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[oklama]

lets have a fun activity for the insane asylum today

everyone rank every doctor you feel like you know anything about, you can explain or not explain your rankings

S tier: paley, assayag, rozbruch
 
A tier: mahboubian, giotikas, Becker

B Tier: Debiparshad, Guichet

C tier: Parihar

F. Halil Buldu, Sedat, Sarin


This is just my general idea, dont take this too serious as im not super well informed on most doctors

[OzBoy39]

A bit of explanation required…

S as in Super
A as in Awesome
B as in…. Butchers
C as in…. C…t
F as in…. funk Never

Sorry, it’s just for a laugh. I don’t  mean to disrespect any butcher here

[SpeedDialer]

lets have a fun activity for the insane asylum today

everyone rank every doctor you feel like you know anything about, you can explain or not explain your rankings

S tier: paley, assayag, rozbruch
 
A tier: mahboubian, giotikas, Becker

B Tier: Debiparshad, Guichet

C tier: Parihar

F. Halil Buldu, Sedat, Sarin


This is just my general idea, dont take this too serious as im not super well informed on most doctors

Makes complete sense to me. The top 3 you listed seem to have good safety records (I think? Based on the diaries)

I think Guichet's lawsuit with Unicorn looked like a big stain on him to alot of people on the forum, but I think he's great for attempting to optimize training/diet so much. It might seem to be overkill/micromanagement but I think the final results will be good for his patients overall. Might be good to do a more conservative amount of length with him ...just in case though, I can't remember if Unicorn did 10cm or 8cm or something? And he also has gnail for tibias as an option, which seems like another plus. Can't remember if he does IT band release but I think he does?

Parihar vs Debiparshad seems like does someone prefer Parihar's greater # of years of experience (but living in India) or Debiparshad's more comfortable city to stay in

And then Becker also having access to a weight bearing tibia option seems great and an advantage of him being the doctor who is succeeding Betz

I think doing becker femurs and tibias might be the most convenient (for going back to work sooner) option for alot of people to be able to use crutches so quickly both times and stick to the same doctor. And Becker doing the IT band release more than Betz may solve alot of the problems previous Betz patients had.

Becker (and I guess Guichet) letting some people do 9-10cm+ is .. well.. some people can handle it and recover. And some people can't. My question is this:  "how is the patient supposed to know he/she can handle that much length until it's too late? And there is no shortening/reverse option for clicking nails so there is no going back right?", sure x-rays and range of motion can help someone make a prediction but it doesn't seem like a guaranteed thing?

I really think that wealthy people should probably go with Paley or Becker, probably Paley. Why take even a single unneeded risk if one is wealthy? Or rozbruch / assayag if they are close to those areas.

And alot of people who want convenience should maybe save up to go with Becker (because can use crutches earlier for internal tibias especially so can go back to work earlier to offset the cost).

People comfortable with living in India should strongly consider Parihar. Fluent Korean speakers should strongly consider Donghoon Lee (precise + hydrotherapy). Greeks and people living in nearby countries should consider Giotikas. People in London should consider Guichet or Dimitrios Giotikas also. French people and Italians should consider Guichet. Germans should consider Becker. Etc etc

For giotikas vs becker (betzbone) the thing is if you want to do internal weight bearing tibias later then it is sort of more  convenient to go with betzbone femurs and the betzbone tibias for weight bearing the whole way (and get to use crutches faster) and stick to the same doctor

[toyz]

Parihar now doesnt offers precise nails bro

So forget abt him if u want precise. For external tibia he is one of the best. probly better than every one on dat list except paley. Most other docs dont even do externals much (like debiparshad who just does cosmetic precise surgs).

[stretched]

Pretty much agree with what SpeedDialer said but I will add a few things:

This is my opinion as someone from the US who prefers the precise nail.

First lets talk about nails.
First, if you are only going to have one surgery done, do the femurs unless your tibias are really short. The best nail on the market was the Stryde, which is now recalled, so you must choose either safety & comfort (precise) or weightbearing (G-nail & Betzbone). It is really up to you to choose what nail to go with as each nail offers their own pros & cons. For me personally, I am light enough and my bones are hollow enough to fit the largest precise 2.2 nails, so I will be able to stand up with the 2 75 pound nails, so to go with the precise nail is the best option for me.

