Wednesday, July 31, 2013

Surgery Day/Surgery Experience (Detailed)

Okay, it is the morning of Wednesday, July 31, 2013. I am getting close to 48 hours post op and I'm now feeling ready to write up a nice detailed entry about surgery! I apologize if I ramble a bit or if I don't make sense at any point. I'm still on medication. I'll edit this some where down the line, I just really want to write everything while it's all still fresh in my mind. All right, here we go!

I'll start from Sunday (the day before surgery). So Sunday morning my friends Kendra and Lauren came to my house and we left from good old Massachusetts around 9:15am. Lauren and I took turns driving to Cleveland, Ohio. Took some stops along the way for bathroom breaks, gas breaks, and a quick lunch and dinner. Arrived in Cleveland at our hotel around 9:00pm. We checked in and brought all our stuff up to the room. Room is beautiful by the way. Nice and roomy. Smells great. Clean. Nice big TV. So many plugs everywhere it's awesome. TV has an easy hook up to plug in my Xbox360. So I set everything up and we went out to the nearby Super Walmart. I had all ready bought a lot of groceries but there was a few things I wanted to pick up like those plates of sliced fruits and some yogurts. I wanted to make sure I was eating fruits and other healthy stuff post-op but I knew if it was anything hard to prepare or eat that I wouldn't want to so the cut up fruit tray helped with that. and I couldn't bring it in the long car ride which is why I picked it up at Walmart. My friends also needed to pick up their groceries at Walmart.

We came back to the hotel. I had my 'last meal' lol because I couldn't have anything to eat or drink after Midnight. I woke up the next morning (soooo thirsty but couldn't drink lol) and I took a shower. I couldn't wear any deodorant (or lotions but I never do anyways). I dressed in comfy clothes and sneakers. I had a very light pair of mesh gym shorts and a T-shirt. I very anxiously waited for it to be 10:30 so I could leave for the hospital. Lauren drove us to the hospital because I was so nerved up. lol I brought a little plastic bag with my plugs (earrings), lip ring, and deodorant for after surgery though I didn't end up putting in or using any of that until back at the hotel anyway. I also brought a jock strap per my surgeon's orders.

We got to the hotel. It's a huge medical center. It took us a few to find the actual building we needed to be in but we were early anyways so it was fine. We get to the waiting room and were sitting there. I was freaking out. I started crying. lol Kendra held me, reassured me I was not going to die. I'm a worrier. It's in my nature. I wasn't worried about bad results or anything like that. I was and still am very confident and comfortable in my surgeon's abilities. I was just scared about having surgery. I've had surgery once before, for my chest, but I was still pretty scared about dying. It's always a possibility that you'll die during surgery but realistically it's very unlikely. I calmed down after a couple minutes. They finally called me into the pre-op room.

Nurses took my vitals. My blood pressure was 153/98!!!!! That is way high for me. I was nervous as heck. The nurses were really nice though. I felt like I was in good hands. They joked with me and made me feel okay. They comforted me. They had me get into a Johnny, footies, and one of those blue caps. They ran the IV and I was really scared of that because I hate IVs but the lady did a good job of it. They called Kendra and Lauren to come and sit with me in there while they gave me lots of fluids via the IV. The nurses asked me a million questions. The anesthesiologist came in and also asked me a bunch of questions. My surgeon came in, asked me a few questions. He checked things out really quick and made some marks on me. This was his first time seeing my genitals in person. I met him one time at the First Event conference in Boston and talked with him a little but we never had an in person consultation. He had me e-mail him high quality photos of my genitals and from the pictures he determined that I was a good candidate for this surgery. We also had a phone consultation about a week prior to surgery where he went over everything with me and answered any questions I had. I all ready knew almost everything I needed to know before that though because I had listened to his presentation at First Event and I had been e-mailing him ever since with all my random questions. He is amazing at getting back to you via your email inquiries.

