Panniculectomy & Hernia repair....46 yr old

I had gastric bypass back in 2000. I have...

I had gastric bypass back in 2000. I have maintained a 150+ lb weight loss and now need hernia repair and a panniculectomy. Been having issues with my pannus since a hysterectomy in 2012 leaving me unable to get much physical activity in. I have platued at my current weight for over a year and would love to loose at least 70 more lbs. Hoping the panniculectomy will help me reach my next goal.

More hoops to jump through.

I got a call yesterday from my local hospital that I am being referred to a different kind of specialist in St. Paul MN. I guess with the general surgeon and the cosmetic surgeon got together to iron out the details it ended up being a bit more complicated than they first thought. Nothing can be simple for me. Feeling a bit discouraged.

I just can't get a break!

Well, I was supposed to meet with the plastic surgeon from this new group tomorrow. The office called yesterday to inform me that the receptionist scheduled me with a doctor who does not to panni's. Not sure why the hernia specialist aked to be scheduled with him...but they got me reschuled with a PS who does do Panni's. Thank goodness it is only a week out....i was panicking that it would be another month to get it. I was about to give up and just have the hernia repair done....it is causing so much pain I can't take it much longer.

Is it just me that keeps getting all these weird scheduling and doctor issues?

more pics

just some more pictures with the tummy exposed to show the before. hope to get in and get a new "after" soon! :-)

Panni surgery consult in 3days.

3 days until I meet the plastic surgeon for this new clinic. I am anxious and nervous. I would love to be 40 lbs lighter, but can't if I want insurance to cover the procedure. And that fact scares me that the surgeon won't want to do until I loose more...but I have a hernia that is killing me and it needs to be repaired now. If I don't get the panni at the same time it may make recovery harder....why fix a hernia only to have 20+ lbs of skin and fat pulling on it? Shoot, I can't even walk around the block right now because of the pain from the hernia.....I just need some help here. :(

feeling heard.

today I met with the new plastic surgeon and for the first time in over 4 years I feel like I was really listened to. I panicked a bit at first as the nurse said the dr will meet with me and IF she decides to do it pictures will be taken after for insurance. That comment sent my heart plummeting! The Dr came in and she was super nice and listened to me. Asked about sores, abcesses, rashes etc. Asked about the hernia. About my heightest known weight, and how much I have lost and kept it off for 14 yrs.

She did an exam and showed me where she will be cutting and lifted the panni and saw the one area that happened to be very irritated today (that probably helped my case) and showed me where she can visually see a hernia over the belly button. Told me she will cut up above the belly button and I will probably loose the belly button. I told her I didn't care...a lot of my infections are in the belly button. She was actually relieved and said that will make thing so much easier and help with healing. SO....i will be bellybutton less. But again, not a concern of mine.

She pretty much guarenteed I would have dog ears but that they can probably be taken care of in clinic down the road if needed. She also suspects that I might have a few other smaller hernias not picked up previously...so since she has me on the table wide open they will look and correct/fix anything they see.

I am feeling so much better now.

Got the call this morning

The hospital called with surgery date. The hernia specialist wants to do her part robotically to avoid having a second large incision site...so we they had to coordinate two surgeons and the robot!

Date set is a ways out...but I am fine with that...I have a date! Sept 10th.!!!!!!!

I am going to work hard at loosing about 15 lbs between now and then...the plastic surgeon said she is fine with a 10-15 lb loss but anything more than that she would want to wait till I platued a bit more. I tend to loose about 15 lbs in the summer...just because we are usually a bit busier. This year though, with the hernia I don't think I will be very active.

This also give us time because my boyfriend is facing a repair of a partially torn achielles tendon. The big problem with his case is that he only has one leg to start with ( lost a leg to cancer as a child) . So if they can get in him beginning of July this may just time out perfectly.

OMG!!!! I have a date!

time is moving slow!

This count down to Sept 10th is taking forever! I had a bit of a scare over the past two weeks....with an appointment for pain (I have fibromyligia) and needing some new pain meds but discussing that my lymph nodes in my neck have been swollen for over a month the Dr got very concerned. Blood work taken, urine tests done, throat swabs etc. No infection found.

