Two years later....

Wow. I cna't beleive that I have been away so long. A lot has happened since my last update. I noticed that I still had a asymmetry in my upper abdomen and so I tried theraputic massage. My doctor thought that it may be fluid trapped in a pocket. While it was relaxing, it didn't do anything for me. I then tried physical therapy. The therapist told me that it was actually the muscle that was bulging and that I had diastasis recti, or a  separation between the two sides of the rectus abdominis muscles.

Just after my one year update, I consulted with a general surgeon regarding these issues as well as weakness in my lower abdominal area (again) and we decided that the best thing to do would be to go back in the original site and do an overhaul. The general surgeon suggested that he work with my plastic surgeon since he had done the other surgeries and knew what had been done. So, a day before my birthday, I went in for the surgery. Believe it or not, I was excited. I wanted to fix it all and move on. I was tired of looking funny and being in pain. I stayed overnight and left on my birthday, hopeful that this would be it.

But it wasn't.

I followed the doctor's instructions. To a T. I was convinced that I had done too much previously or I had somehow caused all of this each time, Again I had drainage issues, seromas, etc. About a month and a half later, I was able to return to work. I still had drains in, but I really wanted to get back to a normal life. I did eventaully get there. A few months later, I was again noticing a large disparity in the way my abdominal area looked. It literally looked like a roller coaster. One small bump on the lower left side, a large dip and then a big hill on the upper right. It felt weird too. I could feel the mesh under the muscle, but I also felt a funny "bubble" that sat on the top of the large bulge. I decided to see if a different doctor could answer what it was. I was hopeful that he may be able to explain things and fix it. I know..... another surgery ?!?! Really ?!?! He did explain that it was just how it was healing with scar tissue and basically there isn't much that he could do. Going in again may not be the best idea. The way he put it was that with each surgery, you run the risk of damaging the muscles even further. To say that I was disappointed was an understatement.

I had gone through all of this stuff and nothing had worked out how I wanted it to. Of course, reducing the risk of breast cancer was some consolation, but I was feeling pretty low. It was depressing. I hated how people asked how I was doing and I explained and they gave me that pitiful "Oh, poor you" look. I didn't want anyone's pity, I just wanted to feel and look normal again. I looked back at pictures that I had taken right after surgery and it literally made me cry. My body had been through so much trauma ove the past two years and looked NOTHING like that. It looked so much worse. Uneven, bumpy, lumpy, gross. Losing a little weight didn't help either, it just accentuated the deformity.

So, that's where I am right now. Not happy with how I look, but dealing with it. I am not sure what my next course of action is. I am going to give it a little more time and maybe I'll see what my options are in 6 months. I am not comfortable wearing form-fitting shirts that I was hoping to wear again. Now, I wear tops that are a size too big so that they do not cling to my lump. Unfortunately, they hang loose on me and I look like I am playing dress up my Mom's clothes. When I do wear something a little bit tighter, people ask if I have lost weight or remark on how much smaller I am. I don't want to have to explain why I wear larger shirts to cover my stomach. It's embarrassing.

Maybe it doens't look as bad as I think, but I am my own worst critic. Someday I'll feel good about my body again. Just not today.

I don't do sit ups anyway !

I always thought that it was kind of funny when the doctor would explain that the "sit up" muscle would be cut during a TRAM Flap surgery. I would joke everytime "Well, I don't do sit ups anyway, so I will be fine." Ha ha ha.......
Unfortunately, that muscle is used for more than just doing sit ups as an exercise. After two years, I am just now finally getting back some use of the rectus abdominis muscles. For example, it is not easy to just sit up in bed or get up off of the floor. I tend to roll my body into the desired position. I call myself a turtle because that is how I feel if I end up on my back. Either I call for one of my kids to give me a hand or I kind of rock myself to one side and hope that there is something around that I can use to pull myself up.
It has gotten better with time, but it will never be as easy to move around as it once was.
In all fairness, I have gone through MUCH more than the average TRAM Flap patient. Not everyone will have the same opinion or lack of mobility that I have experienced. I just wish that I had been a bit more informed about how much you do rely on this muscle and that it is not just for exercising, as most people assume.

One year later.....

So, it had been over one year since my mastectomy. When I decided to have the surgery, I thought for sure that by this one year mark, I would have put all of this behind me and moved on with life. Unfortunately, it has not been that easy. This year has been very difficult. Emotionally, physically, financially.... This year has been very rough. I know that I should be happy that I have greatly reduced my chances of getting cancer. Don't get me wrong, I am VERY happy to have that on my side ! But it has been a struggle for me to try to stay positive and see the good in all of this mess.

Would I have the TRAM Flap surgery again ? That's a tough question. I know that what has happened to me this year could not have been predicted. No one could look at me and say "Your muscles suck, don't do this." LOL So, rather than dwell on the negative, I try to see the positives of this situation.

1. I think that having the surgery has helped me to take better care of myself. I am never going to have another chance to get a tummy tuck, so I need to be more careful about what and how much I eat. I would love to exercise, but I have been afraid to do anything because I don't want to irritate the muscles or make them pop even worse.



2. My family is amazing. Of course, I already knew this, but you really depend on others when you are in this situation. You have no other choice. My husband was there with me every step of the way. Taking me to appointments, making me take pain meds when I tried to tough it out, keeping the kids quiet so that I could nap, urging me to go see the doctor when I didn't want to admit that there was something wrong. My kids are great too. They have really grown up and been a great help. Having my parents close was also a huge help. Picking kids up from school, babysitting during surgery and appointments- I couldn't have some it without them !

3. YOU are your own advocate. If you feel like something is wrong, do not let it go ! You know yourself better than anyone. If you feel like something is off or doesn't look right, talk to your doctor about it. If you don't get the answers that you are looking for, ask for another opinion. I learned that you can't be worried about hurting someone's feelings. This is your body, your health and you are in control. Don't let anyone talk you into doing something that you are not comfortable with and don't take no for an answer if you think that something is not right. You are important ! Don't diminish how you feel or your opinion.Trust your gut. If something is bothering you, tell someone or keep asking questions until you get an answer.


4. Do your research. I thought that I had done my homework before having the surgery. I had read just about everything on the internet about TRAM and basically thought that I could perform the surgery. Ask questions. Talk to others who have had the surgery. Read blogs and books by others who have been through this. A doctor or nurse can give you an idea of how recovery will go, but they have not lived through it.

