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A Guide to SRS with Dr. Chettawut
A Guide to SRS With Doctor Chettawut
So a lot of people have asked for a general opinion on Dr. Chettawut's work.
This is a work in progress. The last update was October 25, 2005.
Overall, from our experience so far, Dr. Chettawut should probably be considered among the upper tier of SRS surgeons and generally one of the better ones in that tier. He's competitive with Suporn in my opinion and there's almost no question his work is superior to any of the North American surgeons. I realize that everyone feels this way about their own surgeon, but I think there are quite legitimate reasons to say this, mainly in the quality of his external structures and ease of recovery. Also, given that he is currently the cheapest legitimate SRS surgeon ($5500) in the world, this is quite impressive.
A friend and I went together and had our consultations together and our surgery a day apart. (For those who have asked, I refer to her as my companion in the sense of traveling companion. She's not my domestic partner.) We probably present a pretty good example for comparison. One of us was 6" flaccid with a very minor partial circumcision that left extensive foreskin available. The other was myself, 2" flaccid with a very deep and heavy circumcision and a similarly small scrotum that the doctor noted had a thickness of the skin which would make working with it difficult.
We both booked the surgery roughly 3 months ahead of time through email to the Doctor. We wired the money ahead of time. I have no idea about refunds, so if you are unsure about the need for a skin graft, you might wish to note this and carry the necessary money ($1500 as of now) as cash to Thailand.
Dr. Chettawut's technique is penile inversion. Glans tissue is used for the clitoris and inner labia. Scrotal tissue is sewn in large patches around the entire vaginal area to produce visible and sensitive labia majora. He moves something underneath them to produce some extension from the mons, but I couldn't tell you what and I'm not sure what's material back there and what's just swelling. The penile shaft skin is inverted to form the entrance to the vaginal passage and the remainder of the vaginal passage is provided by remaining scrotal skin or in the lack of sufficient scrotal skin by either a combination or scrotal and abdominal skin or in the case of me entirely abdominal skin. The abdominal graft is taken from across the bikini line, similar to where a tummy tuck scar would be done. (In fact, as someone who had lost 100lbs in the previous 24 months I had an excess of flappy skin here and he took the opportunity to remove a great deal of it in what might be called a mini-mini-tummy tuck. He joked that he would take the best advantage of needing the graft and he certainly did.)
His surgical procedure is to first create the external structures and vaginal opening and then to evaluate the condition of the neo-vagina for the final vaginal skin grafting. In the case of a simple SRS, the scrotal tissue will generally be grafted immediately. However, if there is any significant bleeding or tissue irritation, it will be delayed for two days to allow healing and done in a short procedure. If you require an abdominal skin graft, it will be delayed by two days.
After surgery, you remain confined to bed for four full days (which in the event of a graft means six full days immobile) before your packing and catheter are removed and you have your first dilation. The confinement to bed is total, you can't get up at all, but there was a couch next to my bed that I was able to leave things on within reach. I was given 8 hours after that to pee and then I was moved to the hotel. You are required to urinate after your catheter is removed, but they do not make a particularly big fuss about it. They simply ask if you "go peepee?" and you don't get out until you do.
Honestly, the hospital care was so nice that I would have preferred greatly to have stayed there for a few more days. This is quite a contrast to Davies after FFS where I couldn't wait to be released.
Anesthesia
His anesthesiologist uses an epidural block along with a sedative. Both of us had breast augmentations which were done prior to SRS and require general anesthesia so I can't really comment on the "SRS only" epidural block. However, my skin graft was done with only the epidural block. If you are wondering, no, with the epidural block you are not awake. You are knocked out so you're not watching it all go on, but I guess just not to the level of general anesthesia. I tend to shake off anesthesia quite easily and actually became conscious during closing of my final grafting procedure and could feel in some very general (and I must stress entirely non-painful and not upsetting) way the packing of my neo-vagina and some stitching of the graft site.
In both procedures the anesthesiologist administered the general anesthetic into a very long IV chain before the epidural block. However, they keep you busy rather than telling you to count or wait or whatever. I was in the process of cooperating as they lay me on my side to enable him to insert the epidural IV in my back when I lost consciousness. I was similarly being moved around when I lost consciousness for my skin graft. The result was that in neither case was I given time to think about what was going on nor was there that period of fretting while you wait for the anesthesia to take effect. For me, this was a very positive experience. I find the last few moments feeling the anesthetic entering my vein and waiting to lose consciousness to be terrifying. The anesthesiologist spoke flawless English and was very reassuring.
Pain Management
I can't say that the pain management is particularly great. You can get morphine in the hospital (supposedly-I never needed it). But where Dr. Ousterhout lobbed vicodin and percocets at you in great multitudes. Here, you get some tramadol (the strong pain reliever) and Tylenol 500s (weaker pain reliever). Thankfully there honestly isn't much pain to deal with anyway, so it's not a big deal. (BTW you're given Tylenol, but it's labeled in British English as paracetamol. This is the same thing acetaminophen. It's just that British and US English have different words for the same chemical.)
