2 Weeks Post-Op Stage 2 (Semi-Rigid Rod & Testicular Implants)

My stage 2 surgery was on October 11th, 2016 with Dr Chen at the Greenbrae Surgery Center in San Francisco. The surgery itself went fine and there were no major issues.

TESTICULAR IMPLANTS: The right side of my scrotum ended up being a tad bit smaller than my left side and so Dr Chen had to shave down silicone-carvings-1 that testicular implant so that it would fit into the sack. Had he not done this it’s likely I would have had issues with erosion if he tried to force the full-sized medium implant in. The nice thing about the Silicone Carving implants that Crane/Chen use is that they allow the surgeon to modify and shave it down to the exact size of the tissue that they are working with. That way you aren’t limited to just small, medium, or large which is the case with any of the gel or saline filled implants – rather, you can get the perfect sized ones for your body with the carvings if the space you can accommodate falls somewhere between the factory issued sm/md/lg. The other thing worth mentioning that Dr Chen noticed while placing the right implant was that the skin was fairly “thin” meaning I could be at a higher risk for erosion on this side which was a contributing factor in his decision to shave the implant down a bit to take some of the tension off the already thin skin and smaller space. I appreciate his conservative approach and efforts to not make a risky decision even though I expressed how much I really wanted the largest implants possible and to have two symmetrical testicles. These factors weighed heavily into my decision making process when choosing an erectile implant type, but I far and away prefer having slightly uneven testicles than risking erosion and ending up with only one testicle, or even none! Ultimately though, my hope is that over time the tissue will stretch with the weight of the implant, gravity,  and by manually stretching it myself. Down the road, be that many months or years from now I think it’s reasonable to assume I’d be able to fit a full-sized medium implant in the right side as a small revision add-on while I’m having an erectile implant replacement/switch.

ERECTILE DEVICE – SEMI RIGID/MALLEABLE ROD: The model of erectile device that I had placed is called the AMS Spectra, one rod, not two. Prior to1-ams-spectra_300 surgery we had discussed doubling up on the Gortex sheath that he wraps the rod in, in order to further aid in bulking up the penis. Upon getting inside though it became clear that I didn’t have enough space to accommodate a second layer of the wrapping. So my surgery was similar to the technique he has always used when placing the rod. He also told me that he was really happy with the positioning that he was able to get and the angle at which the rod was mounted.
Everyone’s pelvic bones are angled just a bit differently, so they don’t know exactly how things will end up being mounted until they get inside and look. He said that in the OR he was able to fully bring my penis straight up against my stomach and that I had a great range of motion. However, since I woke up from surgery I have not been able to bring my penis up higher than a right angle from my body. I can make it stick straight out but I can’t

dacron
Image on right is similar to the Gortex (Dacron) used to wrap the rod

can’t bring it fully up against my belly. In the O.R. there is no swelling so it could just be that all the edema is what’s preventing me from getting the same full range of motion. However, I’m also noticing a strong tugging/tension on the underside scar (from stage one) that the runs the length from tip to base on the penis. The lower portion of the scar when I try to bring my penis upwards feels like the point of tension that is making me feel like I shouldn’t raise my penis any further. It’s also worth noting that this portion of the scar is hypertrophic (thick and raised, but clear/white in color) so it’s my intuition that this scar is what’s causing the issue and that the reason he was able to bring my penis all the way up in the OR, was because my pain from over-stretching that scar didn’t stop him while I was under anesthesia. However, Dr Chen said upon physically assessing things at my post-op appointment, that he believed it was the swelling at the pubic mound where the incision to insert the prosthesis was made (photos below) that is likely causing the current lack of mobility/tension. He told me to continue to gently but firmly test my limits for how high I am able to angle it and that he thought I should see improvement as the swelling subsides. I’m trying to stay positive while also being realistic. I truly believe it’s the underside scar that’s holding it down and I’m not sure if or how this problem can ultimately be remedied if that is the case. I don’t think it’s an issue that would inhibit sex, but it could potentially limit sexual positions and definitely already does limit positioning options in my underwear since wearing it down is the only angle it is comfortable in, pointing up is not an option. Time will tell if this ends up improving or presenting as a problem that needs correcting. One option I am beginning to mull over is potentially getting Kenalog injections along the scar which might help flatten it, but I’m not sure that it would impact it’s flexibility/stretchability at all, which I believe to be the true issue. Pre-implants I had been sleeping with my penis in an upright position to stretch/flatten this scar because I had noticed that it was thicker and almost seemed to bunch a bit from wearing my penis down all day since it’s right in the underside crease. I will continue to update about this issue as I gather more information about corrective options or as things hopefully positively progress on their own!

ERECTILE IMPLANT INCISION: I’ll be curious to see how the pubic scar on my mons from erectile-implant-incisionthe erectile implant heals as it’s about 1.5 inches below the SP scar, about 1.5 inches long and located less than one inch above the connection point/scar of where my penis is attached to my mons. I’ve had quite a bit of swelling at this site over the last two weeks. If I’m up and being more mobile (ie: cooking, driving, walking) I notice that the swelling here increases. I’ve been addressing this by icing 20 min on, 20 min off and that has helped to decrease the swelling.

SUPRA PUBIC CATHETER SCAR REVISION: This was a super minor revision and unrelated to the erectile or testicular implants. At stage one in February I chose to keep my SP catheter in for an additional 2 weeks because I had a bit of a urine leak coming from my scrotum. I chose to do this to allow further healing of the UL without the added pressure of urine constantly flowing through the healing fistula every time I peed. In doing so, I added to the amount of scar tissue that builds up around the SP tube from belly to bladder, since the longer you leave an SP in, the more scar tissue that grows around it. What formed was a thick stalk of scar tissue inside my body that ended up healing with some adhesion so that the skin at the point of the external scar does not float and move normally over the structures below it – it remains stuck . I’ve tried manually breaking up this scar tissue with massage,  but the stalk of scar tissue under the skin is far too thick. So I asked Dr Chen to break the adhesion since he was going to be “in the area”. sp-scar-revisionThe first 1 or 2 days post-op I noticed that the skin was free-floating and mobile. But after a few days had passed I tried to move the skin and it had adhered to the stalk of scar tissue below it again. I had a conversation with Dr Chen prior to surgery about the SP adhesion and I asked whether or not he would be removing the “stalk” of scar tissue as well, to which he said: no, he wasn’t going to chase the stalk because that increased the risk of damaging surrounding structures, and he wanted to be as minimally invasive as possible. We discussed this re-adhesion at my post-op appointment and he was disappointed to find out it had re-adhered. He said it was good information to know though, so that if he ever did this procedure for someone in the future he would advise them to constantly be massaging the scar early on post-op to discourage any re-adhesion of the tissues. I will probably have this adhesion broken again at some point in the future but I would only do so if combining it with other procedures. Again, it’s not a big enough issue that it causes pain or distress. I would just prefer the skin float rather than stick as it does make the scar a bit more noticeable. But still, really minor issue and not something that would equate to even being a minor complication, rather just a common factor in healing from any surgery that produces a scar -adhesion is always a possibility.

PERINEAL DIVOT REVISION: My body took a long time to heal from the revision I had back in June to remove some granulation tissue that had formed at the point of vaginectomy closure at stage one. I had a fistula (not urinary related, just a hole or opening) that had a lot of difficulty healing. When I had the revision in June it opened back up and again had trouble healing. When I finally used an antiseptic powder on this site, it miraculously closed. However, it was open for so long that it did leave me with a small divot once it finally healed. This time around this area has healed well and when he did the revision there was no granulation tissue at the site which is great! I haven’t gotten too up close and personal in that area because I’m still pretty limited in how mobile/flexible I can be. Squatting is quite painful and I try no to do anything that increases pain, as those were a big part of my post-op instructions. If it hurts, STOP – or DON’T DO IT! I have used the Columbia Antiseptic Powder a few times just to make sure that area is healing over well, but I haven’t felt or noticed any issues with it. However, it does feel like there is minor tactile difference/dip between the perineal raphe and where it connects to this revised area which is about an inch from the anus. It’s subtle but it’s there. So I’m not quite sure yet if the revision actually improved the divot or not. I thought I would include a diagram of the male perineal area which labels all the different structures as a reference point. I thought folks might find comfort in knowing that many natal males have a visible raphe/ridge that runs from the underside tip of their penis to the anus. Their bodies closed this gap in utero, whereas transmen who have phallo and opt-in for a vaginectomy and achieve this closure via an incision line really aren’t all that different from the natal male anatomy in this sense.

raphe_on_male_geniitalia_with_labels
This is not a picture of my anatomy, this is an example of a natal male.

