second day of physio

Like any other day at the neuro ward at Sir Charles Gairdner, I would wake up in my room at around 7 or 6 in the morning to get started with my routine. I will be patiently waiting for my breakfast as always. Though the food they gave me was terrible as they made most of it tasteless and mushy like porridge, I still had to eat it to give me a bit of energy to do my physiotherapy. The only reason why they had to make my food in such a way was that my esophagus movements had been affected by my stroke and I found it hard at times to swallow things down my throat, especially normal fluids like water. So they even made the water thicker in order for me to swallow it easier. Other things that I have to consume were liquid antibiotics to prevent any infections from developing inside my body. Thankfully I didn't have to consume them through my mouth as they would most certainly taste disgusting instead they fed me the antibiotics through my feeding tube that was still attached to my stomach. Whenever they inject something down my feeding tube I can feel it directly enter my stomach, the sensation was weird and somewhat uncomfortable.

After taking my antibiotics I would then have to take my levetiracetam otherwise known as Keppra, Anti-seizure pills to prevent me from having seizures and Baclofen to ease the spasticity in my muscles particularly within my triceps and my hamstrings. these muscles were stiff to the point that it feels I have rocks in my arms and thighs. to get rid of this extreme spasticity, my physiotherapist Mena suggested getting a bit of botox injection into the area where the stiffness occurs, this way the botox will help loosen up the muscles which will make it easier for me to move. So one day she called one of the doctors by the name of doctor Gosh to come to the hospital to give me the botox. The syringe he used was like any other ones that most health physicians would use to draw blood from their patients but the one that Dr. Gosh was using had botox in it and the syringe was a bit longer to penetrate my stiff muscles. Thankfully I still had paralysis at that time on the left half of my body so I can't really feel any pain. The moment he injected that syringe into my hamstrings, I felt something was penetrating my leg but it didn't feel painful at all it just felt something sharp was going through my flesh.

The injections were made in two places; my hamstrings and in my pectoralis major. After these two injections, Dr gosh told me and Mena that the dosage is enough to loosen up the muscles but the results will not be permanent as botox is only a temporary fix to muscle spasticity. after the brief explanation Mena and her physio student, Ellie took me to the physio gym to start another daily session of physiotherapy but this time they got something special in my mind for me. As I entered the gym Ellie brought in a transcutaneous electrical nerve stimulus otherwise known as a TENSE device to help me stimulate certain muscles in my arm so that I can move them again. Mena attached the first two diodes on my forearm and the other two on the back of my hand particularly on the radial and ulnar nerve. these nerves have a specific function in moving my fingers. The ulnar nerve controls the ring and pinky finger, the radial nerve controls the thumb and index finger. So it was pretty obvious that Mena and Ellie placed it on the specific location of these nerves. Once the electrodes are in place, they turned up the voltage. my initial reaction to it was nothing since I didn't feel that much of a jolt of electricity rushing through my arm but then it hit me hard and I could feel the electrical pulse rushing through my hand. during this moment I felt like a real-life version of Frankenstein being brought back to life from the dead. Surprisingly the electrical current was enough to move some of my fingers for a short while. after countless attempts, the amount of electricity flowing became unbearable and it was starting to hurt me. having realized that I was in pain, my therapists decided it was time to stop the cruel experimentation. Instead of continuously frying my arm with the electrical nerve stimulation, they decided that an alternative treatment would be better, so they prescribed me a muscle relaxant drug called baclofen. That night before I head off to sleep, one of the nurses came into my room and gave me the baclofen tablets, of which I consumed immediately upon receiving them.



                                    

The brain that changes itself

In my last post, I mentioned some of the activities that stroke patients can do while they are in the hospital, one of them includes reading books. During my time at the neuro ward at Sir Charles Gairdner, my mother had bought me a book at one of the local bookstores at the CBD. It was a book regarding the brain and its tremendous capacity to repair itself. The book is called " the brain that changes itself" by Norman Doidge. The book contains case examples of how neuroplasticity is a real phenomenon and that it can be applied directly after a brain injury. Some cases detail injuries that involve the removal of large parts of one of the brains hemispheres and yet the patient is able to walk and talk normally as if nothing happened.

