And Now For Something Completely Different … – Part IV

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answered prayer, AO Fox Hospital, Bala Cynwyd, balancing tasks, bathroom bills, blood test, cardiologist, curettage, Dr. Carolyn Wolf-Gould, Dr. Sherman Leis, early MTF transition, echocardiogram, EKG, estrogen, female, full schedule, Gender Reassignment Surgery, genital hair removal, genital size, God, God's will, GRS, identity, lab technician, MTF, multi-tasking, new technique, Oneonta NY, orchiectomy, painkiller, passing out, penile skin, personal gender, pubertal blockers, rename, sitting, standing, stress test, surgical risk, surgical technique, testicles, Transgender, undescended genitalia, urinalysis, urination, vaginoplasty

Fifty-four years later, prayers are answered

Sometimes God answers prayers with a yes.  He also has a couple of different ways of saying no.  One is, “No, I love you too much to give you that.”  Another is, “No, because I have something better in store for you.”

And then there’s the one most of us heard at some point in our childhood: “You’re too young now; maybe when you’re older.”  Of course, there is no maybe with the Lord.  He knows whether it will be a yes or a no.  But after all, we are His children.  And sometimes we do need to wait until we are older.

American girls – 1960’s style

I recognized my female identity when I was seven.  It didn’t become problematic until I was around age 10 or 11.  I was at that age that I started to pray that I would wake up with a girl’s body (an interesting prayer, since I still didn’t know what a naked girl’s body looked like).  And it was soon after that time that I renamed myself.  After all, if I trusted that God grants prayer requests, I needed to be prepared with a girl’s name to tell people.

Renaming wasn’t new to me.  By that age, I had heard the story of the younger sibling of a girl in my brother’s grammar school class.  When this sibling was born, the gender assigned at birth was female.  The child was given a female name and raised as a girl.  At some point in time before the sibling started school, the sibling started to complain about severe pains in the abdominal area.

When the doctors did their examination, it was found that this child was really a male who was born with genitalia that didn’t descend out of the body: therefore the female appearance at birth.  After surgery was performed to correct the problem, the child’s first name was masculinized and was now raised as a boy.  And by the time I was ten, I heard about this event.

(As a side note, some of the so-called “bathroom bills” aimed at restricting transgender people from using the bathroom that corresponds with their personal gender identity would require this person and others like him to use the women’s bathroom in public places.  Why?  Because his initial birth certificate identified him as female and that is one of the criteria in these bills for assigning the bathroom to use.  The result: a very masculine person in all other regards breaking the law if he uses the men’s bathroom in public.)

But back to my story: although the battle over dental insurance was ongoing, things had quieted down on the GRS front.  My hair removal was proceeding on schedule and by September, virtually all the dark hairs were removed.  I was ready for my pre-surgery visit with Dr. Sherman Leis on September 13, 2017.  This was where the rubber would truly meet the road.

One of the sobering parts of the meeting is the reading of the long list of possible risks of the surgery.  Some of them were minor and some were rare.  One or two risks were so rare that Dr. Leis said that he had never seen a case or heard of a case of it occurring.  Nevertheless, it was part of the list.  I was glad that death was not on the list.  I took a breath and signed a copy of the list that indicated that I had heard and received a copy.

One of the things that impressed me was that my surgeon stays current on technique.  If I understood him in terms of the time frame, he had learned a significantly new surgical technique compared to what he was using when I had seen him for the initial consult on 11/30/16.  Previously, after the orchiectomy (removal of the testicles), the remaining genitalia was completely removed.  To complete the vaginoplasty, the penile skin is sewn back in.  The surgical scar would roughly be in the shape of the letter “O”.

With the new technique, the remaining penile skin is not completely removed.  At the top of the genital area (i.e. the part furthest from the anus), the penile skin is left attached to the rest of the body.  Anything that needs to be done can be done from that position, but not as many nerves are detached and there continues to be a flow of blood into the penile skin at all times.  This new procedure reduces risk, such as risk of necrosis, and aids in healing the surgical area.  With this procedure, the surgical scar is roughly in the shape of the letter “U”.

