I walked backwards to my second surgery. I was terrified, and still in pain. It took 3 attempts to get an IV into a hand vein because my arms were still too swollen from the arm lift. They also put a blood pressure cuff onto my weak arm (the slowest healing and most painful of the two) which would later explain why it felt like it had been crushed anew: it had been, repeatedly, for hours.
To be fair, waking up from the second surgery was indeed easier than the first. It had to be, with only half the time spent on the table. I still woke up with chattering teeth from the hypothermia, but warmed up much faster. No nausea at all that time either. The first few hours were rather pleasant, all things considered. The strong pain killers allowed me to move my legs some without feeling hardly any pain, and I caught myself thinking, "why this might not be so bad after all." I should have known better, and in fact, I probably did, somewhere in a dark recess of my brain, conveniently ignored by the more optimistic chunk then empowered by the happy drugs. I enjoyed a few hours of relative peace, watched TV, even ate a protein bar. As the drugs wore off, the pain came.
That night in the clinic was unpleasant, but not hellish. I slept in chunks of a couple hours at a time. Getting up was something else. After just a few steps, I felt a wave of weakness hit me, my forehead got all sweaty, and the room started spinning. I'm now pretty sure those were hypoglycemia episodes. After a short rest and a glass of apple juice, I made it to the cab that would take me home.
When I rose from the hospital bed in the clinic, I saw that it was stained from my back incision, testament of a problem exacerbated by all the hours spent lying on my back. An area of the back incision had split open, and normally would have closed on its own, but the hot and humid conditions under which I permanently kept it by lying on my back made it impossible for it to heal. To air dry the area, I would have to be standing for hours, since I could not sit, and even be lying forward at an angle. I did not have the strength to do that. The doctors ended up restitching that area during one of my follow up visits. As the days go by, and I become increasingly mobile, it is slowly healing. I expect the resulting scar in that area to be the ugliest. Fortunately, a well chosen bikini bottom should cover it.
My arms still hurt, and the bad one still has fluid built up in it that is not completely reabsorbed. According to my reading, this may take several weeks. My thighs hurt a bit, especially when I sit, but it is tolerable. I have two hard pockets of fluid that are painful in the groin area. I know those will still be there when I fly back, and I dread the pain from sitting on them for hours on the planes. My breasts are tender, but the incisions are already just a thin pink line. Some of the internal stitches are dissolving from my first round of surgeries. If I run a finger lightly along the incision lines, I feel the little wires sticking out in places. Those can take a couple more weeks to completely dissolve.
The nurses keep saying my incisions look very nice, and the doctors said I heal much faster than the average patient. That is always nice to hear, but honestly, after being in pain daily for 3 weeks now, the only thing that would really cheer me up would be "henceforth, you shall feel pain no more." I suppose "you will see your precious kitty cat in two days" would do nicely as well.
I fly back to Chicago on Friday, the 21st. The trip will suck, but I know I will heal faster without the heat and humidity of Costa Rica. There's also the comfort of better accommodations, familiar foods, favorite TV shows (without the Spanish subtitles), and the kitty. When I get there, I will organize my pictures, and post them up on Facebook, and my Flickr account, for those interested. Hasta luego!
Wednesday, November 19, 2008
Thursday, November 6, 2008
Of pain and... more pain
When morning finally came, and I was allowed to return to my hotel, I was very eager to leave that hellish hospital bed. I did not shed a tear over leaving those awful compression leggings behind as well. My mom set me up in bed, and I slept most of the day, still feeling a warm, generalized sort of pain.
I was wearing a compression suit that goes from mid-thigh to the bust line. That thing is so tight, I feel like a Polish sausage about to burst when I'm in it. Imagine having to squeeze yourself into a bodysuit 4 sizes too small. It takes my mom all of her strength to make two clasps overlap long enough to lock. This suit, I have to wear 24h a day for 4-6 weeks. At this point I would like to remind you all that I am currently in Costa Rica, where it is hot and humid. Yeah. This wonderful piece of textile technology has a convenient slit between the legs to allow one to answer the calls of nature without having to step out of it. Unfortunately, the designers of the garment did not expect the wearer to have just gone through a labiaplasty. This turned out to be the biggest nightmare of my early days, until I told mom to just cut up a bigger opening. At that point, things below started improving slowly, but remained painful until day 7ish.
I also have a drain that comes out of my pubic area. The drain is a tube that runs along my scar, under my skin, all the way around me. The two ends come out of the pubic area where they meet in a Y-shaped connector which leads to a container. This is to collect all the extra blood and plasma generated by the body as a reaction to the trauma. I have been lugging this bag-o-blood with me for 9 days now. It sucks. Between that and the labia, it is not possible for me to sit upright. For 9 days I have been lying down or sitting at a 40 degree incline which means my weight rests exactly, you guessed it, on my incision line.
