Dialysis Misadventures

[mikestar13]

I need some astrological advice on the subject of my dialyis. There are medical ramifications which I have already researched, and possible insurance ramification I need to research. Let me say up front my dialysis is working well (perfect blood numbers), the issue is how it is administered and my relationship with my dialysis clinic.

Some background: In early November 2020, I had a catheter inserted in my right carotid, as is usual for urgent-onset dialysis (should have been started in late September--if Terry wasn't literally terrifying in expressing her anger about it to various medical personnel, they likely would have waited till after Christmas, and I would be dead--I have a sneaking hunch a certain MD would have experienced a rather painful homicide had that happened. Terry and I are both Christians, but neither of us would turn the other check in a case like this. May God forgive us, but there you have it.)

Dialysis went perfectly fine via the catheter without pain, but my clinic kept trying to coerce me into getting a fistula surgery in my arm. (Usual for long-term dialysis in about 80% of patients.) I had seen what other patients with fistulas went through, and I was at least skeptical.

What the surgery consisted of is joining and artery and the corresponding vein directly to one another, causing the combined vessels to swell, making it easier to insert the needles that are used in this type of dialysis--almost impossible to use a normal vein. Had I known what lay ahead, I would have refused AMA (as do 20% of all dialysis patients--but not at my clinic). The clinic kept pestering me until I finally agreed. Surgery was done in late April, and was ready for the fistula to be used.

Then for the first time I saw the needles--big ole horse needles I can them--they are huge. What the clinic had said was they use needles comparable to IV needles--not true. The hole in the tip of the needle is clearly visible with the naked eye and a standard IV needle would fit inside it.

Now for me a standard IV needle is an annoying pinprick (maybe 2 of 10 on the pain scale), rising to that hurts! (5) if inserted very incompetently. The pain from a dialysis needle start at 4 (annoying but easily bearable) if the needle is inserted correctly on the first try. But often it isn't: very frequently the wiggle it around inside, often repeatedly (pain 5-7), and often repeat the insertion, which seems to add a point to the pain scale each try. At times the pain has risen to 9. Some sessions don't have these problems, but about 1 in 3 times, I go through this. BTW, there are two needles, one for outgoing and one for incoming blood. 9 on the pain scale is "bring me morphine NOW!" level of hurt.

Now the advantages of a fistula: less risk of infection and they tend to be less severe if they occurs. The clinic basically claimed that I needed to get the fistula so the catheter can be removed. "Catheters are almost certain to get infected and that infection is certain death." Those are gross exaggerations of the extra risk--it is true that catheter-borne infections are about three times as likely and about twice as likely to be lethal as fistula infections--these events are not actually common much less certain (sources: Mayo Clinic, National Kidney Foundation, ...)

So I have my thrice-weekly pain session, and I still have the catheter in, and they perform antisepsis on it every session whether it has been used of not. The need to do so seems to anger them --but some days they just can't get a good enough connection through the fistula (sometimes they give up, sometime when I'm hurting bad, I refuse continued attempts AMA). So whatever risk I have from having the catheter is still present and the risk (as well as the pain!) of the fistula is added to it.

Bottom line: I want them to stop using the fistula and revert to using the catheter (which has a pain level of 0). Legally they can't refuse to do dialysis, but they will try to find a way to punish me for defying them. I want to be sure something like getting insurance to refuse to pay isn't on the table (it probably isn't but I dare not guess). I will be calling my insurer today. Assuming they give a favorable response, I have three questions I am seeking insight about:

• When would be the best time to confront my clinic -- they are already aware that I would have refused the surgery had I known.
• How to minimize any resulting conflict.
• The possibility I could be making a mistake.

BTW I find it both amusing and disturbing that the American Medical Association and Against Medical Advice share a TLA

[Jim Eshelman]

Mike, what do you estimate is the time frame within which you need to do this? (Weeks, months, longer? I'm guessing "within a very few months," but it would be helpful to know.)

Transits as an overview: Pluto square your Mercury is still the biggest thing going on, and seems mostly unrelated to this.

Next summer, Neptune reaches the opposition to your Jupiter. I've seen this mean incompetent or uncertain medical care, so you need to get yourself in the best shape ahead of that. The other important time of concern is when Saturn makes it's last pass (this cycle) across your MC the first week of February. (Jupiter squares your Asc just before that, and your Mars just after that.)

