Ilike8cm - External Tibias - Dr. Xia - 2012 - OUCH THAT HURTS!!!

[egghead]

Hi Ilike8cm,

I know that you and Princess were not buddies but nevertheless, after you mentioned your internet got cut off, I worried that she's not okay. China's Communist and I assume there is not fully free speech. Do you know if she's okay? Sorry to ask on your diary but it didn't feel like her writing on her last post so I just worried a bit and wanted to know that she's okay there.

Thanks for you're diary. It's really educational and interesting to read. You're very giving to everyone. I wish the best in finishing up your LL and coming home taller. Your attitude is great.

[hotdawg]

@Ilike8cm:  Ice Cube

[luffy]

Yan cheeeee lol she was my maid

Nice videos and pictures

[Dookieman]

ILike8CM - You are right about that. Plus if it does work you come out a double winner!

[Ilike8cm]

Hi Ilike8cm,

I know that you and Princess were not buddies but nevertheless, after you mentioned your internet got cut off, I worried that she's not okay. China's Communist and I assume there is not fully free speech. Do you know if she's okay? Sorry to ask on your diary but it didn't feel like her writing on her last post so I just worried a bit and wanted to know that she's okay there.

Thanks for you're diary. It's really educational and interesting to read. You're very giving to everyone. I wish the best in finishing up your LL and coming home taller. Your attitude is great.

The other patients told me she went back home to the states. I didn't believe it but it's true. @deus knows more details. Supposedly she couldn't eat anything...hospital food or restaurant food.

I would have not known china was communist if it wasnt for what we hear in the media or learned in school. Living in china for 2 months already, the only thing I noticed from out of ordinary is all the porn sites I access back home are blocked here. That and facebook YouTube twitter VPN etc. Kick ass torrents provides more than enough variety of porn so no prob from me.

Hope that answers your questions.

[Deus Ex]

Both my legs are strong. I can walk far (my room to fish pond and back plus some) and for a long period of time (over 1 hour). I am really surprised that I do not have any pin loss considering how much I walk and exercise.

I have recently started to ride the stationary bike…probably was tanor’s bike so thank you! I typically ride for about half an hour. During this time, I would watch a Fluenz Mandarin video. I have made lots of progress on this bike…getting stronger and faster every day.

Because I ride the bike everyday and I break lots of sweat after the session (in the morning), I have started to shower at least once a day. Sometimes I would shower twice a day depending on how much I sweat later on in the day.

Knee bending:
I am starting to develop knee bending; most noticeably in my left leg. @deus says it is nothing to worry about because my knee eventually goes down…however it is taking longer and longer for it to go down completely. Whenever I bend and straighten my legs, I am feeling pin cutting again…perhaps this is due to turning more frequently.

Dude you're like exercising more than JoeDud, me and AL4N combined have done in 4 months lol.

And the lack of pin loss might be because of your weight.

And for your knee bending, if you start to feel that it's getting longer and longer for them to go down you can start sandbagging early.
I mean you do all the other exercises so sandbagging 30 min - 1 hour a day should be nothing + you can sandbag and Fluenz at the same time or something

[Ilike8cm]

Yeah that's a good question? LON seems superior compared to LATN. LON makes it so that you can bear weight throughout the lengthening process much easier. From what I have heard, it's nice to be able to exercise and move around during this whole process. The only advantage I think LATN has is that it reduces initial trauma, and reduces bone infections which are rare anyway.

From my understanding, there are 3 schools of thought regarding external fixators. Kurgan (external w/o rod), Beijing (LATN), and India (LON).  Kurgan strongly disapproves internal rod altogether...this is the ideal method but is not feasible due to most patients' time constraints. Who wants to have frames on during the whole time their bone consolidates? Could be more than 1 year.

The only difference between LON and LATN is the timing of the internal rod. LON inserts the rod during the first surgery. Beijing used to do LON but moved onto LATN. Beijing believes that inserting the rod during the 2nd surgery is better and here is why:

Bone grows from the inside out. LON deters bone growth because the rod takes up place where bone initially grows...from the center...bone marrow and such. Without the rod, bone grows quicker than with rod. No news here. As bone grows stronger and stronger...the center is somewhat no longer needed because the outer bone is dense and strong and weight bearing.  Once LATN finishes lengthening, the rod insertion does screw up with existing mushy bone marrow stuff..not this stuff is not as important after lengthening than during lengthening.

One misconception about LON is the internal rod helps with weight bearing. This is false. The internal rod is locked during the 2nd surgery after patient finishes lengthening.  Therefore the internal rod is suspended ...the rod is NOT locked....if the rod was locked, patient cannot lengthen.

The only benefit I can see from LON is that it prevents bone protrusion (bone popping out, slight misalignment). However, bone protrusion is a small problem compared to possibility of poor bone growth. Beijing has done both LON and LATN and decided LATN is better for their patients. As for me, I have not the greatest bone growth so I lucked out by choosing LATN. If I chose LON, this LL journey would have been a little harder.

If what I wrote above is correct...then why are doctors elsewhere still performing LON?

[jmnj06]

Thanks for that explanation man,

You were saying when they insert the rod during the second surgery it will break apart the boney bridge and marrow that has already formed, so wouldn't LON be better because it would not interfere with the boney bridge because its already forming around the nail and all they have to do is nail the proximal and distal areas once distraction is completed?

