T'was The Night Before Surgery

January 31, 2005

VGP Days to go: 1
Stress Level; Low Pre-op Day

It takes me a few days in the same hotel room with the same bed before I can sleep well, last night was no exception. I had my usual “strange bed and room” unrest for part of the night. I got up a 4:30 AM to make a bathroom stop. I got back in bed trying to catch some more zzzz’s with mixed results. Eventually, we got out of be at 7:11 AM. It’s time to get ready for my appointment at Dr. Meltzer’s office.

We arrived at Dr. Meltzer’s office at 9:20 AM, about 10 minutes earlier than my scheduled appointment time. Jen and I waited for a short time in the waiting area. Since we had some time and not much to do we took some pictures of us in the waiting area. I checked in with Robin the receptionist and she told me they were ready for my pre-op appointment. Cheryl came out and we followed her into one of the exam rooms. I sat down in the dental chair where Dr. Meltzer does the exam and waited with Jen sitting in a chair off to the side. A few moments later Janet on of Dr. Meltzer’s nurses came in, it was all hugs and hello from all of us. Janet asked Jen how she was doing; Jen told her pretty well except for the stream direction. Janet handed me the surgery consent forms to sign, I looked them over and began to initial and sign them. Janet asked me to open my mouth so she could take my temperature with a disposable strip thermometer. I don’t remember exactly what was said at the moment, what I do remember was laughing so hard that I nearly dropped the thermometer out of my mouth. Jen got a picture of this rather funny moment. There was a knock on the door; it was Dr. Meltzer with his usual happy smile. He got the tires we sent him a while ago. The topic of tires came up during one our bicycle chats in October 2004 when Jan was here for her VAG. We chatted about his new bike, his old bike, pedals, and some to the places to pedal in Scottsdale.

We chatted a bit about his uncle who was a doctor when he was still trying to figure out what he wanted to do in the world of medicine and how his uncle influenced him in the health care profession. Years ago, I would have dinner with Dr. Meltzer’s uncle since my sister in law worked for him. He was one of the last doctors I knew of that did house calls and he always had a real interest in his patients on a personal level. He was simply a truly caring individual who practiced medicine. Dr. Meltzer told me his uncle influenced him quite a bit as to what it means to be a doctor who cares about his patients. While doing technically difficult surgeries were intellectually satisfying, it was not personally satisfying in the way taking care of his TG / TS / IS patients were. I honestly believe the TG / TS / IS community is very lucky to have Dr. Meltzer as a doctor & surgeon in this specialty.

The topic of the rising urine stream problem came up and I told Dr. Meltzer that I believe it was rather unpredictable due to the many variables like swelling, the process of healing, individual anatomy, effects of dilatation, stray hairs that can get in the way and etc. He appeared to agree with my observation. Stream direction is usually corrected during labiaplasty, it’s an easy fix according to Dr. Meltzer. He asked Jen if she would like to have her stream direction adjusted while she is here, Jen thought about this for a moment and decided to wait. The topic of body position came up as one of the ways to deal with stream direction. The next topic was my lack of genital electrolysis; this was something he found I did not need during my pre-op exam in July 2004. I was still concerned. With that, we proceeded with my pre-op exam. After a few moments, he confirmed that the hair and me not having any electrolysis in that area was not a problem. As the exam continued he noticed something missing, it was Bert and Ernie. We all began to laugh with this discovery and I told him I had an orchiectomy done several years ago.

The last topic of discussion was me being not circumcise and how that would affect this procedure. Dr. Meltzer started to describe what was done differently in my case with medical specific language that made my head spin. I told him I don’t understand and he got some paper and pencil to draw what was done different. It turns out the skin fold under the gland of the head of the penis tends to neck down smaller so the dissection, incision is made length wise and the graft shape is like a leaf rather than being a simple end extension which is the case of a patient who is circumcise. I also asked him if it would be possible to make a clitoral hood during this procedure, his reply it usually does not work very well partly due to the amount of surgery done in this area and blood supply. So the best results come from the two step procedure. It is generally better than a single step procedure for overall results. I asked about this due to the experience of other patients who were not circumcised and had to deal with a hyper sensitive clitoris post op. Jen asked about pictures, his reply was no pictures are needed. Jen asked if he would like to see the results of the lipo she got done in October. He said sure and handed Jen a black robe. Jen put on the black robe so Dr. Meltzer can do an exam. Dr. Meltzer and Janet returned a few moments later to have a look. The results were really good and he did want a few pictures as a before and after comparison. We all went off the photo area for a few pictures of Jen’s lipo areas. Pictures done, we headed back to the exam room where I sat down in the exam chair again. Dr. Meltzer asked me if there were any more questions, no we were pretty much done. I did want a picture before we headed off and Jen got two pictures of me and Dr. Meltzer. He left the room and went on to his next patient. Janet returned to our room and gave me instructions for the bowel prep. Finally, we were done.

