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I was going to write a diary but decided not to due to dumb-ass comments that caused me to ask question whether the effort of a diary was a good use of my time.
Nonetheless, several folks poked me for an update so here it is...
I arrived St Petersburg on 11 Sep 2018 with no specific goal in mind except longer legs.
I met with Dr. Kulesh a few days later who discouraged bilateral femurs and recommended bilateral tibias. After hearing his points, I tended to agree.
I met Dr. Solomin a couple of days later. He opined that femurs could be done (it was possible), however, he strongly recommended against it due to my hip replacement. He recommended no more than 15% lengthening.
Dr. Solomin also recommended LATN rather than LON because he would be able to use a larger, more stable nail with LATN.
I had surgery on 21 Sep 2018 and began distraction on 01 Oct 2018. I am at 7.9 cm. Hexapods will be installed next week and Dr. Kulesh will ease me to my goal of 8.5 cm (23%) over the next two weeks.
My LATN surgery will be 20 Jan 2019 at the Medem Clinic. Kulesh and Solomin are not currently using the municipal clinic at St. Elizabeth and will work solely with Medem for elective lengthening for the immediate future.
Distraction was easy through 3 CM. At 5 cm, my ankles lost all flexibility and equinas began to be apparent. I accepted that stretching alone would be insufficient and accepted Achilles Tendon Lengthening (ATL).
Kulesh is developing a new procedure for ATL. In "regular" ATL, your tendons are partially severed, your leg is forced into position, the tendon stretches and tears, and the surgery is done. Significant risks are tendon rupture and over or under stretching.
Kulesh does the z-plasty; then, installs hexapods. In this manner, your tendons PLUS all soft tissue gently stretches over a period of weeks. Risk of rupture is essentially eliminated and the lengthening amount is exact. The downside is the procedure is painful.
The total cost of my procedure, including everything--surgeries, nails, meds, hospital, airfare, transfers, taxi, apartment, food, etc. will be approximately $22K.
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I was going to write a diary but decided not to due to dumb-ass comments that caused me to ask question whether the effort of a diary was a good use of my time.
- Lengtening over 15% - check
- Going to russia for LL - check
- Opting for ATL - check
gee, i wonder who is the dumb-ass here...
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Oh great. Lucky me.
Another uniformed, opinionated, dumb-ass adding his two cents!
Sure, don't go to St Petersburg and miss out on scientists who are also the foremost elective leg lengthening surgeons in the world, who enjoy decades of experience, use world-class facilities and techniques they pioneered; not to mention the extremely positive and beneficial cultural experience. Dumb-ass.
What are the risks of lengthening over 15%--and more importantly, how do you monitor your distraction-by-distraction progress to assess whether you are at risk? Do you think maybe the daily opinion of the top surgeons in the world as to whether it is prudent to continue distraction might be helpful? Dumb-ass.
What are the negative consequences of ATL performed properly? Oh, none? Dumb-ass.
Pull your head out of the sand and accept that the experts are the guys like Solomin and Kulesh who have a current caseload of about 500 patients combined and have handled that caseload for decades.
No one is an expert because they did some Internet research or had leg lengthening. Use the information you learn to guide your decisions only.
I approached this adventure by understanding that I had a goal but would listen to the experts; thus, I might not achieve my goal. I have been blessed to work closely with my surgeons--literally, daily interaction, and have been able to safely achieve my goals even though my goals exceed what some understand to be "safe" limits.
Every body is different. Monitor your body. Stop when your surgeon and your body tells you it is time to stop.
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have you had a hip replacement? what your height and age ? im not judging but you gotta be persistent :)
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I am 56 years old. My starting height was about 164 cm and my finished height will be about 173 cm.
I have bilateral hip replacements which is naturally a complicating factor for femur lengthening. That is, femur lengthening can be done internally, or purely externally, or externally with LON or LATN using an anterior approach; however, risks, including infection, are far greater.
Professor Solomin advised me not to consider elective femur lengthening under the circumstances--he could do it if a medical necessity justified the risks but no such justification exists in my case. Thus, my focus turned solely to tibias.
I am very satisfied with a finished height of 173 cm and do not intend to do anything else.
Persistent--probably. But more I believe that you have to commit to a specific course; then, plan and prepare to make that course successful. Many people who start the procedure do not seem to consider what life will be like during the procedure, do not adequately plan for that temporary life; then, encounter problems that should have been anticipated; thus, success is impaired.
I spent significant time planning and preparing--finding the right apartment, obtaining the right equipment, getting in the right supplies when I was ambulatory; then, testing my set-up before surgery.
For example, even though my apartment has ramps and an elevator, it also has 3 high thresholds I must cross to get from my apartment to the outside and vice-versa. While I could still walk, I made dry runs in my chair to see whether I could actually get to the store, etc. I found that I could not get out these doors because they were too heavy. I needed to find a way to prop open these doors while I got my front wheels over the threshold.
The next day while out walking, I found a small piece of solid construction debris that I can insert at the door hinge to hold open the door while I use both hands on the main wheels to clear the threshold. If I didn't do this before my surgery, I would not have been able to ever leave the building on my own.
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LOGISTICS
I am posting this public post in response to a couple of similar PMs:
Invitation Letter & Visa
Invitation Letters are more commonly "sold" rather than "issued". You can get certain facilities to issue an invitation letter for free; however, there is a significant expectation that you will then use those facilities.
For me, it was easier to buy the letter. I used "Fortuna Travel" but many provide this service.
Once I had my Invitation Letter in hand, I used the Visa e-service on the Russian Consulate website. I opted for a 3-year multiple entry Tourist Visa (I am a medical tourist) for maximum flexibility. This Visa allows me to stay in Russia for up to 180 days in one block. If I need more than 180 days in one block; then, I will take the train to Finland, spend the night; then, return to Russia for another 180 days. I can even use this Visa next year to return for nail removal, if desired.
Wheelchair
You will be hard-pressed to find a wheelchair in Russia with adjustable leg supports that permit you to extend your legs out flat. I bought one off Craigslist--most airlines ship wheelchairs for free.
I recommend you practice with your wheelchair. I fell from the chair twice--once just a few days ago going from bed to chair--something I have done without incident hundreds of times before. I also flipped the chair over backwards once trying to negotiate a threshold--this could have been tragic--don't drink and drive.
Finding an Apartment
I found mine on AirBNB using the map search function. I suggest you find something near St. George's Hospital because you will most often use St. George's facilities. 90% of possible apartments you identify will not be wheelchair accessible.
Or, you can do things the easy way by contacting the Property Manager I discovered--Alice Tsay (e-mail=3035358@gmail.com). Alice specializes in medical tourism and wheelchair accessible, high-quality units near St. George.
Alice will also register your address as required and provide transfer to and from the airport (as well as provide many other services upon request during your stay).
Currency Exchange
You can carry up to $10K in cash into Russia -- that is what I did. Make sure your bills are pristine--even a small 1/4 inch tear at the center fold will cause your bills to be rejected for exchange.
All major banks will exchange currency at very favorable rates--I used Sberbank. Just bring your Passport and registered address and the exchange should go smoothly.
Most Russians do not use savings accounts and keep their money on their person or stashed in a safe place. Be like a Russian and lock your door when you leave the apartment.
Leaving Russia for Distraction
I was surprised to learn that a majority of patients leave Russia after the initial procedure--Kulesh told me many are never heard from again.
Perhaps if you are doing a small distraction and have a good follow-up team at home this will be OK. However, if you plan to achieve significant distraction; then, the distraction process is ever-evolving until finished.
Many worry about frames bearing their weight. I was surprised to learn that the internal pressure your legs put on the frames resisting distraction vastly exceeds body weight. For example, your legs may exert 2000 psi against the frames resisting distraction; your additional body weight is negligible.
If you distract more than 6 cm; then, your rods will bend and may need to be adjusted or replaced. My rods have been modified 4 or 5 times. I currently have 4 rods per leg set in hinged fashion but I started with 3 straight rods per leg.
To me, the correct decision is to remain in Russia under care until your final nailing surgery is performed. For me, that means about 4.5 months in Russia.
Scars
My scars are negligible. Perhaps if I had shaved and bronzed legs I would notice some temporary discoloration--but I don't have such legs.
Meds & Supplements
I take a double-dose of high quality multiple vitamin and a double-dose of calcium supplement tablets and eat a balanced diet. I don't know how much difference the supplements make, if any, but I have been healthy through the process.
You will receive all the meds you need from your medical team at prices much lower than in the USA.
I note two exceptions:
First, you will NOT receive any narcotics outside the hospital. If you have some leftover pain meds, I suggest you bring them. I brought 30 Norco (10/325) and have two tablets left.
Next, Russian MDs do not accept the research that NSAIDs (non-steroidal anti-inflammatory drugs like Ibuprofen) interfere with bone regeneration. If you accept this research; then, you should bring some Acetaminophen (Tylenol) with you because you will be prescribed Ibuprofen.
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im still amazed how you could do LL after hip replacement. I always thought that after replacement you basically always use crutches etc.
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So far as I know, one returns to full functionality after hip replacement. I can only speak for myself, but I was on the elliptical 3 days after surgery and doing everything I did before within 6 months of my second replacement. I had an intentional 3 month gap between replacements so one hip would be healed before I started surgery on the second hip.
Most surgeons I spoke with about femur lengthening were more concerned about deep infection than they were about their ability to lengthen below or around the femur stems.
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Received a PM stating in part
Second - i am kindly asking you to send me documents - of course without any your personal data - just the text of contract and invoice for payment
I want to see all prices and terms before i talk with that doctors - Kulesh and Solomin
I don't work for Kulesh and Solomin. If you want details from Kulesh and Solomin--ask Kulesh and Solomin.
Kulesh publishes a lengthening file that contains price lists and all kinds of information. If you want that information, ask Kulesh for it.
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happy New Year !!
and congratulations, we know how difficult this is, a great victory friend!
I have a little doubt LATN has a maximum capacity of how many centimeters?
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Perhaps a maximum height for LATN exists based on the length of available nails, but that is a question best put to Kulesh or somebody with similar expertise.
You are already tall so perhaps you are Scandinavian or want to be an American movie star? I was not tall to start so the length of available nails for me is not a problem.
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Hexapods Installed Today for Final Correction
Distraction= 8.3
Correction calculated for three days.
Then, long films to rule out leg length discrepancy.
Then, final distraction to 8.6 cm via hexapods.
Then, hexapod removal and locking of frames at 8.6 cm.
Then, LATN surgery on 20 Jan.
Less than two weeks from the finish line (excluding consolidation and recovery).
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Long Films
First scheme of correction via hexapods completed. Second scheme consisting of only one day of corrections required for exact alignment.
Long films show leg length discrepancy of 2 mm. Shorter leg will be distracted via hexapod to make up difference.
Final height gain will be 8.7 cm.
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A bit confused. What exactly is long films? Is that a type of x-ray? How exactly are they determining alignment and distraction?
I'm in a post-soviet facility now and they can barely read my distraction from an x-ray.
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As I have come to understand things, the size of an x-ray image is the size of the film canister. Film is rarely used nowadays; the canister is digital--but it helps to think about the plastic x-rays that MDs used to put up on light boxes to understand the concept.
I incorrectly believed that to make a full length (long film) x-ray of legs, a film canister measuring about 3.5' x 2' was used. However, I've come to understand that no such animal exists. Absent very specialized equipment, the largest film canister is the size of the light box MDs used to use.
To obtain a full length x-ray of legs, three images are taken--top, middle and bottom. Then, using very specialized software, these images are stitched together to form a single digital image.
When trying to get long films done in the USA, I discovered that very few x-ray machines have the software that allows the stitching together of images. Fortunately, the Vreden Institute has the technology to make long films.
Long films are used by Kulesh and Solomin primarily to assess leg length. Alignment and distraction are easily assessed on short films. However, short films are not enough because you can lengthen both legs equally but doing so does not ensure that your overall legs are the same length.
By example, I learned that one of my legs is 1 mm longer than the other. Consequently, I don't want exactly equal distraction because to do so would would perpetuate an overall leg length discrepancy--I want my shorter leg to be distracted the additional mm so that my overall leg length is equal. Long films are used for this purpose.
Even older digital x-rays machines should have calibrated software that allows measurement of distraction. Usually, it is as easy as placing the cursor to obtain measurements. St. George Hospital got a new machine while I have been here. I was one of the first persons to use it. My short films said I increased distraction by over 2 cm in 10 days--we knew this was impossible so Kulesh took images of his radiographic rulers to help get the new machine properly calibrated.
Alignment is a similar process. Kulesh uses the software to draw lines and take measurements, etc. All of these calculations are backed up by physical measurements. In fact, it was remarkable to watch 4 MDs perform physical measurements--two on each leg. One would measure while the other recorded. Then they switched--if they did not get exactly the same measurement, they would remeasure and dialog to sort out the difference.
Even if the machine you use does not have calibrated measuring software, a ruler can be added to your image so that distraction can be measured manually. All of my recent images include rulers so that a manual double-check can be performed.
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Hexapods Removed
I have to admit that I have never imagined this much medical attention, expertise, or attention to detail.
Today I had five (5) MDs working on me.
Dr. Kulesh was stationed at the foot of the table supervising everything.
Drs. Roma and Maxim worked on my left leg while Drs. Nikita and Nicholi worked on my right leg.
Each team was responsible to install hinged rods EXACTLY mimicking the hexapods so that the precise correction in place was not even slightly altered.
This means each team had to create a rod installation with absolutely no tension when tightened--everything had to line up exactly even when tightened down. They went through each connection multiple times loosening the connection to confirm that it was still not binding despite tightening other connections.
The work, expertise, and attention to detail was amazing to watch.
Part of what was amazing was how focused each team was on its own leg. Each team collaborated together and with Kulesh--crawling under the table to visualize a screw-hole and confirm the screw-hole was 100% aligned was a common occurrence.
Today, I literally watched the difference between doing things and doings things absolutely right. Craftsmen are not dead.
Before the hexapods were fully removed, x-rays were taken to confirm they got things right.
So, I am locked in at just shy of 9 cm.
LATN surgery is Sunday.
I knew the Solomin/Kulesh team was good, but today I was embarrassed because I saw just how good they are and fear I have not given them adequate deference and respect.
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any pictures /video?
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Is Dr kulesh doing surgery in the municipal hospital now ir It is now doing surgery in the prívate clinic?
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To Sanity:
Pictures or video of what?
To Heightchange:
As I understand things, for the time being, Solomin/Kulesh are limiting surgeries to MEDEM because they have more ability to direct the actions of MEDEM staff and the staff seem to be more able to deal with unexpected contingencies.
In explanation, when performing surgery at a municipal clinic, it is complicated to get the best anesthesiologist; then, after the procedure Solomin/Kulesh must rely on clinic staff to follow-up on the procedure but staff MDs and nurses could be called away for other matters. Plus, if follow-up is less than desired, Solomin and Kulesh cannot really do anything about it--the staff works for the clinic; not Solomin and Kulesh.
So, to provide the best level of care, and a level of care acceptable to Solomin and Kulesh, they are currently doing elective leg lengthening surgery at MEDEM only.
This is an evolving situation and you should really dialog with Kulesh if you want surgery at a municipal clinic.
With that written, I had all of my surgeries at St. Elizabeth's and can attest that I received a better quality of care than at any USA hospital.
My final LATN surgery will be at MEDEM but because of this potentially temporary change in policy midstream, Kulesh will honor the municipal clinic price structure.
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"Pictures or video of what?"
of ur existance...
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So what Will be the cost now for Latn in MEDEM?
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LATN -- Nailing Surgery Completed
Everything went well. Just got a bandage change and everything looks good. Spinal was dc'd this morning so starting to feel things but not too bad at all.
One or two days more at MEDEM and I am on my way home 3.5 inches taller.
Still hard to believe. Had to think twice when the nurse asked me my height.
(https://imgur.com/cPHL8n3.png)
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Congrats. Why didn't you do this sooner in life?
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I suppose I never really thought about it earlier in life. Deciding to do leg lengthening was somewhat spur of the moment in that one day I just decided to look into leg lengthening. Then, things just kept moving forward--I never hit a decisional roadblock and realized it could be done so I continued to press forward and now its done.
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Very interesting. You had a hip replacement right? Do you know how long they are going to last?
And please keep us updated on your recovery!
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Thanks for sharing the pic.
Wishing you a great recovery and a great (taller) life.
How hard was your whole LL journey, in your opinion?
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The logistics of the process was not necessarily hard; there were simply many steps and many balls to keep in the air. All doable and nothing particularly hard; just time consuming and requiring much attention to detail and visualization of the process so that I could accurately plan.
The process for me was painful. The psychological impact of waking up with your legs in jail should not be underestimated. I suffered near constant swelling and edema so have lived with pain at a 4-6 level for nearly five months. Not unbearable but definitely not comfortable, interferes with sleep, etc.
Yet, now that I am done, I do not at all regret my decision. I would not do it again but I am glad I did it.
