Colonoscopy Prep Day

Okay, I started the process. I haven’t drank any of the solution yet; I just added water to the provided jug and put it in the refrigerator. There was a lemon flavor packet stuck to the jug. I debated whether or not to add it but based on some Internet browsing, I put in the flavoring right before mixing it.

The time is about 1:00 pm. I’m leaving for dialysis at 4:30 pm and will hopefully be done by 9:00 pm. I will start on the solution as soon as I get home. I’m supposed to drink 8 oz every 10 minutes and it takes about an hour to start working. Assuming that what goes in comes out and directions says to drink 2 liter tonight. The entire jug holds four liters so two liters is ~68 oz or about 8 1/3 cups. That means it should take about 90 minutes or an hour and a half to drink all of it, and two and a half hours for it to flush though. Hopefully I can get about 3 hours of sleep before getting up again to drink the rest of the solution.

So far, I’ve only had some sips of water and a small bag of CapriSun apple juice. I just opened a can of 7up plus another bag of apple juice to mix. Right now I’m about 80.0 kg with a sweatshirt on so I don’t have much more room for fluids prior to dialysis.

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It’s 8:56 pm and I’m back home from dialysis. I’m mentally prepping myself to start drinking the Golytely solution at 9:00 am. My parents bought me a container of apple & white grape juice. I think I’ll drink some then use it as a mouth rinse after each cup. Or maybe I should use mouthwash?

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Okay, first cup down. I followed it by a sip of the apple & white grape juice, then a quick rinse with 10 year old Scope mouthwash. Before starting, I weighed myself with sweatpants and slippers at 78.4 kg. I want to make sure that I don’t weigh a lot more at the end of the process. I drank the first cup at 9:10 pm and set an 10 minute timer on my Apple Watch.

Truthfully, there wasn’t much taste. There was a hint of lemon flavor but it was mostly water so pretty bland. Maybe I’ll drink slower and try to taste some of it next cup.

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9:24 pm and second cup gone. Really, it doesn’t taste that bad. The only weird feeling so far is drinking that much fluid after being on fluid restrictions for the past 3 years.

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9:37pm and third cup gone. I just weighed myself at 79.3 kg. I probably drank about 800 mL of the solution so there is a bit of the juice as well. I don’t feel much yet. There are some very slight rumblings in my stomach but I don’t know if that’s from the solution or from hunger. Instruction says it may take an hour to feel the effects.

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I’ll keep it short. Had a bowel movement after about 1 1/2 hours. Was on toilet for 20 minutes. I am a bit worried since the first round seems to be over. I only drank seven 8 oz cups so not exactly 1/2 the prep solution. I’m stopping anyway so I can get some sleep and continue tomorrow morning. My weight now is 79.4 kg after drinking about 1.75 liters of the solution so about a liter of water was absorbed. I could be hallucinating but I think I’m getting a slight swelling in my lower leg and ankles. If that repeats tomorrow, then I’ve used up two liters of my fluid allowance for prep even though it’s suppose to go right through you.

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It’s 2:58 am and I just started round two of drinking the prep solution. I ended up going to the bathroom several times during the night but was able to sleep for a few hours. I just weighed myself and like magic, I am back at 78.4 kg, so all the solution either was metabolized or excreted (more likely). Now I have to finish the remaining solution and hope it all passes through me by the time I have to leave the house.

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I ended up drinking eight cups of the solution and left one cup behind. This time, the reaction seemed to come much faster. It pretty much tapered off by 5:00 am so I was able to get another hour of sleep. My final weight was 78.4 kg again so likely I did not absorb any of the water in the solution.

Liquid Diet

On the back of the pre-procedure for the colonoscopy, there is a liquid diet guide. I scanned the page thinking that I would embedded it here, but default WordPress does not have a PDF block option, and my scanner only outputs PDFs. Good thing it auto-OCRs the document so I can copy/paste most of it.

