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Post-Opt Depression

depressionThis is a ‘second’ transition – a transition to living a normal life – and this is not talked about or at least not mentioned to the degree that it should be.  In some ways this was expected but perhaps none of us that have gone through SRS really understood the full ramifications of.  That is post-op depression. For some it’s huge.  For me it’s a slight sidelight hardly worth mentioning, but yet, very important to mention…

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 all that planning etc. is over, done, accomplished – even the dreams stop.  And here we are – marvelously and finally our true selves, whole at last – but all that action is gone, finished, leaving us somewhat devoid and that sends some into a depression or just feeling down.

I use the word ‘we’ as I’m mostly talking about others in the sisterhood (I use ‘sisterhood’ to mean all those that I went through SRS with plus many others that are post-op).

I’m quite active in a number of areas, so for me I was able to simply ease into a relaxed life.  The greatest effect for me was being physically handicapped and unable to do a lot of the outdoor activities I enjoy (hiking, climbing, swimming, kayaking etc.).  But I’m also creative, love learning and do a lot with computers.  So I have many ways that I find rewarding and fulfilling.  I also had spent a lot of time pre-op getting my psychological self in order.

In addition to this sudden lack of intense activity, there is a low level pain that is pretty constant for 4 to 6 months as down there is swollen and still healing. I can see the progress, but it is very slow, measured by the week – not the day.  This has a couple of effects for me.  First it either prevents me from doing activities I love or at best it makes me think twice if I should do something or not.  But the thought is constantly present.

When I was researching SRS, as I was initially looking into the possibility that I wanted to go that far.  I read about the maintenance that is required and was taken back by how much there was.  Dilation for the rest of your life is a big one especially when you understand what and how and how often it must be done.  Add to that the normal but new (for us) activities a woman has to routinely do:  cleanliness, pads/liners, checking yourself/making sure all is ok and how to use the restroom – how to sit, clean, even how to urinate.

All these take additional time that before we never had to even think about.  And now, the time to do all these duties constrains our ability to get into the things that bring us joy and keep us (anyone actually) happy and away from depression.

At times we feel so good, but then something else happens and back we go.  The pain will sometimes abate, only later to come back in a different form.  Just when we think things are getting better something else starts in.  This is a long journey – it’s takes a year to recover from an operation this massively huge.  But relapsing after feeling so good can be very difficult to take mentally.

So we have this seven pronged threat:

  • Intensive mental activity leading up to surgery
  • Physical handicap keeping us pent up and unable to do activities we enjoy
  • Constant low grade pain
  • Things taking so much longer to heal than expected
  • The new duties
  • Maintenance required with our new parts and the lack of time to do enjoyable activities that keep us out of depression
  • Relapses after things were going so good

In a way, it’s equivalent to soldiers coming back from a war.  It’s suddenly over but perhaps too suddenly.  Everything keeps going around in our heads.  It’s hard to let all of that go and settle down.  It happens just too fast.  And the ‘way of life’ is completely different.  Whereas there was so much to do before, now there is a lot to do, but it is totally different.

For my sisters:  this is much larger than you think or possibly can imagine.  This is more than a change of your physical sex.  It’s more than just living as the opposite gender.  It’s also more than how society views you or more importantly, your own insecurities and fears. In addition to all of that, this is a profound life style change – right down to how you ‘wipe’ yourself in the restroom!

My advice for those that are contemplating SRS:  Do your due diligence in researching this.  Join online groups and social media that are targeted for pre-op’s.  Once you settle on a surgeon – ask that clinic what pre-op and post-op social media they have and get invited to those (these are almost always private).  Once connected – read back one year to get a good clear idea of what you are going to face.  You will read about complications, about troubles and issues, but also about marvelous achievements and proud moments.  A word of caution:  everyone is different both in what they experience and the timing for various healings to take place.  Take it all with a grain of salt as they say.  But at least you will have a better idea of the full spectrum of possibilities and outcomes.

A bit of a soapbox moment:  I saw so many sisters that carried high sexual expectations once they completed surgery.  It bears mentioning that around 50% of women (gender) born female (birth sex) ever have an orgasm.  A transsexual after completing SRS is no different and has the same statistics!  We are all sensate (feelings and able to have an orgasm) – but the big ‘O’ is more than just being sensate.  It requires a heavy mental aspect as well.  What it requires is an opening up, being in tune with your body and being calm mentally and letting go.  All of which are completely opposite of what is required of a man and is therefore even more difficult for a transsexual.  My soapbox is this – do NOT go into this for sexual reasons.  You really should only be doing this because you have a deep down need to have your life be congruent, to be whole, to embody the essence of who you are.  Let the rest come – it will.

For most males (birth sex) under the ‘influence’ of testosterone, they have an almost daily urge.  For me this was confusing and at odds to the woman (gender) that I am.  Those urges caused a conflict in me as the male influence of testosterone had it’s way.  This is part of what I called the testosterone poisoning.  Getting on HRT and now completing SRS solved this and got that poison out of my system along with all of it’s effects.  Mind you, if you are a cis male (meaning your birth sex and gender match), testosterone is perfect and wonderful and I appreciate that in others.  However, for me, a transsexual, that was an awful burden that caused great disphoria and conflict.  Of course for some this is a concern – will they still have sexual urges after HRT and SRS?  And for a lot of sisters going through SRS this translated to worries about size/depth (again think testosterone – how many males do you know that are concerned with ‘size’ …) and orgasmic potential (especially after being able to, on demand).  Granted, for those that are young and have or will have a male partner, these things are important – I’m not saying otherwise.  I’m saying these should not be the top priority nor the reason for coming this far.

