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[YellowSpike]

I exchanged lot of emails with Dr. Guichet prior going to dr. Paley. He is very focused and result oriented doctor. I really like him and his patients are doing phenomenal recovery.

But, his physical therapy regiment worries me a lot. Leechlet mentioned that he had to sit on stationary bicycle for 20 minutes on second day. That is too much when your body is going through so much trauma. Eventually he stopped going to therapy. On a bright side his patients are doing very well. He can be good choice but not for me.

I also do not like the clicking mechanism for distraction. I am already on some kind of pain and stifneess. If I have to click for distraction it sure will add more frustration.

Please don't look at Leechlet as an example. He was a terrible patient. Guichet had me on the bike literally as I was waking up from the surgery. The first thing I remember when I came to, I was on the bike, and Guichet was yelling "Get him a coke, he neegs sugar!" Guichet is definitely tough, but that's actually one of the reasons I chose him. I wanted a drill sargeant as my doctor to keep me in line. He's also very conservative, and had me stop at 7cm when I actually wanted a bit more.

Clicking does blow (especially towards the end, it gets ultra painful!), but at least clicking guarantees that you're actually lengthening. I think Precice and Fitbone are great, but I think they sometimes don't always give you what you're lengthening due to muscles (especially for muscular guys) providing a ton of resistance. I've only heard of a few instances of this, but it does seem to happen.

[Cooper]

Please don't look at Leechlet as an example. He was a terrible patient. Guichet had me on the bike literally as I was waking up from the surgery. The first thing I remember when I came to, I was on the bike, and Guichet was yelling "Get him a coke, he neegs sugar!" Guichet is definitely tough, but that's actually one of the reasons I chose him. I wanted a drill sargeant as my doctor to keep me in line. He's also very conservative, and had me stop at 7cm when I actually wanted a bit more.

Clicking does blow (especially towards the end, it gets ultra painful!), but at least clicking guarantees that you're actually lengthening. I think Precice and Fitbone are great, but I think they sometimes don't always give you what you're lengthening due to muscles (especially for muscular guys) providing a ton of resistance. I've only heard of a few instances of this, but it does seem to happen.

I agree dr. Guichet is top LL surgeon. No doubt. Patients are doing remarkably well with him. He is been in the industry for long time.

I am not fan of clicking and see lot of patients of dr. Betz struggling with clicking. Read some of the patient even had to go anesthetic clicking. I waited for precise2 to come out so I can have painless distraction. It's a choice I made. I still prefer non clicking mechanism for distraction. It is just the matter of preference. We can agree to disagree 

You are also correct either precise or fitbone may not able to distract due to muscle tightness. These devices can only withhold some level of resistence and can give up after 6.5/7cm. My left leg did not distract after 6.5cm. I wanted to go 7cm but we did not push it. I could have tried and may have worded out but again I accepted what I gained. Another patient wanted to go 8cm but did not buzz after 7cm.

Just to reiterate I have nothing but highest respect to dr. Guichet. We need more conservative doctor like him .

[Cooper]

Here is the x-ray taken in second day. The nail and screw looks solid. Dr. Monegal also fixated tibia/fibula in angular like dr. Paley or dr. Rozbruch.


http://www.turboimagehost.com/p/23633217/X-Ray_Post_Op_Second_Day.jpg.html

[Aturro]

I recommend doing internal if possible. But if the budget issue than LON will be fine. The hardest part of this surgery is keeping secret and not telling anyone. I need to make up story when I get home so folks does not flip out when they see me in crutches. In addition, I need to come back here 3 months and do another leg. I am looking for compelling story so I can shut everyone with one story. If you guys have any idea please pitch in.

