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[karlston]

Hey LLers,

I’ve been lurking on these forums for almost two years. It has been an incredibly useful resource towards my decision on if and how to lengthen.

In April 2024, I will have a bilateral lengthening surgery with Dr. Giotikas in Athens using the weight-bearing G-Nail to lengthen my femurs by 5cm. I’m sharing this diary with as much detail and data as I can in case it’s useful for others who are considering the surgery.

Motivation
My height puts me at the 25th percentile in my country. I struggle to consistently be confident and outgoing due to a frequent preoccupation with height, which hinders my social wellbeing. I believe being raised (literally) to average height combined with therapy will lead to an improved self-perception and a more fulfilling life.

Stats
Basics: 29, Male, European
Starting height: 171cm (target after surgery: 176cm)
Wingspan: 176cm
Weight: 76kg (target before surgery: 73kg)
Fitness:

• 5k pace: 4:30 min/km
• 10k pace: 4:45 min/km
• Squat: 115 kg 1RM
• RDL: 130 kg 1RM
• Bench press: 80 kg 1RM

Operation
I have the following constraints for the operation:

• Low risk of complications.
• Maintain normal proportions.
• Eventually get back to 90% of my current fitness level.
• Get back to walking as soon as possible.
• Europe based.

Which resulted in the following decisions:

• Length: 5cm as my femurs are already slightly disproportionate to my tibias, and the moderate length will lead to a shorter turnaround time and higher likelihood of getting back to my previous fitness level. Depending on my perception after the surgery, I would consider lengthening a “safe” amount (4cm) on my tibias in ~2 years to reach 180cm and better proportions.
• Surgeon: Dr. Giotikas as he’s one of the most experienced surgeons in Europe, and there are multiple successful diary entries in this forum. He has been empathetic, patient and informative in our consultations so far.
• Nail: G-Nail looks to be the most reliable weight-bearing nail in the market right now. My understanding is that a weight-bearing nail will cause less muscle atrophy and lead to faster recovery compared to an NWB nail. The downside is the clicking mechanism which is more complex and stressful.

Expected timeline

• -90 days (now) - Start preparation
• -3 days - Go to Athens
• +0 days - Operation
• +7 days - Distraction phase and PT begins
• +30 days - Work remotely while doing PT
• +57 days - Consolidation phase begins
• +60-90 days - Go back to home city with less frequent PT
• +120 days - Walk is mostly back to normal
• +150 days - Consolidation phase ends
• + 360 days - Rods removal
• + 375 days - Can gradually resume intense activities (running, tennis)
• + 620 days - (potentially) Start lengthening 4cm on tibias

Preparation
Stretching: Quads, hamstrings, hip adductors, IT band stretch routine in the mornings & evenings.

Gym: Resistance training twice a week to maintain muscle mass. I have large thigh muscles so I'm unsure if it’s best to let those muscles atrophy before the surgery or keep them to maintain strength.

Equipment & supplements:

• Collagen (muscle, bone and skin)
• Glucosamine (joint and soft tissue)
• Whey (protein)
• Omega-3 (anti-inflammatory)
• Curcumin (anti-inflammatory)
• Multivitamin: B, C, D, Zinc, K2
• Melatonin and Magnesium Bisglycinate (sleep)
• CBD (pain management & sleep)
• Compression sleeves (circulation)
• Mattress topper (sleep)
• Laptop & Oculus (entertainment)
• Yoga mat and stretching belt (home stretching)
• Grabber tool
• Hot & cold packs

Would love advice on what else to consider.

Recovery
I plan to stay 4 weeks in either the Grand Hyatt or Novotel in Athens and the remaining 4+ weeks in an Airbnb. It would be great to hear experiences from other patients that have stayed in Athens regarding accommodation. I’m also unsure whether to hire a caretaker or not.

Estimated costs

• Surgery: €48,900
• Rod removal: €4,200
• Accommodation: €100 euro * 60 days = €6,000
• Food: €50 * 60 days = €3,000
• Plane tickets: €300
• Ground transportation: €500

Total: €62900

Next posts
I’ll try to capture in my follow-up posts:

• Pre-op blood work & x-rays.
• Surgery experience.
• Recovery experience & videos.
• Post-recovery blood work & x-rays.

