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Author Topic: No More Mal-Kahn-Tent - External Tibias - Dr Parihar  (Read 417685 times)

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Medium Drink Of Water

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #93 on: July 05, 2014, 10:02:51 PM »

I'm glad you chose Dr. Parihar.  He's the one I would've picked too after reading your consultation summaries, specifically because of his thoughts on fibula fixation, not doing releases unless necessary, and hexapod fixation to correct misalignment.

The hospital doesn't look like anything fancy, but it seems clean and nice enough.  It's about on par with what we had in Beijing, maybe a little better especially the bathroom.  After getting used to Guang Ji Hospital I now think most western hospitals are too luxurious to the point of being overkill and a waste of money.

Thanks on behalf of the LL community for being a pioneer in India and writing this detailed diary, and thanks on my personal behalf because I'm having fun reading your diary and imagining I'm there.  LL is an exciting time in a person's life, and I remember mine fondly, so this brings back good memories.

I hope everything continues to go well for you.  Stay strong and smart through it all.
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Converse

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #94 on: July 05, 2014, 11:00:34 PM »

Congratulations KiloKAHN on beginning your journey, I wish you all the best for your distraction and a speedy recovery! Hopefully, I will be joining your ranks soon. BTW do you plan to stay at Mangal Anand Hospital or move to an apartment nearby? What are the associated costs with everything so far?
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #95 on: July 06, 2014, 04:16:20 PM »

First Day Post-Op
The next morning I was wheeled into the room I had checked into originally. A large group of the staff came in with a frosted vanilla cake with cut mango on top and sang me Happy Birthday. I felt okay aside from earlier when I had a brief moment of wifi connection from upstairs. My mom messaged me through the Line app with “How does it feel to be two inches taller on your birthday?” I lost my connection before I could respond that it doesn’t work that way and I had to slowly get to that point over a period of months. Oh well, she’d soon find out.           

One of the nurses scolded me and said I had to drink more liquids because my urine volume was low and also slightly red colored, which meant I had a mild urinary infection, so she came in with a carton of Tropicana juice and a pepsi, saying I had to drink all of it so I would urinate. The first physiotherapist I saw the day before arrived and guided me through exercises, which were pretty hard to do as the post-surgery pain had started and was located entirely on my right leg. I was glad that my left leg was still completely numb. After the exercises she told me that we were going to try and get me walking to the bathroom the next day. I wasn't looking forward to it, not even starting distraction yet and already hating the annoying discomfort of my right leg. It felt like a growing pain that just went on constantly without letting up. A nurse came in and shot some saline into my IV and said it would help with infection. She left and another nurse came in with the same chicken and rice meal I had earlier. They wanted me to get something else from a different menu, meat based in particular, but I wasn’t up for heavy foods. One reason was because I didn’t want to do any number two until I could use the toilet. I refused to let myself ask for a bedpan. Dr Divya and one of Dr Parihar’s fellows came to my room to check on me. We talked a little while about limb lengthening before they left and I fell asleep.

I woke up to a sharp sensation on the bottom of my right femur and a combo of throbbing and aching on the top of my right tibia. I tried to tough it out and ignore it. Hopefully the pain would go away, I thought. But the constant throbbing and aching pain eventually made me cave and I started swearing, calling myself a total f-ing idiot for ever being eager to do this to my body. What made the pain worse was that I had nobody to vent toward and I wished one of my parents would call me just so I could tell them how much pain I was in and how stupid I was for doing this. One of the nurses came in and saw that I had my hands covering my eyes and forehead. She asked if I was in severe pain and brought in a doctor I hadn’t seen before. I described to him what the pain was like and where it was located before he stepped out and came back with a needle, proceeding to give me a shot on the side of my right femur. A short while later the nurse came back and injected tramadol into my IV. The pain started to go down slowly but was severe enough to prevent me from sleeping more than a few minutes at a time.

Second Day Post-Op
I was given three slices of bread and tea in the morning along with a side of pain killer tablets, which I took right away. I managed to fall asleep finally and was woken up by one of the members of the surgical team who came to change my dressings for me. I noticed the right leg was very clean, but when the left dressings came off I saw the leg was covered in dried blood. He told me it was because that leg was operated on first and so the blood accumulated there. After the dressings were off he changed them all and gave me instructions on how to do it on my own in the future. The physio came and had me stand with my walker for support and walk a few steps. At that point, an elderly man stepped into the room and introduced himself. The surgeon who changed my dressings told me that the man was Dr L.M. Parihar, owner of the hospital and Dr Mangal Parihar’s father. L.M. was really nice and told me he wanted to introduce himself because he heard about the FRRO issue I had. He jokingly said “The FRRO didn’t want to register you as a foreigner, so you are Indian now.” But it turned out he worked hard to have the FRRO register me in Mumbai even though I was registered in Delhi. Apparently the change was definitely not typical, so I had a lot to be grateful to him for. After he left I went back to my bed. Divya then came and I told him of the severe pain I had.

