Hi Phoenix
congratulations for 3 cm height gain and leg correction 
i believe you are still in Delhi and somewhere close to Sir Ganga Ram hospital , i am also from Delhi and somehow i am interested in opting for LL , after going through KiloKahn's diary i made up my mind to visit Dr.Dhawan for a consultation but to be honest, reading about all complications and pain & the long time one needs to wear those frames i was discouraged to go ahead 
would it be possible for me to come and visit you as i am really curious to see a patient (specially scars) in real instead of online pics, i visited Dr.Sarin's guesthouse around 1 month back but there were around 5-7 guys (all Indians) in the room who all had done their LLs there and being a girl i was embarrassed to ask questions while others were all staring at me 
so i couldnt even check anyone's frame and left in few minutes as doctor Sarin was waiting for me outside
please let me know if it would be possible, you can drop a private message in my inbox
all the best with your LL journey
Phoenix.. Rising !! External Tibias with TSF Frames @ Dr. Dhawan, New Delhi
Quote from: parmida on June 12, 2015, 02:14:13 PMHi Phoenix
congratulations for 3 cm height gain and leg correction
i believe you are still in Delhi and somewhere close to Sir Ganga Ram hospital , i am also from Delhi and somehow i am interested in opting for LL , after going through KiloKahn's diary i made up my mind to visit Dr.Dhawan for a consultation but to be honest, reading about all complications and pain & the long time one needs to wear those frames i was discouraged to go ahead
would it be possible for me to come and visit you as i am really curious to see a patient (specially scars) in real instead of online pics, i visited Dr.Sarin's guesthouse around 1 month back but there were around 5-7 guys (all Indians) in the room who all had done their LLs there and being a girl i was embarrassed to ask questions while others were all staring at me so i couldnt even check anyone's frame and left in few minutes as doctor Sarin was waiting for me outside
please let me know if it would be possible, you can drop a private message in my inbox
all the best with your LL journey
Hey Parmida,
Thank you!!
After going through the surgery, I will not recommend LL surgery for anyone unless it is absolutely required. It is a very big commitment and you should know all the pros and cons before getting into it.
I am still in Delhi, and you can visit me anytime. I will PM my contact number to you. Also, if you want I might even introduce you to a female LL patient from Delhi. She is currently in her consolidation phase, and being a female she might be more helpful to you
I have started my lengthening again after a one week break. I am doing physiotherapy regularly, and weight bearing at least a couple of times per day. Left ankle is still stiff, but I can bring my ankle to neutral position during weight bearing.
Also from a few weeks, there is a lot of itching sensation around the pin sites. I know it is very common and natural, but its really irritating. Is there any way to stop it ?
Between my last post and now, my leg issues have doubled. Initially I was weight bearing daily, and only left ankle was stiff, but that too used to come to neutral position after some time. I stopped walking from a long time since my ankle pain started. But, 10 days back, I decided to walk; when I tried to take my first step itself, I lost control and luckily I managed to fall back onto the bed. But, in the process, I put a lot of pressure on my legs I suppose. After a couple of days, my right leg calf muscles started paining and the pain subsided in 2 days. Meanwhile my left leg calf muscles also started paining. I thought it will be back to normal in 2 days too. But, even after almost a week, left leg calf is still paining, and the pain extended to my thighs too. Moreover, I am not able to make my left leg completely straight. It is slightly bent at the knee. This problem started with the calf muscle pain. I am still hopeful that it is not a big problem, and will subside shortly.
Despite all these, the main problem still is my left ankle. I think the ankle stiffness is not because of stretching. I can notice the difference between my left ankle and right ankle. When I stretch my right ankle, the stiffness and pain is usually on the back of leg, in the calf muscles and below knee. I can feel muscles pulling naturally. But, when I stretch my left ankle, it is very stiff, like it is struck there before even my muscles stretch in the back. It is like my ankle bones and my tibia bones are colliding, not the natural elastic movement which I have in right ankle.
