Monday, October 17, 2016

The Forgotten Generation of Cancer Patients.

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This is heartbreaking. But what's even worse is that teenagers like these guys receive the lowest funding of any age group, even though their survival rates have improved least. Here's how we can fix some of that.

Late last year, an exciting thing happened. 

I managed to get medical students invited to the international adolescent and young adult cancer conference for the first time ever!
It's an area of oncology that's been neglected for a long time, despite the fact that there's a huge need. Contrary to popular notion, the incidence of adolescent and young adult (AYA) cancer is higher than that of paediatric ones. There are over 1000 cases in Australia alone per year. Yet despite this, both the rates of improvement, and funding, in comparison to childhood and adult cancers remains markedly lower. 

Hence the excitement. 

How do you get the knowledge gained from this out to as many medical professionals as possible, when little is being done by larger organisations? How do you make sure that less cancers are missed in their earlier phases, and that the needs specific to younger cancer patients, many around our age, are met? You make sure the next generation of doctors are aware of this. 

 Hence this article.

I guess the major takeaways from it can be organised under 3 banners. The science. The services. And the social, psychological and practical impacts of cancer on youth. 

The science.

It’s important to appreciate that cancers affecting AYAs are starkly different to that seen in their younger and older counterparts. Even those that are similar tend to have different prognoses; Acute Lymphoblastic Leukaemias, despite having a very high cure rates in children, are much more deadly to youth, for instance. Similarly, many youth suffering from thyroid cancers have much more dire prognoses than older patients. Factors such as differing hormone levels, leading to different mutation profiles and reactions to treatment, and perhaps more sinister manifestations of cancers down genetic susceptibilities may be reasons for this. But other currently understudied factors exist too. As was pointed out by Olivia Watson of Sydney University, there is a “surprising discrepancy in some treatment outcomes in New Zealand”, pointing to the possibility of race affecting outcomes too.

The lack of knowledge further highlights another issue, the lack of trial knowledge, which stems from both lack of clinical trials focusing on AYAs and a more systemic one, in the deficiencies seen in data collection in cancer. The prior is a result of both the burden of disease of cancer being higher in older populations, and the lack of facilities. “Paediatric hospitals often having higher trial participation” due to better infrastructure highlights that this is an issue that can be fixed, and the government’s recent $7million investment in clinical trials for this age group is a step in the right direction, but more needs to be done on an international scale for results to be seen. The lack of sophisticated, or even complete data collection by cancer registries also poses a challenge to the collection of even epidemiological data, and it’s a challenge faced around the world. Many presenters lamented these shortcomings, but again, progress is being made. I was fortunate enough to sit in on a workshop after the congress with doctors from the US, UK and Australia, trying to make it easier to share data over national lines. Perhaps international cooperation will be the solution in the challenging climate of relatively low numbers of patients?

Of course, issues and priorities very different to those in other age groups are also pertinent, and often less appreciated by doctors and researchers in this field, for this population. Contrary to popular opinion, fertility is a major cause of distress amongst younger cancer patients, being a feature of even 12 to 13 year olds’ thoughts, and “considering sexuality” and “delicately exploring any functional issues” due to the impacts of cancer is also important, points out Sophia, an ex UNSW medical student, as it has “measurable impacts on quality of life”. Finally, survivorship is also a vital issue, especially in this population, with high levels of anxiety due to fear of relapse (often dubbed “scanxiety” by patients), disability and late effects of treatment, including secondary cancers, being huge factors. Indeed, much of this can be attributed to our lack of knowledge. As a presenter pointed out, low rates of trial participation by youth is likely causing either too high, or too low doses of chemotherapy being administered to patients, for identical cancers. 

But there is hope. Not only in the future due to that government investment, but right now, with an exciting presentation being given on one hospital’s successful experiment of giving highly personalised treatment regimens based on patients’ own mutation profiles alone, drawing great applause. Especially remarkable was that the prescribed treatment was based, in many cases, off of other cancers’ trials. A step made necessary by the lack of appropriate treatments.

The services:

Imagine having to pick, on the day after being told there is a high chance you may have to face your own mortality, whether you’d like to be treated in a paediatric, or regular hospital at the age of 16. 

