03/19/18 Dick Diary Update

I have successfully mirrored this blog over on My New Dick Diary Word press called Rat Needs a Dick.

I did this because I have more control with WordPress, and Tumblr gets hinky with adult topics, and buying a dick is definitely an adult topic.

As I put this in, I was thinking of going back and annotating the posts with a different font or something, with the wisdom and hindsight I have now. That might be beneficial to folks that are going into this.

I don’t think there will be much in the way of new posts, but if I do, I will make sure it mirrors all posts on Tumblr as well. At most, I might do a surgery kit round up of the items I found most useful post surgery, and to have on hand. There was some things I wish I had thought of before going down, or had on hand when I got back. The hubbies emergency pillow purchase comes to mind.

Thank you for everyone that supported me through this, and gave me encouragement and kind words. I really do appreciate all of you.

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3/17/18 Dick Diary – Review of Surgeon’s Office

I am pretty much done with this dick diary, but I’d like to give a review of how I felt about the doctors, and their office. I waffled back and forth on doing this, because it’s not all flattering, but in the end my loyalties are to other transgender people that want to use Dr. Meltzer and Dr. Ley’s office. 

We are so often very desperate to get our surgeries, and it’s hard to find good information on what people experience with specific surgeons. Because of that, I am putting this up here. 


The good:

I am very happy with my results. I felt both of them were very fantastic
surgeons. I was Dr. Ley’s first metoidioplasty, alongside Dr. Meltzer. I felt
it was well done and I like the look of it. When I went back to get the mons
resection done, Dr. Ley did some revision work on my empty scrotoplasty. I feel
she has a very good eye for anatomy and is an exceptional artist. I feel she
really does good work.

 I have fantastic results and I’d recommend them again and
again.

The Mediocre:

Nobody in this office will be on time for any reason. I went
to a consult and two surgeries, with multiple visits. There was never a time I
didn’t wait at least an hour. Take this into account with your own time
management. I spent literally hours in the office waiting for my appointments,
well past my appointment time. Hell, in my last surgery, Dr. Ley was hours late
and the hospital staff was even annoyed. This effected my ability to even leave
the hospital. I was ready to be discharged at 9am, but as everyone waited for
Dr. Ley. I was finally informed at 5pm that I could leave because she wasn’t
going to get to me until 11pm that night… I didn’t want to pay for another
hospital night I didn’t need, so since I was fine and had no complications with
the second surgery I went back to the hotel.

Getting actual answers from staff is difficult and felt
adversarial. I worked with Lindsay as the nurse, and she was hard to get a hold
of and even harder to wrangle actual answers out of. It took me multiple calls
to get information about complication rates on scrotal implants, and really
that should be an easy answer. 

I also had an issue where I asked billing how the payment worked. You have to
pay upfront, whereas in most medical settings they bill insurance up front, and
you pay the rest. I got an email back telling me if I didn’t pay they would
take my appointment from me. All from just asking how they do business.

I would also be careful about medical information. I was
told a couple of outright garbage things from the nurse for surgery.

  • I was told to take vitamin B before surgery with
    my metoidioplasty surgery. I can only think it was due to a half assed study
    with a small number of participants that showed laughing gas left the body with
    vitamin B. However, general anesthetic doesn’t work with the same mechanisms,
    and when I asked the surgical nurses they laughed at it.
  • They give you homeopathy in their surgery packs.
    I have some serious questions about any medical office that engages in
    homeopathic remedies. Homeopathic arnica does nothing but pay for the
    manufacturers new house, and probably impending FDA lawsuit defense.
  • The surgery prep for the vaginectomy and
    hysterectomy had a bowel preparation that is gangbusters. I was told to start
    this way too late in the day before surgery. I knew this, having prepped
    patients for surgery as a nurse, and did it earlier. I didn’t do it early
    enough and was literally still having bowl movements while I was prepped for
    surgery. The surgical staff said they hated Dr. Meltzer’s regime, because
    patients would sometimes unload on the surgery table. This is not optimal. You
    hurt nothing by taking your bowel prep earlier if you don’t do anything but
    clear liquids after you start.  When
    asked, Lindsay said bowel preps just don’t last that long and then I knew she
    had probably never done floor nursing because whoa nelly, they do to! I felt I
    was being set up for a far more difficult time than it needed to be.

