SRS Diary (Final) Day 11: Complication and Check-out

Yesterday, my catheter issues continued.  I underwent one more round of catheter removal and an attempt to urinate.  No success.  The amount of pain and discomfort from having the need to urinate but unable to void is truly excruciating.  It was by far worse than even my dilation pain.  Around 6pm, the catheter was re-inserted, and I was duly devastated.  Dr. Meltzer and Linda came in and we discussed our options.  We decided that I will be taking the catheter with me home for tomorrow’s flight.  In 4-5 days, I will take off the catheter and attempt to urinate then.  Linda provided training on how to remove and to attach the catheter.  I was uncomfortable with the thought of doing this on my own, when the pain could be so terrible as to incapacitate me.  I felt demoralized.

My mom was equally unhappy with the thought–moreso because of the introduction of germs from non-hospital environments.  After talking with her, we decided to postpone my flight back to the bay area.  I was going to stay in the hotel for an extra four nights and then go to Dr. Meltzer’s clinic on Wednesday to try the urination attempt.  We relayed this to Linda and the doctor, who assented, and I felt more relieved.

The rest of the evening drained me completely.  I was discharged from the hospital, a night earlier.  I re-booked my flight.  I calculated that the refund that I will receive from the hospital from spending one less night will wash-out the cost of the re-booked flight and the extra nights at the hotel.

I performed my third dilation, took a shower, and proceeded to pack.  My mom, in full “mom” mode, helped me pack and insisted that I pack various sanitary items for my stay–surgical gloves, paper towels, hand sanitizing foam soap, etc.  Already in an unhappy state from the day’s events, her nagging left me snapping back at her occasionally.  I felt bad because I know she was doing so only because she wanted to help.  I had to take deep breaths and listen to her.

Finally, we finished packing.  The hotel shuttle arrived to pick us up.  We walked down to the entrance.  I was so exhausted at this point, I could barely keep my head up.  After arriving at the hotel, I slowly trudged to the room and collapsed onto the bed, while my mom diligently prepared the room for my stay.  I managed to take a 2-hr nap after listening to her dote about sanitation.  I had to wake up because I still had my final dilation.  Ugh.

After waking up, my energy was much better.  I eventually went around to performing my dilation.  It was not a great dilation–I lost half an inch of my depth.  I was worried but was too tired to regain the length.

My attitude with my mom improved.  I *do* love my mom and will try to do less snapping and more rational discussion of the sanitation in the future.

All-in-all, this was an inauspicious end to a smooth recovery at that point.  This concludes my daily diary of my SRS.  I will provide an update once Wednesday rolls around.

SRS Diary Day 10: Catheter Removal and More Dilation

The recovery up to this point has had its fair share of discomfort and pain but nothing out of the ordinary.  Then came today.

Dilation #1

First, I was already having trouble dilating from yesterday.  The first two times were successfully accomplished but the last three times, I did not think I was performing the technique correctly…since I was not feeling the pain =)  I knew that my catheter was being removed today by Linda so I took that opportunity to ask her for help.  (I’ll talk about my catheter *fun* experience in a bit.)  After the catheter was removed, which was a bit unpleasant but fairly mild, she observed while I dilated.  …And of course, I was not.  I was not successfully passing stage 2, the perineal muscle penetration.  Linda left briefly to find a tapered dilator, the “size zero dilator”, to help guide me.  She came back with Dr. Meltzer, who had a more efficient approach–shove that baby in!  I yelped, found my focus zone really quickly, and breathed rapidly before finally slowing down.  I was incapacitated for a minute.  I heard Dr. Meltzer saying something like, “I’m kinda concerned.  She’s not responding to anything right now.”  But as I was stunned, I sensed he was half-smiling.  =) Gradually, I recovered, and they left.

Dilation #2

I had asked Linda to supervise another attempt.  She came with the tapered dilator.  It helped a bit, but I was still unsuccessful.  Finally, she intervened and pushed…her’s was painful but not as bad as Dr. Meltzer’s push.  I was still a bit stunned nevertheless.  She gave me enough tips where I hoped that #3 and #4 were successful.

Dilation #3 and #4

What d’ya know…they were successful!  I needed a couple of attempts to perform it correctly each time, and the tapered dilator did help in mentally preparing me.  My pushes were much gentle…it definitely helped that I knew my body better.  I really hope dilation gets easier with time because 4 times a day for a month requires constant focus.

