Sifan's Journey

3 Months Post Opt

Posted on December 11, 2014 by sifankahale

Oh this has been a long 3 months…. part of it was the most painful of my life. I’m still quite sore down there but remembering what I went through – this is nothing. See my previous posts for details of the SRS operation, my recovery and painful complications I went through. For the most part the pain had to do with the complications – the UTI, not being able to urinate and extending my bladder. Without that complication this operation and recovery, especially in the first month would hardly rate as discomfort or low level pain. For that I am glad – glad that I didn’t have to deal with anything else over and above the complication.

Normally (with out complications) the first month is pretty easy. It’s the second and third months that are hardest. This is due to a number of factors. First Dr. Suporn’s technique is very ‘accurate’ and true to the female anatomy – his technique is the different from all the rest and results are as they say, the Cadillac of the business. This means there is a lot more surgery and construction underneath/inside and this takes longer to heal. It’s like scare tissue which becomes swollen and hard and progresses from one area to another as it heals. This is one reason we have to dilate, to keep the neo vagina open, soft, and to depth. One of the ‘sisters’ called it “beating the dragon” (I prefer to call it ‘training’ the dragon …). By the way, I call the other women that were there in Chonburi having SRS along with me – ‘sisters’ as we formed an international closeness and constantly keep in touch.

This becomes difficult during the 2nd and 3rd months where most of the healing takes place. It gradually gets easier and for some even pleasurable. For others this period is very hard – even extremely hard. I’ve heard of some that took hours to get to depth – which you have to do before you can start timing your dilation. I was lucky this way – the worst I had was maybe 1 min before I reached depth. It is recommended that we do 3 dilations a day – so you can imagine the pain and agony some have had. I had cut down to 2 a day because I was able to maintain my depth. I feel lucky that way. It was hard for a while and I had a hard time preparing mentally for them. But they gradual became easier, less painful and became routine. I will have to dilate the rest of my life – but the frequency tapers off to once a week after 1 year (3 times a day until month 4, 1 once a day after month 6, then once a week or so after a year – mostly to check depth).

Those are the major milestones as well. After the 3rd month things get easier and we can start doing just about everything (swimming, hiking, long trips, working, baths, some exercise, etc.). Then month 6 is another milestone and 1 year basically marks completion. Ya, one year …. Of course every ‘body’ is different and these are only approximate timings for the majority of people that go through this.

In this next section I’m going to tell it like it is – this could be TMI (too much information) for some, so be warned. However, for those who are going to have surgery, I think this is important to know – I wish I had known this beforehand – not that it would have changed anything – just so I could have been more prepared and aware. Of course this is ‘my’ experience and reading the private accounts of others tells me that I’m in the middle as far as my experience and pain/discomfort is concerned.

By the way: most surgeons or clinics have a private FaceBook page that is only for ‘post’ opts. These are very helpful for us to a) keep in touch b) ask questions c) see how others are doing d) peer into the future to see what to expect. Unfortunately they really do need to be kept only for those that are post-opt or immediately pre-opt. But this information is invaluable if you are going to have surgery. They recommend that once you are invited into their group, that you read back 1 year to get a full understanding of what to expect.

For me, right now, I’m going through multiple phases where ‘things get tight’ down there. First a very hard ball (size of a marble) formed just above everything (up by the pubic bone). I had to stay in bed for a couple of days with nothing on down there (as everything, even the weight of the bad sheet, hurt). This gradually ‘morphed’ down along both sides of the frenulum, basically tightening that entire area up (it was all swollen, so this is actually ok, just a bit painful). Now the same sort of thing is happening starting at the tops of the outer labia and working down. Which is also good because my outer labia is huge (swollen) making it difficult at times to close my legs, especially when I want to sleep on my side at night – I have to place a hard thick pillow between my legs.

I still can not sit without using the infamous seat cushion although it is getting better. I forgot it once and was able to carefully sit on a hard chair for about 10 mins. However, if I do too much, like a long car ride or sitting too long at work, or like one day I had to go up to the summit to work – the next day I wind up in bed, legs spread apart and nothing on to let it heal. Sometime I have to take pain meds – sometimes I’ll take a pain pill before I need to do something (like a long ride) where I know it’s going to be hard. At times, it feels like a bowling ball down there between my legs – and I walk like I’ve been riding a horse for hours. My panties feel like they are crushing me during those times and I can’t wait to get home and lay down in bed and allow my bottom to ease up. These times seem to coincide with the ‘tightening’ phases I mentioned above. So I’ll be ok, even ‘great’ for a few days and then another one of these ‘phases’ kicks in and I have to take it easy, stay home and sometime stay in bed. But these ‘seem’ to be getting less as time goes on – progress is being made (although soooo slowly it seems).

I saw my GP doctor today – another checkup. My UA came back ambiguous – but at least it didn’t have the bacteria (e-coli) that caused all the pain and agony before. I sent a question off to the clinic regarding this and they said (and my doctor agrees) that if none of the symptoms are present than all is ok. There are high levels of something I don’t remember what, but those can also be do to the SRS surgery. So we are leaving things alone unless symptoms come back. That is good news!

I’ve been having bleeding (very minor) about once a week, all coming from the same spot (at the bottom inside where the major and minor labia come together on the left side). The doctor examined that in more detail and found it was the equivalent of a ‘skin tag’ – an 8th in long growth protruding out. This can happen as internal ‘sacs’ sometimes comes out through the skin (the labia are created with many layers of internal stitching and sometimes as these heal one of these small sacs can pop out). So the middle of January I go back and will have it removed (plenty of local anesthesia ….!). I’m relieved to know that is all it is.

Other than that, everything looks and operates correctly now. There is sensation is all the correct places. Still sore so I’m very careful with my new parts. A number of the ‘sisters’ that had SRS the same time as me are now reporting they had their first umm, “The Big O’ …. For me, the surrounding areas down there are still too sore for me to even contemplate that …. Put it this way, I still cringe when I see another woman riding a bike or motorcycle. Maybe someday I’ll be able to do that but right now I have that automatic ‘pain’ – same as when someone talks about getting a flu shot – you automatically feel pain in your arm … or when someone talks about going to the dentist … ya … that kind of thing: my bottom immediately goes into panic mode!

So today is the 11th, my 3 month celebration as finally being the true authentic me. I can not tell you how absolutely wonderful it is. First you have to understand the shear disphoria that was before – I’m not sure I have words to describe that horror – the pain of my complications can not come close to the lifelong battle I have gone through attempting to live in the opposite gender. Now I am free to ‘be’, to express myself and to live as who I always was. It is a fantastic and welcome change.

It just struck me – theoretically I am finished with transition! I say theoretically because I could argue both sides of that. Some transsexuals go stealth now that they are fully a woman, truly marking this as the end of transition and simply blend into society as women. Even though this is a completion – on so many levels – I feel that it is important, especially today, to be visible to some degree. The more society sees that transsexuals are ‘normal’ people, involved in normal or credible vocations or even honored/esteemed positions, the better it is going to be for those that follow. The more professionals like myself that come out, the more that society will start seeing us as part and parcel of the human condition. Just like red hair or blue eyes, transsexuals are but one more variation of the human condition. There is a balance of course – this can be and has been deadly (we just honored those murdered on Nov 20th – TDOR – Transgender Day of Remembrance). I am cautious: I do not proclaim who/what I am to just anyone – but I am an advocate and will do what I can to help achieve parity for everyone.

With much Aloha,

Sifan

PS: I’m hoping to swim in the ocean this weekend – I have missed that soooo much ….

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Posted in About, Advice, Diary, Gender Affirmation Surgery, Surgery and tagged Gender Affirmation Surgery, Gender Change, MTF, Post-Opt, SRS, Suporn, surgery, Transgender, Transition, Transsexual. Bookmark the permalink.

Womanly Prep Time

Posted on November 13, 2014 by sifankahale

A good friend of mine asked me how different it was being a woman – specifically regarding the time it takes to get ready or to perform normal everyday activities. I thought I would share my answer. Be warned, a paragraph below contains potential TMI (too much information), so feel free to skip this post. I include this because these are some issues and topics that no one talks about concerning post SRS life. If you are going through transition or considering SRS surgery, these are things you should know. Not that it makes much difference, but I wish I knew this before hand – if just for the information, but also now after SRS, it is ‘comforting’ to know this is ‘normal’. But you can only know that if you have close female friends that are open to discussing these issues.

A male throws water over his face and combs his hair once, wears the same clothes as last month with maybe a change of shirt to make it look different, although he doesn’t see why that matters. He might use a hair dryer but only to ‘dry’ his hair and only if he’s in a hurry. One pair of shoes is all he needs. They only thing he will change often is underwear and socks! 5 to 10 mins max and he’s out of there!

