 little joke.

https://www.facebook.com/musingsofamedstudentpatient <– If you or a loved one needs help or if you enjoy my blogs or if you’re interested in medicine, like this page on facebook =]

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For $20, we won’t name anything after your ex for Valentines, because you’re not a dick and we support that.

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And also because it leaves you the option to keep hittin dat 😉

Valentine’s is a hard day for some. Not only are beta males like us forced to watch on, desolately, as billions share their perfect love lives on social media, we’re also subjected to this shit.

It’s seems like every zoo, and every viral news site in the world have come together to form the ultimate clickholes of clickholes this year around. I was mildly annoyed by this, so, as is my God Given Right as a MILLENIAL – I put in hours (10 minutes) of work to stop this shit. Sign the Change.org to stop this shameless attempt to generate website hits, and be sure to click this link to watch each of these photos in slideshow mode to artificially inflate the views this page gets before this leaves your news cycle.

 

 

If you hate shameless self promotion and clickbait, be sure to check out my upcoming free e-book on how what I did to beat cancer can be used to help you with anything in life, guaranteed (and by guaranteed, I mean it may work – but I’m committed to testing the psychological, neurobiological, learning and motivation science behind this with my app – which powers and automates medical research – Centered Around You.)

If you actually wanna make a difference, donate a mosquito net, one of the most cost effective way to save lives and billions in lost revenue according to GiveWell – which I’m sure you can name after that bloodsucking #$*!# ex of yours too.

 

It was funny the first 100 times… Ok… I’ll be honest… It’s still quite funny. I’m just doing this for teh views lel.

Shameless promo: Follow me on Facebook – or on insta/twitter @nikhilautar . If you wanna help make my startup a success – www.GoFundMe.com/gettosleepeasy

Sign up to my email list.

Follow the journey of my lifesaving startup:

 

If you’re bored watch some of the stupid stuff I get up in hospital/when I’m less sick than usual.

 

Read more about me here!

 

 

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#LockEmUp. #MakeAlternativesGreatAgain. Why Is It OK for People to Fraudulently Spread BS on Health Online?

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For those who don’t know me… My name is Nikhil. I’m a medical researcher, medical student, and ex cancer patient.

I’ve been on both sides of the medical bed in my role as a patient, future doctor, and have also been in the background too – working on, and advocating for medical research. Again, in both my capacities as a professional AND a ‘consumer’ – aka – a patient.

I’ve looked up the literature, evaluated trials and fought to get the medicine which has probably kept me here (azacitidine, which was in early phase trials for my condition, when I’d relapsed, and needed it most). I’ve also been on numerous alternative therapies, from low sugar diets and alkaline water, to tumeric, Chinese herbs, and even medical marijuana. Both for cancer, and the resultant chronic, and potentially fatal illness my treatment has left me with (graft versus host disease).

I know what it’s like to be desperate. I know how crappy doctors can be when considering you as a COMPLETE patient, and person – and why and how complimentary medicine DOES make a difference. Indeed – a massage therapist, and dietician have changed my life. I’m seeing a naturopath soon too.

But I also know the importance of medical science. I also know numerous friends who’ve been turned away from options which gave them a chance, and ended up dying. And in this post, you’ll read a story of HOW I MYSELF WAS ALMOST CONNED into trying Sodium Bicarbonate instead of real medicine when I’d relapsed, and given a 10% chance of surviving, and why we need to PROSECUTE PEOPLE WHO SPREAD MISINFORMATION FOR PROFIT – OR WITHOUT DISCLAIMERS (Click here to lend your voice to the the Change.Org campaign now)

Alternative medicine can be amazing. Many, if not most medical therapies DID come from nature, and knowledge of traditional medicine. And I’d say the majority of naturopaths, massage therapists and yoga teachers only encourage you to be more healthy, mindful individuals.

But especially today, where memes on the internet are unquestioned truth, whilst scientific articles and doctors are doubted (and routinely made to be subjects of conspiracy theories), alternative medicine can be dangerous. The following examples may shock you. But it happens all the time. And it’s literally killing people. Cancer patients who use alternative medicine as opposed to proven therapies have up to a 5.7x higher chance of death!

A video from my series – Medical Factz – that outlines the ridiculous “Cancer is a Fungus, and sodium bicarbonate is the cure” theory that started from fraud, and ended in jailtime for manslaughter, and millions of others being deceived. 

 

Recently, Facebook took action after a natural birth Facebook Group urged an endangered patient to not seek medical treatment at a hospital. The baby passed away.

Right: Another pernicious danger seen often in Facebook groups… Toby is a juice advocate who sells juicing guides and products. He has no clue what cystic fibrosis is. Yet he is still trying to scam them to make a few Dollars. It’s sickening. Vertex is a pharmaceutical company who’s creating treatment for CF, by the way.

Left: One of the biggest proponents of unproven lies about health has to be the antivaccination movement. Find out how one man fraudulently wrote one paper (composed of made up patients and made up results) which caused this movement to go, pardon the pun, viral (he now speaks at conferences for tens, to hundreds of thousands).

This is just the tip of the iceberg. From treating children who contract various illnesses with essential oils and tumeric rather than getting them medical attention, to misleading desperate cancer patients with promises of miracle cures (something which has killed at least 2 friends of mine, to date), to prescribing natural therapy regimes which have left babies malnourished, likely suffering from developmental delays for life, we seem to hear about things going wrong for people every day these days.

Vitamins are often claimed to be efficacious in cancer treatment when this is far from the case. SBS did a feature on this recently. A compounding pharmacist was telling patients – as A NON CLINICIAN – someone who can’t legally advise on clinical judgements according to Australian, TGA legal guidelines – claimed that Vitamin C supplements could cure cancer or help patients. The 2 largest systematic reviews – the highest quality of evidence possible – have said a LOT more evidence is required. There hasn’t been phase 3, randomised controlled trials for this.  It is NOT indicated by the TGA as a treatment for cancer so even if her clinic is supported by GPs – its use is questionable and something I would be interested in reporting to authorities. Would you want big pharma skipping protocols and promoting unfounded claims before approval? No… Why should someone with NO training in this space get a pass? Multiple studies have discontinued high dose therapy use due to high toxicity. It should NOT be advocated for as a viable treatment. She did just that on national TV.

Could it help? Possibly – early studies have shown some improvement. Almost no cures. It it generally well tolerated. But toxicities have also been noted. I’ve been in a desperate position before… There are many options MUCH higher on my list of things I’d try if things got more dire.

Vitamin B6 and B12 was found in a prospective, observational study of over 77,000 patients (one of the highest quality long term therapies) have been associated with 30 – 40% higher risks of lung cancer (a 2x higher risk for patients taking high doses). Vit b12 has been shown to increase esophageal cancer as well.  Many studies show no positive impact on survival. SBS – the news channel which put this together an ‘unbiased show’ where professionals with years of experience and with backing of millions of patients worth of data in research were given an equal platform to individuals who ‘just felt better’ – even reported on an American study which showed vitamin supplements increased risk of all causes of death. Indeed – vitamins nearly killed me.

How I was nearly killed by bad advice.

The picture below outlines a scam I almost fell for. When I’d relapsed, I was given a less than 10% chance of surviving. Palliative care was suggested as an option for me. A second bone marrow transplant was a long-shot, but the only curative option.

At this time, a family friend put my family in contact with a researcher and scientist named Dr J, who promised to have a cure for me.

I was desperate. Willing to try anything. But luckily, I also had a year of medical knowledge under my belt.

We went in to see ‘Dr’ J one day at his apartment. He went into this theory of how sodium bicarbonate could cure cancer. One common, popular alternative therapy promoted by many, is the idea that “cancer thrives in acid, and therefore making yourself more alkaline will cure it”. He also purported another common alternative therapy – that “cancer loves, and is fueled by glucose, therefore low-sugar diets will cure it.” The former is largely known to be false. Cancers, due to their rapid, anaerobic metabolism of energy emit large amounts of lactic acid which PRODUCE an acidic environment. Not the other way around. And in any case – ‘alkaline diets’ or alkaline water will only result in less acidic urine, and slightly more alkaline saliva (not associated with alkaline blood). Your body’s buffer systems keep your blood’s pH in a 0.1 window. Even 0.01 higher or lower than normal ranges result in medical emergency. There’s no way for alkalinity to make it TO the cancer.

When I asked him about how you could make tumor sites more alkaline… he had no response. And when I asked him a basic metabolism question any 1st year student in any health degree would understand (‘if cancer feeds off glucose… your body will produce glucose from elsewhere by breaking down fats and protein if need be. Why wouldn’t the cancer just keep using that glucose preferrentially?)… he again, couldn’t answer me.

He showed me a few case studies from decades ago of 1 or 2 people who seemed to have had tumours regress after trying sodium bicarbonate. But even then I’d been reading on spontaneous regressions, and even then, I knew that if only a few case studies could be produced in the decades since we had this ‘common knowledge’ of how to cure cancer… then it was unlikely to be representative, or statistically significant. And after all this, he turned his attention towards my parents and started his sales pitch on why “Amway vitamins” could cure me. Again, no clear linkages as to why his vitamins were better (or why vitamins could cure cancer for that matter) were made. I later found out that Amway is a company with a pyramid-scheme model, designed to make money through the perpetual, impossible, addition of members who go on to onsell product, and earn commissions on all members they bring into the program. “Dr” J was probably locked in this trap himself.

 

John Oliver, in his brilliant style, breaks down the fraud that is the many mutli-level marketing companies that exist worldwide. 

 

Family and friends pressured me down his pathway. They said it couldn’t hurt. They told me to believe in him. They took me to a seminar where he waxed on and on, and brought up people with chronic conditions cured by his miracle therapies (when likely, their changed lifestyle habits were the real fix), where he wanted me to speak, to endorse his treatments.

I didn’t.

If he, a scientist working at the University of Sydney, couldn’t answer the questions of a 1st year medical student, why should I believe him?

Instead, I went out and looked up every journal I could, and every clinical trial going on in my disease around the world (something easier to do than expected – thanks to this amazing site that anyone can use called ClinicalTrials.gov) – I looked through all my options and presented one – Azacitidine – as a promising option to use to increase my odds post transplant to my doctor. With my doctor’s help, I got it.

 

It’s likely because of that drug, and hundreds of thousands of hours of work from scientists, and doctors around the world, that I’m still here today.

Yet, if I hadn’t had the knowledge I did, “Dr” J above could have killed me.

If you’re in a similar position – but don’t have medical training, please, PLEASE do a simple search on ClinicalTrials.Gov and/or your national clinical trial database for options. When I was looking up my own therapy – it helped me see trends of new therapies and backed my case to my doctor to get me the drug I needed. It’s simple to use – I’ve suggested it to numerous patients who’ve found second options and benefited from REAL SCIENCE through this. Please – try this first!

 

So why does this happen? Isn’t it illegal?

Consumer law protection exists for this kind of stuff. Yet misinformation like the above is rife within the multi-billion dollar alternative medical industry. You can’t sell TVs or Fridges based off false statements and claims. But somehow, it’s OK to gamble with other peoples’ lives, in health.

Why? Well, I’m not a lawyer. I’d love to hear from any medical malpractice lawyers out there who’d like to offer their own perspectives. But one major issue is that legislation against this kind of thing, around the world often lacks teeth.

