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[Muse]

Here;s the response from Dr Jamal Abu Nemer from Medical centre BONAMED .

1) How many patients have you operated for cosmetic Limb Lengthening so far and How many patients do you operate yearly?


We use technique of intraosseous osteosynthesis applying driving devices for femurs (hips) and tibias (shanks) that were developed by prof.Bliskunov (since 1980)  and continuously improved.  You can see  information about our method in our web sites.

Bliskunov Nails
Dragan-Bliskunov Nails
Jamal Nails  (JN)

Limb lengthening programs (pairwise lengthening) by internal method aimed for solution of patient’s social-adaptive problems (relative stunting) were implemented in 47 patients (by Jamal Abu Nemer M.D., Ph.D. in person). 22 legs elongation programs were made with the new generation of devices. Total number of patients operated using Bliskunov’s method for Cosmetic Leg Lengthening exceeds 550.

2) What is the estimated total cost, including post-op treatments, stay, medications, physiotherapy? Are unscheduled surgeries covered and How much does a consultation cost?

The consultation is free of charge. There may be some low costs associated with examination (X-ray, CT, etc)

The total cost of the lengthening program since May 2013 takes into account a stay of a patient in the Ukraine for three months. 90-100 days - this is the time period for conducting a surgery and lengthening of femurs or tibias to the optimum length. The optimum length refers to the lengthening when muscles, tendons, and nerves are adapted sufficiently well to the new state of tension. It is 7.0 cm for femurs and 4.5-5.0 cm for tibias.

The total cost of the lengthening program (TCLP) is 39 000,00 USD, the same as for femurs and for  tibias ( since May 2013).  (Lengthening more than the optimum length increases the time period of lengthening and restoration.  In this case it is necessary to adjust additional costs of the program of lengthening.)

This cost includes the cost of surgeries and a stay of a patient  in hospital for the necessary term (as a rule 2-3 days), and also the cost of a surgery and a stay in hospital for the removal of devices (in 1 - 1.5 years after the beginning of lengthening).
 
The cost of  the lease of apartments during the stay for the period of the lengthening is not includes in TCLP. Assistant can help to lease suitable apartment. /Cost of comfortable apartments is around  1000 USD per month. Additional costs may be associated with a broker service for searching for an apartment - usually half the monthly cost, single payment/.
 
The costs for unscheduled surgery are covered.

3) What kind of physical therapy is assigned to the patient?

It has to be mentioned here that it is very essential for the patient to stay active in the lengthening period and during rehabilitation for successful restoration of these functions. Walking (at first with outer supports, then, without them) is the best way of rehabilitation. The fact is that, graduated weight bearings on the bone and muscle contractions are very effective in recovery and shorten the rehabilitation period.

The more the patient walks, the quicker and more efficient the functions of his musculoskeletal system will restore (return). Success of this process depends only on the patient and his readiness for daily hard work.

As it was mentioned above, the most important factor influencing the speed and quality of the regeneracy of the lower limbs musculoskeletal system functions is the patient’s activity (walking, exercises). When selecting workload, the patient should be guarded by the doctor’s recommendations (the doctor should make some adjustments of the rehab program after studying the check x-ray picture and evaluating the patient’s progress in recovery). The patient should also take into consideration his/her state of health (confidence in motions, fatigue, etc).

Physical exercises also matters a lot. This is a set of special exercises to be performed in a lying position on the bed (the doctor will show these exercises and select the program appropriate for the patient). Regular exercises on the stationary bike (exercycle) also contribute to progress in recovery.

It is recommended for the patient to take some massage during the rehabilitation (not fewer than 10 sessions monthly of intensive lower limbs massage (duration not less than 1 hour).The massage helps muscles regain flexibility and capacity for work more effectively. The patient can also use an electromassage device for .independent procedures.

Regular exercises in the swimming pool can add to regaining the stereotype of walking by the patient. In water, overall load on the body and on the feet decreases; the patient starts feeling more confidently. It is important that the temperature of water be comfortable for the body. It is necessary to monitor the temperature conditions for the stretched muscles. The patient should not become too cold. Before any exercises, the muscles should be prepared for being loaded – legs should be rubbed for more intensive blood circulation, and it is worth doing some surface massage.

