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kirbyboy posted:
Hello. How is the process for a fistula? The dr says he would rather do it sooner than later. Gfr is 22. Looking at first of the yr 2015 for dialysis. If you can lift and your 60 where can you work? Can my husband get disability if he has been self employed for a long time. He has had a very small business and there is no way he can continue to do the work he does. Who can we talk to to find out info re financial issues. We will lose everything. I am the insur carrier but for the 2 of us each month I pay 1100.00 it will go up. Is it better to have him on Medicare/ medical. Thank you
john-skpt responded:
A fistula takes time to "mature". What has to happen is this: when the higher pressure artery is connected to the lower pressure vein, over time the vein very slowly enlarges in diameter and strengthens. The larger diameter vein is much easier to stick and the bloodflow is increased, therefore the machine can run much more efficiently.

So sooner is definitely far better than doing it at the last second.

I didn't have the option to prepare early, so for more than a year I had to depend on temporary venous catheters in the neck or under the collarbone. These are workable, but the bloodflow is never very good, and they present a huge infection risk.
kirbyboy replied to john-skpt's response:
Oh my goodness this is so stressful. Because kidney disease is on the rise, there must be so many people who so stressed and scared when from what it sounds will not get much financial help. And if you lived paycheck to paycheck you are really in trouble. As well as if you are self employed and had a very small no real profit business. It sounds like the dr has to say you can't do your job and even tho you are self employed you still can't do your job without harming your fistula. Then you have to fight to get what you have paid into? How do I tell my husband this? He will feel like a failure and I'm afraid the stress will be to much:(
john-skpt replied to kirbyboy's response:
The expense of dialysis, in every case that I'm aware of, picked up by Medicare (well, 80% of it is.)

The major hitch in this is that it can take a long time to get approved for Medicare and get all the proper paperwork filed. (In a lot of cases, there is Supplemental Security Income, which may or may not be applicable; the requirements are different but it might help tide you over until the Medicare coverage starts.)

Most nephrologists have one or two preferred dialysis centers that they work with, and once you decide to get the fistula done, the doc can put you in touch with the social worker at that center. That social worker can sit down with you and look at finances and get the Medicare ESRD ball rolling. That's a lot of what they are paid to do.

(I don't want to complicate matters any more right now, but you might start thinking about the option of transplant down the road. There are an awful lot of health issues to get checked out, but again, depending on his age and other health conditions, that might be the best long, long term option.)
kirbyboy replied to john-skpt's response:
Thank you john:)

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