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[Nomad]

Hi All,

I've recently finished distracting period of leg lengthening with external monorail device by a doctor and in country, which I don't want to disclose. Because I think very often LL doctors become subject to undeserved criticism in this or the other (old) forums and I am not going to blame my doctor of anything happened to me. And because long time before I had LL I made myself well aware what kind of risks LL represents generally and external monorail devices in particular.

I knew external monorails were prone to cause misalignments and were not capable to fix them. I hoped that I would be fortunate to avoid any serious issues during LL. After having read lot's of materials online and having understood excessive lengthening almost in every case end with some kind complications, I had from the very beginning decided to play safe and to aim for only 5 cm. However, unfortunately it didn't save me to end up with misalignment (and, probably as the result of this misalignment, valgus) in my left tibia, which you can see in the attached X-rays. Sorry for bad quality of pictures, but that's the best I could take with my phone.

http://i.imgur.com/wBlp9ui.jpg

As you see it is not that much of misalignment and that's the reason why my doctor keeps saying that misalignments less than 10 degrees are acceptable, and that he can fix valgus by replacing the device on my left leg, but for some reason after couple months when my legs get better. But I've learned that number of other patients of the same doctor had misalignments and he convinced them to accept their misalignments and not to do anything. I was not happy with my misalignment at all, I was not going to compromise, because of possible risks in the future, for example, of having early arthritis.

So, I've contacted Dr. Monegal about my case, he has been very much helpful so far answering all my questions and I have finally made my decision and going to have my left tibia alligned using intramedullary nail on October 15th, 2015 in Barcelona. So since I've finished distraction period this would be similar to do a LATN. I am pretty confident in Dr. Monegal's expertise, promise to stay positive and update my further progress here in this thread.

Meanwhile, I have couple concerns and would like to ask experienced LLers to elaborate on them.

1. Dr. Donghoon says about LATN on http://www.drdonghoon.com/index.php/archives/2414

During 1st stage surgery, future space needed for the internal rod needs to be considered when determining the positions for the external fixator pins. Also, the correction process before 2nd stage surgery requires much knowledge and care from the doctor. Rather than simply using the Ilizarov, computer assisted fixator systems  like the Hexapod or ORTHO SUV must be used for accurate correction.

In my case no such space had been considered. 1st operation was performed by different doctor with monorail external device 2nd operation will be performed by Dr. Monegal. Now I keep wondering will there be enough space for fixating the internal nail.

2. Another concern of mine is would inserting internal nail indeed correct not only the misalignment, but also correct valgus I have on my left leg?

I already asked the same questions to Dr. Monegal and know his answers, but would like to hear what collective consensus on these kind of problems on the forum. As a matter of fact very often experienced LL veterans form quite professional opinion on many things.

Thanks for your attention!

[microman]

dr. mitkovic uses some aparatus to fix misalingments, maybe it's best you contact him?

[Nomad]

dr. mitkovic uses some aparatus to fix misalingments, maybe it's best you contact him?

Thanks for the suggestion, but I thought I made it obvious I am trying to fix problems caused by external monorail device, so recommending the external monorail doctor is just incongruous.

Besides, I've clearly stated that I've made my decision to get this fixed with Dr. Monegal, the date of operation is fixed, and was asking specific questions to experienced LL veterans.

[Dr.Ruan]

Thanks for  your case.Your xray  is  too short  to look .Would you  please  post  anterioposterior and lateral film?

[sneg]

Misalignment is not that big.

[Nomad]

Thanks for  your case.Your xray  is  too short  to look .Would you  please  post  anterioposterior and lateral film?

Dr. Ruan, thanks for your feedback, but I don't have any other X-Ray and am not going to have any before the op on 15th. Anyway, I know my misalignment is not that big - my main concern is valgus, which you won't be able to see on X-ray anyway. However my valgus is clearly noticeable when looking at my left leg externally. So I am going to Dr. Monegal not as much for fixing the above misalignment as for getting my valgus straighten up.

[Dr.Ruan]

Hope  that  you  will  be  safe and  correct  valgus  successfully  !  I wonder  how  many pins  are  there  on your  external device.From  your  xray just  one  pin  can  be seen  on  upper  portion   of  your  device.Thanks!

[Nomad]

First day post op. Lying in my hospital room with moderate pain even after having some Tramadol. But it's ok taken into attention Dr.Monegal said it was one of the most complicated operation. It took around 5 hours to finish it. Doc says longer than it takes when he performs regular Fitbone operation. Because I had pretty much fked up case. You can see that by looking at the X-ray picture taken just before the op:

http://imgur.com/pqSwjPB

I can give more details in couple days when I have new X-rays. However already I can tell that I am extremely happy with the wonderful job done by Dr.Monegal just by looking at my left leg. Valgus, which bothered me most, is completely gone. As for misalignment IM nail has been inserted, so it also should be straighten up now.

