Self-cannulation

So I am very excited now. I have started to self-cannulate, woo-hoo… Self-cannulate, you ask? It simply means that I am sticking needles into my arm for my dialysis.

Yes, it was a bit of a hurdle to get over. But I think that I had a slight advantage over some people by having been used to needles my whole life. So even though this was my first time sticking a needle into myself, it wasn’t as bad as it could have been. But let me tell you, it wasn’t a walk in the park either.

I was supposed to start on a Monday and the preceding weekend was like a rollercoaster ride. I fluctuated between being excited, having butterflies in my stomach and downright scared and nervous. Would I even be able to do that to myself after all? But then Monday morning arrived and I was ready. I had applied a good dollop of lidocain on both points of entry as soon as I got up and it had worked wonders for the hour and a half that had gone till I sat in the chair with my needles and tubes.

Now, don’t kid yourself. Dialysis needles are not for the feeble at heart. When you sit there looking down at it before it goes into your arm, there is no doubt it has the diameter of a sturdy broom handle – albeit a broom handle with a sharp point at the end, a point that is on its way into your very own arm by your own action.

Then you realize that it really wasn’t that large Friday when the nurse handled it. Yes, it is still one of the largest size needles created to go into the human body. But really I have been on the receiving end for close to 5 months. And now I was the one doing it to me, I was totally in control. I could stick, I could pull out (and show what a sissy I was – I think not!) I could do whatever I wanted with that needle and there was no pressure from anyone as to when or how fast I should do it.

So, one, two, three… I did it. I stuck that sucker (literally) into my skin. And here I’d like to interject, human flesh is a pretty tough substance, and I mean tough as in a steak that hasn’t been cooked properly. But I got through the skin. and soon after there was blood in the tube, just like there was supposed to. I was in the vein. And I was stoked. I had first timed it! I was in I pushed the needle all the way in and had some help taping it down. No need for those nurses if they didn’t do something to help me out.

I had done it. I had self-cannulated.

And I was felling high, not that they had given me any drugs that would help there. But it didn’t last long. The next needle didn’t wanna to into the vein. No matter how I tried and poked and pulled back and poked again, no blood came out the way it was supposed to. I didn’t really understand. The site we used was the one that had been most successful so far. But now it was like it had dried up. So we gave up and used the old tried and true method of the catheter on my chest.

Same thing happened next time. First poke straight into the vein. Second one didn’t go well, but this time I got the nurse to find the vein and it worked, though not quite as good as it should.

So then I got annoyed. I made sure that I could be there with the nurse who knew my arm the best (or at least had had greatest success with poking me) and lo and behold. We are now about a week into it and not once have I missed. I am going full bore self-cannulating. And when I say full bore I mean full bore. I have stepped up the size of my needles by two sizes. So I am using what they consider a ‘regular’ size needle. There is one size bigger but the speed my dialysis is running at it really isn’t necessary for me to go higher at the moment.

Lots of other good things have happened. But I really don’t feel like writing anymore. Also I want people to come back another time. So I think I better stop here. I am getting ready to try out the machine that I am hoping to bring home, the NxStage. Is should be possible to travel with it so that is pretty exciting.

I have also started a new blog. Check it out here: http://disabilityrightsbastard.wordpress.com/

I hope to come back here soon so I can keep y’all updated on all the stuff that is going on in my life.

Advertisements

Fistula success at last!!

Last week, Henning had his fistula scanned. Everything looks fine, so they decided to begin using it on Wednesday. The first stick, the nurse went straight through the fistula. He still has the catheter, so while he iced his arm and applied pressure, he was able to complete dialysis. He came home with a small bump and bruise that spread quite widely.

Friday, they tried again, and managed to use the fistula for venous access. He still used the catheter for the arterial access, and the fistula worked well the entire session. Success!!! If only partial. His pressure was great, and everyone was happy. But it also bruised pretty significantly. Hmm….

