30 Days Post-Op RFF Phallo

Hey fellas! Wow, so today is 30 days since surgery! It’s been a wild ride. Lots of different things I’ve felt over the past month – both emotionally and physically. There were parts of this month than FLEW by and other times that to make it a through a single hour of nighttime felt like it took an eternity to pass. Nights were the hardest for me, from day zero post-op till even the occasional night currently. I typically sleep like a baby. However, when you have a bunch of different body parts that need propping, elevating, no pressure, gauzing from leaking, etc… it’s just not conducive to deep sleep, or even much light sleep. On top of that the mind can spin into unhealthy realms at that hour of the night, bringing you to some dark places that aren’t helpful. Thankfully one of the good friends I had with me in California was sleeping in the next room over and a couple nights when I was feeling anxious, I called him to just come talk to me and help me get out of a bad head space. The other thing I utilized very often and have still been using on and off is the healing power of music. I made healing meditative playlists for surgery and I am SOOOO glad I did. It really helped me to stay positive, relax, and was also a sleep aide.

I know this isn’t an uncommon struggle, but I’ll share that I have trouble asking for help, especially when I feel like it’s an inconvenience or bother to someone else. This process was truly humbling and even though I did a fair amount of mental subduing in terms of asking for assistance (both emotionally and physically) it was a lesson in asking for and accepting help and doing my best to receive it graciously.

Ok, so I’d like to do a body scan and check in about all the different wound sites, how they are healing, if there were any issues that arose, how they were addressed and just update on what my basic mobility and day-to-day life looks like right now. There were times, especially in the hospital when they stood me up the first time, that I thought I would never be “okay” again. The pain was overwhelming and I literally felt like I had the weight of the world draped over my shoulders. Even though cognitively I knew I was going to heal, my body felt like it couldn’t possibly recover from the trauma that I had been through. I don’t say this to scare you – it’s just important to know these thoughts and feelings may arise for you – but you’ll be ok. You’ll get through it. Just relax, rest your body lots, play some soothing music, take your meds, nurture your body the best you can with healthy food, plenty of water, supplements, good company that feeds your soul, and plenty of laughter!! It’s good to talk to other guys to get an idea of timelines for how you might feel tomorrow, next week or next month. But don’t get too fixated or frustrated if/when those things don’t happen at the exact same time for you. This is your story, and it’s guaranteed to be different in some or many ways than everyone else you know – and that’s absolutely normal, so try and not worry so much… You’ll worry anyway ;o) but just keep reminding yourself that it’s all gonna work out. It always does, one way or another.

As always, I try to give an as in-depth a description of things as possible, so this is going to be LOOOONG! However, I’m breaking it up into categories, so if you’re looking for specific info you can just jump to the bolded topic of interest or check out the updated photos since the last time I posted at about 2 weeks post-op.

GENERAL MOBILITY AND DAILY ROUTINE: I’m doing pretty well. Wednesday the 2nd I went with a friend to some doctor appointments since we both had phallo a few days from each other. When we were leaving one of the doctors offices on the 3rd floor, my friends used the elevator and I felt inspired to use the stairs. I sprinted down and beat them, by a LOT! I’m not bragging, I’m relieved!… I’m a runner and I’ve missed the endorphins from running and the feeling of being able to move my body quickly. This actually felt like a monumental accomplishment. First, because it was only like a 1 or 2 on the pain scale (tender scrotum). Second, because I was remembering back to being in the hospital and them standing me up on day 4 and how absolutely helpless I felt. I thought I was going to return to my bed and melt into it for the rest of my life. Not true!!!… My personal goals since returning home have been: 1.) that everyday I will go on at least a 15 minute walk with our dog in the neighborhood 2.) that I get in my car and do at least one thing out in the community. Be that to run an errand, get lunch, pick up mail, sit at the beach, get groceries, see a friend, or go for a joy ride… There are other more basic goals I have set for myself but mostly they are around nutrition, personal hygiene and wound care. It’s crazy how long it takes me to brush my teeth, prep my body for a shower (waterproof donor arm), take the actual shower, dry off, apply lotion and ointments, arrange gauze for draining areas, re-dress forearm, take supplements, and eat. That process alone is long and exhausting, but crucial to things healing well and to maintaining good mental health. You might not feel like getting up and showering, but once you do you’ll feel like a new man.

FOREARM (FLAP DONOR SITE):

  • Xeroform: I had heard a couple of guys say that they were changing their Xeroform twice per day. I got it in my head that more was better and at about day 7 I switched to changing the dressing more often because it seemed a bit dry and as though it might be sticking to the graft and pulling it away from the wound bed a tiny bit during dressing changes. My arm started to get a little too moist and I think this possibly exacerbated the issue I was having because the graft was too moist to really dry out enough to attached to the arm. It didn’t cause any lasting issues from what I can tell, but I just mention this because in this case more doesn’t equal better. If your surgeon suggests changing it twice a day, do that. But if they say only once, it’s better just to listen to them. Everyone’s wounds heal different, some are naturally more wet or dry than others and this could be a reason someone else was instructed differently than you. So don’t assume, ask your surgeon.
  • Swelling in Hand: My hand has had a bit of swelling here and there but nothing major. I was instructed by my hand therapist to gently massage and rub the swelling and fluid across the back of the hand in the direction of the “bridge” since that is the only part of the forearm that where drainage is capable of happening. This does help. You can do the same thing with your fingers if you have swelling there. Just gently start at your finger tips, encircle the finger with your other hand and slide it down towards the web of your hand. This will encourage fluid to make it’s way towards the bridge to drain. The back of my hand feels a bit tender, kind of like a bruise when I press on certain areas. Also, I am continuing to have some hypersensitivity in a “V” shape along the back of the thumb on the hand. I have been instructed by my hand therapist to desensitize the area by touching and rubbing it. The instinct here is to avoid touching the area because the sensation is awful, but it only gets better if you retrain the nerves. This is my hand today, at 30 days post-op:

hand

 

