Archive for the ‘ Hospital ’ Category

Surgeon’s Report and Instructions

I added a new page (look for Surgeon’s Report near the top of the blog) which contains the surgeon’s report in English. The page includes the text of the report (exactly as is typed in the report) followed by a JPG of the two page document.


Flushing the Stent

PLEASE NOTE: This blog is currently in development. As the next several weeks pass I’ll be adding posts as well as adding more information to old posts so be sure to check them again. Eventually I’ll have added everything I remember and I’ll remove this note.

If you’ve read the last few posts you know the nurses flushed the stent in my penis multiple times each day while I was in hospital. Yesterday Marko showed me how to do this myself.

Basically I have a bottle of solution, a syringe, and two needles. The larger needle is inserted into the membrane at the top of the bottle and left there. I am to insert the syringe into that needle, invert the bottle, and draw 2 ml of solution. Then I turn the bottle upright and remove the syringe (leaving the large needle in place in the bottle). I attach the smaller needle to the syringe.

At this point I move to the bed and lie back with my lower body on a absorbent pad beneath me (a small amount of solution comes out of the stent). With a hand mirror in my non-dominant hand (so I can see what I’m doing, lol) I insert the small needle into the stent and flush it by injecting the solution.

While you’re in hospital you will see the nurses do this using the same method.

Post-op Day 4: Pretty good day, leaving hospital

A Norco day.

Today was full but I felt pretty good.

The hospital routine was the usual: flush the stent, antibiotics, temperature, blood pressure.

A stitch came out of my mouth (non-event, lol). The port still in my left wrist was bugging me more. Almost painful, really.

I had another BM which was good timing since I was anticipating a shower and bandage change. Again, I was glad to have wipes with me.

0800 or so

Vesna removed the port from my wrist (yay!) then brought breakfast, including yoghurt (I’m thinking a lot of yoghurt is a good thing considering all the antibiotics I’m taking).

A bit later she returned and told I could shower when I was finished eating. She said Marko would be there in 15 minutes or so to change my bandages and take me to the apartment.

0900 Bandage change and going to the apartment
After emptying the urine bag I clamped the catheter tube closed and removed the bag. Showering was basic and relatively fast but it felt GREAT. Of course, I could only reach down with soap as far as my calves but I’ll survive.

Marko removed the crisscrossed bandages and was happy with how good everything looked. This part doesn’t hurt any more than removing band-aids or tape. But then he removed the drain. Damn. He had to snip a few stitches (pain level 9) then pull the drain out. It hurts but it’s over quickly. The pull of the scalpel on the stitches actually hurt more than removing the drain.

If you look here, near the bottom of the page you can see the drain in the photos (not me) beneath SCROTOPLASTY/TESTICULAR IMPLANTS and FINAL ASPECTS.

Marko removed the gauze from around the catheter where it enters my abdomen then unwrapped my penis (pain level 9). This was a bit more painful than the drain removal but it was over quickly (within moments). We had no mirror but he took photos with my phone so I could see.

He re-wrapped my penis, re-applied crisscross bandages over my testicles, then re-applied gauze and tape around the catheter entry (and re-taped the catheter tube to my abdomen).

I pulled on a clean t-shirt and Marko helped me put on my pants (very, very loose cotton pajama bottoms), socks, and shoes. I put my laptop and other stuff in my backpack and we left the hospital (Marko insisted on carrying my backpack). Vesna was there as we left and I thanked her for her help and care. She smiled and threw her arms wide, lol, so I gave her a hug.

Once we got back to the apartment Marko carried my bag in. Those antibiotics I brought from home? He told me I should start taking those tomorrow morning (since I got antibiotics in the hospital this morning). He told me to limit my walking and told me how to flush my stent. He made sure I knew where the donuts were and that I had everything I needed.

I asked if I should time my showers to be just before they visit (since it soaks the bandages) – he told me to wait a few days before I shower. He asked if I had everything I need and said either he or Miro would be back to see me in a day or two and to call if I needed them. NOTE: I was free of the bandages and able to shower two days later.

