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Author Topic: Jay7 - Internal Femurs - Dr. Guichet - 2010 - Quest for 7cm and a Learning Experience  (Read 96746 times)
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jay7
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« on: April 15, 2010, 01:02:14 PM »

I visited Dr.  Guichet several weeks ago.   It was interesting, and it was different from what I expected – so I think it will be interesting to provide some details about this experience to those who didn’t have the pleasure to meet him yet.

I posted some details allready here: www.makemetaller.org/index.php/topic,3085.msg36369.html#msg36369

And it seemed to be of some interest to others since I received a lot of questions; however, I think this wasn't the right place so I open a new chapter to share my experience with all who are intersted and are also looking into LL with Guichet or Betz soon.  

I also have a consultation with Dr.  Betz next week and I will also write about it with the same level of detail.  This might be of helpt to others to also make the right choice in this difficult comparison.

Getting an appointment with Dr.  Guichet
I sent him two emails to the email address that can be found in the FAQ’s here and the one on his website and never got any reply.  So I finally called on a Tuesday to the number provided on his website.  I asked the lady on the other side if she would speak English and collected my first “no” on this question.  Luckily my French isn’t that bad… It turned out that she was’t M.  Guichet’s secretary, she gave me another number I should call to make an appointment.  Under this number I only reached an answering machine, telling me of a third number, where I also only reached an answering machine. . .
 
I tried both numbers again the following day (Wednesday) and indeed – had Dr.  Guichets assistant on the line.  I got my second “no” on the question whether or not she would speak English – so I tried to fix my appointment in French.  
It turned out that Mr.  Guichet always has his consultations on Thursdays since she told me that he wouldn’t be there the coming week the first appointment she could offer me was two weeks later.  Since I am an inpatient person I asked how about tomorrow which she immediately refused, just to say “un moment” afterwards.  When she came back she offered me an appointment at 8:30am the following day.  

Getting to Marseille in one night
After checking my possibilities to get there by train through half Europe I agreed on 8:30am the next day.  There was a night-train going from Nancy to Marseille – arriving in Marseille at 6am in the morning and I decided do make my way to Nancy and get this trainimmediately (it was stil Wednesday morning).  
Since I couldn’t book this train online from the country I started my journey, I drove to the next French city at the border the same day and tried to buy my ticket there before I went on to Nancy.  What I got was the information that this night-train actually doesn’t exist…. !!! Although it was shown on the web! This was my first bad experience with SNCF (the French railway company) - it got worse whe I went back. . .  ;-)
Instead I was offered a ticket to Paris and suggested to take a train to Marseille from there the early morning the next day.  I would unfortunately arrive not before 10am at Guichet’s place this way.  Anyway, I had no other choice then that or going back. . .  
In Paris I had to take the metro to go from Garre de l’Est to Garre de Lyon.  After arriving there I took a room for Eur 84,- for one night and I called Dr.  Guichet’s answering machine and told it that I would be late the next day – hopping that they wouldn’t just send me away when I was late.  
Early next morning I took the train to Marseille.  In Marseille I quickly jumped in a taxi (EUR 39,- from main station to Guichet’s place, which is not that far.  I now avoid taxis in France!) and drove to Dr.  Guichet’s clinic.   It turned out to be some kind of small emergency clinic with some local doctors having their offices there.  

Waiting for the Master
I went to the second floor where some secretaries stood behind a desk, pointing in one direction when I asked for M.  Guichet.  
I went there and found a waiting area packed with toys and children.   No reception nor someone I could talk to.  
A bit surprised I went back to the ladies at the entrance and asked for Guichets reception – just to hear that there is none – one is supposed to take a place and wait.  

I did so – still surprised about all the children around – and waited.  More children arrived and I had to move and give them more space to access the toys.  After maybe 30 minutes I saw the first sign that I should indeed be near to a famous LL surgeon (and not totally wrong as I guessed in the meantime): A guy arrived.  Good looking, not tall but also not short.  I immediately realized his long femur.  He walked with two crutches, but after dropping them on the floor, he still was able to make some slow steps – completely without any support!
After he took a place a horde of more children arrived and we sat there for maybe one hour  - I started wondering whether or not I should try talking to the ladies at the entrance again.  From time to time one of the surrounding doors opened, women came out and asked one of the children to come in – I started to realize that this were other doctors who shared the waiting area (or I was in a child clinic).
After I really begun to worry the door to the very right suddenly opened and a guy who looked like the picture of M.  Guichet on his website came out! :-)

He asked the other guy how he was and also realized that I was waiting for him!
He came over to me, said hello and asked me if it would be ok if he would speak to the guy with crutches first.  I agreed.  Then he calmed his voice (in order for the children and parents around not to understand) and asked in French whether I come for one or both legs.  Both! I said.  He suggested me to speak to the other guy while waiting and asked him to come over to me and talk since he had to finish his appointment with another patient first.  Great!
The poor guy got up and humped over to me (I would have come to him but there was no place around him).  I got my third “no” on the question if he speaks any English, and started to really get surprised… Wasn’t this supposed to be a very international place?
The guy turned out to be French and even from Marseille, and just got from 164 to 172cm! He told me he planed to get another 0. 5cm and then would stop lengthening.  He also told me that he would be an exception – most patients he met were from all over the world and not local.  That was good to hear….  I got a very local impression up to that point.  He told me the international patients would mostly stay at the recommended residence in Marseille. . .  Sounds good! So there is a place to meet others.  

