Post Hysterectomy Healing

Wow, it seemed so easy. I went in, the surgery was finished in record time it seemed. 50 minutes! I teased my surgeon about hog tying me and throwing up her hands to stop the clock (farm/ranch humor). Anyway, it went really well and I felt pretty normal unless I tried to push something or lift more than 6 pounds, and I was told to listen to my body. That sounded like good advice. One of my incisions looked like it some bruising around it and seeped blood for a couple weeks. My doctors worried about it closing because it was slow to do so. Finally it closed up. However, the 5 week recover time was really, really, long for me and I was waiting to do a bunch of things. I do really physical activities like roofing, changing tires, digging post holes, etc. After the 5 weeks was up, I dove back into working the first day..and then I started bleeding. My doctor told me to wait some more. Apparently the 5 week thing was just a ballpark for healing. Some people need more time than that and I was one of those people. Take away points: Don't pile up a bunch of stuff to do immediately after healing from surgery and you can't speed up healing even if you want to really bad. Your body has its own schedule.

The pesky incision that wouldn't close.

Planning a hysterectomy

I had a doctor appointment the other day to meet the surgeon to as my ex put it "yank that ute". After looking at various techniques and the related recovery times, I've opted for DaVinci robotic assisted surgery and selected someone that has considerable experience with the procedure. I experienced for the first time being in women's space, without being a woman. I walked into the medical waiting room dressed in my black hoody and jeans, with my scruffy unshaved face , (because I had just gotten up), and was met with uncomfortable stares. This was a bit different than my experiences at the plastic surgeon's office where about half of the patients in the waiting room were transguys. So I take it not as many people get hysterectomies... Anyway, there was the typical "What's your name?" moment that I have learned to loath followed by the "My legal name is this..My REAL name is Hawthorne. Please call me Hawthorne". They seemed to roll with it without too much trouble. The doctor was lovely, great attitude, used the correct pronouns, bright, young, and attractive. The wait time for a surgery date will be a couple months if insurance doesn't give me any problems.

Transitioning and body hair

I am on a few different transmen lists on Facebook and I read quite a bit on the internet and I am amazed at the differences in the rates of change from person to person. Personally, I have lived a rather "hairless" 53 years. I have had very little arm, leg, or body hair. What I've seen in body hair growth, including facial hair seems miraculous to me, even when I see pictures of other transmen who have been taking testosterone for only a few months and already have a goatee. Our genetics are really what is determining what changes we see and how fast they happen and as disappointing as that may be for some transguys, this is how it works for cis-gendered men as well. we aren't special in this area. I remember watching that play out during high school when the boys who developed facial hair were the object of envy. Although I have as much butt hair as anyone could possibly want and some new hair on my legs, (along with 13 chest hairs), it's my turn to be envious of every transguy that has more facial hair than me. At 2 years on testosterone I have a little darkening and coarsening of the hair on my top lip, a few curling neck hairs, some wiry additions to my sideburns (grey unfortunately), and some patchy chin hair. There are other random beard hairs sprouting randomly on my face but they show little evidence of grouping together any time soon. Meanwhile, I shave them off because I prefer to look neat and tidy and my wife finds them poky (I have no idea how to spell poky..pokey..pokie?). So, as exciting as new facial hair is, my significant other doesn't really like it and I think that is also a something that cis-gendered guys also find out during puberty. I think I have a lot of shaving
ahead of me.

Differences between testosterone gel and injections on transition

I'm going to write a bit about my thoughts about the differences between Androgel, the topical testosterone gel, and testosterone intramuscular injections. I've used both so I have some experiences to share here. I did some research on both before using them and what I read said that there wasn't much a difference in transition speed. I was concerned about injections making my body have to deal with large amounts of "T" immediately after the shot and being on an emotional roller coaster ride while dealing with peaks and troughs of hormone levels. I was particularly wary of this because I am married to a wonderful woman who I didn't want to subject to a bunch of chaos. Anyway, I decided to go with the gel as it would provide my body with a steady, equal amount of hormone every day. I used the gel for about a year. However, physical changes were fairly slow and I was OK with that since I hadn't talked to my entire family about transitioning yet and I wanted to go about the process slowly for the reasons I already mentioned. My voice got a little deeper, (like I had a slight cold), I grew a lot of unwanted hair on my butt, and I checked my hairline for thinning (because I am vain about my hair). I grew a few hairs on my chest and chin.
After I talked to my family and got chest surgery, I got more impatient about looking more masculine. I switched to injections. At this point I have been using the intramuscular injections for 3 months. Within that period of time I've grown a lot more body hair. Before beginning transition I was virtually hairless besides some blonde arm/leg hair, and fine blonde facial hair that women normally have. I now have brown, coarser body hair in places that I never had like inner thighs, legs, and the backs of my shoulders. I also have more facial hair coming in brown on my sideburns, neck, jawline, and a "dirtstache". It's a lot of changes over a short period of time and I attribute that to the higher inputs of "T" even though it may be the same amounts averaged out over time, the shots give bursts that apparently have caused these changes to happen. Along with more body hair, my face has changed because fat goes to different places, it doesn't distribute evenly, it goes mainly to my stomach. Ugh.

