Have you ever heard those words? Do you know what they mean? This time last year, I don't think I had any idea what the term meant. I had learned each word through my years of medical fascination on television, but I never thought I would experience them first hand.
In June of 2017, only six months ago, I was told by my nephrologist that my kidney function had dropped dramatically. He was happy to put me on the list as soon as possible, but he also wanted me to explore the idea of dialysis. This was a good appointment and bad. I was exciting and nervous to move forward with the transplant, but I was absolutely dreading anything having to do with dialysis.
Dialysis is needing when you are in End Stage Renal Disease and your function has fallen to 10%. There is more than one type of dialysis, but I was only interested in Hemodialysis if I was going to have it at all. I hated the idea of something in my stomach even more than the idea of something in my arm or chest. In hemodialysis, you go three times per week for approximately 2.5 hours. While you are there, a machine is plugged into and out of your veins to "clean" your blood. Dialysis does the job your kidneys can no longer do. This sounds awful, especially when you are young and mostly healthy.
First I went to my neprhologist's office at a different location for an ultrasound of my veins. They need to find which veins are the strongest in your arms and where the best placement would be. So, I was sent to do a consultation with a vascular surgeon that would make my scar look "pretty." Boy, was that a lie. Boy #3 and I met with Dr. Brett Siegrist in Downtown Phoenix. Again, I was the youngest person in the waiting room by about 25 years or more. We both really liked this doctor. I would highly recommend him to anyone in Arizona needed vascular work. He commented on how smart and understanding I was of the medical terminology. He explained most of the procedure and left me to think everything.
I spoke with family, friends, coworkers, Boy #3, and anyone that might listen whether or not I should go through with the surgery. No one would decide for me, but most people thought it would be "better safe than sorry." It was important to do it sooner rather than later because the fistula itself needs time to develop and mature. At this point, it was just a precaution in case I did not find a living donor. The waiting list for my blood type is 5-7 years for a cadaver (dead body) kidney. By that point, I would be 37 years old and need dialysis.
I eventually said yes to the surgery and it was scheduled for July 10, 2017, exactly fives months ago. I was so nervous, anxious, and uncomfortable with the idea. It was in outpatient, so it sounded like no big deal, right? Boy #3 took me to Banner Health in Phoenix that day and we checked in. Waiting was the worst part. Waiting for the check in process to be over. Waiting for them to call me for pre-op. Waiting. Waiting. Waiting.
Eventually, I had to leave my boy and go upstairs to prep alone. I was absolutely terrified. I knew this surgery was going to change my arm for the rest of my life. If you google an AV Fistula, you will see what I mean. The photos show lumpy and deformed veins in the arms of much older people. This was hard for me to accept. A few years ago, I had finally started to care about what I ate and started exercising. This lead to my body looking better and me finally gaining self confidence. This surgery just brought that back down. Aside from vanity, I also knew that it was not a cure or a fix for anything. It was one step closer to dialysis, which just meant I was getting more sick.
During my pre-op with a very nice young nurse, I started to cry. She let Boy #3 stay with me the whole time. He kept me mostly calm and help me use the restroom down the hall after I was already hooked up to the machines. Lots of doctors and nurses spoke with me, which was overwhelming. Then the surgeons, yes there was more than one, told me there would be two procedures not one. I flipped out. I did not, under any circumstances want to come back in six weeks to let them cut my arm open again. The second procedure would be to cut my arm higher up, near my arm pit, to move my vein closer to the surface for better access during dialysis. No thank. Boy #3 tried to calm me down and so did the doctors.It was just unimaginable having to go through all of this again.
They explained that they would cut into my arm to create the fistula. A fistula, of this kind, is a vein and an artery in my arm that are "sewn" together to create more blood flow in the area. This is so a dialyzer can have the best flow of your blood. See picture below from DaVita.
After all of the doctors and assistants left my "room," I was wheeled into the surgery room. I was crying and couldn't contain myself. I remember them moving onto the surgery table and strapping my arms down, then someone telling me it was okay. Then nothing...
Next thing, I knew I was waking up a different room. This must be their recovery wing, I thought to myself. Their was a nurse there doing her stuff on my machines and my notes. My arm felt huge and strange, plus the compression air pumps with still on my calves. I had forgotten about those until I woke up. I was woozy and weird from the anesthesia. It took me a while to wake up and event my boy appeared to help me get dressed. Dr. Siegrist came into to give me a recap of everything. He did everything that day, even though he did not want to. He did that for me and my anxiety. I will always appreciate that. They created the fistula and moved my vein, so my whole upper arm had been affected. From elbow almost to armpit. OUCH.
The ride home was uncomfortable and seemed extremely long. I requested McDonalds, mostly for the McFlurry. But once I got home and took one bite, I had to throw up. Damn you anesthesia. Boy #3 was absolutely amazing during my recovering and during the surgery itself. I will also look back in admiration for that. Thank you for taking such good care of me that day and the next two week KWA.
My recovery took much longer than expected since they did everything in one day. I was off of work for two weeks. It hurt to do everything, including sleep. I had to sleep with my arm propped up on pillows so it was awkward. I had to do everything with one hand because I could barely move my left. The last two weeks of July were the mostly painful and uncomfortable weeks of my entire life. I don't think I mentioned before that it is my left arm. It is usually done on your non-dominant hand.
It took weeks to heal. I also had a slight setback with the bandages getting stuck. My incisions with closed with glue instead of stitches and the bandage ended up sticking to the middle incision. It was disgusting and incredibly painful to peal off. Forget ripping it off like a band-aid. Fuck that.
After going through all of that and starting to feel normal again, the fistula started to "work." This fistula is supposed to mature over time, so it gets stronger with the flow of blood. But when it is in your arm, you can feel and hear your blood flow. It is creepy the first time you experience it. If you place your hand in the crook of my elbow, you can feel a vibration. It is also like a mini cell phone vibrating inside my arm. When I put my arm up to my ear, I can hear the blood flowing. What a bizarre thing to get use to, right?
Not only does it have a sound and a distinct feel, I cannot sleep on the side anymore or care heavy things. I attempted to do light weights at the gym this week and had to stop from the pain. It was only five pounds! I also can't wear watches or bracelets on that arm. Tight tops, forget those too. My left hand also gets much colder than the right now, another odd sensation. Throughout the day, my surgery arm has bizarre sensations, cramps, and pains. It is delightful, but maybe I will get used to it someday. Maybe some handsome young man will find it interesting and won't mind that my vein shows more than his.
Getting ready for surgery.
Fistula in action.