Mother of Four, Including Infant Twins, With Hernia, Spinal Injury, & SEVERE Muscle Separation Having TT, HR, & MR-Wynnewood,PA

I became a member of Realself not too long ago,...

I became a member of Realself not too long ago, but I’ve actually been stalking this site for years. I was looking for ways to get rid of my stretch marks, and I was led to this site. I mostly admired all the brave and beautiful women on here who have gone through this procedure. But, I never thought I'd be writing a review for my own tummy tuck because 1) I’m scared of surgery, 2) it’s expensive, and 3) I have ulcerative colitis.

Anyway, fast forward to 2015 and the hubby and I found out we were pregnant with twins. I’m still adapting to being a mommy of four (11 yr old, 8 yr old, and 5 month olds) just taking it one day at a time. My delivery went well. I had cholastasis during the pregnancy so at 37 weeks I was induced. Luckily, my breeched twin turned head down two days before the scheduled induction, and I was able to have a vaginal delivery without any medication. So, I felt really good that I avoided a c-section with all my pregnancies. The only problem was that immediately after delivery, when I finally stood up to use the rest room, I had severe pain in my back. It felt just as bad as the labor and whenever I sat down I would get spasms in my lower back. I also had a fever so they ran some tests and the doctor said I had a kidney infection and it got into my blood stream. So, I assumed that’s why I was in so much pain and having spasms. I was so wrong! I stayed in the hospital for five days until the fever broke and then was sent home with an iv in my arm so that I could self-administer the medicine. I figured the pain would go away when I finished the antibiotics in 14 days.

It actually ended up getting worse. In addition to the back pain, I had an area on my stomach near my belly button that would hurt whenever I laughed, coughed, sneezed, or breathed deeply. Plus, I noticed that my stomach was not shrinking like it had when I had delivered my two older children. By my six week postpartum checkup, I still looked very pregnant. But, instead of looking like I was pregnant with twins, I looked like I was approaching the third trimester pregnant with one baby. At my appointment, my obstetrician referred me to a specialist to determine whether I had a hernia and also to find out what was going on with my back. The specialist confirmed that I had a hernia, severe muscle separation causing my intestines to distend, and a spinal injury, most likely due to the weight of my belly when I was pregnant. Thinking back now, I did have back pain when I was in my third trimester that made it difficult for me to walk, especially up and down stairs. The specialist recommended surgery and physical therapy to stabilize me enough for the surgery. I was given a bunch of restrictions - no driving, no lifting anything, like laundry, groceries, etc., no stairs, no standing for long periods of time, no cooking, no exercise, no sitting on the floor, no raising my arms, etc. - but they aren’t realistic for my situation. I work from home so I take care of the twins all day and I drive to pick the older ones up from school. My hubby helps out, but I’m sure, as a mommy especially with young babies, you already know how that goes. You may as well do it yourself.

I’ve had three consultations so far. The first was with Dr. Carp, the chief general surgeon at Lankenau Hospital. I was referred to him by the specialist, the therapist, and even my kids’ pediatrician. Everyone had such nice things to say about him, so I went in with high expectations. But, my appointment did not go well at all. He was almost two hours late so he rushed through my appointment. He was really impatient with me when I couldn’t lay straight back from a sitting position. I told him I have to roll on my side and then lay down flat because I have no core strength and it hurts my stomach and back to do it any other way. As I was trying to roll down, he pretty much forced me down and said I shouldn’t be in that much pain. He poked around my stomach with his finger for a few seconds and then said he could “fix me as an outpatient.” When I tried to ask a question about what he would be doing specifically, he said “trust me.” Mind you, he was already inching out the door. So, I pressed him for an answer and he said that he wanted to get a CT scan done first and he would have the nurse set it up. He said this from the hallway. The appointment lasted only about three minutes. I had already made up my mind then that he would not be the surgeon for me. But, I was going to get the CT scan done because I also wanted to know if there was something else wrong with me. Anyway, the nurse never set up my scan. Two days later, I get a call from his assistant stating that it was taking her so long to get back in touch with me because she needed some paperwork from the doctor and he was busy. A week later, I called to inquire about the scan and she said the same thing. This was in December. She still hasn’t gotten the paperwork or called me.