The book wasn't the only thing that kept me busy during my time in the hospital, I also had a bit of fun doing online quizzes and brain games to keep my mind active and distracted from the hospital environment. I visited websites such as www.lumosity.com and www.jetpunk.com to play online quizzes to see if my memory was functional. Luminosity is a good starter for any brain injury patients to test themselves in terms of their memory, concentration, and information processing such as planning and counting. Jetpunk, on the other hand, is more of a knowledge-based quiz asking players certain things relating to certain topics. Most of the time I would pick a quiz regarding ancient history and basic human psychology as a means of testing my knowledge and memory, so far I can get most of the correct answers with only a few incorrect answers, so my memory of certain things seems to be intact.

While I was still inside my room, some of the therapists would come over to test me on my cognition. These therapists are usually occupational therapists asking me questions about my name, my knowledge of my current whereabouts and logic based questions such as problem-solving to see if I was to think coherently if I was faced with certain problems. They would even ask me on mathematics to see If I could still count normally, though I am pretty terrible at maths in school I did find it hard to calculate numbers quickly after the surgery it took me a lot more time to process the correct answer after the surgery. However, after a few sessions, I was finally able to count a little bit faster with fewer incorrect answers. It wasn't only the occupational therapists that came into my room. The speech pathologists also came by to help me talk properly as I had facial paralysis from my stroke which made the left half of my face weaker and caused me to slur my speech sometimes and drool on the left when I'm not talking. At times the drooling got bad that the nurses would have to be called to clean up my saliva as it was making my shirt wet.

The other therapies that I had to do were my physiotherapy. Every morning at around 9 or 10, I would stroll myself on my wheelchair to the physio gym where I would train to walk on the parallel bars and move my elbow joints on the shoulder wheel. All these exercises are made to stimulate the parietal lobe of my brain that controls my movement. Sometimes I would make significant progress and regain my movements quickly. The first significant movement that I made at the physio gym was my knee flexion, I was able to bend it at a nearly normal angle. When I noticed this I felt a sense of accomplishment and went back to my room with a bit of happiness knowing that I could, in fact, regained my normal life back. I read the book again that my mom had given me earlier and focused on its message of neuroplasticity. I would visualize myself of being able to run again after having read the book before going to bed.
               

        
                 

Tips on stroke recovery

In my last post, I talked about how I trained myself to move my paralyzed arm by putting all of my focus on moving it. This shows that our determination and willingness is the key to recovery and it also proves the fact that though some neurons in the brain are damaged after surgery it doesn't mean that the communications between the neural networks have stopped, at times the neurons will still transmit messages between one another despite being damaged. This is because the science of neuroplasticity is a fact. There are billions of unused neurons in the brain that we rarely use, its these neurons that will act as a substitute to replace the damaged cells. Speeding up the process of neuroplasticity is easily done with constant stimulation and good habits. Below are some of the things that would speed up neuroplasticity:

1. Healthy diet: the saying you are what you eat rings true to this one as the human brain can only function at its full capacity when it gets its required nutrients such as omega fatty acids which are found in fish oil or krill oil. Iron is also essential oxidative metabolism which is needed for the growth of neurotransmitters. Protein should also be consumed as it is needed for further growth of brain tissue and muscular growth to prevent muscular atrophy from progressing especially after being immobile from an induced coma.
2. engage in reading: When we read books, the main parts of the brain that are active are the occipital lobe (processing sight) and the hippocampus ( memory storage & language interpretation) constant reading helps these parts of the brain to remain active and it will eventually trigger neurogenesis, the brains ability to grow new neurons, especially in the hippocampus as its the only part of the brain with a fast rate of neurogenesis. 
3. Force yourself to move: if you're paralyzed on one side, it is absolutely essential that you push yourself to move. forcing yourself will help stimulate the neurons in your brain to form a new connection. Once these connections form they can be permanent and maintain a nearly normal movement. 
4. Learn to talk slowly: This advice is given to those with facial paralysis, which gives them a slurred speech. Slurring can be prevented by always remembering to take a deep enough breath to push the diaphragm downwards, which allows air to move freely into the vocal chords that help us produce a clear voice when we talk. The other thing to remember is to move the jaw muscles as wide as possible to pronounce things clearly. 
5. Talk with other patients and hospital staff:  Sometimes socializing helps our recovery by keeping us occupied and distracted from our problems.
6. Stroll around the hospital: being inside the hospital can be boring so moving around your ward can be a refreshing thing to do and you need to expose yourself to sunshine to increase vitamin D in your body.
7. Learn about the brain: Sometimes getting to know about your brain or what happens to it gives you a better idea on how to take care of yourself and have better questions that you can prepare to ask your surgeons, doctors or oncologist.