Hi Cooper, regarding your Topic about what to tell your friends etc I wanted to share my thoughts and recent experience.
I hesitated to do LL for a long time also because I was afraid to tell anyone, friends, parents,...
I almost didnt do it for that reason.
Now that I have the Situation is much different than I thought. I decided not to tell anyone before but be honest afterwards. So I told my Friends that I had this big Dream for a Long Time, Wartung to be taller, and that I now fuLL Forumill this dream and that I am very happy about it.
People are confused at First but get used to it very quickly, ask questions about LL and offer their help if needed.
10 out of 10 positive reactions. I think its Important to be honest first with yourself and then with the people who matter around you. Who cares what others think or talk als long als you have your Important friends and family behind you.

I hated to lie for so many months and it feels Great not to have the need now. I Talk about LL with everbody as if it would be a normal knee surgery or something like that. Its just the news that shocks People not the surgery or the LL itself I feel.

So my idea would be not to lie at all. Its easier than you might think or feel at the Moment...

[theuprising]

Hey cooper I am curious to know what Dr Monegal thinks of your femur lengthening with Paley. There were a few topics on the forum a couple of months ago talking about how internal femur by lengthening along the anatomical axis caused malalignment. Dr Monegal then wrote that his reverse planning method avoiding this malalignment particularly when using fitbone.

I assume that the device isn't important and that the reverse planning of femurs could have been done with Precise.

[Cooper]

Hi Aturro- thanks for some food for thoughts. My friends and family are very close tight and some of them not open minded. I particularly not worried what other think. I might tell the the exact truth as you suggested. Having that discussion is so personal I have not told my siblings either. The difficult part is opening the dialogue.

I think this time there will not be any easy escape. All of sudden I am much teller again. On the first one I told them I was hitting gym and lost lot of weights. Some of them were raising eyebrows when the see first time after the surgery.

[Cooper]

Hey cooper I am curious to know what Dr Monegal thinks of your femur lengthening with Paley. There were a few topics on the forum a couple of months ago talking about how internal femur by lengthening along the anatomical axis caused malalignment. Dr Monegal then wrote that his reverse planning method avoiding this malalignment particularly when using fitbone.

I assume that the device isn't important and that the reverse planning of femurs could have been done with Precise.

I will check with him and get back to you.

[Cooper]

Day 8:
I had little trouble sleeping last night. Wake up at 3am with stiffness and took paracetamol and that put me sleep till 7:30. Doctor prescribed me 3 pain level medicine: 1) Tramadol (strongest) 2) Nolotil (second strongest) 3) Paracetamol (mild).

First PT Session:
I had PT session at 8am. All the good schedule were taken so I took only available slot at 8am. Claudio (Physical Therapist) came to my room and we took elevator to little gym. This was the first time I really had a nice stretch after the surgery. My god I felt AWESOME! It was huge turning point   

He joked he got magic hands and I said you have million dollar hands . He is really good and I really like him. PT is the single most important stuff after the surgery. In West Palm Beach, they used to say anyone can do the surgery but post care is what makes difference. That is physical therapy, complication, pain management and care.

I came to my room felt really good. I took Nolotil and slept till 12PM. Took a nice shower and ready to start my day. Overall feeling better today. I think Claudio made my day

[Aturro]

Sounds great! What did he do, just stretching? I like my PT too, releases the tension...
And I agree people in General are not open minded but who can blame you for living your dream?! No one should...

[Cooper]

Sounds great! What did he do, just stretching? I like my PT too, releases the tension...
And I agree people in General are not open minded but who can blame you for living your dream?! No one should...

Mostly stretching lower muscle and releasing tension. I have not really stretch this level before.

Overall I felt good yesterday. Doctor got me heating pad and am using every now and then. Claudio wants ice over heat pad but me personally prefer heating pad. I asked them ice here but did nit get any. I didn't bother again.

The hot shower really helps as well. When I ma stiff or discomfort I took nice long shower. Yesterday I had three. Feel great each time. One thing I am missing is bath tub. I used to stay in bath tub with hot water and Epsom salt for long time. It defiantly alleviates stiffness. I learned that from Dr. Betz patient.

