Susan's Place Transgender Resources

I don't know if there are too many people on this site who still remember me.  It's the night before my meta surgery with Dr. Miro.  I've gotta get to sleep but I'm too excited/nervous to sleep.

I guess I'm posting this to motivate myself to post more about my bottom surgery experiences, since I was frustrated by the lack of bottom surgery talk on Susan's when I was in the planning stages.  (I later found the Yahoo groups--thanks, Jay--and those have been immensely helpful).

The long flight to Belgrade was not too terrible.  Lufthansa is a nice airline--well maintained planes, clever design (on the big trans-atlantic jet, the bathrooms were below the main deck, so there was a small waiting room instead of people jamming the aisles; there were also self-serve beverages down below), entertainment center built into every seat on the 'big jet'.  The meals were surprisingly included and pretty good.  Oh, and the big jet had decent cupholders with cups designed to fit snug into them.  This is a nice consideration.  On a different plane, I once had someone knock the drink off of their tray and into my lap >.<

Connecting in Munich instead of Frankfurt was less stressful, since Munich is a much smaller airport and the Lufthansa portion only has two areas for gate numbers (G and H), which are next to each other.

I was picked up by a taxi arranged by the doctors and was driven directly to my apartment, where I met Dr. Bizic (surgeon and assistant to Dr. Miro).  She showed me around the apartment and told me the plan for consults with Dr. Miro (head surgeon) and Dr. Korac (anesthesiologist) the next day.

The consults went well.  In my case, the doctors came to the apartment, probably because it was a weekend--which I felt kinda bad about.  They were very nice though.  Friendly, easy to talk to.  Excellent English, in case anyone is wondering.  Dr. Miro and I talked over some details of what tissue is used where.  As it turns out, the aesthetic things I asked about (placement of urethra exit in glans, single-sac or two-sac scrotum, positioning of scrotum and penis) are down to one's individual anatomy.  I already knew this going in, but just for completeness here, the 'individual anatomy' factor applies to length as well.  Dr. Miro seemed to view creating a healthy, functional urethra as more vital than some aesthetic things (which can be later tweaked in revision, such as the joining of the scrotal sac).  I am in agreement with this view, though I also think that his aesthetic results are generally very good.

One last thing on the apartment, which is fully stocked with pretty much everything one needs.  It's nicknamed the 'Admiral' and is within walking distance (20-30 minute walk) to St. Sava Cathedral (amazing building, just saw it today) and the more active, 'central' part of Belgrade with shops, a large outdoor market, and just the general liveliness of a large European 'walking' city.

This was an exciting, full day.  Now let's see what tomorrow brings...

It sounds like an incredible experience just to be there, let alone the surgery part. Good luck on the surgery Ender! and thank you for choosing to share your experience.

Ender, you are where many of us want to be, awaiting surgery.  Good luck to you. Keep us updated in the days and weeks to come.  You have already had a total hyster?

Good luck, and congratulations! I hope everything goes well for you.

You're probably all done by now, so good luck with your recovery.

Beware of the male nurse, he likes needles, LOL.  Enjoy your stay.  I wish I had more time in Belgrade.


Jay

Hope recovery goes well.  Keep us updated.  I've heard nothing but good things about Miro.  He is definately my first choice when I get the bucks. 

Awesome. Hope your recovery goes well and that you'll share more when you're up to it.

I am back from St. Medica, writing this in the apartment on the couch, in a very awkward typing position.  But I'll start from the beginning, as much as I can remember.

Day of Surgery (August 1)

I was picked up at the apartment at 8am on August 1st and driven to St. Medica by George, the taxi driver that the medical team likes to get for their patients.  I was greeted by some of the nurses and one of them introduced herself in good English as Vessna (just spelling it how it sounded to me--she later said her name means 'spring' in Russian, which uses the Cyrillic alphabet).  I was led upstairs and shown my room (the purple one, if anyone has seen photos of St. Medica).  It's a fairly new building (built within the last 5 years) and it looks very, very nice.  It is also kept very clean.

I unpacked some things and put them on the nightstand and waited until I was taken downstairs by the nurses to have blood drawn and an EKG done.  I later saw the cardiologist, who asked some routine questions on family history and current heart health, interpreted the EKG, blood pressure, some sort of chest exam... he spoke enough English to get things done and he gave me the go-ahead for surgery.

I was led back upstairs to my room by a nurse and was instructed to shower and put on a hospital gown.  I also took the time to take a second suppository (oh. yay.), since I was instructed to do that when I arrived at the hospital and got settled.  My first one was the night before (no comment).  By then, it was maybe 9-10am, and I was scheduled for surgery at 2pm.  Apparently they like to do U.S. patients in the afternoon because our internal clocks still say it is morning (Belgrade is 7 hours ahead of CST).

Around 3pm, I was prepped for surgery.  The morning case was a little boy with hypospadias, a surgery Dr. Miro anticipated to be relatively short.  Some complications occurred with the little guy that weren't apparent until he was 'opened up' and more time was needed for the surgery, accounting for the later start date.  No problem, I certainly didn't have any other appointments, lol.  I requested that Dr. Miro take a look at my genitalia prior to surgery, just so I could know his final assessment before surgery (he had previously seen photographs).  The rundown was something like this: 'healthy urethral plate... large, floppy labia, medium sized (18cc) implants... labia minora suitable for urethral tissue... clitoris so-so, but should be good when lengthened, mons will need liposuction'

Then everybody else was called back into the room, I was given some sort of sedative, rolled on my hospital bed into the operation room (still conscious), was helped onto the operating table (still conscious), given an IV and was told by Dr. Korac that the anesthesia would burn a little in the veins up my arm, and when the burning reached my head--I would be out.  And I was.

I was not in terribly much pain when I woke up.  I sort of just drifted in and out of consciousness for a while and was vaguely aware of being connected to more IV drips (fluids, antibiotics, who knows what else) and a catheter bag.  Dr. Korac informed me that I was on very powerful drugs to combat nausea (I have a history of it with general anesthesia).  This was definitely the least nauseous I was after anesthesia, but I still vomited about 4 times that night.  Nothing really came up except mucous, because I had not eaten the day before surgery, had nothing to drink since that morning, and knew I wouldn't even be drinking water for the next 24 hours post-op.  The last is not a usual restriction... I'm just unlucky.

At some point, I saw Dr. Korac, who was interested in knowing if I had farted yet or not.  Uh, nope.  He listened to my bowels and concluded that they were a bit slow (and that also may be the reason for my issues with anesthesia).  Apparently there should be much passing of gas after an operation, but that waited until day 2 for me.

Later that night, I had a significant amount of pain in my lower abdomen.  It felt like the 36-hour nonstop cramps I used to have when I still had a (semi) functional uterus.  That would be pain from the hysterectomy.  The meta/scrotoplasty didn't (and still doesn't) hurt as much as I expected.  One of the wonderful nurses upped my pain meds and I finally fell asleep.

Post-Op: Day 1 (August 2)

My first day post-op, I was still nauseous and slept a lot.  The nurses regularly came in to change out my IV, drain my catheter bag, and flush out the stent in my urethra.  A word on the nurses: they are excellent.  Kind, gentle, and very much on top of things.  The language barrier wasn't much of an issue.  I've already said that Vessna knew English quite well; she was on the day shift and I saw her a lot during the day.  The other nurses varied during the night (unfortunately didn't learn all their names), but all knew the most vital words for someone in the hospital (pain, water, catheter, food, sleep, toilet, etc, yes, no, good, bad, etc.).  I had also learned these words in Serbian, just in case.  We weren't going to have any philosophical conversations, but basic needs were definitely covered.

Dr. Miro was supposed to come in at around 2pm to see me, but I didn't see him until 8pm.  That morning, he was doing another metoidioplasty on a guy from the Ukraine and was apparently supposed to finish up by the afternoon.  Some really, really unforeseen things came up and Dr. Miro had to come up with a way to fix this guy.  When I learned of this, I felt fortunate indeed that my surgery, sandwiched between two complicated surgeries, was basically routine (took maybe 3.5 hours).  I later asked, and apparently the other metoidiplasty patient is doing well.  When Dr. Miro came in at 8pm, he took a look at things, declared it 'nice', and had a nurse and Marko (another younger urological surgeon on the team) change my bandages.  This was the first time I saw my genitals.  I could not see my balls (felt like they flopped down as soon as the bandage was removed), but my penis looked more prominent than I thought it was going to.  At this point, there was no evidence of retraction or 'turtling', so it was fully exposed and sticking straight out.  Cool.  Marko looked pretty exhausted after the previous surgery; Miro looked surprisingly energized.  I also saw Marta, who wished me well--and then the team finally went home for the night.

Post-Op: Day 2 (August 3)

My nausea cleared up by the afternoon on the second day post-op (so August 3rd).  At one point in the morning I felt so damn weak I thought something was wrong.  Really, I just needed food.  And the food at St. Medica is gooood.  That day, I had tea and some graham-cracker-like cookies, followed later by what I thought was going to be simple soup.  It was a broth with herbs accompanied by a whole plate of the most delicious sauteed veggies I have ever eaten.  And I don't think I'm just saying that because I was famished.  Later in the day, I was able to get up to walk for a short while,  which I again later repeated when I felt the need to make a bowel movement (the first since surgery).  It was very weird trying to use those muscles again, especially since I didn't want to strain and hurt myself.  Thankfully, everything was very loose and didn't hurt a bit.  I do, however, strongly recommend bringing wet wipes to the hospital.

Miro came in again to talk.  My mother had some insurance questions, which he answered (no, I don't think our insurance is going to be very good about reimbursement and I have already paid fully out of my own savings, but it has surprised us before).  He checked on the other meta patient, and then dropped by our room again to offer my mother a ride back to the apartment.  Really nice guy.  It's kind of shocking to see a surgeon spend so much time with patients.

Post-Op: Day 3 (August 4)

This day was mostly a blur of sleep, food, very short walks, bowel movements, and nurses coming and going from my room.  There was satellite TV (a lot of the channels are in Engilsh, with Serbian subtitles) on a widescreen TV, which was nice for entertainment.  There was also WiFi.  The signal in my room wasn't stellar, but it got the job done for text+image sites.  I didn't try streaming video.  I was using an iPod instead of my laptop, so there's my reason for no updates 'til now.  With the nausea finally gone and food in my stomach, I felt much, much better and stronger.

Post-Op: Day 4 (August 5)

Now I am up to August 5th, today.  I was released from St. Medica this morning.  I got to take a quick shower.  The bandages were still on, but it was not difficult to avoid them because there was a hand-held shower head.  Anyways, the bandages were going to be changed soon after.  I dried off, got back into bed, and waited a short while for Dr. Miro.  He took a look at things and changed my bandages.  My penis looked much less prominent; it had mostly retracted back into my skin, though the head and a bit of the shaft was clearly visible.  Swelling might also account for this, as the surrounding skin looked quite puffy.  Oddly, it is pointing very much upward, towards my chest, as opposed to straight out and a bit down, like when I first saw it.  Time will tell how this resolves.  I think pumping will be my friend to help with the retraction.  I suspected it would be like this; my body seems to like to heal by strongly contracting its tissues.  It was a bonus for top surgery, when my peri initially left a lot of pleated skin.  Now, it's not so useful.

Miro finished with the bandages and went outside the room, in the direction of the other meta patient.  Nurse Vessna came back in and helped me pack my things and get dressed.  She grabbed my bag for me (I regretted packing as much as I did, though the bag seemed light to me; my laptop adds a lot of weight and I didn't end up using it).  We went downstairs (stairs were easy with a cowboy walk) and waited for Miro.  When he appeared, I bid farewell to Vessna and got into Miro's Mazda.  Getting into the car required some minor maneuvering (push the seat back, put donut on seat), but it was OK.  He kindly took the curves and acceleration easy.  Miro mentioned that he had an interview with a French news channel, comparable to CNN in the U.S. (so apparently quite big).  He also mentioned that he had a patient from France coming at the same time who was going to comment.  I didn't quite catch if the interview was going to cover metoidioplasty.  Guess I'll find out later.  Anyways, that's pretty cool.

We arrived at the apartment in maybe 5-10 minutes, where Marta was waiting.  I got post-op care instructions from both of them (take it easy and rest, pads for underwear are in the cabinet, as are disposable furniture protectors if necessary) and was told Marta would be by tomorrow, then they departed

Since then, I've been pretty much resting and eating as I get hungry--and typing this.  I still can't eat a lot all at once, probably an effect of not eating for 2-3 days.  I've been nomming on fruit mostly.  The produce here is good.

I've taken a closer look at things.  (Thanks to my mom for bringing a hand mirror--not something I would have thought of bringing, even though I'm sure she intended to use it for her makeup and not for my junk, lol.)  My scrotum and balls are tight against my body; I wonder if my balls might hang more once the swelling goes down.  The lower part of my scrotum is a dark purple bruise, but I am not leaking very much fluid (actually I am happy about that, as I am sure of what it would remind me of).  If the retraction resolves, I think (aesthetically) I will be quite happy.

Glad things are going well. Vessna was great; I didn't have her until later in my stay.  I had to stay in the hospital for 5 days due to minor complications.  The team is very attentive, for sure.  I was alone.  On some counts that was good; on others I wish I had someone there with me.  If I get my mons resection I might drag my mother with me.  She is not a traveler but I think she needs to break out of her rut at least once before she dies.  I couldn't convince her to take an all expenses paid trip to San Francisco when I had my top surgery, though. LOL

I had the purple room, too.