I figured if there was some infection it is from the constant rashes or infections under the belly or in my belly button (again....loosing the belly button, sick of those infections!) Well, when all the tests came back with no answer...the term ultrasound with biopsy was used. Terrified me! Not only for a needle being jammed into my neck..but for the fear that something like Cancer could now be keeping me from having this hernia repair and Panni. Not after 5 yrs of trying to get a panni....this is not happening!!! Thank goodness the ultrasound looked fine and nothing suspisious found. (insert large sigh here) Now the Dr wants more blood work thinking auto immune...which I already have fibro....so I am not stressing it so much anymore. I am actually thinking of switching up my allergy meds to see if this years allergies may just be the culprit behind all this...and go from there.

Anyway...I digress, I spoke with the plastic surgeons office today. I called to make sure i schedule any appts (pre and post op) and was told none to be made. She won't be marking me up prior only because they are doing the hernia repair first. I am good with that...as she already generally showed me where she will be cutting. At this really is a straght panniculetomy...no lipo or anything. The surgery scheduler assured me everything is all set for Sept 10 and post op appt will be made before I leave the hospital since I am going to be admitted.

It was nice to hear her say those words again...everything is all set up. Sept 10th can'tget here fast enough!

5 more weeks!

OK...5 more weeks to go and I can not say this enough...time is going so slow! I am trying to keep busy...but when I don't work outside of the house, keeping busy is still limited. I have a little hand- made beaded jewelry and repurposed items business I have been trying to get going...and I have my first craft show this coming week-end. That has helped me in the past week with inventory and pricing etc. I am gratelful for the newest pain meds and muscle relaxers I was given..the hernia only minimally bothers me now. Biggest problem is the anti-inflammitory is causing major gas and nausea/vomiting. And I am not loosing the 15 lbs I wanted to before surgery. I think I need to go ahead and stop taking this anti-inflamitory! I have just 5 weeks to loose this 15 lbs. I can do it! I can do it! I can do it! Lots and lots of water and lean meats, fruits and veggies. Any other advice from those of you who have had surgery....what do I need to have prior to surgery. I have been thinking about clothes to wear home....most of my loose fitting comfy pants probably will fall right off without the "tire" to hold them up. I have a pair of yoga pants that might work..but those tend to "cling" and I am guess clinging clothes will be extremely uncomfy? I have a sundress..but it is white...that kinda frightens me it will get blood or something on it. LOL We have an electric reclining chair I will prob be doing my sleeping in for a few days. I am a tummy sleeper, so the idea of not being able to sleep on my tummy for a while is kinda freaking me out! Any advice for stuff I will need is appreciated.

3 weeks to go

Yesterday I had an appointment at the Hospital Wound Care clinic. I was asked to come in to make sure all rashes, infections on the underside of the belly and in the belly button are cleared up. Ironically that on the day I have to go in to have them looked at, that all rashes and infections are non existing. Thank goodness I have had taken pictures to document some of the infections over the past few months. I was very pleased to hear that both specialists thought my skin under the belly was beautiful and will heal nicely after surgery. I was given some antimicrobial material to keep in my belly fold between now and the surgery and a special cleanser to use in the belly button daily with a special material I have to put in (kinda like a stick) to keep infections away and keep the skin in there dry and hostile towards germs. LOL I have been instructed to just relax, sit back and take it very easy for the next three weeks prior to surgery.

two weeks and counting

well, one week of not doing much of anything other than sitting around and not working out. I am still doing housework...which helps pass the ti.me pass a little bit. I had my pre-op two days ago and was cleared for surgery. I was given an EKG since between the hernia and the panni it is a long time under anesthesia. The cardiologist found what they call an incomplete right bundle branch block and pulled the records from an EKG two years ago and have determined it is new. So tomorrow I have to go for an echocardiogram. At first I was extremely freaked that this was dangerous and would keep me from surgery. My physicians has assured me it is minor and I am still cleared for surgery. The echocardiogram is mainly precautionary and to find an possible reason for the change. I was literally in tears for about an hour thinking after all this I was going to be denied surgery. On the good news side...I have dropped 6 lbs and am happy I am getting closer to the "new me"

One week!!!!