Another physio came and had me do exercises. Eventually I called her because I wanted to walk to the toilet to release all the number two I had been holding. The walker was narrow for my body, despite me using the hospital’s larger walker and wearing narrower frames, and every few steps I would accidentally hit them together, which caused intense vibrating pain for a few seconds each time. It was even more difficult to sit down on the toilet and after the physio waited outside the door I had to slide my shorts off while sitting. Cleaning myself and putting the shorts back on was even more difficult, though I still managed it. After I was assisted back to my bed I was so exhausted from going to and from the bathroom that I did much more poorly on my physio than I had the last times, which was apparently very good for only my second day after surgery – they said it was because I had built up a lot of muscle beforehand. While the second physio was still in my room, a third physio who trained in the States came and got information on the exercises I was doing from the physio who assisted me to the restroom. Divya told her beforehand my lengthening goal and I let her know how long I was able to stay in India, and with that information she left to create a physio plan for me for her visits at my hotel after discharge from the hospital.

At night a young guy stepped into the room with my name and room number written down, asking to see me. Dr Parihar hired him to be my attendant and help me with things like getting on and off the bed, fetching me the urine pot, etc. Divya came back with sandals I had purchased earlier and helped the physio tie straps to them to attach to the fixator for helping prevent equinous. The forcing of the 90 degree angle wasn’t as bad as the slight burning sensation at the bottom of me feet from constant pressure of the sandals. Eventually a nurse came with a wheelchair because I told Divya that I’d like to go to the second floor briefly where there was wifi so I could check my mail. There I saw Dr Parihar again who discussed with me the pain I was having and told me they didn’t want to give me too many painkillers but if I was in severe pain to let the nurse know anyway. Got all my mail checking done, saw that only two people on my whole FB friend list sent me happy birthday greetings the other day, and told my computer screen ‘ah fk you guys’ before turning off the computer and returning to my room with the assistance of the guy Dr Parihar hired.

About My Frames
I saw Dr Parihar before surgery so he could let me know what the external fixators would be like. He decided that because of my bulk he would use smaller diameter rings - during surgery he decided to go even smaller than what he showed me and put on 160 mm diameter rings. Due to the small diameter there is some crowding on the side where my leg is close to the frame, but I prevent them from touching using cotton pads slid in between my leg and the frame. There are four wires and two pins at the distal and proximal ends, twelve points where the leg is being pierced with a pin or wire. There are three rings, and the middle rings typically have two pins going through the leg at the middle of the bone. This would make the frames more stable, but then that would also mean more skin tearing and a long scar down the middle during distraction. Because of this he decided to leave off the pins of the middle ring for now. He explained that leaving the middle pins off would allow more microscopic motion in the middle and result in thick callus forming. This might cause some degree of malalignment at the end of lengthening, but if malalignment happens he will replace the rods with hexapod struts and correct the malalignment. After that is fixed, he will replace them with the standard rods and add the two pins at the middle ring for added stability during consolidation.

You can see them in the photos below. I took closeups of all the pinsites, one of which had stuff coming out of it.



Photos
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #96 on: July 06, 2014, 04:29:30 PM »

I'm glad you chose Dr. Parihar.  He's the one I would've picked too after reading your consultation summaries, specifically because of his thoughts on fibula fixation, not doing releases unless necessary, and hexapod fixation to correct misalignment.

The hospital doesn't look like anything fancy, but it seems clean and nice enough.  It's about on par with what we had in Beijing, maybe a little better especially the bathroom.  After getting used to Guang Ji Hospital I now think most western hospitals are too luxurious to the point of being overkill and a waste of money.

Thanks on behalf of the LL community for being a pioneer in India and writing this detailed diary, and thanks on my personal behalf because I'm having fun reading your diary and imagining I'm there.  LL is an exciting time in a person's life, and I remember mine fondly, so this brings back good memories.

I hope everything continues to go well for you.  Stay strong and smart through it all.

Dr Parihar has been really cool so far and the hospital itself is more than adequate for what you would need. The staff is attentive and you're never left abandoned while in pain, and that's what was important to me. I think the description of Mangal Anand Hospital in that other diary is way too dramatic about how rundown the place is supposed to be. I mean if you're coming to India you shouldn't expect 5 star scenery anywhere aside from a select few hotels.

Thanks for the well wishes. It helps having a community to write too, especially during the times when the pain gets worse.

Congratulations KiloKAHN on beginning your journey, I wish you all the best for your distraction and a speedy recovery! Hopefully, I will be joining your ranks soon. BTW do you plan to stay at Mangal Anand Hospital or move to an apartment nearby? What are the associated costs with everything so far?

