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[jbc]

Hi everyone,

I've emailed a couple of doctors requesting some additional information about the procedure and have yet to hear back. For Dr. Guichet, it's been over 2 weeks. Is this normal, and is it indicative of how they treat their patients? Here are my preferred doctors, in order:

Dr. Guichet, due to supposed fast track recovery time, tenure and experience
Dr. Lee (South Korea), given the fact that I really want to visit South Korea and his credentials
Dr. Paley, because he is US based and has the reputation of being a great doctor with significant experience in this area

I am reticent to go to China or India, realizing I am in the fortunate position of being able to afford to spend more for higher quality health care. I would not mind going to any of those countries, or any other, if there was a physician there whose credentials were impeccable and had a great reputation and track record. With a procedure such as this, with the potential for complications and life-altering negative side effects, saving money is the least of my concerns. Definitely open to recommendations about other doctors who fit this criteria.

I have made up my mind that I will go through this procedure and have mentally and physically prepared myself for the hardships it will place me through. I am planning LL in the very near future, an increase of 5-6 cm max with no more than .66mm increase/day. I am looking at femur lengthening with an internal nail. I really want to minimize risk as much as possible. While this won't get me to my ideal height, it will get me two inches closer to the stars (Gattaca quote) and will not distort my proportions.

Appreciate any insight you can provide about additional reputable doctors, response times, and anything else that may help. I plan to keep a detailed, transparent and thorough diary throughout the process, anonymizing identity only. Will also be equally transparent about recovery. I am active in several sports and would like to return to the same level of physical activity.

Many thanks,

--jbc

[CCMidwest]

I've had email conversations with:

Dr. Paley
Dr. Mahboubian
Dr. Catagni
Dr. Rozbruch
Dr. Birkholtz
Dr. Pili
Dr. Monegal

ALL of them were difficult to get answers and responses from. Most took several weeks to respond, and that was after I sent an additional email showing my seriousness to get LL done, and explanation that I could afford the procedure.

I think they are just busy. Most get lots of emails from people that are interested in LL, but not really serious about ever doing it. One doctor explained to me that the conversion rate of initial email, to consultation, to actual patient is less than 1%

Keep your emails short, but make it known you are serious.

Edit: With the USA doc's, I actually had to call their office and leave my name while stating that I never got a response to my email. Then the doc emailed me back.

[aussieboy]

Yeah I get many people asking questions from me but I don't even know if they are serious? Some questions can be bizarre or even show a lack of proper research and due diligence man. The worst is they ask a barrage of questions non-stop and without even saying "thanks". That's just some basic courtesy in Australia at least.

Never bombard docs with too many questions. Keep questions short. Emails can be aplenty, but make sure each email is easy to respond!

[jbc]

Thanks everyone. I really appreciate your responses. I'm 100% serious and committed, so I suppose phone calls start next

Regards,

--jbc

[ortholengthening]

sure it's better for muscle and nerves-if lengthening 0.66mm/day-but at a rate that slow you risk pre-mature consolidation (bones fusing while you are in process of lengthening). this would especially be the case if you are a "fast healer" and if on the femur.

what is your starting height and weight?

[jbc]

Hi ortho,

I appreciate your response. I will of course lengthen according to how I heal and what the Dr. recommends. I'm only stating the .66 to say that I intend to take a cautious approach. If I am healing faster, and a faster pace of lengthening is recommended, of course I will follow that protocol.

You will forgive me if I don't state my starting height. I don't want to be judged or castigated for doing the surgery at such and such height. I'm nowhere near 6'0", and I'm not 5'2". I'm very height and weight proportionate, my wingspan equals my exact current height, and my weight is in line with my height according to AMA standards with 7% body fat.

Regards,

--jbc

[jbc]

Ortho, I've also started a thread with questions on femur vs. tibia, would really appreciate your thoughts on same.

[TIBIKE200]

Hi ortho,

I appreciate your response. I will of course lengthen according to how I heal and what the Dr. recommends. I'm only stating the .66 to say that I intend to take a cautious approach. If I am healing faster, and a faster pace of lengthening is recommended, of course I will follow that protocol.

