hello
usually I don’t see any reasons to interfere the clients discussion: I respect every community and I understand that nobody here asked my opinion. nevertheless I simply can’t stand aside and just look that 2 ex-patients are trying hard to protect me. I really appreciate that very much. Thank you, dear friends. You’ve done huge the honor to me. (they’re not fakes. Pictures of Jim_dabarber posted on the website straightlegs.ru (Cross-lengthening (LATN & LON).
I’ve spent one day reading this diary. I have no much time for that, but this discussion was extremely interesting. Many interesting persons, many interesting and very important ideas. Sometimes that contains very abusive and impolite language, but that doesn’t change the sense. I’d like just to pay attention to some moments: “money helps to get more successful treatment” - excellent! totally agreed. there are no reasons to start consultation with the words: “I have very limited budget, doc”. “after reading the diary, people could think, that it’s very easy – to get limb lengthening” – perfect! it’s extremely hard and difficult for the patient’s health and mind. especially – lengthening on 6, 8, 9, 13 cm at once (we had such cases). I always very impressed by the foreign patients: come to the different country with different people speaking different language for getting the hard and difficult treatment. they’re should be very brave. and very truthful comment to the photo: “after the lengthening the legs look not healthy at all” – of course! how should it look after 8cm (!) lengthening in case of not young patient? he will need time for rehabilitation. and I hope very much and wish him to restore the condition of the feet totally. excuse me for useless spending of your time: I’m always very interested in investigation of patient’s behavior during treatment and here I’ve found a lot of material.
about the patient, who’s got dropped foot… “I tried my best to listen to my doctors and exercise but most of these problems were out of my hand.” I’ve got permission from that patient to post his pictures. Unfortunately, the conditions of the forum provides pictures of 25KB – that’s nothing.
maybe you know, I don’t discuss treatment with patients by cell-phone, Skype and something like that: I need to store all the information. I use e-mail only and save every message from or to every patient. That is why I can prove every word about treatment of the patient:
in my first message on 27th of February 2018 he has got the file with information about treatment this file contains our recommendations and rules (file is applied). some sentences from it:
“You may go home for period of distraction and for period of fixation. Supervising by regional orthopedist is necessary during these periods.”
“The safest (fewest risk of complications) is Conventional Ilizarov.”
“Early postoperative period and Period of distraction: Manipulations (distraction): Obligatory: Start on 5th-12nd day after surgery (rate of distraction: 0,5-1,5 mm per a day).
We recommend: lengthening no more than 10% of the initial length of a bone”
“Trainings/physiotherapy: We recommend: training 2-3 times a week with trainer”
“In case of hypotrophic regenerate or strong pain syndrome, the distraction can be slowed down, temporarily stopped, prematurely complete; perhaps, one or several additional operations are required. As a rule, at this period patients need supervising by neurologist (80% of the patients) and by dermatologist (50% of the patients).”
“Period of correction: Trainings/physiotherapy: We recommend: training 2-3 times a week with trainer”
“In case of hypotrophic regenerate or strong pain syndrome, the correction can be slowed down, temporarily stopped, prematurely complete; perhaps, one or several additional operations are required. As a rule, at this period patients need supervising by neurologist (80% of the patients) and by dermatologist (50% of the patients).”
“Rebandages: Obligatory: rebandages by doctor once a week
We recommend: rebandages by doctor 2-3 times a week
We consider admissible: rebandages by patient 3 times a week (for the outpatients at home in different city)”
“During treatment we recommend to the patient every day send us information about: morning/evening temperature, pain level (from 1 till 10 points; 10 points is unbearable pain), duration of sleeping in the night, taken medicines, duration of training (with/without trainer), performed rebandages (with/without doctor/nurse), performed manipulations in the frame by patient/nurse/doctor), amount of distraction performed during the day for every segment, total amount of distraction performed during treatment and any other important information).”
after x-rays we’ve informed the patient that 10% from the length of his tibia is 4cm (that’s a usual number)
surgery was performed on 15th of December 2018 without any troubles. to avoid the ballerina feet during treatment feet were held by additional half-ring supports. that means, patient were not able to move the feet till frames removal
patient planned to perform lengthening of lower legs on 10 cm by LATN (message from 12th of December)
at 18th of December he left the clinic
at 22nd of December the lengthening (distraction) was started
at 28th of December he moved to his home country
at 31st of December (performed distraction - 9mm) in the daily report message he complained of the edema of the feet at first time
at 02nd of January he complained of “hard to sleep” at first time (duration of night sleep - 2 hours – very important parameter)
at 04th of January he complained on “hard to sleep” second time (duration of night sleep - 2 hours). were consulted by family doctor, got “pain-killers & sleeping pills”. Patient were not supervised by orthopedist at home. At all.