5. Sometimes things will not go as planned. That's ok, you just have to figure out what's going on and make a plan to get through it. I was pretty naive to think that things were going to go 100% perfectly and I would be fine after a month. Everyone is different and recovery will vary, but expect some bumps in the road. If things go as planned, awesome. If not, you will not be so discouraged.

6. Maybe all of this happened for a reason. I am a true believer in this one. If my experience helps one person, that's a win for me. It makes all of this crap a little more bearable. I hope that someone, somewhere finds this information useful.

So, would I do it all over again ? Yes. I would. This cruddy one or two years of my life is worth knowing that I am safe. If I had not had the surgery, I would live in constant fear and that is no way to live. Would I have a TRAM ? That one is a little tougher to answer. I would have the surgery, but I would ask more questions and I would be more persistent when I thought that something was wrong. It's easy to see all of this now, not so much when you are living it.

Post-Op ..... #4

So, I had my abdominal wall repair surgery last Thursday and came home the following day. The pain and uncomfortable feeling was about what I was expecting. It was similar to my C-sections and the TRAM. The part that I wasn't expecting was the drain that was put in my pelvic area. OMG did that hurt ! Getting up out of bed, using the bathroom was so painful. It is still painful today (Tuesday) but not nearly as bad as it was. I stopped taking the meds Sunday morning and the pain has been bearable. If I get up from my chair the wrong way, I still get that sharp pain in my groin area, but it goes away after a few seconds. I go back to see the doctor this Friday, so I am hoping that he will remove it then and I can finally move forward !

As far as the tummy area, it is very tight. It looks the same as before because my doc just opened up the previous scar. I have stitches, which will probably be removed this week. I tried to sneeze yesterday and wow, did that hurt. Laughing is no laughing matter (I know, I know).....

TMI- As with any surgery, having a BM is very difficult after surgery. I was taking stool softeners before I came home and I had a prescription for softeners as well as laxatives. Even with all of these aids, it took several days to produce anything (even gas !). Of course, once something was ready, it hurt terribly, due to the pressure that you are putting on the stomach muscle. Things are still not 100% normal, 4 days later, but as long as there is something coming out, I am not concerned.

"Muscle Weakness"

Well, I just returned from yet another surgery. This time to repair my "muscle weakness". After the last surgery to remove the scar tissue from my lower left abdomen, my muscle didn't bounce back like it should have. So, my intestines were pushing out beyond my waistline (about 4 inches).  We waited a few weeks to be sure that my insides were all healed. Yesterday was the big deal. It is weird to say it, but I was counting down the days. I have had to wear my fat pants because none of my other pants would fit around the bulge.

This surgery was pretty simple, just repairing the muscle and adding more mesh. However, it seemed much more painful last night. The incision wasn't the worst part. The new drain that was placed in my pelvic area is killing me ! It is a really sharp pain when I go to the bathroom or try to get back into bed. It's not quite as bad today, so I am hoping that it will disapate over the next few days.

Until then, I am under strict orders (from my husband) to sit in my recliner and not do anything. I definitely don't want this to happen again !

The Aftermath...... 6 Months Later

So, I have done a lot of explaining what to expect before and just after a TRAM Flap surgery, but I haven't really covered how it feels. I am just over 6 months out from my surgery and all of my other issues aside, I feel great ! I am back to work, pretty much like nothing has happened. I have noticed  little bit that my stomach muscles are not quite what they used to be. For example, if I am going to sit down in a chair, it is more of a drop and less of a graceful motion. :) I am not sure if that is due to the hernia, lack of toning or if that is just how it is going to be. I think that once all of this other business is taken care of and I can exercise a bit, the muscle will (hurt) begin to tighten up and won't be so loosey-goosey. I still have the fluid build up going on, so my tummy is not as flat as I would like it to be. I might go back to the massage after this next surgery and see if that might get things moving. My stomach is still a little numb, mostly around my belly button. My surgeon fixed that area when he removed the scar tissue, so that may be due to the repair more than the TRAM surgery.

As far as my breasts go, they look AWESOME ! I literally have my "20 year-old" boobs back ! I am very pleased with how they look. The scars are fading quickly. I think that after another six months or so, they will be really hard to see. Not like I am going to be showing them off or anything, but they are looking more "normal". They are still a little bit numb in some areas, my right side more than my left. Overall, I am getting the feeling back in them, meaning that if I pinch myself or scratch myself, I feel it, but it is not painful. It is weird because sometimes I will feel an itch and I literally can't scratch it ! I try, but I can't really tell what I am scratching. There is no sensation in my breasts or nipples when they are touched. Not that I expected anything, just confirming that all of the info that you may have read is true.

What I have been through I *hope* is not typical. I think that most people would be feeling pretty close to 100% at this point. I had no issues, I think that I would be there too, just all of these pesky complications keep coming up and setting me back a little bit each time :)

The "Worst Case Scenario" patient

Side Effects:

Swelling...............................Check
Seroma.................................Check
Delayed Wound Healing......Check
Lymphedema........................Check
Scar Tissue...........................Check
Hernia...................................Check

What's left ?

OK, so remember that "bulge" in my abdomen ? I was having some pain and discomfort and the ER doctor said that it was a hernia. Great. My doc ordered a CT Scan and then I saw him the next day. He said "Good news. No fluid collection and it is not a hernia, just weakened muscle". Unfortunately, there is no way to resolve this other than going back in for surgery again. This is a total bummer, but I was expecting it, so no big surprise. I would be sooooooooo happy if this gets resolved and I have no further issues. It would be so nice to get through this and then move on with my life.

I feel like I have been in a holding pattern for the past 6 months. Once I get through one thing, there is always something else to get through, then something else. When I am feeling down about how long this recovery is taking, I just tell myself that it will be so worth it in the long run. My chances are so much better because of this surgery. Yeah, it really sucks right now. All that I want is to feel normal again. No more aches and pains, no more bulges. I'll get there. I'm trying to be patient, but sometimes that is easier said than done.

Big girls don't cry

I am an optimist. Always have been. I try to see the best in every situation. Sometimes, that is easier said than done. Being BRCA + stinks. No one wants this diagnosis, but there is nothing we can do to change it.

Have a mastectomy, that will fix it. But what happens when things don't go exactly as planned ? I have been trying hard through this whole surgery/recovery to take things as they came and not get too upset when things don't go well. Some days are better than others.

