Since coming off the DL, the fistula is doing great. I'm using the medium size needles now with no troubles. The only question now is whether or not we move up to the big boy needles again. All indications are that I can dialyze with the medium needles and do just fine as far as the quality of the dialysis goes.
That's good news for me, because I got the okay to make another appointment to have the catheter removed from my chest. I'm going to make that call later today.
Since the last infiltration of my fistula, all the nurses and techs have been treating me with kid gloves. They are careful about moving me along too quickly again. Of course, that statement makes the assumption that they moved me along too quickly the first time around. I would say that they didn't.
I say that because I learned the other day that my fistula is shallow. That means that when faced with a challenge of drawing blood out of the fistula, the person doing the sticking needs to consider a different location or try to move the needle further up the fistula, as opposed to trying to stick the needle deeper into it. That was the foundation for the last infiltration.
The needle was in fine, but when the tech got distracted, she lost her focus and pushed the needle in further than it needed to go. Had she been paying attention, she would've seen that she had hit the bulls-eye. It's water under the bridge now, but I'm going to keep reminding everyone about my shallow fistula.
I learned something else during Saturday's dialysis session. Apparently, the dialysis machines can be programmed to pull fluid gradually instead of pulling an equal amount of fluid each hour. I think most people set the machine up for the latter scenario.
The last two times that Pam has put me on, however, she told me that she set the machine up to pull a lesser amount of fluid in the beginning, more in the middle of my time, and then less during the last hour. Both times she ran this profile on me, I was able to make it through the entire session without cramping, which results in me asking to have the machine turned off. As a result, I don't always get the fluid off that we set out to remove for the day.
So, I'm sure this will be another opportunity for me to endear myself to the staff at the clinic. Asking for this profile to be run on me will probably make a couple of the staff mad at me. Too bad!
Showing posts with label fistula. Show all posts
Showing posts with label fistula. Show all posts
Monday, August 15, 2011
Saturday, July 23, 2011
Taking the Fistula Off the DL
I met with Dr. Feldhaus Thursday, and he gave me the thumbs up for getting back to using my fistula. That's great news.
I shared that news with the nurses at the dialysis clinic this morning, so they will resume sticking me on Monday. The only bummer in this deal is that they are going to go back to square one, which means the smallest needle and they are only going to use one needle. I'm sure this approach is the safest, but from where I'm sitting, it's a baby step. I guess if everything goes fine on Monday, I should be back to two needles by Wednesday.
Yes, for the next couple of weeks, my dialysis schedule gets turned around, so I can sit in on some meetings at work, and take part in the Bix, a 7-mile race held in Davenport. The race is next Saturday morning. I'm running four miles without any problems, so I don't anticipate any problems with next week's run. I'm going to run the full distance tomorrow morning and then take a short run Tuesday. Once that's finished, I'll rest until race time.
So, today will be my last day of typing with two hands during dialysis. It will slow me down some, but it's well worth it.
I shared that news with the nurses at the dialysis clinic this morning, so they will resume sticking me on Monday. The only bummer in this deal is that they are going to go back to square one, which means the smallest needle and they are only going to use one needle. I'm sure this approach is the safest, but from where I'm sitting, it's a baby step. I guess if everything goes fine on Monday, I should be back to two needles by Wednesday.
Yes, for the next couple of weeks, my dialysis schedule gets turned around, so I can sit in on some meetings at work, and take part in the Bix, a 7-mile race held in Davenport. The race is next Saturday morning. I'm running four miles without any problems, so I don't anticipate any problems with next week's run. I'm going to run the full distance tomorrow morning and then take a short run Tuesday. Once that's finished, I'll rest until race time.
So, today will be my last day of typing with two hands during dialysis. It will slow me down some, but it's well worth it.
Saturday, June 25, 2011
Fistula Follow-up
I had my follow-up appointment with Dr. Feldhaus on Thursday afternoon. He was pleased with how everything sounded, and as I went through my list of questions with him, I got a better explanation of what he actually did last week during surgery.
First, it turned out that my fistula wasn't completely trashed. He was able to clear the clot and open the fistula up. In doing that, however, he had to cut away an area where the vein and artery are joined together. Rather than stretch the two so tightly to join them, Dr. Feldhaus used a small piece of graft material to join the vein and artery together. This allowed the rest of my fistula to work as before.
I found this to be great news, because I thought that my fistula was doing really well, at least before it was infiltrated. Which brought me to the last question on my list for Dr. Feldhaus.
