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Surgery in Thailand – Part 4, Hotel

Posted on October 31, 2014 by sifankahale

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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!

27384a183062f9d63e8825a94be11dcbWe 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.

a7e2a1e6c70d49f7dfb6eed4a957d18cThat 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!

cbf2e12c0e68190a8f60ea31f6c67aeaThis 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.

0df80b9f88abd6ae148e05701abd0861On 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.

20140918_193113This 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

20140929_155212Caution 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.

20141014_131948We 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.

20140918_193204There 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″.

Sifan at Thailand airportAs 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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Surgery in Thailand – Part 2, Hospital

Posted on October 27, 2014 by sifankahale
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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.

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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.

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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.

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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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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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Transition: Mental and Physical

Posted on October 4, 2014 by sifankahale

I just had an incredible experience: Dr. Suporn’s clinic staff make daily rounds between 10am and noon. I’m not going to mention her name because what I’m going to say applies to all of them.

This was her last time she was going to see me (as they take rotations and I’m leaving on Monday). So she took extra time to sit and talk.

This was unexpected – she thanked me for my positive attitude and optimism. I can only imagine the range of people and personal issues they have to deal with and this is what I want to share with everyone: this staff goes so far beyond just simple care, they truly are amazing. To me, this was a high complement – it’s also means that I really did touch others here – I hope I was able to make my trans-sisters more comfortable but also the staff and everyone else.

Yes, everyone has different experiences – but think about what the staff has to do (and what they have to put up with). And they do it with love and a smile!

You know – it’s sort of like my last post about being able to tolerate pain having a down side. Dr. Suporn’s surgery is (for a lot of us) almost pain free – it’s like little has happened. We get back to the hotel feeling so good and ready to party on the town, not fully taking into account the 7 hour surgery, 7 days in a hospital, etc. And then those that do, get in trouble.

I remember Dr. Suporn’s words about mentally relaxing and not worrying etc. that a lot of this has to do with the inside aspects of ourselves. And that brings up another huge issue: this is both MENTAL and PHYSICAL. You have to ‘solve’ both of these for yourself. His surgery solves the physical – if you are not mentally ready – after surgery you are now going to have to deal with the other half.

I was fortunate. I had a great therapist and worked on the mental aspects of this for more than 10 years. This surgery was the icing on the cake as they say. The night before surgery is when the final pieces of the physical aspects came into sharp focus. See “Why have Surgery” for more on that.

That was the big message the person from the clinic and I came to this morning – being prepared both mentally and physically for this.

And I really do hope that I shed cheer and happiness to those around me – to me, that is an important aspect of my life.

With much aloha,

Sifan
“Hoku Wahine” (literally: star woman, eg female astronomer)

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Why have Surgery

Posted on September 29, 2014 by sifankahale

This is something that happened the night before surgery.  I never doubted or questioned what I was doing.  I knew this must be done.  But there was a piece of the puzzle that was missing.  Now I know why.

The night before surgery, it all came to me.  I had spent so much time on the mental aspects and removing the layers of learned male behavior some of which disgusted me (the testosterone fog).  The piece that was missing was physical part.  “Why would surgery matter if you are already living as a woman?” type of question.

But the night before, my early childhood came back to me.  The memories of something wrong – it was supposed to be smooth down there, I was not supposed to have this thing sticking out.  This was long before I know anything of the sexes – I just knew it was supposed to be smooth.  In fact, I remember wondering how I could possibly urinate if it was smooth!  Then my sister was born and for the first time I figured out what ‘smooth’ was supposed to be.

Fast forward to the night before surgery and my discussion with the psychiatrist, my mind had pushed that out of the way so completely, yet the extreme dissonance remained all my life and caused just as much grief as the mental aspects.  But, just like the mental aspects, there were many layers of this physical part that also had to be removed – and that night before surgery it became clear.

After surgery I have to use a mirror when I do my ‘maintenance’ and the feeling of not only completeness but of wholeness is almost overwhelming.  It’s like being back to what I was (even though I never was this way) but that is the feeling – being correct and true and just ‘me’.  It is so wonderful, so incredibly ‘natural’ – I’m running out of words to describe this.

