It does sound a bit unusual, not to wait for the first to mature, but they can tell more from ultrasound and angiography than we can guess at.
One thing I'd want to know is this: is the fistula simply not enlarging as expected, and if so, what are the chances that the same would happen at the new location? Or else is the placement just wrong?
There was a lot of debate in medical journals about 8 or 10 years back over the accuracy of "vein mapping". It was a fairly new, and supposedly improved, technique for locating a fistula. Many argued that the older technique of letting the surgeon choose the location from physical examination of the veins, and mostly from experience. I realize that you can't directly ask the surgeon these things ("Hrey, doc, did you screw this up?") but you might want to do some internet reading on the current status of "vein mapping" just to familiarize yourself with the current procedures.
A lot of these surgeries just don't pan out, and I guess after 8 weeks, he can tell, but it still bothers me a bit.View Thread
It's impossible to say without more complete information. There are two basic classifications of renal disease, acute and chronic.
Acute renal disease can often reverse itself with treatment. Acute cases can result from sudden blood loss, very low blood pressure, toxicity to medication or some poison, infections, etc.
Chronic renal disease develops slowly, over years, over decades. This type generally needs dialysis or transplant at some stage, when the condition eventually grows severe enough. The class generally arises from diabetes, high blood pressure, narrowing or other restriction of blood vessels, or autoimmune disease.
Keep asking the docs plenty of questions until you have an idea of the probable causes and suggested treatment for his case.View Thread
I'd listen to your nephrologist: advil / motrin / aleve and their generic equivalents are just very toxic to the kidneys.
Yes, tylenol can be toxic to the liver, but overall, in reasonable doses it's much safer than the others.
If you absolutely cannot get by without something else, you may have to consider a narcotic, an opioid like hydrocodone (lortab, etc). It's not a great choice since these have several side-effects and the potential for developing dependence. But short of seeing a pain specialist, or trying alternative therapies like acupuncture, there aren't many safe options.View Thread
Yeah there is a LOT to learn. But unfortunately, I've never found a single source that coveres everything. A lot of it you'll just have to pick up along the way from other patients, nurses, technicians, doctors.
Read anything you can get your hands on. But don't be surprised to find that one source may contradict the next one. Especially internet sources: no single point of view or specific individual experience is applicable to a different patient.
I'm a detail-oriented guy, so I'm not happy with anyone telling me what to do without telling me exactly why that thing is supposed to work. I drive docs crazy with questions, but I figure that's what they are there to do. So don't be shy about quizzing the docs.
It will all start to fall into a logical pattern eventually. Just be patient.
As for states or regions, I can't help. I think that unless you have serious problems with your care locally, it's rarely with the trauma of pulling up roots and relocating to get good care.View Thread
Well, depending on the calculation method, the added data makes it more like 17-18.
The BUN:Creatinine ratio looks ok. (Very generally, indicative of adequate blood flow, or rather, it does NOT indicate reduced blood flow. I know those two things sound like they mean the same thing, but they really don't.)
Obviously get with your doc for specific suggestions.View Thread
It's considered to be quite accurate. Plus, it's fast and fairly cost-effective.
(I'm frankly an old-school curmudgeon, so I still think that nothing beats the old radioisotope 'glo-fil 125' test. But it is tedious, very slow, very expensive, and apparently isn't all that much better than the protein:creatinine ratio, tests in most cases.)View Thread
Considering that the accuracy of creatinine testing generally allows for an 8%-10% difference without being truly significant, I'd consider this change of 0.08 mg/dl to be negligible. (You don't mention how far apart these two tests were.)
HGb still looks good.
The decision to start dialysis is somewhat flexible, based on a number of different symptoms and several different lab tests, but the rough rule is to start by about 15 ml/min/1.72 BSA for creatinine clearance or vaguely the same 15% number for GFR.
.Without knowing your gender, race, or body mass, this is rather inaccurate. But your estimated GFR looks like it's in the 22-25 range.View Thread
The report indicates that this test is following up on a previous 'renal mass'. Was any tissue ever removed from the kidney before? Or is this checking up on a previous CT or ultrasound finding?
In either case, the radiologist seems to suggest that your doc follow up with another type of imaging, either now or maybe at some time in the future.
So it's not a 'perfectly A-OK' report, but neither is it suggesting any urget or crisis action.
Discuss this with the doc who ordered the test and see what he thinks is the best course of action. I wouldn't panic at all, but I wouldn't let the matter drop at least until you have more information.View Thread