#asianftm

Yesterday, my assigned social worker called and told me that my stage 1 bottom surgery will be postponed. I played it off cool and responded in the most professional manner but to be honest, I was filled with so much emotion.

I was told that due to covid-19, and being an outpatient surgery, I would take up resources (PPE). I have spent months mentally preparing myself for this operation and I have spent weeks frustrated trying to figure out medical leave paperwork back and forth with Kaiser and my job. 

I am upset.

I am angry.

I am stressed.

But i understand.

But I am so damn disappointed.

This post will be about my experience with Kamol for keyhole mastectomy (no nipple reduction), hysterectomy with oopherectomy and partial vaginectomy.

Reason for no nipple reduction is cause I trying to save money and also, already so many things to recover from. I had all the above surgery in one sitting, which takes about 4 hours. 

Anyways, I happened to go while exchange rate was bad (1sgd to 23.2-23.35). So yeah, do try to plan your surgery when exchange rate is good if possible. It makes a lot of difference (few hundred).

I paid in SGD because rate is almost same as changing money. I called a few changing money shops and compared. Request to use superrich rate. You tell the coordinator, he will understand what it meant. (Pm me I can give you his contact). Save a lot of trouble to pay in SGD and way less cash to carry (in terms of qty). I might be able to help you get same quote as what I paid. I manage to get it slightly cheaper than what they normally charge.

Before Surgery:

1) Book date for surgery with coordinator. There are some conditions to specify which I forget. One year on T or something. Please check yourself.

Also no T for 2 weeks. However, I am on nebido which is a 3 months shot. So I cannot stop the T. My surgery went well with T.

2) Find your partner or family or friends to go with you and make sure they can take leave from work. I strongly strongly encourage that. I am glad my fiance came with me; it made a huge difference during my recovery. It was tough and challenging. My friend came for the last few days but I realize having partner with you is slightly more different in terms of the emotional, physical and mental support. Also my partner is much stronger physically. I have to rest my full body weight on her hand countless times. It requires two nurse to make me sit up because it’s just too painful for me to use any core. As they were not strong enough, I developed the phobia of asking the nurses. There is just no trust that they can help me sit up or lie down supporting my full weight. Once the nurse couldn’t support my weight towards the end she let me down too fast. My abdomen hurt so bad. It’s really painful to change from sitting down to lie down position on my own. I rest my entire upper body weight on my fiance’s hands and let her slowly lower me down. That’s at least a good 20kg. I cannot use any arm because of top surgery. There is just pain everywhere. So basically all the limbs are useless. 

3) Book flight. No need excess baggage. There is washing machine in Kamol service apartment at the same floor in the same building as the hospital. How convenient. Nothing fancy to pack really. I only recommend bring butt float pillow and neck pillow. Everything else can be bough there cheaply. There is pharmacy and supermarket 50m away. I packed as if I am going for a holiday, with laptop (to watch movies of cause). With laptop I packed exactly 7kg. Also, no need toiletries and towel daily. Service apartment and ward provides. Basically just bring yourself,cash,passport,clothes,laptop,small handkerchief and small pieces of gauze (Explain later). Really don’t need anything else. 

I did not buy my flight ticket back. Only bought one way. I scared if there are complications and delay flight, I might end up buying new one. I only bought it on the 7th or 8th day.

Also, land in thailand in the morning is preferred. Afternoon to settle all lab tests. Night rest. Next day surgery. 

4) travel insurance. A lot is at stake including work leave. So better to get in my opinion.

5) Apply work leave

6) Inform coordinator your flight details. Car will pick you up. Included in price quoted. No need pay extra.

7) Buy simcard from shopee. Very cheap. Bought 7 days for $7?

Some notes: Kamol service apartment is same building as hospital ward and clinic. Hospital ward is level 4? Clinic is 3, service apartment 7. Rest I cannot remember.

Day 1

Driver pick you in morning to kamol. Go level 3 register and meet coordinator who will then bring you up to service apartment to put down bag.

Then go level 3 again for lab tests and xray,consult with Dr Kamol and see psychiatrist in afternoon. Also sign contract and make payment. I didnt get to see the doctor doing hysterectomy. I discuss all with Dr Kamol.