I’ve mentioned before about a body map, a part of the brain that sort of knows what you are, what you have, and where and what these parts are doing.  The example often given is of an amputee who not only still feels their arm but can tell you exactly where it is in relation to their body.  This body map for me is what tells me I’m female, both in the physical and the mental aspects.  The memory from my childhood shows this clearly – I didn’t know what I was supposed to have down there, only that this didn’t match what my body map had.  This is the HUGE relief I have now, when I do my dilation, etc. having to use a mirror and in contact with ‘me’.  It is what was missing, it is what inside me says is supposed to be there.  Now it is!!!!

With much aloha,

Sifan

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14 Month Summary

Posted on August 18, 2014 by sifankahale

Everything is now focused on next month:  SRS.  Because I’m ‘older’ they wanted a cardiac stress test.  Now, I’m in pretty good shape and that, for a stress test, is bad news.  It means they keep you on the treadmill longer, faster and at a higher incline (and keep increasing until you start pumping harder).  The good doctor brought me up to heart rate required for the stress test, looked at me and said, “want to see what you can do?”.  You know, I must be slow in the uptake or maybe I was just not completely taking in what he just said.  Well, from my perspective, all hell broke loose – not supposed to run just walk fast, the darn thing was now a ramp to the ceiling – but, like a fool, I did it.  Then he asked me again – I think my muffled huffing response sounded like a yes.  Right after they had me lay down and they took sonograms of my heart – asking me to ‘hold my breath’ – I was like “WHAT” – that’s not fair and it’s impossible!!  They actually can measure the thicknesses of the different walls, measure blood velocities, etc.  Very impressive.  Well, I passed – however – about three days later my entire upper chest was sore and I had what seems to be a muscle strained under my arm.  It took me a few more days to finally connect this to the stress test.  I was using my upper body – hands on the front bar of the treadmill – to do a lot of work.  When I hike in the mountains I use hiking sticks that basically do the same.  My legs are in the best shape because of the walking/hiking I do, but my upper body was not used to that.  It’s now almost a week later and at last I’m slowly recovering.  Wow – mental note – don’t accept a ‘dare’ from a doctor doing a stress test on you!  Unfortunately, I had to work up at the summit the rest of that week – this really zapped me.

I was sent an invitation to a private FaceBook group for those that have surgery with Dr. S. in Thailand – and for those that have been accepted for surgery.  It’s turning out to be a great resource.  Everyone is helping everyone, lots of good advice, worries, complications, things around town and the clinic and doctors weigh in as well.  So good sound advice.  One person said they just arrived – about 20 others replied with where they are meeting for breakfast, who to see and what to do before hand.  I joined the fray and said I would be arriving next month and already I have 4 other gals (two from here in Hawaii) that will be there the same time – we’ll be getting together!  By far the best is to go back about 1 year and read all the questions and answers, issues real and those easily fixed, what to expect and how everyone else has fared.  I have lots of good advice and perhaps an even better idea for what to expect almost each and every day I am there (one month).

 

One of the purposes of my blog site here is to help others, especially those that are older, to get the information they need to understand and know what this is all about.  To that end, I plan on making as many posts from Thailand as I am able to.  Some might be a bit detailed but I’ll warn you right up front – continue to read at your own …. whatever ….  I’ll probably write the first one tomorrow – about planning and pre-travel.

 

On a different note:

I had a conversation with Lisa a while back.  I was telling her about catching myself in unconscious automatic behaviors, feminine behaviors, behaviors that were not learned or made automatic by rote – how could they be.

We went out to eat at a restaurant in an outdoor mall (most of our malls in Hawaii have open air promenades).  We had a wonderful meal and had strolled down the open air mall talking and admiring clothes and nick knacks in the store windows.  On the way back to the car I mentioned that I had just noticed how I instinctively held my skirt down before a gust of wind suddenly blew and then smoothed it out.  Then it struck me that there are many other instinctive automatic things I do as well – feminine actions that I did not learn and was unconscious of doing.