Today (Monday) they used the fistula for venous access only, but are concerned the fistula is not “quite ready” because of the bruising. *sigh* His vascular surgeon was sure it was “quite ready” weeks before… and offered to draw on Henning’s arm if necessary. Since Henning has a follow-up with him tomorrow, I’m wondering if Henning will come home with new ink…

In any case, slow progress is still progress. As long as the pressure is good, his cleanings are good, and he feels good (relatively speaking), I am happy. I wish it were all happening faster, but I feel that way about everything, usually.

Henning also has an appointment with the cardiologist tomorrow. While his blood pressure and pulse issues have responded to medication, they are fitting him with a halter to do a 24-hour check. The last time he had this appointment, he had to walk out before they saw him because they were so short-staffed and running hours behind schedule. He was going to miss dialysis if he stayed in the cardiology ward, so chose to abandon that appointment in favor of dialysis. His appointment with the surgeon tomorrow is two hours AFTER the cardiologist, so I hope they are doing better with scheduling. Afer all, a two-hour grace period should be MORE than enough.

*Fingers crossed*

No news…

…is good news, right??

As an excuse for not posting recently, it’s a good one, no?

I have stopped going to dialysis with Henning, so I have far less to report lately. He tells me all is well there. I stopped because while it is important for me to know about the machine and how to set it up, tear it down, etc. for when he comes home, I felt that my presence was hindering HIS learning process. He was becoming snappy and irritable with me. On top of that there were issues with his blood pressure and pulse, and his stress over our different learning styles was not helping… So one day, after he totally lost it on me after I recorded what he was sure was a false reading, I just walked out on him. There are nurses there to do what I was doing, after all. And they get paid. It works better this way, I think.

The only down side is… Henning isn’t a great historian, as we used to say during intake when I worked at the hospital, so… I didn’t have much to pass along.

But now I do:

Henning has regular blood work, and his numbers are fantastic. His levels of the more troublesome minerals are within normal limits, for the most part. Normal for healthy people. Which is practically miraculous.

He also just had a kt/V test, and the results are good. He is dialyzing efficiently, and getting good clearance. That news, combined with his usual blood work results, tells us that he is doing fantastic!

His dietician, Eva, is wonderful. I can’t say enough good things about her. She  has a passion for her work that surpasses probably everyone’s I have seen here in Denmark, so far. She also has a great sense of humor. She’s the one that told us months ago that Henning’s numbers were miraculous for not being on dialysis. The last time we saw her, she said, “I don’t often see numbers like this with dialysis patients. Actually, I never have.” LOL

She discussed healthy food choices, but we also talked about empowerment, how to get the patient to BE the hub of their own health care team. I really enjoy talking to her. If every medical professional had her passion and COMpassion for their patients it would transform medicine.

Henning is still dialyzing via catheter. The fistula seems to be doing well, but no one has dared stick it yet. Henning is getting it scanned soon, and if the nurses continue to be hesitant, the vascular surgeon (Johnny) has offered to draw pictures on Henning’s arm along with directions… *sigh* Johnny has actually done that before, he’s not even kidding. Unlike Eva, the man has very little sense of humor.

Medically, Henning is doing great. But he is still often tired and itchy and “spacey”. Since we know it is not directly related to dialysis or his diet, we are looking at other possible sources for his lack of feeling “well”. It may be exercise, it could be all the stress of the past many months catching up with him, it could be many things. But since it is not caused by anything medically acute, we can relax a bit and take some time just “being” while we investigate.

Our marriage took place amid a whirlwind of medical drama and stress, so we are taking a delayed Honeymoon soon. I am looking forward to this time away from our regular life: house, job, kids, illness, stress… and when we come back, I hope we will both be rested, refreshed and newly ready to tackle what life tosses our way.

 

 

 

 

Waiting to take a regular shower…

… is getting old.

