This file is a transcription of the initial information provided by Dr. Eugene Schrang in response to inquiries about SRS or other related surgical procedures. The information here was received in November 1992 and was known to be valid at that time. This information is strictly for review purposes only, it does not constitute an endorsement, and any additional questions or clarifications should be discussed by consulting with him or his staff. The letter makes reference to a map. It was impossible to incorporate that item into a text file. Reference is also made to a consent form being included with this document. It was received, but could not be located at the time of creating this file. Feel free to contact the office of Dr. Schrang for original or current copies of these documents. Only minor punctuation was corrected.
This document was set using WordPerfect 5.1, courier 10 cpi font, and then converted to ASCII for compressing and uploading. The filename was designed specifically to provide for adding subsequent information or comments to be titled serially for reference purposes. Any additional information or experiences are always important and hopefully will be added, but "please consider" using the same basic format of 6 letters and 2 digits NAMEXX.01 filename with just a sequential number if possible.
Transcribed by T.J. Stockus 11-14-92
text: ***************************************************************** Eugene A. Schrang, M.D., S.C. Plastic and Reconstructive Surgery Phone: 240 First Street office: 414-725-6661 Neenah, Wisconsin 54956
This letter is intended to present you with the most pertinent information you will need regarding your transsexual surgery. It is meant to be informative about our requirements, our monetary policy and all of those things that will be necessary for you to know about your operation. Keep in mind that everyone's experiences are different and what material is presented here may not be exactly what happens to you, rather, it is intended to provide a general overview of the entire procedure.
The transgender operations are done at Theda Clark Regional Medical Center located in Neenah, Wisconsin. The town has a population of about 25,000 people and is located about 100 miles north of Milwaukee and thirty miles southwest of Green Bay on Highway 41. The city is covered by air service out of Appleton airport eight miles to the north, or Oshkosh airport eight miles to the south. The area is also serviced by Greyhound bus from Milwaukee and Green Bay. Most travel services can assist you with your travel plans.
If you have never been seen by me, you will be evaluated in my office around one o'clock in the afternoon of the day before surgery. It would therefore be advisable that you arrive either that morning or, if you wish, the day prior which would give you an opportunity to get a good night's sleep before you are seen in my office. We have an excellent hotel in town called The Valley Inn (414-725-8441) or the less expensive Twin City Motel (414-725-3941) which we suggest you consider if you are coming a day prior to your office appointment or if you intend to stay in a hotel after you have been discharged from the hospital before making a long trip home. Both The Valley Inn and Twin City Motel are located too far from the hospital to walk to after your operation. Taxi service (414-722-2888) is available, both from the hospital and from the airports. If you have already been seen by me in my office, you may proceed directly to the hospital the day before your surgery but please be there no later than 2:00 p.m. so the necessary lab work and preparations can be done before the personnel leave for home.
We suggest that you bring only the necessities which you will need in the smallest and lightest carrying case that you have. This is to prevent tearing of the sutures and damage to the new vagina following surgery. You will spend most of your time in bed and, therefore will not need numerous changes of clothes. It is suggested that you bring only one outfit and wear it both arriving and departing. It is advisable to wear something loose fitting as there will be some tenderness and swelling following surgery. Tight fitting jeans and panty hose may cause discomfort. It is certainly possible that there will be some discharge and light bleeding in the genital area after surgery. Although you will be required to use sanitary napkins to absorb the blood, there is a chance that some will leak through, therefore, dark clothes will help conceal any stains on the return trip. You will need to bring your personal toiletries and robe if you want to leave your room after you are up and around. The hospital provides gowns which you will be wearing while you are confined to bed. Personal items to entertain you such as cassette players, reading materials, etc. are suggested but we strongly recommend that you keep your baggage as light as possible.
Theda Clark Regional Medical Center is located on the Fox River at Lincoln and First St. and one block from my office which is at 240 First St., just north along First St. on the corner of First and East North Water Sts. A map is enclosed which should be helpful.
As mentioned before, if you have not been evaluated prior to hospital admission, it will be necessary for you to be seen in my office early in the afternoon before the day of your surgery. At this time you will be interviewed and undergo a physical examination. You will sign consent forms, have your photograph taken, receive instructions and take care of any remaining financial matters.
We must have TWO PSYCHIATRIC EVALUATIONS, preferably one by a psychiatrist and the other by another psychiatrist, psychologist or recognized licensed worker in the gender or sex oriented field. You must understand that the final evaluation to determine your acceptance for surgery is done by me the day before your surgery. We would appreciate your evaluations at the earliest possible time.
