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Post-op: A 20 Day Review

Post-op: A 20 Day Review

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Sidenote: I started this a couple days ago and fell asleep while writing it… Woops. I incremented the days in the title to reflect this.

I’ve been home for about 12 days now and I keep intending to write something… However, sitting in my desk chair is uncomfortable and I don’t really like typing on my laptop keyboard for any length of time, but whatever. I feel like the longer I wait, the less likely that I’ll write anything.

As a bit of fore-warning, I am probably going to be a bit graphic. As such, proceed with caution, depending on your comfort level.

I’m exhausted. Just all the time. Severe lethargy. It seems like the less I do, the more tired I am. Likewise, my pain levels have elevated as well. I guess healing is energy intensive. Who would have thought?

From a healing perspective, things  seem to be mending well, with only one notable exception.  Last Saturday, I popped a stitch. I had noticed the end of the thread had been hanging out since the hotel stay in California, however it didn’t seem to be a big issue. However, the evening, it was totally out.  With the stitch out, the seam of the wound separated.

Monday, I scheduled an appointment with my primary care physician to have her take a look at it. She examined it and she tried to calm my nerves. She said that it has a bottom and it’s not tunneling inside my body, which is a good thing, she also mentioned that the area couldn’t be restitched due to the fragileness of the tissue.

Her suggestion was to stop doing so much. Which she was right. The problem is,  I had been feeling good and I thought I could do more. With that feeling good, the body had not been as responsive as maybe it should be. I can only describe it like getting a sunburn. You really don’t notice until it’s far far too late.

Additionally, she attempted to take stress off the tissue by pulling the skin together and securing it with SteriStrips. The problem with the strips is that when I pee, because everything is kind of swollen still, my pee runs everywhere before it falls subject to gravity. The bulk runs down my labia on either side and then follows that path towards my butt. The wound is at the entrance of the vaginal canal, where it meets the perineum. So when the strips get wet, they lose their adhesion and they come loose. Walking will do the same to a certain extent, especially with a little bit of sweat mixed in with some discharge.   My solution has been to just keep my butt in bed as much as possible.

However, by Wednesday evening, the wound looked like it had gotten larger. I was scared, I was crying… I was inconsolable. Terrified that I was going to ruin everything or end up with some sort of flesh eating infection in my vag, I was just a mess. So I emailed my PCP and explained that it seemed to be getting bigger. Her medical assistant, who’s awesome, called me the next morning and told me to come back in so they could take another look.

So I went in and she was relieved when she saw it, because I guess I had concerned her that it was much larger. She did confirm that yes, it was bigger, and the split had actually gotten into the vaginal tissue. However, she also said that it had tapered itself in such a way that she didn’t expect it to continue to separate further.

Since then, aside from a couple of trips out for food and then Hunter’s 1st Birthday Party, I’ve stayed in bed, on the couch, or sitting on the patio (as I am now). Even the party, I spent the majority of it in a lazyboy with my feet up. This has led to some fairly dramatic healing of the area. I’m sure it’ll be weeks to a month before it’s fully closed. Which is concerning if I’m supposed to go back to work in 2ish weeks. I don’t move much at work, but I have to walk nearly 2 blocks each way to the parking garage and walk up and down 4 flights of steps.

Likewise, the 3x daily dilation regimen will be difficult to maintain with some duration between the 2nd and 3rd. If I get dilate before work, that’d be around 9am. I wouldn’t be able to dilate again until about 8pm and then again around midnight. Basically means I’ll lose 1.5-2 hours that I could be spending with family/friends in my already short evening.

As for the pain, I’m still in a lot of pain most of the time. One would think that the pain would be between my legs, inside the actual vagina, or the wound separation. However, the bulk of the pain is in the pubic area. There’s no visible bruising, but deep down in the tissue, it’s miserable. I’ve just finished my 2nd bottle of percocet since being discharged and I haven’t been taking as much as I would like. I’ve tried replacing it with high dose ibuprofen and it only takes the edge off. Might bring 7-8 pain to a 4 or so.

Still waiting on my surgical declaration letter from Dr. Bowers. I want to get my birth certificate updated before Governor Bevin realizes that it’s legal for me to do so. My luck, he’ll repeal the law in an emergency special session.

More later, stay tuned.

Summer Skin

Summer Skin

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As the dressings were removed, I felt the new life I’ve been leading had been validated. In reality, it was the same life. It just looked different to everyone else. I felt like it wasn’t me that radically changed, but the perception of me. Yet, we all changed in some ways; as we struggled to evolve and adapt to our conditions and environment. I desperately wanted everything, yet nothing to change. Likewise, while the unveiling was something that I took in with satisfaction and joy, not everyone shared that sentiment.

