Surgery in T minus ONE WEEK?!

[aleon515]

I know that some of the guys here talk a lot about how they didn't have much pain, etc. after their surgeries, but I would like to stress that I was in pain the day after surgery and they pain meds I was given didn't do much for me.  I was constipated, weak and feeling like I'd been hit by a train. 

I know that in the US, it seems like guys are basically kicked out of hospital same-day and thus probably seems a bit like the surgery is "no big deal" as it's seen as a "day surgery", but it's a major operation.  I can tell you from my own experience, I would no way in hell have been able to walk to a car, sit for a drive and walk around a hospital and sit and wait.  I was barely able to hobble to the toilet.  Again, these are my experiences, take what you will from them - but I wouldn't advise that your boyfriend try to make it to your surgery the day after his own.  No way would I have been able to do that - everyone is different, but I wouldn't advise it.

If he is going to go ahead and do it anyway, be sure to have some kind of pillow for cushioning for the seatbelt.

Yes they do (the kick you out and let you fend for yourself after surgery). However, this is a typical US surgery situation, and though it was started to save money, I think that there is no reason to think that it is dangerous in anyway. (Not saying you said this.) OTOH, yes, I think it does give some guys the idea this is no big deal. Everybody is affected differently and you have guys who refill their bottle of Vicodin, and guys like myself who didnt' take any. And many people in between.

Second day, I think I finally changed my clothes. But I wasn't really up for much. By day 3-4, I was so stir crazy I could hardly stand it.

Everyone is different. I can't say I felt great, I was tired and so on. But I did walk around but it was more casual walking around, without having to get anywhere. Walk around the pool, walk downstairs and back upstairs, that sort of thing. They told me that it's good to walk around (though not elevate your heart rate). So a tiny bit of activity isn't bad, but don't overrate what you can do. Perhaps you could stay back (the day after), and let the other guy who is going with you, go to the hospital with your bf. I know it's a big deal for him but by day 2, he is going to understand COMPLETELY.


--Jay

[Bimmer Guy]

Yes they do (the kick you out and let you fend for yourself after surgery). However, this is a typical US surgery situation, and though it was started to save money, I think that there is no reason to think that it is dangerous in anyway. (Not saying you said this.) OTOH, yes, I think it does give some guys the idea this is no big deal.

Yeah, it's funny.  It seems completely appropriate to me that we would be discharged the same day.  There were no dressings to change or anything like that, just drains to take care of.  I could get to the bathroom no problem.  I have a hard time understanding what the purpose is of hospitalization?  What do the nurses do for you that your 24 hour assistant ( the person who "agrees" to watch you for 24 hours after surgery) can't?

[aleon515]

Brett, I don't believe same day surgery centers have taken off in the UK and Australia. I think it was mainly a cost cutting thing in the US as well as the fact that there is minaturizing of things like units for anesthesia and that kind of thing, so you can put a whole operating room in a smaller space (at least I recall reading that). Due to the fact that our health care is MUCH more expensive, saving bucks is a big thing here. I think there are benefits to same day like infection control as well.

I don't think there is anything they can do unless you have complications, and severe complications are very rare. I felt very safe in the Same Day. The drains are easy to care for, though I had a little trouble coordinating doing it, once I got the hang of it, I did it by myself.

--Jay

[FlightyBrood]

Yeah, it's funny.  It seems completely appropriate to me that we would be discharged the same day.  There were no dressings to change or anything like that, just drains to take care of.  I could get to the bathroom no problem.  I have a hard time understanding what the purpose is of hospitalization?  What do the nurses do for you that your 24 hour assistant ( the person who "agrees" to watch you for 24 hours after surgery) can't?

Yeah. Everyone  in the office kept telling us how this surgery isnt that big of a deal, since its only skin and there is no muscle involved in the surgery. Of course its still a surgery and they made absolute sure i had everything taken care of after our first plan of having boyfriend care for me, then me care for boyfriend failed.

They told us in no uncertain terms that he will NOT be able to be there with me though, so he will not be.

Im stressed about unlikely complications. My biggest fear is not making it back home to my boyfriend. Its nothing to worry about right?

