Femurs - Betz Summer 2021

Edit Post

Hi All,

I thought I should post an update. It's been a few weeks! I flew back from Germany after a month, and after serving two weeks hotel quarantine, I returned to my flat and to work. Things have generally been progressing, although now I have other things to consider in addition to the lengthening issues.

I have also been keenly following the various other diaries Betz and non-Betz) and it is interesting and heartening to see everyone is generally making good progress (although nothing ever goes perfectly smoothly with a procedure like this).

Here are my current thoughts:
CLICKING & LENGTHENING: The lengthening process has become relatively fast and issue-free now. Much like other diaries, after the first inch, all issues seem to have resolved themselves. In addition, and unlike some other diaries, I have been going super slow for lengthening. I know the process is not fun and does drag on, but I’ve never understood the need to power through the process. The risk of damage is too high. Slow and steady is always the way!

For example, after the first inch, I started feeling faint nerve pains on my shins. I immediately went down to 15 clicks a day (from ~20). That resolved the issue. Once I returned to work, I found that 15 clicks a day was stopping me from being productive (as a result of tightness, exhaustion, etc.). So I went down to 12 clicks a day. Once I get past the 5 cm mark (by next weekend hopefully), I will likely go down to 9-10 clicks a day. 
I have also not been shy about taking the odd day off. Sometimes, the tightness has been so great that I simply took a day off – stretching, moving, but not lengthening. Even a single day of rest has a remarkable loosening effect, more so than any drug can offer. I have used this (sparingly), as required.


IT BANDS & TIGHTNESS: Thankfully, I have not had extreme wide legs even after >4 cm, and am taking various steps to minimise the risk. Whilst there is some slight wideness in my stationary stance, it is readily resolved and walking (with crutches), seems to look pretty normal. I hope my prophylactic steps continue to work, and I offer a list below of my approaches (in no particular order):

E-stim acupuncture: This is fantastic and I go twice a week; ~20 mins per session. They punch holes into various parts of the leg with needles (including the IT bands and hips), and then use an electric field to maximise the effects. I do not know the exact mechanism of action but, the IT band relief may be a result of introducing perforations into the fibrous sheet, such that stiffness is decreased and strains eased

Stretching: Probably the most important thing to do, at least 2-3 times a day. Use many types of stretch, applied from many angles and from many positions.

Cupping: It helps but is not necessarily super-effective on its own. Useful in combination with the other approaches and whilst incorporating range-of-motion exercises. I have been warned that because of the Xarelto, cupping may cause internal bleeding. So, I have used it sparingly.

Massage gun: Others have mentioned this before. Invaluable when things get too much or there is a particular knot/area that needs special attention.

Full leg massager: Available on (e.g. Amazon. Similar to a massage gun, although less intense and applicable to the entirety of the leg(s). These things have been very helpful after lengthening and stretching sessions in helping promote circulation, and to soothe general aches and pains.

TENS: Offers similar relief to a massage gun, but via a completely different pathway. Again, really useful when there is a particular area of the leg giving you bother.

Walking: Whilst walking is exhausting, once you regularly start with the longer distances, your legs do feel stronger and more alive. I would recommend trying to do at least 1-2 km a day, although you will be going at the same pace as geriatrics on zimmerframes. *I always use crutches when walking*

Stationary cycling: Again, one of the best activities for improving general strength, looseness and well-being. I try to do 2-4 km a day.


RETURN TO WORK: For those of you that are career-oriented I would strongly advise careful planning for this procedure. I returned to work after ~6-7 weeks away and am only operating at ~50% (at best), of my previous performance. Thankfully, I have been at my current employer for a few years, and have had relatively good periods, so much so that the current slowdown is being accommodated as a temporary dip.
The performance lag from the CLL operation will really hinder your outputs. Once you factor in the discomfort, stiffness, need to stretch/exercise, need to lengthen, extra sleep required, the numerous drugs (and their attendant side-effects), etc., you will find that a lot of the day is gone! And the remaining time is not as productive or optimally used as it was when you were at your physical and mental peak. Similarly, while walking is recommended – I can easily do >10k steps a day at my workplace – it ends up exhausting every fibre of my being.

If you are on a career path that you really want to see through to the end, then you may have to put off the CLL for a period. I definitely would not recommend it in the first year of any new position. You will not be performing anywhere near your best, certainly not for the lengthening period and likely not in the consolidation period either (i.e.; 3-6 months of sub-standard performance).

