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[Four Inch]

Background: I just had my first femur segment completed yesterday at the Clinica Diagonal. For those that are interested, I'll post my thoughts as I go through the procedure, however, my time is limited since I have to continue to work during my 5 week stay.  I am about 5' 7" and an American if you could not tell by the backwards ass way we use in calculating measurements.  Why we chose not to embrace the metric system is beyond me but i digress.  One important aspect about me is that I'm 50+ years old, I know most of you are much younger.  There is one patient much older than me that is going though the procedure as well. According to Dr. Monegal, he is doing great; I have not yet met this other patient but I look forward to meeting him at some point.

I have been contemplating this surgery for sometime now, about 15 years.   Although, I do feel I am expressing a certain amount of vanity in my decision to go though with this; my height has bothered me for a long time and I am still very conscience of my stature; something I could do without.    I had been corresponded with Dr. Monegal over e-mail for the last few months.  My impression at this point is that he is very caring and is very passionate about his work. I will say that I was expecting a more detailed discussion, with Dr. Monegal, about what I should expect during my 5 week stay.  However, I think Dr. Monegal is very confident in his work and since he will do what he needs to do in order to meet ones expectations; i think he is prone to leaving out details unless you press him which i did not.  Since i was here, I was already committed to doing this.

Risk Factor:

I have been on this forum long enough to know that at least one patient had complications and I can certainly sympathize with them.   However, I would not have come to Barcelona if I did not have full trust in Dr. Monegal.  This is not to say that I did a "ton" of research but i did consider the risks vs. benefits and decided to go though with it.

Clinica Diagonal:

The Clinic is terrific; private room, good food (although I'm not very picky) and a wonderful staff.  I only wish I had taken the time to learn Spanish before arriving.  I feel like I have wasted so much of the staff time by only speaking English. The pre-op experience was a bit frustrating for me because of my Spanish deficiency, I can only imagine how frustrating it was for clinic staff, but they did no show it.   I have visited France and Italy several times and found many more Italian and French that spoke at least broken English than I have found in Spain. You can defiantly visit Paris, Nice, Rome, Venice, and get though the day only speaking English.  This should not be construed in anyway to put down the Spaniards, this was defiantly my short coming since I'm he one visiting their Country - so far they have all been terrific to me!  One thing to note is that the average stature of Spaniards is less that other countries that I have visited.  I would not consider myself tall here by any stretch of the imagination, but I don't feel that I am overly short here either....just a thought, nothing more.

Pain/Discomfort.

My leg started to swell up during the night; I would think this is expected, I'll ask Dr. Monegal when i see him - hopefully today. At this point its' very uncomfortable but I would not classify it as painful yet.  I am now going without the pain relief drip so it may get a bit more painful.  In fact, I can feel the escalation of discomfort.

If you have any questions of me I would be glad to try and answer them but any in depth questions or medical advise should be left to be answered by Dr. Monegal or others on this forum who are qualified.

[helloworld]

All the best to you!
Will you be staying at the Mic after you get out of the Clinica Diagonal?

[Body Builder]

I will watch your diary very carefully my friend because it is very important to have more successful cases from Monegal.
If you have a good result like yagen, auron, helloworld etc and Monegal doesn't increase his prices then I'm sure he would be the first choice for many of us in Europe who want internal LL.

Keep strong and congratulations for your courage to do this surgery at that age !

[Auron]

Hey Four Inch! I did meet that older person that you're talking and he was doing great indeed. Older people tend to feel more pain but hopefully it won't be the case for you. Good luck 

[Four Inch]

Hi all, and thank you for the kind words of encouragement. 

Helloworld; Yes I will be staying at MIC, Dr. Monegal kindly offered to drive me there; I believe I will be at MIC next Monday.

Body Builder, it's very early of course but so far I'm impressed with Dr. Monegal.

Auron, that's great that you got to meet him.  I understand that he is doing so well that he is vacationing with his family somewhere on the coast.  i hope I my testimonial is just as positive.