This great article discussing the UK’s  Consumer Protection from Unfair Trading Regulations 2008 in regards to alternative medicine – goes into some of the issues. Interpretations of the law are often not as clear as their intentions, in the eyes of lawyers and judges. Though it seemingly is clear that the defendent, not accuser, has to prove the claims they make are true, in practice, it often is up to the accuser to prove something’s false. Proving a negative is very difficult. And in a field where not much research is done… this becomes tougher. In addition, a lot of the time, enforcement isn’t followed up on laws. The Competition and Consumer Act 2010 (Australia), and numerous precedents and investigations done by the FTC also mark many of these practices as illegal.

Yet millions get away with this. Indeed, social media and fake news is a big proponent of this too. There are thousands of influencers with millions of followers making millions of dollars pedaling misleading, and often dangerous misinformation. Wellness is a half a trillion dollar, largely unregulated industry. Chinese Medicine, which I tried, were found to have 127 different types of fungal contaminants in just 15 herbal mixes.  And innocuously, there are thousands, maybe hundreds of thousands, advocating for unproven therapies in Facebook groups – turning people away from real therapies – sometimes profiting, sometimes spreading misinformation. People and groups like this, I see everyday in cancer groups where I talk and interact with other patients.

A dangerous meme from a dangerous page. Mamograms are PROVEN to save lives – and their risks and benefits have been studied and found to be effective in reducing mortality in high level studies. The amount of radiation exposure is safe and though there are new therapies coming through the pipeline – Thermographs are shown to be INFERIOR to mamographs. Natural News is a notorious ‘news site’ which spreads dangerous misinformation.

 

Why are they never sued? Well, sometimes they are. Robert O Young, a proponent of the “cancer is acidic, and alkalysing the body is the cure” lost a lawsuit that forces him to fork over $105million to his victims. Dr Simoncini, proponent of the “cancer is a fungus and sodium bicarb is the cure” alternative theory that has been thoroughly debunked is serving a 5 year jail sentence for manslaughter, after he continued to treat people for tens of thousands of dollars a pop at his clinic, despite being convicted of manslaughter and being deregistered earlier in 2006 as well. Doctors prescribing miracle “Defeat Autism Now” therapy regimes which have no scientific basis are currently being sued too. 

But often, quacks and frauds USE the law to continue shady practices. Another naturopath and proponent of the sodium bicarbonate cures cancer movement is suing a whistleblower to ensure she can keep her operation running. A senior member of the renowned site Quackwatch was also sued for defamation.

And often, this stuff goes unchecked on social media. Not just from unscrupulous people like Toby (pictured above), but also from “Influencers,” and “Wellness Gurus and Coaches” who post deliberately misleading posts to millions of followers to sell their own products, or that of other, often unproven, wellness therapies.

An example of one of Facebook’s most virulent anti-science influencer. Sure, it isn’t one of his more ludicrous posts which does things like dissuade people from getting proven, effective therapies for their serious illness, but it shows how far some of these people are willing to go to make a quick buck. Click here to check out a video I made spoofing many of those viral ‘health fact’ videos you see these days.

 

But you know what, I’m sick of this.

Things like this seem innocuous. But it literally kills millions every year. It scams people, many of whom are already under heavy financial strain following intense treatments, of tens of thousands. It’s taken the lives of at least 2 close friends who had other, better options still available to them, and likely many more people I’ve known too.

Alternative and complimentary medicine can be amazing. The fact that practitioners actually sit down, and take the time to listen to you as a whole person is a big reason why it’s so popular. There are many massage therapists, yoga instructors, aromatherapists, dietitians and naturopaths out there who do know their stuff, work with doctors, abide by laws – and they help DO help millions. I benefit from many of the above.

But it’s when they do things like this that they become dangerous.

I believe we need to crack down on this industry, and the crooks who lead millions astray every year. We need to #MakeAlternativesGreatAgain – and when people make false health claims – we need to #LockEmUp – for the good of society – if they make unfounded health claims. If you agree – check out this change.org campaign I’m running soon.

1) IF YOU MAKE CLAIMS PERTAINING TO HEALTH – claiming a therapy WILL cure or fix a condition, or encourage others to try such therapies, without any evidence to back up your claims, without inserting disclaimers or saying “May” – YOU SHOULD BE CULPABLE, AND YOU SHOULD GO TO JAIL if your advice ends up harming someone.

2) – If you profit from the sales, in any way, of products with purported health benefits, YOU SHOULD HAVE TO MAKE THAT CLEAR, and it SHOULD BE YOUR RESPONSIBILITY, to check the validity of those health claims.

I’ll even go so far as to say:

3) If you share misinformation, without any reasonable scientific or other evidence behind it, and it ends up harming someone – YOU SHOULD BE PROSECUTED AS WELL.

 

If not… scumbags like these will continue to exist, and prosper off the suffering of good people. Check out the Change.org campaign I’ve made and add your voice to this campaign for science and reason.

Bell Gibson fraudulently made millions after faking that she cured brain cancer with diet and alternative therapies. Millions of dollars escaped fines. But how many she led astray of real options will probably never be known. Full article here. She joins other fitness and wellness ‘experts,’ such as Sarah Stevenson who’ve falsely claimed they’d beaten a cancer which spontaneously regresses in over 1/4 people due to diet and wellness alone, and then gone on to fraudulently provide wellness coaching sessions, for $300 per 50 minutes (rates doctors who’ve studied for decades don’t charge).

 

There are numerous examples of scumbags like this out there. You may well already be following them. If you are, and you don’t see links to journals, or any kind of evidence which backs up their claim – do me a favour. Unfollow them. And if they say something which you feel may be harmful to society – tag me, @nikhilautar, or use the #LockEmUp to help bring them down.

 

What I’m doing about it.

I’ll be running this campaign soon, this is one thing. But my Startup – Centered Around You – actually aims to be the first app of its kind to not just provide evidence based wellness advice – but TEST IT TOO. A combination of machine learning, my own passion for research, and inputs from world leading clinicians, researchers, and coders/designers, advised by CEOs, senior VPs and heads of national operations of international and ASX listed firms advise us. We won Australian Student Startup of the Year not long ago. Along with numerous other prizes (we made the finals of the Global Impact Challenge, won NSW Student Startup of the Year in a separate competition, and have received numerous other grants and rewards for our work).

Our medical devices will also make life safer and easier for elderly and disabled patients. We are testing with some of Australia’s largest nursing home chains in the near future.

And our products have also generated interest and pre-sales from people interested in getting a better night’s sleep too!

Check out www.GetToSleepEasy and CAroundYou.com for more information.

 

I’m always here to talk. You can reach me (I am incredibly busy, but strive to read all my emails) at info [at [ nikhilautar.com

 

 

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Think Medicine Sucks? Think You Don’t Make a Difference? Try This.

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So recently, a I was linked this article by many people. It’s been all over my Facebook feed, and I’ve been told to read it by many.

It’s really well done and articulates the challenges of hospital well. On both the doctor’s and patient’s side. It goes into the powerlessness patients feel, the confusion they face in hospitals, and the struggle of being a junior doctor in a system that’s pushed to its limits, and seems not to care. It features some really amazing artwork, and is told in the form of a cartoon, that really does capture your eye. As much as I may seem like I’m bagging on it now… it really is well done, and I highly recommend you give it a read.

photos and full article available at The Guardian. 

 

But regarding the “novel” realisation that being a patient sucks…

A) No Shit.

Every 2 months a ‘profound’ article comes out after a doctor enters ED or faces his own health challenge and suddenly realizes – “holy crap I was treated like shit,” and i slapmy head. Hard (it’s probably why my memory sucks so much)…

You see it all the time in your patient’s eyes. It doesn’t take huge amounts of ’emotional intelligence’ to see that. You get used to it and start thinking “that’s just how it has to be.” and you are, quite reasonably, tired yourself, and often unable to do anything.

B) Where you can, instead of clapping your hands and crying ‘amen,’ go do something about it.

Take it from someone who knows… the tiny, little things which HARDLY takes time out of your day make a HUGE difference. When someone asks for pain meds, and they need it, chart it asap. And tell them, or get your nurses to tell them if it’s gonna take time, and explain why if it is going to take a while. “I haven’t got time right now, but I’m gonna try my best to get it to you asap” reduces suffering 90% compared to just being left hanging. Believe me, it does. Same goes for if you’re late, generally, in a clinic, or whatever.

Ask patients if they understand what you said when you chat to them, and if they have any questions. It’s not wasting time. It ensures that they buy into your treatment plan and comply with recovery, and they’ll trust you, divulge everything, and give better histories. If you’re too busy, let them know that you’ll get around to it when you can or to ask the nurses when they’re around next.
Asking about those little things like work, if they’re okay to get home, how they get their medications, is, for similar reasons, not a waste of time. And, importantly, they make you feel cared for.

The tiny things – greeting people warmly. Asking how they’ve been, talking about things important to them as you walk to your consult room… they are HUGE. My haematologist does that. There’s a reason why I drive, or take a train 1-1.5 hours each way to see him.

Because I feel CARED FOR.

That feeling is EVERYTHING. It’s your most powerful tool as a healer.

From someone who’s gone through enormous amounts of physical agony… trust me that I know what I’m talking about when I say that psychological/ emotional agony is 100x worse. And you ALWAYS have the power to change that. No matter what.

I get it. It feels hard to keep giving. Day in and day out, when you work such a stressful job and face failure on a constant basis… when you’re depressed and when everything feels even harder to do than normal… giving back becomes even harder. It seems futile. For many reasons – we doctors don’t take it as seriously as we should. Just going on and telling yourself you can’t do much is how we cope with it. But that’s the biggest trap of depression. Though playing the victim and focusing on the things that stop you is easier at the time, it really makes you feel shitter in the long run.

In truth though, doing the right thing – going “that extra mile”… it’s really as hard as it seems. The little things make just as much of a difference as huge, epic gestures. And ultimately, you being the good person I know 99% of doctors are underneath, wherever you can, helps YOU too. It reminds you why you got into this. It reminds you that you DO and CAN make a difference.

It isn’t that hard to do. And, like with anything in life, making the decision to give back where possible becomes habitual too. It becomes your norm. So anyone reading this… next time you’re out there… go that ‘extra’ foot or two. I guarantee you. It’s worth it.

This was a talk I did for the Australian Indian Medical Graduate Association’s annual general meeting a few years ago. I was quite raw… I’d just come from the funeral of an old friend and fellow medical student who’d taken his own life. I hope it helps those of you struggling out there, wondering, “what’s the point?” realise, that you can and always do make a difference.

 

 

Medicine and Science

How to Ensure Cancer Treatments Keep Imrpoving and Make the Drug Development Cycle more Efficient.

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Last post:                                     My Story:                                         Next One

This was my submission to an essay competition run by the Cancer Council of Australia a few years ago. It was shortlisted but didn’t take down first place unfortunately! I was probably a bit too industry/business model focused for what they were looking for! It does outline major challenges facing drug development though – something fascinating to many, for sure! Let me know your thoughts!