There are two things that totally changed this for me: being a woman, of course, and being post-opt. Both have large time requirements. And as far as sophistication, I’m probably equivalent to a late teenage girl (maybe I’m up to early 20’s by now…). Now and then I’ll ask Lisa for advice on the colors I’m choosing or matching the style of clothing to the jewelry I would like to wear that day. A hair dryer is for styling one’s hair – not for drying it – who would of thunk it! Time is taken to make sure fingernails and toenails are trimmed and proper. Body hair maintenance (not just facial, but legs, arms, chest, etc.) is a huge time component. If I’m going to work or anywhere outside the house, time is spent on choosing the style and look I want that day – things like where I’m going, who I’ll see, casual (and exactly how casual) or business (and what business message I want to project) and what the weather is like, all go into that decision. Thought goes into matching shoes, jewelry, outfit, purse and to a smaller extend hair style, lip stick and perhaps a small amount of makeup.

(TMI alert…) Being post-opt and having ‘womanly parts’ has brought an entirely new dimension to the time taken not just to get ready but also for mundane daily activities of which men just have no idea. After suffering through that UTI (Urinary Track Infection), I am now about as paranoid as the most paranoid women I’ve known when it come to cleanliness, especially down there: washing my hands before and after, washing down there, douching, even being careful with the shampoos, soaps and conditioners I use – making sure they are pH balanced and safe. Case in point: a guy usually only ‘wipes’ after a ‘#2’. Not only do I wipe after everything, but it has to be the ‘down and back’ and never reuse type! Also if the ‘spray’ was a bit to much (a common problem with a #1), then I pour water down there to get clean and prevent a rash. A guy is concerned about cleanliness of basically one orifice (#2) – I have to be concerned about three. Douching and maintaining a pH balance have been added to the list.

And on top of all of that – because I’m a post-opt SRS- for the rest of my life I will have to dilate. Right now that is 3 times a day: 5 mins to set up, 15 mins dilation time, then douche and clean after – totals up to about 1/2 hour for each. I do appreciate how fresh and clean I feel after. But that’s another point: as a guy I never could understand when a woman talked about feeling fresh and clean – oh do I understand now. As time goes on, dilation will reduce to a couple times a week.

Going to work? Who has time to go to work????

Men just do not understand. Before transition, I had an appreciation for the time a woman required to prepare, but it was nothing like the reality I now live. My hope is for those that are starting this journey, that you gleam some information (and perhaps wisdom) from this, that is seldom discussed or disclosed (due to it’s TMI content).

With Aloha,

Sifan

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Surgery in Thailand – Part 5, Complications

Posted on October 31, 2014 by sifankahale

This post also contains what some will call TMI (too much information). If you are squeamish, please skip. I had two complications post surgery that each masked the others symptoms making it difficult to diagnose and cure. In fact one of those I’m still suffering from and only now does it become obvious I had this all the time since I left the hospital. For those that do not wish to read this entire post – here’s the key point: if you are having urinary problems, suspect a UTI (urinary track infection) immediately and get tested! That would have saved me more than a month of torturous pain.

Before we could leave the hospital we had to prove that we could urinate. I had difficulty and had to stand up in the shower to accomplish it. Now urinating at first is something that is difficult for anyone post SRS. Women do it much differently than man do and of course up until then I was used to doing it the male way. A male feels he has to go, then basically pushes it out, but a woman when she feels she has to go, sits, relaxes and when it’s ready it comes out. A very big difference that is hard to get used to at first. One has to relax and not push – if you are in pain and have an intense urgency to urinate – this is impossible.

As a result, myself along with the nurses and clinic staff chalked up my difficulty to this difference.

Then, about one or two days after I was back in the hotel, I had a very bad case of constipation. Constipation is normal after a week in the hospital when basically everything down here is shut down and they gave me laxatives to take the first thing back at the hotel. However, those were not doing the job. After a couple of days it became obvious I needed something more powerful. Finally they sent over an enema kit and dupalux which is a very powerful laxative. The next morning, and all that day, I finally emptied out. Meanwhile, I was in pretty bad pain for about 3 days as all this was figured out.

Once that was solved, the second, worse and more painful problem became obvious. I could not urinate. And this degraded each day, getting worse and worse. It started out that I could only urinate standing up then squatting over the toilet. But it was only a small stream, not enough to empty my bladder. The progressed to having to stand in the shower, rock back and forth until I could go – then even that turned into just dribbles and drops, with very little coming out.

Worse yet I had an intense urge and pressure to go, but could not. This would be very painful, I would almost collapse – I had to hang onto something to keep myself up. My entire body would shake and spasm until a little urine would come out. Then things would calm down and after about 5 mins I could urinate – but just a little.

This would repeat every 45 mins to an hour – day and night. Plus, during the night, I would ‘leak’ due to the intense pressure building up in my now fully extended bladder. Basically all I was able to do was relieve the ‘over’ pressure from the bladder – never emptying it or even reducing it. Each hour I was get this very intense urge to urinate along with this racking pain. I would pace back and forth in the room until I was calm enough to attempt to go. Then I went through the entire process of standing in the tub rocking back and forth, dribbling a bit here, raising a leg would sometimes helped get a bit more out – waiting for more to come out, holding onto the shower curtain rod (being so careful not to pull it down) and racking in pain. I had placed my hands on my hips so much that my hips became painful and I could not compose myself that way any longer either – what a horrible mess.

Sometimes nothing would come out but the intensity and urgency to go was still so overwhelming that I would revert to pacing until that pain once again went down and I would try again. I had to use a cane when pacing – it was that bad. Then, clean up (small 1/2 shower) and back to bed for 30 mins or so before all this would start again. Even in bed, I could tell my bladder was painfully full. I had to find a way to lay down that hurt less that other positions. Even the weight of the bed sheet on my lower area was painful (I would prop up a pillow next to me down there to keep the sheet off of it). Poor Lisa had to sleep on the far side of the bed and give me lots of room (this was probably the hardest part for us as we both always cuddled as we slept all night long – this was/is very important to us). As a result it was very difficult to get back to sleep and it seemed the second I did – boom – it started all over again. The most beautiful part was the morning sunlight starting to shine in the sky – it meant not only that I made it through another night, but that the staff was up and the clinic would be open and I could try to get help.

On top of all of this – I had to go off of my HRT meds for the surgery and was only allowed to start taking estrogen again after the 1st week back in the hotel. Going off estrogen is like going through menopause – hot flashes, cold flashes and mixed up emotions etc. A number of times I soaked my pillow at night because I was so hot.

Throughout most of this Lisa (who is a nurse) was in contact with a nurse friend of hers who has a lot of hospital experience with UTI and in fact the two of them had written a training manual for nurses. So, during the long nights, everything I would get up, I would email her with the latest and she would get back with advice (due to the time differences she was up at those times). It was with her help that I was finally able to describe my symptoms correctly to the doctor here.

This went on for 3 excruciating days and nights, hour by hour, no sleep and the worst pain of my life. I remember one night toward the end of this, just before I finally got the catheter in – I was holding onto the door frame of the bathroom, rocking back and forth crying and telling Lisa that I can’t go on like this, we ‘HAVE’ to get help, this ‘HAS’ to stop.

I think my problem was that I thought this would go away because this was probably due to the surgery and something down there was still swollen and pinching off the urethra and time would heal this. When I described my symptoms to the staff, they were concerned if I could urinate at all – which I could. So this was not taken serious until the 4th day when I called the clinic and explained how much pain I was in and how little I urinated. I have a high pain threshold – so it took a while for me to understand that this was much worse than I thought. And of course the times I explained this to the clinic – I was not telling them a pain level that concerned them. Finally, I had just had enough and once I explained how much pain and that only dribbles were coming out – they got me into the clinic and the doctor put in a catheter.

What a huge relief! As he inserted it, the nurse held my hand tightly. It hurt a little. But the second it reached my bladder and started draining – this relief was beyond belief – I started to cry with happiness. More than 1000cc came out – way too much and means that the bladder was over extended.

I wore the catheter for 3 days. Then, an hour before they were going to take it out, I was to empty it then drink a lot of water. I probably over did it and drank 3 bottles! Well, they took it out – but I still could not go – only just a little.

Later that day it became a repeat of when I came back from the hotel – same hourly urge, same pain, same dribbling and not being able to empty. And it got worse as time went on. I over extended the bladder again and again was in intense pain and only dribbled, repeating this every hour that night, just like before.