Also, in those few days when I did some weight bearing, it put a lot of pressure on my left ankle, and I feel, ankle fixation screw has moved out around 2mm. I can just feel a bulge of the screw head under my skin now. It was not noticeable before. Ankle fixation was good before, but after my 8 degree bow leg correction, the leg angle has shifted a lot, and that might have put the ankle fixation at a wrong angle with respect to new leg structure. I am starting to think that might be the whole reason for this ankle issue.
In fact, I spoke to Dr.Dhawan about it in my last visit, he took a ankle X-Ray and thought everything is fine. And I was also not sure what the problem was then. That was almost 20 days back. So, I will take another fresh X-Ray on my next visit and see if it validates any of my theories.
For now, my physio has asked me not to put too much pain on the legs till the muscle pain is subsided. So, I am resting again. No weight bearing for now, only stretch exercises.
Well I'm here in Delhi.
First thing is when people say Indians are not trustworthy they are not underestimating. Delhi is a bit of a nightmare. The Hospitals are completely packed and it's completely dog eat dog. You really have to be on guard 24/7. Being white is an automatic red flag as well.
Saw Dr. Dhawan and seems geniune enough. Pushed me for TSF frames for a 6 month period. LON or LAPN was not reccommended or talked about at all. He mentioned knee pain and pushed for TSF as his personal recommendation. Which from what I have read is sensible opinion but may not be practical for me.
He said the price is around 10 to 11 Lat which is now with exchange rate changes is quite expensive. No specifics though which is unsettling (but usual). The price is more than Russia now (at 14500 euros).
I am seeing a patient of his tomorrow. Which may or may not be you? Phoenix?
What I have noticed as well is Delhi is run on Kick backs. So basicly as soon as you say any sort of information, a recommendation will come whereby they will get money for it. Taxi, sim card, food, anything and I really do mean ANYTHING. It's really underhand. They will call ahead. Run out to you and hassle you. Follow you. Anything to get your money. This is the vibe you get from everyone in Delhi. So it's hard to get a handle on this doctor or anyone. It makes you question everything and everyone. A lot of people here are actively working to take, by any means, your money.
The hospital for one does not feel like a safe, healthly environment. Wards (in this particular hospital) if you can call them that are under construction and overrun. What provisions there are for any sort of surgery let alone complex surgery it is difficult for me to see at the moment. You are really rolling the dice.
Hmm, when I was there he told me that I had to make a choice between LON or the hexapod. TSF wasn't talked about, but I guess he has direct contact with the manufacturer of TSF now so he can offer them. Did you ask him about just lengthening with the classic frames and then switching to hexapod (their version of TSF) if you develop any misalignment? That will reduce the price a fair amount. I was quoted $9,000 USD for LON and $10,000 for the hexapod, and that's when the USD was weaker against the INR than it is now.
So you saw Dr Dhawan at Sir Ganga Ram hospital instead of his private clinic?
You might also be interested in checking out the Rockland Hospital team and consulting with Drs Verma, Talwar, and Ratra.
Hi Kilo.
Yeah I saw him at Sir Ganga'. Wanted to check out the hospital. He obviously has more expirenced with the TSF now and for making adjustments it does make sense however I do believe the fact that he can charge more for it does come into it.
He reuses the TSF frames it has nothing to the manufacturer in my opinion. I asked 'would it be possible to get the frames removed in the UK'. 'No, the frames are very expensive and we need to reuse them' was his reply. Which is sort of tells you he really gets them on an ad hoc basis and really needs them back. I doubt he has ever bought new TSF frames.
I'm pretty sure the frames are to justify the added cost in comparision to other people offering surgeries in India. So he can now charge £11,000. If he was to offer just hexapod and his qualifications (which may be superior) this does not really differentiate him. TSF are a mark of quality which the hospital and the level of care provided (from first impressions) do not live up to from what I have seen.