  • Strength in Hand: The strength in my hand is probably the best thing I have going for me in terms of my forearm. I probably have 30 or 40lbs of grip strength, just within the hand and that would be in terms of pulling straight traction at the wrist. Lifting something up sideways that would need more wrist flexion or stability is more like 5 or 10 lbs, that’s much harder.
  • Flexibility in Wrist: Passive (or unassisted) ROM (range of motion) is fairly limited. Turning from palm up to palm down while keeping the elbow stable at my side I probably have 80% of my ROM back. Active (or assisted) ROM, I can use my left hand to aide in the turn get it to 100%. Flexing the wrist forward and backwards is the hardest right now. Passive ROM is about 20-25% right now. Active ROM is about 40-45%. I do believe it will get back to 100%. Based on the multiple other wrist surgeries I’ve had (aside from the wound itself) my hand and wrist aren’t really acting all that differently than they have with the past surgeries, which is encouraging.
  • OT & Rehab: Again, in my experience with past wrists surgeries, and this one is proving the same, you really have to push through the discomfort and pain in order to reach your pre-surgery state. If you just wait till it doesn’t hurt before you start to push yourself, the scar tissue is only growing and forming adhesions to the tissues under the skin. Early and somewhat aggressive (or maybe persistent is a better word) exercises and use of the hand, wrist, and elbow will serve you much better in the long run. The first thing I did when I woke up from surgery (seriously, even before I looked at my penis) was start moving my fingers and clenching my fist the best that I could. I really do think that this has it’s benefits in quicker and “easier” recoveries. Your hand/arm isn’t going to feel good regardless of when you start to use it. But as the saying goes, the only way out is through.
  • Slough: I had what is called “slough” on my forearm. I had been worried that underneath this tissue was raw open skin. The split-thickness graft that Crane uses is 1/100th of an inch – that’s insanely thin. So I was having a hard time imaging that there could be anything left of the graft underneath of the slough… I couldn’t have been more wrong. The first photo was taken after I had peeled one tiny piece of the slough off, but the majority of it remained intact. I was really worried about all the dark spots:

slough

However, Dr Crane instructed me to wash my arm gently with a mild cleanser like Cetaphil and to remove the slough. The following is what my forearm looks like after having removed all the slough that would come off. I ended up very very gently using tweezers to remove the pieces that were loose:

healthy

It’s actually pretty amazing. I was shocked. Healthy pink graft!! This is just a great reminder when things are looking rough. Don’t judge a graft by it’s cover. Here are some photos of the underside of my forearm:

The edges of the graft are really well adhered to the healthy tissue around it. There are some areas that have started to blend in quite well and other areas that will be there within a few days I would imagine.

border

This border where the two different splint thickness grafts were sutured together is having a bit harder of a time but it’s doing way better since I stopped the Xeroform and it’s had time to dry out and adhere better. Still, this is the roughest part of my arm right now. There are few spots that are a touch on the moist side, so when I apply moisturizer to my graft I make sure to avoid those areas as to allow them to further dry out:

stitch line

The Leash: This area has been interesting. I feel like I have an unusually long leash compared to some other guys I’ve seen. My incision travels past my elbow. I never asked Crane why this was the case with me. I’m guessing that the place where my artery branched was just at a higher placement than other guys. If that were the case you would think I would have been able to have an extra 1.5 or so inches in length in the phallus, but this was not the case:

leash

I am having some reoccurring swelling along the right side of this incision line on my tattoo. This has been temporarily remedied by gently pressing and rubbing along the right side of the incision, starting closest to the graft and encouraging the fluid to move down the arm. However, it pretty much comes right back. I do have some adhesion along the this incision already and I think normally the fluid would drain straight down but I’m guessing that the adhesion is limiting this draining function. In the meantime, I am continuing with massage to encourage the draining. This photo really captures just how dramatic it looks at times:

bulge

 

THIGH (SPLIT THICKNESS GRAFT SITE): Xeroform finally completely fell off at 3 weeks. Since then I have been using Eucerin on my thigh whenever it dries out, this is usually about 3-5 times per day. It’s really itchy, but the lotion does help some with this. It’s the most itchy when I go too long without applying a moisturizer. The color changes drastically depending on if I am sitting or standing and how cold I am. Historically, during early scar healing, if I’m cold, my scars turn purple. I feel like this usually lasts a solid year for me, but sometimes longer. The purple can be quite dark but as soon as I warm up it turns pink again. I’m not having any issues with my thigh aside from the annoying itching. But itching is a really great sign, because it’s a symptom of healing. So all good things on this front.

