Another week of more challenges on dialysis
Just as I thought we were getting over the rollercoaster of the viral load being or not being undetectable and the change in my antiretrovirals to treat the HIV, there was another lurch in my medical treatment.
Last Wednesday, I attended my usual dialysis clinic as normal. Except that nothing was normal. I think we nearly had every nurse present around my bed as we tried to cannulate the fistula. I tried, I failed. The nurse assigned to me for the day tried and failed. The clinical nurse manager for the unit tried — and yes — he failed as well. Another nurse attempted the seemingly impossible and yep, he failed too. The blood was clotting very quickly in the fistula.
Having had about ten different needles in my arm that day, we decided collectively to leave it until my normal dialysis day on Friday and attempt again. The only difference being that I was asked to arrive in time for the morning shift at 8 am rather than my usual time of 1 pm.
And so it was on Friday morning, after a wonderful day out on Thursday with a friend visiting ancient monastic sites around Drogheda, I got up really early, caught the green bus from Monasterevin to Port Laoise, and walked up to the B Braun unit.
Houston we have a problem
I walked in, and my nurse wanted to scan my arm before we tried to needle it. When he did that, it was quite clear that we had a problem. There was very clear stenosis in the fistula. This meant that there would be a complete change of plans. I have to say a big thank you to the teams both in B Braun Midlands Renal Care Centre and the Midlands Regional Hospital at Tullamore as they worked together apparently seamlessly to coordinate my move to Tullamore for the somewhat inevitable procedure.
As soon as I knew I was going to Tullamore, I asked Andrew to come to Port Laoise so that we could arrive together at Tullamore. I had a feeling that I was going to need his support. I was right.
We arrived in Tullamore and were pretty quickly ushered into a treatment room that even I had not been in before. It was still in the dialysis unit but new to me. A nurse rescanned my arm and confirmed the stenosis. I’m not quite sure in what order everything happened, but I know I got food for lunch, Andrew went out for lunch in Tullamore, and a doctor put in a temporary catheter in my chest as the access to ensure that I got dialysis on Friday.
Back in December 2018, when my kidneys failed, I got a permacath put in, I have no recollection of how or where that was done. This time, I was definitely awake throughout the procedure. Liam, the dialysis support bear, was also allowed to be beside me. Feeling his left foot was one of the most comforting things I have experienced in a long time. I know that sounds daft, but that is how it is. Liam comes from Andrew, because Andrew can’t always be with me. But because Liam was, Andrew was there too. Well, in spirit anyway.
After the temporary catheter was put in, I then had four hours of dialysis as normal. It felt very strange to return to having the blood coming out from my right-hand side rather than my left.
Today’s activity
Today, Andrew and our friend Miriam came to visit me. This also meant that I definitely had all the new medication with me. This morning, before they came, I had another shorter dialysis session. Originally planned for two hours, so that I could leave and play for a wedding… (no, that madcap plan was vetoed by the bride)… we actually ended up with me doing two-and-a-half hours. For those who like numbers,
| TeKt/V | TBV | TSV | ΔBV |
| 0.92 | 46.2 | 9.9 | -0.4 |
Final results of dialysis session on 2023-09-09.
Today was not the most successful dialysis session, but it was about an hour shorter than is normal. But if we estimate the TeKt/V it probably would have been 1.28 which is just over the target of 1.2.
Next steps…
Tomorrow will be a relatively quiet day, I hope. Andrew won’t be in – trains are too difficult to negotiate from Monasterevin, and I don’t really expect to see any other friends either. From midnight Sunday/Monday, I have to be fasting as I have to go to Tallaght University Hospital (back where my first dialysis was) by ambulance transfer so that the team there can have a go at repairing the borked fistula. There are two possible outcomes: firstly, they repair the fistula and it works, the temporary catheter in my chest can be removed; or secondly, they cannot repair the fistula and the temporary catheter in my chest is removed so that a new permacath is put in. Either way, my consultant here reckons that I will be going home out of hospital on Tuesday.
It has been a rough few weeks. I really wish that everything just went according to my idea of the plan. However, I suspect that God has other ideas, which is why everything has gone the way it has. And at some point, I should be getting new books for my next module with The Open University on Public Health.
Originally posted at https://hivblogger.com/2023/09/09/another-week-of-more-challenges-on-dialysis/
