Today’s blog will be a busy one so I’ll get right down to
it. If you wish to see the pictures, please go to the “photos” 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 and 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.
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 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 surgery. For the
week following the surgery, he had to limit how much he could use the arm and
how much weight he could lift.
While his arm was healing, Kevin continued attending his
cardiac rehab sessions. As the month wore on, he began to feel a lot more
tired. Cardiac 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 chat with him. Thankfully they didn’t send Kevin to the ER, but the cardiologist
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 walk away, 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.
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.
Since he was now being punctured to do the treatments, 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.
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 certain special cases.
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