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Posted on Oct 28, 2021, 9:57 pm
#1
I did Limb Lengthening last month and I decided to create a diary because I did 5 weeks in Athens and came back to USA. This is for those who cannot stay 3-4 months in Athens so they will know the experience of someone who did not stay. I am in University and just finished midterms so my posting time is behind schedule.

I had surgery 14 Sept 2021.  I am 20. I started at 176 cm and will go 8 cm and maybe 9.  I will wait until I reach 8 until I decide. 
I started with a free 15 minute consultation with Giotikas before he had GNail. I found out through this forum (V21) that he had GNail. I then paid for an hour consultation once he had GNail. One of my concerns was the pain control.  He told me that U.S. doctors don't want to lose business and they want us to think they have better pain control but the European doctors have the same medicine the U.S. has. Another concern was I could not stay 3 months in Greece.  He said I could stay 5 weeks which was the minimum, although his preference was for all to stay 3 months.  I think Dr. G is pretty business savvy to come up with this idea to a nonexclusive license for use of GNail.  Too bad this wasn't done in the U.S. but probably due to the FDA and all sorts of medical device clearing procedures that might take years (this is just speculation).

Prior to this it was my plan to do Precise with Dr. Assayag in the U.S. My family was very impressed with his standard of care, reputation and abilities. One of my parents is paying for the surgery.  Something happened that the surgery did not occur in early July in Maryland and all future dates before school started were booked. So with my school schedule I would have to wait until December or January to have a schedule that would allow me to be non-weight-bearing again. So I decided I wanted a weight bearing nail. I still highly recommend Dr. A.

I tried Betz but he had no availability until January. I was concerned about weather and possible changes in January due to COVID and Delta Variant that could cause a cancellation. I paid for a consult with him as well. I did not want Guichet because of the requirement of a 3-4 month stay in Italy or the UK (also at the time no real positive reviews to speak of).

Due to the late change of plans - finding out about GNail in August and trying to get there in 4 weeks, many airbnbs were booked.  We could not find an acceptable one in Peristeri.  We wanted 3 br, 2ba.  We found one in Athina that we sent to Giotikas office and they said it was close enough.  It was about 12 minutes by taxi and 4-6 euros. Definitely close enough. We would eventually move from that place due to the size of the elevator, neighborhood and other things.

The hospital is in Glyfada so maybe if you have family spend the first week in Glyfada. Because we didn't know this, my family paid for another place to be close to me during my hospital stay. The anesthesiologist asked me if I am prone to get seasick.  She said if not, I should get an epidural/general anesthesia combination because it would be better for pain.  She made me feel more comfortable about surviving the surgery, so I agreed. The surgery was scheduled for 1:30 pm. The day before I had xrays, filled out paper work and took a COVID test.  On surgery day,  I got there early - about 11:30 and they put you in this ultrathin see thru hospital gown made of blue paper. Another nice older gentleman who had back surgery was in the room. I was nervous but my family being there helped me out.  The anesthesiologist gave me pills for my nerves so that I would sleep.  They rolled me to the operating room at 2:30.  My family said Dr. Giotikas called them at 10:00pm to tell them I was okay.  They were near panic.  He said he put the nail in one of my legs but it wouldn't click so he had to take it out, make sure it would click and then put it back in.

I appeared back in the hotel room at about 11:00 pm.  I asked my family if the surgery was almost over.  My family went to check in to the Bomo Palace Hotel to be close to me although we had the airbnb in Athina it was 30 minutes away.  By then I was vomiting.  No one told me how to call the nurse. I think the person next to me called the nurse.  She put some kind of pad on the floor and told me to turn over and vomit on the floor.  She didn't return and I vomited nonstop with stuff going everywhere.

