I had my pre-op with my gynecologist first thing this morning. It went really well. I think my doctor is a total rock star and I trust her 110%, and I told her this. It feels so good to feel so secure and safe about my surgeon!
She fully intends to perform the surgery laproscopically, but we discussed the multitude of reasons as to why she would have to open me up abdominally. She would love to keep both of my ovaries in me but knows that one may be destroyed by the endometrioma and that she may have to remove it. The worst case scenario is that she would have to remove both ovaries but she does not think this is likely. Endometriosis can spread to other organs, so she will have to check my bladder, bowel, appendix, etc. and would make repairs if necessary.
She hopes that if I have the surgery done laproscopically that I can go home that evening, but if it is done abdominally I will have to stay in the hospital for 2 days. So I will go prepared to stay when I leave the house Tuesday morning, and hopefully that will mean that I don't have to stay!
I am having the hysterectomy first since it is medically necessary, and I emphasized how important it is that the chest surgery happen. She said it is highly unlikely that anything would keep the chest surgery from happening. The most likely reason would be excessive bleeding, but she has no intention of letting her part of the surgery get to that. I feel more confident that I don't have to worry about the chest surgery not happening, but I won't be able to rest until I wake up from surgery and feel my bandaged chest.
I may have to get some more bloodwork on Monday to check my clotting factors, but that is no big deal and I will be at the hospital anyway because I have my final pre-op appointment with my chest surgeon on Monday afternoon. The anesthesiologist will be calling me Monday evening to ask me questions and discuss his/her part of the surgery. I definitely have a set of questions for this doctor and will voice my fear of waking up during surgery and of being aware of the surgery. If I don't voice these concerns it will nag at me for sure!
My mom arrives late tomorrow morning, and I am very excited to see her. She is coming to the LA Pride parade on Sunday -- it will be her first Pride experience! I have a very long day ahead of me today as my department prepares for the Pride festival and parade. It has been a very long week! I work tomorrow evening and most of Sunday. Monday I have my pre-op appointment and a massage and some resting and relaxation to do. Tuesday is the big day, and right now I feel like it won't come soon enough!
Friday, June 12, 2009
Wednesday, June 10, 2009
The Verdict
I'm keeping my nipples. Well, actually, they are being cut off, resized and then grafted on to my new, flat chest. But I'm keeping them.
I am SO glad that my surgeon wanted me to come in for a face to face consultation. She now has a clear understanding of what I want from chest surgery and I have a clear understanding about technique and other specifics. This was a half hour well spent for both of us.
She had initially been considering doing what is called a pedicle procedure where the nipple/areola is kept attached to breast tissue on a pedicle of tissue, and then that is brought back together with the breast. This is common for women who undergo breast reduction, but in their cases they are keeping and want to be keeping breast tissue. What my surgeon is going to do is remove all breast tissue (YAY!) and graft the resized nipple/areola onto my chest. She totally understands that I am going for total flatness, and she completely respects this desire. She is confident that the grafted tissue will survive and that I will have a great looking chest post-op.
One of the biggest reasons I was considering not keeping my nipples was because I feared not being flat enough. So if I can keep my nipples and be totally flat, I'm into that. I think I am indifferent about my nipples, but when push comes to shove, I prefer having a natural looking chest, which to me means having nipples. My surgeon likened it to people who have hernia surgery. Often times it would be easier for the surgeon to take away the bellybutton, but they make every attempt to keep it and even to create a fake one so as to achieve a natural look. She said that people sometimes don't realize how attached they are to their bellybuttons, nipples and other parts until they are gone. I'm not saying that it is unnatural not to have nipples. I just prefer that my chest look natural, and all my life since puberty and growing breasts, I have visualized a flat chest with small nipples -- a man's chest if you will -- in my mind. If my nipples don't survive -- oh well! I just won't have nipples. But like I've said before, I only have one shot to do this, and this is how I'm choosing to do it. My surgeon said she is not looking at me on the gender spectrum, she is looking at me as a human being who will have a natural looking chest.
The grafted tissue will be stitched back on and will be pretty gross for a few weeks as the stitches heal and the tissue returns to a normal color. So there will be a lot of care involved in the healing of not just the large incisions but also of the nipple/areola area. I told my surgeon that if making larger incisions will mean better results that I am fine with that, and she said that is good information to know. Having scars does not scare me at all, and I'd rather have slightly bigger scars if it means better results. She also said that a lot of skin will be removed, and excess skin is usually what causes excess fluid to build up, so I will hopefully be able to get my drains out after about a week. She thinks that she can contour my chest so that it maintains a nice shape when I lose weight, which I fully plan on doing once I am healed and am able to start exercising.
