{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":6.0,"endTime":7.53,"body":"and Chris talk Hand Surgery."},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":17.43,"endTime":18.0,"body":"podcasts."},{"speaker":"Chris Dy","startTime":18.93,"endTime":21.3,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":18.93,"endTime":21.3,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.58,"body":"leaving a rating wherever you"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.58,"body":"get your podcasts."},{"speaker":"Charles Goldfarb","startTime":24.21,"endTime":25.08,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":24.21,"endTime":25.08,"body":"Chris."},{"speaker":"Chris Dy","startTime":25.77,"endTime":26.79,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":25.77,"endTime":26.79,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":27.15,"endTime":29.85,"body":"I am great,"},{"speaker":"Charles Goldfarb","startTime":27.15,"endTime":29.85,"body":"because we're recording a pod."},{"speaker":"Chris Dy","startTime":30.6,"endTime":33.75,"body":"Absolutely. I wish I"},{"speaker":"Chris Dy","startTime":30.6,"endTime":33.75,"body":"could say I was full of energy."},{"speaker":"Chris Dy","startTime":34.5,"endTime":37.23,"body":"But it's been a rough. It's been"},{"speaker":"Chris Dy","startTime":34.5,"endTime":37.23,"body":"a rough day."},{"speaker":"Charles Goldfarb","startTime":37.41,"endTime":38.49,"body":"What too much"},{"speaker":"Charles Goldfarb","startTime":37.41,"endTime":38.49,"body":"cooking."},{"speaker":"Chris Dy","startTime":38.94,"endTime":41.49,"body":"Now, though I did, I"},{"speaker":"Chris Dy","startTime":38.94,"endTime":41.49,"body":"did do some cooking. And that"},{"speaker":"Chris Dy","startTime":41.49,"endTime":45.9,"body":"was fantastic highlight of the"},{"speaker":"Chris Dy","startTime":41.49,"endTime":45.9,"body":"day. But, you know, last night,"},{"speaker":"Chris Dy","startTime":45.93,"endTime":49.26,"body":"I wasn't on call. But we're"},{"speaker":"Chris Dy","startTime":45.93,"endTime":49.26,"body":"participating in this"},{"speaker":"Chris Dy","startTime":49.38,"endTime":52.68,"body":"multicenter, randomized"},{"speaker":"Chris Dy","startTime":49.38,"endTime":52.68,"body":"controlled trial for peg fusion"},{"speaker":"Chris Dy","startTime":52.68,"endTime":56.73,"body":"for nerve repair, and duty"},{"speaker":"Chris Dy","startTime":52.68,"endTime":56.73,"body":"called. And you know, when I got"},{"speaker":"Chris Dy","startTime":56.73,"endTime":59.13,"body":"the call from one of our"},{"speaker":"Chris Dy","startTime":56.73,"endTime":59.13,"body":"partners, it was early evening,"},{"speaker":"Chris Dy","startTime":59.13,"endTime":61.44,"body":"and I said, Alright, great,"},{"speaker":"Chris Dy","startTime":59.13,"endTime":61.44,"body":"that's perfect. We'll get the"},{"speaker":"Chris Dy","startTime":61.44,"endTime":65.01,"body":"patient enrolled, if they want"},{"speaker":"Chris Dy","startTime":61.44,"endTime":65.01,"body":"to do it. And we'll do the case."},{"speaker":"Chris Dy","startTime":65.07,"endTime":68.67,"body":"And I'll be in bed later. And"},{"speaker":"Chris Dy","startTime":65.07,"endTime":68.67,"body":"you know, the case I was"},{"speaker":"Chris Dy","startTime":68.67,"endTime":71.46,"body":"supposed to go in the evening"},{"speaker":"Chris Dy","startTime":68.67,"endTime":71.46,"body":"got bumped for an emergency"},{"speaker":"Chris Dy","startTime":71.46,"endTime":74.16,"body":"trainee, and then just kept"},{"speaker":"Chris Dy","startTime":71.46,"endTime":74.16,"body":"getting bumped."},{"speaker":"Charles Goldfarb","startTime":74.49,"endTime":76.59,"body":"Alright, well"},{"speaker":"Charles Goldfarb","startTime":74.49,"endTime":76.59,"body":"tell me a little bit about this."},{"speaker":"Charles Goldfarb","startTime":76.62,"endTime":79.92,"body":"Because I know about this study."},{"speaker":"Charles Goldfarb","startTime":76.62,"endTime":79.92,"body":"I'm not one of the surgeons, I"},{"speaker":"Charles Goldfarb","startTime":79.92,"endTime":82.17,"body":"haven't had the opportunity to"},{"speaker":"Charles Goldfarb","startTime":79.92,"endTime":82.17,"body":"pass one of these cases off, but"},{"speaker":"Charles Goldfarb","startTime":82.17,"endTime":84.69,"body":"I look forward to that day. But"},{"speaker":"Charles Goldfarb","startTime":82.17,"endTime":84.69,"body":"tell me a little about this"},{"speaker":"Charles Goldfarb","startTime":84.69,"endTime":87.57,"body":"study. And are we it's a"},{"speaker":"Charles Goldfarb","startTime":84.69,"endTime":87.57,"body":"multicenter study, as I"},{"speaker":"Charles Goldfarb","startTime":87.57,"endTime":90.21,"body":"understand it, how are we doing"},{"speaker":"Charles Goldfarb","startTime":87.57,"endTime":90.21,"body":"comparatively."},{"speaker":"Chris Dy","startTime":91.02,"endTime":94.47,"body":"So you know, it's a,"},{"speaker":"Chris Dy","startTime":91.02,"endTime":94.47,"body":"it's a peg fusion technology."},{"speaker":"Chris Dy","startTime":94.98,"endTime":98.64,"body":"For those that are unfamiliar,"},{"speaker":"Chris Dy","startTime":94.98,"endTime":98.64,"body":"it's a newer, it's not new, it's"},{"speaker":"Chris Dy","startTime":98.64,"endTime":101.13,"body":"actually been around for quite"},{"speaker":"Chris Dy","startTime":98.64,"endTime":101.13,"body":"some time. So some of the old"},{"speaker":"Chris Dy","startTime":101.13,"endTime":104.28,"body":"guard will say how it's come and"},{"speaker":"Chris Dy","startTime":101.13,"endTime":104.28,"body":"gone. But there are some newer"},{"speaker":"Chris Dy","startTime":104.28,"endTime":107.28,"body":"studies demonstrating that peg"},{"speaker":"Chris Dy","startTime":104.28,"endTime":107.28,"body":"fusion in which you repair nerve"},{"speaker":"Chris Dy","startTime":107.28,"endTime":110.58,"body":"as you normally would would"},{"speaker":"Chris Dy","startTime":107.28,"endTime":110.58,"body":"suture and then you use a,"},{"speaker":"Chris Dy","startTime":111.15,"endTime":114.57,"body":"essentially a chemical to help"},{"speaker":"Chris Dy","startTime":111.15,"endTime":114.57,"body":"seal the nerve ends together"},{"speaker":"Chris Dy","startTime":114.6,"endTime":119.73,"body":"after you've repaired it. And"},{"speaker":"Chris Dy","startTime":114.6,"endTime":119.73,"body":"supposedly helps to facilitate"},{"speaker":"Chris Dy","startTime":119.73,"endTime":124.53,"body":"and expedite nerve regeneration."},{"speaker":"Chris Dy","startTime":119.73,"endTime":124.53,"body":"Really impressive in the lab and"},{"speaker":"Chris Dy","startTime":124.53,"endTime":128.46,"body":"really impressive preliminary"},{"speaker":"Chris Dy","startTime":124.53,"endTime":128.46,"body":"papers. But this is a technology"},{"speaker":"Chris Dy","startTime":128.46,"endTime":131.46,"body":"that's now being put to the test"},{"speaker":"Chris Dy","startTime":128.46,"endTime":131.46,"body":"with a multicenter, randomized"},{"speaker":"Chris Dy","startTime":131.46,"endTime":135.09,"body":"controlled trial. We are one of"},{"speaker":"Chris Dy","startTime":131.46,"endTime":135.09,"body":"I believe at least eight sites,"},{"speaker":"Chris Dy","startTime":135.09,"endTime":138.39,"body":"I think there still may be"},{"speaker":"Chris Dy","startTime":135.09,"endTime":138.39,"body":"trying to recruit more. And we"},{"speaker":"Chris Dy","startTime":138.39,"endTime":139.14,"body":"are in the lead."},{"speaker":"Charles Goldfarb","startTime":139.71,"endTime":142.56,"body":"Nice, well"},{"speaker":"Charles Goldfarb","startTime":139.71,"endTime":142.56,"body":"done. This is you and Dr."},{"speaker":"Charles Goldfarb","startTime":142.56,"endTime":143.46,"body":"Brogan, I believe,"},{"speaker":"Chris Dy","startTime":143.49,"endTime":146.43,"body":"yeah, so Davids the PI"},{"speaker":"Chris Dy","startTime":143.49,"endTime":146.43,"body":"on the study, and we've got a"},{"speaker":"Chris Dy","startTime":146.43,"endTime":151.56,"body":"great research team, who really"},{"speaker":"Chris Dy","startTime":146.43,"endTime":151.56,"body":"are just handling the majority"},{"speaker":"Chris Dy","startTime":151.56,"endTime":156.09,"body":"of the work it is a ton of of"},{"speaker":"Chris Dy","startTime":151.56,"endTime":156.09,"body":"person hours, as we should say,"},{"speaker":"Chris Dy","startTime":156.63,"endTime":161.25,"body":"that goes into you know, not"},{"speaker":"Chris Dy","startTime":156.63,"endTime":161.25,"body":"only recruiting, enrolling,"},{"speaker":"Chris Dy","startTime":161.94,"endTime":164.46,"body":"doing the randomization, and"},{"speaker":"Chris Dy","startTime":161.94,"endTime":164.46,"body":"then all of the paperwork that"},{"speaker":"Chris Dy","startTime":164.46,"endTime":167.46,"body":"comes with the follow ups. So"},{"speaker":"Chris Dy","startTime":164.46,"endTime":167.46,"body":"we're very fortunate to have"},{"speaker":"Chris Dy","startTime":167.97,"endTime":170.34,"body":"Carrie Burke, and you'll see to"},{"speaker":"Chris Dy","startTime":167.97,"endTime":170.34,"body":"be more fantastic clinical"},{"speaker":"Chris Dy","startTime":170.34,"endTime":174.63,"body":"research team. We had a we had a"},{"speaker":"Chris Dy","startTime":170.34,"endTime":174.63,"body":"visiting scholar for the"},{"speaker":"Chris Dy","startTime":174.63,"endTime":178.32,"body":"government scholarship, Avi"},{"speaker":"Chris Dy","startTime":174.63,"endTime":178.32,"body":"Galadi recently from his center,"},{"speaker":"Chris Dy","startTime":178.44,"endTime":181.89,"body":"at Curtis and he was saying how"},{"speaker":"Chris Dy","startTime":178.44,"endTime":181.89,"body":"it's a hard study to enroll just"},{"speaker":"Chris Dy","startTime":181.89,"endTime":184.26,"body":"because the criteria has got to"},{"speaker":"Chris Dy","startTime":181.89,"endTime":184.26,"body":"be perfect. It's got to be a"},{"speaker":"Chris Dy","startTime":184.47,"endTime":187.05,"body":"nerve injury that can be"},{"speaker":"Chris Dy","startTime":184.47,"endTime":187.05,"body":"primarily directly repaired"},{"speaker":"Chris Dy","startTime":187.05,"endTime":190.23,"body":"within 48 hours of injury. So"},{"speaker":"Chris Dy","startTime":187.05,"endTime":190.23,"body":"it's very hard to thread that"},{"speaker":"Chris Dy","startTime":190.23,"endTime":190.59,"body":"needle."},{"speaker":"Charles Goldfarb","startTime":191.22,"endTime":193.62,"body":"Yeah, for"},{"speaker":"Charles Goldfarb","startTime":191.22,"endTime":193.62,"body":"sure. I mean, fortunately, with"},{"speaker":"Charles Goldfarb","startTime":193.62,"endTime":196.8,"body":"our population, we do have more"},{"speaker":"Charles Goldfarb","startTime":193.62,"endTime":196.8,"body":"opportunities for acute repairs,"},{"speaker":"Charles Goldfarb","startTime":196.8,"endTime":198.93,"body":"just because the nature of our"},{"speaker":"Charles Goldfarb","startTime":196.8,"endTime":198.93,"body":"center, but it's still not easy,"},{"speaker":"Charles Goldfarb","startTime":198.93,"endTime":202.02,"body":"still not easy. And you're"},{"speaker":"Charles Goldfarb","startTime":198.93,"endTime":202.02,"body":"right, you can't do these kinds"},{"speaker":"Charles Goldfarb","startTime":202.02,"endTime":205.2,"body":"of studies without the right"},{"speaker":"Charles Goldfarb","startTime":202.02,"endTime":205.2,"body":"team. It's hard enough on the"},{"speaker":"Charles Goldfarb","startTime":205.2,"endTime":208.17,"body":"surgeons, but having the right"},{"speaker":"Charles Goldfarb","startTime":205.2,"endTime":208.17,"body":"team behind you is really,"},{"speaker":"Charles Goldfarb","startTime":208.17,"endTime":211.2,"body":"really important. So congrats."},{"speaker":"Charles Goldfarb","startTime":208.17,"endTime":211.2,"body":"Keep up the good work. Yeah."},{"speaker":"Chris Dy","startTime":211.2,"endTime":213.54,"body":"So David and I are"},{"speaker":"Chris Dy","startTime":211.2,"endTime":213.54,"body":"very proud, we are well ahead of"},{"speaker":"Chris Dy","startTime":213.54,"endTime":216.42,"body":"our counterparts at other"},{"speaker":"Chris Dy","startTime":213.54,"endTime":216.42,"body":"institutions. You know, and"},{"speaker":"Chris Dy","startTime":216.42,"endTime":219.63,"body":"hopefully, you know, we're"},{"speaker":"Chris Dy","startTime":216.42,"endTime":219.63,"body":"helping the advance the field in"},{"speaker":"Chris Dy","startTime":219.63,"endTime":223.59,"body":"that regard. So I'm tired to be"},{"speaker":"Chris Dy","startTime":219.63,"endTime":223.59,"body":"very honest with you, because"},{"speaker":"Chris Dy","startTime":223.59,"endTime":226.08,"body":"that case went overnight. And"},{"speaker":"Chris Dy","startTime":223.59,"endTime":226.08,"body":"then it just rolled right into a"},{"speaker":"Chris Dy","startTime":226.08,"endTime":229.41,"body":"normal day, which included, and"},{"speaker":"Chris Dy","startTime":226.08,"endTime":229.41,"body":"we talked about this on a prior"},{"speaker":"Chris Dy","startTime":229.41,"endTime":232.68,"body":"episode, because I'm traveling"},{"speaker":"Chris Dy","startTime":229.41,"endTime":232.68,"body":"next week, I added on the clinic"},{"speaker":"Chris Dy","startTime":232.68,"endTime":234.66,"body":"this morning, and it just kind"},{"speaker":"Chris Dy","startTime":232.68,"endTime":234.66,"body":"of went from there."