There was a Starbucks near by and we stopped there for a drink, Jen ordered a Mocha and I ordered a hot chocolate. Jen and I sat down on one of the sunny tables outside. Dr. Kay (retired surgeon friend, also T*) called to say hello and see how I was doing. I told her OK and chatted about stuff for a bit, then passed the phone onto Jen for her to say chat for a while. We enjoyed the sunny Scottsdale day for a while longer before heading over to Landis bike shop where Jen purchased a Landis cyclery water bottle and sort sleeve jersey. Then it was off to Target for a few items we forgot to get yesterday night. This was when I began the, “drink 8oz. of water every hour process.” I don’t have any problem with drinking lots of water or a clear liquid diet.
The only problem I have with this it my need to pee often and sure enough, this is exactly what happened. When I go off on bike rides that are several hours long a liquid diet is preferred and lots of drinking is a must.

Our next stop was Safeway to get Jen some food and me more stuff to drink. A young woman stopped me in the parking lot to comment on my long hair. She told me it reminded her of a Japanese female cartoon character with hair just as long as me. She asked me how long I have been growing it, I told her about 10 years. It was the first time she saw hair this long. After our Safeway shopping trip we headed back to the Holiday Inn to drop off our stuff. The cold stuff went into the fridge and the rest put away where they were needed to be.

Now we had some quite time to relax before visiting the Greenbaum hotel to say hello to familiar faces like Julie, Nancy and the rest of the nursing staff at the Greenbaum recovery (hotel) center. When we got there, it was like old time again, Julie was on duty and so was Nancy. I told them we are back and now it’s my turn so we will be spending the next several days here again.
Jen said it felt a bit strange going back there as we both have many memories from that place back in October 2004.

After that visit, we went back to our hotel room to continue the bowel prep process. Jen went out to get a coffee grinder and filter just like what we did in October. I’m in a pretty good mood overall, not very nervous at all, not fearful, not excited, not stressed. I guess having done this with Jen in October, knowing most of the personalities involved, having been thru the surgery process before, and knowing what is about to happen to me makes a significant difference in how I feel about the whole experience.

At a few minutes pass 5:00 PM, I drank the entire 10oz. bottle of Mag Citrate, It took two gulps to do this. The stuff was just as I remembered it when I tried a little from Jen’s night before surgery. It has a carbonated slightly salty, sweet lemon line flavor, similar to some sports drinks I have tried, but less drinkable and something you don’t enjoy drinking. I gave my hair a good wash and conditioning. It’s going to be several days later before I can do this again.
This is when having really long hair is a real problem.

Jen came back from her shopping trip with a coffee grinder and filter in hand. She got the same coffee grinder we got the last time. The problem will be what to do with the grinder when it’s time to leave for home. Jen made some coffee with the new grinder and coffee filter. Yes, that coffee is good. Home roasted coffee is a real treat that can get you spoiled.

8:00 PM, it’s time for the Bisacodyl suppository. With a bit of KY gel, I put in the suppository and waited. My tummy now feels like a bomb ready to go off. I lay next to Jen to rest for a while. In just about another 30 minutes, it’s time for 4 Bisacodyl tablets. All this was happening while Jen was watching 24 on TV. The 8:30 Pm commercial break came and Jen got me out of bed to take the 4 tablets. Down they went one at a time with some water. About 15 minutes passed and I made a trip to the potty. Just as I got started, my cell phone rings. I call out to Jen and ask her to answer it. The caller was Amy and Jen passed the phone to me. She was calling to see how I was doing and I told her what I was doing at that moment. “Would you like me to call you back later?” No, I can chat while I do this. So, we compared notes from her trip here in July 2004 and a few other things before I said goodbye.

It’s just after 11:00 PM and the plumbing is finally beginning to feel like it’s settling down.
I’m headed off to bed now and hope to get some degree of rest before I need to be at Greenbaum at 10:00 AM. One last shower in the morning, take my last pre-op meds and Jen will drive me over to Greenbaum. Then, the wait and real fun begins..

