Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Fox]

For a guy who is not even close to afford precice and stryde, i feel like in the near future my only chance is LON surgery at best. For my case it will be two surgeries in a year between. First one will be femur. Hopefully 8 cm. Second one will be 6 cm, after about a year after fully healed. -if fully healing is possible-

Background : martial arts and bodybuilding for a long time.
So stretching exercises wont be an issue for me.

I know the infection risk, dont care all about the scars (correctable through cosmetic scar surgery if needed)

I need some general info from patients who had LON surgery.
Does it really take 3 months more healing time compared to internals? How well you are after removing the externals and locking your bones with nail. Were you able to return to normal like before surgery?
and they say lon is the most preferred method around the world right now. any truth to that?

hElP is neEded

[germanlim]

It is not the best method but i guess it is safe. On YouTube you can find an old Video from Paley wih many lon Patients. But take care you choose a good dr

[MirinHeight]

LON tibias is safer than internal femurs in regards to problems such as pulmonary embolism and fat embolism.

--> Dr. Paley has yet to see an internal tibias case that led to fat embolism. This is also proven in literature that internal femurs have a much higher risk for fat embolism than internal tibias.

--> A DVT in a calf vein has a much lower risk of advancing to a pulmonary embolism than a DVT in a femoral vein which is very dangerous and leads to pulmonary embolism a lot of the time

[Fox]

LON tibias is safer than internal femurs in regards to problems such as pulmonary embolism and fat embolism.

--> Dr. Paley has yet to see an internal tibias case that led to fat embolism. This is also proven in literature that internal femurs have a much higher risk for fat embolism than internal tibias.

--> A DVT in a calf vein has a much lower risk of advancing to a pulmonary embolism than a DVT in a femoral vein which is very dangerous and leads to pulmonary embolism a lot of the time

holy sh"t i didnt know any of that. thank you.
i cant go for internal femurs anyway, so what about lon on femurs also?
and what is DVT exactly?

[MirinHeight]

holy sh"t i didnt know any of that. thank you.
i cant go for internal femurs anyway, so what about lon on femurs also?
and what is DVT exactly?

DVT : deep vein thrombosis which is basically a blood clot in the leg. If the clot breaks off and goes into pulmonary circulation this is now called pulmonary embolism. It is more likely for a clot in a femoral vein to break off and go into pulmonary circulation than a clot in a calf vein.

Nobody should do LON on femurs. Imagine having to wear an external fixator for femurs. And LON on femurs is the same risk as internal femurs when it comes to fat embolism because the surgeon is still reaming the bone canal (femurs have higher amount of fat in bone canal than tibia--> this fat can get dislodged and travel in blood stream to cause fat embolism). Also as I stated earlier, when doing hip or femur surgery, the rate of DVT and pulmonary embolism is also higher.

also the doctors I recommend for LON tibias:

1. Dr Donghoon Lee. Dr Paley and Dr. Rozbruch speak highly of him and he is very very experienced in LON surgery.

2. Dr Giotikas: not as experienced as Dr. Lee but has very very high credentials (MD/PHD) from top universities and is very ethical and honest surgeon. Will reject patients, and is upfront with patients about the risks involved. You can read recent diaries with Dr. Giotikas and all patients have made good recoveries so far.

both of these doctors will cost ~$36,000 for LON excluding living costs.

[Fox]

DVT : deep vein thrombosis which is basically a blood clot in the leg. If the clot breaks off and goes into pulmonary circulation this is now called pulmonary embolism. It is more likely for a clot in a femoral vein to break off and go into pulmonary circulation than a clot in a calf vein.

Nobody should do LON on femurs. Imagine having to wear an external fixator for femurs. And LON on femurs is the same risk as internal femurs when it comes to fat embolism because the surgeon is still reaming the bone canal (femurs have higher amount of fat in bone canal than tibia--> this fat can get dislodged and travel in blood stream to cause fat embolism). Also as I stated earlier, when doing hip or femur surgery, the rate of DVT and pulmonary embolism is also higher.

also the doctors I recommend for LON tibias:

1. Dr Donghoon Lee. Dr Paley and Dr. Rozbruch speak highly of him and he is very very experienced in LON surgery.

2. Dr Giotikas: not as experienced as Dr. Lee but has very very high credentials (MD/PHD) from top universities and is very ethical and honest surgeon. Will reject patients, and is upfront with patients about the risks involved. You can read recent diaries with Dr. Giotikas and all patients have made good recoveries so far.

both of these doctors will cost ~$36,000 for LON excluding living costs.

i can't go for internal femurs man, and you're saying it has the same risks as the external femurs so might as well go for lon..

