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[Chris]

I've done LL with orthofix monorails too my friend.
I can assure you that after 2-3 cm lengthening they are not weight bearable so be careful with standing, even with a walker.
I started to walk with monorails and a walker only after about 1.5 month I stop lengthening.
Of course you could start walking almost after finishing lengthening because you did LON while I did external only, but for now be very careful.

Also, I see that your fibulas have a huge cut and I am almost sure that there will be a non alignment between their sides. What did your doctor told you about that and why he didn't to a small cut like in tibias and hold tibia and fibula with a screw to let them lengthen the same?
I am very curious about your doctors decision for your fibulas and I would like to know the reason for doing that.

Hmm... Dr. Deepak is convinced that my monorails are fully weight-bearing. They even wrote it in the medical report for my doctors at home.
Maybe Pitkar devices are more weight-bearing than orthofix devices?
Or they took into account that my weight is ~60kg and that the nail prevents misalignment in case of some minor bending. I don't know.
But I appreciate your advise and will make sure to put less weight on my devices from now on. Better safe than sorry.

Regarding the fibulas, Dr. Deepak told me beforehand that he would have to remove some part of the bone since they would heal "much, much faster".
My doctors at home were surprised about the amount taken out too, but they didn't say anything bad about it.
So maybe it was the right thing to do or maybe it was overkill. Again, I don't know.
I have accepted my faith, that I will have to have another surgery for fixing my left leg's angle, so it doesn't matter anymore if I had to have my fibulas corrected as well I guess...

The longer my diary, the more frustrated and insecure I become 

At 14mm you only have approx 30 more days till you reach your goal and the fixator is off  the swelling should go down soon no biggie. I'm concerned about the pain  ur experiencing while standing for a prolonged amount of time because standing is vital for good recovery but ur only doing 4.5cm so you should be fine. Nice warrior scars too.

Yup, without scars, you haven't really lived 
But it will be more than 30 days, because I'm planning to slow down to 3x 0.25 at some point.

[Chris]

February 21st, 2017

Today, I'm exactly three weeks post-surgery

Amount lengthened: 15mm
Rate of lengthening: 2x 0.5mm per day
Pain from lengthening: none
Pain from surgery: 2-3/10 in right leg
Painkillers: 3x Tilidin
Supplements: 2x 600mg calcium per week
Exercises: 2x 15min per day
Standing: 5min every hour
Strength in legs: 7/10
Knee ROM: 0° to >90°
Ballerina: none


Right now, I'm working on a solution to my problem regarding the max. amount I can lengthen.
My goal is 45mm. The "CD Units" on each of my Pitkar monorail devices have 40mm written on it. But my replacement unit could only be turned to precisely 35mm. Seriously, WTF
There are 40mm and 80mm units available from Pitkar. There is no way that I could fit the 80mm unit on my rail because of the way it was assembled.





Now I've found standard 55mm units from Orthofix and I hope that maybe, just maybe they could fit on my Pitkar devices.

Pitkar

Orthofix



The pins of the Pitkar unit are 5mm in diameter, does anyone happen to know the measurements of the Orthofix units? 
I will just contact Orthofix and hope for the best.

[egocentrical]

How's progress been? You had any solutions in regards to your nail?

[Chris]

How's progress been? You had any solutions in regards to your nail?

Not yet, I'm still waiting for a reply from the Orthofix customer service.
In the meantime, I can go to my uncle's workshop this weekend. Then I will use his power tools to turn the compression-distraction unit with high pressure until it breaks.
I want to find out whether it really can only be distracted to 35mm instead of 40mm, plus the pipe is 50mm actually.
I hope that just the replacement unit is broken and that I won't have to by other ones. One CD unit from Pitkar costs ~100 EUR and I'm sure the Orthofix units will be even more expensive.
So it's worth giving it a shot in the workshop first, before I spend money.

Regarding my progress, I've switched from 2x0.5mm per day to 3x 0.25mm per day.
Didn't have a choice, because my right leg still hurts even without lengthening and it's too sensitive.
When I turned for the last time yesterday, I almost screamed and had sudden twitching in my right leg.
I don't want to take even more painkillers per day, so I just slowed down a bit and it has worked wonders so far.
No I can lengthen without making the pain worse.
I wish this would go away soon, but I rather think that I will have to live with the pain until the fixators come off.

39 days left...

