No More Mal-Kahn-Tent - External Tibias - Dr Parihar

Best of luck for a smooth lengthening and recovery!   

Good luck in your journey

Fourth Consultation: Ashwinii Accident Hospital with Dr Suhas Shah
I had tried to find Dr Shah's clinic once before and failed, but I was lucky enough to find a taxi who knew exactly where it was. When I arrived I realized why I had not found it before. Dr Shah's clinic is actually in an apartment building located right behind a Michelin tires shop, and the hospital sign is partially obstructed in the front. The only noticeable sign from the hospital is hung in the alley leading to it and its entirely in the local alphabet. I saw an open door to the left when I entered the main area to the apartment and saw that it was clearly a clinic. Though small, it was clean and the floors were shiny. A receptionist greeted me and had me put my shoes on a rack next to the door. When I sat on one of the chairs inside I watched a video playing of Dr Suhas Shah describing the Ilizarov method. The wait was about 20 minutes as Dr Shah was meeting a group of three people, but I eventually got to ask all I wanted. The consultation was about a half hour and the fee was 1,000 INR. I was pleasantly surprised at how jovial Dr Shah was, which was very different from his serious appearance and way of speaking in his video on Youtube. The following are the points I can remember.

1) Dr Shah has studied in Germany in addition to USA as a fellow of Dr Paley and Italy as a fellow of Dr Catagni. He has performed over 5,000 surgeries within the last 20 years.

2) He is a fan of weight bearing during distraction and will have you start weight bearing from the third day after surgery.

3) Prefers lengthening tibias over femurs as he says femurs come with a lot more complications.

4) Believes external fixation is the safest method of tibia lengthening but will also perform LON. Is not a fan of LATN.

5) He will perform plate fixation (LATP) as a way of reducing external fixation time. Said he has done plate fixation many times before and he thinks it's as good as LON.

6) He doesn't use the hexapod fixator for corrections after lengthening, unlike Dr Dhawan and Dr Parihar. Will monitor you during follow ups and check for things like valgus, procurvatum, etc, and do the corrections then.

7) Lengthening limit for tibias is 7.5 cm.

8 ) Told me I'd be crazy to consider lengthening a large amount like 10 cm on one segment and would be surprised if I'd be able to walk normally later

9) Also follows Dr Paley's method of fibula fixation both proximally and distally. He fixes the fibula with Shanz screws.

10) Said that in all of his cosmetic cases for tibia lengthening he will release the fascia and nerves. Told me that in his experience, 110% of the time you will face serious problems with equinous later if the releases are not done.

11) Prefers to do an ITB release in all femur lengthenings for cosmetic patients.

12) Asked me what the result of a car accident would be if I were wearing a seat belt versus if I were not wearing one. Said I may survive in either case but I'd be far better off if I took the precaution by wearing the seat belt. Explained that this is why he does the releases in all cases so he can avoid or minimize complications before they happen instead of running into them first and then trying to correct them after the fact.

13) Told me that I could expect to be able to run starting one year after date of surgery if I wanted 6 cm with exfix only.

14) Will perform limb shortening. Said it's not too difficult a procedure but you'll lose significant muscle power after the bone is taken out and would have to work particularly hard to regain the lost strength

15) Will perform humerus lengthening and says it's the easiest segment to lengthen in the body. Doesn't think anyone would need to consider it though after reasonable lengthening in tibias, but said it might be a necessity if you overdo it with two lengthenings and can barely reach your trouser pocket afterward.

16) Thinks internals are a straightforward procedure and if you want Precice lengthening he can do it for you. Only drawback he said was the cost. However he prefers it now over monorails because loss of ROM is a very common complication with them.

17) Showed me a video of a woman walking in shorts with her face blurred. Told me she's an actress who came to him for cosmetic lengthening to help her career. So he's done cosmetic lengthening before, not sure how many though.

18) At the same time, he also said that the reason so few surgeons can do cosmetic lengthening safely is because Ilizarov has a very, very steep learning curve. Said you need to go to someone with years of experience in correcting deformities and the like because those are the surgeons that have the experience with these complications to know how to fix them when they happen or avoid them from coming up in the first place.

19) Told me it's a very bad idea to go to any surgeon in India for leg lengthening who does not specialize in it. Said he's the Vice President of ASAMI (Application of the Method of Ilizarov) and that two certain other surgeons are unknown in India for leg lengthening and certainly not recognized for it internationally.

20) Would prefer to see you once every two weeks during treatment but said once a month is also acceptable.

21) Wants you to stay in India for the entire duration of treatment (meaning consolidation phase also) but said if you can't stay that long then he would want you to stay for distraction and then send him an x-ray every month through e-mail.

22) Said he is a very straightforward person who will tell you beforehand exactly what he plans to do to you during surgery, meaning you won't wake up later with specific releases or what have you done to you without knowing you were getting it beforehand.

23) Price quoted was very affordable.

24) Regarding the chronic knee pain after LON, said it often happens due to the diameter of the nail being improper or the insertion being done incorrectly. He said that with the right technique the chronic knee pain probability should be very minimal.

After the consultation was over I ended up going back to the hotel to deliberate on just who out of the four surgeons I met I'd feel most comfortable with doing my surgery.

Note: This is what i can remember. I wrote down notes but they're in my backpack and I'm not near it at the moment. I'll add anything from the notes that I forgot along with pictures of Dr Shah's clinic on my next update. If you plan on visiting Dr Shah you'd need pics to find his clinic anyway.

Tx again for the very detailed info, your diary will definitely be captivating!

I am curious about statement 15.

How does femur and tibs lengthening affect ur arms reaching your pockets??  Upper body and waist line stay the same, unless you lengthen your torso, your pockets will always be at the same reach.

Number 11. What is itb release?

How are you doing after surgery man??  Keep us updated! 

what doctor did he choose?

Other points from Dr Shah consultation:

25) Has no height limit. Will lengthen you as long as he determines that you're sane.

26) He and his own psychologist will evaluate serious prospective patients.

27) Has a physiotherapist who can come to your hotel for extra cost. His assistamt can also come to help change dressings or with other fixator issues.

28) Also stated that LON does not prevent x-legs.

29) Says psychologically unstable patients or people with low pain tolerance are not candidates. Patients who are the most optimistic and dedicated often have the best results.

Here are the pictures from the clinic. The first picture shows a bit of the tire shop on the left, which is directly in front of the apartment complex where Ashwinii hospital is located.

Quote from: G-Man on June 27, 2014, 07:39:03 PMTx again for the very detailed info, your diary will definitely be captivating!

I am curious about statement 15.

How does femur and tibs lengthening affect ur arms reaching your pockets??  Upper body and waist line stay the same, unless you lengthen your torso, your pockets will always be at the same reach.

I guess he means your arms will look even shorter if you lengthen your femurs a good amount in addition to your tibia, like you're wearing stilts or something. That's what I decided he meant anyway.

Quote from: KirP1 on June 27, 2014, 09:37:50 PMNumber 11. What is itb release?

It's where the iliotibial band is cut. It relieves pressure and it apparently makes lengthening easier.

Quote from: BilateralDamage on June 28, 2014, 10:50:59 PMHow are you doing after surgery man??  Keep us updated! 

I've been writing a lot in MS Word as the days pass. Just haven't gotten the time to post it yet. I'm hoping to post it within the next day or so.

Hi KiloKAHN,

Hope everything went well with your surgery! Do tell us which doctor and method you chose.