I am also fortunate that my surgeries have been deemed "near perfect" and that my regenerate is good. I know I just have to be careful, stay off my feet until I have 3 of 4 points of consolidation, work on strength and flexibility and I am confident I will have 100% success and be 3.5 inches taller for life (which is still something hard to get my mind around.)
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I received several PMs similar to the following so I will respond here rather than individually:
Every time I look at your swollen feet, it reminds me of my own feet..
Hope your consolidation is going well
Counting days to get ride of this frame, so I can get some sleep
One big problem I'm dealing with is my knee extension is very limited, I mean I can't straight out my legs or even lay down, top of my feet burns like hell. I do stretch everyday. Any advice?
Some choose to go home during distraction. In my humble opinion, it is a mistake to do so because by doing so, you generally remove yourself from those professionals who can best address developments when they arise.
As for my swollen feet, 85% of the swelling is gone now. My next x-rays are March 5. I hope they will show that I am at least 75% consolidated so that I can begin weight-bearing. I am confident that once I begin walking, the balance of my swelling will go away.
Already, my legs are feeling much stronger. I am working out and riding the stationary bike every day. I feel good.
The top of my feet also "burned". For me, that sensation was caused by edema. If you were under the care of your surgeon, you could request treatment or a consultation with a specialist that might help.
I could not completely extend my right leg without significant effort until recently. For me, this occurred because my soft tissue did not stretch as quickly as I was distracting. You must remember that your Achielle's tendon is connected to the base of your calf muscle; each side of the top of your calf muscle is connected to your two center hamstring muscles, which in turn are connected to the backside of your pelvis.
When you lengthen your leg bone, all of your soft tissue specifically including your leg muscles and tendons must also stretch. When the muscles and tendons on the backside of your leg do not stretch as quickly as you distract; then, you usually feel it at your knee. That is, you not be able to fully extend your knee. This is normal and usually corrected by time, massage, and stretching -- but you have to massage the entire backside of your leg to help the entire band of muscle and tendon to stretch.
The more you distract, the "smaller" you become. What do I mean? The more you distract; the harder it becomes to distract. Your body will push back against you harder and harder. If you push things as far as I did; then, you will be close to bed-ridden by the time you stop distraction because of pain and because much of your body's energy will be trying to fix the problem you are making. You won't have much energy left over.
Sleep will come when it comes. I felt sleepy at midnight or 2 AM, tried to sleep but often could not sleep. I just rested and watched the hours tick by. Often, I would take my meds and eat breakfast at 6 AM with no sleep; then, sleep from about 7 AM to 1 PM.
I had to learn to do my work from bed with my computer propped on my stomach--rest, pick-up my project again--rest, take meds--rest, eat -- etc.
To be successful at this, in my opinion, it is essential to change your attitude. Your "job" becomes leg lengthening--everything else is secondary. Your situation changes on a daily basis.
But if you listen to your body, accept that your life will be different during distraction, push things but also stop pushing when your body says so; then, one day you will realize you either hit your goal or your max and it is time to stop.
From that day, the process begins to work in the opposite direction. You begin to get stronger, more flexible. You experience less pain. You sleep more. You eat more. Your wounds heal. Your scabs fall away. You begin to feel your feet and legs. You feel more normal and you realize that you have accomplished a very challenging goal and will get to the end of the process.
It is not easy, I would not do it again, but for me it has been worth it.
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35 days after frame removal and LATN surgery.
(https://i.imgur.com/H5zqQfm.jpg)
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Thanks for sharing another pic, California2.
Can I ask you at what distraction length did you first start feeling tight?
You mentioned this in the OP, but I'd really appreciate if you found the time to expand on it:
Distraction was easy through 3 CM. At 5 cm, my ankles lost all flexibility and equinas began to be apparent.
This seems to go in line with what I've seen in the literature. 3cm tends to fall under 10% of the initial bone length distracted.
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For me, 10% would have been 3.7 cm. I ended up doing about 24%.
If by "tight", you mean tight in the ankle joints or the beginnings of equinas or both, I was aware of and cautioned to train against equinas.
Solomin & Kulesh take x-rays at every centimeter interval of lengthening. They also perform an MD bandage change once per week. For both tasks they take photos. Each time they take photos, they instruct you to pull your foot up as much as possible so that they can assess and document dorsiflexion.
I recall hearing comments when distracting up to the 3 cm point like "foot position looks good--good dorsiflexion".
After 3 cm but before 4 cm, I started getting comments like "can you pull your toes up any more?"
After 4 cm, I got a written warning that my "dorsiflexion is not excellent".
At about 5 cm, I was advised to consider stopping distraction or doing ATL. At this time, after stretching I could maintain neutral dorsiflexion (90 degrees).
I resisted ATL arguing that I had neutral dorsiflexion; therefore, I just needed to work hard and stretch 1 mm per day to keep pace with distraction.
After about another week, I accepted that stretching alone was not realistic--too much work and pain to keep at it for another month and, when I got honest with myself, I was not really keeping pace.
I also decided that I had not gone through this f***ing process for 2 f***ing inches. So, I had a long talk with Dr. Kulesh about ATL and realized that most of what I thought I knew about ATL was inaccurate. Additionally, my remaining valid concerns about possible rupture or over-lengthening/under-lengthening were addressed via Dr. Kulesh's new ATL protocol.
Once the 4th half-ring and hexapods were installed, I distracted and stretched my ATL at the same time. I found that I could not BOTH stretch my ATL and distract at a rate of 1 MM per day so I reduced my distraction rate to .75 mm per day.
Thereafter, I continued at pretty much .75 mm per day up to essentially 9 mm but reducing the rate, taking days off, and once or twice increasing the rate, based upon what my body was telling me it would tolerate at that time.
Please let me know if the above does not fully answer your question.
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Thanks for the pic california.
Your ankles / feet still seem a bit swollen, I hope the swelling subsides soon.
When do you expect to start walking / weight bearing?
Thanks
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The most significant hurdle I encountered during this process was edema (swelling of my feet and ankles). I am grateful that my edema began to resolve once I stopped distraction. It is about 80% resolved now and I am told the balance should quickly resolve once I begin walking.
I feel ready to walk now; however, I am instructed to wait until my bones are at least 75% consolidated. My next x-ray is next week and I hope and suspect I will begin walking after that x-ray/appointment.
I am being followed by a local MD team working in consultation with Drs. Solomin and Kulesh.
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For me, 10% would have been 3.7 cm. I ended up doing about 24%.
If by "tight", you mean tight in the ankle joints or the beginnings of equinas or both, I was aware of and cautioned to train against equinas.
Solomin & Kulesh take x-rays at every centimeter interval of lengthening. They also perform an MD bandage change once per week. For both tasks they take photos. Each time they take photos, they instruct you to pull your foot up as much as possible so that they can assess and document dorsiflexion.
I recall hearing comments when distracting up to the 3 cm point like "foot position looks good--good dorsiflexion".
After 3 cm but before 4 cm, I started getting comments like "can you pull your toes up any more?"
After 4 cm, I got a written warning that my "dorsiflexion is not excellent".
At about 5 cm, I was advised to consider stopping distraction or doing ATL. At this time, after stretching I could maintain neutral dorsiflexion (90 degrees).
I resisted ATL arguing that I had neutral dorsiflexion; therefore, I just needed to work hard and stretch 1 mm per day to keep pace with distraction.
After about another week, I accepted that stretching alone was not realistic--too much work and pain to keep at it for another month and, when I got honest with myself, I was not really keeping pace.
I also decided that I had not gone through this f***ing process for 2 f***ing inches. So, I had a long talk with Dr. Kulesh about ATL and realized that most of what I thought I knew about ATL was inaccurate. Additionally, my remaining valid concerns about possible rupture or over-lengthening/under-lengthening were addressed via Dr. Kulesh's new ATL protocol.
Once the 4th half-ring and hexapods were installed, I distracted and stretched my ATL at the same time. I found that I could not BOTH stretch my ATL and distract at a rate of 1 MM per day so I reduced my distraction rate to .75 mm per day.
Thereafter, I continued at pretty much .75 mm per day up to essentially 9 mm but reducing the rate, taking days off, and once or twice increasing the rate, based upon what my body was telling me it would tolerate at that time.
Please let me know if the above does not fully answer your question.
It does fully answer the question - thanks a lot!
Would you say the whole journey would have been easy had you stopped at 3cm? Also, despite any increased ease, do you think such a small lengthening amount would be worth the sleepless nights and pain, depending on the height and goals of the patient?
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Please forgive in advance my long-winded response.
To me, your question involves a primarily personal decision based on personal goal and desires.
For me, I wanted to increase me height at least 3 inches and as much as 5 inches. I originally envisioned two rounds of procedures increasing my femoral length by about 3 inches; then, coming back again and increasing my lower leg length by about 2 inches.
For me again, if I was not going to get a significant benefit from the surgery(ies); then, there was no good point in putting my body through the trauma and my life through the disruption.
So, would it be easy to stop at 3 cm? Yes, it would be quite easy.
But to me, the salient question is "would it be wise to put your body through the trauma of elective limb lengthening surgery and put your life through the disruption of elective limb lengthening surgery for a height gain of about one inch?" For me, the answer is absolutely "no".
The rub becomes that most surgeons pronounce that lengthening by 10% is safe; yet, for most patients, 10% is not enough height gain nor is it enough to justify the surgery and all the surgery entails.
At the outset, Solomin agreed that I could lengthen my lower legs by 15% -- or about 2.2 inches. I could live with that especially if it was possible that I could lengthen my femurs at a later date.
I was fortunate to get 3.5 inches on my lower legs. I never hoped for that much gain. Now that I have it, I would not consider the trauma and disruption of additional surgery to get the other 1.5 inches about which I fantasized. If I feel I need to be taller, there are many shoe manufacturers who can very comfortably give me another 1.5 inches.
So, my bottom line is that unless you are willing to work for 15-20% of gain; then, there are other much easier and much less costly avenues to investigate rather than subjecting your body to the trauma and your life to the disruption of surgery.
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First of all it's a great thing that you managed to go through LL with no serious complications and an overall good outcome. It's also good to know you're satisfied with your height gain, nobody wants to invest that much (money, time and pain) and still be unhappy.
However, are you worried about long-term consequences? While one part of going beyond 15-20% is potential problems with soft tissue resisting to stretching, another part is the life-long feasibility of the new leg arrangement. What are your thoughts about the possibility of developing osteoarthritis in the long run? I'm just curious about your take because that's not a huge topic of discussion in the community.
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No convincing scientific data yet.
But i do see the trend has changed: before people were more ambitious and aiming at 8+ even 10+ cm lengthening in one segment; recently more and more folks became moe conservative and finished under 7.5cm.
Maybe because Dr. Paley set the tone with his precise/stryde nails which cannot go over 8cm? He himself didn’t explain the compelling research behind it either ( if there is).
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However, are you worried about long-term consequences? While one part of going beyond 15-20% is potential problems with soft tissue resisting to stretching, another part is the life-long feasibility of the new leg arrangement. What are your thoughts about the possibility of developing osteoarthritis in the long run? I'm just curious about your take because that's not a huge topic of discussion in the community.
Please allow me to address your question in two parts--first, potential problems with soft-tissue resisting stretching:
Foremost, soft-tissue presents more of a short-term rather than a long-term problem. By this I mean the damage usually gets done during distraction because a certain soft-tissue cannot stretch the same amount as that moment's distraction. As a result, something tears or ruptures or announces great pain, etc.
In contrast, once you stop distracting, soft-tissue has the rest of your life to catch up.
It is important to understand what happens when you distract. Nerves can grow up to 1 mm per day so folks who distract up to 1 mm generally need not worry about nerve damage. Muscle tissue, tendons, ligaments, blood vessels, and skin is another matter.
Muscle, tendons, and ligaments fight back against distraction. It is hard to hurt these tissues because they are very tough. Blood vessels and skin stretch. To me, a ruptured blood vessel poses the greatest risk; yet, skin at the pin sites seems to present the most common problem.
On my 35 day photo, you can see two wounds, one on each of my lower shins. These wounds were each pin sites. As I distracted past 6 cm, my skin refused to keep up at these pin sites. As a result, the skin started to open up below each pin--like an old-fashioned keyhole. This type of wound is common. I had to keep a very close eye on these wounds to ensure each remained within the realm of acceptable risk.
I wrote repeatedly that I believe you must listen to your body as you go through the process. Wounds such as mine are precisely the type of thing I am writing about--if they became only a little bit worse, I would have had to stop distraction before I reached my goal.
On your second point--osteoarthritis. I am aware of no connection between limb lengthening and osteoarthritis. Osteoarthritis is a condition of the joints caused by a breakdown of cartilage in the joints. Limb-lengthening surgery does not directly involve any joint.
This is not to imply that increased height does not implicate some joints--of course it does. When you become 3 inches taller, your center-of-gravity changes. Likewise, the forces on your knee joint as a fulcrum change because the length of the levers acting upon the fulcrum (your femur and tibia) change in relation to one another.
This means that you have to create new muscle memory and become accustomed to your new leg length and center of balance. A perfect example is that a couple of nights ago I was laying on the sofa with my foot up on the sofa arm. I pulled my leg back so that my foot would drop onto the sofa cushion--except it didn't.
My mind understood that my foot should have dropped onto the sofa cushion because my mind was operating from memory of my old leg length. Now however, I still had 3.5 inches to go before my foot cleared the sofa arm.
In time, new muscle memory will replace the old and I will forget what it was to be my old height. Likewise, I will use my ankle, knee, and hip joints slightly differently but I don't think these is any reason to believe that I will wear them out any more than I would have before lengthening.
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Thanks, California. Soft tissue can indeed adapt quite well to lengthening in many cases, although it takes longer than bone consolidation. Quite a lot of the long-term recoveries after lengthening procedures with little complications we saw in the forum looked good.
As for the connection between limb lengthening and osteoarthritis, I'm aware of at least two studies studying the connection - one concerning the femur-tibia ratio and another concerning tibia nailing (so not lengthening, but a common part of many LL surgeries) :
The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees. (https://www.ncbi.nlm.nih.gov/pubmed/26398436)
Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. (https://www.ncbi.nlm.nih.gov/pubmed/18758282)
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As for the connection between limb lengthening and osteoarthritis, I'm aware of at least two studies studying the connection - one concerning the femur-tibia ratio and another concerning tibia nailing (so not lengthening, but a common part of many LL surgeries) :
The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees. (https://www.ncbi.nlm.nih.gov/pubmed/26398436)
Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. (https://www.ncbi.nlm.nih.gov/pubmed/18758282)
I reviewed the abstracts of your two studies; however, neither study draws a causal relationship between osteoarthritis and limb lengthening.
The second study above concludes: "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant."
The primary conclusion is that persons with tibia nails function comparable to the rest of the population. The study also notes "persistent sequelae which are not insignificant". "Sequelae" are conditions related to a certain condition--in this study "tibial shaft fracture treated with locked intramedullary nailing".
"Not insignificant" means the conditions were noted but no causal relationship or even a correlation was found. Moreover, no comparison was made to the population in general. Finally, the study group are trauma patients and not elective limb lengthening patients.
In summary, I do not conclude based on the second study that elective limb lengthening increases the likelihood of developing osteoarthritis.
The first study consists solely of analysis of cadaver bones. Limb lengthening is again not a part of the study. Based on the measurement of 1152 cadaver femurs and tibias, the authors conclude that a tibia should be 80% the length of a femur; and, that if a femur/tibia ratio is otherwise, arthritis may develop.
There is much wrong with this study. Foremost is the failure to identify the ethnic mix of cadavers studied. Second is the conclusion that an 80% ratio is the magic number--many studies suggest otherwise. Last is the conclusion that a variance from the magic number of 80% caused arthritis. There are, in my opinion, simply too many potential causes of arthritis to assert from a cadaver study that limb ratio is the culprit.
To get good information about increased risk for osteoarthritis in limb lengthening patients, you would need a longitudinal study of such patients and a fixed control group of similarly situated persons without limb lengthening surgery.
Moreover, I do not see a good reason to worry about development of osteoarthritis because osteoarthritis is a joint condition. Joints are no directly implicated in limb lengthening. So, to answer your question directly, no I am not worried about developing osteoarthritis caused by limb lengthening in later life.
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The first study is always rolled out in this site and is not useful. It identifies correlation, no causation and does not look at confounders.
Intramedullary tibial nailing is renowned as having long term complications, knee pain being the most obvious. If they are trauma, no lengthening will be happening. All that study has in common with this is that it is tibia surgery.
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Intramedullary tibial nailing is renowned as having long term complications, knee pain being the most obvious. If they are trauma, no lengthening will be happening. All that study has in common with this is that it is tibia surgery.
Since intramedullary rods are used in internal lengthening, it's very relevant to look at complication and long-term studies regarding intramedullary rods. The complications (such as knee pain you mentioned) can occur after accidents and after LL surgery alike.
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With respect, I do not agree with the above statements made by either IWannaBeTaller or HeightChange.
First "intramedullary rods" are the nails used in LON and LATN. They are usually left inside the bone for life although the screws are often removed once the bone heals.
Consequently, intramedullary rods are encountered in external lengthening; not internal.
