{"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":16.55,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.81,"endTime":16.55,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.55,"endTime":19.64,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.55,"endTime":19.64,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.64,"endTime":21.5,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.64,"endTime":21.5,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.049,"endTime":24.329,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.049,"endTime":24.329,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.329,"endTime":25.259,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.45,"endTime":27.67,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.45,"endTime":27.67,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.67,"endTime":28.21,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.69,"endTime":29.68,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.69,"endTime":29.68,"body":"Chris."},{"speaker":"Chris Dy","startTime":30.13,"endTime":31.12,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":30.13,"endTime":31.12,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.469,"endTime":33.089,"body":"Fantastic. How"},{"speaker":"Charles Goldfarb","startTime":31.469,"endTime":33.089,"body":"are you?"},{"speaker":"Chris Dy","startTime":33.719,"endTime":37.019,"body":"I'm fantastic. You"},{"speaker":"Chris Dy","startTime":33.719,"endTime":37.019,"body":"know, I really enjoyed our"},{"speaker":"Chris Dy","startTime":37.019,"endTime":39.719,"body":"conversation with Macy last"},{"speaker":"Chris Dy","startTime":37.019,"endTime":39.719,"body":"week, and I look forward to"},{"speaker":"Chris Dy","startTime":39.719,"endTime":43.259,"body":"hearing the second part of it."},{"speaker":"Chris Dy","startTime":39.719,"endTime":43.259,"body":"You know, I will say that I've"},{"speaker":"Chris Dy","startTime":43.259,"endTime":46.349,"body":"learned quite a bit already. And"},{"speaker":"Chris Dy","startTime":43.259,"endTime":46.349,"body":"I've incorporated some of the"},{"speaker":"Chris Dy","startTime":46.379,"endTime":51.719,"body":"teaching and strategies that she"},{"speaker":"Chris Dy","startTime":46.379,"endTime":51.719,"body":"has described to patients, both"},{"speaker":"Chris Dy","startTime":51.719,"endTime":54.059,"body":"for the non operative treatment,"},{"speaker":"Chris Dy","startTime":51.719,"endTime":54.059,"body":"and also what to expect after"},{"speaker":"Chris Dy","startTime":54.059,"endTime":56.759,"body":"surgery already into some of my"},{"speaker":"Chris Dy","startTime":54.059,"endTime":56.759,"body":"clinic conversations. So I hope"},{"speaker":"Chris Dy","startTime":56.789,"endTime":59.099,"body":"those of you that are listening"},{"speaker":"Chris Dy","startTime":56.789,"endTime":59.099,"body":"who aren't as familiar with"},{"speaker":"Chris Dy","startTime":59.099,"endTime":60.359,"body":"therapy have done the same."},{"speaker":"Charles Goldfarb","startTime":60.0,"endTime":63.54,"body":"Yeah, we don't"},{"speaker":"Charles Goldfarb","startTime":60.0,"endTime":63.54,"body":"usually have an opportunity to"},{"speaker":"Charles Goldfarb","startTime":63.54,"endTime":68.52,"body":"learn from our non surgical"},{"speaker":"Charles Goldfarb","startTime":63.54,"endTime":68.52,"body":"peers and Macy really has a lot"},{"speaker":"Charles Goldfarb","startTime":68.52,"endTime":71.94,"body":"to share. So it's been it's been"},{"speaker":"Charles Goldfarb","startTime":68.52,"endTime":71.94,"body":"very helpful. If you're okay"},{"speaker":"Charles Goldfarb","startTime":71.94,"endTime":75.3,"body":"with it, why don't we take a"},{"speaker":"Charles Goldfarb","startTime":71.94,"endTime":75.3,"body":"listener submitted question."},{"speaker":"Charles Goldfarb","startTime":75.72,"endTime":83.04,"body":"Before we dive in? This one's"},{"speaker":"Charles Goldfarb","startTime":75.72,"endTime":83.04,"body":"from Jason Ghodasra who writes-"},{"speaker":"Chris Dy","startTime":84.48,"endTime":87.27,"body":"Hold on timeout,"},{"speaker":"Chris Dy","startTime":84.48,"endTime":87.27,"body":"timeout. So Jason, I will say we"},{"speaker":"Chris Dy","startTime":87.27,"endTime":90.66,"body":"love your email. Chuck and I"},{"speaker":"Chris Dy","startTime":87.27,"endTime":90.66,"body":"both struggled with your name."},{"speaker":"Chris Dy","startTime":90.66,"endTime":95.28,"body":"And for somebody who has a often"},{"speaker":"Chris Dy","startTime":90.66,"endTime":95.28,"body":"mispronounced last name. I feel"},{"speaker":"Chris Dy","startTime":95.28,"endTime":98.52,"body":"so bad doing that to you. So I"},{"speaker":"Chris Dy","startTime":95.28,"endTime":98.52,"body":"think let's say it's Jason"},{"speaker":"Chris Dy","startTime":98.52,"endTime":101.94,"body":"Ghodasra that maybe that is"},{"speaker":"Chris Dy","startTime":98.52,"endTime":101.94,"body":"that. You can tell us if we have"},{"speaker":"Chris Dy","startTime":101.94,"endTime":103.86,"body":"butchered your name, and we're"},{"speaker":"Chris Dy","startTime":101.94,"endTime":103.86,"body":"sorry, but we love your"},{"speaker":"Chris Dy","startTime":103.86,"endTime":104.31,"body":"question."},{"speaker":"Charles Goldfarb","startTime":104.489,"endTime":108.419,"body":"Yes, that's,"},{"speaker":"Charles Goldfarb","startTime":104.489,"endTime":108.419,"body":"that's well said. So Jason is an"},{"speaker":"Charles Goldfarb","startTime":108.419,"endTime":111.419,"body":"orthopedic hand surgeon in a"},{"speaker":"Charles Goldfarb","startTime":108.419,"endTime":111.419,"body":"large private practice in the"},{"speaker":"Charles Goldfarb","startTime":111.419,"endTime":115.709,"body":"Chicago suburbs. Very nicely, he"},{"speaker":"Charles Goldfarb","startTime":111.419,"endTime":115.709,"body":"wanted to thank us for our,"},{"speaker":"Charles Goldfarb","startTime":115.739,"endTime":120.059,"body":"quote, awesome podcast. And I"},{"speaker":"Charles Goldfarb","startTime":115.739,"endTime":120.059,"body":"like this next sentence. While I"},{"speaker":"Charles Goldfarb","startTime":120.059,"endTime":122.699,"body":"love my job, and partners,"},{"speaker":"Charles Goldfarb","startTime":120.059,"endTime":122.699,"body":"private practice can be"},{"speaker":"Charles Goldfarb","startTime":122.699,"endTime":126.839,"body":"academically isolating. And the"},{"speaker":"Charles Goldfarb","startTime":122.699,"endTime":126.839,"body":"podcast has added a weekly"},{"speaker":"Charles Goldfarb","startTime":126.839,"endTime":129.929,"body":"conference lecture that I've"},{"speaker":"Charles Goldfarb","startTime":126.839,"endTime":129.929,"body":"missed since graduating from"},{"speaker":"Charles Goldfarb","startTime":129.929,"endTime":133.649,"body":"fellowship. That's, that's"},{"speaker":"Charles Goldfarb","startTime":129.929,"endTime":133.649,"body":"really fantastic. And we're glad"},{"speaker":"Charles Goldfarb","startTime":133.649,"endTime":134.519,"body":"we're filling that void."},{"speaker":"Chris Dy","startTime":135.3,"endTime":137.58,"body":"That was kind of the"},{"speaker":"Chris Dy","startTime":135.3,"endTime":137.58,"body":"goal, I think, for us, aside"},{"speaker":"Chris Dy","startTime":137.58,"endTime":143.79,"body":"from just being able to hang out"},{"speaker":"Chris Dy","startTime":137.58,"endTime":143.79,"body":"an hour a week. But yeah, that's"},{"speaker":"Chris Dy","startTime":143.79,"endTime":148.05,"body":"fantastic for us is to hear that"},{"speaker":"Chris Dy","startTime":143.79,"endTime":148.05,"body":"it's been able to fill that void"},{"speaker":"Chris Dy","startTime":148.05,"endTime":151.8,"body":"for you. And, you know, thank"},{"speaker":"Chris Dy","startTime":148.05,"endTime":151.8,"body":"you for this email. I think both"},{"speaker":"Chris Dy","startTime":151.8,"endTime":154.14,"body":"Chuck and I learned quite a bit."},{"speaker":"Chris Dy","startTime":151.8,"endTime":154.14,"body":"And I think it's a good fodder"},{"speaker":"Chris Dy","startTime":154.14,"endTime":154.74,"body":"for discussion."},{"speaker":"Charles Goldfarb","startTime":155.17,"endTime":157.51,"body":"And so we have"},{"speaker":"Charles Goldfarb","startTime":155.17,"endTime":157.51,"body":"to be, you know, when we have"},{"speaker":"Charles Goldfarb","startTime":157.51,"endTime":163.54,"body":"these discussions about cost and"},{"speaker":"Charles Goldfarb","startTime":157.51,"endTime":163.54,"body":"pricing and you carefully, enter"},{"speaker":"Charles Goldfarb","startTime":163.54,"endTime":167.05,"body":"murky waters, and we don't want"},{"speaker":"Charles Goldfarb","startTime":163.54,"endTime":167.05,"body":"to disclose sensitive"},{"speaker":"Charles Goldfarb","startTime":167.05,"endTime":170.26,"body":"information. So we'll be very"},{"speaker":"Charles Goldfarb","startTime":167.05,"endTime":170.26,"body":"vague about things. But I think"},{"speaker":"Charles Goldfarb","startTime":170.47,"endTime":174.28,"body":"Jason said it well, in his"},{"speaker":"Charles Goldfarb","startTime":170.47,"endTime":174.28,"body":"email. I was recently listening"},{"speaker":"Charles Goldfarb","startTime":174.28,"endTime":177.73,"body":"to your episode on JBJS hand and"},{"speaker":"Charles Goldfarb","startTime":174.28,"endTime":177.73,"body":"wrist update. And you mentioned"},{"speaker":"Charles Goldfarb","startTime":177.73,"endTime":180.7,"body":"that the surgery center collects"},{"speaker":"Charles Goldfarb","startTime":177.73,"endTime":180.7,"body":"a higher facility fee for"},{"speaker":"Charles Goldfarb","startTime":180.7,"endTime":184.54,"body":"endoscopic carpal tunnel versus"},{"speaker":"Charles Goldfarb","startTime":180.7,"endTime":184.54,"body":"open carpal tunnel. And let's be"},{"speaker":"Charles Goldfarb","startTime":184.54,"endTime":188.35,"body":"clear, Chris, and I work in a"},{"speaker":"Charles Goldfarb","startTime":184.54,"endTime":188.35,"body":"hospital based outpatient"},{"speaker":"Charles Goldfarb","startTime":188.35,"endTime":192.4,"body":"center. And as we all know, it's"},{"speaker":"Charles Goldfarb","startTime":188.35,"endTime":192.4,"body":"very different reimbursement"},{"speaker":"Charles Goldfarb","startTime":192.4,"endTime":196.99,"body":"model than a true ASC. So Jason"},{"speaker":"Charles Goldfarb","startTime":192.4,"endTime":196.99,"body":"continues in the area where I"},{"speaker":"Charles Goldfarb","startTime":196.99,"endTime":201.55,"body":"practice, the opposite is true."},{"speaker":"Charles Goldfarb","startTime":196.99,"endTime":201.55,"body":"The facility fee reimbursement"},{"speaker":"Charles Goldfarb","startTime":201.55,"endTime":206.47,"body":"for the ASC is 80 to 100 dollars"},{"speaker":"Charles Goldfarb","startTime":201.55,"endTime":206.47,"body":"lower for endoscopic carpal"},{"speaker":"Charles Goldfarb","startTime":206.47,"endTime":213.61,"body":"tunnel than open carpal tunnel,"},{"speaker":"Charles Goldfarb","startTime":206.47,"endTime":213.61,"body":"which is stunning to me. And he"},{"speaker":"Charles Goldfarb","startTime":213.61,"endTime":217.96,"body":"recognizes and he goes on to say"},{"speaker":"Charles Goldfarb","startTime":213.61,"endTime":217.96,"body":"he recognizes that reimbursement"},{"speaker":"Charles Goldfarb","startTime":217.96,"endTime":221.17,"body":"rates vary. And you know, we're"},{"speaker":"Charles Goldfarb","startTime":217.96,"endTime":221.17,"body":"in St. Louis, and he's in"},{"speaker":"Charles Goldfarb","startTime":221.17,"endTime":228.4,"body":"Chicago. But interestingly, you"},{"speaker":"Charles Goldfarb","startTime":221.17,"endTime":228.4,"body":"know, many of his partners and"},{"speaker":"Charles Goldfarb","startTime":228.4,"endTime":231.85,"body":"Jason himself do primary"},{"speaker":"Charles Goldfarb","startTime":228.4,"endTime":231.85,"body":"endoscopy carpal tunnels. So"},{"speaker":"Charles Goldfarb","startTime":231.97,"endTime":236.35,"body":"Chris and I went back and just"},{"speaker":"Charles Goldfarb","startTime":231.97,"endTime":236.35,"body":"to double check this, I pulled"},{"speaker":"Charles Goldfarb","startTime":236.35,"endTime":241.42,"body":"some actual data. And sure"},{"speaker":"Charles Goldfarb","startTime":236.35,"endTime":241.42,"body":"enough, the numbers are really"},{"speaker":"Charles Goldfarb","startTime":241.42,"endTime":247.45,"body":"something in St. Louis, and"},{"speaker":"Charles Goldfarb","startTime":241.42,"endTime":247.45,"body":"again, I got to be a little bit"},{"speaker":"Charles Goldfarb","startTime":247.45,"endTime":256.69,"body":"vague, but in the scopic pays,"},{"speaker":"Charles Goldfarb","startTime":247.45,"endTime":256.69,"body":"sometimes double facility fee"},{"speaker":"Charles Goldfarb","startTime":256.72,"endTime":259.72,"body":"compared to open carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":256.72,"endTime":259.72,"body":"release. Now it's not"},{"speaker":"Charles Goldfarb","startTime":259.72,"endTime":264.16,"body":"universally true. But that's"},{"speaker":"Charles Goldfarb","startTime":259.72,"endTime":264.16,"body":"really remarkable."