Physiotherapy methods are very important too. The physiotherapy blood circulation stimulating effect in muscles and other deeper limb structures proved to be very popular. This physiotherapy can provide mild stimulating influence on the bone tissue regeneracy. There are a lot of varieties of devices for the musculoskeletal system regeneration including those for home use. It is recommended to use physiotherapy devices generating pulsed magnetic field of low frequencies (10-25 hertz).


4) What maximum amount of lengthening do you recommend per segment, regarding patient safety? What is the daily rate of lengthening?


Optimum value of the lengthening: 6,5-7,0 cms for femurs and 4,5 - 5,0 cms for tibias. Maximum "hard" program: 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.
And there is a big resistance of hip's muscles after 6,0 - 7,0 cm of femurs lengthening .
 
We can continue the program (more then optimum values), but it will take more time (and money for patient). Each additional centimeter more (higher) than optimal values ​​of elongation (7cm for hips, 5 cm for shanks) is an additional money  to the total cost of the lengthening program.

This is about 2 500 - 3000 USD for every additional centimeter.  The reason - the extension beyond the optimal value takes more efforts, 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 - it's one millimeter. To get this millimeter You have to realize 24 clicks (in new construction) ...Clicking sound quite hear well...

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 ...

5) What are your opinions regarding the weightbearing of the patients?

Of course, no doubt, devices can take /support/ the weight of the body ... this is an important option of construction,
since it creates conditions for the activity of the patient and a faster recovery ...


6) How often will you follow up with patients during lengthening?

You will see doctor each day during lengthening period.


7) How fast can patients return to normal life (walking without support)? What is the time required to lengthen 5 cm and 7.5-8 cm ?

The period of basic recovery after the lengthening (lasts for 6,5-7 months after the devices were disconnected)).

The period is characterized with gradual restoration of the stretched muscles functions and regaining the stereotype of walking. At this point, bone regenerative process reaches the level which makes it possible to expose the legs to some load (forces) without using any outer supports (such as crutches, walking stick). At the beginning of this period, the patient can drive a car.

Toward the end of the period, the patient can resume his/her work (study) if it does not involve putting excessive forces (load) on the patient’s legs.
 
The period of sufficient recovery (from 7 months up to 14-15 months) from the moment of disconnecting the devices). The period is characterized with further bone consolidation and restoration of muscle functions to the condition, which would allow to remove the devices from the bones and expose the legs to usual (not sports training) load (forces).


Medical centre BONAMED
Dr Jamal Abu Nemer and Dr Dmitry Alipov
E-mail: bonex@ukrpack.net
Phones: +380 44 244-77-61, +380 44 244-77-62
Website: www.correction.kiev.ua and www.lengthening.ukrpack.net

[NBW]

Cosmetic lengthening has exceeded 500, but I'm interested to know how many Dr. Jamal performed himself, not including Dr. Dragan. Can you please ask him this?

Also, has Dr. Jamal started using his own nails? They were reported to be improved to eradicate involuntary clickings, etc.

Thanks.

[Muse]

Cosmetic lengthening has exceeded 500, but I'm interested to know how many Dr. Jamal performed himself, not including Dr. Dragan. Can you please ask him this?

Also, has Dr. Jamal started using his own nails? They were reported to be improved to eradicate involuntary clickings, etc.

Thanks.

Here's the response from Dr Jamal


"Limb lengthening programs (pairwise lengthening) by internal method aimed for solution of patient’s social-adaptive problems (relative stunting) were implemented in 47 patients (by Jamal Abu Nemer M.D., Ph.D. in person). 22 legs elongation programs were made with the new generation of devices."

- - - - -
Devices for hips and shanks have a different construction (different clicker, different locking system (fixation), etc.)
At the same time, these devices are well-tested and we can see how a certain structural component affects the clinical outcome (mostly - convenience for the patient ) ...

