Strokes are the fifth leading cause of death in the United States. An interruption, or lack of blood flow, to an individual’s brain is the main cause of death. Different names such as Cerebrovascular accidents (CVA) and/or an apoplexy mean the same thing as a stroke and can be divided into two categories: Ischemic and Hemorrhagic strokes.

An ischemic stroke is a plaque or blockage to any major artery leading to the brain, such as the carotid artery. This plaque slowly builds up in the artery and deprives the brain from oxygen due to the lack of blood flow.

A hemorrhage is a rupture of an artery – bleeding in the brain. High blood pressure and trauma are the two leading causes. Similar to a heart attack, strokes have a plethora of factors that can be avoided.

Understanding the risk factors strongly increases the chances of offsetting or completely preventing a stroke. According to Dr. McElroy, a medical physician and host of Sawbones podcasts, stated that “80% of strokes are preventable if one takes the proper steps in changing their behavior.” Modifications to one’s lifestyle in combination with the elimination of any harmful habits is a patients best option to consider.

Recognizing the signs and symptoms of stroke is vital in preventing an apoplexy. First and most important thing mentioned was the risk of smoking on a patient susceptible to a stroke. As with everything and anything, smoking is always dangerous segway to multiple diseases, cancers and inevitably death. Therefore, quitting smoking alone could offset the potential of a stroke by miles.

Other lifestyle suggestions include eating a healthier diet, exercising regularly and sleeping well. Eating leaner meats, substituting white bread with whole wheat bread and incorporating fruits will likely prevent atherosclerosis, plaque in major arteries. Dr. McElroy also emphasized on the importance of exercising regularly. Physical activity is good for one’s cardiovascular system to efficiently be able to supply the brain, body and lungs with oxygenated blood. Sleep is vital for ones cognitive and motor control patterns.

Your biggest take away is that strokes could be prevented when taken the right steps. It is key to understand and know the signs and symptoms of a stroke to take quick actions and prevent a case of death. Furthermore, if you witness anyone that may be experincing a sudden stroke, one must ACT IMMEDIATELY. An excellent acronym to keep in mind when facing an individual that is having a stroke is FAST.

F – for facial drooping, an asymmetrical face where the corner of their mouth is drooping.

A – for Arm drop test

S – for speech slers and,

T – for time.

In conclusion, if you or are loved one is at risk of getting a stroke then it is extremely important to start implementing healthier habits in your/their daily life before it is too late. Without proper precautions one may end up in the hospital getting a thrombectomy, a surgical procedure that goes into the brain with blood thinners to remove the clot. An extremely high risk procedure that could possibly harm the proper functions of talk, walk and motor control.

Remember that the longer the brain cells are deprived from oxygenated blood flow, the more serious the damage of a stroke will be. Act fast and do not hesitate to call a professional for help. Suffice it to say, strokes do not require any overthought. Prevent it before it occurs through manipulating your personal behavior and daily activities.

On July 13th 2018, I had the opportunity to observe a total Shoulder Arthroplasty. Here are some notes I have jotted down with continuous elaboration.

Arthroplasty is a surgical procedure to restore the function of a joint.  Shoulder replacements are less common than knee or hip replacements, but it is just as successful at relieving pain. The shoulder joint is a highly sophisticated ball-and-socket joint, allowing the bones to move freely in almost all directions. The top region of the humerus has a ball shaped head that fits precisely inside a shallow socket in the shoulder blade (scapula). This socket that holds the head of the humerus is called the glenoid. The shoulder joint is composed of three bones; the clavicle, the scapula and the humerus. These three bones are connected to each other at the point where the humerus fits into the glenoid fossa of the shoulder blade is called the glenohumeral joint.

A shoulder joint replacement is commonly performed under the circumstances of arthritis or bone fractures. In order for the bones in glenohumeral joint to function pain free with no restrictions there is a smooth substance that covers the bones called Articular cartilage. This clear substance covers the ends of the bones, protecting and enabling free movement with no friction.

With old age the Articular Cartilage wears off, a condition referred to as “wear and tear.” That is when most people begin to feel symptoms of pain or stiffness in the upper arm. The head of the humerus experiences severe pain through the overuse of the cartilage leading to arthritis. The damaged cartilage of the glenohemural joint (Shoulder joint) decreases the space between the head of the humerus and the socket of the scapula. Causing the bones to rub against each other during motion. This condition is called Osteoarthritis, which occurs in people over 65 or with a family heritage of arthritis. As a result of the cartilage decaying, bone on bone friction takes place, causing stiffness and limited mobility.