Though the points above are my ways of recovering after a brain injury. each and every person will have their own ways of recovering themselves. So to each his own, be creative with your recovery and learn to occupy yourself as best you can. 

                       

Room 5

After my consciousness began coming back slowly, my doctors and nurses prepared one of the rooms in the neuro ward for my further recovery. The room that they had prepared was room 5, located directly in front of the nurse's station, should any kind of emergency happen I can just wave my hand and the nurses will see me and they will come in to assist me with anything. you could say it's a good location within the ward and I had a nice view overlooking some hills and trees. However, due to it being directly in front of the nurse's station, I couldn't have any privacy as my door was constantly open and the nurses could see what I was doing. My room was equipped with an electronic bed that can adjust its incline position and its height. Above it was an electronic crane that is used to move immobile patients to either a showering chair to shower them in the bathroom or onto a wheelchair should the patient desire a stroll around the hospital.

Both of these chairs were already provided by the hospital and they were stacked at the corner of my room. Should I need to go to the bathroom or wanting to walk around, all I have to do is just press the nurse's button and one of them will come to assist me to get into these chairs. During this time when I was transferred to room 5, I was barely conscious. You could say I was awake but not fully aware of my surroundings. Sometimes I would be able to respond to questions that my parents or nurses gave me but I would immediately forget it the next second. Other times I would completely forget the very thing that I was doing the last few seconds. You could say that my short-term amnesia was equivalent to Ten seconds Tom from the fifty-first dates movie that was played by Adam Sandler.

My parents were aware of my short-term memory problems and informed it immediately to one of the senior nurses to have a look and see whether it was anything serious that should be further examined by the neurologist. At this stage, they were worried that the deficit will continue to worsen. Then one of the neurologists came inside the room to check on me and inspect my memory problems. my parents told them what was going on and they said that it's not something to be worried at the moment as I've just gained consciousness after an induced coma. The memory problems will eventually go away as the brain is in the process of recovering.

While I was recovering, I still had a tracheostomy attached to my voice box, as this is what allowed me to breathe after I was taken off the ventilator, since I still couldn't breathe on my own. Breathing through the tracheostomy was somewhat hard and uncomfortable as the device was inserted from within my throat and the only way I could breathe or talk was to deflate the balloon inside the device which controls the flow of air within my throat that allowed me to breathe or talk. whenever I'd like to talk, they deflate the balloon halfway to let the air flow into my voicebox and I would be able to talk. sadly deflating the balloon also caused some imbalance of air pressure in my throat that gave off a duck-like sound whenever I breathe and talk at the same time, though I find this extremely funny, it was at times annoying since I couldn't make a clear sound and get my message across the room. however, I slowly got the hang of it and managed to control my breathing and was able to pronounce things clearly without making the duck noise.

Thankfully, it wasn't long before the doctors decided to remove my tracheostomy to allow myself to adapt to my environment and breathe normally on my own. It was only when this device was removed that my memory became clearer and I became fully conscious and I was fully aware of my surroundings, I realized I wasn't in my apartment room nor was I at Hyde Park where I usually hang out for a run. The moment I realized I wasn't in my room, I was bewildered and had no Idea on what was going on. My mother and the nurses were on the right side of my bed, observing me and my reaction. Then I suddenly remembered the exact moment when I had my stroke, I remembered losing sensation on my left and saw my left arm dropping to the floor as if it was made from rubber. The moment I remembered that I knew something wrong had happened to me. I asked my parents and the nurses on what happened and they told me that I had suffered a stroke from a rare type of endovascular condition and a craniotomy was performed to remove the abnormality in order to save my life.

At first, I didn't believe this as it sounds completely surreal and downright ridiculous since I was pretty much healthy and didn't follow any unhealthy lifestyle like eating junk food or over-consumption of alcohol. one of the nurses approached me and debrief me on the situation. she told me I had a hemmoraghic stroke from a rare type endovascular disorder, known as an AVM. It's not because I was unhealthy but because I was born with a ticking time-bomb in my head the very moment I was born. My mother informed me that the nurses will come in to remove the surgical staples on my head that was used to close the surgical cut that was made during the surgery. She then told me that my left side was weak, I didn't understand what she meant by this. When I tried moving my left arm, I realize that I couldn't and knew that I was paralyzed on my left. I wasn't scared or in panic when I had this realization I was crippled. The doctors were still injecting me with a small dosage of medication to keep me calm so I won't panic. A few days later, A nurse by the name of Molly came in and asked me how I was, to which I replied " could be better" and I told her that I couldn't move my left arm. she then told me about how her husband had a traumatic brain injury which gave him a paralysis like mine but he managed to regain most of his movements, through constant focus and self-will, her message was simple; if I keep on my mind focused on my arm by pushing it to move in my mind, it will eventually move and she was right, I could move it slowly day by day and my range of movement became better every day.                             