I started doing my own research for a surgeon in my area with the help of this website. I learned that there is a big difference between a general surgeon, a plastic surgeon and a cosmetic surgeon in terms of their training and qualifications. It was important to me that the person I selected to do my surgery was a plastic surgeon certified by the American Board of Plastic Surgery and a member of the American Society of Plastic Surgeons. Also, if the doctor was certified before 1995, it was important to me whether they maintained their certificate by voluntarily participating in continuing learning and practice improvement programs. Certificates issued before 1995 do not have an expiration date so doctors with those certificates aren’t required to undergo the training programs, whereas the certificates issued after 1995 expire after 10 years. This is how I narrowed down my list of potential plastic surgeons in my area.

My Consultation Experience

When I first started my search, I was interested in the Penn Plastic Surgery Chief Resident's Clinic. But, I was told that chief residents couldn't repair my hernia via the clinic. Instead, they referred me to one of the plastic surgery faculty. Even though the faculty members supervise and assist the chief residents in the clinic, they have their own separate offices. I was scheduled for a consultation on January 26 with Dr. Fischer. The consultation fee was $125. I assumed that he met all my requirements. But, when I verified just for my sanity, I learned that he did not. I checked the other faculty members as well to see if I could select someone else, but many of them weren't certified and if they were, their certifications were not being actively maintained. So, the Penn Clinic was no longer an option.

I had another consultation on February 5. This time it was with Dr. Sean Wright of Wright Plastic Surgery in Media, PA. I had to pay $20 for the consultation. He met all of my requirements. I would say that he had very good beside manner as well. He listened to my concerns and he seemed pretty knowledgeable about the procedure. He said the surgery would last no more than 2.5 hours. Although his office is located at Riddle Hospital, he performs the surgery at Crozer Brinton Lake surgical center, which is about 15 minutes away (possibly more if you're familiar with the congestion of traffic in that area.) He believe he could close my hernia but I would not have a belly button. PAUSE. Instead, he would refer me to a tattoo artist after the surgery to have a belly button tattooed on my stomach. PAUSE AGAIN. I never realized how much I liked having a belly button until he said that. After the examination, he gave me a cost sheet. For abdominoplasty with repair of my umbilical hernia and removal of the umbilicus, he was going to charge me $8180 (surgeon's fee: $6000; Operating Room: $1250; Anesthesia: $930. The price also included liposuction. He didn't mention it, but when I asked him whether he would be doing liposuction, he said I didn't have a lot of fat on my stomach, but he would lipo my love handles. He never asked for my insurance info.

I had another consultation on February 25 with Dr. Ryan Hoffman of the MainLine Institute of Plastic Surgery. His office is located at Lankenau Hospital in Wynnewood, PA. The consultation was free. When I scheduled the appointment, I was given access to a patient portal that would allow me to see a summary of the doctor's notes from my visit and also another patient portal that had videos, articles and other helpful resources regarding the tummy tuck. During my appointment, one of the doctor's assistants took my dreaded 'before' pictures and I was told that I could access them on the portal. Soon after, Dr. Hoffman came in to examine me. He said that my separation was "the worst he had ever seen." As he was examining me, he kept saying "yeah, this is bad, this is very bad." But, he reassured me he could address all my issues. He explained IN DETAIL what he could do for me. He basically answered all the questions I had before I even asked them, which I appreciated. He made me feel so comfortable that I forgot I was undressed talking to him. (Oh, and if you're not comfortable with being alone with a male doctor in the examination room, his female assistant stays in there with you.) There was a touch screen on the wall and he brought up my 'before' pictures. He drew what he was going to do on the pictures so I would have an idea of what I would look like. He said I didn't have fat in my abdominal area, but he would lipo my sides to give me better results. He said he always does liposuction when doing an abdominoplasty because it helps him close the gap better. After the examination, I met with his surgical coordinator, who gave me a copy of the cosmetic package plan, which contained all of the fees for the surgery. She said that my hernia portion of the surgery would be paid for by my insurance company. Unlike Dr. Wright's office, Dr. Hoffman's office requested my insurance information. The surgeon's fee is $7500, but RealSelf members get a $500 discount. The fee for the hospital is $1235-$1525, depending on how long the surgery takes. The fee for anesthesia is $420. If you stay overnight, the hospital fee is $1125. Since I have a hernia, my insurance would cover the overnight fee. There is a $500 non-refundable deposit that has to be paid to reserve the procedure. It is applied towards the cost of the surgery. Oh, and they accept the CareCredit card, but if you use it, then you can’t use the discount.

Pre-Op Pics

My stomach still looks exactly as it did after I delivered. I keep telling people that I'm not pregnant. But, they think I'm being sarcastic because my stomach is really hard and firm to the touch when I stand up. My doctors say that's because my intestines are falling forward out of the muscle separation. When I lay down, I can see my intestines and anything that's being digested. I haven't found a binder, compression garment, or abdominal splint yet that can handle my stomach. They all curve due to the pressure.

