Kimberly's Story

I'm back home from Thailand just over a month post-op for SRS and BA with Dr. Suporn and just over two weeks post-op for hair transplants with Dr. Prasert at the Yan Hee Hospital in Bangkok.  Here's a bit of feedback on my experience there.

I am very pleased with the results of the surgery and would recommend Dr. Suporn unreservedly. I would only suggest that, if at all possible, to choose dates in the Nov, Dec, Jan. time frame as I understand that the weather is much milder then.  During the time I was there (March), it was in the 90s and 100s everyday and going out was simply oppressive.  I did try to see a few sights but because of the heat it was less enjoyment and more to just endure the trip.

Also, a friend accompanied me and proved to be invaluable for, not only the care taking and assistance during recovery, but more for the emotional connection and support. I could have done it with out her but, again, it was the difference between enjoying and enduring. I do realize that I'm blessed to have a friend that would make that trip with me.

Dr. Suporn's staff and facilities: the care and staff are excellent. I found the staff of about 5 women caring, personable and willing to do anything to make my stay comfortable or to fulfill my needs. The hospital seemed well equipped but a bit stark. The one negative I did encounter was that the nursing staff at the hospital was generally pretty lax. For example, my vitals were monitored 4 times a day and often it was pretty obvious that they were just going through the motions of taking the blood pressure and saying "normal". When asked for the actual numbers, one would have to consider my BP to be uncontrolled. :~) One nurse even took my BP with just the cuff and no stethoscope until I said something about it. Another nurse, while changing an IV, dropped the end of the line on the floor and was going to reuse it until I told her no. She then changed the line.

One helpful thing a friend had suggested was a laser pointer. The hospital staff spoke little or no English and being bed-bound for 5 days anything I wanted, I had to request from the staff. It was much easier to simply put a laser spot on what I wanted than to try to explain. I could even put the spot on the exact temperature I wanted the thermostat set to.

One "problem" with Dr. Suporn's recovery is the 5 days being bed bound.  I don't question his judgment on the necessity of total bed rest.  I'm sure he knows best what is needed for proper healing of the neo-vagina but being bed bound will tend to atrophy  muscles and erode endurance.  To counter that tendency, I did what I could do in bed - general Range of Motion (ROM) for the lower extremities and ROM with a bit of weight for the upper extremities (water bottles).  Probably the most demanding thing I did was "straight leg raises" (SLR).  Performing a SLR puts some demands upon your abdomen so you have to be sure to breathe continuously (avoid inter-abdominal pressure).  It is for that reason (avoiding IAP) I did not do bridging exercises although I did use the electric bed to fully extend my back through out the day.

On the fifth day, they let you out of bed.  You still have the packing and catheter but they allow you to walk. The first couple of times I was assisted by a nurse.  Later that afternoon, when I was confident that I could walk alone, I added a walking program to the bed exercises.  I started with 2 laps around the nursing station about every 2 hours.  I monitored my heart rate (pulse) after

each lap.  After the first day I progressively increased the laps and frequency to 8-10 laps about every hour. 

On the seventh day, the morning nurse closes off the urine line.  Later, Dr. Suporn comes and takes the packing and the catheter out.  You then attempt to urinate.  If you can't urinate the catheter goes back in.  I had seen several patients in the hotel several days after their D/C who still had a catheter. To prepare for the removal of the catheter, I drank about 4 bottles of water from

the time the nurse closed off the urine line (about 6 AM) and the time Dr. Suporn came to remove the catheter (about 8:15 AM).  By the time he removed it I was about ready to burst (I suppose 3 bottles would have been enough). I went to the bathroom and started peeing before my butt even hit the seat.

Dr. Suporn then instructs you on how to dilate and clean the wound.  You are expected to dilate twice a day for 2 hours each time.  Printed instructions are supplied and one of Dr. Suporn staff comes later that day to help you with the first dilation you perform.

The next day (8th) you are discharged from the hospital to the hotel. Dr. Suporn's staff visit you at the hotel 1 or 2 times a day to check your status, meds and if you are having any problems doing your dilation.

