Hi Kendra, yes it does feel good. I had the opportunity to travel 4 times during the process of getting my passport. I would most likely have only traveled once but not having the passport just made not going worse.

I just got back from pillion.

Linda said she was going to put me into the far room because they may do some work on me today.

Crystal examined me first. She asked if I was sexually active. I said no. Then she asked if I was orgasmic which I said yes. She asked if there was something I did not like or wanted as a revision? She said my vagina looked pretty good.  I explained that when she and Dr. McGinn examined me when I had my BA that Dr. McGinn asked if I wanted the bottom of my vagina closed and I said yes. She said ok and that she would review it with the doctor.

So when you look at the bottom of my vagina it is open and the labia majora opens out and it is not together.

Dr. McGinn came in and examined me. When she came into the room she said I remember you and your vagina. We smiled and laughed. She asked how dilation was going. I said it was a little painful and after I exercise from the weekends it is painful for a few days, due to swelling. She said she recommends that she:

close off a little hole in my clitoral hood,
lower my urethra,
remove the scar tissue at the bottom of my vagina,
remove the scar tissue ring from the graft,
dissect pretty far to the left and right at he bottom of my vagina (4 or 5 inches),
close off the bottom of my vagina.

She said it would be 2 hours in the OR under general anesthesia. I am scheduled for April 4th.

We reviewed VFS and her thoughts. She said she is not really up on the subject. She said my voice is ok and that it is a mix of male and female. She said she heard Dr. Kim's patients and they sounded ok. She asked who I am going with and I said Dr. Sadaloff. She said he is the god of voice but that she did not know of any trans patients that when to him. She asked what procedure and I said cricoidthyroid subluxation. I explained the difference from the CTA. She said the CTA had long term issues for some patients. I said Dr. Sadaloff explained the issue with the CTA and that the CT seduction was permanent.  She wants me to talk to her 2 years after the operation so if it is successful she can let other patients know.

She said he has the best voice therapy team and that every trans patient should go to them for that. I see them December 4th.

She asked why do more trans patients not go to him and why his procedure not used extensively. I said I did not know. She said the CTA is almost too high then after a while the voice gets lower. She said it is like the difference between a cello and a violin and she thinks the focal folds stretch.

I do know opera singers and singers go to him and that trans do go to him. I will ask the vocal team if they have any recordings pre and post op of trans patients and what the long term prognosis is.


Dr. Sadaloff uses extensive pre-testing I had a scope in my nose and throat taking video of the vocal folds, I had electrical probes in my throat at 8 or so locations measuring the difference between the left and right side. I had an electrical shock test to see how the nerves react.  I will have 2 appointments Dec 1st with is vocal team and I will have an MRI and ultrasound and there is a script for my esophagus to be scoped.  I suspect post surgery I will be going to their voice pathologist team.

On of the things Dr. Sadaloff did say is that older patients can have calcification of the thyroid cartridge which can make it not a candidate for the subduction and then he would do a CTA. He said I had some calcification but he will know only when he is in the OR. I will be awake and talking to him which sounded a bit strange. 

I hope things work out. I know hope is not a plan nor a good thing to rest your purse on.

I had the wrong name for the procedure in the past. It is Cricothyroid Subluxation.

It all sounds as though things are progressing according to plan. I'm glad to hear that you are doing will.

Hugs,
   Laurie

Hi Laurie, thanks for the support.

I am pretty shaken from the extent of what needs to be done with my vagina.  I have some significant scar tissue and it is painful when I dilate. When I walk on Saturday and Sunday 5.7 miles each day with a 60 pound pack my dilation is really painful. I have to twist the dilator back and forth to get it in. It takes a few minutes to help reduce the pain. Getting it out I have to d the reverse.

Aetna took Lower Bucks out of their in network so I will probably pay $2,000 for the OR.

______________________

I received the letter today from Mazzoni from the head of trans care and my primary doctor supporting the medically necessary FFS. Now I need to contact some friends to get advise on the appeal.

______________________

Thanksgiving I plan on going to the State Park and doing the main hill 4 times. I will see if I can do it. If not I will do it to failure. The feeling I get when I am done the hike is fantastic. Hopefully Thursday I have enough endorphins to calm Philadelphia.

______________________

I have 2 tests next Monday (MRI and ultrasound) then 3 tests next Friday ( 2 at Dr. Sataloff"s and a blood test). Monday Dec 4 I have a blood test for prep and a physical for the vocal operation.

