{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.769,"endTime":13.349,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.769,"endTime":13.349,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.349,"endTime":14.489,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.81,"endTime":16.58,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.81,"endTime":16.58,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.35,"endTime":25.25,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.68,"endTime":28.22,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.85,"endTime":30.14,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.85,"endTime":30.14,"body":"Chris."},{"speaker":"Chris Dy","startTime":30.26,"endTime":31.28,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":30.26,"endTime":31.28,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.76,"endTime":33.77,"body":"I am doing"},{"speaker":"Charles Goldfarb","startTime":31.76,"endTime":33.77,"body":"well. How are you tonight?"},{"speaker":"Chris Dy","startTime":34.46,"endTime":37.85,"body":"I am great. I am"},{"speaker":"Chris Dy","startTime":34.46,"endTime":37.85,"body":"great. I am staring at a piece"},{"speaker":"Chris Dy","startTime":37.85,"endTime":40.67,"body":"of apple pie that I'm going to"},{"speaker":"Chris Dy","startTime":37.85,"endTime":40.67,"body":"eat as soon as we're done with"},{"speaker":"Chris Dy","startTime":40.67,"endTime":41.09,"body":"this."},{"speaker":"Charles Goldfarb","startTime":41.66,"endTime":43.58,"body":"That is"},{"speaker":"Charles Goldfarb","startTime":41.66,"endTime":43.58,"body":"incentive to get done."},{"speaker":"Chris Dy","startTime":43.94,"endTime":48.02,"body":"It's been a staring"},{"speaker":"Chris Dy","startTime":43.94,"endTime":48.02,"body":"contest. It's interesting. I am"},{"speaker":"Chris Dy","startTime":48.05,"endTime":52.61,"body":"not shy when I talk in the OR"},{"speaker":"Chris Dy","startTime":48.05,"endTime":52.61,"body":"about my love and appreciation"},{"speaker":"Chris Dy","startTime":52.61,"endTime":60.17,"body":"for food. And she had a one of"},{"speaker":"Chris Dy","startTime":52.61,"endTime":60.17,"body":"our RN first assists his wife or"},{"speaker":"Chris Dy","startTime":60.17,"endTime":65.0,"body":"he convinced his wife to make an"},{"speaker":"Chris Dy","startTime":60.17,"endTime":65.0,"body":"apple pie for me. Literally, the"},{"speaker":"Chris Dy","startTime":65.09,"endTime":66.83,"body":"best apple pie I've ever had."},{"speaker":"Charles Goldfarb","startTime":67.58,"endTime":71.09,"body":"That is"},{"speaker":"Charles Goldfarb","startTime":67.58,"endTime":71.09,"body":"awesome. I am seriously jealous."},{"speaker":"Charles Goldfarb","startTime":72.02,"endTime":76.55,"body":"I had a interesting day. I had a"},{"speaker":"Charles Goldfarb","startTime":72.02,"endTime":76.55,"body":"great day I have intermittently"},{"speaker":"Charles Goldfarb","startTime":76.55,"endTime":78.71,"body":"been able to ride my bike to"},{"speaker":"Charles Goldfarb","startTime":76.55,"endTime":78.71,"body":"work but I was able to do it"},{"speaker":"Charles Goldfarb","startTime":78.71,"endTime":80.81,"body":"today. It was a little chilly"},{"speaker":"Charles Goldfarb","startTime":78.71,"endTime":80.81,"body":"this morning it was around 50."},{"speaker":"Charles Goldfarb","startTime":81.05,"endTime":84.23,"body":"But coming home, it was 75 it"},{"speaker":"Charles Goldfarb","startTime":81.05,"endTime":84.23,"body":"was I came home at like six I"},{"speaker":"Charles Goldfarb","startTime":84.23,"endTime":88.22,"body":"left at six. And it was 75 and"},{"speaker":"Charles Goldfarb","startTime":84.23,"endTime":88.22,"body":"sunny. My God. It was awesome."},{"speaker":"Chris Dy","startTime":88.91,"endTime":91.7,"body":"It was a gorgeous day."},{"speaker":"Chris Dy","startTime":88.91,"endTime":91.7,"body":"I actually came home and both of"},{"speaker":"Chris Dy","startTime":91.7,"endTime":94.13,"body":"my kids were in bathing suits."},{"speaker":"Chris Dy","startTime":91.7,"endTime":94.13,"body":"And I was like did y'all get in"},{"speaker":"Chris Dy","startTime":94.13,"endTime":96.68,"body":"the pool. I was like I didn't"},{"speaker":"Chris Dy","startTime":94.13,"endTime":96.68,"body":"heat it up. But there must have"},{"speaker":"Chris Dy","startTime":96.68,"endTime":99.08,"body":"been so nice outside that they"},{"speaker":"Chris Dy","startTime":96.68,"endTime":99.08,"body":"just could not resist."},{"speaker":"Charles Goldfarb","startTime":99.95,"endTime":101.54,"body":"You and I"},{"speaker":"Charles Goldfarb","startTime":99.95,"endTime":101.54,"body":"might not have enjoyed that"},{"speaker":"Charles Goldfarb","startTime":101.54,"endTime":104.09,"body":"pool. But kids are immune."},{"speaker":"Chris Dy","startTime":104.84,"endTime":107.18,"body":"Yeah, I actually saw."},{"speaker":"Chris Dy","startTime":104.84,"endTime":107.18,"body":"I walked by our chairman's"},{"speaker":"Chris Dy","startTime":107.18,"endTime":109.88,"body":"office today I saw a bike in his"},{"speaker":"Chris Dy","startTime":107.18,"endTime":109.88,"body":"office too. Is it yours or was"},{"speaker":"Chris Dy","startTime":109.88,"endTime":110.42,"body":"it his?"},{"speaker":"Charles Goldfarb","startTime":111.17,"endTime":114.95,"body":"We do not"},{"speaker":"Charles Goldfarb","startTime":111.17,"endTime":114.95,"body":"share office. It's his. He has a"},{"speaker":"Charles Goldfarb","startTime":114.95,"endTime":117.74,"body":"very short commute, but he does"},{"speaker":"Charles Goldfarb","startTime":114.95,"endTime":117.74,"body":"ride often."},{"speaker":"Chris Dy","startTime":118.76,"endTime":120.89,"body":"Very good. Very good."},{"speaker":"Chris Dy","startTime":118.76,"endTime":120.89,"body":"Well, good for you. I look"},{"speaker":"Chris Dy","startTime":120.89,"endTime":124.22,"body":"forward to seeing you out and"},{"speaker":"Chris Dy","startTime":120.89,"endTime":124.22,"body":"about and riding across Forest"},{"speaker":"Chris Dy","startTime":124.22,"endTime":124.64,"body":"Park."},{"speaker":"Charles Goldfarb","startTime":124.94,"endTime":127.46,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":124.94,"endTime":127.46,"body":"The best path to work."},{"speaker":"Chris Dy","startTime":128.21,"endTime":131.6,"body":"My son still reminds"},{"speaker":"Chris Dy","startTime":128.21,"endTime":131.6,"body":"me of that one time during the"},{"speaker":"Chris Dy","startTime":131.72,"endTime":135.38,"body":"guest camera what random day it"},{"speaker":"Chris Dy","startTime":131.72,"endTime":135.38,"body":"was but actually biked him to"},{"speaker":"Chris Dy","startTime":135.38,"endTime":139.07,"body":"school like he was on his bike."},{"speaker":"Chris Dy","startTime":135.38,"endTime":139.07,"body":"I was on my bike and we had a"},{"speaker":"Chris Dy","startTime":139.07,"endTime":141.2,"body":"good time. But it's been a"},{"speaker":"Chris Dy","startTime":139.07,"endTime":141.2,"body":"while."},{"speaker":"Charles Goldfarb","startTime":144.39,"endTime":145.89,"body":"We had a"},{"speaker":"Charles Goldfarb","startTime":144.39,"endTime":145.89,"body":"little hiccup there, but I think"},{"speaker":"Charles Goldfarb","startTime":145.89,"endTime":149.01,"body":"we're back. All right. I think"},{"speaker":"Charles Goldfarb","startTime":145.89,"endTime":149.01,"body":"we're doing an interesting"},{"speaker":"Charles Goldfarb","startTime":149.01,"endTime":150.93,"body":"episode one that I'm kind of"},{"speaker":"Charles Goldfarb","startTime":149.01,"endTime":150.93,"body":"looking forward to. We're gonna"},{"speaker":"Charles Goldfarb","startTime":150.93,"endTime":153.39,"body":"do a little bit of a grab bag"},{"speaker":"Charles Goldfarb","startTime":150.93,"endTime":153.39,"body":"with a couple emails and a"},{"speaker":"Charles Goldfarb","startTime":153.39,"endTime":155.46,"body":"couple of cases. Does that sound"},{"speaker":"Charles Goldfarb","startTime":153.39,"endTime":155.46,"body":"like fun?"},{"speaker":"Chris Dy","startTime":155.88,"endTime":158.37,"body":"Sounds like fun. Did"},{"speaker":"Chris Dy","startTime":155.88,"endTime":158.37,"body":"you get an email from Down Under"},{"speaker":"Chris Dy","startTime":158.37,"endTime":158.97,"body":"recently?"},{"speaker":"Charles Goldfarb","startTime":159.44,"endTime":163.1,"body":"I did, I would"},{"speaker":"Charles Goldfarb","startTime":159.44,"endTime":163.1,"body":"say so. Richard Lawson is a"},{"speaker":"Charles Goldfarb","startTime":163.1,"endTime":167.6,"body":"great guy. He's a good friend. I"},{"speaker":"Charles Goldfarb","startTime":163.1,"endTime":167.6,"body":"don't see him enough who I first"},{"speaker":"Charles Goldfarb","startTime":167.6,"endTime":171.86,"body":"met on my Bunnell traveling"},{"speaker":"Charles Goldfarb","startTime":167.6,"endTime":171.86,"body":"fellowship when I went down to"},{"speaker":"Charles Goldfarb","startTime":171.86,"endTime":178.1,"body":"visit Michael Tonkin. And"},{"speaker":"Charles Goldfarb","startTime":171.86,"endTime":178.1,"body":"Michael kind of pawned me off on"},{"speaker":"Charles Goldfarb","startTime":178.1,"endTime":184.01,"body":"Richard, who took me to a gym to"},{"speaker":"Charles Goldfarb","startTime":178.1,"endTime":184.01,"body":"do rock climbing. And it was"},{"speaker":"Charles Goldfarb","startTime":184.1,"endTime":187.88,"body":"super fun. And I was super"},{"speaker":"Charles Goldfarb","startTime":184.1,"endTime":187.88,"body":"grateful that he was hanging out"},{"speaker":"Charles Goldfarb","startTime":187.88,"endTime":191.75,"body":"with me. And while again, we"},{"speaker":"Charles Goldfarb","startTime":187.88,"endTime":191.75,"body":"don't see each other often. He's"},{"speaker":"Charles Goldfarb","startTime":191.75,"endTime":194.42,"body":"just a really, really nice guy."},{"speaker":"Charles Goldfarb","startTime":191.75,"endTime":194.42,"body":"So I was interacting with him"},{"speaker":"Charles Goldfarb","startTime":194.42,"endTime":200.6,"body":"about something. And he kind of"},{"speaker":"Charles Goldfarb","startTime":194.42,"endTime":200.6,"body":"threw in there casually that Oh,"},{"speaker":"Charles Goldfarb","startTime":200.6,"endTime":201.74,"body":"yeah. Broke my humerus."},{"speaker":"Chris Dy","startTime":202.43,"endTime":204.53,"body":"Wait, wait. So is he a"},{"speaker":"Chris Dy","startTime":202.43,"endTime":204.53,"body":"hand surgeon?"},{"speaker":"Charles Goldfarb","startTime":204.8,"endTime":206.39,"body":"Yeah, he's a"},{"speaker":"Charles Goldfarb","startTime":204.8,"endTime":206.39,"body":"hand surgeon Absolutely. In"},{"speaker":"Charles Goldfarb","startTime":206.39,"endTime":206.72,"body":"Sydney."},{"speaker":"Chris Dy","startTime":206.99,"endTime":210.77,"body":"Got it. Got it. Okay,"},{"speaker":"Chris Dy","startTime":206.99,"endTime":210.77,"body":"so he how did he break his"},{"speaker":"Chris Dy","startTime":210.77,"endTime":211.28,"body":"humerus."},{"speaker":"Charles Goldfarb","startTime":211.51,"endTime":215.05,"body":"I'm just gonna"},{"speaker":"Charles Goldfarb","startTime":211.51,"endTime":215.05,"body":"I asked him he gave me support."},{"speaker":"Charles Goldfarb","startTime":215.05,"endTime":219.61,"body":"So I'm going to just read his"},{"speaker":"Charles Goldfarb","startTime":215.05,"endTime":219.61,"body":"emails not that long. And I"},{"speaker":"Charles Goldfarb","startTime":219.61,"endTime":225.4,"body":"think it's actually pretty"},{"speaker":"Charles Goldfarb","startTime":219.61,"endTime":225.4,"body":"telling so. Hi, Chuck. I love"},{"speaker":"Charles Goldfarb","startTime":225.4,"endTime":230.05,"body":"the podcast. Well done. Sarah"},{"speaker":"Charles Goldfarb","startTime":225.4,"endTime":230.05,"body":"and he's speaking of Sarah"},{"speaker":"Charles Goldfarb","startTime":230.08,"endTime":233.53,"body":"Tolerton brought to my attention"},{"speaker":"Charles Goldfarb","startTime":230.08,"endTime":233.53,"body":"and it is very good. You guys"},{"speaker":"Charles Goldfarb","startTime":233.53,"endTime":237.43,"body":"have an excellent report. Thank"},{"speaker":"Charles Goldfarb","startTime":233.53,"endTime":237.43,"body":"you, Richard. I have to carry"},{"speaker":"Charles Goldfarb","startTime":237.43,"endTime":239.11,"body":"Chris on this podcast but."},{"speaker":"Chris Dy","startTime":240.1,"endTime":244.24,"body":"Just just a workman"},{"speaker":"Chris Dy","startTime":240.1,"endTime":244.24,"body":"hammering nails. Going at it."},{"speaker":"Charles Goldfarb","startTime":244.81,"endTime":246.79,"body":"All right, the"},{"speaker":"Charles Goldfarb","startTime":244.81,"endTime":246.79,"body":"story of the left arm"},{"speaker":"Charles Goldfarb","startTime":246.88,"endTime":249.88,"body":"unfortunately, not very"},{"speaker":"Charles Goldfarb","startTime":246.88,"endTime":249.88,"body":"glamorous. It was but what's"},{"speaker":"Charles Goldfarb","startTime":249.88,"endTime":251.74,"body":"what's great for me and then"},{"speaker":"Charles Goldfarb","startTime":249.88,"endTime":251.74,"body":"part of the reason I wanted to"},{"speaker":"Charles Goldfarb","startTime":251.74,"endTime":256.36,"body":"read this is just hearing an"},{"speaker":"Charles Goldfarb","startTime":251.74,"endTime":256.36,"body":"Australian put things into"},{"speaker":"Charles Goldfarb","startTime":256.39,"endTime":258.4,"body":"written form. It's very"},{"speaker":"Charles Goldfarb","startTime":256.39,"endTime":258.4,"body":"different than what-"},{"speaker":"Chris Dy","startTime":258.4,"endTime":260.47,"body":"I was really hoping"},{"speaker":"Chris Dy","startTime":258.4,"endTime":260.47,"body":"you were going to read this with"},{"speaker":"Chris Dy","startTime":260.47,"endTime":265.3,"body":"an Australian accent. So you"},{"speaker":"Chris Dy","startTime":260.47,"endTime":265.3,"body":"know, maybe we can do a take two"},{"speaker":"Chris Dy","startTime":265.3,"endTime":265.87,"body":"on this one."},{"speaker":"Charles Goldfarb","startTime":266.14,"endTime":269.77,"body":"No, you can do"},{"speaker":"Charles Goldfarb","startTime":266.14,"endTime":269.77,"body":"it. The story of the left arm."},{"speaker":"Charles Goldfarb","startTime":269.98,"endTime":273.43,"body":"Unfortunately not very"},{"speaker":"Charles Goldfarb","startTime":269.98,"endTime":273.43,"body":"glamorous. It was blowing a gale"},{"speaker":"Charles Goldfarb","startTime":273.61,"endTime":276.73,"body":"at the rowing sheds. That's I've"},{"speaker":"Charles Goldfarb","startTime":273.61,"endTime":276.73,"body":"never other than that in my"},{"speaker":"Charles Goldfarb","startTime":276.94,"endTime":277.03,"body":"life."},{"speaker":"Chris Dy","startTime":277.54,"endTime":279.01,"body":"English American"},{"speaker":"Chris Dy","startTime":277.54,"endTime":279.01,"body":"English."