The guy was pretty cool, he was doing well and complained about nothing.  He told me that the first week was terrible; basically he wanted to stop the whole project after one week.  Thereafter, it constantly got better.  During the lengthening he didn’t experience much pain and he was able to take care of himself.  No wheelchair, no external help needed.  He was walking from pretty much the beginning of the treatment on!  Small distances without crutches, I found that very impressive!
He told me that he also went out sometimes, to the cinema or to get a drink with friends.  He also told me that one could have a sex-life during the treatment.  Basically, he seemed to have a normal life, apart from the fact that he walked very slowly (without crutches).  
After a while Dr.  Guichet came out again, the guy spoke a while to another guy Guichet introduced him to (the patient who was consulting with Guichet while we were waiting) and I waited alone for a while.  Finally both guys left and it was my turn!

Meeting a LL Legend
Guichet’s office was consistent with the waiting area (just without children;-): Simple but functional.  A laptop, two chairs, a table and another table for physical evaluation.  

Guichet is not a sales guy (More on that can be found in Jamees diary - I think Jamee made very good points and of course has much more experience with Dr. Guichet – read his diary if you want to find out details about Guichet, and also read growing diary with Betz – he met some Guichet patients and two of them had not-so-good things to say about him - some things which I can not confirm).  
Guichet is not the kind of super-charming-guy as I was told Betz is.  He rather comes through as a scientist.  Or as an ingeneer.  Basically he started the consultation with many questions.  It was the frist time that someone spoke English to me since I was in France. . .  This went quite a while, actually he asked pretty much everything you can imagine and he also spent a lot of time on evaluating my motivation.
Then he moved on to discuss possibilities and spoke about his techniques and nails.  He came through as someone who REALLY REALLY knows what he is talking about and who also knows that he knows.  
I must say I liked the scientific approach he took to this topic.  He always talked about risk percentages and studies.  And basically was not happy about the fact that others would rather market LL as a product than generate serious scientific statistics.
As I expected, he told me about why tibial lengthening is more risky and takes more time.  However, he also made some interesting points about the nails he constantly redesigns: He developed Albizzia nails specifically for the tibiae.  “Other teams” (guess who) just uses the Femur nail also for the tibiae (if a patient insist on tibial lengthening).  Guichet does not, therefore he didn’t do tibiae for a while (since he currently doesn’t have any more Tibiae nails).  
He currently developed the third generation of tibial nails and is waiting for it to be ready in about two month.  That was longer than I wanted to wait… But at that point I didn’t know about his preoperational requirements – I should learn that nail availability is the least problem soon….
Before I went to him I never really understood the difference between Allbizia and “G-Nail”, my understanding now is that there is not really a big difference.  He just more recently uses the new term “G-Nail” instead of Allbizia for the newer generation of nails.   But sometimes the documents his distributes also contain the term “Albizia” – so it’s not 100% consistent.
However, he probably uses a newer generation of his Femur nail than Betz does (assumption) and maybe also a slightly different material (can Betz patients also walk without crutches?).  I will clarify this with Betz next week.  
At one point he asked me to take my cloth off and started a series of checks.  I had to stretch, move, pose for pictures, got measured and so on… Actually I think he did it in great detail.  His comment was dry and short: “You have to do a lot if you want to do this”.  Although I was going to gym three times a week he just said “you don’t look like body builded, you have to do a lot”.  It turned out that lengthening with Guichet is basically like a sports camp: During the lengthening one has to do 2 hours of sports with a personal trainer (who also trains players of Marseill’s football club) every day!
Before the operation he wants me to basically do the same.  
However, he made convincing points why this is required.   And again, the scientist came through: According to his studies, it has an immense impact on how the body is able to cope with the LL procedure.  It actively helps to minimize complications and enable a quick and safe recovery after lengthening.   So, if his studies show such an effect over a large sample size of patients, I think it is natural for a good caring Dr.  to request such a preparation from all his patients – even if it hurts his revenues (since some patients might just go somewhere where less preparation is required).  I however also got the impression that there is “negotiation possible” – which I think is also good since one has to consider the specific circumstances each patient is in.  