Beyond the outcome-related repercussions of your choice, are very real, and very important, other factors too. Whether or not you’ll be able to get access to a social worker familiar with schooling, or university admissions. Whether you’ll be able to see the same doctors, or be referred and treated inside the same hospital during your probable life-long follow up. Whether there is even a support network or buddy system, or even One.  Other. Damned patient with whom you don’t have to verbally joust to avoid allusions to “how unfortunate” it is that you in particular are facing a disease their cousin had succumbed to themselves.
Again forgotten in many regards, the unique challenges of a life completely interrupted, academically or career-wise; issues like fertility-preservation and also that of palliative care, only add to this. Great examples were given of programs to make hospitals more youth, frankly, person-friendly environments, and many, such as opening up reliable wifi to patients and things like shared recreation centres where counsellors could also be stationed, could be done relatively cheaply. But others, such as fertility preservation, will require systemic change, which isn’t easy when there are challenges, such as the government’s proposal to reduce medicare rebates for fertility preservation. Little thought is given to AYA cancer patients in many sectors of health policy and service providence. But luckily, patient groups around the world are striving to fix that. And often, many of the services that do come into systems are pioneered (and often provided solely, as in the case of cancer psychological support services by CanTeen in Australia) by these groups. But systems are necessary to offer support still.

The services are still pretty damn important. CHOC - the Children's Hospital of Orange County - put this together, but just as cool is a Patient Station they have in their hospitals which feature virtual reality platforms too!
As Madeleine FitzPatrick of Western Sydney University’s medical program aptly put “if we treated all our patients as we do in paediatrics, we’d have much better outcomes”, and in many instances, it’s true that they do boast superior support systems. But there are many issues which require more in general, and when you factor in the low numbers, low resources and the lack of specialised staff in this field of medicine, it becomes a tough challenge to solve. 

Interesting is how the interplay of differing health systems, differing classifications of what exactly “youth cancer” meant and differing types of providers, leads to different approaches. The UK, specifically, England, seems to be most ahead of the pack, with its public, regionally-zoned healthcare system allowing for the building and providing of services and treatment to be done from hospital specific cancer units. There are 28 of these, reasonably spread out around the nation. The US with very diverse systems, both state by state and hospital to hospital, would find it challenging to implement such a scheme, so it’s often up to hospitals to learn lessons from others, or, where that doesn’t work, for not-for-profits to pick up the slack, support wise. And in Australia, CanTeen has revolutionised itself to become a service provider, and with help from the government, has established the Youth Cancer Services network, seeking to unite as many young cancer patients as possible to youth cancer specialists in many fields, through strategic placement of staff in major cities. More focus on these, and more funding is indeed, necessary. But knowledge that these services exist by us, the future of this field, will ensure that those services will lead to less suffering.

Perhaps the most eye-opening part of this conference was revealed to us by one of the most inspiring. Palliative care is a topic last on many patients’ mind as they progress through their cancer journey, but it’s not only necessary for some, but very misunderstood too. As Stevie, a palliative care patient herself, put to the audience, it isn’t just something offered to patients to reduce suffering. It restores dignity. It improves functioning. And in many cases, it isn’t even necessary that you need to be dying to access, and benefit from it. Superior pain management is but one example of the benefits of involving palliative care physicians earlier than at day’s end. And the insights Stevie offered into the suffering faced by doctors too as their patients are taken all too young were remarkable. I myself spoke to those gathered and reminded them that no matter what the outcome, they can and will always be able to change lives. It wasn’t the medical decisions and prowess that made my doctors special. What made them special to me was the times they were there for me, beyond all that. Those times we talked about fishing before delving into a consult. When one doctor walked me to a biopsy on his way to another department. When my treating haematologist wrote a letter in to the UMAT board imploring them that I be allowed to sit my entrance exam. Those things changed my life. And I’ll always remember them. Forever. No matter what.

The social:

Social and psychological impacts of disease are often most overlooked in treatment, but when considering the disruption to the crucial developmental and growth periods many in this age bracket are in, and the high rates of depression and suicide it suffers too, it becomes vital these issues are addressed.
Higher rates of depression are faced by patients and survivors of youth cancer, and also by their friends, siblings and parents, all too oft forgotten in day-to-day care. Though it’s impossible to fix every aspect of this, it’s important to, at the very least, acknowledge it, and refer out to specialists which as you now know do exist on this matter. Within Australia, often that’s provided by CanTeen.
Furthermore, risk taking behaviour is also markedly increased in this population, both generally, and specific to youth cancer patients, and so it becomes vitally important to not just be aware of this, but to also take every means possible to reach your patients. Lessons to medicine in general can be taken away from this, as one patient pointed out that they were “more likely to take medications regularly” if they were properly explained “why [they] had to take those medications”.
Indeed, doctors are responsible for much of the suffering faced by patients. And that’s reflected in both scientific studies, and also by a survey I took at a patient and family member conference prior to this one’s commencement.