After done, you are free. Half day left to sightsee or whatever. DO NOT eat seafood or eat streetfood. You do not want to suffer food poisoning just before surgery. Go to reputable places. I also eat probiotics powder from my family doctor to safeguard my stomach just in case. Best is to just stay in room or go nearby cafe to eat. Kamol is not near city centre. So you have to take cab to city centre and back. 

Also DO NOT EAT OR DRINK after 12am. I thought it’s fine to drink plain water. I was WRONG.

First night stay in service apartment upstairs.

Day 2

Morning got free breakfast delivered to the room.

I drink a little plain water (100ml) at 10am and 12pm, surgery supposed to be at 2pm. Because of my mistake, surgery was pushed back to 6pm.

There must be a minimum 6 hour gap

12pm we pack our bags checkout to move to hospital ward. To save money, my fiance sleep in the ward with me. No extra charges. There is a nice leather sofa bed for her. They even gave her cover,blanket and pillow. So it’s pretty hygienic.

Shower first. Then I am asked to wear hospital gown. 

Staff came in to take picture of your surgery areas. You cannot say no I think. It’s stated in the contract you signed. I’m like whatever. They wont use it for publicity without permission. First time is weird but trust me during recovery, you will get used to it. When doctor goes around the ward, he is followed by 2 trainees and a few nurses. Literally a crowd of people will be seeing your bites. I imagine it being a sexual kinky flashing experience so it’s less scary. 

Nurse came in shave my private parts, and give an anal douching (I think thats the word for it). No warning one. I didnt know after she press the nozzle thing up my ass I will immediately want to poop so bad in split second. I almost pooped on myself just from walking to bathroom. I wished she informed me so I am more prepared. I literally pooped for at least 15mins. Stomach hurt so bad from it. Pooping waterfall basically.

Nurse came in to give IV drip. I forget which order came first. But somehow I was stuck with IV drip and dirty butt. So I told the nurse “There is no way I am going operating room with a dirty butt and knowing I cannot shower next few days”. So the nurse had the hold the drip and I struggling to wash my ass with 1 IV drip on my left hand. 

By the way, the nurse has to shave for you. They use this insane sharp blade such that you can feel it scrapping your skin. It’s not painful but it’s very intimidating. And yes you have to open your legs as if you are giving birth.

After all the drama and first time experience, I get to sleep and rest on the bed while my fiance continues to rest on the sofa, using grabfood thinking what to eat for lunch LOL.

One thing I dislike about Kamol is they don’t have a plan or steps in paper for you to see. And you have no idea who is coming next or what to do next sometimes. You just have to keep asking. I don’t know whether it’s normal.

6pm the nurse comes in with wheelchair. My fiance can only walk me up to the operating main door. Say goodbye and some french kiss (just joking). I am asked to walk to the bed at the door. They wheel me in and I transfer myself to the surgical table. So I am thinking, whats the point of the first bed when I can just walk to the surgical table lol. Inside there are approx 7 nurses. You only get to see the anesthesiologist. I was asleep before I get to see Dr Kamol and the other doctor. Till now, I have not seen the other doctor before. Only Dr Kamol do the ward checks during recovery. Anesthesiologist came in to assure me that they had cardiologist on standby due to my existing autoimmune condition. (I am very surprised when she said that because my condition is so rare and the name of my condition is actually dermatology related. So not many knows it’s autoimmune related. That at least shows me they know their stuff which is good).

12am I wokeup in recovery ward. This is not the room ward yet. I was shivering so bad that my wounds hurts. I was in pain cause my body was shaking too much. I called for the nurse and they gave me 4 blankets. I wished they had warm blankets. It took very very long for my body to eventually be warm enough to stop shaking. The anesthesia will keep trying to make you go back to sleep. I use all my energy to call out and murmur “Very cold. Very cold. Pain” before knocking out again.

I was later told by my fiance they didn’t inform her if surgery was successful. She stayed up till 1am before deciding to ask the nurses. I think they could do better on that better to at least inform her. 

Around 1am, I was fully awake. No more shivering. Not much pain unless I move. 

