On June 8, 2004, I had sex reassignment surgery in Neenah, Wisconsin. I've been asked to write up a report of my experiences in hopes that it might help someone else who may be seeking information about the experiences of others. My intent is to leave this document on the web indefinitely. I didn't take detailed notes, so these will be general recollections, although they will be relatively fresh, since I am writing at just over ten weeks post-op.
First, a little on how I came to select Dr. Schrang for my surgery. I began exploring the path toward SRS in early 1992. Dr. Biber was the big name among surgeons, although Dr. Schrang's name was beginning to be mentioned. As the years progressed, too many negative reports about Dr. Biber's work surfaced for me to keep him on my short list. Then in the mid 90's, Dr. Meltzer in Portland began to be mentioned by a growing number of former patients, nearly all glowingly. Less expensive alternatives in Canada, and later, in Thailand gained adherents. The doctors in Montreal had mixed reports, although the aftercare in the Residence was almost universally praised. Precious few negatives came from patients of the various Thai surgeons, and the economics worked in their favor, even including airfare to the other side of the world. But in my mind, the SRS experience would be stressful enough if everything went just perfectly. I didn't feel that I wanted to deal with the potential of a difficult recovery, trying to make myself understood in a language that is not native to the caregivers in Thailand.
I had stepped away from the online community for a few years, but I began reading and participating in a few lists in late 2002, hoping to hear if there were any new surgeons' names that were getting people excited. The only new names I heard were from countries other than the US, so as I approached a decision in the summer of 2003, my short list was back at two names: Schrang and Meltzer.
Dr. Schrang has been doing talks at gender groups all over the country for years; I had seen his slide show twice, but had never seen Dr. Meltzer. For such an important decision, it was in my best interest to get up close and personal with each candidate. Over the course of a week in September 2003, I visited with Dr. Schrang in Wisconsin, then with Dr. Meltzer in Scottsdale.
Dr. Schrang's office is a rather spartan affair, with sometimes one, sometimes two office assistants. He has a large inner office that doubles as the exam room. We talked for a while about the procedure, and then it was time for the physical exam, for which I disrobed while he remained in the room.
Dr. Meltzer's office has a sleeker feel and a larger staff. I interacted with four separate staff members in addition to the doctor himself. Some of the staff had accompanied Dr. Meltzer to the Harry Benjamin conference in Belgium the week before, and we were able to compare notes, since my beloved and I had vacationed there recently.
Had all things been equal, I'd have probably decided to go with Dr. Meltzer for the surgery, but he demurred when I had a special request. In preparing for SRS, I had lost about 100 pounds of excess weight, and really wanted a tummy tuck. Dr. Meltzer suggested that the skin being pulled up to close the tummy tuck and the skin being pulled down in order to create the neovagina was too close, and would be working at cross purposes. This seemed like a reasonable explanation, and he did say that he would do a tummy tuck coincident to the labiaplasty, if I wanted to do it that way.
I expected that even with the depilated scrotal tissue, I'd need a graft to make an adequately deep vagina. I also wanted to avoid the large square scar I'd seen on other graft patients. The skin harvested from the tummy tuck seemed a natural option to me. When Dr. Schrang agreed there'd be no problem with the tummy tuck coincident to SRS, the decision was made that he would be doing my surgery. It was scheduled in early June so that my beloved, a schoolteacher, could accompany me to Wisconsin. Earlier dates would certainly have been possible, which debunks the myth that Schrang's schedules are full 18-24 months into the future.
So, that brings us to the day before surgery. If you choose to go to Dr. Schrang for SRS, be sure to read all his instructions carefully. As for me, when I got a package of papers, telling me to be here at this time, and there at that time, I assumed (ouch!) that one of the appointments was for the internist exam. Nope. We were eating lunch at Uncle Ned's Deli on Wisconsin Avenue, when I did a final review of some papers I had brought, and realized that I didn't have an appointment to see the internist!! Oops! Quickly I got on the phone, and they were able to make room for me to be seen right after I went in to see Dr. Schrang.
With the appointments done (the internist said I was ten pounds lighter than when I left home - can I take his scale home with me?), it was on to the hospital. I was shown to my room, and met my roommate, who was due to be discharged the next day. She was resting, having been on one of her first few walk-arounds after a week in bed.