Thanks a lot. I don't think you're allowed to stay at the hospital during the entire distraction period. I'm staying at a hotel nearby. They gave me a rate of $48.00 nightly inclusive of tax. Mumbai is the most populated city in India and it would be difficult finding an apartment with the amenities you'd want to be comfortable. The surgery itself is around $15,000, which includes the hospital stay, an attendant during hospital stay, food, and medication during discharge. Other costs just come from flight costs, blood test and x-rays before the surgery, hotel stay, food after discharge, and whatever bills you still have to pay while here.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Medium Drink Of Water

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #97 on: July 06, 2014, 06:07:20 PM »

Beautiful little osteotomy cuts he did there. :-*
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paco1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #98 on: July 06, 2014, 06:45:06 PM »

good luck kilokhan,
finally you choose doctor mangal parihar.
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #99 on: July 07, 2014, 10:57:55 AM »

Third Day Post-Op
Woke up a little late. Sister Molly came and asked if I changed my dressings, which I told her no. A little while later my other assistant that switched places with the first guy in the morning ordered me food from the non-veg menu. As I was eating, Sumanyu came and asked when I would be ready to change my dressings. He returned after I was finished and brought the boiled water with saline and gauze strips with him. I had to change my dressings by myself this time and he gave me verbal instructions on how to do it. I had to wash my hands twice, once before I started changing dressings and once soon after because I touched my hair when it was dangling in front of my face. It took me a little over an hour to clean all my pinsites and change the dressings but I was confident afterwards that I would remember how to do it always after that. A guy came in today and brought in an extra-wide walker that was ordered for me. It easily fit both my frames in the center so I could now walk without accidentally clashing my frames together.

Physio came and had me do exercises and walk around the room a bit. I decided to walk all the way to the toilet and back because I really had to go. I still don’t want anyone bringing in a bedpan for me as long as I’m here. After the physiotherapist left I watched the Brazil vs Chile game with my assistant. I forced myself to walk to the toilet again and by the time I got back in bed my legs were throbbing so much that I wasn’t confident I’d be able to do all that well in physiotherapy the next day. It’s amazing how much energy walking takes out of you while in frames. The only bad part about it is actually walking. Standing doesn’t hurt at all and I could probably do it all day without even touching my walker because the frames are stable enough to take my weight.

6/30/2014
Had physio three times today. Woke up to the assistant’s voice saying “Eleven o’cloooock. Time is eleven.”, which irritated me because one of my pet peeves is being told the time when I wake up. I can't explain it, it's just a quirk I have I guess. I didn't say anything to the guy though. I was supposed to have a sponge bath and he pulled my shorts down while I was staring at the ceiling so he could wash my genital area. I pulled them back up immediately nd told him I could do that area on my own. Some things about this assistant get on my nerves, like his insistence that I scrub soap in my hands in the morning for a full minute despite having my hands covered in soap long before that, or missing the bowl by a good deal and getting water all over me when pouring water into it.

A different physio came in the morning. A quite lovely Indian woman who I’d totally try to pick up if I wasn’t in frames. Didn't think getting my crippled flirt on would be the best thing to do though. Dr Parihar came at the end of the day with Divya and Sumanyu to check up on me and offer encouragement.

7/1/2014
Woke up early today despite getting to bed around 4 am. Got a sponge bath and hair washed then had jam and bread with some tea. Physio came today and after my usual exercises she had me walk outside down the hall and back to my bed. Sumanyu came in and marked my rods with directional arrows and painted the nuts on one side. He explained how I was to turn for distraction and said I told to buy my own turning devices. My assistant was told where to purchase them the following day. Dr Parihar wants me to turn .75 mm per day at .25 mm each turn, spread throughout the day almost evenly. Walking was a lot less painful than usual but my pin sites hurt worse when changing the dressings. I saw that one pin site had gotten crusty stuff hanging out of it. I’m just hoping I don’t get any infections after I go back home.  Got my dirty laundry sent to the cleaners. Twelve pieces for 480 rupees and I should have them at 4:00 pm the next day. The second physiotherapist said I had to drink a lot more water because my urine output was still low. Went to bed at 4 am after watching USA get embarrassed by Belgium in the finals.

7/2/2014
Woke up at 12 o’clock. Sumanyu came with some tools and showed me how to distract. I turned for .25 mm on all the knuts. I was still exhausted after he left so I told the assistant that I wasn’t going to do a sponge bath when he brought out the bucket and towel. Had the standard breakfast of bread and jam with tea (I don’t drink the milk as it gives me stomach problems). Later in the day Dr Divya came and replaced my rods with other ones that have a knob that turns after you click a button and lock after distracting .25 mm. It also has a distraction chart on the rod, so I was happy with the change as it makes distraction a whole lot easier. It made it so I didn't have to purchase any turning devices, so I wouldn't have to remember everything Sumanyu showed me about turning the other way. The new rods also add even more stability to the frame.I started a distraction chart too so I always remember how much I turn. The physiotherapist named Pratiksha came again. Did my exercises and walked out to the hallway today. Talked with her a bit about her career plans and informed her that I would be discharged to a hotel tomorrow. Hopefully she’ll be able to see me in the hotel every once in a while because she's the most talkative and friendly of the group of physios. Only got 9 out of the 12 pieces of laundry today. The place said to come back the next day in the afternoon for them to be finished. Oh well.