Do NOT take any RED, ORANGE or PURPLE colored products

You MAY have BLUE, GREEN, YELLOW & APPLE JUICE color as clear liquids

Ugh, more of the ALL CAPS, bold, and underline style of formatting. Further down the page, they list several FOOD GROUPS:

Fruit Juices	Apple, white grape, white cranberries, pear and pineapple (no pulp)
Beverages	Sodas such as Ginger Ale, Sprite, 7up, Sierra Mist, Mountain Dew, green tea, Gatorade, PowerAde, Propel, Kool Aid, lemonade (Crystal Lite, Country Time Lemonade or Minute Maid) must be strained (NO PULP) and drinking water. NO COFFEE at all
Soup	CLEAR chicken, vegetable broth or bouillon
Desserts/Sweets	Popsicles, frozen juice bars, flavored JELLO, Italian ice, sorbet and hard clear candy (jolly ranchers as an example)
Seasoning	Lemon juice, honey, sugar

The closest item to “food” is probably chicken broth, although I’ve never had it by itself versus as part of a soup or dish. I’m getting some white grape juice and we have some Sprite/7up in the house. Looks like I can’t have any of the dialysis protein drinks. We also have lots of JELLO power so I can make a lot of that, but it’s mainly cherry or strawberry flavored so it’s RED.

I’ll probably just drink water or suck on ice for the next 24 hours.

Colonoscopy Prep Tomorrow

Since I’m sharing too much information already, here’s the actual instructions from the prep sheet:

DAY PRIOR TO PROCEDURE
Begin a clear liquid diet from the moment you wake up in the morning
Prepare your solution according to the direction on the container and refrigerate
Be sure to drink an extra 8oz of clear liquid every hour from 11am to 5pm (Gatorade preferred) to keep hydrated, it can be more than 8 oz.
At 6pm begin to drink prep solution 8 oz every 10min until 1/2 of it is consumed
Place remainder of the solution into the refrigerator

GAS TABLET
9pm take 2 gas tablets with 8oz clear liquid
10pm take 2 gas tablets with 88oz clear liquid

Continue drinking clear fluid until bedtime/midnight

DO NOT TAKE ANYTHING BY MOUTH AFTER MIDNIGHT
Except the morning dose of the prep.
Beginning 4 hours before your arrival time drink the remaining solution: 8oz every 10 minutes until solution is gone.

Do take BLOOD PRESSURE and/or HEART MEDICATION the morning or procedure with a SIP of water.
all other medications hold until after the procedure.

HAVE NOTHING BY MOUTH 3 HOURS BEFORE YOUR ARRIVAL TIME.

First, as a former “professional” typesetter (I worked at an advertising agency part-time for one year while in school), the formatting (bold/italics/capitalization/spacing) drives me crazy. I think they wanted to highlight certain points but there are only a few lines of instructions. The inconsistent formatting actually makes the page look chaotic and harder to read. Not what you want for a list of medical instuctions.

Second, my procedure arrival time is 7:00 am on Tuesday, so I moved my dialysis session to Monday (tomorrow) at 5:00 pm to 9:00 pm. I’m afraid the prep solution will cause diarrhea in order to flush out your GI tract so I can’t start taking the solution until after 9:30 pm. I have to push back the prior day schedule by 3+ hours but still get up at 3:00 am Tuesday morning to finish the prep solutions. I think I’m going to take tomorrow off from work, sleep the entire day, and just stay up after dialysis until I’m done with the procedure the next morning. Probably will spend the entire time sitting on the toilet anyway.

Finally, as I mentioned before, that’s a lot of fluid intake. I finished dialysis at 78.4 kg yesterday so I’ll drink until I get to ~80.5 kg since I don’t want more than 3,000 mL of UF at dialysis, especially if it may be a shortened session. Hopefully I will feel well enough after the procedure to pig-out for lunch Tuesday.

30 Second COVID Test

Well, that was much easier than previous tests. Instead of jamming the swab into my brain, they just swabbed the inside of my nostrils for 10 seconds on each side. It was super fast and didn’t hurt at all. Still, the drive there and back took ~45 minutes.

I do have to complain about the test site however. They set up a large, drive-thru tent in the parking lot. The issue was that there were confusing signs everywhere. I believe there was another testing site for another insurance company (Optum) in the same parking lot. That site is not operating but they left all the traffic cones and signs in place. Each of the entrances to the parking lot had an Exit Only sign, and the only sign with clear directions was facing away from the street; you can only see it if you turn in to the parking lot while ignoring the exit signs. I got to the parking lot ten minutes early for my 9:30 am appointment and was still five minutes late to the tent.

