Bilateral Femurs - Dr. Becker/Betzbone December 2022.

Hi everyone,

Long time lurker on this forum, but I figured I would document my experience to stave off some of the isolation of limb lengthening in a foreign country.
Currently it's post-op day 1 for me, and I've got 3 weeks to spend in Germany.

Personal details:
Age: 30
Height 162cm
Weight: 53 kg
Goal: at least 8 cm
Ethnicity: East Asian.

Why limb lengthening:  For the longest time, I believed that having a positive outlook on how I feel about my height would be enough to treat my height dysphoria, however, I never could shake the feeling of discomfort every time I looked in a full body mirror. It eventually got so bad, that I would actively avoid them. I found that I would never participate in group photos, because I would always see myself as the smallest person there.. by a long margin, and then feel disgusted by myself. Sure, I could improve the way I dress, the way I cut my hair, but the first thing that anybody notices is my height, which really isn't surprising as it would be about the bottom 1st percentile in the country I live in. Additionally, I often find that in the work that I do, people subconsciously (or overtly) find it hard to believe that I am an experienced professional, given my outward appearance, despite the air of professionalism I attempt to maintain.

Preparation:

Reached out to Dr. Betz in May 2022, with a zoom consultation. Went through the process, the OR, and post-op regimen.  Very thorough, answered any concerns that I may have had. He suggested 10 cm would be very doable for me given my x-rays, however, I think we will see once we get closer to there.  Was told that Dr. Becker would be doing my surgery in Freiburg, and was put in touch with his team.

Arrived in Germany 5 days prior to surgery. Frankfurt airport is pretty massive, but it's fairly easy to navigate as an english speaker. I take the taxi to the train station and head to freiburg via train, which takes about 2 hours. Freiburg is a smaller city, but still quite lively as the christmas markets are still open. I head to my hotel to avoid any exposure to covid for the next 5 days as much as possible. Food is pretty easy to find in the city, but their delivery service (Lieferando) is much more limited than north american options such as skipthedishes, doordash or uber eats.

I meet Dr. Becker at his clinic. His team takes photos of me for purposes of simulation. I have a chance to speak to Dr. Becker regarding the OR, recovery timeframe and realistic expectations. He says we can try for 10 cm. He takes great care in answering any of my concerns in great detail.

I get a COVID PCR and rapid test 2 and 1 day prior to the operation, which was a bit of a hassle, because the PCR testing center I had booked had suddenly decided to close 1 hour prior to my test, so I had to go around the city trying to find a place that would do a PCR.

On the day of the OR I check into the surgical clinic with my luggage. I meet the anesthesiologist in person for the first time, but had a phone consutlation with them 2 weeks prior.  The surgery is expected to be 2.5 hours in duration, with general total intravenous anesthesia and an LMA for an airway. I eventually get taken into an OR, an IV is started, and the last thing I remember is receiving a facemask for pre-oxygenation.

Post-op Day 0

I wake up in the recovery room, having no recollection of what happened during the surgery, which is a good thing. I feel that I'm able to move my legs, but quickly fall back to sleep. I next wake up in my hospital room, which is spacious and private. Dr. Becker is there to help me ambulate. Using his support I ambulate extremely slowly for about 20 meters, then return to my bed. My legs are heavy and stiff. Lifting them even 20 cm off the bed is a challenge due to the stiffness in them. Dr. Becker instructs me to stretch hourly, and informs me that my initial gap in my femurs is 6mm bilaterally.

The rest of the day I'm mostly in bed, in and out of sleep. I receive IV fluids due to hypotension after the surgery, and drink about 3-4 L of fluids. Dinner is provided, which consists of bread, ham, and pickled vegetables. Not bad.  Eventually my pain starts to rise as the local anesthetic in the surgical sites start to wear off. I'm given a tab of oxycodone and get to sleep without issue.

