Gerald Slept Here!

[amanda100wilson]

Willowtreewren, I'm glad that I'm not alone in my opinion!

[ToddB0130]

Honestly I opened that thread once and it was enough.  I totally skip all of the political threads now.  There's plenty to read here and often enough I already have a headache !!!

[willowtreewren]

Am here to help.

Next time we'll run you through the car wash.

  It's a deal!

Amanda, I figured out a long time ago, there is no "reasoning" with that other fellow. The ranting puts me in mind of a crazed person whose voice is quavering with passion....

Just a bit creepy....

Ugh....I think I need that car wash. 

Aleta

[okarol]

There will be NO personal attacks of members.
Sluff has already posted a warning.
The next step will be a temporary ban.

okarol/admin

[Gerald Lively]

Yes Dear!

[willowtreewren]

I'm sorry, Karol. 

It's not usually my style.

[Gerald Lively]

Dialysis today.  I saw the Doctor there while he was making his rounds.  He wanted to know all about my “not ready for prime time” fistula.  He looks at it, gropes a little then puts his listener thingy on the vein.  He tells me there is a clot.  I have to see the Vascular Surgeon tomorrow.

This fistula business is a pain in the butt.  Well, in my arm, actually.  Do I really want this thing?

gerald

[Gerald Lively]

There I was, in a half empty dialysis center reading my book and minding my own business, when an ambulance drove up. After some hustle and bustle they wheeling this Japanese man in  wheelchair.  I would guess he was about sixty.  He didn’t speak English very well, but I could tell that he was suffering severely from something that wrecked his stomach, huge headache and some distress in his lower legs.

The Doctor broke off our conversation to talk with the gentleman (seated in the next chair) and nobody was communicating.  I knew a few words of Japanese.  It wasn’t easy.  I haven’t heard this stuff for over 50 years.

Long story shortened:  he went to a Super Bowl party and had a few drinks.  He said it wasn’t very many but I suspect he emptied the bar. He also has diabetes.  He claimed all he ate was chips and guacamole.  I tried to find out which team he wanted to win but I didn’t get him to understand. I never found out.  As the session progressed I heard they were taking out 5.8 kilos of water.  Perhaps he was holding all of that Super Bowl water. The Doctor gave him some kind of pill.  The poor guy was really suffering, but he fell asleep.  I think it was the pill.

That’s a lot of water, I hope they know what they are doing?  Coming by ambulance meant he was checked into the hospital.  Perhaps that party is still in progress. I wonder?

gl

[MooseMom]

This fistula business is a pain in the butt.  Well, in my arm, actually.  Do I really want this thing?

Yes, you really want it as long as it works.  Getting it to work seems to be a bit of a problem for you, though.  I take it you are still using a catheter?  Sorry, I can't remember the particulars.  I'll be interested to hear what the vascular surgeon has to say about how he's going to fix it.

[MooseMom]

Hmmm....guacamole/avocados have an awful lot of potassium.  High potassium plus fluid overload...I hope he enjoyed the game.  Big price to pay to see the manslut get beat.

[Gerald Lively]

You put a smile on my face.

Not gonna rub gucamole on my fistula.  Had surgery to put in the fistula followed by two angioplasties.  Tomorrow I will probably schedule another one.  Been about three months.  It quit buzzing and returned to a pulse.

gerald

[willowtreewren]

You put a smile on my face.

Not gonna rub gucamole on my fistula.  Had surgery to put in the fistula followed by two angioplasties.  Tomorrow I will probably schedule another one.  Been about three months.  It quit buzzing and returned to a pulse.

gerald

Oh, Gerald. That doesn't sound good. I hope that they can do the rotor rooter thingy and get it working again.