[Kreuzfidel]

I have a hard time understanding what the purpose is of hospitalization?  What do the nurses do for you that your 24 hour assistant ( the person who "agrees" to watch you for 24 hours after surgery) can't?

I don't know any particular reasons as far as official ones, but they gave me an intra-IV antibiotic drip for 2 days.  They came around every hour the first night to check my temperature, blood pressure and O2.  I agree in that my wife could have helped me to the toilet, changed my bottles, etc. as well as the nurses could have - but I suppose that since cutting costs for patients isn't as much of an issue here, they hospitalise you because a) professional carers (nurses) can look after you and administer your pain meds, etc. and b) because this service is available and isn't costing much to us so why not use it? 

Yeah. Everyone  in the office kept telling us how this surgery isnt that big of a deal, since its only skin and there is no muscle involved in the surgery. Of course its still a surgery and they made absolute sure i had everything taken care of after our first plan of having boyfriend care for me, then me care for boyfriend failed.

They told us in no uncertain terms that he will NOT be able to be there with me though, so he will not be.

Im stressed about unlikely complications. My biggest fear is not making it back home to my boyfriend. Its nothing to worry about right?

I pretty much disagree with summing it up as "it's only skin" because it's not.  It's not open-heart surgery, but it's a surgery nonetheless.

You will make it home to your boyfriend, mate.  Nothing to worry about.  You will be observed under anaesthetic by professionals - observed afterwards by professionals and you won't be discharged if they have any worries.

[Bimmer Guy]

I don't know any particular reasons as far as official ones, but they gave me an intra-IV antibiotic drip for 2 days.  They came around every hour the first night to check my temperature, blood pressure and O2.  I agree in that my wife could have helped me to the toilet, changed my bottles, etc. as well as the nurses could have - but I suppose that since cutting costs for patients isn't as much of an issue here, they hospitalise you because a) professional carers (nurses) can look after you and administer your pain meds, etc. and b) because this service is available and isn't costing much to us so why not use it? 

Oh, yes, if it is available why not use it, makes sense to me.  I am confused about us trying to cut cost here in the U.S., yet with National Health Service I thought there was such a long wait due to cost? 

So if that is the case, why wouldn't NHS try to cut cost by doing same day?  Then they could get more people through, no?  Or, perhaps I don't understand the reason why people must wait so long for health care through the NHS?

Someone school me, please! 

[FlightyBrood]

All this cost cutting talk is very interesting! I didn't know that they didn't discharge people same day outside of the US.

My fevers been gone for two days and I'm just awaiting my cough to fully f-off. Boyfriend managed to avoid it, so far, lets hope he doesn't end up with the same fate as me. Otherwise our entire year is RUINED.

[Kreuzfidel]

All this cost cutting talk is very interesting! I didn't know that they didn't discharge people same day outside of the US.

My fevers been gone for two days and I'm just awaiting my cough to fully f-off. Boyfriend managed to avoid it, so far, lets hope he doesn't end up with the same fate as me. Otherwise our entire year is RUINED.

That's great news!  Fingers crossed for both of you to have a healthy year ahead.  It will all work out  

Oh, yes, if it is available why not use it, makes sense to me.  I am confused about us trying to cut cost here in the U.S., yet with National Health Service I thought there was such a long wait due to cost? 

So if that is the case, why wouldn't NHS try to cut cost by doing same day?  Then they could get more people through, no?  Or, perhaps I don't understand the reason why people must wait so long for health care through the NHS?

Someone school me, please! 

Well, I'm in Australia and the NHS is in the UK, so what we have here is called Medicare (nothing like the US' Medicare program, though).  There are long waits only if you are having surgery in the "public system" - or through a public hospital.  Basically what that means is that if you don't have private health insurance, the government will pay the majority of your costs through your Medicare, but you go on a long waiting list. 

I have private health insurance which is why it is quicker (and most people do have private health insurance here that are looking to have trans* related surgeries).  What I understand is that the US doesn't have anything like our Medicare, so the entire burden of cost is on the patient if they don't have private insurance, hence cutting costs by having top surgery as a day surgery since I think that there are a lot of guys having it that don't have insurance.

