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Author Topic: GrowthSpurt - Dr. Mahboubian - Internal Femurs - 2015 - My Turn For Growth!  (Read 61007 times)
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« on: February 11, 2015, 05:20:11 PM »

Growthspurt has asked me to start a diary for him. Congrats on starting your LL journey. Smiley
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Rainy
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« Reply #1 on: February 11, 2015, 05:33:42 PM »

Welcome!
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GrowthSpurt
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« Reply #2 on: February 12, 2015, 12:25:21 AM »

Welcome!
Thank you! My surgery was on January 15, 2015 at Providence St. Joseph's, Burbank, CA.

PART ONE
I arrived at the hospital much earlier than the specified time of 5 AM, which is always my style. I've been known to arrive at the airport so long in advance of my flight that only the cleaning crews are around. Anyway, turned  out the admission office wasn't even open until 0530. After all the preliminaries, I was up at the receiving ward by around 6 AM, seen by a number of nurses, one of whom was very jovial and cracked jokes all along. A couple of them tried starting my IV and weren't successful. People, I have hosepipe size veins! No excuse. And BTW? Whenever you hear a nurse say things like, "his veins keep rolling," or "as soon as I get in, the veins hide," don't believe it. Trying to blame THEIR lack of expertise on YOUR veins? This is like blaming the ball for your not catching it. So in walks the IV maven nurse (there's always one on every ward) and she tells the other two nurses in so many words, "step aside and watch how this is done." Two seconds flat, she's in a vein.

After that, the anesthesiologist paid her visit, and then Dr. M and his PA (Physician's Asst.) who would be assisting on the surgery. They were reassuring and I felt quite relaxed. Once you are at the moment of surgery, you have to let doubts and fears go. That's for when you're researching your procedure. Once you've made your decision, you must be confident about it and comfortable with it.
Not long after, I was rolled down to the freezing OR to a very happy team of OR nurses. I have curly hair and they and the anesthesiologist were teasing me that, forget about femoral osteoplasty, they were just going to dye my hair purple or something.

When I woke up in recovery, I vaguely remember Dr. M telling me how well the procedure went, including the initial intra-operative distraction of 1 mm. An interesting aside, later on the PA was to reveal to me that my femurs were so freakin' hard that they had to fight with them to break them. I have this image of a perspiring Dr. M wrestling with my damn bones, which just refused to break, and cussing and swearing at them, lol. I'm sure that wasn't the case, but it's an entertaining thought. On return to my room, I was in and out of sleep for a few hours, but soon hunger woke me up and I was ready to chow down. None of this post-anesthesia nausea nonsense for me. My thighs felt tight and rigid, the pain had a burning quality like my bones were on fire. I had the PCA, patient-controlled-anesthesia, of course, with Dilaudid, which kept me comfortable. The worst was I was peeing like a racehorse and having to use that damn urinal, which was always this close to spilling. The nursing care so far had been very good, and the night nurse was wonderful, even though she had a high patient census.

The night seemed long, but morning finally arrived and I was glad to see breakfast. The Dilaudid began being tapered off to be replaced by Norco. Dr. M and the PA came in to take a look at the incisions. They looked terrific. Not even a spot of blood anywhere. Dr. M joked, "Despite my best efforts, I couldn't make you bleed." There was no sign of compartment syndrome and my thighs were not rigid to the touch.

I was gearing up in my mind for that first PT and OT visit because that is the big challenge after the surgery.
When PT arrived, the first thing was to get into seated position at the side of the bed. I had given myself a blast of Dilaudid just before this. PT's name was Jenny, I believe, and she had a student PT who had never seen a patient with LL procedure, so this was really interesting for him. Jenny first showed me how I was going to stand with the help of my arms behind me and my palms down on the bed and an initial thrust using the triceps. Very important to have the legs tucked in underneath, then as you come up grab the arm of the walker with the right hand, and as you're straightening up, grab with the left. It sounds awkward, but if done in a smooth motion, it works. The moment before you actually stand up, you have no idea how you are possibly going to do it. It just feels impossible--the pain and rigidity of the thighs. But I did it and when I was upright it felt amazingly good. Jenny attached a safety belt around my waist as well, and we got ready to go out in the hallway. I used 2 steps for each push of the walker. The effort was so intense that I was sweating heavily, but nothing was going to make me quit. I made it round the ward and back to my room. The morning shift nurses seemed flabbergasted that I had walked that far. I didn't know any better, but Jenny told me that on the first post-op morning, some LL patients tell her (and her OT counterpart) point blank no, they are not going to get up.

Later on the OT guy came with his toys: grabber/reacher, sock aid, dressing aid and so on. That was a very helpful visit and I went online and quickly ordered those so that they'd arrive by the following day when I was scheduled to be discharged. I had a morning and afternoon PT/OT session, and one more on the morning of my discharge. The nursing care was all good--I had no issues, and in fact after I got home I sent a box of chocolates to the ward in appreciation. Before discharge, people kept coming in to ask if I needed anything at home: walker, w/c, shower chair, bedside commode? Yes, yes, yes, and yes. I couldn't understand why they seemed surprised. I hadn't expected that those would be supplied to me via the hospital (and in any case that would have cost me) and to me the prospect of returning home without equipment in place would be a nightmare.

