Back in the Saddle Again


20 February 2019

Well, maybe not the saddle but definitely the stirrups!

10 days after surgery, Valentines Day to be exact, I had my surgery post-op examination. I was met once again by Dr. Gast, Dr. Block and Physician’s Assistant Clare, who has been involved in this surgery from my initial visit back in April of 2018 to the present.

I was and still am quite swollen, but I learned that that it completely normal at this stage. Some things I learned at this appointment are that the sutures should start to dissolve at 2-3 three weeks but can take up to a month. I was also cleared to start sitting up for short periods. I had driven myself to this appointment by sitting on a doughnut pillow, the type used for hemorrhoids or tailbone injuries. I had also split the hour and a half drive up into two segments.

Since starting my transition I’ve had many firsts or rites-of-passage, not just into womanhood but more so into femininity. It took a while for me to use a public women’s restroom, but that was a milestone.

Another very meaningful experience was being a bridesmaid in my BFF’s wedding, not just walking down the aisle holding a bouquet of flowers, but also being with her and the other bridesmaid’s as she had her makeup done and donned her gown.

This post-op visit also gave me another first of womanhood, stirrups! I know this may send shivers down the spines of many of my cis-gender female readers with the thought of cold medical implements and non-compassionate doctors. But this was very different in that these woman who were examining me, helped create the very essence of my new femininity. They were kind, compassionate, extremely intelligent, and most of all nurturing. I have had more than my fair share of good doctors in my life, but having these women who weeks prior used very intricate medical techniques surgically to transform part of my body that had caused emotional trauma into something that now brings me comfort and serenity, and then at this post-op visit to treat me with such warmth and care gave me such a lucid rebirth into my body. There’s no amount of gratitude I can ever show to equal what I feel for and about these people.

I don’t know if every transgender woman experiences what I have felt when and if they have bottom surgery. I feel like I’ve been born and also given birth. I feel renewed into my aging body. Every step I take to becoming the “real” me gives me more life. It makes me want to “be.”

Fast-Forward to today…

Today is Day 17. It has been two-weeks since the compression bandages came off. Swelling continues to very slowly go down. I’m still very tender in spots, but I am able to finally sit upright for longer periods. I am still not allowed lift more than 10 pounds so I’m relying on my spouse for quite a bit.

I think I’ve put on a few extra pounds as I am doing nothing but eating, laying around, and sleeping. I’m sure I’ll be able to walk this off and am returning to work in 5 days. I still, however, won’t be able to lift much for another month.

The idea of lying around for 3 weeks (6 if you’re having full bottom surgery) sounds good at the outset, but when you have restrictions it can be torturous. I’m actually looking forward to getting back to the office and into some routine. I am so grateful for all the support I have received from family, and friends old and new.

I will continue to update on my journey as things progress and heal. I had hopes of starting to video blog while I was recovering, but that will have to wait until I am able to get back into my regular routine.

So for now, stay tuned. Sit back. And um, ma’am, feet in the stirrups, please!

~ Tiff

A NOTE: This blog chronicles my experiences and my journey. I am not an expert or medical professional. I am learning as I grow and my experiences may differ from other transgender people. Everything is correct to my best understanding.

Surgery: Complications?


11 February 2019

As I type this, it was one week ago that I was wheeled into surgery. There was a possibility of still being connected to my drain tube but I was sent home without that drain tube in place. While I was in the hospital I wasn’t draining much at all, and since I’ve been home it has steadily decreased and now resembles light spotting as if from my monthly cycle. My daily schedule is all over the place right now. When I’m awake I feel as coherent as I would on any average day, but when I get drowsy, regardless of the time, I fall into a deep sleep for hours. I’m attempting to keep meal times regular, but sometimes I can’t sleep until midnight. I’m just allowing my body to tell me what it wants.