Of course, you've heard the stories: the next step is the arrival of the Nu-Lytely bowel prep. This stuff actually wasn't too bad. I'd done a colonoscopy a few years earlier, and was given a similar product called Colyte. Having been unable to finish the Colyte, I wasn't looking forward to Nu-Lytely, but I managed to choke it all down, in about an hour more than the minimum time.
Again, Nu-Lytely wasn't as bad as I had feared, but wait! Next comes magnesium sulfate, and I'm not talking about the carbonated version that you get from Walgreens. You get three doses of this stuff, about ten minutes apart, about an ounce each time. It is unspeakably vile tasting. Give the nurses credit, though; they will forewarn you that it's best to treat it as a shooter, and have your (apple juice) chaser ready to follow it.
In the midst of all this is a number of trips to the toilet, of course. Some have recommended using some Vaseline to combat the chafing from the repeated wipings. That seemed to me to create more mess than it cured, so I just toughed it out.
Now that my GI tract is cleaned out, it seems to be a good place to mention something that I never saw in all my research on the process of SRS, and reading the stories of those who had been through it. I don't know if you're actually empty inside, or if you fill up with gas whether you eat something or not. All I can say is that a day or two after SRS, I hadn't eaten very much, but what I had consumed was pushing around the gas (even if it was just air) that had collected in my intestines. Let me tell you, it was painful. No, it was PAINFUL. It wasn't the kind of pain that the Demerol drip is designed to alleviate. It was transitory, and I recognized it for what it was. Anyone standing within a few feet of my bed could hear the massive rumblings as collections of gas moved from one part of my intestines to another. You'll get through this, but just know that it's not unheard of to have these gas pains. They're like no other gas pains I'd ever had before.
During the evening, I was given a razor and asked to shave as much of my pubic region as I could. I'd had four rounds of perineal electrolysis, so that part was clean, and I shaved off as much of the rest as I could safely reach. Later, a nurse came and shaved the rest. Following that was the betadine paint job, a sedative, then sleep. My beloved stayed for a part of the evening, but left fairly early, since she had to be up and about in time to be back before I was carted away in the morning.
I was awakened about six a.m., having slept the sleep of the just. My departure from the room was delayed about an hour or so; apparently Dr. Schrang had other customers that morning. Finally, about eight a.m. I was wheeled to the staging area, where another nurse took vitals and asked medical history questions. I guess it was to make sure I gave the same answers. But what if I had memorized the same lies?? Oh well. My beloved walked along with me as far as she could, then it was off to the waiting room for her.
More waiting in the staging area, then finally, Dr. Schrang showed up. He asked me to stand, and then started drawing on my abdomen, so that he'd know where to make the cuts for the tummy tuck. Not more than ten minutes after that, I was wheeled into the operating theater. The anesthesiologist greeted me, started the IV, pushed in the knockout drops, and away I went. My supposed 7 a.m. operation finally started somewhere between 10:30 and 11 a.m.
I was awakened (so I'm told) somewhere about 7 p.m., in my room. I acknowledged anyone who spoke to me, and asked them to make sure they signed the calendar page that hung on the wall opposite my bed. I didn't think to make any of the jokes that others have told - things like "thank goodness, no more tonsils (appendix, etc)." But my beloved did say that all the different people I'd asked to sign the calendar (I thought there were quite a few) turned out to be only two folks. I know I asked about a dozen different times. In any case, the two who heard me passed the word around, and I wound up with quite a few autographs on my June 8, 2004 calendar page.
During most of the week, I don't recall experiencing much pain. The first couple of days, I'd hit the Demerol button repeatedly, just in case, but it was mainly just to keep me asleep; I had very little else to do. The food was not all that great, and I actually wound up losing about ten extra pounds during the week. I had made a list of people I wanted to inform about my surgery and gave it to my beloved to call. Several of them called me back during the week, including several family members I hadn't heard from in years. Also, my online friend Marsha drove up during the weekend from Chicago for a visit. She and I are both rather quiet types, but she was able to commiserate with me on having to lie there in bed for such a long time.
