Hello,
I've decided to compile my notes on recovering from Dr. Haben's VFS here. For reference:
- my SFF was around 130hz (not very high, but not super low)
- I'm young
- never a smoker
- no vocal tremor, paralysis, or similar injuries
- no alcohol or drugs
- no reflux or "badness" as the doc put it
- I had only the minimally invasive done.
Since he's constantly refining the procedure and recovery protocol himself, some of my advice is in the same spirit of personal adaptation, and should be taken as such rather than a hard and fast rule. I'm completely open about all that I experienced.
Dr. Haben states himself as having done 550+ voice feminization surgeries now, with patients from over 30 countries as far away as New Zealand and China. That definitely shows a lot of practice, and from the calls coming into his office, I get the impression VFS is becoming a key part of his enterprise. He was incredibly clear, professional, and friendly, if perhaps erring on the side of brevity and objectivity, as you'd hope any honest doctor would. He gives you pre and post-op photos on glossy paper and lets you take a cell phone image of the screen from your morning after visit for comparison.
The one month voice rest period is now very strongly emphasized as absolutely total and mandatory. No more voice samples prior to a month! As he put it, any sound coming out of the mouth that you can control is to be avoided during this time period. This includes but is not limited to breathing heavily as with aerobic exercise (I can think of a poster here whose experience would have prompted this protocol revision). He did say that unvoiced (air only) gargling and burping pose no problems.
The voice exam is easier than I'm used to. Instead of going in via the nose and bombarding the whole ENT area with anesthetic that leaves you feeling drugged for hours, it's just a gentle, bitter spray into the back of the throat, and you feel normal within a half hour or so. Though I did find it uncomfortable to phonate in several different registers while maintaining that position. You can swallow, but you can't feel yourself swallow, which is a little alarming if you're not ready for it. It's like trying to hard-swallow peanut butter with a really dry mouth.
My surgery wasn't until around noon, which is a lot later than I'd expected. I suspect he does the lengthier surgeries earlier in the day. The nurses and anesthesiologist were all very nice to me. He gives potent anti-nausea medication during surgery and that you can take post-operatively. My pain was minimal with no cough on a 35% tie, and I did not need the extra anti-nausea med post-op (which I expected to) nor the cough syrup. I'd imagine that those having more of the folds tied or adding a shave / CTA probably have a little more difficulty overall, since there's just more 'stuff' being adjusted.
For relieving cough, he actually recommends gentle throat-clearing (the 'impatient' sound) as opposed to coughing or swiftly moving air. He also recommends warm tea with lemon and honey as the best cough suppressant besides his codeine cough syrup. From my own knowledge, here's why this is so good: honey is actually amazing at keeping wounds sterile, but only if you're using medical-grade honey! At a bare minimum, you want raw, unfiltered honey (obviously this may be an allergy contraindication for some). It will say this on the package and the honey will not be 'clear' or translucent. Manuka honey is the gold standard. Do not add it to hot tea! Let the tea cool for several minutes until it no longer feels hot to the taste at all, then add the honey. This will preserve the healing properties of the raw honey at their optimal level. (Obviously you will not 'swallow it overtop' of your vocal folds, since that would be choking, but it still has benefits.)
If you're going to be out and about a lot, I highly suggest having some kind of easily handheld device capable of making noise. Typing is great, but you want the ability to rapidly communicate something equivalent to a "Hey!" on a second's notice if needed. There's a Walmart about a mile from the Marriot that sells bicycle bells, which suit this purpose perfectly, though I never actually needed mine. (By the way, this Marriott is a really nice hotel!)
Even closer to the Marriott is a Wegmans, which is BY FAR your best bet for food (and honey!!) in the area, especially if you're staying for awhile. The store's selection is really, really good, even by my left-coast elitist standards. The Marriott room's mini-fridges are empty so you can stock up on goodies (they do not have a freezer). Bananas are also a very safe bet. I had no trouble drinking tea and eating a couple the evening after surgery.
Immediately post-op I did have significant phlegm, which I was able to clear by just exhaling with a little force. I did my best to only gently clear the throat a few times as needed. I had no full-blown coughs at all. As you're waking up they give you ice chips to suck on, which I highly recommend. Constant, small sips of something warm or cold really helps suppress the urge to clear mucous. I also had the strong urge to burp, but recalled that HouseHippo had issues with this, so I resisted just in case; and it actually went away without incident on its own before I left the hospital. I don't recall the exact time but I was at the hospital for probably around 6 hours total.
Get the following apps for your phone: "Speak" and "Megatext". You can queue up phrases in each as needed (note - Megatext won't let you use punctuation unless you upgrade). Be sure to test different voices and speeds in Speak so you can be understood clearly. I tried them all and found "(English) Nicky" with pitch at ~1.15 and speed at .45 was easy for others to understand.
