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Author Topic: Why is Weight Bearing Important While Lengthening?  (Read 46247 times)
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BtzLandLiberator
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« Reply #200 on: October 08, 2012, 09:21:22 PM »

Tall is correct in this one and Pascha is lucky that he didn't break his screw/bones or bend his nails. 

Dr.  Betz used to be more gung ho about encouraging his patients to walk without crutches IF they didn't weight much, were in good shape and, especially, if they had the 13mm nail.  When I came for my operation in January of this year, he was already starting to be more cautious about this, due to some complications with some patients overdoing it. 

Almost seven months later, when I left Park Hotel in the end of August (after lengthening 9. 5cm), he changed a lot about this: now he's VERY careful and, unless you have a Wolverine-like consolidation hate (some teenagers patients do), he won't let you walk without crutches for a good time after lengthening. 

My consolidation is great according to him but I still don't have his ok for walking unaided, even 4 months post-lengthening.  I can walk a little bit here in there (like in my room, bathroom or kitchen), but he thinks any more than this is dangerous due to my nail (11mm) and my big gap (9. 5cm) even though my consolidation is, his words, "a little bit better than average".

I think his change of heart is due to some accidents in the last 7 months, with some patients breaking their nails and/or screws during or shortly post-lengthening.  I'm actually very happy that Betz is more cautious now - it shows that he corrects his protocol due to new evidence.  I like the cautious Betz more than the Gung Ho Betz.

It's important to note that I feel strong in my legs (but not 100% of course), I feel that I could walk a lot without crutches with no problem - and I think that's where lies the problem with so many patients: they end up breaking their nails or bone (when you have a screw problem usually the bone breaks too) because they feel recovered, they feel great, healed, but they are not.  So disaster ensues.

I don't doubt that Pascha walked without crutches during lengthening - same people did that when I was in Germany.  I could do it in my first months, BUT I DIDN'T, following Betz recommendation.  There is a big difference between being able to do something and this something not having terrible consequences. 

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pascha
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« Reply #201 on: October 08, 2012, 09:25:19 PM »

@Pascha- Do you think walking unaided may have contributed to your duckass? 15 months post lengthening seems like an eternity to still have it.
Actually my duck ass would have been even worse if I would have crutched my way through LL.  Aside of the obvious reason: LL, I had duck ass because I had very very very short hip flexors...I know that now.  We isolated them with my physio and I could then see the difference...so my case was just very bad luck.  

I truly hope, nobody has to go through what Apotheosis and I went through...

Hope it helps!

Pascha
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Dookieman
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« Reply #202 on: October 08, 2012, 09:40:48 PM »

Actually my duck ass would have been even worse if I would have crutched my way through LL.  Aside of the obvious reason: LL, I had duck ass because I had very very very short hip flexors...I know that now.  We isolated them with my physio and I could then see the difference...so my case was just very bad luck.  

I truly hope, nobody has to go through what Apotheosis and I went through...

Hope it helps!

Pascha

Ah the luck of genetics (short hip flexors). What a capricious deity we serve! LOL Wink
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pascha
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« Reply #203 on: October 08, 2012, 09:44:50 PM »

Indeed...but I can tell you brother....I would this again no-questions-asked!!

Best thing I've ever done in my life....(and the most expensive Cheesy)

Pascha
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goal15cm
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« Reply #204 on: October 08, 2012, 10:18:11 PM »

Hey Pascha,

I'm not getting excited, just worried about the untruths you are posting & how it may be misleading future LLers! It's very nice that you posted a video & all, but that gives no credibility to weather it should be done or the effects of doing so down the road (FYI: the person who posted that video is a friend of mine). It also doesn't matter if negligible patients like yourself or anyone else has chosen to walk on your internal nails or not. I have spoken to both Dr. Betz & Dr. Guichet about this & they both advise to use crutches during lengthening. Did you read the diary of Jay? http://www.makemetaller.org/index.php/topic,3324.0.html Any experienced LLer will tell you that as with any internal nail, the problem is not with the nail it is with the screws that affix the nail to your bone. This is why most surgeons feel that most LLing nails are of similar strength! Wink