February 1, 2005
Surgery Day
Stress Level; Low, Calm and Resolved To Get On With The Process

I got up this morning with an amazing sense of calm. The whole pre-op process from yesterday got me a bit tired. Jen and I got up earlier this morning before sunrise and we watched the colorful sunrise together before going back to bed. I did not sleep all that well but managed to get rested enough until we finally got out of bed at just after 8:00 AM. I took my last pre-op meds this morning completing the pre-op process. One last shower before getting dressed to head over to the Greenbaum Surgery Center Where I will be for the next several days.

This will be the last time I get to listen to Loreena McKennitt for a while too.

10:00 AM, we arrived at the Greenbaum  Surgery Center and signed in with the receptionist. A few minutes later, the other receptionist called me to the desk to verify my Identification and information. I did this with my passport and Driver’s license. She noticed my long hair and we started to chat about owning long hair, it turns out she is a fan of long hair. She asked me to check my information on the ID tags, it all looked fine and this was passed on to Jen, one of the 

intake nurses. She escorted me into a room where she took my vitals and once again verify my personal information. She also commented on my longhair and asked how long I have been growing it, I told her about 11 years. I noticed they had a computer on the net, and told her where there is a picture of me. I typed in the URL and she liked the picture on that web page. I asked nurse Jen to braid my hair and get me two hair caps. She went off and got two hair campo and she braided my hair as I sat down in a chair. I learned how to deal with my hair from a previous surgery. It was the only thing we found that worked the first time and still the best solution for my hair. Nurse Jen asked what my height was, I told her 5’ 7” and she handed me a gown to change into then left the room for me to change. Everything that has happened so far is nearly identical to the first time I had surgery. Once I had changed, with a knock on the door, a different nurse took over, Dana. We finished gathering up my clothes and patient information, then she escorted me to bed# 11. I got on the bed and Dana proceeded to install an IV into my left arm. The first try did not work, it might have hit a vein valve. On the second try she tried my left hand, I don’t know what the reason was, but that failed too. All this has taken about 30 Minutes and I was on the verge of crying over what was happening. I have not had this much difficulty getting an IV installed in the past. Dana asked another nurse to get this done I don’t remember her name, but she got the IV installed on her first try. The only problem with this IV was the location, it was on my wrist and that prevented me from typing until it was removed.

Once the IV was installed, I asked the nurse to get Jen to come in. Jen has been waiting for a while and was getting worried. We greeted each other with a kiss and she sat down and held my hand as we waited for Dr. Meltzer and the anesthesiologist to visit. Dana gave me a pill, I don’t remember exactly what the name was, but it was used to lower my BP for surgery and then an injection of anti- coagulant to reduce the possibility of blood clots during surgery. In short time, Dr. Meltzer came in to chat for a little while. I told him years ago when your uncle mentioned you that performed this procedure regularly, I would have never guessed that would be one of your patients back then. He smiled and we chatted about the events to come. He had just finished surgery on his VAG patient this morning. I will be his second VAG patient for today. He went off to have lunch made by his wife before we got started. The anesthesiologist came in to see me and asked if I have had general anesthesia before, yes, I have. I told him it was done with a combination of drugs Propfol, Fentynal and Gas. I was also given some Anzemet to prevent nausea. I was certain of being intubated; it’s the norm for this type of general anesthesia. He told me these are pretty much the same meds they will use today. Knowing that I have not had a reaction to these specific meds does make me feel better. As he went off to get some meds, OR nurse Cindy came in and told me she will be my OR nurse for today. I gave Jen a hug and Kiss, told her I love you and she mirrored the same words to me. When the anesthesiologist came back, he injected a sedative into my IV line and I floated off into sleepy land as they wheeled me into the OR. The last thing I remember hearing, “Is she gone? Yes.” I don’t’ remember anything more after that.

The surgery team;

Dr. Toby Meltzer, surgeon

Dr. E? , anesthesiologist

Michael, Dr. Meltzer’s surgery assistant

Cindy, surgery nurse

??? Operating room tech

Surgery Day, Feb. 1, 2005, 12:40PM into OR, 1:00PM start of surgery ended at 4:15 PM.