Below you can see the new distraction devices that were put on the frames. There are four on each one that I have to turn. You press a button down on the round silver part to unlock it and then turn it to the right until it automatically locks at .25 mm of distraction. This makes recording your distraction amount very easy.

Photos
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

TRS

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #100 on: July 07, 2014, 11:02:42 AM »

Hehe I had a gut feeling that you'd pick Dr.Parihar and do externals :) Thanks for pioneering CLL with Dr.Parihar. He seems like the best option in India. Your experience will be invaluable for prospective LL'ers who are considering Dr.Parihar or India.
Stay strong buddy, you will be taller in no time.
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Gichelu

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #101 on: July 07, 2014, 03:32:49 PM »

How much does Doctor Shah charge for Precice?
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #102 on: July 07, 2014, 05:42:44 PM »

Hehe I had a gut feeling that you'd pick Dr.Parihar and do externals :) Thanks for pioneering CLL with Dr.Parihar. He seems like the best option in India. Your experience will be invaluable for prospective LL'ers who are considering Dr.Parihar or India.
Stay strong buddy, you will be taller in no time.

Thanks. The experience has been going well so far and I'm hoping it stays that way for the duration of treatment. Dr Parihar was best for me, but if someone wanted to go to a doctor more willing to do other methods like plate fixation, or believes that releases are always necessary for CLL, then I think Dr Shah would also be a good option to check out. Dr Dhawan also appeared to be technically good. Dr Parihar, Dr Shah, and Dr Dhawan all vouch for each other too, so you're probably safe with any of the three.

How much does Doctor Shah charge for Precice?

His external only price is $8,000 and LON is $9,000. I didn't ask him about the cost of Precice, but I imagine it would be the $30,000 for the nails plus the surgery fee. So I'd guess between $38,000 - $40,000 USD, accommodation excluded.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Wannabegiant

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #103 on: July 07, 2014, 08:08:51 PM »

I wish you all the best luck Kilokahn, thank you for this very detailed and well written diary.

One thing i wonder about, what was the specifics of the plate fixation you discussed with the surgeons that made you decide not to do it and go for exfix only instead? Was it simply because that there isnt enough patients who have done it already and thus a lack of knowledge of the results?

Also has the Dr Parihar given you any kind of estimate as to how long you will need to wear the frames? Like if he had some kind of average time frame based on his former patients.

Thank you again  :D
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #104 on: July 07, 2014, 08:30:48 PM »

7/3/2014
Woke up at 11:30 am and distracted another .25 to bring me to 1 mm of distraction. The physiotherapist named Mohini came but I wasn’t done with my sponge bath so she said she’d come in 10 minutes, but I had spent a long time coming back from the bathroom and getting ready so she eventually left without me doing my physio. It’s a shame too because she’s the physio I’ve got a thing for. A team of three physios came later, one lady trained in the US in Connecticut for physiotherapy and was the leader of the group. She told me that they noticed even before the operation that my dorsiflexion was below average and that I have a naturally tight fascia, so they were going to try and release it a little to improve the ROM of my feet. She put some cream on her hands and started on my right tibia where she felt around for a bit and then pressed down before spreading her fingers across the surface in various areas of the top, side, and back of my tibia. There was a deep throbbing sensation that responded to the physios work and when she spread her fingers across the middle of my tibia it felt like I had a really bad bruise that was sensitive to touch. After the session she saw with her measuring equipment that my dorsiflexion had improved by 8 degrees. She gave me exercises to do with my feet to add to the other physio exercises I’m required to do. I’m willing to do it as much as possible though because I want to fight this equinous before it happens.

So far things have been really good here, the only real annoyances I had were with a couple of the attendants. One of them asked a bunch of times for me to help him get a visa into the USA, and when I said I had no way of doing that he told me that I must have a way of knowing how he could get one – somehow he had the idea that I could make it happen. The rest of the day was kind of awkward when I told him that there was nothing I could do. The other attendant was just really... not too smart. Example, I walk to the bathroom on the walker and he straightens out the slippery rug for me to walk on instead of removing it. I’ll come out of the bathroom and he’ll have a bucket of water right by the door that’s too heavy for me to move. He’ll put a bucket with very little water in it directly near the toilet so I accidentally knock it down. He’ll insist on trying to put on my sandals even when I tell him I’ve got it. These are minor things I guess, but when you're in pain in fixators the smaller things tend to grate on your nerves a bit more. I think the only big complaint I had with the guy though was that he would just sit on the bed across from me and stare intently while I’m writing or using the laptop, even though he doesn’t have to stay in the room and at least has a phone with 3G access so he can occupy himself with something other than staring at me.

