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[two]

Then it means he is not a good doc. Paley and literally everyone is the US give xeralto for the whole lengthening period. Assayag even injects some blood thinner into your stomach right after the surgery [source: raaz diary]. I guess it's a bigger issue for a doc if a patient dies in the US than in EU.

Well if he hasn't been giving blood thinners beyond 2 weeks for his patients all this while what do you make of that?

[tallmen]

Well if he hasn't been giving blood thinners beyond 2 weeks for his patients all this while what do you make of that?

Every doc thinks differently in terms of risk management. Blood thinners can cause liver issues and blood in your pee and stuff like that. It's not black and white. I'll still try to get blood thinners for the whole lengthening period otherwise will move back to my country and will get them here. In my current country, you can get asprin from amazon without any prescription or anything or I can just go to a doc here and ask for Xarelto. Other option is to consult with a vascular surgeon in giotikas hospital if giotikas won't give it then maybe they will. If you really want to get it you can get it I don't think giotikas can stop you from getting blood thinners.

[Arcon]

... Paley and literally everyone is the US give xeralto for the whole lengthening period...

They give xarelto full time now in the US because they are only using precise, which is non weight bearing; they didn't do the same when they were using Stryde, which was full weight bearing. I wrote elsewhere: It is the weight bearing limitation of Precise which makes the difference here and I don't think giotikas suddenly went nuts

[tallmen]

They give xarelto full time now in the US because they are only using precise, which is non weight bearing; they didn't do the same when they were using Stryde, which was full weight bearing. I wrote elsewhere: It is the weight bearing limitation of Precise which makes the difference here and I don't think giotikas suddenly went nuts

Read the raaz diary he did stryde with Assayag also you can read Assayag interviews. Paley said in many conferences and on his website that he gives blood thinner irrespective of the nail (stryde or otherwise).

[two]

Every doc thinks differently in terms of risk management. Blood thinners can cause liver issues and blood in your pee and stuff like that. It's not black and white. I'll still try to get blood thinners for the whole lengthening period otherwise will move back to my country and will get them here. In my current country, you can get asprin from amazon without any prescription or anything or I can just go to a doc here and ask for Xarelto. Other option is to consult with a vascular surgeon in giotikas hospital if giotikas won't give it then maybe they will. If you really want to get it you can get it I don't think giotikas can stop you from getting blood thinners.

If you don't trust your own surgeon that is not a good thing. You are agreeing to go unconscious and let the surgeon operate on you as he wants. You are already relying on him to not cause a fat embolism or damage some artery.

And do you really want to fly back to your home country knowing that flying increases the risk of PE? It's better to stay 3 months in Athens and then fly back. People have reported clicking problems with Guichet nail and you may have to travel back and forth. If you get PE on a long plane ride they have to make an emergency landing in a random country and your emergency care will get delayed. And who knows what country that will be and what their facility is like.

And finally Aspirin is over the country in many countries but xeralto is definitely not. Aspirin is way lighter.

[tallmen]

If you don't trust your own surgeon that is not a good thing. You are agreeing to go unconscious and let the surgeon operate on you as he wants. You are already relying on him to not cause a fat embolism or damage some artery.

And do you really want to fly back to your home country knowing that flying increases the risk of PE? It's better to stay 3 months in Athens and then fly back. People have reported clicking problems with Guichet nail and you may have to travel back and forth. If you get PE on a long plane ride they have to make an emergency landing in a random country and your emergency care will get delayed. And who knows what country that will be and what their facility is like.

And finally Aspirin is over the country in many countries but xeralto is definitely not. Aspirin is way lighter.

It's not about trust it's about disagreement.

[two]

It's not about trust it's about disagreement.

What your saying is, you trust his intentions but not his abilities to keep you safe. So it is about trust.

Anyway it is your call. I just wanted to state my opinion.