In any event, while grooves were being worn in the waiting room floor, cuts were made, stitches placed and the scalpels washed and put away. Just two days later I stood for the first time on wobbly knees, nurses on either side. She sat on the couch in front of me, watching on as the staff attempted to wrestle panties around the catheter bag and line while simultaneously keeping me from teetering over onto my face.

During this spectacle, I noticed a drop of blood hit the floor, followed by another. When I looked up, she had averted her eyes; her hand shielding her face as if to protect it from the sun. My concern immediately turned from my own predicament onto her, asking what was wrong.

“I can’t look,” came her reply.

My heart sank somewhere beyond the pit of my stomach. A rush of emotions fueled by hormones and Percocet convinced my brain that this was it. The moment where she could no longer look at my body or me. As the nurses finally wrestled my undergarments into compliance, tears crept from duct to cheek. As I waddled out of the room and down the long corridor, I considered how it had gotten to this place.  How I could be so blind, so stupid.

Once I had completed my victory lap of the 4th floor, I returned to my room. I mumbled through my emotions, asking if it was me, the vagina or the blood. She assured me that it was simply the blood and that she was squeamish. I felt somewhat relieved, but my confidence still shaken to the core.

Somehow, I feel a little more alone now. No matter the proximity. Nothing will ever be like it was before, not for anyone. Everything changes. Just somethings more drastic than others.

‘Cause the seasons change was a conduit

And we left our love in our summer skin

Euphoria

Euphoria

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I tried to think of an appropriate title for this entry.. Like I’ve had this window open for about 30 minutes trying to come up with the a title. In the end, one word was all it took, and it fits perfectly.

So yesterday, I woke up at about 6am. Still partly wired for east coast time and also just being a whole ball of nerves, feels, and other emotions. The day that I have been dreaming of for years and decades and lifetimes had finally arrived. Overcoming all adversity in my way, I had arrived at the finish line and all that was left was to step through the ribbon.

I don’t know that a non-trans person can ever fully understand what this means for someone like me. I don’t know that I could ever articulate it in such a way that would convey the complete story.

Finally getting out of bed at around nine after dozing in and out of consciousness, I bathed for the last time with a special antibacterial soap that hospital had provided.  I shaved my penis, scrotum, and pubic area; forgoing my legs and armpits for once.  I brushed my hair and dressed in a light sundress. I decided that I no longer needed to tuck, for in a couple hours I would no longer have anything to tuck.

We arrived at the hospital just before 10:30am. I checked in at admission and she directed me to the surgical department on the main level. We waited about 10 minutes here, before we were led out of the waiting room. From here, I was weighed and moved into a post-op room and put on my surgical gown. I signed all my final releases and we waited. and waited. and waited. Surgery was originally scheduled for noon. We were notified about 11:55 that we were going to be moved back to 12:30 due to a delays. Dr. Bowers came by, as well as the OR nurse and the Anesthesiologist. My pre-op nurse told me that Dr. Bowers makes the prettiest vaginas and my wife was going to be jealous. I said, “I’m ok with that”.

At, 1:14PM pacific time, I was rolled into operating room #2 at Mills-Peninsula Hospital. The OR nurse, whose name was Megan, introduced me to a couple other people who would be assisting. They had me verify why I was there and what surgery I was having. Being caught off guard, I said GRS, Genital uhhh rea-re-uh-reconstructive surgery. Close enough, right?

They pushed my gurney up against the operating table and had me slide over. The table had a oval hole/indention in it and I was instructed to slide my butt down to the edge. The put arm boards out and then strapped me down to the table. At that point, the anesthesiologist started to run his IV line into my left hand, where it still remains at this time. He hung fluids and then proceeded to administer a sedative to relax me. He said “This is going to make you feel really good.” I closed my eyes for just a second…

And I woke up in the recovery room. It was just after 5PM. A brief panic rushed over me, and I couldn’t really get words out because my throat was so dry. But I managed to ask the nurse if the surgery happened. She confirmed that it had and everything was fine.

At that moment, the euphoria rushed over me. I smiled a huge smile, and some tears welled up in the corners of my eyes. It was as if every wrong in the universe had been righted, the stars had aligned and I was complete.  I pulled back the blanket and lifted my gown and peered down at my crotch and it was perfectly flat. I knew I had made the right decision and that this was what I needed to live my life fully.

innie

Deep in my own feels, I wanted Megan to be with me, but she wasn’t allowed in the recovery room.  Eventually, around 6PM they brought me to my room where I’ve been ever since. I’ve not been able to get up and walk. I’ve been playing on the internet and having ice packs on my crotch.

This afternoon, Dr. Bowers came to see me. She said that everything had gone well. Since I was not overly endowed, and due to some atrophy from lack of use, she had to be creative with the tissue in order to achieve adequate depth. She also said that the aesthetics are beautiful and that I’m going to be very happy with the end result.

