My Transition Diary

2010

28 June
I've been thinking more and more about having a hysto soon. I've decided on a local surgeon whom someone recommended to me, unless he turns out to be a dick or something, and I called his office and am now in his computer system so I can easily schedule a consultation whenever I want. I'm nervous about surgery and don't really want to go alone, and I don't want to have a consultation until I feel ready to schedule the surgery itself. But in August I'll have been on T for ten years, and I'm really ready to have a hysto over and done with. And summer seems like a good time to do it, when I could more easily have time off work to recuperate as necessary because everyone's lives are a little less hectic and stressed. I want a total laparascopic hysterectomy, which would leave essentially no scars and has a recovery time of like three days. A laparascopic-assisted vaginal hysterectomy (LAVH) also doesn't really leave visible scars, but recovery time is more like two weeks or so, I think. (That doesn't mean you're bedridden for that long, just that you have to take it easy. Probably I could still drive and therefore go to work.) And an abdominal hysterectomy, which I'm willing to have but is a last resort, leaves a long scar (which I'm not really fussed about) and has a recovery time of like 6 months, and you are bedridden for a good while. I still have no firm plans in terms of when I'll have it done - I keep wibbling back and forth - but I'd really like it to be over and done with before the end of this year. We'll see.
16 July
My friend T has agreed to go with me to the consult on Thursday, which I'm pleased about. I've known him for a long time now and have always liked and respected him, and I'll be glad for his company and his insight after the consult. We're going to get lunch or a treat of some kind afterwards, because we'll need to meet up there and it'd be nice to chat a bit about everything before we have to go our separate ways again. I just joined the hysterectomies community on Livejournal, which I'm told is Trans-friendly; it looks pretty quiet but I may post there after my consult to get more people's experiences. I'm still a bit nervous about the whole thing but I know the more informed I become, and the more support I get from my friends, the better I'll feel.
22 July
HUGE thanks to the guy on the Compass e-mail list who recommended Vlassis Travias (pronounced TRAV-ee-us), MD, FACOG at Emerson Hospital (actually at Concord OB/GYN across the street) in Concord, MA, when I posted asking if anyone could recommend a surgeon who would perform a hysto without requiring a pre-op exam. I just had my consult with him this morning, and it was AMAZING. My friend T went with me for moral support (thanks again, T!) and can testify that this guy is pure gold.

He got the Trans thing. Like, really completely got it. So did his staff. And without requiring any education from us. He said that there are some people at Emerson Hospital who have an issue with the Trans thing for whatever reason, but that they will not be in the room. Anyone who has a problem will not be there, the end. I often tell people that one reason I chose Brownstein for my top surgery was that he oozed competence from every pore; so does Travias. I walked out of that consult completely ready to put my life in his hands on an operating table. He clearly would have sat there all day if that's how long it took to get all my questions answered and me feeling good about everything. He said 'people' instead of 'women' every time, without slipping or pausing or having to think about it or seeming awkward. He knew about bottom surgery and what that entails. We did not have to educate him about anything; he was already there. And on top of that he was friendly and personable and had great bedside manner. T and I walked out of there and looked at each other and went '... wow.' I think we were both slightly unsure that that had really just happened and we hadn't just been hallucinating about a perfect doctor. And then we went out for Italian food to celebrate.