I stupidly kept going until 9 am the next morning when the clinic opens. Later I found out I could have called any time during the night and a nurse would come to my hotel room to reinsert the catheter. As it was, I made it to the clinic and they put it back in. Once again, more than 1000cc emptied out.

Now the problem was that is was the last week in Thailand – I was going home in a few days. So we decided to keep the catheter in until 2 days before I left. If it worked – great, if not, I would get a special catheter for traveling home.

I got the catheter out early in the morning so that if I didn’t urinate by say 6pm – the nurse would come and put a new one back in.

It didn’t work — so I called and the nurse came right to my hotel room and did it there. Just before we left for home, Dr. Suporn saw me in the clinic and went over the options. The best option was to wear it home – that way I would not have to worry about a complication 1/2 way home – on the airplane!

I was to keep this in for 2 weeks after I got home.

The leading theory was that there was swelling or something that was blocking he urethra. And indeed, each time the catheter was out, there was progress. The first time out I was actually able to urinate sitting down. The second time I actually had a stream instead of a dribble. Both of those were short lived, but it did show progress and point to perhaps swelling that was slowly going down.

In the last two weeks of our stay in Chonburi, most patients are recovered enough that they get out to see the sites, go shopping, eat somewhere other than the hotel, etc. I could do none of that. Walking too much would irritate the urethra possible making it swell worse and extending my issues and pain. So we never ate outside the hotel and at most would walk around the hotel itself – going down to the lobby for an ice cream cone, or visiting the garden.

There are good things about having a catheter (as well as bad). First I did not have to worry about emptying my bladder – each time it was emptied! They had me on ‘training’: instead of having the tube open all the time, I had it closed/pinched off and would only open it when I felt like I had to urinate. This trained the bladder and me. I would still have to get up in the middle of the night – but it was like before – I always would get up once or twice during the night – a huge difference from the hourly painful mess I just had. Some of the bad issues were: hiding the bag – there is a strap that you can attach it to your panties, then I’dd wear a long loose dress and make sure the tubing didn’t show below the hem (in the top picture of this post, the bag is in the large purse I’m holding and you can just see the tube coming from under my dress). The other is that there was constant draining from the irritation from where the catheter entered. And with a tube going straight down from there – this would circumvent any liners or pads I was wearing. As a result I was going through panties and pads like crazy. I brought a lot of panties and would wind up washing almost all of them every day. And of course this cause my inner thighs to chaff no matter how much I washed and dried them. When I didn’t have the catheter in, I was leaking from all the pressure, so I had the same issues then too. What a huge terrible, painful mess that was.

The plane ride home was long and hard especially because I could only sit on my seat cushion and that is not very comfortable. Fortunately Lisa had book us on business class for the trip back. The trip was about 21 hours long which included two 6 hour layovers. On the longest flight we were JAL’s ‘dreamliner’ airplane. The business class seat had everything, including a ‘bed’ mode. That was great because it was the only position that was comfortable at all for me.

The very next day that I was back, we traveled down to Lahaina to see by GP doctor and to figure out how and when to have the catheter removed and what to do if I still had problems. I live in upcountry Maui and this was about an hour long trip – one way. That was difficult and once I had the catheter removed, if I were to have a relapse, that trip would be horrible.

When the day came, we rented a room in a hotel in Lahaina just blocks from the clinic. My appointment was first thing in the morning so that I would have plenty of time to attempt to urinate and if not, would still be able to get back into the clinic to have the catheter reinserted before the clinic closed.

Well, it worked – sort of. I have not had the catheter back in. That day I went about 10 times in a row, sitting down, with a nice stream each time. However, when night came – it was back to every hour and the hour. Sometimes I would have to either stand or squat in order to go. But the good news was that I was going and in a good quantity so that I was not extending my bladder. But I was still having the intense urge and the pain.

This would only get worse in the next few days until on Sat. with nothing else open I went into the ER in Kahalui. OMG what a horrible experience that was. I was there for 6 hours, in my condition that was an eternity. When I got in they had me give them a sample. The restroom was so filthy – there were blood stains on the floor. I did everything I could to keep both the sample and me, my skirt and anything else from touching anything! Then hours later I was admitted, they did a bladder scan that showed I had about 650 cc inside. The test came back positive – I had an UTI (urinary track infection)! They put me on Cipro and Pyridium (standard treatment). They also took a culture and in three days, depending on what they found, they might have to switch medications.

Four days later, I still have the same symptoms – it’s not working – and no call from the Hospital. So we called and for about a hour was passed around between departments only to be told “sorry I can not release that information”. Now I can understand that they can not tell someone else – but this is ME asking about ME!! What a screwed up mess that place is. At least we found out that I was on the WRONG medication – but that is all they would say. We called my GP doctor and she fought the good battle to figure out the rest and she then wrote me the correct prescription (assuming their test results were correct that is….).

Once I got the medication I read what it had to say about UTI’s:

Cloudy urine (mine was slightly cloudy)

Burning sensation when urinating (not really – was like a constant burning sensation all the time)

Have to urinate very often and usually only can go a little bit (bingo – me to a ‘T’)

Have a very strong urge to urinate – usually suddenly (oh boy do I ever)

Pain and muscle spasm in the genital area while urinating and or right after (yes – so intense that I can not go – I have to pace or do something to relieve this)

Pressure over the pubic bone (yes – in fact I was asking the doctor what was under there that would cause this – this only happens when I have to go)

Back pain – would mean the kidney is involved (nope)

Chills and fever – would mean the kidney is involved (nope)

When I read all this — it was the proverbial light bulb moment – this is what I had when I left the hospital in Chonburi and the entire time I was in the hotel and here at home. Holly cow – if I would have described this correctly or if someone could have put all this together back then – well – that’s over a month of the most excruciating pain I ever had in my whole life.

UTI’s are somewhat common when you have a catheter in – like I had those 7 days in the hospital. I’m pretty sure now this was the cause all along. Boy I wish I knew more back then like I do now.

As I’m writing this, I’m on day 2 of the new meds – waiting for them to work – could take up to 5 days. At night, I am still getting up almost every hour (something every 20 mins). I have some pain but not like before. I am able to get ‘enough’ out, but not emptying. During the day I can sit and urinate ‘normally’ and in good volume. However at night I usually have to squat and use pressure, sometime stand to get it going. They gave us this 1/2 moon shaped 2″ deep yellow plastic tray (called an emesis basin) and I would place this between my legs so that I could urinate standing up. It was graduated as well so I would keep a running record of the time and amounts. I was still averaging getting up at night every 1 to 2 hours and about 100 to 300cc. It is still hard to get enough sleep. I would be woken up because I had to go, would only go a tiny bit, but then if I walked out to the living room by the I walked back to the bathroom I could go about 200cc. Then back to bed, try to sleep before I had to do all this again. I was always soooo happy to see the morning twilight …. just like the hardest days in Chonburi – the breaking new day was a really big thing for me.

It is very frustrating and I hope the medicine kicks in soon. This is just too much and too long of a horrible ordeal. And now I’m paranoid about cleanliness.

With Aloha,

Sifan

Postscript: On the 5th night of taking the new medicine the symptoms stopped! Right down to the wire. I was really worried when all I had was one pill left and everything was still a mess and painful. Now 3 1/2 months later as I write this postscript, every time I sit down I have a nice stream and easy time and the thought comes to me – every time – “I will never take going to the restroom for granted ever again in my life”!!

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Posted in Advice, Diary, Gender Affirmation Surgery, Surgery and tagged Gender Affirmation Surgery, GRS, Medical Complications, SRS, Suporn, surgery, Transgender, Transition, Transsexual. Bookmark the permalink.

Surgery in Thailand – Part 4, Hotel

Posted on October 31, 2014 by sifankahale

From my hospital room they wheeled me down to the waiting van carrying all my supplies and luggage, Lisa holding my hand on the way. Now remember, it was only the day before that I was allowed up out of bed. Sitting on anything – using the special seat cushion – was a new experience and not exactly a good one. Trying to find a comfortable position was difficult. Then shifting from the wheelchair into the van was another experience in patience and ‘logistics’. Normally the trip between the hospital and the hotel was about 20 mins or so. However, this time there was a lot of traffic and it took perhaps twice as long. It was difficult just sitting, but then bouncing along on those not so good roads in heavy traffic, stopping and starting, bumps etc. – well, let’s just say I stayed in bed most of the rest of that day letting my new bottom recover!

