Quote from: QuadAssayagPatient on May 15, 2023, 08:24:35 PMStretching: I almost don't want to share too much about this subject because I don't want to give the misimpression that stretching isn't important. The main reason I didn't stretch much is because it was kind of excruciating and I absolutely hated doing it. And I'm constitutionally lazy, in that I put in the minimum amount of effort required to reach my desired goal. So, with the big caveat that this is an n = 1 experiment and that I'm not making any general statements, and also keeping in mind that I lengthened 4.5 cm in the femurs and 3.5 cm in the tibias, such that I was nowhere near reaching the soft-tissue limits...
I think an overlooked factor in this forum in how muscles lengthen is that they need time. This is my anecdotal evidence: I was cleared to fully weight bear on my left leg at the beginning of March. At that point, I wasn't able to straighten my leg with my foot flat on the ground. Because of that and because my right leg was still shorter and non-weight bearing, I kept using the wheelchair until the end of March, when I was cleared to weight bear on my right leg. At that point, I was easily able to straighten my left leg with the foot on the ground even though I hadn't done any stretching on the left leg, only on the right leg, in the intervening weeks. But then I had the same issue with not being able to straighten my right leg. In the next three weeks, I was using the walker and crutches, and weight bearing a lot on the right leg even though I wasn't yet able to straighten it. It took me the same amount of time, three weeks, to get the right leg straight with my foot flat as it had taken me to do that on the left leg. But the left leg had reached that point without weight bearing or stretching. So my layman/uninformed/not-to-be-trusted interpretation of that is that your muscles need to actually lay down longer fibers, and there is a maximum rate at which they can do that regardless of how much you stretch. Stretching is really important for preventing joint contractures, and your muscles probably need some level of stretching throughout their entire range of motion to get the stimulus they need to lengthen completely, but can you actually accelerate the rate at which your muscles physically lengthen through increased stretching? I'm not sure.
I'm saying this partly in reaction to the prevailing sentiment on this forum that people can lengthen ridiculous amounts on one segment if they have good work ethic. Maybe that's true, but I haven't seen the evidence here that you can go back to normal if you lengthen more than 8 cm on the femurs or 5 cm on the tibias.
Diet/Supplements: I ate a bulking diet if you're familiar with the bodybuilding concept. I had two 350-calorie Ensure bottles before bed every night, as well as 60 to 80g of collagen powder with heavy cream every day. I also had two large meals, lunch and dinner, that my dad cooked. I was overeating so much that I kind of hated eating and had no appetite throughout, but I forced myself to keep consuming a calorie surplus. My weight went up to 172 lb at its maximum (starting weight 152 lb), at which point I was a bit chubby, but it's gone down to 162 lb in a month with better body composition (more muscular legs, less fat on the stomach). I probably have the same body fat composition now as I did before the surgery (those 10 extra pounds make sense considering my longer legs). In terms of supplements, I was taking Bone Up, vitamin D, vitamin K, cissus quadrangularis, some Chinese bone healing herbs, magnesium, nettle leaf extract, grass-fed beef colostrum, grass-fed "Living Bone" supplement (I think this is crushed-up bone marrow), and some others I forget. I kind of took a maximalist approach to supplements, which my parents were concerned about, but I'm sure it helped with bone healing and maybe also with pain, given the anti-inflammatory effect that a lot of these pills have.
Incredible! U didn’t stretch much but u recover well that u can weight bearing so early. Do u have any issue such as duck ass? If u didn’t stretch much, how to lengthen soft tissue and not hurt joints? How about strength exercise? If haven’t enough strength exercise, you may be weak to walk normal.
Your supplements list is awesome. Many supplements I haven’t heard. Do u have pictures to show us and where did u buy?
Dr Assayag - Quad Patient - 4.5 cm femurs, 3.5 tibias - Dec 2022
Thanks for the reactions. Everyone's experience is unique so this should all be taken as an individual person's anecdote, rather than any kind of advice.