},{"speaker":"Chris Dy","startTime":265.78,"endTime":268.87,"body":"Yeah, I think that you"},{"speaker":"Chris Dy","startTime":265.78,"endTime":268.87,"body":"know, that's something to keep"},{"speaker":"Chris Dy","startTime":268.87,"endTime":272.71,"body":"in mind if you're a new surgeon,"},{"speaker":"Chris Dy","startTime":268.87,"endTime":272.71,"body":"and you are fortunate enough to"},{"speaker":"Chris Dy","startTime":273.34,"endTime":275.83,"body":"feel facile, doing both"},{"speaker":"Chris Dy","startTime":273.34,"endTime":275.83,"body":"techniques and comfortable"},{"speaker":"Chris Dy","startTime":275.83,"endTime":279.07,"body":"offering both techniques. That's"},{"speaker":"Chris Dy","startTime":275.83,"endTime":279.07,"body":"something that may play into"},{"speaker":"Chris Dy","startTime":279.07,"endTime":282.19,"body":"your decision making. But I"},{"speaker":"Chris Dy","startTime":279.07,"endTime":282.19,"body":"think that most surgeons aren't"},{"speaker":"Chris Dy","startTime":282.19,"endTime":285.97,"body":"always considering facility fee"},{"speaker":"Chris Dy","startTime":282.19,"endTime":285.97,"body":"in their calculus, what they"},{"speaker":"Chris Dy","startTime":285.97,"endTime":289.36,"body":"might consider for better or"},{"speaker":"Chris Dy","startTime":285.97,"endTime":289.36,"body":"worse is their own professional"},{"speaker":"Chris Dy","startTime":289.36,"endTime":293.65,"body":"fee. And I'm not judging one way"},{"speaker":"Chris Dy","startTime":289.36,"endTime":293.65,"body":"or the other. But Chuck, do you"},{"speaker":"Chris Dy","startTime":293.65,"endTime":297.19,"body":"feel like the professional fees"},{"speaker":"Chris Dy","startTime":293.65,"endTime":297.19,"body":"for the surgeon which are"},{"speaker":"Chris Dy","startTime":297.22,"endTime":300.88,"body":"separate from the facility fees"},{"speaker":"Chris Dy","startTime":297.22,"endTime":300.88,"body":"For those of you that are less"},{"speaker":"Chris Dy","startTime":300.88,"endTime":305.23,"body":"initiated with the wonderful"},{"speaker":"Chris Dy","startTime":300.88,"endTime":305.23,"body":"American healthcare system, do"},{"speaker":"Chris Dy","startTime":305.23,"endTime":308.92,"body":"they often go in parallel? So"},{"speaker":"Chris Dy","startTime":305.23,"endTime":308.92,"body":"for example, like, say in"},{"speaker":"Chris Dy","startTime":309.28,"endTime":313.78,"body":"Jason's market in the suburbs of"},{"speaker":"Chris Dy","startTime":309.28,"endTime":313.78,"body":"Chicago, where the facility fee"},{"speaker":"Chris Dy","startTime":313.78,"endTime":317.65,"body":"for the endoscopic is lower with"},{"speaker":"Chris Dy","startTime":313.78,"endTime":317.65,"body":"the surgeon fee also be lower"},{"speaker":"Chris Dy","startTime":317.65,"endTime":320.65,"body":"typically, or are those pretty"},{"speaker":"Chris Dy","startTime":317.65,"endTime":320.65,"body":"unrelated?"},{"speaker":"Charles Goldfarb","startTime":321.28,"endTime":322.75,"body":"Well,"},{"speaker":"Charles Goldfarb","startTime":321.28,"endTime":322.75,"body":"typically, I think of them as"},{"speaker":"Charles Goldfarb","startTime":322.75,"endTime":327.58,"body":"going hand in hand, Jason"},{"speaker":"Charles Goldfarb","startTime":322.75,"endTime":327.58,"body":"relates that the surgeon fee is"},{"speaker":"Charles Goldfarb","startTime":327.58,"endTime":332.59,"body":"or the procedural fee is $50 to"},{"speaker":"Charles Goldfarb","startTime":327.58,"endTime":332.59,"body":"$100 more for endoscopic versus"},{"speaker":"Charles Goldfarb","startTime":332.62,"endTime":337.48,"body":"endo for endoscopic versus open."},{"speaker":"Charles Goldfarb","startTime":332.62,"endTime":337.48,"body":"And in our world, it's that the"},{"speaker":"Charles Goldfarb","startTime":337.48,"endTime":341.35,"body":"reimbursement difference is even"},{"speaker":"Charles Goldfarb","startTime":337.48,"endTime":341.35,"body":"greater. So it's more notably,"},{"speaker":"Charles Goldfarb","startTime":341.53,"endTime":345.43,"body":"positive for endoscopic. But, so"},{"speaker":"Charles Goldfarb","startTime":341.53,"endTime":345.43,"body":"for someone who has thought"},{"speaker":"Charles Goldfarb","startTime":345.43,"endTime":347.98,"body":"about these things for a long"},{"speaker":"Charles Goldfarb","startTime":345.43,"endTime":347.98,"body":"time, when we opened our"},{"speaker":"Charles Goldfarb","startTime":348.1,"endTime":351.64,"body":"outpatient surgery center 15"},{"speaker":"Charles Goldfarb","startTime":348.1,"endTime":351.64,"body":"years ago, we spent a lot of"},{"speaker":"Charles Goldfarb","startTime":351.64,"endTime":354.64,"body":"time, I think you were still in"},{"speaker":"Charles Goldfarb","startTime":351.64,"endTime":354.64,"body":"high school, then. But we spent"},{"speaker":"Charles Goldfarb","startTime":354.64,"endTime":361.6,"body":"a lot of time thinking about"},{"speaker":"Charles Goldfarb","startTime":354.64,"endTime":361.6,"body":"cost and emphasizing cost. But"},{"speaker":"Charles Goldfarb","startTime":361.6,"endTime":366.22,"body":"the reality is, it's so"},{"speaker":"Charles Goldfarb","startTime":361.6,"endTime":366.22,"body":"challenging, as you said in our"},{"speaker":"Charles Goldfarb","startTime":366.22,"endTime":370.54,"body":"American healthcare system. To"},{"speaker":"Charles Goldfarb","startTime":366.22,"endTime":370.54,"body":"put all this together, it just"},{"speaker":"Charles Goldfarb","startTime":370.54,"endTime":373.12,"body":"doesn't make sense. And it"},{"speaker":"Charles Goldfarb","startTime":370.54,"endTime":373.12,"body":"varies from city to city from"},{"speaker":"Charles Goldfarb","startTime":373.15,"endTime":378.76,"body":"ensure to ensure. And as as"},{"speaker":"Charles Goldfarb","startTime":373.15,"endTime":378.76,"body":"physicians, it's really tough"},{"speaker":"Charles Goldfarb","startTime":378.76,"endTime":384.22,"body":"for us to try to use cost or"},{"speaker":"Charles Goldfarb","startTime":378.76,"endTime":384.22,"body":"reimbursement data to influence"},{"speaker":"Charles Goldfarb","startTime":384.22,"endTime":388.03,"body":"our practice. And honestly, it's"},{"speaker":"Charles Goldfarb","startTime":384.22,"endTime":388.03,"body":"probably for the best, right, we"},{"speaker":"Charles Goldfarb","startTime":388.03,"endTime":391.42,"body":"should do the right thing for"},{"speaker":"Charles Goldfarb","startTime":388.03,"endTime":391.42,"body":"the patient based on our"},{"speaker":"Charles Goldfarb","startTime":391.42,"endTime":396.04,"body":"training, our experience and our"},{"speaker":"Charles Goldfarb","startTime":391.42,"endTime":396.04,"body":"expected outcomes, and the chips"},{"speaker":"Charles Goldfarb","startTime":396.04,"endTime":398.71,"body":"fall where they may now some of"},{"speaker":"Charles Goldfarb","startTime":396.04,"endTime":398.71,"body":"the listeners might not agree"},{"speaker":"Charles Goldfarb","startTime":398.71,"endTime":401.62,"body":"with that approach. But that"},{"speaker":"Charles Goldfarb","startTime":398.71,"endTime":401.62,"body":"hasn't been our approach, and I"},{"speaker":"Charles Goldfarb","startTime":401.62,"endTime":403.36,"body":"think will continue to be our"},{"speaker":"Charles Goldfarb","startTime":401.62,"endTime":403.36,"body":"approach."},{"speaker":"Chris Dy","startTime":403.9,"endTime":406.15,"body":"Yeah, and I agree with"},{"speaker":"Chris Dy","startTime":403.9,"endTime":406.15,"body":"you entirely. It's frustrating"},{"speaker":"Chris Dy","startTime":406.15,"endTime":409.87,"body":"when we have to deal with this"},{"speaker":"Chris Dy","startTime":406.15,"endTime":409.87,"body":"side of, of medicine, at least"},{"speaker":"Chris Dy","startTime":409.87,"endTime":412.9,"body":"American healthcare. You know,"},{"speaker":"Chris Dy","startTime":409.87,"endTime":412.9,"body":"for example, yesterday, I was"},{"speaker":"Chris Dy","startTime":412.9,"endTime":416.71,"body":"doing a prior authorization"},{"speaker":"Chris Dy","startTime":412.9,"endTime":416.71,"body":"slash peer to peer for the use"},{"speaker":"Chris Dy","startTime":416.71,"endTime":420.13,"body":"of a nerve allograft for a"},{"speaker":"Chris Dy","startTime":416.71,"endTime":420.13,"body":"digital nerve. And this"},{"speaker":"Chris Dy","startTime":420.13,"endTime":425.14,"body":"particular insurance company had"},{"speaker":"Chris Dy","startTime":420.13,"endTime":425.14,"body":"placed the use of that nerve"},{"speaker":"Chris Dy","startTime":425.14,"endTime":428.23,"body":"allograft on their exclusionary"},{"speaker":"Chris Dy","startTime":425.14,"endTime":428.23,"body":"lists. So automatically,"},{"speaker":"Chris Dy","startTime":429.01,"endTime":431.29,"body":"unbeknownst to me, my peer to"},{"speaker":"Chris Dy","startTime":429.01,"endTime":431.29,"body":"peer was going to be in vain"},{"speaker":"Chris Dy","startTime":431.29,"endTime":435.82,"body":"anyway, because the quote peer"},{"speaker":"Chris Dy","startTime":431.29,"endTime":435.82,"body":"who was not a hand surgeon, you"},{"speaker":"Chris Dy","startTime":435.82,"endTime":437.8,"body":"know, would not have been able"},{"speaker":"Chris Dy","startTime":435.82,"endTime":437.8,"body":"to overturn that decision"},{"speaker":"Chris Dy","startTime":437.8,"endTime":440.59,"body":"anyway. So now I have to go"},{"speaker":"Chris Dy","startTime":437.8,"endTime":440.59,"body":"through an emergency appeals"},{"speaker":"Chris Dy","startTime":440.59,"endTime":442.96,"body":"process, which takes at least"},{"speaker":"Chris Dy","startTime":440.59,"endTime":442.96,"body":"three business days on the"},{"speaker":"Chris Dy","startTime":442.96,"endTime":446.77,"body":"holiday weekend in the States."},{"speaker":"Chris Dy","startTime":442.96,"endTime":446.77,"body":"So this patient surgery, which"},{"speaker":"Chris Dy","startTime":446.77,"endTime":450.46,"body":"has already been postponed one"},{"speaker":"Chris Dy","startTime":446.77,"endTime":450.46,"body":"time and pushed back a week is"},{"speaker":"Chris Dy","startTime":450.46,"endTime":452.98,"body":"now going to be postponed again"},{"speaker":"Chris Dy","startTime":450.46,"endTime":452.98,"body":"for another week, or we're going"},{"speaker":"Chris Dy","startTime":452.98,"endTime":456.61,"body":"to have to harvest a nerve"},{"speaker":"Chris Dy","startTime":452.98,"endTime":456.61,"body":"autograft, which you know, that"},{"speaker":"Chris Dy","startTime":456.61,"endTime":459.82,"body":"works. It's great. It's, it's"},{"speaker":"Chris Dy","startTime":456.61,"endTime":459.82,"body":"going to work well. But he'll"},{"speaker":"Chris Dy","startTime":459.82,"endTime":464.14,"body":"have another incision, more"},{"speaker":"Chris Dy","startTime":459.82,"endTime":464.14,"body":"operative time. It's just really"},{"speaker":"Chris Dy","startTime":464.14,"endTime":468.13,"body":"frustrating. But what we can do,"},{"speaker":"Chris Dy","startTime":464.14,"endTime":468.13,"body":"you know, so first off, Jason,"},{"speaker":"Chris Dy","startTime":468.13,"endTime":470.47,"body":"thank you for your question."},{"speaker":"Chris Dy","startTime":468.13,"endTime":470.47,"body":"Really, really appreciate it. I"},{"speaker":"Chris Dy","startTime":470.47,"endTime":473.26,"body":"think it brings up a lot of good"},{"speaker":"Chris Dy","startTime":470.47,"endTime":473.26,"body":"things to discuss. But when we"},{"speaker":"Chris Dy","startTime":473.26,"endTime":478.93,"body":"have our meeting, at the IFSSH,"},{"speaker":"Chris Dy","startTime":473.26,"endTime":478.93,"body":"our live podcast taping we can"},{"speaker":"Chris Dy","startTime":478.93,"endTime":481.93,"body":"debate these intricacies of"},{"speaker":"Chris Dy","startTime":478.93,"endTime":481.93,"body":"healthcare delivery with our"},{"speaker":"Chris Dy","startTime":481.93,"endTime":486.28,"body":"audience. So if you want to come"},{"speaker":"Chris Dy","startTime":481.93,"endTime":486.28,"body":"check us out at the IFSSH here"},{"speaker":"Chris Dy","startTime":486.28,"endTime":490.15,"body":"is the info. So we are going to"},{"speaker":"Chris Dy","startTime":486.28,"endTime":490.15,"body":"be doing a live taping. The live"},{"speaker":"Chris Dy","startTime":490.15,"endTime":494.38,"body":"taping is going to be let's see"},{"speaker":"Chris Dy","startTime":490.15,"endTime":494.38,"body":"here on Wednesday, the eighth of"},{"speaker":"June at 5","startTime":494.38,"endTime":501.25,"body":"45. Local London time"},{"speaker":"June at 5","startTime":494.38,"endTime":501.25,"body":"in the south gallery room 13"},{"speaker":"June at 5","startTime":501.88,"endTime":504.55,"body":"will be there for 45 minutes,"},{"speaker":"June at 5","startTime":501.88,"endTime":504.55,"body":"we're going to record an episode"},{"speaker":"June at 5","startTime":504.55,"endTime":506.89,"body":"we hope to see lots of people"},{"speaker":"June at 5","startTime":504.55,"endTime":506.89,"body":"there. If there are enough"},{"speaker":"June at 5","startTime":506.89,"endTime":509.95,"body":"people there, we'll just do a"},{"speaker":"June at 5","startTime":506.89,"endTime":509.95,"body":"free for all q\u0026a. The room holds"},{"speaker":"June at 5","startTime":509.98,"endTime":513.34,"body":"70 people so please don't"},{"speaker":"June at 5","startTime":509.98,"endTime":513.34,"body":"embarrass Chuck and I for asking"},{"speaker":"June at 5","startTime":513.34,"endTime":514.27,"body":"for a room."},{"speaker":"Charles Goldfarb","startTime":515.47,"endTime":517.69,"body":"Are you"},{"speaker":"Charles Goldfarb","startTime":515.47,"endTime":517.69,"body":"bringing some swag to London"},{"speaker":"Charles Goldfarb","startTime":517.69,"endTime":518.08,"body":"with you?"},{"speaker":"Chris Dy","startTime":518.65,"endTime":521.71,"body":"There will be swag. We"},{"speaker":"Chris Dy","startTime":518.65,"endTime":521.71,"body":"have actually have a little bit"},{"speaker":"Chris Dy","startTime":521.71,"endTime":525.25,"body":"of the old swag and a ton of the"},{"speaker":"Chris Dy","startTime":521.71,"endTime":525.25,"body":"new swag. So please come into"},{"speaker":"Chris Dy","startTime":525.25,"endTime":527.92,"body":"the slide that we're bringing is"},{"speaker":"Chris Dy","startTime":525.25,"endTime":527.92,"body":"actually perfect for those who"},{"speaker":"Chris Dy","startTime":527.92,"endTime":531.13,"body":"are attending a meeting and need"},{"speaker":"Chris Dy","startTime":527.92,"endTime":531.13,"body":"to demonstrate some kind of"},{"speaker":"Chris Dy","startTime":531.16,"endTime":535.18,"body":"meeting registration if you get"},{"speaker":"Chris Dy","startTime":531.16,"endTime":535.18,"body":"my drift could also be used for"},{"speaker":"Chris Dy","startTime":535.18,"endTime":539.08,"body":"other things like keys, maybe"},{"speaker":"Chris Dy","startTime":535.18,"endTime":539.08,"body":"hospital IDs. I mean, it's just"},{"speaker":"Chris Dy","startTime":539.11,"endTime":541.66,"body":"it's gonna fly off the shelves."},{"speaker":"Chris Dy","startTime":539.11,"endTime":541.66,"body":"It helps that we're giving it"},{"speaker":"Chris Dy","startTime":541.66,"endTime":543.88,"body":"away. But yes, it will fly off"},{"speaker":"Chris Dy","startTime":541.66,"endTime":543.88,"body":"the shelves."