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Author Topic: One Step Closer - External tibias, femurs, humerus - Petersburg, Russia  (Read 68900 times)

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Overdozer

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Alright...





I had my surgery at may 25. We decided to do a different method of osteotomy as you can see, it's not a straight cut. Supposedly it aids bone healing time. I had epidural anesthesia plus medications of kind well I was sleeping for the whole procedure. They also had some pump crap left in my spine and I could control the level of pain killing, quite handy the first few days. Started walking on day 4 after surgery using walkers. It hurt.

I'm now feeling much stronger and my femur soft tissues don't hurt as much. I left the clinic and currently I'm at my home.

Idk what else to say. Lengthening still...
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Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

microman

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any advice for deciding between dr. solomin or dr. barinov?
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Sweden

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Remind me a little please.

Have you done your arms?


Isn't it hell being in frames for so long?

Would you recommend doing femurs with external?


I'm a little interested bc I only feel like I need 4-5cm on my femurs bc I got cheated of my first lengthening. I aimed for 180cm but ended up being "only" 178ish.

What do you think the timespan would be for 4cm external femurs?

Thanks.
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173cm before LL with Sarin, jan -13. Now 180cm tall. Considering 5cm on femurs.

alex

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Hi

are you doing external femurs with full ilzarov rings ? ( I am doing external femur as well, and I am still in the deveice)
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Overdozer

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any advice for deciding between dr. solomin or dr. barinov?
I don't have much experience with either. Dr. Solomin, if I understand it correctly, is the master of Dr. Kulesh. So he must be experienced but I don't know about his aftercare. I think he handles his patients to Dr. Kulesh for aftercare anyways.

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Remind me a little please.

Have you done your arms?
Not yet. I will have to do them at this point, considering my final lengthening amount of 15 cm. Height of 182 and arm span of 170. So that's not much of a choice at this point.

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Isn't it hell being in frames for so long?

Would you recommend doing femurs with external?
It is a hell. Well I didn't feel any pain during fixation period, but the discomfort is still there, which is mainly because of the ring external on the femur. I for sure wouldn't recommend doing external femurs, unless your budget is really limited. It's just hard to tolerate. However, combining externals with nails and lengthening over a nail isn't bad idea IMO. Then again, you probably still don't want to do it bilaterally, because 3 months with 2 ring frames around your femur while lengthening is still a hell. You'll also have a VERY hard time taking a poop. I'd do LON one femur, then remove external - LON second femur. But that will take 6 months just for lengthening phase. Dr. Kulesh actually had a patient who lengthened 5-6 cm bilaterally on femurs from Germany. I think he was talking about how fun it is taking a crap while standing? Not sure. There was also one patient who installed external femurs and tibias in a way I did (cross-lateral), but then flew away (to his country). Apparently he wasn't ready for it.

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What do you think the timespan would be for 4cm external femurs?
Usually it's 1.5-2 months per cm lengthened. It was a little lower for me. However, like I said, you probably don't want to do external femurs bilaterally.

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are you doing external femurs with full ilzarov rings ? ( I am doing external femur as well, and I am still in the deveice)
That's right. The two rings close to the knee are full rings, but the other one is a modified construction, so you can actually sit... a little. Well you can see it on the x-ray even.
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Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

Taller

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How is your knee ROM?
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Overdozer

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How is your knee ROM?
I regained full knee ROM on my previously operated femur. On the current femur ROM is like 30 degrees. I don't even bother working on it as it hurts like hell and it's most likely not going to change a thing. I found working for ROM while in externals is counter-productive, as your pins start tearing your skin, they start bleeding, which in the end causes inflammation. After the external is removed, I found regaining ROM is easy and steady.
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Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

alex

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Hey guys! So I just removed the external frame from my left femur, tibia frame was removed like a month age. So far I've lengthened 7.5 cm both on my tibia and femur. I currently have a very light ballerina - my feet don't go past 90 degrees when standing, but when sitting they're ok. Also I can't bend my knee on my femur leg past 140 degrees (straight knee is 180 degrees)


Hi

after you finished femur lengthening but still in the external deveice, how much you were able to bend the knee ?

