foxtrottangomontreal-blog

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So I spent a good chunk of today getting a chart of sorts ready for surgery. I know I’ve researched to death everything that I need to do pre/post surgery, but my caregivers have not. And I recognize that I may be a bit too sore or drugged up on painkillers to want to manage my care myself. So I found this chore chart at Dollarama and figured it could be perfect to keep track of everything. I’ve made a checklist for any vitamins or medicine that I need to keep up with, special notes for any particular day, and general guidelines on either a daily or weekly basis. Depending on how you like things organized, this may not be all that useful for everyone, but it gives me a lot of peace of mind.

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Pre-Surgery Checklist

My board game shelves are quickly becoming my stockpile for surgery supplies! One of the questions I see almost everywhere in regards to surgery (and one of the first questions I first started looking for answers for) was what do I need to buy before surgery to make sure that I’m prepared? So I’ve put together a checklist of everything that I’ve gathered up in order to make sure I don’t find myself without something I could really use.

Medical Supplies

Extra Strength Tylenol: Advil is out of the question, and I want to use the percocet that I’ve been prescribed as little as possible, so Tylenol it is!

Arnica Montana: Specifically the pellets. My nurse practitioner recommended taking five once daily starting a week before surgery and twice daily post surgery, so I picked up two tubes of 200.

Senokot-S: Something I have never not seen on someone’s surgery checklist is laxatives and stool softeners. I’ve seen that some people will take them preemptively starting the day before surgery, but my surgeon’s office recommended taking them as needed, so I’ll be going that route and see how things go.

Bio-Oil: Although I won’t need any scar treatment until after my scars have fully healed up, I wanted to make sure that I had it out of the way so I can start using it as soon as I’m able. I’ve heard great things about a lot of different scar treatment products, but Bio-Oil seems to come up on most discussion threads I’ve found, and it’s also pretty affordable, comparatively, so that’s the route I’m going for now.

Hygiene

Dry Shampoo: I’m getting dual incision surgery with nipple grafts, so showers are not going to be an easily manageable thing for a while, as I will need to keep the gauze over my nipple grafts dry. So dry shampoo it is!

Baby Wipes & Facial Cleansing Wipes: Since showering won’t be a thing for at least the first 8-10 days until the gauze over my nipple grafts is removed, baby wipes and facial cleansing wipes are the next best thing.

I’ve been told that most first aid style supplies are going to be provided for me in a bag from my surgeon’s office after surgery, so ideally anything else will be covered for my aftercare. If not, I may be sending my parents out for short trips to the drug store when we get back from surgery and I’ll be sure to mention any of that as it comes up.

Food

Chicken Broth: From what I understand, solid food is not going to be easy to eat for the first day or so, so I’ve stocked up on chicken broth. Best part about this is that when I can stomach more solid food, I can slowly add more and more chicken and pasta to the broth to make it more hearty.

Soda Crackers: Simple, bland solid food to help settle my stomach if I’m queasy post-anesthesia.

Protein Shakes: I’ll want to keep my protein intake at a decent level, so I picked up a pack of chocolate protein meal replacement shakes to hopefully last me the first week or so.

Sports Drinks: Electrolytes are great for helping keep hydration levels up, so I got a case of sports drinks to supplement my water intake post-surgery, as hydration is key!

Straws: Just in case I have trouble moving my arms up too high. Plus, who doesn’t love drinking from bendy straws.

Comfort

Extra Pillows: I’ve heard a lot of people singing the praises of those pillows with arm rests, but my nurse practitioner pointed out that having a few spare pillows around can do the same thing for a lot less. As long as you have enough pillows to keep your back propped up, you just need three more. One for under each arm, and one for your lap to rest your arms on and keep your chest protected.

Shoe Horn: Slip on shoes are great, but a long shoe horn can make them even easier. My dad gave me one that should allow me to use it without bending over at all.

Ice Packs or Cabbage Leaves: For comfort, ice packs are always a great idea. However, my nurse practitioner said that refrigerated cabbage leaves can be just as useful and a lot more flexible than ice packs when it comes to hitting all the contours of the chest.

Did I miss anything? Or is any of this less useful than I might think? Let me know!

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Choosing a Surgeon

There are a lot of factors that can help you choose the right top surgeon for you. There are tons of questions you’ll want to ask yourself. I’m listing all the ones that weighed on my decision, but that doesn’t mean that all of these questions will be important to you, or that there aren’t other questions you may need to be asking. I’ll go into a bit more detail on some of the questions I asked myself, and then list a few of the resources I used when deciding on Dr. McLean.

What surgeon(s) are located close to my home?