These last few weeks have been dotted with good days and bad days. I just want to be normal again. Why is this taking so long ? I look so deformed and feel gross. Why is this happening ? I had such great results a month after the surgery. Will it ever look that good again ?  Nothing in my closet fits.  I feel uncomfortable wearing clothes that fit a few months ago. It's so depressing.

Everyone has so many questions about my recovery and sometimes, it's hard  because I don't know the answers. I know that everyone is just curious and have my best interest at heart, but I don't like all of the attention. What I want more than anything is to feel normal again and instead, I feel like I stick out more than ever before.

I've gone through all emotions in the past few months. Happy, sad, relieved, scared, confused, nervous, tired.... I've cried. A lot. It helps. Talking about it helps too. I am lucky to have good listeners who let me talk through things and validate my feelings. No, this was not what was supposed to happen. Yes, it is ok to be worried. It is also ok to want to look and feel normal. That is not shallow or vain, I went in looking one way and now I look worse. It's ok to want to look normal again. Being BRCA+ sucks.

But...... things will get better. Yep. The optimist is back. :)

What a long, strange trip it's been.....And it's not over yet

Well, it has been about a month since my last post and what a month it has been ! The ultrasound showed that I did have a few pockets of fluid hanging around. I also still had my last drain in from the surgery. My doc decided to remove the drain and I was finally free !!! It only took 4 months, but it felt so great to finally be able to move around without that thing attached. You get so used to having the drain, you don't realize how much you are restricted by it. After that came out, I noticed that my stomach was still not right. I was worried about more fluid collection, so we did another ultrasound and that revealed a decrease in the size of the fluid pockets, so that was a plus.

So, if it wasn't fluid collection, what the heck was wrong ? All along, I had been told that it was fluid. It was cellulitis. It was inflammation. It would get better, just give it some time. But it was not getting better. So I asked my doctor to explain what was going on. He explained that the scar tissue grew between my skin and muscle, it would need some time to grow back together correctly. The scar tissue also pushed everything around, causing the inflammation in my stomach area. We decided to wait a few months, try to let things heal and settle, then we will decide where to go from here. I may try massage therapy and see if that might help the swelling go down. At this point, I will try anything !

This may seem like I am whining, but my clothes still do not fit right. After wearing sweat pants for 4 months, I had to try and find something in my closet to wear to work. I still have a bulged out area where the mass was removed, so I need pants that will allow some space in that area. I also have the swollen area on the right side. So, a lot of the my shirts and blouses don't fit either. My stomach looks like a roller coaster. :( I know that this is temporary, but it is disappointing.

Your Body is A Wonderland......

More like a war zone. Seriously. My stomach looks like a treasure map. Stitches, Doctor's markings, stretch marks, scabs. I'm a hot mess. Ever since New Year's Eve, when I first started to notice the abdominal swelling and the big "bulge" in my lower abdomen, I had been feeling discomfort and pain. I went from having a nice, flat tummy to having a lumpy, bumpy mess of a stomach.

Maybe I had just gained some weight or was retaining water. Everyday, I would ask my husband to compare the lumps to the day before.Was one side larger ? I even took a bunch of pictures to try and see if I could tell the difference. Nothing was happening except that I was feeling more and more upset about how things were turning out. After about a month and a half, we finally decided that we needed to go in and see what was going on. I wasn't really nervous about the surgery, but more nervous that I was just being vain and my "pumpkin" belly was just how it was going to be. The doc was only in for about 30 minutes. He pulled out a grapefruit-sized mass of scar tissue and infected tissue from my lower abdomen. It was like "Bam ! I told you so !" Who is excited that there was a mass removed ? This girl !

So, fast forward a week, and I noticed ANOTHER lump right (I know, right ?!?) under my rib on the same side where the last mass was removed. This one is smaller, feels like a golf ball. I called the office and the nurse told me to come in the next day. My doc wasn't there, so I saw another doc who wasn't sure what it was. He didn't think that it was muscular, but wasn't sure what it was. Seriously ! I thought that doctors knew everything !! I seem to get a lot of "I'm not sure what it is...." or "I don't know why this is happening....". I guess that I should have gone to medical school if you only have to know SOME things..... Ok. back to the topic.... He scheduled an ultrasound for the following week, a day after my next appointment with my regular doc. My doctor wasn't much more help. He wasn't sure either, so we went ahead with the ultrasound.

That was Wednesday and today is Sunday. I haven't heard from the office, but I guess no news is good news, right ? I was assuming that I would get the results at my appointment on Tuesday. So, until then, my golf ball and I will be waiting patiently for a diagnosis.

I was pumped full of alcohol and didn't even catch a buzz

Hello. My name is Kelly and I have a seroma. "Hi Kelly".
I wish that there were a support group  for this darn thing. Some days, it feels like I got into the ring with Rocky and I was Ivan Drago. My stomach area feels so tight and it is a constant ache. Getting up out of the seated position or from laying down is a chore and I end up hunched over until I can eventually straighten myself out. The good news is that it is not permanent and it is really a minor complication.

The explanation that my doctor gave me about my continuous draining was that after the surgery, the cavity where the tissue was removed from did not close up completely on its own. Any gaps allow serum (drainage) that occurs naturally in the body to collect in the empty space. Since there is a mini-vacuum installed there, it sucks all of the liquid out.

Solution: Sclerosing the seroma. My doctor took the drainage tube off of the bulb, then injected it with an alcohol/lidocaine solution, which went directly into the cavity. He then clamped it off and left me. I waited in the examining chair. And waited. And waited. After about 30 minutes, he reconnected the tube to a new bulb and the solution came back out. After dumping it, I was able to go home. What they failed to tell me was that the liquid coming out now was no longer "grapefruit juice" or "lemonade", it was straight up vampire blood. Pretty gross.The drainage amount is down, so yeah me !

The idea behind sclerosing the cavity is to irritate the lining and make it try to heal on its own. This may work the first time, or it make take a few repeat treatments to obtain the desired result. At this point, I am willing to try anything because it doesn't seem to want to close up on its own. The alternative is to go back to the surgery room, open up and clean the area out. The last thing that I want right now is another recovery period. I am finally able to do things that I couldn't do a few weeks ago. I am hoping that it will not come to this. On the positive side, it would give me more time to work on the blog :)
 

Drain, drain, go away.....

Well, I couldn't make it to my next appointment with this seroma. My stomach was so tight and all that I could feel was pressure. My regular doc was not in, but his nurse came in to see me. The "fill-in" doc said that this would resolve itself on it's own if we had left it, but since I was there, we would try and see if we could drain some out. If there was a lot, he would decide what to do.