Against the end of the discussion, it became a bit like applying for a job.  He told me about what I need to accomplish before he accepts me and that is more than I can imagine ANY other doctors would ever ask for (at least from what I learned here).  
I knew about the psychological evaluation.  But that’s not all… He wants
-   a personal letter of motivation (three pages)
-   Cybex testing now and after the pre-training phase to proof the improvement
-   Talk to my personal trainer to give him instructions (yes, you are supposed to hire a personal trainer!)
-   The psychologic evaluation
-   A second consultation to check if the motivation is constant
-   …

Indeed, it reminded me of applying for grad school. . .  But fo an ivy-league school! ;-)

I also told him about LON (just in case my Tibiae bone would be too small to fit the nail) and he made some interesting points why he would not really consider it:
-   He said that there would be scientific proof that whoever wears an external fixator (metal going through muscles) for more than two months the muscles will never recover to their previous condition (which might not be such a big issue for tibiae since the muscles are rarely needed – but why accept it if you can avoid it)
-   Complication rates are always and much higher than many doctors state, what many publish are basically marketing announcements
-   Finally, he compared external devices with buying a horse instead of a car today

Well, of course I know that every doctor sells his method as the best one.  However, the interesting thing about Guichet is that I did not at all have the feeling he wanted to sell me anything.  He rather wanted me to convince him to do the operation.  
Maybe he will not be as charming as Betz during the project, but I think I will be with someone who is really doing whatever possible to minimize every potential risk.  If he does that because he cares about you or because he wants to improve the results of his studies. . .  who really cares.  Minimizing risks is what mainly counts to me – for this kind of cosmetic operation.  

Another thing he mentioned is a specific medication that is injected into the leg to support soft-tissue and bone formation.  I don’t exactly know what it is… Vitamins…? Whatever, he said that would be unique.  

Well, I know now that Dr.  Guichet is an extremely experienced and scientific surgeon, but I also understand why people say he is unorganized.  Maybe he is not really unorginzed (I can't judge), but he clearly lacks some support staff.  And makes him appear unorganized in the end.  
I paid the money to him in cash during the consultation - maybe this is normal in France? I would guess in most European countries this is handled by assistants.  

This lack of support staff should seriously be considered before having an operation I think.  Anyways, reading Jamees diary truly insipred me and the guy convincned me in terms of experience and caring about outcome - so I will see how it goes from here and how quickly I in the end can get a surgery date fixed.  

I will see Betz next week and continue with my daily two hours of training and see!

I will keep you posted on the experience with Betz and please also check this before asking questions:

www.makemetaller.org/index.php/topic,3085.msg36369.html#msg36369

I already answered a lot of question there.  

Would be nice to get in touch with someone who also goes to Guichet or Betz in May/June to team up! Shoot me a PM!
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Elkhi
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« Reply #1 on: April 15, 2010, 01:25:30 PM »

Thank you jay7... exactly what i was looking for  Grin . hope it works out for you
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eric_cartman
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« Reply #2 on: April 15, 2010, 06:02:49 PM »

Very insightful Jay, Thanks for sharing with us! Looking forward to hear your experience with Betz.
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« Reply #3 on: April 15, 2010, 11:32:17 PM »

Hey Jay,

thanks so much for you incredibly detailed analysis of your Guichet visit. I'm really looking forward to your Betz report as a comparison. Could you give us a bit more insight into what kind of pre-op training is required? Specifically --weights? And what types of exercises: squats? leg-extension? hamstring curls? And what type of stretching? Cardio also?(i.e. running or biking?). What are the fitness, flexibility, stretching benchmarks one is supposed to hit. It would be wonderful for those of us considering Guichet in the future to be able to get a headstart on some of this. Thanks so much!

K
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skidude
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« Reply #4 on: April 16, 2010, 03:01:40 AM »

Excellent summary jay7!  I can't wait to hear about how your consultation with Betz compares.
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jay7
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« Reply #5 on: April 16, 2010, 04:17:19 PM »

@Kidrobot: Guichet wants you to build muscles, so basic muscle training in the gym 2 - 3 sets, 8 - 12 repetitons... weights, machines, whatever suits you best! He doesn't give you detailed instructions - he wants you to get a private trainer and then talk to him.

However, as I said, it's not that special... whatever makes your legs build muscles is good... Plus a lot of stretching to make them flexible.

He also wants the upper body to develop muslces. You loose about 40% of your muscles during lengthening, so if you boost them before by about 60% you end up having almost the same amount of muslces as before when you're done with your LL. That's the idea behind....

He also mentioned that strong abdominas are important (I forgot why) and strong arms to handle the crutches.
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Tomas170cm
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« Reply #6 on: April 16, 2010, 04:53:05 PM »

jay7:

Quote
"I immediately realized his long femur."
Interesting. How did you notice this? Was he wearing shorts? Was he looking freaky on first casual sight?

 
Quote
"He rather comes through as a scientist.  Or as an ingeneer.  Basically he started the consultation with many questions..."
"At one point he asked me to take my cloth off and started a series of checks.  I had to stretch, move, pose for pictures, got measured and so on… Actually I think he did it in great detail."
What is his stance on proportions? What does he offer on that part, in term of knowledge, statistics, opinion etc?
Would he say no to anyone if he thought it would make them more freaky than taller (if perhaps the person had short arms or torso to start with). Does he go after some kind of mold (vitruvian man to calculate) for proportions? Betz does simulated digital images of how you kinda will look after LL (would LOVE to see yours when you visit Betz  Wink), does Guichet offer anything similar?


Quote
"Cybex"
What is this so called cybex test? I think it has been mentioned before.


