There is a widely circulated story about “putting down the glass.” The story goes like this:
Put down the glass video
A psychologist was giving a lecture on stress management to a group of students. As she raised a glass of water, the students expected her to ask the typical “half full or half empty” question. Instead, she asked, “How heavy is this glass of water?”
The students shouted out answers ranging from a few ounces to a couple of pounds. The psychologist replied, “The absolute weight doesn’t matter. It depends on how long I hold it. If I hold it for a minute, it’s not a problem. If I hold it for an hour, I’ll have an ache in my arm. If I hold it for a day, my arm will feel numb and paralyzed. In each case, the weight of the glass doesn’t change, but the longer I hold it, the heavier it becomes.”
The lesson of the story is that we must put down the glass of water to give our arms a break. This applies to stress management as well. We all have stress in our lives, but it’s important to put it down for a while and give ourselves a break.
This lesson is particularly relevant for those on dialysis. Dialysis patients have to deal with numerous physical and emotional stressors, such as the time commitment of dialysis treatments, dietary restrictions, and potential complications. These stressors can take a toll on a patient’s mental and physical health.
To reduce stress, dialysis patients should practice self-care and engage in activities that bring them joy and relaxation. This could include exercise, meditation, spending time with loved ones, or pursuing a hobby. I do this by writing this blog, making what I think are cool videos, and taking care of our 1/2 acre part of heaven. It’s also important for patients to communicate with their healthcare team about any concerns or stressors they may be experiencing. I have found mine to be always open, caring, and interested in my well-being.
In conclusion, the “glass story” teaches us an important lesson about stress management. By putting down the glass and taking a break from stress, we can improve our mental and physical well-being. This lesson is particularly relevant for those on dialysis, who face numerous stressors in their daily lives. By practicing self-care and communicating with their healthcare team, dialysis patients can reduce stress and improve their quality of life.
Speaking of self-care, I’m off to take my evening shower.
Today’s blog will look into recent medical developments for those interested in Dialysis regardless of viewpoint.
This past Sunday’s The Wall Street Journal, in a front-page article titled “ChatGPT Doctors Will See You Now” by Nidhi Subbaraman, reported that already, in California and Wisconsin, Open AI’s GPT is being used to scan patient messages and draft responses from their doctors. Such use is being rolled out as we “speak.” Here’s the kicker: ChatGPT scored better than real doctors at responding to patient queries, according to a study posted in the JAMA Internal Medicine Journal, a peer-reviewed source. The use of Artificial Intelligence is coming like a freight train. Be prepared to get onboard or get run over.
Recently, Garmin, the GPS/navigation people, rolled out the Dexcom Connect IQ app for Garmin devices. This app supports tracking glucose levels on a Garmin Smartwatch or bike computer. Remember that you need the watch and a Dexcom G6 or G7. Using the app, users should be able to glance at their watch while bike riding to ascertain their current glucose level.
In an article by Robert Hart on April 28, 2023, titled “One-Hour Diabetes Procedure Offers Fresh Hope For Ditching Insulin,” in Forbes, it was reported that a single outpatient endoscopic procedure provides glucose control, a potential improvement over drug treatment. They don’t know why it works at this time, but blind tests are encouraging. The procedure is nonsurgical and involves flexible tubes, lights, and cameras that aid doctors in seeing inside the body, and patients are discharged on the same day as the procedure. Sounds almost too good to be true. Standby.
Lastly, Fierce Healhcare in an article published in Digital Health on April 26, 2023, by Annie Burky titled “DocGo aims to bring kidney care the final mile by partnering with Fresenius Medical Care” to include remote patient monitoring, chronic care management, and urgent care services. Since 2019 DocGo has been FMC’s preferred medical transportation partner. The new service aims to “offer a solution for nephrologists to help patients truly manage their chronic conditions.” Centering around the analysis of “Big Data,” DocGo suggests it will catch trends before they become life-threatening and greatly aid patients toward the “really needing help” end of the spectrum. We’ll see. I already feel that I have more than enough of “Big Brother watching me.”
On Monday, April 24, 2023, on page A12, The Wall Street Journal ran an article by Aaron Zitner titled “‘Very Happy’ Americans Are Pleased to Say Why.” The article concluded America’s happiest people have a few traits in common: They value community, close personal relationships, tend to believe in God, and generally are older and often in their retirement years. As I tend to do, I pondered how this set of concepts or behaviors might apply to those on Dialysis, the target market of this blog. With this in mind, I cranked up my subscription to ChatGPT and entered the following Prompt into ChatGPT’s GPT-4 Model. The results are given below.
