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[Dr Monegal]

Hi all in the forum.

There are several things people is asking me to clarify.
About pricing i am not in charge of the finantial of the Clinic expenses but when you do perform 2 bones (femur and tibia) It is not 2 times 18000 because you save or/anaesthetics/hospital stay expenses of one procedure.
So when performing simultaneous femur and tibia total cost per limb is 31-32000€ approximately.

People from abroad can go home and they can be followed up in their countries. I always ask patients to send me an x-ray to check consolidation progress and they usually come at the end of the procedure for a clinical check.

Barcelona is a wide international city and most people speak English. At clínica diagonal we do receive lots of international patients and do believe that facilities are modern (Clinic Was built 2 years ago) and all patients are astonished when they visit it.
I don t like one of your comments saying people here is depressed and you might get an infection or whatever...i don t think he or she is serious saying China is a best option. He or she might have never been to china, chinese facilities or in touch with Medical and nursing staff over there. But as I always advice to you guys is not a matter of being conservative, but this is serious stuff and it s better to stay in the safe side.

Some of you wanted to contact me and you are welcome to send me an email to my personal address. For those interested to see the Clinic you can have a look at www.clinicadiagonal.com
In this sense, Fitbone manufacturers do select all their COE  (centers of excellence) so all Clinics where Fitbone technique is performed needs their approval.

Once again Thanks to all of you. This forum is very helpful not only for you guys, but Also for LL specialists to understand your concerns and thoughts.

Let me wish you all Merry Christmas and Happy new year

[Leonardo2013]

When it comes to internal lengthening, does any one know what's "easier" (pain, comfort, contracture) to do - femurs or tibias? I mean, I'd like to do only one segment for about 6cm and would like to know the pros and cons. Thank you.

[TomD]

1 femur + 1 tibia at the same time (same leg) = crazy and recovery takes much longer (that's why some doctors perform the infamous and also crazy cross lengthening: right femur + left tibia, then left femur + right tibia)

You can bet there are people on this forum (who may just read and not write anything), who think that getting a total of 20cm would be desirable and achievable without consequences. Never underestimate desire.

If you're set on doing all 4 segments, you should lengthen your tibias less than your femurs to maintain the bio-mechanical ratio of your legs, which is usually around T/F=0.8, but the doctor will give you the exact measurements of your bones and advise you on that.

I was considering your approach of doing both femurs at the same time before I read what Dr. Monegal wrote and started thinking about it. Considering all the variables in my life right now, I think his approach is the best one for me, because I can't really stay away for several months in some foreign country doing this.

1) Posters keep putting up this stuff about it being 'crazy' to do but never get around to showing the abstract or quotes from medical professionals whom suggest it is outrageous or recovery time is greater. I have done my own research to answer this question and have found nothing outside knee pain in children with deformities whom do not have well developed muscles and ligaments.

2) Peoples desires are none of my business. It not for any of us to determine what they are. We all have our opinions on how much we will lengthen but in the end its up to the doctor and patient to decide what is reasonable.

3) I am fairly certain we know how to listen to a doctor and heed his advice, but thankyou anyways.

4) The safest way of all would be the 1 segment at a time if you want to do 4 separate operations which I do not. If you do, then great. I hope it goes well for you.

5 Lengthening the tibs or femurs only then quitting throws your ratios out of whack. Unless your femur / tib relationship is way out to begin with and lengthening the lower or higher bones would correct it. I doubt that is the case with those of us seeking cosmetic surgery.

And again for the 3rd time, I appreciate the point about the fact once you do one leg, you have to hope you can also do the other leg to the same proportions. I wish the doctor would address that issue. Perhaps stats on how many folks are unable to do the second leg as long as the first.

Good luck with your surgeries. Let us know how it goes. 

[Leonardo2013]

This link shows several video clips of Clinica Diagonal:

http://www.clinicadiagonal.com/ca/tour-virtual

[ShortyMcShort]

If I were to go with Dr Monegal then I'd do all four bones(2 femurs+ 2 tibias) in two operations, no way am I going to do 4 separate surgeries.
Thats probably as mad, if not, more than doing 1 femur+ 1 tibia in a single surgery.

2 surgeries for all four bones and tank having one whole leg broken each time is my plan. Not only is doing 4 separate surgeries more time consuming but its also going to be more expensive and a lot of flights back and forth. I wouldnt do this if I were planning to do either only the tibia or femur unless I lived in Barcelona.