Ensuring Cancer Treatments

Improve with

Advances in Research

 

Nikhil Autar
University of Western Sydney
Cancer Council 2015 Essay Competition

 Outline

Cancer treatment has come far over the ages; from the barbaric beginnings of radical mastectomies and infusions of mustard gas1, to the robotic thyroidectomies of today, and cancer outcomes have followed suit2,3.  This is largely attributable to dramatic leaps forward in medical knowledge garnered from research4. In order for advancements in treatments to continue, it becomes apparent that continuing our investment into research is necessary. But in order to maximise our impact, we must consider the direction oncology and treatments are heading, invest in the most
promising of prospects, and ensure our research system has maximal efficiency. In this essay, I’ll discuss the changing nature of cancer treatments and outline where and how we should direct our research to achieve maximum improvements for patients. I’ll also delve into the challenges clinical and academic research face, and suggest systemic solutions that will ensure research of all kinds are done in the most time-and-cost efficient manner.  And finally, I’ll discuss the importance of preparing future physicians to deliver the fruits of research.

Epidemiological:
Increasing Incidence Due to Age

Before discussing solutions we need establish how the field is changing. Largely preventable cancers, like lung and colorectal cancer, are declining or stabilizing in most-all developed
nations5,6, following improved treatments, systems, screening programs and prevention measures7,8. But overall, in the developed world, cancer incidence by type is changing slowly5. The major epidemiological change is an increase in overall cancer incidence due to an older population9-11, who, through various intracellular and extracellular processes, are more likely to develop cancer12,13. Hence research, especially clinical-trial research, should reflect lower tolerance of toxicities, higher rates of co-morbidities14, and other factors prevalent in older populations.

Biological:
The Targeted, Personalised Future

Where oncology is changing most though is in the direction of new treatments, and advances in cancer genomics is driving much of this change. The human Genome sequence set the ground-layer of this field, allowing for cancer genome analysis to occur, and predictions of cancer genomics leading to cancer biology discoveries and guiding patient treatments are already proving true15. Large projects such as The Cancer Genome Project and The Cancer Genome Atlas, which identify and store tumour-mutation profile in databases and direct research from data collected, have already elucidated aspects of cancer biology and development47,48, found potential targets for therapeutics17,18and highlighted many tumour profiles that influence clinical management of individual patients today16,19-21The latter benefit of genomics describes another growing trend of  personalisation in cancer treatment, and this has led to new lines of treatment that differ from traditional small-molecule (small, biochemically active molecules that engage with pathways of cancer development and progression) applications. Biologicals, such as monoclonal-antibodies and growth factors are being recognised for their more targeted, less toxic applications25as well as their increased likelihood to pass early drug development23, and are already attracting more pharmaceutical patents than small-molecules24. Biologicals also offer novel avenues of delivering drugs to cancer sites and cells26,27, especially significant given our growing knowledge of the importance of the tumour-microenvironment in promoting tumour survival and protecting them from drugs39-41,49,50 , joining the ranks of other innovative delivery systems such as nanotechnology28,29. Microenvironment importance has also driven new lines of therapy targeting angiogenesis50, epidermal-growth-factor and downstream pathways109,110, and the newfound understanding of the role of stem cells in tumour growth and recurrence are leading to new therapeutic lines too42-44.
Biologicals have also opened up many exciting avenues in an already exciting field of therapy; immunotherapy22. In addition to the recent discovery and early trial successes of checkpoint inhibitors that work on CTLA4, PD1 and PDL1, which work by allowing patients’ immune systems to recognise and kill cancers30,31, the use of biologicals like monoclonal antibodies, which attack cancers by targeting or attaching to proteins on cancer cell or host tissue surfaces32-34, cancer-antigen vaccines35-37and T-Cell Modification therapies38, which prime patients’ immune cells to recognise and kill tumours, are promising potential treatments. 
When these are combined with increasing discoveries into processes that aid cancer treatment and research, such as the discovery of new bio-markers and the development of adaptable trial-designs45,46, future avenues of cancer research are promising, varied and diverse. But due to the more isolated nature of these targets, the heterozygous natures of tumour mutations, and the multitude of tumour-genesis and survival pathways15,41,42-44, these treatments need be combined for maximal clinical benefit.  

Translational: Less New
Drugs, More Expensive Research

Yet though there are many avenues, and much research directed to new treatment pathways, less and less are being translated into treatments. Industry, which funds the vast majority of clinical trials51, is bringing significantly less new molecular entities(NMEs) to the market each year52-55, despite exponential increases in the amount invested into trial research53-55The tremendous, increasing cost of developing and funding drugs through  clinical trials and approval is the reason behind this reluctance to invest in new therapies. Funding a drug from early trials to approval costs in excess of a billion dollars70-73, with more recent analyses showing companies spend as much as 4-11billion per drug78. This takes between 11 and 14years74; all for a 6-11%75-77chance of being approved for sale. Most of this is attributable to increased regulatory requirements79, reduction in effective patent, marketable, length, by a third80,81,a shift to more targeted treatments, causing drug peak-sales to halve82,and higher attrition rates in early discovery81.
Big-Pharma has reacted. Since 2008, pipeline sizes have decreased by a fifth in top Companies like Pfizer, with the proportion of budget diverted to R&D following suit56-60, and patent filings have also fallen by nearly a third industry-wide61, highlighting this reluctance to initiate new projects. Simultaneously, marketing and sales, which obscure and corrupt physician judgement62,83and harm investor confidence through bloated sales forecasts63, have increased to half the budget; double that of R&D spend62,64. The nature of drugs developed are also impacted by the nature of pharmaceutical investments, with more “Me-Too”, copy-cat drugs; ones that mimic the actions of already developed drugs, hence producing only-slightly-better-than-previous outcomes, being funded in preference to novel ones65,66. Also observable is a focus on blockbuster drugs, those targeting diseases with larger markets, which garner higher returns67,68over rarer, underfunded diseases like neuroendocrine cancers4,69. Other factors such as managerial pressure to deliver short-term profits exacerbate this68, but the reluctance to initiate projects by industry is by far motivated mostly by this cost/time intensive, risky investment that is drug development. In order to stimulate industry, more streamlined, innovative trial structures must be enacted to reduce costs and foster innovation.
The changing nature of oncology established above highlights that systematic changes need be implemented to ensure continued improvement of cancer outcomes. The Australian government can play a crucial role in strengthening clinical trial infrastructure and funding to support industry in Australia, and electronic databases may present a unique opportunity to do this. Research, both industry-funded and academic, should be directed toward promising avenues of cancer research, and strategic direction and partnerships can improve output.

Improving
Clinical Trial Infrastructure

Australian clinical-trial centres have great potential in attracting more industry activity that benefits not only oncology, but also overall care for Australians. Australia is already renowned as a quality nation to conduct trials in; we produce high quality, reliable data accepted by regulatory bodies around the world, have fast ethics-approval structures and an informed and willing population84,85. But Lisa Askie, the manager of the Australia/New-Zealand Clinical Trial Registry, professed, in an interview I conducted with her that Australia needs “more investment in clinical trial infrastructure”, as sites are “underequipped” and “many trials are done on investigator initiative” with little in the way of compensation made for clinical staff conducting trials85. The government’s role in this is clear. Though industry funds nearly 70% of trials in Australia51, it employs only a quarter of clinical-trial staff51. She pointed to the UK’s system in particular as one to emulate.
The UK implemented the National Cancer Research Network after noting their cancer survival and cancer-trial recruitment rates were remarkably low compared to other developed nations86-88. The central features of this overhaul included increasing the number of clinical trial sites along geographic distributions, increasing clinical-trial staff, coordinating both research focuses and enrolment services nationally to increase synergy in the system, and increased funding to public research bodies86,88,89. And it worked. Cancer clinical trial participation increased five-fold88 to world-leading rates, clinical-trial recruitment target fulfillment nearly doubled88, and, most importantly, improvements in patient outcomes and access to trials and new drugs were noted90-92. Hospitals that conducted trials provided better care with lower mortality rates, likely due to more trained, up-to-date physician teams92. Increased economic benefits from industry was also observed, with industry-funded trial staff and investigator numbers rising88. Liverpool Hospital, Sydney, has self-funded the establishment of its own clinical-trial site to a point where it’s self sustaining, and even bringing profits to the hospital, showing such increases to infrastructure is feasible in Australia too137. With Australia’s already positive physician perception of clinical trials51and the fact that industry provides $650million in investments93 and $100million in healthcare savings to the nation94, it’s clear that any government investment that facilitates more clinical trials in Australia is a wise one.   

Using
Technology to Reduce Time and Costs Taken to Trial.

Though structural changes to clinical trial funding is invaluable as a means of reducing time/cost taken to trial, technology has even greater potential to streamline the clinical trial process. actors that have escalated the time-and-cost of conducting clinical trials exponentially are systemic and greatly increase pre-trial attritions of potentially game-changing compounds too68,100. 90% of clinical trials are finished later than scheduled, with patient recruitment accounting for a quarter, and data collection and discrepancy resolution taking up two-fifths, of time96,97. The reasons for the former are varied; physicians don’t even consider clinical-trials 40% of the time98, patients are hardly aware of their existence98,136, and even physical encumbrances like distance from trial centre hamper patients’ trial enrolment rates98,99.
In his best-seller, Bad Pharma, Ben Goldacre not only lambasts Big-Pharma for their unscientific, unethical practices, but also suggests a novel solution for these issues that is currently being trialled in the UK83,95. He proposed that Electronic Medical Records (EMRS) be harnessed as tools to conduct live, randomised trials, arguing key issues prolonging time to trial like time spent recruiting patients, data-collection delays, and also that overall trial costs would fall significantly through such a scheme83,101. They have added benefits of being able to conduct retrospective analyses; saving millions in PhaseIV study costs, provide more clinically relevant and representative results, and can even evaluate combinational therapies101. Research applications of EMRs has been recommended by the American College of Physicians103, but in establishing such a system in Australia, measures like communicating benefits and privacy-securing measures to the public; why UK’s Care.Data failed to pass parliament102, ironing out ethics and efficiency issues101,104, and forward thinking in database-design, which minimises complex, costly data-mining and ensures data quality105,106, need to be considered to ensure our E-Health Record is widely used and effective for research purposes.
The ability to study the effects of combinational therapies is a promising application of trial-friendly EMRs, but even if they were to exist now, industry and regulatory bodies need to modify policy to facilitate their trialling. Many upcoming drugs, due to the trend of more targeted therapeutics being developed, isolate single strands of the web of cancer-cell biology, and, when used alone, will allow cancers to survive down alternate pathways, resulting in reduced success and increased relapse rates15,41,42-44,107-110. Hence combination therapies warrant further investigation. However, though there are many examples of combinational therapies improving care outcomes significantly, between both standard114-116, and more targeted therapies111-113, regulatory bodies’ policies currently restrict their investigation. The FDA heretofore have required such therapies to be given in fixed-dose combinations; in the same vial or tablet with set compound ratios117; understandably hard for biologics, which usually require intravenous administration25, personalised immunotherapies, and personalised dose-analysis studies, to do. They’ve responded to the need though by drafting a policy that allows two therapies to be combined into one “co-development” study, and data to demonstrate the contributions of each drug to be attained from earlier trials or pharmacological studies rather than expensive, time-consuming, clinical-trials118. This should stimulate more investigation. But another factor which stops these combination studies from happening is the conflicting financial interests of pharmaceuticals.