The Neurosurgeons

Professor Neville Knuckey

The success of any surgery would have never been accomplished without qualified surgeons and doctors who conduct them. This entry will be dedicated to the team of neurosurgeons who had conducted my surgery and saved my life. I personally would like to thank Professor Neville Knuckey and all the team of the neurosurgeon department at Sir Charles Gairdner for carrying out my operation and for informing a live update of my condition to my parents and friends while I was hospitalized. I also thank the nursing team at the neuro ward for nursing me back to health after I was released from the HDU. My surgery was both planned and conducted by the head department of neurosurgery of Western Australia, comprising of a group of doctors and a Professor, who is in charge of running this department in all of Western Australia. When I was brought into the emergency room at Sir Charles Gairdner, the doctors were already aware of the possible cause of my stroke, my AVM.


However, due to my serious condition, they had to conduct an emergency craniotomy and the surgeons who were capable of conducting such operations were Professor Neville Knuckey, Professor Stephen Honeybull, Professor Christopher Lind and Dr. Rasmus Langelund Joergensen. All of the mentioned surgeons are capable of conducting my surgery but due to the urgency of my condition and the size and location of the AVM was considered complicated, the department of neurosurgery concluded that it was best for all of these surgeons should be involved. However, the one who is leading and performing the surgery itself was Professor Knuckey. I was lucky to have him conduct my surgery as he has experience with removing AVM's in the past and was renowned by the Neuro department as one of the best in this field.

It was also sheer luck that the professor conducted my surgery before he gone off for his long holidays. If I had my accident a bit later in the coming months, I would have not gotten the professor to conduct my surgery, it would be another neurosurgeon perhaps with less experience and the post-surgical outcome would most likely be very different and I would have both physical and mental defect. A few days after my surgery, The Professor left his office and went off for his holidays and my case was transferred to his colleagues at the neurosurgery department, particularly under Stephen Honeybull and Christopher Lind.

The two professors would often come into my room along with their registrar, Dr. Rasmus to check on my health observation; my blood pressure, oxygen saturation, blood pressure and heart rate. At times when they are not available, they would send in one of the senior nurses to do it for them. It could be said that these two are my legal guardians for the next few months during my stay at the neuro ward, both in the ICU and HDU. Whenever my parents have any inquiries regarding my condition or the next step of my post-surgical recovery, the two professors will always be contacted to give them the clarification that they needed. the main questions that my parents would often ask the professors were regarding the after effects of my surgery and what my potential deficits were. The professors always give them the same response, saying that I will definitely be hemiplegic on my left side as my AVM had ruptured on the right parietal lobe, which is the part of the brain that is responsible for controlling movement on the left side of my body, so they were certain that I will be paralyzed on my left and have little or zero strength on that side. However due to the severity of my brain Injury, other parts of the brain were badly affected and I may have other deficits such as memory loss, speech impairment, and even emotional problems. all that the professor and my parents could do was just wait and hope that by the time I become fully conscious, I would have my memories and mental health intact.


       

13 days coma and 3 weeks a vegetable

While I was unconscious, I was already placed inside the operating theater where a team of neurosurgeons had already begun to shave my hair off and removed the top half of my scalp to perform an emergency craniotomy. They mostly made their incisions from the front to the back of my scalp and removed the right half of it. The second incision was made directly on my cranium, a hole as wide as 3cm was made on the outer surface of my skull in order for the surgeons to insert their tools and begin removing my AVM. At this stage, the bleeding was still happening and the surgeons are doing their best to stop all the feeders that are feeding my AVM and to detach it from any healthy brain tissue. unfortunately, the only option to do this would be to remove a small chunk of my brain, in this case, a small part of my right frontoparietal lobe( part of the brain responsible for left-sided movement). The surgery starts by inserting clippings on the feeder that's supplying oxygenated blood to the nidus, this, in turn, would reduce the bleeding and reduce the swelling on the surrounding healthy cells. Once the clippings have been placed on the arterial feeders of my AVM, the surgeons could begin removing large chunks of the AVM. it is necessary that all parts of it are removed, especially the nidus. If some remnants of it remain, it would eventually recruit unused arteries and create another nidus, causing further complications in my recovery. However, due to my critical condition, the professors had to do it quickly to save my life and it wasn't done thoroughly, leaving 2cm of it behind.

