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[tiggy]

Hi tiggy

sorry to hear that you have problems that cause you to slow the pace.  As I mentioned above, most of problems are due to lengthening/extending.  I think your case is likely the same, since you do feel better after slowing down the pace.  It is a sort of tug of war between contraction forces by your tissues (muscles, tendons, and nerves) and extension forces by lengthening and physical therapy. It is a losing game in the end but everyone is different so it is the matter of when it happens to people.  Unfortunately, it seems to happen too early for you.  You just have to go through it by doing enough PT and adjusting lengthening rate.  I do want to tell you that nerves or muscles seem to adjust themselves at some point, meaning that they may react at the beginning but adjust themselves a little bit to face their new environments.  For example, I had a burning sensation in my right leg around knee at the beginning which made me so hard to stretch the knee.  Later on (I don't remember exactly when, perhaps around 5-6 weeks lengthening), my right leg got better but left leg started to feel the same burning feeling during stretching.  Anyhow, I just managed to finish all my journey.  You can do it too!

Good luck!

Thanks for your comment Ghostfish,
This LL journey is quite something I must say! I am more optimistic now that I have these symptoms at least a little more under control. I realize I am only at around 3 cm, meaning I'm not even half way done so  tightness is going to get intense the more I lengthen, though I guess the benefit of going slow for now is that tightness should be more manageable. But again I may need to speed things up in the future, thus it's  hard to predict how things will go with this surgery. But at least for now the process is a little easier since I no longer feel like someone is inserting knives into my tibias. At the end of the day, the most important thing is to reach that final goal irrespective of the lengthening pace. Im hopeful that I can do this successfully just like you and others on here. Let's see!! Thank you for your words of encouragement.

[TheAlchemist]

Hey Tiggy,

How's everything going? Would be great to hear about your progress.

[tiggy]

Hey man,

I haven't updated the forum because everything is pretty much the same. I'm still on 200 mg gabapentin 3 times a day. My symptoms have improved in terms of burning and the pins and needles sensation. Before I couldn't even put my full weight on my right leg but now I can do so. But again all those symptoms are still there, numbness is there though burning is much less. These days I try avoiding contact with fabric because it's very painful. The left leg is doing well but now I'm also having numbness in my left shins. However that numbness is not permanent and disappears once I shake off the leg. I hope it stays that way instead of becoming permanent, then again I'm already used to the process given the headache wth my right leg, so come what may.

When my right leg symptoms improved I began to lengthen my right leg 3 times a day instead of alternating between 2 times one day and 3 times the next. However when I saw dr R this week he told me to continue alternating between 2 and 3 times on the right leg because the callus formation is slower than it is in the left leg. I'm upset about the slow callus growth on the right leg because it prevents me from lengthening faster. My plan is to put more weight on my right leg until I see him again in 3 weeks. Hopefully there will be more progress in few weeks. Dr R didn't raise alarms about the slow callus formation given I'm only about 7 weeks post op but I am personally concerned and quite irritated.

Anyway that's about it as far as updates are concerned. In terms of mm lengthened, I'm at around 35mm on the right and almost 38 on the left. I can't wait to hit 50mm. By my calculations, I should be at around 50mm next time I see him. From there on I will have 30mm left and mentally that should be an easier target to overcome. Anyway I won't jump ahead, let's see what happens. Thanks for your post!

[Ghostfish]

Hi tiggy

I am glad that things are a little getting better.  As I told you, I also had that sort of sensations and hated touching fabric on the bed.  They will be gone 1-2 months after you stop lengthening.
Regarding callus, as you know, you have to walk and stand as much as possible in order to stimulate bone growth.  And Stretch and stretch!
Take care!!

[tiggy]

Hi tiggy

I am glad that things are a little getting better.  As I told you, I also had that sort of sensations and hated touching fabric on the bed.  They will be gone 1-2 months after you stop lengthening.
Regarding callus, as you know, you have to walk and stand as much as possible in order to stimulate bone growth.  And Stretch and stretch!
Take care!!