Post op Day 1

I wake up, and feel intense stiffness of my legs, even moreso than yesterday. This improves with some very painful stretching every hour. Eventually Dr. Becker returns, and we try walking on crutches. It's quite difficult, as my ability to swing my legs  forward as you would normally is severely limited. Nevertheless, I give it my best shot and make it about 30 meters. I'm now cleared to go to the washroom unsupervised. I continue to stretch, and have 1 PT session later in the day to work on ambulating with crutches.

I'm currently on on ibuprofen, low dose opioids, vitamins , pantoprazole, and a subcutaneous anticoagulant.

Hey man, wish you best of luck on this journey.


Could you please ask doctor Becker about his thought on lengthening the femur along the anatomical axis? Does he worry about malalignment and how does he plan for avoiding it.


I asked several doctors about this question and I’m just curious to get his take on this question.

Best of luck brother!

How many LL surgeries has Dr. Becker done so far by himself?

Do you also take the drug Xarelto as an anticoagulant?

What's the name of clinic where you had the surgery?

All the best!

Hi All, delayed update - but this has been a pretty major change in my life.

POD2-4

Every day I wake up with pretty severe stiffness in the legs, but this goes away quickly. I train walking on crutches about 4-5 times per day, and have gotten to the point that I am able to use the 3 point technique, and go up and down stairs with relative ease. Dr. Becker is happy with my progress. I would say that I still move slower than the average walking gait of a 30 year old male, by about 20-30%.  Prior to the surgery I would run about  7km per day without a problem, but I find that moving around on crutches to be quite exhausting, even at 100m. Hopefully this improves soon. Physiotherapy occurs daily, and recently I have been instructed to use the exercise bike for about 30 minutes up to three times a day in addition to my stretches. I have not required any opioids for pain since POD 2, but maybe this will change with clicking.


As far as independence goes - I found that as of POD 3, I'm able to complete toileting and hygiene by myself without issues. Picking up and carry objects is a challenge if they do not have handles. While I am able to use one crutch, I'm not quite confident in my stability yet to do that while carry items, but we will see how things go in the rehab center.

Care here has overall been excellent. The hospital room is private, and spacious. Nurses are attentive and demonstrate fantastic bedside manner. Food isn't bad, but after a few days of eating german hospital food, you may crave some nasty american fast food every once in a while.  Dr. Becker sees me daily, and takes his time rounding on you, and asking any questions you may have in detail and in honesty. Specifically, he was quite straightforward that I can expect things to get quite a bit worse in terms of pain and stiffness after 2-3 weeks when my muscles have reached maximum tension, and that I can expect things to improve afterwards. Overall I am quite happy with his care.


As far as questions go:

How many LL surgeries has Dr. Becker done so far by himself? - I don't know the answer to this one, sorry!

Do you also take the drug Xarelto as an anticoagulant? - Yes, I transitioned from low-molecular weight heparin to oral xarelto as of POD3 after Dr. Becker was happy with the post-operative hematomas and my ambulation.

What's the name of clinic where you had the surgery? - Praxisklinik 2000

Could you please ask doctor Becker about his thought on lengthening the femur along the anatomical axis? Does he worry about malalignment and how does he plan for avoiding it. - I can ask this question, however, I'm a little curious as what you mean by this. My understanding is that the nail is placed in plane with the femur.. as any other angle would result in quite a bit of pain when distracting and cause malunion.


Thank you all for your time in reading this!

Looking forward for your updates

Hi everyone,

Since the last update, I've been doing quite well, and have been transferred from the hospital to the rehab clinic.