______________________

This time I will go through with the blood test for prep. I need to visit some museums and institutes over the next few months. If I find someone I need to find someone that likes the things I like. I am not going to have sex with someone without liking them and having common interests. If he verbally or physically abuses me I will be out of there. I will never put myself in the position of not having an out in the future.

With so many times you have already been through anesthesia I can imagine how an additional surgery isn't something to look forward to.  Best wishes for April 4. 

For insurance, I'm certainly not an expert but I would think any changes to coverage (Lower Bucks no longer being in-network) wouldn't matter after the fact.  Any reimbursement should be based on the agreement at that point in time.

I am very interested in your potential vocal procedure with Dr. Sataloff.  I am getting quite frustrated with my own voice... I've been going to a speech therapist training since July, she is good but I am not.  I know pitch is less than half the battle, I need to continue working on resonance and articulation but too often I get into a conversation and forget about my pitch until it's too late.  I have considered Yeson in Korea and I don't mind international travel (I am in Marbella a few hours from now) but I had not heard of or considered Dr. Sataloff until you mentioned him.

Kendra, good luck in Marabella. Something to keep in mind about Dr. Spiegel. He softens the face but does not do extensive bones work to the point you look like you had plastic surgery. At times I wish I had more extensive work and others I am ok with the level of work.

Lower Bucks is out of network with Aetna as of 11/20/2017. So April 4th, 2018 I will be liable for 20% until my deductible is paid (it will be paid before then) in which case I will owe 10%.

I need to contact Dr. Sataloff's office Friday and submit for preauthorization. I need for them to state it is for FFS, I am pre-approved for that already. When it is all said and done I will post the costs and results. Dr. McGinn wants to know the 2 year time point result status.

I sent a copy of my new passport, as requested, by Dr. Telang. He sent me a proposal for a scope of work:

PFA the costs of the procedures discussed: ( all costs are in USD):
1) Eyebrow lift : 500
2) Upper eyelid blepharoplasty : 500
3) Cheek implants : 1000
4) facelift : 2000
5) Necklift : 1000 if done along with the facelift
6) Chin reduction : 500
7) vaser lipo of tummy and saddle bags: 2500
Total 8000 USD, inclusive of stay in a single AC room with WiFi, all medications, anaesthesia and airport transfers.

I asked to add buccosal fat removal.

So here are some costs for FFS in Mumbai.

I asked Papillion to ask Dr. McGinn if she would do a brow lift on me and if yes then the cost add when she does the vaginal work.

I had a thought that if I can put up with the scar tissue and pain from it and no one ever sees my vagina then why have the work done? Then that thought passed.  Dr. McGinn showed me how my vagina would look after the work and it is exciting. I would have for the first time genitals that looked normal. Also, having my urethra moved would eliminate and issue when I pee. Because it is just under my citreous and clitoral hood. When I pee the stream hits  citreous. When I had GCS I swelled up pretty bad and the urethra was buried in a hole from the swelling.

Quote from: Kendra on November 22, 2017, 12:12:53 AM
I am very interested in your potential vocal procedure with Dr. Sataloff.  I am getting quite frustrated with my own voice... I've been going to a speech therapist training since July, she is good but I am not.

I just wanted to jump in here to caution against voice surgery.  It is still a very risky procedure and the results aren't nearly as consistent as results from the other MtF transition surgeries.  If you have been seeing a speech therapist since July, that is what, just 4 months of training?  That's barely any time at all!  For many people it takes twice as long to find a female voice, even with weekly lessons and daily practice.  The older you are, the longer it's going to take to develop your voice.  And if you smoked at all in the past, that will also add to the time required.  Please don't give up on voice training so easily.  Yes, surgery is an option, but please make it only the last resort after you give yourself enough time with vocal training.

Hello echo7,

Thanks for the support. Kendra said she had been going to a voice pathologist since July. I have been going since March, about 8 months. I have not been able to make progress with pitch going up. I often find myself going into a lower register when at meetings and when reviewing designs.  I had smoked from 12 to 46 with 2 years in there smoke free. I have not smoked for 9 years. 

I do not want glottoplasty because the loss of vocal power and hoarseness. I was told this is from the web at the front to the vocal fold. I know in time that improves on many people. I had dinner and then a visit with my speech pathologist with a woman that went to a well renown doctor for glottoplasty. She had about a 40 HZ increase and lost vocal power. She sounded feminine but was not happy with the results.

CTA I am told can fail resulting in the former voice returning. I am told you sound very high then the voce drops a bit to a more natural pitch. I have read the opposite here.