Of course, I had some questions.  Someone in the transgender community asked me if Dr. Leis “scraped” (technical term: curettage) to remove any stray or gray hairs.  He said that he did not do so because penile skin is very thin and delicate and curettage tends to be harmful to it.  He would remove any stray and gray hairs with a needle (the only painless form of electrology, presuming the patient is totally knocked out on general anesthesia!).  He might have described it as a form of cauterization, but my memory may be less accurate on the term.

I also wanted to know why he hadn’t asked to examine my genital area.  Other trans women I had read about who either were post-op or were in the process had been examined to make sure they had sufficient depth without resorting to additional procedures.  Dr. Leis asked me I had a normal sex life and if my genitals had developed normally (i.e. not a micro penis or inhibited by using blockers from an early age).  When I responded in the affirmative, he told me that size would not be an issue.  (This can be an issue, however, for those who start their transition these days at a young age and go on pubertal blockers and then start on estrogen to block the effect of testosterone on their body.)

During the visit, we also discovered that I had a gap in coverage during the first two days after I left the hospital.  I could have sworn I was told that I would be in the hospital for five to seven days after the surgery.  It turns out that I was told (I found it later in my notes) that I would be released after three days.  I generally have a very good memory.  The only explanation I can think of is that I read about someone else going through GRS who was going to be released after 5-7 days (or who had that experience).

In some ways it didn’t matter.  None of the people who would be taking care of me for the 11-12 days after my release from the hospital were available for those two extra days.  (In the end the first person taking care of me rearranged her schedule, at a financial cost to her, to come a day earlier, so I was only basically on my own for one day.)  I tried a number of avenues, but another person could not be found who was willing and available to help.  More on my experience in a later post.

I left Bala Cynwyd with two scrips: one for a heavy-duty painkiller that could only be filled in PA.  I held onto that rather than carry around the painkillers for three weeks.  I would fill it the day before the surgery.  The other scrip was for medical tests: blood work, urinalysis and an EKG.

At this point, I was doing my best to balance my preparations for my GRS, my teeth issues and the needs of my clients.  Looking (unsuccessfully) for someone to cover the first two days after the hospital and the pre-op tests added two more items to my plate.

Model with glasses

Knowing that I was losing Medicaid soon, I also had my first eye exam in nearly three years and got new glasses.  I was following up to find out what happened to my school tax credit (STAR program).  I needed to sign up for a Medicare supplement program.  I was searching for an oral surgeon who had appointments available before I lost my dental insurance.  And I needed to keep track of the schedule of weaning myself off of various medications and supplements prior to GRS.

I went in for the blood and urine testing on September 21 (no appointment required) and scheduled the EKG for the following day.  It was almost too late.

The testing brought me back in contact with one of my favorite people at the local hospital a quarter mile from where I live.  In the past, I have had major problems with giving blood.  The first time was in April 1981 when New York required a blood test to get a marriage license.  It was not a big deal to me.  My dad gave blood regularly at work and it was a matter of fact thing and satisfying thing for him to help others in this way.

I went into the lab that day with my fiancé, had the blood taken, had the juice and the cookie, and then went outside with my fiancé.  We were talking about the rest of our day.  The next thing I knew, I was back inside, sitting down and feeling very woozy.  Without warning, I had crumpled onto the sidewalk, leaving my fiancé perplexed as to what to do next: run inside of help and leave me there or try to drag me inside.

