My entire adult life and sense of physical self...
The plans are definitely in the works...but where are my bras???
Okay, then life happened: I could go into the details but there isn't enough space and frankly, that's not why you're all reading this (except I do want to seriously say this: I lived most of my 20s through my 40s as someone who accommodated my life for others' lives; catastrophic changes led to me being where I am today: 54 and working hard to live a true and authentic life for myself first and foremost).
My whole journey to this point has been a long one psychologically, but in terms of the actual "okay, let's make an appointment and DO this thing" seems a bit whirlwind. I went in for my annual mammogram and I thought why not ask them if they know of anyone I could speak with about a possible procedure. As someone else on this site commented, it's not like a breast clinic wouldn't see a fair number of chesticles (love that word) and would no doubt be able to offer a referral. The nurse guide spoke with me and suggested Midwest Plastic Surgery--right in the same building as the breast clinic as well as my ob/gyn, so that made things simple. Got an appointment that same week (March 27) and before I knew it: game on. After answering a few questions during intake and meeting the surgeon, I was told that my insurance carrier (Health Partners) would cover my surgery due to its medical need and the amount of reduction that would occur. Compared to many others' stories I have read on Real Self, I count myself very, very lucky. But I plan on triple checking just to make sure.
And so now I have just under 3 weeks to get my proverbial sh*t in order. Thankfully, I came across this organization and have gained a great deal of knowledge as well as insight and confidence into not only this procedure...but the myriad needs for wanting it done. I am NOT alone and for that, I am so truly very grateful to you all.
Less than three weeks to go...am I ready?
First, I asked my S.O. (at 54 years old, I can't bring myself to say 'boy friend' but we are not married and partner sounds so...clinical, so Significant Other will have to do for now) tonight about how he felt about "it" all and pretty much got the standard guy response--supportive but, you know, yeah, you'll feel better, but you should do what you feel is right... He is an engineer and he admits that this is how he sees most things: practically and pragmatically. After prodding and being upfront about saying what I am going to need during this time (at this stage of my life and with my track record, I have learned that it is better to be clear and direct and not wait for Nora Ephron to write the script for your conversations), he finally admitted that he felt like he might be facing a trap: he did not want to say that having a reduction would improve my figure because he didn't want to make me feel he didn't care for my figure in the first place, but he also didn't want to say having it done wouldn't matter because he didn't want to sound like he didn't support me in this. And it was very edifying and helpful to have him admit this. I told him that it was important to me to have his support in all its various guises (but, being an engineer and not prone to bouts of romantic folly as am I) I also said I would need the occasional hug during this emotionally precarious time. We agreed that he would do that for me and that I would need to understand that part of the way he coped was to think like an engineer ('Doing this will make you feel better, so there is every reason to have this done'). I think we still need to talk about some of it so that I don't have what will obviously be an emotional time exacerbated by any misunderstandings, but it was a start. So there's that.
I have gone shopping for bras and button front tops these past couple of days; tops are fairly easy to source, but the bras are giving me a challenge. I look at the ones without underwire and with a measly C or D cup and I just cannot fathom myself wearing one of them... plus, none are front fastening, so I need to keep searching. I am narrowing down the choices for the 'investment' bras, based on the feedback and commentary found on the RS reviews, but it's those after-the-fact ones that I will need to wear from about the second or so month onward that I am looking for. I have plenty of time, but being a Capricorn, I like to be prepared.
That's another thing: preparing for food, cleaning and all the rest of it for my first week or two post-op. I know from reading everyone's reviews that my appetite will be lessened but that I will need to eat something that is to help me with rest and recovery, so I need to prep all of that out. I also want to ensure I have thought about all of my other needs and placed things so that it will not be detrimental to my recovery to access them. Why is it, then, that I am feeling so overwhelmed by it all that I just don't do any of it? I am waiting for this coming weekend to put some of it together and will finalize everything the weekend after that (the weekend before my surgery on May 9). I also have to make sure that all of my lessons are in order (I am a teacher--and this is a busy time of year as one can imagine) so I am feeling a bit stressed out at the enormity of it all. Trying to 'chunk' it out bit by bit but every now and then the waves hit me.
Is it weird to just want someone to cluck and fuss over you? I feel so selfish thinking this way because after all, it's not like I am having some sort of procedure to save my kidneys or because of cancer... My partner thought my discussion of it was me 'freaking out' about it all, but I tried to tell him that it was rather normal to be caught up in thinking about something that could radically alter the way you felt about yourself. He replied that it was hard for him to truly empathize because there really was no male equivalent for such an experience (his analogy was a guy going from having a sporty race car to driving a van...after I gave him The Look, he conceded it was a sh*t analogy but pointed out that part of him just was incapable of truly understanding what I was going through).
Good Godfrey, this did turn into a pity rant...but I'm not going to delete it because I need to address it and this is a great forum for helping me work though these feelings. So, thank you, RS community, for allowing me the opportunity.
If you are healing, then peace and love to you. If you are preparing for May like me, then I send you even more peace and love as you continue toward your surgery date and is beyond.
Two weeks to go...
The roller coaster of emotions has begun
Apologies for the pity party, but I really don't have any other venue for my thoughts right now.
Retail therapy...works for me!
Just when I thought it was safe...
And now for a bit of comic relief...
So now for something completely different.
I got one of my post-surgery bras in the mail today; it's the MariaE and it was the middle of the range price wise, about $30. And, of course, I tried it on, knowing it would be weird. Yeah, I'll say. First of all, no underwire. I haven't not had underwire in my bra since...um, since...well, NEVER. And because there are no cup sizes, you just order your band width, or thereabouts. So this was a Large, because my band size is 38 to 40. And do then, I just had to stare for a while and take it all in... I asked S.O. to see me in my splendor and his response was, "Well, it's not revealing if you can't see a nipple." Oh, I chuckled heartily at that--and then I smacked him and told him to take these photos. Obviously, I will post more when I have had my surgery and see how these actually fit, but until then, to think that these will be the size I will wear in future is pretty gobsmacking.
NINE MORE SLEEPS!
Pre-op Appointment: Done!
Here's the best part: I can take a shower the day after the surgery! If all goes well, then I am able to remove all of the bandaging from the surgery and take a shower with the strips over the incisions. Obviously I won't soak myself silly, but it will feel so good (physically and mentally) to shower! So good news there!