CT subluxation was told to me by Dr. Sadaloff to be permanent. You are awake and talking during the procedure to get the correct pitch. The doctor said the only issue with older patients is that if the thyroid cartilage is calcified and brittle the procedure can not be done. Then a CTA would be performed, I would not be happy.

echo7, do you have any information? I cancelled my surgery with Dr. Haban because he offers glottoplasty or CTA and I am apprehensive to have those procedures because of what I have read here or with those that had the procedure and I spoke with.

I had the ultrasound of my thyroid and MRI of my throat today in preparation for VFS. The MRI was to have been done with and without contrast. They could not get a vein for the contrast. I hope that does not make a difference.

1st time I had a MRI. It was not bad.

I feel a bit apprehensive. So lets say the operation is a success. I have thoughts that people will think I am transgender when I speak. I know that is not rational. I do not pass and people think I am trans.

I was bagging some old suites, shirts and pants this weekend, I need space in my closet, and thought should I donate them or keep them incase I get fired.  How could I ever go back? There is no way.

I had the same thoughts when I had FFS, not my GCS or BA. The BA really helps me feel good when wearing tops. When I have on my Under Armor or Nike workout thermal gear it looks fantastic . Anyhow, when I had FFS I thought this is it. It is an outward face to the world. The same with my voice, it is outward facing the world.

On one hand I feel embarrassed. I know from experience it is from something new and I will get use to it.

Now if the operation does not go well or my results are poor I will be unhappy. My voice is a mix of male and female and I can not ever pass if it does not improve. However, it is my voice that is at stake. Did I ever mention being trans is a gift that keeps giving.

I still need to tell my wife and daughter   . Courage is not one of my strong points.

I had to reschedule the MRI with contrast. So Friday I have 4 appointments ( 2 at Dr. Sataloff's, 1 MRI with contrast and 1 bloodwork). I have my PCP (prep appointment with blood test and VFS physical) Monday. I know I will puke before this is over.

I confirmed I will need 1 week of vocal rest.

Deep breaths Rachel, deep breathes. You will be okay. Trust me. 

Hugs,
   Laurie

Thank you Laurie.

I am off tomorrow so I would will go to Work from 5 to 7. Then go to Dr. Sataloff's office for a 8 and then 9 am appointment tomorrow then a MRI with contrast at 12:30 in Langhorne PA then 3 pm blood work Back in Philadelphia . Then I can eat and go home. Monday I have my PCP physical and blood work for prep.

When I get the script for prep I will also switch my e and needles to my work insurance plan instead of Mazzoni. When I went to CVS originally I took a lot of crap several times but now I have confidence and will answer them back and not cringe. I remember what Dusty said to me when I told him the stories. He said their job is to fulfill the prescription he makes and not be judgemental, remind them of that. I can do that now.

My therapist cancelled for work reasons . I did electrolysis but skipped group. I like the 6 pm group but have grown out of it. It is tough to go now. I really want to go to the 730 group but then I would get home 910 and get to bed after dilation at 10 then up at 330 for Work. Maybe I could dilate on Tuesday mornings at 3 am or skip one day a week. Dr. Mcginn still has me dilating 7 days a week and with the April GCS revision I need to follow her requests . I need to get into a the social group. There is more drama there and a lot more free dialogue and activities with no LSW thee as a moderator.

I still need to tell my ex ( still lives with me) and daughter about my he vfs.

I have a lunch scheduled with a friend at work that had been on a keto diet for about a year now. She was a vegitarian for many years and now eats a lot of animal and anamal products. I was a almost 100% vegetarian for about 5 years and close to that for 14 years. But now eat meat but cut back significantly ( I started to get naucious thinking about it About three weeks ago). Anyhow, I need to be very thoughtful on what I eat and do it well.

Rachel, that is one busy schedule but you must take time to breathe or you will fall on your face and we can't have that happen, now can we?

Hi Laurie, thanks. I will unwind tomorrow morning in the park. My left knee still hurts from last week. I think I strained it when I was doing flat footed angled pushups with 60 pounds of weight. I went  back on the trail and I felt a sharp mushy pain. I think I hurt the IT band.

I had the two speech appointments today at Dr.Sataloff's office. The one appointment was for documenting my present voice as I use it. I have strain from raising my pitch. I was shown several drills to reduce strain. I had a lung function test and am at 60 percent. Male expected is 80 and female is 71. So I am low. By a good bit.

I had the MRI with contrast and the blood work . All I need is my pcp physical Monday.

It was 3 pm when I passed a pretzel shop. 2 to go and a Diet Coke. Lots of carbs. Then 3 cookie and some pizza. Went home and crashed. I was spent from the nervousness. Did I mention I hate needles.

