This insurance thing is taking some time. The first inquiry was denied because my doctor's office hadn't sent the referral correctly. Now that I've officially been referred to the surgeon, they had to appeal the decision. I should probably have had my doctor write another letter of medical necessity, I have a feeling they're going to deny it again due to it being "cosmetic". Worse come to worse, I'll pay for it. It isn't much comparatively.

I asked my boss when a good time to take a week and a half off would be and she said not til early January because we're still slammed and short staffed. Hopefully by then there will be a lower animal population and we'll have new people all (or mostly) trained up.

Setting things in motion for my second surgery. There a a couple of really exciting things about it. One is that I can probably get it covered by insurance so long as my doctor writes a letter stating that it's not a cosmetic surgery. The other good thing is that it can be done as an outpatient surgery, so even if I do have to pay out of pocket it will be well under a thousand dollars.

The recovery time will supposedly be a bit shorter than the first one. I am trying to store up enough PTO for about a week and a half, which, with weekends added will be adequate. Work is really rough right now as we're very short staffed and the population is very high, so I don't know if they will even approve a long absence as I'm one of very few staff who have been around long enough to train new people properly. So with that and insurance, I may have to wait until January. I was hoping for early December.

I want to get it done in the winter so everything will be healed up for next summer. Hiking, swimming, running. I am excited to work out and be comfortable without a shirt.

I need to start paying more attention to my diet and exercise again. The change of seasons really messed it up for me.

chest update

Well, I had an appointment with my surgeon today. He said that the swelling is gone, but there is still tissue left. He said he will do liposuction with the next surgery. He can make there be almost no tissue between the skin and the muscle. It will still not be flat due to the pectus excavatum, but at least there will be no more of this daft bouncing flesh. He also mentioned that because it healed up so well, I could do the surgery anytime. I still want to wait until fall so I can make the most of summer for camping and hiking. The second surgery is supposed to have less downtime, so hopefully I won't have to take a whole lot of time off work. I am glad to hear that I did heal up just fine and that the size is not just in my head and that there is a solution. I just have to wait. I think I can handle that. I just need to decide if I should get another binder for running and long hikes. The one I have left is really stretched and gross, and I gave the others away to those in need.

two months post op

It's been two months since surgery. There is no pain and only occasional discomfort now, generally in the area of the drain insertion sites. There is still a large amount of swelling, though. I wear a binder when running, but generally don't for everything else. I decided that I don't care enough, even though I can still tell there is something off with my chest. I'm sure others can't. I have an appointment with the surgeon next week to check on the swelling and see if there are any methods to make it decrease.

I should easily have the money for the second surgery by early Fall. I am hoping that the healing time and swelling for that one won't be as long. It seems I've traded having large scars for having a very long recovery, not to mention spending more money.

four weeks

Yesterday marked four weeks post op. The swelling has largely gone down. Generally, my chest looks mostly flat in the morning, but swells a bit about half way through the day. I still tend to wear the binder during the work day because it's tender. I think because the skin is not used to being exposed in that way. Also, my nipple placement is not yet ideal, and is uneven. So we'll see how these intervening months will go with regards to binding. Luckily, I have no need to bind tightly, as I did before. I wear my oldest, loosest binder just to keep a little bit of compression and to negate any uncomfortableness. That binder is not tight under the arms or around my ribs, so it's really not comparable to binding prior to surgery.

My flex spending account funds finally came through. I was denied at first because they called it a cosmetic procedure. So I had to call my doctor and have her write me a letter of medical necessity. They immediately paid. I've been in the process of paying everyone back for contributing to my fund. Actually, many people are refusing to be repaid. This blows me away. I appreciate my friends so much. I now have about 2/3 of the funds for the next surgery, so it may not be as long a wait as I dreaded.

Three weeks post op

I finally feel fairly confident in the way my chest looks, but only after comparing the photos that I've been taking every few days. I will share a photo I took today. Later on, I'll post more for healing comparison.

