I promised so here I go
1) He lengthens between 5-9 (sometimes 10) cm on tibias (though he sais that in terms of proportions 9 is really pushing it and 8 is the max)
2) He uses the precise nail alongside the external fixator (He STRONGLY PREFERS the external fixators).
3) No LON or LATN (Says can cause misallignemnt problems which are much more difficult to deal with unlike pure externals)
4) Achilles tendon lengthening is not the big black boogieman that this forum (and the other one) s saying it is (It usually starts between 4-6cm and he prefers to do it immidiatly as it starts because prognosis is much better than to wait it through physiotherapy)
5) Best physiotherapy according to him is Walking Walking walking. You walk almost immidiatly after operation
6) time frame is usually the same in terms of healing (9-12 months)
7) He no longer operates in Lecco (he has his clinic there though). He works in the San Camilo hospital.
These are the important points I remember from the consultation if you have any more questions feel free to ask
I found quite disturbing that most of those statements are completely different from what most LL doctors advise.
Quote from: Ozymandias on February 29, 2016, 09:28:26 PMI found quite disturbing that most of those statements are completely different from what most LL doctors advise.
Who are these doctors? Paley that was his student for 6 months? Guichet (which also is the only LL doctor that encourages to build muscles before LL)?
He says that physio doesnt really help prevent equinous of the foot.. Only way to keep streching the tendons is to walk.
Sorry for the bit aggressive response... It's the Israeli in me.
To be more precise, I also was in a bit of shock when he told me about physio. I said to him that on the forum about the subject other doctors are taking physio really seriously. He said that according to his own experience, walking was the best physio (and this is why he encourages it as soon as possible). He said that he gives you exercises to do at home and stuff but that walking (and also swimming) are the best two things to do.
I asked about lengthening more than 5-6. He said that the blood vessels regenerate (And he is correct) and that one knows his limit when nerve pains start. The most limiting factor is the muscles and the achilles tendon (which cause bent knee and ballerina respectivly). I asked him about athletic recovery. He said that from his follow-ups, those that went skiing returned to skiing, those that went swimming returned to swimming and those that were running returned to run.
He advocates for atleast 5-6cm (he usually dont accept people who wanna do less) because he sais that it's not worth it (the process and psychological burden).
What I really liked about him that a few people in the town (lecco) said that even though as a person he can be pretty bad, as a doctor he is number one (when we asked people where Catagni's studio is and then we asked them about him). I also liked the fact that he doesn't push you to do it. He said to me "If my son was unhappy with his height I wouldnt suggest him to do that.. But if he would have persisted, I would be the only one I would let my son do it because I think I am capable". Also, he didnt tell me to start thinking about when doing it now.. He told me to talk to the 15-20 patients and ex patients on a list he gave me (with emails and phone numbers) and than to think if this is what I really want. If I would want to do it, that I should know all the risks, and especially the heavy psychological burden of being in these frames for so long.
Quote from: TIBIKE200 on February 29, 2016, 10:20:05 PMSorry for the bit aggressive response... It's the Israeli in me.
To be more precise, I also was in a bit of shock when he told me about physio. I said to him that on the forum about the subject other doctors are taking physio really seriously. He said that according to his own experience, walking was the best physio (and this is why he encourages it as soon as possible). He said that he gives you exercises to do at home and stuff but that walking (and also swimming) are the best two things to do.
I asked about lengthening more than 5-6. He said that the blood vessels regenerate (And he is correct) and that one knows his limit when nerve pains start. The most limiting factor is the muscles and the achilles tendon (which cause bent knee and ballerina respectivly). I asked him about athletic recovery. He said that from his follow-ups, those that went skiing returned to skiing, those that went swimming returned to swimming and those that were running returned to run.
He advocates for atleast 5-6cm (he usually dont accept people who wanna do less) because he sais that it's not worth it (the process and psychological burden).
What I really liked about him that a few people in the town (lecco) said that even though as a person he can be pretty bad, as a doctor he is number one (when we asked people where Catagni's studio is and then we asked them about him). I also liked the fact that he doesn't push you to do it. He said to me "If my son was unhappy with his height I wouldnt suggest him to do that.. But if he would have persisted, I would be the only one I would let my son do it because I think I am capable". Also, he didnt tell me to start thinking about when doing it now.. He told me to talk to the 15-20 patients and ex patients on a list he gave me (with emails and phone numbers) and than to think if this is what I really want. If I would want to do it, that I should know all the risks, and especially the heavy psychological burden of being in these frames for so long.
Is it possible to differentiate between nerve pain and muscle pain? , i know i sounded kind of silly asking this but just curious about it
Quote from: hyong on February 29, 2016, 11:16:59 PMIs it possible to differentiate between nerve pain and muscle pain? , i know i sounded kind of silly asking this but just curious about it
Nerve pain is usually a chronic pain that does not correlate with movement. It is a pulsing pain. It can also come along with weakness of the limb or loss of sensation. Muscle pains, if you touch where it hurts you, it will hurt more. It will become greater with movements and is usually very acute during the making of certain movements.