Yea truthfullly I haven't been doing enough walking lately. I did more in the beginning but then after the right leg troubles appeared I slowed my pace. Sometimes even now I'd be reading a book for example and time would pass by and I'd forget that I need to get up and walk. Starting today though I'm going to walk with most weight on the right leg until legs can't take it anymore! The curious thing is that even with less walking in the past few weeks, the callus formation is doing well on the left leg, it's the right that's lagging behind. So this makes me think that perhaps the walking amount itself wasn't an issue, it was mainly that I didn't put enough weight on the right leg when doing so. But either way I'm going to increase both.

It's interesting you brought up stretching. Does more stretching promote callus formation? I haven't heard of this before.

[TheAlchemist]

Thanks Tiggy. Glad to hear that the numbness and burning is improving. I'm amazed at your progress and coming up to 5 cm soon. That's a huge milestone.

[Ghostfish]

It's interesting you brought up stretching. Does more stretching promote callus formation? I haven't heard of this before.

No, I didn't say stretching for callus formation   I said that because stretch will help your burning or numbness. 
Regarding discrepancy in bone growth, it is probably due to the way you walk or stand since you put more weight on the left leg.  In any case, don't worry.  As long as there is a decent amount of callus formation, after stopping lengthening, bones grow much better!

Take care!

[tiggy]

Thanks for the encouraging words guys, I really appreciate them. The 5cm mark is still a few weeks away but I'm hoping that time goes  by quickly.

I wanted to take a moment and quickly discuss how I've been coping mentally with being cooped up at home for the past 7 weeks. This process has been challenging in that sense, especially because I know I have at least another 8-12 weeks left until I finish lengthening (assuming no other complications). Today the weather was nice and I went out in the yard to soak up some sun. I felt like a caveman seeing the sun for the first time lol. But it felt quite nice because I felt more normal. Staying at home for so long without interacting with the outside world can make you feel abnormal and so I can't wait to reintegrate into my life, but with the new height! I've been fortunate enough to have my  family by my side and that has helped a great deal because at least I get to interact with them. It would be wise for future llers to try and get fresh air as much as possible. I wasn't doing that myself unless I went out to see dr R but I now plan to come out as much as possible and soak up the sun for as long as tolerated. I say tolerated because my right leg starts giving me a headache after being put in the same position for long and so I must maneuver my body into the position that alleviates the pain for me. And of course it is easier to do this in bed than sitting on a chair outside.

As to the new height, I have almost reached the half way mark and I feel a significant difference in height already. I'm taller than my sister and my mom by a good margin. My cousin was also taller than me prior to surgery and now I'm almost at her height (she is around 5'5). It makes me feel quite excited that in another couple of months I will be even taller than them and I can't wait to experience that additional height. Moreover, with shoes on it would feel even better! Keeping this image of yourself in mind is really a powerful motivator, and as you see results in height, that motivation, at least for me, intensifies.

Anyway that's about it for my long update. I plan to update the forum again once I reach the 50mm mark. Stay tuned and be well!

[InFullStryde]

You're on your way, Tiggy.  The process is tough as you mention and I can assure you it's worth every single moment of sacrifice.   We'll keep it going strong!

[tiggy]

You're on your way, Tiggy.  The process is tough as you mention and I can assure you it's worth every single moment of sacrifice.   We'll keep it going strong!

Absolutely IFS! We must fight through the hardships along the way to reach that dream goal. In fact I was thinking of you just a couple of days ago when I was admiring my almost 2 inch height in front of the mirror lol and I realized how truly life changing this surgery was for you. Going from 5'1 to 5'4 is such a tremendous accomplishment. I started  from 5'3 and I'm hovering at almost 5'5 and already notice such a big difference even though I haven't even reached that 2 inch mark yet. In other words, this surgery was worth it for you and I'm glad you feel that way brother! Be well.

