My GRS With Dr Toby Meltzer (1/2)

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This description of my surgery experience is intended to give women who plan on undergoing GRS some idea of what to expect. Nobody else's experiences will be exactly the same, even if they go to the same surgeon, but there are likely to be some similarities. Not all the details are precise, particularly with regards to timing, as this was written some time after my surgery, and my mind wasn't quite functioning at full capacity in the days after the operation. Warning: this page contains some fairly disgusting descriptions (no, nothing likely to be of erotic interest).

The first step in planning GRS is choosing a surgeon. I settled on Dr Toby Meltzer, a plastic and reconstructive surgeon based in Portland, Oregon in the USA. There are very few surgeons in the world with extensive experience in GRS, and experience was one of my most important criteria. Dr Meltzer had an excellent reputation, particularly with regard to preserving sensitivity, and after a lot of research I decided he was the best choice for me. Dr Meltzer prefers to meet his patients before scheduling surgery, but it is not a requirement as for many (including me) an extra tip to Portland would be an unreasonable expense.

Officially Dr Meltzer's waiting list is over a year long, but they get plenty of cancellations so it's possible to move forward quite a bit from the first date they give you, especially if you don't need much notice. My final date was almost five months earlier than originally planned, and could have been sooner if I'd been ready. Dr Meltzer carries out the GRS in two stages to minimise the risks and get the best possible cosmetic result. The main vaginoplasty procedure is followed by a labiaplasty at least three months later (in my opinion three months is too soon). The labiaplasty is technically optional, but highly recommended.

Dr Meltzer sent out a very detailed information pack about the surgery. Unfortunately, there was a lot of repetition, and the quality of the information was sometimes less then wonderful (notably the maps of Portland and the electrolysis recommendations). Variations on the pack were sent out several times before the date of the operation, which seemed excessive. Despite this, the information pack was very useful, and preferable to a tidier but less comprehensive pack. A US$500 deposit was necessary to reserve a date for my operation, with two months notice of cancellation required for a refund.

The full payment was due one month in advance, which proved to be more difficult to manage than I'd expected. I had to borrow much of the fee (more of my income went on electrolysis than savings), and despite having a perfect credit record and being easily able to make the repayments, it was a struggle to get all I needed. Two letters of recommendation for surgery were due eight weeks before the surgery, and also proved to be a problem due to the only suitable psychiatrist becoming seriously ill before writing my second letter. Dr Meltzer's office was very reasonable about the unavoidable delay.

The day before the surgery I wasn't allowed any solid food, or anything containing sugar or diary products. My girlfriend and I checked out of our motel, and were picked up by one of Dr Meltzer's staff for my pre-surgical appointment on the upper levels of a downtown office building. We dealt with some paperwork, and the nurse talked a bit about what would be happening and went over the medications I would need after the operation. We were given a bag of pre-surgical supplies, containing the bowel cleansing preparation, a can of approved nutritional drink, a tube of petroleum jelly, and more documentation. Then Dr Meltzer entered, and discussed the surgery briefly. He wasn't quite what I'd expected, appearing relatively young, short, and energetic.

We were then left alone so I could change into a hospital-type gown, and I sat in something resembling a dentist's chair. Dr Meltzer and the nurse came back into the exam room, and reclined the chair. I'd been dreading this a little, but the examination was brief, and not as distressing as I'd feared. Everything looked fine for the operation. I was left to get dressed again, for the last time in a while.

We arrived at the hospital a few hours early, and my room wasn't ready. After filling in some paper work, we went down to the cafeteria to wait. I drank the can of "high caloric nutritional supplement" Dr Meltzer had supplied, along with lots of water as required by the pre-surgical instructions. My girlfriend got to eat real food, which I was beginning to crave by then. I could have had some broth, but they weren't able to supply anything vegetarian (though after the operation they were very good at providing vegetarian meals). When my scheduled check in time (4pm) arrived, we finished off the paper work and were shown to my room.