Note the differences in space between the humerus and the scapula in the figures below. On the left is a healthy shoulder joint with normal space between the two bones. While the X-ray on the right shows little to no space in between the bones. As the cartilage that covers the ends of the bones wears away, it can result in bone rubbing on bone and produce painful bone spurs.

A typical shoulder joint replacement involves replacing the arthritic joint surfaces with prosthetic components. Components are a metal ball acting as the replaced head of the humerus attached to a stem. These components come in different sizes and can be cemented or “press fit “during shoulder surgery.

Surgery

The shoulder joint is vulnerable to stress, injury and arthritis. The problem occurs when the cartilage between the bones wears away and painful bone on bone occurs. Symptoms include shoulder pain, loss of motion or crepitation…noise. Surgery is recommended when non-surgical treatments fail. Total shoulder joint replacements removed all or parts of the joint to relieve pain and restore the movement.

Let’s discuss the shoulder joint replacement surgery.

To begin the patient will be seated at a reclined position. The surgeon makes an incision approximatley six inches long on the front of the shoulder. This allows the surgeon to access the joint and view the degenerated cartilage. The damaged head of the arm bone (humerus) is removed with a saw, to later replace with prosthetic implants. The bone socket is exposed after the removal of the head of the humerus. The surgeon then smooths and reshapes the bone spurs and damaged cartilage in the glenoid. Then the surgeon then proceeds by making a whole in the socket for the implant to fit in. The plastic glenoid component is pressed into place with bone cement. The surgeon hollows out the upper portion of the humerus to receive the implant. A metal stem is then implanted into thehumerus, secured with bone cement. A metal ball is attached on top of the metal stem. After all the implants are placed correctly, the surgeon then joins the repaired glenoid and humerus components to form the new shoulder joint.

This is a short yet articulate operation. This procedure only took the surgeon 40 minutes with The goal to relieve pain and restore movement in the shoulder.

References

J. Michael Wiater, MD. “Shoulder Joint Replacement – OrthoInfo – AAOS.” Clavicle Fracture (Broken Collarbone) – OrthoInfo – AAOS, Dec. 2011, orthoinfo.aaos.org/en/treatment/shoulder-joint-replacement/.

OACMorthopedics. “Total Shoulder Replacement.” YouTube, YouTube, 3 Dec. 2012, http://www.youtube.com/watch?v=3GSOo_z0vs4.

“Shoulder Replacement Surgery Video.” Arthritis-Health, http://www.arthritis-health.com/video/shoulder-replacement-surgery-video.

Hello World,

On July 6, 2018 I had the opportunity to observe a total hip replacement done on a 66 year old patient. The patient had chronic hip pain and a disability of arthritis. The Doctor that performed the surgery was Dr. James Rubano. The operation was fairly quick, only taking him 35 minutes. I was not really able to see any parts of the incision, since the surgical incision is relatively small. Many times the only view into that surgical window is the doctor’s point of view. However, a very knowledgeable sales rep, Mike stood beside me and thoroughly explained the operation as it went. Although he was in and out of the OR very often to bring the necessary instruments to the surgeon. I was still able to get a decent amount of information down on my notepad. Nonetheless, here are my notes, thoughts and continuous elaboration of the Total Hip Replacement operation.

Anatomy

First, the anatomy! Because without the anatomy, the surgical procedures would not make any sense.

As you could imagine, a total hip replacement takes place at the hip. The hip joint is one of the largest and most important joints in the human body. It allows us to walk, run, hike, and move about freely. The hip is a ball-and-socket joint. The socket is formed by the Acetabulum. A cup-like depression in the pelvis that holds the Femoral head (the ball) in its position. The figure below is a perfect depiction.

The ball-and-socket joint is a highly advanced synovial joint. Where the ball-shaped surface of one rounded bone fits into the cup-like depression of another bone. Another great example of a synovial joint is the glenohumeral joint of the shoulder. Where the rounded head of the humerus (ball) rests in a cup-like glenoid fossa (socket) of the shoulder blade. Or how I like to think of the synovial joint… a billiard pocket for the 8 ball.