Now, I can blog about the catheter removal.  So the entire day, I was also fighting another battle–peeing.  Once the catheter was initially removed, I experienced extreme discomfort within a couple of hours for my attempts at going to the bathroom.  It became too unbearable and the catheter had to be re-inserted.  I was disappointed but Dr. Meltzer and many others said that it is not uncommon for this to occur for a while.  We tried one more round but again, it did not work.  I was also taking Flo-max (sp?), a drug that helps relieve incontinence, and something fairly new that Dr. Meltzer was trying with his patients.  Regardless, the drug did not work, and now, the catheter has been re-inserted.  I hope tomorrow’s efforts will be successful.  If not, I do not like the alternatives–staying extra nights here or bringing home a catheter kit.

SRS Diary Day 9: Dilation

The day started early for me today. Breakfast came, the nurse came with my meds, and very soon afterwards, Tasha came for the dilation.

First, I took a pill that helped create some light-headedness in anticipation for the first dilation.  As I sat spread apart, Tasha snipped the sutures slowly.  Ouch!  There was a lot of breathing and focus this entire session.  She then slowly removed the sutures…some pain.  Then she started to unroll this hidden roll of gauze inside the new vagina.  Eww…very smelly.

Tasha then proceeded to explain the dilation and lubed up the dilator.  For those unaware, the dilator is a stiff ceramic device used to maintain the girth and width of the new vagina as it heals.  A new girl has to stick this in multiple times a day for at least a year.  There are different sizes, and one begins using larger dilators as one heals.  There is the dreaded size 4, which apparently is not used for most girls.

So I was breathing deeply and focusing strongly as Tasha proceeded inserting the dilator.  Yeoww!  Actually, I thought of it as a three stages, and only the second stage really hurt.  The initial stage is the initial insertion.  The second stage involved penetrating through some perineal tissue.   The final stage involved reaching the rectal wall.  Then, I had to take it out and demonstrate it properly.  It was less painful for me since I was more sensitive to my body.  As I laid there for 15 minutes, Tasha continued on with more of the routine.

After I finished, she left, and I cleaned up.  It was definitely not comfortable but not too difficult.

The dilation (and my first bowel movement) drained me so much, I was fatigued most of the day.

I have to dilate 5 times today.  The second time went well, but the third and fourth times, I did not manage to push the dilator as much as I did before.  I missed something.  Ugh.  I will need to talk with Tasha or someone from Dr. Meltzer again for details.  The fifth one is about to occur in 20 minutes.  Fun times.

SRS Diary Day 8: Recovery from the Second Surgery

First impression…OMG, this hurts! …but only if I moved.

Second impression…this is like deja vu from the first surgery. I had an IV in my arm again, I had the leg compressing device shackled to my calves again.  I had a blood oxygen device on my finger again.  The heart rate monitor was strapped around my right arm compressing my arm quite a bit throughout the night (I estimated about every 20 minutes), waking me up, and causing a tinge of soreness.

As soon as the nurse arrived with my first drug cocktail at 4:30am, I immediately asked when I could start walking again.  The nurse replied vaguely that it may be in the afternoon.  I was not too pleased. I asked how long did I have to have my IVs in—until the last IV runs out in 8pm.  Ugh.  This did not sound right, since I knew that breast augmentation is an outpatient surgery.  There was no way I was going to be bedridden the whole day.

The next nurse came in at 9am, and I immediately asked the same questions.  I had a better rapport with this nurse, and Katie knew the Meltzer routine better.  After doublechecking, she cleared me, and all the devices were unshackled from me.  Relieved, I concentrated on trying to get out of bed and walking.

There was truly pain.  I struggled for about 5-10 minutes before I figured out to raise my bed, slink every so slowly to the right edge (I failed on the left edge because one incision was causing too much pain for me to gather strength), pull the cart table towards me, and lift myself up.  The soreness at my chest and lipo areas were tender but not screamers.  After a few minutes standing up and walking, I was at my computer when Dr. Meltzer walked in.

He gave me the verdict…325 ccs per breast.  He *thinks* he got me C’s.  (Another staff member of Dr. Meltzer, Debbie Storey, came in later and judged 34C)  He took off quite a bit of fat and moved them to my butt/hips.  He was very pleased with his efforts, and I got caught up in his enthusiasm.  He wished me well and went off to his next surgery.