All-in-all recovery has been steady and to be perfectly honest, boring. I’m not allowed to lift more than 10 lbs and I can’t sit upright. If any of you have had to reside in bed for more than a week you will understand. At least I can walk to the bathroom or kitchen to stretch my legs but my body longs for more exercise. I am, however, aware of the importance of allowing myself to heal. I’ve endured extended hospital stays for mini-strokes and heart scares. I’ve had to sit and rest after multiple eye surgeries, and reduce bending and activity following retinal hemorrhages. I would rather bore myself with lying around to recover than cause irreversible or unfix-able damage to the most important surgery of my life.

I was released from the hospital last Wednesday just hours after my bandage were removed. Just as Ann-Elizabeth and I were shuttled to Madison prior to surgery by a dear friend from Milwaukee, we were chauffeured home by another dear friend from Madison. We were unsure as to what day or time I would be released from the hospital so it made sense to make departure plans with someone local. After being discharged it took a while for me to make it from my 6th floor lodgings to the hospital entrance, as I only had the option of walking or laying on a gurney. I opted for the slow shuffling, think Tim Conway as Mr. Tudball in the Carol Burnett Show, rather than a corpse suddenly rising from a gurney like the Mummy’s Boris Karloff. I had spent the past 72 hours lying down and wanted to work my legs a bit.

We arrived home around 5:00 pm. All of the fluid that had been steadily infused into me over the past three days was encouraging me to visit the bathroom frequently. I was still getting used to the new method of urinating, something that was complicated by the fact that I had to use a squeeze bottle of warm water to rinse afterwards each visit i made. I was instructed that keeping the surgical site clean and dry was key to a quick, and more importantly, an uncomplicated recovery. Early in the evening I noticed certain areas of the surgical site appeared swollen and red. Over the next couple of hours it even started to “feel” swollen and uncomfortable.

Around midnight, after a few telephone calls to the plastic surgeon on call at University Hospital, the decision was finally reached that I needed to return to University Hospital at 8:00 am  My poor wife spent the entire night watching over me while I got a few hours of sleep. At 6:00 am a wonderful friend arrived to drive me back to Madison. It was a rainy and icy morning but we got to University Hospital just before 8:00 am. I waited only a few minutes before I was taken to an exam room where I was soon joined by my plastic surgeon, the assistant doctor on my surgery, and my physician’s assistant. After an examination it was determined that everything was fine. The concern had been that a hematoma had formed. In reality what had happened is that when the bandages came off the previous day, everything was abnormally “normal”, but when I got home I had been vertical for the first time and some swelling had started to form. Usually for this type of surgery the site is swollen when the bandages are removed. In my case everything looked prefect until I started spending a little time being vertical, during my travelling to and settling in back at home.

Another thing that had been decided that morning was for me to restart the testosterone blocker even though I could no longer produce testosterone. My blood pressures while i the hospital had been rather high as it still was that morning on my unplanned return. Prior to beginning my transition I had been on a couple of medications for treating high blood pressure, an unfortunate complication of diabetes. The testosterone blocker that I was then prescribed had originally been developed as a blood pressure medication, so as its dosage increased I was weened off of my other pills. Then, when I ceased taking the testosterone blocker several days prior to surgery I had no medication to combat my hyper tension. Incidentally, surgery itself can raise blood pressure. Weary from the past 12 hours, but with ease of mind, I returned home to settle in.

The past several days have been relaxing. I have settled into the routine of eating a high protein diet, sleeping as much as possible, and keeping off of my feet. My wonderful wife has been taking extremely good care of me and handling everything from cooking meals to shoveling the snow. In three days, on Thursday, February 14th (Valentines Day), I return to the hospital for a follow-up examination.

I can’t quite express how affirming this surgery has been for me. I lived for almost 5 decades as a male, and I only knew one body. It’s not that I hated how I was born but I didn’t know any other way. In other words I didn’t know what I didn’t know. When Dr. Gast removed those bandages last Wednesday and I looked down, I had what my Aunt calls the “Ah ha!” moment. The week before the surgery I found myself questioning everything I have done these past three years since beginning my journey.

“What the hell was I doing? Am I really transgender? Do I really want to have this kind of permanent surgery?”