Was my fistula damaged by a careless tech, or was it still not developed? He didn't beat around the bush with his answer. He said he and his fellow surgeons see this kind of thing all the time. Now, he didn't think anyone deliberately did anything to my arm, but he did tell me he hears stories all the time about this kind of thing happening, and he sees the results.
I go back to see Dr. Feldhaus in a month. Hopefully by that time, the last little bit of swelling will be gone, and he will give the okay for the clinic to begin using my arm again for dialysis. Ultimately, that's the thing that matters most to me. Starting back with my fistula means we're getting closer to removing the catheter.
First, it turned out that my fistula wasn't completely trashed. He was able to clear the clot and open the fistula up. In doing that, however, he had to cut away an area where the vein and artery are joined together. Rather than stretch the two so tightly to join them, Dr. Feldhaus used a small piece of graft material to join the vein and artery together. This allowed the rest of my fistula to work as before.
I found this to be great news, because I thought that my fistula was doing really well, at least before it was infiltrated. Which brought me to the last question on my list for Dr. Feldhaus.
Was my fistula damaged by a careless tech, or was it still not developed? He didn't beat around the bush with his answer. He said he and his fellow surgeons see this kind of thing all the time. Now, he didn't think anyone deliberately did anything to my arm, but he did tell me he hears stories all the time about this kind of thing happening, and he sees the results.
I go back to see Dr. Feldhaus in a month. Hopefully by that time, the last little bit of swelling will be gone, and he will give the okay for the clinic to begin using my arm again for dialysis. Ultimately, that's the thing that matters most to me. Starting back with my fistula means we're getting closer to removing the catheter.
Saturday, May 21, 2011
Attitude Test
I believe we are always tested. It could be in our work, it could be at home, or it could be with our health. I've always believed that how we face our challenges matter more than the challenges themselves. To date, I feel like I've handled the health tests pretty well. Certainly better than some of the other tests I've faced!
Dialysis with the catheter was fairly uncomplicated, and the adjustments I needed to make with the catheter hanging from my chest weren't the end of the world. Back in December I had a fistula placed. This was a pretty cool experience, and in the weeks following the placement, it was quite the show and tell item with my friends and family!
The fistula is a merging of an artery with a vein.That merger created a buzz within my arm that people are either fascinated by or uncomfortable with. As it developed, the buzzing was more prominent, a good sign that it was strong and going to be great for dialysis when the time came to tap into it. The official term for this buzzing is "the thrill."
Once I cleared all the checks from the surgeon who placed it for me, we were ready to give it a whirl. The staff at the clinic were looking forward to using it too. It was the beginning of the process of getting the catheters removed.
They start you out slow, with a small needle, and gradually work their way up to a bigger needle. All the while, the fistula is still maturing. The plan would be that once I used each needle three times in a row with no drama, I could move to the next size needle. Three more times with no drama, and we move up to the big boy needle. Running good with the big boy needle means make an appointment with the surgeon, because the catheter is on its way out.
Well, as we know, things don't always go as we plan them. The first time the tech tried to access the fistula it infiltrated. That's bad, because it means the needle went through the fistula. My first clue that something was wrong that day was the tech saying, "oh crap." Trust me, this is not something you want to hear from someone sticking a needle into you. In less than the time it took to say "oh crap," my arm swelled up, giving me an arm like Popeye! This wasn't good.
With that, I was hooked up to the catheters. The debut of my fistula was not going to be on this day. The nurses and techs were all nice and supportive. "This happens" is what they all said. Initially, I was down about what happened, but I had to trust the expertise of the people around me, so I accepted that this kind of thing truly did happen, and went to work on getting the swelling down on my arm.
It took almost a month before the selling and bruising cleared up enough for the second attempt. On that second attempt, a different tech tapped into my fistula. Eureka! It worked. I was back in business.
I made it through the small needle with no problems for my required three times. It was time to graduate to the medium size needle. This move was also successful, so three more turns at the trough with the medium needle, and I would graduate to the big boy needle.
The first time with the big boy needle wasn't very productive. There was no infiltration, but there was also no blood. I knew I had blood in me, but I wasn't getting poked in the right part of the fistula to do the deed. So, back to the medium size needles for a few more times. The medium needle continued to work just fine.
One of the techs thought that maybe things would go better if I had a fistula gram to make sure everything with my fistula was fine. The main thing was to make sure it hadn't narrowed or clotted. So, I got my appointment for a Friday afternoon and had my fistula examined. The fistula got great reviews from the surgeon who looked me over, and I was sent on my way, confident that the next time they tried to use the big boy needle, everything would go well.
