Limb Lengthening Forum
Limb Lengthening Surgery => Information About Limb Lengthening => Topic started by: KiloKAHN on October 22, 2015, 08:53:48 PM
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Dr Jamal Abu Nemer (Kiev, Ukraine) has agreed to do a Q&A on the forum. He has asked that you first refer to his new website before you post, as he has made some videos to introduce himself and answer some of the frequently asked questions that he receives.
Here is the link to his new website: www.orthopedicjamal.com (http://www.orthopedicjamal.com)
Here is the link to his thread in the Doctor Directory: http://www.limblengtheningforum.com/index.php?topic=62.0 (http://www.limblengtheningforum.com/index.php?topic=62.0)
You may post all of your questions for Dr Nemer here.
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I will start off with the usual inquiry regarding long-term athletic loss because I think it's important to create something of a consensus on this matter.
What are the recommended safe ranges?
What are the long-term implications of leg lengthening?
What kind of symptoms will said implications have on the athletic function of the legs?
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Dear Uppland,
Thank you for your inquiry. Optimum value for lengthening is: 6,5-7,0 cms for femurs and 4,5 - 5,0 cms for tibias. The maximum "hard" program is: 10-11 cms for femurs and 6-7 cms for tibias. There is a big resistance of Achilles tendon after 4,5-5,0 cm of tibias lengthening.
Please note
There is a big resistance of the hip's muscles after 6,0 - 7,0 cm of femur lengthening .
We can continue the program (more than the optimum values), but it will take more time (and money for the patient). Each additional centimeter more (higher) than optimal values of elongation (7cm for hips, 5 cm for shanks) is an additional an cost of the lengthening program.
This is about 2 500 - 3000 USD for every additional centimeter. The reason is due to the extension beyond the optimal value takes more effort, time and make complexity to the lengthening program.
This cost can vary, but we need to see X-ray pictures of your bones in order to assess the complexity of the "big program."
The approximate rate of elongation of the day is one millimeter. To get this millimeter you will have to perform 18 clicks (in the new construction). The click sound is very clear.
We try to create a comfortable environment for the patient during elongation. In the process of the lengthening we can sometimes go a bit more of a millimeter, sometimes giving rest for a few days. We (and You) assess the condition of the muscles, and choose the optimum way. As your doctor, I will visit very regularly, at least once a day to assess your condition, answer any questions and make sure you are comfortable and safe.
Regards,
Dr Jamal A. Nemer
www.orthopedicjamal.com
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Would I have any problem doing 6.5-6.8 cm femurs?
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Dr Jamal,
Because your nail is based on the Bliskunov nail, I guess your nail has a part that goes into the pelvis too? Is there any pain in the pelvic area when the nail is inside?
I like that your nail is full weight bearing and your center looks nice.
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Dear Daylight & Deutsch Mark,
Thank you for your questions. Up to 7cm, generally speaking is possible as long as there are no severe complications. As Deutsch Mark was referring to our recovery center, I visit my patients everyday and make sure your care and support is up to the highest standard possible. I will assess your condition everyday and make sure complications are avoided before they occur. This is why our pricing for (femur) lengthening of 46,500 USD includes 3 months of room and board. It is essential patients are relaxed and comfortable during their lengthening period and for patients to know they have my full support.
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Do you predict that your prices will remain around what they are currently in the next few years, or do you see them increasing significantly?
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Hello Taller,
Thank you for your question. Unfortunately, to provide the best service possible, we have to continue to adjust pricing to keep up with factors such as inflation and cost of materials since we use only the highest medical grade materials that are made to be fully weight-bearing.
Although, I believe in a cost-friendly service for internal lengthening which is why my pricing always includes the 3 months room & board with daily supervision from myself.
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hello Dr Jamal,
Can a gain of 9 cm in the femur?
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Thank you very much for your honest response, doctor.
Another question: how much of their original athletic ability do your cosmetic lengthening patients typically recover after their procedures?
Do you feel that, generally speaking, tibia or femur lengthening looks better? I know it depends on the individual and the amount lengthens, but what is your general impression regarding aesthetics?
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Which scenario can be favorable for a solid recovery? Assuming there is no cost factor.
