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[afonso]

Hey everyone  September 18th I did my LL Precice II internal femurs surgery with Dr. Mahboubian in Los Angeles.    My starting height was 167cm and my goal is 175cm.  More importantly I'm in my 40s and that is the main reason I'm doing this blog.  I believe I'm the first to write a diary in my age range and successful or not want to give others, like me, a sense of what to expect.  Many of you probably think I'm crazy for doing this at my age but I'm not one to follow the beaten path.  I'm relatively fit, to highlight my level of fitness  I've recently climbed Kilimanjaro and done several century cycle rides (100 miles).  Make no mistake I've read the diaries and know this will be hard and painful but so have many other things in my life.  Hard should never be a reason to stop you from accomplishing the things that will make your life more fulfilling and meaningful.  I will do everything in my power to make this a successful experience. 

Why am I doing this you may ask.  Many of you know the answer for it's similarly themed to yours.  I hate being short and the insecurity associated with that reality has robbed my attention and thoughts for way too long.   Let me be clear I love myself (in a health not narcissistic  kind of way) I'm not depressed and although I've never achieved James Bond level of success with the ladies I've never really had a problem getting a beautiful women to spend time with me.   I'm doing this because it's a bonus to an already good life and don't think 4-6 months is that much of a sacrifice. 

Between now and my LL I will be sharing with you the details of my preparations and activities pre-surgery.  I look forward to taking this, hopefully not too bumpy, ride with all of you.  This community has helped me immensely with my decision and I want to give back so if you have any questions ask away. 
   

[afonso]

I have been maintaining a diary on the old forum and want to post one here as well in the hopes that me sharing my experience can help others interested in going down this road.  To spare everyone as much reading as possible I will limit my initial post to my week to week experiences. 

[afonso]

Operation Day

Operation Day:  You walk into the hospital at 5:30 AM and get registered and taken into a pre-operation Room.  You are put on a gurney half nked as your medical team swarms around poking and asking questions.  If it wasn't for the nervousness of what’s about to happen you feel quite special with all the attention.  I’m serious when I say team you have an anesthesiologist, surgeon, operating nurse, and another half dozen other medical personal all focusing on breaking your legs.  Once all the necessary needles have been attached and administered you are wheeled into the operating room. The anesthesiologist walks in and starts his countdown and its lights out.  It’s amazing how hard and fast you’re out the next thing you remember is waking up in your hospital room attached to an IV and catheter up your penis.  The heavy duty pain killers they inject directly through your IV ensures you don’t feel a thing but it does feel like a 2 ton truck is parked on your legs.  This day your only job is to meet your post operation team and feel as comfortable as possible.

Day 1:  This is when you start questioning your sanity for doing this and experience some of the most painful and uncomfortable moments of your life.  Physical therapy(PT) starts day 1 and you can’t imagine the pain that comes with each slight move and step.  At the end of my first PT session I serious doubts I would every walk again and if there was anyone in this world that could make me do another PT session.  The other new for the day was learning how to urinate into a urine bottle.  To get this right you really have to get your blather aligned just right with the bottle.  This took several tries before I could get a solid blather movement.   The good news for the day Dr M came in a told me the surgery was successful and everything look good. 

Day 2:  PT is getting better I was able to transfer from the bed to the wheel chair without wanting to kill everyone in the room.  You really just have to keep pushing yourself that is the only way your mobility will come back.  With a clean bill of health from the hospital and Dr M was released today.  To get home I rented a van that transported me in a wheelchair for about $100.  Worth every penny I have a sports car and couldn’t imagine even attempting to navigate getting into my car.  For the day only experienced pain when moving. 

Recommendations
Strong upper body strength is a must it’s the only way PT is even slightly tolerable.
Weight below 150 - I didn’t do a great job at this it would have helped being under 150 to avoid the nervousness of passing the 150LB weight limit with Precice II.
Family and/or friends - I have my stepmom with me which is really like my mother and couldn't imagine trying to do this without someone being with me every step of the way.   