Still might need some patients opinion on that external risks for femur

[Zamii]

Does lon tibia (the bone itself) actually heal slower than stryde tibias, if so then how? I thought stryde mainly made it more comfortable

Lon is a very established method though for tibias (compared to pure internal)

[California2]

With respect, based on the background you provide, you are asking the wrong question(s).

The first branch in the decision tree is external versus internal. 

External is the original method--it is safer than internal lengthening, less expensive, and more inconvenient because you have to stay in frames until your bones have healed enough to safely bear your weight.

The external frames both bear some small amount of weight and facilitate distraction.

The time in frames can be reduced by LON or LATN.  Both of these methods insert a metal rod inside your bone and secure the rod with screws.  The rods allow the external frames to be removed after distraction is completed because the rods carry the weight the frames previously carried.

The difference between LON and LATN is the time when the rod is inserted.  Via LON, the rod is inserted during the initial surgery; then, the bone is lengthened around the rod.  Via LATN, the rod is inserted after distraction is completed.

Internal lengthening involves insertion of a nail that can both bear weight and distract.

External lengthening can be safely accomplished in both India and Russia for about $20K; however, I encourage you to carefully research your choices to identify reputable surgical teams and quality facilities.

[Fox]

External lengthening can be safely accomplished in both India and Russia for about $20K; however, I encourage you to carefully research your choices to identify reputable surgical teams and quality facilities.

thank you for your response sir.
of course i will do my research deeply and try to find the most qualified surgeon and the facility
im alright with the slow healing time compared to internals, as long as i have the same successful outcome as the internal methods, if done correctly and if i follow the procedures carefully eg. stretches, nutrition etc.

[ru]

External lengthening can be safely accomplished in both India and Russia for about $20K; however, I encourage you to carefully research your choices to identify reputable surgical teams and quality facilities.

may be in Russia there are good facilities (as you have diary proving you went there) but definitely not in India! Most docs in India like Sarin and Pradeep Sherma do only LON and have no credentials as LL specialists

[California2]

I chose the Solomin/Kulesh team in St. Petersburg for good reasons. 

However, I do not think it is fair or accurate to discount every limb lengthening surgeon in India.

Limb lengthening is neither an easy nor a quick process.

Do real research, make an informed decision, and maintain realistic expectations.

[ru]

I chose the Solomin/Kulesh team in St. Petersburg for good reasons. 

However, I do not think it is fair or accurate to discount every limb lengthening surgeon in India.

Limb lengthening is neither an easy nor a quick process.

Do real research, make an informed decision, and maintain realistic expectations.

can you please explain this process of making a decision especially when you are in a different country?

doctor's education matters? see dr M. he produces one of the best results but his education is quite poor. he is not a MD. He went to schools which shut down due to malpractice. he has also had a history of tying up with old forum to get patients. even now he runs these cringey ads and promo tricks. But his results are excellent. i have yet to hear a single patient say anything bad about him. should one go to him inspite of his education background?

guichet on the other hand had excellent reputation and is known as a pioneer. But until one diary from that woman patient came out every one had thought he was a god.

seriously how can make a decision like this about a doctor for such a serious operation in a different country? in India there are a few docs like Suhas Shah who have great education, (trained with paley and catagni) but he has done horrible things to patients even crippling an international patient. there is also one Milind Chaudry who is again extremely well qualified to do LL but no one wrote any experience of him.

and consultations are not quite useful. unless the doc is really incompetent and stupid or careless ("you can lengthen 20cm no problems" type) you will never be able to weed them out. guichet offers a very sophisticated consultation. after consultation you would think nothing would ever go wrong under his care.

[California2]

I don't know that there is much difference in selecting a surgeon based on the surgeon's qualifications whether the surgeon is next door or across the world.

When considering a surgical team that is geographically distant, you would naturally consider additional factors such as cost and logistics. 

I addressed both of these concepts in prior posts.  You are welcome to read through my prior posts if you think the information may be useful.

[ru]

I don't know that there is much difference in selecting a surgeon based on the surgeon's qualifications whether the surgeon is next door or across the world.

When considering a surgical team that is geographically distant, you would naturally consider additional factors such as cost and logistics. 

