The only problem with Dr. Monegal is the time I'd have to take off. With other internal device doctors, I could lengthen over the summer overseas, then come back home to go back to school (college). With Dr. Monegal, I'd have to spend the whole six months overseas.
Hi ReadRothbard
As far as I know, you don't need to stay for 6 months. You stay about one month for the first stage or one leg surgery and go back home. And then you can lengthen your leg and do PT at home. When your first leg is almost or completely healed/consolidated, which I don't know how long it will take 4mon?, you come back to Spain again for another leg. And then stay again about 1 month and go back home. That is pretty much it. Of course, you need to do lengthening and PT and check X-ray regularly and communicate with Dr. Monegal until it is done. Once two legs are consolidated, which may be about 8-9 month?, you probably can do most of normal life. About 1.5 years later, you go back to Spain again to remove nails.
Cheers,
What are peoples thoughts on lengthening at home? So that means you got to go find your own physio who has somewhat of a clue dealing with patients with broken legs or do you think a normal physio is more than enough?
What are the Visa rules for Spain, from my understanding if you are staying for less than 3 months then you dont need a Visa?
Is there a limit on how many times one can come back in one given year?
Quote from: ForcedPuberty on December 26, 2014, 09:31:52 PMnow your just acting weird. its a common statement. your paranoid acting like there's some sinister nature to it.
sarin also said 6 people are trolling him. doctors will always say this to discredit anyone who doesn't worship the white coat they wear as gods.
a troll is someone who is not sincere. obviously the doctor does not understand the definition to troll. not my problem.
there has never been single study to prove that lengthening the entire leg at a single time is safer, effective and faster or better in any way shape or form. you keep asking me for sources yet YOU HAVE NONE YOURSELF. you have no proof of your claims. your just some guy who sided with a random doctor in a white coat with no studies to back you up or the doctor.
SECOND ISSUE
the link to disobedient was not meant to represent this Spanish doctors surgical technique, you just randomly said that I was saying it was.
I said it would be interesting to read, as it demon straights what happens to soft tissue when you lengthen to fast. you get massive ballerina. I never said this proves or shows anything in relation to the Spanish doctor. in fact I said it is the closest diary we have to his procedure and would be only of value for interest sake. stop saying I said things that I never said.
listen here you imbecile I have studied ligaments, tendons, soft tissue, biomechanics, physiological and anatomical sciences and a hell of a lot of other things at university level, these subjects which are over a dozen cross and are accredited for the medicine degree. I know a crap load more about the body then you ever will.
and quadrilateral and single leg make no difference, because soft tissue on 1 leg does not affect the soft tissue on the other leg. you have no idea what your talking about because you are the laymen not me. I am actually accredited to comment on these issues. because I have a tertiary education in this.
I too have some university education in the field of biomechanics and medicine and I must say that everything you've written on this forum about LL does seem accurate according to what I've been taught.
I've personally toyed with idea of doing 4+4CM quadrilateral (internal femurs and LATN tibiae), but wonder if even this would be too taxing on my soft tissues. Some patients of Dr. Paley have been able to pull this off, but it depends on a lot of individual factors. 4+4CM does seem dangerously close to the soft tissue limit of quadrilateral lengthening in general, though.
If quadrilateral lengthening of 4+4CM proves to be unrealistic after I consult with a few doctors, I'll do 6.5-7.5CM on a single segment (leaning towards femurs) and move on with my life.
Hi Fpuberty
f you go back to the original assessment on this thread you harped on and on about 1 tibia and 1 femur being a 'horrible' idea. You harp on and on about it being 'bull crap' and even insult us as having 'weak minds' for a fad.
Go re read the thread. Read your own words. 
Over the course of this thread we have asked you to prove your profane objections. You have never done so. Now you have been backed into a quadrilateral corner. Nobody asked to do all four segments . You have purposefully twisted it into this because you could not produce any evidence regarding the single femur and tibia operation.
