ARTS & FARCES internet

When I was waking up this morning, I noticed—in passing—that my left forearm was sore. As I fully awoke, I panicked. Oh shit, it’s my fistula, I thought. And it was. No thrill. No pulse. Ordinarily I can actually hear the thrill and pulse with my arm laying several inches away from my ear. Ordinarily I can actually see the pulse throbbing away at the surgical scar. Not today.

Quick, run for the stethoscope. Aw crap. No sound at all anywhere up and down my entire forearm. This is not good. My fistula ordinarily sounds like a whitewater river through the stethoscope. Not today.

I called the nephrologist’s answering service thinking vaguely that I remembered reading something about addressing a clotted fistula was time critical. Apparently not; the nephrologist on-call instructed me to call the vascular surgeon who created the fistula. I called the vascular surgeon’s answering service and got a call back instructing me to go to United Hospital‘s emergency room and he’d meet me there. Then, as an afterthought, he said, “wait a minute, there’s probably not a lot that can be done, so just drive down to my office and call my beeper when you get there. I’ll come across the street from the hospital and take a look—it’ll be cheaper and quicker. We’ll decide what to do from there.”

I like the way the on-call vascular surgeon thinks, and what a name: Roy Hope. I drove down to Roy Hope’s offices, which were of course, closed on a Sunday. True to his word he came across the street from the hospital and examined my arm in his office building’s lobby. He couldn’t get a pulse or thrill either and said his office would schedule a visit with an interventional radiologist for tomorrow morning.

I’ve been through this before. When my fistula was young it had a hell of a time maturing and clotted once. An interventional radiologist was able to dissolve the clot but required me to be admitted to the hospital. Another time angioplasty was performed to widen the blood vessel (no hospitalization required).

After nine years of kidney failure and dialysis I’ve still got a horrible case of white coat phobia. My blood pressure rises 20-30 points when I’m in any sort of medical situation, and even worse in the hospital. I really hate hospitals but I’m really hoping that the clot can be successfully dissolved. I really don’t want another catheter; a direct line to the heart is decidedly dangerous, and no showers for months on end is a real drag. After all my fistula is only eight years old or so; the little guy hasn’t even hit puberty yet.

So Hope is my doctor and hope is what I have.

Update: Monday, 30 March 2009 10:27AM CDT Well, this doesn’t bode well for the day. The surgeon had me all set up for an attempt to repair my fistula this afternoon. He called about an hour ago and said he wasn’t even going to try. He had talked to two interventional radiologists who said they had almost no success with the declotting procedure. When he examined my arm yesterday, he said it was just one big clot. So, in an hour I’ll be going in for a vein mapping that will hopefully show I’m a candidate for a new fistula and surgery to place a catheter in my chest. Surgeon Hope can’t do the new fistula surgery today so it’ll probably happen tomorrow.

This just sucks rocks. It’s like starting dialysis all over again from scratch. And it was a real pain in the ass the first time around.