It is getting closer! I went today and got supplies for the hospital stay ( face and body wipes, new slippers, travel size tooth paste). Got baby spinach, cottage cheese, yogurt, blueberries, protein bars, and individually frozen chicken breasts for protein packed meals for the next week. Not to mention I still want to loose 9 more lbs!!!! My lack of activity really has made weight loss hard! AND these insta dry sheets of material under my belly are starting to irritate me. I better not get any rashes from the irritation. Thinking I should start taking Benadryl so the irritating of them might lesson? It is hard to explain....almost like my panties have rolled down and under the belly kinda feeling. My echocardiogram came back normal, so that stress is gone :-). To think that at this time next Weds I will be done and on the road to recovery! Woot woot!!!!

question about post op personal care

OK...so I just realized that I won't be able to bathe and probably wont be able to shower for a bit after surgery. While I can pick up some dry shampoo...that stuff really only works for one day on me. My hair is so thick and long and gets greasy very quickly. Any suggestions?

wow..I am again truly amazed by the hospital and surgeons I was referred to!

So my boyfriend and I are sitting here chatting watching tv when the Fed Ex truck pulls up. We both look at each other like "who is that for?". I received a package with a note from the hospital and the wound care dept along with a note from the hernia surgeon. She send out a case of Impact Advanced Recovery Nutritional drink. I am to drink 3 a day for the next 5 days and adjust any other daily meals to make sure I get these. Again, I am very impressed by this team of care givers and medical professionals I am working with. Feeling very blessed today.

4 days and a wake up to go!

Getting very excited for Weds. I took a couple pictures to compare to the past ones...8 lbs lighter but the only difference I see in the pictures is that the gut seems to be hanging just a little bit lower now. I also got some pictures of the belly as I am laying down...so I can compare the after. You can see in the pictures the belly button is packed and the material in under the belly fold. As far as I know I will not be getting marked up the morning of surgery because the Hernia specialist is doing the hernia repair first then Dr Heinrich will do the panni.

1 day!

Didn't sleep much last night. I am bloated and a bit uncomfy from these nutritional shakes but I am following Dr's orders. Tonight I get to also drink a Clearfast and one tomorrow morning when I wake. It will help with hunger pains in the morning (along with the medical benefits), but at the same time it kinda makes me nervous as all my life with surgery and procedures they tell you not to eat or drink after midnight. Again...going to follow Drs orders and I know it will be fine. :-)

It's Here!

I have been up...after about an hours sleep! Showered and drinking my carb water I was told to drink. YUCK! Though I have had to drink worse....so I won't complain. I was nervous and a bit emotional yesterday, but this morning I woke up ready to do this! I will try to get on and update later today.

Post surg

Hurting big time...guessing more from hernia reair. Beendosing in and out. Will better update when feeling better. Hugs to all

Had some complications

The hernia actually attached itself tomy small intestines..yesterday's pain levels were off the chart. My blood pressure kept dropping and my hemogglobins too . Got 2units of blood. Still very out of it today.

Puctures

Here are a couple of pictures from yesterday. It's nice to sit in a chair without my belly roll over the edge of the chair.

Swelling

Ok....this morning I am up16lbs from surgery date. Dr Heinrich removed 18 lbs of pants. Meaning I am 33 lbs swollen? That seems a lot. Plastics was already I before they(the nurse) weighed me (on the bed). My nurse said no to go by that scale since my home scale is what I use.... Just curious if that much weight is typical. It seems a lot. Pain is manageable,my upper shoulders seem to be the worse, from using the walker I am guessing. Thank you all for all your encouragement and kind words

So upset!

Today I sent who I thought was my best friend an email that I would probably be released tomorrow. I have explained to her numerous times that I was getting rashes, infections, abscesses on my tummy and in the skin folds. That I was not having this surgery for cosmetic reasons. (Not that there is anything wrong for doing so! I fully understand that aspect of it too). She didn't ask about the complications that came up , only that she hopes I get the results I am looking for. Nothing about a hernia repair, nothing about , here's to no more infections. Just worried about the physical look outcome. Maybe I am over reacting? I have been extremely emotional today :-/
So, it looks like tomorrow is release day and I can't wait to get home. It will be kinda nice not being disturbed every hour for blood pressure etc! Lol

Home

Rough home coming only because my one drain is leaking slightly at the skin line. It has been redressed and we were sent home with more material/ tape stuff. I couldn't find it, my boyfriend continued to ask what I was looking for and I yelled at him in frustration, I felt so bad. I couldn't tell him what I was looking for cuz I didn't know the name of it. Got all calmed down, found it and used more to try and seal the tube. The binder is giving me this burning feeling on tummy, and the incisions are burning a bit too. All in all first day home not to horrible. I am still here and looking forward to what life has to bring me.