I remember very little of my time in Post Anesthesia Care Unit. I had no problems with nausea, recovery time and etc. The only thing I remember during that time was a nurse calling my name and I responded. She removed my O2 mask and they began to wheel me upstairs to room 16. The ride in the bed was totally disorienting, I sort of remember going straight, turning, then into a elevator and finally into my room. Jen was waiting for me there and was worried why I was taking so long in the PACU. The wait brought back memories of what happened to Jen’s mom in December of 2004. I finally arrived to room 16 around 6:00PM. I sat up when Jen came over, gave her a big hug told her I love you and thank you. Jen and I chatted about stuff for a while before we watched a bit of TV together. I ate some Jell-O, soup, and crackers. This was the first meal I had since my liquid diet day on Jan 31 and basically dumping everything down the potty from my digestive tract as part of the prep for surgery. I asked Jen what Dr. Meltzer told her about my surgery. She told me that Prep took 20 minutes, and the procedure started at 1:00PM and took 3 hours and 15 minutes. This was less than his typical 4 hours for this procedure. 

Event at this time, my sense of relief was incredible. It felt like a huge burden has been removed from life and will not be back. I was honestly surprise at how I felt so early post-op.

My nurse for the night was Katie, she is the nursing supervisor, but was filling in for another nursing staff member that nigh.

I was tethered to my bed by an IV, vitals monitoring, urine catheter, two blood drains from my sutured together labia, calf compression stocking to reduce the possibility of DVT and a ice pack on surgical site. I also had Patient Controlled Anesthesia control button. This controls an extra dose of pain meds (meperidine) depending on my needs in addition to the timed program dosage. The pain level as not that high so I that I used the PCA much over the next 12 hours. With all this stuff hanging from me, I was not going anywhere for a while.

I did not sleep well that first night due to all that racket coming from the IV pump, DVT compression device, vitals monitoring device. I was in a state of semi sleep. I felt OK, but I was tired from the events of the day.

Karen a nursing assistant came in several times during the night to check up on me. That made getting any real sleep difficult. Jen stayed with me in our room that night to make sure I was OK. Back in October 2004, I slept in that same recliner and I can tell you, it’s not comfortable to sleep on, it’s lumpy, and hard.

Katie came in at 7:00 AM to take me off the PCA. She asked me if I wanted another hit, I told her, Na. Katie told me some patients like being on the PCA, it’s not surprising since meperidine is a narcotic similar to morphine.

Post-op Day 1, Feb. 2, 2005

This was basically a bed rest day. Charlotte was my nurse for the day. She was Jen’s nurse when we were here in October. Other than trying to get comfy in bed and dealing with all the drainage from the surgical site, dealing with ice bag, and Charlotte changing my IV meds of IV fluids, IV antibiotics and etc, it was a pretty uneventful day.

Janet from Dr. Meltzer’s office came in to do a quick exam and check on me to see how I was doing.

This is the same day I was switched to oral pain meds. I have taken perocet the last time I had surgery and worked OK for me the last time, so I chose the same med again knowing it would be OK. I tend to try not taking any meds if I can. In the case of the pain meds, I should have taken them more often today than I did. It would have made things a bit eaiser.

There was another problem that I’m concerned about, I was not circumcised, those who I have spoken to about this had a hyper sensitive clitoris, sure enough this might well be the case for me. It’s a good and bad thing. 

About 1:00 PM Dr. Meltzer and his surgical assistant Michael came by to see how I was doing. We talked a bit about my surgery. He told me that the procedure took 3 hr & 15 min, less time than usual. Everything went well and nothing out of the ordinary. My blood loss was less than 100cc during this procedure. I was a bit surprised that so little blood was lost over a bit more than three hours of surgery. When I asked Dr. Meltzer about this, he told me since I was a well trained aerobic athlete, you can easily allow the patients blood pressure to be in the 80 / 50 range. This means you bleed a lot less during surgery and the vascular system can tolerate this well. Jen had loss a similar amount of blood during this same procedure. Blood loss has an effect on overall recovery.

I was feeling icky from all the stuff that has happened over the past few days, so Jen gave me a body wipe down with some wipes similar to baby diaper wipes, that felt nice when we were done.

The nurses would come in once ever so often to take my vitals, when they do this during the night, it can get annoying.

We had dinner together in my room and Jen stayed the night again to make sure I was going to be OK. 

I called a few friends to chat and returned a few phone calls. I got some pain meds from my nurse took them and went to bed.

The level and quality of care Dr. Meltzer’s patients recieves is nothing short of special in today’s world of HMO’s and mass production health care. In some ways, many of Dr. Meltzer’s patients and staff is like an extended family. Dr. Meltzer has stopped by every day to spend time with his patients and see how they are doing. He would ride his bike on weekends and stop by Greenbaum to check on his patients to see if they were doing OK, answer any questions or deal with problems that might come up. He would change from his bike clothes and put on his scrubs to do rounds. How many doctors do you know who spends time with his patients in this way? 

:)