Then, Tasha, who is one of Dr. Meltzer’s nurses, came in and removed the ace wrap around my chest and replaced it with a bra wrap.  She proceed to demonstrate the massaging exercises that I had to perform 4-5 times a day.  Omg, when she did this the first time, my knees buckled from the pain.  She then later informed me that the next day, the packing from the new vagina will be removed and she will walk me through the first dilation–that will be *enjoyable*.

Up to this day, I still have yet to have a bowel movement.  I was a bit worried, as it has been 5 days.  I felt the constipation but no amount of cholase and laxative was going to do it today.  As one of the nurses said, for many girls, the first movement occurs after the unpacking is performed, when the pressure of that particular action is released.  So I’ll wait until tomorrow.

My sister flew back to her home today, so my mom spent a lot of time with me at the hospital.  Chatting, eating, surfing the internet, sleeping, watching a bit of TV.  I spent quite a bit doing work, unfortunately.  The work crisis that occurred before SRS had not been solved, and I felt too responsible while coworkers were waiting for data.  I managed to figure out the problem and solution and fired off my last email  9pm.  Ugh.  I hope not to do any more work  this week.

Finally, I had time to really relax.  I guess I did not mind the work because I would otherwise be bored, probably watching TV and sleeping to pass the time.  Sunday, I finally started reading a book.  I brought two books with me to Scottsdale–a fantasy book by Robert Jordan which will engross me but takes effort to concentrate over my pain to imagine the rich descriptions, or the book by Donna Rose, Wrapped in Blue, an easy-to-read autobiography of a trans woman (I met her a few times and she is really nice) and which is something to easily relate.   Lo and behold, I chose Donna’s book.

I’m about to go to bed now, and my pain, though still sore, has subsided from the morning’s intensity.  The chest pain is probably greater than the SRS pain currently.  It was still difficult to get to my bed.  Oh well, I’m looking forward to tomorrow and the unpacking.

SRS Diary Day 7: Surgery Round Two

<written the day after> I had my breast augmentation yesterday.  Actually, I should disclose that there was some liposuction as well.  The entire procedure lasted about 4 hours according to Dr. Meltzer. The timeline was as follows:

4am:  No more food.

12:30pm:  Surgical appointment

12:40pm:  Dr. Meltzer arrived to greet me while I was lying in the waiting area.  I have found out from the nurses by now that Dr. Meltzer is habitually late for these things.  He drew a lot on my body for the liposuction, while all the time he was wearing a nice suit jacket over his scrubs.  Very kewl.

1pm:  Actual surgical time.

5pm: Done with surgery.

7:30pm:  I remember looking at the clock back in room 14.  I was complaining quite a bit to the nurses as they were moving me in my bed to my room about the abundance of phlegm in my throat  I called my sister and mom in a drugged state to bring some hot tea when they came.

10pm:  I was conscious enough to realize the tightness in my chest and that I was basically chained to my bed.  I declared it useless to fight and slept the rest of the night away.

Woke up at 3am.  Watched TV for two hours.  Then finally slept some more.

SRS Diary Day 6: Recovery and Preparation

Today has been a much better day for my energy level.  As much as I was enthusiastic about walking yesterday, I simply did not have enough energy to do much.  Also, it took all my concentration to focus on the pain whenever I sat down.

I spent most of the day out of bed.  I walked quite a bit around the floor.  I explored the paths through all the elevators.  I took a peek at the pediatrician ward downstairs.  I chatted with the other trans girl.  I sat on a chair, typing away at and reading from my laptop.  I talked quite a bit with the nurse in the day shift–I think I have connected with her.  I showered finally for the first time too!  Phew.

The JP drainage balls were removed from me this morning.  Pulling them out hurt a bit but I was glad they were gone.

As much as I am pleased that my energy is recovering, I am already mentally preparing for tomorrow’s breast augmentation.  The surgery will be around noon, and I will be asleep most of the day tomorrow.  From what I hear, this will hurt more than the vaginoplasty.  Pushing the implants under the muscle will do that…ugh.

SRS Diary Day 5: Ambulation

As the name of the entry says, I get to walk today.  Woot!

As soon as I ate breakfast, I summoned the nurse, who kindly helped me through the steps of taking care of my catheter while I walk around.  It’s definitely not a comfortable feeling to plug and unplug the catheter tube.  We tucked the JP drainage balls in my hospital panties and I wobbily stood up and walked around my bed to the bathroom.  Cool!

