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

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!

 

Dad Jokes!

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. 

Pi** off DoorKnockers

This is the kind of thing my dad does. After being woken up by Mormons at 8am on a Sunday, Dad was fed up. So he created this – the ultimate deterrent for any doorknocker. Get this free in an easy to print document below, or buy one from our online store – all profits fund my lifesaving startup – Get To Sleep Easy (more info on THAT here –> gettosleepeasy.org ) – which is creating affordable, lifesaving hospital beds for all!
Sign up to my email newsletter to get it free! (Don’t worry, I don’t spam you, and you get it as soon as you sign up!)
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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… Mr 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!!!!!
 
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Some of his “original jokes” that he kept saying to keep me smiling in the tough times. 

   
Video Proof that we’re Dumb!

So all the memes, jokes and things we get up to, I try and film when it’s remarkably stupid/fun. Check out my playlist on What Cancer Patients Do In Their Spare Time by clicking here.

Be sure to like/comment/subscribe too while you’re there haha! YouTube.com/nikhilautar.

Random Jokes he’d pull out from nowhere.

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!

 



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?

 

The Ultimate Cannulation and Venepuncture Guide!

Last post:                                      My Story:                                          Next One:

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
 

Hallucinations

 Last Post                                     My Story:                                         Next One:
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. 



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 my page on facebook =]

Why and How are Doctors and Medical Students so Depressed? And What Can WE Do About it?

The day I got into medicine, was the greatest day of my
life. 

I’m sure many medical students and doctors would tell you the exact same
thing…

For me it was personal. 

I’d always wanted to study medicine. What better job was there? You could save lives
and live in relative comfort your entire life. I’d get to emulate my childhood
hero growing up, Captain Hawkeye Pierce from M.A.S.H. 

But after leukaemia struck my life… it became personal. 

I wanted to help people as I’d been helped. It was my doctor’s words; that
“The Good News Is You’re 17 and You Have Leukaemia, but the Bad News is
You’re 17, And You Have Leukaemia…” and his actions that got me to
believe that I actually had a chance in this… It was another patients’ words
the day before my transplant that really sunk in, and changed my life. Imagine
being in a position to do that for people everyday!

My first day in medicine was one of the most joyful of my life. 

I was so excited to finally be in a position to give back, and so delighted to
be alongside so many other people who cared just as me. 

But as time went on… things changed. 

For me, and for many of my classmates too. 
 
 

As I progressed through the course, I got more and more burdened with work, and
more and more dissatisfied, and indoctrinated (pardon the pun) into the collective Group-Think of
modern medicine. One which emphasised speed over accuracy, marks over
competence. One which measured success through KPIs such as reduced wait times
and greater efficiency rather than reduced morbility and morbidity, and higher
patient satisfaction and involvement. As I feel many in this profession feel at some point. 
And this in a population who are most educated about
mental illness, and the fact that they are illnesses, not just an abstract
constructs or “excuses,” as many still widely suggest and believe.
Somehow still, amongst those with depression or severe symptoms of
depression, 
only 15% of medical students actually get help… For doctors… the rates are even lower

Why is this happening though? 

Aren’t these people being paid heaps? 

How I imagined life would be after med.
 
Aren’t they close to services? 
 


Don’t they know the risks of the disease, and how altered biochemistry can
alter your very mental state – your very person? 


Well, there are many reasons why. 

Various personality traits and attitudes make doctors more likely to suffer
from depression. 

Perfectionism, hints of narcissism in some, compulsiveness in others, martyrism in most, and disparaging views of
vulnerability are all commonplace. 
Facing death, watching good people suffer, and losing
the battle over and over again
 also burdens doctors. Burnout from stress affects 45%
of doctors
, ladies and senior physicians in particular. And as this article puts so poignantly, Osler, the founder of the
first American residency program, advocating for equanimity in physicians, was
perhaps the largest contributor to all this… 
Many doctors feel that showing
weakness is a failure on their part. A failure.
If they’re not steady under pressure,
how can they serve their patients? 
And that can be a tough burden
to bear…
400 doctors take their own
lives in America alone.
An entire medical school’s
worth…

Junior doctors and medical students have similarly sky-high rates of depression
and suicide ideation (the 10% figure is a conservative estimate; studies in my
nation show , but have the added pressure of exams and the weight of
expectations on their shoulders too. 
Furthermore, other factors, such as living on their own for the
first time, often overseas for many students (where the added pressure of
maintaining a steady income is another burden), high levels of student debt,
and the sheer pressure of the course and succeeding itself plagues many
students. 
Many of my medical student and junior doctors friends
complain about many of the above stresses. Many feel medicine takes over their
lives. In a time where they should be out and enjoying their life, many
students, as well as doctors, regret not enjoying life more. 
And many feel disillusioned too. They feel they were misled
about what medicine actually was. About the impact they have. About the
difference they make. So many of my friends express this in particular. 
But the toxic, competitive hospital environment, where specialty spots are
limited, the medical heirachy is emphasised (
and perpetuated by older doctors in an “If I went
through it, they should too” manner
) and bullying is rife, also pushes many
young meddies over the edge. 

Very recently, in my country, Australia, 
3 junior doctors took their lives within one week

One of those young doctors, a passionate advocate for medical students took her own life. 

 

THREE. YOUNG. LIVES…
With so much to look forward
to.
In. One. Week. 
2 people I knew took their own
life last year. 
1 was an old school mate of
mine. 
What can we do about it then? I guess that’s the question
that remains. 
Well, dealing with how doctors perceive themselves and
mental illness is one step in the right direction. 
This great TED Talk, one of the highest rated of all time I
believe, discusses the expectation of doctor perfection, and how this
counter-intuitively actually worsens patient outcomes. 




When doctors feel they have to be perfect, that their
mistakes are their fault, a great burden is placed on their head. 
It’s important to be competent, don’t get me wrong. But
this unreal expectation of perfection is what, as Brian Goldman points out
here, is only harming doctors more. 
We’re not learning from it right now. There’s no mandatory
reporting of issues or near misses in hospitals. More recently, at a quality
and safety lecture I attended, I learned there was one in our hospitals in my
state in Australia, but that it was under-utilized, and something feared by
doctors, as opposed to the learning tool it was intended to be. 
Something as simple as a place for doctors to confess
mistakes, and seek sympathy from other doctors, could change the lives of
hundreds of thousands of silently suffering, perfection seeking, burned out
medicos. And it could improve patient outcomes too. 
Of course, it needs to be a done in a sensitive manner.
Perhaps confidentially, with identification being made impossible. Though it’s
horrible that some die due to lapses in doctors’ concentration, as pointed out
in this article, 
overworked doctors, facing physical and emotional
stress, are less competent ones
. Hundreds of thousands will die due to medical error this year alone –
medical error is estimated to be the third highest killer
 in the American medical
system. 
The numbers are alarming, to be sure. But not learning from
mistakes, not making diagnostic/prescribing/treatment processes better, and not
giving doctors a place to vent, and relax, is only going to increase this
number if anything. 




A great TED talk by a very
interesting man – Atul Gawande (highly recommend his books on medicine and how
to fix it), discussing a simple process which reduced mortality in surgeries by
as much as 40% – a checklist. These little innovations and improvements are
necessary to accomplish the end goal of saving more lives and reducing
suffering!  
But reducing medical error
alone isn’t the only way we can ease doctors’ strife. 
 
Loss is something many doctors
have to face too. 
 
 
I can only imagine how going to
work everyday, knowing that you’re going to witness suffering, pain and death
can be soul-wrenching. I certainly do feel disillusioned when walking through
wards and seeing the same story, of a seemingly nice person, suddenly finding
their health deteriorating, and then, in most cases, having some scars from all
this tail them for life. 
 
 
It wasn’t easy. It never is at
first. Especially when it’s someone you’ve really connected with.
 
I can’t imagine how you doctors
can deal with it. This is how I dealt, and deal with mine though…
 
When George passed… I was
devastated. It shouldn’t have happened. Not just because he was so young, not just
because he’d left a baby behind, but because it was so sudden. So unexpected.
Just so unfair.
 
And I was bereaved.
Inconsolable. But silently suffering. For weeks.
 
I didn’t realise it at the
time, but I was going through depression. That was the first time I did. That
someone so young, innocent, someone who I’d helped grow to overcome so many
battles and someone who I thought would make it could go so soon made me
question why bother at all? In the face of so much struggle, so much of which
that we couldn’t resolve… Why bother facing anything at all? It didn’t make
sense.