thigh

PHALLUS: I have had zero necrosis! My phallus has really healthy tissue, and an excellent blood supply! Incision line on the underside is clean and skin colored with no more scabs. I can still make out a line of sutures that are intact along this incision line. Everything is healing extremely well and I could probably gently pull the sutures out but I definitely won’t be doing that. I haven’t been picking at anything. I’m just letting my body dissolve stitches and scabs at it’s own rate and when they fall out/off that’s great. At day 10 post-op I was walking around the house a fair bit and letting my phallus hang. I was moving slowly and the tension from him hanging was not intense. However, all of a sudden I noticed there were drops of blood trailing where I had been walking, I had had a thick scab that was plugging the tip of my urethra that Crane told me not to worry about removing. I was scared it might heal the UL shut, but he told me that it was normal and best to just try and ignore it. This scab must have dislodged itself and all the drainage that had been waiting to escape through the phallus came pouring out at once! Good times! This mild to moderate bleeding continued for a solid 3-4 days. I was worried about it and emailed Crane. Again, he reassured me that this is normal and was not cause for alarm. It did eventually stop. Currently,  I occasionally have some drainage that barely even drips, it’s more of an ooze and it’s usually a cloudy or light light light pink color, no dark blood anymore. Sorry, I know. None of this is pleasant to hear about but it’s just all part of the healing process. Another thing I’ll mention in terms of the phallus is that depending on how you place him he will get weird creases or wrinkles. More than a few times (because I can’t feel him yet) he’s been in some crazy weird positions and when I unwraped him from all the ABD pads, he looks pretty funky and crooked. He’s taken the shape of whatever odd position I had him packed away in… But DON’T worry, he won’t stay like that. Let him air out and stretch his legs and he’ll be back to normal shape in no time!

GLANSPLASTY: I had my glansplasty done as a second stage. I mentioned the reason in other posts but I’ll state it again, because people keep being confused about why I didn’t have it done at the time of the initial surgery (which most people do who go to Crane/Chen). I had scarring from an incision because of a surgery when I was 9 yrs old. Pre-existing scarring puts you at a higher risk for necrosis and graft loss because scar tissue doesn’t have the kind of healthy vascularity that regular tissue does. And poor blood supply is really the leading cause of necrosis. So I was really vocal about wanting to wait to do the glans as a later procedure, even if they thought it might be ok to do during stage one. So my glansplasty was done at the Greenbrae Surgery Center, which is in the same building as Crane/Chen’s office, the entrance is just on the other side of the building. This procedure was done at 15 days post-op by Dr Chen. He was great and I felt really comfortable with him – he has an excellent bedside manner. I absolutely recommend him, I think he’s just as skilled as Crane. There’s no doubt his waiting list will quickly grow to the length of Crane’s in no time. I talked with him in pre-op about what I wanted for my glans and showed him a picture of the outcome I was aiming for. He was happy to oblige. Initially I was told this procedure was going to be done under local anesthetic, but they gave me the option of propofol which is essentially like general anesthesia, you are asleep and you don’t remember anything. I selected this option. When you wake up from surgery there is no dressing or bandage on the glans, they don’t use a bolster like some surgeons do around the ridge of the corona. There was very little blood and just some bacitracin that had been applied to the glans. When I got home I laid down for a few hours and when I went to get up to unplug my catheter, I noticed my glans started bleeding. I was applying pressure with an ABD pad but I wasn’t really able to stop the bleed. During this time I was in contact via email with Chen. He instructed me to apply point pressure to the area where the bleed was happening. I did this and I was able to stop bleeding eventually for 1 hr. then after standing up again it returned. I applied pressure holds again and was only able to stop bleeding for 1 min. This continued from Friday, starting probably 5 hours after the procedure, till early Monday morning when I called Chen and told him that it just wasn’t working and that I needed to see him. In hindsight, I wish I had been more vocal about the amount of bleeding I was having and the difficulty with stopping it. I don’t have any doubt that I would have received in person assistance much sooner. It was an easy fix and I could have spared myself a lot of worrying and at least 20 ABD pads that I bled through over the course of 2.5 days. Chen asked if I could make it to CPMC to meet him. I figured he was going to need to cauterize something, and he said occasionally they do need to do that but almost all of the time a pressure hold does the trick. The reason they try to avoid cauterization is because you are compromising vascularity, which makes sense. He brought me to a free exam room across from the North tower at CPMC and did two pressure holds using the tip of a bandage and a gloved hand. The first pressure hold was directly on the spot where the bleed was, I had also been pressing there. The bleed did not stop. He then said that because of how they fold the skin over, the location to press on can be a bit away from where the blood is coming out. SO, he moved his finger about 1 cm above the exit spot of the blood and held that for 1o min and VOILA! It clotted!!! He had me walk around the room to make sure it didn’t unclot. After this I had no issues. Such a simple fix, wish I had known the magic spot to press days earlier… For me, one of the hardest thing with this surgery has been asking for help, even from medical professionals whom I know it’s their job to help me. Please don’t feel bad about speaking up and getting your needs met. If you need to, have your caretaker speak up for you.

GLANSPLASTY DONOR SITE/INCISION (right side of groin): Zero issues, steri-strips still on at 15 days post-op. I gently removed them today. No swelling, pain, or infection. Healing perfectly. I can already tell this incision is going to be pretty much invisible. It’s WAY thinner than my hookup incision. This is what it looked like immediately after the steri strips came off, even before washing it:

glans incision

SCROTUM: I am continuing to drain very small amounts of fluid everyday along a small opening along one of the incision lines on my scrotum. Initially I had very severe swelling and bruising, so the draining is actually needed in order to allow the scrotum to expel the residual buildup of fluid. Each day my scrotum gets a little more malleable and softer/deflated, this is a good thing. From the time of creation, it’s an empty sack, but initially it looks REALLY full because of the swelling. In the beginning you think: damn, I’m not even going to need testicular implants. But the swelling will decrease drastically over time. I did mention it a couple weeks ago but I’ll mention it again, I developed what is called an eschar along the scrotal incision line, it looked like a thick black scab. It was in the shape of a cross. Initially it looked pretty rough, especially when I had all the bruising as well. My scrotum was so bruised it looked black. As of last week the eschar had completely fallen off and 100% of my bruising is gone. So my scrotum truly looks nothing like it did initially. My whole sack is 100% pink now and just has that small opening where it’s continuing to drain fluid. I do have a small urine leak at this juncture. Crane is pretty confident that when it eventually stops draining and closes up that the urine leakage will likely stop as well. For this reason I requested to keep my SP in for longer to aid in healing so that urine wasn’t flowing through it and I wasn’t having to press on it after peeing to fully clear the UL of urine and then clean and pat it dry after peeing each time. There is no data proving that it actually helps to keep the SP in for longer, it’s just my gut instinct and Crane was on board with my plan. When I get down about still draining and the small leak from that area I just go and look at photos of my scrotum from 3 and 4 weeks ago and see how drastically I’ve healed in that time frame. I’m really hopeful that another month of healing is going to land me in an even better space. I do recommend taking daily or regular photos for this reason, even if you don’t show anyone and they are just for yourself. They can be great aides in seeing if your are developing any issues and also when you feel like you aren’t making any progress.

