Fistula Question

[graciekycats]

HI!  I'm new.  Vascular surgeon said right arm is the place for my new fistula.  I tried to tell them No to do left arm.  Apparently my veins are too small and the fistula would fail on left arm.  Since I am right handed I don't know how this will effect my every day life.  I am pre-D for now stage 4.  Does this surgery take 2 months to heal?  How do right handed people deal with normal daily routines till it does heal? I am stressing about being disabled after fistula surgery.

[Shaks24]

I am on PD but had a fistula placed in my left arm. I am right handed. They gave me a follow up for a month after the surgery to check it and it was working. You do have to protect it from injury. Avoid having BP cuff put on that arm. I think on my second check up with  the surgeon which was about 10 weeks after surgery they said they could ok it for use.  Fortunately PD is working for me and I have not had to use it. Its been a bit over a year now.

[obsidianom]

HI!  I'm new.  Vascular surgeon said right arm is the place for my new fistula.  I tried to tell them No to do left arm.  Apparently my veins are too small and the fistula would fail on left arm.  Since I am right handed I don't know how this will effect my every day life.  I am pre-D for now stage 4.  Does this surgery take 2 months to heal?  How do right handed people deal with normal daily routines till it does heal? I am stressing about being disabled after fistula surgery.

You will be fine.
My wife also has small veins and had to have her fistula on her dominant right arm. It never caused any problems healing or laid her up at all. She has had it for 2 and a half years now with no major issues. It works well and she doesnt have any problems with her right arm or hand. She barely notices it when off dialysis.
So you really dont have to worry if you have a good vascular surgeon. In my wifes case we went to the best one we could find who was out of our area about 150 miles away. He neeeded 2 surgeries to get it large enough to use but it is great now. 
It heals quickly in about 2 weeks or less but it takes 2 to 3 months to "mature" to be big enough to use for dialysis. During that time you really dont have to do much special for it and it doesnt cause any restrictions on everyday activities.

[noahvale]

^



   

[Rerun]

I avoid lifting heavy things.  I go about 20 pounds.... maybe more if it is real quick.

[Michael Murphy]

I had a fistula for three and a half years,  I had it installed several years before I started Dialysis.  During that time I had a complete rotor cuff tear in my right shoulder, so for six months I only had the fistula arm to use.  The only thing that limited me was in the hospital after the shoulder surgery They had to put the blood pressure cuff on my right arm instead of my left.  Every time they inflated it I felt like they were ripping off my right arm so of course my bp got higher and higher.  Long story short I now have two arms that work and I will state for the record the best thing I ever did was have the fistula installed early, by the time I started dialysis it was mature and it made the start of dialysis much easier and safer (I skipped the chest tube).  The only time I noticed the fistula was I slipped under my pillow at night and I woke up to the sounds of the ocean.

[JW77]

I'm right handed, had a fistula put in my right arm as my left had already been used for a shunt.

I learned to self needle at the age of 10, still using the fistula today (with 3 transplants and a lot of crap in between).

The exercise for fistula was drummed into me, and I'm pretty sure that sticking to that, as many times a day as possible soon after the surgery was what kept my fistula strong and long lasting, over 20 years).

Good luck:)

[Sugarlump]

I refused the fistula option in my right arm and with the right surgeon, have a really good working fistula in my left upper arm. (I have very small veins)
I am right handed and can't use my left hand for anything much.
In truth I like to be able to hold a book and read, eat a sandwich, do the crossword or sudoku in the newspaper and text, whilst on dialysis.
I would struggle to do any of this if my fistula was in my dominant hand.
I also would worry about using my right arm to pick up heavy dishes in and out of the oven, shopping or holding onto the dog with my fistula arm.

I think you need to choose what is best for you, not necessarily the easiest option available.

[JW77]

I'm right handed

Have a fistula in my right arm, elbow area.

https://www.facebook.com/photo.php?fbid=10152620891245151&l=38bf3ccc35

The key is to EXERCISE and develop your fistula vigorously and ritualistically as soon as its made and the first pain eases off. DAILY, 5 or 6 times a day.  It should last longer, and be easier to use.


http://fistula.memberpath.com/Patients/PatientEducationalMaterials.aspx

http://www.nhs.uk/Conditions/Dialysis/Pages/How-haemodialysis-is-performed.aspx

Fistula Fanatic:
Facebook page for better fistula care:

https://www.facebook.com/purplechick820?fref=nf


 

[kristina]

I am by nature left handed and by training right handed
and in my spare time I love to play the piano...
... and I had my fistula "put in" today in my chest on my right side...
... and I do hope very much that it brings me good luck in the future...

[noahvale]

^

[kristina]

Thank you noahvale, I stand corrected.
I did not have a fistula placed but a catheter and my dialysis starts tomorrow.
I am very hopeful about the results of dialysis, because I am dead-tired and completely exhausted,
even though I have not been doing anything at all...
I am much too tired to approach anything at the moment and I do hope very much
that my sessions of dialysis will make all the difference...
Thanks again for your kind thoughts and good wishes,
Kristina.

[cassandra]

Good luck tomorrow honey, you'll be fine.

Love, Cas

[Sugarlump]

Thank you noahvale, I stand corrected.
I did not have a fistula placed but a catheter and my dialysis starts tomorrow.
I am very hopeful about the results of dialysis, because I am dead-tired and completely exhausted,
even though I have not been doing anything at all...
I am much too tired to approach anything at the moment and I do hope very much
that my sessions of dialysis will make all the difference...
Thanks again for your kind thoughts and good wishes,
Kristina.

Thinking of you today kristina and hope it goes well. I am sure you will feel better after a couple of sessions once all the toxins are cleared out of your blood and feel more energetic. For me, initially, the worse thing was sitting still in a chair for three hours! But you do get used to that! 

