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[Gichelu]

What time of year do you think it's best to come to Pretoria based on weather? I heard south africa is hot but if I come for consultation I'd like it to be in the cooler months.

[Daylight]

Is anyone here asking for visa to SA? My parents will be supporting me with the money. I have less than $2000 in the bank. I dont know if they will provide me the visa seeing that my money has been decreasing only( I am a student without a job).

[Daylight]

This whole visa thing is the only reason why I am not being in SA with DR Franz right now....

[yugiohja]

Hi Dr Franz,
Is there any benefit for bone consolidation if the climate is especially warm/cold or if temperature affects the rate of consolidation at all?

[theuprising]

Sorry Dr Franz I should have specified further as to the cost in rand?

Thanks

[Daylight]

Did you send them Xray already?   If it's PRECISE nail  then they need 4 weeks to order the right size for you.

I am going to do LON. Visa is a pain in the ass because there is no ambassador in my city.

[mediocre]

Get email inquiry from Dr Franz secretary and they can provide you with date possible for  and you can request for letter of consultation that you will show to SA Embassy.

[mediocre]

I went there late April and weather that time is perfect (for me). It's sunny but cool.

What time of year do you think it's best to come to Pretoria based on weather? I heard south africa is hot but if I come for consultation I'd like it to be in the cooler months.

[ShortyMcShort]

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...

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.

Hi Dr B, Im very curious regarding this method. How long would it take to achieve a goal of 11cms(5 tibia and 6 femur) and how long does a patient need to stay in South Africa for before they can go home and into consolidation? I understand every patient is different but could you give a rough estimate of how much time is needed for this kind of procedure?
Thanks

[Franz]

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

It is always safer to follow your own docs guidelines. It is unlikely that the bone will suddenly break with exertion after removal. Should the bone still be soft, it may bend slowly. Once fully consolidated, it will not go anywhere.

[Franz]

What time of year do you think it's best to come to Pretoria based on weather? I heard south africa is hot but if I come for consultation I'd like it to be in the cooler months.

Any time is good. In winter (currently) temperatures range from 0 degrees celsius at night to around 20 degrees at midday. In summer temps range between 15 and 32 generally. The hospital is airconditioned, though.

[Franz]

Hi Dr Franz,
Is there any benefit for bone consolidation if the climate is especially warm/cold or if temperature affects the rate of consolidation at all?

Interesting question. I am not aware of any relationship between temperature and bone consolidation. Because the Ilizarov method was devised in Siberia, maybe cold is beneficial...it could also be the vodka...lol.

[Franz]

Did you send them Xray already?   If it's PRECISE nail  then they need 4 weeks to order the right size for you.

Jip, our lead time needed for Precice 2 is around 2-4 weeks.

[Franz]

Sorry Dr Franz I should have specified further as to the cost in rand?

Thanks

The cost in rand will essentially be the same as the cost in usd at the current conversion rate. Thw absolute value is a bit difficult to pin down for this reason. Should the patient be a South african, some costs could be saved if they use their own accommodation etc.

[Franz]

Hi Dr B, Im very curious regarding this method. How long would it take to achieve a goal of 11cms(5 tibia and 6 femur) and how long does a patient need to stay in South Africa for before they can go home and into consolidation? I understand every patient is different but could you give a rough estimate of how much time is needed for this kind of procedure?
Thanks

Essentially the minimum time in SA would be 90 days, which is the same as for the precice 2 bilateral femorals. The patient could then go home and consolidate and return for the opposite combination after around 9 months. The femur must be strong enough to carry full weight. In total, I think the shortest time to reasonable recovery should be around 18m-2yrs.
Cost will be in the region of 42K USD per step, ie a total of 84K for all 4 segments.

[ShortyMcShort]

Thanks for the quick reply Dr B, one last question. What are the advantages of doing it that way over say Precice femur(both femurs) first and then going home to consolidate and then coming back a year or so later to do the tibias? Could a precice femur patient be able to come back and do their tibias after 9 months as well? Theoretically speaking of course

[Franz]

Thanks for the quick reply Dr B, one last question. What are the advantages of doing it that way over say Precice femur(both femurs) first and then going home to consolidate and then coming back a year or so later to do the tibias? Could a precice femur patient be able to come back and do their tibias after 9 months as well? Theoretically speaking of course

The biggest advantage would be the ability to weight bear on the exfix side theoretically.
Jip if the bone growth is good.

[Taller]

Hello Dr. B. Hope you're having a good day. I was wondering if, should a CLL patient have a natural tibia/femur ratio of 0.8, they should lengthen their tibiae or femurs to have better athletic recovery and favorable walking mechanics. How far beyond the 0.8 ratio can patients go, generally speaking with regards to single segment lengthening of femur or tibiae, before mechanics start to suffer and arthritis becomes a concern?

Thank you.

