I finally had a consultation with Dr. Parihar. His team was there on the zoom call. He seems like an honest guy and he was very straightforward (no BS).
Q. What is the procedure to schedule the surgery?
A. You have to first get on a call with someone from your family and then we can book a date and then you can come 1 or 2 week before the date to arrange living. You can get an Airbnb or a hotel.
Q. What lengthening method you would prefer?
A. Precise (femurs) is most comfortable for the patient and Precise 2 will be available in a month or 2. Currently, no internal nail is available.
Q. My goal is 6cm lengthening. Do you think it makes sense to spend 3-4x amount to do with precise?
A. For 6 cm, I think LON is a better option if money is a constraint. It's discomfort for the patient during the lengthening phase but the result is the same.
Q. Why you prefer LON over LATN? Does LATN has a low infection rate compared to LON?
A. I don't think so. If there is an infection in the external fixator pin then the chances of deep bone infection rate is same in LON and LATN. It's hard to do a proper alignment with LATN and LON is overall easier to do.
Q. Do you do anything to avoid complications like fat embolism or blood clots?
A. We don't give anticoagulant injections. We only give aspirin which is a lighter form of anticoagulant. If you are a high risk patient or if we see blood clots then we inject or give a more powerful anticoagulant. For fat embolism, there's nothing that can be done. We do venting to reduce the chances of fat embolism and we can also do one leg at a time with 1-week gap to reduce the risk in high-risk patients.
Q. Is there any benefit of using ultrasound bone simulators or LIPUS or Exogen?
A. Those devices are not available in India and all of our patients don't face any healing issues. I don't know how effective they are I've never personally recommended to any of my patients. If you think it'll help you you can import it.
note: If it can only be imported by doc then the doc will import for you.
Q. Do you do bone marrow aspiration contraindications (BMAC) for the tibia? Is it beneficial?
This paper says it reduces the healing time for tibia lengthening. What do you think about it?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397746/A. We don't use it because it's very costly for Indian patients. 1 set of BMAC costs 2.5 lac INR. If you want we can do it for you.
Q. Is anti-gravity treadmill or swim–ex available in Mumbai?
A. I am not sure. I think there are some centers that offer aqua therapy. I can find out for you.
Q. What is the risk of knee pain due to tibia nailing? Can it be prevented?
A. It is there in literature but none of his patients ever reported any knee pain issue with nailing. He uses a nail for almost all tibia fractures and most doctors use nailing for tibia fractures and the probability of knee pain is low but it can happen.
Q. How much time it’ll take to be able to walk with walkers? How much time it'll take to weight-bear and walk independently?
A. You can start walking with a walker in few days after the surgery depending on your comfort. We allow weight-bearing or walking (with crutches) once we see some bone. The nail is strong but there is no guarantee that it won't break and we have to use a thinner nail in case of LON. For fracture patients, we can use a full-size nail but for lengthening patients we use a thinner nail. It'll take 6 months to be able to walk with crutches and 9-10 months to walk independently. Some patients recover sooner and some may take longer there is no guarantee.
Q. Any recommended exercises before surgery?
A. Yoga and stretches. Don't do calves workouts. The muscles make it difficult to lengthen.
Q. nail removal time period?
A. 2 years, We prefer to remove nails for younger patients.
Q. Is Gastrocnemius Recession required or help? Do you do it prophylactically?
A. No, It's not required in most cases. We don't do it unless required because it weakens the muscle.
Q. What kind of drugs you give for pain management?
A. We mostly give NSAIDs and paracetamol. We don't give opioids unless required and we keep patients in some pain. The pain medicines we give have no long term side effects.
Q. Is there any quality difference between getting it done here vs west?
A. I don't think so. I have worked in the west. We use equipment from the same company and we are trained there as well as here. It's more like a difference between a 5-star hotel and your house. The quality of core surgery and treatment are the same. Maybe here people will speak in the accented version of English but they can do their job well.
I am writing this from memory because I didn't take notes. 🤦♂️ I maybe missed some points but I think he is a doctor with principles which is rare these days. Now, I have to get my affairs in order in order to get the surgery, and 9 months without walking will be hard but I am young and can only afford LON. I'll wait for maybe 6-9 months to get things in order and then decide on the date.
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Topic: Zoom consultation with Dr Parihar (Mumbai) (Read 520 times)