Fistula, attempt #2:

[Alex C.]

Well, I have an appointment on Monday with a different vascular surgeon. This time, he'll have my vein-mapping in front of him, so I HOPE he'll be able to give me an intelligent opinion on what my possibilities are (rather than the way the last surgeon handled it-cut into me without bothering to research my physiology first).

Before I see him, could some of you with experience give me some ideas of what I should ask him? I'm at the point now where I believe that it's probably better to ask for less-accessible access on my left arm than to have a fistula on my (dominant) right arm. I WILL need to be able to continue working once I start dialysis. I'm thinking that even a left-arm graft is better than a right-arm fistula.

[Whamo]

My first fistula didn't work out.  It failed after the first month, but the second one works fine.  I decided to go the PT route anyways, as the needles hurt during treatment, and I hate them on general principle.  I'm training with the Ultrabag by Baxter, and it's daunting at first, but after a few practice runs it's becoming routine.  My nurse says I'll be able to take off 1 to 2 liters of fluid with each treatment.   

[amanda100wilson]

ask him what diameter the veins are that he is intending to use, and if that diameter is big enough for a fistula to work.  if you are intending to cannulate yourself, let him know about this since it needs to be in an accessible position.

[Alex C.]

I hate needles so much that I would assume that self-cannulation is only a remote possibility. However, I think that, with practice, I might be able to  do it left-handed (I'm pretty good at doing things with either hand), but I'm primarily concerned with soreness after dialysis on my access arm.

[amanda100wilson]

the fistulas of self-cannulator s tend to last longer, so if you can do it yourself, so much the better.youmay even find that it is less pai ful, because with a buttonhole, the needle is insert through a track of scar tissue, rather than regular flesh.

[newgrl]

Alex, I was in the same boat.  After my second fistula failed I was faced with the decision of either a left arm graft or a right arm fistula.  I didn't want to try in my right arm so I went with the left arm graft.  So far it working fine.  It is only my second week of hemo.  However, I have been told that Grafts do not last as long as a fistula would.  However, I would rather keep the graft as long as I can before moving to my right arm.  I have a desk job, but I type on the computer all day.  I don't want to worrk about not being able to use my right arm to pick up things or driving, etc. 
NewGrl

[MightyMike]

Just my 2 cents but I would go with a fistula over a graft.  I hear too many horror stories with grafts clotting off.  Even though your scared of needles some if not all of the fear will subside if you self cannulate because you are in control of doing it so you can stop if it's too painful.  Also wether it's in your dominate arm or not I would choose what will work the best, your health is more important then work because without good treatments you definitely won't be able to work.  I do understand that it is hard for most to give up work for financial reasons but better treatments will at least help you out more if you continue to work.