I had Secondary Sigmoid Colon SRS with PAI

[SpiralCream]

Hi SpiralCream. Hope your still doing ok an your healing is going well. How many more days are you in Bangkok for? How often do you have check-ups with the doctor?
Hope you've found some more interesting food that you can digest

It's been 2 weeks since my surgery and my plan is to stay here for 2 more weeks. When planning for this trip, I decided to stay longer than the minimum required recovery time.  I wanted to give myself plenty of extra time to rest and heal and regain my strength and deal with any unexpected complications before flying back home, especially since I'm traveling alone.

I tried eating some fried rice this morning for breakfast.  It kind of reminded me of the fried rice at a Vietnamese restaurant I enjoy back at home.  It was not salty or greasy or 'heavy' like the fried rice you get at a typical Chinese-American takeout restaurant in the US.  Still, my stomach felt a little uneasy afterward.  It's probably just my body adjusting to a new food.  I'm not too worried.  It sure did taste good! 

The last time I had a check up with Dr Burin was a week ago, after I was discharged from the hospital.  He said everything was fine at the time.  I will see him again for a regular scheduled follow-up appointment tomorrow.  I feel like it would be nicer to have more frequent follow-ups than this though - maybe every 3-4 days instead of weekly?  I kind of miss the daily visits from Dr Burin at the hospital.  There isn't anything wrong with me as far as I can tell, but I do have some questions for him.  But then again if there's nothing wrong with me maybe it'd be a waste of time to just go to PAI clinic for 1 minute, have him say everything is normal, and be done.  I guess if it's serious enough I can just call PAI from my hotel room and they could pick me up so I could see him earlier I guess if necessary.

[Devlyn]

Can you please take your conversation elsewhere instead of hijacking this thread?  Thank you.

Amen.

[SpiralCream]

I had my 2 week follow up with Dr Burin today.  I asked him about a bulge of what felt like dense muscle under my skin.  It runs just above my abdominal scar, but is most prominent and juts out on the left side.  The part that is really noticeable is about 1.5 inches long, 0.4 inches high, and bulges out about 0.3 inches.  The bulge is only visible when I am standing up straight.

Dr Burin said that the bulge is fascia, a layer of connective tissue above the muscle.  During the surgery, they had to cut through this layer and then stitch it back together.  He said that the bulge is part of the healing process and that it will go away on its own.  But it could take a long while.

Other than the pain from my lower abdominal muscles, the other main source of pain is the connection point in my vagina, where the colon tissue was connected to the internal vaginal tissue.  It's really only painful when I dilate though.  Dr Burin examined that and said it was healing fine.  He said I should try to put my finger in there and massage it gently before I dilate, to gently expand it before dilation.  I will need to continue to refrain from using any dilators larger than the first one (28 mm) for the first 2 months, in order to allow that connection point to heal.

I'm glad that there have been zero complications from this surgery so far.  Not even any minor complications.  Because I didn't have any work done on my external bits, I can sit down for hours without any pain (as long as I have a bit of a seat cushion).  Right now the biggest hassles are lower abdominal pain (although this is easily managed by just Tylenol now), being restricted to soft foods in small amounts instead of big meals, and diarrhea several times a day (but just a little bit comes out each time).

Two of my biggest worries going into this surgery were:

1.) excessive discharge.  Even now, it is less discharge than before my colon surgery (when I had granulation tissue causing lots of discharge).  I am sure it will become less with time and hopefully go away completely, but I am already pleased that it's less than before.  If I had to make a comparison, it is similar to the amount of discharge that I had at this same point in recovery after my first SRS.  It's not that bad.

2.) belly swelling.  I read from some old posts here at Susan's Place that some people experienced a lot of swelling in their belly after surgery.  Some comments said it almost made them look pregnant?! But I have not seen that at all (other than the minor bulge from the muscle fascia).  My belly is still mostly flat as it was before surgery.  And the bulge from the fascia is only there if I look closely and if I wore a super tight shirt.  I really don't think anyone else would notice.  I actually tried to take a picture of the bulging fascia with my phone for my own records, but it's hard to see it in the photo.

Overall I'm very pleased with how things have turned out.  I will of course update again when something new turns up.

[SpiralCream]

I thought I should write something about my breast augmentation, because I did get that done at the same time as my sigmoid colon surgery!  There are plenty of stories out there about BA surgeries, so I won't bore you with the details.  But maybe something specific about the PAI experience would be nice to add.

