It’s time again. It seems like I can never go too long without some type of surgery penciled in on my calendar. I’ve honestly come to regard surgery as an irregular, but consistent part of my life. I’ve lost count of how many I’ve had – eye surgeries, transplants, and surgery to remove a tool left in me during another surgery, to name just a few. I’ve gotten to the point where, when the doctor tells me they’re going to be giving me the anesthetic, I try my hardest to stay awake just to see how long I can. My record, based on me counting, is seven seconds. Tomorrow’s surgery is a little bit different though because it is not fixing anything that needs to be fixed and it is something I hope I’ll never have to use as intended. I’m having a fistula put into my arm.
A fistula is something that occurs naturally but it is also something that’s done intentionally to many dialysis patients. In this case, what’s done is a vein and an artery in the arm are both cut and then fused together forming a loop. It’s normally done through vessels that have a relatively high blood flow. As this junction heals, it grows very large and thick, allowing an exceedingly high blood flow. Because it’s close to the surface of the skin, it offers an ideal spot for blood to exit and re-enter the body for the dialyzing procedure.
Currently, the dialysis machine is connected to me via a chest port. This consists of two tubes that come out of my right chest and on the interior, lead straight into my heart. This system has been working fine. However, my best prospect as a kidney donor and subsequent transplant found out at the end of May that she’d have to wait three months to redo a test to see if she is an eligible donor. When my doctor found this out she decided it was time to switch me over to a fistula. Without going into too much detail, she said that the current system I have is never meant to be permanent or long term because it puts the patient at high risk for infection. Seeing as the tubes lead straight to the heart, she said that if an infection comes in, it will immediately go to the heart and if I survived, I’d never be eligible for a transplant. Enough said! She then gave me the option of doing it or not. I don’t know about you, but when a doctor you trust says, “If you survive” it’s an attention grabber.
Given the way the medical system normally works, it took a few weeks to get an appointment with the vascular surgeon who performs this procedure, and a few more weeks for it to be scheduled for surgery. The surgery itself is a pretty minor, outpatient affair. It’s done under what they now call, a twilight anesthetic. This concept fascinates me because you’re awake and able to communicate throughout the operation, but when the drug wears off you have no memory of what happened. Given that you’re conscious, I always wonder if it hurts while the cutting’s being done. I’ve had several surgeries done this way and everything’s been fine. One minute you’re in the operating room and the next, you’re in recovery with no recollection of the time between. I’ve got to remember to ask this time if my alter-ego, who’s awake and talking during the procedure, said it hurt.
I mentioned that I was hoping to never use this fistula. It’s because the healing process, which is which is also a “ripening” process, takes a good eight to twelve weeks to get to the point where it’s usable for dialysis. The fistula has to grow as it’s healing and has to get to a certain size before it can accommodate dialysis.
My hope is that I will have this done, and in the eight to twelve weeks I’m waiting for it to become useful, my potential donor will be cleared and I’ll have had the surgery I really want to have – my kidney transplant. Keep your fingers crossed!
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