},{"speaker":"Charles Goldfarb","startTime":280.03,"endTime":286.72,"body":"It was really"},{"speaker":"Charles Goldfarb","startTime":280.03,"endTime":286.72,"body":"windy at the pond. Probably no"},{"speaker":"Charles Goldfarb","startTime":286.72,"endTime":289.78,"body":"one should have been out some"},{"speaker":"Charles Goldfarb","startTime":286.72,"endTime":289.78,"body":"friends put their double in the"},{"speaker":"Charles Goldfarb","startTime":289.78,"endTime":294.01,"body":"water. The wind took the"},{"speaker":"Charles Goldfarb","startTime":289.78,"endTime":294.01,"body":"aluminum and cloth stretchers"},{"speaker":"Charles Goldfarb","startTime":294.01,"endTime":298.9,"body":"and one sailed into the water"},{"speaker":"Charles Goldfarb","startTime":294.01,"endTime":298.9,"body":"between our nice modern non slip"},{"speaker":"Charles Goldfarb","startTime":298.9,"endTime":304.0,"body":"Pontoon. and the neighboring not"},{"speaker":"Charles Goldfarb","startTime":298.9,"endTime":304.0,"body":"so good structure. I jumped onto"},{"speaker":"Charles Goldfarb","startTime":304.0,"endTime":307.45,"body":"this and down I went. Big jolt"},{"speaker":"Charles Goldfarb","startTime":304.0,"endTime":307.45,"body":"through the radial and ulnar"},{"speaker":"Charles Goldfarb","startTime":307.45,"endTime":311.35,"body":"nerves thought shoulder"},{"speaker":"Charles Goldfarb","startTime":307.45,"endTime":311.35,"body":"dislocation but palpation"},{"speaker":"Charles Goldfarb","startTime":311.38,"endTime":315.43,"body":"revealed a mid shaft fracture,"},{"speaker":"Charles Goldfarb","startTime":311.38,"endTime":315.43,"body":"which is said like such an"},{"speaker":"Charles Goldfarb","startTime":315.43,"endTime":320.98,"body":"orthopedic surgeon. I'm going to"},{"speaker":"Charles Goldfarb","startTime":315.43,"endTime":320.98,"body":"keep going. A very good trauma"},{"speaker":"Charles Goldfarb","startTime":320.98,"endTime":324.25,"body":"surgical friend of mine plated"},{"speaker":"Charles Goldfarb","startTime":320.98,"endTime":324.25,"body":"it post dearly, and I am pleased"},{"speaker":"Charles Goldfarb","startTime":324.25,"endTime":327.76,"body":"to say it as united with no"},{"speaker":"Charles Goldfarb","startTime":324.25,"endTime":327.76,"body":"nerve problems, lessons learned."},{"speaker":"Charles Goldfarb","startTime":328.54,"endTime":332.77,"body":"Number one, fractures are"},{"speaker":"Charles Goldfarb","startTime":328.54,"endTime":332.77,"body":"painful. Wearing a sling from"},{"speaker":"Charles Goldfarb","startTime":332.77,"endTime":336.7,"body":"clothing is worse than a paper"},{"speaker":"Charles Goldfarb","startTime":332.77,"endTime":336.7,"body":"sling, which is worse than a"},{"speaker":"Charles Goldfarb","startTime":336.7,"endTime":341.23,"body":"cloth sling. Can't argue with"},{"speaker":"Charles Goldfarb","startTime":336.7,"endTime":341.23,"body":"that. It is interesting how we"},{"speaker":"Charles Goldfarb","startTime":341.23,"endTime":345.52,"body":"see people on the day the next"},{"speaker":"Charles Goldfarb","startTime":341.23,"endTime":345.52,"body":"day, two weeks, six weeks in"},{"speaker":"Charles Goldfarb","startTime":345.52,"endTime":348.7,"body":"three months. And in each of"},{"speaker":"Charles Goldfarb","startTime":345.52,"endTime":348.7,"body":"those time points, the patient"},{"speaker":"Charles Goldfarb","startTime":348.7,"endTime":352.9,"body":"is usually better. But the line"},{"speaker":"Charles Goldfarb","startTime":348.7,"endTime":352.9,"body":"joining those dots is not"},{"speaker":"Charles Goldfarb","startTime":352.9,"endTime":358.54,"body":"necessarily smooth. I think that"},{"speaker":"Charles Goldfarb","startTime":352.9,"endTime":358.54,"body":"is well set. long bone fractures"},{"speaker":"Charles Goldfarb","startTime":358.54,"endTime":362.59,"body":"and adults are exhausted. After"},{"speaker":"Charles Goldfarb","startTime":358.54,"endTime":362.59,"body":"the first week I went back to"},{"speaker":"Charles Goldfarb","startTime":362.59,"endTime":367.12,"body":"consulting and did three half"},{"speaker":"Charles Goldfarb","startTime":362.59,"endTime":367.12,"body":"days and just went straight back"},{"speaker":"Charles Goldfarb","startTime":367.12,"endTime":372.22,"body":"to bed after each morning."},{"speaker":"Charles Goldfarb","startTime":367.12,"endTime":372.22,"body":"Muscles take ages to heal. I"},{"speaker":"Charles Goldfarb","startTime":372.22,"endTime":375.64,"body":"followed my surgeon's advice and"},{"speaker":"Charles Goldfarb","startTime":372.22,"endTime":375.64,"body":"avoided any rowing and weights"},{"speaker":"Charles Goldfarb","startTime":375.73,"endTime":379.87,"body":"for three months, then went back"},{"speaker":"Charles Goldfarb","startTime":375.73,"endTime":379.87,"body":"obviously to eagerly training"},{"speaker":"Charles Goldfarb","startTime":379.87,"endTime":383.2,"body":"just about every day, but I"},{"speaker":"Charles Goldfarb","startTime":379.87,"endTime":383.2,"body":"thought fairly gently. It all"},{"speaker":"Charles Goldfarb","startTime":383.2,"endTime":386.02,"body":"caught up with me. And by two"},{"speaker":"Charles Goldfarb","startTime":383.2,"endTime":386.02,"body":"weeks, I had to stop due to arm"},{"speaker":"Charles Goldfarb","startTime":386.02,"endTime":389.71,"body":"pain taking the rest of the"},{"speaker":"Charles Goldfarb","startTime":386.02,"endTime":389.71,"body":"season off. Life is better with"},{"speaker":"Charles Goldfarb","startTime":389.71,"endTime":393.46,"body":"exercises and rolling has been"},{"speaker":"Charles Goldfarb","startTime":389.71,"endTime":393.46,"body":"tough not doing the thing I love"},{"speaker":"Charles Goldfarb","startTime":393.46,"endTime":397.69,"body":"for almost five months. And"},{"speaker":"Charles Goldfarb","startTime":393.46,"endTime":397.69,"body":"there you have it try. This is"},{"speaker":"Charles Goldfarb","startTime":397.69,"endTime":403.24,"body":"sage advice, try to keep your"},{"speaker":"Charles Goldfarb","startTime":397.69,"endTime":403.24,"body":"long bones intact. As I get"},{"speaker":"Charles Goldfarb","startTime":403.24,"endTime":404.68,"body":"older, I think about that a lot."},{"speaker":"Chris Dy","startTime":404.95,"endTime":407.5,"body":"That's amazing. And I"},{"speaker":"Chris Dy","startTime":404.95,"endTime":407.5,"body":"would I would say hell try to"},{"speaker":"Chris Dy","startTime":407.5,"endTime":413.47,"body":"keep all your bones intact. long"},{"speaker":"Chris Dy","startTime":407.5,"endTime":413.47,"body":"bones included in the bones you"},{"speaker":"Chris Dy","startTime":413.47,"endTime":414.19,"body":"can swallow."},{"speaker":"Charles Goldfarb","startTime":415.05,"endTime":417.66,"body":"Yeah, keep"},{"speaker":"Charles Goldfarb","startTime":415.05,"endTime":417.66,"body":"them all intact. But the long"},{"speaker":"Charles Goldfarb","startTime":417.66,"endTime":420.6,"body":"bones I must admit I haven't had"},{"speaker":"Charles Goldfarb","startTime":417.66,"endTime":420.6,"body":"a long bone fracture, although"},{"speaker":"Charles Goldfarb","startTime":420.6,"endTime":424.17,"body":"one of our partners recently"},{"speaker":"Charles Goldfarb","startTime":420.6,"endTime":424.17,"body":"has. Let's keep them intact."},{"speaker":"Chris Dy","startTime":424.33,"endTime":429.46,"body":"Well, so two things."},{"speaker":"Chris Dy","startTime":424.33,"endTime":429.46,"body":"The first one is that actually"},{"speaker":"Chris Dy","startTime":429.46,"endTime":433.12,"body":"our partner who fractured his"},{"speaker":"Chris Dy","startTime":429.46,"endTime":433.12,"body":"tibia knew he fractured his"},{"speaker":"Chris Dy","startTime":433.12,"endTime":436.87,"body":"tibia as soon as he did it based"},{"speaker":"Chris Dy","startTime":433.12,"endTime":436.87,"body":"on the same instincts that your"},{"speaker":"Chris Dy","startTime":436.87,"endTime":441.46,"body":"buddy had as well, you know, as"},{"speaker":"Chris Dy","startTime":436.87,"endTime":441.46,"body":"a ski boot kind of thing. And"},{"speaker":"Chris Dy","startTime":441.46,"endTime":444.55,"body":"he's like I, you know, pretty"},{"speaker":"Chris Dy","startTime":441.46,"endTime":444.55,"body":"sure I've midshaft tibia like"},{"speaker":"Chris Dy","startTime":444.55,"endTime":449.56,"body":"when EMS putting the cart, you"},{"speaker":"Chris Dy","startTime":444.55,"endTime":449.56,"body":"know, the second thing is more"},{"speaker":"Chris Dy","startTime":449.56,"endTime":454.81,"body":"serious. And I think it's super"},{"speaker":"Chris Dy","startTime":449.56,"endTime":454.81,"body":"important. I think that as, as"},{"speaker":"Chris Dy","startTime":454.81,"endTime":458.59,"body":"we try to teach ourselves and"},{"speaker":"Chris Dy","startTime":454.81,"endTime":458.59,"body":"and teach our trainees"},{"speaker":"Chris Dy","startTime":458.59,"endTime":464.26,"body":"technique, being really good"},{"speaker":"Chris Dy","startTime":458.59,"endTime":464.26,"body":"about taking care of muscle, you"},{"speaker":"Chris Dy","startTime":464.26,"endTime":468.46,"body":"know, I kind of make a joke"},{"speaker":"Chris Dy","startTime":464.26,"endTime":468.46,"body":"about it. But you know, one of"},{"speaker":"Chris Dy","startTime":468.46,"endTime":471.49,"body":"the things that Lorich what Dean"},{"speaker":"Chris Dy","startTime":468.46,"endTime":471.49,"body":"Lorich was really big about was"},{"speaker":"Chris Dy","startTime":471.49,"endTime":474.88,"body":"very, you know, elegant, sharp"},{"speaker":"Chris Dy","startTime":471.49,"endTime":474.88,"body":"dissection with a knife with a"},{"speaker":"Chris Dy","startTime":474.88,"endTime":477.82,"body":"scalpel and learning how to"},{"speaker":"Chris Dy","startTime":474.88,"endTime":477.82,"body":"dissect with it. And his quote,"},{"speaker":"Chris Dy","startTime":477.82,"endTime":480.19,"body":"well, all the time was don't"},{"speaker":"Chris Dy","startTime":477.82,"endTime":480.19,"body":"meet, don't make dog meat out of"},{"speaker":"Chris Dy","startTime":480.19,"endTime":483.61,"body":"this. And that's obviously a"},{"speaker":"Chris Dy","startTime":480.19,"endTime":483.61,"body":"very callous thing to say. But"},{"speaker":"Chris Dy","startTime":483.88,"endTime":486.58,"body":"I've honestly found myself"},{"speaker":"Chris Dy","startTime":483.88,"endTime":486.58,"body":"saying don't make dog meat out"},{"speaker":"Chris Dy","startTime":486.58,"endTime":490.0,"body":"of this when we're doing some"},{"speaker":"Chris Dy","startTime":486.58,"endTime":490.0,"body":"sort of some dissections where"},{"speaker":"Chris Dy","startTime":490.0,"endTime":492.49,"body":"you want to be very kind to the"},{"speaker":"Chris Dy","startTime":490.0,"endTime":492.49,"body":"muscle and try to keep the"},{"speaker":"Chris Dy","startTime":492.49,"endTime":495.37,"body":"fascial planes intact because of"},{"speaker":"Chris Dy","startTime":492.49,"endTime":495.37,"body":"the kind of pain that you're"},{"speaker":"Chris Dy","startTime":495.37,"endTime":497.92,"body":"describing, you know, the more"},{"speaker":"Chris Dy","startTime":495.37,"endTime":497.92,"body":"patients you see post off, the"},{"speaker":"Chris Dy","startTime":497.92,"endTime":500.98,"body":"more you hear them say, Oh, this"},{"speaker":"Chris Dy","startTime":497.92,"endTime":500.98,"body":"muscle hurts or something, you"},{"speaker":"Chris Dy","startTime":500.98,"endTime":504.16,"body":"know, some of the dissections"},{"speaker":"Chris Dy","startTime":500.98,"endTime":504.16,"body":"that we do are deeper or more"},{"speaker":"Chris Dy","startTime":504.16,"endTime":506.02,"body":"prone to having that kind of"},{"speaker":"Chris Dy","startTime":504.16,"endTime":506.02,"body":"pain."},{"speaker":"Charles Goldfarb","startTime":506.8,"endTime":510.1,"body":"Oh, I think"},{"speaker":"Charles Goldfarb","startTime":506.8,"endTime":510.1,"body":"that's well said I think back to"},{"speaker":"Charles Goldfarb","startTime":510.1,"endTime":513.22,"body":"when I was a resident, I may"},{"speaker":"Charles Goldfarb","startTime":510.1,"endTime":513.22,"body":"have said this before, when"},{"speaker":"Charles Goldfarb","startTime":513.52,"endTime":516.61,"body":"there wasn't a pair of tries"},{"speaker":"Charles Goldfarb","startTime":513.52,"endTime":516.61,"body":"typical approach to the distal"},{"speaker":"Charles Goldfarb","startTime":516.61,"endTime":520.9,"body":"humerus. We went straight"},{"speaker":"Charles Goldfarb","startTime":516.61,"endTime":520.9,"body":"through the tricycle out right"},{"speaker":"Charles Goldfarb","startTime":520.9,"endTime":526.51,"body":"down the middle. And I went, it"},{"speaker":"Charles Goldfarb","startTime":520.9,"endTime":526.51,"body":"was stunning to me. And I hated"},{"speaker":"Charles Goldfarb","startTime":526.51,"endTime":530.89,"body":"it for that reason. And now I"},{"speaker":"Charles Goldfarb","startTime":526.51,"endTime":530.89,"body":"love the posterior approach to"},{"speaker":"Charles Goldfarb","startTime":530.89,"endTime":533.65,"body":"the to the humerus, because"},{"speaker":"Charles Goldfarb","startTime":530.89,"endTime":533.65,"body":"she's moved the triceps either"},{"speaker":"Charles Goldfarb","startTime":533.65,"endTime":535.09,"body":"way, it's like such a no"},{"speaker":"Charles Goldfarb","startTime":533.65,"endTime":535.09,"body":"brainer."},{"speaker":"Chris Dy","startTime":535.979,"endTime":538.559,"body":"Well, I think that's"},{"speaker":"Chris Dy","startTime":535.979,"endTime":538.559,"body":"also why, you know, for a sub"},{"speaker":"Chris Dy","startTime":538.559,"endTime":541.649,"body":"muscular transposition, it's"},{"speaker":"Chris Dy","startTime":538.559,"endTime":541.649,"body":"fine. That surgery hurts so darn"},{"speaker":"Chris Dy","startTime":541.649,"endTime":545.159,"body":"much. Is that just all of that"},{"speaker":"Chris Dy","startTime":541.649,"endTime":545.159,"body":"muscle manipulation? I mean, you"},{"speaker":"Chris Dy","startTime":545.159,"endTime":548.849,"body":"know that that is one reason to"},{"speaker":"Chris Dy","startTime":545.159,"endTime":548.849,"body":"avoid that surgery if you can."},{"speaker":"Charles Goldfarb","startTime":549.479,"endTime":551.309,"body":"That's the"},{"speaker":"Charles Goldfarb","startTime":549.479,"endTime":551.309,"body":"reason I do is that's why it's"},{"speaker":"Charles Goldfarb","startTime":551.309,"endTime":553.589,"body":"not my first choice there."},{"speaker":"Charles Goldfarb","startTime":551.309,"endTime":553.589,"body":"Certainly those who argue do the"},{"speaker":"Charles Goldfarb","startTime":553.589,"endTime":557.279,"body":"last surgery first, which would"},{"speaker":"Charles Goldfarb","startTime":553.589,"endTime":557.279,"body":"be a sub muscular, but I don't"},{"speaker":"Charles Goldfarb","startTime":557.279,"endTime":560.039,"body":"think it's that simple. I don't"},{"speaker":"Charles Goldfarb","startTime":557.279,"endTime":560.039,"body":"it's not my first surgery."},{"speaker":"Chris Dy","startTime":560.64,"endTime":563.43,"body":"Yeah, I think that if,"},{"speaker":"Chris Dy","startTime":560.64,"endTime":563.43,"body":"you know, I think I've shared"},{"speaker":"Chris Dy","startTime":563.43,"endTime":565.98,"body":"this with you before, but when I"},{"speaker":"Chris Dy","startTime":563.43,"endTime":565.98,"body":"was visiting Elizabeth Hoggart,"},{"speaker":"Chris Dy","startTime":565.98,"endTime":569.46,"body":"she looked me in the eye said"},{"speaker":"Chris Dy","startTime":565.98,"endTime":569.46,"body":"would you have that surgery? I"},{"speaker":"Chris Dy","startTime":569.46,"endTime":573.6,"body":"said not unless I had to. That"},{"speaker":"Chris Dy","startTime":569.46,"endTime":573.6,"body":"was a moment for me where I"},{"speaker":"Chris Dy","startTime":573.6,"endTime":575.13,"body":"reconsidered my algorithm a bit."