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If you have in the textured implants that have been recalled due to an increased risk of Non hodgkin's lymphoma, would you leave them in until you potentially develop symptoms like the FDA recommends or would you have them removed immediately?

This is a hot button issue and you will find some disagreement among plastic surgeons, but our thought leaders believe we should follow the advice of the FDA.I am able to give you a forty year perspective.Let’s look at this more closely. Textured implants have been used in some form beginning in the late 1970’s. They were saline devices covered partially with polyurethane foam. they were developed by dr Frank Ashley chief of plastic surgery at UCLA with help from Roger Salisbury a former Dow engineer and silicone expert. The purpose of the foam was to break up the smooth layer of scar or capsule that forms around any smooth device. Collagen is linear in these capsules and have a tendency to contract over time. These early devices were never popular until the mid 80’s when Mr Salisbury developed unique devices called the Meme and the Replicon. These were the first shaped silicone gel devices covered in polyurethane foam and remarkably offered a silicone gel interior that was considerably more cohesive than the existing oily silicone gel available. They were widely popular, because of the lack of capsular contracture and the more natural shapes that were now possible. In an effort to simulate the polyurethane cover, another major player in the implant market was Don McGhan another former Dow engineer. To bypass the patented polyurethane, he mimicked the textured surface by using a lost salt technique. Again these were very popular and the majority of plastic surgeons were moving toward a textured surface by the early 1990’s.By 1992 however, there was a growing concern for all silicone breast implants. Dr David Kessler then chief of the FDA determined that a moratorium would be stay in effect until the companies could prove the safety of silicone gel. They left saline implants on the market. The concern was not ALCL (anaplastic large cell lymphoma) because a case had not yet surfaced. The concern was women’s health in general as many were reporting disease states that occurred after the placement of implants. It was then called Human Adjuvant Disease. Interestingly it was described with all silicone and saline devices but the FDA allowed the continued use of saline—smooth or textured. The illnesses being reported were collagen vascular diseases such as scleroderma, rheumatoid arthritis, Sjogren’s syndrome, chronic fatigue syndrome, and hair loss for the most part.As part of that decision in 1992, polyurethane foam was no longer permitted due to a potential carcinogen from its surface. Polyurethane foam however was still being used in Europe and Asia until quite recently. Polyurethane carries a considerably higher risk of ALCL than the re-called Biocell surface from Allergan. Polyurethane has not been available since 1992 in the US and unless your implants are more than 27 years old it is highly unlikely that they are.By the late 1990’s the first few cases of ALCL were reported but no one associated the disease with the textured surface until retrospective analysis. The FDA and the NIH were charged with determining the safety of breast implants. 10’s of thousands of patients were enlisted in studies at many well respected institutions across the US.After 15 years of studies and meta analyses, the FDA in 2006 came to the conclusion that there was no cause and effect relationship. Women are the victims of all of the reported illnesses by far and women are the recipients of breast implants. In other words: True, true and unrelated. This gave the green light for the manufacturers to reintroduce silicone gel textured and untextured into the market. There is an important phenomenon that occurred. During that 15 years a whole generation of surgeons were using smooth saline devices because the feel of textured saline was too stiff. So, when silicone came back, the next generation opted for smooth rather than textured —-in the U.S.The rest of the world did not follow suit in 1992. Don McGhan with the help of a very savvy plastic surgeon, Dr John Tebbets and later Patrick Maxwell, took his factory to Ireland (no unions, business friendly) and began developing a textured highly cohesive implants in a variety of shapes and sizes. These Biocell surface (lost salt) implants had the advantage of a highly cohesive core working from Roger Salisbury’s playbook as after 1992 Mr McGhan had purchased the patent for the highly cohesive gel. They began use in 1993 in Europe and Asia. Polyurethane was also being used by several other companies including Silimed from Brazil. Few cases of ALCL popped up. The McGhan implants were given the title 410’s which is the style not the size.By 2015 it was coming to our attention that more cases of ALCL were being reported primarily in Australia and some in the US and France. Interestingly at that time there were no cases reported in Asia where these devices were extremely popular. There seemed to be pockets of ALCL from certain locations and not others. This has been attributed to several factors, but the current wisdom is that it is not the surface per se, but rather the biofilm that can hide in this moon crater like surface. The culprit some researchers believe is a gram negative organism, Ralstonia Picketsii. Questions arose as to the irrigation that was recommended by the manufacturers in their instruction for use manuals ( the IFU’s). Due to faulty research, in 1998 the FDA requested that all implant manufacturers prohibit povidone iodine as an irrigant, despite years of experience showing reduced capsular contracture after Betadine rinsing of the pocket (Dr Bpoyd Burkhardt). The concern was that the iodine could be harmful to the integrity of an implant shell. This organism, I am told, will not be reduced by the commonly used triple antibiotic solution (cefazolin, gentamicin and bacitracin). Although logical and deemed effective in some studies, its effectiveness has come under scrutiny of late. Povidone iodine is now used again and the promise is better control of the dreaded biofilms that adhere to the implant shells. In addition, the introduction of the implant was generally directly through the skin incision where the implant would come in contact with the body’s normal flora that could encourage capsular contracture for many years. A huge development a decade ago saw the introduction of a sterile polyethylene funnel known commonly as the Keller Funnel developed by a very clever plasticic surgeon, Gregory Keller. This permits the implant to be extruded directly into the pocket with no contact with the skin breast tissue for the most part.The data is yet to be sorted out in this highly controversial subject. Will povidone iodine or more recently hypochlorite solutions eliminate this risk ALCL? Has the widespread use of the funnel decreased the incidence? Unanswered questions.The perspective I bring is forty years of doing breast augmentation. I have seen all of the problems that have developed from five generations of silicone formulae and design. The textured devices were a major breakthrough in the technology in my opinion. Whether they decrease capsular contracture or not is still debatable but my experience is that they do fulfill this promise. But more importantly they are more stable. By this I mean smooth , round implants (if smooth that means always round because shaped and smooth will flip all over) tend to create problems over time— stretch deformities that cause bottoming out of the implant, lateral displacement far beyond the dissected pocket and more rippling ( although that has been recently addresses with over filled implants but it remains to be seen how they perform in various body types). Textured also brings the advantage of shape. For a woman with scant breast tissue, the appearance of a shaped implant is unbeatable. For women with more breast tissue volume than the implant, it matters little whether they are shaped or round.I would hate to throw the baby out with the bath water. Textured surfaces are here to stay I predict, but they will be modified in coarseness to reduce or eliminate the risk of ALCL . For women undergoing breast reconstruction, especially, shaped devices can be a God send for even with fat grafting to thicken the overlying tissues, there is little to cover these implants and a round implant cannot hold a candle to the results with shaped unless there is considerable thickness of the soft tissue envelope.So that’s pretty much all I have learned over the years. I am a proponent of textured devices and it was wise of the FDA to recommend NO intervention without symptoms—and fear is a response, not a symptom. When the hysteria dies down a bit (and I do not make light here of those women who have suffered the consequences of ALCL), I suspect we will put everything back into perspective. Taking out a textured implant just because it is textured but is otherwise behaving well, should be compared to every woman undergoing prophylactic mastectomies because of a 1:10 risk of developing breast cancer (varies with populations and geography—the Bay Area in California is now thought to be 1:8!) The risk of ALCL may be 1:3000 or closer to the other end of the estimate at 1:30,000. And that is only for the Biocell surface on all Allergan products prior to the recall, including silicone, saline, or even tissue expanders for reconstruction. Sientra, another major manufacturer here in the US is reporting perhaps 1:175,000 and that number may be conflated due to a prior Biocell surface device. Mentor’s Siltex surface does not provide good numbers in my opinion but appears to closer to Sientras experience that Allergans.Talk with a few doctors before making this critical decision. Merely removing the implant does not eliminate the risk of ALCL. The entire scar capsule must be excised. This is traumatic and potentially dangerous. There are plastic surgeons, I am ashamed to say, who are trying to capitalize on women’s fears and promising “en bloc” capsulectomy (not trace left behind theoretically and totally unproven!) The vast majority of plastic surgeons are listening to the smartest men and women out there in plastic surgery and medicine in general—”if it ain’t broke, don’t fix it”.For more information search for the ALCL guidelines from the American Society of Plastic Surgeons. For information on breast implant related illnesses, I would have you read the article “Breast Implant Associated illness—myth v. science” It is written by one of the smartest plastic surgeons alive, Dr Rod Rohrich who is also the editor of the esteemed journal “Plastic & Reconstructive Surgery” . As the editor and as former head of the Department of Plastic Surgery at Texas Southwestern, Dr Rohrich has access to tons of data. And data is what we are still seeking in this difficult subject.Thank you for reading. Dr Berkowitz

What was the outcome of the FDA hearing about breast implants and medical devices held March 25-26, 2019 in Silver Spring, MD?

