Quote from: Arche on February 15, 2014, 08:08:26 PMDear Dr. Birkholtz,
Thank you so much for your reply back. I apologize if I have bothered you in any way. I truly appreciate what you have done for this community.
No problemo. Thanks for the kind words.
Dr. Birkholtz,
Would you ever consider doing quadrilateral lengthening with PRECICE 2? What would be your upper lengthening limit with this process? How much would this cost?
What are the risks associated with quadrilateral lengthening? How long would someone be expected to be in a wheelchair for lengthening 12 cm in total?
Thank you so much for taking time out of your busy schedule for us!!
Hi Dr Franz,
Since South Africa is quite far, if, say, we decide to do LL with you, and everything's been confirmed/paid/etc, can we just head on to Pretoria and do the LL in one go once everything's approved, or you need a personal consultation first, then return back to South Africa for the LL itself?
Do you do your own psychological assessment (just like other doctors do, like Dr Paley) or do you need a separate Psychiatrist?
Thanks.
Quote from: BilateralDamage on February 16, 2014, 03:11:10 AMDr. Birkholtz,
Would you ever consider doing quadrilateral lengthening with PRECICE 2? What would be your upper lengthening limit with this process? How much would this cost?
What are the risks associated with quadrilateral lengthening? How long would someone be expected to be in a wheelchair for lengthening 12 cm in total?
Thank you so much for taking time out of your busy schedule for us!!
Hi, it is possible, but risks of knee contracture is quite high. Maximum length around 10cm, but depends on whether range of motion can be maintained. Cost is slightly lower than for two separate events, but as the major cost drivers are theatre time and cost of the nails, it is not tremendously cheaper. The only advantage is that it is a single process.
Femur or tibia 52K. Both at the same time is around 94K.
Quote from: Franz on February 15, 2014, 04:53:55 PMWe've only had it available for a relatively short time. We've done five precice cases for indications other than cll.
Hey Dr. Birkholtz,
Your input to this forum has helped me tremendously and has elucidated many aspects of CLL that many doctors and other LL forums fail to clarify.
Just like to ask you about the five precice cases you have performed so far. Did you experience any Precice nail failure or complication that required the nail to be changed?
Quote from: Franz on February 17, 2014, 11:33:26 AMHi, it is possible, but risks of knee contracture is quite high. Maximum length around 10cm, but depends on whether range of motion can be maintained. Cost is slightly lower than for two separate events, but as the major cost drivers are theatre time and cost of the nails, it is not tremendously cheaper. The only advantage is that it is a single process.
Femur or tibia 52K. Both at the same time is around 94K.
Dear Dr. B.,
Your recent commitment to this forum has been nothing short of outstanding. There are so many questions regarding this surgery, and so much misinformation as well. I apologize if I have been annoying you in any manner.
How much would it cost to do Quad lengthening with Tibial LON and PRECISE Femurs? Would it be advisable for 10 cm?
Thank you,
Arche
Quote from: mediocre on February 16, 2014, 02:08:41 PMHi Dr Franz,
Since South Africa is quite far, if, say, we decide to do LL with you, and everything's been confirmed/paid/etc, can we just head on to Pretoria and do the LL in one go once everything's approved, or you need a personal consultation first, then return back to South Africa for the LL itself?
Do you do your own psychological assessment (just like other doctors do, like Dr Paley) or do you need a separate Psychiatrist?
Thanks.
Hi,
It is unrealistic to expect you as a patient to travel twice. My suggestion would be to follow these steps:
- make up your mind about CLL and calculate whether you have the finances (remember plane tickets and contingencies)
- contact me via email with a detailed history, including medical history. Remember your height, weight and reasons for CLL (also where you come from). No smokers! ([email protected])
- once I clear you provisionally as a suitable candidate, I will send you an xray protocol to have an xray done at home, which you can forward via email
- I will measure the Xray and we will discuss options and realistic goals.
- If you are looking for more than 5cm per segment (10 in total), please look elsewhere.
- Once we are happy to proceed, we can schedule you for a consultation and surgery.
- The consultation will be the final 'hurdle'. During this phase, we will involve my psychologist, but by this time we will know enough about you! This consultation costs $100. I will not ask for an additional deposit before this step, as long as you understand that I have the right to cancel your operation after this consultation if I do not think it is appropriate to continue for medical reasons. The previous steps should prevent this.
- Once you pass this test (which hopefully you will), we can confirm your place on the list upon receipt of payment. This can be done via eft or credit card.
- The surgery can essentially proceed within a couple of days after the consultation.
- I have a lead time to order Precice and as such, we will need to measure your xrays at least 4 weeks before the surgery date, to ensure we order the correct size nail.
- Upon scheduling the consultation, we will provisionally book your accommodation. A cancellation fee may be necessary if we do not proceed for whatever reason.
- I would prefer for you to stay in Preotria until distraction is complete, and until we can be sure your rehabilitation is well-established.
Hope this gives you clarity.
BTW, the accommodation rate is quoted for a double room, so if you want to bring a friend, spouse or family member, this is included in the price.
Quote from: TheRisingShorty on February 17, 2014, 11:58:33 AMHey Dr. Birkholtz,
Your input to this forum has helped me tremendously and has elucidated many aspects of CLL that many doctors and other LL forums fail to clarify.
Just like to ask you about the five precice cases you have performed so far. Did you experience any Precice nail failure or complication that required the nail to be changed?
Love your profile name!
No, up to now, touch wood, we have not had to revise any of the nails. They were, however, all unilateral, post-traumatic cases.
Quote from: Arche on February 17, 2014, 07:03:18 PMDear Dr. B.,
Your recent commitment to this forum has been nothing short of outstanding. There are so many questions regarding this surgery, and so much misinformation as well. I apologize if I have been annoying you in any manner.
How much would it cost to do Quad lengthening with Tibial LON and PRECISE Femurs? Would it be advisable for 10 cm?
Thank you,
Arche
No worries.
Again, you will essentially save on the cost of the Precice, which will, partly, be replaced with the cost of the fixators, nails and locking procedures. Probably in the region of 80K USD.
I think 10 cm is possible, but it is certainly not guaranteed. It is easier to guarantee a good result with a single level somewhere between 5 and 6 cm, followed by a second phase 1 year later...
Thanks Dr Franz for the detailed steps of getting surgery under you.
A question re: Precice: I'm reading Precice 2 Femur diary at the old forum and at least a couple of them are documenting that the measured lengthening is not equal bilaterally (they're still in lengthening phase). One side is off by few mm and so they compensate by adjusting Precice (more catching up with lengthening on the slower side obviously).
I thought Precice is accurate or is this to be expected and it just needs adjustment till lengthening has finished/consolidated?
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