PERINIUM/VAGINECTOMY SITE: Initially for the first 10 days or so my vaginectomy line along my perineum looked amazing. However, at about 10-14 days post op I noticed that I had developed a small hole, a little smaller than the size of a Q-tip head at the mid point between where the lowest point of my scrotum hangs, and my anus. Although there is no way to know for sure, I’m wondering if the constant wiping of fluids draining down onto this area from my scrotum, and the regular cleansing with wet wipes of the drainage, if the glue that was used on the outer layer of this incision closure was wiped away and encouraged the hole to form. During my post-op appointment, Crane felt confident that it is going to either close or fill in on it’s own and told to me keep it clean and dry. It does look like it might be filling in from the inside out but it’s an area that is really hard for me to closely inspect, even with the handheld mirror I have. There might also possibly be a little drainage continuing to come from this area, I’m not sure though. And if that is the case, it’s unlikely to close until the draining is finished.

NERVE HOOK UP INCISION (left side of groin): The incision line is clean and healing very well. At day 10 when I was up and walking around, the same day I started to have the bleeding dripping out of the phallus, I noticed that I had some swelling and firmness bulging a bit next to the incision line. This lasted for about 2 weeks. Had it continued to grow and get worse it could have been a hematoma that needed to be addressed, but because it was just a little swollen it wasn’t reason for concern. There is a bit of swelling still present next to the incision line, but it’s definitely decreased over the past couple weeks. Most of the sutures are still present as well. The scabbing has decreased by about 75% and much of it is just healthy skin with the sutures still sewn in. 100% of the sutures that were used throughout my entire surgery were dissolvable:

hookup

SUPRA PUBIC CATHETER: I had my original supra pubic catheter switched out for a clean catheter at 27 days post op. At my first time peeing on day 18, I was already voiding more than 75% of my bladder, but because of the small leak, as I mentioned above, I requested to keep my SP in for some additional time to see if it might hasten or help the scrotum along with it’s healing. Most people get their SP’s out at around 3 weeks with Crane/Chen if there are no issues. Had I not requested to keep it in, Crane was going to remove it at my last post-op appointment, day 20, since it was safe to do so at that point with me easily emptying my bladder through my phallus. Make sure to keep up with cleaning around the entry point to your body. The hole that they create that accommodates the tube in your belly is called a stoma. This hole will want to try to heal around the tube and create little scabs. Once or twice a day, gently clean these scabs from the edges of the skin and from the outside of the tubing. It can be helpful to place a very wet and hot (be careful) washcloth around the entry point for 5-10 minutes to moisten the crusties before removing them.

SP

I really can’t advise strongly enough for guys to order a couple stat locks for your SP. They did put one on me during surgery that I woke up with, but they didn’t have anymore to give me. The hospital only had them as part of an entire catheter setup, and understandably weren’t willing to open a kit just to give me the stat lock that they would need for the kit. Because of the added tension of the collection bag that was attached to the tube in the hospital, the stat lock fell off by the time I left the hospital. But you can get a lot more life out of them when you’re plugging your SP and not using a bag that’s constantly pulling tension on the adhesive. These stat locks can easily be found online for purchase. Order a couple well before your surgery, shipping times can be a week easy. Using tape to secure your SP is a drag. Stat locks are well worth the 6 or 7 bucks that they cost:

stat lock

Urinating: Two suggestions… Make sure you get a couple “graduate” containers at the hospital. These can be helpful for a few different reasons. First, you will need to know if you are voiding at least 75% of your bladder through your phallus before it’s safe to remove your SP and have you only voiding that way. Graduates can be a great way to measure if you are doing this. I was also peeing in one and held one between my thighs to see exactly how much I was leaking through my scrotum. I’m glad I did this because it can be deceiving to just eyeball it. The other thing it’s good for is just peeing into if you have a bit of an unreliable stream at first. Lots of guys spray or shoot off in crazy directions at first. I noticed that my stream was really straight but towards the end of emptying my bladder it shoots to the right a bit when the pressure starts to weaken. Usually this is a result of lingering swelling along the UL and should reduce or completely resolve itself once your swelling has subsided.

I am currently only peeing out of my phallus one day a week to see if the small leak I have is reducing at all. I will continue to do this through this week or possibly next week and then completely remove the SP even if the leak is still present.

Graduate

 

That’s it for now. I’ll probably update again at 6 or 8 weeks. Take care.