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alex

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I'm only done with the first lengthening phase. I'll post some pictures when I'm done with the second phase, hopefully I'll have my surgery in two months.

By the way, I still didn't reach 90 degrees knee flexion. Waiting on my knee splint to arrive.

Hi Dozer

you are saying here you can't bend 90 degrees yet, but you said in your first post (Also I can't bend my knee on my femur leg past 140 degrees (straight knee is 180 degrees, so I currently have 40 degrees of ROM)

did you mean you can bend 140 or 40 ??

and another quetsion please, did your tibia heal faster than femur in your first surgey ?
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Overdozer

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Hi Dozer

you are saying here you can't bend 90 degrees yet, but you said in your first post (Also I can't bend my knee on my femur leg past 140 degrees (straight knee is 180 degrees, so I currently have 40 degrees of ROM)

did you mean you can bend 140 or 40 ??

and another quetsion please, did your tibia heal faster than femur in your first surgey ?
40. You can't bend your knee more than 40 degrees with a femur Ilizarov fixator.

And no, my tibia didn't heal faster, quite the opposite, I just lengthened less. I had another surgery quite a while ago where I lengthened only 4 cm on my tibs bilaterally (thinking it would be safe and/or enough, idk lol). I was unsatisfied with the result so I decided to lengthen more. So yeah, this is my THIRD fking surgery. And I still have one more to do.
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Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

alex

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40. You can't bend your knee more than 40 degrees with a femur Ilizarov fixator.

And no, my tibia didn't heal faster, quite the opposite, I just lengthened less. I had another surgery quite a while ago where I lengthened only 4 cm on my tibs bilaterally (thinking it would be safe and/or enough, idk lol). I was unsatisfied with the result so I decided to lengthen more. So yeah, this is my THIRD fking surgery. And I still have one more to do.

Hope the best for you, let me understand some thing. you were doing external femur, and as you said, while you were in ilazarov deveice, you were able to bend only 40, so after you removed the deveice, your knee still stuck at 40 degrees and needed workout to bend more, or removing the deveice made you able to bend more before doing any workout.

I hope you understand my quetsion : D
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microman

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wow the price is soo cheap, with this price I can afford 2x surgeries for the same price as one surgery with mitkovic/barinov.

I am 164.5, wingspan 167, I would be happy to be 174.5, I don't think I would need arm legthening after that , would you agree?

but I ask, do you do 1/mm a day on femur and 0.66mm a day on tibia?

and if that is so, wont you be done with femur lengthening faster than tibia, in which case you can begin the next surgery on another bone part before the tibia is done lengthening.

what is aftercare like, does the doctor come and see you in a hotel, do you get nurses to change bandages weekly etc.

do you know how many patients he has had for cosmetic LL.
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Taller

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If it's not too much trouble, could you post a picture of your proportions so far?
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microman

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yeah maybe it doesn't look too bad.

and yeah 140000 rub is £1,500 for me, that is stupidly cheap, I take it you are charged in rubles, the main doctor page has money in USD so I assumed I would be charged that in USD.

also how long would the whole thing take for 5cm per segment cross lateral, I imagine the timing of the operations would be different due to the different lengthening rates or femur vs. tibia.

maybe it would go:

operation start on Left tibia, Right femur.
right femur lengthening finished in 50 days
do left femur operation
20 days later left tib lengthening is finished, 70 days total
do right tibia operation
30 days later left femur finished and consolidating.
70 days later right tibia finished and consolidating.

would the whole thing be 11 months total, then at that point frame removal?
man seems complex.

also I know that usually femurs are 1m/day and tibia is 0.66m/day, but why not do femur at 0.66 a day anyway because you would still need to wait on the tibia to be done before the consolidation phase is complete anyway.


Actually would it not make more sense time wise to do tibia first, then while that is consolidating, do femur, as won't they both have healed at around the same time, so the whole thing would take 8 months, of course I realize it would be a more difficult process.
« Last Edit: June 12, 2015, 07:58:47 AM by microman »
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Overdozer

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Hope the best for you, let me understand some thing. you were doing external femur, and as you said, while you were in ilazarov deveice, you were able to bend only 40, so after you removed the deveice, your knee still stuck at 40 degrees and needed workout to bend more, or removing the deveice made you able to bend more before doing any workout.

