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[TIBIKE200]

I promised so here I go

1) He lengthens between 5-9 (sometimes 10) cm on tibias (though he sais that in terms of proportions 9 is really pushing it and 8 is the max)

2) He uses the precise nail alongside the external fixator (He STRONGLY PREFERS the external fixators).

3) No LON or LATN (Says can cause misallignemnt problems which are much more difficult to deal with unlike pure externals)

4) Achilles tendon lengthening is not the big black boogieman that this forum (and the other one) s saying it is (It usually starts between 4-6cm and he prefers to do it immidiatly as it starts because prognosis is much better than to wait it through physiotherapy)

5) Best physiotherapy according to him is Walking Walking walking. You walk almost immidiatly after operation

6) time frame is usually the same in terms of healing (9-12 months)

7) He no longer operates in Lecco (he has his clinic there though). He works in the San Camilo hospital.

These are the important points I remember from the consultation if you have any more questions feel free to ask

[Ozymandias]

I found quite disturbing that most of those statements are completely different from what most LL doctors advise.

[TIBIKE200]

I found quite disturbing that most of those statements are completely different from what most LL doctors advise.

Who are these doctors? Paley that was his student for 6 months? Guichet (which also is the only LL doctor that encourages to build muscles before LL)?

  He says that physio doesnt really help prevent equinous of the foot.. Only way to keep streching the tendons is to walk.

[TIBIKE200]

Sorry for the bit aggressive response... It's the Israeli in me.

 To be more precise, I also was in a bit of shock when he told me about physio. I said to him that on the forum about the subject other doctors are taking physio really seriously. He said that according to his own experience, walking was the best physio (and this is why he encourages it as soon as possible). He said that he gives you exercises to do at home and stuff but that walking (and also swimming) are the best two things to do.

 I asked about lengthening more than 5-6. He said that the blood vessels regenerate (And he is correct) and that one knows his limit when nerve pains start. The most limiting factor is the muscles and the achilles tendon (which cause bent knee and ballerina respectivly). I asked him about athletic recovery. He said that from his follow-ups, those that went skiing returned to skiing, those that went swimming returned to swimming and those that were running returned to run.

He advocates for atleast 5-6cm (he usually dont accept people who wanna do less) because he sais that it's not worth it (the process and psychological burden).
 
 What I really liked about him that a few people in the town (lecco) said that even though as a person he can be pretty bad, as a doctor he is number one (when we asked people where Catagni's studio is and then we asked them about him). I also liked the fact that he doesn't push you to do it. He said to me "If my son was unhappy with his height I wouldnt suggest him to do that.. But if he would have persisted, I would be the only one I would let my son do it because I think I am capable".  Also, he didnt tell me to start thinking about when doing it now.. He told me to talk to the 15-20 patients and ex patients on a list he gave me (with emails and phone numbers) and than to think if this is what I really want. If I would want to do it, that I should know all the risks, and especially the heavy psychological burden of being in these frames for so long.

[hyong]

Sorry for the bit aggressive response... It's the Israeli in me.

 To be more precise, I also was in a bit of shock when he told me about physio. I said to him that on the forum about the subject other doctors are taking physio really seriously. He said that according to his own experience, walking was the best physio (and this is why he encourages it as soon as possible). He said that he gives you exercises to do at home and stuff but that walking (and also swimming) are the best two things to do.

 I asked about lengthening more than 5-6. He said that the blood vessels regenerate (And he is correct) and that one knows his limit when nerve pains start. The most limiting factor is the muscles and the achilles tendon (which cause bent knee and ballerina respectivly). I asked him about athletic recovery. He said that from his follow-ups, those that went skiing returned to skiing, those that went swimming returned to swimming and those that were running returned to run.

He advocates for atleast 5-6cm (he usually dont accept people who wanna do less) because he sais that it's not worth it (the process and psychological burden).
 