The door opened into a mini-corridor with a curtain at the other end, and a door to a private bathroom with shower off to the side. Beyond the curtain, the room was maybe 8 by 10 feet, with a big window overlooking the grounds. Beneath the window was some kind of rather temperamental air conditioning device that proved useful as a shelf. A bed with retractable railings on each side was next to the window, and could be adjusted towards a kind of sitting position by a couple of buttons (both the back and the knees moved). In the opposite corner by the curtain, a TV was suspended from the ceiling - a remote by the bed could cycle through the channels (in one direction only) and adjust the volume. There was a reclining chair at the foot of the bed that would be my girlfriend's less than comfortable sleeping place for the next couple of weeks, along with an adjustable table that could also be moved out over the bed. The bedside cabinet had a phone on it, and contained a fridge for our use. The wall opposite the window had a closet and a bench with a wash basin. There was also a big red biohazard bin. Nothing fancy, but pleasant enough.

After changing into the traditional hospital gown, I had some blood taken for tests, and later an IV needle was stuck into my left forearm, with a short tube taped to my arm ending in a plastic socket. At 5:30pm it was time to drink the Magnesium Citrate Effervescent Laxative, which took ages to stop fizzing. It tasted fine, and was probably much better than the Nu-Litely commonly used as an alternative. After that was more water, and two hours later four tablets. I wasn't even allowed water after midnight. I had quite a few trips to the bathroom during the evening - the petroleum jelly helped it all go smoothly and painlessly. Mostly I was just waiting, and very glad to have the company of my girlfriend. I was in a slightly unusual state of mind, being aware that I was about to undergo a very major procedure, and wondering whether I was doing the right thing, but not really doubting my decision or being scared of the possibility of something going wrong. I managed to get to sleep ok.

Standing up after a middle-of-the-night trip to the bathroom, I fainted from lack of food and being drained by the bowel prep. I came to sitting on the bathroom floor with my girlfriend and the nurses around me being concerned. I'd bumped my head, but it wasn't anything serious. They helped me back to bed, and plugged an IV tube into me to get my blood sugar up. It was a bit scary, and a little bit embarrassing, but that was all. I wasn't happy about giving my girlfriend a scare like that.

There wasn't really time to get any more sleep before the preparations for surgery began. I had to use a suppository as the final stage of the bowel prep. I wasn't allowed to move around without assistance following my earlier performance. Various people went in and out, though I didn't get to see Dr Meltzer that morning (he was delayed in traffic). The anesthesiologist commented that my mouth was small, which he was concerned could have been an issue for the tube they stuck down my throat during surgery (something to do with either oxygen supply or anesthetic, I don't recall exactly), but fortunately didn't result in any problems. Around 8am I was lead out into the corridor and lay down on a gurney, and had some kind of sedative stuff pumped into me through the IV. Though I must have been awake for a little bit longer than that, the last thing I remember is kissing my girlfriend and telling her I love her.

I have vague memories of being awake in the recovery room. I don't recall speaking or being spoken to there. My first clear memory is being brought back to my room and transferred from the gurney to the bed (at about 1pm). Though I didn't have any real sense of time having passed, I knew the operation had been completed. I had to help shuffle myself across on to the bed, which was an exertion I hadn't expected so soon after the surgery. I vomited shortly afterwards - it was rather messy, but at least I didn't have to clean it up myself. After the first occasion we kept a container close by, and made good use of it, particularly after I made any attempt to eat. Fortunately the IV was providing a steady supply of nutrients, so I didn't have to worry about malnutrition. The IV was also constantly feeding pain control medication into my system, and I could press a button for an extra dose every few minutes as needed.

I was wearing compression stockings that squeezed my legs rhythmically to aid circulation. They were relatively easy to ignore. There was a dressing over the surgical site, with a yellow catheter tube emerging from the top and curving around over my belly where it was thoroughly taped down. It connected to a clear tube that continued out to the right and lead to a catheter bag, which was usually hung from the bed frame. A drain tube, clear and narrower than the catheter, also stuck out from under the dressing on either side of the catheter, each leading into a small plastic container (also taped to my belly) which gradually filled up with blood and had to be emptied every now and then. The area between all the tape on my belly and the surgical dressing had been shaved while I was unconscious, and stained yellow (from iodine?). There were two deep depressions just below the tape, about 5cm apart, created by very solid looking sutures holding my vagina in place while it healed.