To get another "split" on the year, a quick look at your SSRs: Both your current and your next one are primarily benefic. (You have the Moon-Saturn in the current one but I think that's mostly behind you - the progressions to Saturn and Mars have passed - and the double Sun-Venus makes it primarily benefic.) The next SSR keeps natal Sun-Venus foreground and puts lunar attention mostly on your Mercury, but - again - there is a summer crisis: Just about the time Neptune transits opposite your Jupiter, SQ Moon progresses (about three months after your birthday) to square Pluto. Not necessarily bad, but clearly a significant turning point (and I suspect "significant turning points" worry you a bit more these days).

Finally, I want to mention one other worrisome point for your health: This year, progressed Sun opposes natal Saturn. It's currently just 0°01' past. You've been through the peak of the transit yourself. However, progressed Moon will square these in about a month. The exact Moon-Saturn is November 9, when Sun is 0°06' past (and, of course, this has a roughly one-month orb). I'm unclear whether the focus is primarily your health (the most obvious suspicion: Moon as the trigger) or Terry's (the Moon-Sun progression often involves intimate others). It doesn't come to an SNQ angle until 11/21 - Moon is still in orb, but I think the primary manifestation will have come earlier. (Mike, I know you want unbuffered astro input and are capable on your own to understand this - I just want to get the facts in front of you.)

But now let's turn to the lunar returns and get a sharper lens on the fortnights from now until the end of the year. Here are quick impressions of the lunars and demi-lunars.

BTW, I have really rough lunars during most of next year. I'm looking to a positive solar to get me through that well. As I talk about your SLRs below, I'll mention several are predominantly negative. Please weight all of these against the fact that you have a positive SSR for your baseline. I suspect all of us are going through some hard times in the months ahead - there are just too many people who all of a sudden have "south-turning" astrological patterns about the same time - so some of this may not be individual events but common ones. (Reminder to me to backup the site data base in case something crashes the whole site and I have to reconstruct it.)

Today's Demi 10/7 Jupiter setting is quite good. Overall, a very positive two weeks. A good time to get lucky and get what you need and want.

Oct 20 SLR Bad month with Saturn on IC (but not within 3°) and natal Neptune rising. (It's part of Saturn-Uranus on angles.) The Moon-Sun-Saturn natal progressions peak during this time. Demi-SLR 11/3 has Saturn closely rising (0°28') but Jupiter on EP (1°12'), so it is likely to be a peak of the difficulties along with significant positive amelioration. (Wide Sun-Uranus: A surprising intervention by authority?)

Nov 16 SLR Nothing major in particular transiting, but natal Saturn exactly on MC. Demi 11/30 has Sun-Mercury closely angular, seems important, not sure in which way (but unafflicted Sun angular is generally positive for health usually) - It opposes your Mars near MC, which likely means a battle (but doesn't feel bad for health).

Dec 13 SLR Partile Venus-Pluto conjunction on Dsc, natal Sun-Venus on MC. Nothing here about your health probably other than natal Sun strong (unless Venus really does "rule" the kidneys; the focus seems elsewhere, though). Demi-SLR Dec 28 is complex, with several planets hovering near but not on the angles; probably not a "big event" message by itself.

Jan 10 SLR Saturn exactly on IC (0°03'), a rough time. (Uranus also there.) Demi-SLR 1/24 is primarily positive with transiting Venus and natal Jupiter closely angular (and a little Neptune).

[Jim Eshelman]

Today's Demi 10/7 Jupiter setting is quite good. Overall, a very positive two weeks. A good time to get lucky and get what you need and want.

All of this suggests to me that right now is your luckiest time and, in that sense, you would prosper best by moving quickly to try to get this behind you before October 19 (the day your Oct 20 SLR will start to be felt). Without making any promises on outcome (you know I can't do that), here are some days and effects to consider from quotidians:

Oct 8: SNQ Asc sq. r Sun, often good for confident self-assertions. (Nervous, though, with natal and progressed Neptune on MC.)

Oct 11: SNQ MC conj. t Pluto, sq. r Mercury. A climactic day. Normally would be good for confrontational conversation (and Asc = s Uranus goes with that "mental or communication breakthrough" idea), but I'm a little uncomfortable with Saturn on angles both a day or two earlier and a day or two later.

