Tuesday, July 22, 2014

Recovering from surgery: week 3.

After two weeks I was allowed to remove the tape from the cuts on my chest. For me this was one of those moments when hope turns into reality. Before removing the tape I wasn't sure what it looked like and it could be anything. I knew it wouldn't be perfect. I knew it would still be healing and it would still get better in time. I knew it would be better then how it was before because that fitted me even less then this would. You know there will be scars and when you remove the tape they're still wounds even. You know all this. But when you remove the tape it becomes real. At least, it did for me. Before the surgery I felt deformed. I knew after the surgery I would be mutilated. I know that sounds dramatic, but in a way it's true. Your body has been altered permanently because someone has cut you up and the scars are there for life. It is a constant reminder that I am not 'a real boy'. I had quite some trouble accepting what I saw. I'm slowly getting used to it and now it's healed even more it is starting to look a bit better. It doesn't look like wounds as much as it does as scars and that feels better because that means it's in the past and I can move on. I'm sure there will be days when I hate the way it looks but I am glad I did it. It was the lesser evil and I do feel better. I have no regrets. It just takes some time to get used to this new body.

The binder still had to stay on though. Officially it has to stay on for 4 weeks and after that I can take it off at night and slowly get used to not wearing it. For me it feels ridiculous. I can move quite freely and feel confident when doing normal things around the house. The first few times I took it off to take a shower it did feel awkward and unsafe to talk around without it for more then half an hour. But now I actually take it off for an hour or longer every day so my skin can recover a bit. The binder is tight and wearing it 24/7 chafes my skin. It's getting really irritated and it feels like a graze wound is developing under my arms and around my chest. The heat really doesn't help either. I can't wait to be able to take it off as right now having to wear the binder seems to be costing a lot more energy then I get benefits from it.

My gynaecologist, doctor Milo, wanted to see me for a check up that week. They had made an appointment for me without asking me and the letter they had send to confirm had ended up at a different address so I didn't know until they called on Monday to ask if I could come earlier the next day. Luckily I could. I actually got the letter and some get well soon cards from some friends that afternoon. The person who had received my mail had just returned from holiday and dropped them into my mailbox.
Honestly it felt a bit like a waste of my time. I was on my way for two and a half hours and was only in his office for about 5 minutes. He took a quick look at the scabs, told me to keep them clean and that I shouldn't ride a bike for another 3 weeks or so and that was it. He told me there was no need for me to come back again but if I needed anything I could always call. At least that part is done now. I don't have to think about the hysterectomy any more other then letting the scabs heal. The lowest one is giving me a bit of trouble though as my underwear, jeans, etc cover it and it gets irritated. I hope it starts healing properly soon because it's really annoying. I don't mind walking around in my birthday suit at home at these temperatures but I do need to put something on when I go outside. I guess it just takes time.

Wednesday I went to city hall. I had thought that changing my birth certificate would just be a technicality but it turned out it did feel like an important step. I wanted to get it done so it would all be official and I could really move on. The lady helping me was really nice. They had made a check list of all the information they needed and everything because they wanted to be well prepared. This was all new to them as the new law had only been passed a few weeks before. I was the fourth transsexual to come and change his passport under the new law in my city. One of my oldest friends happened to be nearby so he came along and we had coffee and a chat while the nice lady went to dig up my certificate and scribble on it. It feels really good to have that done. It's a load off. Things are finally getting real. And soon I can really get on with my life. Just a few more weeks of recovery and I'm good to go.

Sunday, July 20, 2014

Recovering from surgery: week 2.

The second week after my surgery I felt much better. The drains were gone and I regained a lot of range of motion rather quickly. I still needed some help but less every day. Slowly I started picking up chores around the house. I would manage making myself a salad for lunch and then I would lie down and take a break before eating it. I always want to do everything myself but I'm also quite capable of listening to my own body and after something like that my chest would clearly give off a sign for me to slow down. Everything took a lot longer then usual but at least I managed. That was the most important thing. If you just sit down and do nothing for 6 weeks it will take longer to recover. You need to keep the blood flowing to supply building blocks and to get rid of the rubble. You need to keep moving to keep the muscles and tendons from shrinking. If you don't your body will get stuck and it can take a lot longer before you can do all the things you used to do again. You have to be a bit bold every now and then. Of course, that's not a problem in my case. I was actually more surprised to see myself holding back and not pushing things too much. The first time I went for a walk again I just went around the block instead of just heading off for a longer distance. Pretty quickly I managed a whole hour again but I didn't force it. By the end of the week I felt like I could do pretty much anything again. as long as I didn't lift anything too heavy.

