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My own experience at Greenbaum with Dr. Meltzer
I had my vaginoplasty done by Dr. Meltzer in July 2004 at Greenbaum Surgery
Center in Scottsdale. Having originally been scheduled for Portland longer ago
than I care to remember, I can say that the delay was more than made up for
by the whole experience at Greenbaum, a modern hospital that was very comfortable
and whose staff was extremely helpful. As was the case with our site's proprietor,
I was 31 years old (well...let's rephrase that: I had been 18 for 13 years)
at the time and in excellent health. I'd been on hormones since 1997 and full-time
since January 1999. My only complication was a rash (probably a drug allergy
coupled with the heat out in Arizona) eighth day post-op. It was more annoying
than anything, and the nurses took care of it promptly and it quickly subsided.
I personally had very little pain and didn't need to take pain meds after about
the third day post-op. It's interesting to compare Andrea's 1998 experiences with Dr. Meltzer's current
technique. Over the last six years, he's made several refinements and changes;
for one, he has you begin bladder training earlier on, which probably reduces
complications when the catheter comes out (I found that by day seven, I was
even getting back the muscle impulses to urinate, and that helped me be ready
for when the catheter did come out). He also has changed his abdominal suturing
techniques, too; they're now internal sutures (two little divots about seven
inches below my navel) rather than external sutures. Here's some general tips from my experiences, followed by a brief log of my
surgery and recovery. First, the tips and observations:
My own experience at Greenbaum with Dr. Meltzer The following are some notes from my own personal experience. Be advised, your
mileage may (and probably will) vary, so take this as information only and not
prophecy. Pre-op day (Monday): I had my consultation. The biggest surprise was that there were no surprises.
Cheryl, Dr. Meltzer's nurse, chatted with me, took my vital signs, went over
my medical history with me, and gave me my bowel prep instructions and supplies.
She also gave me a nice Cabernet robe to wear in the hospital (my free gift,
no matter how I finish in the game). Dr. Meltzer, handsome and charming devil
that he is, came in not long after and we chatted amiably about my home state
and about what I do for a living. He really put me at ease, reassured me about
possible complications, and generally made me feel better. I had worried that
my lack of genital electrolysis would cause problems (or even cancellation of
my procedure), but Dr. Meltzer assured me it wasn't that big of a deal. The nurse instructed me to take off my pants and underwear and put on a robe,
and they'd come back when I was done. The nurse and Dr. Meltzer came back a
few minutes later and examined my genital area (which involved being put in
a rather unique position in a dentist-type reclining chair!). I was relieved
when he told me I wouldn't need grafts. I left the office feeling very confident,
and my friend and I then went out in search of groceries and supplies. We then
came back to the Residence Inn and settled in. I was surprised that the bowel
prep and diet instructions weren't as onerous in practice as they sounded. I
drank several bottles of vanilla Ensure (nearly got addicted to the stuff!)
during the afternoon. The bowel prep itself went well. The magnesium citrate wasn't as bad as some
other stuff I've had to ingest, but it's not at the top of my list...sort of
like straight lemon juice with half a container of salt mixed in. A friend (via
phone) advised me to chug it, which I ended up doing with the last of it. The
fireworks began within a couple hours and lasted much of the evening. Thank
heavens for Cottonelle wipes! The part I liked least was inserting the Bisacodyl
suppository. I've always been averse to inserting things up my rear end. Fortunately,
I was able to get it in the right place and retain it. The sound-and-light show continued until about 11 pm. I was surprised I slept as well as I did, given what was about to happen. I may have gotten up a couple times during the night, but I forget. Day of surgery (Tuesday): I had one last bowel movement right after waking up at 4 am, and then my poor
colon finally waved the white flag. I then took a good shower and made sure
to leave some conditioner in my hair. My friend and I got to the hospital at
5 am and were the first people in the lobby. The receptionist processed my paperwork,
and then I waited. About 6 am, they called me back. The nurse had me change into a gown, put my
belongings in a bag, and took my vital signs. I was running a bit of a temperature
that morning, I guess from stress. She told me I could use the bathroom when
