MOTIVATION
- A mission and a purpose. I need to achieve a goal.
- It has interfered with and stopped me living my life.
- I’m bottle necked.
- Fitness isn’t working. No matter how fit I get I still feel the same.
PHYSICAL STATS
Basics: 35, Male, European
5k pace: 24 minutes
Squat: 97kg
Bench: 91kg
Starting Height: 172cm
Proportions:
Femur: 43.6cm
Tibia: 37.5cm
Ratio: 86%
Standard Deviations:
Femur: 173 x 0.29 = 50cm
Tibia: 50.17 x 0.8 = 41.4cm
In summary my femurs are naturally on the short side. My femurs can go up to 50cm and I’ll be within 1 SD of the mean. This means up to 7cm of growth on the femurs should be aesthetically fine from a proportionality perspective.
BUDGET
DM me for my budget spreadsheet. All in cost including procedure, accommodation in London, tests, pre-op prep, post-op rehab, gym memberships, supplements, drugs, therapy, nail removal and loss of income will be between £110,000 - £150,000 over the course of 18 months. Variation depends on Accommodation crisis in London and reserves to fund unanticipated complications.
Something you might not expect is that you to pay for everything on top of the surgery. For example, you will be asked to buy the disinfectant scrub which will be used to wash your body before the surgery. Yes, really. You are expected to source most things yourself. I spent weeks tracking down all the supplements, bandages, waterproof plasters, glues, scrubs and everything else to be used in the process.
Pre-Op Tests:
Dr Guichet is extremely precise and data driven in his approach. I don’t think other surgeons expect the same level of testing. I am super sensitive to complication risk and appreciate the scientific approach.
X-Ray and 3D Scan: £450
Isometric Test x 2: £300
DEXA: £350
ECG: £50
Blood Test: £1,415
Dental: £150
Psychiatrist: £450
Pre-op Training PT: £3,000
NUTRITION, SUPPLEMENTATION AND PRESCRIPTION PLAN
Whey Protein (protein)
Multivitamin (zinc, selenium, Bs, omega 3, etc)
Melatonin 10mg (sleep)
Paracetamol (Pain killer): 2 pills in case of pain. 2x3 per day maximum
Vitamin C 1000 mg: 1 pill/day at breakfast
Vitamin D3 injectable, 300000 UI: 1 unit to swallow per month (pre- and post-op)
Calcium 1000 mg: 2 pills per day: 1 morning, 1 at 10pm
Multivitamins: 1 daily dose, in morning and 1 daily dose at noon
Xarelto 10mg: 1 per day, to take according to recommendations of Dr Guichet
Acetylsalicilate of Lysine 1000mg: 1 in the morning and evening to begin from the 10th post-operative day only.
Ferrous sulfate 80mg: 1 in the morning for 60 days
Folic acid 5mg: 1 in the morning, 1 at noon x 60 days
Hyaluronic Acid 20 mg/ml: 6 units of 2ml
Nutrition
Dr Guichet’s recommendation is that I consume 4500-5000 calories a day. This will be difficult. My normal range is 1,800 - 2,000 and that's when I'm exercising vigorously every day. I don’t usually eat until about 12pm most days and even that is a light snack/protein shake. All this will have to change.
EQUIPMENT
Medical compression stocks Class 2 (stay-up with toe)
Medical Compression Stockings Class 2 *below the knee with toe: 2 pairs
Crutches
Foldable Walker (with two levels)
Yoga Mat
Stretching Belts
TRAINING SCHEDULE
Pre-operation:
Total time: 1 - 2 hours per day (including stretching, weights and cardio).
8am: Yoga (Hatha / Yin) - flexibility focus.
6pm: Resistance/weights (by muscle group, legs, chest, arms/shoulders, back) or cardio (run, boxing or cycling)
Post-operation:
Total time / day: 6-7 hours (including walking, biking, stretching).
8am - 10am. Physio and Rehab.
12pm - 1pm. Walk.
2-4pm. Workout including 10 exercises of 50 reps x 10 sets (this will likely take longer than 2 hours and need to be spread across the day)
5pm - 6pm. Bike.
6-630pm. Stretching.
OPERATION
Constraints:
Low risk of complications.
Maintain normal proportions.
Regain athleticism.
Get back to walking as soon as possible.
London based.
Resulting in:
Surgeon: Dr Guichet. He is extremely experienced (300+ surgeries), designed the now ubiquitous G-Nail and is very focused on speed of recovery. Some of his patients have had downright bewildering results (5cm in as little as 5 weeks). We’ll see if I’m so lucky. He is also based in London. He also has an intensive data-driven approach to the procedure and is focused on optimisation.