Therefore, the new device - an association of the benefits of devices for the femur and tibia plus a completely new design solutions.
In common it  is a versatile machine for all segments (only sizes are different).

We can not explain all the technical solutions regarding the new device. Better we'll show you how it looks in practice ...During the operation (implantation), we reject the two cuts (reducing trauma) ... Patient self-controlled elongation and feels comfortable (no discomfort at the location of the machine.)

Concerning  Clicks ...

The approximate rate of elongation of the day - it's one millimeter.
To get this millimeter You have to realize 24 clicks (in new construction) ...Clicking sound quite hear well...

Several automatic clicks of the device - it's not a problem. We just have to keep the average rate of elongation ...

For example, a possible dialogue between doctor and patient:
Doctor asks how many clicks you have already done? The patient responds, that he himself  got 15 clicks and heard 3 automatic clicks. The doctor checks the condition of the muscles, and says that  for today another 3-5 clicks will be enough.

 You know, we use a clicker in the form of butterflies in new designs. Activation clicker - the pressure on one of the wings. This is some force in the projection of the clicker for device’s activation  ... It is difficult without your will. Therefore exceed the daily rate of clicks without your will is almost impossible. And You know, the clicker is required only during elongation. It is situated under the soft tissue.

The fact that, in any case, we will make periodic control X-rays pictures ... 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 ...

[TomD]

Thankyou.

Very informative. I appreciate it . I would love to read some patient testimonies.

[Sweden]

Thankyou.

Very informative. I appreciate it . I would love to read some patient testimonies.

Agreed! Me 2.

This seems to be a very healthy option for femurs. I'm "only" looking for 6cm this time.
I liked how he speaks of daily PT, massage, swimming, weight bearing and so on. That's the key to successful lengthening.

Total cost will probably be around $43/44.000 and that's not bad at all.

Anyone wants to share apartment with me next year? 

[Blackhawk]

Total cost will probably be around $43/44.000

What does this include?

I will be doing LL in 2015.  If I was ready next year I would definitely share an apartment with you Sweden.

[Sweden]

What does this include?

I will be doing LL in 2015.  If I was ready next year I would definitely share an apartment with you Sweden.

That includes all above stated by Dr Jamal and unexpected costs such as luxury items(lots of Red Bull and pizza haha)

But second time I am going to be strict about everything. I got too lazy in India and the physio wasn't encouraging me at all.

Second time I know everything I need to do to heal up properly. I already planned which food and supplement I'm going to take so I won't be away more than 3 months. Recovering time is going to be easier with femurs.

I'll be leaving next year no matter what. It would be great to share an apartment to cut costs in half for that part.

What a great 2014 christmaspresent to come back home being 186cm tall  wish I could leave tomorrow!

[TomD]

Agreed! Me 2.

This seems to be a very healthy option for femurs. I'm "only" looking for 6cm this time.
I liked how he speaks of daily PT, massage, swimming, weight bearing and so on. That's the key to successful lengthening.

Total cost will probably be around $43/44.000 and that's not bad at all.

Anyone wants to share apartment with me next year? 

Throw in an extra hockey mask? 

[Sweden]

Throw in an extra hockey mask? 

Deal!

[Blackhawk]

What a great 2014 christmaspresent to come back home being 186cm tall  wish I could leave tomorrow!

I wish I could go tomorrow too but I won't be able to take a break for a couple years.

Thank you Sweden for your contribution to the forums.

I hope we get to read about your femur LL in the very near future.   

[somecm]

One thing I still didn´t understand. Does the new Jamal nail needs to impant a cliker together with the nail, like biliskunov nail, or the new nail works without a clicker like Albizzia?

[Adriano]

U need a clicker.

The main difference is that apparently the new nail avoids accidental clicks.

[Daylight]

I have read some diaries on old forum  and it seems that he is a good and affordable Doctor. Tell me what you think guys.

[Adriano]

I am not impressed by Emmanuel's walking video almost a year post surgery date.

internal femur patients who lengthen less than 8cm should be recovered and walking without a limp after 10 months. I was disappointed to the point where I would rather stay short until a better nail comes up at an affordable price.