The first thing that he did was take out the remaining Penrose drain. Then, he inserted a long skinny tube in the area where the drain was. He attached a "turkey baster" syringe to the tube and began draining some of the fluid. (I was happy that he didn't have to use the needle. Not gonna lie....) He withdrew two full syringes (60mL) and decided that there was more in there than he thought. It went across my whole belly area.

Plan B: Insert a new drain. I can't believe that I am going to say this, but I was kind of excited to get a new JP. I know. I am a freak. It is just so much easier to maintain when all of the fluid goes to one place as opposed to catching it in a pad and not knowing how much is actually draining. So, the doc took out the syringe line and put in a shiny new JP drain.

By the time I drove home and emptied the drain, I had already released another 50 mL. So, for the next two weeks, I will be recording drainage again, in my comfy sweats. Someday  I will be drain free, just not today ! <p>

Is that a seroma, or are you just happy to see me ?

Seroma. Ick. It all started a few days after my "conversion". Once the doctor cut the bulb and drain off, there is no longer suction to the tube in draw out the fluids left in the body. Unfortunately, I think that some of those stringy tissue things have blocked up my drain and I went from changing my pad out every few hours to absolutely NOTHING draining. As the days go on, I have developed a bulge from the fluid building up.

At first, I thought maybe I was imagining it and the draining was just done, but even my husband could tell and he does a daily inspection to tell me that it has gotten bigger. I can see the bulge when I look in the mirror. One side of my belly button is flat, while the other is puffed out.

As much as I hate calling the doctor after hours, I put a call in and the on-call doctor told me not to worry. It was not likely to become infected, I just need to come in and then we could decide what to do. Of course, with my luck, this all began on New Year's Eve, so the office is closed New Year's Day and then we got a major snowstorm last night. So, I have an appointment set up for tomorrow to see what we can do. Hopefully they get the roads clear or this thing starts draining !

I am hoping that the build up will create some pressure and push the tissue stuff out of the way. So far, not so good. :(

What IS the point of a belly button anyway ?

My husband asked me this while we were bandaging up my new belly button. I thought about it and there really is no need for a belly button after you are born, is there other than for looks alone.

After surgery, a new belly button is formed by your surgeon. This surgery is called Umbilicoplasty. My husband is grossed out by the belly button because you can see into the hole before it closes up. He said that he can see my insides. Ok. Whatever.

My doctor suggested putting Bacitracin or Triple Antibiotic Ointment just inside the new belly button. Then, cover it with a Band-Aid. Please check with your doctor for specific instructions.

Do not "poke around", as you might cause the belly button to bleed. If you begin to bleed or have puss coming from the belly button, call your doctor immediately.

A Christmas Miracle ! (Almost)

May be TMI- Don't read ahead if you are offended by fluid, maxi-pads and underwear talk. ;)

So, it is Christmas Eve and I have an appointment. Weird, but I was looking forward to this one because I still have my last ab drain in (5 weeks post-op) and I was really hoping that the draining would slow down and I could have it removed. My doc told me the week before that we could probably remove it if the draining slowed down. He also prescribed me an anti-biotic, in case there was an infection that was causing the fluid. Unfortunately, nothing changed during the week.

When I got into the room, I chatted with the nurse and we discussed the drainage. I asked her if it was normal to still be draining so much fluid. She said that it was not "normal", but it did happen to some people. I asked "Why ?" and she really had no explanation. Yeah, me. Once again, I am abnormal. :)

When the doctor came in, he looked over my drainage chart and asked a few questions and told me that we would "back the drain out" weekly. I didn't get it at first, but he numbed the lower area with a series of shots, then he cut the bulb and tube off. All that is left is the plastic tube that has taken residency in my body (Penrose Drain - The long white tube with the holes in it pictured below).

Each week, I will return and the doctor will remove another section of tubing, hopefully buying some time for the fluid to get out. The nurse put a pad on the area to collect the fluid and told me the best way to deal with it is to buy maxi-pads and tape them on or attach them to my underwear. Sounded easy enough.

When I got home, I put a new pad in my underwear and hoped for the best. We were having company over, so I really didn't want to leak everywhere. Thank goodness, I was good for a few hours, then I went to change the pad and it was 100% soaked. Gross.

This drain is continuous. Even when I sit down to go to the bathroom, I have to put gauze or toilet paper near it to catch the flow. The maxi-pad shifts and doesn't always catch the fluid, leading to soggy pants. Sleeping is interesting. I want to lay on my back because I am still having some breast pain, but I am afraid that the pad won't catch everything that comes out at night. I tried to wrap an Ace bandage around myself, to keep it in place, but it is in such an odd spot, it is hard to keep it from moving.

In the big scheme of things, this is no big deal. Things could be much worse. It is just another uncomfortable part of recovery that I get to experience. On the positive side, I can wear pants again and not have to worry about the tube hanging out or getting caught on something.

I am worried about the area getting infected or something getting into the tube and back into my body, but the doc said that there was nothing different that I should do to clean it, so I guess I will just keep a close eye on things and hope for the best !

The Dummies Guide to TRAM-Flap Surgery

I wish that I had done a better job recounting this recovery week-by-week, so that it might be more helpful for someone one day, but honestly, pretty much the first 3 weeks I did nothing but take meds on cue and sleep. I don't think that I even picked the laptop up until last week. I still have it kind of resting on my knees, because I don't want any extra pressure in the belly area.

I will try to recall basic details, so if you are thinking of having a TRAM-Flap or preparing for one, you will know what to expect. This is going to be an unfinished epic. I am going to keep adding to it when all of the warm, fuzzy memories return. :)

Deciding between the surgeries can be difficult (or simple). Your Plastic Surgeon will be able to let you know right away if you are a candidate for the TRAM-Flap or what size you can expect to be after the surgery. Some plastic surgeons don't even do this surgery, so make sure to check with the office when setting up your appointment. My surgeon said that I had a "good harvest" (his words) which made both my husband and I laugh. I have never thought of a fat stomach that way. I have always been larger-chested, especially since I have had kids. I didn't have a problem going smaller. We decided that it would be a good option for me. I liked the idea of the tummy tuck (DUH !) and using my own tissue as opposed to implants. My sisters and Mom all got implants, but I just wanted to try to avoid it, if I could. If that were going to be the route that I was going to take, I would have just done more research and it would have been fine as well. It just worked out for me to go this way.

