Page 37 of 47
On April 24, 2023, Eva M. Krochow, Ph.D. in Psychology Today, presented an article titled “What’s Your Locus of Control—and Why Does It Matter? Link is here: Her summary is as follows:
- People with an internal locus of control feel they are in charge of their destiny.
- People with an external locus of control perceive themselves as subjects to external forces.
- An internal locus of control is linked to higher levels of well-being and life success.
- Simple tools such as mindfulness and yoga could help to boost a sense of control.
By no stretch of the imagination, I concluded that the concept of Locus of Control should apply at least equally to those of us on Dialysis. This being so, I fired up my ChatGPT4 account with the following results. I first provided the Prompt I authored, followed by an edited version, mainly results from my Grammarly Ai. The lead graphic was generated in Bing Illustrator.
Prompt: Consider the concept of locus of control. Write an 800–1000-word blog entry about the concept as applies to patients on peritoneal dialysis.
The concept of “locus of control,” a psychological construct developed by Julian B. Rotter in the 1950s, refers to an individual’s perception of the underlying main causes of events in life. It’s about where you believe the control of your life rests – either within yourself (internal locus of control) or outside of yourself (external locus of control). This concept holds profound implications in the healthcare sector, especially in patients undergoing peritoneal dialysis (PD).
Peritoneal dialysis, a home-based treatment for kidney failure, requires patients to take an active role in their treatment. They are responsible for administering their dialysis treatments, monitoring their health, and managing potential complications. Consequently, their locus of control can significantly impact their treatment outcomes and overall quality of life.
Those with a strong internal locus of control believe that their actions and decisions significantly influence the outcomes in their life. They are more likely to feel empowered and take responsibility for managing their health. In the context of PD, these patients are typically proactive in learning about their treatment, consistent with their dialysis schedule, and vigilant in maintaining hygiene standards to prevent infections. By believing they can influence their health outcomes, they often show better treatment adherence, experience fewer complications, and report higher satisfaction levels.
On the other hand, patients with a strong external locus of control may believe that their health outcomes are primarily driven by factors beyond their control, such as luck, fate, or the competence of their healthcare team. These patients might feel less empowered, struggle with self-management tasks, and exhibit lower treatment adherence. They might be more prone to anxiety or depression, which can further hinder their ability to manage their treatment effectively.
Understanding a patient’s locus of control can aid healthcare providers in delivering personalized, effective care. For instance, patients with an external locus of control may benefit from additional support and encouragement to boost their confidence in self-care. They might need more education about the impact of their actions on their health outcomes and more regular check-ins from healthcare providers.
Meanwhile, patients with a strong internal locus of control, while generally more proactive, might risk overconfidence, neglecting to seek help when necessary. Healthcare providers must ensure these patients understand that while their self-management is crucial, seeking professional help when complications arise is equally important.
Technology also plays a pivotal role in supporting patients’ locus of control. Technological advancements in PD equipment, such as user-friendly interfaces and remote monitoring capabilities, can reinforce a sense of control and confidence in patients, reducing their dependence on healthcare providers. Simultaneously, healthcare providers can monitor patients’ health and intervene promptly, offering a safety net that can reassure all patients, regardless of their locus of control.
However, the concept of locus of control isn’t a one-size-fits-all approach. It’s crucial to respect each patient’s beliefs and feelings and consider them part of a holistic treatment approach. Some patients may prefer a more hands-on approach, while others may need more support from their healthcare team. A balance between promoting self-management and providing professional support is key to optimizing patient outcomes.
In conclusion, understanding and addressing the locus of control in peritoneal dialysis patients can have profound implications for treatment outcomes and patient satisfaction. By tailoring support based on each patient’s locus of control, healthcare providers can empower patients, promote optimal self-management, and improve overall quality of life. It’s a step towards a more personalized, patient-centered model of care that acknowledges the power of the mind in health and healing.
The Good, the Bad, and the Ugly was a 1966 spaghetti western starring Clint Eastwood that is generally accepted to be one of the best films ever produced. It made his career and others too.