The distal bone is capable of motion around an indefinite number of axes, with one common center. It enables the bone to move in nearly all directions. However, as one ages and the cartilage begins wearing and tearing the patient suffers severe pain and stiffness at the hip joint.

Causes of Hip Pain

A condition called Osteoarthritis, is an age-related “wear and tear” type of arthritis. Typically occurs in individuals 50 years or older with a family history of arthritis. Rheumatoid arthritis, is another common cause of arthritis. It is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This inflammation can damage and deteriorate the cartilage leading to pain and stiffness.

In hip osteoarthritis, the smooth articular cartilage wears away and becomes frayed and rough. Leading to severe cases of pain, stiffness and immobility. The figure below, shows the head of the femur narrowing the joint space, causing the cartilage to deteriorate and be more fragile over time.

  

Surgical Procedure

Now onto the good stuff! I am by no means an expert… yet. This is just MY concise explanation of the surgery.

There’s a lot of preparation that takes place before any operation. But this one looked like it took a little bit more time to fully prepare everything than the others I have observed. The patient’s vital signs are checked to make sure blood pressure, heart rate, body temperature, and oxygenation levels are normal and surgery can proceed. Once the patient is well taking care of, Anesthesia is administrated.

Once everything is set and stone, the surgeon begins by making a 10-12 inch incision on the side of the hip. Cutting through the skin, muscle and any other soft tissue to expose the bones of the hip joint. This is a traditional hip replacement surgery compared to a minimally invasive hip replacement, where the surgeon performs a much smaller incision, about 4-6 inches and cut through less soft tissue. Anyways, after the bone of the hip joint is exposed, the surgeon dislocates the joint. Cutting and removing the arthritic head of femur “ball” with a saw. Once removed, there is access to the Acetabulum, the “socket” in the pelvis. The surgeon then prepares the acetabelum for its implant using a special tool called a reamer. The reamer grinds down the acetabulum to the level of healthy bone. Then places the acetabular cup component into the reshaped socket. This cup may be porous to allow the bone to grow into it over time. Acetabular cup is a hemispheric shell inserted into pelvis.  

Afterwords, the surgeon moves to the femoral bone inserting a prosthetic stem into the canal of the femur. The surgeon does a series of broaches to open the femur canal wider so the femur implant can be placed comfortably. The femoral stem is a narrow, tapered metal shaft that fits several inches down inside the femur. The top of the stem is designed to hold a prosthetic ball that will replace the femoral head. A temporary prosthetic ball is attached to the top of the femoral stem. This ball is specially shaped to move with the new acetabulum cup. The surgeon then inserts the temporary ball into the new socket and move the hip around, checking to make sure the joint has ease of motion and does not dislocate. The surgeon then removes the trial components and inserts the final ball into the acetabular cup socket. Checking again for smooth and easy movement and dislocation. The surgeon will also attempt to restore optimal leg length using one of several clinical techniques.

Finally, X-rays are often taken to assure proper sizing and positioning of the components. The muscle and other soft tissues that were cut are repaired and the skin incision is stitched back together. Voilà a new hip has been placed and the just after a few weeks the patient is able to walk and hopefully experience no more pain.

 

References

 

DePuyVideos. “The Latest Procedure: Anterior Approach Total Hip Replacement Surgery.” YouTube, YouTube, 8 Sept. 2014, http://www.youtube.com/watch?v=5NqJa_J2dfw.

Foran, Jared. “Total Hip Replacement – OrthoInfo – AAOS.” Clavicle Fracture (Broken Collarbone) – OrthoInfo – AAOS, Aug. 2015, orthoinfo.aaos.org/en/treatment/total-hip-replacement/.

Hansen, Erik N. “Total Hip Replacement Surgical Procedure.” Arthritis-Health, http://www.arthritis-health.com/surgery/hip-surgery/total-hip-replacement-surgical-procedure.

