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[Leonardo2013]

Well, I just want to give my two cents. From what I've been communicating with this doctor I understand that other than Fat Embolism (which by the way should not be taken lightly 'cause one could die from it) he prefers to do one leg first (whether is tibia or femur or both) and leave the other leg "fine" so that the patient have more free mobility and comfort and can go back to his activities. Hope this helps. As said before, the best thing is to visit him in Barcelona.

[galaxy1]

The added mobility stops embolism in it's tracks so speak..
Beyond my ll spending budget anyhow, and not really sure how I feel about having all internals with additional surgeries later when the internals will have to all be removed eventualy.

[ShortyMcShort]

One leg = 1 tibia and 1 femur at the same time in one surgery, just to be clear is my understanding

So it helps with fat embolism, but what about the cons?
If you did one leg then you really wouldnt know how your proportions will be or when you should stop as its only on one leg, you'd need 12,13,14 cm lifts to make up the difference or what ever length it is you choose to lengthen. Me Im after 13cm in total, so hopeful of 6.5cm on each. Do they even make 13 cm lifts?

So the whole purpose of this 2 stage surgery is so that you still have one good leg but what happens when the second leg is operated on which is supposedly about 4-5 months after, you'd still end up on a wheelchair nonetheless, no? I doubt the first operated leg will be strong enough to stand on at this stage and be you 'good' leg so you'd still end up on a wheelchair anyway. Am I correct in saying this?

And going home after one month and continue lengthening at home is a bad idea imo, yes it saves money but you really should stay for the whole lengthening process, at least thats what Im going to do. I like how this saves time doing all four(2 tibias + 2 femurs), the first operation should  feel good since you'll still have one perfectly good leg albeit you'll need lifts of equal lengthening amount or there abouts to make up the difference. But on the second surgery I dont think there'll be much of a difference since the first leg is still recovering

Also regarding internal tibias with Fitbone, do you guys think its a good idea considering knee pain?

[ShortyMcShort]

So just to clarify and I hope Dr Monegal can clear this for everyone

66,000 Euros or there abouts is for all 4 bones? As in 2 tibias and 2 femurs?

[KrP1]

Why is so dificult for people to understand that? It is really clear in the first page

[ReadRothbard]

So just to clarify and I hope Dr Monegal can clear this for everyone

66,000 Euros or there abouts is for all 4 bones? As in 2 tibias and 2 femurs?

Yes, that's correct.

In all honesty, the more I think about it, the more I'm starting to consider Dr. Monegal over Dr. Guichet. Yes, you have to lengthen one leg at a time, but you are also simultaneously lengthening the tibia and femur on the operated leg--if you pay for the 61,200 euro package, that is. This means one can gain a total of 14 cm in barely more than six months! Adding in the extra mobility one gets through having only one broken leg instead of two makes me think that this doctor could be a pretty sweet deal.

[TomD]

One leg = 1 tibia and 1 femur at the same time in one surgery, just to be clear is my understanding

So it helps with fat embolism, but what about the cons?
If you did one leg then you really wouldnt know how your proportions will be or when you should stop as its only on one leg, you'd need 12,13,14 cm lifts to make up the difference or what ever length it is you choose to lengthen. Me Im after 13cm in total, so hopeful of 6.5cm on each. Do they even make 13 cm lifts?

So the whole purpose of this 2 stage surgery is so that you still have one good leg but what happens when the second leg is operated on which is supposedly about 4-5 months after, you'd still end up on a wheelchair nonetheless, no?
Also regarding internal tibias with Fitbone, do you guys think its a good idea considering knee pain?

You raise valid point that I did not take lightly. I did some research on it.

1) I would need 6 inch lifts. I even went and made my own and walked around my house . Its bizarre at first but definitely not the end of the world. Sure beats sitting in a wheel chair.

2) At first it was bizarre to me. Hopping around on one leg with this ever growing second leg dangling on the side. However I thought the process through and it does make sense.

-get lifts to increase the good leg while the other one heals. You would only need crutches and eventually when you get good enough at it , probably 1 crutch or a cane.

-I plan to do the right leg first. This is because it will pay off later on. The first operation I will have to get used to the lifts and the crutches so I will be in tough for the first month or so. However, this idea I am racing back to do the second one right away is a non starter. I would only go 3 or 4 months after consolidation of the right leg. This way I have full use of the right leg .