It still feels like I'm wearing a binder: Physical therapy and stretching helps

It's been 7 months since my top surgery. I already talked about "cording", learned about what might cause it, and then had a couple visits with a physical therapist to deal with it. Apparently you can break the tissue under the skin, but it will often grow back. The way to make it less noticeable is to do stretching until it is loose enough under the surface to not be taut and appear raised from the underlying tissue. So, the point is, it's eventually not a big deal if you do the stretching and can no longer feel any constriction when moving your chest or arms. The stretches consist of sticking your chest out as far as you can and bringing your arms and shoulders back for 10 reps, multiple times a day. Lifting your arms up in a sweeping motion as far as you can reach, again, multiple times a day. I had complained to the physical therapist about how it still felt like I was wearing a binder (24 hours a day!), and that the top surgery was supposed to give me a break from that. I asked her how long it would be before that feeling of tightness would last and she said that the stretching should alleviate that feeling in 3-4 months. So if you do not have access to PT (physical therapy), find chest stretching exercises and DO them. That binder feeling will go away eventually. I am including a gratuitous chest pic below. It is very obvious that some of my skin was NOT tan. I'm looking forward to being able to even up my skin coloring after I am finally able to go in the sun!

Even more about scar care

It's been a little over 3 months since my top surgery. I continue to have sensation from my "phantom nipples". It's not that big of a deal though. The major thing right now is the scar tissue changes. It seems to be thickening in some places and I have some stabbing pain occasionally for what seems to be no reason whatsoever. My doctor recommended using scar strips, but also using thick lotion and massaging the scars. Those 2 suggestions seem counter productive. The lotion makes the scar strips not stick and the "massage" could be done in a lot of different ways, but I don't have very specific instructions :( Anyway, I try to switch back and forth between the 2 instructions while looking longingly at the sun that I must stay out of for another 9-10 months. Other than that, I'm still very happy with the surgery and am typing RIGHT NOW with no shirt on!

Note: 11/8/17

I talked to a physical therapist who works with people who have had mastectomies about the stabbing pain in my chest that happens sometimes. She said that it is part of the nerve damage that can happen as a result of the surgery and that the nerves have to be "retrained" how to feel. She suggested firm tapping in the area where the pain is happening to remind the nerves of REAL sensation. I've been following this advice and have had less frequent problems with pain for no reason.

Almost 2 months since top surgery, but mostly about "Cording"

I am healing well and am able to lift normal amounts of weight so doing some carpentry wasn't an issue. The skin on my chest feels a little tight, but not nearly as much as it did a month ago. I recommend doing the exercises that the doctor tells you to do and as frequently as you are supposed to do them if you don't want to be all bent inward!
However, the thing I wanted to discuss in this post is a condition called "cording". Cording is the short and easy name for Axillary Web Syndrome. The weird thing is that no one really knows how or why it happens, but it happens to about 20% of people who have mastectomies, including transgender patients and women being treated for breast cancer.  What happens is connective tissue grows in "cords" from the incision sites in the armpit or on the trunk and forms long strands of stretchy, (but not stretchy enough) "cords" that appear under the skin. They can run all the way from the armpit to the wrist or from the chest incision site to..who knows where. As soon as I heard it doesn't happen to most people I knew that it would happen to me because I'm special. Great...and it DID happen to me. I have cording in my left armpit down to my forearm and from a part of the incision on my chest. The left arm one happened first and I could feel a weird pulling sensation before I could see it under my skin. The cording on my chest happened a few weeks later and was raised under the skin and visible when I raised my arms up over my head. somewhat like in the image below. I pushed on it while it was taut under my skin and I actually felt it tear away from whatever it was adhering to. Ouch, but not incredibly painful. My wife was far more affected than I was. Anyway, I brought it to my surgeon's attention and she referred me to a physical therapist, who I start seeing next week. Since I tore mine I have no images to share but from the web there are some available:



http://www.mylymphedemalife.com/axillary-web-syndrome-aws-also-known-as-cording/


Axillary Web Syndrome
**Photo taken by Elisabeth Josenhans, Hamburg, Germany
elisabeth-josenhans@hamburg.de

1. Cording is rarely discussed as a complication by the surgeon; My surgeon didn't mention it.
2. Some forms of cording may be difficult to see and feel; If you do feel it, you probably won't know what you are experiencing.
3. Some women do not want to complain to their surgeon; (many people feel that doctors are gods)
4. There is no recognized comprehensive physical assessment of Cording; Yep
5. Cording assessment may not be a standard practice in the breast cancer clinic; and
6. There is very limited research into treatment protocols. I find much disagreement about what it is and why it happens. Treatment?  Not much.

Note: More research and conversations with specialists lead me to believe that cording originates where there are damaged lymph nodes.