Some days when that second attendant was there, the scene would like like this for minutes at a time:



7/4/2014
Continuing distraction. Left leg is very sore and I have lots of knee pain. Encountered a new kind of pain today that hurt like hell every time it happened. I find that if I am about to fall asleep and quickly regain alertness, or fall asleep completely and wake up in the morning, I end up getting a muscle contraction that tightens around all the pin sites and relaxes after a split second. The pain is very brief but hurts a lot, especially on the pins and wires by the ankles. Legs were in a lot of pain today even after getting two physiotherapy sessions and exercising to loosen up the muscles. The few painkiller tablets I took didn't help much either.

7/5/2014
Woke up at around 12 o’clock with a really painful muscle contraction around all the pin sites. After washing and having breakfast, Mohini came into my room to do physiotherapy. I always like seeing Mohini. The thing I have for her makes any discomfort from the physio more tolerable. I had my second physiotherapy session at around 6 o’clock with Pratiksha. She taught me three new exercises, which were to help with back pain from lying down so much. Dr Divya came later and told me how discharge was going to work and had the chemist from downstairs meet me. Whenever I was to run out of dressings I would have to give this guy a call and order boxes in advance. I could get a discount of 100 INR ordering from him instead of going to the store. Ten boxes of dressings would cost about 600 INR. After everything was packed, I was taken in a wheelchair to the ground floor where I was put on a stretcher and into the back of the hospital ambulance. They took me to Maharana Inn and I had to use my walker to enter the elevator. The assistant from the room came with me and help set things up in the room. I was given a rate of $46.50 per night due to the extended stay. There was an even cheaper rom but they recommended this one as the other didn’t have any of the nice amenities and my stay would have been far less comfortable. They gave me a room closest to the front desk. Inside was a mini fridge, closet space, table, desk, bathroom with toilet, shower, towel and toilet paper, HDTV and internet access. Room service was all day and laundry service was available as well. Did physio on my own and had a Married...With Children marathon from the DVDs I brought.

X-Rays
Dr Parihar sent me my first set of post-op x-rays. I noticed that instead of a clean cut through the bone, it looked cracked or shattered. When I asked Dr Parihar about this, he said that he doesn't go in the surgery looking to shatter the bone intentionally, actually he prefers a clean cut. But he said not to worry about it. Sometimes the bone is just to solid to do a clean cut at the time of surgery and it ends up shattering, but the shattering allows for more surface area for healing. So I'm not really worried about it anymore. Dr Parihar is a very cautious doctor who tells it like it is, so I trust him that it's not something to be alarmed about.
« Last Edit: July 07, 2014, 09:01:04 PM by KiloKAHN »
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #105 on: July 07, 2014, 08:39:17 PM »

I wish you all the best luck Kilokahn, thank you for this very detailed and well written diary.

One thing i wonder about, what was the specifics of the plate fixation you discussed with the surgeons that made you decide not to do it and go for exfix only instead? Was it simply because that there isnt enough patients who have done it already and thus a lack of knowledge of the results?

Also has the Dr Parihar given you any kind of estimate as to how long you will need to wear the frames? Like if he had some kind of average time frame based on his former patients.

Thank you again  :D

Thanks Wannabegiant.

The reason I didn't do plate fixation really came down to choosing Dr Parihar as my surgeon. I found out he would not perform plate fixation for cosmetic patients at this time when it comes down to it. He said there haven't really been peer reviewed studies on the outcomes of bilateral plate fixation for cosmetic patients, so he wouldn't be able to say how my course of healing would be affected. He also didn't like the idea of doing them instead of LON because plates aren't as stable as nails.  I wanted to avoid the knee pain possibility and any malalignment could be corrected with the hexapod if I did exfix, so I decided to go that route. Had I decided to go with Dr Suhas Shah, who was my second choice, I think I would have done plate fixation then because he seemed to be confident about its use and said he's done it a lot.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Gichelu

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #106 on: July 07, 2014, 09:30:23 PM »

His external only price is $8,000 and LON is $9,000. I didn't ask him about the cost of Precice, but I imagine it would be the $30,000 for the nails plus the surgery fee. So I'd guess between $38,000 - $40,000 USD, accommodation excluded.

That's probably cheapest in the world for Precice! Is it Precice 1 or 2?

Separate question how much do you weight? You said doctors told you your bulk would help with healing. How much bulk is it? I am a little heavier than average also. That will help with healing?
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #107 on: July 07, 2014, 09:47:02 PM »

That's probably cheapest in the world for Precice! Is it Precice 1 or 2?

I believe it's the latest version of Precice as Ellipse is the one contacting specific surgeons in India who they will allow to use it. I don't think they'd contact them for use on an older product. Could be wrong though. Best to send Dr Shah an e-mail:

http://www.suhasshah.com/contactus.html

Separate question how much do you weight? You said doctors told you your bulk would help with healing. How much bulk is it? I am a little heavier than average also. That will help with healing?