[afonso]

Two weeks post operation

Saturday October 4 marks exactly two weeks since I was discharged from the hospital and as suspected a tough week but much better than the week prior.  Here are the highlights:

Mobility:  here is where I had the most positive changes.  Every step still required thought but no where nearly as much as the 1st week. The 1st week every time I transferred from wheelchair and walker I had to mentally brace myself for the pain. It would, at times, take me minutes to get the courage to transfer.  Now my transfers are relatively easy and much less painful.  Some new  firsts for the week I can now lay on my side and stomach.  I normally sleep on my stomach so this makes me very happy.  I can get into my car with just the walker meaning I can now go for rides. I'm very pleased with my progress and new mobility.  Last week I was seriously concerned about how much mobility I would have this week gave me hope.

Pain:  This week wasn't painless but I think that mostly had to do with my aggressive PT after making my PT and LL changes the pain hasn't been that severe.  That said I'm still very dependent on pain killers.

detraction: I've been detracting 1mm per day .33 3x daily. So far this hasn't been painful nor has it produced any muscle tightening but its early in the process.

All and all it has been a better than expected week and hope it's the start of a trend.

[afonso]

Week 3

Mobility: Some things improved and others not so much.   In terms of progress I don’t think I’ll ever match the 2nd week where everyday I was able to do something new and exciting like lying on my stomach. Although I did add sitting on the couch to my repertoire.  Variety is good switching back and forth from bed to wheelchair gets old quick.  Week 3 has been more about making slight improvements like being able to transfer and move into positions faster and with less pain.  My upper body strength has significantly improved.  Using a walker I can lift myself to a standing position from any sitting position solely using my arms to lift me.  I’m hoping I can come out of this with seriously defined arms.  For the future LLers upper body strength will make your life much easier.

Stretching and exercise:  I’m seeing a PT 3 times a week and am maintaining a 3x daily stretching regiment.  I put my exercise bike together this weekend and plan to start that next week. 

Pain: pain has been manageable but I’m never pain free there’s always a constant ache to remind you that you’re a LL patient.  The days are better than nights.  I haven’t been able to go one night without pain meds.  One thing that does annoy me to no end I can’t stay in any one position for any lengthen of time without having to shift.   My left knee is still problematic some lateral moves can be eye opening.  I don’t think this is from the detractions it’s something to do with the operation.   I have to ask Dr M. his opinion on what to do when I see him this coming Friday. 


Interesting observations and lessons learned

Weight loss: I’ve been progressively losing weight I’m now 154lb (164lb at day of surgery) This is kind of intentional.  Cooking isn’t really practical these days so I had to look for a way to get already prepared meals delivered.  If you didn’t know the weight loss people have this segment of the market corned. Since I can lose a few pounds I’m fully embracing this and have been trying out different programs. My goal is to get down to 150lb and maintain any plan should get me there.  The hardest part is finding a program that tastes good. So far I’ve tried Diettogo last week and just ordered Bistro MD for this week.  Diettogo wasn’t tasty at all especially for the cost (approx $10 per meal) let’s see how Bistro MD is this next week.  I’ve also bought some Weight Watchers, Healthy Choice, and Lean Cusine to compare.
P.S. weight loss is easy if you’re not going out for martinis, steak dinners, wine bars.  All things I miss deeply!!!

Neosporin: has really helped with the wounds from the operation and more importantly it keeps down the urge to scratch.   

Wheel chairs get premium seating: being in a wheelchair sucks unless you’re going to the movies.  You get a reserved seat up front every time and if you go to a new theatre they even have a regular seat next to you for your friend or family. 

[afonso]

Week 5

Mobility: I can easily do everything I need to do short of walking and can probably do that as well if it wasn’t for the weight baring restriction.  Everything means transfers to and from bed, couch, stationary bike, walker, toilet, shower, car, and wheelchair.

Flexibility:   Stretching 3x daily with 3 formal PT sessions weekly.  Flexibility is a moving target now that I’m detracting at 1.33mm per day.  Literally my ability to do and any given stretch can change from session to session for the better or worse.  It has become a constant challenge to maintain an acceptable level of flexibility.  I’m on the never ending run from the atrophy monster and feel his hand grasping at my back to often for comfort.  I’ve metalized myself that this is how things are going to be for a while and am taking things one day at a time.  I’m going to maintain the 1.33mm for as long as I can.  I see Dr. M on 11/7 hopefully I can keep it up till then and will be enough ahead of the consolidation threat to slow down a little. 

