Monday, May 3, 2010

The weekend report

24 hours since the last Vicodin intake, 48 hours since the one before that.

I don't know if I should really be as keen to shed Vicodin as I am - my major gripe with it isn't really any fear of long-term consequences as the mental muzziness it induces. Although I can compensate with caffeine well enough to work at a deliberate pace, driving is right out.

And my conclusion from the weekend is that it has been supporting me psychologically to some extent, as well.

On Friday night Shannon and I went shopping (bedside lamp; currently still unassembled) in the early evening. The timing was a mistake, in retrospect, since I was probably already somewhat fatigued due to the hour. We ate while out, which was a very pleasant change from the poor diet I subject myself to at home, but this triggered surprising amounts of pain from my lower left jaw, which wound up radiating back past my ear and throughout the side of my head.

That it's painful isn't particularly surprising - the bone was mauled underneath the roots of all those teeth, after all; and I'm more surprised that I don't have have the same sensation on the other side. By the same token, that also makes me worry that something is happening on one side that isn't on the other (any normal person would say "yes, one side is more numb than the other"; we hypochondriacs have a "glass is not only half empty but also liable to shatter if an opera singer comes on the radio at the wrong moment" sort of attitude).

Painkillers on returning home saved the day and a Rock Band Friday night party ensued. Life was good again.

Saturday was marked by the pain recurring at every meal. I re-read the post-op instructions, and discovered that I was supposed to be taking mega-doses of Ibuprofen (well, 1200-1600mg, anyway), not merely the maximum allowed on the bottle, and with the aid of this and Tylenol, controlled it relatively well; but I grew increasingly worried throughout the day.

Patri returned from part 1 of his Grand World Tour late that evening, with rhymes he'd composed in honour of my new face (he'd been up and travelling for 20-odd hours at that point; I'll spare you the details), and we had a collectively chirpy evening and an early night.

By midnight I was on the verge of panic.

During a dental visit in early March to replace the crown capping my old root canal (resulting of an entirely typical tale of poor discipline from my move to Sydney a decade ago), x-rays revealed that one of the channels in the tooth hadn't been filled quite to the end, and the bone underneath looked a little odd in a way that usually indicated either scarring or infection. I asked the appropriate questions; my dentist said that she could send me to an endodontist to investigate, but asymptomatic abnormalities like this are generally monitored, not treated. I asked about jaw surgery - she said the surgeon would take his own x-rays and make judgements based on that.

Since then, one of the odd things that has emerged about this entire exercise is the apparent lack of interest in assessing my internal bone structure before the surgery. I received no referrals for x-rays and there didn't appear to be any facilities for taking them at the surgery, so I'm guessing that if I hadn't had my own MRI and x-ray data to show, he would have simply inspected visually, then started cutting to see what he would find.

The procedures that I had are, I guess, not that big a deal in the end - it's external bone which is close to the skin and therefore easily seen in contour and palpitated. But the brow work that turned into such a huge debacle on the day is another matter - there's a sinus cavity behind it, and these procedures are somewhat notorious for complications. The more I think about it, the happier I am that I refused to have it done (although, at the same time, I think I agree with him that the aesthetic effect would be a net win).

For background, the procedure pioneered by the surgeon who kickstarted and wrote the book on the field of facial feminization surgery revolves around entirely exposing the forehead bone with an ear-to-ear incision and basically re-assembling the forehead like a jigsaw puzzle. The anatomy, as I understand it, involves layers of sinus membrane and bone, and there's always a risk of causing damage or scarring to the sinus membrane that can result in various problems like continuous nasal seepage.

Dr Zukowski, my doctor of choice, I selected largely based on his ability as a tool-using human, with the tools in question being endoscopic probes and burrs. His hammer is a burr that grinds bone away from the surface; therefore every forehead is a nail. Other than the surgeon I saw back in Australia (who, rumour had it, was to be the anointed successor of the surgeon above who started it all), not one of the surgeons that I spoke to here would ever refer a patient elsewhere, nor allow any possibility that their technique might not be the ideal answer for every person. Discussions on the support lists acknowledge that the practice of routinely denigrating the work of other surgeons is universal in consultations, and this is a large part of the reason for the existence of these lists - somewhere to seek somewhat less biased information.

When I insisted on showing him the images that I'd had done previously, he told me that I basically didn't have a sinus cavity, the void visible on the MRI was rather the brain cavity, and everything would be fine. I'm certainly not qualified to question his judgement - what alarmed me at the time and probably contributed to not going ahead with this is the realization that he would simply have proceeded in exactly the same way if he hadn't had any information about the configuration of my sinuses whatsoever... and there's plenty of mention on the support lists of people who have experienced perforation of the sinuses with both the original technique and burring.

But I digress.

Sometime on Saturday I connected that hypothetical bone infection in my jaw to this new-found stabbing discomfort on the side of my head, and things went downhill from there, with imagined infection spreading from the site upwards towards the brain. Around midnight, I left a despairing message for the doctor, took some more Vicodin, and went to bed wrestling with a part of my mind that was wondering if I was going to wake up in the morning.

I am a reasonably self-aware hypochondriac. I have a lot of respect for my body's own ability to look after itself, and I'm fully aware that my brain has a tendency to over-inflate the importance of vague symptoms and over-estimate the likelihood of severe consequences. Rationally, I knew that my explanation was not likely to be the most realistic one, and so although I wrestled with the decision for a long time, I didn't hit the panic button with the doctor or go to emergency. But although the Vicodin did dull the panic, it didn't stop the anxiety (in retrospect, maybe adding Valium would have helped). Having even a part of your mind worried that this may be the last time you ever close your eyes is not pleasant.

But open my eyes again I did, and sometime today (Sunday) I realized two important things. Firstly, there's a line of stitches at the bottom of the gum on both sides on my mouth that I've somehow managed not to notice until now. I've been taking care to keep these as clean and debris-free as possible today. Secondly, I realized that although the stabbing pain was on the left side of my head, the earlier dental work and potential jawbone infection are on my right.

See? Hypochondria.

Today I've been taking care to eat things that don't require much chewing but have been trying nonetheless to maximize caloric value. Did you know that there's Drumstick-flavoured ice cream? The occasional nut is totally worth it. I've been taking great care of the incisions in my mouth, and consuming the correct amounts of Ibuprofen and Tylenol. The added self-consciousness of eating in public this weekend has made me aware that muscular control of my upper lip is imperfect, and my lower lip and chin are still almost completely numb - as a consequence, fear of messy public eating has me developing a napkin-dabbing habit verging on the obsessive-compulsive.

But it's nice to just be worried about the little things again.


  1. I don't know you and this is the first blog post I've read of yours. I'm a 60 y/o trans-woman and would like to know how old you are and if the surgery, in your opinion, is worth the time, money and trouble? At my age, I'm questioning whether the surgery would measurably improve my life an/or psyche. I must tell you, your writing is interesting, informative and actually entertaining in some way. I have decided to follow your posts for some time into the future to understand how it all turns out for you. This, of course, is all selfish as I wrestle with my own decision-making.

  2. Hi Erica - this is the worst possible time to ask me (or possibly the best; I'll let you decide), since I'm in the middle of that inevitable emotional crash and alternating between feelings of betrayal at my surgeon, worry about the healing process going wrong, and fear of the end result. Ask me in a month or so (or just follow the blog) - much will depend on the quality of the outcome in the end, I expect.

  3. I know this is unrelated to the above post but since you seem to be as tall as me and I am very worried about passability... I ask if you can tell me your rib cage circumference. Itis measured just under the breasts. Thank you.