Good luck with your healing!  It's not terribly painful, just uncomfortable.  And it does sap your energy, so eat well and get lots of rest!  Follow the doctors' instructions.


Jay

I'm not sure how you did this one alone, Jay.  I'm so glad my mom is here with me.  Walking to the store, cooking, and cleaning for myself would sap all of my energy for sure.  I am much less sore because she is here, I think.  I'm also glad she came because my mom has never been to Europe (despite loving traveling) and her dad's side of the family is from the area (Croatia, which is right next door to Serbia and apparently the language is very close).  So it's been cool to see together. 

If you do end up getting a mons resection, I'd be interested to hear about it.  I'm certain I want the scrotal fusion, mons liposuction may be necessary, and I'm undecided on the mons resection.  I'm not a fan of scars in that area, but if it really helps the position, I would accept the scar.  It's just that I've seen so few before/after direct comparison photos of guys who have had a mons resection that I am unsure of how much it actually helps positioning.

To everyone else, thanks for the kind words guys, and I'll have another update soon.

I won't be getting a mons resection until I lose weight again; no sense doing it if I won't get the best results.  And my buried nut is starting to bug me.

Dr. Marta took me to the grocery store on day 1 and I stocked up; then I had the fortune of staying at the apartment where Dr. Marta lives with her mother, and her mother cooked for me.  Very delicioius!  I never got to see much of Belgrade at all, unfortunately, other than the back and forth to St. Medica and the airport.

Would love to go back to Belgrade just to visit. Maybe I can do a European trip and end in Belgrade with the mons resection and ball revision.  Good luck with your healing.


Jay

Quote from: mm on August 01, 2011, 03:00:25 PM
Ender, you are where many of us want to be, awaiting surgery.  Good luck to you. Keep us updated in the days and weeks to come.  You have already had a total hyster?

Thanks, mm.  I had a total hysterectomy, including oophorectomy and colpocleisis (vaginectomy), in Belgrade.  It was performed immediately before my meta by the gynecology team that works with Dr. Miro's team, and everything was removed through the vaginal canal, so I have no external scars due to hysterectomy.  I was under the same round of general anesthesia for both surgeries, so from my standpoint it was all one seamless procedure.

Post-Op: Day 5 (August 6)

Today has been kind of distressing, despite not doing much.  I think this post, made to the Yahoo Metoidioplasty group, explains it all:

"Hi guys... from reading past posts, I was expecting retraction, but
damn...

I was quite pleased when I first saw my penis (2 days post-op when
changing bandages), as it had decent length (size of the first joint of
my thumb) and clearly protruded from my body.

I was surprised but not totally shocked when, at 4 days post-op, my
bandages were again changed and I left St. Medica. My penis had
retracted so that perhaps 1/4" of shaft plus the glans was sticking out
of my body. It also had an upward angle, as if the top side of the
penis (where the cut ligaments were) retracted more than the bottom
side.

Today, 5 days post-op, Marta changed the wrapping on my penis. She had
a somewhat difficult time re-wrapping it because of the retraction. The
wrapping fell off maybe an hour later. She came back down and
re-wrapped it. The wrapping fell off again, and she said that in my
case, I would not need or be able to use wrapping. She also said that
pumping would be essential in my case (I had suspected...).

At this point, my penis has retracted more so that the 1/4" that was
there yesterday is no more. My penis is not protruding whatsoever and
seems to be trying to move into the covered, more internal position that
it had pre-op. The shaft skin looks quite odd, as it is all bunched up
in one place with nothing for it to stretch over and cover.

So, uhhh, should I be worried at this point? I am wondering if anybody
else has been in my place and has still had decent results (ie, some
sort of visible length)."

Post-Op: Day 6 (August 7)

Dr. Miro was by this morning.  He seemed to be checking in with his patients (there are a few other guys here in Belgrade) and he wanted to take a look at my penis.  He didn't seem particularly alarmed, chalked everything up to swelling (which had gotten worse since the penis wrap was removed yesterday),  re-emphasized the importance of pumping post-op, and said he would re-wrap it.  He is much rougher than Marta (he tries to be gentle, however...), but in this case I was kind of thankful for it because he pulled my penis outwards (something Marta did not do--she tried to wrap around it while it was still buried) and then wrapped it tightly.  The wrap seems to be staying in place and my penis is now more visible.  It looks less alarming, at least.  It is much more swollen and thicker in girth than it was before the initial wrapping was removed.

And now I am off to order a few more cylinders for my pump, just so I have a variety of sizes to choose from when I need them.  I already have a 1"ID, 1.25"D flared base cylinder which worked well with my pre-op anatomy, but I now think that the base will be too wide to get a good seal.  Marta also said she would get me one of their homemade pumps, which is basically two syringes connected by tubing.  One of the syringes has the plunger removed, so this is the syringe that goes over the penis; the other one creates a vacuum when the plunger is pulled.

The wrap that Miro put on stayed put for most of the day.  Late tonight, things started to get quite painful, and I noticed that the wrap had shifted on my penis.  The wrap was now pressing directly on the stent, which as it turns out, hurts like hell.  It actually made me feel nauseous.  I didn't want to touch it and was contemplating calling Marta (though it was approaching 11pm), but I took a closer look and noticed that it was loose and about to fall off anyways--so I gently took it off.  Nearly instant relief.  Man, that stent does not like being touched.  By that time, my mom had already given Marta a call, and was trying to explain things.  I think, by the worry in her voice, she made things seem worse than they were.  My mom handed the phone over to me, and I explained things to Marta.  She recommended just leaving the wrap off, since it would cause me more pain to have my penis pulled out (due to the retraction) and wrapped, but said she would come over and wrap it if I wanted.  I asked if there was any harm in leaving it unwrapped--there was not, apart from needing to be more attentive to cleaning the skin folds--so decided against further disturbing my healing flesh.

Post-Op: Day 7 (August 8 )

Today was fairly uneventful.  Marta told me last night that she would be on a 24-hour shift today at the hospital; hope she got some sleep last night.  When I called, it sounded like she was at another one of the apartments taking care of another patient.  The pain from the stent issue last night has gone away, and I spent the day lounging around, mostly on my back.  It is more comfortable than sitting.  I think I may have overdone it with the sitting these past few days; it's just that it felt nice initially, after lying down at the hospital for the better part of five days.

Dr. Miro called in the evening, just to check up on me.  Marta had told him about the wrap falling off again, and he assured me that it would be OK.  I was still feeling kind of freaked out about the swelling on my shaft skin.  He said it could take 2 weeks or 2 months for that swelling to go down (it depends on how each individual heals) and to give it 6 months before considering things more or less settled.  I thanked him for the call; it did make me feel better to hear that things would be OK, directly.  I just hope he's right and my body isn't going to be unusually difficult about healing.

Post-Op: Day 8 (August 9)

No doctors today, just resting.  It was nice, I pretty much spent the day watching American movies from the 90's on TV, browsing the internet, and watching TV shows and movies that I have on my laptop hard drive. 

I haven't been talking much about pain.  At first, in the hospital, I definitely felt pain from the hysterectomy.  Since I left the hospital--and therefore the IV pain meds--I haven't been in as much pain as I thought I would be.  As long as the stent isn't being touched, pain is not particularly noteworthy.  The stent is bothersome even when it isn't being touched, my balls ache, and occasionally the areas where I am stitched together itch, but I would call all of that more 'irritating' than 'painful.'  I am keeping regular with the Extra Strength Tylenol, just to keep any pain at bay (I learned that one with top surgery--don't wait until it hurts, just take the pain meds on schedule at first).

I do have occasional sharp twinges of pain here and there (penis, balls, what else is there?); not sure what that's from, but it subsides quickly.  Overall, I think my top surgery was more painful; I was taking both Vicodin and Tylenol and those just took the edge off of the pain.  I had periareolar top surgery with liposuction, and most of my nerves were left intact and screaming.  That said, I don't think my penis is insensate.  I can feel touch on my glans very well.  Some parts of my balls feel a little numb.  I was worried, with how badly top surgery hurt and the fact that metoidioplasty is a more technically complex surgery, that bottom surgery would hurt more.  That hasn't been the case, thankfully.

There is probably another factor here.  My mother graciously offered to come (wanted to, really), and she's been great.  I don't have to walk to the store, make food, or clean.  I can just sit back, relax, and heal.  Were I up walking more, I think I would be hurting more.

Post-Op: Day 9 (August 10)

Today was the day of stent removal.  From the stories I have heard, I was a little apprehensive, but sooo ready to have that stent out that I just didn't care about whether it hurt or not.  Not that I had any choice in the matter, anyways.

Marta and Miro came by early in the afternoon and Marta removed the stent.  She, jokingly (only half-joking?), asked me not to hit her.  I assured her I wouldn't.  She found the stitch and it was cut so quickly, I hardly had time to prepare for pain.  It just... didn't hurt.  It was done, and I was just laying there like... "That's it?."  She is exceptionally gentle; she works with pediatric patients, too, so that is a good quality to have.  I also took an Extra Strength Tylenol about an hour or two before they arrived; probably helped.  I felt more when the stent was pulled.  It sort of bordered on pain, but felt more weird than anything else.  The stent was maybe 4-5cm long, the length of my extended urethra.  The stent was bloody, but neither of the doctors seemed alarmed.

Miro was observing all of this, and he commented again that he thought things looked good.  He was pleased with the placement of the testicles.  He also said that he thinks, once the swelling and retraction resolves, that I will be happy with the results.  I'm not looking for exceptional length--just a visible, if small, penis and balls that are in a visible position.  We shall see.  I haven't seen the photos of the surgery yet (he said he makes a picture CD of surgery to give to patients for their records).  Perhaps he saw something during surgery that I cannot see now with all of the swelling.

Another good thing is that, so far, no leaks have been detected.  I of course am not urinating through my new urethra.  It is just that, when the stent was removed, Marta flushed my (bare) urethra and no leaks were detected.

After the stent removal, we talked a bit and my mom insisted on taking photos of me, Miro, and Marta.  I asked Dr. Miro about the Bacitracin ointment that I like to use on cuts and which I also used after top surgery, per Dr. Medalie's instructions.  It's basically white petroleum jelly with an antibiotic.  Miro said he did not think it would be necessary (and I am taking oral antibiotics), but it would not hurt if I wanted to use it.  The head of my penis is exposed and the skin is getting hard/irritated, so that is what I am using it on.  I also asked about the 'anterior part of vaginal wall' that my surgery report says was not removed.  Apparently, that skin is the part of the vagina which is closest to the original urethral opening; he uses it to help construct the new urethra.  I was worried the gynecologists were unable to remove some mucosa due to access issues, but that was not the case.  We bid farewell, and a few hours later, Marta called on the landline.

She wanted to know if my mom and I would like to go to the mall.  She knew that my mom wanted to see the mall, but that she was intimidated by the public transit and didn't want to go without me, anyways.  So, Marta, who had Marko's car and apparently needed to run some errands near to the mall, graciously offered to drop us off and pick us up a few hours later.  I asked her if she thought I would be OK enough for that, and she said that there were plenty of chairs at the mall and I could bring my donut.  I knew my mom was getting stir-crazy (her reply to Marta: "wow, yes!") and I was a bit restless as well, so... why not?  Getting into the front seat of the car was not bad; I didn't even need the donut (I think, with the stent out, it is more comfortable without it as long as the seat is soft).  Marta gave us a bit of a car tour of Belgrade on the way to the mall, which was very nice.  It is a big city and, yes, it has its rough areas (many of which are under reconstruction--there is a lot of construction going on), but it also has very impressive areas.  Nice parks, and the downtown areas with outdoor cafes and shops are attractive. 

The mall, Usce, is only a few years old and very big by my standards.  Marta said she thought it was 'small' compared to U.S. malls, but she also said she had been to such cities as L.A. and San Francisco.  For this rural-raised guy, it was big.  I counted three floors in one part, and four in another.  My mom walked into the mall faster and much more gracefully than I.  I decided I was just going to introduce myself as John Wayne if anyone asked.  I got a few odd looks, but whatever.  I walked perhaps 500m in the mall and was exhausted.  (Exhausted and sore--what did I say about the source of my lack of pain being a lack of movement?)  We saw a coffee shop on the ground floor, hit the escalators to see what was up, and then went back to the coffee shop for sandwiches, coffee, and smoothies.  The regular chairs were much too hard for me, but I found a couch, slouched, and was quite comfortable. 

After food, I walked a little bit more down one wing of the mall, got tired and very, very sore, and returned to the couches.  At this point, I just wanted to lay down, but I slouch-sat for a while, the pain went away, and I decided I was good there until my mom came back.  When she returned, she had gotten a necklace, a few souvenirs for people at home, and a shirt that says Beograd for me.  Marta called shortly after that, sounded concerned over whether I was in pain or not, and offered to pick us up right away.  I felt fine while sitting, so she said would be at the mall in half an hour.  When I got in the car, I still felt fine, so she took us the long way back to the apartment, past Kalemegdan fortress and St. Sava Cathedral, both of which are lit up at night.  The fortress was bigger than I thought, and right next to the zoo (where Marta informed me that Dr. Stanojevic, the gynecologist who did my hysterectomy, has delivered chimpanzees--apparently because he loves animals.  Cool guy.).  She also stopped by the cathedral so we could take night photos.  All of this was very, very nice of her and quite unexpected, so we thanked her profusely before we parted ways and turned in for the night.  Then she came back down and gave us a fancy little cake, which she said her sister made for us.  Wow.  After another jaw-drop (on my part) and more thanks, we said good night.