So, surgery was on a Thursday, and by Saturday early afternoon, my caregiver arrived at the hospital to pick me up and take me home.

More in Part 2 coming up.


Thank God for triceps strength. I leaned heavily on the walker and took steps 

 
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GrowthSpurt
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« Reply #3 on: February 12, 2015, 12:26:37 AM »

Growthspurt has asked me to start a diary for him. Congrats on starting your LL journey. Smiley

Thank you. I guess it should be 2015 technically, since the surgery was Jan 15 2015
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Rainy
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« Reply #4 on: February 12, 2015, 06:50:24 AM »

Great details. Seems like Dr M did a neat job. Would be interesting to see some pictures.
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GrowthSpurt
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« Reply #5 on: February 12, 2015, 07:33:35 AM »

Great details. Seems like Dr M did a neat job. Would be interesting to see some pictures.
A very neat and expert job indeed. Does the insert image function work on here? It doesn't open up a browse window
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« Reply #6 on: February 12, 2015, 07:37:13 AM »

No. use photo bucket or tiny pic: http://tinypic.com

Copy paste the link it gives you for forums.
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srimech123
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Hi, nice to meet you!


« Reply #7 on: February 12, 2015, 12:26:02 PM »

Hi Growth,

What was your starting height and which height are you targeting?
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173cm (5'8") tall at the moment, hoping to be at least 180cm (5'11") tall quite soon (or 6'1" at most).   Saving money for my first LL surgery!
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« Reply #8 on: February 12, 2015, 01:04:04 PM »

Thank you. I guess it should be 2015 technically, since the surgery was Jan 15 2015

Great - so the first few PTs were not painful...just hard to do ?
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BelowTheMean
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« Reply #9 on: February 12, 2015, 11:30:49 PM »

Great, another Dr. M diary to follow! Hope everything goes smoothly during the lengthening phase!
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GrowthSpurt
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« Reply #10 on: February 13, 2015, 01:54:06 AM »

Hi Growth,

What was your starting height and which height are you targeting?
I stand 5-3 barefoot and my target is the full 3.1496063 inches (I feel better when I add all the decimal places)
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« Reply #11 on: February 13, 2015, 01:57:50 AM »

Great - so the first few PTs were not painful...just hard to do ?

When I'm doing the PT itself, I don't look at it as pain, probably because I've worked out for decades and my favorite exercise remains squats, and while squatting, you push through the burn to your max number of reps. But after PT is a different story. Although I try to avoid the Norco, sometimes that dull banging ache is too much to take and I succumb to a Norco tablet--but never two
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« Reply #12 on: February 13, 2015, 02:25:26 AM »

When I'm doing the PT itself, I don't look at it as pain, probably because I've worked out for decades and my favorite exercise remains squats, and while squatting, you push through the burn to your max number of reps. But after PT is a different story. Although I try to avoid the Norco, sometimes that dull banging ache is too much to take and I succumb to a Norco tablet--but never two
Ok so I am the same way (have been working out for years.....weights, combat, extreme conditioning etc etc...no stranger to exercise pain). Now tell me you think you can do the PT by yourself ? Also can you do as many sessions as possible in a day or is there a limit ? Thx
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« Reply #13 on: February 13, 2015, 03:51:22 AM »

PART TWO (Full disclosure: I'm also a physician so I might slip into medical jargon, but I'll try not to)

I live in Pasadena, Southern California, so surgery with Dr. M was very convenient--no lodging costs. However because I don't have family near, I am paying a caregiving service. I'll call my caregiver Ronald. Most caregivers will be CNAs, Certified Nursing Assistants. They are there to help with activities of daily living, cooking (abilities vary here), cleaning up, making up your bed, taking you to your doctor appointments, helping with shopping and so on. They are not medical personnel as such, so they are not expected to have in-depth knowledge of your medical condition. As I quickly discovered, it's important to lay our your expectations of them at the start, otherwise they're not sure how much you want done.

Once I was home, my first wish was to get a shower. Three days without one and I was dying for it. I have a shower stall from which I removed the glass door and replaced it with a curtain on a tension rod. I use a sliding seat to get me into the shower. Still it wasn't as easy as all that because I did have to lift my legs a little to clear the small step and the frame of the door. At that point, you can imagine how tender I was and how even the slightest movement could give me a jolt of pain. But boy, did that shower feel good! From the time I went in to the bathroom to the time I came out must have been at least an hour. EVERYthing takes so long when you can't walk/stand.

My house is slightly 2-level so I had a ramp built up and down which I could go in the wheelchair from my bedroom to the bathroom. Although I have a master bedroom and bath, the bed in the master is a little too low to get in and out of, so I am using the high beds in the guest room. Unfortunately I discovered too late before surgery that the ramp was built a little too steep. I reduced the slope a little with the aid of some rugs and a rubber mat. Still in that first week I couldn't go up by myself, so if Ronald wasn't there, I would use the walker to go up and down.