 One important thing to keep in mind when going in for surgery is to be realistic with your expectations. The surgeon is going to remove lower belly fat, not ALL fat. You may be larger on top of the incision than you thought. Unless you have no upper fat, you are not going to come out of this looking like a supermodel. The good thing is that through diet and exercise, you can change this. If you are concerned, ask your doc what he thinks the results will be. 

OK. Surgery Date's been set. What do you need to do ?

I'm a planner and a little OCD. Not sure if I have revealed that fact yet. I am a list maker. I make lists for my lists. I made up a list of EVERYTHING that I wanted to get done about 2 weeks before surgery and just ticked things off, one by one. Everyone will be different. For me, having 3 kids was the biggest thing to plan for. My list was basically:

• ALL laundry done and put away
• Clean sheets on all beds
• FULL grocery shopping done- Anything that you and your family might eat or need (toilet paper, dish soap, comfort food, things that you will want to eat- even treats for yourself :)
• Pack your bag. I mentioned this before, but you really don't need much. You wear hospital gowns and won't eat or do much while you are there, so basically, bring a toothbrush and you're good. 
• Plan for your kids- Babysitters, picking up from school and day care. It sucks, but it needs to be done. My surgery was first thing and an hour away. We dropped the kids off at my parents the night before. My husband ended up staying the first night at the hospital, so Grandma and Papa had them both nights and had to get them to and from school. My husband also just planned hospital visits around school times, so it worked out. If you have pets obviously, you need to plan for them and also have a Back-up, just in case something doesn't go as planned. 
• Tell as many (or as few) people about the surgery. Obviously, if you are an open person and tell people about it, they are going to offer to help out. TAKE THEM UP ON IT !! Even if they get your mail or make a meal, it is one less thing for you or you care giver to do.
• I wrote my kid's teachers a note that I would be having surgery and would be down for a bit and we were going to to try to keep things as normal as possible and that Grandpa would be picking them up some days. I hope that this also helped them understand if homework was done a little more "creatively" with Dad or if they were missing something. 
• Finally, (and most importantly), I loaded up my DVR with a bunch of everything. Surprisingly, I have made my way (or slept) through most of what was recorded. I am glad that I did. It kept me occupied while I was relaxing, but not really ready to read or do much else. 

What do you need to buy ? Well, you don't need to buy all of this if you don't have them, but these things help !

• Recliner. I was lucky enough to already own a big, cushy leather-blend recliner, so I don't know what people who don't have one use to get comfy, but I spent 23 1/2 hours of each day in the recliner (30 minutes going to the bathroom and showering), so if you are thinking of adding a piece of furniture, consider a nice recliner. I bought a washable cover, so every few days, it got a wash. I am on week 4 and still in the recliner for most of the day and sleep the best in the recliner. It takes the pressure off of your belly and it is easier to get out of than a flat bed. We'll discuss this later. 
•  Pillows, pillows and more pillows. You can use them however you need to to get comfortable. You can never have too many, and all sizes and shapes work.  
• I had a detachable shower head already, but I recommend this for "showering". I preferred sitting on the edge of the tub and using the sprayer to clean myself. I have a few areas  with wounds that are slowly healing more slowly that freak me out, so I can make sure to keep them dry this way. I also have a shower with a seat in it, which would work to if I was not worried about the spots. You can stand up in the shower, like any other time, but you will feel weak at first and it will be hard to stand for any long period of time. You may want to rent/borrow/buy a shower chair.
• You will probably need some medical supplies, but I would wait to see what they give you from the hospital and what your doc says that you need. You may not need anything. Lucky you ! 

 One point that I can not emphasize enough that having a strong care-giver or team is sooooo important. You are going to want to do a lot on your own, but you just can't. You shouldn't and you physically can't do a lot on your own for at least two weeks. My husband was AMAZING ! Kept the kids away so I could sleep, kept me comfortable ran out to get me a snack that just "sounded good", took over all of the household chores so that I didn't have to worry about them getting done. I can never thank him enough.

If you are a single gal, please try to line up someone to stay with you or cover shifts. You will be taking meds and even getting up to go to the bathroom can be dangerous. If you don't have someone with you 24/7, have a neighbor or friend who lives close on speed dial so that if you need help at 2 in the morning, they can be there in minutes.

It's here, it's here ! It's finally here !!! The big day !
I know that most people would dread this day, but I had been waiting for so long, I was ready to get it on. I have had my mind made up for over a year, I knew this was what I wanted to do. No second thoughts. Let's just get moving. What to do:

• Follow you doctor's or hospital's instructions- Usually no eating or drinking for 12 hours before the surgery. 
• Only take into the hospital what you need immediately. Insurance cards, Driver's License, cell phone. Leave your bag, lap tops, chargers, etc in the car. Your care giver can grab this stuff later. You won't want to have to lug this around into the pre-op room. 
• Be prepared that even if your surgery is scheduled at 8, you will probably be set to arrive 2 hours ahead. It might seem like a lot of time, but you will check-in, be called back to pre-op, get changed into a gown, take a medical history, talk to a few nurses, get an IV going, talk to the anesthesiologist, talk to your surgeon, talk to plastic surgeon. Maybe a few more people. Before you know it. Its showtime ! 
• One more thing to be prepared for (this has happened a few times, so I know from experience) is that you might get bumped. Not physically, but other surgeries might run behind or longer than planned. I know how nervous/excited you might be, but try to stay calm and just know that it will be done. Just ask the nurses to keep you posted and they will. 
• When the time comes, the nurse will start a drip of meds that will make you groggy, but still awake. I usually remember clearly kissing my husband, saying "I love you" and being wheeled into the OR. At that point, sometimes, I remember getting on to the operating bed, other times, I have been out before that point.

And then you wake up......

• You may or may not remember recovery. Usually you will wake up and a nurse will say "Hello" and explain what is going on and ask you if you need anything like water or ice. Yum. Ice chips. They just aren't the same at home.
• You may be feeling sick, tired, in pain, anything. Just tell the nurse, and they will adjust your meds, get you water or a bed pan. They are your go-to at this point. If your nurse isn't cutting it, have your care-giver grab one of the others. You need to get comfortable and that won't happen if your needs aren't being met. Most of these nurses are really helpful, but my Mom had to go after one guy I had after one surgery because I was in so much pain and he was kind of blowing me off.
• Bottom line- this is about you and it is ok to ask for things. I always felt awkward asking for some crackers or a cup of ice chips. Now I realize that YOU are the one having surgery. They won't think twice about you an hour after you leave, so who cares how many times you ask for something ? You are not putting the nurse out. It is their job to help you ! Oh, and if you throw up on them, it won't be the first time and I am sure that they have seen it all before, so if you are an apologizer like me, DON'T WORRY !!!! 