 

 
I stayed that way for weeks.
Scrolling down Facebook, watching Youtube video after Youtube video… unfeeling,
uncaring. Questioning why continue at all? Until one day, I talked to someone
about it. My father. He came up and hugged me from behind, and just held me.
 
And I asked him, “why do we
bother?” He’d sensed I was going through something. He didn’t know why. But he
did. A parent’s intuition maybe.
 
He said, “Nikhil. Look.
Everyone in this world will die someday.” An abrupt start to what I’d expected
would be an inspiring, or inappropriate joke, something frequently gushing from
his mouth to be sure. But he continued, “We can’t control that. What we can
control, is what we do in our lives. We focus on doing our responsibility, and
that’s all, as best as we can. And where we can, we leave this place a better
state than we found it in.”
 
I saw then, something I believe
is a fundamental truth of humanity.
 
The feeling of helping someone,
of being an active member of a community, in the essential sense of the connection
that humans need to survive. 



I’d always wanted to help people. It was just the right thing to do, it seemed. It’s why I’d wanted to do medicine. Cancer just cemented that. But I realised that it also is the best thing you can do, not just for others, but also yourself. 


Because that feeling of putting a smile on someone’s face, or easing someone’s struggles… unlike things like fame, money, power, men or women – all those things we seem to desire most in life, that can never be taken away from you. That will never seem meaningless. That’s something you can always do.

And I want to share 1 unwaverable truth to all the doctors, medical staff, and regular people out there reading this…



No matter how dire things seem, no matter how much you feel like you’re just a cog in this machine which keeps churning out pain and death, no matter how much you feel hope, and powerless – YOU CAN, and DO, ALWAYS MAKE A DIFFERENCE.

No matter what the outcome.


Because what made my doctors special wasn’t the medical calls they made or their knowledge and prowess, what made my doctors REALLY special to me was the times they’d talk about my biking progress or my basketball before an appointment (that alone mitigated the 1 – 2 hour wait to see them)… the time one doctor walked alongside me and chatted on the way to a lung plural biopsy which I knew was gonna hurt. It was the time my doctor decided to write in to the medical entrance board and allow me to sit the exams that would allow me to become a med student. THAT’S WHAT MADE THEM SPECIAL… to ME.




I’ve sat down with men who were dying’s families and held their hands as they knew they were about to go, and been told by their family that that night we played snakes and ladders a few days before he passed was something he remembered on his deathbed itself. That the barbecue one friend had on father’s day, when a companion of mine in hospital had finally gotten gate-leave on Father’s day was the best barbecue and one of the best meals he’d had in his life.

But to those reading this, I also want you to know also that you don’t have to go this far to create change. Because the little things are Huge. They not only give fleeting happiness to your patients, your small gestures, and make you feel HUGELY cared for too as a patient… something that I realised I hadn’t felt when I had severe, suicidal depression for a year until I visited my old doctor, who’d treated me first (thank God I didn’t take that jump on that day.)… They also make you realise, at a doctor, that YOU ARE making a difference.That YOU DO matter… Those little acts of kindness reinvigorate you.


And if you take that opportunity to be the light in peoples’ darkest day, instead of going into work everyday thinking “Oh here we go, another 12 hour shift where I’m looking after people I can’t even listen to me, yet alone help or save”, “you’ll be thinking, “whose day can I make… whose pain can I ease… whose LIFE can I change?”

And that’s huge. It’s the difference between this being a job and a profession. It’s the difference between being run down or turning to alcohol or drugs to get by, and feeling fulfilled. It’s the difference between life and death.

So go out there and take every opportunity you can to do it. When you have a spare few minutes, take a few moments to see what allied health services around you can do to help improve quality of life for your patients and refer people to social workers to see how you can improve their lifestyles. They’ve made huge changes to my life, and so many others. It takes a median of 15 years for people to go see a pain clinic, for instance. Let’s fix that.


A reason why people won’t come in when they need to – “Oh why wait that long for something that won’t help anyway”



And if you still feel sometimes down despite it all, please, do get help. The biggest reasons doctors don’t seek help is fear for their career, or what their peers will think about them.

If that’s you, let me tell you this. I’m a man who used his mind to find a way of smiling, despite his cancer, 3 days after being told he’d had it at 17. I’m a man who’s ridden 200km 2 months after chemo for cancer charity. I’m a man one who’s running 2 social enterprises, one of which will save HUNDREDS OF THOUSANDS and BILLIONS in healthcare expenditure and most importantly… I’m man who found a way to smile after he’d been told he’d relapsed and that palliative care was a very good option in JUST 10 MINUTES…



But I still couldn’t outthink depression.
I still was miserable, despite my fighting against it and willing myself on, again and again. I still went into that deep dark place of wondering what’s my point in my mind when the pain I face struck.

If others think are thinking you’re weak… then they’d better have done more than me. Otherwise, whoever is or would, is someone who doesn’t understand something that should be basic knowledge. Someone judgemental and incapable of thinking outside the tiny little box that guides their life experience. Someone beneath your concern, someone who you wouldn’t want to befriend anyway.

Someone you shouldn’t worry about, or let get into your way to becoming the most content version of yourself – something you do deserve, no matter what depression makes you feel otherwise. I say this because one of the other biggest reasons we don’t get help is because we’re embarrassed.



Sometimes that person is yourself. Most of us are strong people. We power on. We’ve gotten through gruelling pre-med studies, then through medical schools and internship and everything that comes with the job, or in the struggle to get there. We can beat this. Or we can’t be one of those losers or sadsacks or whiners who suffers. We just get on with it. Scraping by, as some of us always have.

But getting help isn’t the “weak” option. You don’t get anything out of beating it. Why risk proving it to yourself, or put it off, or dismiss it as unnecessary, or just chinning up, and putting on a facade when you can get help to get you through it.

And I can tell you that when I got help, this all changed. Instead of walking in front of a train that day, I decided to walk across the street from the lab I worked in to see my old doctor, tired, cramping and feeling so alone. And thankfully, he was there. He just sat there, talked, and acted as any person would for another. He did what any doctor should do. He cared for me. As well as took care of me. He sent me to emergency, something you guys reading on mostly likely wouldn’t have to do, and I saw a psychiatrist. When I saw her, she said I wasn’t despondent, and didn’t need admitting, but would require therapy, for some time. When I asked about an SSRI (I’d noticed something was wrong for weeks), I remembered tbere was a drug I’d looked up for my unexplainable, untreatable cramping called duloxetine. I suggested it instead of the one she’d prescribed… and on day 2 of it… I not only lost this fog that was clouding my brain for a year every single day that I now know was depression, I also stopped feeling the pain. I’d felt as good as I had for years! Since before cancer. But it wasn’t just a drug that got me there, and got me to stay there.

It was talking to someone about it. My psychiatrist, he mainly does psychotherapy. Indeed, his goal is to minimise drugs (indeed, I’ve eliminated all of my psychiatric;neurological ones for that depression currently), and I recommend seeing someone who does too – maybe a psychologist, perhaps your nations’ doctor – doctor help line or mental health service (something I found out at that national doctors’ conference that we did for the first time). It seems confronting to do – open yourself up and admit things that you’ve never admitted before – to others or yourself – but the very things that make it seem confronting are the very reasons why it’s great.

What you say, can never leave his or her office. You’ll never see them in day to day life, or even have to see them again if you don’t want to. They are literally professionals at their jobs. And whatever you say to them, they legally can’t disclose to anyone! I encourage you to take that first step of reaching out to one, if you haven’t before, and think you may benefit.

And finally, I’d like to say thanks. You may not hear it a lot as doctors. It seems we patients are becoming less and less grateful over the years, but you guys really to matter to us. You see 20, 30, some of you, even 50 or 60 (in India, that’s common according to my Uncle), but we only see 1. It seems like a huge burden when you put it that way. But it’s also a huge opportunity. I hope what I’ve said convinces you to seize it with all your heart.

Nikhil



If you’d like to talk. I’m always here.
Suicide hotlines: 13 11 14 – Lifeline Australia. Add a +61 after your international dialing requirement and punch this number if you don’t have an alternative.