Post-Op: Day 10 (August 11)

I woke up worried that my excursion yesterday had somehow messed up my balls, but they both still looked in place.  For the record, my left one is lower and more settled, and my right one sits up higher but is still in OK position (ie, not right next to or above my penis).  There is more fibrous swelling on the right side, compared to the left.  I think the left one had a drain, while the right one did not.  As for my penis it is still swollen and turtled up, but appears fine.  I can very clearly see the glans; nothing is hiding that.  I just flushed the urethra (with a bare syringe, no needle), and some watery blood came out.  From what I have read, this is normal at this point.

I am still walking like John Wayne and sitting/laying with my legs far apart, just to make sure the testicles don't get knocked out of place.  The longer they have to heal and form capsules, the better.  I am much more comfortable now with the stent out.  My scrotum is mostly back to its normal color, the dark purple having faded to red, then to a light bruise, then to nothing (save for a few spots on my right scrotum) over the past few days.  It is occasionally sore, but the Extra Strength Tylenol takes care of that.  The only discomfort from my penis is when the head gets dry, so either a shower or Bacitracin takes care of that.  I have been taking normal showers, daily, since returning from the hospital.  My genitals are OK with having water directly on them.  It feels good, actually.

I am not in much pain from yesterday, but decided to take it easy anyways, so today has been another quiet day at the apartment.  Marta called in the evening and asked if 'a visitor would be OK.'  She had gotten the Cialis she ordered from the pharmacy for me, as well as the homemade pump that I mentioned earlier.  Dr. Miro recommends taking Cialis for 6 months post-operatively; apparently it increases blood flow to the genitals and helps with healing.  It is much less expensive in Serbia compared to in the U.S., so I am very grateful Marta was willing to help me get it over here.  It cost roughly $280 EUR for 36 20mg pills, which translated into roughly $400 USD.  In the U.S., the cheapest legitimate pharmacy that I know of (healthwarehouse.com) would still have cost around $700-800 USD for the same 36 20mg pills.  I just hope getting it through U.S. customs or security won't be an issue.

My mom, Marta, and I talked for awhile about various things--how she became a part of Dr. Miro's team, how medical treatment for transsexuals varies in different countries, and some other talk about our respective families.  Apparently, in addition to being perfectly fluent in English and Serbian, of course, she also knows Italian and French.  Anyways, we said good night at some point, and I spent the rest of the evening reading "The Brothers Karamazov" (translated from Russian to English, because I am not as talented at languages as Marta, lol) before falling asleep.

I didn't get Cialis (that is something newer they are doing) but I traveled with all of my prescriptions, tylenol, ibuprofen, etc, and nobody blinked. Well, except the Serbian airport personnel.  "you seem to have a lot of pills. let us see" and then they were really more interested in my peanut M&Ms (this was on my way out of the country).  Nobody at Heathrow or US seemed to care.

Glad you are enjoying Belgrade!

Heal well.  I did not get to see anything when there.  Lucky you (and mom).

Jay

Quote from: sneakersjay on August 12, 2011, 08:01:03 AM
I didn't get Cialis (that is something newer they are doing) but I traveled with all of my prescriptions, tylenol, ibuprofen, etc, and nobody blinked. Well, except the Serbian airport personnel.  "you seem to have a lot of pills. let us see" and then they were really more interested in my peanut M&Ms (this was on my way out of the country).  Nobody at Heathrow or US seemed to care.

Glad you are enjoying Belgrade!

Heal well.  I did not get to see anything when there.  Lucky you (and mom).

Jay

Lol @ the peanut M&Ms.  I was joking with Marta that if the security personnel saw the Cialis, they might be tempted to "confiscate" it.  But I didn't have any issues with security, either.  They didn't even care about my pills or T (the Cialis was in my checked luggage).

Yeah, we were lucky.  I honestly wasn't planning on seeing anything, and I probably would not have if my mom had not come along.  OK, I would have probably gone sightseeing the day before surgery, but afterwards my #1 priority would have been sitting on my butt, healing.  I just felt bad since it was her first time in Europe, she hadn't seen much, and she refused to go do stuff without me.

Post-Op: Day 11 (August 12)

Today was another mostly uneventful day with regards to healing.  I woke up, ate breakfast, downed antibiotics, a probiotic (Florastor, which my doctor in the U.S. recommended to accompany the antibiotics), and Tylenol.  I took a shower, making sure to wash all crevices of my genitals, then let myself air dry for a while, before re-doing the dressing around the catheter tube, applying Bacitracin to all sensitive areas, flushing the urethra, and getting dressed.  At this point, the only 'foreign' stuff I have in or on me are the suprapubic catheter (which is small and not very bothersome), a piece of gauze taped around the entry point, and a cotton pad in my boxer briefs to catch any blood.  Nothing is coming from my stitches; I just have a little blood that occasionally seeps from the urethra.  Miro said that is normal at this point in healing.  I also have the 2L catheter bag, which I attach to the catheter and unclamp the tube whenever I need to 'go.'  Standing at a toilet waiting for that tiny tube to drain my bladder takes too long, though it is workable if necessary.

Marta stopped by later in the day.  She dropped off four little sugar-covered pastry-like things with fruit in the middle.  She said her mother made them and she wanted us to try them--very nice of her.  We talked a bit about Marta's dog, Sara, a 12.5-year-old rottweiler, who had just had surgery to remove a tumor.  We saw Marta giving the dog an IV earlier in the day and we wondered what was wrong.  Hopefully Sara will pull through; the members of Marta's family have been in the backyard keeping an eye on her all day.

I went for a short walk down the road in the evening.  My hips hurt more than my balls due to my odd walk, but I'm still determined to walk with my legs apart for a few more weeks.  Miro seemed to recommend taking things very, very easy for the first two weeks definitely, and preferably for the first month.  It is the middle of summer here, so all the trees which line the street have full foliage.  The neighborhood is nice.  Some of the buildings are brand new, while others are older but are kept up.  There are a lot of plants and ivy.  The street is narrow, so the cars have to parallel park on the sidewalk, but it works.  Down the hill from us is what looks like a bar or restaurant, which was lit up when we passed.  There was a band playing; I saw an upright bass, a fiddle, and I believe a guitar.  I was tempted to go inside to watch, but it seemed a bit crowded and sitting still isn't my most favorite activity.  I stood outside awhile and listened, then headed back.  Just that short walk (not even a quarter of a mile) had tired me out.

Later, I popped in a DVD that was in the apartment--"World's Greatest Dad"--and tried one of the pastry things.  It was good; I was expecting something like a jelly-filled doughnut, but the bread was heavier and the filling was a whole piece of fruit, something like a plum (an improvement over sugary glaze filling, I thought).  A note on the DVD player: it can play U.S./Canada Region 1 encoded DVDs.  Had I known that, I would have taken some of my DVDs to watch at the apartment.  I don't know if is compatible with other regions, though.

Post-Op: Day 12 (August 13)

I can't believe today is our last full day in Belgrade.  We fly out at 1PM CEST tomorrow.  Dr. Miro stopped by this morning, just to say goodbye and make sure that everything was OK.  He gave my mother and I coffee mugs that say Beograd, which was a nice gesture.  Mine has buildings on it, while my mom's has laundry hanging on a line.  For the record, while there is a small washing machine, there isn't a gas or electric dryer in the apartment.  There are clotheslines in the backyard and there is a folding metal rack.  We used the rack, and clothes were dry within 24 hours.

Dr. Marta is supposed to come by later today to give me the picture CD of surgery and to say our final goodbyes.  In the meantime, I'm going to go write something in the Admiral's "guestbook" that is on the living room table.  The book is a good read when you first arrive before surgery, as the entries are very positive and encouraging.

Marta called to say that she would be by in the morning instead.  So, my mom and I went to eat supper on the Danube (or maybe it was the Sava--it was near the confluence of the two rivers, anyways) at the restaurant Malevilla, which Marta pointed out to us when we were driving around the city.  Our cab driver, Igor, dropped us off as close to the restaurant as possible, after performing some very talented cab driving that would not go over too well in the States.  We had a nice time at the restaurant, which is actually anchored in the river.  It was a fairly fancy place with good food (a nice fish menu, but I ordered veal).  The menu was dual language (Serbian/English), so that was nice.  We saw the sunset and watched as the riverwalk became very busy.  It was a Saturday night and the atmosphere was like that of a carnival.  Set up all along the sidewalk were inflatable playgrounds, carnival rides (including bumper cars), an arcade with pool, foosball, and air hockey tables, and food and merchandise vendors.  Across the river, Usce tower was lit up.  There was a full moon out.  After eating, we walked along the riverwalk for a short distance before I got tired.  I wish we could have seen more; it definitely went on for a long distance.

So then we headed back to where Igor dropped us off and pulled out the cell phone to call his number--and we couldn't get him.  All we got was a recording in Serbian that neither of us could understand.  We tried calling Marta's landline, which was programmed into the phone, and couldn't get that either.  Great.  My mom tried talking to a very helpful man in what looked like an information booth.  He didn't know English, but he understood her when she said 'taxi' (I'm pretty sure the Serbian variant is written 'taksi' and is pronounced about the same).  So he ran off, I'm not sure for what purpose--maybe to check where the nearest place to grab a cab was--and came back a while later, talking and gesturing towards the nearby highway.  I thanked him with 'hvala' and we headed in that direction.  Along the way, we began to have some misgivings about just grabbing any cab, remembering what Marta said about cab drivers who might take advantage of foreigners.  I could say the address of the apartment fine, but I'm sure I have one helluva accent.

I looked through the call log on the cell phone, which had Marta's cell number listed.  I called that and, thankfully, got through.  She said she was just about to call us.  She was on duty at the hospital, but her dad apparently contacted her because he was worried we were out so late.  We explained the situation, and she called a cab for us.  So, in the end, we got back safely and were even charged the correct amount, thanks to Marta.

Guestbook Entry

July 30 - August 14, 2011 - Metoidioplasty

I cannot thank the Belgrade team enough.  The level of care here is wonderful and the doctors and nurses are some of the most compassionate that I have ever met.

Dr. Miro is clearly a talented and dedicated surgeon.  He is full of energy and excitement when he speaks of his work.  I feel lucky to be his patient.  I have never known a surgeon who actually visits his patients after surgery, let alone gives them a big bear hug and greets them as friends.  Miro, thank you for your work and for all that you have done for people like me.  Thank you for trying to organize a drive to my family's home town in Croatia, where my grandfather was born.  Even though I wasn't quite up to the trip--the gesture speaks volumes and is deeply appreciated.

Dr. Marta is completely awesome.  She helped make this possible--all the details about scheduling surgery, what to bring, where to stay, what to expect. But she went far beyond taking care of details.  She made us feel welcome, at home, safe.  Any worries or concerns I had--she addressed them and made me feel better.  She even brought us delicious food her mother and sister made for us.  She knew that we did not get to see very much of the city, so the opportunity arose where she was able to take us to the mall and give us a driving tour of Belgrade.  We enjoyed it immensely; the city is unique and beautiful.  Marta, you do so much so well--you are amazing.  Take care.

Miro and Marta, thank you both for being friends and going out of your way to help my mom and me.

To all the other doctors--Dr. Korac, Dr. Stanojevic, Marko, Vladimir--I may not have seen as much of you as Miro and Marta, but I know you were involved and I thank you.  To Vessna and all the other nurses, thank you for taking such good care of me at St. Medica.

To anyone who has recently arrived at the Admiral and is reading this for the first time, anticipating surgery: you are in good hands.

Post-Op: Day 13 (August 14)

Today was the big travel day.  Marta came by in the morning, as promised, to say goodbye and to give me the picture CD of my surgery.  George picked us up, brought us to the airport, and even carried our bags into the airport and put them on a cart.  Nice guy.  We paid him for the ride, which was 2000 dinar, and bid farewell.

We waited at the Lufthansa check-in desk, checked our bags, got our tickets, and headed upstairs to security.  The security screening is less rigorous than in the U.S.  There was a metal detector and an x-ray machine for carry-on baggage.  I put my laptop, shoes, and liquids in a bin, though I don't know if all that was necessary.  I didn't have any issues going through security, at any rate.  Nobody cared about the pills I had in my carry-on (antibiotics, probiotics, and Tylenol, all of which I needed on the plane) and I was even able to get a visual screening of my pills and T vial without incident.  (The reason for the visual screening is simply because I don't like having my meds, especially the T, X-rayed.)  My 36 boxes of Cialis were packed in my checked bag along with my other medical supplies, including syringes/needles, bandages, and spare catheter bags.