I think if he said £9000 hexapod people would flat out say no. The hospital is way below substandard. So donated TSF frames equals £11,000 price and the name and look reassures rich westerners.
Think Africa aid clinic then triple the amount of people ten times. You have to be honest. The 'private' rooms are just in the middle of it and patients are flung around the corridors in all manner of states amoungst hundreds of people. I do mean hundreds. I don't doubt his qualifications or skill as such. It's the state of equiptment and facilties which are of grave concern. His recommendations are in line with the best options available for height surgery but he does understand that's why people would come to him and not others and how he will be judged. If he said anything else he would have no patients.
This is obviously a lucrative business as the number of assistants more than tripled when I talked to the dr. They all had the air of wanting to make money about them. Their faces of some of them when I said I wanted to see another Dr were instantly telling. Dr Dhawan even got them to get the doctors number and one was very perterbed by this and remarked in hindi. (Dr was Dr Talwar). There is always that pressure it seems in Delhi. The majority honestly have the constant, I do mean constant, drive to squeeze every penny out of you. More than 50% of Delhi live in extreme proverty and you can feel its effects. People need money. I'm not talking about medical assistants, these are non medical persons. The more people around the more likely there is going to be the Delhi 'mindset'. So the number and their reaction of the 'assistants' worries me. It makes sense that the price will and has been driven up.
Drs, from what I can see, being educated classes can isloate themselves somewhat and Dr Dhawan could be geniune but it's so hard to tell honestly. Most will happily and is somewhat part of the culture to lie to your face (in semi polite manner).
I have just come from Russia. I didn't visit any hospital or anything related to LL as I could only get 1 month visa. But the standards there are leaps and bounds above India. Sanitation? There is zero in India. Russians do have standards. How can you trust a hospital with live construction, doors falling off etc. It's a big ask. Incidence of infection etc. This is the centre of Delhi. Thousands of sick people with untold diseases streaming through. Would you risk open wounds in a shared room for £11,000? Not only that they usually tell the truth and price said is the price paid. No tricks or sob stories etc. Maybe Rocklands might have better standards.
I would happly pay that with decent standards. Tomorrow.
*There has to be some lines. My lines are pretty low. Low, low, low for this. So please don't take my comments lightly if you are reading and thinking whatever. I want this for the right reasons, for me and I am willing to do more than you to get it. I am honestly still considering Dr Dhawan and looking forward to changing my mind tomorrow.. Trust is in short supply...
Hi upandaway, I was busy from a couple of days.. Didnt check ur replies.. You might be meeting me. When Doctor called me to inform that someone from UK is interested to talk to me, I figured it might be you.
Quote from: Phoenix on June 06, 2015, 04:46:01 PM
The only minor inconvenience I have is with the post-op consultations. The hospital is very big, with many buildings and there are lot of patients so where ever I go there is a big crowd. There is a waiting involved every where. Every consultation takes almost 2.5 hrs, where most of the time is consumed for x-rays. This is not even an issue for many, but I hate hundreds of people staring at my legs, and I hate waiting before the X-Ray room, as I feel like a disabled, helpless patient when I sit in that hospital wheel chair for that long.
I informed you before hand how the hospital would be wrt the people. India has 3 times the population of that in US, within one third of its area. So there would be lot of people around, and Delhi is national capital, so very crowded. Also, due to your skin color you will get a lot of stares. Delhi people are shameless at that.
Sir Gangaram hospital is the largest hospital in Delhi catering to both rich and poor. What you saw yesterday was the old building which was built in 1954. It is undergoing some renovation. Old building is used for doctor consultations only. And that is where most people come to, and that is where you went to I suppose. It is not modern and I am sure you did not like it. There is a new building behind this where most of the modern equipment is. That is where the surgery will take place, and that is where you stay post-surgery. They do maintain standards and hospital is clean enough. It is built recently and is modern enough. Many rich politicians and rich people have surgeries here, as the hospital has modern equipment and the doctors are skilled enough. But if you are going to compare it with the hospitals in US/UK, it will be a no match for obvious reasons (The same rich people go to US/UK for complex surgeries.. 