During my pre-op consultation with Dr Burin, we talked about both the sigmoid colon procedure and the BA procedure.  It was a long consultation because Dr Burin spent plenty of time explaining everything to me and giving me time to ask as many questions as I wanted.  After we finished talking about the sigmoid colon surgery, we talked about the BA surgery.  But I was kind of tired by that point and wasn't thinking clearly.  After measurements and discussion, we agreed on 300 cc moderate plus profile, round silicone implants.

The next day, I started rethinking my decision about 300 cc.  I chatted with friends from back home.  I messaged several of my trans women friends who had BA surgery.  I also messaged several of my cis women friends who had BA surgery.  Almost all of them suggested I go a little bigger, as they all had implants bigger than 300 cc.  So I called the PAI office and asked if I could see Dr Burin on short notice.  They said sure, I could come in the next morning to talk to him.

I spent time with Dr Burin again the next morning discussing implant size.  This time we settled on 375 cc high profile, round silicone implants.  At the end of this consultation, Dr Burin smiled and said if I changed my mind again, or if I wanted to ask more questions, I could come in to talk to him again before my surgery.  It turns out I didn't need to, but hearing him say that was really nice.

I'm very happy with how my BA turned out.  I think 375 cc was the perfect size for me (I was previously an A cup after several years on HRT).  And I feel that Dr Burin has really good bedside manners.  The fact that he was willing to see me again at the last minute, and offered to see me again after that if I wanted to, just goes to show how accessible he is.  And of course as I mentioned in an earlier post, he visited me daily in the 8 days I recovered in the hospital.  Always with a kind smile, gently checking my incisions, and giving me plenty of time to ask questions.  I think he's wonderful.

[Mendi]

Spiral, how much did the BA cost at PAI? Been thinking PAI for BA, but then again, there is so many options in Thailand for that, so would be interested of hearing the cost at PAI? I had my SRS there so it would be familiar place though.

[SpiralCream]

I will send you a private message. I prefer not to discuss the specifics of pricing publicly, whether they are good or bad prices. My breast augmentation was of course less expensive than if I had done my breast augmentation at home in the US. 

Dr Burin used Mentor brand implants for me.  Silicone, textured ('Siltex'), round, high profile, 375 cc. My breast width measurement at consultation was 12 cm.  I previously wore a 34A bra.  I'm not sure what my size is right now, especially since I'm still swollen, but my goal was to be a full C. I think it will look great once I'm done healing. They look good already!

[Mendi]

Thank you. I think it is the implant itself which determines most of the cost. Been looking various clinics in Thailand and the price range differs with thousands of dollars depending on surgery method and implant.

Have to see

[SpiralCream]

Here are some pictures I took of my private room at Phyathai Hospital 2, during my one week post op recovery. It was very spacious and comfortable. There was a separate sink outside the private bathroom.  My hospital bed was very, very comfortable, much more comfortable than the bed in which I recovered at Chettawut's clinic for my first SRS. This bed at Phyathai Hospital was nice and soft and did not hurt my tailbone, even after laying there for many days.


http://imgur.com/TXkiFII
http://imgur.com/tfhXMMx
http://imgur.com/buIeVym
http://imgur.com/6JGyZ3Q
http://imgur.com/wdCWetX

[Linde]

Here are some pictures I took of my private room at Phyathai Hospital 2, during my one week post op recovery. It was very spacious and comfortable. There was a separate sink outside the private bathroom.  My hospital bed was very, very comfortable, much more comfortable than the bed in which I recovered at Chettawut's clinic for my first SRS. This bed at Phyathai Hospital was nice and soft and did not hurt my tailbone, even after laying there for many days.


http://imgur.com/TXkiFII
http://imgur.com/tfhXMMx
http://imgur.com/buIeVym
http://imgur.com/6JGyZ3Q
http://imgur.com/wdCWetX

Pretty nice and roomy there!

[Mendi]

Familiar room. Seems like a life time ago, even when it has been only a bit more than 4 months!

[NCAmazon]

SpiralCream,

How far in advance did you need to book to get a surgery date for the Sigmoid Colon surgery ?

What diet tips do you have for the days leading upto the surgery.

[SpiralCream]

I booked my surgery about 4-5 months in advance.  Given that my sigmoid colon surgery was done by a team of 3 surgeons (not including anesthesiologist), I was pleasantly surprised at how quickly I was able to schedule it.