So after that I just waited with my friends for probably about an hour. The anesthesiologist came back and gave me some medicine to relax me and then they took me to surgery. I know she said she wasn't going to start putting me to sleep until I was all ready in the operating room but honestly I don't remember ever seeing the operating room. lol So I'm assuming I knocked out pretty quickly.

Surgery took 4 hours. I haven't talked to my surgeon so I'm not sure why it took longer than expected. He anticipated 2-3 hours. He said usually it takes about 2.5 but I ended up in there for 4. No idea why. The nurses said nothing went wrong so I don't know why. I'll have to ask him next time I talk to him. Anyways, I woke up in the recovery room. I guess I had been in the recovery room for about 2 hours. I woke up and was extremely out of it. I was very disoriented, dizzy and confused but had no pain at all in my penis or testicles. Just soreness on the incision for my pubic lift when the recovery nurse started having me move. (For reference, the pubic lift is a horizontal incision across the pubic area where my surgeon cut some skin out and lifted the whole genital area up and sewed that horizontal incision shut. This lifts the penis and balls so that it is in a more masculine position in the front of the body, rather then in between the legs where a female bodied person's genitals usually are located. It is very helpful and making everything be where it's supposed to but it feels really sore and tight because they pulled everything upwards and sewed it!) She helped stand me up and then sat me in a reclining chair. She had me sit for a few minutes, honestly I have no concept of time so I don't know how long but it seemed very short. They had put me in the jockstrap while I was still under anesthesia, I guess? Because I woke up wearing it I think unless they did it while I was half out of it. They actually might have, I can't really remember. Either way the jock strap was put on me at some point. And while I was in the chair they pulled the jock strap down and showed me my new genitals! I was happy but mind you I couldn't lean forward at all whatsoever because of the pubic lift incision which makes the whole area very tight and sore. Because I couldn't lean forward and because the pubic area and penis was so swollen I couldn't see the balls at all! I remember distinctly asking the nurse "Are there balls in there?" lol To which she very politely replied, "Yes there are two testicular implants." lol

They called in Kendra and Lauren. They gave them a bunch of post-op directions, thank God they told them because I would have never remembered. Then I had to pee so the nurse walked me over to the bathroom. My legs were like jello! I was super dizzy but the nurse guided me all the way there, brought me to the bathroom. But then she left me at the toilet alone to pee and I was like way too high for that. So I sat down and peed but I know something went wrong, I can't remember what it was. Maybe I was confused about how to wipe or maybe I couldn't get the jock strap. Maybe I was just scared cuz blood was dripping and anytime I see blood I freak out and think somethings wrong. lol I can't remember what it was exactly, I just know I ended up needing her help. I called for her but she couldn't hear me. There was probably a bell to ring but I was super disoriented at this point so I didn't think of that. I knocked on the door from the inside but still nothing so then I just opened the door and like anyone around there so me very naked because I was just standing at the door, jockstrap around my knees, dripping blood and looking nasty lol The resident sitting at the desk definitely saw all of my goods and services. lol So the nurse was waiting right outside the door and when I opened it she saw I needed help so she came in and helped me. That's when this second nurse who was super super nice came in to help. One lady helped me stay stable while the other grabbed me some baby wipes and they told me not to wipe but just dab the area so I did. Then they walked me back to the reclining chair I was in before.