Hello world,

I began volunteering at the Christiana care hospital in Wilmington Delaware for about a 2 weeks now. My mission is not to just get volunteer hours, but to dive into the ins and outs of the hospital environment. My primary focus is to be an observer, by exposing myself to as much surgical cases as possible. To watch and learn from surgeons, PA’s and nurses. Surgeries are extremely gruesome…. but fascinating! Although I have never been truly [introduced] to the hospital OR, turns out it was pretty much as expected. As a volunteer, the job duties I am responsible to perform are to clean, wipe and synthesize the entire OR after the case is over. While the cases are in their procedures, I take that time to explore and watch surgeries from the outside window of the OR. Sometimes, I get lucky enough to stand right beside the doctor as he performs the surgery.

On June 29, 2018 I was granted the opportunity to watch a leg amputation. The patient had an infection in his lower leg extremity that caused him to dis-articulate his right knee. Preventing the infection from rising and spreading through the higher leg extremity. The orthopedic surgeons that performed this Knee disarticulations (KD) were two Residents fresh out of the womb of medical school. I ceased this chance to ask as many questions as possible. To learn and to partially see if they really knew what they were doing. Anyways, The lower half of the leg had all sorts of bumps, bruises and hematoma in the tissue. The incision took place in the middle of the kneecap-down. 

The doctors began by outlining the middle of the knee joint to cut directly through the joints and cartilages that connected the femur to the tibia. It is essentially a knee dis-articulation done between the surfaces of bones. Rather than cutting through the actual bone. Cutting through tendons, ligaments and muscular systems to reach all the way through to the popliteus tendon, the posterior region of the knee. As cruel as it may sound, I was excited to see the amputation. When it comes to surgeries, you cannot be soft-hearted. This time I was smart enough to bring a small notepad to write down notes, unlike last time where all the information just slapped me in the face and still left me clueless and overwhelmed. Anyhow, here are my notes, thoughts and further explanation about the case to the best of my knowledge.

The Procedure

The incisions are sharply carried down circumferentially to the level of the knee, through the joint, and along the drawn posterior flap. One of the two doctors began cutting with a scapula through the skin into the tibiofemoral joint, that controls the range of motion of the knee, reaching the cartilage. Where they began using a bovie, an instrument used for electrosurgical dissection and hemostasis. Takes awhile to cut through someone’s leg but nonetheless they cut through the tendon and reached the Anterior Cruciate Ligament, famously referred to as the ACL. It was my first time vividly seeing an ACL and now I have that image stuck in my head. Doctor Ben, one of the doctors performing the procedure, mentioned that the main goal is to reach the popilateral vessel to tie it then cut it. The popliteal artery is a deeply placed continuation of the femoral artery.

So just a refresher on the systemic circulation pathways. Oxygenated blood is pumped from the left ventricle of the heart into the Aorta, down the abdomen into the lower extremity, passing through the pelvis to the illiac artery branching into external and internal arteries, in this case through the external artery into the femoral artery to the posterior popliteal artery.

Essentially, the surgeons were cutting to reach the popliteal vessel and with great care not to disturb the insertion of the Adductor Magnus, a large triangular muscle that adducts and medially rotates the hip. Meanwhile, preserving the cruciate ligaments and the posterior capsule. Once they finally reached the popliteal blood vessel, they tied the end of the artery first, to stop blood flow, then tied the vein. After ensuring all is done correctly the distal leg was removed from the operative field with ligation of the popliteal vessel. However, the surgery was not over yet. After the removal of the lower leg, the doctors shaved down the head of the femoral bone, starting distally and ending proximaly using a saggital saw to shape the head into a box. Then persevered the cruciate ligaments and posterior capsule. With the patella advanced to cover the distal surface of the femur as an end-weight bearing surface. When it came to suturing the quadriceps tendon is sewn to the preserved cruciate ligament and posterior joint capsule so that the posterior surface of the patella is in direct contact with the distal end of the femur. Next, the hamstring muscles are myodesed to the quadriceps tendon and posterior capsule using 2.0 polydioxanone to cover the distal femur. Looking something like this…

There we have it! That was a leg amputation!

All in all, this was an extraordinary yet very knowledge and useful experience for me. I am delighted to be volunteering and learning through exposure through real hospital settings rather than just reading about it through books. These blogs are intended for personal growth in my understanding to medicine. As well as, share these stories of my first encounters in the OR and to refer to them in the future!

References

Albino, Frank P, et al. “Through Knee Amputation: Technique Modifications and Surgical Outcomes.” Advances in Pediatrics., U.S. National Library of Medicine, Sept. 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179362/.