You have to be on a clear liquid diet for 3 days before surgery (not including the day of surgery itself).  I handled this easily for my first SRS by drinking a lot of Coke and Sprite.  But you can't do that for sigmoid colon because the soda drinks can cause gas in the digestive system.  Instead I drank a lot of fruit juice - apple juice and grape juice.  They are cheap and you can buy those in any store here.  You can't drink orange juice because it has pulp and particles in it.  You can drink clear soup broths too, but I preferred juice.  Be sure to eat all your favorite foods before you leave for Thailand!  I ate a lot of hamburgers, pizza, and steak before my trip, haha.

PAI told me the other day that they do 50+ sigmoid colon surgeries per year, the most of any other surgery clinic in Thailand.  I certainly believe that, given how smoothly everything has gone for me.  Even the nurse at the hospital who handled much of my aftercare had lots of experience working with sigmoid colon patients and was familiar with how to handle my recovery in the hospital.  Her English was quite good compared to the other nurses and she was very friendly.  You may be lucky and get her too - her name was NeeNee (not sure about spelling, but that's how her name was pronounced)

[SpiralCream]

Ever since I was discharged from the hospital and began dilating at the 1 week post-op mark, I had no blood coming out of my vagina.  This was quite different from my first SRS, where it was normal to have blood coming out during dilations and even in between dilations during the day.  But after my sigmoid colon revision, I had no blood at all, not even during dilations.  It was just mucus, and not much of it either.

At about 2.5 weeks post op, I started noticing a little bit of blood at the tip of my dilator, after pulling it out.  It was just a small amount.  I didn't have any blood on my bed pads or on my maxi pads, so I didn't think it was serious.  I had only been dilating to 4-5 inches (Dr Burin said to dilate only to 4-5 inches for the first 2 months to allow the deepest part to heal), so I didn't think it could have been from damaging the deep end of my internal vaginal canal.

A few days later at exactly 3 weeks post op, I finished my evening dilation session as usual.  Again, just a little bit of blood on the tip of the dilator.  Same as before.  But a few hours later, when I went to go pee, I noticed quite a lot of blood on my maxi pad. 

That evening was really bad.  I had to keep changing my maxi pads every 2-3 hours because of the blood.  And I was using heavy overnight pads too.  Previously, I had only been changing my pads every 12 hours.  When morning arrived, I called PAI from my hotel room to express my concern and explain the situation.  They sent a driver to pick me up in less than an hour and I went to the exam room to be seen by Dr Burin.

He gave me a full exam, checked the connection point and verified it was holding just fine.  He checked deep inside me too and said everything was fine there as well.  He took some cotton balls and put them deep inside to collect some of the blood.  He showed it to me, and when he asked me if it was the same color (dark red blood) as from the night before, I said yes.

So it turns out that it was just a blood clot.  Dr Burin said it's totally normal that during the surgery, blood clots can form deep inside the sigmoid colon vagina.  Since the sigmoid colon that was used was 8 inches long, it is really deep inside.  And it took a long time for that blood clot to work its way out.  Dr Burin said that it's possible that I may continue to see more blood clots come out over the next several weeks.  I will know it's a blood clot and not an open wound due to the color.

Thankfully it was nothing, but for a while there I was really scared.  To go from no blood, to a tiny amount of blood, to just a ton of blood that required changing heavy duty pads every 2-3 hours, was something I was not prepared for.

[SpiralCream]

Here are a few more tips for recovery.

Your lower abdominal muscles will hurt for quite a long time.  It will hurt whenever you cough, sneeze, or even laugh.  Dr Burin told me that if you're about to do those things, use your hands to put pressure on your lower ab muscles.  That way they won't move as much when you cough/sneeze/laugh, and it won't hurt as much.

Although there is not much information about sigmoid colon revision SRS out there, there is actually quite a lot of information on the internet about colon resection surgery and even specifically sigmoid colon resection surgery.  It is done in cases of colon cancer to remove the affected colon tissue, for example.  The difference is that instead of removing the damaged or cancerous colon segment and disposing of it, the healthy colon segment is transplanted into the vaginal canal for SRS.

You can do Google searches for "sigmoid colon resection" and "sigmoid colon resection recovery" to read lots of information from many websites about what to expect during recovery in terms of your bowel movements, recovery time, how it affects your digestive system, and a schedule of what foods you can eat and when.

