Susan's Place Transgender Resources

There isn't as much information out there about this surgery, so I thought I'd share about mine.  I am now about a week post-op from sigmoid colon revision surgery at PAI, with Dr Burin.

Background: my first SRS was with Dr Chettawut.  I think he did a good job, and I've been pretty happy with the aesthetics.  Everything was fine during my recovery in Bangkok, but unfortunately several weeks after I returned home I had a complication.  To make a long story short, my internal skin graft failed, deep inside.  I struggled with bleeding, discharge, and pain.  I've had to wear maxi pads all day, every day, ever since.  And I permanently lost depth from 6" to 3".  Because of all these problems, I decided to get sigmoid colon surgery.  Not just to restore depth, but also to remove and replace the failed skin graft tissue that had become a source of such pain. 

When I had my pre-op consultation with Dr Burin, he was very patient as he explained all the benefits and risks and also dispelled some myths that I had believed to be true.  He was and has been very calm and patient with me the entire process, with a kind smile.  Communicating with him has been effortless.  His English is excellent, maybe even better than Dr Chet.

Pre-op preparation was similar to my first SRS with Chet.  I was required to do 3 days of a clear liquid diet.  But unlike my first SRS, I could not drink soda (because it could cause gas).  In my first SRS, I think I had to take the Swiff laxative just once, the night before.  But this time, I had to take it twice - the night before, and also two nights before.

My surgery was done at Phyathai Hospital in Bangkok.  I checked into the hospital the night before and got settled into my private hospital room, where I would spend the standard 7 days post-op recovering for this surgery.  I slept in the hospital room overnight.  The morning of the surgery, a nurse woke me up and did 3 enemas on me to clear my bowels.  Each time, she used a liter of saline solution and pumped all of it in!  It was very unpleasant.  Even after the third enema, my 'poop' still wasn't clear, so we did it 2 more times for a total of 5 times.

I will write more later...

I'm curious why you didn't go with Dr Chett for the sigmoid colon revision surgery?

Quote from: AnonyMs on November 09, 2018, 09:30:36 PM
I'm curious why you didn't go with Dr Chett for the sigmoid colon revision surgery?

I did consider going to him, but based on what little research I could find online, I felt like PAI had more experience with sigmoid colon surgery than Dr Chet.  PAI told me that they do about 3 sigmoid colon surgeries for every 10 regular SRS surgeries.  When I asked Chet, he didn't give me a number.  In fact I couldn't find a single story online from anyone who talked about their sigmoid colon revision with Chet (not that there's a ton of accounts of sigmoid colon surgeries at all, but at least there were some from PAI).  I wanted to go to the surgeon/team with the most experience with this particular surgery.  I also felt like for this surgery, I wanted it done in a full service hospital, rather than Chet's private clinic.  And although it wasn't a factor in my decision, PAI's cost for sigmoid colon revision was several thousand dollars less than what Dr Chet's office quoted me.

I an a PAI girl and they did a fantastic surgery using 3 surgeons. Dr Sutin, Dr Preecha and Dr Sirichai with GRS, BA and  FFS all in one session. I am a fan. Hope all comes out well and do keep us in touch.

Thank you, warlockmaker.  Hearing about your positive experiences with PAI was one of the reasons I chose them for my sigmoid colon revision.  Like you, I had more than one surgery at the same session.  I didn't do FFS at the same time (already had it done), but I did decide to do a breast augmentation at the same time as my sigmoid colon surgery.  While I was making arrangements, I asked if it was safe to do both, and PAI told me they said it would be possible, but that Dr Burin would need to examine me first.  He cleared me for both after my consultation.

So, for the first 3 days post-op in the hospital, I could not eat or drink anything while my bowel was healing.  I was not even allowed to drink water.  Combine that with the day of surgery itself, and it was 4 days total of not drinking any water.  My mouth and throat were sooo dry.  They told me about this before surgery and that it's standard recovery procedure, so it wasn't unexpected.  But still it was really, really hard.  They had an IV line connected to me to give me nutrients during this time.

As for the pain, wow!  It has been really intense.  The pain from my first SRS was really not that bad.  Most of the time it was just a low level pain.  But the pain from this sigmoid colon surgery is really sharp and debilitating in many ways.  It affects the lower abdominal muscles, and you use those muscles for everything.  Simply getting in and out of bed is a struggle, even now at 10 days post-op.  This makes getting into position to dilate a real challenge.  The usual pain meds that worked so well for me in my previous surgeries aren't enough to make the pain go away.

Hi, thanks for sharing your story and hope your recovery is going ok. I'm also looking into secondary sigmoid colon with PAI so its been great to hear your experience.

With the pain did you get plenty of morphine in hospital? (I know that sounds like a junkie question, lol) i'm just asking cos when i went through my SRS 15 years ago, morphine was the only thing that got me through the pain. Did Dr Burin do any cosmetic revision for you?

As your 10 days post-op are you in the hotel or still at the hospital? If your at the hotel, is it far from PAI? Sorry about all the questions. Hope your recovery keeps on getting better and it'd be great to hear an update.

Sam x

Yes they gave me a morphine drip at the hospital through my IV line.  The first few days of recovery were especially painful and I asked them to increase the amount of morphine, which they did.  After several days they tried to give me a different pain killer (I don't remember what it was).  It worked, but it made me feel nauseous.  So I asked them to put me back on morphine and they did.  They were very helpful and accomodating in my pain management.  (Now that I am back at my hotel, I am taking Arcoxia (etoricoxib), Tramadol, and Paracetamol for pain)

I was scheduled to be discharged from the hospital after 7 days, but I told them that I didn't feel strong enough to go to my hotel yet.  I came to Bangkok for this surgery by myself.  If I had a friend or family traveling with me to help me at my hotel, then maybe it would have been ok to be discharged at that time.  But since I was alone, I didn't feel I had the strength to take care of myself yet.  So I asked to stay another day in the hospital.  And maybe another day after that, and so on, until I felt well enough.  I told this to Dr Burin during his daily visit to my hospital room, and he told Bune (one of the patient coordinators at PAI; he is so friendly and helpful!).  Bune called me to let me know he would make all the arrangements with the hospital.  I didn't have to do any of the logistics myself.  In the end, I ended up only needing one more day, but it made a big difference for me.  I did have to pay money directly to the hospital for the extra day though.  It was about $300-$350 USD for the room, food, medication, and nurses for that extended stay.  Well worth the cost.  I travel with a credit card that has no foreign transaction fee, for unexpected expenses such as this.

I am staying at the One One Bangkok hotel.  I really like it here.  They have a 24 hr restaurant downstairs, and therefore 24 hr room service for food.  I have been ordering a lot of rice porridge from room service due to my limited digestion.  Also, free laundry service which is great (4 pieces of clothing per day).  It is in a great location just 5 min walking distance to PAI's clinic.  Before my surgery I walked there once just to confirm the distance, lol.  But despite the short distance, PAI has always arranged a driver to pick me up at the hotel so I don't even have to walk at all.  There is a pretty big grocery store next door (Villa Market) to buy all sorts of supplies, juices, drinks.  I have seen a lot of foreigners and westerners in that store.  And there are lots of small trendy cafes next door too.  Also lots of convenience stores and a bank practically next door for currency exchange.  There are so many stores and restaurants and businesses so closely packed here.  Such a convenient location for a hotel!

Dr Burin did not do a cosmetic revision on me.  I did not ask for it.  I feel pretty satisfied with the appearance of my external genitals.  I don't think it's Dr Chettawut's best work, but comparing to my friends who went to some other top tier surgeons, we tend to agree mine looks better than theirs anyway.

Can I ask why are you interested in sigmoid colon SRS?  Did your internal skin graft fail too?  I am starting to think that it is more common than I previously thought.

It would be great if you could follow up with your recovery over the next few months and at one year. There's not much info about this kind of surgery.

In Sigmoid Colon is the cut like a ceasrian birth cut which cuts the stomach muscle? Any muscle cut is really painful in recovery.

Yes, the incision is at the same place as for a Caesarian section (c-section for birth).  If you do a google image search for c-section scars, you will get an idea of the location and appearance of the scar.  The length and appearance of my scar is exactly the same.  Location is same.  It is really painful down there (not the incision, but the muscles underneath).

Quote from: SpiralCream on November 11, 2018, 11:02:37 PM
Yes, the incision is at the same place as for a Caesarian section (c-section for birth).  If you do a google image search for c-section scars, you will get an idea of the location and appearance of the scar.  The length and appearance of my scar is exactly the same.  Location is same.  It is really painful down there (not the incision, but the muscles underneath).

Is there any reason not to do minimal invasive surgery (scope) for harvesting the colon section?  A scope incision would be about 1 cm or less long!  One might need tow such incisions for this kind of tissue harvesting!

How long is the scar?

I wonder if people will mistake if for Caesarian section? Beats the usual scars for being stealth.

Quote from: SpiralCream on November 11, 2018, 09:35:56 PM
Can I ask why are you interested in sigmoid colon SRS?  Did your internal skin graft fail too?  I am starting to think that it is more common than I previously thought.

I'm not really sure, after i had srs the inside of my vagina was very sore on the left side which made dilation really painful  and over the years it has gotten a bit better but even now after dilation and intercourse I am in a lot of discomfort for a couple of days afterwards, again inside on the left side, and there's always been a smear of blood left down one side of my dialator. I've always had a bit of funky discharge as well. When i left Thailand after srs I had lost about an inch of depth and over the years I've been fighting to keep depth and i've lost another 3 inches of depth over 15 years. I feel now its time to do something about it. What you went through sounds very similar, with me it just happened over a longer period of time.

Can you see the red of the colon graft at your vaginal entrance or did they manage to hide it?

Sam x

Quote from: Dietlind on November 11, 2018, 11:15:54 PM
Is there any reason not to do minimal invasive surgery (scope) for harvesting the colon section?  A scope incision would be about 1 cm or less long!  One might need tow such incisions for this kind of tissue harvesting!

Although laparoscopic sigmoid colon SRS is an option, Dr Burin explained to me that the results are different.  He showed me diagrams during my pre-consultation showing the difference in technique.  IMO, the biggest disadvantage for laparoscopic technique is that the vaginal depth is significantly less.  Average depth is only about 5.5 inches (you will find similar results when searching studies online).  Whereas with the open technique patients regularly get 7 inches or more of depth.  I suppose there is the downside of a larger scar, but it is actually quite easily hidden.  My scar is very low and easily hidden by any normal pair of panties, even hipster or bikini styles.  Probably not with a string thong though, lol.

I think I remember reading a post here at Susan's Place from someone who went to Dr Kaushik in India for sigmoid colon SRS.  And I think I remember the person asked Dr Kaushik if he could do the laparoscopic technique.  He said that he could, but that results would be better with the open technique.  Does anyone remember where that post is?  During my research I ran across it, but I can't remember where in this forum it was located and exactly what was written.

Quote from: AnonyMs on November 12, 2018, 01:37:15 AM
How long is the scar?

I wonder if people will mistake if for Caesarian section? Beats the usual scars for being stealth.

I just measured it.  My scar is about 4.7 inches long.  That is well within the range of a c-section scar (4-6 inches).

Quote from: Samanthaburgess on November 12, 2018, 02:56:21 AM
I'm not really sure, after i had srs the inside of my vagina was very sore on the left side which made dilation really painful  and over the years it has gotten a bit better but even now after dilation and intercourse I am in a lot of discomfort for a couple of days afterwards, again inside on the left side, and there's always been a smear of blood left down one side of my dialator. I've always had a bit of funky discharge as well. When i left Thailand after srs I had lost about an inch of depth and over the years I've been fighting to keep depth and i've lost another 3 inches of depth over 15 years. I feel now its time to do something about it. What you went through sounds very similar, with me it just happened over a longer period of time.

Can you see the red of the colon graft at your vaginal entrance or did they manage to hide it?

Sam x

Sorry to hear about your loss of depth and struggle with pain.  :(  I also had pain inside my vagina because of the failed skin graft that had turned into granulation tissue.  Now I am 11 days post-op and already I have no more pain in that space inside. The damaged tissue was removed during my surgery and replaced with the sigmoid colon graft.  I am also surprised not to have any more bleeding, even while dilating.  Overall my discharge, even this early in recovery, is less than I had before my surgery with my granulation tissue.

When I asked him, Dr Burin told me that he connected the colon graft 1.2 inches past my vaginal introitus.  From there, it is possible to see the red of the colon tissue.  So yes, I can see it, but it's not that easy to see.  Dr Burin held it open with a speculum then handed me a mirror so I could see it.

Thanks, but its something I've learned to live with. Glad to hear you have no pain inside, that must be a relief :)

How long do you have to dilate for now and how much depth did you end up with? Have your bowl movements gotten back to normal?

I sent an email to PAI this morning to enquire about the surgery, your post has been so helpful to me

Quote from: SpiralCream on November 12, 2018, 03:23:25 AM
Although laparoscopic sigmoid colon SRS is an option, Dr Burin explained to me that the results are different.  He showed me diagrams during my pre-consultation showing the difference in technique.  IMO, the biggest disadvantage for laparoscopic technique is that the vaginal depth is significantly less.  Average depth is only about 5.5 inches (you will find similar results when searching studies online).  Whereas with the open technique patients regularly get 7 inches or more of depth.  I suppose there is the downside of a larger scar, but it is actually quite easily hidden.  My scar is very low and easily hidden by any normal pair of panties, even hipster or bikini styles.  Probably not with a string thong though, lol.

I think I remember reading a post here at Susan's Place from someone who went to Dr Kaushik in India for sigmoid colon SRS.  And I think I remember the person asked Dr Kaushik if he could do the laparoscopic technique.  He said that he could, but that results would be better with the open technique.  Does anyone remember where that post is?  During my research I ran across it, but I can't remember where in this forum it was located and exactly what was written.

I hope they explain to you how to do proper scar massage?  With the right massage you can make the scar to be almost invisible, and it can look like a skin fold line.

Quote from: Samanthaburgess on November 12, 2018, 07:17:50 AM
Thanks, but its something I've learned to live with. Glad to hear you have no pain inside, that must be a relief :)

How long do you have to dilate for now and how much depth did you end up with? Have your bowl movements gotten back to normal?

I sent an email to PAI this morning to enquire about the surgery, your post has been so helpful to me

I am glad I can help.  When I was in your situation I was frustrated with the lack of information online about this surgery.  There is also a lot of misinformation too.  For example people seem to have this misconception that the discharge smells like poo for a while because it was colon tissue.  Now that I've had this surgery, I can say that is completely untrue.  It has never smelled like poo, not even the first few days of recovery in the hospital.  The colon tissue is thoroughly cleaned before the surgery and so there is no poo smell.

My bowel movements are irregular though and will continue to be for the first month or two.  I finally had my first poop at 10 days post op.  It was mostly diarrhea (similar to my first poop after my first SRS).  I had to go several times the first day.  Digestion is still delicate and I have to restrict my diet for the time being.  No high fiber foods, no vegetables, and no fruits for a while.  Only soft foods, no processed meat like sausage, and no beef.

As for dilations, I only need to dilate twice a day for 15 min each session.  I was instructed to use the smallest dilator (28 mm diameter) for the first 1-2 months.  After that, I can gradually work my way up in dilator size.  The important thing is for me to dilate past the connection point - where the sigmoid colon was attached to my internal vaginal canal.  As I wrote before, that is at 1.2 inches past my vaginal introitus.  Once I get past that point, I don't need to go much deeper.  Dr Burin said I can go to just 4-5 inches for now.  But he warned me not to try for anything deeper than that until 2 months later, so that the end of the colon graft can heal.  I am sure it is deeper than 6 inches (since they used 8 inches of my sigmoid colon), but I'm not going to test it for now.  Once I get past the 1.2 inch connection point, it slides in very easily.  But it can be a bit difficult to get past that connection point.  I need to keep dilating that connection point while it is healing, so that it doesn't scar and shrink.  The colon tissue itself has no risk of shrinking though.  Dr Burin reassured me that I will never lose depth by not dilating to maximum depth.

