Sunday, April 25, 2021

EVALUATION OF RELATIONSHIPS AND SOCIAL LIFE 

 EVALUATION OF RELATIONSHIPS AND SOCIAL LIFE


By Amanda Grandinetti


Evaluation by Jim Myers

1. Introduction

I have been asked to review a study entitled, "RELATIONSHIPS AND SOCIAL LIFE By Amanda Grandinetti for the GET ON TRACK Study Group. This is a very interesting article concerning the effects that a kidney transplant has on our relationships with others and the self-imposed restrictions on our social lives. It is an excellent, well-written article. It is extremely well organized and documented.

I wish to make a full disclosure of any potential conflicts of interest. Amanda Grandinetti is a friend of mine. I support her work and her studies to obtain her PhD. I have had Amanda on my live broadcast with the Urban Outreach Media Network. I do believe this review to be an objective evaluation of her article.

The premise of the study is that post-kidney transplant our relationships and social circle may change. Some of the changes come about naturally, by circumstances we cannot control. Others however, are self-imposed restrictions that we have some control over, that we can in fact overcome or even broaden our social interactions. The piece does a great job of suggesting steps to interact with others and to overcome our fears and social restrictions.

2. Did You Know: Changes After Transplant

The article does an excellent job of defining the theme for the piece in the initial paragraphs. Even though some of the the pre-transplant restrictions have been removed and eventually physically we can engage in many activities we were removed from, mentally there may be limitations that are ingrained that prevents us from engaging in social activities that lead to more contacts.

Changes to relationships are inevitable. This is a normal thing for all persons as time passes, but it can be acute for kidney patients at all stages of ESRD spectrum, including kidney transplant.

Finally, the author makes a great point about carry over inhibitors on social interaction as a result of past kidney experiences on the road preceding a kidney transplant.

My independent research seems to agree with the author's point of view, with some expansion on her points of discussion.

An Australian study seems to indicate the psychologically, the restrictions in the mind of a kidney transplant patient do not change much from the medically and physical restrictions of a dialysis patient.

"Organ failure represents a serious clinical problem with relevant social and interpersonal implications and occupational disadvantages for patients on a waiting list for a transplant. These patients are often incapacitated by asthenia and malaise because they are forced to live for long periods waiting for an organ, with many discomfort disease-related and also life-style limitations (haemodialysis, diet), emotional disturbances such as depression, anxiety, rage and, in some cases, economic difficulties." In other words, the quality of life for many dialysis patients does not significantly improve after kidney transplant due to experience while on dialysis.

Also, my research shows that the author is correct when she states that kidney transplant can bring it's own subset of mental illness that are separate from any dialysis/pre-transplant carry over issues in the event of pre-emptive dialysis.

These issues include;
• Post-traumatic stress disorder;
• Adjustment disorder;
• Psychosomatic disorders;
• Guilt from benefiting from someone else's loss of life ;
• Emotional vulnerability with body image;
• Self-representation disorders, or paranoid reactions to a panic crisis due to the presence of a foreign object (transplanted organ);.
• Reactive psychopathologic process (depression, anxiety, dissociative disorder) both due to transplanted organ acceptance difficulties and immunosuppressive therapy complications.

In addition, a living donor transplant recipient has his/her own unique set of mental issues. A Korean study found issues including:
• Hypochondriasis,
• Depression,
• Hysteria,
• Mental issues with non-related living donations,
• Mental issues with related family members/donors
• Mental issues with spouse/donors

3. How Am I Doing: Issues Addressed in the Article

This is the most focused section of the study. The author makes the point that there are many positive results that occur in transplanted kidney patients.

"Studies show that quality of life increases after kidney transplantation. As a recipient, you can expect a social life that returns you to “normalcy”. Recipients are more likely to join recreational clubs, travel frequently, and participate in recreational/religious activities and social events than when they were on hemodialysis." This is a reflection that adjustments can be made over a post-transplant period that are positive in nature.


The article notes there are two exceptions to the period of adjustment rule:
• The kidney transplant recipient returning to work;
• Participation in sports.
It is of note, that this evaluator was specifically told at the time of his kidney transplant 5 years ago to avoid any contact sports.

Kidney Transplant Patients Returning to Work:

"Most kidney transplant recipients can return to work and other normal activities within eight weeks after transplant. No lifting objects weighing more than 10 pounds or exercise other than walking until the wound has healed (usually about six weeks after surgery). Have frequent checkups as you continue recovering."

Kidney Transplant Patients Playing Sports:


4. What Can I Do: Your Lifestyle After Kidney Transplant

The author points out in this section of the study, that satisfaction with your physical activities and social interaction is subjective; you alone can evaluate your own satisfaction. This is a an important point. It goes without saying, that if you are unhappy with your situation, you can still take steps to make changes.

Very practical advice given here by the author. You can pretty much resume your normal activities. This is succinct and to the point. It is also supported in the literature.



5. How Can I Do It: What Steps Can I Take to Achieve the Lifestyle I Desire After Kidney Transplant

This is the best section of the article. The advice given here is unique:

"Write a list of all the activities you wanted to do but felt you couldn’t before your transplant. This can open up new hobbies and avenues to explore with friends.

• Journal: journaling can provide an outlet to process your experiences. It can also reduce stress.

• Take notes: If some social circumstances seem scary, write them down so you can remember to talk about them with your family, friends, or even your transplant team.

• Find a support group of transplant patients or a peer counselling (available through various organizations e.g. Kidney Foundation of Canada). Getting to know others who have received a kidney transplant can form new friendships, relieve stress, and answer any questions you may not want to ask your team. Other recipients have experienced many of the same things you are now experiencing.

• Get back to the basics: get a full night of sleep and hydrate.

• If you are really struggling, seek a counselor who can help you process some of your fears."


6. Conclusion

This is a terrific piece about a seldom mentioned issue. The mental aspect of the kidney transplant recipient is an important topic for discussion and it is very well done here. The 'how to do it's advice is outstanding.

• Relevance of Content
The content here is entirely relevant and fresh. This is an important topic for any kidney transplant patient.

• Usefulness of Content
The content is extremely useful. The period of adjustments statements give hope to the initially concerned kidney transplant patient.

• Clarity of Content
The content here is crystal clear and simple, comprehensivable explanations of a difficult topic are given here.

• Applicability of Information
The information is very applicable to every kidney transplant patient.

My overall assessment is this is a meaningful article with essential information for kidney transplant patients.



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