Topic: Precice 2: Bilateral Femur With Dr Mangal Parihar (Read 4749 times)

fitness2022 · « **on:** May 07, 2022, 05:44:23 PM »

Hello Guys!

I got precice 2 devices implanted on 19th April at Mangal Anand Hospital, Mumbai, India.

Just like most of you, I have been researching for the last 10 years and have been in contact with most surgeons across the globe. I was supposed to get the surgery done in 2019 but it couldn't happen. I happened to read patients' diaries here on the forum and each diary does give you a lot of information on LL surgery aspects. I must thank all of you for providing significant information. I was thinking to write about my experience but I had to decide on the surgery date first. Here I go... I hope my journey with the team at Mangal Anand Hospital will be smooth.

I assume only 1-2 Dr Mangal Parihar's patient diaries are on the forum. The reason for writing about my journey is to help future LLR patients. Again, am not brave enough to write the diary the way razaldazal & heightjourney2021 did with daily videos and images. I'll prob keep it brief & precise.

Basic info:

I am a non-smoker male in my 30s from the UK
Starting Height : 164cm
Weight: 61kg (134 lb)
Medical History: None

Why India and not the UK

Stryde issue was found in the UK and MHRA UK will be the last one to re-issue the licence/allow the use of Stryde. Precice device family is still not allowed in the UK for both NHS and private Hospitals. Precice got available in India and more importantly Dr Mangal Parihar and Dr Divya Ahuja agreed to operate on me.

fitness2022 · « **Reply #1 on:** May 07, 2022, 07:20:12 PM »

Day 0

A day before surgery, I got admitted to the hospital. I was already asked to get blood reports and chest x-ray done beforehand. Consultants (Three Ortho surgeons doing their fellowship under Dr Parihar & Dr Ahuja) came to see me. They briefed me about the surgery and how the post-surgery journey will be for the first 7 days.

In the evening, the Anesthesiologist came to see me and I asked him wot sort of anaesthesia he will be using on me. He said epidural pump as it will be easy to control the pain even after the surgery. He assured me that pain will be minimum. Then Dr Ahuja spent 20 mins answering all my questions. Lastly, Dr Parihar called me and asked if I hv any questions. I was like I don't have any as most questions were already answered by Dr Divya Ahuja. Dr Parihar asked me where will I be staying during the lengthening and I replied that I'll be staying in Gujurat. He asked if I can stay in Mumbai for a week after discharge from the hospital. Dr Ahuja wished me a good sleep and to see me in the morning around 11.

Day 1 Surgery Day

wow, It is happening. Woke up around 7.00, took shower and got ready. I think I was a little nervous when the nurse came in with an IV and also took blood samples.

Entered the operation theatre/surgery room at 11.30 am. I remembered Dr (Anasthesiologst) greeting me and asking if I am feeling ok. He then said he will give me a pain injection first and then insert a catheter. I was half awake and half sleepy. I remember some music (soothing or healing music) playing. Not 100% sure wot kind of music tho. Next moment, I was in ICU. For the first night, I was constantly on IV fluid as my BP was very low. Again, Anaesthesiologist came to see me and asked me about my pain level. I was like I can't feel anything. This was due to anaesthetic effect. Dr Rajul, Dr Mehul and Dr Anurag came to see me and asked me to move my feet. I couldn't. One of the Dr tried touching my feet but no sensation. They then decided to reduce the epidural dose. Supposed to move from ICU to normal hospital room but they kept me in ICU. Felt sorry for the nurse who was keeping an eye through the night. Taking Oxygen, BP level aswell as keeping IV fluid. Nuvasive/Cure surgical rep came to see me but I didn't speak much coz of drowsiness.

Day 2

Nurse woke me up, and gave sponge bath and medicines. I was completely taken off from Epidural dose but the catheter still remained intact. I had breakfast in bed and my BP was getting back to normal which was quite hearty. Thank god. I was moved to my room at 10ish. Physio came in and showed some stretching exercises wasn't able to do much of them as I was still recovering.
I should mention my pain level for day 1 & 2. First day it was zero pain due to anaesthetic effect, 2nd day was not that bad. Evening Physio came at 5ish. I was like wow two physio sessions in a day. Was able to do some exercise but again it was all done in the bed.

