Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Doctors => Topic started by: KiloKAHN on October 19, 2015, 09:48:08 PM
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General Information and response from Dr Daniele Pili, based in Milano, Italy. Contact for specific information and latest updates.
Note: Please refer to our disclaimer about the Doctors Directory http://www.limblengtheningforum.com/index.php?topic=55.0
(http://i.imgur.com/y6U3YL2.jpg?1)
Profile (From Website):
Dr Pili graduated as a Medical Doctor with Summa cum Laude in Italy and trained as an Orthopaedic Surgeon in Italy and the United Kingdom. From his first experience as an Erasmus student in Germany in the Freie Universität of Berlin understood the importance of an international training. Just after graduating he enrolled at GMC and moved to the United Kingdom to gain more experience in Emergency and General Medicine in Liverpool and Rotherham. He began his training in Orthopaedic Surgery and Traumatology in Newport Isle of Wight and Wakefield south of Leeds together with renowned surgeons.
He returned to Italy to complete his training in Italy and soon returned to the UK to work in Peterborough in the Cambridgeshire, where he worked as a Senior Registrar together with renowned surgeons collaborating with the University of Cambridge and with Martin Parker, famous orthopaedic surgeon renowned for his experience in the treatment of hip fractures. During these years he learned the most advanced surgical techniques to treat orthopedic conditions and developed a wide experience in the treatment of the most common orthopedic disorders.
Selected by SIOT (Italian Society Orthopedic traumatologists) to represent Italy in the Travelling Fellowship in London in 2011 he compared his experience with best orthopaedics surgeons across Europe.
Throughout his career he has presented his work in various scientific congresses in Italy, Europe, South America and the USA. He owes a great contribution to his surgical training to Professor Maurizio Angelo Catagni of Lecco Italy. Working with him as a Ilizarov Fellow he has acquired the Ilizarov technique to treat complicated orthopaedic conditions and learned about limb reconstruction and limb lengthening.
Back to Italy he now works closely with Professor Catagni in Lecco as a Consultant Orthopaedic Surgeon practicing limb reconstruction surgery and limb lengthening, treatment of deformity and bone infections in adults and children. At the same time he is practicing minimally invasive surgery, hip and knee arthroscopy and shoulder surgery as well as hip and knee replacement together with general orthopaedic surgery.
Limb Lengthening Methods:
I perform limb lengthening mainly to correct limb deformities on a daily basis. Our institution is well established in this kind of procedure and we have more than 30 years experience in limb lengthening. We offer surgical treatments to correct lower limb deformities as well as upper limb with the most advanced methods. I do LL with intramedullary nails (internals) and HEF (Hybrid Externel Fixator).
Leg Lengthening with Hybrid External Fixator (HEF)
This technique is an evolution of the Ilizarov technique. It is a very versatile technique which can correct deformities and can generate large amount of bone lengthening. Late consolidation, a feared complication in bone lengthening techniques, is easy dealt with compression of the not well developed new formed bone. In fact bone grafting is rarely necessary with this technique. This can not be achieved with most of the intramedullary (internal) devices. The lengthening speed is of 0.5-0.75 mm/day for a single osteotomy and double (up to 1.5 mm/day) for a double osteotomy. This can also be an advantage with respect of intramedullary (internal) devices.
The HEF has to be kept in place for the all duration of the treatment till full consolidation is achieved. Usually it takes around 100 days for lengthening up to 8 cm and 5-6 months to achieve a full consolidation. During the lengthening time the patient will walk with crutches and follow our rehabilitation protocol to avoid muscle contractures such as ballerina foot. With HEF these complications are better dealt due to the possibility of passive physiotherapy to stretch the muscles. Even though in theory a full weight could be applied to the frames, walking with crutches is advised. As the consolidation progresses and as the patient gains confidence a full weight can be applied. When the HEF is removed a splint is applied to the leg to protect the new formed bone. Sport activities are usually possible within 6 months. The recovery is usually complete.