 During your hospital stay.....

• REST. I can't say this enough. Sleep whenever you feel like it. It doesn't matter what time it is, sleep if you want to. Visitors will understand if you nod off and will either be there when you wake up or leave you a little note. 
• If you have a pump for pain meds, DO NOT be afraid to use it. You will have some pain and discomfort. Don't be a hero. Your doctor ok'd the use of the meds and they are set to only disperse after a set amount of time. You are not going to OD. LOL The meds will allow you to relax and be comfortable. If you don't have a pump, don't be afraid to ask for something if you are feeling uncomfortable. If the nurse asks if you want something, take it ! They can tell by how you look and your body language how you are feeling. They won't think that you are an addict ! They will only give you what you need. The longer you wait to take something, the longer it will take to kick in. Be proactive and hit the pain head on. 
• You may have a catheter in after surgery and that will make things easy on you for the first day or so. Once it is out, you will have to get up and use the bathroom. Your nurse or caregiver can help you at first, but after a few times, you may feel more comfortable doing this on your own. The nurse may collect your urine in a "hat"- a container that fits over the toilet that catches the urine and allows the nurse to measure your "output". This will help in determining how much of the IV is going through your body and exiting the system. 
• Getting out of bed- The nurse will encourage you to try and get out of bed, possibly the day after your surgery. You might think that it is impossible and you might feel tired, but just moving a little more everyday will make your recovery easier. You might start off by walking around your room or down the hall of the hospital. Each time, set a further point to try and walk to. You will be so proud of yourself when you reach those goals ! 
• A Respiratory Therapist may visit you and leave behind an Incentive Spirometer (below) for you to work on breathing. Listen to their instructions or have them write down the goals for you. You may not reach them right away, but keep trying a few times an hour. This will help to increase your lung function. It will be hard at first, but keep trying ! It is very important and will help how you feel in the long run.

•  You will most likely have surgical drains in place after surgery. How many and how long these drain will be in depends on several factors: Your body, the depth of the wound and your surgeon.
• The most common drains are "JP Drains" - Jackson Pratt Drains. For the first few days, your nurse will strip the drains and measure your fluid output. Before you leave, if you have still have drains, your nurse will show you how to care for them.
  Try not to be too discouraged if you leave the hospital with drains. This is very normal. Yes, they are a pain, but they will most likely be removed with a week or two.
• After a few days of resting, walking and lots of doctors and nurses "checking you out", it will be time to go home. This may be exciting and/or scary, but as long as you have someone there to help you, things will be fine. You can do it ! 
• Your doctor will prescribe some pain meds to take home. Try to have them filled at the hospital or have your caregiver have the Rx filled before you leave. The nurse may be able to call some of the prescriptions in to your pharmacy ahead of time, if necessary. 
• You may want to have a pillow in the car to put over your tummy area. Your seatbelt will be tight and the pillow will keep it from hitting you where it hurts.

Home Sweet Home !!!

• Ready or not, you are back at home. Time to move on to the next stage of your recovery. My main advice is to take it easy. You may feel useless for a few weeks, but in the end, it is the only thing that will speed up recovery. You may feel as if you can do things, but bending, stretching and turning will prolong your body's recovery. Here's a link with some tips on going home.
• Your doctor may prescribe a stool softener that will help you "go" without having to strain. Once the magic moment happens, you may want to have someone help you clean the area or use wet wipes. It is difficult to turn like usual, so for the first few days, you just have to do what you have to do. 
• Sleep when you can, take the med on schedule and try to relax as much as possible. Be sure to chart when you take your meds and any drainage from your drains. Also, write down any questions for your doctor. Bring all of this information to your follow up appointment. Your doctor will want to see you a few days after you leave the hospital and then weekly, to check your progress.
• Be sure not to use a heating pad on your breast area. You will not be able to feel how hot it is and there is a possibility for burns. Check with your doctor about using ice.  
• You may not feel much like eating, especially the first few days home, but it is important to eat when taking your meds. This will keep you from getting nauseous. It is also important to eat foods that contain protein in order to promote healing. I know that it is tempting to eat junk food, and it is ok to eat that in moderation, but you don't want to undo what you just did ! 
• Drink lots of water. This will keep you hydrated and also keep your body healthy. Drinking several glasses of water is a good habit to get into, especially if you are not a water drinker.  
• If you are in severe pain, running a fever, vomiting, there is excessive bleeding or something just doesn't seem "right", call your doctor immediately or head to the Emergency Room. Don't feel bad about calling after hours, that doctor is on call for a reason. The doctor will instruct you on what to do. 

Going to the doctor.....

• Your surgeon will want to see you a few days after you are released from the hospital. You may already have an appointment set up or you may call the office when you leave. 
• When going to see the doctor, be sure to bring any charts about drainage or your schedule of meds with you. Bring anything else that the doctor has asked you to keep track of. 
• At your first visit, you nurse or medical assistant will bring you back to a room and may check your blood pressure and/or weight. She will ask some questions about your recovery and how you are feeling. Don't diminish how you are feeling or if something hurts, let the nurse know. Ask any questions that you may have. The nurse may answer them or let the doctor know and he can address them when he comes in.
• When the doctor comes in, he will check your stitches and look at your incisions. He will ask how you are feeling and if you have any questions. If he has any concerns, he will let you know and if there is something that you need to keep track of or tend to, the doctor will tell you and instruct you on how to tend to these areas. Be sure to ask questions that you may have. You will schedule your next appointment to see the doctor within the next few days or weeks.
• He may feel the breasts and check for hard spots. These areas may require some massage to make them soft. Your doctor will let you know if this is necessary. 
• He will check any open wounds and instruct you on how to care for them. 
• You may also have a breast surgeon who is independent from the plastic surgeon. The surgeon will also want to see you and check your progress. 

How you may feel over the first few weeks....