I will do the rest of the shopping prep this weekend: easy to digest foods that will help with getting my bowels back in business, build up my stamina and frankly, just make me feel better. The S.O. is a good cook but his sense of time is not always in sync with the rest of the world's (tonight is a case in point: came home at 5:45 pm today exhausted and sore and said I needed a nap; he was free to start dinner. When I got up an hour and a bit later, he hadn't started, hadn't even thought about it, so engrossed was he in his work...we had dinner at 8 pm). So I think I will need to make it clear that proper meals are to be made and that we will have to follow some sort of loose schedule...
I got my two other bras from Amazon today: the Marena and a "Lady" something or other; the former is the expensive one (not really, compared to what I used to spend!) and the other is the least expensive of all ($14). I tried both on for comparison and same story as before (duh!) but I feel that they will actually be comfortable in the long run. I still can't fathom having the girls actually fit within those scant little pieces of cloth, though!
It has been wonderful to read about those who have just had their surgeries or are on their way to have them: good luck to you all and hope to hear more about your recovery! And for those who are post-op--don't forget about us and keep letting us know how things are going for you--not only do we care and send you joy and good wishes, we continue to learn from you and gain comfort in hearing your stories.
Waddya Mean I Only Have Two Days Left?!?
It also did not help to find out that things were not as rosy in the financial department as I'd first thought. Thanks SOLELY to this site and learning from others within the RS community, I made it a point to call the surgery office to make sure I was not going to have any surprises after my operation. Turns out that when I'd been told during my consult that my insurance company (Health Partners) would cover it, the nurse who was in charge of patient liaison or whatever neglected to include a few things like the four different billers who would want a piece of the insurance pie (anesthesiologist, hospital, lab work and, of course, the surgeon's office). So not only did I get a bill for $180 after the consult, I can look forward to watching these four entities fight out who will submit their claims first...and when the dust settles, I will have to pay the reminder of my deductible (which is about $1500 out of a $2400 annual amount) and then after that, the insurance kicks in and covers the rest...oh, at 80%, not 100%. Actually, in point of fact, that could all be complete horsesh*t, because I really couldn't follow much of what she and then later, what my insurance company was saying. I think it will all come down to paying about $1500 all up and thereabouts...at this rate, with my deductible paid, I might squeeze in a tummy tuck and face lift before the fiscal year is out...
So, lesson to those who have yet to deal with all of the financial hurdles: ask for all the information so you know that nothing will surprise you. Shock you, yes, because of how much you still might have to pay, but at least you'll be ready for it. So, once again, thank you Real Self community.
So, yeah, here it is, three more sleeps before my procedure and I feel like I am not going to be ready until Dr Ruebeck starts applying the texta markers to my chesticles. I took others' advice and got my prescriptions filled, including my normal stuff. I've done most of the shopping for the bras I'll need (please see hilarious photo shoot, above) for the first week or two and have button front tops and pi's. I started to go a bit silly buying tops and then realized I could just wear the SO's if I was just around the house, so that money can be saved for later purchases. No, wait, I'll have to put it toward the damned deductible. Grrr. The things I really haven't done are planned food or menus. It's a VBD (Very Big Deal) to have the SO think ahead and plan and make food (once again, eating at 8 pm tonight since I had a meeting until 7 pm and left him in charge...) so I don't know how things would go if I just left him to his own devices. But who knows what the appetite will be like after surgery?
No, that's not a rhetorical question; who out there can give me some input on what to expect?
Still fighting off some of the rotten voices in my head stuff that tell me I'm too fat in the bod for this all to make a difference anyway, or that they won't be better just because they're smaller...all that junk that I know rationally is ridiculous but still freaks me out somewhat.
Is it crazy to have part of me looking forward to having a bit of time to just retreat from the world while I recover? I can sense there will be some psychological re-building, as well.
And, yes, the fact that I will be only two days post-op on Mother's Day...not sure if I will be weepy and want the progeny nearby or if I will be weepy and want the progeny far away... I want the fuss and TLC, but don't know if I will get it.
How wonderful it is, though, to read the updates and the responses and the comments that flood this blog site! When I opened up the email tonight there were over 50 notices of new mail and nearly half of them were Real Self folks staying in touch with everyone and giving encouragement and kudos on the great recoveries everyone was having or reassuring them that things were going well... So now that I have updated my review, I'm going to go to the 'community wall' and start posting on others's reviews to let them know how much they mean to me. That's YOU, you know! xo
Two More Sleeps
Practical matters: based on suggestions I have read in others' reviews, I measured my bust pre-op. First, I measured standing up and then leaning over at the waist to measure around my back and across the front of my bust. Standing upright: 40 inches; bent over: 44 inches. I am not sure when I will be able to measure post-op to compare, but I will and will post to help others see that it is a true and quantifiable difference.
Interesting how the mind works: we see ourselves in the mirror and become so accustomed to what we see that we accept the normality of it. And in a way, we should; we are all beautiful in our own unique ways and need to work diligently to not compare ourselves to the unrealistic examples being passed off as normal by the mainstream media. However, when we see ourselves through others' eyes, e.g. in photographs or reflections in windows, it seems (to me, at least) like it's a different person than the one to whom I've been accustomed to staring back at me in the mirror. It's like someone said: we get used to it and then when we see a photo, we realize: no, this is not what I want, this is not it at all.
I can't wait to burn my bras.
THIS IS IT!
My nerves were all jangly, like so many chains.
I'd read all the entries from those who'd gone first,
I knew this decision would not be my worst.
The meds were all stored in the bathroom with care
In hopes that their benefits soon they would share.
Button front p.j.'s and loose fitting pants--
All to ensure that my comfort's enhanced.
Bras that would fit me and keep me in tow
Were nestled and lined up in cute little rows.
Pillows and chairs that reclined were all ready
And, for the most part, my nerves were all steady.
Some wobbles at times--a tumultuous week!
Emotions had finally come to a peak.
Wrestling with feelings I'd dealt with for years
Were finally getting checked out of arrears.
Fortuitously I had learned of reviews
That were written by those who had walked in my shoes.
Their words offered comfort, advice and good cheer
Which gave me support as my surgery grew near.
And now on the eve of my hoped for reduction,
I say to my friends, "It is through your production
of stories you've shared of the roads of your own
That this journey I take is not taken alone."