What is intriguing is the recognition that these behaviors or actions were unconscious and very normal – what I would describe as just being me.  This is in contrast to before when I was presenting as a male – most of that had to be leaned and was deployed  ‘consciously’.   Having had to do this for the majority of my life, it sometimes baffles me to realize that most people have never had to consciously ‘be’ what society says is their gender.  That for most people, suddenly realizing that they are acting authentically, is simply never seen or experienced.

I learned quickly at a very young age.  I saw what happened to others, the harassment and bullying they endured and I was blessed with a quick intellect that allowed me to quickly assimilate their examples into a workable model for my own existence.  I learned to keep my truth inside – not hiding from myself – but to present what was expected.  It’s sort of like the cliches “pick your battles” or “work from within the system” or “know your truth and pick the right timing”.

The other fascinating aspect of this, was that I had a detached presence as I watched these behaviors unfold.  That was what prompted the conversation with Lisa.

 

And, I thought I would include a response I wrote to an article questioning why a ‘man’ would ever ‘want’ to change into a woman, considering all the disadvantage:

I’m a transwoman, let me see if I can make some sense here – I can only speak for myself. I was born this way, this is not a choice or something I ‘want’. It’s who I am. The issue becomes how do I deal with this – not about which gender has it easiest. There are a lot of false stereotypes and beliefs surrounding this – that compounded the issue for me as well. As a result it took me until I was older to sort out what and who I am. Just like everyone else, I had to sort out what was real – then I had to accept who I am and then despite all of that plus, as you stated “the disadvantages of being a woman in today’s society” – to proceed and become true to who I am. The fact that there is so much against this should speak for itself.  It has nothing to do with advantages/disadvantages, etc.  For many trans* it is life or death (or even a living death) – makes the disadvantages seem moot huh. To have your core being at odds is very disconcerting. Ask yourself if you really know what it feels like to be a woman (or man) – I mean, do you really know? On a personal level the only way to know is to actually know the opposite. For a trans* person this is a daily and deep question: who am I – not what do I want to be or the relative merits of one gender vs the other. This was one of the reasons it took me so long to come to terms with and accept who I am. The mind does a wonderful job of trying to protect and therefore deny or explain away things it thinks will be harmful – especially in this case. I am glad that trans* issues are becoming better known and slowly things are getting better – especially for the younger trans*. I hope they don’t have to go through what I and many others have.  My hope is that society will understand this better and drop all these pre-conceptions, stereotypes and false beliefs.

With aloha,

Sifan

 

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13 Month Summary

Posted on July 13, 2014 by sifankahale

It20140706_192518 feels good to be past the one year mark.  From what I hear from my trans friends that are going through or have been through transition, most of the emotional changes and a majority of the physical ones are now over and things stabilize.  That’s how I feel right now too.  Of course time will tell – I’ll have to revisit this one year from now …

The biggest challenge I have yet is my weight.  I’ve lost about 30 pounds since I’ve started.  I have to lose another 6 but I would like to lose 11 more pounds.  That gives me a leeway for the surgery requirement.  It’s very strange that when I was 30 pounds heavier, I did not feel fat at all and it was sooo easy to lose weight.  Now, I feel fat, I have a little belly,  even though I’m 30 pounds less.  I do have a smaller frame.  It is now very hard to lose pounds – I no longer care that I’m losing weight in the wrong places (my breasts are getting smaller etc.), I just want those pounds gone!

The countdown is on!  Today is 60 days away from GRS (surgery).  Like I’ve responded to those who have been asking recently – I’m ‘not’ looking forward to the surgery – I’m looking forward to about 3 weeks ‘after’ the surgery  when I’m recovered enough to start my new life in earnest.  Even then I won’t be at anything near running speed.  But at least I hope to have my head above the water by then.

One of the women at work caught me in the kitchen and asked me a couple of questions today. First she complimented me on how much I have changed and that I actually look much younger! She asked me what it feels like now. I told her ‘normal’ and that before and for most of my life I felt like I had to conform to what was expected of a male and that I could not just be me. I said that now it’s mostly a feeling of freedom – I can just be myself. I also said that I’m in a unique position to be able to experience the differences between male and female and it is huge. But we didn’t have time to go into that much further.  Maybe I’ll enter a post just on that sometime in the future.

