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[elanxr]

I'm currently undecided about which doctor/method to go with. Here are the pros/cons I deduce after scouring this forum. Experts on this group: please add your comments - would really appreciate it.

Becker/Betz

Good
- Clean bone cut, good surgical technical
- Great rehab center
- Betzbone easier to click than G-nail (is this true?)
- Patients generally walking faster on crutches with less swelling compared to Dr. G's patients (based on my reading of diaries)

Bad
- More expensive than Dr. G, and cost of therapy/lodging after surgery quite high (was recently quoted by Betz Institute up to 300 euros/day)
- Slow follow up care after leaving facility and returning home

Dr. Giotikas

Good
- Cheaper surgery price, cheaper cost of living in Athens
- Physical therapy, meds, crutches, wheelchair all included in price
- Living in big city with lots of activities outside of hospital
- Can stay in nice hotel like Novotel with buffet, gym, rooftop pool at reasonable cost

Bad
- Dr. G rotates his time between Athens and London, so might not be available when needed
- Harder to click G-nail comparied to Betzbone
- More incidences of complications with Dr. G (misalignment, one death, higher rates of swelling and muscle stiffness and more pain - perhaps due to G-nail vs betzbone?)
- Stingy with painkillers

Comments, corrections welcome please.

[RealLostSoul]

I think it would be very unreasonable and unethical for anyone but yourself to decide which Dr to go to so I refrain from recommending anything.

Few things I could correct on that list: I think clicking is exactly the same. The hospital and rehab in Freiburg is anything but “ran down”

Also you will see once you go home during lengthening it is a huge upswing in mental health. If you understood what to do and not to do I think it’s doable at home imo.

[SpeedDialer]

I'm currently undecided about which doctor/method to go with. Here are the pros/cons I deduce after scouring this forum. Experts on this group. please add your comments - would really appreciate it. I'd like to have the surgery around March based on the responses from others.

Becker/Betz

Good
- Clean bone cut, good surgical technical
- Great physical therapy facilities
- Betzbone easier to click than G-nail
- Patients generally walking faster on crutches with less swelling compared to Dr. G's patients (based on my reading of diaries)

Bad
- More expensive than Dr. G, and therapy/lodging after surgery quite high (up to 300 euros/day)
- Hospital a bit run down

Dr. Giotikas

Good
- Cheaper surgery price, cheaper cost of living in Athens
- Physical therapy, meds, crutches, wheelchair all included in price
- Living in big city with lots of activities outside of hospital
- Can stay in nice hotel like Novotel with buffet, gym, rooftop pool at reasonable cost

Bad
- Dr. G rotates his time between Athens and London, so might not be available when needed
- Harder to click G-nail comparied to Betzbone
- More incidences of complications with Dr. G (misalignment, one death, higher rates of swelling and muscle stiffness and more pain - perhaps due to G-nail vs betzbone?)
- Stingy with painkillers

Comments, corrections welcome please.

Recently there may have been a compartment syndrome issue in Athens for a tibia patient but evidently it was dealt with swiftly and he turned out fine I heard. I'll probably bump into that patient some time next week. I'm still trying to learn about what this "compartment syndrome" complication is / what causes it/ how a patient can recognize it in time

[tallmen]

Does anyone know the pricing for betz's Elke's House?

[elanxr]

This is the information Nora from BetzInstitute sent me:

"Please find below the different packages in the case you decide to stay longer at the Rehab (Mooswaldclinic) centre which is connected to a Hotel (Dorint).

Version 1:
Clinic deluxe room/ full board clinic/ 3x 20min therapy/day/ training area €300/day

Variant 2:
Clinic deluxe room/ full board clinic/ 2x 20min therapy/day/ training area €251/day

Variant 3:
Hotel classic room/ full board hotel/ training area €211/day

Variant 4:
Hotel classic room/ full board hotel/ 2x 20min therapy/day/ training area €311/day"

[RealLostSoul]

Recently there may have been a compartment syndrome issue in Athens for a tibia patient but evidently it was dealt with swiftly and he turned out fine I heard. I'll probably bump into that patient some time next week. I'm still trying to learn about what this "compartment syndrome" complication is / what causes it/ how a patient can recognize it in time

Compartment syndrome = pressure in the fascia of the muscle from trauma and swelling basically bottlenecking blood supply. Patients notices it in time haha. It’s extreme pain that’s not even diminishable with pain medication.