64,000 Euros for all 4 segments, hmmm, that is still expensive but a lot cheaper than other well known doctors. Decisions, decisions

[ShortyMcShort]

Im still not sure about internal tibias and the risk of permanent knee pain though...

Ohh and the hospital looks so clean and brand new from those vids

[TomD]

If I were to go with Dr Monegal then I'd do all four bones(2 femurs+ 2 tibias) in two operations, no way am I going to do 4 separate surgeries.
Thats probably as mad, if not, more than doing 1 femur+ 1 tibia in a single surgery.

2 surgeries for all four bones and tank having one whole leg broken each time is my plan. Not only is doing 4 separate surgeries more time consuming but its also going to be more expensive and a lot of flights back and forth. I wouldnt do this if I were planning to do either only the tibia or femur unless I lived in Barcelona.

64,000 Euros for all 4 segments, hmmm, that is still expensive but a lot cheaper than other well known doctors. Decisions, decisions

Hey shorty. Yeah he does bilaterals so he can do 2 femurs for 32euro which = $39124 US which is pretty sweet if you ask me. 

I am either doing one leg all internals then the other or bilateral femurs then cheap out on monorail in India for the tibs.

[ForcedPuberty]

 (with both the tibia and femur being lengthened at the same time on  the same leg)

your ligaments for 1 leg will not be able to keep up, you will loose range of motion for femur which is normal, but if you loose range of motion for femur you will not even be able to perform stretches for tibia.

but by all means you have been warned. do what you want. there are so many reasons why doing 1 complete leg at a time is a terrible idea.

[Leonardo2013]

Ohh and the hospital looks so clean and brand new from those vids

Yeah, and not only the hospital looks modern and clean but the female staff looks very attractive, which might be a tremendous psychological motivator for many patients.

[TomD]

(with both the tibia and femur being lengthened at the same time on  the same leg)

your ligaments for 1 leg will not be able to keep up, you will loose range of motion for femur which is normal, but if you loose range of motion for femur you will not even be able to perform stretches for tibia.

but by all means you have been warned. do what you want. there are so many reasons why doing 1 complete leg at a time is a terrible idea.

Yeah. About that. Doing two femurs or two tibias is the exact same stress to your ligaments than doing one femur and one tibia at the same time. Its two broken segments.

You systematically have refused every request to put up the abstracts from the medical profession or links to doctors opinions on this matter of one leg tibia and femur so your 'warning' is irrelevant.

We do however, have this medically trained doctor in Spain who has been doing this for a while now telling us its fine and even offers bilateral but does not recommend all 4 segments at the same time.

Surely we should reject his expert medical opinion and listen to a guy on LL hiding behind the internet using a fake name.

Seems legit. 

If anyone else has some abstracts from the medical profession to suggest doing one leg  tibia /femur at the same time has drastic consequences compared to bilateral surgery, feel free to post the links. We will definitely consider those.

[TomD]

Yeah! The female staff are young and attractive (as well as the male staff). And the meals are fantastic! 
Joking apart, it is true that the attention you receive is above and beyond the norm. Nice people over there.

I am seriously considering him for femurs, unless he is willing to offer externals for tibias at a lower price then I am considering the two stage.

39k USD for fitbone is pretty good pricing for a european doctor. 

[ShortyMcShort]

Yeah, and not only the hospital looks modern and clean but the female staff looks very attractive, which might be a tremendous psychological motivator for many patients.

You'll be in hospital for only 4 days lol

Of course they'll show all the pretty ones in the vid, Im sure there are uglier and 'meh' ones as well. The same way you dont show a cars problems or wear and tear when you're trying to sell it

[GeTs]

You'll be in hospital for only 4 days lol

Of course they'll show all the pretty ones in the vid, Im sure there are uglier and 'meh' ones as well. The same way you dont show a cars problems or wear and tear when you're trying to sell it

this 100& especially in Barcelona it seems to be quite common

[KrP1]

people talking here havent been never in Barcelona, i have been there and in clínica Diagonal, and its a really modern and big clinic . probably a lot better than most of USA

[ForcedPuberty]

bad luck TomD its not my job to baby you through the information on dumb topics.

its like me saying if you do leg lengthening you will experience pain. im not going to post medical articles proving you get pain when you do leg lengthening. its preposterous. you lack any basic knowledge on how this works if you think you can lengthen both tibia and femur at the same time and not see any bad consequences.

