Well, the hike in the forest took an unexpected toll on my knees. The next day I was in a lot of pain. I have a torn meniscus in my left knee and was treated with a cortisone injection. Everything was just fine. Until I started climbing around on rocks like some young 65-year-old.
Now I am in "rest and relax" mode. One of my appointments yesterday at the VA was to get my 3-month injection of Eligard. I was wearing a knee brace and she kept checking the medication order thinking I was getting cortisone. We got it straightened out. I told her I planned to get some Epsom salts and soak in the bath. She recommended just using bags of frozen peas. The cold will reduce the swelling and they are reusable and cheap.
My next appointment was with my Psychologist. She has been teaching me how to pace my breathing (for stress management) using a biofeedback machine. We had some girl-talk time and then set up the machine. My goal is to be able to do 6 breaths per minute in a steady repeatable cycle. I clocked in at 6.1 breaths per minute and told her I beat that video game. Then we got into more serious stuff.
I don't mind sharing it here because everyone here has had, or may have a similar experience. When I began transitioning, I searched several online sources (including Susan's) for some type of checklist to help me understand what I want/need to get done. To this day, I am still following that checklist.
The "problem" arises, (the source of my anxiety, stress, depression, and frustration), is that I get stuck at one point and feel as though I can't move forward. Paced breathing calms me while doing it, but then reality sets in and I am still stuck. For example:
My list
Social transitioning:
- Coming out to friends and family as transgender - YES
- Asking people to use preferred pronouns - YES
- Going by a different name - YES
- Dressing/grooming in ways that match gender identity - YES
- Cosmetic prostheses (wigs, breast forms, etc.) - YES {VA Provided}
- Changing all legal documents - YES
Medical transition:
- Mental Health evaluation - YES {VA Provided}
- Hormone therapy - YES {VA Provided}
- Hair removal (face, body, genital hair if preparing for surgery) - VA says Service Not Available
- Voice training - VA said Service Not Available - New VA Program is available now
- Breast augmentation (implants)? - Service Not Available (Cosmetic Surgery not allowed)
- Orchiectomy - Service Not Available (Not Medically Necessary)
- Tracheal shave - Service Not Available (Cosmetic Surgery not allowed)
- Facial feminization surgery - Service Not Available (Cosmetic Surgery not allowed)
- Vaginoplasty - Service Not Available (also due to VA Regulations)
Not everyone will follow this list. Not everyone, including me, will want everything on this list. It is just a generic list for MtF transition.
What happened was that I got stuck at Facial Hair Removal (Electrolysis) and felt like I couldn't move forward. I wanted the opportunity to get to know the electrologist and see their office (is it clean?). Not all electrologists will do pre-op genital clearing, so is this a person I want working down there?
My Psychologist is awesome. She did a "deep dive" into my medical records and documented each and every time some provider mentioned that electrolysis was medically necessary. No less than three times each year since 2019 my Primary Physician, Endocrinologist, Psychologist, Gynecologist, or the Medical Chief of Staff here, stated it was medically necessary and would be covered by the VA. It still has not happened, but the documentation is there and the push is on.
What I explained to my Psychologist is that all of this is wonderful except that we are so focused on getting this one step done, we have lost track of the end goal. I need documentation that Gender Affirming Surgery is medically necessary. The reason it has not been documented as thoroughly as anything else is because VA Regulations do not allow "Genital Altering" surgeries.
If I was on active duty in the military, bottom surgery would be provided at no cost to me. If I was a convicted felon in prison, bottom surgery would be provided at no cost to me. However, the Department of Veterans Affairs continues to discriminate against us based on sex, which is a violation of federal law. Medicare will cover the surgery, but I need this well-documented in my medical records that surgery is necessary (because hormone therapy alone has been unsuccessful in "curing" my dysphoria). I will also need letters of medical necessity from each of my doctors. (I don't need that many, but more is better and I want every medical specialty in agreement that it is necessary and in my records). And with our current political climate, I can't wait around to get this documented. I need it now.
My Psychologist agreed and has begun working on getting all of this down in my medical records. That will set the precedent, so when I see my Gynecologist in June I can ask the same from her. Then when I see my Primary in August I can ask the same from her. Either the VA changes its policy and I will be a candidate for surgery, or it will not but I will have enough documentation to apply for grants or other financial assistance. Hopefully, I can avoid becoming a convicted felon to get the surgery.
When I got home from my appointments, there was a package in front of my door. I hadn't ordered anything. I opened it up and it is a new iPad from VA TeleHealth Service to use for my Voice Training! I contacted the Voice Training Program Coordinator to tell him I had received it and he is notifying the Iowa City VA that we can proceed with scheduling appointments. We are still waiting for the agreement to allow Iowa City access to my records in South Dakota. (It's a HIPAA thing). Once that paperwork gets processed I can get started and check another item off my list.
If the speed of light is the fastest speed there is, then the speed of government is the slowest. Everything in the Universe is in motion. You are not stuck, just not moving in the preferred direction. Every step forward is a movement forward and counts as a win. Keep moving forward at any pace.