Ibrahim, Mohamed, and Stephen Rouse. “Anatomy Final Project: The Lower Extremity .” Google Slides, Google, May 2018, docs.google.com/presentation/d/1ZxDuDNoC6k_hXHZru4x2UlB7GtED86w_NZq1sPTqfek/edit.

Smith, Douglas. “The Knee Disarticulation.” Amputee Coalition, 2004, http://www.amputee-coalition.org/resources/the-knee-disarticulation/.

Hello World,

On June 22, 2018 I had the opportunity to scrub up and step into the OR and observe a plastic surgeon perform a breast reduction on a patient. Although it was my first time, I knew what to I was walking into. The room temp was low and next to the stroller, where the patient laid unconsciously, was a table full of sterilized instruments. I was warned not to come near the table so I watched from afar for quite a while.

The doctor was already half way through the surgery, finishing up one side of the chest. All I could see from where I was standing was the lights beaming down on the patients breasts as the surgeon and his assistant were pulling out and cutting up lards of fat. I was more intrigued when the doctor began doing so and walked over to the other side where I was permitted. I wanted to watch and learn from the jump. I was just impressed at the fact that the doctor was nonchalantly performing the surgery while chatting with his PA and nurses. It was as if he didn’t have a full on human cut up and organs exposed in between his hands. I had no doubt he knew what he was doing, however I was just standing there mesmerized. Lost of words and just trying to fully process that I had been blessed to see something not everyone gets to see. I lost myself into what my eyes perceived and was standing there shook.

As a 19 year old college student, life seems to be only getting more and more stressful by the minute. Living in the constant stress of trying to maintain good grades, working  2 jobs, a total of 30-35 hours a week to be able to pay for my personal expenses, such as gas, driving to school and back. School supplies, phone bill and gym membership. As well as, fixing any car issues that seems to be having issues like every other week, and not to forget personal inquires of living like food, deodorant and any other important personal needs. The feeling of trying to maintain everything and keep it under control is overwhelming at times. The hardship of finishing an 8 hour shift, 2 to 10 hour, then having to go home with barely any time to do homework. Some nights I stayed up until 4 am at times and still get up for an 8 am class. well, that is also my procrastination there. but it’s hard! As if the harder I try, the harder it gets ; the less I care, the more stress and guilt builds up. The everlasting struggle of a going to school and working is exhausting. Not to forget the misery of trying to figure out what I want to do for the rest of my life and hoping I am on the right path in doing so.

Ever since I was a little boy, I dreamed of becoming a heart surgeon. All from this nice little incident that happened when I was about 9 years old. One day, I was extremely ill and had severe chest pain. My mother took me to the doctor’s office and got it checked up to see what’s wrong. This old, white bearded doctor, sadly cannot remember the name, examined and x-rayed my chest and thankfully there was nothing major but just a little fever. Anyways, everything was fine and as we were chatting, the doctor looked at my mother and said “You have a special little intelligent boy…” then looking back at me, “One day I will write ‘Dr. Mohamed Ibrahim – heart surgeon and family doctor’ on the billboard outside of your clinic, if I am still alive.” Since then, that sparked the idea of me being a doctor. Giving my mom that one day I will be a doctor. Not going to lie, I was happy saw the potential in me at such a young age. I was inspired and motivated to learn all about the human body and learn more about performing surgeries. It was extremely fascinating seeing human organs outside of the human body and what each body part’s purpose was. My senior year of high school I decided to take up an Anatomy and Physiology class. It was tons of memorization but got me more excited about the medical field because it some what came to me naturally. I pretended that whenever we dissected in class like I was giving surgery. I performed precise cuts and tried to mimic procedures I imagined surgeons would do. Dissecting a small pig had a fairly similar internal structure to the human body. I first dissected the small and large intensities, as what I had been told. Then went further on by dissecting, what I could and allowed to do such as the thoracic, abdominal, cervical and cephalic regions of the pig. To examine the lungs, stomach, liver, as well as the pigs brain. Essentially, most of the important body parts of the pig’s body but the genitals. Dissecting and observing all the components of the animals body and how each organs shape followed its function was astonishing and mind blowing to me. It attracted my interested and wanted to perform more. We never dissected again in class but I remember Mrs. Harasika bringing in a cattle’s heart to observe. Most of the students were iffy and hesitant but me. Boy I put my gloves on so quick and dove into the bucket with the heart… I started examining it but feeling its texture, seeing the different chambers of the heart, the valves and so on. It was huge heart. Again, fascinating to see how sophisticated the organs of an animal, similar to humans, really is. That class brought my interests to becoming a doctor much higher and wanted to get my hands on more animals to dissect.