Dilation
The regime of dilation (and recovery in general) is perhaps the single biggest difference between Dr. Chettawut and other surgeons. One dilates once for 15 minutes each day for the first four days, then twice a day for 15 minutes each. This may be lengthened a bit for those of us with abdominal skin grafts depending on how well things are going. You eventually move up to dilating for 10 minutes per dilator, moving up. Three dilators is thirty minutes, twice or three times a day. Eventually you can start to eliminate the smaller ones. No you are not reading that incorrectly. The dilation regime for Dr. Chettawut can be as little as 30 to 40 minutes a day.
Depth is impressive and quite easily obtainable while dilating. Both of us were dilated to 6" without any difficulty or discomfort on our first attempt. And both of us ran out of dilator (7") the second day. Since initial dilation it has become more difficult for me to do the initial insertion, and I'm still above 6". My companion finds the entire thing extremely easy. This can be attributed to the differences between genital and grafted tissue. Genital tissue is more flexible and stretches in ways that most other tissues don't. (This is reportedly why Suporn, who always uses grafts, requires such extensive dilation.) I find I do not need to hold the dilator in. You generally are told to keep pressure on it, but eventually I start to run out of dilator and have to stop because it's difficult to remove if it gets completely inserted. There is little or no bleeding. He does not have you douche until almost two weeks after surgery and warns against doing it more often than once or twice a week. In fact, you can't even shower for several days after unpacking and you are forbidden from taking a bath or swimming for two months. He seems to prefer a natural vaginal climate. This doesn't seem to have any negative consequences on either healing or odor.
At one point there were issues with obtaining dilators from Dr. Chettawut, but he has rectified this and will sell you a set for, I believe, $100 US. When we were there, he initially provided only the 0 dilator and wass very cautious about moving you up in size, even when we were dilating without resistance, pain, or bleeding. You might want to confirm that he has a set of dilators for you when you're scheduling your surgery.
Also on dilation, it's easy to lose track of what supplies you go through and the staff replenishes them as you use them. I would advise packing a dozen or two unlubricated condoms and a large tube of KY or other lubricant and not mentioning this to the doctor's staff. Then request supplies from them as you need them, but you will have the reassurance of having your own supplies as a backup.
At three months post-op, both myself and my companion are easily able to dilate with the largest (38mm/1.5 inches) of the Duratek dilators even though we spend a minimum of time dilating. Once daily for me and once every other day for her. She's had sexual intercourse with a male partner without difficulty.
Urination
A few weeks after surgery we were both still swollen and experiencing rapid and unpredictable changes in direction, generally resulting in us peeing all over our bottoms. We did have occasional normal urinations though and it seems to be pointed in the correct direction. The streams are very strong and for those concerned with how they sound in the ladies room, they sound more naturally female with a normal "hiss". Neither of us has any issues with venting directly into the vaginal passage, which is an issue reported with other surgeons. (I doubt if that would ever be an issue with Dr. Chettawut as the vaginal passage is placed quite a distance from the upper vaginal structures.) Over a period of weeks and months this has become regularized for both of us and we pee normally.
Sensation
Sensation is incredible. Everything is sensate and it feels normal and natural-there is very little sensation of something being located in the wrong place. If you were to imagine yourself currently as a woman, and guess where all your bits would be, for both of us that's exactly where they are. There's almost no "mental remapping" required. In my case the only thing seeming out of place was the urethra. At first, this manifested as a feeling that my urine was coming out from a place a few inches outside of my body. Later in my recovery it became an issue because I was misunderstanding some pain as being from my clitoral area when it was actually a UTI.
In purely personal terms, it is extremely pleasurable to touch my outer labia. I can tell that they were once scrotal tissue, but whatever he's done behind them, the sensation is certainly more pleasurable than touching my scrotum ever was. This is more of a sensuous feeling rather than a purely sexual one that would lead to orgasm. I also can obtain extremely pleasurable sensations from the first few inches of my vaginal passage. Even days after surgery, I played around a little bit rubbing my clitoris through my inner labia and it was highly pleasurable. On the other hand with the swelling, the increase in size of the clitoris as one gets excited was somewhat painful (this faded with time). I had my first orgasm from masturbation three months after surgery. I am still extremely sensitive and it would be difficult for a partner to not overstimulate me.
From reading several accounts, this level of hypersensation is not at all unusual; in fact he makes a habit during your unpacking and first dilation of tapping your clitoris at some point with a q-tip. The result for almost everyone is a shockingly intense feeling at which point he laughs and says "sensate structure." It should also be noted that this level of hyper-sensation is relatively common among natal women.
While my companion doesn't have quite this level of reaction on her clitoris, she is fully sensate and had her first orgasm a month after surgery. She has also achieved orgasm from intercourse with a male partner.
Appearance
Appearance is one of the greatest strengths of Dr. Chettawut's work. There's simply no question, what you end up with looks like a vagina. It doesn't look "sort of like" a vagina. One of my biggest criticisms of most neo-vaginas, particularly those of the North American surgeons, is a tendency for the entire structure to be, in crude terms, a hole with a button clit hanging above it and a few folds of skin that pretend to be labia sort of hanging around. Your mileage may vary obviously.
There are three things which are characteristic of his work that might be considered negatives by some women. First, the cleft of thevagina extends higher than it would in a natal woman. I'm not sure how this compares to other surgeons and I suspect it might be an inevitable result of SRS since the penis is located higher on the body than the vaginal cleft starts. In any case, standing up, the vaginal slit is visibly higher than in a natal female. Second, the clitoris is quite small. It's there and there's nothing pathologically abnormal about the size, but it is small. Many women want a large clitoris that is noticeable and this is not Dr. Chettawut's style. Finally, Dr. Chettawut produces large outer labia that some people find too large. It's a matter of taste really and they do become smaller than the post-op pictures you will see of his work. But if you want small labia majora, Dr. Chettawut would not be the best surgeon for you.