},{"speaker":"Charles Goldfarb","startTime":543.0,"endTime":546.99,"body":"I love it. I"},{"speaker":"Charles Goldfarb","startTime":543.0,"endTime":546.99,"body":"love it. All right, Jason. Thank"},{"speaker":"Charles Goldfarb","startTime":546.99,"endTime":549.93,"body":"you again. And without further"},{"speaker":"Charles Goldfarb","startTime":546.99,"endTime":549.93,"body":"ado, we're going to jump back"},{"speaker":"Charles Goldfarb","startTime":549.93,"endTime":555.36,"body":"into part two of Macy educating"},{"speaker":"Charles Goldfarb","startTime":549.93,"endTime":555.36,"body":"Chris and I about the thumb CMC"},{"speaker":"Charles Goldfarb","startTime":555.36,"endTime":561.09,"body":"joint. What is I love this we"},{"speaker":"Charles Goldfarb","startTime":555.36,"endTime":561.09,"body":"just get to pimp you with"},{"speaker":"Charles Goldfarb","startTime":561.09,"endTime":565.53,"body":"questions. What is the"},{"speaker":"Charles Goldfarb","startTime":561.09,"endTime":565.53,"body":"definition because all of our"},{"speaker":"Charles Goldfarb","startTime":565.53,"endTime":567.78,"body":"listeners may not know and I"},{"speaker":"Charles Goldfarb","startTime":565.53,"endTime":567.78,"body":"certainly can always use a"},{"speaker":"Charles Goldfarb","startTime":567.78,"endTime":572.1,"body":"refresher. What is the"},{"speaker":"Charles Goldfarb","startTime":567.78,"endTime":572.1,"body":"definition of in the importance"},{"speaker":"Charles Goldfarb","startTime":572.16,"endTime":577.44,"body":"of if any, iontophoresis in the"},{"speaker":"Charles Goldfarb","startTime":572.16,"endTime":577.44,"body":"care of the CMC arthritic"},{"speaker":"Charles Goldfarb","startTime":577.44,"endTime":577.8,"body":"patient?"},{"speaker":"Macy Stonner","startTime":580.23,"endTime":585.18,"body":"So that is not a"},{"speaker":"Macy Stonner","startTime":580.23,"endTime":585.18,"body":"modality that I practice"},{"speaker":"Macy Stonner","startTime":585.18,"endTime":587.73,"body":"typically and I don't know if"},{"speaker":"Macy Stonner","startTime":585.18,"endTime":587.73,"body":"it's because it became a little"},{"speaker":"Macy Stonner","startTime":587.73,"endTime":591.33,"body":"bit more we'll say antiquated"},{"speaker":"Macy Stonner","startTime":587.73,"endTime":591.33,"body":"but a little bit more in the"},{"speaker":"Macy Stonner","startTime":591.33,"endTime":594.39,"body":"past when I started practicing,"},{"speaker":"Macy Stonner","startTime":591.33,"endTime":594.39,"body":"but there are some physicians"},{"speaker":"Macy Stonner","startTime":594.39,"endTime":596.22,"body":"that request it with their"},{"speaker":"Macy Stonner","startTime":594.39,"endTime":596.22,"body":"patients. I'm going to be"},{"speaker":"Macy Stonner","startTime":596.22,"endTime":599.1,"body":"completely honest and say I"},{"speaker":"Macy Stonner","startTime":596.22,"endTime":599.1,"body":"don't have experience with this."},{"speaker":"Macy Stonner","startTime":599.58,"endTime":604.17,"body":"Um But it's basically"},{"speaker":"Macy Stonner","startTime":599.58,"endTime":604.17,"body":"dexamethasone infused into thumb"},{"speaker":"Macy Stonner","startTime":604.17,"endTime":609.45,"body":"joint, I believe to help"},{"speaker":"Macy Stonner","startTime":604.17,"endTime":609.45,"body":"decrease pain. But the"},{"speaker":"Macy Stonner","startTime":609.45,"endTime":614.82,"body":"instructions are to do it three"},{"speaker":"Macy Stonner","startTime":609.45,"endTime":614.82,"body":"to four times a week. I worked"},{"speaker":"Macy Stonner","startTime":614.82,"endTime":616.35,"body":"at the Milliken Hand Center,"},{"speaker":"Macy Stonner","startTime":614.82,"endTime":616.35,"body":"which is in the middle of the"},{"speaker":"Macy Stonner","startTime":616.35,"endTime":618.87,"body":"city, and there's so many"},{"speaker":"Macy Stonner","startTime":616.35,"endTime":618.87,"body":"patients that I have where our"},{"speaker":"Macy Stonner","startTime":618.87,"endTime":622.47,"body":"biggest deterrent for therapy is"},{"speaker":"Macy Stonner","startTime":618.87,"endTime":622.47,"body":"transportation, parking, getting"},{"speaker":"Macy Stonner","startTime":622.47,"endTime":625.56,"body":"there from work, so many people"},{"speaker":"Macy Stonner","startTime":622.47,"endTime":625.56,"body":"like, it's such a difficult"},{"speaker":"Macy Stonner","startTime":625.56,"endTime":628.17,"body":"thing to get people to come"},{"speaker":"Macy Stonner","startTime":625.56,"endTime":628.17,"body":"sometimes to have them come"},{"speaker":"Macy Stonner","startTime":628.17,"endTime":630.66,"body":"three, four times a week for"},{"speaker":"Macy Stonner","startTime":628.17,"endTime":630.66,"body":"that it's difficult would be"},{"speaker":"Macy Stonner","startTime":630.66,"endTime":637.32,"body":"difficult, I believe. And so"},{"speaker":"Macy Stonner","startTime":630.66,"endTime":637.32,"body":"more frequently now in 2022. I"},{"speaker":"Macy Stonner","startTime":637.32,"endTime":639.66,"body":"feel like they have more"},{"speaker":"Macy Stonner","startTime":637.32,"endTime":639.66,"body":"portable units where they would"},{"speaker":"Macy Stonner","startTime":639.66,"endTime":643.11,"body":"take them home, and just do that"},{"speaker":"Macy Stonner","startTime":639.66,"endTime":643.11,"body":"as an independent therapy at"},{"speaker":"Macy Stonner","startTime":643.11,"endTime":646.92,"body":"home. But, again, I want to be"},{"speaker":"Macy Stonner","startTime":643.11,"endTime":646.92,"body":"really honest and say I don't"},{"speaker":"Macy Stonner","startTime":646.92,"endTime":648.69,"body":"have a ton of experience with"},{"speaker":"Macy Stonner","startTime":646.92,"endTime":648.69,"body":"that modality."},{"speaker":"Charles Goldfarb","startTime":648.75,"endTime":650.61,"body":"And this is"},{"speaker":"Charles Goldfarb","startTime":648.75,"endTime":650.61,"body":"ultrasound."},{"speaker":"Macy Stonner","startTime":651.78,"endTime":654.99,"body":"Yes, ultrasound"},{"speaker":"Macy Stonner","startTime":651.78,"endTime":654.99,"body":"guided steroid. Yeah."},{"speaker":"Chris Dy","startTime":656.16,"endTime":658.62,"body":"Do you know one way to"},{"speaker":"Chris Dy","startTime":656.16,"endTime":658.62,"body":"infuse dexamethasone into a"},{"speaker":"Chris Dy","startTime":658.62,"endTime":660.51,"body":"joint? One time?"},{"speaker":"Charles Goldfarb","startTime":662.25,"endTime":663.3,"body":"Big old meal."},{"speaker":"Macy Stonner","startTime":666.03,"endTime":669.12,"body":"You also asked"},{"speaker":"Macy Stonner","startTime":666.03,"endTime":669.12,"body":"previously, Dr. Dy, about joint"},{"speaker":"Macy Stonner","startTime":669.12,"endTime":669.9,"body":"protection?"},{"speaker":"Chris Dy","startTime":670.26,"endTime":670.62,"body":"Yeah."},{"speaker":"Macy Stonner","startTime":671.1,"endTime":673.62,"body":"We talked about"},{"speaker":"Macy Stonner","startTime":671.1,"endTime":673.62,"body":"joint stabilization exercises."},{"speaker":"Macy Stonner","startTime":673.62,"endTime":677.61,"body":"Joint protection isn't as fancy"},{"speaker":"Macy Stonner","startTime":673.62,"endTime":677.61,"body":"as that it's not rocket science."},{"speaker":"Macy Stonner","startTime":677.61,"endTime":681.54,"body":"But it's it's a thought process"},{"speaker":"Macy Stonner","startTime":677.61,"endTime":681.54,"body":"that a lot of people may not"},{"speaker":"Macy Stonner","startTime":681.54,"endTime":687.66,"body":"have. So some people correlate"},{"speaker":"Macy Stonner","startTime":681.54,"endTime":687.66,"body":"therapy with exercise based"},{"speaker":"Macy Stonner","startTime":687.69,"endTime":691.32,"body":"treatment, you know, a lot of no"},{"speaker":"Macy Stonner","startTime":687.69,"endTime":691.32,"body":"pain, no gain type mentality."},{"speaker":"Macy Stonner","startTime":691.32,"endTime":694.8,"body":"And so when they come to"},{"speaker":"Macy Stonner","startTime":691.32,"endTime":694.8,"body":"therapy, for CMC arthritis, they"},{"speaker":"Macy Stonner","startTime":694.8,"endTime":697.83,"body":"think that's what it's gonna"},{"speaker":"Macy Stonner","startTime":694.8,"endTime":697.83,"body":"look like. And you kind of have"},{"speaker":"Macy Stonner","startTime":697.83,"endTime":701.01,"body":"to re educate them that, you"},{"speaker":"Macy Stonner","startTime":697.83,"endTime":701.01,"body":"know, it's not that kind of"},{"speaker":"Macy Stonner","startTime":701.01,"endTime":704.58,"body":"thing. Joint protection, there's"},{"speaker":"Macy Stonner","startTime":701.01,"endTime":704.58,"body":"some strategies that we just"},{"speaker":"Macy Stonner","startTime":704.58,"endTime":707.64,"body":"want to help you understand. And"},{"speaker":"Macy Stonner","startTime":704.58,"endTime":707.64,"body":"the first we have like a little"},{"speaker":"Macy Stonner","startTime":708.75,"endTime":712.53,"body":"bullet point, handout we give"},{"speaker":"Macy Stonner","startTime":708.75,"endTime":712.53,"body":"our patient with like the basics"},{"speaker":"Macy Stonner","startTime":712.53,"endTime":716.85,"body":"of it with some photos. So the"},{"speaker":"Macy Stonner","startTime":712.53,"endTime":716.85,"body":"first one is to respect pain, or"},{"speaker":"Macy Stonner","startTime":716.85,"endTime":719.52,"body":"always let pain be your guide."},{"speaker":"Macy Stonner","startTime":716.85,"endTime":719.52,"body":"If you're doing an activity that"},{"speaker":"Macy Stonner","startTime":719.52,"endTime":722.01,"body":"causes a lot of basic thumb"},{"speaker":"Macy Stonner","startTime":719.52,"endTime":722.01,"body":"pain, probably not the best"},{"speaker":"Macy Stonner","startTime":722.01,"endTime":723.54,"body":"idea, that's not the kind of"},{"speaker":"Macy Stonner","startTime":722.01,"endTime":723.54,"body":"thing that's going to make you"},{"speaker":"Macy Stonner","startTime":723.54,"endTime":726.39,"body":"stronger. And that seems like a"},{"speaker":"Macy Stonner","startTime":723.54,"endTime":726.39,"body":"very simple thing to understand."},{"speaker":"Macy Stonner","startTime":726.39,"endTime":728.67,"body":"But you'd be surprised at how"},{"speaker":"Macy Stonner","startTime":726.39,"endTime":728.67,"body":"many patients don't know that."},{"speaker":"Macy Stonner","startTime":730.65,"endTime":734.04,"body":"Other things that we instruct"},{"speaker":"Macy Stonner","startTime":730.65,"endTime":734.04,"body":"them is in the use of"},{"speaker":"Macy Stonner","startTime":735.12,"endTime":737.79,"body":"modifications and adaptive"},{"speaker":"Macy Stonner","startTime":735.12,"endTime":737.79,"body":"equipment in the kitchen. So"},{"speaker":"Macy Stonner","startTime":737.79,"endTime":740.85,"body":"like, different types of ways to"},{"speaker":"Macy Stonner","startTime":737.79,"endTime":740.85,"body":"open jars, whether that's with a"},{"speaker":"Macy Stonner","startTime":740.85,"endTime":743.94,"body":"gadget or like a device or just"},{"speaker":"Macy Stonner","startTime":740.85,"endTime":743.94,"body":"a technique where you grip it."},{"speaker":"Macy Stonner","startTime":744.96,"endTime":750.63,"body":"Different types of knives. We"},{"speaker":"Macy Stonner","startTime":744.96,"endTime":750.63,"body":"talked about the importance of"},{"speaker":"Macy Stonner","startTime":750.63,"endTime":753.27,"body":"using larger joints, as opposed"},{"speaker":"Macy Stonner","startTime":750.63,"endTime":753.27,"body":"to smaller joints. So if you"},{"speaker":"Macy Stonner","startTime":753.27,"endTime":755.43,"body":"think about your thumb, CMC"},{"speaker":"Macy Stonner","startTime":753.27,"endTime":755.43,"body":"joint versus your elbow or your"},{"speaker":"Macy Stonner","startTime":755.43,"endTime":758.91,"body":"shoulder, it can withstand so"},{"speaker":"Macy Stonner","startTime":755.43,"endTime":758.91,"body":"much more force as the shoulder."},{"speaker":"Macy Stonner","startTime":758.94,"endTime":762.48,"body":"So like we talked about taking"},{"speaker":"Macy Stonner","startTime":758.94,"endTime":762.48,"body":"groceries in from the car. So"},{"speaker":"Macy Stonner","startTime":762.48,"endTime":765.09,"body":"many people will put seven bags"},{"speaker":"Macy Stonner","startTime":762.48,"endTime":765.09,"body":"in one hand seven bags in the"},{"speaker":"Macy Stonner","startTime":765.09,"endTime":767.64,"body":"other because they don't want to"},{"speaker":"Macy Stonner","startTime":765.09,"endTime":767.64,"body":"take two trips. It seems simple,"},{"speaker":"Macy Stonner","startTime":767.73,"endTime":770.61,"body":"but telling them about the"},{"speaker":"Macy Stonner","startTime":767.73,"endTime":770.61,"body":"importance of like having a big"},{"speaker":"Macy Stonner","startTime":770.61,"endTime":772.5,"body":"shoulder bag and stuff while"},{"speaker":"Macy Stonner","startTime":770.61,"endTime":772.5,"body":"your groceries in there. And"},{"speaker":"Macy Stonner","startTime":772.74,"endTime":776.16,"body":"again, it's, I guess, a little"},{"speaker":"Macy Stonner","startTime":772.74,"endTime":776.16,"body":"bit more of a simplistic type"},{"speaker":"Macy Stonner","startTime":776.16,"endTime":780.18,"body":"thing to educate them on. But"},{"speaker":"Macy Stonner","startTime":776.16,"endTime":780.18,"body":"we've had good receptivity to"},{"speaker":"Macy Stonner","startTime":780.18,"endTime":782.85,"body":"that type of education in this"},{"speaker":"Macy Stonner","startTime":780.18,"endTime":782.85,"body":"population."},{"speaker":"Charles Goldfarb","startTime":784.32,"endTime":788.07,"body":"Next question,"},{"speaker":"Charles Goldfarb","startTime":784.32,"endTime":788.07,"body":"I feel like I'm the attorney."},{"speaker":"Charles Goldfarb","startTime":789.21,"endTime":794.7,"body":"What is the role of paraffin wax"},{"speaker":"Charles Goldfarb","startTime":789.21,"endTime":794.7,"body":"treatments for CMC joint"},{"speaker":"Charles Goldfarb","startTime":794.73,"endTime":798.9,"body":"arthritis like dipping your hand"},{"speaker":"Charles Goldfarb","startTime":794.73,"endTime":798.9,"body":"in the in the thingy and leaving"},{"speaker":"Charles Goldfarb","startTime":798.9,"endTime":799.92,"body":"it there for 20 minutes,"},{"speaker":"Chris Dy","startTime":801.1,"endTime":803.62,"body":"Dipping your hand in"},{"speaker":"Chris Dy","startTime":801.1,"endTime":803.62,"body":"the thingy and leaving it there."},{"speaker":"Chris Dy","startTime":803.62,"endTime":806.74,"body":"That's the very technical"},{"speaker":"Chris Dy","startTime":803.62,"endTime":806.74,"body":"description from our full"},{"speaker":"Chris Dy","startTime":806.74,"endTime":807.34,"body":"professor."