Fistula,Fistula: The shock of the Thrill

drawing-collage by marguerita
Fistula,Fistula:Figaro! Figaro!


Le nozze di Figaro, ossia la folle giornata (Trans: The Marriage of Figaro or the Day of Madness), K.492, is an opera buffa(comic opera) composed in 1786 by Wolfgang Amadeus Mozart with Italian libretto by Lorenzo Ponte,based on a stage comedy by Pierre Beaumarchais, La folle journee, ou le Mariage de Figaro (1784)Figaro! Figaro! Training the Multitasking Brain - TierneyLab Blog - NYTimes.com
Fistula! Fistula ! Fistula! (etc.)
Ah, what frenzy!
Ah, what a crowd!
One at a time, please!
Hey, Fistula! I’m here.
Fistula here, Figaro there,
Figaro up, Fistuladown,
Swifter and swifter, I’m like a thunderbolt:
I’m the factotum of the city.
Ah, bravo Fistula!
Bravo, bravissimo!
A most fortunate man indeed!
Ready to do everything
Night and day,
Always on the move.

Although the play by Beaumarchais was at first banned in Vienna because of its satire of the aristocracy, considered as dangerous in the decade before the French revolution, the opera became one of Mozart's most successful works. The overture is especially famous and is often played as a concert piece. The musical material of the overture is not used later in the work, aside from a brief phrase during the Count's aria.

When a person's kidneys fail, dialysis is often required if transplantation cannot be performed. Dialysis can be performed by filtering the blood. In turn, blood for filtration can be obtained via a catheter or arteriovenous fistula (AV fistula). Catheters can be placed on short notice but have a short usable life-span and are difficult to care for. By contrast, a fistula requires surgery and cannot be used until they heal, but can last for years. Your nephrologist has recommended hemodialysis via a surgically constructed AV fistula
.Fistula, which your vascular surgeon constructs by joining an artery to a vein.

If all goes well, you will go home several hours after surgery. At home, you can gradually resume normal activities as tolerated, but should work up to things slowly. You will be sore and should plan to have someone at home with you to help with meals, house keeping, grocery shopping, and so on, for the first few days or so. You may have a drain; we will give you appropriate instructions and make arrangements for removal. You may remove your dressings and shower/wash the second day after surgery unless other instructions have been given or you still have a drain. You will see your surgeon 2 weeks after discharge for routine follow-up, and 6 weeks after surgery to check the fistula with ultrasound. Once the fistula is functional, we will remove your catheter, if present. We will usually recommend lifelong visits to check the fistula at 6-month intervals.

In the context of this article, dialysis access is an entranceway into your bloodstream that lies completely beneath your skin and is easy to use. The access is usually in your arm, but sometimes in the leg, and allows blood to be removed and returned quickly, efficiently, and safely during dialysis or, less commonly, for other procedures requiring frequent access to your circulation.

After the operation, you should initially keep the access area raised above your heart to reduce swelling and pain. Your surgeon may recommend an over-the-counter painkiller to relieve pain, if necessary.

Following the suggestions below will help you keep your new access site working properly in the weeks after the surgery:

• Keep the incision dry for at least 2 days after the procedure and do not soak or scrub the incision until it has healed.
• Avoid lifting more than about 15 pounds or other activities that stress or compress the access area, such as digging.
• Report pain, swelling, or bleeding immediately to your physician, especially if these symptoms are becoming worse. Some pain or swelling is common and not worrisome if decreasing, but you should tell your physician if you have bleeding, drainage or a fever higher than 101 degrees Fahrenheit

You may initially feel some coolness or numbness in the hand with the fistula. These sensations usually go away in a few weeks as your circulation compensates for the fistula. However, if these sensations are severe or don’t disappear, tell your physician as soon as possible, because the fistula may be causing too much blood to flow away from your hand, a condition physicians call a “steal.”

You should perform exercises to grow and strengthen your fistula, after the pain from the surgery decreases, to make dialysis faster and easier. Your physician may recommend squeezing a soft object using the hand on the arm in which the fistula was placed.

• Check several times each day to make sure the access is functioning. You should be able to feel a vibration in the fistula called a “thrill”. Your physician or dialysis center staff will show you how to do this.
• Monitor any bleeding after dialysis. If the graft seems to bleed longer than usual from the needle sites, you should notify your dialysis center staff.
• Do not carry heavy items with the arm that has the access.
• Do not sleep on that arm.
• Do not wear any clothing or jewelry that binds that arm.
• Do not let anyone draw blood or measure blood pressure from that arm.
• Do not allow injections to be given into the fistula or graft.
• Keep the site of the fistula or graft clean.
• After dialysis, monitor the access for signs of infection, such as swelling or redness.
• Do not use any creams and lotions over the site of the fistula or graft.

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