Day 3 - 7

Same routine and pain level (controlled) as I was taking Nimesulide twice a day and patches. Two physio sessions every day. Started ordering food from outside. According to Physio my leg movement was very little. I guess I need to focus more on physical therapy as advised. Let me just brief you about the medicines and supplements I was prescribed.

For Pain: Nimesulide 100mg BD (Cox-I Inhibitor), Ketoprofen patches
For stomach: Pantoprazole
Supplements: Vitamin D, Calcium & Methyl cobalamine.

I was also carrying paracetamol, co-codamol and Adcal D3 from the UK.

On day 3, Dr Ahuja visited and examined both my legs. He was like I should try and wake up Qudracep group muscles and start stretching/lifting legs up slowly. I told him about no bowel movement since surgery. He asked me to drink plenty of water and eat food with more fibre. I was also given lactulose. Still no bowel movement on day 3 but luckily it happened on day 4 which was quite a relief. Dr Parihar came to check on me. He said we will start distraction on Wednesday (27th).

I had regular physio sessions in beds and was given more exercises to do on my own. On days 5 & 6, I really felt that my right leg is going dead as I was having difficulty stretching. I asked my physio and she said she can muscle spasm there. She asked me to use an Ice pack and also showed me how to break the muscle tightness. I tried cold pack but didn't improve much. I was having a headache. It was more like tension headache with neck pain. I took painkillers and called the nurse for help. All three doctors used to visit me for a regular check-up. One of them advised me not to be stationary and spend some time sitting up.

I realised one needs upper limb strength to move around. Having strong arm and wrist muscles helps a lot. I spent the whole week in bed 24/7. This first week post-surgery was challenging in terms of mental capacity as you can't operate on your own and needed help for everything. Nurses and Mousi (support staff in Marathi) were available 24/7 to assist me.

Day 8: Nurse came in at 7:30 am, checked my blood pressure and reminded me to take medicines. On day 8 I had fewer headaches but muscle spasms on my right thigh wasn't improving. Had a good Physio session in the morning but it wasn't the case with evening physio. Evening physio was like I got to really work on stretching as my distraction starts I need to work more on flexibility.

I forgot to mention about DVT pump which was taken off on day 6 or 7, don't exactly remember. Started on Aspirin 75mg EC daily.

will update on Day 9 (first distraction) - Day 18 (Distraction week) very soon.

mumbai · « **Reply #2 on:** May 08, 2022, 06:32:27 AM »

Great to read this fitness2022. I had heard of another patient getting this done with Dr. Parihar.

Are you going to be on Aspirin to prevent DVT throughout the lengthening period or will it be Xarelto?

informationispower · « **Reply #3 on:** May 08, 2022, 09:09:24 AM »

Aspirin alone is not sufficient to prevent DVT according to current guidlines... It is either paired with LMWH or not taken at all.

fitness2022 · « **Reply #4 on:** May 08, 2022, 02:39:04 PM »

Yes, there was one more patient who got it done just a week before me. I asked one of the Dr if he is doing well and he said he is doing well. Also, if your recovery is slow then Dr Ahuja prefers you to stay longer than usual just to make sure you're comfortable (with no complication), then only they will discharge you.

Yes, I'll be on Aspirin from now onwards. I am not taking any NOACs.

fitness2022 · « **Reply #5 on:** May 08, 2022, 02:52:06 PM »

I was a bit concerned about it. I was thinking to carry either Apixaban or Rivaroxaban with me for a month. I did ask Dr Ajuja and he said he will use DVT Pumps and then Aspirin. He also mentioned not being stationary all the time. Again, the risk of DVT is highest for first 7-10 days (I was on DVT Pump) and then straight to Aspirin EC. I'll speak to Dr again about going for NOACs. I try not to be stationary for longer and do some movement. Finger crossed.

NICE Guidelines say to use NOACS for 4 weeks. I think UK surgeons prescribe you NOACs only for 4 weeks.

KiloKAHN · « **Reply #6 on:** May 08, 2022, 08:05:07 PM »

You're in really good hands. Good to know Mousi is still there, too. Congrats on taking the next step toward getting taller.

tallmen · « **Reply #7 on:** May 10, 2022, 10:35:12 AM »

I got my surgery 1 week before you. How's the pain situation for you?

tallmen · « **Reply #8 on:** May 10, 2022, 10:35:56 AM »

Quote from: KiloKAHN on May 08, 2022, 08:05:07 PM

You're in really good hands. Good to know Mousi is still there, too. Congrats on taking the next step toward getting taller.