},{"speaker":"Charles Goldfarb","startTime":235.47,"endTime":237.75,"body":"Well, in"},{"speaker":"Charles Goldfarb","startTime":235.47,"endTime":237.75,"body":"respect of your time, let's do"},{"speaker":"Charles Goldfarb","startTime":237.75,"endTime":241.68,"body":"two things. One, there's a great"},{"speaker":"Charles Goldfarb","startTime":237.75,"endTime":241.68,"body":"review to share and then two"},{"speaker":"Charles Goldfarb","startTime":241.98,"endTime":245.61,"body":"lets, given that you're tired."},{"speaker":"Charles Goldfarb","startTime":241.98,"endTime":245.61,"body":"The easiest thing for you to"},{"speaker":"Charles Goldfarb","startTime":245.61,"endTime":249.18,"body":"talk about is nerve. So let's"},{"speaker":"Charles Goldfarb","startTime":245.61,"endTime":249.18,"body":"talk about a nerve, the nerve we"},{"speaker":"Charles Goldfarb","startTime":249.18,"endTime":250.26,"body":"haven't talked about in a while."},{"speaker":"Chris Dy","startTime":251.19,"endTime":254.46,"body":"Well, so here's a"},{"speaker":"Chris Dy","startTime":251.19,"endTime":254.46,"body":"great review from Ani Stratzman,"},{"speaker":"Chris Dy","startTime":254.49,"endTime":258.75,"body":"who is a early career hand"},{"speaker":"Chris Dy","startTime":254.49,"endTime":258.75,"body":"surgeon in in Europe. He didn't"},{"speaker":"Chris Dy","startTime":258.75,"endTime":261.78,"body":"say exactly where he is. Looks"},{"speaker":"Chris Dy","startTime":258.75,"endTime":261.78,"body":"like Germany based on the email"},{"speaker":"Chris Dy","startTime":261.78,"endTime":264.78,"body":"address. But he said Hey, Chuck"},{"speaker":"Chris Dy","startTime":261.78,"endTime":264.78,"body":"and Chris, I usually listen to"},{"speaker":"Chris Dy","startTime":264.78,"endTime":267.69,"body":"your incredibly interesting"},{"speaker":"Chris Dy","startTime":264.78,"endTime":267.69,"body":"podcasts on my way to work. One"},{"speaker":"Chris Dy","startTime":267.69,"endTime":270.36,"body":"morning not that long ago, I"},{"speaker":"Chris Dy","startTime":267.69,"endTime":270.36,"body":"gave my 12 year old daughter a"},{"speaker":"Chris Dy","startTime":270.36,"endTime":272.25,"body":"ride to school and after"},{"speaker":"Chris Dy","startTime":270.36,"endTime":272.25,"body":"listening to you for a few"},{"speaker":"Chris Dy","startTime":272.25,"endTime":276.66,"body":"seconds. She said wow, this guy"},{"speaker":"Chris Dy","startTime":272.25,"endTime":276.66,"body":"sounds like Tony Stark- Iron Man"},{"speaker":"Chris Dy","startTime":276.66,"endTime":279.63,"body":"for the Marvel Universe, you"},{"speaker":"Chris Dy","startTime":276.66,"endTime":279.63,"body":"know? And that was you Chuck."},{"speaker":"Chris Dy","startTime":280.14,"endTime":282.84,"body":"Her comment made me laugh out"},{"speaker":"Chris Dy","startTime":280.14,"endTime":282.84,"body":"loud and I hope it makes you"},{"speaker":"Chris Dy","startTime":282.84,"endTime":283.8,"body":"smile at least."},{"speaker":"Charles Goldfarb","startTime":284.82,"endTime":288.69,"body":"I wish I could"},{"speaker":"Charles Goldfarb","startTime":284.82,"endTime":288.69,"body":"say I'm a Ironman watcher so it"},{"speaker":"Charles Goldfarb","startTime":288.69,"endTime":290.85,"body":"doesn't really mean anything to"},{"speaker":"Charles Goldfarb","startTime":288.69,"endTime":290.85,"body":"me but it still sounds like a"},{"speaker":"Charles Goldfarb","startTime":290.85,"endTime":292.68,"body":"compliment so I will take it"},{"speaker":"Chris Dy","startTime":293.07,"endTime":294.81,"body":"that's a huge one"},{"speaker":"Chris Dy","startTime":293.07,"endTime":294.81,"body":"that's that's big. That's big"},{"speaker":"Chris Dy","startTime":294.81,"endTime":298.14,"body":"Tony Stark is good one. So and"},{"speaker":"Chris Dy","startTime":294.81,"endTime":298.14,"body":"then he goes on to very kindly"},{"speaker":"Chris Dy","startTime":298.14,"endTime":300.36,"body":"say your podcast is awesome."},{"speaker":"Chris Dy","startTime":298.14,"endTime":300.36,"body":"It's easy to list. Since you and"},{"speaker":"Chris Dy","startTime":300.36,"endTime":302.67,"body":"every time I pick up something"},{"speaker":"Chris Dy","startTime":300.36,"endTime":302.67,"body":"that I haven't thought or simply"},{"speaker":"Chris Dy","startTime":302.67,"endTime":305.52,"body":"never heard or read about, I am"},{"speaker":"Chris Dy","startTime":302.67,"endTime":305.52,"body":"deeply, deeply grateful that you"},{"speaker":"Chris Dy","startTime":305.52,"endTime":307.68,"body":"share your knowledge. So"},{"speaker":"Chris Dy","startTime":305.52,"endTime":307.68,"body":"generously, you make me a better"},{"speaker":"Chris Dy","startTime":307.68,"endTime":311.34,"body":"hand surgeon. And I must"},{"speaker":"Chris Dy","startTime":307.68,"endTime":311.34,"body":"mention, I'd love to hear more"},{"speaker":"Chris Dy","startTime":311.37,"endTime":311.91,"body":"nerve."},{"speaker":"Charles Goldfarb","startTime":312.36,"endTime":314.43,"body":"Well, well,"},{"speaker":"Charles Goldfarb","startTime":312.36,"endTime":314.43,"body":"let's give it to him."},{"speaker":"Charles Goldfarb","startTime":315.0,"endTime":315.93,"body":"Absolutely. And"},{"speaker":"Chris Dy","startTime":315.93,"endTime":318.57,"body":"then on, he goes on to"},{"speaker":"Chris Dy","startTime":315.93,"endTime":318.57,"body":"a request to be put on the"},{"speaker":"Chris Dy","startTime":318.57,"endTime":322.08,"body":"newsletter email list. So we"},{"speaker":"Chris Dy","startTime":318.57,"endTime":322.08,"body":"will definitely add you and then"},{"speaker":"Chris Dy","startTime":322.08,"endTime":325.14,"body":"anybody who wants to please let"},{"speaker":"Chris Dy","startTime":322.08,"endTime":325.14,"body":"us know, there's a link in the"},{"speaker":"Chris Dy","startTime":325.14,"endTime":328.44,"body":"show notes. So you can always"},{"speaker":"Chris Dy","startTime":325.14,"endTime":328.44,"body":"email us Handpodcast@gmail.com."},{"speaker":"Chris Dy","startTime":329.22,"endTime":332.43,"body":"Or find us on social and we will"},{"speaker":"Chris Dy","startTime":329.22,"endTime":332.43,"body":"be happy to, to hear from you"},{"speaker":"Chris Dy","startTime":332.43,"endTime":332.76,"body":"guys."},{"speaker":"Charles Goldfarb","startTime":333.42,"endTime":336.12,"body":"I love it,"},{"speaker":"Charles Goldfarb","startTime":333.42,"endTime":336.12,"body":"that is a very kind review. And"},{"speaker":"Charles Goldfarb","startTime":336.18,"endTime":338.64,"body":"those words really are"},{"speaker":"Charles Goldfarb","startTime":336.18,"endTime":338.64,"body":"impactful. So thank you for"},{"speaker":"Charles Goldfarb","startTime":338.64,"endTime":343.17,"body":"sharing, and we will definitely"},{"speaker":"Charles Goldfarb","startTime":338.64,"endTime":343.17,"body":"add you to the email list."},{"speaker":"Charles Goldfarb","startTime":344.1,"endTime":350.19,"body":"Alright, so I think we both"},{"speaker":"Charles Goldfarb","startTime":344.1,"endTime":350.19,"body":"delve into this lower extremity"},{"speaker":"Charles Goldfarb","startTime":350.19,"endTime":355.5,"body":"nerve at times, I have mentioned"},{"speaker":"Charles Goldfarb","startTime":350.19,"endTime":355.5,"body":"on previous podcasts that I work"},{"speaker":"Charles Goldfarb","startTime":355.5,"endTime":358.92,"body":"pretty closely with some of our"},{"speaker":"Charles Goldfarb","startTime":355.5,"endTime":358.92,"body":"sports surgeons. And so there"},{"speaker":"Charles Goldfarb","startTime":358.92,"endTime":361.95,"body":"has been an opportunity to work"},{"speaker":"Charles Goldfarb","startTime":358.92,"endTime":361.95,"body":"on this nerve. And likewise,"},{"speaker":"Charles Goldfarb","startTime":361.95,"endTime":365.34,"body":"they know you are a great"},{"speaker":"Charles Goldfarb","startTime":361.95,"endTime":365.34,"body":"resource, especially as this"},{"speaker":"Charles Goldfarb","startTime":365.37,"endTime":369.15,"body":"injury gets more serious. So"},{"speaker":"Charles Goldfarb","startTime":365.37,"endTime":369.15,"body":"take us into our topic."},{"speaker":"Chris Dy","startTime":370.259,"endTime":371.939,"body":"Well, I mean, even"},{"speaker":"Chris Dy","startTime":370.259,"endTime":371.939,"body":"though this is a hand surgery,"},{"speaker":"Chris Dy","startTime":371.939,"endTime":374.879,"body":"podcast hand surgeons get called"},{"speaker":"Chris Dy","startTime":371.939,"endTime":374.879,"body":"to operate, you know, all over"},{"speaker":"Chris Dy","startTime":374.879,"endTime":377.489,"body":"the body, like any of our"},{"speaker":"Chris Dy","startTime":374.879,"endTime":377.489,"body":"partners who do lots of flaps"},{"speaker":"Chris Dy","startTime":377.489,"endTime":380.339,"body":"can tell you but for a nerve,"},{"speaker":"Chris Dy","startTime":377.489,"endTime":380.339,"body":"you're oftentimes asked to help"},{"speaker":"Chris Dy","startTime":380.339,"endTime":383.009,"body":"your at least orthopedic"},{"speaker":"Chris Dy","startTime":380.339,"endTime":383.009,"body":"partners with dissecting out and"},{"speaker":"Chris Dy","startTime":383.039,"endTime":385.979,"body":"maybe even decompressing the"},{"speaker":"Chris Dy","startTime":383.039,"endTime":385.979,"body":"common perineal nerve. So you"},{"speaker":"Chris Dy","startTime":385.979,"endTime":389.039,"body":"mentioned it in the context of"},{"speaker":"Chris Dy","startTime":385.979,"endTime":389.039,"body":"you know, a knee injury in which"},{"speaker":"Chris Dy","startTime":389.039,"endTime":391.979,"body":"maybe they're going to do a"},{"speaker":"Chris Dy","startTime":389.039,"endTime":391.979,"body":"reconstruction of some sort. But"},{"speaker":"Chris Dy","startTime":391.979,"endTime":395.849,"body":"I oftentimes see it in the"},{"speaker":"Chris Dy","startTime":391.979,"endTime":395.849,"body":"patient who has a foot drop for"},{"speaker":"Chris Dy","startTime":395.879,"endTime":399.419,"body":"an unknown reason, supposedly,"},{"speaker":"Chris Dy","startTime":395.879,"endTime":399.419,"body":"or they have double crushing"},{"speaker":"Chris Dy","startTime":399.419,"endTime":402.479,"body":"effects of lumbar spine issues."},{"speaker":"Chris Dy","startTime":399.419,"endTime":402.479,"body":"And, you know, they're still not"},{"speaker":"Chris Dy","startTime":402.479,"endTime":407.789,"body":"recovering their ankle"},{"speaker":"Chris Dy","startTime":402.479,"endTime":407.789,"body":"dorsiflexion. It's usually seen"},{"speaker":"Chris Dy","startTime":407.789,"endTime":410.759,"body":"on the nerve study. So I've"},{"speaker":"Chris Dy","startTime":407.789,"endTime":410.759,"body":"found this to be an incredibly"},{"speaker":"Chris Dy","startTime":410.759,"endTime":415.049,"body":"useful nerve to learn about and"},{"speaker":"Chris Dy","startTime":410.759,"endTime":415.049,"body":"a great procedure to, to learn"},{"speaker":"Chris Dy","startTime":415.049,"endTime":417.599,"body":"and to teach. And I tell every"},{"speaker":"Chris Dy","startTime":415.049,"endTime":417.599,"body":"resident that comes through,"},{"speaker":"Chris Dy","startTime":417.599,"endTime":420.149,"body":"it'd be great if you came off of"},{"speaker":"Chris Dy","startTime":417.599,"endTime":420.149,"body":"this rotation, knowing how to"},{"speaker":"Chris Dy","startTime":420.149,"endTime":422.699,"body":"find this nerve, get it dissect"},{"speaker":"Chris Dy","startTime":420.149,"endTime":422.699,"body":"it out safely, because you never"},{"speaker":"Chris Dy","startTime":422.699,"endTime":425.129,"body":"know when you're going to need"},{"speaker":"Chris Dy","startTime":422.699,"endTime":425.129,"body":"to do it. And then for our"},{"speaker":"Chris Dy","startTime":425.129,"endTime":427.559,"body":"fellows, it's a great procedure"},{"speaker":"Chris Dy","startTime":425.129,"endTime":427.559,"body":"to know how to how to do because"},{"speaker":"Chris Dy","startTime":427.559,"endTime":428.879,"body":"then your partners can ask for"},{"speaker":"Chris Dy","startTime":427.559,"endTime":428.879,"body":"help."},{"speaker":"Charles Goldfarb","startTime":429.66,"endTime":432.21,"body":"Yeah, and"},{"speaker":"Charles Goldfarb","startTime":429.66,"endTime":432.21,"body":"those collaborative cases is you"},{"speaker":"Charles Goldfarb","startTime":432.21,"endTime":437.91,"body":"and I both strongly believe are"},{"speaker":"Charles Goldfarb","startTime":432.21,"endTime":437.91,"body":"fun. Although I will say I need"},{"speaker":"Charles Goldfarb","startTime":437.91,"endTime":441.45,"body":"this location or posterolateral"},{"speaker":"Charles Goldfarb","startTime":437.91,"endTime":441.45,"body":"corner injury to the knee that"},{"speaker":"Charles Goldfarb","startTime":441.45,"endTime":446.43,"body":"has been untreated for some"},{"speaker":"Charles Goldfarb","startTime":441.45,"endTime":446.43,"body":"time. That perineal nerve gets"},{"speaker":"Charles Goldfarb","startTime":446.43,"endTime":450.03,"body":"scarred in and your fun with"},{"speaker":"Charles Goldfarb","startTime":446.43,"endTime":450.03,"body":"your partner can go south really"},{"speaker":"Charles Goldfarb","startTime":450.03,"endTime":451.47,"body":"quickly. So"},{"speaker":"Chris Dy","startTime":451.78,"endTime":455.17,"body":"yeah, they they"},{"speaker":"Chris Dy","startTime":451.78,"endTime":455.17,"body":"definitely this Emily wants your"},{"speaker":"Chris Dy","startTime":455.17,"endTime":457.69,"body":"help. I don't know if they just"},{"speaker":"Chris Dy","startTime":455.17,"endTime":457.69,"body":"wanted to say that you were"},{"speaker":"Chris Dy","startTime":457.69,"endTime":460.39,"body":"there to dissect out the nerve."