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4 Months Post-Op

Posted on January 20, 2015 by sifankahale
01/01/2015 At Mama's Fish House

01/01/2015 At Mama’s Fish House

Progress seems so very slow.  Sometimes the only way to measure is by the week and by seemingly small changes.  However, when I look back at what I have already gone through and realize what is now in the past – it amazes me.

Probably the largest change and one that I will never forget is getting over the UTI complication and being able to use the restroom like a normal woman.  As I’ve stated before – I will NEVER take going to the restroom for granted ever again in my life.  Almost every time I do use the restroom – I remember how difficult and painful it used to be and how it seemed like I would be that way forever.  This is the single most wonderful achievement other then being anatomically correct now.

With all of that behind me, now it’s the ‘normal’ recovery process for SRS that I face.  Of course now that this is front and center it takes over as the number one pain and stress of life and now becomes the next issue that I am waiting to get past.  Everything is swollen ‘down there’ – very normal but as I’ve described it before – it felt like a bowling ball between my legs.  At night, trying to sleep, I have to keep a pillow between my legs because I cannot put my knees together.  But there is progress – it feels like a baseball now.  Slow progress….

There is a whole new drama unfolding within the sisterhood that in some ways was expected but perhaps none of us really understood the full ramifications.  That is post-op depression. For some it’s huge.  For me it’s a slight sidelight hardly worth mentioning.  Basically we have spent an inordinate amount of time and energy planning, researching, questioning ourselves and preparing for transition – taking almost every second of our day and occupying our dreams at night.  Suddenly, it’s over, done, accomplished – even the dreams stop.  This was a large enough subject to warrant it’s own post.

Good news from the sisterhood (those of us that were together at Chonburi for our SRS plus others I know that had surgery with a different clinic around the same time):  a number of my sisters have reported that almost overnight, at about this point in time, the swelling suddenly subsided and things looked, felt and became – normal.  Well, I still have a baseball and am waiting for that to go away.  It is a constant low level pain.  I really feel sorry for and sympathize with those that have chronic pain.  Wearing anything puts pressure there.  Mostly I wear dresses or a skirt, but even panties will sometimes hurt.  Usually I can’t wait to get home and lay back, either in my comfy chair (where I can almost lay out flat!) or in bed.

The other good news from the sisterhood is that an increasing number of them have reported going beyond sensate and achieving the ‘big O’!  I am certainly sensate – but in no way do I want to go beyond that yet.  I’m just way too sore and protective of that area.  I can see where, just like I had to relearn how to urinate as that is completely different from a male, that this might be along the same line.  I am just hoping that my protectiveness does not complicate this.  From the sisterhood I know that I must learn to let go, to relax, trust and open up fully.  But this is all for the future – not now.

The granulations that I mentioned in the 3 month post, are still there – I did not have my doctor remove them.  I wrote to the clinic (and attached pictures) and they recommended to leave them alone, that they will heal by themselves.  They also pointed out that the rawness of the vestibule (center/floor of the inner labia below the clitoris) was actually due to two additional granulations, one of which is about 1/4 inch long – ugh.  My doctor agrees:  if it’s not causing pain or getting in the way – leave it.  These will bleed slightly now and then – but never very much and seems to be less and less.  My doctor says she can always remove them later if needed.  I cringe either way…

The other really good news is that I only dilate once a day now.  Usually that starts at month 6.  But I was able to reduce from 3 a day to 2 a day back in month 2, to only once a day now.  I’m also dilating with the ‘big’ one now.  Before it was only the medium.  The important thing is to be able to maintain depth and I have not lost any depth since leaving Chonburi.  Like my other sisters, I check every time I dilate and watch trends.  I will temporarily lose depth if I’m stressed or was sitting or had a car ride.  But I do my dilations just before going to bed.  This way I’m relaxed and can douche, wash up and go right to bed.  I also do not have any issue in getting to depth.  There have been some horror stories out there in the sisterhood of 1 to 2 hours just to get to depth.  Usually it only takes about 20 seconds for me.  One lesson I have learned – the intruitis and vaginal vault are totally separate from all the other parts down there as far as pain and discomfort are concerned.  The outer labia may be swollen and painful, but that has nothing to do with and no connection to dilation.  Wheeee – thank you very much!

