Topic: No More Mal-Kahn-Tent - External Tibias - Dr Parihar (Read 418020 times)

ramujp17 · « **Reply #403 on:** March 03, 2015, 02:10:42 PM »

really good to hear that u r nearing the end of the long procedure, keep us posted

KiloKAHN · « **Reply #404 on:** March 05, 2015, 09:30:54 PM »

So two weeks ago I told Dr Parihar of my local orthopedist's plan for frame dynamization:

KK: My local orthopedist said he wants to loosen some of the pins when I see him again on March 10, and then 4 weeks after that he said the frames should be ready to come off. He then plans to have me wear protective walking braces for an extra month or so.

I just received a reply from Dr Parihar advising otherwise, along with an attachment to help me see what he was talking about:

Dr P: I would suggest - do not loosen the pins.

instead, back off the nuts on the rings where the threaded rods are attached (the thinner ones, not the thick aluminium ones). they must be alternately on the first and second rings.

they can be backed off by 2 mm on each and the nuts retightened in the new position. this will allow more weight bearing thru the bone, and help in healing it faster.

removal of the pins is not needed or advisable in my opinion.

also - the physio - have you started physio yet or not?

Perhaps I won't be taking the frames off as soon as I thought.

Sean Connery · « **Reply #405 on:** March 05, 2015, 09:44:05 PM »

Quote from: KiloKAHN on March 05, 2015, 09:30:54 PM

Perhaps I won't be taking the frames off as soon as I thought.

Not if you just listen to your local doctor. Just do what your doctor close by says since he's actually seeing you and able to give you advice in person and not just through email.

KiloKAHN · « **Reply #406 on:** March 05, 2015, 09:48:59 PM »

Quote from: Sean Connery on March 05, 2015, 09:44:05 PM

Not if you just listen to your local doctor. Just do what your doctor close by says since he's actually seeing you and able to give you advice in person and not just through email.

I don't think it's a good idea to go against Dr Parihar's advice as he's the one who performed the surgery and everything.

ouroboros · « **Reply #407 on:** March 08, 2015, 08:23:37 AM »

I agree. I would definitely listen to dr Parihar's advice since he has looked at countless x-rays of LL patients and would have the best experience regarding what your x-rays should look like before attempting to remove the frames.

Btw, I read in your diary that you have been taking Ibuprofen a couple of times. I don't know if it has been brought up before, but you are supposed to stay away from such medication since it slows down bone regeneration. At least that what I read from Paley. Sorry if it has already been addressed, I am trying to catch up with reading many diaries in my limited spare time.

Congrats on being so close to getting the frames removed..... you must really be looking forward to it

just_me · « **Reply #408 on:** March 08, 2015, 03:41:59 PM »

If it was me then I would listen to Doctor Parihar - Good luck with your decision. Your X-rays look good. Good luck with your legs.

YellowSpike · « **Reply #409 on:** March 11, 2015, 01:11:48 PM »

Hey Kilo - did you see your orthopedist yesterday? If so, how did it go?

How are you feeling at your new height, are you definitely gonna do a second LL?

Sean Connery · « **Reply #410 on:** March 15, 2015, 05:46:36 AM »

Do you think someone used to western standards would be able to manage Dr. Parihar's hospital? There was another consultation on the old forum where the prospective patient decided he wouldn't do surgery with your doctor because the hospital was supposed to be some godawful mess. Is the poor quality of the hospital exaggerated or did you just suck it up?

ItsMyLife · « **Reply #411 on:** March 15, 2015, 10:07:51 AM »

Quote from: Sean Connery on March 15, 2015, 05:46:36 AM

Do you think someone used to western standards would be able to manage Dr. Parihar's hospital? There was another consultation on the old forum where the prospective patient decided he wouldn't do surgery with your doctor because the hospital was supposed to be some godawful mess. Is the poor quality of the hospital exaggerated or did you just suck it up?

I've seen American hospitals and they are sometimes so messy.
But I suppose indian hospitals are worse.

KiloKAHN · « **Reply #412 on:** March 16, 2015, 08:05:24 PM »

Quote from: YellowSpike on March 11, 2015, 01:11:48 PM

Hey Kilo - did you see your orthopedist yesterday? If so, how did it go?

