My continuing arteriovenous fistula adventure

The blood vessel that makes up my arteriovenous fistula has apparently narrowed again, most likely the result of the inordinately high blood pump flow rates used in US hemodialysis facilities. In my case, the blood pump flow rate is always set for 500 mL/min for three hours. Using a lower, gentler blood pump flow rate would require a longer treatment time which would raise the cost of the corporate dialysis provider — DaVita in my case. So, in the US, in-center hemodialysis patients are subjected to as high a blood pump flow rate as they can tolerate in order to lower provider costs as much as possible.

My blood vessel narrowing requires yet another fistulagram and almost certainly another angioplasty. I’ve explained my fistula adventures throughout this website, most recently in September 2012. Last week, during a dialysis treatment, my venous pressure hit — and remained at — 300 mmHg (a personal record, but nothing of which to be proud). The dialysis nurse called to schedule a fistulagram and probable angioplasty, and the soonest I could get in was two weeks later: Tuesday 8 October 2013.

Next Tuesday, I’ll set off for United Hospital in downtown Saint Paul for a date with the radiologist. I’m a year older now and each birthday is something of a victory. Here’s hoping I can make it onto that damn surgery table, the balloon does its job, and nothing breaks. I gave up on retaining anything resembling dignity with regard to the hospital gown several fistulagrams ago and now just let my freak flag fly.

Allina, United Hospital’s corporate parent, seems to have cleaned up one piece of its act with regard to pre-registering patients. This afternoon, when the administrator called, I was never asked to pre-pay my co-pay; something that really set me off the last go ’round. Instead of being asked if there were any changes with my insurance (there were), I was told that they showed my insurance was Medicare with a BlueCross BlueShield supplement. That information was correct, but how did you know, I asked. “Oh, we always do a database lookup and cross-check before even calling,” came the response.

Of course they do.

I bit my tongue and said goodbye before I could ask the obvious questions: What database and cross-checked with what, where, and how exactly. I’ll wait until after the procedure this time before pissing anybody off.

Update: Tuesday, 8 October 2013 4:07PM CDT: The fistulagram and angioplasty procedures seemed to have gone well enough today. The same interventional radiologist who worked on me last year did this round.
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