Quote from: KiloKAHN on October 23, 2014, 01:08:28 PMI had a goal of 6 cm and stopped turning at around 6.3 cm so the actual distraction was slightly less than 6, but Dr Parihar wanted me to distract another 1 cm to account for margin of error in measurement and the compression during surgical correction of some of my misalignment. So total distraction showed 6.2 cm. If I get any subsidence loss during frame removal it will be within 3 or 4 mm so either way I'm cool with how much I've done. Dr Parihar said it's still within the safe range and it's not like I'll be automatically messed up going 2 mm above the recommended max.
Thanks, 123. Dr Parihar also told me that at the absolute minimum after lengthening 6 cm I'll have to wear these for an additional 4 months for a total of 8 months. I hope I'll have that good a consolidation rate but I'm expecting 9 or 10. I might choose to wear them that long just to be safe. Good to know you're doing well as that gives me more confidence about what to expect.
I feel happy enough to have gotten my tibias done that femur lengthening seems more like a fantasy at this point than something I'd really want to do. So if I did go for femurs I'd probably wait until I'm in a very comfortable financial position to afford internals. I just don't think of femur lengthening bad enough to go through the difficulty of external femurs.
He does external femurs. He won't do cross lateral lengthening though.
does he do monorail external femurs or with illizavor?
No More Mal-Kahn-Tent - External Tibias - Dr Parihar
Update: 10/23/2014
So this will be my first real update in a little while. Just over a week ago I was admitted back to Mangal Anand Hospital after notifying Drs Parihar and Divya that my additional 1 cm of distraction was complete. I arrived by auto rickshaw and had to wait about 5 minutes for the helper (I think they call them "mausi") to bring the wheelchair before being taken to a back room in the male ward on the second floor. One of the sisters (nurses) came in and had me sign some consent forms before I lied back in bed to watch Comedy Central. They had put a refrigerator in each room since the last time I had been in the hospital and I really wanted to pull out that orange delight tropicana but I wasn't allowed to eat anything because of the surgery next day. I was too anxious to go to sleep so I started playing an indie point and click survival horror game on the PC called Five Nights at Freddy's, which lasted me through the night.
The next day I had my x-rays taken again before being wheeled into the operating theater. This second surgery was to add two pins in the middle of each leg in order to add stability. This would help with faster consolidation down the line and also reduce aches and pains (as added stability tends to do). One of the ladies on the surgical team stuck me with the IV and then I had to lean forward and stay still while they performed the awful spinal epidural, which I still think is the worst part of going into the OT because it makes your sides pulsate and you feel an uncomfortable tube wriggling its way into you. Dr Parihar came in and placed my x-rays on a wall with a back light at the other end of the room so he could examine them before surgery. I fell asleep from not having slept before surgery started and woke up some time later to my muscles contracting from the cold temperature in the OT. I was lying at a decline but I lifted my head just brief enough to see Dr Parihar take a large pair of pliers and hear a loud snapping noise. It startled me and I put my head back down and tried to sleep again, but later I found out he had just cut the ends off the top pins and that's what caused the noise. I spent the rest of the night in the same room I was in after my first surgery. The numbness of the legs was nice but I had to sleep at a slight decline to not get sick from the epidural and because my lower body was numb and I had no catheter it took forever to take a piss in the urine pot.
For the rest of the week I spent my days watching cable TV or playing on the PC for entertainment, interrupted by my two physiotherapy sessions each day - one around noon and the other around 6:00 pm. I also had to change my dressings every day, which was the most annoying part because each change takes over an hour and 40 gauze strips. At least the sisters gave me a menu where I could order whatever I wanted from a veg or non-veg restaurant nearby. It was nice to eat from a restaurant other than the one my hotel ordered from just to try out the difference in cooking style.
I developed a severe pain on my right leg that was just underneath the two left wires below the knee, which prevented me from moving my leg certain angles or doing extensions without a jolt of pain. Using the walker was certainly harder as well. The pain kind of worried me but I got a visit from Parihar and Divya, and Parihar told me that the pain was likely due to the load on the pins along with the stretch of the muscles. He told me that he would consider adding another pin in the area to share the load with the wires if the pain doesn't subside but said to start doing electrostimulation and ultrasound therapy for a few days. For the rest of the week I had ultrasound and electric stimulation on that spot for 15 minutes each before I did all my exercises. Dr Parihar was right as it did the trick and by the end of the week I no longer had that pain bothering me.
My previous x-rays showed that I had somewhere around 8 or 9 degrees of misalignment in my legs. My tibias are naturally quite curved so they were looking at my straight fibula bones to determine the correction. During the surgery Dr Parihar had manually corrected most of the misalignment in each leg, so when Dr Divya converted my frames to hexapods and brought back the scan from the hexapod software that showed how to do the corrections, he informed me that I only had 3 degrees of misalignment left and that correction with the hexpod would only take a day. Dr Divya did the first and final turns on the hexapod in the morning and night, but during the afternoon it was one of Dr Parihar's two fellows that did the turns for me.
By the end of the week my rods were changed to thicker more stable ones on the top and the hexapods were removed. The last night I was at the hospital I had a talk with Dr Parihar for about an hour to ask him some more questions and chat for a bit. His two fellows then had me stand and lie at various angles so they could take pictures to see the degree of equinus I had left and what level my leg extensions were at the time. They informed me that along with monthly x-rays I had to send to Dr Parihar, I also needed to send pictures showing how my equinus is coming along and if my extensions have improved.