I got really lucky with how quickly I recover. I still have some time to go but I improved much faster then I had expected. I thought I would still be drinking through straws by now. Turns out it's really not that bad. I guess a lot of your recovery depends on how fit you are when you go into surgery. I don't smoke any more which also helps a lot and I eat very healthy stuff. Plus I heal pretty well in general. My body seems to be quite resilient. I'm just lucky that way. I know I'm not a standard case and most people aren't able to sleep on their sided or stomach even in the second week. I'm not complaining.

One thing people tend to forget is that when you take out your ovaries and don't produce much oestrogen any more your body changes. This is usually called: The Change. But in transmen the testosterone should replace most of the functions of oestrogen. Testosterone and oestrogen are not the same though and you do have some effects of menopause. How much is very different for people. I know one transguy who had horrible night sweats and all of that. Some people hardly notice anything. I got a few hot flashes for about 3 days and that was pretty much it. The only thing I really noticed was how unhappy my bladder was. Your fluid balance changes when you go from oestrogen to testosterone. They simply have different set points. So you lose some weight because you lose some fluids. A lot of women get bladder infections during this period because of the ridiculous amount of fluids that pass through. Three cheers for cranberries. It wasn't just the hormones though. With my uterus gone everything in my belly had started to move around. The first week this was really uncomfortable but it settled quite a bit the second week. Still, it felt weird. And my bladder probably needed to get used to the new neighbours as well. This might take a few weeks but it's not something I need to worry about. It would be nice not to have to get up 3 times at night to go to the bathroom though.

Wednesday, July 16, 2014

Recovering from surgery: week 1.

The first 2 days after the surgery I had to stay at the hospital. I wrote about that in my previous post. On Saturday morning they sent me home with my drains. I was really happy to go home and at that point I didn't care about having to keep the drains. Well, it sucked, but I figured it was better to go home with them then having to stay. I felt much better just wheeling out of there. The dear friend who was picking me up had decided it would be fun to push me around in a wheelchair and she was right; it was.

She dropped me off at home and stayed for a cup of tea. It was so nice to be at my place again, with proper tea and a nice sofa. And no nurses sticking things into my ears and all that. I slept really well that night, even with the drains. The next day I felt even better. This didn't last too long though. Having the drains was, well, draining. The stitches that were holding them in place really hurt. That was actually all that hurt. I quit taking the diclofenac on Monday and on Thursday I took the last paracetamol which I had felt was symbolic anyway. But the pain from the drains made it really hard to move. I was also impossible to have a proper shower and I needed help to get into and out of my binder. I still felt really dependant on other people. I was. Good thing I had lots of help.

This is something I was really surprised about, in a good way. A lot of people will tell you: if you need anything, just let me know. But when push comes to shove you just have to wait and see who actually shows up. My friends had told me I really had to ask and I had assured them I would. But I didn't need to. They offered. And they came. People sent me text messages or PM's on Facebook, asking me if I needed anything and when they could stop by. I actually had to make an effort to keep the visitors down to 2 a day and sometimes someone would just show up and I actually would have 3 people over in one day. People bought me flowers. I never get flowers. But I did now. People brought me vegetables and prepared food for me. They did my dishes. I even got help with my laundry. I couldn't believe it. I felt so blessed. I have a hard time asking for help as I've always needed to do everything on my own and have been quite a loner most of my life. This was a new experience for me and I'm very happy for it.

The rest of the time I mostly spent on the sofa with a book symbolically in my hands. I managed some reading but not much. Having to drag around the drains was exhausting. They ruled my every move. Getting up to walk to the toilet or kitchen was something I needed to prepare for mentally. As the days went by and the fluids got less and less and the drains therefore more useless and just an annoyance, I started to feel like a prisoner again. I went looking for ways to get rid of them as soon as possible. I first asked a friend who is studying to be a doctor but she told me she had never removed a drain so it didn't seem like a good idea. My GP is an idiot. He told me I should just put my drains in a bad and walk over there if I wanted him to take a look at it. Sorry but I just had a hysterectomy, I'm not even supposed to go outside the first week. He didn't understand how that could be a problem. It sounded like he was just panicking and didn't want to help me because he didn't know what to do. Like I said, he's an idiot. I figured I didn't trust him with something like this and I should be getting a different GP anyway so I decided against it in the end. I called the hospital on Monday, hoping they would be willing to get me an appointment sooner then Thursday as they had first suggested. They gave me Wednesday. What a difference a day makes. It seemed much closer now and I had something to count down to. I counted the hours.