The bad:

Post-operative care sucked. Just straight up sucked. In my
first surgery I had a metoidioplasty, hysterectomy, and a vaginectomy. I had
extra bleeding, and some of the worst bladder spasms known to man. When I kept
calling to ask what to do, I was treated like a pill seeking junky by Lindsay
the nurse all over a request for 5 additional Percocet so I could take a half
in the morning and a half at night to get me through my first work week with the
painful spasms.

I was a nurse and did wound care, and I felt these first surgery
incisions were slow to heal (No fault to anyone. Sometimes that happens.), and
I wanted to make sure someone assessed them because they were dicey. I was told
to send in pictures, and when I did, I never heard back. I had to keep emailing
and calling and was told it was fine and not send in follow up pictures weeks
later.

I had to go to my primary care physician to deal with all
this. He was, as always, super supportive and quite horrified at how this went
down.

With my second surgery I was told I’d have to remove my
drain by myself. This can be done, but since I was in Phoenix for so long, I
asked for them to remove it. I had to really push to get them to do this. They
couldn’t do it on the Thursday, Friday, Saturday, or Sunday before I flew out.
Instead I had to go in Monday before my flight left. I was told the nurse would
come in early to meet us and take it out so we wouldn’t miss our plane.

This was an unmitigated fiasco. First, we waited an hour
past our appointment time. Then two nurses took turns trying to yank the drain
before Dr. Ley came in to yank hard on it. Between each attempt a half hour or
so would pass. My husband kept asking about time, and a MA gal kept rolling her
eyes literally at him. This was just so out of bounds and rude.

I passed out because the amount of pain that came with Dr.
Ley yanking on the drain unsuccessfully. I have Graves Disease, so this can
happen with pain for me.

I had to be reopened up, drain removed, then stitched back
closed in the procedure room. The MA gal that rolled her eyes at my husband was
clearly not interested in even dealing with me, and I found out that Dr. Ley
didn’t even know I had passed out cold in the exam room ten minutes earlier. None
of her staff had told her which seems pretty problematic.

We missed that flight home, and it was more due to Delta and
my husband’s diligence that we got home that night. If we didn’t travel for
work and have a good working knowledge on how to work around this, we might
have been stuck with the added time and expense of another night in Phoenix.

I felt this could have all been mitigated if the drain was
1) taken out four days earlier when it should have been or 2) if we had not
been sitting in the office for literally hours past our appointment time.

I was healing fast and fine at home, but then developed a
serious reaction to the extended Keflex prescription. From previous experience
with the office, I dealt with it myself with my own primary care doc. When
called for follow-up information, I felt Lindsay was more worried about
liability than how I was doing. I got a serious third degree about what else
could have possibly caused the reaction. It was the Keflex. It was literally
the only medication I was on at the time. Not even pain meds, which seemed to
shock the hell out of her.

I basically just stopped talking to the office, because I
felt there was no point to it. I did get an email from one of the nurses asking
if everything was good and if I could send pictures. I did and wrote a detailed
listing of my progress including somethings about the long-lasting issues I was
having with my bladder since the first surgery. (I have since asked my own doc
and it’s to be expected. I’m a bit slow on recovery there.) I got back a
“Great!”. I doubt my email was even read. If you are doing triage through email
this is not good.

Overall:

My overall opinion is that Dr. Meltzer and Dr.
Ley do good work, but the office could be a landmine of issues. If everything goes
right, it’s golden. If you have any issues, then you will probably have to
fight the office just to get through. I would do this again and am ecstatic
with my results. However, I would have set up aftercare with my primary care
physician ahead of time, and not even bothered to try and deal with that office
for it.

I am sure they will know exactly who I am if someone there reads this. I am the only person that has ever had a drain stuck in their office. Since they send folks home with drains, and their office communication is rough, that might not be true. This isn’t common, but it’s not exactly uncommon if I recall back when I used to remove drains as a nurse. However, I am the first in office for them. 

This is why I waffled on posting this. It’s not all flattering, but it’s my experiences with the office. I hope by putting this out there, that other people gong to Dr. Meltzer and Dr. Ley can have the information in order to navigate their experiences with less frustration. 

This will probably be the last post of real content here. I am considering mirroring this over on WordPress so I don’t have to worry about Tumblr’s weird issues. I plan to leave this dick diary up, so others can read it if they are considering the surgeries I had. 

3/13/18 Post Surgery Round Up

I am pretty much done with the dick surgery experience. I still have a few stitches fighting their way to the surface, but overall, I am healed and fine. 

I decided to create a general write up on my thoughts on what I consider key points if you are going to buy your own penis. 