Teamwork
Strategies That Unite Researchers From All Sectors

The latter factor is one that seems impossible to evade, but recently, teamwork has become prominent in cancer research; something much needed45. Consortia, an association of multiple bodies with shared research goals, bring together all sectors; not-for-profits, government and industry, to create broadly-usable tools such as biomarkers (useful for diagnostics, clinical trial evaluation and acceleration of drug discovery/development121) that would otherwise be deemed too economically infeasible to fund by singular entities120. Data-sharing is also a focus of many consortia, reducing wasteful duplication of research and producing invaluable knowledge-platforms, such as the cancer genomics consortia discussed above47,48,120. The development of innovative Intellectual Property contracts in Industry Consortia, that allow short term exclusivity of discoveries made by members, also spells out future hope for industry working together on projects where both parties can benefit, such as combinational therapies117.

Strategically
Directing Basic research

Foundation and government research is a lifeline for treatment development, and should also be optimised through teamwork and strategy. Basic research required to discover biochemical pathways and therapeutic targets and proof of concepts, seen as the investment “valley of death” by pharmaceuticals122, for their inability to deliver profits, are essential to therapy development. 85% of this research is funded by governments and foundations123. In addition, rare or neglected diseases, and recent personalised immunotherapy developments, which are largely unprofitable,
require this sectors’ funding4,120,122,124
Innovative,  assertive, collaborative strategies, such as the one used by Australia’s own Cure Bain Cancer Foundation, reduce wastage and increase output in this vital research stage125. The Foundation proactively outreaches to researchers when providing grants, saving over a month of work per-researcher-per-year135, collaborates, and indeed, directs research strategies for the Global Brain Exchange consortia126, and works actively with industry to ensure treatments reach patients125. Similar strategies, if employed by others, would lead to leaps-forward in treatment prospects, and thence, patient outcomes. 
The complexities associated with the personalisation of clinical management and our ever-expanding discoveries in fields like genomics are already stumping doctors127. Though innovative educational tools, such as medical calculators129and the Regulome Explorer genome-map128, and technological training are being provided to bring doctors up-to-date, the most effective way to ensure future physicians are aware of, and can apply these advances is to teach them in medical school. This knowledge isn’t just necessary for future oncologists. All specialists are becoming more involved in cancer care due to multidisciplinary, team-based care130, and GPs, comprising nearly half the profession131, have the most important, currently underused role, in prevention and co-management of cancers132-134. With cancer burden only rising9-11, this becomes vital.
The changing landscape of oncology due to advances in research has made it essential we transform and optimise our clinical trial infrastructure, focus of research and research partnerships, so patient outcomes continue improving. The recommendations made in this essay provide benefits not only to science and patients, but also to industry, researchers and Australia’s health system, and many suggestions can be implemented around the world too. There are many other complex interactions and strategies that can further increase the output of new treatments that couldn’t be discussed in the length of this essay. I’m actually writing a book on the topic. But the fact that there are many pathways and much desire to improve treatments makes the future of cancer treatments bright. Hopefully, these suggestions, if implemented, will make them even brighter.    
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Word Count: 2499 (headings not included in count)
Inspiration/Motivation/Help

It’s been a while… But I’ve been working hard.

Posted on
So it’s been a while since I posted something here. A LONG while. Sorry to all of you!
So where have I been? What have I been up to? Well, I’ve been working hard. Promise. I’ve nearly finished my research degree – the one I decided to complete while I waited for my immune system to strengthen, so I could do medicine again. Hopefully I’ll get some publications and formally contribute to science and human development! 
 
But I’ve also been busy on this startup. One I think could make a huge difference, and hopefully, save many lives. 

So, what are we doing?

I started this up after losing a couple of friends to preventable illnesses and complications. Things like falls, pneumonias, and pressure sores are our most common causes of hospitalisation, they take tens of thousands of lives per year, and cost us billions as well. I looked into the problem. Talked to a lot of nursing homes, patients and carers. And I realised there was an opportunity to create something that made life easier, reduced work for nurses and healthcare staff, prevented these issues – all at an affordable price point!
 
That’s when I founded Get To Sleep Easy. How are we accomplishing this? Through our Smart Inclining Bed. This is a device which sits on top of your bed, and converts any bed into a hospital bed, for a tenth of the price of current beds! In addition to this, our smart sensors underneath can map user movement for a fraction of the price of current technologies. This allows us to, for the first time, let nursing homes, and people like you and me, who wanna keep our loved ones at home longer, be alerted of things like falls, pressure sore development – even if someone’s stopped breathing! Plus, we’ve got some other cool innovations in the pipeline too. Check it out! And be sure to sign up to our email list if you’re interested in becoming a test partner, or just interested in our development. Click here to sign up specifically for that – and click here to join my email list!

 
I’d love to share some awesome news… After a long month of campaigning, and losing a few friends from a bit of spam – we at Get To Sleep Easy won Australian Student Startup of the Year last week, at Startcon (the biggest startup conference on the scene)! 
 
 
 
It’s a huge honour. If you did know about this, whether you voted or not… I’d just like to say thank you, from the bottom of my heart, for all your support. 
 

So where are we? What comes next? 

Well, in a completely separate competition… we may be getting flown out to become GLOBAL Student Startup of the Year (that’ll be amazing). We’ve got working prototypes which we hope to test with our amazing nursing home partners in 3 – 4 months time. For reference, we’ve got a device that converts any bed into a hospital bed for 1/10th of the price and smart sensors that detect and prevent falls, pressure sores – even if someone’s stopped breathing (let me know if you’d like to test these, or get one for loved ones!)! We’ve got opportunities to jump into some prestigious business accelerators which will turbocharge our progress, for sure.

 
And finally, in a few weeks, we’ll be doing some crowdfunding that’ll hopefully get us much needed cash, get our brand out there, and show, even more, to future investors how much these things are needed! I’ll email you on day 1 of launch if you sign up here (your support then would help us out in getting us seen through the Kickstarter algorithm – I’ll explain more in a few weeks). But if you want, you can help us get there faster by supporting our GoFundMe too!

The Mellow- the most ergonomic, scientifically designed pillow on the market! Check this and other products out at GetToSleepEasy.org or support us on GoFundMe!

 

Other updates!

But yeah. Hopefully this can go on to make an impact.
 
In other news, for those of you who follow along on Facebook or Instagram, you may have heard about my recent health troubles… A few weeks ago, I had another cancer scare, after also getting a few sezires. But I’m glad to report all seems to still be well! Here’s hoping there won’t be any other scares like this in the future! 


My research – I’ve completed the degree/exam components! Now I’ve just gotta deliver my research project to graduate from that research degree! Hopefully, sometime over the next few years, I’ll be healthy enough to get back into the wards, but Get To Sleep Easy, if we keep going the way we’re going, will ensure I can keep making an impact, no matter what!
And I’m also writing a book too! Definitely check this out if you’re interested (I need people to act as editors, for sure!)
I’d love to hear more about how you are. Again, thank you so much for all the support you’ve given me. Let me know if there’s anything I can do to help you. And let me know what you think about Get To Sleep Easy too!
Blog

How to Ignore Chronic Pain and Hack your brain to beat it. A step-by-step guide.

Posted on

I wrote this up for a friend recently. And as some of you who follow me know, I’m writing a book about my experiences through cancer, and the science behind the mentality which kept me going. But I realised recently that I hadn’t written up what I wished I did have when I was suffering most from chronic pain… A step-by-step guide which showed HOW you could beat this back.

The thing is – when you have something like chronic pain… everyone around you has suggestions. Eeryone suddenly becomes an expert. When you’re already so drained, physically and emotionally, from the condition itself – being told about miracle cures and being sold things that ‘WILL CURE IT ALL’ is not only heartbreaking, when you find measure after measure fails, but also depressing, in and of itself.

So I’m telling you straight up – this isn’t a miracle cure. I still have issues dealing with the sleep and fatigue I get from this chronic pain/cramping/fibromyalgic-like condition that I have. I still do get frustrated by how it limits me, at time (though I can ignore the fatigue as well, I know it’s healthy to respond to REAL signs it needs rest). With this system, I still feel pain. But my suffering because of it has decreased significantly. It wasn’t even hard to do this. It didn’t require an ounce or bravery, courage or willpower. It did take time. But today, I can, and do ignore pain as it comes on, automatically. Without willpower, or effort, or, as I talked about above, an ounce of bravery or courage. I hope it helps you do the same too.

 

 

It took a few weeks to get there. But the key to this is that I had this long term goal in mind – of getting to a point where my mind would automatically ignore the pain when it came on.

I knew I could do this because I was on duloxetine – an antidepressant – for a while 2 years ago, and that helped me, despite it not actually stopping the cramps which initiated my pain. While I was on it… the pain still happened, but it didn’t affect me as much. This powerful evidence of this working –  of me being able to ignore pain – in the past, really helped get through my head that I could indeed accomplish this. That I COULD ignore chronic pain, which really helped me stay on track.

But it was also reading about the science of chronic pain that solidified this belief and gave it backing. I looked at how greater connections between attentional centres and emotional ones, amongst others sensitizes us to, and enhances the impact of pain via neuroplasticity. I also read about neuroplasticity in general (the science of habit formation in particular), and the effects of positive reinforcement on strengthening mesolimbic (aka reward) pathways – which has numerous effects that makes a thought process or behaviour addictive, and hence, easier to maintain  – from our amygdala (emotional centre), to the pre-frontal cortex (responsible for planning and attention) to our hippocampus (a vital part of memory) –

By learning everything I could about these things, and combining my findings, I figured out how I could hack this process, via positive reinforcement, to make the journey to get to a stage where neuroplasticity would change my reaction to pain, easier. Below, I go into this process, step by step, in a manner that could help you out too!

 

I’ll be talking more about this, and referencing hundreds of articles which helped me ‘hack my brain’ in my book – do sign up to my email list and I’ll keep you updated on its progress! But, these steps I keep talking about are not only simple and replicable, but makes this process easy too!

1) Take a step back and look at the pain I was facing – when it was worst, when it was best etc. and wrote that down.

2) I saw that I could, and did ignore pain when I was feeling happy, when I was on that antidepressant (it didn’t reduce the cramps themselves, but did help me ignore them). When I was able to attach less importance to a burst. I then latched on to that.

3) I knew that I could ignore it, and could focus on stuff that made me happy – and make that an automatic response, in a matter of weeks, as neuroplasticity could rewire my responses to pain.

Almost mantra like, nstead of focusing on the pain once it occurred, I told myself “This is an aberrant, faulty signal that I shouldn’t be attaching significance to,” that “it would be over in seconds – minutes” that “getting annoyed by it, fretting over it happening again was only gonna make it worse” and told myself that “focusing on something else was more constructive – why not do that instead?”

and

4) I rewarded myself every time I ignored the pain. And I allowed myself to be human – acknowledge there would be times I’d fail along the way – but that in the long run, I would get there.

After a week, as I got better at this, I even started looking forward to cramps coming on as an opportunity to show myself I could do it. I’d addicted myself to getting better at doing this. It became easier to do.

After a month, my reward pathways kicked in and I didn’t have to keep rewarding myself – exponentially growing hits of dopamine surged through me as I got closer to my long term goal (another observed phenomenon that my research assured me would kick in).