This was but one response to those questions… 

As you can see… it’s heart-breaking the impact of cancer on young people. Hell, it's heartbreaking for everyone. But as the kid in response 2 and I myself, a 3-time cancer survivor, now medical student can tell you first hand… the impact of being connected to and just talking to someone who’s been through what you have is immeasurable. This, the connection to services and simple friendship is literally the difference between pain and relief, anxiety and acceptance, even life and death for some. And all these things, we have this amazing privilege to be able to provide.
So if you take anything away from this, please let it be that.  

Friday, October 7, 2016

Not Your Usual Motivational Bullshit.

Motivating someone is hard. There are too many 'thought leaders' out there telling everyone who'll listen, 'If I can do it, anyone can!'. But it doesn't work for those who've lost everything. Here's how to motivate those who REALLY need it.
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I saw some rehab specialists today. First time I had actually, which is surprising, given how many different aspects of my life have been compromised by my Graft Versus Host Disease. 

Anyway, that's how I ended up walking up and down a ward, over and over. Apparently the magical cure to my debilitating cramps is walking... 
Who knows though, it could work. Worth a shot, right? 

So there I was,, doing a 6 minute walk test, putting up a number that I'd be ashamed of 5 or 6 years ago, when a lady I kept passing kept calling out to me. I didn't understand her at first, I thought she may have been delirious or something. But on maybe the 5th lap, when I strained really hard, I finally heard what she was saying. 

"It's so unfair... I used to be able to do that."

"Awww, why are you doing this?"

"It's so unfair..."

At first, I was embarrassed. And a little mad. I'd just realised they were making me gallivant my way across these halls in front of peoplew ho can't even get out of bed, yet alone do the things we take for granted, like getting up to go to the toilet. 

My next response. Annoyance. No, closer to Indignation. How dare she say it was unfair that I was doing "well" (most of you who are well bodied and young would agree that being able to walk a grand total of 300m in 6 minutes isn't exactly a portrait of good health). What did she know about what I'd been through to do this? About how the cramps which debilitated me at night and left me screaming, just begging for it to stop??

But I held that back when I remembered where she was. Unable to walk, even get out of bed after a stroke. It was exactly where I was years ago, as I was learning to walk again after my own transplant, as I tried and tried, over and over again to regain a semblance of normality. How would I have reacted to an indignant prick who'd tell me that they'd done their time, their fair share of suffering then? Not well.

But as I thought about what I should say, striding back and forth through the ward, I also asked myself how I'd have reacted to a pompous prick proclaiming, "I've done it, so can you!"

Not well either... 

That's the thing though. "Motivational speakers", "thought leaders" and "inspiring personalities" are all the go these days. There seems to be 30 of them for every one of us. 

It's all good and well when we hear their stories. I mean, if you're normal, or if you feel good about yourself and the world, they often can lift you up. If they can do it, anyone can, right? 

But if you're not in a good place, if you're suffering something devastating like this lady is... If you're facing a chronic illness or disability; something that won't budge, no matter how much you "positively think!" about it, or if you're depressed, and miserable about yourself and the world, it literally feels like these people are saying you're just whinging, ungrateful or inferior for your suffering. That you're weak because you haven't been able to get over it, like them. 

It doesn't help. It literally makes them feel more down. It discourages them, the very opposite of what's intended, when you're not well. I know, I've been there, and I've hated hearing those things too. 

What should you say, you ask? 

Well, it depends on the person. There isn't a one-size-fits-all solution. 

But what do most need? 

Encouragement is one thing. Acknowledging that their pain is real, and important to you, is extremely important. It's vital. No matter how much your mind may say otherwise, no matter if you're a doctor, nurse, or just a friend who's watched on as someone going through much worse just grimaced and got on with it, and are now dealing with someone who thinks their world's just ended or someone who tells you they have nothing to smile about, their suffering is real and just. 

Who are you to say their pain isn't pain? 

I can honestly say that depression, and this chronic illness (not just the horrible aspects of it, like the cramps, but how it makes me feel about myself and what I can do) has been harder to face than every single battle I've had with cancer. 

At least with that, I had an end in sight. Something to work towards. And at least in that, I had my mind on my side. 

So don't tell someone like her, or anyone else who's really down, for any reason, that they should be "grateful because some poorer soul out there is suffering more"... Again, ask yourself how that helps. You've literally given them no way to get through their pain, just told them, in this case, intentionally, to their face, that they're weak and ungrateful and don't deserve to feel the way they do. 

How then do you give someone something to get through their struggles, when those struggles seem so deep? 

