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[theuprising]

Dr B regarding safety in S.A. Are there any special security precautions that have to be taken
in day to day life.

[Franz]

Hello, Dr. Birkholtz,
Can you please give a rough estimation, for a normal patient, after how many months can he walk in crunches ?
Thank you,

It depends on the type of technique we use. For external fixator based lengthenings we encourage full weight bearing as soon as possible. In general, for bilateral cases, most patients are walking on crutches before discharge from hospital and progress to full weight bearing over the next 6 weeks or so.
For Precice 2, it depends on the patients weight. If you weigh below 150 pounds, we can get you onto crutches pretty soon, provided weight is shared between the two legs. Most patients should be on crutches by 6 weeks though.

[Franz]

Dr B regarding safety in S.A. Are there any special security precautions that have to be taken
in day to day life.

This is a good and very important question.
South Africa is not the safest place in the world, but common sense keeps most of us safe.
Don't walk around after dark, avoid danger areas, don't get drunk and pass out, be careful with personal belongings, especially electronics, don't visibly display cash etc etc.
The area around the hospital and guesthouses is safe with ample security in and around the hospital. We are also located close to a police station (2 street blocks away).

Whereas I cannot say that crime is not a problem, some basic precautions will keep you safer than in most places in the developing world.

As I said before: Remember, I raise my kids here...

[Medium Drink Of Water]

How much would it cost to do Precise with just a two week hospital stay in South Africa, and to have the device removed in another country?

[Franz]

How much would it cost to do Precise with just a two week hospital stay in South Africa, and to have the device removed in another country?

Our recommendation is for you to stay in Pretoria for 3 months. In certain selected cases this may be dropped to 6 weeks, but not less.
This is in the interest of patient safety.

[theuprising]

I was looking into South Africa's visa situation where if you want to stay over 3 months you need a visa,
has anyone who's been there know which one you would need for having LL there. Planning to be there
6 months.

[shawty]

With the limit of 5cm on tibias and possible bone shrinkage (I forgot the exact term) it's recommended to do .5-1cm extra.  Does that mean max a person can get 4 -4.5 cm on tibias or the bone will be stretched to 5.5-6 cm to get a final gain of 5cm. Sorry if my question isn't written well. It's way too early for me here and is my day off, so I'm still in bed.

[JP]

Hello Dr. Franz and thank you for your help.

In general,  the nerve deterioration starts how many years after limb lengthening and how many ways can nerve deterioration affect my health?

[Franz]

With the limit of 5cm on tibias and possible bone shrinkage (I forgot the exact term) it's recommended to do .5-1cm extra.  Does that mean max a person can get 4 -4.5 cm on tibias or the bone will be stretched to 5.5-6 cm to get a final gain of 5cm. Sorry if my question isn't written well. It's way too early for me here and is my day off, so I'm still in bed.

I would suggest overlengthening a bit to prevent subsidence.

[Franz]

Hello Dr. Franz and thank you for your help.

In general,  the nerve deterioration starts how many years after limb lengthening and how many ways can nerve deterioration affect my health?

Not sure I follow you... nerve deterioration?

Nerve injury or neurological deficit due to stretching happens during distraction.

I am not aware of nerve deterioration starting late after lengthening.

[Wannabegiant]

Dr Franz,

I looked at some studies earlier about subsidence after LL, and this is the most interesting study i found:

http://informahealthcare.com/doi/full/10.3109/17453674.2010.533934

Im wondering if you have read this study before and what you think about it. It makes a strong argument that subsidence loss is only in the 0.6 mm or lower range. It also directly argues against earlier studies which claimed losses of 1 cm or more.

Is most of your current knowledge of subsidence based on your own experience in the field or from reading studies like this one?

thank you

[gettingtaller]

All of the countries in Africa are a total mess, even South Africa.

Says the world expert sweden whose international expertise probably derives from American news channels and not his own travel or personal experiences. So now I know you hate Muslims and think ALL of Africa is a mess.  Please stop spreading misinformation. Stick to LL and martial arts as these are things u have first hand experience of.

