Question for those who has had meta: post op care

[Jello]

Hi, I just had my full meta (vaginectomy, UL, Scotoplasty) done yesterday in TX. I am still bleeding at the incision sites but I didn't stay at a hospital. I wen home right after surgery. For those of you who has gotten it done, could you please share with me what I should or shouldn't do from now until the next few weeks? Of if there is anything I can do to minimize complications? Thanks.

[Northern Star Girl]

Hi, I just had my full meta (vaginectomy, UL, Scotoplasty) done yesterday in TX. I am still bleeding at the incision sites but I didn't stay at a hospital. I wen home right after surgery. For those of you who has gotten it done, could you please share with me what I should or shouldn't do from now until the next few weeks? Of if there is anything I can do to minimize complications? Thanks.

@Jello   
Dear Jello:
    I am happy to see that you have come to the Susan's Place Forums and that you have submitted your first posting and that you signed up as a member of Susan's Place. 

    As you post here on the forums you will be able to exchange thoughts and comments with others that are experiencing many of the same things.

    This is the right place for you to be to find out what others may have to say that may have been in your circumstances and with your questions and concerns.
    There are a lot of members here that will be able to identify with your situation as you continue to feel free to share it.

    I also want to warmly WELCOME you to Susan's Place. 
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[Northern Star Girl]

@Jello   
Oh, and another thing Jello...
Please plan to find your way to the Introductions Forum so that other members will be aware of your arrival.
     
Thank you again for joining Susan's Place and being involved in the Forums here.
Best wishes to you,
Danielle
NOTE: Now after all of this Greeting Stuff I will let you have your thread back so you can pursue answers to your questions.

[b3ckettn3lson]

Hi Jello,
I can not speak from experience as I have not had any surgeries yet, but you might want to contact the surgeon if still bleeding from site. Wishing you a quick recovery [emoji6]


Sent from my iPhone using Tapatalk

[Dex]

Hey Jello,
I also had meta (first stage) done in TX! I had my surgery in June.

From a post op perspective, you mostly want to listen to your doc on what your activity level can or should be. That kinda goes without saying. Seeping/bleeding from your incision sites is not uncommon for 2 weeks or so at least. You'll want to make sure you're walking at least some to prevent blood clots or other issues like that. Keep your incision sites clean and dry and try not to put too much strain on them.

I had a couple spots that didn't heal up well (wound dehiscence) so I was instructed in packing the sites until it healed in. This took several weeks for me (almost 6 weeks). During that time, I was packing the wounds, keeping them clean, but they were still weeping exudate (the clear pale yellow fluid your body produces while healing). If that happens to you, make sure you point it out at your next post op and get instructions on how to handle it. If you're going to have this happen, it's most likely to happen in the first two weeks of your healing.

I didn't have too much pain with my surgery. Surprisingly for the delicate area The most uncomfortable thing for me was the swelling. Particularly scrotal swelling. It took SO long for that to calm down. And any amount of walking or being up aggravated it terribly. It would get extremely uncomfortable. I started seeing major improvement around week 4 and saw steady improvement weekly through week 8 where I began to really feel normal again. I even ran a 5k obstacle course at roughly 3 months post op with no discomfort (though I did skip a couple obstacles that I could tell would put a lot of strain on that area like a wall climb).

I'm having my second stage (testicular implants, monsplasty, buried penis repair) in TX on 4/26/19. I hope this to be the last surgery I need and I'm very much looking forward to getting back to Texas to get it done.

Let me know if there are any particular questions you have and I hope you're healing well!

Dex

[Jello]

Thanks very much for sharing your experience. As it is turning out, I'm 17 days post ops. Unfortunately I have some tissue necrosis at the tip of the scrotum the size of a thumb, and right above it wound dehiscence where it looks like the scrotum is going to split open from the broken sutures. The doctor didn't say anything but I have my last post op in 2 days I'm going to ask. I am schedule to fly home next week and my biggest worry is that the wound doesn't heal. I still have drainage and I change my pads 3x/day. I hope all goes well with you.

[Dex]

I'm glad you're making sure to talk about it with the doc this week. Wound dehiscence is a pain, no doubt about that. I had oozing and separation in my scrotal separations for 5-6 weeks. It was weeks and weeks of it looking the same followed by one to two days where it just filled in all of a sudden.

I'm sorry to hear you're having some complications. Tissue necrosis is scary feeling. I had only a tiny tiny bit of that where the separation on the front of my scrotum separated. It kinda resulted in a small hole where the ends that were stitched together didn't come together well. After cleaning it out and exposing the good tissue, it did heal in just fine. The body is pretty resilient and it WILL heal eventually, even if it doesn't look exactly like you thought it would. You certainly won't be dealing with long term wound openings for the rest of your life.

Good luck at your appointment and let me know if you have any other questions. You can DM me as well.

[Jello]

Thanks Dex. It is certainly comforting to hear from your experience.

[Jello]

Hi Dex, I was just reading your general post from the other day and I'm not sure if I got it right but do you still have a wound opening that didn't close? If so are you still packing it? From what you wrote it sounds like I have something similar to that. I'm supposed to start peeing through my urethra tomorrow and it'll be interesting how I could keep that open wound clean.

