Adriano.
you cant do both as I understand it.
apart from the obvious. when you lengthen femurs you loose range of motion, and so it is not possible to even do tibia stretches while lengthening femur. it would be impossible to prevent extreme ballerina.
Quote from: Adriano on October 26, 2014, 10:48:39 AMWow man I would like to take this moment to thank you for all you have done for future LL'ers.
For ppl like me on a budget your effort to obtain information and post it put here has been priceless. You feel like a brother to most of us in this forum. You respond to questions u don't have to answer and I am amazed by your ability to help others at no benefit to yourself.
You might remember that I am looking for a Dr to do 4cm monorail external only on my tibias. However, since yesterday I have been wondering if I should just get this all done and over with.
What do u think about 4cm in my tibias external with comfortable monorails and 8cm in my femur with precise simultaneously? I intend to break my femurs 3 weeks after tibias to minimise embolism and other risks.
I figure that if tibias consolidate slower and I only lengthen 4cm that I could be walking with crutches 6 month s from the first operation.
I only weigh 58kg and I expect that to drop to 55kg during LL so I should be able to partially weight bear on the monorails and the precise during distraction.
Please ask Dr Parihar what he thinks as he is my first choice for my LL adventure?
Thanks mate for ur MASSSIVE and SELFLESS contribution to this site. I will be in India around mid November so its a pit yI will miss yah.
Cheers mate
Do Tibias first wait to consolidate or fix ballerina and the go internal.
Thanks guys but how can u get ballerina from lengthening 40mm??
AT 55kg I should be able to partially weight bear with any devise (thus preventing Ballerina).
I based most of conclusions on ppl who used monorails. I also checked out Diso*s diary.
I have noticed that ppl who are immobile for 3 months or more get ballerina or duck ass regardless of what LL method they r doing.
We have also learnt that muscles shorten after a while if they r not used. This should be obvious to any1 and not just the LL community.
I read diaries of guys who almost got ballerina at 3cm.
I am sure we all read diaries of guys who had ZERO ballerina at 4cm (sometimes 5 cm) but suddenly ended up with 7cm (approx.) BL after they reached 7-9cm lengthening!!
this suggest to me that BL is a function that depends mostly on how long one is immobilised and not only on how much u have lengthened.
NB the more u LL the more u r IM and therefore the more u r IM.
I am sticking to 4cm on my TIBIA, this can be done in 6 weeks. I can tell u right now that there is no way u can get ballerina after just 1.5 months!!!
stand flat footed and then stand on ur toes. the diff in height will just be over 6cm but no more than 6.5cm.
Ever wonder why the safe limit is 6,5cm max !!!!!
this is why anything under 6cm is safe.
The monorail fixator is also stable up to 5cm !!!
Read Body builders' diary up to the point he reached 5.8cm as well as Crazy + 6's comment.
I honestly expect that if one did 4 cm tibia external only that they would be fully consolidated after 90mdays from surgery if they took bone healing and medication the day after surgery. lets face it u wont consolidate with this time period if u do 1mm a day.
WE COMPLICATE LL BY TRYING TO LL Beyond THE SAFE LIMIT OF 5CM..
Look at Old But Goldie. the guy is around 40yrs old. he had a rod in his bones which slows consolidation and yet he was running around at the beach within 70 days after LLing the safe limit of 5cm.
When r we going to learn and stop pushing the limits??
I think that consolidation LL external only gains goes something like this.
2cm = 1 month distraction + 2 months + 1 months = 4 months
4cm = 2 month distraction + 4 months + 2 months = 8 months
6cm = 3 month distraction + 6 months + 3 months = 12 months
8cm = 4 month distraction + 8 months + 4 months = 16 months
10cm= 6 month distraction + 10 months + 6 months = 22 months
This is actually very realistic if u look at the guy who did 9cm (external only) in Russia and the fact that he bent one of his tibias by walking too soon on his tibias after LLing for 1.5 yrs aprrox.
Apo also did 1cm tibia and he is still not consolidated. his consolidation is further slowed by the rod inside his bones.
Another case in point is Good Foot Baller.
Quote from: Adriano on October 26, 2014, 02:14:04 PMThanks guys but how can u get ballerina from lengthening 40mm??
AT 55kg I should be able to partially weight bear with any devise (thus preventing Ballerina).
I based most of conclusions on ppl who used monorails. I also checked out Diso*s diary.
I have noticed that ppl who are immobile for 3 months or more get ballerina or duck ass regardless of what LL method they r doing.
We have also learnt that muscles shorten after a while if they r not used. This should be obvious to any1 and not just the LL community.
I read diaries of guys who almost got ballerina at 3cm.