As for what inspired Dr. M to make his statement about the non-twisting action of the Precice nail, I have no idea. I just took him at his word. Wink Perhaps you should email him directly. LOL  Smiley

God Bless,

Tall


Hi Tall
Good reply. Sorry for butting in. But I feel that someone needs to back you up on this. Not that you need anybody's backing up necessarily. I think that this comparison between precise nail and Betz nail is really silly. And people get really excited because they somehow think that the precise nail is a threat to the Betz nail.
When I used to post a comment that mentioned anything good about the precise nail I was being attacked by the proponents or the followers of the Betz nail. If someone is walking without crutches while they are lengthening with the Betz nail, they are either a cowboy or just plain stupid. If they didn't get hurt or bend their nail or screws, doesn't mean that future LLers have to tempt fate by following their example.
You are doing a good service to future LLers by giving good sound advice. We appreciate that.
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Apotheosis
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« Reply #205 on: October 08, 2012, 10:21:53 PM »

Actually you can walk without any aid with Albizzia (as many of us know first hand) from day one ;-)  You need crutches because your muscles can't take it, and you fatigue quite easily...but the new nails can take it for sure...I should know ;-)  

The problem with walking without crutches and doing full weight bearing before you have a bone bridge isn't the strength of the rods, it's the strength of the screws and the strength of your bone that are a problem. The screws can and will bend, and the bone can and will break at the screw insertion points on the distal portion of the osteotomy (as has been mentioned, see Jay7's diary for an example of this). It has nothing to do with your muscles.

Show me an Albizzia patient who lengthened their tibiae & are walking unaided at even 8-10 months post-OP. Wink

I hate to be the devils advocate here Tall, but If I had lengthened only 6.5 cm on my tibias, I think I absolutely would have been walking unaided after 8-10 months post-op (although granted, I do have the Betzbone rather than the Albizzia). Tongue

First of all, Jay7 was not using the nail that Guichet is implanting today; additionally....if you read that diary carefully, you could see that he had a VERY heavy exercising regime...the nails are full body weight bearing....not meant for these type of workouts...so tip #1: read carefully before posting and always check your facts.   Second...is that all you got??  For somebody that posts so comfortably without any real data to back up what they say, maybe one example is good enough Wink  There are dozens of LLers if not hundreds by now, that have done exactly what's on that video since it was posted (me included)...and they are all still jumping like kangaroos, and posting videos here and all over YouTube...just like that one....just go to Saarslife or Marseille...there are surely some cats doing this as we speak Smiley

The nail that Guichet used on Jay7 isn't really important. It wasn't the nail that broke. Jay7's bone broke at the distal screw insertion point. It was the bone that couldn't handle the weight.

Anyone that is jumping like a kangaroo and walking around without crutches while lengthening is an idiot. Did Dr. Betz not tell you about the patient that went jumping on a trampoline while lengthening and broke all of his screws? LL is not a game, and while the Betz and Guichet rods can handle full weight bearing, the bones and screws of every patient cannot. There are people working on the next generation of technology so that people can walk without crutches while lengthening, but it won't be from any new type of internal rod or screws. Right now, the smart way to lengthen with Guichet or Betz is to do it weight bearing on crutches.

Apotheosis
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My femur diary: http://www.makemetaller.org/index.php/topic,3530.0.html
My tibia diary: http://www.makemetaller.org/index.php/topic,4202.0.h
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« Reply #206 on: October 08, 2012, 10:23:03 PM »

Indeed...but I can tell you brother....I would this again no-questions-asked!!