I'm glad you're making sure to talk about it with the doc this week. Wound dehiscence is a pain, no doubt about that. I had oozing and separation in my scrotal separations for 5-6 weeks. It was weeks and weeks of it looking the same followed by one to two days where it just filled in all of a sudden.

I'm sorry to hear you're having some complications. Tissue necrosis is scary feeling. I had only a tiny tiny bit of that where the separation on the front of my scrotum separated. It kinda resulted in a small hole where the ends that were stitched together didn't come together well. After cleaning it out and exposing the good tissue, it did heal in just fine. The body is pretty resilient and it WILL heal eventually, even if it doesn't look exactly like you thought it would. You certainly won't be dealing with long term wound openings for the rest of your life.

Good luck at your appointment and let me know if you have any other questions. You can DM me as well.

[Dex]

Yes, I do still have an opening.  I decided to keep my native urethral opening (simply due to cost and complication risk vs how useful it would actually be to me to STP). The openings on the front of my scrotum and underneath my scrotum both healed up just fine at about 5-6 weeks post op. The one large separation I had was in my perineum. It extended from the urethral opening they left in my perineum (just a very small hole) all the way through to the posterior end of my new perineum. It has gotten smaller, but I do think that because I had to urinate through it (essentially) that it caused it just heal over as is. I haven't had to pack since probably week 10-11. It has completely healed over with skin like tissue. It's not weeping, it doesn't bleed or have exudate, it's clean and dry, just still split. It doesn't hurt. The only irritation is when I urinate that it doesn't come out in just one stream and it kind of splatters. Which is annoying but not the end of the world. I talked to Dr S (who is doing my stage 2 in April) about it and he said it could be fixed with my next surgery so I've just been waiting til then. If I hadn't had a second stage planned, I'd go back for a revision to put it back together.

But, no, I haven't had to pack and it's not messy at all.

Since you had urethral lengthening, as long as you're not urinating into your wounds and the urethra isn't compromised, I don't think you should have to worry about urinating causing issues.

What did the doc say at your post op?

Hope you're feeling better soon.

[Jello]

Hi Dex, thanks for the information. At my first post op, I asked Dr S how my surgery went. He said it was good but I didn't have a lot of growth so he had to maximize every millimeter I had.  My swelling has gone down quite a bit but I still can't really see my phallus except it looks like a bulb. I noticed I have a small opening at the top of the back of the scrotum as I could still see seeping and drainage from there quite a bit. With my necrosis at the bottom tip of the scrotum, he said that the black dead scab will eventually fall off and basically it'll have to heal from inside out. But because of the necrosis, I also have a 2inch opening front and about an inch back right above the necrosis that I have been packing. They didn't tell me to wet the gauze, all they said was to stuff the gauze lightly into the opening, which I have been doing. It's been 3 days I don't think I noticed any improvements. And I keep wondering if I could have stretched the opening further with the packing...
I tried urinating today. Because of my short length basically the urine would just fall along the scrotum, and because of the necrosis and the opened wound, the whole scrotum will be wet. I literally had to shower each time I urinated. I hope it'll be easier as I heal. And because of it, I couldn't really see if there was any fistula....
I'll be going for my last post op on Tuesday to see dr C to take out the suprapubic catheter. I hope they can give me better instructions on how to care for it going forward.

[Dex]

Hey man,
That swelling is going to be miserable for a while. Do you live in the area or will you have to travel once you are released to go home? That travel day for me (on day 18 post op) was the absolute worst. I live in Wisconsin so it was a full travel day between airport, layover, drive home from airport.

With the packing, yeah it's tough because you really don't see a lot of progress straight away. And you definitely don't see progress day after day. I'm not sure if they explained it to you the same way they did me but they said it would be weeks of nothing looking different then it would make a ton of progress all at once. That was exactly correct for me. It was about 5 weeks of no change at all followed by a couple days of rapid healing. As long as you are not packing it tightly, you shouldn't have to worry it's making it worse. I thought that too, particularly with the opening in front, but it healed just fine. Anywhere I was weeping from by 2 weeks, I just put packing in. Your separation underneath sounds the same as one of the ones I had (if I'm interpreting right). If so, I found the easiest way was to fold a piece of packing or gauze and just tuck it up into the crease/incision under my scrotum.

Hopefully once the swelling dies down further (and that took 2 months to feel better and 3-4 months to feel 100% for me), urinating will be easier on you. Everything gets easier as you heal, definitely. If you're concerned about the urinating with your incisions, I would just ask Dr C when you see him Tuesday what he recommends. Maybe there would be a way to prevent it from running into your incisions or at least a way around having to shower every time you have to urinate. That's gotta be miserable.

Keep me posted, man. Keep your spirits up. I went through a tough patch for a bit when I didn't feel like I was healing quickly enough. I typically do get a bit of post-anesthesia blues and having healing issues did not help in the slightest. But you will heal up. And you will get through it.

Will you be going back for testicular implants? If so, it may be a comfort that they can fix or improve a lot of minor aesthetic things in that surgery as well. I know knowing my maximum amount of time dealing with the last two issues I have was only til April was helpful to me.

