{"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":24.06,"endTime":25.11,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":24.06,"endTime":25.11,"body":"Chris."},{"speaker":"Chris Dy","startTime":25.29,"endTime":26.22,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":25.29,"endTime":26.22,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":26.73,"endTime":28.89,"body":"I am well. How"},{"speaker":"Charles Goldfarb","startTime":26.73,"endTime":28.89,"body":"are you today?"},{"speaker":"Chris Dy","startTime":29.28,"endTime":32.37,"body":"I'm fantastic. It's a"},{"speaker":"Chris Dy","startTime":29.28,"endTime":32.37,"body":"beautiful fall day in St. Louis."},{"speaker":"Chris Dy","startTime":32.52,"endTime":35.73,"body":"It got frigid there for a"},{"speaker":"Chris Dy","startTime":32.52,"endTime":35.73,"body":"minute. And now it feels like"},{"speaker":"Chris Dy","startTime":35.73,"endTime":38.28,"body":"the end of summer early fall"},{"speaker":"Chris Dy","startTime":35.73,"endTime":38.28,"body":"that we were all hoping for"},{"speaker":"Charles Goldfarb","startTime":38.64,"endTime":41.25,"body":"is really"},{"speaker":"Charles Goldfarb","startTime":38.64,"endTime":41.25,"body":"delightful. We tell you I had"},{"speaker":"Charles Goldfarb","startTime":41.25,"endTime":45.75,"body":"dinner outside last night at a"},{"speaker":"Charles Goldfarb","startTime":41.25,"endTime":45.75,"body":"nice restaurant and nice walk"},{"speaker":"Charles Goldfarb","startTime":45.75,"endTime":47.52,"body":"today. So yeah, it was great."},{"speaker":"Chris Dy","startTime":47.79,"endTime":50.76,"body":"Yes, it's we are we've"},{"speaker":"Chris Dy","startTime":47.79,"endTime":50.76,"body":"been outside most of the day. My"},{"speaker":"Chris Dy","startTime":50.76,"endTime":55.26,"body":"son had a soccer game. So we"},{"speaker":"Chris Dy","startTime":50.76,"endTime":55.26,"body":"went and did that. And then the"},{"speaker":"Chris Dy","startTime":55.29,"endTime":59.13,"body":"the grade organise a trunk or"},{"speaker":"Chris Dy","startTime":55.29,"endTime":59.13,"body":"treat, which is kind of new to"},{"speaker":"Chris Dy","startTime":59.13,"endTime":62.07,"body":"us. I don't know how much of a"},{"speaker":"Chris Dy","startTime":59.13,"endTime":62.07,"body":"St. Louis thing that is, or just"},{"speaker":"Chris Dy","startTime":62.1,"endTime":66.3,"body":"a family thing that is but super"},{"speaker":"Chris Dy","startTime":62.1,"endTime":66.3,"body":"fun. We're all hopped up on"},{"speaker":"Chris Dy","startTime":66.3,"endTime":66.96,"body":"sugar right now."},{"speaker":"Charles Goldfarb","startTime":67.47,"endTime":70.41,"body":"So when is"},{"speaker":"Charles Goldfarb","startTime":67.47,"endTime":70.41,"body":"Halloween because this episode"},{"speaker":"Charles Goldfarb","startTime":70.41,"endTime":74.43,"body":"is going to drop on the 30th. So"},{"speaker":"Charles Goldfarb","startTime":70.41,"endTime":74.43,"body":"in St. Louis, I think Halloween"},{"speaker":"Charles Goldfarb","startTime":74.43,"endTime":77.13,"body":"is gonna be celebrated on Monday"},{"speaker":"Charles Goldfarb","startTime":74.43,"endTime":77.13,"body":"night, don't you think? Yeah,"},{"speaker":"Chris Dy","startTime":77.16,"endTime":79.17,"body":"I think it will be"},{"speaker":"Chris Dy","startTime":77.16,"endTime":79.17,"body":"much to the chagrin of every"},{"speaker":"Chris Dy","startTime":79.17,"endTime":83.7,"body":"parent out there and any t"},{"speaker":"Chris Dy","startTime":79.17,"endTime":83.7,"body":"shirts for the Tuesday? Yeah,"},{"speaker":"Chris Dy","startTime":83.7,"endTime":86.49,"body":"I'm sure that I don't know,"},{"speaker":"Chris Dy","startTime":83.7,"endTime":86.49,"body":"maybe you you and Talia had some"},{"speaker":"Chris Dy","startTime":86.82,"endTime":90.48,"body":"specific regulations for sugar"},{"speaker":"Chris Dy","startTime":86.82,"endTime":90.48,"body":"intake among the children, you"},{"speaker":"Chris Dy","startTime":90.48,"endTime":93.75,"body":"guys seem like a healthy family,"},{"speaker":"Chris Dy","startTime":90.48,"endTime":93.75,"body":"we try and then we fail."},{"speaker":"Chris Dy","startTime":93.75,"endTime":94.14,"body":"Usually,"},{"speaker":"Charles Goldfarb","startTime":94.72,"endTime":96.22,"body":"We try. I"},{"speaker":"Charles Goldfarb","startTime":94.72,"endTime":96.22,"body":"mean, I've learned a couple"},{"speaker":"Charles Goldfarb","startTime":96.22,"endTime":98.77,"body":"things about Halloween. One is"},{"speaker":"Charles Goldfarb","startTime":96.22,"endTime":98.77,"body":"that as a parent, it really is a"},{"speaker":"Charles Goldfarb","startTime":98.77,"endTime":102.07,"body":"fantastic celebration, because"},{"speaker":"Charles Goldfarb","startTime":98.77,"endTime":102.07,"body":"stealing from your children in"},{"speaker":"Charles Goldfarb","startTime":102.07,"endTime":104.8,"body":"the middle of the night is is a"},{"speaker":"Charles Goldfarb","startTime":102.07,"endTime":104.8,"body":"worthwhile pursuit, because it's"},{"speaker":"Charles Goldfarb","startTime":104.8,"endTime":107.98,"body":"really helping them not to eat"},{"speaker":"Charles Goldfarb","startTime":104.8,"endTime":107.98,"body":"too much sugar. So I like that."},{"speaker":"Charles Goldfarb","startTime":107.98,"endTime":111.64,"body":"And then St. Louis has a great"},{"speaker":"Charles Goldfarb","startTime":107.98,"endTime":111.64,"body":"Halloween tradition. I don't"},{"speaker":"Charles Goldfarb","startTime":111.64,"endTime":115.03,"body":"know if we talked about on this"},{"speaker":"Charles Goldfarb","startTime":111.64,"endTime":115.03,"body":"show. But I really like when"},{"speaker":"Charles Goldfarb","startTime":115.03,"endTime":117.97,"body":"kids come to the door, you don't"},{"speaker":"Charles Goldfarb","startTime":115.03,"endTime":117.97,"body":"just hand them candy. They"},{"speaker":"Charles Goldfarb","startTime":117.97,"endTime":120.7,"body":"literally they really have to"},{"speaker":"Charles Goldfarb","startTime":117.97,"endTime":120.7,"body":"tell a joke. And it can be a"},{"speaker":"Charles Goldfarb","startTime":120.7,"endTime":123.97,"body":"stupid joke, which usually is"},{"speaker":"Charles Goldfarb","startTime":120.7,"endTime":123.97,"body":"like a dad joke. But I love that"},{"speaker":"Charles Goldfarb","startTime":123.97,"endTime":124.48,"body":"tradition."},{"speaker":"Chris Dy","startTime":124.859,"endTime":126.629,"body":"I think it's great. I"},{"speaker":"Chris Dy","startTime":124.859,"endTime":126.629,"body":"didn't have to do that growing"},{"speaker":"Chris Dy","startTime":126.629,"endTime":131.669,"body":"up in Florida. You know it, it"},{"speaker":"Chris Dy","startTime":126.629,"endTime":131.669,"body":"makes it very fun. And you know,"},{"speaker":"Chris Dy","startTime":131.699,"endTime":134.039,"body":"having the kids practice their"},{"speaker":"Chris Dy","startTime":131.699,"endTime":134.039,"body":"jokes ahead of time is always"},{"speaker":"Chris Dy","startTime":134.039,"endTime":137.819,"body":"entertaining. So, yes. And, you"},{"speaker":"Chris Dy","startTime":134.039,"endTime":137.819,"body":"know, we've learned that there"},{"speaker":"Chris Dy","startTime":137.819,"endTime":140.699,"body":"are certain things that belong"},{"speaker":"Chris Dy","startTime":137.819,"endTime":140.699,"body":"to mom and dad out of the candy"},{"speaker":"Chris Dy","startTime":140.999,"endTime":144.869,"body":"out of the candy bag. And I've"},{"speaker":"Chris Dy","startTime":140.999,"endTime":144.869,"body":"been known to keep a substantial"},{"speaker":"Chris Dy","startTime":144.869,"endTime":148.799,"body":"stash in my office for writer's"},{"speaker":"Chris Dy","startTime":144.869,"endTime":148.799,"body":"block to help me get through."},{"speaker":"Charles Goldfarb","startTime":149.309,"endTime":151.589,"body":"I love it. I"},{"speaker":"Charles Goldfarb","startTime":149.309,"endTime":151.589,"body":"love it. Well have a good"},{"speaker":"Charles Goldfarb","startTime":151.589,"endTime":155.369,"body":"Halloween. And we have some"},{"speaker":"Charles Goldfarb","startTime":151.589,"endTime":155.369,"body":"interesting things to talk about"},{"speaker":"Charles Goldfarb","startTime":155.369,"endTime":155.699,"body":"today."