Would not recommend external methods especially on the femurs. Like seriously, there is a reason the top Dr.s refuse to do LON on the femurs, please don't do LON Femurs unless you really hate yourself. Also for the love of God, don't do your surgery with those sketchy ass Drs in Turkey (Wannabetaller and LiveLifeTaller). Yes they're cheaper, but this is a major surgery, DO NOT risk your health to save money. Those Dr.s don't give a   about you and if they fk up, what are you going to do? You won't even be able to walk.

Anyways here is my tierlist of the US docs. If you are from another part of the world, your opinion is going to likely be different than mine, but from a US perspective, if you have the money, my list is the following:
S tier: Paley
A tier: Assayag Rozbruch
<Decent Gap>
B tier: mahboubian, debipashard

Paley, Assayag, and Rozbruch are the best 3 because their practice isn't just CLL, they are general highly skilled orthopedic surgeons who do things other than CLL. In an interview with Cyborg4life, Dr. Paley said make sure your surgeon does other orthopedic surgeries than CLL or they are going to struggle to deal with complications. Remember, the actual surgery is pretty easy for a skilled orthopedic surgeon, it is the follow up that requires attentive skill.

Paley is an obvious first choice because he is easily the most experienced CLL Dr. in the world, and they have been doing CLL for decades. Not much of an explanation needed for him. If you have unlimited money, Paley is the best choice.

Assayag would be my second choice. Assayag is a very skilled surgeon who is located at the International center for LL, which has other orthopedic experts (Dr Conway and Herzenberg) who are going to be able to help you deal with complications. On top of that, there is a house right next to the hospital which you can stay throughout your lengthening phase that is specifically designed for patients just like you. On top of that, the PT there (Moshe) is easily the best in the entire CLL industry. Assayag is also way more cost effective than Paley. Only reason Assayag is not S tier is because he is not as experienced as Paley for CLL.

Rozbruch is great too. TBH I don't really know much about him, but all diaries I've read about him have been really good, and he is an obviously a very skilled orthopedic surgeon. The only thing is his price, which I've heard are way more expensive than everyone else, but If you live near NY and can swallow the price, you can't go wrong with him

Mahboubian and Debipashard seem a little sketchy to me IMO. I'm sure they are both skilled surgeons, but they both give off salesmen vibes and they seem to downplay how major of a surgery this really is. They also advertise CLL as their main practice, which is not really what you want. I don't really know too much about them though so I will refrain further judgement

[TheDream]

Wonder how Monegal with fitbone would be rated.
He had a group of successful diaries a while back. But haven’t heard much since.

[lessthanavg8300]

"I really think that wealthy people should probably go with Paley or Becker"

I could have afforded any option.  If Paley had a weight bearing nail that would have by far been my first choice.  But I do think you need to recognize that theres like 20 surgeons who work under him.  Its very unlikely that Paley himself will be doing your surgery (correct me if Im wrong).  Still...his best practices should carry to those he trains.  But I would have lost my mind in a wheelchair and so thats why I went all the way to Germany for Becker.  And with Becker you know exactly who is doing the surgery....its 1 guy.

That said, clicking absolutely sucks for me (but it seems not for everyone).  In my case, I'm really paying with current discomfort for the ability to walk sooner.  Which Im ok with because otherwise I couldnt have done this surgery at all.

If you're younger, I would honestly wait for the next stryde nail to come out.  If you're in your late 20's or older and cant wait, it could be worth it to take the chance on clicking nails with Becker or Giotikas.

