Saturday, March 25, 2006

Fistula Perils

Hello everyone. I have had quite the adventure this week. I'll start out with last Saturday. I had my dialysis treatment at 6 am so that I could spend the rest of the day with Jenny. The dialysis technician that I had told me that it looked like my regular-shift technicians were using the same area of my fistula too much. He suggested that they try and move the needles a little farther up my arm (away from the original surgery point). But, he was new to my arm and he didn't want to try anything strange, so we just did my dialysis in the same place.

On Tuesday night, I went in for my treatment and mentioned to the tech that I would like to try and move the needles up my arm a little bit, if she could. My fistula vein is very twisty, so I did not know if there was a long enough straight section available to put the needles in farther up. She hunted around for several minutes and thought that she found a place. Unfortunately, the section of vein was not quite long enough, and she ended up infiltrating my vein (which is just a fancy word that means that the needle poked all the way through the vein, in one side and out the other). So, she couldn't use that needle, as blood was seeping out of the vein into my arm. She picked another space higher up and did my treatment from there. The dialysis treatment did not go as well (my kt/V was 0.90 rather than 1.40) and she said that we probably shouldn't try and move the needles again.

They sent me home with an informative sheet that told how to reduce the amount of bruising that I would get. It said that for 24 hours, I was supposed to use an ice pack in 15-minute increments. 15 minutes on, then 15 minutes off, and repeat for 24 hours. I went ahead and tried that at work the next day, which wasn't too bad. The second step was, for the second 24-hour period, to put a warm, damp compress on the area in 15-minute increments (the same as with the ice pack). Since I work full time, I didn't really have time to head back and forth to the sink every 30 minutes to warm up a rag and then try not to drip water all over myself. So, I only did the washcloth once, then I gave up on it.

When I got to dialysis Thursday night, they checked my access like they always do to make sure that there is a strong pulse. Unfortunately, there was no pulse that could be felt in the whole fistula. So, they decided that the vein must have become clotted and said that I had to go home. They called the hospital and got me set up with an appointment for Friday with the vascular surgeon. He would have to go and take a look at my arm and see if there was anything to be done.

Friday morning, I went to the vascular surgeon and he did a quick sonogram of my arm. He said that it was going to require surgery, and he scheduled me for that afternoon. I went in for vascular surgery on Friday afternoon. The doctor opened my arm up in one place, but he wasn't able to get to the clot. So, he moved to a second spot, opened the arm up again, and was still not able to help. He saw narrow veins and blockage, but he could not clear it out. So, he decided not to do any more blind cutting.

I am supposed to go back to the hospital on Monday for a vein mapping. The radiology department will do an intensive sonogram of the veins in my upper arm to see if there is a new place to use for a fistula. The vascular surgeon had them put in another perm-cath into my chest, as I will not have a working fistula for a while. I am hoping that they will find good veins in my upper left arm and will not have to operate on my right arm.

Please pray for the doctor as he looks through my arm on Monday to try and find a good place for dialysis. Pray for quick healing for me (as I have just had two procedures and am soon to have at least one more). Thank you for caring about what happens. I always like to hear comments and e-mails from everyone.

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