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Author Topic: No More Mal-Kahn-Tent - External Tibias - Dr Parihar  (Read 370174 times)

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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #62 on: June 16, 2014, 04:59:29 PM »

Wow, Dr. Dhawan seems to really know his stuff and seems quite confident. But, did he ever come off as arrogant or belittling when you told him what Dr. Verma said about the fibula and monorails? The area around his clinic looks quite nice.

He definitely knows his stuff and will likely be a perfectionist with his cosmetic cases. I wouldn't say he came off as arrogant, more like he's very sure that there's a specific way the surgery has to be performed and if he hears anything that deviates from that he thinks it's incorrect. Although, I did definitely get the impression that he doesn't think you should get lengthening done by any orthopedic surgeon whose primary focus is not on the sub-specialty of Ilizarov. He doesn't like the idea of you going to a spine or knee surgeon for leg lengthening, most definitely. 
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

TRS

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #63 on: June 16, 2014, 05:02:32 PM »

Dr.Dhawan seems very knowledgeable and confident in the Ilizarov techniques. I reckon he would be a very good option in India.
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #64 on: June 18, 2014, 06:42:10 AM »

Haven't gotten around to typing up my notes of the other two consultations. In the meantime, here are my x-rays.

(Click for full size)

« Last Edit: June 18, 2014, 06:57:45 AM by KiloKAHN »
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #65 on: June 18, 2014, 11:25:33 AM »

Third Consultation: Mangal Anand Hospital with Dr Mangal Parihar
After taking some pictures of the outside of the clinic I walked in and was directed to the second floor. The lady at the front desk was very inquisitive and when I said I wanted to see Dr Parihar she wanted to know who my reference was, where I was staying, and to see the visitor’s card from the hotel, which I didn’t have. I showed her the room key to my hotel and just wrote down my stepfather as my reference from back in the States, figuring if they called him it would be better because he can speak Hindi anyway. She told me to have a seat and after a few minutes of waiting in the lobby I was directed to a room in the back where I saw Dr Parihar himself, the man whose Youtube videos I had been watching for a long while now. He didn’t notice me when I first walked in as he was looking at some x-rays on his computer monitor, so I sat down on the chair in front of his desk. When he turned around and said hello I got right to it with the questions. My consultation lasted around 2 hours. Here's the information that will be worthwhile to you guys.

1) I asked him if I should lengthen over my goal to ensure I get my target height in case of compression. He said that once the bone has been lengthened and locked into position then there is no real compression/shortening of the bone. He said that you have to factor in magnification when looking at x-rays.

2) I went on to ask him if I should be concerned about subsidence loss, which causes people to lose a few mm. He said it's possible but the loss is inside 3 or 4 mm. However, one could make a mistake in measuring the height gain in the first place due to x-rays not always being done in the same rotation and having a little bit of obliqueness. Basically, if the x-ray is not centered perfectly and slightly oblique you can get a different measurement by a few mm. He pointed out again that it is next to impossible to lose height and most cases of loss are likely just errors of measurement.

3) When I asked about pin loss, he said that it's almost always present but not to worry because what goes on outside is not mirrored by what is going on inside. He said that initially there is some lag because everything bends a little so the first 5 or 6 mm may not show a lot of distraction.

4) He knows that Dr Paley is an advocate of ITB release for femur lengthening, but he said that maybe 8 out of 10 times he would not find one necessary. He said that those who have the ITB release tend to have less pain while lengthening, but you have to consider whether or not it's beneficial in each case.

5) He thinks cosmetic lengthening is more difficult than lengthening for correction or discrepancy. He gave the example that patients with dwarfism have genetically more lax and stretchy tissues to start with so they don't have any trouble lengthening huge amounts. The same goes with a person with discrepancy, the shorter leg has soft tissues around it that were genetically supposed to be longer, so they're more elastic as well. With normal patients, the soft tissues are genetically supposed to be at the length they are, so they don't respond well to the lengthening.

6) Will not allow you to distract away from Mumbai.

7) If equinous is severe he would do a tendon release. As far as losing push off strength, he said it only matters if you want to be Usain Bolt or something, but it should not affect your day to day activities or your ability to do recreational sports. He said they can lengthen the tendons with what they call percutaneous techniques, where they basically slide the fibers. It leads to a certain amount of weakness but he said the data available shows it's not a significant loss in strength. He also said that the problem is that in medicine not everything is documented and not everything can be documented either. The example he gave was that if he does CLL in 10 patients and they are all from different backgrounds with different physiques, then you cannot extrapolate the results because there will be individual differences, just like how a bunch of siblings raised the same and having the same genetics may have different allergies from each other. So there are things that are reasonable and logical but not always 100% true, which is why one can argue many different ways.