American: https://suicidepreventionlifeline.org

A 24/7 hotline where you can talk to another doctor anytime –

Contact us




And I’d like to announce what I’m doing for the first time on this blog. I’ve started up a social enterprise that’ll, as said above, save hundreds of thousands and billions of dollars a year! Check it out at www.gettosleepeasy.org – here’s what it is.

 

Cancer For A THIRD Time. When Will It Learn, IT CAN’T MESS WITH ME!

So… what’s been going on you ask?

What’s with that chemo drug you were talking about on Facebook? I thought you said it wasn’t for cancer… and now you posted this?

Well, let me explain.

Recently I started a “chemotherapy” drug, but not for cancer.

It’s called rituximab  – and it’s not only in brackets because it’s technically, in my case, not a chemotherapy, as it’s not “A chemical agent used in the treatment of cancers” (it was given for another condition I have – a side effect of my bone marrow transplant; chronic graft versus host disease. I’ll explain it in detail in a later post) but because it’s mechanism of action; the way it works is not in line with most chemotherapies.

Sure, it can have some of the nastier side effects of chemo – nausea, low immunity, diarrhoea; plus a few others (the reaction many, well, most patients have to it on the first dose can kill if a close eye isn’t kept on it), but many people tolerate it pretty well beyond that.

Me included, so I thought after the first infusion. My reaction to it was mild – only a bit of cold/cough symptoms and a slight tightening of the chest. But over the next few days… the worst side effect came on.

The cramping.

Now I’ve had cramps for a while now; at least 1 and a half years. Ones that come on spontaneously that strike anywhere, anytime (though usually more severely at night), and fast, but they leave me in pain and anxiety for ages. They’ve were bad enough to affect my overall outlook on life and whether it was all worth it for a while (I talked about how I deal with that here – don’t worry, I’m past that now) but since starting this medication… which is supposed to reduce them over time… they’ve gotten even worse.

The two days after my first dose, I cramped LITERALLY all day. In the arms, legs, shoulders, abs; everywhere. After the second dose, a week and a half ago now, I didn’t stop cramping the entire week.

But there was another side effect of it that I also was starting to notice. Shortness of breath. And one night… that got even worse than the cramping. The day before what should have been my third dose of the drug, I got up and, within a few, cramp-filled steps, was gasping for breath.

We were on high alert. Any odd signs, even one as tiny as a new cough, was cause for immediate concern and, if outside hospital hours, a trip to emergency, we were warned. It was 7pm… I’d just won a game of poker. So off to emergency we went.

Just another day in the office for the masked bandit…
Haha played 2 big tournaments in this mask to protect me from infections. It also gave me an extraordinary poker face.

Once we were in there and seen we were given a range of possibilities of what it could be and what they were looking for. An infection of some kind was possible; but given my lack of a cough or fever or any other sign of it, unlikely. A pericardial effusion? Maybe because of this mildly abnormal ECG scan… A pulmonary embolism… a detached clot lodging itself in my lungs, though unlikely, had to be ruled out. Whatever it was, it was clear that we needed a scan more thorough than an X-Ray. So I was booked in for a CT.

So there I lay, back in my familiar bone marrow transplant ward, only 2 rooms down from where I’d received my life saving bone marrow donation, awaiting the results, when this new doctor burst in and told me this news.

“Well… we got your CT back… Though it’s clear of any infections or PEs, there was a lesion found on the forth rib. The radiologists have said it has the features of a chondrosarcoma.”

For a second, I sat there frozen, taking it all in. A few years of medical knowledge and intuition came into play… and the cogs in my brain started whirring… chondro – something to do with cartilage… the tense look on the residents and medical students’ faces behind me meant something was up… sarcoma… a cancer… of the  connective tissue.

Questions went racing through my mind, and before I knew it, firing off from my lips, as my confused parents looked to me and the registrar in charge.

“How do they know it’s a chondrosarcoma?”

“Well… they don’t definitively.. but there is some erosion in the bone, one that was there a few years ago, and it matches the features of it.”

“Could it be something else? An infection of some kind eating away at the bone? Some bad scan? Is it just a hunch?”

“Well probably not the former. Infections don’t look like that on scans. The latter… well… we’re still not sure. We’ll have to biopsy it to see.”

And with only a non-committal bye, she left. Leaving my confused parents and I wondering what the fuck just happened.

When I told a friend… he just said “You can’t catch a break, can you?” It certainly feels that way sometimes…

Still, it’s weird though. I didn’t have any pain, or sudden weight loss associated with this sorta thing. Not even when they poked at the site of it. My haematology (blood doctor) team and the orthopedists weren’t convinced by the scans at first, so they were sent off for an MRI and a full body scan (to both get more details on that lesion and see if there are any others elsewhere.

And that bone scan confirmed the worst. There is osteoblast and other metabolic activity in that eroded bone. Meaning that it is some form of cancer. And the orthopaedists were saying… given my history of acute myeloid leukaemia… that it could be a myelosarcoma. The Acute myeloid leukaemia, my original, EXTREMELY agressive cancer, could’ve been back, this time in my bones…

My reaction to this? Exactly the same as here:

Yeah… I may have cancer again. But, just like when I first got it, just like when I relapsed, just as I’ve done in every challenge, when pursuing any goal, just as I’ve done ANYTHING in life… I took a step back, put it all into perspective and decided to focus on what I could control, on what could help me, rather than all the negative emotions, worries and thoughts; than all those things I couldn’t. Because, as I always say, you’ll always have a second way of looking at things. And you will ALWAYS be able to choose how you deal with any situation. No matter how hard it seems… Indeed, once you see that second, more positive, constructive path… taking it becomes the only LOGICAL thing to do.


I went out and looked at all the evidence of this being the worst case scenario… my original leukaemia coming back. There wasn’t much in the way of evidence, bar a few isolated case reports of this happening in AML patients, and all of them had these bone manifestations at initial diagnosis, or relapse in cases where patients hadn’t had bone marrow transplants; whose main purpose is to maintain a constant immune barrier to cancers coming back. And given the fact that there was a small sign of this lesion there a few years ago, and the aggressiveness of AML – the chances of it being that were tiny.

And luckily my haematologists agree. **Phew** In the off chance it is that though… I’ve still got heaps of options. Even if it’s the worst worst case scenario… I’ve got one of my own. Over the last few months I’ve been looking seriously into cancer vaccine immunotherapies – thinking of a way of applying them to a wide range of cancers. There aren’t many therapies that attack all cancers… my methodology may well do that – it uses your own tumour cells to prime your immune system to recognise and kill your cancer cells. Perfect – because unlike many personalised therapies, such as this one, this doesn’t require huge imput and study of patients’ own tumour profiles and the subsequent design of a drug or therapy for it. A version of it has even been used in my disease – AML – with decent succcess. And my methodology takes into account many of the shortcomings and recommendations of that one – and adds more from others. Plus there’s another innovative component that’ll get another pathway of the immune system involved; and all of this is cost and time efficient. My own idea may end up saving me…

But the more likely, less sinister case – that it’s a chondrosarcoma, or some other, localised bone cancer I also looked into. And the good news about that – the 5 year survival rate for that is 90%. There may be post surgery radiation and chemo involved. Given my current situation, the graft versus host disease of the skin and other issues… it may be a bit more  confusing, it may take longer than most patients. But hey! I’ll pull through!

I guess you could call me unlucky… getting a really bad… agressive cancer, relapsing with it, getting a precursor to a different, just as aggressive cancer and now getting YET ANOTHER CANCER isn’t exactly something you’d celebrate.

But when you take a step back and think about it from another perspective; I’m extremely lucky. Because if I hadn’t been cautious, and come in when I started getting that shortness of breath, if I hadn’t had that CT scan… we may never have found this til it was big enough to cause me pain, at which point… it could have spread elsewhere. where it’s virtually untreatable.

You always have a second view of looking at things.

 

So why not choose the one that leaves you happiest?

Well… that’s good and all. But that doesn’t change the hard part… the treatment, though. I guess we don’t really know the complete details of it yet. My orthopaedist, who specialises in bone tumours (in fact, he’s happened to treat a few people I’ve met through this blog, as well as a good friend I know in real life – so I feel very safe in his hands!) is saying that we should just remove the segment of the rib and biopsy it later to find out exactly what it is. Why go in for 2 surgeries, and have the risk of causing swelling and facilitating spread of potential tumour cells when you’re sure it is something that at the very least will progress to cancer, he argues. I guess he’s the specialist here, and everyone else is, so I’m inclined to agree.