In 5-6 weeks, I didn’t have to tell myself any of this at all. I was automatically ignoring chronic pain when it struck. IT DIDN’T EVEN TAKE WILLPOWER – or me reminding myself of those ‘mantras’-cum-realisations I did in step 1 and 2. Neuroplasticity made this a habit. One I maintain to this day.

 

Maybe this could help some of you guys out too.

It isn’t perfect. When I cramp these days, I do still cry out and it does still stop me from doing things as it physically takes a lot more effort to do things when you do have issues like what I have.

But I have been able to ignore the pain more often than not.

 

My psychologist told me “you have to accept the pain”. But doing that was REALLY HARD – accepting that and saying “I may suffer like this all the time…” was impossible for me to just jump straight into. CBT and all that, I mean it could have helped, maybe… but again, that was hard to maintain.

It was the preparation of this mindset – the manipulation of my reward pathways and neuroplasticity – and the knowledge it could – that helped me stay on track. The acknowledgement that it’d take time, and knowing I’d fail and feel crappy some days – but that in the long run, I’d get there – prepared me. When failure did come, when I felt pain overcome me (I knew I inevitably would in my journey),  I’d grit my teeth and bear it, but found myself focusing on the long run, and taking solace in that I would get there, instead of trying to be this ‘brave, strong dude who had to ignore everything’ which I could not. That helped me persist with this and get to this stage I’m at now, where I do ignore the pain, as an automatic response, when it comes on.

 

I think it could possibly help some of you. I wrote this out for a friend, and realised I didn’t have a ‘lay-over’, something to help people as I kept working on that full sized book (don’t worry, it’s only going to be 30-40 pages). So I thought I’d share this with you guys too. Again – sign up to my email list (I only email people once a month or so, don’t worry), and you’ll know when that books’s finally out. I’m gonna try and make it free too!

I know how much is sucked being told “It’s all in your head” when I was really in the dumps because of all this, that’s why I don’t wanna kid you and let you know that it’s not perfect. You can ignore fatigue as well, I’ve found, but my recent health run-ins made me realise that ignoring legitimate signs your body is suffering (something pain is not) is not exactly healthy.

But I hope my getting there can help some of you. Feel free to hit me up if you wanna talk it through – info at nikhilautar.com will ensure you reach me. I’m also decently active on my Facebook page and have a startup – Get To Sleep Easy – I run (we won Australian Student Startup of the Year actually! Check out our GoFundme.) which I’m always working on.

 

But ultimately – the thing that helped me most was the realisation that this life can be very long. Why make my suffering worse by lingering on it? Why let it take anything more than me than it should? That’s what really got me thinking about this.

Let me know your thoughts – good or bad (Please… ROAST ME if you hate this post. I wanna make sure what I’m saying helps the most people possible. I won’t mind at all if you completely hate this).

 

More about my pain condition –

So I’m an ex leukaemia patient, current graft versus host disease sufferer and get chronic cramps. This is sort of common post transplant, but doctors aren’t too sure about what it is, how it happens, and have no clue about treating it in general. You can read more about my journey here. 

I’ve got motor and some sensory neuropathy, and there’s definitely fibromyalgic elements to it too – it was looking at fibromyalgia that got me to ask my doc about duloxetine, actually. Something that had changed my life for the better for a long time. If your suffering is because of something similar, and have found something that helps… let me know!

 

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Dad Jokes!

Posted on
Last post:                                     My Story:                                         Next One During my time in hospital, and the months, years now of near isolation afterwards, my mum was the heart and head of my whole treatment. Keeping me safe, making sure I was comfortable and never alone, coordinating EVERYTHING that came with the cancer treatment, all while working, completing her MBA and keeping the house in order too (I still don’t know how she did it)… all those things. 


But if she was the heart, Dad was the soul of my cancer “battle”. He kept me smiling, organized surprises and events, just him being the larrikin, the easy going person he is made my life that much easier. 


The best thing he used to do though (and still does to this day) – was his jokes. 


But a joke is wasted, if not told. And though he delivers those jokes with the best of them (even jokes I’ve heard thousands of times, I don’t mind hearing again when he tells them)… he sends us these crackers that he “makes up on his own” all the time. So without further ado, I’ll throw in his best ones, so hopefully you too can laugh no matter what too. 

Facebook Banter 

Dad and I have a hate-hate relationship on Facebook. Whenever we get the chance, we take cheap shots on eachother. And I mean whenever… Once he hacked my Facebook and shared all the dirty pictures he could. Let’s just say I had a week of explaining to do… plus a few friendships tainted… 

But this one was gold. 

It was plastering day at med school the other week, and my tutorial happened to be on April Fool’s day. A GOLDEN opportunity to freak out my parents, right??? 

Wrong. Because as I posted this.. he snuck in with this gem. 

I’m not even mad… My Autar… take a bow. But I’d watch out for next time if I were you…
 I mean c’mon, his comment got more likes than my pic. I COULDA BEEN DYING GUYS!!!!!

Some of his “original jokes” that he kept saying to keep me smiling in the tough times. 

   


Why We Pay Upper Management the Big Bucks


A company, feeling it was time for a shakeup, hired a new CEO. The new boss was determined to rid the company of all slackers.

On a tour of the facilities, the CEO noticed a guy leaning against a wall and idly picking his teeth. The room was full of workers and he wanted to let them know that he meant business. He asked the guy,

“How much money do you make a week?”

A little surprised, the young man looked at him and said, “I make a little over $400 dollars a week, why?

The CEO said,”Wait right here.”

He walked back to his office, came back in two minutes, and handed the guy $1,600 in cash and said, “Here’s four weeks’ pay. Now GET OUT and don’t come back.”

Feeling pretty good about himself the CEO looked around the room and asked,

“Does anyone want to tell me what that goof-ball did here?”

From across the room a voice said,

“Sure – he was the Pizza delivery guy from Domino’s and was just waiting to collect the money!”


Marriage Training


Son: Dad, I want to get married. 

Father: First, tell me you’re sorry. 

Son: For what? 

Father: Say sorry. 

Son: But for what ? What did I do? 

Father: Just say sorry. 

Son: But…what have i done wrong ? 

Father: Say sorry! 

Son: WHY? 

Father: Say sorry!! 

Son: Please, just tell me why? 

Father: Say sorry!!! 

Son: OK, Dad…i’m sorry! 

Father: There ! You’re finished training. When you learn to say sorry for no reason at all, then you’re ready to get married!

Owning Door-Door salesmen. 

Witness… dad’s ingenious method guaranteed to own door-door salesmen, or trick or treaters if it’s that season (you will never get my chocolates).

Available to download here for free (cause I’m generous like that): https://docs.google.com/document/d/1BxHoxKeTbkebOKYK4B3fG9SCqN73pY20xqnsYvc1ZHU/edit?usp=sharing

 



Here comes the Bride


A young man excitedly tells his mother he’s fallen in love and that he is going to get married. 

He says, “Just for fun, Ma, I’m going to bring over 3 girls and you try and guess which one I’m going to marry.” 

The mother agrees. 

The next day, he brings three women into the house and sits them down on the couch and they chat for a while. He then says, “Okay Ma, guess which one I’m going to marry.” 

She immediately replies, “The one on the right.” 

“That’s amazing, Ma. You’re right. How did you know?” 

The mother replies, “I don’t like her.” 


Report Card


Father: Why did you get such a low score in that exam? 

Son: Absence. 

Father: You were absent on the day of the exam? 

Son: No but the boy who sits next to me was!


I feel sheepish for sharing this one… 


After a talking sheepdog gets all the sheep in the pen, he reports back to the farmer: “All 40 accounted for.” 

“But I only have 36 sheep,” says the farmer. 

“I know,” says the sheepdog. “But I rounded them up.”


Polly want a WHAT?”!?!!


A man went to a pet shop looking to buy a parrot. The shop had several parrots but one was priced much lower than the others. When the man asked why one was so much cheaper than the others, the pet shop owner assured the man that he did not want the cheaper one because it had a very foul mouth. 

“I’ve tried everything, but I can’t get him to stop cussing”, he explained. 

Eager to save some money, the man bought the parrot, sure he could teach the bird not to cuss. He too tried everything to stop the parrot’s foul mouth. 

Finally, in frustration, he put the bird in the freezer to cool off. After a few minutes, he opened the freezer to find the parrot with a totally changed attitude. 

“Please, I’ll NEVER cuss again! Please let me out! By the way, what did the chicken do?”


You can’t teach common sense


An uneducated father with his educated son went on a camping trip. They set up their tent and fell asleep. Some hours later, the father woke up his son. 

Father: Look up to the sky and tell me what you see. 

Son: I see millions of stars… 

Father: And what does that tell you? 

Son: Astronomically, it tells me that, there are millions of galaxies and planets out there! 

Father slaps the son hard on his hand and says, “Idiot, someone has stolen our tent!”

Trolling the bro

It’s just so fun to do! The poor soul has to suffer SO MUCH of our crap. This here below is why he has trust issues.


The ol’ rancher.


A rancher was minding his own business when an FBI agent came up up to him and said, “We got a tip that you may be growing illegal drugs on the premises. Do you mind if I take a look around?” 

The old rancher replied, “That’s fine, you shouldn’t go over there though.” As he pointed at one of his fields. 

The FBI agent snapped at him, “I’m am a federal agent! I can go wherever I want!” With that he pulled out his badge and shoved it into the ranchers face. 

The rancher shrugged this off and continued with his daily chores. About 15 minutes later he heard a loud scream from the field he had pointed out earlier. All of a sudden he could see the FBI agent sprinting towards him with a large bull on his heels. 

The rancher rushed to the fence and yelled, “HEY HEY!!”, tugging his shirt, “SHOW HIM YOUR BADGE!”

The glass is always half full.


This poor man is facing surgery on both his feet because of severe wounds. The doctor has warned him that he cannot tell how bad the damage is until he gets him in the operating room and he has prepared the man for the worst. 

After surgery, the man is slowly waking up and he sees the surgeon approaching his bed. The doc looks at him and says, “I have good news news and I have bad news – which would you like first?” 

The man nervously responds, “Give me the bad news first.” The doc says, “I had to take both your feet” 

“Oh my, what could possibly be the good news?” says the man. 

“The guy in the bed next to you wants to buy your slippers!” 




I’m gonna keep updating this with more laughs and videos of some stuff he’s done too! Not to mention the post with the dirtier jokes he’s shared with me in another post soon…
So make sure you subscribe here, like Musings of a Med Student Patient on Facebook, check out my YouTube and all the other funny posts on this blog (look under the “Humour in Hospital” section) and hopefully, dad can keep you guys smiling too =] 


It isn’t always easy, but you can always find something to smile about during your toughest times. All you need, at times, is a little push to remind you of that. How I used my mind to stay as healthy, hearty, and, most importantly, happy during my cancer journey. And still do to this day. 



Dad, in any photo. Can you figure out which one is dad?

 

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The Ultimate Cannulation and Venepuncture Guide!