On the third day after surgery, the IV line is removed. It can only stay in the same spot for so long. They asked if I was in much pain, and since I wasn't, they didn't start a new IV in another location. I went on oral pain meds for the rest of the week.
The biggest problem I had throughout the week was staying comfortable in the bed. Normally, you're instructed not to turn on your side. I couldn't handle that restriction. My roommate, who had breast augmentation, said later that she tried turning on her side, but it was too painful for her. I didn't have BA, so it was OK for me. Even though the air conditioning was running, I still got sweaty when lying on my back, I think because the mattress is vinyl and doesn't breathe. When I left the hospital, there were a couple of spots on my back that looked like beginning bed sores. Once I was up and around, they abated pretty quickly. In the meantime, I certainly looked forward to the evening time when a nurse would come around with the sponge bath. I turned on my side and she scrubbed my back, then dried it and powdered it, for the best physical sensation I had all week.
There wasn't much of note during the rest of the week, until stand-up day. The only time the TV got turned on during the entire week was on Sunday, when the NASCAR race was on. Oh, OK, I'll confess. A couple of times during the night I rolled over in bed and managed to grab the wrong part of the nurse button and turned on the TV instead. That wasn't so bad, except that you can't just turn the TV off. You have to step through all the 35 or so channels before you get back to the "off" channel.
So now we're up to day 7, "Stand-up Day." Again, since I didn't take detailed notes, I'm going on foggy memory (lots of Vicodin between then and now!). It wasn't terribly early in the day - perhaps lunchtime or early afternoon. My catheter was removed and I was raised to a standing position beside my bed. Having been forewarned, I was ready to feel woozy, but I actually felt pretty good about getting out of bed. I made the full lap of the 2nd floor at Theda Clark, then went back to bed. I wasn't really tired after the one lap, but thought it would be better not to push it.
I took a few more walks that day. I don't recall noticing before then, but I discovered during this time that I had a sore spot on my bottom. I don't know if it was a hematoma, or a hemorrhoid (which is just a particular kind of hematoma), or something else, but it was painful to sit down. I really wanted to go to the end of the hall where the picture window looked out on the helicopter hangar and the Fox River and get some sunshine. But sitting was just too uncomfortable.
The next hurdle was going to the bathroom. I'd heard stories about people having to be re-catheterized, or held in the hospital for an extra day or two, waiting for all the bathroom processes to restart. Pretty quickly I was able to urinate, but never felt the need for the other business, other than passing the gas that had been painfully rumbling around all week. In fact, having "number two" is apparently not a requirement for release from the hospital. Good thing, too, since it was two weeks following surgery before that happened.
There was a scary time that evening when I was given an opportunity to take a shower. I was more than ready, but I was about halfway through washing my hair when I started to feel woozy. A combination of things, probably, including reduced stamina plus the heat of the shower. I just barely got the shampoo rinsed out when I headed for the stool and pulled the nurse call cord. There was no loss of consciousness, but I was wheeled back to my bed, where it took about an hour for me to feel better. Once I was out of the hospital, I was able to shower with no difficulty.
The next day was release day, which meant removing as many surgical appliances as possible. Off came the bolster, which is a wire that anchors the neovagina in position during the first days of recovery. Also removed were drains from the perineal area, and from my tummy tuck. My beloved was jealous of that move. The drains from her tummy tuck didn't come out for ten weeks. Then comes the removal of the vaginal packing. The stories I'd heard said the packing just keeps on and keeps on coming. It didn't take as long as I expected, though there was certainly a long streamer of gauze issuing forth. Immediately after that, Dr. Schrang took the 2nd largest dilator from my set, poured some warmed mineral oil on it, and dilated me right there on the spot. I'll confess to being more than a little anxious at that point, but it went in with just a small bit of difficulty. He then removed the dilator and asked me to repeat what he'd just done. It was a very strange sensation, but it worked pretty well.