[somecm]

I am not impressed by Emmanuel's walking video almost a year post surgery date.

internal femur patients who lengthen less than 8cm should be recovered and walking without a limp after 10 months. I was disappointed to the point where I would rather stay short until a better nail comes up at an affordable price.

I was walking ecxactly like him 6-7months after lengthening surgery with internal nails.  I am sure in 2 months he will be much better.

[Adriano]

I was walking ecxactly like him 6-7months after lengthening surgery with internal nails.  I am sure in 2 months he will be much better.

how is your walking now?

How long ago was your surgery date?

Thanks for your information.

[emanuel]

I am not impressed by Emmanuel's walking video almost a year post surgery date.
internal femur patients who lengthen less than 8cm should be recovered and walking without a limp after 10 months. I was disappointed to the point where I would rather stay short until a better nail comes up at an affordable price.

No reason to be disappointed   
The truth is that most patients who write a diary only then show a walking video, when their walking is fine. That gives a false impression of the reality of LL.
In PM's/emails/skype conversations with patients of different doctors I have heard of complications that you will not find in the corresponding diarys. People don't like to write about the bad things for various reasons.
 
I have decided to show a video of an earlier stage, but I am sure that in a few months my walking will be much more close to normal (already now it is better than on the video from 2 weeks ago). Basically only my muscles in the hip area need to recover for a normal walking, the rest is fine. I lengthened almost 8cm and stayed in wheelchair 4 months, do you expect that I am running marathon by now? 

Also much more relevant than first surgery date is the date when you stopped lengthening.

[somecm]

No reason to be disappointed   
The truth is that most patients who write a diary only then show a walking video, when their walking is fine. That gives a false impression of the reality of LL.
In PM's/emails/skype conversations with patients of different doctors I have heard of complications that you will not find in the corresponding diarys. People don't like to write about the bad things for various reasons.
 
I have decided to show a video of an earlier stage, but I am sure that in a few months my walking will be much more close to normal (already now it is better than on the video from 2 weeks ago). Basically only my muscles in the hip area need to recover for a normal walking, the rest is fine. I lengthened almost 8cm and stayed in wheelchair 4 months, do you expect that I am running marathon by now? 

Also much more relevant than first surgery date is the date when you stopped lengthening.

Did you stay 4 months on wheel-chair? I thought you were using walkers or crutches during the lenghtening time...
Your walk is ecxactly like mine was 6-7months after LL surgery, from this point it takes 2 months to get normal... It is just the hip muscles that are not strong enough... Good luck for you. I am thinking about doing tibias with Dr. Jamal, just waiting for the right moment.

[somecm]

how is your walking now? 

How long ago was your surgery date? 

Thanks for your information.

- Perfect
- 02 Years and a half
- Albizzia nail

[emanuel]

Your walk is ecxactly like mine was 6-7months after LL surgery, from this point it takes 2 months to get normal... It is just the hip muscles that are not strong enough... Good luck for you.

Thanks. And it's good to hear that it all worked out well for you!
Here is what the Drs from Kiev wrote me after they saw my walking video:
"Your recovery is in normal limits. Stereotype walk at a good level. You're a little wobble when walking. But it will pass after a complete muscle recovery (pelvic tier restored always later)."
 

[emanuel]

I am thinking about doing tibias with Dr. Jamal, just waiting for the right moment.

You should write a diary, it would be very interesting 
I'd love to do tibias with Jamal as well, but my private and financial situation will not allow it for at least the next 5 years.