[tiggy]

Hey guys,

A quick update: today I've reached the half way mark on the left leg. I am at exactly 40mm but the right leg will get there in a few days. In other news, I am able to walk without any support whatsoever. I do carry the walker with me, literally I lift up the walker and walk with it or push it ahead of me just so that it is near if I need it. I walk quite fast too and It feels awesome being able to walk completely on my own. My speed of walking actually surprised me. The only thing is that I walk like a penguin, swaying side to side lol. I am sure that will improve with time as I continue walking.

I have not done any PT from outside sources, meaning I do PT on my own and do not have anyone come in to my home. Neither do I frequent a PT clinic. I am still undecided whether I will even go to one once I am done with lengthening but so far I am leaning against doing so. I think I can continue working at this on my own, and quite frankly I enjoy doing so without 3rd sources present. But again this will depend on my progress and I will assess the situation as I go along. I will update you guys again once I reach that sweet 50mm mark! Feel free to send questions my way. Cheers!

[TheAlchemist]

Hey guys,

A quick update: today I've reached the half way mark on the left leg. I am at exactly 40mm but the right leg will get there in a few days. In other news, I am able to walk without any support whatsoever. I do carry the walker with me, literally I lift up the walker and walk with it or push it ahead of me just so that it is near if I need it. I walk quite fast too and It feels awesome being able to walk completely on my own. My speed of walking actually surprised me. The only thing is that I walk like a penguin, swaying side to side lol. I am sure that will improve with time as I continue walking.

I have not done any PT from outside sources, meaning I do PT on my own and do not have anyone come in to my home. Neither do I frequent a PT clinic. I am still undecided whether I will even go to one once I am done with lengthening but so far I am leaning against doing so. I think I can continue working at this on my own, and quite frankly I enjoy doing so without 3rd sources present. But again this will depend on my progress and I will assess the situation as I go along. I will update you guys again once I reach that sweet 50mm mark! Feel free to send questions my way. Cheers!

Congrats on reaching the halfway point on the left leg, huge milestone!

Sounds like you are pretty mobile and taking a lot of steps walking, which seems like a good source of PT itself. Apart from doing PT, how do you spend the majority of your time? Laying in bed, standing, or sitting? I'm particularly interested in your ability to sit down for long periods of time, as I'm hoping I can use the idle time towards hobbies and side projects that require I sit down (working on laptop, playing piano, etc.)

Thanks!

[tiggy]

Congrats on reaching the halfway point on the left leg, huge milestone!

Sounds like you are pretty mobile and taking a lot of steps walking, which seems like a good source of PT itself. Apart from doing PT, how do you spend the majority of your time? Laying in bed, standing, or sitting? I'm particularly interested in your ability to sit down for long periods of time, as I'm hoping I can use the idle time towards hobbies and side projects that require I sit down (working on laptop, playing piano, etc.)

Thanks!

Hey there, thanks. As of 2 days ago, both legs are past the half way mark!

As to your question, I spend the majority of my time either in bed or in a reclining chair. I sit down to have dinner at the table but that is the only time you can find me sitting in a chair. The reason for that is when I sit for over 5 or so minutes, my legs start to burn and I need to lift them up. The numbness I described above is now permanently present on my left leg, coupled with slight burning sensation. So now I must deal with both legs and switch them around in a sitting position. You can easily work on your computer while in bed or reclining. How long you can play piano would depend on your particular situation. Just because I have numbness issues doesn't mean you will also. Perhaps other veterans can chime in on how well they could tolerate sitting up straight.

When not doing PT, I read (when I can focus) or watch a movie/show. Other times I just spend time with family when everyone is home from work. Sometimes time goes by quickly but other times it's quite slow. Hopefully the remaining half of this trip passes by faster! Let me know if you need to know anything else. 

[Ghostfish]

Hey there, thanks. As of 2 days ago, both legs are past the half way mark!