I wanted, and I went one last time, but despite my fears there was nothing left
from the bowel prep. They put me on a gurney in stall 14 and began to hook me up to stuff, and gave
me a sedative to calm me down and reduce my blood pressure. There was a TV set
next to the bed, and it helped keep me distracted. They also let my friend come
back and keep me company while I waited. We had some laughs and some tender
moments together. Dr. Meltzer came by for a minute to say hello. Finally, about
7:30, they wheeled me back. The entire surgical experience couldn't have been
better. The nurses were very kind to me, the anesthesiologist (Dr. DeLong) was
very professional, and everybody was friendly. I was anxious, but they calmed
me down. They were playing some neat early '70s music in Operating Room 10 (amazing
what I remember! I think it was either the Doobie Brothers or the Grateful Dead
or something similar) when they wheeled me in there. It struck me as a very
soothing place where the surgical staff felt comfortable and happy. I remember
helping them put me on the operating table, having some stuff connected to me,
and then I just faded off to sleep. When I came to I was surprised that I had no dry-mouth as I normally have had
following anesthesia. I found it all to be a very gentle experience. I've been
operated on three times, and this was, without question, the easiest experience
I've ever had with being put under. I was Dr. Meltzer's first surgery that day,
and that afternoon they put me in my room. I remember little bits of waking
up in recovery, then coming up on an elevator and being wheeled into the room.
I drifted in and out of sleep all afternoon. I was surprised by how little pain
I had, and that I had some good coherent periods (coherent enough to call one
of my friends and call my husband and talk with them briefly). The PCA machine
had some problems, but once they were sorted out, I was able to get some relief. They'll bring you a semi-solid diet the first night, but I had very little appetite. I had a few cubes of Jell-O, but that's all I dared have. I drifted in and out watching Roger Clemens get shelled in the All-Star Game. Probably just as well that I was doped out of my skull and drowsy, then. Post-op day one (Wednesday): I was still stuck in bed with the cuffs on my legs. I didn't have problems
with the cuffs, other than how they sometimes made my legs itch just a tiny
bit. They did feel kind of neat squeezing on me. Some women said they had trouble
sleeping with the cuffs on, but it didn't bother me. The first few days, I slept
in short fragments through the night. My dreams, when I had them, were kind
of surreal too, more so than normal. :) Sometime during this day was when it hit me that it was done. I'd been warned
that I'd have some emotions come Day Three, but at some point I realized that
my body was finally the way I wanted it. My friend who accompanied me through
the first few days said I was smiling like the cat that ate the canary. Later
that night I had a full-blown crying spell, complete with tears of indescribable
relief. It felt great to get those feelings out after so many years of holding
them back. The surgery, I found, was like flipping a switch in my psyche. I
was completely different -- almost instantly blissed-out. It was just fantastic. I was light-headed during the day, probably a product of laying around and
possibly as a result of the PCA. Everybody has different reactions to it --
one woman I shared a visit with said it made her nauseous. I found that once
they took me off the PCA, my lightheadedness subsided fairly quickly and was
gone by the next day. Some of Dr. Meltzer's patients from the previous week came by my room this
day. They were exactly what I needed. One of the most pleasant surprises I had
was that I shared my time at Greenbaum with some wonderful women. The support
and friendship we were able to give each other made the experience even better.
I strongly recommend making yourself available to visitors. You won't regret
it, and you'll probably get very lonely very quickly if you don't. Debbie, who is one of Dr. Meltzer's patient care assistants, stopped in to see me. I loved her from the moment I met her. (That we're both Southern girls helped, too!) She brought me my legal paperwork, which cheered me no end. She also brought me a stuffed kangaroo, whom I named Jill and who kept me wonderful company through the whole thing, especially through the moments I felt anxious. If there are indeed angels on this earth, Debbie is one of them. Post-op day two (Thursday): The cuffs came off this day and I walked around for the first time. My first
steps were baby steps, but as my leg strength came back (surprisingly quickly...then
again, I do like to run, so I have sturdy legs, and I'd been careful to move
my legs as much as I could while in bed) I found my footing becoming more sure.