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Needles are a part of medicine. Unfortunately, despite having been discovered centuries ago, there is still no more elegant way of accessing your blood than stabbing a pointy thing through your skin – especially since Theranos turned out to be a huge bust ). An interesting story of how a startup that raised $9billion promising to avoid having to prick skin when taking bloods failed because… it wasn’t possible (meanwhile, my social enterprise just cheered winning a $10,000 grant. We’ll get there. Soon). 
So I guess, as a future doctor, it becomes my duty to be the best I can be in this aspect. God knows it’ll be a major part of my training and (at least) the first five years of my career. May as well be good at it… if not for the sake of the poor beings I’ll be stabbing, for my own pride. After been cannulated at least a hundred times… you’d hope I’d have gotten at least decent in it…
This list below is a bunch of tips that I’ve picked up over my time in hospital as a patient from the best phlebotomists in the business – and the worst. It won’t go through the absolute basics – I’m sure you can find those in medical text books or handouts and the like – but rather those tips you won’t see in textbooks. Here’s the absolute basics – with nice pictures too if for reference! In future posts –  I’ll go into things like subcutaneous injections and local anaesthesia as well – as I gain more experience with them.
You can help out by posting a comment about any awesome tips that can help that I may have missed – and by sharing it – with other medical students, doctors, nurses,
blood collectors and even patients. Discuss it below, put in some of your best and worst experiences with canulations, sub-cuts and blood taking – and I’ll definitely put any good tips I missed into the post. 
I’ve also got in touch with an old friend who’s working in a path lab, and she’s let me know of some further insights into how blood taking methodology can alter results, and, more importantly, how to reduce those alterations! Doctors take these results as gospel truth – but it’s important to note – alterations can happen and results can and do vary depending on how it’s collected. 
A health-sector filled with good injectors will mean a health-sector filled with happier patients – not to mention one more open to giving blood, joining the bone marrow donor registry and picking up diseases before they become serious! AND a population of patients with more accurate results! So it’s in everyone’s best interest to share their experiences and share it with their peers!

THE TIPS:

First off – ALWAYS check the necessity of using a needle in the first place. In many wards, patients commonly have central lines, Hickman lines and other such things which negate the necessity for cannulas and blood tests – and they’re being used more and more. In my own case, nurses would always take bloods from my central line in the morning and I’d only need cannulas if I needed contrast for CTs, or some form of sedation (both of which can’t be injected into a central line). Majority of my blood tests, aside from cultures, were done through the line as well.
Though central lines and other such non-invasive (well, at least not after they’re put in) measures are being used more and more in hospitals, you will still have to resort to cannulation and venipuncture more often than not. And if you have the opportunity to have it done under ultrasound guidance – DO SO! 
But without further ado – here
are my best tips:

Preparing yourself: 

Before cannulating, ask the patient (or check in their files) if any blood needs to be taken that day. It’ll save them another jab which is always appreciated!

1.
Make sure you have the correct basic equipment.  Often forgotten examples include:

I.           –
An empty syringe – when taking blood it provides more suction than regular vacuum tubes so it can often draw blood where regular vacuum tubes can’t.
  •  The syringe should only be used though if the vacuum tubes can’t. From the lab’s perspective, too much suction causes haemolysis (destruction of red blood cells) which can alter results. If that syringe is needed, pull back slowly, allow the blood to pull itself back through the vacuum effect, to reduce the chances of spurious results. 
  • A saline syringe to flush canulas. It should be already attached to the bung/cap of cannula. This saves on the pain of having to manually pull and twist the cannula an extra time when you first flush it (often, that’s the bit that hurts the most). Nexiva canulas, which I’ll talk about below, eliminates this need.
  • A tourniquet to raise venous pressure and hence allow blood to flow. Failing that a blood pressure cuff works fine too and is actually superior as you can set the pressure to be above venous pressure (20 – 30mmHG) yet below arterial pressure too (100 – ish mmHG) to ensure blood pooling without undue risk of hypoxia/ischemia to the hand.  
  • Gauze or cotton balls. A must – I’d keep a few ready and one placed below, or a bluey (or some other, disposable sheet) if possible where you’re about to inject. Blood inside cannula dressings can be an infection risk, and if you miss you should be ready to clamp down on it straight away. Bloody sheets/pillows are never fun. 
  • More than one strip of alcohol wipes, in case you need more cleaning or if you’re checking a few injection sites. It’s not fun being left, anxious and alone in a room, waiting to get stabbed while a nurse or doctor runs outside looking for extra wipes.
  • Gloves and other requirements for sterility. In many areas, cannulation is becoming a fully sterile procedure, and many wards/units are clamping down on “cutting the tip off the end of a glove” for infection reasons, so being able to cannulate with goves will become more and more important. Try and do them with gloves on. 
  • Correct needles, of course. A butterfly is always best for the patient for blood taking purposes, on the patient end. They’re generally fine to use when you only require small samples.
  • Although smaller needles are nicer for the patient – they can alter blood results (very fast flow through the needle can cause haemolysis too!) slightly, and slow down the drawing of blood, making it more likely veins can collapse. Too large though, and it’ll not only be more painful, but also more easy to miss. Getting the right balance is key!
  • Remember you will need to choose the best one for the job – depending on how much blood needed, how big or small the veins look, or, in cannulas, at what rate medication/fluids will be pushed through. 
  • A small, yet short, plastic tube addition to the bung is also recommended. It will reduce pain for the patient from having to twist the cannula every time to flush it or when connecting new medications. Simply attach this to the end of the cannula and the nurses who administer medications through that cannula/port will no longer need to directly touch the injection site (reducing the need to move or twist it; thus reducing pain for the patient, as well as the infection risk). 
Rightmost tube is an example of what I’m talking about. Attach this to the bung and nurses and patients will find it easier and less painful to flush/access the cannula.
    IX     
Tape to hold down any such additions as in the above as well as to secure the IV tubes.

      
 THE NEXIVA CANNULA. 
           This new-ish type of cannula, pictured underneath, has a section of  tubing already attached so you will not have to come in contact with the blood at any point or touch the cannula once inserted.

                
                What makes it the best cannula to use is its basic function. The needle in this cannula is inserted the same way as a regular cannula – with your forefinger placed on the soft tab in the middle (the wings supported by middle finger and thumb). As you withdraw the needle itself though, you need not pinch the vein down proximal to injection site as blood enters the tube meaning you will not come into contact with the blood or have any blood spurting everywhere.
                  After you insert you see initial flashback, followed by a second flash which is where you stop threading it. The amazing thing about this is the needle itself. When you remove it, simple pull back on the tab at the end and it pulls out with a cap on the tip – so needle sticks are COMPLETELY eliminated making it MUCH SAFER for the injector. 

Nexiva cannula pictured above. See sources below for more info. Notice the needle itself can be pulled out with a cap on it (grey part).

 

2.
Make sure you gather all the correct equipment and keep it on a tray/trolley on your non-injecting hand’s side. This will ensure that you can reach all equipment easily without it getting in your way.
3.
Try to be seated comfortably or, at worst, be kneeling, rather than bending over a patient. Unfortunately you may have to spend a while looking for a site to cannulate or injecting properly and hence a sitting down position with the patient high in the bed/seat (so you don’t have to bend over) is best.

Preparing the
Patient:

 

Often ignored, but vitally important is the patient’s own preparation. But luckily there are ways you can help out, even if you just inform your patient so they know better for next time:
1.
Try and get the patient to be properly hydrated before cannulating/taking blood. The more fluid and blood in you, the more likely it is to pool up in your veins, where you’re trying to go. Also, increasing turgor of the skin allows for easier injection.
 
 
My arms 20minutes before and after drinking two glasses of water (obviously not – but in reality it does make a huge difference – one reason why I think doing blood rounds in wards just after patients wake up isn’t too smart even though it’s easier for doctor’s rounds.)
2.
Ask the patient if they’ve got any preferences based on previous experiences – especially if they have been cannulated often. I guess that some patients who have only had a few may not be experts on the matter, but at the same time I feel doctors in particular who cannulate me will often go for veins that I have insisted simply do not work (some god complex – “what would you know, you’re just a patient” mentality) and, more often than not, they’ll fail. I MEAN C’MON! I’ve had at least one hundred by now – and many patients are in the same boat, so if they have had a few before and it isn’t contraindicated – do listen to them. 
3.
In order to make palpating the veins easy – place a heat pack over the arm/area which is most promising. It causes vasodilatation as blood attempts to cool itself by pooling to the surface in your veins and hence makes palpating and cannulating easier.

If a heat pack isn’t available, fill a glove with hot water and place it on desired spot or run a towel under hot water. I picked up this little trick once in the ward where they didn’t have a heat pack so there will always be a way to do this =]

 

4.
Talking to the patient is VERY effective in reassuring patients and will reduce occurrences of syncope and also reduce vasoconstriction due to anxiety and the fight-or-flight response. Anxiety will also mean faster blood return to the heart, meaning less blood in veins to draw blood/cannulate easily. A two way dialogue will be best for this. Seeming confident will also reduce a patient’s anxiety, and hence make you more likely to get it right the first time. So even if you’re not that confident, act like you are – putting on a false bravado about your skills will not only help your patient, but also you as you won’t hesitate and miss by accident.
5.
If veins seem hard to spot or palpate, place the arm you wish to cannulate below heart level with a tourniquet on it before resting it up in a position to inject. This will increase blood pooling to the veins due to gravity and the tourniquet will further the pooling effect.
6.
Don’t forget to ask if they have any conditions which will make this hard/messy – eg) blood thinners, low platelets etc. and plan for it by having the appropriate gear with you.

Choosing/readying your site:

 

1.
TAKE YOUR TIME AND DON’T BE AFRAID TO PASS IT ON TO SOMEONE MORE EXPERIENCED IF YOU’RE NOT CONFIDENT. Too often I’ve seen doctors/nurses rush in to cannulate and miss and end up spending twice as long looking for another vein (often only to miss again)!
2.
When looking for veins, always try and rely on your sense of touch first. Seeing veins is always a good hint of where to go, but a vein should feel soft and spring back – even more so when the tourniquet is placed above it and other preparation measures are applied – and often sight can be deceptive as less suitable, superficial veins will seem more appealing.
3.
For regular venipuncture, the cubital fossa is often a good place to look first. Care must be taken not to inject the brachial artery, but the veins are often large and always closer to the surface. However, for cannulation, the forearm, the dorsum of the hand and a vein on the radial border of the distal part of the forearm are more promising (although the wrist veins are usually small, painful and restrict movement). The cubital fossa is more susceptible to kinks 
and having the cannula tissue/extravasate, as patients move around at the elbow a lot, . People underestimate the pointiness of the actual plastic cannula and don’t realise that it can penetrate the vein from inside if it moves around too much! Unfortunately, in emergency wards, they often attack this vein unnecessarily for cannulation because it’s easier to get. In my eyes – it shouldn’t happen if a patient is being sent up to a ward or observed – only reserved for “get the cannula in or die” situations.
4.
There are deceptive muscles and tendons in your hands that will feel like veins. So get the patient to flex a few times if you’re trying to differentiate between a vein and muscle.
5.
Forked veins seem to roll less but remember – they often have valves by the bifurctication. So instead of going in at the bifurctication, go slightly proximal to it (in order to avoid valve yet still get a vein that is less likely to roll)
6.
Place the tourniquet about 20cm proximal to a promising site. Too far will not ensure enough pooling and too close may just constrict your entry point. It is generally considered safe to have a tourniquet on for five minutes maximum before ischemia becomes an issue – though I wouldn’t risk getting too close to that time, and wouldn’t tighten it too much.
7.
Look for already straight veins. Pulling the vein straight won’t do anything when choosing a sight or when injecting, as it will revert to its original position.
8.
Valves can be tricky. However, they are palpate-able as small dips as you pass along a vein. Avoid these at all costs as they are very hard to navigate out of and cannulate/venipuncture. 
Remember valves are there to stop blood flowing away from the heart in veins. Therefore – if you palpate one on a promising vein, inject to the proximal side of it so you aren’t stuck behind the structure.
9.
Tap the vein gently in order to vasodilate the veins. Doing so will cause slight stress in the vein to release NO which is a vasodilator as well as histamine from mast cells which have the same effect. Rubbing gently has a similar effect and is actually more effective on cubital fossa veins.
10.
When sterilising the skin with alco-wipes, allow at least 30 seconds for it to air dry. Not only will it allow more bacteria to be properly dealt with, it’ll mean the stuff won’t sting if it gets pushed into the vein. Fanning or blowing it will only increase chances of infection and cause the alcohol pool up in areas, potentially increasing the stinging as you inject.
11.
Place the patient’s hand on a pillow or a stable yet soft object in a comfortable position as you are about to inject both for comfort and ease of access for you. Don’t forget to have a bluey or piece of gauze underneath where you’re entering for cannulas!