Quote
"-   He said that there would be scientific proof that whoever wears an external fixator (metal going through muscles) for more than two months the muscles will never recover to their previous condition (which might not be such a big issue for tibiae since the muscles are rarely needed – but why accept it if you can avoid it)"
WOW! That is a revelation. I wonder what former LL patients having done external has to say about this?
But what do you mean "tibiae muscles are rarely needed"?   
Also, what do you mean by "there WOULD be"? Don't you mean "there is"? I'm not trying to be rude, I just wonder if there is a report now or will be that hasn't been published yet? 
 
 
Quote
"Finally, he compared external devices with buying a horse instead of a car today"
Cheesy

Quote
"Another thing he mentioned is a specific medication that is injected into the leg to support soft-tissue and bone formation.  I don’t exactly know what it is… Vitamins…? Whatever, he said that would be unique."
That is very interesting. But the impression I have gotten from Guichet (I mean no disrespect to the guy, haven't met him, but seems to be a good guy and great doctor) from reading on this site is that he likes to stroke his own ego too much sometimes. "injecting some secret medicine no one knows about or uses and will make everything better" - c'mon. But I hope it's true. And would love to hear about it when/if you decide to go with Guichet.

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jay7
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« Reply #7 on: April 16, 2010, 07:23:29 PM »

jay7:
Interesting. How did you notice this? Was he wearing shorts? Was he looking freaky on first casual sight?

No, long pants. I immediately noticed because they just looked unnaturally looong. But if I wouldn't have been in the waiting room of an LL doc, if the guy wouldn't have been on scrutches and if I wouldn't have looked for it... I probably wouldn't have noticed since I usually don't care much about proportions of other guys (at least when not thinking about it every day as I do right now... Wink
The same way I would probably have noticed a long Tibiae... The guy went from 164 to 172 on his femur, so of course this becomes visible when he sits down.

What is his stance on proportions? What does he offer on that part, in term of knowledge, statistics, opinion etc?
Would he say no to anyone if he thought it would make them more freaky than taller (if perhaps the person had short arms or torso to start with). Does he go after some kind of mold (vitruvian man to calculate) for proportions? Betz does simulated digital images of how you kinda will look after LL (would LOVE to see yours when you visit Betz  Wink), does Guichet offer anything similar?

He shows some pictures of former patients, says it depends on how you train your muscles afterwards, and asks you to prepare mockups from front, side, back and in different pants. He is not doing them for you as Betz appearently does. I think he will refuse you if he thinks you are lacking motivation or if you have certain risk factors, I don't think he judges the aestethic side of it too much. But that is just an impression - I don't know yet.

What is this so called cybex test? I think it has been mentioned before.

Google "cybex test" or "cybex 6000" and you will see a machine that tests your physical ability...

WOW! That is a revelation. I wonder what former LL patients having done external has to say about this?
But what do you mean "tibiae muscles are rarely needed"?   
Also, what do you mean by "there WOULD be"? Don't you mean "there is"? I'm not trying to be rude, I just wonder if there is a report now or will be that hasn't been published yet? 
I have no idea where what is published since I didn't see it; he speaks a lot about studies and I bet you won't ask him to proof it all the time. It has some intuitive logic to me: Besides the scars on your skin there remain scars inside your muscles and so they will never 100% get back to how they were before. But if you are not a professional sportsperson this is unlikely to get noticed I assume. And from what I read here it doesn't seem to be a big deal. "Rarely needed" was maybe exagerated, I ment in everyday life you are not using muscles in your lower leg to the same amount as those in your thigh.


   Cheesy
That is very interesting. But the impression I have gotten from Guichet (I mean no disrespect to the guy, haven't met him, but seems to be a good guy and great doctor) from reading on this site is that he likes to stroke his own ego too much sometimes. "injecting some secret medicine no one knows about or uses and will make everything better" - c'mon. But I hope it's true. And would love to hear about it when/if you decide to go with Guichet.
Well, I don't think he was lying to me... Also, I didn't mean to imply that he sold it as some "secret medicine that makes everything better". It was just that the whole consultation took three hours and there was simply not enough time to speak about everything in detail.... He mentioned he uses injection in the leg to accelerate consolidation - and that they would be the only ones doing this to his knowledge. That's all. Sure, that was one of the few selling points in this conversation... You might be right about your assesment of him  stroking his ego sometimes - but I think even a consultation is hardly enough to really judge that and who cares... LL docs are also only humans! ;-)
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nachx
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« Reply #8 on: April 25, 2010, 10:26:37 AM »

Thank you for this report!

Do you know if you are required by Dr. Guichet to stay the whole lengthening phase in Marseille?

Have you already had the consultation with Dr. Betz?
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jay7
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« Reply #9 on: April 25, 2010, 11:23:31 PM »

Hey there!

Stay in Marseille: Not required, but recommended. Just as with Betz...

Yes, I met Betz last week and staid a whole day there. Just returned to my country yesterday - gonna write a report here coming week... Will be long and detailed!