at 06th of January were performed x-rays. quality of the pictures were not enough to estimate the rate of lengthening
at 07th of January duration of sleeping 8 hours - good
12th of January – “feeling some pressure in the left foot”
13th of January – patient found out that instead of lengthening on 2cm he performed lengthening on 3cm (he sent me the photo with the frame and measure tape). he couldn’t explain that
14th of January – he reported about pain, pressure and numbness on the left leg, areas like knee, ankle and sole of foot
15th of January. were performed x-rays not appropriate quality, 16th of January I recommended to decrease the rate of lengthening (distraction) 17th of January I recommended to decrease the rate of lengthening (distraction) second time
19th of January he complained of severe edema of the feet and sent the pictures. I’ve recommended him to get the consultation by local orthopedist – was not performed
22nd of January – complained of “burning pain on the left foot”
24th of January – strong burning pain
27th of January – very strong burning pain
29th of January – “my foot burns a lot”, “I don’t know what to with it” I recommended to reduce the rate of lengthening till 0,75-0,5 mm per a day, consultation by neurologist (was not performed) and by angiologist (was not performed)
30th of January – he informed me “I’m going to slow down lengthening from tomorrow , from 1mm to 0,75mm”
31st of January – “unbearable shooting pain and burning”, (distraction – 39.75mm)
my answer: I can’t say much without looking at your legs, remembered, and he’s close to the more or less “safe” amount of lengthening and informed him, that after this limit the distraction should be harder
from the patient: “waiting for the orthopedist, don’t know when I can visit one, it might take several months. unfortunately it’s not possible to see neurologist either, they said June 5th is the earliest I can see one”
01st of February – I remembered to the patient that “for the effective treatment he needs right now (emergency): supervising (not visit) by the experienced in limb-lengthening and deformity correction orthopedist, consultation (and supervising) by neurologist”, “unfortunately, I cant cure you from Russia even if you’d send me satisfactory x-rays (I haven’t got yet)”, “I hope very much, you’ll get the appropriate treatment as quick as it possible”, "by the way, for the emergency help I’d recommend you to arrest the lengthening for both legs and get the examination by the orthopedist and neurologist today or tomorrow”
from the patient: “I can’t visit a specialist here anytime soon, health care system in here is different” he slowed down the distraction till 0,5mm per a day
02nd of February - I repeated to arrest lengthening. from the patient: “ my family doctor is all I have”. I recommended to remove the distraction “5mm at first” (to perform shortening)
03rd of February patient arrested the lengthening (he's got lengthening on 4cm for every leg). shortening were not performed
04th of February he’s got new x-rays. it was revealed the incorrect performing of the lengthening (right leg were shorter). Patient informed me, he plans to perform lengthening till 7,5 cm
05th of February – patient informed me, that he will proceed the lengthening – 1mm per a day for the right leg and 0,75mm per a day for the left leg
06th of February he restarted lengthening and informed that pain disappeared
07th of February he reported about not strong pain syndrome, last rebandages were performed 1 week ago. I remembered, that it’s not accorded to our recommendations
08th, 09th, 10th, 11th, 12th, 13th, 15th, 16th, 17th, 18th of February he informed about insignificant pain without problems with sleeping, he was taking pain-killers and sleeping pills.
10th of February he informed me, he will arrive on 24th of February (performed lengthening - 5,0cm right leg and 5,5cm - left)
14th of February he asked me to answer the questions from his girl-friend. “she wants to talk to you directly to have piece of mind, I explained to her this frame are straightening bones and make them longer”
her questions was:
1 – how are frames straighten his legs and what the issues before they are correcting?
my answer: had he problems before surgery? we didn’t plan deformity correction. just correction of misalignment caused by cosmetic (!) lengthening of the lower legs
2 – is there any risks after the frames come off?
my answer: yes: refracture, deformity …
example not gaining back full walking ability or blood issues?
my answer: its possible: patient is going more lengthening instead of recommended
3 – how much physic should he be doing in a day?
my answer: till getting full range of motion
4 – do you have a website with examples or testimonials of Marcus’s procedure
my answer: Marcus got files with clinical cases with files about treatment before surgery
She thanked me and didn’t ask any more
15th of February patient remembered to me, that he wants to go up till 7,5cm. I remembered that we recommend no more than 10% of the initial length of a bone.
