No More Mal-Kahn-Tent - External Tibias - Dr Parihar

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Quote from: CCMidwest on August 03, 2016, 08:29:18 PMHey Kilo,

Is there a thread on CECS somewhere? Google isn't helping me much. It's one of the LL related issues I don't know much about, and I plan to also talk to the doctor about tibia LL during the consult.

Thanks man.

I don't think there's a whole thread dedicated to the subject, but MDOW ended up with CECS and here's what he had to say about it:

http://www.limblengtheningforum.com/index.php?topic=680.msg10966#msg10966

His CECS developed after CLL but I have a hunch that what I thought was shin splints from being fat before surgery was actually CECS, and now that I'm trying to run a lot more it's just affecting me more than it used to. I'm getting a referral this month to test for it.

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I thought it was just an LL thing, didn't know it could just happen anyway. Got it, thanks Kilo.

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Quote from: CCMidwest on August 03, 2016, 08:49:49 PMI thought it was just an LL thing, didn't know it could just happen anyway. Got it, thanks Kilo.

Yeah, quite a few athletes get it. Here's a really interesting and detailed case report about a special forces soldier who developed CECS.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811735/

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Update: 8/22/2016
This morning I saw the local orthopedist who removed my frames last year because I wanted to see if I have Chronic Exertional Compartment Syndrome (CECS). I told him about my symptoms of pressure building up on the front and side of my shins whenever I start running, walk up a steep incline for a long time, or carry something heavy for a while.

He checked my dorsiflexion and said I was still a little tight, although that wouldn't account for the pain I've been experiencing. What surprised me is that he said I shouldn't have started high impact activities yet and that with 6 cm of lengthening I should wait for a full year starting from my last set of x-rays taken after frame removal. Since my last set of x-rays was taken January, 2016 he said I need to stop any sort of running starting now and wait until January, 2017. He also told me that doing strength training on my calves will only aggravate the problem and to stop trying to build mass. Instead, he wants me to focus on improving my flexibility and endurance conditioning. The exercises he wants me to focus on are: swimming, elliptical, spinning, and rowing. Ideally he wants me to progress slowly, starting with 15 minutes each exercise, then ice my legs once I'm done. Later on he'll want me to increase the duration. If I see no improvement come January, he said he'll refer me to a foot and ankle specialist who will test for CECS by having me do high intensity exercises for 20 minutes or so and then stick a needle in each compartment to check the pressure. He said the reason he doesn't want to test me for CECS right away is because compared to a lot of lengthening patients he's seen I've had a great result and he doesn't want to set me back by having me go through a surgery and recovery phase once again.

Btw, I have a slight bulge on the  side of each calf that pops up whenever I exercise or have my feet in a neutral position. It's more noticeable on the left leg. My ortho said the reason it's there is because apparently Dr Parihar intentionally cut the fascia to give the muscle more room to expand and prevent CECS from happening. But if it turns out that I do have CECS in a different compartment, he said they'll do the same thing Dr Parihar did but in a different compartment, and I'll have another one of those bumps on each leg. He said that they try as much as possible not to cut the fascia on female patients because women really hate it (a lot of them complain that it looks like they have a cyst).

Took a pic to show you what the legs look like. You'll notice that there's an indentation on my thighs by the knee, and it's the result of muscle loss. Even with tibial lengthening, your thighs take the biggest hit with muscle loss. It's taking a long time to build them back up.

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I think swiming with flippers is very good for the recovery in tibias lengthening and walking in the beach are the best exercises for this recovery.

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KiloKAHN, I thought Parihar requires patients to have a caretaker? How come you were able to do it alone?

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Quote from: paco1 on August 24, 2016, 06:37:36 PMI think swiming with flippers is very good for the recovery in tibias lengthening and walking in the beach are the best exercises for this recovery.

I swam at the gym the other day. A great conditioning workout for the muscles, even though I'm not that good at swimming. I really don't want another surgery so I'm doing all I can.