So, yes, it's the night before my surgery. Incredible that it is finally here! Didn't think it could come and then when it did, it's almost seemed to come too quickly. Am I ready? Did I prepare enough? Is it the right thing to do? Of course it is! Will work survive without me? How will I be able to recover? All those questions and more are coursing through my head, but there is a calm at the center that is helping me stay focused. For those who read this who have a way to go before their surgery date, keep reading and sharing and learning from those on this site and the support networks in your lives; for those who are healing and recovering and who have shared their experiences with the rest of us, thank you for being so gracious with your thoughts, suggestions and comfort. I will continue to update for my benefit as well as the benefit of anyone who gains from reading these ramblings. Really, really glad I found this place!
Okay ladies, wish me luck! Time to get ready for bed (love me some Hibiclens, available for $11.99 at your local CVS) and rest up for my 7:00 am check in time! See you on the other side!
SO, YEAH, THAT HAPPENED...
1. Rocked up at 7 am and was processed by efficient and kind intake person who, when I told her what my procedure was to be, pumped her fist in the air and said, "Yes!!!!" Good omen, I thought.
2. Had the preliminary preparations made (BP, weight--lost 3/5 lbs!--etc and then helped into the changing gowns, et al, but a petite woman about my age--who had had the same procedure done three years ago! We spent quality time chatting and ladies, it was VERY reassuring to hear her story. She was really encouraging for me, particularly as she 'got' the reason it took me so long to make this happen: "We spend our lives doing everything for everyone else and when we have the opportunity to do something for us, we find it hard to accept that we deserve it." Yeah, that helped a lot.
3. Met the nurse who would be monitoring me all day for further rego stuff, then met the anesthesiologist; if you are offered a heated air tube to attach to your gown, take it: it helps with calming your nerves. I mentioned to both that I'd developed a slight cold over the past day and they double checked breathing, lungs etc and declared me fit to proceed. Huge 'whew!' there. Another tip: make SURE that your results from your check up are sent to the hospital; my bloodworm was missing from my records so they had to draw blood again. Seeing as how my veins are the only skinny thing on me, it was tough to tap one, so they had to go with my hand, which hurts like the dickens.
4. Dr Ruebeck then came in and we proceeded to do the measuring and marking. I was grateful I'd researched this so it made it less awkward, plus I could ask intelligent questions and not feel like a dumba**. Here's a tip: have them remove the heating air tube before this point: the marker smeared a bit onto my arms, hand, etc. later when I brushed against any of the markings. Dr Ruebeck examined both sides under my arms and declared that he might have to do more than lip on the left side due to some overhand skin.
[insert ironically funny story here: when I was six days old, I had my first operation: I'd been born with a cyst developing in the left side of my chest so they had to remove it. At the time, the surgeon had told my parents he hoped I wouldn't have any difficulty with breast development...No, the irony was not lost on me this morning, either]
5. The SO came in to be told what was going to happen time wise, etc. and was given the option to go home for the next five to six hours; bless his cotton socks, he elected to stay (of course, he is in the middle of writing another novel so he probs didn't want to lose time in the drive!). Then, one last trip to the loo and off to the operating room (theatre for you UK/Aussie folks!).
5. That was where it all crystalized for me, ladies. I had to stand at the door just a second or two, breathe deeply a couple of times and acknowledge all that had led to this moment. That is where the highest level of anxiety hit (but they were to give me something for that). I met my operating staff and did a bit of stand up for them to work the room; I like people to do what they were about to do liking me and thinking of me as a person. Up onto the table, with arms stretched out on either side and the IV begun. They did a good job of keeping me warm. As the I.V. hit and Dr DeMars asked if I was feeling the effects yet, I said, "Yes, I think.........................."
6. Recovery was about two hours. Really groggy at first but that is okay. Ate the graham crackers and drank the apple juice they offered slowly but made sure I consumed the lot. No nausea, nothing, so I was very grateful. Then, it was time to get dressed and head home (WITH A PILLOW!) Which is where I am now and have been for the past four hours.
How do I feel? Groggy a bit, like the front of my head goes in and out for focusing. Moderate to severe pain in the chesticles (shooting pains within them, incision pain underneath). Tired, certainly, but not as tired as I'd thought, although the first two hours home were spent dozing in the recliner (I am SO bloody glad I got one) cuddled under sheets and blankets (thanks, Wendy, for the tip to cover the chair with a fitted sheet) and trying to return calls of good wishes from my daughters and the friends who know.
Oh, and not regretting one iota for getting this done.
typo take 2
typo take 3
First Shower: A Little Slice of Heaven
And oh, did I tell you I had to take off the bandages and have the big reveal? Okay, that was something else. I had the S.O. in with me to help remove the ace bandage (actually, that was a ruse; I wanted him to be with me) and there was heavy bleeding on the inside gauze, especially on the left side where the extra work had to be done under my armpit. And, well, while the pictures speak for themselves, I must tell you: I cried. I really teared up and could not believe I was looking at me. It has changed my shape clearly. Yes, my tummy is still bigger than I'd like, but to actually see the part of my front that is under my breasts and above my belly button---well, I hadn't seen that in YEARS. I couldn't stop staring. The bruising on the inside took me by surprise; I figured there would be some bruising but this seemed like a lot. Makes sense, considering what went on in there. The left side stitches hurt a lot; I put extra padding along that side to help pillow it. I only have two gauze pads under each breast and that third one folded in half. And I am wearing my Marena bra! To see me in that...what the fromage, it is cray cray! But a good kind of cray cray, I assure you.
So I am spending this afternoon updating my review, resting in my clean self and marena underwire-less bra and comfy yoga pants and button up front top, enjoying the warm weather through the screen doors to the deck and just amazed that this is all really real.
Day Three and counting...
I've also done a bit of puttering around the place: dishes and tidying up and things. I do not want to stretch too far, though, so some dishes will remain on the counter until the SO notices them and puts them back in the cupboards. I am finding my concentration isn't that sustained, so I haven't buckled down to start marking the two big bags of portfolios that await me. I will edge them closer to my recliner in hopes that I feel so inclined soon.