I hope you understand my quetsion : D
You still have 40 degrees after frame removal. And yes you have to do PT every day to increase your ROM, it won't magically improve by itself. Though I did it pretty casually, like no more than a hour per day. Shouldn't be big of a deal once you reach 90 degrees, so you can sit comfortably at least.

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If it's not too much trouble, could you post a picture of your proportions so far?
I'm hoping to post them eventually, but this is not going to be now. I look like crap currently, I mean I lost a lot of muscle, I have duckass, so I can't stand straight, and also huge frames alter perception with my pants rolled up on my ass, because otherwise they come in contact with the pins. So, yeah. Let me remove this piece of crap first.


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wow the price is soo cheap, with this price I can afford 2x surgeries for the same price as one surgery with mitkovic/barinov.

I am 164.5, wingspan 167, I would be happy to be 174.5, I don't think I would need arm legthening after that , would you agree?

but I ask, do you do 1/mm a day on femur and 0.66mm a day on tibia?

and if that is so, wont you be done with femur lengthening faster than tibia, in which case you can begin the next surgery on another bone part before the tibia is done lengthening.

what is aftercare like, does the doctor come and see you in a hotel, do you get nurses to change bandages weekly etc.

do you know how many patients he has had for cosmetic LL.
Price is cheap indeed. I feel like I'm doing this for free lol. And the only, actual price I pay is wearing this ugly god damn frame around my femur. I do 1.25mm/day currently on both, as I've been instructed, waiting for the next x-ray control, then I'll be given new instruction regarding rate of distraction. At once spot I did 1.75mm/day on my femur, my second surgery.

The aftercare is great overall. Kulesh visited me almost every day while I was in the hospital. And I was there for 2 months my previous time, so that talks a lot. He can also visit you at home if it's indeed. He was talking about one of his international patients the other day, saying something about buying McDonalds for him. So I think you should be safe.

Bandages - at previous hospital where I stayed for 2 months, they'd change them every 3 days and every week Kulesh would also be there to see, if your pin sites are infected or inflammed. In the new one, he actually changes them by his own. At home though I do it myself - I've been doing it for years now so that's not a problem. I guess you can order a nurse though it's not needed, changing dressings isn't hard.
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Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

microman

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that's great to hear about the after care, but 1.25mm/day is WAY too much is it not, far above the safety limit.

what did you think of my timescales, 11 months for cross lateral 5cm per segment, or my idea of tibia then femurs (when tibia consolidating, then femur distraction) for 5cm per segment in only 9 months, do these calculations make sense.

I e-mailed solomin to ask about invitation letter and russian visa, I have also asked about current prices as we know they can change.

i can only assume the german patient lived in a nearby hotel for some of the time, does Solomon have a recommendation to hand and general prices.
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Overdozer

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yeah maybe it doesn't look too bad.

and yeah 140000 rub is £1,500 for me, that is stupidly cheap, I take it you are charged in rubles, the main doctor page has money in USD so I assumed I would be charged that in USD.

also how long would the whole thing take for 5cm per segment cross lateral, I imagine the timing of the operations would be different due to the different lengthening rates or femur vs. tibia.

maybe it would go:

operation start on Left tibia, Right femur.
right femur lengthening finished in 50 days
do left femur operation
20 days later left tib lengthening is finished, 70 days total
do right tibia operation
30 days later left femur finished and consolidating.
70 days later right tibia finished and consolidating.

would the whole thing be 11 months total, then at that point frame removal?
man seems complex.

also I know that usually femurs are 1m/day and tibia is 0.66m/day, but why not do femur at 0.66 a day anyway because you would still need to wait on the tibia to be done before the consolidation phase is complete anyway.


Actually would it not make more sense time wise to do tibia first, then while that is consolidating, do femur, as won't they both have healed at around the same time, so the whole thing would take 8 months, of course I realize it would be a more difficult process.
Just be real when it comes to cross-lengthening. It's easy to get lost in your fantasies. This crap brings you down on your knees, especially femur lengthening. Consider doing LON (they offer it too but the price is higher obviously idk the exact) on femurs, as that should reduce frame wearing time by a LOT. Especially if you'd have a bad consolidation - you don't want to be stuck with that frame forever.