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Austin, Texas – Surgery Center Update (and other info)

So I’ve gotten a few new pieces of information over the past couple of days… On June 25th, I actually shifted my surgery date back 16 days from February 11th, to my current date of January 26th, 2016. I am booking with a friend and we initially had the 26th and 28th as our dates but then found out Crane was going to be out of town the following week and thus changed our dates to February. Crane will still be off work the first week in January. However, my friend is feeling like he needs to do this surgery ASAP (who can blame him, I feel the same way) and thus decided to bump his date back to January 28th. In solidarity, I moved mine back as well, except this time to January 26th, since he chose the 28th… I’m not sure why I feel better about it this time but I do. I suppose if I could have things my way, Crane would be available the following week after my surgery, but I feel safe and cared for knowing that he will be there for the first 5 or 6 days after my surgery which for me feel like the time when things are most critical if I needed to have some kind of surgical intervention. Crane typically discharges folks around the 5-day mark, so it’s likely I’ll be out of the hospital and fairly mobile by the time he’s taking off. In addition, the micro team will be available, as well as Crane’s physician’s assistant and a urologist as well that Kelly said she believes will be a reconstructive urologist. In the end I have to ask myself: “do I trust Crane?” because he wouldn’t be leaving me in the hands of folks that weren’t qualified to care for me. And the answer is YES, I do. I believe that I have not only chosen the perfect surgeon for my needs, but in my opinion, one of the most skilled people in the world doing these surgeries with some of the lowest complication rates and he has lost ZERO penises. I know this requires a leap of faith being that the Austin location is a completely new setting. In many ways it’s a new practice even though the constant is Crane. There will be a whole new team he is working with. But I imagine this process of starting up a new practice is going to be more like second nature this time, since it’s literally his second time doing it. Crane’s done this already when he started in San Fran. Granted he took over Brownstein’s practice, but really it was just the clientele that was established with Brownstein’s name. So much of what Crane is doing Brownstein never did in terms of metas with “the works”, v-nectomy, phallo etc. Crane had to create and handpick his whole team and I feel like he’s done a phenomenal job with all of that.  I trust that he’s doing the same thing in Austin. Only this time he’s got a whole lot more practice under his belt.

So, when I first got my surgery date back at the end of May, I pressed for information about where the surgery center was going to be. I could tell that Kelly was hesitant to disclose the location. At the time I had finally gotten it out of her that my surgery might be at Forest Park Medical Center. It’s called: Forest Park Medical Center – Austin (outside of Austin, in Round Rock, Texas which is about a 45 minute drive from the heart of Austin. Anyway, this surgery center (FPMC) is like a hospital version of the Ritz-Carlton. Seriously. It seems like an ideal place to have surgery and to recover in a setting that feels completely different – at least from any hospital I’ve been in. As it turns out this surgery center is still in the process of opening. I’m fairly certain it’s pretty much built (there is a live camera HERE on their website that you can see the place being built) but it seems like they are finished with the outside now and are busy working on getting the guts of the place up to speed. To be honest, I’d prefer not to be some of the first patients in a brand brand new hospital anyway. 6 months – 1 year down the road, ABSOLUTELY! But I’m ok with Forest Park not being ready in time for my surgery…

As of right now, at least if you are having phallo, it will be at Arise Medical Center (everything, or if it’s just for those having phallo. It does seem like this location is much more ideal in terms of being accessible to folks staying in the Austin area. It’s still up in the air about where Crane’s office is going to be. There is a possibility that his office will be in the Arise Medical Center, which would be super convenient. I’m guessing that by the time I get my surgery packet in the mail (around August) that I will know more about that. Also, Kelly said they are currently working on gathering resources for people as far as suggestions about lodging and other helpful information.

What I can say for sure is that currently, phallos are being booked on Tuesday’s and Thursday’s. If you book a Tuesday then you have two options for pre-op. You can either:

A.) Arrive in the area early and meet with Crane’s physician’s assistant to go over paperwork (and Crane as well, by request) the Friday before your surgery… or

B.) You can have your pre-op on the morning of your surgery and the administrative office will send you all the paperwork you need to fill out through the mail as well as your scripts to fill, in advance.

I am not comfortable with doing my pre-op the morning of surgery. I know myself, and I’m too much of an anxious person to feel comfortable with that. I definitely don’t want to feel rushed in my pre-op conversation. I need to feel like I’ve covered everything in a thorough manner – and while that may be possible to do the morning of surgery, it certainly wouldn’t feel that way for me. So for my comfort and to ease my nerves, I will be have my pre-op the Friday before allowing me adequate time in a setting where I don’t feel like I’m “under the gun”.

For those booking on Thursday’s your pre-op appointment will very likely be on Wednesday, the day prior. I say this because when I was originally scheduled for Thursday that’s when my pre-op was set for. And now that my buddy has that date, his pre-op is on Wednesday. So, that’s just some info to consider. Of course, things are always changing, but it seems that’s the case as of right now.

Also, I was under the impression that Crane requires you to stay in the area for one month on average following your surgery. After booking my post-op appointments it seems like it’s actually a bit closer to 3 weeks following your surgery. However, after factoring in arriving a few days early and likely not leaving on the same day as your last post-op appointment (or if you have some complications), 4 weeks does seem almost spot on for general planning. From the date I arrive to my last post-op appointment is 26 days. I intend on leaving no sooner than the day following my last appointment. So I’ll be in Austin for no less than 27 days.

I have 3 post-op appointments setup. It seems that post-op appointments for phallo land on Wednesday, regardless of if you have a Tuesday or Thursday surgery date. Both my friend and I were scheduled on Wednesdays for our post-ops without asking, which is why I suggest that this might be the case. Post-op appointments are each one week out. So this is what my timeline looks like for Austin for those wondering about start to finish and frequency of post op appointments. Obviously though, keep in mind that as with any surgery, especially one of such a delicate nature, depending on how the surgery goes and if I develop any complications, this timeline is subject to change:

Pre-op Appointment: Friday, January 22nd, 2016

Surgery Prep (this is not an appointment): Monday, January 25th, 2016

Phalloplasty – (Stage 1 of 2): Tuesday, January 26th, 2016

1st Post-op Appointment (w/ Dr. Crane’s PA): Wednesday, February 3rd, 2016

2nd Post-op Appointment (w/ Dr. Crane): Wednesday, February 10th, 2016

3rd Post-op Appointment (w/ Dr. Crane): Wednesday, February 17, 2016

Also it’s worth noting that although my first post-op appointment is scheduled to be with Crane’s PA, that is not the standard procedure. I’ll only be meeting with him for that appointment because Crane will be off work that week.

