Fistula questions & info, please

[FMBK]

Numbing Cream

Thanks, ChefNancy. I will try my doctor for advice. My social worker is the reason I am not covered by prescription insurance right now. She gave me wrong advice, saying I do not need to get Medicare Part D for prescriptions. She insisted I was covered for everything on Medicaid. Turns out, I was not! THis is not the first time she gave me incorrect information. I find it very frustrating and end up doing research myself as a result.

I spent hours on the phone for several days to try and sort it all out. The bottom line is, I won't know for certain if Medicaid covers prescriptions until August 1st. I needed cream before that as I had run out. By chance, I went to another Duane Reade and they ended up filling part of my prescription. I was thrilled...but don't have enough for the end of the month. I am looking for alternatives in case it becomes an issue.

Thanks again for your suggestions.

[Pancho3]

Fistula Needle Insertion

I insist and get an injection of lidocaine prior to insertion of the needles into my fisyula. Granted the lido is injected, it feels like a mosquito bite whereas the needle insertion feels like a wasp sting.

Tell your husband to insist on the Lidocaine, I tried it without a few times and prefer the Lido first. And also let him know that as time goes by and his skin " conditions" itself to these tratments, the pain will decrease. All will be good. trust me.

[Justjan47]

Re: Fistula questions & info, please

Hi all! My husband and I recently discovered that the EMLA cream, over time, will break down skin tissue. As a result, both of his buttonhole sites were reddened, itchy and flaky. He has compromised by placing just a small dot of the cream directly on the injection site and this is helping, but still irritates the skin. Now we're going to have to create a new buttonhole, and he really needs to coat the entire area for the new injection site. I know he would be very interested in this injection of lidocaine prior to insertion of the needles. We are doing HD at home - where would we get this injection for him, and would I (his care partner) be allowed to give it?

[chefnancy]

Re: Fistula questions & info, please

I am sure you could be trained to give it just like any other injection. Your husband must be allergic to some component of the EMLA cream as many people have used it for years on end with no troubles. In any case, ask your dr. about the lidocaine injections. Usually the objection to the lidocaine injections is that they build up scar tissue in and around the fistula, but if he can't use the EMLA then that is the only other alternative that I know of.

[Justjan47]

Re: Fistula questions & info, please

Thanks, Chefnancy, I did check out the lidocaine injections with his nephrologist, who suggested, rather, that the ethyl chloride spray be tried first before going to the injections. I understand that the spray has its drawbacks as well, as it basically freezes the skin somewhat. Meantime, tho, we've discovered that he's also allergic to the adhesive on the tape we use to hold his needles. That's going to be a real stumper, I think. As of today, his surgeon 'revised' his fistula, tying off a large collateral vein that was diverting flow. So we're hoping for the best, while continuing to work on these other little problems.

I must say tho, that these problems are VERY small when compared to the huge benefits he gets from dialyzing here at home.

[jody]

Re: Fistula questions & info, please

My dad also just gets the needles put in his fistula without numbing it first. I should have my dad ask for a numbing cream. He also has to wait for about 15 miunutes for the bleeding to stop in his arm. One day my dad went home after dialysis and 4 hours later his arm began bleeding from his fistula site. It seemed like so much blood. He went to the dialysis center and they got the bleeding under control and everything was fine. I always wonder what would have caused this to happen so many hours later?

[chefnancy]

Re: Fistula questions & info, please

Post-dialysis bleeding occurs every so often. The rule of thumb is that if it lasts more than 10 minutes with pressure being applied to the site that you should seek medical help, which you did. If it starts to happen with any regularity then your dad should have his fistula evaluated by his vascular surgeon. It may need revision in that case.

[Justjan47]

Re: Fistula questions & info, please

Just a further note about fistula problems. My husband had a revision to his fistular about a week ago, ligating collaterals. Since then, we've been able to establish a new venous buttonhole site well above the other ones. This has been much better for him, since our previous site(s) were right by a nerve bundle, which caused him additional pain. His fistula is working so much better now that he's been able to do without EMLA cream or lidocaine, and prefers that to just place the needles without any sort of numbing. It's kind of amazing!

[chefnancy]

Re: Fistula questions & info, please

Good for your husband. Everyone with a fistula needs to realize that periodic maintenance is required. Your husband's revision was more aggressive than most, but apparently badly needed.