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[Bron]

Happy New Year LL peeps!

I just want to ask a question, I’m about to do my LL hopefully early this year ( no more procrastinating for me ), at first I wanted to do internal femur but my tibias are quite short so I’ll do tibias instead or tibias first then femur in the future, I read that the general consensus is that externals for tibias is the way to go but now I’m having my doubts because of the scars, if you are me would you consider internal tibias? is it safe? If yes then to which doctor will you go and what will be your max cm to lengthen? let’s say my budget is 20-50k USD including everything (meds, accommodation, food etc.) maybe 60k USD but I’m hoping I won’t spend that much. I’m also looking for the fastest journey I can to come back to normal life.

Hoping for your replies and advices, it would be a good help in making my decision.

[The Dreamer]

If you want to do tibias,the safest method is the external one.
The use of intramedullary nails causes high risks (we are talking about a percentile near to 50%) of developing permanent knee pain.There is a whole thread in the forum with studies and articles regarding it
Your budget is good for doing external tibias,there are several interesting doctors around it

[Knik]

EXTERNAL is the better option
first it's less expensive, but also less risks for tibia
but for femur, only INTERNAL

[Bron]

If externals is the way to go, who do you think is the best doctor for externals? regardless of the price and location

[Android]

If externals is the way to go, who do you think is the best doctor for externals? regardless of the price and location

Dr. Birkholtz, Dr. Pili, Dr. Parihar, Dr. Solomin... Who else?

[Bron]

Dr. Birkholtz, Dr. Pili, Dr. Parihar, Dr. Solomin... Who else?

I agree, but I’m not sure if Dr.Pili and Dr.Parihar do LATN, and if I’ll go to Italy who would be better Dr.Pili or Dr.Catagni? I believe they work together in most cases but still you need to choose between the 2 of them.

[Knik]

I agree, but I’m not sure if Dr.Pili and Dr.Parihar do LATN, and if I’ll go to Italy who would be better Dr.Pili or Dr.Catagni? I believe they work together in most cases but still you need to choose between the 2 of them.

Catagni have more experience, but yes they are working together

[419]

Dr. Birkholtz, Dr. Pili, Dr. Parihar, Dr. Solomin... Who else?

I would add Xia/Lee, thought the money they ask is nothing less than daylight robbery, highly educated white collar thieves

[Bron]

who are the thieves? I’m considering Dr.Donghoon Lee, I just hope his prices is a bit lower

[419]

who are the thieves? I’m considering Dr.Donghoon Lee, I just hope his prices is a bit lower

most of doctors ae thieves, in US all doctors are more than thieves - they are decoits who would sell their souls for money, majority of LL doctors are thieves in the world (including Donghoon) , Xia/Lee are biggest thieves

[Android]

most of doctors ae thieves, in US all doctors are more than thieves - they are decoits who would sell their souls for money, majority of LL doctors are thieves in the world (including Donghoon) , Xia/Lee are biggest thieves

I wouldn't say most doctors are thieves. In the US, cost of living is much higher, and the stricter regulations make things more expensive -- increasing costs for everything from renting operating theaters, equipment, to medication. Litigation is not uncommon either, and costs may be raised in anticipation for such events. Let's not forget that the US healthcare system is also brutally unforgiving without insurance, which CLL (or any cosmetic surgery) doesn't qualify for.

Elsewhere in the world where living costs are lower, I'd say the the increased demand has put a strain on the doctor's workloads, and they've raised prices to dissuade less committed patients. CLL is relatively unknown, but more people are finding out about it every year. They can effectively make the same money without overworking themselves; we as patients don't want to increase risk for error by allowing doctors to take on a handful of surgeries per day either. The solution is to have more specialized doctors to increase supply, and hopefully the increase in demand for CLL and improved surgical methods/equipment will make that possible.

And let's not forget that state-of-the-art internal nails like PRECICE accounts for the bulk of the cost these days. Cost of raw materials doesn't add up to so much, but they have to factor in profit margin, R&D, employee salaries, FDA processing fees, etc. NuVasive isn't the enemy either, since revolutionary products tend to start with high prices to pay for its initial investment.