Today’s popular culture embodies the film’s title as an idiomatic expression typically used when describing something thoroughly. That is, the upsides or good, downsides or bad, and that which could have or should have been done better, the ugly. In this context, I pen the following about my Dialysis Journey thus far, having started on 9/30/2022.
| GOOD | BAD | UGLY |
| I’m here | Changing habits | Cycler alarms |
| Fresenius stock | Social life | Fresenius Tech Support |
| Met nice people | TV schedule | Sleep |
| Supportive team | Glucose, weight | Fainting |
| Takes a village | Medical meetings | No end in sight |
| Supplies | ||
| Lack of info on new cycler |
Good:
- I’m here. However you dice and slice it, dialysis is life-supporting. Without it, I would be long gone. It is working, and for that, I am thankful.
- Fresenius Stock. In support of the company providing me with life-sustaining services, I chose to invest modestly in their stock at a 500-share level. On 1/20/2023, I bought these shares at $18.26 per share, for a total of $9,132.50. Today (5/10/2023), the shares are trading at $24.46 for a total gain of $3,097.50. To a degree, as the company goes, I go. I’m going OK.
- Met nice people & Supportive team: Along the way of my dialysis journey, I have met a host of people, both in and out of the medical profession, that have treated me exceptionally well. I appreciate this most and hope I can live up to their expectations. In particular, I am very adorable and impressed with the sincere care and treatment provided by my Dialysis Team. They are always there, almost like Big Brother but in a supportive role which I deeply appreciate.
- Takes a village. This statement is derived from an African proverb that means an entire community of people must interact with children for those children to grow in a safe and healthy environment. Recently when talking normally with a neighbor in front of our home, I went down with Orthostatic Hypotension. Seemingly in a matter of seconds, his wife was beside me, and a few seconds later, neighbors were there attending to me, and my wife was called. In all, at least eight people were attending to my needs, including calling the EMS and exporting me to our home. In my neighborhood, there are many angels watching over me, for which I am grateful. It’s a good thing in my case.
The Bad:
- Changing habits. The critical need for dialysis had the greatest impact on my daily life, what I could do, when, and how. I am tied to the schedule of the dialysis requirement rather than my environment. This has impacted when I go to bed, how I sleep when there, when I get up, what and when I eat, where I go, and what I do and can do once I get there; everything. It is a massive behavioral change that no amount of classroom effort will prepare you for.
- Social life. I am on Peritoneal Dialysis and have a BMW X5 SUV. I could load up the X5 with dialysis gear and travel to just about any place in the US I wanted to for up to several weeks duration without needing to stock up with dialysis disposables. This is but one aspect. I find that I cannot make rather early-in-the-day appointments without seriously curtailing or rescheduling my dialysis treatments. Same thing later in the day. If we go out with family for dinner and stay too late, I run into the fixed and firm requirement to get on the Cycler or pay the piper the next morning by having to stay on it longer. It is a very unforgiving schedule that is unbudging and intractable.
- TV schedule. This may sound trite, odd, and even funny, but having to be on the Cycler by 09-9:30 PM to get up at a reasonable hour in the morning curtains TV watching in the evening. Luckily we stream everything and can start to watch a show, stop it, and continue the next evening. Still cuts into our family time in the evenings.
- Glucose, weight. We, I say we because the following involves my dialysis team also, are looking for the sweet spot in the strength of my dialysate. The effort involves a balance between acceptable swelling of the feet, hands, and face (edema), and the strength (for me, a 1.5 or 2.5 dialysate) to remove fluid during dialysis. A confounding variable is that as the sugar content of the dialysate goes up and bodily fluid content increases, my glucose readings do also leading me to increase my insulin intake. So we have a critical balancing act between dialysate strength to pull out enough fluid to keep edema in check versus glucose and retention. Compound this with if fluids get to be too low, blood pressure goes down, leading to fainting because of orthostatic hypotension. These three variables interact and cannot be captured in a linear equation, differential or not. It is a little bit of this, a little bit of that, to see what works. Today at least.