PAI has a separate set of dilators for sigmoid colon patients.  It is an additional cost of 6000 Thai Bhat, so be prepared to bring some extra money for it.  The dilators are acrylic and have a curved tip, unlike the straight tip dilators that they give to patients who had penile inversion.  My dilator set has 4 dilators - 28 mm gray, 31 mm blue, 34 mm green, and 36 mm orange.

Quote from: SpiralCream on November 12, 2018, 09:32:25 PM
PAI has a separate set of dilators for sigmoid colon patients.  It is an additional cost of 6000 Thai Bhat, so be prepared to bring some extra money for it.  The dilators are acrylic and have a curved tip, unlike the straight tip dilators that they give to patients who had penile inversion.  My dilator set has 4 dilators - 28 mm gray, 31 mm blue, 34 mm green, and 36 mm orange.

Sounds like the Soul Source dilators. Do you know why they give you different dilators?

I know, I've been searching around for months for more information on colon srs but not much comes up. the only decent thing i could find were posts on here about Dr kaushik but don't really fancy India, I'd rather go back to Thailand, somewhere I know, It makes me feel safer.

Hope your healing is still going well, are you managing to get out of the hotel much?

So what is your diet at the moment? That sounds like a lot of things you can't eat.

Who pays for those surgeries in India, Thailand, etc.  Is this all out of pocket? 
My health insurance say they would pay for the surgery ($250 deductible), as long as it is in state.  They don't even pay out of state for it!

Quote from: Samanthaburgess on November 13, 2018, 02:53:02 AM
I know, I've been searching around for months for more information on colon srs but not much comes up. the only decent thing i could find were posts on here about Dr kaushik but don't really fancy India, I'd rather go back to Thailand, somewhere I know, It makes me feel safer.

I came across an Indian trans forum. You definitely made the right decision going to PAI.

Quote from: AnonyMs on November 13, 2018, 09:15:51 AM
I came across an Indian trans forum. You definitely made the right decision going to PAI.

Hello AnonyMs, could you tell us more about what motivates this advice?

Quote from: Samanthaburgess on November 13, 2018, 02:53:02 AM
I know, I've been searching around for months for more information on colon srs but not much comes up. the only decent thing i could find were posts on here about Dr kaushik but don't really fancy India, I'd rather go back to Thailand, somewhere I know, It makes me feel safer.

Hope your healing is still going well, are you managing to get out of the hotel much?

So what is your diet at the moment? That sounds like a lot of things you can't eat.

The PAI clinic is really advanced, spacious, and modern.  Phyathai Hospital, where I had my surgery and recovery, is also the same.  My private hospital room was modern and huge.  There was an extra bed in case I had a guest.  Five large windows overlooking the city from the 22nd floor, offered a great view and plenty of sunshine.  There was a table and 2 chairs.  There was a safe to store my valuables.  A refrigerator, microwave, and coffee maker.  And my own private bathroom with shower.  And lots of open space in addition to all that.  I think my private hospital room was actually larger than my hotel room, haha.  I don't think that the experience in India for trans patients is nearly as luxurious.

I am not leaving the hotel at all yet.  It is still difficult for me to get around or even to stand up straight because of my lower abdominal muscles are still recovering.  Before my surgery I did a lot of shopping and stocked up on supplies in my hotel room.  I don't need to go out for anything.

For food, I am eating eggs, white bread, and rice porridge with chicken.  I think that's actually all I've eaten since I got to my hotel, lol.  Oh, and lots of juice.  I usually don't drink fruit juices because it's a lot of sugar and calories, but during my recovery it is easy on my digestion and tastes good.  I could probably eat other foods and be ok too, but these foods are working well for me right now and I don't want to risk more pain than I'm dealing with.  So I'm being super conservative in my food choices.  In a few days I will slowly start introducing other foods to my diet.

Quote from: Dietlind on November 13, 2018, 08:28:31 AM
Who pays for those surgeries in India, Thailand, etc.  Is this all out of pocket? 
My health insurance say they would pay for the surgery ($250 deductible), as long as it is in state.  They don't even pay out of state for it!

Yes I have paid for all my surgeries including this sigmoid colon revision out of my own pocket.  I am certain that there are no insurance companies in the US that would pay for any trans surgeries outside the US.  Maybe health insurance in some European countries might pay for it if you jump through some hoops.

Quote from: SpiralCream on November 13, 2018, 10:42:40 AM
Yes I have paid for all my surgeries including this sigmoid colon revision out of my own pocket.  I am certain that there are no insurance companies in the US that would pay for any trans surgeries outside the US.  Maybe health insurance in some European countries might pay for it if you jump through some hoops.

And what caused you to not have it done in the US?  I just had a session with my psychologist, and she feels that I would be ready for surgery in 3 to 4 months. 
She said I should go to Miami, because they are experienced in SRS.  What would speak against Miami?

I do not plan to have a vaginal cavity, but just a vulva, which makes the surgery way easier and shorter!

Quote from: Dietlind on November 13, 2018, 02:23:13 PM
I do not plan to have a vaginal cavity, but just a vulva, which makes the surgery way easier and shorter!

I don't know how old you are, but think that after the surgery your mind and your vision of things may change dramatically.
And also be aware that complications happen more often at the vulva level than inside the vaginal canal. Even with the best surgeons.

Quote from: Lucie on November 13, 2018, 02:48:02 PM
I don't know how old you are, but think that after the surgery your mind and your vision of things may change dramatically.
And also be aware that complications happen more often at the vulva level than inside the vaginal canal. Even with the best surgeons.

I am in my 70's and single,  Pretty asexual for the als 15 or so years, but definitely very lesbian.  I don't expect my sexual activity to change much after a surgery.  I want the vulva for myself, just to not look like a guy anymore!

I made my living with some of that surgical stuff, and can identify problems pretty fast (and I can see the vulva, and observe any possible problems, but I can't see a vagina).

Quote from: Lucie on November 13, 2018, 09:46:54 AM
Hello AnonyMs, could you tell us more about what motivates this advice?

Its the kind of thing that would get moderated. I'll send you a pm.

Quote from: Dietlind on November 13, 2018, 04:30:21 PM
I am in my 70's and single,  Pretty asexual for the als 15 or so years, but definitely very lesbian.  I don't expect my sexual activity to change much after a surgery.  I want the vulva for myself, just to not look like a guy anymore!

I made my living with some of that surgical stuff, and can identify problems pretty fast (and I can see the vulva, and observe any possible problems, but I can't see a vagina).

I understand, this choice seems reasonable in your case.

Quote from: Dietlind on November 13, 2018, 02:23:13 PM
And what caused you to not have it done in the US?

I wanted to go to the team of surgeons with the most experience in sigmoid colon SRS.  As far as I know, there are no surgeons in the US who do this surgery on a regular basis.

Quote from: SpiralCream on November 14, 2018, 07:00:22 AM
I wanted to go to the team of surgeons with the most experience in sigmoid colon SRS.  As far as I know, there are no surgeons in the US who do this surgery on a regular basis.

My psychologischst recommended these people, I don't know if they do your very special surgery!  The advantage with them is that they accept US Health Insurance plans.

http://surgery.med.miami.edu/plastic-and-reconstructive/gender-affirmation

Quote from: Dietlind on November 14, 2018, 07:36:21 AM
My psychologischst recommended these people, I don't know if they do your very special surgery!  The advantage with them is that they accept US Health Insurance plans.

http://surgery.med.miami.edu/plastic-and-reconstructive/gender-affirmation

One more of those surgeons has a lot of really negative posts about them.

Quote from: AnonyMs on November 14, 2018, 07:54:59 AM
One more of those surgeons has a lot of really negative posts about them.

Thanks, I have to read up on them.  My surgery is still pretty far away, my psychologist feels I am ready for it in about 6 months or so.

Not sure I'd trust your psychologists opinion after that.

Quote from: AnonyMs on November 14, 2018, 10:52:37 AM
Not sure I'd trust your psychologists opinion after that.

She is considered the best LGBTQ psychologist in the entire area!

I don't understand why you feel I should not trust her? Can you please elaborate a little about this?
I wanted to know who she knows who accepts my health insurance, and they do!

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 :)

Sam x

Quote from: Dietlind on November 15, 2018, 12:03:03 AM
She is considered the best LGBTQ psychologist in the entire area!

I don't understand why you feel I should not trust her? Can you please elaborate a little about this?
I wanted to know who she knows who accepts my health insurance, and they do!

Because she's so wrong about the surgeon. What else is she wrong about?

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

Quote from: Samanthaburgess on November 15, 2018, 02:47:24 AM
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.

Quote from: SpiralCream on November 15, 2018, 04:25:40 AM
Can you please take your conversation elsewhere instead of hijacking this thread?  Thank you.

Amen.

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.

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.

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.

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!

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 :)

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

Quote from: SpiralCream on November 19, 2018, 06:06:52 AM
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!

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

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.

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)

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.

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.

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.

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.

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.

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!

Quote from: SpiralCream on December 06, 2018, 10:42:35 AM
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!

QuoteI 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.

Quote
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.

Quote from: Lucie on December 06, 2018, 11:04:57 AM
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.

Quote from: SpiralCream on December 08, 2018, 01:44:23 AM
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.

I agree, it's best to follow your doctor's advice.
I wish you to be quickly rid of that UTI and to continue your recovery as smoothly and satisfactorily as possible.

Quote from: Lucie on December 06, 2018, 11:04:57 AM


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.

You don't have a specific  urinary track immunity!  Your immun system is either working, or it is jeopardized for the entire body.  if one is on antibiotics, one should not take any probiotics!

Here is a little more information on probiotics!
https://www.mayoclinic.org/what-are-probiotics/art-20232589

All the symptoms of my UTI were gone within 24 hours after taking my first antibiotic.  The doctor kept me on it for 10 days just to be safe, especially since I had surgery recently.  She changed the antibiotic to a different type for the last 5 days, after the lab culture results showed that a different antibiotic would be even more effective (although the first one was effective too).

On a different note, I had a weird discharge from my vagina yesterday.  After I did my dilation, I sat down to pee, as usual.  And while I was peeing, this brown, semi-solid, icky thing came out of my vagina.  It was about 1.5 inches long.  Here is a picture of it (warning, it looks really gross!):  https://i.imgur.com/nOPmRBL.jpg

My first reaction was 'OMG this looks bad'.  I briefly wondered if it could be feces.  But I'm a pretty rational person so I didn't really panic.  If it was feces, it would indicate a fistula... but the thing is, all throughout my recovery I always passed gas normally, and my feces always came out of my rectum and not my vagina, even when I had loose stools.  I had never had any brown colored discharge from my vagina before, not even a tiny amount.  Also, this brown gunk did not smell like feces.  It didn't smell bad at all - it just smelled like damp paper or something like that.  And the texture was not like feces either.

I fished out the brown gunk from the toilet, put it on a paper towel and took a picture of it.  I sent an email to PAI to ask what Dr Burin thought of it.  I got a reply within 12 hours (so quick, given the timezone difference!).  Dr Burin said that it is normal and nothing to worry about.  He said it's a mixture of old blood mixed with mucus, lubricant, and probably betadine solution (which I had been using to gently douche the inside of me recently as a precaution due to my UTI).

I think my vaginal canal must be pretty deep to be holding all these 'surprises' inside, haha!  Since I am only dilating to 4-5 inches for now, I'm guessing that each time I dilate, I push all this gunk deeper inside my vagina.  And it just kind of accumulates and bunches up deep inside?  I had been douching recently, so maybe squirting the water inside helped dislodge this gunk and allowed it to come out.

Maybe once I start dilating to full depth (2 weeks left until I can do so), the action of normally dilating to full depth will help push this stuff out before it accumulates like this.  I have noticed that unlike last year after my first SRS, where I would end up with lubricant on my bed pads after dilating, my bed pads are spotless after each dilation session.  I think the lubricant gets pushed up inside my deep vagina and just sits there since I'm not dilating to full depth yet.

Quote from: SpiralCream on December 14, 2018, 09:55:16 AM

Maybe once I start dilating to full depth (2 weeks left until I can do so), the action of normally dilating to full depth will help push this stuff out before it accumulates like this.  I have noticed that unlike last year after my first SRS, where I would end up with lubricant on my bed pads after dilating, my bed pads are spotless after each dilation session.  I think the lubricant gets pushed up inside my deep vagina and just sits there since I'm not dilating to full depth yet.

Don't forget that the colon has absorbing ability so the lube gets absorbed compared to skin graft which doesn't.

@Spiralcream, Inspired your recent surgeries with PAI n your thorough post op surgical details helped me with priceless information and cautions to be taken as I also scheduled with PAI for what exactly you had with them i.e BA & secondary colon srs next month. I really do appreciate and just signed up in this place particularly to follow you and to say thank you for letting ppl know your weekly experience on important colon srs which seems lack of resources to learn on currently. I've been looking for kind of posts like yours to best determine my surgery. Please keep updates with your surgical outcomes so that I can learn from you. Of course ppl can learn from you.
Different person have different things I know but we both have some things in common. But my surgeon will be Dr. Sutin. Btw, May I ask a little q that, Had your GI system gotten back to normal now?  Any minor complication or discomfort come up with bowel movement , colon vagina and any other general health conditions etc, are there any new surprise you currently dealing with in 3 months post op? I sincerely curious as I gonna take the same path you took there very soon. Again Many thanks for information.

Quote from: reborn on December 21, 2018, 06:00:12 AM
Don't forget that the colon has absorbing ability so the lube gets absorbed compared to skin graft which doesn't.

Of course!  Why didn't I think of that?  lol.  That is an excellent point.  The primary function of the colon in the body is to absorb water to form stool.  So it makes sense that when it is grafted into the vaginal canal, it absorbs the water-soluble lubricant.  So that's where all the lube is going!  My vagina is naturally soaking it up, haha.  How convenient.  :)

Quote from: M. Sharon on December 21, 2018, 10:55:17 AM
@Spiralcream, Inspired your recent surgeries with PAI n your thorough post op surgical details helped me with priceless information and cautions to be taken as I also scheduled with PAI for what exactly you had with them i.e BA & secondary colon srs next month. I really do appreciate and just signed up in this place particularly to follow you and to say thank you for letting ppl know your weekly experience on important colon srs which seems lack of resources to learn on currently. I've been looking for kind of posts like yours to best determine my surgery. Please keep updates with your surgical outcomes so that I can learn from you. Of course ppl can learn from you.
Different person have different things I know but we both have some things in common. But my surgeon will be Dr. Sutin. Btw, May I ask a little q that, Had your GI system gotten back to normal now?  Any minor complication or discomfort come up with bowel movement , colon vagina and any other general health conditions etc, are there any new surprise you currently dealing with in 3 months post op? I sincerely curious as I gonna take the same path you took there very soon. Again Many thanks for information.

Glad I could help!  Hopefully you will go into this surgery a little more prepared than I was, now that you've read my story and know a little bit more about what to expect!