They also gave me an instruction sheet that contains a section called Self-isolation Instructions. There is one bullet that says:

If you have other medical appointments, schedule them for before your test or for after your scheduled surgical procedure.

Since they scheduled the test so early, I still have three dialysis sessions to attend before my procedure, and there’s no way I can skip them, especially when I’m supposed to guzzle all that fluid beforehand. The other points on the list are not as bad as the directions I received post-COVID test for my cardiac ablation procedure.

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With the bad results from the fructosamine test, now I’m more worried the colonoscopy. Each new test seems to bring more bad news. 😫

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I just realized that my dashcam captured me gettin lost in the parking lot. If I can figure out how to embed videos in WordPress posts, I’ll include it later.

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And that’s a no. I have to upgrade to WordPress Premium to be able to upload my own videos. I can always upload videos to my YouTube account then embed them in my post, but then I would lose the little bit of anonymity that I still have on this blog.

Colonoscopy Prep

Since I’m getting the related COVID test tomorrow, I went over the pre-procedure preparation instructions. On the day before the procedure, I can only have a clear liquid diet, and they want me to drink 8 oz of Gatorade every hour from 11:00 am to 5:00 pm. First, that’s about 1.5 liters of fluid that I have to get rid of through dialysis, and Gatorade is high in electrolytes like potassium and phosphorus. I also have to mix 4 liters of the Golytely solution and drink 1/2 of it that night and 1/2 of it starting at 3:00 am the next morning. All together, I’m supposed to drink ~6 liters of fluids in the 12 hour before the procedure. They must not have considered fluid restrictions for dialysis patients in their instructions. Multiple people said the Golytely is to flush your digestive tract so none of it should be absorbed. That still leaves about 2 liters of extra fluid. I guess I have to stop drinking right after dialysis on Saturday and hopefully the rescheduled Monday session will be able to remove enough excess fluids. Having fluids in your chest cavity and not being able to breathe sucked.

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From this paper, it appears that the incident rate for colorectal cancer in Asian males is 37.8 per 100,000 people. That’s not very much at all but I haven’t had the greatest luck with health issues.

Another COVID Test

In preparation for my colonoscopy procedure next Tuesday, the surgical center is requiring me to get a COVID test tomorrow. That means I have to “quarantine” myself at home afterwards for an entire week. They also made the appointment pretty far away in Santa Ana, near the IKEA store. That’s a 30 minute drive from my house and may take longer since the appointment is at 9:30 am. Seriously, it’s a drive through test site so I’ll be there for under 3 minutes but will spend an hour commuting. I hope its the saliva test and not the jam-a-swab-up-your-nose test.

Since I have to go to dialysis, I don’t know how effective my “quarantine” will be. I typically don’t go anywhere else anyway so I don’t anticipate any changes to my routine.

Dialysis Surgical Procedures

I was replying to a Reddit post on r/dialysis, and for some reason, I started counting the number of surgical procedures I had related to dialysis. Here’s the list:

First chest HD catheter in (July 2017)
PD catheter in (April 2019)
First chest HD catheter out (June 2019)
Second chest HD catheter in (November 2019)
PD catheter out + fistula in (January 2020)
Fistulagram (August 2020)
Second chest HD catheter out (September 2020)

All of these were outpatient procedures, except for putting in the second chest catheter. I was already in the hospital for my heart surgery, otherwise it would have been done in a few hours total. All together, I was under full anesthesia for only two items on the list that included the peritoneal dialysis catheter. The last one is best. A physician assistant didn’t know I was on a blood thinner so he just cut some sutures and yanked the chest catheter out. Blood spurted out of the chest opening and he freaked out a bit.

One-Year Post-Surgery

It’s been a year since my open heart bypass surgery. The surgery was on November 14, 2019. I think they started at around noon and I woke up at 1:30 am the next day. I was on the operating table for about seven hours and it took another five to wake up. I was technically “dead” during the surgery since they had to stop my heart and lungs to operate but I don’t remember anything. One moment I was getting wheeled into the OR, and the next moment I was trying to wake up.