- Medical meetings. I attempt to keep up with my lab results and, in general, my health state in preparation for my monthly meetings with my dialysis team, but try as I might, I seem to miss the boat. What they are concerned about, or not, don’t jump out at me as problematic. What I question at the meetings from my research as being potentially problematic are, in general, glossed over. To some extent, I feel like a third wheel—an object for scientific inquiry at best.
- Supplies. On at least two occasions, I have received monthly supplies from Fresenius that I am positive I did not order. I’m talking multiple boxes of dialysate. While Fresenius, for me, has done a great job giving us a heads-up on delivery, and ordering has been straightforward using the Patient Hub app, the process still is manual and cumbersome. With all the data available via the Cycler, seems automation or at least a recommended list of supplies should be generated in this information age of advancing artificial intelligence.
- Lack of info on new cycler. In April 2022, over a year ago, Fresenius announced the release of a new cycler, the VersiPD, to replace the existing Liberty Cycler. Here we are, over a year later, and nada, zip, zero. Here’s what they said it would provide: “Designed from the ground-up (sic) to enhance the patient experience, VersiPD will allow patients to enjoy restful sleep through its almost silent operation, fewer disruptive alarms, and night mode. The cycler has the capability of more personalized prescription programming to meet the individual needs of a broad range of patients. VersiPD offers a large, intuitively designed touchscreen, as well as embedded videos with audio guidance to assist patients step by step through setup and treatment. The cycler battery and custom cart facilitate mobility around the home, which can further improve a patient’s quality of life.” We’re still waiting, and waiting, and waiting????
Ugly:
- Cycler alarms. I have reported extensively on the excessive amount of drain alarms the Fresenius Liberty Cycler throws off. You can reliably count on alarms 3/4 of every night. Unsat!
- Fresenius Tech Support. As previously reported herein, Fresenius Tech Support is an oxymoron in terminology. I have spoken with them on three occasions concerning drain alarms. Their last solution is to turn the alarms off. They are no “support” whatsoever and distract from an otherwise mutually beneficial relationship with their parent company.
- Sleep. The impact of dialysis on sleep is multifactored. I have had to adjust my sleep schedule, my sleep positions, my sleep regularity, my sleep patterns, my sleep awareness to drain alarms, my concern for alarms bothering my wife, and so on. This is one of the areas most affected by dialysis.
- Fainting. As previously mentioned, I have experienced low blood pressure and fainting while on both hemo and PD. It is not a fun experience and should be avoided at all costs. It is impactful in many ways. My wife has, since my single episode while on PD, taken to walking with me on my morning walk with our Golden Retriever Dickens. I bought her an electric bike for Christmas. Recently I purchased one for myself so I could accompany her on rides in the Plantation where we live. She has nixed this, hopefully for the time being, while I “prove” my stability and lack of fainting so she feels safe in my ability to ride the bike.
- No end in sight. You can say there is an end if I applied for and was accepted for a kidney transplant. I’m still on the fence. I have not been able to reconcile that at my age, 84, someone else could better employ the scarce asset of transplantable kidneys.
It is important to recognize that each patient’s experience with dialysis can be unique and should be assessed on an individual basis.
That being said, there are several attributes that are commonly associated with military training that could potentially be beneficial for dialysis patients. For example:
- Discipline: Military training emphasizes discipline, which can be helpful for patients who need to follow strict dietary and fluid intake guidelines while on dialysis.
- Resilience: Military training often requires soldiers to push through physical and mental challenges, which can be beneficial for dialysis patients who may experience fatigue, discomfort, or other side effects of the treatment.
- Attention to detail: Military training emphasizes attention to detail and following protocols, which can be helpful for patients who need to adhere to specific medication regimens or take other precautions while on dialysis.
- Teamwork: Military training often requires soldiers to work together as a team, which can be beneficial for dialysis patients who may need support from family members, caregivers, or healthcare professionals.
