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[oeioei2]

Am I at risk for fat embolism during the whole lengthening of just in the beginning?
I thought it was just a risk for fat embolism in like the first week or so, but when Dr.Giotikas talked about a previous patient of his who had a fat embolism and died, he said it happened around 7 weeks after the surgery.
How is this possible?

[Yau]

Am I at risk for fat embolism during the whole lengthening of just in the beginning?
I thought it was just a risk for fat embolism in like the first week or so, but when Dr.Giotikas talked about a previous patient of his who had a fat embolism and died, he said it happened around 7 weeks after the surgery.
How is this possible?

Same question here
I also want to know

[ballsackoffury123]

you're supposed to take Xeralto for like 3-4 months every single day after you are released from the hospital. Guess the person prob ignored it, but that is the 1 medicine my doctor, Dr. Debiparshad reminds me to take every single time. He doesnt care if I dont take anything else, but forces Xeralto every single day until he says I can stop.

[DanishViking]

We also got to remember that we don't know wether the person who died was a smoker or vaped. This increased the chances according to Paley, were his 4 cases of fat embolism where smokers. But According to Dr. Giotikas as he stated this in a interview, if I remember correctly after like 2 weeks the chances of getting one decreases by alot.

[ballsackoffury123]

pretty sure the general chances of dying from this surgery is just super slim. it's not a really invasive surgery, especially if you have a good doctor like the US ones. If there was even a 0.1%+ fatility rate for the surgery in US, for a cosemetic surgery, it's never going to be legal lol

[Body Builder]

pretty sure the general chances of dying from this surgery is just super slim. it's not a really invasive surgery, especially if you have a good doctor like the US ones. If there was even a 0.1%+ fatility rate for the surgery in US, for a cosemetic surgery, it's never going to be legal lol

It is an invasive surgery.
Especially when we talk about internals it is almost as invasive as it could get for an orthopaedic surgery and even more for a cosmetic one.

[Hagane]

It is an invasive surgery.
Especially when we talk about internals it is almost as invasive as it could get for an orthopaedic surgery and even more for a cosmetic one.

i just wanna correct you here, because your statement dosnt sit right with me

technically all surgeries are "invasive"
however,  the techniques used in LL would be considered minimally invasive.
this is becuase it means its not an OPEN surgery
minimally invasive just means smaller incisions as opposed to a large incision used in open approach.

even in a tibial LL procedure. while the nailing can go through the patella, it doesnt involve opening the the joint.

i would argue that abdominal plasties and BBLL's are for more invasive.

[oeioei2]

But Xeralto medication is for the blood clot thing no? Not for fat embolism? Or am I wrong?

[oeioei2]

Yes I heard that too but I just dont understand how a fat embolism can happen after 7 weeks.
 Lets say the fact that it can still happen after 7 weeks makes me more scared to do this surgery than before I knew it.

[ballsackoffury123]

I think there are corelation but yeah you're right, i thought you meant pulmonary embolism. This is from google
"While blood clots are far more likely to cause pulmonary embolism, fat embolisms can still cause pulmonary embolisms, too (which are life-threatening medical emergencies). Fat embolism syndrome also causes problems with breathing even when it doesn't cause a pulmonary embolism"

yes Xarelto is for blood clotting, making sure it clots doesnt go up ur bloodstream and into your lungs causing death. and it MUST be taken for like almost 4-5 months EVERY DAY post surgery. Stuff costs like $546 fora 30 day supply, but there are coupons online to buy it for $10. DM me how

[Rockstarz5]

Hey is too much time,¿ do you think it afgects the liver? If so I guess we need to tale so liver protectors not sure if anyone knows

[kamaruusman]

i just wanna correct you here, because your statement dosnt sit right with me

technically all surgeries are "invasive"
however,  the techniques used in LL would be considered minimally invasive.
this is becuase it means its not an OPEN surgery
minimally invasive just means smaller incisions as opposed to a large incision used in open approach.

even in a tibial LL procedure. while the nailing can go through the patella, it doesnt involve opening the the joint.

i would argue that abdominal plasties and BBLL's are for more invasive.