Best thing I've ever done in my life....(and the most expensive Cheesy)

Pascha

This is the one thing that ALL vets agree Wink
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around7
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« Reply #207 on: October 08, 2012, 11:03:54 PM »

There is no miracle, no matter which nail you use. In the end you will recover in the same amount of time.
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Kidrobot
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« Reply #208 on: October 09, 2012, 01:24:21 AM »

The problem with walking without crutches and doing full weight bearing before you have a bone bridge isn't the strength of the rods, it's the strength of the screws and the strength of your bone that are a problem. The screws can and will bend, and the bone can and will break at the screw insertion points on the distal portion of the osteotomy (as has been mentioned, see Jay7's diary for an example of this). It has nothing to do with your muscles.

I hate to be the devils advocate here Tall, but If I had lengthened only 6.5 cm on my tibias, I think I absolutely would have been walking unaided after 8-10 months post-op (although granted, I do have the Betzbone rather than the Albizzia). Tongue

The nail that Guichet used on Jay7 isn't really important. It wasn't the nail that broke. Jay7's bone broke at the distal screw insertion point. It was the bone that couldn't handle the weight.

Anyone that is jumping like a kangaroo and walking around without crutches while lengthening is an idiot. Did Dr. Betz not tell you about the patient that went jumping on a trampoline while lengthening and broke all of his screws? LL is not a game, and while the Betz and Guichet rods can handle full weight bearing, the bones and screws of every patient cannot. There are people working on the next generation of technology so that people can walk without crutches while lengthening, but it won't be from any new type of internal rod or screws. Right now, the smart way to lengthen with Guichet or Betz is to do it weight bearing on crutches.

Apotheosis


Hey Apotheosis, for those of us still saving up money and may be a year or two away from LLing...could you give us some insight or hypotheses about what the next generation of devices that would allow full weightbearing might be like (are there really people working on his?). I mean the PRECISE sounds perfect but I and many others want to do both bilateral lengthening without clicking and yet still want weightbearing --do you think it might be possible in a few years? Thanks.
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6ftby2014
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« Reply #209 on: October 09, 2012, 01:44:14 AM »

It is great hearing from all the other vets coming in and debating this again and sharing personal anecdotes.
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Tall
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« Reply #210 on: October 09, 2012, 03:34:31 AM »

It is great hearing from all the other vets coming in and debating this again and sharing personal anecdotes.


This whole discussion flared up again because Pascha started posting nonsense about the Albizzia nail being full weight bearing & personally attacking my credibility. I never intended for it to turn into the same old discussion, only to stop the spread of misinformation that you can walk during lengthening with the Albizzia. It's misleading to the newbies. Anyway, hopefully with everyone who has posted the debate is over. LOL Smiley
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Tall
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« Reply #211 on: October 09, 2012, 03:53:52 AM »

There is no miracle, no matter which nail you use. In the end you will recover in the same amount of time.

The same amount of time? Are you sure you're not comparing femur consolidation rates with tibiae rates?  Because they consolidate much quicker than the tibiae. If so, you are comparing apples to oranges. Again, I am asking this forum to show me one Albizzia tibiae patient with consolidation rates as fast as Kikau. Citing full disclosure, I'm pretty sure Dr. M's use of Forteo & stem cells also had something to do with it.
« Last Edit: October 09, 2012, 04:19:33 AM by Tall » Logged

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« Reply #212 on: October 09, 2012, 08:40:49 AM »


Hi Tall
Good reply. Sorry for butting in. But I feel that someone needs to back you up on this. Not that you need anybody's backing up necessarily. I think that this comparison between precise nail and Betz nail is really silly. And people get really excited because they somehow think that the precise nail is a threat to the Betz nail.
When I used to post a comment that mentioned anything good about the precise nail I was being attacked by the proponents or the followers of the Betz nail. If someone is walking without crutches while they are lengthening with the Betz nail, they are either a cowboy or just plain stupid. If they didn't get hurt or bend their nail or screws, doesn't mean that future LLers have to tempt fate by following their example.
You are doing a good service to future LLers by giving good sound advice. We appreciate that.
Goal15cm

Thanks Bro! I appreciate that!
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pascha
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« Reply #213 on: October 09, 2012, 12:40:41 PM »

The problem with walking without crutches and doing full weight bearing before you have a bone bridge isn't the strength of the rods, it's the strength of the screws and the strength of your bone that are a problem. The screws can and will bend, and the bone can and will break at the screw insertion points on the distal portion of the osteotomy (as has been mentioned, see Jay7's diary for an example of this). It has nothing to do with your muscles.

