Had PPT/PPV with Dr. Heidi Wittenberg March 9th 2021

68
u/jannaw996
Sat Mar 13 23:25:15 2021 UTC
*
(56 comments)

After 1.5 years of research and planning, my bottom surgery is now complete and I'm quite happy. I wouldn't say euphoric because I still have 3+ months of healing and limited mobility ahead of me before I can live a normal life and use the new equipment, but at least all my anxiety leading up to surgery has disappeared. I think it was mostly related to fearing the last minute cancellation and delays I had with my FFS surgery.

Dr. Wittenberg was caring and accommodating. During my initial consult on the phone with her 1.5 years ago she answered all my questions thoroughly and was candid about the complication rates of her patients. During my pre-op appointment March 4th, she offered me two choices for labia minora. Her usual method is to use scrotal skin and she's found most patients lost most of the definition due to swelling. So with PPT patients she's started using penile skin which is closer in texture to cis-female labia minora and is expected to retain more definition (based on the results of Dr. Suporn's use of the technique - none of Wittenbergs patients are over 8 weeks post op with this technique). I decided to go with the new technique.

For the last 5 or so patients, Dr. Wittenberg has also changed from using packing sutchered into your thighs to using a wound VAC . This reduces suture scars and should also reduce swelling which may help retain some labia minora definition. I suspect the VAC also reduces pain since I've talked to another Wittenberg patient that said the sutures caused a lot of discomfort before packing was removed. I've found myself having almost no pain when I lay still and 1-2 out of 10 when I walk around the last couple days. I've been on only 1000mg tylenol every 8 hours and 400 mg ibuprofen every 8 hours during that time. No narcotics or other pain meds. Same pain levels in hospital though I was on hydrocodone or similar at that point. Of course, everyone's pain response is different.

Another nice benefit of PPT is less need for hair removal. I just needed 1" around base of shaft and 2.5" wide from base of scrotum to anus. They also said it wasn't critical to get the area completely clear which is great because covid shutdowns stopped me from getting removal for many months and I'm not completely clear. I'm not sure why any hair removal is required given that they don't use any external skin for internal parts. I think maybe they don't want it to grow into suture lines can create hairs growing under the skin which forms a little wound that takes awhile to heal (I had two of those in my hair after FFS).

I've found three things post op that I never read anywhere and weren't mentioned on Dr. Wittenberg's post-op instructions. One is that you must breathe in through a spirometer 3-4 times every 15 mins (while awake) trying to get an indicator up to a certain point that means your lungs are completely full. This exercises the lungs and prevents the body from having a spontaneous fever. I didn't really understand the explanation for why the fever forms but if it happens you must use the spirometer every 5 mins and call the doc if the fever doesn't go down. It only takes about 1 min to do the spiro exercise but getting interrupted every 15 mins by an alarm to do it is pretty annoying.

The second thing is that starting 3 days post-op, I have to poop every few hours and do so without putting much pressure on things. This always leads to a point where I feel like there is more in there but it won't come out without too much pressure, so it's a mess to wipe. The need to poop always seems to come on suddenly and is hard to contain so I must rush to the bathroom - not that I can really rush when collecting the wound vac and foley bag and hobbling to the toilet. Then it's an adventure of trying to balance on once cheek because sitting full on the seat hurts the sutures. The doc also suggested some people find it more comfortable to sit on the rim of the toilet but I haven't tried that yet.

The third thing is the doctor wants the area kept on ice constantly to reduce swelling. So make sure the place you stay to recover has a freezer and you bring 6 or so good quality ice trays to make ice to put in the bags provided by the hospital. I brought 3 little freezer packs but they don't last nearly long enough. We also found that higher quality ice trays that came with the air BnB I'm staying at freeze ice much faster than the cheap ones we bought - we're not sure why.

For those wondering, my insurance is Blue Shield of California PPO which is what the doctor recommends. I did the math and going for anything above Silver doesn't actually save money, but it does save you from paying one big cost at once. Basically you'll be paying your yearly out of pocket maximum (~$8000 on silver) for the surgery, unless you paid a lot for other things in the year. The platinum plan has a much lower out of pocket max but the monthly premiums will cost significantly more over the year than what you save with the lower out of pocket max.

I've been pleased with how quickly Blue Shield approved everything. I expected a fight because the PPV surgery is much more expensive than penile inversion but it was approved in just two business days! My electrolysis was approved just as quickly but I've discovered they don't keep any electrologists in network so I'm basically paying full price for it till I meet the "out of network deductible" which is separate from the "in network deductible". Even if I reach the out of network deductible limit, they still only cover 50% of each visit which is a lot less than my previous Kaiser insurance. I did eventually learn that some of their in-network dermatologists can also do electrolysis and I think I would only pay my visit co-pay to go that route. I'll find out in a few weeks.

My main complaint with Blue Shield of California is that they make it really difficult to reach someone who can help with getting transgender care covered. I sent a few emails to their customer service and always got generic responses. Then I called and the rep had no idea and neither did her manager. I asked to speak to a "case manager trained in transgender care" and they said there was no such thing even though I told them I read on reddit that there IS such a thing. They both thought I should go to dermatologists in their network for electrolysis and they'd know how to get prior auth but only one out of about 20 dermatologists I looked at were able to perform electro and they said I needed to get the prior auth myself. Finally, I learned from another trans friend I met that she worked with a case manager named Kelly Sipes. Kelly was able to help me and you can reach her by calling customer service and ask to speak to her by name. Ask for her email and if you can get that, then she told me emailing her is best to set up an appointment to talk or you can ask questions directly. Otherwise, if you get her phone number, then leave a message and leave your email for her to contact you at.

If you're outside California, I think your best bet is to keep calling customer service each day asking to speak to a case manager trained in transgender care and hopefully you'll eventually reach a rep or a manager that will know where to send you. Or maybe Kelly Sipes can help you even if you're not in CA. She also mentioned she can help people in the PPO or HMO network.

Anyway, I'll share one photo of my surgery from immediately post-op (before packing and wound vac). I think it looks pretty good though the labia majora look more swollen then I've seen in other patients. I also know that whatever it looks like now is not at all what it will look like six months from now or a year from now, so this photo isn't all that valuable. However, it does show the difference when using penile skin for labia minora and clitoral hood.

https://preview.redd.it/tujrrj8amvm61.png?width=1042&format=png&auto=webp&s=79b3a92fabbba540c65773395966e12f63726b4a

I can answer questions but please check if they were answered here first. You might also want to read an article I wrote condensing about 100 hours of research down into a plea to Kaiser Permanente to offer PPV surgery rather than penile inversion. Kaiser's surgeons were understanding but said that although Kaiser was looking into hiring someone to train in the procedure, they didn't expect it to be available for 2-3 years, so I moved to Blue Shield.

Edit: In response to a comment, the wound vac is a replacement for the bolster. Dr. Wittenberg has used the vac for the last 5 or so patients. It avoids suturing the bolster in place and should reduce swelling and pain. There is no wound vac or bolster in the picture above - they hadn't put it in place yet. I'll put a pic here of what it looks like currently with the wound vac attached. It's sort of gross but all the dark black is blood that's been dried out by the vacuuming action of the wound vac. I sent this image to the doctor and she said it was completely normal.

https://preview.redd.it/huedutqtgwm61.png?width=1280&format=png&auto=webp&s=462f5a0e05c9386d90d9ce413ac9e5a902faf3bb

The white tube heading to the right leads to the wound vac which is always lightly sucking to keep the plastic pulled tight and remove excess blood and other fluids which collect in a chamber in the vac. The orange tube is the catheter. The vac itself will alarm if it becomes clogged, senses an air leak, or becomes overfull of fluids. I was given instructions on how to fix each of those problems. For anything I can't handle, there is a person assigned to visit me and resolve things and I was given their direct number.

