Vein Balloons

So this is why I missed dialysis on Wednesday. I’m trying to write a paper for my Critical Discourse Analysis course, which obviously isn’t going very well. So this will serve as a little break.

When my kidney doc heard that as a result of a blasted vasculature, I received a synthetic forearm graft instead of a natural fistula, he seemed disappointed, though at the time I did not appreciate the difference. A synthetic graft, being synthetic, tends to have more complications than a natural fistula because of a body’s reaction to it. I, being a young healthy person, am having those reactions. Bummer indeed.

I’ve heard that typically grafts require treatment every 3-6 months, sometimes less and sometimes more frequently. While I had a very high initial “access flow” (meaning the blood was moving through the graft and back to my heart nicely – the number was 1200 something), after about three months the access flow wasn’t flowing quite so nicely (600 something) so I went to the vascular center in a strip mall on County rd D and 35W to have my veins ballooned via angiogram. Piece of cake. I got to watch the whole thing – kind of a crazy enterprise, x-rays, contrast dye, I got to know my left arm and shoulder from the inside. They ballooned one spot in my forearm, not painful at all. I was back at dialysis that afternoon after a nice lunch at Blackbird.

Six weeks after that (in October), I was back at the vascular center with an even slower flow rate (300 something), for some more serious ballooning. This time the narrowing was in my upper arm. I had bravely (stupidly) foregone the sedatives assuming it would be the same cakewalk as my previous visit. I survived fine, but it was a bit of a ride. Ballooning felt like my vein being stretched – which is to say it felt like when I have sat with my legs dangling off a ledge or something, then had jumped down and my feet felt like they had exploded. Know the feeling? It wasn’t quite so acute, but it was uncomfortable, and it lasted about 15 minutes. The vein is stretching and tearing a bit. The interventional radiologist almost put a stent in because the vein was damaged. Lots of breathing and a few bad jokes to try to pass the time. Six weeks was a quicker turn around than most of us hoped for, and the whole graft thing was starting to become the adventure Dr Hall was worried about.

I returned to dialysis feeling more deflated than ballooned, thinking I was now in for a visit to the strip mall every six weeks rather than every three to six months. Two weeks later, when I went in to dialyze, my access was clotted.

I should say that the access clotting was a kind of worst case, nightmare scenario. If the access is clotted, no dialysis. As one tech put it – the access is a lifeline. If it is clotted, the good people at the strip mall clinic work to open it up. If they cannot, they reinstall (the first word to come to mind) a shoulder catheter – the dreaded no-showering, stenosis-causing Hickman. I also would need a more permanent access, a graft in my upper arm. That was Wednesday last week. Not a great day.

However, this story has a happy ending, at least for now – always for now. J

The wonderful people at the strip mall vascular surgery center, with whom I am now well acquainted, were able to clear my graft using some anti-clotting drugs and more balloons. So many balloons! This time I opted for some sedation so I was more comfortable. I still watched and made my comments and asked my questions. Those poor people are used to quiet, sleepy, sedate patients. Not me. As of Monday, yesterday, with the help of balloons and some blood thinners, another access flow test showed a flow rate of a robust 1700. The graft is clear and flowing strong – for now.

As it has happened so many times in my life, right when I’m feeling kind of down about the daily routine of dialysis (always today, yesterday or tomorrow – always always always always) something goes to shit. This week I’m appreciating the daily routine of dialysis. I suppose it was only a matter of time before I started settling into this new normal. And it is only a matter of time before graft will slow again, the veins running from the graft back to my heart will narrow, or the artery leading into the graft will narrow, and the graft might clot off again. Something like this will happen again, maybe soon.  But for now, things are moving, and I need to get back to this paper. Thanks for reading!