[AdamMLP]

Cost is part of our waiting times, there's only a certain amount of funding allocated for trans stuff each year, one of our gender identity clinics has run out of funding for this financial year, so aren't taking on any new patients until April.  (For anyone reading this from the UK, you can still get referred to Charing Cross, they just can't process the referral until they've got the new funding allocation and have cleared the existing backlog of referrals.)

Then there's jumping through the hoops, you've got to have been living as male for a year before they'll give you surgery here, and 6 months for T.  I'm not sure this happens in America, it seems like all you need there is therapist letters.  Private places here do speed things up in that respect, but they're not so common as far as I'm aware.

And it's simply a massively over stretched system, particularly with trans stuff, as it's not physically life threatening.  For example, Charing Cross has to schedule appointments further appart than all the rest because it's the biggest and being in the captial, closest for a lot of people, and that's the only way it can fit in all of the patients that it has.

Doesn't help that some GPs don't understand how to refer, and don't have the time to do their own research, or can't wrap their heads around the documentation shown to them.  I saw my GP first in mid-October last year, again with more documentation and a phone number for him to call 3 weeks ago and I've still not heard anything back from him.

[aleon515]

Uk health care costs a fraction of the cost that health care in the US  (Can include any other country in Western Europe as well as Canada and Australia). Medicare IS actually somewhat like Australia, I believe. It is a single payer but not provider. Though I don't know which systems are single payer or single payer/provider. NHS is the latter. However or medicare it is only for people over 65, as well as disabled people.

One reason to cut costs is for "cosmetic surgery", I don't agree but this is where top surgery is. And insurance doesn't normally cover. So a good reason to cut costs.

I think there are some of these in Canada, but the concept doesn't seem to have gotten across the pond. It might actually make sense.

I think there are other things pro for same day, like lowered infection rate and that kind of thing. You are probably less likely to get a nasty hospital staph infection. Another thing is that moving around is good for you, short of raising your heart rate. I walked around a LOT. Didn't do anything greatly vigorous but being in a hospital connotes being incapacitated.

Most same day surgery centers are connected with a hospital, so if you get an infection (or other serious complication) you could be admitted, if it were necessary. I'm sure ,say, Dr G has admitting rights to the hospital that is next door to Memorial Same Day. I've never heard of anyone getting admitted, but I heard that there are guys he must do in the hospital-- for instance if you had a serious medical condition. (I saw a video of someone who had gotten hydrocephalus treated which involves shunting fluid away from the brain.) I have never read that you are usually in any serious danger after top surgery. It isn't exactly trivial but it's not like heart surgery either.

Most people are not in a terrible amt of pain, so I don't think most surgeons will use drips and so on. Most of the time you are given a prescription of Vicodin or similar drug. Frankly I didn't even take the Vicodin and know many people who maybe took 2-5 of them max. I know a couple guys in the UK, and they took some prescription pain meds (no drip). Top surgery is more uncomfortable than out and out painful, imo.

You wouldn't need your bp and so on taken actually. But since you are in the hospital they are going to justify you being there by doing it. If they didn't do it, they would have a hard time explaining themselves to the local health care boss.


--Jay

[FlightyBrood]

They prescribed us Norco along with celebrex and something for nausea. I know very little about the healthcare system, I'm on my father's insurance through his big name drug company.
I do know that here in California we have medical, which sounds like how it goes in Australia. It actually covers trans things, as does most higher insurances here.

Be careful though-they found out I was close to reaching the requirements to qualify for top surgery and they cut all my gender benefits. Id imagine it's similar if you go through medical. (which I don't qualify for)

[Kreuzfidel]

Uk health care costs a fraction of the cost that health care in the US  (Can include any other country in Western Europe as well as Canada and Australia). Medicare IS actually somewhat like Australia, I believe. It is a single payer but not provider. Though I don't know which systems are single payer or single payer/provider. NHS is the latter. However or medicare it is only for people over 65, as well as disabled people.

One reason to cut costs is for "cosmetic surgery", I don't agree but this is where top surgery is. And insurance doesn't normally cover. So a good reason to cut costs.

