Not yet. The procedure is scheduled for next Tuesday. This time, the vascular surgeon will take it out in his office. Last time, I had to go to the hospital, which means at least a 4 hour wait. Th doctor took it out in the pre-op room anyway, so it wasn’t a full OR experience. This time,it should be much faster. Hello hot showers, again.

The dialysis center also removed my one suture from the fistulagram last Friday. The head nurse did it and commented that it didn’t even bleed when he removed the one stitch. As always, he talked to me aboutTesla since he bought a Model 3 while I was here before.

The fistula works much better now too. The tech was able to cannulate me on the first try for both needles and run the machine at 350 mL/min without any alarms.

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Update: 8/28/2020 3:45 pm

I don’t think I shared this photo before since it’s kinda gross, and it was taken before I started this blog. This was the previous catheter after it was removed form my chest. The procedure was done in the pre-op room at St. Joseph hospital. They were prepping me like I was going into an OR. I was wearing a hospital gown and I think they stuck an IV needle in me. Then the surgeon walks into the room, gives me a local anesthesia shot, then yanked the catheter out. I think he asked me if I wanted to keep it. Uh, no.

It didn’t hurt coming out but it did feel weird. I thought there would be more blood since it was sitting in a large vein for the past 20 months. This time, I’m only going to a doctor’s office to remove it. The actual hole in the chest should close up in a few days so may a week for the first shower in many months?

At dialysis yesterday, the tech was able to get both needles in the blood vessel on the first try, however the arterial needle seemed to have high pressure again. She went and got the OG tech, and he was able to readjust the needle so it flowed much better. They haven’t use the chest catheter for over a week now. I’m getting worried that if they don’t flush it soon, it may clot and won’t work if we need it again.

Also, the tip of the upper needle looked like it was getting pretty close to the fistulagram incision site. Right after hooking me up to the machine, the incision site started to hurt. I think it was still healing from the cut and to have that much blood flow near it wasn’t good. The pain subsided in a bit but occasionally I would get a brief shooting pain near the lower needle. That went on until late in the night last but hasn’t come back yet.

Again, I really don’t like the fistula. It’s ugly and it hurts a lot more than the catheter. No one has shown me the actual statistics for the infection rate for the different access methods. I’m pretty sure infections are more serious with the catheter but is it common? What about compared to all the complications that can happen with a fistula? I also think poking the needle in the same spot all the time can’t be good. The scabs covering the insertion site never heals and there are permanent dark spots on my arm from the repeated cannulations. Even after I get a transplant, those fistula scars will probably never go away. Lovely. Another scar to add to the many on my upper torso: long open heart surgery scar, exit sites for heart fluid draining tubes, peritoneal dialysis catheter port, and two holes for hemodialysis chest catheters on my upper right chest. I feel like Frankenstein.

Hmm, I feel like I can start a new blog just for daily fistula updates. At the dialysis center, the techs rotate pods (areas) once every three months. The tech that has the most success cannulating me is actually in another pod currently. He usually comes over when he has free time to insert needles in my arm. That’s why my nurse usually connected me through the catheter first so I can start the dialysis treatment, then switch the access point if he is successful.

Today, the tech that’s actually in my pod currently wanted to try again, and she was successful on the first try on both needles. There must still be some differences in technique because it hurt a lot more, even with a lidocaine shot. Once in though, the fistula worked pretty well at the 350 mL/min rate. The nurse still thinks there may be a problem with the fistula, even though they have been pretty successful in using it.

Which brings me to my scheduled fistulagram tomorrow. Not sure what is involved but I would feel rather stupid if the surgeon can’t find anything wrong since it seems to be working now. Likewise, I’m not sure what to say if he wants to go in again to do something since I don’t want another surgery unless it’s a kidney transplant.

I was a bit upset with my nurse this morning at dialysis. The one tech who has the most success sticking me got both needles in Thursday so it felt that my scheduled COVID-19 test, quarantine, and fistulagram next week was mainly due to her complaints about my fistula. Since the tech was busy, she hooked me up with the catheter first, then another (there are several) tech tried to stick me. It looked good at first but again, the pressure spiked when the lines were connected to the machine. We had to go one-and-one again, using one needle and one port on the catheter. Ugh, maybe I do need to find out what’s wrong since I may need this fistula for several years.

I also managed to fall asleep awhile ago. All the staff decided at that time to wake me up to sing happy birthday, like at a restaurant. Didn’t expect that since I’ve never heard them do that before. Then they sang for another patient that had a birthday recently too. It was a nice gesture but I hate when people sing happy birthday for me. Now I can’t fall back asleep and there’s over an hour left in the session.

Just got a call from the vascular surgeon’s office. He wants me to get a fistulagram, which appears to be a dye-enhanced X-ray of the fistula. It’s scheduled for next Friday at 7:30 am which means be at the hospital by 5:30 am. I also have to do another COVID-19 test, this time in the hospital ER, then quarantine myself until the procedure by not going anywhere other than home and dialysis. I guess no follow-up dentist appointments next week.