Everything will go - uterus, ovaries, fallopian tubes, and cervix - which is what I want and what he recommends as well. (I'm pretty sure the medical classification for all this is a complete hysterectomy with oopho-salpingectomy. Complete hysterectomy refers to removing the uterus and the cervix, oopherectomy is removal of the ovaries, and salpingectomy is removal of the fallopian tubes.) He said my hysto would be entirely laparascopic and would likely take two to two and a half hours, and if something really went wrong he'd make an abdominal incision, but given that I'm young and healthy and haven't had any other abdominal surgery and therefore shouldn't have any scar tissue around there, he didn't think the abdominal incision would be necessary. I was really impressed at his confidence around being able to do it entirely laparascopically, because I've long been concerned that I wouldn't be able to have that because of lack of atrophy or whatever else. I'm entirely willing to have it done abdominally - seriously, just don't wake me up until that shit's gone, whatever you have to do is fine, I will sign whatever waiver you give me, what? The Jaws of Life? Well sure, if that's what it takes, when I wake up I want you to tell me that it's over and they're gone so you just run along and make that happen for me - but obviously I'd much prefer laparascopic if possible. So to hear him keep going 'You're young, you're healthy, you should be fine, if there's a problem we'll deal with it but I really think it'll work' was so reassuring.

He said ideally I'd come in first thing in the morning - 7.30 or so - so that I would be able to go home the same day, which I hadn't expected at all. I thought I'd definitely have to stay at least one night in the hospital. Dr Travias said that as long as I'm feeling okay after surgery I can go home - so if we do it early, I'll likely be feeling fine before it gets too late in the day, but if we do surgery at 4 pm or something and I don't feel okay until 10, obviously they won't discharge me until morning. I won't be able to do anything strenuous - no heavy lifting or strenuous exercise or anything - for two weeks, but I can do things like get out of bed and walk around and drive as soon as I feel able (although I should wait to drive until I'm off the Percocet and just taking Advil or whatever for the pain, of course). I'll be catheterised during surgery, but it'll be removed before I wake up, so while I might have some discomfort peeing at first because a catheter was there, it's expected that I'll be able to get up and go to the toilet without difficulty quite soon after surgery. I can't eat anything before surgery, of course (nothing after midnight the night before, including water), but as soon as it's over I can eat whatever I want. Whether I actually feel up to eating will be another matter! And obviously I'll take it slow and not be going out for buffalo wings that night or anything silly like that. It'll probably be Sprite and crackers for a little while.

One thing he said that I didn't know was that you don't actually cut the stomach muscles in an abdominal hysto - he said the incision is just through the skin, and then the muscles are sort of pushed aside and then pushed back into place at the end. So that's a lot less recovery time than the muscle having to totally knit itself back together, but it'll still leave you plenty sore for a few weeks! Fingers crossed that I won't need that.

Interestingly, he said that LAVH (laparascopic-assisted vaginal hysterectomy) isn't done so much anymore - it was big about ten years ago, but the equipment and technology have improved enough since then that it's pretty much all laparascopic instead of LAVH these days. He said there's also a full vaginal hysto, without the laparascopic assistance, which might be necessary if a uterus is particularly big or there's some other issue, and then there's abdominal, but those - laparascopic, vaginal, and abdominal - are the big three, and LAVH isn't as common now. I hadn't realised that so I was glad to learn it!

He also said that neither the type of hysto I have nor anything involved in the surgery would potentially affect bottom surgery options/results down the line. I currently have no interest in bottom surgery, but it's certainly worth getting info like that because who knows if I'll change my mind someday. So that was good to hear.

He said it would probably be workable to get the hysto covered under my insurance (Blue Cross Blue Shield of MA) even though I'm listed as male, but he couldn't promise. I have to talk to the Billing department about getting that sorted, and about what it will cost if they can't get it covered, but when I have that information I'll pass it along. One thing that I've found it very hard to get any info about is what a hysto costs if you have to pay for it out of pocket, so if I have to do that, I'll definitely make a breakdown of costs available for people.

Obviously I haven't had my hysto yet - I haven't even scheduled it, although I'm hoping for October - but I'm already so impressed with Dr Travias and wondering why I hadn't heard of him before. If you're happy to go with a recommendation from someone who hasn't had surgery yet, take down his name and please pass it along! And if you'd rather wait to hear what I have to say after he's cut me open and stitched me up again, stay tuned!