I think there are some of these in Canada, but the concept doesn't seem to have gotten across the pond. It might actually make sense.

I think there are other things pro for same day, like lowered infection rate and that kind of thing. You are probably less likely to get a nasty hospital staph infection. Another thing is that moving around is good for you, short of raising your heart rate. I walked around a LOT. Didn't do anything greatly vigorous but being in a hospital connotes being incapacitated.

Most same day surgery centers are connected with a hospital, so if you get an infection (or other serious complication) you could be admitted, if it were necessary. I'm sure ,say, Dr G has admitting rights to the hospital that is next door to Memorial Same Day. I've never heard of anyone getting admitted, but I heard that there are guys he must do in the hospital-- for instance if you had a serious medical condition. (I saw a video of someone who had gotten hydrocephalus treated which involves shunting fluid away from the brain.) I have never read that you are usually in any serious danger after top surgery. It isn't exactly trivial but it's not like heart surgery either.

Most people are not in a terrible amt of pain, so I don't think most surgeons will use drips and so on. Most of the time you are given a prescription of Vicodin or similar drug. Frankly I didn't even take the Vicodin and know many people who maybe took 2-5 of them max. I know a couple guys in the UK, and they took some prescription pain meds (no drip). Top surgery is more uncomfortable than out and out painful, imo.

You wouldn't need your bp and so on taken actually. But since you are in the hospital they are going to justify you being there by doing it. If they didn't do it, they would have a hard time explaining themselves to the local health care boss.


--Jay

I think we will just have to agree to disagree, Jay.  I think it's preferable to be admitted and stay at least overnight and you believe that there are more pros to day surgery.  Either way, whatever works for the country they're in - good on 'em.

Flighty, you will be fine.  Please keep us updated.

[Bimmer Guy]

That's great news!  Fingers crossed for both of you to have a healthy year ahead.  It will all work out  

Well, I'm in Australia and the NHS is in the UK, so what we have here is called Medicare (nothing like the US' Medicare program, though).  There are long waits only if you are having surgery in the "public system" - or through a public hospital.  Basically what that means is that if you don't have private health insurance, the government will pay the majority of your costs through your Medicare, but you go on a long waiting list. 

I have private health insurance which is why it is quicker (and most people do have private health insurance here that are looking to have trans* related surgeries).  What I understand is that the US doesn't have anything like our Medicare, so the entire burden of cost is on the patient if they don't have private insurance, hence cutting costs by having top surgery as a day surgery since I think that there are a lot of guys having it that don't have insurance.

Interesting stuff.  Your Medicare sounds like our Medicaid.  Medicaid is for people who can't afford insurance.  Only one or two private insurance companies pay for trans surgeries.  Most top surgeons won't take the insurance, anyway, so pretty much everyone pays out of pocket in the U.S.

I find it interesting that you all separate out the "haves" from the "have nots" when it comes to medical care (I am assuming non emergent medical care).  The "have nots" go on a waiting list, while the "haves" don't.  That sounds rather American, and yet, we actually don't even do that when it comes to our public/private insurance!     Those on public insurance (Medicaid) would get the same care, on the same time frame as those with private insurance.  What is the downside to Medicaid?   Hmmmmm....besides the fact that it means you don't have much money, it is kick ass insurance with no deductibles/no copays!

lxnder, thanks for the information.  I had a hard time understanding if you were saying you had to live as male for 6 months before you got T?

Yes, here most follow the WPATH standards of care.  As of 9/2012, even a GP can deem you as trans (or rather, they can deem you as having the ability to give "informed consent", meaning that you are able to verbalize and understand what HRT will do to your body), and refer you for HRT. It doesn't have to be a therapist anymore.  The WPATH standards of care say that you need one therapist letter for top surgery.  For bottom surgery you have to live as male for one year and have two letters from mental health professionals.

There are some top surgeons who do not follow the WPATH standards of care and don't require a letter.

You do not have to be on testosterone here to get surgery.  That has never been a requirement here.

[AdamMLP]

lxnder, thanks for the information.  I had a hard time understanding if you were saying you had to live as male for 6 months before you got T?