Like everyone else in the sisterhood, every time we dilate, we all take out our mirrors and a light to meticulously inspect everything down there, watching for anything new or changed or a different color or troublesome, etc.  Just like everyone else, I am so careful with hygiene, washing before and after, being careful what I sit on, wiping seats down before I go, being selective where I go, using two different toilet papers for front and back, always wiping to the back and doing the back last.  That UTI taught me and others a big lesson…

I haven’t talked about HRT changes since before the surgery – time to catch up a bit.  Today is 19 months (slightly more than 1 1/2 years) since I started taking hormones.   Of course after the surgery I no longer take testosterone blockers – I’m only on Estrodiol.  Recently I have had additional breast growth.  Like before, areas of my breasts would get tender, then sore, then hard and then finally turn into growth in that area.  My aureoles have finally expanded along with my nipples – I’m looking much more natural now – they have caught up with the rest!  That was something that I wondered about – so note to others – this took a year and a half.  In fact I ‘show’ too much if all I wear is a shelf bra cami – I have to either wear a bra or use ‘hidden petals’ as they are called.  My skin is softer, my bottom is more rounded and the hair growth over most of my body has slowed down and changed.  I shave my legs and arms maybe once every two weeks (used to be once a week).  I shave my stomach and chest about every other day to every 3rd day (used to be every day).  So changes are still happening.

My estrogen levels have suddenly dropped this last month.  I see my endocrinologist later this week, so I’ll know more then.  They were normal for a younger woman (which is what I need to be at, at this point), now the level is about 1/4 of what it was – still normal for a post-menopausal woman – but not where I need to be just yet!  I’m going to ask for a retest.  There could be a number of reasons for the drop, including that I missed a day or two taking my hormones, could be where I apply the gel is getting less able to absorb it, could be the test itself or that the lady parts goes through phases where it exudes estrogen..  I’m hoping it’s the latter – just a phase of healing.

My new one piece bathing suit.

My new one piece bathing suit.

Finally after waiting so long, I made it to the beach!  I bought a new one piece bathing suit just for this moment.  The beaches and the ocean have meant a lot to me and having to abstain from swimming and wading for these three months following surgery was hard.  During my recovery in the hospital, swimming in the ocean was one of the things I would think and dream about.  That helped me through some of the rough times.  Here in Maui, especially on the south shore by Kihei, the water is nice (almost warm) even in the middle of winter.  I usually will try to go swimming on Mondays right after finishing electrolysis.  I’ll head down to the beach around noon and spend an hour there before heading back up home to get ready for work.

Oh, speaking of the beach – last Sunday I again went to the beach but the waves were in the 5 to 7 foot range.  It took me awhile to gather enough courage to go in.  Like they say, never put your back to the ocean (except to duck under the wave…).  I tried to measure one of them:  I was in about 5 1/2 feet of water – just before the wave the water went down to 2 feet and the wave topped my out-stretched arm – I figure about 6 to 7 feet worth of wave.  You have to know what you are doing out there – how to duck dive and what to do if you get rolled – which happened when I tried to measure that wave ….  Nothing like being in the ‘washing machine’ on spin cycle!  The water was grey with sand – and this was 1,000 feet out from the beach.  One lesson I learned:  lady parts and sand are not a happy combination – for days after!  I’ve rinsed out my new bathing suit a number of times and I’m still getting sand out (and same with my lady parts …).  Ack!

First time at the beach since my surgery.

First time at the beach since my surgery.

My electrologist found a new, better and much more powerful numbing cream.  She tried this out on me 3 weeks ago and was able to get at the very sensitive hairs beneath the nose (oh girl those used to be painful).  Previously, I had a dentist numb my face directly before going in for a 2 hour electrolysis session.  This past Monday I had my second 2 hour session where she used this new cream.  She would apply it, cover it, then work on a different area of my face as that area would numb up.  She is using topicaine.  She says its very important to occlude it.  Wow, she can get a lot done this way.  I’m seeing a lot of improvements.