Just wanted to correct you here.

Any forms of LL are invasive. But that doesn't mean that pure external tibia ll is as invasive as internal femur ll.

[ballsackoffury123]

Hey is too much time,¿ do you think it afgects the liver? If so I guess we need to tale so liver protectors not sure if anyone knows

No, it’s a pretty common drug some people have to take for life. It doesn’t hurt your liver with the prescribed dosage the doctors give. They’re not idiots that’s going to prescribe you something to give you liver failure

[Hagane]

Just wanted to correct you here.

Any forms of LL are invasive. But that doesn't mean that pure external tibia ll is as invasive as internal femur ll.

i dont think you understand what im getting at
both internal and external are still considered "minimallly invasive" surgeries.
the reason why is because it only involves small incisions that the surgeon works around
i belive you guys think its more "invasive" because it involves intermedullary nailing. inserting a nail in itself is not invasive.
if you had to cut open the hip joint in order to insert a nail, then that would be invasive.



this is the precice femur procedure


here is a pure external tibia

[kamaruusman]

i dont think you understand what im getting at
both internal and external are still considered "minimallly invasive" surgeries.
the reason why is because it only involves small incisions that the surgeon works around
i belive you guys think its more "invasive" because it involves intermedullary nailing. inserting a nail in itself is not invasive.
if you had to cut open the hip joint in order to insert a nail, then that would be invasive.



this is the precice femur procedure


here is a pure external tibia

Internal nailing is definitely more invasive.

External involves only breaking the bones, internal nailing involves not only breaking the bones but also drilling inside them. So it's not a rocket science. If you ask any LL doctors, they all will tell you what I'm telling you.

[Hagane]

Internal nailing is definitely more invasive.

External involves only breaking the bones, internal nailing involves not only breaking the bones but also drilling inside them. So it's not a rocket science. If you ask any LL doctors, they all will tell you what I'm telling you.

k man
believe what you wanna believe
but at the end of the day i still stand by the statement that intermedulllary nailing is considered minimally invasive

[ballsackoffury123]

I mean anyone that thinks internal nails is more invasive of a surgery than external fixators can just be ignored lol. What a waste of time to even explain. Having an open wound for access into your bone for months is less invasive than 4 1/4 incisions on each of your legs? K buddy

[Body Builder]

i just wanna correct you here, because your statement dosnt sit right with me

technically all surgeries are "invasive"
however,  the techniques used in LL would be considered minimally invasive.
this is becuase it means its not an OPEN surgery
minimally invasive just means smaller incisions as opposed to a large incision used in open approach.

even in a tibial LL procedure. while the nailing can go through the patella, it doesnt involve opening the the joint.

i would argue that abdominal plasties and BBLL's are for more invasive.

Breaking a bone and riming it to put an internal nail in it is of course a very invasive surgery.
Externals is less invasive and by far less risky, but internal LL has many risks with the most dangerous being the one we discuss here, fat embolism. A non invasive surgery can't cause embolism nor needs anticoagulants for months.
Whatever you believe, LL is by no means a minimally invasive surgery. It is the most invasive cosmetic surgery by far and a generally invasive orthopaedic surgery.

[oeioei2]

I think there are corelation but yeah you're right, i thought you meant pulmonary embolism. This is from google
"While blood clots are far more likely to cause pulmonary embolism, fat embolisms can still cause pulmonary embolisms, too (which are life-threatening medical emergencies). Fat embolism syndrome also causes problems with breathing even when it doesn't cause a pulmonary embolism"

yes Xarelto is for blood clotting, making sure it clots doesnt go up ur bloodstream and into your lungs causing death. and it MUST be taken for like almost 4-5 months EVERY DAY post surgery. Stuff costs like $546 fora 30 day supply, but there are coupons online to buy it for $10. DM me how

Ok so even if a fat embolism can cause a pulmonary embolism, the Xarelto in itself is only for the Pulmonary embolism and not for the fat embolism?
So I just do the surgery and hope for the best in regards of fat embolism? I cannot do anything to reduce my chances of that?