8 ) He's found that in tibial lengthening most patients start having trouble by 5 cm and definitely have issues by 6 cm. If someone were willing to work extra hard then they could probably go a little more, but he has not lengthened anybody more than 6.5 cm. The 6 cm limit is not so much his doing as much as people starting to have difficulty walking and other issues developing at that point. He said someone who is extremely committed might get over that but he doesn't believe it would be a difference of more than 1 cm.

9) Is very skeptical of those who say they can lengthen large lengths like 9 cm and above with no significant problems when he sees so many have problems much earlier than that. He likes to look at what the literature (peer reviewed studies) say and as of now he hasn't seen anyone do 10 cm. He said that maybe doing that much lengthening is very important to someone but then the question is how long are you spending just trying to recover back to where you were.

10) Does not have a fixed height limit in mind but is very wary about taking on cosmetic cases as he's accepted patients before who had no clue what they were getting themselves into. He said with deformity correction the patient may experience a lot of pain with Ilizarov but they don't have much of a choice to start with because they have the deformity, and after the pain is done their major issue is solved. There could also be someone with a condition that requires constant surgery but there's still the prospect of being healed one day so they tolerate the pain and are grateful. With cosmetic patients, he can't make them understand what the pain will be like, and if they don't tolerate it well then the situation is bad, especially for international patients like myself because you have no family to fall back on. He said that around 90% of the people who inquire about cosmetic lengthening never return once they hear about the extent of surgery and recovery time, which he said is good because that means they didn't know what they were going to get into. He mentioned how Dr Paley says the persistent ones interested in CLL have height dysphoria, and said he doesn't have a black or white about who he will and will not accept, or whether CLL is a good or bad thing. He said he can do the surgery technically well but regarding whether or not he should do it for cosmetic reasons are different questions.
 
11) Said that one of the ways he can filter patients is through their psychologists, but unfortunately they're not always available. So he decides himself whether or not the prospective patient is a candidate, but most of the time the ones who are not have selected themselves out.

12) Said he's interested in function over length, and if he finds someone with serious equinous then he will tell the person to stop lengthening.

13) Is not one to do cosmetic lengthening in mass production because of the differences in each patient.

14) When discussing the costs of leg lengthening, he said part of the reason it's so expensive in the West is because they dispose things that can be used again after being sterilized, such as drill bits and fixators. Part of the reason he can charge less is because they can recycle a lot of the materials used in the fixators.

15) Interestingly, he said that the medical counsel in India finds doctor advertisements unethical so you won't find billboards or anything advertising specific doctors in India. Kind of reminded me of Dr Mahboubian's billboard in LA.

16) I told him that in my consultation with Dr Dhawan he made it seem like there are very few people I could go to for CLL with peace of mind that I'm getting it done safely. I asked why that is when I see that there are plenty of orthopedic surgeons world over. Dr Parihar responded that even though there are plenty of surgeons out there who can treat deformities, CLL is something that needs to be done by those at the top of the pyramid because you need someone who has the experience to fix any complications which can occur.

17) Does not perform LATN and hasn't met anyone who prefers it over LON. He doesn't like LATN because you have to fixate the wires in such a way that the nail can be put inside later, and if you don't do it properly then you may have to remove a wire, which runs the risk of subsidence. He doesn't think there is a demonstrated benefit with LATN over LON so you're going through extra trouble for nothing.

18 ) With LON he'll put in the largest diameter nail that he can under the circumstances, but the nail will always be of a smaller diameter in cosmetic lengthening than lengthening for trauma, because reaming is something that is injurious and he'd want to preserve the patient's biology as much as possible.

19) Won't do plate fixation after lengthening for a few reasons. Plate fixation is not as stable as LON, and it has also not been done frequently enough in cosmetic patients to justify its use. For him it would not be something he'd be willing to risk.

20) He's the one who teaches others how to use the hexapod fixation device. He said the hexapod is used only once you finish lengthening and take a full length x-ray, and if you find there's same malalaignment you can use the hexapod to adjust it. So the lengthening is done with the standard Ilizarov and the struts get put on later to turn it into a hexapod to make the adjustment.