This was a very important hearing. My partner was able to be one of the surgeons who spoke on behalf of her breast reconstruction patients. The hearing was in response to two separate issues—BIAI or breast implant associated illness, and BI-ALCL or breast implant associated anapestic large cell lymphoma. Let me break this down with a forty year historical perspective.BIAI. Silicone breast implants had been in general use without sufficient studies submitted to the FDA for 30 years prior to a 1992 ban on all silicone gel implants. This ban was a result of patient complaints of a number of illnesses such as rheumatoid arthritis, scleroderma, chronic fatigue syndrome and thyroid disorders among others. It was all lumped together as Human Adjuvant Disease. Fifteen years elapsed before the ban was lifted. During that time span silicone implants had become the most studied device in the history of the FDA. The few manufacturers who survived at that time submitted the required data to show their safety profile. When silicone returned to the US market in 2006 the FDA had reached two basic conclusions. The first was that breast implants were not associated with collagen vascular diseases, such as rheumatoid arthritis, and scleroderma or chronic fatigue syndrome. This was based on studies from the NIH and several prominent universities. No one denied that yes, women are more subject to these auto-immune diseases and yes, women get breast implants. In other words “true, true and unrelated”. This answer did not sit well with many women who were certain of the cause and effect relationship. The internet gave them a voice. Their voices were heard by Dr Mark Clemens from MD Anderson hospital in paper in Plastic and Reconstructive Surgery last year. With the internet also came much deeper data bases and the ability to construct meta analyses that supported these claims—possibly. His conclusion, as was the conclusion of the FDA, was that these claims will require more scrutiny in the form of more rigorous tracking and reporting to the FDA. Plastic surgeons have been admonished not to dismiss these claims by our patients by our parent societies American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. Implant registries have been established by our societies. We look forward to identifying the relationship if one does truly exist.BI-ALCL. The FDA was responding to the mounting evidence associating certain textured devices with this rare high grade lymphoma as a result of chronic inflammation. The origin of this disease is not well understood.Chronic inflammation is known to be associated with lymphomas. This is known as the oppenheimer effect. Patients with chronic inflammation due to Hepatitis C are known to have a higher incidence of B cell lymphoma. You must treat both simultaneously to successfully eradicate the lymphoma. There have been reported cases of both dental and joint implants that have caused ALCL. There is also some evidence that it may be related to implant surface contamination in surgery due to a gram negative organism Ralstonia Picketsii. This is not a common bug. It would need to be introduced in the insertion and handling of the devices during surgery. Of interest is that the incidence of this disease seems to be more prevalent in Australia and no cases from Asia or Scandinavia where textured devices have been the norm since their introduction almost three decades ago. And all texturing does not carry the same incidence. Polyurethane foam covers, the original form of texturing carries the highest risk wherever they are used. They were eliminated from the market here in 1992 due to evidence of breakdown products could be carcinogens. However these implants were still in widespread use in France where they have banned all textured products. This may have been somewhat of a knee jerk reaction on the part of the French government because of the terrible