Monday, April 18, 2016

Post Op Day 6

Last night, I set my phone to wake me up just before the sunrise this morning.  Arizona doesn’t switch over to Day Light Savings time, so they are the eastern edge of the Pacific timezone.  That makes the sunrise fairly early.

Just over eleven years ago, I stared out the second floor balcony and caught the sunrise on my last day at Greenbaum.  Today, I did the same.  The sun is further north in April than it is in February, so instead of the sun coming up next to the hospital, it came up over the parking garage.  I guess that’s fitting.

I ordered breakfast by asking the person on the other end of the phone if I could just say, “same as yesterday?”  That seemed to work well.  I went back to sleep for another hour and a half before getting up to do some work and pick the place up.  My nurse came in, took vitals, and gave me my meds.  She said that Michelle would be in soon to remove the sutures and catheter, and then go over the dilation instructions.  My nurse asked if I would like anything for the visit…hinting that something to calm and help with pain would be nice.

“Sounds good,” I said, “except I’ll just take the ibuprofen instead of the hard stuff.”

“Michelle usually calls about 30-45 minutes before she comes in, so I’ll bring the meds by when I hear from her.”

“Awesome!”  The nurses here seriously rock.

I ate my breakfast and then my nurse was in with the meds.  I worked for a while; reading emails and responding when necessary.

Soon, Michelle was there with the suture removal kits, the catheter removal kit, and the set of straight dilators.

Since you have to open the package before you can see what is inside, the labial sutures had to be removed first.  It almost seems like cutting 50-pound wire holding up an 85-pound fish that you just caught.  Once those sutures are cut, you can feel the tension in the labia disappear.  Of course, the sutures still need to be pulled out of the labia, but that’s minor.

After that came probably the most difficult part of the morning: removing the packing.  It feels very uncomfortable having the gauze-like stuff slowly pulled from the vaginal cavity.  It’s kinda hard to describe, but it would sorta be like pulling gauze out of your stomach through your mouth.  It’s not painful, per se, but it’s definitely uncomfortable.

Next up, Michelle removed the catheter by connecting to the valve next to the outlet port and deflating the balloon in my bladder.  Boom…it was out faster than she could say it was out.

Finally, time for the dilators.  You could almost hear music from The Good, The Bad, and The ugly in the background.

She said that Dr. Meltzer was switching me to the straight dilators.  Maybe that will make it easier to hit the hole.

My board.
She lubed up dilator #1 for me and then I inserted it like the good ol’ days.  It slid in almost 4.5 inches before it bottomed out.  Michelle confirmed that we were all the way in.  I kept that in for about 20 minutes before pulling it out and cleaning up.  Michelle wrote my dilation schedule for the next few days on the patient board for the room.  Tonight, I have the dreaded 2am dilation.  I thought I’d never have to do that again.

As the day goes on, patients are starting to flow into the recovery rooms here at Greenbaum.  They said that Dr. Meltzer would likely be up mid-afternoon between cases, and sure enough, he showed up around 3pm with Dr. Tal in tow.  He took a look at the exterior and said things looked good, except for the blisters from the tape.  It will probably and hopefully be the last time I see Dr. Meltzer.  He’s helped me out big on two occasions…SRS and resolving this vaginal cyst discharge issue…and helped change my life for the better in more ways than most people can imagine.

My room from the hallway.
After I filled out the discharge paperwork and we headed to the elevator, I started to cry a little.  My wife saw and kinda laughed.

“You want to leave, don’t you?”

“Of course, but there is something special here that makes saying good-bye very difficult.”

She thought I was joking.  My wife is not trans, so I cannot expect her or any other cisgender people to grasp the vastness of these life changing surgeries and the loving care these nurses provide to us in recovery.

I turned my head from my wife as we drove to the hotel, mainly because I didn’t want to see her laugh or smile as I cried.  After I reached a point where I could talk, I tried conversing more with her on the topic.

My bed for nearly a week.
After we made it back to the hotel, we went back to the restaurant we went to the night before my surgery.  This time, I was able to eat.  I probably ate too much.