So tomorrow, I will be able to unwrap my birthday present.  I’m pretty excited to see it, even in it’s swollen and bruised state. I’m hoping to get a shower in and maybe shuffle around the nurse’s station. While this bed is comfortable, I’m ready to be free of it’s pillowy bonds. Monday, I will head back to Dr. Bowers’ clinic for packing removal (the magic scarf trick) and instructions on how to dilate.  Provided no complications, I’ll be released from her care. Life goes on and I hope I to be part of it for a long time to come.

I apologize if this is rambling or incoherent. I think it’s time for me to take a nap.

Against all odds!

Against all odds!

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We’ve finally made it. Today is the day that Megan and I fly to California. On Tuesday, I will have my GRS. A lot of people have asked how I feel. Excited? Nervous?

Honestly, this past week and a half have been a roller coaster of emotions. With Joey’s suicide and that fallout there, that has been the primary concern. I also had to stop all my hormones about 2 weeks ago, and so I’m sure my attitude and mood have been impacted. On top of all that, I’ve started on antidepressants. Basically, I tried to make things as complicated as possible. Holden fuckin’ McNeil.

But anyway, I’m almost to the finish line of this journey. There were times that I wasn’t sure that I could make it, or that I would. The story is fraught with harassment, discrimination, and hurdles. I’ve sat in my car many mornings and cried.

I have to finish packing, so I have to cut this short, but I hope to do a better entry once we’re in Cali and then one post op.

And besides that, Mrs. Lincoln, how was the show?

And besides that, Mrs. Lincoln, how was the show?

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I have been working on an entry for a few weeks. I’ve just been struggling with depression and anxiety lately. It’s made me not really want to do anything. Going to work has been a major endeavor. I have to sit in my car and just kind of psyche myself up to it. So writing has taken a back burner to mostly lying on the couch and also hiding in the dark.

Despite all that, things have been progressing in other ways. First, I switched from oral estradiol via pills to intramuscular injection. Basically I’ve started stabbing myself with needles once a week and injecting lady juice right into my muscles. I’m a doper. I’ve officially moved from the gateway drugs to the really hard stuff. I never thought it could happen to me. I couldn’t help but think of my own kids and the “I learned it from watching you, dad!!!” commercials. Let’s hope it never comes to that. But if it does, so be it.

Since the switch, I’ve noticed that my boobs have been having periods where they hurt continuously. Sometimes they just ache off and on. However, at this point they’re pretty much tender all the time. This is usually a sign that they’re growing. At least I hope they’re growing. I’m probably a solid A cup currently and have been since back in August. Since then, they’ve largely remained the same. I’m hoping that this will jump start them into growing and providing something a little larger. I make due with fancy push up bras, but with my torso, I really need something a little bigger to kind of level things out.

The biggest news though is that on the evening of my last entry, I received a call from Dr. Bowers’ office saying that they had a cancellation and they wanted to offer me the appointment for surgery. Of course, I have accepted. My new date for surgery is May 3rd. My original date was 2/8/2017. So this is a big shift. Originally, I was hoping to have surgery with Dr. Schechter on 3/29, but you all know what happened there. My new date is still slightly tentative due to hospital scheduling and other things, but I should have a firm commitment in the next couple weeks. At that point, I can go ahead and start booking travel arrangements.

So, we’re about 58 days out and I’m alternating between a few different emotions, including but not limited to: “omg omg omg”, “it’s never going to come”, “oh shit, this is like next week” and “what the fuck did i get myself into?”

I’ve never had any major surgery. The most was having my wisdom teeth removed, all four of them being impacted and angry. I remember being loopy as hell from the general. I also remember going out to dinner that night, driving myself while on pain pills. Probably not the best idea. This is considerably more severe and invasive. Of course, the idea of correcting what most bothers me about my body is comforting. Being able to jettison some unwanted cargo, if you will. However, the reality of the situation is a bit more worrisome.  There’s a lot of complications that could happen. Lots of risk.  So you have to balance the eagerness to correct what’s wrong with the nagging concern that you could make things worse.  I don’t think any transwoman goes into the operating room excited about the actual procedure. They go in with the expectation and a hope for a better, more comfortable future. At least, that would be my guess.

Possibly TMI stuff beyond this point….

Because a lot of people have asked me about what all this actually entails, I thought I would give the broad strokes. The procedure itself is supposed to run about 3-5 hours. It will be performed by Dr. Marci Bowers in Burlingame, California. The actual surgery is referred to as single stage penile inversion vaginoplasty. It actually involves a number of different procedures like Orchiectomy (removal of the testicles), Vaginoplasty, Labiaplasty and Cliteroplasty. For the purposes of insurance, some surgeons bill for Penectomy, although almost the entirety of the penis is reconfigured. Despite what most people think, they don’t really cut anything off. Aside from the testicles. Those will go in the trash or maybe in a jar full of formaldehyde. Everything else is sort of a waste not, want not kind of situation, like the Native Americans did with the Bison.