[Franz]

Hello Dr. B. Hope you're having a good day. I was wondering if, should a CLL patient have a natural tibia/femur ratio of 0.8, they should lengthen their tibiae or femurs to have better athletic recovery and favorable walking mechanics. How far beyond the 0.8 ratio can patients go, generally speaking with regards to single segment lengthening of femur or tibiae, before mechanics start to suffer and arthritis becomes a concern?

Thank you.

Thanks. I did have quite a busy day with 7 operations, but am able to relax now.
I am not aware of a lot of scientific literature on the topic.
It is however true that visually, tibial lengthening has more of an effect. Ie tibial lengthening looks longer than femoral.

[Franz]

For most people a 5cm tibial lengthening should not result in major functional longterm issues, as the ratio is changed from around 0.8 to 0.95.

[alps]

Hi Dr. Franz,
Often, I wonder if when I undergo LL, I'm putting myself in a situation where even a slight waver of the surgeon's hand can leave a life-long impact on my legs. 
Is this true to an extent?
You say you did 7 surgeries in a single day, and I wonder if a surgery is a "monotonous" job.

If I went to a "hair dressing machine" that did a fixed hair-style, I wouldn't feel scared even if I have to live that hair-style for the rest of my life (and my hair won't grow back, say ). It is monotonous to the machine, and I wouldn't think anything would go wrong.

But if is a barber who's doing it routinely on a large chain of people, I would have my fears.

poor example, but I hope you got my point.
What is your take on this?

[KrP1]

DR Franz. I want to know your opinion about doing femurs with externals. Do you think is very risky to do 5/6cm with monorail? And LON in femurs?

[Franz]

DR Franz. I want to know your opinion about doing femurs with externals. Do you think is very risky to do 5/6cm with monorail? And LON in femurs?

LON in femurs is very difficult to do and hence has a relatively high complication rate. It is not recommended for cll.
Monorail femurs have a high risk of knee stiffness and is not recommended.
Should an exfix be considered, I would strongly recommend opting for a tibial procedure.

[Franz]

Hi Dr. Franz,
Often, I wonder if when I undergo LL, I'm putting myself in a situation where even a slight waver of the surgeon's hand can leave a life-long impact on my legs. 
Is this true to an extent?
You say you did 7 surgeries in a single day, and I wonder if a surgery is a "monotonous" job.

If I went to a "hair dressing machine" that did a fixed hair-style, I wouldn't feel scared even if I have to live that hair-style for the rest of my life (and my hair won't grow back, say ). It is monotonous to the machine, and I wouldn't think anything would go wrong.

But if is a barber who's doing it routinely on a large chain of people, I would have my fears.

poor example, but I hope you got my point.
What is your take on this?

An interesting point. Whereas the techniques used during an operation (eg suturing) may be repeated so often that they become engrained in muscle memory, it is important for us as surgeons to remember that each 'case' is in fact a person with hopes, fears etc. Each patient is different and needs the personal, human touch. This is why I think we will not be replaced by machines too soon. We can however harness technology to make us better surgeons. An example would be the hexapod fixators like the tsf or tlhex.
The day I do 7 cases on a list and forget that they belong to 7 patients and their families is the day I should hang up my gloves.

[alps]

An interesting point. Whereas the techniques used during an operation (eg suturing) may be repeated so often that they become engrained in muscle memory, it is important for us as surgeons to remember that each 'case' is in fact a person with hopes, fears etc. Each patient is different and needs the personal, human touch. This is why I think we will not be replaced by machines too soon. We can however harness technology to make us better surgeons. An example would be the hexapod fixators like the tsf or tlhex.
The day I do 7 cases on a list and forget that they belong to 7 patients and their families is the day I should hang up my gloves.

But are there any *critical* actions? You do it just *once* and if you felt like sneezing while doing it... there it goes.

[G-Man]

You can also get struck by lightening it all comes down to how dangerously you want to live your life!  When I rode my bike at 270km/h I knew that "complications" could occur, its the same with LL.

[theuprising]

But are there any *critical* actions? You do it just *once* and if you felt like sneezing while doing it... there it goes.

What like Dr Franz sneezes and next thing you know you don't have a right foot anymore?
I think its highly unlikely that anything like that would ever happen also even if you knew about it you're under anesthetic so
your knowledge about critical points in a surgical operation would not matter anyway.

You just have to trust your surgeon.   

[alps]

Of course, there is no

What like Dr Franz sneezes and next thing you know you don't have a right foot anymore?

well, kinda. Not that serious, but a serious complication at a later stage? Of course I'm *asking* about this and not suggesting this is true.
And yeah, it's just to know what I'm signing up for and not about how I'll react during the surgery, lol.

[GeTs]

I think there's a team who do this surgery, all highly experienced doctors who know and control every single step, hence why you pay that much

[Franz]

I think there's a team who do this surgery, all highly experienced doctors who know and control every single step, hence why you pay that much

I guess this is why we spend 14 years at University...

[f458]

Franz  pics not wotk can you upload some photos from hospital? rooms. etc.