outcomes from non-medical grade silicone used in PIP implants there a few years ago. It was a shameful incident for the industry and the French government. Mc Ghan Medical textured implants were introduced into Europe in 1993 through their plant in Ireland. The company is now Allergan. They were widely distributed and very popular in Europe throughout the 90’s and into the millennium. These have had a varying number of reports of ALCL depending upon the country where used but is thought to be about 1 in 30,000 in the US but may be as high as 1 in 4000 in Australia. Again, no Scandinavian or Asian cases to my knowledge. One possibility that has been raised is due to the irrigation used in the implant pocket. While Betadine was popular in the 80’s, it was banned here in the US in the instructions for use in the mid nineties based on some somewhat questionable research. So in the US we have used a triple antibiotic solution. Ralstonia is not sensitive to any of the three commonly used antibiotics in this solution and may actually encourage its growth by suppressing other bacteria. Where Betadine was not banned the incidence of ALCL has been less. The FDA recently lifted that ban here and we are all happily using betadine once again in the US. Other manufacturers than Allergan have all had a considerably lower incidence of ALCL—Sientra and Mentor in this country.So why use textured implants at all given this rare but serious problem? Smooth implants can only be round; they cannot be tear drop. That is an aesthetic concern. More importantly, textured implants are form stable and do not move, shift, bottom out or encapsulate as readily as the smooth ones. For breast reconstruction patients especially, texturing of tissue expanders and the implants have improved outcomes significantly. To do away with textured devices, in my opinion and of many key opinion leaders in our field such as Mary McGrath, Professor of Plastic Surgery and Department Head at UCSF who spoke at the hearings, it would be a giant step backward.Most plastic surgeons in the US use smooth round implants. This has as much to do as the ban on silicone in the nineties that required all surgeons to use saline devices that functioned much better as a smooth implant than it does with the incidence of ALCL. Surgeons who trained with smooth saline migrated to smooth silicone in 2007 logically.But let us consider, as did the FDA, that re-operation carries greater risk than the small risk of ALCL. The FDA has recommended against removing textured implants as a preventative measure for this reason. Likewise, I weigh the risk of malposition, stretch deformities and capsular contracture—all of which are of higher incidence with smooth implants—against the small risk of ALCL.ALCL is not a silent disease. It usually presents as seroma, or fluid collection that swells the breast and alerts the surgeon that this fluid must be tapped and sent to pathologist for cytological testing. Seromas are not uncommon around any breast implant and so not all seromas are due to ALCL. if treated expediently with total capsule removal and the implant, that is considered therapeutic. If the symptoms are ignored then there are cases that require chemotherapy and there have been a few fatalities.“ A few fatalities?” I can hear the gasp. All surgery , all medications, all activities of daily living carry risk and the risk of dying from a breast implant is dwarfed by the risk of death from almost any other surgical procedure. It is important to keep this all in perspective.Bottom line—if any woman in my family had textured breast implants ( and one , in fact, does) I would not recommend removal. If another member of my family wished breasts augmentation, I would consider textured implants from a manufacturer with a lower incidence such as Sientra or Mentor.

Should cracks and water in the crawl space concern me when buying a house?