Ok friends. I think that’s it for now. I’m trying to keep people in the loop as much as possible. I know it’s been really helpful for me to track others through their process with all of this. It’s helping to not only inform me, but also to pass the time and keep me sane. In some odd way, following other guys has made me feel like I’m right there with them. Since this process can be a lengthy one, not only in terms of getting to your first surgery date, but from the true “start” to “finish” with often multiple stages, I know I like being keyed in and up-to-date with the most current info. So I hope this helps.

Upcoming topics for posts will include:

  • Laser & Electrolysis Updates
  • Insurance Verification Process
  • Mailed Surgery Packet (received 4-5 months pre-op)
  • Packing Lists, Medical Supply Lists, Surgery Prep, Helpful Suggestions

*** Please feel free to leave a comment if there is anything that you’d like for me to cover that you feel I’ve missed so far… This blog is for you.

Surgery Date Booked !!!

Possible(((Surgery date changed multiple times – final date is February 4th, 2016 in San Francisco, CA)))

Wow, I can’t believe I finally have a date! This all seems so unreal to me. I was just sitting down relaxing before bed and realized I had a missed called from an unknown number as well as a voicemail. I listened to the voicemail and it was Kelly from Dr Crane’s office. I was shocked because it was late – a few minutes before 10pm (I live on the east coast so there is a 3 hours time difference). I texted my buddy to let him know (since the two of us are having surgery the same week, we need to schedule together) then I gave her a ring back.

Kelly informed me that they were beginning to go through their lists of tentative dates that people had requested and are finally booking people for actual dates now that they know which days the microsurgery team will be working (Tuesday’s and Thursday’s). The only factor that is still up in the air is that even though Dr Crane is in-network with my insurance, they don’t know which insurances the actual surgery center is going to be in-network with just yet. They don’t anticipate it being different from the insurances they are in-network with in San Fran, but won’t know for sure until September or October. This has me feeling a bit nervous, but I’m choosing not to worry all that much about it. I’ve gotten to the point that I really do believe that things are going to work out, one way or another. Worst case scenario I will have to make a case for a coverage exception at a surgery center that is out of my network. ABSOLUTE worst case scenario, they deny it and I end up having to go to Dr Chen in San Fran. Although I feel the most comfortable with Crane (granted I haven’t met Chen), I would be fine going to Chen at this point if it came down to it. The main reasons being because I trust Crane’s judgement. It’s just that I prefer Crane as well as the Austin location.

I ended up patching my friend in on 3-way calling and we settled on February the 9th and the 11th. Kelly also started to talk a bit about pre-op appointments. So Crane isn’t around on Monday’s which means that pre-op for the surgery on Tuesday the 9th would need to happen either on the Friday before the surgery or the morning of. Personally, doing pre-op the morning of  just feels a bit rushed to me. Luckily, my buddy is totally fine with it, so instead of getting into town 5 days before surgery, we can just arrive a couple days before. He will have his phallo done on Tuesday the 9th and I will go on Thursday the 11th.

Kelly said that the surgery packet/paperwork will be mailed out to us 4-5 months before surgery. In the meantime she will be working on finding resources for folks while they are in the area – such as lodging, pharmacies, stores, transportation etc. I was able to find out that the address of the new office will be: 801 West 38th Street Austin, TX  and the hospital is going to be: Forest Park Medical Center. I am still a bit confused on the address of the surgery center though, because from everything I’ve Googled it looks like it’s in Round Rock, TX  which is about 20 minutes outside of Austin. This is confusing because Kelly told me the surgery center is less than a mile from the office. I’m going to have to confirm the address with her.

In the meantime… I HAVE A SURGERY DATE!!! Really, this just doesn’t feel real. I don’t know that any of it WILL in fact until I’m very much post-op. Because I never thought that I would get here, a small part of my deep inside feels like it’s just waiting for something to go wrong and snatch this dream away from me. I felt similarly in the time leading up to my top surgery. I was really anxious that my dreams would be dashed and something would get in the way. For anyone that’s reading this and feeling like this will never happen for you, PLEASE know… I was you. This was a distant dream that I truly didn’t believe was meant for me – money being the main factor that rooted me in that strongly held belief. But the truth is that this is a medically necessary procedure and it’s being treated as such more and more with each and every day that passes. If this is something you need, YOU HAVE TO BELIEVE, this will indeed happen. Then, go out and MAKE it happen. It’s a powerful life affirming experience when you breathe life into your dreams – no matter what the dream is. That experience has the power to INform and TRANSform the rest of your life.