Lisa and I took a beautiful ride on the sw shore of Maui around to Kaupo today. I felt ‘extra’ feminine for some reason. Was a great day to be a woman. Lisa had to go pretty bad so when we got to the top of our favorite hill back there, we parked and walked up and just down the other side – enough so that no one would see. She went first – I gave her some napkins to clean up. Then it was my turn – she asked if I wanted some napkins before she remembered I still had boy parts down there. We laughed about it. She said she had forgotten that I wasn’t physically a woman down there yet and said she actually had visualized me having a vagina! I guess she is truly seeing me as a woman now!

A very good friend of mine from back in my college days got back in touch with me recently.  He had some very good questions and I thought I would share my responses.  These are questions I get asked now and then and perhaps this will help others understand trans* people better.

The first was a comment about memories and the person I was.  For some people, they morn the loss of the ‘former’ me.  My response:

That was a great time we had back then, I also have many wonderful memories.  Those memories along with all of my past don’t and should not go away – they are a part of me.  It took my ex-wife a while to understand that as well.  This does not negate nor dismiss those.  It can be hard to understand, but I was ‘this’ person I am now – back then – and all through my life.  What and who you knew ‘as’ me – the ‘me’ of today – was all along.  What is changing is ‘presentation’.  The latest science on this (both medical and psychological) define these as completely separate: birth sex, gender, presentation and preference (as in partner).  A person can be any combination within these – one does not pre-dispose any other (trans* people have the same ratios of hetro, gay, bi, etc. as the normative cis population).  Of those, latest research shows that only presentation is societal – the rest a person is born with (there is a lot of false beliefs out there claiming nonsense).

I was ‘trained’ to be a man – I think I did a pretty good job of it.  Society back then did not allow for anyone like me – it was just an impossibility back then.  Like so many things in my youth, I learned to adjust and to live with it.  Like many other trans*, I over reached in order to prove I was who society said I was supposed to be.  Don’t get me wrong here – I am very grateful for what was, including being married and fathering two wonderful men.

It took a long time to unravel from all of that.  I started almost 10 years ago.  But it actually started even longer ago when I became a professional instructor and then director of the international technical training for the corporation I worked for back then.  I was much more effective than both genders in that trade.  My style and philosophy of training matched that of a female.  That was 20 some years ago and laid the groundwork – the crack in the dam.

Can you imagine your entire life – knowing something is different, that you do not match who everyone (parents, school, friends – everyone) says you are and not knowing why.  I knew I didn’t fit in and was not quite like the other guys.  I also knew I matched more closely to the girls I knew.  But I also knew that physically I was a boy.  There was life long confusion and dysphoria.

This is such a relief now – it explains so much for me and as they say – it hits the nail right on the head.  I am very happy now – this is a huge load off the shoulders.  This may sound strange, but one of the largest dysphoric situations was being addressed/treated/spoken to as a male – especially in public situations.  To be mistaken like that was hard.  That’s not who I am.  By changing my gender presentation to be consistent with who I am, makes all the difference.  The standard explanation (which is totally wrong however, but it does put this into perspective) is to image you wake up in the morning as female but with all your memories, responses, actions, beliefs etc. remaining male – and worse – no one believes you.  You are relegated to live your life from this point on as a woman.  Well, reverse that and that is me – only without the explicit knowledge of what underlies this until recently.  So, ya – like 1000 times better now!  Not just happiness but quality of life, spirituality, knowing and accepting myself – and the list goes on.

A lot of people have mentioned that my ex-wife and myself had one of the most wonderful marriages and they just can not understand how this could have ended:

Hummm, how can I say this ….. I’ve had a lot of people say the same thing about my ex-wife and my relationship.  It was a wonderful and great period of my life.  I’m very grateful and celebrate what we had.  Like all relationships there were wrinkles and cracks under the surface that were not visible to anyone else.  Perhaps the saying “the bigger they are the harder they fall” has some bearing here – not sure.  Two things I can say:  there’s a lot more to the story and we are both in a better place today then if we tried to stay together.  In no way does this negate my ex-wife’s and my life together – I cherish those times and memories and am very glad I was given that time and experience.