Model: GPT-4
Prompt: America’s happiest people have a few traits in common: They value community, close personal relationships, tend to believe in God, and generally are older and often in their retirement years. Write a 2000-page or more word essay expanding on this with emphasis on how this might help dialysis patients with citations and references at the end. Write at least at the college level.
Introduction
Happiness is a universal human pursuit. It is the emotional state that everyone yearns to experience, and it is often considered the ultimate goal in life. Various factors contribute to the happiness of an individual, and studying these factors can help us understand the foundations of happiness better. In the United States, research has shown that the happiest people tend to have certain common traits: they value community, have close personal relationships, believe in God, and are usually older individuals, often in their retirement years (Westerhof & Keyes, 2010). This essay will explore these traits in-depth, focusing on their potential to improve the quality of life for dialysis patients.
I. The Importance of Community
A sense of community has been identified as a key contributor to happiness. Studies have shown that people who feel a strong connection to a social group are more likely to report higher levels of happiness and life satisfaction (McMillan & Chavis, 1986). This sense of belonging can be even more crucial for dialysis patients undergoing a physically and emotionally demanding treatment process. Inclusion in a community can provide these individuals with emotional support, practical assistance, and a sense of identity and purpose (Davidson, 2017).
Dialysis patients can benefit from being part of a patient support group, where they can share experiences, advice, and encouragement with others going through the same treatment (Cohen & Wills, 1985). Additionally, healthcare providers can help facilitate the creation of these communities and involve patients’ families and friends to create a more inclusive and supportive environment (Davidson, 2017).
II. The Role of Close Personal Relationships
Strong personal relationships, including friendships and familial bonds, are fundamental to happiness (Diener & Seligman, 2002). These relationships provide emotional support, companionship, and a sense of security that contribute to overall well-being. For dialysis patients, nurturing close personal relationships is essential for maintaining mental health and coping with the challenges of treatment.
Studies have shown that patients with strong social support have better adherence to treatment, lower levels of depression, and improved overall quality of life (Gallant, 2003). Healthcare providers can encourage the involvement of family members and friends in patients’ care by educating them about the treatment process and providing them with resources for support (Davidson, 2017).
III. The Impact of Spiritual Beliefs
Belief in God or a higher power has been linked to higher levels of happiness and life satisfaction (Diener, Tay, & Myers, 2011). For dialysis patients, faith can provide comfort, hope, and a sense of meaning during difficult times. Spiritual beliefs can also help individuals cope with the uncertainty and challenges associated with their treatment, providing a sense of purpose and direction (Park, 2010).
Healthcare providers can support the spiritual well-being of dialysis patients by acknowledging and respecting their beliefs and by facilitating access to spiritual care resources, such as chaplains or support groups (Davidson, 2017).
IV. The Wisdom of Age
Older adults, particularly those in their retirement years, tend to report higher levels of happiness compared to their younger counterparts (Stone, Schwartz, Broderick, & Deaton, 2010). This increased happiness can be attributed to factors such as accumulated wisdom, greater emotional regulation, and a focus on meaningful activities and relationships (Carstensen, 2006).
Dialysis patients, regardless of age, can learn from the happiness of older adults by prioritizing meaningful relationships, practicing emotional regulation, and seeking out activities that provide a sense of purpose and accomplishment. Healthcare providers can help facilitate this process by offering resources and support for patients to engage in activities that promote well-being and personal growth (Davidson, 2017).
V. Applying the Traits of America’s Happiest People to Dialysis Patients
By understanding the traits that contribute to the happiness of America’s happiest people, healthcare providers, and caregivers can develop targeted interventions and support systems to improve the quality of life for dialysis patients. Emphasizing the importance of community, close personal relationships, spiritual beliefs, and the wisdom of age can help these patients cope with the challenges of their treatment, foster resilience, and enhance their overall well-being.
Conclusion
In conclusion, the pursuit of happiness is a universal endeavor, and understanding the factors that contribute to happiness can provide valuable insights for improving the quality of life for dialysis patients. By focusing on the traits shared by America’s happiest people, such as valuing community, nurturing close personal relationships, maintaining spiritual beliefs, and emulating the wisdom of age, dialysis patients can enhance their well-being, cope more effectively with the challenges of treatment, and ultimately, experience greater happiness and life satisfaction.