We got settled back into our hotel room, put everything away and ordered some food in. Later one of the clinic staff came in to help me get organized for and do my first dilation (see part 3 about dilation). Everything had a place and everything was handy for doing my dilations. Even still, I would forget something and had to ask Lisa to bring it to me (once I’m in position, it is hard to get up until I’m finished). There were a number of ‘special’ features in these rooms that made it quite nice for trans* people recovering. I have a feeling, since almost the entire 3rd and 7th floors are for us, that Dr. Suporn had a hand in specifying these. For example, there was a fresh water (tap water was not drinkable) spray hose for rinsing our selves off after using the toilet. It was important that it was ‘clean’ water and of course not cold! All these little features really made my stay there comfortable and convenient.

That evening we went down to eat at the hotels restaurant. We had a wonderful Thai meal with delicious appetizers, some with the famous Thai peanut sauce.

This is also where we had breakfast with all the other transwomen each morning. This was one of the most important parts of being here in Thailand at Dr. Suporn’s clinic – to be able to meet and becomes friends with so many others like myself. All different, yet so much in common. They came from all over the globe. We formed a sisterhood that has kept going long after we left Thailand. There is lots of support and shared knowledge between us. We can ask advice and others will respond with how they handled the same issues. When one of us is in pain or depressed or having a hard time – we all respond. This is so awesome – what a community – what a sisterhood!

This is the main lobby of the hotel where we would wait for the clinic van to take pick us up. A lot of times the ‘sisters’ would meet down here too and just have fun. In the far corner was an ice cream vendor, plus wine and cakes. I made use of that a few times. Nothing like ice cream to ease recovery a bit!

Off to the other side was a door that led out to a small garden nestled between parts of the hotel. Lisa and would take walks out there during the times I wore the catheter and could not leave the hotel. This gave me a little exercise without over doing it.

On our floor (7th floor – the top floor) we had a wonderful little waiting area that had current magazines (mostly in Thai however), but also books (in English) and videos that we could borrow. The window looked out over the bay and the ocean. Lisa and I watched a few storms pass by from this window. For those sisters staying on this floor, this was a nice place to meet, chat and just relax. Since just about everyone on this floor was a patient – this sort of was our private little area. The third floor also was for Dr. Suporn’s patients. They had a similar area there too, but there was a patio outside they could go on. Many of us would get something to eat or drink and bring it out there – pending on the heat and humidity and occasional thunderstorms.

We seldom have thunderstorms in Hawaii (almost never) so those were exciting. Lisa and I would leave the curtains open at night during a storm just to watch and enjoy the storm. Most days it was partly cloudy to overcast and hot and humid. This was after the monsoon season so we only got an occasional storm.

This is the view out our window. We were facing east and had the morning sun. For me that felt great as Lisa liked to have our room cold – the sun streaming in warmed up that area of the room and I made use of that. I would sit in the chair under the window, legs up on the bed, seat cushion under my and plenty of pillows around me. I had either my computer or my tablet and would spend the time reading e-books or on-line. Almost all of the sisters were on FB and we kept in touch that way, including making plans for diner or if someone could not get up – we would get them what they needed.

In this view you can see a giant Buddha over on the hill side and just below to the right is a huge Chinese temple complex, you can see the one large building with the orange double roof. One day we say a powered hang glider flying around by the Bhudda!

The farthest away we got was to a 7/11 about 3 blocks down from us. It was interesting trying to find what we needed as everything was in Thai. Finally Lisa had to point to her bottom to ask where the liners and pads where! Because of my complications I was not able to do much more than this. Lisa however, was able to cross the main street and explore the mall on the other side. There was a great pizza place over there and an ice cream place too. I wish I could have gone!

One thing Lisa and I did do towards the end of our stay was to use the hotel’s car and driver and to the Central Plaza – which is a HUGE mall they have there. We arranged for them to pick us back up 1 hour later. This place was really huge. We wanted to buy some Thai souvenirs – but this mall was for them, not tourists – as a result everything in there was ‘western’ stuff – no traditional Thai nick knacks! I was really sore after that trip.

The next post will cover the complications I suffered and at the time I’m writing this – I’m still not recovered from them.

With Aloha,

Sifan

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Surgery in Thailand – Part 3, Dilation

Posted on October 28, 2014 by sifankahale

Caution this post contains TMI (for some this could be “too much information”). Continue only if you wish – you have been warned. I will be discussing the routine ‘maintenance’ that I now must do a number of times each day. I’m writing this for those that are contemplating SRS so they can get an idea of what to expect.

After we arrived at the hotel from being discharged from the hospital, one of the clinic staff came up to our room and helped setup the room for my new daily routine. Oh boy, life is now a bit more complicated then it ever used to be. Things like showering and even how to wipe oneself after using the toilet are now vastly different and hygiene takes on a whole new level of importance. More about this later.

For the rest of my life, I, like anyone who has SRS, must dilate. Basically the body views the neo-vagina as a wound and will attempt to close it up. Dr. Suporn’s technique uses a mesh, which new skin grows on, to form the vagina. It also forms new tissue deeper inside surrounding the vagina as well. One way to think of this is scare tissue – in some ways it is similar – but not really. This new tissue will form hard and expand closing the vagina if not countered. And that is what dilation is all about.

We were given four dilation stents, one small one, two medium ones and one large. We start off with the medium stent, inserting it all the way back and then applying pressure to the back to keep our depth. When Dr. Suporn took out all that packing, he inserted this same stent showing me how to do it and measured my depth (I was 6″ in the hospital). Each stent has markings in both inches and cm. As you can see in the picture, these are HUGE (both is length and width) and FRIGHTENING at first. The first couple of dilations I did, I was amazed I could take all that! At first, we have to dilate twice a day, 30 minutes each – basically I have to go to full depth and then push hard. That was difficult. It is somewhere between uncomfortable and mildly painful. Some people take pain meds before they dilate. I did at first but quickly found I didn’t need to. One has to sit up straight (usually on the bed, pillows behind, plastic sheet on the bed and an absorbent bed sheet on top of that), legs must be straight out, no bending and somewhat close together. Any other position will engage muscles that will make dilation harder. We are taught that no matter what complications or difficulties we face – we always MUST dilate. As you will see later – I had complications where the last thing I wanted to do was dilate – but I still did.

We start with the medium stent and later (6 weeks) we graduate to the larger one. The small stent is used if it becomes difficult to insert the medium one. We then have to dilate with the small one for 5 mins or so and then move up to the medium and complete the dilation. The white stent is an extra medium size and is a bit softer. I think everyone loses a little depth from what was measured in the hospital. I’m at 5.5 inches and have stayed at that ever since – it could be the way they measured it there vs how I measure. The important part is to maintain depth. As I was told, depth will change with the time of day, if we just ate, if we didn’t go to the bathroom first, etc. So it fluctuates, but again, what is important is that it stays somewhat consistent.

There is an entire procedure surrounding this. The person from the clinic setup the bed table and bathroom so that everything I needed is close at hand. As you can see – there is a lot. The procedure gets better and less intense with time. But at first, we shower to clean off, using a special surgical soap on our new bottom – and rinse it off immediately as it can actually burn the skin if left on or used to much. I then lay down as stated above, put on surgical gloves, place a condom over the stent and apply a lot of lube – that last bit is important!

Until things heal enough (Dr. Suporn tells us when) we do ‘static’ dilation which I described above – straight back and apply pressure. When told to, we start dynamic dilation (about 2 weeks after surgery for me – but that is different for each person). Dynamic dilation is a bit easier I think. I start by fully inserting the stent, applying pressure for 10 seconds, then rest, then ‘stir’ it around to enlarge the sides for 10 times. Then we repeat this for 15 mins and have to do this 3 times a day. Months 2 and 3 is where the most healing occurs and where this is most important. The internal tissue is building and this needs to be countered and ‘softened’. Unfortunately, the nerves are becoming active during this same time ….. I’m 1/2 way through month 2 at the moment – so far ok.

Then we have to clean up after. This includes douching with warm water three times then a fourth time with a mild solution of betadine. Then a half shower washing our new parts with that surgical soap. For the first month we also have to apply betadine to the stitch lines down there and apply a silver cream to the inside of the inner labia. And then – collapse on the bed and rest!

At home we no longer have to coat the stitches (most of which have already dissolved), but we do need to get a douche kit that fully reaches inside. As they said – lube plus byproducts of healing inside create an idea culture for bacteria – all lube has to be rinsed out. Also at home we can use regular soap.