No, ..generally, practically speaking, if the House has been standing there for 10 years, it's reassuring. Everything is Fixable..a Shim Here, a Shim there..a Supporting Beam Below to Open up the Space between the Kitchen and the Dining..Go slow and stay Chill..All this is forgivable if you are in the right neighborhood..you want the cheapest House on the Best Street or in the Best Neighborhood you can Afford. If it is the Crawl Space, it could be the result of Frost Heaving ..because on old Houses (pre-1940), often the Foundations were not deep enough..The smaller cracks can be fixed with Polyurethane Injections..You drill holes in the wall around the crack..you install ports ..and then you squeeze in the Epoxy or Polyurethane goo ..you can do this yourself cheaply if you are handy..if not call in the Pros..2 k maybe.so there you have it..it is all figure-outable…lol..Stay positive and avoid falling into that Fear Mindset on that moneypit you bough…lolSee every problem as an opportunity to fix the problem and add tremendous value by adding an extra livable space..in the right neighbor hood or if you feel that you need a dungeon basement or extra bedroom or lounge space or closets..all add value..also add a bathroom..do the pipes before pouring a slab. put in lots of rebars (reinforcing bars in conrete..tied with wire mesh together or welded.... steel rods put a 6 mil polyethylene first to avoid that musty basement smell. caused by water seeping into the concrete walls..not good smell unpleasant and it can create fungal issues...but you solve all those problems if you add that new foundation..it is work..but its doable..find 2 guys to help you..pay them 15–20 an hour, pay them at the end of the day..4–15 days of that and its done..footings, ,The sequence is; footing mini slabs for the post,s, add the posts or jacks..attach them well on top and on the bottom (anchor bolts..buy the Cobras that you can just add later..you just do the 20x20 slab, with rebar,, put poly below them..cushion between the concrete and post and drill half-inch holes with a concrete bit (diamond drill0 and then hammer in them cobra Anchor bolts..Job Done..you bolt your plates to the mini slab that way..easy peasy..lol..attach top plates with 5 inch big nails and 4-inch patio or lumber screws..or lag screws with a hex head that you ratchet in, you need to predrill a hole in the beam above to lodge them in..twist away.., patio screws..nails are stronger than just patio screws sheers they can break in a hurricane or some earthquake …add a few beams supported by those 6 posts...….then excavate, do one section at a time but overhang the rebar 12 inches on each side so that they tie into to the next 8 ft section and you do 8 ft on a side, another 8 ft on the other side of the house..and...if you don't have money to do the slab, just do the posts or the walls.., just put in the 6 mil polyethylene (Home Depot, Lowes ..etc) underneath the concrete ..and maybe add urethane under the slab to keep your feet warm or add radiant heating pipes, linked to a separate water heater and then pour the slab..you can even stamp the slab, add red powder and it will come out looking like Italian tile..so think deeper....and some crushed stone and put in the drains and pits for the pumps..allow ventilation to prevent dry rot ..Insulate down the Road and solve all these issues..or do a messy slab but level (rent a vibrator at your tool rental place, make a few follies with plywood, watch youtube videos on guys doing that exact same thing..google basement slab..et voila....possibly do just with a rake finish, then build tile on top of it or add plywood sheets on top and then hardwood or engineered floor,,..avoid the cheap MDF laminate floors….if you re on a Budget, consider Bamboo Flooring..Stained Caramel..it will age well and contrast the white walls and possibly match the Beams..you want to Highlight.. Another possible finish is to sand the floors which are already perfect (need real pros here, then you add a quarter-inch epoxy finish..ventilate well….and you get the Nerd look of Silicon Valley..add some shimmer flakes here and there and maybe a Hollywood Star (like on Sunset Blvd ) for each of your Children…but you better be there long enough..the next buyer may like it or not but in 20 years, he or she may well add a hardwood floor on top of it. then..Also, some 2x2 panelized floors are also sold in the Big Box Stores..you rest them on top of the