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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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Posted in Advice, Diary, Gender Affirmation Surgery, Surgery and tagged , , , , , , , , . Bookmark the permalink.

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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Posted in About, Advice, Diary, Gender Affirmation Surgery, Surgery and tagged , , , , , , . Bookmark the permalink.

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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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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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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