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[Rush]

Hey everybody, long time lurker, first time poster. I've tried searching about recovery time but none really answered my question exactly.

My plans:
So I'm planning on going to (most likely) New Delhi at the end of March, and get my CLL done by Dr. Shah or Dhawan (currently decided on Dr. Shah because Dhawan only allows you to do 5cm with LON).
I begin school around the 20th in September. That gives me approximately 5.5 months to do CLL if I am able to begin the surgery ASAP.
I've read that LON/LATN is the fastest method and the one that fits my budget, so that is the only choice I'm currently considering.

I really want to get at 6cm done on my tibia. It's really important that I get back to school in September, but I also really, really want to get this surgery now. I will settle for 5cm if I must, but I really want 6.

Information:
I've read posts and articles about how people can recover as fast as 3 months (unlikely) and as slowly as a year, but the number the doctors keep posting is 6-7 months from the doctors. If it was 6 months on the dot, I could probably lie to the professors and say that I'm stuck in India for another 2 weeks or something.

But the Reddit post of the guy (3inchestaller) who got 7.5cm tibial lengthening recovered so fast: https://www.reddit.com/r/short/comments/1ugx1y/im_a_guy_who_just_completed_three_months_of_leg/

3inchestaller began in October and ended March (5 months) for 7.5cm assuming LON/LATN
LittleLiam began in September and ended in March (6 months) with LATN

Questions:
(When I say recover, I mean recover to a state where I am able to fly home and not need a doctor near me for checkups)
1) Is there a good chance possible to recover in 5 months after first LON surgery for 5 or 6cm if everything done properly (pressure, pt, diet, etc)?
2) Is it okay to return home very shortly after fixators have been removed?
3 a) For the people who have been to New Delhi, do I have to find special accommodation at hotels for first floor service, or would I be able to the elevator.
   b) Would a translator, caretaker, or maid be necessary (I don't think I will be able to cook)?
   c) This probably isn't true, but I've also heard that it was dangerous to stay in New Delhi if you aren't Indian or look Middle Eastern, is there any truth to this?
4) If I get x-rays taken in the US, can I have them sent to the CLL doctors so they can operate ASAP?
5) Is it dangerous to live in hotels/flats that cost less than $20/day?
6) Should I do hotel or flat, and which is cheaper?

[Medium Drink Of Water]

I spent 5 months on the dot in Beijing in order to get 7.5cm, so I think your plan is doable.  Once the frames are off and the nails are locked in place, you don't need to have regular checkups with the doctor.  It's okay to go home.

[Rush]

Thanks for the quick reply, I really appreciate your hard work around this forum MGoW. It was your diary that actually made me realize how this was actually possible .

Also I've decided to switch back to Dhawan because living in Mumbai is too expensive, and he seems like the most careful person in the world. Maybe I can convince him to let me do 5.5 or maybe even 6 hehe.

Anyways, I wanted to confirm if I'm completely sure how the LON/LATN procedure worked with the given assumption of time:

0. Consultation: take x-rays, talk about possibilities, schedule surgery.
(0-14 days)

1. First surgery: they break your leg, put in internal rod, nails and external fixators. Then lay in bed feeling bad.
(5-10 days)

2. Distraction phase: Slowly lengthen the internal rod until desired height
(50/60 days - 1mm a day for 5/6cm)
(67/80 days - .75mm a day for 5/6cm)*


Now this is the part that I'm confused about
3. They lock in the screws. Somehow. How? And they remove the external device.
(0 days?)

4. Consolidation phase: chill out until my bones are hard. Chill out meaning physical therapy, walks, micromanagement of nutrition, and the detailed documentation of my time LLing.
( days)**

5. Once the bone is fully consolidated, nails are removed, then rest.
(7 days)

6. Go home

* Doctors usually say people should distract .67mm or .75mm a day, but so many people including MGoW distract at 1mm or higher.

** I don't know how I can get a average of the time it takes to consolidate because most of the LON diaries have Sarin and Sringari as their doctors, doctors like Dhawan and Shah don't operate like them.. I hope.

I have 168 days. Based on these calculations:
For 5cm, worst case scenario:
.75mm a day:
70d or 2m10d to consolidate
1mm a day:
87d or 12w3d or ~3m to consolidate

Is 2 month 10 days, or a little less than 3 months enough to consolidate 5cm?

[Medium Drink Of Water]

Thanks for the quick reply, I really appreciate your hard work around this forum MGoW. It was your diary that actually made me realize how this was actually possible .

Also I've decided to switch back to Dhawan because living in Mumbai is too expensive, and he seems like the most careful person in the world. Maybe I can convince him to let me do 5.5 or maybe even 6 hehe.