[helloworld]

I will see you at Mic then, when I come to visit next time to see some of my friends there. :-)

[Ozymandias]

Hi Four Inch Fold,

From a fellow 5'7, wish you the best for this experience. Keep us informed!

[Four Inch]

Hello All,

It's been almost 3 full days since my surgery and I am feeling very confident at the moment.  I am not taking any pain killers.  Although I do have shooting pain in my knee when I twist my leg laterally, aside from that, the pain has been mild at best. I can move myself from my bed to a rolling recliner without assistance - although the nurse this morning caught me in that act and seemed a little startled and kindly suggested that I call her for assistance.   I am by nature very independent and like to be able to roll my recliner in to the bathroom and empty my own pee bucket.  

Although I have never been hospitalized for days at a time,  my inexperienced perception is that the members of the nursing staff here at the Clinic are exceptional;  I think I'm developing a crush on one in particular  .  Although I, like most I presume, don't like visiting hospitals in general, I am very comfortable here, no "hospital smell", very clean and modern and I even have a great view of Barcelona from the window in my room.

I do understand that there are risks associated with this procedure and it is exactly those risks that prevented me from doing this long ago.  I do believe the procedure has come a very long way in the last 10 years and my instinct is that it's time for me to have the procedure done or live the rest of my life feeling a little less confident in myself. Although I sometimes consider it pure vanity, it bothers me enough to accept the risks and get it done. 

To quote a line in a favorite movie of mine, "Screws fall out all the time, the world is an imperfect place".    i.e. With any  surgical procedure, there can be complications. However, my research lead me to believe that Dr. Monegal's record of success is most impressive.    My biggest concern at the moment is not the complications of the procedure itself, but in disciplining myself to accept the responsibilities of a good patient in making sure that I respect the recovery process and refrain from inducing complications myself.

Albeit a third day impression, on a personal level I feel I made excellent choice in surgeons.  Dr. Monegal has been terrific and very supportive.  I think I could ask him for anything and he would go out of his way to make it happen.  The procedure seems to have gone very well and my x-rays look good. if there should be complications (knock on wood) I'm feeling I would be in good hands with Dr. Monegal.

We'll, it's 8:30 AM in New York, time for me to get logged in and working.  Until next time.

Cheers!

[Four Inch]

Hello fellow forum members,

I have just moved over to MICs; Dr Monegal was kind enough to chauffeur me and another one of his patients over to the MIC's.  The facility here is very nice, much nicer than I expected. Everyone has been very friendly and helpful at MICs.

I am pretty excited that I was able to begin lengthening today and I remain confident that things will continue to progress smoothly.   Surprisingly, at no time did I ever feel anything that I would classify as pain thus far during this procedure, at least while resting my leg.  I did have some shooting pain when I moved my leg in order to get it positioned to stand up, it seems the lateral movements were the hardest.  I learned to use my good leg to assist the other leg with lateral movements, once that technique dawned on me the pain was gone.   In the beginning, there was also a bit of tolerable pain surrounding my knee cap when bending the leg more that 60 degrees or so. 

You are probably all familiar with the stretching machine that is used by the PT's on a daily basis.  I was chugging along daily, building from 80-85-90-95-100 degrees, with the same PT.  Then on Sunday walks in "Carlos the Slayer" (PT by profession).  Carols is a long bearded chap with a seemingly very calm disposition.  I got the feeling that there is not much that alarms or gets to Carlos.  Carlos enter my room, introduced himself and then  casually says, "You have been doing 100, lets try 110 degrees" -  and were off to the races.  The previous PT was moving me up in 5 degree increments so I was not sure what to expect with a 10 degree increase all at once.  Although I was up to it, I can't say that it did not hurt the first 10 repetitions, it did indeed.  In fact, the first five felt like my knee cap was about to explode.   However, I'm glad I did not complain or ask to tone it down a notch;  after the first 10 reps the pain did smooth out and I was actually looking forward to the upcoming rep.  I wish Carlos would have graced my room with his presence earlier in my stay;  I think the intense stretching really helps.  I wish I could have taken that machine and Carlos the Slayer with me to the MICs.