My family returned about 1:00 am and cleaned up the floor and the bedrails. They asked the nurse for a garbage bag or bucket for me to vomit in.  The picture is right after my family cleaned up and I threw up again (didn't attach I will get an imgur acct).  Eventually the nurse came back with a small bed pan for me to vomit in. This was much more sanitary.  Otherwise vomit particles were spewing throughout the room.  Most nurses were annoyed at any request.  There was no machine monitoring my blood pressure or to see if I flatlined and the nurses didn't come in unless you called for them.  Certainly even when you called, they usually didn't come. Family was not allowed to be present if they injected me with anything.  It was like they wanted to eliminate any evidence if they committed malpractice.  While Dr. G was good, the majority of the nurses I encountered were without compassion or care, including the hospital head nurse (different from the homecare head nurse).  Perhaps they are overworked and very underpaid. Either way it was a factor that I had not properly considered when I decided to have surgery overseas.  I could not imagine I would not have flatline monitoring. I would not go back to that hospital to be treated by those nurses. Because it was so late, no walking that night. The next day, Dr. G came with a hospital therapist and tried to get me to walk.  I nearly passed out so he said he would come again.

After a day of vomiting  without leg pain, the nausea stopped and excruciating pain came.  This was the 16th and I ate a little for lunch. I was being given paracetamol (tylenol) by IV and it wasn't doing the trick. I could not sleep more than 30 minutes due to the pain. My family was timing it. My family had to go get the nurses after sufficient time passed to get me more medicine. No one came otherwise. More pain than I ever experienced. The doctor came again for me to walk.  I was out of bed but I was so weak.  The Dr said I needed to be stronger and I wasn't trying hard enough.  My family said I spent a day throwing up, I haven't eaten much and I was in pain.  The dr said maybe it was jetlag.  Either way, I threw up again about 5 minutes after Dr. G left.

By the third day, I was able to eat and able to get out of bed and walk.  I still had a lot of pain but Dr. G showed me how to go up and down the stairs and use the walker.  I walked up and down the hall and did the stairs. They followed me with the wheelchair because they were afraid I would pass out but I didn't. I believe it was this day that Dr. G showed me how to click. It didn't seem too bad. I couldn't wait to get out of the hospital.  One family member slept in the room with me on the chair or floor every night.

On the fourth day, Dr. G showed my family how to help me click.  The left leg seemed easier.  Still it didn't seem too bad at this point. The first click is loud and kind of a shocker at first. On the right leg, the loud click first and then the light reset click.  On the left side the light click first and then the loud click is the reset click. The anticipation for the loud click caused some anxiety. When it was time to check out, I met the homecare head nurse and she had a nurse working with her, with a car big enough to take my family and I along with the shower, chair, walker, crutches and wheelchair provided by Dr. G's program, to the airbnb. That was a relief because having to take a taxi would have been hard. More to come.
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Posted on Oct 29, 2021, 1:10 am
#2
Images
Hospital Room
https://i.imgur.com/W8tPcpj.jpg

Legs at 1 month
1 https://i.imgur.com/c2Y5k1U.png
2 https://i.imgur.com/xdBwNF1.png
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Posted on Oct 29, 2021, 2:22 am
#3
Hi Bro, congrats on your LL, certainly it's not for the faintherted! 
I can't help thinking that you might have already been prejudiced against Giotikas because it was not your first choice (you mention Assyaag and Betz as your first and second choice respectively) and then you became a bit paranoid with everything that was happening there .I am saying this because I've been an inpatient or visitor at hospitals in the US and UK a few times myself and never saw flatllne monitoring in the ward, only in the ICU. Also it is common that visitors leave the ward when ward rounds are done or the nursing care is provided.  Maybe Dr Assyaag can tell us more about his hospital here.

Anyway, I understand that everything is alright for you now and your x-rays look good, so good luck and have a quick recovery.
(PS How on earth did you manage to convince your family to allow you to do LL  at 176cm starting heigght? I could use a little help here bro! GNail with Giotikas 5 Weeks in Athens )
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Posted on Oct 29, 2021, 8:38 am
#4
Hi bro, how's your overal experience using G-nail? Do you have problem clicking? Is clicking painful?