[SpeedDialer]

Oh if precise isn't offered in India anymore, that feels like a huge downgrade. Wait so even the non-cosmetic leg length discrepancy patients in India are just going to use externals now instead of precise? That seems unlucky for them

I think one doctor I wouldn't know where to rank is Dr. Birkholtz. I believe he might have started allowing cosmetic cases again, I'm not sure. Not sure about South Africa, I don't know about that area

He (Dr. Birkholtz) seems honest, I'm not sure what to make of it:

- In his interview he says that around 6.5 cm + femurs and 4cm+ tibia the complication rate starts to go up exponentially -> not overpromising on length

- Is honest he has less experience/volume of LL patients than some other doctors (in his cyborg4life interview saying things like "in my simple hands")

My takeaway from his interview is that it might be good to do a bit less length with him if you go with him, he seems to be more comfortable with that

------------

For Athens, it is affordable and they seem to have a nice package and will walk you through things if you stay during the lengthening period.

But we have to admit that for Athens:

1) Athens the city is not wheelchair friendly and is a bit run down

2) Hospital is a bit old, you get your x-rays as CD's, physical therapy is very crowded in small rooms in Athens, large volume of patients. I don't mind this tbh, it has a certain back in time charm to it

3) We have a bunch of people writing/mentioning on the forum that clicking for the right leg for gnail femurs is potentially... well, might be good to PM several people about it. Gnail is still probably overall a good device but still good to PM people about how the right leg clicking feels even though Ozboy had a good experience

4) There is no weight bearing internal only method for tibias in Athens as of now, takes longer to go back to work. I have a theory that precise tibia patients do less length on average because they can't stand up and bear weight to help stretch the calves (ex: some people who started off very flexible only did 4cm precise tibias in Athens after bumping into some tightness, Height Journey did 3.5 cm though admittedly that was an intentional choice on his part for safety/long term benefit)

I still sort of think it might be worth it to save up to go with Becker instead of Giotikas

[oklama]

Mahboubian and Debipashard seem a little sketchy to me IMO. I'm sure they are both skilled surgeons, but they both give off salesmen vibes and they seem to downplay how major of a surgery this really is. They also advertise CLL as their main practice, which is not really what you want. I don't really know too much about them though so I will refrain further judgement

I agree with this, however I feel mahboubian is still better than debiparshad as atlaseast mahboubian has many good outcomes and diaries, while debiparshad apparently lies about how many surgeries he's done. I dont think mahboubian downplays the surgery/ recovery timespan as much as Debiparshad

[SpeedDialer]

Thinking something almost exactly the same as OP (except maybe the doctors are much closer to each other), maybe something like: 

S tier: paley, assayag, rozbruch (no weight bearing options, can't do more than 8cm because of precise with them, but they appear to have good safety records), maybe Janet Conway here also but we just don't have that many diaries of her and I think she may have height limits. Maybe Donghoon if you speak fluent Korean and therefore are able to communicate with his office well.

A+ Tier: Becker, Guichet (both have weight bearing options for both femur and tibia. I think they also have precise if you want that instead). Personally I think the few negative results about them are mostly from lack of IT band release for some previous Betz patients and the larger amounts of lengths done, but I'm actually not sure. Maybe should be higher ranked if hypothetically we held the amount of length done to be the same across every doctor to have a fair basis of comparison
 
A tier: Mahboubian (no weight bearing options at all at the moment), Giotikas (probably should be a higher tier, they don't have access to a weight bearing tibia nail temporarily right now, this is not their fault)

B+ Tier: Debiparshad (new ish doctor, so we are just wary at the moment. Probably a great doctor and will be higher as more results come in), Maybe Birkholtz and Gdalevitch too? The issue with them all is we just don't have many diaries, they are probably better but we just don't have that much info

B tier: Parihar (Probably should be at least A tier, but doesn't have access to precise now for reasons outside of his control and also living in India is a hurdle for a good percentage of people). Maybe Dr. Koehne should be here too, but not sure what nails he has access to, not too many recent diaries.

I mean I think they may all be pretty close, and alot of things holding each option back are things out of their control (ex: some newer doctors, lack of access to certain nails in some areas for now). Paley argues that his institute has alot more experience dealing with rare complications from the sheer volume of patients/types of LL they deal with, and that is a pretty convincing argument.

Honest question- should cosmetic patients be even considering doctors outside this list? For people doing externals, I wonder why more people don't choose Parihar in India? Cost? Diseases in India?

I know that Guichet and Betz have had some results on the forum that made people question them.