Mousi is not a name it's a designation. It's like saying good to know the nurse is still there.

fitness2022 · « **Reply #9 on:** May 10, 2022, 12:56:31 PM »

Quote from: KiloKAHN on May 08, 2022, 08:05:07 PM

You're in really good hands. Good to know Mousi is still there, too. Congrats on taking the next step toward getting taller.

Thanks you KiloKAHN. You're so rite. I am definitely in good hands. Oh yes, Mousi is still there.

fitness2022 · « **Reply #10 on:** May 10, 2022, 01:01:01 PM »

Quote from: overandover on May 10, 2022, 10:35:12 AM

I got my surgery 1 week before you. How's the pain situation for you?

Hey Overandover! Pain is not that bad. I think it's just soreness and tightness due to the surgery. So far it's good and manageable.

How are things with you? Were you there last Friday for your appointment?

fitness2022 · « **Reply #11 on:** May 10, 2022, 01:02:52 PM »

Day 9: First distraction. Usual routine and still on the hospital bed. Doctors team Dr Rejul, Dr Mehul and Dr Anurag arrived with a technician from cure surgical (the Indian counterpart of Nuvasive). Dr Rejul asked the technician to double-check the previously set programme on ERC. So I was prescribed to lengthen 0.3mm three times daily, making it 0.9mm per segment. I asked Dr Rejul if I can have 1mm daily making it easy for the daily count. The answer was Dr Mangal Parihar prefers 0.9mm (0.3mm TDS).

I already had a 1mm distraction done during the surgery. This means a total of 1.9 mm on each leg today. Excellent start to the new journey. I was having some pain in the legs and neck but it wasn't that bad. I think it was more like soreness in the legs than actual pain from broken legs as it would be intense.

Dr Parihar and Dr Ahuja came to see me in the evening. He asked me to carry on exercising and follow the same method of distraction (0.3mm tds) & visit the hospital in a week time for the x-ray and follow up.

Day 10: The nurse came in to change the bedsheet. I said I am being discharged today. I started thanking the nurses and Mousis for their incredible support. I did my first distraction at 9.00 am. Dr Rejul popped in to say he will prepare a discharge summary and then I can go home. I was like if I'm allowed to go back to London.

I missed the physio session as I left the hospital early. I wanted to thank the physio team as well. Maybe next time when I visit the clinic.

Day 11: Trying to settle down here at the family house. Also, we collected a wheelchair (self-propelled), Walker with wheels, and an adjustable commode chair for home use.

I only did two distractions on day 11 coz of a long journey. I had a weird kind of pain at the night making it hard for me to sleep. I took paracetamol to help me sleep. Again I took Nimesulide as the pain was still there.

KiloKAHN · « **Reply #12 on:** May 10, 2022, 01:03:04 PM »

Quote from: overandover on May 10, 2022, 10:35:56 AM

Mousi is not a name it's a designation. It's like saying good to know the nurse is still there.

Learn something new every day. Hah, well I had a particular nurse in mind 😅

fitness2022 · « **Reply #13 on:** May 10, 2022, 01:04:56 PM »

Day 12 - Day 17

On day 12, I woke up around 8:30 am and had my morning distraction done at 9:00. Did my first set of stretching exercises and then had my breakfast.

Diet: I was trying to sort out my diet plan for the next few weeks as I was not planning to have any protein supplements for the next few weeks. Obviously, I'll surely have protein-rich food. For this week, I was having a light breakfast including fruits, slices of bread (fibre) & cup of coffee with full milk (Calcium), lunch was a bit heavy mostly Indian, with things like varieties of vegetables, beans yoghurts, lentils, paneer & rice. Dinner: Mostly salads. I follow a vegetarian diet so I had to balance out what I eat. This is to make sure I get enough vitamins, minerals and protein. I was having mixed nuts and seeds (roasted) in between as well as a glass of milk at night.

Excercise: following the same exercise as I was doing at the hospital, Quadriceps strengthening, Knee ROM (0-90) exercises, Hip abduction & extension, stretching of hip flexors, ankle & toe ROM exercises, active SLR, prone lying and upper limb strengthening exercises. I aimed to do four sets of all these exercises on daily basis. I think doing 6-8 sets a day will give you muscle soreness and doing just one set won't help you in the recovery. I did already ask my physio and she said to try doing 3-4 sets a day at regular intervals.