},{"speaker":"Chris Dy","startTime":156.15,"endTime":159.45,"body":"We do so we have. We"},{"speaker":"Chris Dy","startTime":156.15,"endTime":159.45,"body":"do have a really interesting"},{"speaker":"Chris Dy","startTime":159.48,"endTime":162.63,"body":"email that came in from a"},{"speaker":"Chris Dy","startTime":159.48,"endTime":162.63,"body":"listener. And you know, we"},{"speaker":"Chris Dy","startTime":162.63,"endTime":165.81,"body":"recently had the Live episode"},{"speaker":"Chris Dy","startTime":162.63,"endTime":165.81,"body":"where we were asked about, you"},{"speaker":"Chris Dy","startTime":165.81,"endTime":168.81,"body":"know what, what we look at when"},{"speaker":"Chris Dy","startTime":165.81,"endTime":168.81,"body":"we look at fellowship"},{"speaker":"Chris Dy","startTime":168.81,"endTime":173.13,"body":"applications. And one thing that"},{"speaker":"Chris Dy","startTime":168.81,"endTime":173.13,"body":"I said was that I look at the"},{"speaker":"Chris Dy","startTime":173.16,"endTime":177.06,"body":"letters of recommendation more"},{"speaker":"Chris Dy","startTime":173.16,"endTime":177.06,"body":"than anything else. And this"},{"speaker":"Chris Dy","startTime":177.06,"endTime":180.39,"body":"listener, I think, in a very"},{"speaker":"Chris Dy","startTime":177.06,"endTime":180.39,"body":"respectful and thoughtful way"},{"speaker":"Chris Dy","startTime":180.39,"endTime":184.5,"body":"challenged me a bit on that, and"},{"speaker":"Chris Dy","startTime":180.39,"endTime":184.5,"body":"said that I openly espouse the"},{"speaker":"Chris Dy","startTime":184.5,"endTime":187.26,"body":"old boy network as my primary"},{"speaker":"Chris Dy","startTime":184.5,"endTime":187.26,"body":"way of evaluating fellowship"},{"speaker":"Chris Dy","startTime":187.26,"endTime":190.56,"body":"applications, stating that me"},{"speaker":"Chris Dy","startTime":187.26,"endTime":190.56,"body":"looking at the letters was a"},{"speaker":"Chris Dy","startTime":190.56,"endTime":194.49,"body":"discriminatory and myopic way of"},{"speaker":"Chris Dy","startTime":190.56,"endTime":194.49,"body":"evaluating potential fellows,"},{"speaker":"Chris Dy","startTime":194.79,"endTime":197.46,"body":"essentially exclude anybody not"},{"speaker":"Chris Dy","startTime":194.79,"endTime":197.46,"body":"fortunate enough to go to med"},{"speaker":"Chris Dy","startTime":197.46,"endTime":200.7,"body":"school or residency with one of"},{"speaker":"Chris Dy","startTime":197.46,"endTime":200.7,"body":"my friends. And there could be"},{"speaker":"Chris Dy","startTime":200.7,"endTime":203.1,"body":"many reasons why an applicant"},{"speaker":"Chris Dy","startTime":200.7,"endTime":203.1,"body":"failed to work with one of your"},{"speaker":"Chris Dy","startTime":203.1,"endTime":205.95,"body":"friends from family or cultural"},{"speaker":"Chris Dy","startTime":203.1,"endTime":205.95,"body":"economic situations to just"},{"speaker":"Chris Dy","startTime":205.95,"endTime":209.61,"body":"plain bad luck. So a wise person"},{"speaker":"Chris Dy","startTime":205.95,"endTime":209.61,"body":"evaluating applications would"},{"speaker":"Chris Dy","startTime":209.61,"endTime":212.49,"body":"look not only at their friends"},{"speaker":"Chris Dy","startTime":209.61,"endTime":212.49,"body":"residents, but also those who"},{"speaker":"Chris Dy","startTime":212.49,"endTime":217.71,"body":"attended institutions without"},{"speaker":"Chris Dy","startTime":212.49,"endTime":217.71,"body":"big research names. And, but"},{"speaker":"Chris Dy","startTime":217.71,"endTime":220.56,"body":"still showed a pension for doing"},{"speaker":"Chris Dy","startTime":217.71,"endTime":220.56,"body":"the work winning small grants,"},{"speaker":"Chris Dy","startTime":220.56,"endTime":223.08,"body":"publishing small journals"},{"speaker":"Chris Dy","startTime":220.56,"endTime":223.08,"body":"presenting research at local"},{"speaker":"Chris Dy","startTime":223.08,"endTime":225.93,"body":"meetings. These are the ones who"},{"speaker":"Chris Dy","startTime":223.08,"endTime":225.93,"body":"will be overlooked by people who"},{"speaker":"Chris Dy","startTime":225.93,"endTime":229.02,"body":"think the way you recommend, but"},{"speaker":"Chris Dy","startTime":225.93,"endTime":229.02,"body":"have been grinding and deserve a"},{"speaker":"Chris Dy","startTime":229.02,"endTime":231.9,"body":"chance you will benefit by"},{"speaker":"Chris Dy","startTime":229.02,"endTime":231.9,"body":"finding overlooked candidates"},{"speaker":"Chris Dy","startTime":231.9,"endTime":234.12,"body":"and they will benefit by not"},{"speaker":"Chris Dy","startTime":231.9,"endTime":234.12,"body":"being overlooked because of"},{"speaker":"Chris Dy","startTime":234.12,"endTime":239.49,"body":"factors beyond their control."},{"speaker":"Chris Dy","startTime":234.12,"endTime":239.49,"body":"So, Chuck, what what what's your"},{"speaker":"Chris Dy","startTime":239.49,"endTime":243.06,"body":"initial take on that? I have a"},{"speaker":"Chris Dy","startTime":239.49,"endTime":243.06,"body":"pretty interesting take on it."},{"speaker":"Chris Dy","startTime":243.06,"endTime":244.83,"body":"But you know, I'd love to hear"},{"speaker":"Chris Dy","startTime":243.06,"endTime":244.83,"body":"your thoughts."},{"speaker":"Charles Goldfarb","startTime":245.22,"endTime":248.52,"body":"Yeah, I, first"},{"speaker":"Charles Goldfarb","startTime":245.22,"endTime":248.52,"body":"of all, we are we're grateful"},{"speaker":"Charles Goldfarb","startTime":248.55,"endTime":253.68,"body":"for the candid feedback, Chris"},{"speaker":"Charles Goldfarb","startTime":248.55,"endTime":253.68,"body":"and I have long said we, you"},{"speaker":"Charles Goldfarb","startTime":253.68,"endTime":256.77,"body":"know, when we say something on"},{"speaker":"Charles Goldfarb","startTime":253.68,"endTime":256.77,"body":"the pod, especially when it's"},{"speaker":"Charles Goldfarb","startTime":256.77,"endTime":260.88,"body":"the live pod, we are sort of,"},{"speaker":"Charles Goldfarb","startTime":256.77,"endTime":260.88,"body":"you know, putting it out there,"},{"speaker":"Charles Goldfarb","startTime":261.15,"endTime":268.41,"body":"and I appreciate this listener"},{"speaker":"Charles Goldfarb","startTime":261.15,"endTime":268.41,"body":"calling us on this, but I don't"},{"speaker":"Charles Goldfarb","startTime":268.41,"endTime":273.66,"body":"know that I can say I fully"},{"speaker":"Charles Goldfarb","startTime":268.41,"endTime":273.66,"body":"agree. And I think the it was a"},{"speaker":"Charles Goldfarb","startTime":273.66,"endTime":277.38,"body":"direct challenge which again, I"},{"speaker":"Charles Goldfarb","startTime":273.66,"endTime":277.38,"body":"appreciate. But I think it"},{"speaker":"Charles Goldfarb","startTime":277.38,"endTime":281.64,"body":"deserves conversation both a"},{"speaker":"Charles Goldfarb","startTime":277.38,"endTime":281.64,"body":"about what you meant when you"},{"speaker":"Charles Goldfarb","startTime":281.64,"endTime":286.29,"body":"said that and be what we do as"},{"speaker":"Charles Goldfarb","startTime":281.64,"endTime":286.29,"body":"we choose fellows and maybe a"},{"speaker":"Charles Goldfarb","startTime":286.29,"endTime":291.18,"body":"see what the true landscape is."},{"speaker":"Charles Goldfarb","startTime":286.29,"endTime":291.18,"body":"So before we dive in, give I'd"},{"speaker":"Charles Goldfarb","startTime":291.18,"endTime":293.55,"body":"love to hear you've thought more"},{"speaker":"Charles Goldfarb","startTime":291.18,"endTime":293.55,"body":"about this. I think that I have"},{"speaker":"Charles Goldfarb","startTime":293.58,"endTime":295.41,"body":"but tell me what your what your"},{"speaker":"Charles Goldfarb","startTime":293.58,"endTime":295.41,"body":"thoughts are."