You will forgive me if I don't state my starting height. I don't want to be judged or castigated for doing the surgery at such and such height. I'm nowhere near 6'0", and I'm not 5'2". I'm very height and weight proportionate, my wingspan equals my exact current height, and my weight is in line with my height according to AMA standards with 7% body fat.

Regards,

--jbc

Why do you care what people in this forum think about you?

[jbc]

TBike, I just want to avoid the debates and judgment, that's all. This is a very personal decision and something I'm doing for me. I would never judge anyone for doing something like this, whether they were 4'6" or 6'4". But others do. So it's really to minimize noise, that's all.

[jbc]

To update the thread - I've received a response from Dr. Lee's assistant, who seems very nice. I also spoke on the phone with Dr. Guichet, who basically said he is completely overwhelmed by email. I'm making travel arrangements to Florida, Italy and Milan. I will consult with each doctor before deciding, I am hoping to have the procedure done during the later part of this year.

Thanks to everyone who took time to respond to my question!

Regards,

--jbc

[Penguinn]

whether they were 4'6" or 6'4". But others do.

True, I would judge the hell out of a 6'4 person doing this. Since you want a reputable surgeon in India, I'd say Parihar based on my research so far cause that's who I'm going with. But if you can afford Paley or Guichet that's whom you should go with.

[CCMidwest]

True, I would judge the hell out of a 6'4 person doing this. Since you want a reputable surgeon in India, I'd say Parihar based on my research so far cause that's who I'm going with. But if you can afford Paley or Guichet that's whom you should go with.

Hell, I judge anyone 5'9 or more that wants this, lol.

To update the thread - I've received a response from Dr. Lee's assistant, who seems very nice. I also spoke on the phone with Dr. Guichet, who basically said he is completely overwhelmed by email. I'm making travel arrangements to Florida, Italy and Milan. I will consult with each doctor before deciding, I am hoping to have the procedure done during the later part of this year.

Thanks to everyone who took time to respond to my question!

Regards,

--jbc

Watch your back in West Palm Beach, Florida. I'm serious. Especially at night or early morning. Keep your wallet in your front pocket, don't carry lots of cash. Highly recommend against public transportation too. Use Uber, or a taxi. (be careful not to get hustled by the taxi driver though)

It's not a real bad area of Florida, but it can be...interesting.

[Alu]

TBike, I just want to avoid the debates and judgment, that's all. This is a very personal decision and something I'm doing for me. I would never judge anyone for doing something like this, whether they were 4'6" or 6'4". But others do. So it's really to minimize noise, that's all.

I'm gonna go ahead and say you're in the ballpark of 5'8-5'11

[Auron]

I'm gonna go ahead and say you're in the ballpark of 5'8-5'11

5'7~5'8 is my guess 

[jbc]

Thanks CCMidwest - I've been to West Palm Beach before, and I must admit I concur with your assertions . I generally just Uber and don't carry cash, and I'm planning to stay confined to the security of my hotel room at night .

[Nightwish]

I'm gonna go ahead and say you're in the ballpark of 5'8-5'11

5'9 fits best I think.

[jbc]

Trips to West Palm Beach, Seoul and Milan booked. Consultations through end of September.

Process so far

Dr. Guichet: very responsive once we contacted via voice. Had to fill out a very lengthy questionnaire and submit copies of my passport. He sent me a very lengthy email about the prospects of the surgery, what to expect, recovery times, and addressed some of my concerns regarding going back to high intensity sports.

Dr. Paley: have not spoken to him yet, only his "new patient concierge". Paid $750 for the consultation up-front, there is an additional $300 at the time of visit. Sent lots of very informative literature about his practice and the Precise 2.2. He also mentions that under full weight-bearing without consolidated bone support any nail will break, no matter what other doctors tell you.