 

Aleta

[Gerald Lively]

The Vascular Doc said it wasn’t a clot.  After two angioplasties, he said this fistula is not working.  So, we have scheduled another fistula surgery for next Monday. The first fistula surgery was on the left side of the wrist, the second one will be two-thirds of the way up the forearm.  I had to do some dialysis rescheduling.  That makes next week rather busy.

gl

[boswife]

dang it gl

[MooseMom]

I'm sorry to hear this, Gerald.  It sounds like your new fistula will be where mine is...2/3rds up the forearm.  Even though I've not had to use it yet, it has been buzzing along now for almost two years, so I am hoping yours will be the same.  I don't know why, but I've gotten the impression that there is a higher success rate with fistulas place further up the arm.  Anyone know...is that true?  Or am I delusional?  I wonder if perhaps that is true more for women than for men as we have smaller veins in the first place, and those higher up the arm tend to be larger.  Anyone?

[cattlekid]

I don't know what the actual stats are, but my vascular surgeon went for the wrist first, then right above the elbow.  All in one surgery.  So I woke up with four, count 'em, four scars.  I was like WTH???  He told me when I saw him in his office that my wrist was iffy.  Okay, so then why did you try it?  What a dip.  Now I have a useless scar on my wrist.  Thanks, doc.   

I'm sorry to hear this, Gerald.  It sounds like your new fistula will be where mine is...2/3rds up the forearm.  Even though I've not had to use it yet, it has been buzzing along now for almost two years, so I am hoping yours will be the same.  I don't know why, but I've gotten the impression that there is a higher success rate with fistulas place further up the arm.  Anyone know...is that true?  Or am I delusional?  I wonder if perhaps that is true more for women than for men as we have smaller veins in the first place, and those higher up the arm tend to be larger.  Anyone?

[MooseMom]

cattlekid, that's a terrible story!!

My mother's access was in her upper arm, so I figured there was a good chance mine would be, too.  The scar and the amasotosisasmatosostis thingy in just below the crook of my elbow, but I'm given to understand that the actually access will be in my upper arm.  My surgeon never considered my wrist area.

Did your vs do a veinmapping?  What did he do..just sorta wing it?  Geez!

[cattlekid]

Like I said, he's a dip.  The access center did a vein mapping, which they sent to him.  He then did an ultrasound in his office.  Both times, the results came back iffy for my wrist.  I will be so happy if I never have to see him again.  Surgeons are generally arrogant jerks (apologies to anyone who is related to a surgeon - but I used to work in a hospital and I saw it first hand every day) and this guy just reinforced my opinion.

cattlekid, that's a terrible story!!

My mother's access was in her upper arm, so I figured there was a good chance mine would be, too.  The scar and the amasotosisasmatosostis thingy in just below the crook of my elbow, but I'm given to understand that the actually access will be in my upper arm.  My surgeon never considered my wrist area.

Did your vs do a veinmapping?  What did he do..just sorta wing it?  Geez!

[MooseMom]

  Surgeons are generally arrogant jerks

I think you may be right.  Mine seemed nice, but he had a very strong Korean accent despite having been here for 30 years, and I could barely understand him, so maybe he was jerkier than I realized.  I had read several posts on IHD about having to go in for a second op where the vein had to be "lifted", so I was really glad when he told me that he did this already when he created my fistula.  I was grateful for his competence.

But some months after surgery, my arm started to really hurt in a way that I had not experienced before.  Since I had never had a fistula, I had no way of knowing if something was wrong.  I had images of clots or something, you know?  So I called his office on a Friday and got an appt for Monday.  His office staff was really nice and accomodating.  So I go and get my fistula checked, and of course it was OK, and the surgeon looked at me like I was crazy and tut tutted about me wasting his time (although he didn't put it quite that brazenly).  Jerk.  But, as long as the damn thing works once I need it to work, I don't care...he can be as jerky as he likes, even in Korean!

[willowtreewren]

Gerald,

I am so very sorry. Do you have the option of a different surgeon if you aren't happy with your current one?

Maybe you could ask your other doctors who they would recommend. That is how Carl found his current dermatologist. Just a thought.

I hope you can get a really good "thrill" going and keep it thrilling.

 

Aleta

[del]

I don't know about the stats of where a fistula is better placed.  Hubby's is on his wrist and has been serving him exceptionally well since 2000!!  Hopefully it will keep working for a long time yet!!

Sorry you have to have another fistula Gerald.  Hopefully this one will work.

