How to Start Tiny Habits for Better Health

President Joe Biden (6s):
If we do this together, by July the Fourth, there's a good chance you, your families, and friends will be able to get together in your backyard or in your neighborhood and have a cookout or a barbecue and celebrate Independence Day.

Unknown (20s):
And what you're looking for is where does this habit or this behavior taking this medication, what does it come after. Once I figured that out, it just clicked in, I almost never miss it.

Terry Wilcox (31s):
Today, creating healthy habits for those with chronic disease. Welcome to the Patients Rising Podcast. I'm your host, Terry Wilcox, Executive Director of Patients Rising, a hundred thousand members strong organization of patients with chronic illness. I'm joined by my cohost, the guy most definitely wearing green underwear to get ready for St. Patrick's Day, the visual is fantastic, he is Dr. Bob Goldberg, Co-founder of the Center for Medicine in the Public Interest. No pinching you right, Dr. Bob?

Dr. Bob Goldberg (1m 5s):
If you only knew why these underwear were green, you know, but that's a whole other subject. It's because I dropped them in the wash with my Kermit the Frog t-shirts.

Terry Wilcox (1m 16s):
I love Kermit the Frog.

Dr. Bob Goldberg (1m 18s):
Is that cloning? I don't know, but anyways, yes, I am, take my word for it, the underwear is green for sure.

Terry Wilcox (1m 26s):
Well, thank you for joining us and having such a great sense of humor today, Dr. Bob. I know it's hard to get you in front of the microphone when major league baseball spring training is underway.

Dr. Bob Goldberg (1m 39s):
Yeah, well, it's just the Yankees, but I'm, I'm always happy to join every week. I mean, I love it because it's fun, but serious fun to help you help patient advocates break down all the debates that are going on in Washington and this with every week, you know, we're focusing on those policies and those decisions that are going to have the most impact on people living with chronic illness.

Terry Wilcox (2m 4s):
And while we're always here on the podcast with updates on healthcare legislation and how it shapes the lives of patients, you can find that on our website and social channels, but a lot of what Patients Rising does day to day is provide resources to help patients, caregivers and family members navigate their day-to-day lives.

Dr. Bob Goldberg (2m 22s):
Absolutely. And, you know, look, we've talked a lot here about the power of technology, accessing your information, health apps, using those to connect with other people or find lower prices on drugs. There's a lot you can do using your phone. Your phone can be a virtual care center.

Terry Wilcox (2m 41s):
Technology can be a great tool in modern healthcare, but it still doesn't take the place of understanding how to change your habits and create new patterns that lead to better health. Now, Bob, this week you spoke to a researcher who's very well known for studying habits, right?

Dr. Bob Goldberg (2m 58s):
That's right, BJ Fogg, who is the author of, I think it's, it is a New York Times bestselling book, Tiny Habits, the Small Changes that Change Everything. Now, BJ started out advising digital health companies and digital platforms, including Weight Watchers, about how people would get the most out of their technology. And he realized that really what it boiled down to are very tiny steps that you can use to build life-changing habits. And that for patients that can mean adjusting your diet, making lifestyle changes, just simple things like looking in the mirror and saying, today's going to be a great day, which believe it or not actually does make you feel better in the morning, or even things like consistency to medication.

Dr. Bob Goldberg (3m 44s):
So the apps can help, but BJ also talked about the importance of these habits, but also coaching people to help create these habits. And that's something I think is a very important part of what Patients Rising Concierge does, whether you're that great team knows it or not.

Terry Wilcox (4m 1s):
Well, I know a lot of people are talking about this book and in our house being, you know, we've been, as everyone knows who listens to this podcast, we've been homeschooling our kids for the year. And one of the things that we're really working on is habit training. There's actual habit training and people have higher success rates and, you know, have more fulfilling lives if they have certain types of habits in place, it just makes them sort of, you know, and I'm sure BJ will speak to this in his interview, and I actually got my copy of Tiny Habits. I'm very excited to read it. I'm really looking forward to his tips on habit forming. That interview with BJ Fogg will be up shortly, but first this week's healthcare news headlines.

Robert Johnson (4m 42s):
In your health news, President Biden marked the one year anniversary of the pandemic with two goals: to make vaccines available to all adults by May 1st and to return to normal life by the 4th of July. Biden said the vaccine order to States will be binding and their compliance mandatory. Earlier this week, he announced more vaccine doses are on the way upping the U.S. Order of the Johnson and Johnson formula by 100 million shots. The decision is meant to safeguard against new Covid variance and prepare for possible doses for kids next year. There's no doubt outbreaks are expensive. So far, the pandemic has cost taxpayers almost $6 trillion in federal relief spending, that's on top of the estimated $16 trillion loss due to economic and personal impacts.

Robert Johnson (5m 29s):
Included in this week's spending package stimulus payments to millions of Americans. Those will start hitting mailboxes this weekend. The COVID virus isn't the only one hitting our checkbooks. Now there's word about the estimated cost of the 2019 measles outbreak in Washington State. A new study says the four month epidemic cost taxpayers there $3.4 million or more than $47,000 per case, a high price to pay for an illness that could have been prevented by routine vaccinations. With so much focus on fighting the Coronavirus, it's been easy to forget about seasonal flu infections, but that's not because the illness was being ignored.