Next, such rods are NOT renown for long-term complications. To the contrary, very few complications attributable to intramedullary rods are known to occur.
In fact, one of the studies referenced plainly concludes "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms...".
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A number of doctors have told me that about 50% of patients experience long term knee pain. Studies support this. For such key decisions that could potentially affect patients for the rest of their lives they need to be fully informed.
Earlier you mentioned about long leg films. These should be found in the majority of radiological departments in the US or Western Europe.
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A number of doctors have told me that about 50% of patients experience long term knee pain. Studies support this. For such key decisions that could potentially affect patients for the rest of their lives they need to be fully informed.
If you believe reliable studies support your contention that use of intermedullary rods to treat tibia fractures causes long-tern knee pain; then, please present those studies.
I showed you using the study you discussed that just the opposite was concluded; namely, "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms...".
I agree it is important to be informed; however, it is more important to be accurately informed.
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45 Days of Consolidation
(https://i.imgur.com/3rfDmis.png) (https://i.imgur.com/PMZC8b3.png)
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Thanks for posting the x-rays California.
It doesn't seem to be happening extremely fast, but it does seem to be filling up!
A question that came across my mind, why don't LLers reduce distraction rate when it clear that there is no risk of preconsolidation? It seems to me that in your case, there was no risk of preconsolidation so could you have gone at 0.5mm per day or taken lots of breaks in between? One of the scary aspects of LL is the lengthening and logic seems to suggest that slower rate of lengthening would be friendlier to the body in all aspects.
This is just a general question that came to my mind looking at some patients' x-rays.
Cheers!
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Thanks for posting the x-rays California.
It doesn't seem to be happening extremely fast, but it does seem to be filling up!
A question that came across my mind, why don't LLers reduce distraction rate when it clear that there is no risk of preconsolidation? It seems to me that in your case, there was no risk of preconsolidation so could you have gone at 0.5mm per day or taken lots of breaks in between? One of the scary aspects of LL is the lengthening and logic seems to suggest that slower rate of lengthening would be friendlier to the body in all aspects.
This is just a general question that came to my mind looking at some patients' x-rays.
Cheers!
Great question.
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I think you are absolutely correct about slowing the distraction rate. So long as the fibula is captured, there is no pre-consolidation risk.
In fact, Dr. Kulesh shared the story of a patient who did just what you suggest with great success. That patient did pure-externals over the course of one year. He distracted .5 mm per day up to 9 mm.
For me, I set an arbitrary deadline by which I must stop distracting so that I could return home and to work. But for my self-imposed deadline, I could have gone more slowly, more safely, and more comfortably.
In hindsight, I probably should have reconsidered my deadline at the start. Unfortunately, once I learned that I could go more slowly with less risk, I already made commitments to others and had my distraction goal in mind so slowing down meant I had to either miss my goal or break commitments--I elected to push to hit my goal while keeping my promises to others.
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I think you are absolutely correct about slowing the distraction rate. So long as the fibula is captured, there is no pre-consolidation risk.
In fact, Dr. Kulesh shared the story of a patient who did just what you suggest with great success. That patient did pure-externals over the course of one year. He distracted .5 mm per day up to 9 mm.
For me, I set an arbitrary deadline by which I must stop distracting so that I could return home and to work. But for my self-imposed deadline, I could have gone more slowly, more safely, and more comfortably.
In hindsight, I probably should have reconsidered my deadline at the start. Unfortunately, once I learned that I could go more slowly with less risk, I already made commitments to others and had my distraction goal in mind so slowing down meant I had to either miss my goal or break commitments--I elected to push to hit my goal while keeping my promises to others.
I am in similar situation, California. I want to be up and moving again by June, so do not want to delay to much. Thank you for your detailed updates.
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It is important to understand what happens when you distract. Nerves can grow up to 1 mm per day so folks who distract up to 1 mm generally need not worry about nerve damage. Muscle tissue, tendons, ligaments, blood vessels, and skin is another matter.
Muscle, tendons, and ligaments fight back against distraction. It is hard to hurt these tissues because they are very tough. Blood vessels and skin stretch. To me, a ruptured blood vessel poses the greatest risk; yet, skin at the pin sites seems to present the most common problem.
Hey, California2 - thanks for all the answers and the patience.
We get almost no threads on the effects of LL on blood vessels. Did Dr. Solomin and Kulesh provide any insight into that issue?
Likewise, you can stimulate arteriogenesis and angiogenesis with exercise.
https://en.wikipedia.org/wiki/Arteriogenesis
https://en.wikipedia.org/wiki/Angiogenesis
Do you happen to know if the doctors recommend exercise for that purpose, after recovery?
Thanks again.
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From my experience, Professor Solomin and Dr. Kulesh keep a careful eye on vascular issues; however, if they suspect such an issue has arisen, they coordinate a consultation with a vascular specialist.
You ask if one can stimulate an increase in blood vessel size (diameter) or grow more blood vessels with exercise. If you want a professional opinion; then, I encourage you to interface with a vascular specialist.
Blood vessels grow but they grow like branches on a tree. When your body determines an area is not adequately serviced by existing vessels, your body releases chemicals that cause a new vessel to sprout.
Blood vessels also constrict and dilate according to a body's needs. Additionally, medication can be prescribed that cause vessels to constrict and dilate too.
Exercise causes vessels to dilate so that the vessels can carry more blood to the effected muscle. Once the need for more blood passes, the vessel constricts to its normal size again. This is all part of the action of the autonomic nervous system that regulates body functions including blood pressure.
So, can you create a permanent change in blood vessel diameter or cause additional vessels to sprout via exercise? I can only observe that when I used to pump much iron, it was common to see, for example, the vessel in my bicep stand-out all the time or see new vessels in my forearm.
Did I cause my blood vessel diameter to increase semi-permanently? I suspect that I was leaner so my existing vessels became more visible and working out caused intentional trauma that my body addressed by, in part, increasing blood supply to the area. However, maybe additional muscle tissue demands more blood; ergo, larger vessels.
As for LL, no doubt exists that persons with more muscle mass at the lengthening site will consolidate more quickly; however, it would be pretty challenging to increase muscle mass at the lengthening site during lengthening.
Please let me know if you come upon any research on point.
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Hello California, I have followed your little journal carefully and I want to know your opinion about solomin and kulesh doctors. I'm from South America I do not know how the medical visa process is, I can go without a visa but only for 90 days which is insufficient. My point is that I have very little muscle mass in my calves, almost nothing and they are constantly hurting me because of the distances I walk. I have a sitting height of only 85 cm and I measure 169 cm at night. I wanted to know if there is any problem with having the calves so thin and if I could aspire to lengthen to 6.5 cm without the ATL launch. And what method would you recommend me with your respective recovery time. Finally, why part of the knee insert the nail. It would be a great favor if you answer these questions friend and luck in your recovery
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If you believe reliable studies support your contention that use of intermedullary rods to treat tibia fractures causes long-tern knee pain; then, please present those studies.
I showed you using the study you discussed that just the opposite was concluded; namely, "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms...".
only 15 (26.7%) denied knee pain with any activity whereas 41 patients (73.2%) had at least moderate knee pain. With respect to swelling, 19 (33.9%) reported asymmetrical swelling affecting the injured limb. However, of the 33 physically examined patients, only 6 (18.2%) had objective evidence of venous stasis.
I agree it is important to be informed; however, it is more important to be accurately informed.
Why do you omit this part from the study mentioned above:
At a median 14 years after tibial nailing of isolated tibial fractures,
patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant.
only 15 (26.7%) denied knee pain with any activity whereas 41 patients (73.2%) had at least moderate knee pain. [/b]With respect to swelling, 19 (33.9%) reported asymmetrical swelling affecting the injured limb. However, of the 33 physically examined patients, only 6 (18.2%) had objective evidence of venous stasis.
https://www.ncbi.nlm.nih.gov/m/pubmed/18758282/
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TemakiSushi is right. People only want to hear positive things. They hide the negative aspects and create a false depiction of reality. LL is hard. LL sucks. LL creates permanent sequelae. BUT people want LL so badly that they don't want to hear that.
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To TemakiSushi:
It appears you are reading a study but you do not understand what you are reading.
When a research conclusion notifies you that "objective and subjective evaluation shows persistent sequelae which are not insignificant"; this means that the study observed other things but could not draw any valid conclusions about these other things.
You point out certain factual complaints made by members of the study; then, ask why I don't focus on such points.
I do not focus on such points because these points were NOT studied.
The objective of the study is: "We conducted a study to evaluate the long-term functional outcomes of patients with an isolated tibial shaft fracture treated with locked intramedullary nailing."
The conclusion of the study is: "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant."
You want to ascribe meaning to survey reports such as "41 patients (73.2%) had at least moderate knee pain".
Unfortunately, this study did not look into a comparison of reports of knee pain from people who have a tibia repaired with an intramedullary nail as compared to knee pain in persons without tibia repair or any other condition you are trying to deem "significant".
Instead, the study looked at what it looked at and concluded what it concluded.
If you locate a study that actually looks at LL recovery issues as compared to similar issues in a non-LL control group; then, please share it. So far as I know, no such study exists.
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Hello California, I have followed your little journal carefully and I want to know your opinion about solomin and kulesh doctors. I'm from South America I do not know how the medical visa process is, I can go without a visa but only for 90 days which is insufficient. My point is that I have very little muscle mass in my calves, almost nothing and they are constantly hurting me because of the distances I walk. I have a sitting height of only 85 cm and I measure 169 cm at night. I wanted to know if there is any problem with having the calves so thin and if I could aspire to lengthen to 6.5 cm without the ATL launch. And what method would you recommend me with your respective recovery time. Finally, why part of the knee insert the nail. It would be a great favor if you answer these questions friend and luck in your recovery
To zlRadamanthys:
I have the highest regard for professor Solomin and Dr. Kulesh; however, you should form your own opinion.
You have not thought through your Visa issues. No Visa is required for tourists from South Africa who stay less than 90 days. However, tourist Visas up to 3 years in duration are available. Consequently, should you go the free route but visit Estonia after 89 days; then, return to Russia for another 90 days; or, should you apply for a longer Visa?
I suspect pretty much anyone can lengthen legs. Whether you are recommended to do so; and if so, how, is another matter.
If you want to lengthen your tibias; then, it is helpful to develop some muscle mass in your calves before surgery. However, even though the calf side of the tibia consolidates faster, the front side still consolidates.
If you can afford internal lengthening; then, get it. Internal lengthening is an easier process.
If you prefer to spend 1/3 to 1/5 the cost of internal lengthening; or, if you have a bone irregularity to correct in addition to lengthening; then, get external.
If you have the time and patience to do purely external; then, this is the safest and surest route. If you prefer to get rid of the rings for consolidation; then, LATN is generally recommended over LON because LATN accommodates the use of a larger nail for consolidation (which is more stable).
Notwithstanding the above, what you choose to do, if anything, and how you choose to do it should be the result of your desires, your budget, and your informed and detailed conversation with your surgeon.
Last, for either LON or LATN, an incision (about 2") is made over the kneecap. The kneecap is pushed aside to expose the top of the tibia. A hole slightly larger than the nail is drilled/reamed and the nail is inserted. Holes may be drilled laterally in the tibia to allow discharge of reamed fat and bone.
If LON, the tibia is cut before the nail is inserted but the nail is not fixed. In LATN, the nail is fixed upon insertion.
I think most anyone can successfully lengthen. However, I also think that most people do NOT critically think about things and process information so as to be successful. If you are disciplined and understand what will be required of you for your situation; then, so long as you do what is required of you for your situation, you will likely be successful.
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Very thanks for your infortaion. I hope you are fine, i respect you. Excuse me my english but my native lenguaje is spanish. I want know if y could send a pm, to do my questions, Thanks u man
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If you have questions, please just post them. Others likely have similar questions. I don't look at this bulletin board very often and someone else may want to respond to your questions.
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Well I would like to know its size, also its size of duck and finally what is the length of your forearm. It would be of great help for me these answers, I hope you have a maximum recovery and my best wishes with you
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Hey, California2. I'm back with some extra questions, if you don't mind.
Most people have a slight limb length discrepancy (LLD). Did you have it, and if so, do you remember by how much? How did Dr. Solomin and Kulesh take that into account during your lengthening?
How was the PT during your lengthening?
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Hey California , what is the expected time to be walking unnaided after nail insertion ? are you walking now with crutches ?
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Regarding the last two questions/posts above:
Leg Length Discrepancy
I doubt I had a material leg length discrepancy before the procedure. However, you should remember that distraction can (and probably will) create a small discrepancy because your distraction will not likely be exactly equal on each leg.
Solomin/Kulesh use the following format: surgery-->distraction-->correction-->surgery-->consolidation.
Once you get your desired length change, you stop distracting. Then, you get tall film x-rays to check for a leg length discrepancy.
Then, you enter the corrections phase. Hexapods are installed that address both alignment and length discrepancy, if any. Once everything is exactly in position, frames are locked in place and hexapods are removed for your final surgery (unless you are doing pure externals--then, no final surgery.)
PT During Lengthening
I am usually not a fan of PT because I can usually do on my own better, whatever it is the therapist wants me to do. In St. Petersburg, I had Dr. Irina--a Ph.D. therapist. She was remarkable AND she did things that I could not do myself.
She trained me 3 days a week and I worked out on my own all other days.
Walking During Consolidation
The rule of thumb for total consolidation is 2 months for every centimeter of lengthening. Because I lengthened 9 mm, I should not expect to be fully consolidated for 18 months.
Solomin/Kulesh opine that the risks of weight-bearing prematurely do not justify the potential benefits.
Orthopedists are historically challenged by the dilemma presented by the need to bear weight to promote hard bone growth balanced against the risk of device failure--here, that the two little screws that anchor the base of my nails will break.
You can imagine the problems that might arise if I sheared my screws and drove my nail into my foot.
So, until I have 75% hard bone touching hard bone, I am to limit my weight-bearing to 30% of my weight.
It is impossible to accurately estimate the amount of weight you put on your feet when walking so walking is out for now. Instead, I stand on a bathroom scale with my walker so that I can accurately manage my weight bearing.
Also, when I am working on the computer, I will put my feet on the scale; then, slide the edge of the desk on top of my bent knees so that the desk pushes down on my tibias. If I need more weight, I put some folders between my legs and the desk.
If things go well (as evidenced by monthly x-rays) I should be able to start walking with a walker in another month or two.
It is easy to stand and to walk; that is, I have plenty of strength to do it and feel no pain, it is just that I go way over 30% when I do so I am taking my time and being careful.
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Hi California2
Thanks for sharing your journey! You are brave and strong. You have made it!! I really hope you have a good recovery and enjoy your life!
Wish you the best of luck!!
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Hi California,
I have done my nailing a week ago and I have a few questions,
One of the major problem I'm dealing with is my feet are suler numb,
I can't move my right toe at all don't feel anything on my right foot, it's like a dead piece of flesh, I can't lift my feet with my leg, so I have to use my arms. looks like nerve damage to me.
Did you have this issue after nailing?
I have that issues and on top of that god damn Edema.
My third major problem is very limited knee contractions.
Any advice? have you gone through any of those, how long did it last
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Hi California,
I have done my nailing a week ago and I have a few questions,
One of the major problem I'm dealing with is my feet are suler numb,
I can't move my right toe at all don't feel anything on my right foot, it's like a dead piece of flesh, I can't lift my feet with my leg, so I have to use my arms. looks like nerve damage to me.
Did you have this issue after nailing?
I have that issues and on top of that god damn Edema.
My third major problem is very limited knee contractions.
Any advice? have you gone through any of those, how long did it last
Seems to me you didnt stretch enough while distracting and got nerve damage after nailing due to that. Are you able to lift your foot up or does it just drop down? Should have really done LON
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Hi California,
I have done my nailing a week ago and I have a few questions,
One of the major problem I'm dealing with is my feet are suler numb,
I can't move my right toe at all don't feel anything on my right foot, it's like a dead piece of flesh, I can't lift my feet with my leg, so I have to use my arms. looks like nerve damage to me.
Did you have this issue after nailing?
I have that issues and on top of that god damn Edema.
My third major problem is very limited knee contractions.
Any advice? have you gone through any of those, how long did it last
Congratulations on entering the consolidation phase. From now on, things should get easier.
Get some support hose (compression stockings) and wear them all the time; keep your feet above your heart when you can. Edema (and the associated pain) should decrease substantially over the next two weeks.
It is normal for your feet to be numb now. If you can move ANY toes, you are ahead of the game.
What do you mean, "you can't lift your feet with your legs?"
When you lie flay on your back, can you keep your leg straight and lift it off the ground (moving from the hip)?
When you sit in a chair, can your extend your lower leg out (moving from the knee)?"
Can you like on your back and do bicycles?
You must have patience while your legs can heal but you must also work to help your body heal. Except for stretching and trying to move parts that are stiff, most of healing will come naturally.
You will start eating more, and gaining more strength, and sleeping better, and feeling better. As you do, you will naturally do more with your legs. This is how things should work. If they don't, contact your MD.