They got me graham crackers and ginger ale and regular crackers. I ate them all and drank the ginger ale. I didn't feel nauseous or anything. They showed my friends how to empty my drain tube. The nurse like managed to splash so much of my drain blood/fluid everywhere and in hindsight it's really kinda funny but also very gross. At the time I was way too messed up and out of it to be phased by it. But looking back it was like on the arm of the chair, on the food table, on my leg. lol very gross. The other nurse came with alcohol pads and was wiping the areas where the blood splashed. Then the nurses got me situated and then the really super nice nurse helped get me in a wheel chair. I felt safe with that nurse because I could tell she cared. Not that the other nurse didn't, but I just felt like the other nurse was more robotic whereas this second nurse just went above and beyond for me. She ended up offering to take over I think it was so the other nurse could go do something else. I kept telling her how grateful I was and how awesome she was. And she kept complimenting me. I don't remember the words she used but basically she was telling me that I was like inspiring and awesome because I'm trans. She didn't use those exact words, she couldn't say the words trans because we were like in the hospital and she was pushing me in the wheel chair so she obviously didn't want to out me but she was basically saying it without saying it. Like just telling me, she thought I was awesome and strong for doing what I was doing. We had a 'moment.' You know? lol For real, I wish I could remember what was actually said. Some point during this time I was starting to get feeling back in my genitals. The nurses told me they used Novocaine to numb the area and that I'd slowly start getting feeling back. While I was at the hospital the underside of my penis started to hurt. I would later see that's because there are tons of stitches on the underside of my penis. Yukky! But it didn't hurt too bad, it was just a little. They gave me a percocet before I left the hospital. They offered to give me pain medication via the IV but I didn't feel like I needed it. Speaking of which, if anyone's wondering the Dr. prescribed me 5mg percocets and told me to take 1-2 every four hours as needed. He also prescribed antibiotics for me to take 4 times a day for the next 7 days to prevent infection.

Anyways, they get me in the car. And then we went to Walmart to fill the script. I was feeling quite good. Kendra held my hand and stayed right by me. We walked very slowly, me kind of waddling and walking like a cowboy, we walked to the pharmacy. While the script was being filled me and Kendra walked a little. It felt good to stretch my legs and use them. Also, one of the ER nurses before surgery was going on and on about how I needed to do a lot of walking post-op to prevent blood clots but then the recovery room nurses were like "a nurse told you to walk around a lot? no, you're really not supposed to do a ton of walking." so we checked with my surgeon's office and the recovery room nurses were right, they said, I should do my normal walking, like walk to the bathroom walk to do the "normal" things I would do but don't do tons of walking like any excessive walking more so then I would usually do because my body really needs to heal. So basically that first nurse in the ER didn't know what she was talking about. Let that be a lesson to listen to the orders of your doctor's staff and your doctor himself because a lot of times doctors work out of big facilities with nurses who aren't specifically familiar with your procedure and they might give you the wrong advice. Luckily, no harm no foul, we found out that I shouldn't do a ton of walking before leaving the hospital. So I've just been doing a little walking. While at Walmart it felt real good to use my legs. I guess they were up in stirrups all surgery long so like the pinky toes on both feet were like numb/pins and needles for whatever reason. I guess the position they had my feet in but so walking was nice and at the time the Novocaine hadn't fully worn off so I wasn't in much pain. While at Walmart I bought an extra pillow.

Then they took me home. I got into bed. I have a laptop tray to keep my laptop off of my genitals. Peeing was really rough for the first day because its hard to get in and out of bed and then to get on the toilet. And the actual act of peeing burned really bad for the first day or so because during surgery they put a catheter in so it irritates the urethra and what not. Oh and because there is so much swelling down there when I pee the stream is just absolutely insane. lol Like I end up peeing all over my thighs and butt. But I have unscented baby wipes and I just pat the genital area very gently and wipe my legs and butt.

The first few days every time I pulled down the jock strap, there was lots of bleeding. It was really gross. I was scared because I worry about everything so I was paranoid but I talked to my doctors office on the phone and described it to them and they said I was fine. At this point I'm almost completely not bleeding anymore. I only have one section on my right testicle where I still have a tiny bit of blood dribble out sometimes. Otherwise no more bleeding.

I have a drain tube and that needed to be emptied every 4 hours for the first 24 hours and the amount that was in it needed to be recorded. My friend Lauren helped me with all of that. At this point not much is coming out anymore and I only need to empty it about twice a day.

That first night I was in very little pain. I had some achy moments but for the most part I was just fine. very comfortable. I had to slowly progress to solid foods so that first night all I ate was yogurt, crackers, and Ensure nutrition shakes. I had no problem with nausea. I did have to pee a whole lot which was very annoying because it hurt and was hard to get in and out of bed. lol but it was manageable. Kendra and Lauren helped me a lot.