No Turning Back Now

My surgery is scheduled for April 14 with Dr. Hoffman. Yikes! I had another appointment with him on March 29 to pay for the surgery, review what he's going to do, get pre-admission testing done, and meet with the anesthesiologist. Due to the significant size of my hernia and muscle separation, Dr. Hoffman wants to do multiple rows of stitching on my muscles and then reinforce his stitching with permanent mesh. Has anyone else had permanent mesh? Can you feel it all the time when you're moving?

Vitamin Regimen

I purchased the VitaMedica Recovery Support Program from Dr. Hoffman's office. He said that it helps with recovery and bruising, and he noticed a difference in patients that didn't take the vitamins in comparison to those that did. One of his employees recently had a tummy tuck five weeks ago and she was gracious enough to talk to me about her experience with recovery. She said she came back to work 2 weeks post-op. She looked amazing and recommended the program as well. It cost $116. It says it helps to support healthy skin and tissue, lessen inflammation, and reduce bruising, swelling, and pain. You get 90 tablets each of the Clinical Support Morning Formula and Evening Formula. You're supposed to start taking these pills two weeks before surgery. The dose is 3 tablets in the morning and 3 tablets in the evening with food. Three days before surgery, you start taking the bromelain with quercetin. The dose is 2 tablets, three times a day. Then right after surgery, you take the Arnica Montana 30X. The dose is 3 tablets, three times a day.

No Wish Pic But I Know What I Don't Want

I haven't really selected any wish pics. But, I know that I want to have a small waist with curves. I'm hoping my doctor can give me back my hour glass figure.

I'm On The Flat Side!

I'm so happy that I woke up from surgery! I had to be at Lankenau Hospital at 6AM, but my surgery didn't start until 7:30AM. Everything went quickly though. They took my vitals and I had to take a pregnancy. I met with my anesthesiologist and went over my medical history. Then, Dr. Hoffman came in with a big smile as usual. He drew on my stomach with a sharpie and joked a bit with me and my hubby. Then, it was time for my surgery. I remember being rolled to the operating room and getting on the table. Dr. Hoffman was already in there waiting for me in his surgical attire. I told him I didn't have any wish pics, but I didn't want to look like Sponge Bob and I wanted curves. I don't remember anything after that. A nurse woke me up and the only pain I felt at first was soreness in my throat. Then, I felt tightness in my midsection. When I asked for the time, they said it was 1:30PM. They said my midsection was really in bad shape so the surgery took a bit longer. I stayed in recovery for another 2 hours. They won't let you leave the hospital until you pee. Finally, after downing cups of apple juice, I had to go. Getting up to use the restroom was when I really felt the pain. I was very sore and I was having sharp stabbing pains in my hips and right under my right rib.
They gave me more pain medication (dilaudid and valium) and an antibiotic. Dr. Hoffman came back to see how I was doing. He said that my muscle repair was the worst he had ever dealt with. He said he would show me pictures of what he had to deal with when he opened me. He said when the lifted back the flesh, I had an extremely thin layer of fascia holding my intestines. He could see their lumpiness. He said he did multiples rows of stitching to try to keep together but they weren't strong enough so I have a permanent mesh wrapped around my abdomen to keep everything in. He said that I could shower the next day if I wanted to. I've been sleeping a lot since leaving the hospital. There are many so many stairs to climb before I even get to the front door of my house. When I made it to my living room, I had to sit. I had a dizzy spell and blacked out for a bit. That was pretty scary, but my mom and hubby were right there so I didn't fall on the floor.

Surgical Pics

My wonderful doctor took these pictures of my tummy during surgery.

My Hubby Is So On Point With Everything!

My hubby has really been taking good care of me. He's emptying my drains and recording the fluids for me. He feeds me my meals since I'm having a hard time lifting my hands. He even takes me to the bathroom and wipes. He wrote down all my meds and when I'm supposed to take them. in addition to my vitamin regimen. I take Dilaudin every four hours, valium every 6, the antibiotics twice a day, a set of morning pills with breakfast, a set of evening pills with dinner, two bromelains three times a day on an empty stomach, three arnica under the tongue three times a day on an empty stomach and dulcolax. It's a lot for me to even keep straight. But, he has been so organized! All of this, while taking care of our 11 year old, 8 year old, and 6-month old twins. Our twins are still on a three hour feeding schedule too. So, my hubby is the real MVP right now! I love him and thank God for him everyday!

