Fitbone Stage Right Tibia Lenghtening (Dr. Monegal), Barcelona, Spain

Background: This is my second CLL surgery. I have done bilateral femur with Precise2 nail with Dr. Paley in St. Mary’s hospital, West Palm Beach, Florida June 3rd, 2014. It was 13 and half months ago. I was back to normal. Playing tennis actively in last month or so. Played few sets of single sometime but barely able to run far.  I have not gotten back the explosiveness partly the rod inside the femur and it was only a year ago I had surgery. But given the progress I had no doubt I will be back to 100% in six month or year after. Life was normal only taller. I did about 6.5 on right and 6.9 on left to correct the few millimeter discrepancy. I was conservative and only wanted to do 7 on femur and 6 on tibia. I cannot thank enough Dr. Birkholtz for his contribution to this forum and the immense knowledge poured to this forum. Because of his note & comment, I am sticking with conservative amount of lengthening. I would avoid any risk of losing athletic ability. I always remember the Dr. Birkholtz saying what good is the long leg if you cannot use it. I wanted to do this surgery with him but he is far away and internet was not strong. I am working while lengthening. Also, Dr. Rozbruch wanted me to do 6.5/6 femur/tibia during my consultation with him. It was planned for long time!

Dr. Inan: I met Dr. Inan in Istanbul February, 2015. He is very cool doctor. I personally liked him. Was planning to go LON external with him.  Plan was stay in Turkey entire time and come back to US after nail removal. He could have been good option for external LON.  I met ChrisIssac and Trail Blazer while I was there. Had great time in super cold weather . I have personally met Dr. Rozbruch, Dr. Mahboubian and obviously Dr. Paley and his elite team. Asked me if you any questions regarding any of them.
Why Dr Monegal: I was searching for cheaper internal nail option.  I found about Dr. Monegal via forum few months ago. I immediately emailed him with lengthy questions to my surprise he responded promptly. I was impressed. We have about 20/30 email exchange. My short listed doctors were Dr. Birkholtz, Dr. Inan, Dr. Lee and remote possibility with Dr. Salemeh.  I finally picked Dr. Monegal because of below reasons:
1.   Spain is in heart of Europe.
2.   Strong internet connection. Important for me.
3.   Saw his video with other doctor on fitbone presentation.
4.   Had published and presented LL case in seminars
5.   His response to my question were reasonable
6.   Other LL patients in hospital and at St. Jordi. You do not want to do this journey alone.
7.   Cost

On side note: I had four hours transit in Toronto. I was in train to downtown to pass the layover time and have a lunch. I decided to call a guy who did the femur with me last year. Within 45 minutes we were hanging out together in downtown. Can you believe that? He was super happy to receive me. Only complain why did not I notify earlier or come a day before blah….blah….blah. We only had an hour but we talked every freaking second of it. I meant it. So much to catchup. It was short but memorable one!

July 12th: Arrived at Barcelona took a cab from Airport to St. Jordi and the fare was about 31 Euro. Very hot and humid. First time here so looking out to distance to glance bits and pieces of city from the back seat. I crashed first few hours and took a shower. Checked my email and Dr. Monegal emailed me patient info who had stayed in at St. Jordi. We met and talked about an hour. It was about 6PM and I was very hungry. We had a great starting conversation we were engaging decent LL conversation but I had to leave for food. He did bilateral femur and so far looked great. Walking fine, muscle flexion and extension looked good. I reviewed the x-ray and looked phenomenal. It was encouraging for me. I then met another patient who is doing cross lengthening with fitbone. He is from South of Spain and I could not communicate to him. But seems very happy with the process and was smiling and happy. I can tell what it feels getting taller and realizing the DREAM!

July 13th: Met Dr. Monegal in Barcelona Hospital not Diagonal Clinic. He looked much younger than I thought. Kind of reminded me of Dr. Mahboubian. He was supervising surgery that day at the hospital and lot of doctors were popping in and asking him questions in Spanish. He checked my flexibility and we are set for next day. We talked briefly about 15 minutes. He went over the process which I kind of knew already. Shook hands and parted our ways. Then I took a train to down town. Hop in tourist bus both red line and blue. Total of 3.5hours. I was looking but barely looking. Mind was all focus on big day, concerned about the surgery and did not enjoy much as one should have. I liked what I see though. Had big appetizer, steak dinner and desert and three glasses of wine. More than I normally eat. I have late schedule surgery and wanted to make sure I ate enough or more to fight it next day.

