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[LL2022]

Hello, I am a long time user of this forum and have finally pulled the trigger on doing this surgery. I chose AFA because I had build up trust for them for almost one year as I started contacting them last year through other AFA patients. I am by no means affiliated with AFA and all my opinions in this diary are strictly my own. I was at first hesitant to publish a diary due to the witch-hunt and accusations of being a shill recently seen on the forums, but many people have DM’d me requesting an update so I will do my best in providing that as I believe in paying it foward.

Stats:
From: Northern Europe
168cm
61kg
Male
Goal 5 cm (up to maybe 5,5cm)
Age: low 20’s

I will speak from my truthful experience as everything is literally fresh in my head. This surgery, especially LON has so far not been easy, the frames are quite painful, heavy and bulky. Even though it’s a customized Illzarov ring fixator with only 2 rings and the upper ring a half circle to be able to reach full ROM.
 
The pins are irritating my skin and causes discomfort and pain to say the least when walking. But do keep in mind I’m still experiencing surgical pains as I am only 3 days post surgery. It is slowly getting better everyday. Furthermore, I’m still very swollen, especially in my left knee area, inhibiting full ROM when trying to bend my knee. Although alot of the pain has subsided. Sofar the pain has been manageable though!

The doctor visits me twice a day to make sure I’m complying to the exercises and see how I’m doing. The nurses come by on routine to check my blood pressure, change painkiller drips etc. Whatever they do use as painkillers works well and does not cause any nausea. It is a busy hospital, Always people coming in and out, I got my feet measured for a customized dorsi flexon shoe. And starting from yesterday I get to use the CPM machine on the daily for my knee ROM.

Doctor Uysal is an extremely competent and compassionatie orthopedic surgeon, no doubt about that, his English is excellent so communication will not be an issue. He wants LON patients to stay in the hospital for minimum 8 days. The hospital is a private hospital located in a small city just outside Istanbul. It is extremely clean and definitely on par with western European hospitals. The nurses are well mannered and helpful (they do not speak English though). AFA has so far been very helpful in arranging everything from logistics, food, translatation, papers, mental support and most importantly so far a 24/7 caregiver during your hospital stay. You will 100% need one the first week if not more. Next week I should go back to the hotel and attend the 2hour sessions of PT AFA offers, can’t speak of that yet but so far I have only heard good things. I look forward to meeting the other patients.

You can follow my Instagram: Ayran_Lon
I will try to frequently update my journey there.

[informationispower]

What was the price for the package?

[LL2022]

The price for LON is around 17k USD Although I think that is subject to change since July. It is best to contact AFA if you want to confirm, their contact info can be found on their web page.

[LL2022]

1/2
Day 21. +1cm left leg, 0,6cm on right leg. Xrays scheduled next week.

It has been 3 weeks since I arrived to Istanbul and I have gotten used to the isolated life style. If you have supportive friends and family I promise you this will be much easier mentally. I have unfortunately chosen to lie to my family and friends, and apart of me regrets doing that. It has perhaps been the most difficult part for me, besides the lack of sleep. Overall though I am quite happy. AFA’s PT team are a happy bunch and make you feel warmly welcomed and treat you like you’re a close friend as soon as you step foot into the PT room. I think this is the Turkish culture. I must admit I appreciate that very much, even though I am anti social I look foward to PT sessions to see and chat with other patients and the PT team. The PT sessions are generous too, it’s 5 times a week 2hours per day. The weekends are the most boring days for that reason haha.

Regarding my legs, I have ever since day 14-15 had strong shin pain that kinda feels like very strong shin splints on my left leg around the osteotomy site. I’d say it’s a constant 5/10 pain at night. The Dr visited and had consultation with patients yesterday in the hotel and told me it’s due to my bones being on the thinner side and the pin that sits above the tibia osteotomy site is irritating the membrane. Hopefully it will pass within a week because this pain is mostly felt during night and makes sleeping very difficult. Doctor have prescribed me sleeping aids but I haven’t really bothered taking them yet because the problem is the pain. Tramadol is a hit and miss, it works sometimes for this kind of pain. The pain is according to the doctor unrelated to lengthening which seems to be correct. The pain is manageable during the day and barely bothers me since I’m distracted with other stuff.