The surgery lasted for a total of 7 to 8 hours. I went into the operating room at 2.30pm and finished at 9.30pm, where I was sent off to the ICU to spend the next 13 days in a coma. While I was unconscious, nurses would come to turn me over on my side to prevent any pressure wounds from appearing as a result of not moving for many days. during my time at the ICU, some of my friends came to visit me, sadly they couldn't do much to help me they were not allowed to come inside the ICU in large groups only one or two were allowed to come inside. Their duration inside the ICU was only between 5to 10 minutes, after that they would have to leave and come back another day. My parents were the first to see me after my surgery, followed by my close friends; Roni, Indira, Jordan, and Eric. They all came bearing gifts and get well cards to no avail, I was absent-minded and couldn't response to anything.

The professors would come in every day to check on my progress. Their goal was to monitor my inter-cranial pressure and ensure that it has reached the stable level so I could be brought back to consciousness from my coma. However, this took a long time for it to happen. during this period my cranial pressure would fluctuate drastically, causing changes in temperature and uncontrollable urination and defecation. Needless to say, I was practically soaking in my own urine and excrements during my time at the ICU. At times the urination would cause rashes on my back and a wound specialist would often be called to inspect these rashes to ensure that it's not serious or life-threatening. At some point at the ICU, one of the doctors discovered that there was still excess cerebral fluid and i was rushed back to the operating theater to be cut open again to insert a draining tube to get rid of the excess fluid. Thankfully this procedure only lasted for a few hours and I was sent back to the ICU ward. Unfortunately, my draining tube was inserted on the left side of my head so the doctors would have to shave my hair and remove my left scalp to drill a hole on my skull to insert the draining tube.

After 13 days, the doctors concluded that it was safe for me to be awakened from my coma and so they slowly reduce my anesthetics( morphine and propohol). The result of this reduction caused me to have epileptic-like seizures which lasted for a couple of minutes, my mother had to watch me shake from my seizures in horror as the nurses and doctors didn't know what to do. however, the seizures eventually came to a stop and an EEG machine was placed on my head to determine whether my seizures were epileptic or caused by the anesthetics wearing off. so far there was no sign of epilepsy and I was brought to the HDU ward to be monitored by my team of doctors and neurosurgeons. By the time I was inside the high dependency unit, I was already awake but not conscious. I was labeled a vegetable as I was in a vegetative state. one of the nurses by the name of Rachel told my mum that I will spend the rest of my life as a brain dead veggie but I proved her wrong after 3 weeks when all of my memories returned and I was finally aware of my surroundings.

My time at the ICU and HDU wards were a complete blur to me, I had no full recollection of what happened during my stay there. At times when I'm doing nothing, I would get sudden flashbacks of me being turned to my side by my nurses, who were looking after me during my time there. While I was there, my mother would try to stimulate me in hope of bringing back my consciousness. She would do this by playing music on my phone that I was carrying while I was running. she would put my headsets o my ear and randomly select the songs on my playlist and play it for a couple of minutes. Sometimes she would use her phone to play videos on youtube. The first few videos were unsuccessful. Later in the coming few days, she eventually succeeded. One of the videos that she played was about an abandoned puppy that was left on the streets, this video made me cry as my dog had passed away while I was doing my studies at University and I didn't have the chance to be with him in his last hours. Though I was crying from watching the video, it wasn't certain if I was fully aware of watching it or if it was just a subconscious response. The crying itself only lasted a few minutes, after that, I went back to being a vegetable again.         

                  

Day zero

On the 24th of August 2016, I was inside my apartment room in unit 36 of the hyde park court building, located on the corner of Vincent and William street in Perth, Western Australia. At around 6:25 AM I was already awake to finish off my uni assignment for remunerations and rewards, I had done the assignment a week earlier prior from day zero. needless to say that I had plenty of time to write up my thesis and conduct research to complete it and include all the relevant references. I spent my past few weeks carefully focusing mostly on completing my assignments as I am not the kind of person who likes to procrastinate as I have a busy life outside of the university, especially when I have to balance my Uni life and my work life at the mining Lab, where I was actually earning decent amount of income to sustain myself financially and to save up enough for a possible business investment.