Evening at the apartment
Wrist still sore and slightly swollen. I imagine it will be better in a day or two. It’s been nice to settle in and watch TV.

It took a few tries to arrange pillows and/or donuts to get comfortable on the couch. When I went to bed it was the same problem all over again. I have to be sure to stay on my back with my legs apart so I use pillows to be sure I don’t roll over in my sleep.

Another day done.

Day 4 was pretty good. It was a full day but I had good levels of energy.
The only pain I had was when the bandages were changed or when trying to sit or lie down. Once you find a comfortable position you stay there, lol. It takes getting positioned just right so that there’s no pressure on anything and no tape pulling skin.
While sitting you either use a donut or you slouch (which is bad for you, by the way, even though at times we find it necessary for a while).
While lying on my back I find it most comfortable to put pillows under my knees, both to relieve pressure on my lower back and to help provide a tent of sorts to keep any covers from touching my genitals (the penis is wrapped and sticks straight out – and is very sensitive).

    EDIT: I later contacted Miro and Marta about having one of those blanket supports available in the apartments (there’s a photo at the top of this post). It would be very helpful.

Post-op Day 3

At times the pain was less, other times a little more, but overall a bit worse than yesterday.

Definitely a Norco day.

Otherwise today wasn’t very different from yesterday.

I’m still naked from the waist down. I’ve been wearing a t-shirt during the day but take it off at night to sleep. I’m also still using a t-shirt to block out light so I can sleep more soundly. Because I get hot so easily, I had them open the window in my room (temperatures at night have been around 45F). That helped me sleep as well – once I grew accustomed to the dogs barking in the middle of the night, lol. Oh, and there are no window screens so the occasional little insect came into the room at night.

The pain was a little more but still manageable with the pain pills I brought from home (generic for Norco 5/325 – which equates to 5mg of hydrocodone and 325mg of acetaminophen). I’ve been up and waddling around a few times today, getting out of bed on my own but very carefully. No matter what, I don’t want my legs to come together. Pressure would be a bad idea.

Miro and Marko stopped by but did not check my bandages. I think Miro was sidelined by another patient. He did stop by again later and said they were going to have me stay until tomorrow morning just to get a few more rounds of heavy antibiotics into me. I am looking forward to getting to the apartment but there is something to be said for having food and water brought to me, lol.

As I had been instructed, the night before surgery and the morning of surgery I used a suppository to empty my bowels. At 1125 this morning I had my first bowel movement since before surgery (the last had been at about 0700 three days ago). The bandages are wrapped in such a way to allow bowel movements without obstruction.

The BM was uneventful, really. Nurse Vesna told me to be careful and take it slowly and I had the call button in the bathroom with me just in case. As I finished I felt a bit of urine escape my urethra. It didn’t hurt or anything but it was just a few drops (I think). I later told the the nurse but she didn’t seem concerned. Afterward I used toilet paper and a baby wipe to, carefully, be sure I was clean. I had put a pack of travel baby wipes in my backpack – I’m glad I did.

In preparation for my release from hospital, nurse Vesna also showed me how to empty my urine bag as well as how to void urine from my bladder through the tube from the suprapubic catheter.

So, tomorrow morning I should expect Miro or Marko to change may bandages and remove the drain. Then I’ll take a shower, dress, and they’ll drive me to the apartment. I brought very loose shorts and a pair of very loose house pants (similar to pajama bottoms) and I’ll probably wear the latter. I know I won’t be wearing the jeans I wore when I came here.

Here’s hoping for no issues when they remove the bandages.

Post-op Day 2

From this point forward I’ll place a pain scale box in my progress posts so you can have an idea how my day went.

The pain shot higher during the bandage change, up to around a 8 or 9, but it was over very quickly.

Definitely a Norco day.

I eventually went to sleep last night. I was awake again around 3am and on Skype for an hour or so. I also took another pain pill while I was online. After my Skype call I went back to sleep and slept off and on until almost 1000.

I woke in a sweat a couple of times but that may be because my hormones are way off. Who knows? I tend to run hot anyway.

The inside of my mouth is a little more tender but still not painful.