I never had a catheter before and totally forget to ask about it. So I had a weird sensation feeling like I may need to pee but also not quite. Sadly, the nurse on shift cannot speak English. I asked her if I have to “release” to pee or it will flow out naturally. So I was half confused whether I need to release my bladder for the pee to flow out. I later found out the pee will flow out naturally. Don’t need to try to “release”.

around 5am my back was in so much pain I couldn’t sleep anymore. I rarely sleep on my back so it hurt so bad but I couldn’t move. I was counting down till 6am to be pushed to ward.

Day 3 (1st day post op)

6am I am pushed back to ward. My fiance sees me first time after surgery. I was so happy because I have so much back pain I was getting depressed.

7am mouth wash came. It’s hard to use mouth wash lying almost flat. Then food came. it’s soup. This is when the first hiccup began. No one told us whether I can drink or eat yet and at what time. The person who delivers food is not in charge. She merely delivers food. My memory of that part is not clear. But what I know is I skipped that. I only started drinking sips of water at 10am after some approval. Some nurse say can drink sips only. Trust me you do not want to end up throwing up. The incisions are so raw and they hurt. No more painkiller at this pain. It’s not pain unless you try to move even a little.

At 12pm porridge came. Because nurse say can drink sip, I assumed no food. So end up never eat. But I was hungry (my last meal was 6pm the night before), I took I think 3 spoons.

I think dinner then I ate some porridge or something. I cannot remember. The food confusion part was quite annoying. I think they should specify how many hours I can start eating or drinking what. 

I am still lying down at this point. Actually I lied for the first 36 hours. It was hell. My back was in so much pain. I have back issue since young just to specify. I was barely incline using the machine bed. Anything more than 30 degrees the incision area starts to hurt. My friends say their recovery not so bad. Maybe it’s just my pain tolerance lower, I don’t know. 

That night, my back was too painful (not my incision lol) I asked for painkiller injection into my IV. She say no. Pain above 6 then can. I don’t want pills because my stomach protest badly with pills. I was already having very bad acid reflux. Then another nurse came back with pills. I asked her same question. This time this nurse say can. I cannot remember the exact senario but it was a nightmare. Miscomm. Finally injected. Within seconds my hands were in burning pain and veins starts to turn red. I became worried. I asked nurse what’s going on she didn’t reply. Just bring ice pack and put and say will ask doctor. I asked her if it’s allergy she say no. I asked her what’s the reason she couldn’t answer.  Till now I have no idea why but within 1 hour thankfully the redness went away. We communicated via google translate which is a good idea. We type question in english then she reply in the phone then we see. Dr Kamol only comes to the ward in less than 2 minutes. Overall there is definitely lack in opportunity to ask medical questions that you have concerns about in need. 

Day 4 (2nd day post op)

They come to change dressing once a day. Wipe me down with wet wipe. 

Everything else same routine. We just waited and waited but mouth wash didn’t come. We had to ask for it. Similar incident happened the next day when they changed my dressing but didnt help me wipe my body. There are still many inconsistency. It’s not that important but we just feel lost sometimes as to what is happening next. I asked my fiance help me wipe my face and she was like “didnt they help you wipe like yesterday.” I was like “dont know leh. They never”. 

Day 5 (3rd day post op)

Still lying down. Tried to sit-up. It was so painful I tell the nurse stop. 

Day 6 (4th day post op)

Kamol package only includes 3 night ward stay. Yanhee is 7 days which is a bonus. Personally I really wish Kamol had 4 or 5 night stay instead of 3. I think they really don’t have enough wards since it’s only 1 level (About 10 wards)

Because of that, the nurses had to force me to sit up and walk within same day (hours) actually because they need clear the room by 12pm. I needed to use my arms. But it’s just too painful because of the drains. I asked the doctor to take it out. By right only 5-7 days then can take out. Thankfully doctor say I am skinny so he approved it. Finally I was able to use some arm without being in so much pain.

My friends tell me the drains don’t hurt taking out. It’s not true for me. It hurt so damm bad. The burning session continues even after it’s pulled out. After the doctor did the right side, I asked them to stop. I wanted to cry already. 2 nurses hold me down and the doctor continue the other say and say “its fine. its okay. very fast over” when they took out the other side, it hurt way worse. 4 tubes in total. Each time hurt so bad. The pain continues for a good 2 minutes at least. 