I did not have the catheter bag connected (the suprapubic catheter tube was hidden in my underwear) and the donut was stashed in a bag out of sight.  Apparently if it looks like you have something medically wrong with you at a Serbian airport, you can be detained until a physician clears you for flight (which might cause you to miss your flight).  Thankfully, I didn't have any issues.  After security was a customs check, where they stamped our passports and took the police cards that Marta got us when we first arrived.  Another note: my passport still said 'F', while my name and picture are clearly male; nobody in security or customs gave me any trouble over this.  We spent some time in the Duty Free shop before heading to our gate.  FYI, our gate had another metal detector and X-ray machine, presumably operated by Lufthansa; I followed the same procedure as the first security check and it was fine.  Unfortunately, one would have to undergo screening again if they wished to leave and re-enter the gate.  This is an inconvenience, since there are no restrooms in the waiting area.

All our flights were on time (yay, Lufthansa).  The flight from Belgrade to Munich was relatively short (around 2 hours) and I was not in pain, having preemptively taken a couple Extra Strength Tylenol.  I had packed one new 2L catheter bag (given to me before I left St. Medica) in my carry-on backpack, which I put in my pocket and attached in the plane restroom.  I bought a 1L catheter bag with leg straps in the U.S. for this purpose and tried it out before the flight, but I found it uncomfortable.  Plastic against the skin isn't nice, and the curve of my leg meant the bag didn't have much room left for liquids.  So, what I did instead was wear cargo shorts with big leg pockets.  I didn't want the catheter tube showing, so I threaded the small suprapubic catheter tube from my abdomen, out and over the waistband of my boxer-briefs, and under my shorts.  I cut a small hole on the inside of one cargo pocket, put the 2L bag in the pocket, and threaded the larger catheter bag tube through the hole, under my shorts, and up to connect with the suprapubic catheter tube.  When I needed to empty the bag, I just went to the restroom, took the bag out of my pocket, unscrewed the port on its bottom, then re-capped it and stuffed it back in my pocket when done (taking care not to kink any tubing).  It worked well and, as long as I didn't let the bag get too full, did not look odd.

Like the flight to Belgrade, the airplane did not stop near the terminal, so there was a short bus ride to the terminal.  I was able to walk between gates at the Munich airport, where we underwent another security/baggage check followed by another passport check.  A wheelchair would have been faster, though.  Also, nobody cared or even took note of the catheter bag in my pocket. 

This flight was much longer at around 10 hours.  Surprisingly, I was not in pain, although I was definitely uncomfortable by the end of the flight.  Reclining the seat to take direct pressure off of my genitals helped a lot.  At O'Hare airport, I got a wheelchair.  It was just way too far to walk, and I was honestly walking more slowly than the little old ladies that I saw in the terminal.  On the upside, people in wheelchairs (and their companions) get to go through a separate expedited line for customs.  This was nice, since the regular line was long.  Also, the woman who was pushing the wheelchair knew exactly where to go, which made things easier.

In all, the trip wasn't as bad as I thought it was going to be, though I did notice that my urethra had increased bleeding, probably due to all the movement.  The swelling of my penis, which had been going down, also got worse.

Post-Op: Day 14 (August 15)

Today we drove home.  Again, Extra Strength Tylenol took care of any pain I may have had (I didn't feel any, just somewhat uncomfortable) and being able to sit in the back seat, where I could sit with my legs apart and recline the seat, helped a lot.  I alternated between using the donut and slouching on the seat.  Changing positions seemed to help, too.

I fell asleep soon after we got back (7pm local time), happy to be in my own bed.  I am still sleeping flat on my back.  I am normally a belly sleeper, but the suprapubic catheter is in the way.  Side sleeping would be out of the question at this point, I think.

Post-Op: Day 15 (August 16)

I woke up at 4am.  Jet lag is weird.  At least I got to watch the sunrise.

I haven't taken any pain pills today.  Nothing really hurts (I'm also not walking much, just wandering about the house occasionally), but the sutures on my penis itch like hell.  Showers and Bacitracin help soothe the itch.  The urethral bleeding is still there, but it is back to being a very small amount (<1mL per 12 hours).  The odd swelling on the underside of my penis shows no signs of subsiding soon, unfortunately.

I really don't have any plans for this week (or next week, or the next) other than keeping the surgical area clean and sitting/laying down and taking it easy.  I'll be glad when the swelling resolves and when I can get the suprapubic catheter out.  It isn't very bothersome, actually, but it reminds me that I have just had surgery and am not back to 100% yet. 

I am drinking plenty of fluids an still walking like a cowboy.  I am taking one antibiotic (Augmentin) and one probiotic (Florastor) in the morning, one probiotic in the evening, and Tylenol as needed.  I have read that other guys flush their urethra with saline until they begin urinating, but Miro told me I did not need to flush my urethra once I left Belgrade.  I forgot to ask him why.

Post-Op: Day 16 (August 17)

Today, I woke up sore at 4:30am.  My scrotum feels kind of like my chest did after surgery.  Parts of it are numb to the touch, yet tender, and there are occasional sudden shooting pains and general soreness.  I have come to associate these things with damaged and healing nerves.  I put off taking Tylenol, just to see if I really needed it, but gave in at 8am.  The pain isn't killer, but it is distracting.  It makes me want to massage my balls to make the pain go away, which probably isn't the greatest idea since my testicle capsules are likely still forming.

The area just above my penis is sore and still swollen.  I think this may be due to the ligaments that were severed above my penis.  The soreness feels similar to when I pumped my penis out a bit too far pre-op.

The side of my mouth where the buccal mucosa graft was taken is healing nicely.  I can now open my mouth all the way without my cheek feeling tight.  I have one lingering long stitch.  The inside of my cheek feels lumpy and I hope it evens out with time.  I can chew food on that side of my mouth, but I still avoid it.

I still have blood exiting my urethra but am not bothering with any pad or gauze in my underwear at this point.  It usually happens right after a bowel movement, and the blood seems to be diluted with a clear liquid.  I wonder if I am simply urinating a little bit whenever I make a B.M.  It wouldn't surprise me, since this is what usually happens.

The reason I am not bothering with anything beyond a pair of loose cotton boxers right now is because I am experiencing the, ahem, joys of having balls in the summer.  It is hot and humid and, despite moving as little as possible, I am sweating everywhere.  I do mean everywhere.  I woke up yesterday morning with a red, bumpy rash where my still-swollen scrotum rubs against my inner thighs.  Owowow.  I'm trying to give it some air.

It probably didn't help that, the night this happened, I went to bed with some sort of non-breathable pad in my boxer-briefs.  I had run out of the pure cotton pads they had in Serbia and couldn't find any kind of cotton pad or gauze in Walgreens, Shopko, or Walmart and the independent drugstores in the area have sadly been run out of business.  Everything was synthetic--polyester, rayon, plastics--so that is what I had to get, though I suspected this might happen.  So yeah, my plans for the day are pretty much to just chill on the couch with a fan pointed at my junk.

Today was also the first day post-op that I dared go near my genitals with a razor.  The hair was just getting too annoying and itchy, so I shaved the front and part of my scrotum, taking care to give wide berth to all incisions, the suprapubic catheter, and of course the rash.  I couldn't get it all, but even a partial shave made things feel better.

So you were staying at the apartment in the same building as Dr. Marta (assuming since you saw the clotheslines and her rottie).  That's where I stayed.  Very nice apartment though I thought I was going to kill myself post-op in that bathtub.  LOL

Jay

Yup, that's the place.  It is nice (the hardwood floor was really cool), but I agree with you on that tub.  It was definitely not a graceful moment getting out of that thing post-op, lol.  I basically hoisted myself out by leaning on the back of the toilet and prayed that I didn't slip and land on my nuts as I was side-stepping out of the tub.

Post-Op: Days 17/18/19/20 (August 17/19/20/21)

I am combining these days because, really, I am running out of things to write.  Healing is monotonous.  I am spending my days resting as much as possible, since the more I move, the more sore I get and the more the odd swelling on the underside of my penis increases.  Despite still walking like a cowboy, the stitches also rub when I walk, making parts of my skin very raw.  I do not have anywhere to go or anything to do, so it seems best to just take it easy; maybe my body will heal a bit faster this way. 

I have not taken any pain meds these past four days.  I occasionally get bouts of soreness or a sharp pain in my scrotum, but nothing worth pain medication.  The dominant feeling now is one of skin irritation on and around my penis and scrotum.  The rash I developed a few days ago is healing (but itchy as hell), thanks to loose cotton boxers, plenty of air, Desitin where my scrotum touches my inner thighs, and Bacitracin on the incisions and stitches.  Those stitches are a pain; they are short, prickly, and poke me along my perineum and in the folds of my penis (which is still mostly retracted).

Taking a shower usually makes things feel better.  So I took a shower but used a scented antibacterial soap on my genitals--bad idea.  It made my skin red and irritated and dried out the skin on my penis.  Though Marta told me to use soap on my penis while I was still in Belgrade (since my penis couldn't be wrapped like usual), they had some sort of gentle, PH neutral soap in the bathroom.  But whatever I used just now... not good.  Lesson learned.

In other news, my urethra still has some blood exiting it.  This mostly only happens after a B.M. or upon getting out of bed in the morning.  The swelling in my scrotum is going down nicely and there is no visible bruising.  The left testicle implant is lower and further back, while the right implant is higher and more forward.  There is still very, very little drainage from my perineal incision, which is good.

Post-Op: Day 21 (August 22)

I am now 3 weeks post-op and feeling much better.  I have recovered from the jet lag and now sleep during normal (for me) hours.  I am still taking it easy.  I am able to recline/sit on soft surfaces (the couch) with no discomfort.  I don't need to use the donut when sitting on soft surfaces.  I went for a walk around the yard yesterday and it went pretty well, but it made my right testicle a little sore.  I think I am done with the pain meds for good, though.  A lot of healing has been happening over the last week.  Swelling in my scrotum has continued to subside, though the penis swelling is still there.  The rash is getting better, and my incisions aren't so itchy anymore.  I've noticed a few stitches from my penis are falling out.  Despite all this, I am by no means anywhere near 100% and still have little desire to leave the house at this point.

I'm getting started on the process of changing the sex marker on my birth certificate, drivers' license, passport, and social security records.  That should keep me busy with paperwork for a while.

Post-Op: Day 22/23/24 (August 23/24/25)

Things continue to slowly heal and improve, though the swelling on the underside of my penis is still there.  It seems less firm, as if there is less fluid, but it still makes a prominent bump below my glans.  I am supposed to start taking Cialis (10mg every 3 days) at 4 weeks post op and also start pumping daily.  Maybe that will help things along.

I've been taking daily walks around the yard.  It makes my right nut a little sore, but I find if I widen my stance, it goes away.  The left side of my sac has mostly softened, but the right side still has hard spots (the back of the implant nearest the perineum).  The hard spots indicate that my body is still forming capsules around the implants.  There is also swelling underneath the incision on my right side where the implant was inserted.  If any pressure is put on this area it hurts, necessitating the cowboy walk and spread legs when sitting.  On the left side, the implant has dropped below the incision line.

The bleeding from my urethra is really slowing down.  A few drops still occasionally escape, but not much.  It isn't pure blood, but is mixed with a clear/yellow fluid.  I'm honestly not sure if it is fluid draining from swelled tissues or urine.

The rash on my scrotum and inner thighs has healed, thankfully without any indication of infection.  I think it was just a heat rash.  Having a fan blowing directly on that area helped the most.  I now, unfortunately, have a rash on my abdomen from the medical tape.  Oh well.  I haven't gotten word from Dr. Miro yet about starting to urinate through my urethra.  I think he's aiming for 4 weeks.  Really, the more time the urethra has to heal, the better.  There are still stitches on the midline of my scrotum and I don't think the incision is 100% healed yet.

About the Hysterectomy/Oophorectomy

I haven't been talking about the hysterectomy at all.  Apart from the pulling, cramp-like pain I had the first night post-surgery, I haven't felt any pain from that area.  I have been deliberately taking it easy on my abdominal muscles, though.  I use my arms to hoist myself up from a laying down to sitting position.  I recently tried sitting up using my abdominal muscles and it hurt, but I actually think that was because of muscles contracting around the suprapubic catheter.

Trying to have a B.M. the first time post-op was strange, as it seemed like I had forgotten how to use my abdominal muscles and I was afraid to strain them.  It ended up not being painful, and I thankfully have not had to deal with constipation yet (quite the opposite, actually).

I am personally glad that I had a hysterectomy/oophorectomy at the same time as metoidioplasty, rather than before.  It is one less round of general anesthetic to deal with and less time, overall, spent healing.  I guess this depends on the person, but my body has not been overwhelmed by trying to heal two relatively 'big' surgeries at once.  Having a hysterectomy in Belgrade is also more cost-effective if one cannot get it covered by insurance in the U.S.  I paid 2000EUR in addition to the cost of metoidioplasty.  How many thousands would it be to have a hysterectomy in the U.S. without the help of insurance?  When I was researching hysterectomy in the U.S., it also seemed like few doctors offered the trans-vaginal approach.  Abdominal or laparoscopic hysterectomy seemed to be the most prevalent; both leave scars, though with the laparoscopic approach they are very small.  With the trans-vaginal approach, there are no external scars at all.  I was worried that the trans-vaginal approach was not going to be possible for me, given that I had never used that hole for intercourse and it was very small and narrow (I needed a pediatric speculum for pelvic exams and on my last one the doctor just gave up and used a Q-tip).  Apparently it was fine; the gynecologist, Dr. Stanojevic, and his team did a great job.

