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How will I look? I know that getting an access is a priority and I have to make a decision, but I'm worried that it will be ugly. People may stare at it and make me feel uncomfortable.
This is a valid concern. Most people are concerned about their looks. How one feels about his or her looks is called body image. Body image is tied into self-esteem, or how much value and worth one places on himself or herself. Your body image and self-esteem are a matter of perspective, or how you choose to see things.

Here is an example of how negative body image and self-esteem work.

I have a fistula in my arm. There are scars and ridges on my arm. I think people will notice them. People will think my arm is strange. Maybe it is strange. I'm ashamed of my arm.

Here is an example of how positive body image and self-esteem work.

I have a fistula in my arm. There are scars and ridges on my arm. These scars and ridges are a unique part of my life and my will to live with chronic kidney disease. I think people will notice my access. That's okay. I'm unique. I'm alive. I can use my arm to educate others about this quiet disease.

What physical changes can I expect?
With a fistula and a graft, scar tissue and marks will be visible from the surgery. You will notice changes occurring naturally as the access matures. With a fistula, the vein wall thickens and increases in diameter. It may look like you have "bulging veins" at the access site. With the graft, the artificial tube will be noticeable under the skin. If you wear short sleeved shirts, it will be noticeable on your arm. If you have a temporary catheter inserted in the neck or chest area, you will have the small scar from the incision. With the PD catheter, you will have the tube permanently placed in your peritoneum (lower abdominal area). You may gain weight due to the sugar in the dialysis fluid. Your stomach area may look fuller due to the dialysis fluid.

Are there others out there who could help me to adapt to these changes?
Yes. You should express your concerns to your doctor. Don't be embarrassed to mention how you feel about your appearance. Your self-esteem is a major part of your overall health and your ability to live with chronic kidney disease. You may want to talk to your vascular access surgeon about vessel mapping and the size and location of the incision. He or she will help you to understand the best placement for your access. Remember to talk to others who are experiencing these same physical changes. Talk to those who are in your pre-ESRD education class. Another good place to find people is through the ESRD network in your area. You can locate the National Forum of ESRD Networks at www.esrdnetworks.org. You may also want to visit the Fistula First website at www.fistualfirst.org. You can also ask your doctor for a referral to a support group in your area.

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