Holy crap! The needles are huge!!

[kitkatz]

I keep telling the techs "I am not a human pin cushion, you know that right?"

[paul.karen]

 Cookie cutter approaches are for cookies.
 Monrein what does this mean?

And Wattle i hear what you are saying.  But i have read here at IHD some people who have had fistulas they never used for years. When i get mine i plan on doing what i have to to keep it operatable for the future.  I am trying to avoid a neck catheter if my PD access were to go bad.
I am trying to miss as little work as possable and tying to be proactive in my own health.  Am i right or wrong in my approach??  depends on who i ask i ques.
Like many of the news articles Okarol puts on this site many contradict each other so we as individuals have to try and decide which is best.  I hope i am doing the right thing.  I also hope i get the fistula and never have to use it.
Just my thoughts.

[kitkatz]

Think she meant exactly what you said. we, as patients, have to be thoughtful and careful in what we let the medical establishment do to keep us alive.  Whether  it is a fistula or a graft, or a catheter we have to make those decisions. allowing a doctor to treat patients the same as one to another is most dangerous. 

When you make cookies using a cookie cutter they all come out the same. When dealing with a doctor you cannot be a cookie and be the same as the next patient.

[monrein]

Get a PD access??
No needles-less food and liquid restrictions and clean the toxins overnight everynight.  And in case of an infection you already have another access for emergencies.

my 

Paul, all I meant by the cookie-cutter comment is that no one approach works for all people.  I would not put in a PD catheter, because I've chosen to do hemo and would not want the tube in my stomach for very personal reasons.  I can't say I've met many (or even any) people who routinely choose to have both types of access, just in case.  The issue with permacaths, from my perspective is that they are very temporary solutions if one gets caught short as can happen even if one plans to avoid one.
Even though my preference is strongly in favour of hemo (nocturnal or short daily) I definitely understand why some people hate the idea of it and prefer to go the PD route.  Sometimes it's a terrific option and sometimes they must switch over at which point a fistula is the best option if possible.  Some people need to have grafts because their veins won't support a fistula and then that's the best option for them. 
When you have a fistula done, you are depriving that arm of one of its 2 veins and one of its 2 arteries which is not an insignificant thing.  I think that is Wattle's point and it's a good one since the number of veins for access is limited.  As much as I hate permacaths, they do have their place (I've had two over
the years) as emergency access and if one needs one then the fistula ought to be created ASAP so the cath can go ASAP.
I understand that you want the fistula as backup and that's your choice, I too don't have a definitive answer about the "right" way to go, but I know that I don't want to do PD.  Of course if that were my only choice then that would be a different matter altogether.
Not easy at all, this decision business.

[paris]

Paul.karen, are you saying you are going to have a PD catheter and fistual surgery?  I got a little confused going through the thread---but then I get confused easily anymore      My doctor wouldn't approve both surgeries (nor my insurance).   He recommends PD, and that saves the arm veins for the future if PD doesn't work.   It is a personal choice, and that is the beauty of IHD. We can learn from everyone's experiences.   

[MIbarra]

I wish I had at least been informed about PD before I had to start dialysis. My doctor did not even inform me of any options. Just said, have a fistula put here and a catheter there. (She owned her own dialysis center and I definitely feel this was motive about not discussing all of my options pre-dialysis.) The unit was horrible too and I dialyzed there for a year because I did not know any better. Now, no doctor tells me what to do before I have really researched and asked questions.

[Wattle]

Paul I am NOT judging you on your decision. I was just making you aware YOU have the choice to choose. I was initially sent to have a fistula and was not given the option of PD. A lot of PKD patients are unable to do PD due to limited space. I changed Nephs in the process (long story) and told them what I planned on doing. I have always been a very proactive home patient who asks the tricky questions and annoys the crap out of everyone. I must admit I thought PD would be a short term dialysis solution and a kidney would come along quickly. That hasn't been the case but I have done very well on PD. There have been many days where I loose the plot and think that the grass is greener on the Haemo side of the tracks. Monrein, I have struggled with the self esteem issues that come with a tube hanging out of my stomach!! My husband is great. My Neph just humours me and tells me "no we are sticking with this at the moment". I know that haemo is in my future at some stage in my life but I am grateful that I still have all my veins intact. It was a very personal decision. My Dad had a lot of issues with access points. He was a home haemo patient in the 80's so I grew up seeing pretty much everything.

You have done the right thing for you. The best decision you can make is an informed one. That is the first step in taking control of your own management plan.