Let’s look in more depth at the second item above, resilience. A dictionary definition is a capacity to withstand or to recover quickly from difficulties, or toughness. Further, resilience is the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands. Isn’t that what’s going on and how Dialysis impacts all of us? We need a degree of resilience to be successfully engaged in dialysis, FOREVER!
US Navy SEALs adhere to the 40% Rule initially compounded by a SEAL named David Goggins. The 40% rule is simple: When your mind is telling you that you’re done, that you’re exhausted, that you cannot possibly go any further, you’re only actually 40% done. Since Dialysis is “never done” for many of us, mentally grab ahold of the 40% Rule for yourself. Internalize it. Make it yours.
Never ring the bell.
This is the last in a series of blog posts in which the US Navy’s SEAL Community’s various creeds, ethos, and codes were used as inspiration for those on Dialysis. I personally draw on their inspirational grit daily in my own dialysis life. It is my guiding light that others may also profit. See the video/ode below. Attribution: I was aided by ChatGPT4, Grammarly, and Pictory.AI in the authorship of the video.
Once upon a time, in a small coastal town in California, there lived a man with a spirit as fierce as the sea. His name was Mark “Wavebreaker” Johnson, a 100% disabled US Navy SEAL who had faced the harshest battles and emerged as a living testament to the resilience of the human spirit.
Despite the challenges that life had thrown at him, Mark lived by the SEAL credo and code, which served as a guiding light through his darkest hours. He was a man of incredible strength and determination, and even though his body had been ravaged by war, his heart and soul remained indomitable.
Mark’s days were spent in solitude at his quaint seaside cottage, where he tended to his peritoneal dialysis treatments with the same precision and discipline as he had once wielded in the field. He relied on the strict regimen to keep him alive, but it was the memories of his brothers-in-arms and the SEAL code that truly sustained him.
As the sun dipped below the horizon, Mark would often sit on his porch, gazing out at the vast ocean before him. The waves that crashed against the shore were a reminder of the power and fury of the sea, a force that had shaped him into the man he was today. He would recite the SEAL credo under his breath, allowing the words to wash over him like the tide: “I will never quit. I persevere and thrive on adversity.”
In the small coastal town, Mark was known as a humble and unassuming man, always ready to lend a hand to those in need. His neighbors respected him not only for his service to the country but also for his genuine kindness and willingness to help others without seeking anything in return.
One day, while Mark was walking along the shoreline, he encountered a young boy named Timmy who was struggling to carry a large piece of driftwood back to his home. Mark could see the determination in the boy’s eyes, and it reminded him of the fierce spirit that had carried him through his own hardships.
Without hesitation, Mark approached Timmy and offered his assistance. Together, they carried the driftwood to the boy’s home, and Mark shared stories of his time as a Navy SEAL, emphasizing the importance of the SEAL credo and code. Timmy listened intently, his eyes filled with admiration and curiosity.
As the weeks turned into months, Mark and Timmy grew closer. They spent their days exploring the beach, collecting shells, and discussing life. Mark taught Timmy the values of honor, loyalty, and perseverance, and in turn, Timmy reminded Mark that even in the face of adversity, one could find joy and purpose.
Through their friendship, Mark found a renewed sense of purpose and meaning in his life. Although his body remained weakened, his spirit remained unbroken. Mark knew that his days on this earth were limited, but he continued to live each day with the unwavering determination and courage that had defined him as a Navy SEAL.
The years passed, and Mark’s health continued to decline. Yet, even as his body betrayed him, his spirit remained strong, and his friendship with Timmy grew. Eventually, Mark passed away, leaving a legacy of courage, strength, and unwavering determination.
Timmy, forever changed by Mark’s wisdom and friendship, honored his memory by joining the Navy and eventually becoming a SEAL. As he embarked on his journey, he carried the lessons he had learned from Mark with him, determined to uphold the SEAL credo and code as a tribute to the man who had taught him so much.
Ultimately, Mark “Wavebreaker” Johnson’s story is one of courage, resilience, and the power of friendship. His life had been shaped by the unforgiving forces of the ocean and the battles he had fought, but it was his humble nature and unwavering spirit that defined him. The SEAL credo and code served as his compass through the stormy seas of life, guiding him toward the light of hope even when the waves threatened to engulf him.