Remember, the rule of thumb for complete consolidation is 2 months per every centimeter of lengthening. If you lengthened 6 centimeters; then, you should not expect to be fully consolidated for one year.
You may begin to bear weight and resume most activities within months, but full healing takes time.
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Hey guys thanks for getting back to me,
Unfortunately I can't lift my feet with my hip, the only way to lift any of my foot in using my arm.
I can move my left toe, but right one is numbs, no feeling.
That has happened after nailing...
And my knee contraction is pretty bad, I do strength everyday.
Depressing time, I have to drag my feet around, I can't extend my feet using my knee when I'm on wheelchair. My right foot feels really heavy.
I get some random nerve pain on both feet, makes me hope life will be back to my feet someday..
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Sounds like you should talk with your MD. You did not have a procedure that would effect your ability to move your lower leg from your hip or your knee. Is the problem in your head rather than your body?
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Sounds like you should talk with your MD. You did not have a procedure that would effect your ability to move your lower leg from your hip or your knee. Is the problem in your head rather than your body?
In your head? LoL
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Sounds like you should talk with your MD. You did not have a procedure that would effect your ability to move your lower leg from your hip or your knee. Is the problem in your head rather than your body?
this forum keeps amazing. here is another prime example of a mentally defective human being.
56years of age. hip replacement. does LL in russia.
When someone (Big Decision) has nerve damage, which is appearently common amongst russian LL surgeons. He comes out to give his sh!tty opinion that its all in his head.
A LLer cannot feel his legs anymore!! and you write this?
edit:
also take ur sh!tty diary and shove it up ur neanthertal ass. This diary only promotes the savages in Russia. How many drop foots and serious complications should we have before you stop promoting?
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Oh Dear! Does BladeRunner need a cuddle?
Or, are you merely jealous that I did something very successfully that you only talk about?
Please share your dumbass uninformed comments with someone else.
Big Decision didn't say he cannot feel his feet. He wrote that he cannot lift his leg from the hip nor can he extend his lower leg from the knee while seated.
These complaints do not appear to be associated with LL surgery.
Big Decision knows why he is having challenges--it has very little to do with his surgery.
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Oh Dear! Does BladeRunner need a cuddle?
Or, are you merely jealous that I did something very successfully that you only talk about?
Please share your dumbass uninformed comments with someone else.
Big Decision didn't say he cannot feel his feet. He wrote that he cannot lift his leg from the hip nor can he extend his lower leg from the knee while seated.
These complaints do not appear to be associated with LL surgery.
Big Decision knows why he is having challenges--it has very little to do with his surgery.
He said he could not feel his right foot , do you know what is peroneal nerve damage? It could be done during surgery , like in this case , and he is not the only one who reported this issue , so stop bum liking your doctor , you are ok , then you are lucky but dont come here to fk others that hasnt got the luck you had because it only shows your lack of empathy.
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He said he could not feel his right foot , do you know what is peroneal nerve damage? It could be done during surgery , like in this case , and he is not the only one who reported this issue ...
Now the dumbasses are stacking up.
You have no idea how much time and empathy I devoted to Big Decision--more uniformed commentary.
The peroneal nerve wraps from the back of the knee to the front of the shin. Even if it was SEVERED, it would only effect function BELOW the knee.
Big Decision says he cannot lie on his back and raise his leg from the hip. He also says he cannot extend his lower leg while seated.
The above symptoms do NOT appear to implicate "nerve damage" or the peroneal nerve at all.
Your uninformed opinions combined with your vulgarity merely make you look juvenile and ignorant.
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Hey guys, let me clear things up.
My feet are numb, the right one is completely numb, I hardly feel anything when I touch or massage it.
My feet are like dead flesh hanging from my body, the right one is worse, I can move my left toes and I feel more when I touch my left foot.
That being said, I don't have control over my feet, so if I lift them up to the air with my hands and release them at once, they will drop down to the floor.
I didn't have this problem when I had frames on.
I hope this clear things up.
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I wonder if you are leaving out some important details?
When did you stop distraction?
What amount did you distract?
When did you begin corrections?
When were corrections completed?
Did you correct a leg length discrepancy? If so, how much over what period of time.
When was your final surgery?
Was your final surgery LON or LATN?
When you lie flat on your back, with your legs out straight, can you lift one foot off the floor from your hip?
Before your final surgery, could you lie flat on your back, with your legs out straight, and lift one foot off the floor from your hip?
Some numbness after surgery is very normal. Inability to move your feet or toes after surgery is also normal.
It is NOT normal to be able to do single leg lifts before surgery but not after. However, no aspect of a LON second surgery or a LATN surgery would effect your ability to move your leg from the hip.
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By saying your feet im assuming just your feet and not your entire leg. If so then yes you definitely
Have nerve damage. Exact same thing happened to me when i first did my left tibia. After nailing i woke up and my foot was like you describe, a piece of flesh just there. The damage was minor and i recovered feeling and touch within 2 months. After nailing of my left femur, nerve damage occured again on same side and i again woke up with no movement in my left foot. This time it took 5 months before i started gaining movement and feeling again. I have regained about 90% of movement and 30% feeling on that left foot. Nerve damage can take up to a year to fully recover.
Best thing to do right now is get an mri and have them check to see if your nerves are still attached. If only stretching was done then you should expect to recover to a certain extent. Patience is key here. I know what your feeling as i went thru the same thing
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I am troubled by the frequent complaints of "nerve damage" in this forum. I write this because it is very normal (and expected) that surgery AND lengthening produce swelling. Swelling is one of the body's natural responses to trauma.
Swelling can compress nerves. Compressed nerves often cannot transmit signals as effectively as non-compressed nerves. However, this is a very normal and temporary condition even if it takes a year to resolve. Such conditions do NOT constitute nerve "damage" per se; that is, nothing is wrong with the nerve--it is merely compressed by swelling.
MRI is not usually the first test for nerve conduction--in fact, MRI is generally used mainly to check for nerve root compression. Normally, the first tests would be a nerve conduction study or an EMG.
However, Big Decision is less than a month out of surgery so it seems far too early to perform any nerve studies.
I am more interested in understanding Big Decision's complaints of inability to control his legs ABOVE the knee.
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When did you stop distraction? One week before surgery
What amount did you distract? 7.5
When did you begin corrections? I had one week of correction
When were corrections completed?
Did you correct a leg length discrepancy? If so, how much over what period of time.
I had 5mm of dicrepancy, and I corrected in same day by distracting 5mm on right leg. Reckless decision
When was your final surgery? It's been 9 days
Was your final surgery LON or LATN? LATE
Thanks Jim, good to hear from you,
Only my feet have this problem and they still have a lot of swelling going on.
Yeah it feels like some weights been attacked to your feet, so you can't lift your feet.
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To Big Decision:
When you lie flat on your back, with your legs out straight, can you lift one foot off the floor from your hip?
Before your final surgery, could you lie flat on your back, with your legs out straight, and lift one foot off the floor from your hip?
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I could do it before, but i can't right now.
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To Big Decision:
What you are writing does not make much sense to me. What does your MD say about your situation?
If you had one week for your corrections, why did you correct .5 cm in one day?
What is your conclusion regarding why you cannot do one-legged leg lifts?
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Me lengthening that much was a reckless decision on made.
If you want to know how it feels, u can imagine putting heavy weight on ur foot and try to lay back on your back and lift ur foot.
My feet feel heavy, really heavy , so when i try to lift it I feel lots of pressure on my knee.
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To Big Decision:
I hope you understand that your MD or anyone else can only help you to the extent you give complete and accurate information.
You lengthened quite a bit -- 7.5 CM; not a small amount. Then, you corrected one leg .5 CM in one day -- why?
No matter why you did what you did, it seems you should expect that your feet will be "dead" for awhile given the specific course of your lengthening.
Are you wearing compression stockings?
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7,5cm is a good amount, but there are people who lengthen more and they are ok
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Not wearing compression stockings waiting to meet my physiotherapist and ask about right compression stockings.
I don't have much info about it
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5mm in one day... That had to hurt.
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To Big Decision:
I found compression stockings to be almost immediately beneficial. It seems the compression reduces the pain associated with edema AND squeezes out the excess fluid.
Also, if any of your pin sites are still draining; the compression stockings will help dry things up--just get two pairs so one can be cleaned while you wear the other.
I suspect your concerns will begin to resolve themselves as you rest, eat, sleep, and get stronger. For me, I felt a little better everyday.
However, it seems like you might benefit from a physical therapist 3x per week.
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5mm in one day... That had to hurt.
This.
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Please please think about
Heinrich's Law:
in a workplace, for every accident that causes a major injury, there are 29 accidents that cause minor injuries and 300 accidents that cause no injuries.
In Russia there has been too many nerve damage problems
In the future someone may get more severe permanent nerve damages
Anyone considering Russia should be aware of the higher risk
Even with femurs there have been nerve complications
How come some people don’t feel the pangs of conscience after knowing the fact and keep promoting Russia still
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Hi California,
Could u send me a link to what compression stockings I should go for, it seems there are many with different size...
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To Big Decision:
Here is a link to an ad about compression stockings: https://www.riteaid.com/articles/the-benefits-of-compression-socks-should-you-be-wearing-them
Socks are sized based on your calf and ankle circumference and shank length. Medium support grade is fine. Compression socks should be hard to put on at first; however, they will should loosen up in a few days.
I do not know what Country your are in, but you should be able to get compression socks from your healthcare system, a medical supply store, drug stores (like Rite-Aid, Walgreen's, and CVS), and Walmart or Target. (I got my first pair from Walmart--tried on a few pairs until I was happy). Later, my MD prescribed a couple of pair that fit even better.
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To TemakiSushi:
In Russia there has been too many nerve damage problems
In the future someone may get more severe permanent nerve damages
Anyone considering Russia should be aware of the higher risk
Even with femurs there have been nerve complications
What nonsense is this?
Did you review all of the LL medical records for each cosmetic patient the world over; then, identify complications (especially "nerve damage" complications); then, sort the per patient rate of complications by Country to conclude that "In Russia there has been too many nerve damage problems"?
Of course you didn't! No one has that kind of information.
Yet, you spread derogatory information as if it were fact with "no pangs of conscience".
I don't care where you go for LL or if you go. If you are in love with Donghoon Lee; then, more power to you. I don't know him and I am not going to besmirch him or Korea in effort to encourage others to avoid him.
I am knowledgeable about the Solomin/Kulesh team. From my personal experience and detailed investigation, I am extremely pleased with my choice. I doubt I would have received better care and expertise for external lengthening at any price. For me, the cherry on top is that I received such quality care at one of the lowest prices in the industry.
Add your uniformed commentary to the peanut gallery if you must, but uniformed commentary benefits no one.
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Hey California2,
How is your pain level now,
I have past two weeks, and still having variety of pains(mostly nerve pain)
Stabbing pain from button of my feet, electric pulse from my left heel and some bone pain are the strongest.
Lyrica doesn't seem to be working anymore. I take up to 4 pills a day.
Edema is still there, as strong as it can be.
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Big Decision:
I was thinking about you today--I am glad you checked-in.
I am essentially pain-free. I take a single aspirin twice each day to prevent blood clots but haven't even taken Tylenol (acetaminophen) for a couple of weeks.
My edema is 90% gone.
I leave my feet down most of the day and go about a normal routine except when I am weight-bearing (usually by putting my feet on a bathroom scale and sitting with my desk on my knees) or working out (I am riding a recumbent bicycle fairly aggressively).
Are you keeping your feet above your heart? Are you wearing tight compression stockings? (I still wear mine 24/7 but they have become pretty loose.)
Are you sleeping better and gaining weight?
Are your wounds healing? All of my wounds are almost healed--no more scabs--still some discoloration and indentation but I will likely begin lap swimming next week now that all of the skin is closed over.
I wonder if it is more beneficial to focus on what you can do now rather than focus on aches and pains?
It is normal to feel more pain during consolidation as swelling decreases. The swelling sometimes interferes with nerve transmission so you do not feel pain that is present; then, when the swelling decreases, the nerve impulse is able to transmit the pain that already was present but masked.
I found that when I had intermittent, non-specific pain, it was good to lean into that pain and try to make it worse. Then, when I let off, the pain usually dissipated.
Are you doing PT?
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Oh!! nice.
Never had Tylenol , i have to try it as my current pain killers are not working;
I juts took my stitches off, going to get tight compression stockings soon. i'm craving to take a bath, its been 4 months.
My sleeping has gotten worse, it's random because of medication,
I could be my depression too, going to ask my doctor some unti-depressing medications.
my wounds are healing well, it's mostly scabs now... you're thinking about swimming?wow, i miss it so much.
I sit behind my desk a few hours a day, my legs are down during this time. my feet are numb but feeling strong enough now to put them on the floor and pull them back to the bed again. feet numbness is one of the biggest concern i have right now, as i don't know how long it will take to see some change , i can pluck hair from my feet without feeling any pain.
I'm going to start PT from tomorrow, as u know i have knee compression, still can't straight out my legs. right know i do use stationary bike every day. plus my toes have bent inward in result of not walking.
I use my feet on the floor while i'm moving on wheelchair to sort of simulate walking.
That's great to hear your Edema is getting better, i'm going to try some unti-inflammatory foods and oil and see, i'm really tired of it .
In overall i'm looking at you and hoping to pass these, however my body surprises me . like the bed sore i have, it's getting better, can you imaging not being able to sit normally or sleep on your back, it made me really weak,
I'm just fighting , even though i don't have much fight left in me.
Feel free to PM me anytime please.
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Big Decision:
Perhaps you are proof that you can do all sorts of unusual things and still successfully lengthen your legs?
Feet being numb and toes curling under is pretty normal. That stuff will go away when you start walking.
How did you get a bedsore? That happens when you lay in one spot without moving for too long. Why not get out of bed and into a wheelchair with footrests and get out of the house?
Tylenol is an over-the-counter mild medicine that people use for headaches and minor muscle aches--no need to try it.
Maybe it would be helpful to get off some medications, get outside, and get some sunshine and fresh air everyday?
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That's right, I need sun on daily basis.
Since I don't move much, my body is always cold, even with layers of shirt and winter jacket I always wear.
I don't know when my bed sore started maybe during my travel.
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Here are several photo montages created by Dr. Kulesh that chronicle my LL journey:
The first is my initial surgery and x-rays:
(https://i.imgur.com/Fcb7n0e.png)
Next is Achilles Tendon Lengthening (ATL) by gradual hexapod (slow lengthening):
(https://i.imgur.com/YqfiXiR.png)
Third is stabilization of ATL and continued distraction (ATL hexapods removed):
(https://i.imgur.com/bxgJLwx.png)
Fourth is final correction via hexapod and LATN nail insertion:
(https://i.imgur.com/iCgIbZT.png)
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Intensive surgery! Hope you are doing better.
You mentioned your Edema is gone, does it come back when you sit on a chair?
Mine comes back,when I sit on a chair like a normal human being.
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I still have about 10% edema in my feet and toes and my toes are still a bit curled. I do not expect these last bits to resolve completely until I am walking regularly.
Sitting in a chair is not a factor for me because I am working full-time and doing all my regular activities from a wheelchair so I am always sitting in a chair. When I wake up in the morning, all edema is essentially gone; however, it tends to build up at about 10% of what it was when it was bad throughout the day.
I just give myself a foot rub and put up my feet in the evening; then, the swelling goes down.
It sounds like you are doing much better. Did you start wearing compression stockings?
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My Edema comes back pretty strong when I sit and my left toe is badly curled, I started working on it.
I didn't buy compression stockings as my nurse recommended me to talk to my Dr first. I got something similar, long tight socks but didn't wear them a lot, made me uncomfortable, i've been wearing very short socks instead.
After all I guess my biggest problem is my right foot being dead. :(
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3.5 Months After LATN
(https://i.imgur.com/lr77ZV5.jpg)
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Great update friend, how is your walk now ?, Would you be willing to upload a video to see how your recovery ?. What is your proportion of tibia and femur ?. I am thinking of doing the same method you did in the warmth, my initial height is 169 cm, which would be the maximum recommended by you and I would also like to know if I would recommend to doctors Solomin and Kulesh for this procedure. Thank you
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To zlRadamanthys:
From my perspective, folks on this forum who are considering leg lengthening can become over-involved analyzing less important details.
For example, the relative length of one's tibias as compared to one's femurs. I have never looked at a person and thought "wow, his/her tibias are really long compared to his/her femurs." Perhaps if someone's shank was significantly longer or shorter than the thigh, I might notice; however, if a person's top and bottom half of legs are within 75% of each other, I don't think I would notice.
To me, it is more important to first decide whether you want to handle the challenges and inconvenience of the surgery. If so, what can you afford and what are you willing to spend?
Next, select a surgeon in your price range. For me, I could afford Paley but I would never be willing to pay Paley rates for surgery so I investigated other surgeons who offered a price point that I might be willing to pay.
If you identify a couple of potential surgeons; then, interface with them to select the one you want. Then, talk with your surgeon to decide most other issues.
For example, I thought I wanted LON on my femurs. After talking with my surgical team, we decided on LATN on my tibias.
