Q&A With Dr Jamal Abu Nemer

Dr Jamal Abu Nemer (Kiev, Ukraine) has agreed to do a Q&A on the forum. He has asked that you first refer to his new website before you post, as he has made some videos to introduce himself and answer some of the frequently asked questions that he receives.

Here is the link to his new website: www.orthopedicjamal.com
Here is the link to his thread in the Doctor Directory: http://www.limblengtheningforum.com/index.php?topic=62.0

You may post all of your questions for Dr Nemer here.

I will start off with the usual inquiry regarding long-term athletic loss because I think it's important to create something of a consensus on this matter.

What are the recommended safe ranges?

What are the long-term implications of leg lengthening?

What kind of symptoms will said implications have on the athletic function of the legs?

Dear Uppland,

Thank you for your inquiry. Optimum value for lengthening is: 6,5-7,0 cms for femurs and 4,5 - 5,0 cms for tibias. The maximum "hard" program is: 10-11 cms for femurs and 6-7 cms for tibias.  There is a big resistance of Achilles tendon  after 4,5-5,0 cm of tibias lengthening.

Please note

There is a big resistance of the hip's muscles after 6,0 - 7,0 cm of femur lengthening .
 
We can continue the program (more than the optimum values), but it will take more time (and money for the patient). Each additional centimeter more (higher) than optimal values ​​of elongation (7cm for hips, 5 cm for shanks) is an additional an cost of the lengthening program.

This is about 2 500 - 3000 USD for every additional centimeter.  The reason is due to the extension beyond the optimal value takes more effort, time and make complexity to the lengthening program.

This cost can vary, but we need to see X-ray pictures of your bones in order to assess the complexity of the "big program."

The approximate rate of elongation of the day is one millimeter. To get this millimeter you will have to perform 18 clicks (in the new construction). The click sound is very clear.

We try to create a comfortable environment for the patient during elongation. In the process of the lengthening we can sometimes go a bit more of a millimeter, sometimes giving rest for a few days.  We (and You) assess the condition of the muscles, and choose the optimum way. As your doctor, I will visit very regularly, at least once a day to assess your condition, answer any questions and make sure you are comfortable and safe.

Regards,
Dr Jamal A. Nemer
www.orthopedicjamal.com

Would I have any problem doing 6.5-6.8 cm femurs?

Dr Jamal,

Because your nail is based on the Bliskunov nail, I guess your nail has a part that goes into the pelvis too? Is there any pain in the pelvic area when the nail is inside?

I like that your nail is full weight bearing and your center looks nice.

Dear Daylight & Deutsch Mark,

Thank you for your questions. Up to 7cm, generally speaking is possible as long as there are no severe complications. As Deutsch Mark was referring to our recovery center, I visit my patients everyday and make sure your care and support is up to the highest standard possible. I will assess your condition everyday and make sure complications are avoided before they occur. This is why our pricing for (femur) lengthening of 46,500 USD includes 3 months of room and board. It is essential patients are relaxed and comfortable during their lengthening period and for patients to know they have my full support.

Do you predict that your prices will remain around what they are currently in the next few years, or do you see them increasing significantly?

Hello Taller,

Thank you for your question. Unfortunately, to provide the best service possible, we have to continue to adjust pricing to keep up with factors such as inflation and cost of materials since we use only the highest medical grade materials that are made to be fully weight-bearing.

Although, I believe in a cost-friendly service for internal lengthening which is why my pricing always includes the 3 months room & board with daily supervision from myself.

hello Dr Jamal,

Can a gain of 9 cm in the femur?

Thank you very much for your honest response, doctor.

Another question: how much of their original athletic ability do your cosmetic lengthening patients typically recover after their procedures?

Do you feel that, generally speaking, tibia or femur lengthening looks better? I know it depends on the individual and the amount lengthens, but what is your general impression regarding aesthetics?

Which scenario can be favorable for a solid recovery? Assuming there is no cost factor.

1. 2-3 cm Internal femur (Precice), 2 cm External Tibia

2. 4-5 cm Internal femur (Precice)

Dr. Nemer,

What is the recovery center like? Is it a medical facility or similar to a hotel? Does it have single-occupancy rooms or do patients have to share?

What is the food there like?  I have a dietary restriction (no dairy products.) Will that be a problem?

Dear Increase, after 5 or 6cm in the Femur, you will experience a big increase in tension, however with that being said, I've had patients who have done more than 9cm in the past so it will all depend on your condition. Safety is my absolute priority.

Dear Taller, if you send me your proportions, I will give my opinion on whether to start with your tibia or femur in regards to aesthetics. This is highly dealt with on a case by case basis.

Dear Average2Tall, there are risks every time you go into the operating theatre. You have to think about the number of complications that can occur with each surgery. 5cm is considered within the safe limits of lengthening - therefore, I would recommend you to think about doing 5cm in one go.

Dear Medium Drink of Water, that is a very good question! For the sake of patient wellbeing, we've created a very homely atmosphere with an in-house nurse team. Your dietary restriction will be no problem for our team to handle, and we will make sure your diet is well balanced for optimal recovery. We have both single and shared rooms (no more than 2 patients in each room) for our patients.

Dr Jamal, you say on your website that the new Jamal Nail causes less scars on the side of the hip.

The old website had pictures of the old scars left by the surgery with the old Bliskunov nail.

When will you be able to provide pictures of the side of a leg that has used the new nail so we can assess the new scars?

I would like to see those pics.

Is it OK lenghthening 2 mm a day, like your patient Purfection did, or does it depend on the patient? Thank you

Thank you for your enquiries, Dingo and Taller expectations.

I will proceed to attach photos from a patient who has approved for her surgical scars to be displayed on this forum.

It seems the photo files are too large - so we have compensated by putting them on this link:

Pic 1: http://s9.postimg.org/x9mmxt7dr/IMG_0580.jpg
Pic 2: http://s9.postimg.org/rqooubzq7/IMG_0578.jpg
Pic 3: http://s9.postimg.org/yd6r9rs0v/IMG_0581.jpg
Pic 4: http://s9.postimg.org/su8t6akdb/IMG_0582.jpg

The incisions are very small, almost invisible, contrary to those of external fixators which can have the possibility to cause scars that will need further treatment. The main visible points of scarring will be on the upper femur on the lateral side, and a small incision site around the hip area.

Hello Dr Jamal.

It's Sweden here who visited you last year with my friend. Hope you are doing fine. I'm still thinking of doing my femurs. Sadly I broke the bottom part of my right tibia where it meets the foot and I left it untreated at first but 4 months later I got a cast on and now, 3 months after that I have a hard time walking on it. It still hurts in the broken area. I have a very hard time running so mostly I walk.
I need to have this part fixed together with my studying before I jump into femur lengthening.

My question: Can you lengthen the humerus with the Jamalnail too?
I read that Apotheosis did it with Dr Betz and it got me curious. I have a hard time going over my wingspan.

Thank you, and take care.

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For the rest of you guys thinking about the food in Ukraine, it was one of the greatest place to eat at. The food is 5 star and very cheap. I could go there just for the food again!!