Dr. Chettawut "officially" attempts to perform a single step construction while still leaving sufficient excess tissue for a full secondary labiaplasty. It's generally safe to assume that you will not need secondary labiaplasty unless you are a complete perfectionist or have an unlucky result.
Appearance is where the differences between my companion and I are the most extreme and where the differences in available material become the most important.
Simply put, her vagina is perfect. She has nicely formed outer labia that open and close naturally to reveal the vaginal opening, inner labia, and clitoris. The clit is natural colored and well hooded. The hooding recedes perfectly naturally into the flesh around her inner labia. She has had a sex partner and he noticed nothing out of the ordinary. The only flaws that might be indicated are general tendencies of Chettawut's. The outer labia are on the large size. The clitoris is a bit low positioned compared to the overall size of the vagina and the hooding. And the vaginal opening is quite wide and somewhat low in placement. I should reiterate, however, that this is all within the norms for natal women.
My vagina isn't quite as good. (Certainly one of the worst I've seen from Dr. Chettawut.) Not surprising since I had only perhaps 1.5cm of glans tissue to work with and only a few inches of scrotal tissue. My outer labia are fine. They were initially quite swollen, but they have regularized and fold naturally depending on my body position. (I'm pretty sure my entire scrotal skin was taken up on them.) My inner labia have shrunk considerably since surgery and are very small. Originally they had some irregularities from stitching during the construction, but they healed completely. If my clitoris is hooded, I'm unaware of it. The entire upper internal vaginal structure is so small however, that it's entirely possible that there's a proportional hood in there somewhere. Nonetheless, it all looks quite good and within norms.
In comparison to other surgeons my companion's vagina is probably the single best SRS result I've ever seen. Prior to this I'd list Dr. Schrang's "giant vagina of doom" on his home page as the best I'd seen, but my friends is in my opinion superior. Though at that point you are talking about your personal view of what makes a vag attractive or not more than you're talking about whether or not it is female normative. I've said that by Chettawut standards mine isn't so hot, but it is probably on a par with the better results of the North American surgeons.
Hair Removal
Genital hair removal before surgery is probably a good idea. Both of us had none and both of us have a few stray hairs within our vaginal canal. These aren't anything of vital importance, but someone doing a GYN exam would see them.
Breasts
His breast augmentation work is excellent, textured silicone implants under the muscle with implantation from the armpit area. The work itself is first rate; my nipple angle and the direction of my breasts are far more standard than they were before and the shape is quite natural.
However, Dr. Chettawut clearly likes big boobs. I would suggest that most patients take his recommendation with a grain of salt and consider going a bit smaller than his suggested implant size. I took his recommendation and while the result looks quite natural, it's on the high size of normal and I thought I had made it clear I wanted to be on the lower end of natural. Given that I would expect some growth post-removal of my testicles and that I'm trying to lose weight and told him that, I'm concerned that I will end up larger than I can tolerate. The implants themselves are also large enough that they can be quite easily felt through the skin-this is not at all unusual for implants, but was the sort of thing I was hoping to evade when I said "not too big."
Judging from other patients, including a few who were completely healed, this is not an unusual instance. Dr. Chettawut recommends large implants.
Breast augmentation is also extremely painful. The operation itself dislodges all sorts of tissue in very sensitive areas and makes it very difficult to use your arms. Combined with srs, this leaves you somewhat helpless the first few days after your procedures. Also, you need to do something called "breast massage" which basically consists of extreme compression of the implants to move them around in the cavity, preventing the buildup of scar tissue and providing a space for them to settle naturally. You would be well served to find a general web site on breast augmentation and read about the process. It's something that very few trans-woman sites bother which very much.
Doctor Chettawut's Staff
The staff is very helpful and consists of Dr. Chettawut's wife Tair and two nurses. The nurses are his surgical nurses and also provide aftercare. Someone will make a daily visit to you in the hotel. You don't see Dr. Chettawut other than a few times though. You will have a consultation the day before where he measures things, takes pictures, and you agree on an approach and if you're having them an implant size. He will then visit you post operatively a few times and unpack you. After that you won't see him for two weeks until you are ready to leave and then he'll check the internal healing, douche you, and take more pictures.
The staff speaks English well enough and will help you arrange for things. They are not a personal care service though and unlike something like cocoon house you will need to have a reasonable ability to fend for yourself. For example, you'll have to take care of your meals and other personal needs. This can extend to some of the items needed by your recovery. For example, we ran out of condoms and were given directions to walk to the 7/11 to get more until they could stop by with a full resupply. On the other hand, when we were not able to walk, they were quite willing to pick them up for us. It all seems reasonable, just remember, they're medical staff, not tour guides.
Hospital
Recently Dr. Chettawut switched from the Vibraham hospital to the Piyavate. This is the same hospital that several other SRS surgeons use and it is oriented more towards non-Thai patients than the old one.