And generally people, environment, the hospital staff, care, everything in Barcelona is superb. But above all Dr. Monegal himself is not only one of the best LL specialists in the world in my opinion, but also is a really cool guy with quite friendly personality.

I'll post more when I have X-rays.

[KrP1]

Hey Nomad! Im happy that everything is going well

[maximize]

First day post op. Lying in my hospital room with moderate pain even after having some Tramadol. But it's ok taken into attention Dr.Monegal said it was one of the most complicated operation. It took around 5 hours to finish it. Doc says longer than it takes when he performs regular Fitbone operation. Because I had pretty much fked up case. You can see that by looking at the X-ray picture taken just before the op:

http://imgur.com/pqSwjPB

Holy crap! This is exactly why I try to talk everyone on this forum out of monorails. They are dangerous! What a misalignment! Looks like Bluebarbie's did during her distraction phase. Looks like she got it mostly straightened out during nailing but not perfectly, and I think part of the problem she's still having is due to that.

You made the right decision in my opinion to get this fixed now. Hopefully the realignment process hasn't damaged your new consolidation bone.

[Nomad]

You made the right decision in my opinion to get this fixed now. Hopefully the realignment process hasn't damaged your new consolidation bone.

You bet I did. As for new bone, of course the intervention disrupted it a bit, but the goal of getting my fked up valgus corrected had more priority than worrying about callus disruption. It will probably take longer for my left leg to get fully healed, however on the other side it has now IM nail, so I can start walking soon putting some weight on it.

I thought it would take couple days, but Doc decided to do X-rays today.



Look at the picture and you easily notice what kind of absolutely amazing job has Dr.Monegal done. Compare the misalignment and valgus before the op to the result on the right side of the picture. Hardly any other LL doctor could come so close to a nearly perfection result as Dr.Monegal achieved in this case. I couldn't indeed be any happier than I am now after seeing post op X-rays. Can't stop thanking Dr. Monegal for such a wonderful outcome.

Here is another one from different perspective:

[Revenge]

I will use monarails too why you say its dangerous ?

[Nomad]

I will use monarails too why you say its dangerous ?

Look at the pre-op picture to see obvious why you should not go with monorails. It is almost inevitable to develop some kind of misalignments/valgus/varus when distracting with monorails. And when it happens there is no possibility for doctor to fix it. He will just put you under MUA and try his best, but only to certain degree, 'coz there is only so much to fix with monorail device. And after that he will try to convince you to accept whatever harsh reality you have, saying "everything will be alright".

Moreover, I can confirm like EVERY single patient in a country where I was doing LL had some problems, usually misalignments. There are several patients in this forum whom I've seen in real life and who are sugarcoating their LL tales here, but in fact they have serious problems because of monorails. I won't name them but if you carefully read monorail diaries you will notice there are some pictures taken just after op, but there is none after couple months. Because of course there is no pride in posting fked up X-ray pictures.

People choose to go with monorails because they think they are more affordable, however in real life they end up spending twice as much as they initially planned because almost everybody goes through additional operations/interventions. So it's your decision what to do with your body, but based on the experience I have gone through I would never ever recommend monorails to anyone.

And guys in monorails countries, don't loose your hearts if you have misalignment/valgus/varus problems and if your doctor is trying to convince with "10% misalignment is acceptable, fked up bone will shave itself" bullcrap, because there is a solid solution - come to Dr. Monegal in Barcelona and he will fix even most complicated cases.

[bluebarbie]

Congratulations on ur misalingnment fixed, Nomad. Did u lose any mms? How much weight can u put on ur legs at the moment? Wishing you fastest recovary.

[Nomad]

Congratulations on ur misalingnment fixed, Nomad. Did u lose any mms? How much weight can u put on ur legs at the moment? Wishing you fastest recovary.

Hi Bluebarbie,

I really can't tell visually right now, because my left leg is all wrapped up with bandages. However, according to Dr.Monegal's X-Ray calculations I didn't loose any - I have 5 cm lengthened on both legs. I can compare knee heights after bandages are taken off.

And I am only second day post-op, so lying in my bad all the time, haven't tried to put any weight on the operated leg yet. I think I'll try to stand one of these days, when Dr.Monegal gives his green light for me to walk.

[Revenge]

I see your problem nomad and all my best wishes with you but ı see so many patients done with monorails any problem why it happened to you?Because of doctor?

[Nomad]

I see your problem nomad and all my best wishes with you but ı see so many patients done with monorails any problem why it happened to you?Because of doctor?

I am telling you to find any good X-ray pictures of late consolidation period of monorail patients. You won't find many if any at all. Because they all have terrible misalignments which they have to compromise with. And I am not blaming a doctor, it's just nature of monorail devices to be prone to misalignments.

[Taller]

How much did it cost you to get your alignment corrected?