The next day I started walking to a mall about a half a mile away from the hotel.   The most limiting thing is the discomfort at the surgical site (SRS).  And for the first couple of weeks it gets uncomfortable to sit or walk for very long.

For sitting, the clinic supplies an inner tube encased in cloth. I returned the inner tube to the clinic staff pretty quickly. I found a neck pillow (a "U" shaped thing) that I had brought along to be just as comfortable, if not more so, and easier to carry around.

Dr. Suporn's clinic is very well equipped and has an OR where he does minor procedures. It was here that he took care of the only complication that I experienced. It was about 2 weeks post-op and self caused. I was particularly concerned with cleanliness and while showering I would run my finger down the crease next to the labia minora. Well it turns out that that crease is a suture

line and I caused a small tear. During my next follow up with Dr. Suporn, I told him I was having some pain there and he told me what was the problem and ended up putting a few dissolvable sutures in both sides and said to only use the spray head to clean there.

SRS: SRS cost me about $14,000 which I feel is still a bargin considering the excelent results he is getting. Prior to surgery Dr. Suporn asks for priorities among sensation, cosmesis, and depth (and that is the order I picked).

For sensation, he places two nerve bundles - one at the clitoris and one near the urethral opening. Currently, they both feel sensate (I would say erotically :~)) The one near the urethra is currently more sensate than the clitoris. I have not attempted any sexual stimulation as his instructions are not to for a month+ so as not to cause any engorgement that may pull any stitches or cause any tears.

For cosmesis, one of the issues is a scar that runs along the crease between the inner thigh and the pubis. In his technique, for a given amount of donor material (scrotum/penis) the more depth that one wants the longer the scar required. In my case I did not have a lot of donor material (but my scars tend to heal well) and so, I approved what ever he thought appropriate during

surgery. The resulting scars are 2.5" extending out at an angle from the bottom of the neo-vagina. In general the structure and "look" is great. I'm fairly amazed that these surgons can produce results like this. I'll try to get some pictures up.

For depth, he said that he could get at least 6". Post surgically I had 7.5" but in the week following the depth reduced to 7". I think the immediate post surgical measurement is increased by initial swelling. I've been able to maintain that depth with subsequent dialation although the last .5" becomes difficult if I have left more than 12 hours go by since the last dialation (like

during the trip back home or a night when I was just too fatigued to do it. As far as diamater, he suplies 3 stents (26mm, 31mm, and 34mm). I never used the smallest stent and have been spliting the 2 hours of dialation (twice a day) - doing an hour of the 31mm and an hour of the 34mm for the last two weeks.  The dilation was fairly easy the first few weeks but got harder the last couple of weeks.  In general dialation is no fun and it sometimes takes me quite a bit of will power to do it.  Sometimes I am able to sleep during it but often I'm not.  I've controled the discomfort with meds. I had been using a 1/2 tab of Vicodin to get through the last hour with the big stint (34mm) but the last several days I have started to use Ibuprofen as it has been getting easier and less uncomfortable. I have taken a Medical Leave of Absence from my job (Physical Therapist.   I've allowed myself 8 weeks post-op (another 3 weeks) and will probably return when scheduled.

Breast Augmentation: Dr. Suporn charges about $5000 for BA - that's about double the current fee of other Thai surgeons but I would not choose two seperate surgeries to save that money. He uses textured Silicon Cohesive Gel placed under the muscle with the insertion under the arm pit. They are somewhat firmer than some pure silicon ones that I have felt and tend to move unnaturally (although I'm told that they will move better with time). The important thing with these is to massage and move around post-op so as to cause a pocket to form for them to move in.

Hair Transplants: About 3 weeks post-op I had a little over 2,000 FTU grafts placed for $2 a graft. I went to Dr. Prasert whom a friend had recomended (Yan Hee Hospital in Bangkok) and, and so far, I am pleased with the results. He said that this would give me about 30% density in the areas that had no hair and that I should follow up with another 2,000 in about a year for about 50-60% density. I would not choose to travel to Thailand just for hair grafts but since I was there already I took advantage of the bargan prices.

Kimberly