I just wanted to tell you that I'm very grateful to have this day-by-day account. Thanks, Ender.

Thanks for the updates!
Cheers
Myles

You're welcome, guys.

I'm just happy somebody's finding my ramblings useful, lol.  Actually, here are a couple more accounts of bottom surgery that I am finding very helpful:


This blog covers pretty much all aspects of transition; this link is to all the posts on bottom surgery (currently updated to 5 months post-op): http://toyneboi.wordpress.com/category/bottom-surgery/ (http://toyneboi.wordpress.com/category/bottom-surgery/)

Very detailed, well-organized account of the first 2 months post-op: http://quirkycalm.wordpress.com/ (http://quirkycalm.wordpress.com/)

Highly detailed account of all aspects of bottom surgery, including revision experiences: http://www.ftmtransition.com/transition/bottomsurgery/bottomsurgery.html (http://www.ftmtransition.com/transition/bottomsurgery/bottomsurgery.html)

Cost breakdown and journal of surgery/recovery: http://www.ryansallans.com/metoidoplasty.html (http://www.ryansallans.com/metoidoplasty.html)


All of these guys are metoidioplasty patients who went to Dr. Miro and his team.

Thanks for keeping this journal.   It's great for you to make this resource available to others. 

You're welcome and thank you, Andy.

About the Vaginectomy

The type of vaginectomy that I had is technically termed 'colpocleisis.'  From what I understand, it involves laser ablation to remove the vaginal mucosa.  As this heals, the vaginal cavity seals shut.  The muscles surrounding the former vaginal cavity are left in place.  After the initial post-surgical bleeding (for which a drain is placed), there will be no more fluid discharge, so the former vaginal site can be stitched closed to create a male-typical perineum.

Apparently, the team has had a high rate of success using this technique: blood loss is minimized and the need for a transfusion is rare.  Colpocleisis is also used to treat vaginal prolapse in elderly patients who have no plans for future sexual activity.

I experienced some discomfort from this area during the first week or two post-op.  The biggest problem seemed to come from sitting in such a way that pressure was put on the closure.  Laying down, slouching, sitting on a donut, or standing up for a while alleviated the discomfort.

Post-Op: Day 25/26/27/28/29 (August 26/27/28/29/30)

I am eagerly awaiting next week (week 4), when I expect to be able to start using my urethra.  Last week (week 3), I really was not feeling like I was ready, given the urethral bleeding that I was still experiencing.  The urethral bleeding appears to have stopped, giving way to an occasional transparent yellow liquid discharge (that I hope is not indicative of an infection).  This fluid reminds me of the discharge one might get from a healing wound (like a scrape on the arm) after bleeding has stopped and healing is underway.  It is slightly sticky and may be lymphatic fluid.

Despite trying to go without the catheter bag during the day since I got home from Belgrade, I know my bladder capacity has greatly decreased over the past month.  Happily, everything appears to still be in working order, as I was woken up in the middle of the night by a strong urge to urinate.  I checked for bends in the suprapubic catheter; because of its small diameter and flexibility, it tends to bend and prevent drainage.  I tape it flush against my abdomen for nearly its entire length to prevent that from happening, so that wasn't the problem.  Apparently the catheter bag was folded over onto itself, blocking the entry point.  Repositioning it flat fixed the problem.

I'll be glad when this catheter is out of me.  Before I started taping the entire tube down, I got it caught a couple times--let me just say, yanking on a tube that enters one's abdomen and is stitched in place does not feel good.  I was worried that I had pulled the tube out of place prematurely, but the stitches are very strong and held it in place.

The catheter bag also developed a leak, but thankfully I had already picked up a couple of spares at a medical supply store.

Post-Op: Day 30 (August 31) - Trying Out the New Urethra

A few days ago, I sent Dr. Miro an e-mail updating him on my healing progress.  He said that I could begin urinating today.  He said that, at this point, spraying and burning would be normal.  If there are any leaks, however, I am to stop using the urethra and resume using the catheter.  If there don't appear to be any leaks, I am to use the urethra for 3 days and if all is still good, I can remove the suprapubic catheter.  Once the catheter is removed, I can start taking the Cialis and start pumping.

So today, I hopped into the shower with a hand mirror and proceeded to try things out.  The stream went sharply to the right and there was indeed spraying, since my penis is still very swollen and has a stitch right at the urethral exit; I'm sure the fact that my penis is still very much retracted into the mons pubis wasn't helping matters, either.  There was dripping/runoff which made it a little difficult to determine leakage.  As far as I could tell, though, the perineal area had no fistulas.  I voided through the urethra an additional two times today and still could not detect any unusual leaks.  Urine comes out with a strong stream, so I don't think I have any strictures.  Burning was minimal as I was well-hydrated.

The biggest annoyance is that the swelling on the underside of my penis forms a sort of ramp from my urethra to my scrotum and I get urine dripping off of my right nut and onto my leg.  I pretty much need to take a shower after peeing; how convenient, since I am already in the shower.  The spraying and dripping are going to have to resolve before I even think about standing at a toilet or urinal.  I haven't tried sitting yet.

In other news, I am able to walk for longer distances with my legs slightly closer together (I still walk like a cowboy, though).  My scrotum no longer aches due to walking.  I am able to sit up straighter without feeling pain, though I still prefer soft surfaces.

Congrats!

It took me a long, long time before I could even think about standing to pee.  Like >9 months.  So be patient!  Your stream will change a lot as things heal up.

Also, I found pumping way too painful.  Even several months out.  I admit I have only pumped a handful of times since surgery.  My main problem is getting a good seal with the cylinder; it doesn't seem to fit well with my configuration but it might work well with yours.

If it is too painful I'd say wait.

Somewhere on here I posted my healing ordeal.  My perineum took forever to heal; Dr. Miro thought maybe because of sweating (I had surgery in the summer, too).  I had to keep gauze on that until it finally healed 4 months later.  It was an annoyance for sure.

Glad things are going well for you.


Jay

Thanks, Jay!

I just hope I'm at least able to sit on a toilet to pee.  Seriously, my stream shoots straight forward about 12"--I think I might miss.  This should be interesting; today's little challenge.

I've tried just putting my cylinder over my penis (no actual pumping out), and I think I might be able to get a seal.  It's 1" ID, 1.25" flared base.  I think I'll need to push the skin burying my penis out of the way, but I had to do that before surgery, too.

I'm mostly worried about pulling on the remaining stitches because I'm not 100% sure all the incisions have healed over yet.  I'll be careful, but I think I'm pretty much going to have to get pumping as early as possible.  The retraction I have is just ridiculous and it's getting worse, not better.  My penis pulls out, but it's now wanting to invert itself into my body--I can literally pull it out a bit and watch it slowly retract back in.  I don't want it to scar over and heal in place like that.

Yep, I've read your post several times (thanks).  The sweat definitely has something to do with it.  My perineum seems to be healing over OK since the rash, but I've been spending my days in boxers with a fan blowing on the area to keep it dry.  However, the bottom of the incisions where the balls were inserted rub against the inside of my thighs--those are still pretty raw looking, whereas the upper part of the incision that is not in a sweaty crease is healing over nicely.  Ah, healing.

Now you have to learn to sit to pee like a guy.  Pants all the way to your ankles, knees wide apart, and because our dicks are small, you need to lean forward a bit so the stream goes down and not out, or not under the seat and onto floor.  BTDT. 

If you've got no leaks, that's the main thing!  The rest is healing and learning curve.


Jay

Quote from: sneakersjay on September 01, 2011, 05:16:41 PM
Now you have to learn to sit to pee like a guy.  Pants all the way to your ankles, knees wide apart, and because our dicks are small, you need to lean forward a bit so the stream goes down and not out, or not under the seat and onto floor.  BTDT.

You are correct, sir!  LOL, yeah, that method works.  I had to do some of that pre-surgery due to a stream that shot forwards (tended to go under the seat and onto the floor or my pants).  The new change is that I now need to lean even further forward.  It's not as messy as I was expecting, thankfully.

I'm still not seeing any leaks, though it's kind of hard to be sure with the runoff.  I need to work on a new STP to isolate the stream.

Post-Op: Day 31/32 (September 1/2)

I never thought I would be this happy to be able to sit to pee.  A few days ago, I was worried that the 'stand and make a mess in the shower' method would be my only method of voiding until the swelling goes down.  Happily, with some adjustments of technique, I'm able to sit without making a mess.  If I sit with my pants around my ankles, knees spread far apart, and leaning forward, all is well.  There is a little runoff requiring wiping but nothing like if I am standing.  Occasionally, however, the stream will veer sharply to the right and hit the inside of my thigh, which is annoying to clean.

Voiding in the sitting position felt strange at first and I was very aware of the urethral extension.  It almost felt a little 'tight,' but it's hard to describe and the flow of urine did not appear to be impeded.  The burning is very slight and the most uncomfortable part is at the tip of my penis, right at the urethral exit.  It's not painful, just different; sensitive, pretty much how it should feel to have a strong stream of fluid exiting the sensitive glans, I guess.

After voiding, there is a little bit of fluid left in the urethra which is easily drained by pushing the balls forward and up.

TMI ALERT: The urine is now clear but the first time I urinated, it was a little cloudy and mixed with small white chunks.  Nasty--but apparently harmless and probably a result of healing and disuse.

Post-Op: One Month Summary

Pain:
-I have not taken pain pills since the start of Week 3
-My scrotum has only minor, occasional aches
-I occasionally get sharp twinges of pain in my penis; the stitches may be poking sensitive flesh

Mobility:
-My days are still spent mostly sitting/reclining on a soft surface; I can do light chores around the house (food prep, laundry) and go on short walks outside
-I can take short walks (<1 mile) with no soreness
-During longer walks (>1 mile) my scrotum becomes sore
-I am walking with my legs slightly closer together than two weeks ago, but still walk like a cowboy
-My movements (when getting up, bending down, getting into a car, etc) are still guarded, but more normal and easier than a few weeks ago
-I have not tried driving yet
-I can ride in the passenger seat with little issue; I still prefer a slightly reclined seat but do not need the donut
-I am still sleeping on my back

Voiding:
-I began voiding on post-op day 30 and appear to have no fistulas or strictures
-I still have the suprapubic catheter but do not use it during the day; I still connect the bag at night
-I am maintaining a high level of hydration to prevent burning during urination
-I need to urinate about every hour
-The more I use the urethra, the less it feels strange; burning is slight and is decreasing with use
-I can urinate sitting without making a big mess; toilet paper is sufficient for cleanup
-I need to push the testicles up and forward to coax the last few drops from the urethra; if I do this, there is no dribbling in my underwear
-I can only urinate standing in the shower due to runoff and need to clean up

Healing:
-Since I started using the urethra, I am no longer noticing yellow discharge or blood
-There is little to no yellow discharge from the perineal incision and no blood
-I still have visible stitches along the perineal incision, implant insertion sites, and penis
-The prickly tied-off stitches on the penis and perineum are annoying but I am no longer having itch-attacks
-I am not pumping yet
-My penis and scrotum are still swollen but not as much as a few weeks ago
-The buccal mucosa graft site continues to heal; I no longer feel stitches, but the area is still lumpy; it is not painful and I can brush my teeth normally

Other:
-About a week ago I noticed that my teeth had a brown film on them, despite brushing daily.  I thought this was odd, because my teeth have always been in great shape.  Some searching revealed that brown spots on teeth can be a result of the antibiotic Augmentin (generic Amoxicillin Clavulanate), which I am currently taking.  It didn't sound like it was harmful to adult teeth, just difficult to remove.  I switched from a soft-bristle to a hard-bristle toothbrush and used my fingernails on some of the stubborn spots.  This mostly took care of the problem; I still have some spots between my teeth (flossing didn't help much) and on the back molars that might require professional cleaning.

i love that you updated with a one month summary.  Will you continue to update throughout your healing process? 

Quote from: Andy8715 on September 02, 2011, 11:55:51 PM
i love that you updated with a one month summary.  Will you continue to update throughout your healing process?

Yep, I'm planning on it.  I'm not sure how long I'll continue updates since I'm not sure myself how long it will take until I consider things 'done' (swelling finally goes down, stream evens out, and I figure out how to STP).  Updates will probably become fewer and farther between as I run out of things to report, but there's still plenty happening healing-wise these first few months.

Post-Op: Day 33/34 (September 3/4)

This whole post concerns orgasms and pumping, so if this is TMI, read no further.

Post-op orgasm #1 was on day 33.  Since I had no evidence of urethral fistula for three days and was technically cleared for pumping, I figured it would be safe.  I kept stimulation to the head only because I wanted to avoid disturbing any lingering stitches on the shaft.  Compared to pre-op, everything felt a lot more localized to the penis.  Before and despite not touching those areas, I would get a lot of peripheral stimulation to areas I didn't like feeling.  So this was an improvement.  Oddly, I felt burning in the former vaginal area, so perhaps trying things this early was a bit premature.  I felt no pain, however.

I pumped for the first time on day 34 post-op.  I can get a seal with the cylinder I used pre-op (1"ID, 1.5"D flared base, 3.875" long) but can't pump out nearly as far.  Pre-op, I measured 2" when pumped in the cylinder.  I didn't measure this time, but I would be surprised if I even reached 1".  I couldn't apply much pressure because I felt pulling at the stitches that are still at the base of my penis.  On the up side, no stitches ripped and there was no bleeding or pain.