[682]

You're on the home stretch now Chris. Each day you are closer to finishing lengthening and then it's on to recovery, consolidation and the rest of your life. Fingers crossed for easy sailing here on out.

[doomsday]

If I was you I would reconsider doing femurs with that hospital.

[TrueSpartan]

Regarding my progress, I've switched from 2x0.5mm per day to 3x 0.25mm per day.
Didn't have a choice, because my right leg still hurts even without lengthening and it's too sensitive.
When I turned for the last time yesterday, I almost screamed and had sudden twitching in my right leg.

39 days left...

Hey Chris,

Maybe you should take a one day break from lengthening and give time for the soft tissues to catch up. I have read many people doing this in many diaries. One day will not make a big difference in your final goal.

[egocentrical]

39 days is not that long and it seems your doing well and occupied in your own environment. once you've finished lengthening, are you flying back to India to get the nail locked and monorail removed?

[IwannaBeTaller]

If I was you I would reconsider doing femurs with that hospital.

Hear hear.

[Chris]

You're on the home stretch now Chris. Each day you are closer to finishing lengthening and then it's on to recovery, consolidation and the rest of your life. Fingers crossed for easy sailing here on out.

Thanks! 

Hey Chris,

Maybe you should take a one day break from lengthening and give time for the soft tissues to catch up. I have read many people doing this in many diaries. One day will not make a big difference in your final goal.

You're right. Not exactly what you meant, but I think I will take a one day break for my right leg tomorrow. I'm gonna lengthen my left leg by 5 more millimeters anyway, so I could give my right leg a break once a week without losing time.

39 days is not that long and it seems your doing well and occupied in your own environment. once you've finished lengthening, are you flying back to India to get the nail locked and monorail removed?

That's the plan...

If I was you I would reconsider doing femurs with that hospital.

Hear hear.

I hear thee.

[egocentrical]

It doesn't sound that bad - maybe reconsider but I mean the complications seem more of a small mistake? The surgery and everything else seemed fine from what I can tell, apart from money transfer ... Then again reading other diaries from different doctors I don't really see any major problem in this one

[Chris]

It doesn't sound that bad - maybe reconsider but I mean the complications seem more of a small mistake? The surgery and everything else seemed fine from what I can tell, apart from money transfer ... Then again reading other diaries from different doctors I don't really see any major problem in this one

Hmm...I'm just not sure about them at the moment.

I like Dr. Deepak and his team. They are friendly and (appear) professional and there is a good chemistry between them. The hospital staff is very kind and helpful. The hospital itself is very clean and the single-bed rooms are good enough for western standards. Their medical equipment is mostly western standard. The food was okay and you can ask for adjustments at any time. The costs are lower, because they don't have different prices for westerners.

The messed up foot angle could have happened with any doctor, I knew the risks and I'm okay with it.

But there is a lot more:
They technically broke my right leg three times. Maybe it was to reduce pressure while putting the nail in. But it's just a guess from my doctors at home.
A lot of bone has been removed from my fibulas. My doctors at home where supersized about the amount taken out, but they didn't say anything bad about it. Was it too much bone? I will finally know on Friday when I'll have new x-rays taken of my legs.
The fibulas have not been fixated with a screw. It doesn't have to be a bad thing, but it can lead to misalignment.
Then they seem the have confused sides. My left leg is shorter, but only the rail on my right leg supports more lengthening. Or not? Because in theory, I could lengthen exactly 5 more millimeters (the missing ones) and go over the edge of the rail without compromising the stability of the fixator. But they never told me to do so.
So they either have tweaked the fixator like pros or they messed up and I'm just lucky to see a solution.
And finally, the CD units. They put 40mm units on my devices. Maybe the screws can unofficially be turned to 45mm, but the replacement unit I got could only be turned to 35mm. Now I'll check whether the replacement unit is broken and whether it could have been distracted to 40 or even 45mm.

So many things look just wrong at the moment, but they could also turn out to be alright.

[egocentrical]

I guess it's hard to say ATM - the surgery itself tho didn't seem shoddy nor the care ... Wonder what the x-ray will look like, if I went there -  I might ask for ideally for the support of the 10cm screw even if that's not what I'm going for so that i don't run into the same complications?

[Chris]

I guess it's hard to say ATM - the surgery itself tho didn't seem shoddy nor the care ... Wonder what the x-ray will look like, if I went there -  I might ask for ideally for the support of the 10cm screw even if that's not what I'm going for so that i don't run into the same complications?

