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[jievince3]

Hello, I am a 20-year-old boy with height of 168cm. I plan to do LL with Dr.kulesh from Russia in November of this year. My goal is 5cm for tibias and i decide to choose method of conventional Ilizarov.
Any body give me some advice? Is my choice wise?

[jievince3]

I plan to stay in Russia for about 1 month and do the extension at home.

[Ghostfish]

Hi jievince3
I don't understand why you chose the oldest method, Ilizarov.  Is that because of money?  Try to choose at least LON if you care about money.  There are many doctors who are doing LON at low price.

[jievince3]

Hi jievince3
I don't understand why you chose the oldest method, Ilizarov.  Is that because of money?  Try to choose at least LON if you care about money.  There are many doctors who are doing LON at low price.

Yes, it's much cheaper.  And based on what I got on the forum(I am not sure about it), llizarov is more safe than LON and llizarov can reduce damage to exercise capacity for tibias.

[Ghostfish]

Yes, it's much cheaper.  And based on what I got on the forum(I am not sure about it), llizarov is more safe than LON and llizarov can reduce damage to exercise capacity for tibias.

Hi jievince3
I see your concern about money. Of course, money is the biggest concern for the most.  I did cll with internal nail, Stryde and never had any intention to use external method for my cll.  So I don't know very well about external method.  But one thing for sure is that most of people who did external method, generally for only tibia, used LON rather than Ilizarov.  I think there must be a reason for that.  Plus, as far as I know about external method including Ilizarov, the external method is slower than internal method and more problem of infection and perhaps complication.  I guess Ilizarov is probably worse than LON.  Look for more information before you really do it.  I really discourage you to do Iliarov.

[jievince3]

Hi jievince3
I see your concern about money. Of course, money is the biggest concern for the most.  I did cll with internal nail, Stryde and never had any intention to use external method for my cll.  So I don't know very well about external method.  But one thing for sure is that most of people who did external method, generally for only tibia, used LON rather than Ilizarov.  I think there must be a reason for that.  Plus, as far as I know about external method including Ilizarov, the external method is slower than internal method and more problem of infection and perhaps complication.  I guess Ilizarov is probably worse than LON.  Look for more information before you really do it.  I really discourage you to do Iliarov.

Hi Ghostfish, thanks for your interest.  I think why why people prefer LON is because LON takes less time to remove frames.   
Money is my key problem and I can only afford about $8,000. To be a short man is very painful so I want to do LL as early as I can.

[jievince3]

If I have enough money, I will definitely choose stryde.

[wannagrowtaller]

The problem with LON (and LATN) is the problem with internal nail in tibia: risk of permanent knee pain. If the surgeon perform suprapatellar approach the risk is reduced. There is not risk with full external.

[jievince3]

The problem with LON (and LATN) is the problem with internal nail in tibia: risk of permanent knee pain. If the surgeon perform suprapatellar approach the risk is reduced. There is not risk with full external.

Thanks for your answer. So conventional Ilizarov is more safer than LON/LATN?

[wannagrowtaller]

Yes.
Besides that, infections on pinsites usually are not problematic. Infection in an internal nail would be catastrophic.

I'm not saying I would do Ilizarov though. The more time with frames is really a disadvantage. I would prefer stryde in tibia. If I could not pay for stryde, I would do LON problably.

http://www.limblengtheningforum.com/index.php?topic=809.0
http://www.limblengtheningforum.com/index.php?topic=4517.0

[California2]

You seem intent to lengthen only 5 cm (which is modest and probably very safe depending on your starting tibia length).

Purely external lengthening (Ilizarov without nails) remains the safest approach and offers the ability to resolve existing alignment issues, if any.

If you plan on actually stopping at 5 cm; then, it is probably safe enough to leave St. Petersburg during distraction; however, you may need to return for a correction phase after distraction is complete but before your frames are locked for consolidation.  You will also likely need to return to remove the frames.  When you plan to go beyond 5 cm, you should carefully question whether you should be geographically distant from your medical team because your body will push back very hard against lengthening which can necessitate adjustment to your frames. 

If you limit distraction to 5 CM; then, you are probably looking at about 2 months from initial surgery to completion of distraction, another one to two weeks for correction; then, 2-3 months for consolidation -- a doable journey in frames.