Edit 2: I recommend staying at whatever hotel is cheapest before the surgery. End the hotel stay 2 days post-op and have your support person move everything to either an airbnb without stairs or a hotel with fridge and microwave as well as elevator access to your room. Make sure to choose an airbnb or hotel that offers full refund if canceled 1 day ahead. Doing all this guards against having to pay the full price of the second part of your stay if surgery is postponed at the last minute. Bonus if you can find somewhere with a nice flat area to walk for 10 mins, 3 times a day. I'm stuck walking round and round a 15-foot space in our room because outside the room it's hills in every direction.

Edit 3: When they say to get maxi pads to catch blood post-op, get the smallest, thinnest ones you can, ie Always Ultra Thin Pads, no wings, size 1. I originally got the largest, thickest pads possible in case there was a lot of blood, and they're ridiculously painful to wear and don't stay in place. Even cut into a small strip they hurt too much and don't stick well enough to panties to stay in place.

Edit 3-20-21:

Here's a photo 11 days postop:

https://preview.redd.it/pqzuygc0t9o61.png?width=960&format=png&auto=webp&s=349a2d9234957a662f72bd8762f025761de5526b

Lots of swelling on labia majora but I think it's healing well? I've kept it iced as much as possible and swelling comes and goes (mostly comes). It still hurts to touch so haven't really looked inside so I hope it's healing well there as well. There's a lot of soreness during my three 10 min walks each day though it mostly fades after the first minute. I assume a lot of soreness is related to the dissolvable sutures which seem to take 2+ months to dissolve for me instead of 2 weeks. I hope they can remove some at my second post-op next week.

Dilations have been minimally painful. About 5 days post-op I felt three spots of extra burning pain that was brief but fairly sharp during my first dilation. This was possibly tearing through the webbing the body tries to put in place to close the canal. This is supposed to not happen much with peritoneal skin as opposed to penile inversion, and I've only felt it that one time so far. It's always a bit of a struggle to get the dilator in the last cm and there's a fairly constant discomfort from having it in place that mostly fades over the ten mins of having it in (some days it doesn't fade). There's always a brief burn when I pull the dilator out the first cm no matter how much lube I use. I discovered KY Jelly is superior to ID Glide (and KY Liquid) as it doesn't dry out as much which makes removal more pleasant. KY liquid seemed fine when my caretaker got it for me on week 3 until I had a dilation that took 10 mins longer than normal and then it dried out and hurt to remove the dilator and there was much more blood than usual. After the first couple days I reduced the amount of jelly I use to what I see on Dr. Wittenberg's videos and that reduced the mess to clean up afterward without causing any friction problems.

The first day after wound vac removal was by far the worst pain day of the healing process. If I moved the wrong way I could have stabbing pain that wouldn't fade for 20 mins. I eventually took oxycodone but it didn't help that much. I kept trying to find ways to sleep on my side with pillows between my knees and all I did was get pain so I eventually slept on my back. That's been true every other night as well even up to last night, though the pain of trying to side sleep is much less.

At this point I'm fairly accustomed to getting up 3-4 times a night to pee, rinsing with dilute hydrogen peroxide, walking and dilating 3 times a day, douching once, then showering. It's a time sink but not too bad pain wise. The pain I experience is more towards soreness, 1-2 / 10, instead of the burning/stabbing 5-6 / 10 of the first day. Just counting the days to my post op...

Edit 3-28-21:

When the nurse said they might remove sutures at my first post op, I think she meant if any had broken and ends were sticking out they would trim the ends. Dr. Wittenberg clarified that the sutures couldn't be removed without cutting me and risking losing structure. So I'm stuck with them... for weeks longer if the length of time it took my FFS sutures to disappear is any indication. So it absolutely sucks having a body that doesn't seem to care about stuff penetrating it (ha).

On the plus side, she said it was remarkable how little swelling I'd had and that there was no separation anywhere which was also unusual. Although she didn't look inside at all which I found surprising but also pleasing since it would have hurt. I don't know if this is thanks to the sutures remaining strong or thanks to me remaining in bed on my back and doing little more than the three ten min walks per day recommended. I also kept ice on things non stop except for possibly a few hours each night when it melted while I slept, but I refreshed it during the night when I woke to find it melted.

After the appointment, pain kept getting worse. Icing it constantly got too painful and I had to do it less and less. At the advice of the doctor I tried increasing amounts of CBD gummies but it seemed to do nothing. About 3 days ago I got a new bottle of 30:1 CBD oil and took increasing amounts sublingually over two days to see what dose would have an effect. In the last 3 hours I took 9 of the 60 doses in the bottle which is just over 70mg of CBD. Pain got significantly worse, so I quit entirely and felt better the next day than I had in the previous week. That trend continued the next few days so I'm pretty convinced CBD actually heightens pain for me. I found the same thing when I tried to use the same vape my GF uses for pain during electrolysis. It made my pain slightly less intense but the pain of each zap lasted longer so overall it felt worse. So thanks again, weird body... but do keep that in mind: CBD doesn't help everyone and may increase pain .

I'm still really sensitive to ice and have to apply it through a blanket instead of a towel or my dress like I was originally doing and it still tends to get too cold after 5-10 mins. I eventually realized that the odd jolts of pain I felt seemingly in places far away from the ice were actually caused by the ice and I just can't tell where certain nerves link to anymore down there. So any time I feel pain I must remind myself to move the ice and it often helps.

Also, I discovered an almost deflated donut pillow helps a lot when your tailbone hurts from laying on your back for 19 frigging days. Anyway, here's the latest photo:

https://preview.redd.it/ljoynkbcnwp61.png?width=720&format=png&auto=webp&s=93c251f45833efc50767b89ba41c936276404ad7

Edit 4-5-21:

The drive home was about 13 hours. I dreaded having to stop and pee in public restrooms every hour so I limited what I drank and managed to keep it down to three pit stops. Having my caretaker with me in a handicap stall made it not a bad experience.

I took an oxycodone two hours before we left and another about halfway through and was pleased to find my pain was pretty tolerable the whole way, 1-3/10. I was laying on my back on a foam bed I'd made in the trunk with the rear seats folded down and keeping ice from a cooler on my bits the whole way. As we neared home I was pretty happy thinking I'd made it back without much pain and without causing myself damage.

But as I wiped myself after peeing at home, the tp was bright red with blood for the first time since my surgery. I took a picture and there was a red line along the lower tip on the outside edge of my labia minora. It didn't hurt but it looked nasty and freaked me out. I was really sad that I'd been so careful, done everything right, and still managed to hurt myself somehow. I was afraid it wouldn't stop bleeding and afraid to make it worse by dilating.

In the end it didn't bleed much and so I dilated a couple hours later with no unusual pain. The doctor responded the next day saying it was a separation, a common thing, and that it would heal and I shouldn't stop dilating. It hasn't bled since then or caused any obvious problems. They said it may or may not form granulation tissue that needs to be treated later.

I knew intellectually I wouldn't be recovered just because I was home but emotionally it was hard to deal with. It felt like many steps backward from staying in SF. I couldn't sit in my usual chair without pain and risking worse separation so I was still stuck on my back. It took 3-4 days to set up my bed with the same computer access I'd had in SF while I worried every new pain was some new injury that would set back my healing.