21) Told him that I'm concerned about the higher rate of re-fracture with external fixation. He said that statistic is because people take the frame off earlier than it should have been taken off. He said their golden rule is "a month too late is better than a day too early." He avoids the risk of re-fracture due to his experience and ability to resist patient pressure to remove the fixator early.

22) Says one month per cm lengthened is the absolute minimum you would need to wear the fixator, but normally it comes to 1 and a half months. So for 6 cm lengthening you would need to wear the externals for 8 months or longer.

23) With his patients apparently nobody has complained of knee pain after LON as of yet, but in terms of healing for cosmetic cases he recommends going with external fixation over LON. 

24) Would lengthen at .75 mm per day starting 7 days of rest after surgery because tissues have to get used to distraction. 1 mm per day is just the outer limit of how fast you can distract tibias.

25) He has used monorail fixators for lengthening before, but said the disadvantage of using it over the Ilizarov fixators is that there is nothing to hold the foot. With Ilizarov fixators, if you develop trouble in terms of equinous you can use rings to get the foot straight by gradual stretching. With monorails you have nothing to hold the foot. Although monorails superficially look easier, he finds them more complicated than Ilizarov because you have to be absolutely perfect with it, or you can run into other complications.

26) Also on the subject of monorails, he said that as a general rule, bulkier patients almost always have a tendency to develop valgus with monorails. The monorails are pulling only from one side and the monorail doesn't get much of a hold on the soft tissues on the other side, especially with bulkier patients, whereas with ring fixators you've got a hold on both sides. So for someone of my width, in order for me to walk around well he'd choose to use the ring fixators.

27) Is not convinced either way whether bulk is good or bad, but says for sure that while lengthening you need to concentrate a lot on stretching. He said he's even more convinced on the importance of stretching because they've had fracture patients who developed foot drop and after three or four years over time with stretching of the foot they've straightened out without the requirement of surgery. So he's convinced if you stretch well then your lengthening will be much easier.

28) Said there's no sense in using the ISKD and subjecting himself and the patient to stress even if it is available. He would use the Precice if internals were chosen because it has a good reputation and is controllable. The only issue is the cost because they charge the same for him to use it as they charge surgeons anywhere else. Doesn't think there's much of a learning curve because putting the nail inside in itself is not a big deal and pretty standard.

29) Apparently, right now the use of Precice in India is on a per patient basis and there are special permissions required for Precice to be used. The whole set comes from UK to India.

30) Worst case scenario, if I were to have problems with healing in the external fixator, then the option to put a nail inside can be done at a later date, even in the US if I were to have to do it.

31) Corrections to the bone can be done all throughout lengthening, even toward the end of distraction.

32) Procurvatum (forward bend), valgus (x-legs), and other malalignment should not happen if your fixator is stable enough.

33) The fixator he uses would have a combination of wires and pins. As long as you have the fixator on you would have to clean the pins each day, so you'll be changing a lot of dressings and doing a lot of cleaning in those months :D

34) There is a small risk of pinsite infection with externals, and if it happens then I would just take antibiotics. It would be next to impossible to get a deep bone infection with externals.

35) Would follow up on you once every two weeks while lengthening.

36) Can give you pain meds during lengthening to help with pain.

37) Is not a believer in weight bearing during distraction. Said there is no problem with weight bearing especially when doing external only, but because you are distracting in a goal to get taller, and when you stand you are compressing it, he finds it paradoxical. He allows weight bearing to the extent that you keep your feet neutral, basically standing. Once lengthening is over, then you should be walking as the more you walk the sooner the bone heals during the consolidation phase.

38) Showed him the snippet about fibula fixation that Dr Paley wrote about and told him how my first consultation determined that there would be no fibula fixation. He said that fibula fixation is very important and began to show me x-rays of how he did fibula fixation. As expected, it mirrored Dr Paley's method by having the fibula fixed at an angle both proximally and distally.

39) Talked a little bit about his fellowship with Dr Paley and said that Dr Paley has a maximum of 5 fellows located in India, one of which is him. Dr Shah and Dr Chaudhary are others.

40) He has never performed limb shortening and would not do it for someone.

41) Told him how there's a split in idea between the safety of humerus lengthening, Dr Paley saying it's the safest to lengthen in the body and Dr Guichet saying it's too dangerous because you can damage nerves and higher risk of paralysis. Dr Parihar shared Dr Paley's thought and said it's the easiest lengthening to do. He said there are ways to avoid nerve damage and that he has performed humerus lengthening before, so he'll do it. However, he thinks that as long as your hands can reach the pockets of your trousers then there should be no need for humerus lengthening. 