“The secret to change is to focus all of your energy, not on fighting the old, but on building the new.”  ~ Socrates

United Healthcare Insurance Update

I found out some REALLY positive news yesterday! I have an amazing HR contact person that has helped me a great deal in finding out info on policies as well as advocating for me. I hadn’t reached out to her since I last had UHC back in 2012. Although my insurance isn’t active yet (it will be another month or so) I decided to reach out to her to see if she was even still working with the company. SHE IS!!! I checked in with her because last I knew the UHC policy I had was offering trans inclusive coverage with a 75k cap. I didn’t anticipate this being an issue until I spoke with Katrina back at the beginning of the year. She informed me that even though Crane quotes patient’s paying “out of pocket” at around the 90-100k price for surgery, this price is GREATLY reduced in order to make it “affordable” to people out of the US and folks within the states that don’t have insurance. But that the full price of the surgery is actually multiple 100’s of thousands of dollars and that even a surgery like top surgery might be like 7 or 8k “out of pocket” would be like $60,000 – $70,000 directly through insurance. So I asked her what cap would be acceptable and she told me there couldn’t be one… I was worried about exactly how this was going to play out with UHC. I could have contacted my HR person months ago, but to be honest I was really afraid what answer I might get about the cap and figured since I didn’t had the insurance back yet, if I did find out they still have the cap, I wouldn’t be able to make any appeals until I had coverage anyway. So for that reason I put it off. However, I finally asked yesterday about the cap and if it still existed and she said there is NO CAP!!! and that actually she didn’t even remember one existing. I’ll have to check my notes about all that because I believe is there was a cap 3 years ago. Regardless, there isn’t one now. So no dollar amount cap, plus trans inclusive coverage, plus In-Network surgeon is really the best scenario I could ask for.

When I received her email I was actually kind of stunned. I thought to myself: “what would it be like for this to actually be an easy process of getting coverage?” For soooo long I didn’t think insurance coverage would be something I would have, and granted I’ve lived through many years of not having inclusive coverage. Then even finally having coverage a few years back with UHC, I worked tirelessly for months trying unsuccessfully to figure out issues concerning an “out of network surgeon” (Meltzer at the time). Still though, THIS process happening now feels new, separate even from prior attempts and it’s going smoothly so far. I am equally parts grateful and equally parts proud of myself for manifesting this reality. Having this coverage did not come without intention. Last year I set very specific goals for myself and have truly hit the marks that I aimed for, each and every one. I am reminded that I am reaping the rewards of my hard work, focus and dedication and achieving my goals. Although this particular part of the process is feeling easy at the moment (health insurance specific), the reason why it’s an utter shock is because it hasn’t been easy getting here… But that isn’t important – what’s important, is that I got here.

On freak outs, feeling frazzled, and finally, finding my way back…

The past 2 months have been a whirlwind of emotion, anxiety, and stress. I believe a lot of the stuff that has come up over this time, as hard as it was to go through, was needed. I feel stronger, granted I also feel emotionally drained from this process. But I’d rather go through as much of the psychological processing that I can of this decision while I’m still pre-op. I feel strongly about needing to tango with every uncomfortable feeling I have that comes up surrounding this surgery. I need to game it out in a way that, although might bring up really difficult feelings, as well as fears, will only serve as a tool in preparation for my outcome and the ensuing new dynamics that are sure to come as a logical part of such a major physical shifting.

For me at least, this process has brought me back to what it was like in the beginning years of transition. The examination of the body, standing in front of mirrors while trying to image changes, lots of introspective thoughts, and unfortunately a sense of finding it hard to just exist in the present moment (wishing surgery was sooner). This annoys me, I feel self-absorbed at times in this process, but I understand and accept that it is time that I need to take with my body to “leave no stone unturned”. This is a way of looking at things from every perspective, from the fantastical to the downright morbid.

Two questions keep popping up in my mind? What do you really want? and What are you willing to risk to have it?….

Fear and anxiety were the strongest feelings I experienced over the past weeks. In the midst of the haze those feelings brought on, I actually lost sight of the main reasons that all along have led me to this point of seeking to make adjustments to my body. In order to allow my spirt to feel “flush” in this physical form there are certain functions that I am seeking from surgery, not merely aesthetic. I’ve known very well that meta, although a perfect option for some folks, just can’t give me the form and function that phallo can. Nevertheless, I’ve spent weeks now trying to convince myself that I could possibly “live” with meta. In this twisting of views I only honed in and focused on the things that meta offered and continuously tried to ignore all that I would be “sacrificing” in choosing this option over phallo as well as focusing on the risks and challenges that come with phallo. I think I justified this process by telling myself: “I’m not burning any bridges, so pursuing phallo in the future will still be an option if need be”.

The truth is, that, well, I’m scared… Yeah, this is a scary process. Honestly, I don’t want phalloplasty. Seriously, there is absolutely nothing about this surgery that I want. Who wants surgery?… But I know that it’s a step I need to take.  This is my evolution, a reconfiguration, through affirmation, my intention born of deep realization… the transformation.

This need isn’t going away. But if I like, I can choose to mask it for a bit by initially pursuing meta. I will try to show myself compassion if that is what I feel I need to do. However, I fear even in the best scenario I will be on to pursuing phallo a year or two from now. Worst case scenario, I see myself experiencing severe depression post-op (meta) because I waited so long for surgery and still haven’t made enough of a change to feel comfortable and be functional in the ways that are deeply important to me – ie: the ability to wrap my whole hand around my cock, feeling the weight and movement of my penis, being able to pull my penis out of my pants to urinate, achieving deep penetration with a partner. These are things that I will experience only, ONLY if I have phallo. This is what I need to remember.

I just want to point out that I am listing these things and talking about this process not in an effort to convince anyone to be swayed in any specific direction for lower surgery. I’m mentioning them 1.) because this serves as a reminder to myself when I’m feeling anxious about surgery, but 2.) because I think it’s important to talk about how we can get caught up in fear, anxiety and perspective and lose sight of the real reasons we’re seeking to make changes. I just want to be honest about what I’m going through. This isn’t easy, and I haven’t even begun the actual surgery process which is going to be all sorts of difficult for MANY reasons, physical as well as emotional and psychological.