The only time I saw the night nurse was when she heard me laughing (while I was on Skype) and came to check on me. She said it was ok just to keep it down a little. I smiled and apologized as she smiled and left.

The night nurse woke me when she came into the room. She touched my arm; I think to wake me so I wouldn’t be startled. She put an antibiotic drip in one port, emptied my urine bag, flushed my catheter, and checked my temperature and blood pressure. After the antibiotics finished she removed the tape from around my ports, removed one of the ports completely, then put fresh tape around the remaining port. When she left I fell back to sleep.

I’d been awake and stirring for about 10 minutes when a lady came in to mop the floor. Seems I remember her doing it twice yesterday. A minute later Vessla came in. She told me she needed to take blood and asked if I was hungry. I wasn’t, so much, but said I’d take breakfast. I know I need to eat. She had a difficult time getting blood and had to stick my right arm twice. Most of the time I give blood very easily but every now and then my veins don’t cooperate. I guess today is one of those days.

About 10 minutes after she finished with the blood, she brought me a croissant and a cup of yoghurt. She said my breakfast was cold since I had been asleep when they brought the food at 0800. I told her it was fine (it was).

I occasionally feel as if I need to urinate. Only a slight pressure. My lower back hurts and my genitals ache. I really just want to sleep, to be honest. I think that’s just my way of getting through the discomfort – sleep until it goes away, lol.

Just got back in bed. Vessla came in twenty minutes or so ago and asked if I had walked today. I told her no and she said I must. She pulled my compression stockings off first then with her close by I sat up (much better than yesterday) then stood. She checked several times to be sure I wasn’t dizzy. Definitely still keeping feet far apart (will be for weeks, I imagine) I waddled around. Immediately I went for the bathroom so I could brush my teeth and used soap and a washcloth to clean from my head to my waist. I even wiped some of the iodine off my upper thighs. Vessla changed the bed sheets while I was up.

Have I mentioned that I’m naked? I can’t remember. But other than the bandages in my crotch I have nothing on. Do I care? Not really, lol. Normally I would but these people have been seeing me naked for two days. And if I had any clothes on I’d be hot, I’m sure, so it works out just fine.

She left the room with my water bottle and told me not to try to lay down without calling her. I just stayed up until she returned with my bottle (which took her a suspiciously long ten minutes). Once I eased back into bed she flushed my catheter. She accidentally poked me and I flinched (I think my stuff moved while I was up moving around). She apologized a few times and commented that it was “so small”. Thanks. lol

She said I need to get up and walk more and to call her so she can come help. In her accented English she says, “Eat, drink, walk, be better.” 🙂

I’m beginning to think I can make a bowel movement soon. I have mixed feelings about that. I’ve been passing gas off and on since yesterday but that’s a little different.

The male nurse just brought me a antibiotic pill to take. Around 1315 Vessla put liquid antibiotics into my port. At 1400 was shift change and Vessla left, as far as I know. I have the guy and Beelyana (?) now.

I’ve been thinking of getting up and walking a bit. Vessla wanted me to buzz her but she’s gone. I don’t really want to buzz the guy. Honestly, I don’t want to buzz anyone and I honestly had rather not get up.

Ah, Marko and Miro came in for my first bandage change. They changed the bandages pretty quickly and the re-bandaging hurt more than the removal. Fortunately the pain was over quickly.

The only part that really hurts is the drain at the back of my left testicle. I’ve had pain there since early yesterday morning; sometimes just an ache but a lot of the time like a little pinch. Not unbearable, just really annoying.

While Marko and Beelyana re-bandaged me, Miro drew my testosterone, made sure he had the right dose, and asked me where I usually inject. Beelyana gave me the shot. Miro said she would be better at it, lol, and Marko said she would be more gentle. Heck, she does a better job than I do – I barely felt it.

Miro told me everything looked good and there was no unusual bleeding. He said he’ll be back about 0900 tomorrow to look again. If the fluid leakage has stopped enough to remove the drain I’ll go back to the apartment tomorrow. If not I’ll stay in hospital until Sunday morning.