42) Externals and LON don't have a noticeable difference in price. They'll both be around 900,000 INR for the surgery.

After the consultation was over I paid the receptionist the 2,000 INR fee for the consultation. When I got back from Dr Parihar’s clinic I just lounged in my hotel room and ordered room service. This time I ordered a chicken tikka submarine, pavlova (New Zealond Meringue baked dessert topped with whipped cream and cuts of green apple), and a drink called Black Cat, which is crushed black current, lime juice, salt and 7UP. Yet again the room service didn’t come up to take my plate after I called them, even though they told me to do so.

Photos of Clinic
 
« Last Edit: June 18, 2014, 11:51:32 AM by KiloKAHN »
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

Medium Drink Of Water

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #66 on: June 18, 2014, 05:46:31 PM »

You sure weren't kidding when you said you were bulky.  Look at those thick legs! :o
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Gained 3 inches on tibias (Ilizarov LON) in 2007 at the Beijing Institute of External Skeletal Fixation Technology with Prof. Hetao Xia and Dr. Aiming Peng.

If you have any questions, ask them here rather than by Private Message:
http://www.limblengtheningforum.com/index.php?topic=64544

KrP1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #67 on: June 19, 2014, 02:35:11 AM »

You sure weren't kidding when you said you were bulky.  Look at those thick legs! :o

Is that fat or muscle?
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Wannabegiant

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #68 on: June 19, 2014, 12:44:19 PM »

I wish you all the best Kilokahn, hope you get a succesful surgery and quick and smooth recovery. I personally would not be able to handle doing 2 surgeries, but in the looong run its probably healthier and more safe to do 2 surgeries with around 5 cm on each compared to doing one surgery with 8 cm.. if one can afford it of course.
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Muse

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #69 on: June 22, 2014, 08:15:56 PM »

Wish you all the best KiloKahn,  I think your diary is awesome. The consultations, travelling logistic and the photos are very detailed and should be a massive help to those considering India.   
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galaxy1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #70 on: June 23, 2014, 01:34:46 AM »

The suspense is killing me. How soon do you plan to have the surgey? Good luck with whoever you dicide on.
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galaxy1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #71 on: June 23, 2014, 05:57:31 AM »

PS - Alot of good info from the consults. Your doing a tremendous help with all the information you obtained, especially for those who might still consider India for this.
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #72 on: June 23, 2014, 06:13:00 AM »

Hi guys. I had planned to update more before this but I've been in bed for three days, having caught some awful stomach virus.  I had to cancel my appointment for getting my measurements because of it.  My insides are on fire and I've got a killer fever. I'll update one I get over this thing.
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

galaxy1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #73 on: June 23, 2014, 06:44:52 AM »

Sorry to hear this. Get better soon.
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Medium Drink Of Water

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #74 on: June 23, 2014, 02:45:59 PM »

I guess that's one of the hazards of lengthening in India.  Get well soon Kilo.
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Gained 3 inches on tibias (Ilizarov LON) in 2007 at the Beijing Institute of External Skeletal Fixation Technology with Prof. Hetao Xia and Dr. Aiming Peng.

If you have any questions, ask them here rather than by Private Message:
http://www.limblengtheningforum.com/index.php?topic=64544

KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #75 on: June 24, 2014, 04:04:52 PM »

Probably got sick from contaminated chocolate ice cream that I bought from a market with an outside freezer. I got sick almost immediately after eating it. Fortunately this has calmed down.

I'm putting down the points of my final consultation, which was with Dr Suhas Shah. I was rather impressed with him and all the info I gathered will be put on my next update.

Have to check out of my most recent hotel tonight. I'm going to the hospital in an hour or so and my surgery is booked for tomorrow morning. After waiting about 8 years for this moment I almost feel like I'm in a dream now that it's finally happening.
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

paco1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #76 on: June 24, 2014, 07:31:51 PM »

VERY, VERY GOOD LUCK WITH YOUR SURGERY.
Your information is very important for the community.
Cheers paco.
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G-Man

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #77 on: June 24, 2014, 11:27:13 PM »

Looking forward to read your diary, all the best!
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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #78 on: June 25, 2014, 12:09:10 AM »

Best of luck to you!  Looking forward to hearing much more!
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Gained 3 inches on tibias (Ilizarov LON) in 2007 at the Beijing Institute of External Skeletal Fixation Technology with Prof. Hetao Xia and Dr. Aiming Peng.