Possible risks of this procedure
- Pin and wires tract infection. This is usually a very superficial infection which is treated with local disinfectants or antibiotics and usually recovers fully without serious problems.
- Delayed bone consolidation which rarely needs a second procedure such as bone grafting
- Deformities are easy dealt acting on the frame
- Neurovascular problems due to blood vessels or nerve stretching. This complication have never been experienced by our patients but are described in the literature.
- All these complications, with the exception of pin and wires tract infection, is common to all bone lengthening methods including intramedullary (internal) nails.
Leg Lengthening with intramedullary (internal) nail Precice I/II or ISKD
The nail is inserted in the leg (femur or tibia) and after the osteotomy (cut of the bone) it is fixed proximally and distally with screws. To start the lengthening the Precise uses a magnetic mechanism while the ISKD is operated with a mechanical mechanism triggered by rotational movements of the segment lengthened (clicks).
This method is quite comfortable for the patients. There are no external devices. Muscular contractures are still possible as for all other techniques. The operation is longer, there is a considerable blood loss and carries the risk of fat embolism. In case of delayed consolidation using ISKD the only option is to have another procedure consisting in bone graft.
At the end of the treatment, when a solid consolidation of the new bone is achieved the nail is removed.
Down points
-Lengthening the tibia with a nail is often associated with permanent anterior knee pain.
-This method is more expensive (2 or 3 times the cost of an external fixture) due to the high cost of the nails.
Possible risks of this procedure
-Wound and bone infection
-Delayed bone consolidation needing a second procedure such as bone grafting
-Deformities needing further surgery
-Metalwork fatigue and break
-Fracture during the surgery. This complication have never been experienced by our patients but are described in the literature. This will need to stop the lengthening and deal with the fracture.
-Muscle contractures
-Neurovascular problems due to blood vessels or nerve stretching. This complication have never been experienced by our patients but are described in the literature.
Pricing:
Prices depend on the method and starts from 20.000 Euro with Hybrid External Fixator for tibia, for the procedure. Internal lengthening can also be performed with Precice I/II or ISKD and go up to 55.000 Euro.
Accommodation:
Accommodation is available if needed nearby the hospital and depends on your needs and preferences, price starts from 500 Euro a month.
Physical Therapy:
Physio is also available with different options depending on your possibilities and preferences, prices starts from 50 Euro a session.
FAQs:
1) How long will I stay in hospital after surgery?
Some operations are performed as day-surgery, for major surgery you will need to stay in hospital for 2 to 7 days.
2) Will I need physio?
Physiotherapy is key to success in some operations. If physiotherapy is indicated we will prescribe you. In any case you will be explained what are the best exercises to do for the best rehabilitation.
3) What do I have to do i case of emergency?
During working days and times you can ring us for advice. You can also seek advice via email, we will reply as soon as possible. In any case if you need urgent help you can go to your local Emergency department.
4) When is it appropriate to request surgery for limb lengthening?
Limb lengthening is performed routinely on patients suffering from dwarfism, in order to be helped in carring out normal daily activities. This procedure is also carried out on patients with idiopathic short stature or for aesthetic reasons.
5) How is limb lengthening performed?
Limb lengthening can be performed with different techniques. In most cases we use external fixators or extendable intramedullary nails. The lengthening is achieved in three main phases:
Surgery
Lengthening
Consolidation
The different methods have advantages and disadvantages that should be carefully evaluated before surgery. The extendable nails can stretch up to a maximum of 8 cm and if you want to achieve lenghtening greater than this you will needed more than one procedure. Obviously, the level of lengthening is carefully assessed in order to maintain the correct proportions and comply with the capability of muscles and tendons to stretch.
6) Which are the leg lengthening techniques available?
The available techniques are:
- External Hybrid Circular Frames with single or double osteotomy. This technique is the most versatile and the lengthening time can be up to 1.5 mm a day with two osteotomies. With this method acquired or already present deformities are easily corrected.