Supplements: Dr. Assayag prescribed calcium and vitamin D, so everything else I took of my own accord. I'm kind of a weird person who does research and takes supplements whenever they have a medical issue, instead of going to the doctor (thanks to America's intimidating health care system 
). It's served me well for some things. For example, I got rid of acne and avoided Accutane through supplements, and I also got rid of my respiratory allergies through things like nettle leaf extract. My allergies were so bad growing up that I had to constantly breathe through my mouth, which caused my jaws to develop wrongly. But since I started taking supplements for that my nose has never been clogged, even when I'm sick. "Supplements" is kind of an arbitrary category that can encompass a lot of effective things as well as a lot of ineffective ones. I'm still taking Bone Up, and I think I'll keep taking it until I'm cleared to run and jump (bone takes a long time to fully consolidate). I'm also still taking collagen, but I was already taking that for a long time before the surgery to counteract the prevalence of muscle meats in our modern diets and the lack of tendon/skin/organ meats.
Muscle strength: My muscles were incredibly weak after 3 or so months of being in a wheelchair. They're still nowhere near the level of strength they had before, and I think it will take several months to fully regain that. I feel like that's the limiting factor in my case when it comes to regaining a completely normal and fast gait. I also didn't do any strengthening exercises during lengthening, but I feel like that would've been somewhat pointless because I wasn't allowed to weight bear. (Actually, I had the 75 lb rods, but I was really scared of causing damage and just treated them as non-weight bearing until I was cleared to fully bear weight).
I'm not super weak anymore though. Less than six weeks after being cleared to weight bear on the right leg, I can already do 30 low bodyweight squats in a row, just to give an objective benchmark. Standing up in the shower isn't fatiguing at all anymore, and I can walk a mile without too much discomfort.
Flexibility: I think the benchmarks and comparisons are really different when you lengthen both segments by a small amount rather than lengthening the femurs by a greater amount. For example, I never had any issue bending my knees significantly beyond 90 degrees, and I also had no issue bending my hips. Basically, flexion was always easy. By contrast, knee extension was really hard. I could technically straighten my legs until the end, but about halfway through lengthening, a lot of muscle strength was required to do that. Straightening my legs with the feet neutral (i.e. not in plantar flexion) was impossible. In the weeks after I finished lengthening, the muscles actually physically lengthened (I assume), allowing me to do those things without muscle tension. Once that lengthening had occurred, I could walk with a "normal" gait (albeit slow and cautious). Before that, I was hitting the ground with my forefoot rather than my heel (on the right leg), so I wasn't walking normally and I was still using the walker and then a single crutch.
I truly don't think flexibility is the limiting factor at this point. My joints have normal range of motion again. I also became pretty knowledgeable about biomechanics and what constitutes a normal gait after I had my hip impingement surgery, and I can tell that I'm not getting restricted by tight muscles when I walk. My PT probably agrees because, aside from a quick calf stretch to get me started, we don't do any stretching exercises, just functional movements that take your joints through their normal range of motion (e.g. squats).
Going from the wheelchair to walking normally is not a quick process, though. It takes several weeks to progress through assistive devices before you're able to walk unassisted, and, like I said before, I expect it will take a couple more months before I can walk normally at a normal pace. A lot of people will say that others can't tell that their gait is off.. I'm not sure about that. I think people are highly attuned, if only subconsciously, to people's gait patterns as an indication of health, fitness, personality, injury, etc. Or maybe that's just me, because I had to become well informed about this due to my various functional issues.
Your reply really helps a lot! Thanks!
What kind of anesthesia did you use for the surgery? General anesthesia or epidural? How long did the surgery last? Does the anesthesia have long-term effects on your memory or your body?
Quote from: QuadAssayagPatient on May 16, 2023, 01:59:05 AMThanks for the reactions. Everyone's experience is unique so this should all be taken as an individual person's anecdote, rather than any kind of advice.