The same friend who had picked me up had offered to give me a ride again and she actually had time that day so it was all perfect. My plastic surgeon first removed the drains without question and I felt better right away. People told me that removing the drains can feel really weird but one I didn't feel at all and the other one felt a bit like something was pulling on the inside but that was what was actually happening. It didn't feel awful or anything, just a bit strange. She took a look and told me everything was fine. She asked if she could take some pictures so she could use them for a presentation in November. People kept asking her about the volume of nipple stems so she wanted to use me as an example. About what? During the chest surgery you cut loose the nipple which has a cluster of veins and nerves (I think it's called the stem). If the stem is too long you have to cut it and do a loose nipple transplant, reattaching it elsewhere. If the stem is short enough and strong enough you can keep it in tact. The advantage of keeping the stem is possibly regaining sensation in your nipples again. They can function close to normal again if you're lucky. The downside, for a lot of transmen, is the bulk of the stem. Most transmen want to be as flat as possible because they want to be as passable as possible. But people are now wondering how much bulk we're actually talking about here. So she needs examples. She asked me to send her pictures of my chest in a couple of weeks and I told her I would also send her some end of October so people can see how it looks in the long run. Four months isn't that long but it's all the time we've got. If you want to see the whole development you can check my tumblr. I'm posting pictures almost every day.
Then she send me home again. I didn't have to make a new appointment or anything. Of course, if I felt the need I could call. I felt home feeling great. You always do when a burden has been lifted. All I had to do now was keep on my binder for another 3 weeks and then try not to run to the gym for another 2. Just a few more countdowns and I can start my life.

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Saturday, July 12, 2014

Surgery part two: my stay at the hospital.

Hospitals are strange places. Nobody really likes them. It's where you go when something is wrong, usually. I don't like hospitals either. One of the things hospitals are, unfortunately, well know for is the bad food. I know I'm difficult with food in general but hospitals are a really bad place to have food allergies and not sticking to the food pyramid. I eat primal and low carb. Grain and I are not friends. I told them this and so they served me gluten free bread. Maybe it's just because they don't serve it a lot (most of the time it arrived frozen) but it tasted like cardboard. It also had the texture of cardboard. I know the anaesthesia didn't help but my stomach reacted pretty much the same way as to normal bread. Not well. I had brought some food myself but not enough and it didn't stop them from trying to feed me cardboard and milk all the time. I didn't have the energy to explain to them why I didn't want any so just repeated I was allergic or simply said no thanks. So this was no fun and really didn't help my recovery.

Don't get me wrong. The nurses were all really nice and trying to be helpful. But they also had instructions to follow, protocols and such. Just like with the people who did my surgery I felt like they had to take an empathy course or something at that hospital. I was truly amazed. They really tried to make me as comfortable as possible with the means they had.

The other thing that didn't help was the lack of sleep. Hospitals are very noisy. And with the heat we had to leave the window open to get in some cooler air. This meant we were also letting in all the lovely sounds of the train, the tram, the highway and the huge flock of blackbirds. I don't sleep well in unknown environments in general and if they are noisy I can pretty much forget about it. A nurse coming in at 1 and 6 in the morning to check my pulse and blood pressure didn't help much either. My temperature has been checked more often during my stay at the hospital then in the 10 years before that. And if the nurses weren't chatting just outside the room which was at the beginning of the hall so everyone had to pass by our room, the other trans guys would be snoring softly. If I had been able to move I would have been tossing and turning all night long. But I couldn't. The drains made it impossible to lay in any other position then coma mode; flat on your back with your arms along your sides. Both your chest and abdomen had been stitched up so you didn't want to put your arms anywhere on your body. Truly wonderful.

