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.