SA can be unsafe but it's a modern country with Western levels of health care if you pay for it. Probably a lot safer than India. I've been to both places more than 10 times. 

[Blackhawk]

Hey gettingtaller,

That quote from Sweden was from 6 months ago and do we have to bring the Muslim topic into every thread?  Let it go.

[gettingtaller]

Hey gettingtaller,

That quote from Sweden was from 6 months ago and do we have to bring the Muslim topic into every thread?  Let it go.

Apologies.  This is the only time I've brought this up though. Sorry but I just very wound up at false bad information being put across in an overly confident way. It's simply not good for the people that don't know better and factor it into their decision making. I'll shut up about the Muslim thing but I'll continue to call out misinformation. Hope that's on.

[Blackhawk]

Apologies.  This is the only time I've brought this up though. Sorry but I just very wound up at false bad information being put across in an overly confident way. It's simply not good for the people that don't know better and factor it into their decision making. I'll shut up about the Muslim thing but I'll continue to call out misinformation. Hope that's on.

Sorry if I sounded rude.  Dr. Franz has voiced his disapproval about some of the comments and language used on this forum.  Dr. Franz is an asset to this forum and I hope that he continues to contribute to this forum.  I also hope to visit him in South Africa in a couple years so I hope he continues posting.

[gettingtaller]

Question for Dr Franz (assuming he has time!).

Is your safe limit in place to minimise issues during lengthening/consolidation? Or are you looking to reduce risk beyond that? If the latter, then what risks due you perceive. Obviously, you will see from my sig that I am already well beyond your safe limit so wondered that since my LL has thus far (touch wood) been pretty easy, am I in your opinion storing up problems for later on in life?

[ShortyMcShort]

Also, gettingtaller do you have a diary on here or the old forum?

[gettingtaller]

Also, gettingtaller do you have a diary on here or the old forum?

I'm sorry. Never got round to creating a diary.
A little too busy (and disorganised) to keep one current.
Happy to answer any questions in the betz thread (probably the most relevant place to consolidate as there are other betz patients looking in there).

[Muse]

(Mods you can make a new thread from my posts if you think I'm hijacking Dr Franz thread)

New thread moved here:  http://www.limblengtheningforum.com/index.php?topic=663.0

[Franz]

Dr Franz,

I looked at some studies earlier about subsidence after LL, and this is the most interesting study i found:

http://informahealthcare.com/doi/full/10.3109/17453674.2010.533934

Im wondering if you have read this study before and what you think about it. It makes a strong argument that subsidence loss is only in the 0.6 mm or lower range. It also directly argues against earlier studies which claimed losses of 1 cm or more.

Is most of your current knowledge of subsidence based on your own experience in the field or from reading studies like this one?

thank you

It is a combination, but mostly from discussions with other surgeons. It is a phenomenon that is poorly understood. I do think the larger subsidence values would be because of soft regenerates at frame removal.

[theuprising]

Hello again Dr B, after lengthening is complete do you remove the nails or plates from the body. If so is this a separate cost?

[Franz]

Question for Dr Franz (assuming he has time!).

Is your safe limit in place to minimise issues during lengthening/consolidation? Or are you looking to reduce risk beyond that? If the latter, then what risks due you perceive. Obviously, you will see from my sig that I am already well beyond your safe limit so wondered that since my LL has thus far (touch wood) been pretty easy, am I in your opinion storing up problems for later on in life?

Both. Larger lengthenings have more complications both during lengthening and longer afterwards.
Hopefully you will be OK. Sounds like youre doing very well so far.

[Franz]

Hello again Dr B, after lengthening is complete do you remove the nails or plates from the body. If so is this a separate cost?

Its better to remove the nails, as we do not know what the longterm effects of the precice magnets would be. The nail also has moving parts which conceivably could cause metal debris theoretically. Plates I would leave up to the patient to decide.
Cost for removal around 2K USD at the day surgery clinic.