},{"speaker":"Charles Goldfarb","startTime":577.5,"endTime":579.99,"body":"All right, I"},{"speaker":"Charles Goldfarb","startTime":577.5,"endTime":579.99,"body":"think you you received an"},{"speaker":"Charles Goldfarb","startTime":579.99,"endTime":581.4,"body":"interesting email as well this"},{"speaker":"Charles Goldfarb","startTime":579.99,"endTime":581.4,"body":"week."},{"speaker":"Chris Dy","startTime":581.63,"endTime":584.27,"body":"Yeah. So you know,"},{"speaker":"Chris Dy","startTime":581.63,"endTime":584.27,"body":"thanks to those of you that send"},{"speaker":"Chris Dy","startTime":584.27,"endTime":587.27,"body":"emails and it really, you know,"},{"speaker":"Chris Dy","startTime":584.27,"endTime":587.27,"body":"it's helpful for us to, you"},{"speaker":"Chris Dy","startTime":587.27,"endTime":590.27,"body":"know, know what questions you"},{"speaker":"Chris Dy","startTime":587.27,"endTime":590.27,"body":"want to answered and also just"},{"speaker":"Chris Dy","startTime":590.27,"endTime":593.78,"body":"to get your feedback so Ryan"},{"speaker":"Chris Dy","startTime":590.27,"endTime":593.78,"body":"Caldwell is a hand surgery"},{"speaker":"Chris Dy","startTime":593.78,"endTime":597.29,"body":"Fellow at Tufts and Ryan, thank"},{"speaker":"Chris Dy","startTime":593.78,"endTime":597.29,"body":"you for the for the email and"},{"speaker":"Chris Dy","startTime":597.29,"endTime":600.95,"body":"I'm gonna go ahead and read it."},{"speaker":"Chris Dy","startTime":597.29,"endTime":600.95,"body":"You He starts by saying thank"},{"speaker":"Chris Dy","startTime":600.95,"endTime":603.32,"body":"you for your podcasts, you've"},{"speaker":"Chris Dy","startTime":600.95,"endTime":603.32,"body":"created an entertaining and"},{"speaker":"Chris Dy","startTime":603.32,"endTime":605.93,"body":"valuable resource for hand"},{"speaker":"Chris Dy","startTime":603.32,"endTime":605.93,"body":"surgery trainees, like myself,"},{"speaker":"Chris Dy","startTime":605.93,"endTime":609.2,"body":"and it's been very helpful to me"},{"speaker":"Chris Dy","startTime":605.93,"endTime":609.2,"body":"as I start my practice. We've"},{"speaker":"Chris Dy","startTime":609.2,"endTime":613.22,"body":"enjoyed doing it. So thank you"},{"speaker":"Chris Dy","startTime":609.2,"endTime":613.22,"body":"for, for tuning in. And he goes"},{"speaker":"Chris Dy","startTime":613.22,"endTime":616.67,"body":"on to say, I'm intrigued at the"},{"speaker":"Chris Dy","startTime":613.22,"endTime":616.67,"body":"larger benefit that sham surgery"},{"speaker":"Chris Dy","startTime":616.67,"endTime":620.54,"body":"shows and trials, both in and"},{"speaker":"Chris Dy","startTime":616.67,"endTime":620.54,"body":"out of the upper extremity, the"},{"speaker":"Chris Dy","startTime":620.54,"endTime":624.02,"body":"power of suggestion, the"},{"speaker":"Chris Dy","startTime":620.54,"endTime":624.02,"body":"scripted role of the patient"},{"speaker":"Chris Dy","startTime":624.02,"endTime":627.08,"body":"getting better, especially if"},{"speaker":"Chris Dy","startTime":624.02,"endTime":627.08,"body":"they liked their doctor. The"},{"speaker":"Chris Dy","startTime":627.11,"endTime":630.59,"body":"immobilization, the emotional"},{"speaker":"Chris Dy","startTime":627.11,"endTime":630.59,"body":"validation of having a surgery,"},{"speaker":"Chris Dy","startTime":630.68,"endTime":634.52,"body":"it all seems to add up to a very"},{"speaker":"Chris Dy","startTime":630.68,"endTime":634.52,"body":"powerful therapeutic effect."},{"speaker":"Chris Dy","startTime":635.09,"endTime":637.28,"body":"There are also several"},{"speaker":"Chris Dy","startTime":635.09,"endTime":637.28,"body":"pathologies that seem to be"},{"speaker":"Chris Dy","startTime":637.28,"endTime":640.19,"body":"treated equally well with many"},{"speaker":"Chris Dy","startTime":637.28,"endTime":640.19,"body":"different surgical techniques,"},{"speaker":"Chris Dy","startTime":640.22,"endTime":642.92,"body":"sometimes based on fundamentally"},{"speaker":"Chris Dy","startTime":640.22,"endTime":642.92,"body":"different theories of"},{"speaker":"Chris Dy","startTime":642.92,"endTime":647.45,"body":"pathophysiology, such as, you"},{"speaker":"Chris Dy","startTime":642.92,"endTime":647.45,"body":"know, various treatments of the"},{"speaker":"Chris Dy","startTime":647.48,"endTime":650.9,"body":"lateral condyle for lateral"},{"speaker":"Chris Dy","startTime":647.48,"endTime":650.9,"body":"epicondylitis, or some of the"},{"speaker":"Chris Dy","startTime":650.9,"endTime":653.15,"body":"various treatments for"},{"speaker":"Chris Dy","startTime":650.9,"endTime":653.15,"body":"Keinbock's disease, whether"},{"speaker":"Chris Dy","startTime":653.15,"endTime":655.88,"body":"you're doing vascularized, bone"},{"speaker":"Chris Dy","startTime":653.15,"endTime":655.88,"body":"grafting, shortening the radius"},{"speaker":"Chris Dy","startTime":655.88,"endTime":659.75,"body":"or even a cord decompression."},{"speaker":"Chris Dy","startTime":655.88,"endTime":659.75,"body":"Again, chronic SL reconstruction"},{"speaker":"Chris Dy","startTime":659.75,"endTime":662.78,"body":"like rotator cuff repair seems"},{"speaker":"Chris Dy","startTime":659.75,"endTime":662.78,"body":"to produce good clinical results"},{"speaker":"Chris Dy","startTime":662.78,"endTime":665.9,"body":"despite radiographic progression"},{"speaker":"Chris Dy","startTime":662.78,"endTime":665.9,"body":"or recurrence of deformity,"},{"speaker":"Chris Dy","startTime":665.99,"endTime":670.58,"body":"something seems amiss. The"},{"speaker":"Chris Dy","startTime":665.99,"endTime":670.58,"body":"surgery for epicondylitis TSCC"},{"speaker":"Chris Dy","startTime":670.58,"endTime":672.71,"body":"tears, proximal nerve"},{"speaker":"Chris Dy","startTime":670.58,"endTime":672.71,"body":"compression syndromes"},{"speaker":"Chris Dy","startTime":672.74,"endTime":676.25,"body":"Keinbock's, chronic SL, et"},{"speaker":"Chris Dy","startTime":672.74,"endTime":676.25,"body":"cetera, help my patients apart"},{"speaker":"Chris Dy","startTime":676.25,"endTime":681.05,"body":"from the placebo effect of"},{"speaker":"Chris Dy","startTime":676.25,"endTime":681.05,"body":"surgery. How can I be sure? So"},{"speaker":"Chris Dy","startTime":681.08,"endTime":682.61,"body":"you know, pretty"},{"speaker":"Chris Dy","startTime":681.08,"endTime":682.61,"body":"straightforward, easy question,"},{"speaker":"Chris Dy","startTime":682.61,"endTime":685.88,"body":"Chuck, one should take this"},{"speaker":"Chris Dy","startTime":682.61,"endTime":685.88,"body":"answer in my two cents this?"},{"speaker":"Charles Goldfarb","startTime":686.0,"endTime":689.27,"body":"Yeah, I'll"},{"speaker":"Charles Goldfarb","startTime":686.0,"endTime":689.27,"body":"take this one, Chris. You know,"},{"speaker":"Charles Goldfarb","startTime":689.27,"endTime":695.42,"body":"it's interesting, because all I"},{"speaker":"Charles Goldfarb","startTime":689.27,"endTime":695.42,"body":"really want is for the patient"},{"speaker":"Charles Goldfarb","startTime":695.42,"endTime":701.69,"body":"to be better. I'd like to do"},{"speaker":"Charles Goldfarb","startTime":695.42,"endTime":701.69,"body":"that in a non interventional"},{"speaker":"Charles Goldfarb","startTime":701.72,"endTime":706.04,"body":"way. I'd like to do it rapidly."},{"speaker":"Charles Goldfarb","startTime":701.72,"endTime":706.04,"body":"I'd like to do it with low"},{"speaker":"Charles Goldfarb","startTime":706.04,"endTime":710.84,"body":"costs. And I recognize that"},{"speaker":"Charles Goldfarb","startTime":706.04,"endTime":710.84,"body":"there is a placebo effect. But"},{"speaker":"Charles Goldfarb","startTime":710.84,"endTime":716.06,"body":"our goal is to just get patients"},{"speaker":"Charles Goldfarb","startTime":710.84,"endTime":716.06,"body":"better. And many of the"},{"speaker":"Charles Goldfarb","startTime":716.06,"endTime":720.86,"body":"surgeries that Ryan mentioned, I"},{"speaker":"Charles Goldfarb","startTime":716.06,"endTime":720.86,"body":"don't love. And I'll share one"},{"speaker":"Charles Goldfarb","startTime":720.89,"endTime":727.85,"body":"brief anecdote. Early in my"},{"speaker":"Charles Goldfarb","startTime":720.89,"endTime":727.85,"body":"career. I was the designee and"},{"speaker":"Charles Goldfarb","startTime":727.85,"endTime":730.01,"body":"that's why I started to love"},{"speaker":"Charles Goldfarb","startTime":727.85,"endTime":730.01,"body":"wrist arthroscopy because no one"},{"speaker":"Charles Goldfarb","startTime":730.01,"endTime":732.2,"body":"else really wanted to do it. And"},{"speaker":"Charles Goldfarb","startTime":730.01,"endTime":732.2,"body":"that's why I started doing it."},{"speaker":"Charles Goldfarb","startTime":732.71,"endTime":737.63,"body":"And we debris did central tears,"},{"speaker":"Charles Goldfarb","startTime":732.71,"endTime":737.63,"body":"we do breathe it radial tears,"},{"speaker":"Charles Goldfarb","startTime":737.93,"endTime":742.52,"body":"and we repaired older tears,"},{"speaker":"Charles Goldfarb","startTime":737.93,"endTime":742.52,"body":"even though we didn't recognize"},{"speaker":"Charles Goldfarb","startTime":742.55,"endTime":746.75,"body":"TFCC related instability, or at"},{"speaker":"Charles Goldfarb","startTime":742.55,"endTime":746.75,"body":"least I did not. And I always"},{"speaker":"Charles Goldfarb","startTime":746.75,"endTime":749.36,"body":"wondered if Maria and I talked"},{"speaker":"Charles Goldfarb","startTime":746.75,"endTime":749.36,"body":"about whether repairing those"},{"speaker":"Charles Goldfarb","startTime":749.36,"endTime":754.19,"body":"dorsal ulnar tears did anything."},{"speaker":"Charles Goldfarb","startTime":749.36,"endTime":754.19,"body":"Because it wasn't a stability"},{"speaker":"Charles Goldfarb","startTime":754.19,"endTime":757.16,"body":"issue. It was just a, you were"},{"speaker":"Charles Goldfarb","startTime":754.19,"endTime":757.16,"body":"doing something and really you"},{"speaker":"Charles Goldfarb","startTime":757.16,"endTime":760.37,"body":"were mobilizing and they got"},{"speaker":"Charles Goldfarb","startTime":757.16,"endTime":760.37,"body":"better. That's an example. I"},{"speaker":"Charles Goldfarb","startTime":760.37,"endTime":762.95,"body":"think we're where I was"},{"speaker":"Charles Goldfarb","startTime":760.37,"endTime":762.95,"body":"overtreating and today, I might"},{"speaker":"Charles Goldfarb","startTime":762.95,"endTime":766.61,"body":"just read that unless it was a"},{"speaker":"Charles Goldfarb","startTime":762.95,"endTime":766.61,"body":"very large tear. Again, fovea"},{"speaker":"Charles Goldfarb","startTime":766.61,"endTime":769.55,"body":"TFCC tears are a different"},{"speaker":"Charles Goldfarb","startTime":766.61,"endTime":769.55,"body":"story. They're about stability."},{"speaker":"Charles Goldfarb","startTime":769.82,"endTime":772.61,"body":"But I think he makes a good"},{"speaker":"Charles Goldfarb","startTime":769.82,"endTime":772.61,"body":"point. I don't like lateral"},{"speaker":"Charles Goldfarb","startTime":772.61,"endTime":777.08,"body":"epicondylitis surgery. I agree"},{"speaker":"Charles Goldfarb","startTime":772.61,"endTime":777.08,"body":"that lots of different ways to"},{"speaker":"Charles Goldfarb","startTime":777.62,"endTime":781.43,"body":"approach that. But we want to"},{"speaker":"Charles Goldfarb","startTime":777.62,"endTime":781.43,"body":"get the patient better. And"},{"speaker":"Charles Goldfarb","startTime":781.46,"endTime":784.64,"body":"many, if not all of the"},{"speaker":"Charles Goldfarb","startTime":781.46,"endTime":784.64,"body":"surgeries mentioned can help"},{"speaker":"Charles Goldfarb","startTime":784.64,"endTime":785.6,"body":"achieve that result."},{"speaker":"Chris Dy","startTime":787.17,"endTime":790.11,"body":"How much of the"},{"speaker":"Chris Dy","startTime":787.17,"endTime":790.11,"body":"improvement? And Ryan thank you"},{"speaker":"Chris Dy","startTime":790.11,"endTime":793.92,"body":"for getting us to a very"},{"speaker":"Chris Dy","startTime":790.11,"endTime":793.92,"body":"philosophical level here. And a"},{"speaker":"Chris Dy","startTime":793.92,"endTime":798.15,"body":"very nicely worded email"},{"speaker":"Chris Dy","startTime":793.92,"endTime":798.15,"body":"eloquent, how many of these"},{"speaker":"Chris Dy","startTime":798.18,"endTime":802.65,"body":"surgeries are deep now how much"},{"speaker":"Chris Dy","startTime":798.18,"endTime":802.65,"body":"of the improvement after surgery"},{"speaker":"Chris Dy","startTime":802.65,"endTime":806.13,"body":"do you think is from the other"},{"speaker":"Chris Dy","startTime":802.65,"endTime":806.13,"body":"things that Ryan stated? I think"},{"speaker":"Chris Dy","startTime":806.13,"endTime":808.8,"body":"it's a really important"},{"speaker":"Chris Dy","startTime":806.13,"endTime":808.8,"body":"suggestion, the scripted role of"},{"speaker":"Chris Dy","startTime":808.8,"endTime":811.77,"body":"the patient getting better"},{"speaker":"Chris Dy","startTime":808.8,"endTime":811.77,"body":"immobilization, emotional"},{"speaker":"Chris Dy","startTime":811.77,"endTime":815.19,"body":"validation of having surgery,"},{"speaker":"Chris Dy","startTime":811.77,"endTime":815.19,"body":"how much of that do you think is"},{"speaker":"Chris Dy","startTime":815.19,"endTime":815.67,"body":"part of it?"},{"speaker":"Charles Goldfarb","startTime":816.72,"endTime":819.78,"body":"All of it is"},{"speaker":"Charles Goldfarb","startTime":816.72,"endTime":819.78,"body":"part of it. And we talked about"},{"speaker":"Charles Goldfarb","startTime":819.78,"endTime":824.46,"body":"it on our last episode about ECU"},{"speaker":"Charles Goldfarb","startTime":819.78,"endTime":824.46,"body":"tendon and maybe part of is just"},{"speaker":"Charles Goldfarb","startTime":824.46,"endTime":829.11,"body":"immobilizing the patient for six"},{"speaker":"Charles Goldfarb","startTime":824.46,"endTime":829.11,"body":"weeks after surgery. It's all a"},{"speaker":"Charles Goldfarb","startTime":829.11,"endTime":833.49,"body":"part of it. One of the reasons I"},{"speaker":"Charles Goldfarb","startTime":829.11,"endTime":833.49,"body":"like fracture surgery is you"},{"speaker":"Charles Goldfarb","startTime":833.49,"endTime":838.92,"body":"fixed you fix the broken bone is"},{"speaker":"Charles Goldfarb","startTime":833.49,"endTime":838.92,"body":"very objective and you know all"},{"speaker":"Charles Goldfarb","startTime":838.92,"endTime":840.75,"body":"this other stuff is less so"},{"speaker":"Chris Dy","startTime":842.37,"endTime":844.47,"body":"I think that you know"},{"speaker":"Chris Dy","startTime":842.37,"endTime":844.47,"body":"the reason why fracture one of"},{"speaker":"Chris Dy","startTime":844.47,"endTime":847.08,"body":"the reasons why fracture surgery"},{"speaker":"Chris Dy","startTime":844.47,"endTime":847.08,"body":"is so gratifying is that not"},{"speaker":"Chris Dy","startTime":847.08,"endTime":849.96,"body":"only can you see it, the patient"},{"speaker":"Chris Dy","startTime":847.08,"endTime":849.96,"body":"can see it like you can show"},{"speaker":"Chris Dy","startTime":849.96,"endTime":854.52,"body":"that to them. It's very hard to"},{"speaker":"Chris Dy","startTime":849.96,"endTime":854.52,"body":"show patients other things you"},{"speaker":"Chris Dy","startTime":854.52,"endTime":858.03,"body":"know, effectively either because"},{"speaker":"Chris Dy","startTime":854.52,"endTime":858.03,"body":"they can't see it, and it's"},{"speaker":"Chris Dy","startTime":858.03,"endTime":860.55,"body":"based on how they feel or"},{"speaker":"Chris Dy","startTime":858.03,"endTime":860.55,"body":"because it's just really hard to"},{"speaker":"Chris Dy","startTime":860.55,"endTime":863.13,"body":"explain you know some of these"},{"speaker":"Chris Dy","startTime":860.55,"endTime":863.13,"body":"concepts escaped illuminate"},{"speaker":"Chris Dy","startTime":863.13,"endTime":866.43,"body":"instability, for example, that"},{"speaker":"Chris Dy","startTime":863.13,"endTime":866.43,"body":"we don't even fully understand."