-With a healthy right leg we can drive an automatic vehicle because there is no clutch. So our freedom is enhanced even further.

The ability to walk around the entire time during both procedures makes it a no brainer to me. I am certain this doctor will be able to offer us the prosthesis necessary to make the other foot the same length so it seems reasonable to me. The 66k euros is pricy but in my opinion worth it. Its a european doctor with no visa hassles.

3) The abstracts regarding knee pain I have read are limited to patients with deformaties who do not have well muscled legs and joints. I have been told its rare with cosmetic patients with well defined lmbs . 

[ShortyMcShort]

So the cons of the 2 stage procedure is that we'd need an equal amount of lengthening shoe lift on one leg at all times, even when you're in the house and dont want to be wearing shoes you'd have to, otherwise its a 13cm difference, well atleast for me since thats my goal.

Im also starting to rethink my journey, originally I was going to go to India and do Precice 2. Dr Monegal is a lot pricier but its Spain, who wouldnt want to lengthen in Spain 

66,000 Euros + accommodation, food, helper(?), physio
Does anyone know how much he charges for physio? I feel that physio and accomodation are going to bring the price up a lot more

So is it 66,000 Euros or 61,200 Euros? I mean thats a huge difference

[Leonardo2013]

ShortyMcShort,

He told me 20 - 40 Euros per session for in-home (they come to your hotel) physical therapy. But he said he could also appoint a PT Center in Barcelona if patient wishes to do outpatient instead. I hope this helps.

[ReadRothbard]

It's 61,200 plus accommodations, food, entertainment, etc. it lists the price on the first page.

Also, I'm pretty sure he makes the lifts for you. It would be awfully strange if he didn't.

[ShortyMcShort]

ShortyMcShort,

He told me 20 - 40 Euros per session for in-home (they come to your hotel) physical therapy. But he said he could also appoint a PT Center in Barcelona if patient wishes to do outpatient instead. I hope this helps.

Thanks for that, could you tell me more about the things you guys talked about? No personal info needed of course
Pm me if you want to keep it private?

How did you find Dr Monegal in your exchanges?

[TomD]

So the cons of the 2 stage procedure is that we'd need an equal amount of lengthening shoe lift on one leg at all times, even when you're in the house and dont want to be wearing shoes you'd have to, otherwise its a 13cm difference, well atleast for me since thats my goal.

Im also starting to rethink my journey, originally I was going to go to India and do Precice 2. Dr Monegal is a lot pricier but its Spain, who wouldnt want to lengthen in Spain 

66,000 Euros + accommodation, food, helper(?), physio
Does anyone know how much he charges for physio? I feel that physio and accomodation are going to bring the price up a lot more

So is it 66,000 Euros or 61,200 Euros? I mean thats a huge difference

I think its fine. I am doing 14 cm and I realize its going to look funny for a while but its not that long. Dont forget it takes months to get to 14cm . Then when you do the other leg it decreases.

If the leg is strong enough after 3 months consolidating then that is all you will have at the maximum 14cm.

I am now going to scout around and see if other doctors will consider this approach. See what they have to say about an internal femur and external tibia to cut down on costs.

[Moubgf]

Spain is a sneaky country now with its current economic meltdown. Everybody there will have cloud of depression over them and i think that will infect your stay at their facility. Id rather go to china. Always proffesional and calm.

[TomD]

I just thought of something that I think is worth mentioning.

You dont need to walk around with 14 inch lifts all the time .Not even part of the time. You can only put the lift on when you want to exercise the broken leg.

Other than that, walk on your good leg with the crutches and simply bend your leg at the knee pushing your tibia backwards and have something to hold it up in a sling. Then you can go to work or whatnot without this ridiculous lift in your shoe. You can tell folks you busted your leg and cant put any weight on it. They could never figure out its longer that the other one in that position.

That is what I would do if I wasn't self employed.

[ShortyMcShort]

Reading the first page again, so do we lengthen both the tibias and femurs at the same time or is it one at a time after the first bone(either tibia or femur) is done lengthening?

So is it 3 and a half months to do 6.5cm tibia and 6.5cm femur for a total of 13cms at the same time?
Or is it 3 and a half months to do 6.5cm on say the tibia, consolidate and do the femur 4 months after?

[TomD]

Hey Shorty.