},{"speaker":"Chris Dy","startTime":295.68,"endTime":298.14,"body":"Well, you went to a b"},{"speaker":"Chris Dy","startTime":295.68,"endTime":298.14,"body":"and c which is way beyond the"},{"speaker":"Chris Dy","startTime":298.14,"endTime":300.96,"body":"two Chuck Goldfarb things I'm"},{"speaker":"Chris Dy","startTime":298.14,"endTime":300.96,"body":"used to You'll have to remind me"},{"speaker":"Chris Dy","startTime":300.96,"endTime":304.59,"body":"what a, b and c are. After we"},{"speaker":"Chris Dy","startTime":300.96,"endTime":304.59,"body":"addressed the firstborn,"},{"speaker":"Chris Dy","startTime":304.59,"endTime":309.27,"body":"forgotten. Yeah. So I, it's"},{"speaker":"Chris Dy","startTime":304.59,"endTime":309.27,"body":"interesting, because I, you"},{"speaker":"Chris Dy","startTime":309.27,"endTime":312.54,"body":"know, when what you I guess the"},{"speaker":"Chris Dy","startTime":309.27,"endTime":312.54,"body":"first one was what I meant when"},{"speaker":"Chris Dy","startTime":312.54,"endTime":315.0,"body":"I originally said that, and I"},{"speaker":"Chris Dy","startTime":312.54,"endTime":315.0,"body":"honestly would have to go back"},{"speaker":"Chris Dy","startTime":315.0,"endTime":317.37,"body":"and listen to exactly what I"},{"speaker":"Chris Dy","startTime":315.0,"endTime":317.37,"body":"said, because I don't remember"},{"speaker":"Chris Dy","startTime":317.37,"endTime":320.7,"body":"all of it. But, you know, I"},{"speaker":"Chris Dy","startTime":317.37,"endTime":320.7,"body":"guess my intention is that, you"},{"speaker":"Chris Dy","startTime":320.7,"endTime":323.52,"body":"know, I think that it's not"},{"speaker":"Chris Dy","startTime":320.7,"endTime":323.52,"body":"necessarily the letters of my"},{"speaker":"Chris Dy","startTime":323.52,"endTime":326.16,"body":"friends, because I don't count"},{"speaker":"Chris Dy","startTime":323.52,"endTime":326.16,"body":"many of the people who write"},{"speaker":"Chris Dy","startTime":326.16,"endTime":329.79,"body":"letters, my friends, because I'm"},{"speaker":"Chris Dy","startTime":326.16,"endTime":329.79,"body":"still pretty Junior. And it's"},{"speaker":"Chris Dy","startTime":329.79,"endTime":332.16,"body":"usually much more senior people"},{"speaker":"Chris Dy","startTime":329.79,"endTime":332.16,"body":"that are writing letters, but"},{"speaker":"Chris Dy","startTime":332.16,"endTime":335.46,"body":"then I know them in terms of I"},{"speaker":"Chris Dy","startTime":332.16,"endTime":335.46,"body":"know who they are and where they"},{"speaker":"Chris Dy","startTime":335.46,"endTime":339.57,"body":"work. And I will say that, you"},{"speaker":"Chris Dy","startTime":335.46,"endTime":339.57,"body":"know, even now looking at"},{"speaker":"Chris Dy","startTime":339.6,"endTime":343.32,"body":"residency applications, which I"},{"speaker":"Chris Dy","startTime":339.6,"endTime":343.32,"body":"think both of us have done"},{"speaker":"Chris Dy","startTime":343.41,"endTime":346.38,"body":"recently, and we're going to do"},{"speaker":"Chris Dy","startTime":343.41,"endTime":346.38,"body":"more of as we head into"},{"speaker":"Chris Dy","startTime":346.38,"endTime":351.15,"body":"residency interview season, I"},{"speaker":"Chris Dy","startTime":346.38,"endTime":351.15,"body":"look at letters for from, from"},{"speaker":"Chris Dy","startTime":351.18,"endTime":353.43,"body":"applicants that are coming from"},{"speaker":"Chris Dy","startTime":351.18,"endTime":353.43,"body":"places that aren't as well"},{"speaker":"Chris Dy","startTime":353.43,"endTime":357.27,"body":"known, if that person is"},{"speaker":"Chris Dy","startTime":353.43,"endTime":357.27,"body":"literally stated as the best"},{"speaker":"Chris Dy","startTime":357.27,"endTime":360.93,"body":"medical student anybody has ever"},{"speaker":"Chris Dy","startTime":357.27,"endTime":360.93,"body":"worked with, or the best medical"},{"speaker":"Chris Dy","startTime":360.93,"endTime":364.41,"body":"student in their class, even if"},{"speaker":"Chris Dy","startTime":360.93,"endTime":364.41,"body":"I have no idea where they're"},{"speaker":"Chris Dy","startTime":364.41,"endTime":368.22,"body":"coming from, and no idea who"},{"speaker":"Chris Dy","startTime":364.41,"endTime":368.22,"body":"wrote the letter, that statement"},{"speaker":"Chris Dy","startTime":368.25,"endTime":373.11,"body":"in and of itself is pretty,"},{"speaker":"Chris Dy","startTime":368.25,"endTime":373.11,"body":"pretty strong. And I will take"},{"speaker":"Chris Dy","startTime":373.11,"endTime":376.11,"body":"that over, you know, I read a"},{"speaker":"Chris Dy","startTime":373.11,"endTime":376.11,"body":"fair number of letters from the"},{"speaker":"Chris Dy","startTime":376.11,"endTime":379.86,"body":"usual players. And you start to"},{"speaker":"Chris Dy","startTime":376.11,"endTime":379.86,"body":"read between the lines for"},{"speaker":"Chris Dy","startTime":379.86,"endTime":382.89,"body":"better or worse, and tried to"},{"speaker":"Chris Dy","startTime":379.86,"endTime":382.89,"body":"parse the details from what you"},{"speaker":"Chris Dy","startTime":382.89,"endTime":386.61,"body":"remember from prior years about"},{"speaker":"Chris Dy","startTime":382.89,"endTime":386.61,"body":"how people looked in that letter"},{"speaker":"Chris Dy","startTime":386.61,"endTime":389.61,"body":"than versus how they actually"},{"speaker":"Chris Dy","startTime":386.61,"endTime":389.61,"body":"looked at the interview. So I"},{"speaker":"Chris Dy","startTime":389.61,"endTime":394.53,"body":"will say, a superlative truly"},{"speaker":"Chris Dy","startTime":389.61,"endTime":394.53,"body":"superlative letter from a person"},{"speaker":"Chris Dy","startTime":394.53,"endTime":396.96,"body":"I've never heard of, and a place"},{"speaker":"Chris Dy","startTime":394.53,"endTime":396.96,"body":"that I've never heard of,"},{"speaker":"Chris Dy","startTime":397.68,"endTime":400.89,"body":"probably says a lot more than an"},{"speaker":"Chris Dy","startTime":397.68,"endTime":400.89,"body":"average letter from somebody who"},{"speaker":"Chris Dy","startTime":400.89,"endTime":402.63,"body":"was well known at a well known"},{"speaker":"Chris Dy","startTime":400.89,"endTime":402.63,"body":"institution."},{"speaker":"Charles Goldfarb","startTime":403.86,"endTime":407.46,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":403.86,"endTime":407.46,"body":"that's very true. Here's how I"},{"speaker":"Charles Goldfarb","startTime":407.46,"endTime":412.65,"body":"mean, fellowship and residency"},{"speaker":"Charles Goldfarb","startTime":407.46,"endTime":412.65,"body":"are very different. And so when"},{"speaker":"Charles Goldfarb","startTime":412.65,"endTime":417.15,"body":"I think about fellowship"},{"speaker":"Charles Goldfarb","startTime":412.65,"endTime":417.15,"body":"applicants, we're, you know, in,"},{"speaker":"Charles Goldfarb","startTime":417.18,"endTime":421.32,"body":"you'll be really owning this"},{"speaker":"Charles Goldfarb","startTime":417.18,"endTime":421.32,"body":"process, we, we use a few"},{"speaker":"Charles Goldfarb","startTime":421.32,"endTime":425.52,"body":"criteria, but the hard thing is,"},{"speaker":"Charles Goldfarb","startTime":421.32,"endTime":425.52,"body":"in residency, the residency"},{"speaker":"Charles Goldfarb","startTime":425.52,"endTime":427.44,"body":"applications are going to go"},{"speaker":"Charles Goldfarb","startTime":425.52,"endTime":427.44,"body":"through the same thing, there"},{"speaker":"Charles Goldfarb","startTime":427.44,"endTime":430.71,"body":"aren't a lot of hard criteria."},{"speaker":"Charles Goldfarb","startTime":427.44,"endTime":430.71,"body":"So we don't have any cut offs."},{"speaker":"Charles Goldfarb","startTime":430.71,"endTime":434.07,"body":"And we don't look at you know,"},{"speaker":"Charles Goldfarb","startTime":430.71,"endTime":434.07,"body":"oh, IITs, you know, fine, if as"},{"speaker":"Charles Goldfarb","startTime":434.07,"endTime":435.99,"body":"long as you do reasonable, we"},{"speaker":"Charles Goldfarb","startTime":434.07,"endTime":435.99,"body":"don't really think about that."},{"speaker":"Charles Goldfarb","startTime":435.99,"endTime":439.05,"body":"So then we're looking at how can"},{"speaker":"Charles Goldfarb","startTime":435.99,"endTime":439.05,"body":"one distinguish himself or"},{"speaker":"Charles Goldfarb","startTime":439.05,"endTime":444.45,"body":"herself? And we'll certainly the"},{"speaker":"Charles Goldfarb","startTime":439.05,"endTime":444.45,"body":"interview and how well, you"},{"speaker":"Charles Goldfarb","startTime":444.45,"endTime":447.54,"body":"know, they do and articulate"},{"speaker":"Charles Goldfarb","startTime":444.45,"endTime":447.54,"body":"themselves and how well they,"},{"speaker":"Charles Goldfarb","startTime":448.68,"endTime":451.68,"body":"you know, share their thoughts"},{"speaker":"Charles Goldfarb","startTime":448.68,"endTime":451.68,"body":"and their future goals. That's"},{"speaker":"Charles Goldfarb","startTime":451.68,"endTime":455.79,"body":"important. Personal Statement,"},{"speaker":"Charles Goldfarb","startTime":451.68,"endTime":455.79,"body":"honestly, for fellowship is not"},{"speaker":"Charles Goldfarb","startTime":455.79,"endTime":460.44,"body":"one of my top criteria. Letters"},{"speaker":"Charles Goldfarb","startTime":455.79,"endTime":460.44,"body":"really do matter. But like you"},{"speaker":"Charles Goldfarb","startTime":460.44,"endTime":463.65,"body":"said, I mean, I know a lot of"},{"speaker":"Charles Goldfarb","startTime":460.44,"endTime":463.65,"body":"people. They're not necessarily"},{"speaker":"Charles Goldfarb","startTime":463.65,"endTime":466.89,"body":"all my friends. And that's not"},{"speaker":"Charles Goldfarb","startTime":463.65,"endTime":466.89,"body":"it. I mean, that's not the goal,"},{"speaker":"Charles Goldfarb","startTime":466.89,"endTime":470.61,"body":"we're trying to figure out."