References
Carstensen, L. L. (2006). The influence of a sense of time on human development. Science, 312(5782), 1913-1915.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310-357.
Davidson, K. W. (2017). Creating a supportive environment for dialysis patients. In C. R. Thomas & S. M. Smith (Eds.), Comprehensive Clinical Nephrology (6th ed., pp. 171-180). Elsevier.
Diener, E., & Seligman, M. E. (2002). Very happy people. Psychological Science, 13(1), 81-84.
Diener, E., Tay, L., & Myers, D. G. (2011). The religion paradox: If religion makes people happy, why are so many dropping out? Journal of Personality and Social Psychology, 101(6), 1278-1290.
Gallant, M. P. (2003). The influence of social support on chronic illness self-management: A review and directions for research. Health Education & Behavior, 30(2), 170-195.
McMillan, D. W., & Chavis, D. M. (1986). Sense of community: A definition and theory. Journal of Community Psychology, 14(1), 6-23.
Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257-301.
Stone, A. A., Schwartz, J. E., Broderick, J. E., & Deaton, A. (2010). A snapshot of the age distribution of psychological well-being in the United States. Proceedings of the National Academy of Sciences, 107(22), 9985-9990.
Westerhof, G. J., & Keyes, C. L. (2010). Mental illness and mental health: The two continua model across the lifespan. Journal of Adult Development, 17(2), 110-119.
Thursday morning, I had my monthly appointment with my Dialysis Team. The Team facility is located across the street from the CVS where my most recent request for a Libre 3 sensor prescription has languished since April 14. I went to the “Consultation” window and was soon approached by a white-coated individual I assumed to be a pharmacist.
I showed her my CGM order on my phone’s CVS app, and she punched some info into her computer and soon informed me that CVS could not fill the prescription as prescribed by my GP. The problem was that the extant script was for three sensors for 90 days, refillable three times. Since the sensor only lasts 14 days, the script was for too few sensors. Further, CVS could not and would not fill the script. She stated that CVS had notified my GP’s office of this conundrum but had to date received no response.
Readers of this blog know that I have been pounding on the system for lack of medical acumen in this area and have repeatedly spoken to the voice on the other end at my GPs, attempting to straighten this out. I called the Doctor directly (I have concierge privileges which I pay for) and informed him of the situation. He checked on his end, and yes, CVS had notified his office, but the notice did not trigger the need for a response for some tangential reason.
Bottom line, while I was on the phone, my Doctor sent a fax to CVS with the correct script and promised me he would personally follow up with a call to CVS to ensure compliance with the requested script.
Do I have a great degree of confidence that the matter is settled? NO!
My CVS app now shows, “Your insurance requires approval.” Reading the tea leaves, I’m stuck paying full freight and buying my sensors from HealthWarehouse.com. So much for insurance and all the hype in the news about CGMs now being covered for Diabetic patients who take insulin. The “system” doesn’t care! I’m tired of shooting myself in the foot over this and ready to move on. The “system” has won.” As the picture below infers, our healthcare “system” has its head up its ass!
As luck would have it, sometimes modern electronics fail us. Recently the sensor for my Libre 3 Continuous Glucose Monitor began provoking false low glucose readings, which resulted in alarms. I’m talking about indicating that my Glucose was in the fifties. If this were so, I would be shakey, probably in a cold sweat, and noticeably irritable; I was none of these. As a diagnosed diabetic of thirty-plus years, I KNOW what it feels like to be hypoglycemic. Not so here.
I put up with this crap for about six days before changing to a new sensor, and the problem disappeared. This is the first sensor in about a year’s experience in using Libre 2/3 products that I have had any problems with.
Since I am paying out-of-pocket for the sensors, I decided to give it a go by contacting Freestyle Product Support. I did a Google and arrived at a support page to fill out a couple of inputs for support. The inputs forced the user to input or choose a selection where the sensor in question was throwing an error code. My errant sensor was not throwing any error codes, erroneously reporting low glucose. So I was forced to phone their support line. For the record, the number is 855-632-8658.
After setting up an account and providing info from the Libre 3 app, I was informed that Freestyle would replace the malfunctioning sensor and provide me with a return package to return the bad sensor to them for analysis.