Pain:  Since the detracting increase definitely more pain. Have been taking 2 Narcos per day -  1/2 pill every 6 hours.  The prescription calls for 1 pill every 6-8 hours I’m staying below that not because I’m a hero but because Narco (Hydrocodone / Acetaminophen 10- 325) can become addictive. To avoid addiction I’m only taking it if I feel pain and will taper off at first opportunity. Unfortunately pain has been consistent especially at night.  Like clock work 4AM comes and my legs let me know its time for my next fix.   The good news is that I haven’t felt any numbness nor sharp bursts of pain just the constant dull pain that increases as the Narco wearing out.   

Diet Plan: Bistro MD was much better than Diettogo but still not worth the almost $40 per day average if you factor in their snacks and shipping.  Instead I’m setting up my own plan using Weight Watchers Smart Ones, Healthy Choice, and Lean Cuisine. I order these biweekly through Vons (local LA grocery chain). They deliver for $9 per delivery.  These meals are typically $3-5 dollars and in many cases taste just as good if not better.   My goal is to maintain a weight of 150-155 lbs presently at 154lb.

[afonso]

Week 6  Oct 27 - Nov 2
Mobility: Went backwards here but only because I started cycling last week and over did it the first time.  Spent ½ the week nursing serious charley horses in both calves.  If not for that mobility would have been the same I think. Let see what this week brings.   

Flexibility:   Stretching 2-3x daily with 3 formal PT sessions weekly.  For most of the week wasn’t able to maintain 3 PT sessions because of the tightness.  Flexibility sucked up to the point of reducing my detractions back to 1mm.  I was really hitting a wall and every PT session was hell.  On Thursday 10/30 Rob (physical Therapist) said my legs were like rocks even the skin was taut.  Since scaling back detractions on Friday I can already see improvements in flexibility.  I hope I don’t have go back to 1.33mm don’t think my body can handle that.

Pain:  on Thursday 10/30 was up to 4 Narcos have since been able to scale back to 2.5.  At 1.33mm the pain was unbearable and sleeping at night impossible.   Night time continues to be the worst.  Can’t manage to find any position that is tolerable for more than a few minutes. 

Lessons learned
The least worst (because up till now there hasn’t been a good position) position to sleep in is on my side with a pillow between my legs.   
Narco hardens stool and when you’re up to 4 pills it petrifies it and makes bowl movements feel like labor pains.  Sorry for the visual just keeping it real.

[afonso]

Week 7
Yesterday had my scheduled appointment with Dr M.  Great news pre-consolidation is no longer a threat I can now permanently go back to 1mm per day.  I almost bursted into song and dance (kidding can't do either very well) I was miserable lengthening at 1.33 it was very painful.  Another bit of good news I'm currently at 4.8cms lengthening nicely and evenly on both legs.   Dr M says that it shouldn't be a problem for me getting to my 8cm goal.  Yesterday was truly a good day and hope it’s a good sign of things to come.

Flexibility/Mobility:   Mobility is still very good and improving I can get around rather well.  As for flexibility that is another matter completely going backwards. PT sessions are turning into the Spanish inquisition.  I can still lock my knees but it’s not fluid and easy any more.  My left leg feels very tight and my right is just slightly better.  I’ve started using Tiger Balm to help with the muscles. It’s helps a little I’ve just ordered FlexPower heard it works even better.  I’m hoping 1mm detraction, cycling, frequent PT and any other aids such as tiger/FlexPower will get me to my 8cm.   

Pain: only using 1 Narco pill at night and regular Tylenol during the day as needed.  Night time is bad can’t find any position that’s comfortable for very long.  Sleeping on my side with pillow seems to be the best but it doesn’t last long.  To get my somewhat regular zzzs I’ve become a napper.   I’m told Benadryl (active ingredient Diphenhydramine) is a very good sleeping aid and might knock me out.  I’ve ordered some for next week will let you know how that works.   

[afonso]

Week 8 (November 10 -16)
The Ellipse lengthening device says that I’m 5.7cm taller and at 1mm per day that translates to 23 more days of lengthening.  Generally speaking the week has been hard and easy all at the same time. 

Flexibility/Mobility:   I’m having a hard time straightening my knees.  I can straighten them if I’m laying stomach down on the floor but not if I’m on my back.  The only way I can lock my knees then is if my legs are angled up on books, pillow, exercise ball etc…    I also have a knee bend when walking on walker.  I haven’t received the FlexPower cream so not sure if that will help.  I did hear that sandbagging helps with knee straightening.  That’s when you force your knees to straighten by laying a sandbag on your legs. Going to try this to see if it helps.