Overall going well so far. I should hit 8mm end of the day.

[Cooper]

Hey cooper I am curious to know what Dr Monegal thinks of your femur lengthening with Paley. There were a few topics on the forum a couple of months ago talking about how internal femur by lengthening along the anatomical axis caused malalignment. Dr Monegal then wrote that his reverse planning method avoiding this malalignment particularly when using fitbone.

I assume that the device isn't important and that the reverse planning of femurs could have been done with Precise.

I forwarded the question to dr. Monegal and he replied with below response:

Lengthening along the anatomical Axis in the femur can cause deviation in valgus due to the shape of the bone.
It has been studied and they concluded That lengthening with an internal Rod along the anatomical Axis of the femur migth cause malalignment by deplacing 1 mm/cm lengthened the MAD (mechanical Axis deviation).

However every single case has to be studied and plannified preoperatively and for a 6cm lengthening the deplacement is very nitchy (6mm).

Antegrade lengthening with internals does not allow Any correction of the mechanical Axis so My recomendation would be:

1- patients with sligth varus in the mechanical  axis MAD < 6 mm can do either Antegrade or retrograde procedures

2- patients with previous valgus or with deviations in the mechanical Axis MAD > 6 mm retrograde procedure planned using the reverse planning method.

In your case your Axis post operatively looks perfect. In male patients Axis is likely to be sligth varus (so was yours) and your final result has been excellent in My opinion.

[theuprising]

I forwarded the question to dr. Monegal and he replied with below response:

Lengthening along the anatomical Axis in the femur can cause deviation in valgus due to the shape of the bone.
It has been studied and they concluded That lengthening with an internal Rod along the anatomical Axis of the femur migth cause malalignment by deplacing 1 mm/cm lengthened the MAD (mechanical Axis deviation).

However every single case has to be studied and plannified preoperatively and for a 6cm lengthening the deplacement is very nitchy (6mm).

Antegrade lengthening with internals does not allow Any correction of the mechanical Axis so My recomendation would be:

1- patients with sligth varus in the mechanical  axis MAD < 6 mm can do either Antegrade or retrograde procedures

2- patients with previous valgus or with deviations in the mechanical Axis MAD > 6 mm retrograde procedure planned using the reverse planning method.

In your case your Axis post operatively looks perfect. In male patients Axis is likely to be sligth varus (so was yours) and your final result has been excellent in My opinion.

I wonder if this axis malalignment is a big deal or not as there have been many patients who did over 6cm with docs like betz, guichet and paley as I have never read any other docs other that monegal even mention the option of reverse planning. Perhaps it takes years for the result of malalignment to show itself?

[Dingo]

He uses super patellar approach which completely avoids tendon. The insertion is done few cm top of knee. It is amazing!

From what I saw on the photo you posted of your legs and what I understand from your statement above, Dr. monegal drilled through your femur to get to your tibia.

Is this correct?

[crimsontide]

femur is a bone


your bone is not drilled or broken

[femoral_indecency]

Hey yellowspike, did Dr. Guichet give you a reason why he demanded you stop at 7cm?

[Dingo]

femur is a bone

your bone is not drilled or broken

Thanks for telling us that the femur is a bone. What a sharp and incisive observation.

Also, if you think you can get limb lengthening without breaking your bones, you might want to reboot and read this entire website again.

Back in the real world, in order to insert the Fitbone nails, the bone (tibia or femur) has to be reamed/drilled for the metal rod to fit into the medullary cavity (which contains the bone marrow).

Cooper is doing his right tibia and he has mentioned that Dr Monegal uses a different approach (suprapatellar), which avoids the patellar tendon by inserting the nail above the knee. If you look closely at the photo he posted of his leg, you'll notice the bandage covering the cut above the knee.

http://s5d2.turboimagehost.com/sp/09f7dd93a167e7a741578aae251271cf/My_nice_looking_leg_but_broken_and_bloated.jpg

But you can't insert a nail in the tibia through a cut above the knee without reaming/drilling through the lower femur. Get it?