I had dinner in bed, brushed my teeth and by the time Ronald's shift was over, I was in bed ready for sleep. At my bedside were my Norco, a Thermos of cold ginger ale (for some reason I find it very comforting), my grabber, and my so-called spill-proof urinals. I was to find out that they are not COMPLETELY spill-proof. I was up numerous times to urinate, and because my body was getting rid of all that junk from the hospital, I hope it's not TMI to tell you that my urine smelled perfectly disgusting. And the amount I was producing was ridiculous. Anyway, I learned the hard way that the safest way to use the urinal is to STAND UP, as painful as that was during the night. I didn't use the bedside commode because it didn't quite fit between my bed and its twin next to it. Anyway, I found pretty quickly I didn't like using it. I don't know, I just have to have something that flushes.

One problem I had in my first post-op week was swelling of the thighs and lower legs. This wasn't so much the muscles themselves but fluid in the deep skin tissues, called edema. I went into surgery at 140 lb, and came out at 148. I think I know what happened. My blood pressure is very sensitive to anesthesia or even light sedation, so during surgery my pressure was probably running low. A little inside track knowledge, what the anesthesiologist does in the case of low blood pressure is pour more fluid in through your IV, which expands your blood volume and brings up the pressure. So this is probably why I was so fluid overloaded and my kidneys were working overtime to get rid of it. After one week of this I got tired of the swelling, got me a diuretic, used it 3 days and bam! got rid of all that excess.

I used the walker either taking 2 steps for each push of the walker, or using it kind of like crutches using triceps to lift both legs in one swing, plant my feet, push the walker, and lift again. Either way works to make sure no one leg ever bears full weight. Tricky parts are when transferring to the toilet and getting up from the seat. I use a grab bar I installed to help me get up and sit down. Everyone will develop their own little tricks.

Regarding pain meds, in the first two weeks I didn't play hero. I used 2 Norco regularly every 6 hours. Similar to the kind of pain in the hospital, it was a fiery, burning pain. After 2 weeks it turned to more of an ache, and it was only then that I could drop to 1 Norco every 6 hours.

All along I had this neurotic fear that at some point I might have put too much weight on one side and bent my nail, hence some of my previous discussions in the general section. These kind of post-op fears are very common--even in a doctor, believe it or not. What I did not do, however, is constantly email my doc or call him to ask him whether I might have bent my nail! Now that the shoe is on the other foot, I don't ever want to become the patient the doctor dreads hearing from! So in Part 3, when I make my first doctor visit a week post-op, you'll find out whether I really did bend my nail or not.  Wink
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GrowthSpurt
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« Reply #14 on: February 13, 2015, 03:56:20 AM »

Ok so I am the same way (have been working out for years.....weights, combat, extreme conditioning etc etc...no stranger to exercise pain). Now tell me you think you can do the PT by yourself ? Also can you do as many sessions as possible in a day or is there a limit ? Thx
Yes, in fact you MUST do PT by yourself in between sessions with your PT person. Even though I can stretch and strengthen on my own, I personally would like to continue to work with PT for another 6 weeks at least, because they know how to move you to the next level of exercise depending on your progress. They also correct mistakes that one can make. For instance, in normal working out, you go to your max and fatigue the muscle (and sometimes your partner can do a forced rep with you) so I had the tendency to start doing that. My PT stopped me and told me that at this early stage, I want to avoid muscle fatigue.
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« Reply #15 on: February 13, 2015, 04:00:38 AM »

Ok so I am the same way (have been working out for years.....weights, combat, extreme conditioning etc etc...no stranger to exercise pain). Now tell me you think you can do the PT by yourself ? Also can you do as many sessions as possible in a day or is there a limit ? Thx
Didn't answer your second part. I think the number of sessions depends. If the PT session was very tough and you feel fatigue, I would say wait till the next day to repeat. Let your muscles and body get the rest they really deserve. Or the other thing I do is, while I'm distracting the Precice nail on one leg, I do some mild flexion/extension at the knee of the other leg.
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« Reply #16 on: February 13, 2015, 04:11:06 AM »



These are my "fat thighs" in the first week when I had excess fluid. You can see the slight sheen of the skin from distention of the tissues.
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GrowthSpurt
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« Reply #17 on: February 13, 2015, 04:13:36 AM »


My thighs restored to normal. The markings are for the distracting.
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Rainy
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« Reply #18 on: February 13, 2015, 04:38:58 AM »

Thank you for your great detailed diary. Do you need to get any tendon release for going to 8CM?
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GrowthSpurt
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« Reply #19 on: February 13, 2015, 05:09:16 AM »



These are my "fat thighs" in the first week when I had excess fluid. You can see the slight sheen of the skin from distention of the tissues.
(Sorry about the huge image. Learning curve)
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