New, confused, ?????

[dpatnfl]

Hi....mom is an 80.5 year old diabetic.  For the past year neph dr. has been insisting she get a fistula but mom is afraid/in denial.

Last month her creatinine was about 4.5.  This past Friday morning she went for bloodwork and that afternoon the dr. called my sister and told her it was a little over 7 and she should bring my mom to the E.R. to get checked out.  My mom was eventually admitted, her sugar/BP reigned in and the level today was at 6.  She has more or less accepted the idea of the fistula, however, the dr. wants to put in a jugular cath and do a few dialysis sessions before she is released.

Unfortunately, the neph dr. made her rounds very early and we missed her, and mom doesn't speak English very well.  I tried to get the BUN and GFR from the nurse, with no success.  Tried to page the dr. and she was too busy making rounds....wanted to address my concerns over the phone!   I really want to sit down and discuss what this cath surgery entails, the lab tests,  etc. etc....I was told the surgeon can answer my questions, but she doesn't want to drag him into this If we have not decided to move forward...isn't this a Catch 22?   

Anyway...I am going to try and catch her during rounds tomorrow.  Since this is new and overwhelming,  I would appreciate suggested questions I should ask the dr.  Meanwhile, I have some of my own that someone here might be able to help with:

What does the cath surgery entail?  Put under?  Outpatient?  Risks? Complications?  Stroke?  Is this temporary until she is released or beyond until the fistula can be done?

What causes the creatinine to jump so much?  Sugar/BP out of whack?  Meds?

is it necessary?  can she survive without it until the fistula is ready?  what should I be asking or looking for in regards to the lab work?

I just feel like the dr. is adamant about doing this, like she is getting impatient with us.

Thanks in advance for your help & support....Donna

[del]

7 is HIGH for creatinine.  If the doc wants to put in a cath she thinks your mom needs dialysis immediately.  There are other major issues like potassium levels as well. If potasium is really high your mom could have a massive heart attack!! Fluid retention is another big thing.  It can get in the lungs or around the heart and case major problems. If the fistula is done it will stay in until the fistula/graft is done and working. Usually takes about 6 weeks after the fistula is created before it is ready to use.  It is a big jump from 4.5 to 7 but it can happen Things can change pretty quickly for a dialysis patient. 

You need to talk to the doc if you can and get answers to questions.  Is it possible to call her office and talk to her.  If the only way is over the phone than you need to do the talking over the phone. Have a list of your questions written down.  Things could change very quickly for your mom if she neds dialysos and doesn't get it.   

[peleroja]

I've had two permacaths put in.  Each one was done under a local (lidocaine).  The catheter has two leads which go into the jugular and then directly to the heart.  Dialysis centers don't like permacaths to be in longer than a year, preferably a lot shorter than that, due to the fact that they do lead directly to the heart.  In both instances I was released the same day.  Also, only a nurse can connect you to the dialysis machine with a permacath, don't know why, unless it has something to do with the heart.  Hope that helps!

[YLGuy]

I was not completely put under when they placed my catheter.  They called it twilight.  It was in for a couple of months until my fistula worked.  They did the catheter and fistula during the same procedure.

[dpatnfl]

Thanks for your replies...BP/Sugar is good today.  nonGFR?=6  AFRAM?=7 Potassium=3.6 and Phos.=5.0.   Bun has decreased from 95 to 91 since yesterday..however creatinine is at 6.91.

Trying to convince her to put cath in and do a few sessions of dialysis before she leaves hospital to see how she feels.  She is afraid of pain/suffering with cath even though we told her she will be under meds. At her age she feels what is the use, why suffer through all this if her quality of life is going to be diminshed