One issue is the trip home vs dilation. Having to dilate 3 times a day and having a flight home that for most of us is 20 some hours long makes for an interesting dilemma – no we do not dilate on the plane or in the airport! So we dilate extra long just before we leave for the airport (the van came to pick us up at 4 am … that meant I was up and dilating around 2:30 am….). Then we need to dilate when we get home. The trouble is, it’s been a long time, things down there have already started to tighten up and the flight home has made us very tense – what a mess. So, we are to wait an hour or so after we get home – do something relaxing – have a glass of wine – whatever to relax us. Then we dilate – this is where some people have to resort to the small stent to get started. I was ok – my depth went down to 5.1″ but withing the next 2 days I was back to my 5.5″.

As you can see from this picture – there is a lot of stuff we bring back with us (the huge pink bag). This includes supplies to last us for a month or so after we get home. It includes betadine solution, bed pads, tons of lube and condoms, a mirror, clock, my stents of course and pantie liners and pads. They gave us a large bottle of betadine but I also had a smaller bottle. The airport security ‘found’ the big bottle and confiscated it, but left the small bottle alone … go figure. Other transwomen were allowed to take theirs – as far as I’ve heard – I’m the only one that this happened to – ratso!

Some last points regarding dilation:

Contrary to what you would think – if you are having troubles dilating, then you need to ‘increase’ the number of times. They can be shorter in time, but you need to do more of them during the day.

As time goes on, we get to reduce the number of dilations each day. Until the end of the critical period (month 3) we need to do three a day. After that we can reduce to 2 a day. After 6 months about once a day and finally after a full year we can reduce to a couple per week – basically to check depth and then if needed do more dilations.

Also, once past month 3 – dilations become easier and other umm activity can substitute for a dilation, making it pleasurable indeed …

I should also mention some of the problems that could be encountered dilating. Make sure you use plenty of lube, you could chaff and that’s no fun. Also a veteran post-opt warned us about the ‘sword in stone’ problem that could happen when you are too tight and when withdrawing the dilator it gets ‘stuck’ (probably because of a vacuum being created above it inside). Just take it slow and use dynamic dilation to ease it out. Something else we all find out right away is sneezing, coughing, laughing too hard and a close lightening strike (I found out about this last one the hard way) can all make for an uncomfortable experience. I wonder if anyone broke things in their room due to flying dilators (to my knowledge only one person said their dilator actually came out – but just barely, mostly it just hurt a bit)!

Another issue is bleeding. As you dilate, you are basically stretching scare tissue (first 3 months) and it will sometimes bleed. Also as things heal, little ‘bumps’ (granulation) can poke up and dilating will cause those to bleed. Counter to what one would think – the solution is to reinsert the dilator and hold it there to stop the bleeding. I had this happened to me twice. Others have said they bled the entire 2 months! Most said they never bled. Everyone is different and this goes away with time and healing.

I had some severe complications which I will talk about in the next post. But even during that period of time – I still had to dilate. It was difficult, but had to be done. Nothing like complicating a complication ….

With Aloha,

Sifan

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Posted in About, Advice, Diary, Gender Affirmation Surgery, Surgery and tagged Dilation, Gender Change, MTF, SRS, Suporn, Transgender, Transsexual. Bookmark the permalink.

Surgery in Thailand – Part 2, Hospital

Posted on October 27, 2014 by sifankahale

Day before surgery – Lisa and I doing a ‘selfie’. I love this picture!

Our third day in Chonburi, Thailand started like the previous ones, get up, wash, dress and then meet the other transwomen for breakfast on the first floor of the hotel at 9 am. Breakfast usually takes an hour as we sit and chat. Then promptly at 10 am everyone goes back to their rooms. Later I would find out that the clinic staff starts their rounds at 10 am and everyone needs to be in their room then. But that would not effect me until after I came back from the hospital. I was told to be waiting at the front lobby at noon for the clinic van for my ride to the hospital. So we went up to our room to select and pack the few things we would need. I brought a dress (and wore another one), my get well cards, computer and tablet to have something to do and some of my astronomy magazines to read. Not much for a week in the hospital! Before we knew it, they called up from the lobby – again our room clock was wrong but was close enough that we were ready and were almost out the door anyway.

I remembered the first trip in the van to the hospital and how the woman in the back seat was on her way in for the surgery and how she was feeling – nervous but excited. I was the same, a feeling of finally, let’s do this. As we waited in the hospital lobby, an older Thai man and his wife started to chat with us – but they didn’t know any English and of course we didn’t know any Thai. It was interesting and a bit uncomfortable as he kept staring at me, probably figured out I was transgender. They were polite, but I couldn’t wait to get up to our room.

Just got into my room, night before surgery. Waiting for the 2nd bed and soft mattresses.

I had a private room with two beds and a nice view of the bay off of the ocean. Lisa stayed in the bed next to me the entire time which was quite a comfort. Being a nurse, she could communicate with the other nurses and the doctors to make sure everything was right, plus she was able to help and to direct my care, given her experience. At times it sounded like yet another foreign language as they spoke to each other in medical’ese! I was really impressed with the nursing staff and doctors and the way they treated Lisa as one of them.

Great Thai food – although due to the language difference we sometimes were surprised by what actually showed up. But that was good too – never disappointed – although surprised. Also some american food they prepared was, well, the best way of saying this is that is was ‘their’ interpretation of what it was supposed to be. It was still good.

View out our window. The bay (tide is in) on the right. This is mud during low tide!

I was admitted at noon the day before the operation. After settling in, getting a special mattress top for the bed (the beds were solid as rock …), we ordered something to eat as the nurses brought all the other ‘stuff’ that I would need afterwards and went through it all with me (dilators, pads, medicines – quite a large amount of stuff). The anesthesiologist came in and had a long talk with Lisa about what I could and could not take (I have a reaction to ibprofin).

Then a psychologist came in to interview me (making sure I really was a transsexual). I had to draw two pictures, one of me, the other of some scene, with trees, etc. The first picture I drew of myself, longer hair, wearing a dress and giving an astronomy talk. The second picture I drew of a cabin in the woods, on a lake, a porch going out over the sand beach and Lisa and I in inner tubes close to shore. He asked about each picture, getting details of why I chose what I did. He seemed impressed by them …

And finally Dr. Suporn and the staff member that would be looking out for me came in. Later that night, after enjoying a particularly good Thai supper – the enema nurse came in …. oh girl. I supposed since I had already enjoyed that meal – what difference did it make ….. Trying to make it to the bathroom that final time was um ‘interesting’ and challenging to say the least.

Right after surgery. I feel great – certainly not how I look tho… This was taken very soon after I came around after surgery.

The next day went soooo fast it’s hard to remember what happened. I do know they came in early – like 6am or so. First was a nurse that shaved me down there. I don’t remember much about that, just that it happened. Then a bit later they came in and inserted an intravenous tube in my veins. At 9 am they came to get me. They wheeled my bed down the hall, into the elevator and down to the operating room. Boy, watching the ‘ceiling’ move, Lisa by my side, nurses by the other side, was a strange feeling. Lisa was by my side all the way into the operating room suite, holding my hand tightly and smiling. I remember holding Lisa’s hand, lots of people in blue and the anesthesiologist (she was very sweet and comforting) talking to me – and then ……. nothing (someone ‘slipped a mickey’ into the intravenous I when I wasn’t watching ….). In the states, they would always say “count backwards from 10” but here, things just went blank.

This next part is from Lisa – as I have no memories of. Lisa got back to the room at about 9:15am and waited there for me. I and my bed were wheeled back into our room at 3:20 in the afternoon. Lisa says that as soon as I saw her, my face just beamed – totally glowing she says. She said I just kept looking at her, I couldn’t keep my eyes off her! I would fall asleep for a bit, then wake up, hold Lisa’s hand and we would talk for a bit before I would fall back asleep.

My first recollection of conscientiousness was back in my room, in my bed, with Lisa giving me a kiss to wake me up! My new bottom was fully bandaged with a stent packing inside me. I had three tubes coming out: urethrae, drain from under the packing and a catheter with a drip bag with a side tube for a morphine drip. Right away, the first feelings I had were of a very deep body sensation of being ‘right’. I had a deep visceral feeling of being back to the way I used to be – even though of course, I was never physically female – but that is the feeling. As things progressed and I was able to register feelings from down there, I was surprised and astonished that these new feelings were oddly very familiar – same way as the visceral feeling of being back to were I was. Both of these experiences deeply affirmed who and what I am.

That evening, a staff member came and slept on the couch and watched over me the entire night. It was so reassuring to have her there. I would look over to Lisa sleeping on one side and the nurse sleeping on the other: I was surrounded by care and love. It made that night very relaxing. I was in no pain what so ever.