He also asked if I have been in touch with my family and seemed pleased when I told him I had.

Nurse Beelyana asked if I’d had lunch (nope) so she asked what I would like. Yesterday’s lunch was good so I asked for chicken and salad. She asked if I wanted barbequed chicken (yes!) and barbequed vegetables (er, um, sure). When I asked for salad she said, “Serbian salad? Tomato?” I told yer, yes, please. Their salad is just cut tomato, cucumber, and onion. Maybe a little shredded cheese. I love it.

Oh, and FYI, by barbequed she meant grilled.

Beelyana took my plate away and emptied my urine bag. She asked if I want juice, coffee, or hot chocolate. I had hot chocolate last night and it is good so I opted for that.

By now I’ve figured out that the woman who waved and said goodnight that first night was probably Beelyana (she did it last night and it seemed familiar). That spelling is the closest I can get to the pronunciation of her name – it’s a tricky one. Today she laughed and said I could just call her Bee, lol.

I’m getting twinges in my genitals. There’s no sharp pain, really. Just a general ache and discomfort. Beelyana just flushed the catheter. That doesn’t hurt either, it just feels weird.

I hadn’t seen Beelyana in a couple of hours. She just tapped on my door, opened it, and said bye and good night. Yep. I think it has been her since the first night. 🙂

I’m two hours over due on a pain pill. This is the first time I’ve done that.

The nurse just took my temp and BP then took a close look at my crotch. As closely as she could with all the gauze anyway. You know, it’s amazing how quickly one becomes accustomed to being poked, prodded, and stared at – not to mention being spoken about in a language one can’t understand – and all without missing a beat.

I think I’ll wrap this one up. I never did have a BM today but still have gas now and then. Tomorrow may be the day, we’ll see.

I’ve just taken a pain pill. I want to be able to sleep and I’m hurting enough to prevent that. I’ll sure be glad when that drain comes out.

Post-op Day 1: Grateful for IV pain meds

First, while in the hospital at St Medica I had a blanket support that is placed over your midsection to keep the covers from touching you (the penis is wrapped and sticks straight out usually with the stent protruding a bit further – and this is very sensitive).

The first couple of days back in the apartment I wish I’d had one of these or something similar. There was a lap tray in the apartment but it wasn’t tall enough to do me any good.

Here’s a sort of time line from just before surgery yesterday. I took notes on my phone so I wouldn’t forget things. I won’t go into so much detail as the days pass. I think guys will want to have a more detailed idea of what to expect especially in the first 48 hours.

NOTE: People have varying levels of pain tolerance and heal differently. My experience is mine – yours may or may not be the similar.

27 October 2010 ~ Surgery Day
I left off yesterday at about 11am…

Vesna gave me the anti-embolism injection in my upper arm

Changed from street clothes to hospital gown and compression stockings

“Pre-medication” injection in the buttocks (to help one “relax”). Miro said this would be done about 15 minutes prior to going to the operating theater.

Vesna looked in but I was still wide awake. She smiled and closed the door.

Foggy Memories
Vesna pushing my bed through the hallways.
Gradimir (Dr. Korac, the anesthesiologist) asking if I could walk. I said of course, and he and someone else held my arms while I shuffled to the operating table. There was a big guy standing nearby and Gradimir joked about him being there if they needed more help. I felt very drunk and made a joke about having a worse time with tequila. I sat on the operating table and that’s my last memory.
What must have been hours later, I remember being in pain and trying to tell the people I could hear (but not see) around me. I was struggling to come out of the anesthesia and I vaguely remember trying to clear my throat and uneven breathing. I was soon out of it again.
Drifting in an out.
I remember receiving something for pain some time later and back in my room. I remember a nurse saying good night and waving to me from the door as she left. I waved in return though I could neither see her face nor remember who she was.
Foggy memory of a woman injecting something into one of my ports. I asked what it was. She smiled and told me it was for pain; that I had asked for it a few minutes before. I smiled and said, “I think I was drunk,” and drifted away again.

