Sept. 15, 2025

S3 E14: "Block Box 6 (From ESRA25!): Our convo with Athmaja Thottungal & John McDonnell!"

S3 E14: "Block Box 6 (From ESRA25!): Our convo with Athmaja Thottungal & John McDonnell!"
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S3 E14: "Block Box 6 (From ESRA25!): Our convo with Athmaja Thottungal & John McDonnell!"
S3 E14: "Block Box 6 (From ESRA25!): Our convo with Athmaja Thottungal & John McDonnell!"
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Season 3

Greetings from Norway!! šŸ‡³šŸ‡“ Amit and Jeff once again return to the GE Healthcare Block Box, this time at the ESRA25 meeting in Oslo! In this episode, we chat with Athmaja Thottungal about her motivation behind a career change, the value of healthcare coaches for preventative health, and some practical tips to chill out and engage in a "digital detox". Following that, we talk with John McDonnell and hear his thoughts on blocks new aaaaand not-so-new (and he teases us with some yet-to-be-published hints about a knee block he's working on...). Two incredibly insightful guests, two adequate hosts. Enjoy!

 

Join us each month for another sassy conversation about anesthesiology, emergency medicine, critical care, POCUS, pain medicine, ultrasound guided nerve blocks, acute pain, and perioperative care!

00:11 - Legends of the Fjords

00:40 - The Glass Box Experience

04:43 - Airport Fish Jokes

06:00 - Guest Introduction: Dr. Athmaja Thottengall

07:34 - Exploring Lifestyle Medicine

11:08 - The Patient Perspective

12:33 - Shifting the Healthcare Paradigm

18:31 - Morning Rituals for Health

21:00 - Digital Detox Strategies

25:37 - The Importance of Quality Sleep

26:56 - Addressing Alcohol and Sugar

27:52 - Conversations with John McDonnell

29:43 - The Journey of Regional Anesthesia

37:44 - Innovations in Pain Management

41:34 - The Future of Anesthesia Techniques

WEBVTT

00:00:03.157 --> 00:00:10.057
Long ago, in the land of fjords, warriors gathered in a hall of glass.

00:00:11.097 --> 00:00:18.137
They came from faraway lands, Copenhagen, Belfast, Eindhoven, Chicago.

00:00:18.717 --> 00:00:22.957
They spoke of legends and of nerve blocks.

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Their wisdom would echo through the ages in the living saga of...

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Block it like it's hot. We'll be right back.

00:00:40.417 --> 00:00:42.037
VƃĀ„rden har du det, Ahmet?

00:00:42.297 --> 00:00:49.477
Ja, har de bra. Wait, hold on a minute, Jeff. Why are we speaking Norwegian badly, number one?

00:00:49.677 --> 00:00:55.337
And number two, why am I yet again sitting in front of you in this in-person,

00:00:55.517 --> 00:00:58.557
in this sort of glass block box? What's happening there?

00:00:59.017 --> 00:01:01.877
Is it okay to switch back to English for this part? Yeah, yeah, yeah. Okay, great.

00:01:02.197 --> 00:01:05.697
We are back in collaboration with our friends at GE Healthcare.

00:01:05.917 --> 00:01:10.057
They've brought us together back in person for the second time.

00:01:10.277 --> 00:01:14.337
Yep, that's correct. This is a joint venture where GE Healthcare is supporting

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Block It Like It's Hot, and the podcast is being recorded inside this amazing

00:01:18.477 --> 00:01:20.357
GE Healthcare glass block box.

00:01:20.497 --> 00:01:25.797
We're not in Florida, however, are we? And for the benefit of our listeners, Jeff, where are we?

00:01:25.977 --> 00:01:31.317
Nein, nein, Florida, no. Oh, sorry. I'm not sure that's even Norwegian.

00:01:32.537 --> 00:01:33.257
That's German.

00:01:34.877 --> 00:01:39.377
It could be. I don't know for sure, but it could be. We're at the 42nd Annual

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European Society of Regional Anesthesia, Ezra, meeting in Oslo,

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Norway. And this is my first time here in Norway.

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I'm really looking forward to it. Yeah, me too.

00:01:49.157 --> 00:01:53.237
I mean, so right now we're currently in the Nova Spectrum in Lillstrom.

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Sorry, I thought we were in Oslo, but actually in Lillstrom.

00:01:55.557 --> 00:01:59.377
But it seems that a box has received a little bit of an upgrade.

00:01:59.437 --> 00:02:02.537
It looks bigger to me, and you're a little bit further away than last time.

00:02:02.657 --> 00:02:06.597
Well, you know, it was a bit too close last time. I asked to be moved a little

00:02:06.597 --> 00:02:08.357
bit away. No, this is amazing.

00:02:08.557 --> 00:02:11.137
We'll share some pictures, obviously, but it's been...

00:02:11.137 --> 00:02:16.777
But like the branding and these two hunky guys right in the background looking slightly mean, right?

00:02:16.937 --> 00:02:19.697
It's a bit odd seeing myself stare at me.

00:02:19.817 --> 00:02:25.097
Yeah, it is very weird. And you do look mean. that picture was used I'll tell

00:02:25.097 --> 00:02:27.717
you about that later was used in a lecture anyway okay

00:02:27.717 --> 00:02:33.697
Anyway so hey get over here for a hug it's been too long Hug Interlude.

00:02:34.869 --> 00:02:36.149
We need to get that out of the way.

00:02:36.409 --> 00:02:37.049
Yeah, absolutely.

00:02:37.629 --> 00:02:40.609
This is going to be a really fun meeting. Yeah, for sure. And it's so exciting

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to be recording our podcast right in, literally in the center.

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We are in dead center of the exhibition hall.

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We're literally smack bang in the middle. Yeah, yeah, I know.

00:02:49.309 --> 00:02:51.269
I know what I'm looking forward to. What are you looking forward to?

00:02:51.589 --> 00:02:54.989
Well, now that my speaking commitments are over, I'm really looking forward

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to catch up with guests. We've got so many guests lined up for this podcast.

00:02:59.169 --> 00:03:03.509
It is a who's who. Yeah, yeah. Of like regional anesthesia and POCUS.

00:03:03.509 --> 00:03:05.289
should make for a great few episodes.

00:03:05.629 --> 00:03:08.589
And I'm sure we'll be talking about some new and exciting things too.

00:03:08.949 --> 00:03:10.909
I remember you were speaking yesterday. How did everything go?

00:03:11.089 --> 00:03:16.609
It went okay. I think in the morning I was talking about blocks of breast surgery and classic.

00:03:16.889 --> 00:03:21.109
I just had that slight drama. Do you know the whole thing when they say,

00:03:21.289 --> 00:03:27.249
please don't use products made by Apple at conferences? And I decided I was going to do that.

00:03:27.369 --> 00:03:29.809
Is it still a thing? Yeah. How is it still a thing?

00:03:29.849 --> 00:03:32.649
I don't know. And then they said, oh, can you upload it? We'll convert it to

00:03:32.649 --> 00:03:34.349
PowerPoint. point i said no oh

00:03:34.349 --> 00:03:35.929
So you're a bit of a brat yeah and.

00:03:35.929 --> 00:03:38.749
So i insisted on using my own computer and then

00:03:38.749 --> 00:03:41.569
the it didn't work for like for a

00:03:41.569 --> 00:03:45.709
good 10 minutes uh of my 30 minutes so you told some jokes no we just sat there

00:03:45.709 --> 00:03:49.449
i started to perspire slightly and then it was okay and then and then it worked

00:03:49.449 --> 00:03:52.609
magically some guy pulled out a cable and plugged it back in again and it worked

00:03:52.609 --> 00:03:57.189
fine so i did that and then i just had a pro-con debate with morne walmerins

00:03:57.189 --> 00:04:01.009
all about mixing local anesthetics so that was all finished i'm

00:04:01.009 --> 00:04:02.809
Sorry what did you say mixing local.

00:04:02.809 --> 00:04:05.009
Please. Yeah, yeah.

00:04:05.349 --> 00:04:06.789
Tell him Mornay beat you.

00:04:07.029 --> 00:04:10.869
Well, the debate was a pro-con debate about mixing local anaesthetics.

00:04:11.069 --> 00:04:14.149
And I don't know, maybe we'll save the outcome of the debate.

00:04:14.149 --> 00:04:17.229
So when we get Mornay to come on as a guest, we'll talk about it later.

00:04:17.469 --> 00:04:20.129
Okay. All right. Let's move on then. Save that for later. Hey,

00:04:20.209 --> 00:04:21.009
have you got a joke for me?

00:04:21.269 --> 00:04:23.849
Yes, I do. Listen, before we start though, I want to tell you,

00:04:24.149 --> 00:04:26.589
did you see that statue at the airport?

00:04:27.190 --> 00:04:29.050
No, I didn't see one.

00:04:29.210 --> 00:04:34.870
There was like a big statue of a fish wearing a tuxedo, like in a bow tie.

00:04:35.050 --> 00:04:38.550
And I thought to myself, now, that's so fish-ticated.

00:04:43.090 --> 00:04:44.190
Airport fish jokes.

00:04:44.390 --> 00:04:47.570
Yeah, yeah. Another one. Another one. yeah

00:04:47.570 --> 00:04:50.690
i mean i've got i've got no idea why i got a thing for fish shakes but i but

00:04:50.690 --> 00:04:55.390
i was gonna say as we were making our way over to the venue i did look out all

00:04:55.390 --> 00:04:59.790
the mountains i was trying to work out why the mountains look so funny to me

00:04:59.790 --> 00:05:08.250
and then it struck me they're hilarious hilarious hill areas no hill areas okay uh stick

00:05:08.250 --> 00:05:09.990
With the fish jokes man that was okay.

00:05:09.990 --> 00:05:13.570
Well i've got one last one all right this was this is from from john bailey

00:05:13.570 --> 00:05:19.590
one of our azra guests what kind of doctor do you see when you have a cold uh

00:05:19.590 --> 00:05:22.150
i don't know an anasneesiologist

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That's good probably.

00:05:23.450 --> 00:05:24.290
The best that's

00:05:24.290 --> 00:05:28.230
Good yeah yeah was that from his kid that was from his kid yeah yeah yeah.