It did. I cruised through my three swings with the big boy needle. I may have even gone a few extra times just for good measure. Finally, I got the okay to make my appointment to have the catheter removed. May 25 was going to be independence day.
I came into dialysis on May 10 excited about the possibilities of washing my hair in the shower without a cape and a towel draped over my shirt to keep the catheter dry. I settled in to my chair, anticipating another smooth day of dialysis. The first needle went in just fine. As the tech was getting ready to start the second needle, some of the other staff were talking with one of the other patients across the way.
There was some laughter, and one of the other techs said something to the tech that was working on my arm, and as the second needle was going in just fine, the tech's ears perked up and she gave one more push into my arm with the needle and I felt it happen.
It was a sting in a place where there isn't supposed to be any pain. I looked down and saw the area around the needle start to swell. Another infiltration. There was no "oh crap" this time. I don't remember what, if anything, was said. All I knew was that my goal of getting the catheter removed was fading into the sunset. I looked at my arm, and I was pleased to see the swelling wasn't as bad as it was the first time this happened.
I ran that day with one needle and one catheter line. I got ice for my arm right away, so I was hopeful the swelling would subside. When I came back fro my Thursday appointment, I thought the swelling had gone down enough to try again. The nurse agreed, so she tried again. The lower needle worked fine,but nothing was happening with the top needle. My arm started to swell again. Time for more ice.
Now I was angry. Not at the nurse. No, I was convinced that the infiltration that happened on my earlier visit that week was caused by operator error. I was sure that the tech that day was distracted by all the fun happening away from my chair. A little more focus and maybe I wouldn't be getting my arm iced.
I shared my frustration with the Nurse Manager, and she did what she was supposed to do. She stood up for her tech. I expected that, but I mostly just wanted to be heard. Despite having the opportunity to vent, I still couldn't let it go. I was back in the chair the next day (my wife and I were going out of town for the weekend), running with both catheters. My anger continued to build as the techs continued to tell me that my fistula probably wasn't developed enough for the bigger needle. Really? The two weeks of running fine don't count for anything? Was it a fluke that I was running well all that time? I couldn't get my head around that at all.
It didn't take long for my body to pick up on all of this anger, and my reward for this really positive outlook I was carrying around, was to get sick. More good news! As I write this entry, I'm still coughing a bit, but I think I"ll be better on Monday. I'm done being angry, although writing about this again has stirred up some of those earlier feelings. These things happen is the way I've got to face this.
One of the nurses thinks my fistula is clotted. That sounds bad, but that can be corrected. I see the surgeon next week, and I'm thinking now he will be making another appointment to get in there and correct the problem. I'm not overly excited about this, but it's better than waiting for my arm to come around on its own, when it's looking like it won't.
So, as another day of dialysis winds down, I'm looking forward to the resolution of this latest drama. The quality of my dialysis has been great since using the fistula. If I can't tolerate the big needle, which is possible, I should be able to do just as well with the medium sized needle. If that's the case, I'll be making that appointment for removing the catheter sometime in July.
I'm crossing my fingers. In the meantime, I have some other cool stuff happening in June that will help me re-focus.
Dialysis with the catheter was fairly uncomplicated, and the adjustments I needed to make with the catheter hanging from my chest weren't the end of the world. Back in December I had a fistula placed. This was a pretty cool experience, and in the weeks following the placement, it was quite the show and tell item with my friends and family!
The fistula is a merging of an artery with a vein.That merger created a buzz within my arm that people are either fascinated by or uncomfortable with. As it developed, the buzzing was more prominent, a good sign that it was strong and going to be great for dialysis when the time came to tap into it. The official term for this buzzing is "the thrill."
Once I cleared all the checks from the surgeon who placed it for me, we were ready to give it a whirl. The staff at the clinic were looking forward to using it too. It was the beginning of the process of getting the catheters removed.
They start you out slow, with a small needle, and gradually work their way up to a bigger needle. All the while, the fistula is still maturing. The plan would be that once I used each needle three times in a row with no drama, I could move to the next size needle. Three more times with no drama, and we move up to the big boy needle. Running good with the big boy needle means make an appointment with the surgeon, because the catheter is on its way out.
Well, as we know, things don't always go as we plan them. The first time the tech tried to access the fistula it infiltrated. That's bad, because it means the needle went through the fistula. My first clue that something was wrong that day was the tech saying, "oh crap." Trust me, this is not something you want to hear from someone sticking a needle into you. In less than the time it took to say "oh crap," my arm swelled up, giving me an arm like Popeye! This wasn't good.