},{"speaker":"Charles Goldfarb","startTime":466.89,"endTime":470.61,"body":"We're trying to look for someone"},{"speaker":"Charles Goldfarb","startTime":471.24,"endTime":475.35,"body":"feeling passionately about the"},{"speaker":"Charles Goldfarb","startTime":471.24,"endTime":475.35,"body":"applicant. And it doesn't matter"},{"speaker":"Charles Goldfarb","startTime":475.35,"endTime":478.35,"body":"if they're from the best"},{"speaker":"Charles Goldfarb","startTime":475.35,"endTime":478.35,"body":"residency in the country, or"},{"speaker":"Charles Goldfarb","startTime":478.35,"endTime":481.41,"body":"less well known residency in the"},{"speaker":"Charles Goldfarb","startTime":478.35,"endTime":481.41,"body":"country, as long as there's"},{"speaker":"Charles Goldfarb","startTime":481.41,"endTime":484.86,"body":"passion behind the letter"},{"speaker":"Charles Goldfarb","startTime":481.41,"endTime":484.86,"body":"writers words, then that's what"},{"speaker":"Charles Goldfarb","startTime":484.86,"endTime":488.61,"body":"moves me. And that's what"},{"speaker":"Charles Goldfarb","startTime":484.86,"endTime":488.61,"body":"impacts man, how much research"},{"speaker":"Charles Goldfarb","startTime":489.39,"endTime":493.68,"body":"certainly can matter. But we"},{"speaker":"Charles Goldfarb","startTime":489.39,"endTime":493.68,"body":"absolutely talk about what"},{"speaker":"Charles Goldfarb","startTime":493.68,"endTime":497.28,"body":"people have accomplished from"},{"speaker":"Charles Goldfarb","startTime":493.68,"endTime":497.28,"body":"situations which are not"},{"speaker":"Charles Goldfarb","startTime":497.49,"endTime":502.05,"body":"research our houses. And so"},{"speaker":"Charles Goldfarb","startTime":497.49,"endTime":502.05,"body":"letters matter. They do. But"},{"speaker":"Charles Goldfarb","startTime":502.05,"endTime":506.13,"body":"it's not it's not a it's not an"},{"speaker":"Charles Goldfarb","startTime":502.05,"endTime":506.13,"body":"old boys network. And in my"},{"speaker":"Charles Goldfarb","startTime":506.13,"endTime":506.55,"body":"opinion,"},{"speaker":"Chris Dy","startTime":507.569,"endTime":510.119,"body":"I could see how, you"},{"speaker":"Chris Dy","startTime":507.569,"endTime":510.119,"body":"know, I think that it can come"},{"speaker":"Chris Dy","startTime":510.119,"endTime":512.909,"body":"across as an old boys network,"},{"speaker":"Chris Dy","startTime":510.119,"endTime":512.909,"body":"if you know if the way that my"},{"speaker":"Chris Dy","startTime":512.909,"endTime":515.099,"body":"statement was interpreted was"},{"speaker":"Chris Dy","startTime":512.909,"endTime":515.099,"body":"that I only looked at letters"},{"speaker":"Chris Dy","startTime":515.099,"endTime":518.519,"body":"and yeah, I kind of get that."},{"speaker":"Chris Dy","startTime":515.099,"endTime":518.519,"body":"It's interesting that because I"},{"speaker":"Chris Dy","startTime":518.519,"endTime":520.889,"body":"came from, you know, from going"},{"speaker":"Chris Dy","startTime":518.519,"endTime":520.889,"body":"from medical school to"},{"speaker":"Chris Dy","startTime":520.889,"endTime":523.499,"body":"residency, I went to University"},{"speaker":"Chris Dy","startTime":520.889,"endTime":523.499,"body":"of Miami, which at that point,"},{"speaker":"Chris Dy","startTime":523.499,"endTime":526.469,"body":"had placed only one other"},{"speaker":"Chris Dy","startTime":523.499,"endTime":526.469,"body":"resident at HSS, before for"},{"speaker":"Chris Dy","startTime":526.469,"endTime":531.599,"body":"residency. And so for me to"},{"speaker":"Chris Dy","startTime":526.469,"endTime":531.599,"body":"match their relied a lot on"},{"speaker":"Chris Dy","startTime":531.599,"endTime":534.539,"body":"letters that I think, you know,"},{"speaker":"Chris Dy","startTime":531.599,"endTime":534.539,"body":"having had the ability to go"},{"speaker":"Chris Dy","startTime":534.539,"endTime":537.209,"body":"back and look at my residency"},{"speaker":"Chris Dy","startTime":534.539,"endTime":537.209,"body":"application, because it was"},{"speaker":"Chris Dy","startTime":537.209,"endTime":540.809,"body":"given to me when I applied for"},{"speaker":"Chris Dy","startTime":537.209,"endTime":540.809,"body":"other stuff. They were letters"},{"speaker":"Chris Dy","startTime":540.809,"endTime":543.719,"body":"that I think were pretty strong,"},{"speaker":"Chris Dy","startTime":540.809,"endTime":543.719,"body":"and were very personal and"},{"speaker":"Chris Dy","startTime":543.719,"endTime":548.009,"body":"people felt very strongly about"},{"speaker":"Chris Dy","startTime":543.719,"endTime":548.009,"body":"me. So, you know, I think that I"},{"speaker":"Chris Dy","startTime":548.009,"endTime":550.769,"body":"benefited from having people"},{"speaker":"Chris Dy","startTime":548.009,"endTime":550.769,"body":"that felt strongly about my"},{"speaker":"Chris Dy","startTime":550.769,"endTime":553.649,"body":"application that helped propel"},{"speaker":"Chris Dy","startTime":550.769,"endTime":553.649,"body":"me maybe to kind of out kicking"},{"speaker":"Chris Dy","startTime":553.649,"endTime":556.319,"body":"my coverage in terms of"},{"speaker":"Chris Dy","startTime":553.649,"endTime":556.319,"body":"residency, but certainly my"},{"speaker":"Chris Dy","startTime":556.319,"endTime":559.199,"body":"residency application had a lot"},{"speaker":"Chris Dy","startTime":556.319,"endTime":559.199,"body":"of other boxes checked in terms"},{"speaker":"Chris Dy","startTime":559.199,"endTime":562.649,"body":"of you know, you know, doing a"},{"speaker":"Chris Dy","startTime":559.199,"endTime":562.649,"body":"lot of research and coming from"},{"speaker":"Chris Dy","startTime":562.649,"endTime":565.679,"body":"a place that didn't do a lot of"},{"speaker":"Chris Dy","startTime":562.649,"endTime":565.679,"body":"research. So I think that, you"},{"speaker":"Chris Dy","startTime":565.679,"endTime":568.109,"body":"know, it is a number of things"},{"speaker":"Chris Dy","startTime":565.679,"endTime":568.109,"body":"that you look at, certainly"},{"speaker":"Chris Dy","startTime":568.109,"endTime":569.969,"body":"residency applications are"},{"speaker":"Chris Dy","startTime":568.109,"endTime":569.969,"body":"different and fellowship"},{"speaker":"Chris Dy","startTime":569.969,"endTime":573.359,"body":"applications. And then with"},{"speaker":"Chris Dy","startTime":569.969,"endTime":573.359,"body":"fellowship, you kind of see"},{"speaker":"Chris Dy","startTime":573.389,"endTime":576.569,"body":"that, you know, places are going"},{"speaker":"Chris Dy","startTime":573.389,"endTime":576.569,"body":"to be looking for very tailored"},{"speaker":"Chris Dy","startTime":576.569,"endTime":578.819,"body":"things as opposed to a broader"},{"speaker":"Chris Dy","startTime":576.569,"endTime":578.819,"body":"five year experience for"},{"speaker":"Chris Dy","startTime":578.819,"endTime":579.419,"body":"residents."