2nd this supposedly amazing doctor from spain is a person and no person is all knowing just because they wear a white coat, that is ludicrous, there is another thread where this doctor sais that internal tibia is a piece of cake and is a good idea, and people have nothing to worry about  because the knee pain probability is extremely low, he even states it is next to nothing in terms of probability of getting knee pain with tibia lon, and then we have massive CLINICAL STUDIES and a range of WORLD CLASS doctors saying that the complication rate for lon and knee pain is greater than 50%. it suggests that your messiah from spain does not know what he is talking about. far from knowing everything like you claim because he wears a white coat.


there are so many reasons why it is a bad idea, and just 1 is that when you lengthen femur you will loose range of motion and you will not be able to do exercises to prevent ballerina foot when you have this femur loss of range of motion. and no my doctor is none of your business but he is certainly much more qualified than this guy from spain.

[Leonardo2013]

people talking here havent been never in Barcelona, i have been there and in clínica Diagonal, and its a really modern and big clinic . probably a lot better than most of USA

There you have it. Someone who has personally been there is confirming that this is a state-of-the-art clinic. 

[Leonardo2013]

I have also been there. In fact, I am a current patient of this doctor. I have visited this wonderful and modern clinic, I have met this doctor personally, and I have already had my first procedure done. In other words, I know a little bit whereof I speak.

Musicmaker,

Great to know you're a patient of Dr Monegal. Are you having cosmetic lengthening or is it for other reasons? Are your from Spain or from other country? How do you like the clinic and the city of Barcelona? Good luck, and hope you can share with us some information. Thank you.

[ForcedPuberty]

grow up music maker, stop with your conspiracy theories.

any top doctor will tell you it is ludicrous to get both the tibia and femur lengthened. yes it can be done but it will be much harder and you will take loads longer because of the ligament issues. and you will certainly be needing a wheelchair if you get your second surgery 4 months later or even 6 months later.

there is no chance in hell you will not need to buy a wheelchair.

also in my opinion there is nothing wrong with this doctor performing surgery on both femurs at the 1 time(providing we have diaries proving he is good). but my qualms have nothing to do with the doctor but the ridiculous way he does his procedure lengthening 1 leg at a time.

 I call bull  on the issue of him freaking out about fat embolism for doing bilateral(on 2 legs), but then doesn't think fat embolism is a problem if he breaks the tibia and femur on 1 leg at the same time.

it sounds more like he is securing the patient into having to do both surgeries as they cant leave the second leg unfinished.

as for me being jealous. that is hilarious considering I already have frames on my legs.

[Dr Monegal]

Dear all

Easy there. I am here to read your opinions and concerns, not to be judged.
I don t know what kind of Medical trainning (probably none) and LL experience apart from your own you have so far, but being slightly more respectfull would be far away much better.
I don t know your sources (probably internet) but our protocols are based on hundreds of LL procedures and experiences we share with other doctors. You can ask the TOP guys (with whom i ve been trainned) and they will say exactly the same words.
 
Let me say it this way..one patient died after bilateral simultaneous femur doing intramedullary device (fortunately not one of my patients) and it s not a matter of safety, it is a matter that if surgeons are aware of this, none of them will carry on doing bilateral because of legal issues.

It is unacceptable you say a surgeon bases his protocols trying to secure a second surgery. This confirms me your ignorance (you obviously don t know me) and your malignant spirit. I have performed hundreds of procedures in dwarf kids for free and fortunately my income does not rely in this.
When i do perform cosmetic Limb lenghtening i first want to meet the patient, his family and we do talk a lot with them. I receive lots of emails and patients everyday and i do reject lots of patients. I have been working hard to make people reach their dream. This takes a lot of time to become a LL surgeon, and it is discouraging to read what you ForcedPuberty just wrote.
It is your decision but making a proper use of the forum is trying to help each other and not to throw whatever on it. You probably won t like a doctor like me... I am sure I would never operate someone like you.

You already have frames so good luck, stay with your doctor and stop Messiing with other doctors.
And don t confuse tendons with ligaments..it sounds ridiculous.

[ReadRothbard]

I don't doubt your knowledge, Dr. Monegal.

[Leonardo2013]

I agree with Dr Monegal on we all shouldn't disrespect each other. This forum should be a tool of knowledge and help and not to insult or discredit anyone without having relevant facts.

Musicmaker,

Best of luck with your procedure and hope that everything goes well for you. By the way, I'm not from Spain. Spanish is my main language but I'm from the US. What do you mean when you say "Virtual follow-up visits are performed by the doctor"? Does he do it online (virtual) or comes to your place? I went to India this year and changed my mind once there, but definitely would love to lengthen in Barcelona. 