I know its confusing and I sure wish the Doc would come and clarify some things. I think we can all agree none of us want 4 separate surgeries . We want 2 surgeries. Either 2 bilateral or 2 legs one at a time.

I wish he would clarify the prices for 1 leg.(31k?) I think he said 8cm for femurs and 6 for tibs.

I also believe he indicated right after surgery we will be on the crutches putting 20kg weight on the broken leg. Then we keep exercising the leg during the 3 months distraction. I would prefer and hook up with a doc right here in Tampa who can do the xrays but I will drive down to Miami where Paley is if I have to.

I would leave Spain as soon as the doc cleared me to fly. Come home do my phsyio here and go to Paley once a month for the xrays.

Then, 3 months after the consolidation (6 months from surgery) We should be able to be fully weight bearing, easily able to walk on the new leg with crutches without the other leg.

So after 6 months we can return to spain and do the whole thing over again. 62k euros is pricy but for internals that offer 1 leg at a time in a western hospital with no visa hassles?

Easy. Half of us in the US speak Spanish anyways. 

[Leonardo2013]

ShortyMcShort,

Well, since Spanish is my primary language, I've been e-mailing this doctor in such a language. Most of the info I gathered I already shared it. As I repeat he seems to be a very conservative doctor and has his own approach for CLL. I personally think that it's a big plus that he doesn't charge extra if unplanned treatment is required and neither for removing the nails 1.5 years later. And to clarify about the price, he charges 18K Euros for one segment, so for instance if you want to do your left leg (tibia + femur together) it will be 36k Euros. Barcelona is a very large metropolitan and tourist destination, so to my understanding English should be widely spoken there. Hope this helps.

[TomD]

Leo

Didnt he give different prices if you do 2 limbs at the same time? Can you ask the doctor to come here and clarify two main points for us

He can do tibia and femur at the same time 1 leg

price of one tibia and one femur.

Thanks.

p.s. Will he let us go home within a week of the surgery if we have a doctor here to take the xrays during the lengthening?

[Leonardo2013]

Implant price is 13700€ for unilateral And 11000€ for bilateral lengthenning.
Price is set by the Company.
Then you have to add Medical expenses end Clinic expenses.

For a unilateral procedure it is approximately 19500-20000€
For bilateral 2 femur or 2 tibia 32000-34000€

[ShortyMcShort]

36k Euros for tibia and femurs, so its 72,000 Euros for all 4 bones?

61,200 Euros I'd do it, 72,000 Euros is kind of pushing it over. Thats a difference of $16,000 for me when converted

[Dingo]

This is what I got from him:

TWO STAGE LENGTHENING:

1 leg (femur + tibia) + the other leg later (femur + tibia) = 64-65000 euros

1 femur + the other femur later = 34-35000 euros

1 tibia + the other tibia later = 34-35000 euros

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

ONE STAGE LENGTHENING

2 femurs in a single operation = 32000-33000 euros

2 tibias in a single operation = 32000-33000 euros


He doesn't recommend the one stage lengthening (both femurs or both tibias at the same time) because of the increased risk of fat embolism, but it doesn't mean he won't do it if you really want it. It's just that doing one leg at a time also has added advantages since you won't be stuck in a wheelchair for 2-3 months minimum. So it's a no brainer for him to recommend a two stage lengthening even though it adds to the cost because of the two separate surgeries to insert the nails, since it increases safety and mobility for the patient.

I'm seriously considering this doctor and I don't plan on using lifts at all. I'll just walk around in crutches with my operated leg growing longer than the other and keep it from toughing the ground like I had an accident or something. I'll stretch it and exercise it when I'm in bed or on a sofa following the doctor's physio instructions. Then I'll come back when the doctor tells me the operated leg is strong enough to bear my weight and that it's time to repeat the procedure with the other leg.

You'll be "out of order" for an aggregate total of around 4 weeks during the entire two stage procedure, not  like in the one stage procedure where you'll spend several months in a wheelchair and then need to start to "learn" how to walk again with crutches because you've lost your muscle strength in both your legs.

I can't really imagine myself in a wheelchair for several months (going to the toilet, washing myself, shaving, climbing stairs, not being able to do the things I want and go where I want, always depending on someone else), when I can choose not to. How do you take the bus in a wheelchair? 

Yes, it will take longer, but in my opinion this is a much better approach.