I feel really great about my appointment. I brought a list of questions with me, and all questions were answered. She even answered some questions that I hadn't had a chance to ask yet! I feel confident that I am making the right decision and that the chest that I have post-op will be the one I have been dreaming of since the 4th grade when I first started growing breasts.
One funny thing about my appointment is that the whole time I stood and sat topless, and my surgeon rarely was making eye contact with me. She was talking to my breasts. It was so hilarious. I could literally see her artist's mind working and making notes. She probably knows exactly what my chest will look like already. She tried to make eye contact with me, but my breasts -- her future work -- were too powerful I guess :)
I thanked her before I left for using the informed consent approach to this surgery. Trans related surgeries and hormone treatments are usually governed by the Harry Benjamin Standards of Care, which basically means an individual needs a gatekeeper -- usually a therapist -- to acquire hormones and surgeries. The therapist has to write a letter saying they believe the person has Gender Identity Disorder and that surgery and/or hormones are necessary. My surgeon only required that I understand what I am doing and that I have thought it through thoroughly. I have a therapist, and believe me, she and I have discussed this through and through. But why should I as a well informed, healthy adult have to have someone else give me permission to do something to my own body?! I am thrilled that my surgeon and I have the relationship that we have around this and that she respects my decision to augment my breasts. True, I am totally removing them, but why would someone have to have a therapist's letter to remove their breasts and not have to have one to make their breasts a DDDD?!
That will be my nightmare the night before surgery -- that I wake up from surgery having had implants put in rather than having had my breasts removed. That is a truly frightening thought!
While I was at the hospital today I went ahead and paid the out of pocket charges for the chest surgery. That sure made it feel real! Money well spent is all I can say :) I am preregistered for my surgeries and have paid the out of pocket fees, so all I have to do is show up Tuesday morning, check in, probably have to sign this and that and then get some of those happy drugs that will make me forget all of my fears and anxieties, and before I know it I'll be post-op. I can't wait!
I am SO glad that my surgeon wanted me to come in for a face to face consultation. She now has a clear understanding of what I want from chest surgery and I have a clear understanding about technique and other specifics. This was a half hour well spent for both of us.
She had initially been considering doing what is called a pedicle procedure where the nipple/areola is kept attached to breast tissue on a pedicle of tissue, and then that is brought back together with the breast. This is common for women who undergo breast reduction, but in their cases they are keeping and want to be keeping breast tissue. What my surgeon is going to do is remove all breast tissue (YAY!) and graft the resized nipple/areola onto my chest. She totally understands that I am going for total flatness, and she completely respects this desire. She is confident that the grafted tissue will survive and that I will have a great looking chest post-op.
One of the biggest reasons I was considering not keeping my nipples was because I feared not being flat enough. So if I can keep my nipples and be totally flat, I'm into that. I think I am indifferent about my nipples, but when push comes to shove, I prefer having a natural looking chest, which to me means having nipples. My surgeon likened it to people who have hernia surgery. Often times it would be easier for the surgeon to take away the bellybutton, but they make every attempt to keep it and even to create a fake one so as to achieve a natural look. She said that people sometimes don't realize how attached they are to their bellybuttons, nipples and other parts until they are gone. I'm not saying that it is unnatural not to have nipples. I just prefer that my chest look natural, and all my life since puberty and growing breasts, I have visualized a flat chest with small nipples -- a man's chest if you will -- in my mind. If my nipples don't survive -- oh well! I just won't have nipples. But like I've said before, I only have one shot to do this, and this is how I'm choosing to do it. My surgeon said she is not looking at me on the gender spectrum, she is looking at me as a human being who will have a natural looking chest.
The grafted tissue will be stitched back on and will be pretty gross for a few weeks as the stitches heal and the tissue returns to a normal color. So there will be a lot of care involved in the healing of not just the large incisions but also of the nipple/areola area. I told my surgeon that if making larger incisions will mean better results that I am fine with that, and she said that is good information to know. Having scars does not scare me at all, and I'd rather have slightly bigger scars if it means better results. She also said that a lot of skin will be removed, and excess skin is usually what causes excess fluid to build up, so I will hopefully be able to get my drains out after about a week. She thinks that she can contour my chest so that it maintains a nice shape when I lose weight, which I fully plan on doing once I am healed and am able to start exercising.
I feel really great about my appointment. I brought a list of questions with me, and all questions were answered. She even answered some questions that I hadn't had a chance to ask yet! I feel confident that I am making the right decision and that the chest that I have post-op will be the one I have been dreaming of since the 4th grade when I first started growing breasts.