[ForcedPuberty]

dr mongeal. no one is calling you a bad doctor in regards to surgical technique, I have no idea how well you perform surgery, I am stating that many doctors think operating on both the tibia and femur at the same time is not a good idea.

your fat embolism argument is irrelevant because your still operating on 2 limbs.

and ps. when we say ligament or tendon we are referring to soft tissue in general, please try to keep up with the slang of a forum, this is not pubmed.

all you have done is go on about some heart felt story about how you donate time to people with achondroplasia, this does not address the issue. its an argument based on emotions.

--------------------------------------------------------------------

dr mongeal I am curious about a few questions?

when you operate on the (tibia and femur simultaneously) on the 1 leg do you use internal for both segments?

and after how many months as an average do you then perform surgery on the second leg?

also how many patients have you performed this unique method of cosmetic leg lengthening (for for both tibia and femur simultaneously on the same leg). I am curious.

[TomD]

Yeah! The female staff are young and attractive (as well as the male staff). And the meals are fantastic! 
Joking apart, it is true that the attention you receive is above and beyond the norm. Nice people over there.

Hey, I watched the videos . The place really is state of the art. Question I have is ........

Someone mentioned earlier that the doctor was prepared to do LON instead of Fitbone. Would he consider LON or externals for the tibias at a reduced price ? I am shying away from fitbone tibias due to some concern about knee pain and the price.

 

[ShortyMcShort]

Hey musicmaker, will you be writing a diary?

Would love to hear about your experiences as Im also planning on going to Barcelona once I have enough for both procedures

Dont worry about ForcedPuberty and his nonsensical bs, clearly an arm chair expert and even I find his comments offensive

[Leonardo2013]

I wanted to share this interesting article talking about Fitbone in comparison to other nails, and where it says:
 
"The Fitbone system was well tolerated. There was minimal or no pain on lengthening and no case of infection. All patients achieved their lengthening goal except for two who had femoral lengthening, one of whom required an exchange to a larger nail to achieve the desired distraction length."

http://www.bjj.boneandjoint.org.uk/content/88-B/7/938.full

*Remember this article is from 2001 and since then the Fitbone nail has been improved several times.

[TomD]

Good luck on your surgery Music Maker.

Please do make a diary if you can manage it. We will be encouraged by your progress 

[TomD]

By the way, in case anyone is interested..............on this very same forum a renouned and well respected German Doctor discusses fitbone and doing one leg femur/tibia at the same time leaving the other leg intact to walk on.

http://www.limblengtheningforum.com/index.php?topic=735.0

I am satisfied that it is a medically endorsed method.

[ForcedPuberty]

well I was actually researching a completely separate issue when I came across this.

but it would appear that the warnings I gave you gys for lengthening both the tibia and femur on 1 leg(apart from my world class doctor) are also backed up by dr paley in writing.

lets go back to my statements.

I said you will not be able to lengthen both segments at the same time because of the soft tissue limitation.

now for dr paley.

Misc. on quadrilateral lengthening.
Chances are, with quadrilateral limb lengthening, you will not be able to lengthen as much as you'd like.  The reason is the intense strain your soft tissue is going under simultaneously, and for this reason, you will only be able to lengthen at max 10 cm.

in case anyone doesn't understand when you stretch 1 segment(ie tibia or femur) in the leg both segments are affected. when you do surgery on both segments at the same time you compound the soft tissue strain.

so now that it has been cleared up in writing by dr paley. all people who disagreed with me kindly jump off a large bridge into a small pool of water. so 10cm............... as a max according to dr paley.

another issue I brought up. when you lengthen both segments at the same time you loose range of motion and so you cant stretch the tibia soft tissue. this will happen to different people to different degrees. my opinion was that if you loose your range of motion in your femur then your ballerina will skyrocket.

now for dr paley......... he agrees. and states that you will have to stop lengthening entirely if this happens. so please forgive me people for warning you. I really cant believe you all couldn't work this out. its really simple.

again for lengthening both femur and tibia at the same time:

and we will be monitoring your rate of progress to see which segments need adjustments based on the complications you're incurring.  ROM is key, and if your ROM is affected, we'll have to act accordingly by reducing your lengthening (for some patients, we have stopped lengthening entirely).

so forgive me guys because I was smart enough to know that there are serious restrictions to this kind of surgery due to soft tissue restrictions. doing tibia and femur on the same leg at the same time has restrictions, paley believes the limit max is 10 cm, and there is a serious issue with range of motion being lost which could result in you to stop lengthening entirely.

in laymen's terms if people cant visualize it:
ps guys if you cant straighten your leg because of femur range of motion issues, then you can not even attempt to stretch you ballerina foot.

and if you cant do any stretching exercise's then you will develop serious issues that will take a long time to resolve. so much so to the point where paley has stopped his patients from continuing to lengthen entirely.


don't get angry at me. im just the messenger. this is paleys opinion. but there are many doctors who think lengthening 1 leg at a time has restrictions and other issues.


my recommendation is if you use this doctor, just get both femurs done at the same time, and to avoid fat embolism then have a 4 week gap in between surgeries which is how all other doctors seem to avoid fat embolism.