I guess you can call it a second birthday since I would probably be dead now if I didn’t have the surgery. From the ER lab results and subsequent stress test and CAT scan, I probably had a heart attack days or weeks prior to the surgery, and would like had more if they didn’t replace my clogged arteries. However, it has been a difficult year, made much worse by COVID-19. I had my diabetes under control for a few years but being on dialyis and being post CABG surgery just makes me doubly at risk. For the past nine months, I’ve been at home or at dialysis, with probably less then a dozen other outings: sister’s house, work, last Thursday’s church cell meeting, etc. Not a good start on a new life. I was all gung-ho about recovery a year ago. I seriously thought I would be running 5k or 10k races after a year, but I didn’t count on all the subsequent heart issues like a-fib and pulmonary edema. Now I’m looking forward to another “birthday” when I get a kidney transplant, hoping that will be the “real” start of a new and healthier life.

Fistulagram Medical Claim

Got a statement of benefits from my work insurance regarding my fistulagram procedure on August 21st. The whole thing was billed at $14,261, and the Medicare rate was $5,744. My work paid 20% of that, which was $1,149. Again, not really knowledgeable about medical costs so I don’t know if that’s a fair price. I did spend a bit of time in the hospital, and was in an intervention radiology operating room with several OR nurses. However, this only covers the hospital portion. I’ll probably get another bill/claim from the vascular surgeon. Some of the line descriptions are not very detailed: Outpatient surgery, Medication, Medical equipment and supplies, etc. I wonder if I asked, someone (hospital, Medicare, Blue Shield) will send me a more detailed statement.

Also, I did a drive-thru COVID-19 test on August 18th, prior to the procedure. That was billed at $65 and the reduced Medicare cost was $33.72.

Call From Thoracic Surgeon

My thoracic surgeon, the one that ordered the CT scan, finally called me back. However, he called on a Saturday, and I was sleeping during dialysis so I missed his calls. Plural since he also called my work phone. Basically he said the same thing as my nephrologist: there is fluid in my right lung and it needs to be drained if it’s causing me problems. He also wanted me to call his office today.

I called this morning a left a message with the receptionist. He has two surgical nurses helping him. I usually just speak to one of them but the other one called me back. She said that the doctor was on vacation starting today (maybe that’s why he called me Saturday) and then gave me a synopsis of the CT scan results. Since I told her I was feeling much better since the scan, we decided to wait to see if taking more fluids out during dialysis will solve the problem. Otherwise, if there is still a lot of fluid, they have to stick a long needle in me to drain the fluid. Definitely don’t want that if I can avoid it.

She also said there was another note in the results but she’s not sure what it means. She will consult with the surgeon when he returns form vacation and get back to me. I think it has to do with me feeling and hearing the sternum when I lie flat on my back.

CT Scanned

Well, that was the fastest medical appointment in a long time. My appointment for the CT scan was at 2:15 pm but the radiology lab asked me to check in at 1:45 pm. I arrive on-time and was checked-in within 10 minutes. It helps to have all my medical appointments in one hospital system; I don’t have to regurgitate all my medical data each time. Instead of making me wait until 2:15 pm, the tech came and got me right away. The actual procedure was only three quick scans in the machine. I was done and back in my car by 2:10 pm, before my actual appointment time. It’s definitely less busy in the clinic with COVID-19. The radiology lab was quite crowded the last few times I was there. Today, there were probably only five people in the large waiting area.

The results will be at the thoracic surgeon’s office after 24 hours. Again, I hope it’s nothing serious and won’t require more surgery.

First Catheter Free Night

I just realized that last night was the first night I didn’t have a dialysis catheter sticking out of me in over three years. Since the first chest catheter wast put in on July 3, 2017, I’ve had either a hemodialysis catheter or a peritoneal catheter in me until last night.

It wasn’t very comfortable though. There is still some pain left from pulling the catheter out. I believe the surgery assistant had to cut some flesh that fused (?) with the catheter cuff so that started to hurt when the lidocaine wore off. Also, since I could not lay down flat on my back, I tried to set the bed to the highest recline and sleep sitting up. All that did was to mess up my back. I didn’t get any sleep last night from both the shortness of breath and the catheter removal.