Robert Johnson (6m 10s):
It's because it disappeared. Mask wearing, social distancing, closed schools and offices all are credited with killing the virus. Also, the number of people who got a flu shot increased on the advice of experts who hoped to avoid a twindemic. That's a flu outbreak on top of the COVID crisis. The latest flu stats are almost hard to believe. Between October 1st and January 30th, only 155 people in the entire country have been hospitalized with the flu. A year earlier, more than 8,000 were admitted for treatment. Finally, the debate over the value of vaccine selfies continues. The Atlantic reporting many people who've been vaccinated are keeping their shots secret.

Robert Johnson (6m 52s):
Some fearing criticism, others wary of exposing the criteria that qualified them for an early dose. That's your health news update for this week. I'm Robert Johnson.

Terry Wilcox (7m 9s):
Now this week, the CDC issued some guidance for those who are fully vaccinated.

Dr. Bob Goldberg (7m 14s):
I'm sorry. He used the term guidance and I'm looking at their guidance and I'm going, I should just stay home.

Terry Wilcox (7m 23s):
There's been a lot of questions leading up to this and a lot of confusion, which would be the outburst right there. If you're fully vaccinated, can you go out and about without a mask? Do you need to social distance? A lot was unclear, but now we have some insights. So I thought we'd kick off our conversation today by looking at these recommendations for fully vaccinated individuals and what it means for patients, caregivers, and family members.

Dr. Bob Goldberg (7m 50s):
Well, I'm fully vaccinated. Aren't you?

Terry Wilcox (7m 52s):
I'm not fully vaccinated yet. My Mother-in-law is fully vaccinated. She's 85. My Mom is fully vaccinated in Texas. My Step-mom is fully vaccinated, but I am on a list. Hopefully, that will happen. So I am not in the group that gets to read the CDC guidance. Yeah. So, what, your outburst says a lot.

Dr. Bob Goldberg (8m 13s):
You know, it's because just to be clear, you know, what they say is that if you are vaccinated, then you certainly can hang out with other people who are vaccinated. If you're not dealing with people who are vaccinated, you take the usual precautions, masks and social distancing, but the way they say it, it makes it seem like there's no point in being vaccinated. And point of fact, your ability to interact with other people is much freer if other people are vaccinated so even if you are transmitting the virus, which is a very, very low risk, by the way, once you're vaccinated, you'll limit the spread, you know, then they went into things about outdoor masks and so on and so forth, and I just wish that the guidances were a bit more forward-looking, like for instance, what does vaccination have to do about going back to school?

Dr. Bob Goldberg (9m 5s):
Why can't you, you know, if the teachers are vaccinated or some of them are, why are we still keeping these kids out of school?

Terry Wilcox (9m 12s):
Okay, I have to stop you right there.

Dr. Bob Goldberg (9m 14s):
I know.

Terry Wilcox (9m 15s):
So this program is airing on the day, the exact day, one year ago today was the last time my children set foot in a school.

Dr. Bob Goldberg (9m 26s):
Well Happy Anniversary, Terry.

Terry Wilcox (9m 28s):
Isn't that fantastic. Thank you for effects. Anyway, that is the last time that they entered a school. And like I said, it's very confusing. We get these letters, these emails from Fairfax County that are like your update on returning to school. And it's, you know, there's a little bit of returning, but you'll see people returning and sitting in there, but the teachers at home and the teachers teaching virtually while the kids are sitting in the class, or it's very strange, I can't pay attention to that. And you know, I've told my kids, we're enrolling in another school next year, just, and you know, we might reconsider again when everything goes back to normal, but I can't keep up with like two days, the teachers at home wear a mask, don't wear a mask.

Terry Wilcox (10m 8s):
There's going to be things you can run around and do, there's not, there's, I just, I can't keep up with all of that. And it's just too confusing for young children. So we're not partaking, but it has been a year. The country has been shut down a year, one year.

Dr. Bob Goldberg (10m 21s):
Well look, you know, just to sort of simplify it again, because I just think the CDC made it way too complicated or got the White House involved to make it way too complicated. Vaccination, you know, protects you, doesn't always protect other people who aren't vaccinated. So you still take precautions, but they made it sound like you really shouldn't go on with your life. When, in fact like myself, when I wasn't vaccinated, before I went to see my Dad, I was tested and I washed my hands constantly. You can't stop living your life. It's almost like patronizing. Like we get it already. We know we need to do.

Terry Wilcox (10m 56s):
Now. Another thing I want to talk about this week is that Patients Rising has endorsed a Medigap expansion bill to help those with end stage renal disease. This is a bill that's been put forth by Congresswoman Axne from Iowa and Congresswoman Beutler from Washington. So we're very supportive of that. Obviously anything that expands access for patients, this is important because sometimes patients won't be able to get coverage for end stage renal disease, end stage renal disease is covered for the most part in this country, but there's a lot of other expenses that may or may not be covered if you're stuck, you know, in this place before you get to go on Medicare, right?