Dr. Lee: exchanged emails with his assistant, who seems very nice. Very surprised at the rates for surgery in South Korea. Dr. Lee seems to be more expensive than both Dr. Guichet and Dr. Paley. Not much in the way of literature. I will visit South Korea as well, since I've never been there, but not certain why I would choose Dr. Lee over Dr. Guichet and Dr. Paley, given their track record and experience.

At this point I have questions about the Guichet nail, given Dr. Paley's comments - I am hoping for an accelerated recovery, so Dr. Guichet's "fast track" program seemed very appealing, but keeping safety in my mind first and foremost. Will post again once I consult with all 3 doctors.

[CCMidwest]

Trips to West Palm Beach, Seoul and Milan booked. Consultations through end of September.

Process so far

Dr. Guichet: very responsive once we contacted via voice. Had to fill out a very lengthy questionnaire and submit copies of my passport. He sent me a very lengthy email about the prospects of the surgery, what to expect, recovery times, and addressed some of my concerns regarding going back to high intensity sports.

Dr. Paley: have not spoken to him yet, only his "new patient concierge". Paid $750 for the consultation up-front, there is an additional $300 at the time of visit. Sent lots of very informative literature about his practice and the Precise 2.2. He also mentions that under full weight-bearing without consolidated bone support any nail will break, no matter what other doctors tell you.

Dr. Lee: exchanged emails with his assistant, who seems very nice. Very surprised at the rates for surgery in South Korea. Dr. Lee seems to be more expensive than both Dr. Guichet and Dr. Paley. Not much in the way of literature. I will visit South Korea as well, since I've never been there, but not certain why I would choose Dr. Lee over Dr. Guichet and Dr. Paley, given their track record and experience.

At this point I have questions about the Guichet nail, given Dr. Paley's comments - I am hoping for an accelerated recovery, so Dr. Guichet's "fast track" program seemed very appealing, but keeping safety in my mind first and foremost. Will post again once I consult with all 3 doctors.

Good stuff JBC.

I never talked to Guichet. Can you share what he said about sports?

And with the nail breaks, Dr. Paley told me the same thing. Said if it doesn't break, it can bend. The extra $300 with Paley is for xrays if I remember correctly.

Edit: One of the reasons Dr. Guichet can lengthen so quickly is that he lengthens you 1cm or so at the time of surgery. That actually concerns me, as it seems like a lot of lengthening all at once. Have you asked about that?

[jbc]

Good stuff JBC.

I never talked to Guichet. Can you share what he said about sports?

And with the nail breaks, Dr. Paley told me the same thing. Said if it doesn't break, it can bend. The extra $300 with Paley is for xrays if I remember correctly.

Edit: One of the reasons Dr. Guichet can lengthen so quickly is that he lengthens you 1cm or so at the time of surgery. That actually concerns me, as it seems like a lot of lengthening all at once. Have you asked about that?

Regarding sports - from Dr. Guichet's email to me:

"Intensive sports can be resumed after full fusion, which occurs generally approximately twice faster than in other teams (count 4 months for a 6-7 cm gain). Some patients resumes professional sports and won international competitions. Gradual lengthening have been performed since 1906 and there is no long term effect provided the flexibility and early full functional recovery are secured."

I believe this is why he insists on a high level of fitness and preparation pre-op, which makes sense. This is elective surgery, but it is incredibly invasive.

I'm not certain about the 1cm lengthening at time of surgery, nor whether it's a concern. He has an excellent track record. Dr. Paley's statement about any nail breaking does give me pause - logically, the statement makes sense. I'm reserving judgment until I meet with both Dr. Paley and Dr. Guichet.

I think I'm going to rule out Dr. Lee, I really do not see a logical reason to have the surgery done in S. Korea, given the two excellent physicians located in countries that have world class medicine and great track records of same. I know a lot of plastic surgery is done in S. Korea, Gangnam district specifically, but for some reason I trust the US and Europe when it comes to doctors .

You are 100% right about the xrays CC, that's what the extra $300 was about. I have spent real money at this point (close to 5K on booking the flights and trips and $750 for Dr. Paley's consultation) so this is nearing reality. I am totally willing to look at this as throwaway money if for whatever reason, safety included, this becomes a non-starter.

