QUESTION ABOUT FISTULA/LABS very imp.

[jenjen76]

Hi everyone I have a question for a friend really hoping to get your input-he is 44 and creat is at 3.3 BUN is 64-he feels week and tired his potassium was 6.1 a few days ago from his primary now is 5.0 -hes waiting for a call from neph-I believe his GFR is around 18-20% wouldnt the dr. recommend prepping him at this point for a fistula?or do you think he needs a cath. right now? He says hes not feeling nausea or tasting metalic in his mouth but hes not really eating-this has came on very quickly and hes a bit taken back by this -I am stage 3 so I dont know all the answers about dialysis but I told him its better to get a fistula ahead of time instead of doing nothing and waiting for it to get so low you need a cath.I guess my question is what is the appropriate move from a neph. at this point-he went to his primary on mon. had a BMP his creat was 3.1 his primary said come back in 2 days and today it was 3.3 he waited all day and called his primary to get results just a lil bit ago they said well we will fax over your results to your neph and let them know you will be calling them-In my opinion I would surely think they would want to see him in the am to discuss the fistula and get him prepped for surgery asap ....?? Am I right? He is a very close friend and I just want to be there for him and know what to expect -thanks everyone!!

[jenjen76]

Re: QUESTION ABOUT FISTULA/LABS very imp.

also can you get a cath. and get prepped for the fistula at the same time or do you have to wait awhile to get the fistula?

[metrogirl]

Re: QUESTION ABOUT FISTULA/LABS very imp.

A cath is usually done on an emergency and temporary basis as they have a higher risk for infection. He should be in discussion with his neph as to what type of dialysis he wants to get etc. If he is at 18% he is getting close to that time that he will need to make a decision. He will need an ultrasound on his arms to determine the best place to place a fistula. Naturally everything will take time so he should definately start preparing now.

[jenjen76]

Re: QUESTION ABOUT FISTULA/LABS very imp.

thankyou so much!!!

[LanaB]

Re: QUESTION ABOUT FISTULA/LABS very imp.

Also, when they had considered giving me a fistula I learned that like Metrogirl said, they send you for ultrasound of your arm first but that it takes a long while for the fistula to mature. Several weeks, .. months?? cant remember. But they did tell me that if I didnt do any fistula surgery that you can wait longer to get PD surgery since they only require 2 weeks I think to be ready to start.
I never was on dialysis so if anyone who is reads this and wants to correct or edit me please go right ahead. This is just from what I remember.
Hope it helps.

Lana

[jenjen76]

Re: QUESTION ABOUT FISTULA/LABS very imp.

Thanks for the info Lana-Hey I remember you had your transplant and was wondering how are you feeling now and what meds are you on? And what are your labs like now? Can you eat whatever you want now? sorry to be so nosey I just like to pick peoples brains on whats life like for them after transplant lol-thanks for the info!!!

[Marina]

Re: QUESTION ABOUT FISTULA/LABS very imp.

A fistula can take 3-6 months to mature (to be ready), although on people with small veins it can take much longer.
It's a great idea to go see a vascular surgeon ahead of time, and get a "vein mapping"
to determine a good fistula site.

Although at it's very hard to tell when you will start dialysis, some Drs ( like mine ) will start patient early on, while others will wait until much later.
I started dialysis @ 13-15% before I was aymptomatic (besides occasional nausea).

[LanaB]

Re: QUESTION ABOUT FISTULA/LABS very imp.

Hey Jenjen!!

Thanks for asking.. I'm doing great. I'm not tired like I was anymore since my hemoglobin is up. It's still not at low normal but its getting there.

They have me on Tacrolimus (prograff*), Mycophenolate (Cellcept*), Septra, and I take two Zantacs at night too. Side effects are FINALLY wearing off, still mild tremor at times but barely noticeable at all.

OK FOOD... what your really wondering about right?? Well, I am able to eat normally now but I have a little food paranoia. I worry about ruining this kidney, worry about putting on weight, and how to eat normally after being so restrictive. It's a little bizarre. I am trying to still eat low sodium while adding in whole grains but I am weak about pizza and when I got out of hospital I ate a chocolate bar EVERY day. I am still addicted to choclate daily but tried to replace it with light hot chocloate. Weird thing here is I never had a sweet tooth before this. I had put on 7 pounds - cant be helped when your finally free with food no matter how hard you try to control. I had too much delivery food and hubby and I were recovering and couldnt shop - add that to christmas time and the food... Working on losing those 7 now before I gain any more!

Blood labs are very good. I have been lucky. blood pressure was low 90/60 and 100/60. They tried to have me take meds to raise it I absolutelly declined. Now it is at 116/70, the exact number it was before transplant. All my numbers are normal, blood sugar too, even though I expected the chocolate binges to ruin that. LOL!

Your NOT nosey! I'm happy to share info sincce I wanted to know as much as I could too. Are you on a list yet yourself?? Or are you still considering it?

Take care! And please ask any questions you like..

Lana

[LanaB]

Re: QUESTION ABOUT FISTULA/LABS very imp.

Jenjen, I was thinking that maybe you dont even need to go on a TX list since your managing so well at CKD level 3. You may have loads of time still, right?? Assuming its maintaining there..

[M3Riddler]

Re: QUESTION ABOUT FISTULA/LABS very imp.