Oct 16: SNQ Asc op. p Mars, too much conflict.

[mikestar13]

Thank you very much, Jim. My intuition was to start the ball rolling this week in absence of strong contraindications. I will call insurance today and verify this wouldn't affect insurance funding. I can start the conversation tomorrow and should the need arise, I will sign formal documents Monday (if they are not available Friday). Whatever they may do in anger, they can't refuse to do dialysis, that is extremely illegal. They legally could demand I explicitly refuse to use the fistula every time. But with Mars rising sextile my Sun-Venus-Eris complex (Mars-Eris is only 25' wide), I am not the person to p*** off. And should they be able to withstand me, a single word from me will sic Terry on them -- and she is capable of anger that makes my worst look like mild annoyance. By God's grace and Terry's, she has never turned her full fury on me. Funny how my fierce determination to love her no matter what reduces the frequency and degree of her moods I have to deal with . ... Even unto the very gates of Hell, my love.

[Jupiter Sets at Dawn]

I'd keep a list of all the people sticking needles into me, with ratings for how much they hurt me. It sounds like bad training if they are mucking it up that badly. Then you can hand the doctor and or head nurse a list of who is allowed to attempt the fistula and who is not. It might improve things.

But if I were you, I'd say nope to anybody trying to use the fistula. It's not working as advertised. It's no longer available.

Easier? Not for you.

[mikestar13]

I checked with my insurance and they are fine with it. I will follow JSAD's advice, starting tomorrow. There are other dialysis companies that aren't so hard-headed and my insurer will help me find one if needed. They also have a formal grievance written and ready file if I am harassed. Mars took the lead today. Terry is rather proud of me.

[mikestar13]

Sitting in the chair, getting dialysis through the catheter. The tech who would have stuck me was relieved he wouldn't have to do it any more. It's been stressing him. The nurse who hooked me via catheter was understanding. Haven't heard from the in house nephrologist ( he likely isn't in today) or the office staff.

[Jupiter Sets at Dawn]

Sounds like the people actually involved in the process either don't much care or actively prefer your way. That's all to the good.

If anybody fusses, complain about being misled about the fistula.

[mikestar13]

Special thanks to Jim E. for the astrological analysis and to JSAD for sound advice. The only hitch yesterday was the transportation company was slightly late picking me up for the trip home -- they'd been stuck in traffic. One thing I've learned from History: the better prepared you are to fight, the less likely you are to need to. (How rising Mars in Taurus is that statement?)

[Jim Eshelman]

Very

... As I sit in a city sacred to the memory of Martin Luther King, who had a background but close opposition of Mars in Taurus to Saturn in Scorpio...

BTW, the motel we're staying, on the outside, has an uncanny resemblance (outside) to his last motel room.

[mikestar13]

Interesting. My Mars - Saturn is wider but foreground. There are few better qualities of MLK to emulate. The archetype of The Peaceful Warrior springs to mind.

[mikestar13]

My clinic is at it again, I threatened to report them for harassment. It may be very tempered by Venus, but by God, I have Mars rising (and Aries Moon). It isn't easy to get me this angry, but they managed.

[Jupiter Sets at Dawn]

So was that the in-house nephrologist harassing you or the office staff or both?

[mikestar13]

Both actually. First time nephrolgist has been in on my days.

[Jupiter Sets at Dawn]

And what did he say when you told him whatever he thought the fistula was going to do for you, what it has done is cause you a great deal of additional and unnecessary pain? Or did he avoid answering?

I hope you called the insurance company.

[mikestar13]

Just finished getting an angioplasty which widened and deepened my fistula, which should allow it to be used more easily at a tolerable pain level. Surgeon was surprised my clinic why they didn't schedule this after my first reports of excessive pain. I am perfectly willing to use the fistula if to pain level is reasonable. Obviously my clinic doesn't a damn about that last part.

[Jupiter Sets at Dawn]

I hope your surgeon does more than act surprised. I hope this works to reduce pain.

[mikestar13]

I hope your surgeon does more than act surprised...

You and me both. One thing that this particular chain of clinics (I've had dialysis at both their Colton and Upland facilities) has never done is to respect my dignity as an adult human being capable of rational choice. They seem to be similar to my experience with several skilled nursing facilities: since many patients are in varying stages of mental deterioration and can no longer act as rational adults, they treat everyone as unruly children, since a not insignificant number actually need to be treated that way -- how else can you deal with someone whose remaining mind is about the equivalent of a two year old but is fully ambulatory?

