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[KiloKAHN]

Monorails aren't done by Dr Parihar for CLL because unlike with standard frames you have nothing to hold the foot in a neutral position while resting and that makes it easier to develop equinus contracture. There's apparently other complications such as x-legs that can be caused by them if the doctor doesn't install them perfectly.

[fivetenneeded2016]

Parihar told that nobody of his patients has experimented that knee pain. Being a professional like him, he will tell you the advantages and disadvantages of each method, If I were you I would go for LON, even Kilo wrote in his diary that if he could come back in time he would go for LON, being in frames for over a year is HELL!!!
When you go for your consultation with Dr. Parihar, can you ask him one thing for your friend, onemorefoot

If severe equinus happens, can we consider the option of percutaneous techniques? Does it leave the Achilles tendon weak?

had a meeting with parihar, it was a 3 step meeting, first was with someone else who jotted down my story, why i want LL, my stats etc. next was dr ahuja, who cleared my questions...yet to have my meeting with dr. Parihar.
So I did ask your question. The answer was yes, it could be done safely(without weakening) if done carefully.

Yet to meet Parihar.
 Dr. Ahuja also said that the 5-6cm max is based on an observation and they say it so that the patient is happy to accept that as a worst case. So anything over that would be a bonus. He said a lot depends on your muscles.

[fivetenneeded2016]

Had a meeting with Dr. Parihar, but unlike expected (which i thought would be more LL related), he asked me to consult a psychiatrist first as well, so he could be sure that my situation is nothing other than height dysphoria.

However i did manage to get my doubts clear from Dr. Ahuja. And also i told him(Ahuja) the Docs i have shortlisted and also asked his opinion on Russian Docs, he took Dr. Solomin's name without thinking twice, although he expressed his doubts if Solomin does CLL.

[Body Builder]

had a meeting with parihar, it was a 3 step meeting, first was with someone else who jotted down my story, why i want LL, my stats etc. next was dr ahuja, who cleared my questions...yet to have my meeting with dr. Parihar.
So I did ask your question. The answer was yes, it could be done safely(without weakening) if done carefully.

Yet to meet Parihar.
 Dr. Ahuja also said that the 5-6cm max is based on an observation and they say it so that the patient is happy to accept that as a worst case. So anything over that would be a bonus. He said a lot depends on your muscles.

If atl is done carefully, then the weakening will be less than tendon overlengthening.
But atl without tendon weakening is completely impossible.

Every doctor who said otherwise should not be trusted.
If you don't believe me (that I had atl) then try on your own this surgery and then you'll regret it for all your life or you'll try to fix it with at shortening surgery.

[onemorefoot]

I dont remember if Parihar asked to consult wuth psychiatrist first to the other patients, that is weird.

[Bander72]

Yeah I remember  reading that parihar would only do it unless absoultely necessary. Usually  he would recomend not to do the atl.

[KiloKAHN]

Dr Parihar and Dr Ahuja sometimes respond with slightly different answers from each other to the same question. Dr Parihar told me that with the data available on ATL side-effects there is a certain amount of weakness that happens afterward, but you should be able to get back to recreational sports. I think he'd rather not do ATL if possible but for severe cases of ballerina will do it if the person is going through months of pain and unable to walk as a result of excessive over-lengthening. 

Was his suggestion to see a psyciatrist something he said at the end of the consultation or did he get to that point right away? What kind of things did he ask you?

I dont remember if Parihar asked to consult wuth psychiatrist first to the other patients, that is weird.

He told me that he has become more strict with who he accepts as a patient for CLL. It's possible he'd say the same to me if I consulted with him these days.

[onemorefoot]

Is good that Parihar recommends Solomin. Do you know why he became more strict with CLL patients?

[KiloKAHN]

Do you know why he became more strict with CLL patients?

He didn't pinpoint one specific reason, but he said that not operating on a patient that he is not convinced will benefit from surgery is as much a part of his duty as a surgeon as operating on someone who he thinks will benefit. He also said that part of the skill of being a surgeon is knowing when not to do surgery on somebody. He wants to be sure a prospective CLL patient has the right motivation and willpower to get leg lengthening, so I wouldn't be surprised if recommending prospective patients talk to a professional first becomes or has already become routine for him.

[0184946]

Maybe its just me but Solomin strikes me the wrong way. It seems to me like he couldn't care less about the patient's accommodation planning and is non chalant about making sure they are in a healthy state of mind while in a foreign country. His just like "ok, i'll break your legs and then you'll have to find whatever hotel room you are gonna be in and translate russian to english somehow."

