I went to West Lake Medical Center this afternoon for my Pre-Operative appointment with Dr. Crane and his PA Toni, who was incredible and able to answer almost all of my questions. In general, I had very few lingering concerns, but some topics haven't been mentioned here or on other blogs, so I'll do my best to summarize the conversation below.
After the appointment, they took me and my partner on a tour of the facilities and I got a chance to chat with an ICU nurse who was very honest about what to expect in the first few days post-op. She's the first person who didn't mince words about how much pain and what type of pains to expect. *Thank you, Pam.* What I will emphasize is that the facilities are small and intimate. To me, this is a plus. The same groups of nurses work there which seems to help with shared experience/knowledge and what looks like a collegial and friendly environment. There are two beds in the ICU and all of the rooms (including the regular ones they move you to after getting out of the ICU) are private and have huge flat screen TVs.
First, here's the plan for pre-op preparations:
- Two days before surgery, stop eating the following types of food: fruit, peas, red meat, course cereal, nuts, beans, fried food, and dairy.
- 24 hours prior to surgery, take a 10 oz. bottle of Magnesium Citrate Oral Solution (can be taken with fruit drink or soda).
- The day before surgery, stop eating solid food AFTER LUNCH and drink only clear liquids, including: water (as much as possible), sports drinks (not red or purple), apple juice or white grape juice, cola, black tea or coffee, Jello-O or popsicles (again, not red or purple), or clear broth.
- Take two stool softener tablets before bedtime and use one Fleet enema the night before surgery.
- You may also shower with Hibiclens the night before or the morning of. This is optional as you'll be wiped down with antibacterial cleansers before surgery anyway.
I expressed my concern to Toni that I didn't want the phallus to shrink under 5" and that I preferred something closer to 5.25-5.5" She said that with the new technique (see below), this was possible and highly likely, but still dependent on the artery in my forearm. I had heard from a lot of guys on the FB pages who landed under 5" that they felt like it was on the small side and some had difficulties with penetrative sex as a result. I don't want mine to be "too big" either and cause problems with finding pants or when working out. But, now that I've left the office I'm thinking that 5.5" is really the size I want and I plan on putting this in my notes that I'll bring with me to surgery.
Another guy recently posted in a private video that Dr. Crane had started using a new technique for creating a more defined ridge for the glans. In this procedure, he used a carving block to create a silicone ridge that he placed under the skin in the way that people do aesthetic body modification work. I asked Crane if he could use this technique during my surgery and he said that he would only do it during a later stage since he wanted to minimize any complications in Stage 1. It's also possible that my glans heals with a defined ridge and I won't need or want the silicone implant. I would like to see a post-op photo of this at least 3-4 months out, too, so I have a better idea as to what the results may look like. For more info on the Glansplasty, trends, and techniques, see my post Glans Decisions.
Changes to Pre-Op, Operation, and Post-Op Care
I was able to clarify a number of changes they've recently made:
- They are starting a new process of having patients irrigate their bladder post-op to decrease the chances of UTIs or other infections. These seem to be common occurrences and can be painful. The staff plans on teaching me how to do this before I'm discharged.
- They no longer require a second enema the morning of surgery - only one is required the night before. Woohoo! One less enema!
- Crane's Vascular Surgeon started a new process of connecting the phallus to a branch of the femoral artery, not directly to the artery itself. The blood flow is great and since it is closer to where the phallus connects to the pelvic region, the surgeon can cut a larger flap from the donor site since the leash from the phallus to the artery doesn't have to be as long. This is making it possible for there to be slightly longer phalluses with RFF than they've been able to do in the past. This is also contributing to a different looking scar where there is more than the rectangle/box frame, but also a triangular/notch located at the end of the flap where they make the urethra - on the lower inside of the forearm and close(r) to the elbow.
- They are no longer using Xeroform as the wound dressing on the donor site. They use a product called Adaptic and will give me about a 10-ish day supply before I leave the hospital to get me started. I have another 12 days worth that I purchased online in advance.
Toni suggested that I don't start my regimen of supplements until I leave the hospital. She said that they've found that some supplements increase the risk of (excessive) bleeding and they want to make sure this is minimized especially in the first few days post-op. I plan to start them the day I'm released from the hospital.
Other Information - Electrolysis, Strictures, and Pain Mgmt.
Toni suggested that I wait 4-6 months before starting electrolysis on my phallus. I had 20+ hours of electrolysis done over the last 5 months, but I was pretty hairy and it takes a while to get through multiple hair cycles. I knew I wouldn't get it all and it's not a problem for the urethra construction. I'm more concerned with the dysphoria a hairy penis is going to cause me. I'll be happy to get back into if and eventually get the hairlessness I desire.
Toni was also able to describe how I would notice if I was getting a stricture - where scar tissue forms and partially or completely blocks the urethra. I thought that this would be something immediately noticable or that it would spontaneously occur. I also falsely assumed that it would occur in the first few weeks post-op and that they'd fix it while I was still in town. This is not the case. Toni said that a stricture is something that could happen between 2-9 months after surgery as a result of scar tissue build-up. If it were to happen, I would notice a decrease in my urine stream. Where it might take a minute to pee, this length of time would increase or I'd notice less was coming out. After 9 months, if there is no change, then I'm likely in the clear.
Last, Toni mentioned that most guys who get a vaginectomy find that muscle relaxers provide the best relief from the pain caused by that procedure. *Good to know!*
Toni was also able to describe how I would notice if I was getting a stricture - where scar tissue forms and partially or completely blocks the urethra. I thought that this would be something immediately noticable or that it would spontaneously occur. I also falsely assumed that it would occur in the first few weeks post-op and that they'd fix it while I was still in town. This is not the case. Toni said that a stricture is something that could happen between 2-9 months after surgery as a result of scar tissue build-up. If it were to happen, I would notice a decrease in my urine stream. Where it might take a minute to pee, this length of time would increase or I'd notice less was coming out. After 9 months, if there is no change, then I'm likely in the clear.
Last, Toni mentioned that most guys who get a vaginectomy find that muscle relaxers provide the best relief from the pain caused by that procedure. *Good to know!*
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