Length. I should remain proportional up to 7cm. This will mean I am between 179-180cm or 5’10.5 - 5’11cm. The same height as people like Johnny Depp, Daniel Craig, Ewan McGregor, River Phoenix, Brad Pitt. In the company of such icons I don’t think the incremental gains of more height are worth the risks. Put another way, if I can’t get through life at this height the problem is with me, not my stature.
Nail. G-Nail. As a weight bearing nail, it enables all round faster recovery, limited/no risk of infection. More expensive and the stressful click exercise, but this is worth it in order to fit within my goals (lower recovery time and as ‘normal’ a life as possible during the process).
EXPECTED TIMELINE
-60 days - Start preparation
-45 days - Start specialised pre-training
+0 days (June 2024) - Operation
+7 days (June 2024) - Distraction phase and PT begins
+30 days (20 July 2024) - Leave serviced apartment, return to home and work remotely while doing PT
+60 days (August 2024) - Consolidation phase begins
+60-90 days (September 2024) - Go back to full time work with less frequent PT
+120 days (October 2024) - Walk is mostly back to normal
+150 days (November 2024) - Consolidation phase ends
+ 360 days (June 2025) - Rods removal. If I can do this a month or two earlier, I will. I’d like to be ‘new’ for summer 2025.
+ 390 days (July 2025) - Gradually resume intense activities (running, kick boxing)
ENTERTAINMENT
Kindle
iPad for movies, TV, general browsing
MOTIVATION
I've spoken to a number of former patients to understand their motivations. I also asked this question of the PT/yoga instructor and psychiatrist that I work with in preop training. Some interesting feedback:
People do it for two reasons: (1) to be perceived differently and (2) to feel differently/true to themselves. In the latter it’s looking in the mirror and being able to say ‘this is the person I should be’. Others are afraid of social judgment. In this respect the quality of satisfaction will be directly linked to that motivation. If you do it to look better in your own eyes, it’s likely the process itself will make some changes. The capacity to endure a difficult challenge and the performance of which is incredible to an extent - convincing it to grow beyond the stage of growth. This is a boost to self confidence and self esteem. To feel at ease at the beach, in bed, without shoes. This is a huge improvement to quality of life.
If you are more concerned with how other people look at you, the quality of improvement will be connected with how these relationships have changed. The quality of information will be more unpredictable. People may subconsciously detect a difference but it's impossible to know how they'll treat you.
In the wide majority of cases people report an improvement in the quality of life. Impossible to say if people look at differently because they are taller or because they themselves are different. Is it the centimetres or the change in attitude that comes with the physical change? We will never know.
Some people get into a sort of a paradox. They want people to notice they are taller, but they are also keen on keeping a secret so don’t notice too much. This can result in uncomfortable choices about changing jobs and moving areas. You are replacing one sense of uncomfortable with another sense of uncomfortable.
MINDSET, PAIN AND RISK
I want to share a conversation I had with a psychiatrist who has met and treated hundreds of CCL patients over the years that I found very balanced and helpful. Paraphrasing:
"I want to say a word about 'narratives'. A narrative is a story we tell ourselves that explains a behaviour. Here's an example: I am doing this because I think it's a a masculine act and a man will do what's necessary to get what he wants no matter how painful and no matter what anyone says or does to resist us. Doing this as an act of "defiance" designed to make me feel powerful or brave.
Bringing this back to reality: 5-10% of people stop the procedure almost immediately because the pain is unbearable, excruciating. A very small minority (1-2%) report no pain at all. Lucky them. 90-95% describe it as moderate to severe, where severe is 'tolerable but very exhausting' - pain that you can stomach, just.
The problem is that in terms of reaction to pain, we are going against nature. Pain exists for a reason. It tells us that what we are doing is bad for us. You put a hand on a flame and remove it because it hurts. This is healthy. It helps us survive.
What we are doing here is to go against this general law and convincing ourselves this pain we are feeling is not damaging us and is taking us closer to our goal. This is not easy as it goes against our most ancient instinct to avoid pain. It will take not just determination: determination can make pain grow stronger. It starts to be a challenge between you and the pain and the more the pain becomes the enemy the more you get focused on the pain. So determination is helpful but the more you use it the worse the pain will be. You need to relax into it. Someone you can have a dialogue with and negotiate with. You must learn a different way of dealing with the pain. Find a different way to push through and achieve your goal.
You shouldn't be alone with the pain. You will have help from the surgeon's team, the surgeon and other patients. But most the time you will be alone with your pain. This will take you to some dark places.
Some examples of things that have endangered people.