23 July
24 hours after my consult, Dr Travias's office called me to say that they've booked my hysto for Wednesday 13 October at 7.30 am. Apparently he wants another surgeon to assist him and that surgeon is only available one day a month, so if I want October, the 13th is it. Nathaniel is coming to nurse me and says the 13th is fine by him, so it looks like all systems are go. I'm still nervous, but increasingly excited! And I'm so glad Nathaniel is coming. There's no one in the whole world whom I'd rather have with me. Knowing he'll be there for me makes me feel a lot safer and calmer about the whole thing.
01 August
In the waiting room before my hysto consult, one thing that T and I talked about was how little info there is out there for long-term transitioned guys, especially regarding health and the long-term effects of T. So as a walking guinea pig, I want to start making my lab results available on here.

On the 18th of this month I'll have been on T for ten years, which is amazing to think about. It seems like forever and at the same time it seems like no time at all. It's also worth noting, as I put up results for things like cholesterol and lipid tests, that I have a family history of high cholesterol and heart disease. Testosterone does not put you at an inordinately high risk of heart attack or anything else, nor does it cause you to keel over and die, unless you're using it irresponsibly and without the supervision of a competent physician. It increases your risk of heart-related problems because that's what testosterone does - it's why men in general are at a higher risk of heart disease, heart attack, etc. than women - but ultimately it's down to your genetics and lifestyle (diet, exercise, smoking, etc.). Going on T puts you at the same risk of heart disease as your own twin brother would be (as well as making you look like your own twin brother). There's enough misinformation out there - please don't go 'Oh god, this guy's cholesterol is a little high! That must be because he's been on T for ten years! In another ten years it'll skyrocket and then he'll DIE and therefore that will also happen to me if I go on T!' That's not the case.

I'm due for labs this October and will post the results then, but for now I'll post last year's stuff. My doctor likes to test for a million things, most of which aren't relevant to my taking T, so I'm just posting the bits that I think are most relevant.

Lipid profile:
CHOLESTEROL: 214 mg/dL. Standard range is 0-199 mg/dL.
HDL ('good' cholesterol, influenced by exercise - higher is better): 66 mg/dL. Standard range is 40-65.
CHOLESTEROL/HDL RATIO: 3.24. Standard range is 0.00-4.90.
LDL ('bad' cholesterol, influenced by diet - lower is better): 135 mg/dL. (My doctor also did an LDL direct measure test, which said 137 mg/dL.) Standard range is 0-130 mg/dL.
TRIGLYCERIDES: 66 mg/dL. Standard range is 0-149mg/dL.

Free testosterone, bioavail, for a male in my age range:
ALBUMIN: 4.60 g/dL. Standard range is 3.5-4.8 g/dL.
TOTAL TESTOSTERONE: 824ng/dL. Standard range is 262-1593 ng/dL.
SEX HORMONE BINDING GLOBULIN: 29.5 nmol/L. Standard range is 13-71 nmol/L.
TESTOSTERONE, FREE: 193pg/mL. Standard range is 47-244 pg/mL.
TESTOSTERONE, FREE %: 2.3%. Standard range is 1.6%-2.9%
TESTOSTERONE, BIOAVAIL: 483ng/dL. Standard range is 130-680 ng/dL.

Yes, my cholesterol - particularly my LDL - is slightly high. This has everything to do with my genetic predisposition. I adjusted my diet for several months, cutting out a lot of saturated fat and cholesterol and increasing my soluble fibre intake, both of which are supposed to help lower LDL and overall cholesterol, and the numbers stayed exactly the same - actually those test results are from after my diet adjustment. I'm sure eventually I'll wind up taking medication for my cholesterol but I don't yet. I still watch my diet and try not to take in too much saturated fat or cholesterol (and I avoid trans fat entirely) and get some soluble fibre, but I'm a lot less careful now than I was a year ago because it didn't make a difference for me.