As to your question, I spend the majority of my time either in bed or in a reclining chair. I sit down to have dinner at the table but that is the only time you can find me sitting in a chair. The reason for that is when I sit for over 5 or so minutes, my legs start to burn and I need to lift them up. The numbness I described above is now permanently present on my left leg, coupled with slight burning sensation. So now I must deal with both legs and switch them around in a sitting position. You can easily work on your computer while in bed or reclining. How long you can play piano would depend on your particular situation. Just because I have numbness issues doesn't mean you will also. Perhaps other veterans can chime in on how well they could tolerate sitting up straight.

When not doing PT, I read (when I can focus) or watch a movie/show. Other times I just spend time with family when everyone is home from work. Sometimes time goes by quickly but other times it's quite slow. Hopefully the remaining half of this trip passes by faster! Let me know if you need to know anything else.

Hi tiggy
I am sorry to hear that you are struggling with those numbness and burning sensation.  But I strongly recommend you to stand or to walk as much as possible.  Spending too much time on bed or even a reclining chair is not really good for lengthening and callus formation.  Thanks to Stryde, you can also walk.  So make your legs move more!

[tiggy]

Hi tiggy
I am sorry to hear that you are struggling with those numbness and burning sensation.  But I strongly recommend you to stand or to walk as much as possible.  Spending too much time on bed or even a reclining chair is not really good for lengthening and callus formation.  Thanks to Stryde, you can also walk.  So make your legs move more!

Hey Ghostfish,
Thanks for looking out for me! I do walk, I just didn't list it thinking it was self explanatory. I walk around the house unassisted and do so as much as I can. Some days I walk more, others less. I'm going to start counting the number of steps I take each day, though I don't know how many steps would be normal during this phase of lengthening, perhaps you know? I'm determined to see more callus in my next x ray, especially in my right leg!

[TheAlchemist]

Hey Tiggy, how is it going?

[tiggy]

Hey Tiggy, how is it going?

Hey Alchemist (cool name btw, I've wanted to complement you for a while lol)

Things are going well, same old. I was waiting to hit 5cm to update the forum, but might as well do it now. Left leg Will hit 4.8 cm Today and the right 4.5. I have had permanent numbness in my left shin as well, accompanied with numbness and some prickly feelings from time to time (usually when I stand on the leg for too long). The right leg is also numb, though doesn't really burn anymore. It's funny how during this process nothing stays the same and the discomfort switches from one leg to the other. Just when you think you have one of your legs where you want it, just then the other leg starts to act up.

I'm still lengthening the left 3 times a day and the right only 2. I am due for a follow up this coming week with dr. R and I hope the callus formation has improved on the right enough to allow at least 3 sessions a day. I have been putting a lot of weight on my right leg so I hope it pays off.

In terms of tightness and flexibility, 10 being totally normal as pre-op and 1 being super tight, my right leg is at about a 9 while the left is about an 8. This is to be expected since I'm lengthening slightly faster on the left leg.

In other news, I am walking unassisted 99% of the time whether at home or outside. I actually went out to eat with my sister on Friday evening. I walked unassisted from the car to the restaurant and back, and even drove home (though the right leg does start to hurt when driving after about 10min). Last night too, I went out with my family and again was unassisted the entire time, though there were some steps to climb so I used my sister as support for that part since the legs aren't strong enough yet. I'm sure I could climb on my own but I don't want to put unnecessary pressure on my legs and potentially damage something. I must say it felt good to be outside, sit at a restaurant and feel normal. The height boost is certainly noticeable and I can't wait to reach the 3 inch mark!

Lastly, I've attempted to stand up from my bed unassisted about a week ago, and while that was certainly challenging, I succeeded. Since then I haven't tried again because I don't want to put too much pressure on my legs but perhaps I'll do so again soon. However, my bed is not as low as a couch for example, and so I haven't attempted to stand up from a couch unassisted and I know that will be much more difficult. Perhaps I'll give it a try sometime soon.

