Dr. Assayag - 3/22 Femur Lengthening/Tibia Bowleg - 11/22 Tibia Lengthening

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1 Month Update

I have been home for a month and wanted to provide an update on my recovery. When speaking with Assayag before I left, it felt like a realistic timeline would be to focus on building strength and flexibility in March/April. In May, continue to transition to walking with less support with an eye towards walking without support by June/July. My personal goal, however, was to build enough strength and flexibility to be walking with no support (walker or crutches) by May and have a fully normalized gait by June/July. I felt the May deadline, which is maybe a little faster than discussions with the doctors, could be achieved because when I was home in September/October, I was able to walk with crutches in about 4-5 weeks and continued to improve quickly from there. So my assumption was that two months back home again with an increased focus and discipline should get me there in two months. 

Seeing as though I had been in Baltimore for about a year, it took about two weeks to get adjusted to being at home and on a routine. When I came home I was in the following condition:

• Flexibility: Almost able to lock out left leg, but far away from being able to do that with the right leg. Extremely tight ankles, calves, hamstrings, quads, hip flexors, IT band/QL, and pretty much anything else you can name in the anterior and posterior chain.
  
• Strength: Very weak both on the upper body and lower body. Probably able to stand for a max of 3-5 minutes. Able to walk with a walker for maybe 5 minutes max. This was with a horrible walk/gait however as my ankle flexibility was almost zero. Unable to stand up unassisted from any height.

I am currently doing the following to help with my recovery:

• Going to Physical Therapy 2x/week: These are orthopedic physical therapists that are not experts in limb lengthening. Given I go to StretchLab, we spend almost close to zero time on manual therapy/flexibility and the majority of time on strength training.
  
• Going to StretchLab 5-6x/week: I started off at 2-3x/week and was not making progress as fast as I wanted to. After increasing the frequency in the past two weeks I am progressing much faster.
• Going to the gym or walking on anti-gravity treadmill 2-3x/week: This is separate and apart from the physical therapists.

After the last month of work, I am now in the following condition:

• Flexibility: Pretty much able to lock out the left leg, almost able to lock out the right leg. Hamstring and calf flexibility have improved substantially. Absolutely think I can get both legs locked out within the next few weeks. Able to transition to traditional stretches that we needed to modify a few weeks ago. Everything is loosening up.
  
• Strength: Considerable improvement but still weak overall. Able to stand unassisted for much longer. I haven't tested it but maybe 20-30 minutes. Able to walk with a walker for at least 15-20 minutes with good form/technique. Able to stand up unassisted from a seat height of 19-20". Almost close to being able to do that from a regular seat height. 

Now that I am four weeks in, my goal of walking with no support by the beginning of May seems to be slightly out of reach at this time. I think there are two things causing this that I didn't fully appreciate. The first is a much lower baseline of strength to start from this time vs. when I was home in September/October. Essentially, I did a second surgery before I fully recovered from the first and I am starting from an even lower point this time around vs. September/October. The second is that it took longer to get a routine in place. I think this is emotional exhaustion in a way. Realizing I was weaker than the last time and also being on this road to recovery for so long made it challenging to get on a routine as fast as I did last time.

With that said, I am happy with the progress, particularly what I have been able to achieve in the last two weeks. I think I'm in a good place now and continue to get closer to my goal. I am still aiming for being able to walk unassisted by May and will update you guys as I progress.

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hey lostinsole,
were you in a wheelchair the entirety of your tibial lenghtening?

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Quote from: Hagane on April 01, 2023, 09:39:47 PMhey lostinsole,
were you in a wheelchair the entirety of your tibial lenghtening?

Yes, I had 75lb nails and was encouraged to stand/walk as much as I can. However, I did less of that in the first two months due to 1) hitting my hard max on PT visits insurance would cover which left me with no access to the alter-G, and 2) pain in my right leg at the osteotomy site when standing. In regards to the second point, there was nothing structurally wrong with the leg or bone growth, I just needed to push through the pain/discomfort. When the new year came and I was able to go to Sinai PT and start to use the alter-G, the pain around the osteotomy site disappeared fairly quickly.

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Early Thoughts - What Does it Feel Like Being 5" Taller? Are you happy you did this?

I have been asked the above questions repeatedly and the truth is I don't know yet or some variation of I think I will be happy but I will let you know in a few months. For context, I do not go out to socialize -- only for PT. I have had interactions with some friends and women I am dating, but a lot of this is from a mobility scooter so I am not standing. The only time I am consistently standing around others is within the last week and a half when I use the walker to walk into PT. Prior to that, I would utilize a wheelchair service to bring me from the car valet at the front of the hospital to the PT clinic b/c the walk was too far. One thing I can say is that my reference point for everything has changed:

• I have to bend down a lot more to wash the dishes and reach sinks/etc.
  