00:05:28.230 --> 00:05:30.170
You've got one for me right yeah

00:05:30.170 --> 00:05:35.790
Well listen like a friend of mine just recently got a job a can crushing plant

00:05:35.790 --> 00:05:41.650
okay But he's just, he's really down. It's so depressing.

00:05:42.290 --> 00:05:45.630
Oh, that's good. Okay, so, so.

00:05:46.590 --> 00:05:50.750
Okay, you know what? We'll just spare you the rest of the bad jokes and get right into it.

00:05:50.910 --> 00:05:54.290
Our first guest is the amazing Athmaja Thottengall from the UK,

00:05:54.290 --> 00:06:00.090
who is an anesthesiologist, pain doctor, educator, and recently lifestyle medicine specialist.

00:06:00.310 --> 00:06:04.190
She has some words of advice we could all benefit from. All right,

00:06:04.630 --> 00:06:06.810
Amit, I am super excited for our next guest.

00:06:07.490 --> 00:06:11.390
Yes, I have to say I have a big connection with this particular individual.

00:06:11.990 --> 00:06:16.290
We were training together. We were trainees together. We cycled through many

00:06:16.290 --> 00:06:17.450
of the same hospitals together.

00:06:17.590 --> 00:06:18.610
But she doesn't look 60 years old.

00:06:18.610 --> 00:06:23.190
She looks much younger than I. You're absolutely correct. So we are joined by

00:06:23.190 --> 00:06:25.910
none other than Dr. Athmarja Thottengall.

00:06:26.452 --> 00:06:31.112
an anesthetist, regional anesthetist, pain physician, and lifestyle physician,

00:06:31.232 --> 00:06:32.972
amongst many other things.

00:06:33.312 --> 00:06:35.672
Atma, thank you so much for joining us.

00:06:35.752 --> 00:06:36.252
Thanks for coming.

00:06:36.692 --> 00:06:39.672
Thank you, both of you. Such an honor, such a pleasure.

00:06:39.932 --> 00:06:46.072
I mean, you both, as Amit said, you know, we grew up together in the field of regional anesthesia.

00:06:46.352 --> 00:06:48.772
We both were fellows of Rafa Belkut.

00:06:48.772 --> 00:06:49.792
That's absolutely right.

00:06:49.992 --> 00:06:50.732
Oh, okay.

00:06:51.072 --> 00:06:52.452
And El Sora London Society of

00:06:52.452 --> 00:06:57.112
Regional Anesthesia. And we were like Jeff Godson, like Lord of Regency.

00:06:58.132 --> 00:07:03.472
You know, we looked up to you, even though you're the same age as us, just to clarify.

00:07:03.652 --> 00:07:03.972
Wait, what?

00:07:05.292 --> 00:07:09.072
But it is such a pleasure. And we listened to your podcast and,

00:07:09.232 --> 00:07:12.592
you know, your dad jokes. He had it even from that time.

00:07:13.252 --> 00:07:15.012
Yeah, it wasn't something I developed just for this.

00:07:15.012 --> 00:07:16.412
I think he comes by it naturally.

00:07:16.652 --> 00:07:18.552
Yeah, that's right. Such a pleasure.

00:07:18.552 --> 00:07:25.532
When Athmarja talks, I cannot help but force myself to stop and slow my breathing down and relax.

00:07:25.712 --> 00:07:30.672
There's something about the way that she talks that has such a calming influence.

00:07:30.912 --> 00:07:34.812
So there is a whole other side to you that we don't know about, right?

00:07:34.992 --> 00:07:38.352
So we talked about sticking needles into people and regional anaesthesia,

00:07:38.552 --> 00:07:43.412
but there's a whole other side to you. So tell us a little bit about what you

00:07:43.412 --> 00:07:46.372
do outside the traditional region of anesthesia.

00:07:46.592 --> 00:07:50.192
And then we're going to talk to you a little bit about how we can improve ourselves

00:07:50.192 --> 00:07:53.112
and make life beneficial and better for us. So tell us about that.

00:07:53.472 --> 00:07:57.852
So officially, yeah, I will tell a little bit of history behind it.

00:07:58.152 --> 00:08:03.412
Like everyone else, I did my medical school as normal, conventional medical education.

00:08:03.752 --> 00:08:09.212
Then became, I was interested in surgical field always. So, I did six months

00:08:09.212 --> 00:08:13.112
of pediatric surgery because I really like surgical side.

00:08:13.412 --> 00:08:18.472
But I kind of realized emotionally I was so distressed every day seeing these

00:08:18.472 --> 00:08:22.292
kids suffering. I said, you know, I cannot continue this for my entire life.

00:08:22.412 --> 00:08:26.472
So, I moved to the happier side of pediatrics, which is obstetrics.

00:08:26.772 --> 00:08:27.492
Okay, yeah.

00:08:27.632 --> 00:08:29.652
So, I worked as an obstetrician for two years.

00:08:29.852 --> 00:08:31.312
Whoa, I didn't know that.

00:08:31.312 --> 00:08:32.872
This is whereĆ¢Ā€Ā¦ We're learning so much.

00:08:32.992 --> 00:08:33.692
This is what's amazing.

00:08:33.732 --> 00:08:38.712
This is where I saw women suffering with pain. pelvic pain.

00:08:39.052 --> 00:08:43.832
And pain itself is a dark speciality in anesthesia. Nobody is interested.

00:08:44.072 --> 00:08:47.212
You know, as soon as you hear the word chronic pain, eyes are rolling upwards

00:08:47.212 --> 00:08:48.472
and nobody wants to know.

00:08:48.652 --> 00:08:52.712
And in the pain world, pelvic pain, especially female pelvic pain,

00:08:52.832 --> 00:08:55.352
is the darkest corner of that speciality.

00:08:55.800 --> 00:08:57.660
One, we don't know what to deal with this,

00:08:57.680 --> 00:09:01.660
And we don't want to kind of acknowledge that women are suffering.

00:09:01.900 --> 00:09:06.720
I thought something has to be done about it. So I changed my career to become

00:09:06.720 --> 00:09:09.400
an anesthetist, to get trained in pain.

00:09:09.940 --> 00:09:11.880
That was always your end goal.

00:09:12.020 --> 00:09:19.460
Correct. So that is why my subspecialty interest is in pelvic pain and pelvic pain. Yeah, okay.

00:09:19.820 --> 00:09:25.500
But as a doctor, I was, I mean, as a person, I was always very close to yoga.

00:09:25.800 --> 00:09:30.460
because that was part of my dancing training and everything to get focused.

00:09:30.780 --> 00:09:32.000
Wait, are we dancing on this podcast?

00:09:32.360 --> 00:09:35.920
We are not. Dr. Sotico can dance.

00:09:36.160 --> 00:09:42.940
Yeah, so it was there in my blood. And always I knew something is not right

00:09:42.940 --> 00:09:45.160
the way we are treating our patients.

00:09:45.600 --> 00:09:50.580
Something is missing somewhere. Until I became a person myself,

00:09:50.580 --> 00:09:57.440
I realized everything that we look at is symptom, symptom management.

00:09:57.820 --> 00:10:01.340
We never talk about the root cause analysis of the problem.

00:10:01.600 --> 00:10:05.780
We are very good at treating acute problems. Like you come with a heart attack,

00:10:05.860 --> 00:10:09.760
I still go to a medical hospital to have my thrombolysis done.

00:10:10.480 --> 00:10:13.180
Once they are done, you chuck them out.

00:10:13.400 --> 00:10:14.460
Yes, it's so true.

00:10:15.100 --> 00:10:20.660
You treat the acute problem like the cause. Yes, we never think why this patient had that one.

00:10:20.940 --> 00:10:24.440
Was there anything that could have been prevented and what

00:10:24.440 --> 00:10:27.500
can we do to prevent happening again we

00:10:27.500 --> 00:10:32.680
never think same with the pain as well regional anesthetist as we anesthetist

00:10:32.680 --> 00:10:37.080
we are trained in the theater what can you do where can i stick a needle in

00:10:37.080 --> 00:10:43.240
how much pain relief can i provide or zero pain in the recovery once they are

00:10:43.240 --> 00:10:46.160
out of the recovery that's it well we don't

00:10:46.160 --> 00:10:48.420
See it if you don't see it it doesn't happen therefore

00:10:48.420 --> 00:10:49.920
It's not a problem correct right

00:10:50.353 --> 00:10:56.653
As a chronic pain specialist, I picked up these patients at the end of their journey, way down.

00:10:56.893 --> 00:11:02.153
And when you look at their journey, we pick up so many points, we missed the boat.

00:11:02.353 --> 00:11:08.253
Right. Or we could have probably changed around it. But I was not doing anything formally at that point.

00:11:08.853 --> 00:11:14.193
COVID came, long COVID happens. I had a long COVID. I became a long COVID patient.

00:11:14.433 --> 00:11:15.293
Really? Okay.

00:11:15.293 --> 00:11:23.173
That was the time, as a patient, you see a completely different perspective of medicine.

00:11:23.573 --> 00:11:27.573
People were looking at me like a symptom rather than a person.

00:11:28.013 --> 00:11:31.613
They wouldn't correlate symptom A with the symptom B.

00:11:31.993 --> 00:11:35.493
Right. They wouldn't even connect those two dots together.

00:11:35.713 --> 00:11:41.033
And then I started my own research. And this is where I realized the most important

00:11:41.033 --> 00:11:44.893
features that we can modify or patient factors.

00:11:45.293 --> 00:11:49.973
So, if you look at any of these articles published about the prevention and

00:11:49.973 --> 00:11:55.273
factors, risk factors, predictive risk factors, lifestyle factors and pre-existing

00:11:55.273 --> 00:11:59.273
pain is the major factor than our regional techniques.

00:11:59.453 --> 00:12:01.353
Yeah. Yeah. Even surgery.

00:12:01.833 --> 00:12:07.713
So, if those conditions exist before a surgical insult, that is going to influence

00:12:07.713 --> 00:12:13.273
what happens afterwards much more than what we do the last 16, 18, 24, 36 hours.

00:12:13.433 --> 00:12:16.773
Correct. We make beautiful slides for our presentation.

