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Author Topic: PD For The Elderly With No Fistula  (Read 2056 times)
PrimeTimer
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« on: August 02, 2017, 09:50:58 PM »

Hubby told/prepared his mother about getting a fistula installed before needing dialysis. She said she doesn't want one, wants to do PD and that besides, her neph told her she didn't need one. Ookay...we took that pretty much the same way when she said she had no swelling (and she does). In other words, she doesn't want no ugly fistula and doesn't think she needs one. We doubt that the neph told her she didn't need one but whatever... SOO..hubby talked to her about a chest cath. Nope. She says she doesn't need that either. That when the time comes, she will be doing PD. Well ok, then! Alrighty! Yippy skippy! The woman seems to know what she wants and that IS THAT. Except that she has scar tissue from previous surgeries that might make placement of a PD cath difficult. Hubby and his sister have both agreed that if "mom" wants to do PD, then by all means, let her do PD! Sheesh....this is like watching a train wreck about to happen. I'm staying out of it as much as possible. MIL already thinks I'm a loser and blames me for things she knows nothing about so I am sure as heck not going to get involved in her dialysis. Hubby has spent a lot of time educating her over the phone (since we live long distance) but she doesn't think any of it applied to her. She never listens to him anyway. Told hubby this will be no different. We can't help someone if they don't want our help and we can't force someone to do something they already said they are not going to do. So now we just wait for the call that she's crashed and in the ER with a chest cath sticking in her for emergency dialysis.  ::)
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Husband has ESRD with Type I Diabetes -Insulin Dependent.
I was his carepartner for home hemodialysis using Nxstage December 2013-July 2016.
He went back to doing in-center July 2016.
Simon Dog
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« Reply #1 on: August 02, 2017, 10:32:11 PM »

So now we just wait for the call that she's crashed and in the ER with a chest cath sticking in her for emergency dialysis.  ::)
If it happens on a weekend or an OR is not available, she might get a femoral line in the groin.   BTDT.
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kickingandscreaming
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« Reply #2 on: August 03, 2017, 03:13:50 AM »

I'm elderly (75) and I do PD with a belly catheter.  For this, i don't need a fistula in order to begin.  If her beginning is sudden (as mine was) then she might get a chest catheter to do emergency hemo.  I don't know if I'll ever get a fistula as I am set against doing hemo.

If I were your MIL, I would check in with a vascular surgeon to find out if she is a candidate for a PD catheter and then go from there.  I don't think that abdominal surgery is necessarily an obstacle.
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Diagnosed with Stage 2 ESRD 2009
Pneumonia 11/15
Began Hemo 11/15 @6%
Began PD 1/16 (manual)
Began PD (Cycler) 5/16
Shaks24
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« Reply #3 on: August 03, 2017, 10:09:44 AM »

She should at least visit a vascular surgeon to make sure the scar tissue is not an issue for a PD catheter. If not there is such thing as urgent PD where PD is initiated right after surgery with low volume fills of solution while the patient remains laying down on their back. You can google urgent start PD to learn more about it.
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Congestive heart failure 2011
Currently about 19% Kidney Function
September 11, 2013 PD Catheter and Fistula Surgery
September 27, 2013 Started PD
smartcookie
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LMSW

« Reply #4 on: August 03, 2017, 11:27:30 AM »

I agree with the others, that the PD cath may still be possible even with the scarring. 

However, I know you needed to vent, too.  So vent away!  Here are some true sayings I believe apply to your MIL:

You can lead a horse to water but can't make it drink.
Can't teach an old dog new tricks.
If she was meant to be controlled she would come with a remote control.
She is as stubborn as an old mule.
Selfish people end up only having themselves. 

Anyways, maybe you and your hubby should try to only offer advice when it is asked for?  Sometimes people I know like your MIL hate it when others give advice.  They want to do it their way, no matter what.  It is annoying, especially when you know better.  All you can really do is love her for who she is, faults and all, and try not to say "I told you so" when she gets cathed. 
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I am a renal social worker.  I am happy to help answer questions, but please talk to your clinic social worker for specifics on your particular situation.
PrimeTimer
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« Reply #5 on: August 03, 2017, 05:46:35 PM »

At first we thought SIL was siding with MIL just to side with her about doing PD but now we realize that my SIL is kind of agreeing with my husband; their mother does not listen to either one of them. She called hubby asking all kinds of questions and wanting advice, he gave it. He told her first things first, get a fistula while you can to avoid a catheter. Then silence. She said she didn't need a fistula and is all gung-ho on doing PD, etc, etc... At this point and given her history of never taking advice she asks for, we've decided that "silence is golden". We (me, hubby and his sis) know that sooner or later the doctors are going to tell her what she needs. Now, whether that will be in the setting of a doctor's office or an ER, we won't know til the day comes. But one thing is for sure, hubby has answered her questions and warned her and has tried to prepare her. Nothing more he can do. I think that's the part that is most upsetting to me. I am concerned about this added stress on him. He doesn't need it. No one does. So I told him that he's done what he can do and what she does with his advice is up to her now and either way, the doctors will be telling her too, altho we suspect they have already. We think that is why she is quiet right now. She doesn't want to face this and really, who does? If she thinks that certain things or the "rules to this game" don't apply to her, then let her think that. We know that no matter what she is thinking that she will probably be starting dialysis soon enough. No point in arguing with the woman.
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Husband has ESRD with Type I Diabetes -Insulin Dependent.
I was his carepartner for home hemodialysis using Nxstage December 2013-July 2016.
He went back to doing in-center July 2016.
PrimeTimer
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« Reply #6 on: August 03, 2017, 05:47:21 PM »

She should at least visit a vascular surgeon to make sure the scar tissue is not an issue for a PD catheter. If not there is such thing as urgent PD where PD is initiated right after surgery with low volume fills of solution while the patient remains laying down on their back. You can google urgent start PD to learn more about it.

Thanks. We will keep this in-mind.
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Husband has ESRD with Type I Diabetes -Insulin Dependent.
I was his carepartner for home hemodialysis using Nxstage December 2013-July 2016.
He went back to doing in-center July 2016.
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