1	RENAL REPLACEMENT THERAPIES KEEPING PACE WITH CHANGE.
2	LIVING WITH THE FEAR OF THE UNEXPLODED. Most people become angry, depressed, frustrated, with the demands of treatment, but are also worried about the ongoing quality of life during dialysis. Will it ever be the same again?
3	THE WAY WE WERE, BABS. People often expect life to return to the way it was before they were diagnosed with renal disease. This rarely happens.
4	I HAVE SEEN IT WITH MINE OWN EYES! Why? Because others may think of you, or you may think of yourself, as somehow being different, as having been changed by the experience. And indeed you have. Transmogrification!
5	SOMETHING HAPPENED WHEN I WASN’T LOOKING. Those who have experienced treatment and its aftermath describe the first few months as a time of change, often profound change. It is not so much "getting back to normal" as it is accepting the new reality.
6	THEY BECOME ANXIOUS AND / OR DEPRESSED ANXIETY IS THE SAME AS FEAR, BUT UNATTACHED! I.E. YOUR BODY IS TELLING YOU TO BE AFRAID, BUT OF WHAT IS UNCLEAR.
7	DEPRESSION IS FAMILIAR TO EVERYONE. Depressed mood. Can’t enjoy the usual things. Unplanned weight loss / gain. Insomnia / hypersomnia. Can’t learn, concentrate, remember. Psychomotor agitation or retardation. Feelings of worthlessness / guilt. Recurrent thoughts of death.
8	AND SO IT ALL CHANGES, THERE IS A SHIFT TO A DIFFERENT WAY OF BEING, THINGS HAVE TO BE THOUGHT OF IN A DIFFERENT WAY. LIVING IN A NEW DIMENSION.
9	DISEASE CENTRED LIVING THE CONDITION, ITS TREATMENT, FOLLOW UP, AND ONGOING AWARENESS SEEM TO DEFINE AND DICTATE LIFE.
10	WHY ME? GREAT OPPORTUNITY TO GET ANGRY, BLAME SELF, BLAME OTHERS, JUST WHY DO YOU THINK YOU GOT ILL? WHAT IS YOUR THEORY, EXPLANATION OR BELIEFS ABOUT YOUR CONDITION?
11	DISEASE MODEL. THE DISEASE MODEL IS A SHORTHAND WAY OF SAYING “HERE IS MY BELIEF, MY HYPOTHESIS AS TO YOUR PHYSICAL STATE”. IT DESCRIBES THE FAILURE OF A BODILY ORGAN OR SYSTEM.
12	THE ILLNESS MODEL THE ILLNESS EXPERIENCE MAY NOT HAVE ITS ORIGINS IN THE FAILURE OF A BODILY ORGAN OR SYSTEM, BUT IN OTHER SYSTEMS, SUCH AS :-
13	Sources of Illness. SOCIAL SYSTEMS: Limited opportunity, poverty, unemployment. WORK SYSTEMS: Shift work, overtime, stress, etc. FINANCIAL SYSTEMS: Debt, low wages, mortgages, overdrafts, etc RELATIONSHIPS: Marriage, divorce, family, etc. EXISTENTIAL DILEMMAS: Meaningless life, retirement, growing old, etc. THE EXPERIENCE OF THE DISEASE, IS THE ILLNESS.
14	ILLNESS MODEL. THE CLINICAL DIAGNOSIS, I.E. THE DISEASE, IS NOT THE ILLNESS EXPERIENCE. THE EXPERIENCE OF THE DISEASE, IS THE ILLNESS. THE TWO MODELS ARE NOT IN COMPETITION BUT COMPLIMENTARY, THEY ARE NOT MUTUALLY EXCLUSIVE.
15	I REPEAT. ILLNESS IS THE EXPERIENCE OF THE DISEASE, AND IS INDIVIDUAL AND UNIQUE TO THAT INDIVIDUAL.
16	THE ILLNESS MODEL takes in factors such as: Age, Gender, Emotional reaction, Psychological state, Cultural norms, Spiritual / religious beliefs,
17	And such as:- Social situation, Level of education, Impact on lifestyle, Person’s theory about the disease, Alternative treatments, etc.
