21 Days Post-Op

Today marks 3 weeks since my RFF Phalloplasty with Dr. Curtis Crane in Austin, TX. I'm happy to report that quite a bit has changed in the last week. I had my second hand therapy/OT appointment and my second post-op appointment with Toni and Dr. Crane this week. I'll admit, it's been hard staying up-to-date with this blog for a number of factors. My mental processing is still pretty slow, I have a hard time concentrating for long periods of time, and my arm is relatively immobile and achy a lot of the time. All of this makes it hard to type at length. I'll go back and do a 1-week and 2-week recap in the next few days.

Overview of Changes - Good News
The big highlight is that I continue to feel more and more like a normal human being. I still have a hard time concentrating and my mental processing and memory are subpar. However, I can tell that my brain is clearing up (thanks in part to getting off narcos) and I've been able to start reading and playing board games again. I'm beginning to get tired of watching TV and movies and I really can't stand being nakey from the waist-down all day, so I started wearing loose boxers. I feel better being able to wear clothes!! And it's nice to have some dick coverage. I wear the boxers and sometimes sweatpants over them most of the day and even on short rides to pick up food or something, but if we're going to a doctor's appointment or making an excursion, I put the mesh briefs on to strap the little guy in.

It looks like my phallus is healing well, although I'm such a competitive person that I kept wanting to hear from the docs that I'm ahead of schedule or that I'm healing exceptionally well. Really? I can be such a teenager sometimes. Back to my phallus - some of the spots that were black (primarily on my scrotum and along the glansplasty) have sloughed off and turned to pink and the swelling in my scrotum has gone down noticeably. It has a little movement to it that it didn't have before and is starting to look more symmetrical. One side, probably where the drain was in, is still misshapen and hard/firm. The swelling has gone down slightly in my phallus, but it is only noticeable in the morning when it feels less full and has a bit more flexibility to it. By mid-day, it is back to feeling full, heavy, and more rigid. We are using less bacitracin on the wounds in the genital region since some of the suture lines, like the one under the phallus, are already healed up.

The swelling and pink appearance of the suture line along my right hip/pelvis for the artery and nerve hook-up has gone down. However, a small portion of the suture nearby appears to have opened up a bit. I sent Toni a picture of it via text late last week and she said it looked okay and to keep and eye on it. She was still unconcerned by the time she looked at it at my post-op appointment. Either way, I've been putting MediHoney on it and that seems to help keep it from opening up further. I anticipate that area will scar more heavily.

I got the staples out of my arm!!! Boy, they were bugging the crap out of me and I couldn't wait. I could feel the ones along my wrist and they were soooo uncomfortable.  It's amazing how many Toni took out! (Of course, we thought we got them all, only for me to find 2 more in the shower later that morning. They were hidden by large scabs. Yuck.) Only a few of them hurt coming out. For the most part, I couldn't feel them being removed, fortunately. Parts of my arm graft are healing very well. There's a section that's clearly miles ahead of the rest. It's looking nice and pink and healthy. And, I'm getting more mobility in my arm back. It is still hard to flex my wrist back (little to no movement), but flexing my hand and fingers forward is getting better as is rotating my arm in/out. It's hard to rotate it outward, but that's still progressing. The pain on my thumb is decreasing/changing, but definitely not gone. I'm not sure how long it'll be here. It's annoying and one of the more painful parts of this whole experience.

Now that my arm, overall, is healing well, I can wear the brace sparingly. My hand therapist also suggested that I use HTCC.org to find a certified hand therapist back home to continue my care. I called someone a few minutes from my house and I'm waiting to find out if they have experience with grafts and wound care. Back to the brace - mostly, I wear it when I'm sleeping and when we're out and about running errands. I don't want to accidentally bump into anything this early on. Also, I am able to shower with the dressings off and use a mild soap (Cetaphil) and water (not directly from the shower head) on my arm. I was incredibly nervous the first time I did this. So nervous, actually, that I kept pacing around in front of the shower and finding last minute things I simply had to do before getting in. It was laughable. I didn't know what to expect or what it would feel like. Clearly, I survived the experience to tell about it. I must say that seeing my arm exposed for that long was, well, creepy. It's totally creepy looking. But, I gotta give thanks to the selflessness of my left forearm for donating most of its skin to my dick. Thanks, Lefty!