While Dr. Schrang examined me prior to the dilation, he commented on some necrosis in the vaginal area. He seemed rather matter-of-fact about it, saying that it happens from time to time, but that it's not life threatening. He said that I should just give it some time, and it would slough off, in a manner not dissimilar to a baby's navel. In the meantime, it's literally dead tissue that's just hanging around, and it has a horrific fragrance. I called Dr. Schrang several times over the coming weeks ("Are you sure I shouldn't see a local doctor to take away this tissue?") and he was always reassuring that it would go away. It did, about six weeks after surgery. Coincidentally (or not), the pain I had from sitting down abated as bits of the tissue gave way, and went away entirely when the last bit of tissue was gone.
We stayed in the area for three days after I left the hospital. I think it's a good idea to stay as long as you can, and see Dr. Schrang before you leave. For all but a few, he's too far away to just pop into his office if something comes up. Of course, you'll want to have a doctor wherever you are who at least will agree to see you, even if he/she is not conversant about what you have done, and how treating you may be different from any other person who hasn't had genital altering surgery.
As far as dilating goes, I wasn't immediately able to comfortably tolerate the 2nd largest dilator that Dr. Schrang had used. I reverted to the 3rd largest, the middle of the five stent Duratek set, and used it exclusively for the first week or two after escaping the hospital. After it started feeling relatively comfortable, I started in with the next largest dilator, and continued with it for the next few weeks. From time to time, I would try the largest one, and finally at about seven weeks post-op, it went in comfortably on the first try.
I noticed that I used the term "comfort" several times in the above paragraph. Honestly, "comfort" is a relative term at best in this situation. I complained to several of my post-op girlfriends over the first month to six weeks that it felt like a football kicker was practicing on me while wearing steel-toed Doc Martens. Part of that could have been the pain associated with the hematoma or necrosis or whatever was working down there, but it really took quite a while, six weeks or more, for dilating to become anything approaching truly comfortable. If it works for you sooner that that, consider yourself lucky.
That state of affairs didn't persist very long, I'm sad to say. At the beginning of the ninth week post-op, I resumed something approaching my pre-op normal routine. When I did that, there wasn't time for five dilations per day. For a couple of weeks, I managed to stay with three per day, because I was on a slightly reduced schedule. Once I was at top-speed, however, I was lucky to get in one per day. As I write, approaching five months post-op, I can get the biggest one in, but not right at first. It works much better to start off with the 3rd largest for about 10-15 minutes, then the 2nd largest for 15-20 minutes. Then, especially if I've manipulated the dilators during that time, spread the lube around and loosened things up, the large one goes in. If I try to push it too quickly, there is a stretching sensation, and a bit of stinging as the big one enters. At least there doesn't appear to be a lessening of depth associated with fewer dilations. I have been taking time to do a 60-90 minute dilation now, mostly just to assuage my guilty feelings for not being able to dilate more frequently.
The day after my 50th birthday, I flew back to Wisconsin for labiaplasty and breast augmentation. Booking a room at the Holiday Inn (formerly Valley Inn - many locals I ran into still called it that!) for a week meant that transportation to and from the hospital would be a snap. The first night, I met up with one of my SRS roommates who was also in town for labiaplasty. She'd had BA with SRS, so she was able to give me some advance intelligence on what to expect from that while we shared dinner. I was in surgery by about 7:30 or so on Monday morning, and came out about noon or so. Waking up was a slow process, but by about 2pm, I was ready to leave the hospital. I immediately had to resort to some new body mechanics because of the breast implants. Typically, I'd used my arms to push myself up out of a chair. With the implants, though, when I pushed down with my arms, my pectorals flexed, and that made the implants move around. It's not that it was particularly painful; rather, it was just a sensation that I'd never had, and didn't know whether or not it was OK to have that sensation. Better that I shouldn't jiggle things around until after more healing that just a couple of hours. So, my new preferred method for getting out of a chair was to rock well forward until my center of gravity was out in front of the chair. Then I can just push with my legs to stand up. It drove my nurse crazy. She thought I was going to pitch all the way forward until I hit the floor. She was grabbing at me, saying "No, no, no," and I was saying, "I'm fine, I'm fine, really." We had a bit of a giggle as I demonstrated that I was in control of my motor skills.