There is a good selection of English language television channels available in the hospital, but they do not have internet access. And there is a cafeteria and flower shop on the premises. It is a bit further from the Baan Siri than the Vibraham and if you are visiting other patients, it can be difficult to take a cab as they don't want to drive that far.
The below are my observations about the Vibraham. I'm told that the Piyavate is an upgrade in most ways with more modern equipment but the same high nursing staff levels and quality of care.
I have absolutely nothing but good things to say about the hospital. (This was pretty much opposite to my experiences in Davies Medical, San Francisco for FFS.) The nurses are very kind and attentive and there is an absolutely incredible nurse to patient ratio. (We counted as many as nine nurses in our room at once.) I felt like I was very very well cared for.
I had two issues with communication. Both were quite unpleasant, but neither was in any way life or health threatening. I had a horrendous attack of acid in my stomach (seems to be a personal reaction to anesthesia) and it was unclear whether they didn't understand the issue or they were getting permission to medicate from my doctor, but getting medication was delayed. To be honest, they didn't medicate me for the same issue any faster in Davies, though at least there I knew that the issue was a refusal to treat without talking to the doctor rather than a lack of understanding. However, by the time I got an antacid, I was literally holding my stomach in pain. I had a similar problem with communicating my needs when I had some severe back pain after being in hospital for several days. It was a fold in an air mattress digging into my back and while they understood I had back pain, communicating the intricacies of exactly what was causing it and the idea that there was a very simple solution for it rather than general pain medication was difficult. One thing we learned from this is that if you can't get what you want, page and ask specifically for an English speaking nurse. They will find one. And I never felt that they didn't care or didn't want to help or that they had forgotten me.
The food is adequate, which is obviously a huge improvement over any US hospital where the food is something that a court at The Hague should look into. Once you can eat solid food, there is a reasonable menu with a good assortment of things to eat, including a few western meals. I'd suggest sticking with the Thai choices. If you don't like anything else, there's always fried rice. We were on liquid diets and were able to obtain milk and juice on demand. The menu has prices, but ignore them. It's all covered by your SRS fee.
If you are paranoid about medical issues, you might not feel the same way about the hospital. There were some obvious minor staff mistakes. We were offered solid food once when we were supposed to be on a liquid diet. Both of our ages were incorrectly listed (it's hard for me to be upset at being thought of as 28 though). They do not obsessively look at your bracelet before they hand you an aspirin. (They do check the bracelet and confirm your identity verbally before taking you off for SRS.) The hospital was also not a wastefully costly model of plastic and fibercloth disposability and technology that a modern US hospital is. There were no machines that go bing. Sheets were occasionally worn or patched. And actual cloth was used in the OR and it showed occasional wear or patches. It also obviously clean and sterile and was never handled with anything other than forceps when they were spreading it on a gurney for me to transfer too and they made two transfers of gurney in order to assure a sterile environment. BP and temperature in the regular hospital room are taken with a manual pump BP meter and a non-electronic thermometer. The IV used a pure gravity feed rather than the electronic pump you might see in a US hospital. I have no issues with any of this, but if someone, particularly a relative who is coming with you, has fears about some type of third world butcher shop, they could find enough differences from a state of the art US hospital to (incorrectly) feed their imaginations. The hospital is certified. It's safe. These are simply examples of appropriate inexpensive technology combined with a cheap work force. (The cheap work force figures in with some issues of disposability. It's cheaper in the US to buy disposable than it is to sterilize. Here workers are inexpensive to hire and reuse becomes overall cheaper.) And really, can someone explain to me what exactly is wrong with a gravity drip IV for someone with very routine surgery? (And really SRS is pretty minor and routine.) Seems to work quite fine, but that's the kind of thing that terrifies some Americans. The addiction to unnecessary technology is one of the reasons our health care system is so expensive and performs so poorly. It's also why SRS in Thailand is $5500. Frankly, I'll take Thailand on this one. I'd far rather have 9 nurses than nine machines that go bing.
Communications with the outside world in hospital are dreadful which is the only real downside to the hospital. There is officially no internet. I spent God only knows how much time trying to get into one of the wireless ones I could detect. I even guessed the right WEP key and IP scheme for one, but could never find a gateway. A friend who went six months later was able to occasionally get online with a wireless connection. Whether there's a new network or this was an anomaly of particularly good reception I don't know. Phone service is ludicrously expensive and is performed through an operator who places the call for you. When I had difficulty reaching my partner and instead went to her voice mail this became an issue because they didn't put me through to the voicemail unless I asked at which point I had missed all the prompts to leave a message. They will also not put you through to calling card services.
Hotel
We stayed in a regular room at the Baan Siri Rama Place (http://www.bangkok-hotel.com/), which is the cheaper of the two hotels that Dr. Chettawut has arrangements with and the one most patients stay at. It is roughly $30 a night. And with a few phone calls, internet, and food, our final bill was a bit under $50/day (total, not per person). It seems to cater to hostelling backpackers, a few Asian tourists, some very desperate looking tech startups on business travel, and transsexuals who are seeing Dr. Chettawut. Spending a lot of time in the lobby chatting on the internet, I also noticed a few working girls going upstairs with clients, but they're not hanging around the lobby or otherwise obvious and they are all adults.
