Saturday, September 27, 2014

GRS: Recovery in the Hospital

My surgery was only one hour forty five minutes from start to finish.  Brassard's surgeries are shorter than most but you have to take into account that there are 2 surgeons working in tandem here and that they do a lot of these procedures.  This is one of the top rated and most popular destinations worldwide for GRS, and when you consider that many from the US and other countries choose to come here and most of the Canadian provincial governments fund surgeries, you can see why Drs. Brassard and Belanger stay so busy.

Right now I am in the recovery center next door to the hospital.  Commonly known as "the residence", this is more of a convalescent house and it is named L'Asclepiade.  I'm writing this blog on Saturday, still only three days post op.  I was taken to this house yesterday morning in a wheelchair, across the parking lot from the hospital.  This post will focus on my initial recovery in the hospital, before being rolled into L'Asclepiade.


By the time I'd made it into my room after surgery, I was awake and aware enough of what was going on to ask Mitchell to snap a few pictures of me in my mobile bed.  The smile on my face showed that I was very happy to have made it through the operation but was tempered by being groggy and in whatever pain I could feel at that time. 

My roommate Samantha, who had surgery directly before me, was not yet back in our room when I was taken upstairs, but she was back when I returned about 2:45 PM.  Mitchell and Mama were in the room waiting for me, of course, and they had smiles and relieved looks on their faces.  I guess at that point we were all happy to have it over with.

For this surgery I was given a spinal block that consists of a shot into the spine that deadens the area below the waist.  This is similar to the epidurals women are often given during childbirth and assures that we won't feel any pain in the surgical area during the operation.  My understanding is that the effective duration of these spinal blocks is about 3 hours, so the fact that Brassard/Belanger are able to complete the GRS procedure in a much shorter time period than other surgeons allows this to be an option here.

In addition to the spinal block, an injection is given to put us into a "twilight sleep" during the operation.  I can say that very soon after that needle went into my left arm I was completely out until after the surgery.  There have been cases of patients waking up during surgery, or being awaken by staff if any problems were encountered. 

This was a major concern of mine during the time I was researching the surgery and at one point I'd considered insisting on general anesthesia so there was no chance of my waking up during surgery.   The fact that general anesthesia comes with greater side effects and more of an element of risk helped me decide on the spinal block/twilight sleep method of sedation.  The Brassard Clinic really pushes this safer method of anesthesia  and the fact that they are able to do this here is one of the advantages to having GRS in Montreal.


As the afternoon progressed into evening, pain set in as the spinal block and other medications used during surgery gradually wore off.  I was given an injection of dilaudid every 3 hours all the way through the first night post op.  I didn't get much actual sleep, just nappy pass outs from the medicines, and the nurses also came in at least every three hours to check all vital signs.

During surgery, a catheter was placed into my bladder so all of my urine essentially ran into a bag secured beside the bed.  There was also another tube draining blood from the surgical area into a fist sized container, but it never accumulated a large quantity of fluid.  These drains were emptied periodically by the nursing staff, who also made regular checks and cleanings of the surgical area.

As far as the vagina itself, a stent was packed into it that is goes in approximately 6" and is the thickness of one of the larger dilators.  A large mound of gauze is placed over the entire area and the catheter extends from that mass.  This gauze is sewed into the skin and other gauze pads, that are regularly changed, are placed all around it.  The area around the mound of gauze is kept dry and clean but the gauze mound itself will adsorb blood and other fluids over the next few days, until it is removed.


During the first night the pain was more aggravating than intense.  There was a constant feeling of needing to urinate that I am told is caused by the catheter and the stent.  It seems like every time pain would begin to overwhelm me, a nurse would come in with another dilaudid injection. 

Later in the evening, maybe 8 hours after surgery, nurses came into the room to help me stand up.  That was pretty much it for the first day, just get up and stand for a minute beside the bed.  Believe me, that took a lot of effort and concentration.  I felt like I'd walked a couple of miles after that.  Having had her surgery a little earlier, Sam was doing these steps before I did, but by the next day we were pretty much on similar schedules that were governed more by how we felt that than anything else.

I will note that I was very aware the entire day after waking up post operation.  I drifted off to sleep a few times and was in sort of a druggy haze, but i was not completely out of it.  As the evening drug on past their usual dinner time, I advised Mama and Mitchell to leave and get something to eat.  They could visit whenever they wanted to the next day, so soon after dark they took off.


I got a lot of rest that evening, posting on Facebook periodically, but I didn't feel like concentrating on anything enough to read any of my books, write, blog, etc.  There was no television in the hospital rooms.  I was allowed to eat some crackers but by that time nausea, caused mostly by the narcotic pain killers, had set in and I coughed them back up.  Through the night I got sick a few more times, mostly from water, but by morning I wasn't drinking much water and was reduced to dry heaves.

The nurses also gave me injections for nausea, which allowed me to not vomit so much.  That made me feel a little bit better but I still could not hold down much water.  It would be morning before any real food was served.  Someone came by soon after wake up, when the room lights come on and activity begins to pick up in the halls.  The first vital signs for the day are taken and we received our injections as we made some choices from a simple breakfast menu.


I was sort of groggy when the surgeons came into the room to check us out.  It was a little before 7 AM and when Dr. Brassard saw me he said I looked pale and asked if I was nauseated.  I was a little sick at the moment but after both doctors examined me they said I was doing fine and everything in the surgical area looked great.  That made me feel a little bit better but when breakfast arrived I barely touched it.

