Dr. Betz Femurs June 2022

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I would do Betz because of the possibility for 10cm if I had a guarantee it was actually Betz the whole time as I thought that’s what I was paying for.  And I would have stayed for a longer time in Germany doing físio.  Outside of the increased length of the betznail, I would choose Dr. G.
I still believe betz is a good surgeon and I got left behind in their transition.  I don’t have enough info to comment on anything concerning Becker.

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Quote from: leonazul99 on December 24, 2022, 06:59:41 PMI was given 3 months of Xarelto which I took to the last tablet.  Betz told me take it for 3 months not until you finish lengthening during the initial consult.  Later Becker said until you finish lengthening after the PE.  Dr. G along with some other surgeons only do prophylaxis for a month or so.  There was no noncompliance on my part.  Highest risk for PE  is in the beginning when patients are less mobile.  My PE happened after a mild muscle tear and I was more bedbound after the 3 month mark.  I was told nothing but “keep stretching” at the time.  I was at the cusp of the betz/becker transition and I don’t think it was handled very well.

Do you think that the PE was due to the muscle tear or the lenghtening?

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Quote from: leonazul99 on December 24, 2022, 07:45:09 PMI would do Betz because of the possibility for 10cm if I had a guarantee it was actually Betz the whole time as I thought that’s what I was paying for.  And I would have stayed for a longer time in Germany doing físio.  Outside of the increased length of the betznail, I would choose Dr. G.
I still believe betz is a good surgeon and I got left behind in their transition.  I don’t have enough info to comment on anything concerning Becker.

Dr. G. offers the G-Nail, a weight-bearing nail with the same 10 cm length possibility as the G-Nail.

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Quote from: Limbfan2020 on December 24, 2022, 08:01:56 PMDo you think that the PE was due to the muscle tear or the lenghtening?

Being in bed and not moving much (físio came to house) secondary to the tear.

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Maybe doing unilateral lengthening is not a bad idea after all. There have been quite a few cases of PE reported on the forum and doctors seem to have varying protocols to prevent it.

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In fact my Mexican inpatient doctor wanted me to stop clicking and didn’t want to hear anything about my surgery.  Becker said I could keep going. Betz ignored me.  If I stopped clicking it would have meant preconsolidation and end of lengthening at 6cm. Told hospital I am going to leave against medical advice.  Was not even hooked up to IV on day 2 and just getting oral anticoagulants.  Oxygen saturation improved to 95% without supplemental oxygen and vitals were stable.  Mexican doctor said I risk dying if try to click.  I went home and clicked after reading more on the medical science of DVTs and subsequent PEs and given my condition.   The fear was palpable though.

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Quote from: leonazul99 on December 24, 2022, 08:41:32 PMIn fact my Mexican inpatient doctor wanted me to stop clicking and didn’t want to hear anything about my surgery.

Why? Doesn't he trust german doctors? Or was he just envy?

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Quote from: Limbfan2020 on December 24, 2022, 08:54:06 PMWhy? Doesn't he trust german doctors? Or was he just envy?

Lots of reasons: ignorance, arrogance, fear of lawsuit or bad outcome,etc.

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Quote from: Limbfan2020 on December 24, 2022, 08:54:06 PMWhy? Doesn't he trust german doctors? Or was he just envy?

I can confirm that local doctors can be really really arrogant about it. In that case I would advice to not listen to them, listen to your surgeon that did LL on you.

Quote from: ten on December 24, 2022, 08:29:59 PMMaybe doing unilateral lengthening is not a bad idea after all. There have been quite a few cases of PE reported on the forum and doctors seem to have varying protocols to prevent it.

Instead of choosing unilateral that won’t even reduce the risk of PE from DVT, it is more important to never skip bloodthinners. Never, not a single day. It’s the only real dangerous risk of death if you are many weeks post OP.
There are 2 types of PE.
1) fat emboli. This indeed has a lower risk if you do unilateral. But fat emboli syndrome happens right after surgery. Not weeks later.
2) thrombosis (DVT). This happens due to immobility and a blood clot forming in your leg veins. This is what leonazul experienced. If you are mobile (bike, walk) etc you have a much less risk. But it’s not enough to do only that. You need oral blood thinners until you are almost normally mobile again (most likely a few weeks post lengthening). With xarelto 10mg daily you will most definitely not experience it.  Paley, Becker and many others follow this obvious protocol. It’s the most important medication bc skipping it could lead to death even weeks/months post OP.
With unilateral you are also barely more mobile than with weightbearing and if you skip the blood thinners you have the same risk. Just saying.

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Quote from: RealLostSoul on December 24, 2022, 09:39:54 PM
Instead of choosing unilateral that won’t even reduce the risk of PE from DVT, it is more important to never skip bloodthinners. Never, not a single day. It’s the only real dangerous risk of death if you are many weeks post OP.
There are 2 types of PE.
1) fat emboli. This indeed has a lower risk if you do unilateral. But fat emboli syndrome happens right after surgery. Not weeks later.
2) thrombosis (DVT). This happens due to immobility and a blood clot forming in your leg veins. This is what leonazul experienced. If you are mobile (bike, walk) etc you have a much less risk. But it’s not enough to do only that. You need oral blood thinners until you are almost normally mobile again (most likely a few weeks post lengthening). With xarelto 10mg daily you will most definitely not experience it.  Paley, Becker and many others follow this obvious protocol. It’s the most important medication bc skipping it could lead to death even weeks/months post OP.
With unilateral you are also barely more mobile than with weightbearing and if you skip the blood thinners you have the same risk. Just saying.

I think you are overstating the importance of blood thinners because many other world renowned doctors don't prescribe it for beyond 2-3 weeks after surgery. Guichet, Giotikas, Assayag, Gdalevitch off the top of my head. Some of them are Precice docs and even then don't give blood thinners for months after surgery.

I wish we could know if ratcheting nails make the problem worse. But we'll never know unless these doctors publish data. Has Betz published a paper after his decades of experience documenting all the complications his patients faced? I don't think anything like that exists for GNail also. I personally know of 3 cases of PE so far in people who used ratcheting nails.