.
This hospital gets government funding as it was service oriented, so they do surgeries to some poor trauma patients every year free of cost, or for some nominal price depending on their financial capability. I am sure they will re-use the TSF rings for such patients for deformity correction. After the consolidation, you are not obliged to take off rings here, irrespective of what D. Dhawan wants. You can do it anywhere, and any doctor will do it easily. Dr Dhawan might "like" it if you returned the frames, so he can use it for other poor patients, but he has no right what so ever to insist you to return them.
Also 2 days back I went to hospital for changing my Struts on the frames. They brought there a big TSF Kit, which has a lot of screws, Struts, Rings etc., all new in TSF branded boxes. Doctor does say they get it directly from the manufacturer, and I dont think the rings I saw in the kit are old, or re-used. After wearing the TSF for 3 months, I know that even if frames are used for 10days, they will wear out. It is made of aluminium with black paint on it. Same as a black IPhone which looses its paint around its edges after a few days of use, TSF frames lose a lot of paint after using for a few days. Also there will be lot of nicks on the edges. So, it is easy to distinguish a re-used TSF frame. But I think it is not that easy to recognize a re-used classic ilizarov frame, as there is no paint on it, and everything is aluminium (or what ever that metal is).
I am not trying to convince you to do surgery here with Dr.Dhawan, in fact he sent few of his prospective LL patients like you to talk to me before too (or just to look at my TSF frames, and generally I am happy to talk to new people, so I let them visit me), and I always manage to scare them off if I think they do not understand the depth of their decision, and just want to be tall. I sent a few of them for further consultation with Dr.Talwar too. I believe people should have a complete understanding of what they are getting into before having this surgery. If you are basing your decision on the infrastructure available, before taking a decision, just have a look at the new building too. And being a foreigner, you will not be sharing room with anyone, you will get a separate room after surgery. There are many options for room facilities you can choose from. Even if you decide to go with Dr. Talwar, you will face similar issues. But, may be his hospital might have more corporate look (Not sure, never visited his hospital) as it is completely private and profit oriented. I did not prefer Dr. Talwar as he prefers Monorails, does not fix fibula, and the surgery is actually done by other doctors, he just supervises them (I got this last part from someone from Dr dhawan's team, so I might be wrong too). I did not like that idea.
Also, you can just have surgery with Illizarov/Hexapod frames as Kilo suggested if you dont want to spend more on TSF frames. That will reduce a lot of cost. Dr. Dhawan has started trusting TSF more than classic frames due to their good performance, and comfort. But, he do offer classic ilizarov if insisted. Like many indians, even he might have assumed you are the richest person around (It is a kind of racism though not explicit), so suggested the best option he offers. Most of the surgery cost in my case, (Almost 5 Lakhs) is for the TSF frames itself. So, opting for Hexapod will reduce the cost.
Irrespective of the doctor you go to, or the hospital you have surgery in, all my comments are generic, and apply to pan-india or at least for delhi.
Where ever you go in India, you will face people who look to make some money out of a foreigner. Their salaries are not so high, but cost of living is very high in metro cities like delhi. So, they tend to approach rich people for tips for services they provide. And in their narrow, limited view, a foreigner is like the richest person they ever saw in their life. But, generally, they are not very greedy and it might be a dollar or two more than they charge an Indian (2 Dollars is 120 Rupees which is a considerable amount for them). And considering all that, you should be able to negotiate to save few bucks. In a way you should be street smart to deal with people here. The silver lining out of this is, in India, you can get anything if you are willing to spend money. You can have maid cooking food for you, cleaning, washing and all help.. under $60. You can find a hair stylist(or rather I should call him a barber) who comes to your house and does a hair cut under $5 and so on. Finding english speaking maid/barber is a bit difficult though..
