I am a 37 year old mother of my seven year old son...
The first surgery I am getting is breast lift and augmentation (extended breast feeding did a number, weight loss did them in) and a tummy tuck (excess skin removed and muscle repair). The second one I am planning is an arm lift, so that for the first time in my adult life I can wear a short sleeved shirt. The last surgery is butt and thigh lift. I am sure I will need this however my body is still showing gradual change in those areas.
I chose Dr. Kyle Wanzel in Toronto for two reasons. His reviews are near perfect, also, my friend went to med school with him briefly and recommended him. I did meet with a surgeon closer to where I live, but didn't like the idea he does his surgeries out of his clinic versus a hospital.
I had my first consult with Dr. Wanzel in March and really liked him. His assistant Helen is wonderful and patient also. I was slightly uncomfortable standing in front of the doctor in such a way I haven't even let my own husband see me, but it wasn't as awkward as I thought because he was so professional about it. He has a calming demeanor and a sense of humor. He was very thorough. A that time we agreed I should lose about 30 more pounds before the surgery. I've done that so I am now going to see him again July 18th to put my deposit in and book the surgery. It's obvious he takes pride in his work and this isn't just about money to him. He wants me to look good and natural.
I am hoping that I can use this site as a way to meet others and get advice and all that fun stuff as I can be a bundle of nerves at times. I have done so much research using this site already, I'm glad I found it. :)
The breast lift and augmentation: he has decided to go under the muscle for me. He said he was on the fence and I guess after a little bit of back and forth ultimately decided this would be the best route. I am happy about this, even though I was good either way. Reading a lot more now that this will be best for me. I don't recall the exact size, but the odd number of 347cc is standing out. He recommended that for the most natural look. I'm easy. My husband was probably hoping for much larger but I want natural. ;)
The tummy tuck and muscle repair I guess is just going to be typical. I had a c-section seven years ago without complication and have a nice faded scar so he thinks I will do well with this.
My surgery is scheduled for September 25th. I am freaking out about not waking up or having dire consequences of doing this. I guess that's a normal reaction? I'm worried about having a panic attack before too.
We are staying in a hotel the night of my surgery as the hospital will charge me $1200 to stay. Hotels are cheaper and I will have hubby with me. Doing this because we are an hour plus away from the hospital.
I may post pictures this week. I've got lots and I am almost brave enough to take the nudie ones, since the surgeon took his before pictures Thursday. Mortifying! ;)
A few pictures....
I figured I should start adding pics though...perhaps that will get me on top of updating.
Half of me is gone, and I did it on my own.
Scary old pictures.
I am having a hard time reaching my surgeons office about my down payment. I think she secured. My date, she gave it to me, without a down payment. She didn't take the payment because she was going to try to get me an earlier date. Now I am panicking that my date isn't really secured because I didn't put a payment down. This is the first time I've had a communication problem with them. I'd drive to the office but it's an hour away. Grr.
A few more weeks....
I have been overwhelmed reading about all the little tips to help. I think to help my back a little we are going to rent a walker. I feel like I am 90, I may as well play. The part. :)
I already have the Total Body Pillow from Hammacher Schlemmer (never used it but it feels awesome!) and a binder and bras (pics attached). Apparently they will provide those to me as well, but I know you need at least two for cleaning purposes.
I feel like I should make a list or something because every little detail I am afraid to miss overwhelms me even more. If I put stuff on paper maybe it won't look so bad.
Please, tell me to lighten up. :)
Do I have to drink colon blow the night before? Do I need a pre-op with my family doc? When I secured my date, all I got was general day of surgery "rules" (no earrings, remove nail polish, etc.) and directions for where to go once I arrive at the hospital. I guess I will contact my PS office this week to ask these silly questions.
And I was so worked up about getting my period since I track them and it was to arrive the day of my surgery (not allowed tampons, ugh) but last month I started early (!!!) so that altered the projected date for this month. Hopefully it will come on time which means it will be done by surgery day. Pleaseohplease.
I'm ridiculous. :)
Skin and Nipples and Undies, Oh My!
I will post descriptions with the pics.....
As I said, "I feel like I am 90, I may as well play the part"...
Things are coming together, less than two weeks to go!