Also it looks like you got it wrong. Cross-lengthening works this way: you install frames on, say, LEFT tibia and RIGHT femur. You lengthen and then WAIT until you remove them. Then you go for another surgery, where you install frames on your RIGHT tibia and LEFT femur. You don't install them all after each other, that will leave you very unhappy, trust me. 5 cm cross-lateral and total 10 cm of lengthening should take you about 2 years. However, like I said, you can do LON and remove femur external fixator earlier, which should allow you to install another one right away. 5 cm per segment is a rather safe goal.

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also I know that usually femurs are 1m/day and tibia is 0.66m/day, but why not do femur at 0.66 a day anyway because you would still need to wait on the tibia to be done before the consolidation phase is complete anyway.
Not true. It depends solely on your consolidation.
Logged
Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

microman

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oh right i thought you could begin the next operation once the bone is in consolodation phase, i had no idea it had to be at the very end.

wow 2 years, well never mind then, i thought cross lateral was a good idea because it saved time, i naturally thought you can do what i thought you could do, for LON does that make much of an impact on timescale, so maybe 1.5 years instead of 2.

but yeah both those figures are too long for me.

any idea how many international patients he has had for cosmetic LL, I just need to make sure he has done the process of sending patients home and making the referals to my local hospital for my x-rays, as my hospital won't do that without a referral.

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Overdozer

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oh right i thought you could begin the next operation once the bone is in consolodation phase, i had no idea it had to be at the very end.

wow 2 years, well never mind then, i thought cross lateral was a good idea because it saved time, i naturally thought you can do what i thought you could do, for LON does that make much of an impact on timescale, so maybe 1.5 years instead of 2.

but yeah both those figures are too long for me.

any idea how many international patients he has had for cosmetic LL, I just need to make sure he has done the process of sending patients home and making the referals to my local hospital for my x-rays, as my hospital won't do that without a referral.
LON in theory could cut the time down to just 1 year.

I can't know the numbers, but he had quite a few international patients.
Logged
Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

alex

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You still have 40 degrees after frame removal. And yes you have to do PT every day to increase your ROM, it won't magically improve by itself. Though I did it pretty casually, like no more than a hour per day. Shouldn't be big of a deal once you reach 90 degrees, so you can sit comfortably at least.

How long did you take to move from 40 degrees to 90 degrees ? you can bend now 180, isn't that ?

by the way, how many cm you did in your femur and how long time you had the frame on the femur ?
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microman

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i emailed solomin, after 2 emails he told me to email Dr. Pavel Kulesh, I haven't recieved an e mail from him after contacting him.

just thought i'd let people know how i got on in case others were thinking of doing LL there.
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Overdozer

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How long did you take to move from 40 degrees to 90 degrees ? you can bend now 180, isn't that ?

by the way, how many cm you did in your femur and how long time you had the frame on the femur ?
A month and a half or so. I lengthened 7.5 cm and I had the frame for 9.5 months.


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just thought i'd let people know how i got on in case others were thinking of doing LL there.
They do their filtering too. Kulesh usually responds to mails within a day.
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Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

alex

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A month and a half or so. I lengthened 7.5 cm and I had the frame for 9.5 months.

I thought 7.5 cm wouldn't take more than 8 monthes in femur as they heal fast than tibia.

after removing the deveice from femur, did you had any problem with your back as duck ass and so ?
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Overdozer

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I thought 7.5 cm wouldn't take more than 8 monthes in femur as they heal fast than tibia.

after removing the deveice from femur, did you had any problem with your back as duck ass and so ?
Duckass disappears shortly after distraction is complete. With enough standing.
Logged
Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

Taller

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How long do you think it would take to cross lengthen tibaie and femurs by 4CM each using LON?
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Overdozer

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How long do you think it would take to cross lengthen tibaie and femurs by 4CM each using LON?
LON on both tibia and femur? Well, around 50 days to lengthen 4 cm and remove the external fixators and then repeat in a month or so? So around 130 days before you'll remove all the externals. And then few months extra before you can actually walk unaided.