In the past week+ I was able to reduce my narcotic intake from 2 pills every 4 hours to 1 pill every 4 hours (Tylenol every 6), and then to 1 pill and 1 Tylenol every 6 hours. Today I'm trying out 2 Tylenol every 6 hours. I'm still on a full dose of Ibuprofen - 4 pills every 8 hours. Don't get me wrong, I'm still achy and in pain, particularly my arm. But, I know it's going to be a while before that's totally gone. And, I discovered yesterday that I had gone an hour without noticing I had missed my dose of Ibuprofen, which tells me the pain is lightening up. I'm not in a race to get off narcotics, but I also don't want to drag out my use of them. Weaning off of narcotics is a precarious thing for numerous reasons. You can experience physical pain from withdrawals, which is not the same as actually having pain from your wounded areas. That makes it hard to trust your body as to whether or not you really need them. I also found that no one really tells you how to do it. I've looked up tapering guidelines and they're primarily directed towards people taking much higher doses than we get. They suggest going down 20%-50% of the dose each week and increasing the intervals. I found this Opioid Tapering document fairly helpful although, again, the focus is on higher doses than we're on. If it gives you some perspective, I as able to go from 2 pils every 4 hours to Tylenol in about 11 days. Toni suggested taking the first two steps that I mention in terms of lowering the dose and increasing intervals, but not how to get off them entirely. Another thing to keep in mind is, as the narcotics are replaced with Tylenol/acetaminophen, make sure that you're not exceeding the daily amount of acetaminophen. Research over the last several years has shown overdoses of this drug to be deadly! Seriously, don't F around. The narcotic I was given was mostly acetaminophen, so tapering off meant that I could only take 1 extra strength Tylenol at each 6 hour interval until I was completely off of the narcos, then I could up it to the full dose of 2 ever 6 hours. The bonus to fewer drugs/longer intervals meant longer periods of uninterrupted sleep throughout the night. Hell freakin yes!!!! What a gift!

Last, but not least...drum roll, please...I get to try urinating out of my phallus tomorrow!!! Woohoo! I am ridiculously excited and pretty darn scared, too. The process of urination tends to reveal all of the trouble spots that haven't healed yet and many guys find that they have small holes (fistulas) that urine leaks out of, usually behind the scrotum or between the scrotum and the phallus. It is incredibly common and Toni told me to be prepared that it might happen. The majority of these heal up on their own by 3 months post-op, but if that's not the case, then a revision surgery is necessary. The goal is to urinate 2/3rds to 3/4ths of the contents of my bladder out of my phallus and empty the remainder from the catheter. If I can do this successfully and consistently by the time of my next post-op (on Tuesday) and there is little to no leakage elsewhere, then I can get the suprapubic catheter out. I don't want to get ahead of myself, so we'll see how it goes. If I have to leave it in for longer, no big deal. It's not too annoying and it sounds super easy to remove on your own. I'm simply thrilled to be able to try peeing from my dick. That seems pretty spectacular all on its own.

Wish me luck!

Challenges/Bummers
I thought I'd start this week off by sleeping in a normal bed with my partner and pushing the sofa bed I'd been sleeping on back in for good. To me, this seemed symbolic of the next step in the healing process and had me feeling like I was getting back to normal routines. Well, it didn't quite work out. The rental we have has a master with a double bed. I'm pretty sure we were not entirely comfortable sleeping in it together before I had surgery. There simply isn't enough room, especially now that I need to be on my back and use extra pillows to prop up my arm. I woke up with a sore arm, feeling defeated. It was easier to reconcile this loss when I remembered that the pull-out bed gave me all the room I needed...and, I'm still healing. It's a much longer road than I want it to be.