Interesting note - if you're trying to increase your fibre intake, products that say 'multigrain' are worthless. For all you know, they have tiny ground-up useless bits of fifteen different grains in there. What you want are products that say 'whole grain'. Whole grains are what provide fibre and nutrients, whether there are a bunch of different kinds of them or not. Also, while insoluble fibre is what you want for helping with constipation, soluble fibre is what you want for lower cholesterol.

17 November
I've been rather delayed in writing about my hysto experience, which was fantastic, but here it is in full!

My surgery was at 7.30 am on Wednesday 13 October, eight days after Nathaniel arrived. (We spent the first week running all around trying to do as much as possible before we'd be stuck at home for a while.) My surgeon was Dr Vlassis Travias of Concord OB/GYN and again, I cannot recommend him highly enough. He and his staff were just excellent.

Caden was giving us a ride to and from the hospital, so he spent the night beforehand. On the day of surgery, we got up at 4.45 because we needed to be there at 6.30, an hour before surgery. I had shaved the night before so I just showered and used mouthwash. I was too tired and busy trying to get out the door to be very nervous, but still was a bit. I wore a button-down shirt and pyjama bottoms so I'd be comfortable and not have to pull anything up over my head, given that my abdomen was likely to be quite sore after surgery.

We arrived early - at about 6. We let the receptionist know I was there and sat down to wait. An older couple was sat waiting too, but no one else there. Nathaniel reminded me to let them know that it was okay to give him information since he's not officially my next of kin, which I did. The nice secretary told me I didn't need to sign any forms; my word was enough. I sat with Nathaniel and Caden again, just for a few minutes, and then nurse Debbie came to get me.

She chatted to me a bit as she brought me back through the doors to the surgery prep area, asked if I was nervous, and told me she'd worry if I said I wasn't nervous at all. We went into room 4, which she told me to remember in case I went to pee, and indicated where the toilet was. Debbie took my medical info and typed it into a computer that was in the room by the bed. She chatted to me a bit about Trans stuff but mentioned that she knew this wasn't an appropriate time to ask questions, but that she didn't know a lot about it and wanted to learn more. I asked multiple times, just to be very sure, about what would be removed and she reassured me that everything would go. She was unclear about why anyone would elect to leave some bits in, so I said it's just about being comfortable in your own skin really, which made sense to her but she had a hard time wrapping her head around not going 'all the way' once you'd decided to transition. We didn't talk about it for long though.

Debbie left me to change into hospital gown and slipper socks (which they provided and I got to keep - neato), and I put all my stuff into the bag she'd given me. She came back and I signed some papers saying that they could look after my stuff while I was in surgery and that I was allowing them to go ahead with the procedure, and a third thing I don't remember. Then she had me lie back and said she'd give me a little Novocain before she put the IV in. She was going to do it lower in my arm but I said I'd prefer it in the elbow, where I'm used to being pricked with needles and where I have great veins anyway. She said that was fine, and that she was glad to be working at Emerson Hospital where they let her do what she wants because the last place she worked was all 'We don't do it that way' when it wouldn't actually hurt anything. She put the Novocain in with a tiny needle that barely hurt at all, and then said she was going to put the IV needle in and I should feel some pressure but no pain. (Of course I didn't watch any of this.) It felt like a lot of pressure and lasted for a few seconds so I wondered just how huge this needle was and how far up my arm she was sticking it, but there was only the tiniest bit of pain. Then she said she was all done so I could look as she taped it all down. I lay there with my arm still for a few minutes before she told me I could move it, although I had just been keeping it still because it was comfortable and not because I was afraid to move it. She said she'd had patients complain that their hand had fallen asleep, which was because they'd been holding their arm completely still because they were afraid to move it - not because the IV was actually cutting off their circulation or anything. She showed me on another needle how the needle bit came off and a flexible catheter was all that was now in my arm, so I could move freely and not have to worry about pain or having the needle bend or break or come out. That was reassuring.