How are you feeling at your new height, are you definitely gonna do a second LL?

My local orthopedist used a 10 mm wrench to loosen the nuts on each of the rods. A lot of them were on really tight and by the time everything was loosened I had terrible soft tissue pain just below the knees that lasted for 5 days. He still wants to get my frames removed in mid-April and put me in walking braces for a month or two afterward, so he said to ask Dr Parihar if he thinks differently.

Quote from: Sean Connery on March 15, 2015, 05:46:36 AM

Do you think someone used to western standards would be able to manage Dr. Parihar's hospital? There was another consultation on the old forum where the prospective patient decided he wouldn't do surgery with your doctor because the hospital was supposed to be some godawful mess. Is the poor quality of the hospital exaggerated or did you just suck it up?

You can see pics of my room earlier in the diary. I really thought the condition of the hospital was fine. Yeah you're not going to see shiny marble floors, but it's got everything you would need to be comfortable. I honestly think that someone who won't do surgery there solely based on how it looks is a drama queen. The hospital's OT is clean and sterilized so there's no need to worry about that.

KiloKAHN · « **Reply #413 on:** March 20, 2015, 06:50:23 AM »

Update: 3/19/2015
Got back from another physical therapy session. He decided that the only exercises I can do at the moment are things I can do at home and don't need to be there for, so he decided that I'll have my next session once these frames are removed (mid-April if Dr Parihar allows it) and to just keep doing home physio. Good news is that since my appointment last week my dorsiflexion has improved from left leg -30 degrees and right leg -25 degrees to left leg -15 degrees and right leg -10 degrees. My goal for the next meeting is to get to 0. He said for normal walking you want 10 degrees dorsiflexion on each leg, which I think will be possible for me with enough time. I'm waiting longer than usual for my x-rays to be processed for pickup. Hopefully they'll be ready for me to post tomorrow.

alps · « **Reply #414 on:** March 20, 2015, 12:08:18 PM »

Wow man, you're recovery is taking quite long.
It'll soon be a full year. Did you anticipate this?

Do LON patients usually take this long?

KiloKAHN · « **Reply #415 on:** March 20, 2015, 02:28:31 PM »

I did slightly over 6 cm so I expected it to be 9 months wearing frames at a minimum. It's amazing that a woman can develop a baby faster than my bones can heal with exfix only lol.

LON patients have the benefit of walking around sooner and taking the frames off in one third the time you have to wear frames for exfix only.

TRS · « **Reply #416 on:** March 20, 2015, 02:54:49 PM »

Quote from: SAD on March 20, 2015, 12:08:18 PM

Wow man, you're recovery is taking quite long.
It'll soon be a full year. Did you anticipate this?

Do LON patients usually take this long?

Dr.Parihar is quite conservative and recommends external fixation for 1.5 months per cm. Kilokahn did his surgery on the 25th of June, 2015, lengthened around 6 cm and it's nearly 9 months. This is normal. Some doctors are even more conservative, for example Dr.Birkholtz and Dr.Rozbruch both recommend 2 months of external fixation per cm.

KiloKAHN · « **Reply #417 on:** March 20, 2015, 09:55:03 PM »

Latest X-Rays (3-10-2015)

crimsontide · « **Reply #418 on:** March 20, 2015, 10:28:24 PM »

definitely takes over a year of getting back to full recovery, so tbh, no reason not to wear frames a while

just_me · « **Reply #419 on:** March 20, 2015, 10:37:36 PM »

Your X-rays looks good. Nice to read a diary which always show the progress as it goes on. Good luck.