Let me know what other information would be useful.

[Silzz]

I'll see u there bud. Mine is scheduled for end of Febuary. Gnail femurs as well 

[piikachu]

Why not Betzbone with Dr Becker in Freiburg im Breisgau?

[Rockstarz5]

 Would you or anybody consider  nitrous oxide like arginina?..  not sure if doctor accept it but, I have listen amazing things, it helps to recover the body after gym and increase blood preasure because it make it the vein bigger.. a lot of gym rats used ir for restauration of the body after big fights with the gym

[karlston]

Pre-op prep update

Logistics:
The flight and hotel are booked. I've ended the lease for my current apartment. I will be putting whatever I don't take with me in storage as I plan to stay at least 2 months in Athens.

Stretching:
I originally planned to stretch twice a day. It's been hard to sustain that as life gets in the way. Practically I've been able to stretch around 6 times a week.

I've had a lot of success using the PNF technique to increase my range of motion when stretching. By contracting the muscle for 5 seconds when already at your perceived maximum ROM and then relaxing again, you trick your nervous system to go past that ROM.


Sentiment:
It feels surreal that I'm actually be going through with the operation in a few weeks. In about 1/10 days I feel like it's a mistake and I should cancel everything, but in the other 9 days I feel confident in the decision. So averaging it out it's probably still worth going ahead with it .

While I'm worried about the pain, potential complications, and proportions, my main fear is being too long away from work. I'm not sure how the time away and lower performance when recovering and working remotely will put my employment at risk.

I'll see u there bud. Mine is scheduled for end of Febuary. Gnail femurs as well 

Hey Silzz, good luck with your operation, see you there!

Why not Betzbone with Dr Becker in Freiburg im Breisgau?

Dr Becker seems like another great option in Europe. I chose Dr. Giotikas in Athens because the location was convenient and there's an abundance of patient journals here.

Would you or anybody consider  nitrous oxide like arginina?..  not sure if doctor accept it but, I have listen amazing things, it helps to recover the body after gym and increase blood preasure because it make it the vein bigger.. a lot of gym rats used ir for restauration of the body after big fights with the gym

That wasn't on my radar, thanks for the heads up. I'll look into it and talk to my doctor.

[DonBones]

Hey man,

just to manage your expectations a bit, walk back to normal after 120 days and rod removal after 360 is very optimistic. I'd say multiply both times two and it will be a more realistic estimate.

Playing tennis 15 days after rod removal won't happen either, I am afraid. It will be 3 - 5 months before you can do intense sports post nail removal, assuming no issues. The main reason is there will be an increased risk of fracture for a few months post nail removal. Because of this 15 days post nail removal you will likely hold crutches in your hands, not a tennis racket.

Sorry to sound a bit negative, but it is important to know what is coming. I had the same expectation as you and when I realised I was wrong that was very frustrating for me and my wife. So please remain optimistic, but do not understimate this procedure. This is very hard and takes a very long time, involving setbacks along the way.

That said, it can be done. All the best!

[Marie_Bard]

Hey man,

just to manage your expectations a bit, walk back to normal after 120 days and rod removal after 360 is very optimistic. I'd say multiply both times two and it will be a more realistic estimate.

Playing tennis 15 days after rod removal won't happen either, I am afraid. It will be 3 - 5 months before you can do intense sports post nail removal, assuming no issues. The main reason is there will be an increased risk of fracture for a few months post nail removal. Because of this 15 days post nail removal you will likely hold crutches in your hands, not a tennis racket.

Sorry to sound a bit negative, but it is important to know what is coming. I had the same expectation as you and when I realised I was wrong that was very frustrating for me and my wife. So please remain optimistic, but do not understimate this procedure. This is very hard and takes a very long time, involving setbacks along the way.

That said, it can be done. All the best!

Nah!...I do take your point but he is only lengthening 5 cm so I think his numbers should be doable .

[karlston]

Pre-surgery update

Tomorrow is the big day. I had a pre-surgery meeting with Giotikas and his team. I'm really impressed with the professionalism and empathy from everyone. Despite having some (healthy) anxiety for tomorrow, the team has made me feel more confident with the operation.

