The Battle Against Cholesterol – Chapter 5 (Photos Included)

Today’s blog will be a busy one so I’ll get right to it. As always, if you do not wish to see the pictures, please go to the “text only” version.

During the previous chapter, Kevin’s hemodialysis catheter was removed to prevent dangerous stimulation of his vagus nerve. His fistula was still new, and wasn’t rising to the surface. We went back to the vascular access office so the doctor could do a quick scan to make sure nothing was blocking the new fistula. From the scans he noticed there were “feeder” veins that were stealing some of the blood flow from the fistula. He was able to close one off with a coil, but could not reach the others.

Scan showing the feeder veins

Scan after the doctor added the coil to close off one feeder vein. It looks like a tiny fish hook.

The next week, Kevin met with his vascular surgeon. The doctor had reviewed all the information from the most recent scans and informed Kevin he would need to undergo a CVT (cephalic vein transposition) surgery. Because Kevin had large, muscular arms, the fistula was not going to be able to surface without help. The surgery was scheduled for two weeks out, but Kevin caught a break and took an earlier appointment.

The CVT surgery entailed temporarily removing the connection between the artery and vein, lifting the vein up and channeling it through the skin, then reconnecting the artery and vein. The surgeon also cut off other feeder veins that had developed. Kevin would still have to wait another four to six weeks to determine if the fistula was ready for use. Because this surgery was much more invasive, Kevin couldn’t use his arm for the first day after. For the week following the surgery, he had to limit how much he could use the arm and how much weight he could lift. These pictures show the progression of his recovery:

About five hours after surgery

The following day

Four days after surgery

One week later

While his arm was healing, Kevin continued attending his cardiac rehab sessions. As the month wore on, he began to feel increasingly tired. Rehab started to become a burden instead of a help. A few weeks later, he called from rehab to tell me he had to stop in the middle of his workout due to chest pain. They did an EKG in the rehab office and a cardiologist came to check on him. They didn’t send Kevin to the ER, but the doctor prescribed him anti-angina medication. A week later we met with Kevin’s cardiologist. He suspected Kevin’s beta-blocker could be causing issues, but there might also be more going on. He knew how fast Kevin developed blockages and was worried about the stoppage of the apheresis treatments. He concluded the best option was to send Kevin to the hospital for an exploratory catheterization. If there was a blockage forming, they could take care of it right away. In the meantime the doctor told Kevin to stop attending rehab and take it easy.

The next week we went to the hospital so they could take a look. They prepped Kevin with an IV, fashionable hospital gown, and traction control booties. Since the cath lab was only a short distance, they let him walk instead of riding on a gurney. I headed to the waiting room, not sure what to expect. A very short time later (less than an hour), they called me back. The cardiac surgeon explained that Kevin didn’t have a typical blockage. He said the stent he placed six month prior had grown a bit of scar tissue and it appeared to be blocking some smaller side arteries. We were both relieved it was only scar tissue and not cholesterol run amok. The doc gave Kevin a prescription for a special nitroglycerin to be used during exercise. He advised Kevin it was okay to engage in light exercise and he should meet with his cardiologist to discuss when to resume rehab.

The following week (about six weeks after the CVT surgery), Kevin met with his vascular surgeon. He was happy to report that Kevin could begin using the fistula. He felt confident it was mature enough, and he was very happy with the size and how strong it felt. A few days later, Kevin had his first lipo-apheresis treatment in exactly two months. It took a load off our minds knowing he would be back on track for keeping the cholesterol under control. Kevin was also able to resume cardiac rehab and get back into a normal routine.

The lipo-apheresis treatments were slightly different using the fistula. Because he was being punctured with 17 gauge needles,  Kevin used lidocaine cream on his arm to numb the area. The first treatment using the fistula went very well, and Anthony was very pleased with the blood flow. He treated 6,000mL of blood in just over four hours. Kevin experienced some nausea, but we suspected that was the heparin. Here’s what the process looked like with the fistula:

The plastic wrap keeps the lidocaine cream in place so it can numb the area

First needle is in

Both needles are in and lines are hooked to the machine

Kevin is able to work during the treatment

A closer view of the machine (you can see the three filters in front)

Next week, I will wrap up the story with how the treatments have been going since using the fistula, medication reactions, and how we found out lidocaine causes nausea in special cases.