Then she brought Nathaniel and Caden in and we chatted for a bit. Various people came in to say hello. I saw the anaesthesiologist and reminded him that I'd given them my anaesthesia records from top surgery and that I was concerned about the anaesthesia taking a long time to drain from my system and possibly causing depression, and he looked through the papers again and said they probably wouldn't need to use quite as much this time and would be sure to not give me more than I needed. I said that was good as long as he promised I wouldn't wake up prematurely! He promised and so did the other anaesthesiologist who came in and checked my IV and put a silly OR hat on me. She said 'everybody gets a party hat' and I'm sure I looked very silly indeed, especially with the way Nathaniel and Caden were giggling at me. I double-checked that there was anti-nausea stuff in with the anaesthesia, which they said there would be. The assisting surgeon, Dr Muto, came in and said hello and let me know he'd be assisting. Dr Travias came in to say hi and get me to sign another paper authorising him to do the procedure, and said my insurance company were doo-doo heads for not covering it. I asked if he charged a different fee for people who had to pay out of pocket and he said that he charges the minimum amount that any insurance company would give him - so if his fee is $2,000 and the least he'd get from some insurance company was $900, he'd only charge me $900. (Actually his fee was $3,500, but he charged me quite a bit less than that.) The anaesthesiologist reminded him that he needed to write on me so they'd be very sure that the right person went in for the right procedure with the right doctor, and he just made an X on my stomach with the special marker they handed him. They told me that they were putting antibiotics in my IV just as a routine thing to help prevent infection, and then they said they were giving me something to relax me - presumably Valium.

Then they were ready to take me into surgery, promptly at 7.30, so I said goodbye to Nathaniel and Caden and they wheeled me off. I remember most of the journey to the OR and I remember shifting myself onto the operating table, which was blue and looked like it had egg-crate foam on it and was surprisingly narrow. I remember shifting myself over but not lying down or anything else. Then I remember hearing a nurse say 'Let's just take this oxygen mask off you' and a hand reaching to take the mask off my face, and then I remember waking up in a recovery room.

I'm not sure how long I was lying there before someone came to check on me, but I don't think it was very long at all. It was a different nurse whose name I can't remember - apparently Debbie only did pre-op stuff and this other nurse only did post-op stuff - but she was nice too, and asked if I wanted Nathaniel and Caden to come in, which I very much did. It was just after 12 at that point. They came in and sat by my bed for the next couple of hours. Mostly Caden played on his Nintendo DS and I think Nathaniel had a puzzle book he was working on. They chatted to each other a bit and to me occasionally, but mostly I dozed and was really out of it so I don't think I said a great deal, except Nathaniel tells me I kept saying I was sore. I don't remember that at all, but I definitely remember them being there and my closing my eyes a lot, opening them occasionally, and closing them again. I wanted to stay awake and chat with them - and to never take my eyes off of Nathaniel because I was so happy he was there - but I knew the best thing was to rest and not fight to stay awake, so I did my best to relax and let myself doze. The nurse told me I could stay as long as I needed, and to get up and go pee whenever I felt like it, get dressed whenever I felt like it, and I could leave whenever I felt like it as long as I had had something to eat and drink and had got to and from the toilet.

They offered me a choice of drinks - a couple of kinds of soda, apple juice, or orange juice - and I had ginger ale first, but I think I switched to orange juice after that. I remember thinking that fizzy stuff didn't feel like a good idea with my abdomen in the shape it was in, and I didn't fancy apple juice, but I started with ginger ale because it sounded so nice (comfort food). So I sipped ginger ale and orange juice and nibbled the graham crackers they brought me. I turned out to be really thirsty so after two cups of beverage and with no nurse in sight to bring me a refill, I asked Caden for some of the million little juice boxes he had in his bag. I think I went through two of them and I think they were grape juice, which isn't my favourite thing but I was so thirsty that I finished the first one really quickly and asked for another. My mind wasn't very hazy at all, although Nathaniel told me a few days after surgery that I had kept saying I was sore and I definitely didn't remember that at all. But it was such a contrast to top surgery, where I remember very little from when I got the Valium in my IV (before surgery) until we got outside after surgery - I remember that my mind became instantly clear in the fresh air and my memories from that point onwards are much clearer. I don't know whether they drugged me less for my hysto or the hospital is better ventilated than the surgery centre in San Francisco was, or both, but I have much clearer memories - and more of them - this time around and while I was tired immediately after surgery, I don't think I was as woozy. And there wasn't a sudden rush of mental clarity when I got outside this time like there was last time.