[Raden]

Then it means he is not a good doc. Paley and literally everyone is the US give xeralto for the whole lengthening period. Assayag even injects some blood thinner into your stomach right after the surgery [source: raaz diary]. I guess it's a bigger issue for a doc if a patient dies in the US than in EU.

I also saw Buldu injected blood thinner to their precice patient during lengthening on LLT IG story november 6.

[LU213]

It is not about trust, you have to manage your own health to an extent (be proactive) and doctors are human. Also, the doctor cannot know everything. No one on earth can. I don't put complete faith in man only our creator. For example, if my father says he is going to pick me up from University, I trust him because he always comes and has five days a week for the last 3 years but I keep taxi money just in case because he is human and events beyond his control can stop him from coming or even his own negligence in running a light and getting into a car accident.

I just saw an interview with Cyborg4Life last week and Betz also gives blood thinners the whole time. So I am not sure it has anything to do with weight bearing but maybe it does.  Anyway I flew home for 14 hours total (2 flights) and the other guy didn't and I am doing well.  So I don't think staying in Athens is the key. If you aren't having any problems clicking, they won't suddenly arise.  Clicking only gets easier.  I left at 5 weeks, and never was unable to click.Although clicking was always the worst part while I was there.   Almost all of Betz's patients fly home after 2-3 weeks.

[thankscience]

I thought the point of a weight-bearing nail is so that you can exercise frequently after surgery and keep the blood flowing. Shouldn't this mean there's a much smaller chance of DVT/PE?

[tallmen]

I thought the point of a weight-bearing nail is so that you can exercise frequently after surgery and keep the blood flowing. Shouldn't this mean there's a much smaller chance of DVT/PE?

I don't think walking can substitute blood thinners.

[thankscience]

I don't think walking can substitute blood thinners.

I agree. I just know that technically there should be a much smaller chance with a weight-bearing nail of this happening.

Anyway, Giotikas is currently at the top of my list so I'm curious as to whether he will change his protocol (assuming it's related to not prescribing Xarelto for long).

[two]

It is not about trust, you have to manage your own health to an extent (be proactive) and doctors are human. Also, the doctor cannot know everything. No one on earth can. I don't put complete faith in man only our creator. For example, if my father says he is going to pick me up from University, I trust him because he always comes and has five days a week for the last 3 years but I keep taxi money just in case because he is human and events beyond his control can stop him from coming or even his own negligence in running a light and getting into a car accident.

I just saw an interview with Cyborg4Life last week and Betz also gives blood thinners the whole time. So I am not sure it has anything to do with weight bearing but maybe it does.  Anyway I flew home for 14 hours total (2 flights) and the other guy didn't and I am doing well.  So I don't think staying in Athens is the key. If you aren't having any problems clicking, they won't suddenly arise.  Clicking only gets easier.  I left at 5 weeks, and never was unable to click.Although clicking was always the worst part while I was there.   Almost all of Betz's patients fly home after 2-3 weeks.

Trust is both trust in intent and trust in ability/competence. My point was that we are talking about the latter.

Anyway it's just a choice of words. All I meant to say was that the surgery itself requires enormous trust in the surgeon and one should trust that the surgeon is knowledgeable to enough to keep the patient safe after surgery. In your case if you are consulting with another US doctor near you then it's fine. But taking blood thinners over the counter isn't (the other poster was talking about this).

As for flying, flying is known to be a danger after any ortho surgery. Mobility reduces chances of PE and if someone is terrified of PE they shouldn't fly long flights ideally.

As for clicking difficulties, they can arise as the bone grows. So even if it is easy today it can become difficult in the future.

[tallmen]

Trust is both trust in intent and trust in ability/competence. My point was that we are talking about the latter.

Anyway it's just a choice of words. All I meant to say was that the surgery itself requires enormous trust in the surgeon and one should trust that the surgeon is knowledgeable to enough to keep the patient safe after surgery. In your case if you are consulting with another US doctor near you then it's fine. But taking blood thinners over the counter isn't (the other poster was talking about this).

