Some of you have lived this process with me (the development of my buttonhole sites), and so I feel a need to update everyone that they are still working well.

Extremely well in fact.

It’s gotten to the point that the needles just sort of slide right in, with minimal persuasion from me.
The sites have not gotten any larger, and are very easy to use. If I would have been using them since the beginning I feel my arm would look a lot more “normal” now.

I strongly encourage any of you who are unfamiliar with this to read more about it.
There are very few contraindications – the most prevalent of which is simply the Dr. or clinic’s lack of familiarity with it.
Many doctors and clinics tell their patients that they are not candidates for buttonholes for many reasons, but I fear that frequently this information is incorrect.
Many more patients could be utilizing this technique than are now, and it is the fault of the dialysis industry, and the doctors coupled with them. It’s yet another example of how healthy people who take care of sick people never fully realize how their actions affect the end user.

The buttonhole sites are going awesome. Every treatment or two I run into some resistance – no two sticks seem to be identical. I have been able to get them in though, and have figured out how to “back out” and try again through my buttonhole track.

Arterial and venous pressures are awesome, and I have no pain at the sites. For those of you thinking about this: DO IT.
There is no contraindication that I have found. Why doctors aren’t offering this to everyone is beyond me.
Advocate for yourself, and educate yourself. This is the key. If you feel this technique is good for you, push for it!

And again: see you all next week.

As always, any trip must first be arranged weeks in advance – to coordinate between the dialysis clinics, and make sure all the paperwork is in order. You’d think that since these companies are by and large ‘for profit’ entities, they’d have a “come as you please and dialyze” service. Nothing like that quite exists yet.
So to take a trip, you must first find a clinic where you’re going, then make sure they even accept traveling patients. If they do, you move to the next step – coordinating schedules, faxing patient histories, Dr’s orders, etc. This can be a bit of a pain, and sometimes it seems as if the whole process is very delicately balanced.
You sort of just wait for the bottom to fall out. Not once have I traveled and had everything go as it was supposed to. This is of course to be expected, we are playing the game of Life after all. But leaving home and not being certain that the arrangements for dialysis will be in place before you get there is a bit disconcerting.

More than two weeks ago I set the ball in motion. I even did the leg work – I found the clinic, called them, checked their schedule, (actually Anna found the clinic, but still…). The social workers then should communicate with each other, and figure out all of the particulars. Everything seemed to be going smoothly – orders were faxed, calls were made, questions asked. I should have known better. On Wednesday Anna asked me to check and make sure everything was set (I figured no news was good news – but I’m an idiot). Well, sure enough there was a mixup. Another patient here is traveling, and supposedly there was some confusion as to who was going where, when. So apparently no real communication had been made, and today the clinic where I’m going let our Administrator know that I can only dialyze there on TTS (Tuesday Thursday Saturday shift). This poses two problems. One, I will leave here on a Tuesday, meaning I won’t dialyze between Monday and Thursday. That’s essentially two weekends in a row. Ok, I can handle that. But we’re flying back the following Tuesday, which means I’ll have an über-weekend between Saturday and Wednesday (when I will return to my clinic).
After thinking about it for a bit I realized there was no way that was going to work.
Our F.A. (Facility Administrator) is awesome in the absence of a social worker here – In 30 minutes he was able to do more “legwork” than three past social workers. Typically the social worker takes a lot (LOT) of time to get things like this done, and when things need to be done quickly, it’s nice to have someone decisive, and better still, proactive.
Well, before leaving today, our F.A. let me know that he had found another place willing to let me dialyze there on MWF (Monday Wednesday Friday shift).
Awesome – after nearly blowing my top earlier, all is well again in the Universe.

Lesson?
Don’t try to arrange family trips to quickly.

No … the lesson is chill out! None of this stuff is worth getting worked up about. It all works out.

See you all next week

So I guess I’m officially a buttonhole patient now. I’m much less apprehensive about travel now, knowing that not only can I stick myself, but I can stick myself easily with these newly established buttonhole sites.

I’ve also learned that it is in no way abnormal to have one site develop faster than the other. It’s also not uncommon to have to “spit on it” and really push that needle in there.
If you’re establishing buttonhole sites and having trouble, stick with it. I was adamant about continuing to develop this site rather than move to a new spot, and here we are a week later with it working fine.
Feel free to email me if you have questions about this experience.