• You may feel extremely tight in the stomach area
• You may have a hard time taking deep breaths
• You may feel gas bubbles or the feeling of air moving around your belly
• You may have a hard time having a bowel movement
• You may have pain and/or discomfort in the areas where you have stitches
• You may have numbness or tingling sensation in the surgical areas
• You may feel hard areas in the reconstructed breast or in your belly area
• You may have a hard time sitting up straight for a period of time
• You may have pain/discomfort in the drain areas
• You may feel weak, tired and have a hard time doing everyday activities
• You may have a hard time standing for a period of time
• You may have a hard time walking for a period of time or going up/down stairs
• You may feel like your stomach area is rock hard to the touch
• You may feel a lack of appetite or like a "stuffed turkey" after eating

You may feel all of none of these symptoms. These sensations will lessen over time. The first 3-4 weeks are the hardest. After week 4, you should be feeling a little more like yourself. The extreme tightness was much less by Week 4 for me. Over time, you will begin to regain some feeling in the "numb" areas. You may never fully have sensation in some areas. You can reduce the amount of pain meds that you take and eventually, you will be done. Don't toss them just yet, you may have a bad day and need something to help you get by.

Your doctor will give you the OK to start driving once you have stopping taking pain meds and your stitches are out. Your muscles may feel tight or weak, so be careful to make the trips short until you feel more comfortable. Try not to brake hard and be careful making turns. You would be surprised how much making a turn can hurt !

Follow all of your doctor's instructions over the next few weeks and continue your appointments so that he can keep track of your progress.

The Big Reveal

Yesterday was a milestone- I left the house, not to go to the doctor but a luncheon for work. It was my first time out of the house other than the doctors for anything and ....wait for it..... I was in a DRESS! Kind of a big deal, since I have nothing but elastic (or a bra) for the past 4 weeks. I really wanted to wear pants, but I have one last bulb in the lower area, so it was very uncomfortable when I tried them on. That in and of itself was a production.

I have been so excited to see what size I might be now and if any of my clothes fit (secretly hoping the answer was "no" so I could buy a new wardrobe). Well, it was 50/50. I dug deep, back into my closet where my clothes go to "retire". You know, we all have that section of clothes that we hang on to "just in case I lose a few pounds". I pulled out a few blouses and honestly, I was a bit disappointed. Other than the fact that they now fit more correctly in the chest area, they pretty much fit the same. After I thought about, it makes sense. I don't know why I was expecting my ribs and their "cushion" to magically shrink after the surgery. I have always been broader across the top, so everything basically fit the same.

I was pleasantly surprised when pants that I haven't worn in probably 6 or 7 years fit (and looked GOOD) !! Only problem was that darn JP drain. It hurt like a mother because the pants kept pushing it back "inside" and my body was like "Um. No. I don't want that back in here". I can't wait to try them on again next week, without pain involved. Bottom line, I dropped probably 3-4 pants sizes !!!! I looked at myself in the mirror and was amazed by my profile. I haven't looked that "slim" since before I had kids !! Bye-Bye "Mom-gut" !

However, it was a reminder that I need to work on my upper body. I am not sure how, but I need to do that. I think that I need to start easy, do some walking and eventually get into a more active routine. My goal is to get back into running. I used to "run" (ok, jog) back in the day and would love to get back into the habit. I always had some excuse why I couldn't exercise or make time, but now that the kids are almost at the age where they can stay home alone for 30 minutes or so I am kind of excited to get out on my own and have some "thinking time". So, I am putting it out there. Since I have been given this chance to 1. Save my life and protect me from future bad stuff and 2. Give me my figure back, I need to grab it and not get all chubby again. I have only lost a few pounds from the surgery since the surgeon basically played "Musical Fat" and just rearranged my tissue. The way that I am eating has also changed.

I am not a "big" eater. I am more of a snacker. Since the surgery, I am slowly getting my appetite back. However, the skin and my stomach are very tight feeling and when I am feeling full, I literally feel like I am going to burst. Everything feels really "jam packed" into my abdominal area. I am sure that the tightness will ease with time, but for now, It is borderline painful to eat or sneeze !

OK, focus Kelly. Lunch. Christmas Party. Work friends. I was really hoping to wear pants because they had the most dramatic effect, but I just couldn't do it. It was really uncomfortable. So, I chose a  flowy dress that I hadn't worn in about 2 years. I had never worn it to work, so it would look new to them :) I could tell the difference in the fit immediately and could see it in the mirror. Even my husband who is such a "man" commented and said I looked "great and beautiful" without being prompted ;) I have to admit, I was hoping for more of a reaction from my co-workers about how I looked. They all came over, sub-consciously looked at my boobs, gave me a hug, told me that I looked great, and asked how I was feeling. I guess I was hoping for "Oh my goodness, you look amazing" or " Look how thin you are !", but I have to just keep in mind that I really only showed off my top half and not the real difference-maker, so maybe when I wear pants, it will be more obvious. Next challenge- Family Christmas party. By that time, I will have my last drain out and I am wearing pants no matter what !!!!!

So, what do Angelina Jolie and I have in common ?

Well, aside from long, dark hair, a couple of kids, our moms both had cancer, we both have BRCA+ diagnoses.We are a bit different in the fact that she has a BRCA1+ and I am a BRCA2+.

I have to admit. I have never been a big fan of Ang. The whole Billy Bob, blood in a vial.... She just always seemed weird to me. When the whole "Brad/Jen" split happened, I was totally on Jen's side and made me like her even less (Like anyone cares). Didn't like her. Didn't like her movies. Thought she was fake. Adopting kids from all corners of the earth- I thought she was just trying to change the public opinion of herself. Then the article came out that changed my mind. Angelina Jolie's op ed- Please read

I read the article and I felt sad for her. She had lost her mom and grandma at very early ages. I am proud of her for being tested so that she could be there for her kids. No matter if they are her's biologically or adopted, no one deserves to grow up with out a mom. My Mom was diagnosed with breast cancer in 2012. When she called me, I cried. I'm 34, but I didn't want my Mom to die ! Thank God, she caught it very early and is clear today, a year and a half later. She also gave us a gift- The ability to be tested for the BRCA mutation. Of the 5 girls in our family tested, 3 of us were positive.

When I was going back and forth about the surgery, THAT was the reason that made my decision. How silly if I decided not to have surgery and then eventually get cancer. Why would I take the risk of leaving my kids without a mom when there was something that I could do to prevent it ? Now, near the end of the surgical process, I can't believe that I even hesitated.

So, although I may not have millions in my bank account like Angie, we both do have our kid's best interest at heart. <3

Do's/Don'ts and everything that I wish that I had known......