},{"speaker":"Charles Goldfarb","startTime":580.98,"endTime":583.62,"body":"Yeah, listen,"},{"speaker":"Charles Goldfarb","startTime":580.98,"endTime":583.62,"body":"I went to medical school, the"},{"speaker":"Charles Goldfarb","startTime":583.62,"endTime":587.07,"body":"University of Alabama, in"},{"speaker":"Charles Goldfarb","startTime":583.62,"endTime":587.07,"body":"Birmingham. And so when I'm"},{"speaker":"Charles Goldfarb","startTime":587.07,"endTime":589.89,"body":"coming out of medical school,"},{"speaker":"Charles Goldfarb","startTime":587.07,"endTime":589.89,"body":"when I'm looking for a"},{"speaker":"Charles Goldfarb","startTime":589.89,"endTime":597.09,"body":"residency, I needed someone to"},{"speaker":"Charles Goldfarb","startTime":589.89,"endTime":597.09,"body":"be okay with UAB as my medical"},{"speaker":"Charles Goldfarb","startTime":597.09,"endTime":604.56,"body":"school, and thankfully Once"},{"speaker":"Charles Goldfarb","startTime":597.09,"endTime":604.56,"body":"University was, and I do I maybe"},{"speaker":"Charles Goldfarb","startTime":604.56,"endTime":610.32,"body":"I, maybe I didn't state it very"},{"speaker":"Charles Goldfarb","startTime":604.56,"endTime":610.32,"body":"clearly, I do believe that there"},{"speaker":"Charles Goldfarb","startTime":610.32,"endTime":613.68,"body":"is a risk if one is overly"},{"speaker":"Charles Goldfarb","startTime":610.32,"endTime":613.68,"body":"dependent on letters,"},{"speaker":"Charles Goldfarb","startTime":613.89,"endTime":617.46,"body":"specifically overly dependent on"},{"speaker":"Charles Goldfarb","startTime":613.89,"endTime":617.46,"body":"letters from your peers and the"},{"speaker":"Charles Goldfarb","startTime":617.46,"endTime":622.65,"body":"people, you know, well, but I"},{"speaker":"Charles Goldfarb","startTime":617.46,"endTime":622.65,"body":"think we, you, me and everyone"},{"speaker":"Charles Goldfarb","startTime":622.65,"endTime":626.01,"body":"else here at WashU. When we"},{"speaker":"Charles Goldfarb","startTime":622.65,"endTime":626.01,"body":"think about hand fellowship"},{"speaker":"Charles Goldfarb","startTime":626.01,"endTime":629.79,"body":"applicants, it is not about who"},{"speaker":"Charles Goldfarb","startTime":626.01,"endTime":629.79,"body":"the letter is from, or it's not"},{"speaker":"Charles Goldfarb","startTime":629.79,"endTime":633.09,"body":"only about who the letters from,"},{"speaker":"Charles Goldfarb","startTime":629.79,"endTime":633.09,"body":"it is about the quality of the"},{"speaker":"Charles Goldfarb","startTime":633.09,"endTime":637.53,"body":"letter and how well that letter"},{"speaker":"Charles Goldfarb","startTime":633.09,"endTime":637.53,"body":"captures, or grabs us to kind of"},{"speaker":"Charles Goldfarb","startTime":637.53,"endTime":642.48,"body":"intrigue us about this applicant"},{"speaker":"Charles Goldfarb","startTime":637.53,"endTime":642.48,"body":"from, as the writer says, from a"},{"speaker":"Charles Goldfarb","startTime":642.48,"endTime":643.83,"body":"place we may not know as well."},{"speaker":"Chris Dy","startTime":645.36,"endTime":650.16,"body":"Well, we certainly"},{"speaker":"Chris Dy","startTime":645.36,"endTime":650.16,"body":"think the listener who obviously"},{"speaker":"Chris Dy","startTime":650.37,"endTime":654.0,"body":"took a lot of time to write that"},{"speaker":"Chris Dy","startTime":650.37,"endTime":654.0,"body":"email, so thank you, to you for,"},{"speaker":"Chris Dy","startTime":655.17,"endTime":657.6,"body":"for sharing your thoughts and"},{"speaker":"Chris Dy","startTime":655.17,"endTime":657.6,"body":"inviting us to have this"},{"speaker":"Chris Dy","startTime":657.6,"endTime":660.9,"body":"conversation. And, you know,"},{"speaker":"Chris Dy","startTime":657.6,"endTime":660.9,"body":"it's, it's always good for us to"},{"speaker":"Chris Dy","startTime":660.9,"endTime":663.69,"body":"think about it if anybody else"},{"speaker":"Chris Dy","startTime":660.9,"endTime":663.69,"body":"has any thoughts on what, what"},{"speaker":"Chris Dy","startTime":663.69,"endTime":666.24,"body":"their opinions are, please feel"},{"speaker":"Chris Dy","startTime":663.69,"endTime":666.24,"body":"free to share."},{"speaker":"Charles Goldfarb","startTime":666.84,"endTime":670.68,"body":"Yeah, we're"},{"speaker":"Charles Goldfarb","startTime":666.84,"endTime":670.68,"body":"gonna say some, as we fear, we,"},{"speaker":"Charles Goldfarb","startTime":670.89,"endTime":675.12,"body":"you're gonna say some stupid"},{"speaker":"Charles Goldfarb","startTime":670.89,"endTime":675.12,"body":"stuff. And I have to say, when I"},{"speaker":"Charles Goldfarb","startTime":675.12,"endTime":679.26,"body":"edit is not really to edit out"},{"speaker":"Charles Goldfarb","startTime":675.12,"endTime":679.26,"body":"stupid comments, it's to, you"},{"speaker":"Charles Goldfarb","startTime":679.26,"endTime":682.17,"body":"know, make it sound better. So"},{"speaker":"Charles Goldfarb","startTime":679.26,"endTime":682.17,"body":"we're gonna say some things"},{"speaker":"Charles Goldfarb","startTime":682.17,"endTime":687.87,"body":"which, you know, may not age"},{"speaker":"Charles Goldfarb","startTime":682.17,"endTime":687.87,"body":"well or may not represent"},{"speaker":"Charles Goldfarb","startTime":688.26,"endTime":691.29,"body":"exactly our thoughts. And that's"},{"speaker":"Charles Goldfarb","startTime":688.26,"endTime":691.29,"body":"the risk we take with a podcast."},{"speaker":"Charles Goldfarb","startTime":691.29,"endTime":695.55,"body":"But, but and I like you, I"},{"speaker":"Charles Goldfarb","startTime":691.29,"endTime":695.55,"body":"appreciate the writers comments,"},{"speaker":"Charles Goldfarb","startTime":695.76,"endTime":698.88,"body":"I think it's an absolutely"},{"speaker":"Charles Goldfarb","startTime":695.76,"endTime":698.88,"body":"important point, and one that we"},{"speaker":"Charles Goldfarb","startTime":698.88,"endTime":701.88,"body":"talk about and think about, not"},{"speaker":"Charles Goldfarb","startTime":698.88,"endTime":701.88,"body":"just in response to that"},{"speaker":"Charles Goldfarb","startTime":701.88,"endTime":704.55,"body":"person's letter, let's talk"},{"speaker":"Charles Goldfarb","startTime":701.88,"endTime":704.55,"body":"about a case,"},{"speaker":"Chris Dy","startTime":704.669,"endTime":707.279,"body":"I've had a couple of"},{"speaker":"Chris Dy","startTime":704.669,"endTime":707.279,"body":"interesting cases. And I"},{"speaker":"Chris Dy","startTime":707.279,"endTime":711.809,"body":"remember, you know, whenever I"},{"speaker":"Chris Dy","startTime":707.279,"endTime":711.809,"body":"would present cases as a fellow"},{"speaker":"Chris Dy","startTime":711.809,"endTime":716.069,"body":"and as a junior attending,"},{"speaker":"Chris Dy","startTime":711.809,"endTime":716.069,"body":"basically where everybody on the"},{"speaker":"Chris Dy","startTime":716.069,"endTime":718.859,"body":"call, or in the conference would"},{"speaker":"Chris Dy","startTime":716.069,"endTime":718.859,"body":"know it's heading towards an"},{"speaker":"Chris Dy","startTime":718.859,"endTime":722.729,"body":"amputation, no matter whether"},{"speaker":"Chris Dy","startTime":718.859,"endTime":722.729,"body":"it's now or in three or six"},{"speaker":"Chris Dy","startTime":722.729,"endTime":726.599,"body":"months. One of our partners,"},{"speaker":"Chris Dy","startTime":722.729,"endTime":726.599,"body":"Ryan Calfee would say, you know,"},{"speaker":"Chris Dy","startTime":726.599,"endTime":729.869,"body":"wait until, in most situations,"},{"speaker":"Chris Dy","startTime":726.599,"endTime":729.869,"body":"wait until the patient"},{"speaker":"Chris Dy","startTime":730.049,"endTime":734.699,"body":"recognizes and realizes and even"},{"speaker":"Chris Dy","startTime":730.049,"endTime":734.699,"body":"asked for an amputation. You"},{"speaker":"Chris Dy","startTime":734.699,"endTime":738.059,"body":"know, so I have had a couple of"},{"speaker":"Chris Dy","startTime":734.699,"endTime":738.059,"body":"interesting cases recently,"},{"speaker":"Chris Dy","startTime":738.059,"endTime":740.159,"body":"which it's come to the point"},{"speaker":"Chris Dy","startTime":738.059,"endTime":740.159,"body":"where patients have asked me for"},{"speaker":"Chris Dy","startTime":740.159,"endTime":742.739,"body":"amputations is, is that"},{"speaker":"Chris Dy","startTime":740.159,"endTime":742.739,"body":"something that happens"},{"speaker":"Chris Dy","startTime":742.739,"endTime":744.839,"body":"frequently in your experience?"