The whole cycle took half an hour but look at it as if I saved the $100 or the replacement cost. BTW, the order for replacement Libre 3s that my GP placed with CVS (for my international readers, CVS is one of the largest US drug store chains) is still listed on my CVS App as “Processing. We’re working on your order.” Which raised another question: Why can my Brother-in-law Jerry walk into a CVS in Podunk, Indiana, and pick up Libre 3s, but here in the Dallas-Fort Worth area, they have to “work on it?”
To keep things interesting, I took the raw text from above and shoved it into Designs.ai’s video maker portion of the apps. The result for your viewing pleasure (and should be awe) is embedded below. All I provided is the test; AI found and selected all the clips, voice, etc. This technology is absolutely awesome!
The entry is different from past entries. I bought into Pictory.AI which supports rendering text into videos. I used it with judicial editing on my part with a script captured from the normal blog entryway below and produced the following video. I will be doing this from time to time because I can. Enjoy!
At about 6 PM on Tuesday, April 24, 2023, I received another call from Fresenius Medical Corporate. This time via number 781-699-13211. There was a very young and sweet voice on the other side, inquiring about my last call on or about 9 April to “Tech Support” concerning the never-ending drain alarms I have been experiencing since starting PD on 9/30/2022. But she was not the least bit interested in drain alarms. During the call, I related to the soulless voice on the other end that I was experiencing swelling in my face, hands, and feet which was and is true. My dialysis nurse and I have since adjusted the strength of the solution I’m using in the Cycler, which has been mitigating.
No, she asked if I was able to complete my dialysis???? I replied yes, and then she inquired if I had been hospitalized. It should be plain as day to anyone with a grain of gray matter that this was not a call to ascertain the status of my health or respond to incessant Cycler drain alarms. Plain and simple, it is Fresenius covering its legal exposure. Yes, in the Navy, I would have said ass. So there I did. It was very apparent that she (it was a she, but that’s not the point) was merely going down a checklist and either could not or would not deviate from it.
At the call’s end, she encouraged me to contact “Tech Support” with any more problems, to which I replied that putting tech and support together regarding Fresenius is an oxymoron. That comment didn’t fit her script, and she signed off.
As I commented after my first corporate call along the same lines, my Dialysis Team knows my medical status at all times. I have complete and essentially instantaneous access to my Dialysis Nurse, who is most attentive to my situation. She knows every minutia about my dialysis journey. Why isn’t Fresenius Corporate talking to the locals about patient care and feeding? A faceless and emotionless phone call that accomplishes nothing except filling in some blanks on a legal form doesn’t get it for me. How about you?
On 3/14/2023 the lead to my blog entry for that day was as follows:
“Practicing mindfulness and gratitude can contribute to happiness while on dialysis. Mindfulness involves being present and aware of one’s thoughts and feelings without judgment. Dialysis treatments can be stressful, and it is easy to become overwhelmed by negative thoughts and emotions. However, practicing mindfulness can help to reduce stress and anxiety levels. Additionally, focusing on things to be grateful for can help to shift one’s perspective and create a more positive outlook. It can be as simple as being grateful for the healthcare team, supportive loved ones, or even the ability to receive life-sustaining treatments.”
There is a new (not tested by me and I have absolutely no business ties to the company) website ogimi.ai that professes to provide online and free Mindfulness support for individuals.
They provide a Chrome extension for that browser and provide the following verbiage about the same:
Ogimi generates custom-guided meditations tailored to your specific needs.
Introducing Ogimi, the chrome extension for your personalized AI Meditation Coach.
Ogimi generates custom guided meditations tailored to your specific needs, allowing you to target specific challenges in your life. A consistent guided meditation practice can help you:
1. Improved focus and concentration
2. Reduced stress and anxiety
3. Shift your mindset to positivity and gratitude
4. Sleep Better
5. Increase self-awareness and process emotions
6. Improve relationships
Track your meditation practice and maintain your consistency with features
Check it out on your own. It is AI-driven so it may surprise all of us.
Friday’s April 21, 2023, WSJ page B4 ran an article by Brian Gormley titled “Startups Are Making Human ‘Organoids’ for Drug Testing.” Startups in the field include Xilis Inc., Herophilus Inc., and Parallel Biosystems Inc. Xilis uses cancer cells and aims to help inform cancer treatment decisions. Parallel creates organoids of lymph nodes, and Herophilus created organoids to model the rare disorder Rett syndrome according to the article.