As the years went by, Timmy grew into a strong and courageous Navy SEAL. He carried the memory of Mark with him on every mission, drawing strength from the wisdom and lessons his friend had imparted to him. Through Timmy, Mark’s legacy lived on, and his spirit continued to inspire a new generation of warriors who embodied the values of the SEAL credo and code.
The small coastal town never forgot Mark “Wavebreaker” Johnson, the humble hero who had once walked their shores. In his honor, a monument was erected by the beach, depicting Mark’s determined gaze, forever looking out at the ocean that had shaped him.
In the hearts of those who knew him and in the actions of those he inspired, Mark’s memory lives on, a testament to the indomitable spirit of a true Navy SEAL. His story serves as a reminder that even when life’s storms batter the shores of one’s soul, it is possible to rise above, persevere, and find meaning in the face of adversity.
And so, the legacy of Mark “Wavebreaker” Johnson continues, etched into the sands of time like the waves that had shaped him, a humble hero whose spirit and determination would never be forgotten.
The TAKEAWAY from this story for us on Dialysis is NEVER RING THE BELL!!
Attribution: This story was written with encouragement from ChatGPT4, guidance by Grammarly, and insights from me. The lead picture is of a US Navy SEAL surfing on a submarine. He got into lots of trouble for this “feat.”
The embedded video above, made with the assistance of ChatGPT4 and Pictory.AI, captures the essence of the USNavy SEAL’s code of “leaving no man behind” as applies to those of us on Dialysis.
- Communication: Communication is key in any relationship. Be open and honest with her, and listen actively when she speaks. Express your feelings and emotions clearly and respectfully, and encourage her to do the same.
- Respect: Show her respect and treat her as an equal partner in the relationship. Respect her opinions, values, and boundaries.
- Affection: Show her affection in ways that are meaningful to her. This can include physical touch, verbal affirmations, and acts of kindness.
- Support: Be supportive of her goals and aspirations, and encourage her to pursue them. Offer emotional and practical support whenever she needs it.
- Quality time: Spend quality time together doing activities that you both enjoy. This can help strengthen your bond and deepen your connection.
Remember that love is a journey, and it requires effort and commitment from both partners. The best way to love a woman is to be attentive, caring, and willing to work together to build a strong and healthy relationship.
The Fresenius Liberty Cycler is the machine I use to conduct Peritoneal Dialysis EVERY night. In general, although noisy in its operation, it gets the job done. EXCEPT the other 75% of the time when it wakes me out of a sound sleep to tend to drain alarms. By getting out of bed and standing upright, the alarms may mitigate to the point that eventually, I can go back to bed and sleep for another two hours until my sleep is interrupted again. And on and on.
This has been going on for months and months with no resolution on the horizon.
None of the common tactics to alleviate this situation work so according to Fresenius Tech Support, I’m stuck with it. No help there. No Cycler replacement. No love. Just live with it.
I’v gotten to the point where it’s almost laughable. I have been reading about ChatGPT’s ability to write stories, so I thought I would put it to the test to write a story based on my situation. I wrote the following Prompt and submitted it to my ChatGPT3.5 subscription with the following story. Concluding remarks are at the end.
Prompt: Write a 500-word or so fictitious story about a science fiction realm where a patient on dialysis battles with his Fresenius Liberty cycler over alarms.
ChatGPT
In the distant future, medical technology has advanced to the point where people suffering from chronic kidney disease are able to undergo dialysis from the comfort of their own homes. The Fresenius Liberty cycler is the latest in a line of cutting-edge dialysis machines that have made this possible. However, for one patient, the Liberty Cycler has become the source of constant frustration and anxiety. (That’s me for certain, and a host of others!)
Jared had been on dialysis for years, and the Liberty Cycler had been a lifesaver for him. But as time went on, he found himself becoming increasingly annoyed by the constant beeping and flashing lights that seemed to accompany every dialysis session. The cycler was designed to alert patients to any issues or abnormalities during treatment, but for Jared, it seemed like every session was plagued with false alarms.