On day 4 Dr. Suporn came back and removed the bandages/covering. Then on day 6 he came back to remove the stent packing inside. Holy cow – it was like watching a magic show where they pull a scarf out of a hat or something and it just keeps coming and coming and coming ….. There was a lot of stuff in there! I thought “exactly how big am I” — geeesh. Now I was allowed to getup out of bed and finally had my first shower – boy that felt good (although I was not allowed to move without a nurse present).

Day 7 was release day – they pinched off the catheter, I had to drink lots of water, then they removed it and I had to prove I could urinate before they would allow me to leave. This was difficult, but I was finally able to do so by standing in the shower – which is good cuz I could take a shower and when I dried off, the wheelchair was there ready to take me to the waiting van and off Lisa and I went, back to the hotel.

The only ‘pain’ I experienced the entire time in the hospital was a sore butt as I had to stay in the bed for 5 days without getting up. I remember having 3 tubes in me and having to be very careful when turning side to side. Thank goodness all three tubes were on the left side – not a problem. Then on day 4 they moved the catheter to the right side —– that was just not fair …..!!!! Moving was a tad more complicated then. I would do small exercises in bed, like lift my bottom up, move my legs and arms around, etc. just to try to prevent them from getting sore laying there. That did seems to help. They had the infamous morphine button by my bed too. I only used that once the entire time, and then it was not because I was in pain, but because I started to feel something down there more and more and thinking it might turn into pain decided to head it off at the pass kind of thing… Who knows if I really needed to do that.

The next post will cover dilation – something I’ll need to do for the rest of my life.

With Aloha,

Sifan

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Posted in About, Advice, Diary, Gender Affirmation Surgery, Surgery and tagged Gender Affirmation Surgery, Gender Change, GRS, Suporn, surgery, Transgender, Transition, Transition summary, Transsexual. Bookmark the permalink.

Surgery in Thailand – Part 1, Arrival and Hotel

Posted on October 24, 2014 by sifankahale

Dr. Suporn in Chonburi has an amazing setup, everything is coordinated and taken care of, from the hotel, the clinic just a block away to the hospital. He has nurses and staff that check up on use all the time and make sure we are ok. We are even picked up at the airport and driven back when finished. He is the only one in the world that ‘keeps’ patients for 30 days to make sure all is working correctly. He personally sees us once or twice a week and will do ‘corrections’ if needed during this time. His technique is vastly different from the ‘standard’ method for SRS and his results are known world wide as the BMW or Cadillac of the business. Also Thai medical practice is not hindered by insurance dictating limits on procedure costs, so this was full care.

They have the above picture on all the literature (books and instructions etc.) that they give us at the clinic. It’s a beautiful image of a chrysalis changed into a beautiful butterfly, painted in a beautiful Thai style. And, we are known as Suporn Butterflies! Although someone also coined the phrase ‘supornistas’! But what a beautiful and perfect icon this is and it so perfectly reflects what I have just went through. I kept this picture along with all the cards people sent me, close to my bed in both the hospital and the hotel.

Comparing my surgery with three other friends of mine that had surgery within the same week as I did – oh wow – did I make the right decision!! They were in the hospital 2 days, recovery in the clinics hospice for 4 days and then sent home! I had a 6 hour surgery, was kept in the hospital for 7 days and then stayed in the hotel for another 3 weeks before flying back home. For my friends, that flight home was excruciating! It was difficult for me, but omg – nothing like the pain they had.

It was a long exhausting trip from Hawaii, almost 21 hours long including two 6 hour layovers. Because of Lisa’s knee, we had a wheelchair for her. But a couple of nights before, I stubbed my toe on the bed frame, jamming the bones behind and hardly could walk, so I got a wheel chair too. We had the airlines contact the intermediate airports to make sure wheel chairs were waiting at each place. Good thing too. I never could have walked that far.

We had a 6 hour layover in Narita (Toyko, Japan). So naturally at some point I had to use the ladies rest room. The Japanese are way ahead of us in automation and that includes ‘toilet technology’!! Basically you have your choice of 5 different types of toilets all labeled on the stall door. They range from the standard US type, to the Asian hole in the floor, to three types of ‘automated advanced function’ toilets! I tried one of the advance electronic ones. Well, you can choose to have music played or a running water sound to ‘mask’ your bodily sounds, you can turn on a bidet type function to squirt water on your front, or on your back or both and you can have warm air blown on your bottom to dry it without the use of toilet paper. And I don’t even remember what the other 10 or 12 functions were. It was like programming a VCR – it was complicated and you needed an instruction book! Of course each button had an icon (if you could figure out what it meant) and words in both Japanese and English. I was sort of afraid to touch anything least flashing lights and disco music would turn on!

We arrived at Bangkok almost at midnight. They brought us through security in our wheel chairs, collected our luggage and brought us out front. There waiting for us was a Suporn staff member named Fon and the clinic van. It was a 1 hour drive from the airport to Chonburi, just south of Bangkok located on a bay off the ocean. We were checked into our hotel and whisked up to our rooms.

We had a deluxe room on the top floor (7th). Our room looked out the back and had a beautiful view of the hills and forest. There was a temple directly below us, a huge Buddha on the next hill over and a Chinese temple complex off to our left. Our deluxe room had a queen size bed (was larger than our size here in the states – almost a king size, but oh was it ‘firm’), fridge, mini-bar, two nice chairs, desk, large LCD TV which was also a monitor (which I found out the last day I was there ….). It was a very comfortable room.

Good thing too as I spent a month there without being able to go out much (due to a catheter I had to wear – a complication I developed). I have a feeling the design and layout of these rooms had some input from Dr. Suporn, especially the bathroom. There were a number of extra’s that you just don’t see in hotel rooms. For example, they had a special spray hose next to the toilet to wash ourselves ‘down there’. What was unique was that this was hooked up to a source of pure water. You can not drink the water from the tap – the hotel supplied bottled water (we would ask for 8 to 10 bottles a day as I had to douche with bottled water as well after a dilation), plus I was told to drink lots and lots of water after this operation.

We had a great view out the back of the hotel into the forested hills. Sometimes in the morning we could watch the steam rising up from the forest and swirling about. There was a temple directly below us, a large Buddhist statue on a hill over to our left and a huge Chinese temple complex to the far right. One day we watched a powered hang glider circle the skies above the Buddhist statue. Another day they had a celebration in the small temple complex directly below us, everyone bringing flowers, taking their shoes off and walking inside. Meanwhile, the local dogs were busy sniffing the shoes!

This floor had a large seating area with books and videos we could borrow. It had a large window looking out over the ocean too. Later, we would meet and sit with our ‘sisters’ in that area. Other “trans-sisters” had rooms on the 3rd floor. They also had a nice sitting area that lead out to a small deck where you could be outside and enjoy fountains, birds and a nice garden. Many people would pick up a lunch or diner and come up here to eat.

On the first floor of the Chon Intr hotel was their restaurant. It was open most of the time. The daily schedule once you are post opt was: you got up early in the morning, showered, dilated, cleaned up and got dressed. You would finish by 9 am then come down for breakfast at the restaurant with all the other sisters. We would have our breakfast (buffet plus omelet bar) and chat, compare notes, network and support each other. Then at 10 am sharp we all went back up to our rooms as the staff would come around at that time to checkup and exam our parts, see if we needed additional medication and let us know the next steps we were expected to do, including when we had appointments at the clinic or special events like sight seeing trips or trips to the shopping mall or to the beach.

One of the best parts of this entire experience was meeting the 30 or so t-sisters, most already had their surgery and were putting in their 3 weeks before leaving, the rest like me, were just arriving. Meeting and chatting with these woman provided a huge support platform that was invaluable – not just about this surgery, but about being trans*, about all our experiences and about being part of this international sisterhood. This was awesome and so very important to this experience. If someone could not leave their room, one of us would go to the store to get them whatever they needed, or to help in any way. It was a family – a sisterhood.

Lisa and I slept good that night.

In the van, they gave me a card with all the appointments for that next day. I had three different appointments, it was a busy day.

First, we met a person from the clinic who walked us over to the clinic (about 2 blocks away) – a walk I would be repeating often. There I was given my set of dilators (in a very pretty Thai decorated box, more about dilators in another post), measured for breast implants (more about that in a moment), given a book all about what was going to happen and discussed all the aspects of the coming days. I also had to give them the originals of the letters from my therapist and from my HRT (hormone replacement therapy) doctor stating that I met the WPATH requirements for SRS. Because of my age, I also had to give them the original letter from my GP doctor including the results of my cardiac stress test, verifying I was fit for surgery. Then they gave Lisa and I a very delicious cold drink (found out later when I asked for another that that was only for your first visit … ratso). The hospitality at the clinic, the hospital, the hotel – everywhere, was amazing.