July 14th: THE BIG DAY!!!!!!!
I took a cab from St. Jordi and I think I paid about 25 Euro.  I was asked to come at Clinica Diagonal at 9 to meet Peppe. I never met the guy instead I was helped by Mariano (lady communicator). Most staff speaks very little English. In order to have decent conversation you will need translator. But Dr. Monegal speaks fine English. Hospital looked great. No less than what I have seen & heard in this forum and comparable to western standard. Did the blood work, EKG and x-ray of my right tibia. The surgery was scheduled at 3PM. It was kind of late for me. I had not have any food or drink from the night before. I was getting hungry around 1PM. I told Mariano half-jokingly I might fall down and if I do put me on stretcher and take me to surgery room. I am not turning back . I have so much time to kill. I met three other patients in the hospital.

#1: Paco1 doing second tibia surgery. Man, I loved his family. We had exchanged PM he knew I was coming in town for surgery. What a family he has. Seriously I have not seen anyone that happy before in my life. Mom and dad was talking me in Spanish knowing I would not comprehend. They want to tell me so much and poor Paco would translate word or two for me. My spirit was high up seeing such an enthusiastic and positive energy in the room.

#2: I met another male patient from Barcelona doing second femur. He was very happy with procedure so far. Muscle flex were great and we talked for 30 minutes or so. We exchanged email and promised to meet after I leave hospital for drink and hang out. See how that goes. He left the hospital next day.

#3: Then I finally met our beloved musicmaker. She is a trooper and smiling most time. She and I had exchanged PM in forum and expecting me. I have utter respect for female doing CLL. I met a few in Florida last year and till date we communicate every now and then. Promise to meet someday and have a few glasses of wine perhaps few bottles!!! We partied almost every day in West Palm Beach. It was like college life. We had blast and I really meant blast. I spent about 80 days and it was best part of me. I will never forget and meet some good people.

I met Dr. Monegal and his team right around 3PM. A young nurse saved my leg and they put me in IV and I was ready to go. This is it. I told Dr. Monegal I AM ALL YOURS NOW and he smiled. I was bit nervous and thought no way going back now. My life will change forever. I have same school of thought when I did femur with Dr. Paley last year. I was very nervous right before anesthesia process both time. It was last awakening breathe before I voluntary break my nice looking bone in exchange for couple inches gain. I knew in my heart I have to do this. Otherwise it will hunt me as long as I live. I was thinking about tibia and searching for the doctor since January of this year.

Around 3:30 they took me to OR. The OR looked very modern like any hospital in US. Then I do not remember anything. Passed out and in deep sleep. I wake up around 9 I think. It was late not sure why that late. I have to ask Dr. Monegal regarding that. Least concern so have not followed up on that.

First Night: I was brought to my room. I immediately ask nurse to bring my laptop bag. I got few things to get done --work related stuff. I worked for an hour or two. To remind you I worked 8 hours on my day of femur surgery and was hoping to repeat same here. However, I felt sleep after few hours. I wake up and asked for food. The nurse did not allow me. She insisted I cannot eat before 2AM which was hour away. I think it was the protocol. Back in St. Mary’s hospital I was given food as soon as I get to my room and I ate but throw up right away. So it did make sense to me.

I was in pain around 3AM.  Sensational burning pain never had it before, not even when I broke two femur bone same time last year. I was vehemently worried and paranoid. What’s going on, was there any mistake, something wrong, irreversible mistake of any kind? Dang, I was so worried. Being alone, first time in the country and barely speak the language. It was toughest moment!!!!!!!!!!!!!!!!!!!!!!!!!

I called the nurse and they may have not fully understand the magnitude of the pain. I specially told them I have done this sort of surgery before and pain is not manageable and tolerable. And I am not a CHILD. If I say I am in pain than I meant it. All hale broke loose that night. I was different person and I might have cursed out. Which is not normal.  I was in severe pain from 3-7AM. The nurse tried the tramadol with me but did not buzz. I felt my body is rejecting the narcotic for some reason. The pain killer have zero impact. I felt miserable, devastated and very lonely!!!!  To add insult to injury they had forgotten to put catheter at surgery table. They put it on my bed while I am coping pain. It was five minute process but my god the timing. It was like Murphy law!