That's why I'm asking Cooper to get some clarification from Dr Monegal, so we can all become more knowledgeable about this approach (and what it means in terms of safety and results).

[crimsontide]

DINGO,


since you're going to act like  a child, I'll treat you like one

I had surgery with monegal, so no need for me to look at  Copper's scar and ponder


Yes, the bone has to be reamed..   The femur ,of course, does not have to be reamed when one is doing the tibia... Suprapatellar approach simply means the patellar tendon  is not cut, and insertion is through the quadriceps, not the femur.  The femur should not be  reamed  You can actually read about it online

If you actually  spent any time reading, you would know why some want to  use this approach

I'll tell you why though, since clicking the search button can be very difficult

It's called anterior knee pain

[Dingo]

@crimsontide

I'm not questioning the motives for the technique (avoiding tendon pain later) or Dr Monegal or anything like that. In fact, he's on the top of my list of prospective doctors. That's why I'm so interested in knowing more about his technique.

I'm interested in the technical aspects of his tibia insertion technique because I'm finding it hard to wrap my head around the idea that one can insert the nail above the knee whilst avoiding the lower femur, that's all.

Maybe I'm looking at the wrong bandage in Cooper's photo of his leg (the one closest to the camera in the middle of his leg just above the knee). Maybe the nail was inserted through another cut. That's what I'd like to know.

[crimsontide]

no problem

heres a link

ill be honest, i dont really understand it either... my insertion site is sore still. i dont have any anterior knee pain, but the top of my leg, it's sore.. if it doesnt go away, well,  its a bit uncomfortable. i think it should  go away  though

a lot of people complain about anterior knee pain when the nail is inserted through the patellar

http://www.researchgate.net/publication/221809122_Insertion_of_intramedullary_nails_from_the_suprapatellar_pouch_for_proximal_tibial_shaft_fractures._A_technical_note

[Cooper]

Update:
I have taken x-ray 14 days post op. Everything looks good. The distraction is working as expected.

http://www.turboimagehost.com/p/23697941/X-Ray_Post_Op_14_days.png.html

I was in acute muscle pain/stiffness. I was doing 4 turns equivalent to 1.08MM. I reduced to 3 turns (0.8mm) and it's been heaven. No muscle stiffness and pain. I only take pain killer few times a day now. The dose is already reduced to half. Yesterday I took one after PT session and one before to sleep.

My feet is still some what swollen and I feel 50% numb over the top and side. The bruises is 85% gone. Overall very happy with the progress.

I intend to cut down on pain killer completely once I get home. For sleeping aid I will use Benadryl. I am leaving Barcelona tomorrow. Looking forward to getting back home .

[Cooper]

@Dingo- I have no knee pain. The nail is insert through tip of knee via muscle and completely avoids patella tendon and femur bone.

Everything else is same. Rimming and insertion are done in some fashion as Precise or other internal nail.

[Cooper]

Update:
I arrived home safely. Did not have much issue at the airport. I requested wheel chair assistance and booked economy plus ticket. The extra leg room definitely helps. I had bit issue for first few hours after that no problem. I also slept few hours on the plane.

I needed a transformer to convert 110 to 220v. I thought i could easily find in big stores but not really. I checked in walmart, best buy, staples and sears. Nada, i was frustrated. Walmart sells travel converted that changes from 220 to 110 for travel overseas but not scale up.

I ordered it Amazon.com and pick the next day shipping. It arrived and was able safely lengthen again. I kinda of took 2 days break from distraction.

I feel good at home. Life is almost normal except the crutches. I start driving and even went to movie yesterday. I finished the entire movie in one sitting (no break).

[glenn]

Hi Cooper!
Glad to hear everything is well with you. Thanks for reminding us about the voltage issue. I didn't even consider that one at all.