I was also wearing a compression bra for my new jewels. Again, the piece of clothing is not designed for someone coming out of an arm lift and the arm holes go high in the armpit, rubbing against my permanently humid incisions. Much pain came from this as well, and the arms are the reason I pushed back my second surgery. I do not want to be an invalid from top and bottom simultaneously again.
It's been a very hard week on several levels. For several months leading up to the trip, I trained very hard. 45 minutes of cardio a day at 80% of my maximum heart rate, with strength training added in the last few months, every other day, to reinforce my abs and other upper body muscles that would likely be affected. I felt healthy and strong when I got here. The day after surgery, I fainted from the effort of peeing. I had overestimated my strength or underestimated the trauma, but the result was that it turned out to be even harder physically than I had imagined. Emotionally, the ups and downs of pain gave me huge mood swings ranging from mere grumpiness to late-night despair. I think the hardest part has been the helplessness. Relying on someone else for the most basic needs. It made me think quite a bit about those who live like this for a lifetime, not just a couple of weeks. I've also seen how much work it is for someone to take care of a disabled person, and I understand how parents of such children can end up splitting up or sink into deep depression.
The adventure has been full of surprises so far. I thought the lower body lift would be my biggest source of pain. The stomach part has been virtually painless, save for a bit of straining around the belly button the first few times I tried sitting up on my own. The butt only hurts because my body weight pushes on the incision over 20 hours a day, but it is more of a soreness type of pain. The breast surgery was completely painless. The labia and the arms, which I thought were the most minor procedures, were by far my greatest source of pain.
I was scheduled to have the thigh lift done today. Yesterday, I met with Dr. Cohen, and asked if I could push it back a bit, due to still having significant pain in my arms. Ironically, the dictionary word of the day for yesterday was "footless." Omen? In any case, I am going back tomorrow, for surgery, at 10 am. It is often said that fearing the unknown is bad, because our imagination can run wild. I am now of the opinion that fearing the known can be much, much worse.
I was wearing a compression suit that goes from mid-thigh to the bust line. That thing is so tight, I feel like a Polish sausage about to burst when I'm in it. Imagine having to squeeze yourself into a bodysuit 4 sizes too small. It takes my mom all of her strength to make two clasps overlap long enough to lock. This suit, I have to wear 24h a day for 4-6 weeks. At this point I would like to remind you all that I am currently in Costa Rica, where it is hot and humid. Yeah. This wonderful piece of textile technology has a convenient slit between the legs to allow one to answer the calls of nature without having to step out of it. Unfortunately, the designers of the garment did not expect the wearer to have just gone through a labiaplasty. This turned out to be the biggest nightmare of my early days, until I told mom to just cut up a bigger opening. At that point, things below started improving slowly, but remained painful until day 7ish.
I also have a drain that comes out of my pubic area. The drain is a tube that runs along my scar, under my skin, all the way around me. The two ends come out of the pubic area where they meet in a Y-shaped connector which leads to a container. This is to collect all the extra blood and plasma generated by the body as a reaction to the trauma. I have been lugging this bag-o-blood with me for 9 days now. It sucks. Between that and the labia, it is not possible for me to sit upright. For 9 days I have been lying down or sitting at a 40 degree incline which means my weight rests exactly, you guessed it, on my incision line.
I was also wearing a compression bra for my new jewels. Again, the piece of clothing is not designed for someone coming out of an arm lift and the arm holes go high in the armpit, rubbing against my permanently humid incisions. Much pain came from this as well, and the arms are the reason I pushed back my second surgery. I do not want to be an invalid from top and bottom simultaneously again.
It's been a very hard week on several levels. For several months leading up to the trip, I trained very hard. 45 minutes of cardio a day at 80% of my maximum heart rate, with strength training added in the last few months, every other day, to reinforce my abs and other upper body muscles that would likely be affected. I felt healthy and strong when I got here. The day after surgery, I fainted from the effort of peeing. I had overestimated my strength or underestimated the trauma, but the result was that it turned out to be even harder physically than I had imagined. Emotionally, the ups and downs of pain gave me huge mood swings ranging from mere grumpiness to late-night despair. I think the hardest part has been the helplessness. Relying on someone else for the most basic needs. It made me think quite a bit about those who live like this for a lifetime, not just a couple of weeks. I've also seen how much work it is for someone to take care of a disabled person, and I understand how parents of such children can end up splitting up or sink into deep depression.