},{"speaker":"Macy Stonner","startTime":808.92,"endTime":812.22,"body":"So definitely, I"},{"speaker":"Macy Stonner","startTime":808.92,"endTime":812.22,"body":"definitely think it has a role"},{"speaker":"Macy Stonner","startTime":812.22,"endTime":815.28,"body":"but not because of the wax"},{"speaker":"Macy Stonner","startTime":812.22,"endTime":815.28,"body":"medium, but because of the heat."},{"speaker":"Macy Stonner","startTime":815.49,"endTime":818.85,"body":"So that can be warm towels, a"},{"speaker":"Macy Stonner","startTime":815.49,"endTime":818.85,"body":"heating pad that you plug into"},{"speaker":"Macy Stonner","startTime":818.85,"endTime":822.18,"body":"the wall, warm rice that you put"},{"speaker":"Macy Stonner","startTime":818.85,"endTime":822.18,"body":"in the microwave and slightly"},{"speaker":"Macy Stonner","startTime":822.18,"endTime":826.23,"body":"grip, paraffin, whatever makes"},{"speaker":"Macy Stonner","startTime":822.18,"endTime":826.23,"body":"the patient feel better. I'm all"},{"speaker":"Macy Stonner","startTime":826.23,"endTime":831.48,"body":"for. I do instruct patients and"},{"speaker":"Macy Stonner","startTime":826.23,"endTime":831.48,"body":"keep therapy for this particular"},{"speaker":"Macy Stonner","startTime":831.48,"endTime":833.76,"body":"thing. But I'm always very"},{"speaker":"Macy Stonner","startTime":831.48,"endTime":833.76,"body":"honest and say this isn't going"},{"speaker":"Macy Stonner","startTime":833.76,"endTime":836.73,"body":"to make your arthritis go away."},{"speaker":"Macy Stonner","startTime":833.76,"endTime":836.73,"body":"You can do it once you can do it"},{"speaker":"Macy Stonner","startTime":836.73,"endTime":840.36,"body":"five times a day does not"},{"speaker":"Macy Stonner","startTime":836.73,"endTime":840.36,"body":"matter. But uh, it's not"},{"speaker":"Macy Stonner","startTime":840.36,"endTime":842.04,"body":"something that I would have"},{"speaker":"Macy Stonner","startTime":840.36,"endTime":842.04,"body":"somebody come to therapy for"},{"speaker":"Macy Stonner","startTime":842.04,"endTime":845.1,"body":"once or twice a week just to do"},{"speaker":"Macy Stonner","startTime":842.04,"endTime":845.1,"body":"paraffin. I would instruct them"},{"speaker":"Macy Stonner","startTime":845.1,"endTime":847.47,"body":"how to do it using a home unit"},{"speaker":"Macy Stonner","startTime":845.1,"endTime":847.47,"body":"or if they were already coming"},{"speaker":"Macy Stonner","startTime":847.47,"endTime":851.22,"body":"for other things, and they"},{"speaker":"Macy Stonner","startTime":847.47,"endTime":851.22,"body":"wanted to do it then great. But"},{"speaker":"Macy Stonner","startTime":851.22,"endTime":853.02,"body":"I mean, I think we all know that"},{"speaker":"Macy Stonner","startTime":851.22,"endTime":853.02,"body":"it's not going to change the"},{"speaker":"Macy Stonner","startTime":853.02,"endTime":856.8,"body":"course of their arthritis"},{"speaker":"Macy Stonner","startTime":853.02,"endTime":856.8,"body":"progression. But if it helps the"},{"speaker":"Macy Stonner","startTime":856.8,"endTime":859.17,"body":"patient manage their day a"},{"speaker":"Macy Stonner","startTime":856.8,"endTime":859.17,"body":"little bit better. I'm all for"},{"speaker":"Macy Stonner","startTime":859.17,"endTime":859.35,"body":"it."},{"speaker":"Chris Dy","startTime":860.92,"endTime":864.76,"body":"Macy without naming"},{"speaker":"Chris Dy","startTime":860.92,"endTime":864.76,"body":"names. What are some of the"},{"speaker":"Chris Dy","startTime":864.79,"endTime":869.14,"body":"misconceptions that you have to"},{"speaker":"Chris Dy","startTime":864.79,"endTime":869.14,"body":"correct when patients come in?"},{"speaker":"Chris Dy","startTime":869.2,"endTime":872.68,"body":"Perhaps they've seen a hand"},{"speaker":"Chris Dy","startTime":869.2,"endTime":872.68,"body":"surgeon either at our medical"},{"speaker":"Chris Dy","startTime":872.68,"endTime":875.35,"body":"school or somewhere else? What"},{"speaker":"Chris Dy","startTime":872.68,"endTime":875.35,"body":"do you have to unteach?"},{"speaker":"Macy Stonner","startTime":878.57,"endTime":881.57,"body":"That they need to"},{"speaker":"Macy Stonner","startTime":878.57,"endTime":881.57,"body":"come once or twice a week for"},{"speaker":"Macy Stonner","startTime":881.57,"endTime":884.72,"body":"five weeks? Because I feel like"},{"speaker":"Macy Stonner","startTime":881.57,"endTime":884.72,"body":"that would be I don't I don't"},{"speaker":"Macy Stonner","startTime":884.72,"endTime":888.41,"body":"have enough to teach that"},{"speaker":"Macy Stonner","startTime":884.72,"endTime":888.41,"body":"patient that often. I would say"},{"speaker":"Macy Stonner","startTime":888.41,"endTime":891.44,"body":"so I would feel fraudulent"},{"speaker":"Macy Stonner","startTime":888.41,"endTime":891.44,"body":"billing somebody's insurance"},{"speaker":"Macy Stonner","startTime":891.62,"endTime":894.68,"body":"that frequently for this"},{"speaker":"Macy Stonner","startTime":891.62,"endTime":894.68,"body":"diagnosis. I didn't truly"},{"speaker":"Macy Stonner","startTime":894.68,"endTime":898.19,"body":"believe that I was making an"},{"speaker":"Macy Stonner","startTime":894.68,"endTime":898.19,"body":"impact. So the frequency at"},{"speaker":"Macy Stonner","startTime":898.19,"endTime":903.17,"body":"which the referrals written And"},{"speaker":"Macy Stonner","startTime":898.19,"endTime":903.17,"body":"then if it says something like"},{"speaker":"Macy Stonner","startTime":903.71,"endTime":906.14,"body":"strengthening work conditioning,"},{"speaker":"Macy Stonner","startTime":903.71,"endTime":906.14,"body":"work hardening or something like"},{"speaker":"Macy Stonner","startTime":906.14,"endTime":911.09,"body":"that, where you think"},{"speaker":"Macy Stonner","startTime":906.14,"endTime":911.09,"body":"strengthening of the thumb. So a"},{"speaker":"Macy Stonner","startTime":911.09,"endTime":913.01,"body":"lot of people have like therapy"},{"speaker":"Macy Stonner","startTime":911.09,"endTime":913.01,"body":"putty where they're just"},{"speaker":"Macy Stonner","startTime":913.01,"endTime":915.89,"body":"pinching it to strengthen their"},{"speaker":"Macy Stonner","startTime":913.01,"endTime":915.89,"body":"thumb. And sure that's going to"},{"speaker":"Macy Stonner","startTime":915.89,"endTime":919.22,"body":"strengthen you. But it's going"},{"speaker":"Macy Stonner","startTime":915.89,"endTime":919.22,"body":"to make you much more painful."},{"speaker":"Macy Stonner","startTime":919.64,"endTime":922.22,"body":"So what's the point of a really"},{"speaker":"Macy Stonner","startTime":919.64,"endTime":922.22,"body":"strong thumb? If it hurts so"},{"speaker":"Macy Stonner","startTime":922.22,"endTime":929.36,"body":"bad, you're not going to use it?"},{"speaker":"Macy Stonner","startTime":922.22,"endTime":929.36,"body":"So those would be my things."},{"speaker":"Charles Goldfarb","startTime":929.78,"endTime":933.59,"body":"What, I do"},{"speaker":"Charles Goldfarb","startTime":929.78,"endTime":933.59,"body":"want to share one paper, which I"},{"speaker":"Charles Goldfarb","startTime":933.59,"endTime":936.86,"body":"literally think is the only"},{"speaker":"Charles Goldfarb","startTime":933.59,"endTime":936.86,"body":"while there's a couple of"},{"speaker":"Charles Goldfarb","startTime":936.86,"endTime":940.52,"body":"papers, but what other"},{"speaker":"Charles Goldfarb","startTime":936.86,"endTime":940.52,"body":"modalities do you believe are"},{"speaker":"Charles Goldfarb","startTime":940.52,"endTime":942.29,"body":"helpful? Or have we hit them"},{"speaker":"Charles Goldfarb","startTime":940.52,"endTime":942.29,"body":"all?"},{"speaker":"Macy Stonner","startTime":945.38,"endTime":949.01,"body":"I would say or go"},{"speaker":"Macy Stonner","startTime":945.38,"endTime":949.01,"body":"to heat, warm rice, or paraffin"},{"speaker":"Macy Stonner","startTime":949.01,"endTime":953.66,"body":"or heating pad, not cold. I"},{"speaker":"Macy Stonner","startTime":949.01,"endTime":953.66,"body":"mean, they, if they particularly"},{"speaker":"Macy Stonner","startTime":953.66,"endTime":955.85,"body":"find that helpful for them,"},{"speaker":"Macy Stonner","startTime":953.66,"endTime":955.85,"body":"great, but most people don't"},{"speaker":"Macy Stonner","startTime":955.85,"endTime":960.8,"body":"like it. Electrical Stimulation?"},{"speaker":"Macy Stonner","startTime":955.85,"endTime":960.8,"body":"No, I don't have a lot of"},{"speaker":"Macy Stonner","startTime":960.8,"endTime":964.25,"body":"experience with patients using a"},{"speaker":"Macy Stonner","startTime":960.8,"endTime":964.25,"body":"tens unit on their thumb. But if"},{"speaker":"Macy Stonner","startTime":964.25,"endTime":968.03,"body":"it makes them feel better"},{"speaker":"Macy Stonner","startTime":964.25,"endTime":968.03,"body":"temporarily, then sure. At least"},{"speaker":"Macy Stonner","startTime":968.06,"endTime":970.58,"body":"ultrasound, no evidence to"},{"speaker":"Macy Stonner","startTime":968.06,"endTime":970.58,"body":"suggest that's going to do"},{"speaker":"Macy Stonner","startTime":970.58,"endTime":972.41,"body":"anything. I think we've had them"},{"speaker":"Macy Stonner","startTime":970.58,"endTime":972.41,"body":"all."},{"speaker":"Chris Dy","startTime":973.7,"endTime":975.77,"body":"Good. Chuck, before we"},{"speaker":"Chris Dy","startTime":973.7,"endTime":975.77,"body":"jump into that paper, what do"},{"speaker":"Chris Dy","startTime":975.77,"endTime":978.26,"body":"you tell people to do at home,"},{"speaker":"Chris Dy","startTime":975.77,"endTime":978.26,"body":"Macy? You mentioned the"},{"speaker":"Chris Dy","startTime":978.26,"endTime":981.74,"body":"exercises, you know, making an O"},{"speaker":"Chris Dy","startTime":978.26,"endTime":981.74,"body":"and then see what else do you"},{"speaker":"Chris Dy","startTime":981.74,"endTime":983.69,"body":"teach them? And how frequently"},{"speaker":"Chris Dy","startTime":981.74,"endTime":983.69,"body":"do you ask them to do it."},{"speaker":"Macy Stonner","startTime":985.94,"endTime":988.82,"body":"So the exercise, I"},{"speaker":"Macy Stonner","startTime":985.94,"endTime":988.82,"body":"wouldn't say, I write on the top"},{"speaker":"Macy Stonner","startTime":988.82,"endTime":991.43,"body":"of their paper, this is a"},{"speaker":"Macy Stonner","startTime":988.82,"endTime":991.43,"body":"lifelong exercise. If you do it"},{"speaker":"Macy Stonner","startTime":991.43,"endTime":995.0,"body":"once today, zero times tomorrow"},{"speaker":"Macy Stonner","startTime":991.43,"endTime":995.0,"body":"and seven times next day. Great."},{"speaker":"Macy Stonner","startTime":995.06,"endTime":997.31,"body":"This is something to have in"},{"speaker":"Macy Stonner","startTime":995.06,"endTime":997.31,"body":"your back pocket to pull out"},{"speaker":"Macy Stonner","startTime":997.37,"endTime":1000.97,"body":"throughout the years. That's the"},{"speaker":"Macy Stonner","startTime":997.37,"endTime":1000.97,"body":"only thing I have them do like"},{"speaker":"Macy Stonner","startTime":1001.3,"endTime":1006.43,"body":"on a regular basis well with"},{"speaker":"Macy Stonner","startTime":1001.3,"endTime":1006.43,"body":"those parameters, but the other"},{"speaker":"Macy Stonner","startTime":1006.43,"endTime":1010.15,"body":"things, being cognizant about"},{"speaker":"Macy Stonner","startTime":1006.43,"endTime":1010.15,"body":"the thumb posture, and a lot of"},{"speaker":"Macy Stonner","startTime":1010.15,"endTime":1014.08,"body":"the drop protection techniques"},{"speaker":"Macy Stonner","startTime":1010.15,"endTime":1014.08,"body":"are the heat all day every day,"},{"speaker":"Macy Stonner","startTime":1014.08,"endTime":1017.05,"body":"they can incorporate those"},{"speaker":"Macy Stonner","startTime":1014.08,"endTime":1017.05,"body":"things into ADLs. And that type"},{"speaker":"Macy Stonner","startTime":1017.05,"endTime":1019.36,"body":"of thing. So it's, it's not the"},{"speaker":"Macy Stonner","startTime":1017.05,"endTime":1019.36,"body":"kind of therapy that you think"},{"speaker":"Macy Stonner","startTime":1019.36,"endTime":1021.46,"body":"of okay, at my Exercise folder,"},{"speaker":"Macy Stonner","startTime":1019.36,"endTime":1021.46,"body":"and I have to do these four"},{"speaker":"Macy Stonner","startTime":1021.46,"endTime":1023.77,"body":"times a day, and then I do 10"},{"speaker":"Macy Stonner","startTime":1021.46,"endTime":1023.77,"body":"minutes, and then I hold for"},{"speaker":"Macy Stonner","startTime":1023.77,"endTime":1027.79,"body":"five seconds. Like, it's not"},{"speaker":"Macy Stonner","startTime":1023.77,"endTime":1027.79,"body":"like that. It's more come to the"},{"speaker":"Macy Stonner","startTime":1027.79,"endTime":1030.34,"body":"session for an hour. Let me"},{"speaker":"Macy Stonner","startTime":1027.79,"endTime":1030.34,"body":"educate you a lot about what"},{"speaker":"Macy Stonner","startTime":1030.34,"endTime":1033.91,"body":"this looks like and how to"},{"speaker":"Macy Stonner","startTime":1030.34,"endTime":1033.91,"body":"incorporate basic strategies"},{"speaker":"Macy Stonner","startTime":1033.94,"endTime":1037.45,"body":"into everyday life, whether"},{"speaker":"Macy Stonner","startTime":1033.94,"endTime":1037.45,"body":"that's cooking, driving,"},{"speaker":"Macy Stonner","startTime":1037.66,"endTime":1042.49,"body":"brushing your teeth, etc. So"},{"speaker":"Macy Stonner","startTime":1037.66,"endTime":1042.49,"body":"it's not the sexiest treatment,"},{"speaker":"Macy Stonner","startTime":1042.52,"endTime":1046.09,"body":"I would say. And I might treat"},{"speaker":"Macy Stonner","startTime":1042.52,"endTime":1046.09,"body":"this diagnosis very differently"},{"speaker":"Macy Stonner","startTime":1046.09,"endTime":1050.05,"body":"than some of your listeners"},{"speaker":"Macy Stonner","startTime":1046.09,"endTime":1050.05,"body":"here. But I'm just here for my"},{"speaker":"Macy Stonner","startTime":1050.05,"endTime":1050.98,"body":"insight, I guess."},{"speaker":"Charles Goldfarb","startTime":1052.58,"endTime":1055.76,"body":"That is why"},{"speaker":"Charles Goldfarb","startTime":1052.58,"endTime":1055.76,"body":"you are here. Because we value"},{"speaker":"Charles Goldfarb","startTime":1055.76,"endTime":1058.61,"body":"your insight and you feel"},{"speaker":"Charles Goldfarb","startTime":1055.76,"endTime":1058.61,"body":"passionately about CMC."},{"speaker":"Macy Stonner","startTime":1058.64,"endTime":1059.3,"body":"I do."