[TomD]

well I was actually researching a completely separate issue when I came across this.

but it would appear that the warnings I gave you gys for lengthening both the tibia and femur on 1 leg(apart from my world class doctor) are also backed up by dr paley in writing.

lets go back to my statements.

I said you will not be able to lengthen both segments at the same time because of the soft tissue limitation.

now for dr paley.
in case anyone doesn't understand when you stretch 1 segment(ie tibia or femur) in the leg both segments are affected. when you do surgery on both segments at the same time you compound the soft tissue strain.

so now that it has been cleared up in writing by dr paley. all people who disagreed with me kindly jump off a large bridge into a small pool of water. so 10cm............... as a max according to dr paley.

another issue I brought up. when you lengthen both segments at the same time you loose range of motion and so you cant stretch the tibia soft tissue. this will happen to different people to different degrees. my opinion was that if you loose your range of motion in your femur then your ballerina will skyrocket.

now for dr paley......... he agrees. and states that you will have to stop lengthening entirely if this happens. so please forgive me people for warning you. I really cant believe you all couldn't work this out. its really simple.

again for lengthening both femur and tibia at the same time:

so forgive me guys because I was smart enough to know that there are serious restrictions to this kind of surgery due to soft tissue restrictions. doing tibia and femur on the same leg at the same time has restrictions, paley believes the limit max is 10 cm, and there is a serious issue with range of motion being lost which could result in you to stop lengthening entirely.

in laymen's terms if people cant visualize it:
ps guys if you cant straighten your leg because of femur range of motion issues, then you can not even attempt to stretch you ballerina foot.

and if you cant do any stretching exercise's then you will develop serious issues that will take a long time to resolve. so much so to the point where paley has stopped his patients from continuing to lengthen entirely.


don't get angry at me. im just the messenger. this is paleys opinion. but there are many doctors who think lengthening 1 leg at a time has restrictions and other issues.


my recommendation is if you use this doctor, just get both femurs done at the same time, and to avoid fat embolism then have a 4 week gap in between surgeries which is how all other doctors seem to avoid fat embolism.

You put information that is again without any links for anyone to objectively verify so it is again irrelevant. Put up the link to Paley so we can see for ourselves what he wrote . Secondly, your  quote from paley is for quadrilateral which does not apply. This doctor wants two stages, not all in one stage.

The ROM is a legit concern but this Spanish Doctor states for himself that its not an issue and the link I provided was a direct interview Daemon had with the German doctor who also recommends the 1 leg surgery.

Most importantly, you keep stating and restating that 'your recommendation is' and your 'advice' is. I dont mean to be rude but at this stage we need to be a little more blunt.

You are a layman. A guy who is not a medical professional. In fact, you havent even had LL surgery so you cant even give us that experience.

Yet you still sit here and tell us your musings like you are some kind of expert in the field. In my opinion you have some delusional grandiosity issue .

Nobody gives a flying @#$#@ what your 'advice' is regarding LL surgery. I dont know how to make it any clearer to you.

You have repeatedly refused to put up any links backing up any of your posts, I would like to ask you to kindly stop acting like some authority on the medical theory on here. You have no medical advice to give anyone so stop. Get a grip on yourself.

If you have links from Paley stating that doing 1 leg (not all 4 legs or some other spin you try to put on it) is a bad idea, just put up the link and shut up. We can view Paleys thoughts for ourselves.

Thank you

[ForcedPuberty]

it was from this forumn.

http://www.limblengtheningforum.com/index.php?topic=237.msg6876#msg6876

also it does not matter if it is quadrilateral lengthening. dr paley was stating how each leg will behave, and have a max limit of 10 cm.
doing 1 leg at a time will not change the soft tissue strain per leg. that is simply a ridiculous statement. you don't even understand basic physiology if you believe those statements.

and actually you are incorrect in saying I have no medical training. but no I am not a dr. but very far from a laymen.

[Leonardo2013]

ForcedP,

When are you going for surgery, so we can start reading your diary?