It's perhaps 20 or 30 years old and it's nothing fancy. There was a small water stain one place on the ceiling (given the downpours we saw I'm not surprised) and the rooms show a reasonable amount of wear and tear. However, it is quite clean and the staff is extremely attentive and helpful. It's just an aging place that's seen better days. But they make the most of what they have. In addition to the hotel, they have a number of bungalows on the site. These seem very appealing and are in a gardened section behind the hotel. They don't seem to be a great deal more expensive. We didn't get to see the inside of any though.
The rooms have a double bed or two twins and private bathroom. There's a couch and two comfy chairs and a small coffee table. They're good sized. All in all, it's not bad.
The bathroom has a normal US setup with a shower that is usable (ie, the showerhead is not located at chest level). The water from the faucet isn't drinkable (it isn't anywhere in Thailand). Towels are provided daily and there are the usual itty bitty soap and shampoo sets.
There is a tv with AV inputs and satellite television. The TV receives several English language channels including HBO Asia, a channel of mostly reality tv from the US, a channel of US sitcoms, BBC World News, CNN International, CNBC, ESPN and Star sports channels (sports offer a reasonable selection that's obviously heavier on world sports, but we were able to watch the Red Sox-Yankees game on ESPN live from New York (live baseball at 7am, gotta love it) as well as the UEFA Champions League final). There's also a third sports channel in Thai. You can rent a DVD player, I have no idea about DVDs or what region it plays (we had DVD compatible laptops). The satellite goes out if there's a storm and did so daily.
There is a mini-fridge in each room. It comes stocked with 2 half-liter bottles of drinking water each day. (Tap water is not drinkable in Thailand.) You can have them add a selection of drinks and fruit juices, but we found it easier to simply go to 7/11 (walk out to the street and turn left and it's down one block) once we were healthy enough to walk. I'm willing to wager it's cheaper as well.
There are makings for tea and coffee (instant-2 of each per day) and hot water is available on the 7th floor at the end of the hall with a karafe in each room. We also occasionally stole regular drinking water from the jugs left by the hot water pot. And occasionally grabbed extra coffee packets from the cart in the hallway. I have no idea if that's kosher or not, but before we were comfortable running to the 7/11 it was what we did.
The restaurant downstairs has a menu with English/Thai and pictures. It's quite cheap by US standards with most items under $3. We generally spent between 6 and 8 dollars per person for dinner with appetizers, desert, and drinks. The food is quite good and you can charge it to your room (a 10% gratuity is included by default if you sign it to your room). They do room service, but the easiest way to deal with this once you're able is to go downstairs and point at what you want and have them send it up. (You can't really order room service over the phone, they inevitably give up and send up a waiter with a menu.) There's a piano player and violinist and the entertainment in the restaurant will seriously amuse you in an expatriot life sort of way. They do hover over you at the restaurant while you make your choices. I found it a bit disturbing. The menu is also huge and it can take a while to figure out where everything is. BTW Thai's don't use chopsticks, they use a fork and spoon. One of the better deals for the restaurant is the breakfast buffet. They have ham, bacon, eggs, and "sausages" (hot dogs actually) as well as fruit, cereal, and some Asian options. There's also a coffee machine that produces fresh brewed coffee in a sort of espresso style. And unlimited juice and milk. I found it a good way to get a lot of protein, coffee, and fruit & juice.
There's also some kind of outdoor eating spot at the end of the parking lot in sort of a beer garden kind of setup. They have what I think here are mostly lunch entrees, but they're actually a lot closer to the type of food you'll find in a Thai restaurant in the US. We found the food a lot better than inside and the portions are smaller and cheaper, so you can sample a lot more things. I particularly recommend the pork with stir fried lettuce (yes really) and the roasted items. During the day it's pretty hot, but in the evening it's actually sort of pleasant if you've been in air conditioning all day. There's also the occasional kitty wandering about. Downside to it is that you are sitting on picnic tables and they're a little on the hard side. As far as I know, there's no way to charge these meals to your room. They're not that expensive anyway. Nothing here is.
McDonalds (dial 9 for an outside line and 1711) and a pizza place (9 then 1112) make deliveries. Ask for someone who speaks English. We never had a problem with McDonalds, but the pizza place was a bit of a trial. We were never able to get a "normal" pizza but were instead pointed at specialty ones (Ocean scallop, chunky sausage, and tasty chicken-I recommend the chicken as the sausages were hot dogs. I never tried the ocean scallop but it looked good.) They also have delicious wings and sort of generic garlic bread. They had spinach lasagna, but I never tried it. There are street vendors selling food if you go out the hotel parking lot in either direction. At the time we were there, to the left near 7/11 was a spot with delicious spring rolls (raw/fresh with squid and fried with some type of meat), fried rice, and soup and if you made a right out the parking lot a very fishy smelling soup place, a few spots with roasted meats (mainly duck), and a bakery vendor (pigs in a blanket seem quite popular here) about 10 minutes to the right. The street vendor food is delicious and ludicrously inexpensive. (3 spring rolls for 25baht or about 70 cents).