I made my first baby steps while the nurse was in, and she told me she'd come
back and see to me in a little bit. I finally got tired of waiting on the bed
and just went ahead and walked around by myself. The nurse came back to find
me sitting in a chair! She was pleased. An hour or so later I took my first shower in two days. Words can't describe
how wonderful that felt. I also met my next-door neighbor, whose surgery was
immediately after mine, and we quickly became friendly with each other and found
many common threads in our lives. She was a most excellent companion through
the ensuing days. Bladder training began this day. I didn't understand it at
first, but by Sunday it all made sense, and I was getting the old feeling back
in my bladder. By Tuesday, there was no doubt my bladder's sensation was back
to normal! I got my first good night's sleep thanks to an Ambien the nurse got for me. I think I had a pain pill that night, and that was the last painkiller I had. Post-op day three (Friday): I had an Ambien hangover, so I catnapped that morning. Later I took a hot shower
that set off the hypersensitive fire alarms (yes, you should run the exhaust
fan!). I quit wearing the mesh panties that day, because they made me itch.
Instead, I went back to my regular cotton underwear. If you're not going to
go anywhere, consider going without underwear as much as modesty will permit. The nurses removed the drains that morning. The first one hurt just a tiny bit coming out, but the second followed well enough. It's a quick removal, though, and I was glad to get rid of them. I walked over to the Walgreen's that afternoon, my first trip outside. It was 107 degrees outside. The nurses warned me not to push myself. I was slightly woozy when I got there, but I made it back just fine. This was the last night I slept with the ice pack. It was giving me chills at night, so I quit using it. Post-op day four (Saturday): I began to get dejected that I hadn't had a bowel movement. I was also experiencing
some pretty severe homesickness, and some pretty severe gas pain that was messing
with my appetite. On top of that, I was just bored to tears. Dr. Meltzer reassured
me about the bowel movement, that it wasn't uncommon for women to go several
days without one, and that if I hadn't had one by Tuesday, they could get me
going. That calmed me down. I had to force myself to eat breakfast and didn't
have any lunch. Simethicone and lots of really awesome contest-grade belching
helped soothe that, and a long phone call to hubby back home made me laugh again.
By dinnertime I was a little hungry and I was feeling cheerful enough to go
visit one of the new girls. I also had a sinus headache most of the day. Two acetaminophen caplets killed it. I finally just bought some acetaminophen to keep on hand for these moments. Were I to do it over again, I'd have packed some acetaminophen along with the Arnica, acidophilus and other stuff. Pain and swelling weren't bad, although my sutures were beginning to pull a little bit and my cathether tube was banging around and pulling. The adhesive holding the tube in place on my tummy was starting to let go. The nurse taught me how to empty my own catheter bag. Aside from meds, meals, water and ice, I was now pretty much self-sufficient. I was walking around more and feeling stronger. Post-op day five (Sunday): Still no movement, although the urge was growing stronger. I think it was a
psychological thing -- altered anatomy coupled with me really wanting to get
moving again. Also, my sutures were pulling and I was concerned about tearing
them. Dr. Meltzer reassured me they could get me going. He also told me they
wanted to take my packing and sutures out the next day, so I'd have something
to look forward to. If I didn't get things moving after that, they could give
me something to help. On the other hand, I did have two reassuring things happen.
First, my bladder sensation was coming back just fine, and I was again getting
the normal urge to go. Second, as I was watching a movie with a somewhat steamy
love scene, I felt sensation down below. Nothing spectacular, but just enough
to reassure me that the wiring was working just fine downstairs! My spotting was improving, but I kept running out of pads and got tired of asking for the ones the nurses gave me. I used them faster than they could supply them, and I wasn't crazy about them. I finally bought some of the thick four-layer Stayfree maxi-pads at Walgreen's, and found them to be just perfect, the right length and width, and very absorbent. The extra padding made sitting a little more bearable, too. This was another slow, make-your-own-amusement day. I caught up on some e-mail, went to Walgreen's again, watched some television and did some visiting. My neighbor and I made several circuits of the upstairs halls. Later, we dropped in and visited with another patient. Post-op day six (Monday): This day had a promising start. I had my first really normal night of sleep,
even sleeping on my side for a while as I normally do, with no real discomfort.
And when I woke up there was a Janeane Garofalo movie on television. What more
could I want? :) Okay, so maybe the one thing that would have made me happier was a bowel movement.