ERC & Distraction: Same rate as advised except missed once (less 0.3mm). Using ERC is easy but I can not locate the actual mark to place this ERC on my own. It's ERC 2 and not the latest ERC. It has a big middle bit that won't allow you to bend and look for the marking, Anyways, this does the job. Should provide ERC 3 tho.

Work: I work for the health sector, working from home doesn't apply to me. 'so yeah It's more like a vacation. I still try to go online and catch up with my colleagues and do backend work.

Pain: I would say the pain level is not as expected. I was actually expecting moderate pain as seen and read. Some of the diaries here did mention the level of pain and sleepless nights. I do get pain here and there, mostly muscle pain and headaches but it is manageable. I only take pain medicines as required, including paracetamol and Nimesulide. Also, Aspirin if you can consider Asprin as a pain killer.

I did/do not take any opioids (no oxy, no tramadol) except pain injections containing opioids while I was at the hospital.

I had my first follow up appointment with Dr Parihar on Friday 6th May.

fitness2022 · « **Reply #14 on:** May 10, 2022, 01:06:59 PM »

Quote from: KiloKAHN on May 10, 2022, 01:03:04 PM

Learn something new every day. Hah, well I had a particular nurse in mind 😅

Both Nurse and Mousi are there. You probably meant sister Mouli? Mousis are there to support you as a carer/helper.

fitness2022 · « **Reply #15 on:** May 10, 2022, 01:09:19 PM »

Day 18: I had my first follow up appointment. I was supposed to have an appointment on Wednesday but I requested to be on Friday. Dr Rejul met me at the reception and he took me straight to the X-ray room. Took AP & lateral X- rays. I asked Dr if he can notice the distraction and he zoomed it just to show me. I was like yay ERC is working. I did morning distraction before this X-ray and the total distraction was 9.1 mm per segment. Just about 1cm.

After that, they checked surgical sutures. Dr said they are healing well and I can start taking a full shower. Then, Dr Anurag asked me to see him in his office, and he asked me about pain and recovery. He then made notes on his computer. He said the same thing as Dr Rejul. One more win. Straight away in my mind, slowly slowly winning the race. He asked me to wait to see Dr Parihar. I then went to see nurses and physio to greet them.

Dr Parihar called me in and said things look good. Dr Divya Ahuja was there too and asked me to raise my legs one by one. He also checked knee ROM. Advised me to carry on doing regular exercise and to contact them If I see any problems. Dr Ahuja said I still need to work on my right leg which I thought was doing pretty good. Dr Parihar said to look after my diet and exercise.

Well, all went well except for the Mumbai traffic. Not to mention, Indian summer and Mumbai traffic can go as bad as you can imagine.

I was told that I can take a regular x-ray every 2 weeks and send it to Dr Parihar. They will review it and give me feedback. I don't need to visit them unless there's a need for it like any complication. But yer I'll have to visit them once before I fly back to the UK.

I'll attach X-ray images. It is very early to say but do let me know if the X-ray looks good.

KiloKAHN · « **Reply #16 on:** May 10, 2022, 01:11:45 PM »

Quote from: fitness2022 on May 10, 2022, 01:06:59 PM

Both Nurse and Mousi are there. You probably meant sister Mouli? Mousis are there to support you as a carer/helper.

Oh yeah, Sister Molly was it (I had to go back and read my patient experience to double check). Can't believe its been 8 years already.

mumbai · « **Reply #17 on:** May 10, 2022, 01:20:11 PM »

Great diary man! I would love to see some pics of the facility, etc if you managed to get any.

Is it really possible to fly to the UK soon? Do you have someone to go with you? I have no idea how you can manage the 12 hour journey without any weight bearing. If you are really going, please check with the doctors if you should take stronger blood thinners for the journey.

fitness2022 · « **Reply #18 on:** May 10, 2022, 01:32:22 PM »

Quote from: KiloKAHN on May 10, 2022, 01:11:45 PM

Oh yeah, Sister Molly was it (I had to go back and read my patient experience to double check). Can't believe it's been 8 years already.

Wow, 8 years very long time. You're still helping everyone here. Amazing but true. I'll defi say Hi to Sister Molly from your end when I go there next. Once again, thank you for all you do for this forum.

fitness2022 · « **Reply #19 on:** May 10, 2022, 01:49:04 PM »

Quote from: mumbai on May 10, 2022, 01:20:11 PM

Great diary man! I would love to see some pics of the facility, etc if you managed to get any.

