Fistula: Right or left arm?

[Alex C.]

Here's my dilemma: My first fistula surgery (left arm, by wrist) was unsuccessful. Only AFTERWARDS did the surgeon send me for vein-mapping, after which it turns out that my RIGHT arm is the better one for such a procedure. I am right-handed.

So, as far as my choices go, I can choose to either have a fistula put higher-up on my left arm, resulting in a much more obvious scar (and probably longer healing time, as well), or have a surgery on my right wrist. I'm still probably at least 1 year away from needing dialysis.

So, which would you suggest? I write a lot at work, so I'm not certain that having dialysis in my right arm would be a good idea, but OTOH, I'd like there to be a good chance of my fistula actually lasting for a few years. I'll be seeing the new surgeon in a couple of months.

[Whamo]

I have a fistula on my upper left-arm.  It seems my fistula works best when they poke me up high, but it freaking hurts.  And that's after the initial poke, during the treatment, as they use pain-killers to set me up.  The fistula works really well, but I'm going to PD because I hate hemo.  As for writing, I'm  writer, but I use my keyboard.  My handwriting is so bad.  I would think writing with your right hand and using the right arm for a fistula might be problematic.  I get cramps in my left arm from time to time when I use it a lot.  For example, when I prune the leaves off my herbs.  Things go better when I remember to squeeze the ball in my left and right arms.  It's supposed to lower blood pressure by 20 systolic points, in addition to helping your fistula.  Good luck with your new fistula.   
 

[Sydnee]

I hope you get the fistula that works well for you.
You might wan't to ask those that have a fistula in their dominate arm how that is working out, or those that have one in their up arm how hard it was to heal. (if those are your 2 main concerns)

Can't answer your question sorry. At least you still have options 

[M3Riddler]

Here's my dilemma: My first fistula surgery (left arm, by wrist) was unsuccessful. Only AFTERWARDS did the surgeon send me for vein-mapping, after which it turns out that my RIGHT arm is the better one for such a procedure. I am right-handed.

So, as far as my choices go, I can choose to either have a fistula put higher-up on my left arm, resulting in a much more obvious scar (and probably longer healing time, as well), or have a surgery on my right wrist. I'm still probably at least 1 year away from needing dialysis.

So, which would you suggest? I write a lot at work, so I'm not certain that having dialysis in my right arm would be a good idea, but OTOH, I'd like there to be a good chance of my fistula actually lasting for a few years. I'll be seeing the new surgeon in a couple of months.

Alex,

Can I ask why they put a fistula in if you are at least a year away?  Yes, it does take approx 2-5 months for it to mature, but in my opinion, it sounds early.  Also, if they did not do any kind of mapping before the surgery, I would ask for a second opinion on surgeons. 
Even with doppler ultrasound, the results can be skewed, but if I understand your post, they did not do any type of mapping/ultrasound before hand. I have heard of surgeons just looking at the arms and picking a spot. In my opinion, this is unprofessional and should tell you right away to get another doc.

Also, many surgeons have different comfort levels on what they will create a fistula with. Some because it adds to their success record and not what is better for the patient.

Sometimes you dont have a choice in what arm. If you do, then by all means pick the non dominant arm.

Remember, dont be afraid for a second opinion. A good nephrologist should encourage this. remember, the fistula is our lifeline, so why not look for the best.  After all, do we not research when we buy a car or house or do we pick the first one we see?
It is also important to educate yourself.  Ask questions.....

///M3Riddler

[Riki]

Personally, I'd go for the upper left arm.. The scar is actually in the fold of your elbow, and isn't easily seen.  It's not the surgery scar that's so noticeable, though, it's more the access sites once they start using the fistula that are noticeable, but in the upper arm, they can easily be hidden with a sleeve of a tshirt.  I wouldn't worry too much about scars.  They are badges of honor among us.. *G*

[Leanne]

Since you have plenty of time I would do left upper arm.  Youhave plenty of time for that to grow.  I guard my dominant arm with my life.  Last resort only.  When I first started using my fistula it would bruise and hurt and was difficult  to use that arm sometimes. 

