Topic: St. Petersburg Lengthening -- DISTRACTION COMPLETED (Read 20798 times)

Great321 · « **Reply #155 on:** October 25, 2019, 11:05:23 PM »

I see. Thanks. Congratulations on your progress! Good to hear.

Do you think you could have ditched all the walking aides even earlier?

California2 · « **Reply #156 on:** October 26, 2019, 12:08:09 AM »

To Great321:

Could I have walked earlier? Probably, but now I will never know.

You may know that two schools of thought exist on this topic--one says walk early and often and make bone grow. The other says walking before 75% consolidation is too risky because it is easy to break your ankle screws and drive your nail through your heel.

My surgical team strongly holds the latter opinion; I decided it was prudent to follow the advice of my surgical team.

Great321 · « **Reply #157 on:** October 26, 2019, 07:12:29 AM »

Interesting. Wise decision. Then I' hope my supposedly large diameter nail will be stable enough:)

California2 · « **Reply #158 on:** October 26, 2019, 03:59:46 PM »

For me, LATN was recommended over LON because LATN allowed the use of a larger; ergo, more stable nail. LATN allows a larger nail because the nail is inserted after distraction; thus, the space for the nail is increased by the length of the distraction.

However, irrespective of the size of the nail, the weak points are the two screws at the bottom of each tibia. Your entire body weight is supported by those two screws until bone grows to share the load and eventually carry the load.

Those screws can and do break. When they break, consequences can be severe.

In my humble opinion, patients who run and jump before 75% consolidation relying on those screws to support their weight are playing with fire.

California2 · « **Reply #159 on:** November 20, 2019, 06:45:28 PM »

I wrote before that I do not do personal messages because personal messages deprive others who may have the same concern of information and also cause me to duplicate responses.

A member inquired:

Quote

I wanted to know something it would be very helpful if u could help me out. As i know you did LATN i wanted to know what was the scarring after nailing. In terms of compared to initial surgery how bad was it. like if initial surgery caused the scaring would you say nailing caused double that amount or the scars wernt an issue. If you could elaborate it would be very helpful.

LATN in the tibia causes no appreciable scarring. The surgery is performed via an about 3 cm incision over the kneecap. The kneecap is shifted to the side, a hole is drilled in the top of the tibia, the center of the tibia is usually reamed to remove the fatty deposits; then, the nail is inserted.

Screws to secure the nail are installed through very small incisions below the knee and above the ankle.

For me, incisions for screws left no scars at all. I have a very narrow hairline scar over each kneecap; however, even this scar is becoming very hard to locate.

In my opinion based on my experience, scars as a result of LATN are not an issue.

California2 · « **Reply #160 on:** December 20, 2019, 02:34:42 AM »

As I keep writing, I do not respond to personal messages because doing so requires duplicate work. If you have a question for me, please post it here.

I received the following PM:

Quote

Hi sir. Did I understand correctly that you went for a 9 cm surgery split between tibia and femur with dr kulesh? How was your experience 1/10? What was your starting and end height? Any complications? What was your impression on the doctor and clinic. Was it modern? Dirty?

Please answer truthfully. I am thinking about this surgery but I am scared as fking hell to do it. I really need to find a proper doctor. And I am willing to pay around what you did.¨

Almost all of these questions are already addressed in my diary. Please read my diary for your answers.

The only question I see that I do not recall answering previously is "How was your experience 1/10?" Answering this question would grossly oversimplify the experience. Moreover, my experience will not be your experience.

Next, all of my input on this forum has been factual and frank--read it if you like and draw your own conclusions.

Last, if you are fearful of any elective surgery; then, you should not do the surgery. Instead, continue to work to gather information and understand options until you feel informed and comfortable to go forward. Leg lengthening surgery is not for everyone.

Zion · « **Reply #161 on:** January 20, 2020, 08:07:13 PM »

I have on question: I believe it's possible to do a second surgery right at the moment of the frame removal (all in same surgery), correct? Do you know if Kulesh approved of this?

California2 · « **Reply #162 on:** January 21, 2020, 03:53:14 PM »

I encourage you to discuss your question directly with Dr. Kulesh.

I think the question is not whether something is possible; rather, the question is whether doing something that may be possible is wise.

Many folks who are considering two surgeries on the same segment or lengthening both the tibia and femur on the same leg do not fully consider the impact of these procedures.

Whether you lengthen tibias or femurs, you stretch the tissues from ankle to hip. Tissue can only stretch so far. Think about folks who keep trying to put larger and larger rings in their ear lobes. Eventually, the lobe tears because all of the available stretch is used up.

In the same vein, perhaps you can safely and successfully stretch either your lower leg or your upper leg by 15%. This does NOT mean you can stretch both by 15%.