Now on to my body. The hair on my phallus that I didn't get completely removed from only 6 months of electrolysis has grown in and while it doesn't look horrible, it's a bit hard for me to see. I feel sad when I see it, like it is some marker that I don't quite yet have the penis that I want. I'll have to wait until I'm 4-6 months post-op before resuming electrolysis and hopefully it'll be quick and relatively painless. Even though I built up a great relationship with my electrologist, I'm feeling more sheepish than I ever imagined about going back to see her. Undoubtedly, I will. Still, I didn't expect to feel so...um, modest? about the whole thing. When I think about it, I'm not sure why I'm so surprised by this. It is my genitals after all.

Another new development that is relatively annoying is that the plastic-like thread they use to suture the wounds is popping up all over the place. There are these clear thread spikes all around the top of the glansplasty and on the sides and undercarriage of my phallus. Some of them seem to be growing in length, too. Toni said they'll fall out on their own or I could probably even pull them. I took a deep breath and tried on a few, but they wouldn't come out. Why am I complaining? They catch on everything and scratch the side of my leg when my penis is resting against it. Also, some of them seem to be opening up part of the suture as they break through the skin. Like the staples, that'll be another thing that I'll be happy to have gone, sometime soon I hope.

The skin graft on the top part of my forearm isn't healing well and I'll need to keep putting dressings on it for at least another 2-4 weeks longer than normal. Many guys get to switch from an arm dressing to a sleeve at this point or within the next week and that won't be the case for me. I had a feeling this was the case since that part of the graft is obviously a different color then the rest - mostly yellow/pale white with some spots of red showing through. There's no sign of infection, but Toni and Dr. Crane want me to keep an eye on it in case it does get infected. The hand therapist said her impression is that it's healing from the inside out, which is why you can see the healthy red parts coming through. I think it's supposed to all turn that reddish color before healing like my other grafts.

Soon after surgery, my partner noticed that I had a little piece of skin, a skin flap, in my butt on my perineum. Once I was able to feel around back there, I found it and it was pretty noticeable. I mean, in a flat crack anything would be and this small flap of skin definitely is. It's not a huge deal, but it's something that my mind continues to obsess over. We'll be riding in the car and I'll think to myself, "Great, I have a fucking flap of skin by my asshole. Gross." I talked to Dr. Crane about it and he said that it happens sometimes when they're closing things up and it's better to let some of the skin poke through like this rather than to have the opposite happen. He said it should go away on its own or he'll remove it when I come in for my next stage. Nevertheless, it's unpleasant and it makes me feel a little weird about that area of my body now.

Another thing that is on my mind, which may sound silly is that I have no idea how I'm going to get my dick into underwear. It's a big flaccid penis. I'm getting suggestions from guys on FB and I think it'll be trial and error for a while. Luckily I still have another 6-8 weeks before returning to work, so I have some time to figure it out. Yikes! I'm worried I might have to get some new pants, too. I hope it doesn't end up costing too much.

OMG, I almost forgot - Anal Cramps! Yep, you heard me right. Two nights this past week I woke up with severe cramping pain in what felt like my asshole, which I found out later was the spasming/cramping of my perineal muscles. Holy shit it hurt! The first time, I couldn't move and screamed to my partner (who thought I was dying and panicked), and in his moment of fear was able to get me the right medication - the muscle relaxers that were prescribed specifically for bladder spasms. We figured, what's the difference between spasms? and we were right. Within a few minutes, the pain started to subside and I could go back to sleep. When it happened a few days later, the pain wasn't as bad, but it lasted longer or seemed like the medication took longer to kick in that time. I really hope that's behind me now (pun intended), but at least I know what to take for it.