The first part of the surgery is to remove the testicles. The penis is then dissected. The vaginal canal is fashioned from the skin of the penis.  The skin is turned inside out and the end sewn shut, hence the “inversion” part of the name. The clitoris is formed from the tip or glans of the penis maintaining the nerves and blood supply. Even a portion of the erectile tissue is retained, in order to engorge when aroused, causing the clitoris to become more exposed.  The urethra is shortened and the vulva and labia are fashioned from the scrotal skin and surrounding tissues. SCIENCE!  The vagina is packed with gauze and in some cases a stent, to maintain the structure. Surgical drains along the incision site and then a big fancy surgical dressing. All the stitches are dissolvable.

After surgery, I get to spend 4 days, 3 nights in a luxury, all-inclusive hospital bed. During this time, I’ll be fully packed and will have a catheter in place to give my newly shortened urethra time to start healing. Assuming no major complications I should be up and walking within a day or so. Discharge is on the 3rd day. I’ll still have the catheter at this point, still stuffed like a thanksgiving turkey. I’ll spent 3 or so more nights at local hotel.

Six days post-op, I should be back at the surgeon’s office to have the packing removed. I have nicknamed this experience the “magic scarf trick.” This is based on discussions with other post-op ladies who say they they start pulling and it just keeps coming out…. foot after foot. Heheh.  They’ll also remove the catheter at this time.

At this point, they’re going to teach me the finer points of zen and the art of vagina maintenance. Namely, dilation. Dilation is something I’m going to be doing a lot of. As in, three times a day for the first 3 months. It’s kind of like getting your ears pierced. You need to make sure the newly formed “neo” vagina doesn’t lose any of it’s depth or diameter. So for 15 minutes, thrice daily, I’ll insert a dilator and just kind of let it hang out for 15 minutes while I watch tv or something… Ponder world peace… Whatever girls do when they’re very full of Perspex. After 3 months, I can go down to twice daily until 9 months and then once per day. After the first year, most ladies will go down in frequency, especially if they’re sexually active with penetration. Intercourse is not a perfect replacement, but it serves it’s purpose in more ways than one. If everything goes well, I should be in California between 11-12 days. Flying home should be exciting. Remind me to make sure I have plenty of pain meds and the rubber donut for that flight.

My primary concerns are, and in no particular order:  infection, loss of depth or the vagina itself due to graft complications, nerve damage, loss of the ability to orgasm, and/or urinary problems. There’s also a small risk of death. Which I guess, you know, could happen. If they were to nick or penetrate the bowel, I could end up with a colostomy bag and a very botched set of genitals. Nothing to worry about, right?

Statistically, based on Dr. Bowers volume, major complications seem very unlikely. I’ve only read a few people who were displeased with her results. There’s a reason that she runs a waiting list that’s nearly 2 years long. She’s sought after. The only surgeon in the US that had a longer waiting list was Dr. Metzler. The two of them are pretty much the rock stars when it comes to store bought vaginas. The win out for Bowers is one, she’s a woman…. and two she’s a transgender woman. I think that ultimately, she probably knows what I want more than I do at this juncture in my life. Who better to help me? Plus she has a good sense of humor and her jokes are both somewhat crass and sarcastic.. which is kind of my thing.

A Mother-Daughter Talk

A Mother-Daughter Talk

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A year ago today, I told my mother the news. I came out to her as transgender. It wasn’t as easy as everyone else. For some reason, I just couldn’t seem to find my way to have this conversation. I had intended to tell her before Christmas…. and then before New Years… and well, it never happened. Not counting family events, I actually had to go to her house three times before I could get the words to come out.

She (and my step-father, via proxy) was the last of the family that I wanted to tell, face to face. I had worked my way through the other members, one-by-one, telling them the new reality of the boy/man/son they knew and loved. Thus far, it had gone pretty well. Everyone had been supportive. They even promised not to tell anyone else, until I had covered my bases. They couldn’t though…. because by the time I got to my mom, I think everyone on my dad’s side of the family knew. I started getting texts and FB messages from people who weren’t supposed to know.

I tried to prioritize the list of people I told, based on how I expected they’d react. I prepared for all of them to go poorly. The whole mantra of planning for the worst and hoping for the best. The majority were done in public places, like the mall or restaurants. All with a clear plan of how to get away if things did go poorly. I would make sure to have viable exit and a well thought out method of egress.

Throughout the process of working through this list, I would go to visit my mom and try to find my nerve. In the end, I’d sit and talk for a couple hours and then I would leave. Too scared to just say it. No longer afraid to be myself, but terrified of the reactions of those who I loved most. I had squarely placed my mom on the end of the spectrum of people that I couldn’t bare to lose.

