How did you overcome your Fat Embo fears

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It looks like of all the possible complications this is by far the scariest one. To LL vets, how did you overcome this fear? 

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Paley's current "Risks" page says even with "precautions our incidence of symptomatic fat embolism requiring treatment is 4%."   A 4% incidence rate for something that can kill you is scarier than getting in a car

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Quote from: Movie on October 29, 2020, 08:27:20 PMis that current data? I think that might've been old probabilities, today it's lower, and I agree with Mule, although I knew about Fat embolism I just put negative thoughts out of my head and thought positively, prayed everything would turn out fine and thankfully it did. No risk no gain, simple as that.

Thanks, legend.  Did Dr. M say anything about it beforehand?

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Quote from: GenralizedAnxietyDisorder on October 29, 2020, 08:32:19 PMDeep bone infection leading to amputation above the knee is more scary to me.

This fear makes me want to do one leg at a time. Also doing one leg at a time reduces chances of fat embo by half.

Regarding fat embolism I've still not found one source clearly telling how long after surgery you are completely safe. There are docs who don't even prescribe blood thinners and there are those that prescribe them till even after lengthening.

Where have you heard of a case of infection nearly that bad in CLL?

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Quote from: Michael J. Assayag, MD on October 30, 2020, 01:55:34 AMAlright! It is time to shed some light on the difference between fat embolism and pulmonary embolism.

Fat embolism is a clinical syndrome consisting of a rash in the trunk, shortness of breath and confusion. It is usually related to unstable fractures, and can occur during insertion of a rod through a bone.It happens when droplets of fat go into the bloodstream and lodge into the small circulatory vessels. after surgery, when bones are fixed, the risk is virtually non existant.

It is extremely  rare (i have never seen a clinically significant one in 10 years of doing a LOT of intramedullary rods) and is usually treated with oxygen therapy. Don’t forget that the 4% number quoted includes patients with all type of other medical problems, mostly elderly. Interestingly enough, fat embolism is the most quoted complication by patients inquiring about CLL. However, it is likely the complications surgeons fear the Least.

Pulmonary embolism(PE)  is when a blood clot goes into the circulation and lodges itself in the lung vessels. It can be easily recognized intraoperatively. It is rarely fatal. It is uncommon in healthy individuals. It can also happen post operatively due to prolonged immobilization, or plane flights . Blood thinners should be given for 3 to 4 weeks to mitigate that risk.


As for infection, it has to be promptly recognized and treated. Deep infection during limb lengthening is not nearly as worrisome as prosthetic joint infection after hip or knee replacement.
It can usually be treated by a simple washout of the surgical site, and antibiotics. In the worst cases, it may require exchange of the lengthening rod with an antibiotic coated trauma rod when the lengthening is done

I hope this helps dispel some fear related to ft embolism and PE.

You're a hero Dr. Assayag.  Thanks for this most-informative post; this forum was sorely lacking something that contextualizes these fears appropriately

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Quote from: AnotherShorty on October 30, 2020, 09:22:39 AMMany thanks, Dr Michael Assayag for being there for us despite having a tight schedule...
Could you please throw some light on the possibility of amputation, because that's my greatest fear... I watched your entire interview on Victor's Channel but that part was not discussed.

Best regards and thank you !!!

Where is this amputation fear coming from?  Unicorn's story seems to be the worst example of crippling throughout this forum (or anywhere else).  And even she hasn't had her legs amputated.