 Hi Rachel,

  I was told at my first voice appointment my vocal cords are tight. My first lesson was learning to breathe right to produce better sound followed with a lesson to make noises at a comfortable normal pitch then 2 tones higher w/o straining then transitioning from low to higher and back. They also recorded my normal voice for comparison for later exercises with me rating them for how I think it meets the goals I want. We've gone onto inflections and forward mouth forward focus speaking vs chest speaking. I feel silly doing a lot of the exercises but they tell me I'm making progress. If this doesn't work enough for me to sound female I'll probably just say to heck with it. I feel I do a fair job when I concentrate but it is far from a natural effort.
   I hope your MRI was satisfactory as well as the other tests.  Keep an eye on those carbs as they usually go hand in hand with calories. I probably put on a few pounds I didn't need by eating my whole mincemeat pie 1/8 of it at a time. One slice had twice the 60 carbs that was suggested to me for a meal.
  Needles? I've never been a fan of them myself but when I became a diabetic, I started giving myself shots in the tummy. I'm down to only twice a day now. It helped me get over the stigma against shots.
   Hang in there Rachel. You'll be fine.

  Hugs,
    Laurie

Hi Laurie, I like fruit cake, I know odd. I did 6.5 miles yesterday and 5.5 miles today with a 60 pound pack up and down hills. I used up a lot of calories. When I come home I cook 3 pablino peppers with high MCT butter, add in white chedder chease then 4 non-GMO small farm raised cage free eggs. Of coarse sprinkled with red pepper.

I too hope all is well with the testing. Dr. Sadaloff felt that my one thyroid glands was bigger than the other. He also though one vocal fold vibrated faster than the other. He measured the rate of vibration of the vocal foldes and the nerve response to electrical shock. Talk about two very painful tests   . All with 5 fellows and intern doctors watching.

I am sure he will let me know if there is an issue and resolve it. If I have an issue I am sure he will address it and I will get it taken care of. I am 1 week and 1 day away from surgery.

For the first time in my life I want to live.

If my thyroid cartledge is too calcified for the subluxaion proceedure I will ask him to do the shave and ask if he can do a glottoplasty instead of a CTA. The glottoplasty, from what I read, has been a proceedure that has better long term results. I am also thinking if the subluxation can not work then perhaps just close me up.

His glottoplasty is from 30 to 50% web. He leaves a portion of the mucosal membrain for about 1/3 of the proceedure. This is incase he needs to reduce the web later then the vocal fold will not be adversely affected. He also said it reduces the scar at the top of the web which can reduce breathyness. He did say the result will be a more breathy voice.

I had vocal tests done Monday. I asked the speach pathologist if he has a lot of trans patients. He said he has not been there long (he is young) but that he has worked with more FTM than MTF patients. He said the FTM did not undergo surgery. He said they are very busy and deal with many different patients for different reasons. They deal with a large amount of singers and teachers that have issues with their voices.

I know there are two walls in the waiting room filled with Singers and Opera singers pictures thanking the doctor.


Dr, Sadaloff presentation starts at about minute 41.

I went to my PCP and did my pre-surgical physical and then final blood work. We also did bloodwork for PrEP.

I need to tell my ex tonight about the operation. I am a chicken.

I was thinking I will let Dr. Sataloff know if the subluxation proceedure will not work then either sew me up or do a glottoplasty.

I told my ex and she was ok. She made a statement that she can not understand me when my pitch is raised.

I called Dr. Sadaloff's office and requested a glottoplasty if the CT subluxaction will not work. He was fine with that. Although, glottoplasty is general anesthesia and I will need someone to pick me up. I made arrangements for someone from work to pick me up. I work 10 minutes across own.

I need to be at the hospital 0600 on Monday. I can not believe I am doing this . Noone at work thinks anything about me getting a trans proceedure and I get a lot of people saying good luck.

I am going to try to get to work Tuesday.

Tomorrow I will be at Taylor state park before 6. We are expecting snow and I really want to be well into the park at sunrise when it starts to snow. There is a field I love to see sunrise from and can not wait to see it with snow. There are usually a half dozen deer in the field as the sun rises.

Quote from: Rachel on December 08, 2017, 07:17:37 PM
> We are expecting snow and I really want to be well into the park at sunrise when it starts to snow. There is a field I love to see sunrise from and can not wait to see it with snow. There are usually a half dozen deer in the field as the sun rises.

Rachel when I compare the first couple pages of this thread to what you write now the change is immense.  And so inspiring to others.  You are literally looking forward to tomorrow because you are enjoying life.