Tonight will be my first night not in a hospital bed.  I’ve piled up 3 large pillows so that I don’t have to lay flat and can take pressure off my stomach incision.  I’m planning to take half a pain pill around 11pm, get up at 2am to dilate, and then take a full pain pill to get back to sleep.

Sunday, April 17, 2016

Post Op Day 5

Just a note...NSFW below.

I walked over to Starbucks again this morning, and, like yesterday, I was exhausted when I got back.  If I go slow, I feel pretty decent.

Well, the recovery ward is empty.  I'm the only one here, but yet, when I went past the nurse's station, there are still two nurses here.  I figure it's facility rules to always have at least two here.  At least they have a light load today and tonight, but I'm sure that surgeries will start up again tomorrow morning.

Yum...Culinary Festival!
I took a picture of how things look so far (see below).  I have the usual catheter stuff coming out of the sewn up labia, but I think the labia is sewn up to keep the packing in.  Dr. Meltzer said he was going to slice along each side of the interior vagina and then use skin from the stomach to graft into the back portion of my vagina.  You can see that my skin is very sensitive and doesn't like tape.


Fortunately, though, I was able to avoid the booty blisters this time.  They put one of those large pads underneath me, but it has a plastic layer, as well.  I think the plastic layer retains or reflects the heat back at me.  I think it is what caused my booty blisters previously and started to warm me up this time, too.  I kinda push it to the side, especially when sleeping, in order to keep my booty blister-free.

This afternoon, the wife and I walked to the Scottsdale Culinary Festival here in downtown Scottsdale.  They had some food booths out, and this one rib joint smelled delicious.  I had a small plate of ribs and they totally hit the spot.  It made me wonder if the protein cravings will kick in after surgery.

Round 2 of the catheter.
It was hot out, but we walked slow.  I took along some water because of just how hot it was, but the festival gate people asked me to leave it behind.  When I showed them the hospital band around my wrist, that I just had surgery, and that it was water to keep me hydrated, they let me in with my water.  I'll take it as a small victory.

Saturday, April 16, 2016

Post Op Day 4

With my wife pregnant and a natural sleeper, she doesn't make it over to Greenbaum very early in the morning, but she does usually get me a morning tea.  This morning, though, I decided to walk over to the cafe on my own.

It took a while to get across the street and over to Starbucks, but I made it.  Doing laps around Greenbaum's second floor the past few days have definitely helped get me ready for my first big venture out again.  I was exhausted when I got back, though.

During my later laps today, the nurses have also informed me that I will be the only patient tomorrow as everyone is checking out.

It's interesting this time...I haven't really run into anyone in the recovery rooms and I only brought along my wife this trip.  My stay is also 2-3 days shorter than the average stay for SRS.  Previously, I had at least one friend here with me or chatted and hung out with some of the other people that were recovering.  This time, I haven't talked to anyone else.  It's kinda lonely since my wife only makes it over for a few hours during the day.  Surprisingly, though, the days seem to go by fast.

Friday, April 15, 2016

Post Op Day 3

I took the two pain pills right at 9pm last night and about 15 minutes later I could feel the warmth fill my body as the pain disappeared.  I figured I would sleep through the entire night with the two pain pills.  I woke up and it was still dark out, unfortunately, so I knew it was before 5:30am.  When I looked at my phone, it said 11:47pm.  Sheesh!  I barely made it 3 hours.  Luckily, I was able to get back to sleep without too much trouble, but slept intermittently until around 6.

The shift change happens between 7 and 7:30, I think, and my nurse usually comes in around 7:30am to do vitals and anything else that needs to happen.  In this case, my drains were to be removed.  I thought someone from Dr. Meltzer's office would remove the drains, but my nurse was able to snip the suture holding them in place and then gently slid them out.  It wasn't as bad as I thought it was going to be.

I also didn't realize how far down along the labia the drains ran under my skin, but I think one of the channels for the drains aggravated a nerve in my right leg.  Over the past few days, if I touch my right inner thigh in a certain way or stretch out my right leg so that the inner thigh has any sort of tension on it, it feels like it lights up on fire.  Like, seriously on fire.