[Linde]

Did he explain why they did not use saline solution to flush those blood clots out?  I don't know about this type of surgery, but in it is common standard procedure to irrigate a surgical site to remove any possible blood clots.  Blood clots could be a possibility for bacteria to settle in, and cause an infection near or at the surgical site.

[SpiralCream]

I had my final checkup with Dr Burin today.  Today is exactly 4 weeks post-op.  I fly back home to the US tomorrow.

I asked Dr Burin about the blood clots again.  I still get blood on my pads when I am sleeping at night, but that's about the only time it happens now.  Otherwise, during the day, there's no blood at all, except at the very tip of my dilator after I pull it out.  He said this is normal and that it may continue for a bit longer, but it will be fine.

Dr Burin explained the surgery to me again like this: He removed the damaged internal skin graft tissue (granulation tissue) by extracting it through my vaginal canal.  The surgical team (including a colon specialist surgeon) made the incision in my lower abdomen to access the abdominal cavity.  They cut an 8 inch segment of my sigmoid colon and, while the colon segment was still in my body, pulled it down into place in my vaginal cavity.  They stitched the deep end closed, and they stitched the other side into my vagina (the 'connection point', which is 1.2 inches inside my vaginal introitus).  And of course they reconnected the remainder of my colon to reconnect my digestive tract.

The deep end of my vaginal canal (now comprised of sigmoid colon tissue) is, according to Dr Burin, continuing to heal from the sutures.  That is why he emphasized from the very beginning that I should not push dilation depth beyond 4-5 inches for the first 2 months.  The deep end is still healing and oozing.  That is where a lot of the blood is coming from, both during surgery and even now as it heals.  Eventually it will heal completely and the bleeding will stop entirely.

During the exam, he noted that my connection point was wider (thanks to dilations) and the tissue there was also softer.  It's coming along quite nicely.  Although his recommendation was to dilate twice a day for 15 min each session, I had been doing it for 45 min each session instead.  It seemed like such a hassle for me to set up for a dilation, only to do it for 15 min.  It is not painful to dilate and actually quite relaxing, so I get set up and watch a TV show in Netflix for 45 min.  Initially the connection point was a bit painful to get past, but nowhere near the amount of pain I felt while dilating in the initial weeks of my first SRS.  And now, 4 weeks post-op, dilations are pain-free.  It's great.

My lower abdomen muscles are still a source of a little pain though.  I don't have any trouble getting in and out of bed like I used to, but coughing and sneezing still hurts.  Bowel movements are still highly irregular and at times painful.  I can feel the fecal matter as it passes through my lower colon.  It feels like a brief stomach ache (but lower in my body) as it passes through, then just as the poo exits my body, the pain goes away.  This is all normal for a colon resection surgery of any kind, but still something to keep in mind.  Irregular and painful bowel movements are to be expected for the first 2 months post-op, according to Dr Burin and also from what I have read about colon resection surgeries online.

[SpiralCream]

Just some final thoughts about PAI as I get ready to leave Thailand...

They are a first class organization.  I was happy with my experience with Dr Chettawut and his team, but I am totally blown away with my experience with Dr Burin and the PAI team.  I think PAI is highly, highly underrated and hope that more western patients, especially from the US, have an opportunity to go to PAI, to see firsthand just how amazing they are.

Bune and Jessie, the patient coordinators here, are so fun, helpful, and friendly.  I am going to miss them!

I have to say especially Dr Burin has been amazing.  He's been so incredibly patient as I asked him a million questions both pre-op and post-op.  He's always been available whenever I had concerns.  Even as I left today, he smiled and told me to feel free to contact him with any questions after I return home!

Obviously my colon surgery turned out great, which was my main concern.  But my breast augmentation turned out great too.  I actually went against Dr Burin's initial recommendation for a 'natural looking' 300 cc implant and insisted on a 375 cc implant.  It still looks good, but maybe a bit bigger than I expected.  But that is all on me; that's what I chose myself!  I'm not willing to share pictures of my breasts here (lol) but I've shown some of my friends and they all say they look beautiful and perfectly symmetrical.  The under-breast incisions are already healing to near invisible too.  Dr Burin did a wonderful job.  I've had a fantastic result from both my sigmoid colon surgery and my breast augmentation surgery, and my experience with Dr Burin has been way beyond my expectations.