In the meantime, this is what is helping to offer me some peace of mind: 1.) reading experiences that other guys have gone through such as blogs, Facebook groups, and Yahoo groups  2.) having amazingly supportive people in my personal life that can listen and offer support while holding my emotions as valid and not pushing me in any direction or pushing their personal attachments to my body being or not being any particular way, on me  3.) reaching out to other men who are post-op and asking questions  4.) journaling  5.) checking in (and when necessary commiserating) with a friend that’s at a similar point in moving forward with surgery… You’ll notice that 4 out of 5 of these things are about community and being supported and truly seen by another human being. Something I think we all so desperately need in life. Trans or not. Seeking surgery or not.

Today I feel grateful to have found my way back to some sense of sanity – in that the fear and anxiety have been greatly soothed. I can’t say that I won’t experience this again in the next 8+ months before surgery. I keep trying to remind myself that this is uncharted territory. Although it is a bit similar to top surgery, the intensity is amplified about a thousand times. Not to mention that even 10 years ago it was much easier to find other guys who had already had top surgery. To go to an FTM support group and have 10 guys take their shirts off and be able to see results up close, in person, and have them embodied by the whole person that lives and breathes and animates that body every day is just a totally different experience than looking at lower surgery photos online – it’s a night and day difference. I feel incredibly grateful that I’ve been able to attend 2 lower surgery “show and tells” at the Philly Trans Health Conference. To say that that experience was EPIC for me is an understatement. I hope to be able to give back some day, it’s so important and desperately needed within the community. I know that I’m just one of hundreds of incredibly grateful men for this gift of knowledge and witnessing of the beautiful bodies and souls that courageously have shared and have yet to share.

Another BIG Milestone!!! (Health Insurance)

I found out last Thursday, April 16 that I am receiving the promotion that I’ve been aiming for in order to be eligible for health insurance through my employer. I knew this position was opening up about 7 months ago and I made it my TOP PRIORITY to prove to all my managers that I was the only person for the job and my efforts have paid off. My boss confided in me that even though she still has to post the position, that I will be receiving the promotion!

The company I work for only gives managers and department “leads” full-time positions and unfortunately they only offer healthcare benefits to full-time employees. This wasn’t always the case. A few years back when I found out that I was working for a company that had trans-inclusive healthcare coverage, the company announced that they were no longer going to be offering healthcare benefits to part-time employees. Before I was able to make surgery happen, I lost those benefits.

I’d rather not say where I work,  but I will say that our company has continuously received a top rating of 100% from the HRC Corporate Equality Index for many years and are listed within the Index. If you have not checked out the Corporate Equality Index, I HIGHLY suggest that you do. A few years back I stumbled onto the fact that I was working for not one, but TWO employers with a 100% rating (that rating equates to trans inclusive coverage, INCLUDING surgeries). It was finding this out that made my plans for surgery feel realistic and feasible. I think starting that conversation with an insurance company before you know you have coverage (and even when you know it already exists) can really be an anxiety inducing, nerve rattling experience. For me it just feels downright embarrassing even though the person on the other end of the phone doesn’t know me personally and will never meet me. But it’s still an awkward thing to call up and ask about coverage or start the process of getting pre-approval for coverage. So I can understand why so many folks are hesitant to do it, and might not even realize they have coverage to begin with. So many of us just assume we won’t be covered, I know I did.

Anyway, I guess I just wanted to document this. I was crazy relieved when I got this news last week. It’s been a huge weight off my shoulders, even though I’m sure there are plenty more obstacles to come. I was going to be pursuing coverage through MassHealth as a backup plan if I didn’t end up getting this promotion. Either that or I was going to look for a full-time position elsewhere with health insurance since all Massachusetts health plans now need to cover trans-related care. The only issue with MassHealth is the amounts at which they are reimbursing which is the true issue…

To be honest I feel a bit guilty for not pursuing coverage with MassHealth because I know there are a lot of people in this position that are on MassHealth and need surgery. I would have liked to have been able to make that path a little easier for others to come, but I feel it would be unwise for me to forfeit this golden opportunity (that I seriously worked my ass off for) that is going to afford me trans-inclusive insurance and has Dr Crane listed as an in-network provider.

Even though I’m not making the process of using MassHealth any easier for folks, I hope that I can at least be a bit of inspiration for people to know that if you want/need this, you can for sure obtain it. I started from the “end” and have worked my way backward. I don’t know if that makes any sense but I started from the point of (1)employers listed high on the Corporate Equality Index, then went after the (2)position that would get me the (3)insurance with that employer. I just sat down and started asking myself the questions that were truly going to get me somewhere. I KNEW guys were having these surgeries covered by insurance and thought to myself: “This isn’t a RARE thing – this isn’t unattainable. These guys with coverage aren’t just lucky, there isn’t anything all that unique about their situations that block me from also making it happen for myself”… It’s the naysaying/negative mindset that will get you trapped into mistakingly believing that your life and your future must be different than it can be! There is so much potential there, you just need to use all your focus and attention to find the path that’s going to lead to where you need to go. I truly believe that this process has a lot of power in my life. Not just the fact that I need lower surgery for a better quality of life. But the fact that this is making me realize that I am able to manifest things in my life in a really big way. Things that I never thought were meant for me… If I can do this, I know that I can really go after and achieve whatever else in my life that I desire and believe in. It might sound corny, but it’s true for me.

My Personal “Pros & Cons of NOT Having Vaginectomy” w/ Phalloplasty

I plan on revisiting this list in the coming months to see if my feelings have shifted at all on the different areas mentioned. But for now, I’m finding this to be a good way of visualizing the many and sometimes conflicting feelings I have about this procedure in a way that hopefully will allow me to make the best decision for myself. I’ve assigned a personal value of importance to each area to create a “total” for both the Pros and Cons to further help weigh this decision.

No Vaginectomy Pros and Cons - 03.13.15