So I knew I had a history of passing out by the time I had a blood test a few years ago when Dr. Carolyn Wolf-Gould became my primary physician.  Now blood work was a big deal to me.  Then I met the lab technician at the hospital.  On her office door, she had a child’s drawing of a vampire.  A woman who I would guess to be in her late 40’s or early 50’s (warning: I’m not very good at estimating ages), her hair was dyed blue, green and black.  It was so different that it helped put me at ease.  When I saw her pulling out one vial after another, I joked with her, asking if she was going to leave me with any blood.  She joked back, “A little.”  Still I warned her about my past problems and she took the blood with me lying down on a gurney.

That was the last time I needed the gurney.  Maybe my metabolism is slowing down.  Maybe it’s the effect of the estrogen.  (I was quite chagrined when I learned that young males are far more likely than women to pass out after giving blood.)  Maybe this technician has gotten me so relaxed that I no longer have a problem, even when she isn’t the one taking the blood.

So it was time for blood work again.  But first, my body was telling me to give the urine sample.  It was primed and ready, locked and loaded.  I went into the privacy of the bathroom and faced a decision.  Although I didn’t have to, ever since I knew it was likely that I would transition, I have sat down to urinate.  (The only exception was when I was still wearing men’s clothes and no stalls were available at the Penn Station men’s room.)  I knew it would be much more difficult to give the urine sample sitting down.  So (presumably) one final time in my life, I peed standing up.

It is also worth mentioning that in my head and heart, I knew that GRS was the right thing for me.  But was it God’s will for me?  Even if God does not have a problem with this surgery in general, that doesn’t necessarily mean it was right for me.  With these tests coming up and the surgery less than a month away, I went to the Lord and prayed that if I had been dull of hearing and ignored the Lord telling me not to go forward with the surgery, that He would intervene and do something to stop it.  And for a while, it looked like that might be the case.

My EKG – September 2017

The UA and blood work results came back and there was nothing in them to prevent the surgery.  The EKG was another matter.  I had never had or felt any problems with my heart.  No one in my immediate family has had heart problems.  I had one uncle on my mother’s side who suffered a heart attack, but no one else among my grandparents, aunts, uncles or cousins that I knew of.  But the EKG came back with some irregular readings.  I would need an echocardiogram and a stress test before I could be cleared for surgery.

This created a new problem.  Time was growing short and we were also running into the Jewish holidays.  A stress test must be administered by a cardiologist and I didn’t have one.  And many of the doctors in my area are Jewish.  I couldn’t get the stress test done at my local hospital without first establishing a relationship with a cardiologist on staff or with residency privileges there.

Instead, I had to drive two and three quarter hours each way to the hospital upstate with which Dr. Carolyn is affiliated.  At 7 AM on a cold October 2 morning, watching the news coverage of the Las Vegas shooting, I waited to have my tests.  I drove up the afternoon before, not wanting to leave at 4 AM (or worse, oversleep and miss my appointment).  Fortunately I had some rewards points to lower the cost of the motel room.  Between the alarm and a wakeup call, I got up in plenty of time.  Instead of 165 minutes, it was a five minute drive.

I learned that I need to go back to the gym.  I was breathing heavy after the stress test, but that was in part because I couldn’t really get the hang of a treadmill. I never have.  But my recovery time was a lot faster than two men I had seen take the test before me.  I learned that I have some minor valve problems, yet nothing serious enough to prevent the surgery.  I took this as an indication that God had answered yes.  This was above and beyond the promises He makes to His people.  Even so, every good gift and every perfect gift comes from Him. (James 1:17)  But the extra tests and travel took one more day away from me as I finished up one more client’s tax return and tried to get final planning and packing done for the two weeks I would be away in Bala Cynwyd.

Finally, October 4 arrived.  It was time to do my last minute list checking and packing.  Mid-afternoon, I called Dr. Leis’s office to let them know I was just about to leave.  A short while later, I brought the last items to my car and began to drive to Bala Cynwyd for the third time.  After years of waiting, wondering and almost losing hope, surgery was T minus 17 hours and counting.  This was it.  This was really it.