The surgery is on tomorrow. Or failing that Thursday. And it’s gonna be painful as hell, I’ve been told. Not just the wound, which is gonna probably take longer to heal given my skin disease and steroid dosage, but the rib resection itself, which’ll probably leave me in pain every time I breathe. The cramps I get, which are only getting worse really (another major concern of my haematologists and neurologists now) could make that even worse. Cause they happen in the chest and back – places he’s planning to cut into. So that’s gonna be… uncomfortable (a word doctors use to say pain when they don’t want to say pain) to say the least…

There are some risks, my lung cavity could be pierced, there could be infections that come around with it.

But hey – I’m in great hands.  And I’m choosing to see this, just as I have every other time, a minor inconvenience that’ll lead to me being healthier and happier in the long run. As I’ve said before here… and as I spoke about here… fear can be paralyzing…

But it’s not only normal to feel that way about things like these… and knowing of, and acknowledging it isn’t scary… it’s the best thing you could do for yourself. Because when the hard times come over the next few days of surgery and weeks of recovery… I’m not gonna crash down into despair… I’m gonna look at the big picture. What this is all for. And I’m gonna get through it. Like I always have!

Thanks to everyone for those amazing messages and all the concern, and to all those friends in real life visiting too. Keep them going! Cause they’ll keep me going over the next few weeks I’m sure! I’ll keep you all updated but don’t worry – in the meantime – I’ll still be busy. I’ll still keep working on those projects I’ve been hinting at. Cause hospital’s boring. This may well get me working more efficiently than ever on it (IF I’m not high on morphine all the time that is =P ).

Thanks again everyone – and please don’t worry. I’m in good hands. My doctors, my nurses, my parents, and my own. Share this, or this sentiment around, and I hope it helps others going through their own tough times too.

 

How to build self confidence and become the happiest version of yourself!

I was diagnosed with leukemia at 17 and given a 10, maybe 20 percent, chance of living.

And I was devastated… as any human being would be. But after a while I started to dislike that feeling.

The constant depression.

The tears.

The gut-clenching dread.

I wanted this to all be over. I wanted a way out of the hole that I’d found myself in. But with chemotherapy, uncertainty, and probable death in my future, there wasn’t much to really look forward to.

In the end, what ended up helping me most wasn’t this spark of inspiration or willpower or bravery after watching some inspiring talk or reading some book. The words of everyone around me felt hollow.

What did they know about what I was going through, after all? I was 17, and had just been told I probably wouldn’t live to see 22.

What really helped me was a simple thought process I did after just being sick of that angst.

I decided, “Why not take a step back and looked at what had happened to me, as if it had happened to someone else.”

From there I guess I saw everything that had happened to me objectively. So I could finally question everything that was going on and more importantly, how I was dealing with it.

And I did that through asking why. Why was I feeling that way?

There was no answer. In the end I realized I had what I had. Though it may suck, I couldn’t go back in time and change what had happened. I couldn’t take away my cancer.

So, what was my anger and frustration accomplishing? Nothing. Other than making me feel worse about everything.

Why was I feeling that way then? In the end, it was coming from me, my brain. Why was I doing that to myself?

I didn’t have an answer for that.

Nikhil Autar Scar Stories 3
Photo credit: Analia Paino

But that question alone made me realize one thing that stays with me to this day. Because if all of that was coming from me, my brain, my mind… that meant I could take that away, too.

In the end, we will always have the final say on how we deal with things. At the very least, we’ll always have a second way of looking at things.

But we’re only human, right? And with months to years of chemo, pain, treatment — all of which is likely leading to me dying anyway — there wasn’t much to look forward to, right?

So I questioned those fears and doubts, too.

Again, one question got me through that — Why? Why was I thinking I was cursed for being diagnosed so young?

My doctor’s words as this happened rang through my head as I heard this. When I was diagnosed he told me, “The good news is, you’re 17 and you have leukemia, but the bad news is, you’re 17 and you have leukemia.”

Good news? “Good news? Really dude!” I remember thinking for a while after that.

But when I thought about it, being diagnosed young meant I could get the optimal treatment — I could recover faster. I didn’t have a job or a family or kids to worry about. Indeed, I had one right there beside me the whole way!

What I once thought was a curse turned out to be a blessing. But why was I so afraid?

I was looking at chemo as a thing that brings pain and misery. And it would. And that sucked.

But wasn’t it also a medicine? The very thing that could get me out of this? Indeed, my doctors wouldn’t be putting me through this if they didn’t think it could work.

Why was I so pissed off, afraid and depressed?

In the end, I was worrying about all these things I couldn’t control. And that worry and stress were only hurting me more.

From stepping back and looking at my situation objectively I could see the only logical thing to do was to focus on the things I could control.

My health.

My actions.

My happiness.

Because what this has taught me is you will always have a second (better way) of looking at things. Always.

It’s not easy to see that straight away. Definitely not if you’re overwhelmed and in the midst of it. Depression makes that harder, too.

But if you can take a step back, talk about it with someone, and just ask, “Why?”’ You can get yourself through just about anything and become the happiest, most successful version of yourself.

It doesn’t take courage. I wasn’t brave or inspiring in my “battle” (in truth, it was a beating) with cancer.

I cried, I wailed for it to be over. I still do sometimes. (Beating cancer isn’t always the end of pain for many survivors. Depression came, too. It’s something I face, and I write about it here as well as on my own blog). But I kept in mind these things — what it was all for — and by doing that I saw something good in the darkest days of my life.

You don’t need some superhuman willpower or positivity, either.

Because in the end, if you can take that step back, and ask why… if you can help your friends and family do the same… then it becomes only logical. It only makes sense to take the path that leaves you most well-off.

And I hope what I’ve said can help you do this.

Nikhil Autar Scar Stories 2
Photo credit: Analia Paino. Sign up to my email list to get my latest blog as soon as it comes out!


One place where I think I’ve done this after cancer, against something which some of you may be feeling (whether you’ve had cancer or not), is with my social anxiety post-treatment.

You see, before cancer (not to brag or anything) I was quite a hunk (at least I thought I was). I wasn’t too fussy about how I looked but was a little, just as much as any awkward teen is. But I was fit. Very fit. I used to train for basketball almost every morning before class, and during breaks, and abide by a strict weight regimen.

But after treatment ravaged my body, I was left bloated out of my mind, unable to jump an inch, yet alone run. I’d lost a huge part of me. And it sucked.

Without even realizing it, I began using my health as an excuse not to go out. Whenever I did, the glances from people would bore into me, asking questions as to why I had such horrendous features, and when I tried to walk around the suburbs and try to run again, I’d feel ashamed when I’d puff out after less than a football field.

As I started my medical degree, I’d made friends but didn’t want to go out for fun or to events. I even stopped going out to see old friends at all, worried about what they were thinking. And that made life so much worse.

One day though, I sat down, took a step back and asked, “Why am I feeling this way?”

After a few days of thinking about it, I realized I was afraid. Not of chemo, or radiation or bone marrow transplants and other things that could kill me this time, but from other peoples’ thoughts about me.

It already seemed ludicrous to me at that point. But when I questioned it, I found no answer as to why I should care so much about other peoples opinions about me.

Because:

(a) Most people aren’t thinking anything bad of me at all. People have to look somewhere when they walked, and if they happened to look at me, most people wouldn’t think anything nefarious so much as to walk on. Many would smile. Most would smile back I’d say.

(b) Why was I caring so much? If they were judging me, they’d be pretty shallow, inconsiderate people who I really wouldn’t like to be friends with. Why do we all — whether we have scars or not — try so hard to impress people we don’t even like for that matter? Why not instead, focus on what we’d like to do. On the things that make us happy?

Now that was the first step. It wasn’t like I came up with this new philosophy and started becoming this happy #YOLO optimist in one day. I started small, by first starting to smile at people (most of the time, they did smile back) on my walks and jogs, then not shying away from asking people for directions at the university or hospital when I was lost or asking the workers at the groceries store instead of trying to find everything on my own.

I finally reached a point where I could walk around and not care.

Now I’m very open about my journey but can also do talks, in front of thousands or just a few, about how I deal with things.

Indeed, I’m the most confident version of myself.

Nikhil Autar Scar Stories who cares?
Photo credit: Analia Paino

But most importantly, this helped me become the most happy version of myself.