My penis doesn't fill the diameter of the cylinder like it used to, leaving room for the swollen underside to expand.  I think this cylinder may be good once the swelling goes away and my penis heals into a normal shape, but for now I think I would benefit from a smaller cylinder.  I'm getting one that is 0.75"ID, 0.875"D flared base, 3.125" long; hopefully that will keep the swollen tissue from enlarging further.  The next size down is 0.5"ID, 0.625"D flared base, 3" long; I think that would be too constricting, since the head of my penis measures slightly larger than 0.5" in diameter.

BELOW LINKS ARE NSFW:
I purchased the cylinders here: http://www.extremerestraints.com/nipple-and-pussy-pumps_221/clitoral-enlargement-cylinder_1247.html (http://www.extremerestraints.com/nipple-and-pussy-pumps_221/clitoral-enlargement-cylinder_1247.html)

And I purchased my pump here: http://www.extremerestraints.com/penis-pump-accessories_220/deluxe-metal-penis-pump_407.html (http://www.extremerestraints.com/penis-pump-accessories_220/deluxe-metal-penis-pump_407.html)

There's also a kit with all three cylinder sizes plus a pump but I wanted an all-metal, not plastic, pump: http://www.extremerestraints.com/nipple-and-pussy-pumps_221/clitoris-enhancer-clit-pump-kit_1248.html (http://www.extremerestraints.com/nipple-and-pussy-pumps_221/clitoris-enhancer-clit-pump-kit_1248.html)

I've had both the metal pump and large cylinder for 2 years and can attest to the build quality of both.  The cylinders are Vac-u-Loc, so the pump can be detached and the cylinder will still keep pressure (useful for extended pumping sessions).  I use a water-based lubricant inside the cylinder to reduce friction while pumping out.

Despite the penile 'workout' of the past two days, I still have no evidence of urethral fistulas.

Post-Op: Day 35/36 (September 5/6)

It is evident that I no longer need the suprapubic catheter and I have an appointment on September 7th to have it removed by a local urologist.

For now, I have been pumping with the simple syringe pump that Marta gave me.  I am able to pump a little more out compared to the first time and it is also easier to pump.  The penis seems less tight/shriveled and more willing to stretch; I suppose that would be the scar tissue softening.  However, it's still nowhere near as much as I used to be able to pump out and it doesn't pump out as easily, either.  Hopefully with time comes improvement.

Miro sent an e-mail inquiring about how voiding went.  I said it was very good, all things considered, and I told him about the appointment for the suprapubic catheter removal and asked how long I was to take the antibiotics (Augmentin) after catheter removal.  He replied with 3 days and again reminded me to pump regularly (oh I am, believe me... obsessively, almost). 

Post-Op: Day 37 (September 7): No More Catheter

Today I got the suprapubic catheter taken out (yes!).  So overall it was a very good day but also kind of upsetting.  Nothing bad actually happened, but it was a day of 'outing,' getting half-naked, and general awkwardness for me.  Throw in my anxiety about my penis appearance--not due to its actual size so much as the fact that, right now, it looks like I have no shaft--and it made for an unsettling day.

My P.A. called the urologist before surgery to make sure that he would not have an ideological problem with treating me after metoidioplasty.  I found out that while he is directly across from the local Catholic hospital, he is not affiliated with them and would have no problem seeing me.

I went to the urologist's office and everybody was really very nice and respectful.  The doctor (who is both a urologist and a urological surgeon) and his P.A. did seem somewhat curious about my case, but were professional.  I had the papers from Dr. Miro describing what was done during surgery as well as the photo CD of surgery, which helped.  Here's why: when the doctor came in, one of his first questions was if I had the erectile device implanted yet.  Clearly, he was expecting a phalloplasty.  He looked at the photos on the CD first and commented that the final post-op photo looked like very neat work (maybe in regards to placement and how cleanly the incisions were stitched--how do surgeons judge these things?).  He also commented on the surgical 'drape,' saying that it looked like cloth and that disposable paper is used in the U.S.  He inquired about the hospital quality in Serbia and seemed surprised to hear that the facility I went to was recently built, very clean and modern-looking.  He recognized Dr. Djordjevic's name and said that he knew about Miro's contribution to hypospadias repair--something about a conference in Philadelphia.  So that was cool that he had heard of my surgeon, but I don't think he was familiar with metoidioplasty.  One of his questions, in looking at the photos, was 'why did they leave just the glans?  Didn't they lengthen it?'  Ouch.  Honest question, but I winced at it.  I said that the length was entirely dependent on one's own anatomy.  He asked why phalloplasty was not performed to which I said that, while the surgeon performs both, it was my preference to have metoidioplasty.  He seemed curious as to why, so I explained that I needed to get a job and get on with my life--a shortened version of my reasons, but he understood it and acknowledged that phalloplasty can be a difficult surgery with lengthy recovery times.

He and the P.A. first took a look at the suprapubic catheter site and then looked at my genitals.  I awkwardly pointed out that my shaft was still very swollen and retracted.  He put a gloved hand under the testicle implants and commented that they were in good position.  Then I zipped up and we talked about what would be done.  He said he wanted to do a VCUG before removing the suprapubic catheter--standard procedure in the U.S., I gather--and seemed shocked when I said that I had already been urinating out of my urethra for several days with no issues.  Personally, I liked the 'try the urethra yourself before removing the catheter' method; it let me know that everything was indeed working while still having a 'backup system' installed.  It also let me get used to the new urethra before trying to urinate contrast dye into a portable urinal in front of an X-ray technician.  Anyways, despite it working fine as far as I could tell, I agreed that it would be good to get an inside view of the constructed urethra.

I was sent over to the aforementioned Catholic hospital to have the test done.  There was significant awkwardness over the fact that I was still 'F' in their system (I was born there and basically my entire history was on file, minus transition-related stuff), but the nurse who was getting me ready for the test was really very nice about it.  l ended up needing to tell her what surgery I had done and why, to which she said 'oh, thank God!' as though I had cleared up a great confusion.  My appearance is clearly male at this point, and I guess she was having a quandary over the 'F' on my lab order sheet (I didn't even know that was on there, but I should have guessed).  It's her job to get the portable urinal (male or female style) and notify the appropriate X-ray tech (male or female), so I can understand the problem.  She was awesome about it, though, and brought in the male technician who was also nice about everything. 

I was led to a huge machine and laid on a horizontal table.   At this point, I was in a hospital gown that opened in the front.  A drip of the contrast dye was set up and connected to my suprapubic catheter.  As soon as the second tech who would be running the machine came in, the drip was started.  The second tech seemed a bit curious about the surgery and asked where it was done.  He seemed slightly off-put, but remained professional.  Anyways, he was operating the computer behind glass.  The first tech that was actually touching me was better about things.

When my bladder felt full (the drip took an especially long time, perhaps due to the small diameter suprapubic catheter), the table I was lying on rotated into the vertical position.  Standing, I was given the portable urinal, which I put very close to my genitals so it was touching the underside of my penis to catch any runoff.  The imaging device was attached to a movable arm and the tech with the computer adjusted its position and gave me the go-ahead.  Peeing in front of people is not my forte, but I concentrated on a fire sprinkler in the ceiling and got the stream started.  After several stops and starts, I finally emptied my bladder.  The test was done; the tech said he had a good image, which he sent to the urologist (presumably electronically because by the time I went back, it was already on the computer).  I re-dressed and headed to the urologist's office.

The P.A. met me and relayed that the doctor said it looked good and that she would be taking the suprapubic catheter out.  She found the stitch and clipped it (small sting), then started to pull the catheter.  It was slightly adhered at the entry point, but it came undone easily.  It felt weird and burned a bit as it was pulled, but it was out quickly.  She asked what I had been doing to clean the site (sterile saline solution, Bacitracin, change dressing 1-2x/day) and she said that it looked like I was having a reaction to the Bacitracin.  Oops.  Apparently it can actually promote the growth of yeast--really should have taken Miro's advice of 'you don't really need this' more to heart.  It had worked really well on my drain sites after top surgery, but then I wasn't also on a broad-spectrum antibiotic.  Anyways, she said it didn't look serious.  I kept pressure on the site for a while with a gauze pad, then she taped it up.  She said the wound might drain and there could possibly be a little urine (?!), but not to worry--it would heal over within a few days.

The doctor came in and basically went over the findings.  No fistulas, apparently, but he actually seemed more hung-up on other visual findings--as he put it, "this is still a very female structure."  I really didn't know what to say to that (was thinking: well, yes... the surgeon isn't going to start messing with internals for a urethral lengthening), so I kind of just gave a blank stare.  He then said something about tubularization and that my urine was coming down into 'the V between the legs', as in the female manner.  I wish I would have asked for more clarification.  I was just a bit taken aback.  Another thing I wish I would have asked for clarification on is that the X-ray was taken from the front only; it showed the original urethra very clearly, but the neo-urethra was obscured and a side view probably would have shown it more clearly.  He gave some advice on the implants (if the skin feels especially warm to the touch, it's probably infected) and I was led back to the waiting room.

I am no doctor--maybe he could tell that all was well with the neo-urethra by just the front view--but after I left his office, I got the feeling that maybe we weren't entirely on the same page after all.  I gave him Dr. Miro's surgical report and the photos from surgery, but I could have perhaps spent more time talking about what was done.  Thing is, he didn't ask or give the immediate impression of being confused and I have reservations about telling doctors (especially the only urologist within a couple hundred miles) 'how to do their jobs.'  In retrospect, though, I think I would have felt better about this doctor visit had I spoken up more.  But after the length and 'female structure' comments, along with questions (which seemed more like doubts) about the quality of care in Serbia, all I really felt like doing was bolting out of there.

Post-Op: Day 38 (September 8 ): Improvement

Today I am feeling much better.  I still have some lingering concerns about the VCUG: was the image sufficient to really check out the neo-urethra?  My bladder looked like it was obscuring the former vaginal cavity--what if that didn't seal correctly and I am now urinating into the cavity, impeding healing?  Maybe I'll ask the urologist for a copy of the X-ray so I can send it to Dr. Miro and ask his opinion on the matter.

But functionally, urinating seems fine, and I'm thankful for that.  Emptying my bladder is much, much more comfortable without the suprapubic catheter (I was surprised by how quickly things started feeling 'normal' in that regard).  I am still peeing frequently (and drinking plenty of water), but it is approaching the normal-for-me rate that I had pre-op.  The urgency that I had with the catheter isn't there so much and holding it seems easier.

Yesterday, I noticed some pus-like fluid coming from the catheter site, so I changed the dressing several times.  Later today, the drainage stopped and the site looked like it was scabbed over, so I switched to a breathable band-aid.  I am noticing that my lower abdominals feel very sore and tight.  It's sort of like going overboard on sit-ups isolating the lower abs and then finding that you can't easily stand up straight the next day.  I notice this upon moving from sitting to standing.  After I've been standing for a while, it stops feeling so tight.

Another thing I am thankful for is pumping and Cialis.  I've already talked about pumping and I am making slow (very, very slow) gains.  It pumps out easier now, but I don't think I'll be able to hit my former length for a long time.  Prior to surgery, it took a year or so to get to that point and only the last 6 months could really be called daily pumping.  Also, as soon as the pressure is released from the pump, most length disappears (same as before surgery), but a small gain remains--for a short while.  I could literally watch as my penis moved and retracted inwards until it was more of an 'innie' than an 'outie.'  So last night, feeling rather bummed about my results and about the whole day, I took my first 10mg of Cialis.  Wow, that works fast.  I took it, continued with pumping, and when I was done, I found that my penis was not returning to the 'innie' position.  Further coaxing resulted in it sticking straight out from my body with more length than I have ever seen and it was honestly the best thing I could have seen at that point.

I woke up today to a penis that was, for the first time since being wrapped at St. Medica, external.  The effects of the Cialis remained throughout today, though not as strong as initially.  Additionally, the swelling on the underside of my penis has been going down (I'm noticing a clear, sticky substance exiting the stitches).  With the penis protruding more as a result of Cialis, the extra skin from the swelling is stretching out and looks better.  I can't wait for the 10th, which is my next Cialis dose. 

Wow--just realized that my mood is now linked to my penis.  Oh, and the Packers just won the first game of the regular season :D

Wow, some story  about getting the catheter out!  I just snipped the stitch and took it out myself while lying on my bed.  No doctors or x-rays or contrast involved.  :)  Glad it all went well, though.  Glad you are able to pump. I have not even tried in a long long time.  But part of that is also finding time; I have kids who can barge in on me at any time, and they get miffed if the door is locked; I can't relax and pump.


Jay

Quote from: sneakersjay on September 11, 2011, 08:18:04 AM
Wow, some story  about getting the catheter out!  I just snipped the stitch and took it out myself while lying on my bed.  No doctors or x-rays or contrast involved.  :)  Glad it all went well, though.  Glad you are able to pump. I have not even tried in a long long time.  But part of that is also finding time; I have kids who can barge in on me at any time, and they get miffed if the door is locked; I can't relax and pump.