Sadly by 2016, my workload at the lab was reduced due to the slowing down of the mining boom in Western Australia. As a result of my workload reduction, I wasn't earning enough to consistently pay my bills for my rent and to save for my business idea. Therefore I had to get additional jobs; being a welcoming attendant at the local park and a cashier at the food court. However, having been made redundant from my current job at the lab, I  had more free time to complete most of my uni assignments, which is why I was completing it around 6:25in the morning. After adding a couple of words to the content of my thesis for remunerations and rewards, I got myself ready to go for my routine run at Hyde Park, which is just next door to my apartment, all it takes is a minute walk and crossing the street. As usual, I have my phone in my pocket and headsets on my ear to listen to some music while I run around the park until I get myself exhausted to better release my endorphins, to help me concentrate on my writing later on when I continue it in uni.

As I entered the running track, I played the first song on my song list, Hellraiser by motley crue, I ran in accordance with the duration of the first track which was about 3 minutes and then played the next track, Poison by Alice Cooper, this song was roughly 5 minutes in duration. listening to the sound of Alice Cooper and his godlike rock melody, it gave me an energy boost that made me run faster than the usual pace, though my breathing was getting heavy and I was beginning to get exhausted myself, I pushed beyond my limits to get the runners high(a sense of euphoria that runners get when running). As I got the runners high, I felt extremely peaceful and lightheaded. however I also felt something else, I felt numb on the left half of my body, I thought I was just tired so I ran further but then my left arm felt funny, it felt like it was hitting something as i was running, it felt like it was hitting some rocks and pebbles. As i looked on my left arm, i was shocked to see that my entire left forearm was on the floor and elastic looking, like the arms of Mr. Fantastic from fantastic four. I remember looking at it with such amazement and picked it up to stretch it and I found it extremely funny, that my left arm was stretchy and started laughing. sadly I didn't know that I was actually having a stroke. I may have laughed for a couple of seconds, after that, I blacked out and completely lost consciousness.           


 

My background

In my last post, I explained my reason for writing this blog and to clarify the different types of endovascular disorders that are responsible for causing hemorrhagic strokes; Anyeursm and AVMs. I know, however, would like to tell you about my personal life leading up to the incident. As I've told you in my last entry,  my name is Samuel, I am originally from Bali, Indonesia. Having grown up on the archipelago, most would consider me to be Indonesian by nationality. Though I'm Indonesian, I've spent the majority of my childhood and teenage years at an international school, where I did most of my secondary education. needless to say, that going to an international school was considered a privilege since most of my school curriculum was done in English compared with the local schools, where its mostly done in Indonesian.

Going to school was somewhat of a mundane task for me as I have to wake up early every morning to be there to attend morning assembly, where we would recite the morning prayer and here announcements regarding important matters. Having said that the sense of lethargy after each assembly in the morning would continue to follow me throughout my day at school even after I go home. I remember being tired in one of the classes to the point that I would lose focus on the subject that was being discussed. needless to say, I was a tired kid throughout my school year and really didn't enjoy it. I remember being tired that I would often forget what I was supposed to do for my class assignments and the teacher would often yell at me or make me stay behind after class to finish it. After school assignments just completely degenerate my brain power and would often put me in bed earlier. By 2007 I was already in the seventh grade and the workload starts piling up every day and it was making me stressed out. by grade 8, 9 and 10, the depression got stronger and it would often interfere with my sleeping pattern. Because of this, I've consulted with doctors and psychologists to identify the cause of both my depression and insomnia. both of them, however, couldn't find any cause and so I was left to handle it alone until I graduated high school and left for Australia to further my studies.

While I was down under my depression got a bit better and was having a blast with my new environment in Perth, Western Australia. the moments of joy lasted for about 7 months and then the feeling of anxiety came back to haunt me again. This time it has made my insomnia worse and i couldn't sleep for a couple of days. This made me go to the local chemist every now and then to purchase melatonin tablets to help me fall asleep every night. This dependence on melatonin became a habit for a couple of months. If any of you out there have trouble falling asleep at night, I would recommend melatonin as a quick solution, however, it shouldn't be used in the long run as there may be some side effects. However, if you are looking for a natural solution to insomnia, then physical exercise would be the answer as it helps release more dopamine and endorphins to decrease stress and form a better circadian rhythm at night. I highly recommend long distance running or any other form of cardio as it is the quickest way to tired the body. 

Standard melatonin supplements