},{"speaker":"Charles Goldfarb","startTime":1060.47,"endTime":1063.05,"body":"Alright, so my"},{"speaker":"Charles Goldfarb","startTime":1060.47,"endTime":1063.05,"body":"favorite paper in the literature"},{"speaker":"Charles Goldfarb","startTime":1063.05,"endTime":1065.69,"body":"on this topic. And again, I said"},{"speaker":"Charles Goldfarb","startTime":1063.05,"endTime":1065.69,"body":"there were a couple there are,"},{"speaker":"Charles Goldfarb","startTime":1065.69,"endTime":1069.5,"body":"but most of them are like meta"},{"speaker":"Charles Goldfarb","startTime":1065.69,"endTime":1069.5,"body":"analyses looking at outcomes,"},{"speaker":"Charles Goldfarb","startTime":1069.5,"endTime":1072.29,"body":"and they really aren't that"},{"speaker":"Charles Goldfarb","startTime":1069.5,"endTime":1072.29,"body":"helpful. Just like honestly, the"},{"speaker":"Charles Goldfarb","startTime":1072.29,"endTime":1074.84,"body":"surgical papers aren't that"},{"speaker":"Charles Goldfarb","startTime":1072.29,"endTime":1074.84,"body":"helpful. Because every you know,"},{"speaker":"Charles Goldfarb","startTime":1074.84,"endTime":1077.69,"body":"in my opinion about every"},{"speaker":"Charles Goldfarb","startTime":1074.84,"endTime":1077.69,"body":"surgery does pretty much the"},{"speaker":"Charles Goldfarb","startTime":1077.69,"endTime":1082.46,"body":"same, which is good. But not"},{"speaker":"Charles Goldfarb","startTime":1077.69,"endTime":1082.46,"body":"that you know, doesn't help"},{"speaker":"Charles Goldfarb","startTime":1082.46,"endTime":1087.14,"body":"distinguish. So this is a paper"},{"speaker":"Charles Goldfarb","startTime":1082.46,"endTime":1087.14,"body":"out of Rotterdam. The first"},{"speaker":"Charles Goldfarb","startTime":1087.14,"endTime":1091.76,"body":"author's last name is Tsehaie,"},{"speaker":"Charles Goldfarb","startTime":1087.14,"endTime":1091.76,"body":"I'm not going to try to"},{"speaker":"Charles Goldfarb","startTime":1091.76,"endTime":1094.76,"body":"pronounce it. But the title of"},{"speaker":"Charles Goldfarb","startTime":1091.76,"endTime":1094.76,"body":"the paper is outcome of hand"},{"speaker":"Charles Goldfarb","startTime":1094.76,"endTime":1099.83,"body":"orthosis and hand therapy for"},{"speaker":"Charles Goldfarb","startTime":1094.76,"endTime":1099.83,"body":"CMC osteoarthritis in a daily"},{"speaker":"Charles Goldfarb","startTime":1099.83,"endTime":1103.67,"body":"practice a prospective cohort"},{"speaker":"Charles Goldfarb","startTime":1099.83,"endTime":1103.67,"body":"study. So well designed study"},{"speaker":"Charles Goldfarb","startTime":1103.67,"endTime":1107.69,"body":"Rotterdam, I visited they're"},{"speaker":"Charles Goldfarb","startTime":1103.67,"endTime":1107.69,"body":"part of part of one of my"},{"speaker":"Charles Goldfarb","startTime":1107.69,"endTime":1109.79,"body":"traveling fellowships, we've"},{"speaker":"Charles Goldfarb","startTime":1107.69,"endTime":1109.79,"body":"been back a couple of times,"},{"speaker":"Charles Goldfarb","startTime":1109.97,"endTime":1114.2,"body":"it's a really good group of"},{"speaker":"Charles Goldfarb","startTime":1109.97,"endTime":1114.2,"body":"plastic surgeons primarily, that"},{"speaker":"Charles Goldfarb","startTime":1114.2,"endTime":1118.61,"body":"really kind of get hand surgery,"},{"speaker":"Charles Goldfarb","startTime":1114.2,"endTime":1118.61,"body":"adult and pediatric. And bottom"},{"speaker":"Charles Goldfarb","startTime":1118.61,"endTime":1123.29,"body":"line just to cut to the chase is"},{"speaker":"Charles Goldfarb","startTime":1118.61,"endTime":1123.29,"body":"this had this. This study had a"},{"speaker":"Charles Goldfarb","startTime":1123.29,"endTime":1128.84,"body":"2.2 year follow up. And the"},{"speaker":"Charles Goldfarb","startTime":1123.29,"endTime":1128.84,"body":"magic number is only 15% of"},{"speaker":"Charles Goldfarb","startTime":1128.84,"endTime":1132.86,"body":"patients that were sent to"},{"speaker":"Charles Goldfarb","startTime":1128.84,"endTime":1132.86,"body":"therapy ended up having surgery"},{"speaker":"Charles Goldfarb","startTime":1132.86,"endTime":1140.09,"body":"in that timeframe. Just pretty"},{"speaker":"Charles Goldfarb","startTime":1132.86,"endTime":1140.09,"body":"remarkable. They paint and"},{"speaker":"Charles Goldfarb","startTime":1140.09,"endTime":1144.53,"body":"proved primarily early on the"},{"speaker":"Charles Goldfarb","startTime":1140.09,"endTime":1144.53,"body":"MHQ Score, Michigan hand"},{"speaker":"Charles Goldfarb","startTime":1144.53,"endTime":1148.7,"body":"questionnaire was basically flat"},{"speaker":"Charles Goldfarb","startTime":1144.53,"endTime":1148.7,"body":"over the period of the study."},{"speaker":"Charles Goldfarb","startTime":1149.06,"endTime":1152.96,"body":"And I think it has to do a lot"},{"speaker":"Charles Goldfarb","startTime":1149.06,"endTime":1152.96,"body":"of what we just heard from Macy"},{"speaker":"Charles Goldfarb","startTime":1152.96,"endTime":1156.05,"body":"it's about teaching patients"},{"speaker":"Charles Goldfarb","startTime":1152.96,"endTime":1156.05,"body":"what they can do, how they can"},{"speaker":"Charles Goldfarb","startTime":1156.05,"endTime":1160.07,"body":"manage their pain. And, you"},{"speaker":"Charles Goldfarb","startTime":1156.05,"endTime":1160.07,"body":"know, I think the lesson for me"},{"speaker":"Charles Goldfarb","startTime":1160.31,"endTime":1163.37,"body":"is just don't be so quick to run"},{"speaker":"Charles Goldfarb","startTime":1160.31,"endTime":1163.37,"body":"to the operating room. You know,"},{"speaker":"Charles Goldfarb","startTime":1163.37,"endTime":1166.79,"body":"I'm a surgeon, I love surgery, I"},{"speaker":"Charles Goldfarb","startTime":1163.37,"endTime":1166.79,"body":"think it can be very helpful."},{"speaker":"Charles Goldfarb","startTime":1166.88,"endTime":1171.08,"body":"But you know, many patients will"},{"speaker":"Charles Goldfarb","startTime":1166.88,"endTime":1171.08,"body":"like the concept of trying to"},{"speaker":"Charles Goldfarb","startTime":1171.08,"endTime":1174.26,"body":"avoid surgery trying to avoid"},{"speaker":"Charles Goldfarb","startTime":1171.08,"endTime":1174.26,"body":"injections. And I do recommend"},{"speaker":"Charles Goldfarb","startTime":1174.26,"endTime":1177.44,"body":"this 2018 study for those of you"},{"speaker":"Charles Goldfarb","startTime":1174.26,"endTime":1177.44,"body":"who are interested and I'll put"},{"speaker":"Charles Goldfarb","startTime":1177.44,"endTime":1178.64,"body":"it in the show notes as well."},{"speaker":"Macy Stonner","startTime":1181.04,"endTime":1184.52,"body":"Thank you for"},{"speaker":"Macy Stonner","startTime":1181.04,"endTime":1184.52,"body":"educating us on that paper. And"},{"speaker":"Macy Stonner","startTime":1184.58,"endTime":1187.52,"body":"I don't want to get into this"},{"speaker":"Macy Stonner","startTime":1184.58,"endTime":1187.52,"body":"but I'd be curious to know if"},{"speaker":"Macy Stonner","startTime":1187.52,"endTime":1190.76,"body":"they how they operationally"},{"speaker":"Macy Stonner","startTime":1187.52,"endTime":1190.76,"body":"defined therapy like was does it"},{"speaker":"Macy Stonner","startTime":1190.76,"endTime":1193.97,"body":"just go to therapy? Yes or no or"},{"speaker":"Macy Stonner","startTime":1190.76,"endTime":1193.97,"body":"what was done in therapy? I'm"},{"speaker":"Macy Stonner","startTime":1193.97,"endTime":1196.13,"body":"not really sure if you know that"},{"speaker":"Macy Stonner","startTime":1193.97,"endTime":1196.13,"body":"but it's something that I would"},{"speaker":"Macy Stonner","startTime":1196.13,"endTime":1197.45,"body":"be interested in looking at the"},{"speaker":"Macy Stonner","startTime":1196.13,"endTime":1197.45,"body":"future."},{"speaker":"Charles Goldfarb","startTime":1198.38,"endTime":1202.34,"body":"Yeah, so"},{"speaker":"Charles Goldfarb","startTime":1198.38,"endTime":1202.34,"body":"basically They all got general"},{"speaker":"Charles Goldfarb","startTime":1202.37,"endTime":1207.11,"body":"custom made or prefab orthosis."},{"speaker":"Charles Goldfarb","startTime":1202.37,"endTime":1207.11,"body":"They had two sessions of hand"},{"speaker":"Charles Goldfarb","startTime":1207.11,"endTime":1210.56,"body":"therapy per week, which is what"},{"speaker":"Charles Goldfarb","startTime":1207.11,"endTime":1210.56,"body":"you said you didn't like to do"},{"speaker":"Charles Goldfarb","startTime":1210.71,"endTime":1211.04,"body":"for an-"},{"speaker":"Macy Stonner","startTime":1211.58,"endTime":1212.69,"body":"It depends on"},{"speaker":"Macy Stonner","startTime":1211.58,"endTime":1212.69,"body":"what's done."},{"speaker":"Charles Goldfarb","startTime":1212.69,"endTime":1219.47,"body":"For an average"},{"speaker":"Charles Goldfarb","startTime":1212.69,"endTime":1219.47,"body":"of 25 minutes. And basically,"},{"speaker":"Charles Goldfarb","startTime":1219.65,"endTime":1222.62,"body":"the therapists controlled what"},{"speaker":"Charles Goldfarb","startTime":1219.65,"endTime":1222.62,"body":"was done. And when it was done."},{"speaker":"Charles Goldfarb","startTime":1223.37,"endTime":1227.15,"body":"Some patients only got the"},{"speaker":"Charles Goldfarb","startTime":1223.37,"endTime":1227.15,"body":"orthosis. Some patients, you"},{"speaker":"Charles Goldfarb","startTime":1227.15,"endTime":1230.24,"body":"know, went over a course of"},{"speaker":"Charles Goldfarb","startTime":1227.15,"endTime":1230.24,"body":"multiple weeks. And so it was"},{"speaker":"Charles Goldfarb","startTime":1230.27,"endTime":1233.12,"body":"there was a sounds like a fair"},{"speaker":"Charles Goldfarb","startTime":1230.27,"endTime":1233.12,"body":"amount of variability and what"},{"speaker":"Charles Goldfarb","startTime":1233.12,"endTime":1238.34,"body":"exactly they did. But that"},{"speaker":"Charles Goldfarb","startTime":1233.12,"endTime":1238.34,"body":"number is remarkable. It's"},{"speaker":"Charles Goldfarb","startTime":1238.34,"endTime":1241.34,"body":"remarkable that only 15%"},{"speaker":"Charles Goldfarb","startTime":1238.34,"endTime":1241.34,"body":"converted to surgery after"},{"speaker":"Charles Goldfarb","startTime":1241.34,"endTime":1245.84,"body":"seeing a surgeon for CMC"},{"speaker":"Charles Goldfarb","startTime":1241.34,"endTime":1245.84,"body":"arthritis. And two years later,"},{"speaker":"Charles Goldfarb","startTime":1245.87,"endTime":1248.81,"body":"only 15% answered. It's great."},{"speaker":"Charles Goldfarb","startTime":1245.87,"endTime":1248.81,"body":"It's fantastic."},{"speaker":"Chris Dy","startTime":1249.08,"endTime":1251.21,"body":"What do you think your"},{"speaker":"Chris Dy","startTime":1249.08,"endTime":1251.21,"body":"number is? What percentage do"},{"speaker":"Chris Dy","startTime":1251.21,"endTime":1254.24,"body":"you think your patients that you"},{"speaker":"Chris Dy","startTime":1251.21,"endTime":1254.24,"body":"see, since the therapy then"},{"speaker":"Chris Dy","startTime":1254.24,"endTime":1255.2,"body":"cross over to surgery?"},{"speaker":"Charles Goldfarb","startTime":1257.21,"endTime":1259.43,"body":"You know, if I"},{"speaker":"Charles Goldfarb","startTime":1257.21,"endTime":1259.43,"body":"don't know the answer to that"},{"speaker":"Charles Goldfarb","startTime":1259.43,"endTime":1263.06,"body":"question, I, the ones I know are"},{"speaker":"Charles Goldfarb","startTime":1259.43,"endTime":1263.06,"body":"the ones that come back for"},{"speaker":"Charles Goldfarb","startTime":1263.06,"endTime":1267.05,"body":"injections until they fail. And"},{"speaker":"Charles Goldfarb","startTime":1263.06,"endTime":1267.05,"body":"my pattern, I assume is like"},{"speaker":"Charles Goldfarb","startTime":1267.05,"endTime":1269.99,"body":"everybody else's the first"},{"speaker":"Charles Goldfarb","startTime":1267.05,"endTime":1269.99,"body":"injection, and especially in a"},{"speaker":"Charles Goldfarb","startTime":1269.99,"endTime":1273.02,"body":"patient who doesn't have"},{"speaker":"Charles Goldfarb","startTime":1269.99,"endTime":1273.02,"body":"terrible arthritis is good, you"},{"speaker":"Charles Goldfarb","startTime":1273.02,"endTime":1275.45,"body":"know, maybe nine months or a"},{"speaker":"Charles Goldfarb","startTime":1273.02,"endTime":1275.45,"body":"year, and then it slowly"},{"speaker":"Charles Goldfarb","startTime":1275.45,"endTime":1277.97,"body":"declines. And when patients are"},{"speaker":"Charles Goldfarb","startTime":1275.45,"endTime":1277.97,"body":"seeing me every three months for"},{"speaker":"Charles Goldfarb","startTime":1277.97,"endTime":1280.52,"body":"an injection, they get tired of"},{"speaker":"Charles Goldfarb","startTime":1277.97,"endTime":1280.52,"body":"it and they scheduled surgery."},{"speaker":"Charles Goldfarb","startTime":1280.61,"endTime":1281.96,"body":"Is that your experience?"},{"speaker":"Chris Dy","startTime":1282.53,"endTime":1284.9,"body":"Yeah. But I mean, I"},{"speaker":"Chris Dy","startTime":1282.53,"endTime":1284.9,"body":"feel like the 50% feels about"},{"speaker":"Chris Dy","startTime":1284.9,"endTime":1287.75,"body":"right to me. Yeah, but our"},{"speaker":"Chris Dy","startTime":1284.9,"endTime":1287.75,"body":"practices are at very different"},{"speaker":"Chris Dy","startTime":1287.75,"endTime":1291.08,"body":"points in maturation. You know,"},{"speaker":"Chris Dy","startTime":1287.75,"endTime":1291.08,"body":"so I think, you know, I remember"},{"speaker":"Chris Dy","startTime":1291.08,"endTime":1293.78,"body":"and I've said this on the pod"},{"speaker":"Chris Dy","startTime":1291.08,"endTime":1293.78,"body":"before, I mean, my first year,"},{"speaker":"Chris Dy","startTime":1294.23,"endTime":1296.6,"body":"when I was in board collection,"},{"speaker":"Chris Dy","startTime":1294.23,"endTime":1296.6,"body":"I didn't do any thumb CMC"},{"speaker":"Chris Dy","startTime":1296.6,"endTime":1299.78,"body":"surgeries, because my practice"},{"speaker":"Chris Dy","startTime":1296.6,"endTime":1299.78,"body":"was just starting. And it's not"},{"speaker":"Chris Dy","startTime":1299.78,"endTime":1303.08,"body":"what I jumped to right away. But"},{"speaker":"Chris Dy","startTime":1299.78,"endTime":1303.08,"body":"it took a while to even get a"},{"speaker":"Chris Dy","startTime":1303.08,"endTime":1305.12,"body":"reasonable clip. And I was"},{"speaker":"Chris Dy","startTime":1303.08,"endTime":1305.12,"body":"certainly not one of the highest"},{"speaker":"Chris Dy","startTime":1305.12,"endTime":1308.66,"body":"rollers in your study, mainly"},{"speaker":"Chris Dy","startTime":1305.12,"endTime":1308.66,"body":"because I didn't do a lot of it"},{"speaker":"Chris Dy","startTime":1308.66,"endTime":1313.31,"body":"and still don't do a ton. And"},{"speaker":"Chris Dy","startTime":1308.66,"endTime":1313.31,"body":"maybe that's just the nature of"},{"speaker":"Chris Dy","startTime":1313.31,"endTime":1315.86,"body":"the practice I have, because I"},{"speaker":"Chris Dy","startTime":1313.31,"endTime":1315.86,"body":"see so much nerve and other"},{"speaker":"Chris Dy","startTime":1315.86,"endTime":1318.65,"body":"stuff, too. But I'd like to"},{"speaker":"Chris Dy","startTime":1315.86,"endTime":1318.65,"body":"think I have a pretty robust"},{"speaker":"Chris Dy","startTime":1318.65,"endTime":1321.29,"body":"general answer to your practice."