[amanda100wilson]

A good surgeon should defer to vein mapping over visual exam. to determine best placement for a fistula.  I saw five vascular sugeons in total.  I didn't even see the first one look at the vein mapping but he glanced at my wrists, asked me which was my dominant hand, then told me that he was going to do it in that wrist.  I don't remember him looking at me diectly once.  He went 'bye-bye.'. Then the next one did vein mapping (more money wasted, as they wouldn't use other doctors ones).  He then asked me if I knew that fistulas last on average, only two years.  Know I know that this is bunkum, so I thought "well, maybe yours have a bad track record for lasting, so he went 'bye-bye' too.  The next one looked at the vein mapping but then every time I saw him, started ultrasounding it himself.  Not sure that he knew how to use it properly because all I could see whenever he did it were little branching veins.  Shame that I hadn't waved 'bye-bye'. to him because he made a fistula in my right wrist that immediatly failed.  When I went back and he eyed up my other wrist, I thought 'no way.'. Should have trusted my gut instinct on him too.  After that I tavelled to California to see some docs. Suggested to me by the nephrologist that I used to see when I lived in that State.  Both seemed good, both said that the veins in my wrists were too small.  i picked the one whose wife wasn't imminentlygoing to have a baby as I thought that he may a bit pre-occupied and sleep-drived.  The one who did it mentioned that it may need to be a two- stage surgery, but it sounded like a 'maybe' rather than a dead-cert.  discharged me without any follow-up instructions.  I had to e-mail him about three times to get any.

I also wrote to a doc. in Texas whose paperI had read on-line with a view to going to him if needs be since no-one seemed to be recommending anyone worthwhile.  He put me in touch with an atlanta nephrologist, who recommended a vacular surgeon to me.  I went to see him and he told me that they would need to transpose the vein because it was too deep.  Told me that I would have a four to five inch incision.  Wake up to find that it's from my elbow all the way up to my armpit.  Now I may not be the most propotionally-built human being but I don't have four or five inch length upper arms!  Added to that, the incision was  right on the far inside of my arm, and the fistula was right under the incision even though from my first consultation with him, I had empahsised that I intended cannulating myself, and looking at the position of the fistula, I despaired that I would ever be able to self-cannulate.  Well, the nice incision line healed up and the scar broadened out and broadened out as it hypertrophied.  My dialysis nurse agreed that it would be virtually impossible to cannulate even by someone else and he accompanied me to the doctor's office to tell him th'is. So off I go to the operating theatre again, and he moved it across to where I told him I wanted it, which is down the middle of my bicep.

It then took an inordinant length of time to mature sufficiently that it could be used, and even then was still pretty skinny, only really growing once they started to use it.

I would like to point out that sometimes the op to make the fistula and the procedure to lift the vein are done separately to allow the vein time to grow a bit before they lift it, particularly if the vein is small, since it is delicate and can be damaged during the transposition, more easily so, if it is small.

I am sorry for this huge post, but I am hoping that this will be a cautionary tale to say that it is important to be comfortable with the doctor.  Your gut-feeling is often right, so trust it and leg it out of the door if you doubt the doctor's ability.  Inform yourself beforehand and ask lots of questions.  Stand firm on what you want.  I got there eventually and have a good strong fistula now, but boy, did it take some work to get there?

[willowtreewren]

Amanda! You ROCK! 

[MooseMom]

Oh geez, what a story, a100w!  Thanks for explaining why sometimes a fistula is created and then lifted in a second op; that makes sense. 

I went to the vs recommended by my neph, and I asked if he trusted him to do a good job.  He said yes but that I'd probably have trouble understanding him, which turned out to be true.  When I had my first appt with the vs, I asked him about his experience, and he said that for decades he'd been creating at least 20 fistulas a month, so I figured that was pretty extensive experience.

My mom, however, spent 18 months using a catheter while they faffed about with her fistula.  She ended up going to one of the top vs in the Texas Medical Center who got her fistula working beautifully.

It's hard to know who to trust, although sometimes it's easier to know who NOT to trust!

[big777bill]

 Thanks for posting Amanda.  This info is going to be helpful to me. Sorry you had to go through so much crap to get things done right. We really are our own best advocates. Some of those Docs out there will kill ya if you don't watch it.