[onemorefoot]

That was before, now Pavel Kulesh takes care of you, MEDEM clinic offers translation services.

[fivetenneeded2016]

Is good that Parihar recommends Solomin. Do you know why he became more strict with CLL patients?

I couldnt ask much regarding LL with parihar at all. It was like a 3 round meeting..one with a young guy who was an assistant...he checked my stats wrote down my needs.
second with dr ahuja whom i asked stuff about LL, their cases, their techniques and a few other questions..He suggested Dr. Solomin.
With parihar i dint get much to discuss regarding LL.

[fivetenneeded2016]

He didn't pinpoint one specific reason, but he said that not operating on a patient that he is not convinced will benefit from surgery is as much a part of his duty as a surgeon as operating on someone who he thinks will benefit. He also said that part of the skill of being a surgeon is knowing when not to do surgery on somebody. He wants to be sure a prospective CLL patient has the right motivation and willpower to get leg lengthening, so I wouldn't be surprised if recommending prospective patients talk to a professional first becomes or has already become routine for him.

No, I doubt if Dr. Parihar would send everyone for a prior councelling with a psychatrist. He said he normally doesnt do it.
 Its just that he felt I could be having a psychological issue as well. He also said that its not that he is refusing to operate on me , but he wants to wants to be first sure that i am suffering from height dysphoria and anything pyschological should be corrected first and then would he decide if i should be operated upon.
He caught me at why i wanted this surgery, which i feel is a normal question for any surgeon doing a cosmetic procedure. Since i dint plan for this question, i probably ended up giving a bad reason. I said i feel low because of my height, get emotional at times as well. From then on he changed his tone i guess

[fivetenneeded2016]

Dr Parihar and Dr Ahuja sometimes respond with slightly different answers from each other to the same question. Dr Parihar told me that with the data available on ATL side-effects there is a certain amount of weakness that happens afterward, but you should be able to get back to recreational sports. I think he'd rather not do ATL if possible but for severe cases of ballerina will do it if the person is going through months of pain and unable to walk as a result of excessive over-lengthening. 

Was his suggestion to see a psyciatrist something he said at the end of the consultation or did he get to that point right away? What kind of things did he ask you?

He told me that he has become more strict with who he accepts as a patient for CLL. It's possible he'd say the same to me if I consulted with him these days.

I got stuck with his first question, which was why i wanted the surgery. He said he belives in a "unsaid mutual bond between a doc and patient" prior to a surgery and he feels that would come from his side once i had the recommendation by a psychatrist.

[onemorefoot]

I would recommend you to follow his instructuons, if you start a diary here will be great.

[fivetenneeded2016]

I would recommend you to follow his instructuons, if you start a diary here will be great.

I plan to get my LL done this year end/early next year. Currently i am just exploring my options given my budget to fix my doc.
I am kind of particular about the gain, specially after seeing my evening height after yesterdays measure. I was shorter than I thought I measured :/ .
So I am still wondering if Parihar would be the best option for me or if i should save up more and try catagni/aimen peng.
Not that Dr. Ahuja said 6cm is the max limit, he said as long as they feel you are doing fine(which is most cases is till 5cm).
Among the factors that determine the length that could be lengthened apart from tendons/muscles, Dr Ahuja also said the surgical techniques used like oesteotomy and other techniques , could also play a key role.
So i guess technique wise Dr peng/catagni could help me with that extra push, not that i say parihars technique is not good.

[fivetenneeded2016]

I would recommend you to follow his instructuons, if you start a diary here will be great.

Plus i definetly would see a psychiatrist that he would recommend and find out reasons to convience him as well :p . Just that after my travel to mumbai my brain was too tired to think of good reasons.
That way I if I could convience him, I would have a recommendation letter from the psychiatrist regarding dysphoria, which could come handy should any other doc require it.

[crimsontide]

Cross off Parihar. He is lying or simply ignorant  regarding ATL.

It is physically impossible to have ATL and not be weaker. Impossible.   Shah said the same exact thing to me before my surgery.   Afterward he told me the surgery would make my tendon  1 grade weaker.

When you do ATL, you are doing 2 things.