 

PEEING W/ THE ROD: Initially it was a bit harder to urinate the a couple of days following surgeryholding-a as I’m sure I had a good deal more swelling than I do now. I was also in SOOO much pain when I stood up that once I got to the bathroom I needed to sit down to relieve pain before I was able to relax enough to pee. Sitting to pee is more difficult for me and I think it’s something about the changed angle of the neourethra with the natal urethra ever since stage one that has made it a bit harder to pee in that position. I’ve noticed it takes longer to empty my bladder and my stream is weaker when my body is bent at that angle. The differences I’ve noticed with urinating since the rod has gone in is that I prefer to hold my penis differently now. I instead of holding it in the “A” position (pre-implants) I now hold it in the “B” position. The reason for this, is the rod is now filling up my penis as much as is safely possible without minimizing the needed space for the urethra to expand and fill with urine. If I hold it like photo “A” gravity is angling the rod down and adding pressure holding-bagainst the urethra where my hand wraps around the underside and creates further pressure. I can still pee that way if I really wanted to but I can feel the urethra being somewhat compressed and it’s just more comfortable to give it the full amount of space by holding the sides or top half of my penis so that the underside, where the urethra runs is unobstructed. I meant to mention this earlier, but if the last sentence didn’t explain it and you’re still wondering, the rod is placed on the topside of the urethra… This dick-handling adjustment hasn’t been all that big of a deal. Grip “B” is not quite as instinctual or natural as “A”, but it’s a small price to pay for being the proud owner of a hard dick. Also, if I really wanted, I can easily pee without holding my penis at all since the rod really keeps it at whatever angle I put it in. But it just feels more natural to hold him while I’m peeing. And since I’m not really holding him UP exactly when I’m peeing, I’m really kind of just mostly using my thumb to guide him in the direction I’m aiming, if that makes sense.

BENDING THE ROD/STIFFNESS: The rod is actually a fair amount stiffer than I had anticipated. I messed around with the model that was in the office, but I’m sure that one has seen plenty of handling and was likely much looser for that reason. I do think that even in the 2 weeks since I’ve had it, it’s already started to loosen a bit and I’m quite happy about that. There was a palpable clicking sensation when pointing my penis in different angles. I could also hear a very soft clicking noise as the “joints” flexed into different positions, and I can’t say I found that aspect all that sexy. It made me wonder what that sensation might feel for my partner when I was inside them. I’ll have to get back to you on that one as it continues to loosen up. The good news is that I’ve talked with some guys that have had the rod in for months or even years longer than me and they reported that is did indeed go away! Otherwise the rod is easily bent and positioned with one hand. I can move it up to a right angle and even a bit higher. If I am laying down and I point it to a right angle my penis will stay pretty much at whatever angle I put it in. If I am standing it will want to lower a bit, but generally will stay close to the angle that I put it in when I take my hand away.

(GIRTH) SIZE INCREASE: At this point and there is likely still a bit of swelling along the shaft but not much, but I’ve gained close to 3/4 of an inch in girth. This might not seem like a whole lot, but slight increases in girth are much more drastic than slight increases in length, in my opinion anyway. I feel much more comfortable with my girth now. Ideally I would have landed squarely on the 5 inch mark for a nice beefy thickness, but the 4.5ish range feels like a reasonable size to me as well. I can comfortably live with that and feel satisfied.

GUESSTIMATIONS ON EASE OF PENETRATION: I honestly can’t speak from experience about this for obvious reasons. Being only 2 weeks out I’m nowhere near being able to use my guy for play yet. However, I will say that going into this, I anticipated having far less rigidity than I do. Obviously I was getting an erectile implant for the purposes of topping. But a VERY close second on that list was choosing an option that enhanced my current package and really beefed things up. From obsessively reading phallo listservs over the past decade, participating in groups, and talking with numerous guys who have had different models of the rod, I’ve heard more than a couple guys say they wished their erections were firmer and heard some guys have issues with buckling, or the tip of the head drooping over the end of the rod which was possibly placed very conservatively far back behind the glans, etc. But I must say, I’m impressed. My rod goes all the way to within one cm from the tip of my penis, so I don’t anticipate any issues with the head not being firm enough and causing issues with initial penetration. There is zero droop at the tip of my penis. The rod itself bends easily, yet gentle exploration thus far seems to look like it will be plenty firm enough for sex, both vaginal and anal. Again, I’ll have to give factual, experienced-based updates on this at a later time… for the good of science of course!

SENSATION/ORGASM: This is a big one and I almost left it out. Since the rod was placed I completely lost all sensation in my penis. ALL of it. I had the most sensation at the tip which was incredibly sensitive and a few large spots around the shaft where sensation was coming in. Dr Chen assured me that it really should come back and that it’s fairly common but that it could take a few months up to a year to come back and that it’s likely that the nerves are just in shock. I’ll be totally honest and admit that I’m pretty scared. This fear provoked me into making sure I still retained the ability to orgasm even in spite of not having any shaft sensation. I’m happy to report that all is ok. Although I don’t recommend it, since you’re risking detaching the erectile device, we do what we have to do to manage and get through these really difficult surgeries where there are of course no guarantees and a level of uncertainty even though most guys will make out ok in the big picture. I personally don’t know any men that are not able to orgasm. I know guys that don’t have much or any shaft sensation but orgasm is still possible. I won’t get too much into the mechanics of all that and exactly how it’s possible, but I’ll say that the base where my penis was fixed to my pubic mound, is HIGHLY sensate and erogenous. Actually quite a bit more so now with the introduction of the testicular implants and i believe also the placement of the rod had something to do with it. I can actually “reach” (stimulate) my original smaller buried penis easier than I could pre-implants. Hopefully the nerves are just stunned though and they’ll wake up soon. I’ve spoken with some other rod-guys and they had a similar experience. So chances are everything is fine. I also noticed post fat grafting that my sensation decreased a fair amount for a while. It makes sense if you think about it because they are jamming things down into the penis where the nerves are growing for both the fat grafting and for any erectile device, rod or inflatable.

THE BATTLE OF THE BULGE!: Ok, so I’m pretty IMPRESSED! Again, there is certainly some getting used to this aspect of having a firm penis 100% of the time and never being flaccid. BUT, I must say, I really am enjoying it so far! I feel like it’s definitely had the impact on my self confidence that I had anticipated would result immediately following stage one. Had my forearm contained a more dense layer of subcutaneous fat, I think it’s likely that would have been my experience immediately following stage one. But this stage feels really fulfilling for me because it’s finally “scratched that itch” that I’ve been desperately waiting for since stage one and just never felt like I landed on. I experienced some pretty heavy depression in February after my first surgery, I believe in large part because this basic need I had just didn’t feel met. But now I really enjoy how effortlessly I fill out my underwear and I love reaching down and feeling my full package. I can’t speak from the experience of having had the pump (since I haven’t) and being able to compare this to that. But I do believe this experience is a better fit for me, at least at this point in my life given the current erectile device options that are on the market as well as current options for insanely expensive, “permanent” (lasting up to 2 yrs) fillers to add fullness and bulk to the penis. The pump is absolutely amazing in that it allows for the more natural experience of a flaccid AND and erect penis and all the stages in between of becoming erect and filling up. I do hope I get to be able to experience that some day as well. Clearly that’s the more “natural” option for many, if not most guys that are seeking an erectile device. But with my circumstances, I really do like that even though I’ve ended up with a more modest sized penis both in length and in girth, that I appear to be a show-er now, even if there’s no growing that will be happening later on, no passersby actually know that. That’s been really exciting for me – a definite confidence booster. Here are some quick photos I snapped just to show what my guy looks like in undies. The bulge is definitely MORE noticeable with just underwear – and much LESS dramatic/obvious with shorts or sweats on over the top. Also, keep in mind that I do have some swelling still going on (mostly scrotal)… Once I get back home and have more clothing options to play with I’ll probably snap some better photos in a few different kinds of underwear and types of pants, shorts, sweats etc. and model those for you.