Pain:  day time is fine sometimes I take a Tylenol but not always.  Night time now that is a different story read my previous post for more details.  Sleeping sucks on my last post I was going to sleep on the couch to see if that would improve things.  That didn’t work same issue persists.  As stated previously I will live with this for the next 23 days and become a napping expert.  If I catch myself complaining too much I think back of the first 2 weeks of this process and move on happily I’m not there. 

Overall Mood:  The knee bending bothers me I’m concerned that if this keeps getting worse it will prevent me from reaching my goal.  If it’s only pain and discomfort in the short term no worries that I can handle but I will not chance walking like a crippled. 

[afonso]

Week 9 (November 17-23)

Achieved: 6.4cm
Goal: 8cm
Days to completion: 16

Early on in the process of researching LL I was talking to an Ellipse rep (makers of Precice) and she told me that most people don’t reach 8cm.  When they get close to the 7cm range they rationalize that the difference to 8cm isn’t worth the extra effort.  I was baffled by this rationalization considering the power of Height Neurosis and the LL cost (approx 1K per MM). Barring legitimate health concerns, I couldn’t understand why anyone would not balls to the wall go for the max.  Now that I’m in their shoes I can understand the thinking.  After weeks of sleep deprivation, exhausting stretching exercises (3x daily), cycling, and the nagging concern that your bent knees might be permanent the distance of a cm on a ruler isn’t that impressive. I’m not stopping but now I really do understand. 

Overall Mood:    Optimistic the week was still sh!ty but not any worse than the week prior - that’s progress in my book. Bent knees and sleep are the two biggest threats to completing my goal.  Still can’t sleep more than 2-3 hours at a time but as long as I can supplement with naps I’m ok. 

Flexibility/Mobility:   My bent knees are getting slightly better with PT but If it gets worse I will have health concerns.  I’m scheduled to see Dr. M on Dec 2 we will see what he recommends. 

Pain:  Day time is still fine not much pain very manageable.  Night time is very crappy usually take 1 Narco.  The only silver lining are my dreams the struggle with sleep produces some off the wall weird and very entertaining dreams.  I’m going to start a sleep diary.     

Lessons learned
Sleep aids like ZZzquil and Benadryl don’t work for me. You go to sleep fast sure but then you wake up 2 hours later groggy and unable to sleep because of the leg pain.  If they aren't going to get me more total hours of sleep then they are no help. 

Avoid using heavy blankets or comforters during lengthening phase.  The effort needed for your legs to move under these will bring pain very quickly.  Use heating pads, more clothing, and light sheets instead.

[afonso]

Week 10 (November 24-30)

Post Op:  73 days
Achieved:  7.1 cm
Goal: 8cm
Days to completion: 9

This phase of the lengthening process is exhausting no so much because of the high pain level but like Chinese Water Torture it’s subtle but relentlessly persistent. Getting your sleep 2 hours at a time 3x per day is not ideal in any way, shape, or form.  It gets the job done but you’re tired all the time.    Not so good if you’re working and trying to maintain your stretching and exercise schedule.

Flexibility/Mobility:  My bent knees are getting slightly worse.  I believe the reason was no physical therapist this past week.  He was on vacation for the Thanksgiving holiday.  I still maintained the same stretching and exercise schedule but it’s not the same.  There’s only so much pain you will inflict on yourself.  I can’t say again how important it is to have a physical therapist during this process.  If you are shooting for high numbers I don’t think you can do without. 

Pain: pain is consistent day and night now that I have stopped trying to sleep the whole night. The only downside with less pain is that my dreams went away.  Last week my pain med schedule was below.  Will try to follow same schedule for next week.

Med schedule
6-8 AM  - ½ Norco and 2 Tylenol 500 mg extra strength
12-2PM – ½ Norco and 1 Tylenol 500 mg extra strength
8-10PM - ½ Norco and 2 Tylenol 500 mg extra strength

Overall Mood:    Like last week sh!ty and optimism is disappearing as my flexibility diminishes. I’m a little concerned Dr M is going to make me stop. Not necessarily the end of the world at 7.3cm but disappointing if it comes to that.   I’m scheduled to see Dr. M on Dec 2 we will see what he recommends. 
   