[Jello]

Hi Dex, thanks for the encouragement. I could not imagine travelling 18 days post op. I live in Canada so it will be a full day travelling for me and I postponed it to 30 day postop. I live in a small town so not much of a medical support there.

I was able to take a closer look today and I think there is a fistula at the back of the scrotum which dribbles pretty much as fast as through the phallus. I'll definitely bring it up. I guess I have definitely underestimated the number of potential complications or maybe I'm just unlucky.

Anyway yes I plan to be back for implants and monreduction, and potentially whatever repair that needs to be done. I don't know much about it but I really hope it wouldn't be as extensive as this one.

[Dex]

My next surgery (less than 3 months away!) is pretty much the same - testicular implants, monsplasty, buried penis repair (to make as much of the phallus as possible visible).

I've heard from other research I've done - the first metoidioplasty surgery is really trying to get a good foundation laid down. The next surgeries are about tweaking things to make it the best it can be by making improvements aesthetics wise and function wise. With my first surgery, I was told to expect 8-12 weeks off and went back to work after 6. With my next surgery I was told to expect 2-4 weeks off and I only have to be in Texas 1 week. So just from a recovery expectations standpoint, it seems the subsequent surgeries are easier to recover from. It makes sense, I guess. The first surgery is basically a complete reconfiguration of your lower hardware. That is quite a bit for your body to attempt to heal. I think Dr C mentioned to me once that all incisions really are is putting two pieces of your body together and asking it to stick.

I will agree that I don't feel like I was prepared for the swelling and wound separations I had (emotionally). We actually talked to Dr S about how it's hard to understand just how much swelling and such there will be. He said they try to prepare patients but that is one area they are always trying to improve on because it's hard to describe with words in a way people understand.

I would say that has been the case for me with every surgery I've had, though. I had a congenital impingement of my hip that went undiagnosed until an injury when I was 29. That surgery was hands down the worst I've ever had to recover from. And I was completely unprepared for how uncomfortable I would be and for how long.

However, the body has a great capacity for adapting and for healing. These setbacks are tough and frustrating, but you'll get through it. Even with the setbacks I had, I am immensely happy with how things are and am excited for the last step. Trust that your body will do what it needs to and that there will be options for you in your subsequent surgery to improve what you end up with.

And awesome about being able to stick around through 30 days post op. I was getting pretty homesick by the 18th day and it was nice to be in my own bed. It was an extremely unpleasant travel day though. And I didn't even have to go through customs. I don't envy you that.

[Jello]

Went for my last post op appointment today. Had my suprapubic catheter taken out. Since then I have been urinating every hour and half or so, which is quite annoying as each time I have to change the dressing. Urinating takes a while too as the flow isn't strong and it's stop and go. But I think I have felt better. I am glad I didn't take the doctors suggestion to fly home the next day as it would be horrible to journey home with such an active bladder. I have started taking the antibiotics for the bladder infection as well. I hope my bladder will settle soon and that I will get used to all the works involved with urinating (washing hands first, plugging the wound opening at the back, wipe down the scrotum afterwards, repack the wound front and back), until all wound is healed. I'll report again after a couple of weeks. Thanks for all your support Dex. I really appreciate it.

[Dex]

Yes! Changing dressings every time I had to urinate was absolutely the most irritating part of the separations I experienced.  I was packing my wound in my perineum for almost 3 months. It was especially burdensome on vacation when we were out and about a lot and public restrooms are not the cleanest. But now that I have no packing, it's not been a big deal at all. Just slightly annoying.

Hopefully the antibiotic works quickly. An infection is definitely a contributor to urgency.

I hope the next few weeks bring some healing and less hoops to jump through.  I try to stay somewhat active on the forums so I'll keep an eye out for any questions.  A lot of guys tend to drop off after bottom surgery, especially, which kinda leaves a vacuum of information available online post op. You can always DM me as well. Good luck on your travels home!

[Jello]

Hi Dex, I couldn't DM you but have been thinking about how your surgery went. Hope all was good.

[Dex]

It's not quite here yet, but less than 2 weeks away now.

My wife and I leave on 4/23 and my surgery will be 4/26.

I've been having a hard time concentrating on much other than getting back there and getting this last step done. It's almost all I can think about haha.

I will definitely keep the thread updated with my pre op and post op experiences.

Hope you're doing well as well.  How has your healing been? Hopefully you're feeling back to normal at this point?

[Jello]

My recovery was okay. The necrosis healed up. Because the doctor said I didn't have a lot of growth, even with the urethral lengthening I still can't urinate standing up. It would drip down through the scrotum. Also, there is a tiny hold on the skin surrounding the head so urine would sleep through there. I think at times there are days where there is discomfort, probably the nerves. I do hope to go back for a revision but not sure what they can do to make things better. Ill check it out probably in a few months time.

[Dex]

Sorry to hear your healing hasn't been going great. I'm glad the necrosis healed up but that is a bummer about the fistulas.

It's certainly worth asking what they could do in a revision. At least you'll know what your options are.

Are you mostly back to normal now? Activity wise?