},{"speaker":"Charles Goldfarb","startTime":867.65,"endTime":872.84,"body":"Yep, totally"},{"speaker":"Charles Goldfarb","startTime":867.65,"endTime":872.84,"body":"agree. It is interesting though,"},{"speaker":"Charles Goldfarb","startTime":872.87,"endTime":876.59,"body":"the flip side of what you just"},{"speaker":"Charles Goldfarb","startTime":872.87,"endTime":876.59,"body":"said is if you treat a patient"},{"speaker":"Charles Goldfarb","startTime":876.95,"endTime":884.21,"body":"for a fracture, and they develop"},{"speaker":"Charles Goldfarb","startTime":876.95,"endTime":884.21,"body":"a painless fibrous non union we"},{"speaker":"Charles Goldfarb","startTime":884.21,"endTime":886.49,"body":"might be okay with that but"},{"speaker":"Charles Goldfarb","startTime":884.21,"endTime":886.49,"body":"sometimes patients are not."},{"speaker":"Chris Dy","startTime":887.06,"endTime":888.86,"body":"Right and that's where"},{"speaker":"Chris Dy","startTime":887.06,"endTime":888.86,"body":"I start to lay the crepe from"},{"speaker":"Chris Dy","startTime":888.86,"endTime":893.48,"body":"the very beginning. Now I think"},{"speaker":"Chris Dy","startTime":888.86,"endTime":893.48,"body":"they're I think they're, you"},{"speaker":"Chris Dy","startTime":893.48,"endTime":896.33,"body":"know, of the surgeries you"},{"speaker":"Chris Dy","startTime":893.48,"endTime":896.33,"body":"listed at the end each of those"},{"speaker":"Chris Dy","startTime":896.33,"endTime":899.42,"body":"has value when done in the"},{"speaker":"Chris Dy","startTime":896.33,"endTime":899.42,"body":"appropriate setting. Now of"},{"speaker":"Chris Dy","startTime":899.42,"endTime":901.94,"body":"course I'm by is because we're"},{"speaker":"Chris Dy","startTime":899.42,"endTime":901.94,"body":"the ones were the arbiters of"},{"speaker":"Chris Dy","startTime":901.94,"endTime":909.59,"body":"what's appropriate. fair or not."},{"speaker":"Chris Dy","startTime":901.94,"endTime":909.59,"body":"But I, I've tried to take, I've"},{"speaker":"Chris Dy","startTime":909.59,"endTime":914.33,"body":"tried very firmly to avoid the"},{"speaker":"Chris Dy","startTime":909.59,"endTime":914.33,"body":"supply induced demand. Just"},{"speaker":"Chris Dy","startTime":914.33,"endTime":916.34,"body":"because I can do something"},{"speaker":"Chris Dy","startTime":914.33,"endTime":916.34,"body":"doesn't mean that I should do"},{"speaker":"Chris Dy","startTime":916.34,"endTime":919.79,"body":"it. But I can see very easily"},{"speaker":"Chris Dy","startTime":916.34,"endTime":919.79,"body":"how if you haven't run a good"},{"speaker":"Chris Dy","startTime":919.79,"endTime":922.49,"body":"experiences with some cases,"},{"speaker":"Chris Dy","startTime":919.79,"endTime":922.49,"body":"you're gonna push the limits on"},{"speaker":"Chris Dy","startTime":922.49,"endTime":925.43,"body":"some stuff, and really feel like"},{"speaker":"Chris Dy","startTime":922.49,"endTime":925.43,"body":"you know, in your heart of"},{"speaker":"Chris Dy","startTime":925.43,"endTime":927.35,"body":"hearts, that you're doing"},{"speaker":"Chris Dy","startTime":925.43,"endTime":927.35,"body":"something for that patient, and"},{"speaker":"Chris Dy","startTime":927.35,"endTime":929.72,"body":"maybe they're going to do well,"},{"speaker":"Chris Dy","startTime":927.35,"endTime":929.72,"body":"because of the other reasons"},{"speaker":"Chris Dy","startTime":929.72,"endTime":930.38,"body":"that you stated."},{"speaker":"Charles Goldfarb","startTime":931.2,"endTime":937.14,"body":"Yeah, it's a"},{"speaker":"Charles Goldfarb","startTime":931.2,"endTime":937.14,"body":"really tough concept. And I can"},{"speaker":"Charles Goldfarb","startTime":937.14,"endTime":939.75,"body":"sit here and be judgmental of"},{"speaker":"Charles Goldfarb","startTime":937.14,"endTime":939.75,"body":"people who've gotten a great"},{"speaker":"Charles Goldfarb","startTime":939.75,"endTime":943.98,"body":"result from something I don't"},{"speaker":"Charles Goldfarb","startTime":939.75,"endTime":943.98,"body":"do. And that may not be fair."},{"speaker":"Charles Goldfarb","startTime":944.13,"endTime":949.23,"body":"And I think it is incumbent on"},{"speaker":"Charles Goldfarb","startTime":944.13,"endTime":949.23,"body":"all of us to practice"},{"speaker":"Charles Goldfarb","startTime":949.23,"endTime":952.2,"body":"appropriate medicine, it's"},{"speaker":"Charles Goldfarb","startTime":949.23,"endTime":952.2,"body":"sometimes it's easier said than"},{"speaker":"Charles Goldfarb","startTime":952.2,"endTime":954.72,"body":"done at the patient's putting"},{"speaker":"Charles Goldfarb","startTime":952.2,"endTime":954.72,"body":"pressure on you about an"},{"speaker":"Charles Goldfarb","startTime":954.72,"endTime":958.5,"body":"intervention. And it just gets"},{"speaker":"Charles Goldfarb","startTime":954.72,"endTime":958.5,"body":"really tricky. But you know,"},{"speaker":"Charles Goldfarb","startTime":958.53,"endTime":963.81,"body":"the, you want to sleep well at"},{"speaker":"Charles Goldfarb","startTime":958.53,"endTime":963.81,"body":"night. And that is not always a"},{"speaker":"Charles Goldfarb","startTime":963.81,"endTime":970.8,"body":"way to think about it. Because"},{"speaker":"Charles Goldfarb","startTime":963.81,"endTime":970.8,"body":"if you're directionality you can"},{"speaker":"Charles Goldfarb","startTime":970.8,"endTime":973.41,"body":"get you can, you can deceive"},{"speaker":"Charles Goldfarb","startTime":970.8,"endTime":973.41,"body":"yourself about whatever you want"},{"speaker":"Charles Goldfarb","startTime":973.41,"endTime":975.93,"body":"to do. So it's not always about"},{"speaker":"Charles Goldfarb","startTime":973.41,"endTime":975.93,"body":"sleeping well, but that's my"},{"speaker":"Charles Goldfarb","startTime":975.93,"endTime":980.04,"body":"threshold. And I try to be"},{"speaker":"Charles Goldfarb","startTime":975.93,"endTime":980.04,"body":"scientific, I try to follow the"},{"speaker":"Charles Goldfarb","startTime":980.04,"endTime":983.55,"body":"literature. And I feel pretty"},{"speaker":"Charles Goldfarb","startTime":980.04,"endTime":983.55,"body":"comfortable that I don't over"},{"speaker":"Charles Goldfarb","startTime":983.55,"endTime":984.18,"body":"treat people."},{"speaker":"Chris Dy","startTime":985.5,"endTime":989.01,"body":"I try to be a good"},{"speaker":"Chris Dy","startTime":985.5,"endTime":989.01,"body":"steward for, you know, testing,"},{"speaker":"Chris Dy","startTime":989.01,"endTime":991.32,"body":"and you know, that kind of"},{"speaker":"Chris Dy","startTime":989.01,"endTime":991.32,"body":"stuff. But sometimes, honestly,"},{"speaker":"Chris Dy","startTime":991.83,"endTime":995.37,"body":"some patients just want some"},{"speaker":"Chris Dy","startTime":991.83,"endTime":995.37,"body":"imaging that maybe I would not"},{"speaker":"Chris Dy","startTime":995.37,"endTime":999.18,"body":"have ordered, but I actually"},{"speaker":"Chris Dy","startTime":995.37,"endTime":999.18,"body":"know that just getting the fact"},{"speaker":"Chris Dy","startTime":999.21,"endTime":1002.36,"body":"that I'm getting something and"},{"speaker":"Chris Dy","startTime":999.21,"endTime":1002.36,"body":"doing something for them is"},{"speaker":"Chris Dy","startTime":1002.36,"endTime":1005.81,"body":"therapeutic. So I'm guilty of"},{"speaker":"Chris Dy","startTime":1002.36,"endTime":1005.81,"body":"ordering some therapeutic"},{"speaker":"Chris Dy","startTime":1005.81,"endTime":1006.71,"body":"imaging at times,"},{"speaker":"Charles Goldfarb","startTime":1007.37,"endTime":1010.97,"body":"for sure. And"},{"speaker":"Charles Goldfarb","startTime":1007.37,"endTime":1010.97,"body":"I will add, one of the best"},{"speaker":"Charles Goldfarb","startTime":1010.97,"endTime":1016.13,"body":"things about being an academic"},{"speaker":"Charles Goldfarb","startTime":1010.97,"endTime":1016.13,"body":"medicine is you have people"},{"speaker":"Charles Goldfarb","startTime":1016.13,"endTime":1019.88,"body":"judging each step you take you"},{"speaker":"Charles Goldfarb","startTime":1016.13,"endTime":1019.88,"body":"have residents and fellows"},{"speaker":"Charles Goldfarb","startTime":1019.88,"endTime":1023.69,"body":"questioning while you're doing"},{"speaker":"Charles Goldfarb","startTime":1019.88,"endTime":1023.69,"body":"something, and you can't kid"},{"speaker":"Charles Goldfarb","startTime":1023.69,"endTime":1027.2,"body":"yourself, and you can't deceive"},{"speaker":"Charles Goldfarb","startTime":1023.69,"endTime":1027.2,"body":"yourself, and you have to be"},{"speaker":"Charles Goldfarb","startTime":1027.2,"endTime":1030.32,"body":"able to defend yourself. Not"},{"speaker":"Charles Goldfarb","startTime":1027.2,"endTime":1030.32,"body":"just do it because I said to do"},{"speaker":"Charles Goldfarb","startTime":1030.32,"endTime":1035.06,"body":"it. They don't question you"},{"speaker":"Charles Goldfarb","startTime":1030.32,"endTime":1035.06,"body":"though, right? i When people"},{"speaker":"Charles Goldfarb","startTime":1035.06,"endTime":1038.84,"body":"come on my rotation now I don't"},{"speaker":"Charles Goldfarb","startTime":1035.06,"endTime":1038.84,"body":"know if they do or not. But it"},{"speaker":"Charles Goldfarb","startTime":1038.84,"endTime":1041.99,"body":"when people come on rotation,"},{"speaker":"Charles Goldfarb","startTime":1038.84,"endTime":1041.99,"body":"that's the first rule. If we are"},{"speaker":"Charles Goldfarb","startTime":1041.99,"endTime":1044.87,"body":"in the or if we are in the"},{"speaker":"Charles Goldfarb","startTime":1041.99,"endTime":1044.87,"body":"clinic, and something doesn't"},{"speaker":"Charles Goldfarb","startTime":1044.87,"endTime":1047.75,"body":"feel right, or you don't think"},{"speaker":"Charles Goldfarb","startTime":1044.87,"endTime":1047.75,"body":"I'm doing the right thing. I"},{"speaker":"Charles Goldfarb","startTime":1047.75,"endTime":1051.41,"body":"expect you to speak up and if"},{"speaker":"Charles Goldfarb","startTime":1047.75,"endTime":1051.41,"body":"you don't, and something goes"},{"speaker":"Charles Goldfarb","startTime":1051.41,"endTime":1053.09,"body":"amiss, I will be really"},{"speaker":"Charles Goldfarb","startTime":1051.41,"endTime":1053.09,"body":"disappointed."},{"speaker":"Chris Dy","startTime":1054.2,"endTime":1056.66,"body":"People who never gave"},{"speaker":"Chris Dy","startTime":1054.2,"endTime":1056.66,"body":"me you never gave me that first"},{"speaker":"Chris Dy","startTime":1056.66,"endTime":1058.07,"body":"rule. The first rule was don't"},{"speaker":"Chris Dy","startTime":1056.66,"endTime":1058.07,"body":"sing."},{"speaker":"Charles Goldfarb","startTime":1060.82,"endTime":1062.95,"body":"The second"},{"speaker":"Charles Goldfarb","startTime":1060.82,"endTime":1062.95,"body":"rule was don't speak up Dr. Dy."},{"speaker":"Chris Dy","startTime":1064.3,"endTime":1066.88,"body":"That's fine. It's it"},{"speaker":"Chris Dy","startTime":1064.3,"endTime":1066.88,"body":"on a lighter note, I remember"},{"speaker":"Chris Dy","startTime":1066.88,"endTime":1070.21,"body":"getting sign out about your"},{"speaker":"Chris Dy","startTime":1066.88,"endTime":1070.21,"body":"rotation. And it was so funny"},{"speaker":"Chris Dy","startTime":1070.21,"endTime":1072.43,"body":"because like when you're an"},{"speaker":"Chris Dy","startTime":1070.21,"endTime":1072.43,"body":"attending, people will think"},{"speaker":"Chris Dy","startTime":1072.43,"endTime":1075.67,"body":"that you want all these things"},{"speaker":"Chris Dy","startTime":1072.43,"endTime":1075.67,"body":"or don't want certain things and"},{"speaker":"Chris Dy","startTime":1075.67,"endTime":1078.52,"body":"it's just this like lower that"},{"speaker":"Chris Dy","startTime":1075.67,"endTime":1078.52,"body":"gets passed down that you know,"},{"speaker":"Chris Dy","startTime":1078.52,"endTime":1081.85,"body":"Goldfarb wants things exactly"},{"speaker":"Chris Dy","startTime":1078.52,"endTime":1081.85,"body":"this way every time and it's"},{"speaker":"Chris Dy","startTime":1081.85,"endTime":1084.55,"body":"probably because like some"},{"speaker":"Chris Dy","startTime":1081.85,"endTime":1084.55,"body":"random thing happened one time,"},{"speaker":"Chris Dy","startTime":1084.91,"endTime":1087.67,"body":"and they just like took it to"},{"speaker":"Chris Dy","startTime":1084.91,"endTime":1087.67,"body":"heart. But yeah, it's it's very"},{"speaker":"Chris Dy","startTime":1087.67,"endTime":1091.27,"body":"funny to see. You know, how you"},{"speaker":"Chris Dy","startTime":1087.67,"endTime":1091.27,"body":"actually practice in your actual"},{"speaker":"Chris Dy","startTime":1091.27,"endTime":1093.25,"body":"preferences versus what I was"},{"speaker":"Chris Dy","startTime":1091.27,"endTime":1093.25,"body":"told about you?"},{"speaker":"Charles Goldfarb","startTime":1094.15,"endTime":1097.03,"body":"Yeah, I'm sure"},{"speaker":"Charles Goldfarb","startTime":1094.15,"endTime":1097.03,"body":"that's true. I'm sure that's"},{"speaker":"Charles Goldfarb","startTime":1097.03,"endTime":1101.2,"body":"true. I that was I love that"},{"speaker":"Charles Goldfarb","startTime":1097.03,"endTime":1101.2,"body":"conversation. There's no easy"},{"speaker":"Charles Goldfarb","startTime":1101.2,"endTime":1103.9,"body":"answers, as you obviously know,"},{"speaker":"Charles Goldfarb","startTime":1101.2,"endTime":1103.9,"body":"as we all know, but interesting"},{"speaker":"Charles Goldfarb","startTime":1103.9,"endTime":1104.59,"body":"conversation."},{"speaker":"Chris Dy","startTime":1105.1,"endTime":1107.44,"body":"Now, no, I think Ryan"},{"speaker":"Chris Dy","startTime":1105.1,"endTime":1107.44,"body":"deserves a mug. Chuck, are there"},{"speaker":"Chris Dy","startTime":1107.44,"endTime":1108.31,"body":"any mugs left?"},{"speaker":"Charles Goldfarb","startTime":1108.58,"endTime":1110.44,"body":"There are a"},{"speaker":"Charles Goldfarb","startTime":1108.58,"endTime":1110.44,"body":"few mugs left. We should get"},{"speaker":"Charles Goldfarb","startTime":1110.44,"endTime":1113.44,"body":"Ryan's address. Ryan, if you're"},{"speaker":"Charles Goldfarb","startTime":1110.44,"endTime":1113.44,"body":"listening, send us your address,"},{"speaker":"Charles Goldfarb","startTime":1113.44,"endTime":1114.79,"body":"and we will send you a mug."