I’m supposd to remove the original bandage at 5:00 pm today. I hope all the bleeding has stopped and the hope is not too big for my bandages. I thought recovery felt easier last time.

Chest Catheter Removed

Second chest catheter removed. It was much easier than removing the first one in the hospital. I went into the doctor’s office, sat in a reclining chair, and the nurse laid me flat. The only problem was she stuck a pillow under my back so to arch my back, but that made breathing 100x harder. I think I was going to pass out a few times. Then the surgeon came in with his assistant, who I’ve met several times. I think the surgeon was more interested in my fistula that he worked on then the catheter (he didn’t put that in). He told me the assistant will remove the catheter, and that I need more fluids taken out since my ankles were swollen. OK, thanks. He’s got to know I’m a dialysis patient and there are literally a team of people watching for edema in my legs.

The assistant, let’s call him “J”, gave me several shots of lidocaine, the wonder local anesthesia, and proceeded to cut the sutures holding the catheter in. I think some of the flesh grew in around the catheter cuff so he had to cut around that too. Then J gave a hard tug, and it was out. Only problem? No one mentioned to him that I was on a blood thinner, and of course no one told me to hold the medication. Blood started squirting out of the opening. I didn’t see this but J told me later. He had to grab a lot of gauze and bandage to stop the bleeding, even asking me to put pressure on the wound. Good thing I didn’t pass out from the lack of oxygen. I was already breathing hard; putting pressure on my chest just made it even worse. Finally, after three gauze changes and lots of pressure bandage tape, the bleeding stopped and I was allowed to get up… and breath. Even thought J tried to wipe it down, there was quite a bit of blood on the chair. After dialysis with the fistula though, I was used to it. No pics this time, I was too busy trying to breath and not pass out. Here’s a photo after the previous catheter was removed if anyone is interested. I assume this one was similar; I didn’t even look afterwards.

Finally, they let me get up and leave, after giving me an instruction sheet. One of the item says: “Do not lay flat for 12 hours after catheter removal to reduce likelihood of bleeding.” Arg! Why did they schedule me for a 4:30 pm catheter removal, knowing that I have to sit upright until 5:00 am the next morning?! I can’t lay flat anyway but they didn’t know that. Other points are pretty normal post-op stuff.

So, another tiny chapter in my life comes to a close. I kinda like the catheter versus the fistula, even though I couldn’t take showers. I heard other people do shower with waterproof tape, bags, and other homemade contraptions to keep the catheter dry. I’m too nervous to try. Maybe that’s why I’ve never gotten an infection after 2.5 years of using the chest catheter. Supposedly I can take a shower after 24 hours, even if the hole in my chest hasn’t fully closed. yet. Hmm… I think I’ll wait. No point having shower water running through a hole and into your chest cavity.

Catheter Removal Later Today

So the chest catheter I got during heart surgery is getting removed today. I’ve had it since November 13th, which is about 9 1/2 months. The first chest catheter I had lasted over 20 months. I felt this time the dialysis staff was more insistent on its removal as fast as possible. Maybe they had some infection cases recently?

The nephrologist doing rounds today came pretty late. I was getting the needles removed when he showed up. I told him about the catheter removal, the upcoming CT scan, and gave him an update on the transplant process at UCLA. I think he knows the doctor I spoke to at UCLA; there was a sign of recognition when I mentioned his name. He also lowered my dry weight again to 86.0 kg and said we may even go to 85.0 kg if I’m okay. He agrees that my ankles are swollen and there may be a few extra kg of fluids in me. That could also affect my blood pressure which has been higher recently. Again, the nephrologist is supposed to be responsible for the dialysis patient’s blood pressure, and he seems the least worried out of all my doctors.

One small bit or worry is that the arterial needle site was bleeding during dialysis again. It’s the third time in a row now. Maybe it’s the blood thinner I’m taking but it does coagulate under the medical tape so it’s not leaking out everywhere. I’m just worried that after today, there won’t be any backup access if the fistula blows up or something. I guess they can always put in a third chest catheter but I’m trying to keep actual holes in my chest to a minimum.

Enough, Make It Stop!