The article triggered the thought for me along the lines “I wonder if Organoids are being used in kidney research, and if so, where does the research stand? A new source of kidneys and/or kidney replacement obviously could obviate the need for dialysis in the future. So this topic is of interest to those on dialysis, especially those who are much younger than I am. As I have been trained to do so in such instances, I turned to my research assistant ChatGPT for input which is included below with modest editing by Grammarly and yours truly. The first paragraph below is the Prompt I generated to quiz ChatGBP Pro, followed by the edited response. The lead picture was generated in Dalle Ai with the Prompt “provide a picture of a potential organoid used for kidney research.”
Prompt: There is a relatively new research field involving organoids. Please provide a 2000 or more-word essay with citations and end references on the use of organoids in kidney research. Consider the audience to be people on or interested in dialysis.
Title: The Role of Organoids in Kidney Research: A New Hope for Dialysis Patients
Introduction
Organoids are three-dimensional (3D) structures generated from stem cells that mimic the organization and functionality of real organs. They have emerged as a promising tool in various fields of biomedical research, including kidney research. For patients on dialysis or interested in dialysis, advancements in organoid technology offer hope for improved treatments and, potentially, a cure for kidney diseases.
This essay will provide an overview of organoids and their applications in kidney research, focusing on the potential benefits for dialysis patients. It will discuss the use of organoids in understanding kidney development, disease modeling, drug screening, and regenerative medicine.
Organoids: A Brief Overview
Organoids are 3D multicellular structures derived from stem cells that closely resemble the architecture and functionality of real organs (1). They can be generated from different types of stem cells, such as pluripotent stem cells (PSCs) and adult stem cells. By providing the appropriate environmental cues, stem cells can differentiate into specific cell types and self-organize to form organoids that mimic the organ’s structure (2).
The use of organoids in biomedical research has several advantages over conventional two-dimensional (2D) cell culture and animal models. Organoids offer a more physiologically relevant model for studying organ development, disease, and response to drugs. They can also be generated from patient-derived cells, allowing personalized medicine approaches and reducing the need for animal testing (3).
Organoids in Kidney Research
Kidney organoids have been successfully generated from both human PSCs and adult stem cells (4). These organoids contain multiple cell types found in the kidney, including nephrons, collecting ducts, and endothelial and stromal cells. Kidney organoids have been used to study kidney development, disease modeling, drug screening, and regenerative medicine.
Understanding Kidney Development
Kidney organoids serve as valuable models for studying the complex processes involved in kidney development, such as nephron formation, branching morphogenesis, and vascularization (5). By examining how organoids develop and comparing them to real kidneys, researchers can gain insights into the signaling pathways and molecular mechanisms underlying kidney development. This knowledge is crucial for understanding kidney diseases and developing new therapeutic strategies.
Disease Modeling
Kidney organoids derived from patient-specific cells provide a powerful platform for modeling kidney diseases and understanding their underlying mechanisms. For example, organoids have been used to model polycystic kidney disease (PKD), a genetic disorder characterized by the formation of cysts in the kidney (6). By generating organoids from PKD patients’ cells, researchers can study the disease’s progression and identify potential therapeutic targets.
Another example is the use of organoids to model kidney diseases caused by mutations in the podocyte, a specialized cell type crucial for kidney filtration (7). Organoids derived from patients with podocyte mutations can help researchers understand the cellular and molecular mechanisms leading to kidney dysfunction and identify potential therapeutic targets.
Drug Screening
Kidney organoids provide a physiologically relevant platform for screening potential drug candidates for kidney diseases. As they contain multiple cell types found in the kidney, organoids can more accurately predict a drug’s efficacy and safety compared to conventional 2D cell cultures (8).
For example, kidney organoids have been used to screen drugs for nephrotoxicity, a common side effect of many medications that can lead to kidney damage (9). By identifying drugs with lower nephrotoxicity, researchers can develop safer treatment options for patients.
Regenerative Medicine
Organoids hold great promise in regenerative medicine, particularly for patients with end-stage kidney disease (ESKD) who require dialysis or a kidney transplant. The generation of functional kidney tissue from patient-derived cells could potentially lead to the development of bioengineered kidneys, reducing the need for donor organs and providing a life-saving solution for patients on dialysis waiting for a transplant (10).