I think this would also apply to those (very lucky few who can afford it) at the university level as well. Unless it is the first year, where little matters (&/or you have time to make up any shortfalls), I would recommend waiting until after your degrees are done, or carefully timing the operation so that it does not interfere with your studies. Your performance will drop off massively. And if you do subjects that require practical work/physical presence (e.g.; science, engineering, architecture, etc.), then be prepared for an even greater drop!


IMAGES: Finally, I appreciate that x-rays are currency on this forum, and while I do not intend to share everything, I thought I should post at least one or two images to prove my bona fides as well as highlight how things are progressing. The attached x-ray image is just after the ~4 cm point. I am pretty happy with how it is all shaping up!

https://imgur.com/a/RkqnI88

Edit Post

Very good progress!

Couldnt agree more on the work performance part.

Note on the slow lengthening. I had the exact schedule as you but clicking resistance has increased significantly after 7cm, because the callus is hardening. Dont go too slow unless you are stopping at 8cm.

Edit Post

Thanks man!

I think you may be right or the consolidation issues. But I think I will call it at the end of the month (September) anyways. I should be at 7 cm by then and I think that is plenty. the trade-offs (potential complications, getting back to work, etc.) mean I would be hapy with that return.

Fingers crossed for the final month!

Edit Post

Hi All,
 
UPDATE: This is likely to be the penultimate major update before I call it quits. I have passed the 5 cm mark this weekend, and now my intention is to see out September and get to 7 cm, hopefully by the end of the month, give or take a week. I’ve grown weary of the lengthening process and it is taking out far too much from other aspects of my life. Everything is a compromise, and 7 cm seems like a good balance (hopefully I can get it!). 
   So far, I still have not had any major issues. No nerve pain, contractures, or duck-ass. I have no major secrets to success beyond that which I’ve listed previously. The most important thing is to build a routine, stay regular and push yourself a little further every day. My IT bands are tight, and it is always more comfortable to stand with legs a little wider apart, but I can still get my legs together without too much effort and I can stand with legs a normal distance apart when I focus on my stance. The longer the legs are forced together, within reason, the less uncomfortable it gets. With things going so well with the process, it seems silly to push my luck. My biggest weakness are probably my hamstrings; they get very tight. My knees also get a little sore when in a single pose for too long. That’s it though, so far.
   Also, the extra height is a little noticeable now, but it is not something world-changing! Even with the eventual 7 cm, I don’t think it is something that will turn my world upside-down! Just something that will allow me a greater degree of self-confidence, and to waste less of my finite bandwidth spent worrying about it. Thankfully, I have a pretty decent life in general and I wasn’t expecting revolutionary changes from the process! For those of you that are, perhaps re-evaluate your approach and expectations.
   
UPDATES ON COSTS: Previously, I promised an update on costs. Once the housing costs in Germany were included, as well as the multiple PCR tests, flights, hotel quarantine, various extra instruments that I bought (in addition to items listed below, a walkpad, stepper, bike, various other gym items), extra drugs and supplements, taking taxis everywhere instead of public transport, hiring a cleaner, paying for a meal prep & delivery service (3 meals daily) to avoid cooking distractions, etc., the total cost of the entire bilateral femur process is EUR~70k. I’m hoping there are no further surprise costs. I'm lucky in that after returning home, my x-rays, physio and acupuncture etc., have all been covered by employer insurance. That may have added a few thousand to the running total otherwise. While 70k is a decent sum of money overall, I think it is perfectly reasonable for the result that has been achieved and the various extra steps I have taken to either make life easier for myself, or to maximise the likelihood of a positive comeback. I imagine the total cost for bilateral tibias would be in the region of 5-10k extra.

BEYOND 5 cm: From now on, in addition to continuing with lengthening and stretching etc., I will also look to speed up bone recovery (beyond 5 cm, my early consolidation fears have disappeared!). To this end, I have bought various toys to help me along with the process (each used once daily) including:

• Osteotron/LIPUS: Supposedly will help speed up bone healing, improves bone quality and so, return to normal life
  Extracorporeal Shock Wave Treatment: Same benefits as for osteotron.
  Infra-red light therapy: similar benefits as for osteotron.
  TENS: I mentioned this before during lengthening and it helps massively with soreness/pain relief. But, it may not necessarily do anything for bone regrowth.
  E-stim acupuncture: Again, another that was mentioned during lengthening. I go twice a week. This is supposedly also useful for callous formation and growth.

Supposedly, these aids may decrease bone consolidation time by 30-40%! I thought it was worth splurging if it can help me save that amount of time. Hopefully it works.

I hope to update the diary with a successful lengthening conclusion in early October!