I heard that some need clicking under anesthesia. I am considering between Precice or G-nail. Anyway i wish the best for your LL journey
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Posted on Oct 29, 2021, 12:12 pm
#5
I am not prejudiced against Giotikas.  He was not my first choice because I live in the U.S. and he only had nonweight-bearing nails - the same nails as the US doctors.  Why would I go to Europe to get Precise, when there are excellent doctors here that do it?   I wouldn't do it to save $10,000 because it wouldn't be worth it to me. Not liking the hospital, which is a common experience among others I spoke to,  doesn't mean I have anything against him.  As I said I think he is a good doctor.  Also where I am from in the U.S (that includes two states) when you come out of surgery, you are hooked up to a machine that monitors your blood pressure and pulse constantly. Thus when you lose your pulse, it knows you flatlined and beeps and the nurses run in. Even those in the ER are hooked up to a machine. Also from the Betz diaries, it seems they are hooked up to a machine that monitors their blood pressure. I will explain my clicking next but no I never needed clicking under anesthesia.  I just haven't finished writing my diary and my recommendation of Dr. A was not meant to imply that I do not recommend Dr. G. I went with Dr. G - just saying that because I chose him didn't mean I didn't like Dr. A.  In fact I also liked Dr. D in Nevada.  I definitely recommend Dr. Giotikas so far - of course I haven't finished so things may change.

As far as the surgery at my height, My father is about 196cm and my mother is the most compassionate person on this earth.
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Posted on Oct 29, 2021, 1:00 pm
#6
So mentally prepare yourself for the clicking for the first few weeks. 

We were sent home with deepon, tramal, vitamin D liquid for once a week and lyrica. At surgery Dr. Giotikas provides the patient with 1 cm. On Sunday (surgery was Tuesday) was my first day clicking - 3 sets of five.  Someone in the family helped me do it the way we were shown in the hospital for the first set.  The left clicks were quite easy, though not without some pain.  The pain level on the loud click was about 5 and then it subsided.  Clicking caused great anxiety.  For the second set, we could no longer get the right leg to click as we had just done it 8 hours earlier.  So we looked up videos on Youtube and found a Betz patient video.  We were able to get it to click in that manner.  The left leg I could click without assistance from family.  So we used that method.  At that point, we realized that I may click one way and then not be able to click that way the next time, so I decided to click twice a day, 1 at 8 and the next at 7.  I went to PT on Tuesday.  The PT was good.  It was small but had all the equipment plus more. It had an AlterG and you get to meet and talk with other patients.  The PT staff are excellent and just very nice people.  I had clicks on my left leg during PT.  I just logged them in my spreadsheet and reduced the number I did at home. PT really work on Range of Motion (ROM) exercises.  They push you to the limit and it is painful at first.  I am much more flexible because of it.

From PT accidental clicks, I learned that if I attempted to lay on my right side and bring my left leg to close on top of my right leg, I could click my left leg pretty easily.  So I started doing my clicks on my left leg that way.  The Betz way stopped working on my right leg. We searched another video on Youtube and found Guichet patient videos on Dr. Guichet's channel on how to click 2 ways, 1  with a couch cushion and leaning on a stool.  I then began to click my right leg leaning on the walker with my right leg on the bed.  This worked for a while.  The Guichet video was instrumental in understanding that the Albizzia nail prodigy were not made individually for each leg so that the right leg was almost always harder than clicking the left leg. Clicking got increasingly painful and harder.  A little before 2 weeks, Dr Giotikas sent a text to take ibuprofen for a number of days and increase clicks to 21. I got the ibuprofen from the PT clinic. I though, after the first few days, could do my clicks without assistance from anyone but there was always  anxiety and pain. I needed encouragement to do it otherwise I would procrastinate. I should mention I also take ZMA and before the surgery I took a blood builder iron pill.

I still dislike clicking but it is much better.  Now I do the right leg on the couch or sitting on the bed with the right leg bent up beside me and push my thigh or knee forward until it clicks. Deepon never helped.  Tramal made me vomit (always take it with food). Advil actually helped.  My family brought ibuprofen with them so I was taking it before it was provided because of V21's experience.  I understand it may affect bone growth so not too much.