Last, I decided on Solomin/Kulesh because I was greatly impressed by their skill and experience. The fact that I saved about $100K as compared to someone like Paley was icing on the cake. After going through the procedure, I do not hesitate to recommend them. In fact, I now know they are even better than I expected.
But external lengthening is not for everybody. Internal seems to offer a shorter process with less pain and disability during the process. If I could have gotten internal lengthening for $20K from a reputable surgeon, I would have selected that process. But you can't get internal lengthening for $20K.
Last, I suspect some on this forum are merely trolls for certain surgeons. I write this because the level of toxic, dumbass commentary from several who have not had the surgery is untenable. Every surgery has inherent risks; yet, most surgeons who regularly perform cosmetic lengthening are very aware of risks and exercise appropriate caution good judgment when performing the surgery.
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3.5 Months After LATN
(https://i.imgur.com/lr77ZV5.jpg)
wtf?
when u last posted a pic of your tibia post LL i thought the image was vertically upscaled.
then i see this.
let this serve as warning to all new patients considering over 6cm let alone 9 cm in tibia.
Edit:
wtf again.. your ankles. whats up with them? it looks like you are tippy toeing, same with the other picture u posted. But there you can see the heels are touching the floor.
fking disaster of a LL and yet you have the audacity to roam around this forum giving advices to newbies. fking state of this community.
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I'm really happy seeing you standing up!!
Great job!
By the way, did you do scar removal? I don't see any scar.
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I still have some indentations and discoloration; however, most has already faded and filled-in. The lighter bumps below my knees are the screw heads under my skin--I will remove the screws next year.
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Today will be my final day contributing to this forum. I wish all the best to those who elect to undergo the procedure.
Today will be my final day because I am cleared to bear up to 80% of my weight. I successfully lengthened my tibias nearly 4 inches via the external Ilizarov procedure and LATN. This means that I now stand at almost 5' 10' in my dress shoes. I have no complications to speak of and am well on my way to full recovery; thus, I see little benefit in continuing to monitor this forum.
I am very pleased with my choices throughout this process. I am especially pleased that I selected St. Petersburg for both the exceptional quality of care and the extremely reasonable price. My only regret is that I did not do this 30 years ago.
This forum is full of toxic posters who will never attempt leg lengthening. Similarly, this forum is full of posters who are not emotionally sound enough to successfully complete the surgery. I encourage serious candidates to sift through the bulk of posts to find the 5-10% that might contain accurate AND useful information for your situation.
Most important, if you will attempt this surgery, listen to your surgical team and your body. Goals are nice at the start, but only your body and your surgical team can give you meaningful input on whether to continue to pursue your goal.
Last, what makes leg lengthening especially challenging is that most surgeons righteously recommend lengthening of no more than 10% as the safe limit; however, most lengtheners will not be satisfied with a mere 10%. Consequently, to get a meaningful height increase, you generally must accept some risk.
If you do not heed the advice of your surgical team and listen to your body, the consequences of risk can be catastrophic. If you listen to your surgical team and your body; and, provided you are mentally, physically, and emotionally prepared for a long and sometimes difficult process; then, you can successfully lengthen a meaningful amount just like me.
Good luck to all who elect to undergo this procedure.
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Today will be my final day contributing to this forum. I wish all the best to those who elect to undergo the procedure.
Today will be my final day because I am cleared to bear up to 80% of my weight. I successfully lengthened my tibias nearly 4 inches via the external Ilizarov procedure and LATN. This means that I now stand at almost 5' 10' in my dress shoes. I have no complications to speak of and am well on my way to full recovery; thus, I see little benefit in continuing to monitor this forum.
I am very pleased with my choices throughout this process. I am especially pleased that I selected St. Petersburg for both the exceptional quality of care and the extremely reasonable price. My only regret is that I did not do this 30 years ago.
This forum is full of toxic posters who will never attempt leg lengthening. Similarly, this forum is full of posters who are not emotionally sound enough to successfully complete the surgery. I encourage serious candidates to sift through the bulk of posts to find the 5-10% that might contain accurate AND useful information for your situation.
Most important, if you will attempt this surgery, listen to your surgical team and your body. Goals are nice at the start, but only your body and your surgical team can give you meaningful input on whether to continue to pursue your goal.
Last, what makes leg lengthening especially challenging is that most surgeons righteously recommend lengthening of no more than 10% as the safe limit; however, most lengtheners will not be satisfied with a mere 10%. Consequently, to get a meaningful height increase, you generally must accept some risk.
If you do not heed the advice of your surgical team and listen to your body, the consequences of risk can be catastrophic. If you listen to your surgical team and your body; and, provided you are mentally, physically, and emotionally prepared for a long and sometimes difficult process; then, you can successfully lengthen a meaningful amount just like me.
Good luck to all who elect to undergo this procedure.
thank God and get the feck outta here.
Oh I hope you really leave this forum and not go back to your other account Pyotr (http://www.limblengtheningforum.com/index.php?topic=9168.msg94454) (you seem to have a history of "quitting" when the heat is on, only to resurface with new account and spread bile)
I hope admin can mark this thread with a big warning sign: "how not to do LL".
Good luck you 60-year old, hip-replacement wearing, 9cm lengthening, disproportionate, mentally defective s0n of a b!tch.
9 CM on tibia and seeing your legs becoming deformed in mirror, it never occured to you that maybe it is a good idea to stop lengthening?
And this diary is a big red mark on the savages in russia doing this kind of surgery. The other diaries of dropfooters, nerve damaged idiots jim_dabarber, overdozer, rgkey, android etc. dont really flatter your surgeon, do they? I also hope admin can delete your posting history of shilling for these surgeons. It hurts and misleads future patients!
You epitomize everything wrong with this forum.
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How are comment's like that allowed on the forum?? when someone is doing a LL, he instead need support. That's a weird forum. U want to share your experience but it makes it worse for you.
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I don't think we have full control over a successful LL,
I think you never know how your body reacts to it, I have so many complications like drop foot, nerve damage, curled toe, ballerina foot, knee contraction, stiff ankles, edema.
I tried my best to listen to my doctors and exercise but most of these problems were out of my hand.
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thank God and get the feck outta here.
Oh I hope you really leave this forum and not go back to your other account Pyotr (http://www.limblengtheningforum.com/index.php?topic=9168.msg94454) (you seem to have a history of "quitting" when the heat is on, only to resurface with new account and spread bile)
I hope admin can mark this thread with a big warning sign: "how not to do LL".
Good luck you 60-year old, hip-replacement wearing, 9cm lengthening, disproportionate, mentally defective s0n of a b!tch.
9 CM on tibia and seeing your legs becoming deformed in mirror, it never occured to you that maybe it is a good idea to stop lengthening?
And this diary is a big red mark on the savages in russia doing this kind of surgery. The other diaries of dropfooters, nerve damaged idiots jim_dabarber, overdozer, rgkey, android etc. dont really flatter your surgeon, do they? I also hope admin can delete your posting history of shilling for these surgeons. It hurts and misleads future patients!
You epitomize everything wrong with this forum.
Hey tlannister
I see your points but your attitude is simply wrong. You can address what you want to say in a much more mature way. Your comments are really too vicious. Hope you make better comments in the future.
Hi California2
Thanks for sharing your hard and long journey with us! You finished the hardest part of lengthening!
Hope you have a great recovery!
Wish you peace and happiness!
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How small is your d!ck? jesus lol
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Tlannister. Wya bro? Im actually recovered to about 90% of my pre LL athletic ability. Can run,jump, and have no pain whatsoever 😂 yea i had complications but guess what. I have a lot of money in my pockets by not doing internal and im 3.5 inches taller and very proportional. I went to Russia to get scar removal 2 weeks ago so nobody will even notice anything from now on. You talk a lot of crap thru here. Im flying out to vegas today for a bachelorette party for the weekend meet me there insecure prick or better yet ill come to you since your probably to broke to travel 😂 Lets see if you can call me an idiot to my face and while we are together you can see for yourself how recovered i am. Dumb asss
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Tlannister. Wya bro? Im actually recovered to about 90% of my pre LL athletic ability. Can run,jump, and have no pain whatsoever 😂 yea i had complications but guess what. I have a lot of money in my pockets by not doing internal and im 3.5 inches taller and very proportional. I went to Russia to get scar removal 2 weeks ago so nobody will even notice anything from now on. You talk a lot of crap thru here. Im flying out to vegas today for a bachelorette party for the weekend meet me there insecure prick or better yet ill come to you since your probably to broke to travel 😂 Lets see if you can call me an idiot to my face and while we are together you can see for yourself how recovered i am. Dumb asss
lol your 90% is probably just some walking. jumping after tib and EXTERNAL femur lengthening? its a joke haha. no doc in the world does EXTERNAL femur lengthening. you also had nerve damage I think? Did it recover fully? i certainly bet you cant jump and run lol. EXTERNAL femurs form scar tissue and cut through thick femur muscles, no one in the world who does EXTERNAL femur lengthening would be able to run and jump.
doing EXTERNAL femur lengthening to save some money is silly. you can always earn back money but the joy of jumping and running you wont get back...
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There are external ways with Lon, with an orthofix tool and a nail inside. It's not like the iliazrov frames it's just a temporary fixator that can be removed after you finish lengthening.
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Hey tlannister
I see your points but your attitude is simply wrong. You can address what you want to say in a much more mature way. Your comments are really too vicious. Hope you make better comments in the future.
I may be harsh in my wording, but dont attack that.. attack my points instead.
I do not want California or other LLers to feel bad. I am not randomly insulting people for fun. I am writing in this particular diary because it causes people pain and leads them to a high risk surgery. Those risks can be mostly mitigated by going to safe country with safe method.
In fact, I just clicked into that moron aboves diary and found these two posts in page two:
hey guys
new here and very confused
i'm thinking about LL for a while and don't know really how you guys chose your Dr, i'v sent message to a few Dr and they never got back back to me
It's a big decision because i do martial art and i got flexible legs, Split, not a problem and i know after all these im gonna loose it all!!'but i have made my mind!!
About taking time off, I'm going to just quit my job, staying wherever the clinic is to make recovery as easy and safe as possible. Look around the forums and you'll see this mentioned by others too, like Purushrottam (http://www.limblengtheningforum.com/index.php?topic=4823.msg76619#msg76619). Some take a month or more off in the form of a sabbatical, don't expect to do that unless you've been with a company for a while. And if you're doing external femurs, you're really going to regret having to work.
Big decision and android at this point in time (2018) were healthy individuals with bright future ahead. Fast forward to today, they are crippled, certainly influenced by the fake diaries of jim_debarbar, pope, overdozer and the rest of the rent boys. How would big decision and androids life be today if they had made the right choice? think about this. Dont come at me because I use some harsh words, look deeper into the problems caused by these diaries. Android, big decision and probably many who dont even have diary were normal people like you and me. Deceived by what they read here, they made a horrible judgement. Now their lifes are changed upside down. It could have been avoided if the moderation of this forum was present, but its not.
When there is lack of governance, it creates a vacuum which is filled by people like me taking the matter in our own hands. Thus me insulting California to make readers aware that this type of outcome is not acceptable for a LLer in 2019. We have come further than this with technology.
I will be honest, california2, in particular. I would take my belt off and fecking whip him black and blue if i ever saw him in real life. A massive sh!tehawk. Not because I disagree with his opinions but the obvious damage he causes to new patients reading this.
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lol your 90% is probably just some walking. jumping after tib and EXTERNAL femur lengthening? its a joke haha. no doc in the world does EXTERNAL femur lengthening. you also had nerve damage I think? Did it recover fully? i certainly bet you cant jump and run lol. EXTERNAL femurs form scar tissue and cut through thick femur muscles, no one in the world who does EXTERNAL femur lengthening would be able to run and jump.
doing EXTERNAL femur lengthening to save some money is silly. you can always earn back money but the joy of jumping and running you wont get back...
Nerve damage is gone completely. Im able to fully dorsiflex both feet. I only say 90% recovered because i cant run as fast or jump as high yet as before but then again i havent been working on it as much as i should. But im able to jump in moshpits at festivals and i can hold my ground very damn well.
Are you a doctor? Or why are you making assumptions ? External femur bolts dont cut through muscles you dipshiit 😂 shows how much you actually know about externals. Scar tissue? Yes of course! Especially around the knee but i trained hard and broke all of the scar tissue and regained full knee flexion. God im so tired of this freaken forum. Ill update my diary with videos just to make you dumbasses feel stupid. And even then you guys will say im a fake. This is the same damn reason vets leave the forum. So much hatred and toxicity.
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Tlannister is just mad cause i did what he doesnt have the balls to do. External femurs is for the strong buddy. Keep hating. And like i said ill come to you personally, or are you scared? I mean according to you im cant run or jump so theres nothing to be scared of 😏
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Tlannister is just mad cause i did what he doesnt have the balls to do. External femurs is for the strong buddy. Keep hating. And like i said ill come to you personally, or are you scared? I mean according to you im cant run or jump so theres nothing to be scared of 😏
Tlannister. Wya bro? Im actually recovered to about 90% of my pre LL athletic ability. Can run,jump, and have no pain whatsoever 😂 yea i had complications but guess what. I have a lot of money in my pockets by not doing internal and im 3.5 inches taller and very proportional. I went to Russia to get scar removal 2 weeks ago so nobody will even notice anything from now on. You talk a lot of crap thru here. Im flying out to vegas today for a bachelorette party for the weekend meet me there insecure prick or better yet ill come to you since your probably to broke to travel 😂 Lets see if you can call me an idiot to my face and while we are together you can see for yourself how recovered i am. Dumb asss
read the 3 bold lines above again. Thats the reason I ignore you.
Being anonymous one cant see the other person, but actions and words can give a ballpark estimate of a person.
Instead of just writing "Im flying out vegas for the weeked" you wrote that thing above. You come off as a sxx deprived insecure rent boy looking to boast about his first encounter with a female.
You keep saying "screw my health, i got 30k extra in my bank". The troll guichet_chop is right. Money comes and goes. Health is priceless.
Then further down theres again emphasis on money. You seem to taunt me/insult me because "im broke and cant afford to fly". Since when is ones arguments in a discussion devalued because of how much money one has in the bank? Everyones voice is equal, poor or rich.
I would love to have a fair and fruitful debate about LL with someone I feel is on my intelectual level. But boy, are you far off that mark.
One more thing since money seems to be the sun your world is orbiting around;
I am from a country that has so much oil we cant get rid of it fast enough. My salary is what you earn if you work 10 years straight.
You dont see me telling people to silence because of this? cuz money is sh!t. It is just piece of paper.
I value a person by ones actions, not money or appearence.
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More like 150k extra. I lengthened both femur and tibia. Whatever man. Instead of bashing on me and my decision just go ahead and do LL yourself. Whatever makes you happy man, but please stop spreading nonsense about me without even knowing the facts. Anybody can have complication s when undergoing this surgery. I understood mine and decided to go along with it and ended up fine. I didnt hold a gun to anybodies head and make them go to my doctor. But saying i had a bad outcome is pure lie.
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Jim_dabarber:
Congratulations on your success!
Please remember that when you tussle with a pig, you both get dirty but the pig likes it.
The Angry Imp (t.lannister) will never do lengthening. S/he is probably paid by one of the surgeons to spew hate against the competition. You could probably figure out who s/he works for by eliminating the surgeons s/he spews against; then, see who is left.
Also, I suspect s/he is not even always the same person. Different posts appear to be written by different persons. You may have noticed that just today s/he created a new moniker (guichet_chop) to spew under a different name.
While I certainly understand why you might want a face-to-face with the Angry Imp, you probably would need to carry around a step ladder so the Imp could crawl up on it to do it. Otherwise, it would be more like the Imp's face to your belly button.
Last, s/he now implies s/he is from the Middle East. So, just think of her like one of those Persian women who scream "la la la la la la!"
An Angry Persian Imp Troll screaming "la la la la la la" -- what a combination!
That's it for me. All the best to the serious folks!
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Hey guys,
So I visited a neurologist and did EMG test, I was told my peroneal as well as sciatic nerves are being damaged.
They can't do anything, I just have to wait and hope my feet get better.
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jim ::
Just post video of jumping and running and show your scars. I will shut up forever about Russian surgeons and external methods. At this point i think you are misleading people by telling you can jump and run. 'jump' = 2 cm off of the ground? 'run' = 40 meters? you made your choices i respect it and money was a huge criterion in your choices. there may be others in your shoes who would jump the gun and get LL quad lengthening with EXTERNALs thinking they can run and jump. it's not fair right?
And I am NOT tlannister. please speak objectively and not emotionally.
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here are some posts from poor Big Desision
"I have past two weeks, and still having variety of pains(mostly nerve pain)
Stabbing pain from button of my feet, electric pulse from my left heel and some bone pain are the strongest.
Lyrica doesn't seem to be working anymore. I take up to 4 pills a day.
Edema is still there, as strong as it can be. "
"My feet are numb, the right one is completely numb, I hardly feel anything when I touch or massage it.
My feet are like dead flesh hanging from my body, the right one is worse, I can move my left toes and I feel more when I touch my left foot.