Lessons learned – none worthy of mention this week

[afonso]

Week 11 (Dec 1 - 7)

Post Op: 80 days
Achieved: 7.2 cm
Goal: 8cm
Days to completion: 8

As reported earlier after seeing Dr M. I’ve had some setbacks this week. Just to recap I lengthened 2.5 mm less than being reported by the Precice machine and Dr. M had me take a 3 day break from LL to give my soft tissue time to catchup.  That said I’ve enjoyed the break for one I’ve been able to get more sleep.  Not the desired 8 hours yet but a sold 4 hours straight.    I hope I can maintain that next week but if not that’s ok we are at the finish. 

Flexibility/Mobility:   With the break my bent knees are getting slightly better.  Overall I feel a little looser.  Unfortunately I’m sure to lose all that flexibility next week with the final 1cm push.

Pain: By the end of the break I was taking half the pain meds.  That made me happy really want to wean off meds as soon as possible.  My guess is by middle of next week I’ll be at my previous pain med levels.  That’s ok one week and this part will be over. 

Overall Mood:    Back to optimistic was really happy to see pain and sleep deprivation greatly diminished in the 3 short break days.  Still concerned about bent knee but even that improved slightly.  Going into this last week enthusiastically and happy to finish. 

Bone Growth and Consolidation: Now that we are close to this phase I will start reporting on this.  From last weeks xrays it looks like my right leg has good bone growth but the left still has a ways to go. Dr. M isn’t concerned at the moment but has recommended that I start doubling up on Vitamin D to 4000 iu and start taking Silica.     

Lessons learned – none worthy of mention this week

[ShortyMcShort]

Great diary, rather late than never right 

Do you know how much you've spent in total thus far? Considering next week is your last week?

[Plzen]

Thanks for starting your diary here Afonso.
I have had the same surgery, and am currently in lengthening/distraction phase (Precice II in South Africa).
 I am in the process of reading your whole diary. I have one question. At one point you were distracting 1.33mm per day (as opposed to 1mm per day).  Did you request 1.33mm/day or did the doctor recommend it without you asking for it. What does Dr. Mahbooubian say about the benefits and risks of 1.33mm/day vs 1mm/day.

[afonso]

Great diary, rather late than never right 

Do you know how much you've spent in total thus far? Considering next week is your last week?

Hi and thanks! As for costs the surgery and hospital is 68,000 other costs to consider:

Physical therapist  -  my insurance paid for this but if you have to pay expect $80 3x week x 13 weeks - $3,120
Home aid - I had family with me but if you don't have that you will need someone full time the first 2 weeks
Transportation (doctor / hospital etc...)  I found someone that transported me for $100 per trip including return - I needed that 2x per month = $800
Clean lady - very hard to clean yourself had someone come in every week @ $60 x 13wk = 780
Housing - I'm paying with utilities 2000 per month for condo near Dr M.
Equipment - wheelchair, walker, heating pads, commode, crutches, exercise bike etc - $600 - $800   

[afonso]

Thanks for starting your diary here Afonso.
I have had the same surgery, and am currently in lengthening/distraction phase (Precice II in South Africa).
 I am in the process of reading your whole diary. I have one question. At one point you were distracting 1.33mm per day (as opposed to 1mm per day).  Did you request 1.33mm/day or did the doctor recommend it without you asking for it. What does Dr. Mahbooubian say about the benefits and risks of 1.33mm/day vs 1mm/day.

Hi and congrats on your surgery going to 1.33mm is not advisable Dr. Mahboubian only prescribed it because I was close to preconsolidation.  I did it for 2 weeks and it significantly impacted my pain levels, sleep, and flexibility.   How far are you along?

[Plzen]

I have a diary here as well. I have distracted 2cm so far.

[Uppland]

Hi alfonso hope you're doing well. Will you let us know how your recovery is going when you've finished lenghtening? It'll be interesting to hear from an athletic person.

[afonso]

Hi alfonso hope you're doing well. Will you let us know how your recovery is going when you've finished lenghtening? It'll be interesting to hear from an athletic person.

Hi Uppland doing well almost at the end.  Definitely plan on keeping up the diary especially during the consolidation phase.  After that will make a point of doing monthly updates for as long as there is interest.   