Very little lab work is necessary and it can be done at Theda Clark Regional Medical Center the day before the operation. We do require a negative HIV test or AIDS test which we cannot do the day before, therefore, it must accompany the patient and must be done by an acceptable laboratory sometime during the prior three weeks.
If it is determined that you are eligible for transsexual surgery, you will be sent to Theda Clark Regional Medical Center for admission. At that time you will sign hospital consent forms, check your valuables, pay any remaining fees and get your lab work done. The hospital staff is courteous, friendly and competent and although they will be as helpful as possible, any technical questions regarding the surgery are best reserved for me.
It is most important to prepare the patient both inside and out, therefore, you will be given an enema and a thorough bowel prep to make the inside of your body as clean as possible for the operation. You will be asked to take a shower with a shampoo and there will be a perineal and perianal prep which amounts to having those areas shaved.
This will be followed by painting the middle part of your body with an antiseptic solution to keep the bacteria count down. Supper is served around 6:00 p.m. and you will be given a sleeping pill around 10:00 p.m.
In the morning you will be given your pre-operative medication which will make you feel groggy. You will then be taken down to the operating suite where a general anesthetic will be administered. You will remember nothing until you wake up in the recovery room.
Depending on what is done, the operation can last anywhere from three to five hours. If you are having additional work such as a skin graft, more time, of course, is required.
It is important that you know about a basic fundamental problem regarding the depth of the vagina. Obviously, the longer the penis, the deeper we can make the vagina - but even so, the vagina may not end up being as deep as one would like. Therefore, if future sexual intercourse is not in your plans, and you have an adequately long penis, I would suggest the standard genital procedure be done. On the other hand if sexual intercourse is an important factor in your plans for the future, but your penis has relatively little length, I would suggest that a skin graft be used to help make the vagina deeper. The skin graft comes from the area beneath the umbilicus and the pubic hair; sometimes it can be taken from the thigh. The donor site does leave a mark and is noticeable. The determination whether or not to use an ancillary skin graft would be made at the time of the physical examination. It goes without saying that if the length of the penis is more than adequate, whether or not you have sexual intercourse in your plans, a skin graft would not be considered. The shorter your penis and the greater your desire for future intercourse, the more likely a skin graft would be considered.
In the event that you would like more depth to your vagina - say six months or longer after your genital surgery - this can be done IN SOME CASES by a vaginal deepening operation and the use of a skin graft, whether or not a skin graft was already used at the time of your original procedure
While in the recovery room, we make every effort to avoid the feeling of nausea and vomiting which we do with both drugs and the administration of oxygen. You will have a Foley catheter in your bladder which may give you a feeling of wanting to urinate. This feeling will pass. Once you are awake, you will be returned to your room where you will sleep for much of the remaining day. The IV in your arm usually stays until the following day. Should you feel pain, you can ask for a shot from the nurse. Sleeping pills will be given every night that you are in the hospital.
Counting the day of surgery, you will be confined to bed for six days. For example, if your surgery is on Tuesday, you will not be able to get up and out of bed until the following Monday. Since this may seem like a long time to you, it is best that you bring reading material or paperwork to occupy your time.
Constipation is not unusual and you may not have your first bowel movement for three or four days. Of course, it will be necessary for you to use a bed pan as we cannot allow you out of bed until more healing has occurred.
Your sanitary napkins will be changed as necessary and sponge baths will be given while you are in bed.
You will find that there is a wire tied over cotton in your pubic area which will be removed on the sixth day. In addition, you will be getting up on the sixth day and you will feel weak, but your strength will recover rather quickly. A shower or bath will be allowed on the sixth day after your strength has returned.
If urination is difficult, it is because of swelling and packing in your vagina and should you be unable to urinate, the catheter will be temporarily replaced.
You will be leaving the hospital on the eighth day. For example, if your surgery was done on Tuesday, you will be discharged on Wednesday of the following week. The day before you leave, your vaginal packing will be removed and you will receive instructions as to how to keep your own vagina dilated. If you are sent home on additional drugs, they can be obtained at the hospital pharmacy but be prepared to bring enough money to cover costs. Because we have experienced non-payment of our fees in the past, we have formulated the following fee policy. If you consult with me in my office any time other than the day before your surgery, I charge $75.00 for this time and this $75.00 is to be paid IN ADVANCE BEFORE YOUR OFFICE CONSULTATION IS SCHEDULED. To avoid cancellations, no shows and people who are not serious, this fee is NONREFUNDABLE.
The basic fee for the genital surgery is $4000.00. If your penis is so small as to warrant a skin graft procedure along with the usual inversion technique, there will be an additional $500.00 charge.