The thing is this: the USA doctors don't let people lengthen as much (since the precise nail only does 8 cm max). So the USA doctors most likely do less length on average than the European doctors so it's not exactly a 1:1 comparison.

But if you do the IT band release + let's say we held the amount of length done constant between doctors (ex: if everyone did 8cm femur and 5cm tibia, just as an example), I wonder if Guichet and Betz/Becker would have better safety results than the forum posts make it look like?

Ex: Can't really make a fair comparison between a 4-5cm tibia paley patient and a 8-9cm tibia betz patient. Can't compare an 8cm femur paley patient vs an 11 cm femur betz patient fairly. In that sense, a doctor sticking to more conservative limits should on average have a better safety record just from that alone.

But there is nothing stopping a Becker patient from doing just 4cm or 5cm or 6cm like some recent Becker patient are doing (and I think it is smart tbh, I know they'll be shorter than some other patients, but I think that they will like both the short term and long term results of being extra cautious). So with Becker/Guichet you just have alot of options (in nail type, in how much length you do) and that could be seen as an advantage or disadvantage with going with them

[Siegfried]

B+ Tier: Maybe Dr. Koehne should be here too, but not sure what nails he has access to, not too many recent diaries.

Koehne does precise 2. He mainly does medically required lengthening cases (mostly discrepancy cases)

[hippo60]

Rozbruch is great too. TBH I don't really know much about him, but all diaries I've read about him have been really good, and he is an obviously a very skilled orthopedic surgeon. The only thing is his price, which I've heard are way more expensive than everyone else, but If you live near NY and can swallow the price, you can't go wrong with him

Rozbruch has been doing this surgery for decades as well, not just Paley. He's the Chief of the Limb Lengthening and Complex Reconstruction at HSS, which is the number 1 (!!!) orthopedic hospital in the US. Putting him below anyone on this list, including Paley, is ridiculous.

Beyond the surgery itself (which is obviously important), the advantage with Rozbruch is that he's your actual Doctor. He's checking up on you pre / post surgery, and you're meeting him on your follow ups. With Paley, from what I can see, you're only meeting him during consultation. He'll do your surgery, but you're never going to see him again, and will communicate with others throughout the process.

I think the big advantage for Paley, is the support system. I think they have housing options where you can socialize with other LL patients, and also their PT center which you go to 5 days a week. That's really convenient, and can really help mentally as well. Rozbruch doesn't have anything like that, so you're more "isolated". Of course it does mean you have to stay there for the entire lengthening process, which isn't possible / convenient for some people.

[SpeedDialer]

I think the big advantage for Paley, is the support system. I think they have housing options where you can socialize with other LL patients, and also their PT center which you go to 5 days a week. That's really convenient, and can really help mentally as well

Yeah it's interesting. I asked in Athens if I could pay to do a 5th day (patients do only 4 days a week) and the doctor in Athens was against it, saying we need a break (we usually do MonTues break ThursFriday and then the PT center is closed on the weekends in Athens). I'm not sure what to make of it, I guess this is also an advantage of Paley to have the option to do 5 times a week.

I've usually used the no-PT day (wednesday) to go swimming for femurs (feels pretty good/easy to stretch thighs in the water). I don't think swimming/walking in the water is that useful for tibias in the early stages, like it helps with strength but I don't think stretching the calves in the water is that good. The water just holds your body up and you don't end up putting that much force on the calves (not that we'd even want to for precise 2) though bending the upper body down while doing it can help slightly (but it stretches hamstrings too).

I wonder if Paley Institute PT center is open on the weekends (?), which could allow for more flexible scheduling or like 2 days PT, 1 day off kind of thing (for 66.6% of days having PT?). Not sure how they do it

After seeing the ballerina foot on one patient in real life, I would have been willing to pay to do a 5th day of PT per week in Athens out of fear--- but it seems awkward to sort of do this with the PT center against my doctor's advice (the PT center talks to the doctor alot). And my conclusion from this is that if he doesn't want us to do a 5th day, then I will need to get a better training routine at the hotel.

If I do tibias with precise, it seems like something like this for at home training?