And I hope this helps you feel happier about yourself, too.

Nikhil writes a blog about his journey, hoping to help out patients, inspire the medical profession (he’s studying medicine now) to educate people on worthy causes and to help others out in all kinds of circumstances (he truly believes this mentality can help with anything, from the mundane struggles we have in day-to-day life, to the epic journeys we take in life). He’s also doing many exciting things, including working in cancer immunotherapy research and a social enterprise that’s revolutionizing the hospital bed, to not just increase patient comfort, but to also hopefully reduce unnecessary cases of infections, fall, and pressure sores — to name a few — which literally kill hundreds of thousands per year, as well as potentially make millions of dollars a year!  Most importantly though, he hopes he can help you, too. 

This post was originally published on Scar Stories.

Your Mind is the best way to Lose Weight and Get Fit. Not crazy, unsustainable, diets (or bootcamps!)

I talked about this topic on radio recently. Have a listen to it if you want (it’s at the bottom)


Heaps of people around me have been saying how much thinner and healthier I’ve started looking, and almost all of them have been asking me how or what I was eating or doing to get there… a few even asked if everything was okay… healthwise.



Well, no, I’m totally fine, and I did mean to lose this weight. 


To be honest though… it wasn’t really that hard at all.


Everyone talks about how they can’t stay on a diet and how they can’t find the time to do exercise… They talk about how hard it is to make changes in their life and how they just don’t have the willpower or ability to be healthier people. 

But even while on 50mg of prednisone, a corticosteroid (which increases your appetite, screw around with your hormones and energy metabolism, and eat away at muscles) and even while I was still getting some chemotherapy which makes me anaemic for a one or two weeks every month, I didn’t find it hard at all.


You wanna know why? 

Because all I did to become a healthier person was change my MINDSET.

By understanding how my brain, its rewards pathways, and its neuroplasticity, as well as how my body processed foods, I was able to hack this, in an evidence based, scientifically guided manner, to make this ‘tough’ journey, as easy as possible.

It didn’t require “willpower”, “bravery”, or even long bursts of commitment. By hacking my mentality, I made healthy habits just that – a habit. And in truth – it was EASY.
 

Doctors all tell us that weight loss requires a lifestyle change, rather than drastic, quick-fix 12-day-detox/Biggest Loser boot camp solutions. And they’re right. You should look to lose weight AND keep it off. It’ll help you with heart problems, lower your chances of diabetes, reduces your risk of cancer and also – a healthy diet can make you feel better, more energetic than ever before.


But the words “lifestyle change” imply that it’s hard, that it requires constant effort and struggle to do, and that’s a big reason why people aren’t willing to make that change.


Eating the right foods, and getting some exercise on a continuous basis IS vital to weight loss. But what’s even more important is if you can maintain that way of living. 

And that’s where your mind comes into the picture.
But trust me, this isn’t some “Yoga,” “Spiritual” or “YOU CAN DO IT” #MotivationalMedia Bullshit.
It’s 100% based on the science of memory formation and learning. It’s 100% cited here.
I’m not trying to sell you shit.
And most importantly, it’s Easy.
 

A few months ago, I was sitting at around 106-107kg. I was trying everything to get fit and lose weight. I started juicing, cutting carbs out of my diet and went out, trying to run, get back into my old sprint training and back into the weights. And that was working – as it would for anyone – for a few weeks at a time.

Before: 107kg

But with my low immunity putting me into hospital with infections every few months, with my treatments lowering my bloodcounts, I kept getting sent back to where I began from over and over again… and it was frustrating as hell.

I yoyo dieted. Like crazy. I calorie counted. Stopped carbs. Intermittent fasted. Got into calorie deficits.

But dieting is hard. Forcing yourself to not eat is unnatural and really hard to do consistently.

I wanted to lose weight and become as fit as I was before cancer… I wanted to see results… but they just weren’t coming. 

But after a while of this, I took a step back and saw that I was going through a cycle over and over again. It’s the same cycle a lot of yoyo/fad dieters go through.

I wanted results and I wanted them NOW. But they weren’t coming. 

So I changed the way I looked at getting healthy.
I changed my mindset… how I viewed my journey to come.
And the same thing that helped me beat cancer helped me get fit.


You don’t need huge “willpower” to do it. All it takes are a few small changes in how you view things.

 

 
~5 months later, on the same dose of steroids… I could still fish.
But I’d lost nearly 20kg. It looks like a lot, but really, it was 1kg/week.
I ate KFC, pizzas, tacos and junk food the entire way. As much as I wanted.
Hell – I went TOO low. 6 months after this, I hadn’t weighed myself, and I found out I was 73kg.
So I ate a bunch of KFC for a few months. And got back to 80kg. And I’ve stayed there for 7 years.

The only time I gained weight again after this was 2 years after this, when I got a third cancer in my ribs, was in hospital, and when I thought I’d need chemo again.

The amount of calories I’ve counted? Zero.
The amount of willpower I’ve exerted?
I maybe stopped myself from eating 3 or 4 times in that first week?

So what did I do?
1) I told myself it would take time.
2) I let myself be human, and cheat or fail every now n then.
3) I took a  step back and changed how I looked at food.
4) I challenged the thought processes that made me keep wanting to eat while I was eating.
5) I SLOWLY – we’re talking 1 pizza slice less per month  – reduced my portion sizes.
6) I ATE WHATEVER THE DUCK I WANTED – and let myself be human, knowing, that by reducing my portion sizes slowly over time, my stomach would get smaller and my brain would form neural pathways would make NEW thought processes that would become my habit.

7) I didn’t have to do anything else. I don’t have to do anything else. Ever. Neuoroplasticity has ensured that I never
have to try to diet again.

In more detail and for the science, keep reading. If you’d like to read the whole science kinda thing, and check out the papers behind this – check out my like 30 page book which summarises all of this (all free, lol, I should monetize this to grow it, but I’ve got no time). 
But yeah. I hope this helps. Email me if it does or if you wanna talk anytime.

# 1 – I Told Myself that it Would Take Time

 

–> This is one of the most important realisations you’ve gotta make. No matter how much we want it to, results don’t come in a few days. But they do come.

The trick is to not only remind yourself of this – but to keep looking at the big picture, on your entire journey – as this will make maintaining changes easier to accomplish. Instead of falling down in a heap if you can’t resist that desert at a party, you’ll remind yourself that the amount of times you had been good, and that in the long run, you were on the right path.

That lessened burden alone will make you SO much less likely to quit. Letting yourself be human is shown to result in higher adherence to long term plans.
But also key is to give yourself a LONG TERM GOAL. Something to strive to. Your mind is rigged to release more and more dopamine the closer and closer you get to one, meaning over time, this becomes EASIER to accomplish. 

The science only helped me further believe, hell, it made me KNOW I could do it. But I mean it only made sense… I was only beginning my journey to get healthy – I was starting from scratch. It would take time to get to where I wanted to go. It wouldn’t happen overnight.

But that wasn’t a bad thing. I mean, it’s simple statistics. If I did things generally right, over a long period of time, I’d get to where I wanted to be. And by looking at it this way, I wasn’t forcing myself into doing something I didn’t want to – I was ALLOWING MYSELF TO BE HUMAN. knew I wouldn’t give up, or worry, or hate myself if I had a few slip-ups on the way either.

That’s exactly how you should look at weight loss, or any goal for that matter. It’ll give you the best chance of getting there (and of staying happy on the way too).

#2 – I Took A Step Back, and Made SMALL Changes To How I LOOKED At Food

–> Instead of making huge, drastic changes to my diet, or instead of starving myself, I

  1. Took a step back, and
  2. Questioned my current habits, until I saw
  3. An alternative perspective, or way of looking at things, that would leave me healthiest 

 

The simple act of self distancing is shown to reduce blood flow to emotional centres, and regions of your brain that reference yourself, allowing you to be objective. This is shown to improve decision making. But from this step back, you also are able to see all your options more clearly. From here – choosing to start looking at the path that leaves you happiest and healthiest not only just makes sense, it also comes FROM YOU. Don’t just read how I did it – examine yourself from this perspective yourself – and you’ll get the person most likely to motivate you on your side – YOU. Motivation works best when it’ comes FROM YOU. 