Once the nurse was satisfied with my progress, I proceeded to brush my teeth and brush my hair.  I was finally able to open my luggage for the first time.  I packed my bag ridiculously way too much–I will definitely need help carrying this bag as lifting things up is not easy.  I also finally made my first lap around the floor.  It was quite empty, only a few patients in a floor of about 20 rooms.  I peeked into my trans neighbor’s room but she was showering.  The other trans girl had her door closed.  I’ll knock on her door tomorrow.  After finishing the lap, I was winded and laid back on my bed.

I made the mistake of checking my work email again.  Another day, another crisis, it appears.  I talked with my co-worker a bit on the phone in an attempt to work through the problem.  Eh…he told me not to worry…I agreed and left it at that.  I shot a short “I’m well” email to my team lead and logged out.

My pain level is much less smaller.  It hurts to sit down, which explains the “neck pillow” that Dr. Meltzer provided in his goody bag.  I sat on it and it helped a bit.  The biggest annoyance has been the gas from my gastrointestinal system reawakening itself.  Walking helps to relieve myself of the discomfort.

I’m glad I got to walk around today, but I’m starting to feel the boredom.  I can’t really focus on reading or other things because the discomfort is enough to ruin it.

SRS Diary Day 4: Bedrest

I spent the entire day attached to the hospital bed.  As anyone can imagine, being stuck to one spot can be a tortuous experience.

The hospital food here is tremendous!  My eyes lit up at the breakfast menu.  Pancakes, sausage, scrambled eggs, corn flakes, toast, stuff that one would see in a restaurant.  And the quality was decent too.  I did not imagine having a full-course meal for my first meal.  In my past hospital experiences, usually, the meals are some sugar-less light diet with a piece of toast or jello.  Lunch and dinner were just as fabulous.  I made sure I ate more controlled amounts of food because I was uncertain about how I would proceed with my first bowel movement.  At least, I can eat some delicious food while being stuck in bed.

The pain grew worse today.  The cause of this was most likely due to my IVs being removed.  I erroneously thought the pain would have been the worst yesterday and was not prepared for it.  I tried lying down more often because I thought that keeping the site elevated would be better–this did not work.  The pain grew intense, and the burning grew with my passing breaths.  I finally asked the nurse for tylenol.  I took a long nap and also propped my bed up, which seemed better for my pain.  After I woke up, I did feel somewhat better.  Dr. Meltzer soon showed up to check up on me and delivered me some welcome prescription–dioted!  Yum, I took that with my dinner and the rest of the pain went away.

The hospital staff has been good to this point, but I think I was spoiled by Dr. Ousterhout’s hospital–Davis Campus Medical Center, which is a top-20 rated hospital in the US.  The quality of the stay depends so much on the particular staff people.  So far, in Scottsdale, I had one really great nurse and one really great tech, and I had some nurses and techs who have been pleasant and nice but are  just not quite as tentative.

I spent the rest of the day talking with friends on my cell, texting, emailing, talking with my mom and sister.  I watched a bunch of TV.  One of my neighbors, who had SRS Tuesday, stopped by, and we had a couple of pleasant conversations.

I think in these hospital stays, to overcome some of the boredom, is to focus upon the improvement and progress in small steps.  First, the removal of the heart monitor was a tiny success.  Then, the removal of the IV made me feel a little better.  Then, the removal of the pulse oximeter.  Then, focusing on the different feelings that newly arise from the healing surgical site.  Then, focusing on the multiple catheter drainages, the liquid clearer with each time (I know, yuck).  Then, the multiple blood drainages, a little less every time (double yuck).  Then, the burning pain disappearing.  Tomorrow, it will be a bigger progression…I will be walking again!  …I forgot to add another way to overcome the boredom–sleep!   Time for bed. =)

SRS Diary Day 3: Surgery

I am writing this the day after my surgery.  As one can imagine, I was pretty much out of it yesterday.

Here’s my rundown…

9:15am  Check-in to the hospital.  It was *very* close from the Holiday Inn, like 4 blocks away.

~10:45am  I met Dr. Bess, who is Dr. Meltzer’s anesthesiologist and reputed great guy.   He lived up to the billing.

11:15am Surgery.  I actually do not know if the surgery was actually performed at this time.

~2:15pm  Surgery done.  Diloted is now my favorite anesthesia.  Zero nausea or vomiting, compared to the extreme nausea from morphine I get from previous surgeries.