I've only started feeling more positive the last day or so. My walks aren't so grueling, I'm not so tired, I can shift in bed without triggering pain that takes 5 mins to fade when I lay absolutely still. I can even lay my keyboard on my belly and get stuff done on my computer without the mental exertion making me want to sleep. I also found my bed is soft enough I don't need the donut pillow.

I still get strange pains or sensations in new places every day, and some of them worry me, but I'm trying to trust this is just how it is. The worst part right now is waking every 3 hours to pee at night, but at least I'm not so worried the frequent urination means I have a bladder infection. Today I was felt strong urges to pee hourly in small amounts until 7:30pm when I suddenly made a big pee and felt better. I think things were swollen and preventing me from releasing everything.

Progress picture:

https://preview.redd.it/rq5b4rs2zhr61.png?width=720&format=png&auto=webp&s=75b77edc2cc129b59d6029d1bf04d4aedd734987

Edit 4-13-21:

Today is exactly 5 weeks after surgery and I'm pretty sure I still see the faded yellow of the "3 week" dissolvable sutures. At least inflammation around the sutures is way down. Based on my experience with sutures in my nose, I suspect they are softening/stretching/thinning but will not completely break and fall off from where they are visible for who knows how much longer. I suspect many are also trapped beneath scabs. It was disheartening to look at a 3-week picture from another of Heidi's patients and see fresh skin where I still have scabs and sutures. I'm hoping my slow healing will at least make for better structure in the end.

Standing, walking, or just moving too much produces something closer to soreness than the sharp pain it used to, but the level of pain still varies quite a lot from day to day or hour to hour with no obvious pattern. It tends to be worse in the morning and I think it's usually better after icing but not always. I still hobble and hate walking but it seems to lessen the pain after a couple minutes, "breaking things up" as the nurse suggested. On rare occasions I can get up and walk with not much pain at all. The warmth of the shower seems to loosen things and I noticed it allowed me to temporarily stand up straight with my legs almost together a couple mornings ago.

Needing to pee continues to be a problem that comes and goes. Some days I'm up hourly, others I can go 2-3 hours. I stop drinking more than sips of water around 9:30-10pm but my record for sleeping between pees is still only 3-4 hours. The few times I've reached 4 hours have always been by waking after ~2 hours, feeling mild need to pee but managing to fall asleep again. I did learn from the doc that I can pat dry after spraying with dilute hydrogen peroxide with a reusable towel instead of TP. This avoids bits of TP sticking and getting pulled inside during dilation. I keep the towel folded so I'm touching the side with my fingers that doesn't touch my vag.

Three days ago, dilating became suddenly much tighter. The first time it happened it took 10+ mins just to get past the first inch because everywhere I pushed felt like there was no hole there.Once I finally got it deeper it felt like I was 1cm lower than where I was used to pushing it in. The next dilation felt 1cm higher again. I still don't understand it. I later realized I could shine a flashlight in and be absolutely sure I was in the right place if necessary.

At my last post op the doctor said tightening was expected around 2 months but since this happened at only 4.5 weeks, it worries me. Doc didn't seem concerned and suggested using a smaller dilator, but I'm already using the smallest orange dilator included in the kit they gave me. I ordered the smaller purple one (which is also the smallest they sell) but have to continue with the orange until it gets here. So every dilation is a 45 min struggle to reach full depth with me using more pressure than I'd really like to have to use. I really hope the tightness doesn't continue to worsen.

Doc said I could stop icing constantly at 4 weeks but I continue to use it regularly because it helps control pain. It's really hard to find a balance that doesn't make things too cold and cause cold-based pain, however.

Swelling doesn't look obviously different the last couple weeks but I did notice the skin of the labia majora is getting a bit more elastic. Originally I noticed it behaved almost like a gel around the dilator but now it's stretching more naturally. It still doesn't want to naturally separate and show the labia minora and pulling it apart hurts a bit so I don't.

Progress pic:

https://preview.redd.it/v2appz7lr1t61.png?width=720&format=png&auto=webp&s=9d68464cdf6bd8f40f29f15e4a7066263054ccfb

Edit 4-20-21:

Exactly 6 weeks post op. Waking up to pee at night is still the worst part. The times I can sleep for 2.5-3 hours are getting more common, at least. My fatigue seems to be less in general and I have the motivation and focus to work a little more (remotely). Pain is significantly improved and hasn't prevented me from sleeping or been a nagging distraction too much. Usually it's more of a burning soreness at worst, though I occasionally have sharper random jabs.

I'm able to walk slowly with an almost normal gait, but slow, and it always burns to various levels. I'm more flexible and have been surprised at the positions I was able to take in order to reach stuff. However, I think being in weird positions may have resulted in more pain over the next day or so, and I had one more case of bleeding a bit.

I discovered "U by Kotex Barely There Liners" and have found them to be much more comfortable than the Always Ultrathin pads. Basically, panty liners are a thinner version of maxi pads and so they tend to flex more easily and be less irritating. They're also much more narrow which helps keep legs closer together without rubbing painfully. I still must pull my panties down a bit when I walk so the pad isn't directly rubbing my groin, but the liners are much more comfortable in bed. They're also short front to back and so I use two in a row to cover everything. They have a long version I haven't tried but it's only 1.5" longer so I don't think it will be enough.

Being very thin, panty liners won't absorb enough for the first couple weeks of healing, at least for me. Even now I'm still oozing significant brown scab forming gunk and I'm pretty sure that's because the sutures keep irritating things. The panty liners still sometimes stick to the long suture lines near my thighs but they seem to stick less often than the pads did. Unsticking them always causes pain but not as much as it used to.

Everything hurts a lot less to touch and I'm growing more interested to spread the inner labia and see what my clit looks like... But it will probably be a mess of healing gunk so I still haven't gotten the courage to look. I'm finding myself to be very sensitive to looking at gore or surgical stuff in the dramas I've watched since my surgery. I feel really empathic to anyone who's injured or healing. I also want to smack the writers when someone is able to walk normally on a leg after getting shot in the leg the day before.

I've managed to keep using the orange dilator. It hasn't really gotten any harder or easier to reach max depth in the last week. I hate wasting 45-60 mins to finish a "10 minute" dilation but I'm a bit paranoid that if it suddenly tightens further and I've already reduced to the purple dilator I won't have anything smaller to use. The doctor says 1cm of depth is usually lost but by my second or third dilation of the day I usually reach what I think is the same point as immediately post op. I usually can't get there on the first dilation, however.

I spread my legs a little farther than usual for this update photo and managed to get the labia minora to show a bit. I'm glad to see they're still there:

https://preview.redd.it/7kyr3cw0idu61.png?width=720&format=png&auto=webp&s=2890a415d94a795a7f6e33ec8edfb4d9f3b1850a

I also see some fresh skin instead of scabs or sutures which must mean at least some of the sutures have fallen off, so that's good.