 What I really liked about him that a few people in the town (lecco) said that even though as a person he can be pretty bad, as a doctor he is number one (when we asked people where Catagni's studio is and then we asked them about him). I also liked the fact that he doesn't push you to do it. He said to me "If my son was unhappy with his height I wouldnt suggest him to do that.. But if he would have persisted, I would be the only one I would let my son do it because I think I am capable".  Also, he didnt tell me to start thinking about when doing it now.. He told me to talk to the 15-20 patients and ex patients on a list he gave me (with emails and phone numbers) and than to think if this is what I really want. If I would want to do it, that I should know all the risks, and especially the heavy psychological burden of being in these frames for so long.

Is it possible to differentiate between nerve pain and muscle pain? , i know i sounded kind of silly asking this but just curious about it

[TIBIKE200]

Is it possible to differentiate between nerve pain and muscle pain? , i know i sounded kind of silly asking this but just curious about it

 Nerve pain is usually a chronic pain that does not correlate with movement. It is a pulsing pain. It can also come along with weakness of the limb or loss of sensation. Muscle pains, if you touch where it hurts you, it will hurt more. It will become greater with movements and is usually very acute during the making of certain movements.

[texasbruce]

Nerve pain is usually a chronic pain that does not correlate with movement. It is a pulsing pain. It can also come along with weakness of the limb or loss of sensation. Muscle pains, if you touch where it hurts you, it will hurt more. It will become greater with movements and is usually very acute during the making of certain movements.

I heard some people mentioned "electric feel". Is it the nerve limitation indication ?

[crimsontide]

he is 1000% wrong on achilles lengthening

there are numerous studies on achilles lengthening, and every one of them says the operated limb was significantly weaker than the non operated limb

it's just not possible that the   achilles c is as strong... you are thinning it and elongating it....while using the same achilles tissue


It's not possible that the tendon  generates as much force


achilles lengthening should be avoided.... there's a reason rozbruch and paley advise against it

my right achilles, which looks okay, unlike the left, it too is weaker than before

will the force come back... no idea... the left, not a chance

 nerve damage doesn't always hurt

my nerve damage intially did not hurt... it's numb though, and there's this odd  electric tingling that I get when I flex muscle

the leg though is very weak... hard to describe but i'll make an attempt

imagine trying to walk  faster, or trying to run, but no matter how hard you mentally try, the leg  doesn't do a thing... that's the best I can do to describe nerve weakness... the  leg just doesn't work as it used to

[Ozymandias]

Sorry for the bit aggressive response... It's the Israeli in me.

No problems man, just advising you to get a second (and third) opinion on these statements. Yes, they are completely different from what Guichet and Paley say, but also from Baumgart, Birkholtz, Monegal, Rozbruch, and a large etcetera.

1) He lengthens between 5-9 (sometimes 10) cm on tibias (though he sais that in terms of proportions 9 is really pushing it and 8 is the max)

I asked about lengthening more than 5-6. He said that the blood vessels regenerate (And he is correct) and that one knows his limit when nerve pains start. The most limiting factor is the muscles and the achilles tendon (which cause bent knee and ballerina respectivly). I asked him about athletic recovery. He said that from his follow-ups, those that went skiing returned to skiing, those that went swimming returned to swimming and those that were running returned to run.
He advocates for atleast 5-6cm (he usually dont accept people who wanna do less) because he sais that it's not worth it (the process and psychological burden).

It is very, very strange that he uses 5-6 cm as a lower limit. Virtually any other doctor agrees that going over 5 cm is dangerous. As an example, I'm going to quote Franz Birkholtz:

"Tibial CLL should probably be limited to around 4-5cm. This has to do with muscle tension and contractures primarily. Although the muscles to grow in the process of distraction histogenesis, there is an element of stretching that has to take place as well and if this is excessive, contractures result (eg ballerina foot) and this may be permanent."

Many patients (Sweden, for example) regret having done more than 5 cm in tibia.