Again we meet on different sides of an opinion Apotheosis ;-)

First of all, you are not in the club of people that can even join this conversation out of own experience.  I saw you from Day 1, and you were a VERY BIG guy even back then...so even as much info & knowledge you have about LL, there are some topics where you are missing the 1st hand experience, this being one of them.  Second, your visits and time in Germany has been "touch and go" so you can't comment on how the every day activities go in Saarslife and the Park for extended periods of time....and this topic falls into that as well.  It is clear that Betz would tell YOU that YOU are not allowed to do this....and of course...no LL doctor in the world would allow somebody that doesn't have the right metrics to put their full weight on their nails...but do you really think that the whole fleet of LLers in the 50-60kg range got the same recommendations as you did?  (The answer is no ;-))   Third...I think you must have missed one of my posts on this thread before you posted yours, but here it goes again...

NOBODY is saying that one should bear weight on nails just like that...clearly Tall wanted to make it sound like that (he still hasn't come back with a good response about his open support of unsupported facts btw...Wink)...but he's perhaps talking from his outdated experiences back in 2006 when people did do things without thinking...  LLers that do are indeed idiots, I'll join anyone that says that.  But, to get B or G nails implanted and not be able to use them to their full potential has no point either.  So, when patients have been allowed to put their full weight on their nails, it's because they have carefully looked at this point TOGETHER with their LL doctors. During my time, each screw was designed to hold between 20-25 kilos.  Depending on your set up and body weight, you would know immediately if you are a candidate or not.  You Apotheosis are not one of us, and you indeed should follow the instructions that apply to you...but this also tells me that you never heard the talk that people got when they did fit the profile...you didn't did you Wink?  For the rest of us, that fell into that category, we would still need to show that the rest of our functionality was up to a certain level, we looked at X-Rays, this was done in consultation with the physios, etc.  Only after all this, and if we got a green flag FROM THE LL DOC would it be OK for us to put weight on our nails.  This was never just our call...  On top of this, EVEN when we got a green flag, we were always told that this was not a 24/7 thing.  There were caps set on this as well.  Additionally, bearing your weight on the nails is great for consolidation (you all should know this!) and there are plenty of patients that have shown a huge increase in their consolidation rates just by walking (full weight on nails) just a few hours a day, and then back to crutches.  If there is anyone that can talk to Dr. B now...ask him about a patient that had a foot injury and was constantly walking on just one leg and the other on a crutch...his consolidation on the leg bearing his weight was almost double of the other one in just 1 month.

Any questions on this topic, I will happily discuss this again...(and again...)...and again Wink... I am ALL for safety and responsibility ESPECIALLY while lengthening...but I find it ridiculous that people make other terrified of LL without telling them both sides of the story.   

So in conclusion: YES, there is a way to bear full weight, and stay safe.  As long as you do it in coop with your LL team....if you meet the metrics, and are in good condition, full weight bearing is something that many LL doctors will allow you to do.

By the way, those videos I posted, were done AFTER Jay7's time....AND even more interestingly.....Guichet has them posted on HIS website....so...I wonder how you guys (the screamers then) can explain that Wink

Pascha
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BtzLandLiberator
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« Reply #214 on: October 09, 2012, 01:03:41 PM »

Quote from: pascha link=topic=4624. msg66115#msg66115 date=1349786441
Second, your visits and time in Germany has been "touch and go" so you can't comment on how the every day activities go in Saarslife and the Park for extended periods of time. . . . and this topic falls into that as well.   It is clear that Betz would tell YOU that YOU are not allowed to do this. . . . and of course. . . no LL doctor in the world would allow somebody that doesn't have the right metrics to put their full weight on their nails. . . but do you really think that the whole fleet of LLers in the 50-60kg range got the same recommendations as you did?  (The answer is no ;-))

When did you have your surgery Pascha? Because I spent 7 months this year living in Park Hotel, with constant contact with Betz and other patients, and that's not what I experienced.