You can always elect LATN later if you want to get rid of the frames.  Though people on this forum insist LON or LATN causes knee pain, etc., I am aware of no valid, on-point study that supports that notion.  I can also attest that I have no knee pain or loss of range of knee motion.

I encourage you to discuss your choices frankly with your MD team.  Dr. Kulesh will accept your decisions and make what you want to happen actually happen because he ascribes to the doctrine that "the patient is always right". 

However, most patients are dumb as a post when compared to his or her physician.  Therefore, it is always important to ask your medical team "what do you advise?"  Carefully consider that advice and the underlying rationale before you decide to not follow it.

Best of luck!

[wannagrowtaller]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333649/

[California2]

The above article is a good example of an article that is being referenced for something other than it reports.  I encourage you to read the article to understand what it actually says.

What it does NOT conclude is that tibia nails cause knee pain.  What it DOES conclude is that patients who's nail ends farther from the end of the tibia; that is, patients who's nails are buried deeper in the bone, experience less pain.

Then, read the causes of the pain reported and you realize that most of the pain reported was due to the surgical procedure itself.  Don't know why anyone would expect to undergo surgery without any pain?

[wannagrowtaller]

For me that's ok. Like I said, I'm willing to take the risk for less time with frames.

[cheekycabs]

You seem intent to lengthen only 5 cm (which is modest and probably very safe depending on your starting tibia length).

Purely external lengthening (Ilizarov without nails) remains the safest approach and offers the ability to resolve existing alignment issues, if any.

If you plan on actually stopping at 5 cm; then, it is probably safe enough to leave St. Petersburg during distraction; however, you may need to return for a correction phase after distraction is complete but before your frames are locked for consolidation.  You will also likely need to return to remove the frames.  When you plan to go beyond 5 cm, you should carefully question whether you should be geographically distant from your medical team because your body will push back very hard against lengthening which can necessitate adjustment to your frames. 

If you limit distraction to 5 CM; then, you are probably looking at about 2 months from initial surgery to completion of distraction, another one to two weeks for correction; then, 2-3 months for consolidation -- a doable journey in frames.

I really don't think this timeline is accurate, so I will clarify it as my experience so far. I'm now on month 7, still consolidating, with at least 1-2 more months until frame removal. That is with the scheduled exercise of walking, usage of nandrolone, testosterone, estrogen, all vitamins and protein for speeding up recovery. I am JUST this week starting to use forearm crutches and am off using my zimmer walker. I would say my walking is improving a lot but I am far from finished. I think when it is all said and done, 5.5cm will have cost me 9 months, and this is on the low end if everything goes well. When I was doing the surgery initially I was told numbers like that, 5cm for 6 months, I just don't think it's true.

[Renaissance]

I may be wrong but I sincerely believe that the majority of people who want to do LL think on the basis of two variables:
probability ratio of recovery chances/ price.
and
number of centimeters gained.

for example

I want to gain 5 cm.

if I spend $ 100,000 for this surgical operation, I estimate the probability of total recovery at 95%.

on the other hand for 8000 dollars, I estimate the probability of total recovery of my functions to 60%. that means hat I have 6 chances out of 10 that everything is going well.

so for a variation of 35% I still save 92000 dollars which is tremendous.

so never mind I'm missing out on that 35% chance, but I'm saving a lot of money. 

I specify that these data and especially the percentages of recovery are absolutely arbitrary and imaginary. it's just for the example.

Finally it's a little like parachuting.

Let's imagine that I want to do a skydiving jump.
So I'm going to buy one

The first I find in a store costs 100 dollars, it is very old and I see a lot of holes in the sails.

The second is much more expensive about $ 10,000 but it is a new parachute last generation.

Again in reality there are intermediate prices of course but here it is an example between two specific choices

I do not know many people who will choose to jump with the $ 100 parachute.

The reflection would be rather I have 10000 dollars and I can skydive or I do not jump.

[Renaissance]

so to answer your question'' is my choice wise?'', from my point of view the answer is no.
and in my opinion it is simply because the pain you feel and the eagerness you have to eliminate it prevents you from reasoning rationally

[wannagrowtaller]

I really don't think this timeline is accurate, so I will clarify it as my experience so far. I'm now on month 7, still consolidating, with at least 1-2 more months until frame removal. That is with the scheduled exercise of walking, usage of nandrolone, testosterone, estrogen, all vitamins and protein for speeding up recovery. I am JUST this week starting to use forearm crutches and am off using my zimmer walker. I would say my walking is improving a lot but I am far from finished. I think when it is all said and done, 5.5cm will have cost me 9 months, and this is on the low end if everything goes well. When I was doing the surgery initially I was told numbers like that, 5cm for 6 months, I just don't think it's true.