After a hysterectomy (removal of the uterus and ovaries) you only have to stay one night but after a mastectomy (the chest surgery) you have to stay a bit longer. It depends on the drains sticking out of your armpits. Usually it's 2 or 3 nights and then they remove the drains. Sometimes they send you home with drains though. After 2 nights of about 3 hours sleep each I was ready to go home. I felt like a prisoner, claustrophobic and helpless. I'm not good at giving up control and having people prod and poke me 6 times a day, feeding me bad food and pills while I have a bunch of tubes sticking out of me was not my idea of a good time. I was amazed at how quickly I plummeted into feelings of depression and it really scared me. I knew I had to get out of there. So on Saturday morning I managed to convince the nurse to convince my doctor to let me go home, drains and all. She called my doctor and a few hours later I was on my way home. I felt so relieved. At that point I didn't care I had to keep the drains for 5 more days until my check up. All I wanted was to go home so I could sleep. And I did. I slept 10 hours that night while I usually sleep about 6 or 7. I was so happy to be home. The worst had passed. Things were only going to get better.

For pictures of my recovery check out my tumblr.

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Wednesday, July 9, 2014

Surgery part one: the surgery itself.

It has been 12 days since my surgery and I am healing well. I'm feeling well enough to attempt to write a blog. I'm not sure if I'll be able to finish it in one go but we'll just have to wait and see.

First things first: how was the surgery?
Scary. No matter how well you prepare and how ready you think you are, you get scared. Even if it's just for a few seconds. I knew I would and I knew it was okay. A wonderful friend drove me to the hospital at 6 in the morning and waited with me until they wheeled me to surgery. I had to be at the hospital at 6:30 and would be brought down to surgery at 7:30. This meant they had an hour to check a my vitals and some data, give me painkillers, and let me get nervous. You sit there in your blue gown, waiting, and you have time to think. Am I making the right choice? Do I really have a choice? What if something goes wrong? What if they do something I didn't sign up for? What if there are complications and the results are horrible and I would have been better of not having the surgery? And a ton of other similar questions. But they're not real questions. It's not real doubt. There is no way back. I  passed the point of no return two and a half years ago when I realized I had to go into transition if I ever wanted to be happy. In for a penny, in for a pound. I knew I had to do this.

At some point someone told me I would be fine, after all, this was what I wanted. This comment really bothered me and still does. A lot of people think that, being transgender, you want to have surgery. Actually, you don't. You want the results surgery can give you. You don't actually want a bunch of strangers knocking you out, laying you out on a table, naked and completely defenceless, cutting you up. Nobody wants that. That was one of the scariest bits about it all. I didn't see her again and was glad. The anaesthesiologist I had recognised my Terry Pratchett tattoo and that immediately put her in the category of good people so that helped a lot. Everyone was really nice and they asked me several times which procedures I was having to make sure I knew what was happening and it reassured me we were on the same page and they weren't going to do things I didn't want them to.

So now it's 13 days as a friend stopped by and I didn't get around to finishing this yesterday. On with the story.

They didn't ask me to count down from whatever when they put me under. They gave me oxygen and told me to take deep breaths while the drugs were pumped into my veins through the IV. And then I woke up again. So that was that. It had been done.

You don't feel yourself falling asleep or anything. It's like a light switch. One moment you're there, the next you're gone. When I woke up I was not in pain. I was mostly just dizzy from the morphine. I felt like I really had to lie down, even though I was already flat on my back. I felt like I had smoked bad weed. Not very comfortable. A nurse asked me something and I tried to respond but my throat was sore and I could barely talk. She told me it was from the tube they had used to breath for me. This came as a bit of a shock as no one had mentioned this to me. I had read it in one of the many brochures they had given me but it was so much information I hadn't registered it. The thought of not having been able to breath on my own is a scary one but I didn't have time to really think about it. They were pushing more morphine into my IV and I felt too dizzy to comment on anything. My heart rate and blood pressure went up. Looking back I think it was caused my the morphine. I'm a very independent person and am terrible at not being in control of my own body. The morphine pretty much paralysed me and my brain gave off a fight or flight response. Luckily I had been given a PCA so after the first shots I could regulate the morphine myself. I cut back to one tenth of the allowed dose and felt better quickly.

Both surgeons stopped by to tell me how things went. The gynaecologist was very happy. He said everything went really well and blood loss had been minimal. I should make an appointment for a check up later on. He is going on a holiday for 3 weeks mid July and if I didn't manage to get an appointment before then it was fine to come see him when he was back. If he doesn't see any need to see me sooner then in 6 weeks time or so I feel like I have nothing to worry about at all when it comes to the hysterectomy. This was very comforting.

