Dr tierlist

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

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

Quote from: oklama on February 12, 2023, 10:50:45 PMlets 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

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).

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

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

"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.

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

Quote from: stretched on February 13, 2023, 04:31:21 PM
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

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