So you find out you have CKD ad need dialysis. You're likely prepared for the prospect of strapping yourself to the dialyzer for four hours, three times a week. But what you likely haven't prepared for are the surgeries that will accompany the treatment. The first procedure you are going to need is having a chest catheter/ PIIC line put in. This is considered very routine day surgery. No big deal, right? Well, I'm no stranger to pain. Having the chest cath installed wasn't terrible. But one thing was a tad awkward. It legitimately feels like the doctor is punching you repeatedly in the neck- well, because he kinda is.
I was explained that this is because there is no way to really guide the catheter through the artery to the heart with tech...at least not at my hospital I guess. As I lay there, blissfully numb from the local anesthesia, I thought to myself:
This must be how a scarecrow feels when it's getting stuffed.
A few months later I was in the waiting room of the local vascular surgeon's office.
I had just signed up for elective surgery to have one of my veins altered through the creation of a fistula in order to create an artificial artery. A fistula is a big honkin' vein capable of handling the volume and pressure that is associated with dialysis blood exchange.
Within a few weeks I was once again awake on the operating table as I was being worked on. Luckily, I was in an artificial dream-like state thanks to the skill of my hunky anesthesiologist.
Less then two hours later I had a vertical incision bisecting my left arm just below the elbow. It was wrapped in white bandages and still oozing blood. But the pain was pretty minimal.
My wound healed pretty quickly and my fistula developed sooner then expected and was deemed mature at my next appointment. Unfortunately for me, my fistula developed in an angle that was not conductive for easy access. It was at an awkward angle. As a result, it was decided to do a secondary graft to re-route the artery to a better location.
Within the next week, I was again in the hospital for day surgery. This time the incision was much bigger. It ran the length of my upper arm. When I awoke from the general anesthesia, my arm was still totally numb. After the analgesic worse off, the pain was immense. Making matters worse, I was under strict orders to not use my arm for several weeks while the incision healed and the fistula matured.
Warning graphic images ahead:
Soon my incision was healed again. The swelling in my upper arm abated and I was ready to face the needles.
I've seen grown men blanch at the prospect of having blood drawn. The needles used in dialysis are much, MUCH larger.
In a graduated process the nursing staff at my dialysis center began to access my new fistula with at first a single lower gage needle to then two and eventually went through three sizes of needles until reaching the full gage.
My fistula worked beautiful. BUT, (isn't there always a but?) During my treatment, inevitably when my fistula engorged with blood flow, a nerve was triggered. It begins with a sensation office cold water running from my neck to finger tips and gradually changes to the feeling of burning flames consuming my arm.
My pain tolerance is pretty high. But even at my best I can only stand the sensations an hour. This not a usual result.
Back to vascular surgery I go.
Veins are viewed. Looking great. Next comes expert accessment. And it's bad news. Nerves are highly individual. It's impossible to access where they lay from traditional imaging. The doctor could not guarantee any treatment would work.
My beautiful access that cost me so much pain is now in disuse. I keep it in case of emergency but I rely on my central line chest catheter for daily dialysis.
I still have a cluster of scars from my needles that make me feel shy when I wear short sleeves, but I very I frequently add to them by taking the needle these days.
Time I did my nerve reaction went off the rails and my arm went numb and limp for a week.
Everyone experiences dialysis differently. We all have our scars and stories. These are mine.
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