That's pretty much it as far as updates go. I still stretch 3 times a day (instead of 4) because stretches take longer for me now. This is because when in the same position, my left leg starts to burn and I must change position for about a minute or 2 to let the feeling pass. Then I go back to finishing the exercise. And I repeat this about every 3-5 min because of the burning. So you can see how this adds to the length of time it takes to complete the stretching routine. I think stretching at least 3 times is fine at this point, especially because I'm lengthening the left leg 3 times instead of 4. Plus I walk quite a lot too so for now I think this is sufficient. Once I get more tight (and hopefully if my left leg burning subsides) I can ramp up the stretching to 4 times a day. We will see how things go and how tight I feel in the coming weeks.

If you have questions, throw them my way. Otherwise I will update again at the end of next week once I see him for a follow up. Thanks for reading.

[TheAlchemist]

Nice Tiggy! Awesome progress- must feel amazing to be well past the halfway mark and moving closer and closer day by day.

I read earlier that you stopped taking pain meds. Do you think that if you continued with them they would help manage the burn and allow you to keep at it with 4 sessions/day? Also, how is your sleep going?

[tiggy]

Nice Tiggy! Awesome progress- must feel amazing to be well past the halfway mark and moving closer and closer day by day.

I read earlier that you stopped taking pain meds. Do you think that if you continued with them they would help manage the burn and allow you to keep at it with 4 sessions/day? Also, how is your sleep going?

Yes it absolutely does feel great to know I'm getting closer to finish line. I think once the half way mark is done, the other half is easier to get past, mentally at least.

Good question re the pain meds. In My experience the pain meds don't help with the pins and needles sensation I had in the past with my right leg, and that sensation was also accompanied with the burning sensation. I found that none of those symptoms improved. Besides dr R tries to get his patients off pain meds asap and I've tried to get off them in similar fashion. I also think he had me lengthen the left 3 times because I was lengthening the right only twice. I'm of the opinion that he lowered my left leg so that the discrepancy between them doesn't get too large. But again this is my assumption because I didn't actually ask why I didn't lengthen 4 times on the left leg. During my last follow up, my left leg was doing fine but I'm sure that now after I tell him my left leg is numb and burns, it's unlikely that he will have me do 4 sessions unless my callus is forming extremely fast. My hope is that at least he increases my right leg sessions if the callus is forming better.

As to sleep, actually my sleep is worse now than it was the first couple of weeks after surgery. I've tried laying off Tylenol pm and sleeping naturally but I find that I keep tossing from side to side and the discomfort doesn't allow me to sleep. It's as if my body is too awake to sleep without it. Even when I fall asleep, I turn at night and that wakes me up and then I can no longer sleep. I hate relying on any type of pills in general, especially to fall asleep. I know that Tylenol pm isn't addictive but I'm still concerned that taking it won't lead to anything good. At the same time I know this is a difficult time and I need to get past the lengthening phase, and so I'm conflicted. So to answer your question, I can only sleep well when I take it. Without it I'm half awake all night. I hope this improves soon because I hate taking pills!

[tiggy]

Hey everyone,

Latest update after my follow up with Dr R:

I'm 10 weeks post op, left leg is at around 54mm, the right is at 50mm as of today. The X-rays don't show much change in my right leg in terms of callus formation, so things are moving slow. Dr R hasn't raised any alarms yet even though I am personally concerned. If you recall, before my follow up I was lengthening the left leg 3 times a day and the right was alternating between 2 and 3 lengthening sessions. During my visit I expressed to him that my left leg is now experiencing almost the same symptoms as my right leg in the past, albeit not as intense. The symptoms in my right leg have calmed down and that remains true still. However as Ive described before, the left shin had burning and numbness, accompanied by occasional sharp needle pain if standing on that leg for too long. As a result of these symptoms, he decided to drop the left leg lengthening sessions to alternating between 2 and 3 times, just like we did with the right leg when I experienced those symptoms. I am sure this will greatly alleviate the current discomfort with my left shin. Dr R was going to leave the right leg at the same pace (alternating), however because of my concern for the slow callus formation, I thought it would be a better idea to drop the right leg by a session, meaning I will be lengthening only  2 times a day without alternating. He agreed to allow me to do this since the callus formation is slow. I believe this is the best route for me at this time because rushing to lengthen  while leaving a big gap of unhealed space in my legs is certainly not what I want. First and foremost I prioritize callus formation and I hope that lowering to twice a day will give it more time to fill in. By my calculations, I will be done with my right leg at the end of September which puts me at 4 months of right leg lengthening. That is far from ideal but like I said, safety first. I really don't understand why the callus is forming so slow. I'm starting to think that maybe Tylenol pm may play a part. I didn't bring this up to him but will do so on my next visit. Just to be safe, I've cut my use of Tylenol pm and I am now training myself to sleep without it.