Testosterone and estrogen help your recovery? How much testosterone enanthate are you using?

[jievince3]

You seem intent to lengthen only 5 cm (which is modest and probably very safe depending on your starting tibia length).

Purely external lengthening (Ilizarov without nails) remains the safest approach and offers the ability to resolve existing alignment issues, if any.

If you plan on actually stopping at 5 cm; then, it is probably safe enough to leave St. Petersburg during distraction; however, you may need to return for a correction phase after distraction is complete but before your frames are locked for consolidation.  You will also likely need to return to remove the frames.  When you plan to go beyond 5 cm, you should carefully question whether you should be geographically distant from your medical team because your body will push back very hard against lengthening which can necessitate adjustment to your frames. 

If you limit distraction to 5 CM; then, you are probably looking at about 2 months from initial surgery to completion of distraction, another one to two weeks for correction; then, 2-3 months for consolidation -- a doable journey in frames.

You can always elect LATN later if you want to get rid of the frames.  Though people on this forum insist LON or LATN causes knee pain, etc., I am aware of no valid, on-point study that supports that notion.  I can also attest that I have no knee pain or loss of range of knee motion.

I encourage you to discuss your choices frankly with your MD team.  Dr. Kulesh will accept your decisions and make what you want to happen actually happen because he ascribes to the doctrine that "the patient is always right". 

However, most patients are dumb as a post when compared to his or her physician.  Therefore, it is always important to ask your medical team "what do you advise?"  Carefully consider that advice and the underlying rationale before you decide to not follow it.

Best of luck!

Thank you very much for your reply and suggestions. Also, do you think kulesh is a good doctor? There seems to be no negative news about kulesh at the forum.

[jievince3]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333649/

Okay, I will read it.

[jievince3]

so to answer your question'' is my choice wise?'', from my point of view the answer is no.
and in my opinion it is simply because the pain you feel and the eagerness you have to eliminate it prevents you from reasoning rationally

Hi, thanks your reply. 
If I have $100,000, I will no doubt choose paley; if I have $50,000, I will choose Giotikas. However, I only have $8,000 now. I need to make a relatively good decision. For the extension of the tibia, the traditional Irizhalov is very safe, 5cm is also a relatively safe length, in addition, Dr. Kulesh also has a good evaluation.
Why is this not a good choice?
(English is not my first language, I may be unclear in some places, sorry.)

[jievince3]

The length of my tibia is about 40cm.

[jievince3]

In addition, my calf is not very straight because it has a slight knee overextension due to the fast walking speed. Can this be corrected while extending?

[Renaissance]

Hello

First I will never allow myself to say that you are not making the right choice I am nobody to say that.


I said in my opinion you are not making the right choice but maybe I'm wrong. I am not a doctor I am not a specialist and I have never done any intervention with paley nor with this doctor that you have chosen so I can not even compare with my personal experience.

But I invite you to watch the following video.



This is paley who gives a lecture on the lengthening process and the different techniques used in the world.

Look at the minute 27. He talks about the different types of incision practiced for this operation.

That brings a lot of questions.
First, what is the level of technology that will be used for your operation.
Does your surgeon have an image intensifier.
If he does not have it he will have to make a big incision in your legs to be able to practice the osteotomy safely because he will not be able to see it on the screen.
Do you know who makes the frames that will be used for your external fixator?

I read the document that was sent to you in a link that I saw above on your diary, and I notably mention the notion of bone necrosis. The main cause of bone necrosis and the fact that metal alloys used for external fixator frames are not biocompatible.
 Biocompatible alloys are expensive to manufacture to produce and perhaps factories and engineers in India do not have the technical and financial means to manufacture them. Hence the derisory price of the frames and the operation itself, even if it can be correlated with the standard of living in the country. Also note that according to the statistics you have 120 percent chance of having a major complication during your lengthening process with external fixator. It means that you will encounter at least one major complication.