1. I have heard that slant board while sitting is one of the best things to do? since you can't do slant board while standing with precise 2, at least at my weight (too much)

2. Wearing the splints/braces (they are huge in Athens at least, like armor) when awake  to stretch calves, maybe being on the computer to distract yourself from the discomfort?

3. Wearing some pair of softer splints when sleeping/resting? Officially I don't think Giotikas talks about this, but other patients I've talked to say that the huge splints/braces are not possible to sleep in?

4. Possibly wearing some kind of drop foot product when using the walker, but we use the walker for such short periods of time with precise 2, I'm not sure this matters. But maybe eventually when there is enough bone growth to use the walker more frequently?

5. On amazon there is some kind of strap that connects or wraps around your sock that someone here in Athens seems to like, maybe I will try this, anyone tried it?: https://www.amazon.com/Stretcher-Stretching-Fasciitis-Achilles-Tendonitis-Hamstring/dp/B08JHZYQ7X/ref=sr_1_7?crid=3RIPPBMX2MTQK&keywords=calves+stretcher&qid=1676408299&sprefix=calves%2Caps%2C1084&sr=8-7

If I had a bit more money dedicated for tibias, I think I would go with Becker for weight bearing instead --but I might just either not do tibias. Or do 4cm tibias precise 2 based on what I've seen of other precise tibia patients.

When you're thinking about internal tibias, I think Guichet and Becker look much better on a tier list than they would initially seem to people. Like the ability to use crutches and do standing stretches during tibias seems great compared to being wheelchair bound for so long and having to do seated/lying down stretches for so long. I could be wrong, but it also seems that clicking for tibias is not that painful.

I wonder if there any downsides for clicking tibias that I'm not considering though? Since Giotikas doesn't do internal weight bearing tibias, wonder if there is any health risk for doing them? We just don't have that many clicking tibia diaries, which leonzul was talking about earlier and the reasons for why became clear. Maybe an argument to put Becker/Jean-Marc Guichet in S tier if we remove things like problems related to the IT band release (we'll see how Becker's approach goes, I think it may work out great) and the more extreme lengthening cases. I get why no one would put them in S tier though when we have the impression that the Paley says his institute has a better safety record than other places (and I think I and most people would agree that this statement is probably true)

[uponly]

S tier: Paley, Rozbruch

I can't speak to the other doctors, but this is dead to rights accurate. These two are the undisputed heavyweight champions of this procedure. Both have decades of experience with many internal and external devices, with the lowest rates of complication. This is really a coin toss choice and will ultimately depend on which recovery process you're more comfortable with.

One reason you see more Paley diaries is the community aspect of doing the surgery with Dr. Paley. There are patients concentrated around the campus, and they're much more willing to speak about their experience. I met several in person during my visit and they were very forthcoming with questions, etc. Dr. Rozbruch is also a lot more selective of who he takes for this procedure, as you still have to pass psych eval with Dr. Westrich. Dr. Paley no longer uses that filter (he used to use Dr. Westrich as well).

With Dr. Rozbruch, patients usually go back into an environment they can thrive in and PT is on your own, and just kind of hide away. The former part of the process really appealed to me as I have a nice well appointed condo in a warm place and I'm retreating there for the remainder of this process. Even with Dr. Paley's patients, none that I spoke to were keeping an active blog. I suspect 90+% of people that undergo this procedure do it very quietly and with extreme anonymity.

Both are world renowned as limb deformity surgeons. Things that impressed me about Dr. Paley and Dr. Rozbruch's practice were the number of patients there for severe limb disformities and other non-CLL related issues.  I saw kids, elderly people, etc. with leg, arm problems, external fixators, etc. They are both also teaching doctors with lots of fellows. Dr. Rozbruch was in the OR every day of the week and still made his rounds to his patients.

During COVID, elective surgeries were not allowed in New York. So for 2+ years, Dr. Rozbruch converted his clinic into an urgent triage center for patients with deformities, etc. who could not get care anywhere else. His practice is just now beginning to get overwhelmed with CLL again. I was scheduled 6 months out.