POD 5-10

I was discharged from the hospital on POD 5, after some baseline bloodwork and x rays of my bilateral legs. Getting out of the hospital has been great for my mental health, as there's not too much for you to do in your hospital room. Also the hospital food was starting to get kind of boring. The rehab center is actually quite nice, and is attached to the hotel. My room is an upgraded hotel one, with accommodations for disabilities, which has been nice. The room is quite spacious, and there  is pretty good Wi-Fi access here. The rehab center/hotel is equipped with a fairly robust gym and physiotherapists. You have the option of eating included meals at the clinic, but I would highly recommend paying the extra 71 EUR per day to switch to the hotel meal plan. There's nothing quite as demotivating as finishing 4 hours of stretching, then physio, then cardio to eat cold bread and canned fish for dinner. The food at the hotel side, however, is fantastic.

My mobility has continued to improve since the surgery on two crutches. I am able to move short distances on one or zero crutches, however, my gait is quite poor, and I find it to be highly energy consuming, so this is something that I will have to train more later. I find that my mobility can vary highly depending the amount of sleep I've been getting (more on this later), as well as levels of pain/stiffness, so there are always dips and peaks with this, but overall, I am happy with my progress at POD 10.

As far as pain goes, I found that the surgical pain actually decreased significantly by POD 5. Due to my rapid progress, Dr. Becker suggested that I start clicking earlier, on POD 5, and so I did. As of POD 8 I have been doing 20 clicks a day, and I am now experiencing fairly deep, boring, persistent bony pain, about 4-10 in character. This can be managed with the tilidine that is prescribed, however, this becomes a larger issue at night, where higher potency opioids have been required.

Sleep has been quite poor since I have started clicking. It's often hard to fall asleep if you are in pain, and I find that I am woken up by pain around 0300. Further complicating things are the sweats that I have been experiencing with tilidine, which make sleeping quite uncomfortable. I had tried sleeping on my side one night, and this was a huge mistake due to the resultant pain I experienced upon wakening.

Clicking was initially quite difficult and incredibly painful for me on the first few days, however, now both the motion and the pain have been quite manageable. It takes me about 20 minutes to complete my clicking, however, the first click on each leg can take up to 3 minutes of loosening myself up. I find that this is easier after showering and stretching rather than attempting to do this cold.

Stretching is prescribed to you 4 hours a day. It is highly recommended that you do at least this amount, otherwise you may develop complications such as unremitting stiffness, wide legs, or anterior-pelvic tilt. I won't lie, it does get pretty drab at times, however, I can often watch TV while stretching which is nice. I will stress that the stretching should be at an intensity where you won't be able to focus completely on the screen, but having something on does help pass the time.

The care by Dr. Becker and his team remains excellent. Dr. Becker has continued to round on me every day except Sunday, which was Christmas. He takes my concerns regarding sleep and pain quite seriously, and will work out solutions with me. He is also involved in teaching you proper stretching maneouvers. He also continues to perform wound checks appropriately. Dr. Becker is assisted by Tonja, who is able to help you with everything else associated with your stay, such as getting items that you need or lending you her theragun. She's quite uplifting. I was also visited by their personal trainer David today, who pushes me to perform the stretches more accurately and intensely.

Overall, things are looking good, but there's still a very long road ahead. I'm actually most concerned about dealing with the airports on the way back!

Questions for other LLers:

1) How do you deal with getting your luggage checked in, getting through security, and physically getting on and off the plane?
2) I'm only prescribed 400 IU of Vitamin D daily, which is quite low. Dr. Becker states that he is concerned with pre-consolidation, so he would prefer a smaller amount at least for the first 4 cm, but 400 IU is even less than the daily recommended amount in my country, and also much lower than what other surgeons prescribe. I trust Dr. Becker, but I was hoping to get everyone else's thoughts on this.

When I get this surgery I'm bringing on a carry-on size suitcase with 4 wheels.  A 2 wheel suitcase is going to be a pain in the ass to deal with.  If you want to go super light you could just do a backpack but that might not be sufficient.

Congrats mate.
Any updates?

Quote from: mc623 on December 26, 2022, 04:32:27 PMHi everyone,

Since the last update, I've been doing quite well, and have been transferred from the hospital to the rehab clinic.