3pm <zonk>

4pm <zonk>

5pm I woke up around this time.  I woke up in room 14 in the hospital.  No suite this time as it was for my FFS surgery.

6pm-8pm  I was still groggy from anesthesia.  Pain felt like a burn in the surgical site.

8-10pm  I was awake enough to talk a bit with my mom and sister.  Kara called around this time.

10pm-the rest of the night.   Sleeping with intermittent visits by the hospital staff.  There was a nurse who changed the ice packs on the surgical site.  The nurse had a gender-neutral name and had a genderqueer appearance and a genderqueer persona.  (I have seen facial hair on this person today.)  The nurse also changed the IVs and fed me my medicine.  There was also a tech who drained the JP balls that collected blood and drained the catheter.  The pain was definitely uncomfortable.  However, the pain was muted enough by the painkillers that I was able to explore and try to “sense” any differences.  I was able to squeeze a kegel or two.  There was definitely a feeling of void…whether it was because of the numbness from surgery  or because of no more male part, I don’t know.  I actually felt a tinge of excitement at this thought…until the pain re-surfaced.

SRS Diary Day 2: Pre-Op

I woke up with just enough time to get was ready before Rachael from Dr. Meltzer’s office came by to transport me to the clinic.  I arrived at 9am and was greeted warmly by Kristy.  I then received a huge ‘tome’ of papers about the SRS procedure to sign off on.  This ungodly amount of paper by far outweighed my FFS paperwork.  I was then led through some instructions for the various pills to take.

Dr. Meltzer came and went through the procedures with me.  Like many other surgeons, he was very thorough in his description of the various incisions and techniques, talking to me but probably more to himself about how he was going to proceed.  My meeting with him lasted only 15 minutes but I was satisfied after conversing with him.  When it came down to breast size, surgeons do not know what is a ‘C’ or a ‘B’ cup size but by the volume.  He said 300-325 cc would be good for me.  I do not know the conversion to cup size, but I at least relayed my concerns about having breasts large enough for my transgender frame but not so much to look unnatural.  In his hands, I trust.

Afterward, there was picture-taking by Linda and a final say from Dr. Meltzer after looking at the pictures.  Then, I took home two whole bags of ‘goodies’ for the coming week.  I was very impressed by the sheer amount of stuff there.  I was so impressed that I took a couple of pictures of the contents.  Unfortunately, I did not bring my adapter for my computer or I would be able to post them.  Later, perhaps.  Well, an inexhaustive list includes patient gown, vegetable laxative, bowel prep stuff (latex glove, enema, the tasty magnesium citrate oral solution laxative, lube), travel-neck-rest-converted-to-butt-cushion, catheter, and the centerpiece–dilators!  There were four dilators of various thicknesses wrapped in a nice cloth satchel.  I was a bit surprised that the goody bag included a mirror&brush…I guess girls just *have* to look pretty even after surgery.

I returned to my hotel room and spent the rest of the afternoon bloating myself continuously in my liquid diet.  I have had a liquid diet before from a previous surgery and I rested as the eventual energy drain from not eating solid food kicked in.  In the early evening, I consumed the magnesium citrate oral solution.  It was not as bad as I expected.  As I continued my bowel preparation steps (lotsa lotsa water), I fluctuated between temporary headaches and uneasy bloatedness.  The prep eventually climaxed with the enema and I was hurdling to the bathroom frequently.  Blech.

My mom and sister arrived sometime around the beginning of my bowel prep.  We went to the local Red Lobster to get some dinner for them…I just drank some water and unsweetened cranberry juice.  It was then that I asked my mom if she was okay about coming here.  She gave me a pleasant answer–she is going to support me no matter what.  We are family.  She still wishes that I would at least pray, but she will support me in whatever endeavor I feel will lead to my happiness.  She also finally acknowledged that I have been thinking about this a lot.  Touched, I remained mainly silent but acknowledged that I appreciated that.  It was quite a bit to take in.  Then, whether one can call it comical or timely, my bowel started to act.  I proceeded to the ladies’ restroom, where I sat and really let her words sink in.  Ahh…I wonder how many epiphanies or ground-breaking ideas in the history of mankind occurred from sitting on the toilet?? =)

I am now sitting in my hotel room, 10 hours away from surgery.  Blogging…waiting…yawning…my mom snoring loudly next to me…but it’s fine, I love her for coming here.

I’m ready for tomorrow.