},{"speaker":"Chris Dy","startTime":1115.33,"endTime":1118.09,"body":"Fantastic. And I think"},{"speaker":"Chris Dy","startTime":1115.33,"endTime":1118.09,"body":"we also owe one of our former"},{"speaker":"Chris Dy","startTime":1118.09,"endTime":1121.75,"body":"fellows a mug the one one of the"},{"speaker":"Chris Dy","startTime":1118.09,"endTime":1121.75,"body":"things that we said was if they"},{"speaker":"Chris Dy","startTime":1121.75,"endTime":1125.05,"body":"published an article from their"},{"speaker":"Chris Dy","startTime":1121.75,"endTime":1125.05,"body":"fellow research project that"},{"speaker":"Chris Dy","startTime":1125.05,"endTime":1128.86,"body":"they will get a mug and your"},{"speaker":"Chris Dy","startTime":1125.05,"endTime":1128.86,"body":"mentee on this project. Dr."},{"speaker":"Chris Dy","startTime":1128.86,"endTime":1133.15,"body":"Jocelyn Compton recently scored"},{"speaker":"Chris Dy","startTime":1128.86,"endTime":1133.15,"body":"a nice JHS publication on how"},{"speaker":"Chris Dy","startTime":1133.18,"endTime":1136.15,"body":"none of us need to fix Jersey"},{"speaker":"Chris Dy","startTime":1133.18,"endTime":1136.15,"body":"fingers anymore. So bravo."},{"speaker":"Chris Dy","startTime":1136.18,"endTime":1137.35,"body":"Definitely mug worthy."},{"speaker":"Charles Goldfarb","startTime":1138.13,"endTime":1140.41,"body":"Have we talked"},{"speaker":"Charles Goldfarb","startTime":1138.13,"endTime":1140.41,"body":"about that article? I think we"},{"speaker":"Charles Goldfarb","startTime":1140.41,"endTime":1140.56,"body":"did."},{"speaker":"Chris Dy","startTime":1140.56,"endTime":1142.81,"body":"We talked about it. We"},{"speaker":"Chris Dy","startTime":1140.56,"endTime":1142.81,"body":"talked about it on the hand"},{"speaker":"Chris Dy","startTime":1142.81,"endTime":1149.38,"body":"society wrap up when it won the"},{"speaker":"Chris Dy","startTime":1142.81,"endTime":1149.38,"body":"award for the best. Best poster?"},{"speaker":"Charles Goldfarb","startTime":1149.71,"endTime":1151.87,"body":"Yeah, it is a"},{"speaker":"Charles Goldfarb","startTime":1149.71,"endTime":1151.87,"body":"really interesting article read"},{"speaker":"Charles Goldfarb","startTime":1151.87,"endTime":1155.83,"body":"it everyone in journal of hand"},{"speaker":"Charles Goldfarb","startTime":1151.87,"endTime":1155.83,"body":"surgery. It does not say don't"},{"speaker":"Charles Goldfarb","startTime":1155.83,"endTime":1160.84,"body":"fix FDPs. But it does question"},{"speaker":"Charles Goldfarb","startTime":1155.83,"endTime":1160.84,"body":"why it's a knee jerk reaction"},{"speaker":"Charles Goldfarb","startTime":1160.84,"endTime":1163.96,"body":"because complications are"},{"speaker":"Charles Goldfarb","startTime":1160.84,"endTime":1163.96,"body":"higher, and outcomes are not"},{"speaker":"Charles Goldfarb","startTime":1163.96,"endTime":1165.28,"body":"clearly better for many."},{"speaker":"Chris Dy","startTime":1165.88,"endTime":1167.98,"body":"Now I took that as"},{"speaker":"Chris Dy","startTime":1165.88,"endTime":1167.98,"body":"don't fix them or send them to"},{"speaker":"Chris Dy","startTime":1167.98,"endTime":1171.07,"body":"the Senate to the senior author"},{"speaker":"Chris Dy","startTime":1167.98,"endTime":1171.07,"body":"of Dr. Compton's article."},{"speaker":"Charles Goldfarb","startTime":1171.25,"endTime":1172.87,"body":"Oh, please"},{"speaker":"Charles Goldfarb","startTime":1171.25,"endTime":1172.87,"body":"don't."},{"speaker":"Chris Dy","startTime":1174.67,"endTime":1176.8,"body":"That's exactly what"},{"speaker":"Chris Dy","startTime":1174.67,"endTime":1176.8,"body":"you want a bunch of non-op zone"},{"speaker":"Chris Dy","startTime":1176.8,"endTime":1177.07,"body":"ones."},{"speaker":"Charles Goldfarb","startTime":1178.91,"endTime":1182.66,"body":"Yes, exactly."},{"speaker":"Charles Goldfarb","startTime":1178.91,"endTime":1182.66,"body":"Tell me about an interesting"},{"speaker":"Charles Goldfarb","startTime":1182.66,"endTime":1183.77,"body":"case you've done recently."},{"speaker":"Chris Dy","startTime":1185.16,"endTime":1188.67,"body":"So you remember when"},{"speaker":"Chris Dy","startTime":1185.16,"endTime":1188.67,"body":"we were talking about our radial"},{"speaker":"Chris Dy","startTime":1188.67,"endTime":1193.98,"body":"tunnel technique? And he said,"},{"speaker":"Chris Dy","startTime":1188.67,"endTime":1193.98,"body":"yeah, just go interior. And then"},{"speaker":"Chris Dy","startTime":1193.98,"endTime":1196.11,"body":"I joked and said, Well, you"},{"speaker":"Chris Dy","startTime":1193.98,"endTime":1196.11,"body":"don't like to release all of the"},{"speaker":"Chris Dy","startTime":1196.11,"endTime":1204.45,"body":"radial tunnel. So really? Yeah."},{"speaker":"Chris Dy","startTime":1196.11,"endTime":1204.45,"body":"I recently, I saw patients and"},{"speaker":"Chris Dy","startTime":1204.66,"endTime":1208.98,"body":"ended up revising a radial"},{"speaker":"Chris Dy","startTime":1204.66,"endTime":1208.98,"body":"tunnel. And it was the exact"},{"speaker":"Chris Dy","startTime":1209.43,"endTime":1213.69,"body":"textbook kind of distal"},{"speaker":"Chris Dy","startTime":1209.43,"endTime":1213.69,"body":"compression. And to the point"},{"speaker":"Chris Dy","startTime":1213.69,"endTime":1220.02,"body":"where, you know, we examined her"},{"speaker":"Chris Dy","startTime":1213.69,"endTime":1220.02,"body":"in the Neo preop and put an exon"},{"speaker":"Chris Dy","startTime":1220.02,"endTime":1223.5,"body":"where they were maximally"},{"speaker":"Chris Dy","startTime":1220.02,"endTime":1223.5,"body":"tender, and lo and behold,"},{"speaker":"Chris Dy","startTime":1223.53,"endTime":1227.91,"body":"that's where the residual"},{"speaker":"Chris Dy","startTime":1223.53,"endTime":1227.91,"body":"supinator was. And the first"},{"speaker":"Chris Dy","startTime":1227.91,"endTime":1230.1,"body":"surgery had been done through an"},{"speaker":"Chris Dy","startTime":1227.91,"endTime":1230.1,"body":"anterior approach by an"},{"speaker":"Chris Dy","startTime":1230.1,"endTime":1233.25,"body":"excellent surgeon. But you know,"},{"speaker":"Chris Dy","startTime":1230.1,"endTime":1233.25,"body":"it's just one of those things"},{"speaker":"Chris Dy","startTime":1233.25,"endTime":1236.01,"body":"that you just, it's really hard"},{"speaker":"Chris Dy","startTime":1233.25,"endTime":1236.01,"body":"to see the distal end of the"},{"speaker":"Chris Dy","startTime":1236.01,"endTime":1240.63,"body":"supinator. And I don't go dorsal"},{"speaker":"Chris Dy","startTime":1236.01,"endTime":1240.63,"body":"very often and isolated manner."},{"speaker":"Chris Dy","startTime":1240.63,"endTime":1243.33,"body":"And that is a humbling approach"},{"speaker":"Chris Dy","startTime":1240.63,"endTime":1243.33,"body":"to do when you're trying to just"},{"speaker":"Chris Dy","startTime":1243.33,"endTime":1248.28,"body":"perfectly get the, the fascial"},{"speaker":"Chris Dy","startTime":1243.33,"endTime":1248.28,"body":"planes and not make dog meat. As"},{"speaker":"Chris Dy","startTime":1248.28,"endTime":1252.3,"body":"I mentioned earlier, if you're"},{"speaker":"Chris Dy","startTime":1248.28,"endTime":1252.3,"body":"even just a planer to off a"},{"speaker":"Chris Dy","startTime":1252.3,"endTime":1254.7,"body":"couple of clicks off, you know,"},{"speaker":"Chris Dy","startTime":1252.3,"endTime":1254.7,"body":"that can change your whole"},{"speaker":"Chris Dy","startTime":1254.7,"endTime":1257.37,"body":"approach and clearly obscure"},{"speaker":"Chris Dy","startTime":1254.7,"endTime":1257.37,"body":"where you need to be."},{"speaker":"Charles Goldfarb","startTime":1258.36,"endTime":1260.97,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1258.36,"endTime":1260.97,"body":"well said, I like a couple of"},{"speaker":"Charles Goldfarb","startTime":1260.97,"endTime":1264.36,"body":"things that you said. The first"},{"speaker":"Charles Goldfarb","startTime":1260.97,"endTime":1264.36,"body":"is that, and I've said this over"},{"speaker":"Charles Goldfarb","startTime":1264.36,"endTime":1268.59,"body":"and over, I love examining and"},{"speaker":"Charles Goldfarb","startTime":1264.36,"endTime":1268.59,"body":"marking patients in the"},{"speaker":"Charles Goldfarb","startTime":1268.59,"endTime":1272.31,"body":"preoperative holding area, I"},{"speaker":"Charles Goldfarb","startTime":1268.59,"endTime":1272.31,"body":"mark my incisions, I mark the"},{"speaker":"Charles Goldfarb","startTime":1272.34,"endTime":1276.63,"body":"masses, and I mark the areas of"},{"speaker":"Charles Goldfarb","startTime":1272.34,"endTime":1276.63,"body":"greatest discomfort. So I love"},{"speaker":"Charles Goldfarb","startTime":1276.63,"endTime":1279.99,"body":"that for radial tunnel, that's a"},{"speaker":"Charles Goldfarb","startTime":1276.63,"endTime":1279.99,"body":"super helpful thing. And I think"},{"speaker":"Charles Goldfarb","startTime":1279.99,"endTime":1282.78,"body":"it can guide your approach. So"},{"speaker":"Charles Goldfarb","startTime":1279.99,"endTime":1282.78,"body":"love that."},{"speaker":"Chris Dy","startTime":1282.0,"endTime":1286.47,"body":"You know, I don't do"},{"speaker":"Chris Dy","startTime":1282.0,"endTime":1286.47,"body":"the dorsal approach, often in"},{"speaker":"Chris Dy","startTime":1286.47,"endTime":1289.92,"body":"isolation. The other case I'll"},{"speaker":"Chris Dy","startTime":1286.47,"endTime":1289.92,"body":"share with you guys later, you"},{"speaker":"Chris Dy","startTime":1289.92,"endTime":1294.81,"body":"know, I use the dorsal approach"},{"speaker":"Chris Dy","startTime":1289.92,"endTime":1294.81,"body":"as an accessory. But a pure"},{"speaker":"Chris Dy","startTime":1294.81,"endTime":1297.93,"body":"dorsal approach is challenging,"},{"speaker":"Chris Dy","startTime":1294.81,"endTime":1297.93,"body":"and especially when you start to"},{"speaker":"Chris Dy","startTime":1297.93,"endTime":1301.65,"body":"encounter a scar. And that's"},{"speaker":"Chris Dy","startTime":1297.93,"endTime":1301.65,"body":"when it gets real and very"},{"speaker":"Chris Dy","startTime":1301.65,"endTime":1305.76,"body":"challenging to try to free up"},{"speaker":"Chris Dy","startTime":1301.65,"endTime":1305.76,"body":"the PIN in an area where you've"},{"speaker":"Chris Dy","startTime":1305.76,"endTime":1309.12,"body":"got a lot of small vessels."},{"speaker":"Chris Dy","startTime":1305.76,"endTime":1309.12,"body":"You're around a lot of muscle."},{"speaker":"Chris Dy","startTime":1309.12,"endTime":1312.81,"body":"It's not exactly the easiest"},{"speaker":"Chris Dy","startTime":1309.12,"endTime":1312.81,"body":"surgery in a revision setting."},{"speaker":"Charles Goldfarb","startTime":1313.53,"endTime":1318.9,"body":"Yeah, I did"},{"speaker":"Charles Goldfarb","startTime":1313.53,"endTime":1318.9,"body":"that. Very similar surgery for"},{"speaker":"Charles Goldfarb","startTime":1318.9,"endTime":1324.63,"body":"different reason. But I, I did I"},{"speaker":"Charles Goldfarb","startTime":1318.9,"endTime":1324.63,"body":"took a patient to the or who had"},{"speaker":"Charles Goldfarb","startTime":1324.63,"endTime":1329.37,"body":"proximal radioulnar sent us a"},{"speaker":"Charles Goldfarb","startTime":1324.63,"endTime":1329.37,"body":"proximal radioulnar impingement"},{"speaker":"Charles Goldfarb","startTime":1330.78,"endTime":1334.62,"body":"after radial head replacement,"},{"speaker":"Charles Goldfarb","startTime":1330.78,"endTime":1334.62,"body":"and removal of the radial head"},{"speaker":"Charles Goldfarb","startTime":1334.62,"endTime":1340.17,"body":"implant. And so with rotation,"},{"speaker":"Charles Goldfarb","startTime":1334.62,"endTime":1340.17,"body":"he was impinging radius on ulna."},{"speaker":"Charles Goldfarb","startTime":1340.74,"endTime":1345.75,"body":"And so the first thing I did was"},{"speaker":"Charles Goldfarb","startTime":1340.74,"endTime":1345.75,"body":"find the radial nerve and find"},{"speaker":"Charles Goldfarb","startTime":1345.75,"endTime":1350.19,"body":"it entering and exiting the"},{"speaker":"Charles Goldfarb","startTime":1345.75,"endTime":1350.19,"body":"supinator and can't get safe."},{"speaker":"Charles Goldfarb","startTime":1351.6,"endTime":1354.84,"body":"And then I created an"},{"speaker":"Charles Goldfarb","startTime":1351.6,"endTime":1354.84,"body":"interposition combination of"},{"speaker":"Charles Goldfarb","startTime":1354.84,"endTime":1359.52,"body":"Antonius and Allah graft, super"},{"speaker":"Charles Goldfarb","startTime":1354.84,"endTime":1359.52,"body":"fun surgery, super trying"},{"speaker":"Charles Goldfarb","startTime":1359.52,"endTime":1363.69,"body":"surgery. But that approach, as"},{"speaker":"Charles Goldfarb","startTime":1359.52,"endTime":1363.69,"body":"you just said, with scar tissue"},{"speaker":"Charles Goldfarb","startTime":1364.35,"endTime":1368.73,"body":"can be tricky, but feels really"},{"speaker":"Charles Goldfarb","startTime":1364.35,"endTime":1368.73,"body":"good when you see the anatomy as"},{"speaker":"Charles Goldfarb","startTime":1368.73,"endTime":1369.93,"body":"you as you describe."},{"speaker":"Chris Dy","startTime":1370.23,"endTime":1372.15,"body":"Now is that a dual"},{"speaker":"Chris Dy","startTime":1370.23,"endTime":1372.15,"body":"incision approach?"},{"speaker":"Charles Goldfarb","startTime":1373.11,"endTime":1377.34,"body":"Did not I just"},{"speaker":"Charles Goldfarb","startTime":1373.11,"endTime":1377.34,"body":"went sort of an extended ankle"},{"speaker":"Charles Goldfarb","startTime":1377.34,"endTime":1381.93,"body":"as approach really sort of where"},{"speaker":"Charles Goldfarb","startTime":1377.34,"endTime":1381.93,"body":"they made the previous decision,"},{"speaker":"Charles Goldfarb","startTime":1381.93,"endTime":1383.34,"body":"but I just made it a little bit"},{"speaker":"Charles Goldfarb","startTime":1381.93,"endTime":1383.34,"body":"longer."},{"speaker":"Chris Dy","startTime":1383.82,"endTime":1385.71,"body":"We should in the"},{"speaker":"Chris Dy","startTime":1383.82,"endTime":1385.71,"body":"future episodes spent some time"},{"speaker":"Chris Dy","startTime":1385.71,"endTime":1388.59,"body":"talking about proximal"},{"speaker":"Chris Dy","startTime":1385.71,"endTime":1388.59,"body":"radioulnar synostosis. That's a"},{"speaker":"Chris Dy","startTime":1388.68,"endTime":1390.0,"body":"tough condition to treat."},{"speaker":"Charles Goldfarb","startTime":1390.6,"endTime":1392.52,"body":"Unfortunately,"},{"speaker":"Charles Goldfarb","startTime":1390.6,"endTime":1392.52,"body":"I have experienced with both"},{"speaker":"Charles Goldfarb","startTime":1392.52,"endTime":1396.39,"body":"synostosis and impingement. And"},{"speaker":"Charles Goldfarb","startTime":1392.52,"endTime":1396.39,"body":"I really as you know, have"},{"speaker":"Charles Goldfarb","startTime":1396.45,"endTime":1400.08,"body":"gained, you know, really started"},{"speaker":"Charles Goldfarb","startTime":1396.45,"endTime":1400.08,"body":"to love elbow. So yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1400.08,"endTime":1400.92,"body":"that'd be a fun episode."},{"speaker":"Chris Dy","startTime":1401.58,"endTime":1402.66,"body":"I'm glad you love"},{"speaker":"Chris Dy","startTime":1401.58,"endTime":1402.66,"body":"elbow."