I have to be at the hospital for 9:30 as my surgery is at 11:30. I'm still slightly anxious but feeling more calm as Inge fall in to place. I have my last appointments lined up with my chiro, I'm seeing my family doc next week (she hasn't seen me since I lost this 182 pounds!) to see about some anxiety meds to keep me calm and something to keep me from feeling pukey after, as well as a good muscle relaxant for post surgery, since going in to it my back is already a mess.
I am overly dramatic but I am starting to accept that what will be, will be. I can't change or prevent anything, I can only deal with it and I am fortunate to have resources, tools and people to help me through it all.
I am having a bit of mommy guilt as my surgery isn't until a Wednesday but I'm having my mom and dad take my son for the week starting the Sunday before. That gives me a couple of stress free days before the surgery (he is seven and very stressful to me right now, LOL) without me having to say goodbye to him the night before or the day of. This way I can say my goodbyes but have many more chances to see him before that final one, should I need it. Or I can just call him.
I told you, I'm ridiculous. :)
All is well. All is well. All is well.....
My son has a cold and I have been fighting it off for a couple of weeks, faithfully drinking my organic apple cider vinegar every day (it works), but I am still waking up kind of grungy every morning. Will they still do surgery if I get a cold?
We went to the US today to do some shopping so I picked up a whack of things there (cheaper, better selection) for post op. I'm feeling much more calm and excited about this coming up now that things are coming together. :)
Ten more days....
One more week!
I went to my family doctor yesterday. I haven't seen her in about nine months. Since then I have had the biggest changes in my body and face from the weight loss, and her reaction was priceless. Definitely the best one I've had thus far. She walked in the room and did a double take and stared at me as if she was trying to process who the heck I was. Of course that all happened in about two seconds. It was funny. She gave me a prescription for Ativan for possible anxiety and Flexeril, a muscle relaxant.
I have a busy week ahead of me, I am very in demand socially right now. I guess all my friends want to see me before I go in....so do I, just in case. ;) I will be fine though. I know this. :)
Good luck to everyone coming up and happy healing to those who have recently been done!
I am drinking my organic apple cider vinegar and will amp up the fruits. I wanted to go in to this strong. My back was finally starting to feel better. I have literally not coughed or sneezed since the morning of February 16th, the day I sneezed and threw my back out, six hours before leaving for Las Vegas. Almost didn't get on the plane. That's how I remember the date. It scared me so much I have been afraid to sneeze since.
What is the universe trying to tell me? Or is it just that I am getting all these bad things out of the way so I can focus on healing next week? Yeah, that's gotta be it....this is a good thing. All is well....right?
What, me worry?
"To be honest the hospital will only cancel your surgery if you have a high fever, or chest congestion, and if you have a bad cough. They have to insert the breathing tube....so not good if you're coughing."
Everything will be messed up if they cancel. Please stay in my head, or better yet, GO AWAY!!!!!
We walked around, went on the Sky Wheel and went to Margaritaville for lunch. Then it was time to take my son to my parents for the week. We visited for a bit and then I had the gut-wrenching task of saying goodbye. I know I will be fine, but he is very scared, just like I am, and it was serious business for both of us. Hubby snapped some pictures....because we are super dramatic that way. I thought I would share.
Not looking good.
Every surgeon on here in the Q&A say cancel (when someone else asked). I feel like I can't. I want it over with. We have rented medical equipment, taken time off work, my back pain and period worked out, I can't wait months again. We have a trip planned in February. Wednesday was the perfect date. And a cold, a stupid little cold, will ruin it all.
I made my body healthy and now it is letting me down when I need it strong the most. :(
Thank you all....
So far, I assume I'm still on for tomorrow.
I just posted my Facebook status...."Dry toast and Ativan, breakfast of champions". Not hearing from the surgeon yesterday made me feel we may still be on. Of course that can change once I drive all the way into the hospital. But I don't think it will. I'm not coughing. I don't have mucus in my lungs. If there was a chance they would cancel, they would have called me back because they would want to fill that OR time. I talk like I know how it all works. I don't. I'm making stuff up so I can feel more in control. Ugh.