LOL, yeah, it is kind of a long story.  I was inclined to just take it out myself because it would be easier and cheaper (in retrospect, waay easier), but my mom was very, very against the idea and just made the appointment for me.  Figured if I already had the appointment, might as well go.

Pumping is priority #1 for me right now.  Finding time isn't hard (laid off), but since I'm back at my parents' place, privacy can be a problem.  Awkward...  Aren't your kids getting to an age where they would want more privacy?  Maybe the 'please knock first' rule could be made a two-way street.

Did you find that retraction resolved naturally over time, despite not pumping, or did you not experience much retraction after surgery?

I did not experience significant retraction.  Somewhere out there in the universe is a video I made of urinating through my fly.  I can't get a good seal with my pump, though.


Jay

Quote from: sneakersjay on September 11, 2011, 12:27:18 PM
I did not experience significant retraction.  Somewhere out there in the universe is a video I made of urinating through my fly.  I can't get a good seal with my pump, though.

Yup, I've seen it.  Thanks for sharing--hopefully I'll be able to do the same some day.  I think it's going to be contingent on the retraction resolving, which has me worried.

At this point, I can get the best seal with the homemade pump (two 60mL syringes, one with the plunger taken out, connected by a tube) from Belgrade.  Something about the shape of the flat, non-flared base makes it better.  The flat area also pushes back on my pubic fat, which helps.  I have a harder time with my metal pump with the flared cylinders.  Definitely worth trying different things, though you've probably already been there/done that.

Post-Op: Day 42 (September 12): 6 Weeks Post-Op

It's 6 weeks post-op and I'm feeling better and more mobile now that the catheter is out.  Some stitches in my penis still remain, mostly at the base.  I clipped some of the loose stitches on the top of my penis, since it was clear that everything had healed together and the stitches were working on either dissolving or falling out.  I notice I sometimes lose a stitch after pumping, but I have no worries at this point of anything 'coming undone.'  My shaft looks healed over with no raw areas or obvious incisions.  The stitches where my right implant was inserted have fallen out completely, leaving a thin line scar.  The stitches where my left implant was inserted are much tighter an have not fallen out yet.  I still have a few stitches along my perineum (most are at the vaginectomy site), but everything appears to be healing over nicely.  The hole where the suprapubic catheter was has scabbed over completely.  If I pull my abdomen skin upwards, all seems fine, but if I pull it downwards, it becomes clear that there is a small adhesion; no big deal and not surprising. The buccal mucosa graft site continues to smooth over and I can brush my teeth and eat normally.  Overall, no signs of infection or problems anywhere.

My scrotum still feels a little hard in places around the implants but it has softened considerably.  I'm starting to walk a little more normally, but still keep my legs apart out of caution.  I drove for the first time yesterday.  Sitting upright felt fine (no pain in the vaginectomy site), but my scrotum got a little sore from keeping my legs closer together.  There's enough room in the seat to keep my legs apart, but I have to move my right leg inwards when braking.  It's an automatic, so no issues with needing to bring my left leg inwards to use the clutch.  Anyways, I can drive well enough--finally, freedom!

I got my new smaller-diameter cylinder today.  It's a little binding girth-wise, but with enough lube it works.  I'm glad I didn't also get the smallest size; it would have been too small and would not have worked.  I'm finding that I can't pump out as much length with this cylinder; it starts to pinch before I can that far.  However, it does draw out my retracted penis and I can leave it on for extended periods (at this point, maybe 5-10 minutes) without the surrounding tissue getting stretched out.  It doesn't take much pressure just to draw out my penis: maybe 2-3 inHg.  Before surgery, I could pump up to 10 inHg with the larger cylinder to stretch it to maximum length.  The inHg readings mean I am back to using my metal pump with the pressure gage.  Now that more stitches are falling out, my flared-base cylinders are comfortable again.

Right now, I alternate between super-happy with and a bit worried about my results.  My scrotum looks great.  The implant position is forward and both balls are prominent.  The right implant has been dropping a little and it is now more even with the left.  Neither implant is right next to my penis; both are comfortably below.  At this point, it doesn't look like I'll have issues with implant position.  I can sit upright without sitting on my balls.  If I lean forward, the bottom of my sac will touch the seat, but it isn't uncomfortable and from looking at photos this is fairly normal for a scrotum, surgically created or not.  The urethral lengthening seems to be free of complications, though the stream can still be unpredictable (which is apparently normal at this stage). 

My biggest worry is my penis.  When it is protruding, I am very happy with how my package looks; when it starts to retract inwards or is covered by pubic fat--not so much.  For some reason when I'm sitting, my penis likes to retract inwards along its top side (I can actually feel the bone that it draws itself under), resulting in a sharp upward angle.  Pumping and Cialis are helping overall with retraction and it is much better than it was a few weeks ago, but I wonder how much more it can really improve.  I suppose it's still too early in healing to tell. 

As far as the pubic fat is concerned, the best position is laying on my back; my penis always protrudes in that position.  When I'm sitting or standing, however, the fat is free to move downwards and 'settle' right over the top of my shaft.  The bottom side of my penis always protrudes over my scrotum, it's mostly the visibility of the top and sides that is the problem.  If I push that fat back in any position, it looks great.  Miro mentioned liposuction as soon as he saw my pre-op genitals in person and Marta was absolutely right when she said my biggest problem was not length but suprapubic fat.  Prior to this, I didn't think fat was going to be a huge issue for me; 143 lbs on a 5'4" medium frame is considered a healthy weight on male charts, but that's at the upper range.  I could stand to lose more weight and maybe the weight in the mons area will go down in turn--I just hope the extra mons weight isn't going to be one of those ridiculous lingering 'female' traits.  Finally, I think my biggest problem in not foreseeing this was complete ignorance over how much pubic fat is considered 'a lot' for a male, particularly one with a juvenile-size penis.

All this might be TMI, but honestly if I were to read about someone else who had similar issues and it was eventually resolved (by correction of retraction be it by pumping or surgery, weight loss, pubic lipo, mons resection or V-Y-plasty) it would make me feel 100% better to know that there can be a solution and that someone else has gone through the same thing.

I always hated the mons (vomit-inducing word, LOL) and am seriously considering getting it resected and repositioning one nut.  I'm about the same size as you are and need to lose a bit of weight and get fit before I decide to do something like that.  It does look F to me.

Jay

Post-Op: Two Month Summary

Pain:
-I'm not entirely pain-free, but it feels that way much of the time
-Pain pills are not necessary
-My scrotum has largely stopped aching.  If there is prolonged pressure, it will begin to feel sore but will feel better once the pressure is removed
-I occasionally get quick twinges of pain in my scrotum and penis.  These twinges feel similar to what happened after my top surgery--nerves 'waking up,' maybe?

Mobility:
-I can walk without soreness
-I can walk pretty much normally.  I have a normal stride (no waddle), but make a point to keep my legs apart a little further than I used to (out of caution, probably not necessity)
-I can put my legs closer together than I could a month ago
-I can sit upright without pain on any surface but like to keep my legs apart
-I can drive my automatic car
-I am still sleeping on my back (have gotten used to it) but can also sleep on my side.  Haven't tried belly sleeping yet, but have laid on my belly for short periods of time while propped up by a pillow

Voiding:
-Voiding patterns are back to normal pre-op state
-No burning of the urethra
-I still prefer sitting to urinate, due to some spraying and stream unpredictability, though this has improved over the last month
-I still push the testicles up and forward to coax the last few drops from the urethra
-No fistulas at all, no evidence of stricture yet

Healing:
-No bleeding or discharge from incisions; all incisions are scarred over
-Stitches have almost entirely fallen from the perineal incision, implant insertion incisions, and penis
-Only some small stitches on my penis remain; I clip the ends off when they protrude beyond the skin
-I am pumping 3x/day for 10-15 minutes and using Cialis; retraction seem to be slowly resolving
-Scrotal swelling seems to be pretty much gone
-There is firm, fibrous tissue leading from each testicle incision to each implant; the tissue on the left side seems to be softening faster than on the right
-The swelling on the underside of my penis seems to be gone, but some excess loose skin remains
-My left testicle has mostly softened (there is a hard spot on the back end) while my right testicle is not as soft as the left; capsule formation is still on-going
-The initial numbness of the scrotal skin and skin directly above my penis (where the ligaments were cut) is slowly improving; I expect it to take months or years to approach normalcy, similar to what happened with top surgery
-The buccal mucosa graft site is still lumpy but it continues to smooth out; it is not otherwise bothersome

Other:
-I still make a point of it to wear loose jeans: tighter jeans put pressure on my package when sitting, which can get uncomfortable

Thanks for another good report. Sounds like you are making good progess with your recovery.  I am interested in your progess in voiding, as I would really like to be able to void standing at an urinal.  I use the men's room almost always now and hate having to use a stall, seeing all the guys using the urinals is a real dysphia for me.  I want to be like all the other guys I see when I pee.

Post-Op: Six Month Summary

Whoa, time has flown.  I really did mean to keep up with doing an update at least once a month, but things didn't work out that way.  For starters, after the 2-month point, I began feeling well enough that there really wasn't much to report (for those wondering, if I had a desk job, I could have gone back to it).  Also around this time, I was having a hard time accepting my results for what they were.  The loose skin left by swelling and the fat and extra skin courtesy of a puffy mons covered up my penis to the point that it looked like I had a just a small head poking out from a sac or even from between two swollen labia.  Not really what I was hoping for, result-wise; it sent me for a head trip.  It was best that I just stopped obsessing about my dick for a while, and that included stopping the updates and photographs.  Anyways, to the very brief rundown:

Pain:
-Usually totally pain-free
-Occasionally, my right testicle will ache if something is pressing on it, but the ache goes away as soon as the pressure is removed

Mobility:
-I am back to normal mobility: walking, running, sitting any way I want, driving, laying any way I want
-I have not tried riding a bike yet (too snowy outside)

Voiding:
-Voiding is back to normal (apart from the change in urethra location, of course)

Healing:
-buccal mucosal graft is still smoothing out, but I only notice it if I think about it; the area is a little numb to the touch, but nothing bothersome
-I would consider myself 98% healed
-The 2% accounts for the occasional testicle soreness and lingering hard patches at the rear of both testicles
-I am still pumping 3x/day for 10-15 minutes (or alternately 1x/day with the cylinder locked on for 30 minutes straight if I don't have the time for multiple sessions--I don't know if this is necessarily recommended, but sometimes it's all I can fit in) and using Cialis; retraction seems to have resolved

Other:
-I can wear tight jeans with no discomfort

I know voiding is a big thing post-op, so here's where I'm at with it.  Since 2 months, I have been trying to void standing up at both a toilet and a urinal.  Sometimes it is successful, sometimes it isn't.  Since 2 months, my stream has gotten more predictable (less of a spray, more of a stream), but it still veers sharply right sometimes.  This especially happens if the stream is weak, when I don't have to go very much, or towards the end of going.  So what basically happens is that I can successfully pee through my fly (both boxer briefs/boxers and jeans) for everything except the very end, when the stream (sometimes) shoots to the right and (sometimes) leaves a wet streak on my right leg.  Obviously, 'sometimes' is not acceptable for being in public, so I sit if I'm out and about.  Unfortunately, the bathrooms at home are carpeted so 'sometimes' isn't really acceptable there, either.  In short, I've been making peace with sitting for now.  With sitting, it is also easier to get that last little bit out of my urethra by pushing up and forward from behind my balls.  If I do not do this, there will be a little bit of urine left in my urethra that will drain out as I walk or the next time I sit down (not cool).  So that is unfortunate but not totally unexpected.  Maybe I will be able to pee standing some day, it really depends on if my stream becomes more predictable as I heal further.  Additionally, pumping makes my stream more unpredictable and can even turn it into a spray again; I think this is due to the tissue swelling that pumping causes.

Another note: urinals are easier to use than toilets when standing up.  I think this is because my penis points straight forward on its own.  If I'm trying a toilet, I need to know where the stream arc is going to end up (I almost always miss at first) or try to point my penis down, but that's hard because my hands are busy pushing the underwear/jeans flies out of the way and pushing fat back to expose my penis.  As for sitting techniques, for the first few months (when it hurt to manipulate my penis), I sat far back on the seat and leaned forward to get the stream to go in the bowl instead of over the top of the rim.  Now, I'm able to just grab it and point it down, which is cool.  I can control where it goes and can play target practice with stains on the porcelain if so inclined.

I don't have any real issues with the urethra: no fistulas, no strictures, and for that I'm thankful.

So back to my thoughts on visual results.  I think my balls look fantastic.  The placement is ideal, they aren't in the way like I thought they would be (though I will occasionally 'pinch' one doing some activities, but they're kinda squishy and don't hurt).  They are plenty visible from all angles and just generally look good to me.  I was fortunate to have had "large, floppy labia" (Miro's words), so wandering implants resulting from insufficient scrotal space are not a problem for me; I did not need tissue expanders.  My scrotum is not fused, so there is a deeper cleft than factory-issue scrotums tend to have, but it's OK for now.  I will probably have it fused in the future.  My penis... looks great when the fat and extra skin are pushed back.  I gained a little bit of length and can now pump out to 2.5" as opposed to 2" prior to surgery.  I can actually see my head when not pushing any skin out of the way; prior to surgery, it could not be seen at all from the front and was really buried.  But I think I would really benefit (cosmetically) from mons liposuction, trimming of the extra skin around my penis, and a mons resection to lift everything up higher.  Marta said that I was of average size (for a meta) and that my biggest problem was the mons fat and I believe her.  So yeah, losing weight for starters and then I'll start looking into a revision later down the road.