},{"speaker":"Chris Dy","startTime":1318.65,"endTime":1321.29,"body":"And I think 15% feels about"},{"speaker":"Chris Dy","startTime":1321.29,"endTime":1323.69,"body":"right in terms of conversion,"},{"speaker":"Chris Dy","startTime":1321.29,"endTime":1323.69,"body":"maybe it's even a little higher"},{"speaker":"Chris Dy","startTime":1323.69,"endTime":1327.17,"body":"than what I see. Again, me I'm"},{"speaker":"Chris Dy","startTime":1323.69,"endTime":1327.17,"body":"not as passionate about this in"},{"speaker":"Chris Dy","startTime":1327.17,"endTime":1330.32,"body":"terms of like jumping to the"},{"speaker":"Chris Dy","startTime":1327.17,"endTime":1330.32,"body":"bar. But I'd like to think I"},{"speaker":"Chris Dy","startTime":1330.32,"endTime":1331.4,"body":"have reasonable indications."},{"speaker":"Macy Stonner","startTime":1332.47,"endTime":1334.36,"body":"So I've worked"},{"speaker":"Macy Stonner","startTime":1332.47,"endTime":1334.36,"body":"with both of you in your clinics"},{"speaker":"Macy Stonner","startTime":1334.36,"endTime":1338.2,"body":"and Dr. Goldfarb, I know No,"},{"speaker":"Macy Stonner","startTime":1334.36,"endTime":1338.2,"body":"well, either you there's a"},{"speaker":"Macy Stonner","startTime":1338.2,"endTime":1340.18,"body":"patient coming in for like"},{"speaker":"Macy Stonner","startTime":1338.2,"endTime":1340.18,"body":"routine injections, obviously,"},{"speaker":"Macy Stonner","startTime":1340.18,"endTime":1342.64,"body":"like they've probably been done"},{"speaker":"Macy Stonner","startTime":1340.18,"endTime":1342.64,"body":"therapy route before, that's not"},{"speaker":"Macy Stonner","startTime":1342.64,"endTime":1344.26,"body":"going to be somebody that I know"},{"speaker":"Macy Stonner","startTime":1342.64,"endTime":1344.26,"body":"that I need to go write a"},{"speaker":"Macy Stonner","startTime":1344.26,"endTime":1347.32,"body":"referral for. But do you feel"},{"speaker":"Macy Stonner","startTime":1344.26,"endTime":1347.32,"body":"like somebody coming in as a new"},{"speaker":"Macy Stonner","startTime":1347.32,"endTime":1350.26,"body":"patient never been to therapy,"},{"speaker":"Macy Stonner","startTime":1347.32,"endTime":1350.26,"body":"kind of that same case you"},{"speaker":"Macy Stonner","startTime":1350.26,"endTime":1353.74,"body":"described in the beginning of"},{"speaker":"Macy Stonner","startTime":1350.26,"endTime":1353.74,"body":"this podcast with both of you?"},{"speaker":"Macy Stonner","startTime":1354.1,"endTime":1357.55,"body":"100% And that person therapy?"},{"speaker":"Macy Stonner","startTime":1354.1,"endTime":1357.55,"body":"Maybe like depends on what your"},{"speaker":"Macy Stonner","startTime":1357.55,"endTime":1359.83,"body":"mood is that day? Depends if you"},{"speaker":"Macy Stonner","startTime":1357.55,"endTime":1359.83,"body":"have a therapist in the clinic,"},{"speaker":"Macy Stonner","startTime":1359.83,"endTime":1361.75,"body":"I'm just curious to know like,"},{"speaker":"Macy Stonner","startTime":1359.83,"endTime":1361.75,"body":"Are you always gonna send that"},{"speaker":"Macy Stonner","startTime":1361.75,"endTime":1362.32,"body":"person?"},{"speaker":"Charles Goldfarb","startTime":1363.28,"endTime":1366.55,"body":"100% of time I"},{"speaker":"Charles Goldfarb","startTime":1363.28,"endTime":1366.55,"body":"offer and push gently towards"},{"speaker":"Charles Goldfarb","startTime":1366.55,"endTime":1370.72,"body":"therapy. I mentioned the other"},{"speaker":"Charles Goldfarb","startTime":1366.55,"endTime":1370.72,"body":"treatment options, which may be"},{"speaker":"Charles Goldfarb","startTime":1370.72,"endTime":1373.33,"body":"a mistake, because sometimes"},{"speaker":"Charles Goldfarb","startTime":1370.72,"endTime":1373.33,"body":"they'll be interested in"},{"speaker":"Charles Goldfarb","startTime":1373.33,"endTime":1375.28,"body":"injection at the same visit with"},{"speaker":"Charles Goldfarb","startTime":1373.33,"endTime":1375.28,"body":"me."},{"speaker":"Macy Stonner","startTime":1375.28,"endTime":1375.61,"body":"Yeah."},{"speaker":"Charles Goldfarb","startTime":1375.88,"endTime":1378.61,"body":"I always"},{"speaker":"Charles Goldfarb","startTime":1375.88,"endTime":1378.61,"body":"suggest therapy."},{"speaker":"Chris Dy","startTime":1380.29,"endTime":1382.09,"body":"I try not to put"},{"speaker":"Chris Dy","startTime":1380.29,"endTime":1382.09,"body":"needles in people the first time"},{"speaker":"Chris Dy","startTime":1382.09,"endTime":1384.64,"body":"I meet them if I can avoid it,"},{"speaker":"Chris Dy","startTime":1382.09,"endTime":1384.64,"body":"because our needles tend to"},{"speaker":"Chris Dy","startTime":1384.64,"endTime":1388.36,"body":"hurt. But I will mention it like"},{"speaker":"Chris Dy","startTime":1384.64,"endTime":1388.36,"body":"Chuck and sometimes you know,"},{"speaker":"Chris Dy","startTime":1388.36,"endTime":1392.41,"body":"they take you up on it. If I"},{"speaker":"Chris Dy","startTime":1388.36,"endTime":1392.41,"body":"have a head therapist and clinic"},{"speaker":"Chris Dy","startTime":1392.41,"endTime":1396.76,"body":"with me and usually in that"},{"speaker":"Chris Dy","startTime":1392.41,"endTime":1396.76,"body":"clinic I do. I will say I want"},{"speaker":"Chris Dy","startTime":1396.76,"endTime":1399.91,"body":"you to talk to so and so either"},{"speaker":"Chris Dy","startTime":1396.76,"endTime":1399.91,"body":"usually in the south county"},{"speaker":"Chris Dy","startTime":1399.91,"endTime":1402.34,"body":"clinic, it's Kathy or Jamie,"},{"speaker":"Chris Dy","startTime":1399.91,"endTime":1402.34,"body":"they talk to Kathy or Jamie."},{"speaker":"Chris Dy","startTime":1403.09,"endTime":1405.7,"body":"They'll determine whether how"},{"speaker":"Chris Dy","startTime":1403.09,"endTime":1405.7,"body":"frequently you might need to"},{"speaker":"Chris Dy","startTime":1405.7,"endTime":1409.03,"body":"come for some therapy. And or if"},{"speaker":"Chris Dy","startTime":1405.7,"endTime":1409.03,"body":"you're in clinic with me down"},{"speaker":"Chris Dy","startTime":1409.03,"endTime":1413.35,"body":"the main campus, talk to me see,"},{"speaker":"Chris Dy","startTime":1409.03,"endTime":1413.35,"body":"let's see what she thinks. And"},{"speaker":"Chris Dy","startTime":1413.35,"endTime":1415.72,"body":"we're very fortunate to have"},{"speaker":"Chris Dy","startTime":1413.35,"endTime":1415.72,"body":"that environment where we can do"},{"speaker":"Chris Dy","startTime":1415.72,"endTime":1418.9,"body":"that. And it's not automatically"},{"speaker":"Chris Dy","startTime":1415.72,"endTime":1418.9,"body":"a prescription and like you said"},{"speaker":"Chris Dy","startTime":1418.9,"endTime":1422.2,"body":"for some of our patients, you"},{"speaker":"Chris Dy","startTime":1418.9,"endTime":1422.2,"body":"know, transportation resources"},{"speaker":"Chris Dy","startTime":1422.2,"endTime":1425.29,"body":"are a challenge. And you know,"},{"speaker":"Chris Dy","startTime":1422.2,"endTime":1425.29,"body":"insurance stuff is a reality and"},{"speaker":"Chris Dy","startTime":1425.29,"endTime":1426.22,"body":"that can be very tough."},{"speaker":"Charles Goldfarb","startTime":1427.72,"endTime":1430.0,"body":"Let's, let's"},{"speaker":"Charles Goldfarb","startTime":1427.72,"endTime":1430.0,"body":"pivot for the last few minutes"},{"speaker":"Charles Goldfarb","startTime":1430.03,"endTime":1433.45,"body":"if that's okay, and let's just"},{"speaker":"Charles Goldfarb","startTime":1430.03,"endTime":1433.45,"body":"talk about postoperatively."},{"speaker":"Charles Goldfarb","startTime":1434.11,"endTime":1438.73,"body":"First of all, may see what is"},{"speaker":"Charles Goldfarb","startTime":1434.11,"endTime":1438.73,"body":"your favorite surgery favorite"},{"speaker":"Charles Goldfarb","startTime":1438.73,"endTime":1443.77,"body":"CMC surgery to help a patient"},{"speaker":"Charles Goldfarb","startTime":1438.73,"endTime":1443.77,"body":"with postoperatively Do you have"},{"speaker":"Charles Goldfarb","startTime":1443.77,"endTime":1447.85,"body":"a preference? Is it is it the"},{"speaker":"Charles Goldfarb","startTime":1443.77,"endTime":1447.85,"body":"standard LRTI? Is it the intro"},{"speaker":"Charles Goldfarb","startTime":1447.85,"endTime":1452.14,"body":"brace? Is it another procedure?"},{"speaker":"Charles Goldfarb","startTime":1447.85,"endTime":1452.14,"body":"Do you have a favorite or do you"},{"speaker":"Charles Goldfarb","startTime":1452.14,"endTime":1453.97,"body":"feel like they all recover about"},{"speaker":"Charles Goldfarb","startTime":1452.14,"endTime":1453.97,"body":"the same?"},{"speaker":"Macy Stonner","startTime":1456.52,"endTime":1458.68,"body":"It just goes back"},{"speaker":"Macy Stonner","startTime":1456.52,"endTime":1458.68,"body":"to my gender point. I think it's"},{"speaker":"Macy Stonner","startTime":1458.68,"endTime":1463.78,"body":"a guy. I like the intro brace"},{"speaker":"Macy Stonner","startTime":1458.68,"endTime":1463.78,"body":"reconstruction. I feel like they"},{"speaker":"Macy Stonner","startTime":1463.78,"endTime":1466.9,"body":"come out of that postop dressing"},{"speaker":"Macy Stonner","startTime":1463.78,"endTime":1466.9,"body":"just rock solid. They got a"},{"speaker":"Macy Stonner","startTime":1466.9,"endTime":1469.06,"body":"really good posture their thumb"},{"speaker":"Macy Stonner","startTime":1466.9,"endTime":1469.06,"body":"I just look at their thumb and"},{"speaker":"Macy Stonner","startTime":1469.06,"endTime":1473.02,"body":"like, that's a good outcome. The"},{"speaker":"Macy Stonner","startTime":1469.06,"endTime":1473.02,"body":"CMC joint is nicely positioned"},{"speaker":"Macy Stonner","startTime":1473.02,"endTime":1476.59,"body":"their MP joints flexed they just"},{"speaker":"Macy Stonner","startTime":1473.02,"endTime":1476.59,"body":"look good. And they typically"},{"speaker":"Macy Stonner","startTime":1476.59,"endTime":1478.96,"body":"don't need a ton of therapy for"},{"speaker":"Macy Stonner","startTime":1476.59,"endTime":1478.96,"body":"me because they're pain free."},{"speaker":"Macy Stonner","startTime":1478.96,"endTime":1483.85,"body":"Their range is good. They can"},{"speaker":"Macy Stonner","startTime":1478.96,"endTime":1483.85,"body":"start strengthening early. They"},{"speaker":"Macy Stonner","startTime":1483.85,"endTime":1488.65,"body":"do great and again anecdotally"},{"speaker":"Macy Stonner","startTime":1483.85,"endTime":1488.65,"body":"speaking for a woman a kind of"},{"speaker":"Macy Stonner","startTime":1488.65,"endTime":1492.97,"body":"feel like an lrti Because you're"},{"speaker":"Macy Stonner","startTime":1488.65,"endTime":1492.97,"body":"casted depends on the provider"},{"speaker":"Macy Stonner","startTime":1492.97,"endTime":1496.18,"body":"but typically for maybe six"},{"speaker":"Macy Stonner","startTime":1492.97,"endTime":1496.18,"body":"weeks and so they just have a"},{"speaker":"Macy Stonner","startTime":1496.18,"endTime":1498.67,"body":"little bit more opportunity to"},{"speaker":"Macy Stonner","startTime":1496.18,"endTime":1498.67,"body":"stiffen up and they don't come"},{"speaker":"Macy Stonner","startTime":1498.67,"endTime":1500.62,"body":"out of that post operative"},{"speaker":"Macy Stonner","startTime":1498.67,"endTime":1500.62,"body":"dressing. Just kinda like"},{"speaker":"Macy Stonner","startTime":1500.68,"endTime":1504.46,"body":"unstable and weak and scared."},{"speaker":"Macy Stonner","startTime":1500.68,"endTime":1504.46,"body":"They're just like rock solid and"},{"speaker":"Macy Stonner","startTime":1504.46,"endTime":1508.81,"body":"that nice thumb position. Again,"},{"speaker":"Macy Stonner","startTime":1504.46,"endTime":1508.81,"body":"the LRTI obviously, you have a"},{"speaker":"Macy Stonner","startTime":1508.81,"endTime":1511.03,"body":"little bit more rehab to do"},{"speaker":"Macy Stonner","startTime":1508.81,"endTime":1511.03,"body":"regarding the wrist, their"},{"speaker":"Macy Stonner","startTime":1511.03,"endTime":1514.57,"body":"wrist, it's a little bit more"},{"speaker":"Macy Stonner","startTime":1511.03,"endTime":1514.57,"body":"stiff and painful. But I think"},{"speaker":"Macy Stonner","startTime":1514.57,"endTime":1517.06,"body":"they're both very reliable. And"},{"speaker":"Macy Stonner","startTime":1514.57,"endTime":1517.06,"body":"it depends on the patient."},{"speaker":"Macy Stonner","startTime":1517.33,"endTime":1522.01,"body":"Obviously, if it's a revision"},{"speaker":"Macy Stonner","startTime":1517.33,"endTime":1522.01,"body":"surgery, I think that my mantra"},{"speaker":"Macy Stonner","startTime":1522.01,"endTime":1528.04,"body":"for this is less is more, I see"},{"speaker":"Macy Stonner","startTime":1522.01,"endTime":1528.04,"body":"so much more recurrence of pain"},{"speaker":"Macy Stonner","startTime":1528.04,"endTime":1533.89,"body":"or recurrence of a collapsed"},{"speaker":"Macy Stonner","startTime":1528.04,"endTime":1533.89,"body":"posture, rather than stiffness."},{"speaker":"Macy Stonner","startTime":1534.16,"endTime":1537.37,"body":"So if I had the opportunity to"},{"speaker":"Macy Stonner","startTime":1534.16,"endTime":1537.37,"body":"have a say, and how long they"},{"speaker":"Macy Stonner","startTime":1537.37,"endTime":1539.29,"body":"were mobilized, I'm always going"},{"speaker":"Macy Stonner","startTime":1537.37,"endTime":1539.29,"body":"to be a little bit more"},{"speaker":"Macy Stonner","startTime":1539.29,"endTime":1544.39,"body":"conservative and have it longer."