Here's an interesting article by Dr. Birkholtz from September 2017, precisely about his takeaways of being a doctor as well as becoming a businessman:
Orthopaedic surgery as a business - getting it right

In the end, doctors indeed want to make money, just like all of us. It is a profession and they spent a lot of resources to become an expert in their field. They're not operating a charity and they are not your friend; they don't owe us anything. CLL is a cosmetic surgery, so no one is forcing us to do it. Lucky for us we have the internet, we have airplanes, and we have a lot of doctors to fit our unique needs.

[Zeo]

most of doctors ae thieves, in US all doctors are more than thieves - they are decoits who would sell their souls for money, majority of LL doctors are thieves in the world (including Donghoon) , Xia/Lee are biggest thieves

What gives you the right to make a statement like that?

A lot of these doctors contribute more to the world in one day then what you would contribute in your whole life

Just because you can't afford Paley that doesn't make a theif. Cosmetic LL is a LUXURY, not a right

You sound really entitled person, the world or doctors don't owe you anything, if you don't like the price don't get it, or go to a cheaper doctor

[The Dreamer]

What gives you the right to make a statement like that?

A lot of these doctors contribute more to the world in one day then what you would contribute in your whole life

Just because you can't afford Paley that doesn't make a theif. Cosmetic LL is a LUXURY, not a right

You sound really entitled person, the world or doctors don't owe you anything, if you don't like the price don't get it, or go to a cheaper doctor

When you are paying high sums of money (maybe life savings)  and putting at risk your body,they owe you something.Or do you think that doctors like Sarin/Sringari ecc don't have to be blamed ?
When you're doing this kind of operation,your doctor should perform 110% of his possibilities
Prakash for once is right. The majority are thieves.Think about the nail's cost(maximum 10-15.000€) and they are charging ofte 60.000€+ for internals
And Paley belongs to that cathegory,asking 100.000€ and then being fired from Baltimore for malpractice and going to Florida where laws allow him to do everything he wants

[Zeo]

When you are paying high sums of money (maybe life savings)  and putting at risk your body,they owe you something.Or do you think that doctors like Sarin/Sringari ecc don't have to be blamed ?
When you're doing this kind of operation,your doctor should perform 110% of his possibilities
Prakash for once is right. The majority are thieves.Think about the nail's cost(maximum 10-15.000€) and they are charging ofte 60.000€+ for internals
And Paley belongs to that cathegory,asking 100.000€ and then being fired from Baltimore for malpractice and going to Florida where laws allow him to do everything he wants

First of all you're twisting my words, of course once you pay them, they have an obligation to do their best. Also I am specifically arguing against the point that "Dr.Paley/Rozbruch are theives for charging 100k for LL". I'm not talking about other doctors. I am just talking about the price with these specific doctors.

First of all something is worth what one is willing to pay for it. And just because you are paying 100k for a surgery that only lasts a few hours you need to realize that you are also paying for the DECADES of training and studying and learning that it took to get them to that point of expertise. It's like saying that a tattoo artist should only charge you 50$ for a expert tattoo because you only used 30$ worth of ink.

Also have you listened to some of Dr. Paley's presentations? People literally fly in their children in from all over the world becuase while other ortho surgeons recommended amputation, he was actually able to save the child's limb and function. He fixes children's limb deformities/saves childrens limbs and changes the lives of people with immense bone deformities all of the time. Think about that when you read Prakash saying that Paley is a "deceit who would sell his soul for money".

The biggest problem of people here is that they arn't getting laid as much as they would like. Boo fcking hoo. It a blessing that these doctors decide to do cosmetic LL at all.

Just because they have the skill set, it does not mean they have an obligation to make their services available to you for cheap. This is what I mean by they owe you nothing. And this is why I am saying that prakash/you are entitled. You think they have an obligation to make LL available to you on your low budget just because your insecure about your height. 

[Stadiometers]

Prakash for once is right. The majority are thieves.Think about the nail's cost(maximum 10-15.000€) and they are charging ofte 60.000€+ for internals

PRECICE costs approximately 15,000€ PER NAIL, price can increase further depending on country due to import taxes and other factors. Unless you are only lengthening one leg, the cost to the doctor just to order the nails for surgery is approximately 30,000€.