Best,
Glenn

[Aturro]

Great news Cooper, your recovery seems to go exceptionally well.
I couldnt do a Long hour flight or a movie.

[Cooper]

Great news Cooper, your recovery seems to go exceptionally well.
I couldnt do a Long hour flight or a movie.

Aturro- tibia is much easier than femur. With femur I was not even able to stay in 15mins for haircut. I had to move position but tibia is definitely easy because it is all lower section of the limb.

It is getting easier every day. I feel good and optimistic each passing day. I do miss other good leg . I was in meeting for 5 hours today. I had no issue but was little inconvenience in final hours. I did not take pain killer either.

I took nolotil mild pain killer and iced my leg as soon as I got home. So far so good!

[Cooper]

Hi Cooper!
Glad to hear everything is well with you. Thanks for reminding us about the voltage issue. I didn't even consider that one at all.

Best,
Glenn

I know I was really frustrated. I had all sorts of paranoia ran through my brain. I thought my lengthening journey is finished and this is it. I feel like dump and irresponsible not managing this before hand. I wish someone knew and reminded me of that. Well at least you guys know now. It cost less than $30USD but give me $26K headache

[JourneyToTheEast]

Hey Cooper,

I am happy that you are doing OK. Keep it up; this is for you and no one else. By the way you should have your bandages off by now? Would you mind posting some pictures of your scars? Specifically I am interested in where the antenna is inserted and placed.

To decrease the risk of compartment syndrome post-op, Dr. Betz patients get hook up to a pump and drains. They work 24/7 for several days to reduce swelling and expell excess fluids. He also sends in a massage therapist every day to perform a type of soft massage to further help with swelling. Dr. Betz nurses also come in to check on you every hour or so. Along with this, he prescribed anti-thrombosis (blood thinner) medication for fat embolism.

Bohemia, musicmaker, paco1, glenn, and cooper : I know some of you didn't do tibia but do you know if Dr. Monegal does any of the above?

[JourneyToTheEast]

crimsontide, the last question is directed at you too if you happen to know the answer.

[Cooper]

Hey Cooper,

I am happy that you are doing OK. Keep it up; this is for you and no one else. By the way you should have your bandages off by now? Would you mind posting some pictures of your scars? Specifically I am interested in where the antenna is inserted and placed.

To decrease the risk of compartment syndrome post-op, Dr. Betz patients get hook up to a pump and drains. They work 24/7 for several days to reduce swelling and expell excess fluids. He also sends in a massage therapist every day to perform a type of soft massage to further help with swelling. Dr. Betz nurses also come in to check on you every hour or so. Along with this, he prescribed anti-thrombosis (blood thinner) medication for fat embolism.


Bohemia, musicmaker, paco1, glenn, and cooper : I know some of you didn't do tibia but do you know if Dr. Monegal does any of the above?

Therapist comes almost every day to MIC. I do not know about the massage therapist but if you ask dr. Monegal he can probably arrange one. I will post picture soon.

[spaller2015]

is therapy included in the price? if not, How much is it?

[Cooper]

Update: 07/15/15

I probably achieved 2.5cm (an inch). It's been about a month i had surgery. Need to take X-ray to confirm but seems leg is longer by an inch. My legs feels alright but still some numbness on feet area. The area of numbness has reduced significantly but has not disappeared 100%. I am worried about it. It's been month and this should not be an issue at this point.

Legs is slightly swollen. Get worst when i go out especially for work related meeting. i have to iced it and/or compress when i get home. The wounds are almost healed except the osteoporosis area (the big cut). Its coming along well but i think taking bit longer. 

I do stretching and therapy 2/3 times a day at home. I stay in stationary bicycle about 15 minutes session usually 2 times a day. Been pretty busy these days. Doing normal stuff like work, movie, restaurant, get together with family & friends. Though i do not like to get out as much. Lot of inconvenience to be in crutches. Limiting myself and only go out when i must.