 

SLEEPING: It’s still very EARLY DAYS and so I’m sleeping on my back to not cause any pressure on the pubic connection point. This is pretty miserable because I’m predominantly a belly sleeper, and an occasional but much less frequent side-sleeper. I’ve done a bit of side-napping using two very fluffy pillows propping my legs apart and then propping my penis up a bit so it’s not dangling at a drastic sideways angle. But I’m really paranoid that I’m going to fall asleep and then try to roll the rest of the way over onto my belly. It’s hard to know for sure yet, but I think I should be able to comfortably and safely belly sleep in another 4-6 weeks. I am doubtful that I’ll be able to do as many belly facing yoga poses as I was able to in the past though. I can indeed see this device potentially limiting me in that sense when it comes to lying on hard or even firm flat surfaces. Being a really lean guy means that I don’t have that extra belly or thigh fat to buffer the rod that’s sticking out when lying on my stomach. Hopefully I’m wrong about this though. If it ends up restricting my mobility enough it could be the deciding factor in eventually switching to an inflatable.

THE SHWING!!!: Alright, so I am noticing a bit more movement and jiggling while I walk as the days progress. I’m sure the decreased swelling and the loosening of the joints in the rod are probably equally responsible for that. Things of course don’t flop around nearly as much as they did pre-stage two, and it’s undoubtedly a big adjustment. I enjoyed my floppy dick, but not all the time, and not all that much. I didn’t like how it fell between my legs when I was sitting or driving – I felt like it got lost down there. Of course, the lack of testicles I’m sure played a large part in that too. But overall, I wasn’t all that happy with the size of my package. I had always imagined myself having a lot more going on, even though I’m really not a size queen. Anyway, things seem like they’re loosening up a bit. I notice that it is more likely to swing left to right a bit than it is to go in any other direction when I’m walking. There isn’t much downward motion/bounce since the shaft sits firmly against my scrotum and I kind of curve him around my nuts. I wouldn’t mind a bit more of a SHWING when I walk, but I may get that over time as swelling continues to go down, and the device continues to loosen up a bit with some *ahem*, “use”.

WRAP IT UP: I think that mostly covers things for now. My next post: which is already in draft, will be an explanation of Pump vs. Rod – How I Decided. I’ve been getting that question at least daily and I figured it’d be easier to have a post to direct people too with the long-winded reasons rather than typing the cliff-notes version over and over… As always, if you have any questions please feel free to ask or make requests for specific topics to be covered. I will update on all of these topics again at the 1 month mark. I can’t promise that it will be posted exactly one month post-op to the day, but I am still aiming to get all the correct content in for the listed timelines even if they are days or weeks late to go live. Thanks for reading!

Stage 2 – Surgical Prep

~((( JUST A REMINDER: While these prep instructions may reflect the instructions of other surgeons and teams, these directions are specific to patients having any form of implant surgery (erectile and/or testicular) with Dr Crane & Dr Chen. )))~

There is some body preparation needed for stage two RFF (Erectile & Testicular Implants) however it’s very different from the body prep that is needed prior to stage one. There is no need for a bowel prep this time around!!! Hooray!!! However there are two things that were not required for stage one that are required in preparation for implants.

Prophylactic Antibiotics – Two mornings before your surgery you start an antibiotic called Bactrim. It’s a twice daily 10-day course. My surgery is on the 11th, so I start the antibiotics on the 9th which allows 2 full days doses and then one pill the morning before surgery.

Hibiclens Soap or Chlorhexidine Gluconate Wipes – This is an antimicrobial soap or wet wipe that can drastically reduce your chances of acquiring a surgical infection. You’ve got a couple options depending on which you’d prefer to use. Keep reading for additional info that might help you decide between these options.

What is Chlorhexidine Gluconate? Chlorhexidine Gluconate (CHG) is an antiseptic that helps reduce bacteria that can cause infection MRSA. Sage’s 2% CHG cloths contain FDA-approved formula that stays on your skin where it’s needed most. Ordinary bottled CHG soaps require rinsing in the shower. With Sage 2% CHG Cloths, none of the bacteria-fighting ingredient goes down the drain.

Further reading comparing the two if you’re a nerd like me —>  GEEK OUT

You can find SAGE Cloth wipes HERE

The Hibiclens soap you can find at any drug store, large grocery store, or Amazon.

EXTRA SKIN PREP & CLEANSING INSTRUCTIONS FOR THE TRULY OBSESSIVE (this is a 5-day prep pre-op and was not required by my surgeon but is by some other teams and for some other procedures) I don’t know that I’d use the CHG for 5 days prior, but the instructions to use a thin layer of Mupirocin (Bactroban) just inside the nose is a really good preventative, even if only applied the night before and morning of surgery – as staph likes to live inside the nose.

*           *           *           *           *

The following are other items/supplements I chose to add into my recovery regime.

Homeopathic Remedies: I used these remedies for stage one as well and figured it couldn’t hurt to add them in for stage two. The suggested dosage is 5 pellets, 3x per day for each of the remedies. NOTE: 1.) Don’t touch them with your fingers (it affects the potency) tip the bottle upside down and twist the cap… 2.) Let them dissolve under your tongue, chewing/swallowing exposes them to stomach acid which affects potency… 3.) Take them one at a time, don’t dump all 3 different remedies under your tongue at once, again this can, you guessed it, affect potency.

Arnica Montana(30c): Helps with bruising, swelling, and pain

Staphysagria(30c): Helps with the healing of surgical wounds

Graphites or Thiosinaminum(30c): Helps reduce scar tissue.

 

Ice Packs (Thera Pearl): I bought two of these rectangular ice packs in preparation for surgery because I’m anticipating lots of swelling, especially in the scrotal region. I found them on Amazon as “add-on” items. They also come in a round option as well, which I imagine would probably be great for balls!

 

Mesh Underwear: Always a good call for a few days when things might still be oozing and bloody. You can also ask the nurses in the recovery room after surgery if they’d be kind enough to send you home with a few pairs, they’ll usually oblige.

d062632f-070a-4566-9281-4724218caf0f

 

X-Top for Men: These are incontinence sheaths designed specifically for men. You can visit their website and request a sample of each of the three absorbencies to be sent to you absolutely free! The reason I thought to get these was because post erectile implant, while you’re still healing it’s advised that you not milk and shake the penis after peeing, or at least do so with extreme caution as this aggressive movement could cause the mounting point at the pelvis to break away. I figured this might be a good option to use that would protect my clothes and absorb odor. They are pretty pricey though,  so I only got the 3 free samples. Toilet paper will do just fine after I use up these freebies.

 

Edibles (Pain Management): I’ve historically had a REALLY difficult time stomaching any type of narcotic,deb483f7-5131-4b50-a3ca-dcb33f8a702f even with the use of antiemetics. For this reason, in addition to wanting to try something more natural, and because I heard more than a few guys suggest it, I decided to try edibles. If you’re not familiar, think weed brownies. The location where I’m staying in California is about a 4-hour drive from Oregon where they have legal recreational use of cannabis. So I took a drive up there to pick some up. The hope is to be able to strictly use edible THC and CBD to manage pain post-op and completely avoid nausea.

 

COLUMBIA ANTISEPTIC POWDER: I had SUCH good luck with this miracle powder completely healing a hard to heal wound in the past. I decided to have a minor revision on my perineum again and I wanted this close by to use prophylactically. If you are combining your implants and/or erectile device with any kind of perineal revision or procedure, I really can’t recommend this powder enough. Some wound beds need moisture to heal but the perineum is different, it needs to be kept dry.

26c6a659-7665-4cfb-baa1-cd9cf9fb5935

FLEXIBLE TAPE MEASURE: Also, really unrelated to recovery, though it could be used to track swelling. I brought a tape measure to see just how much girth the gortex and erectile rod will truly end up giving me.