By the way, I really underestimated how much help I was going to need for this surgery. They had to help remind me about meds, and ice packs, and emptying drains, and dressing and cleaning and basically everything! But you can read more about that when I write up about some of the follow up care. lol This will be it for now. Pretty detailed story of surgery day. Next I'll write about how healing has been going since surgery and how follow up care has been.

Tuesday, July 30, 2013

Surgery Day (quick post)

So I had surgery early this afternoon. It's past midnight so technically it was yesterday afternoon. I'm going to keep this short and elaborate more another day but I just wanted to let everyone know that I had surgery and am doing well!

It took 4 hours. Then I was in recovery for about 2 hours. Then my friends took me to fill my prescriptions and now I'm hanging in the hotel room. I'm feeling surprisingly well and looking surprisingly well considering I just had surgery today. I have A LOT of swelling. lol And that's an under statement. It's at times uncomfortable. And sometimes it hurts a bit. But it really isn't that bad. So far so good.

All righty, well I will definitely write a long detailed description of surgery day sometime soon but for now, it's time to relax and heal. :-)

Monday, July 29, 2013

Why this procedure?

Some guys who are familiar with the many different options for bottom surgery have asked the question "Why have you chosen simple meta with testicle implants and pubic lift over all the other options that are out there?"

I want to answer this question but first I should give just a little background information for those of you who are unfamiliar with the different lower surgery options for trans men. 

There are two main branches of genital surgery for trans men: Phalloplasty and Metoidoplasty. There are many pros and cons of each surgery and generally men have to weigh out the pros and cons to decide which main branch is right for them. Once they have decided which which of these two main branches they want to follow then there are tons and tons of options under these two main branches. I'm going to give you a very short list of SOME of the pros and cons of these two main branches of surgery. I'm going to keep it very simplified. If you want more details about the different options and you are a transgender man feel free to contact me and I will connect you with really great resources where you can learn everything you would need to know about lower surgery.

Metoidoplasty: taking the hormonally enlarged clitoris and using it to create the penis. Optional - urethra extension through the penis and scrotoplasty with testicular implants.

  • Pros - statistically less complication, cheaper, natural genital skin color, very little scarring, natural erections, less risk of sensation loss/changes 
  • Cons - very small, to the point that sometimes peeing through your fly is difficult/impossible and possibly too small to participate in penetrative sex



Phalloplasty: taking skin from one area of the body and using it to create the penis. Optional - urethra extension through the penis and scrotoplasty with testicular implants.

  • Pros - large adult sized penis which if done successfully is capable of normal penetrative sex and there is no problem peeing through the fly.
  • Cons - riskier surgery (higher complication rates), results in more scarring then meta, a device needs to be implanted to make erections possible, higher risk of sensation change/loss, electrolysis is often needed because of hair on the donor site, much more expensive


(Please note again that these pro/con lists are not everything. These are very simplified lists stating only SOME of the things that really weighed in on my personal decision for my body and another person's pro/con list may be very different from mine. But I have certainly done much research on all the options available at this time. I have been researching for the last 7+ years.)


Now, on to why I have chosen simple medoioplasty and scrotoplasty with testicular implants and a pubic lift.

For one, I chose this surgery because I'm not 100% sure which surgery, Phalloplasty or Metoidoplasty is "right" for me. By having the metoidoplasty, I am creating a small penis and scrotum with testicles. Even though it will be on the small side, it is giving me the opportunity to have genitals that match who I am. For me, it's about looking in the mirror and having male genitals, even if they are small, I know it will make me feel so much better than seeing what I have now. By having metoidoplasty (meta) I am in no way preventing myself from later going on and having a phalloplasty over it if at some point down the road I feel that the meta isn't big enough for me to feel 100% complete. I honestly, really want meta to be enough. I love the sensation I have. I don't really want a lot of scarring. I also don't have $25K - $60k for the kind of phallo I would want. And for me, there is just a whole lot of risk with phallo that scares me. But at the same time, I know that if the meta doesn't relieve me of 'most' of my dysphoria I will someday have the phallo over my meta. Even if some day I do go down that road, I feel like the meta is the right decision for me at this time because I know it's going to make me feel so much more comfortable in the mean time. 