Now that the drains were out and I was able to walk, it was time to shower.  It felt good to wash my hair and just sit under the warm water.  Greenbaum needs to fix their shower heads, though, as they pretty much suck…at least mine did.

Thursday, April 14, 2016

Post-Op Day 2

I slept OK last night, but still woke up a bunch of times.  The pain was manageable, but I probably should have requested more pain killers in the middle of the night.  Sometimes I just feel bad getting the nurses in the middle of the night.

My nurse was in early this morning and removed the IV port.  That was basically the first thing to go that was hooked into me.  I still have drains, the catheter, labial sutures, and the packing that will come out over the course of my stay.

After the IV port was out, my nurse showed me how to cap the catheter (the same as I did 11 years ago), and then I was mobile.  While I was up and walking about my room, I decided to wait until my wife was there before we did laps.

Meg also stopped by this morning and took a look at the surgical and graft sites.  She noticed that I had small blisters from the tape.  That seems to be my only thing right now.  Hell, I don't even have any bruising.

After breakfast, I started having gas and very slight pains in the stomach.  Is this a sign that I'm going to poo on day 2?  The first time that I was here it felt like forever until I went poo.  Sure, enough, though, I went poo four times today.  They were relatively small poos, but the stool softener did well and I just kinda let things happen on their own.  Gravity did well.

My wife made it in slightly before midday and we did a few laps throughout the time that she was here.  I only did one lap at a time before coming back to the room to rest.

Tonight, I told my evening nurse that I wasn't getting the sleep that I got with the pain pump.  She asked if I wanted two pain pills.  I said, "yes," of course.  The pain pills are down and I'm having one of my chocolate covered oreos before I jump into bed.  Hopefully it's a good night's sleep.

Wednesday, April 13, 2016

Post-Op Day 1

The PCA button enabled me to sleep about an hour at a time from about 9pm until around 5 or 6 this morning.  It's all kinda hazy.  I feel refreshed, but it wasn't like I slept a continual 8 hours.

Today, I'm on bed rest.  Remembering my first time at Greenbaum, I had booty blisters after less than 2 days.  I think it was due to the absorbent pad they put under you in combination with the coarse fabric of the hospital's disposable underwear.  My body would get hot in those areas and start to sweat, and with constant pressure on the skin, blisters would form.  I guess I just have sensitive skin.

I made sure to push the absorbent pad to the side with the catheter connection and hopped into the nicer disposable underwear in Dr. Meltzer's goody bag.

For breakfast, I ate a bunch of fruit, but I wasn't that hungry.  For lunch, I had a salad.  When I was here with Amber when she had her SRS in 2004, she started back on fruits and salads.  I think it's a good way to get the system going again, plus they also give me stool softener.  I was almost going to ask for prune juice today, but I realized that I didn't want to have to shit in my bed, so I'll hold off.

Dr. Meltzer came in to check on me and said that the surgery went well.  He was able to open up the hole and removed a cyst about 5cm size which I think he said unfolded into the skin that was originally up there.  He said he removed as much skin from beyond the hole, except for a patch that was attached to my bladder.  He said he hit that patch with the cauterizer instead of risking cutting my bladder.  After that, he used the skin graft to reline the reopened portion of my vagina.

I asked him what happened to cause this...did I not dilate deep enough or what...because I dilated like crazy the first 6 months and on schedule for the first 5 years.  He figured that it took years for the vaginal skin to take hold and that it probably gradually closed up.  While he has performed vaginal deepening on numerous people who had their original SRS in Thailand, he said he has had to perform very few vaginal deepening procedures on his own patients.  He said I was around the 4th.  Out of several thousand, that's pretty good.  I just happened to be one of the unlucky ones.

Remembering back to that early gynecologist visit where she dug out the excess surgilube, probably from the same cavity, I wonder if I just jumped up too early in dilator sizes and didn't get the dilator past that little constricted area.  Years later, I bet this is also what caused the half day of funky discharge from my vagina after dilating.  Eventually, I bet it closed off until the cyst started producing discharge that I noticed. 

Dr. Meltzer was off to San Francisco to perform surgeries for Kaiser on Thursday and Friday.  He said Meg would be in to check on me while he was away.