I was discharged on the 9th day post surgery and started lengthening on the 10th day. The doctor is very conservative which I think in general is good. The hospital stay was not a bad experience but I have to admit there was alot of mixtures of pain during this period. I had edema, skin allergies, many blisters and blood blisters that had to be popped. Day 1-3 the surgical pain were sharp and agonizing, I’d say the highest were around 8/10 but with pain killers through IV the pain was slightly more manageable. I learned that some patients even got stronger pain killers through Spinal IV. I was alittle bummed I didn’t get it my first days because the pain was for sure the greatest I have ever experienced, especially around the knees where they drill and insert the trauma nail. It felt like my knees were going to pop with the slightest movement. Maybe I just didn’t display my pain so well to the nurses or complain enough haha. Currently though my knees have fully healed and ai can fully bend them, my ROM is according to the Dr perfect!

The reason my left leg has reached 1cm and my right leg only 0,6cm is that my right leg fixator had a issue with the security nuts that you are supposed to loosen so you can lenghten with the key was so tight it didn’t lengthen anything, it is a bummer and my own fault for not paying attention but luckily I noticed it early and got help from AFA straight away to fix it. I literally called the coordinator in stress and full of anxiety 1AM trying to describe my problem. The founder of AFA came to my room 10 minutes later with another key to help loosen the tight security nuts and made sure I could lengthen properly again. This is something that I sincerely appreciated very much.

[LL2022]

2/2
Day 21. +1cm left leg, 0,6cm on right leg. Xrays scheduled next week.

Overall, sofar communication with the AFA and Dr Uysal is very good and I am satisfied with my decision choosing them. The only complaint is that the hotel room that I was arranged is like the furthest way possible down the corridor which makes walking to the PT with the walker more difficult when you are in pain during the early days. Very unlucky, I know… So I have been relying on one of the PT trainers or coordinators/translators helping me push me to the PT room on the first floor. I will change to a double room to share with a friend of mine (met through forums) also undergoing LON illzarov Tibias next week so I hope this room location will be better. I recommend sharing rooms if you’re on a budget as you will save nearly 1/3 of the accommodation cost for a single room.
Furthermore I really dislike taking the elevators, it’s a busy hotel and there is seemingly frequently people in the elevator you’re taking, they give you pitful looks which I hate but that’s inevitable when you see someone with the bulky illzarov frames. All in all these are very minor issues and nothing other patients seem to be bothered by so it’s highly subjective.

There is more to say but I realize this has gotten to lenghty. I am writing this at 5AM because I am frequently waking up due to pain or discomfort so I had nothing better to do lol. Overall I don’t regret my decision, it’s tough but manageable as long as you have a real good reason for doing this.

Also, a question to veterans. I sometimes get tingly sensations on my left feet up to my toes after lenghtening, it comes randomly here and there and isn’t painful. Is this something I should be worried about? I’m just worried this is a sign of nerve damage or if I need to slow down lengthening.

Take care and stay strong guys and girls~

[Thehighest]

How do You feel the knee?? Is there any pain??

[hoopdreams]

I’m legit shocked to hear the Vietnamese are doing LON femurs. This doctor is officially on my watchlist and it might come down to your doctor or Buldu for obvious monetary reasons. Looking forward to more posts on this thread and wishing you a speedy recovery.

[LL2022]

How do You feel the knee?? Is there any pain??

There is very slight stiffness still. But all knee pains are long gone and I can fully bend my knee now, no problem.

[LL2022]

I’m legit shocked to hear the Vietnamese are doing LON femurs. This doctor is officially on my watchlist and it might come down to your doctor or Buldu for obvious monetary reasons. Looking forward to more posts on this thread and wishing you a speedy recovery.

Thanks for your kind wishes . Dr Uysal does LON femurs too but recommends Precise for obvious reasons. Buldu definetly also does LON femurs. LON femurs are doable if you’re light and flexible, there’s some girls who did it and based on their experience they seemed to be doing very well with very good ROM.

Trying not to be biased but Dr Uysal is definetly a very competent Ll and Orthopedic surgeon. He went to America to practice LL, I think it was under Dr Paley but don’t quote me on that.

[LL2022]

Day 31

Right: + 2,2cm
Left: + 1,9cm

Days are going by slow. Eat, PT, sleep repeat. I mostly sit on my walker to get around in the hotel room as it is simply just more convenient and less painful. I underestimated how important legs are to even do simple daily tasks such as washing clothes, get to the bathroom, wash yourself, go the the fridge to get icepacks or water, get inside elevators and get over door steps. As such everything takes atleast 3x the time.