00:12:17.653 --> 00:12:21.213
You know, the risk factors, catastrophization, anxiety, depression,

00:12:21.533 --> 00:12:27.333
sleep deprivation, previous or opioid usage, female gender, obesity.

00:12:27.773 --> 00:12:32.673
We put the slides on our presentation. What do we do about it? Nothing. Nothing.

00:12:33.153 --> 00:12:37.853
So this is where, as a patient, I decided I need to have a formal training.

00:12:37.853 --> 00:12:42.453
This is where I did the lifestyle medicine degree from the International Board

00:12:42.453 --> 00:12:45.913
of Lifestyle Medicine and the British Society. So I am duly certified.

00:12:46.213 --> 00:12:48.273
And I thought, oh my God, I can change the world.

00:12:48.513 --> 00:12:48.773
Yeah.

00:12:48.953 --> 00:12:55.053
Yeah. I realized patient didn't want to change because as doctors, we are different.

00:12:55.602 --> 00:12:57.022
prescribe. Yeah.

00:12:57.322 --> 00:13:00.282
So that's what they're expecting? Yes. A prescription? Prescription.

00:13:00.622 --> 00:13:05.522
But as patients, nobody likes their autonomy being taken away.

00:13:05.762 --> 00:13:07.002
Their power is taken away.

00:13:07.562 --> 00:13:11.442
You say, you have to stop smoking. Yeah. You have to lose weight.

00:13:11.702 --> 00:13:14.562
If they could, they wouldn't be in that position to start with.

00:13:14.722 --> 00:13:17.002
Yeah. Can you prescribe a treadmill? Correct.

00:13:17.462 --> 00:13:20.922
How can you prescribe? You say, go and reduce weight. They can't do that.

00:13:21.042 --> 00:13:22.342
That is why they are there. Yeah.

00:13:22.662 --> 00:13:28.982
I went and inquired, how can I become a better physician who is in partnership

00:13:28.982 --> 00:13:32.982
with the patient and where I can empower the patient, you know,

00:13:33.102 --> 00:13:35.542
putting that responsibility back into the patient's court.

00:13:36.002 --> 00:13:41.442
So I went and did health coaching certification from Institute of Integrated

00:13:41.442 --> 00:13:45.182
Nutrition, where the nutritional part of lifestyle medicine is very important,

00:13:45.342 --> 00:13:50.302
and coaching, how you become a good coach for the patient, which made a big difference.

00:13:50.602 --> 00:13:56.902
So now by changing the language that I use, patients feel they are making the decision.

00:13:57.242 --> 00:14:02.662
They are deciding to stop it. They will stick with it because it is your rule and your decision,

00:14:02.902 --> 00:14:06.282
Not mine. I do that with my surgeons. I make them think that they asked for

00:14:06.282 --> 00:14:08.022
the block. It was really me asking for the block.

00:14:09.962 --> 00:14:14.742
That's really clever of you to combine those, have the insight to say,

00:14:15.162 --> 00:14:18.642
okay, I have the knowledge to make you better, but you're not listening to me,

00:14:18.682 --> 00:14:21.482
so I need to become a coach to have those skills.

00:14:21.682 --> 00:14:26.082
How many people would go and educate themselves or train themselves to become better?

00:14:26.182 --> 00:14:28.022
Exactly. Oh, I'm listening to me.

00:14:28.522 --> 00:14:34.382
No, this is what is. So the change in the thought process was number one player

00:14:34.382 --> 00:14:37.562
in the world in any sport, they have a coach. Right.

00:14:38.042 --> 00:14:43.542
Why do they need a coach? They are the number one. Coach will always show you your blind spots

00:14:43.542 --> 00:14:46.922
That's a great question I mean.

00:14:47.082 --> 00:14:50.362
Because it's guys number one Why does he need to be talking to somebody who's

00:14:50.362 --> 00:14:51.702
maybe not good at playing as he?

00:14:51.822 --> 00:14:57.462
Correct Because the coach may not be as good a tennis player as a number one player Blind spots,

00:14:57.582 --> 00:14:59.782
Okay So coach is not a trainer

00:15:00.445 --> 00:15:05.585
Right. Trainer will train you the technique. We are all educators and trainers. This sounds like

00:15:05.585 --> 00:15:09.325
It should be obvious information, but it isn't necessarily, is it?

00:15:09.465 --> 00:15:15.985
For me, it was showing my blind spot as a trainer. So now I am becoming a coach for my trainees.

00:15:16.585 --> 00:15:17.005
Right.

00:15:17.265 --> 00:15:23.765
Not necessarily just a trainer. Right. I coach them so that they can see their blind spots.

00:15:24.165 --> 00:15:26.225
They can improve. They're all skilled. They are professionals.

00:15:26.245 --> 00:15:29.525
Do you train your fellows? Do you mentor your fellows? Or do you coach your

00:15:29.525 --> 00:15:31.005
fellows? or do we'll do all three?

00:15:31.245 --> 00:15:35.185
I would love to say that I do a little bit of both, but I probably need to do

00:15:35.185 --> 00:15:37.145
a better job at the coaching part, I think. Yeah.

00:15:37.665 --> 00:15:41.545
So can you give us an example of a patient interaction? Like when do you see them?

00:15:41.885 --> 00:15:47.725
So this is where we feel as professionals or regional anesthetists,

00:15:47.945 --> 00:15:51.765
the most important part is the regional anesthesia. Nothing else in the world changes.

00:15:52.785 --> 00:15:59.945
So like today, both my lectures were about how the lifestyle factors need to come in.

00:16:00.285 --> 00:16:05.185
And I'm going around educating everybody to understand when we see a patient,

00:16:05.345 --> 00:16:08.745
we need to see the whole patient, not just that particular thing.

00:16:09.225 --> 00:16:13.885
And SRI is actually taking that initiative to form a new working group called

00:16:13.885 --> 00:16:18.925
POPOS, Perioperative Pain Optimization, which includes, it's like an umbrella

00:16:18.925 --> 00:16:23.125
term for including the lifestyle factors, the patient factors,

00:16:23.605 --> 00:16:29.785
the pain factor preoperatively, continue that transition through the intraoperative

00:16:29.785 --> 00:16:34.805
period and also fill the gap between the acute pain, three months,

00:16:35.145 --> 00:16:39.565
chronic pain, six months, that gap, and bring all these people,

00:16:39.865 --> 00:16:44.765
everyone together around one table, how we can make the journey of a patient

00:16:44.765 --> 00:16:48.285
much more useful and more productive.

00:16:48.725 --> 00:16:52.945
And, you know, whatever money we are spending, we need to have the value for the money as well.

00:16:53.613 --> 00:16:54.473
Which is so important.

00:16:54.633 --> 00:16:59.213
Rather than everybody working in silos. All these things, I personally,

00:16:59.393 --> 00:17:01.473
as a doctor, I learned a lot in this journey.

00:17:01.693 --> 00:17:06.893
But as an individual, I realized how important it is to look after yourself.

00:17:07.113 --> 00:17:07.293
Yeah.

00:17:08.153 --> 00:17:11.233
You know, care the carer first. Yeah.

00:17:11.573 --> 00:17:15.873
You need to be, see, if you're anxious, if you're not in your best emotional

00:17:15.873 --> 00:17:19.753
state, you will not give the best care for the patient.

00:17:20.013 --> 00:17:22.973
Yeah, that's true. You need to look after yourself. And actually,

00:17:23.093 --> 00:17:25.733
doctors and all healthcare professionals are the worst patients as well.

00:17:25.993 --> 00:17:31.173
I can 100% attest to that. There must come a point in everyone's life where,

00:17:31.373 --> 00:17:34.693
so I thought I was cruising for a while and it came to a point when suddenly

00:17:34.693 --> 00:17:40.353
I started to feel a bit more anxious about things or you have life stresses or things take over.

00:17:40.553 --> 00:17:45.413
It's very difficult not to let that translate into the practice of what you do.

00:17:45.493 --> 00:17:48.733
And we all try to separate our work life and our home life. If you're stressed,

00:17:48.833 --> 00:17:53.493
you're worried about things. So what are the strategies that we can employ as

00:17:53.493 --> 00:17:58.353
individuals to be healthier, to be less anxious, to deal with their symptoms?

00:17:58.473 --> 00:18:05.293
Because I feel like this thing is maybe not great because my life revolves around

00:18:05.293 --> 00:18:06.653
the thing that I'm holding in my hand.

00:18:06.813 --> 00:18:10.173
Just for clarity, if people are not watching on video, I'm talking about my

00:18:10.173 --> 00:18:11.493
phone as opposed to anything else.

00:18:11.780 --> 00:18:17.000
So everything that I need to know and do based upon this, what are the type

00:18:17.000 --> 00:18:19.340
of things that we can do to have a healthier,

00:18:19.560 --> 00:18:24.540
Cleaner life? You know, people think, oh, it is very difficult to do.

00:18:24.720 --> 00:18:30.540
Actually not. It's about the change in the perception and what we think is important.

00:18:31.020 --> 00:18:35.220
As a doctor, you are dealing with an emergency, whether it is regional anesthesia

00:18:35.220 --> 00:18:38.260
or anesthesia. Are you thinking about your phone at that point?

00:18:38.420 --> 00:18:40.600
At that moment, I really hope not.

00:18:40.880 --> 00:18:43.740
Yeah. Correct. Precisely. So we are focusing on the patient.

00:18:43.960 --> 00:18:50.920
So this is all about how we learn to focus on something by prioritizing it.

00:18:51.060 --> 00:18:56.400
You can do very simple practice in your life. For example, the first thing in

00:18:56.400 --> 00:18:57.740
the morning when you wake up.

00:18:57.860 --> 00:18:59.000
I know what she's going to say.

00:18:59.580 --> 00:19:04.460
Yeah. Don't have your phone next to you. Yeah. You have to stand up,

00:19:04.780 --> 00:19:09.440
go, get the phone and do it if you can't control yourself.

00:19:09.440 --> 00:19:12.660
Yeah, yeah. I'm guilty of that, too, because I use it as an alarm clock.

00:19:12.680 --> 00:19:15.060
Then the first thing I do is like, oh, what's new today?