Well, I think letting them know that it is gonna be hard, that it does, and will suck at times, is vital. It doesn't kid them, it doesn't give them an overly rosy perspective of the journey to come, and contrary to what you may think, when you're facing something terrifying, and are at rock bottom anyway, it prepares you. And gives you only one way to look, and think. One way to go. Up! 

After this, show them that though it is a long journey, you can make it easier. There are hundreds of little tips and tricks, things that take only minor changes to your habits, lifestyle and mindset, that'll help you get through things easier. 

Facing long rehab? Like you're just trying to get up and out of bed for the first time in hospital, or for the first time in a while when you're depressed, rehab? 
Do those exercises that seem to take everything out of you in the evenings, or mornings, when you're about to shower anyways, or do it right after food, when you're most energetic. Get the pros to help you. Get them, or get others who know (the internet and chat rooms can be a great resource to help you do this), to give you the easy ways of doing things. The rehab physicians I saw today gave me exercises to do while sitting down at a chair! Perfect for not just my cramps, but my exams coming up soon (God help me). 

Ask a friend to help you, commit to something you can't easily skate out of, and you get others on your side in this battle.  
Indeed, if you're in a position where you're trying to help someone, get them someone they can look up to! Someone who may have been through something similar to them. You may not be able to fathom what they're going through (and I believe this doesn't mean you can't help), but there will always be others who can! And they can help so much... That was certainly the case for me... When I was going into my first bone marrow transplant, I was terrified deep down, until I saw someone who'd been through it too. Just seeing them gave me a sense that this could be okay. That the pain and misery in my future did have an end point. And the chats we had throughout it, the tips and tricks and encouragement she gave me just stuck more. There are so many tools out there, set up by the government, hospitals, foundations and just the internet that connect people together. Even if you can't find the right words, right away, someone out there can! 

Feeling like it's not working? That all the work you're putting is getting you nowhere? Or that getting better is so long away? 
Give it time. But give yourself something to work towards. Look at the big picture, what this is all for, and give yourself a goal. An end point, something to keep you marching forwards in those hard times. Make it a long term goal. One that you can keep yourself accountable to by setting smaller achievements to accomplish. Write it down somewhere. Post it to Facebook, and make yourself accountable. 
Make that reason for going on an ideal; something greater than you. To care, or take away the suffering of your loved ones, to work for others, or something you believe in. And by doing this,  and you rig your mind to not just look at the big picture, but place getting there as one of your top priorities. 

But if you're feeling like giving up, then the last, best thing you can do is to let yourself be human. Believe me, you'll feel like giving up, or that it's pointless, or that you'll never get there many times on your journey. Whatever you're accomplishing is hard enough when you're normal and facing so many external hardships, yet alone when you're facing internal ones you feel like, or you physically can't control. I've done some crazy things in my time, and so many people call me an inspiration for many of them. 

But the truth is, I've given up on so many things too. I've told myself, "Why bother exercising when I'm gonna get sick and lose all I've gained anyway? When I can't even do half of what I used to," so many times now, it's not funny. And I've succumbed to those too, along the way. 

But it's when I'm pushing myself too hard that I do this. When I tell myself "Anything's possible" and set myself on something that, halfway through, feels impossible to me, I lose hope, and feel like giving up. 
Which is why acknowledging to them, or yourself, that there will be hurdles, obstacles and failures along the way; that your goal may take months, or years to accomplish is so important. 
It's why telling them, that their goal, their deepest desire may not be fulfilled isn't disheartening. Because giving a shot and trying, even if it brings only small comfort will still matter, if not to them right away, then to those they love. 
It doesn't discourage you, if done right. If these are acknowledged, but you're also given ways of getting through those hurdles, or at least, assurance that help and friendship will be there when trouble comes, it actually makes you more likely to succeed. 

And I guess that's at the heart of what I always try to say. 

Do I believe you can do anything you set your mind to? 

Well, if you're well of mind and body, and if you're afforded the opportunities you deserve (which many, including the poor, women and other marginalised populations aren't) then, barring the impossible-according-to-the-laws-of-physics, yes. 

But if you're not, it can be much, much, harder. 

You should never impose your beliefs and values onto others; especially those who may need your help. 

But that doesn't mean you can't. 

And I hope I've given you one way to try and do that. 

So what did I tell her? 

I told her that I'm sorry for her pain. That I could only begin to imagine what she was going through. That it must be horrible.

But then that I myself had been at a low point once myself. That I'd seen others who had been through what she had, and recovered. 