POD 5-10

I was discharged from the hospital on POD 5, after some baseline bloodwork and x rays of my bilateral legs. Getting out of the hospital has been great for my mental health, as there's not too much for you to do in your hospital room. Also the hospital food was starting to get kind of boring. The rehab center is actually quite nice, and is attached to the hotel. My room is an upgraded hotel one, with accommodations for disabilities, which has been nice. The room is quite spacious, and there  is pretty good Wi-Fi access here. The rehab center/hotel is equipped with a fairly robust gym and physiotherapists. You have the option of eating included meals at the clinic, but I would highly recommend paying the extra 71 EUR per day to switch to the hotel meal plan. There's nothing quite as demotivating as finishing 4 hours of stretching, then physio, then cardio to eat cold bread and canned fish for dinner. The food at the hotel side, however, is fantastic.

My mobility has continued to improve since the surgery on two crutches. I am able to move short distances on one or zero crutches, however, my gait is quite poor, and I find it to be highly energy consuming, so this is something that I will have to train more later. I find that my mobility can vary highly depending the amount of sleep I've been getting (more on this later), as well as levels of pain/stiffness, so there are always dips and peaks with this, but overall, I am happy with my progress at POD 10.

As far as pain goes, I found that the surgical pain actually decreased significantly by POD 5. Due to my rapid progress, Dr. Becker suggested that I start clicking earlier, on POD 5, and so I did. As of POD 8 I have been doing 20 clicks a day, and I am now experiencing fairly deep, boring, persistent bony pain, about 4-10 in character. This can be managed with the tilidine that is prescribed, however, this becomes a larger issue at night, where higher potency opioids have been required.

Sleep has been quite poor since I have started clicking. It's often hard to fall asleep if you are in pain, and I find that I am woken up by pain around 0300. Further complicating things are the sweats that I have been experiencing with tilidine, which make sleeping quite uncomfortable. I had tried sleeping on my side one night, and this was a huge mistake due to the resultant pain I experienced upon wakening.

Clicking was initially quite difficult and incredibly painful for me on the first few days, however, now both the motion and the pain have been quite manageable. It takes me about 20 minutes to complete my clicking, however, the first click on each leg can take up to 3 minutes of loosening myself up. I find that this is easier after showering and stretching rather than attempting to do this cold.

Stretching is prescribed to you 4 hours a day. It is highly recommended that you do at least this amount, otherwise you may develop complications such as unremitting stiffness, wide legs, or anterior-pelvic tilt. I won't lie, it does get pretty drab at times, however, I can often watch TV while stretching which is nice. I will stress that the stretching should be at an intensity where you won't be able to focus completely on the screen, but having something on does help pass the time.

The care by Dr. Becker and his team remains excellent. Dr. Becker has continued to round on me every day except Sunday, which was Christmas. He takes my concerns regarding sleep and pain quite seriously, and will work out solutions with me. He is also involved in teaching you proper stretching maneouvers. He also continues to perform wound checks appropriately. Dr. Becker is assisted by Tonja, who is able to help you with everything else associated with your stay, such as getting items that you need or lending you her theragun. She's quite uplifting. I was also visited by their personal trainer David today, who pushes me to perform the stretches more accurately and intensely.

Overall, things are looking good, but there's still a very long road ahead. I'm actually most concerned about dealing with the airports on the way back!

Questions for other LLers:

1) How do you deal with getting your luggage checked in, getting through security, and physically getting on and off the plane?
2) I'm only prescribed 400 IU of Vitamin D daily, which is quite low. Dr. Becker states that he is concerned with pre-consolidation, so he would prefer a smaller amount at least for the first 4 cm, but 400 IU is even less than the daily recommended amount in my country, and also much lower than what other surgeons prescribe. I trust Dr. Becker, but I was hoping to get everyone else's thoughts on this.

How much per day did you pay for the room and accommodation at Rehab?