00:19:15.640 --> 00:19:19.320
Going through the phone, your dopamine is through the phone. What did I miss?

00:19:19.320 --> 00:19:21.780
What did I miss overnight? Correct. What did Amit text me overnight?

00:19:21.900 --> 00:19:22.260
Yeah, yeah, yeah.

00:19:23.260 --> 00:19:26.080
Then your cortisol is through the roof already.

00:19:26.300 --> 00:19:26.580
Yeah.

00:19:26.980 --> 00:19:31.480
Yeah. Even before you get out of the bed, your blood pressure is up. Yeah.

00:19:31.640 --> 00:19:35.660
But why is it? You're right. But why? Why are we getting wound up? What is it?

00:19:35.660 --> 00:19:39.560
The dopamine is more addictive than anything else, actually.

00:19:39.660 --> 00:19:42.420
That is why everybody gets addicted to sugar.

00:19:42.660 --> 00:19:46.860
Sugar is more addictive than even your cocaine because your dopamine surge.

00:19:47.120 --> 00:19:52.540
Why the kids are so glued to the food? Because it is the dopamine and they get

00:19:52.540 --> 00:19:53.560
the dopamine withdrawal.

00:19:53.880 --> 00:19:56.540
So it's just like, I have to do it. I have to do it.

00:19:56.881 --> 00:20:03.301
So, I practice yoga and I take a conscious decision at least once a year to

00:20:03.301 --> 00:20:05.481
have an electronic gadgets holiday.

00:20:05.741 --> 00:20:10.461
For how long? That depends upon how much time I can have.

00:20:10.761 --> 00:20:12.861
Like this year, I had three days.

00:20:13.061 --> 00:20:13.521
Okay.

00:20:13.661 --> 00:20:13.801
Complete.

00:20:14.221 --> 00:20:16.641
No digital contact at all.

00:20:16.681 --> 00:20:20.081
Just leave it. Phone is there. Phone is there that, you know,

00:20:20.141 --> 00:20:23.421
if you need an emergency or whatever it is, it is there. Like now,

00:20:23.601 --> 00:20:24.961
we started this podcast.

00:20:25.221 --> 00:20:28.941
Yeah. You put your phone away. I immediately put it on my phone and in the aeroplane mode.

00:20:29.161 --> 00:20:29.381
Yeah.

00:20:29.461 --> 00:20:31.981
So nothing is going to come. Right. So it is there as a tool.

00:20:31.981 --> 00:20:33.841
How are you feeling right now? A bit jittery?

00:20:33.981 --> 00:20:34.181
No.

00:20:34.381 --> 00:20:35.181
I'm joking.

00:20:35.521 --> 00:20:37.321
Yeah. But I might be.

00:20:37.561 --> 00:20:41.641
Yeah. This is what, you know. Yeah. See, I know that it is there in case of

00:20:41.641 --> 00:20:44.681
an emergency or anything. I have got access to the tool.

00:20:45.021 --> 00:20:46.941
That is a tool for me.

00:20:47.121 --> 00:20:47.361
Right.

00:20:47.521 --> 00:20:48.661
Not my life.

00:20:48.961 --> 00:20:52.861
But when you are doing your digital detox, say for three days,

00:20:53.161 --> 00:20:57.061
do you couple that with when you're on an actual holiday or a break because

00:20:57.061 --> 00:20:59.901
presumably if you're out to work, it's not possible.

00:21:00.061 --> 00:21:05.921
You can do micro digitalized toxicity removal as well from your life.

00:21:06.141 --> 00:21:11.421
Like for example, when you get up in the morning, I wake up with gratitude.

00:21:11.901 --> 00:21:16.781
Gratitude is an emotion for you to bring your body vibration.

00:21:16.981 --> 00:21:23.361
We all know that we have a frequency in our body that bring to the highest level possible for you by

00:21:23.361 --> 00:21:27.441
Be by having gratitude you take your body frequency to the highest

00:21:27.441 --> 00:21:33.601
Level yes i love that how many times have you said thank you in your mind i'm

00:21:33.601 --> 00:21:35.301
Getting goosebumps when she's saying this because

00:21:35.301 --> 00:21:41.641
Your parents yeah your loved ones yeah your children your wife your dear one

00:21:41.641 --> 00:21:46.961
near ones your friends whoever it is even being just alive waking up in the morning.

00:21:47.181 --> 00:21:48.541
The answer is not enough.

00:21:48.981 --> 00:21:49.101
Correct.

00:21:49.541 --> 00:21:50.721
The answer is not enough.

00:21:50.821 --> 00:21:54.301
So take that five minutes for you. Yeah. Or even a few minutes.

00:21:54.301 --> 00:21:56.761
This feels like counseling for me right now.

00:21:57.401 --> 00:21:58.821
I feel free to charge us for this too.

00:22:01.941 --> 00:22:02.961
That's so true.

00:22:03.441 --> 00:22:07.861
I love that concept that embracing gratitude helps your health.

00:22:08.301 --> 00:22:13.681
Absolutely. That brings your cortisol. Because naturally in your circadian rhythm,

00:22:14.061 --> 00:22:17.201
morning cortisol levels are high. in your body.

00:22:17.741 --> 00:22:22.361
And by looking at your phone and going through the social media and all these

00:22:22.361 --> 00:22:26.661
negativities around you, you are just skyrocketing that through your...

00:22:26.661 --> 00:22:32.581
Once you have that cortisol up, your sugar is up, all your immunosuppressants

00:22:32.581 --> 00:22:37.641
are high in your body, why do you start on the wrong foot in the morning yourself? Yeah.

00:22:37.961 --> 00:22:43.841
This is inspiring me, but what... Okay, let's be pragmatic or practical about

00:22:43.841 --> 00:22:47.941
it so i totally get don't make it be the first thing you reach for

00:22:48.599 --> 00:22:49.699
I think I can do that.

00:22:49.939 --> 00:22:50.039
Yeah.

00:22:50.199 --> 00:22:55.059
I think I can do that. But in reality, the jobs that we're doing,

00:22:55.259 --> 00:22:57.359
we're doing a podcast, there's a little bit of promotion,

00:22:57.559 --> 00:22:59.199
But there's also natural curiosity.

00:23:00.139 --> 00:23:02.139
We are using these platforms.

00:23:02.359 --> 00:23:02.519
Correct.

00:23:02.879 --> 00:23:07.419
Is there a way to be sensible with how you use them? Absolutely.

00:23:07.759 --> 00:23:12.019
So limit the time period with which you engage with certain platforms.

00:23:12.319 --> 00:23:14.879
Don't you put restrictions on your children?

00:23:15.119 --> 00:23:15.779
Yeah, we do try.

00:23:16.039 --> 00:23:16.319
We do.

00:23:16.319 --> 00:23:21.139
Do you know, we have our kids, we were late to get our kids' phones because

00:23:21.139 --> 00:23:24.259
we were concerned about exactly this, right?

00:23:24.339 --> 00:23:27.239
So our two older kids have phones, our two younger ones don't.

00:23:27.359 --> 00:23:28.859
But the rule is it can't go upstairs.

00:23:29.139 --> 00:23:33.239
So at nighttime, in the evening, plugged in, in the dock, and they're upstairs.

00:23:33.479 --> 00:23:35.919
But my wife and I have our phones at our bedside tables. Correct.

00:23:35.919 --> 00:23:39.219
I wonder if we should be putting ours downstairs too.

00:23:39.359 --> 00:23:39.639
Simple things.

00:23:39.799 --> 00:23:41.959
Maybe just buy an old-fashioned alarm clock.

00:23:42.259 --> 00:23:42.359
Yes.

00:23:43.039 --> 00:23:47.219
Do you know, I tell my patients, bedroom is for sleep and sex,

00:23:47.359 --> 00:23:50.259
nothing else. Oh, my gosh. Honestly. Yeah.

00:23:50.459 --> 00:23:51.699
Yeah. It shouldn't be for anything else.

00:23:51.779 --> 00:23:55.159
No electronic gadgets. No scrolling. No TV. Because the blue light.

00:23:55.199 --> 00:23:59.939
Oh, it's horrible. When you have in your brain, that resets your biological clock.

00:24:00.179 --> 00:24:06.119
Because your melatonin production is depending upon the festive blue light ray coming into your mind.

00:24:06.479 --> 00:24:11.159
Yeah. 16-hour zone, your body produces melatonin. So when kids or ourselves

00:24:11.159 --> 00:24:16.699
are like scrolling through the TV or phone, your melatonin production is low.

00:24:16.839 --> 00:24:18.759
So your sleep quality is poor.

00:24:18.939 --> 00:24:23.739
If you ask me one thing other than, you know, forget about the food,

00:24:24.099 --> 00:24:28.799
whatever it is, one thing that you have to change in your lifestyle, quality sleep.

00:24:29.119 --> 00:24:30.379
Quality sleep. Wow.

00:24:30.599 --> 00:24:31.279
Quality sleep.

00:24:31.439 --> 00:24:35.419
I know the answer to this. I'm going to ask you, how much sleep do you get per night?

00:24:35.599 --> 00:24:38.659
Okay. So it used to be not enough. used to

00:24:38.659 --> 00:24:42.799
be not a lot and then i read this book why we sleep by matthew

00:24:42.799 --> 00:24:46.519
i forget this last name but it was horrifying the

00:24:46.519 --> 00:24:49.239
first part is like the physiology of sleep which i kind of knew

00:24:49.239 --> 00:24:54.339
about like ram and non-rab and then the second part was all the bad stuff that

00:24:54.339 --> 00:24:57.159
happens to you when you don't get enough sleep and the horrifying message was

00:24:57.159 --> 00:25:02.579
it's not reversible like what's done is done i've done the damage i can't like

00:25:02.579 --> 00:25:06.199
i used to think oh i'll catch up on the weekend you can't catch up It doesn't

00:25:06.199 --> 00:25:07.579
work that way. Yeah, yeah, yeah.

00:25:07.899 --> 00:25:11.879
Anyway. This is not about the duration necessarily.

00:25:12.059 --> 00:25:12.699
It's the quality.

00:25:12.899 --> 00:25:16.879
It is the quality of sleep and how deep sleep you get it.