That I didn't know what was possible for her. That I did know there would probably be times you feel no difference, that you may go backwards at times, that you may wanna quit.  

But that there is an end goal that you can and should aspire to. That this could well be the very thing that gets here there. And that she was in the best place to get her there.  

I wish her the very best. 

Sunday, July 31, 2016

How to Renew Your Faith in Humanity

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This may be weird... I'm gonna be writing a blog post within a blog post within a blog post today. 
But yes, basically, I wrote this comment to a group of medical students on social media, after writing the bottom comment to a guy who writes this great blog on medical practice. I knew I needed to share this with you. This is directed towards medical student, doctors and anyone who cares about their welfare. So, hopefully, everyone! A popular blog post I wrote not too long ago that delves into the extreme depression that healthcare professionals go through. 

"I read this blog of a medical intern intern recently, and saw, as I always had for the past few years I'd been following him, a trend of dissatisfaction and depression. So I decided to comment this (the stuff below), and it ended up turning into pretty much a blog post of my own haha (I do this sometimes lol... it's how half my blog posts start) This may be able to help some of you out. Here I talk to a doctor... but if you can remember that all the strife we go through as students; the pressure to succeed, the threats of failing, and the constant, unending, life absorbing study - that it all goes to us being able to accomplish amazing things. That how the very hand you're using to click on things, one filled with miles of vessels, nerves and muscle/bone fibres, all coordinated perfectly to deliver the perfect amount of nutrients, energy and oxygen required to function stems from millions of years of evolution, is fascinating in its very EXISTENCE... it could make your life right now feel more worthwhile if it isn't already.
If you guys ever wanna talk btw - I'm right here. Message me here or on my blog (in case I don't see it) and I'll be more than happy to talk!
"Hey man. I've read your blogs for a while now. One thing I notice as a theme is one of depression. Of feeling overwhelmed, as if you aren't really accomplishing much from all of this. The great lie that is medicine I guess is that we will proceeed, in our lifetimes, to save hundreds of suffering people.
First off, I wanna tell you something I tell all doctors in your position.
That no matter what, you can, and ALWAYS will be able to make a huge difference to peoples' lives, no matter how insignificant this thing can make you feel.
Pain and suffering, and indeed, death, you can't alleviate all the time. But the way in which you influence someone's life in their most vulnerable, painful, hopeless moments, makes a HUGE difference to patients' lives. I know from personal experience (I'm a 2 time BMT recipient to treat my AML and suffer severe chronic GVHD because of it now). At the beginning of my journey, when I was first diagnosed, it was my doctor's words that got me to feel that I had some control in all of this. It was his actions, and the way that he practiced that inspired me even further to get into medicine. It was a letter from him to the medical board that allowed for that dream to actually happen.
But even now, with this incurable, long lasting, life threatening disease that is graft versus host, even after I developed this thought process that helped me get through the hardest parts of treatment, I find my doctor's words and interactions influence me greatly.
My care changed hands recently, as my old doctor had retired. My new ones left me disingenuous about my own health. They talked down to me, they refuted everything I said, it was almost as if they wanted to prove me wrong all the time (despite the fact that the publications on medications I'd looked up for a more recent disease I'm dealing with, bronchiolitis obliterans, they hadn't even read papers on... since then, I've been put on the medication...), and left me feeling anxious about my health, for the first time in years. The attitude I'd developed to deal with all those kind of feelings dropped away with that, perhaps because it exacerbated my depression.
Then I saw a doctor, as a second opinion, from another hospital. We talked about my health. The back and forth was glorious. Finally! Someone who was well read in his field actually explaining things to me! Finally, someone who actually cared about my sleep, stress and quality of life. Someone who treated even the little things, like my feet which were aching, rather than dismissing them in favour of "the bigger problems". That one consultation changed my outlook on everything immensely. I still know I may well die to this disease. That it could happen in years too. But I no longer worry so much, I feel better cared for, and that's spilled over to my life in general.
You can do that every single day as a doctor. It won't mitigate the long hours, the fact that many patients won't be helped, or listen to your advice, nor will it eradicate this system, that, in your country in particular, often dooms the poor to poor outcomes. But it will change at least 2 lives.
The first of that patient.
The second, your own.
Because if YOU can go into work, everyday, telling yourself that you're going to be that doctor that eases the pain, suffering and misery of others, you'll not just renew your faith in your ability to cause change, but perhaps even enjoy it again.
I hope this gets to you. And I hope this helps you out."

A video I did on this;

Tuesday, July 26, 2016

Cancer Patient Plays Well, and Wins Big For Charity.

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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?


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.

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!

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.