Tag Fistula

Caution: Rough Road Ahead

Michael 9 Comments

I don’t think I’ve ever started a post apologizing for not posting. As much as I find myself an interesting fellow I can’t imagine any of you (if there are any of you still reading) working yourself into a lather because I’ve deprived you of my drivel these many days. But that’s just it. It’s been many days. Many more than I’ve ever gone without posting unless I was unconscious in a hospital bed. That’s just plain rude so for that I apologize.

Technically though, I have been unconscious in a hospital bed but just for a couple of hours. And I’ve been awake on a hospital bed a few days but not any of them in a row. Let me start in the middle for you and maybe that will clear things up.

When we last left our kidney transplant journey there were potential donors being poked and prodded, tested and vetted. They still are but all are nearing their finish lines. Will any be found as able as they are willing? The best I can say is we’ll see.

Until then, dialysis continues to be the means by which my own, slightly overworked and underappreciated kidneys are given a hand doing what they used to do best. Smoothly is generally not a term used to describe how dialysis goes. And it isn’t. Three weeks ago at an anything but routine dialysis session (routine also not descriptive of the dialysis procedure) my fistula imploded. You remember my fistula. It’s a pair of blood vessels surgically connected then anchored just below the skin so the dialysis nurse can shove two needles about the size of ball point pen cartridges into the arm to get the blood to and from the dialysis machine. Repeated stabbings cause scarring and plaque to build up inside the fistula and about every six months the surgeon runs a catheter through my arm by which he can clean things up in there. There is a fairly descriptive description (which is truly the best kind of description you can have) along with a couple truly disgusting pictures (and when describing a fistula, disgusting is truly the best description you can make) in a post from earlier this year.

Even with careful maintenance, sometimes the fistula just fails. That’s what happened to mine on November 6 which just happened to be the day after the last day I posted anything. Coincidence? Umm, not really. After repeated attempts to get a needle seated properly in the fistula with nothing but resistance to show for it, the nurse declared my arm a no dialysis zone. Unfortunately that did not give me carte blanche to swap the dialysis recliner with a seat at the Chinese restaurant down the road although lunch would have been welcome since I rushed through breakfast in order to participate in the American election process. Instead I was able to swap that chair for a bed at the hospital outpatient surgery area and await an emergency clearing of the fistula.

To make a long story short (I realize I’ve already exceeded that marker but it sounds good and I rarely get to use that as an opening line), after two more attempts with equally poor results, everyone admitted that the fistula was no longer a viable and a temporary catheter was tunneled into the right external jugular vein. It was during that procedure I had my previously noted period of unconsciousness in a hospital bed. (I get to be awake during the cleaning procedure, known as a fistulagram, and can actually watch the progress. It’s fascinating stuff but I’d still rather see a Bond, James Bond movie any day of the week.)

CVCThe unfortunate thing about dialysis catheters is that unlike say administration ports one might receive chemo through, they terminate outside the body and do so on a pair of tails. I’m posting a drawing so you can better see what I am trying to describe. (I could take a picture of my actual catheter but it’s not a selfie I’m anxious to snap and if you just type “dialysis catheter” into your favorite search engine you’ll get no end of new disgusting pictures to peruse at your leisure.) The part of the catheter inside floats and can actually be felt depending in where the tip resides at any particular moment. Reaching for anything higher than one’s shoulder, which given my modest height is anything off the counter, means moving the catheter around in there, also rather obviously noted. And because there is really no good way to anchor the outside tails, any movement or position change comes with a reminder that there is a part of you that isn’t really a part of you.

Fortunately I have the opportunity to be unconscious in a hospital bed again next Thursday when a new fistula will be fashioned into my other arm and I’ll get to have the catheter removed as soon as the new fistula completely heals and toughens enough for dialysis use. That shouldn’t be much after Ground Hog Day.