00:25:16.959 --> 00:25:21.799
Because you produce so much of waste and things in your body,

00:25:21.799 --> 00:25:26.119
all the cleaning up process, your repair, everything is happening,

00:25:26.239 --> 00:25:27.419
including your DNA repair.

00:25:27.539 --> 00:25:32.279
So we are not allowing our DNA to be repaired properly by not sleeping. Correct.

00:25:32.279 --> 00:25:36.099
And that's why cancer rates are associated with inadequate sleep.

00:25:36.419 --> 00:25:36.879
Dementia.

00:25:37.179 --> 00:25:37.639
Wow.

00:25:38.346 --> 00:25:41.786
So, I no longer have caffeine afternoon.

00:25:42.766 --> 00:25:43.326
Afternoon.

00:25:43.566 --> 00:25:45.506
Well, I guess I'm having some now.

00:25:46.046 --> 00:25:50.386
It's, again, you know, some people are very sensitive to caffeine.

00:25:50.746 --> 00:25:52.046
Yeah. Some people are not.

00:25:52.426 --> 00:25:59.266
But the general advice is if you can avoid caffeine later in the night, always good for you.

00:25:59.346 --> 00:26:03.786
And as doctors, by default, we put ourselves under a lot of stress.

00:26:03.786 --> 00:26:08.946
Like, for example, the night shifts and things like that disrupts our circadian rhythm big time.

00:26:09.206 --> 00:26:14.806
On top of that, you know, risky substances that people use and the stress level

00:26:14.806 --> 00:26:16.366
that we go through and lack of sleep.

00:26:16.706 --> 00:26:20.906
That is why doctors after a certain age, they have the highest incidence of

00:26:20.906 --> 00:26:25.386
medical problems, stress-related problem, and early death.

00:26:25.526 --> 00:26:29.726
Can I ask you a question? Of course. So, avoid blue light close to bed.

00:26:30.126 --> 00:26:33.486
Avoid caffeine if you're, you know, close to bed. alcohol.

00:26:33.886 --> 00:26:37.766
I'm hearing more and more about, I know about the effect of alcohol on sleep,

00:26:37.906 --> 00:26:41.386
but I'm hearing more and more about the effect of alcohol on just everything,

00:26:41.746 --> 00:26:43.826
you know, how long you'll live.

00:26:44.986 --> 00:26:49.286
There are more and more people I'm hearing about that are just giving up alcohol altogether. Yeah.

00:26:49.766 --> 00:26:55.906
Alcohol, smoking are well-known risk factors. Yeah. But I would add sugar.

00:26:56.286 --> 00:26:56.626
Yeah.

00:26:56.826 --> 00:27:03.586
We are bringing up a generation of children who will be living at least six

00:27:03.586 --> 00:27:06.606
to seven years shorter than their parents,

00:27:06.786 --> 00:27:12.426
purely because we are making them metabolically unwell from a very early age.

00:27:12.686 --> 00:27:15.786
Would you give your children alcohol when they are four years old? No.

00:27:16.286 --> 00:27:17.866
Only if I wanted them to sleep. No.

00:27:18.106 --> 00:27:19.826
Yeah. Okay. Yeah.

00:27:20.186 --> 00:27:20.706
Yeah.

00:27:20.906 --> 00:27:25.366
Yeah. Why do you give this much processed food and alcohol as any sugar to them?

00:27:25.626 --> 00:27:25.846
Yeah.

00:27:26.246 --> 00:27:30.486
So that is why we see young children as nine years old, 10 years old,

00:27:30.666 --> 00:27:34.806
coming with a fatty liver, non-alcoholic fatty liver, and this is becoming the

00:27:34.806 --> 00:27:38.226
next ticking time bomb, diabetes and non-alcoholic fatty liver.

00:27:38.466 --> 00:27:40.946
There is a lot we need to do as doctors.

00:27:41.626 --> 00:27:49.566
I think we need to get a whole episode or two with Athmar on it because we could

00:27:49.566 --> 00:27:52.626
speak to you, we could listen to you forever.

00:27:52.866 --> 00:27:58.106
There is a wealth of information in here presented in such a calm and beautiful

00:27:58.106 --> 00:28:00.666
manner that I could listen to you speak for hours.

00:28:00.806 --> 00:28:00.926
Yes, I agree.

00:28:01.506 --> 00:28:02.826
So, thank you.

00:28:03.026 --> 00:28:05.246
And I don't feel I could.

00:28:05.406 --> 00:28:08.606
I don't want to spoil this by asking for a joke. I think we've just left it

00:28:08.606 --> 00:28:10.666
with lots of things to think about.

00:28:10.926 --> 00:28:15.306
And it would seem to try to introduce a sense of humor to this bit.

00:28:15.486 --> 00:28:19.226
Just because you asked a joke and it is in that I'm still related.

00:28:20.786 --> 00:28:25.246
I'll tell you something. When is the worst time to have a heart attack?

00:28:25.446 --> 00:28:28.826
Oh, gosh. Oh, my God. This is... Okay, no idea.

00:28:29.515 --> 00:28:31.155
When you are playing a Damsharads.

00:28:31.655 --> 00:28:35.555
When you're playing a what? Damsharads. Yeah. So tell me with that.

00:28:35.655 --> 00:28:36.215
Oh, yeah, yeah.

00:28:36.315 --> 00:28:41.995
Because nobody will believe you that you're having a heart attack.

00:28:42.095 --> 00:28:44.035
I got it, I got it. It's a heart attack.

00:28:44.255 --> 00:28:48.095
Yeah. Don't break my heart. Very good.

00:28:48.355 --> 00:28:51.455
Wow. She made us think about that. Yeah, it was good. Thank you so much.

00:28:51.575 --> 00:28:53.235
Thank you for joining us.

00:28:53.715 --> 00:28:59.675
You know, it's so, how can I say? It's again, you know, overwhelming happiness

00:28:59.675 --> 00:29:05.495
to see you both doing such a wonderful job and spreading the word of regional

00:29:05.495 --> 00:29:07.855
anesthesia and also making it so cool.

00:29:08.295 --> 00:29:09.215
Oh, I try.

00:29:09.475 --> 00:29:10.115
Well, thank you.

00:29:10.735 --> 00:29:11.395
Thank you for being here. So

00:29:11.395 --> 00:29:15.295
good to see you. And I think we've got to get Dr. Athma on as an episode.

00:29:15.295 --> 00:29:18.035
Yes, if you'd be willing to. If you can bear us again.

00:29:18.555 --> 00:29:20.375
Always good to talk to you guys.

00:29:20.515 --> 00:29:21.375
Thank you very much.

00:29:21.495 --> 00:29:25.815
Thank you. Next up, we interviewed longtime friend and incredibly humble and

00:29:25.815 --> 00:29:30.315
great guy, John McDonnell from Galway, Ireland, who told us the origin story

00:29:30.315 --> 00:29:34.595
of a very familiar block and teases us with some new things he's come up with.

00:29:34.755 --> 00:29:38.255
But in the end, he just wants to be remembered for the flick.

00:29:38.755 --> 00:29:40.635
John. No, you're not John. Who are you?

00:29:40.755 --> 00:29:41.095
I'm Jeff.

00:29:41.255 --> 00:29:42.275
Yeah. Hi. Jeff.

00:29:42.555 --> 00:29:42.815
Yeah.

00:29:43.055 --> 00:29:48.875
Nice to meet you. Nice to meet you. So I'm going to introduce a guy called John in a short while, who,

00:29:49.055 --> 00:29:52.455
like some of the other the people we've had on the podcast has kind of left

00:29:52.455 --> 00:29:57.415
a stamp on regional anesthesia uh left his name there and and done lots of things

00:29:57.415 --> 00:30:01.555
but he's not only done what i'm not allowed to talk about which we'll come to

00:30:01.555 --> 00:30:05.055
later but he's taught me how to do paravertible blocks so he is the guy

00:30:05.055 --> 00:30:06.655
He's the guy that taught you how to do.

00:30:06.655 --> 00:30:09.995
Pvbs yeah so he said to me i met him somewhere in

00:30:09.995 --> 00:30:13.075
london and he told me we're talking about paravertible blocks he said come i

00:30:13.075 --> 00:30:16.235
won't do the accent he said come over to ireland come over

00:30:16.235 --> 00:30:20.735
to ireland and spend a day and a half with me which is which i did and i call

00:30:20.735 --> 00:30:24.855
my surgeon at lunchtime on the first day i was like got to give me extra time

00:30:24.855 --> 00:30:28.075
in theater when i come back next week because i've seen this guy do some crazy

00:30:28.075 --> 00:30:32.475
stuff and that was the beginning of my journey in paravortals i'd love to introduce

00:30:32.475 --> 00:30:35.955
the one and only john mcdonald john thank you so much for joining us john

00:30:35.955 --> 00:30:39.955
Welcome buddy fantastic to be here and it's also so frightening

00:30:39.955 --> 00:30:40.595
To do here.

00:30:42.215 --> 00:30:44.735
This is a gentle podcast. I have no doubt.

00:30:44.855 --> 00:30:49.795
But I've been listening to it for a long time. I've phoned and complained. Phoned and complained.

00:30:50.155 --> 00:30:50.755
Yeah, yeah, yeah.

00:30:51.195 --> 00:30:55.555
And I've been pushing Amit to get this as part of our CPD or CME.

00:30:55.775 --> 00:31:00.475
It's a great resource, but it is extremely intimidating to be in a glass box

00:31:01.215 --> 00:31:02.595
when I haven't been committed.

00:31:03.415 --> 00:31:05.635
The door's all locked. You can always get out if you want.

00:31:06.235 --> 00:31:07.215
It's an escape room.

00:31:07.495 --> 00:31:08.675
The sound desk says otherwise.

00:31:10.135 --> 00:31:14.515
So listen, you know, as an icebreaker, we often use a bit of humor here.

00:31:14.855 --> 00:31:19.295
And one of the things that John was most nervous about was coming up with a

00:31:19.295 --> 00:31:21.515
joke. So have you managed to come up with a joke?

00:31:21.555 --> 00:31:22.715
We have come up with a joke.

00:31:22.755 --> 00:31:23.935
Oh, okay. Excellent. That's great.

00:31:24.330 --> 00:31:25.350
What do you call this?