Pain wise has been the downside. I took off the ace bandage to take my shower the day after surgery (per doctor approval) and have been wearing one of the three that I bought online; I am using extra gauze pads, because there is definite seepage along the outer sides of the incisions (weepy and light pink) but today I just used some tissues folded over as I've run out of gauze pads. I had the 'zingers' people talk about on Saturday but not many yesterday and pretty much none today, yet the pain along the sides and under my arms is intense if I move or sit incorrectly. I also wish that sitting wouldn't allow the bras at the bottom band to curl and ride up, as they roll up and squash against the incisions and I am forever trying to adjust them without turning my arms into weird, twisty shapes that end up doing more damage and give more pain. I bought the Marena with the two inch band but even that one rides up. I put a question out to the docs about going back to the bandeau and one responded to contact my surgeon asap and ask but by the time the response showed up, the surgeon's office was closed so I'll call tomorrow morning. I am pretty sure if he said to shower and didn't say 'put the ace back on' that what I'm doing is fine, though.
Tell you what, girls: the Leading Lady bra has been the best bra by far for me. It's online and only $24 and comes in heaps of different colors. REALLY soft combed cotton and covers enough on top to make me feel protected. The Marena seems a bit low cut for me, at least it was yesterday and with my high, hard hooters, I felt like I was cup caking over the top of them. I bought two more of the LLs and am also waiting on the Adori that everyone's been raving about.
Speaking of swollen, I am not as rock hard as I was when I first came home and through the weekend. They're still solid, but it's not like I could bounce a quarter off of them like I could before. SO says the bruising in the centre is going down but the bruising along the sides is even more colorful and widespread, so I don't know what that is all about. The seepage is coming out of the sides along the bottom. I cannot tell if he just lipo'd both sides or if he put an incision on the left, but it feels like the latter. It doesn't connect with the incision under the left breast, though...? Meh, what do I know, if you want to talk dangling prepositions or new historicism critical theory, I'm your gal. If you want to talk medico stuff, I'm as thick as a brick.
The other things I wanted to point out include the fact that you will need reassurance that you are 'okay'. Having my eldest over for Mother's Day yesterday was nice with some (normal) gentle teasing and stuff; I felt like my youngest who rang from uni did so out of obligation and wasn't exactly tripping over herself to see how I was getting along. Afterwards, the SO reminded me that self absorption is rather typical for a 19 y.o. but it still kind of hurts. My son (who lives literally on the other side of the planet) was his usual non-loquacious self in a FB message ['I hope you're going to take it easy'--thank you, Prince Understatement]. I think it is okay to ask for the reassurance. I said to the S.O. that I needed him to reassure me about his feelings for me and in his engineering way, he did. I tried to talk with him earlier about the whole 'identification of yourself as a big breasted person' and how that would change but I don't really think men get it. When I tried on a top and asked 'Okay, do you see me or the top first' he said, "I'm a guy--I look at the chest" but he was trying to lighten the mood because I think it is difficult for him, as well.
Back to practical stuff: hydrate, hydrate, hydrate! I have been really conscious about drinking lots of water and also cranberry juice. I did have a milkshake at lunch today (sadly, it did not bring any boys to my yard...) but mainly, it is water. Still no BMs, but I do take a gentle laxative every night. I feel some 'bubbling and gurgling' down there and have had to pass gas (which is a good sign?) but so far, nuttin'. I don't have any pain or discomfort from that yet, either, but I am hoping to get back on the colon track sooner than later.
Hot flashes--anyone else? I use a .05 vivelle patch twice a week as HRT which has usually kept things at bay but hasn't been all that effective the past couple of months. It is rather muggy now where we live (Minnesota, US) but I can tell the difference between heat caused by temperature and heat caused by my body's release of stuff. Luckily, my yellow lab Newton doesn't mind if I sit around in the half nuddy every so often.
Oh, yeah, and itchy boobs! Itchy everything, actually, so I am using the extendable back scratcher I got for SO a couple of years ago quite a lot. I don't want to stretch my arms to reach certain areas, and this really does the trick! But if I can just gently rub my fingers across my jubblies, it really helps take the itches away. I also take a benadryl (walgreen's version; just as effective, says the pharmacist) each time I take a pain med. OH, and thought I would be stoic and wean myself off of the pain meds...that was stupid. Stay the course, ladies, stay the course and do what feels right for you.
I don't know if the rainy, dreary weather is helping or not. I feel like I have an opportunity to do a lot of thinking and planning and that is one of the good things about this time: outside imposed stillness. Being a Capricorn/middle-child/co-dependent, it is hard for me to plan things just for me, but that is what I am starting, ever so tentatively, to do now. Yes, I will take three yoga classes a week (when my body is up for it) and yes I will eat better foods. The SO wants to get me a bike and we can start biking around the lakes and trails around here; that will be fun. He also said, "I think it will be fun to watch you get new clothes"...I think it will be, too, especially because he's said he actually interested in that kind of stuff. I hope all of you have support people in your lives during this time; this is the first relationship I've ever had where I have a truly caring partner, so I am beyond grateful.
Hmm, I meant to end this entry with something whimsical or upbeat or funny... I think I will end it with hoping that those reading this who've come to the Smaller Side are doing well with their recoveries and are discovering new and wonderful facets about themselves, no matter what place you are at in your journey. For those of you yet to 'cross over', please know that it is so very much worth it all. It really and truly is.
Rotten, Terrible, No Good Day
So I am having a really sh*t day and I just want to feel normal again and yeah, I wish I could be witty or snarky but I'm just sad and angry and wretched.
Thus endeth the pity party.
"What a Difference a Day Makes..."
BTAIM, the appointment went fine and answered my questions: swelling is normal and (thanks to the folks on this site, I already knew) would come and go; the seepage will possibly continue another week or so and yes, it is natural for it to turn a yellowish/green color; cutting back on the Percocet is fine if I don't think I need it and the Bromelain is fine (he'd heard it was used for bruising...) along with any para or ibu type pain relievers I'd need. Don't get me wrong: I trust this man as a surgeon, but I did get the impression he deals with a lot of patients who don't go into this having prepped like they were taking their LSATs, so maybe I put him off. However, he felt that things were going along really well for this stage and that I should have no problem returning to work on Monday, provided I keep the weight lifting to ten lbs or less and watched how I manipulated my arms (he did suggest some stretching exercises which I might try). I now don't have to see him for a month, so that is set for June 19, with the caveat that I should call him any time I had questions or concerns.
I don't know how I feel about going back to work; I will have a longish day on Tuesday for a student who is presenting a Major Work and I should be there on Monday for her rehearsals, but I think if I explain to admin, I can get someone to cover for me, as I do not think I could last working a 7:30 am to 7:30 pm day and then drive home. I feel bad, but there have to be limits and actually, I've worked heaps from home on her project as well as correspond with students and my sub. I shouldn't feel guilty, but I do... Gotta work on that.