The adventure has been full of surprises so far. I thought the lower body lift would be my biggest source of pain. The stomach part has been virtually painless, save for a bit of straining around the belly button the first few times I tried sitting up on my own. The butt only hurts because my body weight pushes on the incision over 20 hours a day, but it is more of a soreness type of pain. The breast surgery was completely painless. The labia and the arms, which I thought were the most minor procedures, were by far my greatest source of pain.
I was scheduled to have the thigh lift done today. Yesterday, I met with Dr. Cohen, and asked if I could push it back a bit, due to still having significant pain in my arms. Ironically, the dictionary word of the day for yesterday was "footless." Omen? In any case, I am going back tomorrow, for surgery, at 10 am. It is often said that fearing the unknown is bad, because our imagination can run wild. I am now of the opinion that fearing the known can be much, much worse.
Wednesday, November 5, 2008
The Diving Bell and the Butterfly
I know I'm overdue for an update, but it could not have been typed any sooner, and even today is a bit of a stretch.
I would love to describe what I've seen of Costa Rica, but typing is still physically very demanding so I will save that for a later time. Forgive me for this dry, chronological account of my first few days. I promise that my usual wit and wisdom shall return as I shed the (hundreds of) stitches.
The pre-op consultation with Dr. Rashi went very well. He's a smart, charismatic man. We discussed my various procedures, and I was pleased to discover that his artistic sense of beauty seemed to naturally line up with mine. This was most important for the breast augmentation because that's where plastic surgeons get to "express themselves," for lack of a better expression. I had brought him some pictures, and we talked about size, slope shape and angle, nipple size and position. It was a bit disconcerting to be customizing my breasts, as if I were in a build-a-boob workshop, but it gave me great confidence in Dr. Rashi to see how well we got along.
Next, they drew some blood, and most people would not feel the need to mention this obvious, quite mundane step, but for those who know me well, you know it is worthy of mention in my case. I have always dreaded needles, and I knew this was only the first of many to come. The nurse seemed very competent, and I would qualify my experience as "very unpleasant," which I deem to be high praise considering the fright gauge needle was pointing to "sheer terror" as she approached me.
I know I have listed my procedures to be done in this trip in my first post, but here they are again in greater detail:
A lower body lift (LBL) which is the combination of an abdominoplasty (tummy tuck), a buttocks lift, and some liposuction on the outer thighs. The incision for this procedure is a full circle around my body, positioned to be covered by a reasonable bikini bottom (meaning thongs excluded).
A thigh lift. The incision for this one is L-shaped, starting inside the knee, running straight up to the groin, bending and following the groin line for a bit.
A breast lift with augmentation. Initially, I had decided to do only a lift but after squeezing the extra skin with my hands to predict the outcome, I feared I would be left with very little. Doing the augmentation at a later time would mean a lot more money than doing it at this stage, combining it with the lift. During a consultation with Dr. Jay Pensler in Chicago, I learned about the "next-gen" breast implants: cohesive silicon gel implants. Firmer than saline, they hold up (pun intended) better over time, and cannot leak, unlike their liquid silicon predecessors. There are some drawbacks that could turn off potential patients. Cost, for one, as they are significantly more expensive than any other kind. Shape could be another, for women who prefer the half-grapefruit breasts, as these only come in anatomically correct shapes (teardrop). Lastly, and most significantly for women only looking for an augmentation without a lift, is the incision type. Due to their more solid nature, these implants require a wider incision than others. Armpit insertion is very difficult, therefore yielding inconsistent results. Areola insertion is not possible at all. The only reliable incision type for this, is under the breast, about 5 cm wide for average implants.
These beauties are only accessible to selected patients of selected surgeons in the USA as part of an ongoing study. When I asked the Rosenstock-Lieberman clinic which implants they used, I was shocked by their response: "We have been exclusively using cohesive gel implants for years, as has most of Europe. They are only reaching the US now, but some countries have been using them for over 10 years." That is what swayed me. I would have my own pair of gummy bear implants, as they are affectionately nicknamed. Gummy bear implants in my build-a-boob workshop. How's that for humor?
Arm lift. The incision for a brachioplasty usually starts inside the elbow, and ends in the curve of the armpit.
There is one more procedure that I wanted to get done. Originally, I meant to keep this one a secret from the public. I now believe that I must disclose it for this account the be honest and accurate. I thought it would be such a meaningless little procedure in the grand scheme of things, but since I turned out to be dead wrong about that, I will talk about it here. I am talking about a labiaplasty. I am not going to describe what it is, just saying it is embarrassing enough. Go google it if you must.