- Internal leg lengthening to the femur or tibia wit an extendable nail such as Precise (I/II) nail inside the bone.
Contact Information:
Website
http://drpiliortopedico.it/en/
E-Mail
info@drpiliortopedico.it
Phone Number
+44 2035294777
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It's always good to find other options. He's the only Italian doctor I know of so far who performs femur lengthening. Apparently Dr Catagni won't do any femur operations for cosmetic reasons.
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Dott. Pili performed my surgery in collaboration with dott. Catagni, I know him personally and I can say that he is really professional and careful.
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I have seen a few diaries from Dott. PILI and his patients do well and are very happy. No complications seen so far.
Considering he is doing also internals I believe he could be considered a new star in this field.
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Does anyone know how one goes about to hire a caretaker or local nurse for the entire consolidation period? This is one of the hurdles potential patients will face if they don't have friends or family in the city.
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Does anyone know how one goes about to hire a caretaker or local nurse for the entire consolidation period? This is one of the hurdles potential patients will face if they don't have friends or family in the city.
I exchanged a few emails with him asking that and he said his assistant would help to find you accommodation and nurses. You can email him yourself. He is very responsive
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Would you choose Catagni or Pili?
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good
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If you could choose which one would you choose?
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i am considering him , anyone who did it with him?
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There is a user NotTooTall doing it right now.... apparently everything is going well with the exception of having to get ATL surgery after 5cm. He is now over 8cm.
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According to him and his teacher Catagni there is no problem with ATL if done right after the appereance of ballerina. Could be because if you lengthen it right away, it will then stretch again and become strong? BOH
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you can go suck a DiKK if you think im paying half a million for internal method femurs 55.000. this guy ..
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He is a little expensive for a country like italy but if he's a good doctor I guess it's worth paying the price.
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Hi guys
I had my surgery with Dr Pili last week.
I would like to start my diary but I don't know how...
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Hi guys
I had my surgery with Dr Pili last week.
I would like to start my diary but I don't know how...
you don't know how to create a new topic or what to say ?
For the second case, see other diaries for the firt you can see on "Limb Lenghtening experience" the possibility to start it
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I do not know how to start a new topic.
Do I have to send a request to the forum administrator/moderator?
Please advice me.
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How tall are you exagerate?
What method are you using?
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I do not know how to start a new topic.
Do I have to send a request to the forum administrator/moderator?
Please advice me.
I sent you a message.Check it out.
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Hey I did it! :)
Wish me good luck
This is the link to my diary:
http://www.limblengtheningforum.com/index.php?topic=3481.msg52717;topicseen#msg52717[/b]]http://www.limblengtheningforum.com/index.php?topic=3481.msg52717;topicseen#msg52717 (http://[b)
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I want to get surgery from him, but I can't seem to find any price information from the above.
Can anybody PM or reply how much it would take to go through surgery from him ?
Thank you very much
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I want to get surgery from him, but I can't seem to find any price information from the above.
Can anybody PM or reply how much it would take to go through surgery from him ?
Thank you very much
Pricing:
Prices depend on the method and starts from 20.000 Euro with his Hybrid External Fixator HEF for tibia, for the procedure. Internal lengthening can also be performed with Precice I/II or ISKD and go up to 55.000 Euro.
I have met a guy who said he payed less than 50k for Precise II LL :-X
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How he paid less for precice 2?? Was his second surgery? That is a sweet new.
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The price for internal lengthening is 45 000 euro, but in case of nail breakage the cost becomes 65 000 euro.
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The price for internal lengthening is 45 000 euro, but in case of nail breakage the cost becomes 65 000 euro.
45000 ? Are you sure? I thought It was 55000
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Yes, l am sure about price but don' t remember if he uses Precise l or ll.
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Yes, l am sure about price but don' t remember if he uses Precise l or ll.