[Nomad]

How much did it cost you to get your alignment corrected?

I paid 2450 euros for one week stay in Hospital Privado Universitari Sagrat Cor and another part to Dr.Monegal and his team for the operation, which only Dr.Monegal can disclose if he wants. All I can tell Dr. Monegal will have to see your case and give you a good deal. Of course, every case is different, so costs might vary.

[Nomad]

Important edit:

I somehow typed 3450, sorry. In fact, the hospital stay for one week costs 2450 euros.

That's 350 euros per day, which I believe is quite normal for state of the art hospital in the center of Barcelona. Staff, care, food by the way are excellent here.

[Nomad]

Congratulations on ur misalingnment fixed, Nomad. Did u lose any mms? How much weight can u put on ur legs at the moment? Wishing you fastest recovary.

Bluebarbie, I can now answer your question if I lost any mms, because Mr. Monegal was nice enough to visit me tonight (after he performed two LL operations) and finally freed my left leg from those very much thick and uncomfortable bandages. So now I can start bending my leg, flexing my knee and moving around. As you can see on the new picture knee heights are identical:



Also X-rays confirmed I didn't loose any length. Because Dr. Monegal and his team were careful enough to fixate the distracted length before inserting IM nail. Dr. Monegal explained to me what kind of measures they took to perform this complex operation, but there are too many technical details which I am afraid won't be able to properly explain here. Maybe I'll ask Dr. Monegal to elaborate on my case in this thread.

Again, I am so much relieved Dr.Monegal has completely fixed terrible terrible valgus and misalignment I had. There is little knee pain, but I believe it is quite normal to have some pain on the second day after IM nail insertion. I am pretty sure it will subside soon.

[Nomad]

After having a correction operation by Dr. Monegal with wonderful result and spending one week in the hospital just to recover little bit, I flied off from Barcelona yesterday, I've already arrived to my destination today and I feel it is the right time now for me to post my final entry in this forum. I didn't want to end this page just by disappearing as I know how sad it feels seeing other "unfinished" diaries. So I wanted to put at least some final thoughts and try to explain why I am taking off.

Well, in fact for various reasons I never wanted to participate in the public forums like this in the fist place. One of them, for example, is that English is not my first language and I wouldn't be able to write a good diary anyway. But most importantly I believe writing a diary would mean to potentially influence someone else's life, health, destinty. That's a big responsibility to take.

Also, unfortunately, I witnessed with my own eyes how young insecure, immature guys go for remote countries and get crippled just because they were impressed with sugarcoated or even false fairy tales of others just to find out the reality was completely different at too late stages. As a quite straight-forward person I wouldn't be able to write all the true things either as doing so often time means hurting others: doctors, other too much verbose LL patients who naively start to believe they are now top LL experts just because they were doing LL and who start consult other guys as uneducated and immature as themselves.

On the other hand, no doubt there are lots of sincere and truthful participants here or the old forum. However, I do firmly believe all the time and efforts of that kind of good part of the forum is often wasted in vain, not paid attention to, not easily found and then thoughtfully processed, seriously analyzed to take further decisions about LL. And that's not their fault, but the nature of this kind of public forums - not the best organization of information. To say frankly in my opinion this or the old forum are big two free-for-alls with lot's of unnecessarily repeated questions, answers, true facts and not so much true pieces of information, absence of admin diligence or often times on the contrary authority abuse.

And if some ask why I did start this page at all if I was so critical of the forums, then I really didn't want to, but sort of had to (when I developed terrible misalignment, my first doctor put me under MUA two times on top of the first operation, he really couldn't fix it and I realized I was tired of empty hopes and must start searching the solution elsewhere and luckily found it in Span with Dr.Monegal.) Because I wanted to publicly demonstrate how badly can monorail LL cases go awry; to give to potential monorails LLer another alert about this particular method of LL. So take it as my tiny contribution and I'll be happy if my particular story saves someone from taking a bad decision.

Finally, I really would like to wish all the best to everyone and use the right to exercise my personal decision - not to take part in this anymore and start having a new life.

[Alu]

I can fully understand your decision and outlook on life and what goes on with the LL community. It's sad to see someone as obviously experienced as yourself leave but after what you've been through I think that you should just forget about it as best you can and move on with your life. I hope for the absolute best recovery and life for you. If you ever do decide to drop by in extended periodic time then I would welcome it; in any case best wishes!

[blahblah]

Nomad you speak the truth and I 100% agree with you about these public forums. That said, I hope and wish I never see any posts from you again I wish that you are out living your life and never ever have to look back at this. Good luck on an awesome recovery man

[Taller]

That looks like a Mitkovic fixator.

And it would make sense because I know for a fact that Dr. Mitkovic has often told patients that misalignments less than 10 degrees are acceptable and do not require correction. This whole diary is possibly gaining some context and I think some dots are starting to connect.