While the prospect of bioengineered kidneys is still far from clinical reality, significant progress has been made in recent years. For instance, researchers have successfully generated vascularized kidney organoids by combining human PSC-derived kidney cells with human endothelial cells and mesenchymal stem cells (11). These vascularized organoids displayed improved functionality compared to non-vascularized organoids, demonstrating the potential of organoid-based approaches for kidney tissue engineering.
Another promising approach involves the use of decellularized kidney scaffolds, which are obtained by removing all cells from a donor’s kidney, leaving behind the extracellular matrix (12). These scaffolds can be repopulated with patient-derived kidney cells, such as those from organoids, to create a functional, bioengineered kidney. While this approach has shown promise in preclinical studies, significant challenges remain, such as achieving the necessary cell density and functional maturity of the engineered kidney tissue.
Challenges and Future Directions
Despite the significant advancements in kidney organoid research, several challenges need to be addressed before organoids can be widely adopted in clinical settings. One major challenge is the variability and reproducibility of organoid cultures. Factors such as the cell source, differentiation protocols, and culture conditions can affect organoid morphology and functionality, leading to variability between different laboratories (13).
Another challenge is the limited maturity of kidney organoids compared to native kidneys. Currently, kidney organoids resemble fetal kidneys rather than adult kidneys, which may limit their applicability for modeling adult kidney diseases and drug responses (14). Further research is needed to optimize organoid culture conditions and protocols to achieve more mature and functional kidney organoids.
Finally, the ethical considerations surrounding the use of human stem cells and organoids should be taken into account. As organoids become more complex and closely resemble human organs, concerns regarding the potential for organoid “consciousness” or pain perception may arise (15). Clear ethical guidelines and regulations will be necessary to ensure the responsible use of organoids in research and clinical applications.
Conclusion
Organoids represent a revolutionary tool in kidney research, offering new possibilities for understanding kidney development, modeling diseases, screening drugs, and exploring regenerative medicine approaches. For dialysis patients, advancements in organoid technology bring hope for improved treatments and, potentially, a cure for kidney diseases. Although significant challenges remain, ongoing research and collaboration between scientists, clinicians, and ethicists will continue to drive progress in this promising field.
References
Clevers, H. (2016). Modeling development and disease with organoids. Cell, 165(7), 1586-1597.
Fatehullah, A., Tan, S. H., & Barker, N. (2016). Organoids as an in vitro model of human development and disease. Nature cell biology, 18(3), 246-254.
Lancaster, M. A., & Huch, M. (2019). Disease modelling in human organoids. Disease Models & Mechanisms, 12(7), dmm039347.
Takasato, M., Er, P. X., Chiu, H. S., & Little, M. H. (2015). Generation of kidney organoids from human pluripotent stem cells. Nature protocols, 11(9), 1681-1692.
5. Lindström, N. O., De Sena Brandine, G., & Tran, T. (2018). Progressive recruitment of mesenchymal progenitors reveals a time-dependent processof cell fate acquisition in mouse and human nephrogenesis. Developmental Cell, 45(5), 651-660. 6. Cruz, N. M., Song, X., Czerniecki, S. M., & Freedman, B. S. (2017). Organoid cystogenesis reveals a critical role of microenvironment in human polycystic kidney disease. Nature materials, 16(11), 1112-1119.
6. Hale, L. J., Howden, S. E., Phipson, B., Lonsdale, A., Er, P. X., Ghobrial, I., … & Little, M. H. (2018). 3D organoid-derived human glomeruli for personalised podocyte disease modelling and drug screening. Nature Communications, 9(1), 1-14.
7. Low, J. H., Li, P., Chew, E. G., Zhou, B., Suzuki, K., Zhang, T., & Xia, L. (2019). Generation of human PSC-derived kidney organoids with patterned nephron segments and a de novo vascular network. Cell stem cell, 25(3), 373-387.
8. Phipson, B., Er, P. X., Combes, A. N., Forbes, T. A., Howden, S. E., Zappia, L., & Little, M. H. (2019). Evaluation of variability in human kidney organoids. Nature Methods, 16(1), 79-87.
9. Bonventre, J. V. (2018). Kidney organoids: accurate models or fortunate accidents. Genes & Development, 32(19-20), 1319-1321.