I’m writing about how I used this mentality to get me through cancer, get into med school, start up a pattern changing health tech startup, and learn to ignore chronic pain – amongst other things – and it’s out NOW (lol just updated this – it is out)! Join my email list and it’ll come in your email for free. Hope it helps!



3) Hacking your Stomach, and Hacking your Brain
Reduce your Portion sizes. SLOWLY:

When trying to reduce how much I ate – I realised that, especially with foods I liked, I was just gulping down food down by the spoonful. But in truth… I wasn’t really taking the time to savour them. The first 5, 10, maybe 15 spoonfuls or bites were most enjoyable. The last few… even with my favourite foods, well, to be honest, I was really only trying to finish off what was left. 

To change that I made small gradual reductions to my portion sizes. I started savouring my meals and once I realised I was full, I’d just leave it, put it in the fridge or throw it out, and next time take out less.

Over time… the portions got smaller and smaller. When going out… if I didn’t really feel like finishing off my plate, I’d just leave it and ask if anyone else wanted a few bites. I was brought up on the whole “Finish your plate, there are children in Africa who’d KILL to have what you’ve gotten!” sort of mentality… and it’s true. We waste tremendous amounts of food, and do need to respect it more.

But why was I destroying my veins, my health, my vitality to assuage this preconception, when I could instead just take out a few less spoons, order a medium (and in time, a small) meal instead of a large one, and pack away good meals for breakfast or lunch the next day, and feel better for it?

Your stomach usually has a capacity of 200mL, but can stretch to hold up to 1L in most humans, by relaxing smooth muscle cells which comprise most of its wall. Over time, however, if not stretched to larger limits, the stomach loses the number of smooth muscle cells, and pacemaker cells (those which cause coordinated digestive contractions), leading to lowered capacity to relax. Furthermore, levels of neurons which release nitrous oxide, which promotes relaxation of smooth muscles, also reduces in patients who have lost weight recently.

So over a period of a few weeks, slow, sustainable reduction in meal sizes will cause you to lose the ability to eat larger meals over time!

It’s interesting to note that even after a while of this kind of fasting, even after overconsuming, average stomach stretchability did not return back to normal levels, meaning you’ll have the ability to have the occasional splurge without starting back at square 1 again.

 

But key to all of this working is the neuroplasticity of your mind. It’s widely conceived that you need huge willpower to resist the temptation to continue eating. But the simple changes in the way you think about food described above is what ensures you’ll get to that stage where your stomach adapts.
Neuroplasticity is the brain’s ability to form new cortical maps – linkages between series of neurons – in response to various scenarios. ‘Neurons that fire together, wire together,” is the basic principle on which this idea is built – so reminding yourself that

  1. You like food, but hate that fatty, full feeling afterwards
  2. You like food, but often shovel in the last few bites just for the sake of it. And that
  3. You enjoy meals even more when you really take your time to savour the meal

for just a few days in a row, will start forming these cortical maps. In weeks, these cortical maps become so solidified and prolific – they become your automatic response. You won’t have to think these things anymore, you’ll already, subconsciously believe them. And though weeks of resisting temptation seems hard to do, because it

  1. Is coming from YOU telling yourself these things;
  2. Because your cortical maps are forming and becoming more and more solid over time, and
  3. Because you’ve got a long term goal, which causes more dopamine to be released each step you take towards it –

it’s actually quite easy to do. They’re subtle, small changes to how you view food, but combined, they make a HUGE difference. It’s the difference between going into a diet, hating life and having to force exert significant willpower to control yourself, and eating what you want, but slowly, and surely, changing your mindset, and letting your brain lose the weight for you.

Remember, thinking is HARD. We’re lazy, and we don’t wanna work, because your brain consumes oxygen. But if you understand HOW the brain works and learns (pretty much everything we do and get better at relies on this neuroplasticity), and you make changes that make your NORMAL thought process a HEALTHY one that DOESN’T REQUIRE willpower to do… Well being healthy BECOMES the lazy, easy thing to do.

 

And you know what? It worked. In January this year, I could eat a whole pizza, and I’d go up for second servings when lamb curry was made at home. Now… I can still do a half pizza… maybe more, but only when I feel like it. And I barely finish 3/4 of a plateful of rice and curry (I used to eat 1 – 1.5 lol). That small change in mindset resulted in a huge reduction in my calorie intake per day. And it’s the main reason why I’ve lost so much weight AND KEPT IT OFF without trying.


Making Healthier Choices:
Me – I’m a foodie. I like trying different things, new cuisines. And I like variety in my day to day life. I also like my meat, hate salads on their own (chemo’s changed my taste a lot – I used to love the taste of lettuce… now it tastes like dirt at times) and I like eating carbs like bread or rice with meals. Who doesn’t really?

With these simple changes, I was able to eat all these things and still lose weight.

But I knew I could stand to benefit from eating generally healthy foods… so again, I took a step back, questioned my current habits, and made small changes to my mindset on food, which helped me eat more healthily too, without depriving myself of the pleasures of life. 

Carbs… I did like them, but what I liked more was what I was eating with them.
So I changed the portions around, added more fillings or curries, whatever I was eating at the time and reduced the proportion of that to however many slices of bread or spoonfuls of rice I’d eat with them. Again, this happened over weeks, not instantly.

With  salads, whose taste I couldn’t stand post chemo, I started drizzling, sometimes dumping tasty dressings based in oils (luckily regular olive oil is good for you), and added things like cottage cheese or olives to make them tastier.
Juicing, though it gets good vitamins and veggies/fruits into you, was too much of a hassle to do regularly, especially cleaning the damn things. So I started looking around for good fruit/vegetable juice mixes with no added sugar or preservatives and came across this brand, which uses pressure instead of preservatives, and doesn’t add sugar to the mix and saves me time too. There’s bound to be something similar in your location!

I liked variety in my diet, and that was good. So I picked cuisines to eat regularly that were easy to prepare, and tasted good and were still healthy for me – things like tacos or stir fries (which have good amounts of veggies, are easy to cook, low in carbs and have good, but not excessive amounts of meat) and I mastered them. They’re like a staple to me now. And I don’t hate eating unlike most people who diet – so I maintain this healthy lifestyle still, to this day.

 


I couldn’t believe this came from CostCo either when I first tried it. But I highly recommend it – their Kale/Sweet Potato/Quinoa cous cous salad.

Taking out the Junk Food

To be honest, I haven’t taken out all junk food. I probably eat junkfood once a week now, still. But I lost all that weight while eating junkfood every few days.

Still. Junk food is junk… food. How did I reduce the amount of crap I ate?

Well I mean I looked at them, from that step back, and asked why I used to have that crap so often… I mean they do taste good, and they are cheap and easy to prepare… But I hated that “fat”, “oily” feeling I had after eating a packet of chips, some chocolate or a burger or box of chicken from KFC. 

I didn’t cut them out entirely, which many people do, instead I only got a few small bits and pieces from fast food places or fish n chip shops, every now and then, and had them alongside other, healthier stuff. KFC – I made sure I had that with these pre-made salads I found in CostCo which complimented it perfectly. With the chocolates, and chips, instead of gulping down a handful or packs of tim-tams at a time and then feeling bad afterwards, I shared them around with other people, or scabbed a few chips or bites from friends instead of buying a full pack and feeling like I had to devour it. Those small changes made me eat healthier (and also saved me money too – sorry guys). I still got to enjoy the taste. But I sidestepped feeling crap!

They are easier to cook, I guess, and many people just don’t have enough time to cook – but those meal suggestions I made above really help with that. Another thing that makes cooking easier for me is marinating meats and eating them with salad or veggies or a good slice of cheese (which acts as a side dish for me – I love block cheese and it’s high in proteins too so it makes you fuller quicker). I marinate a huge amount of meat in tandoori paste, or honey soy dressing – whatever I feel like – leave it over a few days (the longer it marinates, the better it tastes) and cook it in meals with this simple frier/grill which only requires me to flip once and makes meat really tender too and it’s done quickly. It’s quicker than a drive out to the closest McDonalds, and takes only a few flips in total to make it. 



These small changes to how I viewed eating, small changes to my mentality, was all it took to improve my diet drastically. I haven’t cut anything out, I’m not hating myself and making myself less likely to succeed by following strict diets and better meals is a MAJOR reason why I’ve lost so much weight and why I’m so healthy right now too! 