All of that doubt and questioning completely disappeared the moment I looked down. I had been given a gift. The gift of who I truly am. The affirmation that I am a transgender woman. And I am on the exact path I need to be on to become my authentic self.

~ Tiff


A NOTE: This blog chronicles my experiences and my journey. I am not an expert or medical professional. I am learning as I grow and my experiences may differ from other transgender people. Everything is correct to my best understanding.

Surgery: Best Care Anywhere

best care

8 February 2019

“Best Care Anywhere”

This was the tag line for the fictional Army Medical Unit on the popular 70s-80s television show M*A*S*H. I know of a real-life contender for this moniker.

The nurse connected something to my IV tube and pushed the plunger on the syringe, the doors to the prep room were opened, and I was wheeled out and everything faded to nothing.

Not even to black.

I remembered nothing until the groggy haze of waking up in a hospital bed in a small private room. It felt like I was wearing a diaper and I lazily tried to survey my surroundings and get a grip. The past four hours felt like an instant. I glanced to my right and saw the smiling face of my wife. I couldn’t remember why I was there or what was happening. The anesthesia was doing a great job of sedating me.

11 months prior I experienced my first major surgery when I underwent facial feminization. I also experienced an awfully bad reaction to anesthesia. It had me vomiting for the first 24 hours after surgery. Not a good thing to be doing when you’ve just had your nose reconstructed and your brow bone shaved down. Going into this new surgery with that knowledge was extremely helpful. And worrisome!

All along the journey in getting to this point I made it a habit to let my new medical team know that I had had a bad experience with anesthesia, but it was my aunt that suggested requesting a scopolomine patch which is used for stopping nausea from motion sickness or anesthesia. It was a relief when I was in the prep room for surgery and one of the first things the nurse did was to place that tiny patch behind my left ear. The anesthesiologist also assured me that there were other things that they could do to reduce the chances of nausea after surgery. He was good to his word and I was very glad in my post-op state that I was just groggy and not sick to my stomach!

I think I slipped in and out of consciousness for a while. I remember my wife telling me that Dr. Gast came to her after surgery, telling her everything went perfectly. And that she was then told what my room number was and where she could wait for me.

At one point she asked if I was hungry to which I must’ve responded to the positive. We had brought tiny bags of Nilla Wafers, provided by friends Jon and Chloe (“They are the perfect snack and only 20 grams of carbs per bag! Easy to account for!”). My wife fed me while, not within my memory, I sang David Bowie tunes very quietly.

“Ch Ch Ch Ch Changes……”

I know that I slipped back into unconsciousness for a while and eventually woke to some sort of stable lucidity. I was laying in the hospital bed with an IV of fluids and antibiotics as well as insulin. I wear an insulin pumps 24/7 but it is only good if I am coherent and able to monitor it. As with my last surgery, I suspended the pump and relied on the anesthesiologist to control my blood sugar levels and make adjustments with glucose or insulin based on their incremental testing during surgery. Post surgery I was still unable to stay awake for long periods, so I was left on that insulin drip so that the nursing staff could monitor my blood glucose levels for me.

IMG_0559Panoramic view of the room from my hospital bed.

I was also catheterized, a new experience for me. But since the catheter was inserted during surgery, and afterwards I was wrapped pretty tightly, it just made it easier for everyone involved. It was odd though to not have to get out of bed to urinate even though I was hydrating regularly.

Eventually my wife left for the evening and retired to her hotel room. It was within walking distance but with the cold weather and the benefit of a complimentary shuttle service she rode back and forth to her accommodations. I quickly and easily fell asleep but was woken every hour for a blood sugar check and every six hours to take pain medication. It’s not as bad as it sounds, especially when you’re doing nothing but sleeping or lying about.

The next morning I received visits from the plastic surgery team that accompanied Dr. Gast. It is a college hospital so there were many of the staff from the OR to the nursing staff who were students. Mid-morning Dr. Gast came in and inspected the compression bandages. I was also visited by the assisting surgeon, Dr. Block, another wonderful doctor. I feel very fortunate to have had not only an extremely skilled and compassionate team but also predominantly female, something that I hadn’t realized made a difference to me until I was recovering.