Anyways, I wanted to confirm if I'm completely sure how the LON/LATN procedure worked with the given assumption of time:

0. Consultation: take x-rays, talk about possibilities, schedule surgery.
(0-14 days)

1. First surgery: they break your leg, put in internal rod, nails and external fixators. Then lay in bed feeling bad.
(5-10 days)

2. Distraction phase: Slowly lengthen the internal rod until desired height
(50/60 days - 1mm a day for 5/6cm)
(67/80 days - .75mm a day for 5/6cm)*


Now this is the part that I'm confused about
3. They lock in the screws. Somehow. How? And they remove the external device.
(0 days?)

4. Consolidation phase: chill out until my bones are hard. Chill out meaning physical therapy, walks, micromanagement of nutrition, and the detailed documentation of my time LLing.
( days)**

5. Once the bone is fully consolidated, nails are removed, then rest.
(7 days)

6. Go home

* Doctors usually say people should distract .67mm or .75mm a day, but so many people including MGoW distract at 1mm or higher.

** I don't know how I can get a average of the time it takes to consolidate because most of the LON diaries have Sarin and Sringari as their doctors, doctors like Dhawan and Shah don't operate like them.. I hope.

I have 168 days. Based on these calculations:
For 5cm, worst case scenario:
.75mm a day:
70d or 2m10d to consolidate
1mm a day:
87d or 12w3d or ~3m to consolidate

Is 2 month 10 days, or a little less than 3 months enough to consolidate 5cm?

I see where you're confused now.  The consolidation (#4 in your list) phase will take approximately a year.  You go home and do that part while living a relatively normal life, then you go back to India get the nails removed (or leave them in forever, which is an option).  Phases 0-3 are what took me 5 months exactly.

[Rush]

Oh okay, that makes much more sense now.
So basically, when one is finished with distraction, then they no longer need any monitoring from the doctor (assuming he or she isn't doing anything risky).

When doctors say that it takes 6-7 months to heal, they are not including the consolidation phase then, right?

Another thing that bothers me about the recover is this-

Just wondering if LATN/LON is really worth lengthening with?

Especially if the risk of permanent knee pain is 30-50%.

From what I have read on this forum, people risk permanent knee pain regardless of how much they have lengthened

Is the risk actually 50%?
That sounds a little bit extreme based on the diaries I've read (disregarding the Sarin ones) have actually reported any long term pain.

[Medium Drink Of Water]

Some say that the consolidation is slower with the internal nail, so you might be able to be completely finished sooner if you do external-only.  But 6-7 months is a very liberal estimate.  Dr. Mitkovic told me 9 months for 7cm external-only, and it took Kilokahn a year to do 5cm external-only.

I believe TRS is getting that figure from a study done by Dr. Lee in South Korea.  He found that 50% of his patients had knee discomfort with the internal nail in, and only 50% of that 50% had their pain relieved when the nails came out.  So 25% reported permanent knee discomfort due to tibial nailing.

It still hurts me to kneel on hard surfaces even after eight years, and I believe that's because of the surgery to split the patellar tendon and insert the nail in the tibia.  Right where that surgery was is where the sensitive spot is when I kneel.  This could be a coincidence though.  I also have a condition called Patella Baja (lowering of the kneecap) due to LL, and it could be that the bottom of the kneecap is pressing on the nerves in the knee when I kneel.  It's all just speculation, though.  I went to an orthopedic surgeon who says he can't tell me 100% what's going on with my knees when I kneel.

[Rush]

Oh, so that is what he meant. I wouldn't mind if the knee pain was caused by use. Are there any cases of chronic knee pain where it would just be there all the time?

When you decide to have the pins set, do you just set the pins as soon as possible, or is there a waiting period?

Also, I know you're one of the lucky few who walked away with very little side effects, but I wanted to know if it's common for people like you who do as much as 7.5cm LON and return home as fast as 5 months, or does it require someone with very powerful regenerative abilities?

[Medium Drink Of Water]

I've never heard of constant, chronic knee pain associated with LL.

By "have the pins set," I assume you mean locking the nail in place.  That's done with titanium screws.  There are screws connecting the internal nail to the bone above the gap from the beginning.  After you're done lengthening, screws below the gap are installed so the nail is holding the leg together from both sides of the gap.  Before that, there's a waiting period of about 1-2 weeks to let the muscles and tendons settle before the fixators are removed and the nails are locked.

Most people on here are quite conservative about how much lengthening you should do.  3 inches was about the average amount people lengthened (or planned to lengthen) back in 2007.  Lots of people got their 3 inches in approximately 5 months like I did.  Regenerative abilities don't make the process go any faster until you get to the consolidation stage at home, so I wasn't a special case in that regard.

[Rush]

Man MGoW, you're like the best moderator for any forum I've ever been on. Definitely the most active and on point one.
Thanks to your help, I think I'm completely set on what I want to do now  .

One last question though, hehe.

In DEM's LON diary, he was finished turning 5cm ~2.5 months into his trip
(he arrived on 5/6/13, began lengthening on 5/14/13 and lengthened 4.4cm on 7/4/13).