Consequently, if you want to do multiple lengthenings; then, most folks are advised to wait for a couple of years between lengthening.

However, perhaps you have a good reason to do what you want to do. If so, I encourage you to discuss in detail your idea with your surgeon.

Zion · « **Reply #163 on:** January 21, 2020, 10:12:41 PM »

Quote from: California2 on January 21, 2020, 03:53:14 PM

I encourage you to discuss your question directly with Dr. Kulesh.

I think the question is not whether something is possible; rather, the question is whether doing something that may be possible is wise.

Many folks who are considering two surgeries on the same segment or lengthening both the tibia and femur on the same leg do not fully consider the impact of these procedures.

Whether you lengthen tibias or femurs, you stretch the tissues from ankle to hip. Tissue can only stretch so far. Think about folks who keep trying to put larger and larger rings in their ear lobes. Eventually, the lobe tears because all of the available stretch is used up.

In the same vein, perhaps you can safely and successfully stretch either your lower leg or your upper leg by 15%. This does NOT mean you can stretch both by 15%.

Consequently, if you want to do multiple lengthenings; then, most folks are advised to wait for a couple of years between lengthening.

However, perhaps you have a good reason to do what you want to do. If so, I encourage you to discuss in detail your idea with your surgeon.

Thank you very much for your detailed answer I appreciate it a lot.

Glad you are doing fine and accomplished your goal, even at your age (no offense), well done!

Was it really hard to go out on shopping? going to the groceries store, cooking, cleaning, showering, etc, while on the wheelchair and on frames? I still picture it extremely hard for oneself to do all that...any advice would be gladly appreciated.

Finally, where did you stay and did surgeries on? clicnic #1 #2 or #3?

Thank you in advance California2

California2 · « **Reply #164 on:** January 22, 2020, 04:07:55 PM »

Regarding cooking, cleaning, shopping, showering, etc.

I find that most challenges in life can be overcome with proper mindset, preparation, discipline, and strength of will.

As to cooking and cleaning--I had no problem cooking in a wheelchair. In fact, I got much pleasure from preparing elaborate meals for my neighbors from time-to-time. Doing so also provided an opportunity for social interaction. As for cleaning, I could push around a vacuum or mop but had a cleaner in twice a month.

As for showers--no showers until frames are removed and wounds are healed. Sponge bath only.

As for shopping--I tested my wheelchair and route before my surgery to identify problems and develop fixes. I had no real problems--not easy or convenient but doable--unless it was snowing. Wheelchairs do not work well on snow or ice. When the snow came, I had to plan my outing to the store for right after the pathways were cleared.

As for clinic 1, 2, or 3--I don't know what you mean. My initial appointments and x-rays were done at the Vreden Institute and St. George's Hospital. My first surgery was done at St. Elizabeth's Hospital. My nail insertion (LATN) was done at the Medem Clinic in downtown St. Petersburg.

Vreden and St. Elizabeth's are next door to each other--St. George is about two miles away.

Zion · « **Reply #165 on:** February 04, 2020, 08:45:17 PM »

Thank you very much California2.

The number of clinics is in regard to how Dr. Kulesh points it out on his document (the one he sents when you ask about prices, etc).

Any advice on how to buy food (and other stuff) online? I am sure going shopping with the frames cant be nice

Additionally, I would also appreciate if you could advice on how to use the bathroom (pee and poo) when on frames at home, etc...

California2 · « **Reply #166 on:** February 05, 2020, 03:41:06 PM »

Most accommodations in St. Petersburg are large high-rise apartment buildings. These often have central courtyards with outdoor gym equipment and child play areas. All have a variety of stores and shops on the ground floor--groceries, restaurants, barber shops, nail salons, etc.

Consequently, going shopping involves little more than going to the ground floor. Similarly, you can order food online for delivery from some nearby shops--I ordered both pizza and sushi a few times. Some websites (like Domino's) are in multiple languages--otherwise, Google Translate worked well enough.

Last, you can hire an aid to come once a week and help you do things if you want. 1000 Rubles is about $15. You can get a lot done for 1000 Rubles in St. Petersburg. Also, from time to time I asked my MD or physical therapist to swing by Burger King--they have coupons online to get a Whopper and a Big Burger and two small fries for 200 Rubles--about $3.

As for the restroom--first, make sure your chair can get into the unit's bathroom. Get a bottle urinal or a quart milk bottle for urine. So long as you can get your chair into the bathroom, you will be able to move from the chair to the commode when necessary. You will also be able to empty your bottle in the commode and rinse it out in the sink for next time.

Zion · « **Reply #167 on:** February 05, 2020, 03:52:48 PM »

Thank you very much man you are very kind to share your experience in a very detailed way. Also glad you are recovering!