This is the information Nora from BetzInstitute sent me:

"Please find below the different packages in the case you decide to stay longer at the Rehab (Mooswaldclinic) centre which is connected to a Hotel (Dorint).

Version 1:
Clinic deluxe room/ full board clinic/ 3x 20min therapy/day/ training area €300/day

Variant 2:
Clinic deluxe room/ full board clinic/ 2x 20min therapy/day/ training area €251/day

Variant 3:
Hotel classic room/ full board hotel/ training area €211/day

Variant 4:
Hotel classic room/ full board hotel/ 2x 20min therapy/day/ training area €311/day"

Mooswaldclinic =/= Elke’s house. Mooswald is an orthopedic rehab center (there are a lot of elderly patients with hip and knee replacement, stuff like that)

[SpeedDialer]

G-nail stands for Guichet nail



Becker/Betz


- "Betzbone easier to click than G-nail (is this true?)"
-> Although I can't prove it, I believe it may be true based on my experiences with gnail + the official video of Betz's patient doing clicks + videos from Dr. Guichet (the G in Gnail is from guichet in France, not giotikas if anyone is curious)

- "Patients generally walking faster on crutches with less swelling compared to Dr. G's patients (based on my reading of diaries)"
-> You might be right, but I am not sure if there is a significant difference for g-nail femurs vs betzbone femurs. Alot of patients seemed to be able to use crutches walking for g-nail pretty early. Confusingly, there are two Dr. G's (Guichet from France, the g-nail inventor, and Giotikas in Athens who did not invent g-nail)

Its good to see some of Guichet's (the French doctor, not the Athens one) official youtube videos to get a sense for how quickly you can walk

I would say most likely the hospital with Becker/Betz is nicer than the Athens hospital( Athens one feels as if its a bit old but neat and clean inside for the most part)

Dr. Giotikas

Bad
- I disagree with this statement: "More incidences of complications with Dr. G (misalignment, one death, higher rates of swelling and muscle stiffness and more pain - perhaps due to G-nail vs betzbone?)"

-> I actually doubt that Dr. Giotikas has more complications than Betz. I doubt this because Betz patients lengthen more on average than Giotikas patients. So probably Betz patients have more complications, but its not a fair comparison since Betz patients tend to go for more length. And also more Betz patients lengthen far away from Betz, which I think also adds other variables. Unsure if we could ever get a fair comparison without the data. However, I will say that for some people, the first big click for the gnail on the right leg is a b___ and I wonder if its related to more patients I've talked to having problems with their right leg compared to left leg. I don't know, though, its just a hypothesis. That being said, my pain for clicking with gnail is less than at the start and is now rarely above 3/10 pain and is usually much less. But some patients are getting more pain than this from clicking still.


- Stingy with painkillers
-> Sorta. In Athens, you get alot at the start and then you sort have to keep asking the physical therapists for more painkillers when you run out and they give you a pack or so at a time, but they generally say yes.

You are right that alot of Athens is run down but if you stay in Novotel you won't have to deal with that

[elanxr]

After some thinking, I've come to the conclusion that the full IT band release and 1cm distraction performed by Dr. Giotikas during surgery is what's causing the initial difficulties post-surgery for the first few days (compared to soft IT release and no(?) distraction by Dr. Betz/Becker). So it's not the surgical skill or nail that causing the difference in initial outcomes. I'm ready to stand corrected if mistaken.

[RealLostSoul]

After some thinking, I've come to the conclusion that the full IT band release and 1cm distraction performed by Dr. Giotikas during surgery is what's causing the initial difficulties post-surgery for the first few days (compared to soft IT release and no(?) distraction by Dr. Betz/Becker). So it's not the surgical skill or nail that causing the difference in initial outcomes. I'm ready to stand corrected if mistaken.