Terry Wilcox (11m 37s):
You may not have the kind of coverage that you would have if you were already on Medicare and had end stage renal disease. And so therefore, this is a really good bridge for those patients that might find themselves stuck in that position. And so we definitely are highly supportive of that. As I told everyone, my Dad had end stage renal disease. That isn't what took his life last year, but he did have dialysis twice a week. It's a grueling thing on the body for patients and anything that we can do to help make that easier is definitely something that we should do as a country, because it does take three days a week. You're literally sitting there all day, you know, getting dialysis.

Terry Wilcox (12m 17s):
So another thing I want to talk about a little bit is it's Colon Cancer Awareness Month and it's Colon Cancer Awareness Month all month. And so last week we talked to the Colon Cancer Foundation and one of the things that's so fantastic that they did unfortunately only lasted the first week of the month and it was called the Give a Crap Campaign. And I have to tell you, I hope we link to this in the show notes because I hope you can still see the campaign and get the information of what they were trying to do there or what they did there I'm sure. It was just such a fantastic campaign. And I love these innovative campaigns that really are focused on the public and are focused on prevention.

Terry Wilcox (12m 57s):
When we first started Patients Rising, the National Melanoma Foundation did a fantastic campaign called Get Naked. And I actually called their communications person. And I was like, I just love this campaign. Like anything we can do to help push it out, because those are the kinds of campaigns that give you pause, and you know, make you think, Oh, maybe I, you know, I need to think about scheduling my colonoscopy, et cetera, getting my skin checks and things like that. I think it's so important. So I love it when there's really great preventative campaigns that just sort of take you off guard. And that one definitely did and it was really funny.

Dr. Bob Goldberg (13m 31s):
Well, what it does and BJ Fogg points out, is that you want to turn something that you have to do into an accomplishment in combining with a moment of celebration. So these kinds of awareness campaigns do a great job of just that.

Terry Wilcox (13m 46s):
I want to talk about a couple of health apps before we bump into your interview with BJ Fogg, which I'm again, excited to hear. ICER has a Lupus review coming up at the end of the month, so any of our listeners out there who are Lupus patients or have family members who are Lupus patients, you might want to just tune into that a little bit. They are going to be reviewing some newer medications. And they, like I said, they put out a report which will come out two or three weeks after that, that can affect access if insurers decide to follow their pricing recommendations. So there's a lot of things to consider. We will be talking more about that later this month and this week we're submitting Multiple Myeloma comments and that review is coming up in the summer.

Terry Wilcox (14m 30s):
So those of you with Multiple Myeloma might want to be on the lookout for that as well. But that's just a couple of ICER highlights that I just wanted to let our audience know about. Speaking of habits, I'm a lover of, you know, things to improve my life. There has been a rise in popular health and, you know, habit setting apps like Noom. Why is habit setting important for those with chronic disease? I mean, we can answer that, but what are your top reasons for why patients with chronic disease really want to tune in to this?

Dr. Bob Goldberg (15m 1s):
Yeah, well the first one, I don't know if I should lead with it, but I will. Anyways, medication adherence, the reason I didn't want to lead with it as it becomes a should have. In other words, you want to stick on the medication if it's working, but you also want to change the medication if it isn't working. So you need that kind of iteration to really, you don't want people to stick to a medicine that doesn't work for instance, but that's part of this larger effort of achieving habits because I don't think BJ would talk about achieving habits as a part of changing behavior. So there's diet and nutrition, of course, but there's also just your interaction with people on a daily basis, how to make it happier and healthier, how to deal with the conflicts in life, how to deal with isolation, how to deal with a sense of helplessness, which are all things that everyone experiences regardless of whether they have chronic diseases or not.

Dr. Bob Goldberg (15m 56s):
And then of course the other thing is that you want a sense of accomplishment. That's where companies like Noom and Weight Watchers for instance, have become much more successful in terms of giving people not a goal to lose 40 pounds overnight, or get jacked up in two weeks, or run a marathon, or improve your memory in two weeks, it's by looking at the behavior you want to achieve, but breaking down habits and timing of habits and the timings reminders of the habits to make progress,

Terry Wilcox (16m 26s):
We can all find a million reasons not to do something. We're all really busy. And especially if you look at my life, I mean, I have standing appointments for two hours a week that I like, you know, have to deal with my body. You know, my exercising during this time. If I don't do that, I can go weeks. I can go weeks and then I can barely move and my neck hurts and I can't, you know, it gets really out of hand. So habit training is especially key. Another thing, I always think about this when I think about these reminders, you have all the reminders and everything for taking the medicine, when the best time is, things that you're tracking. With certain patients, I'm like, if you have one of those insurance designs that every three months you have to get a new prior auth and you need to make sure you do things here so that you can adhere to your medicine because otherwise it might not be approved on time.