Concrete..and they are tongue and groove with a plastic finish that looks like Lego on the Bottom and Aspenite on top,.I don't like Aspenite..I prefer half-inch plywood or 5 Eights Ply which is std flooring..it will not be affected by a flood or sewer backing up like the Aspenite -Flake Board that will be irretrievable if you don't set in Motion very Quickly the Big Industrial Ventilators, Heaters and DeHumidifiers (rent them at too,l rental outfits)..they Do a swell job drying up a flooded Basement….Radiant heating is possible with the Urethane Finish, the Tile Job Finish, or the Hardwood Floor Finish….the Insta Soup Finish of the 2ft x2fty Panels will end up costing you more for a moment of convenience..but good old ply on top of the slab, with a cushy quarter-inch packaging type of bubbly roll thing underneath or standard underfloor for they use under laminate floors (but you ll put in hardwood) will give your step a bounce in that basement…lol. The cushy thing only if you don't have Radiant Heating ..Radiant heating, you could do just in the Bathroom or 3 ft wide in front of the kitchen where you stand a lot..put Hardwood elsewhere ..but have Urethane or styrofoam below the concrete to cut out that shiver factor…lol..Lots of cheap Urethane 2ft x4 ft panels floating around in them salvage yards..use that..find basement windows salvage too for 100–15)$ each instead of 600$ + new especially for large windows…add pits outside to make windows as big as possible and bring in light..a lighted space looks bigger..MDF Laminate floors don't resist water issues but hardwood is unperturbed by it…easy to refinish hardwoods down the road although these prebaked factory prefinished floors have strong veneers polyurethane finishes..if you are a granola vegan hippie, buy tongue and groove strips at the local mill (unvarnished) , give it a good sanding, then add linseed oil mixed in with bee s wax..it can be pretty also..or give it a distressed look..urban shabby chic..you paint them then slightly resand them..it gives it an industrial loft vibe SOHO Vibe...Americans in some places would carpet directly on top of the slab in Texas but in Northern Climes, they would usually rest and glue (PL Glue) sheets to the slab, then Carpet it..people with kids prefer that option..but hardwood floors are a sure bet and will add lots of resale value..over the years..that floor that may cost you 3 USD per sqft x800 sqft =2400$ + installation can add upwards of 20–30k on Resale,..Think about it..like the Chimney..use the old Oil Boiler chimney..reline it with 8 gauge round chimney pipe (inserted in 4 ft sections ) and add a firewood or gas fireplace or woodstove..it will heat the house if there is a power failure and it will prevent your pipes from freezing..or get a Generator..but they are noisy..and in some uppity neighborhoods, people complain but hopefully, you ll only use them once in a blue moon..lol>Carpetting is kind of tacky and outdated….unless your brother in law can get you hotel-quality carpeting ..lol. I prefer area rugs (old Persian rugs you can find in flea markets,.give them a good shampoo job on the front lawn and they have this distressed shabby chic bohemian look that adds Soul to a place..very Ralph Lauren type of look…lol..or Franciscan Mission LA type of Vibe..My Old House - Ep. 3 - 1908 Craftsman Home - Basement Concrete Footings and FloorsFor the impatient, -urethane Panels or styrofoam ..use what you can salvage —Roxul Mineral Wool (moisture-resistant and fireproof..a great product)in between 2x4 studs is also good but then add an aluminum foil-covered airfoil styro panel half-inch 4x8 ft panels (skirt a house with this and keep your pipes from freezing some furrings horizontally every 2 ft or 16 inches c-c.. of wood 1x2, 8 ft long ..on which you can screw your Gyprock but a Concrete Panel, in front the Fire Oven,.and make a sweet space from all this mess..If the House upstairs is Big enough, Don't Bother, just add a Post here and there in Areas where you see Gaps or Weakness..it will sturdy up them Floors..in the Old times, the poor Neighborhood Houses built with what they could find..often 10 ft pieces of lumber but they were quite resourceful..using a big rock that was there to sit their posts on and it was there for 80 years..it s just not earthquake-proof..ideally, you want to attach things with anchor bolts you have to add in them post footings…if not, at least add a few bolts of big nails to attach the