00:31:25.870 --> 00:31:26.510
He's sort of

00:31:26.510 --> 00:31:27.310
Waving his hand.

00:31:27.310 --> 00:31:31.670
A little bit. So you know what? There's a trend because your Irish colleague

00:31:31.670 --> 00:31:34.870
did the same one, but used words. Is that a microwave?

00:31:35.210 --> 00:31:36.150
It is a microwave.

00:31:39.550 --> 00:31:42.630
Louise Moran told the same jet. I'm pretty sure she told the same.

00:31:42.650 --> 00:31:46.950
She told me that last night. She set you up. She set me up. Okay,

00:31:47.090 --> 00:31:50.590
I have a second one. Why did the two skeletons not fight each other?

00:31:50.890 --> 00:31:54.770
Why did the two skeletons not fight each other? it's going to be something like

00:31:54.770 --> 00:31:58.330
no body, no muscle. I don't know.

00:31:58.570 --> 00:31:59.330
They had no guts.

00:31:59.690 --> 00:32:04.430
No guts. Okay. Listen, that is a hundred percent. That's good. Nailed it.

00:32:05.430 --> 00:32:09.210
So John, you've kind of been practicing regional anesthesia for a pretty long

00:32:09.210 --> 00:32:11.190
time and you're based in Galway, right? Yes.

00:32:11.590 --> 00:32:15.970
So where did your interest in regional anesthesia first start and how long do

00:32:15.970 --> 00:32:18.370
I have to let the podcast go before I can talk about the tap block?

00:32:20.270 --> 00:32:26.190
I thought I killed a tap block. I started when I was a registrar and I was working

00:32:26.190 --> 00:32:30.630
in hospitals where we didn't have a lot of, I suppose, ability to do epidurals

00:32:30.630 --> 00:32:32.890
because we didn't have the beds to place patients into.

00:32:33.030 --> 00:32:36.790
So the ability to do another block that wouldn't require a high dependency or

00:32:36.790 --> 00:32:41.650
an ICU bed or a monitored bed is what stimulated my interest in regional anesthesia.

00:32:41.910 --> 00:32:46.990
And then obviously the initial work with a tap block and then my move to Galway

00:32:46.990 --> 00:32:50.850
to work with like my heroes, like Brian Canarns, Jerry Coughlin,

00:32:50.990 --> 00:32:54.690
Bob Kincannon, and then threw that to all the other people internationally.

00:32:54.690 --> 00:32:58.610
But it started with the fact that we couldn't do the gold standard.

00:32:58.850 --> 00:33:02.090
We couldn't provide epidural based analgesia. And you couldn't

00:33:02.090 --> 00:33:04.950
Do that because they had to go into a high dependency bed?

00:33:05.170 --> 00:33:08.110
Yeah, because the nursing care and the wards might not have been of a standard

00:33:08.110 --> 00:33:11.050
that was good enough to look after somebody who had sent her in your actual blockade.

00:33:11.410 --> 00:33:16.610
And everything I've done since then is it's trying to find a solution to a problem

00:33:16.610 --> 00:33:22.030
or to look at what's being done and see if there's an easier way to do it.

00:33:22.330 --> 00:33:27.290
My problem is that I can't just put the probe on and see everything.

00:33:27.390 --> 00:33:28.490
I have to prove it to myself.

00:33:28.670 --> 00:33:31.130
I have to have a stepwise manner of doing everything.

00:33:31.370 --> 00:33:34.510
You know, in the morning I get up a certain way, I press a certain way.

00:33:34.870 --> 00:33:38.090
It has to be stepwise. And likewise with regional anesthesia,

00:33:38.350 --> 00:33:41.750
I have to have a logical way of doing my blocks. Right.

00:33:41.850 --> 00:33:43.830
So I end up changing a lot of what I'm doing.

00:33:44.030 --> 00:33:48.150
And that's where the top block came along, because as you know, there are no new blocks.

00:33:48.390 --> 00:33:51.050
There's just new approaches to old techniques.

00:33:51.310 --> 00:33:55.970
And the top block wasn't a new block. It was an adaption of Bernard Dillon's

00:33:55.970 --> 00:33:58.370
work and other people who were doing local infiltration.

00:33:58.971 --> 00:33:59.471
So what was

00:33:59.471 --> 00:34:02.151
The kind of like aha moment for you with that.

00:34:02.231 --> 00:34:06.651
Though? Oh, the story is a little bit infamous. We had a young lady in Limerick

00:34:06.651 --> 00:34:13.271
who was having a midline laparotomy for ovarian CA, so a pelvic clearance.

00:34:13.711 --> 00:34:18.311
And she was, I think she was 21 years of age. And we couldn't give her an epidural.

00:34:18.771 --> 00:34:23.411
Full length laparotomy. And my consultant at the time said, is there anything you can think about?

00:34:23.671 --> 00:34:26.951
Can you do rectus sheath blocks before ultrasound? And it was,

00:34:27.111 --> 00:34:31.651
yes, I can, but I haven't done many. I was only two years, three years in practice.

00:34:32.251 --> 00:34:35.611
And he said, well, can we look at something else? We were looking at Bernard

00:34:35.611 --> 00:34:40.091
Dayland's work. And he said, can you find a way to get in posterior to the mid-axillary line?

00:34:40.431 --> 00:34:42.571
He went home, took out his netter,

00:34:42.691 --> 00:34:46.091
asked me, could we palpate the lumbar triangle of a T on that girl?

00:34:46.551 --> 00:34:50.511
Came in next morning, palpated her. Said, do you think you can get a needle in?

00:34:50.871 --> 00:34:56.191
She said, yeah, of course. So I got a blunt needle, the plexifix needle,

00:34:56.311 --> 00:34:58.651
which was just going out of fashion and out of production at the time.

00:34:59.091 --> 00:35:05.331
Did tap blocks on her, threw everything we could in terms of opioids at her and prayed.

00:35:05.951 --> 00:35:10.211
Next morning, came back to see how she'd done. We'd asked the nurses overnight

00:35:10.211 --> 00:35:12.911
to make sure that she'd been comfortable and that she'd had enough opioid.

00:35:13.391 --> 00:35:15.471
Came in, she had gotten 10 milligrams

00:35:15.471 --> 00:35:19.491
of opioid morphine overnight and she wasn't in her bed. She was gone.

00:35:20.011 --> 00:35:23.231
So we didn't know what happened. nurse said she was there a few minutes ago

00:35:23.231 --> 00:35:25.531
she might be gone for a walk gone

00:35:25.531 --> 00:35:26.011
For a walk

00:35:26.691 --> 00:35:30.511
Midline laparotomies found right the front door of the hospital having a cigarette

00:35:30.511 --> 00:35:37.611
and uh are you okay i'm fine are you sore no so

00:35:37.611 --> 00:35:40.591
Hold on let me get this straight she just had a midline laparotomy but this

00:35:40.591 --> 00:35:43.391
big thing yeah and only ten of morphine

00:35:43.391 --> 00:35:47.971
Intraoperative opioids opioids in recovery but overnight 10 milligrams were

00:35:47.971 --> 00:35:50.391
given to her because she must be sore yeah

00:35:50.391 --> 00:35:51.471
You expected she was good

00:35:51.471 --> 00:35:52.691
Yeah so we got the nurses to

00:35:52.691 --> 00:35:53.831
Work protocols yeah.

00:35:53.831 --> 00:35:58.271
And the next morning she left her hdu ic bed was out the front of the

00:35:58.271 --> 00:36:00.151
Hospital she was on a ward we didn't have

00:36:00.151 --> 00:36:00.951
Oh she didn't

00:36:00.951 --> 00:36:03.291
Because she didn't have so we couldn't do an epidural she left

00:36:03.291 --> 00:36:04.391
The ward and was at the front of

00:36:04.391 --> 00:36:07.151
The hospital smoking a cigarette and she looked my surgeons really upset with

00:36:07.151 --> 00:36:11.271
me and we're like why well i was trying to do some crunches this morning because

00:36:11.271 --> 00:36:14.631
i want to keep my body and we're looking kind of going this is something not

00:36:14.631 --> 00:36:19.111
right she's either psychiatric or we've done something and have we done some damage?

00:36:19.451 --> 00:36:22.651
Brought it back, assessed her, everything was fine. And then we did a few more

00:36:22.651 --> 00:36:27.271
blocks of similar quality. And then it was coming towards the end of my time in Limerick.

00:36:27.411 --> 00:36:30.991
But what we did was, Nadeem Rafi was the chap that came up with going through

00:36:30.991 --> 00:36:31.851
the Lumber Triangle of a T.

00:36:32.091 --> 00:36:33.371
He was the guy.

00:36:33.371 --> 00:36:36.571
He was a locum consultant in Limerick at the time. And we asked him,

00:36:36.611 --> 00:36:40.451
did he want to stay on the research? And he said, no, I don't need it. So I went back to Dublin.

00:36:40.831 --> 00:36:43.231
I met the one and only Brian O'Donnell.

00:36:43.411 --> 00:36:43.551
Yeah.

00:36:43.831 --> 00:36:50.651
I told Brian, I have this block that works. Brian looked at me like I was batshit crazy and said yeah

00:36:50.651 --> 00:36:51.311
It's fine you're good

00:36:51.311 --> 00:36:52.111
So

00:36:52.850 --> 00:36:53.610
Prove it to me.

00:36:53.970 --> 00:36:58.390
Did a few in Tala with Brian. Brian was, wow, we have something here.

00:36:58.630 --> 00:37:05.030
And then Brian made the top block because Brian did all the ethics, all the approvals.

00:37:05.510 --> 00:37:10.490
Brian did all the hard graft. I just did the blocks. And it just grew legs.

00:37:11.330 --> 00:37:14.430
But we pushed for years and years and years to get it to where it was.

00:37:14.550 --> 00:37:20.330
And then we had the whole problem with ultrasound coming in and changing the dynamics of the block.

00:37:20.630 --> 00:37:22.990
So it's been a journey. It's been a big journey.

00:37:23.150 --> 00:37:27.010
That's so cool. But it's amazing how those index stories, right?

00:37:27.070 --> 00:37:28.530
You do it once and like that.