One funny thing about my appointment is that the whole time I stood and sat topless, and my surgeon rarely was making eye contact with me. She was talking to my breasts. It was so hilarious. I could literally see her artist's mind working and making notes. She probably knows exactly what my chest will look like already. She tried to make eye contact with me, but my breasts -- her future work -- were too powerful I guess :)
I thanked her before I left for using the informed consent approach to this surgery. Trans related surgeries and hormone treatments are usually governed by the Harry Benjamin Standards of Care, which basically means an individual needs a gatekeeper -- usually a therapist -- to acquire hormones and surgeries. The therapist has to write a letter saying they believe the person has Gender Identity Disorder and that surgery and/or hormones are necessary. My surgeon only required that I understand what I am doing and that I have thought it through thoroughly. I have a therapist, and believe me, she and I have discussed this through and through. But why should I as a well informed, healthy adult have to have someone else give me permission to do something to my own body?! I am thrilled that my surgeon and I have the relationship that we have around this and that she respects my decision to augment my breasts. True, I am totally removing them, but why would someone have to have a therapist's letter to remove their breasts and not have to have one to make their breasts a DDDD?!
That will be my nightmare the night before surgery -- that I wake up from surgery having had implants put in rather than having had my breasts removed. That is a truly frightening thought!
While I was at the hospital today I went ahead and paid the out of pocket charges for the chest surgery. That sure made it feel real! Money well spent is all I can say :) I am preregistered for my surgeries and have paid the out of pocket fees, so all I have to do is show up Tuesday morning, check in, probably have to sign this and that and then get some of those happy drugs that will make me forget all of my fears and anxieties, and before I know it I'll be post-op. I can't wait!
Monday, June 8, 2009
Pre-Op Week Has Begun
This morning I went in for my first pre-op appointment. This appointment was for my pre-op bloodwork. The tests are time sensitive so my results should already be to my doctor. No news is good news! I will feel less anxious once I know that everything came back normal and that bloodwork won't postpone my surgeries.
My pre pre-op appointment with my chest surgeon was moved from Thursday to Wednesday, and I am happy about that. It is one less day I have to wait to discuss the nipple situation and other details with my surgeon. I assume she will tell me then what the results of my bloodwork are, and I assume that if something were wrong they would contact me tomorrow.
Friday morning is my pre-op appointment with my gynecologist. I am looking forward to that as well. I have a list of 10 different questions for both my chest surgeon and my gynecologist. I would love to reach a decision with my doctor on Friday as to what kind of hysterectomy I am having, but being the good doctor that she is, she will probably really want to wait until surgery day when we're in the OR to make the decision. She will want to do the least invasive procedure possible that will give the best results.
One thing my wife and I are concerned about is the fact that I'm having my surgeries at a religious hospital. My wife is my power of attorney, and we worry based on past experiences that the hospital could give her trouble about making decisions for and about me since we are a same sex couple. Even though we are legally married in the state of California, people are still homophobic and bigoted, and we are preparing ourselves for the worst case scenario. I am giving my Advanced Health Care Directive to both of my surgeons as well as to the hospital, which should more than cover the bases. But we are considering bringing our actual marriage license with us to the hospital in case anyone challenges Rachel. It is disgusting that we even have to be worrying about this, but we have had problems at hospitals in the past, so we have to be prepared.
Time sure is flying by, though. The weekend came and went quickly, and my Monday work day has come to a close. I spent the afternoon painting and spray painting sign handles for the LA Pride parade, and I managed to get more of the white on myself than I did on the handles. Four more days of work plus LA Pride this weekend and it will be time for surgery! The rest of this week should fly by, and I will be so busy this weekend with my mom arriving and with Pride happening that it will surely fly by as well. My wife and I will pick up Mom from the airport late Saturday morning and then spend the afternoon with her. I have to work at 5pm Saturday and basically all day Sunday. Monday I have a massage scheduled, my pre-op appointment with my chest surgeon and hopefully a therapy session. It would be really nice to touch base with my therapist before the big day, because who knows when I will be up to seeing her again once I'm post-op.
My clear liquid diet starts Sunday morning. It will not be at all convenient since I'll be out at the Pride parade and festival all day, but I'll make it work. Monday I just want to go to my appointments, rest, do some laundry and pack for the hospital and maybe go to a knit store or two with my mom. I've been having such a hard time sleeping, I laugh at the idea of trying to sleep the night before surgery. But who knows -- I just might sleep like a baby that night. I need to focus more on trying to get some good R & R between now and then or I'm doomed!