You should be ready to deal with all these issues and people, if you decide to do surgery in India, or look else where.
Quote from: Phoenix on July 10, 2015, 09:24:29 AMI did not prefer Dr. Talwar as he prefers Monorails, does not fix fibula, and the surgery is actually done by other doctors, he just supervises them (I got this last part from someone from Dr dhawan's team, so I might be wrong too). I did not like that idea.
That is true. Dr Talwar is the head of the orthopedics department at Rockland so it's considered his team, but the main surgeon doing the Ilizarov surgery at Rockland is Dr Rajesh Verma. http://www.hbgmedicalassistance.com/doc-details.php?did=275
He's the one who I did my first consultation with. It's true that they prefer monorails, and they prefer externals, but they will use classic frames if you go with LON. They're now offering Precice for femurs too.
Many things have happened in the past few days. On Tuesday this week, I went to consult with Dr. Dhawan. Initially, he changed a few struts which reached their maximum capacity for lengthening, and replaced with longer struts. Then I told him all about my left leg pain and stiffness at the knee and ankle. And how I feel it is not a problem due to lengthening. He asked a few questions, and then suspected it might be due to fibula consolidation pre-maturely. He advised me to take X-Rays to confirm the same. My fibula did consolidate quickly, and the two ends attached with thick re-generate. It happened due to bow leg angle correction of my left leg. It being a 8 degree bow leg, I had to bend the whole leg outwards by that angle, which brought together the two fibula ends. This led to quick consolidation over the last two weeks.
Doctor has advised me to have a surgery immediately to break the fibula again. As my legs are already straight, and since my main concern was not lengthening, I wanted to avoid extra surgery and offered to go back by 1cm, and stop lengthening at 4cm only if it can avoid surgery. But he said, that will not really help, and that fibula should be broken to ensure I do not have any problems in the future. And he didn't like the idea of lengthening only 4cm, just to avoid a simple surgery. Dr. Dhawan also assured me he will do the surgery as inexpensive as possible.
At last I agreed, gave blood sample for some medical tests for surgery and went back home. On doctor's advice, I turned back left leg by 5mm to ease off some pain and pressure on the leg. On thursday, I arrived at hospital by 8am. Immediately they prepared me for surgery, and I insisted on speaking to Dr.Dhawan before giving me anaesthesia. He came to talk to me. I explained him all the pain areas again, and then asked him to remove the fibula fixation screw too in the same surgery. I felt that post bow angle correction, the fibula fixation screw is giving me problem. More like my instincts were telling me I might have issue with that in the future. He explained to me that all the issues I experienced was due to fibula consolidation issues, and removing the screw might displace fibula and cause mis-alignment. But In a way I insisted, and half heartedly he agreed as my lengthening is almost done, and hence less chance of misalignment now. In a couple of hours, after surgery, I woke up and my leg was straight. It was not stuck in 90 degree angle at knee anymore. And no more pain in leg, probably due to pain killers.
By evening I was discharged, so came home with a much better leg, though it was cut open and bone broken on the same day. Surgery cost me $320.
Now I am just taking all the painkillers and antibiotics which he prescribed after surgery. Apart from the possible fibula mal-alignment issue, my leg is in better shape now. I am not sure about ankle movement yet, as it is covered in lot of bandage which is restricting active movement.
My right leg lengthening is completed. I stopped at 5.2cm. I started my left leg lengthening again today. Need to still lengthen 7mm, which includes the 5 mm I went back before surgery. Still 1 more week to go. By then I need to practice and be able to stand straight for X-Rays to finalize my leg angle and length. Doctor has asked me to go till 6cm if needed, but I said I am not interested in that. I cannot be in frames for that long. I have to be off this frames by December or January, and walking without aid by february. Just hoping I can achieve that.
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