As for flying, flying is known to be a danger after any ortho surgery. Mobility reduces chances of PE and if someone is terrified of PE they shouldn't fly long flights ideally.

As for clicking difficulties, they can arise as the bone grows. So even if it is easy today it can become difficult in the future.

I don't trust any doc in the world it doesn't mean I shouldn't get treatment. It just means I'll do my own research and will be skeptical of the doctors. Also, who is stopping someone to walk in the plane. Book first class and keep walking in the area back and forth.

[LLSouthAmerica]

As a former LLer, I absolutely recommend booking first class or extra leg room and walking every hour. I even used compression socks during my first flights.

[thankscience]

As a former LLer, I absolutely recommend booking first class or extra leg room and walking every hour. I even used compression socks during my first flights.

Would you say this is still necessary even after three months has lapsed since surgery? My understanding is the risk of blood clots is almost zero after three months.

[LLSouthAmerica]

Necessary? No, but I strongly advise it. The risk of blood clots may be closer to your baseline (depends on many factors: age, mobility, etc), definitely not zero. However, if you remain in the same position you may be uncomfortable and maybe stiff. You need space. Even after 3 months, you may experience pain and other problems.

[two]

Read the raaz diary he did stryde with Assayag also you can read Assayag interviews. Paley said in many conferences and on his website that he gives blood thinner irrespective of the nail (stryde or otherwise).

Can you share links? I had asked Assayag via message once and he had said he gives it only for 2 weeks or so. Maybe LU213 can help confirm this.

[LU213]

While I was in the hospital,  i was given blood thinners and then I was provided a little over 2 weeks of blood thinners when I left, so it is probably about 3 weeks of blood thinners total.  Dr. Assayag only provided me with enough blood thinners for my flights to and from Baltimore.  On my next appointment I will ask him about his protocol but he doesn't perform surgery with these nails developed off of the original Albizzia nail.  I will say that we cannot jump the gun and say anyone is to blame.  Certainly I go over and over in my head how someone can show up to PT telling them he has pain and then receive the full, difficult PT and then have a heart attack on his way out waiting for a taxi without it coming to the PT's head that perhaps this patient needs to be seen by a doctor.  However often the main PT owner/specialist was not there and still I don't know if the PT employees were told how to identify the signs of DVT or PE.  The incapacity of the person that had surgery the same day as I did haunts me.  However, it doesn't mean that Dr. Gio is not a good doctor.  Go in knowing the risks. If you are considering him, talk to him and tell him your concerns and what you heard. If he addresses your concerns and you feel comfortable, you can use his services. Doctors cannot speak in terms of names/PII but they can speak about publicly known information and address real situations without names/PII.

Also remember you pay the doctor, he or she does not pay you.  Do not be afraid or intimidated to ask questions tactfully and respectfully (as you should do any human) no matter how they react.  Do not be afraid to call for emergency or call the doctor, who gives everyone his phone number, --who cares if it happens to be a false alarm? still call.  You paid for this service.

If you have someone with you, you get help right away and you don't need to wait for someone to find you.  I know that option is not available for everyone.

Do not do any special diets.  Eat well-balanced meals.  Don't consume protein to the exclusion of the other things such as carbs and fats. (this I learned from Dr. Assayag - stay away from keto diets while LL)

As far as clicking, I can do my clicks while riding in a car safely confined in a seatbelt.  It has not been a source of stress and anxiety for a number of weeks.  I saw a message in ab608's diary that distraction with the magnet was extremely painful with precise in her left leg.  So painful that it was a level 8 for hours and she skipped it altogether one day. Everyone's body is different.   So I believe my choice of the GNail with Giotikas was the best choice for me. Still I have a lump in my throat.

[Arcon]

... Certainly I go over and over in my head how someone can show up to PT telling them he has pain and then receive the full, difficult PT and then have a heart attack on his way out waiting for a taxi without it coming to the PT's head that perhaps this patient needs to be seen by a doctor... 