The reality that I am one week away from surgery is sort of setting in. I keep saying to people that I know I'm going to get my ass kicked in a week. I believe and understand that intellectually, but emotionally I don't think I'm processing it. I am excited beyond words that I will be having a life changing surgery in one short week. I've been preparing logistically for months. I am as ready as I can be in that respect, but what about my spirit and emotions? I had a dream last night that I was at the hospital getting ready for surgery and they were preparing to begin surgery without giving me anesthesia. This is clearly connected to a fear I have of being half awake or of waking up during surgery. I spoke to my therapist today about my fears. One of my biggest fears is that I'm not processing the reality that I am having two major surgeries and will have one major recovery and that it will hit me as I'm being wheeled into the OR. I worry that I will be panic stricken and afraid the moments before surgery. I just want to feel peaceful and grateful that it is finally happening. It's hard to deal with reality when I am so unbelievably excited. The excitement seems to be keeping me from experiencing healthy fears now. I just have to believe that it will all happen the way it's supposed to happen, and in due time.
My pre pre-op appointment with my chest surgeon was moved from Thursday to Wednesday, and I am happy about that. It is one less day I have to wait to discuss the nipple situation and other details with my surgeon. I assume she will tell me then what the results of my bloodwork are, and I assume that if something were wrong they would contact me tomorrow.
Friday morning is my pre-op appointment with my gynecologist. I am looking forward to that as well. I have a list of 10 different questions for both my chest surgeon and my gynecologist. I would love to reach a decision with my doctor on Friday as to what kind of hysterectomy I am having, but being the good doctor that she is, she will probably really want to wait until surgery day when we're in the OR to make the decision. She will want to do the least invasive procedure possible that will give the best results.
One thing my wife and I are concerned about is the fact that I'm having my surgeries at a religious hospital. My wife is my power of attorney, and we worry based on past experiences that the hospital could give her trouble about making decisions for and about me since we are a same sex couple. Even though we are legally married in the state of California, people are still homophobic and bigoted, and we are preparing ourselves for the worst case scenario. I am giving my Advanced Health Care Directive to both of my surgeons as well as to the hospital, which should more than cover the bases. But we are considering bringing our actual marriage license with us to the hospital in case anyone challenges Rachel. It is disgusting that we even have to be worrying about this, but we have had problems at hospitals in the past, so we have to be prepared.
Time sure is flying by, though. The weekend came and went quickly, and my Monday work day has come to a close. I spent the afternoon painting and spray painting sign handles for the LA Pride parade, and I managed to get more of the white on myself than I did on the handles. Four more days of work plus LA Pride this weekend and it will be time for surgery! The rest of this week should fly by, and I will be so busy this weekend with my mom arriving and with Pride happening that it will surely fly by as well. My wife and I will pick up Mom from the airport late Saturday morning and then spend the afternoon with her. I have to work at 5pm Saturday and basically all day Sunday. Monday I have a massage scheduled, my pre-op appointment with my chest surgeon and hopefully a therapy session. It would be really nice to touch base with my therapist before the big day, because who knows when I will be up to seeing her again once I'm post-op.
My clear liquid diet starts Sunday morning. It will not be at all convenient since I'll be out at the Pride parade and festival all day, but I'll make it work. Monday I just want to go to my appointments, rest, do some laundry and pack for the hospital and maybe go to a knit store or two with my mom. I've been having such a hard time sleeping, I laugh at the idea of trying to sleep the night before surgery. But who knows -- I just might sleep like a baby that night. I need to focus more on trying to get some good R & R between now and then or I'm doomed!
The reality that I am one week away from surgery is sort of setting in. I keep saying to people that I know I'm going to get my ass kicked in a week. I believe and understand that intellectually, but emotionally I don't think I'm processing it. I am excited beyond words that I will be having a life changing surgery in one short week. I've been preparing logistically for months. I am as ready as I can be in that respect, but what about my spirit and emotions? I had a dream last night that I was at the hospital getting ready for surgery and they were preparing to begin surgery without giving me anesthesia. This is clearly connected to a fear I have of being half awake or of waking up during surgery. I spoke to my therapist today about my fears. One of my biggest fears is that I'm not processing the reality that I am having two major surgeries and will have one major recovery and that it will hit me as I'm being wheeled into the OR. I worry that I will be panic stricken and afraid the moments before surgery. I just want to feel peaceful and grateful that it is finally happening. It's hard to deal with reality when I am so unbelievably excited. The excitement seems to be keeping me from experiencing healthy fears now. I just have to believe that it will all happen the way it's supposed to happen, and in due time.
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