Well, since you're planning to do femurs, there are no feet or fibulas that could get messed up, so I think you should be fine with the ISIC, regardless of what has happened to me.
And again, because this is the way I am I ask you to NOT do more than 6-7cm on femurs, ever!

On Saturday or Sunday, I will take one of my replacement CD units apart, than we will know if we can trust the numbers written on it.
By the way, I think that I have found a simple way to lengthen a bit more without buying longer CD units. Also gonna write about it this weekend.

Edit: Oh, and it would be awesome, if you could also write a diary about femur LON at the ISIC, if you decide to have your surgery with them

[Whereintheworld?]

Chris,

As at least one other has agreed with you, 4 cm is definitely 'worth it'. When two people are of comparable heights, the difference between them is very noticeable from both ends when one takes off their shoes- most shoes are only around 3cm, if even that.

Keep at it man, you'll be done with it before you know it.

[Chris]

Chris,

As at least one other has agreed with you, 4 cm is definitely 'worth it'. When two people are of comparable heights, the difference between them is very noticeable from both ends when one takes off their shoes- most shoes are only around 3cm, if even that.

Keep at it man, you'll be done with it before you know it.

Thanks and I'm staying modest
I'm afraid that correcting my left foot angle and perhaps the fibulas could cost me height due to compression. Then I would gain less than 4cm.
That's why I'm thinking about doing 5mm extra.

[Chris]

February 23rd, 2017


Amount lengthened: 16.5mm
Rate of lengthening: 2x 0.5mm per day 3x 0.25mm per day
Pain from lengthening: since 15mm some pain in right leg
Pain from surgery: 2-3/10 in right leg
Painkillers: 3x Tilidin
Supplements: 2x 600mg calcium per week
Exercises: 2x 15min per day 3x 30min per day
Standing: 5min every hour
Strength in legs: 7/10
Knee ROM: 0° to >90°
Ballerina: none


Nothing to report actually. Will have my next x-rays taken tomorrow.

In the meantime:


My Life Hacks for Lengthening at Home
Part 1: Raising the Bed Frame

I'm a lover of futon beds (very low ones), but they are definitely not designed for LLers.
Too bad that I had completely forgotten about it until I had returned home with broken legs
I had to ask my beloved family to raise the bed frame for me.

So, as a reminder to everyone who wants to lengthen at home, make sure that your bed frame is high enough and that you can easily sit down and get up again with just using your hands.
41-43cm is a typical height for chairs, at least where I live. Take also into account that you will grow in your legs

[0184946]

3/10 pain? thats great your bed frame looks like a nightmare for a LLer lol. Like if you accidentally banged your leg against it you'd die.

[egocentrical]

Did you get your x-rays and stuff?

[egocentrical]

cant edit previous post - sorry.

Did you need a medical visa still and if so, how did you get one?

[Chris]

Did anyone of you LLers have early consolidation?

Was it a "real" surgery or was it just an ambulant and rather quick treatment?

Could it be re-cut easily, because it was still "soft" callus?

How painful was it compared to the first surgery?

Where you able to leave the hospital the same or the next day (and go home)?

If you did it in India, Russia, Poland or Czech Republic, how much did you have to pay approx. for re-cutting?

Do you know a good (and affordable) hospital in Russia, Poland or Czech Republic where I could have my callus re-cut? (I'm trying to avoid India)


Sorry for all the questions, but I'm somewhat panicking right now.
Thanks in advance!

PS: if you didn't have early/per-consolidation, but still have VERY good knowledge about it, please feel free share your information too.




X-ray from yesterday.
I started distracting 10 days after surgery @ 1mm per day.
But the osteotomy in my left leg was done poorly, leading to early consolidation no matter how fast I lengthened.
I was doomed from day one without knowing.
I turned to 1,7cm, but I'm still at 7mm, the rest became pin bending.

[TIBIKE200]

Poor osteotomy... Rotated tibia... These docs sure don't seem to know what they are doing...

 Sorry to hear about your difficulties Chris

[6FeetSoon]

Poor osteotomy... Rotated tibia... These docs sure don't seem to know what they are doing...

 Sorry to hear about your difficulties Chris

Ugh.. this is heartbreaking. A lot of these "doctors" see a desperate client base and an opportunity for easy money... makes you wonder if there shouldn't be some sort of universal accreditation process to be allowed to perform this sort of surgery.