Someone in comments asked about my abdominal incisions. They continue to be almost entirely pain free. There's only some discomfort if I push on them and I can feel the area is harder than the area around the incision. I've kept them covered in "AWD Medical Silicone Tape" which remains stuck for around 2 weeks before the edges start peeling enough I feel the tape should be replaced. I replaced the tape today:

https://preview.redd.it/pac3hnzsidu61.png?width=1280&format=png&auto=webp&s=eb7bb3d97ba5b80f94d2eed93e6cfbf5d35baefb

Here's each incision with the tape off:

https://preview.redd.it/qwgn1cqxidu61.png?width=1280&format=png&auto=webp&s=cbf8b369d9d1a78019a199fcdabf5227295a16d4

https://preview.redd.it/hj1okfazidu61.png?width=1280&format=png&auto=webp&s=397d9c20128bb57a847ccdf4898cc46e04cd22f8

https://preview.redd.it/cew972o0jdu61.png?width=1280&format=png&auto=webp&s=31985b52245eb063d3bd7991f9bac24cdfc3a67b

https://preview.redd.it/v2p6b652jdu61.png?width=720&format=png&auto=webp&s=b29c4f8336380f61d6551f00ba0d5f29513d9702

And the belly button incision:

https://preview.redd.it/z1vbjyt4jdu61.png?width=1280&format=png&auto=webp&s=8778766d2f8de335a391068867f2d5f7e515eb80

The belly button looks most healed. It never had silicone tape on it since it's not flat enough. Instead, I put on aquaphor every few days and kept it covered with a bandaid. The last week or so I left it uncovered. I suspect the other incisions would be less scabby if I left them uncovered but I've read scientific studies about how silicone sheets reduce scarring so I'd rather let them heal slower and hopefully be less visible in the long run. The basic theory is that silicone prevents the wound from getting stretched as much and it's the wound stretching that tends to create bigger scars.

Note that the AWS medical silicone tape is not specifically advertised as a scar reduction tool. The products advertised for scar reduction tend to be much more expensive and I suspect they're just marking them up as most cosmetic products are marked up. Reviews of AWS tape show people have used it to reduce scars so I'm hoping I can trust those experiences. I also wanted the tape because it can be cut into long enough strips to cover the sutures along my groin but I've been waiting till it heals significantly before I try using it there.

Edit: I tried taping one of the suture lines but after I shifted positions it wouldn't stop hurting so I took the tape off. Apparently it puts extra strain on the area as I move, probably especially where the tape ends, and I don't want to risk tearing something. I'll try again once it's healed more.

Edit 4-27-21:

7 weeks after surgery. I'm going to post an update each week, on Tue if possible. Progress photo first:

https://preview.redd.it/p2aj0y53csv61.png?width=1215&format=png&auto=webp&s=95c63b3f0344482e4f31ef2eb152df8036b01850

I continue to gain flexibility. I can now reach my toenails to trim them but it's a strain. Pain continues to improve and I can usually snuggle my SO without wincing every time they move which is really nice. I can also wash things in the shower without much wincing but pushing or spreading still hurts. There is still always some level of pain while walking and it feels like I'm wearing a pad against my groin when I'm not. Sitting hurts and so does closing my legs completely. I'm still miserable and tired from needing to pee every 1-2 hours at least 2 out of every 3 nights, and I can't figure out why I can hold it for 3-4 hours on 1 out of 3 nights.

Dilation has not gotten any easier or harder. Deeper "sore" pain has increased while shallower sharp pain has decreased. I finally realized that spreading my legs wider actually makes it much harder to insert past the first inch, so closing my legs more has made things easier to start. Unfortunately, nothing I've tried makes getting in the last 1-2 inches easier so I always spend 15-30 mins on that. It helps a bit to move it out and in to coax the lube a little deeper. Sometimes twisting or switching which hand I use to push helps but it's not too consistent.

I made my first trip out of the house for a vaccination shot a few days ago. The drive hurt more than my trip from San Francisco at first but after taking an oxycodone and keeping ice on, the drive back was about the same as the SF trip. I was standing in line at least 30 mins without major pain. There was no bleeding but I felt more sore than usual the next day.

I asked the doc about this white triangle at the top middle of the picture below and they said it was a "staple" that would either be absorbed or "spit out". It felt fairly hard and well stuck, yet the next day it was folded over and the day after it fell out, all without obvious pain or bleeding:

https://preview.redd.it/aztngq8lrrv61.png?width=2035&format=png&auto=webp&s=1b1743367edfe37ff18701117aa1a2a769dceb02

I also complained about the sutures you can see at the bottom of the pic. I assumed they were supposed to dissolve in 3 weeks yet they look strong. So I researched sutures and learned the most common ones dissolve by "hydrolysis", meaning water dissolves them. This says they tend to dissolve beneath the skin surface and remain intact above the surface. It said it's best to pull them out once they became loose, and Dr. Wittenberg also said we could gently tug out loose stitches. I couldn't see well enough with a mirror so I got a closeup USB camera and tweezers dipped in alcohol. It didn't budge with light tugging but it didn't hurt, either.

It was surprisingly hard to aim the tweezers and hold the camera so I gave up tugging additional sutures and am glad I did because the next day the doctor said the sutures in the photo won't dissolve for 3-4 months!

I used the same camera to look closely along the labia majora scar and found only one possible suture. Some may still be hiding under scabs but I suspect most have fallen out. I can touch the scar line without much pain so I think the sutures are reasonably close to being dissolved. I don't know why the scabs never fall off, however. I also don't know what is causing the big scabs to the left and right of the clit hood:

https://preview.redd.it/aagsi8z2wrv61.png?width=1325&format=png&auto=webp&s=acce4903e9f11414dae25778e120abda10005295

They look almost like liquid so I tried cleaning one off with a saline-soaked q-tip and gentle rubbing barely stained the q-tip and would not budge the brown stuff. Similar brown stuff radiates in small spots around the hood as if it were spattered and I managed to pick some of that off from where it had clung to a hair. It reminds me of tree sap and the skin beneath was undamaged. I asked the doctor about it and they said it was normal but didn't explain further.

There's also some white yeasty stuff beneath the brown where the skin is usually folded together but I could barely get any of it off with the q-tip. I hope it doesn't cause issues. I tried spreading the labia minora with my dilator to see if I could see my clit with the camera but couldn't see deep enough and spreading wider would have hurt.

I found this thread where a few people say how they felt 6 weeks post op. Of the 7 meaningful responses, 1 sounds worse than me, 2 sound better, and 4 sound similar or unclear. So maybe my healing process isn't as below average as I thought. Nevertheless, I did some research and found this describing what affects the rate of healing. Being middle aged works against me but it says I can supplement my diet with the following (items with * are most important):

  • Oxygen*
  • Amino acids (especially methionine, lysine, proline and arginine)
  • Vitamin A*
  • Vitamin B*
  • Vitamin B2
  • Vitamin B6
  • Vitamin C
  • Carbohydrates
  • Vitamin D
  • Zinc*
  • Vitamin K
  • Iron, copper, manganese

My mood has improved and I hope I'm past the worst of the healing process. I worry most about the parts I can't see inside, about infection, and about dilation getting more difficult or more painful. I'm grateful I never had major complications like the painful separation described in this thread . I actually had anxiety over their pain for a couple days but I was relieved when they found a working treatment using saline to clean it and possibly Aquaphor to protect it.

EDIT: I forgot to mention that a few days ago I noticed that after showering, if I sit on the toilet a significant amount of water drips out even after patting dry. I'm not sure if this was always true or is due to a recent change in anatomy but in the interests of keeping as dry as possible, I now sit on the toilet for a minute after each shower.

Edit 5-4-21:

I exceeded the max post length so will continue in a new post.