Drains

these drains are driving me crazy, the leak constantly. i have only been home 3 days and went through all the gauze and film the hospital sent home with me. my boyfriend went and purchased a box of gauze and 8 more films yesterday. as of this morning i have used over half those films. i have blood stains all over my bedroom floor and slippers and bed sheets. though i hve been sleeping in alarge leather side chair.....its the only chair i have big enough that my thighs dont rub on it. thus no pressure on the drains. my back is killong me. i could deal with the pain in/on the tummy for the most part. but the back....there's no way. i have my first post op today...i am hoping they remove the one drain that has been putting out only 15 ml every 6-8 + hours. the other one was pretty consistant at 30ml still....tho overnight it put out 100 :-(

Pictures from today

Not very good pictures, but this is the best I could do today.

not sure how to title this one.

so...this is rather personal (not that we haven't discussed personal things on here...LOL) but I am finding something that is very bothersome and kinda embarrassing. My drains are attached to the upper outter theighs and I pin them up to a tank top at my waist line. My incisions all look pretty darn good. They are seaping slightly, but nothing horrible and I keep it all nice and dry. Only thing out of the norm I can really see is that at the end of the flank part of the incision on my right it is blistered pretty good. Just one large blister. It isn't read around it from what I can see. No redness from around the drain holes...so it all seems to be fine...except this one factor. It just STINKS! The best way to describe it is that is smells like what my periods used to smell like. I am guessing I am just super sensative to the smell...cuz back befor I had my hysterectomy i would complain all the time of the smell then but my sisters/friends or even boyfriend said I was just crazy. Am I? Does anybody else have this issue?

On another note...I keep trying to download pictures from my Ipad but they wont work. I will try and take some from my actual camera later today to post. Hope you all have a beaufitufl day.

Swelling is outta control!

Even my feet are 3 times there normal size. Take a nap and go for a walk....that will help. Is everybody else exhausted after getting cleaned up and changing the dressings ( on the drains) everyday? I hope these pictures come through (it looks like they are only going up sideways,)

When it rains

Woke this morning and went to the bathroom to empty the bladder and my drains and discovered my incision was dripping/ bleeding a bit. Walk back to the bathroom to change out the abdominal pads and it was as if the flog gates opened! Blood running down my legs and dripping all over the carpet. All the surgical strips have for the most part galled off, even the ones replaces just on Friday. I have had pads taped over it instead and seemed to be doing fine til this morning. In general the incision looks good....but you can see how irritated the skin is from all the tape :-(. I must get up to pee again, and I am afraid to...lol

Omg

How did my post post twice?

im back in the hosp.

infection and a issue with fluid build up in my tummy. so i sit and wait for my turn to go back under the knife. my right sided drain pulled out yesterday, so they will also replace that.

Lucked out.

Just went to ultrasound and they numbed the belly to insert a tube to withdraw a bunch of fluid and added another J Tube drain. We shall see how the infection does and go from here

New suture vac

Had a new suture vac installed/placed today to help with the constant large amounts of leakage I was having. I will be staying inpatient for a while, if not here in wound care than they are transferring me to transitional care. Hopefully soon I will be back to taking short walks and getting a bit more energy

Sent home again

So, since I am mobile enough with a walker transitional care turned me down. I guess it doesn't matter if your caregiver is physically handicapped and can only do so much. An order for home care was put in, so we shall see how they can help. Not sure what kind of time/days a week. It is nice to be home....in my own bed, chairs, couch. So I have the one original left side drain from surgery and the one put in by ultra sound also on left side of belly. Then they reinstalled a vacuum suture also coming off the left side of the belly. This one is totally different than the one I had originally during surgery.

no transitional care, waiting on home health care to contact me.

had to go back to the wound care clinic today and they removed the suture vac and put a new one on. it keeps going off saying there is a leak and i had found it earlier and put some clear sticky film on it. It seems to get irritated by having the binder on.....so I might just have to remove the binder until later. I will see how it behaves the rest of the night. i know all the drains are an essencial aspect of recovery with this surgery, but i am getting very tired of them! ;-)