3) No LON or LATN (Says can cause misallignemnt problems which are much more difficult to deal with unlike pure externals)

LON or LATN can cause misalignment problems? Intramedullary nails were developed to prevent misalignments often associated with purely external fixators. So this statement sounds quite weird... Did he explain this further?

4) Achilles tendon lengthening is not the big black boogieman that this forum (and the other one) s saying it is (It usually starts between 4-6cm and he prefers to do it immidiatly as it starts because prognosis is much better than to wait it through physiotherapy)

See crimsontide's previous post

6) time frame is usually the same in terms of healing (9-12 months)

Not sure about what he wanted to say with this.


To sum it up, I would get a second and third opinion. Ask Birkholtz, for example. He has a Q&A thread here, and he also offers externals & Precice (as well as LON/LATN). Email Guichet or Monegal. Let's see what they have to say about these things.

And as a final note:

What I really liked about him that a few people in the town (lecco) said that even though as a person he can be pretty bad, as a doctor he is number one (when we asked people where Catagni's studio is and then we asked them about him).

It may sound childish, but I don't want a bad person to be my LL doctor. Aftercare could be an issue.

[Knik]

It is very, very strange that he uses 5-6 cm as a lower limit. Virtually any other doctor agrees that going over 5 cm is dangerous. As an example, I'm going to quote Franz Birkholtz:

"Tibial CLL should probably be limited to around 4-5cm. This has to do with muscle tension and contractures primarily. Although the muscles to grow in the process of distraction histogenesis, there is an element of stretching that has to take place as well and if this is excessive, contractures result (eg ballerina foot) and this may be permanent."

Many patients (Sweden, for example) regret having done more than 5 cm in tibia.


with external or internal ?

[TIBIKE200]

1) about the misallignment. To make myself more clear, it's not that it would not happen with pure externals, but what I meant is that if it happens with externals, it is much much much more easier to correct (you do it by simply manipulating the device). He said that the tibia with internals is not good also because of the shape on the bone (having a narrow middle part and pretty large distal parts) which make the nail unstable thus augmenting the possibility of misalligment.

2) ATL. I talked with him alot about it. He said that it's better to do it immidiatly when ballerina appears and not afterwards (which will make the recovery much much worse). I said about loss of force or function because of it. He said "Cazzate" which means bull . He does it all the time (with cosmetic and non) and there doesnt seem to be any problem with doing it (if it's done properly... Crimsonetide's scar clearly shows that Dr.Shah has no idea what he is doing with a knife). He showed me photos of scars of this ATL  and they dont look like anything that Crimsontide has.

3) About lengthening amount.
  Because he knows that people who do it are not really short and that the problem is in their heads, he prefers them to do larger amounts because they will rarely be satisfied with anything below 5cm (he said that it was at this mark +/- that people started to become satisfied of their new height). I said to him that other docs prefer to put 5 at max. He replied that it's because they are not good enough.

[TIBIKE200]

Anyway, this meeting with him really helped with my height neurosis. I am much more calm about this whole thing (Before it seems I was ery very scared from this operation). Now, after facing an LL doctor and really talking about everything my mind is in peace. If will do this thing it will be with this guy. Now I will just need to know if I will eventually do it.

So this is me leaving this forum for now. Good luck to everyone

[goldenegg]

1) about the misallignment. To make myself more clear, it's not that it would not happen with pure externals, but what I meant is that if it happens with externals, it is much much much more easier to correct (you do it by simply manipulating the device). He said that the tibia with internals is not good also because of the shape on the bone (having a narrow middle part and pretty large distal parts) which make the nail unstable thus augmenting the possibility of misalligment.

so you didn't mean LON and LATN vs external as you said originally?  I agree with ozymandias. the whole point of having the nail in LON is that misalignment is less likely to happen is the first place compared to externals since the nail maintains alignment of the bone.