Around noon the clinic van came to the hotel to pick Lisa and I up for a trip to the hospital. The clock in our room unfortunately was wrong and they had to call up to remind us! This was the preliminary checkup for surgery. It involved waiting in lines at a number of different stations. There were three other people with us – one like me was getting the initial checkup, the other was going in for her surgery (her friend was accompanying her). The clinic staff would come and get us and bring us to each station. I had my blood drawn, an EKG taken, xrays of my chest and chin area, blood pressure and of course weight. I was only worried about the weight – the limit was 205 pounds – I came in at 204.2 pounds – just under the limit. About 2 years ago, I started at 242 pounds and have been dieting and losing weight all this time to make this goal. Wow, made it. Today as I’m writing this, I’m at 197! I’m so happy to be under 200. My goal is 180 – I have some beautiful dresses that will look awesome on me at that weight – not to mention my swim suit!

When the van came back to pick us up to bring us back to the hotel, they also picked up a woman who had her surgery 7 days ago and was on her way back to the hotel. She didn’t look that well, but talking to her it became clear that she was in high spirits and no pain – just still under the influence of the drugs.

That afternoon I had my third appointment, this one back at the clinic and would be the first time I would meet Dr. Suporn. He does one operation each day in the morning, then in the afternoon sees all the post-opt patients and exams them. He also meets the new patients like me. As a result Lisa and I had to wait. During our wait we got to meet more of the women that were here – people we would see again at breakfast. Most of them were sitting somewhat uncomfortably on their seat cushions – something I will become very familiar with later. I had friended a number of people in the private Facebook page for Suporn and while waiting for my turn, two woman came up, asked if I was Sifan and introduced themselves saying who they were and they knew me from Facebook! Wow.

Finally it was our turn to see Dr. Suporn. Lisa came into his office with me, which was a very good idea. I get a reaction to Ibuprofen so they had to make sure to use drugs that were not of the same genre. Nurse Lisa and the doctor had a long conversation, most of which I could not understand – but was very glad Lisa was there to answer and ask questions. Whatever they talked about and agreed upon certainly worked!

Dr. Suporn then examined me and told us about his technique and what I could expect. He highly discouraged me from getting breast implants. As he put it – that was the easiest operation to do from a surgeons point of view but the most difficult and painful for the patient. Whereas SRS is the hardest on the surgeon but the easiest for the patient! Part of the difficulty with breast augmentation is that the implant is placed under the muscle and after surgery, for quite a while, the patient has to ‘move’ the implant around (massage it) to create and maintain a cavity under the muscle for the implant to move, making the result very real as it will move naturally the way it is supposed to. After hearing all that, I decided (and would thank the doctor later) not to have breast augmentation. Later, with the complications I had, I am very glad I made this choice.

We had a questionnaire that we (Lisa and I) filled out just before seeing him. One of the questions on the questionnaire was to rank three expectations of the surgery in the order that we thought was important. They were: vaginal depth, overall aesthetics, and sensate expectations (orgasmic). Dr. Suporn’s technique is different than any one else’s in the world and is known for being able to give you the maximum depth, much more than any other surgeon or technique (we are talking 7 to 10 inches here …..). And because of his technique, we get a fully functional bottom, with nerves in all the correct places and even the muscles are arranged as per a natal female. There is even the equivalent of a G-spot. He truly creates the Cadillac of SRS and is world renowned for it!

So, my choices? Well, depth does not mean anything for me – I’m married to Lisa and to be able to please her is the most important thing. So sensate was number one, then aesthetics. But he still wanted to know what depth I expected or wanted. I had no idea what to say – I did not want much, just enough – but what is ‘just enough’? Lisa and I looked at each other and said 5 – 6″. After the surgery I had 6″ – but that usually reduces and today I’m maintaining 5.5. Right in the middle of the range I asked for!

The next day we had free. But we were so tired from out trip and the whirlwind of the previous day that we spent the day in the hotel getting to know our way around. We had a wonderful diner in a beautifully decorated Chinese restaurant on the 2nd floor of the hotel.

Next post will cover the hospital stay.

With aloha,

Sifan

2 Comments

Posted in Uncategorized and tagged Suporn, surgery. Bookmark the permalink.

POISONED !

Posted on October 12, 2014 by sifankahale

Some of the following I have written about in previous posts. Something wonderful and difficult has happened that brings a slight twist (and then maybe not) to my perspective on being a trans-woman. Perhaps it’s a nuance, most of what I’m about to write seems like what I have always been feeling and saying. However, there seems to be a deepening and a visceral understanding of my life as a result of this.

If you have been following my posts, you already know that I had my SRS surgery last month. In fact I just celebrated my 1st months anniversary. This is actually a bit scary, as months 2 and 3 are the hardest. This is when the ‘insides’ finish healing and the nerves start reconnecting and become active. The body views this as a wound and attempts to close it. I have to counter that with daily maintenance (three times a day) to soften and keep it’s form. The combination of these makes these next two months difficult and painful.

Needless to say, this means that I’m quite familiar with my ‘new’ anatomy. I put quotes around new because it is new only that it’s one month old. But here’s the kicker: it’s not new, it’s been there all along …. Now that might seem a bit strange, so let me explain. This realization came to me when I was in the hospital, minutes after I woke up from surgery. My immediate thoughts and feelings were “Finally, I’m back to the way I was” – even though I was never like this. But that was the internal visceral response I had.

I have talked about the ‘body map’ a few times before. As a refresher: medical science has found that we carry a body map located in a part of the hypothalamus. This map basically says what we have and where it is at any moment in time. It also tells us what things are supposed to feel like and the feeling those parts are normally supposed to produce. The oft used example is the person that has their arm amputated yet still feels their fingers and can tell you where their arm is located – even though it’s not there.

My experience post surgery was a huge confirmation of this body map. That is what I meant “I’m finally back to the way I was” and that this was not something new, but was always there – it was always there in my body map! My ‘new’ bottom did not feel different – did not seem new – was not strange – I was not missing something. Instead I felt normal, I felt the ‘nothing’ that everyone else feels about their parts – it’s just simply is who I am. Ask yourself, what does it feel like to have your ‘parts’? Does it feel like anything at all or is it just the way it is – that is, just you – nothing – nothing special – just is.

That is how it is now for me. That was NOT how it was pre-surgery for me:

That … is the big difference.

That … is the hardship a transsexual faces daily until they transition.

My previous ‘down there’ was not in my body map. Things did not match up to what was supposed to be according to my body map. And, it is not just the physical aspects but also the mental, emotional and hormonal aspects of the body map that were not in agreement.

Let me re-tell a couple of incidents from my youth plus another one from my previous marriage to illustrate:

As a very small boy, I knew that I was supposed to be smooth down there, I was not supposed to have ‘that’ hanging out. Ever being the budding scientist, I have a distinct memory of trying to figure out how was I supposed to urinate if it was smooth there! This is when I was around 5 years old. I had no concept of sex or what a woman/girl looked like – I just knew this was not me – I was supposed to be ‘smooth’ down there. When I was 7 years old, my sister was born. The first time I saw her ‘down there’ – well, everything came together. For the first time in my young life I knew what I was supposed to look like, what my young body map identified with.

The second incident occurred a few years after this. My mother was a seamstress – not professionally, but she created clothes for our family, relatives, neighbors and friends. Being intrigued both by the creativity but also by the mechanics and design aspects of sewing, I would watch and learn. Finally I felt that I could create and sew something myself – from scratch – no patterns, I would make my own. So I did. I made a beautiful skirt that fit me perfectly. It had a hem (I remember using this stick with a bulb on top and a movable nozzle that would squirt chalk at where you wanted the hem to be – in order to get it perfectly level all the way around), I also had belt loops, elastic around the waist plus a zipper on the side. I was very proud of my creation. I did all this without my mother’s knowledge as I wanted to surprise her. When it was finished, I waited for her to come home and proudly showed off my new creation. My mother is 100% German and very strict and conservative and was very brutal. My pride turned to shame is less than a second. The scolding and punishment and continued reminders of what I did drove any thoughts of me being a girl to be deeply buried. This was the start of the ‘layers of the onion’ and more and more layers were added to deeply bury any sense of me being a woman.

In one way I consider myself fortunate. I attended a very conservative Catholic grade school back in the 1950’s, in a very redneck conservative northern city. I was ‘fortunate’ to witness some of my classmates as they tried to assert who they were (being different than anyone else) and witnessing the severe reaction of both the other kids but also from the teachers, nuns and priests. I was an observant little girl inside a boy’s body who learned very quickly from others to keep my identity secret. This sort of sealed the onion layers for good.