Eventually Ann-Elizabeth arrived and I ordered some breakfast from the hospital food service. They have an ingenious method of using iPads given to each patient for choosing from the menu. The iPad is issued to each specific patient and contains several pieces of information such the food menu as well as ones care team.

I cannot say enough about the wonderful team that cared for me in recovery. There was Beth, Tara, Ashley, Rachel, Vivi, Pentrecia, Jasmine, Maddie, Devon and Bri, and I’m sure I’m leaving some out. I am so grateful to all the nursing staff on floor 6 as well as the room service staff that took such good care of me while I was recovering. Their dedication to care is inspiring and so very appreciated!

The day was not significant in any form except that by mid-afternoon I was cleared to connect back to my insulin pump. I do want to say that as far as pain, I did not feel anything other than mild discomfort. There really was only a dull pain in the general area of the groin. I was only on taking acetaminophen. The only other pain that I incurred was in my back from having to lay in pretty much one position. I was allowed to recline but no more than a 40 degree angle to avoid putting direct pressure on the wound. Even now as I write this on day 5 I am not allowed to sit upright.

I slept very little that night due to an extreme ache all throughout my back. The next morning was Wednesday, Day 3. We had reserved the hotel only through noon of that day. We were waiting for Dr. Gast to arrive and find out if if the bandages would come off and we would be able to go home, or if we would have to remain another day thereby requiring us to hold the hotel room for another night for Ann-Elizabeth.

I ordered breakfast from the electronic menu. Food usually arrived within 30-40 minutes. The previous day I had learned the difficulties of eating while reclined and began to choose menu items based on their ability to be cut and consumed without too much mess. My omelet arrived and I began to eat. About halfway through breakfast Dr. Gast arrived to remove the bandages.

This was it! I would be more comfortable, I would be getting the catheter removed, and most importantly I would see my transformation!

I was packed and taped quite thoroughly. Over the bandages I wore some hospital supplied white mesh boy shorts. The shorts were pulled down and sniped off and then the impressively secure tape was peeled off, followed by the not too bloody gauze pads. I lay my head back as Dr. Gast and the nurse did their work. Next the drain tube and reservoir was removed. I was told that this drain tube may stay in place until my followup 8 days later, however not much fluid was draining so it was decide that the tube would be removed. Dr. Gast announced, “This is going to feel weird,” or something to that effect. She pulled the tube from the bottom of the sutures. It wasn’t that odd or painful. She then removed the catheter. Oh boy! I’m glad that it was quick because it was also intense! Not painful. Not too unpleasant. Just intense.

After a quick cleanup she called AE over to point out the different areas. Now, my wife is an amazing woman, but she is not prone to handling even mildly graphic medical situations too strongly. She admitted later on that she almost fainted, I knew the moment that Dr. Gast called her over it was not a great idea, but my trooper of a wife came over and saw my new transformation for herself.

I scrunched forward a bit and looked down. I almost burst into tears.

The previous Monday I had been at my day job questioning my entire journey. Was I transgender? Was bottom surgery the right thing for me or was I about to make a terrible mistake?

Looking down and seeing the smoothness of my new womanhood let me know that everything I had done was right. I could not believe the elation I felt. I was complete.

Erasmus or Rotterdam said, “The summit of happiness is reached when a person is ready to be what (s)he is,”

I hadn’t realized how ready I was to be me.

But I was ready, and I was extremely happy!

~ Tiff

A NOTE: This blog chronicles my experiences and my journey. I am not an expert or medical professional. I am learning as I grow and my experiences may differ from other transgender people. Everything is correct to my best understanding.

Surgery: The Big Day

surgery big day

7 February 2019

Let me take you back to a more complex time.

A time of conflict.

A time of tucking.

Well, four days ago actually, to Monday, February 4th at 11:00 am.