The morning of surgery, Dr. Rashi took plenty of "before" pictures. He then drew some incision lines for the LBL. The plan for that surgery was to start with the LBL, and move on to the arms if all went well. He drew incision lines on my arms. Then, "just in case," as he winked at me, he drew incision lines for my breasts. One injection, and an IV insertion later, I was taken to the operation room and set up on the table. The anesthesia, which I was dreading more than anything else, was every bit as unpleasant as in my unmercifully sharp yet 26 years old memory, but blessedly short.
I woke up hours later, feeling a sort of hot, body-wide, mild pain mixed with numbness. Actually, this is not exactly true. My first memory, before being fully conscious, is certain hypothermia. I remember feeling my limbs shaking wildly and my teeth chattering loudly. I do not know at what temperature they keep surgery rooms, but I know I was freezing before I was even put to sleep, so imagine after.
Two surgeons working together for 7.5 hours of surgery yielded me a massive surprise: they had done everything but the thigh lift. This was excellent news considering that it would give me that much more time to recover before I flew back to Chicago, but you all see me coming with the downside: all-over pain. Breasts, arms, butt, stomach, and that other delicate zone. Ensued the longest night of my life.
I was not mentally prepared for such utter helplessness. From the groin up, I could only turn my head. My legs, left untouched by surgery, were encased in huge, electrically-controlled, inflatable leggings which compressed my calves periodically to maintain normal blood circulation. At that moment, I glimpsed the hell that Jean-Dominique Bauby (The Diving Bell and the Butterfly) must have lived, his healthy mind locked inside a non-responsive human shell. The pain was increasing by the hour, and despite being weak and sleepy, the discomfort of my position combined with the inability to reposition myself never allowed me to doze off for more than a few minutes at a time. I remember waking up once to find all the day staff gone, the place deserted except for an unfamiliar nurse. She greeted me: "Hola! I'm the night nurse!" My heart soared. "It must be midnight! Almost halfway til morning!" I asked what time it was. 7:30. A whole hour and a half after my mom had left. Oh. My. God.
The nurse slept in my room. I woke up and dozed off several more times until I could no longer fall asleep at all because of the pain. I told myself it must have been close to 5 am by then, and maybe I could just tough it out. 5 minutes later, the nurse woke up to check on me. I was constantly moving my legs, desperate to hang on to the shred of control I still had over my body, and the swishing noise of the leggings must have woken her up. I asked her what time it was. 11:20. I started crying, and begged her for a pain pill. She gave me one, and offered me a sleeping pill as well. The rest of the night went well, as from that point on, I was only waking up hmm, 4, 5 times per hour?
Well, it took me several hours to type this up, with frequent rests, and I'm not even to the halfway point of my story. I will have to stop here for tonight, and hope that I can finish tomorrow. Hasta luego!
I would love to describe what I've seen of Costa Rica, but typing is still physically very demanding so I will save that for a later time. Forgive me for this dry, chronological account of my first few days. I promise that my usual wit and wisdom shall return as I shed the (hundreds of) stitches.
The pre-op consultation with Dr. Rashi went very well. He's a smart, charismatic man. We discussed my various procedures, and I was pleased to discover that his artistic sense of beauty seemed to naturally line up with mine. This was most important for the breast augmentation because that's where plastic surgeons get to "express themselves," for lack of a better expression. I had brought him some pictures, and we talked about size, slope shape and angle, nipple size and position. It was a bit disconcerting to be customizing my breasts, as if I were in a build-a-boob workshop, but it gave me great confidence in Dr. Rashi to see how well we got along.
Next, they drew some blood, and most people would not feel the need to mention this obvious, quite mundane step, but for those who know me well, you know it is worthy of mention in my case. I have always dreaded needles, and I knew this was only the first of many to come. The nurse seemed very competent, and I would qualify my experience as "very unpleasant," which I deem to be high praise considering the fright gauge needle was pointing to "sheer terror" as she approached me.
I know I have listed my procedures to be done in this trip in my first post, but here they are again in greater detail:
A lower body lift (LBL) which is the combination of an abdominoplasty (tummy tuck), a buttocks lift, and some liposuction on the outer thighs. The incision for this procedure is a full circle around my body, positioned to be covered by a reasonable bikini bottom (meaning thongs excluded).
A thigh lift. The incision for this one is L-shaped, starting inside the knee, running straight up to the groin, bending and following the groin line for a bit.
