I think that the more that the girls know about the risks of surgery, the more they will pester the doctors for answers until they are satisfied that their life and welfare will be taken seriously. I think there is not enough attention to the bleeding problem. Most doctors never run clotting time tests, and often don't discover that a patient is bleeder, until they are doing surgery on them. I only found out about being a heavy bleeder from a single line in a surgical report that I found on myself, that said, "this patient bleeds like an aspirin taker". I totally forgot about that, until I wound up in Taylor hospital with a swollen scrotum. When I told the resident urologist about being a bleeder, he went totally ballistic. The reason they kept me overnight was to see if I was still bleeding internally. Overnight, they took blood samples every four hours, and in the morning, he said that: my hemoglobin had stabilized, and he would not have to operate. If things had gone the other way, I would have been faced with getting surgery in a strange city, with a strange doctor, and no family or friends around to see to my welfare.
My experience with Dr. Spector is not unique. Several other people that were done by him, had experiences similar to mine, but elected to have hometown urologists correct the mistakes made surgically by Spector. All were angry that they were put through that ordeal, for such a simple operation. None took any precautions. They just accepted his word that all would be OK. The common reason for accepting the Spector propaganda was in all cases (including mine), a sense of desperation. After being refused by so many other doctors, they were willing to believe and endure anything, to just get the castration done and over with. I sense that same desperation in a lot of Transsexual people. They are so overjoyed when some doc says "yes", that they throw caution to the winds, and hop on the first plane. They are willing to risk their life by doing surgery in a foreign nation, just to circumvent the SOC requirements, and get a lower price. Those that have bad outcomes always pay more in the long run having local docs correct the problems made by others, than they would have paid by doing it in the USA or Canada. There is no free ride. You get what you pay for. Ironically the people that most lead the prospective surgical candidate astray are the "lucky ones" that somehow came through the surgery without a scratch. They give the prospective patient a false sense of confidence that everything will be OK, and not to worry.
After reading Nicole's wrenching tale of surgery gone wrong, I was struck with similarities to what happened to me in 1997. In July 1997, I was orchied by Dr Spector in Philadelphia. I had to fly from Los Angeles, California to Newark, New Jersey. I then rented a car and drove to Philadelphia. Someone I had met on the internet, and had been orchied by Dr Spector, and had recommended Dr. Spector to me, met me there. He had told me that although the doc's technique was a bit marginal, he was the only one that was doing it (in 1997) and he like I was desperate enough to overlook his short comings, just to get it done, and save my sanity. The surgery took three hours instead of the one hour that everybody told me that it would take. Three hours after the surgery, my scrotum had swollen to the size of an avocado. We went back to the doc's office, but he didn't seem to know what to do to fix my situation. Later that night, I called 911 and was taken to Taylor Hospital in South Philadelphia, where I was ridiculed by the staff for even wanting to get orchied, and kept overnight for observation. My whole groin and upper legs and abdomen had turned black from blood leakage overnight, and the swelling was large enough that my penis had receded into my body and couldn't be found. The next day, I took a shuttle flight to Newark, and flew back to L.A.. What followed after that, was: 6 months of local docs not wanting to treat me, and alternating between wanting to operate, and telling me that the swelling would go down if I left it alone.
I also had three rounds of infections, and three months of oozing puss from the wound, and cleaning the wound out with peroxide and cue tips several times daily, and wearing wet saline compresses to make the swelling reduce. Finally, I told the docs to screw it, and I decided to live with what I had, and take my chances that it would work out in time. It did, but it took two years to do so.
The big lesson might be as follows:
1. Natural bleeders are a surgeon's nightmare. If the surgeon is used to
doing normal surgery where they use cold knife scalpels, and don't regularly use electrocautery knives, that seal everything that they touch, the patient is an accident waiting to happen, when: they encounter a person like me (and probably also Nicole) that bleed a lot more than normal. Once slow capillary bleeding gets going, after they seal up the surgery site, things degrade rather quickly, and they find themselves with a problem case that won't go away. Dr Sanguan's remarks about "not knowing what went wrong" with Nicole's case, were almost word for word what Dr. Spector said to me, when mine went wrong. They instantly become clueless, and are afraid to open the site up again and fix things, because they are afraid of more blood loss. They then start acting stupid, or they get overcautious and delay treatment until test
results come in, rather than administering antibiotics for prophylactic
preventive reasons. It's easy to see how things can get out of hand without much effort. Especially when that happens in a foreign nation without the safeguards we all have become so used to here in the USA.
2. SRS and orchietomy are similar in a lot of ways. They both happen in the one place in the body where there are the most capillaries and the highest blood pressure. This makes it an accident waiting to happen for a surgeon that does not use electrocautery, and is a bit sloppy or careless in his technique. Best to check all the references you can, and possibly witness a SRS on another person and follow their post op case before deciding on a particular doc.
3. Getting surgery done far from home may seem attractive for a lot of
reasons, but when things go wrong, you end up being defenseless at the hands of people that could: really care less about your welfare, and often become nasty, or intransigent, or greedy, when you start crying out for help. Best to consider local surgeons. You can go to Thailand for half the price, but then spend the difference having local surgeons correct the foreign mistakes. No matter what you do, you will pay the cost of doing it local whether you go to Thailand or not. Murphy's law equalizes all costs. So, save your money, do it in the USA and save your sanity.
4. When things go wrong with surgery, the first thing that happens to the patient is that they go into a rage, and blame the doctor. Then what follows is about a year of correcting complications and more rage and loss of self-esteem. Then the patient tends to go into a period where they become thankful that they survived the experience, and they tend to forgive the doc, gloss over their complications and in some cases even recommend the doc that did them wrong! Why not avoid all that trauma. Too much trust is placed in the hands of doctors. Patients need to demand the blood tests, to see if they are a bleeder, BEFORE surgery, not after! They also need to see if the doc uses electrocautery, and if he has had any heavy bleeder complication cases, and what were the final outcomes.
Before choosing surgeon a lot of things that might effect their outcomes should be considered. Like:
1. Is the patient a heavy bleeder?
2. Does the patient suffer from high blood pressure?
3. Are they overweight (200 lbs and higher).
4. Do they have an irregular heartbeat or any arrhythmias?
5. Do they have any allergies to penicillin or any other antibiotics?
6. Has the surgeon had any bad outcomes, and what were the reasons?
7. Does the surgeon use electrocautery to stop bleeding
Those with surgical experience could probably increase the list ad infinitum.
Thanks for listening
Crystal James