So, for anyone reading this who isn't sure about the procedure or is still waiting for That Magic Day, trust me when I say that it IS worth it, even on those rotten, no good, horrible, very bad days. Because they turn into kinda okay think I can handle it days which turn into hey this was a great thing I did for myself days...and so on.
One Week Post Op and Ready to Party!
The SO and I were invited to a friend's 50th, so I had an opportunity to dress up and 'mix it' tonight. It was weird to do things like put on make up (foundation? what the heck is that?) and do my hair and all the rest of it...without four pounds of interruption getting between me and the mirror. The moment of truth came when I put on my ensemble; I had worn this top before and it had always been a matter of 'did I choose the right bra for the fabric'...honestly, when I put it on and then worked up the courage to look in the mirror--I cried, I really did. Because I saw the dress first. It looked 'right' on me and despite the fact that I also created a new yoga position while putting on my Spanx, it didn't look like I was wearing something two sizes too small. Add some capri leggings and some sassy coral wedges and I was ready! Most of the guests were the SO's friends from years back so no one really noticed anything about me, but someone there who has known me a while looked me up and down and said, 'Wow, you look great!' (she didn't know about the BR) so that was just a taste of what's to come when I go back to work on Monday.
I must confess to some trepidation to returning to work but I've planned out my wardrobe to allow for some...discretion.
Today and yesterday were much better days energy wise, as well; I have made a huge dent in my marking and know I will finish it off tomorrow and be ready to go in and face the monster days I will have waiting for me. I have investigated asking a colleague to supervise my students in the afternoon while I take what will no doubt be a much needed nap on either one of the days and I will make sure I have a full body of Tylenol or some such to alleviate the soreness that will eventuate.
It is amazing to think that exactly a week ago today I'd just had this major surgery and I am actually starting to become accustomed to my new shape--although, as I said before, it sometimes still catches me by surprise. A good surprise.
First Day Back at Work Tomorrow...YIKES!
Also, I will have to deal with the three levels of questions: those who have no clue why I was gone so long ("how ARE you??? what is wrong??? are you better???" and their genuine concern), those who know I had some sort of surgery ("so...everything...okay???") and those who know the whole story (I think there are five now, including a colleague who'd had a BR done a few years ago and has been helpful with various tips and suggestions). As far as students go, they are incredibly naive or bold; there is not a lot of grey area! But for the most part, I have really lovely classes of kids and they will be rather kind and caring overall.
Is this odd: I have planned out my entire week's wardrobe, all to help blur the body lines. I don't want to wear baggy things (although much of my wardrobe no longer fits very well in certain areas and ways), but I am not comfortable really 'showing off' the new me, either. For anyone who is aware of things, it is definitely clear that I have decreased in the bust, but as many on this site have offered from their own experiences (and from what a friend said last night), it will be a matter of "Have you been losing weight?" kind of thing. It's like when a colleague I'd known for years shaved off his beard and mustache--no one could really figure out what was different about him! I am not embarrassed by what I have done, but despite my reputation at work, I do not like to call attention to myself. I like to call attention to things I do, but not me individually, if that makes sense. I am at the age where I will be able to respond to anything and everything that might come my way, but having gone through my adult life (over 30 years of it now) having had my large chest shape how I look at the world and how the world looks at me, it will be different to interact.
I Made It!
I wouldn't advise going back to work with only ten days recuperation after this type of surgery if one could help it, or if one had to, maybe then only going half days or something. I am definitely exhausted (not tired, but rather the 'in your bones and brain' kind of fatigue) and I am DEFINITELY more swollen. I am going to make a point of bringing the Bromelain to work with me so I can keep up with those to alleviate the swelling if I can. The bruising is subsiding more and more on the breast tissue itself but not along the sides; I look like an extra from 'Raging Bull', the bruises are so large, dark and deep.
So at twelve days and I am finding that the steri strips (which I have been advised by the PS to keep on until they come off of their own volition) are starting to lose their stickiness and edges are drying or shriveling up. I snip those bits off as it occurs and it is giving me just teensy glimpses and touches of the stitches and incision. Also, the incisions under the breasts are sore and itchy. I am really looking forward to being able to rub the bio oil (is that right?) into them and massaging them each night, as I've read about others who have done so. I think that will not only help with the scar tissue (I fear there may be some braiding developing with parts of the lower under breast incision) but also the swelling. I know I should drink more water, but being at work, I end up forgetting as I go back to my old (bad) habits of getting caught up in the teaching and forgetting that hey, I can stop and take a drink or two if I need it. Any teachers reading this will know what I mean: there are days when you get home from work and you are just BUSTING to use the toilet and when you do, you realize why: you haven't gone all day, you've been so busy running around like a headless chook. Oy vey, what a mess.
So three more days before the long weekend and I think I can make it through if I pace myself. Early home tomorrow and Friday so that will go a little way to helping. I am really going to rest up this weekend, though, and take guilt-free naps. I think I remember the recipe from my maternity days...
Little Things Mean A Lot
Oh, and another 'small' thing: showed the SO me in a top I'd had for a while and I remarked how different it was NOT to see myself in the mirror with those big breasts of before; his response when I asked if it looked better was 'No...I looked 'just perfect.' So yeah, that was pretty nice...!
Two Weeks Out and How Do I Feel...?
As some of you know, I went back to work this week after ten days off and sadly, it was not a normal one, but one filled with the extra bits that come with the end of the school year: Capstone performances, meetings and presentations, a retirement party thrown in for a good and dear friend (I spoke at it so there was no way I was going to miss it)... so last night (Friday) after a late-ish dinner, I fell asleep on the (beloved) recliner and slept from 9 to 11 pm...woke up and went to bed...and slept until 12:15 pm when the SO finally had to get the lawn mower started which woke me up. I would safely venture that my body went on strike and told my brain to eff off so it could replenish itself. I have never slept like this since undergraduate uni days! Amaze balls!
Over the course of the week, I definitely could feel the swelling ebb and flow--I've been taking the Bromelain, but probably not as faithfully as I should. I went without any pain meds during the day (even Tylenol) because I didn't want to run the risk of driving poorly on my commute or of having any weirdness during the teaching day. At night, I would change into comfy clothes, take some pain meds (usually just oxycodein) at about 9 pm and then go to sleep. Sleeping in bed this week with the whole pillow nesting arrangement has been absolutely wonderful. While I slept well in the recliner, the routine of getting ready for work, etc was helped by the familiarity of sleeping in bed (didn't work out so well for the SO--he had to sleep in the spare room as there was no room for him with me, my pillows and Newton, our 60 lb lab). I found that I am able to sort of sleep on my side if I use the two side pillows (if you can get the memory foam ones, really thick and lovely, they are wonderful) as ballast.