There's a supermarket "Jesco" down to the right. It's at the very end of the street. It's walkable in about half an hour, but your best option would be a taxi, particularly post-op. (For taxis, the 'taxi meter' taxis run on meters so you don't need to bargain and they're everywhere. Have the front desk call one for you. And you can find them near almost every shopping area.) It's the plaza with the McDonalds in front. If Tair pointed out a plaza to you with McDonalds in it, this is the same one. The pizza place is in the same plaza as well. If you go there early in your trip to pick up something at Jesco's it might be a good idea to grab menus from McDonalds and Pizza Company. The Jesco plaza also has a separate pharmacy in the strip mall section. And if you are looking for western style food, there's a place that I think is called "13 coins" (if I figured it out right) that specializes in western food and has a variety of pasta dishes, seafood, hamburgers, and even US sized steaks. It looks small and plain and a bit low rent and has the words "STEAK" and "SEAFOOD" painted on the outside. They have full menus in English and they were quite inexpensive. (85 baht for a burger which came with fries up to 500baht or so for a "US style" steak.) The burger wasn't the best I've ever had, but it's a real burger not a McBurger and it's a bit of home. There's a few oddities, a chili burger isn't a burger with chili on top, it's a hamburger with Thai chilis embedded in the burger. It was good, in a hotter than volcano sort of way, but not what we were looking for. (Oddly after returning to the US, I've found myself craving one of these chiliburgers.)
Secon Square is a giant shopping mall. It has an extensive food court and includes US based chains McDonalds, Dunkin Donuts, KFC, and Sizzler. There are two pizza places and both were recommended by a friend. Her husband is Italian and she's American. She says one of the places is very American style in pizza and the other very Italian style. There are also a lot of Asian places with soup or Shabu Shabu (they bring a pot of boiling water and you dip thin pieces of meat and veggies in to cook them--if you saw Lost In Translation it's the restaurant type they were making fun of). Some of the Thai food shops in Seacon work on some kind of confusing coupon system that we didn't bother to figure out. Unless you're teeny, you won't be able to shop for clothes. They're beautiful, but Thai women simply don't come in US sizes. I doubt if you could find much there over a size 6. It also has a Tesco-Lotus superstore, which is rather like a Wal-Mart with both groceries and department store goodies. In general, if you can't figure out where to get something, this is the place. Going to a shopping mall seems like kind of a silly thing to do in a foreign country, but I felt like it gave me a sense of where people were at.
Phone calls to home from the hotel can be dialed directly, but are expensive. You can also pick up phone cards on the internet before you leave that make calling a lot more reasonable. Google "Thailand calling cards" or "Hatari" card. I used www.callthai.net and their current prices (9/06) are 1 cent US to Thailand and 10 cents Thailand back to the US. The Baan Siri hotel is a Bangkok exchange number, which is separate from the rest of Thailand and cheaper. There should be a book in your room explaining all the dialing rules. We used mostly internet to keep in touch with home. Since the time difference is 11 or 12 hours, depending on US daylight savings, most of the times I thought to call my partner, I remembered were the middle of the night for her or when she was at work.
Another possibility for making phone calls is Skype (www.skype.com), which is a voice over IP phone service that most importantly, through "Skypeout" allows you to dial out to real phone numbers. So you could hook up a headset to your laptop and call US phone numbers for 2.1 cents. Or someone could call your hotel room in Thailand for 6.2 cents a minute. The downside is if you are calling home, high speed is only available in the lobby. Still I met a young IT entrepreneur there who was chatting with his family back in the People's Republic of China.
One option that most US residents will not have is cellular phone service. The sad reality is that the US uses several proprietary systems and the rest of the world uses one. You will also, should you choose to go shopping, see a variety of inexpensive handsets far superior to anything in the US. Oh, and lots of cheap generic third party ring tones, graphics, and so on. The one exception is T-Mobile, which uses the world GSM standard. You can pay excessive prices for roaming service, but I understand you can also get them to "unlock" your phone so you can pick up a temporary SIM card and use a Thai carrier. But for most of us, our phone will sit on the "searching for system" screen and go nowhere.
Internet is available in the lobby. There's a small network of virus and adware infested machines for you to drive yourself insane trying to use. They have a variety of messengers and web browsers and seem to have no protection against installing anything else you want (and lots of things you don't). Or you can bring a laptop and simply steal a network cable from the machine closest to you. Internet access is 100baht/hour. There was only one morning desk clerk, whom we dubbed "The Net-Nazi", who actually ever charged though. Once we figured out which one it was, we just scouted the lobby first. I don't think we were the only ones. I've been told since that they are more aggressive in making sure to charge you. But still, your mileage may vary.
They will tell you that internet is available in the rooms, but this is not quite correct. They will wire a second analog phone jack to your room on demand. But you will need your own dialup connection. You can apparently obtain internet access cards at some of the stores in Seacon Square. If you're going alone, I would very highly recommend this idea since it would be nice to chat with friends.
Voltage in Thailand is 220 and the outlets are dual use, so you can use US style plugs as long as the appliance has a 110/220 switching power supply. If you bring a laptop you should not have a problem as almost all have autoswitching power supplies with one exception. The outlets in the hotel are old style ungrounded and only have two prongs and you will need one of those adaptors to plug a three prong grounded plug into a 2 prong outlet as many modern laptops have the three pronged varieties. Nothing "foreign" here, just the same old one you find at the hardware store for use in older homes in the US.
Around the corner to the left and a block down is a 7/11 and a bank where you can change money or get it from a credit card or bank card through an ATM (though it's easier to just do this when you arrive at the airport). If you didn't get them ahead of time, you can buy phone cards at the 7/11.