At some point I wanted to pee - I think it might have been about 1. I was full of juice and increasingly feeling like I couldn't hold it in any longer given that I was already in some discomfort from surgery. Nathaniel helped me get up slowly and shuffle to the nearby bathroom. We were in there so long that the nurse knocked and asked if I was okay. I was already wearing a pad in the nice underwear they gave me - shaped like boxer briefs but with no waistband and made out of a mesh material - and I had trouble sitting down but Nathaniel helped me get onto the toilet. I was surprised at how much blood there was in the toilet when I was done - although less surprised than disgusted and resigned, I think. I knew I'd bleed post-op, especially on my first toilet trip, but everyone had told me 'spotting', not 'bleeding', so I don't think I expected quite so much. Nor was I thrilled about it, to say the least. Fortunately peeing wasn't painful - I had been nervous about having discomfort or pain when I peed for the first time because I was catheterised during surgery, but it was fine. (The catheter was removed before I woke up, which I was very pleased about.) I put a new pad in my lovely mesh underwear and shuffled back to bed with Nathaniel's help.

Not long after 2 I really wanted to get dressed, so Nathaniel helped me up and got me into my shirt, pyjama bottoms, socks and trainers. The nurse asked if I wanted to go back to bed or if I was ready to leave; I thought about it because I didn't want to leave too soon if I didn't really feel ready. I was determined to listen to my body and not rush things. But I decided that I did feel well enough to go home, especially given that I was just going to go back to bed once I got there. Caden went off to get his car and wait at the main entrance, and the nurse brought a guy with a wheelchair to take me there while Nathaniel walked with us. It was about 2.50 when I got into the car and we headed out - five hours and 20 minutes after they wheeled me into surgery.

We had a prescription for Percocet for me, and Nathaniel asked me if it was okay for us to stop at CVS on the way home to fill it. I was okay with that so we popped in - or rather, Nathaniel and Caden popped in while I dozed in the car - and then went home with Percocet and a bottle of Sierra Mist. My prescription only cost $3 which I was confused about as usually my copay is $20 or so, but whatever. As soon as we got home, Nathaniel helped me up the stairs with Caden following behind. I found that climbing stairs wasn't a problem at all, which was a big relief. (Most of the pain I had came from getting up or down, but once I was up, walking around wasn't painful really. I moved gingerly for a few days so I shuffled instead of walking properly, but it wasn't painful to do so.) Caden gave us hugs goodbye and left, and Nathaniel helped me get settled in bed and I think I just dozed for the rest of the afternoon. At about 9, Nathaniel helped me go back to the bathroom to pee and change my pad and get ready for bed, then got me all settled in bed and went to crash in the other room as he'd been up since 4.45 am too - without the two-hour nap or all the dozing that I'd done!

We spent the next week just hanging out at home. I dozed a lot for the first few days and took Percocet religiously every four hours rather than find out just how painful this recovery actually was. I think it was after three or four days that I switched from Percocet to Aleve. Mostly I stayed in bed and played on Nathaniel's DS because he's a wonderful boy who shares his toys with me. The bleeding continued, although it became less and less, but it was definitely bleeding and not just spotting. I'm still spotting now over four weeks later, although it's very light at this point. But a month of wearing a pad non-stop is not my idea of fun and I can't wait for the bleeding to be well and truly over.