I do have a concern about the Guichet nail and related level of pain with the clicks - there seems to be consistency in the diaries about this. Would love to hear about this from other folks, this is another question I'll have for both doctors. The fast track plan appeals to me in terms of time, certainly, an insane level of pain does not .

[drvbmc]

JBC,

I am really glad to hear that you are doing your due diligence in finding the right surgeon, and not going too far with your desired gains. I am a year or more behind you in my thoughts about this surgery, and am glad that we have these forums to learn from each other's experience.

My ideal goal is to gain 4 cm in femurs and then 3.5 cm in tibias a couple years later This is ONLY IF I am able to return to acceptable function after the first operation.

I would be interested to hear your thoughts on recovery likelihood with this plan.

[jbc]

Articles like this give me hope for a good recovery. They mentioned this on TV the other night during the USA-Canada game and I was floored.

http://olympic.ca/team-canada/gavin-schmitt/

He's playing in the Olympics with two internal nails in his tibias due to stress fractures. Given, his injuries are different than LL, but he recovered 3 months after surgery with a very intensive PT regimen, and he was in Olympic-level shape, which certainly factors in the fact that he is able to participate in a high-impact Olympic sport with nails in his legs 3 months after insertion.

I anticipate to lose some athletic ability, initially, but I also anticipate to recover all of it if at all possible, and I'll do my absolute best to do so. I'm in tremendous physical shape and very flexible, I've never smoked or taken drugs, and have a casual drink once every 6 months or so if anything. I also don't want anymore than 6 cm at the very top. I could go for more, but I want to keep this procedure within the utmost safe parameters. Proportions are also a big deal for me. I re-measured my wingspan and it's 2 1/8 inches longer than my overall height, so 5-6 CM at most seems right.

Assuming I don't encounter any surprises that cause me to back out of this procedure, I'm going to have the surgery with one of these 2 physicians and am giving it my absolute best to prepare. I've incorporated Pilates and Yoga to my workout regimen, and am hoping to ace all of Dr. Guichet's strength and flexibility tests in a month or so .

The pain, frankly, really scares me. This is something that I'm building myself mentally for, and something I'm taking very seriously. But I've decided I want to do this and I'm going to power through it like everything else (with the help of very strong painkillers if necessary).

[Polycrates.]

Having a nail inserted isn't as huge a deal as having a nail inserted and subsequently having the bone separated 6cm over the nail. Lots of people get nails for broken bones, not so many for LL.

[jbc]

Obviously LL is much more complicated and harder to recover from. Also, Gavin Schmitt is not lengthening anything, thus no issues with overextended muscles, tendons and nerves.

It's still a pretty big deal though, given the fact that most people with nails in their tibias can barely walk. I had a colleague who had to get a nail inserted due to a fracture in his left leg. He was wheelchair bound for 3 months due to obesity before he could even weight bear. Gavin is playing in the Olympics 3 months after his procedure with rods in each leg because of the tremendous physical shape he's in.

Physical fitness and preparation matters a lot, just like in most other medical procedures. I certainly cannot claim to know what LL is like, unlike the folks here who have done it, and reading diaries such as Unicorns' gives me quite a bit of mental reticence over the pain I'll have to endure. All I can do is prepare with the utmost intensity and fervor to give me the best chance to come out of this as quickly and with the best possible set of results.

[xevildragonx]

hi jbc

Do you mind telling us the price of those three doctors? most price are pretty outdated on this website, it will be nice to get some info from you. Thx

[Deads]

Obviously LL is much more complicated and harder to recover from. Also, Gavin Schmitt is not lengthening anything, thus no issues with overextended muscles, tendons and nerves.

It's still a pretty big deal though, given the fact that most people with nails in their tibias can barely walk. I had a colleague who had to get a nail inserted due to a fracture in his left leg. He was wheelchair bound for 3 months due to obesity before he could even weight bear. Gavin is playing in the Olympics 3 months after his procedure with rods in each leg because of the tremendous physical shape he's in.