There is still swelling, but not nearly so much so I am confident that it is indeed subsiding. The second surgery with tighten up any skin that doesn't do so on its own in the months between surgeries. The areola will also be resized, leaving me only with small scars around the nipples that will be neatly hidden by the skin tone changes.

Now if I could just get back to running and eating healthfully, I'd feel so much better about my body. However, I tried to run yesterday and it hurt my chest because of the bouncing, so a bit longer on that.

Well, it's been over two weeks since surgery. I've just gone back to work without restrictions which is fantastic, because I wasn't so keen on spending the whole week in the call center. I feel mostly healed up. A bit sore and tight, but basically back to normal. I might try running soon, just to see. The doctor seemed a bit perplexed about the remaining swelling, but said that since it wasn't fluid, I wouldn't need drains anymore. He assured me that it was flat when he was finished with the procedure, and that it would be again. I've been gently massaging everything and I think it might be helping. I also have still been in a compression vest. Actually, a binder, as it's more comfortable that the zip up surgical compression vest they supplied. It sucks to still have to wear that regularly though. Last night I put a washcloth in the abyss in my chest and I think it may have helped with the swelling a bit. I think the fact that the compression doesn't actually compress down between is part of the problem. So I'll just keep doing that and hope it helps.

I keep taking photos every now and then to compare. Someday, when it's all done and I feel confident, I'll likely post some of them for comparison to catalog the process. 

Honestly, I'm a bit discouraged with the visual results so far. I can wear a t-shirt and it looks mostly normal, but I still feel odd about it when I move certain ways. And without a shirt is definitely not an option. I know it's a process and I knew going in, that it would be incomplete until the second surgery. But that doesn't stop me from being impatient and slightly disappointed. 

A week and change.

I got those horrible drains removed. I feel like a real person now. The flat-chested sort! There is still a lot of swelling, but it's gone down quite a bit. It may swell a bit more as my body switches from draining the fluid to absorbing it. The process for removing the drain tubes hurt rather a lot on the right side, but after it was all done, it felt amazing. No more itchiness and discomfort. I only have to deal with the compression vest/wraps for a few more days and then I'm basically back to normal. I cannot wait until I can start being active again. I feel so fat and lazy. I know I'm supposed to be lazy for a time, but it sure feels horrible, and notice my gut seems to be expanding. I need to rein in my eating. But since Easter's just past, I cannot pass up half price candies. Ugh.

Anyhow, I feel much better and it's amazing to sit around in a t-shirt. What a feeling to not have to deal with layers. This summer is going to be great.

5 years

Today is the fifth anniversary of starting hormone replacement therapy. I took the last photo a few days before surgery because I knew there was no way I was getting into that shirt only a week after surgery. I messed up because I took it landscape instead of vertical. Oh well.

These five years have been some of the best I've ever had. It's really great to comfortable in my presentation. I am super excited to no longer have to bind. Next year the comparisons will be fantastic.

Have I mentioned that I hate the drains? I am so ready for them to be gone. I'm also going crazy with inactivity. I want to hike. I want to run. I want to do push ups. Ah well. Soon, I'm sure.

Post Op day 6

Not a whole lot new to report today. Drains are really bothering me. Itchy and painful. But I can last another two and a half days until Tuesday afternoon. I think the swelling has gone down a bit. I took off the bandage for awhile around the house. It's so odd to only wear one layer. And it's awesome to be visibly flat.

Post Op Day 5

The bandages are off and I got to shower. However, they decided to leave the drains in until next week. Apparently they’ve been having to put them back in for others because of fluid build up. So that sucks, but at least I won’t have to deal with ballooning back up. Showering was amazing. No more funky antiseptic smell and much less itching.

I’m pretty swollen, especially toward the abyss in the center of my chest, so the reveal wasn’t as amazing as I’d hoped, but in time the swelling will leave and then I can enjoy a comparatively flat chest.

Everything is pretty numb, with some slight tingling sensations when touched. It's a very odd feeling. No pain to speak up, but definite discomfort where the drains are inserted. 