Terry Wilcox (17m 18s):
You know, there's all kinds of other notes that you can take within that aren't just always necessarily taking the medicine or habits, but just being able to maintain your insurance stuff.

Dr. Bob Goldberg (17m 30s):
Yeah, no, I mean, those kind of reminders are part and parcel of it. And I think is, you know, what BJ says in the book is that especially they can be very, very stressful. They can provoke anger, resentment, fear. There's a way to take those moments, challenge and turn them into moments of celebration. This is a very, very compassionate but brilliant individual who is shifted from, you know, the technological environment of digital apps to turning to people directly particularly people who want to improve their lives and he's provided a book just for that purpose. So with that, here's my interview with Dr.

Dr. Bob Goldberg (18m 13s):
BJ Fogg, Author and Behavioral Scientist at Stanford University. Professor Fogg, thank you for joining us. We told people at the opening of the show that your claim to fame began with the book Persuasive Technology, Using Computers to Change What We Think and Do. And that really did help launch a rethinking of the way that digital technology, whether it's video games or health apps, should be developed. Unfortunately, I don't think a lot of people read the book very carefully.

Dr. BJ Fogg (18m 44s):
No, well certainly when the book came out, I thought it would create a big splash. I thought policy makers would take action against the downsides of persuasive technology and the book launch. And some people read it, but the rest was crickets and it didn't really start getting attention until probably 10 years after persuasive technology was published. And by that point, my research had moved on and my interest had moved on to like habits and just human behavior change in general with nothing to do with technology.

Dr. Bob Goldberg (19m 17s):
Right, and that's what we're going to talk about today. And I think frankly, that's where we should have started at least in the healthcare sphere. And you wrote this excellent book, Tiny Habits, Small Changes that Change Everything, which we are going to link to on our site, and I wanted to start off with the Fogg Maxim one, which has helped people do what they already want to. Now that seems so intuitive, but yet it's so hard. Why is that?

Dr. BJ Fogg (19m 46s):
Wow. You know, Bob, I resisted that idea at least for 10 years, maybe 20, and finally I embraced it about eight or 10 years ago. And this is the only thing that works for helping people change in the long-term is you help people do what they already want to do. And if you're changing your own behavior, then it's help yourself do what you already want to do. And I think people get tripped up on that. Whether they're creating products for others or their own habits, if somehow they think, Oh, we can magically get people to do things they don't want to do. So let's get good at persuading or manipulating people into things they don't want to do.

Dr. BJ Fogg (20m 25s):
That does not work in the long-term. And that definitely does not work for creating habits in our own lives. There's no magical way to convince ourselves or persuade ourselves or manipulate ourselves into acquiring a habit that we don't want to have.

Dr. Bob Goldberg (20m 41s):
In the book, you talk, you know, weight loss is one thing that comes up all the time, but you did it in front of a group, say to people, make the difference between a behavior and a habit. You told everyone right now save $500. You focus a lot on specific behaviors. These are where the tiny steps come in. Right? I mean, we, can't just sort of, I haven't worked out in a year, I'm going to go run a marathon tomorrow, right? I mean, that's prescription for disaster.

Dr. BJ Fogg (21m 9s):
And one way to think about it, and I don't often use these terms, but I think this'll be the Claras because you have these sort of abstract goals and then you have specific actions that help you achieve those goals. Now, instead of using the word goal, I use the word aspiration and I use the word outcome because those are two different things, but both of those can be characterized as goals for something as abstract as, Oh, I want to lose weight or I want to sleep better, or I want to run a marathon, that doesn't tell you what to do in this moment. And so a big part of my work and what people find in the book Tiny Habits is how do you take that abstract thing, whether it's an aspiration, like sleep better or an outcome like run a marathon in the summer, and how do you break it down to specific behaviors that you can turn into habits?

Dr. BJ Fogg (21m 57s):
It's those specific behaviors, and many of them will become habits, that then take you to that aspiration or that outcome. So distinguishing between here's this aspiration or outcome, or let's call those together, the goals you can't design directly for those, instead you've got to break it down and figure out what are the specific behaviors or actions that I can design for.

Dr. Bob Goldberg (22m 21s):
You talk about action prompts, which I think is important. Many of the people that listen to the podcast are in some from a medication or have to take their blood levels and the adherence situation, you know, there's been a lot of technology poured into it, but really until I read your book, you know, and talked about action prompts and went, ah.

Dr. BJ Fogg (22m 40s):
Yeah, shall I give an example from my own life on exactly that?

Dr. Bob Goldberg (22m 45s):
Yes, please.

Dr. BJ Fogg (22m 46s):
Years ago, I was finally diagnosed. I didn't know what it was, but it was Restless Leg Syndrome, which is not a serious issue, but it's super annoying. And so for many years, you know, I'd have to take this little medication every night so I wouldn't twitch and, you know, be restless and wake up my partner and whatever, but I never wired it in as a consistent habit. It was just sort of like randomly remembering to take this little medication, which is not a good idea because sometimes you don't remember. So instead I use my own method, the Tiny Habits method to wire it in as a habit. And it goes like this, after I walk out to the kitchen after my evening shower, so I shower in the evening, so there's always a moment where I'm, you know, my hair is kind of still wet and I walk out into the kitchen.