Sigh. Occasionally I have days that are hard to get through. Nothing has changed overnight but I just get fed up about everything. Right now, it’s the heart issues and what seems to be too much fluid in me. I know some people have real scary diseases that cannot be managed. My issues are more like a very slow moving train but it’s hitting new stuff on the tracks. It seems like there is an answer to everything that ails me but the totality is overwhelming sometimes.

For several weeks now, I’ve been having more and more trouble breathing while lying down. For awhile, I could get by sleeping on my right but slowly, that’s not working either. It’s 3:40 am and I haven’t slept one bit. I’ve been trying to get the bed into a position that allow me to breath a bit but have not found it. As soon as my head hits the pillow, I’m gasping for air. Plus the pressure on my chest seems to be increasing as well. I’m pretty positive it’s not the heart itself since I walked 15 minutes on the treadmill last night and felt mostly fine, while bending over to pick up laundry winds me.

Then there’s the swelling in my ankles and feet that seems to be persistent. Post heart surgery, I was pretty bloated and it took a few extra dialysis sessions to bet rid of the excess fluid. Since March, it seems the fluid retention has gotten worse even thought my weight has dropped. I think my real weight (without fluids) is even lower since I’ve been eating a lot less, and I still have too much fluids in me. I haven’t come close to the amount of cramping as before on hemodialysis. Maybe I can ask the nurse to pull more fluids out today, or see if I can talk to a nephrologist since it’s Tuesday.

The current situation is that I run out of breath kind of randomly, probably based more on body position than exertion. My doctor friend thinks it may be the chest wall healing and constricting, while my cardiologist thinks it’s musculoskeletal too. I need to call today to set up that CT scan so the thoracic surgeon can see what happened. The excess fluid is just uncomfortable since I can feel the extra pressure as more nephropathy. I think the danger is that the skin will stretch out and crack, and I’ll get several spots where infections can take hold. Infection of the feet for diabetics is bad news.

3:51 am. Maybe I can sneak in a 30 minute nap before leaving for dialysis. Another week of life in paradise…

Chest CT Scan

Another twist in the healthcare saga. I spoke with the thoracic surgical nurse and explained my situation with the chest scar, keloid, pressure, and weird clicking sounds. She thinks I will need to get a chest CT scan then see the actual surgeon that performed the bypass surgery. They have to call me back to arrange a time for the scan. I asked what it could be and she said it may just be cartilage, for which there is no fix. I also may require additional surgery if it’s something they have to fix.

I can’t believe this news is coming on the same day as the transplant call. If I have to get cut up again, I’ll need to go on hold again and delay transplant for months if not derail it. I can’t win.

Musculoskeletal Issues?

My cardiologist wrote me back late tonight. She has been pretty good with replying to my messages so she must have been busy. Since the shortness of breath doesn’t come when I exercise, it’s probably not coronary artery disease. She thinks it may be musculoskeletal and I should try calling the thoracic surgeon. I guess I’ll call the surgery nurse tomorrow and see if she has any ideas. It is definitely getting worse though. I was at church earlier tonight and just by walking down a set of stairs and across to the first row in the parking lot winded me again. I’m going to walk a bit on the treadmill to see what happens since I haven’t done so in awhile.

I thought the bypass surgery “fixed” my artery issues, at least in the short term. The thoracic surgeon should have bypassed all the clogged arteries during the operation. Unless I clogged some other existing blood vessels or the replacement arteries, I’m not sure what’s going on. Also, it shouldn’t be COVID-19 since I’ve been tested four times since the shortness of breath symptom started.

Finally, the sternum bone movement is most worrisome. I don’t know why this happened all of a sudden. I’m hoping the thoracic surgery people will tell me that this is normal or expected 9-months post surgery and it will pass. With my luck, likely something else is wrong and this will sideline me for a kidney transplant, again. ~~Maybe I’ll never get off dialysis.~~ Ugh, I can’t even think about that.

Sternum Noises

Sigh. Looks like another problem.

For heart surgery, the surgeon cut through my sternum to open up my chest and ribcage so they can have access to my heart. After surgery, they bind the sternum together with wire so the bone will fuse back together. All good, right?