When I consulted with Dr. Paley, I asked if he would be the one performing the surgery and he said yes. So AFAIK, in both cases, Drs. Paley and Rozbruch would perform the surgery for you.

I should mention that I also consulted with Dr. Franz Birkholz in South Africa for a third opinion. I found him to be incredibly competent, and he is a very well known surgeon with a great reputation. He would essentially be my only overseas option, but overseas was not an option for me. Surprised to see his name is not here.

[KiloKAHN]

With Dr Paley straight up burying him as a beginner who doesn't know what he's doing, it's amusing to see Debiparshad getting these opinions on the forum of being a high tier doctor.

@ 1:04:30

"This is very common, but it's a beginner mistake... I'll tell you one thing, if I was gonna be in a big name magazine, I wouldn't send out an x-ray showing that I have no idea how to prevent this from happening. This is a beginner mistake by a surgeon who clearly gets a PR and then shows the whole world that they don't know how to prevent this. That's bad. I mean that's really bad. Not to say I haven't had this, I did in the early days. But then my early days are a long time ago...we all go through our learning curve. You know, on a selfish basis, you'd like to not be someone's learning curve. This should not occur...Problem is that this patient is going to be happy with their length, but they're gonna be very unhappy with their alignment and they'll probably eventually seek surgery to get that done. Anyway, bottom line is be careful that your surgeon knows these things... I think you should move up your learning curve far enough that you're not making these mistakes before you go out there and advertise that you do these type of procedures. It's not fair to the public. This got published. I saw this and just about fell off my chair and thought 'oh my God, seriously?' And you know, of course the lay public reading this doesn't see what's wrong. It's just glaringly obvious to any expert in the field that this is just a beginner mistake." - Dr Dror Paley

[Body Builder]

Wonder how Monegal with fitbone would be rated.
He had a group of successful diaries a while back. But haven’t heard much since.

And many tragic cases too. Also fitbone is the most unreliable nail ever so any doctor that still uses it is a big no for me.

Also I can't understand why some of you rank Guichet anything more than the worst tier.
The money he wants are almost the same as Paley, who is the best LL doctor in the world, and had many terrific cases that we only hear in third world countries.
For me only a fool would give so much money to go Guichet.
And also Becker is a new doctor in LL. Of course he can't be a top tier compared to trauma doctors with much experience like Giotikas, Pili etc.
And finally, merchants like Derbipashad can't be top tier for that and only, even if they are good doctors which I doubt because top.doctors don't need merchandise.

In a few words, I completely disagree with most of the lists above.

[uponly]

KiloKahn, what a spot-on post and reminder that this procedure should not be taken lightly or undergone with suboptimal Doctors and/or in unsafe environments. I remember a Jeff Bezos quote:

"There is no algorithm for experience"

And that rang true to me with considering options.

I did due diligence on this for 5 years before pulling the trigger, and missed the Stryde window, maybe fortunately. Throughout my assessments, Dr. due diligence, etc., my #1 overall goal remained safety.

Dr. Paley mentioned the numbers stated on the video in my consult with him. Same with Dr. Rozbruch. I asked how many Precice nails he had implanted and he said "thousands". Both also said "we have the facilities and experience to get you out of any bump in the road should you encounter one."

My two cents, at any rate. Everyone has different reasons, goals, resources etc., but IMO this is not a procedure you leave to chance and in inexperienced hands.

[stretched]

My two cents, at any rate. Everyone has different reasons, goals, resources etc., but IMO this is not a procedure you leave to chance and in inexperienced hands.

Facts, NEVER cut corners and try to save money and go with a sketchy Dr. Your ability to walk is not something you want in the hands of chance

[oklama]

And many tragic cases too. Also fitbone is the most unreliable nail ever so any doctor that still uses it is a big no for me.

Also I can't understand why some of you rank Guichet anything more than the worst tier.
The money he wants are almost the same as Paley, who is the best LL doctor in the world, and had many terrific cases that we only hear in third world countries.
For me only a fool would give so much money to go Guichet.
And also Becker is a new doctor in LL. Of course he can't be a top tier compared to trauma doctors with much experience like Giotikas, Pili etc.
And finally, merchants like Derbipashad can't be top tier for that and only, even if they are good doctors which I doubt because top.doctors don't need merchandise.