I was also constipated, which I'd been told to expect, and I took stool softeners regularly to try to get stuff to move. No joy, even when I took two pills instead of one. I ultimately gave up on the stool softeners and bought a bottle of prune juice, which I'd hoped to avoid because I hate the taste. I went through the bottle over the next couple of weeks, a little at a time, and it was very effective. All people wanting a hysto, take note: While prune juice tastes gross, it absolutely works, while stool softeners may not. And I had not had constipation after my top surgery, but I definitely did after my hysto, so don't assume that you won't have it just because you didn't have it before!

What I did not have, fortunately, was depression or lethargy or anything like that from the anaesthesia. My mood and energy level were absolutely fine. I don't know how much of that is due to less anaesthesia being used this time compared to what was used for my top surgery (if they did use less this time; I have no idea), how much is due to my being able to get out of bed sooner and therefore being more active and spending more time out in the fresh air, and how much is due to Nathaniel being here - that boy is so good for me. But whatever the reason(s), I'm so grateful to not have had to deal with depression on top of the rest of my recovery.

At one week post-op, I drove to Dr Travias' office for a check-up. Nathaniel wasn't so sure about the idea of me driving because it uses more in the way of abdominal muscles than you think, but I felt okay and Dr Travias had said I could drive as soon as I wanted as long as I wasn't on the Percocet as that's a narcotic. The drive turned out to be fine, fortunately, and Dr Travias confirmed that driving - as well as walking around - were fine for me to do at that point. He said I should do nothing beyond walking around for another three weeks - not even light exercise really - and then after that, I could do a little more until I was six weeks post-op, at which time I could go back to doing more strenuous activity. He said I could possibly have spotting for up to six weeks, although he'd be surprised if it lasted that long, so it wasn't a problem that I was still bleeding after one week. He said he'd have been surprised if I bled for less than that. So much for the load of people who told me that they only spotted for a few days after their hystos! He had a look at my incisions - no internal exam or anything - and was pleased with how well they were healing. I apparently was healing faster than he'd anticipated. So yay for that.

About a week and a half ago I lifted something heavier than I should have done - rather by accident as my mother was supposed to take most of the weight and then she didn't so I found I was holding it pretty much by myself - and had some very heavy bleeding that evening and overnight, soaking through several pads in the course of the night. It wasn't painful, just extremely inconvenient and rather scary as I worried I'd torn internal stitches or something. The bleeding eased way off during the following day, but I called Dr Travias' office anyway and spoke with a nurse, who told me that as long as the bleeding was slowing way down again it should be fine, but if I started bleeding heavily again (which she defined as needing a new pad every hour for at least three hours) I should call them. Fortunately that didn't happen and the bleeding has continued to ease off since then, but there is still some spotting so I'm still wearing a pad. I've been wearing pads for five weeks straight now and I will be very glad when this damn bleeding finally stops!

Two days ago I had my second post-op appointment with Dr Travias. All but one of my stitches fell out within the last week and he was pleased with how my scars look, and said I can put stuff on them if I want but he wouldn't bother because they'll fade and eventually disappear anyway. He wasn't worried about the fact that I still have a bit of spotting because I'm young and healthy, and the younger and healthier you are, the more blood flow you have to that area so the more likely you are to bleed. He said if I'm still bleeding in December, he wants to hear from me and he'd probably have to do an internal exam, which would be my first ever and now has me deeply nervous. But he said as long as I continue to take it easy, the spotting should go away within another week or two. Fingers very tightly crossed about that. If the bleeding does go away, I'm all set - no more post-op appointments necessary and I can ease myself back into more strenuous activity once the bleeding's been totally gone for a couple of weeks.

So that was my hysto experience! Here's a breakdown of the costs:

Again, Dr Travias, his staff, and everyone I came into contact with at Emerson Hospital were outstanding and I recommend them very highly. Big thanks to Caden for doing the driving and eternal love and gratitude and Dunkies to Nathaniel, who flew over 3,000 miles and took such amazing care of me even with so much other stress on his plate and who was the best part of this whole experience.