When did you ask him? He uses precice 2, p1 is not used now
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Last month I had a consultation with him. He wrote a comparison between external and internal method with prices but l don't have the paper now. Anyway he is in the habit of taking photos of what he says. I will ask him to send me an email with the pic of the prospectus but I am quite sure about the cost of both procedures.
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He prob did pay less because I was reading something on his website and if you like get your tibia done and come back for the femurs there is a supposed discount. Don't quote me on that I may be wrong.
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Someone have some information about his internal femur ?
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I asked about scars. I don't understand, according to this forum internal femur are better for scares ?
"Good morning,
Whatever the method you will get some scares. With an external fixator there will be more scares but they will be smaller end can be removed more easily. You should not let this sole factor make you take your decision on the method.
You should rather consider all actors as risks and complications as well as scares.
I would suggest you to come and see me in order to talk about all these factors."
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I asked about scars. I don't understand, according to this forum internal femur are better for scares ?
"Good morning,
Whatever the method you will get some scares. With an external fixator there will be more scares but they will be smaller end can be removed more easily. You should not let this sole factor make you take your decision on the method.
You should rather consider all actors as risks and complications as well as scares.
I would suggest you to come and see me in order to talk about all these factors."
Doctor clearly says the 2 things:
Internal - less but bigger scars
External - more but smaller scars
In the later case, they are easier to remove according to his judgement.
What is it that bothers you ?
Personally I think one shouldn't be worried about scars more than function, pain, problems down the line and so on.
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What is the price of femur LL with external fixator?
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What is the price of femur LL with external fixator?
Are you sure you want to do that ?
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When the HEF is removed a splint is applied to the leg to protect the new formed bone.
Does anyone have information on this “split” Dr. Pili uses?
It sounds a lot less invasive than nailing, but does anyone know if there are drawbacks of this?
Also how big the split is etc.
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Hi, I will have a individual consultation with Dr Pili in his studio for a limb lenghtening with his Ilizarov HEF.
If someone have some questions, just drop them.
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Hi, I will have a individual consultation with Dr Pili in his studio for a limb lenghtening with his Ilizarov HEF.
If someone have some questions, just drop them.
I have two questions, could you please ask him:
1. can one go back to his country after 3-4 weeks and work(desk job). Does he recommend or have had anyone do so? provided the physios are religiously done.
2. can the 10-15% length compression(subsidence) be avoided by wearing the HEF frames longer?
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Hi, I will have a individual consultation with Dr Pili in his studio for a limb lenghtening with his Ilizarov HEF.
If someone have some questions, just drop them.
Hey Frederico, I have some questions regarding the split Dr. Pilli uses post lengthening with his HEF technique.
He says that:
When the HEF is removed a splint is applied to the leg to protect the new formed bone
Does this mean he does not insert a classic nail which is normally used in LATN (lengthening and then nailing) which a lot of other doctors use with externals?
If he says Yes, can you ask him:
1: What does the split look like?
2: Is it just 1 split or multiple?
3: What are the advantedges and disadvantedges of the split he uses compared to the classic nail most other doctors use?
Thanks.
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This splint is after ilizarov removal. There js no real difference with what other doctors use and it has nothing to do with nails.
It should be a splint to keep the bone stable for about a month after ilizarov removal. If bone is fully consolidated is not even necessary imo.
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This splint is after ilizarov removal. There js no real difference with what other doctors use and it has nothing to do with nails.
It should be a splint to keep the bone stable for about a month after ilizarov removal. If bone is fully consolidated is not even necessary imo.
Thanks for your reply BB
I just have a hard time understanding how a “split” holds the bone stable.
I always picture the nail inside the bone sealed with screws that we see a lot of examples of from LATN and LON diary’s.
From what I understand Dr Pili does not insert a nail into the bone which is then hold together with screws. So I can’t really understand / picture how a split is inserted to hold the bone stable
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"The HEF has to be kept in place for the all duration of the treatment till full consolidation is achieved. Usually it takes around 100 days for lengthening up to 8 cm and 5-6 months to achieve a full consolidation. During the lengthening time the patient will walk with crutches and follow our rehabilitation protocol to avoid muscle contractures such as ballerina foot".