My first appointment was 10/4 and I was 21 mm on 1 leg and 24 on the left.  I don't know how that happened.  Dr. Giotikas said that was about 45 clicks difference. He had a margin of error of+-1mm though. Anyway by time I was to leave they were about the same. I left 10/15.

On 10/6, I received the foldable forearm crutches I bought from amazon.de.  The ones I ordered in September from amazon.uk never arrived. The forearm crutches were a game changer for my mobility. I left the american style crutches at PT for them to donate.

I came with a massage therapy gun, a tens unit, urinal and a narrow comfortable raised toilet/toilet riser set. I left the toilet at the PT to see if another patient wanted to have it.  https://www.amazon.com/gp/product/B07TSFX9PL/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&th=1

Things a weight bearing nail allowed me to do  while in Greece, I toured the Acropolis and Parthenon, the National Museum, saw the guards changing, first Olympic stadium.  I also went to Santorini for 3 days flying Aegean air.  Flights are must cheaper in the offseason.

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Posted on Oct 29, 2021, 1:18 pm
#7
Throwing up is very common after surgery. I am really surprised the nurses weren't prepared to help. To ask a patient to turn to the side and throw up on the floor on a pad sounds unbelievably bad. Maybe there are underpaid as you said.
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Posted on Oct 29, 2021, 5:01 pm
#8
According to reports, Greece's economy (like many other countries including some US states) is having some difficulty so that is certainly a possibility. It could also be that the nursing staff had not planned for someone coming out of a planned surgery at 11pm. At least in the U.S. you have to show up at some ungodly hour in the morning for surgeries - like 6 am and the hospital is fully staffed.  When I came out,the  hospital was probably not fully staffed. I learned later that 1 LL patient had gone before me that day.
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Posted on Oct 30, 2021, 7:16 am
#9
I see. It seems like it's going to need some experiment with clicking. Compare to PT session, which one more paintful, clicking or PT session?

Can this clicking problem be solved by asking a nurse to come to our home everyday to help clicking?
It would be anxious and painful if one day we tried many position for clicking but it's always failed. Have you ever experienced one day you always fail to click until the next day?
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Posted on Oct 31, 2021, 3:11 am
#10
For me, the nurse is not better at clicking. They are new to Gnail as well not like Guichet's nurses who probably have done this for years but maybe by the time you are there they will know more.  My most painful clicking was the one time at the PT with the head nurse.  I have been always able to click and after the first few days without assistance from others. The PT pain is like the pain of working out hard where you decide to endure it to reach a goal and it lasts for the 10-20 seconds they keep you in a difficult position, rest and then repeat. It is not something that caused me anxiety.  They also have this equipment to make your legs feel better before you leave. PT pain gets less as the flexibility increases.  The clicks are worse than PT. 

There are those who come alone that pay for a nurse to help them click twice a day.  I found the videos on the internet instructive enough so I could do it myself (of course I have family too but I do them alone and log them on my phone).  Now they are pretty easy - still some pain but  bearable.

There was a day or two  where I procrastinated, fell asleep and failed to do my second set of clicks so I had to do 10 and 11 for a few days until I caught up. It was not though that I was unable to click.  In those early days, I always found a way to click even when we had to to different methods.  Once you get the first click, you are golden the rest come easier.  PT owner recommended heat therapy prior to starting the clicks.  He said hot towels if you didn't have a heat pad.  Others recommend bike riding.  I also have had no problem sleeping since the first few days. I did take melatonin and zma just in case though to avoid a problem.

I made videos of myself clicking any time I was successful so I could remember the positions and the different ways I do it.  If I had difficulty one day, I would look at a video and get it.This is only for first 2-3 weeks, now of course, it is not necessary.

At this stage of 1.5 months, I can really see the height difference.  It feels good.  My family sees it but I have visited many friends and they don't even notice. 
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