[TIBIKE200]

Ugh.. this is heartbreaking. A lot of these "doctors" see a desperate client base and an opportunity for easy money... makes you wonder if there shouldn't be some sort of universal accreditation process to be allowed to perform this sort of surgery.

Actually there is.. It's called ASAMI. I bet the docs in that hospital are not members of this association. I believe Rozbruch is as the rest of the top tiers ones (for those who use or used ilizarov)

[6FeetSoon]

Actually there is.. It's called ASAMI. I bet the docs in that hospital are not members of this association. I believe Rozbruch is as the rest of the top tiers ones (for those who use or used ilizarov)

But thats what i mean... its a paper tiger registration if you don't have to be a member and can still perform it.

[TIBIKE200]

But thats what i mean... its a paper tiger registration if you don't have to be a member and can still perform it.

That's the problem with third world countries and some western ones as well. Even in the USA there are certain "wacky docs".

[fujitora]

Did anyone of you LLers have early consolidation?
Yes. I had an early consolidation in my right leg, both Tibia and fibula. This happened at around 3 cm, when my doctor spent weeks trying to correct bow legs with improperly placed TSF frames. So I had to undergo another surgery to re-break my tibia and fibula, re-position a rod and wires that hold the lower TSF ring onto the bone.

Was it a "real" surgery or was it just an ambulant and rather quick treatment?
It was a real surgery. The duration of the surgery was about 2 hours and I was under general anesthesia. However, unlike my first surgery, I didn't have to get admitted for 5 days. It was an outpatient surgery, so got admitted at 8:00 am in the morning and left the hospital at 10 pm in the night.

Could it be re-cut easily, because it was still "soft" callus?
Yes. It wont be solidified so the process is less easy and not noisy. The scars however remain the same size, in fact are more pronounced because the cut is made in the same area.

How painful was it compared to the first surgery?
It was not as painful as the first surgery. I was on painkillers for only couple of days. I had this surgery 3-4 months post my first surgery, so I guess my body is used to dealing with this pain.

Where you able to leave the hospital the same or the next day (and go home)?
Same day

If you did it in India, Russia, Poland or Czech Republic, how much did you have to pay approx. for re-cutting?
I paid 33k INR , which is 500 USD.

[Chris]

Thanks for your info, fujitora.

My German doctor said they have a special tool for cutting callus and it should be just a small outpatient surgery.
I'm still waiting for the estimate and hope it won't cost me a fortune.
I don't want to fly back to India.

@egocentrical
Stay away from the ISIC !
I can't prove it, but I just know that each of my legs where done by different people.
I think that Dr. Deepak did my good leg and someone else of his team did the messed-up one.
This will be a gamble if you go there and you won't know who will operate on you.
And they can very well mess up your femurs. They could make a poor osteotomy which will result in early consolidation (like it happened to me).
They could twist one of your femurs which would rotate your entire leg in- or outwards, not just the foot (similar to what happened to me). And the monorail on one of your femurs could later turn out to be too short, as it also happened to me.

[egocentrical]

did you have only early consolidation on one leg then?

[Penguinn]

Man, this is terrible. What did Dr. Deepak have to say about this?


Good luck and stay strong. It will be worth it in the end.

[Chris]

did you have only early consolidation on one leg then?

Yes, only in my left leg.
My right leg is totally fine (apart from the mysterious cracks and pain) and my left leg is f*cked up and has probably every complication known to mankind.

Man, this is terrible. What did Dr. Deepak have to say about this?

Good luck and stay strong. It will be worth it in the end.

Thanks, and I haven't contacted him yet. I wanted to but there was a lot to work out first.
But I think now I have a list: 

• twisted tibia leading to foot pointing inwards
• 3cm of fibula cut out; still no callus as of now
• fibula in left leg has misalignment (in both legs no screws used)
• poor osteotomy in left leg
• very early and inevitable consolidation because of the poor osteotomy
• bending in the monorail, because of unknowingly lengthening to 1,7cm while having consolidation at just 7mm
• 1.5cm discrepancy in leg length (and slowly getting more)
• because of the pin bending the angle of the monorail has changed and now I will have to turn more mm for less mm of lengthening
• too short monorail, only allows lengthening to 4cm instead of 4,5cm; maybe confused left and right leg
• the compression-distraction units from Pitkar have 40mm written on it but can only be distracted to max 35mm
• 10mm of the rail wasted because of the consolidation and bending
• max. 25mm possible now (only left leg)
• Pitkar can't be bought where I live