Next nightmare, catheter take out, it’s not as painful but it’s still pretty painful. By this point, I am just glad everything is out. 

The whole process was just pain. When I first stood up, I was so damm scared. I CANNOT breathe properly. I have literally no breathe to even speak. I whisper to my fiance I cannot breathe. My coordinator say its fine. At that point, imagine not being able to breathe. It literally scared TF out of me. I have never felt this way before. It’s worse than asthma. I cannot exhale enough air to even speak normally. I didn’t think it was normal because I did not hear anyone mentioning it before. It’s not reassuring with no doctor beside. It lasted for a good hour.

It’s super difficult to sit or lie down because it’s no longer a mechanical bed. It’s a freaking soft bed. It was just pain trying to move in any position. I tried because my tummy is so bloated (I looked like 4 months pregnant). I was worried that the bloatedness will affect my healing or that it’s due to internal bleeding. I am just constantly worried because no one told me about this bloatedness. It was pretty bad. So I tried to walk in the room as the nurse also told me to walk today. So I assumed I must walk more. I walked for a good 30minutes.

There are many occasions I needed to cough but I can’t. IT HURTS. I force myself not to cough even lightly. So remember, DO NOT try to do surgery if you have cough or flu. The pain is insane. I don’t even know if it will burst the stitches. Ask someone who is hygienic to accompany you. You cannot afford to fall sick or catch a cold etc

Unlike what people said, I was able to poop. I think it’s due to antibiotics. It was the one that will cause diarrhoea normally. So I am glad no hard poops. 

First pee will see blood. Just be prepared. Till now, I still have not showered nor did the nurse let us know when I can shower or touch water. It’s very annoying. I think such things are important to inform the patient. Because it was just a mess down there, I was the shower head, point downwards from my back, and tried to wash my ass. Then I took a gauze that was given to me by my friends to pat dry at the sides. It is still way to sensitive to even pat the vagina area. So I lied on the bed with no pants to air dry them before putting on pants.

Get BIG pants because anything that touches the “hole” hurts. So the middle line of pants are the worst. I make sure it doesnt touch. 

Day 7 (5th day post op)

Service apartment only serves breakfast so from this day onwards we ordered grabfood.

I continued to wash my ass after poop and air dry below. When I went back Singapore my friend told me the nurse help him shower at day 2 already. So that’s the inconsistency I am talking about. Why so confusing. Recovery is as important as surgery itself.

I go to level 3 change dressing once a day. My friend told me they changed for him twice a day. At this point I just give up. Nurse say I am still bleeding below so asked me to dont walk and suppose to be on bed rest. Everyone say different thing I am confused.

I shower my hair by bending my neck abit and wrap towel around my neck. Body just wipe. Bring some handkerchief easier.

Also none of my friends experienced this but my bladder hurts so bad before and during and after pee. It’s not UTI but it just hurts so bad. The pain only went away close to 18 days post op. I asked the doctor and nurse they say it’s fine. At that point I didn’t felt that it was fine because it didn’t felt like a normal experience by others.

Day 8 (6th day post op)

I think I saw Dr Kamol on this day, or is it day 9 I cannot remember. I get to ask him one question quickly. I asked if he can shower; he say can. Then I am like wound how? Dressing how? Pat dry with what? But he already left. Like I said he already have 2 minutes max to see your wound. So till then I still had no idea how to take care of my wound.

I just shower my hair only and this time wash my legs also with some water near my groin. Still wiping back etc.

Day 9 (7th day post op)

I think this day I finally took my first shower. I leave the wound air dry or pat with gauze. 

By this day I am able to walk and sit. But I still need help lying down. Put pillow at your thigh otherwise you will feel like incision at your abdomen is stretching when you lie down flat. 

Binder will be on throughout. All 7 days they wrap for you and change. 8th day onwards is like a binder kind that will be given to wear at home for another 7 days. I took out by 4th day at home because it’s way too uncomfortable. I had no more bruising so I decided not to wear. One bad thing is they gave 1. No way to wash while still wearing. My friend from yanhee had more than 1.