So yes, I will say I am not cancelled. Hence the Ativan. ;)
"Kathy is ready", I learned how to eat properly. I also started making exercise my passionate and priority. It really is a science that is constantly changing. I wanted to never diet again because diets fail. I wanted to learn how to eat everything, even the yummy treats, and still lose because if I just dieted, eventually if would want that brownie. I share a lot more detail on Facebook, if anyone wants to friend me there, feel free: www.facebook.com/forensicsgal
I will update later if I hear anything, otherwise expect to hear from me after my surgery. Good luck to everyone sharing the date, everyone coming up and thanks to all for your support. :)
Heard from the surgeon
My medical rentals just arrived. My stunning power lift recliner and a super handy dandy wheeled walker. Has anyone seen my Ben Gay?
Here is one last shot, from a different angle. I realized I have a cute little freckle on my tummy I won't have anymore. Weird. :)
Can someone tell me how to cough? Ugh
I see Kyle next Thursday and that will be my first reveal. No showers until then. My hair is already a disaster.
I really need to cough. The pillow trick doesn't work, I had some pretty good muscle repair, I feel like I'm going to blow out stitches if I cough too hard. I can't worry abut that, right?
My drains are huge and obtrusive.
Nothing seems to be touching any of my pain. :(
Can we talk poop? And pics...
My drains are huge, not those cute little bulb things everyone else seems to have. Hubby is clearing them for me. He's the best. My upper body pain from the lift and implants is no worse today than after an arm day workout. However I do feel I am being harpooned square in the nipples.
The ab repair was extensive and the pain indescribable. The incision line is no worse than my c-section, just wider. The binder is rolling up on to my drain incision (he has them on my hips) and that is freaking me out.
I cannot take the binder off or the bra off until I see the doc next Thursday. No showers, just sponge baths. I feel I'm going to stink when he removes the binder next week. I hope the drains will come out then. I want to feel normal again.
I'm not as hunched over as I thought I'd be, that's a small blessing. My cooter and thighs sure look different....will that last? ;)
I really thought I'd be tougher than this. The cough is making things really bad though. The mucus is thick like gelatin. Sorry, only brutal honesty from this girl.
I feel so bad
Update, three days post op
I had a rough night with back pain, lower and upper, shoulder and neck pain too. Sleeping in a recliner is brutal.
I decided today it's time to get my act together. My son comes home, I don't want to scare him. I need to move more. I need to get this gas out. The coughing is still happening. It feels like my intestines are coming out my incision.
I'm still so tired.
My boobs are starting to burn at the sides too. I've stopped Percocet (hoping to get my bowels moving) and am taking Tylenol back pain, hoping to help my back too. I am not sure if this has been a wise move or not. I'm hurting.
My drains are still producing stuff but less each day.
Hubby loosened my compression garment a little. In the one pic I am sharing, you can see the line the nurse drew on it for where the doctor had it. It's about an inch away now. I feel a little better, but at the same time not so great about it.
The other pic, the drains are in the way but you can kind of see how flat I am. In case you aren't sure what you're looking at, I'm facing left in the picture and have my hand on my belly. My left arm is behind my back.
Still thankful for the help here...
Keeping It Real....The Ugly Truth
I've also been hit by post operative depression. It's common, especially after this surgery. But it is not acknowledged, talked about and worst of all not treated. There is no treatment. The treatment is to not have the surgery at all. Adding extra stress and drama didn't help. I should have told the world before my surgery to just be kind to me after. Or I should have just shut the world out. I can't tell if it's my fault. It probably is. I have to blame someone.
I can't laugh at anything. I want to laugh. It's the best medicine, right? My insides feel they are being ripped apart. The searing pain all through my body just laying still is enough to make me want to die. Even narcotics provide little relief. I have been in this binder since surgery. It is tighter than the grip of an anaconda. I cannot remove it. I don't know what is happening to me underneath it. Is my skin healing? Are my intestines hanging out like I feel they are? My guts are feeling crushed, my ribs feel broken. I am not breathing right. I am itchy everywhere. I will get no relief until at least Thursday. At that point I'm sure I will be ready to rip all my skin off. The binder rolls up at the sides and up my back. It digs in at exactly the spot the drains are stitched in to my hips. Those spots are no longer covered by bandages. It's raw and exposed. Nerve endings. Burning pain. I don't know if I ever had bandages there. I probably should have. I wonder about infection. Yet still, the surgeon says keep the binder on.
It's not like I want to remove it anyway. I feel it's holding everything together inside. Getting up and walking hunched like I have to, I get such a tired burning pain from my boobs to my crotch. I can't stand or walk for long. My flank muscles have completely seized up. I have been on my back since surgery. Always on my back. My tailbone hurts. I have to sleep elevated, on my back. There is no relief until the drains come out. Praying for Thursday.