With that, I was hooked up to the catheters. The debut of my fistula was not going to be on this day. The nurses and techs were all nice and supportive. "This happens" is what they all said. Initially, I was down about what happened, but I had to trust the expertise of the people around me, so I accepted that this kind of thing truly did happen, and went to work on getting the swelling down on my arm.
It took almost a month before the selling and bruising cleared up enough for the second attempt. On that second attempt, a different tech tapped into my fistula. Eureka! It worked. I was back in business.
I made it through the small needle with no problems for my required three times. It was time to graduate to the medium size needle. This move was also successful, so three more turns at the trough with the medium needle, and I would graduate to the big boy needle.
The first time with the big boy needle wasn't very productive. There was no infiltration, but there was also no blood. I knew I had blood in me, but I wasn't getting poked in the right part of the fistula to do the deed. So, back to the medium size needles for a few more times. The medium needle continued to work just fine.
One of the techs thought that maybe things would go better if I had a fistula gram to make sure everything with my fistula was fine. The main thing was to make sure it hadn't narrowed or clotted. So, I got my appointment for a Friday afternoon and had my fistula examined. The fistula got great reviews from the surgeon who looked me over, and I was sent on my way, confident that the next time they tried to use the big boy needle, everything would go well.
It did. I cruised through my three swings with the big boy needle. I may have even gone a few extra times just for good measure. Finally, I got the okay to make my appointment to have the catheter removed. May 25 was going to be independence day.
I came into dialysis on May 10 excited about the possibilities of washing my hair in the shower without a cape and a towel draped over my shirt to keep the catheter dry. I settled in to my chair, anticipating another smooth day of dialysis. The first needle went in just fine. As the tech was getting ready to start the second needle, some of the other staff were talking with one of the other patients across the way.
There was some laughter, and one of the other techs said something to the tech that was working on my arm, and as the second needle was going in just fine, the tech's ears perked up and she gave one more push into my arm with the needle and I felt it happen.
It was a sting in a place where there isn't supposed to be any pain. I looked down and saw the area around the needle start to swell. Another infiltration. There was no "oh crap" this time. I don't remember what, if anything, was said. All I knew was that my goal of getting the catheter removed was fading into the sunset. I looked at my arm, and I was pleased to see the swelling wasn't as bad as it was the first time this happened.
I ran that day with one needle and one catheter line. I got ice for my arm right away, so I was hopeful the swelling would subside. When I came back fro my Thursday appointment, I thought the swelling had gone down enough to try again. The nurse agreed, so she tried again. The lower needle worked fine,but nothing was happening with the top needle. My arm started to swell again. Time for more ice.
Now I was angry. Not at the nurse. No, I was convinced that the infiltration that happened on my earlier visit that week was caused by operator error. I was sure that the tech that day was distracted by all the fun happening away from my chair. A little more focus and maybe I wouldn't be getting my arm iced.
I shared my frustration with the Nurse Manager, and she did what she was supposed to do. She stood up for her tech. I expected that, but I mostly just wanted to be heard. Despite having the opportunity to vent, I still couldn't let it go. I was back in the chair the next day (my wife and I were going out of town for the weekend), running with both catheters. My anger continued to build as the techs continued to tell me that my fistula probably wasn't developed enough for the bigger needle. Really? The two weeks of running fine don't count for anything? Was it a fluke that I was running well all that time? I couldn't get my head around that at all.
It didn't take long for my body to pick up on all of this anger, and my reward for this really positive outlook I was carrying around, was to get sick. More good news! As I write this entry, I'm still coughing a bit, but I think I"ll be better on Monday. I'm done being angry, although writing about this again has stirred up some of those earlier feelings. These things happen is the way I've got to face this.
One of the nurses thinks my fistula is clotted. That sounds bad, but that can be corrected. I see the surgeon next week, and I'm thinking now he will be making another appointment to get in there and correct the problem. I'm not overly excited about this, but it's better than waiting for my arm to come around on its own, when it's looking like it won't.
So, as another day of dialysis winds down, I'm looking forward to the resolution of this latest drama. The quality of my dialysis has been great since using the fistula. If I can't tolerate the big needle, which is possible, I should be able to do just as well with the medium sized needle. If that's the case, I'll be making that appointment for removing the catheter sometime in July.
I'm crossing my fingers. In the meantime, I have some other cool stuff happening in June that will help me re-focus.
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