Dr. BJ Fogg (23m 32s):
After I walk out into the kitchen in the evening, after my shower, I will take my restless leg medication. So what I found, what I figured out is where does this fit naturally in my life? And what you're looking for is where does it this habit or this behavior, taking this medication, what does it come after? And once I figured that out, it just clicked in. I almost never miss it. I don't want to say never because a lot of what you do in your life, you just go on autopilot, I'll take my shower, dry off, you know, put on some stuff on my face so my wrinkles done appears so quickly and you know, put on some kind of evening clothes and walk into the kitchen and then boom, that's the moment that has worked for me to wiring in a very, very solid habit of taking that daily medication.

Dr. Bob Goldberg (24m 21s):
And these prompts, they are highly personal and they have to be key to making you feel good. And I think that's why like health apps are all about prompts, but they never ask you what kind of prompt you would like and when you'd like the prompt and also who are the people that are good at adherence, we should hack their habits as opposed to trying to think we can do something more with technology, I would think.

Dr. BJ Fogg (24m 46s):
I guarantee some people listening to this, hearing like how do you find what your medication comes after, people are saying that's exactly what I do. So let's say, Oh, you got this medication, you're supposed to take it in the morning that doesn't tell you exactly when to take it. And what's not helpful for most people is to have an alarm go off at 10:30 every morning because you might have a friend there, you might be doing something else, you might be in the middle of a Sudoku puzzle, and so the hack here is rather than relying on post-its or alarms or just plain remembering is you attach it, and I call it anchoring, you anchor it to something you already do in your routine. So there's not like the exact moment in the evening when I shower, but there's always a time when I shower, you know, it's not like six o'clock, but there's always a time and so I know there's always going to be a time when I walk into the kitchen.

Dr. BJ Fogg (25m 38s):
And that means, I know there's going to be a time when I will take the medication and it's not rigid or brittle like an alarm going off. That's very brittle. You know, that's like, am I able to do it at this moment when the alarm is going off? Well, maybe not, but I'm always able to do it when I walk into the kitchen in the evening after my shower.

Dr. Bob Goldberg (25m 56s):
And that anchor can also be a pivot point. There's a story about one, I think she may be a Tiny Habits coach now, a woman named Amy who had a horrible relationship with her ex and she started to use the time that her ex acted up as a way to pivot from an angry response and use that as an anchor to say, I'm going to respond compassionately.

Dr. BJ Fogg (26m 20s):
I am so glad you shared that, Bob, because that is a type of a tiny habit approach that we call Pearl habits. So Pearl habits is a subset of this broader technique that I call tiny habits, Pearl habits, you take something that's annoying and you turn it into something positive. I'll give a few quick examples. Then I'll give a real one from my life that has to do with an injury that I had. A quick example might be every time I hear someone else's phone ring, I'll take a deep breath and relax. Okay. Somebody else's phone ringing can be annoying, but you can turn it into a moment of relaxation. Every time my child complains, I will think how fortunate I am to be a parent of this child.

Dr. BJ Fogg (27m 6s):
Here's something that just happened to me. So I was surfing on a pretty big day around Christmastime and I made a bad decision on a really big wave and I got hurt. My board hit me. It didn't crack my ribs, but effectively it was that I was injured and hurt like crazy. So instead of letting that pain annoy me. So think of this as a grain of sand, you want to turn it into something beautiful, like a Pearl. So what I figured out in about a day or so, cause it was annoying me and I was thinking, Oh, poor me, I can't go surf, I'm going what's going on, and worried about it as well, instead I decided the Pearl habit was going to be this, after I feel the pain right here, I will focus on something that I'm able to do, that I'm still able to do that's important to me.

Dr. BJ Fogg (27m 60s):
So I took that pain and using the Pearl habits method, I had it propel my mind to identifying something that I'm still able to do, that it wasn't taken from me because of the accident. And Bob, that helped so much for me not to feel sorry for myself or worry or feel bad. I don't have a way to prove this, but I think it also helped me heal better.

Dr. Bob Goldberg (28m 25s):
My daughter is a clinical social worker and she uses different modalities. But she said to me, this is, this is a way of turning cognitive behavioral therapy into a way of orienting your life. And actually I think she's going to sign up for your coaching class. I hope other people do too, because she's found it to be so helpful, not just with usual anxieties and so on, but people who are really at the depths, you know, drug addiction or loss of a significant other. And I want again, everyone to read the book, but just to show you that this is a science-based, evidence-based approach that has been tested and retested, but it has had significant impact on people's lives beyond me just having a beautiful refrigerator.

Dr. Bob Goldberg (29m 11s):
Maybe we could talk a little bit about Linda who is now a coach and what that one little habit did for her life.