At first, he tried to ignore it. He would grit his teeth and try to tune out the beeps and blips that filled the room as the cycler worked its magic. But over time, it became harder and harder to ignore. The beeping grew louder and more insistent, and the flashing lights seemed to pierce his eyes like lasers.
Jared became obsessed with the alarms. He would spend hours poring over the manual, trying to figure out what was causing them. He experimented with different dialysis settings, adjusted his position on the bed, and even tried to meditate his way through the beeps and blips. But nothing worked.
As time went on, Jared began to feel like he was battling the Liberty Cycler itself. He would glare at the machine as it beeped and blinked as if daring it to give him another false alarm. He became convinced that the cycler was out to get him, that it was deliberately trying to drive him crazy.
And then, one day, something snapped. Jared had just settled in for a dialysis session when the alarms began to sound. As usual, he tried to ignore them at first, but they only grew louder and more insistent. He leaped out of bed and rushed over to the cycler, determined to silence it once and for all.
But as he approached the machine, something strange happened. The beeping and blinking seemed to grow more intense, almost as if the cycler was angry at him for trying to shut it down. And then, without warning, the machine sprang to life.
Jared watched in horror as the cycler’s various arms and hoses began to flail wildly, almost as if they had a mind of their own. The beeping and blinking grew even more intense, and Jared felt like he was caught in the middle of a storm.
He tried to fight back, but the cycler was too powerful. Its arms and hoses wrapped around him like tentacles, squeezing the breath out of his body. The alarms blared in his ears, drowning out all other sounds.
And then, just as suddenly as it had started, it was over. The cycler went still, its arms and hoses dropping away from Jared’s body. The alarms fell silent, and Jared was left gasping for breath on the floor.
For a long moment, he lay there, staring up at the ceiling in shock. And then he started to laugh. He laughed and laughed until tears streamed down his face. He knew it was crazy, but he couldn’t help feeling like he had just fought a battle with the Liberty Cycler and come out victorious.
From that day on, things were different. The alarms still sounded, but Jared was no longer afraid of them. He had faced his fear head-on and emerged stronger for it. And although he would never forget that fateful dialysis session, he knew he would always be able to face whatever challenges came his way.
Closing Remarks: Back from the realm of fiction to the here and now. My Liberty Cycler and I are NOT on speaking terms; at least 75% of the time, I am awakened from a sound sleep to tend to the needs of the Cycler. It has a life of its own and, as such, takes precedence over mine. It requires me to tend to it while I hope and pray it will tend to me. And the world is worried and concerned about Artificial Intelligence and their livelihood. I wish beyond wishing that the Liberty Cycler and the people concerned with its deployment had some modicum of AI themselves. Any “Intelligence” in this area would be a breath of fresh air, which is totally lacking at this point!
The lead picture was created by Microsoft’s Bing using the prompt: Using the Fresenius Liberty Cycler as a basis, create a creature with hoses and pipes and sounds coming out of it
I am constantly on the lookout for new tools to use in editing this blog’s content. The use of AI is very much in the news now, and AI tools to provide video content are at the head of the pack. I use Pictory.ai to make many of the videos for the blog. I use Grammarly to assist in my editing. I use ChatGPT for ideas and content. I use text to pictures, and illustrations for some of the graphics. AI makes life much easier for bloggers such as myself.
Recently I tried out a newcomer – to me at least – named WiseCut. You provide an mp4 video, and it does all kinds of wonderful things to the provided video, like take out pauses, provide audio-to-text overlays, background music, and other purported magic. It does not work for me. It is sluggish, slow, and does not faithfully transcribe audio to text. Granted, you can go through and clean up the text, but Pictory.ai does a much better job. Rendering is slow. It’s just slow. I was running the free version, which might have something to do with this but…. The video output from WiseCut is embedded below — you can see for yourself what AI video editing can do. I’ve included a screenshot of what WiseCut purported to have done to my source video.