You are changing into a female (you are already a woman). Your body is now going to act and respond as one.  This includes the much more subtle urges, the relaxed sexual tension (compared to before) and a completely different way that we orgasm.  Many worry (I did) about how will we be satisfied if perhaps we can not orgasm or as often and ‘easily’ as we could before.  When you come out of the ‘testosterone fog’ and into femaleness, the urges change too.  In other words, you are now a female and your urges and abilities will match a female’s as well – do not fret over this, let it happen.  Let me put this yet another way:  your new body and self will match … perfectly!

And for those that have had surgery:  This is HUGE!  You had a major surgery – it does things to your body that take a long long time to heal.  You might feel ok at the moment – but is it not finished.  We need to take this one day and one thing at a time.  Conquer it and it alone, then focus on the next.  Don’t get overwhelmed – it’s so easy to do.  This is going to take up to a year – all the adjustments, all the issues that come up – both physical and mental.  So many times, the clinic has told us – recovery is 90% mental and it’s very true.  I remember the first time I saw blood on my dilator – omg I went crazy worried.  I reread the ‘manual’ the clinic sent me a dozen times.  Did what they said – and no problem.  But the mental anguish was difficult.  Of course now I just put pressure on the spot (always a granulation) and it’s gone and done – not a biggie.  And that is how most of recovery has to be dealt with.  One day at a time, one thing at a time and put-in the time!

For some, this is a difficult period and an unexpected complication.  I have a feeling that this may have been the reason two people I know of that committed suicide. So this is serious.  If this is you – please, there is so much help out here – reach out – please ….  There are a lot of us that have been through this – we made it, it’s more than possible – it’s just more hard work.

With so much Aloha

Sifan

 

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Surgery in Thailand – Part 6, Trip Home

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

3 Months Post Opt

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 ….

Surgery in Thailand – Part 5, Complications

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”!!

Surgery in Thailand – Part 3, Dilation

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

Surgery in Thailand – Part 2, Hospital

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

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

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

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.

20140911_061312

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.

20140911_191614

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

Surgery in Thailand – Part 1, Arrival and Hotel

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

20140911_071013They have the above picture on all the literature (books and instructions etc.) that they give us at the clinic.  It’s a beautiful image of a chrysalis changed into a beautiful butterfly, painted in a beautiful Thai style.  And, we are known as Suporn Butterflies!  Although someone also coined the phrase ‘supornistas’!  But what a beautiful and perfect icon this is and it so perfectly reflects what I have just went through.  I kept this picture along with all the cards people sent me, close to my bed in both the hospital and the hotel.

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

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

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

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

20140918_193241We had a deluxe room on the top floor (7th).  Our room looked out the back and had a beautiful view of the hills and forest.  There was a temple directly below us, a huge Buddha on the next hill over and a Chinese temple complex off to our left.   Our deluxe room had a queen size bed (was larger than our size here in the states – almost a king size, but oh was it ‘firm’), fridge, mini-bar, two nice chairs, desk, large LCD TV which was also a monitor (which I found out the last day I was there ….).  It was a very comfortable room.

20140918_193232Good thing too as I spent a month there without being able to go out much (due to a catheter I had to wear – a complication I developed).  I have a feeling the design and layout of these rooms had some input from Dr. Suporn, especially the bathroom.  There were a number of extra’s that you just don’t see in hotel rooms.  For example, they had a special spray hose next to the toilet to wash ourselves ‘down there’.  What was unique was that this was hooked up to a source of pure water.  You can not drink the water from the tap – the hotel supplied bottled water (we would ask for 8 to 10 bottles a day as I had to douche with bottled water as well after a dilation), plus I was told to drink lots and lots of water after this operation.

20140918_193113We had a great view out the back of the hotel into the forested hills.  Sometimes in the morning we could watch the steam rising up from the forest and swirling about.  There was a temple directly below us, a large Buddhist statue on a hill over to our left and a huge Chinese temple complex to the far right.  One day we watched a powered hang glider circle the skies above the Buddhist statue.  Another day they had a celebration in the small temple complex directly below us, everyone bringing flowers, taking their shoes off and walking inside.  Meanwhile, the local dogs were busy sniffing the shoes!

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

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

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

Lisa and I slept good that night.

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

20141014_132004First, we met a person from the clinic who walked us over to the clinic (about 2 blocks away) – a walk I would be repeating often.  There I was given my set of dilators (in a very pretty Thai decorated box, more about dilators in another post), measured for breast implants (more about that in a moment), given a book all about what was going to happen and discussed all the aspects of the coming days.  I also had to give them the originals of the letters from my therapist and from my HRT (hormone replacement therapy)  doctor stating that I met the WPATH requirements for SRS.  Because of my age, I also had to give them the original letter from my GP doctor including the results of my cardiac stress test, verifying I was fit for surgery.  Then they gave Lisa and I a very delicious cold drink (found out later when I asked for another that that was only for your first visit … ratso).  The hospitality at the clinic, the hospital, the hotel – everywhere, was amazing.

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

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

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

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

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

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

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

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

Next post will cover the hospital stay.

With aloha,

Sifan