I hope you do well on PD and a transplant is just around the corner.

[paul.karen]

Paddbear sorry for taking your thread off track.


And thx for all your opinions. and thoughts.  I have no fear of needles use to donate blood and plasma for years.  TBH i want to do dialysis at home.  And hemo seems very much more involved and im not sure i could sleep with needles.  And unlike many i am not the best with food restrictions nor liquid restrictions.  Thus it seems PD is the natural choice.  And i never thought of it being harder to do PD if you have PKD.  But since hearing it it does make sense.  Back to step one which is confusion 

[paddbear0000]

Now get rid of that catheter young lady.  Not good for you!!!  xx

I can't have it taken out yet. they are still using it! They do one needle in the graft and use one tube of the cath for a week to make sure the graft works okay. After a week, they then do both needles, but leave the cath in for 2 weeks to make sure everything goes well. I am only on day 3 of using only 1 needle. And I am perfectly okay with this process because don't want to turn right around and have another cath placed.

Get a PD access??
No needles-less food and liquid restrictions and clean the toxins overnight everynight.  And in case of an infection you already have another access for emergencies.

my 

PD is not an option for me. I am a very unstable diabetic and having all that glucose in  my abdomen would just worsen the problems I already have. Also, I do not have any fluid or dietary restrictions right now. I still produce some urine and my potassium and phosphorus levels are perfect without limiting certain foods of any kind.

In regards to getting both a fistula and a PD cath paul.karen, there are potential side effects from fistulas. Mine is in my left arm, and my left hand is always cold, frequently goes numb and tingles during dialysis. It is because there is diminished blood flow to your hand with the fistula. When they create one, they are diverting the blood from that hand. Just keep that in mind. If for some reason you end up with the fistula in your dominant arm, this can become quite a pain in the butt!

[Lucinda]

Paddbear sorry for taking your thread off track.


And thx for all your opinions. and thoughts.  I have no fear of needles use to donate blood and plasma for years.  TBH i want to do dialysis at home.  And hemo seems very much more involved and im not sure i could sleep with needles.  And unlike many i am not the best with food restrictions nor liquid restrictions.  Thus it seems PD is the natural choice.  And i never thought of it being harder to do PD if you have PKD.  But since hearing it it does make sense.  Back to step one which is confusion 

I am doing home dialysis training at the moment as you well know and the actual process for me is a bit of a walk in the park.  Learning the machine and the needling was easy. In fact I love the feeling of being in control.   I am having problems with allergic reaction to the kidney on the machine and getting my dry weight right because my own kidneys are still putting out but the actual process is not overwhelming at all.  Because of the hours I will eventually be doing, I won't have any restrictions with food and fluid much at all.  I am like monrein, I wouldn't have wanted to do PD for personal reasons.  I also went through PD training with a friend and to be perfectly honest, I find the hemo much easier and more straight forward because you get a better picture of the mechanics taking over from your own body.  Shoot me, but I have found the whole process really interesting and that has certainly taken away from the reality that I am actually doing it to my own body.  Hard to explain but I am really happy I chose to do the home hemo.  By the way, I had my graft in for two years before I started using it and had no problems at all except they used a new graft on me in the beginning that was inferior to the old graft but once they put the old graft material in I have had no problems at all for the last 18 months.  Hope that is some help! xx   

[JasonEb]

I've used the 15-guage needles for the majority of my time on dialysis, but for a while last year I was using first dull-edged needles for buttonholing, but most of the techs weren't very comfortable (or very good) using them, and started regularly infilitrating me (for the first times since my first year of dialysis).

Then I switched to 14-guage needles, which helped my clearance, but I started having clot issues in my fistula.  I'm told it was just a coincidence, but after I went back to the 15's (and a fistulagram), things went back to normal.

[Jess21]

Think of it this way.  When dogs/cats get microchipped, the needle is 12 gauge.  Yes, 12!  Makes 15 look tiny! At school I was microchipping a cat, and my partner made me do it because she just couldn't poke him with that big of needle!

[dwcrawford]

Holy Caca\

That does it!  I'm backing out of this project.

[Angelicfury]

They are a little imitating at first but getting used to them takes time. I'm on 15 gauge and I've stopped feeling the pain a month after I started. There was a patient that quoted from the movie Armageddon when he was talking about sticking the needle in him and stabbing the tech with it. "Have you ever seen Pulp Fiction". I lol'ed for a week.