A breast lift with augmentation. Initially, I had decided to do only a lift but after squeezing the extra skin with my hands to predict the outcome, I feared I would be left with very little. Doing the augmentation at a later time would mean a lot more money than doing it at this stage, combining it with the lift. During a consultation with Dr. Jay Pensler in Chicago, I learned about the "next-gen" breast implants: cohesive silicon gel implants. Firmer than saline, they hold up (pun intended) better over time, and cannot leak, unlike their liquid silicon predecessors. There are some drawbacks that could turn off potential patients. Cost, for one, as they are significantly more expensive than any other kind. Shape could be another, for women who prefer the half-grapefruit breasts, as these only come in anatomically correct shapes (teardrop). Lastly, and most significantly for women only looking for an augmentation without a lift, is the incision type. Due to their more solid nature, these implants require a wider incision than others. Armpit insertion is very difficult, therefore yielding inconsistent results. Areola insertion is not possible at all. The only reliable incision type for this, is under the breast, about 5 cm wide for average implants.
These beauties are only accessible to selected patients of selected surgeons in the USA as part of an ongoing study. When I asked the Rosenstock-Lieberman clinic which implants they used, I was shocked by their response: "We have been exclusively using cohesive gel implants for years, as has most of Europe. They are only reaching the US now, but some countries have been using them for over 10 years." That is what swayed me. I would have my own pair of gummy bear implants, as they are affectionately nicknamed. Gummy bear implants in my build-a-boob workshop. How's that for humor?
Arm lift. The incision for a brachioplasty usually starts inside the elbow, and ends in the curve of the armpit.
There is one more procedure that I wanted to get done. Originally, I meant to keep this one a secret from the public. I now believe that I must disclose it for this account the be honest and accurate. I thought it would be such a meaningless little procedure in the grand scheme of things, but since I turned out to be dead wrong about that, I will talk about it here. I am talking about a labiaplasty. I am not going to describe what it is, just saying it is embarrassing enough. Go google it if you must.
The morning of surgery, Dr. Rashi took plenty of "before" pictures. He then drew some incision lines for the LBL. The plan for that surgery was to start with the LBL, and move on to the arms if all went well. He drew incision lines on my arms. Then, "just in case," as he winked at me, he drew incision lines for my breasts. One injection, and an IV insertion later, I was taken to the operation room and set up on the table. The anesthesia, which I was dreading more than anything else, was every bit as unpleasant as in my unmercifully sharp yet 26 years old memory, but blessedly short.
I woke up hours later, feeling a sort of hot, body-wide, mild pain mixed with numbness. Actually, this is not exactly true. My first memory, before being fully conscious, is certain hypothermia. I remember feeling my limbs shaking wildly and my teeth chattering loudly. I do not know at what temperature they keep surgery rooms, but I know I was freezing before I was even put to sleep, so imagine after.
Two surgeons working together for 7.5 hours of surgery yielded me a massive surprise: they had done everything but the thigh lift. This was excellent news considering that it would give me that much more time to recover before I flew back to Chicago, but you all see me coming with the downside: all-over pain. Breasts, arms, butt, stomach, and that other delicate zone. Ensued the longest night of my life.
I was not mentally prepared for such utter helplessness. From the groin up, I could only turn my head. My legs, left untouched by surgery, were encased in huge, electrically-controlled, inflatable leggings which compressed my calves periodically to maintain normal blood circulation. At that moment, I glimpsed the hell that Jean-Dominique Bauby (The Diving Bell and the Butterfly) must have lived, his healthy mind locked inside a non-responsive human shell. The pain was increasing by the hour, and despite being weak and sleepy, the discomfort of my position combined with the inability to reposition myself never allowed me to doze off for more than a few minutes at a time. I remember waking up once to find all the day staff gone, the place deserted except for an unfamiliar nurse. She greeted me: "Hola! I'm the night nurse!" My heart soared. "It must be midnight! Almost halfway til morning!" I asked what time it was. 7:30. A whole hour and a half after my mom had left. Oh. My. God.
The nurse slept in my room. I woke up and dozed off several more times until I could no longer fall asleep at all because of the pain. I told myself it must have been close to 5 am by then, and maybe I could just tough it out. 5 minutes later, the nurse woke up to check on me. I was constantly moving my legs, desperate to hang on to the shred of control I still had over my body, and the swishing noise of the leggings must have woken her up. I asked her what time it was. 11:20. I started crying, and begged her for a pain pill. She gave me one, and offered me a sleeping pill as well. The rest of the night went well, as from that point on, I was only waking up hmm, 4, 5 times per hour?
Well, it took me several hours to type this up, with frequent rests, and I'm not even to the halfway point of my story. I will have to stop here for tonight, and hope that I can finish tomorrow. Hasta luego!
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