As it so happened, I was to be off work on a Thursday. With all of the trans stuff and then the holidays compounded on top, I had become a little ball of stress. In December,  I had met a new friend, who happened to be a licensed massage technician. That Wednesday evening, I messaged her to see if she had any openings. She confirmed that she could get me in at 10:45. So, even though I was still presenting as male, I put on some yoga pants and a ladies t-shirt and I headed down to her office. For the next hours, I let her force out 34 years of pent up stress. I left there feeling very zen and centered. I decided that it was time to tell mom. Megan had said she would go with me to be my moral support, but she was at work and I was feeling like a million bucks.  I hopped in the truck and drove from the Highlands down to Bullitt County.

However, much like the other visits, this one pretty much played out like the others. I got nervous and I couldn’t get the conversation started. In fact, I had given up and was getting ready to leave. My mom had gone to her room to lay down and I got a brief moment of courage and I took a deep breath and decided I needed to tell her just one last thing.

I came in and I sat down on the bed and I told her that I needed to tell her something important. Immediately, she was sitting up and worried that I was dying of an incurable disease. Putting out that fire, I started in on the next. As was customary in my various coming out speeches, I led in with “So I’ve been seeing a therapist…. and I’ve been dealing with some issues, and well… I’m transgender” We talked for probably 30 or more minutes. I explained that this was something that I had always felt. I had never been truly comfortable in my own skin, etc, etc, etc…

Her response was that she had known since I was 3 or 4, but she always kind of just figured I would be gay. I said something like “Well if you had said something, maybe we could have saved a lot of time.” I explained to her the next steps. That I was seeing an endocrinologist in the coming weeks and hoping to start hormones as soon as possible. I told her about my upcoming laser hair removal. I answered all her questions, to the best of my ability.

Once we had come to a conclusion of the conversation, she went out to the living room with me and we sat down and had the same conversation with my step-father. Now, my step-father and I have always had a great relationship. They have been married for 30 years, and he’s been with me since I was 5. He’s as much my dad as my own biological father. In some ways, more so. So to say that his approval was important to me would be putting things extremely lightly.

If I had to explain his reaction in only one word, I would say that word would be “confused.” I had opened with the same bit about therapy, which I did to kind of offset the “are you sure” line of questioning. Even still, he asked “Did you get a second opinion?”

I considered how to answer that question and the best I could come up with was, “She was the second opinion.”

He thought about it some more and he said something along the lines of “It would be a lot easier if you were just gay.”  To which I agreed. However, I thought about that too and then I explained that I was a lesbian, so actually I was gay. I explained that I did not have any intentions of leaving Megan and that we were going to try and make this work.

At this point, I think his brain actually locked up and needed a reboot. He was having a really hard time separating gender from sexuality. He could comprehend a gay man, having them in the family. However, a guy who’s transitioning to a girl, who still likes girls? We might as well have been trying to divide by zero.

However, in the end he was accepting and we hugged and he kissed me on the cheek and I went on my way.

Once it was all said and done, my mom was upset with me. Not because I was trans. But because I had waited so long to tell her compared to other people. She was upset that my aunts and uncles knew before her, but to my credit…. they weren’t supposed to know.

With that out of the way, next came the letters and then the facebook dump. Which I refer to as the scorched earth approach. No one can turn around and tell someone else, I already told them. So there!

My Two Surgeons

My Two Surgeons

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So let me tell you about what I’m dealing with these days….

I had planned to write this entry for the last few days. I even have a couple of drafts that will likely never see the light of day. I wanted this to be a happy entry, a fun entry. Something exciting. Much wow.

I was hoping to be able to say that I’ve finally got a real date for my surgery. That I can sit back and relax and just check off days on the calendar. However, this is not that entry. Oh no, of course not. One door opens, and then a Trump-like villian builds an electrified Jurassic Park style 10,000 volt fence.

So, as you may recall…. I originally had picked Dr. Bowers. Because reasons. A myriad of reasons. However, with that reputation comes droves of dysphoric transgender women looking for new hoo-haas. So the wait has been an issue. I’ve been on the cancellation list trying to get a leg up on the situation. It had not happened. I started to get nervous and began to look at other options.

In October, I found a surgeon in Chicago by the name of Dr. Schechter. He seemed very competent, amazing resume, etc. I set up a consultation with him in early November. Post consult, they had submitted a request for a pre-determination to my insurance company. That’s where things get weird.

I spoke with Dr. Bowers face-to-face later in November when she was in town for a banquet and I explained my unique situation. She seemed concerned and interested in helping me, so I immediately contacted her staff.  Things looked good and the office manager said we needed to start in on insurance approval immediately. I hurriedly sent over all the paperwork and crossed my fingers for the best.

Not long after, I received notice from Dr. Schechter’s staff that my claim had been denied. The reason was that I haven’t met certain requirements today. However, we were attempting to schedule for after those requirements had been met. They would not schedule me without this approval. Unless, of course, I want to pay out of pocket.