[ On to part 2 ]

all 56 comments



8
u/[deleted]
Sun Mar 14 01:09:10 2021 UTC
(9 children)

I have her next month and all of this sounds great! I’m glad she started using penile skin and had actually talked to her about it during consult. I haven’t done much hair removal but she said it actually wasn’t a requirement anymore just a recommendation

3
Sun Mar 14 01:16:39 2021 UTC
(5 children)

Ayy I have her next month too! And i'm so glad she doesn't require it anymore, I got a few sessions into hair removal and gave up :x

1
OP
Sun Mar 14 01:28:33 2021 UTC
(4 children)

She doesn't require it for PPV (Peritoneal Pull-through vaginoplasty) where peritoneal skin from inside your body forms the vaginal canal. But if you're doing penile inversion, then very thorough and complete hair removal is still required.

4
Sun Mar 14 01:48:48 2021 UTC
(0 children)

I'm aware, I'm getting ppt done

3
Sun Mar 14 09:45:34 2021 UTC
(1 child)

PPT for Peritoneal Pull-Through vaginoplasty, PPV is Penile-Preserving Vaginoplasty, which is another option she also offers that preserves the penis, but is not what you had done.

4
OP
Sun Mar 14 16:22:47 2021 UTC
(0 children)

Are these terms officially defined somewhere or just a reddit convention? I've seen PPT used a lot around Reddit but I find it quite awkward as it literally stands for "Peritoneal Pull-Through [nothing]". When I say PPV, I mean Peritoneal Pull-through Vaginoplasty. But I can see the problem with that conflicting with Penile Preservation Vaginoplasty. Maybe PPTV is a better term.

1
Sun Mar 14 05:47:06 2021 UTC
(0 children)

I’m just excited to not have to have a bolster thing it looked excruciating

2
Sun Mar 14 04:02:47 2021 UTC
(1 child)

Fancy seeing you here hehehe

2
Sun Mar 14 05:41:31 2021 UTC
(0 children)

Heauxes 4 lyf

5
u/Objective-Database
Sun Mar 14 04:39:57 2021 UTC
(4 children)

Hi, I have a couple of questions: How has your recovery been so far? What made you choose Dr. Wittenberg over other doctors? Do you recommend Dr. Wittenberg? What made you choose the peritoneal technique over the penile skin inversion technique? How are you getting the stay in San Francisco? How is Dr. Wittenberg's aftercare going? and by the way many congratulations on the surgery.

6
OP
Sun Mar 14 05:24:10 2021 UTC
*
(3 children)

Pain has been way better than I feared. I never got above a 2 out of 10. There is extra pain with PPV caused by carbon dioxide used to inflate the belly so they can see things internally, and a lot of ladies say that gas is the most painful aspect of the surgery. For me, it only caused pain occasionally for 5-10 second intervals while I felt the gas shift around. I read a study saying almost all the gas is absorbed by the body within 48 hours so after that you're home free.

They gave me an amazing huge corner room at Saint Francis Memorial Hospital with beautiful views out three windows. They said they like to give trans patients the corner rooms because it's such a happy time in their lives. Nurses were checking on me almost too often (I couldn't sleep more than two hours without a nurse waking me) and they responded to the call button in 5 mins or less 95% of the time. My longest wait was about 10 mins. All the nurses were friendly.

I mainly chose Dr. Wittenberg because she's the only doctor in America who offers true-PPV as a non-revision and doesn't require unusual insurance. At least when I looked into it in late 2019. Things may have changed since then (I expect Dr. Ting and related surgeons in NY may offer true PPV at this point), but she's also located in my home state and it's nice to not have to travel across country or out of country. She also doesn't have a crazy long waitlist.

My only other option was PriyaMed in India and I crossed them off my list when they repeatedly claimed none of their patients had had any complications except those who hadn't followed instructions. I talked to at least two patients with complications unrelated to not following instructions. PriyaMed's procedure is at least twice as long as Dr. Wittenberg's and that makes it less safe.

I do recommend Dr. Wittenberg, though I can't say that I did much comparison between her and other doctors because finding a doc who would do PPV was my primary goal. When I spoke with Dr. Wittenberg Nov 2019 she said she'd done 256 surgeries, 12 of them being PPV, so she definitely has a lot of experience and is a solid choice. I'm sure the number of PPVs she's done has at least doubled by now. I really appreciated the way she spoke and explained everything, doing her best to answer all my questions completely and not making me feel rushed. She also had lots of detailed info to share.

As for why I prefer PPV, the article I wrote details the advantages I believe it has. It's not the right choice for everyone, but I really wanted the self lubrication and the internal surface that's as close to cis-female as possible.

Dr. Wittenberg requires patients to stay in San Francisco within 5 miles of the hospital for 4 weeks total. About 6 days of that are before surgery.

I think her aftercare is great. The usual hospital stay is 3 nights but with covid on the loose she allows patients to leave after 2 nights if they're doing well. I decided to leave after 2 nights and was driven to my air bnb laying on my back in a bed I'd constructed in the back of my car. That worked out quite well and was much nicer than sitting.

They give you access to a phone app to ask questions which get sent to Dr. Wittenberg and all her staff and generally get a response within 10 mins, even on weekends, but not usually when people are sleeping. I also have a phone number to call if there's an emergency.

The pre-op and post-op instructions were thorough except for the three things I mentioned in my original post that caught me by surprise. But they did go over those things either in my pre-op appointment or in the recovery room, so it's not a big deal they were left out of the official instructions. I haven't noticed that they missed anything important and that's more than I can say for my FFS experience with Kaiser. In that case, nobody told me to keep my glasses off my nose till I asked about it a few days after surgery, and nobody told me to keep sunscreen on my tracheal scar until a month later. Nobody told me to remove the bandages from my head before I came in to my post-op appointment looking like a mummy. And there was no system to quickly reach the doctor or staff outside business hours.

Thu Mar 18 10:44:10 2021 UTC
*
(1 child)

[deleted]

2
OP
Fri Mar 19 00:21:09 2021 UTC
*
(0 children)

You're welcome. I'm glad that all the hours I spent researching can benefit others. I actually found a number of papers that Dr. Wittenberg wasn't aware of so maybe it's made her less hesitant to offer the surgery to future patients.

Thank you for the video. I've seen still image comparisons but I hadn't seen video comparisons of the different skin types.

I think the next big breakthrough might be using Tilapia skin instead of peritoneal skin so the abdominal incisions and laparoscopic robot wouldn't be required but I was afraid it would be too bleeding edge for insurance to cover or for the doctor to try. In hindsight maybe I should have at least asked about it. Based on a small study you get about the same result as with peritoneal flesh. I also found this study . I haven't looked into it again since late 2019.

3
u/MissInterpreted22
Tue Apr 27 22:25:55 2021 UTC
(0 children)

Again, thank you for this. It’s making me jealous of your recovery but at the same time, it’s making me happy that there’s someone out there who’s healing and starting to regain their normal life. As for me, the pain has improved but no sign of the wound dehiscence being healed. It’s made me more spiritual though. I hope my post which you linked here will help others to learn and be prepared on what is unknown out there. Hoping for your full recovery my Reddit friend. Thank you for keeping us posted.

2
u/ledaria171
Sun Mar 14 00:11:54 2021 UTC
(2 children)

How were u able to reach Kelly sipes, I tried some time ago and was never able to reach her through her number.

Eventually just called customer service to find out i didn't need pre authorization for consultation for ffs 😅

3
OP
Sun Mar 14 01:16:10 2021 UTC
(1 child)

I called her twice and left one or two emails. She responded through email a few days later. Her response time since then has been highly variable and some of my messages get ignored so just keep trying. I guess she's overworked and one time she said she'd been sick for a week or so and out of the office. She does seem like she cares, so keep trying.

