Surgery Day - Day 3 Post-op

 I'm officially three days post op for stage 1 metoidioplasty. It's SO wild to be on the other side after all of the anticipation and planning that has gone into this. I want to give a recap of the last three days so that I have something to look back on while I'm a little further out in healing.

November 17th, 2021: Day of Surgery

I woke up at 6:00 to take a shower with antibacterial soap and take my piercings out (which is always more of an ordeal that I want it to be). My partner and I headed out of our AirBnB around 7:00 AM to park and get to the pre-op area check in by 7:30. We checked in, I signed some papers, they gave her a pager to keep her updated on the progress of my surgery, and we went to sit together in the waiting area. They called me back to pre-op about fifteen minutes later, so I said goodbye to my partner and headed on in. Everything was very standard once I was in the pre-op area - I got naked, put on the gown and socks, and laid down to talk with nurses/anesthesia/everyone else before surgery. They started a forearm IV and then pretty soon after that I got something through the IV from anesthesia, not exactly sure what. They wheeled me to the OR in the bed and then had me move over to the operating table (this is something I have no recollection of doing with top surgery - maybe I was already out at that point? anyways it was cool to see the inside of the OR!). Then I remember nothing until waking up!

Surgery was scheduled to last 5.5 hours and actually ended up being closer to 4.5 hours. I had no issues coming to in the PACU which is such a blessing, immediately drank some water and felt pretty comfortably chatty and conscious after about 30 mins. They transported me upstairs to my room and then lifted me into the bed using the sheets, which was a fun experience. My partner was able to come in and see me right after I arrived in the room so we hung out, ordered dinner (the works: applesauce, cranberry juice, mandarin oranges, beef broth), and then she left when I started getting tired around 9:30. I had never stayed overnight in the hospital before and I can't say I loved it - my mom (who is a nurse) always says, "You don't go to the hospital to get more sleep" and that was certainly true. I was woken up a few times to get my vitals and take my scheduled meds but it wasn't the worst sleep I've ever had.

November 18th: Day 1 Post-op

I woke up at 6:00 in the morning for my scheduled Tylenol and my partner arrived right when visiting hours started around 7:00. At this point I was planning to go home later in the day so was getting excited about that. A urology resident came by to check on things and told me everything was looking great. We had breakfast and I took my first oxycodone since surgery in preparation for getting up and walking around. This is where things get weird - rather than having the constipation problem that most people have after surgery, I was totally ready to poop immediately after eating breakfast. I was pretty uncomfortable and knew things were going to come out fast, so I had the nurse help me into the bathroom. The good news is that I was able to poop, the bad news is that I then proceeded to pass out on the toilet, kick the container that held my newly emptied urine from my catheter all over the bathroom, and needed to be carried back to my bed. I came to pretty quickly (as I was being carried to bed and looked around to see a room full of people lol) and felt fine once I was laying down again. We were hoping it was a fluke so I tried again, this time with the intention of moving to the chair, but passed out again after standing for about ten seconds. Again, the nurse was right there and he lowered me to the bed no problem. 

At this point it was getting a little concerning so they ordered an EKG and labwork, all of which came back normal. It was also becoming clear that I was probably going to spend another night in the hospital. I ate lunch and again, immediately felt like I had to poop (yay for overactive bowels). This time we tried the commode rather than the toilet, so I only had to stand up and pivot to sit. Sadly I passed out again, this time very briefly, and came to just in time. I hung out on the commode for a while (super cute), and then mustered the ability to move to the chair with the help of the nurse. I still felt pretty crappy sitting up in the chair but it improved over time. I sat there for several hours, ate dinner, hit the commode again, sat for a while longer, and finally went back to bed (again, all with the help of at least one nurse). While I was sitting in the chair before dinner Dr. Hadj-Moussa came to see me which was extremely comforting. She's very confident and somewhat nonchalant in a way that works really well for me. She took a look at everything, talked about the surgery being very textbook, and we discussed the benefits of using the topical estrogen before surgery. I'm looking forward to seeing her again at my first post-op!

TLDR: this was all super stressful. I'm very glad I didn't fall and was always supported, but it feels shitty to pass out regardless, especially to do it three times in a row. I had a little bit of lightheadedness after top surgery / hematoma surgery several years ago, but nothing this intense. Something to keep in mind if/when I have to go back under general anesthesia, I suppose. Anyways, I went to bed earlier and played some rain sounds on my phone so I slept a lot more soundly that night even if I was still in the hospital.