},{"speaker":"Chris Dy","startTime":457.69,"endTime":460.39,"body":"But those are hard. They're"},{"speaker":"Chris Dy","startTime":460.39,"endTime":463.39,"body":"incredibly scarred. And I think"},{"speaker":"Chris Dy","startTime":460.39,"endTime":463.39,"body":"those are, you know, multi legs"},{"speaker":"Chris Dy","startTime":463.39,"endTime":466.21,"body":"and posterolateral corners."},{"speaker":"Chris Dy","startTime":463.39,"endTime":466.21,"body":"Those are really challenging"},{"speaker":"Chris Dy","startTime":466.21,"endTime":468.94,"body":"injuries just in general. You"},{"speaker":"Chris Dy","startTime":466.21,"endTime":468.94,"body":"know, during the beginning of"},{"speaker":"Chris Dy","startTime":468.94,"endTime":472.93,"body":"the pandemic, I did a webinar"},{"speaker":"Chris Dy","startTime":468.94,"endTime":472.93,"body":"for the American orthopedic Foot"},{"speaker":"Chris Dy","startTime":472.93,"endTime":477.19,"body":"and Ankle society. And it was"},{"speaker":"Chris Dy","startTime":472.93,"endTime":477.19,"body":"me, Jeff Johnson, Matt matava."},{"speaker":"Chris Dy","startTime":477.61,"endTime":480.22,"body":"So Jeff's Sports or excuse me, a"},{"speaker":"Chris Dy","startTime":477.61,"endTime":480.22,"body":"foot and ankle surgeon who"},{"speaker":"Chris Dy","startTime":480.22,"endTime":483.01,"body":"recently retired, he's now"},{"speaker":"Chris Dy","startTime":480.22,"endTime":483.01,"body":"practicing at the VA, really"},{"speaker":"Chris Dy","startTime":483.01,"endTime":485.71,"body":"well known in this field, an"},{"speaker":"Chris Dy","startTime":483.01,"endTime":485.71,"body":"expert at the bridle procedure,"},{"speaker":"Chris Dy","startTime":485.71,"endTime":487.9,"body":"the combination of tendon"},{"speaker":"Chris Dy","startTime":485.71,"endTime":487.9,"body":"transfers to restore ankle"},{"speaker":"Chris Dy","startTime":487.9,"endTime":492.04,"body":"dorsiflexion. And that Matava"},{"speaker":"Chris Dy","startTime":487.9,"endTime":492.04,"body":"former, you know, sports or"},{"speaker":"Chris Dy","startTime":492.07,"endTime":495.28,"body":"former team doc for the St."},{"speaker":"Chris Dy","startTime":492.07,"endTime":495.28,"body":"Louis Rams, and an incredibly"},{"speaker":"Chris Dy","startTime":495.28,"endTime":498.07,"body":"well known sports surgeon. And"},{"speaker":"Chris Dy","startTime":495.28,"endTime":498.07,"body":"then our last panelist was Susan"},{"speaker":"Chris Dy","startTime":498.07,"endTime":500.32,"body":"MacKinnon, who obviously needs"},{"speaker":"Chris Dy","startTime":498.07,"endTime":500.32,"body":"no introduction as a peripheral"},{"speaker":"Chris Dy","startTime":500.32,"endTime":504.19,"body":"nerve expert. So I'm moderating"},{"speaker":"Chris Dy","startTime":500.32,"endTime":504.19,"body":"this panel, which was super fun"},{"speaker":"Chris Dy","startTime":504.19,"endTime":507.94,"body":"to do showing cases. And we"},{"speaker":"Chris Dy","startTime":504.19,"endTime":507.94,"body":"agreed on nothing, which shows"},{"speaker":"Chris Dy","startTime":507.94,"endTime":510.82,"body":"you just not even like, you"},{"speaker":"Chris Dy","startTime":507.94,"endTime":510.82,"body":"know, what's the best strategy"},{"speaker":"Chris Dy","startTime":510.82,"endTime":514.93,"body":"in terms of timing of each of"},{"speaker":"Chris Dy","startTime":510.82,"endTime":514.93,"body":"our individual surgeries? How"},{"speaker":"Chris Dy","startTime":514.96,"endTime":517.36,"body":"what to tell the patient to"},{"speaker":"Chris Dy","startTime":514.96,"endTime":517.36,"body":"expect what's most important in"},{"speaker":"Chris Dy","startTime":517.36,"endTime":520.81,"body":"terms of outcomes, it is wide"},{"speaker":"Chris Dy","startTime":517.36,"endTime":520.81,"body":"open in terms of, you know,"},{"speaker":"Chris Dy","startTime":520.81,"endTime":524.14,"body":"finding some way to unify"},{"speaker":"Chris Dy","startTime":520.81,"endTime":524.14,"body":"everybody into figuring out what"},{"speaker":"Chris Dy","startTime":524.14,"endTime":526.48,"body":"to do with these patients"},{"speaker":"Chris Dy","startTime":524.14,"endTime":526.48,"body":"because universally they don't"},{"speaker":"Chris Dy","startTime":526.48,"endTime":526.93,"body":"do great."},{"speaker":"Charles Goldfarb","startTime":527.53,"endTime":529.93,"body":"So true. And"},{"speaker":"Charles Goldfarb","startTime":527.53,"endTime":529.93,"body":"that's no matter what the"},{"speaker":"Charles Goldfarb","startTime":529.93,"endTime":532.75,"body":"situation is, but especially"},{"speaker":"Charles Goldfarb","startTime":529.93,"endTime":532.75,"body":"with those sports injuries, so"},{"speaker":"Charles Goldfarb","startTime":532.75,"endTime":538.06,"body":"let's let's play some yes, no."},{"speaker":"Charles Goldfarb","startTime":532.75,"endTime":538.06,"body":"Do you always get a nerf study"},{"speaker":"Charles Goldfarb","startTime":538.09,"endTime":541.96,"body":"in the setting of a traumatic"},{"speaker":"Charles Goldfarb","startTime":538.09,"endTime":541.96,"body":"perineal nerve injury?"},{"speaker":"Chris Dy","startTime":542.89,"endTime":545.8,"body":"Yeah, I do. And we can"},{"speaker":"Chris Dy","startTime":542.89,"endTime":545.8,"body":"elaborate if you want me to or"},{"speaker":"Chris Dy","startTime":545.8,"endTime":548.65,"body":"not, but I think it is useful."},{"speaker":"Chris Dy","startTime":545.8,"endTime":548.65,"body":"It gives us a good baseline."},{"speaker":"Chris Dy","startTime":548.65,"endTime":550.51,"body":"These are always such poor"},{"speaker":"Chris Dy","startTime":548.65,"endTime":550.51,"body":"prognosis, you know,"},{"speaker":"Chris Dy","startTime":550.54,"endTime":553.51,"body":"prognostically it's pretty poor"},{"speaker":"Chris Dy","startTime":550.54,"endTime":553.51,"body":"most of the time just because of"},{"speaker":"Chris Dy","startTime":553.51,"endTime":556.51,"body":"the force on that nerve that you"},{"speaker":"Chris Dy","startTime":553.51,"endTime":556.51,"body":"know, if it's enough to disrupt,"},{"speaker":"Chris Dy","startTime":557.53,"endTime":559.81,"body":"you know, give you a multi leg"},{"speaker":"Chris Dy","startTime":557.53,"endTime":559.81,"body":"knee disruptive posterolateral"},{"speaker":"Chris Dy","startTime":559.81,"endTime":564.64,"body":"corner ACL PCL, you know, it's"},{"speaker":"Chris Dy","startTime":559.81,"endTime":564.64,"body":"going to be bad and typically"},{"speaker":"Chris Dy","startTime":564.64,"endTime":567.91,"body":"that zone of injury to the nerve"},{"speaker":"Chris Dy","startTime":564.64,"endTime":567.91,"body":"is incredibly broad and that is"},{"speaker":"Chris Dy","startTime":567.91,"endTime":570.73,"body":"pretty much directly associated"},{"speaker":"Chris Dy","startTime":567.91,"endTime":570.73,"body":"with their ultimate outcome"},{"speaker":"Chris Dy","startTime":570.73,"endTime":573.85,"body":"because there aren't great"},{"speaker":"Chris Dy","startTime":570.73,"endTime":573.85,"body":"options in terms of nerve"},{"speaker":"Chris Dy","startTime":573.85,"endTime":576.7,"body":"reconstruction there if the if"},{"speaker":"Chris Dy","startTime":573.85,"endTime":576.7,"body":"the zone of injury is really"},{"speaker":"Chris Dy","startTime":576.7,"endTime":579.64,"body":"wide. So I like to get the nerve"},{"speaker":"Chris Dy","startTime":576.7,"endTime":579.64,"body":"study just to establish you"},{"speaker":"Chris Dy","startTime":579.64,"endTime":583.06,"body":"know, honestly, how bad it is."},{"speaker":"Chris Dy","startTime":579.64,"endTime":583.06,"body":"And then if it's you know,"},{"speaker":"Chris Dy","startTime":583.06,"endTime":586.03,"body":"usually don't have the luxury of"},{"speaker":"Chris Dy","startTime":583.06,"endTime":586.03,"body":"time in these patients because"},{"speaker":"Chris Dy","startTime":586.54,"endTime":589.84,"body":"you'll you don't want to go"},{"speaker":"Chris Dy","startTime":586.54,"endTime":589.84,"body":"after the knee surgery has been"},{"speaker":"Chris Dy","startTime":589.84,"endTime":592.54,"body":"done and everything as rescored"},{"speaker":"Chris Dy","startTime":589.84,"endTime":592.54,"body":"back end, so you kind of got one"},{"speaker":"Chris Dy","startTime":592.54,"endTime":594.79,"body":"shot and that's when you got to"},{"speaker":"Chris Dy","startTime":592.54,"endTime":594.79,"body":"negotiate with your partners as"},{"speaker":"Chris Dy","startTime":594.79,"endTime":596.41,"body":"to when the right timing to do"},{"speaker":"Chris Dy","startTime":594.79,"endTime":596.41,"body":"it is"},{"speaker":"Charles Goldfarb","startTime":597.1,"endTime":599.83,"body":"yeah, and as"},{"speaker":"Charles Goldfarb","startTime":597.1,"endTime":599.83,"body":"we all know, our sports surgeons"},{"speaker":"Charles Goldfarb","startTime":599.83,"endTime":604.06,"body":"will wha definitely get an MRI."},{"speaker":"Charles Goldfarb","startTime":599.83,"endTime":604.06,"body":"Is that sufficient for"},{"speaker":"Charles Goldfarb","startTime":604.06,"endTime":606.67,"body":"visualizing the nerve? Or do you"},{"speaker":"Charles Goldfarb","startTime":604.06,"endTime":606.67,"body":"need an ultrasound?"},{"speaker":"Chris Dy","startTime":607.33,"endTime":609.76,"body":"I think it depends on"},{"speaker":"Chris Dy","startTime":607.33,"endTime":609.76,"body":"where you are. You know, I think"},{"speaker":"Chris Dy","startTime":609.76,"endTime":612.49,"body":"one thing that I like about the"},{"speaker":"Chris Dy","startTime":609.76,"endTime":612.49,"body":"ultrasound not only in this"},{"speaker":"Chris Dy","startTime":612.49,"endTime":615.82,"body":"context, but just in general is"},{"speaker":"Chris Dy","startTime":612.49,"endTime":615.82,"body":"that for injuries in which you"},{"speaker":"Chris Dy","startTime":615.82,"endTime":619.0,"body":"have a closed or a ballistic"},{"speaker":"Chris Dy","startTime":615.82,"endTime":619.0,"body":"mechanism, and ultrasound can"},{"speaker":"Chris Dy","startTime":619.0,"endTime":622.18,"body":"pretty quickly tell you is this"},{"speaker":"Chris Dy","startTime":619.0,"endTime":622.18,"body":"a nerve in continuity or not in"},{"speaker":"Chris Dy","startTime":622.18,"endTime":625.96,"body":"continuity, and that has been"},{"speaker":"Chris Dy","startTime":622.18,"endTime":625.96,"body":"really helpful for us. You know,"},{"speaker":"Chris Dy","startTime":625.96,"endTime":629.05,"body":"for example, for things like,"},{"speaker":"Chris Dy","startTime":625.96,"endTime":629.05,"body":"you know, gunshot wounds, which"},{"speaker":"Chris Dy","startTime":629.05,"endTime":631.84,"body":"we've seen St. Louis around the"},{"speaker":"Chris Dy","startTime":629.05,"endTime":631.84,"body":"knee, getting an ultrasound has"},{"speaker":"Chris Dy","startTime":631.84,"endTime":634.81,"body":"told us that nerve is not in one"},{"speaker":"Chris Dy","startTime":631.84,"endTime":634.81,"body":"piece. And then why wait any"},{"speaker":"Chris Dy","startTime":634.81,"endTime":637.72,"body":"longer than you have to get"},{"speaker":"Chris Dy","startTime":634.81,"endTime":637.72,"body":"patient on the schedule, because"},{"speaker":"Chris Dy","startTime":637.72,"endTime":640.87,"body":"you have a shot, you know, if"},{"speaker":"Chris Dy","startTime":637.72,"endTime":640.87,"body":"you if you get there early, so I"},{"speaker":"Chris Dy","startTime":640.87,"endTime":643.15,"body":"like the ultrasound for that"},{"speaker":"Chris Dy","startTime":640.87,"endTime":643.15,"body":"reason, I think the MRI is"},{"speaker":"Chris Dy","startTime":643.15,"endTime":645.52,"body":"useful, but I still like it in"},{"speaker":"Chris Dy","startTime":643.15,"endTime":645.52,"body":"the ultrasound because it gives"},{"speaker":"Chris Dy","startTime":645.52,"endTime":648.61,"body":"me the exact information I need."},{"speaker":"Chris Dy","startTime":645.52,"endTime":648.61,"body":"And I can't always rely on the"},{"speaker":"Chris Dy","startTime":648.61,"endTime":649.6,"body":"quality of the MRI."},{"speaker":"Charles Goldfarb","startTime":650.32,"endTime":652.3,"body":"Perfect,"},{"speaker":"Charles Goldfarb","startTime":650.32,"endTime":652.3,"body":"unless you have other"},{"speaker":"Charles Goldfarb","startTime":652.3,"endTime":656.53,"body":"preoperative considerations, I'd"},{"speaker":"Charles Goldfarb","startTime":652.3,"endTime":656.53,"body":"like to jump to just diving into"},{"speaker":"Charles Goldfarb","startTime":656.53,"endTime":657.91,"body":"the weeds of the surgery."