Overall

Most people fly back on 12th day or 14th day. I flew back on 10th day post op because I just want to come back. Kamol will provide driver again. No need pay extra.

And please ask for wheelchair. I thought I was feeling better

I love the service apartment. It’s gorgeous and most importantly very clean. I strongly recommend staying there. Bangkok is very very very hot. You DO NOT want to be even outside for 1 minute with all the binder and gauze and sweating. I stay in the service apartment throughout. I initially planned to move to hotel after first few days but decided the service apartment was good. It’s really comfy.

I wished Kamol post op service will be slightly better and one more hospital ward night stay. They mechanical bed can save a lot of pain. 4 nights i think is just nice. My limbs are in pain if I were to use any. I need that magic bed. 

I am writing this at 3 wks post op. Till now, there is still pain and tenderness from doing simple things. So go easy on your body. It needs time to heal. I cannot imagine the pain if I were to do double incision mastectomy. Keyhole alone together with hysto and vaginectomy is too painful. Salute my friends who did double incision together.

Total spending around 14K SGD including surgery, accommodation, air ticket.

Hello Tumblr,

It's been about a decade since I've last blogged on this platform. For those of you who don't know me, my name is Muaj Kooj (a.k.a. MK) Vue, originally known in the trans community as “Liam”. I started my transition in the year of 2011 with hormone therapy. In 2012, I flew to Florida to have my double incision top surgery done by Dr. Garramone. This surgery was paid out of pocket costing me about $9,000 including hotel and travel. After I healed, I decided to start Accutane treatment in 2012, as I had severe cystic acne after starting hormone therapy. This helped a lot with controlling my massive breakouts.

A couple years into healing and working out my chest, I noticed there was an imbalance in my muscles. This made me feel very dysphoric, so after many years of contemplation, I decided to go in for another consultation in April of 2018 with Dr. Gurjala to get it corrected. I am much more happy with the results now.

Between 2012 and 2013, I suffered from painful and unbearable cramps. I have not had a menstrual cycle since being on hormones. My obstetrician-gynecologist informed me that there wasn't much she could do for me as the treatment for my cramping would contradict with my testosterone, and we don't want that. In 2014, I decided to have a full hysterectomy done through Kaiser's women's health clinic. With this surgery, the pain I had been suffering from was eliminated but along came post-menopause. This means I would have low estrogen which leaves you at risk for osteoporosis, heart disease and genitourinary atrophy. After a year of healing from having a hysterectomy, I did start to feel more fatigued than normal.

If there is one thing that I regret from having a full hysterectomy, it would be that I did not opt to freeze my eggs. I was pulled back by the yearly cost of storing them. But hey, it's too late now and there's always other options for having children like In Vitro Fertilization, surrogacy, or adoption.

Bottom surgery has always been something that floated in the back of my mind. After endless research on phalloplasty, I had my first consultation with Dr. Chen in 2015. After meeting with him, I felt confident and set my date for ALT phalloplasty in October 2016. Sadly, when my surgery date nearly arrived, Dr. Chen left the practice. I was left to float around, waiting for a call to see what my options were. I decided that I would hold off on bottom surgery since I did not feel comfortable with a new surgeon.

In 2017, Kaiser no longer worked with doctors outside of their network. I was informed that Dr. Salim would be the head surgeon to perform bottom surgery for their transgender clinic. I went in for a consultation in August of 2017. Though I did not feel 100% sure of him, I decided to set a date anyway for May 2018. That would give me at 9 months to do more research on him and mentally prepare myself. Came April 2018, I received a call from a job that I applied for. I was given the great news of an attentive offer that I could not refuse. I decided to cancel my surgery date and start my career in May 2018. I was given a one year probation with this job position. It has now been 1 year and 7months and I am very happy of my decision to delay bottom surgery.

Today, I am happy to say that I'm finally in a content place in my life where I don't foresee anything that will stop me from getting bottom surgery. My job is secured, my finances are in control, and I will be finished with my degree next spring. I had my "brush-up" consultation with Dr. Salim a couple of weeks ago. I will be having ALT bottom surgery this coming summer of 2020.