November 19th: Day 2 Post-op

I woke up again at 6:00 for my Tylenol and then had to poop pretty soon after that, which was of course right in the middle of the 7:00 shift change. Luckily, I was able to make all of my movements without losing consciousness! Such a huge relief. I ate some breakfast and had my mind set on being able to leave later that day, so sat in the chair for a while, stood up for a while, the works. The urology NP came in to talk to me about my meds - she was incredibly informative and kind. I was able to get all of my prescriptions filled at the hospital and they even came up and delivered them (which my nurse said was probably my NP pulling some strings; apparently you usually have to be "in a lot worse shape" to get that sort of treatment!). Once I had my meds I strung on another gown/cape and took a walk in the hallway with my partner. I felt anxious but physically solid, which was reassuring on its own. 

After we walked around for a while I called the nurse back to take out my IVs. I got dressed (with much help from my partner), gathered my belongings, and geared up to leave the hospital. We wheeled me right to the car and I didn't have much trouble getting from the chair to the car. I've been surprisingly comfortable in a somewhat-seated position and the 20 minute ride back to the AirBnB was uneventful. It felt SO good to be in my own clothes, to smell a little bit less like the hospital, and to have more privacy and independence. Yesterday I watched a ton of tv, pooped (water) (tmi sorry) several times, and had delicious chicken noodle soup for dinner. When I got home I was taking Tylenol every 6 hours and AZO every 8 hours, plus my antibiotic twice a day and the "magic mouthwash" as needed. This magic mouthwash stuff is awesome - it's essentially bubble gum flavored lidocaine. The buccal graft from my cheek hasn't been wildly painful but it'll catch me now and then feeling super tender, and the gaping sensation is pretty disturbing where the wound is at its deepest. The magic mouthwash numbs everything out and feels cleansing so I'm super happy to have that.

I slept alright last night - better than when I was in the hospital but not amazing. It's hard to get comfortable and I was having some chest pain when I tried to lay more flat. I think it was a combination of tightness, anxiety, and indigestion but it certainly kept me up a few different times (and then of course I had to spend some time googling when chest pain is an emergency). I woke up at 2:00 AM for Tylenol and AZO, which have been very helpful. When I laid in a propped position the chest pain was better and I slept until 8:00! Which is when the alarm for more meds went off. 

November 20th: Day 3 Post-op

Today was my best day by a huge margin. I still felt a little weak / off when I woke up, I felt like sleeping took a lot out of me? But I was able to walk to the bathroom without a problem and then waddled over to the couch to start in on Tiger King season 2. I am very grateful that my pain feels manageable with over the counter meds - I don't like the feeling of oxy - even though I know it has helped with my pain in the past, I'd rather not do it if I can avoid it. Today I took less Tylenol as well and replaced one of those doses with Ibuprofen. I'm hoping that tomorrow I can do the same thing and rotate what I'm taking. I also added in my first round of Miralax (certainly hadn't needed it the other days), an herbal probiotic, some homeopathic arnica pills, and an immune support tablet. 

I mostly watched a bunch of television and played chess on my phone today. I didn't put underwear on the whole day which has been fun - according to the NP I can "officially free ball" now (lol) so I took advantage of that. I also took my first SHOWER post-op which was amazing. I was pretty nervous about it because of the passing out but I did fine. My partner stayed right by the door and held my catheter bag while I soaped/rinsed. I was getting pretty tired so called it off after about 5 minutes, even though the water was still running a little pink at that point. After the shower we did my first dressing change, which meant taking the gauze sponge off of my catheter site and off of my mons incision. We discovered that the blood/pink water was most likely just from the blood-saturated mons incision gauze, since everything was pretty clean underneath. It feels good to get things more cleaned off and then I just air-dried naked before redressing the sites. I also put (most of) my piercings back in today which was it's own adventure. Haven't attempted the nipple piercing yet and may just be done with that one. We will see tomorrow.

I'm now back in bed and typing all of this up on my laptop using the cool adjustable laptop stand I bought for surgery! I find that I'm a lot more comfortable on the couch than I am in bed - not sure if it's the firmness of the mattress or what, but my butt gets really sore in bed pretty quickly. I'm going to try sleeping more propped again tonight and hope that I don't have the same weird pain from last night. Waking up again at 2:00 for Tylenol and Azo but maybe this will be the last night we have to do that. Not much on the docket for tomorrow except for more tv, more waddling around (I actually am walking more easily than I anticipated - my mons incision is low enough that it doesn't prevent me from standing up relatively straight), icing my BLUE nuts (holy shit I am so bruised), and healing. I feel good and grateful today and we shall see what tomorrow holds!