},{"speaker":"Chris Dy","startTime":659.26,"endTime":661.15,"body":"Well, I think what"},{"speaker":"Chris Dy","startTime":659.26,"endTime":661.15,"body":"would be more useful than"},{"speaker":"Chris Dy","startTime":661.15,"endTime":663.58,"body":"talking about it in the multilin"},{"speaker":"Chris Dy","startTime":661.15,"endTime":663.58,"body":"context was just kind of a"},{"speaker":"Chris Dy","startTime":663.58,"endTime":666.31,"body":"standard common perineal nerve"},{"speaker":"Chris Dy","startTime":663.58,"endTime":666.31,"body":"decompression, because that's"},{"speaker":"Chris Dy","startTime":666.31,"endTime":669.04,"body":"what most people are going to be"},{"speaker":"Chris Dy","startTime":666.31,"endTime":669.04,"body":"treating. If they do treat this"},{"speaker":"Chris Dy","startTime":669.04,"endTime":672.37,"body":"population. Honestly, it's not"},{"speaker":"Chris Dy","startTime":669.04,"endTime":672.37,"body":"that different than many of our"},{"speaker":"Chris Dy","startTime":672.37,"endTime":675.4,"body":"other upper extremity nerve"},{"speaker":"Chris Dy","startTime":672.37,"endTime":675.4,"body":"decompressions. You know, so"},{"speaker":"Chris Dy","startTime":675.4,"endTime":678.25,"body":"the, you know, the CPN,"},{"speaker":"Chris Dy","startTime":675.4,"endTime":678.25,"body":"oftentimes, you'll see these"},{"speaker":"Chris Dy","startTime":678.25,"endTime":682.06,"body":"patients with a foot drop either"},{"speaker":"Chris Dy","startTime":678.25,"endTime":682.06,"body":"a florid foot drop, or just"},{"speaker":"Chris Dy","startTime":682.06,"endTime":684.67,"body":"motor weakness in trying to"},{"speaker":"Chris Dy","startTime":682.06,"endTime":684.67,"body":"bring your ankle into"},{"speaker":"Chris Dy","startTime":684.67,"endTime":687.34,"body":"dorsiflexion. And oftentimes,"},{"speaker":"Chris Dy","startTime":684.67,"endTime":687.34,"body":"that great toe kind of drags"},{"speaker":"Chris Dy","startTime":687.34,"endTime":690.67,"body":"down, that's in addition to the"},{"speaker":"Chris Dy","startTime":687.34,"endTime":690.67,"body":"classic paraesthesia, just like"},{"speaker":"Chris Dy","startTime":690.67,"endTime":692.86,"body":"you would for any peripheral"},{"speaker":"Chris Dy","startTime":690.67,"endTime":692.86,"body":"nerve, and this one happens to"},{"speaker":"Chris Dy","startTime":692.86,"endTime":696.97,"body":"be on the dorsum of the foot"},{"speaker":"Chris Dy","startTime":692.86,"endTime":696.97,"body":"typically. So there are a couple"},{"speaker":"Chris Dy","startTime":696.97,"endTime":699.94,"body":"of pearls that I like on the"},{"speaker":"Chris Dy","startTime":696.97,"endTime":699.94,"body":"physical exam, and maybe you can"},{"speaker":"Chris Dy","startTime":699.94,"endTime":703.24,"body":"share your, you know, expertise"},{"speaker":"Chris Dy","startTime":699.94,"endTime":703.24,"body":"in this too. But, you know,"},{"speaker":"Chris Dy","startTime":703.27,"endTime":706.09,"body":"oftentimes, you know, patients"},{"speaker":"Chris Dy","startTime":703.27,"endTime":706.09,"body":"are pretty strong with ankle"},{"speaker":"Chris Dy","startTime":706.09,"endTime":708.85,"body":"dorsiflexion. And you kind of"},{"speaker":"Chris Dy","startTime":706.09,"endTime":708.85,"body":"have to work hard to show them,"},{"speaker":"Chris Dy","startTime":708.88,"endTime":711.79,"body":"you know, that they're"},{"speaker":"Chris Dy","startTime":708.88,"endTime":711.79,"body":"particularly weak. Now, if they"},{"speaker":"Chris Dy","startTime":711.79,"endTime":714.67,"body":"are, you know, you want to make"},{"speaker":"Chris Dy","startTime":711.79,"endTime":714.67,"body":"sure that you're pulling real"},{"speaker":"Chris Dy","startTime":714.67,"endTime":717.04,"body":"hard on them and show them on"},{"speaker":"Chris Dy","startTime":714.67,"endTime":717.04,"body":"the other side how strong they"},{"speaker":"Chris Dy","startTime":717.04,"endTime":719.26,"body":"are. Oftentimes, if they're"},{"speaker":"Chris Dy","startTime":717.04,"endTime":719.26,"body":"strong enough, on the other"},{"speaker":"Chris Dy","startTime":719.26,"endTime":722.41,"body":"side, you kind of pull them"},{"speaker":"Chris Dy","startTime":719.26,"endTime":722.41,"body":"forward on the, on the chair, or"},{"speaker":"Chris Dy","startTime":722.44,"endTime":725.08,"body":"kind of pull them off the exam"},{"speaker":"Chris Dy","startTime":722.44,"endTime":725.08,"body":"table almost. And you can really"},{"speaker":"Chris Dy","startTime":725.08,"endTime":727.81,"body":"find some weakness there. For"},{"speaker":"Chris Dy","startTime":725.08,"endTime":727.81,"body":"the ones that have a florid foot"},{"speaker":"Chris Dy","startTime":727.81,"endTime":730.24,"body":"drop, and you're looking to see"},{"speaker":"Chris Dy","startTime":727.81,"endTime":730.24,"body":"if there's any recovery, I think"},{"speaker":"Chris Dy","startTime":730.24,"endTime":732.67,"body":"crossing the leg over like"},{"speaker":"Chris Dy","startTime":730.24,"endTime":732.67,"body":"you're making a figure four,"},{"speaker":"Chris Dy","startTime":733.21,"endTime":735.43,"body":"it's very useful to take gravity"},{"speaker":"Chris Dy","startTime":733.21,"endTime":735.43,"body":"out of the picture to really"},{"speaker":"Chris Dy","startTime":735.43,"endTime":738.49,"body":"find that kind of m two. And"},{"speaker":"Chris Dy","startTime":735.43,"endTime":738.49,"body":"that's one thing that I show our"},{"speaker":"Chris Dy","startTime":738.49,"endTime":739.75,"body":"residents and fellows all the"},{"speaker":"Chris Dy","startTime":738.49,"endTime":739.75,"body":"time."},{"speaker":"Charles Goldfarb","startTime":740.62,"endTime":741.97,"body":"No, I love"},{"speaker":"Charles Goldfarb","startTime":740.62,"endTime":741.97,"body":"those I don't know, they have"},{"speaker":"Charles Goldfarb","startTime":741.97,"endTime":745.27,"body":"more to add, I really only do"},{"speaker":"Charles Goldfarb","startTime":741.97,"endTime":745.27,"body":"this operation in the context of"},{"speaker":"Charles Goldfarb","startTime":745.27,"endTime":749.8,"body":"a multiligament knee injury."},{"speaker":"Charles Goldfarb","startTime":745.27,"endTime":749.8,"body":"But, you know, I now have the"},{"speaker":"Charles Goldfarb","startTime":749.8,"endTime":752.47,"body":"lingo down, Chris texted me"},{"speaker":"Charles Goldfarb","startTime":749.8,"endTime":752.47,"body":"earlier to suggest this topic"},{"speaker":"Charles Goldfarb","startTime":752.47,"endTime":758.17,"body":"and said, Let's talk about CPN."},{"speaker":"Charles Goldfarb","startTime":752.47,"endTime":758.17,"body":"And I'm like CPM, CPM. What the"},{"speaker":"Charles Goldfarb","startTime":758.17,"endTime":761.83,"body":"heck is going on, but now, if I"},{"speaker":"Charles Goldfarb","startTime":758.17,"endTime":761.83,"body":"want to be a real nerf surgeon,"},{"speaker":"Charles Goldfarb","startTime":761.83,"endTime":765.46,"body":"I have to have the window down."},{"speaker":"Charles Goldfarb","startTime":761.83,"endTime":765.46,"body":"So CPN, Common Peroneal Nerve,"},{"speaker":"Charles Goldfarb","startTime":765.46,"endTime":765.85,"body":"I've got it"},{"speaker":"Chris Dy","startTime":766.48,"endTime":769.0,"body":"nice, nice. And then"},{"speaker":"Chris Dy","startTime":766.48,"endTime":769.0,"body":"the other, the other, the other"},{"speaker":"Chris Dy","startTime":769.0,"endTime":771.4,"body":"pearl that I found on exam, and"},{"speaker":"Chris Dy","startTime":769.0,"endTime":771.4,"body":"this is all stuff that I mean, I"},{"speaker":"Chris Dy","startTime":771.4,"endTime":773.92,"body":"didn't see this in fellowship,"},{"speaker":"Chris Dy","startTime":771.4,"endTime":773.92,"body":"but just kind of learned it"},{"speaker":"Chris Dy","startTime":773.92,"endTime":777.85,"body":"along the way, you know, with"},{"speaker":"Chris Dy","startTime":773.92,"endTime":777.85,"body":"with checking ankle eversion,"},{"speaker":"Chris Dy","startTime":777.85,"endTime":780.58,"body":"which is the function of the"},{"speaker":"Chris Dy","startTime":777.85,"endTime":780.58,"body":"perineum, longus and brevis."},{"speaker":"Chris Dy","startTime":781.48,"endTime":784.42,"body":"Oftentimes, when you do that,"},{"speaker":"Chris Dy","startTime":781.48,"endTime":784.42,"body":"patients will use a lot of"},{"speaker":"Chris Dy","startTime":784.42,"endTime":788.32,"body":"compensatory muscles to show you"},{"speaker":"Chris Dy","startTime":784.42,"endTime":788.32,"body":"to basically try to evade their"},{"speaker":"Chris Dy","startTime":788.32,"endTime":791.77,"body":"ankle. So if you're not careful,"},{"speaker":"Chris Dy","startTime":788.32,"endTime":791.77,"body":"you will see they will"},{"speaker":"Chris Dy","startTime":791.77,"endTime":794.74,"body":"compensate by externally"},{"speaker":"Chris Dy","startTime":791.77,"endTime":794.74,"body":"rotating your hip by abducting"},{"speaker":"Chris Dy","startTime":794.74,"endTime":797.86,"body":"their hip and activating their"},{"speaker":"Chris Dy","startTime":794.74,"endTime":797.86,"body":"IT band. So you'll see these"},{"speaker":"Chris Dy","startTime":797.86,"endTime":802.45,"body":"things I really tried to when"},{"speaker":"Chris Dy","startTime":797.86,"endTime":802.45,"body":"I'm examining them how one hand"},{"speaker":"Chris Dy","startTime":802.45,"endTime":805.39,"body":"on the outside of the knee to"},{"speaker":"Chris Dy","startTime":802.45,"endTime":805.39,"body":"stop them from compensating that"},{"speaker":"Chris Dy","startTime":805.39,"endTime":809.2,"body":"way, and then really see how"},{"speaker":"Chris Dy","startTime":805.39,"endTime":809.2,"body":"well they can even get out. And"},{"speaker":"Chris Dy","startTime":809.2,"endTime":811.48,"body":"I found that to be helpful,"},{"speaker":"Chris Dy","startTime":809.2,"endTime":811.48,"body":"again, you know, demonstrating"},{"speaker":"Chris Dy","startTime":811.48,"endTime":814.12,"body":"to a patient that there is"},{"speaker":"Chris Dy","startTime":811.48,"endTime":814.12,"body":"something you know, what's"},{"speaker":"Chris Dy","startTime":814.12,"endTime":816.52,"body":"visible and notable and"},{"speaker":"Chris Dy","startTime":814.12,"endTime":816.52,"body":"examination, I think, is"},{"speaker":"Chris Dy","startTime":816.52,"endTime":818.44,"body":"compelling it that a lot of"},{"speaker":"Chris Dy","startTime":816.52,"endTime":818.44,"body":"times, you know, especially if"},{"speaker":"Chris Dy","startTime":818.44,"endTime":820.78,"body":"you're in the context of you"},{"speaker":"Chris Dy","startTime":818.44,"endTime":820.78,"body":"know, maybe we should talk about"},{"speaker":"Chris Dy","startTime":820.78,"endTime":821.29,"body":"surgery."},{"speaker":"Charles Goldfarb","startTime":822.209,"endTime":825.509,"body":"So, are these"},{"speaker":"Charles Goldfarb","startTime":822.209,"endTime":825.509,"body":"patients usually sent to you for"},{"speaker":"Charles Goldfarb","startTime":825.509,"endTime":830.159,"body":"surgery? Because I assume you're"},{"speaker":"Charles Goldfarb","startTime":825.509,"endTime":830.159,"body":"not commonly making this"},{"speaker":"Charles Goldfarb","startTime":830.159,"endTime":832.229,"body":"diagnosis on your own?"},{"speaker":"Chris Dy","startTime":833.37,"endTime":836.25,"body":"Um, no, I mean, they"},{"speaker":"Chris Dy","startTime":833.37,"endTime":836.25,"body":"usually sent to me with, you"},{"speaker":"Chris Dy","startTime":836.25,"endTime":839.4,"body":"know, evaluate for foot drop,"},{"speaker":"Chris Dy","startTime":836.25,"endTime":839.4,"body":"where they've come from the foot"},{"speaker":"Chris Dy","startTime":839.4,"endTime":841.98,"body":"and ankle surgeon because they"},{"speaker":"Chris Dy","startTime":839.4,"endTime":841.98,"body":"were sent by the spine surgeon"},{"speaker":"Chris Dy","startTime":841.98,"endTime":843.99,"body":"to the finagle surgeon for"},{"speaker":"Chris Dy","startTime":841.98,"endTime":843.99,"body":"attended transfer, and they"},{"speaker":"Chris Dy","startTime":843.99,"endTime":845.55,"body":"said, well, maybe there's"},{"speaker":"Chris Dy","startTime":843.99,"endTime":845.55,"body":"something in between that we"},{"speaker":"Chris Dy","startTime":845.55,"endTime":848.76,"body":"could do. And, you know, I think"},{"speaker":"Chris Dy","startTime":845.55,"endTime":848.76,"body":"that, you know, our residents"},{"speaker":"Chris Dy","startTime":848.76,"endTime":851.01,"body":"and fellows have helped kind of"},{"speaker":"Chris Dy","startTime":848.76,"endTime":851.01,"body":"drive this too, because if"},{"speaker":"Chris Dy","startTime":851.01,"endTime":853.59,"body":"they're rotating with me, and"},{"speaker":"Chris Dy","startTime":851.01,"endTime":853.59,"body":"then they go and rotate with one"},{"speaker":"Chris Dy","startTime":853.59,"endTime":856.86,"body":"of the other Doc's and are doing"},{"speaker":"Chris Dy","startTime":853.59,"endTime":856.86,"body":"a tonnelle sign around the the"},{"speaker":"Chris Dy","startTime":856.86,"endTime":860.16,"body":"fibular neck, super helpful for"},{"speaker":"Chris Dy","startTime":856.86,"endTime":860.16,"body":"me, because they'll bring that"},{"speaker":"Chris Dy","startTime":860.16,"endTime":862.98,"body":"up, I think with with the"},{"speaker":"Chris Dy","startTime":860.16,"endTime":862.98,"body":"faculty that they're working"},{"speaker":"Chris Dy","startTime":862.98,"endTime":865.74,"body":"with, and I think it's an"},{"speaker":"Chris Dy","startTime":862.98,"endTime":865.74,"body":"outside is really helpful in"},{"speaker":"Chris Dy","startTime":865.74,"endTime":868.11,"body":"this particular condition,"},{"speaker":"Chris Dy","startTime":865.74,"endTime":868.11,"body":"because sometimes it's not"},{"speaker":"Chris Dy","startTime":868.11,"endTime":870.3,"body":"necessarily foot drop, it's just"},{"speaker":"Chris Dy","startTime":868.11,"endTime":870.3,"body":"a pair of features that bother"},{"speaker":"Chris Dy","startTime":870.3,"endTime":870.57,"body":"them."},{"speaker":"Charles Goldfarb","startTime":870.96,"endTime":876.03,"body":"Right, right."},{"speaker":"Charles Goldfarb","startTime":870.96,"endTime":876.03,"body":"Okay. We've talked about exam,"},{"speaker":"Charles Goldfarb","startTime":876.06,"endTime":879.0,"body":"we've talked about imaging, is"},{"speaker":"Charles Goldfarb","startTime":876.06,"endTime":879.0,"body":"it time to talk about my"},{"speaker":"Charles Goldfarb","startTime":879.0,"endTime":880.11,"body":"favorite thing next,"},{"speaker":"Chris Dy","startTime":880.38,"endTime":881.19,"body":"the nerve study?"