However, now almost 2 years later, going through 2 years of community college and trying to maintain a steady 3.3 gpa, I have no idea if that is the career I want to pursue. If my grades are good enough to get into graduate/Medical school or if this is that what I am truly passionate about. What I want to do in life, I want to excel. I do not want to be average, I do not want to do the bare minimum to pass, I do not like feeling guilty for trying my absolute best, and it not being good enough. Therefore, I have been thinking a lot of what I want to do for my  near future. So I tried other doctoral related jobs and shadowed or observed what the job consisted of. I went to ATI, a physical therapy office, and shadowed for about a month in the summer of 2016. It was interesting to see all the exercises and movements one had to do to rehabilitate or recover from an injury, but got too boring because all that came in where old people and it was a lot of massaging!!! So then I tried to shadow at a chiropractor, who I went to for shoulder, groin and lower back pain and that is where I learned just a little about the spine and bones in the body. That was really interesting, at the time I walked in with a not so perfect posture, and as the doctor was working on me to fix my posture, it felt great cracking my back and giving me tips on how to have a better posture but also became uninterested real quickly by all doing the same procedures over and over and over again that had no help in curing my groin and shoulder pain whatsoever. So I just stopped going.

As a college student, I am in the constant struggle and stress of figuring out what I want to do with my life. What to actually do to reach my dream job or if I will have a career path in mind to commit to. So far I have discovered no passions, and have no set career in mind. I have always had the dream of becoming a doctor or surgeon; However, I do not exactly know, what kind of doctor (Chiropractor, physical therapist, or a physician) if that is what I want to perform for the rest of my life. I do have strong interests towards those careers, but I want to be something more. I believe it is important to pursue a career one is passionate about rather than working for a job just for the sake of money. Because no matter how much money you make, nothing will help you overcome the feeling of doing something you hate.

However, one in fact can make great amount of money while doing what they are passionate about, it is just a matter how hard you are willing to work to reach that job. According to Larry Smith, in order to achieve a “great career”, you must find your passion, and work your way towards that career. No matter how hard or how ridiculous you may look, one must “work really, really, really hard” and “not be afriad to pursue [their] passion.” In order to achieve greatness, one should not be afraid to try, nor be have the fear of looking ridiculous. Which is all true, the fundamentals stated by Mr. Smith are all valid points to take in consideration when pursuing the ultimate career job. In order for one to find their true passion and achieve that such a thing, one must consider failure along the way. Because without failure in life, one will not achieve success. I see myself following this philosophy of finding my true passion and working until my brain becomes inside-out to achieve my dream job. All in all, do what you love and love what you do.

Where do you go when you need peace?

What is your foundation?

Who do you reach out to when you need to talk? When you need help? You need to get stuff off your chest? when a lot is on your mind and you’re personally stuck, who do you go to? Is it your best friend? your mom? Your dog? Someone at least willing to listen and actually wants to see you succeed. Who?

Are they helping you?

Are you where you need to be? Are you on track with what you have to do, to head to where you need to be?

Are you distracted? Or are you just Scared? Or maybe you’re trying but you’re just struggling?

YOU KNOW BETTER, BUT YOU’RE NOT DOING BETTER.

What is it about you, what you provide, that will make you stand out of the competition?

What makes you unique?

What are your motives?

Think about yourself, think about your goals, think about your dreams. Are you or are you not willing to sacrifice remotely anything distracting drifting you away from your goals.

“LET ME BE GREAT”

Well, what makes you great?

Because working for a great company does not make you great. Having great parents, does not make you great. You see, it is possible to live in a great house or work for a great corporation but you, yourself, is not great.

A lot of people think that wealth will make you great. But contrary to popular belief there are a lot of rich people that are not great people. Trump.

Your greatness is not upon your income.

Greatness comes from within.