KiloKAHN · « **Reply #420 on:** March 22, 2015, 12:07:15 PM »

It's quite possible I'll be wearing the frames for a whole year, based on Dr Parihar's response to my last set of x-rays. He's not in agreement with my local orthopedist about removing the frames and putting me in walking braces in mid-April.

i have seen the X-rays.

they show progress. since the nuts have been loosened only on this visit, i would expect to see the improvement due to that only on the next set of X-rays.

removal of frames:
i usually remove the frames only when i can see corticalisation of at least 3 out of 4 sides of the bone - (medial cortex and lateral cortex are seen on the AP X-ray, and anterior and posterior cortex on the lateral X-ray)

in patients who have a nonunion etc, the leg can be protected in a brace after fixator removal. in patients who have a long regenerate (as in your case 6 cms), i believe that the risk of refracture or bending of the regenerate is too high to trust a brace, unless the 3 cortex sign as mentioned above is present.

as i may have told you at the initial consult.
- a month too late is better than a day too early.
- the consolidation phase is when the most patient patient becomes impatient, and i think i can ascribe the lesser number of complications that we have to the fact that i am able to resist patient pressure to take off the frame, before i am convinced that it is ready for removal, based on my clinical and X-ray findings, rather than on patients feelings or discomfort.

feel free to share this with your local orthopedist.

crimsontide · « **Reply #421 on:** March 22, 2015, 01:16:02 PM »

sux to wear the frames...

but if you take off too early, you might need to get leg rebroken again and wear a frame anyway... there's just no way of getting around the long time frame with external fixation

and after a year, you'll not be walking normally right after they come off

this whole process takes a while

Alittletooshort · « **Reply #422 on:** March 22, 2015, 02:38:46 PM »

Hey Kilo,
Great diary so far! I am still undecided when it comes to the method of lengthening (LON\external). How do the frames affect your daily life? Are you able to do stuff like buying grocceries or just take a stroll?

KiloKAHN · « **Reply #423 on:** March 22, 2015, 07:35:24 PM »

The frames are sometimes not a bother at all and sometimes a real pain in the ass. The longer you wear them, the more the pin sites slowly open up due to skin stretching and movement, and the more uncomfortable wearing them gets on average in a day. Right now I'm back to having a lot of difficulty sleeping without taking pills before bed. I don't think I'd be able to go grocery shopping with them on considering how slow I walk, plus I probably wouldn't be able to carry much while having to grip on to the walker. If you have a wheelchair you can get around fine so long as you have someone to drive you to your destinations.

Exfix is certainly more uncomfortable long term than LON, but I did it to avoid the possibility of chronic knee problems that comes with insertion of the nail into your tibias.

Plzen · « **Reply #424 on:** March 22, 2015, 11:37:44 PM »

Hey Kilokahn,
Being in external fixators ,for one year, is a long time. Hang in there. You are almost there. When it comes to LL, I would rather be safe than sorry. Good luck to you.

KiloKAHN · « **Reply #425 on:** March 24, 2015, 09:51:42 PM »

Here's what my walking looks like now. I still have a tendency to lean forward while walking but it's getting better.

Alittletooshort · « **Reply #426 on:** March 24, 2015, 10:05:10 PM »

Quote from: KiloKAHN on March 24, 2015, 09:51:42 PM

Here's what my walking looks like now. I still have a tendency to lean forward while walking but it's getting better.

Looks awesome man! I don´t see anything wrong with your walking, it´s just a little slower.
Do you think you could use crutches instead of a walker, I´d feel a little weird using a walker in public (like an old man

).
Keep us updated, I really appreciate your diary it´s so detailed and well written. This is definitely one of the most valuable sources available for future patients.
I must say that your tibias look very good, not disproportionate at all!

Smallguy · « **Reply #427 on:** March 24, 2015, 10:07:14 PM »

Looks great and natural. Your proportion seems to be better now as lengthening your lower legs have balanced out your wider upper body. LL definitely benefited you. Without the frame, I wouldn't be able to detect that you have done LL.

With the external frames though, I would be careful of x-leg or knee knock. That seems to be a common occurrence both in India and Russia. But I'm sure Dr. Parihar is a great doctor and I just want to put this out so you are aware of it and prevent it from happening. Cheers.