[SpiralCream]

I'm 5 weeks post-op as of today.  I think maybe the blood from the blood clots are over with.  For the past 5 days or so, I haven't had any blood coming out onto my pads while sleeping.  And as of today there isn't even any blood on the tip of my dilator.  There's just no blood at all anymore, both during the day and during dilations!

The amount of mucous discharge during the day(and night) is quite low.  I'm pleasantly surprised by this.  I had the impression before this surgery (mostly from unfounded rumors I read on the internet!), that there would be a ton of nonstop discharge for many months.  But even now at 5 weeks post op, it's already very minimal.  I could probably go the entire day with only 1 maxi pad.  I do change my pads every 12 hours for sanitary reasons, but there just isn't much discharge for the maxi pads to collect.  The smell is also not bad at all.  I remember at this point in my recovery from my first SRS with Chettawut, I needed to douche the inside of my vagina at least once a week because it smelled really bad inside.  But ever since my sigmoid colon revision, I haven't douched the inside of my vaginal canal at all.  Zero.  Not even my surgeon or nurses douched my vaginal canal before I left.  They even told me to wait until at least 2 months post-op before douching my vaginal canal in order to let the sutures in the deep end heal.  I was worried the smell would get bad in the meantime, but it's barely noticeable at all.  I wonder if the colon mucosal tissue makes my vagina self-cleaning?

One bit of bad news though is that I got a UTI 2 days ago.  I woke up with a burning need to pee and blood in my urine.  I felt like I had to pee constantly, even after going repeatedly.  I had never had a UTI since my initial SRS a year ago, but I knew from these symptoms it was almost certainly a UTI.  I went to an urgent care clinic, gave them a urine sample, and they tested it within minutes.  The doctor prescribed antibiotics for me and sent the sample to a lab for further testing to determine the exact bacteria strain.  Once we get the results back, the doctor may change my antibiotic.  But for now the medication seems to be working great.  I actually started feeling better within an hour after taking it, and the blood in my urine was gone after 6 hours or so.  I'm glad I was able to take care of it quickly.

I think the main reason I got this UTI was because of my frequent bowel movements and loose stools.  It's a side effect from any colon resection surgery, and until my digestive system fully adjusts (hopefully in the next month), it's just something I have to deal with.  I bet some of the bacteria in my loose stools made their way into my urinary tract.  I'll have to do a better job of cleaning my external bits with betadine/water after every dilation.  I have to admit I got a little lazy with that since I got back home!

[Lucie]

I'm 5 weeks post-op as of today.  I think maybe the blood from the blood clots are over with.  For the past 5 days or so, I haven't had any blood coming out onto my pads while sleeping.  And as of today there isn't even any blood on the tip of my dilator.  There's just no blood at all anymore, both during the day and during dilations!

That's great!

I remember at this point in my recovery from my first SRS with Chettawut, I needed to douche the inside of my vagina at least once a week because it smelled really bad inside.

I think it depends on people. In my case (1 year post-op with Chettawut) I never douched the inside of my vagina. I just took probiotics a few months ago because I had noticed an unpleasant odor during a short period. Since then no more bad smell at all.

I think the main reason I got this UTI was because of my frequent bowel movements and loose stools.  It's a side effect from any colon resection surgery, and until my digestive system fully adjusts (hopefully in the next month), it's just something I have to deal with.  I bet some of the bacteria in my loose stools made their way into my urinary tract.  I'll have to do a better job of cleaning my external bits with betadine/water after every dilation.  I have to admit I got a little lazy with that since I got back home!

Perhaps you could try to take probiotics, at least as long as your digestive track is adjusting. It could help enhancing your urinary track immunity.

[SpiralCream]

Perhaps you could try to take probiotics, at least as long as your digestive track is adjusting. It could help enhancing your urinary track immunity.

Thanks for the suggestion, but I'm not comfortable trying probiotics.  I've never taken them before, so I don't know how my body would react to them.  I don't want to take a risk with an unknown supplement.  I made that mistake before when I took Arnica Montana in the past.  Although a ton of people continue to recommend it all over the internet to help with healing from medical procedures, my body treated it as poison and it gave me the worst stomach pains and vomiting - all while my body was trying to heal.  I'm never again trying anything new in terms of foods or supplements during surgical recovery unless my doctor orders it.

When I'm healthy, I do eat yogurt regularly, so I guess I get probiotics naturally from that food.  But I've stayed away from dairy products and will continue to do so as part of my low residue diet for now.