If you have any questions, ask them here rather than by Private Message:
http://www.limblengtheningforum.com/index.php?topic=64544

BilateralDamage

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #79 on: June 25, 2014, 04:09:12 AM »

Good luck Kilo!!! You're going to do great  :D  Excited to hear who you ended up choosing.
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Muse

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #80 on: June 25, 2014, 08:26:56 AM »

Best of luck for a smooth lengthening and recovery!    :)
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KrP1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #81 on: June 25, 2014, 02:30:19 PM »

Good luck in your journey
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #82 on: June 27, 2014, 05:27:23 PM »

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

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

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

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

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

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

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

7) Lengthening limit for tibias is 7.5 cm.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

23) Price quoted was very affordable.

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

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

Note: This is what i can remember. I wrote down notes but they're in my backpack and I'm not near it at the moment. I'll add anything from the notes that I forgot along with pictures of Dr Shah's clinic on my next update. If you plan on visiting Dr Shah you'd need pics to find his clinic anyway.
« Last Edit: June 27, 2014, 05:42:47 PM by KiloKAHN »
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

G-Man

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #83 on: June 27, 2014, 07:39:03 PM »

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

I am curious about statement 15.

How does femur and tibs lengthening affect ur arms reaching your pockets??  Upper body and waist line stay the same, unless you lengthen your torso, your pockets will always be at the same reach.
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KrP1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #84 on: June 27, 2014, 09:37:50 PM »

Number 11. What is itb release?
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BilateralDamage

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #85 on: June 28, 2014, 10:50:59 PM »

How are you doing after surgery man??  Keep us updated!  ;D
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KrP1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #86 on: June 29, 2014, 12:04:08 PM »

what doctor did he choose?
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #87 on: June 30, 2014, 06:43:41 PM »

Other points from Dr Shah consultation:

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

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

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

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

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

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


« Last Edit: June 30, 2014, 08:28:49 PM by KiloKAHN »
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #88 on: June 30, 2014, 08:17:39 PM »

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

I am curious about statement 15.

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

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

Number 11. What is itb release?

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

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

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

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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

Converse

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #89 on: July 04, 2014, 12:48:22 AM »

Hi KiloKAHN,

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

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #90 on: July 04, 2014, 09:02:24 AM »

Out of all responses from the meetings I think Doctor Shah looks like best choice. He does the releases like Paley and he is the only one who does the plate fixation. Looks like he has the most experience too.
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GetTallOrGoGay

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #91 on: July 05, 2014, 07:05:51 AM »

I would like to know more about number 10, can anyone describe the necessity/benefit?
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #92 on: July 05, 2014, 09:23:56 PM »

As you all can see from the topic title, I had decided to do surgery with Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. It wasn't easy choosing a surgeon as I met more than a couple good ones, and my ultimate decision came after a full weekend of thinking it over. Despite choosing Dr Parihar, I would have felt safe with a couple of the other surgeons as well, so for those considering India I think it would be a good idea to meet them too and not just use my patient experience as your basis for choosing a surgeon. You might actually find one of the other ones better for you in terms of personality, CLL methods they offer, location, budget, etc. However, I do think I made the best choice for me and have high hopes for a positive outcome in all this.

Initially I was planning to do plate fixation and did not like the idea of spending so many months wearing frames. But after talking it over with Dr Parihar and Dr Divya, I changed my mind and decided to go with exfix only. If someone decides to go with Dr Shah or Dr Dhawan, perhaps then we'll have a patient experience regarding plate fixation. After being in frames for a bit now, I think I can tolerate wearing these for the time required.

Now on to what I guess would be the official start of my patient experience.

Visa Extension Troubles
A very annoying part of my CLL quest in India was being able to extend my visa. When I originally applied for a medical visa, Rockland Hospital in New Delhi had sponsored it. I was told that because tourist visas cannot be extended or changed, it would be far less of a hassle to just come on a medical visa and extend that if necessary. I came to India under the impression that although Rockland was on my visa, I wouldn’t be beholden to them if I decided that I would like treatment from a different doctor. Of course, if I had come to India right after I received it back in the mail, then I wouldn’t have needed an extension as they’re typically granted for just a day under 6 months. Unfortunately, the date of issuance was January 27 and I was unable to get free from work until mid June. This meant that as of my arrival in India, I only had a month and a half left.