Can anyone confirm at what point I would be walking again and able to move on my own?
Id be traveling from near the UK to Italy for this surgery so im trying to determine how long I would be staying there?
So my understanding is that I would in the HEF fixator twisting the pins however required for a period of 100 days. What happens though during the subsequent 5-6 months consolidation phrase that follows?
Would I still be in the HEF fixator or is it removed after lengthening? if not is it only removed after the 5-6 month consolidation period?
Im not sure what id tell my family but im thinking id say im going traveling for a year as it looks like it will be a good 9 months before I could return home.
Many thanks for any help provided
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"The HEF has to be kept in place for the all duration of the treatment till full consolidation is achieved. Usually it takes around 100 days for lengthening up to 8 cm and 5-6 months to achieve a full consolidation. During the lengthening time the patient will walk with crutches and follow our rehabilitation protocol to avoid muscle contractures such as ballerina foot".
Can anyone confirm at what point I would be walking again and able to move on my own?
Id be traveling from near the UK to Italy for this surgery so im trying to determine how long I would be staying there?
So my understanding is that I would in the HEF fixator twisting the pins however required for a period of 100 days. What happens though during the subsequent 5-6 months consolidation phrase that follows?
Would I still be in the HEF fixator or is it removed after lengthening? if not is it only removed after the 5-6 month consolidation period?
Im not sure what id tell my family but im thinking id say im going traveling for a year as it looks like it will be a good 9 months before I could return home.
Many thanks for any help provided
You Will keep the Ilizarov rings for all the lengthening And consolidation phase, so near a year
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"During the lengthening time the patient will walk with crutches and follow our rehabilitation protocol to avoid muscle contractures such as ballerina foot"
Ok so i understand that I can expect to be in HEF frame for the guts of a year. So would it be correct from the above to assume that after the 100 days of lengthening that you would still be in the frames but be able to walk without crutches?
Im guessing you would be walking like frankenstein though with frames still on so if out in public would probably be better to use crutches.
Also I think I read that frames can be removed from your own surgeon at home. This seems quite odd to me as im not sure how this could be done?
Im from Ireland and in my country, your doctor makes a referral to a hospital, they take and xray and schedule surgery if needed to fix an injury or condition. There are long backlogs as it is so its not like you can rock up with some frames around your legs, saying you got limb lengthening and surgeons will just remove frame.
Id personally be too embarrassed to explain it all to my local doctor so id hope Dr Pili could remove them when that time comes.
Dr Pili does list some possible complications and how they can be resolved. I suppose my two greatest fears would be fat embolism and any non union complications leading to amputation.
Are these risks still a real possibility or is it safe to assume that with modern surgical procedures being followed they can be eliminated?
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I have two questions, could you please ask him:
1. can one go back to his country after 3-4 weeks and work(desk job). Does he recommend or have had anyone do so? provided the physios are religiously done.
2. can the 10-15% length compression(subsidence) be avoided by wearing the HEF frames longer?
Hi, you can of course do desk job. After a couple of days you can go home safely.
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Hey Frederico, I have some questions regarding the split Dr. Pilli uses post lengthening with his HEF technique.
He says that:
Does this mean he does not insert a classic nail which is normally used in LATN (lengthening and then nailing) which a lot of other doctors use with externals?
If he says Yes, can you ask him:
1: What does the split look like?
2: Is it just 1 split or multiple?
3: What are the advantedges and disadvantedges of the split he uses compared to the classic nail most other doctors use?
Thanks.
Hi, what you can split, wich is splint, is a device used for support or immobilization tool wich can be made of plastic and other material, or by making a fabric bandage that you wear to cover the leg. It is basically a guard, to protect the leg and the new bone. So you will wear one for leg.
