Last year in January, I flew out here to San Francisco because I needed to stare into the eyes of the person that was going to do this surgery for me. I needed to see the man! TAKE ME TO THE MAN!… After flying to the other side of the country for a quick 48-hour turnaround, I finished my consult with Crane and was flying high as I walked back to the Lucky Drive bus stop in Greenbrae. I rounded the corner and walked over this bridge and saw this view:
I remember thinking: ok, this is it. I’m finally making this happen for myself. I have to wait over another year to bring it to fruition, but I’m doing this! I will make it happen! At that point I had paid out of pocket for the trip out west, as well as for the consult fee itself. I did not have inclusive insurance, only an unstoppable determined will to attain it. Surgery felt so close and yet still so far off… It’s been a long 13 months since then, but it’s absolutely been worth the wait and every last bit of hard work. And it took A LOT of hard work… I walked over this bridge again today, and for the last time that my body is as it is.
* * * * * * * * *
Ok, I admit it. I’m not nervous or anxious at all. But… I’m starting to feel a few butterflies! Getting my pre-op appointment out of the way doesn’t really feel like a factor in the sensation I’m feeling in my stomach. I think it’s the anticipated physical preparations and accommodations my body will begin to go through tomorrow morning that is making me feel like: “ok… it’s here!”
My first friend who will be with me till I’m discharged from the hospital is arriving this evening. Planning on going out for a light early breakfast with her in the morning and then returning to my place alone to begin my bowel prep at 10am. – ain’t nobody need to witness that.
PRE-OP APPOINTMENT –
The following is what I can recall to the best of my ability of my pre-op appointment with Dr Curtis Crane. I’ll just list the questions I asked and his answers to make it easy:
Me: When does the Foley catheter (the one in the phallus) come out?
Crane: Before leaving the hospital on the 5th day
Me: Are you able to start the flap further away from the wrist crease in the way that the UK team does? They seem to be able to do that without risking losing any length
Crane: It seems as though the UK team is using a different artery to hook the phallus up to. It’s more central on the pelvis and therefore closer to the phallus, which would need a shorter “leash”. That method ends up resulting in an abdominal scar and also there is an added risk for hernia. We prefer to use the artery in the thigh, which doesn’t result in the abdominal scar and eliminates the hernia risk. However, our method does requires a longer “leash” of artery and nerve to be taken because the hookup location is further away.
Me: So if I start the flap further from the wrist do you think I would still be able to get a solid 5 inches in length?
Crane: The thing with length is that we can never guarantee any length. You can cut a piece of skin and the exact length you want it to be but when you lay it out it shrinks up some. Some people shrink a lot and others not so much. So we tell people you’ll have + or – anywhere from .5 inches to 1 inch with the midline being about 5.25 inches. Some guys shrink up a bit afterwards and others actually get longer as the swelling goes down and gravity pulls things down more.
Me: So if I request to be a certain length it doesn’t really matter with RFF, because so much of it really comes down to how you heal whether you retract more or stretch out?
Crane: Exactly, we always take the largest flap that we can with RFF. As of yesterday we’ve done 171 phallos and with only 2 have we taken less than the full amount of tissue available, and that was because they specifically requested a smaller length and said that they never wanted an implant. Everyone always asks about length and girth but we always do the exact same thing, every single time. The variations you see in length and girth on the website are all a result of different body types and how people heal.
Me: I’m considering holding off on doing the glans until later in order to reduce complication rates because of my pre-existing scar tissue from surgery on my wrist. I’m really worried about necrosis and I have no problem waiting to do the glans till later. My question is, it seem that the glans that are done in the office post-op are a bit more on the conservative side with the cut that’s made – would you say that’s true? That the OR glans are able to be deeper given the environment in which the procedure is taking place – and that the in-office glans are just a bit more on the conservative side?
Crane: I don’t think I would say that. Everyone wants a really defined glans. The reason you see such huge variations, is that some people just really flatten out after surgery and others don’t. It’s all a product of individual healing. We do the glans the exact same way every single time. But as for your scar tissue we may need to make that call intraoperatively. If the tissue is really healthy and bleeding, we’ll be able to tell that it’s safe to do the glans. If it isn’t bleeding so much, then we’ll know we need to wait.
Me: What do you think about my wanting to leave my SP catheter in for longer than 3 weeks and delay using my urethra for urination for a couple more weeks?
Crane: That’s totally fine if that’s what you would like to do – no problem. Some teams remove them at 2 weeks no matter what, if you have fistulas or not, it just automatically gets pulled. Other teams will leave them in for 3-6 months at the slightest sign of a leak. I like to wait a little longer, have people try to pee at 3 weeks then if there is a leak, have them keep it in for another week or two to see if the fistula(s) close on their own. But it’s absolutely fine if you’d prefer to leave it in for longer and have it removed back home.
Me: What do you think about doing a urethrogram while I’m in the area, before I leave?
Crane: A urethrogram with contrast? I don’t like to do those till at least 6 weeks. Sometimes the pressure that’s created with that test can actually burst open sutures and cause a fistula. (I hope I’m getting the name of the surgeon he mentioned right but he also said that:) For a long time Monstrey(?) was doing Urethrograms on all his patients and that ultimately he didn’t find that the test was all that useful in giving them any information that they weren’t already able to surmise.
Me: Will I have any staples that need to be removed prior to leaving the hospital?
Crane: Yes, you will have staples attaching the wound vac to your arm that will come out when the wound vac is removed. I will be with you of course all day Thursday and then will come see you again on Friday… Saturday – Tuesday I am away but will be back for your first post-op appointment. The micro team fellows will be seeing you frequently and they will be the ones that remove the staples and the wound vac. I am of course always reachable by phone but you will be in very good hands with both the hospital staff and the micro team.
* * * * * * * * *
That was really the bulk of my questions. Any others that I had I can’t remember at the moment.
OH!!! He actually had another surgeon in there shadowing him as well. A very tiny, quiet, Japanese woman who is learning his technique and hoping to bring it back to Japan to help guys there. I was asked if I was ok with her being in the room during my pre-op appointment and I of course said yes. We need more surgeons doing this work and any small way I can help make that happen, I’m on board with. I’m guessing she might be in the OR on Thursday, but I don’t actually know. That wasn’t mentioned, only that she’s shadowing him.
Ok guys, this is it. I might do one more update tomorrow night. We shall see. The bowel prep fun begins tomorrow morning!!!
36 more hours!!!
Tick… Tick… Tick…