Well only a couple doctors said outright that bulk is good. Dr Parihar for example said it depends on what kind of bulk you're talking about and didn't really say yes or no about bulk being a good thing. Only thing for sure the bulk caused was me having to wear frames of a smaller diameter than most patients.

When I got on the scale at the hospital it said I was 96 kg (211 lbs). I'm very compact and most people don't guess I weigh that much. I've got a wide frame for my height though:
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Blackhawk

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #108 on: July 08, 2014, 12:50:47 AM »

That's a lot of weight for someone your height!  I am about 167 and my highest weight when I worked out a lot was about 85kgs.

Do you think you might have too much muscle and resistance to lengthening on your legs?  I remember reading captain Americas diary and he had a lot of muscle and he had problems.  But maybe Sarins frames were just weaker.
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BilateralDamage

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #109 on: July 08, 2014, 04:03:05 AM »

So glad to hear you're doing well Khan.  The nights get lonely, I definitely know this, but once you start standing next to people and realizing you're almost average height, it makes it all worth it.  Stay strong!

Btw, I envy your starting weight.  You're built like a brick man!  You're going to look great post lengthening.  ;D
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Classical

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #110 on: July 08, 2014, 05:45:37 AM »

Thank you for the fantastic dairy! These are definitely some great pictures you took ;D The beginning two weeks are very painful. I hope you are feeling better now. In terms of the crust you see around the pin site, don't worry, they are normal. If the discharge is yellow and clear then it's just regular bone discharge. However, if the color gets opaque and you are in pain then it's infection. For me, I on purposely leave these dried discharge on my pin site, they seem to help stabilizing the wound to the pin and cause less pain from movements.
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crimsontide

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #111 on: July 08, 2014, 05:51:27 PM »

kilo... do you have an email for dr shah??? i have to get release for my equinus
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yugiohja

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #112 on: July 09, 2014, 03:36:15 PM »

How is the air quality like there?
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KrP1

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #113 on: July 09, 2014, 07:51:51 PM »

Is that weight of muscle or fat?
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Moubgf

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #114 on: July 10, 2014, 12:34:54 AM »

Lol i thought i was fat. i guess i don't have to tighten up anymore then. Pizza order incoming..
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #115 on: July 10, 2014, 09:16:09 AM »

That's a lot of weight for someone your height!  I am about 167 and my highest weight when I worked out a lot was about 85kgs.

Do you think you might have too much muscle and resistance to lengthening on your legs?  I remember reading captain Americas diary and he had a lot of muscle and he had problems.  But maybe Sarins frames were just weaker.

I'll have to ask Dr Parihar tomorrow about whether or not he'll think muscle resistance will end up a problem for me later down the line. As of now I haven't noticed any particular tightness or resistance to the turning. Fortunately my frames aren't bending like Captain America's did, though it's because exfix only frames are more sturdy and full of more components than frames you wear for LON.

So glad to hear you're doing well Khan.  The nights get lonely, I definitely know this, but once you start standing next to people and realizing you're almost average height, it makes it all worth it.  Stay strong!

Btw, I envy your starting weight.  You're built like a brick man!  You're going to look great post lengthening.  ;D

Yeah, one of the downsides of doing lengthening here is that not only am I the first international cosmetic patient (Dr Parihar has done 10 cosmetic cases all for locals), but nobody in this hotel is international. Actually since I've been here I'm the only Westerner I've seen. I saw one guy from Africa and a Chinese family at the Foreigner registration office and that's it. Not quite used to Indian cuisine either so there's that hurdle.

Hah, well my build definitely helped when I was on the wrestling team. I was often wrestling people much taller than me as nobody my height was close to my weight. It was awkward for them and it resulted in a lot of wins for me. :D

Thank you for the fantastic dairy! These are definitely some great pictures you took ;D The beginning two weeks are very painful. I hope you are feeling better now. In terms of the crust you see around the pin site, don't worry, they are normal. If the discharge is yellow and clear then it's just regular bone discharge. However, if the color gets opaque and you are in pain then it's infection. For me, I on purposely leave these dried discharge on my pin site, they seem to help stabilizing the wound to the pin and cause less pain from movements.

Yeah the first two weeks seem like they'll have been the worst. I'm just over that and despite continuing distraction the pain has lessened with more physiotherapy and increased standing. From what both you and Dr Divya described about infections, I think I have an infected pin near my ankle. I'm going to check on it tomorrow and see if I can get antibiotics for it. By the way, do you change your dressings every single day? I change them each day and clean them by soaking sterile gauze in boiled water. Is that the same procedure you were given for cleaning the pins?

How is the air quality like there?

Air quality is similar to what I'm used to, though I lived in downtown Los Angeles so I guess I'm used to bad air. It seems clean enough, but there are definitely areas of Mumbai where you just get this sewage smell that's not at all pleasant. I've found that Mumbai is very similar to Shanghai in a lot of ways.