I am now 7 weeks post-op.  Nothing new to report on my vagina.  No problems.  The main inconvenience is my digestive system.  While I'm permitted to eat almost anything, I still need to be careful.  The food that seems to be giving me the most trouble right now is dairy.  It's ok if I eat it in small amounts, but if I overdo it, my body doesn't like it (I never had trouble with dairy before my surgery).  About a week ago I ate vanilla ice cream.  I was just going to eat a little but, but then I ended up eating half the container, haha (the full container was 1.5 quarts = 1.4 liters).  I ate it just before going to bed (so dumb, huh?).  The next morning I spent about 2 hours sitting on the toilet doing so much poo.  It was all normal poo, not constipated, not diarrhea, no blood, no pain.  But still a lot.  It was annoying.  I had eaten a little bit of ice cream a week before that, and I had no problems.  So I guess it was just too much ice cream at once.  (ice cream is my favorite food, hence my username SpiralCream)

Several days after that, I ate a LOT of pizza for dinner.  I also ate cheese quesadillas, lol.  First time for both foods since my surgery!  A few hours after dinner, I had to go poo pretty badly.  It was normal poo at first, then I had diarrhea accompanied by lower bowel pain as I continued to have bowel movements.  It was the first time I had diarrhea and painful bowel movements since I returned from Thailand.  The next day, I had some minor sharp pains in my lower left abdomen that would come and go.  It continued for several hours.  I think all of these things were from all that pizza and cheese quesadillas.  It's probably ok to eat stuff like that, but probably not so much at once.  I have been doing fine since then, eating cheesy junk food in moderation but mostly sticking to colon-friendly foods.

Colon-friendly foods are foods that you find on low-fiber diet plans and low-residue diet plans.  The one food that I am strictly avoiding for now is popcorn.  I have read on colon surgery recovery sites (such as those where people discuss recovery from colon removal due to colon cancer) that popcorn is especially bad because the kernels can irritate the colon.  I will wait until 3-4 months post-op before I eat popcorn.

On the bright side I can eat 2 large orders of McDonald's French fries and it has no bad effects on me, lol.  French fries are potatoes, and potatoes are easy on my colon.  I guess my body is fine with grease and fatty foods, as long as it's not dairy, haha.

Recovery from colon removal surgery (well, an auto-transplant in my case, but still a removal from my digestive tract), is a very individual process.  Each person heals differently at different rates, from what I have read on colon recovery forum websites.  I have no doubt I will make a full recovery, but it's just a matter of time.  My digestive tract still needs more time to fully adjust.

I have been spending a lot of time on the toilet from frequent bowel movements ever since my surgery.  I recommend an iPad to play with so you won't be bored while sitting on the toilet, lol.  Also more importantly, lots of soft toilet paper from all the wiping.  I like Charmin toilet paper - it's very gentle on my sensitive bum.

Regarding all the junk food I've been eating - I usually eat very healthy.  My normal BMI is about 20 (before surgery).  But I lost a lot of weight from this surgery and have been struggling to gain it back.  My low weight is, I think, contributing to overall low stamina and inability to regulate my body temperature - nowadays I get cold very easily and also too hot very easily.  So I have been trying to eat more to gain weight, and maybe add yummy junk food to encourage myself to eat more, hahaha.  When I returned from Thailand, my BMI was less than 18, underweight and not healthy.  Now my BMI is 19, so it's better, but I still want to get back to a BMI of 20 for my usual health.

As for my breast augmentation, I've been going shopping for bras and it's looking like I'm a very full C cup: 34c.  I barely fit into a 34c though.  So maybe I should wear a bigger size, but both a 34d and a 36c bra are slightly too big, so I don't know what I should really be wearing.  For now I'm just wearing bralettes because they're stretchy and comfortable.  I used to be a small A cup before surgery.

I'm not sure how I feel about my bust size.  On some days I really like them, but on other days I wonder if I should have chosen 300 cc instead of 375 cc.  Is 75 cc even that big of a difference?  I'd probably have been a small C instead of a full C?  I don't know.  I'll try to be patient and see how they continue to develop as they settle, drop, and fluff over the next several months.  Regardless, I'm happy that I'm not flat chested anymore!  My chest was actually the least dysphoric part of my body for me (face and genitals were way worse, hence why I prioritized FFS and SRS), but it still feels good to have a nice bosom.  :)

OMG you're a sign from the heavens as Im long overdue with this issue.

Same story with you in 2014 I failed in depth with Chettawut 3inch only

Some questions:

1. My biggest concern is sensation during sex, will you feel internal orgasm? I just wanna enjoy during sex.

2. I heard people take 4 months to recover and have irregular bowels which might get internal infections, Im scared of this

3. Are the scars of the surgery obvious? im scared being clocked

4. Will you be able to double-penetrate? anal-vagina. it was always my fantasy

5. and very important is how much cost the surgery?

Quote from: Evolving Beauty on December 22, 2018, 12:10:34 AM
OMG you're a sign from the heavens as Im long overdue with this issue.

Same story with you in 2014 I failed in depth with Chettawut 3inch only

Some questions:

1. My biggest concern is sensation during sex, will you feel internal orgasm? I just wanna enjoy during sex.

2. I heard people take 4 months to recover and have irregular bowels which might get internal infections, Im scared of this

3. Are the scars of the surgery obvious? im scared being clocked

4. Will you be able to double-penetrate? anal-vagina. it was always my fantasy

5. and very important is how much cost the surgery?

Sorry to hear you had depth issues too.  I think it is more common than people realize.  In my opinion sigmoid colon revision is the best solution for restoring or extending depth.  The colon tissue is strong, flexible, and resilient, unlike thin skin graft tissue or fragile peritoneal graft tissue.  I have had zero bleeding from my vagina during dilations, because the colon tissue is flexible and stretchy, just like a cis vagina.

To answer your questions:

1. I haven't had sex yet since my surgery.  I'm only 7 weeks post-op so it's too early.  But my sensation from my clitoris is still the same as before my sigmoid colon revision.  I was able to experience clitoral orgasm before this surgery, and I have already confirmed I can still experience it.  The way the dilator feels inside my vagina is mostly the same as before my sigmoid colon surgery, so I have no doubt that I will once again experience pleasure during vaginal penetration too.  I'm glad that Dr Burin was able to remove all the damaged, painful granulation tissue inside my vagina without affecting any of the surrounding tissue that relates to pleasurable sensation.

2. Intra-abdominal infection is a very real possibility, and Dr Burin warned me about it before the surgery.  The greatest risk is the first week post-op, during which you are in the hospital the whole time.  The nurses checked on me every few hours for my blood pressure, heart rate, and temperature, to check for fever and any signs of infection.  I was also on intravenous antibiotics.  Dr Burin visited me daily to check the drainage tubes and incisions for any possible infection.  I was not allowed to even drink water for the first 3 days after my surgery, and no food for longer than that.  It was all so that my bowels would have plenty of time to heal and reduce chance of internal infection from food and drink.

When I was released from the hospital after one week, he said the chance of infection was only about 1% by that point.  By the time I was ready to fly back home a few weeks later, he said chance of internal infection was 0% at that point.  I believe that the best way to avoid internal infection is to very seriously follow the all-liquid clear diet for the 3 days before surgery.  Take the Swiff laxative solution each day, 2 days before surgery as instructed.  Make sure your bowels are completely 100% clean before surgery so that no contaminants can leak from your colon into the surgical area during surgery.

Also, I took a few more precautions myself.  Each day before the surgery, I douched the inside of my vaginal canal with betadine and water to clear bacteria.  I also brought anti-bacterial soap before I flew to Thailand.  The night before my surgery, I washed my body and hair thoroughly with my anti-bacterial soap.  I wore fresh, clean new clothes to the hospital before my surgery.  Oh, I should also mention that once I was on the operating table, the doctors told me that they would scrub and clean my body before opening me up (but after I was put under with anesthesia).  So they take every precaution to minimize the risk of infection.

And as long as you follow a low fiber, low residue diet during your recovery, your colon will heal ok.  Your colon resection will heal just fine and it's very unlikely that the colon will burst open and cause infection.  Be gentle and eat small amounts of food, many times a day.  It's better than eating a few big meals, so that your colon is not under too much stress at one time.

There is a greater risk of external infections such as UTI, because of frequent bowel movements.  Be sure to wipe thoroughly after each bowel movement.  Don't be afraid to use lots of toilet paper and wet wipes.  And after dilation, always rinse the outside of your vagina and the urethral area with the betadine/water solution as instructed.  The nurse told me to use 200 ml water mixed with 20 ml betadine.  Probably need to keep doing this until bowel movements return to normal.

3. My abdominal scar looks exactly like a C-section scar in appearance, placement, and length.  There are no other scars in, or outside, my vagina from this surgery.  There are scars from drainage tubes on either side of my lower abdomen, but they are minor and I'm sure they will fade away normally.  They are already less prominent than the scars from the drainage tubes in my mons pubis area from my first SRS with Chettawut.

4. Probably yes?  There was no change to my anus or rectum, and the sigmoid colon length that was used was 8 inches (the entire sigmoid colon length is 15 inches, so half of my sigmoid colon should still be there).  If you were able to have double penetration before sigmoid colon revision, you can probably do it afterward too.  I have never done DP though, and have no intention to ever do so.  You'll have to report back after your own surgery and let us know how DP works for you, lol.

5. Sigmoid colon SRS is about 50% to 70% more than regular standard SRS, based on quotes I got from various Thai surgeons.  Different surgeons have different cost, you can contact them for specific numbers.

 :-* Hi Spiralcream, Again  you enlightened me up with another vital decision on BA as I primarily chose to go for 475 cc and now reconsidering to switch to smaller size. I have 5' 8" Height with moderate wide chest that I chose 475cc while consultation with Dr. Sutin at first place. Pretty the huge boobs, wouldn't they? that can give some inconvenience later on I guess. Of course I'm not going to load more trouble myself while I would have it enough from colon srs Lol.  To me choosing Bigger may make greater chance of sagging due to heavier weight. Hence thinking of a bit more of cc just above 400 will be best for a long run I think. Hey I also like icecream a lot as u do and yes we have to eat it in small potions for the first months to void massive poop. haha. On different thing, So you did not eat meals 3 days before surgery just eaten liquid soups pre operatively, is it? I feel a little nerves as time is drawing nearer to appointed day X. ;) ;) Are lofts of bread the high fiber foods to void to let colon a lot of rest  n healing by early post op days? Did I understand right? Kindly let me know what were your regimented meals within 2-4weeks so that I can look for shops nearby hotel around Sukhumvit area before surgery. Well thank you for providing all important facts to take account to go well with colon srs! Love, M.sharon.

Quote from: SpiralCream on December 21, 2018, 03:23:07 PM
Glad I could help!  Hopefully you will go into this surgery a little more prepared than I was, now that you've read my story and know a little bit more about what to expect!

I am now 7 weeks post-op.  Nothing new to report on my vagina.  No problems.  The main inconvenience is my digestive system.  While I'm permitted to eat almost anything, I still need to be careful.  The food that seems to be giving me the most trouble right now is dairy.  It's ok if I eat it in small amounts, but if I overdo it, my body doesn't like it (I never had trouble with dairy before my surgery).  About a week ago I ate vanilla ice cream.  I was just going to eat a little but, but then I ended up eating half the container, haha (the full container was 1.5 quarts = 1.4 liters).  I ate it just before going to bed (so dumb, huh?).  The next morning I spent about 2 hours sitting on the toilet doing so much poo.  It was all normal poo, not constipated, not diarrhea, no blood, no pain.  But still a lot.  It was annoying.  I had eaten a little bit of ice cream a week before that, and I had no problems.  So I guess it was just too much ice cream at once.  (ice cream is my favorite food, hence my username SpiralCream)

Several days after that, I ate a LOT of pizza for dinner.  I also ate cheese quesadillas, lol.  First time for both foods since my surgery!  A few hours after dinner, I had to go poo pretty badly.  It was normal poo at first, then I had diarrhea accompanied by lower bowel pain as I continued to have bowel movements.  It was the first time I had diarrhea and painful bowel movements since I returned from Thailand.  The next day, I had some minor sharp pains in my lower left abdomen that would come and go.  It continued for several hours.  I think all of these things were from all that pizza and cheese quesadillas.  It's probably ok to eat stuff like that, but probably not so much at once.  I have been doing fine since then, eating cheesy junk food in moderation but mostly sticking to colon-friendly foods.

Colon-friendly foods are foods that you find on low-fiber diet plans and low-residue diet plans.  The one food that I am strictly avoiding for now is popcorn.  I have read on colon surgery recovery sites (such as those where people discuss recovery from colon removal due to colon cancer) that popcorn is especially bad because the kernels can irritate the colon.  I will wait until 3-4 months post-op before I eat popcorn.

On the bright side I can eat 2 large orders of McDonald's French fries and it has no bad effects on me, lol.  French fries are potatoes, and potatoes are easy on my colon.  I guess my body is fine with grease and fatty foods, as long as it's not dairy, haha.

Recovery from colon removal surgery (well, an auto-transplant in my case, but still a removal from my digestive tract), is a very individual process.  Each person heals differently at different rates, from what I have read on colon recovery forum websites.  I have no doubt I will make a full recovery, but it's just a matter of time.  My digestive tract still needs more time to fully adjust.

I have been spending a lot of time on the toilet from frequent bowel movements ever since my surgery.  I recommend an iPad to play with so you won't be bored while sitting on the toilet, lol.  Also more importantly, lots of soft toilet paper from all the wiping.  I like Charmin toilet paper - it's very gentle on my sensitive bum.

<edit by moderator>

Breast implant size is a very personal decision.  Some women want larger breasts, some women want smaller breasts, some women want something in the middle. As long as the implant width matches or is near your breast width size, you have some freedom in the size you choose.  Consider your lifestyle and image you want to convey with your look. Personally I do not like to wear flashy or sexy clothes, very rarely wear any dresses or skirts, have no intention to ever wear a bikini, and generally am quite modest in my fashion style. Now that I think about it, I can count on one hand, the number of times I wore a dress or skirt in the last year, lol. Maybe I should try to be more feminine, haha.  Hence having big boobs is not really my preference. So that is why I am wondering if I should have done 300 cc instead of 375 cc. I think a lot of women (both cis and trans) would actually be very happy with 375 cc or more.

Anyway, as I wrote earlier, I am now a [full] 34c bra size. Even with 375 cc.  I think most people would consider that to be pretty average actually.

3 days before sigmoid colon surgery, you can still eat some clear soup broths (no vegetables in the soup though!). For the remaining 2 days before surgery, you better be cautious and eat nothing, and drink only clear liquid. No orange juice, no mango juice.  Only clear juice like apple juice or grape juice.  That is what I did, and I recommend the same.  Better to be extra safe and not risk any food remaining in your colon before surgery.

After surgery, I ordered a lot of room service. Mostly congee mixed with cooked egg for protein. No vegetables at all, not even cooked vegetables. I also ate white bread (avoid high fiber whole wheat bread). For specific information on what you can eat after colon surgery, do a google search for "low fiber diet" and "low residue diet" and "what to eat after colon resection surgery". There is lots of information on the internet on what to safely eat after colon surgery.

Quote from: M. Sharon on December 22, 2018, 11:45:03 AM
:-* Hi Spiralcream, Again  you enlightened me up with another vital decision on BA as I primarily chose to go for 475 cc and now reconsidering to switch to smaller size. I have 5' 8" Height with moderate wide chest that I chose 475cc while consultation with Dr. Sutin at first place. Pretty the huge boobs, wouldn't they? that can give some inconvenience later on I guess. Of course I'm not going to load more trouble myself while I would have it enough from colon srs Lol.  To me choosing Bigger may make greater chance of sagging due to heavier weight. Hence thinking of a bit more of cc just above 400 will be best for a long run I think. Hey I also like icecream a lot as u do and yes we have to eat it in small potions for the first months to void massive poop. haha. On different thing, So you did not eat meals 3 days before surgery just eaten liquid soups pre operatively, is it? I feel a little nerves as time is drawing nearer to appointed day X. ;) ;) Are lofts of bread the high fiber foods to void to let colon a lot of rest  n healing by early post op days? Did I understand right? Kindly let me know what were your regimented meals within 2-4weeks so that I can look for shops nearby hotel around Sukhumvit area before surgery. Well thank you for providing all important facts to take account to go well with colon srs! Love, M.sharon.