[The Dreamer]

Also have you listened to some of Dr. Paley's presentations? People literally fly in their children in from all over the world becuase while other ortho surgeons recommended amputation, he was actually able to save the child's limb and function. He fixes children's limb deformities/saves childrens limbs and changes the lives of people with immense bone deformities all of the time. Think about that when you read Prakash saying that Paley is a "deceit who would sell his soul for money".

Paley was fired from Baltimore for several malpractices.Was FIRED,what is not clear from those words ? But no one talks about it
From one that requires 100.000€ it is unacceptable
As was well documented by Tibike200,he went to Florida because it is the only state that hasn't laws against malpractice
But still here there is the worship for him and I don't understand why(maybe promoters ?)
I also hate this attitude of genuflexion towards doctors considering them like gods.They are humans and if they made mistakes,they have to pay.This is not a game
And leave out my budget,you don't have idea what are you talking about neither it was the subject of the discussion.

[The Dreamer]

PRECICE costs approximately 13,000€-15,000€ PER NAIL, price can increase further depending on country due to import taxes and other factors. Unless you are only lengthening one leg, the cost to the doctor just to order the nails for surgery is approximately 30,000€.

Well,let's say nails cost 30.000€.And other +70.000€ that are required by him how are explained ?
You will say clinical costs(that are nuts) and skills,experience ecc.
Every doctor is allowed to make what price he wants.But I'm also free to say that price is out of world,considering that the doctor has made mistakes in past and for me who asks 100.000€+ should be literally a machine.
So in this case I fully agree with Prakash

[Stadiometers]

Paley was fired from Baltimore for several malpractices.Was FIRED,what is not clear from those words ? But no one talks about it

In the U.S. medical malpractice lawsuits are public record, easily searchable online. If that's true you should provide the links to these lawsuits. A lot of patients considering Dr. Paley might change their mind.

As was well documented by Tibike200, he went to Florida because it is the only state that hasn't laws against malpractice

Your statement is incorrect. Every state in the U.S. has laws regarding medical malpractice and the patients ability to file a lawsuit. Specifics of the law simply vary by each individual state.

[Stadiometers]

Well, let's say nails cost 30.000€. And other +70.000€ that are required by him how are explained? 100,000€ is unacceptable. 100,000€ should be literally a machine.

Dr. Paley charges a total of 73,300€ to lengthen both femurs including 5 days per week physical therapy.

If you do not have U.S. health insurance Dr. Rozbruch charges a total of 81,500€ to lengthen both femurs, that price does not include physical therapy. If you have U.S. health insurance the price can be significantly lowered with Dr. Rozbruch to only 40,000€. One of the cheapest options available anywhere in the world for PRECICE.

Considering the astronomical cost of healthcare in the United States, it could easily be argued the prices by these doctors are justifiable. Particularly when you factor in the cost of the hospital stay, operating room, surgical and nursing staff, malpractice insurance, etc...All costs the doctor has no control over. In fact, the only cost a doctor has any control over is the surgeon fee. 

[The Dreamer]

In the U.S. medical malpractice lawsuits are public record, easily searchable online. If that's true you should provide the links to these lawsuits. A lot of patients considering Dr. Paley might change their mind.

Your statement is incorrect. Every state in the U.S. has laws regarding medical malpractice and the patients ability to file a lawsuit. Specifics of the law simply vary by each individual state.

Here is the discussion where there are documents speaking about this:
www.limblengtheningforum.com/index.php?topic=3501.0;wap2
Page 2:the lawsuits that were faced by Paley
Page 5:description of the legal system in Florida

[Stadiometers]

Here is the discussion where there are documents speaking about this:
www.limblengtheningforum.com/index.php?topic=3501.0;wap2

In the U.S. medical malpractice lawsuits are public record, easily searchable online. If that's true you should provide the links to these lawsuits. A lot of patients considering Dr. Paley might change their mind.

