Dialysis, My Favorite Hate

Dialysis has a bad reputation that is well-deserved. Since September, I have had to return to regular dialysis and to say that I hate it like a fat kid hates a salad is an understatement. It is often physically uncomfortable. It is a huge waste of time that I could spend more wisely boning a duck (get yer mind out of the gutter), watching Squidbillies, talking baby talk to my Doberman or even just twiddling my thumbs. Asking someone (me!) to sit still for four hours is an exercise in futility. There is a remarkably fossilized old man who finishes his up his treatment around the time I start mine. For the last half hour of his purgatory, he points and flexes and stretches like a ballerina. Even this guy can't sit perfectly still for hours on end and he leaves the facility by ambulance, horizontally. I can't believe that we haven't come up with a better way to replace the function of the kidneys. It's 2010, for Christ's sake. Let's get those kids in Virginia on it tout de suite. Save my life without the obligation to cannibalize yet another of my near and dear ones, please. There, the gauntlet has been placed politely on the ground. 


When I received Ger's kidney, I never imagined that I'd be back in the Big Blue (this time) Chair and back for an undetermined period of time. If you skip through the archives to the early posts of this blog, you'll see that I did a lot of unstylish whining about dialysis. Here comes some more. I am not, however, whining about the dialysis center- this time I got lucky and was assigned a center staffed by actual RNs and very skilled techs, too. The staff are all friendly and welcoming. I feel like they respect me, like they have a genuine desire to provide good care and for the most part, that they understand how much dialysis sucks. I don't have any serious complaints, so far. But, it is early days.


I have both common types of access right now: a PermaCath (tessio) in my R chest and an AV fistula in the approximately 6 cm directly above my L wrist. I hate the PermaCath with an intense passion. It's a constant danger of deadly infection. It's itchy. The required dressings pull off my skin each time it is changed and there is nothing to be done about it. I can't get wet unless I rig up a waterproof dressing that has some probability of success. This means that taking a shower is a major undertaking, requiring planning, logistics and a man with a clipboard. I absolutely can not immerse my whole body in water and with a little luck it will be removed before I go to California in the spring. The fistula came with a nifty 2 cm vertical wrist scar that I hope will finally win me some Emo cred. I have already written extensively about the PermaCath and its rigamarole of care. The fistula comes with some nifty features of its own. The PermaCath and fistula were both installed at NYU, by Dr. Thomas Maldonado. Dr. Maldonado is a very tall, friendly dude who is really cute in scrubs. Not everyone is, you know.


I recently returned to NYU to see Dr. Maldonado (installer of the lot) to see what he thought about how the fistula was coming along. I also wanted some insight into exactly when Cathy would be removed. My fistula was the subject of lots of speculation at the dialysis center, with the general consensus being that it was a failure. Dr. Maldonado didn't exactly agree but he did propose a revision if the fistula did not mature. Dr. Maldonado gave me a note for the dialysis center, saying that the fistula was ready to be used. He said that he'd remove the PermaCath when the fistula was utilized consistently for two weeks. Later that day I found out what dialysis with needles had in store for me. It's not much of a lark. Even when the needle is in and working, the slightest movement can stop the treatment or cause the needle to shift enough to penetrate the other side of the blood vessel and cause blood to leak into the surrounding tissue (infiltration). Successful placement of the large-bore needles is largely a function of the skill of the person inserting the needles.



I reported this to Dr. Klein (the NJ nephrologist) and he told me that NYU was a big university hospital but unless they were affiliated with a free-standing dialysis unit, they were 20 years behind the times. He told me that I was going to see his colleague, vascular surgeon Dr. Geoffrey Wong. So I did.

Dr. Wong is cute and young and looks just like his picture on JFK's website. He told me that I have a "good" fistula and reminded me that it is still new. He suggested that I have a sonogram of the vasculature so that he could get a good idea of what the other doctor did in there. I'm pending the sonogram, happening on Friday. He assured me that the fistula could be used and would likely mature further. He may want to surgically revise it after he gets a look inside. Until then, I'm stuck with catheter dialysis. My arm is black and blue from infiltration. Dialysis needles are like a Mack truck and I understand that they're big because they have to conduct large cells at high pressures. But man oh man, it sucks. I thought I had been harpooned in every way in which a human can be shivved but I was wrong. They're thinking up new ones as we speak.