[Rerun]

Okay, let's get back to Gracie's post.  We can wish Kristina best of wishes on her topic.

Rerun, Admin.    

[kristina]

Thank you Sugarlump and thank you Cassandra for your kind thoughts, it is very much appreciated...
... and I am very sorry Gracie and Rerun, I did not mean to interrupt ...
Sorry again from Kristina.

[graciekycats]

I am doing well with my AV fistula - it seems mature to me by now Nov - Feb.  Might have to start using it  GFR went from 18 a month ago to 13.5.  I feel like crap, tired but still pee.  I know I'm gaining fluid even on Lasix - weight gain not all from food.  I am often thirsty.  Drink water (chug it is more like it) Gotta change to ice chips I know.  My biggest fear is those huge needles.  Too bad they can't use butterflies.  But I am looking forward to feeling better. Neph said as soon as I start D he will recommend transplant.  I don't have a LIVING DONOR handy. Ah - the adventure continues.

[cattlekid]

My advice to you is not to wait for your nephrologist to recommend you for transplant.  If your GFR is 13.5, I believe most centers will list you.  If I recall correctly, the GFR ceiling is 20 to be listed.  No point in waiting, if a transplant is what you want to pursue.

Check into your desired centers to see if they allow self-referrals that don't require the nephrologist.  I self-referred to both Northwestern here in Chicago and University of Wisconsin in Madison. 

I am doing well with my AV fistula - it seems mature to me by now Nov - Feb.  Might have to start using it  GFR went from 18 a month ago to 13.5.  I feel like crap, tired but still pee.  I know I'm gaining fluid even on Lasix - weight gain not all from food.  I am often thirsty.  Drink water (chug it is more like it) Gotta change to ice chips I know.  My biggest fear is those huge needles.  Too bad they can't use butterflies.  But I am looking forward to feeling better. Neph said as soon as I start D he will recommend transplant.  I don't have a LIVING DONOR handy. Ah - the adventure continues.

[Simon Dog]

I My biggest fear is those huge needles

I cannot even begin to describe the unsettled feeling I got the first time I went to the clinic and they had the needle packs setting on the table by my chair.

I would suggest as a "first step" do have your MD prescribe Elma cream - it really helps.   I found the biggest way to get over the fear of needles is to do them myself.   I'm using buttonholes, but I have also self-cannulaed with sharps, and it really does hurt less when you do it yourself.    Consider home hemo and, if that is not for you, at least consider having the clinic train you to self cannulate.   I still don't like sticking myself wiht 15 gauge needles, but I have totally lost any fear of the process.

Another option is PD, which is much less intrusive on your life than hemo - but only if it works for you, and you feel good about that option.

[graciekycats]

I am doing well with my AV fistula - it seems mature to me by now Nov - Feb.  Might have to start using it  GFR went from 18 a month ago to 13.5.  I feel like crap, tired but still pee.  I know I'm gaining fluid even on Lasix - weight gain not all from food.  I am often thirsty.  Drink water (chug it is more like it) Gotta change to ice chips I know.  My biggest fear is those huge needles.  Too bad they can't use butterflies.  But I am looking forward to feeling better. Neph said as soon as I start D he will recommend transplant.  I don't have a LIVING DONOR handy. Ah - the adventure continues.

Feel better now on dialysis. All seems to be going well now. My center has me on 17 gauge needles and I told them I can't go bigger, they terrify me.  They said the doctor would talk with me but I would gradually go to 14 gauge which I've seen to clean my blood better. Only if they knock me out! I don't think they understand how bad it scares me.  I could cry right now thinking about it.  I tolerate the 17 gauge just fine. I've had many IVs and used to give blood. Any suggestions?

[Michael Murphy]

Don't look, no kidding I stopped looking at the needles going in when I realized they look like the holland tunnel that runs between NJ and NY.  I don't mind watching them come out.  I am on the 14 gauge needles I think I know there is one larger size and there are a few people who use them.

[noahvale]

^

[graciekycats]

To Noahvale - to answer your questions:
A few questions first...

1) Back in Feb. you were voiding urine.  Is this still true or has it greatly diminished?  **I still urinate about the same.
2) What is the average amount of fluid you have to remove each treatment? **They take off 2-3 lbs each treatment.  I haven't figured out the KG equivalent yet. Still on Lasix.
3) How long is your current treatment time?  **I do 3.5 hrs a day (3x week)
4) What is the blood pump speed? **No idea.  I'll have to ask.
5) Are you using the ladder or buttonhole technique with your fistula?  **Right now ladder - but want to do buttonhole.
They are giving me iron.  I'm apparently anemic based on labs.  Sodium/Potassium are ok Phosphorous getting higher.  They will start me on binders.
The first two treatments were not good (till they found right combination) First time bad cramps in legs, second time low BP nausea, light headed. They got it right now.

[Sugarlump]

I agree with either shutting your eyes or looking away completely when they put the needles in.
I can't watch them go in.
Now I have a graft, with proper needling I don't feel it go in. (We are using 17 gauge shorts because of shallowness of fistula graft.Only problem with 17 gauge needles
is it restricts pump speed to 250... waiting for delivery of 16 gauge shorts. TBH you don't feel much difference between 17 and 16...)
Look on machine or ask nurse what your pump speed is? (Affects amount of dialysis)

[graciekycats]

My pump speed is 250 with the 17 gauge needles.  They want me to try the 16 next treatment.  The cream doesn't seem numb as well as I thought it would.  I put if on 1 hour prior.  The cream is Lidocaine 2.5% and Prilocaine 2.5%.