[The Dreamer]

In the U.S. medical malpractice lawsuits are public record, easily searchable online. If that's true you should provide the links to these lawsuits. A lot of patients considering Dr. Paley might change their mind.

Read what I have posted before copy-pasting the same message

[Stadiometers]

Read what I have posted before copy-pasting the same message

I did read what you posted. My response is the same, for the third time....

In the U.S. medical malpractice lawsuits are public record, easily searchable online. If that's true you should provide the links to these lawsuits. A lot of patients considering Dr. Paley might change their mind.

[Purushrottam]

When you are paying high sums of money (maybe life savings)  and putting at risk your body,they owe you something.Or do you think that doctors like Sarin/Sringari ecc don't have to be blamed ?
When you're doing this kind of operation,your doctor should perform 110% of his possibilities
Prakash for once is right. The majority are thieves.Think about the nail's cost(maximum 10-15.000€) and they are charging ofte 60.000€+ for internals
And Paley belongs to that cathegory,asking 100.000€ and then being fired from Baltimore for malpractice and going to Florida where laws allow him to do everything he wants

The physical therapy department at Paley Institute is billed as part of Paley's total costs. So, if you pay $90,000 for femurs like I did,
about $30,000 of it came from the nail,
about $ 225 * 5 * 12 = $ 13500 came from the physical therapy department.

That leaves $46,500. Now, the Paley Institute is "leasing" facilities from St. Marys. That means they pay fees to St. Marys for using its surgery room, anesthesiologits, nurses, etc.

I don't have an estimate for the cost of that, but lets say an anesthesiologist makes $300k a year (according to glassdoor), then 4-5 hours of an anesthesiologist's time is worth $144 * 5 = $720.

Its not just Paley operating on the patient, theres a team (I think Robbins and Packer). If we were to assume that an orthopedic surgean makes $500k a year (glassdoor), then their time costs $240 * 5 * 3 = $3600.

You end up with around $42k, which covers hospital rent, malpractice insruance, administrative staff, etc.

I didn't even include the costs of the medication and blood bank (for transfusion) during surgery (ie saline solution, etc). Those things are also relatively expensive.
----
Its definitely an expensive surgery, but lets not forget all the costs involved in an elective, cosmetic, non-necessary surgery.

I see no valid reason to complain about the costs.

[Android]

Its definitely an expensive surgery, but lets not forget all the costs involved in an elective, cosmetic, non-necessary surgery.

I see no valid reason to complain about the costs.

It all comes down to this, thanks for the breakdown. Sometimes we take for granted that we're breaking functionally perfect legs to fix a problem in our heads.

[Body Builder]

It all comes down to this, thanks for the breakdown. Sometimes we take for granted that we're breaking functionally perfect legs to fix a problem in our heads.

Its a social problem, not something only in our minds.

[Android]

Its a social problem, not something only in our minds.

Yes, the social aspect is what drives us to do it. Height isn't much of a problem if you're the last person on Earth.

Some men actually don't mind, it doesn't bother them; at least not to the point of seeking surgery. For us obviously it does, and we'll voluntarily take the necessary risks to level the playing field.

There are some objectively tall people getting CLL, so it's a mix of societal pressure and our internal struggles to define desirable height.

[419]

I wouldn't say most doctors are thieves. In the US, cost of living is much higher, and the stricter regulations make things more expensive -- increasing costs for everything from renting operating theaters, equipment, to medication. Litigation is not uncommon either, and costs may be raised in anticipation for such events. Let's not forget that the US healthcare system is also brutally unforgiving without insurance, which CLL (or any cosmetic surgery) doesn't qualify for.

Elsewhere in the world where living costs are lower, I'd say the the increased demand has put a strain on the doctor's workloads, and they've raised prices to dissuade less committed patients. CLL is relatively unknown, but more people are finding out about it every year. They can effectively make the same money without overworking themselves; we as patients don't want to increase risk for error by allowing doctors to take on a handful of surgeries per day either. The solution is to have more specialized doctors to increase supply, and hopefully the increase in demand for CLL and improved surgical methods/equipment will make that possible.