The hotel staff can arrange for guided tours and such. Or pretty much anything else you'd like. For a place that looks like cheap chain motel, they provide concierge services that you would never see in a place of this type in the US.
One other warning for those of you who pass or generally live in stealth or aren't otherwise part of the transcommunity. The 8th floor seems to be entirely Dr. Chettawut territory and the vast majority of western women we saw in this hotel when we were there were transwomen who are often not looking their best (I know I didn't) or are entirely unpassable. The result is that while everyone is utterly polite, you do become aware that virtually everyone you run into on staff and generally among the other guests has figured out that if you're white and female, you're trans. Both my companion and I are Dr. O graduates and live in functional stealth and having people walk into the restaurant, instantly clock us, and say hello as a fellow patient took more than while to get used to. On the other hand, among guests and staff, I never got a second glance in any cruel sort of way. It's just that you know they know and if you're not used to that, it can be a very disarming experience. Don't knock it though. It's also your best way of getting information about the area and what's going on with you. We'd never have found the pizza shop or the 13 coins restaurant without our English friend.
General Tips
Airport:
Honestly, the first thing you will notice is the smell. Thailand smells like Thailand and you will notice it because you're not used to it. Eventually you won't notice. Customs was super easy in Thailand. You go directly from the plane to a passport check. Directions are in English as well as Thai. You will have been given a card to fill out on the plane. Wait in a short line. They stamp your passport and let you in. (I grieve somewhat that my little stamp will be lost when they swap out my passport for a permanent one.) You collect your luggage after customs and there was no inspection. You then walk through the "nothing to declare" door and into a large lobby where you can (and should) change money. At the end of the lobby are about 5000 people with signs, one of whom is Tair. For return, you will be provided with a letter from the doctor that you can exploit to get extra space on the plane, wheelchair rides around the airport, preboarding, and all of that if you choose. In my opinion, it's not necessary. Frankly, the idea of standing is a lot more appealing than sitting. Leaving was a little confusing. You go in and your checkable luggage is xrayed and the zippers are sealed with tape (I assume that's a drug smuggling thing). Then you check in. And then you go to customs-make sure you fill out the little card that's stapled in your passport. And then on to the usual security check and your flight. See below about code sharing flights and make sure Tair has all the information for your flight.
Companion:
You will want to bring a companion if at all possible. This is not so much so they can help you out with things, though that is certainly helpful to have. But it's more to simply keep you sane. Our situation of two of us going and having surgery together worked quite nicely. Quite simply put, the nurses visit for about half an hour and that means you will be alone in a very foreign country for 23 ½ hours a day and the recommended stay is three days prior to surgery and 3 weeks after. This is really longer than you can endure alone. One friend who tried it alone discovered that in the end, it would have been cheaper to pay for a companion than the amount she spent on telephone calls home. Don't forget that unlike a business trip or tourist trip, you will be in the hotel or hospital alone virtually all of the time. You have a very limited mobility. For the first week back in the hotel, sitting clothed in the lobby for an hour to chat with my partner on the internet was quite taxing. Clothing is another issue with bringing someone, ideally you should have someone with whom you are comfortable being nude and taking care of personal care issues around. Your life revolves around things like what direction your pee goes in or how deep or difficult your dilations are. It's ideal if the two of you are comfortable enough to talk and joke about these things. And it's just not comfortable to be clothed for the first week or so back at the hotel and it's not really practical to put up any sort of divider. If someone didn't want to see you dilate, it would be very difficult. Also, some male companions, even those comfortable with a pre-operative woman as a romantic partner, might have issues with the level of female TMI.
Packing
You don't need to pack much. In all honesty, we spent most of the time nude except for our bras and got dressed only to go out of the hotel room. I read ahead of surgery that skirts were virtually required in Thailand. That isn't the case around the hotel. Thailand is a very formal country and most women over 30 were in skirts, but they were also what I'd consider in fairly formal clothing styles. I'm not sure that the casual skirts I had were any more acceptable than jeans. And there were plenty of young women in jeans. Thailand is also a very hot country. You want lots of cottons and linens. Don't even think about wool. The AC in our hotel was unpredictable and cold, so you might actually bring a cardigan or hoodie. You won't need PJs after surgery because you'll prefer to sleep without bottoms. (Bottoms, even just panties, will just irritate your new labia)
I was told to bring dozens of pairs of undies. Neither of us went through very many though. In terms of recovery. I would bring a large package (ie, 24-36 count) of pads (you don't need absorbency, but longer length is important and I strongly suggest the winged type as they won't irritate your sutures as much), a few dozen condoms, an extra tube of KY.
If you're having your breasts done, bring 3 or 4 cotton sports bras. I found mine at KMart, but I'm sure most discount stores have them. You don't want a real heavy compression sports bra, just a multi-size cotton one. They're good because they're generally comfortable (important since you wear them 24 hours a day) even if snug and they adapt to a range of cup sizes. And they're usually inexpensive.
In addition to the usual bathroom items, I'd consider bringing a small bottle of laundry detergent. I was short on bras and ended up washing one out a few times during our stay using soap and water. Tossing some things for indigestion and diarrhea wouldn't hurt either. And a bottle of Tylenol and not a small bottle. I did not find the pain management (tramadol) to be particularly great and mostly took the Tylenol. There was one point where I ran out. Also consider a packet or tub of babywipes. It's easy to run out and you'll use a lot. And you might want to buy one of those rubber inflatable donut things to sit on. Frankly, I find them to embarrassing to use in public, but YMMV.