I’m not an
expert, I’ve only bought one penis in my life. I can give you the benefit of
that one penis-buying experience though.

  1. Funding may be easier than you think. For the
    longest time, we could only do these surgeries through private pay. Now days,
    there are a lot of insurance companies that cover this. 

    The first step would be to call your insurance company and ask about coverage.
    Some, like Group Health/Kaiser Permanente have transgender care specialists
    that work as case workers. Ask your insurance company if they have specialists
    for transgender care. Specialists will know far more than your first line phone
    bank employee.

  2. With insurance coverage will come some hoops to
    jump through. For myself, I had to get two psych letters, which I am generally
    opposed to for political reasons. Yet, if I wanted to get any gender
    confirmation surgeries this seems the be the norm, not the exception.

    Insurance companies, if you are going through them, will have a list of covered
    therapists. Do not be afraid to tell them you are not willing to go through
    multiple visits, and to ask for the most expedient trans friendly therapist
    they have. (If you want more therapy visits, that’s cool, but I worry more
    about gatekeeping.) 

    Don’t be afraid to do your own research on this front. I had a good local
    Seattle therapist lined up that was known for 1-visit surgery letters. I’d
    rather pay $150 out of pocket for the visit and letter, than be dragged into
    months of gatekeeping therapy that I did not want or need. These days, you have
    therapist options. Google them up and ask your local community. 

  3. You will have to choose what kind of dick
    surgery you want. The quick and dirty is that there are two categories, metoidioplasty or phalloplasty. 

    Phalloplasty is the bigger better dick. It is the Cadillac of rebuilt penises.
    However, like a high-performance race car, it takes more surgical
    interventions, and costs more all around. There are donor sites for tissue, and
    multiple stages. 

    Metoidioplasty takes what you have when your clitoris has been enlarged by
    testosterone and frees it up. It will never be the giant dick you’d see in
    porn. It would be a small penis. However, it’s a far less invasive surgery with
    less healing time. It also has retained orgasmic abilities with little risk. (Phalloplasty
    can too, but there are higher risks.)

    Then you have to decide on the extras. Dick surgery is kind of like going to
    the salad bar at Sizzler’s. One you decide on your entrée, you get to pick and choose
    the side items. Do you want testicles, implants or empty scrotoplasty? Implants
    have a risk of rejection and drift, where as an empty scrotoplasty might be
    absorbed back into your body over the years. You might not want balls at all,
    and it’s perfectly fine if you feel that way. 

    Do you want your urethra moved so that it runs through your penis like a cis
    gendered man? In Phalloplasty this is all but a guarantee of being able to
    stand to pee, in a metoidioplasty it’s up to how much enlarged clitoris you had
    to begin with. It’s not uncommon to have a catheter for an extended period, and
    possible revisions when getting urethral lengthening done, and there will have
    to be donor sites for creating this longer urethra. 

    You need to be aware of your own anatomy. In my case, I had a lot of fatty
    tissue in my pubic area, that necessitated a “cosmetic” surgery called a mons
    resection. It’s like a lower tummy tuck/dick lift all in one. Without it my
    metoidioplasty would have been buried and invisible. With it, I have a
    respectable penis. It was not covered by insurance, but the $4000 was worth it
    to me. Where insurance refused, VISA stepped up.  

  4. Surgeons that you can use might be dictated by
    not only what your insurance will cover, but by the procedure you choose. I
    found that it was harder to find a surgeon for metoidioplasty than
    phalloplasty. 

    In general, there are not a lot of surgeons that do these surgeries and unless
    you are exceptionally lucky geographically, you will probably have to fly
    somewhere to get it done. 

    That said, call around and have consults with whomever you feel drawn to. A lot
    of new surgeons are getting into the game these days, and there is no test or
    requirement to meet in order to do these surgeries. My recommendation is to go
    to someone with a long background in this kind of work. Check with communities
    to see what some folks say about their surgeons. There are surgeons that have
    terrible reputations and getting this fixed is a lot more difficult than
    getting it done right. 

  5. Ask questions. Ask a lot of questions. There is
    this sense of desperation in our community around just getting our surgeries.
    We don’t like to rock the boat, and sometimes we just go along with things
    because we are so desperate to have these issues surgically fixed. 

    However, this is your body. Ask every question you want. Ask how long to heal.
    Ask what the complication rates are. Ask how they deal with complications. Ask
    what time the surgeon will be back to check on you in the hospital room. Ask
    anything you might want. This does not make you a bad patient. It’s their job
    to make sure you understand what they are doing to your body.