I wanted to make sure that the surgeon I chose was either going to be close to home allowing me to get back home easily the same day. I was willing to consider staying for several days in another city if need be, but I knew that could dramatically increase the amount of money I’d need to save up. You need to know if these are costs that you’re able to afford or willing to save for.

What surgeon(s) will take my insurance coverage (OHIP) to reduce the cost?

I had a strong preference for surgery covered by my OHIP coverage originally, though this was something I was prepared to overlook if need be. I was not happy with the aesthetic results of the only surgeon that would be fully funded. I was looking at either saving up the full cost of surgery with Dr. McLean who is located about an hour from my home, or seeing what surgeons could be partially funded by OHIP.

Thankfully, Ontario restructured their funding of transgender surgery not long after I began medically transitioning, and the only cost I have to worry about paying with Dr. McLean are the chest contouring fees.

How satisfied am I with the results from this surgeon I’ve seen?

This was the main reason I was ready to pass on getting funding with the GRS Montreal office. I was just not satisfied with any of the results I had seen and was willing to save up and wait a few more years.

How much experience do they have with the form of top surgery I’ll be getting?

Are revisions covered if I’m unhappy with the results?

Aside from figuring out what is most important to you when deciding on a surgeon, the best resource available is reading the accounts and viewing the results from other people who have had surgery with the surgeons you’re looking into.

FTM Subreddit: Lots of people who have had top surgery will post pictures of their surgery results and/or details of their experience with their surgeons. Just search the subreddit for the name of the surgeon you’re looking into and see what people are saying.

Transbucket: This site requires you to create an account, but it is incredibly worthwhile. You’ll be able to narror down results by the name of the surgeon and the type of surgery you’ll be getting.

When looking at results, also try to find a few examples of people with a body type similar to yours. This can definitely be something that effects the outcome. Also remember that just because there are no results posted, it doesn’t mean that the surgeon won’t be good or right for you. It’s just one resource that can help you make your decision.

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Pre-Op Exam

In order to make sure that I’m eligible for surgery, the McLean Clinic required that I have blood work and a physical exam with my regular clinic. As long as the blood work comes back clear (which I am assuming it will), my clinic has cleared me for surgery. Not only did I come out with normal findings, but my clinic’s nurse practitioner was also incredibly thorough and offered me tons of suggestions and advice for both surgery preparation and recovery. I was even able to clear off several of the questions I was going to ask the surgeon’s office when I have my pre-op appointment next week.

The only part of the preparation I wasn’t overly stoked about was getting a pregnancy test. Seeing that mark on my lab work form triggered a bit of dysphoria, but the lab was fantastic about it. They simply handed me the specimen cup and didn’t mention anything else about it. Not sure if it’s because they were trying to be respectful, or because they were confused about a guy in his 30s coming in for a pregnancy test, but I’ll take it.

Once I’ve spoken with my doctor next week I’m planning on putting together a complete list of everything that I’ll need to have on hand for both surgery and recovery, but I want to make sure that I’ve gotten everything that the surgeon’s office recommends first.

Is there anything else in regards to surgery preparation that people are curious about? I’m sure I’ll come up with plenty of things to cover, but if anyone reading has anything they’re particularly curious about, send me an ask to let me know! If it’s a quick question I’ll go ahead and ask it, and if it’s more in depth I’ll make sure to make a post about it.

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I spent most of my life overweight, and constantly thinking that I should be doing something about it, but giving up a couple days into any program or plan. But after T, things changed. I was able to stick with my attempts to drop the weight. I started counting calories, and not long after that, running.

I can only guess at why, but I think for the first time I realized that if I started to get results, I’d actually be happy with them. The more in shape I got, the more stereotypically masculine I would look. And I realized that’s exactly what I want. This is definitely not required for everyone. Or even desired. But for me, it made me feel good about my body for the first time in my life.

The weight loss was going well, but it wasn’t until I started working out that I found my passion for fitness. I wanted to start building muscle specifically because I had heard many times how beneficial a muscular chest can be for top surgery results. Having defined pectoral muscles can give a surgeon an easier guideline to follow for scar placement. I have no idea how much truth is in this, but at this point, I’m not working out for the surgery results, I’m working out because I love it. So although working out is not directly tied to transition, it is deeply connected to my personal transition.

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Getting my Surgery Date

I figure it makes the most sense to start this blog off by describing what the process was like for me to get my top surgery date. Of course, this is just the specific process that I went through and it may differ for other people. I am located in Ontario, Canada, so any specific regional guidelines are going to differ from province to province, or country to country.