I am hot. I am cold. I am tense. I am sad. I want to shower. I feel like if I could just clean my hair (dry shampoo does jack shit in case you are wondering) and make my face not feel like leather and put on a little mascara I would be a different person. Not until at least Thursday. Damn you Thursday, where are you?
All of this I chose. And why? I don't know anymore. I'm told some day I will know and I will be so grateful. But right now, I think I am certifiably batshit insane for paying $13,000 to feel like this.
Someone tell me this is okay....please.
I can't believe this is me.
This is me. Me with swelling. I'm going to get even better, but I'm willing to take THIS. Unreal. Totally.
The boobs will settle as time goes on as well, they are under the muscle and still high up there.
It feels surreal.
I go back the 18th for stitch removal and to talk scar therapy.
My surgeon is amazing.
Hope this doesn't last.
Thank you all for your comments.
Drawback Of Major Surgery #8637: Just had my first actual shower and now I need a nap.
The perk: I smell fantastic!!
Another thing I wondered about, there is so much said about the binder, "don't wear it too tight", "but don't wear it too loose". How do you know? I can't believe I am 11 days out and feeling so out of the loop.
LLB Inspired, Side By Side
Pics at 13 days post op
Had a good couple of days. Nights are still rough finding a comfortable way to sleep. My tailbone is begging for mercy, my shoulders and neck are a mess. I saw my chiro tonight and he did a modified adjustment on me. I feel so much better.
Not much else to report, next appointment with Dr. Wanzel is the 18th. Getting wiggy about my belly button. I have not been given any info for care, in the shower I do nothing but let water run over it, get out, pat dry and use the hairdryer on all surgical sites for 2-3 minutes. That's it. I don't know if it's getting gunky or smelly or anything. And I can't touch it. Even though I can't feel it externally, I feel it internally and it makes me all woozy. :)
Sleep, Cramps, Exercise
I've been to the chiropractor a few times this week for modified adjustments. Those have been good. In fact I have been able to sleep in my bed since Tuesday (we have a Tempurpedic mattress that I neeeeed), on my side and stay in bed until morning. I'm sleeping better than on the recliner but still not great. I've been using rolled up socks between my boobs and the pain there has lessened. I feel more comfortable with each night.
However......every single night I am still getting these involuntary muscle spasms in my abdomen. Last night was the worst, I think I had six. I can feel them coming on in my sleep and it wakes me up. It's like a Charlie horse or a stretch you can't control. They are very uncomfortable and making me worried I am doing internal damage to the muscle repair (which I understand in the whole cause of these). I'm also concerned because they affect the muscles of my back as well, so I struggle with back discomfort. I've been having these since early days and thought they would subside once I got in the bed and out of that ridiculous position I was stuck in. I see the surgeon on the 18th and will discuss with him. These aren't avoided with muscle relaxants or anything before bed.
On the plus side, I am walking my five miles every day again but it is broken up in to two walks. I am hoping to transition to one walk every day next week. I feel good doing it but I am still listening to my body.
Most of the steri strips came off my tummy. I still have the horizontal ones across the middle. I'm having trouble with the drain site on the left side still being goopy. I also have a strange area that sticks out on the left side. I'm not sure if it's normal swelling, fat, my new shape or ugh, seroma. I don't have the waterbed effect, my stomach is pretty flat and taut. My belly button is also kind of icky. The surgeon suggested I put polysporin on it and my drain site until he sees me but if things change he will call in another script for antibiotics.
I still have all steri strips on my boobs. I'm letting them all come off on their own. Not safe to pull them. :)
The swelling has gone down in my saddlebags since I have started moving. I had been measuring with a tape measure. I had gained almost five inches around that area from pre-surgery. I'm down three, so about two to go to get where I was.
I still have monster crotch.
Busy weekend this weekend. It's thanksgiving here in Canada. Today is also my dads 70th birthday and tomorrow is my birthday. I'm also trying to catch up with some friends I haven't seen.
Hope everyone is doing well. Admittedly I haven't been reading (I suck) but will try to find some time to do that today or this weekend. :)
Couple more pics
No more steri strips!!!
