Because of concerns with my ongoing lower back issues, as well as the sensitivity I am feeling in my abdomen, plus what I feel to be too large a personal commitment, I am saying "No" to the Peritoneal Dialysis, and am saying "Yes" to the Hemo Dialysis.
Also, I am strongly considering doing Home Hemo Dialysis. All the literature I've read indicates that the average patient has more energy on home hemo, a better appetite, and a significantly reduced recovery time following each treatment that would allow me to have a better quality of life.
Home Hemo entails 5 days/week, and between 3-4 hours per treatment (Tx), versus 3 days/week and 4-6 hours per Tx. (These times also includes prep and cleanup times.) Add the time difference to the benefits listed above, and you can see why I am leaning towards Home Hemo. Additionally, if I do the home dialysis, all supplies would be delivered to my door--which would significantly lessen any potential issues with supply stocks.
Also, because I am going with Hemo Dialysis, I am going to be scheduled to have an AV Fistula implanted in my arm. This is needed for blood access for the dialysis itself. Shunts and catherters are no longer the preferred method of access as tissue growth in and around the adjunct. Plus septic concerns surrounding the access points are eliminated with the AV Fistula, and incidences of infection are rare.
What is an Arteriovenous (AV) Fistula?
An AV fistula requires advance planning because a fistula takes a while after surgery to develop—in most cases from 3-6 months. A properly formed fistula is less likely than other kinds of vascular access to form clots or become infected. Also, properly formed fistulas tend to last many years—longer than any other kind of vascular access.
A surgeon creates an AV fistula by connecting an artery directly to a vein, frequently in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis treatments easier. For the surgery, you’ll be given a local anesthetic. In most cases, the procedure can be performed on an outpatient basis.
(arteriovenous fistula.)
Arrows show the direction of blood flow. Two needles are inserted into the fistula. One needle carries blood to the dialysis machine and the other needle returns blood from the dialysis machine.
*From the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
So, I'll be contacting my doc tomorrow (following more Hemo dialysis consultation) to set up the outpatient procedure. After that, the AV Fistula has to heal and strengthen--usually 3-6 months. IF my kidney's decide to shut down before the AV Fistula is ready for use, then I'd be given a temporary venous catheter, usually inserted in the neck. Dialysis would be done through this until the AV Fistula is strong enough for Hemo Dialysis.
I will keep you up to date about the schedule of the procedure. Assuming the anesthetic is a local, I may be able to give a first hand account of the whole thing. That would be danged cool! I've seen many surgeries in my paramedic training, and it's always fascinating!
In Other news, I continue to feel exhausted 24/7. Yesterday in fact, I took a 4.5 hour nap in the middle of the day, and still dragged around all evening.
My sleep is as terrible as ever. My dreams are OK; nothing to be concerned about. I just can't stay asleep for more than 45 minutes or so before waking, then struggle to get back to sleep. Plus, the area over my kidneys is just so painful. Right now, I'm averaging about 4.5 hours of sleep per night.
The ammonia I smell never reduces these days. In fact, there are days that it is worse than ever...like today. Just nasty!
My appetite remains up around 2-3 cups per day. The last two days I've eaten between 1.5-2 cups; but I'm hoping this is only temporary, and will soon be back up again.
My headache is like the Energizer Bunny. It goes, and goes, and goes...
Everything else remains the same. With my kidney function dropping I don't expect things to change for the better any time soon.
That's it. I'm tired, so I'll go rest now.
Again, I'll keep you up to date regarding the AV Fistula procedure. If you have any questions, please write to me and I'll do my best to answer them.
Good Health to All!
ScottW
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