I got back to my hotel yesterday and was glad to see the familiar setting. I've started looking for flights back home and will book one tonight most likely. Dr Divya told me to visit the hospital one more time the day before I leave just to say goodbye and all that, so I'll likely be able to get some more pictures of the hospital or staff. I'll be consolidating at home and although Dr Parihar says it will take a minimum of 4 months, I expect it will be 5 or 6 for me. In any case, I'll still wait that long before coming back for frame removal. Dr Parihar said that for removal they like to do it slowly and loosen the frame a bit first to see how the walking is before deciding whether to keep the frame on longer or remove it. Being an international patient, he advised I wait a full month after he tells me the bone looks fully consolidated before I go back to him for frame removal.
Right now the only annoyance is the remaining equinus contracture, which Dr Parihar says should take a month or a month and a half to correct. Although it sucks to have equinus, I'm fortunate enough to have gotten it later towards the end of my lengthening as that means it will be more easily fixed with stretching. The ones who have the real issues are those who get their equinus early on. Additionally, my knee flexion contracture is fully corrected so I've got that good news to be happy about.
My experience here has honestly been better than I could have hoped. Despite doing a lot of research I was still nervous at deciding on a doctor because I'm the first to report with any experience. But I think the very positive experience I've had with Dr Parihar strengthens my thoughts that patient diaries should not be the primary basis for choosing a surgeon. I took the time to seek out other avenues without focusing on patient diaries and it paid off as a result. So if you find a doctor that doesn't have any patient diaries, yet you have a really good feeling about him and have heard good things, don't disregard him anyway because you haven't read accounts from other patients. You may be missing out on a great option that can also be good for future lengtheners.
Some Pictures (I'll post my final x-rays later)
The hospital bought me a mango cake and sang to me for my birthday the day after surgery. Made staying in a hospital then less of a depressing experience.
These are two of the four physiotherapists employed by Dr Parihar. The woman on your left is Tejal and she is the one that does the massage technique to loosen the fascia, which hurts during it but makes your legs feel nice and loose afterwards. The woman on your right is Pratiksha. She was my regular physiotherapist for my evening sessions. Both are very sweet ladies with a lot of experience doing physiotherapy on Ilizarov patients. 
Top down view of my legs in the hexapod frames. 
Side view of left leg in hexapod frame.
Another angle of left leg in hexapod frame.
Top down view of left leg in hexapod frame.
Top down view of right leg in hexapod frame.
Top down view of current frames I'm wearing for consolidation.
Current frames, right leg.
Current frames, other angle of right leg.
Current frames, left leg.
Current frames, other angle of left leg.
Hi Kilokhan.
I hope things are going well for you. Your tibias look like long.
Cheers, paco.
Quote from: Greek-Semidget on October 23, 2014, 01:45:37 PMdoes he do monorail external femurs or with illizavor?
I've seen patients there for deformity correction on femurs with monorails, rings, and hexapod, so I'm not sure which ones he'll do for cosmetic lengthening. It might be on a case by case basis.
Quote from: GROWtalORdieTRYING1 on October 23, 2014, 01:36:28 PMthe more I hear from this doctor the more I like him. he is saying all the things he should. cross lateral is not a good thing. its just a fad. scientifically not very smart approach.
Mal-Kahn-Tent, can you ask pariah what he thinks is the safe external femur length to stick to?
When I asked him about cross lateral lengthening he said it's one thing if you're doing internals but externals is a different issue all together. I then asked "even if you use the monorails on femurs?" and he responded that monorails are a different issue all together. He said that stretching the tissues is independent of what fixator is used, and if you're doing 2 or 3 centimeters then that's okay, but 6 cm for example really puts the load on whatever device you're using. He then said that monolateral fixators are great for collapsed fractures so the soft tissues are meant for a greater length, so even if you do 5 or 6 cm in that instance you're just taking them back to where they were originally. But for someone who is otherwise normal, the moment you start reaching 6 cm, you're putting a lot of strain on the tissues. You also have a risk of internal scarring which can inhibit your knee ROM.
If I have a chance to ask him what his max is for external femurs during my last visit to the hospital I will.
Quote from: paco1 on October 23, 2014, 07:28:14 PMHi Kilokhan.
I hope things are going well for you. Your tibias look like long.
Cheers, paco.
Thanks 
Doing well. Biggest thing to worry about now are the flight arrangements.
Did the hexapod cost extra from what you paid for surgery?
I paid the price for LON and the cost for the nails that I didn't use covered the hexapod, additional pins, meds, dressings, food, and week hospital stay.
Can you also double check with him that he has no limits for internal Precice 2 femurs? So he'll let patients go the maximum of 8cms?
He'll let you go the full 8 cm if you do Precice femurs.
Ah okay thanks
Regarding those physio sessions you've been having, how much were you charged? And was there ample space in your hotel to do the stretches and exercises?
And do you think your body could have taken more lengthening? Say another cm should Dr Parihar approve of further lengthening?
All physiotherapy sessions done at the hospital come with the surgery fee, meaning you won't be charged anything. You'll only be charged by the physiotherapist if he or she comes to your hotel. I'm not sure if they each have their own rate, but Dr Chaudhary charged me 1,000 INR (around $17 USD) per session and left me an electric muscle stimulator that I could use whenever during the day. Hotel room had more than enough space to do everything. Half the exercises can be done on the side of the bed and there was plenty of wall space for the standing exercises.
I think I could have pushed to 7 if I wanted to but it would have resulted in equinus that would take much longer to correct as well as more time spent in the hexapod to correct misalignment. By the time I got to 6 cm I already felt a change in muscle tightness. I think 6 cm is definitely a reasonable maximum for tibias.
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