I sincerely doubt my penis would be useful for penetration, but I don't care.  I always wondered if my lack of interest in relationships and sex was because of my body, but that doesn't seem to stop a lot of other trans people.  As for comfort levels, at 2 months post-op I was running around on a beach, naked except for small boxers and quite comfortable; if my penis was less buried and more defined, I think I'd be fine with a nude beach, small and all.  At this point I think I'm just not a particularly sexually driven person, rather than body shy or uncomfortable in my skin.  I have tried it out, though, and orgasms are fine.  Whatever nerves control that were not at all damaged during surgery.  I do have a numb spot right above my penis where the ligaments were severed and the sensation on my sac is pretty patchy--it sort of feels like my chest did after peri, though the chest sensation did mostly come back after several months/years.

So, in all, things are pretty good, even if I am going to be seeking revision to address the extra mons fat/skin, hopefully improve shaft prominence, and fuse the scrotum.  And I just realized that in a few days I'm going to be 3 years on T... again, how time flies.

Quote from: mm on October 18, 2011, 03:56:45 PM
Thanks for another good report. Sounds like you are making good progess with your recovery.  I am interested in your progess in voiding, as I would really like to be able to void standing at an urinal.  I use the men's room almost always now and hate having to use a stall, seeing all the guys using the urinals is a real dysphia for me.  I want to be like all the other guys I see when I pee.

Sorry for the long delay before I saw this.  Hope my latest entry answers your question at least in part, mm.

Glad you finally posted an update.  I was wondering about you the other day.  Glad to know things are going good.

I am 18 months post-op and my stream still occasionally sprays at an odd angle or gets on my pants.  It definitely helps to have a really full bladder to help get a good strong stream.  I mostly sit, but lately have been standing more.  Did get a good drip on my pants at work; thank g*d for black jeans so it didn't really show.  Urinals are easier as they catch the spray when it veers.  Not sure why it sprays more sometimes vs others.    Most men have post-pee drips, which is why they shake it, so I'm not really concerned about that.


Jay

I just recently read the entire account so far - thanks for posting. Meta is what I'm going for, and it really helps to hear first hand accounts. Little details are important in gauging how my own experience is going to be. And as mm said, it seems like recovery is going really well despite the few residual issues.

Quote from: Andy8715 on January 22, 2012, 11:35:25 PM
Glad you finally posted an update.  I was wondering about you the other day.  Glad to know things are going good.

Yeah... I felt kinda bad having a 3-4 month gap in updates, even if there wasn't much to say.  The next time I update will probably be when/if I have something more to say about voiding or whenever those hard spots at the back of the implants finally soften.  Beyond that, I'm having a pretty good time just getting on with life.

Quote from: sneakersjay on January 23, 2012, 08:05:10 AM
I am 18 months post-op and my stream still occasionally sprays at an odd angle or gets on my pants.  It definitely helps to have a really full bladder to help get a good strong stream.  I mostly sit, but lately have been standing more.  Did get a good drip on my pants at work; thank g*d for black jeans so it didn't really show.  Urinals are easier as they catch the spray when it veers.  Not sure why it sprays more sometimes vs others.    Most men have post-pee drips, which is why they shake it, so I'm not really concerned about that.


Jay

Yeah, black pants are a good thing.  Most of the pants I have are dark-colored, anyways.  I've also found that long, straight flies are easier to work with than the short flies on skinny jeans (they're OK, but I need to pull them down about 2" for the fly to be in ideal position).  That's true about urinals, they're much better for catching a veering stream than toilets.  And I now have some understanding of guys who leave droplets all over the seat (or even on the floor) in public restrooms.  When I was using my STP pre-op, I used to wonder why guys found it so difficult to aim properly... well, I think I know, now.  An STP with a perfectly smooth, round, manufactured tube results in a highly predictable stream.  Surgery, obviously not so much, but I have to wonder about the predictability of factory-issue streams, too.

As for my stream veering right, I did notice that my urethral exit is not perfectly circular (obviously--it's not for anyone, I don't think).  It is a vertical slit that stretches from the middle to the bottom of my glans, but I think the problem lies in the fact that there is an indentation or a fold of skin on one side of the slit (the right side, surprise surprise, same side that the stream veers).  And I have more problems with spraying if I've pumped recently, as I said, but I also have problems with spraying if my foreskin gets too close to my stream.

Quote from: Caseyyy on January 23, 2012, 09:55:45 AM
I just recently read the entire account so far - thanks for posting. Meta is what I'm going for, and it really helps to hear first hand accounts. Little details are important in gauging how my own experience is going to be. And as mm said, it seems like recovery is going really well despite the few residual issues.

You're welcome, glad it's useful.  I've gotta say, in the absence of major problems (mostly the possible urethral complications), the little issues have started to seem bigger to me.  But I think that being aware of even the little details, good and bad, is important before deciding on surgery.  The fewer surprises with something like this, the better--though of course everybody heals differently.

I just realized I don't think I've ever posted in this thread.  Thanks so much for taking the time to write all of this, gaps and all.  As someone who is still on the fence about bottom surgery, this is extremely helpful.

Re: urine stream, I think I remember reading about a guy who self-cathed with progressively larger catheters in order to get a better stream.  He also had no complications IIRC.  Maybe something to think about and discuss with either Miro and/or a urologist. 

My urethra is more of a mercedes benz logo shape slit with upside-down V (ie tiny flap at the bottom).

I also found that boxer brief flies are more forgiving than trying to lower the elastic waistband of briefs.


Jay

Thanks for the detailed info Ender. 

Ender, this is an amazing thread.  I don't know if you will ever see this post, but I just wanted to say I am blown away by the time you took to write this.  i will be going to Crane for meta in 3/2016 and when I hit the search key to find a thread like this I really doubted I would find anything of significance.  Your goal of having a thread that a guy in the future would very much appreciate was indeed met.  Thank you so much!

P.S. Any updates?

Quote from: Bimmer Guy on June 27, 2015, 06:17:42 PM
i will be going to Crane for meta in 3/2016

Oh, boy. When did you book the appointment? I don't know how far in advance he is scheduling, but I thought that I should probably get a consultation about a year and a half in advance of my first procedure because I am shooting for summer 2017 and need to book the surgery during a very narrow window of about one week in June. If I can't get it done then, I will have to wait another year.

I guess I have a little time to get my act together. But still...

Quote from: Arch on June 27, 2015, 10:22:43 PM
Oh, boy. When did you book the appointment? I don't know how far in advance he is scheduling, but I thought that I should probably get a consultation about a year and a half in advance of my first procedure because I am shooting for summer 2017 and need to book the surgery during a very narrow window of about one week in June. If I can't get it done then, I will have to wait another year.

I guess I have a little time to get my act together. But still...

It was only 3 weeks ago, but I am getting the surgery in Austin, so he just started scheduling there.  If I wanted to schedule with him in CA, it would be an additional 7 months wait (which would mean a 16 month wait total).

I knew for certain that I wanted Crane so I would have waited as long as needed.  If you know you want him, no downside to calling now to see if they will schedule out that far.  The only benefit I see to waiting is if you want to see if new techniques come out that another surgeon does that you may find you like better.  A LOT can change in two years.

Your other option is to schedule with Crane now, and cancel later.  You will lose the $1,000 scheduling fee, though.

Good luck to you, Arch.  I know you have waited a long time to be able to get this surgery.

Bimmer, I don't have an academic calendar for that far in advance, and one of my schools is supposedly going to a new academic calendar by then. If it does, I might have to schedule further out because I'll be grading work from two schools at once instead of the usual one. Sheesh, who knows when I'll have all of this sorted out. Sometimes I wish I had a regular job; I would simply take medical leave.

Looks like I'll have to sit tight and wait to see what happens. But I can definitely get in touch with Crane's office and see when he expects to be in CA that year. D'you suppose they would know that two years in advance? Guess I'll find out.

I haven't even scheduled hysto yet, mainly because I'm stressing out. Arranging bottom surgery is going to make me a nervous wreck.

Quote from: Arch on June 29, 2015, 03:11:50 AM
Bimmer, I don't have an academic calendar for that far in advance, and one of my schools is supposedly going to a new academic calendar by then. If it does, I might have to schedule further out because I'll be grading work from two schools at once instead of the usual one. Sheesh, who knows when I'll have all of this sorted out. Sometimes I wish I had a regular job; I would simply take medical leave.

Looks like I'll have to sit tight and wait to see what happens. But I can definitely get in touch with Crane's office and see when he expects to be in CA that year. D'you suppose they would know that two years in advance? Guess I'll find out.

I haven't even scheduled hysto yet, mainly because I'm stressing out. Arranging bottom surgery is going to make me a nervous wreck.

Arch, somehow I missed this and you might have your answers by now.  Crane's plan is to travel to SF quarterly for two weeks each time.  This is already in place for 2016.  Perhaps this will become his standard schedule. 

You can get your hysto done during your bottom surgery with Crane.  All in one shot.  That is not uncommon for guys to do.  He does not do the hysto, but works with a GYN surgeon who comes in.

Thanks for bumping this! I'd read through the links to external sites that were posted in the past, but it was nice to see a day by day account of the experience in Serbia and coming home. Hadn't seen this on here before.

I've been really torn lately about which procedure I truly want, but I'm settled on Dr. Miro and this has been so helpful.

Quote from: ftmax on August 01, 2015, 01:43:02 PM
Thanks for bumping this! I'd read through the links to external sites that were posted in the past, but it was nice to see a day by day account of the experience in Serbia and coming home. Hadn't seen this on here before.

I've been really torn lately about which procedure I truly want, but I'm settled on Dr. Miro and this has been so helpful.

hey, ftmax.  I know you were thinking about Miro and Crane.  I am wondering if you get trans health insurance if you are still set on Miro? 

There is a big difference in the way that Crane does the scrotum in the meta.  Crane fuses the scrotum at the mid line, rather than just placing the testicular implants into each labia majora.  Too, he places the scrotum in a more anterior position.  However, you do have to have two surgeries if you go with his approach.  He creates the scrotum at the first surgery and then you go back 6 months later for the testicular implants.  Some guys don't even bother with the implants because they feel that they already have a full enough scrotum.

Crane does a vaginectomy which results in complete closing of the vaginal cavity, making it look the same as any male perineum.  Miro does a colpocleisis, so there needs to be a small drainage hole left.

You may already know all of this, but I just wanted to highlight it for you if you are considering meta.  I don't know what differences there would be if any (besides the vaginectomy vs. colpocleisis) for their phallos.

If I have any of the above wrong (about miro's surgery), I hope someone comes in to correct me.

If I got better insurance, I'd definitely be open to Crane.  It seems doubtful at this point though, unless I'm willing to move and that won't happen for another year (my only real hope of changing insurance around here is if I get a government job, and I'm not a veteran in an area that caters to people who already have clearances). And if I have to go out of pocket, Miro is a fraction of Crane even if we include all the travel. Still, gives me more time to think about things.

I've been leaning more towards phallo for the last few months. Top surgery made life a lot better, but now I'm focused downstairs 24/7 and so abysmally unhappy. Based on what Crane has online, I prefer Miro's aesthetics. I'd have to email Crane's office though before I was 100% sure - he doesn't have any pictures in his gallery of guys that used the MLD donor site, which I'm most interested in.

Makes sense, ftmax (your entire post).

I suspect he doesn't have any MLD posts because he never recommends them.  So, perhaps he doesn't do many of them?  ;D

You are aware the issue is it is about how MLD uses a motor nerve rather than a ? nerve?  I don't know all that much about it since my focus has been in meta.  However, my understanding is that the sensation is quite different and more muted, so to speak, with the MLD.  Crane always recommends RFF.  ALT is the other wone he does on a regular basis.

Yeah, that interested me because both of the surgeons in Serbia I've looked at do MLD exclusively based on the results I've found. I'm not sure if it's just skin quality at the donor site or what, but aesthetics wise everything looks much better to me.

I hadn't heard that that was the case with sensation, so I'll read up on it. Sensation isn't in my top five of most important qualities though, so it's not a deal breaker if that is the case.

Quote from: ftmax on August 03, 2015, 05:11:43 AM
Yeah, that interested me because both of the surgeons in Serbia I've looked at do MLD exclusively based on the results I've found. I'm not sure if it's just skin quality at the donor site or what, but aesthetics wise everything looks much better to me.

I hadn't heard that that was the case with sensation, so I'll read up on it. Sensation isn't in my top five of most important qualities though, so it's not a deal breaker if that is the case.

Hi, ftmax,

I would want the MLD too, based on donor location.  I also like how Serbia stitches it back up.  I am not sure what I would do if faced with the question of donor site, personally.  If sensation wasn't in the top 5, I can see myself choosing the MLD.  I think for the ALT and MLD, the girth of the shaft is the issue.  It is pretty common for Crane to do lipo on his ALT penises later.

Crane did a video explaining the differences and gave the information on the issue of nerves.  However, evidently the person who did the video no longer has it up.

Ender,

I am sorry for high jacking your thread.  To get back on track......

it would be great to get an update from you.  :)