I contacted Dr. Bowers’ staff again and let them know of the situation. They advised me that I should attempt to appeal but that it would be 1-2 months… yes, MONTHS… before they could even get around to filing my insurance paper work. So I moved forward with the appeal.

I submitted the appeal on December 14th, assuming that Blue Cross Blue Shield would take the full 30 days to make a determination. So I sat on my hands and I waited. I didn’t email any of the doctor’s. I enjoyed the holidays and I tried not to think about it.

Last Monday, I got a letter in the mail saying that my appeal had been denied. From what I could tell, the insurance company totally ignored my letter altogether and doubled down on their original verbiage. That’s point where I lost my collective shit. Remember “Ferris Bueller’s Day Off?” That scene where Cameron looks down and sees the odometer on the Ferrari? Just like that, except without the hot tub later on.

As I have been known to do, I went to twitter and I started a (nearly) perfect (shit)storm.

From there, things got weird. The next day, I decided that work was not in my best interest, what with my heightened mental status. So, having finally blown off some of the steam, I was going to try and just let it go. Maybe I would have to wait until March. I had some other ideas. But then there was a knock on the door. Who could that be?

Ok, so I earned that. 140 characters doesn’t give me enough rope to truly hang myself. Wait, that’s not right either. Umm.. I was trying to say people denied care are more likely to commit suicide. Not that I was going to kill myself. Simple misunderstanding.

After having an awkward conversation with the very nice police officer, I went back to Twitter and some friends and I bantered back and forth about the denial, the police and the “man.”

But later that day, I got a phone call from Blue Cross. In a crazy turn of events, they reversed the denial. After a brief rush of euphoria, I emailed Dr. Bowers’ office and let them know that I was approved for surgery and politely asking what the next step would be.

Despite a number of emails exchanged, the most informative answer I’ve gotten from Dr. Bowers’ office is that that they’ll work on it this week or next. This is even with a representative at the insurance company willing to personally process the claim.  I have basically begged them for more information, but all I get are vague replies, days later.

So, I decided that maybe I just needed to give up on Bowers. Maybe it just wasn’t meant to be. Schechter’s office wanted a bunch of additional clarification from the insurance company, which the rep at BCBS agreed to do. She faxed them a special letter with the info they needed. I thought that at that point, I could get a date. So I emailed them on Monday and asked them what the status was. I waited until today (wednesday) to call them and see what was up. Now they’re wanting additional info. They still won’t schedule me. Well, she offered to schedule me if I would pay out of pocket.

I let the lady have it. I really just let it all go. I told her that I didn’t feel like they really wanted my business. I felt like they were not putting enough effort forward to obtain their required documents from the insurance company. That I had done all the heavy lifting because once again, no one will advocate for me except me.  She was unmoved by my plight.

  
I contacted the rep at BCBS again and asked if she could help hand hold Dr. Schechter’s office through whatever they needed. She said she would reach out and get back to me as soon as she had more info.
Meanwhile, by Christmas, I’m sure Bowers will find my file under the pile.

Edit: As my friends so eloquently explained, GRS/GCS is a seller’s market. There’s a ton of demand and only so many surgeons. I think this climate has led to the poor customer service that we’re seeing. We are put on endless wait lists and we’re meant to feel lucky when it’s our turn. It’s sad, because I don’t think that’s what the providers intended for when they started in this field.

In any event. for months, I’ve been walking on eggshells with both doctors. I know they don’t need me like I need them. Writing all this might make it worse. I might never get a surgery at this point.

Update, 10:16 2016.01.14 – email from my insurance regarding Dr. Schechter’s refusal to schedule me, still. 

  

Insurance Woes.

Insurance Woes.

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I’m lucky enough to have insurance that covers the vast majority of transgender related care. I’ve had no problems accessing therapy, endocrinology appointments or getting my hormones.

When I changed my name with my workplace back in April, Blue Cross Blue Shield issued me a corrected membership card without me having to even call or write. Which is more than I can say for CVS Caremark who can’t be bothered and still like to misgender me and then tell me to update my gender marker. (I have.)

So I was fairly hopeful for a smooth process of getting coverage for my upcoming GRS. Dr. Schechter’s office submitted the paperwork for pre-approval on November 13th. Yesterday, December 4th, I received a denial letter in the mail. Of course, I also got a phone call from Dr. Schechter’s office prior to that saying that they had gotten a denial letter.

The reason cited is that I have not completed the one year requirement for “real life experience.”  That is, I haven’t yet completed a year in my gender role (*cough*)… Which is 100% true and accurate, except they’re ignoring the fact that when the service is rendered, I will be compliant.  My one year date is March 16th for “full time” and March 18th for hormones.

denial

I’m being told by the insurance company and Schechter’s staff that I need to wait until March to resubmit. Which is great, except that Dr. Schechter won’t schedule a date until they have insurance pre-approval. I’m trying to get scheduled for March. Obviously the date I’m shooting for won’t be available anymore at that point. This is not shocking when you consider Dr. Bower’s availability. I scheduled with her in May of 2015, for a date in Feb of 2017.  Furthermore, what happens if I don’t have insurance at that point? I have so much money tied up in this surgery and I’m still not 100% sure it’s going to happen.