When they removed the stitches on the catheter, they inserted a statlock stabilizer until the access finishes healing under his skin. It will probably take another couple of weeks. It’s small but kind of cumbersome, AND it is yet another thing that can’t get wet. *sigh*

PCL_Dialysis_hero

Henning has had the permanent catheter for a few weeks now. It worked great initially… but lately his arterial pressure has gotten high enough during the run to set off the alarms. To reduce the pressure, he has had to reduce the flow rate, and if you have been reading along, you know that is NOT a good thing. He has usually been able to increase it as time goes on during the run, but it is still worrisome. Twice however, they have had to reverse the access mid-run. No one has any idea why this is happening, and while switching does solve the problem, it causes a less efficient cleaning after the switch. And less efficient cleaning when he is already at the low end of “good” is not ideal. He has a dr. appt. soon, and this is one of the things that will be discussed.

His fistula continues to heal well after surgery. He has had no infections and no issues with the stitches, so we anticipate being able to start using it in a few weeks. When his fistula is finally viable (after nearly a YEAR of issues with it!) we will be VERY glad to get rid of the catheter.

The obvious lessening of risk is first, of course. Big things I look forward to:

* Not worrying about someone forgetting to close the port during set-up or break-down of the dialysis run, including Henning being that someone. I am getting good at playing complacent… but I still jump on the inside every time I see him or the nurse go near the port and I know it is still open. I know the risk of danger is small, and the staff is VERY good about reminding him, but if that damn thing is opened to the air, BAD SHIT WILL HAPPEN! (More on my role during dialysis in a future post)
* Not worrying about infection. So far, everything has been fabulous, but the risk remains.
* Not worrying about placement. The risk of the catheter shifting and puncturing his lung is very small. Not small enough.

Those are some of the big things… but the little things add up, too.

Little things I look forward to:

* Not having to worry about pulling it or bumping it in the night. That will be wonderful.
* No more bandage changes, at least, no more BIG bandage changes. THAT will be fabulous. Henning has sensitive skin and the constant changes are really stressing his skin’s surface.
* SHOWERING WITHOUT PLASTIC COVERING BANDAGES!!! I think this is the one small thing I most look forward to. Henning gets cranky, I get cranky… and it sets us both up for more crankiness next time around. The day he can finally soak from head to toe without worrying about anything getting wet that shouldn’t… I may just have to celebrate. 😀

Surgery number… I forget

Henning had his third fistula surgery last Wednesday. His flow rate was increased from 200ml/m to 800 ml/m (see Greg’s BigD reblog about flow rates) so this is GREAT news. The fistula is already more visible than it was, and in about three weeks or so we’ll begin to test it out.

We had no issues with admission, arrival, nor errant nurses offering food and drink to delay anything this time. In fact, it went as well as I think it could have. Henning was discharged within two hours of surgery, just after lunch, in fact.

The site is healing well, and aside from some initial pain, persistent itching, and some shower restrictions at first, it seems to be the least troublesome surgery he’s had on this fistula to date.

Here’s how it looked the other day:

2013-01-10 15.34.24

When the stitches come out, it will be interesting to see how little it is scarred, compared to the first fistula surgery debacle. You can see the first one by his wrist… HUGE scar, including stitch marks…. and after all that, it didn’t work. Blah. That is why we now insist on Johnny. Even if his hours are short and we have to wait to see him, he is a magician at vascular surgery.

More updates to come on the state of the permanent catheter, and how Henning is doing with dialysis. Stay tuned!

The second surgery in a week…

…actually happened.

It was at the other hospital (Herlev, as opposed to Riget), so there was no food or fluid restriction. This surgery was for removing the acute catheter and replacing it with the permanent (still temporary, though) catheter. This one basically goes right to the heart the same as the acute, but not directly into the jugular at the neck. The access is behind the collar-bone and it is far less fragile, and less vulnerable to infection.