Dr. Haben places everyone on 6 days of glucocorticoids. Curiously I was also given 5 days of antibiotics at the hospital, which Dr Haben had not mentioned at all during the pre-op consult, but did the day after. He also prescribes 1-2 months of Prilosec, or in my case because I have low stomach acid, a month of Zantac. But I also have no reflux and found the Zantac too foul to palate, so all I did was add the "active" anti-reflux practices of not eating a few hours before bed, sleeping with my upper torso elevated, and avoiding trigger foods like onions, mint, garlic, chocolate, fatty foods, etc. If you have something high in calcium late in the day like coconut milk, that probably has a similar effect as well. He did say that for me the anti-reflux medication was on the level of, "if you can tolerate it, I do suggest you take it." In any case, I was alright without it, but most would consider my diet and habits "healthy" rather than "American".
I actually reacted badly to basically every medication he gave, and for me this was far more stressful than the actual healing itself. Of them all, the steroid is the most important since you need to keep the swelling at a minimum especially in the first week. I managed to get down 4 of the 6 initially prescribed pills on the first night (they taste bad), and at my day-after checkup I had optimally-minimal bruising or swelling, so I took that as the measure of an effective starting dose for me. The dosing on this steroid varies enormously depending on what you're using it for (it has many, many uses) and I couldn't find anything that really pins down a quantification based on your body weight beyond vague generally-prescribed ranges. The Medrol dosepak is essentially a one-size-fits-all, which obviously won't be optimal for everyone.
The steroid gave me lots of anxiety, restlessness, headaches, increased urination, nausea, mood swings, and decreased appetite, which I was not ready for. Essentially it felt like a hangover but more debilitating. Be prepared to taper your dosage in a way that makes sense for you if needed, since trying to cold-turkey it is not really an option and could be dangerous in more than one way. Its half-life ranges from 18 to 26 hours, so if you have to adjust it as I did, at least you won't completely lose the therapeutic benefit. The tablets can also be split into halves or quarters. (Note: avoid grapefruit. It causes the steroid to stay in your system longer.) It also is an immunosuppressant, so if your school or work requires you to be in close-quarters with others who might pass along some kind of crud, I definitely recommend taking the next week off - reduced immunity and earlier in the healing process don't exactly mix well with sickness.
I actually didn't really get random urges to cough (as opposed to just clear my throat) except for a few moments in days 3-6, since the sensation of the suture in the throat became a little more of an irritating than an "oh, right, that's there" tickle, but light sips of honey lemon tea seemed to help. I could also feel the vocal folds move a bit if I yawned, sneezed, or was holding back laughter (all unvoiced of course), so I did my best to suppress those functions. I might sound like such a rebel modifying medication protocol, but it really was all in the goal of optimal healing. What we're doing, after all, is largely uncharted territory. Only a few doctors in the world even perform this surgery!
It's also a good idea to consider what nutrients your body will need for wound healing and make sure you're getting plenty of those - the method by which this surgery succeeds is for the new commissure to form early and with strength, so you absolutely want to be sure your body is properly equipped to make that happen. Yet I've not yet seen a single poster mention the importance of this! Get enough complete proteins, vitamin A, B-complex, C, Zinc, Copper, Magnesium, and Iron, in particular. You don't have to megadose on supplements. Just eat foods that contain them, especially in the week or so pre-surgery, so that your body can store them up and put them to work immediately, then add them back in while healing as you feel able. It kind of boggles my mind to imagine someone wouldn't bother to prioritise such a vitally important step as making sure their body is equipped to do its own best job in recovery.
The five things Dr. Haben lists as within your control that could cause sutures to break earlier than desired are:
1 - Early or excessive voice use. Many on this forum were using their voices well before the one-month mark and ended up fine, but let's not test the waters, eh? Follow the good doc's conservative advice and take the month off.
2 - Coughing. Obvious one that everyone fears. If you develop a cough or some kind of illness that causes a cough, use the medicine he gave you.
3-4 (listing them together) - Reflux or regurgitation. Same thing, basically, but the latter is worse. Do your best to keep your stomach contents inside your stomach. Use medication if needed. Just an FYI, your vocal folds are connected to your windpipe, so technically you would have to aspirate (take something down the wrong tube) in order for it to contact your vocal fold area directly. Silent reflux is probably the bigger risk here. Still, be responsible about this. There's lots of information available about preventing it, and a lot of it comes down to healthy eating practices (there are reasons these conditions are ludicrously common in America).
5 - Smoking. If you don't smoke, you should avoid second-hand smoke, thick pollution, or other airborne irritants. If you do smoke, this is just not the time to be lighting up. But the amount and frequency matter a lot, so if you're one of those few for whom no words of caution or advice will stop you from imbibing something, three things together will minimize the risk.
a) Use the absolute smallest amount possible, b) Use a long-whip vaporizer that heats the material to sub-combustible temperatures, c) Filter your vapor (not smoke) through a water-pipe so it is cooled and humidified. Know that if you do this it's at your own risk, but that if you're amounting to the equivalent of 3-4 cigarettes in mass of cooled, filtered vapor over the course of a month, that's by nature going to be much different than even smoking as many cigarettes per day.
I'm not going to post a voice sample because im very happy with my result, and rather than pump your adrenaline with a sweet voice sample to envy (of which I'm sure you've heard plenty already, giving such surgeons the reputation they deserve), I'd rather the focus of my post be on giving you practical advice for what to expect recovering and tips that might make walking this path a little easier (the sole reason I even post here at all, really.)
Happy healing!