The surgery took less than four hours, with no complications, and I didn't loose much blood. My girlfriend was very relieved. I think I was relatively alert and rational when I woke up, under the circumstances, but my girlfriend thought I was a bit out of it. I didn't experience any pain to speak of, thanks to the IV.

The first day after surgery I wasn't feeling too bad. The dressing was removed from the surgical site in the morning, and replaced with a pad. I wasn't in any great hurry to see the results, but eventually we acquired a mirror. The surgical site itself was very swollen, with the labia stitched together with dark sutures - not very much to see, though that was in itself an improvement. The catheter came out from between the labia at the top, over the clitoris (which wasn't really visible), and the drain tubes emerged from the skin at about the same level, about the same distance apart as the two big sutures. The two drain sites and the clitoris were the source of most of the blood for the next few weeks, but it was mostly old blood trapped in the area during the operation gradually leaking out rather than fresh blood.

I was given a sponge bath by my girlfriend and one of the nurses (a male nurse, which didn't concern me in my mental state at the time but in retrospect I don't think was entirely appropriate). Most of the time I was feeling hot, so this helped cool me down as well as freshening me up a bit. The hospital gowns are designed to make this easy to do. Nurses came in every now and then, including in the middle of the night, to check my pulse, blood pressure, etc. They didn't find anything that concerned them.

I had odd dreams, which may have been nightmarish if my mental state had been closer to normal, but the same drugs which probably caused them also kept me calm. During the day I was fairly tired, and at times I drifted between wakefulness and dreams whenever I closed my eyes, without really being asleep, which was weird. At night I was a little restless, and asked for something to help me sleep a couple of times. I didn't have any regrets about having gone through with the operation, but I did feel a sense of having done something really major, and being kind of overwhelmed by it and not sure quite what to think.

On the second day after surgery the compression stockings were removed from my legs, and the IV tube was taken out. The IV needle was left in, in case they needed to resume intravenous supply of anything later on (they didn't). I think the needle was removed the following day. Without the IV I had to take oral pain killers (I can't find the exact details right now), but they were quite sufficient to keep pain to a minimal level. I got out of bed briefly for the first time, which was a relief as my rear end was getting quite uncomfortable by then from lying on my back for so long (the disposable net panties didn't help). Getting up was awkward, especially with the catheter bag to deal with, and walking was difficult and tiring, but with my girlfriend's assistance I made it to the door of the room and back. Later I got up for a second time. I think I managed to keep some food down (mostly just jelly, but possibly a few bites of more solid food).

The worst part of my surgery experience was a bad case of muscle spasms. I think it started the first night after surgery, with an involuntary spasm in my legs waking me up suddenly. It happened more the second night, and I brought it up with the nurses. I was mostly concerned that the sudden movement might damage the surgical site in some way, but I was reassured that that wasn't an issue. By the end of the third night, it was a major problem. Around five or six in the morning I called the nurse and asked for some muscle relaxant or other medication to stop the spasms. I was told that only Dr Meltzer could prescribe it, and I'd have to wait for him to come in for the surgery he was doing that morning. In the mean time I was told to try taking more pain killers.

It was an unpleasant wait, with my legs trembling constantly. It was impossible to sleep or even relax, and very tiring as I had to keep my muscles tense to control the spasms at all. But when Dr Meltzer did arrive, he began the day's surgery without seeing me. I had to wait several more hours for him to complete it. Walking around or sitting on the edge of the bed helped a little, but at this stage I was still barely capable of walking, and sitting up for extended periods was very uncomfortable. I got up and lay back down several times. This was the day on which I was supposed to be signing out as a patient (though remaining in the hospital as a guest), and they actually tried to make me sign more than once while I was in this state. Naturally I refused.

Eventually, about eight hours after I first asked for help, Dr Meltzer finally showed up and prescribed some valium. He also switched me to Demerol (50mg Meperidine) for pain relief, as the original pain medication could have been the cause of the spasms. Another half hour or more later, the valium equivalent arrived, and I began to feel better and was able to get some sleep at last. That one dose (10mg Diazepam) was sufficient to totally resolve the problem (possibly in combination with the change in pain killer), though it took a few hours to completely take effect. I did take one more pill (5mg) later as a precaution, but in retrospect it was probably unnecessary.