Going In – keeping the patient calm and getting it right:

 

You’ve picked your spot and have it fully prepared. Now all you’ve gotta do is get in there.
1.
To stop vein from rolling away, pull the skin and muscles a few centimetres from the vein taut. Do not attempt to straighten the vein
overtly, as, as I’ve mentioned before, it will retract to its usual state as you inject anyway, causing tissuing and more pain.
2.
Distraction therapy is helpful. Not only can you talk to a patient as it is about to go, I’d suggest getting them to look away. The natural fight-or-flight response will quicken heart rate, even subconsciously, and cause less blood to pool in the veins you’re aiming for. Other methods include getting them to focus on doing other things like wiggling their toes or tapping on a table (not your rest table of course) to get their mind off it.

With kids in particular, this is vitally important. You cannot lie to them about the pain, as it may lead to involuntary jerks or movement as you inject, but getting their mind off it will definitely help. Again, the trusty glove can be blown  up and have a smiley face drawn on it to make it look like a spiky-haired friend. Definitely will cheer up the kids =]
3.
Hold the
patient’s arm firmly
with your non-injecting hand, as involuntary jerks are common and can disrupt the procedure. Also be sure to watch for any signs of syncope.
4.
As you inject, the best angle, in my experience (and that of the best jabbers I’ve talked to) is anywhere between 10 and 30 degrees. Also, a quick jab as you pass through the skin is most effective in reducing pain – although taking it slow after you hit the vein wall is essential. You don’t want to jab through the other side.
5.
Don’t forget to point the bevel up towards you!
6.
Local lidocaine, a weak anaesthetic, is also an effective way to stop pain. But only if you can master injecting it into the dermis (level of skin just under the surface) rather than into the vein. A small jab into the dermis only 1 or 2mm into the skin followed by a slight push of only one or two drops should be enough to make the cannulation almost painless. This is usually more useful in larger gauge cannulas or on difficult-to-cannulate patients, and, like any local, you should give it time to take effect before penetrating the skin again for the cannulation.
7.
Don’t feel you have to inject from right above the vein! Pressure directly on top of the vein can often cause elastic veins to roll more, so going at an angle and entering the vein under the skin rather than going straight above it can help.       
8.
Once you are inside, and you see a flash of blood, go a few millimetres deeper in order to ensure that the cannula is genuinely inside the lumen of the vein
and not just the needle tip. Has happened to me a few times where they removed the needle too soon and just ended up being a bloodier-than-usual miss. 
As you can see in the picture above, the cannula may give a
false impression of being inside the lumen when only the needle point/bevel end is. Going
only a little deeper will ensure the cannula is properly inside. Using a nexiva cannula while withdrawing (requires a bit of practice) the needle removes this necessity. 

9. If you do not see the flash of blood, do not immediately remove the needle.  Attempt, with consideration for the patient (as it can be painful) to withdraw the needle a few millimetres
in case you went to deep. The needle may be resting on the opposite vein wall, so doing this will ensure quicker blood flow into the needle during venipuncture in particular.  

Palpate around the needle to see where the vein is and where you  should go if you need to adjust it further. Though painful, in my experience, and from what nurses and doctors have told me, “digging around” for the vein after you’ve missed is less torturous than having the needle reinserted elsewhere.
 10.   If you do happen to miss, you should have a piece of gauze/a bluey underneath your spot so blood spurting should be fine. Remove the needle and cannula as usual and immediately
press down to prevent bruising
from blood seeping into tissue. 
11.          If you have missed, try the other hand, or choose a spot that is proximal to the elbow on the arm as it will not be impacted by the miss further down on the vein as severely.
12.        When taking blood, remember to keep the vacuum tube ready to insert into the suction cap. If that doesn’t work use the empty syringe instead to pull out blood. As it has a more powerful vacuum, it can often produce results where the vacuum tube cannot – though care should be taken to make sure you don’t end up pumping air into the vein. Remember, you should always try to take blood from a cannula if it’s required as patients like me will definitely appreciate not having to get stabbed twice. Do not do it after flushing cannula though as it will heamodilute the blood sample thus distorting results. 
12.   TAKE THE TORNIQUET OFF AS SOON AS BLOOD IS BEING DRAWN! It’s OK to leave it on prior to a patients’ blood being taken, but too long can alter results slightly. Ideally, it should be removed/loosened as soon as blood starts being drawn. 
13.   Flush after placing cap on needle. As you are placing the cap, pinch the vein a few centimetres proximal to injection site to stop blood from spurting out.

POST CANNULATION

 

1.
Try and put a small tube that extends beyond the cap of the cannula and tape it down along the length of the forearm/arm. This ensures that the patient will not have to have the cannula twisted every time it is accessed and hence reduces chance of kinking and extravascation inside the vein too. 
 As seen above – there is a small tube attached to the cannula which the nurse is flushing the cannula with. This avoids having to twist and move the actual cannula when using the cannula. 
2.        When required, or if delays are occurring during blood collection for whatever reason, keep already collected tubes moving (turn them from facing up to down rapidly 5 times) to reduce the chances of the blood clotting too early and distorting coagulation results.
3.
Anchoring the cannula. The most powerful anchor on a cannula I’ve seen and had done on me was to place a strip of tape underneath the cannula, perpendicular to the direction of the cannula with the stick side facing up. Criss-cross the tape around the insertion site, making a “bow” shape (see picture below). Place your usual, preferably transparent dressing over the cannula as you usually do and finish by placing a strip of tape again perpendicular to the cannula direction, but this time toward the cap to anchor it firmly. Although you may not see the injection site, most problems arise from the cannula slipping out rather than an infection near the entry site (which can be seen through this anchor anyway) so a good anchor like this IS necessary. 
 That’s right… admire my impressive paint skills.
 
4.
Give the patient a “sock” to place over the cannula. Can be easily created from a cotton ribbed stockinette (easily findable in any medical store-room) by cutting a decent length of it out, enough to cover cannula and portion of forearm, and making a small slit on the side where you can feed the patients thumb through. This will protect the cannulation site and stop
unnecessary kinking and pain on the patient’s end too. Having just had a cannula tissue due to the dressing pulling back today, I realise doubly how important this is now!

Removing the needle:

 

1.
Again, keep a piece of gauze ready as you remove the cannula/butterfly/syringe.
2.
Immediately after removing it, press down hard on the insertion site. This will reduce bruising significantly post removal as the major cause for bruising in this procedure is allowing blood to seep into the tissue and hence bruise the area. Ask the patient to hold it down for two minutes after removal of cannula. 
3.
A very good tip is to tie a tourniquet around the insertion site very tightly (around a piece of gauze/the dressing of course). This causes any bleeding to stop rapidly and will significantly reduce bruising and bleeding.
So these are the best tips I’ve picked up over years of being cannulated by the pros! 
Remember – share this with other patients, med/nursing students and doctors and anyone else who may be interested and share your experiences/own tips by commenting below! If I see really good ones – I’ll definitely add them to the post. It’s all about improving the experience for the patient so don’t be ashamed or shy to do so!


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Nexiva cannula – more info/reference and details on if they’re in your hospital:
http://www.sarb.be/fr/journal/artikels_acta_2005/artikels_acta_56_3/acta_56_3_vanzundert.pdf
 
Blog

Hallucinations

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Your mind is a powerful thing.
 
It’s your personality, your spirit, it’s every aspect on how you view the
world.
 
It’s you.
 
It’s no surprise, therefore, that when your   mind gets affected by something and you lose control of yourself, it is often a torturous, traumatic experience.
 
During my treatment, I had a brush with that. 
 
I developed an allergy to a drug I’d been taking for a long time for some reason or another that gave me PRES (Posterior Reversible Encephalopathy Syndrome) – a
very rare, but luckily, reversible condition, that sends people down into a staggering path of seizures, altered personalities, nausea and hallucinations.
 
Those 2 weeks I was being treated for it 2 of the worst in
my life. 
 
But looking back I am able to see past that and not let it affect me. It wasn’t easy to do so. It took some time, but today I can look back and draw from my experience in a positive manner.
 
I hope what you’re about to read can help others do the same.
 
The scariest part of my condition was definitely the hallucinations. How real your mind can make impossible situations seem and the weird sort of links you see in the world when you’re out of your mind can be just plain frightening. But the fact that they are the projections of your inner soul – your inner person – allows yourself to see who you REALLY are deep inside. I was lucky enough to come out of it good…
 
But not everyone would be as lucky as me, or able to see their way past a mental illness and come out the other end like I had. And their trials aren’t limited to extreme things like hallucinations. Things like trauma and depression people face on a day to day basis are even harder to see out of sometimes because it becomes a part of someone. Some of the things
I experienced and saw really makes me sympathise with anyone who has to face that struggle every day of their life.
 
And unfortunately, millions of people do.
 
Here are a few of the most powerful, moving hallucinations I
had. For anyone who’s ever gone through anything similar to this or anyone who
may be going through a severe issue such as this, I really hope that this helps you get past your experiences and
encourage you to talk to someone about your fears and concerns (that someone can be me) and find a way
to move past them.
 
 

Time travelling

You guys remember the whole Mayan Calender – “The world is gonna end!” – Armagedon sort of event that was predicted to happen on December 21 2012 right?
 
Well, I experienced it all a few days before you all… 


Let me explain.
 
During my time with PRES, I was obsessed with the idea of time. I don’t know why but things like the clock and the time display on the
computer terrified me. 
If I glanced at a clock face in that time, the hands would change directions every now and then, they’d sometimes grow a tail and even flip around, and twist and move in different directions.
One day, I was on my laptop. It was the 12/12/12 andapproaching 12am, midnight. My mind in its state, shifted it to 21 though and as time ticked over – I entered Judgement Day 8 days before everyone else.
 
I was panicking – I knew about the whole Mayan Calendar thing and in my confused, delirious state, really thought that the world was going to end. I started clutching at the straps restraining me, struggling to sit up to look through a window at the sky that wasn’t even there in the Intensive Care Unit, and see what was happening to the world.
 