Dr. BJ Fogg (29m 19s):
Wow. Well, I know Linda really well. At the end of the book you find out ta-da - Linda's my sister, sorry, spoiler alert everybody. But wow, Linda has had so many challenges. I'm going to give one that's not in the book, Bob, and this is another Pearl habit. Linda has faced so many hardships in her life. She lost a son to an accidental drug overdose. Her daughter got leukemia when she was young. Another daughter is struggling with mental health issues. They were multimillionaires and lost everything. She lost her horse ranch. And then recently her husband got early onset Alzheimer's and that was a terrible journey and he did pass about a year ago.

Dr. BJ Fogg (30m 0s):
So Linda has certainly seen adversity and she found that the Maui habit in the morning where you get up and you say, it's going to be a great day, that was so helpful. In other aspects of tiny habits, she says, literally saved her life. She would have checked out of this life, off of this planet, had it not been for this method. And one use that she shared with me and this isn't in the book, this is more recent than the book, and this is when her husband was really fading fast and was in a memory care center, and she found herself resisting going. She intended to visit him every day, but it was so depressing to do so.

Dr. BJ Fogg (30m 40s):
And so she knew she had to change some things up. So one of the things she did was in the morning, instead of getting up and saying, it's going to be a great day, she would put her feet on the floor and she would say, I'm going to make it a great day for Brent. Brent is her husband. Because she knew for herself, it was not going to be a good day because of the troubles. So that helped. And then the other thing she did was she created this Pearl habit that after she got back in her car, in the parking lot after visiting her husband in the memory care center, so after I get back in the car, I will bow my head and give thanks for the people who are caring for my husband.

Dr. BJ Fogg (31m 22s):
So she would use that moment where she was, you know, upset, it's disturbing to see how he was declining, but she would use that moment to give thanks. And Bob, that shifted how she thought about those visits. So rather than part of her brain resisting it, or just, you know, trying to come up with some excuse because there is this sabotage that goes on, she found that shifted. And then she looked forward to those visits. She could handle them better, her interactions with the people there and with her husband shifted all because of this Pearl habit that she would do in just a few seconds of giving gratitude.

Dr. Bob Goldberg (31m 60s):
I wish we had more time, but your book is impactful. It's important on a number of levels. And it does remind me, I mean, Viktor Frankl, who was a Holocaust survivor, wrote Man's Search for Meaning. And I think he says something along the lines of the last human freedom is to choose one owns way. And what you've 've done with Tiny Habits in your work is you've allowed people to break down to not just make the choice, but figure out how to go their own way once that choice is made. So I want to thank you on behalf of me and thousands of others for the work that you've done and continued success in the years ahead.

Dr. BJ Fogg (32m 37s):
Thank you. You know, and I just want to wrap with a message of hope and you know, Linda, years ago we sat down and she helps teach Tiny Habits with me and she trains the coaches and so on. And when we sat down and said, okay, things are going great. You know, but what is it that we're really doing here? Yes. We're helping people create habits. Yes. We're giving people the skills of change. Yes. We're helping them feel positive emotions on a regular basis. But the number one thing, and we decided this years ago, and it was the right decision, Tiny Habits gives people hope by doing that method, they become more hopeful, they see evidence that they can change, so the hope isn't from like a motivational talk or hearing a beautiful piece of music or seeing a sunset.

Dr. BJ Fogg (33m 24s):
The hope in this case comes from seeing evidence you can change. And that tackles fear that tackles anxiety and your hope blossoms. And that really is what Tiny Habits is about. And with that, that has a broader, more sweeping impact in people's lives.

Terry Wilcox (33m 51s):
This episode of the Patients Rising Podcast is brought to you by Patients Rising Concierge, a new service from Patients Rising that helps patients and caregivers find the resources they need to find stability and support throughout their healthcare journey. From finding a professional advocate, to help with insurance challenges, to legal and tax counsel, to local caregiving resources and so much more, our team is standing by to help you navigate the healthcare system and connect you to the services you need to learn more, visit patientsrisingconcierge.org, or email us at askusanything@patientsrising.org.

Terry Wilcox (34m 34s):
Thank you for bringing us that interview, Dr. Bob. Up next, our Field Correspondent Kate Across America has an interview with a patient from the UK, so maybe we should say it's Kate Across the World. Here is Kate's interview with Jess Logan, about her diagnosis of Inflammatory Bowel Disease and long wait times to see a specialist who didn't even listen to her complaints. Take a listen.

Kate Pecora (35m 1s):
Today we're talking with Jess Logan. Jess lives in the UK, but I think that her story is really universal to something that all patients go through at one point or another. And that is the ability to be heard. Welcome, Jess.

Jess Logan (35m 13s):
Hi.

Kate Pecora (35m 14s):
So as I understand it, you're diagnosed with Inflammatory Bowel Disease and Ulcerative Colitis. Can you tell me a little bit about your story and what has led you to some additional diagnoses as of recent?