As I said before, he's much more cautious right now.  Even the fellow light weight female patients (all of them certainly weighting less than 60kg) didn't get Betz's authorization for walking without crutches during lengthening (the exception being short distances on your room, bathroom or when eating). 

Maybe Betz thought it was ok for some patients to walk without crutches before, but that's not the case anymore.
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pascha
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« Reply #215 on: October 09, 2012, 01:20:19 PM »

Yes, that is true....but she was not in the 13mm nail club...so she was also not a candidate. 

She had 11mm, and then by definition, you are out of the "group" I described. 

Pascha
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around7
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« Reply #216 on: October 09, 2012, 01:42:24 PM »

The same amount of time? Are you sure you're not comparing femur consolidation rates with tibiae rates?  Because they consolidate much quicker than the tibiae. If so, you are comparing apples to oranges. Again, I am asking this forum to show me one Albizzia tibiae patient with consolidation rates as fast as Kikau. Citing full disclosure, I'm pretty sure Dr. M's use of Forteo & stem cells also had something to do with it.

Man, do not read too quickly. I was comparing nails and not bones. Femur albizzia x femur precise x femur ISKD x femur biliskunov...In the end the recover will be just the same...
« Last Edit: October 09, 2012, 01:55:05 PM by around7 » Logged
Apotheosis
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« Reply #217 on: October 09, 2012, 02:28:11 PM »

Again we meet on different sides of an opinion Apotheosis ;-)

First of all, you are not in the club of people that can even join this conversation out of own experience.  I saw you from Day 1, and you were a VERY BIG guy even back then...so even as much info & knowledge you have about LL, there are some topics where you are missing the 1st hand experience, this being one of them.  Second, your visits and time in Germany has been "touch and go" so you can't comment on how the every day activities go in Saarslife and the Park for extended periods of time....and this topic falls into that as well.  It is clear that Betz would tell YOU that YOU are not allowed to do this....and of course...no LL doctor in the world would allow somebody that doesn't have the right metrics to put their full weight on their nails...but do you really think that the whole fleet of LLers in the 50-60kg range got the same recommendations as you did?  (The answer is no ;-))   Third...I think you must have missed one of my posts on this thread before you posted yours, but here it goes again...

NOBODY is saying that one should bear weight on nails just like that...clearly Tall wanted to make it sound like that (he still hasn't come back with a good response about his open support of unsupported facts btw...Wink)...but he's perhaps talking from his outdated experiences back in 2006 when people did do things without thinking...  LLers that do are indeed idiots, I'll join anyone that says that.  But, to get B or G nails implanted and not be able to use them to their full potential has no point either.  So, when patients have been allowed to put their full weight on their nails, it's because they have carefully looked at this point TOGETHER with their LL doctors. During my time, each screw was designed to hold between 20-25 kilos.  Depending on your set up and body weight, you would know immediately if you are a candidate or not.  You Apotheosis are not one of us, and you indeed should follow the instructions that apply to you...but this also tells me that you never heard the talk that people got when they did fit the profile...you didn't did you Wink?  For the rest of us, that fell into that category, we would still need to show that the rest of our functionality was up to a certain level, we looked at X-Rays, this was done in consultation with the physios, etc.  Only after all this, and if we got a green flag FROM THE LL DOC would it be OK for us to put weight on our nails.  This was never just our call...  On top of this, EVEN when we got a green flag, we were always told that this was not a 24/7 thing.  There were caps set on this as well.  Additionally, bearing your weight on the nails is great for consolidation (you all should know this!) and there are plenty of patients that have shown a huge increase in their consolidation rates just by walking (full weight on nails) just a few hours a day, and then back to crutches.  If there is anyone that can talk to Dr. B now...ask him about a patient that had a foot injury and was constantly walking on just one leg and the other on a crutch...his consolidation on the leg bearing his weight was almost double of the other one in just 1 month.