Improving My Fitness/Exercise Habits:



When I started trying to get fit after my second transplant, a year ago, I told myself I was going to take it slow and build up from there. After my first transplant, I pushed straight into weights and basketball, I didn’t even focus on getting any endurance back before doing so and in the end, it didn’t help me get healthier… It just made me frustrated (because I wasn’t improving much) and probably made me sicker overall too.
This time around though, I didn’t have a relapse, and lower blood counts stopping me from improving. What I did have was excuses and laziness and self-consciousness about my abysmal fitness, which made me not train consistently, which made me frustrated that I wasn’t getting fitter, which made me lose the will to get fit – initiating a huge cycle where I’d get motivated and exercise for a week or two and then stop, only to repeat it, again and again.

Taking that First Step. 

Well, changing how I looked at things helped me get more consistent in my training. Motivating yourself to get off your bum and start is the hardest thing to do when exercising. But by changing your perspective on exercise, from a thing that is painful and excruciating to do, to something that you can build up on – something that gives you more energy throughout the day – gets you over that initial burden of getting up and doing that first set. Looking at your long term goals becomes really important here. Remembering to focus on the fact that you will get there – in time – as long as you’re doing the right things OVERALL, as opposed to expecting to beat your PB every session, ensures you won’t give up when you face failure – instead, as you’re prepared for these, you’ll be picking yourself up.

It’s when you have a bad, or disappointing workout that this patient thinking really helps. Instead of getting down and sad about it – you’ll be ready to go the next day, because you’ll know for that 1 bad workout, you’ll have 5 other good ones, and you’re still be heading in the right direction.

 

Another great tip – do something FUN! You’re much more likely to commit, and form good habits, if you make yourself accountable. So get a gym buddy, or join a team! 3/4 adults played sport growing up, but only 1/5 play as adults. Why is that?

Start Easy and Build Up From There


When building up from scratch, which I’ve had to do plenty of times, looking in the long term REALLY helps. 
In my case, and that of many other patients who read my blogs, treatments and concurrent infections would bring me back to starting position, walking and body weight exercises were excellent in building me up. I started with push-ups, squats and sit-ups in front of the TV. Those things gave a good burn and made me feel like I did something and gave good, constant improvements when I did them consistently too. I didn’t just like walking for no reason, so I used my mind and my interests to my advantage and started walking down to the river with a rod in hand, looking at the tides, watching the small fish and how they moved, and getting good ideas and experience to improve my fishing. Basketball – my favourite sport – always keeps me motivated, and watching a good basketball video or movie would always get me up and ready to have a shoot around. You can use whatever passions you like. Cycling, rock climbing, diving, whatever you want to motivate you to keep you in the gym or in the pool or on the track.
Make exercise time valuable. I know many students find it hard to sit down and study – so download your lectures and put them onto your music player and go for a walk or run. Same thing goes for podcasts of your favourite radio shows, or just blasting your own music. Makes it easier and even fun to train – in fact, Jana Pittman, a classmate of mine does this to keep up with medicine and still train at an Olympic level. 

The power of incidental exercise doesn’t just stop at boosting the calories you burn a day, but also extends to formulating strong, neuroplasticity-moulded, attitudes towards exercise. Each time you pick the stairs – you make yourself more likely to pick them next time!

 

Don’t Be Shy, Or Worry About What Others Think of You


Taking that first step was hard for me. After chemotherapies, where I’d have to start from scratch, I’d always feel embarrassed and self-conscious at how little I could do, and also about how weird I’d look. You may feel the same way when someone racks up more weight than you can squat on the bench press, or when someone laps you in the pool or when someone blocks you on the basketball or volleyball court. Whenever I wanted to work out, I would always feel the stares of others on me and that stopped me from wanting to go out and get healthy in the first place. When you take a step back and see it in another way though, you’ll see that you’re stopping yourself from being the healthiest and happiest version of yourself because of what other people may be THINKING about you. Read more about how I managed to get past my self consciousness and become the most confident, happiest version of myself here.

Overall – losing weight and getting fit and healthy is NOT something hard. The only thing standing in the way of you getting there is YOU and your mindset. Get your mind on your side and the rest will become easy. 

Those fad diets and boot camps can help lose weight and they do work. But they’re not easy to maintain – they’re not for everyone. Using your mind to your advantage is the best thing you can do to help you get healthy.


Myself – I’ve gone down from 97kg in November last year to about 80kg now. And I’m in that luxurious position of needing to gain weight (to keep a good amount of fat, which makes the injections I get in my belly easier to handle, and lowers the chance of bruising there too). 


I talked about this on radio actually – have a listen to it here:

Feel free to leave any tips of your own down here. To help me and others along on their journey to get fit and healthy.

 

My Social Enterprise – How it’s going to save HUNDREDS of thousands of lives. Get To Sleep Easy!

My life changed a few years ago when I was told, “Nikhil, the good news is you’re 17 and you have leukemia, but the bad news is you’re 17… and you have leukemia.”

Then I asked him the one question every cancer patient dreads: “What are my chances?” He looked at me, sighed and said, “10-20 percent that you’ll live the next five years.”

Somehow, I got through that.

But it did get close. Quite a few times actually. And now that I’m a medical student and cancer researcher, I can appreciate just how close “close” actually was.

During my treatment, I suffered from many infections and falls, a few pressure sores, and a deep vein thrombosis (clot). Three of these four things could have killed me. One (those pressure sores) stayed with me for nearly two years, and even stopped me from swimming and washing my back.

Nikhil with nasal prongs on

The thing is, these things are common complications seen in hospitals:

Pneumonias (depending on the type and treatment) can affect 70 percent of cancer patients.

Falls will seriously injure nearly 1/10 people over 65 admitted to a hospital.

Deep vein thromboses affect up to 20 percent of those who are immobile, and will kill 15 percent of those who have them dislodged.

And pressure sores affect seven percent of those who enter hospitals (with nearly 1/4 in ICUs).

Each of these problems cost literally tens of billions to hospital settings, just in America alone! And most of these are unnecessary. Even one that often isn’t for cancer patients (pneumonias) can be reduced.

How? By simply sitting up. That simple act can reduce the severity and time spent in the hospital by 35 percent — more than two days in the hospital on average.

But although they’re recommended by physicians and have surgical guidelines around the world, and although I knew in the middle of chemo that any infection could kill me, I still couldn’t find it in me at my sickest and tiredest state to walk those few meters to my hospital bed.

And even though patients are told to exercise (or at least move their legs around to prevent dangerous clots where they happen most), and nurses are told to move patients around to prevent pressure sores, and patients are encouraged to wait for nurses’ assistance to get up when particularly weak, or at risk of falls… right now hundreds of thousands are falling through the cracks.

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I knew I had to do something about it. I’d lost too many friends to these preventable issues myself. And I saw a perfect way to do so — by changing something that hasn’t really been changed in decades.

The hospital bed.

I’ve created a version of the hospital bed that will reduce, perhaps even eliminate, the incidence of all of these! How? Well, I explain in this video.

The features on our beds not only make lives more comfortable for patients, or those who are being cared for at nursing homes or homes, but they also save lives.

The inclining ability of the legs will increase blood flow to vital organs in times of shock. The decline feature, when combined with the incline of the head, will make this a chair that encourages patients to sit up much more effectively than any distant hospital bed could. Hence, reducing the rates and severities of infections.

The massage prongs will stop blood from pooling around the legs, which will reduce rates of blood clots. The contouring features and weight sensors will reduce tissue pressures where they’re highest, thus reducing pressure sores. And many features, such as the slide out rails, embedded charging ports, intuitive IV pole placement and a bed pan chamber, will reduce the need to get up for those who shouldn’t.

But we’re not only creating this. We’ve also got provisional patents on an adjusting wedge pillow — something that’ll help millions with lung or back conditions, acid reflux, or those wanting to lounge in bed more comfortably.

I think the best thing about this is that instead of the profits going to my back pocket, I’ll be giving away all of the profits we can towards charity, research and ensuring manual, affordable versions of this get to nations who need hospital beds the most. Personally, I feel relieving pain and putting a smile on someone’s face is so much more fulfilling than money could ever be.

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We’re already partnering with Engineers Without Borders to create a version of this bed that can be produced cheaply, and close to source!

Plus, this is something that’ll save hospital systems money and lives.