Supplements: Dr. Assayag prescribed calcium and vitamin D, so everything else I took of my own accord. I'm kind of a weird person who does research and takes supplements whenever they have a medical issue, instead of going to the doctor (thanks to America's intimidating health care system ). It's served me well for some things. For example, I got rid of acne and avoided Accutane through supplements, and I also got rid of my respiratory allergies through things like nettle leaf extract. My allergies were so bad growing up that I had to constantly breathe through my mouth, which caused my jaws to develop wrongly. But since I started taking supplements for that my nose has never been clogged, even when I'm sick. "Supplements" is kind of an arbitrary category that can encompass a lot of effective things as well as a lot of ineffective ones. I'm still taking Bone Up, and I think I'll keep taking it until I'm cleared to run and jump (bone takes a long time to fully consolidate). I'm also still taking collagen, but I was already taking that for a long time before the surgery to counteract the prevalence of muscle meats in our modern diets and the lack of tendon/skin/organ meats.
Muscle strength: My muscles were incredibly weak after 3 or so months of being in a wheelchair. They're still nowhere near the level of strength they had before, and I think it will take several months to fully regain that. I feel like that's the limiting factor in my case when it comes to regaining a completely normal and fast gait. I also didn't do any strengthening exercises during lengthening, but I feel like that would've been somewhat pointless because I wasn't allowed to weight bear. (Actually, I had the 75 lb rods, but I was really scared of causing damage and just treated them as non-weight bearing until I was cleared to fully bear weight).
I'm not super weak anymore though. Less than six weeks after being cleared to weight bear on the right leg, I can already do 30 low bodyweight squats in a row, just to give an objective benchmark. Standing up in the shower isn't fatiguing at all anymore, and I can walk a mile without too much discomfort.
Flexibility: I think the benchmarks and comparisons are really different when you lengthen both segments by a small amount rather than lengthening the femurs by a greater amount. For example, I never had any issue bending my knees significantly beyond 90 degrees, and I also had no issue bending my hips. Basically, flexion was always easy. By contrast, knee extension was really hard. I could technically straighten my legs until the end, but about halfway through lengthening, a lot of muscle strength was required to do that. Straightening my legs with the feet neutral (i.e. not in plantar flexion) was impossible. In the weeks after I finished lengthening, the muscles actually physically lengthened (I assume), allowing me to do those things without muscle tension. Once that lengthening had occurred, I could walk with a "normal" gait (albeit slow and cautious). Before that, I was hitting the ground with my forefoot rather than my heel (on the right leg), so I wasn't walking normally and I was still using the walker and then a single crutch.
I truly don't think flexibility is the limiting factor at this point. My joints have normal range of motion again. I also became pretty knowledgeable about biomechanics and what constitutes a normal gait after I had my hip impingement surgery, and I can tell that I'm not getting restricted by tight muscles when I walk. My PT probably agrees because, aside from a quick calf stretch to get me started, we don't do any stretching exercises, just functional movements that take your joints through their normal range of motion (e.g. squats).
Going from the wheelchair to walking normally is not a quick process, though. It takes several weeks to progress through assistive devices before you're able to walk unassisted, and, like I said before, I expect it will take a couple more months before I can walk normally at a normal pace. A lot of people will say that others can't tell that their gait is off.. I'm not sure about that. I think people are highly attuned, if only subconsciously, to people's gait patterns as an indication of health, fitness, personality, injury, etc. Or maybe that's just me, because I had to become well informed about this due to my various functional issues.
Awesome!
I also have respiratory allergies, I have already searched nettle leaf. Oh! It seems like great help for allergies symptom. Thanks a lot! May u tell me the supplement to get rid of acne? May I contact u to ask more details about supplements? Another LL question: Before LL surgery, which supplements should stop to take and which ones should take?
Quote from: youyin12 on May 16, 2023, 03:24:58 AMWhat kind of anesthesia did you use for the surgery? General anesthesia or epidural? How long did the surgery last? Does the anesthesia have long-term effects on your memory or your body?