Towards the end of the third day after surgery I switched to VIP status, ie I was no longer being cared for as a patient of the hospital, but I was still staying in a hospital room (staying in the hospital as a VIP is an optional extra costing US$100 per night, and you can go elsewhere if you wish, but I strongly recommend staying). This meant being responsible for emptying my own blood drain bottles and catheter bag, and taking my own medication, which I'd obtained back in New Zealand. Dr Meltzer estimated the cost of filling the prescriptions in Portland to be at least US$150, but it cost less than US$50 in NZ, even without government subsidies. Americans are getting ripped off by the pharmaceutical companies. The next day I had my first post-surgical bowel movement (an important indication that my system was recovering from the surgery), and had a proper shower (very pleasant after days in bed). The day after that I learnt to disconnect the catheter bag and walk around with the catheter plugged, to get my bladder back into shape after a week of total relaxation. I made it all the way to the main entrance of the hospital.

Most of the time in VIP status I spent just lying around watching TV, eating (my appetite and tolerance for food returned gradually), and walking around a bit. Walking was still very tiring, and a bit uncomfortable. The main discomfort from was tightness in the skin of my belly which had been stretched down during the surgery. I was walking round somewhat hunched forward for quite some time. Sitting up in a chair wasn't too much fun either, but necessary for practical eating. The doughnut cushion was useful there, though I didn't really need it after checking out of hospital. I read a bit, but didn't feel like it too much (unusual for me). The cable TV was a little annoying - the first channel was a constant update of what was on the other channels for the next couple of hours, but often the most interesting programs listed were on the few channels the hospital didn't get. Still, it did keep us occupied fairly well.

On the sixth day after surgery, one of the nurses removed the drains and cut the stitches holding the labia together. I was very nervous beforehand, but it wasn't particularly traumatic. The drains were much longer than I'd expected, with little holes along their length to let the blood drain into them. Having the sutures cut wasn't too bad either. It felt a little weird, but didn't hurt. The packing (placed there to stop it from shrinking while it healed) was then removed from my vagina - another weird feeling, though there wasn't as much of it as I'd imagined from reading other accounts. It was immediately obvious that the labiaplasty would be essential to achieve anything resembling a natural appearance, as the labia were essentially V-shaped with the clitoris sitting completely exposed between them at the top. The whole area was very swollen, and the clitoris was covered with some kind of black scab, but that was normal for so soon after surgery.

Once the packing was out, it was time to dilate. I was given a set of four dilators in a pretty pink cloth holder, a douche kit, and a large tube of surgilube. The dilators were transparent plastic, and gently curved. They ranged from two and a half to three and a half centimeters in diameter, with a series of dots from ten to fifteen centimeters along to help measure how far in they go. The largest was quite terrifying.

The nurse inserted the narrowest dilator for the first time, then I reinserted it myself under supervision, to make sure I'd be able to start doing it myself in a few hours time. It went in easily enough, and I had to hold it there for at least ten minutes. I had to dilate four more times that day, including once in the middle of the night. Without the packing there constantly, it became a little more difficult with subsequent dilations. It took a little while to get it all the way in (and figuring out exactly when I'd reached the end wasn't that easy), and was a little uncomfortable though not really painful. I also had to start douching twice a day, which was more pleasant than the dilation. It produced some fragments of dead tissue and other debris. That evening an internet acquaintance who lived in Portland stopped by to visit. It was pleasant, but afterwards I was absolutely exhausted just from sitting and chatting for an hour.

The day before checking out of the hospital, both the catheter and the sutures in my belly were removed. I was extremely nervous about having the sutures cut; even after the first had proved to be completely painless, I was nervous about the second. Having my sweetheart to hold my hand helped. The catheter was shorter than I expected, especially considering how long it took to come out. I'd heard that the catheter removal could be quite painful, but in my case it didn't hurt particularly. Having the last of the tape on my belly removed (it had been holding the catheter and drain tubes in place) was a relief. I had no trouble urinating afterwards, though the swelling made it a bit messy as expected.

On To Part Two

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