Physical fitness and preparation matters a lot, just like in most other medical procedures. I certainly cannot claim to know what LL is like, unlike the folks here who have done it, and reading diaries such as Unicorns' gives me quite a bit of mental reticence over the pain I'll have to endure. All I can do is prepare with the utmost intensity and fervor to give me the best chance to come out of this as quickly and with the best possible set of results.

Everyone is different, but if you are physically prepared and maintain a level of flexibility throughout your lengthening, keep moving in one way or another and really push the envelope every chance you get when it comes to physical therapy, your soft tissues will recover quicker better and stronger. That is of course if you don't go overboard with your lengthening (which you aren't). If you lengthen too much, then recovery with be arduous regardless.. But this is why Guichet patients can distract and and recover faster. They're somewhat prepared physically.

[jbc]

Not at all. From Dr. Guichet:

"The overall budget in London for one level of surgery (both femurs for instance) that you need to face is approx. £50000 (for surgery (hospital, implants, fees, but not removal) including 2 months of training/physiotherapy (11 sessions per week), but not housing, exams, food nor transports. In Italy the budget is a bit less but for people who have housing in London or who prefer an English speaking country, it may not be a better option. You can come for one month of training (count an additional GBP 3000 per month in a gym with supervision of my Team) then the surgery after it.

We offer, in addition to the surgery package, additional packages for housing, exams, and also a very specific preoperative training program for one month under my full control in Milano or London, but not food nor transports. The initial consultation is £300."

Dr. Paley's prices on his website are current, I confirmed this with his new patient consultant. Here is the relevant data:

http://www.paleyinstitute.org/centers-of-excellence/stature-lengthening-center/costs-financial-considerations

I am not considering Korea or Dr. Lee at this point. I have decided that if I will do this, I am going with Dr. Guichet or Dr. Paley only. I'm fortunate to be in a financial position to do this, and even if I weren't, I would save like mad if I wanted this bad enough, and would not compromise on costs vs. the two best physicians on the planet that are qualified to do this procedure.**

I am keeping track of hard costs spent. Thus far, this is money that has left my bank account, so to speak:

$750 - Dr. Paley consultation (prepaid as required)
$904 - Trip to Florida (plane tickets ++ hotel stay)
$3,409 - Trip to London (plane tickets ++ hotel stay)

Anticipated: $390.01 (in today's exchange rates from GBP to USD) for Dr. Guichet's consultation
Anticipated: $300 for Dr. Paley's X-ray fees.

I am not spending any money on training, as I work out 6 days per week and have for years . I've increased my time in the rock climbing gym and added Pilates and Yoga for maximum flexibility, but that's it. The only thing I can't do is a full set of splits yet, and I'm hoping to be able to do that by the time I visit Dr. Guichet in September. I'm 7.5 inches on the dorsiflexion test and incredibly flexible otherwise, so I hope he waives the month of training with him, but prepared to pay the extra cost for this as well if needed.

(**to add: absolutely not judging anyone for going with other physicians due to cost, this is my choice and my opinion only. This is tough surgery filled by difficult choices, and I'm opting in to medical choices that I feel are best for me, everyone else makes similar decisions based on their circumstances).

[Mtall]

Sent lots of very informative literature about his practice and the Precise 2.2. He also mentions that under full weight-bearing without consolidated bone support any nail will break, no matter what other doctors tell you

If I pm you my email ID will you please please please send me that information Dr. Paley sent you regarding the Precice 2? Because I'm seriously considering internal femurs instead of external tibias.

[jbc]

If I pm you my email ID will you please please please send me that information Dr. Paley sent you regarding the Precice 2? Because I'm seriously considering internal femurs instead of external tibias.

mtall, I'll have to check to see if I can. I don't mind sharing, but if the article is somehow restricted, I'm going to abide by that. I'll also see if it comes up in a Google search by searching for relevant keywords. You should try calling the clinic, they may just email it to you. There are 2 articles regarding the Precise.

TL;DR from the article: The Precise 2.2 has only 1 nail breakage, fewer complications, is 4 times stronger and has some improvements that Dr. Paley designed.