My inability to defecate was starting to bring me down emotionally and bother
my appetite, too. I informed my nurse and she started me off with a Bisacodyl
tablet at about 8:15. That didn't do much, so she brought me some milk of magnesia
to take at about 10:55. I got more and more frustrated, but at about 1:00 pm
the urges told me maybe I'd best go see about things. The first efforts were
difficult, especially since one of the big sutures holding things closed downstairs
would pull hard when I'd bear down. But eventually it worked, and I felt so
much better! I was so psyched about it I went up to the nurse station and shared
my glee with my nurse. She was very happy for me. Janet, the nurse from Dr.
Meltzer's office, took care of my sutures, packing and dilation training that
afternoon. The sutures came out with surprisingly very little pain. Packing
removal felt weird, though! Almost like a vibrating bowel movement unspooling
just in front of my colon. Nothing could have prepared me for it! I was glad
I'd had that bowel movement, otherwise I may well have ruined the bedsheets.
:) The first dilation was incredibly difficult and painful (brace yourself!),
but the second one was the direct opposite, actually quite easy and not really
unpleasant. It was a weird experience! But well worth it. I was very pleased
with my depth, too! Since we were running late that day, Janet told me I only
had to dilate three more times that day, the last of them in the middle of the
night. My first self-directed dilation and douching were both pretty phenomenal experiences.
I decided it would be best to douche in the shower. Unfortunately, the goofy
faucets in the hospital make it difficult to get lukewarm water -- the sinks
have a sensor switch, and the shower wands put out huge spray patterns. I ended
up using the shower wand, which, although messy, let me set my own temperature.
The douche kit you get from Dr. Meltzer is a little flimsy, so I recommend getting
a sturdier one with a firmer bulb when you get back home. The documents tell
you that the nurses should wake you up in the middle of the night for your only
late-night dilation, but I just went ahead and stayed up for it. I made up for
the missed sleep the next morning. Sorta like being back in graduate school.
:) Much of my energy was back this day. I probably wouldn't go running the Boston Marathon just yet, but except for the catheter tugging on me and the annoyance of the delaminating hospital bracelet on my arm, I felt just about normal. Once my vaginal sutures were out, I was walking around (advisedly, of course) at almost my normal speed. I'd used the bathroom, I felt great, I was dilating okay, my bruising was getting better, and even the muscle impulse to urinate was returning just fine. I felt great! And I was happy again. All in all, a great day. Post-op day seven (Tuesday): Slow waking up this morning. I was also dreading dilation a little, since it
was still just a little painful. It was feeling like there was an air pocket
between the tip of the dilator and the length of my vagina, and that was causing
some difficulty. Once I got it inside, though, I could retain it and move it
according to instructions with no difficulty. Getting started, though, was a
psychological hang-up that subsided with experience. I did my first dilation of the day prior to taking my morning shower. I also
timed my daily douching with my shower, since douching involves getting very
wet. Once I was dilated, douched and cleaned up, I was ready to take on the
world. I saved breakfast for after dilation and douching. That really helped
motivate me to get them done. My neighbor told me she found that dilation worked
better for her if she did it prior to a meal, rather than after. I took her
advice! The other big revelation was that if you distract yourself, the stent will
go in *much* more easily. I found that dilating while watching television helped
relax me. If I paid more attention to the television than the stent once I had
it in my vaginal entrance, I could slip the rest of it in more easily. Once
in, it wasn't bad. (It's surreal to dilate while watching "Teletubbies,"
for sure.) Dr. Meltzer's instructions tell you to keep the stent in 15 minutes,
but I routinely stretched that by a few minutes a session. I never dilated for
*less* than 15 minutes. Janet came by to check on me, and was pleased with my progress. She said I
was already looking better down there, compared to the day before. She told
me my catheter would come out the next day, and advised me not to take any pain
meds beforehand. I had two weeping areas from where the drains had been, but
Janet showed me how to keep pads made from Kleenex next to them and they would
heal up. I told her that I was getting used to how high-maintenance I now am,
but she told me that by six months the maintenance level would be comparatively
low, once my body has retrained itself. The body still thinks the new vagina
is a wound and wants to close it, but over time and with proper care it'll get
accustomed to the vagina and take care of it as its own. If you get discouraged
by the high maintenance early on, remember that it will improve over time, so
don't give up! Don't let a little pain cause your massive investment in yourself
to be ruined. Another excellent day, and in the afternoon, I goofed around. Among other things,
I went over to Walgreen's (what would I do without that place?) for more supplies.