Arrival to Athens
I've enjoyed Athens so far and it's been smooth getting around from the airport to the hotel and the hospital. Looks like there is plenty of food options and the hotel is very comfortable.

Operation
I will be under full anesthesia and receive intrathecal morphine before the ~4-5 hours surgery. They expect me to go to a regular hospital room within 45 min of the surgery being completed. I'll be staying 3 nights in the hospital before coming back to the hotel. Dr. G has approved the larger nail size, which hopefully results in a more stable recovery.

Supplementation plan

Straight after surgery

• Whey protein (protein)
• Collagen (protein, soft tissue)
• Glucosamine (joints and soft tissue)
• Turmeric Curcurmin (anti-inflammatory)
• Multi-vitamin (zinc, selenium, Bs, etc)
• Magnesium Bisglycinate and Melatonin (sleep)

1 week after surgery:

• Continue with the above
• Omega-3
• L-arginine (improved bloodflow)

Here's a pic of the whole kit 


Height goal
I am still keeping the target at 5cm, but after more research and speaking to patients I am flexible (pun intended) to go up to 5.7cm if the recovery process goes well.

Cyborg4life (Victor) session
I booked an hour session with C4L  a few weeks ago and it was immensely helpful -- definitely recommend. He gave me insights about how to optimize recovery and shared some real patient experiences with my doctor.

Hey man,

just to manage your expectations a bit, walk back to normal after 120 days and rod removal after 360 is very optimistic. I'd say multiply both times two and it will be a more realistic estimate.

Playing tennis 15 days after rod removal won't happen either, I am afraid. It will be 3 - 5 months before you can do intense sports post nail removal, assuming no issues. The main reason is there will be an increased risk of fracture for a few months post nail removal. Because of this 15 days post nail removal you will likely hold crutches in your hands, not a tennis racket.

Sorry to sound a bit negative, but it is important to know what is coming. I had the same expectation as you and when I realised I was wrong that was very frustrating for me and my wife. So please remain optimistic, but do not understimate this procedure. This is very hard and takes a very long time, involving setbacks along the way.

That said, it can be done. All the best!

Thanks for this, it's helpful to hear a different perspective. I've checked the post-rod removal concern with the doctor, and it you're right it will take way longer than 15 days. 120 days to go back to walking is optimistic, but a possible goal. You've given me more motivation to focus on physio to prove you wrong [/list]

[Azerty12]

Hello good luck ! I Hope it will be fine.
Why just 5,7 cm ?

[karlston]

Post-surgery update

The surgery
After arriving early at the hospital, I had my pre-surgery preparations and some medicine to ease the nerves. I got to meet the operating team as they brought me into the OR prior to surgery. The surgery itself was successful, lasting 4-5 hours in total with the actual the operation taking ~3 hours.

After waking up in the recovery room without any pain, Dr. Giotikas demonstrated that the nail was working correctly by clicking each leg before taking me to a private room where I'll stay for 3 nights.

The private hospital room

Initial recovery
In the hospital room, I've been constantly visited by nurses to give me pain killers, antibiotics and medicine to prevent nausea. My pain has been 0/10 when still and 2/10 on the wounds when stretching. I have no muscular pain whatsoever 26 hours after the surgery -- I guess I'm one of the lucky ones for now. I've also been lucid the whole time (~90% of normal), so they didn't overdo-it on the anesthesia. I could probably work for 4+ hours a day remotely which is reassuring.

After the surgery, I've had some mild fever (37.5oC) and what looks like an allergic reaction probably from the antibiotics. After receiving some anti-allergy medication (Cortisone) those symptoms went away.

I had a catheter for the first night, but it was removed in the following morning.

Dr. Giotika's physical therapist has given me compression socks and stretches to do every 45 minutes. We also practiced with the walker and I am now able to go independently to the bathroom, despite having some instability on lateral movements of my leg. I've had one or two accidental clicks on my left leg, but I was told it's nothing to be concerned about. I'm very happy with the service from the physio, Dr G., and the nursing staff.

