Limb Lenghtening with Dr Guichet 2017

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Hi everyone! I am a 22 year old medical student from South America, and I will be traveling to Milan on January 25th for the pre-op training with Dr. Guichet. I am starting this thread to contact any LimbLengthener currently in Milan, and also to answer any question you may have regarding the procedure or the post-op management. Please excuse my English! Good luck for everyone who has decided to embark on this journey. Stay safe.

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Internal femurs. Starting height 166 cm. Goal: what my body can handle, realistically 7-8 cm. For the surgery you have to pay in 2 different bank accounts: 28000 euros (nail implants) 31000 GBP (surgery itself). You can do the math. Pre-op exams, medications, cardiac and dentist consultation are not included.

About getting in contact with Dr Guichet, it is very variable. The first time I wrote to him, I had to wait about 1 month for the response. (Dr Guichet said he had no secretary at the time). Then he always responded the following day. Now that almost all is planned (appointments in Milan, documents ,etc), the only thing I do not know is when the initial consultation will be. I wrote to him last week, but no answer yet. Does anyone know a way to reach Dr. Guichet other than his email?

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Quote from: fivesix on January 14, 2017, 05:20:53 PMMaybe its because he's from South America and he's better with Spanish?

Actually, I'm pretty sure they speak Italian in Italy 

I can touch the floor with my legs straight (not the whole palm). My flexibility is average at best. After 30 days of pre-op training, I believe the surgery will take place late February or early March. London is overall a more expensive city, but the main reason is that I have a place to stay in Milan (distant relative) at least for a couple months. I speak a little Italian, at least enough to survive everyday life.

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Aren't there many reports and diaries about fitbone malfunctioning? While I would've preferred a "cheaper" lengthening, it is a surgery with many risks, some of them permanent. I am not interested in being a pro athlete, but functionality is my number 1 priority. That being said, Paley and Guichet are living legends in the lengthening business. They have developed the procedure throughout the years, especially Paley who is very active in the scientific community (https://www.ncbi.nlm.nih.gov/pubmed/27892743). There are plenty good doctors out there, but for this procedure, I want the best I can get.

You are lucky you get a gym and pool, and support from caretakers and fellow limb lengtheners! Post-op period is most important. Dr Guichet is also really stern about physical condition and training.

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Dr Guichet uses an improved version of the Albizzia nail. Dr. Paley uses Precise 2, but he is not the only one. You can find many doctors who also have experience using Precise 2 and are much cheaper (although not as good as Dr. Paley I imagine). He is more expensive than Dr. Guichet. 

"Precice and fitbone sure are a step ahead of the albizzia": I am not quite sure. Guichet claims his nail is full weight bearing but whether that is true remains to be seen (I'll tell you in one month!). However, I know for a fact (searched in Pubmed), all the articles about Precise 2 specify that it is only partial weight bearing. The Precise 2 has the most amount of research done among the new nails I believe and is FDA approved (better than Fitbone).

What I like about the Gnail is that I am allowed to walk and therefore notice if there is something wrong along the way, and immediately stop if that is the case.

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Quote from: TIBIKE200 on January 16, 2017, 06:06:53 PMI dont care what guichet claims. Neither what Paley or any other doc claims... I only look into scientific articles and paper. Guichet uses the Albizzia (there is nothing wrong with this fact btw) which is an old intramodullary nail.. His weight is more weightbaring because it is made from cobalt chrome (I think that's the material) unlike the precice or fitbone. The fact that he calls it Gnail instead of "more robust version of the albizzia" doesnt change the fact that it is still an albizzia nail. It can't go backwards (which is crucial in case of soft tissue limitations such as muscle spasm or extreme loss of range of motion, and also in case of joint contractures and subluxation) and also uses a "traumatic" way to lengthen (the clicking mechanism).. There is a reason (in my opinion) why the albizzia is no longer being used in any modern hospital in well developped countries.

You should be wiser than to only look at scientific articles (many papers about LL I've read have methodological errors). There is not plenty of evidence about the Guichet Nail and since he is the only one who uses it, there may be a publication bias. I have read many cases of Precise patients who have a seemingly complication free lengthening ( no infections, minimal stiffness). However, when they start walking, they notice duck ass and ballerina feet. I agree with you that the "backwards" function of the Precise is a definite advantage. Nonetheless, since I will be in control of my lengthening and evaluate myself continuously from post op day 1 , I hope to notice before such soft tissue limitations take place and stop immediately if that is the case.

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I believe there is a bit too much propaganda about Dr. Monegal in the forum. The Fitbone is only partial weight bearing. Why would anyone choose Fitbone over Precise (FDA approved , much more research done)? I've read many cases about Fitbone malfunctioning, patients requiring multiple surgeries, etc. For Precise and GNail you only need 2.

About the difference in surgical skill, the learning curve is about numbers. Of course Dr. Paley and Dr. Guichet are better than Dr. Monegal. In my humble opinion, Dr Paley is a "extra safe" Iphone 7 , Dr. Guichet is a "weight-bearing , sportive" Iphone 7 and Dr. Monegal is that Chinese smart phone which in many cases is as successful as the others, but it's just not the same.

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As I said, the main advantage of the Gnail is the weightbearing, but we can agree to disagree on that one. However, it is a fact that it is more likely that a Fitbone user requires more surgeries and the nail malfunctions more than the Precise.

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Quote from: Auron on January 17, 2017, 01:51:37 PMBtw and even though we haven't had many precise diaries lately, I'd like to point out that the latest precise diary that we have in this forum reported a malfunction with 1 nail.

Of course I did not say Precise is infallible, merely that it is a safer bet than Fitbone. Also, I didn't say Dr. Monegal is a bad doctor, I merely highlighted that Dr. Guichet and Dr. Paley are much more experienced. In any case, this is a diary not a discussion board for a brand of nail or other. Neither is it a competition board among LL doctors. I will be having limb lengthening with Dr. Guichet and I intend to be 100% truthful about surgery and post op recovery.

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Changing the topic... I'm meeting Dr Guichet January 26th. Does anyone have any questions (regarding the lengthening, post-op or nail itself) that you would like to ask Dr. Guichet? For example, I'm gonna ask him what to do when you "lengthened too much" and have reduced range of motion, or other complication since the Guichet Nail can't go backwards as TIBIKE200 said.