Is that weight of muscle or fat?
Well when I was at my peak level of fitness on my university's wrestling team, I weighed 84 kg (185 lbs) and had very little body fat. I've done weight training for mass gain since the age of 13 so most of that weight was made up in solid muscle. However, after two years of being forced at a desk job for 10 hour days and slowed metabolism, I packed on the fat. Pretty much all of it was concentrated on my abdomen. Judging from my wrestling team body weight and level of fitness, I would guess that I have around 30 lbs of fat that I could stand to lose.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Claude

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #116 on: July 10, 2014, 09:56:55 AM »

Nice diary KK, i think you have chosen the best doc for this procedure in India. From looking at your pic i think you could go down near 80 kilos. Man Indians are "funny".
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #117 on: July 13, 2014, 05:22:11 PM »

Update: 7/13/2014
The other day I went to see Dr Parihar. For some reason I was out of breath every few steps on the walker and I had to rest for a bit. It was very odd because each day before I had no breathlessness. Getting on the auto rickshaw was a pain and it took me probably ten minutes to walk to the ATM. It was raining outside and one of the hotel staff had to cover me with an umbrella. I arrived at Mangal Anand Hospital and had to wait downstairs a bit for the x-ray guy to arrive and get the updated x-rays of my legs. After that I went to the second floor and walked slowly and out of breath toward Dr Parihar's office. He was standing at the end of the room with a concerned look and asked me how long I had this issue. He had me get a chest x-ray immediately after moving me to a wheelchair, but fortunately there was nothing wrong with my lungs. He supposed that my tiredness was due to putting too much weight on my arms while moving with the walker and not enough on my legs.

I was led into one of the doctor's offices and had my osteotomy staples removed. They were taken out with pliers but I hardly felt it at all. Dr Divya then changed all my pin sites and looked at the ones I thought were infected, but he and Dr Parihar both said it was normal discharge. A few of the wires near the knee and ankle have larger holes surrounding them than the others, which was done intentionally by Dr Parihar. He cut the skin around them because there's naturally more movement in those areas and doing so would reduce pain and skin tearing. The issue with this is that more discharge tends to get stuck in those areas and I have to work harder to clean them.

You can see in the photos below that the fibula osteotomy is a lot larger than the tibia osteotomy. Dr Divya told me the reason it's much longer is because there's a blood vessel right behind it as well as muscle blocking the bone. They don't do a fibula osteotomy similar in size to the tibia osteotomy because the smaller it is the more blind the surgeon is getting to the fibula and the risk of damaging something is further increased. The tibia osteotomy can be very small because the bone is right underneath so there's no real risk involved.

I was given antibiotics and more pain medication. I had to pay for them so any further medication you get is not covered by the original surgery cost. You also have to pay for your own dressings, which are 500 INR per box.

I had to have a physiotherapy session downstairs after seeing the doctors and this time I had to do 15 reps on all the exercises. I was also given new exercises for arm strength in addition to breathing exercises.

The last couple days have been very uncomfortable and I've had a hell of a time trying to get to sleep due to discomfort from the pin sites. Dr Divya said he'll get me some sleeping medication to help with it.

Photos
 
« Last Edit: July 13, 2014, 05:56:44 PM by KiloKAHN »
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Classical

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #118 on: July 16, 2014, 02:00:12 AM »

Hi Kilo, glad that you didn't get pin infection! I don't dress my pin site everyday. It's either every other day, or every three days. What I do is I use iodine swaps to clean the sites. After letting them dry for 5-10 mins, then I wrap them tightly with gauze.

Looking at your picture of the fibula scar, woo, they do look quite long. I am looking at mine now. Yes, mine is also longer than the tibia scar, but not by much. Also, it seems quite interesting that doctors in India like to use surgical staples to close scars. Mine is done with surgical glue.

Have tried to take Melatonin to go to sleep? For me, that world even better than sleeping pills, plus it doesn't have much side effect. I usually take 10gm. Hope you feel better!
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #119 on: July 16, 2014, 03:05:46 PM »

Responding to ShortyMcShort's question from Dr Dhawan's page:

I read your other posts Kilo and Im not sure if it was you or another poster who said add another $15,000 or so for accommodation, food, physio and etc. So another $15,000 and its at $25k, and it could even reach $30k. My question is why did you choose going to India  with Dr Parihar over say Dr Birkholtz in South Africa who has a package for $30k externals and $35k for LON/LATN, yes I understand Dr B is still more expensive, but no hassle of having to find accommodation and etc. And the hospital and accommodation seems really nice in South Africe(based on the pictures of course) and clean, which is the complete opposite of India

Genuine question by the way, not trying to discourage you or anything like that and I hope it doesnt sound that way. Very curious about your journey as it could help me to decide on my decision soon when Im ready. Thanks

With Dr Parihar I think everything will total around $25,000 USD maybe a little extra. For Dr Dhawan it might be closer to $15,000 + depending on the hotel you stay in (generally cheaper in Delhi than Mumbai) and how lucky you are with finding cheap flights. You might save even more with Dr Dhawan if you can arrange a flat and a caretaker.