Although far from a pro, I can get around on crutches; I made a short jaunt to the Shop down the street to grab a bottle of Cola and napkins; I've been craving a Coke since my second day at the clinic.  Surprisingly the MICs provides everything your need but there was no starter package with things like a few napkins, condiments  etc. (but there was a bowl of fruit that was a pleasant surprise) -  I just now go up to check to see if there was any toilet paper as I had forgotten to check, luckily either the MIC's or the last occupant left a few rolls so I am fully stocked on that item.

I have meet a few fellow LLer's since starting the procedure.  A young man at the clinic that very much impressed me with his control and wisdom.  I believe he was only lengthening 4cm, something that seems to be rarely done; many (me included) want as much bang for their investment as they can tolerate. This young man has inspired me to do some very hard thinking as I lengthen to determine where to stop the process.

The second person I met was from a neighboring country and was on his second limb.  He was the other patient that Dr. Monegal shuttled over to MICs today.  He seemed to be doing fabulous, he looked just as tall as Dr. Monegal to me (something I'm pretty sure is a foul in Dr. Monegal's rule book)  - he also spoke better English than me which kind of pissed me off 

As i walked into the MICs, I met a very beautiful and friendly young lady. I learned quickly that she happened to be a forum member who I consider to be the most influential third party in helping me select my surgeon.  This influence was merely based on her public posts throughout the forum.

As mentioned, I am feeling very confident but continue to understand the risk that I have accepted with this procedure.  So far, I think I have been slightly lucky with how well things seem to have gone; however, I have nothing but kudos for Dr. Monegal thus far.

We'll time to get back to work......unfortunately, I still need to work for my living while here in Barcelona.


Cheers everyone!

[dawdawd]

Great to see a new diary from Dr. Monegal's patient. We really need more like yours ! Please keep us informed. Wish you a pleasant lengthening journey ahead !

- Daw

[helloworld]

I am happy that you seem to be doing well!
I will pay a visit to Mic next week or week after.

[notimportant]

In the guesthouse ask people and you will see the truth

[helloworld]

I am happy that you seem to be doing well!
I will pay a visit to Mic next week or week after.

I guess I will see you tomorrow at lunch. :-)

[OldieButGoldie]

Good luck with your LL.
I did it at the age of 45. I am now 49, doing sports like crazy, everything fine so far.
All the best to you,
Cheers
OBG

[Mdream]

OBG, how much did you do? My theory is that 3inch is safe for 20's/30's but for 40's, maybe 2inches is safer.

[TIBIKE200]

OBG, how much did you do? My theory is that 3inch is safe for 20's/30's but for 40's, maybe 2inches is safer.

He did close to 6cm

[Four Inch]

Hello Word

I guess I will see you tomorrow at lunch. :-)

It was a pleasure meeting you helloworld. It's nice to meet and chat with others that have gone through this procedure.

[Four Inch]

Just a quick update.

I have been sleeping though the night with no problem at all; no pain when leg is stationary thus far. That's been a blessing since I like my sleep. So far, no pain to speak of when my leg is stationary.  Bending my knee, to the point where there is resistance, creates a little pain - perhaps a 2 of out 10.  Based on feedback from Dr. Monegal, I am expecting to feel pain at some point during the lengthening process.  He gave me an estimate of about 2 weeks into lengthening.  I'm hoping it is bearable and does not cause me to slow down on my lengthening schedule.

I stretch 4 times a day, once right before I lengthen.  I stretch one hour in the morning while in bed, twice in the afternoon while standing, and then once again before I call it a night.  After lengthening I like to nap or at least remain stationary for 30 minutes.  Nothing that I have been told to do, and perhaps not even recommended...any thoughts on that?  I'm trying to hit the exercise bike one a day for 30 - 60 minutes depending on my energy level.  I have not started PT yet, I'm planning on starting this coming week.