By lunch I was not as nauseous and ate some mashed potatoes and vegetables but didn't really touch the ham.  I had made the choice for ice cream and I did enjoy that. :)  My loved ones visited me that afternoon, as well as my new big sister Evonne and a couple more local friends I'd met online, Isabel and Erica.  Samantha's mother had arrived from Edmonton to spend time with her, so much of the afternoon was spent talking to friends and loved ones.

Around mid day, they took us off the pain killer shots and gave us pills.   Both Samantha and I began to be bothered by pain after making this switch, so we called the nurse in to address the issue.  She put in a call to Dr. Brassard, who was in his final surgery of the day, and when he finally got out of the operating room and responded he sent the order for us to each get one more injection, then switch to the pill form of dilaudid. 

During the time of increased pain, both Samantha and I experienced burning sensations in the surgical area and I also remember a stabbing feeling.  Those feelings have come and gone since surgery but the dilaudid has been able to manage it, while the pills they initially gave us, (oxycodone) didn't.

I did get in two walks Thursday, one in the morning and one in the afternoon.  Mitchell went with me on my second walk, in place of a nurse, and I got a little frisky and made it almost 2 times around the small circular hall of the hospital's first floor.  These were indeed baby steps but I was less than 24 hours out of major surgery when I took them.  They have told me since the beginning here that the quicker I get active, the quicker I will recover, although it is key not to overdo it.


Thursday evening Mitchell and Mama went back to the bed and breakfast right before dark.  I knew that the next morning I would be heading next door to the recovery center between 9 AM and noon, so I told them I'd just see them when I got over there.  Having eaten a decent dinner myself, my first good meal since surgery (with ice cream dessert) and back on an effective regimen of pain management, I expected to have a decent night and maybe even get some sleep.

About 9 PM I decided to make one more venture out of bed.  I'd asked the nurse if I could go into the bathroom, brush my teeth, wash off and shave.  She said that would be alright and she helped me get up and get going to the bathroom, which was next door but seemed like quite a distance. 

When I came out of the bathroom, there was no nurse, but I managed to get everything back into my room and get into bed.  Such a normally routine activity was a production on this night, but I felt so much better after having freshened up.

From my bed I finished my blog on The Surgery, as I wanted to get that one written and posted while the big event was still fresh in my head.  When midnight rolled around, it was time for another round of pain killers and then I planned to get some much needed rest.  All the visitation, walking, writing and basically anything I'd done that day had tired me out.

When the midnight medicine came through I had the nurse cut my light out and prepared for sleep but Samantha, who'd been sleeping for the last few hours, woke up in some pain and had trouble sleeping the next few hours.  She did get up a walk a couple of times during the night, as they told us that would help, and it wasn't until the 3 AM round of medication that both of us were able to fall soundly asleep.


Friday morning they let us sleep a little longer, until just after 6:30 AM, and the same older gentleman who woke me up the morning of my surgery and spoke to me as I was on the operating table being put to sleep, was the first to greet us on this last morning in the hospital. It turns out he is a very nice fellow, not sinister at all.  I think I had just gotten creeped out when he asked me if I remembered him, as I was being put to sleep before the operation.  I guess at that moment, with all that was in my head, I really didn't remember who he was.

So, we had our breakfast, and I ate a good one, then lay in bed waiting for the orders to go next door.  Sam was to go first, at 10, and then I was scheduled to depart at 10:30.  Dr. Belanger came in to check on us and she helped take my catheter bag off as well as the blood drain.  At the recovery house I would have the catheter tube hanging loose and have to manually operate it when I peed, standing up.  She also said everything was looking good.  :)

A lot of things were about to change as we made the move from hospital to convalescent home.  I'd only been in the hospital 44 hours post op but it seemed like much longer than that.  As my things were packed up and I headed to the door, I took a brief look back at my temporary home in the house of pain.  It seems like it should have been a nightmare but it really seemed more like just taking care of business. 

Walking down some steps and out the door of Centre Metropolitain De Chirurgie I was placed into a wheelchair and rolled quickly across the parking lot by the young male attendant.  I had only seen the brick building before me in pictures, L'Asclepiade.  What would I face in this recovery center?  Stay tuned for the next installment to find out.....


Some of my live postings on Facebook in the hours following surgery....

I just wanted you all to know that my surgery went well, I am awake and not having too much pain right now. The operation took one hour 45 minutes and I'm told it was successful. I'm extremely happy right now and a little hungry but cannot eat yet.


They just helped me stand up for a minute.
— at Dr Brassard & Dr BĂ©langer: Sex reassignment and plastic surgery in Montreal.

The pressure and intense feeling of having to urinate is really wearing on me. The catheter is doing it's job but this feeling is by far the biggest source of discomfort right now. As I near 12 hours post up the actual pain is subsiding as long as I lie still. I'm told everything is normal right now but I'm starting to really, really look forward to getting this Stent out. Almost time for another dilaudid injection, which makes me nauseated.

I'm not going to let pain get me down and am so happy to be doing so well here only 15 hours post.

After my walk and a downgrade in the strength of my pain medication, the pain is quite intense. My roommate Samantha, who had surgery right before me, is experiencing something similar.

I just woke up from a good nap. I'm back on dilaudid now and pain is manageable. Also my loved ones arrived after visiting the Basilica this morning.

Ice is your friend.


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