One of the reasons I chose India was because I have a little extra security over here. I have family with a lot of personal connections in India and valid visa status, so should anything go wrong I could have some trusted people come to assist me at quick notice. Finding accommodation here wasn't really difficult. It could be if I wanted a flat or apartment in Mumbai, but I preferred to stay at a hotel anyway because the hotel staff takes care of so many things that there's no real need for a caretaker. Plus it's just way more comfortable, so I don't mind spending the extra money. The hospitals themselves may not be fancy but they have what you need for the surgery and the brief stay at the hospital. I wasn't able to be all that mobile so even if the hospitals were fancy I don't think I could have made much use of it. Being seen by a doctor who was trained and recommended by Dr Paley but also in my price range was a huge plus as well. Dr Parihar is very active in workshops teaching Ilizarov and is probably the most famous Ilizarov surgeon in the country. If you look online he's attended a lot of ASAMI conferences that Dr Paley, Dr Guichet, and others have attended too. So there's that extra layer of confidence that my surgery was done well.


Hi Kilo, glad that you didn't get pin infection! I don't dress my pin site everyday. It's either every other day, or every three days. What I do is I use iodine swaps to clean the sites. After letting them dry for 5-10 mins, then I wrap them tightly with gauze.

Looking at your picture of the fibula scar, woo, they do look quite long. I am looking at mine now. Yes, mine is also longer than the tibia scar, but not by much. Also, it seems quite interesting that doctors in India like to use surgical staples to close scars. Mine is done with surgical glue.

Have tried to take Melatonin to go to sleep? For me, that world even better than sleeping pills, plus it doesn't have much side effect. I usually take 10gm. Hope you feel better!

I slept so hard with the sleeping pills I took the night before that I slept all throughout the day and didn't change my dressings. I was worried a bit but reading that you do yours every other day or every three days is comforting as you don't have any pin site infection issues. Yeah the staples were fun to look at. It made me think I was put together like a Frankenstein creature lol. I'm feeling better now but I've got a lot of sensitivity on the osteotomy site on my right leg and on the back of my left calf muscle.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

ShortyMcShort

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #120 on: July 16, 2014, 04:15:42 PM »

Thanks for the reply KK

I have a few questions I'd like to ask
1/ How long do you intend on staying in India for? Just for the distraction phase or will you be staying there until frame removal?
2/ Could you take some pictures of the hotel you are currently staying at, when you are ready of course and only if you can.
3/ How did you pay the hotel? In instalments or did you pay for your whole stay in one transaction?
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #121 on: July 16, 2014, 04:42:51 PM »

Thanks for the reply KK

I have a few questions I'd like to ask
1/ How long do you intend on staying in India for? Just for the distraction phase or will you be staying there until frame removal?
2/ Could you take some pictures of the hotel you are currently staying at, when you are ready of course and only if you can.
3/ How did you pay the hotel? In instalments or did you pay for your whole stay in one transaction?

I'll be here just for distraction. Dr Parihar said I should be fit to leave in the second or third week of October. I can take pics later but here's the link to the hotel I'm staying at so you can get an idea of what it's like. It's about 5 minutes away from Dr Parihar's clinic by auto rickshaw. www.hotelmaharana.com

I'm paying the hotel in one payment once I leave but they will give you other payment options if you ask. I got a discount rate due to extended stay of 2877 INR per day, which is around $46 USD. They have their own restaurant,  complimentary wifi, all rooms have a private bathroom and shower, HDTV with cable access, and laundry service which is a separate charge.

Biggest challenge for me is getting used to Indian cuisine. I just want a steak or a burger.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

GeTs

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #122 on: July 16, 2014, 05:16:29 PM »

I'll be here just for distraction. Dr Parihar said I should be fit to leave in the second or third week of October. I can take pics later but here's the link to the hotel I'm staying at so you can get an idea of what it's like. It's about 5 minutes away from Dr Parihar's clinic by auto rickshaw. www.hotelmaharana.com

I'm paying the hotel in one payment once I leave but they will give you other payment options if you ask. I got a discount rate due to extended stay of 2877 INR per day, which is around $46 USD. They have their own restaurant,  complimentary wifi, all rooms have a private bathroom and shower, HDTV with cable access, and laundry service which is a separate charge.

Biggest challenge for me is getting used to Indian cuisine. I just want a steak or a burger.
I'd be happy as long as it's healthy , then would enjoy everything i wanted to after LL
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KiloKAHN

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Re: No More Mal-Kahn-Tent - External Tibias - Dr Parihar
« Reply #123 on: July 16, 2014, 10:46:17 PM »

Felt like posting a video showing how easy it is to distract with the turning devices put onto the frames. Every turn equals .25 mm of distraction.

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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience
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