One thing I find interesting, is that the article starts off by stating that it typically takes 2-3 months to establish buttonhole sites. Has this been the case with any of you? From everything I’ve read the “normal” time is 6-9 cannulations, that’s 2-3 weeks. Certainly it must take longer sometimes, but is 2-3 months really the norm?
I bring this up, because the article then proceeds to explain a technique wherein a “peg” is placed in your arm after the needles are pulled after your treatment, and this peg is left in until your next treatment. Obviously this gives something for your track to graft around, so it seems to make sense (in theory anyway). What perplexes me, is that their results are viewed as a success, because the time to create the sites is shortened to 2-3 weeks.
If it takes most of us 2-3 weeks anyway, why would this study be seen as a success?
Also, is there increased risk of infection? The study indicates that nobody had serious problems with infection, but with a sample size of 37 patients is that really telling us anything?
It is an interesting idea, but I would think a slightly more scientific study would be needed to conclusively say this was a safe way to rapidly establish buttonhole sites.
What do you think?

To our dismay, the same thing happened that happened before, the arterial needle seemed to be “glancing” off the side of the fistula, causing it to push over. And once again, a sharp slid in easy as pie.
So I spoke with two of the buttonhole “gurus” who happened to be visiting our clinic doing the quarterly transonic testing. They both told me that this was fairly normal, and that it was also fairly normal to have one site establish much quicker than the other.
I was told that I most likely had the tunnel established, evidenced by how easily the sharp was sliding in.
Their recommendation was simple: “push harder”.
It seems that it is normal to encounter some resistance with the blunt needles, and theoretically you can’t hurt the fistula with one since it is dull (I’m not going to test this theory however).
So I was simply told to push harder, and “twist”. The thinking is that the needle is entering the track, and then hitting resistance at the vessel wall. Since I’m so careful (after sticking with sharps), I’m probably not exerting enough pressure on the needle to break through this last “flap” of resistance.
Here’s the plan folks, tomorrow I will attempt blunt needles again (the venous site is doing fine with the blunts by the way), and will not be such a pansy with my arterial stick. I’ve been told it is safe to apply three times more pressure than usual with these needles.
3 X !
I’ll let you know how it goes.
It is true by the way that constant site cannulation hurts a lot less. I noticed the very first day that I started developing the sites, that the sharps slid in easier, and hurt much less.
Just sticking yourself hurts a lot less (seriously), so give it some thought.

Now when I mentioned sticking into the “exact” same place I meant it. Not only is the needle trying to enter the same spot on the arm, it is trying to follow the same exact track down to the fistula. This means that the arm needs to be in the same position while the tracks are developed, and also means that the angle of the needle needs to be exactly the same.
I felt comfortable enough with sticking myself that I thought I could handle it, and so I took a special class on buttonhole technique and was then “allowed” to establish the sites.

Well over the last two weeks I have been sticking the EXACT same spots, and have been feeling the tracks of scar tissue form. I was excited Monday to attempt to stick both the arterial and venous sites with the dull buttonhole needles. I sat down, cleaned off my arm, pulled off my scabs (oh yeah, you have to pluck those pesky scabs off each time before re-sticking a site), and prepared to “glide” in the buttonhole needle.
First time was a no-go. The needle just kind of stopped, and seemed to be pushing off the side of the fistula. I was very nervous about this, but quickly realized that infiltration was essentially impossible not having a sharp needle. After trying again though (and not succeeding), it was decided to use a sharp needle, in another place. Disappointed, I still wanted to try the arterial site – and we did.
I lined up the blunt needle, began to insert it, and it basically just slid right in. Wow
So here we are – it’s Wednesday, and again I have one sharp in, and one blunt. I (we) decided to let the venous site establish a bit more before trying to stick it again with the blunt needle. So I think we’ll continue sticking it with the ole sharpy another three times or so, until it’s *really* ready.

What a great feeling! Not only am I putting these needles in myself (I feel like an old pro now), but I’ve become a successful guinea pig with the buttonhole technique. I hope now that some of the patients who really need this can begin to develop constant sites.
Who needs this you ask?
Well, lots of patients have fairly healthy fistulas, but have trouble finding “good” sections of it to use. Some people have a very small section of fistula that works well, and would benefit greatly (especially in the long run) from developing buttonhole sites.
Just because you haven’t heard of it at your clinic don’t assume it not an option. Many clinics I’m learning are “behind the times”, and sometimes need patients to help steer them in the right direction.

As always, take charge of your own treatment – become involved with your life – and stay healthy.