Edit Post

Hey, sorry if I missed this, but did you not do any follow-ups with Betz after leaving Germany? How many hours away from Betz are you?

Edit Post

Quote from: Want-3-inches on September 05, 2021, 01:37:03 PMHey, sorry if I missed this, but did you not do any follow-ups with Betz after leaving Germany? How many hours away from Betz are you?


Hi,

So I am 10-12 hours away from Germany. That was one of the big fears - having to traipse back halfway around the world in case of complications. But no issues yet!

For contact, I have Dr Betz's number, and I have messaged him sporadically, as required. He is always good about replying etc. But I haven't really had much need to contact him. I know what needs to be done. Now I just need to get on and do it. The last exchange we had was a few weeks ago, about x-rays and general progress. He seemed happy. I was happy.

I have also been in touch with the Betz Institute physio, Peter (probably more so than Betz tbh). Again, checking on progress, having sporadic video calls to check progress etc. Likewise, things seem to generally be positive in this regard.

Edit Post

Hi All,  

COMPLETION: This update reports on the completion of my bilateral femur lengthening journey at ~7 cm. This is beyond my original 6.5 cm minimum target. I reached ~173 cm on 23nd October 2021; a nearly 4 month-long process from surgery to clicking completion. 

STOPPING AT 7cm: While I could have continued and tried to reach 9 cm (the top end of my initial goal), the interference of CLL with my daily life(including work performance that I mentioned in a previous post), tiredness with the lengthening process, and the knowledge that risks exponentially increase as more extreme lengths are encountered, have convinced me to call it a day. In addition, while the first ~5.5 cm were relatively straightforward, the final ~1.5 cm have been extremely tough. It doesn't look like much on a ruler, or sound a great deal, but the difference in stiffness, discomfort and exhaustion is night and day. For example, knee pains, hip pains, cramps in calves etc. Slowing down to just below 0.5 mm a day helped a lot (i.e.; 9 clicks from 13 clicks), but I didn't see the value in pushing on, especially with all these new and unwanted issues suddenly coming up. For those that have gone on to 8/9/10 cm, I salute you! It is a phenomenal effort and test of will.

All those in my cohort went through the same decision process. One wanted 5 cm, and got around that. Of the others, we all planned for 9-10 cm at the beginning. One finished at 5.5 cm. I finished at 7 cm. Another finished at 7.5 cm. All simply reached a point where they were happy with the length achieved, all had excellent x-rays, and no major complications to that point. Once you pass the halfway point, you start to think about recovery and return to normal life etc. Most people don't see the need to push on  to the very end, especially as potential risks exponentially increase and the process continues to drag-on for months on end (I took it very slow and was the last of the cohort to finish lengthening). Also, if I really feel the need for extra height, I can always return for another 4-5 cm on the tibias (5'10" would be nice)! I have a few other things I want to deal with and invest money into first though.    

Now, most of my height issues are resolved - although I appreciate that many people would not consider my new numbers overly impressive, I am content. Also, I currently feel pretty good and have had zero major complications along the way(i.e.; no nerve issues, no numbness, no serious IT band issues, excellent bone health and regeneration etc.). I have been extremely lucky and it seems silly to push that luck just for a couple of extra cm – no need to be too greedy, nearly 3 inches is plenty! In addition, in my current state, I feel very confident that I can get back to my original fitness level (if not better!), which was one of my big fears before starting the CLL procedure. Again, if I continue lengthening, I may pass the elastic limit of the soft tissue, and so impair my physical performance forever. 

FUTURE: From now on, I plan to continue with stretching etc., but also incorporate more weight-bearing and other exercises in order to speed up recovery and rehab during the consolidation period. I will speak with Peter Woll, the Betz Institute physio, to develop an effective plan for the consolidation phase. My aim is to return to full function (minus sprinting and other extreme activities), by Xmas. I plan to stop using crutches asap, and move onto a walking stick for a month or so (more as a protective measure when walking among crowds), before I start to do away with any and all walking aids. 

I’ll continue to update the diary with my progress, and answer any PMs, although future updates are likely to be even more sporadic than my posts to-date! I hope that my thoughts, recommendations and the record has been/will be helpful to those considering the CLL journey. I’m very glad I went through with the process. I’ve had a blessed run with no major complications, and come out of the other side having exceeded my initial aims (thanks to the whole team at the Betz Institute for their facilitation and help along the way!). I only wish I had done this 10 years ago (either by having the means, or the procedure being a lot cheaper... especially as I was never willing to contemplate externals). I had few commitments back then and could probably have reached the very top end of the lengthening range, with little trouble. Still, better late than never!