They also did 0.5cm initial gap for me. Some other patients here had more. We lengthen 1 mm / day until like about 3cm while Giotikas does 1.5mm. More radical IT band release indeed makes it tougher to walk in the beginning that’s why they are on a walker first while we were on crutches from day 1.

[SpeedDialer]

After some thinking, I've come to the conclusion that the full IT band release and 1cm distraction performed by Dr. Giotikas during surgery is what's causing the initial difficulties post-surgery for the first few days (compared to soft IT release and no(?) distraction by Dr. Betz/Becker). So it's not the surgical skill or nail that causing the difference in initial outcomes. I'm ready to stand corrected if mistaken.

I'm a giotikas patient doing gnail. The PT's tried to teach me to use crutches I forget (maybe 2nd day? after the surgery can't remember) but unlike most of the other patients I felt too unstable doing it. Maybe I suck, dunno? I feel like most of the gnail patients used the walker for at least 1 week, some 2 before switching to crutches. I was behind schedule and didn't use the crutches until 2 weeks ish

So in the interview with cyborg4life, Giotikas claimed he does 0.8 cm during the surgery instead of 1cm (anyone can correct me on this? I did not really pay attention to the total length early on)

At the start, I did 15 clicks per day = 1mm per day

Then during what he called the "inflammation phase" shortly afterwards we did 21 clicks per day, which I believe is 1.4 clicks per day (? 21/15) for I forget 1 or 2 weeks which might be the origin of the 1.5 the reallostsoul mentioned?

And then for me personally at least and a few other patients, a few weeks later Giotikas lowered my clicks down to 10 clicks per day (about 0.66 mm per day I believe based on 10/15)

Based on what I see in Athens on who is suffering the most during PT, it looks like the guys with lower flexibility/even pre-existing mild health conditions are suffering alot and having issues. I've talked to almost all the patients during PT and that's my impression. Whereas there is a 23 year old with great flexibility who is.. doing great, I can't believe how good of range of motion he is still getting when I see it. And ozboy39 seemed to do pretty well when he was here. I think I'm doing a bit worse than ozboy but I have less nerve pain than him I think. The guy who got compartment syndrome did quadrilateral, I'm not exactly sure what happened. There's a precise femur patient and honestly his walking on the antigravity treadmill looks not that great compared to most of the gnail femur patients

You're correct that the IT band surgery at the start causes significant short term pain/difficulty. But recently a guy who I believe (?) did not do IT band surgery (he went with a diff doctor originally) came to Athens to get an IT band surgery because he is no longer able to close his legs (his legs are always in a V shape). So I'm pretty happy I got the IT band surgery done.

Anyone wanna correct me?

[SpeedDialer]

I'll say this: if I had infinite time and money, I think I would have gone with Betz (germany) or Dr. Jean-Marc Guichet (milan Italy and also France locations available I think), then stayed in their area, and then paid extra if need be to get physio 5+ days a week (I think Paley does 5-6 times per week) + would pay for a location with a pool/hydrotherapy. If I had infinite time and money, I think I woulda done 7-8 femurs with Betz or guichet, waited a year, then come back did 5cm on tibia, then either stop or continue or rebreak (depending on x-rays/range of motion) to do 2-2.5 more on tibia by rebreak.

I do think that someone with good enough flexibility / training can sometimes get more than 8cm in one shot on one segment and fully recover -- Betz/guichet have seen 8+ cm in one shot accomplished with them all the time, so it must happen regularly enough. I'm not sure this is a good idea for someone with below average flexibility like me though?   

I'm doing a more budget option of G-nail Giotikas + wait a year + Gnail removal with Giotikas + precise tibias with Giotikas + not sure where to go for precise nail removal, aiming for 7 femurs, 5 tibias if I can do it

With Giotikas in Athens, you get physio 4 times per week, which is fine I think probably if you are dedicated

Novotel in Athens does have a roof pool (which I heard feels good to walk in) but its extremely shallow (less than the length of your legs I believe, not sure) and there are unfortunately stairs to reach it (the elevator stops at the floor right before the roof) but I hear that you can get two strong guys who work at the hotel to lift your body up the stairs if you are on a wheelchair from precise

[RealLostSoul]