For all the promises of God in him are yea, and in him Amen, unto the glory of God by us. – 2^nd Corinthians 1:20

God bless,

Lois

And Now For Something Completely Different … – Part I

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Alice in Wonderland, Andrew Cuomo, androgynous, answer, blending in, blessing, bureucracy, Charles Dickens, Christian, confusion, consult, counseling, Counselor, diagnosis, doctor, Dr. Carolyn Wolf-Gould, Dr. Sherman Leis, family medicine, gender transition, general practitioner, government agencies, health insurance, herbal equivalents, Hurricane Sandy, Kathleen O'Brien, Lewis Carroll, Lord, Medicaid, mental health professional, Obamacare, Oneonta NY, patient navigator, Pennsylvania, personal, personal care physician, plastic surgeon, prayer, prescription hormones, professional courtesy, psychiatry, psychology, real-life experience, sessions, shark, surgery, Transgender 101, transgender health care, upstate New York, VCS Rockl;and, wait

The Journey Begins

Well, it’s different for me, anyway.  In no way do I consider myself a pioneer.  Even so, I’ve decided to chronicle the next step of my gender transition journey.

Charles Dickens

Where to begin?  Charles Dickens began “David Copperfield” with the sentence “I am born.”  No, I think that is too far back.  Perhaps the more appropriate Dickens quote would be (personalized), “Lois Simmons asked for more.”  (Or for less?)

Part of the necessary steps for me to start on prescription hormones and to live my life as Lois was counseling sessions to determine if transgender was a valid diagnosis in my situation.  By the third session, we worked together well: she would give me one or more assignments and I would come back the following session with my homework extensively done.  The single most-used phrase uttered by my counselor was “Hold on, let me catch up.”  We usually were pressing up against the end of the session and would squeeze in the scheduling of the next appointment at the very end.

But one time, somehow we ended up with about 15 minutes left and everything from my assignments had been covered.  So my counselor, Kathleen O’Brien, brought up the topic of surgeries.  We hadn’t discussed them up to that point.

I dismissed bottom surgery immediately, totally for financial reasons.  I didn’t have health insurance at the time.  Besides at the time, most health insurance policies weren’t covering transgender related health care of any kind.

As far as breast augmentation, I said that I would wait to see how well hormones worked.  But then I added, I might consider some minor facial feminization procedures.

Kathleen looked at me in astonishment.  “Why do you think you need that?” she replied.  As it turned out, she was spot on.  While I am no beauty contest winner, no one has read me for male, even when I first started appearing female in public and had been on prescription hormones for less than a month.

I also took mild herbal equivalents for about one year prior to getting prescription hormones.  In fact, my first day was the day of the October blizzard in the NYC metro area.  The last day was the day that Hurricane Sandy hit my area and knocked out my power for three days (and a lot longer for some).

Within four months of counseling, I had my transgender diagnosis confirmation.  (Your time may vary.)  Kathleen and I then started to work on finding a source of hormones for me.  Her preference was an endocrinologist in Albany.  But he had a six month waiting list for new patients.  And that would put me needing to go to Albany in mid-March with the possibility of winter weather and the certainty of tax season getting in the way.  Six months became eight.

A clinic in the Greenwich Village area of Manhattan was the next choice.  Over the phone, I was told that there was a six week waiting list.  Later, I was told that the time frame was not definite and I should not have been given one.  The point was moot.  Hurricane Sandy hit their facility hard and pushed everything back.

Then I remembered that I had found a transgender knowledgeable doctor in Northern New Jersey: a different state but closer to me than the other two.  I received a referral letter from Kathleen, waiting for phone service to be restored to this doctor.  I faxed the letter there.  They claimed that they didn’t receive it.

I told the receptionist that I would drive it there.  She said they were closing in a few minutes, but I could do so the next day.  I showed up, referral in hand.  “When would you like an appointment?” I was asked.  “As soon as possible,” I replied.  “How about tomorrow?”