I am sure we all read diaries of guys who had ZERO ballerina at 4cm (sometimes 5 cm) but suddenly ended up with 7cm (approx.) BL after they reached 7-9cm lengthening!!
this suggest to me that BL is a function that depends mostly on how long one is immobilised and not only on how much u have lengthened.
NB the more u LL the more u r IM and therefore the more u r IM.
I am sticking to 4cm on my TIBIA, this can be done in 6 weeks. I can tell u right now that there is no way u can get ballerina after just 1.5 months!!!
stand flat footed and then stand on ur toes. the diff in height will just be over 6cm but no more than 6.5cm.
Ever wonder why the safe limit is 6,5cm max !!!!!
this is why anything under 6cm is safe.
The monorail fixator is also stable up to 5cm !!!
Read Body builders' diary up to the point he reached 5.8cm as well as Crazy + 6's comment.
I honestly expect that if one did 4 cm tibia external only that they would be fully consolidated after 90mdays from surgery if they took bone healing and medication the day after surgery. lets face it u wont consolidate with this time period if u do 1mm a day.
WE COMPLICATE LL BY TRYING TO LL Beyond THE SAFE LIMIT OF 5CM..
Look at Old But Goldie. the guy is around 40yrs old. he had a rod in his bones which slows consolidation and yet he was running around at the beach within 70 days after LLing the safe limit of 5cm.
When r we going to learn and stop pushing the limits??
I think that consolidation LL external only gains goes something like this.
2cm = 1 month distraction + 2 months + 1 months = 4 months
4cm = 2 month distraction + 4 months + 2 months = 8 months
6cm = 3 month distraction + 6 months + 3 months = 12 months
8cm = 4 month distraction + 8 months + 4 months = 16 months
10cm= 6 month distraction + 10 months + 6 months = 22 months
This is actually very realistic if u look at the guy who did 9cm (external only) in Russia and the fact that he bent one of his tibias by walking too soon on his tibias after LLing for 1.5 yrs aprrox.
Apo also did 1cm tibia and he is still not consolidated. his consolidation is further slowed by the rod inside his bones.
Another case in point is Good Foot Baller.
If you lengthen 5cm external tibia, consolidation will take around 7 months (until you can take of the frames and walk with crutches).
4 cm is safe limit
but even if you lengthened 5cm. and you had ballerina, it would go away by itself one month after the distraction.
during distraction I had ballerina, and you could ask "machine" about it as he mentioned it's almost about the same as his ballerina but 1 month after I finished distraction it disappeared and I wasn't even standing for a min at that time.
Update: 10/28/2014
I arrived at LAX around 12:15 pm yesterday after a ridiculously long flight from Mumbai to Newark and a not so short flight to Los Angeles. One of Hotel Maharana's managers took the cab with me to Mumbai International Airport (which is super nice and much better than Delhi's btw) and helped me with my luggage until he could no longer proceed through security. The security in Mumbai asked me a bunch of questions about my frames but let me through after looking at Dr Parihar's doctor note. I had to go through customs and not only did they need to see the FRRO stamp on my passport, but they also wanted to look at my Stay Visa form allowing my visa extension provided by the FRRO (make sure you don't lose that if you extend your stay). I booked an economy plus seat on United that had a bunch of leg room, and although that helped I had to lift myself off the seat and hold myself in the air many times during the flight to get relief from the butt soreness. I didn't eat or drink the entire day previously so I didn't have to go to the restroom multiple times, but I still ended up going once on the flight. I was allowed to bring my walker on the plane and one of the flight attendants helped me to the restroom across from me, even blocking people from waiting by the door while I was in there. The on flight movies were good and I saw a bunch of new releases, but I got a little nervous when I saw on the flight route that we flew over Pakistan and Afghanistan. I couldn't stop thinking "what if we got shot down?"
At Newark I had to collect my baggage and go through customs again before checking in my luggage and going through security once more. A lady who worked there pushed me on the wheelchair and held my walker for me at the same time, making the process easier. Unfortunately I missed my flight because TSA said they found trace amounts of explosives when they swabbed my hands so I had to be taken to a side room for a private screening which involved another pat down and more attention to my groin area from the TSA agent. At least I was able to get put on another flight to LAX only 30 minutes afterward, but man was I annoyed.
The flight attendants on both flights were very curious about what happened to me so I made up a story about how I had a double fracture landing from a high balcony while trying to perform a stunt. They felt really bad for me and I felt a little pathetic, but hey this procedure was worth it I think. When my mom picked me up at baggage claim the first thing she said was that I became as thin as a rail and looked like John Lennon with my below shoulder length hair and Ned Flanders mustache (which I've really got to shave). My sister met us at the car and she was excited to see me, partly because she got to put her medical assistant work to use and assist me in the car and fold up my wheelchair. She's been a big help and volunteered to be the one to prepare my boiled water and pour the pitcher of water over my hands while I scrub them during dressing changes.