In other news, I've displayed my bravery for walking unassisted to dr R lol. He was very surprised that I was walking unassisted pretty much full time but he cautioned me against doing this again because of the right leg having little callus. While my weight is within the nail's specifications for full weight baring, he still advised that I continue walking with some type of device to not put full weight on the nails. This just takes me back to my previous point, meaning it makes no sense to lengthen quickly when your bone isn't forming fast enough because you will continue walking with an assisted device (for safety reasons) even if you are capable to walk on your own. Safety is priority.

So I think that's about it for updates. What remains now is slow lengthening until I hit those 8cms. I will be seeing him again in 3 weeks and will update again regarding the callus formation at that time. Feel free to send questions and be well.

[TheAlchemist]

Thanks for the update Tiggy! In the grand scheme of things 4 months / September isn't that long relative to being taller for the rest of your life, rooting for you man!

In terms of slow callus forming, were there any indications as to the cause other than the possibility of it being Tylenol PM? I know you mentioned you were 30, but could it be lack of movement or not enough movement? Genetics/ ethnicity? Low Vitamin D levels?

[tiggy]

Thanks for the update Tiggy! In the grand scheme of things 4 months / September isn't that long relative to being taller for the rest of your life, rooting for you man!

In terms of slow callus forming, were there any indications as to the cause other than the possibility of it being Tylenol PM? I know you mentioned you were 30, but could it be lack of movement or not enough movement? Genetics/ ethnicity? Low Vitamin D levels?

Hey Alchemist,

Thanks for the support. Actually no there were no indications. We went over the medications and vitamins  I was taking (I mentioned everything but Tylenol pm since I forgot) including the doses of vitamin D and all seemed in order according to him. Im taking over 5000 ious of vitamin d per day. I think that's the norm. I'm Caucasian for what it's worth and in terms of walking, I walk a lot and stretch regularly. As I've said before, I was walking unassisted and putting full weight on the legs to hopefully promote growth but to no avail it seems. Perhaps I just simply need to give it time since my bones are healing slowly. Let's hope that the further downgrade in lengthening sessions helps on that front. In fact I asked dr R whether continuing to lengthen will increase the likelihood of bones not fusing and he said no. He said the condition of the healing hasn't worsened since my last visit, and so he took that as a good sign and I think that is why he said it's fine to proceed. Only time will tell though

[BeYourBest]

Hey Tiggy,

Sorry to hear about your callus issue. I hope it will get better with time.

Can I ask if you smoked before surgery? If so, for how long, how often, how long before surgery did you stop etc?

Keep a positive mindset, listen to your body and doctor's advice and all should be well. I'm glad you're taking the lengthening slowly as safety is extremely important as you've highlighted.

Routing for you my man!

[tiggy]

Hey Tiggy,

Sorry to hear about your callus issue. I hope it will get better with time.

Can I ask if you smoked before surgery? If so, for how long, how often, how long before surgery did you stop etc?

Keep a positive mindset, listen to your body and doctor's advice and all should be well. I'm glad you're taking the lengthening slowly as safety is extremely important as you've highlighted.

Routing for you my man!