A few things I am concerned about: there seems to be some 'braiding' along the underside of the incision, just as the curve comes upward toward the center of my chest; I am hoping that will subside as the steri strips come off and the stitches eventually come out; I can feel some of the stitches where the steri strips have fallen off and they are really sharp--is that normal? The steri strips that are under the breast along those incisions seem to be a bit sodden; I have stopped leaking but they are still sodden even though my breasts are so small now that there is no overhang (hurrah!) and I worry that there might be some sort of ickiness going on down there that will create a situation for poor healing. I do air my breasts out (this week it has only been at night for about 15 minutes) but I don't think that has been enough. I don't go to my next post op until June 19 so I worry about the strips being on too long, etc.
Bruising is definitely subsiding, even under my arms where the lipo was done; the swelling is another story. VERY tender under there, the most painful of anything I experience. I don't have the sharp 'zinger' pains I've been reading about, but I do have pain that I believe is due to the nerve reconnections, etc.
I am so anxious to see the scars/incisions without any steri strips on them but I know I should not remove them prematurely; one of the bits came off and it is now redder there, which is a bit worrying, but so far no pain attached to it. Tons of itching along the incisions, which leads me to believe things are healing...
Right now, at nearly 2 pm on Saturday of the long (US Memorial Day) weekend, I feel a bit lumpy and sore, and still tired (!). We are going to friends for dinner tonight--they know nothing about my surgery so it will be interesting to see their reaction (they are good enough friends where the wife will ask if I've lost weight and then when I tell her what I've done, both of them will come up and stare unabashedly--which is fine! Luckily, they will cook most of the (delicious) food and serve some lovely wine and since I won't be driving, I will have some. Then it's two more days to grade a HEAP of work and putz around the house and rest up before the penultimate week of school.
Enough of me prattling on about myself; I am now going to stalk the forum and catch up with all you gals! Hogs and quiches to all of you!
16 Days Post Op and A Picture's Worth a Thousand Bucks...er, Words
Three Weeks Post and all is...most well
I really needed to wean myself off of the pain medication, though, because the constipation was not worth it; I don't take Tylenol 3, but I might invest in some now. I am trying to get by with just the regular ibuprofen. Certainly after a day at work, I get home and want to rest in the recliner; it's as others have said: it's not like I have a physically demanding job, but just the constant up and at 'em plus computer use et al means that there is no 'down time' during the day.
Incision wise, it seems weird to still have the steri strips. I desperately want to remove them: they look grotty, and I am anxious to see the incisions themselves. I am holding back, though, because I can see that they could rip open scabbing that has occurred along the incision line and I don't want to run the risk of having little openings or damaging the skin. Some parts of the strips have come off of their own accord; I have just snipped those away and added the magic blue 3M tape to keep the incisions protected (of course, not until I've inspected the heck out of what I can now see!). The incisions are so fine and delicate around the areola. As far as underside of each breast, the pictures might be able to show the 'braiding' that others have mentioned having. I am trusting that it will all flatten out with time. Until then, I keep trying to remember that patience is a virtue...
Emotions have definitely been swinging back and forth; it seems like anything and everything can set me off. Yesterday was particularly bad for a combination of reasons: not really 'clicking' with my youngest right now (she is heading overseas in a few days to spend two months holiday back with her friends in Oz; I feel I am good mainly for my credit card and the like, plus I am being held to account for past grievances--looooong story but suffice to say, I feel under appreciated by her) and so when I found out that a colleague's sister and brother in law had been involved in a fatal motorbike accident the day before, I pretty much broke down. I think my students caught on that something was amiss when I started to choke up in lecture; they were rather well-behaved that class period! But there are days when I feel I can take on the world and the very next I am feeling very vulnerable and insecure. Even without a uterus, I think I still have hormonal swings during what might have been my cycle; that and menopausal repercussions from HRT no doubt add to the mix. Gee, it's fun being female, isn't it??? I am also at a point where I wonder if I will ever see the swelling go down and know what my shape will actually be. I feel fortunate in that my breast shape is relatively even on both sides and the nipples are closely aligned. I have slight puckering but nothing drastic and the tightness is relaxing, although I can still feel slight pain at the slightest amount of pressure.
I really want to get back to yoga; I'd started investigating it before my surgery and found it was so beneficial to my mental health. The owner of a local studio I'd attended got back to me with very good advice about how to slowly bring myself back in and I am going to treat myself to that starting this coming week. As long as I tell my instructor my situation and listen to my own body, I feel I will be fine with it. If anyone else has experience with this, I would love to hear from you and how things went for you post surgery. This summer will be one of re-growth and renewal for me in many, many ways; in a way, it's like my tattoo (a lotus on my inner left forearm) because my breast reduction is a physical and tangible reminder of how much I can control of me and my life. And what power I actually have over the choices I make.
Geez, I feel a Helen Reddy song coming on...
The Muse has arrived: My Five Week Ode...(with apologies to Julie Andrews, et al)
No boobs that get in the way of my selfies;
PJs which are held up with small, satin strings:
These are a few of my favorite things.
Going to yoga and able to sit straight;
Dining at tables without boobs plopped in plates;
Appearing in public without much chagrin:
These are a few of my favorite things...
When my mood falls, when my chest aches,
When I'm feeling sad
I simply look back on my pics on RealSelf
And then I don't feel--
Well, you get the idea. Five weeks this past Friday the 13th, but it wasn't unlucky for me. I am truly getting more and more used to my new body shape and while there are still 'miles to go before I sleep' (on my stomach, that is), I do know that every day/week is progress. For starters:
BRUISING: almost gone, really. Vestiges of yellow spots here and there, but nothing like the "Fight Club" look that I had been sporting for the first three weeks.
SWELLING: almost gone as well; there is some 'lumpiness' here and there depending upon the angle one has, but I think that the shape is really settling into what it is meant to be. There is a definite softening overall, but I do feel smallish lumps the size of prunes or so within the breasts themselves. Which brings me to--
SORENESS: This is where I am still having a bit of a rough patch. My incisions along the sides (under my underarms) are the sorest and get the most irritated more frequently. I definitely favor the bras like the Fruit of the Loom sports bras that are longer on the bottom to prevent any sort of irritation under the breasts themselves. Inside the breast is where I feel the most sore; as I mentioned, if I press on any one spot, I can feel a tender spot (I know, I know: "stop pressing") and they ache if I am too active for too long.