Dr Parihar and Dr Divya both sent me an e-mail asking if I made it home safely. I replied the affirmative and gave them my thanks for my positive experience with them. Haven't gotten a reply yet though.
My legs got really sore last night and my left calf and hamstring began to throb like crazy. I was in so much pain that I took three Ibuprofin NSAIDs throughout the night so I'd stop having to rub them vigorously. I'm hoping the pain goes away completely within the next month. I also saw that my equinus had become less serious when I did my standing with my walker. These new reinforced straps that Mr Shringare attached to my sandals a few days ago allowed me to make my feet stay at a tighter neutral position and really stretched out my calves, which I think is the main reason my equinus seems to have gone down significantly in the last few days.
Quote from: Slim_tim on October 26, 2014, 04:08:39 AMwhy did you increase the rate?
Also the reccuring theme seems to happen, so if we just lengthen .75 mm it all will go smoother.
I foolishly thought I'd save some time in the distraction phase but all it did was make it take longer because Dr Parihar told me to abstain from distracting for a while to rest my tissues and work on the equinus.
Quote from: ShortyMcShort on October 26, 2014, 06:00:00 AMWhat does it feel like being 6cm taller now? Is it that much of a difference?
What are some new things you've noticed?
I see the difference in my tibia length and my mom and sister commented that I look much taller, but I haven't been up and walking near people so I haven't yet seen how much of a difference that 6 cm makes me feel around others.
Quote from: GROWtalORdieTRYING1 on October 26, 2014, 10:22:44 AMhehe you couldn't resist the extra 2 mm 
I have a feeling it will be the same with me.
congratulations how does it feel to finally finish?
it is very tempting to do more than .75mm everyday, I don't know if I could stick to that limit but I will try. did you get equinox when you were lengthening at 1mm or 0.75mm each day?
anything you would have done different in hindsight?
When I finished distraction I was at 6.5 cm. I kind of wanted to just stop at 5.5 cm but Dr Parihar said that if I wanted 6 cm I'd need to turn another cm because he had to compress my tibias and I should also account for margin of error in x-ray measurement. He said I might be a little over 6 after the second surgery but it wouldn't make a difference in my recovery with that small an amount.
I wouldn't have done 1 mm per day ever if I could go back and do it differently. The first time I alternated between .75 and 1 mm per day I ended up with severe pain that made walking almost impossible and weakened my legs so that extensions were almost impossible by myself. The second time I did 1 mm per day for 7 days and at the end of that I had developed equinus. 1 mm daily is too fast for tibias, imo.
Quote from: Adriano on October 26, 2014, 10:48:39 AMWow man I would like to take this moment to thank you for all you have done for future LL'ers.
For ppl like me on a budget your effort to obtain information and post it put here has been priceless. You feel like a brother to most of us in this forum. You respond to questions u don't have to answer and I am amazed by your ability to help others at no benefit to yourself.
You might remember that I am looking for a Dr to do 4cm monorail external only on my tibias. However, since yesterday I have been wondering if I should just get this all done and over with.
What do u think about 4cm in my tibias external with comfortable monorails and 8cm in my femur with precise simultaneously? I intend to break my femurs 3 weeks after tibias to minimise embolism and other risks.
I figure that if tibias consolidate slower and I only lengthen 4cm that I could be walking with crutches 6 month s from the first operation.
I only weigh 58kg and I expect that to drop to 55kg during LL so I should be able to partially weight bear on the monorails and the precise during distraction.
Please ask Dr Parihar what he thinks as he is my first choice for my LL adventure?
Thanks mate for ur MASSSIVE and SELFLESS contribution to this site. I will be in India around mid November so its a pit yI will miss yah.
Cheers mate
Thanks Adriano. I hope your lengthening goes smoothly and await with interest to see which doctor you will choose. I know Dr Parihar isn't exactly a fan of monorails for cosmetic lengthening. He said they're good for lengthening a fracture that collapsed and left the leg shorter than usual, so when you lengthen it just takes you back to your original length. But for lengthening beyond your natural length it becomes more difficult than Ilizarov frames. He also said that it's easier to get equinus with monorails and if you've got thick legs it's easier to develop valgus (x-legs) with them also. If you're keen on monorails though just talk to him about it and he might do them if you really want them, though there's a chance he'll say no. I know for sure that he won't lengthen four limbs at once so you won't be able to do simultaneous internal/external with him. I'm not sure about Dr Shah's stance on that though. I know for me, external tibias was hard enough by itself. I can't imagine lengthening tibs and femurs at once.