I addressed both of these concepts in prior posts.  You are welcome to read through my prior posts if you think the information may be useful.

i went through your posts and found this

In general, that the surgeon performs leg lengthening regularly (or exclusively); that is, that leg lengthening is a primary focus of the surgeon's practice.  That the surgeon also conducts research regarding leg lengthening and is published (books or peer-reviewed articles).  That the surgeon performs both medically necessary and elective leg lengthening.  That the surgeon has no public record of discipline or gross malpractice and is regulated by a professional body.  That the surgeon employs a team of qualified professionals.  That the surgeon practices in a first world country with modern facilities.

my observations
1. medical qualifications are not in your list as per this post. someone who went to a bad uni, is not MD (MD requires u to be a better student than others like osteopathy) are not major reasons for you to drop a surgeon. ironically you have also praised dr Solomin for being an MD and phd holder and for having written an important book. pls note I'm not attacking you or anything. You have no obligation to respond or to back up each one of your previous posts, i Understand that. I'm just trying to understand how past patients chose their surgeons and why not other surgeons
2. India is a not a first world country. so I'm not sure why India can even be an option because its not a first world country (referring to your last line) any wrong choice made in India can be more dangerous than in europe or US.

As for what difference whether surgeon is next door or not? the difference is if the surgeon is next door but not super qualified but literally everyone in your neighbour hood has nice things to say about the surgeon then you can drop your qualification requirements

as for cost and logistics, they are very important but completely unrelated to surgeon quality . They are also very easy to evaluate unlike surgeon

[California2]

Thank you for finding my prior post.  Near that post is another post with discussions amplifying my comments; however, I do not specifically recall what I wrote so I leave it to you to find and read those amplifying posts.

Reviewing my post regarding criteria for selecting an MD that you shared, those criteria still seem valid and appropriate to me.

Medical education is important; education creates a foundation for experience.  However, once educated, experience becomes a far more important criteria in my opinion.  That is, I would rather be defended for murder by a guy who went to night school and challenged the bar exam but won 100 murder trials than be defended by a Harvard valedictorian on his or her first murder trial.

Mohoubian is a more pertinent example.  He is a DO rather than an MD; yet, he has significant experience in limb-lengthening.  His experience should vastly override any concern about his education.

I did not choose a surgical team in India because, in part, India is not a first world country.  However, one should not generally extrapolate to conclude that a quality limb-lengthening result is not possible in India.  India has first-world surgical facilities and first-world surgical teams even though the country in general is not considered a first-world country.

If you want to rely on your neighbors' opinions regarding professionals in the neighborhood; then, you are free to do so.  I am not a fan of testimonials unless I can support such testimonials by objective evidence.

I do not agree that costs and logistics are easy to evaluate.  It is plain that using the MD next door is easy.  It is far from clear how complicated using a geographically distant MD may or may not be. 

Whichever path you choose, I wish you all the best.

[Fox]

So under an experienced and well qualified surgeon, LON might be a good choice for us who cant afford internals?

[California2]

"LON" is a subset of external lengthening. 

So, it is more correct to say that "external lengthening" is an option for folks (like me) who do not want to pay the cost for internal lengthening.

If you choose external lengthening; then, you also choose whether you will do: a) purely external lengthening; or b) lengthening over nails (LON); or, c) lengthening and then nailing (LATN).

Purely external lengthening remains the safest way to lengthen; however, it leaves you in frames for the longest time. 

The frames serve two purposes:  first the frames are the tool that pull apart the bones; second, the frames support your distracted bones until your bones heal enough to bear your weight.

LON and LATN significantly reduce the time in frames.  In addition to frames, nails are inserted inside your bones.  Once distraction is competed, the frames are removed.  The nails hold your bones apart and can bear some weight until your bones heal enough to bear full weight.

If you want to do LON or LATN in connection with external lengthening; then, you will discuss with your surgical team which process is best for you.  Via LON, the nail is inserted at the initial surgery.  Via LATN, the nail is inserted when the frames are removed.

Internal lengthening does not use frames so you can look and be more 'normal' during the process; and, you can bear more weight earlier so recovery is generally faster but it can costs four times as much as external (depending on where you get external done).

[Fox]

"LON" is a subset of external lengthening. 

So, it is more correct to say that "external lengthening" is an option for folks (like me) who do not want to pay the cost for internal lengthening.

If you choose external lengthening; then, you also choose whether you will do: a) purely external lengthening; or b) lengthening over nails (LON); or, c) lengthening and then nailing (LATN).

Purely external lengthening remains the safest way to lengthen; however, it leaves you in frames for the longest time. 

The frames serve two purposes:  first the frames are the tool that pull apart the bones; second, the frames support your distracted bones until your bones heal enough to bear your weight.

