Buttonholing is great: less pain, easy insertion, less chance of a blowout, less time holding the needles after removal – what’s not to like about it?

Well there are a couple of obstacles, at least for me.  Both can slow you down, but both can be overcome.

First the scab plays hard to get.  If I push the needle all the way in, so that the hole is sealed by the barrel of the needle (which is the intuitive thing to do) the hole eventually forms an indentation.  Scabs being what they are grow over the indented hole rather than flush with the surface and can be  quite difficult to remove next time.  Difficult equals time consuming.

One way around this is to leave a small part of the needle exposed (say width of a couple of hairs) at the hole.  Tape the needle so that the needle stays in that position, rather than being pushed into the hole.  This takes a little practice, but can be quite effective.

Second, my fistula moves like Harry Potter’s staircase.  I find that after about three months the easy-open hole in my fistula moves away from the needle track.  Fistulas are always growing, even if only a tiny amount a week, and eventually the hole wanders away from the business end of the buttonhole track.  As a result, it becomes progressively more difficult to find and needling takes longer.  You can of course ‘chase the hole’ by moving the tip of the needle in various directions until you find it, but this only works for so long.

I still hold the needle by the plastic tubing below the barrel use a gentle twirling motion to search for that easy entry.  Pushing the needle hard into the fistula wall just causes trauma.

But eventually I need to make new holes.

I spent more than 10 minutes searching for the holes for last time a week ago and decided to create some new buttonhole tracks, with sharp needles.  Because my fistula is pretty scarred and calloused, it takes quite a push to start a new hole, and it can be a little messy (blood wise) until the hole forms.  However after about 5 sessions, the hole starts to form a pathway.  Within a further 5 sessions, the track should be sufficiently established to switch to blunt needles.

In choosing the new buttonhole locations, I look for three things:

1. Ease of access (no strange angles or half-obscured entry points)
2. A short path between the entry hole and the fistula wall (less chance of creating multiple tracks)
3. Sufficient needle space to accommodate the entire needle in the fistula (so I don’t risk going through to the other side).

These requirements often mean revisiting old locations.  (Or perhaps I am a chicken about attacking half hidden virgin real estate.)

Once the track is formed, you can feel it.  If you press down gently on the area around the hole you’ll feel a hard, oblong mass (a bit like a cyst) starting at the hole and ending inside the fistula.  It’s actually a callous tunnel.

Once you abandon a buttonhole location, the hole itself heals fairly quickly, but it takes months for the tunnel to disappear.

I should say that this 3 month buttonhole life span is not everyone’s experience.  I have heard of many buttonholes lasting at least twice as long – and sometimes for years.

For me, it may be that the gym has something to do with it.  Apart from a break of about 4 months, I have gone to a gym for about the last 5 years.  During this time I have used weights to try to keep fit, including on my forearms and biceps.  While I have only registered miniscule growth (small children still kick sand in my face), maybe it has been enough to cause my fistula to wander.

Perhaps this is a lesser-known example of Newton’s First Law:  for every action there is an unwanted side effect.