The thing is, for a project this big to become a reality, we’re gonna need lots of help, so feel free to donate or buy some products that’ll help you Get To Sleep Easy (we also have some pretty cool merchandise, too.) You can also follow our journey through our email list, on Facebook Twitter or Instagram.

And watch out for a pretty hilarious campaign we’ll be releasing next week called #GiveMeAWedgie. We’ve got a bunch of people ready to help share that out, so join us!

I hope this can help as many people out there as possible. I decided to study medicine because I knew I could make an impact on peoples’ lives. I’m working on some interesting immunotherapy cancer research because I saw you could save potentially thousands of people at a time… if you discovered something awesome.

And something like this could save millions of lives, and do so continuously and sustainably, for years to come.

nikhil medical researcher and student

I hope what I’ve said convinces you to help make this vision a reality.

Nikhil Autar was diagnosed with acute myeloid leukemia at 17 and given a 10-20 percent chance of surviving. Despite that, he made it into a medical degree at 18, and is currently doing medical research and running his social enterprise, Get To Sleep Easy. You can find him here or at his blog, Musings of a Med Student Patient.

Cancer Patient Plays Well, and Wins Big For Charity.

Last post:                                     My Story:                                         Next One
Recently, I was given some pretty bad news. I’ve got bronchiolitis obliterans, a lung manifesation of the graft versus host disease that plagues me after my bone marrow transplant. Essentially, it’s my donor’s immune system (in bone marrow transplants, you inherit the blood making cells of your donor, which includes their white blood cells) attacking me. This time though, in the lungs. Over time, it’s something I’ll have to watch very carefully, as the survival outcomes for this aren’t that great, and it’s something that progresses too.As you’d expect with anything of this nature, I was scared. Anxious, without even knowing it. Exams were going on too when I got the news, so I didn’t even get time to properly take it in, yet alone look it up. When I did, I realised how bad it could very well get for me. And I got even more scared.A range of emotions go through you when you hear bad news. You’d think I’d be good at dealing with these things now, given how I’d dealt with my cancer, and then my relapse and then a third cancer, and everything else (and there have been a lot of other things too) on the way. But though that attitude I took on board after all those things does help in the long run, it’s almost impossible to make some good come out of this when it just hits you. Experience isn’t exactly much help with these things. 

But as these things happen time and time again for me, what seems to hit, and stay with me most, and longest, is a sense of finality. 

Dealing with the leukaemia was the easy part, I feel often when I look back. The chronic effects of this all, combined with the frustration and grief (loss is loss; grief needn’t be associated with death) it brings about, makes me prone to feeling this way. 

So I had this crazy notion a few weeks ago. What if this was the thing that brings me down? What if one of my hundreds of other conditions caused something like this too? Who knows how long I had left? 

So why not live out my dreams?

For those who don’t know, I play poker. I started about a year and a half ago, when the cramps I get, that nowadays leave me debilitated and in pain most nights, started progressing. I needed something to do. Something to get my mind off things. So I started playing this game I learned years ago, something I’d played just for fun and in passing, at our local club. I was gonna cramp sitting at home anyway. Why not play poker while I got them

And slowly, but surely, I got better at it. I started playing buy-in, tournament events (I’d played for free for the better part of a year,  and win some money in the process). Nothing huge. In fact, til just a few weeks ago, the highest buy-in I’d posted was a $25 one. Most games I played were either free, or under $15. And til just a few weeks ago, I’d won over $6000, from less than $1200 in buy-ins! $2050 of that went to charity – as a reader of the blog had insisted on donating something to me, and that it be used for ME to have fun. That act stays with me til this day. The reason she wanted me to spend it on me just hit the nail on the head in terms what I was feeling at the time. But I couldn’t just take someone’s money in good faith. So I decided to donate all the winnings from her donation to charity instead! You can follow that journey here! 

So, where was I? Ah, right. My dream. Well, for a while now was to go and play in the World Series of Poker’s Main Event. A HUGE poker tournament with over 6000 entrants every year, a first prize of over $7,000,000 (and a prize pool of over $60,000,000), but most importantly, one that attracts the world’s best poker players!


I knew I was gonna play it at some point in my life. But after hearing the bad news a few weeks ago, I desperately wanted to do it this year. Even after the inital fear and that feeling of doom dropped away, I knew that life could turn at any moment, especially in someone like me. Who knows if I’d even be healthy enough to play the gruelling, 7 day tournament next year??


Yet I was still afraid. The buy in for this was $10,000! I’d be playing some of the best players in the world! People who played this for a living! I knew I was good. But was I that good? What would my parents, what would everyone around me think? Was it really worth spending a good chunk of my savings on this??? 


In the end though… this happened. 

Yep. I did it. I booked the next flight out, for me and my brother, and the next day, we were there. 
And the result?
This. 
I did it. I’d studied my butt off (because contrary to most peoples’ perceptions, poker is a game of incredibly complex strategy, math and risk stratification), read all my stuff and played the most focused, quality poker I’ve ever played, for 10 hours a day, for just under 40 hours and not only made a healthy profit, but beat out thousands of poker professionals (including some of my heroes – who I got to play against too!) to get there!
It was the best couple of weeks I had in my life! All because I made this decision on a whim. 
I think Jim Carey encapsulates every lesson you could take away from this in one minute.

 

 

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So. What am I gonna do with the winnings? 

Well, it’s not a $28,000 profit. Remember, $10,000 was used to buy me in. 

But that’s still HUGE for me! 

10% of the money goes to my brother. He’s long been suffering alongside me. Indeed, more than me, I’d say. It’s not easy going through cancer… but I reckon it’s MUCH tougher watching someone you love have to go through something like that, while not being able to do anything. He’s suffered not just the emotional and physical burden of looking after me, but also given up much of his life, just so I may have a semblance of a normal one. I can never thank him enough for that. But I can definitely try!

Around 10% will be going to my cousin, whose family took me in for a couple of months, and treats me as their own, til this day,  and my father, who’s turning 50 this year. 

And 10% will be going to charity. I’m an effective altruist, and don’t just believe, but KNOW that the best way we can make a difference in our lives is to give to the organisations that change the most lives per dollar spent. A great website actually does the research for you and ranks these charities for you. Which of these top charities am I giving to then? 

 


 
A great summary of Effective Altruism – a way of giving that makes sense!

In a way, all of them. Because, also something you may not know, recently, I started up a social enterprise – a charity that works as a business and distributes all profits to charities – called PlayWell! It’s been slow work, but as soon as I’m a little more healthy, I can dedicate more to it. And it’s well worth it. Because this thing could change the world. 

Imagine being able to make those hundreds of thousands of hours you‘ll spend in your lifetime on entertainment achieve good. Well, on PlayWell, you can. Through many direct and indirect ways, your every action on this entertainment app will allow you to make the hours you’d be spending on Facebook, or YouTube, or Tumblr or Instagram – the things you’d be doing anyway – make money for charity! Every tiny action of yours will generate revenue for charity! All while you enjoy watching stuff from your favourite stars, supporting them, and discovering the best content on the internet! If you know an internet star/a budding one – let them know they’re invited to join now! Hopefully, it’ll be a thing – sooner, rather than later, and help charities make money in a completely different, currently untapped, way!

 

If you know anyone who’s a budding/current online star, who wants to make more money while helping the world, tell them to sign up at www.playwel.org!

And the rest of the money? Well… that’ll be put to letting me play Next Year too! And in bigger tournaments for the year to come! At least 10% of all my poker winnings from this day forwards will be going to charity. And I’ve proven to myself that I can play with the best of them. I’m sure now that this is an investment that will pay off


While I was in America, I also visited some amazing doctors. And it’s not too bad news for me overall, and the lungs! A doctor who I get second opinions from routinely saw me in person for the first time, and said I looked much better in real life than on paper – which was great for my prognosis with this disease. The lungs are still iffy, all agree, but it’s not progressing, and indeed, may not progress in the near future, if I convince my doctors to get me on some drugs I’ve been telling them to put me on for months now... If you sense frustration there, you’re right. One of my doctors described the care I’d been receieving from my recent doctor as “neglect”… And though there’s one little issue left that may be concerning, overall, it’s still great news!

And most importantly, I feel good! This trip has done so much for me. No matter how much I tell myself I can still do a lot – something that’s kept me going despite the frustration this disease brings – I still occasionally get brought down. Now, I’ll have at least one week that can remind me that I definitely can. Hopefully, that will help me continue to try and do as much for this world as possible.