Once we set a surgical date, whether or not you have bee seen by me in my office, we require a $500.00 deposit to reserve that date which is to be received in our office NO LATER THAN ONE WEEK FROM THE DATE THAT YOUR SURGERY IS SCHEDULED. This $500.00 is ABSOLUTELY NONREFUNDABLE once we set the surgery date and you should cancel for any reason whatsoever. The only exception to this would be if I determine at the time I first see you in my office that you are not a candidate for transsexual surgery, your $500.00 will be refunded. The remainder of your bill is to be paid at least one week prior to your surgery and NO PERSONAL CHECKS PLEASE.
Hospital and anesthesia fees MUST LIKEWISE BE PAID IN ADVANCE. Please have separate cashier's checks made out to each provider in the designated amount. The hospital fee is $3900.00 should be made out to Theda Clark Regional Medical Center. The anesthesia fee is $730.00 and should be made out to the Association of Hospital Anesthesiologists, Inc.
Other ancillary operations done to feminize the face, chest and genitalia are as follows:
OFFICE SURGERY HOSPITAL ANESTHESIA PROCEDURE CONSULT FEE FEE FEE --------------------------------------------------------------- Orchiectomy - unilateral $75 $ 600 $ 510 $ 340 Orchiectomy - bilateral $75 $1200 $ 510 $ 340
Labioplasty $75 $1000 $ 590 $ 375
Tracheal Shave $75 $1000 $ 315 $ 375
Submalar Implants $75 $1000 $ 550 $ 375 Cost - Implants/pair 200
Later Deepening of vagina $1000 $1950 $ 375 With skin graft
Augmentation Mammaplasty $75 $2000 $ 630 $ 375 Cost - Implants/pair 530
Subcutaneous Mastectomy $75 $1900 $1190 $ 375 (2 hr) (Female to Male) $75 $3130 $1190 $ 525 (3 hr)
If procedures are staged, such as orchiectomy followed later by SRS, the initial procedure will be full price. When the second procedure is scheduled a price break will be given; we will reduce the SRS fee by subtracting 1/2 the price of the initial procedure.
Any other transsexual operations not specifically mentioned in the foregoing (for example: Reconstruct a previous operation) will be treated on an individual basis.
If more than one operation is done (for example: Genital Transformation plus Augmentation Mammaplasty), it is customary for the surgeon and the anesthesiologist to cut the cost of the lesser procedure in half. This is NOT the policy of the hospital however; their fees are additive because they have already discounted their prices well below the standard going rates as a special favor to cosmetic and transsexual patients.
Please remember that all hospital quotations for ancillary cosmetic and transsexual surgery are for ONE DAY STAY ONLY. There is an additional $80 charge if you stay overnight; but if, for any reason you remain at the hospital longer than 24 hours, your quoted fees will no longer apply and you will be charged much more. Therefore I suggest you limit the procedures you want to a reasonable number. There is a limit to how many different operations I can do on one person at one time. I will determine how much surgery will be judicious and prudent and can still be done on a one day basis.
All fees are subject to change.
Regarding insurance - experience has taught us that insurance does not pay for cosmetic surgery nor gender dysphoria problems. There is, however, always that rare exception but since the hassle with insurance companies is so great, we ask that if you have insurance which will cover your procedure, PLEASE HAVE THIS FACT NOTED IN WRITING from your insurance company and we will then, and only then, SEND WHAT FORMS YOU GIVE TO US into the insurance company. We still ask for payment in advance and any monies received from insurance companies will be refunded to you. Lastly, please do not ask this office to send letters to insurance companies trying to convince them that your problem is medically necessary. This is just the hassle we wish to avoid. We suggest that this be done in advance of your being seen by me.
Enclosed find a map of the area and a copy of the male to female consent form which you may find helpful to read.
Hopefully the above has provided adequate information, but if not, please call our office and any one of us will gladly answer what questions you may have. It is our sincere wish that your transsexual operation will be a relatively pleasant experience - we will do everything we can to make it so.
Very sincerely yours,
Eugene A. Schrang. M.D.
addendum page follows: ***************************************************************** GENDER DYSPHORIA OFFICE POLICY INITIAL OFFICE CONSULTATION
We have established the following guidelines for setting an initial consultation with Dr. Schrang. We ask that the patient to send the following to our office:
1. Name 2. Address 3. Telephone number 4. Date of Birth 5. Name of referring physician or agency 6. $75.00 check for prepayment of consult
Upon receipt of the above, we will contact the patient and secure an appointment time for their initial consult.