FATIGUE: pretty much gone, except for the normal stuff. At five weeks, I think I am back to my normal energy level and while the end of the academic year brought long days and some evenings (farewells, grad open houses, and the like) this past week has afforded me the opportunity to sleep to the glorious time of 8 am or even later! Huzzah!
EMOTIONAL: I think things are evening out in this regard. It's probably a combination of all the drugs out of my system, plus a bit more rest and days where I am able to set my own schedule, for the most part, but I definitely feel as if I have the upper hand in this regard.
PSYCHOLOGICAL: Is it weird to say that I am starting to 'see' myself as looking normal with my changed size/shape? When I look at myself in the mirror, I am amazed by how I had previously gotten used to seeing my abnormal and disproportionate shape as 'normal' when I see myself now: while I wish that my breasts were even smaller than they are currently (particularly on the sides), I still am struck by the much more proportional 'me' that I see today. And when I see myself in clothes, I am absolutely gobsmacked by how 'normal' I look--I see ME not my boobs/me. I sometimes tear up a bit when that happens.
So what now? Well, reading others' accounts of people at this mark or so tells me that I should expect nothing but more of the same. I am keen to get ahold of some of the oil that people talk about and begin to use that on my incisions, which are definitely drying out and beginning to flake. I feel VERY lucky that my incisions are healing up as nicely as they are: no holes, gaps or splitting. But they are dry and darkish in places so I would like to see if I can lessen any of that. Does anyone else find that they are sometimes rubbing their breasts absentmindedly to take the aches or pains away? Luckily, I haven't done this in public (well, not that I can remember...) but stopped at lights while driving I have actually caught myself! Hope I haven't given the other drivers any odd thoughts!
Going for my second post op appointment on June 19; I am not sure what to expect or what to ask about. If anyone has advice about what to do/say/ask/expect at the six week appointment, I would be most grateful for your input. There are some little weird anomalies I will ask about in terms of their 'normalcy'--things like the odd bit that pops out on the top of my left areola or the little edges to some of the incisions...but I am very grateful to have nothing really untoward going on in terms of my recovery at this stage.
I am loving the luxury of sleeping on my side, sometimes even three-quarters turned toward my tummy. Last night I tried to sleep in my jammies sans bra...not doing that again for a while! And I am looking forward to buying some proper brassieres as well in a proper lingerie shop. And doing so without mortgaging my house to pay for them.
It's been lovely to read how everyone else is progressing; I guess the May group is all old hat now, huh? But I still enjoy reading about how everyone is doing at each point of their journey. And I hope that I can offer some helpful advice or suggestions to others.
And now for something completely different: Co$t$
Okay, political rant over and now you know my leanings.
But here's the lowdown on the moolah:
Total charges (day surgery) was $11,786.63 with that breaking down to
1. Hospital charges of $7,340.28 [I will pay $346.19]
2. Surgeon fees of $4,848.00 [I will pay $518.29]
3. Anesthesia fees of $1,085.60 [I will pay $562.26]
4. Lab fees of $584.00 [I will pay $82.76]
So out of a total bill of $11, 786.63, I am out of pocket for $1,209.50 which I consider to be pretty darned fair and reasonable, considering my deductible is $2400 and I had already gone through about $800 of that with other things for the fiscal year.
Each institution will bill me separately and as of this writing (exactly six weeks out) I have not received a statement, except for office visits to the PS. Because I budgeted for this, I will pay them in full as they arrive so that I am ready to hand over all the rest of my money to my daughter's university bursar's office starting next month...
Okay, so on to the appointment itself:
I did not have (m)any concerns but I did want to bring things up including: the soreness and tenderness that still exists around the areas under my arms; the various and sundry lumps (the size of grapes) within the breasts that are tender; the condition of the incisions (were they looking normal, etc); and my ability to increase my activity.
In a nutshell, Dr Ruebeck said all things look good; the soreness under the arms is still normal at this point due to the use of the lipo device on the right and the actual surgical procedure on the left (snipping out the excess skin); the little lumps are either a bit of edema or the fat necrosis, neither of which concerned him as they are normal as well (just keep an eye on them); the incisions were a bit red, he observed and the outer edge of the incision under the right breast was wider than he'd have liked. This last bit was the part that made me a bit upset (more on that later) because I didn't want to have any trouble with the healing of the incisions. I'd actually never noticed it before, but when I came home and looked, it is about one to 1.5 cm wide, I think. My first thought was that I'd been sitting in one of the chairs (when not in the recliner) that has a tall arm: I put the laptop on the right armrest and balance my elbow up to write; could that have damaged the skin by pulling too much (I always felt a bit sore there after having it up for ten or so minutes)? The PS said it will "no doubt be fine" (easy for him to say...) but that when I see him again in six weeks, he will check for it again. He still gave me the go ahead to increase my participation in yoga to classes other than yin, gentle and hatha, so I will work my way back up to vinyasa in a couple of weeks (that hatha really took it out of me today!). I also asked about the bio oil and he supported that as well, so I stopped to pick that up on the way home ($13 for a 2.0 fl ounce bottle at Walgreen's).
Overall, the healing is going fine, physically and psychologically; as I mentioned before in an earlier post, I am beginning to get used to my 'new normal' and that is a pretty heady thing! There are (very few) moments when I think "Oh, they're just as big as they ever were" but that is really only when I am wearing something that would make Angelina Jolie look plump. Because of what I learned on RS, I know I have large 'breast roots' and so my breast will no longer be 'pendulous' but wide and firm. That's just fine with me, because they are no longer the first thing I see when I look at my reflection in the mirror!