Hobbling around on my walker: https://imgur.com/a/P0HilZY (excuse my piss bag)

I expected to receive anticoagulant injections in my stomach last night, but it wasn't administered yet. I'll ask the doctor to give me them today.

The food is pretty decent, and after asking for more protein they have started giving me eggs with every meal. I've also started drinking Whey protein and collagen despite not being recommended to do so .

Sleep
Sleep has been relatively good, though it was intermittent as I was woken up by a steady stream of nurses during the night. Having ear plugs and a sleep mask has really helped.

Next steps (hah)
There's no much action happening right now, I'm playing the waiting game. The next key milestones are:

• Tomorrow (3rd day after surgery) I'll be able to walk one foot at a time with the walker.
• On Saturday (4th day after surgery) I'll be discharged to go back to the hotel
• Next Tuesday (7th day after surgery) I'll start clicking and going to physical therapy.
• Every two weeks I will take an x-ray to track my progress

Upcoming challenges
I've heard that lengthening the first 3cms is challenging, with some patients having to click under pain killers. I'll do my best to reduce inflammation in these early days and hopefully I'll click without much pain.

Hello good luck ! I Hope it will be fine.
Why just 5,7 cm ?

Four main reasons:
1) Maintaining athletic ability is very important to me.
2) I already have long femurs compared to my tibias.
3) If I ever decide to do tibial lengthening, increasing the femur beyond 6cm would result in a wonky leg-to-torso ratio
4) I want to get back to walking as soon as possible.

[jbfjbj4]

Right it's time for a reality check. At 171cm every centimetre matters up to about 183. Your frickin 'athletic ability' or proportions only you notice is nowhere near as important as getting the maximum centimetres - you did not start at 175cm, you don't have this luxury. As an aside, why is it that every manlet with a diary is super fking concerned about playing sports?

Get the 8cm done and enjoy actually being average height (176 aint it anywhere in Europe). You'll regret it otherwise.

[lucindaris]

Great to hear so you think it's doable to even do some small IT work for 4 hours a day? Also this is a price that you've paid - Femoral lengthening with X-Os  G-(Guichet) nails: 48900 Euro?

[Azerty12]

Thanks for Your answer. I am also really concerned about being able to do the same things as today. I am planning to do 6cm on femurs with dr guichet. Today i am able to squat 190kg and deadlift maybe 230kg. I have long tibias (36,3cm ) in proportion to my femurs (41,3). My height is 170,8 cm at my peak but usually its 169,8cm. If the first operation is good i Hope to do a the tibias for 4cm. To have a total of 10cm it would be perfect. Do you have informations about patients with good athletism before surgery having recover at 100% ?

[DonBones]

Thanks for Your answer. I am also really concerned about being able to do the same things as today. I am planning to do 6cm on femurs with dr guichet. Today i am able to squat 190kg and deadlift maybe 230kg. I have long tibias (36,3cm ) in proportion to my femurs (41,3). My height is 170,8 cm at my peak but usually its 169,8cm. If the first operation is good i Hope to do a the tibias for 4cm. To have a total of 10cm it would be perfect. Do you have informations about patients with good athletism before surgery having recover at 100% ?

Everyone has a different notion of what 100% means, but for the vast majority of people this surgery means that competitive contact sports, especially if it requires agility and speed, won't ever be possible to the same standard as before the surgery. That is true even if you restrict yourself to a modest lengthening amount of say 5cm. That said, most people won't ever achieve anything noteworthy in any of these sports anyways, so if you struggle with height the trade is worth it imo.

[lucindaris]

if you are not doing it professionally that makes it your main source of income and want to do some normal (not professional/competitive level sports in the future) then I wouldn't care.

[karlston]

1 week post-op update

Estimated height increase: 10mm (7mm from surgery, 3mm from clicking)

The first week after the surgery, while challenging, was better than I expected. I'm trying not to be overoptimistic though as I hear the upcoming secondary inflammation phase is tough due to more tightness when clicking and the need for more clicks per day (21).

It's been extremely helpful to have a caretaker for the first week. Having to do everything by myself would be time-consuming and stressful distracting from recovery. Also, I'm sure being alone during such a vulnerable and trying time would have gotten me to a dark place mentally.