It would be great to have your fistula in and ready to go wh en its time.  You may think you have plenty of time but if you end up like me your function could drop a good distance quickly.  My wrist fistula didnt grow an d we hadnt yet did the one in my upper arm si I ended up with a chest cath.  For nine months. Sucked.  My veins are small so it took my fistula ten weeks to grow.  Then when we did begin to use it we sometimes had to rest it for infiltrations etc so I had to keep the chest cath.  My center gradually raises needle size too and the I had to have six treatments with 15 guage before I was allowed to have my cath taken out.  Sooooo more to think about . 

[MomoMcSleepy]

2hjgI have it in my upper left (non-dominant).  I did not have finger mindedness after first day or two, but arm pain, tingling, and numbness lasted months, and it is still sore from time to time.  I also had a
hard time gardening and stuff for a couple of months, like once I was using a rubber mallet and the vibration (I used both hands to swing) was too much for me. 

there are still time when I am holding something up with both arms, and my left arm feel weird and wants to give up. 

I was told not to "favor" my fistula arm, and I don't.  I find it buzzes nicely when I use it, esp. Playing video games 

I am of two minds.  Since it could cause permanent nerve damage, (unlikely but possible), I would avoid using my dominant arm; however, if the left arm looks like it might not take, anyway, then use the dominant arm.  You will still be able to use it fine, the pain is not too much (not after a couple weeks), the scar is not too terrible (in my opinion, but I am pretty proud of it, and it is HUGE, make no mistake), so if you think you can get over the whole scar thing (which, 5 months after surgery, still itches like a dickens), then just get the upper.  I have heard writes work better, though.  I suppose I am tilting toward dominant arm, but only because you make it sound like your left is a poor candidate.  I had poor veins all around, left was slightly better than right, but not much.

btw, I'm pre-d and don't know which needle sticks are more painful.  Just aim for best outcomes.  I, too get mine sort of early, but my rate of failure is unpredictable.

hey, anyone else find the doctors and nurses a bit cavalier, like they were removing a mole or something?  I got the feeling that they did these a billion times a month, and I was treated like I already knew what was going on, and already knew everything about fistulae.  Maybe I should have fried or something.

[CebuShan]

I am left handed and both of my fistulas have been in my right arm. I had one in my forearm but that didn't work very well. Fortunately, when they did the forearm one, they also did my upper arm (Left it deep) "just in case". When the time came, they pulled it to the surface and it didn't take very long to heal. I am on home hemo now and glad it's in my right arm. It's very easy for me to stick and I am establishing button holes.  Ask these questions also to your surgeon, if they don't seem to want to be bothered, get another Dr. QUICK!  Good Luck!

[amanda100wilson]

BEFORE you go ahead an have any surgery, make sure that you have vein mapping done and get the doctors to explain to you their preference.  If veins are big enough go for upper dominant arm.  if not, suggested a graft in dominant wrist.  this will help veins develop in upper arm should you need a further fistula later so that matuarion to e won't be so long.  these deep gains can take a long time to mature and often require a two-part surgery, one to make the fistula and a second to transpose it to nearer the surface.  if you are planning to cannulate yourself, it's a good idea to ask them to move it across your arm to make it easier to reach and also away from the scar.  mine took a year to mature and this is not an unusual length of time for this type of fistula, maybe the reason why your surgeon wants to get it established now.

[Alex C.]

So far, with 5 votes, NOBODY has chosen my right arm. I think that we may  have a consensus here....

Now, I just need to ask, especially for those who have a graft (especially those who HAD a fistula before the graft), would you say that a graft on my left arm is preferable to having a fistula on my right arm? The choice may come down to that, so I'd like some input before I see the next vascular surgeon.

[sullidog]

I have an upper arm graft in my right arm, hasn't affected me any. Like you I had a lefty but it didn't work very well do to small veins.