The fact you claimed to have studied some medical information in university and dropped out is fine but it is utterly irrelevant compared to a medical doctor who performs these surgeries. Surely we can all agree on that.
We who believe in the procedure read your objections. You dont need to keep repeating yourself. This thread is about the doctor and its up to us to decide . To be fair, we understand you are entitled to that opinion, but it stands to reason we will take the opinion of two medically trained doctors over yours.
Paley says you can do it but you should limit yourself to 10cm per leg. 20cm growth at the same time. He never states you 'cant' do it or that its dangerous. Many doctors on here recommend 5cm maximum using bilateral or even single segment surgery of all stripes. That means 10cm as well . Just as Paley indicated for the quad.
The Disobedient thread indicated at only 5ft tall she did 11cm easily but the doctor told her to stop in fear of doing too much. This was on both legs at the same time using externals. Stands to reason someone of our stature being 5ft 7 only doing 1 leg internals should be able to do 12 to 14 cm without major complications. Maybe we can, maybe we wont. I can live with 11 cms if I had to.
For the third time, we get it. You dont like the one leg surgery. Your laymans opinion was duly noted long ago. Feel free not to do the surgery. . We got it the first time. Move onto something constructive.
Suggestion; Start up a Qaud thread and serve up all your concerns about it there. 
This thread is about Doctor Mongeal's facility and his 1 leg or one segment or bilateral options.
I have some feedback from Dr Mongeal I wish to share. I am going to follow up with 2 objections
1) What if you lengthen 13 or 14 cm and then your other leg cant lengthen that much?
2) What about the range of motion and the ability to lengthen both bones at the same time. What kind of stress does that put on the knee?
I assume he cuts the femur higher up towards the hip and the tib/fib lower down so the leg muscles and tendons at the knee are not strained anywhere near as much. That is my layman guess. We shall see what he says.
I have some feedback from the Doctor that might be interesting to some of you.
Dear Tom
Please find my answers as follows
1) Are you prepared to do LON for 1 femur and 1 tibia for the same leg at the same time?
This is technically possible but I do not recommend this. First of all because of the disturbance that might cause having to external fixators in the same limb. And second because temporary LL discrepancy that is created. But of course this can be done.
When doing simoultaneous procedures using LON technique the most commonly done is bilateral femur or tibiae. Some doctors perform tibia in one side and femur in the contralateral limb. I do not recommend this crossed-limb technique. When doing this procedure knee joint is temporary at different height and it obligates patients to undergo second crossed limb procedure.
Sometimes when performing bilateral femur or tibiae, some patients are happily satisfied with the result of the first procedure and they prefer not to perform second procedure.
2) If so , how much is the Cost?
For a bilateral procedure using LON technique cost is
3500€ Clinic and Medical expenses
15000€ materials (2 ex fix/2 nails/12 hydroxiapatyte pins)
5000€ Medical team (2 surgeons/anaesthaesist/scrub Nurse)
Price includes preoperative tests and planning
3) Are you prepared to do Fitbone for femur and LON for tibia for the same leg a the same time?
I have never done this in the past. This is technically possible but I do not think this is a good idea. The reason is that pinsite infection occurs in almost 100% of cases and I am not happy to implant a 12000€ device with a "close risky infection zone" that close.
I know all patients are mostly concerned about cost and time. I always try to show them to the safe zone. I don t think it s a matter of being conservative, it s a matter to stay away from problems. And do believe me in LL sometimes trying to speed up slows down the process, and cheap becomes more expensive.
4) If so , how much would that Cost?
It is approximately 4000-4500 euros more expensive than 2 LON. Diffference is basically because of implants different price.
5) If I do LON, could I keep it on until the bone is 100% weight bearing ? I ask because I have to come back to Spain to get the external pins removed and I wonder if I could do the other leg while I was There.
When performing LON what I normally do is to proceed inmediately to lock the nail and remove the external Fixator.
I don t think this is a good idea for 2 reasons:
1- having pins during such a Long time increases risk of infection and cosmetic result of the scars is much worse.