18	NO TWO PEOPLE EXPERIENCE A SERIOUS DIAGNOSIS IN THE SAME WAY. A PERSON’S ILLNESS IS THEIR EXPERIENCE OF THE DISEASE, AND WHATEVER THAT EXPERIENCE IS, IT IS VALID. i.e. the expert on the person, is the person!
19	THE NEXT STEP. THE LONGEST JOURNEY BEGINS WITH THE FIRST STEP. LET’S GET ON WITH IT. OTHERWISE YOU MIGHT GET LEFT BEHIND AND YOU HAVE LOST ENOUGH TIME ALREADY.
20	WHAT TO DO? DEVELOP A WELLNESS PLAN MAKING CHANGES IN THE WAY YOU EAT, EXERCISE, AND LIVE YOUR LIFE DOES IMPROVE QUALITY OF LIFE AND A SENSE OF BEING IN CONTROL.
21	IF ITS NOT ONE THING IT IS ANOTHER. MAKING CHANGES AND LOOKING AFTER YOURSELF CAN HELP YOU FEEL BETTER AND MAY ALSO LOWER THE CHANCES OF DEVELOPING OTHER HEALTH PROBLEMS. (PEOPLE WHO HAVE KIDNEY DISEASE DO DIE OF OTHER THINGS, YOU KNOW.)
22	QUIT SMOKING. IT DOES NOT MAKE SENSE TO GO THROUGH THE RIGORS OF TREATMENT TO PREVENT A PREMATURE DEATH WHILST SUICIDING FROM SMOKING.
23	DYING FOR A FAG. TOBACCO, OTHER WISE KNOWN AS “COFFIN NAILS”. (AROUND 18,000 DIE EACH YEAR FROM TOBACCO.)
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25	YOU KNOW YOU WANT ONE!
26	THE SECOND BIGGEST KILLER OF AUSTRALIANS IS… ALCOHOL, IN ITS MULTIPLICTY OF FLAVOURS AND COLOURINGS. (AROUND 3,500 DIE EACH YEAR FROM ALCOHOL.) (That’s enough to drive you to drink.)
27	CUTTING DOWN ON ALCOHOL. ALCOHOL INCREASES YOUR CHANCES OF DEVELOPING OTHER DISEASE STATES (BUT IT IS GOOD FOR THE HEART.)
28	EXERCISE. THE BENEFITS OF PHYSICAL EXERCISE CANNOT BE OVERSTATED. E.G. REDUCTIONS IN BREAST CANCER RATES, PANCREATIC CANCER, OSTEOPOROSIS, OBESITY, DIABETES, DEMENTIA AND UNATTRACTIVENESS. STOP MAKING THE WORLD UGLY!
29	EXERCISE AND UNATTRACTIVENESS. ARE YOU LOOKING YOUR BEST?
30	I AM TIRED OF THIS FATIGUE. REST OR SLEEP DOES NOT "CURE" THE TYPE OF FATIGUE MANY EXPERIENCE WITH CHRONIC ILLNESS. THE FATIGUE IS PROBABLY RELATED TO DEPRESSION, THEY ARE WHAT ARE CALLED THE “SMILING DEPRESSED” OR “WALKING WOUNDED”.
31	Innocent, your honour, failing that, I will plead guilty. Don’t be feeling guilty and apologetic for displaying the symptoms of your condition. Hands up all those who choose to be tired and / or in pain? There are days when you will achieve very little, if you want to convert that into reason to spank yourself, well it beats me!
32	LIFE AND LOVE, BOTH TERMINAL CONDITIONS ISN’T IT AMAZING HOW YOU ARE JUST WADDLING ALONG, MINDING YOUR OWN, AND BOOM! YOU GET A DIAGNOSIS, AND YOUR WHOLE WORLD CHANGES IN SECONDS.