[Ilike8cm]

Holy shi* good question. I have no idea. All i do is speculate and use common sense.

I think bone marrow and the soft goey stuff is important for initial bone growth... like a tree...the stem (trunk) of the tree starts small...thin.. then as it grows it develops rings and rings. Once has has develop some rings, you can cut out the center and it would still maintain its structural integrity. I think what is more important is bone growth during lengthening than bone growth after lengthening....bone growth after lengthening..you have unlimited time...but while you lengthen...you are limited on time and other resources.

Since Beijing has has done both LON and LATN... and hasn't switched back...and I am sure they have good reasons. It is just not 1 doctor here...it is a group of doctors here. I actually asked the doctor a while back and their answer was it is better for bone growth. I guess it is apparent that the cost vs. benefit for this Beijing clinic favors LATN.

[jmnj06]

Thanks man,

So what your saying when they insert the rod it will break apart the bone marrow but will not break apart the boney bridge (outer layer) that has formed during distraction.

The boney bridge just looks like a cloud on xrays and it seems so easy to break apart especially if your having a second surgery that disrupts that area.

[balzakin]

This is interesting discussion. Food my reading on the inter webs, there are two types of marrow, red and yellow. Both types contain blood vessels which I guess supplies nutrients to your bones. So if you scoop out the marrow it wouldn't be as good. I think marrow regenerates quickly though. It would be good to hear some doctors opinion instead of us speculating.

Another thing I noticed is that Beijing patients seem to endure a bit less pain than others. Or they are less vocal about it...

[Ilike8cm]

I see it as:

The best external method is NO internal rod. If that cannot be achieved due to time constraints than, less rod is better than more rod.

With LATN, you can decide if you want internal rod or not after you lengthen...however with LON, there is no option.

----------------------------

Becomehappy is a new patient here in Beijing and she had her surgery 7/19/2012. I hope she does not mind me sharing this information with you all. She seems to be very easy going gal and mentally strong and I hope this journey is easy for her as it is for me.

[Ani]

I see it as:

The best external method is NO internal rod.  If that cannot be achieved due to time constraints than, less rod is better than more rod.

With LATN, you can decide if you want internal rod or not after you lengthen. . . however with LON, there is no option.

----------------------------

Becomehappy is a new patient here in Beijing and she had her surgery 7/19/2012.  I hope she does not mind me sharing this information with you all.  She seems to be very easy going gal and mentally strong and I hope this journey is easy for her as it is for me.  :)

Hi Ilike8cm,

I am quite curious about your statement regarding internal rods and was wondering if you can explain why less rod is better.  Also, in your opinion, which external method is better and with less complication?

Thanks
Ani

[Gregory]

I see it as:

The best external method is NO internal rod. If that cannot be achieved due to time constraints than, less rod is better than more rod.

With LATN, you can decide if you want internal rod or not after you lengthen...however with LON, there is no option.

----------------------------

Becomehappy is a new patient here in Beijing and she had her surgery 7/19/2012. I hope she does not mind me sharing this information with you all. She seems to be very easy going gal and mentally strong and I hope this journey is easy for her as it is for me.

I absolutely agree with you on this one Ilike8cm. Dr Xia created the internal rod supposedly so any patient who finished lengthening and began the consolidation period could go home and out into the real world, and could begin walking, without having to have the ugly external frames attached until the end of the consolidation period. And indeed, with the internal rod, one can go home without the ugly frame, but then the rod and the nails are relatively weak so you have to be really careful of what you do because if not the screws can break, the rod can bend, or things at the nail-rod meeting point can get even if just a bit misaligned with a few careless stomps (and these do happen to most); so it still means you have to careful and be most frequently in bed or in a couch for about 4-6 months post second surgery, which totally defeats the purpose of the internal rod to begin with. When I was in china, I remember there was a Chinese girl that did all externals with no rods (at her request), and she was done with all aspects of LL 9 months after her initial surgery (not to mention that meant only 2 surgeries as opposed to 3 [1 less surgery to pay for]). For most of us that do internal rods, we are not done until after 2 years from the initial surgery, and for one of those years, we still won't be able to walk like normal human beings. If I could choose again, I would have asked to have no internal rod at all.

[jmnj06]

If I could choose again, I would have asked to have no internal rod at all.

Gregory thanks for your input,

But how about all the places that uses LON? When they lengthen the bony bridge forms around the rod, and when they are done distracting all they have to do is a minor surgery of locking the nail at both ends.

[egghead]

I'm curious if there have been incidents of the rod breaking during removal. If so, what happens then? Does anybody know if there have been any problems with rod removal and if so, what would cause this?

[Ilike8cm]

I found this great resource and wanted to share to all those considering Ilizarov:

http://www.ilizarov.org/INST01.html

[Levi]

Thanks for the link.

[balzakin]

I found this great resource and wanted to share to all those considering Ilizarov:

http://www.ilizarov.org/INST01.html

http://www.makemetaller.org/index.php/topic,845.0.html

[stevie]

Time to update your diary, man. We would love to hear more from you. How are your legs? Any pain? How much taller are you now? take more pictures...