1. 2-3 cm Internal femur (Precice), 2 cm External Tibia
2. 4-5 cm Internal femur (Precice)
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Dr. Nemer,
What is the recovery center like? Is it a medical facility or similar to a hotel? Does it have single-occupancy rooms or do patients have to share?
What is the food there like? I have a dietary restriction (no dairy products.) Will that be a problem?
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Dear Increase, after 5 or 6cm in the Femur, you will experience a big increase in tension, however with that being said, I've had patients who have done more than 9cm in the past so it will all depend on your condition. Safety is my absolute priority.
Dear Taller, if you send me your proportions, I will give my opinion on whether to start with your tibia or femur in regards to aesthetics. This is highly dealt with on a case by case basis.
Dear Average2Tall, there are risks every time you go into the operating theatre. You have to think about the number of complications that can occur with each surgery. 5cm is considered within the safe limits of lengthening - therefore, I would recommend you to think about doing 5cm in one go.
Dear Medium Drink of Water, that is a very good question! For the sake of patient wellbeing, we've created a very homely atmosphere with an in-house nurse team. Your dietary restriction will be no problem for our team to handle, and we will make sure your diet is well balanced for optimal recovery. We have both single and shared rooms (no more than 2 patients in each room) for our patients.
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Dr Jamal, you say on your website that the new Jamal Nail causes less scars on the side of the hip.
The old website had pictures of the old scars left by the surgery with the old Bliskunov nail.
When will you be able to provide pictures of the side of a leg that has used the new nail so we can assess the new scars?
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I would like to see those pics.
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Is it OK lenghthening 2 mm a day, like your patient Purfection did, or does it depend on the patient? Thank you
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Thank you for your enquiries, Dingo and Taller expectations.
I will proceed to attach photos from a patient who has approved for her surgical scars to be displayed on this forum.
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It seems the photo files are too large - so we have compensated by putting them on this link:
Pic 1: http://s9.postimg.org/x9mmxt7dr/IMG_0580.jpg
Pic 2: http://s9.postimg.org/rqooubzq7/IMG_0578.jpg
Pic 3: http://s9.postimg.org/yd6r9rs0v/IMG_0581.jpg
Pic 4: http://s9.postimg.org/su8t6akdb/IMG_0582.jpg
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The incisions are very small, almost invisible, contrary to those of external fixators which can have the possibility to cause scars that will need further treatment. The main visible points of scarring will be on the upper femur on the lateral side, and a small incision site around the hip area.
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Hello Dr Jamal.
It's Sweden here who visited you last year with my friend. Hope you are doing fine. I'm still thinking of doing my femurs. Sadly I broke the bottom part of my right tibia where it meets the foot and I left it untreated at first but 4 months later I got a cast on and now, 3 months after that I have a hard time walking on it. It still hurts in the broken area. I have a very hard time running so mostly I walk.
I need to have this part fixed together with my studying before I jump into femur lengthening.
My question: Can you lengthen the humerus with the Jamalnail too?
I read that Apotheosis did it with Dr Betz and it got me curious. I have a hard time going over my wingspan.
Thank you, and take care.
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For the rest of you guys thinking about the food in Ukraine, it was one of the greatest place to eat at. The food is 5 star and very cheap. I could go there just for the food again!!
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The pictures of the girl are from the old site of Bliskunov nail, these were posted earlier on another thread 3 years back.
http://www.limblengtheningforum.com/index.php?topic=53.0
They are also on the old bonamed website:
http://www.correction.kiev.ua/news/news.htm
So I guess there are not any new pictures ? Anyway the scars even with the old mechanism look very good.
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Do you think femur leng. with Lon is safe ?
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I don't have bad information about Dr Jamal because cases of non union were not his fault, but I don't like he's using those old pics instead of new ones.
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My question: Can you lengthen the humerus with the Jamalnail too?
I read that Apotheosis did it with Dr Betz and it got me curious. I have a hard time going over my wingspan.
Sweeden dont you have 180 cm wingspan?.And you are 179 now.If you will lengthen 4 5 cms how much can this make you disproportionate to have -2(inch) ape index.?More than -5 cms it will be noticeable imo..What do you think? Or will you lengthen more than 5 cms?
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I will definitely not pass 5cm. Never.
Aiming for 4cm.
My wingspan is just barely 180, more like 179,6cm. Height is 178/179.