[Adriano]

YOu are very correct Emanuel,

most of my expectations r based on what i have read and seen on old forum . That sight only puts up information that promotes LL. It is very biased.

come to think of it, this is why we have not seen Tall walking or even Apo (instead he jumps on a mini-trampline!!! lol). members there wait till they r walking at an acceptable level before posting videos. (there are exceptions ofcos like Sweden)

Thanks so much for ur honesty.  All the best in ur recovery

[somecm]

YOu are very correct Emanuel,

most of my expectations r based on what i have read and seen on old forum . That sight only puts up information that promotes LL. It is very biased.

come to think of it, this is why we have not seen Tall walking or even Apo (instead he jumps on a mini-trampline!!! lol). members there wait till they r walking at an acceptable level before posting videos. (there are exceptions ofcos like Sweden)

Thanks so much for ur honesty.  All the best in ur recovery

But Adriano,
I am sure Emanuel walking (like showed on his video) is in a very acceptable level. When I was on this same level of walking, I was going all the way around, going to parties, job, everything, sometimes someone would come to me and ask what happened and I always would say I had a bike or soccer accident and was just recovering... In two months his muscles will be strong enough and the limp will go away.

[somecm]

Thanks. And it's good to hear that it all worked out well for you!
Here is what the Drs from Kiev wrote me after they saw my walking video:
"Your recovery is in normal limits. Stereotype walk at a good level. You're a little wobble when walking. But it will pass after a complete muscle recovery (pelvic tier restored always later)."

Perfect explanation of dr. Jamal.

About wheel-chair, I didn´t understand well... Were you using walkers, crutches or wheel-chair during the lengthening period?

[somecm]

You should write a diary, it would be very interesting 
I'd love to do tibias with Jamal as well, but my private and financial situation will not allow it for at least the next 5 years.

The Korean doctor Donghoon seems to me a good option too, but Jamal is a little bit cheapper...and I think both would give you the same treatment.

[iwanttobetall]

Hello guys,

I actually emailed Dr. Jamal several days ago and he raised the cost at the beginning of 2014. It is going to be 31500 EUR femur and 33500 EUR tibia.

Furthermore, besides that additional cm is changed from 2500-3000 USD to 2500-3000 EUR, and apartment from 1000 USD to 1000 EUR per month.

His old price was really attractive to me since it's just the upper limit of my budget - however the additional 4000 EUR and extra conversion from USD to EUR really make this unaffordable to me 

[KiloKAHN]

Hello guys,

I actually emailed Dr. Jamal several days ago and he raised the cost at the beginning of 2014. It is going to be 31500 EUR femur and 33500 EUR tibia.

Furthermore, besides that additional cm is changed from 2500-3000 USD to 2500-3000 EUR, and apartment from 1000 USD to 1000 EUR per month.

His old price was really attractive to me since it's just the upper limit of my budget - however the additional 4000 EUR and extra conversion from USD to EUR really make this unaffordable to me 

Have you tried getting a personal loan from your bank? If your credit is good you can get enough to accommodate the price increase.

[iwanttobetall]

Unfortunately no 

I'm only a college junior and the budget I got so far are from internships and part-time jobs, and some savings by eating less lol

I doubt any of my parents will be my cosigner, and I don't want them to know -_-

[emanuel]

Hello guys,

I actually emailed Dr. Jamal several days ago and he raised the cost at the beginning of 2014. It is going to be 31500 EUR femur and 33500 EUR tibia.

Furthermore, besides that additional cm is changed from 2500-3000 USD to 2500-3000 EUR, and apartment from 1000 USD to 1000 EUR per month.

His old price was really attractive to me since it's just the upper limit of my budget - however the additional 4000 EUR and extra conversion from USD to EUR really make this unaffordable to me 

Well, that sucks; it's quite a significant price increase, especially for tibias. I remember when Jamal talked about the idea of raising his price back in march or so and I asked him not to do it so that people have an affordable internal LL option.
I can't quite understand the logic of that price increase; I mean it's not like they have tons of LL patients at the moment...

[somecm]

Yes it is strange... it is more than 30% increase... it must have a reason...

[emanuel]

About wheel-chair, I didn´t understand well... Were you using walkers, crutches or wheel-chair during the lengthening period?

Had to use wheelchair unfortunately. I got a little unlucky as I needed one extra surgery, because the clicking didn't work in the right leg. Before that additional surgery I already had made it from wheelchair to walker (crutches would have been the next step). But after that extra surgery I somehow couldn't make it back to the walker, my muscles were too weak. You can read all the details in my diary.

Anyway, now I am doing better than ever before and I am sure in a few months I can show a nice video!