Facial hair remains one of the more difficult self-conscientiousness issues.  It is difficult for any woman, but especially so for me as I have to stop shaving on Friday and let everything grow out over the weekend so there is enough to ‘grab’ for electrolysis on Monday.  This makes going out or doing anything on Saturday and Sundays difficult and embarrassing.  Right now, I have a faint 5 oclock shadow in a thin strip above my upper lip.  I noticed at work, that a couple of the women there have this as well.  So I’m getting there.

For the last month, occasionally I would wake up in the middle of the night (3am ‘ish).  I would be very sensitive to everything:  weight of the blankets on me, discomfort of my lady parts, refrigerator kicking in, dog barking in the distance, wind rustling the trees, my spouse cuddling me or being too close (normally we cuddle the entire night as we sleep).  These would prevent me from going back to sleep.  My mind was clear – no issues, nothing bothering me, etc.  My doctor gave me a prescriptions for pain, sleep and anxiety pills – none of which I want to use regularly.  Finally I found that I could take a Tylenol – it would take 30 mins but I would be able to sleep and more importantly, to be able to cuddle!  I’m going to talk to my therapist and doctor more about this.  I also posted to the sisterhood to see if anyone else went through something like this.

Jan. 3, 2015 Snow at the summit of Mt. Haleakala

Jan. 3, 2015 Snow at the summit of Mt. Haleakala

Seems this winter has it’s share of storms.  In the beginnings of January we had this ‘small’ storm come across the island of Maui.  The information from radar and satellite didn’t concern us at the observatory so no extra precautions were taken.  Oh girl – this storm flared up as it hit us and wound up dumping a bunch of snow and ice at the summit.  Could have been worse – the big island had blizzard condition on top Mauna Kea.  As usual, one of the engineers and I were the ones that had to run up and rescue things the next day.  It was freezing cold up there.  I had to fall back on my Minnesota experience: dressing in layers, shoveling snow and chopping ice just in order to get into the door of the observatory!   I had fun making a snow ball – first time in about 7 years since I had left Minnesota.  Next day, I found a little snowman in this same spot. I wound up having to go up to the summit three days in a row before the observatory was back on-line and on-sky.  Even now there are 5 remaining non-critical issues that I will have to get back up there to fix (I’ll probably go up this week sometime).

Dec 25, 2014 Christmas dinner at the Makena Beach resort

Dec 25, 2014 Christmas dinner at the Makena Beach resort

Lisa and I had a wonderful holiday.  I bought a new red dress for Christmas dinner.  We went out to the Makena Beach resort.  It’s a beautiful resort situated on a beach and overlooking the ocean.  Of course we got there a bit before sunset and watched as the sky turned beautiful pastel colors out over the ocean.  They have a huge smorgasbord of food from around the world.  It was a quite the feast with so many different foods and flavors.  It was difficult to choose from as there is no way a person could taste even a small piece of everything and not be wheeled out in a wheelbarrow!  Plus we celebrated with a bottle of delicious champagne – what an evening to remember!

For New Years, we went out to another favorite spot here on Maui – Mama’s Fish House.  This has got to be one of the best restaurants in Maui – if not all of Hawaii.  It’s on a cove on the north shore and is filled with memorabilia and nick-knacks, its architecture a bit eclectic with twisted tree limbs and roots for some walls, ship’s propeller and outrigger canoes as parts of the ceiling!  The food is very delicious.  This is where we go to celebrate my birthday.   Hummm, how do I convince Lisa that we should celebrate my new birthday (the date of my surgery) by going to Mama’s twice ….

01/01/2015 Celebrated New Years at Mama's Fish House

01/01/2015 Celebrated New Years at Mama’s Fish House

For the holidays, Mama’s Fish House put up a ‘sandman’ (a snowman would not last very long in the cove with the sea mists blowing over …).  So I had to get a picture with the sandman!