I am currently not having my urethra extended for a few reasons. One being that if I do eventually have phallo, I do not want the surgeon to have to deal with an all ready surgically altered urethra. Urethra lengthening is arguably the one of the most risky parts of this surgery. Complication rates are pretty high. So I'd rather figure out exactly what will be the last step for my genitals before I extend the urethra. 

In other words, urethra extension is very complicated and risky, and I have every intention of taking that risk some day, just not yet. If meta ends up being "enough" for me to feel whole then I will eventually save up money again and have a urethra extended through the meta. If I decide on phallo as my last stage then I will have the urethra extended through the phallo.

I really like certain aspects of the meta. Natural erections. Little scarring. Natural skin color. Much less risky to lose sensation. Obviously the small size is the one con that I have with it. But I really wanna give it a shot and see if this will be enough for me to be fully comfortable. And I know at the very least it's going to make me way more comfortable then I am with my body right now. 

I am okay with being a man who has a small penis. I'm not at all okay with being a man who has the genitals I currently have. I know there are many other trans men who do not want genital surgery and are totally happy with how their body is and I think that is awesome. If you're one of those men, then good for you! But I personally am not okay with it on myself and I know that I absolutely need to have genital surgery.

Another lesser reason for why I felt meta now was a good choice, is because just in the last 7 years of reasearching genital surgeries I have seen the surgical techniques improve SOOOO much. Which makes me wonder, what will the surgical techniques be like 10 years from now? If I have meta, and it can at least hold me over for a while, by the time I'm more financially stable (or maybe health insurance finally gets on board) and I can afford a phalloplasty, I bet phalloplasties will be amazingly awesome by then, even more so then they all ready are. But to think about not having surgery for another 10 years, I just can't even fathom that.

Some might say, but ur wasting more money by having a meta and potentially a phallo on top of it. I don't see it as a waste because I can't deal with my body how it is right now. Another thing that goes into my decision is, if you have a phallo and don't like it, you can't say, "okay I change my mind, give me a meta", but if you have a meta first, you CAN later change your mind and say "give me a phallo". So with this surgery, I just see it as a step to figuring out exactly what my wants and needs are. I "want" a big huge penis. lol But do I "need" it to be comfortable is what I'm trying to figure out. And at this point, sensation and natural erections is outweighing the risks of having a phallo. 

Again, I certainly haven't ruled out phallo by any means. After seeing some phallos in person I was actually pretty dead set for a while on having a phallo. Because they were magnificent in person. I swear, pictures don't do them justice. If you're a trans guy and you ever have the opportunity to get to a conference where they have lower surgery show and tells be sure to check it out. Anyways, I've also seen some cute natural looking metas and although they're small, the benefits that they offer might be more up my alley. So yada yada that was a very long winded response on MY thoughts and feelings for my own body and why I have made the decision on simple meta.

If you're wondering why I've chose to have testicle implants and a scrotoplasty, well that because I want balls. lol not every trans men has that done and I can't really speak for their reasoning behind it because I'm not one of them. I want them. I feel like I am going to need them to feel comfortable with my genitals.

If you're wondering why I'm having a "pubic lift" which is basically when they cut across your lower abdomen (in the pubic region) and lift up your skin and sew it shut. I'm having that because it pulls the penis and testicles more up front on the body to a more masculine positioning so that the penis and balls are not so in between the legs. If you've ever noticed on a female bodied person the genitals tend to be located lower on the body then on a male bodied person. So the pubic lift is to correct the positioning of everything.