33	TIME TO PAUSE FOR THOUGHT. (an experience unfamiliar to many.) THE REVIEW PROCESS BEGINS, WE BEGIN TO CHANGE PRIORITIES AND WHAT WE RATE AS “IMPORTANT”. A REVIEW OF WHAT A PERSON WANTS TO DO WITH THEIR LIFE BEGINS, WITH A CONCOMITANT BELIEF IN THE LIMITED DEGREES OF FREEDOM AROUND US.
34	JUST WHEN I THOUGHT I HAD IT ALL WORKED OUT. (They gone and changed the rules again, mama). DO YOU USE THE TERM, “ALCOHOLIC”? DO YOU USE THE TERM “BROKEN LEGIC”? “FLUIC”? “RENALIC”? IS A PERSON REALLY TO BE DEFINED BY THEIR HEALTH? IS THE CONDITION THE TOTALITY OF WHAT WE ARE?
35	MORE THAN JUST A Dx. IS HAVING A DIAGNOSIS AN EXPERIENCE IN MY LIFE, OR, THE DEFINITION OF MY LIFE? This is part of the burden of disease.
36	BURDEN OF ILLNESS. HOW DO YOU THINK OF YOU? THAT DEFINES YOU. DO YOU SEE YOURSELF AS A “VICTIM” OF RENAL DISEASE? WE ARE ALL STRUGGLING TO MAKE IT THROUGH.
37	CHARACTERISTICS OF PEOPLE WHO COPE WITH STRESS. OPTIMISM AND REALISTIC EXPECTATIONS OF SELF, OTHERS, AND THE WORLD. SEEING PROBLEMS AS TEMPORARY, LOOKING FOR A POSITIVE. RECOGNISING THAT TASK FAILURE IS NOT EQUATE WITH BEING A FAILURE AS A PERSON.
38	SECOND CHARACTERISTIC INTERNAL LOCUS OF CONTROL. Belief in personal self efficacy, agent not object in life controlled by external forces. Can accept credit for success, but don’t automatically attribute all failure to themselves. They are not responsible for all the world’s problems.
39	THIRD CHARACTERISTIC STRONG SOCIAL RELATIONSHIPS / NETWORK WITH FRIENDS AND COLLEAGUES. NETWORK ENABLES PROBLEM DISCUSSION WHEN THINGS ARE DIFFICULT. THEY HAVE ACCESS TO EMOTION FOCUSSED COPING STRATEGIES.
40	FOURTH CHARACTERISTIC LEADS A BALANCED LIFE. MAKES TIME FOR AND ENJOYS WITHOUT GUILT RELAXATION TIME, QUALITY TIME WITH FAMILY, PLEASURABLE ACTIVITIES, LEISURE TIME, HOBBIES ETC.
41	FIFTH CHARACTERISTIC TIME MANAGEMENT SKILLS. HAS THINGS UNDER CONTROL, NOT CHAOTIC. ENACTS PROBLEM FOCUSSED COPING STRATEGIES.
42	MOVING IN WHICH DIRECTION? THE NEXT STEP – IS IT BACKWARD, SIDEWAYS, RUNNING ON THE SPOT? FORWARD, OR STEPPING UP?
43	"ALL ARE POSSIBLE" ALL ARE POSSIBLE, ALL ARE VALID – IT JUST DEPENDS WHERE YOU WANT TO GO, WHERE YOU WANT TO GET TO.
44	STEP BACK Why would someone step back? TO TAKE TIME OUT? TO AVOID THE FUTURE? TO RECREATE AN IDEALISED PAST? TO VIEW FROM A DISTANCE? TO WORK OUT JUST WHAT IS GOING ON?
45	STEP SIDEWAYS. Why would someone step sideways? TO PAUSE AND TAKE A BREAK? TO THINK? TO GET OUT OF THE SPOTLIGHT? TO REGROUP?