Quote from: sexmachine on August 28, 2016, 12:45:35 AMKiloKAHN, I thought Parihar requires patients to have a caretaker? How come you were able to do it alone?

He requires a family member or caretaker present for local Indian patients. For international patients, if you stay in a hotel the staff acts as caretakers since they have room service, cleaning, laundry and the like. So he doesn't make you hire a caretaker (in fact he brought someone in to act as mine for my first week in the hospital), but he does insist that a friend or family member is informed that you will be undergoing surgery at his hospital before he agrees to accept you as a patient.

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Quote from: sexmachine on August 27, 2016, 05:25:31 AMI'm graduating soon and I was wondering when should I schedule a surgery with Dr. Parihar? (1 year before or 3 months before etc)

Also, how much money should I save in total for this surgery? Because I read your post that it will cost about 30,000 USD in total, not including food and other stuff. In your case, how much did you spend in total?

Lastly, how many months after surgery were you able to go back to work? Was it after you got your frames removed?

Answering your message here so others can see.

I sent an email to Dr Parihar in May, 2014 requesting a consultation and told him that my flight was confirmed for June 10. He replied with dates that were open for him and after I picked he told me what time of day to come in. I recommend deciding on a month that you think works best for you and then asking him if he's avaliable then for consultation plus surgery at the time you picked before you buy a plane ticket. There are times when he has a lot of reconstructive patients and won't take any new CLL ones until his schedule is more open and it would suck if you flew out there only to be told that he wasn't taking new CLL patients for a while. So you could get lucky and he'll be available within a week or you might be told to schedule for months down the line.

Here's the list of expenses I put together after I returned home (2014 exchange rate):

Surgery   -  $14,977 / 900,000 INR

X-Rays & Appointment  -  $240.00 (charges at front desk ranged between 1,000 - 3,000 INR. I think it depended on how much time I spent in Dr's office)

Physiotherapy at Hotel -  $17.00 / 1,000 INR per session (Mr Chaudhary's rate)

Medications      -  $40.00

Zimmer Frame  -   $60.00

Wheelchair through Mr Shringare  -   $434.00 / 26,000 INR (I bought the most expensive wheelchair in the catalog but there were many cheaper options available)

Mr Shringare's Custom Splints  -   $55.00 (I recommend each patient to get splints made through him. The splints from local carpenters would eventually break from tension but Mr Shringare's were very sturdy and never did)

Dressings  -   $265.00 (each box cost 600 INR and had enough gauze for 2.5 changes)

Hotel Stay  -   $1,500 per month (at Hotel Maharana Inn)

It only goes up to $30,000+ expenses when you factor in lost income from not working while lengthening.  I was able to go to work a week after I returned with frames on and in a wheelchair with a blanket covering my legs. I had a desk job though and my position was one in the company where I didn't have to move a lot. I can't imagine any other scenario where I could work in frames though. If you have to move around a lot for work then I don't see a way to go back until you get your frames removed, which could mean a year of unemployment.

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It'll be cheaper now. The rupee has gone down. For example, $14,977 isn't 900,000INR.. it's 1,005,555.

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Quote from: KiloKAHN on August 28, 2016, 03:22:47 AMI swam at the gym the other day. A great conditioning workout for the muscles, even though I'm not that good at swimming. I really don't want another surgery so I'm doing all I can.

He requires a family member or caretaker present for local Indian patients. For international patients, if you stay in a hotel the staff acts as caretakers since they have room service, cleaning, laundry and the like. So he doesn't make you hire a caretaker (in fact he brought someone in to act as mine for my first week in the hospital), but he does insist that a friend or family member is informed that you will be undergoing surgery at his hospital before he agrees to accept you as a patient.

Whaat, so he has to talk to a friend or a relative before the surgery? I live with a friend so he will know about it, but does he really have to talk to Dr. Parihar?