As all this is going on, my fistula worked fine today. The tech used regular 16-gauge needles and was able to stick both needles in on the first try. They were also able to run at 350 mL/min without causing any error alarms for the entire four hours. In fact, they didn’t even hook me up with the catheter, and they even drew blood for labs from the fistula. It was a bit painful and itchy however.

I don’t think this is the last step yet. It’s just for him to go look at possible narrowing of the blood vessel and to see if there are clots. If not, there still a chance of more surgery. Dang it.

The tech that’s been gone for three weeks was back today. I thought someone said medical leave but he told me he was on vacation. He went on vacation back in April; do dialysis techs get a lot of vacation days in addition to working only three days a week?

He came by at around 7:00 am to stick me. Originally I though my dialysis nurse was going to do it. At first glance, it looked like he was successful on both needles. However, once hooked up the machine, the arterial line had pressure issues. After adjusting it for awhile, he gave up and they used the chest catheter to pull blood from my body. He did say that he should have used the regular needle instead of the short one since my artery seems to be deeper down, though a huge blood vessel bulge is developing at the site. Someone else prepped the medical supplies this morning and I think he just used whatever was at my chair.

The only problem is that the arterial needle site is hurting, even three hours after dialysis. I don’t know if he poked around too much or what. At least I’ll get a break on Thursday since it’s monthly lab day and they like to use the catheter to make sure I get a good cleaning. He said he’ll try again this Saturday. Can’t wait…

It’s about 2:30 am. I woke up at 2:00 am and haven’t been able to fall back asleep. I’ve only slept about two hours so far. Of course, I can catch up on some sleep during dialysis but usually the fistula keeps me awake, and Tuesday is when the nephrologists do their rounds so someone will wake me up.

The dialysis center changed chairs since I started dialysis there three years ago. I think it was before I left for PD. I don’t remember having any problems with the older chairs. The new ones look the same but are brown instead of green. However, they seem to give me lower back issues. Usually the nurses wants your legs up so you can’t fall forward out of your chair. Sometimes that happens when your blood pressure drops too much and faint. With the legs raised, it puts a lot of pressure on my tail bone area and it becomes very sore in about an hour. I then have to put my legs down and sit up straight to relive the pressure. With PD, at least I get to sleep in my own bed.

At least my dialysis center offers patients pillows and (heated!) blankets. When I was at the other dialysis center across the street for about a month, you had to bring everything yourself. No onsite pillows or blankets offered. I’m going to try to sit on a pillow today. The pillows are really flimsy anyway, and try a rolled up blanket as a headrest to see if that helps. Otherwise I end up walking out after the session like an old(er) man.

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Wow, list price of the Champion Series 54 medical recliner is ~$2,500. Why is everything so expensive in the world of medical supplies? My home office chair was only $150 from IKEA and I’ve slept in it before.

I think they should upgrade to a full-body shiatsu massage chair. The Inada one from Japan is $8,000 but it looks much more comfortable. And it reclines.

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Update: 7:32 pm

Well, that didn’t work out any better. I tried to sit on the pillow this morning and grabbed an extra blanket as a headrest. The pillow didn’t do anything since it was very flimsy. As soon as the air was squeezed out, it became flat as a bedsheet. The blanket-pillow was better since it provided more support but since I rolled it up to get more height, each time it fell down to the base of the backrest, it was impossible to retrieve and put back under my neck. Initially, this was with both arms free. After they stuck one needle in my fistula so I can’t move it, it was super hard to reposition the pillow and the blanket. I think my butt hurt more than before so I’m not sure what to do. Maybe I need to bring in a nice firm seat cushion to sit on.

For the past 2-3 weeks, I’ve been using the chest catheter because the only tech that can stick me is out. I got used to having the use of my right arm again during dialysis, and no pain! With the proliferation of personal protection equipment at the clinic, I think the risk of infection with the chest catheter is lower than before. I’m also still waiting fo the vascular surgeon to get back to me on yesterday’s fistula ultrasound.

So about an hour into the session, my current nurse comes by with two 17-gauge short needles and said she wanted to try. I think she tried once before an failed. She goes ahead and feels for my veins for awhile, and sticks both needles in one try. The arterial one did hurt on insertion even though she used lidocaine, and the venous one hurt for the rest of the session but no bruises or leaks. Since she used 17-gauge needles (thinner), they could only run the machine at 250 mL/min max. So even though the dialysis wasn’t as effective, at least the fistula got used for three hours. Now what do I tell the vascular surgeon?