1
Sun Mar 14 04:28:42 2021 UTC
(0 children)

Ah email, I didn't have her email only her number

I don't need her atm, but I might later this year if my ffs gets held up

I may have been calling her when she was sick😅

My therapist was the one who told me about her, she works with a lot of her clients.

2
u/[deleted]
Tue Mar 16 01:54:32 2021 UTC
(5 children)

This is one of the best American results (if not the best) I have ever seen. Especially for 2 days post op. Congrats!

1
OP
Wed Mar 17 03:20:19 2021 UTC
(4 children)

The picture I posted is actually immediately post op, not 2 days. However, it still looks similar as of today (7 days) though there is more swelling. I wouldn't count on it looking anything like this six months from now. I've seen so many cases where time and swelling obliterates the labia minora almost entirely. I'm not sure what factors help prevent that. The doctor thinks using penile skin instead of scrotal skin for labia minora will help but we need to wait months to learn if that's true.

2
Sun Jun 20 01:12:17 2021 UTC
(3 children)

apparently the fatty tissue dies off, according to my surgeon. because they expect that, they leave as much of the fat in the labial tissue as possible as, if too much survives, it can easily be removed, but it's very hard to put the fatty tissue back in once what was originally there has died off.

1
OP
Sun Jun 20 20:59:21 2021 UTC
(2 children)

Are you talking about leaving fatty tissue in labia majora or minora or both?

Unfortunately, the line between majora and minora is getting pretty subtle after 15 weeks. I don't know what else surgeons can do to make it hold the shape better... maybe 6-12 month sutures? But that would make healing time really ridiculous.

2
Sun Jun 20 21:07:51 2021 UTC
(1 child)

both. apparently the definition is easier to preserve when there's more fat there to start with as more is likely to survive. they may be able to do a revision to lipo some fat from elsewhere to restore the definition but a lot of that is apparently going to die as well. they didn't give me a clear explanation of why this happens but from what I've been able to piece together, graft vasculature doesn't perfectly reconnect at the transplanted location so some of the tissue is starved. eventually, new vasculature grows in but the fat stores never really recover.

1
OP
Tue Jun 22 02:07:16 2021 UTC
(0 children)

Yeah, I've researched fat transfer breast augmentation and a good percentage of the injected fat doesn't survive because it doesn't get blood supply. One study of 82 patients showed 82% +/- 18% fat survival using the right techniques but of course it's not quite the same as bottom surgery which is a lot more traumatic to the tissue.

I still feel like the problem isn't so much a loss of fat but a loss of depth of the valleys that bound labia majora and minora. There was basically a week over the course of which those valleys suddenly got very shallow and I think it's when sutures/staples/whatever let go and stopped pulling them deep. At this point I'll just be happy if the valleys don't disappear entirely.

2
u/riahsimone
Sun Mar 21 21:51:48 2021 UTC
(2 children)

What kind of waitlist did she have?

1
OP
Sun Mar 21 22:12:28 2021 UTC
*
(0 children)

I scheduled my surgery Nov 2019 and at that time she was scheduling people about 3 months after they completed hair removal. I had to schedule mine for March 2021 because I couldn't change health insurance to Blue Shield in 2020 (I had FFS through Kaiser already scheduled for Feb 2020). I couldn't do Jan or Feb 2021 because they want about 2 months of buffer to get prior auth for the procedure. Ironically, my prior auth was completed around Jan 9th.

Now that Dr. Wittenberg is becoming better known as one of the few American doctors who offers PPTV as a non-revision, her waitlist could be longer, so I would contact them through mozaiccare.net and ask. There were also a lot of surgeries postponed due to covid so the wait time may be longer due to that as well. She's also trained Dr. Adam Bonnington over the last year to do the procedure (at least penile inversion, I'm not sure about PPTV) and they recently said he has a minimal waitlist.

1
Fri May 7 07:10:09 2021 UTC
(0 children)

I'll be getting PPTV with Dr. Wittenburg this July and her waitlist is now about a year. However, her associate Dr. Adam Bonnington, who she trained, also does PPTV and his waitlist is about 6 months.

2
u/MissInterpreted22
Thu Apr 22 02:24:00 2021 UTC
(1 child)

Thank you for keeping this post up to date. I regularly check this post as I am 15 days post op with Wittenberg, PPV, too. I am having difficulty with my recovery. I have a terrible wound dehiscence and I’m in terrible pain. I use your experience as reference. You have no idea how helpful you are. Thank you so much and hoping for your speedy recovery.

1
OP
Thu Apr 22 03:20:34 2021 UTC
*
(0 children)

Erf, I'm so sorry to hear that. I physically winced. Terrible pain was my biggest fear going into this but I can't say I ever had anything above a 4 or 5 out of 10 for short periods. What's ground me down has been the length of time I've had lesser pain that keeps me from doing anything normally or getting good sleep. Sometimes I think I'm a big baby to be down about it because I know some others go through so much worse.

Everyone has such different reactions and healing experiences. I think I'm healing slower than average but I'm not sure of that. The only other account I've found with frequent updates is at https://mygenderconfirmation.wordpress.com/blog-2/ and they definitely healed faster. At 40 days they talk of vacuuming and walking normally around the grocery store while I'm still hobbling to the bathroom at 44 days and worrying about my trip to get a covid vaccine shot tomorrow. I can't imagine pushing a vacuum. I really do blame the slow dissolving of the sutures. The blogger also said the doctor was surprised how quickly they healed so you can probably use them as a best case scenario while I'm closer to a worst case.

Earlier today I gently picked at a bit of white I kept thinking was stuck TP but which never washed off in the shower. Turns out it seems to be some medical mesh substance. No surprise, it's not dissolved yet... but picking at it only hurt slightly and there was no blood and the pain went away a few mins later. This gives me the sense that I'm healed enough that it would take some significant accident or willful disregard of pain warnings to do significant damage to the healing process at this point.

I've heard at AA they say take it one day at a time. Focus on getting through that day rather than thinking about how long it might be till things are some level of normal. So I try to do that. And I hope you'll heal faster than me in the end. Don't be afraid to use the extra strength pain killers if you need to, especially if they help you sleep.

Edit: My trip to get the shot ended up feeling more painful than my trip from San Francisco. Probably because I thought I could go without oxycodone and I wasn't using ice at first. Once I added those things it got better on the way back. I had to stand in line for 30+ mins which wasn't as bad as I expected, maybe 1-2/10. They even gave me a place to lay down after the shot for the 15 minute observation. But the first time I got up after resting at home for awhile, I definitely feel more sore then I have the last few days. At least there's no blood so I think things are mostly ok.

2
u/becoming-sky
Tue Jun 22 04:39:20 2021 UTC
(5 children)

Holy crap girl. Thank you for the detailed review. I have Kaiser Permanente Mid Atlantic States and I have my consult for PPTV with Dr. Geolani Dy coming up. So I did want to mention that they have hired someone. I haven’t read your file (yet) but I’m glad you were eventually heard

1
OP
Tue Jun 22 20:11:54 2021 UTC
(4 children)

Oh? That's great news! Could you ask them when/if they will be offering the same service to California Kaiser patients? I know people around here that would be very interested.