95c8ef49-0198-4a85-a386-8e4dabe4a3e7

8 Weeks Post-Op RFF Phallo

{Surgery Dates: Stage 1 = 2/4/16, Glansplasty = 2/19/16}

{Surgeons: Dr Curtis Crane, Dr Bauback Safa, & Bunke Micro Team}

{Locations: California Pacific Medical Center = 2/4/16, Greenbrae Surgery Center = 2/19/16}

GENERAL: The biggest news I have to update about is that I’ll be returning to work on Monday. Surgery was 2/4 and I’ll be returning to work on 4/4, just 2 months post-op!!! Had I absolutely needed to, I suppose I could have return at 6 weeks, but it would have been pushing it. And as it turned out I came down with a fever and I was feeling pretty ill a little over a week ago, so I’m really glad that I’ve had the time to take easing back into my routine, at a pace that feels calm and right to me. A big part of me is already brainstorming picking up a second job to be saving for stage two and plans for moving out of state once surgery stuff is taken care of. However, I’m trying to be mindful that my body is STILL HEALING and not get too over eager with filling my schedule. I haven’t even returned to my main full-time employment yet and here I am looking for a second job. Today I made an agreement that I would give myself at least one month back at work before considering adding on a second employment responsibility. I suppose it’s kinda my MO to work more than is healthy, and in unsustainable ways. Earlier today I was thinking about how I busted my ass in the lead up to this surgery for the sole reason of affording surgery yes, but also to be able to take the time that I needed to heal and rest from working constantly. In the year prior to surgery, I spread myself really thin and self-care practices went by the wayside in order to achieve financial goals to make all this possible. Now, instead of using my free time to take on another job, more than ever I feel like it’s important for me to resume those practices in the forms I’m capable of  in order to aide in a deeper healing as my body slowly gets back to 100%. No Bikram yoga or distance running just yet, eventually though.  It’s been really hard to be in this new form that’s so much more comfortable, finally feeling much more mobile than I was even a couple weeks ago, and keeping myself from going out and doing everything too fast!!! I keep looking at the calendar and thinking back to what I was feeling like at the beginning of this month. I had just arrived back home from California, I had my SP catheter in, my arm looked pretty gnarly, and I was still kinda shuffling around and walking a bit like a cowboy. Somehow I keep forgetting that was this month, THIS MONTH!! Things really can and often do improve quicker than you anticipate, but it was often really hard to see the big picture in the moment. A practice I would have utilized going back in time would have been to write down one thing each day that I wasn’t able to do the day before – or one thing that I noticed improved with my health. It can be really challenging to see the full scope of massive, but slow healing and changes taking place when you’re oozing blood, and knee deep in xeroform, catheters, and covered in hundreds of stitches. But it’s happening, and the pain really is temporary even when it doesn’t seem to be.

HAND THERAPY: Ok, so I was seeing a hand therapist and I wasn’t all that impressed with my care so I cancelled my sessions with her. The folks I saw out in California who were familiar with free flaps and grafts were very well informed. I highly suggest squeezing in 2-3 appointments while you’re in the area, they can even be contacts for whomever you end up seeing once you get back home. The person I was seeing locally just didn’t impress me and was completely inexperienced with grafts. Also, I mentioned it to her twice but she had long nails and when she was massaging my scars, her nails were scratching me and leaving bright red marks on my skin. No thanks… I’m no stranger to O.T. as I’ve had multiple surgeries on both wrists. I also felt like I knew more about graft care than she did, as she admitted that she rarely worked with grafts and never any this large. So I was continuously making suggestions about heating methods, stretching techniques/exercises, and specific “tools” to use to help with adhesion. All that being said, as of last week I started just doing my own thing at home to continue rehabbing my hand/wrist. I might pursue another therapist in the area, or I may not.

I wanted to share a photo of the “torture device” that the folks at Hand Therapy of Berkley and El Cerrito made for me. I was experiencing severe hypersensitivity along the backside of my thumb and hand and exposure therapy is often times all you can do to calm it down – that and time. So this stick has a bunch of different textures that I was given to rub on the hypersensitive areas as much as I could stand… Sounds like fun, eh??!

FullSizeRender-1.jpg

And yes, you’d be correct in guessing that the two in the middle are Velcro. Not a fun sensation, I tell ya – it did work though! Honestly, I didn’t use this device all that many times, but I constantly rubbed fabric on, tapped my fingers, and massaged the hypersensitive areas as much as I could stand and eventually it faded into being hardly noticeable to the point that I totally forgot that it was ever an issue. It is still slightly there, but not much. Now I mostly just have a pretty sensitive nerve running along the radial side of my wrist. It can be downright painful if I’m not gentle with it. I’m hoping with time that that also calms down. I truly can’t imagine being tattooed there given the sensations I feel when just massaging lotion into that spot. It can spike to a pain rating of an 8 or 9 when triggered.

This is Dycem. It’s essentially a non-slip product. It’s used for all sorts of things from opening jars, to coating slippery surfaces to guard against falls. But they also use it in O.T. to help release adhesions that the body forms with the existence of scar tissue .

IMG_2595.JPG

As the scar tissue develops, it wants to adhere and grow onto the tissue below/around it, whereas regular healthy skin typically glides quite freely over the structures below/around it. The Dycem can be placed over the scar and you can press and gently but firmly and continuously work at tugging/moving the scar and encouraging it to let go of the tissue that it’s adhered to. The earlier you begin this practice (even with regular massage and no Dycem) the better. The longer you wait, the more the tissue has grown and adhered, the thicker it will be and the longer it will take to release it. I certainly have a lot of adhesion along my wrist which is why it’s taking LOTS of effort to get mobility back there. I also had quite a bit of adhesion along the bend of the elbow where the leash incision is. For many weeks it was very painful to even attempt to fully extend my arm and reaching out to the side with a fully extended arm was even harder and impossible for quite some time early on.

Another really cool tool you can use to help release adhesion is called the Extractor:Extractor.jpgIt’s actually a tool used to extract venoms and poisons from animal/insect bites/stings. I used to work in wilderness where there was a very high population of rattlesnakes and copperheads – we never carried these kits because they really don’t work for that. However, it IS a great way to more aggressively release adhesion over just utilizing massage alone. It uses suction which is helpful because it literally pulls the scar tissue up and away from the adhesion. Over time I’ve seen scars fully release and the skin is much more mobile. So if you’re having trouble, you might request this at your O.T. appointment or invest in your own for around $15. –> Extractor Pump Kit by Sawyer on Amazon

In terms of strengthening my hand, I did purchase a $10 Gripmaster (there is a name brand one called Digiflex, but they’re both the same thing), which is specifically for both digit and full grip strength. It can work the whole hand at once or individual fingers and comes in a handful of strengths. It’s suggested to use at lower tensions and to do more repetitions rather than going for the highest tension you are capable of and doing far fewer reps. I purchased the 5lb per finger model.

IMG_2594.JPG

DONOR SITE: My graft is doing well. My wrist is still tight because of the adhesions in that area, but I am seeing improvement with my continued stretches. pray-hand.jpgMy wrist is still pretty locked with the scar tissue, so while I will often use the “prayer position” stretch (see photo), as well as just manually flexing my wrist back and forth, I find that placing my hands flat on a counter or down on my yoga mat and using my body weight to slowly progress the stretch is easier. There was a time when I couldn’t stand and place my hand flat on a table because my wrist just wouldn’t flex. So it’s nice to know it is getting better, it’s just going to be a lengthy process for me.

 

SCAR CARE: I ordered a sheet of silicone a few weeks back and I had been using it fairly diligently. Although it’s been comfortable, I haven’t really noticed much difference in the flattening of some of the most prominent ridges along my graft, especially where the two grafts were sewn together. So I ordered this Silipos 3×10 Gel Tubing Sleeve that Olga at CPMC recommended I get, and after just a few hours, my graft had noticeably flattened!

IMG_2604.JPG

 

The sleeve is quite long. I was hoping to be able to cut it in half and get two sleeves out of it, but there’s no way that it would have covered the entire graft had I done that. So I trimmed off 2 in. of it and it fits great. The inside is silicone and the outside is a soft fabric:

IMG_2611.JPG

It’s very snug and getting it on can be a challenge. My method is to turn it completely inside out, slide it just to the wrist crease, then pull it down over itself and back to right side out. Another option if it’s too tight is to cut it open and then use velcro to reclose it allowing easier application and a more catered fit for larger sized forearms. However, the reason I think I’m seeing results with this so much quicker is because this is offering the compression that the silicone patch alone didn’t have. It doesn’t look like it so much from directly above:

IMG_2605.JPG

 

But from this angle I can clearly see how flat the ridge became, it was like a mountain peak just hours earlier. I will say that once I took the sleeve off for a few hours, I did notice the ridge returning some, but I think continued use even over the next 1-2 weeks is really going to yield amazing results, as the expensive silicone sheet that I had been using didn’t have this kind of effect even after WEEKS of use. Maybe if I had always been wearing a compression sleeve over it, it would have helped more. I’ll be sure to update on this.

IMG_2607.JPG

The one thing that I did notice with this silicone sleeve is that because there is no hand compression and the sleeve is also pressing down on the bridge where the only drainage from the hand exists and thereby slowing/limiting fluid from moving away from the hand, that I did have a bit more swelling in my hand. I mostly noticed the swelling in it when I was moderately to heavily using my arm. So I started using the Isotoner “compression glove” in tandem with the Silipos sleeve when I notice my hand getting more puffy.