The plastic surgeon stopped by as well. She was also quite happy with how things went. She was able to leave the blood vessels and nerves to my nipple in tact so this means in time I can actually get some sensation back. I was very happy to hear that. And that was pretty much it. All that was left was waiting until they would let me go home so I could start recovering.

If you want to see some photo's of my chest and how it's healing you can check my tumblr.

Tuesday, June 24, 2014

The first day of the rest of my life.

If all goes well the day after tomorrow will be the first day of the rest of my life. I'm still half expecting one of my surgeons to have the flue or something. But it will happen. It has to. I have been waiting for this too long already. My bag is packed, I'm ready to go. I have a friend driving me there, another one picking my up and a few visiting me during my stay (including a friend who is like a brother to me who will come visit on his birthday! Love him to bits). After that I have plenty of offers from friends to help me with stuff I need like cooking, food shopping and other chores around the house. Everything is set. All I have to do now is wait for 36 more hours and that's it.

People want to know if I'm nervous. That's a silly question. If course I'm nervous! Something would be wrong if I wasn't. But I'm not scared. It's like the first day of school. Or more like the start of a journey, like I'm moving to a different land. I bought my ticket, I know where I want to go and when I've landed I have to make sure I find my new apartment. Once I'm there everything will sort itself out. But first I have a plane to catch and luggage to check in and pick up again, passport checks and metal detectors to walk through, and a long while of sitting and waiting to get there while I'm moving through time and space. I have been preparing for this for over 2 years now and it is finally happening. Yes, I'm nervous, because this is very important to me and I am very excited, but I'm not scared.

I've said this before: transition is like having a baby. You think about it for a long time, then you make the decision and start preparing for it. Once things have been set in motion you can't go back. There is a lot of waiting, a lot of people poking your body and your mind, and hormones going off balance, but you know it will be worth it. You've been making changes around the house, in your wardrobe, in your social life, all preparing for this. And then, suddenly, it is really happening. It's just around the corner. You are really doing this. You already knew you couldn't go back any more, you passed the point of no return the moment you made the decision to do this, but now it really is final. There is no other option but to go through with this. It's not that you're having doubts. Not at all. It's just that you know that your life will never be there same and you don't know what it will be like after that moment. In a way, very little will change. But in a way, everything will change. It's scary. Change is always scary, no matter how exciting it may be. I'm pretty sure I'll be crying tears of relief after the surgery. And after that? Who knows. It will be the first day of the rest of my life and anything will be possible.

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Wednesday, June 11, 2014

Two weeks and counting.

Fourteen days and one night until my surgery. That doesn't sound very long does it? When I called the hospital to ask when I could get my surgery they told me 4 to 6 weeks after the surgeons have seen you. In my case it turned out to be 11 weeks and it took a lot longer to see my surgeons that I had hoped as well. You are allowed to have surgery one year after you have been given permission to start hormone treatment. Waiting your turn for the screening and the actual screening take quite some time as well. In total it has been 2 and a half years since I came to the conclusion that this was something I had to do. Two and a half years. That's a long time. So what's an extra three months? What's two more weeks? It's a lot I tell you. A lot.

I know I come across as very level headed. Everyone thinks I'm a stable, independent, resilient, strong person who can handle things very well on his own. And they're right, usually I can. But it has been two and a half years of my life constantly revolving around my transition. Me jumping through hoops and sitting on my hands while waiting for others to make major decisions over my life. To say it has been stressful would be an understatement. And I am done. I am tired of it all. I need this to be over. After this I still have to change my passport and of course the VUmc has designed a few more hoops to jump through before I can do that. I can see if I can arrange it some other way once I've had my surgery but that would be more hoops still. I'm not sure which would be easier. I'm tempted to give in and pay the VUmc the 65 euro's simply because I don't have any fight left in me, even though I should have the right to change my passport without their expert statement after my surgery.

I am a strong person. I'm an adult. My transition has been relatively easy. The only people who objected to my transition are people who are not really part of my life any more anyway. Until recently I didn't have any real trouble with the hospital or insurance company (delays don't count, they are normal). And still, I am at the end of my rope. I am done. I am out of energy. I am so tired I feel like banging my head into the wall. I can't sleep, I'm too restless. I can't eat, I'm too stressed. I can't work, I can't focus. Even breathing takes effort. I need this to be over. But there is nothing I can do. 14 days, 12 hours and 17 minutes. I'm counting.