Thanks to Frank at NxStage

A fistula, for the non-iniated, is a vein that is surgically connected to an artery  -- usually in the forearm. Because the arterial connection forces the vein to grow larger, it allows for the near-daily hook-up to a dialysis machine. One inserts "fistula needles," 15-guage spears that are so large you can actually see down the barrel of each little trochar.

There's no getting around it, a 15-guage needle is impressive no matter which end of the needle you're on!

Experts advocate "Fistula first!" This, I believe, represents the plea to plan ahead for your patient's End Stage Renal Faiilure so that a patient can start their Hemodialysis with a mature fistula. The options of grafts and central lines are more dangerous. Especially with the latter, I've heard, "it's not a question of if they will become infected; it's a question of when."

I suspect Steve has had more problems with his fistula access than the average person, but I certainly don't know that for sure. Maybe everyone really does have three surgeries and at least as many fistulagrams. And I understand that diabetics -- like Steve -- are more likely to have difficulties with their fistulas, as their blood vessels are more tenuous.

Nonetheless, we currently have the best access yet -- and for that I am grateful. Threading the last fistula felt more like threading an IV -- with a 15-guage needle.

Yesterday, as Steve and I were doing his treatment, I was able to puncture without any problems. But the machine was reading pressures that simply didn't make sense.

So I called the Technical Support person at NxStage with my questions. We weren't in any danger, and we weren't "calling from the State of Confusion," mind you. We just wanted to know if there might be something wrong with the machine or the disposable cartrige that contains the "guts" of the dialysis process.

We have talked to a number of Technical Support people over the last two years. And this guy Frank (Frank, I so apologize; I can't remember your last name. Emal me and I'll add it!) was a prince.

Here are some of the factors that made Frank's assistance so commendable:

• He was cordial and polite.
• He didn't make the automatic assumption that we had done something wrong!
• He conveyed the attitude that troubleshooting was a challenge -- maybe even interesting, and that solving the problem would be a triumph for all of us.
• He said, "If you have the time, I'd like to stay on the phone with you for a few minutes?" (If I have the time? Frank, come on over -- we're not going anywhere!)
• He was a cheerleader: liberal with praise and encouragement.
• He was a clear advocate for Home Hemodialysis.
• Frank conveyed that he liked the work he was doing.
• We ended the call with a sense of greater understanding of the process and more knowledge about the parameters of the machine -- good information to know.

Now, I want to be careful to point out that almost all of the Technical Support we've received has been very good. But, as in any healthcare experience, there's a range. And Frank got Honors.

It's always struck me that in healthcare, one of the most effective things a helper can do is to simply act polite! Fake it 'til you make it, I don't care. Just sound respectful.

So thanks to Frank for making our day better. We certainly ended our call feeling more clear and less isolated. And when you've hit a snag, every bit helps!

Take care. Linda Gromko, MD