Jay

PS: One comment in advance: This is a tough choice... I like them both. Each one for other reasons.
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jay7
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« Reply #10 on: April 29, 2010, 11:15:07 PM »

Meeting Dr. Betz

Getting an appointment
It was literally exactly the same as with Dr. Guichet. Two emails first, no reply… Then waiting and finally calling. Several times until finally someone took the phone (I later learned it was his wife) and made an appointment for me. I got an appointment within two weeks from the day I called and was even already told about the availability of surgery slots (“we might have something against the end of May…”) – THIS was different from getting an appointment with Dr. Guichet and set the tone for the things to come.

Getting there…
Having learned my lesions from the appointment with Dr. Guichet, I didn’t count on any night trains this time. I had my appointment at 10:30am and I decided that I had to be in Germany already the day before if I wanted to make it in time. So I visited some friends who life in a town, which, at least on the map, is not that far away from “Lebach” – Betz’s place.
I figured out that I could catch a connection via train at 7am in the morning to get to Betz until 11am.  Unfortunately, it wasn’t one train but fife subsequent trains, a connection that actually required me to change trains every half an hour – fife times overall… highly risky if one of the trains would be late as I learned before in France!
It however went well, trains in Germany are generally in time – in fact they really hit the minutes there!
The closer I came to Betz’ place, the more I realized that he is living in deepest country-side Germany. I drove through fields and woods, admired a lot of grass, cows and mountains and felt like in Heidiland – (if this expression is known in the anglo-sacon world…).
When I switched trains for my last connection, I mistakenly took the wrong train and had to learn when I was in it that it went to “Sarbruck” – the next big city from Betz place – instead of Lebach.
I tried to call Betz to ask if it would matter being an hour late (remembering that I had to wait for hours at Guichet’s place – so why hurry if you are anyways only sitting around later…?) but couldn’t reach anyone there.
In order to limit my unconfirmed lateness, I just took a taxi from Sarbruck and had it drive me to Lembach. This went rather quick, but came with an incredible price of 72 Euros.

The taxi driver dropped me off in front of the hospital in which Betz has his office and also conducts his operations. It literally was in the middle of nowhere. Not “in” a small countryside city in Germany, but actually outside this city; surrounded by fields and forest.  Beautiful (especially when the weather is as great as it was on this day) but also kind of lonely – in the middle of nowhere…
I went in and asked for Betz, not really sure I was really in the right place since I had read different things about an own kind of small house  (“The Betz Institute”) on this site. In the hospital they told me to leave the main building again, go to the right and then take some stairs outside on the left that would bring me up to a small bungalow, where I found find a “Ms. Muller” that could help me on my way to Betz.
All right! I indeed found the small bungalow, scanned it for signs like “Betz Insitute” or whatever since it really didn’t look like a place where a doctor was working, but there was absolutely nothing. A completely neutral grey building. I entered through a door on one side of the container-like buidling, expecting to see some toilets or a storage-room or whatever, but no! A nice smiling brunette girl sitting behind a counter, the kind of things you expect when entering a doctors office, was waiting for me! :-)

Dr. Betz Office
I asked her if I would be closer to Dr. Betz and she nodded. I finally really found it! ☺
She asked me to wait and pointed out that it could actually take very long (preventing me from excusing too much for being late myself). There was one other guy waiting in the waiting area, so I asked her for a place to have lunch at.
She mentioned that there would be Bistro at the Hospital or I could walk down the street ten minutes to arrive at a MacDonalds… I did the last and had lunch.
I realized that there probably was a German army base around since the MacDonalds was crowded with German soldiers. Not necessarily the nicest lunch company… Germans are really tall by the way! I also noticed that German girls seem to have nicely grown fronts on average. Whoever wants to live here, needs even more LL.

Meeting some patients
When I went back the picture was still the same: The same guy was still waiting in the waiting area. I tried to chat a bit with Betz’s assistant and she turned out to be really nice. I learned that the two guys who were working as Betz assistants before (two former patients) had left Betz and she started her job recently to replace them. Interesting! Actually I was a bit disappointed since I had read about these two assistants a lot before, but anyway, she was also really very nice. She was a German girl, born and raised in this small German town.
I asked her if I could use the time and maybe see some Betz patients, and she took me over to the hospital. ”Currently”, she said, there are two patients. “An Amercian guy and a German lady”. We decided to meet the – recently operated – America guy first. He was a young looking, well worked-out cool chap and it was a great pleasure for me to finally speak English with someone who did not suffer from a strong German accent. We started to chat until Betz assistant had to return to her work, she told me the German lady’s room number  (to also meet her afterwards) and went off.
Let’s call the guy Tom to protect his privacy. I liked Tom. I don’t want to tell anything about him here, but I learned one thing: People have LL for various reasons. Imagine you marry your wife, being a tad taller than her (when she is at the end of her teenage years and you are in your mid twenties) and three years later you find yourself having a wife who is taller than you because she had a late growth-spurt! Well, even if she doesn’t mind, you might not feel that great about it and decide to just get two inches to turn this around again… No need to go further than that. I quite liked this motivational background;-)!
The guy had his surgery just a couple of days ago and was surprised not to experience any pain. He hadn’t start clicking yet. After chatting a while with him I moved on to also see the German lady. After Tom made me feeling relaxed about the pain issue, she managed to destroy this pretty quickly again. “The pain is worse than I expected”, she told me, “I even cried today”. However, when she spoke to me she was pain free.  The pain came to her when she moved, and if she didn’t move but just laid on her back it got better but was having enormous discomfort. One impression I also had through these conversations was that it is extremely important to have some interesting company or something to do. It gives you some distraction, makes you laugh and everything is easier to bear. The lady also complained about insomnia, she almost couldn’t sleep at all….
Finally, I went back to Betz office; a grey haired guy went into the office just behind me, and it turned out that he was Dr. Betz! He was exactly the kind of nice-guy I had expected – very friendly and charismatic. He and his assistant sent me off to the hospital to get some Xrays first.
When I came back with my Xrays, the guy who was waiting there since the early morning was still sitting there and two more people – a mother and her son – Germans as it turned out – were also waiting there now.
I waited for about an hour (the Germans went off to get some Xrays) and finally got my slot after the guy who sat there all day (just to see Betz for a half an hour meeting before his operation next week)! The assistant brought me into the room and left me there saying “I will join you soon” – I was wondering what for? It should soon be explained…