I also got a picture of the gun store across the street from the hospital, whose
sign depicts a teddy bear contentedly clutching a machine gun. It's like a Warren
Zevon album cover that never happened, but should have. Dr. Meltzer came back by for a visit and reminded me that the catheter would
came out the next day. I told him I really hoped things would function. "Oh,
you'll pee," he assured me. "Think positive!" I felt so good that another woman and I took a walk around Scottsdale, stopping off for smoothies along the way and visiting the civic center park and saying howdy to the ducks and swans and geese in the pond there. It was the longest I'd been walking since surgery, and I had no ill effects at all, not even out in the heat. My poor swollen mons felt like it was vibrating, but I'm an intense walker anyway. Then it was time for one last dilation, some writing, and then bedtime. Post-op day eight (Wednesday): A minor medical mutiny this morning: I finally had enough of the bracelets
and yanked them off. Shades of Tom Hanks ripping off the biomed sensors in "Apollo
13." :) Over the course of the night I started to itch. The catheter tape was bothering
me like crazy, and some other areas had started to itch too. When I got out
of the shower and looked in the mirror, I saw red blotches on my back. My fair
skin (a gift from me beloved Scots-Irish mum!) was all red and blotchy! I notified
my nurse about it. It was either an allergic reaction to some drugs, or a heat
rash. Catheter came out this day. Normally one of Dr. Meltzer's nurses does it, but
one of the hospital nurses did it. Whatever works! It was a weird feeling, like
the mother of all urinations. I clutched Jill and gasped a bit when it came
out. But it was over quicker than I'd figured it would be! And "sweet liberty"
doesn't begin to describe the feeling. I had no urge to go, because I hadn't
been told to fill my bladder before they removed the catheter. I had to drink
some liquids in order to get the urge to go. I was told not to force it, to
wait for the urge and not strain or agonize over it. Sure enough, after a little
while, the urge came and it was amazingly natural. It was so awesome to know
the plumbing worked! Even if it was all over my butt and the back of my legs,
it worked! Yippee! Cheryl, Dr. Meltzer's nurse, came in and visited. She took a look at my rash
and said it could be either drugs or the desert heat. She figured the culprit
could be the Celebrex, so she took me off it and ordered some hydrocortisone
cream for me, which I got that afternoon. Both helped the rash clear up within
about two days, so no permanent damage was done. Cheryl also took a look downstairs, said I was doing well, and then gave me
sort of a pre-departure briefing about what to expect (don't be surprised if
you spot the rest of your life -- you have a hole now, and what comes in must
come out; if the discharge gets funky, call her; don't be distressed by misdirected
urinary streams, because until the swelling subsides you won't know how things
will be; if you prang the urethra with a dilator or the douche wand and it bleeds,
put a golf ball-sized wad of paper towels against it and lay down for 20 minutes;
drink enough fluids so that you urinate at least every two hours). She asked
if I needed anything for pain, sleeping, or anything for the trip home, and
said she could order it in at Walgreen's for me if I needed anything. They really
do see after you so well here. Other than that, I felt great. Everything was working! I was very happy, since
urination was the last real milestone. The only thing keeping me from leading
a "normal" life was that it was still difficult to sit down for a
while. Dilation still wasn't any more fun, but I was keeping with it, staying
motivated, and finding it a little less difficult each time. Dr. Meltzer was
happy with how things were going when he visited me that evening, so all was
well. And last dilation of the night went very well and reassured me that things
inside were stretching very nicely. If I had this done and my worst complaints
on Day 8 were a mild heat rash and blisters on my feet from my sandals, I think
it's a good deal. That said, I was looking forward to getting sprung the next day and soothing myself for a couple days in a hotel before my flight back home. I was grateful for all the attention from the nurses and visitors, but I was aching for some time alone. Post-op day nine (Thursday) Rash was much-much-much improved today. Not quite gone, but it had really faded.