top plates to the Beams on top of them..S just use your logic..Figure it Out,.it s not Brain surgery..Mediocrity can Happen Quickly..Do your research..and come out wiser..have the Humility to learn..the more you Do yourself. with 2–3 guys, the less it will cost..let them Do the Work,..Supervise them on all these Details I mentioned..rebar, shimming..Pits, drain around the outer walls..etc..access to that new unit..plan a staircase..watch videos on that..do it one step at a time over 10 years when you have idle time..it will be a fun distraction..have the right mindset..this can be very fun ..and it adds immense value to a house that had issues..easier if you ever resell it..not just price-wise that it will help you but also because these issues can be real deal-breakers..I have sold houses because I exposed an Old Brick Wall, or reused old sturdy 3 inch thick joists I recovered as Window Sills or Bookshelves..add a touch of Rustic creativity..the technology alone is important but good design can add another 10k-100k or more to space,..and the initial cost is fairly minimal compared to the value of the house….Put the Mesh 4x8 ft mesh panels..wired steel 8x8 inch squares in the Slab as well as some rebar…The Vibrator makes the concrete fill all the gaps and make it quite level just trowel it or dolly it up after half-hour later when it is a bit harder…the Vibrator finish alone is Ok if you add Ply on top of it..just make sure that there are no climbs anywhere..Take a 2x4 -4 ft long and to attach a handle to it 2x2 attached with 2 strips of plywood at angles between the handle and the 2x4 that will skim the concrete like a rake..you can use a garden rake too.. to hold it square..that s called a dolly. and you pull and push on it to put the basement in place, then put the vibrator in action..and it will make it as flat as a lake….dont over vibrate…vibrate the edges to push the concrete in the crevices of the wall..or ground..add that polyethylene 8 mil first and insulation then re-bat and the grid 4x8 steel mesh…locate all your pipes for the kitchen, washing machine, sinks tub, toilet ..etc.….if you must put in a drain (not a good idea), make sure you put in a Pee-trap to keep bugs and sewer gases out (they often dry out when the water evaporates and the sewer gases enter the house and that is why Drains in the floor are a Bad idea,.If you need, extra Space..rent a Conveyor. Buy Contractor Garbage Bags or rent a sturdy trailer and excavate that crawl space. Before you start excavating, install 4–6 new columns..Steel 4x4 or Contactor Jacks will Do the Job Fine..Find those contractor Jacks Salvage for 50USD each.6x50 + the Labor..Peanuts Bro..then you excavate with a small bObcat you rent ..and presto subito, you have a Basement ..Build 8 ft Sections, if you Don't Have Good Horizontal support..maybe add 4 Beams, if you want to sturdy up the Pace..either, find Scrap Metal I Beams in your local Construction Material Salvage Yard..and get a Bunch 2x10s at your Home Depot or Lowes. or Mills Some Beams (Go see your local Mill..this could be an architectural feature if you design it right and add some Urethane to cut the Cold Bridge..thermal Bridge. You could also pour the posts in Concrete..do that if You re Italian, hey they like Concrete..lol. All kidding aside, for those jacks, pour a 6 inch Footing 20x 20 inch..add a bit of rebar..Home depot , half incgh diameter..a Few Bags of Premixed Concrete et voila..you pour 6 nice footings ..and you rest your adjustable jacks..they screw up or down to adjust to the real Height…Very strong or But in Round 4–5 inch posts you found at the Salvage Yard..It s all ..The Plates come with the Kit..If the plates went missing, go to the Scrapyard, give the guy a 50$ tip and have him cut you 6x2 plates (12 plates ) of 10x10 inches..or 8x8 if you lack room ..and there you go..the Old Foundations stay there..the new Foundation is 5 inches in front of the Old One Inside but it goes 24 inches Deeper ..so the wall will underpin the old Foundation ..and you solved those pesky frost crakes..you may also have had Settlement ..if the house sits on Clay ..Don't worry, if the House is 10+ years old ..it has settled..Most of the settlement 80–90% occurs in Year. Some clays are like Jello ..and they wobble. I had a House on Square st, Louis in Montreal, that sat on wobbly grey River clay..all the Houses in that street had cracks, and most got piles driven to the bedrock to control the