That being said, I don't have control over my feet, so if I lift them up to the air with my hands and release them at once, they will drop down to the floor.
I didn't have this problem when I had frames on.
I hope this clear things up. "
"Unfortunately I can't lift my feet with my hip, the only way to lift any of my foot in using my arm.
I can move my left toe, but right one is numbs, no feeling.
That has happened after nailing...
And my knee contraction is pretty bad, I do strength everyday.
Depressing time, I have to drag my feet around, I can't extend my feet using my knee when I'm on wheelchair. My right foot feels really heavy.
I get some random nerve pain on both feet, makes me hope life will be back to my feet someday.. "
jim, california2 - please post some video evidence of you jumping and running. no one will be able to see you or identify you. Let us play it objectively. It is wrong to be prejudiced like me but this seems to be every Russian tale - get frames, lengthen great amounts, legs atropy like crazy, develop serious contracture and ballerina foot, get nailing done, get drop foot, go back home to north america. Now if you are seriously telling these are normal and don't affect final outcome, please show some evidence if you can. lots of people travel to russia to save money and this would make them take an informed decision. leaving the forum because of trolls will just make the trolls win and nothing else.
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I thought california had written his last post? please leave you big loser.
also the reason I am critisizing such diaries as this is, I used to read this and and believe the LL would be the challenge of my life.
Then I went to do internal weight bearing nail and the experience was like night an day. I was shocked I never experienced what people here warned me about.
I have to come realize there is no point in torturing ones with such medieval devices when there are better options out there. I want future patients to follow the path I took and end up with same experience and outcome.
Diaries like these do not represent the right outcome of modern CLL. We need to advice against going to Russia!
If in 5 years a new tech came out which let one do CLL in 1 month and recover 100% withing days. Then I too would advice against the weight bearing nail I used. Its called to act responsibly to the next generation of CLLers.
None of the russian frauds here can run/jump properly. Especially not california with 9 CM on tibia. What the hell is wrong with you? how can you even do such a thing at age of 60 with a freaking hip replacement?
Guichet_chop is third_world (http://www.limblengtheningforum.com/index.php?action=profile;area=showposts;u=6863)(he has another account named Fodawupa (http://www.limblengtheningforum.com/index.php?action=profile;area=showposts;u=6724))
its funny guichet_chop (as fodawupa) started mocking another member he disagreed with. Then he (as third_world) started mimicking him to make fun of... slowly the new modus operandi consumed him. He (as guichet_chop) became disillusioned with this forum diaries and came to know the person he initially disagreed with was completely right. At long last the student became the master!
Carry on son, Im proud of you ;D
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Hey guys,
So I visited a neurologist and did EMG test, I was told my peroneal as well as sciatic nerves are being damaged.
They can't do anything, I just have to wait and hope my feet get better.
I feel sorry for you. Good luck! What does that mean specificly for your everyday life now?
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Guichet_chop is third_world (http://www.limblengtheningforum.com/index.php?action=profile;area=showposts;u=6863)(he has another account named Fodawupa (http://www.limblengtheningforum.com/index.php?action=profile;area=showposts;u=6724))
its funny guichet_chop (as fodawupa) started mocking another member he disagreed with. Then he (as third_world) started mimicking him to make fun of... slowly the new modus operandi consumed him. He (as guichet_chop) became disillusioned with this forum diaries and came to know the person he initially disagreed with was completely right. At long last the student became the master!
Carry on son, Im proud of you ;D
i am out of words for u ned_flanders .
leaving this forum is an enhancement to ur life. u seem to have been in a very bad state of mind and leaving this forums is a good start to recover. i hope u do. u can stop being bitter if u try.
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LOGISTICS
I am posting this public post in response to a couple of similar PMs:
Invitation Letter & Visa
Invitation Letters are more commonly "sold" rather than "issued". You can get certain facilities to issue an invitation letter for free; however, there is a significant expectation that you will then use those facilities.
For me, it was easier to buy the letter. I used "Fortuna Travel" but many provide this service.
Once I had my Invitation Letter in hand, I used the Visa e-service on the Russian Consulate website. I opted for a 3-year multiple entry Tourist Visa (I am a medical tourist) for maximum flexibility. This Visa allows me to stay in Russia for up to 180 days in one block. If I need more than 180 days in one block; then, I will take the train to Finland, spend the night; then, return to Russia for another 180 days. I can even use this Visa next year to return for nail removal, if desired.
Wheelchair
You will be hard-pressed to find a wheelchair in Russia with adjustable leg supports that permit you to extend your legs out flat. I bought one off Craigslist--most airlines ship wheelchairs for free.
I recommend you practice with your wheelchair. I fell from the chair twice--once just a few days ago going from bed to chair--something I have done without incident hundreds of times before. I also flipped the chair over backwards once trying to negotiate a threshold--this could have been tragic--don't drink and drive.
Finding an Apartment
I found mine on AirBNB using the map search function. I suggest you find something near St. George's Hospital because you will most often use St. George's facilities. 90% of possible apartments you identify will not be wheelchair accessible.
Or, you can do things the easy way by contacting the Property Manager I discovered--Alice Tsay (e-mail=3035358@gmail.com). Alice specializes in medical tourism and wheelchair accessible, high-quality units near St. George.
Alice will also register your address as required and provide transfer to and from the airport (as well as provide many other services upon request during your stay).
Currency Exchange
You can carry up to $10K in cash into Russia -- that is what I did. Make sure your bills are pristine--even a small 1/4 inch tear at the center fold will cause your bills to be rejected for exchange.
All major banks will exchange currency at very favorable rates--I used Sberbank. Just bring your Passport and registered address and the exchange should go smoothly.
Most Russians do not use savings accounts and keep their money on their person or stashed in a safe place. Be like a Russian and lock your door when you leave the apartment.
Leaving Russia for Distraction
I was surprised to learn that a majority of patients leave Russia after the initial procedure--Kulesh told me many are never heard from again.
Perhaps if you are doing a small distraction and have a good follow-up team at home this will be OK. However, if you plan to achieve significant distraction; then, the distraction process is ever-evolving until finished.
Many worry about frames bearing their weight. I was surprised to learn that the internal pressure your legs put on the frames resisting distraction vastly exceeds body weight. For example, your legs may exert 2000 psi against the frames resisting distraction; your additional body weight is negligible.
If you distract more than 6 cm; then, your rods will bend and may need to be adjusted or replaced. My rods have been modified 4 or 5 times. I currently have 4 rods per leg set in hinged fashion but I started with 3 straight rods per leg.
To me, the correct decision is to remain in Russia under care until your final nailing surgery is performed. For me, that means about 4.5 months in Russia.
Scars
My scars are negligible. Perhaps if I had shaved and bronzed legs I would notice some temporary discoloration--but I don't have such legs.
Meds & Supplements
I take a double-dose of high quality multiple vitamin and a double-dose of calcium supplement tablets and eat a balanced diet. I don't know how much difference the supplements make, if any, but I have been healthy through the process.
You will receive all the meds you need from your medical team at prices much lower than in the USA.
I note two exceptions:
First, you will NOT receive any narcotics outside the hospital. If you have some leftover pain meds, I suggest you bring them. I brought 30 Norco (10/325) and have two tablets left.
Next, Russian MDs do not accept the research that NSAIDs (non-steroidal anti-inflammatory drugs like Ibuprofen) interfere with bone regeneration. If you accept this research; then, you should bring some Acetaminophen (Tylenol) with you because you will be prescribed Ibuprofen.
How do they get their rods out if they are not heard from again? I didnt understand what he meant by that part.
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@california the guy who was rude here has finally moved on it appears like. pls update if u feel like, we can all behave like adults here and agree to disagree. :) it was just that one guy who spoiled the entire situation here
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Hi California2,
I also have a hip replacement. I was encouraged to do internal tibias because external frames could risk infection and premature hip implant failure. Did you consider that at all when you had the procedure done?
Kind regards,
Resilience
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Foremost, there is no shortage of bad information on this forum.
Elective leg lengthening is a cosmetic procedure--by definition, that means the procedure is NOT medically necessary.
The process involves significant surgical procedures. Every significant surgical procedure has risk up to and including death.
The likelihood of dying from leg lengthening performed by a competent surgical team in a first world environment is remote--but not zero. This means that if you decide on elective leg lengthening, you could die from a procedure that was medically unnecessary.
If you are worried about risks of the procedure; then, purely external lengthening remains the safest procedure available. That is, external lengthening is known to have fewer complications AND a lower risk of infection.
Yes, people can and do fail to care for their external pins sites which can create pathways for bad things. But don't be those people--keep your pin sites clean as instructed.
I personally know of no research linking tibia lengthening and premature hip implant failure. Moreover, the notion seems unlikely. Hip implants fail for a variety of reasons--most often repetitive stress. No hip implant is designed to last forever. However, I can conceive of no good reason why leg lengthening might hurry along the normal process of hip implant deterioration.
It is another matter to consider femoral lengthening with hip implants. While lengthening over implants can be done, the risk of infection is far greater such that Dr. Solomin flatly advised against it except in cases of medical necessity.
Risks are further managed by having reasonable goals; actively managing the lengthening process in concert with your surgical team, and listening to your body.
What does listening to your body mean? It means that you will feel all sorts of unusual things during the lengthening process. You have to sort out whether something you feel is BAD or merely UNUSUAL. When you conclude something feels BAD, stop lengthening and reassess.
For me, I continue to improve. I am able (and approved) to bear full weight; however, due to balance issues and muscular atrophy, I am using two canes.
I hope to be ambulating without assistance in two months (which will be about one year out from my initial surgery).
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https://www.youtube.com/watch?v=gM_RD3UnGhY
Watch Dr. Rozbruch's video, get's interesting at 4:55. It's apparently common for hip implant patients to have retrograde femoral lengthening to correct LLD.
Wouldn't external tibial lengthening pose a greater risk to a hip implant than internal lengthening?
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To Resilience:
Now it is you who is contributing bad information.
It seems some percentage of persons who post on this forum simply do not understand information provided.
You watched a video; then, concluded " It's apparently common for hip implant patients to have retrograde femoral lengthening to correct LLD."
Your conclusion is not in any way supported by the video you posted. At the 4:55 hack, Rozbruch shows a woman with a screwed up hip which created a leg length discrepancy.
He then shows how a hip replacement reduced the leg length discrepancy. He then zeroed out the discrepancy via tibial lengthening of one leg. (Perhaps this was a case where femoral lengthening over the hip implant could have been considered because, by lengthening the tibia to correct the discrepancy, the patient's knees are at different heights.)
This video does NOT depict leg lengthening causing a bad hip.
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hello
usually I don’t see any reasons to interfere the clients discussion: I respect every community and I understand that nobody here asked my opinion. nevertheless I simply can’t stand aside and just look that 2 ex-patients are trying hard to protect me. I really appreciate that very much. Thank you, dear friends. You’ve done huge the honor to me. (they’re not fakes. Pictures of Jim_dabarber posted on the website straightlegs.ru (Cross-lengthening (LATN & LON).
I’ve spent one day reading this diary. I have no much time for that, but this discussion was extremely interesting. Many interesting persons, many interesting and very important ideas. Sometimes that contains very abusive and impolite language, but that doesn’t change the sense. I’d like just to pay attention to some moments: “money helps to get more successful treatment” - excellent! totally agreed. there are no reasons to start consultation with the words: “I have very limited budget, doc”. “after reading the diary, people could think, that it’s very easy – to get limb lengthening” – perfect! it’s extremely hard and difficult for the patient’s health and mind. especially – lengthening on 6, 8, 9, 13 cm at once (we had such cases). I always very impressed by the foreign patients: come to the different country with different people speaking different language for getting the hard and difficult treatment. they’re should be very brave. and very truthful comment to the photo: “after the lengthening the legs look not healthy at all” – of course! how should it look after 8cm (!) lengthening in case of not young patient? he will need time for rehabilitation. and I hope very much and wish him to restore the condition of the feet totally. excuse me for useless spending of your time: I’m always very interested in investigation of patient’s behavior during treatment and here I’ve found a lot of material.
about the patient, who’s got dropped foot… “I tried my best to listen to my doctors and exercise but most of these problems were out of my hand.” I’ve got permission from that patient to post his pictures. Unfortunately, the conditions of the forum provides pictures of 25KB – that’s nothing.
maybe you know, I don’t discuss treatment with patients by cell-phone, Skype and something like that: I need to store all the information. I use e-mail only and save every message from or to every patient. That is why I can prove every word about treatment of the patient:
in my first message on 27th of February 2018 he has got the file with information about treatment this file contains our recommendations and rules (file is applied). some sentences from it:
“You may go home for period of distraction and for period of fixation. Supervising by regional orthopedist is necessary during these periods.”
“The safest (fewest risk of complications) is Conventional Ilizarov.”
“Early postoperative period and Period of distraction: Manipulations (distraction): Obligatory: Start on 5th-12nd day after surgery (rate of distraction: 0,5-1,5 mm per a day).
We recommend: lengthening no more than 10% of the initial length of a bone”
“Trainings/physiotherapy: We recommend: training 2-3 times a week with trainer”
“In case of hypotrophic regenerate or strong pain syndrome, the distraction can be slowed down, temporarily stopped, prematurely complete; perhaps, one or several additional operations are required. As a rule, at this period patients need supervising by neurologist (80% of the patients) and by dermatologist (50% of the patients).”
“Period of correction: Trainings/physiotherapy: We recommend: training 2-3 times a week with trainer”
“In case of hypotrophic regenerate or strong pain syndrome, the correction can be slowed down, temporarily stopped, prematurely complete; perhaps, one or several additional operations are required. As a rule, at this period patients need supervising by neurologist (80% of the patients) and by dermatologist (50% of the patients).”
“Rebandages: Obligatory: rebandages by doctor once a week
We recommend: rebandages by doctor 2-3 times a week
We consider admissible: rebandages by patient 3 times a week (for the outpatients at home in different city)”
“During treatment we recommend to the patient every day send us information about: morning/evening temperature, pain level (from 1 till 10 points; 10 points is unbearable pain), duration of sleeping in the night, taken medicines, duration of training (with/without trainer), performed rebandages (with/without doctor/nurse), performed manipulations in the frame by patient/nurse/doctor), amount of distraction performed during the day for every segment, total amount of distraction performed during treatment and any other important information).”
after x-rays we’ve informed the patient that 10% from the length of his tibia is 4cm (that’s a usual number)
surgery was performed on 15th of December 2018 without any troubles. to avoid the ballerina feet during treatment feet were held by additional half-ring supports. that means, patient were not able to move the feet till frames removal
patient planned to perform lengthening of lower legs on 10 cm by LATN (message from 12th of December)
at 18th of December he left the clinic
at 22nd of December the lengthening (distraction) was started
at 28th of December he moved to his home country
at 31st of December (performed distraction - 9mm) in the daily report message he complained of the edema of the feet at first time
at 02nd of January he complained of “hard to sleep” at first time (duration of night sleep - 2 hours – very important parameter)
at 04th of January he complained on “hard to sleep” second time (duration of night sleep - 2 hours). were consulted by family doctor, got “pain-killers & sleeping pills”. Patient were not supervised by orthopedist at home. At all.
at 06th of January were performed x-rays. quality of the pictures were not enough to estimate the rate of lengthening
at 07th of January duration of sleeping 8 hours - good
12th of January – “feeling some pressure in the left foot”
13th of January – patient found out that instead of lengthening on 2cm he performed lengthening on 3cm (he sent me the photo with the frame and measure tape). he couldn’t explain that
14th of January – he reported about pain, pressure and numbness on the left leg, areas like knee, ankle and sole of foot
15th of January. were performed x-rays not appropriate quality, 16th of January I recommended to decrease the rate of lengthening (distraction) 17th of January I recommended to decrease the rate of lengthening (distraction) second time
19th of January he complained of severe edema of the feet and sent the pictures. I’ve recommended him to get the consultation by local orthopedist – was not performed
22nd of January – complained of “burning pain on the left foot”
24th of January – strong burning pain
27th of January – very strong burning pain
29th of January – “my foot burns a lot”, “I don’t know what to with it” I recommended to reduce the rate of lengthening till 0,75-0,5 mm per a day, consultation by neurologist (was not performed) and by angiologist (was not performed)
30th of January – he informed me “I’m going to slow down lengthening from tomorrow , from 1mm to 0,75mm”
31st of January – “unbearable shooting pain and burning”, (distraction – 39.75mm)
my answer: I can’t say much without looking at your legs, remembered, and he’s close to the more or less “safe” amount of lengthening and informed him, that after this limit the distraction should be harder
from the patient: “waiting for the orthopedist, don’t know when I can visit one, it might take several months. unfortunately it’s not possible to see neurologist either, they said June 5th is the earliest I can see one”
01st of February – I remembered to the patient that “for the effective treatment he needs right now (emergency): supervising (not visit) by the experienced in limb-lengthening and deformity correction orthopedist, consultation (and supervising) by neurologist”, “unfortunately, I cant cure you from Russia even if you’d send me satisfactory x-rays (I haven’t got yet)”, “I hope very much, you’ll get the appropriate treatment as quick as it possible”, "by the way, for the emergency help I’d recommend you to arrest the lengthening for both legs and get the examination by the orthopedist and neurologist today or tomorrow”
from the patient: “I can’t visit a specialist here anytime soon, health care system in here is different” he slowed down the distraction till 0,5mm per a day
02nd of February - I repeated to arrest lengthening. from the patient: “ my family doctor is all I have”. I recommended to remove the distraction “5mm at first” (to perform shortening)
03rd of February patient arrested the lengthening (he's got lengthening on 4cm for every leg). shortening were not performed
04th of February he’s got new x-rays. it was revealed the incorrect performing of the lengthening (right leg were shorter). Patient informed me, he plans to perform lengthening till 7,5 cm
05th of February – patient informed me, that he will proceed the lengthening – 1mm per a day for the right leg and 0,75mm per a day for the left leg
06th of February he restarted lengthening and informed that pain disappeared
07th of February he reported about not strong pain syndrome, last rebandages were performed 1 week ago. I remembered, that it’s not accorded to our recommendations
08th, 09th, 10th, 11th, 12th, 13th, 15th, 16th, 17th, 18th of February he informed about insignificant pain without problems with sleeping, he was taking pain-killers and sleeping pills.