<edit by moderator>

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Quote from: SpiralCream on December 22, 2018, 02:20:39 PM
3 days before sigmoid colon surgery, you can still eat some clear soup broths (no vegetables in the soup though!). For the remaining 2 days before surgery, you better be cautious and eat nothing, and drink only clear liquid. No orange juice, no mango juice.  Only clear juice like apple juice or grape juice.  That is what I did, and I recommend the same.  Better to be extra safe and not risk any food remaining in your colon before surgery.

After surgery, I ordered a lot of room service. Mostly congee mixed with cooked egg for protein. No vegetables at all, not even cooked vegetables. I also ate white bread (avoid high fiber whole wheat bread). For specific information on what you can eat after colon surgery, do a google search for "low fiber diet" and "low residue diet" and "what to eat after colon resection surgery". There is lots of information on the internet on what to safely eat after colon surgery.

Thank you Spiralcream, now I know many dos & don'ts and potentials to face by next month. Meanwhile if you have any incident or new surprise would ever come up in later post op period, don't forget to share so that we can learn from you and share our thoughts in light of sisterhood as we're taking the same journey.  :-* :-* I will come back with my story after I underwent BA & Secondary colon srs with Dr.Sutin, PAI very soon. Hope mine will be as smooth as yours sister! With lots of loves, M.Sharon

Spiral thanks so much for the infos I'm really inspired but quite scared of the pain. Is it really that painful compared to the standard SRS, can you describe in words what pains and how it feels (if possible) to be psychologically prepared. OMG already the standard SRS was the worst of the worst experience that happened to me as pain, I can't imagine something worse than that.

2. Aesthetics. I always had that idea they would have to start over again but I see they take 2 hours only for Sigmoid cool then. my question is will the sigmoid damage the original aesthetics? Cos Chett did mine so perfect and I dont want it to be disturbed.

3. Will the scars be obvious as it's gonna be the 2nd time right

The pain from my sigmoid colon SRS has been a different kind of pain from my first SRS.  This time, there was never any pain in or around my vagina.  Instead the pain was in my lower abdomen, because of the incisions and cuts in my abdominal muscles that the surgeons had to make to access my abdominal cavity.  It took a while for my abdominal muscles to recover.  The first week was very painful if I tried to move at all (but I was lying in my hospital bed the whole time, so it was ok).  The second week I was back at my hotel.  It was painful to get in and out of my bed.  But once I was standing up and walking, I wasn't in much pain.  Sitting down was also painless.

I think overall the pain can be pretty intense the first 2 weeks, but after that the pain isn't much at all.  Compared that to my first SRS, where I had lower pain levels that lasted longer.  I also struggled to sit down when I had my first SRS.  I had to use a donut cushion for almost 6 months after my first SRS.  But this time, I only used a donut cushion for 2 weeks.  The only pain in my vagina is at the connection point, and only when I am dilating with a new, larger dilator.  Once the connection point gets used to stretching after using a larger dilator size for a few weeks, the pain goes away there too.

I am now 7 weeks post-op and have no pain in my vagina or abdomen at all.  Completely pain free.  Actually I think I was pain-free earlier, maybe at the 5 or 6 week point?  The last bit of pain from my abdominal muscles only happened when I was sneezing or coughing.

As for aesthetics, there was no change or damage to the appearance of my vagina or labia or anything.  Dr Burin was able to do the surgery without affecting any appearance.  You don't need to worry about that.

As for scars, there is no way to avoid the abdominal scar.  It is about 4.7 inches long.  But it looks like a C-section scar.  I will try to apply creams to reduce the appearance, but it may never go away completely.  I'm ok with that though.  Lots of women get C-section when delivering their babies, and there is no shame in having a scar that looks like that.

There are no scars in or around my vagina from this surgery.  I think the only possible concern may be if you are coming from minimal depth or zero depth SRS... you may not have enough depth to attach the colon tissue to your existing vagina canal without showing the appearance of sutures, scars, or even the colon tissue itself.  I feel like you need at least 2 inches of depth to make this work without changing existing aesthetics.  But as long as you had a regular SRS beforehand, then you have nothing to worry about.

The biggest hassle from this sigmoid colon surgery has been, and continues to be, the change to my digestive system.  Irregular and frequent bowel movements and careful monitoring of my diet is much more of a hassle than my vagina, which is feeling fine.

I don't care of the abdominable scar as long as men dont clock my vagina  :o

What do you mean by Irregular bowel movements? You go to toilet more often now? And will this me permanent or what? omg

I beg you please when you have your first sexual relationship, please let me know if you feel good or let me know the sensation.

Quote from: Evolving Beauty on December 23, 2018, 04:11:29 PM
What do you mean by Irregular bowel movements? You go to toilet more often now? And will this me permanent or what? omg

It is temporary.  You may want to do some more research about colon resection surgery and recovery process and typical timeline.  A sigmoid colon SRS is basically the same as a sigmoid colon resection surgery (which cis people might do, in order to remove a diseased or cancerous colon). Except in the case of SRS, only about half of the sigmoid colon is removed, so recovery is easier due to less colon removal and also because sigmoid colon is the least important part of the colon.  And of course, instead of disposing of a diseased colon, the healthy colon tissue is grafted to the vaginal canal.

1. And how many months to FULLY recover for regular bowels and 2. how many months recovery to have sex 3. and how many months for full overall recovery?

Last question, I heard sigmoid once after a few months of dilating it's not even use to dilate anymore, how true is this?

1. From what I've been told and what I've read, it varies greatly depending on the individual.  Right now I have about 3-4 bowel movements per day.  My poo looks normal, there is no blood, and there is no pain, so it doesn't bother me too much.

2. Minimum of 2 months.  Probably 3-4 months if you want to be safe.

3. What is your definition of "full overall recovery"?

4. It is true, to an extent.  You need to dilate the connection point (where the colon was stitched to the vagina).  Otherwise the area will become scarred and become hard.  But once you have dilated it and stretched it to maximum width to soften the tissue, you don't need to dilate it anymore other than to make sure your vaginal introitus and connection point are stretchy and wide enough.  There is no need to dilate to maintain depth, because the colon tissue itself will never shrink.

Spiral so you meant the vagina region or the new colon canal doesn't pain at all?  And it's only the belly where was cut is the real painful thing?

Correct.  After surgery, I had zero pain in my vagina region or the new colon canal.  It was only after I started dilating (after 1 week post-op) that I started to feel pain in my vagina - and the pain was localized to only the connection point.  The pain wasn't that bad either - it was much, much less than the pain I felt while dilating after my first SRS.  After my dilator got past the connection point, the pain subsided for the rest of my dilation session.  When I wasn't dilating, the pain was almost nothing.  Gradually, as the connection point became stretched and used to the dilator size, I did not have any pain at all.  I plan on going up one dilator size after 4 weeks on each previous size.  And I'm sure I will have some pain as the connection point adjusts to a larger dilator each time.  But then it will get stretched and the pain will probably go away again.  As I said, it is minor pain and not bad at all.

The main source of pain was from my belly, where the abdominal muscles were cut.  For the first 2 weeks, the pain was really awful.  Any time I tried to use those muscles (such as getting in bed, or getting out of bed, or sneezing, or coughing, it was really, really painful).  I had to be very gentle and take my time to get out of bed, rolling to my side, and slowly putting my feet first on the ground, without bending my stomach.  It was difficult.  Sneezing and coughing was also super painful.  Dr Burin told me to hold my stomach still with my hands while sneezing and coughing to help reduce movement and help reduce pain.  Sitting and walking did not hurt much, but I could not stand up straight because of my abdominal muscles.  I walked with a hunched back for a while.

After 2 weeks, things got much better.  I still had belly pain, but it wasn't quite so debilitating.  After 3 weeks, the pain was almost gone.  And after 4 weeks, I had no more abdominal pain while moving.  The recovery from this surgery has been much quicker than the recovery from my first SRS, in terms of pain.

What about the scars in the vaginal region,  will they cut it again where the same previous incision of Chettawutt? I'm scared of vaginal scars

Hi cream, next month on this day I am having my secondary colon srs and BA with Dr.Sutin PAI. I rent a condo room sub-lane behind PAI named park 19 residence. I will be there 35 days post operative including 1 week hospital stay. so 5 weeks of post period in total. My room got kitchen and congee will be cooked myself after 2 weeks post op and I am going to setting the scene based on your experience such as putting n getting ready my medical stuffs, clothes, electric and electronic devices to get ready in my bed to minimize utmost stomach movement for first week after discharged hospital. On different note, I have sagging skin at my tummy from my recent big weight loss (from BMI 29 to 21) that healing time at incision area may take longer than you did due to little fat deposit around in that part. I think you don't have any of this fat on your tummy, didn't you. It is external skin that sagging abit and have to go for mini tummy tuck after 6 months. Now everything seems to be ok to go for it after mentally prepared from your accounts. I can't be thanking you enough for sharing each micro single important thingsyou had from your colon srs and BA. But please don't forget to share after your first intercourse either LoL. Loves, M.sharon

Quote from: Evolving Beauty on December 26, 2018, 03:14:24 AM
What about the scars in the vaginal region,  will they cut it again where the same previous incision of Chettawutt? I'm scared of vaginal scars

As I mentioned earlier, there are no new scars in my vaginal region.

Again, a quick summary of the procedure:

• incision is made in the lower belly (C-section scar)
• via this incision, a segment of sigmoid colon is cut, and the remaining colon is re-connected
• the cut segment of sigmoid colon is pulled downward (while still inside the body) into the vaginal area
• via the existing vaginal opening, old and damaged vaginal canal tissue is removed
• the bottom part of sigmoid colon segment is stitched to the remaining healthy vaginal canal.  The top part of sigmoid colon segment is stitched shut (forming the deepest part of the vagina)

If you can visualize this, you can understand why there are no scars, other than the abdominal (c-section) scar.

Quote from: M. Sharon on December 27, 2018, 12:58:09 PM
Hi cream, next month on this day I am having my secondary colon srs and BA with Dr.Sutin PAI. I rent a condo room sub-lane behind PAI named park 19 residence. I will be there 35 days post operative including 1 week hospital stay. so 5 weeks of post period in total. My room got kitchen and congee will be cooked myself after 2 weeks post op and I am going to setting the scene based on your experience such as putting n getting ready my medical stuffs, clothes, electric and electronic devices to get ready in my bed to minimize utmost stomach movement for first week after discharged hospital. On different note, I have sagging skin at my tummy from my recent big weight loss (from BMI 29 to 21) that healing time at incision area may take longer than you did due to little fat deposit around in that part. I think you don't have any of this fat on your tummy, didn't you. It is external skin that sagging abit and have to go for mini tummy tuck after 6 months. Now everything seems to be ok to go for it after mentally prepared from your accounts. I can't be thanking you enough for sharing each micro single important thingsyou had from your colon srs and BA. But please don't forget to share after your first intercourse either LoL. Loves, M.sharon

Be sure to bring some short-sleeve, loose, comfortable, button-up shirts to wear while you are recovering from your breast augmentation.  Button-up shirts will be easier to put on and take off, since regular t-shirts will be difficult to put on and take off over your head.  Also don't put anything on the top shelf in your hotel room.  It will be difficult to reach for things in high places while you are recovering from BA surgery.

Buy some anti-bacterial soap and bring it with you to Thailand.  The night before your surgery, take a shower and wash your entire body and hair with the anti-bacterial soap.  I did this myself, and I feel like this is a good extra precaution to take to further reduce the risk of intra-abdominal infection during surgery.  Wear freshly cleaned clothes when you go to the hospital.

If you are traveling alone like I did, and if you can afford it, do not check out of your hotel during your 7 days at the hospital.  It will cost more, but it is worth the convenience of not having to pack and unpack your luggage.  Especially after surgery, you will be physically very weak, painful to move around due to abdominal muscles, and it will be difficult to have any energy to unpack, go shopping for supplies, or do anything else except rest.  It is better to buy all your supplies, drinks, and food before surgery, store them in your hotel room, then leave it there while you have your surgery.  Then when you come back to your hotel room after surgery, all your supplies will be there and you can just rest, instead of having to worry about going shopping when you are so tired and weak and in pain.  If you travel with a friend, this is less of a problem since your friend can go shopping for you.

During your recovery in the hospital, bring your cell phone and charger.  Also bring an extension cable for your phone charger, so you can keep using it while it is plugged in from the far-away wall outlet.  There is a TV in the hospital room, but it is mostly Thai language with a few boring English-speaking channels that I never watched.  All of my entertainment was through my phone.  I also used my phone to text and chat with friends at home, to keep from being lonely... 7 days is a long time to spend in a hospital room, especially if you go alone like I did.  If after 5-6 days of recovery, you feel like you need more than 7 days in the hospital, don't be afraid to ask to extend your stay.  I stayed one more day (8 days total) and it was well worth the extra cost.  Oh, I also brought my iPad to my hospital room, but I never used it.  I was so weak and in so much pain and I could barely move, that even my new iPad (that I bought 1 month before surgery) was too heavy for me.  So a laptop would probably be too heavy too.  You may only have enough strength to use a cell phone at the hospital.  The hospital has good reliable WiFi.

You will use a lot of toilet paper after sigmoid colon SRS, while your bowels are recovering.  You may want to prepare beforehand and buy more softer toilet paper than the hotel provides, for your comfort.  Also buy a lot of thick maxi pads, in case you get a lot of heavy blood clot discharge, like I did.  Buy lots of bottled drinking water, apple juice, and grape juice before surgery, so you can drink it in your hotel room while recovering.  You will need to drink a lot of water and juice to replenish your body from all the bowel movements post-op.

Congratulations on your recent weight loss!  Lucky for me, I was never overweight and had a flat stomach before my surgery.  So I don't know how your sagging skin at your tummy will affect your recovery.  I recommend you ask Dr Sutin about it during your pre-surgery consultation.  It will probably be ok.

Good luck with your surgery and let us know how it goes!!  You are in good hands with PAI.

What did the extra day in hospital cost?

@spiralcream I will also be alone there as you did. So I will certainly prepare based on your advice and what you've experienced lately. Jessie never wanted me to stay even a few blocks away from PAI to void possible inconvenience visiting PAI in case there are some urgent things come up with my post op such as bleeding or open wound etc. So I rent a condo residence that's only 5 min walk to PAI.

One more thing, Shall I buy some full C cup bra now to wear first 3 weeks post op before able to walk n shop around? I think it sounds a little silly blind purchasing to get it inhand while i can't figure out how big n what shape my boobs gonna be. haha. Or was it worth to get these ready beforehand? I can't wait to get such sexy big boobs as it's exactly one month away and thinking of it always make me feels warm inside. Mine will be 450cc and I chose Smooth surface Silicon gel round gummy bear made of Mentor manufacturer If i am not wrong. How was the level of pain in boobs post op? You did not mention much about pain in chest that I assume it must be quite well tolerable or very less enough not to mention for As A Pain. Is it? Well I now have more thorough facts to handle my colon srs & BA best from your smooth surgeries and of course I will get back with mine as soon as I am ready. Thanks a heap for letting me know with all updates and post operative priceless info. Kiss, M.Sharon.

Quote from: AnonyMs on December 28, 2018, 04:21:03 AM
What did the extra day in hospital cost?

From a post I made earlier, on the first page of this thread:

Quote from: SpiralCream on November 11, 2018, 09:35:56 PM
I was scheduled to be discharged from the hospital after 7 days, but I told them that I didn't feel strong enough to go to my hotel yet.  I came to Bangkok for this surgery by myself.  If I had a friend or family traveling with me to help me at my hotel, then maybe it would have been ok to be discharged at that time.  But since I was alone, I didn't feel I had the strength to take care of myself yet.  So I asked to stay another day in the hospital.  And maybe another day after that, and so on, until I felt well enough.  I told this to Dr Burin during his daily visit to my hospital room, and he told Bune (one of the patient coordinators at PAI; he is so friendly and helpful!).  Bune called me to let me know he would make all the arrangements with the hospital.  I didn't have to do any of the logistics myself.  In the end, I ended up only needing one more day, but it made a big difference for me.  I did have to pay money directly to the hospital for the extra day though.  It was about $300-$350 USD for the room, food, medication, and nurses for that extended stay.  Well worth the cost.  I travel with a credit card that has no foreign transaction fee, for unexpected expenses such as this.

