Quote from: Franz on November 21, 2013, 12:40:32 PMDear Kilokahn,
I think the debate around CLL goes wider. I suppose it has to do with cosmetic surgery in general. The reality is surgery is invasive and never perfectly safe. Up till recently we have not really had devices that were reliable, reproducible and predictable for femoral lengthening. Now with Precice we have that. In addition, the desired length is important. Anything beyond 4-5cm per segment becomes really problematic in terms of complication rates. Realistically the cost is almost prohibitive to go through a 4 segment lengthening, which means most patients end up with 5 cm either femoral or tibial. With this in mind, we have to ask whether the patient will really be happy with gaining 5 cm.
Having said all this, I realise very well that there are individuals who benefit greatly (physically and psychologically) from CLL, and it is this select group that I believe are the ideal patients.
As you can see this leaves us with a small group of patients who can a) afford it and b) be happy with it c) are healthy enough and d) are appropriate candidates (2 standard deviations shorter than the population average).
Once we've met all these criteria, there are few patients left.
From a doctor's perspective there are really 3 issues: patient safety, medicolegal risk and lastly a potential increased arthritis risk after CLL.
Hope this all makes sense?
Btw, Ballpark figure for CLL using bilateral Precice in our unit would be around 40 000 Euro. Tibial lengthening can be done with frames and would be a little less.
Rgds,
F
I understand where you're coming from and that does make a lot of sense. Thanks a lot for your response Dr. Birkholtz.
Quote from: Dingo on November 22, 2013, 01:01:07 PMIf it includes all that I've mentioned above, then the 40k euros are not really that steep. If not, then it's very expensive. (one can get internal femurs in South Korea with ISKD for 35k euros with everything included)
Can't really compare ISKD with PRECICE. Sure you can get ISKD cheaper for the initial price, but the ISKD is known throughout to have a very high rate of mechanical failure compared to other internal methods. Not only that, but it's hard to control the distraction rate and that can lead to difficulty in trying to prevent premature consolidation or when trying to slow lengthening in the possibility of non-union. If that happens, you can only guarantee that the ISKD stops lengthening by getting an additional surgery that puts an external fixator around the nail. When thinking of all those potential complications, you'd likely end up paying a whole lot more for ISKD than you would for PRECICE - not only in terms of money, but also in terms of recovery time.
Dr Franz Birkholtz (Pretoria, South Africa)
Hi,
South Africa is not as safe as Switzerland. Very few places are.
Remember that emigrants often paint a more negative picture of a country.
Nobody can guarantee anyone's safety anymore (Twin Towers, North Korea, Syria, Boston Marathon, Phillipine Hurricane). However, our patients are safe. Remember I raise my kids here!
The quoted BALLPARK figure includes:
Bilateral femoral lengthenings with Precice by experienced surgeons
Access to and use of our multi disciplinary team comprising psychology, physiotherapry, occupational therapy,orthotics, specialized nursing etc.
Hospitalization in a private room. 1 day high care and 5 days general ward.
All professional fees.
Guesthouse accommodation with three meals per day. (Safe)
Daily visits with nursing team to perform adjustments.
Xrays throughout.
A top notch mutlidisciplinary team.
Should tibial LONs be performed, the price will drop to approximately 25K euro.
As you can see, the single largest element in the cost (approx 25K) is the price of Precice nails.
Hope this helps?
That sounds like a really good deal. If I hadn't already done LL I'd certainly consider going to you. South Africa isn't US/Canada/Japan/Western Europe, but it's certainly cleaner and nicer than the 3rd world countries that charge only slightly less for LL.
Is the air there breathable? 
Because if it is, it sure beats New Delhi or Beijing. I was lucky enough to have gone in 2007 when they were restricting factories and cars to clean up the air for the Olympics, but when I went back afterward for IM nail removal in late 2008 the air made me sick.
Quote from: Kilokahn on November 22, 2013, 07:43:24 PMCan't really compare ISKD with PRECICE.
Yes, the ISKD sucks compared with the Precice. I've written about all those things you mentioned in another thread.
Quote from: Kilokahn on November 22, 2013, 07:43:24 PMSure you can get ISKD cheaper for the initial price, ...
This is incorrect. A friend of mine from southern Brazil (actually a distant relative) has lengthened 1 tibia with an ISKD nail, because of an accident. The costs were covered by her health insurance and she saw the break up of all the costs given by the hospital to the insurance company. The ISKD nail was marked as having a price of 34,000 BRL which is around 15k USD.
Dr Paley has confirmed that the price of 1 Precice nail is 13k USD, so basically around the same as the ISKD.
There's no reason for the costs for Precice to be higher than those for ISKD. Actually, because of the potential complications with the ISKD we all know about, the costs for Precice should actually be lower!
Doctor Birkholtz,
Thanks for all your answers here; I sent you a lengthy email, please let me know if you received it. I'm very serious about doing LL with you.
Quote from: BilateralDamage on November 25, 2013, 04:09:15 AMSomething I want to know as well! I know Dr. Donghoon Lee prefers LATN according to this post by Walk6 in his diary: "it offers a much quicker recovery time post-frame removal. He informed me that while the frames would stay on for a bit longer during LATN than LON, because there is no nail implanted during the actual lengthening and fixation process, the bone would be much stronger after the fixators are removed and hence recovery would be noticeably smoother for LATN.
So why not just go straight for External only and be done with the nail all together.
Sure you're in frames for longer, but once you're done, you're done.
Quote from: An_Apple_A_Day on November 25, 2013, 04:24:45 PMSo why not just go straight for External only and be done with the nail all together.
Sure you're in frames for longer, but once you're done, you're done.
My thoughts exactly when I went to Dr. Mitkovic. I was going to do all-external and live in Serbia for 9 months, then I'd be done with the whole thing forever.
Look, it is certainly the safest. It does mean long frame times though.
Quote from: Franz on November 25, 2013, 05:16:35 PMLook, it is certainly the safest. It does mean long frame times though.
I have read that long time in frames = permanent muscle damage, is this rubbish?
Hello Dr. Franz,
I've noticed that the new bone that is formed is not of a normal shape. It bulges out quite a bit. It is of a diameter greater than usual. Is this all right?
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