Greatness will cost you something and not somebody else. It’s going to cost you some time. It’s going to cost you some energy. It’s going to cost you some resources. It’s going to cost you the price. Going the extra mile. Doing the things others are not willing to do.

Greatness is not cheap! Greatness always cost you more and a lot of people are not willing to pay the price.

Greatness is not immediate. You cannot just walk in your room and come out great. It takes time, discipline, action. You have to stay with it. You got to stay at it. You can’t just give up, you got to keep working. We give up too quickly.

Thoughts influence action. If you constantly have this voice inside your head saying, “I am not good enough”…” I am not prepared.” or “I just don’t feel like doing it.” Then you will never get shit done and you need to reconsider your self affirmation.

“I am the greatest” was Muhammad Ali’s self affirmation. He kept reminding himself that he is in fact the greatest. Staying confident in what he believes in even when no one agrees with you.

Because if you don’t remind yourself than who else will?

No one.

Don’t waste your energy feeling bad for yourself. Surround yourself with people that love you and want to see you succeed and get away from those trying to break you down.

Never give up on your beliefs. Don’t wait for anyone’s approval. Keep moving forward.

 

Mary Jane, I cannot get you out of my mind. You put me in the purest state of mind. Your presence helps me escape the cruelty and wrongdoing of the world we live in today. You make me wheeze, absent-minded, and more forgetting of the troubles of the world. You help me gravitate to a higher up of my thoughts and creativeness, midst while pushing away all the negative tension. When I am with you, I feel free. My mind free of any worry helps me to focus more on living in the moment instead of worrying about the past or what the future may hold. Soliloquizing, reminiscing, observing and appreciating the beauty of nature and the world around. You’re my stress reliever; no, you are the reason I stay sane. Mary Jane, I love you.

We have had our ups and downs. It was not until recent that I have discovered I may not possibly stay sane without you. In some sense, you make me who I am. Your presence from time to time succors my character, builds my conscious to think outside the box and unfollow the norm that society has put for the world’s population. However, I do recall the short period of time when we were constantly attached to each other. You were there for me when no one else was. You were my only friend. You were my late night kiss and my morning coffee. Nevertheless, I could not stop craving you throughout my day. As the stress levels built up throughout the day, the more I wanted to reach out to you and let all my worries run free. I became dependent on you where I could not possibly go a day without thinking about you. We then spent several of days together. Breakfast, lunch, and dinner, you were there playing with my head and making me superficially happy… But deep down I was still drowning in my own worries. I kept going back to you for help. You always seemed to have the answer. But constantly being together became unhealthy for us both. Being in your presence for too long made me overthink, anxious and lazy. Not to forget you were expensive. Sucking all the money out of my weekly checks, where I often did not care about because I was just happy to be with you. You pay your money and you take you choice, and I always chose you. It was not until you made me feel stupid to the world that really caused the breakdown in our relationship. Always in the noncaring state of mind caused me to overthink my actions, struggles and past too much causing me to sometimes wish for a death bed to no longer worry about being a loner or trying to satisfy others, where they never are happy with what you do. To lose the precious memories, where I wished I could go back and do them differently. You were nonstop nagging in my head, wishing I could go back and change the past but that is no man’s capabilities of doing so. What is done is done, convincing myself to move on, but you mind tricks made miserable about my past. Made me weak, unconfident in my decisions, care free of my appearance, and more importantly carefree to face the hardships of life. Yet having no one else but you by my side always made me go back to you. “One last kiss before I go to work…. One more hit before I went to school.” My mom began noticing the exhaustion in my eyes, the drowsiness in my movement. She knew what was wrong and told me to stop seeing you. But Mary Jane you were the light to my dark alley, the smoke to my lungs that gave me the greatest high, triggering my creativity and self-love.  But it wasn’t until we were always together making me go out of my way to just stay with you. Saying things like, “Call out baby, you look tired. Just come lay with me on the couch tonight and let’s watch animal planet. That’s more fun than work.” But little did you know I was with you to ignore my problems and you always knew how to win me over.