I was wearing a purple disposable gown with a hose connected to it inflating it with temperature controlled air. The papery-plastic thing expanded like I had just consumed one of Willy Wonka’s experimental sweets, I had been anxiously watching the red digital clock on the opposite wall for the past two hours. It now glared 11:00 as the nurse slowly injected a sedative into my IV.  I think I remember them pushing the wheeled bed out of the room and down the hall.

Everything faded from color,

to grey,

and then nothing.


We had arrived the previous day, Super Bowl Sunday, at 3:00 pm  and checked into our room at the Best Western just down the street from University Hospital. I would only be staying the night but my wife would reside there for the next 2 or 3 days while I recovered. After settling into the room, we took a Lyft to the nearest Target store for some supplies, and then back to the hotel and dinner in the hotel restaurant. It would be my last meal until after surgery. We ate a healthy portion of a delicious pepperoni pizza and took the left-overs up to the room so that Ann-Elizabeth had something to eat the next day.

I had to take a preparatory shower that night as well as the next morning with a specific, hospital supplied anti-bacterial soap. After the morning shower I prepared myself with comfortable leggings and long sweater, and accompanied AE to her morning breakfast. I was only allowed the option of four liquids prior to 7 am that day: water, apple juice, tea, or black coffee. I had some water up until about ten to seven, but I really wasn’t hungry due to the anticipation of this major milestone in my transition.

Gender confirmation or gender affirmation surgery, often referred to as “bottom surgery,” previously referred to as sexual reassignment surgery, is THE surgery for so many male-to-female transgender persons. It is the surgery that removes the testosterone producers and allows, those that seek it, a more aligned physical representation of how they should have been born.

There are several options for how this surgery is performed, but in many cases the transgender woman will be able to have a fully functioning neo-vagina with sensate clitoris. There are variations to the surgery such as not having a full vaginal canal created but having everything but. This is the option that I opted for. I’ve written about this in previous entries so I won”t go into it here.

After breakfast I packed my bag and we rode the complimentary hotel shuttle to the hospital some 5 minutes away. I had been to the clinic entrance of this building twice prior for my initial meeting and pre-op appointments with the plastic surgeon who would be giving me my new future. However, this time we were entering the hospital entrance and making our way to the 3rd floor and “First Day Surgery.”

We were both in an extremely happy and giggly mood. Being a type 1 diabetic of almost 35 years, I have had my share of hospital visits, often out of necessity. This was the first time I was there to have a major operation that I wanted and had been waiting for for so long. I registered and shortly a wonderful nurse named Elizabeth ushered us to surgery prep room number 17. I donned my purple inflatable gown and proceeded with all of the necessary steps of answering questions, having an IV inserted, cataloging the things I was bringing with me for the duration of my stay. Opposite the wheeled bed I was lying in, above the sliding double glass doors that we entered through, was a large red digital clock. We were there the required two hours prior to surgery, and I kept looking at that clock as preparations were made and the flurry of medical staff came in a performed their parts. Dr Gast, my brilliant and skilled plastic surgeon stopped in as well as the assisting surgeon, anesthesiologist and other assorted surgical and prep people. I think at one point I was given two tablets of Valium and I remember someone saying  “We’re just waiting for the go-ahead that the operating room is ready.”

And then BOOM, it was go time.

The nurse connected something to my IV tube and pushed the plunger on the syringe, the doors to the prep room were opened, and I was wheeled out and everything faded to nothing.

Not even to black.

I remember nothing.

While I was in surgery, Ann-Elizabeth would be shown to a waiting area designated for the relatives of loved-ones being operated on. She was given a pager that indicated specific stages in the operation, and was eventually greeted by Dr. Gast at the end of my 4 hour surgery with news that everything went perfectly and that I was going to be taken up to my hospital room on the 6th floor where she could await my arrival.

– Tiff


A NOTE: These are my experiences with my journey., and this blog is a place for me to tell my story and journal my transition. I am not an expert or medical professional. I am learning as I grow and my experiences may differ from other transgender people. Everything is correct to my best understanding.