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[ItsMyLife]

hey guys

I've a theory on why some docs set hard-and-fast limits on the tibia. They want you to do both tibia and femur surgery.... its simply a matter of business!

so I asked about full resumption of athletic endeavours

dr fahri and bagirov are of the view that 8 cm tibia is fine (at least for me, perhaps)... they say 8 cm tibia is better than 5 cm tibia done with 3-4 cm femurs.

of course, they lose out on some money (since I will not come back for further surgeries).....but it heartens me that they are not so money-faced....

they routinely do  femurs but they advise against doing both tibia and femurs as it is more traumatic for the body

dr fahri says not to worry about the tibia-femur ratio, as long as the femur is longer...

he also says not to worry about other doctors opinions, and he says that I can do 8 cm if I am able to... (don't know what he means I am able to... perhaps there might be some problems for some patient and they have to stop earlier?)

either way I am at 5.2 cm on both legs. left leg I have stopped lengthening due to some problems with device and flying back to russia

[Medium Drink Of Water]

Do they really prefer you to do both?  I think it's more about what they perceive as safe limits per bone segment than about just making more money out of patients.  The Beijing Institute are the kings of greed and they promise 10cm on tibia and are wary of doing femurs at all, and even when they do there's a 5cm limit.

[5.7to5.9]

Hello Itsmylife, If you have to maintain your athletic abilities I guess you have to stop now at 5.2 and don't go for femur either. You are already at a great height of almost 180cm which is way above average for your country. I guess with your current height only 10-15 percentile of population from your country might be taller than you. That is sufficient to achieve great success in life. I don't understand why do you want to be more tall? If you lengthen more I doubt you might feel general weakness in your body due not stronger muscle growth around lengthened area or achilles tendon contracture or just not regaining you former self in athletic ability. Even though they are minor they might effect your motivation to achieve greater things in your life. Just stop being so obsessed with numbers and start enjoying your new height. If at all you can go to maximum 6 cm in tibia and no more femur imo

[ForcedPuberty]

don't go past 6.5 cm if you value being a top basketball player.

[ItsMyLife]

if I push to 8 and succeed, maybe the forum could benefit (maybe not, cause maybe im the exception).... it would be like an experiment. I mean Im promised a full recovery, so lets see.

[ItsMyLife]

Yes I would be 10th to 15th percentile if I am 180 cm.

But I wanna push 182 cm, cause at the basketball court the dudes are so tall (especially the semi-pro or pro players) ... but it usually goes only as high as 180 to 190 at a neighbourhood court though. (surprisingly, most neighbourhood players are not tall, probably 2-3 out of 10 are above 180)

[ItsMyLife]

I don't understand why my doc would lie to me. He knows I am on these forums and I am writing a review. He also knows I am in the medical field. He knows I am fine with 6 cm. Why would he repeat that 8 cm is fine and just do it in tibias. Don't do it femurs and tibia? perhaps really, a two-staged operation is more traumatic to the body than a one stage 8 cm?

Of course, one staged 6 cm is the best, but what is to say that a one-stage 8 cm will have a more arduous recovery but you still end up fine?

2 cm is not much. But I am in Yellow's situation. I don't wanna end this process being unhappy or whatever, saying that I COULD HAVE got to 182. 182 is above average in most parts of the world. and I think I will be very happy with that (I might immigrate when I am older, to Australia/USA or even Korea); I need a global height.

At least, the clinical parameters are good. I have stopped tramadol for a few days. Just paracetamol and 75 mg Lyrica every night. Pains are at zero, even though I am still lengthening right leg. Equinus status is good, same for knee contracture (Knee contracture is a bigger problem though).

Main question, why is it that a two-staged operation is better than a one-stage??

[ItsMyLife]

Hi ItsMyLife
I'm still finishing my paperwork and cannot answer in detail, but there are some reasons why a two-stage surgery is better. I will try to answer your question on Sunday.
Best regards,

I mean tibia + femur (two stage), as compared to just tibia (one stage).
(am not referring to Dr Monegal's method of doing the tibia operation in two stages)

[5.7to5.9]

Main question, why is it that a two-staged operation is better than a one-stage??

Two stage operation is better as the limit of each segment maintaining its athletic ability is 5 cm. So you can do 5cm tibia and 4cm femur going for 9cm. This is better than 8cm on one segment for the said reasons. Both are worse than 6cm in one segment. This is simply based on assessing the recovery from so many post LL guys on this forum.

180cm is an excellent height all over the world. I lived in London for 10 years until recently I came to India 4 months back. London is a cosmopolitan city with people from different backgrounds. It is similar where ever you migrate to in the world. 180cm is good even for a Caucasian male.