Okay, well, I'm going to post this, I really need to go back over this to check for spelling errors and revise this draft but for now I'm going to post it and I'll edit it soon. I am having surgery tomorrow morning. I'm a little nervous! But mostly I'm just a bit scared of being in pain. I know my surgeon is going to take good care of me. I'm very confident and comfortable in his abilities. I'm being very realistic about the results I can expect (i.e. I'm not expecting to wake up with a huge penis. lol) so I'm not too worried about being disappointed aesthetically because he's a great surgeon. But when it comes to pain, I'm a big baby! So that's what I'm worrying about. lol And just having surgery in general is a scary thing. But I'm crossing my fingers and overall I'm really really excited for tomorrow. :-)

I will be sure to write about how healing goes. I'd also like to write about why I chose this particular surgeon, among other things soon.

Friday, July 26, 2013

Cost

Many people ask about cost so let me start you off with a cost break down from my surgeon as of my surgery date July 29, 2013.


Cost Breakdown:

Surgeon's Fee: $5,500
Anesthesia Fee: $725
Operating Room Charges: $750
Recovery Room: $275
Testicular Implants: $1,750 (those are some expensive balls!)
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Surgery Grand Total: $9,000 
(and this fee is due in full two weeks prior to surgery)

Then of course, there is travel and lodging which will differ for everyone depending on where you're from. 
If you live near by to the place you're having surgery then recovering at home is going to be cheaper then paying for a hotel room. Travel is cheaper if you are going down the street vs. if you're going to another country etc.


This is my estimate of travel and lodging and I will update this after I actually make the trip.

Hotel: $520 for 8 night stay at La Quinta Inn (I got the room with a fridge and microwave so preparing food would be easier and cheaper)
Fuel: ~$230 according to MapQuest Fuel Estimator for my car (approx a 10 hour drive from MA to OH)
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Estimated Travel and Lodging Total: $750

Other things to consider regarding money:

  • Food Money while you're out there healing. I got a room with a mini fridge and microwave and am bringing a bunch of non-perishable items that I've been collecting from sales over the last few weeks. This is in part because I'm a vegetarian and I didn't want to leave it up to my non-vegetarian friends hunt me down vegetarian food everyday, but mostly I did this to save money because getting take out every night is expensive.
  • Medications Post-Op - not sure how much they cost yet
  • The money you're going to lose from being out of work and bills that you have to pay even though you're out of work! For reference, the Doctor said people with a desk job would be back to work in 2 weeks, and people with a more physical job would be back to work in 4 weeks. I have a physical job so I needed money for the bills to be paid in the next month.
  • (Optional) Activity Money for doing stuff while you're out there, but honestly I don't think I'm going to be doing much of any site seeing. lol I plan on doing lots of sleeping, plus I'm bringing my Xbox360 w/ Netflix, my laptop (and laptop tray because obviously this laptop wont be resting on my junk anytime soon), and Nintendo 3DS with a bunch of games. Point being, if you really want to save money while you're traveling for surgery you can stay inside, rest, and just watch movies/play games or whatever makes you happy.
Okay, well that's the cost information. I'll update sometime soon, hopefully before surgery, with information on why I've chosen this procedure so stay tuned.

Introduction

Hey Everybody,

I'm creating this blog primarily for other trans men who want to hear first hand experience on FTM lower surgery experience. This is also suitable for those curious to learn a little about trans FTM lower surgeries.

There are many surgical options for trans lower surgery. On this blog I will mostly be addressing simple metoidoplasty, scrotoplasty with testicle implants and a pubic lift, as that is the procedure I will be having in 3 days! I will discuss why I have chosen this procedure, what my possible future plans are for having more surgery, and my experience in arranging, having, and healing from this procedure. If this interests you, read on and feel free to share this blog with anyone else who may be interested. Perhaps you're considering surgery, but have some scared family or a partner that wants more information about what it's "really" like, as opposed to just what you read on a surgeon's website. Feel free to share it where you see fit. I intend to be as honest as I can possibly muster up and have no intention of sugar coating things.

I'm nervous as hell but even more excited as my surery gets closer. So let's see what happens!