It's Time For An Update: PODs 1 - 3

I haven't updated my review in a bit because, to be honest, I was feeling down. But, I'm better now after reading the reviews of other realselfers and their comments. So, let me continue with my experience so far with Dr. Hoffman, in case anyone wants to use him as their surgeon.

POD #2
Dr. Hoffman called and left a message checking up on me first thing in the morning. He left me his personal cell phone number because he wanted to hear back from me. Most doctors are just like call the office and then you play phone tag for a bit. But, he was genuinely concerned and called me back very quickly after I called his cell phone. I was still pretty out of it this day. I slept more than I was awake. Dr. Hoffman said I could shower this day if I wanted to, but I had absolutely no strength for it. Plus, I was still getting dizzy and blacking out on the way back from my bathroom trips. I didn't have an appetite at all during this time. I was barely even drinking water, but I just kept peeing. No bowel movement in sight though. I'm taking stool softeners to help. Oh, and Dr. Hoffman had a beautiful bouquet of flowers delivered to my house. The card attached to them thanked me for trusting him to be my surgeon. I thought that was so sweet and thoughtful. :)

POD #3
Shower Day! My hubby bought me a shower stool, which is a life saver. I got a peak at my tummy. I'm still in the hospital binder and it rides up every now and then. My tummy seems flat, except for an area above my incision which concerns me. I couldn't see my incision because of how swollen this area was. I didn't faint in the shower, but I did get very dizzy at one point. I still can't stand upright and I walk hunched over very slowly. I rely on my hubby a lot to get back and forth from the bathroom because of the dizzy spells and the pain. I fainted on one of the trips back from the bathroom. When I came to, I was leaning into my hubby's chest with my head down and he was holding me up under my arms and telling me to wake up. He didn't want to grab my waist or try to pick me up and do any damage. Gradually, the feeling came back into my legs and I was able to hobble with him back to my bed.

POD 4

I visited Dr. Hoffman today and he pulled one of my drains. It didn't hurt at all and happened very quickly. It was out before he could finish saying "take a deep breath." He wants to keep my other drain in for another couple of days and then he will have me measured for a compression garment. In the meantime, he wants me to wear a t-shirt under my hospital binder to protect my skin. He said that since the tape is coming off I may get some leaking. He also wants me to start rubbing vaseline on my belly button. He said because of the condition of my belly button and hernia, he couldn't give me a deep belly button. Also, he showed me the pictures he took during surgery and promised to email them to me. We spoke about my area of concern above my pubic area. He said it was swelling and would come and go as time goes on. I'm hoping he's right and it's not a sign of a revision.

POD 5

This is when I started to get a bit emotional. Maybe it's the pain meds because I really have no legit reason to be this sad. I think it began when I started missing picking up my twins and soothing them. They are only 6 months old and just starting solid foods. So, I feel like I'm missing out, even though my hubby brings them to visit me often. It's hard hearing them cry and not be able to go get them. I feel guilty just laying here in bed when they visit. I know they would love to be in my arms, but they are very active and would end me. lol! Then, for some reason, my mind decides to start thinking about every sad thing that has happened to me or has not even happened. For example, a thought popped in my head that my 11 year old would be going off to college in a few years. Um, that's such a long way off from now. But, my brain had me sobbing like he was already packed. I sobbed about every little thing today. I'm hoping tomorrow is better.

POD 6

Today I went back to see Dr. Hoffman to get my drain pulled out. Unfortunately, he had not come out of surgery yet. So, his lovely nurse pulled out my drain for me. Again, it didn't hurt at all. Then, she took my measurements for my compression garment and said it would be mailed to me in two days. She wants me to start wearing it instead of the hospital binder. She also asked if I had a bowel movement yet. I still didn't have one and was feeling quite miserable. She recommended taking the Surgilax that they gave me once in the morning and once before bedtime. It only says to take it before bedtime. But, since I have ulcerative colitis, it's hard for me to get the urge to go when I'm not flaring. When I'm flaring, you can't stop me from having bowel movements. Lol! It's a crazy illness.

POD 7

My hubby went back to work today. It's just me, my mom, and the 4 kiddies. My two older boys are in school and she picks them up for me while I stay with the twins. The school is not that far away so she returns in about 30 minutes. It was hard getting around without the hubby's help. I didn't want to trouble my mom because she had her hands full. I'm still waiting on my bowel movement. I haven't had one since April 13, the day before my surgery :( I took the extra laxatives like the nurse suggested and still nada!