Quote from: TIBIKE200 on February 29, 2016, 11:20:21 PM Nerve pain is usually a chronic pain that does not correlate with movement. It is a pulsing pain. It can also come along with weakness of the limb or loss of sensation. Muscle pains, if you touch where it hurts you, it will hurt more. It will become greater with movements and is usually very acute during the making of certain movements.
I heard some people mentioned "electric feel". Is it the nerve limitation indication ?
he is 1000% wrong on achilles lengthening
there are numerous studies on achilles lengthening, and every one of them says the operated limb was significantly weaker than the non operated limb
it's just not possible that the achilles c is as strong... you are thinning it and elongating it....while using the same achilles tissue
It's not possible that the tendon generates as much force
achilles lengthening should be avoided.... there's a reason rozbruch and paley advise against it
my right achilles, which looks okay, unlike the left, it too is weaker than before
will the force come back... no idea... the left, not a chance
nerve damage doesn't always hurt
my nerve damage intially did not hurt... it's numb though, and there's this odd electric tingling that I get when I flex muscle
the leg though is very weak... hard to describe but i'll make an attempt
imagine trying to walk faster, or trying to run, but no matter how hard you mentally try, the leg doesn't do a thing... that's the best I can do to describe nerve weakness... the leg just doesn't work as it used to
Quote from: TIBIKE200 on February 29, 2016, 10:20:05 PMSorry for the bit aggressive response... It's the Israeli in me.
No problems man, just advising you to get a second (and third) opinion on these statements. Yes, they are completely different from what Guichet and Paley say, but also from Baumgart, Birkholtz, Monegal, Rozbruch, and a large etcetera.
Quote from: TIBIKE200 on February 29, 2016, 08:53:04 PM1) He lengthens between 5-9 (sometimes 10) cm on tibias (though he sais that in terms of proportions 9 is really pushing it and 8 is the max)
Quote from: TIBIKE200 on February 29, 2016, 10:20:05 PMI asked about lengthening more than 5-6. He said that the blood vessels regenerate (And he is correct) and that one knows his limit when nerve pains start. The most limiting factor is the muscles and the achilles tendon (which cause bent knee and ballerina respectivly). I asked him about athletic recovery. He said that from his follow-ups, those that went skiing returned to skiing, those that went swimming returned to swimming and those that were running returned to run.
He advocates for atleast 5-6cm (he usually dont accept people who wanna do less) because he sais that it's not worth it (the process and psychological burden).
It is very, very strange that he uses 5-6 cm as a lower limit. Virtually any other doctor agrees that going over 5 cm is dangerous. As an example, I'm going to quote Franz Birkholtz:
"Tibial CLL should probably be limited to around 4-5cm. This has to do with muscle tension and contractures primarily. Although the muscles to grow in the process of distraction histogenesis, there is an element of stretching that has to take place as well and if this is excessive, contractures result (eg ballerina foot) and this may be permanent."
Many patients (Sweden, for example) regret having done more than 5 cm in tibia.
Quote from: TIBIKE200 on February 29, 2016, 08:53:04 PM3) No LON or LATN (Says can cause misallignemnt problems which are much more difficult to deal with unlike pure externals)
LON or LATN can cause misalignment problems? Intramedullary nails were developed to prevent misalignments often associated with purely external fixators. So this statement sounds quite weird... Did he explain this further?
Quote from: TIBIKE200 on February 29, 2016, 08:53:04 PM4) Achilles tendon lengthening is not the big black boogieman that this forum (and the other one) s saying it is (It usually starts between 4-6cm and he prefers to do it immidiatly as it starts because prognosis is much better than to wait it through physiotherapy)
See crimsontide's previous post
Quote from: TIBIKE200 on February 29, 2016, 08:53:04 PM6) time frame is usually the same in terms of healing (9-12 months)
Not sure about what he wanted to say with this.
To sum it up, I would get a second and third opinion. Ask Birkholtz, for example. He has a Q&A thread here, and he also offers externals & Precice (as well as LON/LATN). Email Guichet or Monegal. Let's see what they have to say about these things.
And as a final note:
Quote from: TIBIKE200 on February 29, 2016, 10:20:05 PMWhat I really liked about him that a few people in the town (lecco) said that even though as a person he can be pretty bad, as a doctor he is number one (when we asked people where Catagni's studio is and then we asked them about him).
It may sound childish, but I don't want a bad person to be my LL doctor. Aftercare could be an issue.
It is very, very strange that he uses 5-6 cm as a lower limit. Virtually any other doctor agrees that going over 5 cm is dangerous. As an example, I'm going to quote Franz Birkholtz:
"Tibial CLL should probably be limited to around 4-5cm. This has to do with muscle tension and contractures primarily. Although the muscles to grow in the process of distraction histogenesis, there is an element of stretching that has to take place as well and if this is excessive, contractures result (eg ballerina foot) and this may be permanent."
Many patients (Sweden, for example) regret having done more than 5 cm in tibia.
with external or internal ?
You must be logged in to post a reply.