Overall, four months out from surgery, I would summarize by saying life is starting to settle into a new rhythm.  I am finding out more about myself, my body, as everything meshes and comes together.  Looking back, I think the biggest realization occurred right before and directly after surgery when I discovered that my body had disphoria in addition to my head.  I had spent all that time ‘in the head’ beforehand – that was very important – but I had missed all the clues from my body.  Perhaps being on the right hormones and now finally having SRS, I’m able to listen to my body – to be in touch with it and to love it.  Maybe it’s because of the lack of testosterone, perhaps it’s finally being congruent or maybe it’s just being female.  Such a difference from before …. such a difference …

With much Aloha,

Sifan

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Surgery in Thailand – Part 6, Trip Home

Posted on January 12, 2015 by sifankahale
10/6/14 Business class lounge in Bangkok waiting for our flight home.

10/6/14 Business class lounge in Bangkok waiting for our flight home.

The day finally came (actually very early morning) when we had to leave to go back home.  It turns out this was a very very sad time.

To leave this wonderful clinic, their staff, the new sisters and the sisterhood that I’m now part of – was a difficult thing – I have tears as I write this just thinking back to that day.  We had everything packed the day before, except for what we needed to sleep and for my dilation.  The fresh clothes we were going to wear were put out neatly.  We got up at about 2am (ouch), I got up, emptied the catheter bag, did a long dilation, showered and emptied the bag again, then got dressed as Lisa got up and showered.  I then cleaned the rest of my dilation kit and packed it away.  Once we were ready we did a quick inspection of the room to make sure we didn’t miss anything (we did, we left a nice ice pack in the freezer part of the little room refrigerator).  Then we called for bell service to carry our luggage down to the lobby.

Once at the lobby, we didn’t wait long before the driver showed up with the clinic’s van.  It was so sad driving away from the hotel for the last time, driving down the main road of Chonburi, leaving …  He stopped at a place to buy water for us just on the outskirts of the town.  Right after that the road turned into a major highway and off we went.  It takes about an hour to get to the airport.  This was a very very long trip in my condition.  The seat cushion only helps a little.  I would put both arms down straight to lift myself up off the cushion every time I saw a bump coming.  I missed a lot of them ….  Once there, he got us to the check-in gate.  However, we were about 45 mins early and had to sit and wait before it opened.  Once they opened and because Lisa got us in business class, we were able to check in pretty fast.  They got us wheel chairs and whisked us through security.

Leaving Thailand - lots of water down there.

Leaving Thailand – lots of water down there.

Unfortunately, I packed a large bottle of benedine that the clinic gave us in my travel bag instead of check-in.  Security did not like that and confiscated it … grrrr.  After I got home, I posted this to the sister-hood and no one else had any problems like this.  I must have gotten the early morning security guard ….  In fact, I had posted this question before I left and was told there was no problem, especially with the note that Dr. Suporn gave us for the airports.  Oh well …

Then they pushed our wheelchairs to the business lounge – we were on JAL and oh my, what a beautiful lounge.  And there was a bar (that didn’t matter, I was not going to drink before a long trip) and a smorgasbord of breakfast food set out.  Lisa would get me settled (it was still painful) and then get something to eat.  Eventually I had to get up to use the restroom (meaning undo the catheter pinch then empty the bag), so after that I got some food myself.  It seemed like a long wait before the ‘wheelchair guys’ came back to get us and bring us to the plane.

A week ago, on our only outing in Chonburi, Lisa and I went to the huge mall they have there in an attempt to purchase some souvenirs for ourselves and friends back home.  This didn’t work out because the entire mall was stocked with ‘western’ goods that the people there wanted!  So we had planned to shop at the airport.  Unfortunately the JAL lounge was far from the shops – way to far for to Lisa to walk and forget it if you think I was going to walk anywhere at all.  So the only souvenirs we had were the couple of things we bought from the hotel (purse, jewelry boxes etc.) and a dress, shawls and earrings from the mall.