Last time my doctor measured me I was 180 so I guess 179 is correct.
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I will definitely not pass 5cm. Never.
Aiming for 4cm.
My wingspan is just barely 180, more like 179,6cm. Height is 178/179.
Last time my doctor measured me I was 180 so I guess 179 is correct.
you will be 183 with 180 wingspan.So you considered humerus lengthening for -3 cm ? :o
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you will be 183 with 180 wingspan.So you considered humerus lengthening for -3 cm ? :o
I can't say I do. Just out of curiosity.
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I can't say I do. Just out of curiosity.
I see...Well you are really lucky about your wingspan.And i really think you will look great after 4 5 cm.You have potential :) .I have same height with you(pre op).But my dumb wingspan same with my height.I will go 4 cm and stop.I really dont want to look like a trex when i wear tshirts.But i will never reach my dream height(5'11) i guess.Ah harsh truths.. :-\
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Dear members,
Apologies for the old photos, however, it is often extremely difficult to get full consent to use photos. And the photos we do sometimes get permission for are not always the clearest to fully represent the post-op scars. Privacy of the patients is extremely important.
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Dear Sweden!
Sorry for the late reply... it's great to hear from you again and thank you for visiting! Can you email me on orthopedicjamal@gmail.com or give me a call directly? Do you still have my number? We can talk about your situation update in much more depth.
Perhaps give me an email first just to let us know what time you're going to call - since I might be occupied.
Many thanks
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Dear Limb Lengthening Forum members,
Regarding a question that has been asked increasingly in our emails, I would like to assure that all complications that occur from the limb lengthening surgery resulting in the need for more surgery, is covered in the initial price. All our patients should feel safe in the knowledge that if something goes wrong, they will not have to pay extra to return to good health.
Regards,
Dr Jamal A. Nemer
edit: repeated website url/email
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Dr. Nemer, which do you prefer LON or LATN? Is there any way to avoid the knee pain or damage, and how much time does using these nails save. Are they worth it or do you prefer straight Externals
How is the safety in Ukraine right now and do you feel comfortable there as a person of Middle Eastern decent? (I am too)
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Dear Kian222,
Thank you for your question. Life in Kiev is normal and much like any other city in Europe. I have faced very little discrimination as a muslim man by heritage, perhaps the only real barrier would be language for you. However, patients here are always accompanied by a translator here and are always supported with a private driver.
Regarding your question about external methods, please be aware this is my personal opinion. I strongly feel that external methods (especially for femurs) are obsolete methods for limb lengthening. The risk of infection, trauma, slow recovery and extreme stress that the body has to endure is simple not necessary now since internal methods are now widely available at very competitive pricing.
Please feel free to email me personally if you would like to arrange a phonecall on orthopedicjamal@gmail.com if you would like to talk more in depth.
Best regards
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Hi Dr Jamal :)
I'm wanting to lengthen only 5cm, but concerned with contracture.. Would I lengthen 5.5cm to account for possible contracture or is there a way to guarentee that we can avoid bone compression altogether?
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Hi Dr. Nemer.
Thank you for taking time out of your busy schedule to interact with the forum.
If you don't mind, I have a few questions:
1. In your opinion, what is the optimal way to prepare for the surgery. Is there any level of fitness that someone ought to be at?
2. From your experience, what is the approximate rate of complications per patient and what sort of complications arise?
3. In regards to LL, are there likely to be any long term effects - e.g. higher risk of arthritis etc?
4. Is the rate of lengthening consistently at 1mm a day, or is it likely to change pace the further someone goes. In your experience what would be the average timeframe to lengthen 6cm?
5. In regards to rehabilitation, how much physio would be expected per day and what would this entail?
Many thanks!
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Hello Deads,
You do not need to worry about contracture after the device has been locked. The device and screws are made titanium which does not allow for compression.
Hello Nightwish,
Your questions relate to case to case basis which differ so highly with each patient and the methods that are being used. Are you directing your question for internal or external limb lengthening specifically?
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Hello Nightwish,
Your questions relate to case to case basis which differ so highly with each patient and the methods that are being used. Are you directing your question for internal or external limb lengthening specifically?
Oops, helps if I state this! Questions are in regards to internal femur lengthening.