Later in my teen years all that was left was a rationalization that I was a boy but with all these extra capabilities – emotions, what I liked, mannerisms, ability to understand and listen to people … the list goes on. I could not stand the playground games of the boys and would prefer the girls but I had to be careful to mix it up … I had buried my truth so deep that I no longer knew myself and accepted my role as a boy and rationalized the rest. It took another 40 to 50 years to unravel and peel back that onion.

Now, here’s the new part. This revelation suddenly came to me during a talk with my ex-wife. I don’t think I would have seen this before surgery – somehow it took being whole again to be able to see this next piece. This is a bit hard to discuss and embarrassing for me – please bear with me as I try to find the words for this ….

During puberty my body changed drastically. Testosterone was now cursing through me and creating a lot of changes that were upsetting. However, I could not figure out why – again I had a deep rationalization that I was a boy. It wasn’t the physical aspect of puberty but the mental and hormonal parts that really disturbed me. Here it gets hard for me to put this to words – hang on: one example, it’s a pretty well known fact that most men masturbate many times a week, some daily. This urge was intense and of course I hated that – that part was not me – why was this happening. I had so much shame around that but I could never understand. Of course the Catholic church drills into us that is a sin. And of course the other boys bragged about it. Why was this so awful for me? That wasn’t all – there are other incidents that I was very ashamed of as well, both growing up and throughout married life. I carried these all my life, not understanding what drove me and carrying the guilt and shame all these years.

In my talk with my ex-wife a couple of days ago it suddenly became crystal clear and I broke down crying. Hindsight is like that I suppose, but this required me to already have had my surgery in order to be able to put this together.

I was POISONED!!!!

Others have called this the “testosterone fog”. If you are a male (birth sex) and a man (gender) then testosterone is the correct hormone. But I am not. I don’t expect men to get what I’m about to say, but I think any women would and any transsexual definitely will. As a woman, having a high testosterone level, I would experience these hormone driven urges and their results and was mortified by them. Disgusted and shamed as I would witness myself in those moments and then the regrets afterwards. Again, for a male/man these are natural and congruent – no problem. But for me – this was horrible and these feelings have haunted me my entire life. But, I didn’t know why – the layers of that onion were so thick by now – I had long ago buried and lost my gender identity. Only these hints were left.

It’s only now, that I’m physically, mentally, socially, hormonally and internal-chemistry-wise finally a woman that I could solve my last great quandary that has plagued and weighed on me all my life.

As a woman – I was POISONED by testosterone!

I had to go off of spiro (a testosterone blocker) a couple of weeks before the operation – this gave me a really good ‘scientific’ test of what for me was the intensity of this poison. It confirmed and validated my views and led to the realizations that I am writing about here.

Again, testosterone is absolutely appropriate for a male/man, but I am not – I’m a woman and this has tormented me so much. At last I have come to peace with those disturbing aspects of my life that only now do I realize are part and parcel of being a transsexual woman.

I want to apologize profusely to those that I have hurt unintentionally and hope for your forgiveness.

I now understand.

I am now free.

With much aloha,

Sifan

7 Comments

Posted in About, Diary, Surgery and tagged Gender Change, GRS, hrt, MTF, SRS, Testosterone, Testosterone Fog, Testosterone Poisoning, Transgender, Transition, Transsexual. Bookmark the permalink.

High Pain Tolerance in not a good thing

Posted on October 5, 2014 by sifankahale

I just figured out – it is a bad thing to have a high pain tolerance ….

While recuperating from SRS surgery here in Thailand, I had a complication, an extended bladder. I had 2 severe episodes. I went way way to long before saying something. The first was 3 nights of excruciating pain – I endured it thinking it will get better.

The second time, I waited till morning to call for help. Stupid!!! I could have called in the middle of the night and a nurse would have come to my hotel room and re-inserted the catheter (as is what happened the second time but in the morning). I’m learning.

So, now, when something is just a bit painful, I tell Lisa and we figure out if it is more serious or not. Ack, never thought that having a high pain tolerance would be an issue!

When I look back, I see that a number of times I’ve over extended myself, but not enough to feel the pain that I should have. Only to have a very sore ‘whatever it was that I did’ show up three days later.

But this episode with an over extended bladder was the worst pain in my life – yet I endured way longer than I should have. Mostly because I either thought it would go away or because I didn’t want to wake someone up in the middle of the night.

I’m learning. Being female brings with it a whole new regime of care and maintenance. It also brings a new appreciation for listening closely to one’s body and taking heed of what it says.

Being this much in touch with my body is a new experience. It’s also one that I knew I was missing before transition. This is actually a very beautiful and wonderful feeling. It’s not just being in touch with the body, but also with nature and it’s cycles. It brings so much together. It is wondrous.

With much aloha,

Sifan

Hoku Wahine (Hawaiian: literally star woman, eg. woman astronomer)

Pono

Posted on October 5, 2014 by sifankahale

Another incredible experience: Today is my last day here in Chonburi (unless a certain typhoon that is scheduled to land at Tokyo the same time our plane does – actually does …. grrrr).

So today I had the last visit by the staff. Again, I do not want to mention her name because all of them are so very special, so this post is dedicated to staff of Dr. Suporn’s clinic.

She made a comment about my optimism and enthusiasm – about how that has helped the staff to remember just how much of an impact they make. It is so difficult and hard to work with people from all over the world, all of different cultures and personalities. Some not prepared psychologically – not about transition – but about being in a situation far away from home, having such a radical surgery performed, being in a foreign culture (maybe for their first time) – all these things add up and a person can become quite negative and demanding.

But this staff tries hard, not just surgery related, but as a helping hand, someone to listen to, someone to give advice and help, especially in this culture.

I can commiserate with them: for 13 years I was a director of international training. I was overseas 1 out of every 5 weeks! One heck of a lot of travel. Many time, the overseas offices in the entire region would send their students to where ever I was teaching. For example, if I was teaching in Singapore, the Thailand office, the Taipei, Hong Kong, Seoul, and Tokoyo offices would send their students to Singapore or where ever I was.

As a result, I was the ‘only’ common person they had with the country and culture of that venue. I had to not only teach, but take care of these people – much like the staff here does for us. Same as the staff here, personalities range from demanding to enthusiastic. I have first hand experience of what they do and I commend them highly! It can be so difficult.

Ok, small story: was teaching in London and had a handful of French students in the class. They ‘hated’ English food – so who did they ask for suggestions and help – me. That was scary: an American giving culinary advice to the French – the top of the list experts on food !! They liked it, only one hitch: the English always have a condiments tray that has about 5 different mustards, etc., one of these was called ‘French’ mustard. Oh boy – the comments: “Dis is NOT ze French Muesterd ….” etc.

Can’t help it – another small story: I was teaching in Seoul, Korea in the winter. We had people from all over the region including Singapore up there. For many of the Singaporeans, this was their first taste of very cold weather. Well on the 2nd day of training, they are all looking to the front of class but I’m looking out at them and the windows beyond, and noticed it started to snow. I stopped the class and brought the people from Singapore outside to experience the very first snow fall in their lives! What an experience to watch the joy and happiness in their faces!

One only has to look at the experiences and blogs of others that have had surgery else where, especially in the US with it’s tight Insurance grip resulting in minimization of expenses, to see how wonderful we have it here in Chonburi. Back there, they do not have a clinic staff to hold our hands, sit with us all night after the surgery, pick us up, arrange medicine and care in the middle of the night …. etc.

So once again, I am thrilled that someone noticed kindness and joy and as she said – brings back the feelings of why they choose to be and do what they do – to balance out their hardships with others and to again demonstrate how much of a difference they make in the lives of others.

And for me – what an affirmation of my spirit – that for me, is the best and most important experience I take away. I, in some small way have helped.

In Hawaii we have a saying about pono (do what is right and show respect) and do everything with and always show aloha (love):

“When a person is Pono they have the feeling of contentment that all is good and all is right in their life, a life of full integrity: Ma‘alahi is a Hawaiian word we’ll often use to describe this feeling, for it’s “a pervasive persuasion toward calm, peace, and serenity.”

With much aloha,
Sifan Kahale
Hoku Wahine (Hawaiian: literally “star woman, eg. woman astronomer)

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Sifan's Journey

3 Months Post Opt

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Surgery in Thailand – Part 5, Complications

Surgery in Thailand – Part 4, Hotel

Surgery in Thailand – Part 3, Dilation

Surgery in Thailand – Part 2, Hospital

Surgery in Thailand – Part 1, Arrival and Hotel

POISONED !

High Pain Tolerance in not a good thing

Pono

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