IMG_2644.JPG

PERINEUM: My v-nectomy site is still having issues closing. One week ago (03/17/16) I had an appointment with a urogynecologist in the Boston area. Yeah, yeah, it wasn’t ideal, and it was awkward initially to be walking into an area where people are receiving very gendered care, but I knew it was the place where I could see someone who does this specific procedure, and it was worth it to me to endure a little embarrassment and dysphoria in order to have a specialist look at my wound in person rather than just sending Crane photos. I had no signs of infection, but I wanted confirmation via a culture and a second opinion about the wound. It is still the same size as it has been for many weeks now, it hasn’t gotten any smaller, it’s still a little wider than the size of a Q-tip head and I can stick about 2/3 of the cotton tip into the hole. Granted, because this is a hole, the healing does take place from the inside out, slowly filling in. So healing rates can also be really hard to determine. Crane’s instructions when I left Cali were to keep it clean and dry. So I had been using a squeezy perineum bottle to wash and thoroughly rinse and dry the wound a couple times per day. FullSizeRender-3.jpgBut still it was continuing to exude fluids and was staying more wet than dry. For peace of mind I just wanted to have a specialist start following me in the instance that I needed or decided to have this closed surgically i.e. “primary intention” rather than waiting for it to close on it’s own, also called “secondary intention”. Either way, I need to wait 3-4 months. It will likely take that long to heal on it’s own, and even if it doesn’t, they wouldn’t go in to surgically close it until at least that much time has past since my initial surgery. So either way it’s a waiting game. The good news is I was instructed to start packing the hole. I say “good news” because now I feel like I’m doing something proactive to aide in its closure, whereas before I was just washing it with soap and water and patting it dry.

PACKING A WOUND: I had heard of guys needing to pack wounds before but I really didn’t know what this consisted of. Were they using regular gauze? Did they dip it in some kind of solution or medicated formula before packing??? I had no idea. So I thought I’d give you the lowdown on wound packing, or at least what I’m doing these days to pack mine. I guess I haven’t quite ditched the “packer” swag yet. :O) Depending on your wound size and how exudative it is, you may need to do something completely different, so check with your provider for personalized medical care and instructions. This is just to give you an idea of what the process can be like.

Here’s my little setup: Small handheld mirror, Q-tips, Tweezers, Scissors, and 1/4″x 15′ Iodoform packing strip. The Iodoform packing material smells VERY strong, like a hospital.

FullSizeRender-2.jpg

I say packing STRIP, singular, because it’s just one long continuous strip and you simply cut off what you need. It takes about 1.5 – 2 inches of this tiny gauze to fill the hole. I trim off a piece and use a Q-tip to press about a centimeter of the gauze in at a time. Then you just leave a short tail on it for easy removal once it’s completely soaked and needs to be repacked hours later. And voila!

IMG_2600.JPG

IMG_2601.JPG

I really wanted to give props to and pass along this surgeon’s name because he was more than kind to me. Even though he was booked up for many weeks out, their office was incredibly accommodating and squeezed me in within 2 days of calling and explaining my situation. It can be really challenging to find good care, or even just subpar care where you aren’t having awkward interactions with every single healthcare “professional” that knows your trans status. But Dr Roger Lefevre, his phone and front desk office personnel, and his physician’s assistant/nurse definitely gave me 5-star care at Beth Israel Deaconess Medical Center in Boston, and I made a sure at the end of my appointment with him to take the time personally thank him and his staff for their kindness and professionalism. I was treated like a regular human being seeking medical attention, as I should have been, but unfortunately that’s still an all too rare experience in most places. If you’re in the Boston area and need any follow-up care regarding your v-nectomy site, I’d highly recommend this gentleman. The office location IS in an OB/GYN wing, so that’s something to consider. You might feel more comfortable bringing a woman with you so it looks as though you’re there as her support. But at no point did anyone tell me I was in the wrong place, question my gender, or even make a hint of a weird face about me being there, and I’ve been on Testosterone for well over 10 yrs now. So while I was internally very uncomfortable entering and checking into a women’s area, externally I wasn’t being treated awkwardly and I really didn’t notice any patients looking at me funny either. For all they know there could be another treating physician unrelated to OB/GYN care in that wing. I think most people are focused on their own stuff and didn’t see anything odd about my presence… Ultimately I feel confident knowing that if I need to seek surgical intervention to close this site in a few months, he is a geographically close and viable option and willing to help.

FullSizeRender-4.jpg

 

SCROTUM: I actually meant to mention this in my previous entries but forgot. About 2 or 3 weeks ago I was looking my scrotum over with a mirror and noticed that I have an area along the far ends of an incision that runs horizontal across my scrotum that is like a little pocket. One side is a sizeable pocket and the other side is really practically not there at all, about 75% smaller. Sorry, this is kind of gross, but I’m just going to be honest because I had never heard of this experience and I’m all about transparency through this process and I think the more information that is available, the more easily you can be on the lookout for things that could potentially arise in your own medical process. Also, the more people hear about varied experiences, the less likely they are to feel alone if/when it happens to them… So, the pocket when I found it hadn’t been washed since my surgery (like 5-6 weeks earlier) so it essentially had a HUGE buildup of smegma in it. I didn’t even realize the pocket existed until I pressed down and around the edge of the end of my incision and the pocket kind of turned inside out. What the inside looks like is there is some slightly sebaceous tissues within a pocket-like formation. It seems to be the skin that transitions from the outside of the labia majora to the inside where the skin is thinner and more moist and hair free. It’s that thinner moist-ish tissue (I know that because both the sensation and visual matches that of that exact same tissue pre-op) that is inside this weird little “pocket”. It’s gotta go!!! I can bury most of the cotton part of a Q-tip into this pocket. It just feels dirty and like it’s an area begging for infection. In the meantime I’ve been soaping it up and using the squeezy bottle to spray water in there to totally rinse it out. And I’ve also use Q-tips to clean it. I’m not into Q-tipping this ball-pocket indefinitely. So I’m looking at a scrotal revision to get remove it and possibly a small v-nectomy revision to close the small wound if it isn’t closed by 3 months. Because of also needing the scrotal revision, it’s likely that I’ll pursue having both of those issues addressed in New York, either by Dr Nikolavsky or Dr Zhao. I know both are in my network, but I haven’t yet reached out to either of them – it’s on my to do list. I’m hoping that I can get the revision out of the way sometime in May, or the latest, April. I suppose I could wait till October when I have my stage 2 done, but given the way my body reacted to the initial scrotoplasty (severe bruising, swelling, and developing an eschar) I’m worried that trying to revise my scrotum AND place implants might result in, or at very least unnecessarily heighten my risk of extrusion occurring. I feel more comfortable with staging this revision many months away from implant placement so that I have plenty of time to heal.

I think that’s all for now. Not really much new info to report on the other wound sites. I’ll save photos till there is a more noticeable progression in healing.

6 Weeks Post-Op

Well, another milestone. Today makes 6 weeks since I had RFF with Dr Curtis Crane in San Francisco, CA. Things are coming along well. I did make a brief post when I had noticed that my small urine leak which was coming from my scrotum, closed up. Since my last big post at 4 weeks, the biggest changes have been that my scrotum stopped leaking (both urine and other fluids that were draining), and my SP (supra pubic) cather was removed. Those two things were HUGE for me. Honestly, since the time I started plugging my SP (at 13 days post-op) and was able to ditch the catheter bag, having a SP catheter got A LOT easier. It wasn’t a big deal – it wasn’t exactly ideal either, but it was manageable. It was mostly just annoying, and thankfully not painful. But still I did have a constant worry of something accidentally getting snagged on my tubing (even though it was under my clothes), or accidentally tugging on it with my hand when I would reach into my underwear to adjust my guy (that WAS painful). There was also general tenderness around the opening where the tube entered the body and the need to clean the opening a couple times per day so the scab didn’t take over. So while it wasn’t a huge deal to have the SP, and I mostly tried not to think about it, it was an utter relief to have it removed.

Before SP Removal.jpg

I felt human again afterward. From the time you arrive at the hospital the morning of your surgery and get that first medical device hookup up to you (usually an IV) you’re connected to a ridiculous amount of stuff – both devices and bandages, for many weeks. So as you shed them, one-by-one it’s like coming to life again. It seriously felt like being reborn, especially with the introduction of your radically altered anatomy!