The reality hasn’t really hit me yet. Probably because the swelling makes it so that there isn’t a huge difference in size (yet). Also, I have to keep a tight wrap around my chest for a couple more weeks, so it still just seems like I’m binding.

I took some photos, but I am unwilling to share them just yet, I feel really self-conscious. Mostly because I know it’s all still swollen and funky, but also because it’s such a new idea to me to share photos of my chest. Once the healing is much further along, I’ll definitely share.

It looks much different than any other ftm chest surgery results I’ve seen personally. Because it was the peri-areolar technique, the incisions are only a couple inches long under the nipples. I have been used to seeing two long incisions that span nearly the whole chest. I think this method will be very good in the long run because of the slight scarring, but for now, it seems as though hardly anything was actually accomplished.

Post Op day 4

Tomorrow is the big reveal. I am so excited to get this tight and itchy bandage off, as well as the very uncomfortable drains. I am excited to see my chest. It will obviously need to heal more. And in a few months, I will be getting a revision to remove any skin that doesn't shrink up and to resize the nipples. But for the first time since I was 12, I'll see myself with a flat chest. Well, as flat as possible with my pectus excavatum. I hold 12 as my magical age. It was that age before menstruation. The age before breasts. It was the last age I was happy with my body. Testosterone has done wonders for my self confidence. I love the added body hair and the muscles. But I have never liked my chest. I have never felt my naked body was really mine. I have never had the debilitating revulsion that some trans people feel for their bodies, and for that I am grateful, but I have always disliked it. This is a huge step into really owning my body. I cannot wait to see the results.

Post Op Day 3

I'm restless. I hate being cooped up lying on my back all day. Got a nice sponge bath, and felt human again for a bit. I cannot wait to get these itchy drains out on Friday and have a proper shower. I've pretty much phased out the norco. I took only half of one today and I haven't been in any pain. I will likely only be taking it at night now.

I had a memory of waking up from anesthesia. My entire body was shaking like it does when I used to drink too much. I remember trying to explain to them that it's not an unusual thing to happen to me.

People are being really awesome. I've had some friends come visit and hang out. Everyone has been texting me and sending nice messages on facebook and tumblr. It's nice to have support and love and well-wishes.

I have a nagging fear of my mother. I really just think that things will be best if she never knows of this. I have no intention of telling her, and I certainly hope no one else does, as it is my business and mine alone.

Post Op day 2

Drains are pretty blech. Still no real pain, but I can feel where they go into the sides and it’s just odd and uncomfortable. I got my hopes up a tad at my pre op appointment when I was told that for this procedure, drains weren’t always necessary. Welp, they were for me. 

So far so good. Bit more tender today than yesterday but not as bad as I’d feared.

Post op day 1

I'm now a day post op. So far so good. Yesterday I felt really good, just a bit tired. It felt like I just did heaps of push ups to make my chest tight and sore. Today its a little more sore in the pain way, but still not bad. I'm using lots of ice packs to numb it and take the swelling down. I've been taking arnica and prescription strength ibuprofen for the inflammation and bruising.  I have also been taking norco (the not quite vicoden narcotic). I have had no ill effects that I was worried about.

I am definitely limited on movement, but I don't feel trapped in bed which is good. I've just been relishing the ability to relax with no nagging feelings that I need to be elsewhere doing anything specific.

We'll see how long it takes me to get truly restless.

Pre Op Appointment

The pre op appointment went well enough. I asked a couple more questions of my surgeon. All of my fears are quite allayed.

Side note: He's possibly the most dapper person I've ever met. Today, being St. Patrick's Day, he was wearing grass green slacks with a matching pocket square in his black jacket. Possibly the only person I know who can pull of green pants in a professional setting.

Anyhow, the nurse gave me all of my herbal supplements for proper healing. It was also mentioned that due to the nature of the periareolar procedure, I may not have to have drains. This is a surprise, but definitely a good one. Everyone I know who has had chest surgery has said the drains were by far the worst part.