However, since mid-March, I’ve had some shortness of breath, especially when lying flat on my back or walking up stairs. I thought it was related to my a-fib condition but it has continued after my cardiac ablation procedure. I thought it was getting better but now it seems worse. There is definitely a clicking sound and feeling of bone grinding at the base of the sternum when I’m flat on my back. It’s kind of freaky feeling. I didn’t experience this early on during heart surgery recovery when the bones should be moving. Not sure why it’s happening 9 months after surgery. Not even sure who I should contact… my cardiologist or the thoracic surgical nurse?

One problem at a time. First is another dental appointment Monday. Then a video call with UCLA Transplant Center medical director Friday. Then an appointment with the ophthalmologist Monday. I guess then I can call my cardiologist about the sternum and maybe do a Lexiscan since I’m not breathing right. Ugh.

Post-Fistulagram

At first I was going to name the post “Post-Surgery” but it wasn’t really surgery, though the OR was pretty real. I wonder if the cost will be similar to a full surgery.

Since eating the breakfast burrito (with bacon) for breakfast after the procedure, I’ve had no appetite at all. My mom made dinner but I didn’t even go downstairs to check it out. I think it’s all packed away now. I probably need to drink a protein shake or something so my blood sugar doesn’t plummet later tonight.

I’ve also been super tired all day. I thought they only gave me a minimal amount of sedatives but today was the most tired I’ve felt in months. I probably took 4-5 naps after breakfast. I did use another vacation day at work in case the fistulagram became more serious, so I didn’t even look at the emails until late in the afternoon. It’s 10:00 pm now. Let see if I can get any sleep tonight before dialysis.

Fistulagram Done

Today’s hospital visit was fairly quick. I got there at 5:30 am and was done by 9:00 am. Due to the coronavirus, I feel the hospital is more efficient in their check-in procedures since they want to minimize face-to-face contact. In fact, I didn’t have to do any admissions paperwork; it was already in the system or taken care of in an earlier phone call.

A nurse walked me into the pre-op area and even though they were only working on my lower right arm, I was told to change into a hospital gown. I hate hospital gowns since you always freeze to death. At least I got to keep my underwear on. That wasn’t always the case on previous visits. All they did during pre-op was insert an IV line into the back of my hand. And of course, the same thousand questions they ask each time I’m there.

*They must have my allergies in their system yet each time, they seem surprised I’m allergic to heparin. “What happens with heparin?”*

At 7:30 am, a nurse wheels me into the operating room. This time it was different because I was awake throughout the entire procedure. They had me scoot over to the OR table, and at this point, they usually give me general anesthesia and then I’m out. This time, I had to converse with 2-3 nurses, trying to follow them around the room while strapped down to the table (at least my arm was restrained). There was a lot of prep work with shaving, antiseptic, some sedatives in the IV line, and lots of sterile drapes(?) to isolate my arm. It was strange to feel the sedative hit. I felt a bit groggy but managed to stay awake. None of that twilight sleep stuff for me.

The vascular surgeon came in and immediately injected several hits of lidocaine in my arm, then made an incision to insert a ink injecting catheter. I can see the same X-ray video he’s watching on the wall. Next he inserted a balloon catheter and proceeded to widen the artery with the balloon. I think because the lidocaine was injected into the skin, each time he inflated the balloon, it hurt pretty good. He did this three times then I could feel him pulling the balloon catheter out. That’s it. He said the fistula was fine. There was some minor narrowing but the dialysis nurses and techs should have been able to cannulate me easily. I guess he was fixing the high pressure issue with the dialysis machines. He also said that we may need to do this several times, or he may even need to go back in surgically to widen the blood vessel. God I hope the transplant comes through before the fistula acts up again.

They then wheeled me out to post-op and since I wasn’t under general anesthesia, I was released and got dressed within 30 minutes. My dad came to pick me up since I was not supposed to drive for 24 hours. After getting home, I wanted a breakfast burrito. Totally forgetting the no driving rule, I ordered over the phone and drove to pick it up.

I have a couple of sutures in my arm from the catheter insertion point that needs to come out in 2-3 days. Otherwise I don’t feel any different. Hopefully this hasn’t been a total waste of time and money, and the fistula works better now.