},{"speaker":"Charles Goldfarb","startTime":1403.44,"endTime":1404.67,"body":"I've many have"},{"speaker":"Charles Goldfarb","startTime":1403.44,"endTime":1404.67,"body":"said that to me."},{"speaker":"Chris Dy","startTime":1404.0,"endTime":1407.12,"body":"But then, you know the"},{"speaker":"Chris Dy","startTime":1404.0,"endTime":1407.12,"body":"other part that was interesting"},{"speaker":"Chris Dy","startTime":1407.12,"endTime":1410.33,"body":"about this case is that they had"},{"speaker":"Chris Dy","startTime":1407.12,"endTime":1410.33,"body":"come in with an ultrasound from"},{"speaker":"Chris Dy","startTime":1410.33,"endTime":1413.96,"body":"elsewhere. And the ultrasound"},{"speaker":"Chris Dy","startTime":1410.33,"endTime":1413.96,"body":"from elsewhere showed that the"},{"speaker":"Chris Dy","startTime":1413.99,"endTime":1416.87,"body":"superficial radial nerve was not"},{"speaker":"Chris Dy","startTime":1413.99,"endTime":1416.87,"body":"enlarged compared to the"},{"speaker":"Chris Dy","startTime":1416.87,"endTime":1420.59,"body":"opposite side. But she added"},{"speaker":"Chris Dy","startTime":1416.87,"endTime":1420.59,"body":"smells that will you know,"},{"speaker":"Chris Dy","startTime":1420.59,"endTime":1423.11,"body":"coincided with the area where"},{"speaker":"Chris Dy","startTime":1420.59,"endTime":1423.11,"body":"the superficial radial nerve"},{"speaker":"Chris Dy","startTime":1423.11,"endTime":1426.08,"body":"exits from underneath the"},{"speaker":"Chris Dy","startTime":1423.11,"endTime":1426.08,"body":"brachioradialis and she was this"},{"speaker":"Chris Dy","startTime":1426.08,"endTime":1430.31,"body":"aesthetic in the SRN"},{"speaker":"Chris Dy","startTime":1426.08,"endTime":1430.31,"body":"distribution, motor wise had"},{"speaker":"Chris Dy","startTime":1430.31,"endTime":1435.41,"body":"recovered everything from her"},{"speaker":"Chris Dy","startTime":1430.31,"endTime":1435.41,"body":"last surgery but we went ahead"},{"speaker":"Chris Dy","startTime":1435.41,"endTime":1439.37,"body":"and did the SRN decompression"},{"speaker":"Chris Dy","startTime":1435.41,"endTime":1439.37,"body":"and the brachioradialis anatomy"},{"speaker":"Chris Dy","startTime":1439.37,"endTime":1443.09,"body":"and the nerve just didn't look"},{"speaker":"Chris Dy","startTime":1439.37,"endTime":1443.09,"body":"right. And I it's totally like a"},{"speaker":"Chris Dy","startTime":1443.09,"endTime":1447.32,"body":"squishy, very kind of anecdotal"},{"speaker":"Chris Dy","startTime":1443.09,"endTime":1447.32,"body":"and soft call, but it just"},{"speaker":"Chris Dy","startTime":1447.32,"endTime":1450.53,"body":"didn't look right. And I can"},{"speaker":"Chris Dy","startTime":1447.32,"endTime":1450.53,"body":"clearly I think you could feel"},{"speaker":"Chris Dy","startTime":1450.53,"endTime":1454.97,"body":"and see the area where the nerve"},{"speaker":"Chris Dy","startTime":1450.53,"endTime":1454.97,"body":"was not normal. I can't say it"},{"speaker":"Chris Dy","startTime":1454.97,"endTime":1458.84,"body":"was terribly enlarged. But I"},{"speaker":"Chris Dy","startTime":1454.97,"endTime":1458.84,"body":"could I think maybe I'm"},{"speaker":"Chris Dy","startTime":1458.84,"endTime":1462.14,"body":"rationalizing along maybe with"},{"speaker":"Chris Dy","startTime":1458.84,"endTime":1462.14,"body":"what Ryan was saying in his"},{"speaker":"Chris Dy","startTime":1462.14,"endTime":1464.69,"body":"email, but rationalizing to"},{"speaker":"Chris Dy","startTime":1462.14,"endTime":1464.69,"body":"myself that it was the right"},{"speaker":"Chris Dy","startTime":1464.69,"endTime":1466.64,"body":"thing to do to add that distal"},{"speaker":"Chris Dy","startTime":1464.69,"endTime":1466.64,"body":"decompression."},{"speaker":"Charles Goldfarb","startTime":1467.9,"endTime":1469.46,"body":"I'm sure it"},{"speaker":"Charles Goldfarb","startTime":1467.9,"endTime":1469.46,"body":"was the right thing to do."},{"speaker":"Charles Goldfarb","startTime":1469.46,"endTime":1473.03,"body":"Because when you're you know you"},{"speaker":"Charles Goldfarb","startTime":1469.46,"endTime":1473.03,"body":"have you should have more"},{"speaker":"Charles Goldfarb","startTime":1473.06,"endTime":1476.36,"body":"freedom to do a little bit more"},{"speaker":"Charles Goldfarb","startTime":1473.06,"endTime":1476.36,"body":"in a revision situation."},{"speaker":"Charles Goldfarb","startTime":1476.48,"endTime":1479.24,"body":"Obviously, you want to get"},{"speaker":"Charles Goldfarb","startTime":1476.48,"endTime":1479.24,"body":"everything done right the first"},{"speaker":"Charles Goldfarb","startTime":1479.24,"endTime":1481.97,"body":"time when possible. But in"},{"speaker":"Charles Goldfarb","startTime":1479.24,"endTime":1481.97,"body":"revision situation, you have to"},{"speaker":"Charles Goldfarb","startTime":1482.0,"endTime":1485.66,"body":"be willing to do more because"},{"speaker":"Charles Goldfarb","startTime":1482.0,"endTime":1485.66,"body":"you want to not be back a third"},{"speaker":"Charles Goldfarb","startTime":1485.66,"endTime":1485.87,"body":"time."},{"speaker":"Chris Dy","startTime":1486.5,"endTime":1489.5,"body":"Right, exactly. And"},{"speaker":"Chris Dy","startTime":1486.5,"endTime":1489.5,"body":"then the last thing I'll add is"},{"speaker":"Chris Dy","startTime":1489.5,"endTime":1491.99,"body":"that in preparing for the case,"},{"speaker":"Chris Dy","startTime":1489.5,"endTime":1491.99,"body":"I cracked open the old"},{"speaker":"Chris Dy","startTime":1491.99,"endTime":1496.55,"body":"government Blue Book from 1993."},{"speaker":"Chris Dy","startTime":1491.99,"endTime":1496.55,"body":"Which I love that book, by the"},{"speaker":"Chris Dy","startTime":1496.55,"endTime":1500.09,"body":"way. I mean, it's such a nut for"},{"speaker":"Chris Dy","startTime":1496.55,"endTime":1500.09,"body":"textbooks as we talked about it"},{"speaker":"Chris Dy","startTime":1500.09,"endTime":1506.3,"body":"earlier. And it talks about the"},{"speaker":"Chris Dy","startTime":1500.09,"endTime":1506.3,"body":"total off the cuff like level"},{"speaker":"Chris Dy","startTime":1506.3,"endTime":1510.23,"body":"five evidence but says the rate"},{"speaker":"Chris Dy","startTime":1506.3,"endTime":1510.23,"body":"of distal decrease of distal"},{"speaker":"Chris Dy","startTime":1510.23,"endTime":1513.53,"body":"compression meaning you know,"},{"speaker":"Chris Dy","startTime":1510.23,"endTime":1513.53,"body":"it's at the distal edge is"},{"speaker":"Chris Dy","startTime":1513.53,"endTime":1517.55,"body":"superior to being 5%. That"},{"speaker":"Chris Dy","startTime":1513.53,"endTime":1517.55,"body":"number felt right to me. Maybe"},{"speaker":"Chris Dy","startTime":1517.55,"endTime":1519.62,"body":"it's a little high. But does"},{"speaker":"Chris Dy","startTime":1517.55,"endTime":1519.62,"body":"that number feel right to you?"},{"speaker":"Charles Goldfarb","startTime":1520.73,"endTime":1524.33,"body":"That number"},{"speaker":"Charles Goldfarb","startTime":1520.73,"endTime":1524.33,"body":"feels right to me as well. Very"},{"speaker":"Charles Goldfarb","startTime":1524.33,"endTime":1525.95,"body":"low, but it's not zero."},{"speaker":"Chris Dy","startTime":1526.76,"endTime":1528.95,"body":"Right. Now, you know"},{"speaker":"Chris Dy","startTime":1526.76,"endTime":1528.95,"body":"that Graham Lister do what he"},{"speaker":"Chris Dy","startTime":1528.95,"endTime":1531.41,"body":"was talking about. Just a little"},{"speaker":"Chris Dy","startTime":1528.95,"endTime":1531.41,"body":"bit."},{"speaker":"Charles Goldfarb","startTime":1533.24,"endTime":1535.31,"body":"Can I share"},{"speaker":"Charles Goldfarb","startTime":1533.24,"endTime":1535.31,"body":"something with you about a case?"},{"speaker":"Chris Dy","startTime":1535.4,"endTime":1536.18,"body":"Yeah, absolutely."},{"speaker":"Charles Goldfarb","startTime":1536.36,"endTime":1539.3,"body":"It's a case"},{"speaker":"Charles Goldfarb","startTime":1536.36,"endTime":1539.3,"body":"that you will never do. Dr. Dy?"},{"speaker":"Chris Dy","startTime":1539.45,"endTime":1540.08,"body":"Oh thank goodness."},{"speaker":"Charles Goldfarb","startTime":1540.08,"endTime":1542.27,"body":"I think? I"},{"speaker":"Charles Goldfarb","startTime":1540.08,"endTime":1542.27,"body":"think the discussion around it"},{"speaker":"Charles Goldfarb","startTime":1542.3,"endTime":1543.38,"body":"is super interesting."},{"speaker":"Chris Dy","startTime":1543.38,"endTime":1544.97,"body":"Let me guess, did you"},{"speaker":"Chris Dy","startTime":1543.38,"endTime":1544.97,"body":"did you make a thumb out of"},{"speaker":"Chris Dy","startTime":1544.97,"endTime":1545.42,"body":"something?"},{"speaker":"Charles Goldfarb","startTime":1545.96,"endTime":1549.14,"body":"No, but"},{"speaker":"Charles Goldfarb","startTime":1545.96,"endTime":1549.14,"body":"that'll be part of this child's"},{"speaker":"Charles Goldfarb","startTime":1549.14,"endTime":1551.99,"body":"treatment. I want to leave out"},{"speaker":"Charles Goldfarb","startTime":1549.14,"endTime":1551.99,"body":"some of the some of the"},{"speaker":"Charles Goldfarb","startTime":1551.99,"endTime":1557.3,"body":"demographics in the life. But I"},{"speaker":"Charles Goldfarb","startTime":1551.99,"endTime":1557.3,"body":"treated a patient with ulnar"},{"speaker":"Charles Goldfarb","startTime":1557.33,"endTime":1563.57,"body":"dimelia, more commonly known as"},{"speaker":"Charles Goldfarb","startTime":1557.33,"endTime":1563.57,"body":"mirror hand. And the mirror hand"},{"speaker":"Charles Goldfarb","startTime":1563.57,"endTime":1568.19,"body":"part, while certainly not"},{"speaker":"Charles Goldfarb","startTime":1563.57,"endTime":1568.19,"body":"straightforward, pretty accepted"},{"speaker":"Charles Goldfarb","startTime":1568.28,"endTime":1572.12,"body":"steps for treatment. And I don't"},{"speaker":"Charles Goldfarb","startTime":1568.28,"endTime":1572.12,"body":"want to bore anyone. So I'm"},{"speaker":"Charles Goldfarb","startTime":1572.12,"endTime":1577.82,"body":"going to jump to the part which"},{"speaker":"Charles Goldfarb","startTime":1572.12,"endTime":1577.82,"body":"is more uncertain, and more"},{"speaker":"Charles Goldfarb","startTime":1577.82,"endTime":1583.52,"body":"challenging, which is the elbow."},{"speaker":"Charles Goldfarb","startTime":1577.82,"endTime":1583.52,"body":"So when, and I share this map,"},{"speaker":"Charles Goldfarb","startTime":1583.52,"endTime":1585.41,"body":"because I want to bore people"},{"speaker":"Charles Goldfarb","startTime":1583.52,"endTime":1585.41,"body":"the details of how to treat"},{"speaker":"Charles Goldfarb","startTime":1585.83,"endTime":1589.73,"body":"mirror hand and ulnar dimelia"},{"speaker":"Charles Goldfarb","startTime":1585.83,"endTime":1589.73,"body":"with limited elbow motion. But I"},{"speaker":"Charles Goldfarb","startTime":1589.73,"endTime":1592.73,"body":"think some of the principles of"},{"speaker":"Charles Goldfarb","startTime":1589.73,"endTime":1592.73,"body":"what we did felt really good."},{"speaker":"Charles Goldfarb","startTime":1593.06,"endTime":1598.22,"body":"But very briefly, just to set"},{"speaker":"Charles Goldfarb","startTime":1593.06,"endTime":1598.22,"body":"the stage, if you have two ulna"},{"speaker":"Charles Goldfarb","startTime":1598.22,"endTime":1602.81,"body":"bones, and may come together at"},{"speaker":"Charles Goldfarb","startTime":1598.22,"endTime":1602.81,"body":"the distal humerus, essentially"},{"speaker":"Charles Goldfarb","startTime":1602.81,"endTime":1609.74,"body":"what happens is the child can't"},{"speaker":"Charles Goldfarb","startTime":1602.81,"endTime":1609.74,"body":"flex. And so elbow surgery is"},{"speaker":"Charles Goldfarb","startTime":1609.74,"endTime":1613.55,"body":"designed to try to restore at"},{"speaker":"Charles Goldfarb","startTime":1609.74,"endTime":1613.55,"body":"least passive if not active,"},{"speaker":"Charles Goldfarb","startTime":1613.55,"endTime":1616.88,"body":"flexion to some degree, because"},{"speaker":"Charles Goldfarb","startTime":1613.55,"endTime":1616.88,"body":"we all know that a straight"},{"speaker":"Charles Goldfarb","startTime":1616.88,"endTime":1620.66,"body":"elbow is not functional, eating"},{"speaker":"Charles Goldfarb","startTime":1616.88,"endTime":1620.66,"body":"stuff, and many daily activities"},{"speaker":"Charles Goldfarb","startTime":1620.66,"endTime":1624.41,"body":"are tough. And so I my personal"},{"speaker":"Charles Goldfarb","startTime":1620.66,"endTime":1624.41,"body":"philosophy is to do this surgery"},{"speaker":"Charles Goldfarb","startTime":1624.41,"endTime":1629.21,"body":"younger to give the joint time"},{"speaker":"Charles Goldfarb","startTime":1624.41,"endTime":1629.21,"body":"to remodel after you do what you"},{"speaker":"Charles Goldfarb","startTime":1629.21,"endTime":1633.86,"body":"do. And we did the surgery, it"},{"speaker":"Charles Goldfarb","startTime":1629.21,"endTime":1633.86,"body":"was felt very good. But what I"},{"speaker":"Charles Goldfarb","startTime":1633.86,"endTime":1638.06,"body":"liked most was our planning, and"},{"speaker":"Charles Goldfarb","startTime":1633.86,"endTime":1638.06,"body":"the kind of the cognitive"},{"speaker":"Charles Goldfarb","startTime":1638.06,"endTime":1644.45,"body":"exercise around it. We got a CT"},{"speaker":"Charles Goldfarb","startTime":1638.06,"endTime":1644.45,"body":"scan, and 3d reconstructions on"},{"speaker":"Charles Goldfarb","startTime":1644.45,"endTime":1648.59,"body":"the CT scan, we got an MRI,"},{"speaker":"Charles Goldfarb","startTime":1644.45,"endTime":1648.59,"body":"which honestly was not as"},{"speaker":"Charles Goldfarb","startTime":1648.59,"endTime":1650.81,"body":"helpful as the CT. But I was"},{"speaker":"Charles Goldfarb","startTime":1648.59,"endTime":1650.81,"body":"curious about the muscle"},{"speaker":"Charles Goldfarb","startTime":1650.81,"endTime":1653.51,"body":"development, but it wasn't the"},{"speaker":"Charles Goldfarb","startTime":1650.81,"endTime":1653.51,"body":"best MRI. So I couldn't learn as"},{"speaker":"Charles Goldfarb","startTime":1653.51,"endTime":1656.15,"body":"much as I wanted. But what I"},{"speaker":"Charles Goldfarb","startTime":1653.51,"endTime":1656.15,"body":"did, which made me really,"},{"speaker":"Charles Goldfarb","startTime":1656.15,"endTime":1662.3,"body":"really happy was I got a 3d"},{"speaker":"Charles Goldfarb","startTime":1656.15,"endTime":1662.3,"body":"model printed of the, of the"},{"speaker":"Charles Goldfarb","startTime":1662.3,"endTime":1667.37,"body":"elbow. And again, it's a 3d"},{"speaker":"Charles Goldfarb","startTime":1662.3,"endTime":1667.37,"body":"model of the bone, which doesn't"},{"speaker":"Charles Goldfarb","startTime":1667.37,"endTime":1671.69,"body":"reflect the cartilage. But it is"},{"speaker":"Charles Goldfarb","startTime":1667.37,"endTime":1671.69,"body":"really, really helpful in"},{"speaker":"Charles Goldfarb","startTime":1671.69,"endTime":1675.44,"body":"strategizing how to approach the"},{"speaker":"Charles Goldfarb","startTime":1671.69,"endTime":1675.44,"body":"elbow, and what we might need to"},{"speaker":"Charles Goldfarb","startTime":1675.44,"endTime":1679.4,"body":"do. And it's a fascinating,"},{"speaker":"Charles Goldfarb","startTime":1675.44,"endTime":1679.4,"body":"fascinating limb development"},{"speaker":"Charles Goldfarb","startTime":1679.4,"endTime":1684.32,"body":"problem. And we spent a lot of"},{"speaker":"Charles Goldfarb","startTime":1679.4,"endTime":1684.32,"body":"time we got the result we want"},{"speaker":"Charles Goldfarb","startTime":1684.32,"endTime":1688.28,"body":"and we got about 80 to 90"},{"speaker":"Charles Goldfarb","startTime":1684.32,"endTime":1688.28,"body":"degrees of flexion. And super"},{"speaker":"Charles Goldfarb","startTime":1688.28,"endTime":1691.28,"body":"fun. And I think it was a great"},{"speaker":"Charles Goldfarb","startTime":1688.28,"endTime":1691.28,"body":"exercise for myself, but also"},{"speaker":"Charles Goldfarb","startTime":1691.28,"endTime":1694.76,"body":"for the trainees and Dr. Wall"},{"speaker":"Charles Goldfarb","startTime":1691.28,"endTime":1694.76,"body":"partner with me on this surgery."