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[mumbai]

I am choosing between precice or fully external tibias in India. Based on my research Dr. Parihar has done the most precice cases in India but even he has only done half a dozen or so. Dr. Suhas Shah also has some experience but then again very few in number.

But they have done plenty of externals. Externals means no chance of deep bone infection and fat embolism. I can also weight bear and not be confined to whellchair.
I don't know if Precice will get support from Nuvasive in India if there are problems with the nail or ERC machine. Also from what I heard we have to get a license from the Indian FDA for Precice which is  another extra step.

In the US Precice would be the right choice but in India would it be different?

[c]

only Parihar  good

[mumbai]

He is good but my question is more about whether the surgeon not using preecice nails enough can be  a problem.

Another thing is He wants you to bring a family member with you so you can't do it with full privacy. This is true even if you are an adult.

[HateLAPELoveSTEM]

You can check this post, where accumulates many advantages and disadvantages of various lengthening methods:
http://www.limblengtheningforum.com/index.php?topic=95.0
But for external fixators, I also learned from several cases that due to the pins bending, the amount of achieved growth will be likely not to match with the actual growth showed in your bones' X-rays(less than the X-rayed growth).

[mumbai]

My question is more like if the surgeon is not much experienced with Precise nails but is experienced with externals will he have difficulties with Precice?

[tallmen]

My question is more like if the surgeon is not much experienced with Precise nails but is experienced with externals will he have difficulties with Precice?

Precice surgery is just putting a nail into the femur which any surgeon can do. Also, Dr Parihar doesn't require you to bring someone with you. He just needs you to inform someone close to you like a wife or a parent so that they know you are doing this. I think his 6-7 cases experience is enough. He has a lot of experience with externals and even with treating bone infections and complex fractures. Fully externals is the best method for tibia in my opinion but if you want to do femurs then precice is better.

[mumbai]

Precice surgery is just putting a nail into the femur which any surgeon can do. Also, Dr Parihar doesn't require you to bring someone with you. He just needs you to inform someone close to you like a wife or a parent so that they know you are doing this. I think his 6-7 cases experience is enough. He has a lot of experience with externals and even with treating bone infections and complex fractures. Fully externals is the best method for tibia in my opinion but if you want to do femurs then precice is better.

Yeah he can handle any complications that's for sure.

My concern is more about the working of the precice nails. Like if doesn't work or the ERC machine stops working. I checked that Nuvasive does not have an office in India and to use the nails I have apply for a special license. So if there any problems with the devices then I don't know if I can swiftly get a replacement.

[mumbai]

One more thing I am worried about is I do not think he gives anticoagulants, not even for 2 to 3 weeks after surgery. With precice we are completely in wheelchair. He is quite strict about not walking. Is it not very high risk to not take anticoagulants? Some people have died after this surgery due to this.

[tallmen]

One more thing I am worried about is I do not think he gives anticoagulants, not even for 2 to 3 weeks after surgery. With precice we are completely in wheelchair. He is quite strict about not walking. Is it not very high risk to not take anticoagulants? Some people have died after this surgery due to this.

1. He gives them for the entire period of lengthening for precice patients.
2. You can buy whatever medicine you want in India and take them. You can buy Xarelto on your own and take them if he refuses but I've asked him and he said he'll give for the entire lengthening period. You can even visit a vascular surgeon and ask him for Xarelto if you are so concerned. It never hurts to talk to a specialist and those guys and specialists in blood clots.

[tallmen]

Yeah he can handle any complications that's for sure.

My concern is more about the working of the precice nails. Like if doesn't work or the ERC machine stops working. I checked that Nuvasive does not have an office in India and to use the nails I have apply for a special license. So if there any problems with the devices then I don't know if I can swiftly get a replacement.

Nuvasive sends 6 nails for each segment of lengthening. 1 size above and less in length and 2 sets of each size so for 1 leg they'll send in total 6 nails and for 2 legs they'll send 12 nails so you shouldn't worry about the nail not working as they'll have extra sent just for your surgery which will be returned after the lengthening period. They also have multiple ERC devices so don't worry about that too.

[tallmen]

1. He gives them for the entire period of lengthening for precice patients.
2. You can buy whatever medicine you want in India and take them. You can buy Xarelto on your own and take them if he refuses but I've asked him and he said he'll give for the entire lengthening period. You can even visit a vascular surgeon and ask him for Xarelto if you are so concerned. It never hurts to talk to a specialist and those guys and specialists in blood clots.

You can also buy a dvt pump from amazon.

[mumbai]

That is very good to know. It reassured me as that was the biggest worry. Do you know if they will send the new ERC machines or old ones? It does not matter much if they send multiple but I was just curious.

Can I DM you please?