At the same time, before all of this happened Dr. Bower’s office came back and said that they might be able to get me in earlier but again, we need insurance pre-approval. They were/are in the process of submitting to BCBSIL for the same thing. So I’m trapped. I can’t afford to pay for the surgery out of pocket. Who has $25,000 just laying around for a rainy day? Maybe I could sell a kidney? Anyone want a Kidney?

One thing that I want to argue is that the WPATH SOC is a guideline. It’s not something etched in stone. It’s not designed to be so inflexible that there aren’t exceptions. I argue this point and I’m not even looking to be that exception. I’m not trying to get surgery before the 1 year mark. I think I’m a great candidate for it. I have one of the best situations a trans person can have. I’m employed. I’ve changed every possible thing that I can. I have full support of my family and friends. I’ve been in continuous therapy for nearly a year (4 days from now) and I think my therapist and I are both bored because my life is mundane at this point.  So, do I think the RLE should really apply to me?  No, not at all. I went full time as quickly as it was practical. I started hormones as soon as someone would actually write the prescription. I changed my name as soon as I went full time. I changed my gender marker as quickly as I could.  I dunno, just rip the stitches. Get it over with. No anesthesia.

Do I think that I’m somehow going to change my opinion before then? Am I going to detransition? Will I regret this surgery? Of course not. Regret is something that might come if there’s unforeseen complications. There’s nothing that’s going to happen in the next 3.5 months that’s going to put me back into boy mode.

So what’s next? I guess I try and argue my point with them.. It’s my only option right now, short of winning the lottery or selling a kidney. I could refinance my house, maybe?  I just know that I can’t spend anymore days at work crying at my desk because some CIS person in an office thinks that I need to prove my gender identity.

Thanksgiving

Thanksgiving

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So there’s been a lot of me talking about GRS already. Or SRS or GCS or whatever you want to call it. I typically refer to it as GRS, which is “Genital Reconstruction Surgery” but GCS sounds very positive as “Gender Confirmation Surgery.”

I’ll be honest, it’s the only thing I can focus on right now. To me, this is the final step in my transition. While the hormones will continue to do their thing long after the scalpel is gone, the wounds turned to scars…. this is the last step. The point at which I feel like I can relax and just kind of be able to get back to living life.  As the one year of being out as trans is rapidly approaching, I consider all the things that have happened since 12/13/14. In some ways, I can’t imagine fitting much more into a year.

People ask me if I’m excited about surgery. The answer is not so easy. It’s complicated. Of course I’m excited but also I’m scared, it’s a major surgery. I could die or any number of lesser complications. I could end up numb for the rest of my life, and I don’t mean mentally. But still, I gotta. Because reasons. To steal a quote from a friend on Twitter, who said it better than I could:

“To me, GRS is an undesirable necessity. Like having a gangrenous limb removed. It’s traumatic and has downsides but I can’t really not do it.”

She’s right. I have often lamented to friends and others that I wished I could live as a “non-op” trans woman. That is, there are plenty of trans folk who never undergo any type of surgical intervention. Or something less drastic like a orchiectomy. It would be less expensive, less painful and ultimately easier in every shape form and fashion.  However, I’m not that lucky. I’ve always intended to go all the way. “No more half measures, Walter.”

no-half-measures

So what I still don’t know is who’s doing the surgery. As I mentioned in the previous post, I am nearly double booked. At this point, Dr. Schechter’s office has submitted a request for pre-approval from my insurance company. We should have that back sometime in the next week or so. At that point, his office will go ahead and lock in a date for me.

However, in the meantime and in between time…. Megan and I attended the Transwomen National Banquet, for which Dr. Bowers was the keynote speaker. After the dinner had ended, I had a brief moment to speak with Dr. Bowers. While I didn’t come out and say that I was going elsewhere, I let her know that she was my pick forever and always, but that I wasn’t sure if I could wait until 2017. While non-committal, she said she might be able to add a day to her schedule or something like that.

With that glimmer of hope, I did email again to her office manager late that evening relaying this conversation. I was hoping for a reply this week, but based on their past email reply timeframes compounded by the fact that it’s Thanksgiving week, that reply has not yet arrived. I’m fully expecting that when Schechter’s office calls to schedule I still won’t have an answer from Bowers.  At that point, I don’t know what I will do. I don’t want to put down another deposit and then maybe lose that money too.