In a few words, I completely disagree with most of the lists above.

Becker learned from Betz for many many years, he's new in being the one running the practice but as far as I remember he's been there like 6-10 years? Which yeah, he's not paley/rozbruch level, but im sure he's still good enough.

The more I learn about giotikas it seems like he's the best option for those of us who aren't rich. He offers a weight bearing nail and his price is not ridiculous. Obviously its smarter to go with paley or rozbruch, but for some people including me we cant bear to continue living our lives like this, so ill get one lengthening with him in the next few years.

[SpeedDialer]

It feels like Becker still has a big advantage over Giotikas for tibias because Becker has a weight bearing internal tibia nail option. Ex: someone could do betzbone 2.0 femurs, wait 1.5 years, fly back to Germany, and have them removed +  have the betzbone 2.0 tibias put in. Same with Guichet, they could do something similar and have weight bearing the entire time/be able to go back to work earlier because they can get on crutches earlier. Dr. Betz claimed in his cyborg4life interview that patients who go back to work seem to do well (? not sure why? because they are forced to walk a bit more? Is betz wrong?)

I don't know anyone who has done this: Giotikas gnail femurs -> fly back to Greece gnail femur removal -> fly to Germany -> Betzbone 2.0 tibias. I think once someone goes with Giotikas once, they are pretty likely to go with Giotikas again (get used to Athens, the PT center, getting used to interacting with Dr. Giotikas) instead of going to Guichet or Becker for weight bearing tibias. That's just a guess though. If someone did this (two LL's with Dr. Giotikas), they would probably do precise tibias and miss out on weight bearing clicking tibias

Clicking tibias vs precise tibias. How long do each stay in a wheelchair on average and how much length do each get on average? We don't have stats but I think we may have a hunch. Height Journey did 3.5 cm precise tibias. I know two people who did 4 cm precise tibias. There should be some cases of 5 cm and 6 cm around in this forum for precise tibias. Some rarer cases of people trying to go for 7cm precise tibias, but I don't know the final outcomes

What about for clicking tibias? How much length did they do and how long did they stay in a wheelchair on average?

There are some questions to ask oneself- how long can you personally tolerate being in a wheelchair? When do you need to get back to work or walk around school? How much length on tibias are you trying to get? If you want externals, how will you respond after they are put on? If you still have your external frames on after leaving your doctor's area, what will you do if the externals are damaged after you have left your doctor's area? (a former Athens patient is going through that now and will fly back to Athens) Different answers for different people.

But in a few years this may all change if new nails come out and maybe so maybe this will all become moot if everyone gets access to weight bearing internal femur and weight bearing internal tibia options eventually. In that scenario, I wonder if Parihar would become very popular if that happened. He would have good training from Paley and access to potentially a great device someday.

[kamaruusman]

And many tragic cases too. Also fitbone is the most unreliable nail ever so any doctor that still uses it is a big no for me.

Also I can't understand why some of you rank Guichet anything more than the worst tier.
The money he wants are almost the same as Paley, who is the best LL doctor in the world, and had many terrific cases that we only hear in third world countries.
For me only a fool would give so much money to go Guichet.
And also Becker is a new doctor in LL. Of course he can't be a top tier compared to trauma doctors with much experience like Giotikas, Pili etc.
And finally, merchants like Derbipashad can't be top tier for that and only, even if they are good doctors which I doubt because top.doctors don't need merchandise.

In a few words, I completely disagree with most of the lists above.

Giotikas was attractive until he had a dead patient.

[Body Builder]

Giotikas was attractive until he had a dead patient.

Do you have more info about it? I never heard it before and it is very important to know if it is true and what was the reason.

[kamaruusman]

Do you have more info about it? I never heard it before and it is very important to know if it is true and what was the reason.

http://www.limblengtheningforum.com/index.php?topic=71100.msg219710#msg219710



Btw, OP should replace Giotikas with Dr. Leonid Solomin. You can't have a dead patient after only performing so few surgeries and be A-tier.