Statistically, of course, maybe your neighbor will encounter two major complications and you will not have one, but statistically everyone develops a major complication with external fixator and especially with what the alloys are not biocompatible. Perhaps you should save and do this operation in the safest possible way if you want to recover your life from before with a gain in height. Again it all depends on your expectations and the risk you are willing to take.

[Renaissance]

On another part you're quite young you're 20 years old so your chance of recovering are better.

Please do the basics and check your bone densitometry before undergoing the surgery check the biocompatibility on the device and do x-ray because you said that your tibia are 40cm I'm doubtfull because we have the same size and my tibia are 34cm measuring with X-ray.

[jievince3]

On another part you're quite young you're 20 years old so your chance of recovering are better.

Please do the basics and check your bone densitometry before undergoing the surgery check the biocompatibility on the device and do x-ray because you said that your tibia are 40cm I'm doubtfull because we have the same size and my tibia are 34cm measuring with X-ray.

It should be that my measurement method is not accurate. I use a ruler to measure the length of my calf. In addition, how much is your height? 34cm * 15%(at low risk) is just 5cm.

[jievince3]

Hello

First I will never allow myself to say that you are not making the right choice I am nobody to say that.


I said in my opinion you are not making the right choice but maybe I'm wrong. I am not a doctor I am not a specialist and I have never done any intervention with paley nor with this doctor that you have chosen so I can not even compare with my personal experience.

But I invite you to watch the following video.



This is paley who gives a lecture on the lengthening process and the different techniques used in the world.

Look at the minute 27. He talks about the different types of incision practiced for this operation.

That brings a lot of questions.
First, what is the level of technology that will be used for your operation.
Does your surgeon have an image intensifier.
If he does not have it he will have to make a big incision in your legs to be able to practice the osteotomy safely because he will not be able to see it on the screen.
Do you know who makes the frames that will be used for your external fixator?

I read the document that was sent to you in a link that I saw above on your diary, and I notably mention the notion of bone necrosis. The main cause of bone necrosis and the fact that metal alloys used for external fixator frames are not biocompatible.
 Biocompatible alloys are expensive to manufacture to produce and perhaps factories and engineers in India do not have the technical and financial means to manufacture them. Hence the derisory price of the frames and the operation itself, even if it can be correlated with the standard of living in the country. Also note that according to the statistics you have 120 percent chance of having a major complication during your lengthening process with external fixator. It means that you will encounter at least one major complication.

Statistically, of course, maybe your neighbor will encounter two major complications and you will not have one, but statistically everyone develops a major complication with external fixator and especially with what the alloys are not biocompatible. Perhaps you should save and do this operation in the safest possible way if you want to recover your life from before with a gain in height. Again it all depends on your expectations and the risk you are willing to take.

Thanks for your info very much. I think I should seriously consider my decision and get more info about Ilyzalov.

[California2]

I could afford any procedure; however, I chose Solomin/Kulesh because, for me, they offered the greatest expertise.  When that fact is combined with the lowest price, it was a no-brainer.

Solomin literally "wrote the book" on external lengthening:  https://books.google.com/books?id=DbJGAAAAQBAJ&pg=PA52&lpg=PA52&dq=solomin+kulesh+google+book&source=bl&ots=tBxfp4g-GI&sig=ACfU3U2zMq8wTuOwIec3byWeWHMxxk419g&hl=en&sa=X&ved=2ahUKEwjkgJD5geThAhXdJzQIHblpArgQ6AEwCnoECAcQAQ#v=onepage&q=solomin%20kulesh%20google%20book&f=false

[Renaissance]

i'm 170 cm

89 cm CHEST
43 CM FEMUR
34 cm tibia
4cm feet

yes 5,1cm at 15% max safe zone 20%. 
recovery time on tibia is longer because of less vascularization an tow bones broken instead of one for the femur. tibia and fibula.

being able to practice sport seems to help you muscle to increase vascularization and so reduce the recovery time.

Try to think about a maximum of parameter before your surgery.

[Renaissance]

to obtain  your chest/ leg ratio, devide your leggs lenght by your total height the normal ratio should be betwen 50 to 52 %

in my case 89/170= 0,47

for tibia femur ratio normal is 0.80 above you have short femur compare to tibia. Below short tibia.

Me 34/43=0,79 so short tibs   

sources quote : Paley video above at 20 min. 

good luck

[Renaissance]

Sorry my bad.

81/170 = 0.476