},{"speaker":"Charles Goldfarb","startTime":883.62,"endTime":885.0,"body":"I can't take"},{"speaker":"Charles Goldfarb","startTime":883.62,"endTime":885.0,"body":"it anymore."},{"speaker":"Chris Dy","startTime":886.049,"endTime":888.779,"body":"The Ultra I think for"},{"speaker":"Chris Dy","startTime":886.049,"endTime":888.779,"body":"for CPN. I think that you know,"},{"speaker":"Chris Dy","startTime":888.779,"endTime":891.869,"body":"there's lingo again, and our"},{"speaker":"Chris Dy","startTime":888.779,"endTime":891.869,"body":"physiatry colleagues will call"},{"speaker":"Chris Dy","startTime":891.869,"endTime":894.539,"body":"it the fibular nerve instead of"},{"speaker":"Chris Dy","startTime":891.869,"endTime":894.539,"body":"the perineal nerve. So just you"},{"speaker":"Chris Dy","startTime":894.539,"endTime":897.359,"body":"know, we may be caught off"},{"speaker":"Chris Dy","startTime":894.539,"endTime":897.359,"body":"guard. I think ultrasound is"},{"speaker":"Chris Dy","startTime":897.359,"endTime":899.189,"body":"super helpful in terms of"},{"speaker":"Chris Dy","startTime":897.359,"endTime":899.189,"body":"looking at enlargement"},{"speaker":"Chris Dy","startTime":899.189,"endTime":901.529,"body":"especially compared to the"},{"speaker":"Chris Dy","startTime":899.189,"endTime":901.529,"body":"opposite side, analogous to"},{"speaker":"Chris Dy","startTime":901.529,"endTime":903.959,"body":"cubital tunnel, it's, you know,"},{"speaker":"Chris Dy","startTime":901.529,"endTime":903.959,"body":"a nerve working its way around"},{"speaker":"Chris Dy","startTime":903.959,"endTime":906.359,"body":"the bone. So looking for a"},{"speaker":"Chris Dy","startTime":903.959,"endTime":906.359,"body":"conduction velocity loss is"},{"speaker":"Chris Dy","startTime":906.359,"endTime":910.229,"body":"useful. And then also looking at"},{"speaker":"Chris Dy","startTime":906.359,"endTime":910.229,"body":"changes in the motor amplitudes."},{"speaker":"Chris Dy","startTime":910.229,"endTime":913.619,"body":"But again, that's a topic for"},{"speaker":"Chris Dy","startTime":910.229,"endTime":913.619,"body":"kind of really getting into the"},{"speaker":"Chris Dy","startTime":913.619,"endTime":917.999,"body":"weeds. But I think surgery, it's"},{"speaker":"Chris Dy","startTime":913.619,"endTime":917.999,"body":"it's a great surgery, I'll be"},{"speaker":"Chris Dy","startTime":917.999,"endTime":921.449,"body":"honest with you, I think it's a"},{"speaker":"Chris Dy","startTime":917.999,"endTime":921.449,"body":"fun surgery to do. You know, I"},{"speaker":"Chris Dy","startTime":921.449,"endTime":925.649,"body":"think it helps patients a lot."},{"speaker":"Chris Dy","startTime":921.449,"endTime":925.649,"body":"You know, and I've even done it"},{"speaker":"Chris Dy","startTime":925.649,"endTime":926.009,"body":"awake."},{"speaker":"Charles Goldfarb","startTime":926.49,"endTime":928.14,"body":"I did an awake"},{"speaker":"Charles Goldfarb","startTime":926.49,"endTime":928.14,"body":"surgery today, which I should"},{"speaker":"Charles Goldfarb","startTime":928.14,"endTime":931.86,"body":"tell you about at some point. So"},{"speaker":"Charles Goldfarb","startTime":928.14,"endTime":931.86,"body":"is it time,"},{"speaker":"Chris Dy","startTime":932.309,"endTime":934.199,"body":"it's time we can talk"},{"speaker":"Chris Dy","startTime":932.309,"endTime":934.199,"body":"about the surgery?"},{"speaker":"Charles Goldfarb","startTime":934.65,"endTime":936.87,"body":"All right, I"},{"speaker":"Charles Goldfarb","startTime":934.65,"endTime":936.87,"body":"want to start with your"},{"speaker":"Charles Goldfarb","startTime":936.87,"endTime":938.97,"body":"positioning, how do you position"},{"speaker":"Charles Goldfarb","startTime":936.87,"endTime":938.97,"body":"the patient on the table."},{"speaker":"Chris Dy","startTime":939.809,"endTime":941.909,"body":"So this is a case"},{"speaker":"Chris Dy","startTime":939.809,"endTime":941.909,"body":"where I don't know what it's"},{"speaker":"Chris Dy","startTime":941.909,"endTime":944.339,"body":"like in other places. At least"},{"speaker":"Chris Dy","startTime":941.909,"endTime":944.339,"body":"the culture here has been for"},{"speaker":"Chris Dy","startTime":944.339,"endTime":947.969,"body":"these, you know, relatively"},{"speaker":"Chris Dy","startTime":944.339,"endTime":947.969,"body":"short ambulate, outpatient hand"},{"speaker":"Chris Dy","startTime":947.969,"endTime":950.549,"body":"surgeries, essentially anything"},{"speaker":"Chris Dy","startTime":947.969,"endTime":950.549,"body":"two hours or less. We do"},{"speaker":"Chris Dy","startTime":950.549,"endTime":953.039,"body":"everything on a stretcher here"},{"speaker":"Chris Dy","startTime":950.549,"endTime":953.039,"body":"with a you know, a hand table"},{"speaker":"Chris Dy","startTime":953.039,"endTime":956.039,"body":"kind of slid underneath the"},{"speaker":"Chris Dy","startTime":953.039,"endTime":956.039,"body":"stretcher. For me, this is no"},{"speaker":"Chris Dy","startTime":956.039,"endTime":959.549,"body":"exception. You know, I think"},{"speaker":"Chris Dy","startTime":956.039,"endTime":959.549,"body":"that it's great to do a non"},{"speaker":"Chris Dy","startTime":959.549,"endTime":962.609,"body":"sterile tourniquet, bump under"},{"speaker":"Chris Dy","startTime":959.549,"endTime":962.609,"body":"the ipsilateral hip making sure"},{"speaker":"Chris Dy","startTime":962.609,"endTime":964.889,"body":"that you're able to externally"},{"speaker":"Chris Dy","startTime":962.609,"endTime":964.889,"body":"rotate or internally rotate them"},{"speaker":"Chris Dy","startTime":964.889,"endTime":968.699,"body":"a fair bit. And especially if"},{"speaker":"Chris Dy","startTime":964.889,"endTime":968.699,"body":"we're going to do a superficial"},{"speaker":"Chris Dy","startTime":968.699,"endTime":971.699,"body":"perineal nerve decompression at"},{"speaker":"Chris Dy","startTime":968.699,"endTime":971.699,"body":"the same time, putting a little"},{"speaker":"Chris Dy","startTime":971.729,"endTime":975.539,"body":"that little bone foam wedge,"},{"speaker":"Chris Dy","startTime":971.729,"endTime":975.539,"body":"sliding it right underneath the"},{"speaker":"Chris Dy","startTime":975.539,"endTime":978.329,"body":"upper thigh on the posterior"},{"speaker":"Chris Dy","startTime":975.539,"endTime":978.329,"body":"aspect, I think is super useful"},{"speaker":"Chris Dy","startTime":978.599,"endTime":981.809,"body":"in terms of getting them exactly"},{"speaker":"Chris Dy","startTime":978.599,"endTime":981.809,"body":"where you need them to be. How"},{"speaker":"Chris Dy","startTime":981.809,"endTime":984.239,"body":"do you position them? Or is it"},{"speaker":"Chris Dy","startTime":981.809,"endTime":984.239,"body":"mainly dictated by the sports"},{"speaker":"Chris Dy","startTime":984.269,"endTime":984.839,"body":"surgery?"},{"speaker":"Charles Goldfarb","startTime":985.11,"endTime":987.57,"body":"Yeah, I don't"},{"speaker":"Charles Goldfarb","startTime":985.11,"endTime":987.57,"body":"usually get a lot of say I do my"},{"speaker":"Charles Goldfarb","startTime":987.57,"endTime":990.87,"body":"darndest to get a bump under the"},{"speaker":"Charles Goldfarb","startTime":987.57,"endTime":990.87,"body":"hip to give me some of that"},{"speaker":"Charles Goldfarb","startTime":990.87,"endTime":995.79,"body":"positioning. But usually I'm in"},{"speaker":"Charles Goldfarb","startTime":990.87,"endTime":995.79,"body":"an awkward position trying to"},{"speaker":"Charles Goldfarb","startTime":995.85,"endTime":997.17,"body":"that thigh"},{"speaker":"Chris Dy","startTime":997.17,"endTime":999.51,"body":"holder is the worst."},{"speaker":"Chris Dy","startTime":997.17,"endTime":999.51,"body":"They like that little you that"},{"speaker":"Chris Dy","startTime":999.51,"endTime":1002.06,"body":"they put underneath the post"},{"speaker":"Chris Dy","startTime":999.51,"endTime":1002.06,"body":"your thigh that just hoses you"},{"speaker":"Chris Dy","startTime":1002.06,"endTime":1002.69,"body":"every time."},{"speaker":"Charles Goldfarb","startTime":1003.11,"endTime":1005.42,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":1003.11,"endTime":1005.42,"body":"thankfully, they're not usually"},{"speaker":"Charles Goldfarb","startTime":1005.42,"endTime":1009.05,"body":"scoping. So it usually is just"},{"speaker":"Charles Goldfarb","startTime":1005.42,"endTime":1009.05,"body":"supine, but it doesn't make it"},{"speaker":"Charles Goldfarb","startTime":1009.05,"endTime":1011.66,"body":"any easier because their goals"},{"speaker":"Charles Goldfarb","startTime":1009.05,"endTime":1011.66,"body":"and my goals are not the same"},{"speaker":"Charles Goldfarb","startTime":1011.69,"endTime":1013.25,"body":"other than great care for the"},{"speaker":"Charles Goldfarb","startTime":1011.69,"endTime":1013.25,"body":"patient."},{"speaker":"Chris Dy","startTime":1013.49,"endTime":1016.31,"body":"Right, of course, you"},{"speaker":"Chris Dy","startTime":1013.49,"endTime":1016.31,"body":"don't quite think about that, if"},{"speaker":"Chris Dy","startTime":1016.31,"endTime":1018.92,"body":"you ever are going to be in a"},{"speaker":"Chris Dy","startTime":1016.31,"endTime":1018.92,"body":"case for somebody scoping you"},{"speaker":"Chris Dy","startTime":1018.92,"endTime":1022.13,"body":"need to go first. Because once"},{"speaker":"Chris Dy","startTime":1018.92,"endTime":1022.13,"body":"those subcutaneous tissues get"},{"speaker":"Chris Dy","startTime":1022.13,"endTime":1024.8,"body":"blown up by the liters of fluid"},{"speaker":"Chris Dy","startTime":1022.13,"endTime":1024.8,"body":"that get pumped through there,"},{"speaker":"Chris Dy","startTime":1024.8,"endTime":1028.97,"body":"all your normal planes are gone."},{"speaker":"Chris Dy","startTime":1024.8,"endTime":1028.97,"body":"You take a surgery that would"},{"speaker":"Chris Dy","startTime":1028.97,"endTime":1032.3,"body":"take you a much shorter period"},{"speaker":"Chris Dy","startTime":1028.97,"endTime":1032.3,"body":"of time, and you can trip double"},{"speaker":"Chris Dy","startTime":1032.3,"endTime":1033.35,"body":"or triple the time needed."},{"speaker":"Charles Goldfarb","startTime":1034.07,"endTime":1037.1,"body":"Absolutely,"},{"speaker":"Charles Goldfarb","startTime":1034.07,"endTime":1037.1,"body":"absolutely. So usually what I"},{"speaker":"Charles Goldfarb","startTime":1037.1,"endTime":1039.62,"body":"have done again, in the context"},{"speaker":"Charles Goldfarb","startTime":1037.1,"endTime":1039.62,"body":"of working in one of my sports"},{"speaker":"Charles Goldfarb","startTime":1039.62,"endTime":1042.98,"body":"partners, whether that's"},{"speaker":"Charles Goldfarb","startTime":1039.62,"endTime":1042.98,"body":"pediatrics, pediatric sports, or"},{"speaker":"Charles Goldfarb","startTime":1042.98,"endTime":1047.84,"body":"adult sports, is sort of just a"},{"speaker":"Charles Goldfarb","startTime":1042.98,"endTime":1047.84,"body":"posterior lateral incision, sort"},{"speaker":"Charles Goldfarb","startTime":1047.84,"endTime":1055.19,"body":"of over the fibular head heading"},{"speaker":"Charles Goldfarb","startTime":1047.84,"endTime":1055.19,"body":"proximately I try to always just"},{"speaker":"Charles Goldfarb","startTime":1055.19,"endTime":1057.95,"body":"classic for me, I always start"},{"speaker":"Charles Goldfarb","startTime":1055.19,"endTime":1057.95,"body":"small and end up enlarging my"},{"speaker":"Charles Goldfarb","startTime":1057.95,"endTime":1061.67,"body":"incision. Tell me about your"},{"speaker":"Charles Goldfarb","startTime":1057.95,"endTime":1061.67,"body":"landmarks for your initial"},{"speaker":"Charles Goldfarb","startTime":1061.67,"endTime":1062.27,"body":"incision."},{"speaker":"Chris Dy","startTime":1062.93,"endTime":1064.79,"body":"Um, you know, I think"},{"speaker":"Chris Dy","startTime":1062.93,"endTime":1064.79,"body":"that that's pretty much how it"},{"speaker":"Chris Dy","startTime":1064.79,"endTime":1067.07,"body":"goes, if you're working with"},{"speaker":"Chris Dy","startTime":1064.79,"endTime":1067.07,"body":"somebody who needs to get to the"},{"speaker":"Chris Dy","startTime":1067.1,"endTime":1068.9,"body":"you know, the posterolateral"},{"speaker":"Chris Dy","startTime":1067.1,"endTime":1068.9,"body":"corner is that they're going to"},{"speaker":"Chris Dy","startTime":1068.9,"endTime":1071.6,"body":"want to cheat the incision,"},{"speaker":"Chris Dy","startTime":1068.9,"endTime":1071.6,"body":"probably more proximal, or I"},{"speaker":"Chris Dy","startTime":1071.6,"endTime":1074.75,"body":"guess the technical term is"},{"speaker":"Chris Dy","startTime":1071.6,"endTime":1074.75,"body":"cephalad than where you would"},{"speaker":"Chris Dy","startTime":1074.87,"endTime":1078.05,"body":"normally put it if you're just"},{"speaker":"Chris Dy","startTime":1074.87,"endTime":1078.05,"body":"working on the nerve. If I'm"},{"speaker":"Chris Dy","startTime":1078.05,"endTime":1080.45,"body":"just working on a nerve, it"},{"speaker":"Chris Dy","startTime":1078.05,"endTime":1080.45,"body":"tends to follow the course of"},{"speaker":"Chris Dy","startTime":1080.45,"endTime":1083.6,"body":"the nerve. So it tends to sit a"},{"speaker":"Chris Dy","startTime":1080.45,"endTime":1083.6,"body":"few centimeters distal to the"},{"speaker":"Chris Dy","startTime":1083.6,"endTime":1087.47,"body":"very proximal end of the fibular"},{"speaker":"Chris Dy","startTime":1083.6,"endTime":1087.47,"body":"head. Because that's where I"},{"speaker":"Chris Dy","startTime":1087.47,"endTime":1091.19,"body":"know the nerve is going to be I"},{"speaker":"Chris Dy","startTime":1087.47,"endTime":1091.19,"body":"do I make, I don't go straight"},{"speaker":"Chris Dy","startTime":1091.19,"endTime":1093.11,"body":"transverse I know a lot of"},{"speaker":"Chris Dy","startTime":1091.19,"endTime":1093.11,"body":"different ways to make this"},{"speaker":"Chris Dy","startTime":1093.11,"endTime":1095.72,"body":"incision, you just got to find"},{"speaker":"Chris Dy","startTime":1093.11,"endTime":1095.72,"body":"the nerve, and you know, the"},{"speaker":"Chris Dy","startTime":1095.72,"endTime":1098.84,"body":"nerve is gonna wrap just below"},{"speaker":"Chris Dy","startTime":1095.72,"endTime":1098.84,"body":"the fibular neck, you know,"},{"speaker":"Chris Dy","startTime":1098.84,"endTime":1102.53,"body":"basically around the neck, at"},{"speaker":"Chris Dy","startTime":1098.84,"endTime":1102.53,"body":"the head neck junction. And in"},{"speaker":"Chris Dy","startTime":1102.53,"endTime":1105.41,"body":"Missouri, that's a little bit"},{"speaker":"Chris Dy","startTime":1102.53,"endTime":1105.41,"body":"hard to feel that fibular head"},{"speaker":"Chris Dy","startTime":1105.41,"endTime":1108.62,"body":"in some patients a very reliable"},{"speaker":"Chris Dy","startTime":1105.41,"endTime":1108.62,"body":"landmark is a tibial tubercle"},{"speaker":"Chris Dy","startTime":1108.65,"endTime":1111.98,"body":"because proximal to distal The"},{"speaker":"Chris Dy","startTime":1108.65,"endTime":1111.98,"body":"tubercle tends to lie at the"},{"speaker":"Chris Dy","startTime":1111.98,"endTime":1115.19,"body":"same level as the fibular head."