46	RUNNING ON THE SPOT. Why would someone run on the spot? BECAUSE THEY ARE AMBIVALENT ABOUT THE OTHER OPTIONS? ARE THEY CONTEMPLATIVE? BECAUSE THEY DON’T KNOW WHAT ELSE TO DO? TO FACE THE FUTURE, BUT NOT MEET IT?
47	STEPPING FORWARD. Why would someone step forward? TO MEET THE FUTURE AND MOVE INTO IT? TO GO FORTH AND TRY? TO SEE WHAT THE FUTURE HOLDS? DOES IT TAKE COURAGE?
48	STEPPING UP. Why would someone step up? TO MAKE THINGS BETTER? TO CONTINUE IN THE GAME? BECAUSE THEY OWE IT TO THEMSELVES TO TRY? TO TAKE THEIR PLACE AS HAVING MET THE CHALLENGE AS BEST THEY COULD, AND AS SUCH, DESERVE TO BE ON THE WINNERS PODIUM.
49	R n’ R MASTERY OF ANY SITUATION DEPENDS ON LEARNING HOW TO RESPOND APPROPRIATELY NOT REACTING OUT OF HABIT. “Habits at first are as cobwebs, at last as chains.”
50	THINK SERIOUSLY ON THIS. IF THIS WERE TO BE YOUR LAST DAY ON EARTH, HOW DO YOU WANT TO SPEND IT? EACH DAY YOU CAN WAKE AND MAKE A CHOICE ABOUT YOUR ATTITUDE AND EMOTIONS AND IN FACT, YOU DO
51	HEADS OR TAILS? EVERY TIME WE WAKE WE MAKE A CHOICE, TO HAVE A POSITIVE HEALTHY ATTITUDE TODAY OR TO HAVE A NEGATIVE UNHEALTHY ATTITUDE TODAY.
52	TO BE OR NOT BY FAR THE MAJORITY HAVE NEVER LEARNED TO ASK THEMSELVES ON WAKING THE QUESTION “HOW DO I WANT TO BE TODAY?” THEY DON’T THINK ABOUT IT BUT MAKE THE CHOICE OUT OF HABIT.
53	PASSIVE ACQUISITION OF THE BLUES. WHAT IF YOU HAVE THE HABIT OF MAKING A BAD CHOICE? WHAT IF YOU HAVE GIVEN UP ON OPTIMISM?
54	ANY REASON WILL DO. “I AM GOING TO DIE, SO WHAT IS THE POINT” OR “ITS ALL RIGHT FOR YOU, YOU DIDN’T GO THROUGH IT OR HAVE IT.” THE POINT IS THAT WE ARE ALL GOING TO DIE, BUT UNTIL WE DO, WE ARE STILL LIVING.
55	I AM THE BIGGEST INFLUENCE IN MY LIFE. HOW YOU LIVE IS INFLUENCED BY YOU. EVERY DAY I CAN CHOOSE TO BE A VICTIM OF MY CIRCUMSTANCE OR I CAN CHOOSE TO LEARN FROM IT.
56	TOSS THE DICE, PILGRIM EVERY DAY WE CAN CHOOSE TO BE POSITIVE OR NEGATIVE, TO REACT OR RESPOND, TO BE IN A GOOD MOOD OR IN A BAD MOOD,
57	"TO LET PEOPLE AFFECT OUR..." TO LET PEOPLE AFFECT OUR MOOD OR TO NOT LET PEOPLE AFFECT OR MOOD,
58	"TO LEARN" TO LEARN OR TO COMPLAIN, TO BELIEVE THAT LIFE IS UNFAIR, OR THAT LIFE IS SIMPLY IS AS IT IS.
59	"IT IS ALWAYS OUR CHOICE..." IT IS ALWAYS OUR CHOICE HOW WE LIVE OUR LIFE. EVERY DAY WE CAN CHOOSE TO LOVE OUR LIFE OR TO HATE IT.
60	"NO ONE CAN TAKE THAT..." NO ONE CAN TAKE THAT CHOICE AWAY FROM US, BUT WE CAN GIVE IT UP.