POD 8

It finally happened today!

POD 16

I haven't updated in a while, but I'm slowly making progress. My compression garment came on POD 10 so I was able to get out of that hospital binder. I have a love/hate relationship with the binder though. It wasn't easy getting it on and I had to have my hubby help me. When I first put it on, I noticed right away that it allowed me to stand up straighter. It is also crotchless, which is perfect for bathroom trips. It wasn't completely uncomfortable, so I was like I can deal with this. Hmmp. Not so fast. I fell asleep in the binder at 12:30AM and then the twins woke us up at 4:00AM. You couldn't convince me that there wasn't a boa constrictor wrapped around me that had chomped on my butt cheeks. Basically, the garment had compressed around my booty and the area of booty that was exposed was being smooshed so it became swollen. My hubby tried to help me adjust it, but he was laughing so hard. It was cartoonish in nature. When I saw it, I had to force myself not to bust out laughing because it still hurts when I laugh or cough. I took more pain meds and it helped me to go to sleep. The next morning it was better and the swelling had gone away. I also noticed that the areas around my incision weren't as swollen after wearing the garment for a night. But, the tightening around the buttocks keeps happening at night. I haven't found a solution yet though.

On POD 14, I had an appointment where my surgeon removed the tape on my incision. He also checked to make sure I didn't have any fluid in my tummy. My stomach under my belly button to my mons pubis is extremely hard like a rock. There is no give to it whatsoever. I am standing somewhat straighter but not fully erect. I had some concerns about my left hip and thigh because I am having difficulty moving it and it's also very swollen. If I am sitting down, I can raise my right leg off the floor about a foot. I can't raise my left leg at all no matter how hard I try. My pain is mostly in that left hip area along with most of the swelling. I also have a spinal injury, which I have to go to therapy for once I heal, but I was able to move my legs normally before surgery so I know it's not my spine. When he was examining me, he noticed that when I stood up I was kind of leaning. My spine is tilted forward and slightly to the right, so I guess that's why. He thinks that could be contributing to the swelling on the left side. He said that he wanted me to continue trying to move the left leg as the swelling subsides over the next two weeks. He says there are nerves in the area where the incision was made that could be affected, but that normal function usually returns. So, we'll see what happens over the next two weeks. Other than that, he wants me to start massaging my incision with cocoa butter and Biocorneum. I told him I had already bought Bio-Oil, and he said that was fine too. But, I'm thinking that I may get it as well, since it has silicone in it.

5 Weeks PO Update - a little setback

The issues with my left thigh and hip have resolved. Yay! I still have some tightness in it, but I can move it. I had my 4 week appointment with my surgeon on Monday. Last weekend, my stomach was really swollen, and my incision started bleeding in a small area. He said it was old blood that was finding a way out of my body. So, he opened the incision and drained out as much of the old blood as he could. He said I also had a "bubble of blood" under the skin so he popped it for me. I'm still numb so it didn't hurt at all. The incision is less than a 1/4" wide. Today is Friday and it's still bleeding. I don't mind because I'd rather this "old blood" get out of my body than stay inside. Also, I noticed that my swelling has decreased somewhat. My stomach is still very hard to the touch from my belly button to the top of my vaginal area. My doctor says I'm still very swollen but massaging will help to loosen the hardness over time.

I'm On My Own...

My mother went back to work. These grandmother's now-a-days with their working and volunteering for good causes. How dare she leave me to raise my own children on my own? LOL! Just kidding! But, it was good to have her help for five weeks. My twins are now 7 months old. I lifted them - one at a time, of course - for the first time yesterday, and I definitely felt it in my stomach. I also pick up my older boys from school in the afternoon and lifting them when they're in the car seat hurts really badly. The twins weigh 16 and 17 pounds. The car seat by itself doesn't weigh that much. But, you pop a baby in one of those things and it feels like you're lifting 50+ pounds.

2 Month Update

Just a quick update about my setback. My incision finally stopped leaking and is continuing to heal. I still have swelling all over, and there is hardness along the incision and under the belly button. Above my belly button is no longer numb. I can feel the mesh holding my abdomen together if I press my hand into the area above my belly button. But, I don't feel it at all during my daily activities. I am still numb under my belly button. I'm not completely flat yet, but my doctor says that my surgery was so extensive that it will take a little bit longer to see my final results. I was given permission to begin working out, but I have to slowly work on my core and back for now. I am so looking forward to shedding the twin pregnancy weight.
Dr. Ryan Hoffman

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