Had appt to check seroma

Was supposed to have an outpatient procedure in radiology to check the seroma and it turned into inpatient surgery that afternoon because my incision got to infected. They surgically cleaned out a bunch of puss, bad tissue and basically gave me an open wound vac. Go back to surgery Monday morning to clean out more and change the dressings. And surgery again prob on Weds for another cleaning changing. Hopefully after that they can be done bedside and not in surgery. The goodness..... No drains, just the wound vac machine. 3rd trip back to hosp since initial surg they finally put in a pic line so I don't have to be constantly stabbed for IV lines and blood draws. I have been ensured numerous times by many different Drs/surgeons that this is nothing I did or was done wrong with previous care ...it happens in like 2 out of 100 patients. I am so great full for the wound care nurse (who was actually off duty yesterday) who came to help with dressing change and right then and there said no.. You are not going home, and she went and got the surgeon on duty.

In transitional care

Yesterday I was released from the hospital and I am now in transitional care at a care facility a lot closer to home. I am hoping this isn't for too long, even though the healing of this open wound is going to take months. It would be nice if maybe after just a couple of weeks the woun d is healing enough that I can go home with having a home health nurse coming out a few times a week to pack/repack clean things out.

Friday was my first wound check/repacking while awake. It was really quite gross! I had my pain pils before hand and ironically things didn't hurt so much as the feeling of the hands in my wound/belly pulling out old foam, cleaning and rinsing out the wound. Pictures were taken and the wound care nurse showed me a couple and I couldn't take it. It really is just a large pink tissue opening on my abdomen. Again....the feeling when they were cleaning it out was just undescribable. My next change should be Tuesday here at the care facility.
It is kinda nice to be able to get up and walk and go without having to inform nurses of what I am doing. Walking down to the dining room is nice too....a bit of socialization vs being stuck in a hospital room.
I have been asked if I am mad at how things have happened. While I can't say I am thrilled, I am not mad. I was informed of the complications that can happen from surgery. I am disappointed in the break down of communication from the first time I was home and supposed to have a home nurse coming out. I am dissapointed it will take me at least 6 months for this wound to heal...but in general....I am alive. I had one serious scare after initial surgery and a few more disappointments with the infection and all since, but I am alive. I have wondered why me....but why waste my energy on that? I need to get healthy and heal. I need to forgive and move on. It was not any one persons fault this happened. Sometimes things happen. I will still be extremely hesitant to go home, when it is time, with home nursing care...only because the first time it failed the infection happened. I will get through this. I will conquer yet another hurdle put in front of me. I can and will do this!

wound change (again) with no warning!

While I can't complain that the wound changing isn't getting done, I can complain that they have changed out the wound packing and all 3 times already since being here, and with each time I am told after lunch that they are going to do it. I need time to mentally prepare for this! This is extremely gross and weird feeling to have peoples hands pulling out foam, washing out the wound and shoving more foam back in this wound. It is so gross I get very nauseated at times during the procedure. All I am asking for is more than an hours notice. That is barely enough time for the pain pills to kick in. This is also a different nurse doing it...so how can she compare how it looks now vs last time? She can't. I guess I shouldn't complain though....because they are on top of making sure the changes are done.

New pictures

I decided to take a couple quick snap shots of how the belly now looks. My nurses have told me the upside down shelf look will get better, it is currently that bad because of all the foam packed in there. I suppose I should try to take a picture laying down so you can see the wound vac and packing.....maybe tomorrow.

OK....try again with the pictures

I got them uploaded to my computer and took a couple of the actual open wound packed showing how much foam is packed in there...making that "upside down shelf" I had to call the nurse to my room to help get myself put back together cuz between the tube from the wound vac and my binder I get all bamboozeled on where to put the tubing with the binder. LOL

Been a bit blue lately

I have been here just 2 weeks now and I am feeling so frustated that I am even here. The nursing care is awesome. They are doing all the changes of the wound on time, and even going the extra mile when a leak comes up. We have gotten a schedule down for when the changes will be taking place and plans on pain meds at lunch then the change about 45 minutes later.

My nerves are starting to wake up and Lidocain gel has been ordered to help with the spots that are still "burning/tearing pain" even after the oral pain meds. Not only are the pain senses waking up with my nerves...the ticklish senses are too. While they are in the wound wiping up/out the hippacleanse they hit spots that tickle something fearce like.