Two more weeks of waiting.

Then more waiting after that for everything to heal up.

So close!

Tomorrow, I go in for another consult with the surgeon to ask a few more questions about why he does periareolar in two separate surgeries and exactly what each surgery entails. I also have my pre-op appointment with his nurse where she will give me all the supplements that will help me get through everything.

Soon.

Starting to get anxious/excited. Two and a half weeks.

I am not worried about the surgery itself. I am a bit worried about painkillers though. I've never really had them. When I had my wisdom teeth out, I was prescribed vicoden, but when I took half of one, I got dizzy and nauseous and reverted to ibuprofen. I'm afraid of what narcotics will do do my head. I'm actually just sort of wary of them in general for a variety of reasons, my brother's addiction being one of them. I really don't want them at all. But I'm also worried that it might be too painful to go without.

I am also a bit worried about money. I have enough for the surgery, but it's basically emptying my savings account. I just hope nothing happens, I won't have a rainy day fund for awhile.

A loss for words (but actually only spoken ones, I can write a decent amount...)

So I was sort of despairing of getting enough money scraped together for surgery by March 30. I would have easily had enough, but I was counting on the FSA. Since that will only work as a claim after the surgery, I was seriously worried about it. I considered rescheduling. I was so loathe to borrow more money on top of my current student loans and car loan. But a couple people suggested I do a gofundme. I was reluctant. I always sort of scoffed at people who had those. I figured they could just be slightly smarter with their money. Or wait a bit longer or work a bit harder and whatnot. But I set one up anyhow, explaining the FSA and assuring everyone reading that I would repay them as soon as my claim went through and I got my money back.

I was surprised by the outpouring. Likes, shares, comments, and of course contributions. I had no idea all those people cared enough to actually help me out. I am so humbled and grateful. I met my goal in a single day. A day. I was expecting that I may still have to take another loan. Or that I'd annoy everyone on my feed by reposting the campaign every few days. But I don't have to worry. And I don't have to bother anyone.

Now all I have to worry about is the surgery itself. Being bored and immobile for a couple of weeks. And submitting that blasted FSA claim.

I really love my friends.

Transition Costs Revisited (unspecified amounts)

I wanted to go back a few years in this blog to the beginning of my transition and revisit a list I made.

From April 15, 2010 (italics) current updates (bold)

Figured I'd breakdown the basic expenses a trans guy faces.

binder- for the purpose of hiding one's chest: I have several. I use both T-Kingdom and Underworks. I like them both. But Underworks is much more affordable. I only use underworks these days. It sucks to have been binding for over 6 years.

soft packer- for the purpose of creating the bulge: again, I have more than one. Not expensive, but they do wear out over time. I forgot to include the packer harness. Again, not expensive, but the elastic doesn't last so long.

STP (stand-to-pee)- I use a modified medicine spoon. It was very cheep indeed. However, I also purchased an STP packer. It was not really worth the cost. I'm pretty sure I'm only on my second medicine spoon ever. I also don't use it much at all unless I'm in a public restroom and occasionally in the woods.

Strap-on- for the purpose of intercourse. I've no experience in this area. I now have experience in this area. Not particularly cheap.

Therapist- for the purpose of getting a letter for the the following. I actually enjoy therapy and I didn't just go so that I could get the official diagnosis to proceed with medical transition. However, I did get that letter written. And I have also not ditched my therapist. I no longer go to a therapist regularly.

Physician- for the purpose of getting a prescription. I've yet to find out if my health insurance pays for my doctor visits and blood-work. I go to my physician once or twice a year for a physical and bloodwork. My insurance covers the physicals and the general visits.

Testosterone- for the purpose of making one hormonally male. I use AndroGel. I rub it onto my upper arms once daily. Many other guys opt for the injection because it is much (much) cheaper. My insurance fails me in this regard. I have been on injections since September of 2010. The cost is low, especially with a pharmacy coupon. I am on a fairly low dose so my vial lasts many months.

