Q & A With Dr Franz Birkholtz

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Posted on Oct 19, 2015, 8:56 pm

#81

Quote from: Alu on October 19, 2015, 08:41:41 PMAdding to Nightwish,

Would you be willing to use that method to length? If so, I know it's probably gonna be more time consuming, but would it also be more expensive?

It is certainly something to consider if the patient prefers that route.

The issue is the cost of physio and hospitalisation is roughly the same whether we do one or two sides. This means that doing them separately is around 1.5 times as expensive as doing them together.

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Moose

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Posted on Oct 19, 2015, 9:08 pm

#82

any chance you have an idea when precice 3 is coming out?

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alps

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Posted on Oct 20, 2015, 3:56 pm

#83

hey Dr. Franz,

how likely is it for severe complications to occur "while" lengthening as opposed to during surgery?

the main complications during lengthening we know are nerve damage, non-consolidation.

is it possible that things might be really unpredictable when it comes to these while lengthening?

should someone lengthening be in constant fear of something like this happening every second of the months of lengthening?
since you mentioned mental stability, I think this would be personally one of the scariest things while lengthening. constant dilemma, fear and paranoia.

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Franz

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Posted on Oct 22, 2015, 11:49 am

#84

Quote from: Moose on October 19, 2015, 09:08:41 PMany chance you have an idea when precice 3 is coming out?

Unfortunately I don't know

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Franz

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Posted on Oct 22, 2015, 12:02 pm

#85

Quote from: SAD on October 20, 2015, 03:56:10 PMhey Dr. Franz,

how likely is it for severe complications to occur "while" lengthening as opposed to during surgery?

the main complications during lengthening we know are nerve damage, non-consolidation.

is it possible that things might be really unpredictable when it comes to these while lengthening?

should someone lengthening be in constant fear of something like this happening every second of the months of lengthening?
since you mentioned mental stability, I think this would be personally one of the scariest things while lengthening. constant dilemma, fear and paranoia.

The complications of surgery can be divided into acute, early post-op, during distraction, during consolidation and long-term.
Examples are:
Acute (during surgery): anaesthetic complications, fat embolism syndrome, excessive bleeding, damage to arteries and nerves with the osteotomy, unwanted propagation of the osteotomy (ie bigger break than expected)
Early post-op: pain, stiffness, wound infection, deep vein thrombosis and pulmonary embolism
During distraction: device failure, premature consolidation, slow bone formation, joint contractures
During consolidation: delayed or non-union, regenerate bending, device failure
Long-term: functional impairment, arthritic changes

The good news is most of these can be managed by an experienced doctor. The thing that makes a surgeon good is not only surgical skill, but the way that they prevent and manage complications. If that is done with care and empathy, that is a great surgeon.

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alps

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Posted on Oct 22, 2015, 7:07 pm

#86

Quote from: Franz on October 22, 2015, 12:02:45 PMThe complications of surgery can be divided into acute, early post-op, during distraction, during consolidation and long-term.
Examples are:
Acute (during surgery): anaesthetic complications, fat embolism syndrome, excessive bleeding, damage to arteries and nerves with the osteotomy, unwanted propagation of the osteotomy (ie bigger break than expected)
Early post-op: pain, stiffness, wound infection, deep vein thrombosis and pulmonary embolism
During distraction: device failure, premature consolidation, slow bone formation, joint contractures
During consolidation: delayed or non-union, regenerate bending, device failure
Long-term: functional impairment, arthritic changes

The good news is most of these can be managed by an experienced doctor. The thing that makes a surgeon good is not only surgical skill, but the way that they prevent and manage complications. If that is done with care and empathy, that is a great surgeon.

Thanks Dr Franz!

From what I can guess, non-union, regenerate bending, device failure cannot be controlled by the surgeon. Is that right?

And did you miss nerve damage during distraction? isn't that a possibility? something like "I was at 6.9cm yesterday when I decided to make it 7cm. I haven't been able to feel one part of my left foot ever since." ? is that how it can happen?

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alps

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Posted on Oct 24, 2015, 4:34 am

#87

Also, Dr. Franz, this doesn't concern CLL, but what is your take on HGH for normal kids who are just short and meant to be short?

Considering how ghastly this surgery is, do you think it's better to play the HGH card and see how it goes when you're young?

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Franz

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Posted on Oct 29, 2015, 12:33 pm

#88

Quote from: SAD on October 24, 2015, 04:34:56 AMAlso, Dr. Franz, this doesn't concern CLL, but what is your take on HGH for normal kids who are just short and meant to be short?

Considering how ghastly this surgery is, do you think it's better to play the HGH card and see how it goes when you're young?

Good question. My concern is two-fold: Firstly, not every kid who ends up as a short adult will necessarily want to be taller. The question is when is it appropriate for a parent to prophylactically adjust the kid's growth without their consent. The second more important issue is whether there are any long-term negative effects to HGH. It is hormonal treatment and we simply do not really know the long-term safety profile.

Hope this helps

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alps

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Posted on Oct 29, 2015, 3:28 pm

#89

Thanks Dr. Franz.

I think you missed my earlier question.

Can nerve damage happen overnight while lengthening? Hypothetically, if you are doing fine now and distract by 1mm, is it possible that your nerve could have got damaged?

Or are there always gradual signs that show an upcoming complication like nerve damage?

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Franz

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Posted on Nov 3, 2015, 1:56 pm

#90

Quote from: SAD on October 29, 2015, 03:28:46 PMThanks Dr. Franz.

I think you missed my earlier question.

Can nerve damage happen overnight while lengthening? Hypothetically, if you are doing fine now and distract by 1mm, is it possible that your nerve could have got damaged?

Or are there always gradual signs that show an upcoming complication like nerve damage?

Jip, missed your question. Sorry.

It is possible. Nerves do not particularly like stretching and although they are elastic up to a point, they stop working after stretching beyond a certain point. Think of an elastic band that can stretch freely, but stops at some point and can break. Now the nerve doesn't typically break, but stops functioning. If the stretch is discontinued, the nerve can recover, but there is also a point at which that nerve function loss can become permanent. This is different for different people, so it is not possible to give accurate amounts/distances. In general terms, this is one of the reasons why we have safe limits for CLL and should be careful to go beyond that.
Sometimes the earliest sign that the nerve may be in trouble is a tingling sensation, almost like when your foot goes to sleep. We call this paresthesia. Your doctor should be alerted of this immediately.
My approach is then to stop distraction for a day or two and recommence at a slower rate. Should the symptoms not improve, I will start talking to the patient about stopping distraction altogether or performing a nerve release.

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