The hospital will arrange for the Holiday Inn shuttle van to retrieve you. Dr. Schrang will prescribe an antibiotic for infection (in my case, it was Keflex/cephalexin) and a pain reliever (Vicodin/hydrocodone). In the pre-arrival instructions from Dr. Schrang's office, you're encouraged to bring cash to the hospital so you can pay for the prescriptions from the hospital pharmacy. I asked the shuttle van to drive me a few blocks down Commercial Street to a Walgreen's pharmacy. Two reasons for that in my case. One, my records are already on file with Walgreen's (including my health insurance) and they can access them from anywhere. That meant I'd only pay the copay for the meds instead of the full price. Two, with a Walgreen's in my neighborhood, any refills that might be necessary can be gotten with greater ease. My health plan's copay for the two prescriptions was less than ten dollars.
Back at the hotel, I spent a few minutes answering and sending some email, then by about 4pm I was ready for some rest. I figured that a morning under general anesthesia plus 10mg of Vicodin at 4pm would keep me out until the following morning, and I was ready for that. Not a chance. By 7pm, the Vicodin had worn off and I was awake again. There was no pain, really, just this curious sensation on my chest where these two big bags were sitting. They were tender, but that was more from the stretching of the existing tissues to conform to the implants than anything else. It was frustrating, being awake, but I got out of bed, watched some TV, ordered room service, then took another dose of Vicodin about 11pm or so. When I awoke again about 3am, I decided that I didn't need to take any more of that stuff. I did manage to sleep off and on for the rest of the night.
The rest of the week was pretty relaxed. By noon, I was getting hungry, so I drove to Zacatecas Mexican Restaurant a couple of blocks up the street. After lunch, I felt well enough that I drove to Appleton and did the mall crawl, including a stop at my favorite place, Godiva Chocolate.
The next day was my post-op appointment with Dr. Schrang, and I didn't try to add too much more to that than a trip for lunch. Your post-op instructions are to resume dilating when you feel up to it. For no particular reason (boredom/laziness), I didn't feel up to it until Thursday night, so I set up my three-dilator routine. I was surprised, verging on alarmed, when each dilator was covered in blood upon removal. Now, it wasn't that much blood, but it was by far the most I'd ever seen during a dilation. It was also far more than would have been indicated by the tiny amounts I'd seen on my pads during the week. Naturally, I was on the phone the following morning to Dr. Schrang's office, and he returned my call about mid-day, after I'd done another dilation with similar results. He attempted to calm my fears, assuring me that it was not out of the ordinary to see some blood during dilation, but to keep in touch with him if the problem didn't abate soon. One more dilation that evening contained a very small amount of blood, and none since have had a problem.
Thursday my other SRS roommate was in town for her labiaplasty, so we went to dinner. Her surgery was Friday, so when she called Friday afternoon saying she felt great and wanted to meet for dinner again, I was pleasantly surprised. We stayed up late, gabbing while I got most of my things packed, then Saturday morning I flew home.
The dressing from the breast aug was due to come off Monday morning, but I couldn't get in to see my doctor until Tuesday morning. He pulled off all the wide sticky stuff, leaving the steri-strips behind. The next morning, when I showered, the steri-strips washed away, leaving the suture lines showing. Off to work I went, only to be surprised about halfway through the day with a big wet spot under my left breast. Turns out there was a place where the incision was still slightly open, and a mostly clear fluid was draining. Well, my clothes were washable, thank goodness, and a call to Dr. Schrang allayed my fears. I just wore overnight pads underneath my bra for three or four days until the drainage stopped.
Now, as I write, I'm beginning my sixth week following labiaplasty. I'm thrilled to have reached this point, and am ready to move forward with the rest of my life, unencumbered by having to deal with this issue. Of course, being transsexual will always be a part of my history, but now the time dedicated to focusing on how to get from pre-op to post-op will be mine to do with in other, hopefully more productive, ways.
At this point, I have to say Thank You to all those folks who went before me, and who shared their experiences along their respective paths. I don't think I've directly copied anyone's path from beginning to end, but have borrowed strategies on dealing with certain situations from a variety of folks.
This document is my humble attempt to continue that work, by paying forward this recounting of my experiences. I hope that those who read it will find something of value.
Elaine Poe
November 9, 2004