},{"speaker":"Macy Stonner","startTime":1539.29,"endTime":1544.39,"body":"Because you can't go back, you"},{"speaker":"Macy Stonner","startTime":1544.39,"endTime":1548.26,"body":"can always work on motion and"},{"speaker":"Macy Stonner","startTime":1544.39,"endTime":1548.26,"body":"stiffness, but can't tighten up"},{"speaker":"Macy Stonner","startTime":1548.26,"endTime":1551.5,"body":"that joint even more if I just"},{"speaker":"Macy Stonner","startTime":1548.26,"endTime":1551.5,"body":"hate to see somebody start"},{"speaker":"Macy Stonner","startTime":1551.5,"endTime":1552.49,"body":"moving too early."},{"speaker":"Charles Goldfarb","startTime":1553.99,"endTime":1555.46,"body":"It's an"},{"speaker":"Charles Goldfarb","startTime":1553.99,"endTime":1555.46,"body":"interesting point, because there"},{"speaker":"Charles Goldfarb","startTime":1555.46,"endTime":1559.21,"body":"is no doubt that trend is"},{"speaker":"Charles Goldfarb","startTime":1555.46,"endTime":1559.21,"body":"earlier mobilization, even for"},{"speaker":"Charles Goldfarb","startTime":1559.21,"endTime":1563.71,"body":"LRTI. And the study out of Salt"},{"speaker":"Charles Goldfarb","startTime":1559.21,"endTime":1563.71,"body":"Lake City, by Hutch and others"},{"speaker":"Charles Goldfarb","startTime":1563.71,"endTime":1566.41,"body":"really describe that and eight"},{"speaker":"Charles Goldfarb","startTime":1563.71,"endTime":1566.41,"body":"compared, you know, two weeks"},{"speaker":"Charles Goldfarb","startTime":1566.41,"endTime":1569.86,"body":"versus four weeks and get the"},{"speaker":"Charles Goldfarb","startTime":1566.41,"endTime":1569.86,"body":"same results. But I am with you."},{"speaker":"Charles Goldfarb","startTime":1569.86,"endTime":1573.4,"body":"I mean, I don't find any harm"},{"speaker":"Charles Goldfarb","startTime":1569.86,"endTime":1573.4,"body":"and immobilize no longer with a"},{"speaker":"Charles Goldfarb","startTime":1573.4,"endTime":1574.93,"body":"soft tissue reconstruction."},{"speaker":"Macy Stonner","startTime":1575.38,"endTime":1577.87,"body":"Exactly what's the"},{"speaker":"Macy Stonner","startTime":1575.38,"endTime":1577.87,"body":"harm in it, I it's just very"},{"speaker":"Macy Stonner","startTime":1577.87,"endTime":1582.1,"body":"rare that I would see somebody"},{"speaker":"Macy Stonner","startTime":1577.87,"endTime":1582.1,"body":"that gets too stiff. And"},{"speaker":"Macy Stonner","startTime":1582.1,"endTime":1584.05,"body":"sometimes there are those cases"},{"speaker":"Macy Stonner","startTime":1582.1,"endTime":1584.05,"body":"where you can tell they might"},{"speaker":"Macy Stonner","startTime":1584.05,"endTime":1588.64,"body":"have a little bit of a CRPS vibe"},{"speaker":"Macy Stonner","startTime":1584.05,"endTime":1588.64,"body":"or a lot of anxiety about a cast"},{"speaker":"Macy Stonner","startTime":1588.64,"endTime":1592.33,"body":"or you know that they're super"},{"speaker":"Macy Stonner","startTime":1588.64,"endTime":1592.33,"body":"swollen, their their fingers are"},{"speaker":"Macy Stonner","startTime":1592.33,"endTime":1595.99,"body":"stiff, likely a good idea to get"},{"speaker":"Macy Stonner","startTime":1592.33,"endTime":1595.99,"body":"them started a little early,"},{"speaker":"Macy Stonner","startTime":1596.26,"endTime":1598.45,"body":"take them out of the cast, put"},{"speaker":"Macy Stonner","startTime":1596.26,"endTime":1598.45,"body":"them in a custom brace that they"},{"speaker":"Macy Stonner","startTime":1598.45,"endTime":1602.41,"body":"can take off to breathe. But"},{"speaker":"Macy Stonner","startTime":1598.45,"endTime":1602.41,"body":"obviously, it's a very case by"},{"speaker":"Macy Stonner","startTime":1602.41,"endTime":1603.37,"body":"case basis."},{"speaker":"Charles Goldfarb","startTime":1604.72,"endTime":1609.04,"body":"What do you"},{"speaker":"Charles Goldfarb","startTime":1604.72,"endTime":1609.04,"body":"when you educate LRTI patients?"},{"speaker":"Charles Goldfarb","startTime":1609.16,"endTime":1611.92,"body":"How long do you believe? And it"},{"speaker":"Charles Goldfarb","startTime":1609.16,"endTime":1611.92,"body":"may not be a fair question,"},{"speaker":"Charles Goldfarb","startTime":1611.92,"endTime":1614.32,"body":"because I don't know if you see"},{"speaker":"Charles Goldfarb","startTime":1611.92,"endTime":1614.32,"body":"them long enough. But how long"},{"speaker":"Charles Goldfarb","startTime":1614.32,"endTime":1617.41,"body":"do you tell them, it's going to"},{"speaker":"Charles Goldfarb","startTime":1614.32,"endTime":1617.41,"body":"take them to get over the"},{"speaker":"Charles Goldfarb","startTime":1617.41,"endTime":1620.38,"body":"surgery and get back to you"},{"speaker":"Charles Goldfarb","startTime":1617.41,"endTime":1620.38,"body":"know, back to a situation where"},{"speaker":"Charles Goldfarb","startTime":1620.38,"endTime":1622.96,"body":"they're not thinking about their"},{"speaker":"Charles Goldfarb","startTime":1620.38,"endTime":1622.96,"body":"thumb. So really get over it."},{"speaker":"Macy Stonner","startTime":1623.83,"endTime":1628.03,"body":"Eight to 10 weeks,"},{"speaker":"Macy Stonner","startTime":1623.83,"endTime":1628.03,"body":"I would say typically"},{"speaker":"Macy Stonner","startTime":1628.03,"endTime":1632.41,"body":"strengthening isn't initiated"},{"speaker":"Macy Stonner","startTime":1628.03,"endTime":1632.41,"body":"until 10 to 12. Again, depends"},{"speaker":"Macy Stonner","startTime":1632.41,"endTime":1635.59,"body":"on the provider depends on how"},{"speaker":"Macy Stonner","startTime":1632.41,"endTime":1635.59,"body":"the patient's doing. But if you"},{"speaker":"Macy Stonner","startTime":1635.59,"endTime":1637.84,"body":"need a ballpark, I would say 10"},{"speaker":"Macy Stonner","startTime":1635.59,"endTime":1637.84,"body":"to 12. Let me know if you"},{"speaker":"Macy Stonner","startTime":1637.84,"endTime":1641.95,"body":"disagree. But to get over it to"},{"speaker":"Macy Stonner","startTime":1637.84,"endTime":1641.95,"body":"where you're really just kind of"},{"speaker":"Macy Stonner","startTime":1641.95,"endTime":1645.7,"body":"living your life not thinking"},{"speaker":"Macy Stonner","startTime":1641.95,"endTime":1645.7,"body":"too much about it. I feel like"},{"speaker":"Macy Stonner","startTime":1645.7,"endTime":1648.97,"body":"probably eight to six weeks they"},{"speaker":"Macy Stonner","startTime":1645.7,"endTime":1648.97,"body":"meet you. They're freaked out,"},{"speaker":"Macy Stonner","startTime":1649.06,"endTime":1652.06,"body":"you make him a brace, teach them"},{"speaker":"Macy Stonner","startTime":1649.06,"endTime":1652.06,"body":"how to move to them, or I would"},{"speaker":"Macy Stonner","startTime":1652.06,"endTime":1655.45,"body":"say twice a week, by the eight"},{"speaker":"Macy Stonner","startTime":1652.06,"endTime":1655.45,"body":"week point met them probably six"},{"speaker":"Macy Stonner","startTime":1655.45,"endTime":1657.55,"body":"times, and they're getting a"},{"speaker":"Macy Stonner","startTime":1655.45,"endTime":1657.55,"body":"little bit more confident."},{"speaker":"Macy Stonner","startTime":1657.61,"endTime":1659.32,"body":"They're not thinking about as"},{"speaker":"Macy Stonner","startTime":1657.61,"endTime":1659.32,"body":"much they probably have full"},{"speaker":"Macy Stonner","startTime":1659.32,"endTime":1662.26,"body":"motion, maybe starting to do"},{"speaker":"Macy Stonner","startTime":1659.32,"endTime":1662.26,"body":"some live activities without the"},{"speaker":"Macy Stonner","startTime":1662.26,"endTime":1664.36,"body":"brace on life just a little bit"},{"speaker":"Macy Stonner","startTime":1662.26,"endTime":1664.36,"body":"better for them."},{"speaker":"Charles Goldfarb","startTime":1665.38,"endTime":1667.87,"body":"Chris, what do"},{"speaker":"Charles Goldfarb","startTime":1665.38,"endTime":1667.87,"body":"you tell them for LRTI till they"},{"speaker":"Charles Goldfarb","startTime":1667.87,"endTime":1669.34,"body":"stop thinking about it daily?"},{"speaker":"Chris Dy","startTime":1670.02,"endTime":1674.19,"body":"Six months. You know,"},{"speaker":"Chris Dy","startTime":1670.02,"endTime":1674.19,"body":"I used to tell them three"},{"speaker":"Chris Dy","startTime":1674.19,"endTime":1680.58,"body":"months. And then we had Jeff"},{"speaker":"Chris Dy","startTime":1674.19,"endTime":1680.58,"body":"Stepan one of our former fellows"},{"speaker":"Chris Dy","startTime":1680.58,"endTime":1683.58,"body":"and now superstar faculty at the"},{"speaker":"Chris Dy","startTime":1680.58,"endTime":1683.58,"body":"University of Chicago, he did a"},{"speaker":"Chris Dy","startTime":1683.58,"endTime":1686.67,"body":"qualitative project,"},{"speaker":"Chris Dy","startTime":1683.58,"endTime":1686.67,"body":"interviewing patients who had"},{"speaker":"Chris Dy","startTime":1686.67,"endTime":1691.17,"body":"thumb CMC surgeries. And they"},{"speaker":"Chris Dy","startTime":1686.67,"endTime":1691.17,"body":"all said and a lot of these were"},{"speaker":"Chris Dy","startTime":1691.17,"endTime":1694.14,"body":"my patients. So I took this"},{"speaker":"Chris Dy","startTime":1691.17,"endTime":1694.14,"body":"pretty personally that we told"},{"speaker":"Chris Dy","startTime":1694.14,"endTime":1696.87,"body":"them it was that the recovery"},{"speaker":"Chris Dy","startTime":1694.14,"endTime":1696.87,"body":"was shorter than it actually"},{"speaker":"Chris Dy","startTime":1696.87,"endTime":1700.62,"body":"was. So I tell them that it's"},{"speaker":"Chris Dy","startTime":1696.87,"endTime":1700.62,"body":"going to take six months until"},{"speaker":"Chris Dy","startTime":1700.62,"endTime":1702.84,"body":"they start to feel like you"},{"speaker":"Chris Dy","startTime":1700.62,"endTime":1702.84,"body":"know, they don't hate me every"},{"speaker":"Chris Dy","startTime":1702.84,"endTime":1706.2,"body":"time they use their thumb. But"},{"speaker":"Chris Dy","startTime":1702.84,"endTime":1706.2,"body":"eventually they will get there."},{"speaker":"Chris Dy","startTime":1707.04,"endTime":1710.46,"body":"And I'd love it. I don't know"},{"speaker":"Chris Dy","startTime":1707.04,"endTime":1710.46,"body":"maybe is it 10 to 12 weeks from"},{"speaker":"Chris Dy","startTime":1710.49,"endTime":1713.64,"body":"when they start therapy? Or is"},{"speaker":"Chris Dy","startTime":1710.49,"endTime":1713.64,"body":"it 10 to 12 weeks from surgery?"},{"speaker":"Macy Stonner","startTime":1714.54,"endTime":1717.75,"body":"10 to 12 weeks"},{"speaker":"Macy Stonner","startTime":1714.54,"endTime":1717.75,"body":"from surgery, being able to do"},{"speaker":"Macy Stonner","startTime":1717.75,"endTime":1722.34,"body":"some like resistance type thing."},{"speaker":"Macy Stonner","startTime":1717.75,"endTime":1722.34,"body":"So like actually pulling your"},{"speaker":"Macy Stonner","startTime":1722.34,"endTime":1724.62,"body":"pants up with your thumb and"},{"speaker":"Macy Stonner","startTime":1722.34,"endTime":1724.62,"body":"index finger like that kind of"},{"speaker":"Macy Stonner","startTime":1724.62,"endTime":1728.07,"body":"thing. So that's when life gets"},{"speaker":"Macy Stonner","startTime":1724.62,"endTime":1728.07,"body":"a little bit easier because they"},{"speaker":"Macy Stonner","startTime":1728.07,"endTime":1731.07,"body":"can actually they're allowed to"},{"speaker":"Macy Stonner","startTime":1728.07,"endTime":1731.07,"body":"use it to different stories,"},{"speaker":"Macy Stonner","startTime":1731.07,"endTime":1735.66,"body":"they have recurrent pain. So we"},{"speaker":"Macy Stonner","startTime":1731.07,"endTime":1735.66,"body":"obviously share very different"},{"speaker":"Macy Stonner","startTime":1735.66,"endTime":1737.94,"body":"timelines. But I think it"},{"speaker":"Macy Stonner","startTime":1735.66,"endTime":1737.94,"body":"depends on what exactly we're"},{"speaker":"Macy Stonner","startTime":1737.94,"endTime":1738.66,"body":"talking about here."},{"speaker":"Chris Dy","startTime":1739.77,"endTime":1743.82,"body":"I'd rather under under"},{"speaker":"Chris Dy","startTime":1739.77,"endTime":1743.82,"body":"promise is I guess there's a"},{"speaker":"Chris Dy","startTime":1743.82,"endTime":1746.19,"body":"term for this. But I mean, you"},{"speaker":"Chris Dy","startTime":1743.82,"endTime":1746.19,"body":"also don't want when you talk to"},{"speaker":"Chris Dy","startTime":1746.19,"endTime":1748.89,"body":"patients about this, you have to"},{"speaker":"Chris Dy","startTime":1746.19,"endTime":1748.89,"body":"be very careful because you"},{"speaker":"Chris Dy","startTime":1748.92,"endTime":1753.99,"body":"don't want to you don't want to"},{"speaker":"Chris Dy","startTime":1748.92,"endTime":1753.99,"body":"over promise. You don't want to"},{"speaker":"Chris Dy","startTime":1753.99,"endTime":1756.21,"body":"under promise because also want"},{"speaker":"Chris Dy","startTime":1753.99,"endTime":1756.21,"body":"to scare him away from what you"},{"speaker":"Chris Dy","startTime":1756.21,"endTime":1759.54,"body":"know is a good surgery that can"},{"speaker":"Chris Dy","startTime":1756.21,"endTime":1759.54,"body":"help a lot of people. But there"},{"speaker":"Chris Dy","startTime":1759.57,"endTime":1762.36,"body":"are some people that are on the"},{"speaker":"Chris Dy","startTime":1759.57,"endTime":1762.36,"body":"fence reasonably so about"},{"speaker":"Chris Dy","startTime":1762.36,"endTime":1766.83,"body":"surgery, and the amount of time"},{"speaker":"Chris Dy","startTime":1762.36,"endTime":1766.83,"body":"it's going to take but that"},{"speaker":"Chris Dy","startTime":1766.83,"endTime":1770.7,"body":"number seems to have worked for"},{"speaker":"Chris Dy","startTime":1766.83,"endTime":1770.7,"body":"me recently. Chuck, do you tell"},{"speaker":"Chris Dy","startTime":1770.7,"endTime":1773.16,"body":"them something somewhere in"},{"speaker":"Chris Dy","startTime":1770.7,"endTime":1773.16,"body":"between are you closer to Macy?"},{"speaker":"Chris Dy","startTime":1773.16,"endTime":1774.03,"body":"Closer to my number?"