One response to pain is to stop and procrastinate. So you stop clicking, say. You tell yourself you'll do it tomorrow. You begin accumulating undone clicks. But every day takes you one step closer to the bone being completely reformed. So clicks become harder and harder as the bone is reforming. It does not get easier. It gets harder. Every day you lose and miss is a risk that you will fall short of your goals. In order for you to achieve your goal do all clicks that are requested exactly as requested.
Here is another response. Some patients know they have to do the click. But they start to prioritise. In their mind they say clicks are the growth and stretching is secondary. This is extremely dangerous. Athletes that build a massive amount of muscle mass that don't build flexibility of tendons and ligaments are subject to serious injury because the body has grown but not harmoniously. Same thing here. You are creating new muscle fibre, space, bone. You must bring the rest of your body with you.
Here is another response. Pain killers. Pain killers will interfere with the speed, length and depth that the body reforms. Pain killers could slow or accelerate your bone growth. It will put you at risk of not growing or fractures, suppress your appetite and smother your motivation. Do not take more pain killers than prescribed.
So what can you do? You might be surprised to know that the simplest thing is 'talk to the doctor'. If the pain killers are not as effective as you hoped he/she may be able to explore other pain killers if the current ones don't work. The doctor knows how your body will react. The doctor has your data and knows your body than you do. Do not self diagnose. He is the only one that can do it for you. He might be able to show you different ways of clicking if you are having problems. But you have to speak to the doctor. If you don't speak to the doctor he cannot help you. He is an expert in his field but unfortunately not a mind reader. So the question is why don't people speak to the doctor?
This is where psychology comes into place. the reason why they don't do the simplest thing at hand is the same reason why people take the surgery. Because you want to look better. You want to appear more masculine or dominant or powerful. To tell the doctor 'I can't do it' will compromise your self image. So many patients refrain from speaking to the doctor because they are worried they will appear not brave enough or not strong enough or not man enough. The brutal truth is you need to put the ego aside for the surgery. Put the ego in the freezer and take it out after the whole process is over. Put the ego in a cryogenic freezer and unfreeze it when you are done. You don't need ego. You need transparency and honesty and compliance and cooperation. To speak plainly and transparently to the doctor about what is happening. Otherwise you are compromising your goal or worse putting your health permanently at risk.
Now I'm going to talk about the 1% that feel no pain. Or say it's a lot less pain than you were expecting and you say "oh that's manageable". Some patients start over-clicking. They say "oh I can click 15 instead of 10". Speak to the doctor first. The doctor will know if your body can take those extra clicks. If you do it anyway, fracture is waiting for you around the corner. The lucky 1% become the unlucky 1%.
This surgery is like one of those fairy tales. There is only one safe path through the woods. Every time you deviate from the path there is a wolf or bear waiting to fk you. Do whatever the doctor tells you. If you can't do what he tells you then come forward and speak out. Be transparent. Ask for support. Do not deviate from the path. "Do it yourself" doesn't work, rebellion doesn't work, secrecy doesn't work. When it's over you can have your secrets and ego back. But not before.
Remember, this is meant to be a challenge but it's not meant to be torture. You are entitled to respect and support. But nobody can read your mind so you must be vocal about what is happening. Do not ignore pain that feels particular or unusual - something may be seriously at risk. Everyone in the process wants you to be successful and safe. You must be transparent with them to succeed. It's about overcoming the challenge. The way you do it is really irrelevant. It is the outcome that is important. Once it's over, all that is going to matter is the result. Keep your eyes on the prize.
Some other challenges. If you are socially driven, you may feel lonely and like your whole life is passing you by. People going on dates, on holidays, this and that. You're stuck in your apartment clicking in pain. Pain alone is difficult. So lean on people. Friends, family, anyone that is close. If you don't then you need to somehow seek that help elsewhere. Other patients that are doing this. Anyone you can trust. If you try do all this alone you will fail. Remember - the ego, the lone wolf, the "John Wayne walks into town" guy will only lead you to failure.
You can't expect everything to come back for you immediately. Always check with the doctor before you try a new activity to make sure it's safe. The true normality, the "I'm back" moment is not until the nails are removed. The nails will always remind you. Flying? Cabin pressure will cause them to expand and remind you of its presence. Once they are out, you will be you again, but taller. This will be between 1.5 - 2 years for 8cm of growth on the femur (though everyone is of course different).
Most the mythology with how high risk it is comes with external fixators. For weight bearing nails, it is still invasive surgery. You are messing with your bones. But it's no more risky than many other kinds of cosmetic surgery that is out there. It is not a miracle in terms of likelihood of success. It is a miracle in the sense that it defies the laws of nature and anything that goes against the natural trajectory of biology can be described as a miracle. But it's not as unlikely as the resurrection of Lazarus or turning water into wine."