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  1. #1
    Join Date
    03-10-06
    Posts
    279

    Question Numbness in fistula arm

    Hi Dr. Agar,

    I've been on dialysis for 18 years now. I've been on daily nocturnal home hemo for the last nine years. I have a fistula in my left upper arm. I dialyse six nights a week, about 7-8 hours each night.

    For the last few months, on the nights I don't dialyse, my left arm becomes numb. The numbness has been worsening and I am having trouble sleeping on non-dialysis nights due to this. If I elevate the bed such that I am almost sitting, the numbness is better. Many times, I wake up with unbearable numbness. I then stand, walk about a little, shake my arm, massage it and the numbness gets better, only to return again in some time.

    Surprisingly, on the nights I dialyse, there is no numbness.

    I have shown this to a vascular surgeon and he checked the flow in the arm with some device that resembled an ultrasound machine and he said the flow was ok and would not worry about it if the flows during dialysis were fine. My nephrologist put me on carnitine but that has not helped - in fact, the symptoms have gradually become worse.

    Any suggestions on what this could be? Thanks!

  2. #2
    Join Date
    11-17-09
    Location
    Geelong, Victoria, Australia
    Posts
    470

    Default Re: Numbness in fistula arm

    Dear Kamal

    It sounds rather neurological. As though something is affecting sensory nerve function - though why it should be OK when you are on dialysis and only occur off dialysis is odd ... unless you sleep in a different position (neck/shoulder especially) when NOT on dialysis. To me, this has all the hallmarks of a positional issue with your cervical spine and neck!

    I am guessing, now, but are you sleeping in a more structured position when you ARE on dialysis (eg: propped up on pillows with your dialysis fistula arm also supported by a pillow) but then, on the nights you are NOT on dialysis, you are more snuggled down on your side?

    If so, this suggests a positional problem with your cervical spine ... perhaps Cx discs 4-5-6-7 with the 5-6 disc predominating. Having had a compressed fracture of my 5th cervical vertebra as a 21 year old, I have similar symptoms myself. It is annoying, but not life-threatening!

    I may be right off the mark here (though I suspect not) but it doesn't sound dialysis-related to me ... and certainly not something with the fistula ... but something more positional/skeletal/disc/nerve-root compression related.

    If you ARE sleeping differently off dialysis compared to on dialysis, try mimicing your dialysis position when sleeping on your non-dialysis nights ... and see if that works. Then, at least, you'll know you have an annoying problem, but one that wont kill you.

  3. #3
    Join Date
    11-17-09
    Location
    Geelong, Victoria, Australia
    Posts
    470

    Default Re: Numbness in fistula arm

    Dear Kamal

    It sounds rather neurological. As though something is affecting sensory nerve function - though why it should be OK when you are on dialysis and only occur off dialysis is odd ... unless you sleep in a different position (neck/shoulder especially) when NOT on dialysis. To me, this has all the hallmarks of a positional issue with your cervical spine and neck!

    I am guessing, now, but are you sleeping in a more structured position when you ARE on dialysis (eg: propped up on pillows with your dialysis fistula arm also supported by a pillow) but then, on the nights you are NOT on dialysis, you are more snuggled down on your side?

    If so, this suggests a positional problem with your cervical spine ... perhaps Cx discs 4-5-6-7 with the 5-6 disc predominating. Having had a compressed fracture of my 5th cervical vertebra as a 21 year old, I have similar symptoms myself. It is annoying, but not life-threatening!

    I may be right off the mark here (though I suspect not) but it doesn't sound dialysis-related to me ... and certainly not something with the fistula ... but something more positional/skeletal/disc/nerve-root compression related.

    If you ARE sleeping differently off dialysis compared to on dialysis, try mimicing your dialysis position when sleeping on your non-dialysis nights ... and see if that works. Then, at least, you'll know you have an annoying problem, but one that wont kill you.