Just because I was having so much fun at the hospital, last Thursday when I was preparing to return to the world of blogging, I received a call from the dialysis center. The labs drawn earlier returned with a critically low calcium level endangering my health on any number of levels and I was instructed to return again to the hospital, this time to the emergency room where orders would be waiting to repeat the test and administer IV calcium if still returning a lower than normal level. It was, they did, and I got to recline on the sixth hospital bed (but conscious for five of them!) in 11 days.

And you thought getting on a transplant list was going to be boring between the listing and the planting.

Related Posts:

Transplant Journey Posts

First Steps (Feb. 15, 2018)
The Next Step (March 15, 2018)
The Journey Continues (April 16, 2018)
More Steps (May 31, 2018)
Step 4: The List (July 12, 2018)
Step 1 Again…The Donor Perspective (Sept 6, 2018)
And The Wait Goes On (Oct. 18, 2018)

Other Related Posts

Walk This Way…or That (March 9, 2017)
Looking Good (May 18, 2017)
Technical Resistance (May 25, 2017)
Those Who Should Know Better (July 24, 2017)
Cramming for Finals (May 3, 2018)

 

 

My Day

Michael 6 Comments

I’ve never done a “day in my life” post and you should be thrilled. Unfortunately, all good things must end and your thrill just ended.

Today is not a just any old day in my life though. Today I went to the hospital. For the first 57 years of my life I never spent a night in a hospital unless I was working there. I never even had an outpatient procedure until I was 55. Wait. That’s not completely true. I was born in the fifties in the USA where childbirth was a minimum three day hospital stay. But after that, all my sleep was in my own bed or one of my choosing. Ok, that’s not 100% true either. There were some nights the U. S. Army insisted I spend away from my favorite pillow. But otherwise…

ADIL

Back to today. Don’t worry. It won’t be that traumatic an event. We’re just going for a simple procedure to open the fistula used for my dialysis. A fistula is a piece of artery and one of vein sewn together and pulled to just under the skin so the dialysis nurse can more easily jam a pair of needles roughly the size of a ball point pen into it. With all the puncturing and high velocity blood flow, the inside of the fistula scars and it slowly narrows, raising the pressure of the blood flow through it, decreasing the efficiency of the dialysis treatment. To correct this, because my fistula is in my upper arm, the surgeon will cut a small hole and enter the vein just below the fistula and thread a catheter through the vein into the fistula. This will be tracked by a scanner mounted over my arm transmitting images to a monitor above me. Once the physician finds the narrowed space he’ll pass a balloon into the catheter, up to the fistula and inflate it, pushing the occlusion against the vessel wall. (If that sounds like what you’ve heard as coronary angioplasty that’s because it’s the same procedure except on a fistula rather than a coronary artery.) While all this is happening I’ll be half asleep making incoherent conversation with the surgeon. It’s ok. He’s a friend.

MPH

Breakfast

I woke up a little after 6 showered (no, no pictures there), dressed comfortably, and got breakfast. This morning’s breakfast was two mycophenolate capsules and a sip of water since I will be anesthetized to the point of being half asleep. About 8:30 my sister came to take me to the hospital. She will be my accompaniment for the day since I will be anesthetized to the point of being half asleep. Because we’re Italian she brought food.

Traffic was light and we got to the hospital a few minutes after nine for my 9:30 report time. The nice lady in registration breezed me through and sent me off to the outpatient department with a stop at the lab for a quick blood draw. We arrived in the outpatient department at 9:45. By 10:05 I was changed into a hospital gown (still no pictures), had vitals recorded, an IV started in my left wrist, and left to wait for someone from the cath lab to come get me at 11:30. This was a boring 85 minutes and I read the paper. Did I mention it was boring?

 

Fistula_Before

Before

At 11:40 I got picked up for the procedure I already described, it went off without a hitch, and I went back to my room in the outpatient department where they said I looked great, go home.

Fistula_After

After

We went home, had lunch (a late lunch since it was then 2:30) my sister went home and because we’re Italian, I gave her food. Then I sat down and wrote this.

You know what? These things are really dull. Who came up with this idea anyway? In case you’re wondering, I am now just wonderful and when I go back to dialysis I’ll have the smoothest flowing blood of anyone there.

And you heard it here first!