@SpeedDialer

It‘s different approaches from different Drs.
Dr G does 1.5mm/day in the beginning then goes down to 0.66 quickly. We did 1mm/day then slowly go down to 0.78mm and then depending on your case down to 0.72 or even 0.67 at about 6cm.
The reason why Paley gives PT so often is probably because you are stretched there. In my case stretching is my “home work“ that I vigorously need to do. PT (2x/week -> definitely enough in my case) is only there to help guide you and give strong massages to help loosen up. Also check on your gait and help you with that.
In my opinion this approach is not for everyone because if you aren’t disciplined you are screwed. Maybe to reduce non-compliance Paley wants the stretching to be done by his team.
However, if you do as they tell you; stretch very hard, 4h a day (for 0.75mm/day) everyday without any days off you will have a great result. from what I have seen here with other patients: outcome directly correlates to the amount of stretching the patients did. LL = stretch or quit.

No It band release is bad but I do feel like I can stretch my sides well. I had wide legs at 3cm but they are totally gone now and I can easily close my legs and even have more range of motion while stretching now than before. Maybe it’s just the TFL that I stretched, I don’t know. But the studies that I have seen which showed that “IT band is almost unstretchable” stretched the IT band of corpses. Imo this can’t be one to one directly compared to our situation. We are a living changing organism which has the unique stimulus of elongation. Like I said I am not sure but I did stretch away my wide legs (during lengthening).

I highly disagree with flexibility pre surgery being important at all. I was very inflexible but caught up because I stretched a lot. It’s not so much about what you start with but how serious you take it once it is important (= when the bone gets longer and soft tissues needs to catch up). Before you have normal flexibility for normal functionality. Everyone does. Then you lengthen and everyone, even the most flexible people on earth will become too tight. If you are super flexible maybe it starts at 4cm. For most it starts at 3cm. For me it started at 2.5 or something.
Doesn’t really matter though because then it’s important to stretch hard. If you don’t stretch your preflexibility won’t safe you.
Paley also confirmed this and said stretching pre surgery is only good for getting into it.


I think both Doctors are good options but I would highly recommend everyone to get a weightbearing option. The clicking in the beginning is definitely worth it compared to the alternative.

[Growth.journey]

Either is fine but personally if you have the money I’d suggest betz because
A) weight bearing from day 1
b) less time overseas before returning home
C) 20+ years of experience

[hippo60]

I highly disagree with flexibility pre surgery being important at all. I was very inflexible but caught up because I stretched a lot.

Both Rozbruch and Paley say stretching pre-surgery isn't needed but something doesn't add up for me. Sure - you have to stretch a lot during the lengthening part, but I just don't see how it's contradicting. Paley literally said stretching only have short term impact on flexibility, but that's obviously not the case post surgery, right? So I find it a bit confusing...

[RealLostSoul]

Both Rozbruch and Paley say stretching pre-surgery isn't needed but something doesn't add up for me. Sure - you have to stretch a lot during the lengthening part, but I just don't see how it's contradicting. Paley literally said stretching only have short term impact on flexibility, but that's obviously not the case post surgery, right? So I find it a bit confusing...

It‘s because the lengthening is a unique situation for the body to adapt to. If you stretch before as a normal person the muscle gets looser but doesn‘t have to adapt to a different length, so it goes back to normal after a few hours. When the bone is elongated you need to stretch to tear up the muscle so it can adapt to the new length.
The more flexible you are pre surgery the later the tightness hits you but it‘s minimal. My doctor told me very very flexible people may get it at 4cm while the average person gets it at 3cm.
It really isn‘t necessary tbh. You have the first few cm where you should be conditioned into stretching (before you are getting tight) anyways.

[hippo60]

It‘s because the lengthening is a unique situation for the body to adapt to. If you stretch before as a normal person the muscle gets looser but doesn‘t have to adapt to a different length, so it goes back to normal after a few hours. When the bone is elongated you need to stretch to tear up the muscle so it can adapt to the new length.
The more flexible you are pre surgery the later the tightness hits you but it‘s minimal. My doctor told me very very flexible people may get it at 4cm while the average person gets it at 3cm.
It really isn‘t necessary tbh. You have the first few cm where you should be conditioned into stretching (before you are getting tight) anyways.