Quote from: M. Sharon on December 28, 2018, 12:40:22 PM
@spiralcream I will also be alone there as you did. So I will certainly prepare based on your advice and what you've experienced lately. Jessie never wanted me to stay even a few blocks away from PAI to void possible inconvenience visiting PAI in case there are some urgent things come up with my post op such as bleeding or open wound etc. So I rent a condo residence that's only 5 min walk to PAI.

You made a wise decision to choose a hotel that is close to PAI.  My hotel (One One Bangkok Hotel) was also 5 min walk to PAI.  Even if nothing goes wrong during your recovery, it is peace of mind to know that PAI is very close to your hotel.  Especially if you are traveling alone to Thailand.

Quote from: M. Sharon on December 28, 2018, 12:40:22 PM
One more thing, Shall I buy some full C cup bra now to wear first 3 weeks post op before able to walk n shop around? I think it sounds a little silly blind purchasing to get it inhand while i can't figure out how big n what shape my boobs gonna be. haha. Or was it worth to get these ready beforehand?

Yes, you should buy several sports bras at home, before you travel to Thailand.  If you are going to choose 450 CC implants, you may want to also buy D cup sports bra and DD cup sports bras too.  Buy the bra style that has a zipper front closure - it will be easier to wear.

Quote from: M. Sharon on December 28, 2018, 12:40:22 PM
How was the level of pain in boobs post op? You did not mention much about pain in chest that I assume it must be quite well tolerable or very less enough not to mention for As A Pain. Is it?

The pain from my breast augmentation surgery was pretty bad for the first 2-3 days.  There is no doubt that it made my recovery more painful, as it added to my overall pain level.  But it was never as bad as the pain from my sigmoid colon surgery.  Compared to my FFS, or my first SRS, or my sigmoid colon SRS, the pain from my BA surgery was not bad in comparison.  The pain is also very temporary.  Most of the pain in your breasts will be gone by the time you are released from the hospital.

Thank you cream for all the advices and tips provided so detail. You in deed is a clear road map for me playing a role of glistening guiding star on this X'mas time. Of course you are gifted as a guiding star to me. Wishing you A Merry Christmas and a very happy New year 2019 dear !! Take a good rest and enjoy the holiday.  A Hug :-*  :-* M.Sharon

Hi Evolving beauty, I read in some others notes in which you are talking about type 3 forehead countering planning to go with Dr. Chett in Bangkok back in 2015. Have you had it with him? if so, could you please share how things went through with your results and experience. Thanks. Any other tips over type 3 forehead reconstruction? I live in Asia and travelling to Europe or States is a bit too far.

I'm about 2.5 months post-op.  Now that it's safe to do so, I decided to dilate deeper.  I was able to get to 6.5 inches very easily (the initial max depth from my first SRS was slightly less than 6.0 inches.  And the max depth later on became only about 3.5 inches after the granulation tissue damage).  I thought about going deeper than 6.5, but just to be on the safe side, I decided to stop there.  To me, there is no benefit to going deeper than that for now.  Maybe many months later after I've completely healed, I'll try for more just to see what the limit is.  But for now I just don't want to risk anything.  Besides, 6.5 inches should be more than enough for sex with most men (average penis length is 5.2 inches).  I also can't lose depth ever, so if I do happen to have sex with a man someday who has a penis even longer than 6.5 inches, I guess we'll find out then just how deep he can go, haha.

The discharge from my vagina is very minimal now.  I only change my maxi pads twice a day, and there's not even much on there.  I could definitely get by with just one maxi pad for the entire day, but I just feel like that wouldn't be as sanitary, so I change every 12 hours.  Dr Burin told me that the colon tissue will automatically generate more lubrication when stimulated by contact.  So during dilation (or sex) when something is inserted, it auto-lubricates.  But when there's nothing in there, lubrication is decreased.  I can confirm this, because I have very little discharge when not dilating.  But when I do dilate, some more mucus comes out on my dilators.  I also am finding that I need significantly less lube compared to before my sigmoid colon SRS (I do still need some lube for insertion, in order to lubricate my labia and vaginal introitus).

The smell isn't bad either.  It's hard to describe what it smells like because I doubt many of you have smelled colon mucus.  But it's not a rancid smell or anything like that.  To give you an idea... a cis woman's vaginal pH is between 3.5 and 4.5.  The pH in the colon is between 5.5 and 7.  So that's probably the pH range of my vagina?  I wonder if it will gradually change in the future because the tissue has been re-purposed, or if it will stay the same.  I guess I'll have to wait and see.

My bowel movements are slowly getting better.  No constipation and certainly no diarrhea.  I can manage 4-5 hours without using the bathroom.  So it's not too inconvenient.  But still it's not completely normal yet either.  I would eventually like to get to where I was before surgery, when I only had to poop once a day.  Maybe that will happen as the remaining parts of my colon continue to adjust.  It's only been 2.5 months since my surgery, and I suspect that this is the part of the recovery that takes the longest.

Hi cream, It is always great to hear your latest recovery status. I am going Bangkok next tuestday and my surgery date will be on 29th. BA and secondary colon srs, the same jobs you have had there. One thing to my curious that if you ever had any pain inside the lower parts where colon was resection? Any bad feeling down there inside the bowel and it's segment reconstructed as vagina? Currently I am rather curious about internal pains such as colon surgical sites discomfort as most other things have been learned so detail from you. Thank you for keeping all occurrence updated which are extremely important for me as I'm gonna take the same boat you're rowing in. Loves,  :-*

hi M.Sharon, good luck with your upcoming surgery!

As for pain, most of the pain you will feel early on will be from the abdominal muscles near your abdominal incision site.

After you are discharged from the hospital, you will start to feel pain from your reconnected colon tissue.  When you are going poo, sometimes you will sense what feels like a stomach ache.  But the pain will not be from your stomach, but lower in your body.  The pain will be coming from the anastomosis point - the remaining parts of your colon that were reconnected to re-form your digestive tract.  As the poo travels through that anastomosis point, you will feel the pain increase, then go away.  I experienced this a number of times while I was recovering in Thailand, but not all the time.  Sometimes I would go poo and I wouldn't have any pain at all.  After I returned home, I had this pain again just two more times - once after I ate a lot of pizza for the first time, and again after I ate a lot of corned beef hash for the first time.

I also experienced pain when I dilated past the connection point - where the sigmoid colon tissue was grafted to my vaginal tissue.  The pain gradually decreased as I dilated more.  But this pain is pretty minor, and not nearly as painful as the other pains I experienced.

The worst pain is in the first week after surgery, while you are in the hospital.  But you will have morphine to help you get through it.  Even with morphine though, it is very painful.  Be ready for it.  After the first 2 weeks, the pain becomes much easier to deal with.

Hi cream, well noted and brace myself for upcoming surgeries. I will be able to easily assess what is going on with me in first post-op weeks particularly in dealing with pain, poo, dilation, blood, foods and bowel complications more accurately based on your experiences. Because of you I really feel peace in mind about my surgeries which are just around the corner as I have learned best from you. For instance, finding some trace of blood on nose of dilator after dilating can probably be determine as blood clot and supposed normal that need not to be too concerned overnight as you did it for your junior sisters like us.  Taking risk pushing dilators to deeper depth like 7" in that early days n finding blood can't simply think as blood clot I know. Such a clear road map you have paved and I know I can't thank you enough.

M.Sharon - good luck with your upcoming surgery.  I am also planning secondary sigmoid srs with Dr Sutin soon. I look forward to hear your story and experience 🙂

Spiral - thank you so much for sharing ur experience!! I had my first SRS with Suporn in 2003. After 16 years, I lost 1/2 or 1/3 of my depth and needing an upgrade.  Ur story giving me so much hope for a secondary srs. ❤️

LaLa_girl, sorry to hear you lost depth after 16 years.  It seems that losing depth with a skin graft technique after many years is more common than I thought.

Spiral - how's your scar doing? Are u able to exercise (weights or running) yet? Would it be possible to see a pic of your scar? I am most likely will have the secondary sigmoid srs with Dr Sutin in March.  I'm excited but also nervous.  Dr. Kamol confirmed he does laparoscopic technique that can give the same depth as open.. however, I couldn't find much information from other ppl experience so I don't want to take that chance.  PAI price also increases a lot from previous year....do you mind msg me about ur price?  Thx 😙

Quote from: LaLa_girl on January 21, 2019, 10:39:03 PM
M.Sharon - good luck with your upcoming surgery.  I am also planning secondary sigmoid srs with Dr Sutin soon. I look forward to hear your story and experience 🙂

Spiral - thank you so much for sharing ur experience!! I had my first SRS with Suporn in 2003. After 16 years, I lost 1/2 or 1/3 of my depth and needing an upgrade.  Ur story giving me so much hope for a secondary srs. ❤️

Hi Lala girl, thank you for kind message. I guess you are the one who sent pm to me asking about prices and accommodation and waiting time. I tried to respond through pm but unfortunately failed attempt, hence, i will post it here.

Hi Aisla, I was quoted $15,000 for secondary colon srs it includes labiaplasty as i got some unacceptable appearance at vulva floor from my first SRS back at 2005. I ended up with 3.5 inches though I primarily got 5 inches in my early post op with skin graft. BA is quoted $5000 for 450c cohesive silicon gel, high profile, mentor brand, smooth surface.

I waited 3 months since first consultation and I was asked to have BMI 23 for my height 5'8".

I am staying at a good service room near PAI and will be staying here for 1 month post operative recovery. hospitalizing will be 6 days after surgery so total of 35 days post surgery stay in bangkok for my adequate recovery period.

The room I rent is 26 m.sq space which is just enough for single person stay with favourable n affordable 25000 Thai Baht by monthly plan without breakfast. Colon surgery won't make you eat most of foods except congee n soft diet that missing breakfast is not a thing to loose for. Some juice, yogurt and soft diets are only your regimented foods to eat after colon surgery. Today I went through pre medical check up at Payathai hospital and just got back to room now.

Don't hesitate to ask more q dear.

Best regards, M.Sharon

M.sharon - thx so much for the information. I was quoted the same but I am not changing the external as I love the result Suporn gave me.  It looks and function well.  Based on Spiral review, they didn't damage or add new scars to her external...so that's exactly what I want.  My most corcern is the scar....like how noticeable would that look.. I google for c section scars and saw some are pretty bad.. kinda make me nervous

Quote from: LaLa_girl on January 23, 2019, 11:15:21 AM
M.sharon - thx so much for the information. I was quoted the same but I am not changing the external as I love the result Suporn gave me.  It looks and function well.  Based on Spiral review, they didn't damage or add new scars to her external...so that's exactly what I want.  My most corcern is the scar....like how noticeable would that look.. I google for c section scars and saw some are pretty bad.. kinda make me nervous

Any scar quality varies from surgeon to surgeon, and also how concerned they are to leave a nice looking scar behind.  Some can create scars that are hardly visible, others create big red welts for the identical surgery.

I believe age and ethnicity also influence scarring.

Quote from: AnonyMs on January 23, 2019, 05:54:32 PM
I believe age and ethnicity also influence scarring.

Not really, age may influence healing a little, but certainly not scaring, and ethnicity should not have anything to do with it, because a surgeon can adjust for all kinds o different skins.

Quote from: Dietlind on January 23, 2019, 06:02:27 PM
Not really, age may influence healing a little, but certainly not scaring, and ethnicity should not have anything to do with it, because a surgeon can adjust for all kinds o different skins.

I've heard it from surgeons and doctors before, but I looked up a few references. Its good news for me for a change.

Overview of Surgical Scar Prevention and Management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055805/

• Aging tends to decrease skin tension and sebaceous gland activity, and as such, hypertrophic scars are observed with lesser frequency in the elderly. This is in contrast to incisional scars in children, among whom hypertrophic scars are common because of increased cellular activity, prolonged scar maturation, rapid physical growth, and increased skin elasticity.
• Additionally, ethnic skin characteristics and their association to postoperative scar response have been well documented. People of European descent are more likely to form fine scars, while people of African descent appear genetically predisposed to hypertrophic scars and keloids.

Keloids: Pathogenesis, Clinical Features, and Management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884925/

• Although keloids have been documented in virtually all major ethnic groups, they are most commonly seen in individuals of African, Asian, and, to a lesser degree, Hispanic and Mediterranean descent
  
• Although keloids can occur at any age, they are most likely to occur between the ages of 11 and 30 years.

Being older helps skin heal with less scarring
http://www.dermatologytimes.com/wound-healing/being-older-helps-skin-heal-less-scarring

• Older skin might heal more slowly, but it heals with less scarring than younger skin.

As I said, surgeons are able to adjust for those differences, and can decide whether to close a wound with sutures, staples, Steri Strips or skin adhesives.  Sutures are the way cheapest method for wound closing, and also do not require to learn a new wound closing technique.  That is the reason they are used most of the time.  Steri Strips and skin adhesives are providing the cleanest looking scars, but are more expensive and requiring a certain know how for the application.  some surgeons may not have this know how.
Once the scar is healed (wound is closed), scar massaging can reduce a lot of ugly looking scars, and make most scars looking pretty good.

Quote from: LaLa_girl on January 22, 2019, 10:46:22 PM
Spiral - how's your scar doing? Are u able to exercise (weights or running) yet? Would it be possible to see a pic of your scar? I am most likely will have the secondary sigmoid srs with Dr Sutin in March.  I'm excited but also nervous.  Dr. Kamol confirmed he does laparoscopic technique that can give the same depth as open.. however, I couldn't find much information from other ppl experience so I don't want to take that chance.  PAI price also increases a lot from previous year....do you mind msg me about ur price?  Thx

Sorry I am not comfortable publicly posting pictures of my scars.  But another trans woman did.  If you go to the review website RealSelf, a woman posted her post-op pictures of her colonvaginoplasty with Dr Sutin at PAI in 2017.  In that review, you can see her pictures of the abdominal scar.  I can say from my own experience that my scar looks exactly the same in location and size.  My surgery was with Dr Burin, but I am pretty sure that neither Dr Sutin nor Dr Burin make the abdominal incision.  There is another surgeon at the hospital (the colon surgery specialist) that does the abdominal scar incision and stitiching.

I am able to do every exercise now, but I am not pushing myself.  I think after 2 months I felt like I could do anything physically.  But I am a pretty slow healer overall, so I bet most other people could begin exercising sooner.

I am not going to write a new post as I'd like to fill or add up additional info here based on my own story with PAI. Well, it's 3 days post operative from my secondary colon srs with Dr.Sutin from PAI. Everything went well and most intense pain I had past 2 days are almost gone. Only mild tolerate pain at 3 surgical sites persist which are at BA, my C section cut at lower abdominal, and genital Vulva.

I admitted in Payathai 2 hospital before midnight the surgical date. The hospital rooms are big, medical amenities modern and nurses are very active wearing smile day and night. I slept there overnight and early morning around 6, two nurses work me up to enema for bowel flushing . Each time it was 1 litre of saline water and total of 3 and it was easy on me.

There were 3 surgeons involved in my operation Dr. Sutin, the colon surgeon, his assistant, and anesthesia's. It took 6 hrs for secondary colon srs, genitalia repair, and BA.