However, it is not something that should be expected to change your life in one fell swoop - the change, while noticeable, has not been world-changing. I would suggest getting all your other life goals lined up/sorted as well, when planning for this procedure. I had a pretty good/successful life before the surgery (one that I am very keen to fully get back to), and I return to it a little taller, and with fewer height-related issues taking up my attention and energy. The larger benefits for me were from the longer-term preparation. Learning how to make, save and invest money. Learning specialist skills. Learning to work with and make the best of what you have, regardless of any shortcomings. Etc.  

Good luck to everyone on the journey currently, as well as those of you considering it. While the cost is steep (i.e.; financial, physical, mental, etc.), and every experience is unique (i.e.; pain, complications, length gained, etc.), it is something I have zero hesitation in recommending. You will come out of the other side a changed (hopefully for the better) person, in every way. Also, while I have no interest in fanning flame wars between acolytes of different surgeons, I would happily recommend Dr Betz and his whole team to those of you considering the procedure. I have been very happy with the whole process and felt fully supported and taken care of from the first enquiry, all the way up to now. But, do your own research and make your own informed picks! Although slow, I could not have asked for a smoother process with a successful outcome. I hope this continues into consolidation and full recovery.

Edit Post

Wow, what an ending man. I just wanted to say that I enjoyed your diary and very much appreciate you put this up.


I think this thread should've gotten more attention. Very well written out and great with the details. But it seems 7.5cm is more common now a days. Which is great for this community.

How has your height been treating you?

Did you ever get back your fitness level?(You seemed very confident about this one).

Ever considered the thought of going back for more?


Cheers bro

Edit Post

Hi All,

For the sake of completeness, and a couple of weeks shy of my 1 year operation anniversary, I thought I should post an update on my recovery progress. This is likely to be the last major update to this diary (although I may post again in a year or two when I have the nails removed!). Much like most others that have had this surgery, I've looked to get on with life and move on from the procedure - I rarely visit the forum and don't even think about height any more. Most days I forget I even had the procedure done! I love the fact that I have so much free bandwidth to focus on other, useful and more valuable things! Peace of mind has been my biggest takeaway from this whole process. However, during my planning phase, I liked to read on the progress of patients well after they finished their lengthening process to see how things panned out into consolidation and beyond. I felt that many diaries ended on a cliffhanger. As such, I wanted to bookend my experience and so provide a realistic overview and record of the full process.

AFTER CLICKING COMPLETION: So, I finished clicking in late October 2021. I am now ~7.5 months into consolidation and recovery. It took around a week after clicking completion for my body to feel the benefits/relief. It took me ~3 weeks into consolidation to get off the forearm crutches, and onto a single walking stick. After another ~3 weeks I moved (very gingerly and awkwardly) onto aid-free walking. However, the timeline is not smooth or linear. It is very frequently one step forward, two steps back. For example, one day I might walk the full day without any aids. The next couple of days, I would have to revert back to crutches, as my body betrayed me. This is likely because I was pushing too hard and too fast. In addition to movement, any other issues also quickly resolved. For example, I had some slight numbness on my right leg, around the knee. A couple of months into consolidation and that numbness etc., completely disappeared.

INITIAL BACK-PAIN: The biggest headache, beyond the legs, for the first ~6 weeks of consolidation, was the excruciating lower back pain. This involved huge amounts of tightness and pain after walking relatively short distances. The first few weeks, I needed to sit after a couple of hundred metres. The distances between walk-rest gaps slowly increased with practice.

MUSCLE MASS RECOVERY: Excepting this back issue, everything else improves extremely fast into consolidation. My thighs and glutes have rapidly recovered their volume (and may even be bigger than before!), so much so that the tibias look a little small bulk-wise, next to them. The legs also feel extremely solid, muscle tightness is mostly gone and the speed and stamina during walking have also returned (although quickly changing direction etc., is still not all that smooth or fast). Walking up stairs is completely normal and fast now, although going downstairs is a little trickier, but still pretty good.

WALKING SPEED & RECOVERY: So, 7.5 months in, I would say I am pretty much back to normal walking including the speed. I still cannot run yet nor can I fully sit 'seiza'-style, with ass to heel, but very light jogging for ~50 m bursts has been possible. Nevertheless, I am generally happy with where I am at, within a relatively short recovery period. It is not as fast or as comprehensive a recovery as I had first hoped, but perhaps I was being unrealistic with my plans. Truthfully though, I don't think I will be completely back to normal until the nail is taken out. But that is still some time away. So to clarify, I am still not back to my original fitness level, yet.