[Uppland]

Hi Uppland doing well almost at the end.  Definitely plan on keeping up the diary especially during the consolidation phase.  After that will make a point of doing monthly updates for as long as there is interest.

That's good to hear man. Will you post pictures and/or videos to show how you manage? I understand if you're uncomfortable but visual diaries are always the most helpful. It helps alleviate much of the fear and uncertainty of the surgery.

[afonso]

What kind of pictures/video would you like to see? 

[Uppland]

We are all mostly concerned with your physical recovery. Perhaps a few videos that show how you walk, run, jump, your flexibility and agility. Of course you can hide your face if you feel awkward.

Some people (including myself) are also interested in how it looks when one's legs have been lenghtened. Most people look normal especially to an unaware eye but we're always interested in more real life pictures to show how proportions are affected.

All this is optional and we're already grateful you've shared your experience but it would help many people who feel frightened by this surgery (again myself among them) to be more prepared and to know what they're getting themselves into.

[afonso]

Week 12 (Dec 8-14)
Post Op:  87 days
Achieved: 7.9 cm
Goal: 8cm
Days to completion: 1

By 11:59PM Monday 12/15 I get to put away my proverbial rack and bring the detracting phase of my LL to an end.  Words can’t describe how happy I am to reach this point both from a sense of accomplishment and more immediate an end to pain and sleepless nights.   Luckily for me it has so far been a relatively uncomplicated process with few unhappy surprises.  Although I must admit I wasn’t prepared for sleep deprivation or how tight my legs would get on the road to 8cm. 
 
Flexibility/Mobility:   As expected all the flexibility gains from last week are long gone.  My soft tissue feels like the suspension cables holding up the George Washington Bridge.   My bent knees are slightly worse and if it wasn’t for how quickly things loosened up during the 3 day break I would be concerned. 

Pain: By the end of the week pain med intake was slightly higher than before the break. With meds pain level is manageable. 

Overall Mood:    Ecstatic!!! The tunnel is almost clear and the light is bright.  On to consolidation and recovery
Bone Growth and Consolidation:  Will know how much upping Vitamin D and adding Silica has contributed to this when I see Dr. M on Friday, December 19.

Lessons learned – none worthy of mention this week

[Plzen]

Congratulation. I am happy for you. Hopefully you pain/flexibility/sleep will improve in the next few days. Enjoy the new height and keep us updated.

[afonso]

Congratulation. I am happy for you. Hopefully you pain/flexibility/sleep will improve in the next few days. Enjoy the new height and keep us updated.

Thanks I look forward to sleep the most

[Plzen]

Afonso,
Reading your diary, it looks like bent knees were your biggest problems in terms of flexibility.
Did your PT tell you that your bent knees were mostly due to tight hamstring muscles?
Exactly what exercises did you do to solve the problem of bent knees?
Did you have problems with tight Quad muscles? Piriformis muscles problems?

[afonso]

Unfortunately the problem persists and yes my PT told me its my hamstrings.  He's confident the problem is resolvable with some PT after LL.  Currently doing several hamstring stretches 3x per day.  The main one is in bed on my stomach with legs below knee dangling over bed.  Letting the weight of my legs force them down.  I do this until tolerable which has been about 3-5 minutes.   I'm also going to start using the pool at a local gym to walk.  I haven't done this yet because I haven't had the courage to drive.  Will start doing that towards the end of the month. 

[afonso]

Done – 8CM !!!!!
Just finished last detraction.  The attached picture is the Ellipse detraction device (a.k.a. The Rack). If you look closely the total detracted is 166.70mm (both legs) or 83.35mm (8.335cm) single leg and limb lengthened.  The reason for the additional 3.35mm.  The last time I saw Dr. M I was told that there was a 2.5mm discrepancy between actual and Ellipse device. That was at 7cm.  I calculated that 8.3cm on the machine would equal 8cm (8cm is the Precice II maximum). 
Ok now I can go back to bed and not  sleep.  Hooray - these sleepless nights are numbered!!!

[alps]

congrats mate!

[Moubgf]

Did it go faster or slower than you thought?

[afonso]

Sad, thanks

Slim_Tim, excruciatingly slow especially when sleep deprivation kicked in full gear at about 5cm.