00:37:28.650 --> 00:37:32.130
I remember trying to relay that story, but it's so much better hearing it from

00:37:32.130 --> 00:37:33.450
the man himself. Yeah, yeah, yeah.

00:37:33.610 --> 00:37:34.750
I'm glad you didn't, actually.

00:37:34.930 --> 00:37:37.330
Well, no, I have told it once before. If you remember back in the day,

00:37:37.370 --> 00:37:38.370
I blocked it out.

00:37:38.610 --> 00:37:41.790
Yeah, you blocked it out. Yeah, very good. But you've made your stamp on history,

00:37:41.890 --> 00:37:44.590
which is great. But that's not where it ends, right?

00:37:44.730 --> 00:37:47.470
Because you'd think, hey, I've done my, i put my

00:37:47.470 --> 00:37:50.190
name in regional anesthesia and actually check that box he

00:37:50.190 --> 00:37:53.070
doesn't want to talk about the tap block anymore he's over that so there

00:37:53.070 --> 00:37:56.890
was a whole but you did have those nice studies showing tap blocks with local

00:37:56.890 --> 00:38:01.530
answer contrasts going up into the paravital space which was an eye opener for

00:38:01.530 --> 00:38:04.530
us we're like okay when you don't want to do them here we want to be doing them

00:38:04.530 --> 00:38:09.030
back here but i don't want to talk about that because just recently published

00:38:09.030 --> 00:38:12.870
in was it in bja was it anesthesia Anesthesia.

00:38:13.530 --> 00:38:17.690
You published another block, man. I thought we were done with new blocks.

00:38:17.750 --> 00:38:20.970
It's not a new, again, there's no such thing as a new block.

00:38:21.130 --> 00:38:24.450
What have you just recently published and why are you excited about it?

00:38:24.670 --> 00:38:29.010
Again, it's an adaption of what's being done. So you've got Axel Suter,

00:38:29.410 --> 00:38:33.930
Jens Borglum, Rafa, all these guys that are doing this amazing work in innovation.

00:38:34.270 --> 00:38:40.470
And I end up being in a situation where I can't provide a certain type of analgesia.

00:38:40.630 --> 00:38:44.550
Again, it came back to the fact I had a patient for a hip morbidly obese

00:38:44.550 --> 00:38:47.490
who'd had a spinal decompression so midline

00:38:47.490 --> 00:38:50.250
decompression from l2 down as far as

00:38:50.250 --> 00:38:53.050
l5 so i couldn't do a spinal couldn't do an obviously do

00:38:53.050 --> 00:38:57.290
an epidural she was for revision hip surgery and because she was so obese i

00:38:57.290 --> 00:39:00.430
was worried about the opioids i don't thought what will i do and i was scared

00:39:00.430 --> 00:39:04.870
of about doing a source compartment block because of stephen mannion's work

00:39:04.870 --> 00:39:08.770
on terms of the sheets and the epidural sheets coming out and she was big and

00:39:08.770 --> 00:39:12.990
there has to be something that I can adapt. The QL block wasn't going to be enough.

00:39:13.290 --> 00:39:15.250
So I said, if I go a little bit deeper...

00:39:15.932 --> 00:39:17.892
And go into the psoas fascia,

00:39:18.012 --> 00:39:22.952
Just under the psoas fascia, into the psoas muscle, inject, pull back until the fascia pulls away.

00:39:23.152 --> 00:39:27.052
And then the local anesthetic should spread very much like a rectus sheath block

00:39:27.052 --> 00:39:30.812
within the psoas muscle and get the nerves as they come out through the psoas

00:39:30.812 --> 00:39:32.972
muscle and you might get some trickle back.

00:39:32.992 --> 00:39:37.412
Hold on, let's go back again. So you're not doing a QL? No, definitely not.

00:39:37.572 --> 00:39:39.512
So you're coming from posterior?

00:39:39.512 --> 00:39:42.232
I'm using Jens Borglum's transmuscular approach.

00:39:42.372 --> 00:39:42.532
Right.

00:39:42.912 --> 00:39:46.532
But not stopping at the QL, I'm going further and I'm going into the substance

00:39:46.532 --> 00:39:50.492
of the source muscle to get my needle placement because the fascia tense a little bit in front of you.

00:39:50.552 --> 00:39:51.772
So you make sure you're in psoas.

00:39:51.972 --> 00:39:54.232
Yeah, but millimetres. Like doing a rectus,

00:39:54.312 --> 00:39:56.532
Well, the opposite of rectus sheet where you go in the muscle inject and then

00:39:56.532 --> 00:39:58.772
you go a bit further to get to the fascia. You're overshooting.

00:39:58.792 --> 00:40:01.632
I'm overshooting slight, but millimetres and then pulling back.

00:40:01.632 --> 00:40:03.612
I don't want to inject in the substance of the muscle.

00:40:03.732 --> 00:40:06.832
I want to inject when the fascia lifts off the psoas muscle.

00:40:07.132 --> 00:40:08.212
Yeah, the inside of the sausage case.

00:40:08.372 --> 00:40:10.512
Exactly. Just like a rectus sheet block. You and your food.

00:40:10.832 --> 00:40:11.452
I love sauter.

00:40:11.512 --> 00:40:12.112
I get hungry.

00:40:13.012 --> 00:40:16.952
So not in the division within the psoas where the.

00:40:16.952 --> 00:40:19.372
Lumbar plaque is there. No, not in there. Superficial to this.

00:40:19.612 --> 00:40:22.652
Okay. And so initially I called it the sub-psoas fascia.

00:40:23.152 --> 00:40:26.592
And then I had this fantastic registrar, Ben Canton, who's in Canada,

00:40:26.912 --> 00:40:28.452
gone to ICU. What a waste.

00:40:29.132 --> 00:40:34.352
And he said, no, no, no, no. We have to call it the PSB psoas sheath block.

00:40:34.572 --> 00:40:35.872
So like the rectus sheath block.

00:40:36.232 --> 00:40:39.692
So the idea is that you're getting this sheath or envelope type effect with

00:40:39.692 --> 00:40:43.632
the local NSA. Yeah. And we've just had fantastic results with it.

00:40:43.832 --> 00:40:45.772
So you get like a lumbar plexus block.

00:40:45.772 --> 00:40:46.332
Essentially.

00:40:46.852 --> 00:40:51.412
Why isn't it a lumbar plexus block? It is of sorts.

00:40:51.412 --> 00:40:56.412
But I think the duration of blockade is too long to just be a lumbar plexus block.

00:40:56.592 --> 00:40:57.852
How much volume are you using it?

00:40:57.912 --> 00:41:02.792
20 to 30 cc's. So again, it comes back to the whole way of how we think about

00:41:02.792 --> 00:41:06.212
regional anesthesia being just a sensory afferent nerve block.

00:41:06.332 --> 00:41:11.112
To me, and I haven't proven it yet, much like the tap block and the thoracic

00:41:11.112 --> 00:41:13.552
paravertebles, we're blocking sympathetic chains.

00:41:13.772 --> 00:41:16.832
And that's why we're getting two to three days of analgesia.

00:41:16.952 --> 00:41:18.372
Two to three days of analgesia?

00:41:18.412 --> 00:41:22.232
Yeah, analgesia as part of a multimodal analgesic regime.

00:41:22.412 --> 00:41:23.552
No motor block.

00:41:23.832 --> 00:41:26.872
Little or no more. You can't say no motor block, but in recovery,

00:41:26.972 --> 00:41:31.312
our patients are able to straight leg lift. They're walking same day of surgery.

00:41:31.832 --> 00:41:34.252
Wow. And we're getting really good results. But it's again...

00:41:34.909 --> 00:41:39.349
it's the whole thing about having a problem and trying to find a solution it's

00:41:39.349 --> 00:41:42.269
the problem is there's too much going on in the head and then it's for me to

00:41:42.269 --> 00:41:47.829
get it onto paper i need people like brian o'donnell yeah ben canton these people

00:41:47.829 --> 00:41:52.369
and and there's a major failing of mine it's that i have the ideas but it's

00:41:52.369 --> 00:41:54.049
getting to the next stage we're

00:41:54.049 --> 00:41:58.689
Hearing so many of these ideas of these super intelligent people having a coffee

00:41:58.689 --> 00:42:01.889
waking up being in the garden thinking i've got a complicated problem how am

00:42:01.889 --> 00:42:04.989
i going to fix it come out with i mean yeah when i have a look at my list for

00:42:04.989 --> 00:42:09.849
next week i'm like oh okay i've got to deal with it i don't invent a block yeah but it's not even

00:42:09.849 --> 00:42:12.849
Inventing it's just like is there anything that i can do that's better yeah

00:42:12.849 --> 00:42:17.029
like we're doing now and then after that came well i've got the hips but what

00:42:17.029 --> 00:42:20.869
about knees and what it'll work for the anterior knee but what about the posterior

00:42:20.869 --> 00:42:23.989
knee what about the capsule is there anything better what's there it's pain

00:42:23.989 --> 00:42:27.709
blocking amazing genius like god i wish i had his brains

00:42:28.109 --> 00:42:31.509
i wish his ability i wish i had his his ability to

00:42:31.509 --> 00:42:34.909
push but is there anything that's even more simple just to make things simple

00:42:34.909 --> 00:42:39.329
yeah not to make them complicated how can i do this in such a way that a muppet

00:42:39.329 --> 00:42:43.909
like me could do the block and so that's what we moved on to now and then after

00:42:43.909 --> 00:42:47.029
that then we could do our shower then after that then i've got a new jersey

00:42:47.029 --> 00:42:48.229
coming out for cycling and

00:42:48.689 --> 00:42:53.209
it's just it's really tiring being in my head really really there's

00:42:53.209 --> 00:42:57.449
Lots of things going yeah but you're working on a whole series of things now

00:42:57.449 --> 00:42:58.449
Some of which you can't

00:42:58.449 --> 00:42:59.349
Talk about because

00:42:59.349 --> 00:43:02.489
Yeah, but this is what's great about here.

00:43:02.989 --> 00:43:06.809
It's also one of the reasons I don't like coming here to the conferences.

00:43:06.829 --> 00:43:08.809
I come to meet my friends, my family.