Settlement..it was so liquid that if you took a piece of rebar or 4x4 steel beam, and you let it go, it just vanished into the clay..scary stuff..imagine a man getting eaten up by that…But I did many basements 7 or 8 (all houses I owned) and renovatedMy Italian Contractor friend had put a 6 mil Polyethylene on the Floor and then some crushed stone much later..but the guys would walk there held by that plastic film kind of adhering to that clay..the Guy had Balls..I did his engineering Drawings required by the City but he knew what he was doing. One day, I get there, He Had taken away the entire first floor (it was all crooked..but nice timbers….cracked in some places because plumbers had cut into them to pass their pipes or there was water damage and carpenter ants from a leaky shower above a beam and them ants love a moist beam they can put their teeth into…lol. Them critters change their African nest every year so you can get multiple pockets they dugout on the beam..so you clean it up with a brush.. cut out the real rotten part..replace it with a new 2x10, add some plywood, glue on top like a Bandaid, screwed, nailed and Glued intermittently but it is floating (use PL=Construction Glue) then the same ply on the other side of the Beam, then 2 new 2z10 long joists ..glued, nailed and screwed ..supported by the Brick wall already there..brick is a Great Material when combined with Wood..also avoid the Wood Touching Concrete..,.so add a layer of this mushy underfloor stuff or some old-time black roofing paper..and then rest your Beams on the Concrete…If you use Metal Posts, they can rest directly on the Concrete but if you want to cut the thermal Bridge, add a Plastic Mushy Foam Material underneath..it is more durable than Paper, but Paper may do ..if it is dry.Interior Foundation Crack Repair | Avoid Bad Patch Job in BasementAdd a French Drain on the Inside of the linked-to two Sum Pumps…Seal them Pits with Plastic or Steel Plates shut tight..keep an eye on the High Rain Periods, monitor pumps .(listen) sometimes there is a Power Outage, the Pumps don't Work. Find a Gravity-exit for the Water of the Drain oif possible.Have an Egress window or Patio Door at one End as a 2nd Exit or if you are Hip, have a Deep Pit with an Outdoor Shower outside..with Door Access and a Window next to it…if you Do that, add lots of Urethane, to keep the Frost from getting in…maybe have a translucent flexy Corrug Roof tPanels above the Pit o keep water away from the foundations and cut the wind and ice…A crack in the Attic Space..how big a Gap..maybe, they used wet greenwood when they built it..and it shrunk as it dried up.Is it a horizontal crack, a Vertical Crack, or at an Angle..How Big is that Crack..a Hairline crack or a quarter-inch Gap…maybe the Snow Loads..you may have to Brace it Somewhere..easily fixable…Houses with such Visible Things can Help you Haggle 10k for that and 10k for the rat you found in the Crawlspace under the House or Basement..How are the Foundations,.that is where cracks can do Harm..water Infiltration, the smell of Moisture..if you do decide to remodel the Basement, dig 18 inches, go add some hight..add 18 inches to them Foundations, Poor Concrete Below them, one section at a time..that way, you build Support, Do the next 8 ft ..etc..Go slow, Think twice, Measure Twice, Sleep On It. If you are willing to put in Some Elbow grease, no sweat. If not, get a referred Contractor friend (somebody that knows houses), a local architect or engineer or Home Inspector, or a Friend that knows Houses maybe another Agent to have a look at it, give you a Verbal opinion. If you don't mind spending $400usd.-500usd, get a written report.Are the cracks big enough to let them Bats in ..those little Critters..we are All sentient Beings..so, a friend of Mine is renovating a Castle in France, old strong Timbers, the pillar and post-construction ..and all seemed fine until they realized that the top 5 ft was housed by Bats.So what they Do..he hired an ecologist, who set up an infrared camera to see the trajectory of them Bats every Night and to see where their Point of Entry was. The Commune (County) gave him the Permit under the proviso or condition that he must incorporate a Space for the Bats…and to build a Point of Entry (louvers) to give them Free Access. They Do little Damage and keep the Flies at Bay.. That is the modern way of solving problems..in a Chill Way…lol

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