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Typhoon Vong Phong receding to the north as we land in Tokyo. Gad it won the race to Tokyo!

There was one tiny ittsie bittsie little problem …..  seems a certain mega-typhoon was in a race with us to get to Tokyo! Typhoon Vong Phong, dubbed the ‘most powerful storm on earth’.  From the headlines of the day “The most powerful storm on earth this year is heading for Japan” (http://mashable.com/2014/10/07/super-typhoon-vongfong-japan/).  It was a race, one I didn’t care to win.  So leaving Bangkok we were racing this pretty bad typhoon that had Tokyo as a target.  Turned out we lost, the typhoon won by about 4 hours. By the time we got there we had blue skies.  We landed with just a little turbulence. Out the window to the north we could see it receding in the distance.  Leaving Tokyo however, was delayed as all the planes that were grounded by this storm were now queuing to take off. We had about an hour delay.

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 booked us on business class for the trip back.  The trip was about 25 hours long which included two 6 hour layovers.  On the longest seqment 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 windows had electronic darkening – 6 levels of darkening so you could adjust to just what you wanted and still see out.   It had colored led ceiling lighting that changed depending on what was happening: boarding, meal time, sleep, etc.  What a plane!! Really glad Lisa splurged on the flight home …..

Honolulu at last - oh what a beautiful sight!

Honolulu at last – oh what a beautiful sight!

Around 21 hours after leaving Bangkok, we came in for a landing at Honolulu.  The first words spoken to us as we got off the plane here: “Aloha, e’ komo mai” (hello and welcome) …. mmmmmmm, yesssssss, home!  Oh how wonderful it was to have someone speak to us in English and understood right away what we said and not having to repeat or mimic – wheeeeee. Little things that say “you are home now”.

At last HOME !!!!! Wowowowowozie. Left Chonburi today at 4 am in the morning, arrived home at noon today (still Monday).  That’s a total of 25 hours driving, flying, waiting forever in airports on layovers, etc.  It’s weird – we left Narita at 8 pm Monday and arrived 11 am Monday …..9 hours BEFORE we left. Ah, the wonders of the international date line.  So, am I 9 hours younger now? Personally I think the stress of this long trip more than made up for that.

My bottom is sooooo sore ….. And it feels so good to be back on Maui. OMG just seeing the beaches and mountains as we flew in …. Of course it helps when all the other people on the plane are tourists and were also very excited. Now I just have to figure out what is night and what is day.  Before I went to bed I had to do the ‘infamous’ first dilation at home.  Infamous because due to the long flight and stress, this would be a difficult one – it lived up to the hype …

A very tired Lisa and Sifan on the DreamLiner - what an airplane!

A very tired Lisa and Sifan on the DreamLiner – what an airplane!

Well, my turn has come to say aloha to Chonburi, to Dr Suporn, to the marvelous staff and especially all the beautiful sisters I have had the pleasure to meet. What an experience this was. What a glorious sisterhood we belong to. I think Shakina coined the phrase ‘supornista’ – yesssss! And we are all Suporn butterflies – this one is starting to feel the wind beneath her wings.

There is a sadness here – both Lisa and I started feeling it as we drove out of Chonburi – we are missing everyone so much. I have tears in my eyes just writing this. Lisa and I want to wish everyone else still at Chunburi their own safe journeys. And to everyone we have met, aloha nui loa (very much aloha/love) – may all of our life journeys lead to joy and happiness!

With much aloha,

Sifan

La papillon Dame Sifan sent le vent sous leurs ailes

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3 Months Post Opt

Posted on December 11, 2014 by sifankahale

20141127_173748Oh 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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Surgery in Thailand – Part 5, Complications

Posted on October 31, 2014 by sifankahale

20140929_115815This 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.

Sifan at Thailand airportThe 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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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
20140910_130432

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.

20140910_130333

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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POISONED !

Posted on October 12, 2014 by sifankahale

woman in fog 2Some 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

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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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