},{"speaker":"Chris Dy","startTime":1695.72,"endTime":1699.02,"body":"Super, as has been"},{"speaker":"Chris Dy","startTime":1695.72,"endTime":1699.02,"body":"pointed out before, super"},{"speaker":"Chris Dy","startTime":1699.02,"endTime":1701.03,"body":"interesting. It's something we"},{"speaker":"Chris Dy","startTime":1699.02,"endTime":1701.03,"body":"like to say here and around"},{"speaker":"Chris Dy","startTime":1701.03,"endTime":1705.62,"body":"these parts. When you do that,"},{"speaker":"Chris Dy","startTime":1701.03,"endTime":1705.62,"body":"what do you do with the model?"},{"speaker":"Chris Dy","startTime":1706.67,"endTime":1709.13,"body":"At the end, at the end of the"},{"speaker":"Chris Dy","startTime":1706.67,"endTime":1709.13,"body":"case? You don't just chuck it"},{"speaker":"Chris Dy","startTime":1709.13,"endTime":1709.4,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":1710.12,"endTime":1711.77,"body":"Definitely"},{"speaker":"Charles Goldfarb","startTime":1710.12,"endTime":1711.77,"body":"not. There's a couple of funny"},{"speaker":"Charles Goldfarb","startTime":1711.77,"endTime":1716.15,"body":"things. One, I haven't worked"},{"speaker":"Charles Goldfarb","startTime":1711.77,"endTime":1716.15,"body":"with this particular 3d printing"},{"speaker":"Charles Goldfarb","startTime":1716.15,"endTime":1720.35,"body":"lab. And I said, Hey, is there"},{"speaker":"Charles Goldfarb","startTime":1716.15,"endTime":1720.35,"body":"any way you can make a model?"},{"speaker":"Charles Goldfarb","startTime":1720.35,"endTime":1722.96,"body":"It's kind of last minute and he"},{"speaker":"Charles Goldfarb","startTime":1720.35,"endTime":1722.96,"body":"says, No problem. I'll get it"},{"speaker":"Charles Goldfarb","startTime":1722.96,"endTime":1724.73,"body":"done. I'll print it over the"},{"speaker":"Charles Goldfarb","startTime":1722.96,"endTime":1724.73,"body":"weekend. I'll be ready for you"},{"speaker":"Charles Goldfarb","startTime":1724.73,"endTime":1726.35,"body":"on Monday. And."},{"speaker":"Chris Dy","startTime":1726.98,"endTime":1728.48,"body":"Then he's like, What"},{"speaker":"Chris Dy","startTime":1726.98,"endTime":1728.48,"body":"the hell is this up there two"},{"speaker":"Chris Dy","startTime":1728.51,"endTime":1728.9,"body":"ulnas?"},{"speaker":"Charles Goldfarb","startTime":1731.27,"endTime":1734.15,"body":"No, but he's"},{"speaker":"Charles Goldfarb","startTime":1731.27,"endTime":1734.15,"body":"we had a little phone zoom. And"},{"speaker":"Charles Goldfarb","startTime":1734.15,"endTime":1737.24,"body":"we talked about things, but what"},{"speaker":"Charles Goldfarb","startTime":1734.15,"endTime":1737.24,"body":"was interesting was he printed"},{"speaker":"Charles Goldfarb","startTime":1737.24,"endTime":1742.7,"body":"it, you know, one to one to the"},{"speaker":"Charles Goldfarb","startTime":1737.24,"endTime":1742.7,"body":"CT scan, which was essentially"},{"speaker":"Charles Goldfarb","startTime":1742.88,"endTime":1748.73,"body":"life size, which was like this"},{"speaker":"Charles Goldfarb","startTime":1742.88,"endTime":1748.73,"body":"big. Because it was, you know,"},{"speaker":"Charles Goldfarb","startTime":1748.73,"endTime":1751.61,"body":"it was a young kid. And so I"},{"speaker":"Charles Goldfarb","startTime":1748.73,"endTime":1751.61,"body":"talked to him later on. I said,"},{"speaker":"Charles Goldfarb","startTime":1751.64,"endTime":1754.22,"body":"Can we just scale that next time"},{"speaker":"Charles Goldfarb","startTime":1751.64,"endTime":1754.22,"body":"to do it two to one he's like,"},{"speaker":"Charles Goldfarb","startTime":1754.22,"endTime":1756.26,"body":"of course we can't you just got"},{"speaker":"Charles Goldfarb","startTime":1754.22,"endTime":1756.26,"body":"to ask. Like."},{"speaker":"Chris Dy","startTime":1759.35,"endTime":1761.69,"body":"Maybe he just assume"},{"speaker":"Chris Dy","startTime":1759.35,"endTime":1761.69,"body":"since you're a peds ortho"},{"speaker":"Chris Dy","startTime":1761.69,"endTime":1763.79,"body":"surgeon is used to operating on"},{"speaker":"Chris Dy","startTime":1761.69,"endTime":1763.79,"body":"small stuff."},{"speaker":"Charles Goldfarb","startTime":1764.12,"endTime":1766.7,"body":"It's true, it"},{"speaker":"Charles Goldfarb","startTime":1764.12,"endTime":1766.7,"body":"still was helpful. But it's"},{"speaker":"Charles Goldfarb","startTime":1766.7,"endTime":1770.0,"body":"sitting on my desk, I love it on"},{"speaker":"Charles Goldfarb","startTime":1766.7,"endTime":1770.0,"body":"my desk, it's gonna stay there"},{"speaker":"Charles Goldfarb","startTime":1770.0,"endTime":1770.51,"body":"forever."},{"speaker":"Chris Dy","startTime":1770.72,"endTime":1774.83,"body":"So is there ever any"},{"speaker":"Chris Dy","startTime":1770.72,"endTime":1774.83,"body":"reason to get another CT scan on"},{"speaker":"Chris Dy","startTime":1774.83,"endTime":1778.13,"body":"this child? And then could you"},{"speaker":"Chris Dy","startTime":1774.83,"endTime":1778.13,"body":"get another model printed to"},{"speaker":"Chris Dy","startTime":1778.13,"endTime":1779.48,"body":"show the work that you did?"},{"speaker":"Charles Goldfarb","startTime":1780.8,"endTime":1782.96,"body":"What would be"},{"speaker":"Charles Goldfarb","startTime":1780.8,"endTime":1782.96,"body":"really interesting and there's"},{"speaker":"Charles Goldfarb","startTime":1782.96,"endTime":1785.93,"body":"really almost nothing in the"},{"speaker":"Charles Goldfarb","startTime":1782.96,"endTime":1785.93,"body":"literature. One of my friends"},{"speaker":"Charles Goldfarb","startTime":1785.93,"endTime":1788.96,"body":"from Japan actually has a pretty"},{"speaker":"Charles Goldfarb","startTime":1785.93,"endTime":1788.96,"body":"reasonable article which"},{"speaker":"Charles Goldfarb","startTime":1788.96,"endTime":1791.84,"body":"describes sort of what we did,"},{"speaker":"Charles Goldfarb","startTime":1788.96,"endTime":1791.84,"body":"but there's so little because"},{"speaker":"Charles Goldfarb","startTime":1791.84,"endTime":1796.64,"body":"it's an uncommon problem and bah"},{"speaker":"Charles Goldfarb","startTime":1791.84,"endTime":1796.64,"body":"bah bah, but I do think it will"},{"speaker":"Charles Goldfarb","startTime":1796.64,"endTime":1801.53,"body":"be interesting because the old"},{"speaker":"Charles Goldfarb","startTime":1796.64,"endTime":1801.53,"body":"bones are rotated. So they're"},{"speaker":"Charles Goldfarb","startTime":1801.53,"endTime":1804.59,"body":"not sitting directly posterior,"},{"speaker":"Charles Goldfarb","startTime":1801.53,"endTime":1804.59,"body":"they're both rotated around a"},{"speaker":"Charles Goldfarb","startTime":1804.59,"endTime":1808.16,"body":"little bit. So they're kind of"},{"speaker":"Charles Goldfarb","startTime":1804.59,"endTime":1808.16,"body":"sitting at 45 degrees to one"},{"speaker":"Charles Goldfarb","startTime":1808.16,"endTime":1814.28,"body":"another. And so that may limit"},{"speaker":"Charles Goldfarb","startTime":1808.16,"endTime":1814.28,"body":"in the future motion. I would"},{"speaker":"Charles Goldfarb","startTime":1814.28,"endTime":1817.79,"body":"love to know what the elbow"},{"speaker":"Charles Goldfarb","startTime":1814.28,"endTime":1817.79,"body":"joint looks like, at eight years"},{"speaker":"Charles Goldfarb","startTime":1817.79,"endTime":1821.39,"body":"of age or skeletal maturity, it"},{"speaker":"Charles Goldfarb","startTime":1817.79,"endTime":1821.39,"body":"will be fascinating, for sure."},{"speaker":"Chris Dy","startTime":1822.2,"endTime":1824.0,"body":"I'm wondering if"},{"speaker":"Chris Dy","startTime":1822.2,"endTime":1824.0,"body":"there's a way to do it when,"},{"speaker":"Chris Dy","startTime":1824.03,"endTime":1828.74,"body":"obviously, radiation"},{"speaker":"Chris Dy","startTime":1824.03,"endTime":1828.74,"body":"conservative manner. But yeah,"},{"speaker":"Chris Dy","startTime":1828.74,"endTime":1831.56,"body":"that'd be super interesting that"},{"speaker":"Chris Dy","startTime":1828.74,"endTime":1831.56,"body":"there I said it again, it's very"},{"speaker":"Chris Dy","startTime":1831.56,"endTime":1832.13,"body":"interesting."},{"speaker":"Charles Goldfarb","startTime":1833.84,"endTime":1835.49,"body":"Who was given"},{"speaker":"Charles Goldfarb","startTime":1833.84,"endTime":1835.49,"body":"us grief about that, I don't"},{"speaker":"Charles Goldfarb","startTime":1835.49,"endTime":1836.81,"body":"remember who it was. But it was"},{"speaker":"Charles Goldfarb","startTime":1835.49,"endTime":1836.81,"body":"funny."},{"speaker":"Chris Dy","startTime":1837.26,"endTime":1841.25,"body":"That is pretty funny."},{"speaker":"Chris Dy","startTime":1837.26,"endTime":1841.25,"body":"So, you know, I have one more"},{"speaker":"Chris Dy","startTime":1841.25,"endTime":1844.07,"body":"case to share. And I don't know"},{"speaker":"Chris Dy","startTime":1841.25,"endTime":1844.07,"body":"if you have any other ones. But,"},{"speaker":"Chris Dy","startTime":1844.52,"endTime":1847.07,"body":"you know, we talked about it"},{"speaker":"Chris Dy","startTime":1844.52,"endTime":1847.07,"body":"before on the podcast, and I"},{"speaker":"Chris Dy","startTime":1847.07,"endTime":1850.94,"body":"can't remember, probably set it"},{"speaker":"Chris Dy","startTime":1847.07,"endTime":1850.94,"body":"in other venues. But I think we"},{"speaker":"Chris Dy","startTime":1850.94,"endTime":1855.17,"body":"vastly underestimate the amount"},{"speaker":"Chris Dy","startTime":1850.94,"endTime":1855.17,"body":"of trauma that gunshots due to"},{"speaker":"Chris Dy","startTime":1855.17,"endTime":1860.84,"body":"nerves. And, unfortunately,"},{"speaker":"Chris Dy","startTime":1855.17,"endTime":1860.84,"body":"being in St. Louis, we see a"},{"speaker":"Chris Dy","startTime":1860.84,"endTime":1864.02,"body":"fair bit of firearm violence."},{"speaker":"Chris Dy","startTime":1860.84,"endTime":1864.02,"body":"And we wrote about that recently"},{"speaker":"Chris Dy","startTime":1864.02,"endTime":1870.2,"body":"and JBJS, and suddenly spiked"},{"speaker":"Chris Dy","startTime":1864.02,"endTime":1870.2,"body":"since the pandemic. And two"},{"speaker":"Chris Dy","startTime":1870.2,"endTime":1875.87,"body":"cases, both recently one with"},{"speaker":"Chris Dy","startTime":1870.2,"endTime":1875.87,"body":"you know, a bullet that went"},{"speaker":"Chris Dy","startTime":1875.87,"endTime":1879.95,"body":"through the deep perineal nerve"},{"speaker":"Chris Dy","startTime":1875.87,"endTime":1879.95,"body":"and just skirted right by the"},{"speaker":"Chris Dy","startTime":1879.95,"endTime":1884.48,"body":"superficial perineal nerve, like"},{"speaker":"Chris Dy","startTime":1879.95,"endTime":1884.48,"body":"almost impossible shot. But you"},{"speaker":"Chris Dy","startTime":1884.48,"endTime":1890.51,"body":"know, had a very anatomically"},{"speaker":"Chris Dy","startTime":1884.48,"endTime":1890.51,"body":"matched, you know, palsy had"},{"speaker":"Chris Dy","startTime":1890.51,"endTime":1893.48,"body":"intact e-version, kind of this"},{"speaker":"Chris Dy","startTime":1890.51,"endTime":1893.48,"body":"aesthetic in the ESPN"},{"speaker":"Chris Dy","startTime":1893.48,"endTime":1896.06,"body":"distribution, but you know,"},{"speaker":"Chris Dy","startTime":1893.48,"endTime":1896.06,"body":"pretty normal, and that"},{"speaker":"Chris Dy","startTime":1896.06,"endTime":1900.23,"body":"completely density perineal"},{"speaker":"Chris Dy","startTime":1896.06,"endTime":1900.23,"body":"palsy. And, of course, there was"},{"speaker":"Chris Dy","startTime":1900.23,"endTime":1902.78,"body":"a fibula fracture to same"},{"speaker":"Chris Dy","startTime":1900.23,"endTime":1902.78,"body":"location, you can see where the"},{"speaker":"Chris Dy","startTime":1902.78,"endTime":1905.48,"body":"bullet was, I mean, it was"},{"speaker":"Chris Dy","startTime":1902.78,"endTime":1905.48,"body":"remarkable. And again,"},{"speaker":"Chris Dy","startTime":1905.48,"endTime":1908.87,"body":"ultrasound saved the day, told"},{"speaker":"Chris Dy","startTime":1905.48,"endTime":1908.87,"body":"us that there was a partial"},{"speaker":"Chris Dy","startTime":1908.87,"endTime":1912.44,"body":"transaction of that nerve from"},{"speaker":"Chris Dy","startTime":1908.87,"endTime":1912.44,"body":"the bullet allowed us to act"},{"speaker":"Chris Dy","startTime":1912.44,"endTime":1914.78,"body":"sooner, and I think gives us a"},{"speaker":"Chris Dy","startTime":1912.44,"endTime":1914.78,"body":"much better chance to make"},{"speaker":"Chris Dy","startTime":1914.78,"endTime":1919.28,"body":"things better. And then the"},{"speaker":"Chris Dy","startTime":1914.78,"endTime":1919.28,"body":"another related case was-"},{"speaker":"Charles Goldfarb","startTime":1919.49,"endTime":1922.46,"body":"So how soon do"},{"speaker":"Charles Goldfarb","startTime":1919.49,"endTime":1922.46,"body":"you prefer to act? You saw the"},{"speaker":"Charles Goldfarb","startTime":1922.46,"endTime":1925.19,"body":"patient, you got the ultrasound?"},{"speaker":"Charles Goldfarb","startTime":1922.46,"endTime":1925.19,"body":"Is this something you want to do"},{"speaker":"Charles Goldfarb","startTime":1925.19,"endTime":1927.17,"body":"in the first two weeks? Or"},{"speaker":"Charles Goldfarb","startTime":1925.19,"endTime":1927.17,"body":"what's your goal?"},{"speaker":"Chris Dy","startTime":1927.89,"endTime":1929.78,"body":"I think that we don't"},{"speaker":"Chris Dy","startTime":1927.89,"endTime":1929.78,"body":"really know. And I hope that"},{"speaker":"Chris Dy","startTime":1929.78,"endTime":1934.94,"body":"some enterprising and bright"},{"speaker":"Chris Dy","startTime":1929.78,"endTime":1934.94,"body":"young hand surgeon or therapist"},{"speaker":"Chris Dy","startTime":1934.94,"endTime":1937.85,"body":"will try to understand this, but"},{"speaker":"Chris Dy","startTime":1934.94,"endTime":1937.85,"body":"we don't know how long it takes"},{"speaker":"Chris Dy","startTime":1937.85,"endTime":1940.91,"body":"for that zone of injury to truly"},{"speaker":"Chris Dy","startTime":1937.85,"endTime":1940.91,"body":"declare itself. And in what"},{"speaker":"Chris Dy","startTime":1940.91,"endTime":1943.82,"body":"situation I think many of us"},{"speaker":"Chris Dy","startTime":1940.91,"endTime":1943.82,"body":"have accepted three weeks,"},{"speaker":"Chris Dy","startTime":1944.3,"endTime":1948.2,"body":"roughly as the amount of time it"},{"speaker":"Chris Dy","startTime":1944.3,"endTime":1948.2,"body":"takes. So this patient, you"},{"speaker":"Chris Dy","startTime":1948.2,"endTime":1950.84,"body":"know, we've seen in the clinic,"},{"speaker":"Chris Dy","startTime":1948.2,"endTime":1950.84,"body":"about three weeks out from the"},{"speaker":"Chris Dy","startTime":1950.84,"endTime":1954.08,"body":"injury, had an ultrasound done"},{"speaker":"Chris Dy","startTime":1950.84,"endTime":1954.08,"body":"in the next week, and it was in"},{"speaker":"Chris Dy","startTime":1954.08,"endTime":1958.73,"body":"the or before by the five week"},{"speaker":"Chris Dy","startTime":1954.08,"endTime":1958.73,"body":"mark. And, you know, knowing"},{"speaker":"Chris Dy","startTime":1958.73,"endTime":1961.55,"body":"that we're going to have to"},{"speaker":"Chris Dy","startTime":1958.73,"endTime":1961.55,"body":"graft now as a very reasonable"},{"speaker":"Chris Dy","startTime":1961.55,"endTime":1965.6,"body":"graph length and is with you"},{"speaker":"Chris Dy","startTime":1961.55,"endTime":1965.6,"body":"know, within a very reasonable"},{"speaker":"Chris Dy","startTime":1965.6,"endTime":1966.89,"body":"timeframe to see recovery."