10th of February he informed me, he will arrive on 24th of February (performed lengthening - 5,0cm right leg and 5,5cm - left)
14th of February he asked me to answer the questions from his girl-friend. “she wants to talk to you directly to have piece of mind, I explained to her this frame are straightening bones and make them longer”
her questions was:
1 – how are frames straighten his legs and what the issues before they are correcting?
my answer: had he problems before surgery? we didn’t plan deformity correction. just correction of misalignment caused by cosmetic (!) lengthening of the lower legs
2 – is there any risks after the frames come off?
my answer: yes: refracture, deformity …
example not gaining back full walking ability or blood issues?
my answer: its possible: patient is going more lengthening instead of recommended
3 – how much physic should he be doing in a day?
my answer: till getting full range of motion
4 – do you have a website with examples or testimonials of Marcus’s procedure
my answer: Marcus got files with clinical cases with files about treatment before surgery
She thanked me and didn’t ask any more
15th of February patient remembered to me, that he wants to go up till 7,5cm. I remembered that we recommend no more than 10% of the initial length of a bone.
17th of February – patient slowed down the rate of distraction because of strong pain
18th of February – he had complained on “burning on his feet” and problems with the extending of the knee joints; duration of night sleeping – 5 hours. I recommended to stop the distraction at all (third time) (amount of performed distraction - 5,9 right, 6,3 left)
19th of February – he had complained on “burning pain on his feet”. I asked about the distraction. In a daily report he posted 1.25mm for every leg
21st of February – he complained: “Every time I want to lay down or straighten out my legs, top of my feet starts to burn and hurt”. I answered: “that’s over tension of the nerves, I recommend you to stop lengthening”. he stopped
22nd of February – he asked me for permission to proceed lengthening. Professor Solomin remembered him, that “severe pain is contradiction for lengthening”
24th of February – the patient has remembered to me, he didn’t reach 7cm, he need
25th of February – he arrived to St.-Petersburg
26th of February – by the x-ray pictures performed in St-Petersburg it was founded that reached amount of lengthening was 6cm. his feet were very swollen. Moving of the toes were not revealed. Diagnosis by neurologist: traction lesion of tibialis and peroneal nerves of both legs. Patient decided to restart the distraction till 7cm.
28th of February - he informed me, he performed distraction 1mm for every leg and asked to increase the distraction by 0.25 because “I need to take my frame off no longer than end of third week of March. So I need to make sure I finish the lengthening and correction before that time”. And he informed me, that his pain is low.
01st of March patient informed me that he’s performing the distraction 1 cm (!) per a day. He insisted that I recommend him that, but, I think, he just couldn’t understand the difference between cm and mm. When I saw him next time, his legs and frames were not lengthened on couple centimeters.
02nd of March - in a daily report he informed me: “Amount of distraction performed during the day for every segment: approximately 1cm”, “Total amount of lengthening: R: 6.4 cm L: 6.4cm”
03rd of March - in a daily report he informed me: “Amount of distraction performed during the day for every segment: approximately 1cm”. Total amount of lengthening: R: 6.5 cm L: 6.5cm
he planned to reach 7cm till 8th of March and get the nailing surgery
he kept distraction till 8th of March
08th of March - after x rays (shown amount of lengthening for right leg 66mm, left leg 71mm) patient took a decision to keep lengthening till 74 mm
09th of March he started the correction. The nailing surgery was planned on 17th of March. Patient booked a flight on 21th.
correction were finished on the evening of 15th of March (we planned the smoother rate of correction to perform it very accurate). We’ve started frames reassembling (preparing for the surgery) at 19.00 in the evening and finished that at 01.30 in the morning: we wanted not to perform this difficult procedure in the day before surgery and saved 1 day for the any troubles.
While reassembling the frames patient ordered to perform the additional lengthening for the right leg – 5mm at once. He was explained that should be extremely risky. nevertheless, he insisted and confirmed that. all members of the team were really shocked at that moment: late night, patient moaning from the pain and asking: “5 millimeters more! I need that!” (this frase only I can't proove by mails)
at 01.32 in the morning I’ve sent the message to the patient and strongly recommend him to remove no less than 5mm lengthening on every leg (wasn't performed)
at 05.46 in the morning I recommended him to come to the hospital on 16th of the March instead of 17th of the March to relief the pain – he didn’t.
17th of March nailing surgery were performed excellent. during the surgery frames were removed. frames held feet in a right position by the screws. that means, patient couldn’t move the feet all the period of frames treatment. after removing the frames patient couldn't move the feet
So: I’d not say, if the patient followed the recommendations
What should I say?
1st: we never perform the cosmetic surgery without order and insisting from the patient
2nd: we never recommend the cosmetic lengthening more than 10% from the initial length (world-wide information)
3rd: we always inform in writing about complications. if patient plan to perform the lengthening after 10% the complications not “may be”. that “must be"
4th: we don’t perform lengthening. patient performs it. he determines the amount of lengthening and informs us. we comment his manipulations and his condition according to daily reports and x-rays
5th: we don’t damage the nerves and vessels during surgery. traction damage caused by over lengthening before second surgery and increasing after second surgery by additional edema
we always recommend Conventional Ilizarov – “1-surgery way of treatment” – is the safest. no second surgery – no additional risk to get additional complications
and: all our team wish to the patient the quickest and complete recovery.
try to understand, please: should be accurate playing with fire: using it accurate you’ll be warmed during cold (like California2 and Jim_dabarber), using it thoughtlessly, you may hurt yourself
best regards, dr kulesh
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After this reply! I feel so heartbroken.
I am not sure what to believe and what not to believe in this forum. At times everyone look correct & at times all look fake. I am not sure where to find more resources which are not influenced by conspiracy, lies and fake users or doctors.
I want to believe Dr Kulesh is posting himself. If he is, all other information or negativity seems obsolete.
Once again at times, I feel all conspiracy seems correct but on the other hand, We are just puppet of this forum who don't know what to trust 😭
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Hi dr kulesh,
What is the reason that russian doctors do not provide PRECICE / Stryde?
It seems that russian doctors make no effort in this direction, WHY?
Is it because its not profitable to you? Because no one would be able to pay that high price for LL
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To clarify -- Dr. Kulesh is not talking about my case--my initial surgery was September 2018. I do not know which case he is discussing but conclude he is explaining why some surgical outcomes are different than other outcomes.
To Sylar94:
By my understanding, internal lengthening is not yet approved in Russia. I understand that Dr. Kulesh's team is trained in internal lengthening; however, Russia's version of a medical regulator has not yet approved the procedure.
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Dr kulesh,
Discussion between doctors and patients are absolutely private,
And should not be shared to public in any form.
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To Big Decision:
Dr. Kulesh did not identify the patient he discussed.
Are you identifying yourself as the patient discussed above?
Even if you are acknowledging that Dr. Kulesh's comments are about you (Big Decision), you still have not actually identified yourself--you merely related comments to your anonymous moniker.
Moreover, under your anonymous moniker, you volunteered all sorts of personal information so you should hardly complain if other information is anonymously revealed because all such information is still anonymous.
Stated differently, if you want your medical information to be private; then, keep it private--don't post it on a public forum. If you chose to publicly post your medical information anonymously (as you did); then, don't act surprised when other information is published anonymously.
Posting accurate information without identifying yourself is the point of an anonymous forum. If Dr. Kulesh was addressing your case (without identifying you), was anything reported by Dr. Kulesh inaccurate?
Whether or not you are the patient discussed, I hope Dr. Kulesh's comments will help you and others.
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I do not usually respond to private messages because I am nobody's private resource for limb lengthening information and most private requests for information duplicate information posted or questions asked by others so if you have a question, please post it publicly.
I don't monitor this forum regularly (and planned to stop monitoring it all together); however, recent posts got me involved again. Consequently, I noticed I have several messages--most have already been addressed but I want to take this opportunity to address the following part of a message:
"I noticed you stopped at 173 cm. How come?"
I want to address this topic because I note that some posters are writing things like "the limit for lengthening is 8 cm period."
There is no theoretical limit for leg lengthening. Some children have successfully lengthened a limb by 30 cm.
There is a practical limit for lengthening and sometimes a mechanical limit for limb lengthening.
The mechanical limit arises because some internal devices can extend only 8 cm; ergo, some people incorrectly understand the physical limit to be 8 cm.
Most surgeons advise that 10% lengthening is the safe limit. That is, if the bone being lengthened is 80 cm; then, going to 88 cm is generally considered a safe goal.
I lengthened about 23-25%. Why did I stop? First, I exceeded my goal. Second, my body told me I pushed things as far as I could or should. Third, while most surgeons don't get too bent out of shape about 15% lengthening; 25% is not 15%.
As you distract, your body resists distraction and begins to complain. When your body complains loudly about 1/4 mm distraction so that you can only complete 1/2 mm per day, you should seriously think about locking in the gains you've made and stop.
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Popping in to say hi, great updates! I believe we met; you liked your room cold, we tried to troubleshoot your phone line, and you gave me some chocolates.
Throwing in a fact nugget: peroneal nerves (e.g. nerves in the hands and feet) regenerate, takes anywhere from a few months to a year and a half. Stay strong, BD.
I'm not quite convinced that Dr. Kulesh registered and posted here. He's not a man of many words, I just doubt he'd spend all this time here.
P.S. -- I'm doing much better, I just don't feel like hanging out here since this is where I came to kill time during work before CLL. I have so many other fun things to do...
Edit: MAYBE it is Dr. Kulesh's account. If it is... I advise you to stay away! This is a wild place.
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Popping in to say hi, great updates! I believe we met; you liked your room cold, we tried to troubleshoot your phone line, and you gave me some chocolates.
Throwing in a fact nugget: peroneal nerves (e.g. nerves in the hands and feet) regenerate, takes anywhere from a few months to a year and a half. Stay strong, BD.
I'm not quite convinced that Dr. Kulesh registered and posted here. He's not a man of many words, I just doubt he'd spend all this time here.
P.S. -- I'm doing much better, I just don't feel like hanging out here since this is where I came to kill time during work before CLL. I have so many other fun things to do...
great news !
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To Android:
Yes, we met as you described. Your room was toward the end of the hall--mine was near the middle. I am glad to hear you are doing well. I hope you stayed in touch with the slender nurse--you two looked good together!
Dr. Kulesh did write the lengthy post above--apparently he was curious and had some time on his hands. I know it is him because he and I talked about the forum while I was in Russia. Last week he asked me for the forum address; then, sent me an e-mail to inform me that he wrote on the forum.
Like you, I cautioned him to be careful because folks on the forum can be vicious and the forum is full of trolls with agendas.
While I don't know his motivation or purpose for posting because I did not discuss these aspect with Dr. Kulesh, I surmise he was surprised by both misrepresentations and unrealistic expectations and wants to correct the record.
I doubt he appreciates how challenging it can be to correct the record when anonymous trolls have unlimited time to craft a false narrative that supports their agenda.
This is getting a bit soapboxy so let me end by reiterating that it is good to hear from you (Android) and I wish you continued success.
I also continue to wish Big Decision continued healing and recovery. I wrote before that Bid Decision might be proof that you can do lots of things against medical advice but still successfully lengthen (albeit very uncomfortably).
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Its quite unprofessional to copy paste doctor's notes of a patient. A patient reporting complications faced is not justification for a doctor to paste the entire notes. The patient here didn't even blame the doctor, he was merely reporting his problems. He seems to have copy pasted that text without even summarising or paraphrasing or generalising it! This would probably not even be legally allowed in the USA but may be is fine in Russia.
Doctors being on patient forums is not exactly comforting. dr Kulesh should try to not spend time here.
Because of this incident I am quite sure this will be the last interaction of the patient he referred to here. I hope that was not the intended goal!
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Stated differently, if you want your medical information to be private; then, keep it private--don't post it on a public forum. If you chose to publicly post your medical information anonymously (as you did); then, don't act surprised when other information is published anonymously.
What an argument. What and how much someone posts about themselves publicly is entirely up to them. Other people don't have a right to append additional information!
For example, just because you choose to reveal that you are from California and are 50 years old that doesn't mean your doctor can pop in here and add that you are asthmatic and are an expert in lawn tennis. If someone you know IRL came here they would be more sure that it is you with the additional information known! Is this something you can comprehend?
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To Big Decision:
Dr. Kulesh did not identify the patient he discussed.
Are you identifying yourself as the patient discussed above?
Even if you are acknowledging that Dr. Kulesh's comments are about you (Big Decision), you still have not actually identified yourself--you merely related comments to your anonymous moniker.
Moreover, under your anonymous moniker, you volunteered all sorts of personal information so you should hardly complain if other information is anonymously revealed because all such information is still anonymous.
Stated differently, if you want your medical information to be private; then, keep it private--don't post it on a public forum. If you chose to publicly post your medical information anonymously (as you did); then, don't act surprised when other information is published anonymously.
Posting accurate information without identifying yourself is the point of an anonymous forum. If Dr. Kulesh was addressing your case (without identifying you), was anything reported by Dr. Kulesh inaccurate?
Whether or not you are the patient discussed, I hope Dr. Kulesh's comments will help you and others.
the state of this forum....
a "doctor" creates an account on a online forum to attack. totally unprofessional.
then the doctor proceeds to post patient logs.
doctors patient, big decision, finds it inappropriate that a surgeon can post such private things online.
Then here comes the 60 year old in-real-life loser, california2, to defend the surgeons actions. Like he was in some fking court.
To readers of this diary, if you havent already drawn a mental picture of what kind of sad pathetic loser california is, then i dont know.
Lets summarize:
- almost 60 year old guy, at this age who is supposed to have family, even grandchildren and wife, goes to russia to lengthen tibia 8cm+
- has hip implants
- leg looks deformed in all pictures
- masquarades on the forum as a successful LL outcome to give youngsters ill advices.
California if there is something called Karma you will have it coming you way pathetic loser. Get the fk off this forum and delete this diary unless you can actually prove you can ever jump or run again. You cant, you will never be able to do that.
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Again, I generally do not respond to personal messages because they tend to request information already posted; and, personal messages keep information away from others who have the same questions.
So, if you have a question of me, please post it openly.
From Gustavklimt:
Q: I noticed you swell a lot. Are you feeling better now?
A: Yes, my swelling is long gone.
Q: How was your IT band. Because you lengthen quite a lot.
A: The iliotibial band (IT band) is a tendon on the outer thigh that runs from the top of the pelvis (ilium) to the top of the tibia. It helps keep your hips and knees stable.
Because the IT band is a tough and thick tendon, it sometimes is a problem in femur lengthening. I lengthened my tibias--my IT band is not affected.
Q: Regard to doing external is safer I wonder why is that?
A: Purely external is known to be the safest form of leg lengthening--per my understanding, this is so mostly because it involves a single surgery and the surgeon has great control of the lengthening process and alignment.
It stands to reason that adding LON to external lengthening would undermine some of the control benefits of pure external lengthening.
LATN preserves all of the control but adds a second significant surgery which likely undermines some of the saftey benefits of pure external lengthening; however, I am aware of no good studies that compare the relative safety and effectiveness of external LON or LATN with internal lengthening.
From T:
Q: The costs of LATN on both tibias and femurs, staying at hospital, staying at hotel/apartment for months and registering Visa cost you $22,000, am i right?
A: Yes and no. I lengthened only tibias by about 9 cm. The approximate total cost of the procedure and all medically related costs was $15K. All other costs including airfare, local transportation, meals & groceries, an apartment for 4 months, Visa, etc. was about $7K.
I continue to recover well. Recovery has been a slow but steady process. I am walking unassisted now and my local medical team anticipates they will stop following me after my next appointment in October.
Remember, the average "full" healing time is 2 months for every centimeter of lengthening so I should not expect to be fully recovered until March 2020 even though I may appear fully recovered before that time.
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my objective questions california 8)
1) what is ur expectation of full recovery? which activities do u expect to perform?