AESTHETICS: In terms of aesthetics, I think the longer legs look great and not at all weird/abnormal! This is likely because; 1) My femurs (and femur:tibia ratio) were relatively shorter to begin with; 2) I didn't lengthen an overly abnormal amount (~7 cm), and; 3) Once the muscle volume comes back (my thighs were always pretty meaty), it all starts to balance out very well and look extremely natural.

CONTINUED PHYSIO & RECOVERY: With respect to physio and activities; I am doing a variety of things (pandemic restrictions did delay many of my intended recovery plans, but things have opened up this past month, so thankfully faster progress is being made). For example; 1) gym twice a week - every day is leg day, and; 2) single weekly sessions of yoga, pilates and alexander technique. All those focus on alignment, posture, stretching etc. Learning to walk and reorient yourself properly again is important and there are various bad habits that are picked up during lengthening (e.g.; feet pointing at weird angles during standing, etc.) as well as due to tight muscles and imbalances. I would strongly recommend practicing movements in front of a full-length mirror to regain movement precision.

RESPONSES FROM OTHERS: With regards to people's perception of the change, honestly, there has been very little so far! Apart from a couple of weird looks from one or two people, most of the people I've met have not noticed a thing (or if they have, they have not voiced their opinions). There might be a few reasons for this (beyond people simply keeping their reservations to themselves for fear of sounding silly...);
1) I kept my gain to a relatively sensible amount;
2) I was always relatively broad and well-built. So perhaps they simply see the difference as weight-variation in bodily dimensions;
3) Perhaps we overestimate how closely people pay attention to us - everyone is wrapped up in their own worlds and have little bandwidth to spend on others, and;
4) (Most likely) More for the sake of foot and leg health, I have been wearing various types of 'barefoot shoe' since the operation, which does otherwise rob me of ~1-1.5 inches of height from standard boots/trainers etc. Thus, the height change that others observe is far more modest than the actual gained. I plan to re-start wearing boots and other footwear styles in a couple of months, although I am now extremely fond of the minimalist style shoes (and also have no fear about wearing them!) - my feet, ankles and calves feel fantastic and it forces you to adopt a more 'natural' gait! In addition, I have also found it liberating to not constantly have to worry (perhaps pointlessly) about what I wear (clothing and footwear) and how tall/short I appear. I've also thrown out many of the ugly shoes I used to wear simply for the fact that they would give an extra couple of cm or so, of height (I never really got the hang of lifts as they gave me painful calf cramps!).

More generally, apart from quizzical looks and brief questions initially, I honestly doubt if most people will truly notice the change if it is kept conservative. The only people that I am certain will notice (and have zero fear asking/berating me about) are my parents. Due to the pandemic, I haven't managed to see them since the operation. That will change soon and I am interested to see/hear their reactions!

TIBIAS(?): For the general outcome, I am extremely happy and very glad that I finally did the procedure. Would I consider tibias in future? Never say never - I know I would be very happy with the end result, based on the positives from the first procedure. But, realistically, I don't think I could (or would even want to, should the opportunity arise) use so much of my life, time and energy on another procedure like this. It takes a lot out of you, and there is a lot of time, social, professional etc., sacrifice required. From my original height, the price of all those sacrifices was worth it. From my new height, I'm not so sure... Life is short. There are lots of things to do. I can't be forever ruminating and investing in this one aspect.

SCARS: Finally, a note on the scars. While I am not that bothered about the scarring/skin discolouration, I found the deep pits (~3 mm depth) at the hips, a little off-putting - it was more pronounced on one side than the other, but both were still a little unsightly. I imagine this pitting would be worse and more numerous for those that use externals. While I appreciate that these same openings will be re-used for rod removal, that is at least another year or two away for me (I don't want to remove too soon). So, I decided to get the pitting treated. The dermatologist recommended HLA injections as well as Fotona laser skin treatments. Together, they helped fill out the pits and apart from the scar/discolouration (which has also been reduced), you can barely see any other artifacts. Again, many of you will see this as pointless, but for those that have had externals, you might want to use the same protocol, to fix any of the more numerous and apparent skin pitting issues fixed using the HLA and laser treatment combo. It worked really well for me, although it is not cheap...

CONCLUSIONS: OK, I think that wraps things up and brings the diary up-to-speed. I think the improvements from now onwards will be far less marked and really, only perceptible to me. Hopefully, things will continue moving forward smoothly. Thanks for following my journey - I may update again in a couple of years. Good luck to you all!

Edit Post

加油