},{"speaker":"Charles Goldfarb","startTime":1967.55,"endTime":1968.33,"body":"That's"},{"speaker":"Charles Goldfarb","startTime":1967.55,"endTime":1968.33,"body":"awesome."},{"speaker":"Chris Dy","startTime":1970.46,"endTime":1973.28,"body":"And again, another"},{"speaker":"Chris Dy","startTime":1970.46,"endTime":1973.28,"body":"gunshot wound, but a gunshot"},{"speaker":"Chris Dy","startTime":1973.28,"endTime":1976.82,"body":"wound to the proximal form. And"},{"speaker":"Chris Dy","startTime":1973.28,"endTime":1976.82,"body":"kudos to one of our trauma"},{"speaker":"Chris Dy","startTime":1976.82,"endTime":1981.38,"body":"colleagues who when they were"},{"speaker":"Chris Dy","startTime":1976.82,"endTime":1981.38,"body":"plating the approximate radius"},{"speaker":"Chris Dy","startTime":1981.38,"endTime":1985.64,"body":"from a dorsal approach was kind"},{"speaker":"Chris Dy","startTime":1981.38,"endTime":1985.64,"body":"enough to find the PIN and tell"},{"speaker":"Chris Dy","startTime":1985.64,"endTime":1989.66,"body":"me that it was completely"},{"speaker":"Chris Dy","startTime":1985.64,"endTime":1989.66,"body":"transected completely transected"},{"speaker":"Chris Dy","startTime":1990.29,"endTime":1993.2,"body":"so helpful, because I'm not"},{"speaker":"Chris Dy","startTime":1990.29,"endTime":1993.2,"body":"going to sit and wait and watch"},{"speaker":"Chris Dy","startTime":1993.2,"endTime":1996.17,"body":"this one, you know, you know,"},{"speaker":"Chris Dy","startTime":1993.2,"endTime":1996.17,"body":"didn't even need to get any"},{"speaker":"Chris Dy","startTime":1996.17,"endTime":1998.99,"body":"imaging or anything like that"},{"speaker":"Chris Dy","startTime":1996.17,"endTime":1998.99,"body":"got them back to the or within a"},{"speaker":"Chris Dy","startTime":1998.99,"endTime":2006.22,"body":"few weeks. And completely"},{"speaker":"Chris Dy","startTime":1998.99,"endTime":2006.22,"body":"through the pie. Right where you"},{"speaker":"Chris Dy","startTime":2006.22,"endTime":2009.34,"body":"know, it was intact, kind of"},{"speaker":"Chris Dy","startTime":2006.22,"endTime":2009.34,"body":"halfway through the supinator"},{"speaker":"Chris Dy","startTime":2009.34,"endTime":2012.16,"body":"and towards like the distal two"},{"speaker":"Chris Dy","startTime":2009.34,"endTime":2012.16,"body":"thirds of the supinator just"},{"speaker":"Chris Dy","startTime":2012.19,"endTime":2016.18,"body":"blown apart. And then it for"},{"speaker":"Chris Dy","startTime":2012.19,"endTime":2016.18,"body":"those of you that are familiar"},{"speaker":"Chris Dy","startTime":2016.18,"endTime":2019.72,"body":"with the branching pattern of"},{"speaker":"Chris Dy","startTime":2016.18,"endTime":2019.72,"body":"the PIN after you know, maybe"},{"speaker":"Chris Dy","startTime":2019.72,"endTime":2022.84,"body":"about two or three centimeters"},{"speaker":"Chris Dy","startTime":2019.72,"endTime":2022.84,"body":"after an emerges from the distal"},{"speaker":"Chris Dy","startTime":2022.84,"endTime":2026.02,"body":"end supinator it splits into"},{"speaker":"Chris Dy","startTime":2022.84,"endTime":2026.02,"body":"that superficial branch which"},{"speaker":"Chris Dy","startTime":2026.05,"endTime":2028.87,"body":"tends to go towards the the"},{"speaker":"Chris Dy","startTime":2026.05,"endTime":2028.87,"body":"fourth, fifth and sixth"},{"speaker":"Chris Dy","startTime":2028.87,"endTime":2032.14,"body":"compartment and then a deep"},{"speaker":"Chris Dy","startTime":2028.87,"endTime":2032.14,"body":"branch which tends to go to the"},{"speaker":"Chris Dy","startTime":2032.14,"endTime":2036.46,"body":"thumb. So the first and third"},{"speaker":"Chris Dy","startTime":2032.14,"endTime":2036.46,"body":"compartment and it mean the"},{"speaker":"Chris Dy","startTime":2036.46,"endTime":2039.58,"body":"anatomy was just beautiful, but"},{"speaker":"Chris Dy","startTime":2036.46,"endTime":2039.58,"body":"seeing how it was just"},{"speaker":"Chris Dy","startTime":2039.58,"endTime":2044.71,"body":"transected just proximal to that"},{"speaker":"Chris Dy","startTime":2039.58,"endTime":2044.71,"body":"bifurcation gave us a fighting"},{"speaker":"Chris Dy","startTime":2044.71,"endTime":2047.62,"body":"chance with the graph. I also"},{"speaker":"Chris Dy","startTime":2044.71,"endTime":2047.62,"body":"added a distal nerve transfer"},{"speaker":"Chris Dy","startTime":2048.13,"endTime":2052.33,"body":"because there was a kind of a"},{"speaker":"Chris Dy","startTime":2048.13,"endTime":2052.33,"body":"freebie branch to the EDC. So I"},{"speaker":"Chris Dy","startTime":2052.33,"endTime":2057.55,"body":"took the AIN from the pronator"},{"speaker":"Chris Dy","startTime":2052.33,"endTime":2057.55,"body":"quadratus flipped it backwards"},{"speaker":"Chris Dy","startTime":2057.55,"endTime":2059.86,"body":"through the interosseous"},{"speaker":"Chris Dy","startTime":2057.55,"endTime":2059.86,"body":"membrane as described by"},{"speaker":"Chris Dy","startTime":2059.86,"endTime":2062.59,"body":"Bertelli but instead of putting"},{"speaker":"Chris Dy","startTime":2059.86,"endTime":2062.59,"body":"it into the thumb extensors put"},{"speaker":"Chris Dy","startTime":2062.59,"endTime":2065.59,"body":"it into the EDC because I"},{"speaker":"Chris Dy","startTime":2062.59,"endTime":2065.59,"body":"figured there might as well give"},{"speaker":"Chris Dy","startTime":2065.59,"endTime":2066.07,"body":"it a shot."},{"speaker":"Charles Goldfarb","startTime":2066.76,"endTime":2071.44,"body":"Wow, well"},{"speaker":"Charles Goldfarb","startTime":2066.76,"endTime":2071.44,"body":"done. I have seen two gunshot"},{"speaker":"Charles Goldfarb","startTime":2071.44,"endTime":2075.49,"body":"wounds right at that bifurcation"},{"speaker":"Charles Goldfarb","startTime":2071.44,"endTime":2075.49,"body":"at the distal end of the"},{"speaker":"Charles Goldfarb","startTime":2075.49,"endTime":2080.86,"body":"supinator. And that is tough."},{"speaker":"Charles Goldfarb","startTime":2075.49,"endTime":2080.86,"body":"When you have small branches and"},{"speaker":"Charles Goldfarb","startTime":2080.89,"endTime":2085.39,"body":"a segment is destroyed that is"},{"speaker":"Charles Goldfarb","startTime":2080.89,"endTime":2085.39,"body":"really tough. So I do think your"},{"speaker":"Charles Goldfarb","startTime":2085.42,"endTime":2088.33,"body":"your patient was somewhat lucky"},{"speaker":"Charles Goldfarb","startTime":2085.42,"endTime":2088.33,"body":"and I think adding the nerve"},{"speaker":"Charles Goldfarb","startTime":2088.33,"endTime":2089.38,"body":"transfers a no brainer."},{"speaker":"Chris Dy","startTime":2090.34,"endTime":2091.87,"body":"Yeah, it was it was"},{"speaker":"Chris Dy","startTime":2090.34,"endTime":2091.87,"body":"and I think it was a good"},{"speaker":"Chris Dy","startTime":2091.87,"endTime":2094.06,"body":"example of we talked about"},{"speaker":"Chris Dy","startTime":2091.87,"endTime":2094.06,"body":"earlier that radial tunnel"},{"speaker":"Chris Dy","startTime":2094.06,"endTime":2096.4,"body":"surgery. It's a good example of"},{"speaker":"Chris Dy","startTime":2094.06,"endTime":2096.4,"body":"being facile with all the"},{"speaker":"Chris Dy","startTime":2096.4,"endTime":2099.22,"body":"approaches because in order to"},{"speaker":"Chris Dy","startTime":2096.4,"endTime":2099.22,"body":"find healthy nerve I had to go"},{"speaker":"Chris Dy","startTime":2099.22,"endTime":2102.49,"body":"back into your Hear and kind of"},{"speaker":"Chris Dy","startTime":2099.22,"endTime":2102.49,"body":"do the approach at the arcade"},{"speaker":"Chris Dy","startTime":2102.49,"endTime":2105.85,"body":"level, find a healthy nerve. And"},{"speaker":"Chris Dy","startTime":2102.49,"endTime":2105.85,"body":"honestly, the nerve, the"},{"speaker":"Chris Dy","startTime":2105.85,"endTime":2109.18,"body":"supinator just look like mush,"},{"speaker":"Chris Dy","startTime":2105.85,"endTime":2109.18,"body":"even though theoretically it's"},{"speaker":"Chris Dy","startTime":2109.18,"endTime":2112.12,"body":"innovation had already come in,"},{"speaker":"Chris Dy","startTime":2109.18,"endTime":2112.12,"body":"just didn't look great because"},{"speaker":"Chris Dy","startTime":2112.12,"endTime":2114.64,"body":"of all the direct trauma to it,"},{"speaker":"Chris Dy","startTime":2112.12,"endTime":2114.64,"body":"but then found the nerve there"},{"speaker":"Chris Dy","startTime":2114.67,"endTime":2117.85,"body":"that allowed me to work back on"},{"speaker":"Chris Dy","startTime":2114.67,"endTime":2117.85,"body":"the dorsal side and put the"},{"speaker":"Chris Dy","startTime":2117.85,"endTime":2120.88,"body":"grafted. And again, because we"},{"speaker":"Chris Dy","startTime":2117.85,"endTime":2120.88,"body":"got there within a reasonable"},{"speaker":"Chris Dy","startTime":2120.88,"endTime":2124.3,"body":"amount of time, reasonable grasp"},{"speaker":"Chris Dy","startTime":2120.88,"endTime":2124.3,"body":"length and a decent chance of"},{"speaker":"Chris Dy","startTime":2124.3,"endTime":2126.34,"body":"recovery across across the"},{"speaker":"Chris Dy","startTime":2124.3,"endTime":2126.34,"body":"graph."},{"speaker":"Charles Goldfarb","startTime":2126.88,"endTime":2130.03,"body":"Yeah, love it."},{"speaker":"Charles Goldfarb","startTime":2126.88,"endTime":2130.03,"body":"Love it. Awesome. All right,"},{"speaker":"Charles Goldfarb","startTime":2130.03,"endTime":2130.84,"body":"this has been fun."},{"speaker":"Chris Dy","startTime":2131.44,"endTime":2133.9,"body":"But yeah, a little a"},{"speaker":"Chris Dy","startTime":2131.44,"endTime":2133.9,"body":"little grab bag episode. You"},{"speaker":"Chris Dy","startTime":2133.9,"endTime":2135.94,"body":"know if anybody has any"},{"speaker":"Chris Dy","startTime":2133.9,"endTime":2135.94,"body":"questions, they want to email"},{"speaker":"Chris Dy","startTime":2135.94,"endTime":2141.52,"body":"us, you know, the the thing"},{"speaker":"Chris Dy","startTime":2135.94,"endTime":2141.52,"body":"handpodcast@gmail.com or leave"},{"speaker":"Chris Dy","startTime":2141.52,"endTime":2145.27,"body":"it in a review. Chuck likes"},{"speaker":"Chris Dy","startTime":2141.52,"endTime":2145.27,"body":"positive affirmation and"},{"speaker":"Chris Dy","startTime":2145.27,"endTime":2149.05,"body":"feedback. So please, provide"},{"speaker":"Chris Dy","startTime":2145.27,"endTime":2149.05,"body":"that for him and me. But mainly"},{"speaker":"Chris Dy","startTime":2149.05,"endTime":2149.41,"body":"Chuck."},{"speaker":"Charles Goldfarb","startTime":2149.98,"endTime":2152.8,"body":"For sure."},{"speaker":"Charles Goldfarb","startTime":2149.98,"endTime":2152.8,"body":"Please do that. I'll leave you"},{"speaker":"Charles Goldfarb","startTime":2152.8,"endTime":2157.27,"body":"with I am grateful for spring."},{"speaker":"Charles Goldfarb","startTime":2152.8,"endTime":2157.27,"body":"That's it."},{"speaker":"Chris Dy","startTime":2158.56,"endTime":2162.19,"body":"Yeah, I haven't lived"},{"speaker":"Chris Dy","startTime":2158.56,"endTime":2162.19,"body":"in St. Louis that long. But you"},{"speaker":"Chris Dy","startTime":2162.19,"endTime":2165.4,"body":"know, these up and down spring"},{"speaker":"Chris Dy","startTime":2162.19,"endTime":2165.4,"body":"things where it's like 70"},{"speaker":"Chris Dy","startTime":2165.4,"endTime":2168.46,"body":"degrees one weekend, and like,"},{"speaker":"Chris Dy","startTime":2165.4,"endTime":2168.46,"body":"30 the next weekend with snow. I"},{"speaker":"Chris Dy","startTime":2168.46,"endTime":2171.52,"body":"don't like it so much. I do like"},{"speaker":"Chris Dy","startTime":2168.46,"endTime":2171.52,"body":"spring weather though. So my"},{"speaker":"Chris Dy","startTime":2171.79,"endTime":2173.92,"body":"next thing I'm grateful for is"},{"speaker":"Chris Dy","startTime":2171.79,"endTime":2173.92,"body":"also spring."},{"speaker":"Charles Goldfarb","startTime":2175.0,"endTime":2178.3,"body":"I totally"},{"speaker":"Charles Goldfarb","startTime":2175.0,"endTime":2178.3,"body":"agree. All right, man. It's been"},{"speaker":"Charles Goldfarb","startTime":2178.3,"endTime":2179.8,"body":"fun. Thank you very much."},{"speaker":"Chris Dy","startTime":2179.89,"endTime":2180.94,"body":"All right. See you"},{"speaker":"Chris Dy","startTime":2179.89,"endTime":2180.94,"body":"next week."},{"speaker":"Charles Goldfarb","startTime":2182.71,"endTime":2184.69,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2182.71,"endTime":2184.69,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2184.69,"endTime":2185.23,"body":"real soon."},{"speaker":"Chris Dy","startTime":2185.48,"endTime":2188.0,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2185.48,"endTime":2188.0,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2188.15,"endTime":2190.4,"body":"@Handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2188.15,"endTime":2190.4,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2190.76,"endTime":2193.61,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2190.76,"endTime":2193.61,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2193.76,"endTime":2197.12,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2193.76,"endTime":2197.12,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2197.12,"endTime":2200.63,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2197.12,"endTime":2200.63,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2201.56,"endTime":2203.69,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2201.56,"endTime":2203.69,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2203.69,"endTime":2204.8,"body":"get your podcasts."},{"speaker":"Chris Dy","startTime":2204.83,"endTime":2207.05,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2204.83,"endTime":2207.05,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2207.05,"endTime":2207.47,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2207.82,"endTime":2210.13,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2207.82,"endTime":2210.13,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2210.13,"endTime":2214.09,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2210.13,"endTime":2214.09,"body":"upper hand. Come back next time"}]}