When I finally decided on having treatment with Dr Parihar, he had a doctor downstairs submit my documents to Airtel so I could get a sim card and had another person escort me the following day to the FRRO to get my visa extended. The trip there was about 20 minutes by taxi and the one who escorted me was unable to go with me through the checkpoint (which was guarded by a soldier wielding an assault rifle). I climbed to the third floor, noticing that Pakistani nationals had their own special section to register on the second floor, and waited in line a good while before I reached the front desk. I informed the woman that I wanted to extend my medical visa and was told to go to a room on the side to make copies of my documents. After making copies, the lady took them and disappeared for a bit before coming out with a document which said I did not need to register because my visa was issued for a duration of less than 6 months. I looked at her bewildered and told her that the reason I came to the FRRO was to extend my Visa by three months (I even had a letter from Dr Parihar explaining everything). She gave me my passport and simply told me that I was endorsed by Rockland Hospital in Delhi so they could not extend my stay in Mumbai. All I could do was go back to Delhi and see the FRRO with an extension request from Rockland Hospital.

Now obviously if I was not planning to get treated by Rockland Hospital, there would be no reason for them to go through the trouble to register me. I was screwed and it looked like the only thing I could do was return to the States and wait for my visa to expire before applying once again with a letter from Dr Parihar to the Indian Embassy. I went back to Dr Parihar’s office and explained the situation. He went to the immigration bureau website and pulled up an e-mail address that he wrote to, asking if officers have some discretion in situations such as mine because he already accepted me as a patient and it would just be needless expense, time, and trouble for a genuine case to go back to the US just to apply all over again. He explained that he was an honorary surgeon at the Nagpata Police Hospital, so the guys at FRRO should be familiar with him and not to worry about it.

When I got back to my hotel I wrote to Cox and Kings Global Services for advice on what to do and in the morning they just said I had to follow the FRRO’s rules. I was about to start browsing flights back home when I was forwarded a message sent to Dr Parihar from the e-mail he wrote to, which said to have me see the chief of police at the registration branch to re-examine my case. When I went back to the FRRO a second time and showed that e-mail along with the other necessary documents, the same lady at the front desk didn’t even have me see the chief of police, but instead took my blood reports from Mangal Anand Hospital and directed me to a room where I was to wait for an agent. After some questions about what exactly my medical problem was and where I was staying, I was given an extension until October 27, effectively giving me more than four months in India. I think that lady at the desk may have been spoken to or something, but it was good to not have to fly all the way back to the States before treatment.

Checking into Mangal Anand Center for Limb Lengthening & Reconstruction
I was picked up at my hotel by a driver sent from Mangal Anand at around 9:30 pm and told to go to the first floor, where I would be taken to my room. I took room number 23, the first room on the first floor (which was actually the second floor but the first is called ground), and was approached by a nurse who had me sign a consent form and other paperwork agreeing to the surgery. She had me step on the scale and I saw that I had lost 9 lbs since arriving in India. No doubt I’d be losing even more weight in the coming months, both from lack of appetite and muscle atrophy.  I unpacked some things from my suitcase and watched some Lord of the Rings: Two Towers on the tv, which had good cable access with a decent amount of English channels, one of which played movies all day. The room I was in had a large fan on the ceiling, an air conditioner, an extra bed, and its own restroom, so it was quite roomy.

Once my movie watching was over I entered the restroom and shaved my tibias, which took forever because I only had a single Gilette razor and no shaving cream. What worked the fastest was putting my foot in a bucket, filling it with water, and using the bucket water from the sink to continuously add lubricant for the razor. I tried to go to sleep afterwards but I was too anxious and slept maybe 20 minutes before being woken up at 8:30 and connected hands and feet with some tubes that acted like suction cups on my skin. One of the assistant surgeons came in afterward and told me to step out so he could take pictures of my legs from various angles. After that, Dr Divya came to stand next to me for a picture that I assume will be used as a “before and after” photo. I was then taken to Divya’s office to use his wifi so I could forward e-mail attachments from my banker to Dr Parihar, confirming that my payment had been wired. Divya told me then that the surgery would take around 6 hours and rather than be put under general anesthesia I would just be given an epidural that would make me numb from the waist down. I spoke to my parents a brief moment on Dr Parihar’s cell phone to inform them that I was about to enter surgery and then went back to my room to wait for the anesthesiologist to arrive.