2
Tue Jun 22 20:14:27 2021 UTC
(3 children)

It’s with OHSU out of Portland, Oregon. I thought that’s what Kaiser uses for everyone? I mean I’m certainly not close! Same place where Dr. Dugi is. In fact, Dr. Dugi assists Dr. Dy in this procedure

1
OP
Tue Jun 22 22:02:45 2021 UTC
*
(2 children)

Maybe everyone in Kaiser mid Atlantic uses that facility but in southern California they send patients to a different team of surgeons in a Kaiser Los Angeles facility. The team was started in 2017 and consists of Melissa Poh for plastic surgery while Polina Reyblat and Amanda Chi trade off for reconstructive urology. They were looking to hire someone to trade off with Dr. Poh last I heard in late 2019. They were also looking to train someone for PPTV but it wasn't expected to be done for 2-3 years. I think they also have a different team for Kaiser northern California that was started earlier than the Los Angeles team so socal patients were sent up there before 2017. California has had its own laws guaranteeing trans care for much longer than Obamacare so I'm guessing we do a lot more surgeries than most other states.

Anyway, thanks for the info!

2
Tue Jun 22 22:04:18 2021 UTC
(1 child)

Oh ok. I can ask my case manager next time I talk to her

1
Wed Jun 30 16:15:31 2021 UTC
(0 children)

So ya apparently Kaiser operates almost completely independently from the other regions. So just because MAS works with Pacific Northwest doesn’t mean others can see them from other regions (e.g. California). I’m sorry about the bad news

0
u/MissInterpreted22
Sun Mar 14 00:38:16 2021 UTC
*
(1 child)

Thank you for posting this and I hope you recover well.

I read from other girls that a bolster is used with Dr. Wittenberg’s work. What is it and where is it on your picture? And what is a wound vac? Thank you for your post again

Edit: I clicked the wound vac link and read about it. Is this in replacement to the bolster? Thanks

1
OP
Sun Mar 14 01:54:22 2021 UTC
(0 children)

I replied to your question by editing the original post because it wouldn't let me include a picture in this comment.

1
u/MotorSuccotash1825
Sun Mar 14 03:05:13 2021 UTC
(1 child)

I had the wound vacuum when I had my SRS in 2017.....that thing is from the devil! It hurt like hell I’m still scarred

3
OP
Sun Mar 14 03:18:49 2021 UTC
*
(0 children)

I'm sorry to hear that. Maybe the technology has improved or maybe I'm just lucky but my pain level is zero most of the time. I only get pain around 1-2 when I move significantly or walk. I'm only on tylenol/ibuprofen and gabapentin.

For those with upcoming surgeries, you can ask Dr. Wittenberg if other patients have complained of extra pain caused by the wound vac and decide if you want to use it or go with the traditional sutured bolster approach. She didn't mention to me that previous patients had complained of vac pain and I think she would have if it were a common thing.

One of the ladies I talked to who went with Wittenberg mentioned the traditional bolster added significant pain and awkwardness while walking. The doctor said it was safe to close my legs completely with the wound vac though I generally don't because it hurts to do so.

1
u/52jag
Sun Mar 14 06:14:10 2021 UTC
(0 children)

Looks good, particular the hood. Congrats👍

1
u/Androgynoplasty
Sun Mar 14 09:43:33 2021 UTC
(0 children)

Congratulations! I hope your recovery continues to go well!

1
u/voltrontestpilot
Mon Mar 15 13:29:47 2021 UTC
(4 children)

I wish she worked with Tricare. She was one of my top choices.

If I went out of pocket, would you mind saying what the bill came out to? I feel like I'm never going to finish this long process 🙁

3
OP
Mon Mar 15 14:40:25 2021 UTC
*
(3 children)

I'm happy to share that but I don't expect to see my official bills until I return home in April. In late 2019, the doctor said that the surgery itself was about $60k but adding the laparoscopic robot pushed it up to $200-$240k. I saw someone else comment recently that the total cost was now $130k. If so, then the robot rental cost might have come down but it's still out of range of most people to pay out of pocket.

While I can't recommend PriyaMed in India, their total out of pocket cost was $16k last I checked so that might be your best bet. I also mention a few other doctors you can look into in the article I wrote (see main post).

EDIT 3-29-21: The total bills before insurance paid them are $175k. $30k of that was Dr. Wittenberg, the rest was hospital/facility. I'll update if I see any additional bills.

EDIT 4-6-21: I received two bills in the mail asking for $34.43 from a third party wound vac rental and $268.40 for Anesthesiologists medical group of San Francisco. I'm not sure why the later was separate from the itemized hospital facility fees. Without insurance, these would have added $1100 and $2300.

EDIT 4-23-21: I received a $384 bill from Paragon Diagnostics of San Francisco for a tissue exam on the date of my surgery. The bill looked like they hadn't billed anything to my insurance so I called them and learned they didn't have my insurance info. I provided it and they said to disregard the bill and wait to see if there was a co-pay. EDIT 6-21-21: Got their revised bill of $123 after they billed insurance. The Blue Shield claim says they're out of network so Blue didn't pay anything but I guess the provider gave me their insurance discounted rate or something. It's really obnoxious so many of these claims are ruled as out of network when they're all part of a service from an in-network procedure.

Also, my insurance still shows the $30k claim with Dr. Wittenberg is "pending" and the $140k claim with the facility is "settled" but also "out of network", and yet "patient responsibility" is $0. My part of an out of network visit should never be $0 but I'm guessing they basically dropped the facility claim because it was part of Dr. Wittenberg's services which are "in network". I suspect they're handling everything in the Wittenberg claim and negotiating how much everyone gets paid or something. I'm expecting my part of the bill to be the max out of pocket expenses for the year (around $7k with my policy) and in fact, Dr. Wittenberg collected $3k and the facility collected $4k from me ahead of the procedure because of that expectation. If insurance doesn't acknowledge that I paid that, then they can keep charging me for future services till the end of the year, so I may have to fight for them to acknowledge that or for a refund from the doctor or facility. Just yesterday I paid $100 for medication that should have been free because my max out of pocket has already been met for the year, so I may try to get reimbursed for that once the surgery claim settles.

EDIT 5-19-21: The $30k claim finally settled and insurance paid $24k and said patient responsibility was $6k. I originally paid Dr. Wittenberg ~$4k up front so I owed another ~$2k. Now what really worries me is that I also pre-paid ~$3k to Saint Francis Memorial Hospital. This was based on the idea that I'd pre-paid Dr. Wittenberg $4k, my yearly max out of pocket with insurance is $8200, and I'd already spent $1k with insurance elsewhere. SFMH put in two insurance claims for a total of $250k and both are showing as settled with insurance paying $0 and so my co-pay is $0. The insurance claim seems to be saying the whole $250k is "in-network savings" which makes no sense to me - how can they write off the entire bill? If that's really accurate then they owe me my $3k pre-payment back, but I'm afraid to talk to them and have them investigate and be like hey, you owe us even more cause insurance paid nothing. I spoke to someone at Mozaic and they said they don't pay anything to SFMH and they couldn't tell me why insurance paid SFMH nothing. So as it stands, I've paid ~$10k out of pocket for the medical part of this surgery even though my insurance max out of pocket is $8200. Grrr.

Also, for some idea of why hospital prices are so crazy, watch https://www.youtube.com/watch?v=CeDOQpfaUc8&t=1s

EDIT 8-29-21: I finally noticed on the first claim from SFMH to Blue Shield for $144k, all the line items were marked with a "1" and at the bottom it showed that 1 means "Under the terms of the providers/hospitals agreement with the Health Plan, these charges have been denied as the provider/hospital did not comply with the prior authorization requirements. As a result, there is no member liability for these charges."