My Consultation
Betz started off completely different from Guichet. Where Guichet started with a lot of questions about me, my past, my motivation and so on, Betz started without too much structure. He quickly realized that I was a very informed patient with good research background (I told him that I already visited two other LL Docs before). So he started talking about some insider topics (nail distributors etc.…) – up to a point where it became a bit to much off-topic. But it was ok – he also went back and at one point started getting into a structure that was defined on a sheet of paper in front of him.
What I realized (comparing to Dr. Guichet) is that we didn’t speak about my motivation at all. I also don’t know if he left it out because I told him that I met two LL docs already (so that he correctly assumed I would be tired to speak about my motivation) or if he generally doesn’t cover this point? Guichet pushed pretty far with his questions (“How do you see yourself, now and after LL? Why do you wan it? How do you life your life… How many night per week do you go out?...”) and I think it might be a good idea to discuss these questions since it makes you understand your patient better.
The same applies to risks. Apart from a quick “read the chapter about risks on the info sheet” there was nothing he mentioned about risks. Guichet made me feel really consider twice what I am doing, with Betz I felt like talking about getting an every-day service. Again, I did not have the feeling he did this on purpose, he either figured out that I am informed enough to know about it, or/and probably is also tired to always talk about the same stuff (especially when it always works out so well for so many patients).
Anyway, I was happy not to go through this again! So it was fine. 
Betz finally came to the measurement part, and it turned out that this was the part he needed his assistant for. I had to take out my cloths (in front of this nice young girl) and what then came was in many points similar to Guichet’s examination: Betz took my wingspan (180) measured my size (that was funny, he measured me with 170. When I complained “it’s strange that Dr. Guichet found me being 174.1cm” he was surprised first, said “No”. Then looked at the measurement scale again and said “Ups, ah, yes, sorry, It is 175, exactly”.)
That was in the late afternoon by the way, Guichet measured me a tad less in the early afternoon. Strange…

Then, he checked my flexibility; similar to Guichet’s examination, I had to get on a table and he moved my legs around. However, this part went much quicker than at Guichet’s place, and Betz didn’t take the maximum stretching angles down as Guichet did. Guichet spent maybe 20 minutes on getting all these measurements on and off the table, at Betz place I was just on the table for maybe 2, 3 minutes.
Betz also didn’t measure my sitting height (Guichet on the other hand didn’t measure wingspan). Betz told me that my flexibility would be very good and I would be in a good condition for the operation (whereas Guichet said repeatedly “you have to do a lot if you wan this operation” – or “you can maybe get away with 4cm with your current flexibility, not more”.)
In fact Betz said I would be the ideal candidate for 7cm on the femur... Having a wingspan 5cm over my height and a Tibae of about 82% of the Femur.
I spoke to Betz about these discrepancies between him and Guichet’s approach (and I must say I pretty much like that about Betz, you can really speak about everything with him). Basically, he doesn’t see physical fitness as such a relevant thing as Guichet does. Sure, flexibility is good – he also gives you some instructions for stretching exercises – but there are no requirements at all as Guichet has them (personal trainer, Cybex, test, letter of motivation, building muscles, etc… nothing comparable with Betz).
Betz and Guichet have a good relationship in general, but no regular contact. So he just couldn’t judge Guichet’s praxis. He said Guichet would be a good Dr., he made clear that he really has a good opinion of him, but obviously didn’t want to speak to much about the discrepancies between both their approaches (which I can understand).
One other thing I noticed, is that Betz explained me the modifications he made at the nail, and why he made them. He exchanged the location of one screw, which he found to repeatedly cause patients troubles (since it rubbed the other bones at the knee somehow…). He told me that he also recommended Guichet to modify his nails accordingly when he met him last time, but Guichet didn’t seem to be interested.
Another interesting point is that I asked him about his Tibiael nail, and he admitted hat he used the same nail for the Tibiae, but he exchanged the locking mechanism (Guichet didn’t find using the same nail for both segments a good idea at all – read above). Betz then doubted that Guichet’s new Tibial nail would actually become reality.. (“The new nail? Ah, it is “available soon” since two years!”)

