Dr Assayag - Quad Patient - 4.5 cm femurs, 3.5 tibias - Dec 2022

Hey everyone,

I had two surgeries with Dr. Assayag in December of last year. They were three weeks apart, one surgery on each leg. Dr. Assayag corrected a femoral deformity (which made a large part of the cost covered by insurance), and inserted Precice nails on both the femur and the tibia. The lengthening process took a little over two months for each leg, and, for both legs, I was cleared to fully weight bear two weeks after I stopped lengthening.

During lengthening I had a discrepancy between the legs because I'd started the left leg three weeks earlier, but it was corrected at the end and they are now equal lengths. I am now walking without any assistive device. I'm still walking slower than normal, like 2-2.2 mph instead of 3-3.5 mph, but I expect to be walking completely normally after another one or two months. My gait is good (accounting for some asymmetry given that the right leg is three weeks behind the left leg in terms of muscle development etc.). I attribute that partly to the fact that we lengthened each segment by about 10%, such that the tibia to femur ratio was preserved. My flexibility is also pretty much back to normal. I don't feel like it's an impediment anymore.

I'd be happy to answer any questions for the next couple of weeks. There are very few quad diaries on this forum and none of those patients had a sequence like mine (tibia and femur at the same time, but one leg per surgery). I think that was a great treatment plan and I expect to make a full recovery. In fact, due to the correction of the functional deformity that I had, I expect to be even better than before, as the symptoms that I had (hip instability, pain, and clicking) have resolved, knock on wood.

X-ray picture: https://imgur.com/a/96f8pdp

What was your starting height?

Starting height was 169.3 cm, as measured by the stadiometer, and it's now 177.8 cm. It looks like I gained an additional 0.5 cm by correcting the femoral deformity.

How old are you? Anyway, wish you a swift recovery:)

Thank you! I'm in my late twenties.

Sorry that I ask different questions in every post... Only that I think of different questions every time haha.
Care to share a little why you decided to do this surgery? Did you suffer from height dysphoria? if so for how long?  How did your family and/or close friends reacted to your decision to go forward with this surgery? Why you didnt do it earlier? And also, did other people notice your height difference? And how do you feel with your new height?

Hi! Hope you recover soon. I am also planning to do surgery with Dr Assayag. What painkillers did you take after surgery? Will the pain be severe? What is your opinion on local accommodation and safety issues in Baltimore?

Quote from: QuadAssayagPatient on May 15, 2023, 04:51:46 PMHey everyone,

I had two surgeries with Dr. Assayag in December of last year. They were three weeks apart, one surgery on each leg. Dr. Assayag corrected a femoral deformity (which made a large part of the cost covered by insurance), and inserted Precice nails on both the femur and the tibia. The lengthening process took a little over two months for each leg, and, for both legs, I was cleared to fully weight bear two weeks after I stopped lengthening.

During lengthening I had a discrepancy between the legs because I'd started the left leg three weeks earlier, but it was corrected at the end and they are now equal lengths. I am now walking without any assistive device. I'm still walking slower than normal, like 2-2.2 mph instead of 3-3.5 mph, but I expect to be walking completely normally after another one or two months. My gait is good (accounting for some asymmetry given that the right leg is three weeks behind the left leg in terms of muscle development etc.). I attribute that partly to the fact that we lengthened each segment by about 10%, such that the tibia to femur ratio was preserved. My flexibility is also pretty much back to normal. I don't feel like it's an impediment anymore.

I'd be happy to answer any questions for the next couple of weeks. There are very few quad diaries on this forum and none of those patients had a sequence like mine (tibia and femur at the same time, but one leg per surgery). I think that was a great treatment plan and I expect to make a full recovery. In fact, due to the correction of the functional deformity that I had, I expect to be even better than before, as the symptoms that I had (hip instability, pain, and clicking) have resolved, knock on wood.

X-ray picture: https://imgur.com/a/96f8pdp

Dr Assayag is a caring and reliable doctor.
Where did u live during distraction and consolidation phases? How long did u stay local? Did u have PT sessions in Sinai Hospital or hire Moshe Roth PT? Did Dr Assayag prescribe Blood Thinner one month only or entire distraction phase? What painkillers did he prescribe and how did u manage your pain? I fear nerve pain and irritation may lead to permanent nerve damage. Did u have any severe nerve issue?
Almost 5 months after your surgery, how do u feel? Do u regret?

Dr. Assayag prescribed Tylenol, Oxycodone, and an NSAID whose name I forgot. I ended up not taking the NSAID because I didn't feel like I needed it and I didn't want to compromise the bone healing in any way (even though Dr. Assayag assured me that it wouldn't). The pain was never such that I had to take Oxycodone, but I did take 10 or so out of the 30 pills he prescribed--kind of recreationally, although, surprisingly, they didn't have that effect and may have ended up giving me a bit of agitation and insomnia. What I did take consistently was 1,000 mg of Tylenol before sleep, and that was really helpful. I still take 500 mg before sleep just to make sure my sleep isn't affected by any random aches or pains, screw irritation etc. I could do without it but I like having that insurance.

A lot of people recommend edibles. I did take them a few times, and they were a good way to escape reality for a bit, get lost in a movie, but they didn't really have a pain relieving effect for me. In fact, a couple of times they would actually aggravate the pain.

With respect to the immediate post-operative pain, it was very manageable after the first surgery. After the second surgery, on the right leg, I ended up getting an elderly nurse that wasn't really on top of things, and this was close to New Year's, so there was a bit of a skeleton staff vibe at the hospital. My pain probably went up to a 7 that afternoon, but I texted Dr. Assayag and he made sure that I got an IV pain medication. That evening, a new nursing team came and they were really competent and on top of the medications, and my pain became significantly more manageable. I left the hospital the day after the surgery for both surgeries, which was fine. I would have left the day of the surgery if I could, because it was impossible for me to sleep there.

I should note that I probably have higher-than-average pain tolerance so I don't think my experience is typical. By contrast, I'm prone to anxiety, and that was the worst part of the process. If you're a bit hypochondriac, this journey will give you a lot of stuff to obsess over. Which is why it's important to have a doctor who's accessible and whom you can trust, which was definitely the case with Dr. Assayag.

With regard to accommodation, I live an hour's drive from Baltimore, so I just stayed home. Baltimore seems like a fine city in terms of safety, but I don't know it well enough.

How long after surgery exactly were you full weightbearing? It seems like you had exceptional bone regeneration.

We are similar cases, unilateral quad patient here in his late twenties as well. Also did 3.5 on tibias and I did 5.2cm on femurs.