While lying in bed, I still have a very sharp pain in my knee on occasion when I sometimes twist my leg laterally while its fully extended.  The pain level is a 10/10; it feels like my knee cap has exploded.  I can't seem to reproduce the pain by intentionally twisting my leg so I'm not sure exactly what I'm doing that is causing the pain.  I'm hoping it's related to the swelling which I had plenty of -even Dr. Monegal confirmed that I had a lot of swelling.  It's a little bit concerning since the other LL patients of Dr. Monegals that are here at MIC, have not experienced this sensation.  I would be very interested to know if anyone out there has had this same type of pain.  I now bend my knee before moving the leg laterally and that seems to prevent me from ever hitting that painful "sweet spot".  I'll have to ask the Dr. about this next time I see him; if this is a long term pain, it's definitely going to put a damper on my kiting/surfing activities.

I have been lengthening now for 5 days; the first two days I lengthened .8mm per day and the last three days I'm doing 1mm per day.  After lengthening there is minor pain in my knee, maybe a 1 or 2; I expect that is normal. As mentioned previously, my leg is still swollen but it has definitely starting returning to its normal size; I am thankful for that; it's hard to tell just how much tension the lengthening is causing on your leg muscles are when your leg is swollen.

Since I have already scheduled my flight back to have the second procedure done on my remaining femur, I am planing to continue lengthen at 1mm a day (unless my body tell me differently).  That will give me time to lengthen as much as I feel comfortable doing before the next procedure.  I can always postpone my trip if more days of consolidation are required before surgery on the second leg.   I hoping that even if I just a a week or two of consolidation before the next surgery, that it will be enough time to be able to place more weight on the leg - another topic of discussion for Dr. Monegal.

That's it for now.  I'll certain provide an update soon!







 

[helloworld]

Hello Word
It was a pleasure meeting you helloworld. It's nice to meet and chat with others that have gone through this procedure.

It was great to meet you as well as all the others!
Glad you are sleeping well! Seems like you are doing very well!

[Four Inch]

Hello everyone!

It's now day 19 since surgery update.  Dr. Monegal viewed a new set of xrays a couple of days ago and everything looked good.

I'm continuing to lengthen at 1.08 mm a day and i can feel the pressure in my knee from the lengthening, feels strange but I'm starting to see the results of lengthening.   As of today, I have lengthened 17.5mm ( that includes the 4mm that Dr. Monegal lengthened during surgery.  I was a little concerned that I was starting to feel muscle tension this early but I'm told this is normal.  I continue to stretch four times a day and ride an exercise bike for 50 minutes a day, at the moment it's requires more energy each day to get though my stretching and biking.  I'm not sure if it will continue to get more difficult each day but I suspect it will until I finish the lengthening; I have a long ways to go.

The pain in my knee that I was complaining about when I move my knee laterally seems to have gone away completely; very thankful for that.  I imagine it just took a bit of healing from the surgery to take care of it.

I do have moments of random, but mild, pain in my leg, mostly around the knee.  The pain level is not enough that I feel the need to take pain killers, however, I have them available should i need to resort to them.

I feel the need to vent a little about the Internet connection at the MIC.  It's pretty bad at certain times of day; in the evenings is seems to be the worst; I guess every one is streaming video at that time. Since I need to connect remotely to my company servers, keeping up with work has been challenging.  I did complain to the Director of the MIC and she was nice enough to send a tech here a few days later.  The tech told me that there is a line issue with the entire block; which would seem to make sense since I'm seeing 50%-60% packet loss at certain times of the day.  I think if they upgraded the measly 10MB connection to 60 or 100 MB that would help.  I'm not sure why they think 10MB is enough to share between all the residents staying here at any one time; forget about trying to connect to a SlingBox without getting completely annoyed. I'll need to find other accommodations for my next procedure or find some sort of affordable unlimited 4G LTE Internet option. I'll have to research that before my next visit.

