You seem intent to lengthen only 5 cm (which is modest and probably very safe depending on your starting tibia length).
Purely external lengthening (Ilizarov without nails) remains the safest approach and offers the ability to resolve existing alignment issues, if any.
If you plan on actually stopping at 5 cm; then, it is probably safe enough to leave St. Petersburg during distraction; however, you may need to return for a correction phase after distraction is complete but before your frames are locked for consolidation. You will also likely need to return to remove the frames. When you plan to go beyond 5 cm, you should carefully question whether you should be geographically distant from your medical team because your body will push back very hard against lengthening which can necessitate adjustment to your frames.
If you limit distraction to 5 CM; then, you are probably looking at about 2 months from initial surgery to completion of distraction, another one to two weeks for correction; then, 2-3 months for consolidation -- a doable journey in frames.
You can always elect LATN later if you want to get rid of the frames. Though people on this forum insist LON or LATN causes knee pain, etc., I am aware of no valid, on-point study that supports that notion. I can also attest that I have no knee pain or loss of range of knee motion.
I encourage you to discuss your choices frankly with your MD team. Dr. Kulesh will accept your decisions and make what you want to happen actually happen because he ascribes to the doctrine that "the patient is always right".
However, most patients are dumb as a post when compared to his or her physician. Therefore, it is always important to ask your medical team "what do you advise?" Carefully consider that advice and the underlying rationale before you decide to not follow it.
Best of luck!
The above article is a good example of an article that is being referenced for something other than it reports. I encourage you to read the article to understand what it actually says.
What it does NOT conclude is that tibia nails cause knee pain. What it DOES conclude is that patients who's nail ends farther from the end of the tibia; that is, patients who's nails are buried deeper in the bone, experience less pain.
Then, read the causes of the pain reported and you realize that most of the pain reported was due to the surgical procedure itself. Don't know why anyone would expect to undergo surgery without any pain?
For me that's ok. Like I said, I'm willing to take the risk for less time with frames.
Quote from: California2 on April 21, 2019, 04:51:44 PMYou seem intent to lengthen only 5 cm (which is modest and probably very safe depending on your starting tibia length).
Purely external lengthening (Ilizarov without nails) remains the safest approach and offers the ability to resolve existing alignment issues, if any.
If you plan on actually stopping at 5 cm; then, it is probably safe enough to leave St. Petersburg during distraction; however, you may need to return for a correction phase after distraction is complete but before your frames are locked for consolidation. You will also likely need to return to remove the frames. When you plan to go beyond 5 cm, you should carefully question whether you should be geographically distant from your medical team because your body will push back very hard against lengthening which can necessitate adjustment to your frames.
If you limit distraction to 5 CM; then, you are probably looking at about 2 months from initial surgery to completion of distraction, another one to two weeks for correction; then, 2-3 months for consolidation -- a doable journey in frames.
I really don't think this timeline is accurate, so I will clarify it as my experience so far. I'm now on month 7, still consolidating, with at least 1-2 more months until frame removal. That is with the scheduled exercise of walking, usage of nandrolone, testosterone, estrogen, all vitamins and protein for speeding up recovery. I am JUST this week starting to use forearm crutches and am off using my zimmer walker. I would say my walking is improving a lot but I am far from finished. I think when it is all said and done, 5.5cm will have cost me 9 months, and this is on the low end if everything goes well. When I was doing the surgery initially I was told numbers like that, 5cm for 6 months, I just don't think it's true.
I may be wrong but I sincerely believe that the majority of people who want to do LL think on the basis of two variables:
probability ratio of recovery chances/ price.
and
number of centimeters gained.
for example
I want to gain 5 cm.
if I spend $ 100,000 for this surgical operation, I estimate the probability of total recovery at 95%.
on the other hand for 8000 dollars, I estimate the probability of total recovery of my functions to 60%. that means hat I have 6 chances out of 10 that everything is going well.
so for a variation of 35% I still save 92000 dollars which is tremendous.
so never mind I'm missing out on that 35% chance, but I'm saving a lot of money.
I specify that these data and especially the percentages of recovery are absolutely arbitrary and imaginary. it's just for the example.
Finally it's a little like parachuting.
Let's imagine that I want to do a skydiving jump.
So I'm going to buy one
The first I find in a store costs 100 dollars, it is very old and I see a lot of holes in the sails.
The second is much more expensive about $ 10,000 but it is a new parachute last generation.
Again in reality there are intermediate prices of course but here it is an example between two specific choices
I do not know many people who will choose to jump with the $ 100 parachute.
The reflection would be rather I have 10000 dollars and I can skydive or I do not jump.
so to answer your question'' is my choice wise?'', from my point of view the answer is no.
and in my opinion it is simply because the pain you feel and the eagerness you have to eliminate it prevents you from reasoning rationally
Quote from: jcayabo on April 21, 2019, 07:03:26 PMI really don't think this timeline is accurate, so I will clarify it as my experience so far. I'm now on month 7, still consolidating, with at least 1-2 more months until frame removal. That is with the scheduled exercise of walking, usage of nandrolone, testosterone, estrogen, all vitamins and protein for speeding up recovery. I am JUST this week starting to use forearm crutches and am off using my zimmer walker. I would say my walking is improving a lot but I am far from finished. I think when it is all said and done, 5.5cm will have cost me 9 months, and this is on the low end if everything goes well. When I was doing the surgery initially I was told numbers like that, 5cm for 6 months, I just don't think it's true.
Testosterone and estrogen help your recovery? How much testosterone enanthate are you using?
Quote from: California2 on April 21, 2019, 04:51:44 PMYou seem intent to lengthen only 5 cm (which is modest and probably very safe depending on your starting tibia length).
Purely external lengthening (Ilizarov without nails) remains the safest approach and offers the ability to resolve existing alignment issues, if any.
If you plan on actually stopping at 5 cm; then, it is probably safe enough to leave St. Petersburg during distraction; however, you may need to return for a correction phase after distraction is complete but before your frames are locked for consolidation. You will also likely need to return to remove the frames. When you plan to go beyond 5 cm, you should carefully question whether you should be geographically distant from your medical team because your body will push back very hard against lengthening which can necessitate adjustment to your frames.
If you limit distraction to 5 CM; then, you are probably looking at about 2 months from initial surgery to completion of distraction, another one to two weeks for correction; then, 2-3 months for consolidation -- a doable journey in frames.
You can always elect LATN later if you want to get rid of the frames. Though people on this forum insist LON or LATN causes knee pain, etc., I am aware of no valid, on-point study that supports that notion. I can also attest that I have no knee pain or loss of range of knee motion.
I encourage you to discuss your choices frankly with your MD team. Dr. Kulesh will accept your decisions and make what you want to happen actually happen because he ascribes to the doctrine that "the patient is always right".
However, most patients are dumb as a post when compared to his or her physician. Therefore, it is always important to ask your medical team "what do you advise?" Carefully consider that advice and the underlying rationale before you decide to not follow it.
Best of luck!
Thank you very much for your reply and suggestions. Also, do you think kulesh is a good doctor? There seems to be no negative news about kulesh at the forum.
Quote from: wannagrowtaller on April 21, 2019, 05:33:03 PMhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333649/
Okay, I will read it.
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