My pains are mostly related to swelling and soreness around my anterior shins/tibial osteotomy site and sometimes fibula. Seem to be worsened after lengthening so I was suggested to slow down lengthening if I can’t withstand the pain. The pain gets worse after intense PT sessions (they are still necessary so your your achilles and calfs get stretched, so I attend these despite pain and discomfort). The painful exercises for me are related to dorsi flexon. It creates pressure on my anterior shins when PT forces dorsi flexons and it can feel like the Tibia bone is gonna snap. Regularly maintaing dorsi flexon is important though as it prevents muscle contractures (If I have understood correctly). Bandages are checked and changed regularly (2-3 times a week) so I’m not very concerned about infections. They use beatine to clean pinsites + some kind of antibiotic solution on pinsites areas with “open wounds” which seem to work very well as I haven’t had any skin infection yet.

The pain is likely due to the pin site of the Illzarov device below the knees going through the shins. I used to get sudden attacks of very sharp pain around 8/10 during nights, I woke up feeling like my shins where cut or stabbed by a knife on my left shin slightly below the osteotomy site and it usually lasted up to an hour or two. Thank god I haven’t experienced these kind of pains in almost one week. This pain was truly horrible, I was literally rolling around in bed and moaning like a lil bitch non stop.

Pain is highly subjective, I’m 1 month post LON Tibias surgery and take one tramadol almost every night since I reached around 1.2cm, Just so I can sleep. The constant aches around my shins/osteotomy sites are normally around 3-4/10 which usually is pain on a manageable level (it is not easy to concentrate on studies/work for sure though) and something I expected before I did this surgery. However, the problem is that the pain is worsened during night time which disrupts my ability to sleep. I know patients who only need to take paracetamol and have no nightly pains while others have sharp pains even with 2x 100mg tramadol per day.

These are my xrays from day 20:
https://imgur.com/a/XabBwgO

[boklecrt]

take your tramadol, why do you this to yourself? rolling around in pain for 2 hours in the middle of the night? thats insanity and totally unnecessary

tramadol max daily dose = 400 mg

take 75-100mg around 9pm and have a restful sleep like a normal person

i did 2 months in frames and took 75 mg tramadol/paracetamol 3 times a day for a combined total of 225mg tramadol/1800 mg paracetamol per day

pain = basically non existent to maximum 1/10. did 1mm per day too til the end

no opiate addiction too because tramadol is the weakest opiate

GOOD LUCK

[LL2022]

take your tramadol, why do you this to yourself? rolling around in pain for 2 hours in the middle of the night? thats insanity and totally unnecessary

tramadol max daily dose = 400 mg

take 75-100mg around 9pm and have a restful sleep like a normal person

i did 2 months in frames and took 75 mg tramadol/paracetamol 3 times a day for a combined total of 225mg tramadol/1800 mg paracetamol per day

pain = basically non existent to maximum 1/10. did 1mm per day too til the end

no opiate addiction too because tramadol is the weakest opiate

GOOD LUCK

Thank you, I took tramadol before sleep to ensure a as painless night as possible. Nowadays I barely have any strong pains anymore, maybe also contributed by only lenghtening 0,75 per day now. So I don’t need tramadol as often.

[LL2022]

Xrays from day 35 post surgery:
https://imgur.com/a/t3a5I8O

Unfortunately due to slow callus formation, I was advised to slow my lengthening. I began doing 0,75mm/day and will see if situation is improved for the next Xray.

Overall, I have no pain or very manageable pain levels nowadays. Only big problem is that my left leg is limping due to the anterior tibialis muscle being weak. Furthermore my left ankle feel extremely fragile when I try to take a step forward and it is difficult to dorsiflexon due to stiffness (Not due to achilles or calve tightness) I am doing exercises to fix this. Hopefully it will pass soon as I’m trying to walk as much as possible for callus formation.

Take care.

[boklecrt]

callus does look really strained and weak, do you eat enough calories? protein is what builds the callus, you need to be hitting the protein hard every single day

get some more meats and eggs going in there, 5 eggs whole eggs a day minimum and dont worry about the cholesterol myth, when you eat a lot of eggs the body lowers its own cholesterol to keep its internal balance

[LL2022]

callus does look really strained and weak, do you eat enough calories? protein is what builds the callus, you need to be hitting the protein hard every single day

get some more meats and eggs going in there, 5 eggs whole eggs a day minimum and dont worry about the cholesterol myth, when you eat a lot of eggs the body lowers its own cholesterol to keep its internal balance

I have been drinking protein shakes and eating plenty of protein and taking  all the necessary vitamins/minerals. Basically the same diet as my roommate who has very good callus on his Tibia/fibula. It’s a mystery to me… Could be my inconsistent sleep, I wake up every 2 hours and in total maybe get 5-6 hours per night.

I have been upping my weightbearing as an attempt to increase callus. We will see next week’s xray. Hopefully some improvement or I will have to slow down further