Wednesday, February 6, 2013

December 17 through December 26 - Another bloody mess

In our previous episode they finally started using the fistula in Mom's right arm for dialysis, but after two sessions she has a very large area of bruising on her arm. To my untrained eye it looks like a significant amount of bleeding has taken place below the skin. We are anxiously waiting on Monday morning so Mom can show her arm to the people at the dialysis clinic. Surely they have seen all types of complications with fistulas and can tell her what's going on, right? Wrong.

December 17, 2012 (Monday): Mom went to the dialysis clinic early this morning before her appointment to show them her bruised right arm. They said they had never seen anything like it and recommended she contact the surgeon who did the fistula, or go to the emergency room tomorrow morning if she can’t contact him. Mom called Dr. K’s office and spoke to his nurse. Someone will call Mom back. In the meantime, she’ll go on to dialysis and they’ll have to use only the permacath again. So here's another setback on using the fistula and getting rid of the permacath.

Mom talked to Dr. K later in the day. He said since the fistula still has the thrill (strong pulse), and when they listened to it with a stethoscope at dialysis today it sounded ok, the fistula has not been compromised. He believes the fistula bled internally after the Friday dialysis session, and what we’re seeing is that blood dispersing throughout her arm. He wants her to keep it elevated and keep ice on it, and he’ll see her next week, after Christmas.

Well we certainly weren’t expecting to hear that, and part of me wants to have Mom go to the emergency room anyway. But if she did go to the emergency room, they would just contact Dr. K and he would probably tell them the same thing he told Mom, so I guess we'll follow the doctor's orders and keep checking for the presence of the thrill.

December 18: Mom came over to our house today and it should come as no surprise that I took pictures of her bruised right arm.

Fistula internal bleeding
Bruising after initial use of fistula

Although the fistula itself was created in the bend of her elbow, the needles for dialysis are inserted in the upper arm (biceps area), with one in a vein and another in an artery. When they remove the needles at the end of the dialysis session, they have Mom put two fingers over the insertion points. So what probably happened is the bleeding through the skin stopped, but the vein or artery the needle was in was still bleeding under her skin. It looks like the blood has run down her arm (below the skin) and has pooled on the inside of her elbow. The darkest areas of the bruising are almost black.

December 19: At today's dialysis session, a new tech got Mom set up to start. After making all the connections he turned on the machine and blood started spraying the machine. This time it wasn't actually Mom bleeding, but a connection that must have come loose when the pump started. It took three people to clean up all the blood. One of the nurses walked over to the new tech and said something like, “Well I hope you remember what you did so you don’t make that mistake again.”

December 21: Mom had previously requested earlier dialysis appointments on Friday, December 28 and Sunday, December 30 due to family activities and her travel plans. She checked with them after dialysis today and found out they had scheduled her for 6:00 AM on Sunday, December 23 instead of December 30. Good grief. They really have their act together down there, don't they?

December 22: TUD (The Unknown Donor) has talked to someone at the pre-transplant group about his blood pressure situation. He was told he can’t be on any blood pressure medication and donate a kidney. The person with the transplant group said he should perhaps work on improving his exercise and diet. TUD already exercises pretty much daily and outwardly appears to be in good shape, so there isn’t much to improve there. His diet isn’t awful by any means, but she suggested he try a very low sodium diet for a couple of months to see if that helps. So he’s planning on doing that.

Mom was told about TUD this evening. Circumstances are such that I will not be revealing TUD's identity on the blog just yet. Sorry about that.

December 26 (Wednesday): The dialysis machine started clotting during Mom's dialysis session today and they had to stop dialysis early, after about three hours (instead of three and a half). As a result, Mom lost some blood because the machine couldn’t pump it back into her. Her hemoglobin was last at 7.7 (below 10 is abnormal), so this is not a good time to be losing blood. She was very cold when she got home, which is what usually happens when her hemoglobin is very low.


So that's a wrap on 2012. The year started with Mom being denied a liver transplant, and a few months later she was told to prepare for dialysis. She was evaluated for a kidney transplant and was told she must have a living donor. The first potential donor was quickly ruled out due to medication, and the second potential donor may be ruled out due to high blood pressure.

She tried to go on peritoneal dialysis, even to the point of having a major surgery, only to eventually end up having to go on hemodialysis anyway. Dialysis has been anything but a good experience, with one issue right after another including a bleeding incident that could have easily been life-threatening, two catheter replacements, an inability to take a specific type of drug that dialysis patients need to be on, and an allergic reaction to an antibiotic that made her itch like crazy for over a week. As the year finishes up she still isn't on her permanent dialysis access (the fistula), since something went really wrong the first time it was used and she has a massive bruised area on her right arm to show for it. And her hemoglobin has been low since at least August.

I believe that's two hospital stays (8 nights total) and four outpatient procedures in 2012. Let's home things calm down a little in 2013.

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