Saw my hero....er, I mean my surgeon
The surgeon removed stitches and strips today, checked for seroma (nope) and says I am doing awesome and looking wonderful for three weeks out. I love this man!!!
More pics with close ups of my lollipop scars!
I'm quite swollen tonight. I didn't get as much walking in today. Grr..
Silicone scar sheets
The Mepiform silicone strips were recommended. That's what I am trying. I'm only using them on part of the belly as you can't out them on scabby or raw sites. I am not using them on the boobs....yet.
I stopped using polysporin (that was recommended by the surgeon for the belly button and drain sites) and they are finally starting to heal. I would never have believed it if someone told me a product I believed in would DELAY my healing.
I give up, RealSelf
Four Week Pics
Belly button close up and silicone scar strips
I did a full week of scar strips so I thought I'd take a pic before reapplying for this week. I can't wait to see if they make a difference. :)
Hope everyone is doing well.
Strange feelings.... (in the head, not physical)
Six weeks post op today....
My old jeans
I will post two pictures. The first one was today, post shower. I noticed my pesky left side scar, right at the end, the one I had problems with, gradually turning dark. I could feel a small stitch poking through for about 2-3 weeks now. Bio oil after the shower today eased it out. It was so tiny, like an eyebrow hair.
Fast forward to half an hour ago. I'm standing in the kitchen and I feel something on my leg, like blood running down it. It is blood running down it!!! This spot has pretty much blown open and is draining reddish, clear fluid but looks black, and there is a hole. See second picture.
Freaking. Do I need to call the doc? I don't feel pain, but I am still numb there. :(
Had my follow-up
It was a good appointment. He looked over everything, snipped a few threads poking out in my tummy, belly button and boobs. He cleared me to do pretty much everything exercise wise, being cautious, obviously. My trainer put together 50.15 hours of training for December, I am so excited to have been cleared to do it.
We also talked about my brachioplasty (I'm reviewing that here: http://www.realself.com/review/toronto-arm-lift-body-wanzel-time-for-the-arms) and I booked my surgery date for that. He also took "befores" of the arms.
Not much else going on here....hope everyone is doing well. :)
That thing that happened in November....
The last few days, the drain site on the right side started bulging out and turning black. Today it blew out, but a lot slower. It's slowly seeping blood. This one hurts, I can feel it. At least I know it will stop and heal over again, since I now have experience. ;)
But I wonder, is that it now? I wonder if I should be concerned about blood building up and then blowing out.
This is on my left breast, which has healed well. The scar above the nipple started turning red two days ago. I had been keeping an eye on it and not doing anything except bio-oil. Today when I checked it, without even touching it, I watched it split open and white stringy stuff came out (with blood and pus), it looked like a can of silly string, the way it was shooting out. I am numb, so I am not sure if it hurts.
Dr. Wanzel is away but Helen suggested a visit to the doc for some meds. She thinks it's infection. Hopefully this won't go on forever. Anyone else have this happening?
I have also sinned over the holidays. I have sodium bloat and feel utterly disgusting. I can't believe in my old 350 pound life I ate like this all the time. Blech!!
12 Week Pics
Brachioplasty In FIVE Days!
Like when will I be able to drive again? And do I need to wait ten days for a real shower if I don't have drains? In surgery, how do they monitor the BP? And where does the IV go? Please don't say the foot. Pleasedontsaythefoot. ;)
I am the first surgery at 7:30am. I need to be at the hospital at 6:00. In Toronto. An hour away. At least I can sleep during surgery. ;)
I'm looking forward to this one, for sure. That hasn't stopped the anxiety though.
Brachioplasty is done!!
It was a rough night with limited sleeping positions. Prescribed meds aren't as effective as simple old Motrin.
Dr. Amazeballs did great once again. Good news, I woke up much better from this surgery, but it was half the time of the last one. Also good, he didn't have to take the incision as far as initially thought. It goes from elbow, and into the armpit instead of from elbow, through the armpit.
I'm not vain but I would like to honestly admit that the vain part of me is glad to see my "quadriboobs" also appear to be gone. Those little pockets of fat between the arm and boob on the front.
Aside from that, I had this done for my comfort, not for looks. I'm proud of my choices and my scars. I won't hide them, there's a heck of a good story behind them.
I sent a whack of questions to the doctor on Thursday and didn't get a response. Now it's the weekend and I see the surgeon Monday anyway.