As much as I try to stay positive I find myself having random crying fits. Of course only while hiding in my room or bathroom, so I am not put on some anti-depressent. That is all I need! I just don't understand why. Why I was put in this situation. I have been through so much crap in my life from childhood abuse, to abusive adult relationships, mutliple medical issues all my life (obesity, endometrosis, thyroid disorder, RLS, Fibromyligia, Degenerative Disc Disease, herniated discs, spinal stenosis, bad knees, arthritis) I have has issues with homelessness usually thanks to the bad or abusive adult relationships. Newly married at 19 my husbad was in a head on car accident 5 weeks after our son was born. I had to deal with a husband in a coma for 4 months then who was a jack ass mean SOB after the accident. He was left a quadrapoligic and I stuck it out as long as I could. A son who is special needs so as he was growing up I lost a few jobs over the none flexibility I needed to take care of him. Please don't get me wrong....I know I have had such an easier life than many others out there. I would just like to know why...why am I always being knocked back down?

I did everything my surgeons asked of me! I followed all the steps, I was very careful. How did this infection find me...leaving me with a huge open abdominal wound? How did this happen when I was on antibiotics? I don't get it. Was it something so simple as that the Home Health Care company never contacted us and never got out to evaluate me and help with the then closed incision and suture vac? It had been only 8 days. I had a follow up at the PS office and they didn't see anything on the 19th...but just a few days later on the 23rd I was back in the hospital. Again, I don't get it.
So here I am in a Nursing Home....and I shouldn't have ever been put in this position. I just wanna cry til I can cry no more.

picture of Open Wound****graffic***

I just wanted to share a picture of my open wound. One of my nurses took a picture of it yesterday while doing the dressing/vac change. It has to now heal from the inside out. My results of having a pannilectomy is not going to be very nice, While I do not have the hanging part of the gut any more....the part of the upper stomach/skin that was pulled down to make a more even looking flatter stomach is no longer. This totally sucks! The one picture shows me before the incision had to be opened (with panties covering the incision) and the other is the open wound.

What a difference 3 weeks makes!

Today I had the wound changed out again. Twice a week, every Monday and Thursday. I posted a pic of the wound previously and that was after it had been slowly starting to heal. They say that once it starts healing and filling in, it goes quickly. Well...three weeks later I am amazed how much it has filled in.

open wound getting smaller with each wound/dressing change

It is amazing how much the wound is now closing up. It is getting smaller with each change. Every Monday and Thursday are the changes. The down side is that I am still fighting a dang staph infection. Two weeks ago it was staph and E. Coli. Finshed the 10 days of anti-biotics and the E. Coli infection is gone but the culture from last Thursday still shows a Staph infection. I don't understand how it keeps coming back. :-( Below are the latest pictures of the wound.....

No more Wound Vac!!!!!!

Follow up with the hernia specialist today (who took over the case right after the panni incision had to be opened) and she removed the wound vac. Orders are for wet to dry changes twice a day. I can shower again!!!!!! I just have to remove all the bandages and hop in the shower and gently clean out the wound and let it rinse out, then rebandage. I will still be in the transitional care for a few more days as they work with me to get used to doing the changes, and until they can set up Home Care Nurse to come out. At this point I don't know to what extent that will happen...but the orders are in. I can't believe how small the wound has gotten. It has pratically filled in completely in the center...the nurse said about the width of a pencil in the center is pretty much all filled in....so it is just the sides now that have to finish up.
Dr Cherrie Heinrich

Dr Heinrich is actually out of St Paul MN. Her and her staff are all beyond what words can describe. She is professional, kind, explains things well. Her staff have all been super nice and helpful. They make you feel welcome and at ease. Being a larger gal still, I was worried about being judged still about the weight but I saw no signs of that from anybody! My post op appointment the PA and Nurse were just all out there and fun to deal with and just made me laugh. Even my boyfriend has said over and over how impressed he is with Dr Heinrich and all her studens/PA's she had with her in the hospital. When things got very scarey in the hospital the day after surgery they were on top of it and did everything they could to get me out of danger. Again, my boyfriend was impressed with how well they handled it. They have given me a new and better chance at a longer and better quality of life. LOVE LOVE LOVE them, Dr Heinrich is TOPS!!! I have not had to deal with billing so I didn't rank.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Wait times
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