17th of February – patient slowed down the rate of distraction because of strong pain
18th of February – he had complained on “burning on his feet” and problems with the extending of the knee joints; duration of night sleeping – 5 hours. I recommended to stop the distraction at all (third time) (amount of performed distraction - 5,9 right, 6,3 left)
19th of February – he had complained on “burning pain on his feet”. I asked about the distraction. In a daily report he posted 1.25mm for every leg
21st of February – he complained: “Every time I want to lay down or straighten out my legs, top of my feet starts to burn and hurt”. I answered: “that’s over tension of the nerves, I recommend you to stop lengthening”. he stopped
22nd of February – he asked me for permission to proceed lengthening. Professor Solomin remembered him, that “severe pain is contradiction for lengthening”
24th of February – the patient has remembered to me, he didn’t reach 7cm, he need
25th of February – he arrived to St.-Petersburg
26th of February – by the x-ray pictures performed in St-Petersburg it was founded that reached amount of lengthening was 6cm. his feet were very swollen. Moving of the toes were not revealed. Diagnosis by neurologist: traction lesion of tibialis and peroneal nerves of both legs. Patient decided to restart the distraction till 7cm.
28th of February - he informed me, he performed distraction 1mm for every leg and asked to increase the distraction by 0.25 because “I need to take my frame off no longer than end of third week of March. So I need to make sure I finish the lengthening and correction before that time”. And he informed me, that his pain is low.
01st of March patient informed me that he’s performing the distraction 1 cm (!) per a day. He insisted that I recommend him that, but, I think, he just couldn’t understand the difference between cm and mm. When I saw him next time, his legs and frames were not lengthened on couple centimeters.
02nd of March - in a daily report he informed me: “Amount of distraction performed during the day for every segment: approximately 1cm”, “Total amount of lengthening: R: 6.4 cm L: 6.4cm”
03rd of March - in a daily report he informed me: “Amount of distraction performed during the day for every segment: approximately 1cm”. Total amount of lengthening: R: 6.5 cm L: 6.5cm
he planned to reach 7cm till 8th of March and get the nailing surgery
he kept distraction till 8th of March
08th of March - after x rays (shown amount of lengthening for right leg 66mm, left leg 71mm) patient took a decision to keep lengthening till 74 mm
09th of March he started the correction. The nailing surgery was planned on 17th of March. Patient booked a flight on 21th.
correction were finished on the evening of 15th of March (we planned the smoother rate of correction to perform it very accurate). We’ve started frames reassembling (preparing for the surgery) at 19.00 in the evening and finished that at 01.30 in the morning: we wanted not to perform this difficult procedure in the day before surgery and saved 1 day for the any troubles.
While reassembling the frames patient ordered to perform the additional lengthening for the right leg – 5mm at once. He was explained that should be extremely risky. nevertheless, he insisted and confirmed that. all members of the team were really shocked at that moment: late night, patient moaning from the pain and asking: “5 millimeters more! I need that!” (this frase only I can't proove by mails)
at 01.32 in the morning I’ve sent the message to the patient and strongly recommend him to remove no less than 5mm lengthening on every leg (wasn't performed)
at 05.46 in the morning I recommended him to come to the hospital on 16th of the March instead of 17th of the March to relief the pain – he didn’t.
17th of March nailing surgery were performed excellent. during the surgery frames were removed. frames held feet in a right position by the screws. that means, patient couldn’t move the feet all the period of frames treatment. after removing the frames patient couldn't move the feet
So: I’d not say, if the patient followed the recommendations
What should I say?
1st: we never perform the cosmetic surgery without order and insisting from the patient
2nd: we never recommend the cosmetic lengthening more than 10% from the initial length (world-wide information)
3rd: we always inform in writing about complications. if patient plan to perform the lengthening after 10% the complications not “may be”. that “must be"
4th: we don’t perform lengthening. patient performs it. he determines the amount of lengthening and informs us. we comment his manipulations and his condition according to daily reports and x-rays
5th: we don’t damage the nerves and vessels during surgery. traction damage caused by over lengthening before second surgery and increasing after second surgery by additional edema
we always recommend Conventional Ilizarov – “1-surgery way of treatment” – is the safest. no second surgery – no additional risk to get additional complications
and: all our team wish to the patient the quickest and complete recovery.
try to understand, please: should be accurate playing with fire: using it accurate you’ll be warmed during cold (like California2 and Jim_dabarber), using it thoughtlessly, you may hurt yourself
best regards, dr kulesh
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Topic: St. Petersburg Lengthening -- DISTRACTION COMPLETED (Read 20828 times)