Pain and medication
The pain during the day has been manageable, I'm having some issues during the night which I go into more detail below. I'm taking paracetamol every 6 hours, medicine for nerve pain once a day, and an opiod at night. Stretching also helps with pain due to tightness; definitely recommend getting very comfortable with stretching pre-op.

I've stopped taking glucosamine, collagen, arginin, and curcumin due to concerns from Dr G. on interactions with the blood thinners. Will consider resuming it later in the distraction phase.

Mobility
I will not be allowed on crutches until 2-3 weeks post-op, so right now I'm relying on the wheelchair and walker. I've been progressively getting better on the walker, but it's hard to continuously use the walker for more than ~5 min at a time because my upper body gets tired. I'm able to stand still for longer periods of time though (~20min).

It takes a bit of practice to learn the different transfer skills (in order of difficulty): walker -> chair, walker -> bed,  chair -> bed, walker -> toilet, walker -> shower seat, walker-> car seat. They all become easier with good upper body strength, so I'm very thankful that I prepped with weighted dips pre-op; 100% recommend.

Athens and the hotel
Athens has been good so far. Taxis are widely available through and quick through Uber. Wolt for food delivery has many good protein-rich options. It's also been very sunny, which helps with the mood

The Grand Hyatt hotel at Athens was the right decision. I had to annoy them a little bit to improve the accessible room (remove carpets, fix loose handles in bathroom), but after settling in it's been great. There is a nice rooftop area to get sun with a great view of the Acropolis and pools with easy access that will be helpful when I'm cleared for it. The hotel was not much more expensive than Novotel when staying for a full month but the facilities seem much better.


Hotel rooftop pool and view

Sleep
I've been sleeping worse these past 3 days (1-3 hours) due to a burning pain in the muscle I'm using to stabilize my feet and legs. If I lay down straight, I feel pain in my hamstrings. When raising my feet, on the quads. When externally rotating, on the adductors. When internally rotating, on the IT band. There is no position where it's comfortable. I was able to to get slightly better sleep last night by using a cold pack, supporting my feet with additional pillows, and switching positions (sleep in 90min intervals).

Dr G. thinks it's micro sprains in the muscles due to stretching. However, I'm barely stretching my IT band and adductors but still feel the burning sensation on those. I'm worried that the secondary inflammation phase could be arriving earlier than expected. If so, I think it would make sense to start earlier on the anti-inflammatories.

The sleep I do get seems to be low quality according to my watch. My RHR is up to 72bpm (from ~52bpm pre-op) and HRV down to 20ms (from ~55ms pre-op) which worries me, but I hope it goes back as I recover from the surgery.

In days 4 & 5 post-op I was peeing ~5x during the night despite drinking about 10% of what I'm peeing out. I suspect this was liquid being expunged from my previously swollen legs.

Clicking
From past diaries and speaking with other patients here, it seems that easiness of clicking is somewhat luck based. I've been lucky that clicking has been relatively straightforwards so far, being able to click by myself from day 1.

My left leg barely needs any rotation to click, and I can do 15 clicks in under a minute.

My right leg takes more rotation to get a click and I feel much more pressure on my muscles. It was taking ~8 min at the start for 15 clicks and now I'm down to ~3 min.

What I've found is that the most important thing is to completely relax your leg muscles (as if your leg was detached from your body).

BJR team
I'm getting daily visits from a nurse and physiotherapist that work for Dr G. full time. They've been empathetic and supportive and are quick to respond. There's also a dedicated driver that takes us to physio every day (7 euro) and can pick up clothes for laundry (10 euro).

Next steps

• Tomorrow (+9d after surgery) I'll start on the stationary bike.
• Monday (+12d after surgery) Physio will get more intense, so far it's been just stretching and relaxation
• Monday (+12d after surgery) Inflammation phase is scheduled to begin, will start taking anti-inflammatories and increasing the click rate
• 21 days post-op I will start on the anti-gravity treadmill

Great to hear so you think it's doable to even do some small IT work for 4 hours a day? Also this is a price that you've paid - Femoral lengthening with X-Os  G-(Guichet) nails: 48900 Euro?