Regarding societies stereotypes:

As you can imagine, this is a very difficult and highly personal thing.  I too had to overcome a lifetime of misconceptions and stereotypes and then to embrace who I am knowing that the majority of the world still carries those.  Not exactly the cup of tea I needed … but we are dealt a hand and are committed to play it.  If nothing else, this should attest to the seriousness of this and speak for the determination to transition.  Even in spite of these, it is that important and necessary!

Lisa came along at the right time and not only accepted who I was but embraced it.  This is difficult for her as she does not see herself as lesbian, however, society now does.  You can imagine the confusion  However – one nice thing about being older (and hopefully wiser) – one sees through that and instead embraces their true selves.  After all, is she really a lesbian?  Her preference is for males, her love is for me, regardless of gender.  And does this make my ex-wife a lesbian?  After all I was born this way, therefore I was a woman all along ……  You can see the difficulty with our current language and the assumptions inherent within !  As a society, we need to start transcending this transphobic misogyny and get real.

Keeping pictures of the ‘former’ me from the past:

As for pictures of Steph (I admit – even I talk about Steph in the 3rd person) – I’m glad you are keeping those – that is so nice!  Let me re-emphasize:  who I am now – I always was: as Steph and now as Sifan.  I’m proud of my life and celebrate ‘all’ of it.  I’m not out to deny any of it – it all goes into the ‘me’ that is here and now.  That is the one part of that analogy that is so wrong (“imagine tomorrow you woke up as a woman”) – this is not a bad thing – nor something I regret – nor was living my life as a man all those years.  It just simple ‘is’ and it is my life’s story.  Would I have rather been born cis (same birth sex as gender) – of course!  Given that I’m trans – would I have rather transitioned back then – of course!  But this is my life and even with this, it is a wonderful life.  Now, it’s just that much more wonderful !

I’m hoping this helps others (trans* and friends of trans) understand just a bit better.

With much Aloha,

Sifan

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On Being Passable

Posted on April 24, 2014 by sifankahale

As I started this transition, a lot of time and energy (and worry) went into being “passable” as a woman.  I’ve read and heard a lot of debate on this, mostly about being yourself and what others think does not matter.  And while that is true, when one is on the beginning part of transition looking forward this is a huge concern.  It has only been after HRT’s effects have had time to take hold, that I was able to be comfortable enough to be able to let down my guard and be able to perhaps see the larger picture where these statements are true.

It’s only in the last couple of months, where coincidentally I’m ‘passable’ enough, that now ‘passing’ is not that important and I can say things like “it does not matter what others think” or “what/who is important is you”.  Perhaps the better way of putting this is: “what is important is what you think”.  This changes as you go through a transition, this means wanting to be passable at the start is just as valid as seeing that it does not matter after you are through.

Lately (I’m starting month 12 as I write this), most of the places I go, people I see or ‘massively public’ areas I’m in, I am not noticing any side looks, comments or raised eyebrows.  Now, I have had to be ‘up in front’ at public events a number of times recently, giving a talk on astronomy, manning a booth at the astronomy open house (1500 people came through), teaching astronomy at a local school (320 students), etc., and have never experienced problems or issues.

At this point in my transition, my ideas surrounding being ‘passable’ are changing.  I’m now along the lines of “that is their assumption – no biggie”.  Yes, I am who I am and I’m the happiest I have ever been in my life.  Everything matches, especially my gender and my gender expression.  And for the most part, that is reflected back to me from society.  Now, I do not believe that I am fully ‘passable’ – not by a long shot.  But enough of the ‘clues’ are present that people seem to assume I’m female and treat me as such.  Even those that hear me first (my voice has a long way to go) and use the wrong pronoun usually will look a bit embarrassed once they see me.

But the real difference is that I no longer mind.  The ‘sting’ is gone.  I’ve had women tell me that they have been called ‘sir’.  I’m sort of at the point I guess – people make mistakes in this area – but more important I know who I am and this does not challenge that, nor does it in any way negate it.