[Body Builder]

Fat embolism is a risk for any LL procedure. And Giotikas did many LL surgeries, not a few as you wrote.
Also Betz and Guichet had dead patients from the same reason.

Finally, Solomin? Good luck with going to the scam and terrorist place called Russia at 2023 to do LL. I would only go there if my only other choices were India and Turkey. It can't be compared with Greece or any other EU country though.

[kamaruusman]

Fat embolism is a risk for any LL procedure. And Giotikas did many LL surgeries, not a few as you wrote.
Also Betz and Guichet had dead patients from the same reason.

Finally, Solomin? Good luck with going to the scam and terrorist place called Russia at 2023 to do LL. I would only go there if my only other choices were India and Turkey. It can't be compared with Greece or any other EU country though.

It's a risk. But good doctors would be able to minimize such risks. Paley has done over 25k++ osteotomy cases and not a single death? Giotikas how many has he done? A couple of hundreds and already a dead patient? In my opinion, it's a red flag.

Dr. Solomin is a more experienced doctor who's been doing it since the 80s but regarding the place, yeah that could be an issue for this time but I was merely talking about the surgeon itself.

I'm not saying that Dr. Giotikas is the worst surgeon, but after a dead case in such a short career, I feel that he might not be the best option.

[Body Builder]

I agree with all these. But as far as I know, Giotikas use anticoagulant shots for 20 days after the surgery while other doctors don't even use. So I think that he does his best to avoid this tragic incident. I really wonder what happened with this case.

[kamaruusman]

I agree with all these. But as far as I know, Giotikas use anticoagulant shots for 20 days after the surgery while other doctors don't even use. So I think that he does his best to avoid this tragic incident. I really wonder what happened with this case.

He talked about it briefly in this interview at around 32:45 and seems that he doesn't want to reveal too much about it.



By the way, Dr. Franz Birkholtz should probably be A-tier as well.

[DanishViking]

He can't really say more than that in the interview, because his not allowed to. If he was hiding something, he would have denied it and lied in the interview.

As he states, some higher law inforcement agency (don't know the correct term lol) actually checked the situation following up the incident and came to the conclusion that this wasn't his or his teams fault, but simply happened even tho all safety precautions was taken. This has also happened to alot of other surgeons, but many of them just ain't gonna be honest about it, and that is even worse. Espically surgeons in Turkey and India. It's a part of this surgery that your're running a extremely low risk of dying and Dr G even points this out before surgery, not like many other crap surgeons who never openly talks about potiential complications and the risk here of.

Good luck finding a surgeon with more experience, who is more honest and is taking more precautions by doing things in a certain way to avoid complications, for a better more reasonable price than dr Giotikas in Europe. It ain't gonna happen at least for now...

[Jaki19]

Can somebody finally ban werewolf pls

[kamaruusman]

He can't really say more than that in the interview, because his not allowed to. If he was hiding something, he would have denied it and lied in the interview.

As he states, some higher law inforcement agency (don't know the correct term lol) actually checked the situation following up the incident and came to the conclusion that this wasn't his or his teams fault, but simply happened even tho all safety precautions was taken. This has also happened to alot of other surgeons, but many of them just ain't gonna be honest about it, and that is even worse. Espically surgeons in Turkey and India. It's a part of this surgery that your're running a extremely low risk of dying and Dr G even points this out before surgery, not like many other crap surgeons who never openly talks about potiential complications and the risk here of.

Good luck finding a surgeon with more experience, who is more honest and is taking more precautions by doing things in a certain way to avoid complications, for a better more reasonable price than dr Giotikas in Europe. It ain't gonna happen at least for now...

Yeah sure on paper he might not be at fault. But we don't know if their country's safety precautions are up to US standards. And if he was doing the things that were not necessarily required by the regulations but necessary for the patient's best interest and safety.

The point is this, Paley has performed over 25k cases and no death while Giotikas who has only performed hundreds of cases and already had a patient died in his hands.

It's probable that Paley has just been extremely lucky all this time and Giotikas just had the worst luck. But it's also probable that Giotikas just doesn't offer the same level of safety for this surgery.

[Eieiron]

Where is Dr Lee??