2) will u post a anoynymous video of recovery after LL? not for trolls but for real LL community to learn something objectively from ..
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To Fodawupa:
Many leg lengtheners seem to worry about not being able to do all pre-lengthening activities after lengthening. Bottom line is that time will tell. My expectation is that by March 2020, I will do all activities that I did before lengthening.
My next x-rays will be in October and I will post them. If I can figure out how to make and post an anonymous video, I will do so at that time as well. My expectation is that I should be looking pretty normal by October even if I am not technically fully recovered until March 2020.
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LATN in St. Petersburg
One Year after Initial surgery
Full Bone Healing anticipated March 2020
100% Weight Bearing for Approx. 3 Months
Screws approved for Removal
(https://i.imgur.com/CahhmdN.png)(http://i.imgur.com/PMCTo6g.png) (https://imgur.com/PMCTo6g)
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what do you mean by "100% Weight Beaeing for Approx. 3 months"?
or is the approx. 3 months referred to "screws approved for removal" ?
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I mean that I have been bearing 100% of my weight without assistance; meaning without walker, crutches, or cane, for the past 3 months.
Bone growth has reached the point where I am now approved to remove my screws; that is, my bones can now support 100% of my weight so I can disconnect my bones from my nails.
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I see. Thanks. Congratulations on your progress! Good to hear.
Do you think you could have ditched all the walking aides even earlier?
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To Great321:
Could I have walked earlier? Probably, but now I will never know.
You may know that two schools of thought exist on this topic--one says walk early and often and make bone grow. The other says walking before 75% consolidation is too risky because it is easy to break your ankle screws and drive your nail through your heel.
My surgical team strongly holds the latter opinion; I decided it was prudent to follow the advice of my surgical team.
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Interesting. Wise decision. Then I' hope my supposedly large diameter nail will be stable enough:)
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For me, LATN was recommended over LON because LATN allowed the use of a larger; ergo, more stable nail. LATN allows a larger nail because the nail is inserted after distraction; thus, the space for the nail is increased by the length of the distraction.
However, irrespective of the size of the nail, the weak points are the two screws at the bottom of each tibia. Your entire body weight is supported by those two screws until bone grows to share the load and eventually carry the load.
Those screws can and do break. When they break, consequences can be severe.
In my humble opinion, patients who run and jump before 75% consolidation relying on those screws to support their weight are playing with fire.
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I wrote before that I do not do personal messages because personal messages deprive others who may have the same concern of information and also cause me to duplicate responses.
A member inquired:
I wanted to know something it would be very helpful if u could help me out. As i know you did LATN i wanted to know what was the scarring after nailing. In terms of compared to initial surgery how bad was it. like if initial surgery caused the scaring would you say nailing caused double that amount or the scars wernt an issue. If you could elaborate it would be very helpful.
LATN in the tibia causes no appreciable scarring. The surgery is performed via an about 3 cm incision over the kneecap. The kneecap is shifted to the side, a hole is drilled in the top of the tibia, the center of the tibia is usually reamed to remove the fatty deposits; then, the nail is inserted.
Screws to secure the nail are installed through very small incisions below the knee and above the ankle.
For me, incisions for screws left no scars at all. I have a very narrow hairline scar over each kneecap; however, even this scar is becoming very hard to locate.
In my opinion based on my experience, scars as a result of LATN are not an issue.
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As I keep writing, I do not respond to personal messages because doing so requires duplicate work. If you have a question for me, please post it here.
I received the following PM:
Hi sir. Did I understand correctly that you went for a 9 cm surgery split between tibia and femur with dr kulesh? How was your experience 1/10? What was your starting and end height? Any complications? What was your impression on the doctor and clinic. Was it modern? Dirty?
Please answer truthfully. I am thinking about this surgery but I am scared as fking hell to do it. I really need to find a proper doctor. And I am willing to pay around what you did.¨
Almost all of these questions are already addressed in my diary. Please read my diary for your answers.
The only question I see that I do not recall answering previously is "How was your experience 1/10?" Answering this question would grossly oversimplify the experience. Moreover, my experience will not be your experience.
Next, all of my input on this forum has been factual and frank--read it if you like and draw your own conclusions.
Last, if you are fearful of any elective surgery; then, you should not do the surgery. Instead, continue to work to gather information and understand options until you feel informed and comfortable to go forward. Leg lengthening surgery is not for everyone.
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I have on question: I believe it's possible to do a second surgery right at the moment of the frame removal (all in same surgery), correct? Do you know if Kulesh approved of this?
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I encourage you to discuss your question directly with Dr. Kulesh.
I think the question is not whether something is possible; rather, the question is whether doing something that may be possible is wise.
Many folks who are considering two surgeries on the same segment or lengthening both the tibia and femur on the same leg do not fully consider the impact of these procedures.
Whether you lengthen tibias or femurs, you stretch the tissues from ankle to hip. Tissue can only stretch so far. Think about folks who keep trying to put larger and larger rings in their ear lobes. Eventually, the lobe tears because all of the available stretch is used up.
In the same vein, perhaps you can safely and successfully stretch either your lower leg or your upper leg by 15%. This does NOT mean you can stretch both by 15%.
Consequently, if you want to do multiple lengthenings; then, most folks are advised to wait for a couple of years between lengthening.
However, perhaps you have a good reason to do what you want to do. If so, I encourage you to discuss in detail your idea with your surgeon.
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I encourage you to discuss your question directly with Dr. Kulesh.
I think the question is not whether something is possible; rather, the question is whether doing something that may be possible is wise.
Many folks who are considering two surgeries on the same segment or lengthening both the tibia and femur on the same leg do not fully consider the impact of these procedures.
Whether you lengthen tibias or femurs, you stretch the tissues from ankle to hip. Tissue can only stretch so far. Think about folks who keep trying to put larger and larger rings in their ear lobes. Eventually, the lobe tears because all of the available stretch is used up.
In the same vein, perhaps you can safely and successfully stretch either your lower leg or your upper leg by 15%. This does NOT mean you can stretch both by 15%.
Consequently, if you want to do multiple lengthenings; then, most folks are advised to wait for a couple of years between lengthening.
However, perhaps you have a good reason to do what you want to do. If so, I encourage you to discuss in detail your idea with your surgeon.
Thank you very much for your detailed answer I appreciate it a lot.
Glad you are doing fine and accomplished your goal, even at your age (no offense), well done!
Was it really hard to go out on shopping? going to the groceries store, cooking, cleaning, showering, etc, while on the wheelchair and on frames? I still picture it extremely hard for oneself to do all that...any advice would be gladly appreciated.
Finally, where did you stay and did surgeries on? clicnic #1 #2 or #3?
Thank you in advance California2
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Regarding cooking, cleaning, shopping, showering, etc.
I find that most challenges in life can be overcome with proper mindset, preparation, discipline, and strength of will.
As to cooking and cleaning--I had no problem cooking in a wheelchair. In fact, I got much pleasure from preparing elaborate meals for my neighbors from time-to-time. Doing so also provided an opportunity for social interaction. As for cleaning, I could push around a vacuum or mop but had a cleaner in twice a month.
As for showers--no showers until frames are removed and wounds are healed. Sponge bath only.
As for shopping--I tested my wheelchair and route before my surgery to identify problems and develop fixes. I had no real problems--not easy or convenient but doable--unless it was snowing. Wheelchairs do not work well on snow or ice. When the snow came, I had to plan my outing to the store for right after the pathways were cleared.
As for clinic 1, 2, or 3--I don't know what you mean. My initial appointments and x-rays were done at the Vreden Institute and St. George's Hospital. My first surgery was done at St. Elizabeth's Hospital. My nail insertion (LATN) was done at the Medem Clinic in downtown St. Petersburg.
Vreden and St. Elizabeth's are next door to each other--St. George is about two miles away.
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Thank you very much California2.
The number of clinics is in regard to how Dr. Kulesh points it out on his document (the one he sents when you ask about prices, etc).
Any advice on how to buy food (and other stuff) online? I am sure going shopping with the frames cant be nice ;D
Additionally, I would also appreciate if you could advice on how to use the bathroom (pee and poo) when on frames at home, etc... ::)
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Most accommodations in St. Petersburg are large high-rise apartment buildings. These often have central courtyards with outdoor gym equipment and child play areas. All have a variety of stores and shops on the ground floor--groceries, restaurants, barber shops, nail salons, etc.
Consequently, going shopping involves little more than going to the ground floor. Similarly, you can order food online for delivery from some nearby shops--I ordered both pizza and sushi a few times. Some websites (like Domino's) are in multiple languages--otherwise, Google Translate worked well enough.
Last, you can hire an aid to come once a week and help you do things if you want. 1000 Rubles is about $15. You can get a lot done for 1000 Rubles in St. Petersburg. Also, from time to time I asked my MD or physical therapist to swing by Burger King--they have coupons online to get a Whopper and a Big Burger and two small fries for 200 Rubles--about $3.
As for the restroom--first, make sure your chair can get into the unit's bathroom. Get a bottle urinal or a quart milk bottle for urine. So long as you can get your chair into the bathroom, you will be able to move from the chair to the commode when necessary. You will also be able to empty your bottle in the commode and rinse it out in the sink for next time.
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Thank you very much man you are very kind to share your experience in a very detailed way. Also glad you are recovering!
I am planning on going in June this year, I hope all goes smoothly as I will also travel alone and I know zero Russian.
If you allow me, the last 2 questions that came to my mind was, why did you mention the intramedullary nails are usually left there for life? wouldn't that be a problem? why can they just remove it at a later date when consolidation is 100% done?
St. George's Hospital is the municipal hospital? the one that is the cheapest option to do surgery, please correct me if I am wrong.
Thanks again and I hope you can forgive me for asking so many questions :-[
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The intermediary nails used in LON and LATN are just pieces of stable and inert metal. They contain no magnets or other potentially harmful material.
You can remove these nails if you like. However, most people only remove the screws that hold the nails in place.
Once the screws are removed, the nails become completely encased in what would otherwise be a hollow space in your bone. Most people become essentially unaware of the nails after the screws are removed; thus, they do not remove them.
If you are bothered in any way by the nails; then, you can always have them removed. But that is a decision to make a couple of years from now.
Best of luck with your procedure! I am confident you are in good hands.
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As for municipal clinics--St. George's and St. Elizabeth's are both municipal clinics; thus, the least expensive.
When I had the surgery, Professor Solomin was at odds with St. George's administration so he did not do surgery at St. George's; however, Dr. Kulesh used St. George's for x-rays.
I do not know which hospitals they use for surgery today--it was St. Elizabeth's and the MEDEM Clinic downtown when I had my surgery.
Frankly, while St. Elizabeth's was less modern and showed more wear and tear (as might be expected at a municipal clinic), the rooms were much larger and included a kitchenette, and the staff seemed more friendly; thus, I preferred the municipal hospital all-in-all.
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Thank you so much for all this valuable information!
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Hey California2 how are you feeling? how is consolidation going so far?
Hope all is good!
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I am having an unrelated procedure on my foot. My podiatrist wanted to be certain my Achilles tendon is fully stretched.
He recommended a device made by Joint Active Systems: https://www.jointactivesystems.com/products/jas-sps-ankle (https://www.jointactivesystems.com/products/jas-sps-ankle).
It is a boot you use to for both plantar flexion and dorsiflexion.
I am generally not a fan of devices but this works pretty well so I thought I would bring it to the list's attention because of its potential application in tibial lengthening.
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Seems very useful to use during distraction and consolidation stages for patients who are doing internals. Don’t think this would work with patients that are doing externals but until after the frames are removed. Thank you for the information! How is everything going, btw? How are your legs feeling?
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I do not generally reply to PMs because doing so prevents others from getting the same information and causes repeat questions.
One poster asks:
After reading your diary I staring seeing Dr. Solomin & Dr. Kulesh as my potential go-to for Cll. Are they still taking cosmetic cases and is there a height restriction? I’m a 23 y/o male with a height of 1.77-1.78.
My impression is that Russian surgeons give you their best advice for your situation; whether or not you follow their advice is more up to you than in the USA. I am not aware of any pre-surgery height prohibition.
Also, I read that in total you spent $22k on everything, $15k on surgery related expenses and $7k on everything else. Do you think this price could be lower if I did somethings differently, i.e instead of staying in the hospital for 3 weeks, leaving after 5-7 days, not hiring a maid/cook, etc... things like that.
No. I doubt you could reduce the overall price by much--it is already quite reasonable.
Best of luck.
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Thanks for your excellent and detailed reports, California2.
I was wondering about what you said a few posts up, that people sometimes leave the nail in forever. Is this the case for both the LON nail and the thicker LATN nail?
I am somewhat bow-legged and average height (1.79m) and am considering having LL while simultaneously having my tibias straightened, which will hopefully prevent me needing knee replacement in the future. I would be happy with 4 cm. Do you know of any patients who have done that with Drs Solomin and Kulesh? I understand it would be LATN, with the straightening done alongside the lengthening. Would it require extra time to do the straightening?
On a long term note, I enjoy lifting at the gym - reasonably heavy: squats up to 100kg. Would that be possible a year or so after the surgery? Ever? Would I need to have the nail removed?
Many thanks once again for your kindness in taking the time to post.
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I encourage you to direct specific questions to your surgeon but I am happy to share my understanding of things.
As for bowed legs--purely external can correct bowed legs because the bone can continue to be aligned after lengthening but before consolidation. Once a nail is inserted, the bone is fixed in position. Consequently, if you decide on a procedure that uses any form of nail or rod from the start; then, you cannot correct bowed legs.
Professor Solomin and Dr. Kulesh regularly fix bowed legs but it usually means more time in frames. You should speak with them about options.
As for LON or LATN-- the nail inserted is simply an inert metal rod--no magnets or anything to worry about. The nail is completely encased in bone after healing.
(On a related matter, because my nails are Russian, when I had an MRI through the VA I was concerned that my nails might have been made from old Lada parts and that my legs would be slapped against the MRI wall. The technician tested my nails with a huge magnet and assured me my nails were inert medical grade devices. Moreover, the nails I have are actually made in Poland.)
To remove the nail, you must open the bone to get to the nail. Many people remove the nail--I am not sure why--is it because they do not like a foreign object inside their bones or because they believe bone is more flexible than metal--who knows?
My US surgeon who removed my LATN screws but not my nail was a regular orthopedic surgeon. He says he repairs broken legs in football players and always recommends leaving in the nail because it just replaces fat stored inside the bone and the bone is far stronger with the nail inside.
So, different thoughts about the same topic. You should do what you believe to be the correct thing for you when the time comes to make a decision. If you choose to leave the nail in; it should in no way prevent you from doing anything and may even leave your legs stronger (if you accept my surgeon's position).
Good luck to you.
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Thanks again for the reply.
I saw that you also have bow legs, but you decided not to get them realigned during your external tibias for time reasons. Did the Drs explain how much longer it would take to do so? Is it necessary to complete the lengthening, then start another period of realignment before inserting the nail?
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Whats your level of physical recovery? can you post multimedia material to show it with sufficient redaction personal information to your satisfaction?
congrats on pursuing your dream at a relatively higher age.
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Thanks for your excellent and detailed reports, California2.
I was wondering about what you said a few posts up, that people sometimes leave the nail in forever. Is this the case for both the LON nail and the thicker LATN nail?
I am somewhat bow-legged and average height (1.79m) and am considering having LL while simultaneously having my tibias straightened, which will hopefully prevent me needing knee replacement in the future. I would be happy with 4 cm. Do you know of any patients who have done that with Drs Solomin and Kulesh? I understand it would be LATN, with the straightening done alongside the lengthening. Would it require extra time to do the straightening?
On a long term note, I enjoy lifting at the gym - reasonably heavy: squats up to 100kg. Would that be possible a year or so after the surgery? Ever? Would I need to have the nail removed?
Many thanks once again for your kindness in taking the time to post.
Honestly bro at 179 I would not ever even consider this, but bow legs are free to fix with insurance or the copay will be cheaper than Russia
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Whats your level of physical recovery? can you post multimedia material to show it with sufficient redaction personal information to your satisfaction?
congrats on pursuing your dream at a relatively higher age.
any updates here California2? You were online recently. I am keen on observing your recovery.
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Actually his goal ain't actually CLL...it's to correct bow legs to prevent future joint problems..LL is just an extra bonus(offcourse he has to pay for it)..but whn ur already going under the knife and have to break ur bone any way why not get something extra out of it😁..ig tht's wht his plan is.
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Here are several photo montages created by Dr. Kulesh that chronicle my LL journey:
The first is my initial surgery and x-rays:
(https://i.imgur.com/Fcb7n0e.png)
Next is Achilles Tendon Lengthening (ATL) by gradual hexapod (slow lengthening):
(https://i.imgur.com/YqfiXiR.png)
Third is stabilization of ATL and continued distraction (ATL hexapods removed):
(https://i.imgur.com/bxgJLwx.png)
Fourth is final correction via hexapod and LATN nail insertion:
(https://i.imgur.com/iCgIbZT.png)
How are you doing - do you have any knee pain or other issues with having putting nails inside your tibias?