},{"speaker":"Charles Goldfarb","startTime":1774.33,"endTime":1776.7,"body":"I say four to"},{"speaker":"Charles Goldfarb","startTime":1774.33,"endTime":1776.7,"body":"five months, but what I'm"},{"speaker":"Charles Goldfarb","startTime":1776.7,"endTime":1781.02,"body":"telling them is my thing is four"},{"speaker":"Charles Goldfarb","startTime":1776.7,"endTime":1781.02,"body":"to five months until you are"},{"speaker":"Charles Goldfarb","startTime":1781.02,"endTime":1784.26,"body":"back doing all your activities"},{"speaker":"Charles Goldfarb","startTime":1781.02,"endTime":1784.26,"body":"and you're not thinking about"},{"speaker":"Charles Goldfarb","startTime":1784.26,"endTime":1788.19,"body":"your thumb. I think at eight to"},{"speaker":"Charles Goldfarb","startTime":1784.26,"endTime":1788.19,"body":"10 weeks people are back to most"},{"speaker":"Charles Goldfarb","startTime":1788.19,"endTime":1790.38,"body":"of their activities, but they"},{"speaker":"Charles Goldfarb","startTime":1788.19,"endTime":1790.38,"body":"are still thinking about that"},{"speaker":"Charles Goldfarb","startTime":1790.38,"endTime":1791.49,"body":"thumb. It's like-"},{"speaker":"Macy Stonner","startTime":1791.52,"endTime":1792.3,"body":"That's a good"},{"speaker":"Macy Stonner","startTime":1791.52,"endTime":1792.3,"body":"point."},{"speaker":"Charles Goldfarb","startTime":1792.75,"endTime":1794.61,"body":"It's like it"},{"speaker":"Charles Goldfarb","startTime":1792.75,"endTime":1794.61,"body":"to me it's like any painful"},{"speaker":"Charles Goldfarb","startTime":1794.61,"endTime":1798.75,"body":"situation. You know you can"},{"speaker":"Charles Goldfarb","startTime":1794.61,"endTime":1798.75,"body":"start using the painful joint or"},{"speaker":"Charles Goldfarb","startTime":1798.75,"endTime":1801.36,"body":"the injured joints sooner but"},{"speaker":"Charles Goldfarb","startTime":1798.75,"endTime":1801.36,"body":"it's really when they aren't"},{"speaker":"Charles Goldfarb","startTime":1801.36,"endTime":1803.64,"body":"thinking about it that that"},{"speaker":"Charles Goldfarb","startTime":1801.36,"endTime":1803.64,"body":"means they're over the hump. So"},{"speaker":"Charles Goldfarb","startTime":1803.64,"endTime":1805.56,"body":"it's just definitions. I think"},{"speaker":"Charles Goldfarb","startTime":1803.64,"endTime":1805.56,"body":"we're all saying."},{"speaker":"Macy Stonner","startTime":1805.59,"endTime":1806.19,"body":"I agree."},{"speaker":"Chris Dy","startTime":1806.43,"endTime":1809.16,"body":"How about golf? I've"},{"speaker":"Chris Dy","startTime":1806.43,"endTime":1809.16,"body":"had some patients recently,"},{"speaker":"Chris Dy","startTime":1809.16,"endTime":1811.47,"body":"obviously, with the time of the"},{"speaker":"Chris Dy","startTime":1809.16,"endTime":1811.47,"body":"year asking about golf."},{"speaker":"Charles Goldfarb","startTime":1812.64,"endTime":1815.16,"body":"With an"},{"speaker":"Charles Goldfarb","startTime":1812.64,"endTime":1815.16,"body":"internal brace, I would let that"},{"speaker":"Charles Goldfarb","startTime":1815.16,"endTime":1818.19,"body":"let them start pitching and"},{"speaker":"Charles Goldfarb","startTime":1815.16,"endTime":1818.19,"body":"putting in five to six weeks and"},{"speaker":"Charles Goldfarb","startTime":1818.19,"endTime":1821.37,"body":"progress as tolerated. From"},{"speaker":"Charles Goldfarb","startTime":1818.19,"endTime":1821.37,"body":"there. I honestly think it's"},{"speaker":"Charles Goldfarb","startTime":1821.37,"endTime":1824.79,"body":"like 10 to 12 weeks before"},{"speaker":"Charles Goldfarb","startTime":1821.37,"endTime":1824.79,"body":"they're getting out the big"},{"speaker":"Charles Goldfarb","startTime":1824.79,"endTime":1826.44,"body":"driver and going crazy."},{"speaker":"Chris Dy","startTime":1827.97,"endTime":1830.31,"body":"Maybe I want to ask"},{"speaker":"Chris Dy","startTime":1827.97,"endTime":1830.31,"body":"one more question about this."},{"speaker":"Chris Dy","startTime":1830.55,"endTime":1834.66,"body":"Because it's a surgery that in"},{"speaker":"Chris Dy","startTime":1830.55,"endTime":1834.66,"body":"the right situation works"},{"speaker":"Chris Dy","startTime":1834.66,"endTime":1837.42,"body":"incredibly well. But it's not"},{"speaker":"Chris Dy","startTime":1834.66,"endTime":1837.42,"body":"universally used. What about a"},{"speaker":"Chris Dy","startTime":1837.42,"endTime":1838.71,"body":"CMC arthrodesis?"},{"speaker":"Macy Stonner","startTime":1843.33,"endTime":1845.79,"body":"They do great"},{"speaker":"Macy Stonner","startTime":1843.33,"endTime":1845.79,"body":"depends on the right patient. I"},{"speaker":"Macy Stonner","startTime":1845.79,"endTime":1848.04,"body":"anecdotally speaking again, I"},{"speaker":"Macy Stonner","startTime":1845.79,"endTime":1848.04,"body":"feel like the classic patient"},{"speaker":"Macy Stonner","startTime":1848.04,"endTime":1853.74,"body":"would be like a 40 or 50 year"},{"speaker":"Macy Stonner","startTime":1848.04,"endTime":1853.74,"body":"old guy or woman who are a"},{"speaker":"Macy Stonner","startTime":1853.74,"endTime":1856.32,"body":"little bit too young for the"},{"speaker":"Macy Stonner","startTime":1853.74,"endTime":1856.32,"body":"board reconstructive procedures."},{"speaker":"Macy Stonner","startTime":1857.85,"endTime":1861.03,"body":"Rarely do I have a complaint."},{"speaker":"Macy Stonner","startTime":1857.85,"endTime":1861.03,"body":"It's like slam dunk pain is"},{"speaker":"Macy Stonner","startTime":1861.06,"endTime":1865.41,"body":"zero. I have strength and good."},{"speaker":"Macy Stonner","startTime":1861.06,"endTime":1865.41,"body":"The only complaint I would say"},{"speaker":"Macy Stonner","startTime":1865.41,"endTime":1868.95,"body":"is if like the thumb was brought"},{"speaker":"Macy Stonner","startTime":1865.41,"endTime":1868.95,"body":"out too far into palmar"},{"speaker":"Macy Stonner","startTime":1868.95,"endTime":1873.21,"body":"abduction, where it's a little"},{"speaker":"Macy Stonner","startTime":1868.95,"endTime":1873.21,"body":"bit in the way. But other than"},{"speaker":"Macy Stonner","startTime":1873.21,"endTime":1876.03,"body":"that, from a pain perspective"},{"speaker":"Macy Stonner","startTime":1873.21,"endTime":1876.03,"body":"and a function perspective, I"},{"speaker":"Macy Stonner","startTime":1876.03,"endTime":1877.35,"body":"think that they do quite well."},{"speaker":"Charles Goldfarb","startTime":1879.17,"endTime":1881.27,"body":"I'm a fan too."},{"speaker":"Charles Goldfarb","startTime":1879.17,"endTime":1881.27,"body":"I think you know that, Chris, I"},{"speaker":"Charles Goldfarb","startTime":1881.27,"endTime":1884.48,"body":"don't I don't remember the last"},{"speaker":"Charles Goldfarb","startTime":1881.27,"endTime":1884.48,"body":"time I did one. But in a young"},{"speaker":"Charles Goldfarb","startTime":1884.66,"endTime":1888.35,"body":"patient with high demands, I"},{"speaker":"Charles Goldfarb","startTime":1884.66,"endTime":1888.35,"body":"really like it. I think it can"},{"speaker":"Charles Goldfarb","startTime":1888.35,"endTime":1891.56,"body":"really provide a good outcome."},{"speaker":"Charles Goldfarb","startTime":1888.35,"endTime":1891.56,"body":"And certainly, you know, I just"},{"speaker":"Charles Goldfarb","startTime":1891.56,"endTime":1895.22,"body":"see a very young population that"},{"speaker":"Charles Goldfarb","startTime":1891.56,"endTime":1895.22,"body":"sounds can benefit from it."},{"speaker":"Chris Dy","startTime":1895.0,"endTime":1898.57,"body":"I think that's that"},{"speaker":"Chris Dy","startTime":1895.0,"endTime":1898.57,"body":"procedure has been has gotten a"},{"speaker":"Chris Dy","startTime":1898.57,"endTime":1901.72,"body":"bad rap mainly because of that"},{"speaker":"Chris Dy","startTime":1898.57,"endTime":1901.72,"body":"RCT that was stopped prematurely"},{"speaker":"Chris Dy","startTime":1901.72,"endTime":1906.28,"body":"in Europe, because of the high"},{"speaker":"Chris Dy","startTime":1901.72,"endTime":1906.28,"body":"non union rates. But, you know,"},{"speaker":"Chris Dy","startTime":1906.28,"endTime":1908.92,"body":"radiographic non union does not"},{"speaker":"Chris Dy","startTime":1906.28,"endTime":1908.92,"body":"necessarily equate to a"},{"speaker":"Chris Dy","startTime":1908.92,"endTime":1911.38,"body":"symptomatic non union. And I"},{"speaker":"Chris Dy","startTime":1908.92,"endTime":1911.38,"body":"think that was the experience"},{"speaker":"Chris Dy","startTime":1911.38,"endTime":1913.78,"body":"that I think it was it was the"},{"speaker":"Chris Dy","startTime":1911.38,"endTime":1913.78,"body":"KJ Hippensteel, one of our"},{"speaker":"Chris Dy","startTime":1913.78,"endTime":1916.36,"body":"residents who wrote that paper"},{"speaker":"Chris Dy","startTime":1913.78,"endTime":1916.36,"body":"with Dr. Gelberman and some of"},{"speaker":"Chris Dy","startTime":1916.36,"endTime":1921.52,"body":"the other partners. Yeah, the"},{"speaker":"Chris Dy","startTime":1916.36,"endTime":1921.52,"body":"the non union rate is real. Now,"},{"speaker":"Chris Dy","startTime":1921.52,"endTime":1925.51,"body":"the symptomatic non union rate"},{"speaker":"Chris Dy","startTime":1921.52,"endTime":1925.51,"body":"was quite low. So I think with"},{"speaker":"Chris Dy","startTime":1925.51,"endTime":1928.18,"body":"some changes in the technique"},{"speaker":"Chris Dy","startTime":1925.51,"endTime":1928.18,"body":"and some of the newer implants"},{"speaker":"Chris Dy","startTime":1928.18,"endTime":1931.75,"body":"specifically designed for that"},{"speaker":"Chris Dy","startTime":1928.18,"endTime":1931.75,"body":"arthrodesis. It's a surgery that"},{"speaker":"Chris Dy","startTime":1931.75,"endTime":1933.91,"body":"works really well. And I don't"},{"speaker":"Chris Dy","startTime":1931.75,"endTime":1933.91,"body":"use one of the special implants"},{"speaker":"Chris Dy","startTime":1933.91,"endTime":1935.74,"body":"but I love that surgery in the"},{"speaker":"Chris Dy","startTime":1933.91,"endTime":1935.74,"body":"right patient."},{"speaker":"Charles Goldfarb","startTime":1937.09,"endTime":1939.7,"body":"Yeah, totally"},{"speaker":"Charles Goldfarb","startTime":1937.09,"endTime":1939.7,"body":"agree. All right, Macy, final"},{"speaker":"Charles Goldfarb","startTime":1939.7,"endTime":1942.31,"body":"thoughts on your favorite joint"},{"speaker":"Charles Goldfarb","startTime":1939.7,"endTime":1942.31,"body":"in the body?"},{"speaker":"Macy Stonner","startTime":1944.08,"endTime":1947.44,"body":"I guess my final"},{"speaker":"Macy Stonner","startTime":1944.08,"endTime":1947.44,"body":"thought would be to remember"},{"speaker":"Macy Stonner","startTime":1947.44,"endTime":1952.81,"body":"that less is more in a postop"},{"speaker":"Macy Stonner","startTime":1947.44,"endTime":1952.81,"body":"patient, and in a conservative"},{"speaker":"Macy Stonner","startTime":1952.81,"endTime":1956.2,"body":"management patient. You just"},{"speaker":"Macy Stonner","startTime":1952.81,"endTime":1956.2,"body":"have to approach it the right"},{"speaker":"Macy Stonner","startTime":1956.2,"endTime":1959.44,"body":"way. Doesn't require a ton of"},{"speaker":"Macy Stonner","startTime":1956.2,"endTime":1959.44,"body":"therapy. Just give them a really"},{"speaker":"Macy Stonner","startTime":1959.44,"endTime":1964.0,"body":"good education session and got"},{"speaker":"Macy Stonner","startTime":1959.44,"endTime":1964.0,"body":"to find the right patient. And,"},{"speaker":"Macy Stonner","startTime":1964.45,"endTime":1966.97,"body":"yeah, that would be it. I"},{"speaker":"Macy Stonner","startTime":1964.45,"endTime":1966.97,"body":"appreciate y'all having me"},{"speaker":"Macy Stonner","startTime":1966.97,"endTime":1967.36,"body":"tonight."},{"speaker":"Charles Goldfarb","startTime":1968.86,"endTime":1971.77,"body":"Oh, the"},{"speaker":"Charles Goldfarb","startTime":1968.86,"endTime":1971.77,"body":"pleasure is ours. This will be a"},{"speaker":"Charles Goldfarb","startTime":1971.77,"endTime":1975.19,"body":"highly rated episode for sure."},{"speaker":"Charles Goldfarb","startTime":1971.77,"endTime":1975.19,"body":"I've learned as I always do when"},{"speaker":"Charles Goldfarb","startTime":1975.19,"endTime":1978.97,"body":"we when we chat and we'll have"},{"speaker":"Charles Goldfarb","startTime":1975.19,"endTime":1978.97,"body":"to figure out the next topic to"},{"speaker":"Charles Goldfarb","startTime":1978.97,"endTime":1979.81,"body":"dive deep on."},{"speaker":"Chris Dy","startTime":1983.23,"endTime":1986.23,"body":"Questions for Macy,"},{"speaker":"Chris Dy","startTime":1983.23,"endTime":1986.23,"body":"handpodcast@gmail.com. Send them"},{"speaker":"to Macy. Attention","startTime":1986.23,"endTime":1988.3,"body":"Macy."},{"speaker":"Charles Goldfarb","startTime":1990.31,"endTime":1992.68,"body":"Alright, y'all"},{"speaker":"Charles Goldfarb","startTime":1990.31,"endTime":1992.68,"body":"have a great night and we'll see"},{"speaker":"Charles Goldfarb","startTime":1992.68,"endTime":1993.1,"body":"you soon."},{"speaker":"Macy Stonner","startTime":1994.18,"endTime":1994.66,"body":"Good night."},{"speaker":"Charles Goldfarb","startTime":1996.73,"endTime":1998.71,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":1996.73,"endTime":1998.71,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":1998.71,"endTime":1999.22,"body":"real soon."},{"speaker":"Chris Dy","startTime":1999.49,"endTime":2002.01,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":1999.49,"endTime":2002.01,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2002.16,"endTime":2004.41,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2002.16,"endTime":2004.41,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2004.74,"endTime":2007.62,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2004.74,"endTime":2007.62,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2007.77,"endTime":2011.25,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2007.77,"endTime":2011.25,"body":"spelled dy. And if you'd like to"},{"speaker":"Chris Dy","startTime":2011.25,"endTime":2014.64,"body":"email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2011.25,"endTime":2014.64,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2015.57,"endTime":2017.73,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2015.57,"endTime":2017.73,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2017.73,"endTime":2018.78,"body":"get your podcasts."},{"speaker":"Chris Dy","startTime":2018.84,"endTime":2021.06,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2018.84,"endTime":2021.06,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2021.06,"endTime":2021.45,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2021.84,"endTime":2024.12,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2021.84,"endTime":2024.12,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2024.12,"endTime":2028.11,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2024.12,"endTime":2028.11,"body":"upper hand. Come back next time."}]}