Transitioning is a scary and potentially dangerous thing to do.  It is fraught with high stress and anxiety, especially when starting.  Being concerned with passing when you start is not only ok – it could be necessary.  Yes, some transsexuals will never be able to pass.  Taken at a ‘healthy’ level, this fear can be helpful and prevent potentially dangerous situations.

This is a long winded way of trying to say it’s ok to want to be able to pass.  Perhaps, like me, that was a phase (not completely through it  – maybe at some level I’ll never be).

As the months pass and I settle into my true being, more and more of these things that back then were paramount are now starting to seem trivial.  They are not – it’s just that my journey is now a bit more “down the road”.

With much Aloha,

Sifan

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Choosing a Surgeon

Posted on April 24, 2014 by sifankahale

I have finally chosen the doctor and clinic for my GRS  (gender re-affirmation surgery).  I will have my surgery in mid September.

In order to qualify for GRS (some call it ‘bottom’ surgery), a transsexual person needs to have:

  • Signed letter by a therapist stating you are indeed a transsexual and that surgery is required, plus that you do not have any other psychological disorders that would prohibit or complicate this
  • Documentation showing that you have lived at least one year totally and completely in the chosen gender (this is called the RLE – real life experience)
  • Medical documentation that you are fit and can ‘live’ through a 7 hour procedure.

It has been difficult to choose a surgeon/clinic for my GRS.

Basically, from everyone I have talked to, emailed, read blogs, etc. that have personally been through GRS plus reading many different clinic web sites and information – it came down to three:  Dr. Bassard in Canada, Dr Bowers in California and Dr. Suporn in Thailand.  Anyone that had been to any of these three had raving reviews for their doctor and would go to them again.  Everything put these three at being precisely equal as well.  This made the decision all that much harder.

Dr Suporn’s method is not the standard method for GRS.  It is not the ‘inversion’ method and it results in most everything being ‘reused’.  This results in most of the same areas being sensate that a natal female has.  One of the women I talked to stated that this was a very high importance to her and Dr. Suporn came through.  She stated that other doctors would not guarantee the result would be orgasmic, however Dr. Suporn did (however she would have to pay the airfare to come back for corrective surgery – but he would guarantee it and the corrective surgery would be paid by him).

Two other factors also helped in choosing Dr. Suporn.  As my GP doctor stated:  “go with who has the most experience” and that is Dr. Suporn by a long shot.  His fees are lower as well.  I’ll be able to get both the GRS and a breast augmentation for the same price as the GRS alone here in the states (and that includes the travel expenses and the hotels).  They also keep you longer.  I will be staying in Thailand for 30 days, verses the two weeks with the others.

Dr. Bowers is herself a transsexual, having had the surgery from one of the pioneering doctors in this field and going on to study from him and eventually take over his clinic when he retired.   It was hard not to choose her.

I’ve had glowing reviews from people I know that went to Dr. Bassard’s clinic in Montreal.  My sons and grandsons live in Minnesota and I would have been able to stop over on my way back, breaking up the journey and being able to recuperate closer to the clinic.

But in the end, it was a letter from a friend that went to Dr. Suporn that finally allowed me to decide.  The different technique, the additional sensate tissues and layers, the more ‘normal’ appearance and the additional comfort that Thailand affords, all added up to make it the winning ticket!

Of course there are other things that I now have to take care of:

  • Airline tickets that cross the international date line (the flight is 21 hours, plus crossing the date line – so exactly which day do I actually land?  The tickets give the time of landing but not the date – ack)
  • Getting my passport updated, in time.  I already had turned this in only to have it returned stating that I used the wrong form and please attach a letter from my doctor, which I had and they did not return!
  • Getting a visitor visa for Thailand.  Their consulate here is on a different island, so I may have to fly over there just to get this.
  • Transferring a large amount of money overseas – governments don’t like that – smells of terrorism.  So lots of red tape plus a lot of intermediate banks that all want to charge a fee.
  • Cardiac stress tests (like why do I want to stress that?  Does not sound nice at all) and other medical tests.
  • My partner (will be my spouse a week from now) is coming with and will have to deal with all the name changing and especially passport and visa issues.

I’ll keep posting as this progresses.

With much Aloha,

Sifan

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