[Limbfan2020]

Ok so even if a fat embolism can cause a pulmonary embolism, the Xarelto in itself is only for the Pulmonary embolism and not for the fat embolism?
So I just do the surgery and hope for the best in regards of fat embolism? I cannot do anything to reduce my chances of that?

The reason for fat embolism syndrom (FES) is the crossing of fat particles from the medullary cavity into the bloodstream during the reaming process. These particles might cause serious blockage of certain arteries in the lung, heart or brain.

In my opinion, a good surgeon who uses right reaming and venting technique can reduce the risk of FES. Otherwise, you can do unilateral lengthening which reduces FES by 50%.

[thankscience]

Fat embolism syndrome is really only a risk up to 72 hours after surgery. Pulmonary embolism is slightly different and you are at greatest risk 2 weeks after the surgery, though there is an enhanced risk up to about 3 months after surgery. Every day the risk becomes less and less. Not all doctors prescribe blood thinners for the full lengthening period, particularly if the nail is weight-bearing as it is expected you are less likely to have a clot if you are moving around.

[Hagane]

Breaking a bone and riming it to put an internal nail in it is of course a very invasive surgery.
Externals is less invasive and by far less risky, but internal LL has many risks with the most dangerous being the one we discuss here, fat embolism. A non invasive surgery can't cause embolism nor needs anticoagulants for months.
Whatever you believe, LL is by no means a minimally invasive surgery. It is the most invasive cosmetic surgery by far and a generally invasive orthopaedic surgery.

once again my point is the way you use the term minimally invasive is not inline with its medical definition.
you percieve reaming and nailing as invasive, because you have no exposure to it other than reading about it.

you know what i shouldnt have bothered mentioning it

Fat embolism syndrome is really only a risk up to 72 hours after surgery. Pulmonary embolism is slightly different and you are at greatest risk 2 weeks after the surgery, though there is an enhanced risk up to about 3 months after surgery. Every day the risk becomes less and less. Not all doctors prescribe blood thinners for the full lengthening period, particularly if the nail is weight-bearing as it is expected you are less likely to have a clot if you are moving around.

this is a great statement thankscience, it should be sticked and maybe there would be less posts asking the same thing about PE and FES
 

[Hagane]

Breaking a bone and riming it to put an internal nail in it is of course a very invasive surgery.
Externals is less invasive and by far less risky, but internal LL has many risks with the most dangerous being the one we discuss here, fat embolism. A non invasive surgery can't cause embolism nor needs anticoagulants for months.
Whatever you believe, LL is by no means a minimally invasive surgery. It is the most invasive cosmetic surgery by far and a generally invasive orthopaedic surgery.

if you to the nuvasive site, they literally say precice is " minimally invasive"
https://www.nuvasive.com/surgical-solutions/precice-limb-lengthening-physicians/#:~:text=The%20Precice%20system%20provides%20a,Proprietary%20magnet%20technology

i feel like im failing to properly word what im trying to say:
the term minimally invasive is not spectrum, its a technique. a technique meant to reduce recovery time by decreasing the size and number of incisions. 

ok im done nitpicking 

[Hagane]

Yes I heard that too but I just dont understand how a fat embolism can happen after 7 weeks.
 Lets say the fact that it can still happen after 7 weeks makes me more scared to do this surgery than before I knew it.

do you have the source that says it was a fat embolism?
if you listen to the cyborg interview with dr giotkas he says pulmonary embolism
 

[Yau]

Fat embolism syndrome is really only a risk up to 72 hours after surgery. Pulmonary embolism is slightly different and you are at greatest risk 2 weeks after the surgery, though there is an enhanced risk up to about 3 months after surgery. Every day the risk becomes less and less. Not all doctors prescribe blood thinners for the full lengthening period, particularly if the nail is weight-bearing as it is expected you are less likely to have a clot if you are moving around.