Hey BYB,

No I have never smoked in my life. There are also no other prior illnesses/conditions that I have had which could adversely impact bone growth. It is all just luck, you could never predict how your body is going to respond to this or any other surgery even if you do everything right. I think I just need more time than others in my age group to get past the callus formation stage. Thanks for your post.

[cena]

Hi Tiggy can you post your latest x-rays?

[tiggy]

Hi Tiggy can you post your latest x-rays?

Hey, I haven't taken a photo of the X-rays but will try to do so during my next visit.

[BeYourBest]

Hey BYB,

No I have never smoked in my life. There are also no other prior illnesses/conditions that I have had which could adversely impact bone growth. It is all just luck, you could never predict how your body is going to respond to this or any other surgery even if you do everything right. I think I just need more time than others in my age group to get past the callus formation stage. Thanks for your post.

That's fair - thanks for your response. I hope everything gets better very soon!

[tiggy]

That's fair - thanks for your response. I hope everything gets better very soon!

Thanks, I'm hoping for more of the same. The important thing is to stay positive because depressing over something we can't change won't make things easier, though I know this is easier said than done, but I'm trying!

[cena]

Is Dr. Rozbruch somewhat disconnected with patients tiggy? I get that impression from reading another girl's diary here who had issues.

He is obviously one of the best in the business but he somewhat seems aloof about CLL: no clear price estimate, emails full of punctuation mistakes, no designated PT after surgery, does not distract nail after surgery to test if it works, etc.

I am sure you will be fine tiggy! Keep your spirits up!

[tiggy]

Is Dr. Rozbruch somewhat disconnected with patients tiggy? I get that impression from reading another girl's diary here who had issues.

He is obviously one of the best in the business but he somewhat seems aloof about CLL: no clear price estimate, emails full of punctuation mistakes, no designated PT after surgery, does not distract nail after surgery to test if it works, etc.

I am sure you will be fine tiggy! Keep your spirits up!

Hey Cena, interesting question. I would say he is aloof in a sense that he seems to approach the surgery lightly. When he is in the room with you he doesn't rush or anything, but I feel as though he doesn't ask enough questions and let's you tell him if there are things that bother you. Another reason why I feel as though he is aloof, for example during my last visit he told me (as he usually does) that I have 2 options, I can continue or stop. He made it sound as if 2 inches is a big enough gain and I should be happy with it. Don't get me wrong, 2 inches is a big deal and I am happy with it but given that I've spent over $100k to have surgery with him, I'd like him to appreciate that fact and encourage his patients to go forward if it is safe for them to do so. I explicitly asked him whether it is safe for me to proceed, to which he replied yes. So I was a little confused as to why he would even bring up stopping when he knows my goal is to go to the end unless I am unable to do so for whatever reason. Mind you, my flexibility is at 130-135 degrees knee bend, which is quite great. As his patient i would like him to appreciate not only the monetary cost but also the pain and suffering we go through for this surgery just to gain 3 inches. So I personally felt as though he takes all these factors lightly. Perhaps to him $100k is pocket change but for most other people it's  a significant sum, including myself.

Yes  punctuation is also quite horrible and he keeps his emails very brief. I understand that in the interests of time he may be rushed to get emails out especially since very few people who email him actually end up scheduling a procedure. However given that you spend like what $400 or $600 (I forgot) to see him, it would be nice to write more than a few words in his replies.

There are other reasons why I'm not completely happy with him, including that after surgery I actually didn't see him until 2 days post op. However I do feel confident in his expertise and I do like that he doesn't have a salesman type of mentality when it comes to this surgery. But there must be a balance I think.

In terms of him checking the nail during surgery, I never asked him whether he does so but I do believe that IFS in his diary stated that he does distract the nail after surgery to make sure it works. I just assumed that this was the case and never actually asked him myself. So I can't comment one way or another to the validity of that statement.

[cena]

Thanks for the reply.

Dr. Paley presented a video about CLL and in that he mentions that he tests the nails after surgery and goes on to say that Dr. Rozbruch doesn't test them and that he (Paley) gets all the bad nails. Don't know if it was a joke.