2) ATL. I talked with him alot about it. He said that it's better to do it immidiatly when ballerina appears and not afterwards (which will make the recovery much much worse). I said about loss of force or function because of it. He said "Cazzate" which means bullcrap. He does it all the time (with cosmetic and non) and there doesnt seem to be any problem with doing it (if it's done properly... Crimsonetide's scar clearly shows that Dr.Shah has no idea what he is doing with a knife). He showed me photos of scars of this ATL  and they dont look like anything that Crimsontide has.

just cause "he said so" doesn't change the fact that many top doctors are overwhelmingly against ATL and doesn't prove much.  studies or more proof would be helpful to make this point.  "I do it all time" is not enough and probably what dr. shah said to crimsontide when he got it   

3) About lengthening amount.
  Because he knows that people who do it are not really short and that the problem is in their heads, he prefers them to do larger amounts because they will rarely be satisfied with anything below 5cm (he said that it was at this mark +/- that people started to become satisfied of their new height). I said to him that other docs prefer to put 5 at max. He replied that it's because they are not good enough.

this is the most concerning statement I've heard so far if it's true.  lengthening amounts are limited by your body, not the doctor.  like dr. birkholtz said you're stretching the muscles and nerves.  guichet was always conservative in lengthening amounts with me and it was clear that reaching my goals would be a more a result of my flexibility, body's reaction, and dedication to post-op PT, not how good he was as a doctor (even though he is an excellent doctor) 

LL is a serious surgery with life long consequences, so everyone who is saying to get a second or third opinion from other doctors before committing is giving good advice. best of luck if you decide to do it

[crimsontide]

I DO IT ALL THE TIME... YOULL BE PERFECT

thats exactly what shah said... no worries


all studies on achilles lengthening say the leg becomes weaker

i mean literally all.

rozbruch did tell me pt would help right leg fully recover, but we'lll see


you can see achilles lengthening papers online... they all say the leg becomes weaker

[Ozymandias]

3) About lengthening amount.
  Because he knows that people who do it are not really short and that the problem is in their heads, he prefers them to do larger amounts because they will rarely be satisfied with anything below 5cm (he said that it was at this mark +/- that people started to become satisfied of their new height). I said to him that other docs prefer to put 5 at max. He replied that it's because they are not good enough.

No comments 

with external or internal ?

I'm not sure if you are asking about Sweden's case, or if it is a more general question. Anyways, as goldenegg said, lengthening amounts are limited by your body, not by your doctor, and not by the method used (at least, not crucially, although externals can have some extra issues due to the very long time with frames)

[Alittletooshort]

3) About lengthening amount.
  Because he knows that people who do it are not really short and that the problem is in their heads, he prefers them to do larger amounts because they will rarely be satisfied with anything below 5cm (he said that it was at this mark +/- that people started to become satisfied of their new height). I said to him that other docs prefer to put 5 at max. He replied that it's because they are not good enough.

That answer by him was not only unprofessional but also extremly stupid. No Dr. in the world can change the way the body adapts to the surgery, saying that the others are simply not good enough makes him seem like a total jerk. Some people are restiricted to lower amounts due to their genetics, there is no way this can be changed by his skills as a Dr. in any way.

[aspirant185]

I am sure the doctor did not believe what he said. Its like the way Southern/Eastern Europeans think and joke about the time. I ve heard that Mitkovic joked with a patient who said that he doesnt feel any pain and Mitkovic joked that its probably because he had a nerve injury and he will never feel his legs again or when another asked how to control pain, Mitkovic replied that he needs to take drugs, and not the ones that are being sold in pharmacies Same with Catagni, I am sure he would lengthen you 5 cm..if anything u can say u wanna do 5 and stop at 4 he cannot force you to continue...

[TIBIKE200]

Physiotherapy. It doesnt help. Everyone get's ballerina. It can help reduce it and even solve it only after you got it.

complications: He didnt say they wouldnt happen, but that he knows how to handle them.

ATL: Where is the research about it's devestating effects?

[ub40]

It's refreshing to see that walking is the best physio.

[Moubgf]

price for tibia?

[TIBIKE200]

price for tibia?

 20k

[chineseguy]

20k euro   same with dr pili


but i belive they are good surgeon