Yes, it would be doable if everything goes perfectly. Often it doesn't. Dr. G. recommends taking at least the first 2 full weeks from work. After going through the process I can 100% agree with this. I personally took 6 weeks of work, but I might reduce that to 4 weeks if things go well.

Thanks for Your answer. I am also really concerned about being able to do the same things as today. I am planning to do 6cm on femurs with dr guichet. Today i am able to squat 190kg and deadlift maybe 230kg. I have long tibias (36,3cm ) in proportion to my femurs (41,3). My height is 170,8 cm at my peak but usually its 169,8cm. If the first operation is good i Hope to do a the tibias for 4cm. To have a total of 10cm it would be perfect. Do you have informations about patients with good athletism before surgery having recover at 100% ?

I would look at the V21 diary who did 6cm with Dr G. in 2021. He seems to have gotten most of the athleticism back. I'll let you know how it goes for me in 2 years time 

[earti193]

Hi! Any update on how you are going? Really appreciate the detailed thread here. I'm booked for 17 June with Dr Guichet in London, femurs with G-Nail, hoping for 6-7cm depending on how things go.

[karlston]

Post x-rays update (+22d post-op)

Estimated height increase: 25mm

It has now been 3 weeks post-op, and I have had my first check-up with Dr. Giotikas to look at x-rays. I'm well recovered from the surgery and my wounds have healed nicely. On the negative side: I'm still struggling with sleep due to muscle tightness and it has become much more difficult to click my right leg.

First follow-up with Dr. Giotikas
I had my first check-up just under 3 weeks after surgery, which is later than what I expected. Fortunately, everything is looking good:

• My range of motion is in a good state compared to before surgery.
• The x-rays show the expected distraction length and early signs of consolidation.
• The nail shows no signs of bending and the alignment looks good.
• My mobility and strength are better than expected and I've been cleared to walk with crutches up to 2 hours a day.

X-rays


Mobility
I was cleared for using crutches and the anti-gravity treadmill as of last Thursday (15 days post-op). It's refreshing to be able to walk after 2 weeks on a wheelchair and walker. I'm positively surprised that my muscles seem to have not atrophied too much as my walk is looking good with ~50% of BW support on the treadmill. I've also been able to walk in the hotel pool with the water about waist-high.

Here's me walking with crutches 3-weeks post-op:



I'll try to get a video of my walking gait without crutches on the gravity treadmill next week.

Sleep
As I've entered the inflammation stage since week 2, sleep has continued to be poor. Dr. G. has prescribed me sleeping meds, but they have not helped much. I'm averaging 3-5 hours of sleep as I need to get up due to muscle soreness every ~1-2 hours.

I've had one good night of 6 hours of sleep so far. Hoping I can become consistent so I can get back to work.

Clicking
Clicking has unfortunately has been much harder on my right leg since the inflammation phase. I had a few sessions that took 30-45 minutes just for my right leg with significant stress. Now I'm down to ~15 min but still having to push through tightness and pain. I'd rate the stress levels as 7/10 and pain as 6/10 and I'm drenched in cold sweat after every session. My day revolves around getting ready for clicking, clicking and recovering from clicking.

I heard it gets easier post ~3.5cm, so I'm holding on to that hope. I'm a relatively tough guy but the thought of having to click through this pain for the rest of the process is terrifying.

After my own experience and speaking with 5 other patients currently here, clicking is by far the most difficult part of the process.

Here is how easy clicking was in the first week:

It would be amazing to get back to that.

BJR team
I've stopped getting daily visits from the nurse and PT in the hotel as I'm independent now. They still show up when needed, for example to show me how to use the crutches. I've been happy with their support and expertise. My only complaint is that they sometimes are slow to respond to Whatsapp messages that are not urgent.

Next steps

• +28d post-op I will move from the hotel to an Airbnb
• +50-60d post-op I will finish lengthening

Hi! Any update on how you are going? Really appreciate the detailed thread here. I'm booked for 17 June with Dr Guichet in London, femurs with G-Nail, hoping for 6-7cm depending on how things go.

Sorry for taking this long, it was hard to find the time with the more intense process during the inflammation phase. Wishing you the best during the operation with Dr. Guichet.