31 December
I saw my doctor yesterday for my annual chat and blood-drawing (five vials - she likes to test for a lot more things than I think are really necessary at this point, but whatever, I don't have to pay for it and my blood replenishes itself). While I was there, she showed me the pathology report from my hysto, which Dr Travias' office had copied to her. (Any time tissue is removed, they're required - by law, I think, or by decree of the AMA or something - to test it for various diseases and problems even if they think it's fine, just in case. It helps increase the likelihood that if there is something wrong, they'll catch it early and have better success in treating it.)

I hadn't expected there to be anything interesting in my pathology report, since I'd never had any health issues related to those bits and the hysto went exactly as planned - no fibroids or anything got in the way and necessitated larger incisions - but there was a bit of a surprise for me.

(Icky medical stuff ahoy! Skip ahead to the paragraph after the bold-faced list if you're worried about being squicked.)

* Right ovary: Multiple follicle cysts, no other diagnostic abnormalities recognised.
* Right fallopian tube: No diagnostic abnormality recognised.
* Left ovary: Multiple follicle cysts, no other diagnostic abnormalities recognised.
* Left fallopian tube: No diagnostic abnormality recognised.
* Endometrium: Weakly proliferative phase endometrium, there is no evidence of hyperplasia.
* Myometrium: No diagnostic abnormality recognised.
* Cervix: Atrophy.

Relevant part of the 'gross description': 'The right ovary has a nodular tan yellow smooth outer surface, measuring 2.2 x 2.2 x 1.5 cm. Upon sectioning it is found to consist of tan red soft tissue and to contain multiple smooth walled cysts containing serosanguinous to clear fluid measuring up to 0.8 cm in maximum dimension.'

 
A few terms defined (thank you Google!):

* The endometrium is the uterine lining that grows and is shed with menstruation. It's also known as the inner layer of the uterine wall.
* Endometriosis (which I did not have) is when that lining grows in places besides inside the uterus.
* Endometrial hyperplasia is when the endometrium grows too much, but still inside the uterus. It's not cancerous, but in some cases it can lead to uterine cancer. PCOS, among other issues, increases risk of endometrial hyperplasia.
* The myometrium is the middle layer of the uterine wall, which consists of smooth muscle cells and supports stromal (connective) and vascular (circulatory) tissue. (The outer layer of the uterine wall, if you're curious, is called the perimetrium, which is a serosa or serous membrane, which produces serous fluid - see below.)
* Serosanguinous fluid means it contained both serous fluid (a term used for various bodily fluids that are typically pale yellow and transparent, and of a benign nature, that fill the inside of body cavities - serous fluid exists in saliva, for example, and helps you digest carbohydrates) and blood.

So after ten years of T, only the cervix was atrophied, which is interesting but not really a surprise given that I'd already been told there wasn't any atrophy. The fallopian tubes were fine, and while a little of the uterine lining was indeed forming inside the uterus, it wasn't too much and it wasn't growing anywhere else, so it wasn't a problem. But both of my ovaries were cystic. News to me. I asked my doctor if that was common, to have cysts that caused no problems or issues and just sort of hung out there, and she had no idea because generally people only have their ovaries looked at (beyond a basic pelvic exam) if there is an issue. Hopefully over time, more folks who have elective hystos can make their post-op information available to start to form some meaningful data. All told, though, this makes me glad all over again that my hysto is over and done with and I no longer have to worry about the health of those reproductive organs - because I haven't got them.

Some of my lab results have impressively already come in, but they're not the more relevant ones - T levels and lipids - so I won't post them here. I will post the relevant results when I get them. I'm very interested to see what my T levels look like after having a hysto and dropping my dose from 50mg to 40mg per week.

 

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