Any questions on this topic, I will happily discuss this again...(and again...)...and again Wink... I am ALL for safety and responsibility ESPECIALLY while lengthening...but I find it ridiculous that people make other terrified of LL without telling them both sides of the story.    

So in conclusion: YES, there is a way to bear full weight, and stay safe.  As long as you do it in coop with your LL team....if you meet the metrics, and are in good condition, full weight bearing is something that many LL doctors will allow you to do.

By the way, those videos I posted, were done AFTER Jay7's time....AND even more interestingly.....Guichet has them posted on HIS website....so...I wonder how you guys (the screamers then) can explain that Wink?  

Pascha

Pascha,

You started this whole debate when you asserted that the patients of Dr. Betz and Dr. Guichet could begin full weight bearing immediately after they finished lengthening before they have a bone bridge. Your exact words were:

Actually you can walk without any aid with Albizzia (as many of us know first hand) from day one ;-)  You need crutches because your muscles can't take it, and you fatigue quite easily...but the new nails can take it for sure...I should know ;-)

Both Tall and I disagreed with you. We said that while patients could choose to do that, it is not safe to do so. Some patients will be able to walk without crutches from the moment they stop lengthening and not have any problems, but others will bend or break their screws, their nails, and possibly even their bones. There is no way for any doctor to be able to determine which patient will have problems with these complications and which will not. I was with Dr. Betz in Saarchlief less than eight weeks ago, and he prefers that his patients NOT walk without crutches before they have a bone bridge. The biggest problem with that is that Dr. Betz also wants to make his patients happy, so some patients push him for permission after he has said no, and some just ignore his advice altogether. I met a patient in Saarchlief recently who had broken some of his screws from doing just that, and this patient probably weighed 60g - 70kg. Full weight bearing without crutches is NOT "something many LL doctors will allow you to do" as you claim. Almost every LL doctor in the world will not let you do it. Many LL doctors (such as Dr. Paley) consider it malpractice that a doctor would even allow you to walk on crutches while lengthening.

Less than 10% of the patients of Dr. Betz get 13mm Betzbone rods in any bone section (you keep mentioning the Albizzia, which is no longer used by Dr. Betz or Dr. Guichet). I have 13mm rods in both my tibias and femurs. This "club" you keep talking about of people that you think are candidates for weight bearing without crutches is surely made up mostly of 11mm rod patients. The screw holes on an 11m rod are smaller than those on a 13mm rod and are held in place by thinner screws. So while I may be bigger than most, I also have larger screws holding my rods in place and larger bones. My 13mm rods with large screws holding me have a similar bearing impact as an 11mm rod with smaller screws holding up a 60kg - 70kg person. The size of the person and the size of the rods are inconsequential. Weight bearing while lengthening is meant to make lengthening more convenient, but cowboys like yourself and many people I have met think this means they can walk around without crutches as much as they like. Some of them get away with it. Others bend or break their screws, their nails or have other complications.

The safe way to do full weight bearing is on crutches. Period. Leg lengthening is not a party. It is not a vacation. The goal is to get taller and get better as quickly as possibly. Walking without crutches at any point before there is a bone bridge adds unnecessary risk to your lengthening. Is it possible to walk without crutches? Yes. I have done it during both of my lengthenings. Is it advised? Absolutely not. You can stand without crutches, but once you start walking you increase the risk exponentially. If you are lengthening at home, at Saarchleif or at the Park Hotel and bend your screws or break your rod, you will have to return to have another surgery to get them replaced. This adds time, cost and pain that is not necessary. The overall rule here should be safety first.

Apotheosis
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My personal apotheosis to the very best me I can be. Starting height: 171 cm. 9.5+ cm added to femurs. 10.5+ cm added to tibias. Final Height: 189.5 cm +/-

My femur diary: http://www.makemetaller.org/index.php/topic,3530.0.html
My tibia diary: http://www.makemetaller.org/index.php/topic,4202.0.h
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