[HateLAPELoveSTEM]

My question is more like if the surgeon is not much experienced with Precise nails but is experienced with externals will he have difficulties with Precice?

IMO they are irrelevant. For this question you can just inquire accurate informations with your surgeons. Only they themselves know how expertise they are at Precise.

[mumbai]

To get a license for precice in India you have to fill a form called 12A with the Indian FDA called : CDSCO. In that form they ask for details about the employer and what occupation the applicant is doing. Is that really necessary?? They even asked for contact details of the company. Will they talk to the applicant's employer about this license?

[mumbai]

Precice surgery is just putting a nail into the femur which any surgeon can do. Also, Dr Parihar doesn't require you to bring someone with you. He just needs you to inform someone close to you like a wife or a parent so that they know you are doing this. I think his 6-7 cases experience is enough. He has a lot of experience with externals and even with treating bone infections and complex fractures. Fully externals is the best method for tibia in my opinion but if you want to do femurs then precice is better.

How do we prove to him that we have informed someone? Does he need some letter to be signed by a family member?

[tallmen]

How do we prove to him that we have informed someone? Does he need some letter to be signed by a family member?

Phone call

[mumbai]

ok that is better. That is a phone call that can be taken care of. It should be possible to convince a family member although not ideal

But the employer thing is just odd. Why should we get our employer's permission to get a license to use Precice?? This license thing really sucks.

[tallmen]

ok that is better. That is a phone call that can be taken care of. It should be possible to convince a family member although not ideal

But the employer thing is just odd. Why should we get our employer's permission to get a license to use Precice?? This license thing really sucks.

You don't have to fill anything. Just give your id to the agent he'll take care of everything. He won't ask you employee details or anything like that. He'll write self-employed on the form and no one cares about that. They add it to make sure that you're not in business of selling these products in India and you are ordering it for personal use only.

[mumbai]

You don't have to fill anything. Just give your id to the agent he'll take care of everything. He won't ask you employee details or anything like that. He'll write self-employed on the form and no one cares about that. They add it to make sure that you're not in business of selling these products in India and you are ordering it for personal use only.

That makes sense why they ask for this detail.

Do they write "LL" in any part of the license application? Would be nice if it is kept completely discreet.

[tallmen]

That makes sense why they ask for this detail.

Do they write "LL" in any part of the license application? Would be nice if it is kept completely discreet.

No they don't

[mumbai]

No they don't

They actually require a prescription to be attached with the license application. Maybe the agent is taking that from the doctor directly. "LL" will probably be written on the prescription. The form is called form 12A.

[tallmen]

They actually require a prescription to be attached with the license application. Maybe the agent is taking that from the doctor directly. "LL" will probably be written on the prescription. The form is called form 12A.

Yeah, they write LL in the prescription.

[mumbai]

Does the doctor make all precice patients get CT or EOS scans?

[tallmen]

Does the doctor make all precice patients get CT or EOS scans?

How will they order your size nail without it? Do you expect them to guess your bone diameter?

[mumbai]

How will they order your size nail without it? Do you expect them to guess your bone diameter?

xrays

xrays are different from EOS and CT scans. Xrays are more widely available. CT scans are way more radiation. EOS scans are way more expensive.

[tallmen]

xrays

xrays are different from EOS and CT scans. Xrays are more widely available. CT scans are way more radiation. EOS scans are way more expensive.

I agree but I think it's hard to get diameter and stuff from the x-ray so doctors prefer CT or EOS scans.

[SpeedDialer]

How much in USD should you budget in total for 6 cm tibias with Parihar when factoring in living costs?

[ReadRothbard]

I would go with Dr. Parihar or Dr. Suhas Shah, but I strongly prefer the former.

[SpeedDialer]

If you are from outside India, does he still require you to inform a family member and does he still call that family member? I don't have a wife and I don't want to inform my mom, who doesn't like the idea. I could tell my dad but he'd probably tell my mom. There is the option of telling one of my brothers, but he might tell my mom. I'm not really close with any other family member.

[mumbai]

I agree but I think it's hard to get diameter and stuff from the x-ray so doctors prefer CT or EOS scans.

Giotikas uses xrays only. Assayag also used xrays only until they recently got an EOS machine. Rozbruch still uses xrays I think.

The problem with CT is you can't shield your gonads 

[tallmen]

Giotikas uses xrays only. Assayag also used xrays only until they recently got an EOS machine. Rozbruch still uses xrays I think.

The problem with CT is you can't shield your gonads 

Yeah, x-rays are much better. I don't think Assayag or Rozbruch measure diameter or they have to measure diameter accurately.  They can do that during surgery but that's not an option for Parihar as in India they order the nail for that size and it takes a month to arrive. Assayag and other US doctors generally have multiple sizes stock readily available during the surgery.