10. van den Berg, C. W., Ritsma, L., Avramut, M. C., Wiersma, L. E., van den Berg, B. M., Leuning, D. G., … & Mummery, C. L. (2018). Renal subcapsular transplantation of PSC-derived kidney organoids induces neo-vasculogenesis and significant glomerular and tubular maturation in vivo. Stem cell reports, 10(3), 751-765.
11. Song, J. J., Guyette, J. P., Gilpin, S. E., Gonzalez, G., Vacanti, J. P., & Ott, H. C. (2013). Regeneration and experimental orthotopic transplantation of a bioengineered kidney. Nature medicine, 19(5), 646-651.
12. Przepiorski, A., Sander, V., Tran, T., Hollywood, J. A., Sorrenson, B., Shih, J. H., … & Davidson, A. J. (2018). A simple bioreactor-based method to generate kidney organoids from pluripotent stem cells. Stem Cell Reports, 11(2), 470-484.
13. Takasato, M., & Little, M. H. (2015). The origin of the mammalian kidney: implications for recreating the kidney in vitro. Development, 142(11), 1937-1947.
14. Hyun, I., Scharf-Deering, J. C., & Lunshof, J. E. (2020). Ethical issues related to brain organoid research. Brain Research, 1732, 146653.
As patients on Dialysis, we can learn a lot from US Navy SEALS and their credos. This blog will offer insights from my loose association with the SEAL Community during my 25 years in the Navy.
A recent 2023 study suggests that psychological and physiological changes are associated with training to become a Navy SEAL. No less than Steve Jobs, the co-founder of Apple Computer, suggested that to succeed, we must “Think Different.”
How do SEALs “Think Different” that, as mere mortals on Dialysis, might be to our advantage to incorporate into our merely mortal lives? Read on.
The tagline for the blog is “Never ring the bell.” This credo comes from US Navy SEAL BUDs training. When the going gets too tough for SEAL trainees, they can “ring the bell and opt-out.” They have given up. As Dialysis patients, we can’t give up. I take inspiration from the SEAL credo, “Never ring the bell.” If they can do it, so can I. At least I’m in a warm bed, and no one is shooting at me in comparison. Never ring the bell!
Another adage from a top SEAL that I have incorporated into my daily routine is making our bed upon my rising in the morning. My wife always proceeds me to take care of our Golden Retriever, Dickens. Admiral McCraven in a 2014 commencement speech at his alma mater University of Texas, spoke about many aspects of SEAL training, including making your bed every day. He stated that making your bed first starts the day off with an accomplishment extending to little things that matter. Start with little things in Dialysis that matter, like keeping your catheter area clean and tidy, and the rest will follow.
Admiral McCracken said that in SEAL training, everyone must paddle to succeed in the mission to pass BUDs. In Dialysis, you must surround yourself with a strong team that “paddles” together to keep you not only afloat but moving in the right direction. In the surf off Coronado, CA, you can’t paddle alone, nor can you in your Dialysis journey.
I’ve embedded a video of his speech at the blog’s end. Watch it. He has lots to say that pertains directly to Dialysis as well as successfully getting through BUDs and becoming a Seal.
I want to relate one more SEAL story that is personal to me. When I went through Vietnamese Language School in Coronado, CA, I had a room in the Bachelor Officers Quarters along with many SEALs. Cornado is the West Coast base for SEALs. Directly across the hall from me, door to door, so to speak, a Navy SEAL Lt was housed. We came to be on speaking terms as we came and went from our rooms. His name is Tom Norris. See this link. He is a Medal of Honor, recipient. My family had stayed in the Long Beach, CA area while I was in school in Coronado as I had orders after school to go In-Country Vietnam as an Advisor. My wife decided to bring our two boys down on a train and stay with me in the BAQ for an outing for our two sons. I related this to Tom in a casual conversation, and he informed me that he would be out of town on a mission and volunteered his room for our sons to stay in, which they did.
After my posting to Vietnam, I ran across Tom on various social occasions in Saigon. He was awarded the MOH and soon after was wounded, losing sight in one eye. And this is where the SEAL credo kicks in. Tom medically retired from the Navy but joined the FBI and qualified with small arms with one eye and met all other physical requirements, almost like a one-armed paper hanger.
The point taken from SEAL Credo is that just because we’re on Dialysis doesn’t mean that life’s over for us. As Admiral McCraven states in his commencement speech, the will to succeed is based on the size of the heart, not the size of one’s swim flippers.