You’re definitely going to prefer being under general anesthesia for this. Can’t say I’d recommend an epidural in any case. Unless you enjoy considerable (avoidable) discomfort.
Xarelto is like the one medicine the doctor wants you to take cause you can die even 3 months into lengthening, though insanely rare after like the first month. It’s $10 bucks for 30 pills without insurance using the online coupon lol. No need to be stingy on it.
Yeah, I'm kind of crazy. Definitely take Xarelto. I remember now that the main reason I didn't take it is because I had surgery on the right leg three weeks after the left leg and I didn't want to have clotting issues. But you can quit Xarelto three days before the second surgery and you should be fine. Also, you should let your surgeon and anesthesiologist know about all the supplements you're taking because they can affect clotting and interact with anesthesia. Don't take anything I'm saying as medical advice.
I wanted to leave a few parting thoughts before I quit the forum and move on with my life.
First, I noticed that my walk has gotten a lot better since I stopped using a cane last Thursday.
Walking asymmetry: https://imgur.com/6H3YJaX
The Apple Watch, in combination with the iPhone, measures walking asymmetry. You can see that mine has gone from 18.3% last Thursday to 0.44% today, which is equivalent to what it used to be pre-surgery. The measurements before last Thursday are unreliable and significantly higher (e.g. 50 to 100%) because I was using assistive devices. So my limp has gotten a lot better--maybe I don't even have a visible limp anymore.
In terms of walking speed, I'm averaging 1.8 - 2.7 mph, whereas pre-surgery it used to go all the way to 3.5 mph. I feel like this underestimates how slow I still am, because when I'm walking down the street I'm still the slowest person and everyone passes me by. But good progress nonetheless.
The parting thoughts are:
1) Pre-consolidation: I feel like this forum is obsessed with the idea of premature consolidation, even though it's an incredibly rare complication. My bone growth was significantly above average, I think the word "exceptional" got said a few times, I was lengthening at the slowest possible rate (0.5 mm/day/segment), and I was still nowhere near running into the risk of premature consolidation. Even so, I was able to fully weight bear two weeks after I stopped lengthening. I've read of people who refuse to take calcium or who purposely undereat because they're afraid of premature consolidation... That's insane. We're all here thinking that we're Wolverine when in fact we're more likely to have delayed healing due to stress, age, mineral-deficient diets, endocrine disruptors etc. I think people should be doing all they can to accelerate bone healing during the lengthening phase.
2) Lengthening rate: This is related to the previous point. No one should be lengthening faster than 1 mm/day, and 0.75 mm on the femur and 0.5 mm on the tibia are even better rates. You won't be delaying your return to normality because you'll have better bone consolidation and your muscles will have more time to lengthen. If your surgeon says you should be lengthening at 1.25 or faster because your bone is healing too fast, be suspicious.
3) Go with a reputable doctor: This forum has so many depressing horror stories. This surgery is serious and there should be a clear standard of care such that doctors shouldn't allow patients to lengthen beyond the safe limits or above the safe lengthening rates. I feel like this is the case in the US but other countries feel like the Wild West when it comes to this surgery. I don't mean to disparage anyone--I just read pretty much every diary over the course of my lengthening and this was my impression. Obviously, I couldn't recommend Dr. Assayag and his team more highly.
Good luck to everyone!
Quote from: QuadAssayagPatient on May 16, 2023, 01:59:05 AMI'm still taking Bone Up, and I think I'll keep taking it until I'm cleared to run and jump (bone takes a long time to fully consolidate). I'm also still taking collagen, but I was already taking that for a long time before the surgery to counteract the prevalence of muscle meats in our modern diets and the lack of tendon/skin/organ meats.
What about the other supplements? Did you stop once you were cleared to walk unassisted?