I'm not aware of what other doctors do, if he don't do it probably there is a reason. I suppose that you need a surgery to put a nail on, so the answer it's pretty simple.
Have a nice day
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Gentlemen,
Thought this information from emailing Pili might help others; please see below.
i) How many millimetres of lengthening would you advise for optimal recovery whilst achieving a good height gain? (I train at a Muay Thai Boxing gym 3 days a week and would like to continue with this sport after surgery).
It depends on your wishes and on the way you will react to the procedure. However 6-8 cm is usually a good gain.
ii) Once the distraction / lengthening phase is complete can I return to England whilst consolidation takes place and provide you x ray images via email?
Yes, you can, but you will have to come and see me when I will ask you to. Usually once as month.
iii) Can you provide an up to date price for Hybrid External Fixator for tibia?
19-25.000 depending on where is the main procedure performed.
iv) How many physiotherapy sessions are required? Once, twice a day?
2-3 a week will be enough.
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Thanks a lot,Random Hero !
Have you already done a consultation with him ?
I will follow carefully your case since your starting height it is not very different from mine and since I live in Italy ;)
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RH, CLL will kill any chance of being competitive in Muay Thai. Your stamina will drop, your legs will be more sensitive to impact, and they'll feel heavier because your quads have to put in more work to move longer shins. Don't do it if muay Thai is still important to you.
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Thanks a lot,Random Hero !
Have you already done a consultation with him ?
I will follow carefully your case since your starting height it is not very different from mine and since I live in Italy ;)
No worries; we are all here to help each other :)
I'm going to set up a consultation as soon as my work schedule dictates hopefully in next two months.
Ah nice! I would have never had known you were Italian as you can write better than me (native English speaker)! Haha
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RH, CLL will kill any chance of being competitive in Muay Thai. Your stamina will drop, your legs will be more sensitive to impact, and they'll feel heavier because your quads have to put in more work to move longer shins. Don't do it if muay Thai is still important to you.
It would be an extremely proud moment to fight in the Thai stadiums at some point but I've passed my prime sadly so little point in perusing that avenue.
I'd just be happy with one or two amature bouts now and then but I am aware I will be at a disadvantage.
As long as I can still defend myself about and about on the street against yobs that's good enough for me.
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Anyone know how much the consultation cost is?
Looks like it's only 30 minutes long too judging by his website which is a bit odd.
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Round 200-300€. Send him a email and ask, he is a fair dude.
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Double post
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Round 200-300€. Send him a email and ask, he is a fair dude.
Tyvm; booked a date now in Milano but no mention of fee.
That price seems very reasonable Guichet was £300 but it lasted nearly 2 hours if I remember.
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What about internal femurs with pili? There are some experiences?
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I'm looking for the same thing.
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Good, its strange that noone know nothing.
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Yeah, it really is.
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Am I wrong or is doing CLL with the HEF only a purely external procedure? As in, LATN or LON are not available options. From the text, it seems obvious that it is, but it doesn't hurt to ask.
Also, I'm sure Pili or his assistant would reply to your inquiries about doing internal femurs under his care. Contact (http://drpiliortopedico.it/en/contattaci/) is provided here.
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He does also internal Nail with Stryde.
I have met at least 3 patients doing this method with Pili.
They looked quite pleased with this method but mobility looks better with HEF, especially at the beginning.
https://drpiliortopedico.it/en/allungamento-con-chiodo-endomidollare-allungabile/ (https://drpiliortopedico.it/en/allungamento-con-chiodo-endomidollare-allungabile/)
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Does anybody knows how much Pili charges for internals?
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Does anybody knows how much Pili charges for internals?
He charges:
20-22 k for HEF on tibia
48-50 k for Precice II
57-60 k for Stryde
Prices are in EURO
I had HEF procedure myself on tibia and got 8.3 cm
Now I am planning to do Stryde on my femurs to do another 6-8 cm
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Is his price that much for Stryde?
I thought he was closer to 50k euros.
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He quoted me as 55k-65k for Stryde.