[Jupiter Sets at Dawn]

With rewards. Never ever punishment. Natural consequences, but that only works with some. If you want to see a movie, you have to put your clothes on. That sort of thing.

Trouble is, so many patients have been treated so badly for so long, retraining them is daunting.

I used to work at a hospital for developmentally disabled people that started out as an epiletic asylum. If someone acted up because they were having a seizure, most of the aides would try to take their rewards for good behavior away. Seizures CANNOT BE TRAINED OUT, nor can the person having one control it in any way. But way too many people in health care are incapable of understanding that.

I started using a reward system on the aides. I even told them that's what I was doing. They did a good job, they got a piece of candy. They screwed up they didn't. It worked on most of them. But you have to understand there are people who were abused or are just too stupid to be trained.

Way too many people automatically go to punishment to change behavior. It's automatic. Add in overwork, bad stuff at home, and poor training and it goes from bad to worse.

[mikestar13]

What JSAD says from his experience as a worker is exactly what mine has been as a resident. Punishment as your goto method for actual two year olds is wrong and wrong headed as well as for eighty year old mental two year olds. Punishment is only appropriate when (a) the behavior is life-threatening or of comparable severity (not merely annoying to staff) and (b) other methods have been tried unsuccessfully.

JSAD, I have noticed a tendency in these facilities toward collective punishment and rule making where if the most impaired resident can't do an activity safely, the activity is forbidden to everybody. Has this been your experience?

When I was President of the Resident's Council, an interesting case came to my attention: two long term residents began a romantic/sexual relationship. Staff did everything to stop it, just as was their normal procedure in the dementia ward--which neither of these people were in. The two individuals were both of unimpaired mind but had physical issues. She was epileptic, her seizures tended to be severe, though under the medical treatment she received, they had become less frequent. He was blind and had some other ailment which was never disclosed to me, but based on his appearance, it was probably a liver problem.

They were both rational adults and filed a grievance demanding the facility cease interfering with their relationship. Before the case was resolved, it became moot: they broke up because she discovered he was cheating on her. This was not because of any mental defect on his part, but a defect of moral character. While I believe non-exclusive relationships can be valid with the full knowledge and consent of the parties, if you promise exclusivity you give exclusivity. It was a shame, she was a nice lady, a friend of mine who might have become more in a universe where Terry did not exist but I still managed to find an interest in living--though I'm not at all sure that universe is possible.

[Jupiter Sets at Dawn]

JSAD, I have noticed a tendency in these facilities toward collective punishment and rule making where if the most impaired resident can't do an activity safely, the activity is forbidden to everybody. Has this been your experience?

Yes. Henry can't cook by himself like John does because he has parkinson's and will cut himself. The staff doesn't want to explain that to Henry (or John) so they just make it a blanket rule.

Relationships are especially fraught. Even when explictly told not to impose their own religion or sense of morals on other people, a lot of staff are not capable of letting people who aren't hurting anybody else alone. (You should see what is done to same sex couples.)

There's three basic problems. Stupidity, laziness and a need to dominate. I don't know which is worse.

[mikestar13]

The stupid can sometimes be educated, the lazy can be motivated by enough complaints that they fear for their jobs, those who need to dominate are beyond help.

[mikestar13]

I'm happy to report that my dialysis clinic is now taking me seriously and the angioplasty they had performed on my fistula has substantially reduced my pain load, which should allow me to use the medically safer fistula, and have the catheter removed in December or January should this prove to be the case. First use of the newly expanded fistula was yesterday and it went extremely well. The feeling was unpleasant, but I can deal with unpleasant, just kindly hold the agony. A pleasant surprise to be treated as a ration adult--and if I had to cram it down their collective throats a bit--well what's rising Mars for?

[Jupiter Sets at Dawn]

I'm so glad you fought for what you need. And now you know the doctor wants to know if you're having problems.

[mikestar13]

The angioplasty is making all the difference. Today the lower stick (nearer the wrist) barely hurt at all and the upper stick only maybe 50% more than an ordinary IV.

[Jupiter Sets at Dawn]

That's really good news Mike. I bet Terry's pleased.