One thing Guichet did not do but Betz did is to provide some mockup pictures. He took photos (Guichet did that too) and then asked his assistant to work on them. She went out and came back with two printouts - one original and one with 7cm on my Femurs. Betz and I found the 7cm on my Femurs looking pretty good, and his assistant (I needed the opinion of  girl!) very much agreed that it looks great when I asked her.

Against the end of the consultation, Betz had the idea to show me how some of his patients actually conduct the famous "clicking" excercice. I liked this suggestion and we left the consultation room together...

Clicking with some of the other patients
Coming soon…

Getting back
Coming soon…

The Choice
Coming soon…
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skidude
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« Reply #11 on: April 29, 2010, 11:56:43 PM »

Another excellent summary.  I can't wait for the conclusion!
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Tomas170cm
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« Reply #12 on: April 30, 2010, 01:54:21 AM »

Jay, thank you for these informative logs. They are very much appreciated! It is very good to know beforehand what to expect from these consultations. Nowhere has these consultations been so extensively covered as you have done here. So I thank you for that. One thing that continually surprises me is the lack of debriefing potential patients get from their LL surgeons. Without this site, no one would really be aware of what one is getting himself or herself in to. And the LL doctors don't put much effort in to it. They assume and expect you know or simply don't care, I find that worrisome. Don't get me wrong, you should prepare and educate yourself about the procedure to the best of your abilities, it is your responsibility, but how can one ask the right questions when you lack expertise in the field...

"Whoever wants to live here, needs even more LL."
HAHA  Grin

"Again, I did not have the feeling he did this on purpose"
What I have gathered from reading other Alibizzia diaries, this matches exactly the impression I have gotten about Betz. So... on purpose I believe! =)

"or/and probably is also tired to always talk about the same stuff (especially when it always works out so well for so many patients)"
If that was true, it would be careless, irresponsible, naive and stupid of the doctor. It would be like no doctor would go through risks and complications because HE has gone through it many times, he doesn't want to bother anymore cause he doesn't have many patients that suffer complications. No doctor should ever assume anything. All patients deserve to be debriefed about risks and complications and whatnot, despite what the patient says. It is not exactly like taking your driving license exam again after failing the first time and now you have to sit there and listen to the same "dos" and "donts", is it Cheesy.

"I had to take out my cloths (in front of this nice young girl)"
HAHA Smiley Completely naked or in underwear?

"Betz also didn’t measure my sitting height (Guichet on the other hand didn’t measure wingspan)"
INTERESTING! Either the respective doctors have different priorities compared to each other, but always the same priorities, or they like to mix it up Tongue Either way, it would have been interesting if you had brought it up, what would their responses have been? Did Guichet perhaps forget? Since many talk and talk about that he is such a thorough scientist but at the same so unorganized.

"Having a wingspan 5cm over my height and a Tibae of about 82% of the Femur."
Ah! Did you miss a part of the experience to document? When, how and where did he do this tibia calculation? What does it mean exactly? Were your tibias [unusually] long?
Also, did he measure armlength? Cause wingspan doesn't necessarily mean longer arms. You can just have that excessive 5 cm in shoulder width alone.

"He told me that he also recommended Guichet to modify his nails accordingly when he met him last time, but Guichet didn’t seem to be interested."
HAHAH! Ouch Smiley

"Betz then doubted that Guichet’s new Tibial nail would actually become reality.. (“The new nail? Ah, it is “available soon” since two years!”)"
Mjau Smiley They swing some mild jabs towards each other every now and then.  This has actually been mentioned in someone else's diary (or two) before.
Hence why my impression of Guichet is that he has a bit of an ego (of course, which doctor, or person, hasn't?).

"Betz and I found the 7cm on my Femurs looking pretty good, and his assistant (I needed the opinion of  girl!) very much agreed that it looks great when I asked her"
I hope you are not putting too much weight in her opinion? Nothing against the girl, but obviously she can not be objective or give an objective opinion. Since you said you read some diaries here about Betz's assistants, then you know they are trying to sell you something here. I would suggest throwing up a pic on the proportions section for people to comment on.
Btw, would love to see one of those Betz mock-ups (of course you distort your face), I have always wondered how they look. 


Tomas
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Elkhi
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« Reply #13 on: April 30, 2010, 08:28:12 AM »

I think with Guichet there is a lot more emphasis on returning to full functionality... in some studies about albizzia, they mentioned in particular the knee angle flexion (if that's the word for it lol) and how that's affected by lengthening and also mentioned that external fixators have a negative affect on this. I think that's why he took so many measurements. That is one thing I quite like about Guichet. But

By any chance did guichet mention about the time frame for lengthening... I understand that jamee said they clicked 21 times a day! that's like 1.4mm... that goes against illizarov's standard of 1mm (maybe the difference is due to the different methods). You'd be done with 7 cm of lengthening in just under 2 months. Did he give any information on this?

Thanks again jay7...
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jay7
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« Reply #14 on: April 30, 2010, 09:26:29 AM »

"I had to take out my cloths (in front of this nice young girl)"
HAHA Smiley Completely naked or in underwear?