},{"speaker":"Chris Dy","startTime":1111.98,"endTime":1115.19,"body":"So when you can't feel the"},{"speaker":"Chris Dy","startTime":1115.19,"endTime":1117.89,"body":"fibular head in some patients"},{"speaker":"Chris Dy","startTime":1115.19,"endTime":1117.89,"body":"just mark it off of the tubercle"},{"speaker":"Chris Dy","startTime":1117.89,"endTime":1121.67,"body":"in terms of how far to where to"},{"speaker":"Chris Dy","startTime":1117.89,"endTime":1121.67,"body":"put your incision. So I found"},{"speaker":"Chris Dy","startTime":1121.67,"endTime":1124.76,"body":"that very useful, it tends to be"},{"speaker":"Chris Dy","startTime":1121.67,"endTime":1124.76,"body":"almost a transverse but a kind"},{"speaker":"Chris Dy","startTime":1124.76,"endTime":1128.45,"body":"of more oblique. And it goes all"},{"speaker":"Chris Dy","startTime":1124.76,"endTime":1128.45,"body":"the way from kind of close to"},{"speaker":"Chris Dy","startTime":1128.45,"endTime":1130.58,"body":"the tibial crest because I want"},{"speaker":"Chris Dy","startTime":1128.45,"endTime":1130.58,"body":"to make sure I get over there,"},{"speaker":"Chris Dy","startTime":1130.97,"endTime":1134.06,"body":"and then carrying it, you know"},{"speaker":"Chris Dy","startTime":1130.97,"endTime":1134.06,"body":"just posterolateral to the"},{"speaker":"Chris Dy","startTime":1134.06,"endTime":1134.75,"body":"fibular neck."},{"speaker":"Charles Goldfarb","startTime":1135.65,"endTime":1138.367,"body":"So to clarify,"},{"speaker":"Charles Goldfarb","startTime":1135.65,"endTime":1138.367,"body":"I'm gonna translate for Chris"},{"speaker":"Charles Goldfarb","startTime":1138.429,"endTime":1141.949,"body":"Missouri, some of our patients"},{"speaker":"Charles Goldfarb","startTime":1138.429,"endTime":1141.949,"body":"are large, and those large"},{"speaker":"Charles Goldfarb","startTime":1142.011,"endTime":1145.964,"body":"patients it is so true can be it"},{"speaker":"Charles Goldfarb","startTime":1142.011,"endTime":1145.964,"body":"can be difficult to palpate the"},{"speaker":"Charles Goldfarb","startTime":1146.026,"endTime":1149.484,"body":"fibular head but that is a"},{"speaker":"Charles Goldfarb","startTime":1146.026,"endTime":1149.484,"body":"fantastic trick. I have heard"},{"speaker":"Charles Goldfarb","startTime":1149.546,"endTime":1152.881,"body":"that before. Use the tibial"},{"speaker":"Charles Goldfarb","startTime":1149.546,"endTime":1152.881,"body":"tubercle for your proximal"},{"speaker":"Charles Goldfarb","startTime":1152.943,"endTime":1156.649,"body":"distal or cephalad khordad."},{"speaker":"Charles Goldfarb","startTime":1152.943,"endTime":1156.649,"body":"alignment. So you go to the neck"},{"speaker":"Charles Goldfarb","startTime":1156.71,"endTime":1160.231,"body":"slash post your aspect of"},{"speaker":"Charles Goldfarb","startTime":1156.71,"endTime":1160.231,"body":"Abraham to find your nerve, and"},{"speaker":"Charles Goldfarb","startTime":1160.293,"endTime":1163.875,"body":"then trace it proximally and"},{"speaker":"Charles Goldfarb","startTime":1160.293,"endTime":1163.875,"body":"distally working through scar"},{"speaker":"Charles Goldfarb","startTime":1163.937,"endTime":1167.395,"body":"tissue if it's a post traumatic"},{"speaker":"Charles Goldfarb","startTime":1163.937,"endTime":1167.395,"body":"situation. It's not post"},{"speaker":"Charles Goldfarb","startTime":1167.457,"endTime":1171.101,"body":"traumatic. I don't think there's"},{"speaker":"Charles Goldfarb","startTime":1167.457,"endTime":1171.101,"body":"any magic or difficulty in"},{"speaker":"Charles Goldfarb","startTime":1171.163,"endTime":1174.745,"body":"finding it. But in the post"},{"speaker":"Charles Goldfarb","startTime":1171.163,"endTime":1174.745,"body":"aromatics, if you haven't done"},{"speaker":"Charles Goldfarb","startTime":1174.807,"endTime":1176.66,"body":"this before, it can be a bear."},{"speaker":"Chris Dy","startTime":1177.02,"endTime":1178.73,"body":"Yeah, absolutely. I"},{"speaker":"Chris Dy","startTime":1177.02,"endTime":1178.73,"body":"mean, I think in the post"},{"speaker":"Chris Dy","startTime":1178.73,"endTime":1181.91,"body":"traumatic so you're tend to be"},{"speaker":"Chris Dy","startTime":1178.73,"endTime":1181.91,"body":"going proximately anyway, the"},{"speaker":"Chris Dy","startTime":1181.91,"endTime":1185.12,"body":"short head of the biceps, if"},{"speaker":"Chris Dy","startTime":1181.91,"endTime":1185.12,"body":"it's intact, is your home,"},{"speaker":"Chris Dy","startTime":1185.42,"endTime":1188.45,"body":"because you know that it's going"},{"speaker":"Chris Dy","startTime":1185.42,"endTime":1188.45,"body":"to be tucked right behind. So if"},{"speaker":"Chris Dy","startTime":1188.45,"endTime":1190.52,"body":"you feel on yourself, if you're"},{"speaker":"Chris Dy","startTime":1188.45,"endTime":1190.52,"body":"listening and you have you're"},{"speaker":"Chris Dy","startTime":1190.52,"endTime":1193.13,"body":"not driving it you can feel your"},{"speaker":"Chris Dy","startTime":1190.52,"endTime":1193.13,"body":"short head of your biceps on the"},{"speaker":"Chris Dy","startTime":1194.15,"endTime":1196.37,"body":"you know the posterolateral"},{"speaker":"Chris Dy","startTime":1194.15,"endTime":1196.37,"body":"aspect of your thigh just above"},{"speaker":"Chris Dy","startTime":1196.37,"endTime":1199.49,"body":"your popliteal fossa. You can"},{"speaker":"Chris Dy","startTime":1196.37,"endTime":1199.49,"body":"feel that tendon you can roll it"},{"speaker":"Chris Dy","startTime":1199.49,"endTime":1202.01,"body":"around that nerve is going to be"},{"speaker":"Chris Dy","startTime":1199.49,"endTime":1202.01,"body":"sitting tucked right underneath"},{"speaker":"Chris Dy","startTime":1202.01,"endTime":1204.53,"body":"there. And if you're slender,"},{"speaker":"Chris Dy","startTime":1202.01,"endTime":1204.53,"body":"you can actually feel your own"},{"speaker":"Chris Dy","startTime":1204.53,"endTime":1207.47,"body":"perineal nerve. And oftentimes"},{"speaker":"Chris Dy","startTime":1204.53,"endTime":1207.47,"body":"patients can sometimes get some"},{"speaker":"Chris Dy","startTime":1207.77,"endTime":1210.32,"body":"compression there if they cross"},{"speaker":"Chris Dy","startTime":1207.77,"endTime":1210.32,"body":"their legs, you know, in a"},{"speaker":"Chris Dy","startTime":1210.32,"endTime":1214.07,"body":"certain way, but, you know, so I"},{"speaker":"Chris Dy","startTime":1210.32,"endTime":1214.07,"body":"use that as home when I'm doing"},{"speaker":"Chris Dy","startTime":1214.07,"endTime":1217.43,"body":"the more proximal dissections,"},{"speaker":"Chris Dy","startTime":1214.07,"endTime":1217.43,"body":"because it tends to be more"},{"speaker":"Chris Dy","startTime":1217.43,"endTime":1219.89,"body":"normal up there. Although"},{"speaker":"Chris Dy","startTime":1217.43,"endTime":1219.89,"body":"sometimes with these wide zones"},{"speaker":"Chris Dy","startTime":1219.89,"endTime":1222.17,"body":"of injury, it can be pretty"},{"speaker":"Chris Dy","startTime":1219.89,"endTime":1222.17,"body":"rough, you know, in terms of"},{"speaker":"Chris Dy","startTime":1222.17,"endTime":1225.53,"body":"that initial approach and the"},{"speaker":"Chris Dy","startTime":1222.17,"endTime":1225.53,"body":"nontraumatic setting. You know,"},{"speaker":"Chris Dy","startTime":1225.53,"endTime":1228.32,"body":"if it's a trainee that's"},{"speaker":"Chris Dy","startTime":1225.53,"endTime":1228.32,"body":"starting off the case, just in"},{"speaker":"Chris Dy","startTime":1228.32,"endTime":1230.84,"body":"terms of getting them oriented"},{"speaker":"Chris Dy","startTime":1228.32,"endTime":1230.84,"body":"and setting their depth, I'll"},{"speaker":"Chris Dy","startTime":1230.84,"endTime":1234.92,"body":"have them dissect and start with"},{"speaker":"Chris Dy","startTime":1230.84,"endTime":1234.92,"body":"a knife. And they really get to"},{"speaker":"Chris Dy","startTime":1234.92,"endTime":1237.68,"body":"the fascia on top of the"},{"speaker":"Chris Dy","startTime":1234.92,"endTime":1237.68,"body":"anterior lateral compartments."},{"speaker":"Chris Dy","startTime":1238.13,"endTime":1241.04,"body":"Because once you're going from"},{"speaker":"Chris Dy","startTime":1238.13,"endTime":1241.04,"body":"an anterior to posterior, you"},{"speaker":"Chris Dy","startTime":1241.04,"endTime":1244.07,"body":"kind of fall off a cliff. And if"},{"speaker":"Chris Dy","startTime":1241.04,"endTime":1244.07,"body":"you're obviously too deep with"},{"speaker":"Chris Dy","startTime":1244.07,"endTime":1247.13,"body":"your, with your scalpel with"},{"speaker":"Chris Dy","startTime":1244.07,"endTime":1247.13,"body":"whatever instrument you're"},{"speaker":"Chris Dy","startTime":1247.13,"endTime":1249.38,"body":"using, you're gonna get close to"},{"speaker":"Chris Dy","startTime":1247.13,"endTime":1249.38,"body":"where the nerve is really coming"},{"speaker":"Chris Dy","startTime":1249.38,"endTime":1253.82,"body":"from the back and coming to the"},{"speaker":"Chris Dy","startTime":1249.38,"endTime":1253.82,"body":"front. So setting depth on the"},{"speaker":"Chris Dy","startTime":1253.82,"endTime":1257.93,"body":"fascia, and then after we've set"},{"speaker":"Chris Dy","startTime":1253.82,"endTime":1257.93,"body":"our depth, then going back and"},{"speaker":"Chris Dy","startTime":1257.93,"endTime":1261.17,"body":"finding nerve as it wraps around"},{"speaker":"Chris Dy","startTime":1257.93,"endTime":1261.17,"body":"the fibular neck, I like to see"},{"speaker":"Chris Dy","startTime":1261.17,"endTime":1264.32,"body":"the nerve all the way posterior,"},{"speaker":"Chris Dy","startTime":1261.17,"endTime":1264.32,"body":"and then after that, then come"},{"speaker":"Chris Dy","startTime":1264.32,"endTime":1265.76,"body":"from posterior to anterior,"},{"speaker":"Charles Goldfarb","startTime":1266.42,"endTime":1269.12,"body":"and how far"},{"speaker":"Charles Goldfarb","startTime":1266.42,"endTime":1269.12,"body":"proximately in a non traumatic"},{"speaker":"Charles Goldfarb","startTime":1269.12,"endTime":1272.9,"body":"situation, do you tend to"},{"speaker":"Charles Goldfarb","startTime":1269.12,"endTime":1272.9,"body":"decompress it, or trace it,"},{"speaker":"Chris Dy","startTime":1272.93,"endTime":1275.586,"body":"I don't think you need"},{"speaker":"Chris Dy","startTime":1272.93,"endTime":1275.586,"body":"to go very far. Honestly, once"},{"speaker":"Chris Dy","startTime":1275.636,"endTime":1278.843,"body":"you've seen it kind of wrapping"},{"speaker":"Chris Dy","startTime":1275.636,"endTime":1278.843,"body":"around and coming from posterior"},{"speaker":"Chris Dy","startTime":1278.893,"endTime":1282.051,"body":"to anterior, you inspect and you"},{"speaker":"Chris Dy","startTime":1278.893,"endTime":1282.051,"body":"make sure there's there aren't"},{"speaker":"Chris Dy","startTime":1282.101,"endTime":1285.108,"body":"any odd bands that are back"},{"speaker":"Chris Dy","startTime":1282.101,"endTime":1285.108,"body":"there. I know that some are more"},{"speaker":"Chris Dy","startTime":1285.158,"endTime":1288.366,"body":"enthusiastic about releasing all"},{"speaker":"Chris Dy","startTime":1285.158,"endTime":1288.366,"body":"that fascia, I don't think it's"},{"speaker":"Chris Dy","startTime":1288.416,"endTime":1291.523,"body":"particularly helpful. Because"},{"speaker":"Chris Dy","startTime":1288.416,"endTime":1291.523,"body":"once I found that then I go from"},{"speaker":"Chris Dy","startTime":1291.573,"endTime":1294.53,"body":"P to a from posterior anterior"},{"speaker":"Chris Dy","startTime":1291.573,"endTime":1294.53,"body":"and I find that first clinic"},{"speaker":"Chris Dy","startTime":1294.58,"endTime":1297.687,"body":"compression, which is usually"},{"speaker":"Chris Dy","startTime":1294.58,"endTime":1297.687,"body":"the worst one that you know, the"},{"speaker":"Chris Dy","startTime":1297.737,"endTime":1300.845,"body":"posterior cural septum, which is"},{"speaker":"Chris Dy","startTime":1297.737,"endTime":1300.845,"body":"that kind of back edge of the"},{"speaker":"Chris Dy","startTime":1300.895,"endTime":1304.002,"body":"perineum longest. And just start"},{"speaker":"Chris Dy","startTime":1300.895,"endTime":1304.002,"body":"releasing there, because that"},{"speaker":"Chris Dy","startTime":1304.052,"endTime":1307.16,"body":"usually is the point, the most"},{"speaker":"Chris Dy","startTime":1304.052,"endTime":1307.16,"body":"offensive point of compression."