Sunday, April 8, 2012

The Final Countdown to Gender Confirmation Surgery

We are in the home stretch before DJ's gender confirmation surgery.

She's had her pre-operative physical performed, lab work taken, therapists and doctors will be penning their letters of endorsement, hopefully, within the next couple of weeks, she is nearly at the point where she discontinues her contra-hormone therapy (and will apparently experience a "menopause"-will the fun never cease?), she has completed all electrolysis/laser hair removal requirements so that scar tissue will be concealed, has been measured for her new breasts (I joked that it will be a family tradition that the women in this family get their boobs "done."), and will inform her dietician of her post-surgery nutritional requirements since she will only be allowed fluids for two-three days prior to and following surgery.  We still need to shop for a few items the surgeon recommended for her comfort post surgery but for the most part, at this point, it's a waiting game.

DJ's most recent visit with the team at her surgeon's office was informative and comprehensive in laying out what we can expect for her recuperation.  DJ will be having a tracheal shave, breast augmentation, and neovaginoplasty all of which will be done on the same day. Each procedure has its own healing requirements.

For instance, DJ will be FORBIDDEN from speaking for two entire days following her surgery.  Even whispering is a no-no since it is even harder on the vocal chords than regular speaking.  While the tracheal shave does not involve the vocal chords directly, the means of locating the exact location indirectly involves the vocal chords, so that is why they are not to be used for two days, I'm assuming to avoid damage as a result of possible swelling in the area.

While DJ is to be absolutely silent for two days, she also will be completely bed-ridden for the same amount of time.  This is a requirement for the neovaginoplasty.  Let's face it-an entire new orifice is being created.  It will, for the rest of her life, be in constant defiance of gravity.  Certainly, giving that new interior vagina a chance to "stick" for two days is not too much to ask.  During this time, DJ will experience the thrills of having a urinary catheter.  Again-a new means of urinating is being created. Perhaps saying a new urinary tract would be more apt.  They are taking the urethra, the tube through which urine passes to exit the body, and redirecting it.  Tissue that has been "messed with" tends to want to close up, so putting a catheter in place to keep it open and to allow waste products to leave the body is a requirement for a week following the surgery.  This is a good thing because remember, she will be bed ridden-how else will she relieve herself?

Speaking of relieving herself-her urinary relief will be addressed, but what about the other means of relief?  For the first couple of days, she won't likely have that necessity present itself because three days prior to the surgery, she begins a liquid diet.  The day before the surgery, she will drink something akin to milk of magnesia which will cause her to eliminate all the contents of her bowels in the day before the surgery. This is HUGELY important.  Considerable organ manipulation will be taking place during the surgery.  Keeping the area as free of contaminants as possible makes perfect sense.  Immediately following surgery, she will begin taking stool softeners so that when her colon does begin working in earnest again that she will not have to "strain" in any way to perform that necessary function and hopefully that area will be spared any unnecessary pressure, if you know what I mean.

It's a damn good thing that the surgeon and the eating disorders folks insisted on the healthy weight that DJ has been maintaining successfully (high five to DJ) for the past couple of months because she will likely lose a few pounds being on a liquid diet for 5 days.

The procedure that is likely to cause her the most discomfort, according to the surgeon's team, is the breast augmentation.  The breast prosthesis will be placed under the muscle in the chest wall for better protection against rupture.  DJ was initially reticent about the breast augmentation: she wanted to have it done but was frightened about the possible side effects as a result of the prostheses rupturing. The physician's assistant that helps her surgeon run the practice had DJ handle a prosthetic device, which put DJ's mind at ease when she saw how "resilient" these things are.   The next biggest issue is the prevention of scar tissue building up around the prostheses. This requires somewhat vigorous massage in the area which can be unpleasant, to put it mildly. But that can be done following her pain meds.

DJ will likely look like she's been in a car accident from the neck down, at least for the first couple of weeks, because she can expect considerable bruising from all three procedures.  That is not a big deal.  What we worry about is post-operative pain.  She will be "snowed" with medications for the first two days.  Before anyone gets all worried about addiction, etc., most of us in the medical profession know that treating pain aggressively AIDS in the healing process and does not lead to addiction.  Addicts can become addicts when they treat their slight pain by using a howitzer (prescribed narcotics) to manage their pain when it's time to step down to a 22 caliber pistol (over the counter tylenol) to manage their pain.  Bulldog and I are both paramedics who have a core belief system in managing pain because of its inherent advantages in being both a healing aid and MERCIFUL, so we will be watching her like a hawk and nagging the nurses, if necessary.  However, the folks at this hospital are very skilled at managing this specific group of patients.  They are used to it.  They likely will not need two overbearing parents breathing down their necks.

As a family, we've been preparing for this, mentally, emotionally and financially for nearly two years. Bulldog immediately began saving within months of DJ coming out to us, to his credit.  And DJ has been preparing for this, physically, for two years, as well.  Likely, she's been hoping for this for many years beyond that.  We'll keep you informed.  Keep DJ in your prayers, or hopeful thoughts, please.

LGBT info by state

Interested in seeing how your state fares with LGBT issues?  Flying Pig strikes again by providing us with excellent information because she is one TUNED IN Flying Pig.  Please check it out-