Well, oddly enough nothing happened. Not even through the day. But I lived a full day – more than a week in advance – all in my head. I actually lived it – experienced everything from the taste of the breakfast muffin dad got me that morning to the feel of a fan cooling my face to even seeing and talking to visitors who never actually came – all in my head!
 
Even more amazing – I envisaged a whole day’s worth of international cricket (a sport we Aussies love to watch) playing on the TV the whole day. Australia had a great days play so looking back at it now, it’s made me realise how much pride I have for my country. I even watched a YouTube music video of a “newly released” song by Eminem, Kanye West and Hopsin all in my head. I looked it up a few months afterwards when I was thinking back to this particular hallucination and realised that I had, in the span of 3:45 minutes,
made up A WHOLE SONG – chord progressions, beat, lyrics and all WITH music video to match in my head.
 
That in itself is amazing!
 
But the next day when I woke up and saw that it was actually the 14th of December – I was shocked. The whole time I was hallucinating, I didn’t even know I was. I had lucid moments where I was myself  for a few minutes a day but I don’t remember those. So naturally I panicked as I believed that I’d just travelled through time. I lashed out at doctors, nurses, my family – accusing them of making up my whole disease and forcing me through useless treatments, asking questions they couldn’t answer like why the windows were open when there weren’t any in the ICU anyway in my confusion.
 
It was my family who got me through it all – who grounded me every time – sometimes even playing along with hallucinations and withstanding the tempers and tantrums that came with them. What I was going through was hard  enough – but I can’t even imagine having to watch someone you love go through all that pain. My brother in particular had to focus on this AND his final years’ exams too – how he managed to do as well as he did still astounds me! They kept me laughing, kept me as sane as possible – something I can never be grateful enough for.
 
Something that I now realise countless carers and supporters do for people with mental illnesses every day of their lives!
 
 

Kill me.

It started off a normal day. I had just started losing my hair again after chemotherapy actually and in my almost deranged state – was scared out my mind by visions of floating strands of hair entering my central line – an exaggeration of how germophobic I get when my immune system gets killed off from chemo.

Footage of me having a hallucination. I was seeing hairs everywhere, and my oxygen prongs was acting as a shield, protecting me from them. It was super trippy.
 
In any case, my doctor came into the room and I had a sudden vision. The light shifted and it was as if all those hair particles were emitting from HIM and coming to almost attack me.
 
The scary thing was the sense of doom I got from it. I connected his presence with the reason for me being attacked and infected by all the bugs I was getting sick and I found myself shouting at him to get out of the room.
 
What I did next I can’t even believe. I reached for my central line and was seriously contemplating pulling it out. It wouldn’t be lethal if I had done it, but I had just been overwhelmed by my circumstance and had made the conclusion that the hairs were going to cause an infection and kill me.
I wanted out.
 
Nurses came running in and I was asking about euthanasia and if they could do it for me. To be asked that question by someone who only days before had been smiling and genuinely
happy must’ve been terrifying – but as usual, they did their job well and grabbed the doctors. I suspect I was also put on suicide watch or something like that too. 
 
What I did later that night though horrifies me to this day.
 
I was suddenly pulled out of my reverie before I started sleeping and saw small chunks of hair entering my central line again.
 
I grabbed my mother’s hair and screamed at her, “KILL
ME NOW! BEFORE THEY DO!” I pointed at my line again, urging her to see the clogged up chunks of possibly lethal shavings running into my veins. 
“PLEASE!”
 
To be asked that by someone you love is horrifying. The way she managed to calm me down with the help of the nurses and remain smiling in front of me astounds me to this day. I can never thank her enough for all she’s done for me – but that one night in particular stands out from the hundreds she spent running back and forth from home to hospital, 45 minutes away, cooking and preparing meals all the time and sleeping on a too-small couch in that dreary hospital room for months on end.
 
It made me really appreciate the support I had behind me and it made the horrifying experience just bearable for me. Her support, her courage, is why I can write this today without being affected by it.
 
And there will always be someone who can do that for you in your time of need – whether it be someone, like my amazing mother in my case, in your family, a friend or partner, me even (feel free to comment your own experiences anonymously below) or best of all – a professional. Do not feel ashamed or weak to do so. In truth, if you take a step back and ask yourself why you shouldn’t talk about it – you’ll see it’s only an excuse to not get better and taking that first step and confiding in someone is actually the most courageous thing you can do.
 
Though the first two may seem otherwise, not all of my hallucinations were dreary, dark things with little hope. In fact, most, though scary or confusing at the time, are actually quite funny looking back at them now and there are a few that I as exalting, inspirational revelations rather than something to feel down about. Hopefully by reading about this one you can
see that any issues you may have – any trials you may face in your future – can ALWAYS be seen in another, more positive way.
 
 
The Most Amazing Hour Of My Life
 

This one started not too long after the last one. 

 
A few days prior to this particular hallucination, I’d had an episode of cortical blindness – a weird kind of blindness where your mind refuses to register images that you see
but you’re still able to walk around without falling over things and are still otherwise aware of your environment  For some reason I was suffering from extremely blurred vision for the days after that too.  
 
It was 7:30pm on Sunday night – and my favorite show was about to come on – “Extreme Fishing Adventures with Robson Green.” My elder cousin – a really good friend of mine – had come in to sit down and chat and I hadn’t seen him in weeks so I was glad to have him there.  Dad was there too – he wouldn’t miss that show unless he absolutely had to!
 
But for some reason, I was getting a really weird vibe from them both. The way they’d look at each-other every now and then with solemn looks and then turn away when I caught them looking made me think something was afoot. And I was getting an odd feeling in my chest – a little tightening maybe – that was bugging me.
 
The episode began with the these song playing and it was like a veil being lifted away from my eyes for the first time in years. The blurriness, the weird flashes of light that kept coming up and annoying me as I tried to see things shifted in an instant and I could see perfectly again. Everything was well defined and clear as if a group of electricians had come in and with
pit-stop-team efficiency changed my television to the most high-tech, advanced HD possible and left without me noticing.
 
I exclaimed “This is amazing!” and Dad and Manik, my cousin, looked over questioningly, with slight, almost knowing smiles on their faces.
 
“What’s up?” asked Manik.
 
“I can see everything… better than I have before. The TV, all the posters in the room – I can see people’s faces on the street!”
 
“That’s good man,” he said, calmly.
 
“Yeah, it’s cool isn’t it,” said Dad.
 
I was a little confused at their lack of excitement at the sudden reversal of my symptoms, but the show that was on was so beatific I soon found myself entranced by it. One of my greatest hobbies in life – fishing – was being displayed in the most perfect way possible. The host, Robson Green was sitting at a spot not too dissimilar to one of my favourite places of all time, a little lake surrounded by trees and sand and wading out to mid-ankle  level and casting at fish he could see and – more importantly – catching them too.
 
My conversation with my cousin was one of the funniest and one of the best I’d had ever, as we relived all our old experiences of playing basketball together, of holidays we’d gone on years in the past and laced it with exaggerated, mostly made up references of our conquests and the prowess we displayedin dealing with the fairer sex.
 
As the show ended, everything became even more surreal than
before. 
 
Breathing was getting harder – but not painfully so – just requiring a little more effort than usual.
 
“How are you feeling,” asked Dad, concern showing clearly on his face.
 
“I dunno but I’m feeling a little slow I guess, but it’s probably me just a little tired. How good was that show?”
 
“Yeah it was good wasn’t it,” he agreed,”Your timer’s getting low, might wanna buzz the nurse in soon.”
 
Sure enough, my medication pump started beeping and in a few minutes the nurse came in, checked my medications and put on the 5 minute, post medication flush, nodding at my father and Manik as she left the room. I gazed at them questioningly but was distracted again by the show.
 
It was as if everything had shifted. Robson – the host of
the show – talked and it was as if he was talking directly to me.
 
“The end is near. And it will go off with a bang.”
he pronounced, gently caressing a little trout he’d just pulled in. “Don’t
worry – don’t be afraid – it won’t be hard, in fact, it will be beautiful. I
present to you Extreme Fishing, the Movie.”
 
A sense of finality came over me. But it was peaceful – soothed by the smiles of my father and cousin and made happy by the montage of scenes of his upcoming movie playing in the background.
 
I was starting to get a little scared and glanced anxiously at the timer on the pump as it ticked down closer to 0.
 
I thought I was going to die.
 
“Don’t worry, Nikhil,” assured Dad. “It’ll all be over soon. And it won’t hurt”
Robson’s voice called out, breaking the little silence,
“It will not be sad, it’ll be over quickly. And it’s coming soon.”
 
“Dad, what’s happening? Why are you guys acting so weird.”
 
The pump started beeping.
 
“Don’t worry, Nikhil. Press the silence button. Trust me – you’ll be fine.”
 
I glanced over him and at Manik tentatively. I looked at my pump again and the time was out. I suddenly realised they must’ve rigged the “Silence Buzzer” button to release a medication that would end it all peacefully.
 
I glanced at them, tearing up a little. But they glanced back, solemn looks on their faces, and nodded for me to continue.
 
I looked back to the button and slowly extended my finger  outward. It would all be over soon. I could feel it. But I wasn’t scared. 
I trusted them and knew they’d know best of what was to come. Though I was shaking, tears streaming down my face, I slowly found it in myself to extend that finger and closed my eyes as I pressed the button, leaving us in silence.
 
I waited – knowing it would take a while for the medication to take effect.
 
After a few minutes, however, I opened my eyes, and blinked
a few times. 
 
Nothing had happened. I turned my head back toward my cousin and father to my right and saw them beaming at me – grins stretched across their faces and eyes shining tears.
 
“What happened?” asked Dad, struggling to hold back a smile.
 
“I don’t know… Why did you do that to me? I was so scared…”
 
“Why do you think you’re going to die! Son, you’ve made
it. You’re fine!” he said, choking back a sob.
 
I sit here now, crying in joy as I write this, and am still astounded by that one moment of pure joy, of pure ecstasy that my mind had made me experience.
 
Can you imagine the utter joy that experience brings me?
 
It let me know that deep down, in the core fibres of my being, my inner soul – I was so sure, so CERTAIN I would be fine, that I wouldbe happy – despite all my struggles and pain, despite being told I had only a 10 – 20% of surviving twice and despite all the doubts I had along my journey. That I could envision something so uplifting, so motivating, so beautiful in a time where I was at the lowest in my life amazes me. And I thank my experiences, the attitude I’d developed with the help of my family, doctors, nurses and friends and myself
every day for allowing me to experience such a thing in my life.
 
*****
 
Your mind is a power thing.
 
And when something about it goes wrong, it can be a harrowing, life changing experience.
 
I am lucky enough to be able to have a healthy mind now (though I’m sure my brother would dispute this claim) and am so much more aware and sympathetic of the struggles people face on a daily basis in their battle with mental illnesses.
 
It affects a lot of us – depression will hit 1/2 people during their lifetime, dementia and Alzheimer’s are on the rise along with many other mental disorders and people face trauma and struggle to deal with pain every day of their lives.
 
I hope that my story of my own experience can help you to see that it isn’t something you should be ashamed about, or something that has to take you down. Give it time, do talk to someone about your problems – if possible a professional – and I hope that you do get better.
 
I know that each and every one of you can have all the happiness in the world.

 

All you’ve gotta do is give it some time and you’ll realise
that YOU have the power to control how you feel. 



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