A laptop with a DVD player or a portable DVD player will wonders for keeping your sanity. If you have the right connectors, there are RCA jack inputs on the television. It'll also do a lot for your internet access as compared to the virus laden machines they provide.
I have a Dell DJ (an i-pod clone) and I can't tell you how nice it was to have (virtually) my entire music collection available to me. If you are at all considering one of these and can afford it, get it before you leave and load all your CDs onto it. You won't regret it at all. You can obviously transfer your music collection to a laptop as well, but the ipods are so convenient and they're also easy to use on the plane.
I read 3 books and consumed 4 magazines cover to cover. Light and amusing is best. You aren't going to be up to a lot of deep thought and what deep thought you do get up to is likely to be about transition. I brought a fluffy fantasy romance and that turned out to be perfect. Humorous books and DVDs are great, with the exception being that all your parts jiggling while you laugh can be tough for the first few days.
Flight Arrangements
The doctor will give you a letter that you can use to get extra space on the flight back. This most likely means they'll sit you in the emergency exit row or in an empty area where you can spread out. (One friend was given an entire 4 seat middle row of a 747 on her return trip.) Of course, if the flight is packed they can't give you seats they don't have. I picked up a hint from seatguru.com before leaving that turned out pretty nicely. At the rear of a 747 are 3 rows of seats where the fuselage starts to narrow, in these rows, the window sections have 2 seats and extra space where the third would normally be instead of 3. If you are with a single companion, you can book these for no additional cost and they give you a lot more space to spread out as well as not needing to share with a third. Just don't get the last row unless you want to get intimate with everyone using the toilet.
I would strongly advise cutting out any unnecessary layovers and flight time. This is a very very long flight. From the US, the flight to Thailand is generally from the US to Taiwan or Tokyo and then a second leg to Thailand. If you're on the West Coast this isn't as much of an issue, but on the East Coast, you'll usually end up taking a third flight to LA or SF. That can really get crazy. Most of the airlines that service Bangkok are also not going to be found on Expedia or Travelocity, so check out their sites directly. There's a number of foreign carriers that operate cheaper and easier flights with far better service than US carriers. Thai Airways, Eva Air, Singapore Air are all contenders. They're comparable or cheaper in cost to US carriers and each has it's own specialty. Eva offers a super-economy class that offers business class seats at economy prices (and economy seats for ludicrously low prices). Singapore has laptop power at all seats and wireless internet. The service and food on virtually any foreign carrier is superior to a US one. And so on. East Coasters can also fly via Europe which cuts around 4 hours flight time as compared to flying to the west coast and then across the Pacific. Other than British Airways, I think you'd have to book two separate flights though and transferring between different airlines might not be a great deal of fun.
Many carriers are partners with other airlines and share flights. This is particularly true of booking flights with a US carrier to Asia, but it can be true of any airline. For example, one of our British Airways flights was actually Qantas. Sometimes these flights are only listed by the Bankok airport (BKK) by only one of their flight numbers and some partner airlines actually fly out of different terminals at BKK. So make sure you know what airline you are actually flying on and provide this information to Dr. Chettawut's staff so they can properly meet you and drop you off.
Oh, the rest of the world has not lost their minds with paranoia and grief and changing planes and getting through security outside the US is a wonderful breath of fresh air. No removing shoes or other idiocy. And their planes don't drop from the skies. Most of these other countries have been dealing with terrorism longer than most of us have been alive and they've figured out the difference between what adds real security and what looks impressive but doesn't do anything but inconvenience people.
Money
Leaving aside souvenir shopping. We only went through about $150 each. That mostly went for food, both delivery, eating out, and a lot of junk food and drinks from 7/11. We did eat a lot at the hotel and charged that all to the room which was put on a separate credit card and amounted to roughly $50 a day total. And we didn't do much touristing. But we were also here for almost a month. Generally speaking, people are cheap there and meat is expensive. If you don't like Thai food, you could spend a fortune on trying to find western food. Meat isn't much cheaper than the US. On the other hand, if you are willing to be a bit more adventurous and grab a few spring rolls and duck on rice from a street vendor, you'll spent a dollar or two for lunch and eat like a Queen.
There's no real need for traveller's checks. The easiest thing to do is to just bring cash. You can leave anything you don't to carry with you in the hotel or hospital safe. And Thailand is a very safe country with most of the crime against tourists being instances of fraud not robbery.
I'd advise wiring Dr. Chettawut the money for surgery btw. If for no other reason than that carrying large volumes of cash can elicit comment from customs people if you alert them to it.
Language
We tried to learn a little bit of Thai and got nowhere. But we never had communication issues. Restaurants mostly had English or photo menus. Street vendors understood us when we pointed at items. And everyone seems to understand numbers to tell you how much. Or can write something down for you. Just be polite and good natured and people in Thailand are wonderfully friendly.
Request For Comments
Our experience is our own, but I would like this to become a more complete guide. If you have been to Dr. Chettawut or Thailand in general and have anything to add to this guide, please write to me (kathygnome aat kathygnome dott com) and I will add the information.
Created on 02/14/2006 12:46 PM by admin
Updated on 10/19/2006 11:51 AM by admin
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