Fistula surgery

[houndawg]

On August 25th my hubby had a fistula placed in his lower left arm for hemo.  Tuesday when we went back for a recheck the fistula doesn't work.  This whole effort to place a fistula in the arm has been a disaster.  First the mapping department ASKED Dick which are HE preferred instead of mapping both. When we visited the "Surgeon" he said "no problem.  He actually boasted that he was going forward with surgery as planned but would put the fistula in the in the left arm between the hand and elbow. (Right arm veins were small.)  HE could tell the vein was strong and didn't need mapping.  He actually said he had done thousands of these and he could do it with his eyes closed.   On surgery day HE showed up four hours late for the scheduled surgery!!!  His excuse - scheduling conflict!!!  The hospital didn't even know where he was until they paged him - a half hour after surgery was scheduled.  I must wonder if they had not called if he would have even bothered to show up.  When "Mr. FLYBOY" doctor saw that the fistula didn't work his words were "oh well, we try again! "  When asked what our alternatives were he said none - I said oh yes there is we get another opinion!!!  (The look on his face was worth a million bucks to me.)  Now we must find a good surgeon to perform this fistula.

When the dialysis doctor found out last night that we fired the surgeon he was upset and said Dr. Lynd was one of the best!!  Fistulas fail everyday!!  It's a fact of life.  He also said we were going to have to get an arm fistula quickly in order to ensure Dick's health.  He recommended another doctor but he has a bad rep for failing surgeries also.  Before going anywhere I'm researching this surgery.  I'm also going to call his transplant team at Hershey medical center to see if we could get it done at Hershey.  For those of you who are in the Southcentral PA area - Wellspan stinks for kidney patients AND many other problems. (Want to know more - ask me.)

I realize things go wrong but my question is how common is failure?  It seems to me this is an easy place to scam patients, insurance companies, and medicare.  If one in four surgeries fail and the doctor repeats the surgery his income is increased by one fourth!!!!  I am suggesting this when I mail my letter of complaint to the AMA asking that he be reviewed.  I also complained to the hospital but since they are Wellspan I do not expect a good result there.

Any suggestions how to proceed ? I would deeply appreciate it.  Dick is so depressed he actually said maybe he should stop dialysis all together.  (Yes, he knows the consequences .)  He actually reminded me that the last hospital visit one of the doctors said that ESRD patients are a one way ticket - all downhill!!!! That has stuck with Dick.  Wellspan has actually increased Dick's problems several times over.  Beginning with giving him meds that caused a stroke two years ago!!  We didn't sue but I'm tempted. They also allowed his condition to go down hill with PD even thought we kept saying we didn't think it was working.  It was only after we fired his PD doctor and insisted on a temp fistula to start hemo that we've seen any improvement in Dick.  I'm afraid he has deteriorated to the point physically (weak) that the transplant team in October will remove him from the list.  If this happens I know he will just stop living. 
Any help you can offer would be greatly appreciated. 
Houndawg  

[Desert Dancer]

Houndawg, how awful for you! 

This might not be terribly helpful, but will Wellspan let you go to Philly? It's a bit of a haul from Hershey, I know, but the doctors there are second to none. It doesn't seem to me that you'd have much of a pool of docs to draw on in Hershey.

I really hope this gets resolved for you guys soon.

[CebuShan]

Certainly they should have mapped him! But by now maybe an angioplasty would help.
Not sure if this will help or not.
My fistula didn't fail but it was VERY slow in developing. 1st surgery in Sept.'10, recheck in Oct. Not developing fast enough.Angioplasty Oct. Recheck Nov. Still not very developed. 2nd angioplasty Dec. recheck Jan '11 much better. recheck Feb. good enough to try it!
My fistula is almost invisible on the surface but it has an excellent "thrill". (I always say that it feels like a cat purring).
Don't know anything about Wellspan, (we have BC/BS of Tennessee. [I say BC/BS of Tenn with an emphasis on the BS!]), but it can't hurt to try. The worst they can do is deny it.

Good Luck! Here's hoping things get better for you both.
   

[MooseMom]

I don't think it is true that one in four fistula creations fail; whoever told you that is probably trying to cover up for something.

I am horrified that any medical person would tell a dialysis patient that ESRD is a one way ticket to the grave.  Untreated esrd certainly is, but while it is not easy, optimal dialysis can increase a patient's lifespan immeasurably.  If your husband is well enough to be on the transplant list, then that means he has no significant co-morbidities, so good dialysis can keep him going for a long time.  But of course, the operative words are "good dialysis" which is hard to achieve in a clinic. 

The key is in finding a really good vascular surgeon, and if you can go to Philadelphia to get the best, do it.  It took my mother 18 months to get a good working fistula, and she ended up having to go to the Texas Medical Center in Houston to get it, but she found the best surgeon and was lucky she made the effort to find him.

Your husband must feel so terribly depressed. 

Do you have any idea why the fistula failed?  Did the surgeon bother to tell you?  I can't believe he didn't do a mapping.  That's awful

[Dannyboy]

Houndawg,  So sorry to hear about all this.    I will defer to the experienced members here to comment on your fistula questions....as it happens, I just had one done today. 
---Dan
PS:  welcome   

[houndawg]

Thanks for your kind words.  I want to clarify that our transplant team is located at Hershey Medical Center.  They had nothing to do with this.  If my message was unclear I'm sorry.  As a matter of fact I've decided to call the transplant team Monday or Tuesday to see if they can recommend a surgeon at the Hershey medical center to do the fistula surgery.  Hershey is an hour and a half away so it is very doable.  We just need to get the name of a surgeon to contact.
 
The culprit Is Dr. Clifford Lynd.  He is on staff at Wellspan York, PA Hospital.  Wellspan is a medical group not an insurance company.  (Insurance is another tale.)  Wellspan has wonderful nurses and really horrible doctors.  If any of you are lucky enough to be in the York, Gettysburg, Lancaster area of Pa this is the big group on the block.
 
I spoke with the Chief of Doctor Staffing this afternoon.  Of course apologies and a promise to speak with Dr.Lynd.  I was assured he was a good surgeon but over confident.  I have been asked to be part of a "board" to share concerns for patient treatment by doctors at the hospital.  HA  HA  HA  As I told him that doesn't change the fact patients must repeat procedures that can be potentially life threatening.  I also pointed out that the hospital as well as the doctors make extra monies from "repeat" surgeries.  He didn't seem to be happy when I told him I mailed a copy of the bill and letter given to Dr. Lynd and York Hospital to the AMA and to medicare suggesting possible double dipping on these surgeries.  He suggested that possibly the hospital and surgery bill will be cancelled.  BIG DEAL.
Thanks, Liz

[jbeany]

I lost one out of 2 before I even got to use it, and the doc opened another spot in my wrist to look at a third site and didn't even attempt it.  Unfortunately, failing surgeries for D accesses are pretty common, but I don't know the stats.

If you look in the FAQ section, there's a thread I posted after a legal seminar about what you have to prove to win a medical malpractice case.  The real sticking point is always the same - you have to find another doc in the same specialty who is willing to testify that your doc did something that is less than "the standard of care."  Unless he seriously screwed up, it's hard to prove another surgeon wouldn't have done the same thing.

[sullidog]

I am on my second graft. I too had a surgeon that was praised.  I had to switch surgeons because the graft was failing every month, I finally found a good one! My previous one couldn't figure out why the graft was so hard to canulate.