Quote from: QuadAssayagPatient on May 16, 2023, 01:59:05 AMI truly don't think flexibility is the limiting factor at this point. My joints have normal range of motion again. I also became pretty knowledgeable about biomechanics and what constitutes a normal gait after I had my hip impingement surgery, and I can tell that I'm not getting restricted by tight muscles when I walk.
That's great! I also wonder how is your flexibility related to pre surgery. For example, are you able to touch your feet / floor when standing? Is that easy?
Quote from: QuadAssayagPatient on May 16, 2023, 01:59:05 AMLess than six weeks after being cleared to weight bear on the right leg, I can already do 30 low bodyweight squats in a row, just to give an objective benchmark. Standing up in the shower isn't fatiguing at all anymore, and I can walk a mile without too much discomfort.
Do you mind sharing a little more about your progress over these weeks from starting to walk to walking a mile, standing in in the shower & doing squats?
Quote from: QuadAssayagPatient on May 16, 2023, 08:25:35 PMYeah, I'm kind of crazy. Definitely take Xarelto. I remember now that the main reason I didn't take it is because I had surgery on the right leg three weeks after the left leg and I didn't want to have clotting issues. But you can quit Xarelto three days before the second surgery and you should be fine. Also, you should let your surgeon and anesthesiologist know about all the supplements you're taking because they can affect clotting and interact with anesthesia. Don't take anything I'm saying as medical advice.
I wanted to leave a few parting thoughts before I quit the forum and move on with my life.
First, I noticed that my walk has gotten a lot better since I stopped using a cane last Thursday.
Walking asymmetry: https://imgur.com/6H3YJaX
The Apple Watch, in combination with the iPhone, measures walking asymmetry. You can see that mine has gone from 18.3% last Thursday to 0.44% today, which is equivalent to what it used to be pre-surgery. The measurements before last Thursday are unreliable and significantly higher (e.g. 50 to 100%) because I was using assistive devices. So my limp has gotten a lot better--maybe I don't even have a visible limp anymore.
In terms of walking speed, I'm averaging 1.8 - 2.7 mph, whereas pre-surgery it used to go all the way to 3.5 mph. I feel like this underestimates how slow I still am, because when I'm walking down the street I'm still the slowest person and everyone passes me by. But good progress nonetheless.
The parting thoughts are:
1) Pre-consolidation: I feel like this forum is obsessed with the idea of premature consolidation, even though it's an incredibly rare complication. My bone growth was significantly above average, I think the word "exceptional" got said a few times, I was lengthening at the slowest possible rate (0.5 mm/day/segment), and I was still nowhere near running into the risk of premature consolidation. Even so, I was able to fully weight bear two weeks after I stopped lengthening. I've read of people who refuse to take calcium or who purposely undereat because they're afraid of premature consolidation... That's insane. We're all here thinking that we're Wolverine when in fact we're more likely to have delayed healing due to stress, age, mineral-deficient diets, endocrine disruptors etc. I think people should be doing all they can to accelerate bone healing during the lengthening phase.
2) Lengthening rate: This is related to the previous point. No one should be lengthening faster than 1 mm/day, and 0.75 mm on the femur and 0.5 mm on the tibia are even better rates. You won't be delaying your return to normality because you'll have better bone consolidation and your muscles will have more time to lengthen. If your surgeon says you should be lengthening at 1.25 or faster because your bone is healing too fast, be suspicious.
3) Go with a reputable doctor: This forum has so many depressing horror stories. This surgery is serious and there should be a clear standard of care such that doctors shouldn't allow patients to lengthen beyond the safe limits or above the safe lengthening rates. I feel like this is the case in the US but other countries feel like the Wild West when it comes to this surgery. I don't mean to disparage anyone--I just read pretty much every diary over the course of my lengthening and this was my impression. Obviously, I couldn't recommend Dr. Assayag and his team more highly.
Good luck to everyone!
How do you get cleared after 2 weeks? Most people cant weight bear until like 3 months after lengthening right? That's pretty absurd
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