Do you simply want to stand tall in the basketball court or perform? I really doubt you can perform with the first two strategies.

As per doctor, I am sure he must have tried to convince you to do 6cm. If you don't listen he will simply play your tune as risk is your's and he has no guilt as he had tried to convince you earlier. This goes with every profession in an advisory role
 

[ItsMyLife]

Two stage operation is better as the limit of each segment maintaining its athletic ability is 5 cm. So you can do 5cm tibia and 4cm femur going for 9cm. This is better than 8cm on one segment for the said reasons. Both are worse than 6cm in one segment. This is simply based on assessing the recovery from so many post LL guys on this forum.

180cm is an excellent height all over the world. I lived in London for 10 years until recently I came to India 4 months back. London is a cosmopolitan city with people from different backgrounds. It is similar where ever you migrate to in the world. 180cm is good even for a Caucasian male.

Do you simply want to stand tall in the basketball court or perform? I really doubt you can perform with the first two strategies.

As per doctor, I am sure he must have tried to convince you to do 6cm. If you don't listen he will simply play your tune as risk is your's and he has no guilt as he had tried to convince you earlier. This goes with every profession in an advisory role

[/b]

But my doctor holds the diametrically opposite view.

I didn't insist 8 cm. I asked them very nicely and didnt say I had to have 8 cm. They just asked me how much I wanted? And I said 8 cm but I expressed reservations about losing athleticism.

And yes you are wrong.I just said I want full athletic abilities cause I Play basketball competitively. Both doctors said 8 cm is OK. At no point of time did they say, do 6 cm, or 6 cm is better.

I even asked Prof Bagirov about 1-2 weeks after my operation, whether it is better to do 7 cm instead of 8 cm. He said it is the same, 7 or 8, I will recover. I was NOT insistent at all about 6 cm.

180 cm is only 10th to 15th percentile In Singapore, I want to be less than 10th percentile.

Main question, why does my Prof and doctor both hold a different view? Is it really better to do 8 cm on tibia as compared to 5 cm on tibia and 3-4 cm on femurs? Why?

I suspect with each operation, poses greater trauma, more scar tissues.

[5.7to5.9]

Hi itsmylife, hope you are in good hands. I guess there are 2 different types of complications involved in these two methods. With 8cm one segment it might be the case of weaker callus formation, weaker muscle growth around the lengthened bone and Achilles tendon complications. I also doubt if you can stretch your Achilles tendon that much, and how much of stretched length in tendon is permanent and how much is temporary - that is, it stays alright as long as you stretch daily though out your life? Could you ask this query to your doctor? And the complications in the second method might be simply due to greater trauma and scar tissue as you said.
So its a trade off between two, imo 2 segments is better

[5.7to5.9]

Also does your doctor do femoral lengthening? General tendency is any professional only supports only services what they provide and they are proficient in. They do not support things that they are not experienced in. This also might be the case why your doctor doesn't support 2 segments. 

[ItsMyLife]

Hi itsmylife, hope you are in good hands. I guess there are 2 different types of complications involved in these two methods. With 8cm one segment it might be the case of weaker callus formation, weaker muscle growth around the lengthened bone and Achilles tendon complications. I also doubt if you can stretch your Achilles tendon that much, and how much of stretched length in tendon is permanent and how much is temporary - that is, it stays alright as long as you stretch daily though out your life? Could you ask this query to your doctor? And the complications in the second method might be simply due to greater trauma and scar tissue as you said.
So its a trade off between two, imo 2 segments is better

I am in good hands, as far as my research goes:
1. Both doctors are traumatologists, which requires much more skill than cosmetic LL
2.They are widely praised and recommended in Russia and Russian forums (I did a search with the doctor emails)
3. Two patients here recovered uneventfully. One patient recovered well even though did not follow instructions and lengthened so fast, and didn't walk or do PT.

I think each individual is differnet. For me, I do not have any equinus contracture. yes my dorsiflexion is about 10 degrees worse, but I still have 10-15 degrees on both legs. I am already at 5.3 cm, so I think that is a good sign. Some doctors "guarantee" you will get ballerina at 5 cm. My doc said: if you stretch and walk more, you will not get it. Its true. RGKey did 9 cm. He didn't get it at any phase.

My doctors do femur. In fact, they asked me to do 8 cm tibia and 4 cm femur for the "perfect" ratios. But, after my operation, I don't know why but Prof Bagirov said its better for me to avoid femur surgery. They do femur, because a rusian patient who I was with, did femur lengthening on one leg, together with two legs (she had unbalanced femurs). But I think Prof Bagirov was concerned I cant handle the pain, because femur is very painful cf. to tibia.