After SP Removal.JPG

Everything felt new and fresh and I was soooo grateful for the freedom and mobility that has come with each new step towards full health. haha. It’s like that scene in Forest Gump when the bullies were chasing him down the dirt road and Jenny yells: “Run, Forest, RUN!!” And as he does he starts to bust out of the leg braces that he’s been wearing forever to help straighten his back. Annnd, life is just never quite the same again.

FOREARM: My arm is doing well, and looking super healthy:

Top Side @ 6 Weeks.JPG

At this point the graft is 99% healed and has been for a while. I’m well past any fears with it “not taking” which can be worries early on with patches looking odd and all sorts of colors going on.

Underside @ 6 Weeks.JPG

There are too teeny tiny scabs still present, both existing along incision lines. One where the two grafts are sewn together:

Graft Merge @ 6 Weeks.JPG

And the other along the edge of one of the incisions that meets the “bridge”. If I am too rough with massaging it with lotion they will open a bit and bleed the slightest bit. You might not even be able to see them in the photos because they are so tiny…

Bridge @ 6 Weeks.JPG

I continue to have some mild to moderate swelling in my hand. The amount of swelling really fluctuates depending on how much I’m using my hand and what I’m doing with it. The more physically demanding, the more edema.

Hand @ 6 Weeks.JPG

Funnily enough these two hand pictures were taken just moments from one another. Just an example of how deceiving photos can be. You don’t really see how swollen my hand is without the comparison to my non-donor hand, and the different angle helps too:

Hand Comparison @ 6 Weeks.JPG

I also continue to have some moderate swelling along the tattoo/incision line towards my elbow. But otherwise, the “leash” incision line has flattened out really well. Initially there were some weird puckers going on and they’ve completely smoothed out without a whole ton of effort on my part, just minor occasional massage.

Leash @ 6 weeks.JPG

Finger strength is pretty good. It was measured at my OT appointment 1 week ago (3/10/16) and it’s almost 2/3 of my non-donor arm. I think my grip strength with my left hand was 70lbs and my right was 45lbs. So still strong, but indeed has a long way to go. Wrist flexion continues to be my biggest noticeable issue/hinderance with my donor arm. I’m hoping in another 6 weeks that I’ll have about 80% (or more) of my range of motion back. I’m currently going to OT 2x per week. I planned my surgery to happen at the beginning of the year so that once I hit my max out-of-pocket the rest of my care for the year would be free. So my OT appointments are totally free now. No co-pay and no co-insurance. I think I have 35 visits per year, so I’m utilizing all the “free” care that I can get. I could certainly rehab my arm myself, but since I have the time and the free care, there’s no reason not to take advantage of it, it’s part of why I planned things the way I did… I’m using Eucerin on my forearm 1 or 2 times a day (I applied it more frequently initially). I have my silicone sheet that I just got recently –> Cica Care Silicone Sheet and I’m planning on wearing that for at least 6+ hours at a time to really help continue to flatten the scars out and blend them in with the surrounding tissue. This silicone sheet is VERY comfortable!

Cica Care.JPG

There is also a much cheaper option of a silicone sleeve that you can find on Amazon for a fraction of the price. It was recommended by Olga, one of the hand therapists at CPMC and she said has been used by a lot of guys. Depending on your graft size, you might even be able to cut it in half and get TWO sleeves out of it. You can find it here –> Silipos Gel Tubing. I was also given a cheap compression “sleeve” at OT (the one that’s cut off a long wheel and then they cut a hole for your thumb):

Compression Sleeve.JPG

It’s ok. I’ve worn it a couple times. It’s long enough that it covers the area I’m experiencing edema along my tattoo at the beginning of the “leash” incision point. They do wear out after a week or so of use and you eventually need to replace it. The other issue is that it doesn’t provide full compression coverage in my hand where the majority of my edema is. So I’m overall not into it, since it doesn’t address my main need from a compression garment at this time.

My hand therapist also fitted me with a relatively cheap compression glove at my OT appointment and charged me $12 for it. You can buy them here.  –>  Isotoner Glove. I ended up being an extra small. You might want to just have your hand therapist measure you for one so you don’t order the wrong size. It seems as though I’m a medium in most other gauntlets that I had been looking at online, so I was surprised when I was an extra small for this one.

Isotoner Glove.JPG

Today she started me using thera-putty and charged me $7 for one container of the orange strength.

Putty.JPG  Putty.2.JPG

FYI, you can buy a set of 4 containers/”strengths” on Amazon for $9 with free shipping –> Therapy Putty. I’ve always been given putty for free at every other OT location, so I was surprised they charged me for the putty and the glove. I have even been given a silicone sheet for free which are much more pricey than putty and an isotoner glove.

I’ve been given lots of hand exercises to do, with and without putty. I’ll include photos of the exercise sheets. From my first appointment at 10 days post-op, till present:

IMG_2402.JPG

IMG_2404.JPG

OT @ 6 weeks.jpg

THIGH: My thigh continues to itch like CRAZY! I’m often tapping or slapping at it though my sweatpants to make it stop… it doesn’t. So lotioning is really the only thing that helps. I’m applying lotion and massaging it probably 5-8 times per day. The lotion feels good but the massage really helps to stop the itching for longer than just a quick “rub & run” application (*wink). When I’m massaging it I can really see how the tissue is healing. I’m better able to see which areas are going to fade sooner than others and the general look of the scar is less severe after spending just 3 or 4 minutes doing this. I’m still experiencing drastic changes in the scar color depending on what I’m doing and what my body temperature is. If I’m colder or well vascularized it’s still turning a dark purple color:

Purple Thigh.JPG

If I sit down and rub my thigh for a minute it turns this pink color again and the purple fades away. This is just my personal experience with new scars – it will eventually stop.

Pink Thigh.JPG

PHALLUS/PEEING: Man, I feel like I am like an 8 year old boy. I am sooooooo grateful to have a penis and be able to pee from it. That function alone has totally transformed how I feel IN and ABOUT my body. When I stand in front of the mirror and look at my shape I am still just utterly amazed. Standing sideways looking at my profile and seeing my penis jutting down and slightly out is just so amazing. Even the color changes when I stand up – it flushes and turns a shade of pink, especially in the glans!!! I wasn’t expecting that and I view it as a total bonus for the time being, even though I’m planning on having veins tattooed and adding a more natural or flushed genital skin tone at some point. I honestly still can’t believe it, there are so many feelings I am still processing about all of this – mostly gratitude and joy. At times it’s just so overwhelming and I can’t fathom the reality that I am finally a man with a penis that I can relate to, and that I feel whole. I feel more whole than I ever dreamed was possible with this process. I’m not sure if this statement will convey what I mean for it to, and I hope that it doesn’t come across as offensive, because I certainly don’t mean it to. But I don’t feel like I have a phalloplasty – I just have a penis. And I’d imagine that’s probably a really common experience among the men that have this surgery. From the moment I woke up from surgery, I immediately felt it was mine, but when I had my glans done 15 days later, I deeply related to my phallus as the intrinsic piece of my body that I had been mourning for 31 years. The flesh, the warmth, the hang, the jiggle, the sensation of it in my hand as it fills up like a hose and thickens when I pee, and having something to shake off after I’m done. I’m sure these things sound ridiculous and silly to to people that haven’t lived with a missing body part that’s integral to so many different daily bodily functions, as well as being so intimately woven into their gender identity. But these seemingly “small” things have radically transformed my life in ways I don’t know that I’ll ever “get used to” or have the capacity to take for granted. When you’re life’s biggest need and deepest wish convene and MANIFEST, new ground is broken and what lies beyond is completely unknown territory. I feel like a massive mental landscape has been swept clear for me to focus on other crucial areas of development, growth, and pursuits that I was incapable of fully accessing till now. I still have lots of healing and stage 2 (erectile and testicular implants) to take care of, but the majority of the emotional shift for me with this surgery has already occurred and truly exceeded my expectations.

GLANSPLASTY: I am now 4 weeks out from this procedure and my glans is healing SUPERBLY! I haven’t had any issues with it since the bleeding drama I had while in SF. Once that was stopped using a 10 min pressure hold by Chen at CPMC, there have been zero issues. I was applying a layer of bacitracin to it 2-3 times per day for like 2+ weeks and then stopped about 10 days ago. There are still visible sutures present at the glans. I don’t pick at or try to remove them. I just let them do their thing. If they clearly appear to be unattached and dangling, then I will give a gentle tug or trim it. But only if it’s long or likely to snag on something.