LON and LATN significantly reduce the time in frames.  In addition to frames, nails are inserted inside your bones.  Once distraction is competed, the frames are removed.  The nails hold your bones apart and can bear some weight until your bones heal enough to bear full weight.

If you want to do LON or LATN in connection with external lengthening; then, you will discuss with your surgical team which process is best for you.  Via LON, the nail is inserted at the initial surgery.  Via LATN, the nail is inserted when the frames are removed.

Internal lengthening does not use frames so you can look and be more 'normal' during the process; and, you can bear more weight earlier so recovery is generally faster but it can costs four times as much as external (depending on where you get external done).

thank you for the information sir.

and yes i do know the differences between lon/latn and purely internal methods like precice and stryde.
the thing about lon that is appealing to me is, the external device stays on your leg only during the lengthening period. this is so good for me because, lets say i'm going to lengthen my femur by 8 cm, it will stay on my leg only for 80 days which i can bear.

and when the lengthening is finished, they remove the device and leave the nail inside so that your bones can consolidate. if i am not mistaken.

from my point of view i really really dont think it wouldnt be as successful as the pure internal methods, since i'm more interested in the outcome, rather than the process being comfortable.

just the infection risk that i'm aware of, around the pin sites. but that risk can be avoided if treated carefully.

these are my thoughts

[ru]

Thank you for finding my prior post.  Near that post is another post with discussions amplifying my comments; however, I do not specifically recall what I wrote so I leave it to you to find and read those amplifying posts.

Reviewing my post regarding criteria for selecting an MD that you shared, those criteria still seem valid and appropriate to me.

Medical education is important; education creates a foundation for experience.  However, once educated, experience becomes a far more important criteria in my opinion.  That is, I would rather be defended for murder by a guy who went to night school and challenged the bar exam but won 100 murder trials than be defended by a Harvard valedictorian on his or her first murder trial.

Mohoubian is a more pertinent example.  He is a DO rather than an MD; yet, he has significant experience in limb-lengthening.  His experience should vastly override any concern about his education.

I did not choose a surgical team in India because, in part, India is not a first world country.  However, one should not generally extrapolate to conclude that a quality limb-lengthening result is not possible in India.  India has first-world surgical facilities and first-world surgical teams even though the country in general is not considered a first-world country.

If you want to rely on your neighbors' opinions regarding professionals in the neighborhood; then, you are free to do so.  I am not a fan of testimonials unless I can support such testimonials by objective evidence.

I do not agree that costs and logistics are easy to evaluate.  It is plain that using the MD next door is easy.  It is far from clear how complicated using a geographically distant MD may or may not be. 

Whichever path you choose, I wish you all the best.

Thanks for the thoughtful reply and addressing all my concerns.

asking neighbours is indeed not objective. but the only completely objective way is to find evidence of malpractice in public records. even dr Paley who is considered god like has these. dr M probably doesnt (couldn't find any). but more the surgeries a surgeon does, more the chances of something having gone wrong at some point

it's all the more hard to find these records in other countries. guichet probably has some in france but Ive not found any documents. betz, some patient had taken him to court once. in India, I dont think anything like this would even surface up. courts are not for normal people in developing countries like India.

there is at least one patient of dr rozbruch who claims he abandoned them after a surgery didnt go right and no doctor would taken them. there are some youtube videos on this. This seems to a strange problem in US. Surgeons abandoning their patients and other surgeons being hesitant to take up such cases.

other than that, diaries on the forum, google reviews and other website reviews can be easily faked or mis represented. that's why I felt a good surgeon would have good reputation locally and that could be a good way measuring his (or her) ability. please suggest any other objective ways (not counting educational, writing books, getting phd etc)

This is a very complicated problem to solve

[ru]

thank you for the information sir.

and yes i do know the differences between lon/latn and purely internal methods like precice and stryde.
the thing about lon that is appealing to me is, the external device stays on your leg only during the lengthening period. this is so good for me because, lets say i'm going to lengthen my femur by 8 cm, it will stay on my leg only for 80 days which i can bear.

and when the lengthening is finished, they remove the device and leave the nail inside so that your bones can consolidate. if i am not mistaken.

from my point of view i really really dont think it wouldnt be as successful as the pure internal methods, since i'm more interested in the outcome, rather than the process being comfortable.

just the infection risk that i'm aware of, around the pin sites. but that risk can be avoided if treated carefully.

these are my thoughts

There is this device called salameh fix which is more conevenient to wear but it's not used by any other surgeon apart from dr Salameh. I have no idea about whether he is good or not. It just looks much cooler and socailly acceptable to wear salameh fix which is tiny than full external fixators.