    For example, I was originally going to get testicular implants. I got home, and
    the idea of tissue expanders, and possible implant drift had me calling the
    office repeatedly until they could tell me how often they have to revise these
    implant surgeries. Turns out 25%-33% of the time they have some sort of
    complication. I would not have gotten that information without digging at it.
    It caused me to change my mind to getting an “empty scrotoplasty” because at
    the end of the day, easier and complication free was my personal big focus. 

  6. The actual surgeries will probably take place
    out of town, so make sure you have a good primary care physician that is
    willing to handle things at home. I ran into an issue post-surgery where I had
    complications and my surgeon was in another state. They were less than helpful,
    and if it hadn’t been for my primary care physician I would have been in a lot
    of trouble. 

    I have heard again and again from other transgender patients that this is an
    issue with their surgeries. They have hematoma’s, complications with stitches,
    or other low-level things that takes nothing more than a doctor visit to solve. 

    Prescriptions will also be an issue if your surgeon is out of state, so a good
    primary care doc at home will be helpful in getting you any refills on meds, if
    you need them. 

  7. Take someone with you that can be focused solely
    on you during your surgery recovery at the hotel. They can sneak to the
    breakfast bar at the hotel and get you a plate, they can help you hobble to the
    bathroom, or they can run to the store to get some dinner because you refuse to
    pay room service prices. 

    Some folks do this without help, but it’s risky. My second surgery, the mons
    resection, went so well I actually went out and did things afterwards. I had no
    problems at all. I just packed up my drain and taped it to my stomach so it
    stayed out of the way. My first surgery? I was a mess. I had complications, I
    could barely walk or pee. I needed all the help I could get. 

    The thing with surgery is you might be fine, but that extra person will really
    be crucial if you are not.

    Plus, when I used to nurse, I always told people to bring a loved one with them
    to the hospital. You never know. Sometimes things just don’t go down right, and
    as transgender person, having someone there to advocate for you might be
    necessary when you are half out of it post-surgery.

  8. Be patient. It can take between six months to a
    year to really see what you have going on. It’s just the nature of surgery.
    Your body had to heal. If you are younger and super healthy? That will go
    faster. If you are not in that boat? It can go slower. Swelling and scars just
    take a while to see what you are really working with. 

  9. Wait lists are a thing. There is such a flood of
    transgender patients due to insurance coverage that it can take 18 months to 2
    years to get in. I was exceedingly lucky and had the means to hop on a
    cancellation. I was also willing to work with Dr. Meltzer’s protégé, Dr. Ley.
    She is a fantastic surgeon but had not as much experience with metoidioplasties.
    It cut my wait time down to six months. That is not typical at all.

I will be putting out a review of my experiences specifically with Dr. Meltzer and Dr. Ley’s office in the next few days. I have mixed feelings on that, but I think as a community I want to lay it all out on what I experienced. 

2/22/2018 Dick Diary

Okay. I got a response from Dr. Meltzer/Dr. Ley’s Office. I was asked a series of questions, and I wrote in depth answers to them. Some of my answers should have been red flags. I got a “Thanks for the update.” 

I swear. This office, man. Not that I was going to handle those red flags with them, because 1. it’s half a country away, and 2. I think I’d get better followup care elsewhere. 

Great surgeons, but followup care needs an overhaul or something. 

2/22/18 Dick Diary

I heard back from Sara via email about the pictures I sent to Dr. Ley. Apparently they look good? 

I guess it took a month to look?

In other update news, things are going well. I’ve been working out great, at least until I re-disolocated my left collar bone. So despite feeling great, and like I could work out surgery-wise, I am not until that sorts itself. 

I am fighting with the dissolvable stitches in the long abdomen incision. It’s easy to clearly feel the knotted sutures under the skin. I just hit 3 months, and if I recall it took me closer to 5 months too that to sort last time. 

I have not used any scar treatments, and the incisions look exactly like my top surgery scars where I did use scar treatment. They retreat a bit every week, and look better and better. I also have a very hairy belly, so that will kind of obscure that scar anyways. 

I plan to get a fighting rooster tattooed there anyways, so that will obscure it more. I’m not showing people my actual dick when they inevitably ask because I’m trans, but I will show them my “cock” when I get it tattooed on my lower belly. My tattoo guy thinks it’s hilarious. 