Yeah that was my gut feeling - you mostly delay when you get that tightness, but it's coming either way. Not entirely sure I'm following "When the bone is elongated you need to stretch to tear up the muscle so it can adapt to the new length.".

[RealLostSoul]

Yeah that was my gut feeling - you mostly delay when you get that tightness, but it's coming either way. Not entirely sure I'm following "When the bone is elongated you need to stretch to tear up the muscle so it can adapt to the new length.".

Wait that‘s the most important fact of LL, let me rephrase it.
The bone gets longer -> soft tissue needs to get longer too. to do this you stretch the muscle so it lengthens. When you hold it in stretch for at least 2 min the myofilaments get “torn up” and the muscle longer so to speak and in lengthening patients they then adapt to the new length instead of adapting back to the origin length.

[hippo60]

Wait that‘s the most important fact of LL, let me rephrase it.
The bone gets longer -> soft tissue needs to get longer too. to do this you stretch the muscle so it lengthens. When you hold it in stretch for at least 2 min the myofilaments get “torn up” and the muscle longer so to speak and in lengthening patients they then adapt to the new length instead of adapting back to the origin length.

Yeah I understand, but the process of muscle tearing & recovering happens regardless of LL, right? That's what threw me off a bit...

[RealLostSoul]

Yeah I understand, but the process of muscle tearing & recovering happens regardless of LL, right? That's what threw me off a bit...

Not really for elongation, no. I mean yea you can change it even as a normal person with very hard work (yoga eg does it too) but it’s nothing on the scale compared to what the muscle needs to accomplish for LL

[hippo60]

Not really for elongation, no. I mean yea you can change it even as a normal person with very hard work (yoga eg does it too) but it’s nothing on the scale compared to what the muscle needs to accomplish for LL

Yeah 100% - it's similar just way more extreme

[SpeedDialer]

Yeah I sort of wonder now, I agree now that stretching alot before the surgery has very limited effects. Maybe the best training is something like this?

Before LL:

- lose weight if you can unless you're already thin
- no vaping/smoking obviously
- stop wearing high lifts if you're doing that, I think its better to give the joints some rest before the surgery, maybe look into those running shoes with big cushion air/foam boosts if you want extra height
- maybe some light stretching at least the month before to get in the habit / familiar with the muscles you'll be stretching
- if someone is a couch potato, I think some light walking might be good just to have healthier legs and joints before the surgery

Basically I agree with them now - I think pre stretching is not that amazing, but I still think losing weight is great and its convenient + easier on your wrists for alot of movements not to be too heavy (also weight is more important for non-weight bearing nails like precise but less important for gnail/betzbone etc). I still thinking losing weight overall helps the experience be more comfortable, like if you have fat thighs + you add the swelling after surgery -> they will be really big and it will be uncomfortable

Whether you should stop working out certain muscles (because the PT in Athens told me if you have really big muscular thighs, it can make clicking for femurs more painful)..- I'm not sure-- especially for tibias, it sort of feels like stretching calves with things like slant boards is already almost kind of working them out

After the surgery:

- stretch, stretch, stretch + w/e else they tell you
- I think Dr. Robins at the Paley institute even recommends not working the first month (ex; for people who work remotely) at all and just focusing on your physiotherapy?
- stretch, stretch, stretch

Something like this? What do you guys think?

[Taller90]

Yeah I sort of wonder now, I agree now that stretching alot before the surgery has very limited effects. Maybe the best training is something like this?

Before LL:

- lose weight if you can unless you're already thin
- no vaping/smoking obviously
- stop wearing high lifts if you're doing that, I think its better to give the joints some rest before the surgery, maybe look into those running shoes with big cushion air/foam boosts if you want extra height
- maybe some light stretching at least the month before to get in the habit / familiar with the muscles you'll be stretching
- if someone is a couch potato, I think some light walking might be good just to have healthier legs and joints before the surgery

Basically I agree with them now - I think pre stretching is not that amazing, but I still think losing weight is great and its convenient + easier on your wrists for alot of movements not to be too heavy (also weight is more important for non-weight bearing nails like precise but less important for gnail/betzbone etc). I still thinking losing weight overall helps the experience be more comfortable, like if you have fat thighs + you add the swelling after surgery -> they will be really big and it will be uncomfortable