• I can now reach shelves and cupboards I couldn't before.
  
• Doorknobs, tables, windows in doors, everything is at a different level when standing
• A girl I am dating now has to stand on her tippy toes to kiss me and I am looking down - before, we just kissed, no adjustments needed. Random thoughts when this first happened, "This is new" and "Oh, this is what a lot of women experience when dating taller guys"
• I no longer am able to determine with any level of accuracy whether someone is shorter or taller than me from a distance - Of course, if they are extremely tall/short I can, but it's crazy how often I look at someone and I think, are they taller than me or am I taller than them
• When I look at my legs in bed, sometimes I'm shocked at how long they appear relative to what I have had most of my life

The place I see the most individuals while standing is PT. Maybe 20-50 people in there at any one time. While I still don't know how it feels to be taller, it is weird that I have gotten used to not being the shortest already. I now look at people that are shorter than me and try to remember what it felt like to be shorter than them and how taller/shorter would I have been in relation to them and it's not something that I can easily connect with. Seeing as though I am now hovering around average height for a male, I am also aware that there are still a lot of people "taller" than me so it is not like I have a physically commanding presence just from height. Outside of that, I am still working out what the feelings and emotions of this procedure will be post-recovery. I will continue to share updates on my perspective and whether this surgery was worth it or not based on my interactions both professionally and personally over the coming months.

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Quote from: lostinsole on April 02, 2023, 03:36:30 PMYes, I had 75lb nails and was encouraged to stand/walk as much as I can. However, I did less of that in the first two months due to 1) hitting my hard max on PT visits insurance would cover which left me with no access to the alter-G, and 2) pain in my right leg at the osteotomy site when standing. In regards to the second point, there was nothing structurally wrong with the leg or bone growth, I just needed to push through the pain/discomfort. When the new year came and I was able to go to Sinai PT and start to use the alter-G, the pain around the osteotomy site disappeared fairly quickly.

interesting im currently doing mine with dr gdalevitch in canada. shes pretty much said to be walking with a walker day one and discouraged any wheelchair use. im curious if that will help speed up a return to normal walking gait.

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If you lengthen the femurs by 8 cm and the tibias by 5 cm, (8+5), how much will you actually grow? How much less than 13 cm?

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Quote from: Robert Adam on April 03, 2023, 02:44:16 PMIf you lengthen the femurs by 8 cm and the tibias by 5 cm, (8+5), how much will you actually grow? How much less than 13 cm?

From my understanding, you should gain all the height. With consistent work over the next 12-24 months, you can also regain 100% of your previous athletic ability. I will actually gain a little more than the 13 cm as I also had a bowleg correction. That may add up to about 1/2". I am waiting for my posture and flexibility to go back to normal to get the official measurement of how much height I gained.

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Quote from: Hagane on April 02, 2023, 06:12:45 PMinteresting im currently doing mine with dr gdalevitch in canada. shes pretty much said to be walking with a walker day one and discouraged any wheelchair use. im curious if that will help speed up a return to normal walking gait.

I think everyone's situation is a little different. I think your initial starting weight and the size of the nails also come into consideration. If you have the 50lb nails, there is less flexibility vs. someone who has the 75lb nails in. Also, different doctors have a different level of comfort with how much they want you to stand/walk during lengthening.

I was unable to use the alter g (anti-gravity treadmill) for the first two months of recovery given I ran out of PT visits and could not go to PT at Sinai. I am sure if I was able to utilize that, and did more standing/walking in my room as Dr. Assayag recommended, my recovery would be faster.

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Quote from: lostinsole on April 04, 2023, 02:24:57 AMI think everyone's situation is a little different. I think your initial starting weight and the size of the nails also come into consideration. If you have the 50lb nails, there is less flexibility vs. someone who has the 75lb nails in. Also, different doctors have a different level of comfort with how much they want you to stand/walk during lengthening.

I was unable to use the alter g (anti-gravity treadmill) for the first two months of recovery given I ran out of PT visits and could not go to PT at Sinai. I am sure if I was able to utilize that, and did more standing/walking in my room as Dr. Assayag recommended, my recovery would be faster.

definitely, i belive i also have the 75lb nails in.
i wish i had access to an alterg treadmil but i just walk to my buildings gym and use the cardio bikes 

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Hey, don't know if you're still active, but if you are could you estimate a percentage of what was covered by insurance? Actually in a similar situation because I have bow legs and was curious as to how much it cost in your situation.