Before I would’ve replied back and said, “but babe I can’t, I need the money. I need the education, I need my life to run smoothly to get where I need to be in life but you’re making it more complicated.” But then I smell your strong scent linger into my nostrils, even more, teasing me to stay home with you and waste my time again. Essentially, I would convince myself to stay home claiming “maybe I don’t really need to go to class today, I just hope I don’t miss anything important.” Or if it was work “I could call out of work sick tonight, I don’t really need the money right now”… I just needed you. Then my lifestyle went downhill you started making me fall behind with my school work and responsibilities piling up as I sit with you wishing I never even met you. I hated the feeling of falling behind, being broke, missing class later resulting in the failure of my tests. It was all because of you, MJ. I then developed this hatred towards you. That is when I decided to separate for a while to try and get my shit straight again. But It seemed like I couldn’t get you out of my mind. It was then during our break up where I met another girl named Nikki.

Nikki came to me out of the bloom. Never in my mind thinking I would fall in love with a girl like her. She was trashy but her kisses were much softer, much sweeter, and much more pleasing to my mind. Her breath did stink, but her affection made me love the buzz of being with her. She was similar to you Mary Jane, yet she was easier to handle, easier to go out with, easier to make me function, easier for a quickie in the car and still be able to go to work and school. While with you, a quickie would turn into an all day thing. She was much more inexpensive and much less obsessive to be around. But Nikki did me dirty. Her trashiness got to me, burning me out. I became addicted to her and her withdrawals hurt me much more than you did. If it a was a few hours away, I would suddenly get headaches, so strong, that it developed into migraines. Nikki made my eye sockets saggy and black. She started craving me than I craved her, begging for me to remain with her. I too stupid, physically and mentally exhausted, to understand the consequences of staying with her. I then realized I became trashy myself. I became like Nikki. I then started being curiously conscious of the long-term consequences of staying with her. I knew for a fact if I stayed, I would be running risks of getting heart disease or lung cancer. As well as, lowering my life expectancy. So, I left her.

Mary Jane, it was during that time away with Nikki that showed me how much you were there for me. How much you helped me fight the feeling depression, that I wouldn’t tell anyone bu you. No one but you knew how to take it all in and tell me everything will be alright. Let my mind run loosely, carefree with no worries. I needed you… I was depressed again. I just did not know how to use you effectively. Mary jane, every time I inhale you, you would alter my neurotransmitters causing my brain to function at a steady rate. In the name of your affection that you exerted to me, called Tetrahydrocannabinol or THC, caused specific regions of my brain that dealt with thoughts, imagination, and perception to heighten to a point that whatever my senses picked up became much more enjoyable. Interestingly enough, you let my thoughts float freely in my head. A study just published online in Psychiatry Research suggested that this effect may be due to the drug causing ‘fast and loose’ patterns of spreading activity in memory, something known as ‘hyper-priming’. letting all the worry, thoughts and imagination loose. Pondering more freely creating more creative ideas in my brain. If I used you right, it was nothing but love. I started thinking outside the box, perceiving and observing human behavior from many different angles. Interoperating myself, in a higher conscious, to think of a certain person’s actions and thoughts as my own. Observing the actions of other people and understanding why and how they did that certain action. You also helped me with my sleep deprivation and muscle tensions. Where I would be late in bed, tossing and turning not being able to fall asleep. Or helping my body relax when all the stress and anger is built up. You were the helping hand to bypassing my struggles, loss of appetite, physical and mental stress, as well as insomnia symptoms. I discovered you were nowhere near as dangerous and addicting to my health as Nikki was, only if I used you right. Thus, I have come back to you. But this time in a much smarter way.

Instead of wasting my time with you, I began organizing my time much more efficiently. Seeing you only once a week, or whenever I felt like I was not wasting my time being with you. Time is something that none of us can seem to get right, especially with relationships. You used to make me throw away my plans I originally had and follow you into the hazy, wasteless unknown. Now, as an older, much wiser individual who is trying to manage his time more effectively has no issues with seeing you every once and awhile and maybe not at all. It was the unhealthy addiction between us that caused laziness and lack of self-determination to spike. Now, I have become less dependent on anyone and anything, and have become more dependent on myself. Realizing that my thoughts and actions dictate where and how I want to live the rest of my life. Mary Jane, I have no time to waste to be in a relationship. My focus has shifted to worrying more about what I need to get done to build my future. Therefore, I want to stay as friends, because believe it or not, you still are my only friend. You helped me self-discover myself and who I want to be. I still want to be buds that when we link up to relax, shut off our thoughts, live in the moment and forget about the stress of the world.