[Leonardo2013]

I can't really imagine myself in a wheelchair for several months (going to the toilet, washing myself, shaving, climbing stairs, not being able to do the things I want and go where I want, always depending on someone else), when I can choose not to. How do you take the bus in a wheelchair? 

Yes, it will take longer, but in my opinion this is a much better approach.

Dingo, I agree with you on this one. Having freedom of mobility is a plus to drive (with your good leg) and be independent during the treatment. Let us know if you happen to go with Dr Monegal 'cause I'm also considering him.

[ReadRothbard]

Not to mention the psychological benefits of having a functional leg.

[Leo]

TomB

I'm 99% sure that the price is about €66k for all 4 bones. Half if you do 2 bones.

Leo

[TomD]

This is what I got from him:

TWO STAGE LENGTHENING:

1 leg (femur + tibia) + the other leg later (femur + tibia) = 64-65000 euros

1 femur + the other femur later = 34-35000 euros

1 tibia + the other tibia later = 34-35000 euros

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

ONE STAGE LENGTHENING

2 femurs in a single operation = 32000-33000 euros

2 tibias in a single operation = 32000-33000 euros




I'm seriously considering this doctor and I don't plan on using lifts at all. I'll just walk around in crutches with my operated leg growing longer than the other and keep it from toughing the ground like I had an accident or something. I'll stretch it and exercise it when I'm in bed or on a sofa following the doctor's physio instructions. Then I'll come back when the doctor tells me the operated leg is strong enough to bear my weight and that it's time to repeat the procedure with the other leg.

Hey Dingo

From what I read , the doctor wants you to put 20% weight bearing on the operated leg right after surgery . I feel the bone will grow faster and we can avoid ballerina if we walk around on it with crutches.

I am getting the lifts, but again only when I am at home during the evening or feel like going for a short walk. Going to work I would stick my broken leg in a sling or some other apparatus and just use the good leg and crutches.

I am for doing the right leg first. This is because during the first surgery we dont know how to deal with the crutches, pain, and our hobbled leg. So we probably wont be doing much driving anyways.

Then what that is done and we are used to the side effects of the surgery, our right leg will be full weight bearing when we do the left leg. Now we can drive a vehicle and with our experience with the crutches we should be able to be a lot more mobile .

Just my .02

[Dingo]

There is one thing that we must be aware of and follow the instructions of the doctor very closely when doing the two stage procedure, and that is to keep the distracted length within reasonable limits.

This advice is valid for all limb lengthening procedures but in a two stage procedure it takes on a new dimension.

Why? Because most of the times, people want to do large amounts of lengthening to get a bang for their buck and then at one point one of their legs stops them from going any further due to muscle or tendon pain, ballerina, etc. So they stop lengthening and end up far from their crazy initial goal of 10cm per segment but with both legs the same length.

When doing a two stage procedure, one must really be conservative about the amount of lengthening per segment (<6cm), because you might be able to do say 8cm with your right leg during the first stage of lengthening, but then get insane amounts of pain after reaching 6cm on your left leg at the second stage, disabling you from going any further and making you end up with a 2cm discrepancy. You really don't know which leg will be the first to say "NO MORE!", when your initial goal is unrealistic.

So stick with a conservative amount of lengthening and follow your doctors instructions very carefully.

[ForcedPuberty]

exactly dingo.

there are many reasons why this 1 leg(femur + tibia) at a time time is such a bad idea.

[TomD]

There is one thing that we must be aware of and follow the instructions of the doctor very closely when doing the two stage procedure, and that is to keep the distracted length within reasonable limits.

This advice is valid for all limb lengthening procedures but in a two stage procedure it takes on a new dimension.

Why? Because most of the times, people want to do large amounts of lengthening to get a bang for their buck and then at one point one of their legs stops them from going any further due to muscle or tendon pain, ballerina, etc. So they stop lengthening and end up far from their crazy initial goal of 10cm per segment but with both legs the same length.

When doing a two stage procedure, one must really be conservative about the amount of lengthening per segment (<6cm), because you might be able to do say 8cm with your right leg during the first stage of lengthening, but then get insane amounts of pain after reaching 6cm on your left leg at the second stage, disabling you from going any further and making you end up with a 2cm discrepancy. You really don't know which leg will be the first to say "NO MORE!", when your initial goal is unrealistic.

So stick with a conservative amount of lengthening and follow your doctors instructions very carefully.

This is a very good point. I did put some thought into it but the amount of patients who have to stop short of 5cm is very rare.