Underwear, having her there made it a bit more exciting compared to the dry and very technical same situation at Guichet's place.. ;-)

"Having a wingspan 5cm over my height and a Tibae of about 82% of the Femur."
Ah! Did you miss a part of the experience to document? When, how and where did he do this tibia calculation? What does it mean exactly? Were your tibias [unusually] long?
Also, did he measure armlength? Cause wingspan doesn't necessarily mean longer arms. You can just have that excessive 5 cm in shoulder width alone.
No armlength meassurement. Tibiae/Femur ratio is unfortunately normal for me (no long Tibea). Allthough, according to Betz/Guichet's magic 80% rule I would have a slightly above-average Tibae, according to the other 52:56 range of F:T ratios that other docs use and can be found in FAQ's here, I would have a slightly long Femur. Guichet didn't even know about this 52:56 thing (or didn't want to hear about it). So I didn't even mention it to Betz. They have their 80% rule; fine. I feel that the empiricial average is probably more like 82%, so having a 80% rule makes it easier to recommend patients to go for Femur... ;-)

Mjau Smiley They swing some mild jabs towards each other every now and then.  This has actually been mentioned in someone else's diary (or two) before.
Hehe... indeed.

"Betz and I found the 7cm on my Femurs looking pretty good, and his assistant (I needed the opinion of  girl!) very much agreed that it looks great when I asked her"
I hope you are not putting too much weight in her opinion? Nothing against the girl, but obviously she can not be objective or give an objective opinion. Since you said you read some diaries here about Betz's assistants, then you know they are trying to sell you something here. I would suggest throwing up a pic on the proportions section for people to comment on.

Btw, would love to see one of those Betz mock-ups (of course you distort your face), I have always wondered how they look. 

Sure she is biased. However, she is only with Betz for a short time and I think she was honest. Anyway, allready had my mocks in the prop section here and YOU recommended Femur as well btw.. Wink
Why I mention that she is with Betz just for a short time? My feeling is that if you get used to all these long femurs around you you find them normal after a while. And then you tell everyone that it looks good, no matter how much out of proportion it is. You just adopt to your envrionemt... Might not even be a sales tactic... Just a preference they develop over time.
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jay7
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« Reply #15 on: April 30, 2010, 09:35:32 AM »

I think with Guichet there is a lot more emphasis on returning to full functionality... in some studies about albizzia, they mentioned in particular the knee angle flexion (if that's the word for it lol) and how that's affected by lengthening and also mentioned that external fixators have a negative affect on this. I think that's why he took so many measurements. That is one thing I quite like about Guichet. But
Elkhi, what's this lonely "but" standing for?Huh? ;-)

By any chance did guichet mention about the time frame for lengthening... I understand that jamee said they clicked 21 times a day! that's like 1.4mm... that goes against illizarov's standard of 1mm (maybe the difference is due to the different methods). You'd be done with 7 cm of lengthening in just under 2 months. Did he give any information on this?.

Both go 1mm per day on average. So you get 6cm in two month.
Betz goes of with 1 klick first day, 2 second day and so on ("so you can get slowly used to this"). Guichet starts with 21 clicks in the beginning and then goes down. In the end they both have the same average rates...

I also found this interesting since it again refelcts the different styles in handling this procedure: Feelgood factor ("so you don't get scared of clicking") vs. scientific argumentation ("In the beginning your body has more to give, so you can click more").

But probably they both are flexible enought to alter this for your case if you ask them for it...
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Elkhi
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« Reply #16 on: April 30, 2010, 12:44:05 PM »

lol pardon the but dude.... i 4got it was there haha.
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Kidrobot
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« Reply #17 on: April 30, 2010, 04:20:58 PM »

Jay,

once again an absolute pleasure to read(i love all your anecdotal details and your impressions --if you had a daily blog about your life, i would follow it in a heartbeat!) --but also tremendously informative. I must say, reading these two comparisons --and it's almost a gut reaction --I would personally go with Guichet --even though it seems that Betz is far more available and has a greater support system(e.g. if you were staying in Lebach, during the procedure). It's a tough one!!

Best of luck in your decision --I look foward to reading much, much more from you!

cheers,

K
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Tomas170cm
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« Reply #18 on: April 30, 2010, 09:38:43 PM »

"Anyway, allready had my mocks in the prop section here and YOU recommended Femur as well btw.."
OH! Hehe, ok Smiley Then I guess you are already sorted out Tongue

"Why I mention that she is with Betz just for a short time? My feeling is that if you get used to all these long femurs around you you find them normal after a while. And then you tell everyone that it looks good, no matter how much out of proportion it is. You just adopt to your envrionemt... Might not even be a sales tactic... Just a preference they develop over time."
Pretty logical actually. Smart guy.
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nachx
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« Reply #19 on: May 03, 2010, 10:32:14 PM »

This exactly reminds me my consultation with Dr. Betz. Thank you!

 Did you visited the Park Hotel? It seems a nice place to continue lengthening after you're discharged from the hospital.
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