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
Dr Assayag - Quad Patient - 4.5 cm femurs, 3.5 tibias - Dec 2022
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.
Thank you! I'm in my late twenties.
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.
I will get to all the questions, including the one about height dysphoria.
Blood thinner: Dr. Assayag did prescribe Xarelto for 30 days after surgery (I think). I ended up not taking it because I was already taking a lot of blood-thinning supplements and herbs, like cod liver oil, and I was going to the sauna a couple times a week, using a calf massager and heat pads, and generally moving my legs throughout the day (but without any weight bearing). Note, I didn't tell Dr. Assayag this and he didn't sign off on it. You should follow your doctor's instructions and take the medication as prescribed. I'm not a very good patient I guess 
PT: I did PT sessions every two weeks at Sinai Hospital whenever I would go there for X-rays. Those sessions were quite painful and, to be honest, I didn't feel like they were particularly helpful because the stretching effect would quickly dissipate. I also did daily sessions with my dad, who was staying with me, for 15 to 20 minutes once a day. This was a lot less than recommended but I never had the motivation to increase the intensity because when I would go to PT they would say that my flexibility was fine relative to the stage of lengthening that I was at. I wasn't trying to circumvent the traditional protocol, but things just ended up that way because I wasn't able to find a local PT who was familiar with the leg lengthening process. I can talk more about this if it's interesting.
Now that I can weight bear as tolerated, I've been doing PT twice a week locally. The PT is focused only on muscle strengthening as my flexibility is pretty normal. I feel like those sessions are helpful because they force me to do squats, lunges, etc., but if you're a disciplined person and can commit to doing those exercises by yourself, the formal PT sessions aren't strictly necessary at this point. My insurance is covering them, though, and the copay is only $9 per visit, so I think it's worth it.
Bone healing: I was full weight bearing two weeks after I stopped lengthening, on both legs. My bone healing was indeed faster than usual. This was probably due to various factors: 1) I was eating a big calorie surplus, including high-calorie Ensure, and I never lost weight after the surgery (in fact I gained weight). This was a good strategy as I quickly lost the extra body fat once I started walking again; 2) I didn't use opioids or NSAIDs, at least not consistently, just Tylenol; 3) I took a lot of supplements that have research supporting their use for bone formation, like Bone Up and cissus quadrangularis; 4) I went to the sauna and used heating pads throughout, which theoretically enhance angiogenesis and bone healing; 5) I lengthened the tibia at 0.5 mm/day and the femur at 0.75 mm/day for the first half and 0.5 mm/day for the second half of the process.
Nerve symptoms: I didn't have any nerve symptoms on my left leg. On my right leg, I opted not to do a prophylactic peroneal nerve decompression (as I'm a stubborn patient), and I ended up getting partial numbness on the outside of my leg and top of the foot. Those symptoms have improved considerably since I stopped lengthening. I think I've regained full sensation in about half of the previously numb area, and the areas that are still partially numb are probably 60 to 70% recovered. It hasn't even been two months since I've stopped lengthening the right leg, so I do think my nerve will make a full recovery. Even if it doesn't, the partial numbness isn't bothersome.
I didn't get nerve pain, maybe only a little bit, but this reminds me: Dr. Assayag prescribed gabapentin for the restless legs syndrome that I had in the first few weeks after surgery. I took it for three weeks, but I feel like it didn't help at all for that symptom, and it was difficult to taper off of. If you look on Reddit, a lot of people say that gabapentin withdrawal is worse than opioid and maybe even benzodiazepine withdrawal. So, if you get nerve pain, my advice is to first slow down lengthening and/or take a few days off, rather than go on gabapentin. For restless legs syndrome, I found quinine to be super helpful. I think its use is discouraged in the US for some reason, but it worked really well for me. And I think time and healing will take care of RLS in any case, so you shouldn't feel panicked if you experience it.
Regrets: I definitely don't regret doing this--I think it's one of the best decisions/investments I've ever made, only second to corrective jaw surgery. It cost me about $90,000, which is relatively cheap, and I was able to get paid medical leave at work. I regret the fact that I spent a lot of mental energy being anxious during the process, browsing this forum, and waiting for things to get really bad, which they never did. But it's easy for me to think that way now that I'm close to the end and everything went well.
Quote from: informationispower on May 15, 2023, 05:15:19 PMSorry 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?
I feel like I could write a memoir about these issues because they're so involved and intertwined with my life history. I was always one of the shortest people growing up and that took a toll on my confidence, but I think I've done a good job of living my life and doing the things that I want without letting that affect me too much. In terms of dating, I didn't feel like I was too disadvantaged because gay men aren't as focused on height as women. I did feel the classic need to compensate for my height through other attributes, and I guess I felt an innate sense of inferiority standing next to taller people, but I was good at suppressing that.