~ Based on the time Miro telephoned my mother and my fiance, surgery must have been over between 1830 and 1900 ~

Inside of mouth on left side completely numb. I remember thinking that whatever it was they used as a local anesthetic, the dentists in America need it. I’ve never had a local last so long.
Still groggy and sleepy. Have to close one eye to type on my phone and still make a lot of errors. Back to sleep.

Grogginess lifting but I’m sleepy.
The nurse comes in to check my IV or something. I think this must be Miro’s nurse from the children’s hospital (he always has her with us the first night). I ask her name. She tells me and when my eyebrows go up and I shake my head with a smile she laughs. I asked her to say it again, slower, and she does. “Ah, ok.” She asks if I know it and I say, “Drageetza,” rolling the r. She smiles and says yes. So I repeat it 2 or 3 times and she smiles. Then I reach for my phone to type it in phonetically (as it is here) so I won’t forget and she laughs.

Drageetza started antibiotics through one IV port and changed the (saline?) bag to the other port. I asked for pain medicine. The pain was becoming a bit sharp again. It wasn’t unbearable but I didn’t want it to become so. I’d rather stay ahead of it for the first couple of days.

She pushed pain meds into the port then gave me a glass of water. I had to gently rinse my mouth a couple of times first (in case of dried blood from where they took the tissue for my urethra) then I drank a bit of water. Good!

In and out of sleep through the night. Every couple of hours sterile water was flushed into the stent in my penis. It doesn’t hurt but it’s an odd sensation to feel cool water moving through.

My temperature and blood pressure are also checked periodically, and they empty the urine bag that’s connected to the suprapubic catheter.

28 October 2010 ~ The day after surgery
Drageetza just flushed the stent again and refilled my water glass. Because the nurses are in and out so much they usually leave a light on. I wish I’d brought something to cover my eyes. I asked her to get my black t-shirt out of the cabinet and I used it to cover my eyes (and my ears) to help me sleep.

There is a heavy cloth that is folded three times over and lays across the bed beneath me (on top of the sheet that covers the mattress). Drageetza and another nurse just changed that cloth which meant I had to raise myself up off of it. Sort of balancing on heels and shoulders, as well as I could manage.

I haven’t been terribly thirsty and I’ve only had 2 glasses of water since last night. I wonder if it’s because I’m sleeping so much or because they’re really keeping me hydrated through the IV.

The inside of my left cheek feels weird when I explore it with my tongue. Of course it feels as if they took almost the whole thing, lol.

My stomach just growled again. It did a few hours ago too but I’m not really hungry.

Gradimir just stopped in (Dr. Korac, the anesthesiologist). I really like this guy; he’s quick to smile and has a great sense of humor.
He asked whether I’d had breakfast and checked the bandages. He said everything went fine. He gestured toward my bottle of water and said the more I drank the less they’d have to hydrate me through the IV. An hour or so ago I’d asked Drageetza to get my bottle out of the cabinet and fill it with water. It has a sport top and is easier to drink from while lying down. I told Gradimir I would drink more, he said good.

I told him I was beginning to feel some sharper pains again. It’s been a little over 9 hours since I last had pain meds. He said they would give me some more then I could start using the pain meds I brought from home (hydrocodone). He also told me I could get up and move around but to keep my legs apart, “you have strong thighs” lol. The doesn’t want me to put any pressure on my testicles. I think I’ll wait for the pain meds to kick in before I try anything!

Just got breakfast – a cup of yoghurt and a large croissant with sesame seeds on it. Very good! You drink the yoghurt; it’s thick and tastes a little like buttermilk. I like it a lot. The croissant is more dense than those in the states and is good too.

I don’t know if they forgot to give me pain meds or Gradimir forgot to tell them but I just took a hydrocodone and a anti-nausea pill (just to be safe).

Just woke from a nap. Some time ago I woke to a needle in my arm. Vesna was giving me a shot for pain. Oops. I guess Gradimir did tell them. I should have buzzed and asked about it when it took so long.

A few minutes ago the blond nurse came in (I don’t think she knows any English but she’s friendly). She took my temp and BP and removed the fluid line from my IV.