I am planning on going in June this year, I hope all goes smoothly as I will also travel alone and I know zero Russian.

If you allow me, the last 2 questions that came to my mind was, why did you mention the intramedullary nails are usually left there for life? wouldn't that be a problem? why can they just remove it at a later date when consolidation is 100% done?

St. George's Hospital is the municipal hospital? the one that is the cheapest option to do surgery, please correct me if I am wrong.

Thanks again and I hope you can forgive me for asking so many questions

California2 · « **Reply #168 on:** February 05, 2020, 04:07:21 PM »

The intermediary nails used in LON and LATN are just pieces of stable and inert metal. They contain no magnets or other potentially harmful material.

You can remove these nails if you like. However, most people only remove the screws that hold the nails in place.

Once the screws are removed, the nails become completely encased in what would otherwise be a hollow space in your bone. Most people become essentially unaware of the nails after the screws are removed; thus, they do not remove them.

If you are bothered in any way by the nails; then, you can always have them removed. But that is a decision to make a couple of years from now.

Best of luck with your procedure! I am confident you are in good hands.

California2 · « **Reply #169 on:** February 05, 2020, 04:16:32 PM »

As for municipal clinics--St. George's and St. Elizabeth's are both municipal clinics; thus, the least expensive.

When I had the surgery, Professor Solomin was at odds with St. George's administration so he did not do surgery at St. George's; however, Dr. Kulesh used St. George's for x-rays.

I do not know which hospitals they use for surgery today--it was St. Elizabeth's and the MEDEM Clinic downtown when I had my surgery.

Frankly, while St. Elizabeth's was less modern and showed more wear and tear (as might be expected at a municipal clinic), the rooms were much larger and included a kitchenette, and the staff seemed more friendly; thus, I preferred the municipal hospital all-in-all.

Zion · « **Reply #170 on:** February 05, 2020, 06:30:45 PM »

Thank you so much for all this valuable information!

Zion · « **Reply #171 on:** February 17, 2020, 10:24:20 AM »

Hey California2 how are you feeling? how is consolidation going so far?

Hope all is good!

California2 · « **Reply #172 on:** November 23, 2020, 04:35:03 PM »

I am having an unrelated procedure on my foot. My podiatrist wanted to be certain my Achilles tendon is fully stretched.

He recommended a device made by Joint Active Systems: https://www.jointactivesystems.com/products/jas-sps-ankle.

It is a boot you use to for both plantar flexion and dorsiflexion.

I am generally not a fan of devices but this works pretty well so I thought I would bring it to the list's attention because of its potential application in tibial lengthening.

Skyisthelimit · « **Reply #173 on:** November 23, 2020, 05:50:59 PM »

Seems very useful to use during distraction and consolidation stages for patients who are doing internals. Don’t think this would work with patients that are doing externals but until after the frames are removed. Thank you for the information! How is everything going, btw? How are your legs feeling?

California2 · « **Reply #174 on:** November 23, 2020, 07:27:08 PM »

I do not generally reply to PMs because doing so prevents others from getting the same information and causes repeat questions.

One poster asks:

After reading your diary I staring seeing Dr. Solomin & Dr. Kulesh as my potential go-to for Cll. Are they still taking cosmetic cases and is there a height restriction? I’m a 23 y/o male with a height of 1.77-1.78.

My impression is that Russian surgeons give you their best advice for your situation; whether or not you follow their advice is more up to you than in the USA. I am not aware of any pre-surgery height prohibition.

Also, I read that in total you spent $22k on everything, $15k on surgery related expenses and $7k on everything else. Do you think this price could be lower if I did somethings differently, i.e instead of staying in the hospital for 3 weeks, leaving after 5-7 days, not hiring a maid/cook, etc... things like that.

No. I doubt you could reduce the overall price by much--it is already quite reasonable.

Best of luck.

chipsnsalsa · « **Reply #175 on:** January 27, 2021, 11:30:05 PM »

Thanks for your excellent and detailed reports, California2.

I was wondering about what you said a few posts up, that people sometimes leave the nail in forever. Is this the case for both the LON nail and the thicker LATN nail?

I am somewhat bow-legged and average height (1.79m) and am considering having LL while simultaneously having my tibias straightened, which will hopefully prevent me needing knee replacement in the future. I would be happy with 4 cm. Do you know of any patients who have done that with Drs Solomin and Kulesh? I understand it would be LATN, with the straightening done alongside the lengthening. Would it require extra time to do the straightening?

On a long term note, I enjoy lifting at the gym - reasonably heavy: squats up to 100kg. Would that be possible a year or so after the surgery? Ever? Would I need to have the nail removed?

Many thanks once again for your kindness in taking the time to post.