2- having the ex fix on does not allow recovery of the knee joint and can create stiffness and delay the full recovery.
So as I told you before, sometimes fast becomes allow and cheap becomes expensive.
In 2001 Paley wrote a paper about introducing a nail when doing monolateral ex fix lenghtening. One of the reasons why they Did recommend LON over ex fix itself Was early removal of the ex fix and early recovery of knee joint.
I hope my replies were helpfull and not very confusing. If you need any other support or you want me to answer to other questions just let me know.
By the way...whhere are you from?
All the best
Dr Alex Monegal
Notes: I get the impression that the only way to do one leg is fitbone for both. Otherwise he recommends bi lateral surgery using LON or other external methods.
I will follow up with soft tissue and knee objections when doing 1 leg
Quote from: galaxy1 on December 27, 2014, 12:23:52 AM
Tom, being that you are in your 40's, it's possible lengthening over 10 cm and doing at slower a rate will work out for you great. You won't have a very high risk of preconsolidation as a younger person would. Did Dr. Monegal in your PM communications give his expert opinion on the matter?
You raised a good point. Yes he did. He indicated that someone my age would have no issues someone in their 20s would have, save for the rate of recovery. In other words, what you guys can lengthen at age 25 is the same I can, but you will on your feet much faster
you keep repeating the same nonsense tomD.
1)soft tissue stress on 1 leg does not affect or interact with soft tissue stress on the second leg. so everything you say is completely irrelevant. you need to learn how the body works before we can debate this because you are not educated.
2) disobedient did 10cm as I understand it. and it was not easy. she will recover I believe. but she had a 7cm ballerina if I remember correctly at 1 time and she is still recovering after a very painful and long journey. I wish her well.
3) I did not drop out. you made that up. and further more your argument is going in circles, you were calling me an uneducated laymen for so long and I resisted telling you that I was actually educated, only after finding out do you then proceed to tell me being educated does not matter. this is a silly tactic where you keep trying to discredit people based on education but magically if they are accredited then it is irrelevant. you don't need an education to learn things, it was you who brought it up not me. I just happened to be accredited and was sick of you tring to discredit my opinion based on academics.
4) QuoteStands to reason someone of our stature being 5ft 7 only doing 1 leg internals should be able to do 12 to 14 cm without major complications.
this statement is groundless, I can tell you now that your rational for thinking you can do 12-14cm is wrong. as I pointed out earlier disobedient had a very long and grueling time and is still recovering after a extremely tough time because of soft tissue restrictions. and she only did 10cm.
AND FINALLY: YOU HAVE NEVER ONCE GIVEN ME PROOF TO YOUR CLAIMS OR CLINICAL STUDIES SHOWING THAT LENGTHENING 1 ENTIRE LEG SIMULTAINIOUSLY IS BETTER OR EQUAL. YOU KEEP DEMANDING PROOF WHEN YOU HAVE NO PROOF.
LET ME REPEAT YOU HAVE NO PROOF. YOU NEVER WILL BECAUSE YOUR WRONG. and you will never understand why unless you gain a tertiary education.
from dr mongeal:
QuoteWhen doing simoultaneous procedures using LON technique the most commonly done is bilateral femur or tibiae. Some doctors perform tibia in one side and femur in the contralateral limb. I do not recommend this crossed-limb technique. When doing this procedure knee joint is temporary at different height and it obligates patients to undergo second crossed limb procedure.
think about it guys.
Seriously Forcedpuberty, you ought to compared apples with apples and not bloody watermelons.
Disobedient did all externals on all four bones in one go, how is that relevant to the one leg all internals procedure Dr Monegal does...? Le sigh
Plus disobedient was well.... disobedient. She listened to no one but her borderline quack of a doctor and went against everyones advice. She only listened to what she wanted to hear and her doctor only told her things she wanted to hear. She failed to think outside the box. But thats not the point, the point is theres no relevance to your comparison
On another note, you two should take your little debate to another thread and stop hijacking what is essentially the Dr's thread.
Have some decency geez
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