Barcelona is a terrific city and the weather has been glorious.  I'm thankful to have a balcony, although there were no chairs or a table.  I pulled one of the living area chairs out to the balcony and was lightly reprimanded about doing that.  They brought me an wicker chair after that.  . That's it for now....back to work.

[francisackerman]

Hello Four Inch Fold! Happy to see you're doing great! Are you able to upload your latest X-rays? I'm really interested how consolidation goes with fitbone. It seems its better than other nails when looking at auron and helloworld x-rays.

Thanks - Francis

[Datum]

Aren't you posting your X-rays? I would like to see th

[Four Inch]

Here is the link to my first xray, this was two weeks after surgery.

https://www.dropbox.com/s/f5ruqeljdaef2ub/xray-1.jpg?dl=0

 

[Four Inch]

If my calculations are correct, I should have lengthened about 2.3 cm so far.  A few days ago i did start feeling enough pain in the knee area  to keep me from sleeping much.   I started a routine of walking around the apartment for about 30 minutes, then going back to bed.  Walking seems to make the pain go away.   Although I would fall back to sleep quickly,  I was only sleeping 10 - 20 minutes before the pain would wake me up again.  I would repeat my walking/sleeping cycle for most of the night.

Dr. Monegal suggested that I reduce the amount of lengthening per day just a tad to see if that helps with sleeping.  However, I think I'll continue with the lengthening 1mm per day as long as I can. At the end of next week I'll also be returning home to continue lengthening - Yahoo!

[francisackerman]

Good job Bro! But actually you should listen to your doc! And remember: When you reduce the rate, you will have a better recovery!

Your x-ray looks interesting. What is that bone piece on the side? Do you have another view from the x-ray?

Francis

[Four Inch]

Thank you Francis! Yes, perhaps you are right; I think he was just concerned about the reducing the pain rather than thinking I was lengthening to much. I'll check with the doc to be sure.

The bone piece on the side is what Dr. Monegal described as "the lucky spike".    He said it a good thing, i believe the way he described is that the "spike" will encourage the femur to heal with a greater diameter by including that fragment.  He mentioned that it's purely coincidental and he does nothing to try to produce the spike, it just happens sometimes.    He showed me several xrays where a spike was produced and the bone looks much stronger in that break area than those that were not lucky enough to get the lucky spike.

I'll be sure to check with him to be sure I'm explaining it accurately and report back if I need to retract or correct my explanation.

[francisackerman]

Ok interesting point. I don't have the experience to say anything about that. Do you have another view of your x-rays? How does the spike look from the side?
Was the spike already there on the x-rays right after the surgery?

francis

[Four Inch]

I just noticed that there is another xray on the disk that I received, I believe this is a side view.

https://www.dropbox.com/s/xclicar6osgs8l5/ScreenHunter_83%20May.%2021%2006.22.jpg?dl=0

I'm not an expert for sure, but at a different angle it does not look nearly as alarming.  From my laymen perspective,  I does seem like that particular area with the so called "lucky spike" would produce more bone making it stronger as Dr. Monegal described. The two different angles certainly make the area of the fracture look quite different, I'll question Dr. Monegal so that he can put these two different views in perspective.

I don't have copies of the xrays taken a day after surgery, but Dr. Mongegla did show them to me on his phone and made mention of the "lucky spike".

On another note, I did sleep my better last night.  The trick seems to be to elevate my upper body; I have no idea what that did; perhaps increased blood flow to my leg??? In any case, my leg did not bother me nearly as much and I slept for an hour or more at a time before having to get up and walk a bit.  I also skipped the 50 minutes of stationary biking last night but will resume that routine today.

Cheers!

[onemorefoot]

How are you doing, buddy?

[Four Inch]

Hey onemorefoot,

Doing very well  I believe.  Still lengthening but I'll be done in the next few days and will be returning to Spain in a little over a month to start work on my remaining leg.  Looking forward to gaining 2.5 inches and getting this behind me.

[onemorefoot]

Very Happy for you, continue like this.