},{"speaker":"Charles Goldfarb","startTime":1307.7,"endTime":1310.22,"body":"Okay, and how"},{"speaker":"Charles Goldfarb","startTime":1307.7,"endTime":1310.22,"body":"far distally Do you trace the"},{"speaker":"Charles Goldfarb","startTime":1310.22,"endTime":1311.12,"body":"nerve into the muscle."},{"speaker":"Chris Dy","startTime":1312.2,"endTime":1314.608,"body":"So then, you know,"},{"speaker":"Chris Dy","startTime":1312.2,"endTime":1314.608,"body":"what I like to do with this"},{"speaker":"Chris Dy","startTime":1314.661,"endTime":1317.907,"body":"decompression is that, you know,"},{"speaker":"Chris Dy","startTime":1314.661,"endTime":1317.907,"body":"you see the fascia of this is"},{"speaker":"Chris Dy","startTime":1317.96,"endTime":1321.154,"body":"pretty interesting, it really"},{"speaker":"Chris Dy","startTime":1317.96,"endTime":1321.154,"body":"does wrap around the individual"},{"speaker":"Chris Dy","startTime":1321.206,"endTime":1324.401,"body":"compartments and then in the"},{"speaker":"Chris Dy","startTime":1321.206,"endTime":1324.401,"body":"anterior compartment between the"},{"speaker":"Chris Dy","startTime":1324.453,"endTime":1327.542,"body":"muscles and it's almost like"},{"speaker":"Chris Dy","startTime":1324.453,"endTime":1327.542,"body":"these, the fascia is coming up"},{"speaker":"Chris Dy","startTime":1327.595,"endTime":1330.58,"body":"and you've got the muscle on"},{"speaker":"Chris Dy","startTime":1327.595,"endTime":1330.58,"body":"each side of it. It's almost"},{"speaker":"Chris Dy","startTime":1330.632,"endTime":1334.036,"body":"like an IV. So you know, finding"},{"speaker":"Chris Dy","startTime":1330.632,"endTime":1334.036,"body":"the back edge and releasing that"},{"speaker":"Chris Dy","startTime":1334.088,"endTime":1337.073,"body":"posterior lateral portion of the"},{"speaker":"Chris Dy","startTime":1334.088,"endTime":1337.073,"body":"deep part of the lateral"},{"speaker":"Chris Dy","startTime":1337.125,"endTime":1340.424,"body":"compartment fascia is the first"},{"speaker":"Chris Dy","startTime":1337.125,"endTime":1340.424,"body":"step. And then after that, it's"},{"speaker":"Chris Dy","startTime":1340.477,"endTime":1343.671,"body":"really retracting, and being"},{"speaker":"Chris Dy","startTime":1340.477,"endTime":1343.671,"body":"kind to that lateral compartment"},{"speaker":"Chris Dy","startTime":1343.723,"endTime":1347.022,"body":"musculature as you're releasing"},{"speaker":"Chris Dy","startTime":1343.723,"endTime":1347.022,"body":"it, because unlike for example,"},{"speaker":"Chris Dy","startTime":1347.075,"endTime":1350.164,"body":"like a flexor pronator release,"},{"speaker":"Chris Dy","startTime":1347.075,"endTime":1350.164,"body":"if you're doing a, an older"},{"speaker":"Chris Dy","startTime":1350.217,"endTime":1352.625,"body":"nerve sub muscular"},{"speaker":"Chris Dy","startTime":1350.217,"endTime":1352.625,"body":"transposition, some of that"},{"speaker":"Chris Dy","startTime":1352.678,"endTime":1355.82,"body":"nerve supply to the lateral"},{"speaker":"Chris Dy","startTime":1352.678,"endTime":1355.82,"body":"compartment comes in proximal to"},{"speaker":"Chris Dy","startTime":1355.872,"endTime":1358.857,"body":"where the fibula neck is"},{"speaker":"Chris Dy","startTime":1355.872,"endTime":1358.857,"body":"crossing. So if you just were to"},{"speaker":"Chris Dy","startTime":1358.909,"endTime":1362.156,"body":"take a bipolar or a bogey and"},{"speaker":"Chris Dy","startTime":1358.909,"endTime":1362.156,"body":"just go right through the muscle"},{"speaker":"Chris Dy","startTime":1362.208,"endTime":1365.245,"body":"to release the nerve, you'd"},{"speaker":"Chris Dy","startTime":1362.208,"endTime":1365.245,"body":"actually be losing some of the"},{"speaker":"Chris Dy","startTime":1365.298,"endTime":1368.126,"body":"nerve supply that you're trying"},{"speaker":"Chris Dy","startTime":1365.298,"endTime":1368.126,"body":"to keep to the lateral"},{"speaker":"Chris Dy","startTime":1368.178,"endTime":1371.425,"body":"compartment. So you really have"},{"speaker":"Chris Dy","startTime":1368.178,"endTime":1371.425,"body":"to dance around the muscle and"},{"speaker":"Chris Dy","startTime":1371.477,"endTime":1374.671,"body":"release to the fascia get over"},{"speaker":"Chris Dy","startTime":1371.477,"endTime":1374.671,"body":"the top and then get some kind"},{"speaker":"Chris Dy","startTime":1374.724,"endTime":1377.97,"body":"of like Dr. Mckennon called down"},{"speaker":"Chris Dy","startTime":1374.724,"endTime":1377.97,"body":"curve attractor, other people"},{"speaker":"Chris Dy","startTime":1378.023,"endTime":1381.164,"body":"call like a lagenback or you can"},{"speaker":"Chris Dy","startTime":1378.023,"endTime":1381.164,"body":"use direct mail, get on the"},{"speaker":"Chris Dy","startTime":1381.217,"endTime":1383.887,"body":"other side of the lateral"},{"speaker":"Chris Dy","startTime":1381.217,"endTime":1383.887,"body":"compartment, release that"},{"speaker":"Chris Dy","startTime":1383.94,"endTime":1387.186,"body":"anterior cural septum and then"},{"speaker":"Chris Dy","startTime":1383.94,"endTime":1387.186,"body":"work underneath. And that helps"},{"speaker":"Chris Dy","startTime":1387.239,"endTime":1390.328,"body":"you set your depth. And then"},{"speaker":"Chris Dy","startTime":1387.239,"endTime":1390.328,"body":"it's just individually hopping"},{"speaker":"Chris Dy","startTime":1390.381,"endTime":1393.156,"body":"over each of those little"},{"speaker":"Chris Dy","startTime":1390.381,"endTime":1393.156,"body":"fascial vertical bands. And"},{"speaker":"Chris Dy","startTime":1393.208,"endTime":1396.193,"body":"releasing them you know, you got"},{"speaker":"Chris Dy","startTime":1393.208,"endTime":1396.193,"body":"a posterior septum, your"},{"speaker":"Chris Dy","startTime":1396.246,"endTime":1399.649,"body":"anterior septum, and then the so"},{"speaker":"Chris Dy","startTime":1396.246,"endTime":1399.649,"body":"called the nominate septum. It's"},{"speaker":"Chris Dy","startTime":1399.702,"endTime":1402.634,"body":"usually not the innominate"},{"speaker":"Chris Dy","startTime":1399.702,"endTime":1402.634,"body":"septum that's tight, but it's"},{"speaker":"Chris Dy","startTime":1402.687,"endTime":1405.41,"body":"usually posterior and anterior"},{"speaker":"Chris Dy","startTime":1402.687,"endTime":1405.41,"body":"that are the tightest"},{"speaker":"Charles Goldfarb","startTime":1406.79,"endTime":1411.17,"body":"two more"},{"speaker":"Charles Goldfarb","startTime":1406.79,"endTime":1411.17,"body":"questions. One, nerve"},{"speaker":"Charles Goldfarb","startTime":1411.17,"endTime":1413.99,"body":"stimulator, and in which"},{"speaker":"Charles Goldfarb","startTime":1411.17,"endTime":1413.99,"body":"situation, would you use it?"},{"speaker":"Chris Dy","startTime":1415.34,"endTime":1417.588,"body":"I think the nerve"},{"speaker":"Chris Dy","startTime":1415.34,"endTime":1417.588,"body":"stime is useful, I guess, if"},{"speaker":"Chris Dy","startTime":1417.637,"endTime":1420.717,"body":"you're having a really hard time"},{"speaker":"Chris Dy","startTime":1417.637,"endTime":1420.717,"body":"finding the nerve. Usually, if"},{"speaker":"Chris Dy","startTime":1420.765,"endTime":1423.307,"body":"you're having a hard time"},{"speaker":"Chris Dy","startTime":1420.765,"endTime":1423.307,"body":"finding it, it's in a post"},{"speaker":"Chris Dy","startTime":1423.356,"endTime":1426.191,"body":"traumatic setting. And you've"},{"speaker":"Chris Dy","startTime":1423.356,"endTime":1426.191,"body":"already been digging through"},{"speaker":"Chris Dy","startTime":1426.24,"endTime":1429.173,"body":"scar and tourniquets probably"},{"speaker":"Chris Dy","startTime":1426.24,"endTime":1429.173,"body":"wind up a while. I don't think"},{"speaker":"Chris Dy","startTime":1429.222,"endTime":1432.351,"body":"it's I don't use it routinely in"},{"speaker":"Chris Dy","startTime":1429.222,"endTime":1432.351,"body":"a non traumatic setting or even"},{"speaker":"Chris Dy","startTime":1432.4,"endTime":1435.235,"body":"in a dramatic setting. I think"},{"speaker":"Chris Dy","startTime":1432.4,"endTime":1435.235,"body":"there's probably a role for"},{"speaker":"Chris Dy","startTime":1435.284,"endTime":1438.314,"body":"nerve to nerve action potential"},{"speaker":"Chris Dy","startTime":1435.284,"endTime":1438.314,"body":"like kind of two probes one on"},{"speaker":"Chris Dy","startTime":1438.363,"endTime":1441.394,"body":"each side of a scar and seeing"},{"speaker":"Chris Dy","startTime":1438.363,"endTime":1441.394,"body":"if something conducts across it"},{"speaker":"Chris Dy","startTime":1441.443,"endTime":1444.278,"body":"if you're looking at a dense"},{"speaker":"Chris Dy","startTime":1441.443,"endTime":1444.278,"body":"neuroma and continuity, but I"},{"speaker":"Chris Dy","startTime":1444.327,"endTime":1447.504,"body":"have not used a nerve stimulator"},{"speaker":"Chris Dy","startTime":1444.327,"endTime":1447.504,"body":"in this setting. Unless you kind"},{"speaker":"Chris Dy","startTime":1447.553,"endTime":1450.486,"body":"of come across a funny branch."},{"speaker":"Chris Dy","startTime":1447.553,"endTime":1450.486,"body":"You want to see what it does."},{"speaker":"Chris Dy","startTime":1450.535,"endTime":1451.22,"body":"How about you?"},{"speaker":"Charles Goldfarb","startTime":1451.37,"endTime":1453.11,"body":"Yeah, I"},{"speaker":"Charles Goldfarb","startTime":1451.37,"endTime":1453.11,"body":"haven't used it. I've often"},{"speaker":"Charles Goldfarb","startTime":1453.11,"endTime":1456.8,"body":"wondered, you know, in that"},{"speaker":"Charles Goldfarb","startTime":1453.11,"endTime":1456.8,"body":"situation with a post traumatic,"},{"speaker":"Charles Goldfarb","startTime":1456.8,"endTime":1459.89,"body":"would it? Would it be helpful? I"},{"speaker":"Charles Goldfarb","startTime":1456.8,"endTime":1459.89,"body":"haven't ever thought it would be"},{"speaker":"Charles Goldfarb","startTime":1459.89,"endTime":1462.98,"body":"helpful in finding the nerve."},{"speaker":"Charles Goldfarb","startTime":1459.89,"endTime":1462.98,"body":"And so I haven't done it. So I'm"},{"speaker":"Charles Goldfarb","startTime":1462.98,"endTime":1465.71,"body":"actually happy to hear that you"},{"speaker":"Charles Goldfarb","startTime":1462.98,"endTime":1465.71,"body":"haven't. And then the second"},{"speaker":"Charles Goldfarb","startTime":1466.19,"endTime":1470.0,"body":"question is, if one of our"},{"speaker":"Charles Goldfarb","startTime":1466.19,"endTime":1470.0,"body":"listeners who may have done"},{"speaker":"Charles Goldfarb","startTime":1470.0,"endTime":1473.03,"body":"this, but not done it recently,"},{"speaker":"Charles Goldfarb","startTime":1470.0,"endTime":1473.03,"body":"once you review some of the"},{"speaker":"Charles Goldfarb","startTime":1473.03,"endTime":1476.3,"body":"anatomy that you have alluded"},{"speaker":"Charles Goldfarb","startTime":1473.03,"endTime":1476.3,"body":"to, is there a best source and"},{"speaker":"Charles Goldfarb","startTime":1476.3,"endTime":1478.43,"body":"we can always put in the show"},{"speaker":"Charles Goldfarb","startTime":1476.3,"endTime":1478.43,"body":"notes if you don't recall it off"},{"speaker":"Charles Goldfarb","startTime":1478.43,"endTime":1479.12,"body":"the top of your head."