GLANSPLASTY INCISION: This incision is of course also 4 weeks old, as it was the location where the graft was harvested to use on my phallus for the glansplasty procedure. The incision line looks beautiful. It’s thin, and very flat. I can still feel a few sutures present. Again, not messing with them. I’m happy to let them hang out till they’re ready to let go.

Glansplasty @ 4 Weeks.JPG

You can also sort of see the SP scar hidden in a nest of pubic hair. The scar has an interesting shape to it. It’s fully closed, and has been since within 24-hours of the catheter being removed (10 days ago). However, I feel like the pubic skin while I had the catheter, was being pulled down by the weight of my phallus more so than it was when they initially placed the catheter. At the time of placement, my phallus hadn’t yet been created and so I don’t think there was any tug happening to pull the skin down, I was also in a supine position. But after 4.5 weeks of having it in and the skin being pulled down a bit by the weight of my penis while I sit or walk, I think it contributed to a bit of a dimple. Here’s a closer look at it:

SP Scar @ 6 weeks.JPG

When you have an SP in the body starts to create a tunnel of skin that heals around the tubing. Once the tube is removed and the hole closes up, but the outer tunnel/scar tissue still remain. So when I press/rub on the scar I can feel where the tunnel used to be. I haven’t done any massaging of this scar yet, but I think with a little regular effort working at the adhesion, I can likely resolve the minor dimple.

NERVE HOOKUP INCISION: I’m fairly confident that all the sutures have finally dissolved/fallen out along this incision. I have done ZERO massage or moisturizing of this area – I probably should as it would likely help to lighten the scar. The nice thing about it though is that it largely blends in with my natural hip/groin crease.

Hookup @ 6 weeks.jpg

SENSATION: I still only have partial sensation in my scrotum. The far right side (opposite of the nerve hook up) is highly sensate (both tactile and erotic) but the rest is still numb. From what I understand this is not unusual and sensation could take many weeks or months to return. In terms of the phallus, I have both tactile and erotic sensation in some spots on my mons pubis around the connection point of the phallus. I was not expecting this, this is new. It’s a radiating sensation that feels like it’s coming from my pre-surgery penis – it’s interesting. Also, when I tug on my phallus or when I walk around with no underwear on, press my hips up against a counter that I’m leaning against, or grind into my bed while I’m laying on my stomach, I feel erotic sensations coming from the base where the little guy is buried. I started having orgams at day 34, just shy of 5 weeks. Having the ability to both pee from my penis, and orgasm is a total relief. Knowing that I can already orgasm while having zero sensation in my shaft, and that things are only going to get exponentially BETTER… well, it’s a beautiful life. I’m really looking forward to the nerve hookup growing in, but I am surprisingly not desperate for it. It just feels like an exciting bonus that I’m going to slowly start to experience – an unfolding of sorts. The painfully long wait just for my penis to be here and to gain the ability to stand to pee made me all the more grateful for it. I anticipate a similar experience in that over the next 2.5 years while full sensation grows in, in equal parts will grow my gratitude for that gift of that sensation, having had to wait for it as well.

VAGINECTOMY: I am continuing to deal with a pretty minor hole that opened up along my vaginectomy incision line. This experience is all too common and usually rectifies itself – so I’m not too worried. In the meantime it’s mildly annoying because it is leaking a very tiny amount of fluid (far less than it was initially) but it’s also tender and sore if I sit completely upright and put pressure on it. I keep it clean and dry and do a visual check of it almost everyday with a mirror. There looks to be no sign of infection, no puss, no red irritated skin around the small opening. However, to be on the safe side I did reach out to my local provider who performed my hysto exactly 4 years ago. She doesn’t personally do vaginectomies so she referred me to a provider that does. So I’m going to call on Monday and see if I can get in to have him take a peek at the wound and possibly swab it just to make doubly sure that there is no infection going on. It’s always good to play it safe. While I do feel somewhat self conscious of that area seeing as there is currently a form of small hole going on, I feel safe knowing that the provider who did my hysto and performs them on tons of transmen, gave me the referral. I also received a call from Crane’s office today and one of the nurses was checking in on me. I updated her about this issue and she reassured me that this is super common and eventually it WILL close up, but that it wouldn’t hurt to get it looked at by a professional. Hopefully by the next time I make another update it will have closed up/filled in. But I know it’s not uncommon for it to take many months at times. I can’t complain, this is a very minor thing and everything else has gone so well.

STAGE TWO (IMPLANTS): I’m currently aiming for stage 2 with Chen in San Francisco. Crane said I could have that done as early as October, which is when I’m hoping to be scheduled. I’m waiting on a call back from their scheduler to set an exact date. The plan right now is to get the inflatable, and one testicular implant, since the implant will utilize one nut for the placement of the bulb to pump up the inflatable. I hope eventually they design the bulb on the pump to emulate the size and shape of the testicular implants that are available. It’d be really nice to have two testicular implants that are more closely symmetrical. I don’t think visually it will really be noticeable, but it would be nice to feel the symmetry as well. Until just recently with the “Zephyr Implant Line” up and coming there were no erectile prosthetic implants that had been designed specifically for the neo phallus, and the FTM one at that! The current pumps with their odd shaped bulb is designed to be implanted in the cis male scrotum, and the patient retains both of their testes (assuming they have two). So it was never meant to replace a missing one, as it should in our case… I’d be tempted to ask for two testicular implants as well as the pump and just have the bulb be a third entity, as it is in natal males that have an IPP (intrapenile prosthesis) or ED (erectile device). However, it’s my understanding that the European teams site that the most common reason for failure of the pump is typically related to tightness and lack of space in the scrotum. For that reason alone it wouldn’t be worth it to me to risk it. I think I will be getting the Coloplast inflatable and either a medium or large testicular implant (whichever fits).

Alright. That’s all I got for now. I’ll catch ya again probably around 8 weeks if I feel like there have been some changes that seem worthy of posting about in the next couple of weeks. Take care guys. Thanks for reading and of course, feel free to ask any questions or make requests.

13 days post-op, follow-up appointment

Crane instructed me to start plugging my catheter today, and to try to pee on Friday. I had thought I would wait longer to use my UL but everything has healed really fast. If I have leaks on Friday I’ll stop peeing from the phallus and wait another week or two for more healing to take place. I get my glans done one week from today by Chen at CPMC and then home the following day. I had to wait on the glans because of scarring on my wrist from a surgery when I was younger…

 

Thigh is doing well. ZERO pain there, just very slow to peel away – Started trimming the edges two days ago.

                            

(Left Photo: Inner Thigh – Right Photo: Outer Thigh)

I have been experiencing shooting electrical shocks at the point of of my pre-phallo penis. It feels like it’s at the tip of my original glans.It’s odd and started at about 3 days post op. It’s my understanding that this sensation is nerves firing off and beginning to find their way again before growing into the phallus.

When I have my glansplasty done next week Crane said they will take a full thickness graft from my groin, the opposite side that they did the nerve hook up on. I had been under the impression that for “2nd stage” glansplasty that they take it from the upper thigh, but I guess not. This will all be done under a local anesthetic at CPMC.

Not too much else to report. I’m healing well. The severe bruising and swelling that I initially had in my scrotum has drastically improved. I am still dealing with an eschar that is sloughing it’s way off but each day it looks better and better. I’m honestly shocked at how incredibly natural my scrotum looks, I love it. Will be out of this world once I get my testicular implant and the pump in 9 months or so!

             
My arm is doing really well, the graft is taking, and my fingers are capable of doing A LOT! Started hand therapy Monday at Hand Therapy of Oakland & El Cerrito. They were wonderful and are experienced with free flaps so it wasn’t awkward and I trusted that they knew what they were doing. I definitely recommend them to anyone looking to get a jump on O.T. before returning back home. Even if just to check in with and get some instructions from folks that are familiar with this surgery. I felt welcome, respected, and comfortable.

The scar near my elbow where they took the leash of nerves and artery is a bit sore – mostly when I extend my arm out all the way. This is part of what I’m working on in OT. It appears that there were no sutures used at this location, only glue.

                       

If you have any questions or if there is anything I missed feel free to ask.

8 Days Post-op… Hospital Re-Cap

Hey folks, I’m still alive. Sorry I haven’t updated till now. My top priority has been resting and healing and although I want to be active in keeping up with updates, it’s of course more important that I focus on recovery. This surgery really takes it out of you. So much of the ways you are used to being mobile, caring for yourself, doing painfully simple things for yourself, peeing, really everything, changes at least initially after surgery. I have often felt like an infant during the early days because I’ve been completely at the mercy of those around me in order to get my needs met. I guess I’ll give a rundown of my experience at the hospital. The exact day-to-day occurrences really float out of the mind pretty quickly. So I’ll do my best to recall what I can.