[GeTs]

do you know how much do you have to wait before u're able to run if u do 5cm on tibiae with ilizarov external device, and also for lengthening and consolidation how much should I expect ( 8 months?)

[GeTs]

can you please answer to me franz?

[Franz]

do you know how much do you have to wait before u're able to run if u do 5cm on tibiae with ilizarov external device, and also for lengthening and consolidation how much should I expect ( 8 months?)

Lengthening and consolidation in externals takes 1.5 - 2 months per cm. this means 7.5 - 10 months in frames.
Comfortable running should be possible 6-9 months after frame removal, but is difficult to predict.

[theuprising]

Dr Franz I'm curious to get your opinion on lengthening two segments at once on the same leg e.g tibia+femur on right leg while weight bearing
on the left then proceeding to lengthen the left after the right leg has sufficiently healed as some Doctors suggest.

Also do you accept payment in rand?

 

[Franz]

Dr Franz I'm curious to get your opinion on lengthening two segments at once on the same leg e.g tibia+femur on right leg while weight bearing
on the left then proceeding to lengthen the left after the right leg has sufficiently healed as some Doctors suggest.

Also do you accept payment in rand?

 

We do accept Rands. It has Mandela's face on it afterall! The reason we quote in USD is that it is more universally used...

Two possible scenarios: do one side first, ipsilateral femur and tibia. Good, but will result in a leg length discrepancy until the second side is done. If the second side is never done because of pain, finances etc, it means we have turned you into a 'cripple'.
The second scenario (preferred), is to perform femoral precice on the one side with an exfix tibial lengthening on the other of roughly equal amounts. This means the overall leg lengths stay the same throughout and the exfix leg becomes the weight bearing leg. Again, if we do not proceed with the second phase, the knees will end up on different levels, but at least the legs will be roughly equal in length.

If a patient is very committed I would choose the second option.

[Wannabegiant]

I allow full weight bearing from day one as much as the patient can tolerate. If you want to jump, you are welcome to (as long as it is not off a buiding! :-). Generally I would say that jumping comfortably would be similar to running.
Our fastest healers have been at just below 1 month per cm (28 days), but the average is around 1.3 - 1.5. Not to create false hope, we add another 0.5.

Ah I see!

Just to make sure im not misinterpreting you, do you mean that after the frames have been removed, it is already possible to run and jump from day one? but "comfortable" running will be possible on average after 6 months after frame removal like you mentioned earlier?

is this because of muscle atrophy and the body needing to relearn how to run the reason why running comfortably takes so long after frame removal?

Thank you again Dr Franz!

[Franz]

Ah I see!

Just to make sure im not misinterpreting you, do you mean that after the frames have been removed, it is already possible to run and jump from day one? but "comfortable" running will be possible on average after 6 months after frame removal like you mentioned earlier?

is this because of muscle atrophy and the body needing to relearn how to run the reason why running comfortably takes so long after frame removal?

Thank you again Dr Franz!

It is so difficult to predict exactly, but I would certainly allow a patient to run on a fully conslidated bone. Whether it would be comfortable is an entirely different question...

[Wannabegiant]

It is so difficult to predict exactly, but I would certainly allow a patient to run on a fully conslidated bone. Whether it would be comfortable is an entirely different question...

Okey i understand what youre saying 

Im just confused because my own doctor (or his assistant rather) told me that the bone wouldnt exactly be 100% consolidated until about 6 months to a full year after frame removal, but strong enough to walk on the day they remove the frames.

And they adviced me not to do sports or work out the legs like doing legpress until the bone was strong enough, apparantly according to them it isnt strong enough for those activities when they remove the frames.

I didnt get an specific answer from them (its hard because they dont speak english very well) but i assume i would risk a fracture if i didnt follow those instructions, maybe even lose height due to compression? (like subsidence maybe?)

Sorry for making the question so convoluted, but im very paranoid about this stuff, thank you again for your help  Dr. Franz