Jess Logan (35m 26s):
Yeah, of course. So in 2017, my previous diagnosis of Irritable Bowel Syndrome changed. So the symptoms are very similar, but they are completely different illnesses. So originally from my childhood, I lived with Irritable Bowel Syndrome. So I had chronic constipation. I wouldn't go to the toilet for up to two weeks. And then in April 2017, there seemed to be quite a drastic change in my bowel habits. So a new symptom was going on. I was having urgency, constantly went to the toilet, having accidents, and there was also blood and wiping. So I went straight to the doctors and went, look, my bowel habits have changed, can we please look into this?

Jess Logan (36m 8s):
So they were absolutely fantastic. They put me forward for the tests that I needed, blood tests and stool samples. Then my tests came back. So my bloods were fine, but my stool sample was meant to be not 50, and it came back as 2046, so it was severely inflamed. At that point, they put me forward to a specialist, a gastroenterologist, and I don't know if it's the same in America, but in the UK, the waiting lists are quite long. So I was put in that nice little waiting list, not little but long. And it was a waiting game. So well the months were going by, by the time it got to June and it had progressed again, and my doctors pushed me for an urgent referral.

Jess Logan (36m 51s):
So within the same week I got referred and my GI saw me. So the gastroenterologist started asking questions, but the questions kept him going back to my IBS and I knew it wasn't my IBS, but they kept on referring back to more constipation, they didn't look at my new symptoms. They didn't discuss that in detail. And they didn't even look at my test of 2046. So it seemed like they were blanking all my new stuff off and still focusing on what was happening in the past, which wasn't happening anymore. So I felt like I was being ignored. I felt like they thought I was imagining all this stuff happening, but there was blood in the toilet. There was clear evidence that something was going on.

Jess Logan (37m 33s):
However, they put me forward, they went, okay, we'll do some scopes for you, but you'll be put on the waiting list, the waiting list for the colonoscopy in the UK is up to three months, so I was put on that waiting list, and by July, my symptoms had gotten really severe so I was going to the toilet 30 times a day. It was just blood. There was no feces so I couldn't empty my bowels and I got to the point where it was affecting my other health as well at that point so I was struggling to get out of bed. I was basically fighting a battle with my body because it was fighting what was happening inside.

Jess Logan (38m 14s):
So I got to the point where I was forced to go into the hospital. My parents were like, you need to take yourself in. I was on the toilet, crying out in pain. I couldn't handle any more if I'm honest. So I had to take that drastic measure of going into AME. But at that point I was forced to. So at that point I felt relief because the doctors in AME were listening to me. They were adamant that it was inflammatory bowel disease, looking at my past my history within those three months looking at my tests. So they started me on treatment without even getting a diagnosis. So I started on a high dose and treatment that's linked with inflammatory bowel disease.

Jess Logan (38m 57s):
At that point, it was over the weekend, I had to wait for my scope but as soon as I had my scope, I received my diagnosis, which felt like a weight off my shoulders because I had waited from April until that point. I had finally a diagnosis and that diagnosis was acute severe ulcerative colitis. The reason they cast it as acute was that it was so sudden that my symptoms started in April to how severe it was up to that day. At that time, it was my whole colon and my rectum. And they knew how severe it was so I was treated as an urgent case at that point. So they put me on infliximab, which is one of the highest drugs that they use for inflammatory bowel disease.

Jess Logan (39m 41s):
So it's an immunosuppressant. I started that on Wednesday the 19th, and on the Friday, I was then told that I needed emergency stoma surgery because my symptoms weren't getting any better and there was a chance that I could die anytime soon. It was a waiting game. At any point, my bowel could perforate and they didn't want that stage to happen, so it was life or death. So as you can imagine, being 25 years old to hear that, I was, I can't even explain what I was like. I was an emotional mess over the weekend, basically. And then it came to Tuesday and I went down for my surgery. So I had to have more colon removed and a stoma put in place.

Jess Logan (40m 25s):
So at that point I felt butchered. I felt butchered by my gastroenterologist. I kept thinking if he had listened to me back in, even in April, when I was originally referred, if he had listened to me then would the scenario have been different?

Kate Pecora (40m 41s):
So it sounds like because your GI wasn't really listening to you, they actually ended up making things a lot worse and you suffered because of that, this sort of disregarding, it's very common among patient populations, especially those who do have more complex cases. That being said, you know, you were presenting symptoms that were sort of just being disregarded. How has that instant sort of impacted your life since 2017 when all of this happened?

Jess Logan (41m 6s):
So I've now had four surgeries in total. I am someone called a J pouch. So I don't have a stoma anymore. I haven't had a stoma for over a year and that caused a lot of complications. So I had a lot of bowel obstructions. I was in and out of hospital to have an emergency surgery as my bowel had twisted. So it was just like a roller coaster journey that whole year. So it wasn't just a simple fix, I was in and out. I had blood transfusions and I had a really severe case of food poisoning but it caused kidney damage because I couldn't keep fluids down and because I didn't have my colon anymore, it caused it to become so severe so it was in hospital for a week with that so it wasn't just a simple fix.

Jess Logan (41m 52s):
It caused other issues because of not having your colon, you don't absorb as well.