Like I posted earlier, I didn’t sleep very much or at all this morning. I arrived at dialysis super tired. I usually watch videos or play games, but today I put on some music and was out during the first song. I thought the senior nurse wanted to try and stick my arm again but when I woke up the first time at 6:55 am (about an hour into the session), there was nothing. I don’t know if she decided to skip today since I was asleep? I was going to do something else but fell back asleep again, waking up at around 9:00 am. That’s three hours of napping, during what felt like the shortest dialysis session ever. I usually can’t sleep on planes, which is murder during long Transpacific flights to Asia. I would be overjoyed on the rare occasion that I did fall asleep on a flight. Yeah, this felt like that.

My blood pressure was still weird. Since I only measured 150’s in the morning, I only took the Olmesartan as recommended by my nephrologist. However, the BP readings went up a bit at the beginning of dialysis so I took the Metoprolol as well. It started in the 150’s, even with both pills, and ended up in the 180’s. When I took the final standing reading, it was still 162/90. Usually I would take an extra 10 mg of NIFEdipine but did not do so today. I’m still at a loss with what to do with the mostly high, but wildly erratic blood pressure readings.

I did leave dialysis at 86.5 kg. You would think my blood pressure would be a bit lower with all that fluid removed.

I’m disappointed that no one at the dialysis center wanted to try to stick me today. The one tech that have been successful is still out. Usually the techs lay out the fistula needles on my chair. They didn’t even do that today; they only prepped supplies needed to connect me with the catheter. I thought at least someone would try to stick me since it can be done. I guess I’m using the catheter for the next week and a half.

Today, the needles went into my arm very smoothly. The tech got both needles in on the first try so it only took about 2 minutes from start to finish. My arm also didn’t hurt that much during the session. However, I think the venous needle caused a small bruise, but it’s mostly gone now. My arm is getting pretty scarred.

The arm is getting pretty lumpy too as the vein is getting bigger. You can feel an hear the blood rushing through the blood vessel in my lower arm.

I’m still waiting for a call from the vascular surgeon. I think they may want to do an ultrasound to see what’s up with the fistula and why sometimes it’s difficult to get the needles in right. Until then, the chest catheter stays. Here’s a photo of the last one they removed about an year ago. Catheter is on the left; it runs from the right side of my chest across to the heart through one of the large blood vessels (vena cava?).

There are these huge biohazard bins at the dialysis center that gets replaced every so often. I think the waste deposited in the bins are incinerated; not sure if it’s done at the hospital or offsite. There is a lot of hazardous waste since almost everything in the clinic is contaminated by patients’ blood. For me, it’s double the waste since I’m using both access points: catheter and fistula.

For the catheter, first they have to pull the leftover anti-coagulant, in my case it’s argatroban, which uses two locking syringes. These get filled with blood and tossed.

When the fistula is used, the needles are also disposed in the blue bins after dialysis. On Tuesday, the tech had issues inserting the needles in my arm and had to used up four needles instead of two. There’s also the small syringes used to inject lidocaine. Finally, all the tubing and dialysis filters go into a bigger red bin for disposal. There is a crazy amount of waste with dialysis. This was also true when I was on peritoneal dialysis at home.

The tech who has been sticking me consistently had problems today with the needles. He ended up using four needles to get good flow on both arterial and venous connections. There is also a difference of opinions on what I should do. My nurse and (assigned) tech has been harassing me to go see the vascular surgeon. I’m not sure what he is going to do when I tell him the dialysis center is having problems. I don’t want another surgery on my arm. At the same time, the head nephrologist came by today and asked me to get my chest catheter removed. The same vascular surgeon said he will remove it in his office. The last time I had to go to the hospital; it was just the pre-op area but still took 4-5 hours.

Ugh. I’m so done with doctor appointments.

My dialysis center rotated techs this week so there are two different techs in my area. I know all of them since they rotate every three months but since the person assigned to my chair has not seen my fistula before, she wanted to try and stick me. Also, they don’t even bring out supplies for hooking up the chest catheter; it’s all stuff for the fistula.

She tried Tuesday and was not successful so she called over the tech that has been sticking me for the past few weeks. Likewise, she was unable to hit the vein yesterday so she call the other tech to help again. However, since she made several attempts already, when the other tech finally hit the vein, my arm was already pretty sore. He also had some problems with the arterial needle so my arm was hurting pretty noticeably for the entire four hours.

At the end of the session, when the tech pulled out the needles, the arterial wound would not stop bleeding. I was applying pressure with a gauze pad but blood kept flowing out of the hole and made a mess. I’ve seen this happen to other patients but to experience it was weird. We finally managed to stopped the bleeding and I sat for 20 minutes applying pressure to the needle sites.

Happy 4th of July!

This is my 3rd anniversary for dialysis. I started hemodialysis on July 5th, 2017.

A different nurse tried to stick me today and came up dry. Shehad to call the recharge from another unit to finish inserting the needles. Since he had to dig a bit, it hurt a lot more than the two previous day’s.