I still haven’t had any unbearable pain. It’s gotten a little sharp a couple of times but it hasn’t been bad. I want my laptop from the cabinet and I consider getting up to get it. Nah, maybe not.

Vesna just asked if I’m hungry (a little) and got my laptop for me (yay). Then she pushed a fat syringe of antibiotics into one of my ports. Now my arm is warm from my knuckles to my shoulder. Weird. A little later they brought my lunch. It was good. Chicken, salad, french fries, a roll, and soup.

Vesna, the blond, and a guy came in. They looked at my dressings and chatted amongst themselves. Vesna told me I could sit up on the edge of the bed but they would help me with that in a bit. She and the guy also told me I cold move my legs around (I told them I have been). I think they want me to move them even more.

1630 Walking
The guy and a female nurse came in and wanted me to get up and walk a bit. Man, that was awkward. And a bit painful. They lowered the bed and helped me to get up. I swung one foot off the bed and pretty quickly went from “maybe I’ll sit on the edge of the bed” to “oh, hell, that hurts, I think I’ll stand up instead.” Rather than “walk” I kept my feet very wide and tried to keep my thighs as far apart as I could so it was more like a painful penguin waddle.
The up side is that I went into the bathroom and brushed my teeth and washed my face.
Getting back into the bed was awkward but not as bad as getting out of it. The female nurse had left but the guy was still there. I sort of leaned and “landed” on my left side, keeping my legs as far apart as possible, then rolled to my back. MAN did I have a sharp pain in the area of my left testicle (everything is wrapped up tight down there). I tried to position myself as best I could on the bed but that pain wouldn’t stop. I made plenty of faces and noises but the guy finally left. What was he going to do?
Part of the problem with getting up and then back into the bed is my left hand. The ports are in just at the wrist and I can only bend it so far. I really can’t use that hand much to prop or push. This also makes moving around much on the bed tricky.

Eight hours since my last pain pill – good timing for me to take another one. After 30 or 40 minutes the pain was pretty much gone.

I’ll tell you, I am not looking forward to dressing change tomorrow. I’m not looking forward to walking again either. Not at all. Don’t get me wrong, I’m not crying about it or dreading it every waking moment, lol, but I’ll be glad when, say, the next 3 weeks is over.

Dinner. A huge roll, cheeses, ham, and another cup of yoghurt. I love that stuff.

I’m wrapping up this blog post. I have twinges now and then but nothing painful. The nurse on for tonight came in about 15 minutes ago to start an antibiotic drip and flush my stent. I asked her to lower the head of the bed so she gave me the remote for adjusting the bed myself. Great! I wish I’d known about that before.

Alright, time to get some sleep. The first day is over.

Post-op: Notes about surgery

PLEASE NOTE: This blog is currently in development. As the next several weeks pass I’ll be adding posts as well as adding more information to old posts so be sure to check them again. Eventually I’ll have added everything I remember and I’ll remove this note.

Twenty-four hours ago I came out of surgery where Dr. Miroslav “Miro” Djordjevice (at left) and his team performed the metoidioplasty, colpocleisis (vaginal closure), scrotoplasty with medium implants, and urethral lengthening with buccal mucosa grafts. (Some patients have enough genital tissue alone to lengthen the urethra but for most he also uses tissue from inside the cheek of the mouth, buccal mucosa).

Miro now has both small and medium testicular implants on hand for surgery. He has found that some guys don’t have enough space for the medium prosthetics so he has the small on hand as well. He asked my permission to make the call while in surgery. Without hesitation I gave him permission. I told him I’d rather have smaller testicles than try to force larger implants only to have complications. (As it turned out I had plenty of space for the medium-sized implants.)

As with many other guys, I will need a mons resection for optimal results. Even though I’m not terribly overweight, I have a fatty mons, lol. It has to go. I asked him for a time and money estimate and coming here for mons resection would definitely be the best option. He takes no salary for the mons following the meta so the cost would be between 1000-1500 euros. I’d need to be here 4 days (1 day before surgery, the day of surgery, then two more). Usually after two days the drains can come out and you can go back home. He said it’s normal to be off work 10 days afterward.

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