California2 · « **Reply #176 on:** January 28, 2021, 12:29:54 AM »

I encourage you to direct specific questions to your surgeon but I am happy to share my understanding of things.

As for bowed legs--purely external can correct bowed legs because the bone can continue to be aligned after lengthening but before consolidation. Once a nail is inserted, the bone is fixed in position. Consequently, if you decide on a procedure that uses any form of nail or rod from the start; then, you cannot correct bowed legs.

Professor Solomin and Dr. Kulesh regularly fix bowed legs but it usually means more time in frames. You should speak with them about options.

As for LON or LATN-- the nail inserted is simply an inert metal rod--no magnets or anything to worry about. The nail is completely encased in bone after healing.

(On a related matter, because my nails are Russian, when I had an MRI through the VA I was concerned that my nails might have been made from old Lada parts and that my legs would be slapped against the MRI wall. The technician tested my nails with a huge magnet and assured me my nails were inert medical grade devices. Moreover, the nails I have are actually made in Poland.)

To remove the nail, you must open the bone to get to the nail. Many people remove the nail--I am not sure why--is it because they do not like a foreign object inside their bones or because they believe bone is more flexible than metal--who knows?

My US surgeon who removed my LATN screws but not my nail was a regular orthopedic surgeon. He says he repairs broken legs in football players and always recommends leaving in the nail because it just replaces fat stored inside the bone and the bone is far stronger with the nail inside.

So, different thoughts about the same topic. You should do what you believe to be the correct thing for you when the time comes to make a decision. If you choose to leave the nail in; it should in no way prevent you from doing anything and may even leave your legs stronger (if you accept my surgeon's position).

Good luck to you.

chipsnsalsa · « **Reply #177 on:** January 28, 2021, 07:01:21 AM »

Thanks again for the reply.

I saw that you also have bow legs, but you decided not to get them realigned during your external tibias for time reasons. Did the Drs explain how much longer it would take to do so? Is it necessary to complete the lengthening, then start another period of realignment before inserting the nail?

las vegas baby · « **Reply #178 on:** January 28, 2021, 07:22:35 AM »

Whats your level of physical recovery? can you post multimedia material to show it with sufficient redaction personal information to your satisfaction?

congrats on pursuing your dream at a relatively higher age.

Activatedxx · « **Reply #179 on:** January 28, 2021, 08:03:11 AM »

Quote from: chipsnsalsa on January 27, 2021, 11:30:05 PM

Thanks for your excellent and detailed reports, California2.

I was wondering about what you said a few posts up, that people sometimes leave the nail in forever. Is this the case for both the LON nail and the thicker LATN nail?

I am somewhat bow-legged and average height (1.79m) and am considering having LL while simultaneously having my tibias straightened, which will hopefully prevent me needing knee replacement in the future. I would be happy with 4 cm. Do you know of any patients who have done that with Drs Solomin and Kulesh? I understand it would be LATN, with the straightening done alongside the lengthening. Would it require extra time to do the straightening?

On a long term note, I enjoy lifting at the gym - reasonably heavy: squats up to 100kg. Would that be possible a year or so after the surgery? Ever? Would I need to have the nail removed?

Many thanks once again for your kindness in taking the time to post.

Honestly bro at 179 I would not ever even consider this, but bow legs are free to fix with insurance or the copay will be cheaper than Russia

las vegas baby · « **Reply #180 on:** February 24, 2021, 05:21:00 AM »

Quote from: las vegas baby on January 28, 2021, 07:22:35 AM

Whats your level of physical recovery? can you post multimedia material to show it with sufficient redaction personal information to your satisfaction?

congrats on pursuing your dream at a relatively higher age.

any updates here California2? You were online recently. I am keen on observing your recovery.

Kal el · « **Reply #181 on:** February 24, 2021, 05:49:41 AM »

Actually his goal ain't actually CLL...it's to correct bow legs to prevent future joint problems..LL is just an extra bonus(offcourse he has to pay for it)..but whn ur already going under the knife and have to break ur bone any way why not get something extra out of it😁..ig tht's wht his plan is.

Bob · « **Reply #182 on:** May 13, 2021, 04:51:27 PM »

Quote from: California2 on May 02, 2019, 06:05:23 PM

Here are several photo montages created by Dr. Kulesh that chronicle my LL journey:

The first is my initial surgery and x-rays:

Next is Achilles Tendon Lengthening (ATL) by gradual hexapod (slow lengthening):

Third is stabilization of ATL and continued distraction (ATL hexapods removed):

Fourth is final correction via hexapod and LATN nail insertion:

How are you doing - do you have any knee pain or other issues with having putting nails inside your tibias?

Limb Lengthening Forum

Author Topic: St. Petersburg Lengthening -- DISTRACTION COMPLETED (Read 20798 times)