00:43:09.190 --> 00:43:10.890
And we say goodbye to Luc Cermas today,

00:43:11.070 --> 00:43:14.510
Which is really, really, really upsetting. But you get to meet people,

00:43:15.110 --> 00:43:17.930
Salvi Salablanche, Axel Souter, you know.

00:43:17.970 --> 00:43:19.190
Jeff Gadsden. Jeff Gadsden.

00:43:19.390 --> 00:43:23.970
I'm it. You know, but we're now talking about, let's forming a group that we

00:43:23.970 --> 00:43:25.050
can do the research together.

00:43:25.210 --> 00:43:27.650
Because I can't do it all in Galway.

00:43:27.850 --> 00:43:32.090
But I need these leaders that can do things that I can't do.

00:43:32.270 --> 00:43:35.090
And coming here is really, really good. But at the same time,

00:43:35.430 --> 00:43:40.390
what really obsessed me about these meetings is how you have to protect the idea.

00:43:40.650 --> 00:43:45.290
And here I am. And I can't tell you what I'm doing for the knees because I'm

00:43:45.290 --> 00:43:49.450
afraid someone will steal the idea and run with the idea. And it's not even about me.

00:43:49.670 --> 00:43:52.770
It's about the institution needs the credit to get the money,

00:43:52.870 --> 00:43:56.790
to get the research, to have the international profile, to speak about it.

00:43:56.970 --> 00:43:59.930
So we're holding back the hip stuff we're doing three years.

00:44:00.330 --> 00:44:03.210
One little case series on it, randomized controlled trials.

00:44:03.890 --> 00:44:08.530
The knee stuff we're doing, we've done 16, 17 horrendous surgeries.

00:44:08.770 --> 00:44:10.270
I mean horrendous surgeries.

00:44:10.930 --> 00:44:15.970
Dyselfemoral replacements, revision knees where we take out the femur and the tibia.

00:44:16.090 --> 00:44:19.510
And we have patients that are relatively comfortable, fast scores 1,

00:44:19.610 --> 00:44:22.390
2, 3, over long protracted periods of time.

00:44:22.670 --> 00:44:26.730
And that should be out in the world. No, I have to go and do randomised control trials.

00:44:26.890 --> 00:44:29.690
I have to go and do just to prove efficacy. instead of saying,

00:44:29.790 --> 00:44:33.830
well, why don't a group of us do it and then come to a consensus on it and then

00:44:33.830 --> 00:44:38.970
publish that or talk about it or come here and teach and get it out there.

00:44:39.430 --> 00:44:42.890
So that's interesting, John, because I think that what you're describing with

00:44:42.890 --> 00:44:45.610
the RCT has always been the way that we've done this, right?

00:44:45.710 --> 00:44:48.170
That's when I was a resident, like if you wanted something done,

00:44:48.470 --> 00:44:53.250
this is a five-year time horizon for me to get your idea onto paper or whatever.

00:44:53.390 --> 00:44:57.910
But I wonder if that's changing a bit now because you can make a tiktok video

00:44:57.910 --> 00:45:02.770
maybe that's an extreme example yeah but get an idea out there and maybe you

00:45:02.770 --> 00:45:05.190
might not that might not result in funding for your institution.

00:45:05.190 --> 00:45:09.790
Yeah it's not important but the funding i think we lose sometimes there's certain

00:45:09.790 --> 00:45:13.710
people that have to publish to exist yeah and then you've got people who want

00:45:13.710 --> 00:45:17.290
to do blocks i want to do them because they work and it really impacted my patients

00:45:17.290 --> 00:45:21.470
right i like talking because i love teaching i love i absolutely love teaching

00:45:21.470 --> 00:45:24.410
i can tell yeah yeah i really do at same time

00:45:24.870 --> 00:45:27.610
when you come up with an idea and then you go

00:45:27.610 --> 00:45:30.370
somewhere and you see somebody talking about the idea and they've got

00:45:30.370 --> 00:45:33.370
it wrong and you're trying not to

00:45:33.370 --> 00:45:37.190
decapitate them physically get on the stage and that becomes very very stressful

00:45:37.190 --> 00:45:40.850
yeah it's i don't know it's just it just seems that we're moving further and

00:45:40.850 --> 00:45:45.170
further away from the core of what we should be doing and the core is the patient

00:45:45.170 --> 00:45:50.790
and what it seems to be is an industry about publication and it's got to the point now where

00:45:51.482 --> 00:45:55.882
If I'm going to go and learn something, I'm going to go watch Roman Suker and a simulation team.

00:45:56.322 --> 00:46:01.542
Rather than going in and listening to my didactic lecture on my opinion about

00:46:01.542 --> 00:46:04.582
X, you know, I think that's a big problem.

00:46:05.582 --> 00:46:11.042
Well, I tell you what, I cannot wait for you to get your next block out,

00:46:11.262 --> 00:46:12.722
whatever it's called, where it's going to be.

00:46:13.022 --> 00:46:13.842
I haven't got a name.

00:46:14.122 --> 00:46:16.842
Well, I can help you. I think power, I've always looked for something.

00:46:16.942 --> 00:46:19.662
I want the power to be on something. But I'm going to try.

00:46:19.682 --> 00:46:20.282
The thingamajiggy.

00:46:20.662 --> 00:46:23.782
The thingamajiggy. yeah but i think we could you know this

00:46:23.782 --> 00:46:25.102
Is it a single.

00:46:25.102 --> 00:46:28.602
Injection single injection single injection guys

00:46:28.602 --> 00:46:31.642
You heard it here first where's the camera look into one of these cameras look

00:46:31.642 --> 00:46:35.082
into that camera and tell us that we it's gonna big things are coming

00:46:35.082 --> 00:46:39.022
Yeah well hopefully and the thing is you don't know whether you're just hitting

00:46:39.022 --> 00:46:44.062
a batch of unusual people in which the systemic effect of the local anesthetic

00:46:44.062 --> 00:46:48.482
is happening or if you've got local anesthetic instead of spreading where you think it is.

00:46:48.622 --> 00:46:52.542
Because we did the top block and we were sure it was in the top plane and that's

00:46:52.542 --> 00:46:55.982
what's important, the anterior spread, only to realize that it doesn't matter

00:46:55.982 --> 00:46:58.242
at all anteriorly. It's the posterior spread.

00:46:58.402 --> 00:47:01.442
So we're really at the beginning of this, but it's trying to get,

00:47:01.702 --> 00:47:05.362
I suppose, the team of people that would be interested in helping and being

00:47:05.362 --> 00:47:09.382
part of a team rather than taking the idea and making it.

00:47:09.662 --> 00:47:13.382
It sounds very egotistical of me that I want to be remembered for the block.

00:47:13.542 --> 00:47:16.102
I don't really want to be remembered for the block. I want to be remembered for this.

00:47:18.582 --> 00:47:22.342
what's that now you know when you've got your ultrasound on the power when you're

00:47:22.342 --> 00:47:25.542
doing a power virtual and you do the little flick oh yeah that's all I want

00:47:25.542 --> 00:47:27.262
I want the Mcdonald flick I

00:47:27.262 --> 00:47:32.662
Just want that well this will be the Mcdonald flick if I

00:47:32.662 --> 00:47:37.502
Die and I'm remembered not for tap lock or the cure or the whatever Ben calls

00:47:37.502 --> 00:47:40.982
the source thing if I'm remembered for this I'll be so happy

00:47:40.982 --> 00:47:47.422
I'm going I'm going visible on that camera this is the Mcdonald flick yeah for power virtual I'm

00:47:47.422 --> 00:47:51.062
Going home on Monday. I'm going to do some teaching and I'm going to say,

00:47:51.182 --> 00:47:52.862
stop what you're doing. You need to do the McDonald's flick.

00:47:52.862 --> 00:47:54.742
Get your pro brand and then flick.

00:47:55.122 --> 00:47:58.802
Oh, there we go. Listen, I do that. He taught me to do it, but he never gave it a name.

00:47:58.902 --> 00:48:01.202
No, that's the only thing I like. That's the only thing I want to remember for.

00:48:01.402 --> 00:48:04.762
Well, consider it done. John, it's been an absolute pleasure.

00:48:05.002 --> 00:48:05.702
I'm so glad that's over.

00:48:05.902 --> 00:48:05.982
Thanks.

00:48:08.102 --> 00:48:12.722
I know, I know. I want to hear more too. Stay tuned because we have lots more

00:48:12.722 --> 00:48:16.082
Ezra Blockbox interviews where that came from. In the meantime,

00:48:16.482 --> 00:48:22.262
go find a friend who hasn't heard of this podcast and sneakily hit subscribe on their phone. Okay?

00:48:22.602 --> 00:48:25.322
Great. Thanks. We'll catch you next time on Block It.

00:48:25.200 --> 00:48:41.507


Athmaja Thottungal Profile Photo

Athmaja Thottungal

Dr

Consultant- Anaesthesia and Pain management, Kent and Canterbury Hospital
East Kent University Foundation NHS Trust

Special interests in Regional Anaesthesia, Integrated transitional Pain Medicine, Neuromodulation and Medical education.
IBLM/BSLM Certified Lifestyle Medicine Physician and IIN Health coach.

ā€¢ Recipient of 2024 ESRA (European Society of Regional Anaesthesia and Pain management) award of ā€œRecognition of Education in Pain Medicineā€
ā€¢ An Internationally renowned educator in regional anaesthesia and Pain medicine.
ā€¢ Faculty and examiner of various national and international governing bodies, fellowship and certification programmes.
ā€¢ An innovator and thought leader in holistic pain management, anaesthesia and palliative care. Winner of multiple awards for presentations, research, leadership and academic achievement.
ā€¢ A firm believer and practitioner of holistic approach to healthcare and wellbeing.
ā€¢ Avid practitioner of lifestyle medicine and preventive medicine for personal, professional and organisational wellbeing.
ā€¢ Active member of the community, with external interests spanning a range of charitable and value-focused initiatives.
ā€¢ Author and co-author of many chapters in books and articles

John McDonnell Profile Photo

John McDonnell

Prof. Dr.

Husband to the fabulous Philippa, father to four amazing sons, part time triathlete and occasional anaesthetist