I'm glad you made it home, post LL flight is a challenge!
Quote from: KiloKAHN on October 28, 2014, 11:04:49 PMWhen I finished distraction I was at 6.5 cm. I kind of wanted to just stop at 5.5 cm but Dr Parihar said that if I wanted 6 cm I'd need to turn another cm because he had to compress my tibias and I should also account for margin of error in x-ray measurement. He said I might be a little over 6 after the second surgery but it wouldn't make a difference in my recovery with that small an amount.
Why did Dr.Parihar compress your tibias and how much length did he expect to lose? Did Dr.Parihar say anything about callus subsidence after frame removal?
Quote from: KiloKAHN on October 28, 2014, 11:04:49 PMI wouldn't have done 1 mm per day ever if I could go back and do it differently. The first time I alternated between .75 and 1 mm per day I ended up with severe pain that made walking almost impossible and weakened my legs so that extensions were almost impossible by myself. The second time I did 1 mm per day for 7 days and at the end of that I had developed equinus. 1 mm daily is too fast for tibias, imo.
Do you think I will be able pull off 1mm/day if my maximum target is 4cm with externals without risking equines or any other contractures associated with tibia lengthening? I barely have any muscle mass on my lower leg, you can think of me as a stick figure.
Quote from: FullmetalShorty on October 29, 2014, 04:14:45 PMI'm glad you made it home, post LL flight is a challenge!Why did Dr.Parihar compress your tibias and how much length did he expect to lose? Did Dr.Parihar say anything about callus subsidence after frame removal?
Do you think I will be able pull off 1mm/day if my maximum target is 4cm with externals without risking equines or any other contractures associated with tibia lengthening? I barely have any muscle mass on my lower leg, you can think of me as a stick figure.
Yeah the airport was one of the most annoying parts about this whole thing lol.
He had to straighten the bones out and correct some misalignment during the second surgery. I forgot the exact reason for why the compression was done afterward but it had to do with that. He said the compression would only be a few mm, but if I hadn't turned the extra cm under his instruction, then I might have ended up with just a little over 5 cm instead of closer to 6 cm.
He made it seem like subsidence loss should not happen usually even with exfix, but on the chance it does happen it shouldn't be more than 3 or 4 mm.
Your body might respond differently to it than mine did. If you aren't suddenly getting heavy pain and your calf muscles don't feel tight then you could probably go up to 4 cm at 1 mm per day without issue. Dr Parihar first wanted me to test out the 1 mm per day by alternating days between .75 and 1 mm but my muscles didn't respond well to the increased distraction rate.
Update: 11/7/2014
Yesterday I had an appointment with an orthopedic surgeon that my GP referred me to, conveniently located a mere 5 minute drive away from my office. The co-pay was $40 because I had to get an x-ray of my tibias in the radiology department before meeting the ortho. The two guys doing the x-rays were very curious about the Ilizarov frames and one of them was in disbelief that I chose to lengthen my legs. After his initial shock he didn't pester me about it though. After my x-rays were done I saw the ortho, who was genuinely interested in my case. He's not an Ilizarov surgeon but he's had people come in with frames who were operated on for discrepancy or deformity. When I told him I voluntarily lengthened my legs and said it was primarily due to social situations being less than ideal for me while having very tall half-siblings, I was prepared for a response along the lines of "you're an idiot for doing this to yourself" or general rudeness that other lengtheners have experienced from their orthos back home. To my surprise he was sympathetic about it and just told me that it's unfortunate that I felt I had to go to such an extreme to feel better about myself.
My GP who wrote the referral put down that I had gone to India for lengthening and he asked about who I went to see over there. I told him a little about my multiple consultations and how I decided on Dr Parihar due to my good impression of him and his prior fellowship with Dr Paley, to which my ortho replied "Dr Paley is the king". Looks like Paley is held in high regard by orthos across the board, not just Ilizarov surgeons. He examined my legs a bit, going over the pin sites and checking to see if there was any soreness before looking at the x-rays I had just taken. To my relief he said my healing looks to be going exceptionally well and that I have "massive regenerate" in both legs. He gave me a prescription for oral antibiotics in case of pin site infection later and said I can just get over the counter supplements for my calcium and zinc intake. I'm supposed to continue weight bearing as much as I'm able and see him every three weeks.
Right now I still have a lot of aching in the calves, but a lot of it is on my hamstrings and near my hips, which I believe is from the atrophy. The left calf is a little swollen but I took an ibuprofen which helped it go down. I thought all the aches and soreness would go away as soon as distraction was over but I guess it's more of a gradual thing.
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