Still just taking ibuprofen for pain but my back went in to spasm a couple days ago too so I have taken cyclobenzaprine which makes me a zombie.
Going to the bathroom has been more difficult this time around too, I think because of my back spasms.
I'm feeling the blues too.
I have been getting sharp pinching pain in my armpits, funny tingling feelings that feel like bugs under my bandages, and my bandages are slipping, which naturally upsets the drama queen within me. Oy.
Five Days Post-Op, Unwrapped!!
Brachioplasty update: seven days post op
Two weeks post-op (brachioplasty)
Six months later....and saw Dr. Wanzel
I saw Dr. Amazeballs today. He is pleased with how things are going so far. He removed the steri-strips and stitches and gave me the preparation just in case my armpits don't really like what is going on in them ("the body doesn't like corners") :)
I go back to see him in a month, but in the meantime I get to start the massage of the scars.
I am having crazy pain in my forearms still but for the most part my movement is good. No weights for at least six weeks, the longer the better. I told him I am petrified of these things opening so I will hold off. I also have pinching feelings in my armpit but they aren't constant. It all wigs me out. :)
I also asked about the extra skin in my armpits. Because it is "crepe-y" it has to stay. I'll deal with it. I trust him.
Pics are good
Brachioplasty: Four weeks later....
"Four weeks post op. Uncontrollable swelling, and new, non-stop pain all along the scar. Excruciating forearm pain also continues. Was it worth it? Hell yes. Sorry the first pic is blurry."
Uh oh (brachioplasty)
Left armpit, right at the end of my scar, I have a huge, hard, painful lump. I know about the pimple like bumps that resolve themselves, but I never had one this big or painful with the other surgeries. And this is less like a pimple and more like a boil. A big boil. As in it probably has it's own digestive and circulatory system. I think it waved at me.
I've attached pics so you all can laugh at the drama queen within me. Maybe this just seems huge to me because it looks like it's breathing, when in reality (which I am rarely in touch with) it's just a teeny nuisance.
Brachioplasty: 13 weeks post op
The epic swelling remains in the left arm, which I believe was done by the student doctor. I also have new swelling in both armpits. You can see it in the pictures. Also on the left arm, down near the elbow I continue to have problems with, I think, a stitch. Very sore spot.
No more forearm pain, that went away in both arms a couple of weeks ago, so about ten weeks post op. I do still have pain on touch in both upper arms and along the scar line especially. I also have new pins and needles type pain all along the scar line. It's random and grabs my attention when it happens.
I am still frequently checking for openings, ripping, blood, because the pain I feel sometimes make me think something grody is going on.
I am training (cardio) like crazy for this marathon in November. Also lifting every other day, we are gradually increasing weight as my pain levels allow.
Even with all the fear and discomfort, I'd do this one over and over again if I have to. I just wish my armpit skin wasn't so crepe-like and he could have removed more in that area.
PS: that mother in my armpit started draining and settled down on it's own. It was vile. Lol.
It's been one year since my tummy tuck, abdominal muscle repair, and breast lift. I had help doing some updated photos today.
I went in to this surgery at around 177 pounds. I am currently 152. Total weight loss, 198 pounds!!!
The scar has faded quite a bit, I can't even see it in a few places. I still have some numbness, and weird places where if I touch, I feel it somewhere else. I'm told that's nerves. The steroid shots in the belly button that I got a month ago have made my belly button kind of weird, but it's no longer tight and knotted. The boob scars are pretty much invisible.
I also have updated arm pics. I am just six months out of that surgery. I have swelling in my left arm still, and just a little in my right. I am thankful for a skilled surgeon who didn't pull my arms too tight, I wanted a really natural, still jiggly result. He nailed it. As I am cutting fat right now, my abs are starting to show through better, and my arms are slowly progressing as well.
I am finally embracing the stretch marks and still stick to my belief that you have to thrive, not deprive. Curves are good. So is food.
Best decision of my life.
My pics didn't show up!
Dr. Wanzel is an amazing and talented surgeon. He takes pride in his work and does not make promises he isn't sure he can keep. I think it works well that I don't seek perfection (though his work is pretty perfect) and he doesn't want his patients to look unnatural. He explains everything thoroughly, right down to the little things that can be expected. I am so happy I chose him to do my surgeries. Helen is also wonderful. She is very friendly and helpful with returning phone calls and emails.