},{"speaker":"Charles Goldfarb","startTime":746.91,"endTime":750.12,"body":"Well, yes, I"},{"speaker":"Charles Goldfarb","startTime":746.91,"endTime":750.12,"body":"mean, it certainly happens. It"},{"speaker":"Charles Goldfarb","startTime":750.12,"endTime":755.7,"body":"actually hasn't happened in the"},{"speaker":"Charles Goldfarb","startTime":750.12,"endTime":755.7,"body":"in the recent past for me. Let"},{"speaker":"Charles Goldfarb","startTime":755.7,"endTime":758.76,"body":"me let's before we get to there"},{"speaker":"Charles Goldfarb","startTime":755.7,"endTime":758.76,"body":"to that point, maybe we'll back"},{"speaker":"Charles Goldfarb","startTime":758.76,"endTime":762.78,"body":"up just a second and say that,"},{"speaker":"Charles Goldfarb","startTime":758.76,"endTime":762.78,"body":"you know, fingertip injuries, or"},{"speaker":"Charles Goldfarb","startTime":762.78,"endTime":766.44,"body":"more than fingertip injuries are"},{"speaker":"Charles Goldfarb","startTime":762.78,"endTime":766.44,"body":"tricky. And a lot of them are"},{"speaker":"Charles Goldfarb","startTime":766.44,"endTime":770.04,"body":"cared for in the emergency"},{"speaker":"Charles Goldfarb","startTime":766.44,"endTime":770.04,"body":"department, as a service to"},{"speaker":"Charles Goldfarb","startTime":770.04,"endTime":774.54,"body":"patients and trying to minimize"},{"speaker":"Charles Goldfarb","startTime":770.04,"endTime":774.54,"body":"that need to come back multiple"},{"speaker":"Charles Goldfarb","startTime":774.54,"endTime":779.91,"body":"times. I think an emergency"},{"speaker":"Charles Goldfarb","startTime":774.54,"endTime":779.91,"body":"department revision, amputation"},{"speaker":"Charles Goldfarb","startTime":780.72,"endTime":786.54,"body":"can be an outstanding procedure."},{"speaker":"Charles Goldfarb","startTime":780.72,"endTime":786.54,"body":"And then sometimes it's better"},{"speaker":"Charles Goldfarb","startTime":786.54,"endTime":791.4,"body":"done in the operating room. And"},{"speaker":"Charles Goldfarb","startTime":786.54,"endTime":791.4,"body":"so that's a tricky place to"},{"speaker":"Charles Goldfarb","startTime":791.4,"endTime":797.94,"body":"start. But many, many, many"},{"speaker":"Charles Goldfarb","startTime":791.4,"endTime":797.94,"body":"patients do well from initial"},{"speaker":"Charles Goldfarb","startTime":797.94,"endTime":802.38,"body":"treatment and never did anything"},{"speaker":"Charles Goldfarb","startTime":797.94,"endTime":802.38,"body":"else. But absolutely, I have a"},{"speaker":"Charles Goldfarb","startTime":802.38,"endTime":806.25,"body":"handful of patients, you know,"},{"speaker":"Charles Goldfarb","startTime":802.38,"endTime":806.25,"body":"always on the docket, that that"},{"speaker":"Charles Goldfarb","startTime":806.25,"endTime":810.33,"body":"are not thrilled with their"},{"speaker":"Charles Goldfarb","startTime":806.25,"endTime":810.33,"body":"amputation. And you're either"},{"speaker":"Charles Goldfarb","startTime":810.33,"endTime":813.18,"body":"trying to coax them through it"},{"speaker":"Charles Goldfarb","startTime":810.33,"endTime":813.18,"body":"as I am now with a couple of"},{"speaker":"Charles Goldfarb","startTime":813.18,"endTime":816.15,"body":"patients, especially as we head"},{"speaker":"Charles Goldfarb","startTime":813.18,"endTime":816.15,"body":"into winter, or we're talking"},{"speaker":"Charles Goldfarb","startTime":816.15,"endTime":818.13,"body":"about that neck surgery, the"},{"speaker":"Charles Goldfarb","startTime":816.15,"endTime":818.13,"body":"revision."},{"speaker":"Chris Dy","startTime":819.6,"endTime":822.06,"body":"So let me paint let me"},{"speaker":"Chris Dy","startTime":819.6,"endTime":822.06,"body":"give you one of the two"},{"speaker":"Chris Dy","startTime":822.06,"endTime":826.53,"body":"scenarios. And one of them is a"},{"speaker":"Chris Dy","startTime":822.06,"endTime":826.53,"body":"patient who had a, an open"},{"speaker":"Chris Dy","startTime":826.53,"endTime":831.21,"body":"central slip injury. And that I,"},{"speaker":"Chris Dy","startTime":826.53,"endTime":831.21,"body":"you know, subsequently saw in"},{"speaker":"Chris Dy","startTime":831.21,"endTime":834.63,"body":"the office a few days later, and"},{"speaker":"Chris Dy","startTime":831.21,"endTime":834.63,"body":"did a repair and actually did it"},{"speaker":"Chris Dy","startTime":834.63,"endTime":837.6,"body":"awake, because I thought it was"},{"speaker":"Chris Dy","startTime":834.63,"endTime":837.6,"body":"helpful to me and patient wanted"},{"speaker":"Chris Dy","startTime":837.6,"endTime":841.5,"body":"it that way. And, you know, talk"},{"speaker":"Chris Dy","startTime":837.6,"endTime":841.5,"body":"to them about, you know, the"},{"speaker":"Chris Dy","startTime":841.5,"endTime":844.38,"body":"technique and what we were doing"},{"speaker":"Chris Dy","startTime":841.5,"endTime":844.38,"body":"what we were seeing, and I felt"},{"speaker":"Chris Dy","startTime":844.38,"endTime":848.28,"body":"good about it. But that said"},{"speaker":"Chris Dy","startTime":844.38,"endTime":848.28,"body":"patient returned to activities"},{"speaker":"Chris Dy","startTime":848.28,"endTime":854.67,"body":"sooner than I think I had wanted"},{"speaker":"Chris Dy","startTime":848.28,"endTime":854.67,"body":"anticipated. And eventually, I"},{"speaker":"Chris Dy","startTime":854.67,"endTime":859.77,"body":"think got to the point where his"},{"speaker":"Chris Dy","startTime":854.67,"endTime":859.77,"body":"finger was very swollen. There"},{"speaker":"Chris Dy","startTime":859.77,"endTime":863.58,"body":"was concerns about the wound."},{"speaker":"Chris Dy","startTime":859.77,"endTime":863.58,"body":"And as it continued to unfold,"},{"speaker":"Chris Dy","startTime":864.36,"endTime":866.28,"body":"you know, suture started"},{"speaker":"Chris Dy","startTime":864.36,"endTime":866.28,"body":"spinning, and it wasn't the"},{"speaker":"Chris Dy","startTime":866.28,"endTime":869.31,"body":"nylons at the skin. So we all"},{"speaker":"Chris Dy","startTime":866.28,"endTime":869.31,"body":"kind of knew where this was"},{"speaker":"Chris Dy","startTime":869.31,"endTime":874.11,"body":"going. And then on multiple"},{"speaker":"Chris Dy","startTime":869.31,"endTime":874.11,"body":"visits, you know, we kind of"},{"speaker":"Chris Dy","startTime":874.11,"endTime":876.27,"body":"talked about the options. I"},{"speaker":"Chris Dy","startTime":874.11,"endTime":876.27,"body":"said, I think we should wash"},{"speaker":"Chris Dy","startTime":876.27,"endTime":882.27,"body":"this out. And he said no. And"},{"speaker":"Chris Dy","startTime":876.27,"endTime":882.27,"body":"then eventually, you know, we"},{"speaker":"Chris Dy","startTime":882.27,"endTime":886.53,"body":"kept pushing it kicking the can"},{"speaker":"Chris Dy","startTime":882.27,"endTime":886.53,"body":"down the road. And you"},{"speaker":"Chris Dy","startTime":886.53,"endTime":889.26,"body":"eventually came in and said you"},{"speaker":"Chris Dy","startTime":886.53,"endTime":889.26,"body":"know what, I don't even use it."},{"speaker":"Chris Dy","startTime":889.26,"endTime":891.81,"body":"Why don't you just cut it off?"},{"speaker":"Chris Dy","startTime":889.26,"endTime":891.81,"body":"And it was it was an index"},{"speaker":"Chris Dy","startTime":891.81,"endTime":892.23,"body":"finger."},{"speaker":"Charles Goldfarb","startTime":893.13,"endTime":894.78,"body":"Yeah, that was"},{"speaker":"Charles Goldfarb","startTime":893.13,"endTime":894.78,"body":"my next question. Which finger"},{"speaker":"Charles Goldfarb","startTime":894.81,"endTime":898.35,"body":"because that really does play a"},{"speaker":"Charles Goldfarb","startTime":894.81,"endTime":898.35,"body":"role. So let's go back to your"},{"speaker":"Charles Goldfarb","startTime":898.35,"endTime":901.59,"body":"repair so you didn't a wide"},{"speaker":"Charles Goldfarb","startTime":898.35,"endTime":901.59,"body":"awake Central slipped prepare"},{"speaker":"Charles Goldfarb","startTime":901.59,"endTime":906.21,"body":"from an open injury. Which, you"},{"speaker":"Charles Goldfarb","startTime":901.59,"endTime":906.21,"body":"know, certainly that deserves an"},{"speaker":"Charles Goldfarb","startTime":906.21,"endTime":910.86,"body":"open repair doesn't sound like"},{"speaker":"Charles Goldfarb","startTime":906.21,"endTime":910.86,"body":"you pan the joint getting up in,"},{"speaker":"Charles Goldfarb","startTime":911.07,"endTime":914.85,"body":"which I might have. So you are"},{"speaker":"Charles Goldfarb","startTime":911.07,"endTime":914.85,"body":"depending on the patient? And do"},{"speaker":"Charles Goldfarb","startTime":914.85,"endTime":917.43,"body":"you what are you trying to"},{"speaker":"Charles Goldfarb","startTime":914.85,"endTime":917.43,"body":"immobilize that pap joint for"},{"speaker":"Charles Goldfarb","startTime":917.43,"endTime":918.24,"body":"six weeks,"},{"speaker":"Chris Dy","startTime":918.72,"endTime":920.55,"body":"not six weeks, I was"},{"speaker":"Chris Dy","startTime":918.72,"endTime":920.55,"body":"going to try to go three or"},{"speaker":"Chris Dy","startTime":920.55,"endTime":924.51,"body":"four, because I felt really good"},{"speaker":"Chris Dy","startTime":920.55,"endTime":924.51,"body":"about the repair. And probably,"},{"speaker":"Chris Dy","startTime":924.54,"endTime":927.81,"body":"maybe foolishly so but you know,"},{"speaker":"Chris Dy","startTime":924.54,"endTime":927.81,"body":"we had the conversation. And you"},{"speaker":"Chris Dy","startTime":927.81,"endTime":931.62,"body":"know, I told him what I expected"},{"speaker":"Chris Dy","startTime":927.81,"endTime":931.62,"body":"of him and was trying not to"},{"speaker":"Chris Dy","startTime":931.62,"endTime":936.12,"body":"lose too much motion by pinning"},{"speaker":"Chris Dy","startTime":931.62,"endTime":936.12,"body":"the joint. So I can't say I in"},{"speaker":"Chris Dy","startTime":936.12,"endTime":939.06,"body":"retrospect, I would pin it this"},{"speaker":"Chris Dy","startTime":936.12,"endTime":939.06,"body":"time around because probably"},{"speaker":"Chris Dy","startTime":939.06,"endTime":939.87,"body":"would have fractured the pin."