Lots has been going on with me lately. I've been too overwhelmed to care enough to talk about it. Two weeks ago I had my fistula revised.
For months I had been insisting that my fistula was very high flow, and I was worried about what that meant for my heart, and the fistula. Over the year since I had started using it, it had grown multiple large offshoot veins, and the Transonic flow tests alternated between the 1000's and the 3000's. It was a short, but large and strong fistula. I finally convinced my nephrologist to have an ultrasound done to determine actual flow rates, and where all those accessory veins were connected.
It turned out I had a stenosis further up my arm, and with the high flow, the pressure was causing it to split off new veins (and at my elbow, break through vein valves and flow backwards through a portion, then branch off in another direction). I had a fistulagram to get a better view, but not to open the stenosis because that would have just increased the total flow rate. I was scheduled to see a vascular surgeon for having the fistula revised. The surgeon did a drawing right on the exam table paper covering at the consultation:
Compared to my fistula on the outside (with buttonholes):
He wanted to tie off the branches, open up the stenosis, and if it looked like a good idea, slightly band the fistula to reduce the flow. He also thought transposing it - moving it up on top of my bicep, instead of on the inside of my arm - was a good thing to do. It's apparently the usual thing to do with a basilic vein fistula, but my original vascular surgeon didn't think it was necessary (and it wasn't, really, until these problems popped up).
So I had the surgery two weeks ago, woke up with a dressing from elbow to armpit and some obvious upper arm swelling, and went home.
Unfortunately, the dressing was put on before the swelling started, and the adhesive on that dressing held on tight. So tight, that as my arm swelled, the adhesive didn't budge, with caused some nasty blisters to form. One blister was 3 inches long, half an inch high, right over the new location of my fistula. I saw the surgeon about it, he took off the dressing, put Silvadene cream (used for burns) over the blisters, applied new nonstick dressings to the blisters, wrapped my whole upper arm in gauze, and told me to do the same when I change it every day.
That took care of the blisters pretty quickly. Within 5 days I was able to just knock the scabs off and have red areas that looked like sunburn where the blisters used to be, then I saw him again to get the staples out. Too bad, he decided the fistula was ready (since it didn't need to mature), so he called my nephrologist and recommended that, and she put in the order to start using the fistula, no one considering that the fistula was still
right under the very sensitive skin from the blisters. Great.
We started on Thursday with 17 gauge needles, one at a lower part of the fistula that wasn't under blistered skin, but the other had to go through the sensitive skin. I don't know if it's that the skin still needs healing, or that the fistula is just naturally now very shallow at that spot, but both times it's been stuck so far, it's squirted as soon as the tip of the needle penetrated the skin. So I'm looking forward to plenty of bloodbaths.
We used 15's on Saturday to get my flow rate back up to 400, and my venous pressure was better that it was before (which was a problem while training for home hemo - interrupted for now). Arterial pressure about the same, but it was never a problem. I've been trying hard all weekend to heal faster. In an hour and a half I get stuck again.
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