Assuming worst case in that he does .75cm per day, he would need 8 days to read 5cm. 5/6 to 7/12 is 69 days.

Let's assume that he is satisfied with the 5cm rather than the 7.5cm. Then, let's say he takes 3 days off to recover like he did in his diary. And finally the external fixator removal, followed by another 3 days rest before returning home leading for a total of 72 days.
I also calculated for him doing a minimum of .67mm/day successfully for the entire distraction phase, in that case, it would result in 81 days.


Is the briefness of this trip realistic, a trip of less than 3 months?

Do you think I should include more rest in here?
I would really like to go home ASAP (in reason), in the case where I have enough strength to use crutches to get on the plane to return home without damaging myself in the process.

[Medium Drink Of Water]

Hey, thanks Rush.  Glad to help.

Everyone had a plan like that when they started LL, and nobody was able to stick to it.  Calculations like that are for ideal circumstances, and LL rarely works out that way.  You've got to plan for pin bending and correction of misalignment, and other potential complications like infections.

Some people in Beijing had deadlines for school and were turning ridiculous amounts toward the end of their lengthening phase to catch up and get to their desired height before their set-in-stone departure dates.  The doctors were worried this one girl was going to snap her Achilles she was lengthening so much so fast, and they ended up confiscated her wrench.

I know you want to spend the least amount of time away doing LL as possible, but as a vet who's done it and seen lots of people do it, I recommend you give yourself plenty of time for rest and resolution of complications.

[Rush]

Ah, thanks for the concern.
I reread DEM's diary, and I noticed that he actually did take a 6 week recovery period after taking the externals off.

Is the main purpose of the recovery period to check if anything went wrong so the patient can return to the doctor?

Any other timed resting period I should have besides this one?

[Medium Drink Of Water]

You'll definitely have three timed resting periods:

1. Between surgery and beginning lengthening.
2. Between stopping lengthening and getting the frames off.
3. Between getting the frames off and going home.

Maybe more if you need to stop because of tendon tightness or infection.

Waiting period #2 is to give your legs time to settle and get the tendons to adjust to their final length.  Misalignments could happen during this phase, and if they do, they'll notice and correct it on the operating table.  I don't think it needs to be six weeks long, though.  You should ask your surgeon how long he recommends these waiting periods to be.

[Deads]

For external, I've read it's 2months consolidation time per cm lengthened.. I thought Kilo gained 6cm?

[Rush]

I thought it was 1.5cm.

Also, I was wondering if this was a possibility:

Book flight for 5 months. Have surgery within the first 2 weeks, then stop distraction and have fixators removed 1 month before my flight.

[Medium Drink Of Water]

That's definitely a possibility.  You could probably do it in 4 or 4 and 1/2 months, but 5 is nice and safe.

[Rush]

Another thing that is on my mind is the removal of exfixes.
Will there be complications during this phase?

I'm imagining two opposing views on this.
First, I imagine the happy case, the one where you just limp around in your crutches and are happy that you've made it.

Then, I wonder if there could be anything as bad as what people experience right after surgery or during distraction. Things like extreme swelling, bad infections, misalignment, etc.

[Medium Drink Of Water]

Your legs will probably swell up for a few days, and infection is always a risk with surgery, but I've never heard of someone developing a misalignment after frame removal and nail locking when there wasn't one before.

[Rush]

I've also read about how Sweden lost 3cm after the surgery. However, his signature still says 180cm. Is this an actual possibility?

[Medium Drink Of Water]

I don't know how that happened, or even that it did.  Most likely that's due to a measurement error at some point during his LL.  3cm doesn't just "disappear."

[tx1111]

Yeah. I had my surgery on May. Had the frames off on August. I planned like OP did only to get my plans derailed by an infection and slow regeneration. If you have deadlines (school/work) my advice is be prepared to disregard them and whatever you calculate for your needed budget, add more for complications and for when you get bored.

I am at the 7 month mark and able to go out with crutches and basically waddle from one end of my flat to the other without crutches and someone closeby for assistance due to limited balance.

Medium Drink of Water:

After 5 months you had frames off like me. You chose to go home immediately. How long were you in crutches for?

[Medium Drink Of Water]

I used a walker/crutches for maybe 2-3 months after frame removal.

[Alittletooshort]

Yeah. I had my surgery on May. Had the frames off on August. I planned like OP did only to get my plans derailed by an infection and slow regeneration. If you have deadlines (school/work) my advice is be prepared to disregard them and whatever you calculate for your needed budget, add more for complications and for when you get bored.

I am at the 7 month mark and able to go out with crutches and basically waddle from one end of my flat to the other without crutches and someone closeby for assistance due to limited balance.

Medium Drink of Water:

After 5 months you had frames off like me. You chose to go home immediately. How long were you in crutches for?

How much did you lengthen?

[tx1111]

6.1 cm