},{"speaker":"Charles Goldfarb","startTime":941.37,"endTime":944.49,"body":"Yeah, yeah."},{"speaker":"Charles Goldfarb","startTime":941.37,"endTime":944.49,"body":"Good point. So now he's back is"},{"speaker":"Charles Goldfarb","startTime":944.49,"endTime":947.31,"body":"the index finger is interesting"},{"speaker":"Charles Goldfarb","startTime":944.49,"endTime":947.31,"body":"being the index finger, because"},{"speaker":"Charles Goldfarb","startTime":947.55,"endTime":951.36,"body":"for the index finger, while we"},{"speaker":"Charles Goldfarb","startTime":947.55,"endTime":951.36,"body":"all recognize and, and for those"},{"speaker":"Charles Goldfarb","startTime":951.36,"endTime":955.32,"body":"of you who haven't had this"},{"speaker":"Charles Goldfarb","startTime":951.36,"endTime":955.32,"body":"conversation, clearly the index"},{"speaker":"Charles Goldfarb","startTime":955.32,"endTime":960.33,"body":"finger is the one you can lose"},{"speaker":"Charles Goldfarb","startTime":955.32,"endTime":960.33,"body":"most easily and can get in the"},{"speaker":"Charles Goldfarb","startTime":960.33,"endTime":963.66,"body":"way. And so in an amputation,"},{"speaker":"Charles Goldfarb","startTime":960.33,"endTime":963.66,"body":"the index finger is totally"},{"speaker":"Charles Goldfarb","startTime":963.66,"endTime":967.47,"body":"reasonable, and patients don't"},{"speaker":"Charles Goldfarb","startTime":963.66,"endTime":967.47,"body":"miss it. But it's also the one"},{"speaker":"Charles Goldfarb","startTime":967.5,"endTime":972.42,"body":"that would be most successfully"},{"speaker":"Charles Goldfarb","startTime":967.5,"endTime":972.42,"body":"treated with PRP joint fusion."},{"speaker":"Charles Goldfarb","startTime":973.26,"endTime":976.2,"body":"Because you know, you are"},{"speaker":"Charles Goldfarb","startTime":973.26,"endTime":976.2,"body":"depending on the index finger to"},{"speaker":"Charles Goldfarb","startTime":976.2,"endTime":980.46,"body":"function and extension, the IP"},{"speaker":"Charles Goldfarb","startTime":976.2,"endTime":980.46,"body":"joints do best with fine pinch,"},{"speaker":"Charles Goldfarb","startTime":980.64,"endTime":983.37,"body":"and even with large grasp and"},{"speaker":"Charles Goldfarb","startTime":980.64,"endTime":983.37,"body":"relative extension, whereas the"},{"speaker":"Charles Goldfarb","startTime":983.37,"endTime":987.12,"body":"ring and small finger are more"},{"speaker":"Charles Goldfarb","startTime":983.37,"endTime":987.12,"body":"needed for grasp and, you know,"},{"speaker":"Charles Goldfarb","startTime":987.36,"endTime":991.5,"body":"flex pap fusion is doable, but"},{"speaker":"Charles Goldfarb","startTime":987.36,"endTime":991.5,"body":"not quite as smooth."},{"speaker":"Chris Dy","startTime":992.91,"endTime":994.924,"body":"What about if the"},{"speaker":"Chris Dy","startTime":992.91,"endTime":994.924,"body":"patient's already kind of come"},{"speaker":"Chris Dy","startTime":994.966,"endTime":997.567,"body":"in bypassing their index finger"},{"speaker":"Chris Dy","startTime":994.966,"endTime":997.567,"body":"pinching against their middle?"},{"speaker":"Chris Dy","startTime":997.609,"endTime":1000.169,"body":"Do you still think about going"},{"speaker":"Chris Dy","startTime":997.609,"endTime":1000.169,"body":"to an arthrodesis for the PIJ?"},{"speaker":"Charles Goldfarb","startTime":1001.52,"endTime":1004.052,"body":"I think it's"},{"speaker":"Charles Goldfarb","startTime":1001.52,"endTime":1004.052,"body":"the conversation piece. And"},{"speaker":"Charles Goldfarb","startTime":1004.115,"endTime":1007.977,"body":"there, you know, I think most"},{"speaker":"Charles Goldfarb","startTime":1004.115,"endTime":1007.977,"body":"patients will not be, you know,"},{"speaker":"Charles Goldfarb","startTime":1008.04,"endTime":1011.586,"body":"don't jump to asking for the"},{"speaker":"Charles Goldfarb","startTime":1008.04,"endTime":1011.586,"body":"amputation and some in some"},{"speaker":"Charles Goldfarb","startTime":1011.649,"endTime":1015.511,"body":"respects, I appreciate that."},{"speaker":"Charles Goldfarb","startTime":1011.649,"endTime":1015.511,"body":"Because it means they've thought"},{"speaker":"Charles Goldfarb","startTime":1015.574,"endTime":1019.246,"body":"through this. And if it does"},{"speaker":"Charles Goldfarb","startTime":1015.574,"endTime":1019.246,"body":"come to amputation, you and I"},{"speaker":"Charles Goldfarb","startTime":1019.31,"endTime":1022.918,"body":"know that patient will do"},{"speaker":"Charles Goldfarb","startTime":1019.31,"endTime":1022.918,"body":"wonderfully. But if they're not"},{"speaker":"Charles Goldfarb","startTime":1022.981,"endTime":1026.78,"body":"really convinced, then I will"},{"speaker":"Charles Goldfarb","startTime":1022.981,"endTime":1026.78,"body":"tuck them into a PIP fusion in"},{"speaker":"Charles Goldfarb","startTime":1026.843,"endTime":1028.3,"body":"this situation, I think"},{"speaker":"Chris Dy","startTime":1029.63,"endTime":1032.69,"body":"now, I guess in my"},{"speaker":"Chris Dy","startTime":1029.63,"endTime":1032.69,"body":"situation where I have some"},{"speaker":"Chris Dy","startTime":1032.69,"endTime":1036.56,"body":"concerns about adherence to"},{"speaker":"Chris Dy","startTime":1032.69,"endTime":1036.56,"body":"recommendations, I think we're"},{"speaker":"Chris Dy","startTime":1036.56,"endTime":1038.96,"body":"not supposed to use the word"},{"speaker":"Chris Dy","startTime":1036.56,"endTime":1038.96,"body":"compliance, but adherence to"},{"speaker":"Chris Dy","startTime":1038.96,"endTime":1044.03,"body":"recommendations, would you still"},{"speaker":"Chris Dy","startTime":1038.96,"endTime":1044.03,"body":"trust that you could get a VIP"},{"speaker":"Chris Dy","startTime":1044.03,"endTime":1047.21,"body":"joint to fuse in somebody who"},{"speaker":"Chris Dy","startTime":1044.03,"endTime":1047.21,"body":"may not listen to what you're"},{"speaker":"Chris Dy","startTime":1047.21,"endTime":1047.96,"body":"asking them to do?"},{"speaker":"Charles Goldfarb","startTime":1049.19,"endTime":1052.7,"body":"I think so. I"},{"speaker":"Charles Goldfarb","startTime":1049.19,"endTime":1052.7,"body":"don't know. There's different"},{"speaker":"Charles Goldfarb","startTime":1052.7,"endTime":1056.93,"body":"techniques. I'm a big fan of the"},{"speaker":"Charles Goldfarb","startTime":1052.7,"endTime":1056.93,"body":"tension band technique. Still, I"},{"speaker":"Charles Goldfarb","startTime":1056.93,"endTime":1060.5,"body":"recently revised a patient who"},{"speaker":"Charles Goldfarb","startTime":1056.93,"endTime":1060.5,"body":"had been fused with two small"},{"speaker":"Charles Goldfarb","startTime":1060.5,"endTime":1064.67,"body":"headless screws. I think that's"},{"speaker":"Charles Goldfarb","startTime":1060.5,"endTime":1064.67,"body":"tricky and an index finger,"},{"speaker":"Charles Goldfarb","startTime":1064.67,"endTime":1067.94,"body":"especially given the"},{"speaker":"Charles Goldfarb","startTime":1064.67,"endTime":1067.94,"body":"positioning. So I'm a big fan of"},{"speaker":"Charles Goldfarb","startTime":1067.94,"endTime":1073.34,"body":"tension band, I think you can"},{"speaker":"Charles Goldfarb","startTime":1067.94,"endTime":1073.34,"body":"get a very solid, strong repair"},{"speaker":"Charles Goldfarb","startTime":1073.52,"endTime":1077.3,"body":"that should do well, long term."