I took some Benadryl before bed, and that helped me sleep and relieved the itch.
I got up several times during the night to pee, and everything still worked
just fine. I realized how spoiled I'd been while hooked to the catheter bag.
:) On the other hand, at least I could sleep on my side again without worry. My rash was getting better. I also noticed that the swelling around my mons
and labia was very slowly getting better. My bruising was much-improved, too.
There must be something to that Arnica Montana stuff! I was still too swollen,
though, to think much about being sexual with my new genitalia for a while. I dilated, douched and showered. As I was about to get dressed, Janet the nurse
came in for one last look, said I was doing well, and gave me some final instructions.
She was amused when I reported "all three holes are working just fine."
She said Dr. Meltzer would come see me between cases. After she left, I got
dressed, ate breakfast and finished packing. My neighbor and I made arrangements
for our flowers to be given to other patients who could use some cheering up.
They'd certainly brought us cheer, and we wanted someone else to feel the same.
There was nothing left to do but sign discharge papers, say last farewells,
wait for a last visit from Dr. Meltzer and give him a big hug (he was about
2:30 coming through, as he had a very lengthy surgery that morning), and catch
a ride to the hotel. I shared a ride with another patient, so don't be surprised
if you have company. Robin took me to my hotel, helped me get my things up to
the room, and then bade me farewell. After this incredible experience, it was
nice to have some time to celebrate it quietly by myself before returning home.
I got a suite with a very nice, quiet, secluded bedroom so I could have extra
quiet and privacy while dilating. The nurses will be glad to give you a supply
of Chux pads (big yellow absorbent pads) to lay on so you don't ruin the sheets
with dilation sludge, so don't hesitate to ask for a supply for the road. The rate for my suite included a bottle of champagne or sparkling cider (I chose the latter, being Safety Girl), so that night I drank a toast to all those who made it happen. Of everything I'd felt the last ten days, gratitude was the most overwhelming emotion. An awful lot of people helped make this happen, and made it more pleasant, and the love I have for them is just overwhelming. Post-op day 10 (Friday) It's amazing how well you sleep when you're in a big, soft bed in a quiet room that isn't in a hospital! Too hot in the July heat to do anything outside, so I mostly just stayed in the room and caught up on sleep, eating, dilating, relaxing and watching "Law & Order" reruns before catching the big airplane that would take me to the little airplane that would take me back to home, hubby and cat. It's impossible to express how good it feels to pamper yourself after something this big. Post-op day 11 (Saturday) I flew home today. I knew I wouldn't be able to dilate in the airport, and
given today's security environment (and also given just how icky most airplane
lavs are) I didn't want to spend 20 minutes holed up in the lavatory of our
airplane, so I took care to dilate as much as I could that morning before leaving
the hotel. I had no problems on the trip home. The only thing I shouldn't have done was try to put my own carry-on bag in the overhead bin -- the muscles in my side quickly barked at me for trying too much too soon! Get a flight attendant to help you. That's why they are there. Aside from that, I had no problems. The coach-class seat was perfectly adequate for my comfort, so I didn't need the inflatable ring at all during the three hours back to Atlanta, my three-hour layover there, the one-hour flight back to my hometown, or the forty-minute car ride home. Once I got home, I dilated as soon as I could. Post-op day 12 (Sunday) After many hours of blissful sleep alongside my beloved hubby and our beloved
cat, I resumed my normal dilation schedule the next day, and things went from
there. I found that the more relaxed I was, the easier dilation went for me. Over the coming days and weeks my body healed, I became less sore, dilation became less of an ordeal, my urination became less messy as things mended, and my bruising went down. I increased my activities each day as my body would let me, always careful not to push myself, and life slowly returned to normal. Well, at least as normal as it gets for me, anyway. :) Closing thoughts Well, I'm glad I stuck with Dr. Meltzer and held out to have him do my surgery. It was a first-class experience, every bit of it, and I have no regrets. I'm happy with my result, become happier with it every day, and believe it's the best money I've ever spent. I don't believe I could have done it any better than this! 
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