Surgery Day – February 4th: I got to the hospital early, around 5:45 for check-in. It was very quick and easy. The registration process was incredibly streamlined, the nurse goes over the paperwork with you and you have a touch-computer screen facing you. Whenever you need to sign a document, you just sign the screen and the documents are all electronically saved. This took not much longer than 5 minutes and then my friend and I were brought down the hall, she waited in a family area while I was taken back to get changed, tagged, IV’ed and gurney-ed. They give you a Bear Paws gown that if you want while you are waiting, you can hook up to a tube that fills the gown with warm air. They are specially designed to keep your body at optimal temperatures during surgery. My friend was eventually called back to wait with me about 30-45 min later. I met with the anesthesiologist, Dr Crane, Dr Safa, and the micro team came in briefly to introduce themselves to me. When it was time to go I said goodbye and they wheeled me down the hall to the OR I was fully awake and not sedated at all when I was brought into the OR. I have had that experience many times before but I suppose it was a bit more intense this time because I was looking all the around the room at the multiple tables they have set up with hundreds of medical instruments of each one. If this surgery didn’t feel real up until that point, it absolutely did then. The anesthesiologist told me he was going to give me some medicine to feel relaxed and that was it. When I woke up the first thing I remember seeing was my donor arm. They had the wound vac on it but they hadn’t placed any sort of splint on it (grafted areas REQUIRE early immobilization). One of the micro team members came by to check on me in the immediate recovery room that they bring you to while you are first waking up. It’s the same area as pre-op. He seemed shocked that my arm wasn’t splinted and went and got materials to brace my arm and came back. He splinted me and then fairly soon after I was moved to the TICU unit. At some point in the hours after I was moved to the TICU unit they noticed that there were some issues going on with my scrotum. I had severe dark, dark bruising and swelling that engulfed my entire scrotum and then spread down to my butt cheeks and onto my thighs. I looked like someone beat me with a bat. The scrotum was black but the other areas were a deep purple. They started worrying that I had a hematoma. The ice chips they had been giving me occasionally stopped and they were assessing whether or not I needed to be brought back into the OR to fix a hematoma. At this time you are being checked with a doppler to assure healthy blood flow to your penis is occurring. You will also have a headed pad that forces warms water through tubes and into the pad to keep your penis nice and toasty. This helps to keep the blood vessels unrestricted and very open so they can do their job the best they can. You are also hooked up to about two dozen things. Probably 6 or more wires on your chest, an Oximeter on your finger, a blood pressure cuff that goes off randomly, nasal oxygen tubes, plus the other things I mentioned already. You also have at least one drainage tube coming out of you, usually the scrotum, but I also had a teeny tiny little tube at the end of the groin incision where they do your hook up. Plus a foley catheter coming out of the tip of your penis. It’s a lot!

Day 1 Post Op: Multiple doctors were watching me and eventually Dr Crane came in the next morning before surgery and said that he didn’t think it was a hematoma in my scrotum and he didn’t want to rush me back into the OR if it wasn’t absolutely necessary because there are added risks every time they put you under – and more risks of infection. He went and did another case and said he’d be back to reassess. When he came back a few  hours later he decided it wasn’t critical to bring me back to the OR and would be a better plan to just wait it out and watch the area and see if it healed on it’s own.

Day 2 Post Op: I believe I was brought to the 3rd floor on this day? It’s still very regular care by the nurses but it’s not as intense as the first couple days when they have you under very close observation in the TICU when things are the most critical and likely to go wrong. Most of my nurses were very attentive and kind and made sure to check on me and make sure my legs were comfortable and propped up on pillows and my donor arm was elevated and I had everything I needed. I believe my nurse Reza hit this one out of the park, she was an angel. The most attentive nurse I’ve ever met. Mimi and Raymond were also very kind. The time goes by slow, especially the nights when they are coming in to Doppler your penis and check vitals every single hour. It’s hard to get any normal sleep. Pain medication makes you a little drowsy, but when I started to have itching and they gave me benadryl, it was the benadryl morphine combo that I really began to look forward to because it allowed me to occasionally get more than 30 minutes of sleep. I think this was the day they came in and cut the ace bandage off my thigh where the split thickness graft was harvested from. Under the Ace bandage they had place a Xeroform dressing. This is the same stuff you dress your arm with starting the the day you leave the hospital. It’s yellow and greasy. When they cut the Ace off blood is pretty much everywhere. They bring a huge hot air blower over to your bedside and it stays aimed at your thigh for the next few days till the Xeroform turns black with beaded up dried blood on it. You leave this on your  leg till it falls off – trimming the edges as it naturally releases from your skin underneath.

Day 3 Post Op: I was a bit more awake and with it by now. I was able to call and order room service but often they would need to call and remind me that the meal window was closing and ask if I wanted anything. It was nice of them to do that. I’d think I wanted food and then when it came I usually didn’t eat much. The fruit bowls and juices were mainly what I lived off while I was there. Over the next few days the issue with my scrotum started to look better and better. Much of my sack was slowly turning from bruised black, back to pink again. However there remains a scab-like crusty spot on part of it that is still black. This is called an “eschar” sometimes they flake off on their own and other times they need to be removed surgically. We are still watching this. It’s not uncommon for them to take many weeks to resolve.

Day 4 Post Op: Time to stand up! Wow, so this is really intense. Aside from just feeling weak from being in bed for 4 days, everything is very very tender… ok painful. The female nurse that was in the room with a male nurse as well preparing me for this event kept telling me that I’m going to want to hold my penis when I stand up because I’m going to worry it would fall off. She wouldn’t stop talking about this. She kept telling me how unnecessary that is and that I shouldn’t hold it and that it’s on there securely and that it was essentially irrational to hold it while you walk. I was  tempted to say: “hey lady, don’t tell me what to do with my dick.” I felt like she was actually bothered by the fact that we want to support it. Honestly, I’ve seen far too many separations happen at the shaft and scrotal areas that I plan on supporting my new equipment till I am more than certain that it isn’t coming off. I don’t care how irrational anyone thinks that is. I waited my whole life for this package… I sat for about 10 maybe 15 minutes at the most and then asked for help back to the bed. Sitting was highly highly uncomfortable and I was really slouched back to take all the weight off of my perineal area. Not fun. Once I got back in bed I stayed there for the rest of the day. But I was able to get up late at night and use the toilet to have a bowel movement. This was quite an experience, being so weak, and still in so much pain, with two tubes coming out of your (bladder and scrotum) still attached to the wound vac, and trying to balance on the toilet while experiencing going to the bathroom for the first time with new anatomy down there. It was kind of mind blowing. I might not have related to the genitals that I had, but I had of course gotten very familiar with the sensations of voiding and even having a bowel movement is a very different sensation. Everything feels different and I was pretty obsessed about not wanting my new package to touch the toilet seat, so that will be an interesting new challenge. I finally made a toilet paper nest and was able to lay him across the seat.

Day 5 Post Op: The micro team came in quite early. I heard them coming down the hall and they said: “You know what day it is?!” and I said Yes I do!!! And they said: “It’s GRADUATION DAY!” There were 4 or 5 of them and all within about 3.5 minutes they had pulled out my scrotum drain, pulled out my doppler wire, pulled out the drain on my groin scar, ripped off my wound vac, and re-bandaged me with my first round of Xeroform and Kerlix wrap. It was not the most pleasant experience of my life but it was over fast. Deep breaths… Deep breaths… It was a Tuesday and I was scheduled for my first post-op appointment the next day, Wednesday, so Dr Crane just came up to my room before I left and met with me briefly there. He told me I didn’t need to come to the office the next day and that I could just come to the office next week. I was grateful because I was feeling overwhelmed just by the idea of getting back to the AirBnb house. Thinking about leaving the next day seemed absolutely dreadful. After I met with him I saw the hand therapist Olga (?) she’s VERY VERY nice and she made me a splint and talked with me for quite some time. She also gave me information about finding a hand therapist while I’m still in the area. Then I got all my scripts and paperwork together and they packed me up and wheeled me downstairs so my friend could drive me home.

That’s what I got for a re-cap from the hospital experience. I think most people are unsure of what all is going to go down for the actual surgery and the time until you are discharged. I hadn’t intended on writing so much but I hope it helps those who are curious.