My wait time went from six months to six weeks to sixteen hours!  It was the first and last time that doctor saw me in male mode.  He was pleased and amazed by what he saw on my next visit.  A few visits later, he confided to me that occasionally one of his cisgender patients would ask him if he knew who was in his waiting room.  One of his transgender patients was there, sticking out like a sore thumb.  Then he added, “No one has ever mentioned you.”  Indeed, I would sometimes engage in light conversation with another patient, family member or pharmaceutical salesperson in the waiting room.

Dr. Carolyn Wolf-Gould, my personal doctor and a beautiful person, inside and out.

But then Obamacare came along.  Not only did my GP sell his practice because of all the additional record-keeping requirements, but my public insurance (Medicaid) would not port over the state line.  As I wondered about waiting lists and finding a new doctor, Kathleen told me about Dr. Carolyn Wolf-Gould in Oneonta. It has been my good fortune for my basic medical care that I have not needed to provide Transgender 101 training for a medical practitioner.  And that was certainly true of Dr. Carolyn.

Dr. Carolyn and her husband, while also providing family medical care, have built an upstate New York oasis of medical care for transgender patients par excellence.  Their practice continues to grow and their patients come from surrounding states as well as New York.  Words cannot describe how much of a blessing she has been to me.

https://www.theguardian.com/society/2016/may/03/transgender-healthcare-doctor-oneonta-new-york-carolyn-wolf-gould

And one of those blessings came during a six month checkup.  She asked me if I knew that Governor Cuomo had issued an executive order that required insurance companies in New York to cover transgender health care, including gender reassignment surgery.  I said I did, but I thought it only covered private insurance. She replied that it covered public insurance as well.  Furthermore, she had done some investigation and found a surgeon in the Chicago area who was experienced and took Medicaid.  Since inexplicably no surgeons in New York were doing the surgery, let alone accepting Medicaid, I could port my insurance outside of the state.

So I started pointing toward Chicago.  And I had two hurdles: a letter from my counselor (an MSW) and a letter from a mental health professional with a “Dr” title in a related field (i.e. psychiatry or psychology).

Kathleen was ready to write the letter right then and there.  She knew how successful I had been in my real life experience, far beyond the one year minimum requirement.  Then she looked through her notes.  We had only talked about surgery for a few minutes.

And I was glad for a few sessions devoted to the topic.  In some ways, this was a tougher decision than presenting my true self full-time to the world.  This meant a major surgery, something that never should be taken lightly.  Furthermore, I had passed age 60 and never had a reason to stay overnight in a hospital since my mom brought me home after I was born.  In December 2014, I had a tiny cyst removed from my eyeball: in by 7 AM, out by noon.  They don’t even put you under for that surgery: just a local plus a nice floating feeling, but you can still respond to instructions from the surgeon to look in various directions.  Until 2017, this was the only surgery I ever had.

No, this was going to something completely different.  Was I tempting fate?  As a Christian, I reminded myself that this wasn’t the right question.  Instead, would the Lord be with me in this or against me doing it?  It was even possible that this wouldn’t be considered a sin in general, but it might not be His will for me.

After prayer and contemplation of scripture, I didn’t receive any dissent from the Lord.  I was reminded that when I was a pre-teen, I had prayed for a while to wake up with a girl’s body.  I didn’t get the results I prayed for (although my body remained quite androgynous).  But I never got a “no”, either.  At that age, I lacked the knowledge and sophistication to understand that “wait” is a possible answer from God.

Now I needed to search for that second mental health professional, one at the level of doctor, for that second letter.  I found many who took my insurance, but none in my county who had the slightest experience in transgender issues.  I was tipped off on a husband and wife practice in a neighboring county that fit both conditions.  He had an 18-month waiting list; she wasn’t taking any new patients at all.