Whether you should stop working out certain muscles (because the PT in Athens told me if you have really big muscular thighs, it can make clicking for femurs more painful)..- I'm not sure-- especially for tibias, it sort of feels like stretching calves with things like slant boards is already almost kind of working them out

After the surgery:

- stretch, stretch, stretch + w/e else they tell you
- I think Dr. Robins at the Paley institute even recommends not working the first month (ex; for people who work remotely) at all and just focusing on your physiotherapy?
- stretch, stretch, stretch

Something like this? What do you guys think?

I would agree and add that walking or at least any kind of exercising your legs after surgery is key for a quick recovery. Stretching is only 50%-70% and the minimum that your muscles are not going to freak out when they get stretched. At least, thats what I have noticed that I got a very positive impact from every exercise like aqua walking, limb press, adductor/abductor press, sauna, jacuzzi etc.) in which I have pushed my blood circulation in the muscles. I strongly believe that this was the key for my very quick and good recovery. Well now I had weight-bearing nails but in a limited way you ca do the same with a non-weight bearing nail as well. It is also positive for the stretching, if you warm-up your muscles so that you will benefit in this regard as well.

[SpeedDialer]

limb press, adductor/abductor press, sauna, jacuzzi etc

Yeah this sounds like a good idea, I think I might do this when I get back to the United States after I finish my stay in Athens. I think the PT place in Athen has a uh what's it called, that quad only exercise machine (you go from bent knee to straight knee), I'm gonna ask them if I should use that after I finish lengthening.

1. So adductor/abductor machines won't hurt too much? And they will help you build stabilizing muscles/eventually help you walk? It sounds like a good idea, I haven't thought about that yet because my hips feel sort of odd in certain motions , I'm doing gnail femurs now

I will say that when I try to walk, I don't yet feel stable unless I have a medium to wide stance with the legs or having my crutches obviously. I'm not sure which muscles are responsible for allowing someone to walk up straight with legs close ish to each other but I'm assuming some kind of stabilizing muscles

2. Is "limb press" another name for the leg press or is it another machine?

thanks!!

[hippo60]

Whether you should stop working out certain muscles (because the PT in Athens told me if you have really big muscular thighs, it can make clicking for femurs more painful)..- I'm not sure-- especially for tibias, it sort of feels like stretching calves with things like slant boards is already almost kind of working them out

I do have muscular thighs so I was trying to learn/read about it as well. I remember someone in the forum mentioned it can be harder to connect with the magnet but not sure if true. I asked Rozbruch & his team and they didn't say it's needed.

[Taller90]

Yeah this sounds like a good idea, I think I might do this when I get back to the United States after I finish my stay in Athens. I think the PT place in Athen has a uh what's it called, that quad only exercise machine (you go from bent knee to straight knee), I'm gonna ask them if I should use that after I finish lengthening.

1. So adductor/abductor machines won't hurt too much? And they will help you build stabilizing muscles/eventually help you walk? It sounds like a good idea, I haven't thought about that yet because my hips feel sort of odd in certain motions , I'm doing gnail femurs now

I will say that when I try to walk, I don't yet feel stable unless I have a medium to wide stance with the legs or having my crutches obviously. I'm not sure which muscles are responsible for allowing someone to walk up straight with legs close ish to each other but I'm assuming some kind of stabilizing muscles

2. Is "limb press" another name for the leg press or is it another machine?

thanks!!

1. No and if it would hurt than stop. I have started with all kind of leg muscle machines from day 5 after surgery and have practiced them on a daily basis (so was Betz’s advice) always with a minimum weight! It is only about getting your joints flexible and to stop the muscle decrease which you will suffer due to the missing mobility.

Of course if you are not feeling stable you need to start with smaller steps but it is important to do any movement on a daily basis. The worst you can do is to relax and only stand up for stretching…
I mean why do you think the professional sport person are all coming back as soon as possible into their training? They know that standstill is the worst you can do for your body…

2. yep I meant leg press.