The surgery went well, and the doc did a great job at minimizing the amount of scarring and using minimal stitching. Henning complained a bit… the scars make him look like he was attacked by a vampire. Kind of cool… but few will ever see it, due to the doc’s great stitch-work…

So now this catheter is working great. He can even fully shower with it, which is fabulous. I am still leery of it. I can’t quite figure my reaction. I have changed many a bandage in my day, and after working as long as I did in both the nursing home and the hospital, you’d think nothing would throw me. In fact, I can witness anything… but I just can’t get a grip on my reaction to changing the plaster on this catheter. I don’t know if it is because it does go right to his heart, or because it is so vital to his health, or what. But in any case, Henning can do it himself, so it is not a huge deal that I can’t do it without getting cranky or some other inappropriate reaction… but it bothers me that it bothers me… which doesn’t really help at all.

Anyway, the day after the catheter surgery, we picked up my daughters from the airport and had a whirlwind two weeks seeing every sight Denmark has to offer in the winter, that we could get to and from in any given 7-hour day. The girls were astonished that it was only daylight for such a short time… lol

It was a fabulous visit, and too short. But we look forward to them coming this summer. Hopefully by then, we will have this round of endless surgery behind us, and if not dialyzing at home, be very close to that goal. The days will be longer too, and we won’t have to worry about blizzards at the zoo…

2012-12-23 15.47.17

Schedules and other oddities

We are not organized people. It’s not that we lack the capacity to maintain a schedule. We both have the knowledge. Henning has his teaching/conference schedule and his private practice, both of which need time management. I used to be a manager in many incarnations of my varied careers. I like to walk into chaos, and organize it. I’m really good at lists, plans, etc. HOWEVER… when it comes to private life, neither of us like the idea of having that time scheduled. It’s not that we lack the skill… just the will.

But that has all changed.

With dialysis three times a week at four hours a pop (MWF), doctor’s appointments, and of course, social engagements, on top of our regularly scheduled activities… we are getting into the swing of having a pretty rigid, detailed schedule… which is good, considering the weeks ahead. This coming week, for example, has two (yes, TWO) surgeries and… my kids are coming for the Christmas holiday. So… if any of you are wondering what we will be up to in the coming days, here’s a preview.

Today is a dialysis day, so that means 4 hours in the morning – which, really, goes until about 1pm… so saying morning is kind of silly. Dialysis is really the equivalent of adding a part-time job to the schedule. Today is also Henning’s last day with his long-term PT (she is moving to the mainland), so that got fit in right after dialysis. He also has an appt. this afternoon, so that means a full day of driving around, after the big D.

Henning is having surgery on his fistula Wednesday. This is minor surgery to tie off some veins near the site to force the fistula to mature faster. While this is a one-day, in-and-out visit, it takes up a lot of time because we have to do the admission paperwork 24 hours in advance. Plus, because the surgery is on Wednesday, that means rescheduling dialysis. Our regular unit at Herlev Hospital seems accommodating, but since the surgery is at Riget Hospital, he’ll dialyze there. In this case, he will dialyze on Tuesday afternoon, as they didn’t have a Wednesday spot available.. So that means two trips to the Kingdom (Riget Hospital) on Tuesday, and one on Wednesday.

He is then having surgery on Friday to insert a permanent catheter behind his collar-bone. The one in his neck is working great, but it is not a long-term solution. It is more vulnerable, and, honestly, a pain in the… well… you get it. Since we don’t know how long it will take for the fistula to mature, this is a better, longer-term option.

Again, this requires the paperwork to be done 24 hours in advance, but since this surgery is in our unit at Herlev, it is closer. Making daily trips is not such a big deal.  Also, again, the surgery is on a dialysis day, but since this is our unit, it is easier to re-schedule the dialysis… we hope.

And to top off a week of busy, busy, busy, my kids are coming this Saturday (yes, the day after surgery #2) to spend two weeks with us. We have a tentative schedule full of trips to the city, museums, Tivoli Gardens, Sweden to visit Henning’s dad… it’s NUTS!! (But in a good way) The girls are well prepared to suspend any and all activities depending on how Henning is feeling, or if something unexpected comes up. But regardless we will be pretty busy. We also have a trip to Immigration planned. It is that time… fingers crossed.

I think we may come up for air sometime in January…