Perhaps the doctor can shed some light on this because no matter how cautious you are, if you lengthen your first leg any amount, you have to lengthen the other one the same.

I suppose they would have to stop the lengthening, let the bone consolidate as you tendons and muscle repair, then rebreak it and finish the job. That would be a major hassle but not the end of the world as you already have the internal devices still in there.

[Dingo]

there are many reasons why this 1 leg(femur + tibia) at a time time is such a bad idea.

I agree with you that doing 1 leg (femur+tibia) in a single surgery is probably a bad idea because you'll really overstretch it. It's too much for one leg to have two segments being lengthened at the same time and your recovery will last forever.

But I think there are many advantages in doing a two stage lengthening, provided you do only femurs or only tibias, stay below the recommended limits (<6cm femurs; <5cm tibias), and follow your doctor's instructions very carefully.

Advantages:

- only one segment is "broken", so you have less overall pain and your recovery is faster because your body is "concentrated" on healing that segment

- you can move around in crutches and still do most things you used to do before surgery, which is better for your recovery and your psychology

- if you study at a university, you can do 1 femur when classes are over in June/July, and then do the other femur during the Christmas/New Year break 5 or 6 months later

- if you work, just take 2 weeks off and do 1 femur (down time after surgery is about 1 week), then take another break some months later and do the other one (without leaving your job)

I'm planning to do 1 femur then the other femur a few months later, and I won't go beyond the recommended limits so there shouldn't be a problem.

I just wanted to warn people with crazy plans of doing unreasonable amounts of lengthening beyond the recommended limits.

[TomD]

I agree with you that doing 1 leg (femur+tibia) in a single surgery is probably a bad idea because you'll really overstretch it. It's too much for one leg to have two segments being lengthened at the same time and your recovery will last forever.

But I think there are many advantages in doing a two stage lengthening, provided you do only femurs or only tibias, stay below the recommended limits (<6cm femurs; <5cm tibias), and follow your doctor's instructions very carefully.

Advantages:

- only one segment is "broken", so you have less overall pain and your recovery is faster because your body is "concentrated" on healing that segment

- you can move around in crutches and still do most things you used to do before surgery, which is better for your recovery and your psychology

- if you study at a university, you can do 1 femur when classes are over in June/July, and then do the other femur during the Christmas/New Year break 5 or 6 months later

- if you work, just take 2 weeks off and do 1 femur (down time after surgery is about 1 week), then take another break some months later and do the other one (without leaving your job)

I'm planning to do 1 femur then the other femur a few months later, and I won't go beyond the recommended limits so there shouldn't be a problem.

I just wanted to warn people with crazy plans of doing unreasonable amounts of lengthening beyond the recommended limits.

1)When you do both tibias or both femurs,you are imparting the same amount of stress on your body as one femur and one tibia. Its two broken segments either way.

Doing one segment at a time isnt what I would do. I would do 2 segments at a time , if its bilateral or this approach.

I am not a fan of only doing femurs or tibs and then quitting. If I do the LL it will be all 4 segments in 2 surgeries.

2)This doctor advised us the 'safe' limit is 6cm for femurs and 6.0 for tibias on page 1 . I dont think anyone on this thread has planned on doing much more than this. Maybe 1 cm more. I didnt read anyone wanting anything crazy like 10cm segments.

If he caps us at 6 and 6 , I am ok with it. The only thing that I agree with is your assertion that a catastrophe can strike and you have to stop the other leg before it catches up to the first leg.

And in that unfortunate case , like I stated above, you would need to let that segment heal for a while then rebreak it to lengthen again.

I understand that you do not like this approach. I appreciate your thoughts on it. 

[Dingo]

1)When you do both tibias or both femurs,you are imparting the same amount of stress on your body as one femur and one tibia. Its two broken segments either way.

I was talking about the difference between the one stage procedure and the two stage procedure:

1 femur + other femur later = 1 tibia + other tibia later = 1 "broken" segment at a time = less stress and trauma and shorter recovery

2 femurs at the same time = 2 tibias at the same time = 2 "broken" segments at the same time = more stress and trauma and longer recovery due to loss of muscle strength

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)

I didnt read anyone wanting anything crazy like 10cm segments.

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.

2)This doctor advised us the 'safe' limit is 6cm for femurs and 6.0 for tibias on page 1 .

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.