As u said, patient is at greatest risk 2 weeks after the surgery and risk up to about 3 months after surgery. I wonder many doctors don’t recommend 3 months blood thinners after surgery, maybe just 1 month blood thinners.

[oeioei2]

Fat embolism syndrome is really only a risk up to 72 hours after surgery. Pulmonary embolism is slightly different and you are at greatest risk 2 weeks after the surgery, though there is an enhanced risk up to about 3 months after surgery. Every day the risk becomes less and less. Not all doctors prescribe blood thinners for the full lengthening period, particularly if the nail is weight-bearing as it is expected you are less likely to have a clot if you are moving around.

a

[oeioei2]

do you have the source that says it was a fat embolism?
if you listen to the cyborg interview with dr giotkas he says pulmonary embolism
 

Oh I must have heard wrong then, so the embolism the Dr is talking about was the pulmonary embolism? His patient did not die from Fat embolism?
 after 7 weeks?

[Body Builder]

if you to the nuvasive site, they literally say precice is " minimally invasive"
https://www.nuvasive.com/surgical-solutions/precice-limb-lengthening-physicians/#:~:text=The%20Precice%20system%20provides%20a,Proprietary%20magnet%20technology

i feel like im failing to properly word what im trying to say:
the term minimally invasive is not spectrum, its a technique. a technique meant to reduce recovery time by decreasing the size and number of incisions. 

ok im done nitpicking

Nuvasive wants to sell its nail and say bs as many merchants LL doctors who say that LL is almost nothing to their patients and the later end up being crippled.

Breaking a bone and puting a nail inside it is an invasive orthopaedic surgery. End of discussion. Even externals is an invasive procedure because the bone must still broke and have screws on it.
We are not talking about a boobjob here but the most invasive and hard cosmetic surgery. And only some naives who haven't done LL and maybe they will never do it think otherwise, because if they truly do it they would understand what I am saying from the first time they open their eyes after the surgery finishes. 

[Hagane]

Oh I must have heard wrong then, so the embolism the Dr is talking about was the pulmonary embolism? His patient did not die from Fat embolism?
 after 7 weeks?

yeah it most likey could have been from an unfortunate combination of factors.


attached is a picture of virchows triad which shows the three categories that contribute to clotting.

without knowing much about the actual details of the case , it is most likely that the cause could be from circulatory stasis and hypercoagulability, as it was 7 weeks post so there is no acute vascular injury.

its very likely that the patient was not mobilizing which caused hemostasis leading to a clot formation that dislodged and caused the PE
 

[kamaruusman]

Another thing that worries me about Dr. Giotikas is that he just openly admits the risks of dying from FE/PE as if he wouldn't be able to do much to treat it if it does happen. This conveys that he's actually not very confident about the safety of this surgery under his hands. The risk of dying according to them is 1/9000 which does seem to be quite high. In reality, the risk of dying under him is not even anywhere that low as his total osteotomy cases are probably just a couple of hundreds.

In contrast, if you ask Paley the same question, he'll just confidently tell you that you won't die under him.

By the way, I just find this thread about how you can actually prevent pulmonary embolism easily: http://www.limblengtheningforum.com/index.php?topic=66627.msg194898

[thankscience]

Dr Giotikas used to work as a trauma surgeon in the army so limb lengthening cases would be relatively simple. Having consulted with him myself, he told me he does about 4 surgeries a week currently. Considering he has been a surgeon for 15+ years then he would have done at least a few thousand surgeries by now. Certainly more experienced than a lot of the other doctors on this forum imo.