Is it really possible to fly to the UK soon? Do you have someone to go with you? I have no idea how you can manage the 12-hour journey without any weight bearing. If you are really going, please check with the doctors if you should take stronger blood thinners for the journey.

Hi Mumbai! I didn't click any pics. I can say the facilities are good. I wouldn't say it's a world-class or modern hospital but they do deliver the best possible care.

No, I won't risk myself going back to the UK now. I'll fly back once I finish the lengthening phase. I then need to be seen by Dr Parihar before I return back.

mumbai · « **Reply #20 on:** May 10, 2022, 02:14:08 PM »

Quote from: fitness2022 on May 10, 2022, 01:49:04 PM

Hi Mumbai! I didn't click any pics. I can say the facilities are good. I wouldn't say it's a world-class or modern hospital but they do deliver the best possible care.

No, I won't risk myself going back to the UK now. I'll fly back once I finish the lengthening phase. I then need to be seen by Dr Parihar before I return back.

Thanks for the response! Can I private message you?

fitness2022 · « **Reply #21 on:** May 10, 2022, 02:16:18 PM »

Quote from: mumbai on May 10, 2022, 02:14:08 PM

Thanks for the response! Can I private message you?

Sure

tallmen · « **Reply #22 on:** May 10, 2022, 02:20:07 PM »

Quote from: fitness2022 on May 10, 2022, 01:01:01 PM

Hey Overandover! Pain is not that bad. I think it's just soreness and tightness due to the surgery. So far it's good and manageable.

How are things with you? Were you there last Friday for your appointment?

It's been hell for me since the last week in terms of pain. I am taking ultracet (tramadol) and paracetamol but still it's very hard to manage. I'll start with pregabalin today. Yup, I was there last Friday.

mumbai · « **Reply #23 on:** May 10, 2022, 03:36:49 PM »

Quote from: overandover on May 10, 2022, 02:20:07 PM

It's been hell for me since the last week in terms of pain. I am taking ultracet (tramadol) and paracetamol but still it's very hard to manage. I'll start with pregabalin today. Yup, I was there last Friday.

Are you also only on Aspirin for blood thinning?

tallmen · « **Reply #24 on:** May 19, 2022, 05:27:19 PM »

Quote from: mumbai on May 10, 2022, 03:36:49 PM

Are you also only on Aspirin for blood thinning?

Nope, I am allergic to Aspirin.

tallmen · « **Reply #25 on:** May 19, 2022, 05:27:48 PM »

How's it going, pal? Long time.

mumbai · « **Reply #26 on:** May 20, 2022, 05:59:08 AM »

Quote from: overandover on May 19, 2022, 05:27:19 PM

Nope, I am allergic to Aspirin.

So Xarelto?

Did you take Aspirin after LL and find out that you were allergic or you knew it before? Maybe I should pop in a pill and check before LL.

tallmen · « **Reply #27 on:** May 20, 2022, 08:03:58 AM »

Quote from: mumbai on May 20, 2022, 05:59:08 AM

So Xarelto?

Did you take Aspirin after LL and find out that you were allergic or you knew it before? Maybe I should pop in a pill and check before LL.

I found out after taking it.

52.Female.lengthened.11.5 · « **Reply #28 on:** May 22, 2022, 09:33:31 AM »

Hey I have just read your journal so far, keep strong and work hard on your rehabilitation. I am a 52 year old patient who has just completed my quadrilateral lengthening, I am alao aharing my jourey I like the way you are sharing yours, people like us can help fiture patients!

I know times can be tough, just stick with it, its not forever, fight through the pain you will get there and if you need any moral support don’t hesitate to contact me!

All the very best

Neko

mumbai · « **Reply #29 on:** May 22, 2022, 10:13:43 AM »

Quote from: overandover on May 20, 2022, 08:03:58 AM

I found out after taking it.

It can be dangerous to not be taking any blood thinners and be completely bed ridden with 2 broken legs. Please keep moving around.

Growing Experience · « **Reply #30 on:** June 01, 2022, 01:44:55 PM »

Dude, where are you? Its been 20 days since your last update!

I'm soon getting femur Precise done with Dr. Parihar. Need to know how things are going with you..

Also, really looking forward to see your X-Ray.

Limb Lengthening Forum

Author Topic: Precice 2: Bilateral Femur With Dr Mangal Parihar (Read 4749 times)