I'd get bilateral external-only tibias and at the same time install 1 LON femur, lengthen, remove the femur fixator and install another LON femur shortly after. 4 cm shouldn't take too long to consolidate and external tibs are usually tolerated well.
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Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

microman

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I got a response from him, he sais if i choose MEDEM Clinic they all speak english! maybe that is a department in the Petersburg hostpital?, he says if i choose St Elizabeth Hospital I will need to have a transaltor app on my phone to communicate with people.

dozer do you know any information about this, if there is a place nearby where staff speak english, it would be most adventageous for us to know.

Dozer are you saying it would noly be 5 months with frames on for LON 8cm.

are you also saying the best option would be eixternal tibs, and while lengthening that you lengthen one femur, is that not a bad recomendation, i thought you could only lengthen 2x legs at one time.

if you can adhvise id like to know total time until frame removal of 4cm for tib and femur total 8cm, using which ever method is best for time.
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Taller

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Do you plan to do anything about your pinsite scars after lengthening?
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Overdozer

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I got a response from him, he sais if i choose MEDEM Clinic they all speak english! maybe that is a department in the Petersburg hostpital?, he says if i choose St Elizabeth Hospital I will need to have a transaltor app on my phone to communicate with people.

dozer do you know any information about this, if there is a place nearby where staff speak english, it would be most adventageous for us to know.

Dozer are you saying it would noly be 5 months with frames on for LON 8cm.

are you also saying the best option would be eixternal tibs, and while lengthening that you lengthen one femur, is that not a bad recomendation, i thought you could only lengthen 2x legs at one time.

if you can adhvise id like to know total time until frame removal of 4cm for tib and femur total 8cm, using which ever method is best for time.
MEDEM clinic is a fancy commercial clinic, St. Elizabeth Hospital is a government hospital. Staying in MEDEM is very expensive, like 200$/day or so, the surgery will also be more expensive.

You should be fine with google translator though. I think... May be... Yeah...

Also, you're asking me a lot of questions regarding the time you need to lengthen 'x' centimeters. Keep in mind, that I can't tell you that, as every case is unique and I can't know your bone healing capabilities. And when I say "I'd get" I actually don't give a recommendation, it's just what I personally would do, but to me that's a different thing. I know that I could tolerate more than what I have right now and you can't know that. Like I said, keep your goals realistic and try to not overload yourself.

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total time until frame removal of 4cm for tib and femur total 8cm, using which ever method is best for time.
External-only bilateral tibias 50 days distraction for 4 cm and approx 7 months overall until frame removal.

LON femurs after you've finished lengthening tibias (50 days) to ease the process for yourself, 3 months each for 8cm, about 6-7 months total.

So that's 50 days + 7 months, around 9 months, if everything goes cool. I don't recommend going that route though, as it'll be very difficult. External femurs are very hard to tolerate, let alone lengthening back to back with tibias and also having 3 externals at the same time.


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Do you plan to do anything about your pinsite scars after lengthening?
May be. Scar revision is probably not the worst idea after lengthening so much with external devices. I hope I can walk in and YOLO all the scars at the same time, so I don't have to waste much time on it.
Logged
Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0

microman

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honestly it doens't sound appealing for international patients to go to this hospital.

ill see what MEDEMs prices are, i take it it's the same doctor regardless?

okay so the whole thing would take 9 months total, but you don't recomend, yeah i don't see many patient diaries of people lengthening femurs while tibs are consolodating that's for sure.
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Overdozer

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Had an x-ray few days ago. Been suggested to increase distraction rate on my femur to 1.5mm/day and if possible to tolerate, to 1.75mm. Tibia - osteotomy wasn't full and my tibia broke completely and disconnected after I started lengthening, so I had to compress 4 mm and temporary stop lengthening. You can see valgus on the tibia x-ray, Kulesh explained it's because of the fibula resistance, I've been given instructions for correcting it, turning the screws on the left, fibula side one more time.



Logged
Pre-surgery - 167 cm, Post-surgery - 181 cm
Final arm span - 177 cm, Sitting height - 90 cm

Lengthened 7.5 cm in tibias and femurs and 3.5 cm in each humerus. Surgeries performed all external by Dr. Kulesh, in Saint-Petersburg, Russia - http://www.limblengtheningforum.com/index.php?topic=1671.0
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