And let's not forget that state-of-the-art internal nails like PRECICE accounts for the bulk of the cost these days. Cost of raw materials doesn't add up to so much, but they have to factor in profit margin, R&D, employee salaries, FDA processing fees, etc. NuVasive isn't the enemy either, since revolutionary products tend to start with high prices to pay for its initial investment.

Here's an interesting article by Dr. Birkholtz from September 2017, precisely about his takeaways of being a doctor as well as becoming a businessman:
Orthopaedic surgery as a business - getting it right

In the end, doctors indeed want to make money, just like all of us. It is a profession and they spent a lot of resources to become an expert in their field. They're not operating a charity and they are not your friend; they don't owe us anything. CLL is a cosmetic surgery, so no one is forcing us to do it. Lucky for us we have the internet, we have airplanes, and we have a lot of doctors to fit our unique needs.

It is no only my opinion. Go to google and write 'most doctors are' and the first hint you get is 'corrupt'. HIV drugs being sold for $150k , really? and when Indian companies made (for poor indians, India's gdp pr cpita $4500) generics, in response the CEO of a big pharma company said 'our hiv drug is for rich westrners not poor indians'. To give my personal life exmaple - I was a student then(had free medical insurance from university) , I had chest pain I went to student healthcare center who sent me to bigger medical college hospital - they kept me for 8 hours did numerous tests and told me at the end - take painkillers !! I said 'for how long?' thy said until the pain goes away! I said what if the pain does not go away in 2 years, 3 yars, 50 years!! they said oh ok - then take for 6 months if pain does not go away come back! Fast forward - I joined job, my student insurance was covering me till october so I decided that I dont need company insurance till January (u can take in june or january) unfortunately I fell down while crossing road in november, I was out of insurance so I went to hospital and told them that I wil pay from pocket and I don't need them to do 100 tests just need an xray to tell me if my hand had broken, they did an xray and gave me a gloves kind of thing to wear - thats it- for that they charged me $1400. Sam kind of stories I hear everyday. do you know the profit margin on medicines? whole medical profession in US is under corrupt clutches. And btw did you know - US govt spends 6 trillion dollars a year for medical of elderly people in US !!

[Android]

Welcome to America. My old roommate's appendix burst, we dragged his unconscious 6'3" body into a car since we knew he couldn't afford an ambulance ($700-1200). There's a lot to be angry about when it comes to America's healthcare practices, but it really doesn't translate well for cosmetic procedures.

Yes, it sucks that you had to pay so much for an x-ray, and you're allowed to be upset about it. You had to do it for your own safety, you had no choice. CLL, you do. It's a luxury, not a right. And you've been here long enough to know that there are plenty of affordable doctors who do a good job, so I don't understand the need for anger when we have the freedom to choose our own doctor. It's not like HMO in which we have an assigned doctor.

[419]

Welcome to America. My old roommate's appendix burst, we dragged his unconscious 6'3" body into a car since we knew he couldn't afford an ambulance ($700-1200). There's a lot to be angry about when it comes to America's healthcare practices, but it really doesn't translate well for cosmetic procedures.

Yes, it sucks that you had to pay so much for an x-ray, and you're allowed to be upset about it. You had to do it for your own safety, you had no choice. CLL, you do. It's a luxury, not a right. And you've been here long enough to know that there are plenty of affordable doctors who do a good job, so I don't understand the need for anger when we have the freedom to choose our own doctor. It's not like HMO in which we have an assigned doctor.

I agree 100% with what you said, but because of demand-supply gap I believe some doctors are overcharging - but you are right - it is our choice - leave it or take it. It is more of frustration then anger - with highest healthcare expenditure in world (taken from our taxes) we get nothing whil Finland, Canada with almost half the spend give free halthcare. 6 trillion of tax money on elderly health expenditure, in a country of 330 million, do the math. Enough to be frustrated and or angry.

[Purushrottam]

lol dudes like a chick on her period. Damn drama queen

I'm done replying to you. Waste of time. I don't need to argue with someone who thinks Italy is a third world country. I think you even said India is better than Italy for doctors. lol, just lol

The quality of care at top private Indian hospitals is actually quite comparable or even better than the care you would receive in an American hospital. Hence the medical tourism.