},{"speaker":"Chris Dy","startTime":1480.35,"endTime":1483.193,"body":"So Dr. McKenan has"},{"speaker":"Chris Dy","startTime":1480.35,"endTime":1483.193,"body":"great videos on this. I don't do"},{"speaker":"Chris Dy","startTime":1483.249,"endTime":1486.594,"body":"it exactly the same way. But"},{"speaker":"Chris Dy","startTime":1483.249,"endTime":1486.594,"body":"whenever a trainee comes to the"},{"speaker":"Chris Dy","startTime":1486.649,"endTime":1490.106,"body":"service, current generation of"},{"speaker":"Chris Dy","startTime":1486.649,"endTime":1490.106,"body":"trainees tends to go to videos,"},{"speaker":"Chris Dy","startTime":1490.162,"endTime":1493.451,"body":"by and large, so I send them to"},{"speaker":"Chris Dy","startTime":1490.162,"endTime":1493.451,"body":"her videos. I think they're"},{"speaker":"Chris Dy","startTime":1493.507,"endTime":1496.74,"body":"great. I think they're on"},{"speaker":"Chris Dy","startTime":1493.507,"endTime":1496.74,"body":"YouTube as well as her education"},{"speaker":"Chris Dy","startTime":1496.796,"endTime":1500.197,"body":"platform. You know, one of our"},{"speaker":"Chris Dy","startTime":1496.796,"endTime":1500.197,"body":"residents who, who was matched"},{"speaker":"Chris Dy","startTime":1500.253,"endTime":1503.208,"body":"at Harbor View for his hand"},{"speaker":"Chris Dy","startTime":1500.253,"endTime":1503.208,"body":"fellowship next year. Nik"},{"speaker":"Chris Dy","startTime":1503.263,"endTime":1506.553,"body":"Dwivedi, he and I wrote some"},{"speaker":"Chris Dy","startTime":1503.263,"endTime":1506.553,"body":"review articles on this, which"},{"speaker":"Chris Dy","startTime":1506.608,"endTime":1510.121,"body":"are in the orthopedic clinics in"},{"speaker":"Chris Dy","startTime":1506.608,"endTime":1510.121,"body":"North America at some point in"},{"speaker":"Chris Dy","startTime":1510.177,"endTime":1513.577,"body":"the last year or so. And then"},{"speaker":"Chris Dy","startTime":1510.177,"endTime":1513.577,"body":"Pauline Glyn, who is going into"},{"speaker":"Chris Dy","startTime":1513.633,"endTime":1517.034,"body":"sports, at HSS. Next year, he,"},{"speaker":"Chris Dy","startTime":1513.633,"endTime":1517.034,"body":"he and I wrote an article that"},{"speaker":"Chris Dy","startTime":1517.09,"endTime":1520.435,"body":"summarize the, the, the webinar"},{"speaker":"Chris Dy","startTime":1517.09,"endTime":1520.435,"body":"that I mentioned earlier. So"},{"speaker":"Chris Dy","startTime":1520.491,"endTime":1523.891,"body":"there's a bunch of stuff out"},{"speaker":"Chris Dy","startTime":1520.491,"endTime":1523.891,"body":"there, those are good ones, they"},{"speaker":"Chris Dy","startTime":1523.947,"endTime":1527.292,"body":"actually kind of include a lot"},{"speaker":"Chris Dy","startTime":1523.947,"endTime":1527.292,"body":"of the anatomy resources, you"},{"speaker":"Chris Dy","startTime":1527.348,"endTime":1530.582,"body":"know, and there's a lot to"},{"speaker":"Chris Dy","startTime":1527.348,"endTime":1530.582,"body":"unpack here in terms of all the"},{"speaker":"Chris Dy","startTime":1530.637,"endTime":1533.982,"body":"variations in the anatomy, and"},{"speaker":"Chris Dy","startTime":1530.637,"endTime":1533.982,"body":"we don't need to get into all"},{"speaker":"Chris Dy","startTime":1534.038,"endTime":1537.383,"body":"that detail. Um, one thing that"},{"speaker":"Chris Dy","startTime":1534.038,"endTime":1537.383,"body":"I think is important is, you"},{"speaker":"Chris Dy","startTime":1537.439,"endTime":1540.896,"body":"know, that I was teaching one of"},{"speaker":"Chris Dy","startTime":1537.439,"endTime":1540.896,"body":"our fellows recently was that"},{"speaker":"Chris Dy","startTime":1540.951,"endTime":1544.575,"body":"once you've released your CPN, I"},{"speaker":"Chris Dy","startTime":1540.951,"endTime":1544.575,"body":"like to see the branching of the"},{"speaker":"Chris Dy","startTime":1544.631,"endTime":1547.641,"body":"deep and the superficial"},{"speaker":"Chris Dy","startTime":1544.631,"endTime":1547.641,"body":"perineal. And sometimes even,"},{"speaker":"Chris Dy","startTime":1547.697,"endTime":1551.098,"body":"it's not so much a bifurcation,"},{"speaker":"Chris Dy","startTime":1547.697,"endTime":1551.098,"body":"it's even a trifurcation. You"},{"speaker":"Chris Dy","startTime":1551.154,"endTime":1554.666,"body":"can even see some branches, not"},{"speaker":"Chris Dy","startTime":1551.154,"endTime":1554.666,"body":"necessarily to the joint, which"},{"speaker":"Chris Dy","startTime":1554.722,"endTime":1557.844,"body":"is what's in the book, the"},{"speaker":"Chris Dy","startTime":1554.722,"endTime":1557.844,"body":"articular branches, but there"},{"speaker":"Chris Dy","startTime":1557.9,"endTime":1561.022,"body":"are some branches that go to"},{"speaker":"Chris Dy","startTime":1557.9,"endTime":1561.022,"body":"the, to the, to the outside"},{"speaker":"Chris Dy","startTime":1561.078,"endTime":1564.367,"body":"interior that come off more"},{"speaker":"Chris Dy","startTime":1561.078,"endTime":1564.367,"body":"proximal than you think. So you"},{"speaker":"Chris Dy","startTime":1564.423,"endTime":1567.768,"body":"really got to be careful about"},{"speaker":"Chris Dy","startTime":1564.423,"endTime":1567.768,"body":"saving whatever branches come"},{"speaker":"Chris Dy","startTime":1567.824,"endTime":1571.113,"body":"off, because they may be going"},{"speaker":"Chris Dy","startTime":1567.824,"endTime":1571.113,"body":"into the muscle, and you can"},{"speaker":"Chris Dy","startTime":1571.169,"endTime":1574.346,"body":"trace that if you'd like. But"},{"speaker":"Chris Dy","startTime":1571.169,"endTime":1574.346,"body":"then I think also releasing"},{"speaker":"Chris Dy","startTime":1574.402,"endTime":1577.803,"body":"products proximal to distal,"},{"speaker":"Chris Dy","startTime":1574.402,"endTime":1577.803,"body":"releasing some of that posterior"},{"speaker":"Chris Dy","startTime":1577.859,"endTime":1581.26,"body":"curl septum, along the course of"},{"speaker":"Chris Dy","startTime":1577.859,"endTime":1581.26,"body":"the superficial parenting or"},{"speaker":"Chris Dy","startTime":1581.315,"endTime":1584.828,"body":"perineal nerve can help because"},{"speaker":"Chris Dy","startTime":1581.315,"endTime":1584.828,"body":"even though you've released the"},{"speaker":"Chris Dy","startTime":1584.883,"endTime":1588.117,"body":"deep component, if you don't"},{"speaker":"Chris Dy","startTime":1584.883,"endTime":1588.117,"body":"release that back apart, that"},{"speaker":"Chris Dy","startTime":1588.173,"endTime":1591.351,"body":"can take it can hang up the"},{"speaker":"Chris Dy","startTime":1588.173,"endTime":1591.351,"body":"superficial perineal nerve to"},{"speaker":"Chris Dy","startTime":1591.406,"endTime":1594.863,"body":"love that. Sorry, this guy, this"},{"speaker":"Chris Dy","startTime":1591.406,"endTime":1594.863,"body":"guy really jargony and really"},{"speaker":"Chris Dy","startTime":1594.919,"endTime":1596.09,"body":"nerdy really quickly."},{"speaker":"Charles Goldfarb","startTime":1596.15,"endTime":1598.58,"body":"No, I love it."},{"speaker":"Charles Goldfarb","startTime":1596.15,"endTime":1598.58,"body":"But I'm going to take it to the"},{"speaker":"Charles Goldfarb","startTime":1598.58,"endTime":1601.82,"body":"basics. I mean, here's my two,"},{"speaker":"Charles Goldfarb","startTime":1598.58,"endTime":1601.82,"body":"you got to come up with two. But"},{"speaker":"Charles Goldfarb","startTime":1601.82,"endTime":1605.48,"body":"I of course have to, here's my"},{"speaker":"Charles Goldfarb","startTime":1601.82,"endTime":1605.48,"body":"two take homes. Number one, you"},{"speaker":"Charles Goldfarb","startTime":1605.48,"endTime":1608.51,"body":"got to know the anatomy. And in"},{"speaker":"Charles Goldfarb","startTime":1605.48,"endTime":1608.51,"body":"this situation, if you're not"},{"speaker":"Charles Goldfarb","startTime":1608.51,"endTime":1611.84,"body":"there all the time, you got to"},{"speaker":"Charles Goldfarb","startTime":1608.51,"endTime":1611.84,"body":"know it well. And so prepare for"},{"speaker":"Charles Goldfarb","startTime":1611.84,"endTime":1615.8,"body":"cases like this. Number two, if"},{"speaker":"Charles Goldfarb","startTime":1611.84,"endTime":1615.8,"body":"you heard Chris say, this was"},{"speaker":"Charles Goldfarb","startTime":1615.8,"endTime":1619.25,"body":"not something he got a great"},{"speaker":"Charles Goldfarb","startTime":1615.8,"endTime":1619.25,"body":"deal of experience with during"},{"speaker":"Charles Goldfarb","startTime":1619.25,"endTime":1624.53,"body":"his training. So you're learning"},{"speaker":"Charles Goldfarb","startTime":1619.25,"endTime":1624.53,"body":"and your potential for cases and"},{"speaker":"Charles Goldfarb","startTime":1624.56,"endTime":1630.29,"body":"even specialty focus. Absolutely"},{"speaker":"Charles Goldfarb","startTime":1624.56,"endTime":1630.29,"body":"should and can extend after your"},{"speaker":"Charles Goldfarb","startTime":1630.29,"endTime":1632.96,"body":"training is over. So it"},{"speaker":"Charles Goldfarb","startTime":1630.29,"endTime":1632.96,"body":"certainly has happened to me,"},{"speaker":"Charles Goldfarb","startTime":1633.02,"endTime":1636.08,"body":"you know, elbow arthroscopy is"},{"speaker":"Charles Goldfarb","startTime":1633.02,"endTime":1636.08,"body":"the example and and just a lot"},{"speaker":"Charles Goldfarb","startTime":1636.08,"endTime":1639.23,"body":"of work around the elbows and"},{"speaker":"Charles Goldfarb","startTime":1636.08,"endTime":1639.23,"body":"examples. So I love that. And"},{"speaker":"Charles Goldfarb","startTime":1639.23,"endTime":1641.87,"body":"and I think it's a good message"},{"speaker":"Charles Goldfarb","startTime":1639.23,"endTime":1641.87,"body":"for all of us."},{"speaker":"Chris Dy","startTime":1642.739,"endTime":1645.439,"body":"Yeah, I mean, I think"},{"speaker":"Chris Dy","startTime":1642.739,"endTime":1645.439,"body":"that, you know, obviously, I'm"},{"speaker":"Chris Dy","startTime":1645.439,"endTime":1647.869,"body":"biased because of the fellowship"},{"speaker":"Chris Dy","startTime":1645.439,"endTime":1647.869,"body":"director now. But I think that"},{"speaker":"Chris Dy","startTime":1648.019,"endTime":1650.269,"body":"we offer a great fellowship,"},{"speaker":"Chris Dy","startTime":1648.019,"endTime":1650.269,"body":"because we give you tools for"},{"speaker":"Chris Dy","startTime":1650.269,"endTime":1652.759,"body":"your toolbox, you know, so that"},{"speaker":"Chris Dy","startTime":1650.269,"endTime":1652.759,"body":"when you leave here, you can"},{"speaker":"Chris Dy","startTime":1652.759,"endTime":1655.429,"body":"learn and teach yourself to do"},{"speaker":"Chris Dy","startTime":1652.759,"endTime":1655.429,"body":"these kinds of surgeries,"},{"speaker":"Chris Dy","startTime":1655.429,"endTime":1658.369,"body":"obviously, with the appropriate"},{"speaker":"Chris Dy","startTime":1655.429,"endTime":1658.369,"body":"preparation, both reading"},{"speaker":"Chris Dy","startTime":1658.369,"endTime":1661.249,"body":"videos, and even getting into"},{"speaker":"Chris Dy","startTime":1658.369,"endTime":1661.249,"body":"the cadaver lab, but I remember,"},{"speaker":"Chris Dy","startTime":1661.249,"endTime":1663.559,"body":"you know, doing this procedure"},{"speaker":"Chris Dy","startTime":1661.249,"endTime":1663.559,"body":"as an attending for the first"},{"speaker":"Chris Dy","startTime":1663.559,"endTime":1666.979,"body":"time and going to the lab and"},{"speaker":"Chris Dy","startTime":1663.559,"endTime":1666.979,"body":"practicing and taking pictures"},{"speaker":"Chris Dy","startTime":1666.979,"endTime":1671.299,"body":"and all that kind of stuff."},{"speaker":"Chris Dy","startTime":1666.979,"endTime":1671.299,"body":"Because it's technically pretty"},{"speaker":"Chris Dy","startTime":1671.299,"endTime":1673.309,"body":"straightforward procedure. Like"},{"speaker":"Chris Dy","startTime":1671.299,"endTime":1673.309,"body":"you said, you got to know your"},{"speaker":"Chris Dy","startTime":1673.309,"endTime":1676.759,"body":"anatomy, but it's a great"},{"speaker":"Chris Dy","startTime":1673.309,"endTime":1676.759,"body":"service you can provide for your"},{"speaker":"Chris Dy","startTime":1676.819,"endTime":1678.169,"body":"for your patients and your"},{"speaker":"Chris Dy","startTime":1676.819,"endTime":1678.169,"body":"partners."},{"speaker":"Charles Goldfarb","startTime":1679.16,"endTime":1681.02,"body":"I love that. I"},{"speaker":"Charles Goldfarb","startTime":1679.16,"endTime":1681.02,"body":"think we should wrap this up and"},{"speaker":"Charles Goldfarb","startTime":1681.02,"endTime":1681.77,"body":"you should go to bed."},{"speaker":"Chris Dy","startTime":1682.4,"endTime":1685.01,"body":"Yeah, no, I'd like to"},{"speaker":"Chris Dy","startTime":1682.4,"endTime":1685.01,"body":"but there is some more stuff to"},{"speaker":"Chris Dy","startTime":1685.01,"endTime":1688.55,"body":"be done tonight beforehand, but"},{"speaker":"Chris Dy","startTime":1685.01,"endTime":1688.55,"body":"I thank you. I appreciate that."},{"speaker":"Charles Goldfarb","startTime":1689.06,"endTime":1691.46,"body":"All right."},{"speaker":"Charles Goldfarb","startTime":1689.06,"endTime":1691.46,"body":"Have a good night. Good night."},{"speaker":"Charles Goldfarb","startTime":2527.53,"endTime":2530.02,"body":"Hey Chris, that was fun. Let's"},{"speaker":"Charles Goldfarb","startTime":2527.53,"endTime":2530.02,"body":"do it again real soon."},{"speaker":"Chris Dy","startTime":2530.32,"endTime":2532.84,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2530.32,"endTime":2532.84,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2532.84,"endTime":2535.24,"body":"at hand podcast. Hey, Chuck,"},{"speaker":"Chris Dy","startTime":2532.84,"endTime":2535.24,"body":"what's your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2535.57,"endTime":2538.42,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2535.57,"endTime":2538.42,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2538.6,"endTime":2541.974,"body":"Mine is @ChrisDYMD"},{"speaker":"Chris Dy","startTime":2538.6,"endTime":2541.974,"body":"spelled d-y. And if you'd like"},{"speaker":"Chris Dy","startTime":2542.042,"endTime":2545.83,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2542.042,"endTime":2545.83,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2546.399,"endTime":2548.529,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2546.399,"endTime":2548.529,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2548.529,"endTime":2549.639,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2549.67,"endTime":2551.89,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2549.67,"endTime":2551.89,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2551.89,"endTime":2553.6,"body":"word out. Special thanks to"},{"speaker":"Charles Goldfarb","startTime":2553.6,"endTime":2555.88,"body":"Peter Martin"},{"speaker":"Charles Goldfarb","startTime":2553.6,"endTime":2555.88,"body":"for the amazing music. And"},{"speaker":"Charles Goldfarb","startTime":2555.88,"endTime":2558.94,"body":"remember, keep the upper hand"},{"speaker":"Charles Goldfarb","startTime":2555.88,"endTime":2558.94,"body":"come back next time"}]}