Kate Pecora (41m 57s):
And so since all of these complications and the additional, you know, diagnoses of chronic fatigue syndrome, you have still led a really active lifestyle, right, and so one of the things that I think people might not know about you just seeing you and actually just hearing your diagnosis is that you actually participate in a lot of pageants for charity in the UK. So I want to ask about what your motivation was for doing this and putting yourself out there like that. I think, you know, a lot of people might say it's more brave to be able to do that when you have something like a J pouch, something that, you know, plenty of people probably don't come in contact with every day and it can be a very vulnerable situation. So why did you do that? And have you enjoyed it since then?

Jess Logan (42m 38s):
So I absolutely love pagentry, so a lot of people who come in, they, they know I'm not a girly girl, so I don't wear makeup all the time, but we like to get glammed up every now and then those girls, even if we're boyish, we do like to get a bit of a glamour, but that wasn't why we were doing this. So for me, the pageant is a really good platform to raise awareness. So I know they're really big in America and they are getting bigger in the UK, and to me, I feel it's the most diverse industry in the beauty industry. So they accept people of all shapes and sizes. They accept all races, they accept all disabilities. There is inclusion there, and that's what I wanted to be a part of.

Jess Logan (43m 21s):
And for me, I wanted to show all these young girls or even people my age and older, that your journey doesn't have to define you, that you can still make a difference. Yes, my illnesses create challenges every day and yes, there will be days where I have to let people down and I can't go ahead, but on my good days, that is when we have to focus on being the best version of us and that's what I've done with pageants. They've helped me build my confidence again, because having a stoma for a year really affected me because you wake up every day with a bag attached to your stomach. You don't poo normally, you have leaks, you have all these added pressures with a stoma bag.

Jess Logan (44m 5s):
And I did lose my confidence after surgery, but pageants have helped me gain that confidence back and even more. So I feel more accepted than I ever was. I now have body confidence, which I don't think I ever had pre-surgery and pageants have helped me gain that because you get on that stage and no matter how daunting it is to before you get on that stage, as soon as you're on that stage, you feel on top of the world, you hear all the cheers and you feel accepted finally, and you know that you are beautiful because you've got all these cheers from other powerful women that you feel powerful.

Kate Pecora (44m 44s):
Could you talk about some of the messages that you've tried to raise from this type of work?

Jess Logan (44m 49s):
Yes. So for me, the one thing I think I really struggled with after my surgery was going into disabled toilets and walking out and getting that judgment, whether it was them actually raising their word or whether it was just a look, I walked out feeling I suppose, embarrassed because they didn't think that I had that right to use the toilet, but I did. At first I was angry and upset, but then I realized there was a lack of education out there. So for invisible illnesses in the UK, that is 80% of disabilities but it's always wheelchair symbols, walking sticks symbols that symbolize a disability, but 80% of disabilities are invisible.

Jess Logan (45m 40s):
And I wanted that to be represented. I felt that there was a lack of education around the invisible ones, even autism. A lot of people get judged on that. So I felt like although disabilities were represented, the invisible ones weren't being represented. And it was so important that there had to be a message around that. So I created these images to try and symbolize what people were hiding underneath their clothing. So it could be heart disease. It could be anything. There's so many of them that I wanted to be the voice of averse. So I don't mind talking about my illnesses, but I know other people do, and that's fine.

Jess Logan (46m 23s):
You can be comfortable, you can be uncomfortable, but I wanted to be the voice of everyone. If I could, then why not? And I started then to create all these different projects. So I actually run my own pageant. And that's for people with invisible illnesses and disabilities that raises money for charity. At the same time, I have merchandise which have these images on to highlight them. I've got posters, which are being used locally. And I'm hoping when COVID settles, that can be spread across the world. And we're working together by all these people that are trying to raise awareness. We're raising a voice for those that are too afraid to.

Terry Wilcox (47m 8s):
Thank you, Kate. And thank you so much, Jess, for sharing your story. Jess has founded an advocacy organization in the UK called Making the Invisible Visible, and you can learn more by heading to the links in the show notes.

Dr. Bob Goldberg (47m 21s):
If there is a healthcare policy or policy issue impacting your loved one, we want to hear about it. Just send an email to me andTerry at podcast@patientsrising.org that is podcast@patientsrising.org.

Terry Wilcox (47m 35s):
Thank you so much for joining us for today's episode. We know your time is valuable and we certainly appreciate your support. And we want to know what you, yes you, think about the show and make sure we are bringing you the information you want to hear. So if you would please take a few seconds to leave us a rating and a review on Apple podcast or send Bob and me an email. We would love to hear from you.

Dr. Bob Goldberg (47m 58s):
That's right, Terry, and while you're there, don't forget to hit the subscribe or follow button. Please know, as always Patients Rising podcast is always free and you'll get the latest episodes delivered straight to your phone each and every Friday.

Terry Wilcox (48m 13s):
We'll be right back here again next week with another new episode. Until then, for Dr. Bob and everyone at Patients Rising, I'm Terry Wilcox, keep your distance and stay healthy.