Ok. Here's a crash course on what to do before/during and after your surgery:

Before:

• Make sure that you have arrangements for yourself. You can not do this alone. I don't care if you are Wonder Woman. You can't do it. Be sure to have a ride home and someone to stay with you for a week or two. You will also need someone to drive you to and from weekly doctor's appointments. 
• Make arrangements for kids and/or husband. Who's going to get the kids from school ? Can they stay with Grandma and Grandpa for a few days ? Maybe make a few meals and freeze for Dad to toss in the oven. Let school know that maybe the kids might miss a day of school or maybe their homework won't be on par because mom is going to be away for a few days. You don't have to be specific.
• Get laundry done and put away and get things set up for when you return home. If you are like me and see something out of place, you want to fix it. But you can't. Let it go !!!! It will be ok. I promise !!! 
• Pack your bag for the hospital. I thought "I'll bring books, my Kindle, phone, paper, extra clothes, socks, etc. ". Guess what I used. My Kindle and my phone. I checked Facebook occasionally and email and called home a few times. other than that. I slept. The hospital gives you the gown to wear and socks, so just wear home what you wore to the hospital. 
• I went grocery shopping before and bought everything you might need for a month. I also made sure to get some bland things that I like to eat, just in case you are not feeling great when you get home. The hospital has most of this stuff, so don't bother bringing your own.
• Graham Crackers
• Saltines
• Lorna Doones
• Pringles
• Bagel Chips
• Jell-o
• Pudding

• Make sure your husband or caregiver can do a multiple text or phone call to all those who are worried about you. 

During: Not much YOU can do DURING surgery, but as I said, get as much rest  as you can. Sometimes it can be hard when the nurses come in every two hours to check your vitals, but you can make up for that sleep during the day.

• How does it feel ? It is hard to get into a seated position from a reclining position. It is hard to twist and turn. Ask for help and you life will be so much easier !!!
• It may be hard to breathe. It feels very tight in your chest. You may feel like you are able to walk around for a bit, don't overdo it !!!
• Follow the exercises that the nurses give you about flexing your feet and be sure to get your heparin shots ! These will help keep you from getting blood clots.
• Listen to what the doctors and nurses say. If you don't feel like you will remember, ask them to write the instruction down or have your caregiver listen for you. 
• If you have ANY questions, ask them ! Doctors and nurses have heard/seen it all. You are better off being embarrassed and having a direct answer than going home wondering.
• One thing that I did not know when I was going to have the TRAM surgery was that there would be drains in my pubic area. ACK ! Embarrassment city !!! I almost asked my doctor's assistant at my last appointment, but I was too embarrassed. They at least waited for me to pass out before they trimmed the hedges, but they also have 2 drains in that area, where they are constantly stripping, checking and showing to students. So basically, I am no longer ashamed about my body, since just about every single person on the earth has seen it by now. So, just be prepared.

After: Don't be a hero !!!! Just because you think you can, you shouldn't ! You may be feeling great, but it is going to eventually come back to bite you in the butt.

•  How does it feel ?  The tightness has moved down more from my chest into my waist area. remember, the doc pulled all of that skin down and the area where the two areas come together is pretty tight. By staying on top of meds, you can avoid some discomfort. I also feel a lack of appetite or just a smaller appetite (not that I am complaining...) I am not sure if this is temporary, but I'll take advantage of it. 
• The first time I looked at the mirror to see the "new me" I kind of freaked out. I looked like a penguin. I was really puffed up on top (rib-area) and I was super hollowed out in the waist area. I almost wanted to cry. I told my PS and he said that the swelling would go down and it would look better (P.S. It did go down and it does look better :).
• It has been almost two weeks and I still have both drains in the groin area and I can not wear underwear because it tugs on the drains. I just change pants everyday :)
• Just a warning- When the drains come out, they don't feel good. It is not horrible, but a very quick, sharp pain. Literally, it its over in a second. Nothing to stress over, but just a warning.
• Sleep when you can. Sleep when you can. Sleep when you can.
• If you have any questions, don't hesitate to call your doctor if you have a question or if something doesn't seem/look right. Any leakage, seepage, discoloration.....Call. Trust me. I have sent cell phone pics of a rash on my breast "just to be sure". (BTW- One and only time I have taken naked pics of myself with the phone). You will feel much better for them to say "Don't worry" rather than sit and stress about it.
•  Some of your drains will produce different amounts of "stuff". It may be clear, cloudy, chunky, wormy, dark, light, just about anything. The color may be different too. One of mine is rosy colored, while the other one looks like it could be used on CSI for blood splatter. No joke. Just keep track of how much and what color the discharge is and this will help the doctor decide when to take out the drain.
•  This is a long-distance race, not a sprint. Be prepared that things are not going to happen over night. Every morning you will wake up, you will be better than the day before. I asked my doc's assistant this week (day 8) when I would start feeling better or at least more like myself. She said that by next Friday (day 18), you will feel more like your regular self. Looking forward to that day !!!!

Upkeep

Whew. Life is rough. Sleeping and eating. LOL Of course, there is a lot more going on daily in order to care for everything. First, there are the "granades" or "JP Drains". Here's how to strip and empty your drains Your doctor or nurse will show you how to do this, but this is a good refresher (We never had gloves, we just used the alcohol wipes). For the first few days, I had my husband doing this, but at about a week later, I am doing it myself. (Go me !)

Showering: I invested in a hand-held shower before, so that seems to be the easiest for me to clean off. I can wash my hair quickly and quickly clean off all of the necessary areas with soap and water by sitting on the edge of the tub. I had a bad experience with staples and showers with one of my pregnancies, so I prefer to keep it is as dry as possible. I know that I don't have staples, but I am weird, ok ?

I did have a blister when I left the hospital and they did not really explain what to do with it. We finally called the doctor today and they instructed that we clean it well, use Silvadene cream and a loose fitting pad. After a few hours, repeat. Of course, if you have any issues, call your doctor immediately and follow their instructions.

Sleep: Sleep whenever you are able to ! Visitors will understand. Tell them to drop the Tupperware on the counter and you'll call them later. :) If they don't get it, just start nodding off and maybe they will start cleaning up for you. If all else fails, just come out and say it. "I'm really tired. Would you mind coming back next week when we can chat more ?"

My main piece of advice: Even if you think that you can do it, you shouldn't ! Your pain meds will give you false confidence. Yes, you will be able to do things like laundry and lift children, but it is not a good idea. This is your time to take it easy and let someone else have a turn.