I haven’t got a lot to report, other than I have a nice small penis, and it works. In this case no news is good news. 

I think in a couple months I will write up a nice essay on my takeaways from this process, and what someone should do to prepare if they want to go have surgery with these surgeons, and with this surgery. 

1/25/2018 Dick Diary

Yesterday Lindsay the nurse tried to call, but it was during work hours, and I am super busy at work right now. It’s deadline season, and all hands on deck. 

I was going to call back eventually, but figured whatev’s. I’m already healing and to be fair it’s been hit and miss with the office. I figured they didn’t really care much with my last surgery experience. 

Today I got a call, and was home, so I answered. It turned out to be the nurse named Sara. She asked me how I was doing, and was totally great. She was the one that was actually super nice to my husband and I during that whole fiasco with the drain. 

What caught me off guard is she asked me to send her some pictures so Dr. Ley could go over them. I was surprised by that because I had tried to send pictures during the healing process with the first surgery when I had problems, and was kind of told not to bother. 

I don’t know if something has changed, or if this has to do with that whole passing out, stuck drain, reopening my incision fiasco when I left Arizona that they want to really make sure things are fine with me. 

I’ll send those in tomorrow, when I can get the hubby to take some. 

In other news, I reviewed all my post surgical pics from last time to present. My first metoidioplasty surgery really resulted in some terrible healing. I used to be a nurse, and it’s pretty obvious that I was very slow to heal, and was having issues from the look of the incisions. 

There’s not much you can do, but I really did didn’t have much support after that first surgery when I had so many complications. If anything it makes me feel better looking through to confirm I wasn’t nuts. There were complications, and I could have benefited with help. 

This last surgery? I don’t really need help, because I have no complications, and I’m doing really well. I’m already healed mostly, with the only problem being my perpetual failure to absorb dissolvable sutures. That will work itself out one way or another with time. 

It’s a good time for pictures because the swelling has really reduced, and is close to gone. 

In completely separate news, I have been told it takes about 5 years for nerves to regrow when they get damaged. I’ve been told this can result in some weird sensations while it’s happening. 

I’m two year out from top surgery, and my nipples, which were grafts, itch like crazy. The tissue can become erect with cold, and the area in a line straight down from the nipples to the surgery scars has been gaining back feeling. 

That’s kind of cool. I wonder how much feeling I will get. I can feel pressure, and the area that I can’t really feel much is shrinking. 

Nice. 

1/20/2018 Dick Diary

It’s been a few weeks. The area I had previously pulled stitches out of has healed really well. It’s flattened right down. I still have one or two half hurried stitches that I can’t get to, but in the scheme of things it’s no big deal. 

I did decide to take that first two weeks off form working out this months. Now we are back to the normal gym folks. (Except for little-miss-I-don’t-wear-headphones who blared house music during my workout from her phone. You, ma’am? You can piss right off.)

The mons resection, and redo of revision I got on 11/29/17 is just not as big a deal as a surgery as the actual vaginectomy/hysterectomy/oophorectomy. The hysterectomy by itself can be a real pain in the butt for some folks. 

I am still pulling the same weight, and running the same amount. I haven’t managed to go up in those amounts, but I’m just glad I didn’t start from scratch. 

I also can’t help but think having a regular weight and cardio program before the second surgery helped my recovery. I couldn’t do that prior to the first, far more invasive surgery, because the whole lichen sclerosis thing. If I worked out, the friction would fray the skin, and I wanted to give them the best possible working surface. So I didn’t. 

I feel like I am still in recovery from those bladder spasms from the hysterectomy back in May, just a bit. It’s not a huge deal, but I wonder if over the next year and a half if it will shake out. 

Anytime you do a major change to your body, it takes a while to sort. 

As for my actual surgery sites this time? They look good. The area I could remove stitches look better. 

The swelling that happened on the right side of my dick, has receded to nothing. Now that side looks really good. 

The left side? It’s more swollen along the incision. The incisions look great, but I think that whole dissolvable stitch thing is the reason. If it’s like last time, month 4-ish is when the under skin dissolvable sutures actually started breaking down. 

The nice thing, is at almost 8 weeks post surgery, I don’t really think about it much anymore. It’s still healing, and doing it’s thing, but it doesn’t impact my life much. 

I think the only thing I noticed with this recovery period, is I get more tired than I’d expect. That’s fading though, and I’m sure with resuming my workouts that will definitely disappear. 

Things are going well.