So apparently Blue is claiming the hospital didn't get prior auth for my procedure. I confirmed I have prior auth for everything that was done and that prior auth shows MozaicCare as the entity authorized to do the procedure. I asked Mozaic before the procedure if I needed anything else and they said no. Since Mozaic chose SFMH as the facility to do the procedure and SFMH is in the Blue network I don't see why any additional auth would be required, and if something else was required I don't see how I ever would have known. So I don't know if someone at the hospital or Mozaic messed up and didn't notice SFMH wasn't listed on the auth or if Blue is just trying to get out of the bill. Maybe because of covid, SFMH was too busy to fight it or maybe they did something wrong. But I clearly should not owe them $3k and am trying to get it reimbursed. At most I should owe about $500 which would get me to my max out of pocket for the year with Blue. I left a message with SFMH a week ago and it was not returned so this may turn into a stressful ordeal just trying to get someone to pick up the phone much less take action... Bleh.

EDIT 8-31-21: I was drafting an email to someone at dignity health (owners of SFMH) explaining the situation when I noticed Blue Shield had posted a revised claim on 8-21. This claim shows Blue finally paid $10k (of the requested $125k) to SFMH, I owe ~$1k "co-insurance", and the rest of the bill is "in-network savings". Blue shows I've now paid $9.5k for the year, $1.3k over my max out of pocket, so I hope that means they'll send me a reimbursement check at the end of the year. For now, I should probably wait and see if the other denied SFMH bill gets resolved and then look for reimbursement if they don't send one automatically. I probably won't be able to make another update about it here since Reddit locks posts after 6 months but I'll probably talk about it in one of the main update posts I've been making once I get a final resolution. I do feel much better seeing Blue pay one of the bills instead of claiming there wasn't prior authorization which I was afraid might provoke the hospital to come after me for the full amount or at the least refuse to return what I paid them.

EDIT 12-1-21: The denied bill for $144k remained unchanged so I decided to push for some resolution. I first emailed the person at SFMH who originally charged my credit card ~$3k saying my combined insurance claims showed I only owed ~$1k so they should refund me ~$2k. She spoke to her manager who replied "This account still has a balance due posted on the account. Please call the business office to inquire if there were uncovered services or if there is an additional adjustment due." This frightened me because it implied I owed them - were they going to make me pay even more because Blue denied the $144k claim?!

I called the number which turned out to be a bill pay number that wanted me to enter the number from the top of a bill in order to pay it or press 0 if I didn't know the number. I pressed zero and the hold music soon changed to a slow beep. I gave up after a few mins.

I filled out this form explaining the situation and was surprised to be called back about an hour later. I spoke to Jackie from the "financial services" department for Dignity Health (which runs a ton of hospitals including SFMH). She said my ~$2k refund was already sent to my credit card in late Nov! I was stunned but it's actually there and I didn't even request it. I would have seen it later this month when I paid my credit card, so I basically wasted my time but I'm really happy to have the situation finally resolved. Only took 9 months!

So in summary, SFMH billed $125+$144k = $269k, of which Blue Shield paid ~$10k, I paid ~$1k, and the rest was just "discounted" or possibly forfeited if the hospital actually did fail to properly follow some sort of prior auth procedure. Crazy...

1
Mon Mar 15 14:42:53 2021 UTC
(2 children)

Oof, that is a nice house right there...no way I'm getting a loan like that...and I don't think I can have other insurance 😢

Thank you, though

1
Mon Mar 15 20:14:05 2021 UTC
(1 child)

months

My daughter got secondary insurance as a student that covers GRS, so it is possible. She has no surgical coverage through tricare as a dependent.

1
Mon Mar 15 20:16:41 2021 UTC
(0 children)

I'm active, so it is not allowed 😥

u/[deleted]
Wed Apr 14 04:46:50 2021 UTC
(4 children)

[deleted]

2
OP
Thu Apr 15 04:38:58 2021 UTC
(3 children)

Ha! Thanks! I think I've had above average results so far. I'm still not counting on it to hold its appearance six months from now, but hopefully it will continue to do well.

The abdominal incisions are a curiosity because I've never felt more than a slight pain when I push on them and rarely even that. I was hoping for only 3 but there are five, each about 1cm long. They were covered with really strong glue that didn't pull off for 2.5 or more weeks. There were dark, fairly soft threads sticking through the glue that partly pulled off when the glue came off but you can still see darkness beneath the skin. I assume the threads were dissolvable sutures that the glue dissolved much faster than my body.

After the glue came off, I covered them with silicone scar tape and they haven't changed noticeably since then. I've always healed slowly and I think my body is overwhelmed with things to heal so things are healing even slower than usual. Wouldn't be surprised to find they don't lose the darkness for a few months but I certainly hope it fades eventually.

Thu Apr 15 06:13:53 2021 UTC
(2 children)

[deleted]

1
OP
Thu Apr 15 16:49:14 2021 UTC
*
(1 child)

It seems likely but I think I'd need more data than just my one case to say such a thing. There have probably been scientific studies on that and Dr. Wittenberg may have an opinion now that she's used the vac on a dozen patients or so.

I can say that unlike the bolster, the wound vac lets you apply ice closer to the skin to keep the area cold and at the doctor's recommendation I kept it cold constantly except for a few random hours where ice melted while I slept. Cold definitely helps against swelling.

I can also say that I may be genetically resistant to swelling. I've never had much swelling from injuries and the doctor commented that there was little swelling from my FFS surgery.

1
u/[deleted]
Fri Apr 30 06:49:42 2021 UTC
(6 children)

I have my surgery next with Wittenberg next Thursday. Just found out today I’m getting the bolster. Aghhhh.

1
OP
Fri Apr 30 07:33:06 2021 UTC
*
(5 children)

Why is she going back to bolster?

Edit: I see you said something in another thread about it being because you're using a different hospital than the one I used. Weird that it would matter since they rent the wound vac from a third party company, but maybe there's no trained wound vac rep in your area. Sorry to hear that...

1
Fri Apr 30 13:59:26 2021 UTC
(4 children)

Saint Francis is like the test hospital for it so all patients at st Francis get the woundvac is what she said yesterday. I was supposed to be scheduled their but then my surgery got moved to the Bernum Campus. Idk I’m not happy about it

1
OP
Fri Apr 30 20:24:31 2021 UTC
(3 children)

Damn. I know it would suck to reschedule again but you could if you really want the wound vac at St. Francis.

I also noticed you said you were staying in Berkeley for recovery but I was told "We do ask that you stay within San Francisco City limits or 30 traffic minutes from one of the hospitals the doctors have privileges at." I wouldn't think Berkeley is close enough unless there's an alternate hospital there but as long as you've told them the address and they okayed it then you're fine.

1
Sat May 1 03:37:21 2021 UTC
(0 children)

Yeah it’s fine. They are aware and I’m still within 30 min it was a 21min drive from st Francis and my mom is more then willing to airlift me to a hospital if necessary so we weren’t extremely worried

1
Sat May 1 23:03:41 2021 UTC
(1 child)

I live in Berkeley and have been recovering here since my surgery last April 6th. Not that far from SF, less than 30 minutes drive.

1
Mon May 3 02:52:26 2021 UTC
(0 children)

Yeah seems like it’s pretty hard to get out of SF but there rarely has been traffic going into it. I’m assuming early morning are probably the only really busy time esp. with Covid and not having that many people on the rode yet.

1
u/Amy_JUSH_Winehouse
Sat Jul 10 23:07:35 2021 UTC
(1 child)

Any recent update pics? X

2
OP
Mon Jul 12 06:54:43 2021 UTC
(0 children)

For more recent pics, follow the link at the bottom of the main post to find the next post in the series. I've posted an update each Tues.