The pain I had from 0-10   was 7-8 in the following day 1 and 6-7 on post second day. Today I think it is 4-5 moderate pain I got but I am still on morphine. Dr.Sutin visits everyday to check things are under control and he remove my BA blood drainage today as it is no more needed. He encourage me to walk slowly to get gas pass to motivate colon gotten back to work. He asked whether I fart yesterday but this morning when he visit I had non yet. Now I fart 3 times lying in bed and let him know that I am allowed to sip water a little by a time just enough to quench. I was not allowed anything by mouth (NPO) for total of 3 days since the surgery.

Dr.Sutin at PAI is, to me probably the best surgeon in the world especially on colon srs , as he can find out and fix my long term urine inconvenience problem after I had it in my first srs with Dr.Pichet in Bangkok a long time ago.

I was always in the great problem with urine dripping by every night while asleep and had to wear diaper  like a little child. I was so shocking and let Dr. Pichet know as soon as It happened to me in my early post operative days and just got respond "I might cut your urethra too short and it seems irreversible, it is a kind of common complication, but there is one medicine name Tofrail (Imipramine) that can be bought on counter". Killed my hope to seek to other surgeon for alternative treatment, by that time, as i thought he know the most what he did to me. Since then I always carrying diaper wherever I travel. Furthermore, My vulva area has ended up with unacceptable appearance and orgasm is lost ever since.

Yesterday Dr. Sutin mentioned I had urinary fistula in my vagina that is probably the cause of my dripping problem and he said he has closed it now.

Could not be happier to hear it as I really really do believe this was a root cause of peeing in bed, to me, it can be as compare to a lost-son- found that my happiness was beyond words, it has just now been solved and thanked to Dr.Sutin for being able to troubleshoot accurately. His competence in surgical skill at this point was very impressive already though his new works were not unpack yet.
At the same time I insisted that I will never go to Dr.Pichet even for a minor acne treatment again.  He did this thing to me and he did not know what's wrong with me till a qualified surgeon like Dr.Sutin could sort it out after many years. All the things he had done on me had to repair : depth, vagina, urethra, etc.

I hope when I healed up this operation my night time urine dripping problem would be solved.

I will write later ...

4th days post operative

- vaginal bundle is removed
-Dr. Sutin allowed to start drink and clear broth as I get gas pass.
-mild fever since day 1 post-op around 37 and I am told this is normal.
-every 45 min nurses come and check such as IV, BP, urine, blood drainage, antibiotic.
-I start to walk in the room for a few min and not bad.
-all blood drainage are removed breast & vagina
-the bandage ties with implants and chest brutally so tight that make me most discomfort. hardly breathe in :( but no pain now.

Sharon - congrats! You did it! And thank you for sharing us your experience.  I am in the process to finalize my booking with Dr Sutin for my secondary sigmoid srs.  I hope you have a speedy recovery and can't wait to see more of ur post

Quote from: LaLa_girl on February 02, 2019, 07:22:39 AM
Sharon - congrats! You did it! And thank you for sharing us your experience.  I am in the process to finalize my booking with Dr Sutin for my secondary sigmoid srs.  I hope you have a speedy recovery and can't wait to see more of ur post

Thank you Lala_girl for kind words, I am now 5th days postop and getting better each day in terms of pain, fever,apetite etc. You are in good hands with PAI either you choose Dr.Sutin or Burin as they are efficiently well trained by Dr Preecha. The colon surgeon they use is such a good lecturer of Royal Thai universities majoring this subject especially for your safety. The whole team is of top surgeons in their respective fields. For my personal advise, please quit smoke at least 2 months prior surgery if you are a smoker. Do lots of physical exercise as early as you can such as running on treadmill it really pays off for me now.  stop hormones, steroid and Vit E 2 months prior and eat well balance foods. As these are so important to prevent a deadly complication like "anastomotic leakage" (mostly happen 3%) the leak at sigmoid colon where two colons are joined but it is extremely scary complication rather than kinds of other wound Infections. I am going to stay in hospital as my senior sister "sprialcream" did because 80% (more than 2% out of 3%) of colon leakage happens in this very first week and I needed to be sure I discharge hospital without it. The rest 20% possibility is to take care by myself for the rest 1 month postop. Meaning we should not eat whatever we want in that sensitive time frame to keep us safe from such worst case scenario. I will keep update.

Sharon,

Great information, thx for all the tips.  Leakage would be my most concern as well, but I don't think there are of those cases.  I have been working hard on my fitness as well.. lots of gym time and sports. I'm about 5'6 and 138 at the moment and Dr told me not to gain any more weight. How would u rate the abdominal incision pain compared to boobs? I can't wait to hear ur first dilation experience....have a speedy recovery! If you are still in BBK around mid March.. we should definitely link up!

Surgery booked for 3/19 with Dr Sutin.  Nervous to go through this procedure again but also excited to have a functional vagina and getting my sex life back. I am getting the secondary sigmoid srs, which only regain my lost depths.  Nothing will be changed externally as dr Suporn gave me a beautiful looking vagina 16 years ago.

Spiral and Sharon! I hope ur recovery is going well. Any updates? Hope to hear from both of u soon. ❤️

Quote from: LaLa_girl on February 19, 2019, 02:18:07 PM
Spiral and Sharon! I hope ur recovery is going well. Any updates? Hope to hear from both of u soon. ❤️

A lot has happened since I discharged from hospital 2 weeks ago. Firstly, on the 7th day when I was preparing to discharge from hospital though i intended to stay one more night in hospital but I think i was ok to go back hotel despite not being strong enough yet but just enough to move a short walk. Staying extra night will cost me around 11000 Thai baht (approx 330 USD) which is alot of money for me just to sleep one night there. By that time, all IV line and morphine are removed since 2 night before already and all the care the nurses providing were hourly BP, blood oxygen and urine disposal from catheter bag and giving medicine twice a day, that's all, that I determined I need no intensive care to have to pay extra stay for. But if you could extend your stay and could afford 300+ USD / night it really the better for you to have adequate rest. I do recommend it if you travel alone. A wheel chair is arranged all the way from my hospital room 22nd floor of Pyarathai 2 to the door of awaiting PAI car. A big thing happened just before I get out of room I stand up and collected my personal belongings by aid of nurses and sip a water, a lot of blood poured out into my pad as if all the water i just drink instantly drain out of my vagina but I know it's not possible to be water to come out of vagina that i looked down to check in my pad i neatly wore. Bloods were red dark color as much as 70-80 ml I think that the whole heavy duty pads sank wet and it even could not absorb and able to hold all leakages that blood also wet my pant . I was so scared immediately and nurses were rush reaching for me holding my hands put me back on the bed to lie down. Nurse were calling to surgeon to express what was going on with me by phone. I did not suffered any pain down there nor have fever that i realized it can't be kind of anastomotic leak which I afraid the most to happen throughout in my first week,  I then instantly could figure out about this dark blood leaking from what i've learned from earlier Spiralcream posts that really made me relax in mind to certain degree. Thanked to Spiralcream for all the detail information provided as it played a vital role as a full guide in my surgery. The nurse then asked me to lies on bed by side and to watch for another 15 min if blood still coming out or not. Fortunately it was non, no more blood from vagina that I was let to proceed to discharge from hospital same evening by the instruction of my surgeon to attend nurse through phone. So i could assure it must not a big deal. Of course, what Spiralcream experienced about dark red blood clot by her 2.5 week post op has happened on me exactly at 1 week post.  I sit on donut given by hospital and the foley catheter was still in place that I put the urine bag on the floor. I was kinda of too discomfort with certain amount of tiredness when I arrived hotel. It was the only one complication so far till 3 weeks post op now and everything went very smoothly well. today is 3rd appointment (final) at PAI having got checked with Dr.Sutin and learned everything is healing fine and so well that I was allowed to fly back home. However I will be here a few more weeks and doctor to check another final exam before i fly back home as I have 3 surgical sites, colon-vaginoplasty, vulva reconstruction, urethra fistula closure. I will get back with more important details and recovery tips shortly how things i went through past 2 weeks since i get back to hotel.

Sharon,

I am glad everything is fine with your recovery and hope it gets better each day.  I am definitely taking notes on this one as I know I will freak out if I see lots of blood.  How's dilation so far? Easier and less painful? I will head out to Thailand exactly 3 weeks from today and my surgery is on the 19. At this point, I'm only going to have secondary sigmoid to fix my lost depth. There might be a chance dr Sutin will do fat transfer on my vulva to have the vagina less of a gapping .  Mine doesn't look too bad but when I spread my legs, I feel like my vagina opens a little bit haha .  Can't wait to hear more of ur experience because you are really helping me to prepare for my upcoming surgery ❤️

There were 4 pre consultation sessions I have had at PAI before my colon vag and BA. 1 with Dr preecha and 3 with Dr Sutin. Brief discussion points and my personal concerns and their answers were as follow:

BA : Both surgeons recommend Smooth surface silicon gel implants as it has very less report of possible (rare but possible) BIA-ALC cancer (auto immune cancer) compare to texture surface according to FDA and their research and I agreed I would go smooth surface after I also find out that info on internet 1:4000 to 1:30000+ possibility of ALC with textured surface on FDA website. I choose 500 cc high profile smooth mentor silicon gel as I have moderate wide of chest and 173 cm height (approx 5'8").

Urine leakage: I had that problem for more than one decade affecting my quality of life as I had to wear diaper by night time to manage this dripping. By day time I seems to be able to control my bladder but some pee spot in my panties when rush to bathroom but not a big deal. Dr Sutin stated this thing can't be done and cannot guarantee to solve as there are 2-3 factors causing urine to leakage I had in my previous srs surgery with Dr. Pichet that he may not be able to locate what wrong with me exactly. He insisted he would try his best finding cause but cannot guarantee at all.

Vulua reconstruction: I have unacceptable vulva floor no labia minor and proper shape of clitoris and pretty wide open vagina introitus that looks so ugly. Dr. Sutin will fix this cosmetic reconstruction.

Orgasm : I never ever have orgasm ever since my first srs surgery back at 2005 and asked Dr Sutin if he can manage to solve this thing and he cannot guarantee saying I might ended up with damaging important nerve in my previous surgery that he can't fix it.

vagina depth: I asked I'd like to have 8" depth after colon srs. Dr sutin said Colon graft has elasticity and suggest he would spare 1.5 to 2 inch skin at entry and join colon at that point cutting 6 " to have around 8" and I can accommodate any 8" penetration. To me, it sounds that he seems suggesting me not to too greedy on depth to be cutting off as much as 8" long colon graft net while 6-7" colon can be expected to easily accommodate any 7-8" penetration. I thus convinced it must have come up with some drawback laid behind for having cut 8" or more of colon length in terms of possible higher risks of excessive mucous discharge or bleeding or something  that I agreed 7" to be my total vaginal depth post op. And I assumed very single inch cutting more of colon length may make higher chances of longer irregular bowel movement to my understanding. While Average cis woman depth was 5" plus some extent of elasticity to adequate sex and mine having got 7" plus similar elasticity is quite acceptable that I confirmed mine to be 7".

I will write up more about post op results, dilation, dealing with bowel movement, catheter and pain shortly.

https://www.realself.com/review/mtf-vaginoplasty-secondary-colon-srs-drsutin-pai

this is me (above link)  on Realself with colon neo vagina photos if somebody wonder.

Colon srs recovery was very hard for me though i did not had any major complication. For the first two day since I wake from anesthesia, I suffered intense pain and great discomfort at breast implants, reconstructed vulva area and great soreness at lower part bowel area that i even can't correctly locate which part got how much pain the most. Morphine and IV line are continuously given for five days in hospital. Nurses were very caring and hospital room was very big and comfy. There was another bed in the room if someone accompany with me. The breast pain was intense that I felt like regret to choose big 500cc HP implant on me and thought I should have been going 425cc which may make less tightness n pain in my chest. I even got another regret to have this colon srs in the first week. Can't stop thinking and blaming myself for going this surgery as big mistake just because of wanting to get back sex life which is unworthy to risk with tons of bowel health and possible big complications I may have to deal for the rest of my life. I even cried alone in my hospital room. After I got back hotel, my foley catheter is still in place for another week to let fistula healing up. On day 8 postop, I was picked from hotel to PAI where Dr.Sutin teach how to dilate, he insert #1 dilator in the examination room and it was like slaughter, I shout aloud from pain when dilator pass colon-skin joint but Dr. Sutin won't give up and finally it reached its desired depth to 5" and I was asked not to go beyond 5" to let inside colon part to heal for 2 months. It was the worse pain i ever got in my colon srs that can't be control by any sort of pain killer.  It really hurt to dilate for another 2 days in hotel to reach 4-5" but it get abit easier each day from 3rd day onwards. After 2 week Dr Sutin removed catheter and checked if my urethra heal up well and checked everything and said I am in good healing process. I stll not poo till my 12 days postop. I was in strong feeling of poop but could not stain due to foley catheter in place. It was big distressing and made me big concern for unknown status of unpredictable up coming poo, pee, and fistula healing condition. I was very unhappy with all discomfort not only physically but also emotionally. I was on antibiotic for 3 weeks for 3 surgical sites and I did not need to take paracetamol since i discharge from hospital. Pain was only at first 2 dilation sessions and I did not had big wound pain that I stopped taking pain control med starting from 6 th days when i was in hospital so far. The thoughts of regret about colon srs fade away after 3 weeks postop when I am enough recover to fly back home and yes improve self confident in mind that I can have sex with any guy successfully which was limited and ever opted out in my life before. Wow changed in mind I did the right thing, praised myself and praised the Lord. Of course I say many prayers many times a day in my early weeks ,of course, it surgery will also draw you closer to Lord as it has a lot to concern.

Dilation : First 4 sessions were really hurt, but on 3rd day the dilation pain is getting better and relief significantly. But still discomfort when dilator nose pass colon-skill joint inside untill 2 weeks. But each time it gets easier though. Now I am 26 days post and having pain free dilation. I dilate twice a day n each session I put it 45 min although I was asked to do it 30 min for each session.

Mucus discharge: It comes usually within 30 min after each dilation session with some blood trace in it. But from 2nd week it subside significantly with lesser blood content in it. After 3rd week it come out very small amount only after dilation session it clear like water gel odorless and now it is as few as amount of mucus you spit out lung mucus when you cough. I am pleasantly surprised by this.

Pain : I do not have particular pain that make me hard to bear. Hence, I stopped paracetamol since i get back to hotel. But there are some sting n soreness at vulva where Dr.Sutin created Labia minora and new clitoris hood and at discomfort urethra and bladder swelling while peeing due to 2 weeks dwell of catheter. The incision at bowel muscle cut is a source of discomfort but numbness is more accurate to express than to say it pain.

UTI: today is 26 days post op and I have UTI this morning, I have Augmentin (Amoxicillin trihydrate plus potassium antibiotic) ready in my room that I started to take it, it's Sunday here and PAI closed. But I informed Jessie (patient coordinator) about it and got reply he will forward message and doctor's management tomorrow morning. I expected this UTI to happen learned from Spirelcream and many other former colovaginoplasty patients. Almost all girl experience UTI in their 4 weeks to 6 weeks postop. I also had UTI back at home once or twice in a year and E.coli was always reason for UTI and urine culture resulted to be treated with Amoxicillin that I bought Augmentin beforehand. This med can be bought at any pharmacy in Bangkok without prescription. I had to go toilet several time for pee with some soreness at bladder while urinating. Now I feel like normal and symptoms go away even with 1 pill. I have to go another 4 days for full dose. I have no fever nor blood in urine but a little feeling of chilling this morning.