YellowSpike · « **Reply #428 on:** March 24, 2015, 10:10:16 PM »

KiloKAHN, your proportions look phenomenal. And your walking is really coming along. Great job bro!

crimsontide · « **Reply #429 on:** March 24, 2015, 10:11:37 PM »

i dont feel so bad about my walking now... external fixation when you do 6- 8 c simply takes forever to recover from

kilo... the odds are you wont be walking normally without any assistance until more than a year after surgery...same thing for me

did you expect this or has the duration surprised you??

i think those considering having external fixation should pay attention.... especially if youre doing 7 or more cm....it will realistically take over a year to function somewhat normally without any walking aid

Uppland · « **Reply #430 on:** March 24, 2015, 10:14:21 PM »

Huh, your proportions look completely normal. Congratulations.

KiloKAHN · « **Reply #431 on:** March 26, 2015, 05:52:25 AM »

Quote from: Alittletooshort on March 24, 2015, 10:05:10 PM

Looks awesome man! I don´t see anything wrong with your walking, it´s just a little slower.
Do you think you could use crutches instead of a walker, I´d feel a little weird using a walker in public (like an old man ).
Keep us updated, I really appreciate your diary it´s so detailed and well written. This is definitely one of the most valuable sources available for future patients.
I must say that your tibias look very good, not disproportionate at all!

I might be able to use crutches now, but it's something I don't want to attempt until I have a friend around. I tried walking with crutches a month or two ago and I lost my balance and fell. Didn't feel good at all. The walker is a bit cumbersome but I feel safe with it. I'm thinking of buying a smaller one that has wheels in the front though, because they're a lot easier to move.

Quote from: Smallguy on March 24, 2015, 10:07:14 PM

Looks great and natural. Your proportion seems to be better now as lengthening your lower legs have balanced out your wider upper body. LL definitely benefited you. Without the frame, I wouldn't be able to detect that you have done LL.

With the external frames though, I would be careful of x-leg or knee knock. That seems to be a common occurrence both in India and Russia. But I'm sure Dr. Parihar is a great doctor and I just want to put this out so you are aware of it and prevent it from happening. Cheers.

Thanks. Fortunately I don't have valgus. Yeah it did seem a lot of patients developed it with other docs while wearing the frames.

Quote from: YellowSpike on March 24, 2015, 10:10:16 PM

KiloKAHN, your proportions look phenomenal. And your walking is really coming along. Great job bro!

Thanks.

Quote from: crimsontide on March 24, 2015, 10:11:37 PM

i dont feel so bad about my walking now... external fixation when you do 6- 8 c simply takes forever to recover from

kilo... the odds are you wont be walking normally without any assistance until more than a year after surgery...same thing for me

did you expect this or has the duration surprised you??

i think those considering having external fixation should pay attention.... especially if youre doing 7 or more cm....it will realistically take over a year to function somewhat normally without any walking aid

I thought I'd be walking better by now even though I figured I'd still have the frames on. Didn't realize how long it would take to get my balance back. Those who want to do 7 cm or longer should probably think about just risking the possible knee pain issue with LON. I don't know if I could tolerate 14 months of these. 12 months is already going to really stretch my patience. lol

Quote from: Uppland on March 24, 2015, 10:14:21 PM

Huh, your proportions look completely normal. Congratulations.

Thanks.

I'm a bit surprised that you guys think my proportions look totally normal. I left India thinking that my tibias looked really long, but I guess I had the different perspective because I've been used to how short my legs are. I guess my frame helps with the proportions. Right now my wingspan and standing height should be roughly the same, + or - 1 cm. I was a little concerned about arm length because my arms are a bit on the shorter side, but I guess they look in proportion with everything else.

Uppland · « **Reply #432 on:** March 26, 2015, 11:27:28 AM »

KiloKahn to be fair it's hard to judge your proportions when you walk a bit hunched over, plus both the frames and the walker clutter things, you arms aren't straight for example.

We'll know for sure when the frames are off and you can stand up straight, walk run etc.

Wouldn't surprise me if you will appear very normal though.

KiloKAHN · « **Reply #433 on:** March 26, 2015, 04:37:29 PM »

Makes sense. I can stand straight when my back's against a wall. No idea how long it's going to take me to walk normally. Boy, this takes forever.

Limb Lengthening Forum

Author Topic: No More Mal-Kahn-Tent - External Tibias - Dr Parihar (Read 418020 times)

just_me

just_me