Then a new door opened.  VCS in Rockland, a group I was very familiar with by this time, had started a mental health clinic that accepted Medicaid.  By January 2016, I had my second mental health professional.  By the end of tax season, I had the second letter.  And by this time, Dr. Carolyn informed me that she had found a surgeon closer to me.  She assured me that he had an excellent reputation, was known for being very caring, and that he accepted Medicaid.  And that was how I found out about Dr. Sherman Leis in Pennsylvania.  He was everything advertised … and more.

http://www.drshermanleis.com/

http://www.thetransgendercenter.com/

But that is skipping ahead a few steps.  There is always a bureaucracy to deal with.  And it rose up at every turn.

Early in my adult life I worked for HUD in New York City.  I left that job to run a housing assistance program for a local housing authority.  After four years in public housing I became a financial professional, starting as a stock broker and adding other specialties over the years.  This might be the heart and soul of capitalism, but I still dealt with a government agency (SEC) as well as bureaucracies with the NYSE and NASD.

Even so, that was a relative lull until I started preparing taxes professionally.  Now I was dealing with the IRS and various state tax agencies (usually New York and New Jersey, but also Pennsylvania and California to name a few other states: over the years, I have prepared tax returns for 28 different states, DC and Canada).

I thought I qualified for a PhD in bureaucracy.  Then I started dealing with health insurance bureaucracy gremlins.

The first step is for the “patient navigator” to request approval for a consult with the surgeon.  This was submitted at the end of May, shortly after I delivered all the necessary paperwork from my two mental health professionals and Dr. Carolyn added her required letter.  I was told that this process should take about six weeks.

In mid July, six weeks had come and gone.  The patient navigator admitted surprise.  She told me that around the same time, she had submitted a request for another patient with the same circumstances: same surgeon, same insurance carrier, same surgery, same state of residence.  The other patient’s request was approved promptly.

This would be the first of many times I would become a ping pong ball between various people acting for my benefit, each claiming someone else needs to solve the problem.  Finally in mid-September I put my foot down and demanded that these people talk to each other and to stop going through me, the least influential in the process.

(I have been on the other side of this dynamic, when I deal with tax agencies on behalf of clients.  I have far more clout than the clients do.  I illustrate this with the following joke.

A ship wrecks and three men end up in one of the life boats.  One is a priest, one is a soldier, and one is a lawyer.  After rowing for a while, they spot an island nearby.  But the current is against them reaching the island with normal effort.  Furthermore, there is a school of sharks between them and the island.  Swimming to the island seems out of the question.

Finally they decide that maybe one could get through to the island and hopefully get help on the island.  But who should be the one?  The priest argues he should go because the Lord would protect him during the swim.  The soldier counters that he is by far in the best shape and would have the best chance of getting through, either outswimming or fighting off the sharks.  Rather than enter the discussion, the lawyer simply takes off his shoes and jumps in the water.

To the soldier’s amazement, the sharks open a path for the lawyer to swim through and he makes it safely to the island.  The soldier asks the priest if he knows why that happened.  The priest replies, “Professional courtesy.”)

Finally the parties involved talked directly to each other.  And what did Dr. Carolyn’s office find out?  My insurance carrier wanted paperwork that pertained only to an in-state service request.  This service was being performed out of state.  Even so, it took another few days for the patient navigator to decide that the best way to resolve this impasse was to simply fax the request again.

Alice in Wonderland’s white rabbit

With the cover page please include a statement that this is an out of state request, I suggested.  She did.  On September 26, I had approval for a consult with Dr. Leis.  There was a minor problem that the approval was good for only 30 days and it took over 60 days to get a consult with Dr. Leis.  In a few days, the approval was extended and I had an appointment for a consult with Dr. Leis on November 30.  It was a consult that should have been held before Labor Day.  Little did I know my trip through health insurance Wonderland was just beginning.

O Lord, righteousness belongeth unto thee, but unto us confusion of faces … – Daniel 9:7 (portion)

God bless,

Lois