  4. #4
    Join Date
    03-10-06
    Posts
    279

    Default Re: Numbness in fistula arm

    Ok. Dr. Agar. I will try this and let you know how it goes. Dr. Peter Laird also suggested a Spurlings Test to check on this.

  5. #5
    Join Date
    11-17-09
    Location
    Geelong, Victoria, Australia
    Posts
    470

    Default Re: Numbness in fistula arm

    Kamal ...

    It seems from the FaceBook site that Dr Peter Laird and I felt both came to the same conclusion here ... that your problem was likely nothing to do with your access, or with steal, or with any of the other dire 'you going to lose your hand' warnings that some of the FB-users suggested ... but that your symptoms suggested a neurological problem and likely had more to do with your cervical discs and nerve root symptoms than with vascular issues.

    What has been the outcome so far? Has that been borne out?

    I have just been interested to know.

  6. #6
    Join Date
    11-17-09
    Location
    Geelong, Victoria, Australia
    Posts
    470

    Default Re: Numbness in fistula arm

    Kamal ...

    It seems from the FaceBook site that Dr Peter Laird and I felt both came to the same conclusion here ... that your problem was likely nothing to do with your access, or with steal, or with any of the other dire 'you going to lose your hand' warnings that some of the FB-users suggested ... but that your symptoms suggested a neurological problem and likely had more to do with your cervical discs and nerve root symptoms than with vascular issues.

    What has been the outcome so far? Has that view of Peter's and mine been borne out?

    I have just been interested to know.

  7. #7
    Join Date
    03-10-06
    Posts
    279

    Default Re: Numbness in fistula arm

    Hello Dr. Agar. I have got an X Ray on Saturday and will be collecting the report and going to see the neurologist this afternoon. I will post an update once I see him. Thanks again for your help!

  8. #8
    Join Date
    03-10-06
    Posts
    279

    Default Re: Numbness in fistula arm

    Hello Dr. Agar, the X Ray did not show anything wrong. The neurologist asked me to get a Nerve Conduction Study done. He wanted to check if there was any 'mononeuropathy' or any 'pressure palsy'. The study just showed peripheral neuropathy which was much worse on the left side. The left hand is where I've been having the symptoms I have explained above. He said it is just a manifestation of the neuropathy that has become worse over the years. I have peripheral neuropathy for about 4-5 years now. He asked me to take Duloxetine 20 mg at bed time.

    Not sure what to really make of all this. I am going to watch for a few days and then decide. Unless you have any other thoughts. Thanks!

  9. #9
    Join Date
    11-17-09
    Location
    Geelong, Victoria, Australia
    Posts
    470

    Default Re: Numbness in fistula arm

    To me - and from the outset - it sounded very neurological. The symptoms seem clearly to be the result of pressure on a nerve root in the cervical region. These things are annoying, but usually only that. I have a similar problem myself. It annoys me, but it wont do me in! I suspect you are in the same boat. As a last (and I mean LAST) resort, these sorts of problems can be offered surgical decompression of the nerve root ... but I plan to live with mine as, while surgery can be helpful, it can also easily make no difference - or even make matters worse. Knowing that its annoying - but not usually more severe than that - is often reassuring enough to actually lessen the problem as it lifts the veil of 'not knowing'. Find a position to sleep in that doesn't cause the symptoms = trial and error. The fact it doesn't occur on dialysis nights suggests that the position you sleep in on dialysis may be the very position you should also adopt on the non-dialysis nights when your symptoms have been occurring. One thing seems evident, to me, and that is that some of the dire warnings about the imminent loss of the limb that you received on-line were a trifle over-dramatic.

  10. #10
    Join Date
    03-10-06
    Posts
    279

    Default Re: Numbness in fistula arm

    Hahaha... yes Dr. Agar, they were over-dramatic. As with many other things on the internet and especially Facebook. It is so reassuring to hear your thoughts. Thanks a ton for being there!

    - Kamal

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