Bowel movement and poo : I had my first poo 12 days postop. It was very difficult to strain poo for me as catheter is in place and cannot able to squeeze bladder for pee resulted in unable to poo though i have strong feeling of poop. Very difficult time for me trying to poo with catheter throughout 2 week. Only very little amount of poo come at a time thus I ever dare not to eat soft diets foods much worrying if i make more poo in bowel and getting more trouble. Another concern is i was afraid to give strong pressure on bowel movement concerning if my anastomotic suture could be tear or leak. So I drink Ensure liquid diet throughout 2 weeks to minimize poo accummulation in my guts. Very little poo I made were normal poo like 1" solid poo but not too hard to be constipation. And yes it was weird to have both feeling of hiarrhea and constipation at the same time. Now affter 3'weeks when i eat enough (but only boiled rice, some soft bread, half boiled eggs and Ensure drinks) are still my daily meals so far, that I poo much and better and only 4 to 5 times a day I need to go to bathroom to make small poo at a time but poo are normal poo. So it can be said that my Bowel movement is slowly getting back to normal within fourth weeks. At the moment,  have no idea if i eat heavy meals like before and how my colon would respond it but i have to introduce little by little next weeks. I'm also waiting how bowel movement goes with Spiralcream to learn here to take some necessary precaution.

I will add up info here in this post soon enough. I am sorry about my English as I am not English native speaker but I hope you guys can understand.

Sharon,

Good to hear from you. I think it's common to feel down after major surgeries. Sorry to hear about the pain and discomfort u went through. I'm glad you feel better each day and no complications. You mentioned earlier that you wanted to correct the opening of the vagina. Did he fix it? By what method? The only thing I would fix my vulva is the gaping as well and he said can be fixed with fat graft. How deep is ur colon connection point?

Your picture looks great! I'm surprised your abdominal scar looks so good 3 weeks post.

Dear LaLagirl, He fixed my opening by constructing labia minora which is absence in previous surgery. He also created very natural clitoris hood and I am very pleases with new cosmetic appearance. I don't know which method he used technically but it definitely looks much better than before. Colon connection point is 1.5 inches he said but I doubt it is at 2" as dilator goes smooth till 2" and struggled to move forward there. After some discomfort of tightness and stretch meet at 2" passed, it again goes smoothly in but colon push back dilator after 15 min that I usually slowly push dilator back inside to reach desire depth ie. 4.5 inches currently. Dr.Sutin said colon surgeon cut 7" that I have total of more than 8" when I heal up completely. Colon never loose depth that I need not to worry about it whereas penile skin inversion will definitely loose 2 to 3" later in most patients. I got 5.5 initial depth and ended up 3.5 inches which is not compatible with any penetration sex. Scar is getting fade each week at belly and under breast. I will come back with recovery tips about buying necessary stuff to stock in before surgery to make you utmost convenience and to void unnecessary movement in your early recovery days.

Just a clarification by a person who made her living with infection control & prevention.  It should not be seen aas a given that one gets a UTI after surgery and catheterization.  It is very common to experience UTI's in these situations, but all research we did on this, clearly indicated that somebody did a breach of sterile procedure.  In most cases, this breach was done by the staff who inserted the catheter!  If these persons would be better educated and would take more care about the possibility of an UTI when applying/inserting the catheter, most of those could be avoided!

I only had a UTI once, shortly after I returned home from Thailand.  It was entirely my fault, because I did not clean my vagina after dilation, for several sessions in a row.  I was lazy after returning home.  I only wiped with toilet paper, but did not rinse with water or betadine.  Since my UTI, I learned my lesson and I always rinse the area after every dilation with a water + betadine solution as originally instructed by the nurses in Thailand.  Since then I have had no UTI.  I think the risk for a UTI is higher in the weeks and months after colon SRS because of all the frequent bowel movements and loose stools.

I've noticed a few differences in recovery from M.Sharon and me.  Other than the blood clots, I had almost no bleeding during my recovery in Thailand and at home.  Sometimes I would see a tiny one or two drops of pink blood (mixed with other lube) on my pads, but it was very minimal.  I also had very little pain in my first dilation after surgery and very little pain throughout all my dilations since my surgery.  I have a little bit of pain and a tiny bit of blood when I increase my dilator size to a new larger size, but the pain and blood goes away after a few days.  The main issue is that the connection point between my vaginal tissue and colon tissue is still quite tight.  It stretches with dilation without any pain, but the default is to be quite tight.  I hope it will become less tight with more time and more dilations in the months to come.  It is not painful, just tight and needs to be stretched.

Recently I had a bit of an issue when I went to a bigger dilator size and had some more blood and pain than usual.  Nothing serious, just very minimal few drops of pink blood, nothing to fill my pads or even close to it.  But the pain wouldn't go away after using this larger dilator size, even after a week.  (it was not serious pain, I didn't need to take any pain medicine, maybe a 1 or 2 out of 10 on the pain scale, so almost nothing, but still it was a little bit of pain when previously I had no pain, so I was a bit worried).  I went to a LGBT clinic where they have a doctor who has examined many post-op transgender women.  She gave me a full exam and said everything looks healthy and fine.  She said the connection point of vaginal/colon tissue is very secure and healthy.  No tearing or bleeding or granulation inside or outside my vagina.  She said everything looks perfect.  It was a relief, and sure enough after another week or so the lingering pain from using a larger dilator size went away, and now I am using the larger dilator size without any problems.  I think at this point after 4 months post-op, it is safe to say that my surgery was a complete success and that Dr Burin did a wonderful job of creating strong sutures in my colon/vagina that has held strong and healed nicely with very little pain throughout.

Regarding the catheter, when I had my colon SRS, Dr Burin removed my catheter at 5 days post-op, while I was still in the hospital.  Maybe M.Sharon has to keep her catheter inside longer because she had more procedures done with external genital work and urethral fistula correction from her previous surgery.  But since I only had the secondary colon work done, the catheter was removed quite early.  It is also interesting to note that when I was coordinating my surgery in the months leading up to surgery, Peera (the patient coordinator at PAI) told me that Dr Burin was going to use a newer technique on me that would allow removal of the catheter earlier than usual.  So maybe that was a factor too.

As for breast implants, I think another interesting point of difference there.  Dr Burin urged me to get textured implants because they are safer in his opinion.  It's interesting that Dr Sutin advocated for smooth implants for M.Sharon.  In my research, I have learned that the overwhelming majority of breast implants used in the USA are smooth implants.  But in every other part of the world - Asia, Europe, Australia, etc - the overwhelming majority of breast implants used are textured implants.  You can see the difference in the "textured implant look" vs the "smooth implant look" when you look at the breasts of porn stars from the USA vs the porn stars from the UK or Asia.  They look different and the breasts also move differently.  I think it is a matter of personal preference which is better.  I am happy with my textured implants.

As for size, I am ok with my 375 cc implants.  But... if I had it to do again, I would choose 300 cc instead.  I think I should have gone with my initial instincts and done 300 cc, but I listened to my real-life friends (who also got implants) and also what I read on breast implant forums telling me that 300 cc is considered to be too small.  (for example if you go to JustBreastImplants.com, discussion for 300 cc implants is in the 'small' implants subforum, haha).  I know that many, many women would be happy with 375 cc implants or even larger, but I think my own personal preference is for smaller breasts.  But oh well.  375 cc isn't huge either.  I am consistently fitting in 34C or 34D bras - I am kind of between the two sizes.  And I think that's not considered to be too big by almost any standard.  And again, many women would be super jealous to have breasts in this size range. 

Now the part about my bowel movements.  At almost 4 months post-op, I think I am still healing.  But doing better.  I can eat anything I want and even eat big portions at meals without any problems.  Bowel movements are still a bit annoying though.  Sometimes I will go 10 hours or more without any bowel movements, but rarely sometimes I need to go twice in 1 hour.  And sometimes I need to sit on the toilet for a while because not all of the poo comes out at once.  Another problem I sometimes have is that I cannot pass gas easily without some poo coming out with it.  This makes sense because it is the function of the sigmoid colon to allow gas to pass without releasing poo.  I am hoping that this will get better over time as the rest of my colon adjusts to handle this job, but for now it is inconsistent.  Sometimes I pass gas and nothing else comes out, but sometimes a little bit of poo comes out with the gas.  Because sometimes it works fine, I have hope that this problem will eventually get better and go away completely with more time healing.

I think these are side effects of losing the sigmoid colon in the digestive tract (although I did not lose all of the sigmoid colon - the total length of sigmoid colon is about 15 inches, and the surgery only cut out 6-7 inches of it).  Although it's the least important part, it still has a function unlike the appendix.  The ability to pass gas easily, or the ability to store poo and release it all at once - those are things that the sigmoid colon does.  I am noticing that over time, the rest of my colon is learning to adjust as these issues are decreasing in frequency, but I am not sure if it will ever be 100% like normal.  I have hope though.  After all, 4 months is not enough time for the body to heal completely from major surgery.

Oh, forgot to mention about discharge and smell.  I forget when exactly, maybe it was a few weeks ago.  But there is almost no smell at all anymore.  There is still a little bit of discharge, but it is easily taken care of with a light maxi pad.  Maybe with more time, the discharge will stop completely, I hope.  It has only been 4 months post-op after all.  But the smell (which wasn't that bad to begin with) is really just gone now.  It doesn't smell like anything anymore.

Quote from: Dietlind on February 24, 2019, 11:19:51 AM
Just a clarification by a person who made her living with infection control & prevention.  It should not be seen aas a given that one gets a UTI after surgery and catheterization.  It is very common to experience UTI's in these situations, but all research we did on this, clearly indicated that somebody did a breach of sterile procedure.  In most cases, this breach was done by the staff who inserted the catheter!  If these persons would be better educated and would take more care about the possibility of an UTI when applying/inserting the catheter, most of those could be avoided!

Do you know of any papers on this?

Sharon and Spiral

Thanks for the update ladies..happy to hear from both of you and hope ur recovery continues to get better.  How long did you stopped ur hormones before surgery? PAI only requires 5 days, but other surgery I have had in the past require a month. Spiral, can u hold on pooping like before? Like if u stuck on a bus or train lol..or have u had sex yet? Would love to hear ur experience. ..also, any advice on what to pack or eat would be highly appreciated from u 2.

Thx ❤️

Quote from: AnonyMs on February 25, 2019, 12:54:47 AM
Do you know of any papers on this?

Not off hand.  I am retired to long that it have them readily available.  But it is a well know subject in the field of infection control.  Every well run hospital should have an infection control specialist on staff, and they can give you all the information you need.

Here is a papr that talks a little bit about it
If the staff makes sure that the biofilm gets destroyed,it will prevent an infection!

https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/urinary-tract-infection-uti-in-the-catheterized-patient/

Quote from: LaLa_girl on February 25, 2019, 06:25:53 AM
Sharon and Spiral

Thanks for the update ladies..happy to hear from both of you and hope ur recovery continues to get better.  How long did you stopped ur hormones before surgery? PAI only requires 5 days, but other surgery I have had in the past require a month. Spiral, can u hold on pooping like before? Like if u stuck on a bus or train lol..or have u had sex yet? Would love to hear ur experience. ..also, any advice on what to pack or eat would be highly appreciated from u 2.

Thx ❤️

I stopped hormones 1 week before sigmoid colon SRS. For other surgeries that I did previously, I think I stopped hormones 2 weeks before surgeries.  And yes I can hold my poop just like before. The main difference is that I need to go more often.  These days it is maybe 2-3 times per day of having to do poo? It used to be more often, earlier in my recovery. But  it's  not too bad now at 4 months post op. Hopefully with more time it will go down to 1-2 times per day. But I never have any danger of pooping in my pants, lol. I have full control and don't need a diaper or anything like that!  I have not had sex yet, so nothing to report there.  But I can still orgasm by myself no problem!  I am sure sex will feel even better!

Spiral,

how's dilation at 4 months mark? Painful? What if u skip a day? And are u still doing it 2x per day?

Today is exactly 30 days post op and I am still in Bangkok. Poop is getting better this week I can hold when I go out to 7-11 store and Big C supermarket near hotel. Sense of poo urgency is significantly improved and I only need to poo 3-4 time a day. Poo are  normal poo but very less amount each time. UTI is gone since first day i started taking Augmentin. Peeing also a lot better with minimal bladder and urethra swelling stain where I had fistula healing and 2 weeks stain of catheter inserted. I eat more these day and no bowel upset has been encountered. But dare not to eat meat, burgers or rices in a large potion yet as i don't want to push my bowel habit within 1 mo postop. So most of foods I eat are kind of low fiber soft diet. Yes Spiralcream, I also get gas pass with poo sometime especially while i walk or stand up sometime, but fart in the bed never happen gas accompany with certain poo. I hope this will also get better in the months ahead. I would like to how when you step up to bigger dilator size spiralcream, I guess you were doing on #1 of complimentary white set for first two mo, don't you?
The dilator set sold by PAI for 6000baht (US$200) has little degree of curve at tip and its #1 is distinctly bigger than complimentary #1. Which #1 are you on now? or which #2 are you doing dear? I have final check up on 4th March and going back home on 6th. In fact, I was granted to safely back home since 3rd week postop. Yes I felt fit to go and have enough energy to set travel on 3rd week but I rent hotel on monthly basis and like to stay more weeks to deal with possible complication if there come up any. Of course UTI jumped in lately and managed with usual antibiotic I used to take when It happened in past and relieved. BA discomfort n tightness at breast seems getting better each week now. I am so happy now how my breast turned out in good LOOK sexier fuller figure with full DD size I think. I initially depress about my BA implants sizes i have chosen 500cc from what I got sharp pain n intense tightness and having got big discomfort in my early postop days that even considered to removed it as soon as I could. But now I started to feel very pleased when things got to settle in terms of look, pain, and tightness.  PS: Lala_girl I stopped taking hormone since many many years ago.

Sharon,

Glad to hear from you and that your recovery is going well.  Kinda make me nervous poo came out when passing gas lol....I hope this is just a short term issue.  I assume you can hold your fart as well? Cross fingers..lol.. I hope you enjoy your last week in Bangkok and a safe journey home.

It is 32'days since I had secondary colon srs and BA with Dr. Sutin at PAI. Yesterday and today I started to eat fried rice and asian meals like white rice with curry and no any bowel problem at all. But i had to go bathroom for 6 times but poo are normal in less amount as usual. No bowel pain nor stomach upset though. So far still no major complication except some bleeding by 7th day, and UTI by 3 week. So it can be said everything went very well. Some Bowel habit change and discomfort or moderate pain at incision, surgical areas are inevitable for this type of surgery and to be expected to deal with. These sideeffects are also getting slowly better i think.

Whoever the surgeon you choose at PAI (Dr. Burin or Dr. Sutin) for colon srs, the colon specialized surgeon they use who will perform on you is only one same person. To me, his name is pronounces as "Tha-we-sar" in Thai according to Jessie, the patient coordinator. For my particular case, it was like primary colon srs as I had to undergo all revision from previous penile skin srs from urethra fistula to every single part of new neo vagina except labia majora however it also has to be fixed to proper appropriate position as it goes wide open when my laps are spread. So it is 90% work of newly reconstruction of neo colon-vaginoplasty.

Tips for stuff to be stocked in your room are Condoms, a handheld small mirror, KY gel tube, saline water, blue pads sheets and betadine solution for dilation sessions. The hospital provide one big bottle betadine solution but it's not enough if you stay in bangkok more than 3 weeks postop.

you may also want to buy diaper pants or strip pads to wear to make you ease in bed throughout postop period. I bought both diaper pants and strip sanitary pads a lot that really make me easy sleep n indoor stay whole month postop. The hospital supply one pack of strip sanitary pads consists of 10 items but it's only for 3 days trial that I asked Jessie to sell this thing in my second postop week both PAI and Hospital do not have this thing to deliver extra for their patients. So Jessie helped me look for this product and it was so difficult to find that his finally call PAI messenger who come and pick sample pack from me to look around in town and got me delivered 5 packs in the evening. His transportation charges was only 50 thai baht.

'Ensure' nutritional powder were my main food to depend entire first 2 weeks when I can eat most foods due to strong bowel irregularity and difficult to sit on commode with my indwelling catheter for 2'weeks. I took dozens of Ensure drinks that really helped my recovery safely with colon srs. I did not ear any solid foods till 2.5 weeks and thereafter i started to order boiled rice from hotel twice a day.