Yes, normally they require you to live as male for 6 months before giving you T, with proof from your work that you have been living as male with a male name. Fortunately its very simple to change your name here compared to everywhere else. Sometimes they won't start counting your "real life experience" until you get to the gender identity clinic, but I know some people who have gotten round that by proving they were doing it before.

Its normally if you cannot hold down a job, education, or voluntary work, but they can give you T on the basis of just seeing you for 6 months and councilling you, but they don't like doing it at all.

[Bimmer Guy]

Yes, normally they require you to live as male for 6 months before giving you T, with proof from your work that you have been living as male with a male name. Fortunately its very simple to change your name here compared to everywhere else. Sometimes they won't start counting your "real life experience" until you get to the gender identity clinic, but I know some people who have gotten round that by proving they were doing it before.

Its normally if you cannot hold down a job, education, or voluntary work, but they can give you T on the basis of just seeing you for 6 months and councilling you, but they don't like doing it at all.

It really is interesting how it depends on the country where you live.  I assume they have the same expectation of MTF individuals? 

[CursedFireDean]

Yes, normally they require you to live as male for 6 months before giving you T, with proof from your work that you have been living as male with a male name. Fortunately its very simple to change your name here compared to everywhere else. Sometimes they won't start counting your "real life experience" until you get to the gender identity clinic, but I know some people who have gotten round that by proving they were doing it before.

Its normally if you cannot hold down a job, education, or voluntary work, but they can give you T on the basis of just seeing you for 6 months and councilling you, but they don't like doing it at all.

Living full-time for some length before getting hormones seems like a really strange requirement to me. It's hard to live full time as your proper gender if nobody reads you as such. Some are lucky enough to pass without hormones, but some also can't pass without them.

[aleon515]

Don't mind disagreeing politely with anybody,Kr.
There are advantages and disadvantages to various systems and our's always goes to having money. I'm guessing that is actually the case in Europe. I know of guys who tire of waiting for the approval of their government insurers and just go out and go to the US or go "private" which is an option in some places.

One option here we have in getting T (and surgery in some cases) is informed consent, basically saying you know what you are getting into. I am guessing this is almost not ever the case for lower surgery. Though there are doctors who will do this for someone who has lived as male for very many years (Dr Crane will do this for one). I know a few guys who have lived as male for decades, so this is a good option for them.
I'm guessing you could do informed consent in Canada, and this might be something that will spread. Except that one way to lower costs is to create artificial shortage, i.e. waiting lists. Sadly.


--Jay

[Kreuzfidel]

Living full-time for some length before getting hormones seems like a really strange requirement to me. It's hard to live full time as your proper gender if nobody reads you as such. Some are lucky enough to pass without hormones, but some also can't pass without them.

This always boggled my brain.  Most pre-T trans* guys do not pass well (or, if they do, pass as young boys) in general.  I don't understand how it's expected that one (safely) live full-time being unable to pass.  I see nothing but negatives in this - constantly being misgendered and contributing to mental distress, putting oneself in danger potentially in less open-minded societies and the potential of being accused of presenting a false identity when one is claiming to be male and using a different name.  I don't see the benefits.

[aleon515]

I think the "living full time" thing is straight from the MTF side, as the MTFs I know have mostly done this. (Though not all, I know someone who was a gal in some situation and not others. Seemed to work very fine for her.) The idea that one even HAS to be "full time" is quite a binary expectation.

I think a lot of us just start living as male when we start being read as male. This only happened for me at about 8 months on T. I think in some areas might even jeopardize someone's safety if they are required to live in a way that might not be accepted by the community.

Really outdated, imo.
I really think informed consent makes the most sense.


--Jay

[FlightyBrood]

I have never heard that you have to live full time before you can even get t! Here it's usually a letter from a therapist after three months of therapy. I didn't even need that though.

I lived full time for...maybe four years or so before t? I can tell you it was not fun in the least. I ended up giving up on explaining to people and just denied being trans. Too much of a hassle. Strangely people believed me when I denied it. I definitely didn't pass, I don't even pass after a year and some change on t!