Hi everyone I have a question for a friend really hoping to get your input-he is 44 and creat is at 3.3 BUN is 64-he feels week and tired his potassium was 6.1 a few days ago from his primary now is 5.0 -hes waiting for a call from neph-I believe his GFR is around 18-20% wouldnt the dr. recommend prepping him at this point for a fistula?or do you think he needs a cath. right now? He says hes not feeling nausea or tasting metalic in his mouth but hes not really eating-this has came on very quickly and hes a bit taken back by this -I am stage 3 so I dont know all the answers about dialysis but I told him its better to get a fistula ahead of time instead of doing nothing and waiting for it to get so low you need a cath.I guess my question is what is the appropriate move from a neph. at this point-he went to his primary on mon. had a BMP his creat was 3.1 his primary said come back in 2 days and today it was 3.3 he waited all day and called his primary to get results just a lil bit ago they said well we will fax over your results to your neph and let them know you will be calling them-In my opinion I would surely think they would want to see him in the am to discuss the fistula and get him prepped for surgery asap ....?? Am I right? He is a very close friend and I just want to be there for him and know what to expect -thanks everyone!!

JENJEN,

Your friend should definetely be getting prepped/ready for the fistula. You should try to avoid caths at all costs as each time you get one, it will form scarring and can result in that arm not being able to be used for a fistula. This is one major issue that the nephs dont seem to get. They wait until the last minute to be worked up for a fistula thinking they can just place a cath in if you need dialysis and then get worked up for a fistula. This is totally opposite of how it should be for the reason I stated above.
It takes approx 3 or more months for a fistula to mature and be ready to use. This is a good time for your friend to be having the workup and seeng a vascular surgeon for this procedure.
This is also the time that the nephrologist should be discussing her dialysis options with her. Meaning the differerent types of dialysis.....PD....In-center hemo and home dialysis. Most nephrologist will just throw you into in-center dialysis. This is the worst decision they could make. With in-center you only dialyze approx 12 hours per week. No where near enouph dialysis for anyone as your kidney work 24/7.
I would highly suggest home dialysis as you are dialyzing 4-6 days a week with hemo. Even with PD you will be getting better results.
Learn as much as you can, openly discuss with the nephrologist your issues. IF your nephrologist tells you to leave it up to him/her, then this is the wrong approach. The patien needs to be involved as much as possible as well as making their own decision on what type of dialysis to go on making the decision based on the patients individual needs. It should not be up to the doc to just throw someone in center. It is also the nephs responsibility legally to review all options with you.
If the nephrologist givesyou trouble, its time for a new neph. Everyone needs to work together as you have to advocate for yourself. The doc has many patients to look after, you have yourself.
I would demand to be worked up for a fistula, or even a pd cath if dialysis is in the near future. Avoid caths if possible.

[metrogirl]

Re: QUESTION ABOUT FISTULA/LABS very imp.

Yes, fistulas take time to mature. Jesse had his fistula placed on March 1st. Shortly after his fistula surgery he decided he didn't want to do hemo afterall and wanted to go with PD. He had his catheter surgery on June 28. Now let me back up a little bit, during the time that he was getting ready for his PD catheter they were still checking his fistula to see if it was good for use so the catheter would have time to heal just in case he needed to start dialysis because he was already pretty sick. They said his fistula still hadn't matured as much as they would have liked but they could use the fistula if he ended up needing dialysis anytime soon. Well he had his PD surgery on 6/28 and it went well. He went home but was feeling sick to his stomach. We chalked it up to the anethesia. The next morning we were to return to the PD clinic for a catheter flush and he was really sick now. Vomiting, confusion, and extreme agitation. When I told the nurse what was happening, she called for the Neph and the Neph told the nurse to wheel him down to the ER and that he was being admitted. He started emergency hemo dialysis that very day using his fistula. He only did 4 weeks of hemo before transferring to PD.

We thought we had a little more time but in the kidney failure world, we just never know when dialysis is going to be needed. Hopefully your friend starts making preparations now before it becomes an emergency situation.

[jenjen76]

Re: QUESTION ABOUT FISTULA/LABS very imp.

Thanks for your responses thats exactly what I thought but being that im stage 3 and 55% function I thought it better to ask all yall-I told him this is the best website you could ever ask for -you have all been a true lifeline for me and I dont know where Id be without you-I love and respect you all so much its so wierd but you are all are like another family to me-im so greatful for Davita--thanks again!!

[jenjen76]

Re: QUESTION ABOUT FISTULA/LABS very imp.

oops forgot @ Lana that is sooooo awesome -I loved hearing your story especially about the food part-I hope a cure will come before I ever need a transplant but its so nice to hear -I dream about being able to eat all the veg I want as for me now -I eat very very lil potassium but still is an issue -that is my dream to regain that freedom

[kkri]

Re: QUESTION ABOUT FISTULA/LABS very imp.

Pursue the fistula as soon as possible. Based on my own experience, fistulas don't always mature or mature on schedule. Catheters can clog or become infected and should only be used as a last alternative.

kkri

[kkri]

Re: QUESTION ABOUT FISTULA

Pursue the fistula as soon as possible. Based on my own experience, fistulas don't always mature or mature on schedule. Catheters can clog or become infected and should only be used as a last alternative.

kkri