PAI offers 2 sort of dilators set (kit of 2 stents made of glass and a kit 4 color stents made of unknown material) if their patients wish to buy. glass set sold with 3000 Baht and the rest one is of 6000 Thai baht approx $200. You can always deny if you think it unnecessary but I chose one (6000 baht kit) as it looks to me easier to dilate in future as its nose tip goes narrower to slightly expend to full width to reach its designated diameter and its nose about 10 degree curve for first 2 to 3 inches. I have no idea why these dilators has to be concave at tip but PAI nurse mentioned that it's easier to goes in. It really looks to me head of bullet train of Japan LoL, but i am sure it won't goes as fast as it runs into my vagina as I already fed up with their smallest free set #1 in my early dilation sessions. I don't know if I can use bigger sizes trouble free. Presently, I am still doing on conventional dilator #1 supplied as complimentary by PAI and has not get tested any of those of high tech ones. Purchased set's #1 is significantly bigger in width my current doing #1 so i think of asking Dr.Sutin try on me if he say i am ready in final check up. So there will be another disaster for me at PAI with step 2 dilation. Lol.

Many thanks spiralcream for her every single details as it guided me so well to get through my surgery. Hi LaLa girl, though we could not meet in person in March, yet I might come back Bangkok in April for follow up especially when i increase dilator size to get check for possible injury colon-skin joint as my home town does not have any transgender clinic or any service providers familiar with this thing. So if you are still in Bkk by April, I hope we could link up ! Lucky me I lives in neighbour country located next to Thailand that it takes only 1:55 hr flight from Bkk to my hometown and vise visa. So i can easily fly back whenever i need their attention.

Quote from: LaLa_girl on February 27, 2019, 07:47:47 AM
Spiral, how's dilation at 4 months mark? Painful? What if u skip a day? And are u still doing it 2x per day?

Dilation is not painful at all now.  I still dilate twice a day.  A few times I was just too tired and dilated only once a day.  The next time I dilated after that, it was more tight than usual.  So I try to keep dilating twice a day for now.  I think the amount you need to dilate will depend on how your body heals and how much you did dilation from your first surgery.  PAI did not give me a firm schedule that I need to follow for my dilation, so I am just going by how I feel.  If it feels tight, I dilate more often.  If it feels easy, I dilate less or increase dilator size to a larger diameter.

Quote from: M. Sharon on February 28, 2019, 10:06:17 AM
I would like to how when you step up to bigger dilator size spiralcream, I guess you were doing on #1 of complimentary white set for first two mo, don't you?
The dilator set sold by PAI for 6000baht (US$200) has little degree of curve at tip and its #1 is distinctly bigger than complimentary #1. Which #1 are you on now? or which #2 are you doing dear?

Yes I only used the smallest dilator size for the first 2 months after my sigmoid colon SRS.  After 2 months, I gradually increased dilator sizes.  I am currently using Dr Chettawut's dilator #4 (32 mm).  It is a size between PAI dilator #2 (31 mm) and PAI dilator #3 (34 mm).  I am using both Chet's dilators and PAI's dilators to increase my dilator size very gradually in 1 mm or 2 mm increments.  I am probably being overly cautious, but after the problems I had from my first surgery, I prefer to to be extra safe.  And besides, I have two sets of dilators, I might as well make use of them both!

How much cost you to do revision? I have same problems and thinking to do revision.

Many thanks for info over dilation regime. It was easy switch from complimentary #1 to pai #1 when Dr.Sutin trained on me by last consultation last week. Of course Pai #1 is significantly larger in width than complimentary #1. I am home now and It is 43 days postop and pain and tightness uncomfort at breast, tummy and vulva areas are almost gone nearly got back to normal. I had bad bowel movement a few days ago as I ate lots of fried rice in large potion twice in same day and had to go bathroom for 15 times the whole day. Poo were normal poo but had many and last 6 times were almost nothing to poop for but had strong urge. It was very difficult to deal with upset lower part bowel movement that I took metronidazole pill on my own. Yes it did work, symptoms all gone within an hour as if it was taken away. And i convinced that I still have to take precaution with large meals in these early months. I am doing dilation pain free and mucus discharge were subsided even after dilation session. I only have to change my pad twice daily. Each time there is no discharge on pads at all. I am very pleased with it. Nothing to mention apart of bowel upset i got lately and everything are just going fine with me. I will keep update soon again. I am also exciting to hear your first sex experience Spiralcream ;) ;).

Sharon,

Good to hear from you and your recovery is coming along.  I arrived bkk yesterday and will have my consultation today as well as blood work. I went to the night market last night and pretty much enjoy my last good meals for awhile haha. I stuff my face with seafood and fruits. The next 3 days will be clear liquid food...so I need to pickup a few juices from the market.  I am staying at One One hotel, nearby the clinic and it seems pretty good.  I hope everything goes smoothly like u and Spiral.  What day were u able to walk around? Like go downstairs buy food. Were u able to tour around the city after surgery? BBK is a interesting city and I wish I'm heeling well to tour the city a little during post op.

I can't wait to hear Spiral first sex experience as well 😂

Hey my name is Jasmyn and I am so grateful to have found this thread SRS surgery is very important to me and I am trying to make the best decisions based on cost price and value and this thread and your story has been so precious thank you so much for such a comprehensive review of your journey.
I'mgoing to have to do my own investigation research of course and I likely will go to Thailand and speak directly with the hospital  for my own consultation my only complaint about this whole review is that so far price has not been discussed not even an estimate given I personally feel like since so much personal information has already been shared why not in order to help other girls share an estimate of the full cost that you endured during this journey it just makes things a little bit more difficult for me to follow in your footsteps without knowing exactly how much money I should have with me back overall this was a wonderful review and I am so grateful that you were able to share your story good luck on the rest of your recovery and thank you again you are helping girls that you may possibly never meet and that's a beautiful thing so thank you thank you thank you again

Hi LaLa girl, got your msg. My colon srs was on 29th Jan 2019 that Dr Sutin was right it was 2 months past according to month, calendar but to be exact, it is 45 days post op so far. I am doing very well now but my bowel movement is still irregular, but it seems slowly improve that I can stay 3-4 hrs without needing to go toilet. In total, still I have to go to bathroom to poop 5-6 times a day just to burst gas with very small poop each time. I am eating normal but not large potion at a time. All pain and discomfort at surgical area are 90% gone that I even started to hike hill using incline slope car track which i used to do every evening for a couple of years before and am doing great. No pain at tummy incision area at all. Mucus discharge are seen very rarely sometime on pad for a tiny wet and I never embarrass about it. I only need to change my pad every 8 hrs for my sanitary reason not because of discharge. Different people have different healing time but  i think you will start feel like good to walk outdoor about 2 weeks for a short distance. One One hotel have everything nearby and it's convenient place. I can find that hotel right before PAI, only 4-5 min walk i guess. You will feel fit and good to take city tour around 3 weeks as you get back enough energy and got lesser pain. For me I had vulva area repair that was big challenge for me to walk within first 2 weeks as if i just underwent primary sex change operation. If your case not include this job you will walk better even earlier after 10 days post op for shopping but be careful with strong urge of poo urgency that can last for a few weeks and caution for not lifting heavy things for 2 months.  Thus taking a long ride on a cab might be pretty challenge due to highly irregularity of bowel movement. Make sure you collect all stuffs you may need to use in your room for second n third week and if something needed emergency just skype to Jessie or Bune and they will arrange messenger to have you delivery for the things you need. Oh I misses Jessie and Bune they are very supportive, sweet and always ready to help and responsive as well. You are in GOOD hands with PAI and hope your colon srs will also go very well.

I had consultation with Dr Sutin today and was feeling down. I guess after hearing all the risks and infections kinda worry me.  I keep asking me when I'm doing this to myself and blah blah blah.  I was feeling down pretty much all day.  I know at the end I will be much happier.  I am starting my 3 days prep now, so nothing but clear soup, clear juices and water.  Boun is so lovely and caring ❤️.  I'm very pleased with the staffs, dr Sutin, and staffs at hospital so far.

Oh btw, how much weight have you lost since the operation?

I lost 8 lbs approx 4 kg average after surgery but it regain fast after good rest n diet. Now i have even more weight than before surgery; on top of lost 4 kg ;)

I am now 11 days post op from the secondary sigmoid srs without changing the vulva with Dr Sutin. Everything went went and my recovery is good so far.  My experience with PAI is similar to Spiral and Sharon...they are great! Nothing but positive. Here my recovery timelines

  - 3 days before surgery, I had to be on clear liquids diet. To me, it was hard since Thailand is known for good food 😋
  - surgery day was emotional for me.. just like everyone else. Waking up was a shock because it was painful... maybe 8/10.. all I remember was keep saying 'pain...pain...', the next thing was I woke up in my hospital private room and pain level dropped down to 4/10.. and pretty much slept through next day
  - day 1: pain level around 3-4/10..and slept pretty much throughout day/night
  - day 2: pain level 2-3/10..I was able to sleep sideways and able to get up and walk with nurse assistance.. wasn't painful... just dizzy
  - day 3: pain level 2/10 and was able to walk outside the hallway 6 laps lol... no more pain meds needed. I was able to pass gas as well
  - day 4: pain level 1-2/10, Dr removed urine catheter, vagina packaging, and abdominal drain. Wasn't painful at all. I'm also allowed to eat clear broth and drink water
  - day 5: not much pain, only if I move around or coughs.. I was able to eat congee. Also stopped with IV
  - day 6: no pain, able to eat congee with some boiled veggies and papaya fruit .. yes dr said it was ok. I felt bloated and constipated. All drains iv needle removed
  - day 7: no pain.. ate wontons, apple and papaya for breakfast. Lunch with egg noodles and some boiled veggies.
  - day 8: discharged and checked in hotel. Wasn't painful at all. I walked normal, just slower.. I don't think anyone can tell I had major surgery. I was able to poo too, no pain.
  - day 9: post appt and Dr showed me how to dilate. I wasn't too painful compared to my first srs 15 years ago. I have to dilate 2x per day with 30 mins each.
  - day 10-11: just hang out at hotel, met other girls, went to market and little shopping nearby

The only thing bother me a little is the bowel movement. I constantly feel bloated and constipated. I asked Dr Sutin what I can eat..coconut?papaya salad? Pad Thai, coffee? Mango? Shrimp, clams? He said yes to all lol .. maybe start out in smaller portions

Overall, I'm very happy with my result and the experience with PAI. Oh he said my depth is 8". That's more than enough for me as I'm only 5'5 😂. No complications so far and the pain wasn't bad except for first day waking up from surgery .

If u have more questions, pls feel free to ask 😃

@LaLa_girl 
Dear LaLa_girl:
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@LaLa_girl
Oh, and another thing LaLa_girl...
Please plan to write a post and tell us briefly tell us about yourself in the Introductions Forum (https://www.susans.org/forums/index.php/board,8.0.html) so that other members will be aware of your arrival... therefore you will be able to share your thoughts with more members here.
     
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NOTE: Now after all of this Greeting Stuff I will let everyone have this thread back so that the very enjoyable conversation and sharing of thoughts can continue.   
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I'm at 2.5 weeks post op and everything is great!  I'm able to pretty much walk normal, shopping, sightseeing.. I also increased my dilator from complementary #1 to PAI #1. Dilation is so much better than my first SRS. It went in much easier and no pain at all after it's in. Another thing I noticed that I didn't have to keep holding the dilator after it's in...unlike my previous SRS.. I had to keep holding and pushing in or else the dilator shoots out like a missile.  I have pretty much little to none with the discharge and no smell at all.  I change my pads twice a day and rarely there's any on it.  For the smell, the only time it smell when I played with myself (masturbate lol) then my fingers smells a little fishy but not bad at all.  Dr Sutin also approved me it's safe to flight back home.  The only thing annoying now is my bowel movement.  I don't have any good restrictions but certain food upsets my stomach more and I'm still learning. I usually poo every morning. Now I poo at least 3 times in the morning because each time i poo just a little.

Spiral and Sharon - how's your recovery going? I hope you both doing fine and would love to hear from you with any updates.  Are you guys still have the belly bulge? Dr told be it should be gone in a few months. Any sex activities yet? lol what's ur dilating schedule and size now? Is ur bowel movement back to normal?

hi Lala girl, I am so glad your surgery went very well. Your recovery was better than me and happy to know there was not even a minor complication. PAI's are such experts in this field thank to PAI team. I am on dilator #2 and will step up to #3 end of April.  it's almost 2.5 month postop and my recovery just going well. Vaginal discharge are extremely lesser to none n there is no smell at all. Tummy bulge was never happened to me. I am regaining all my balance and doing incline hiking every evening and no problem at all. Only bowel movement is still a case but it's getting better as i can hold poo 4 hrs without needing going bathroom. A little poop urgency is still there but getting less frequent in number. Dr. Sutin did a great job on me that I no more peeing in bed as my long standing  hidden problem of urethra fistula is totally solved and I am urinating quite normal now. I am super happy with it as it affected my quality of life for many years with unknown cause. Dr.Sutin can find and fix this big problem.

I am not having sex yet lol,  I will get back to you how things turned out after sex. I also kinda awaiting Spiral cream new updates and some her sexual experience if she'd had any. :) I do hope your recovery keep going well. :) a hug n a kiss.

M Sharan Lala  or SpiralCream,

Is 3 weeks stay in Thailand adequate for this type of surgery?   Is the bowel movement problem really that bad?

  I am very interested in this type of operation.

Quote from: NCAmazon on May 12, 2019, 12:48:36 PM
M Sharan Lala  or SpiralCream,

Is 3 weeks stay in Thailand adequate for this type of surgery?   Is the bowel movement problem really that bad?

  I am very interested in this type of operation.

I would stay based on the doctor recommendation.  Also depends on how many procedures you are having. Are u having primary sigmoid srs or secondary?  From my experience, I only had secondary, and no pain medication after day 3.  On day 7, I was able to walk to nearby market and restaurants. 2nd week post, I def felt well enough to fly home. I also never use the pillow to sit on either since I didn't chance my vulva.

I'm at 2 months post now, with only minor bowel movement problem. Basically I poop 3 times in the morning instead of 1 time like I used to...because each time less poop.. no pain or anything.  My heeling process was much quicker than from other ppl.  I was able to play beach volleyball at 5 weeks post op and I am now on my dilator #3 and only dilate 1x per day. Sometimes I skip a day and didn't notice tightness or anything.  I still haven't had sex yet but probably will be soon. I had oral sex and no complaints of any smelly lol.  I'm really in love with my new upgrade vag 😂😃

Hi NC Amazon, 3 weeks is enough for you going back home. Some colon srs patients fly back by 2 weeks if their procedure do not involved additional surgery like mine. For me i underwent urethra fistula revision from previous srs surgery and reconstruction of vulva too. So I stayed there 4 weeks post. But bowel movement is still highly irregular by that time meaning you have to rush to toilet several times especially after when you have meals. It seems colon can't hold even a small descending poo and make you feel you poop. I am now 3.5 months post op and just going well with everything. Bowel movement slowly getting better as i only need to go bathroom 2-3 times a day now. the more you eat the more times you go to poop as like i said colon won't hold even a small poo which is previously supposed to be stored several hours in sigmoid colon passing it only once or twice a day. I am on Pai dilator #3 and no pain from anywhere at all. I have not sex yet and will be update here how it was going through. I hope Spiral cream and lala girl are doing well.

Thanks for tips all.. This helps a lot. I emailed clinic about current pricing, prerequisites for colon surgery,  time of stay etc for surgery and I got email just stating BMI 24.99 required and no HIV or prev abdominal surgery.

They really didn't provide any other info. Is there a easier way to communicate with the clinic ?  I was surprised at such short response.

Glad your bowels are getting better!!