1-Lengthening the tendon,  therefore losing tension

2- you are making the tendon thinner, and possibly permanently reducing tendon mass.  If they  use the "slider" technique, they simply slide a piece of the tendon down. If they use the   Z plasty technique, they  cut out small pieces of the tendon in a zigzag shape.. Z plasty  reduces overall   tendon mass

Think of a lever, or a rubber band. There is no way that ATL will not decrease plantar  torque.

Had a meeting with Dr. Parihar, but unlike expected (which i thought would be more LL related), he asked me to consult a psychiatrist first as well, so he could be sure that my situation is nothing other than height dysphoria.

However i did manage to get my doubts clear from Dr. Ahuja. And also i told him(Ahuja) the Docs i have shortlisted and also asked his opinion on Russian Docs, he took Dr. Solomin's name without thinking twice, although he expressed his doubts if Solomin does CLL.

[fivetenneeded2016]

Cross off Parihar. He is lying or simply ignorant  regarding ATL.

It is physically impossible to have ATL and not be weaker. Impossible.   Shah said the same exact thing to me before my surgery.   Afterward he told me the surgery would make my tendon  1 grade weaker.

When you do ATL, you are doing 2 things.

1-Lengthening the tendon,  therefore losing tension

2- you are making the tendon thinner, and possibly permanently reducing tendon mass.  If they  use the "slider" technique, they simply slide a piece of the tendon down. If they use the   Z plasty technique, they  cut out small pieces of the tendon in a zigzag shape.. Z plasty  reduces overall   tendon mass

Think of a lever, or a rubber band. There is no way that ATL will not decrease plantar  torque.

It was told by ahuja..that too it would be performed under sever ballerina although he would have stopped u fr lengthening before the situation arises.
Safety wise i dont doubt parihar or ahuja. They dont sugar coat things.

[crimsontide]

Then forget Ahuja

ATL will   severely weaken you. That is a fact.  I'd stay away from any Dr that minimizes it. Ask Paley or Rozbruch

[Body Builder]

Cross off Parihar. He is lying or simply ignorant  regarding ATL.

It is physically impossible to have ATL and not be weaker. Impossible.   Shah said the same exact thing to me before my surgery.   Afterward he told me the surgery would make my tendon  1 grade weaker.

When you do ATL, you are doing 2 things.

1-Lengthening the tendon,  therefore losing tension

2- you are making the tendon thinner, and possibly permanently reducing tendon mass.  If they  use the "slider" technique, they simply slide a piece of the tendon down. If they use the   Z plasty technique, they  cut out small pieces of the tendon in a zigzag shape.. Z plasty  reduces overall   tendon mass

Think of a lever, or a rubber band. There is no way that ATL will not decrease plantar  torque.

I agree with everything except that z plasty reduces tendon mass.
Maybe only if you do a huge cut and then connect both of the tendons ends in a straight line.
But if you cut the tendon and then stick bith ends side by side, then tis gap unites with scar tissue and then the overall mass is like before more or less.
Of course, scar tissue isn't as strong and especially as flexible as real tendon but it is still reasonably strong.
But the overall tendon mass remains about the same.
So I think that what you call as slider technique is in the reality the Z plasty technique.
The zigk zagk technique you mentioned is not Z plasty but three cuts doctor's do in the tendon (pecurtaneously, not with open technique like Z plasty) where they indeed stretch the tendon. It is like some partial tendon tearings.
Anyway, I had Z plasty lengthening and it is exactly like what you called slider technique where they cut the tendon in a Z shape and they slide one piece of the tendon down and connects both pieces in the middle. This technique doesn't reduce tendon mass (due to scar tissue been formed between) but that doesn't mean that the tendon doesn't become weaker due to loss of tension.

And thats the biggest by far problem with atl, the loss of tension which is the most important because it has to do with the power that the tendon can exert from gastrocnemius muscle.
Thats why the biggest the tendon lengthening, the worse the tension is and the less the push off power because the more you increase the distamce between tendons and muscles, the less power the tendon can exert.

So, because I don't want to be offtopic, atl should not be used for equinus deformity for LL patients. It is much better to turn back the fixators and correct equinus by loosing 1cm of lengthened height (when you haven't consolidated of course) or if there isn't any other solution (PT etc) to do gastrocnemius recession which is by far easier and with better outcomes than atl.
Don't trust any doctor who tells you that atl won't cause any problem because he is either lying or doesn't know what he is doing.

[Stripes]

Crimson is right, I would absolutely try to avoid ATL as much as possible. It should be an absolute last resort.. say goodbye to any remaining "spring in your step."