Okay, the emotional part alluded to earlier: so later in the evening I mention to the SO "The doctor thought my incision on the one side was a bit too wide." Barely looking up from his book, he said, "Oh?" and went back to reading. Well, that put me off, I can assure you. Later that night, rather than stew about it for days (my usual M.O.--I do not advise it for maintaining healthy relationships), I said that I had been hurt by his seeming lack of interest in the doctor's comment. Long and drawn out conversation short: he had been waiting for me to say more about it and when I didn't, he assumed that meant it wasn't a VBD to me since I hadn't gone on to elaborate. I explained that I was hoping for a bit more than "Oh." It's a challenge for me (the "let's talk it out about everything and discuss every nuance of your vocal inflection to explore what you really mean") to talk with him (the "I'm an engineer and as long as there is nothing practically wrong, then I don't see why we should talk about anything; give me a problem, and I'll help you solve it, but beyond that...?"). Deborah Tannen does a lot of stuff on the differences between the way males and females communicate (and I think she has branched into same sex couple communication styles, as well) but I still get really frustrated at not getting just a bit of (with a hug), "well, if the doctor's not too worried, try not to be, either, okay" or what he actually said to me later on which was "if it is only cosmetic and not a healing issue, who's going to see it besides you and me, and I certainly don't mind". I think it is still difficult for him (and probably most males) to understand how one's concept of oneself as a female can be greatly determined and shaped (rightly or wrongly) by things that have been objectified by society but over which we really have no control.
So, after six weeks, would I do it again? In a skinny minute, I would. And I am learning that there are as many ways to heal (both physically and emotionally) as there are women who undergo this procedure, so I hope that the ramblings I offer are a means by which others can gauge, not judge ("comparison is the thief of joy") and know that their own 'normal' is right for them.
Seven Inning Stretch...or not.
One of the things I am feeling positive about is the way I look and (psychologically) feel: I have been buying some tops and things that I would NEVER have looked at prior to the surgery! I have actually been OUT IN PUBLIC WITHOUT A BRA! There is a consignment store that I love and I recently got a Michael Kors silk top: gorgeous colors and a cut that gathers around the neck, bearing one's shoulders (AND I got it for $16, thank you very much). I wore it to a meeting this past week sans brassiere and felt really comfortable in it. I am not teeny, as you can tell by the pictures; I would say I am probably a 38 C (large) or possibly a D, but I look in proportion. More importantly, I feel confident.
Two Months to the Day...
At two months, I am really coming into the mindset of feeling like this is who I am; Peediewife said in another reply post that the person/shape she is now is who she really is, not the busty broad she was before her surgery. I rather feel like that. As I've mentioned before, I no longer do double takes when seeing myself in a reflection, but in fact am truly starting to accept the shape I have. It helps when the SO will remark out of the blue about 'yes, the surgery was a really good choice for you' or 'it was the right decision' and things like that. I am also noticing that I am engaging more in life without the preface of 'I am the person who had a breast reduction', as in "I am post breast reduction and I am going out to lunch" or "I am post breast reduction and I am going to the shops" or whatever. Occasionally I am meeting up with people who have not seen me since the surgery and they of course will comment (always positively and kindly) and I have to think: oh, yes, I had that done. What I mean is this: for weeks prior and for weeks post, every part of my life was linked to the surgery. All the weeks of anticipation and wondering and worrying and then afterward, the days and then weeks of physical and then mental and psychological recovery...you can't help it, you are living and breathing it.
Yet, just as I didn't want to be defined by my large breasts prior to the BR, I now find I don't want to define myself by having had this procedure. I am grateful for it, oh yes, am I ever! And I am thankful all the time. But it is not the guise or persona through which I am living my life, which I think is positive and the right way to be in my recovery. I mean, I had a full hysterectomy/oophorectomy three years ago and I don't define myself by my lack of reproductive organs!
That said, the change means having to change how I perceive myself and how I perceive myself amongst others. When I had the hysterectomy et al, I was far beyond childbearing time in my life, so the loss would not have been as emotional for me as it would for someone who was still at a point in her life where children w/could be an option. And regardless of the age, a woman's breasts are a way that shape our sense of femininity (for more on this diatribe, please see earlier posts!). Maybe it is because I am past 50 years old and society doesn't really 'see' me anymore anyway that this is easier for me to work through. For those younger woman in their teens, 20s and even 30s, society still considers you vibrant and engaged, so the change in your perception of yourself after a BR would be different to my experience in that regard. Please know I am not 'dissing' middle aged women; my point is that there are other 'social signals' that let us know we are not as...important (c'mon--when was the last time you saw someone over the age of 25 in a lingerie ad? or a perfume campaign--Isabella Rosselini was cut from Lancome when she hit her forties...). I am really enjoying, appreciating and celebrating the liberation from that burden, though--there are many barriers that women need to remove and one that I see changing is the age barrier.
Wow...I went pretty far on that one, didn't I? Okay, so getting back to my boobs...at two months on, there are still physical pains (every now and again the electric shock of nerves reconnecting; the ache after a long day; incision sensitivity) and sometimes even a down day emotionally (my tummy looks more pronounced, now I am paying attention to those spider veins in my legs, will someone please hike up my jowls?!) and psychologically (why won't my guy touch my breasts???). But at this point, I still know what I did was the best thing in the world, yes I wish I'd done it earlier but I did it now and that's great, and I am so enjoying rediscovering me.
Two Month photo gallery...
My initial interaction with my surgeon, Dr Ruebeck, was very positive. Women are normally sensitive to their bodies and breast size in particular. While Dr Ruebeck did not treat me clinically he did treat me professionally and respectfully. When I asked him questions about the procedure as well as about his experience and desire to perform this and other plastic surgery, he met my questions with courtesy and was (I believe) grateful to have a patient who was preparing as well as one could to become a 'partner' in the relationship. I really believe that is important: it is YOUR body and rather than simply hand over responsibility completely to the surgeon, take control and know that it really is--and should be--all about you. Pre-op visit: This went well but that is partially due to my having readied myself with a list of questions from this site! Dr Ruebeck was very patient and supportive of my being informed; it is a partnership, after all! He clarified some things for me and I didn't feel rushed through at all, which went a long way to giving me more confidence about the procedure. Although he's been doing this for nearly 20 years, it is my first (and I hope, only) time so I really appreciated the fact that he seemed to respect my time, input and involvement. Surgery Day: Fairview Southdale in Minneapolis is a great place to have this done if you are near it geographically. Parking is ample, lounges are nice (well, not the one near the surgery, but there are others all over the place) and they keep you updated efficiently through the use of a pager. Dr Ruebeck was his usual calm and quiet self, which instilled me with confidence; plus, I saw his bare arms and they look good, so that's a plus. My anesthesiologist is Dr David DeMars and he is a peach of a person! Kind, gentle and really, really good at what he does. My nursing/support staff was great for intake and everything went really smoothly.