When I first started my transition, the only way to get OHIP (Ontario Health Insurance Plan) to cover your surgery was to get approval from CAMH (Centre for Addiction and Mental Health). The process for that could take years. I got my doctor to put me on the wait list. I’m pretty sure this happened before I started taking testosterone. From my understanding, with CAMH I would be waiting about two years to hear back from them and make my initial appointment, followed by a few more appointments while they decided whether or not I was actually suffering from gender dysphoria and would finally put me in contact with a surgeon at which point I could finally book a consultation. From what I had read from other people’s accounts, this whole process would take anywhere from 2-4 years on average.

Thankfully, in March 2016 the Ontario government made some changes to streamline this process as the wait list was getting longer and longer. It was now possible for a doctor or nurse-practitioner to refer a candidate for in-country top surgery. For some reason, my clinic decided that they would be referring people only after they had been on HRT (hormone replacement therapy) for at least one year. This meant I had to wait until October 8, 2016 before they would set me up with a referral. I was aware that this went against WPATH (World Professional Association of Transgender Health) guidelines, but the idea of even trying to find another doctor who would refer me for top surgery in that time frame seemed exhausting, so I opted to wait.

In October 2016 I requested that my referral go to Dr McLean, as after comparing results I had found through numerous sources online, his were the most aesthetically satisfying to me, and his clinic is only about an hour’s drive away. I got my Confirmation of Approval very quickly. I don’t remember the exact timeline, but I believe it was no more than a couple weeks. As soon as I got the letter, I called Dr. McLean’s office to book my consultation.

At this point I want to clarify where my expectations were sitting as far as surgery goes. Earlier in 2016 I had two local friends both have consultations with Dr. McLean, and within a few months also have their surgery. I so I was anticipating a consultation date later that year and surgery some time early 2017. I knew the wait list may have grown some, but I did not anticipate my consultation being booked for April 4, 2017.

In March, with the consultation date coming up, I realized that despite working two jobs, my finances were not yet in a place where I would be able to pay for surgery, let alone cover my expenses for the several weeks of recovery time after. I started a fundraiser on YouCaring to help cover my upcoming costs.

My consultation began great. Dr. McLean was very friendly and answered any questions I had. I then sat down with someone else in the office as we discussed expenses. OHIP does not cover the male chest contouring that helps ensure an overall masculine appearance of the chest, which is very important to me. The costs for that will be $2000+tax. Otherwise, everything is OHIP funded. After that discussion, she dropped the bad news. The wait list had gotten so long, with OHIP only funding a set number of surgeries per year, so my estimated surgery timeline would be around March of 2019. Almost two years later. I was devastated. Pretty sure I didn’t speak a work on the drive home or for several hours after getting home.

The next couple months I spent assuming I was going to be waiting for years. Positive news started to slowly trickle down, however. The McLean Clinic took on a second plastic surgeon specializing in top surgery, Dr. McEvenue. I then heard from a friend that one of their friends had gotten his surgery date this year, after originally being told mid-2018. The clinic had been petitioning the government for the funding to perform more surgeries. I was becoming more optimistic, but doing my best to just not think about it to avoid disappointment.

Then, on October 20, 2017, I got a phone call from the McLean Clinic. They had gotten the approval to perform 20 more surgeries this year, and I was one of the top 20 spots of the wait list. The dates I was offered ranged from November 15 - December 21. As much as I would have loved a November date, there is just so much going on in my life that I opted for the first December date available. This would give me a bit more time to get organized and try to raise a bit more money to cover expenses. So now, after months of doing my best to avoid thinking about surgery, it is on the forefront of my mind as I get to spend the next two months getting ready for the big day.

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I’m also still saving up to pay for my surgery, so any help would be greatly appreciated. Donate if you can, share if you can’t. OHIP will cover the cost of my actul mastectomy, but the male chest contouring is not covered, so I’ll be paying $2000 out of pocket for that.

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Why Make This Blog?

Hey folks, my name is Alex and I am currently just under two months away from getting my top surgery with Dr. McEvenue at the McLean Clinic in Mississaugua. I wanted to document the lead up to my surgery for a number of reasons.

I’ve spent years researching top surgery, but haven’t found one place that holds all the information I wanted to find. So I’ll probably be writing lots of lists as far as supplies, appointments, and plans for surgery and recovery.

I also want something to keep me both focussed and distracted at the same time. I want to make sure that I don’t go into this unprepared, but I also know that if I just spend the next 8 weeks reading about it, I’ll end up feeling overly anxious and getting myself worked up when I don’t need to. Writing about the experience leading up should help me channel all my thoughts.

Finally, I used to love writing, and I haven’t given it a lot of time in years. Hoping that this will get me used to fitting writing into my schedule again.

If you have any questions about my transition, just ask!