Regarding Payment
Something I should mention that’s very important is how you should make payment to your chosen surgeon. The easiest way is through a wire transfer, but most banks will require you to make the wire transfer in person because they need your signature on the transfer request witnessed by a banker. Most likely you won’t want to transfer any money to a doctor before you go to India and meet him yourself. If you are still ‘doctor shopping’, then you definitely wouldn’t be in a position to transfer money before you leave for India.

The best way to get around this is to set up a joint account with a person you really trust, probably one of your parents. That joint account should be accessible online along with your checking account and whatever other account you may have. Once you’re sure you want to initiate the wire transfer, just transfer online the payment from your checking or wherever that money is stored to that joint account you set up (the transfer will show immediately), then send the doctor’s bank details to the other person on  your joint account. That person can then go to the bank in the States for you and transfer the money to your doctor on your behalf. This is the simplest and fastest way I’ve found to make the payment.

Surgery
I walked into the Operating Theater and sat on a medical table in the center of the room, which was clean and had all the equipment you’d find in any OT I presume. It all looked modern and that relaxed me considerably. As all the medical assistants entered the room, Divya had me scroll through his iPod to choose background music. I decided to put on a classical playlist as I thought it would have the best ambiance. One of the operating assistants then put the needle for the IV into the top of my right hand, which stung a bit but wasn't bad. The worst part of the whole surgery came next, which was placement of the epidural. It was like a xenomorph from the Aliens series pierced my back with its tail and started squirming it up my spine. Aside from the initial stinging sensation, the worst part was the constant throbbing on my lower back in the side regions. The throbbing was similar to a throbbing toothache, just in your back, and the pressure felt like a hole was going to burst open. After a few minutes I was unable to feel anything at all from the waist down and I imagined I knew what a paraplegic feels like, or perhaps a tarantula after getting paralyzed by a tarantula hawk. The heaviness of my body was a little unnerving and my imagination raced (what if I had gotten this done on a boat and it started to sink right after? I’d be screwed!) but my concentration soon went on my legs being bent in the air and contorted to various angles as they were covered in Povidone-Iodine. I had something on my waist so I couldn’t see exactly what they were doing, but I saw them maneuver the catheter tube and knew they had put that in already. At that point I was thankful for the epidural.

Dr Parihar arrived not long after and asked me if I had chosen the music playing in the room. I hadn’t realized it but it had switched to Italian opera. “I told Divya that classical music was fine” “Yes but this is way too classical” said Dr Parihar as he switched it to music that was symphony and not opera. I dozed off for a little bit from lack of sleep and woke up with Divya asking me if I was tired. I could see one of my legs being cut into by Dr Parihar from a reflection on the wall to the right of me and looked at it out of curiosity a bit before falling asleep again until I was woken up and told by Dr Parihar that the surgery was over. I then moved onto a gurney and was maneuvered to another room where I was to spend the rest of the day. I fell in and out of sleep until a woman came and told me that she was the physiotherapist. She explained the different exercises to me and had me perform them. Every 30 minutes or so I was supposed to move my ankle up and hold it there for five seconds before moving it down and holing it there for five seconds. This was to be done on each leg for a set of 10. I had to do the same reps and sets for raising my legs in the air and moving my knee toward me. My left leg was unable to move at all but my right leg was fine for some reason.

Divya, Sister Molly (a very nice nurse and one of the operating assistants), and another operating assistant named Sumanyu came in to see me. They said I could have a sandwich if I was starving but said I should just drink liquids and start with light foods the next day, which was fine by me as I didn’t feel like eating. When I woke up again I had three slices of bread and a cup of water. A different physiotherapist came during the day and showed me some other exercises. Basically just tightening my knee on each leg for five seconds and releasing, moving my leg up and to the side, and back raises to help with the back pain from laying so much. After a few hours Sister Molly ordered me fried rice with chicken and egg inside from a nearby restaurant. I told her I could eat anything as long as it wasn’t spicy (non-spicy food was pretty limited up to this point) but I was pleasantly surprised at how good and non-spicy the rice was when it arrived. I hadn’t any pain as my body was still numb, which made doing the exercises very easy.  So I did them for a while until I went back to sleep.

Photos (Click to Enlarge)
« Last Edit: July 05, 2014, 09:35:47 PM by KiloKAHN »
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)
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