I was doing the quick math in my head the other day regarding the expenses of GRS for me thus far and they tally up to $2200 out of pocket, excluding travel expenses and lost of wages from taking time off work. To which none will probably count against my deductible or out of pocket maximum for insurance.  Keep in mind, this is just for GRS. This doesn’t count the costs of just getting on hormones which was over $1000 between therapy, lab work and actual doctors visits. Being trans is expensive. Laser hair removal is super expensive too.. Ugh.

I had my 8 month endocrinology follow-up this past week. My blood work revealed that my body really would rather run on estrogen than testosterone. My T level is sufficiently suppressed. Per the lab, the normal range for adult females is 8 to 55, I’m currently a 10. The only 10 I’ll ever be, sadly. 😉 Estradiol levels were in the mid 200’s, I don’t have the numbers in front of me…. and the Progesterone levels have dropped from being off the scale high even by fem standard to middle of the range. Poorkay says keep doing what you’re doing, come back in 4 more months. That’ll put me back there the week before the tentative date for surgery and a week past my 1 year HRT anniversary.

253 Days on Hormones. ~122 days until GRS.

 

Oh, Chicago

Oh, Chicago

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So, a lot has happened in the last few weeks. Big shit poppin’, in the parlance of our time.

Back in May, I had applied for and scheduled surgery with Dr. Marci Bowers to do my gender confirmation surgery. I had picked her out of the half dozen or so doctors that do the procedure because I liked her presence in the community. She has a great reputation for the work she does and so on and so forth. The problem is that with that reputation comes high demand. Specifically, that the earliest date I could get was 2/8/2017. When I heard this, I was extremely disappointed. Especially since I had to give her $1000 upfront as a deposit.

As the months have passed, my situation has changed. As I progress further and further into my transition, my dysphoria regarding my body has increased. The daily mental turmoil of dealing with my genitals has been huge. Waiting another (as of this writing) 451 days, 13 hours and 33 minutes seemed like a prison sentence I couldn’t fathom.

So, I started looking again for different surgeons that might be capable of doing the surgery. Someone that had a good reputation, but without the million day wait. At the same time, I was looking for a surgeon for a friend that did a different type of GCS that’s less common in the states. I had found Dr. Schechter for her, initially.. but when she said they didn’t typically have a waiting list, the gears started turning.

I went ahead and sought out yet another psychologist. Now I have two. Because reasons. Because Insurance. Because WPATH requirements. I setup an appointment with Dr. Kleinman here in Louisville to do an evaluation of my mental status and my readiness for GCS. See, if you’re a trans person and you want to actually transition, you have to jump through hoops. A lot of hoops. Oh, did I mention that the hoops are on fire? So on October 22nd, I met with her and spent a little over an hour explaining my story and life and how gender dysphoria has impacted me. She took a lot of notes, and we scheduled a follow-up for November to review the letter and make sure that it read to my approval.

I setup my own consultation with Dr. Schechter for 11/9. Megan and I went to Chicago this past weekend to meet with him. He was very personable, has a very impressive resume and list of accolades. He said he does about 150 gender confirmation procedures each year, which include both MTF and FTM folks.  He answered my questions and more importantly, Megan’s. I left knowing that, unless something dramatic changes, that he would be my new surgeon. I gave them the letter that I already had from my endocrinologist recommending me for the GCS, as well as my original hormone referral letter from Dr. Morse (my primary psychologist), who was not able to complete a new letter before my appointment, due to a medical issue of her own.

His office will not schedule a date until they have all the letters submitted. Once they have the letters, they will contact my insurance company to pre-authorize the surgery. Only after insurance gives a pre-approval will they lock in a date. I was able to pickup my referral letter from Dr. Kleinman on Thursday and I faxed it to Dr. Schechter’s office.  With the situation with my primary psych, they went ahead and submitted my insurance info. They said it can take up to 30 days, but usually they have something back from them within 2 weeks. Sooooo, if all goes well, I should have a firm date in a couple days. We’re shooting for 3/29/2016.  This date will satisfy my insurance (and WPATH) requirement that I live in my new gender and receive HRT for 1 year. Real Life Experience, they call it.

Between now and then, I am having to take on a new task. Hair removal. On my genitals. Yes, I am (somewhat) willingly letting someone shoot laser beams in my crotch. This is an interesting sensation. It’s not nearly as painful as I expected it to be. The laser on my face hurts much worse. The worst part about this is that it’s not covered by insurance. So it’s a requirement for the surgery. The surgery is covered, but the prerequisites are not? That doesn’t make sense. So yet more money out of pocket. I can’t even apply those costs towards my deductible or my out of pocket max for this surgery.

So I have 4 sessions planned. For that area, it’s recommended to wait 6 weeks between sessions. Having 1 session down, that leaves 3. Six weeks times three sessions, that’s 18 weeks. 135 days between now and 3/29. That’s 19.xx weeks. Cutting it close, but I think it’s doable.

The goal is to have everything planned and in place by the end of 2015. Then all I have to do is lie back and let my crotch be zapped between then and March. How hard can it be?