Top Surgery- negates the need for a binder. I do not at this time wish to have a double mastectomy, though I do wish I had a flat chest. My surgery date is March 30 in Boulder. I will not need the double incision technique that is most common among trans guys. My surgeon said periareolar was the best option. This means I get minimal scarring and the retention of the nerve stalk for the nipples. However, it is two surgeries, and thus half again as much money as I was anticipating. This will be my largest expense in the whole process. It will be well worth it.

Bottom Surgery- yeah... I don't want this. Some do. I still have no intention of getting any sort of genital reconstructive surgery. Perhaps someday hysterectomy/oophorecotmy but that's way out of budget now. It'll save on testosterone cost though!

So yeah, I have a chest surgery date. I'm still worried about money, but I'll get it worked out. I will likely have to use the surgery office's line of credit, but it is no interest for a year, so I think I can handle that. I will be out of work on paid time off for two weeks. I will unfortunately have to spend most of that time in bed or at least minimally active. Send me your TV show, movie and book recommendations. Also, come visit me. I'm going to be super bored, but hopefully not too much in pain.

Now that I'm done wallowing in self-pity, I have some serious thinking and planning to do. Namely saving all the money I can for the surgeries in hope I can get them done sooner rather than later. I am mentally kicking myself for thinking in the moment so much. I could have had all the money I need on hand right now. But I tend to spend rather frivolously. Books, DVDs, movie theaters, gas (I need to ride my bike even in winter...), clothes, alcohol, junk food, restaurants, etc. I need to pare my spending down to essentials. And I count hiking and moderate travel as essential.

Now that I know I can use my flex spending account, I feel better. I won't lose that money. I just have to pay upfront, and then submit a claim. So again, more thinking about and rearranging money. 

I also think I need to talk to the surgeon more. I want to know if I can see any results from him. I have been doing heaps of research and have noted that many of the results are less than satisfactory. I am assuming this is why two surgeries are required, but I need to know more.  I am very impressed with his double incision results, having seen several patients in person. And as much as I'd like to not have such scars, I am wary of trying something unknown.

Chest surgery updates

Dr. Hartley says I'm a go for the periareolar procedure. This means I won't have the long double incision scars. However, it does mean that I will need two separate surgeries.

He said that my pectus excavatum would not pose a problem. He will not remove as much breast tissue, instead sculpting it a bit more naturally to "fill in" the hole in my chest.

Now I'm just worried about money. I have enough for the initial surgery- the same amount it would cost if I did do the double incision. I do not however have the extra ~$4 grand. The second surgery would be a few months after the first one, so I can probably get about half of it, but I'll likely have to borrow some. I have a couple of options there.

I have a date scheduled for the end of March. I have to decide if I will go ahead with it, or postpone until later in the year instead of taking out loans.

I thought I'd been pretty good at saving money, but I'm realizing that's not really true. I will be better for the next few months. I will have to be very deliberate on what I spend my money on.

I also need to talk to my job about taking time off and easing back into work. The doctor said I need to take two full weeks off to recover. I have the PTO for that, but if I can talk to my supervisors about doing some desk work for some of the second week, I think I would like to save some of the PTO. It's made quite a bit more difficult by not having a manager currently. Ours recently left and they've yet to hire a new one. Also, the head of HR is brand new, so I feel a bit strange with the whole situation.

Mostly I'm just freaking out in my head that it's actually coming so close to happening. I certainly prefer this method to the double incisions; I just don't prefer that it costs half again as much. I like knowing that the scarring will be minimal. I like knowing that I'll still have nipple sensation, as the nerves will not be severed and nothing will be grafted.

I had a hard time deciding whether or not to inform my parents of this procedure. I finally called my dad because he reads this blog anyway. Through that conversation, I realized that I don't need to tell my mom. There is almost no way for her to find out anyhow, even if she sees me. My relationship with her is pretty good lately, and I'd really hate to ruin that.