Finally Dr. Monegal showed up around 7-7:30. I have emailed him I was in severe pain most of the second part of the night and called him around 7AM. Did not want to wake him up early. He picked up the phone and came to hospital right away. He was shocked to see my pain level. He told me he has never experience anyone at that pain level before. Paco1 did the same surgery few days ago second one and he perform exactly same and he is doing just fine. I must be the unlucky patient. Why me???

May be almighty was sending me message that one segment lengthening was enough. This was not necessary. Dr. Monegal immediately asked me if I feel pressure on my left and my answer was BIG FAT YES. I had bandage from my femur to ankle wrapped around from the surgery. He cut the bandage out. AND THAT WAS IT. THE PAIN WENT AWAY JUST LIKE THAT. The pain starts subdued in no time. Less than 2 minutes the pain level dropped to manageable. WAS IN BIG RELIEF. I began to feel much better. My muscle has swollen so much the tight bandage was pressurizing and generating sensational burning pain. I wish nurse knew this and helped me. Preventable pain but no one knew except the doctor. Such an unfortunate event. 
I have read many diaries especially from India/Russia/China where patient goes through 10/10 pain. I never understood until this moment. The bright side is I get to experience firsthand.

 After the bandage removal my experience has been very smooth ride so far. Dr. Monegal told me everything went PERFECT and I believed him. I reviewed the x-ray and looks great. The issue was not with the surgery technique but pain management and a simple issue of bandage removal. Obviously it’s been only 5 days. Time will tell more and promise to update.  4 golden days and 1 very bad one!

Day 2: Dr. Monegal texted me with couple good news. He talked Precise representative and told me he can extract the nail. He had mentioned before coming into surgery that he will not charge anything but I have to pay the rental fee for the extraction tools. He was very worried about me. He was calling and texting me to make sure I have no more pain. Directed me to call him directly if needed. I was moved by his caring spirit. It meant lot to me. He is the sole reason I am here and I think he understood that very well. I did not tell him that. He said and I like to quote, “I will do anything for my patient.” He really meant it and I have not seen any slight indication not to believe that. He visits me every day. Mostly twice a day in the morning around 9 and after 5/6pm.

Day 3: Everything was normal pain level 0. I was working each day few hours. Then I would watch TV, check out social media etc. I was feeling good. Pain level 0 or 1. Two times therapy in hospital. Food is great and nurses are attentive. But may be language barrier issue but few of them speaks at communicative level. Walked few steps on crutches with physio help. Slept well at night without pain.

Day 4: Catheter and epidural out. Game changer and starting to feel getting back on life.  Pain level 0. Took good long shower, comb hair put nice perfume and head back to bed. I changed hospital gown and put on own cloth. That gave me the impression or feeling that I am back and I am starting to take control and independent. A big psychological boost. Start flirting with nurses, a typical me . Took a long walk about 100 feet on crutches on my own. A small milestone. Worked little bit. Had a nice dinner and watched old movie in youtube. Slept about 2 hours during the night but had 4/5 hours sleep during the day.

Day 5: Feeling much better each passing day or even hour. Pain level 0.  Took shower, worked little bit, surf internet. Today is Saturday and only one physio session. Took a long walk about 300 feet. Feet is swore and stiff today. Dr. Monegal came in the morning, he left early to buy a car and promised to come back and show his new ride. He is pretty laid back. Comes and lays on my sofa bed. Makes me feel very comfortable. He is very caring and upfront and serious about patient well-being. Two guys same age. We started to converse like buddies now.  One breaks the leg and other one accepts it and calls him a friend. What a world we live in . He took me to parking lot and show me his new baby. We are now beginning to interest on personal stuff and sharing a lot of life experience. We have plans to hang out when I get strong and back to St. Jordi.  I have requested vitamin D and he brought me two bottles today for 2 month supply. So far so good. My leg has swollen quite a bit but significant improve lately. Very happy with the progress so far. Live from Spain, Arios and see you minanya!

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