Hi @LU213, as far as I know the heart attack happened before the PT session when the poor guy had just arrived there and the taxi driver called everyone out to help.

[two]

I think LL patients are quite tired, anxious, feeling a bit sick, etc all the time and it is probably hard to tell the difference between early onset of PE and just usual fatigue.

All that really matters now is whether the protocol for dealing with PE needs to change. But we just heard that even Assayag doesn't give blood thinners even for Precice cases after the initial couple of weeks.

[LU213]

I have not been feeling fatigued or sick since the first 2 weeks.  I felt pain during clicking for sure for probably 4 weeks after surgery but when I was not clicking, I did not feel sick. Most days, the other guys at PT did not look sickly when I saw them, although dealing with serious pain. We had a good time laughing and talking during PT.  One of the guys even has a great voice and sang for us.  I have slept well this entire process but I started with melatonin and ZMA based on previous experiences of others.  I have a month left and I do feel tightness in one leg or the other but I feel okay. My PT is focusing on my Frankenstein walk.  I flew to visit family this weekend and they definitely noticed I was taller.

I spoke to Dr. Giotikas and he said it was a unique case with rare background factors affecting it.  He said he evaluated his protocol and is not going to change it.  These are the signs of a PE that he provided:

The symptoms of PE usually are shortness of breath or shallow or quick breathing, cough, pain in the chest. Symptoms may be subtle in a mild incident of PE.

[LU213]

I am now at 6.8 cm. I have not felt any more difficulty since 5 cm.  I can walk to kitchen and bathroom without crutches.  Otherwise, I always use the forearm crutches. New at this length is Dr. Giotikas said not to walk more than 1-1.5 hours even with the crutches so as not to put too much stress on the implant. As we know the more you lengthen, the more stress is placed on it because you are getting closer to the edge of the thick part of the implant.   X-ray below

https://imgur.com/fQtlnOE

[Arcon]

I am now at 6.8 cm. I have not felt any more difficulty since 5 cm.  I can walk to kitchen and bathroom without crutches.  Otherwise, I always use the forearm crutches. New at this length is Dr. Giotikas said not to walk more than 1-1.5 hours even with the crutches so as not to put too much stress on the implant. As we know the more you lengthen, the more stress is placed on it because you are getting closer to the edge of the thick part of the implant.   X-ray below

https://imgur.com/fQtlnOE

Thank you for sharing your x-rays, the regenerate looks very good.

[LU213]

I appreciate that. I am 7 days away from 8 cm.

[Nyc brother]

They give xarelto full time now in the US because they are only using precise, which is non weight bearing; they didn't do the same when they were using Stryde, which was full weight bearing. I wrote elsewhere: It is the weight bearing limitation of Precise which makes the difference here and I don't think giotikas suddenly went nuts

You are 100 percent right. When Giotikas does precise he does give Xarelto for the full time of Lengthening.

[184dream]

any updates

[Issun-Boshi]

Can I ask what the nails look like externally?
I've been trying to Google for pictures of the G-nail on patients and all I've seen are the nails on their own or an x-ray, but I can't see what they look like on a person normally. Like do the nails come out of your thigh so your wounds are basically exposed all the time?
Would be great if you can post a picture (and censor your privates of course).

[canterk]

wow so you basically have done 8 cm in about 3 months. g nail is really fast compared to other methods it seems!
i am curious about the recovery period of g-nail too. since most gnail patients are still in the consolidation phase or lengthening phase there is not much detail about when to expect normal walking and athletic recovery for gnail patients. i have yet to read a diary of a gnail patient about nail removal

[karin123]

hi how are you doing now

[Hatch]

You are 100 percent right. When Giotikas does precise he does give Xarelto for the full time of Lengthening.

I have noticed that recently blood clots cases have increased among ll patients. One common thing is that none of them had Xarelto while got blood clots. So im pretty convinced that even patients who using weight bearing nails should use Xarelto at least whole lenghtening period.