Another important factor that led me to leg lengthening was the functional issue that I had with my legs. Ever since I started puberty, which is when I guess my femurs and hips developed abnormally, I've felt an inchoate sense that there was something wrong with my legs and body. I felt unstable and like I couldn't walk right. A couple years ago, I had arthroscopic surgery to fix my hip impingement. It gave me a lot of mobility at the hip that I didn't use to have, but then the functional issues came back because the root cause hadn't been addressed. These issues led me to obsess more than usual about my legs and led me further down the road towards seriously considering lengthening. For example, I might not have noticed that my legs were unusually short were it not for these issues (even as a 5'10 man with legs that are 8.5 cm longer than they used to be, I'm wearing 30x30 jeans). So I may not have gone through with this if I had been a 5'7 man with normal and functional legs.
Indeed, I didn't just feel a sense of unease regarding my height, but also regarding the fact that I thought my legs were disproportionately short for my height. They were about the same length as my dad's, and he's 5'2-5'3. That thought became more prominent in my mind this past year due to some experiences I had. First, after working remotely at a new job for about a year, I went to an in-person event where multiple people felt the need to remark, "Oh my god, you are so short!," and "I had no idea you were this short." I started noticing that every time I would meet someone in person whom I'd only interacted with virtually, they would have a similar reaction, where they would either outright comment on the fact that I'm short, or not say anything and slightly chuckle to themselves and immediately adjust (downward) their standard of deference for me. As if they subconsciously thought to themselves, "I had been mistakenly treating this guy as a normal/tall person. I can't believe he got away with misrepresenting himself like that." That sounds really cynical, but after hearing these comments and experiencing this kind of reaction from multiple people, I don't think it's all in my head. This is something that I would ordinarily dismiss, but the fact that multiple people verbally expressed their surprise at my being short made me think that there was something there. I also realized that this was the first time in my life that I had met and interacted with people without their knowing that I'm short, which might explain why they felt this sense of dissonance that they couldn't hide.
I also had some annoying experiences going on dates, after ending a long-term relationship, where people felt the need to comment on my height in a kind of gleeful way, as if they were happy to be "superior" to me in that way. I wasn't interested in those people even though they were pretty eager to keep seeing me.
I've told my best friend and my parents about the surgery. I told my dad about the lengthening aspect only a couple days before I had the surgery. He was very supportive after I woke up from the first surgery with a healthy appetite and a good outlook, and he realized that things would be fine. He stayed with me for slightly over five months, and he was really helpful and supportive. I told my mom about the lengthening aspect when she came to visit me, at which point I had finished lengthening, and she noticed when I stood up that I was a lot taller. She was also really supportive. Both of them think this was an excellent decision and are very happy for me, even though they would have been completely against it if I had told them before the surgery (because they'd be afraid, obviously). My friend has been supportive too, and he understands why I did it. I'm not planning on telling other people, aside from my brother when I see him in person, but we'll see.
It's really obvious that I've gotten taller. I haven't seen that many people yet, but the friends that I have seen immediately noticed the height gain when I started using the walker. I just told them that the functional, medically necessary part of the surgery (which is all they know about) had made me a bit taller.
It's amazing being average height. I'm taller than 95% of women and more than half of men, whereas before I was shorter than almost every man. I can't wait until I'm fully recovered and I can go out to clubs and bars and start reaping the psychic dividends of my new height I feel more complete and grown up, like I don't have to apologize for myself or for my height. It's nice to be average.
Quote from: hippo60 on May 15, 2023, 07:03:58 PMCan you share a little more about your PT during lengthening? You really didn't do anything beyond these 15-20 minutes a day and your flexibility was fine? How did it feel when you stated walking compared to now in terms of tightness?
And would love to hear more about your supplements and diet. That's a topic and isn't discussed often here but is so important...
Stretching: 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.
Quote from: informationispower on May 15, 2023, 08:08:16 PMCould you share a body pic? I wonder about your proportions post op. I am curious to see
I'm really tempted to do this but I most likely won't since I'm trying not to give out too much identifying information. I think my proportions look great, a lot better than before, and even the friends who didn't know about the lengthening aspect of the surgery have said I look good, unprompted.
Quote from: hippo60 on May 15, 2023, 08:04:22 PMBeyond the fact that people made the remark, do you believe they were treating you differently afterwards? It's one thing if they just met you, but if it's people who already know and respect you - I wonder if that's going to change. At least that's not my experience, and I was way shorter than you 
Some of them definitely were treating me differently afterwards--the ones that verbally expressed those feelings. They turned out to be generally unpleasant people that I wouldn't want to be friends with anyway. One of them is a very tall, overweight, and ugly gay man who kept trying to flirt with me inappropriately and texts me to this day without my responding. I don't think everyone is as bad as that, though. Most people are fine. But I think it is generally seen as incongruous when a short man expresses confidence in themselves and assertiveness. I think many people will subtly or not-so-subtly give out hints that that's not comme il faut. Which is not to say that the solution is to have this extreme surgery; in an ideal world none of us would be doing this, but we live in a terrible society.
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.
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