My wife is not an early riser, so she made it in around midday.  Around that same time, they took me off the PCA pump.  No more deliciousness.  Fortunately, they put me on oral pain pills, which I guess are better for the body.

Otherwise, today was kinda boring.  I haven't done much.  We watched a movie on the hospital TV system and that's been about it.  My wife got me a local paper to read and some chocolate covered oreos from Godiva.  They are the manifestation of decadence, and quite delicious, but not quite as delicious as the pain pump.

Well, I'm about to shut down again.  It's late and I need to get some rest.  I figure tonight will be more difficult than last night since the PCA is not there to keep me asleep.

Back in Greenbaum, about to sign off for the night.

Tuesday, April 12, 2016

Day 0 - Surgery Day

I woke up at 4:30am this morning, took my shower, and then packed everything up.  I was ready to leave a little after 5am in order to be at the surgery center at 5:30am.  My wife, who on a normal work day can wake up and leave in under 20 minutes, was having a hard time getting out of bed and into motion.  Let's just say that we go to Greenbaum before 6am.  Seriously, it doesn't take 2 hours to prep for surgery, but I'm sure they want us there early to go over all of it and not have to rush with everyone.

This was my third time at Greenbaum.  I checked in, paid the copay, filled out the paperwork, and then headed back.  We did the normal vital check, and then I took off my clothes and put on the hospital gown.

The nurse prepping me, though, asked, "I just want to be sure...you don't have a uterus, right?"

I smiled.

"No, I don't have a uterus."

After that, I was on the gurney where she inserted the IV port and completed the prep.  Numerous people came by including the transport nurse, a surgical nurse, and, of course, my anesthesiologist.

I just realized that everyone that has performed surgery on me has always been older than me.  At 45, I'm not a spring pup anymore, but it's interesting that my surgeons have all been older then me.  Realizing that I was well past 40 now, and the recovery time from surgery takes a lot longer than my 30's, I had actually spent the past year trying to get in really good shape.  I usually don't get out of shape, but I had a bout of plantar fasciitis hit me about a year and a half ago that stopped my running for several months.  Once I was able to run again, I pushed myself for more miles each month.  Hopefully getting my metabolism in good shape should help with recovery and the ability to ambulate.

My wife came into the OR prep area after a while.  She had already coordinated the delivery of my suitcase upstairs to the recovery floor.  I wanted to do it before surgery because I didn't want her lifting the big bag down from the vehicle while she is pregnant.

Dr. Meltzer stopped by one last time before surgery.  He had ridden in on his bicycle.  Soon, they were ready to take me into the OR.  I said good-bye to my wife and the anesthesiologist hit me with some calming juice.  I actually never felt anything as we drove through the lower hallways of Greenbaum.  Once in the OR, they had me hop over to the surgery table, and the anesthesiologist hit me with something stronger because I don't remember anything until waking up in the recovery area.

Waking up in the recovery area is a very unique experience.  I realized where I was almost immediately, but since I wear strong glasses, I couldn't make out anything in particular.  I tried keeping my eyes open and staying awake, but gravity and sleepiness kept pulling me back down.  Eventually, I was alert and awake enough that they moved me upstairs.  I want to say I made it up here by 2pm.  I had probably been in the recovery area for 2 hours, so it looks like Dr. Meltzer only took about 4 hours, quite a bit less than the 6 hours he said he would usually book.

My wife caught up with me in my room where she was able to put my glasses on me.  Surprisingly, I had stall 14 in the pre-op area and room 14 upstairs. 

The nice thing is that I was hooked up to a PCA pump which delivered a small amount of pain meds on a continual basis, and more pain meds when I pressed the button.  Delicious!  I'm not in that much pain with the low level dose, but when I press the button, it usually knocks me out.

I was actually alert enough to eat dinner tonight, but now I realize that I shouldn't have told them that I was lactose intolerant.  They have shut me down from ordering anything with dairy in it.  The thing is, I have my Lactaid pills with me which enable me to eat dairy without any consequences, but I guess they don't want to risk it.

Anyway, I am shutting down and pressing the button for some delicious sleep.