},{"speaker":"Charles Goldfarb","startTime":1073.52,"endTime":1077.3,"body":"So yeah, I mean, again, the"},{"speaker":"Charles Goldfarb","startTime":1077.3,"endTime":1080.3,"body":"patient needs to own part of"},{"speaker":"Charles Goldfarb","startTime":1077.3,"endTime":1080.3,"body":"this, but I think we could get a"},{"speaker":"Charles Goldfarb","startTime":1080.3,"endTime":1080.72,"body":"deal."},{"speaker":"Chris Dy","startTime":1082.1,"endTime":1086.75,"body":"So when patients have"},{"speaker":"Chris Dy","startTime":1082.1,"endTime":1086.75,"body":"this particular situation, say"},{"speaker":"Chris Dy","startTime":1086.75,"endTime":1089.87,"body":"you don't go to the fusion, but"},{"speaker":"Chris Dy","startTime":1086.75,"endTime":1089.87,"body":"you follow their request for an"},{"speaker":"Chris Dy","startTime":1089.87,"endTime":1093.95,"body":"amputation, what's the level in"},{"speaker":"Chris Dy","startTime":1089.87,"endTime":1093.95,"body":"which you would shorten the"},{"speaker":"Chris Dy","startTime":1093.95,"endTime":1094.37,"body":"digit?"},{"speaker":"Charles Goldfarb","startTime":1094.999,"endTime":1097.969,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":1094.999,"endTime":1097.969,"body":"that's the question. And I think"},{"speaker":"Charles Goldfarb","startTime":1097.969,"endTime":1102.079,"body":"that is actually maybe harder"},{"speaker":"Charles Goldfarb","startTime":1097.969,"endTime":1102.079,"body":"for a patient to conceptualize."},{"speaker":"Charles Goldfarb","startTime":1102.079,"endTime":1105.679,"body":"Now, the good thing about the"},{"speaker":"Charles Goldfarb","startTime":1102.079,"endTime":1105.679,"body":"index finger is you're not gonna"},{"speaker":"Charles Goldfarb","startTime":1105.679,"endTime":1108.079,"body":"have a hole in your hands, so to"},{"speaker":"Charles Goldfarb","startTime":1105.679,"endTime":1108.079,"body":"speak, always talk about"},{"speaker":"Charles Goldfarb","startTime":1108.079,"endTime":1111.769,"body":"dropping m\u0026ms If you amputate"},{"speaker":"Charles Goldfarb","startTime":1108.079,"endTime":1111.769,"body":"the ring finger at the MP joint."},{"speaker":"Charles Goldfarb","startTime":1111.769,"endTime":1115.339,"body":"That's not people don't do well"},{"speaker":"Charles Goldfarb","startTime":1111.769,"endTime":1115.339,"body":"with that. But for the index"},{"speaker":"Charles Goldfarb","startTime":1115.339,"endTime":1120.469,"body":"finger, I think you really have"},{"speaker":"Charles Goldfarb","startTime":1115.339,"endTime":1120.469,"body":"two choices. If it's truly about"},{"speaker":"Charles Goldfarb","startTime":1121.129,"endTime":1125.989,"body":"breadth of the hand and strength"},{"speaker":"Charles Goldfarb","startTime":1121.129,"endTime":1125.989,"body":"and less about appearance. I"},{"speaker":"Charles Goldfarb","startTime":1125.989,"endTime":1129.259,"body":"think you can do it mid proximal"},{"speaker":"Charles Goldfarb","startTime":1125.989,"endTime":1129.259,"body":"phalanx, but if it's truly about"},{"speaker":"Charles Goldfarb","startTime":1129.259,"endTime":1133.939,"body":"appearance, you can make a"},{"speaker":"Charles Goldfarb","startTime":1129.259,"endTime":1133.939,"body":"beautiful hand and no one will"},{"speaker":"Charles Goldfarb","startTime":1133.939,"endTime":1139.399,"body":"notice with a mid metacarpal Ray"},{"speaker":"Charles Goldfarb","startTime":1133.939,"endTime":1139.399,"body":"resection, I mean, you can have"},{"speaker":"Charles Goldfarb","startTime":1139.399,"endTime":1142.699,"body":"a great first webspace you can"},{"speaker":"Charles Goldfarb","startTime":1139.399,"endTime":1142.699,"body":"have an incision that looks"},{"speaker":"Charles Goldfarb","startTime":1142.699,"endTime":1146.239,"body":"beautiful, and a highly"},{"speaker":"Charles Goldfarb","startTime":1142.699,"endTime":1146.239,"body":"functional hand. So that's the"},{"speaker":"Charles Goldfarb","startTime":1146.239,"endTime":1151.519,"body":"tricky part but in a like a male"},{"speaker":"Charles Goldfarb","startTime":1146.239,"endTime":1151.519,"body":"labor not to you know generalize"},{"speaker":"Charles Goldfarb","startTime":1151.549,"endTime":1156.199,"body":"overly. Maybe it's maybe it's"},{"speaker":"Charles Goldfarb","startTime":1151.549,"endTime":1156.199,"body":"through the proximal phalanx."},{"speaker":"Chris Dy","startTime":1156.62,"endTime":1159.95,"body":"How do you decide if"},{"speaker":"Chris Dy","startTime":1156.62,"endTime":1159.95,"body":"you're say you're shortening?"},{"speaker":"Chris Dy","startTime":1161.42,"endTime":1164.09,"body":"You're not saving the proximal"},{"speaker":"Chris Dy","startTime":1161.42,"endTime":1164.09,"body":"failings? How do you decide"},{"speaker":"Chris Dy","startTime":1164.09,"endTime":1167.21,"body":"between an MP disarticulation"},{"speaker":"Chris Dy","startTime":1164.09,"endTime":1167.21,"body":"and the trans metacarpal re"},{"speaker":"Chris Dy","startTime":1167.21,"endTime":1167.84,"body":"amputation?"},{"speaker":"Charles Goldfarb","startTime":1169.31,"endTime":1172.13,"body":"I don't think"},{"speaker":"Charles Goldfarb","startTime":1169.31,"endTime":1172.13,"body":"an NP dislocation looks good."},{"speaker":"Charles Goldfarb","startTime":1172.7,"endTime":1178.7,"body":"It's easy to do. It's fast. But"},{"speaker":"Charles Goldfarb","startTime":1172.7,"endTime":1178.7,"body":"it ends up looking like in"},{"speaker":"Charles Goldfarb","startTime":1178.7,"endTime":1182.12,"body":"congenital Hansard. We talk a"},{"speaker":"Charles Goldfarb","startTime":1178.7,"endTime":1182.12,"body":"lot about situations where you"},{"speaker":"Charles Goldfarb","startTime":1182.12,"endTime":1186.95,"body":"kind of get an L shaped"},{"speaker":"Charles Goldfarb","startTime":1182.12,"endTime":1186.95,"body":"deformity whether that's with a"},{"speaker":"Charles Goldfarb","startTime":1187.04,"endTime":1191.39,"body":"extra thumb reconstruction, or"},{"speaker":"Charles Goldfarb","startTime":1187.04,"endTime":1191.39,"body":"whatever, and patients hate"},{"speaker":"Charles Goldfarb","startTime":1191.39,"endTime":1195.47,"body":"that, right. There's no l shapes"},{"speaker":"Charles Goldfarb","startTime":1191.39,"endTime":1195.47,"body":"in the in the normal anatomy of"},{"speaker":"Charles Goldfarb","startTime":1195.47,"endTime":1199.01,"body":"anything. And so that's what you"},{"speaker":"Charles Goldfarb","startTime":1195.47,"endTime":1199.01,"body":"get when you do an MP"},{"speaker":"Charles Goldfarb","startTime":1199.01,"endTime":1203.93,"body":"disarticulation So I generally"},{"speaker":"Charles Goldfarb","startTime":1199.01,"endTime":1203.93,"body":"push patients to let's not maybe"},{"speaker":"Charles Goldfarb","startTime":1203.93,"endTime":1205.67,"body":"do it at the joint even though"},{"speaker":"Charles Goldfarb","startTime":1203.93,"endTime":1205.67,"body":"there's nothing wrong with it."},{"speaker":"Charles Goldfarb","startTime":1205.67,"endTime":1209.18,"body":"Let's go back a little more"},{"speaker":"Charles Goldfarb","startTime":1205.67,"endTime":1209.18,"body":"proximately. If it's distal 1/3"},{"speaker":"Charles Goldfarb","startTime":1209.18,"endTime":1211.4,"body":"of the metacarpal, that's still"},{"speaker":"Charles Goldfarb","startTime":1209.18,"endTime":1211.4,"body":"fine. And I do a little"},{"speaker":"Charles Goldfarb","startTime":1211.4,"endTime":1215.06,"body":"obliquity. So I'm taking more on"},{"speaker":"Charles Goldfarb","startTime":1211.4,"endTime":1215.06,"body":"the radial side, and less on the"},{"speaker":"Charles Goldfarb","startTime":1215.06,"endTime":1218.69,"body":"owner side, just because you"},{"speaker":"Charles Goldfarb","startTime":1215.06,"endTime":1218.69,"body":"avoid that bump and you avoid"},{"speaker":"Charles Goldfarb","startTime":1218.69,"endTime":1221.18,"body":"that deformity. How do you how"},{"speaker":"Charles Goldfarb","startTime":1218.69,"endTime":1221.18,"body":"do you think about that?"},{"speaker":"Chris Dy","startTime":1221.899,"endTime":1225.799,"body":"Well, I mean, I think"},{"speaker":"Chris Dy","startTime":1221.899,"endTime":1225.799,"body":"there's the dogma about expose"},{"speaker":"Chris Dy","startTime":1225.799,"endTime":1228.889,"body":"cartilage being a night is for"},{"speaker":"Chris Dy","startTime":1225.799,"endTime":1228.889,"body":"infection. Do you believe in"},{"speaker":"Chris Dy","startTime":1228.889,"endTime":1232.549,"body":"that? I've been told that a"},{"speaker":"Chris Dy","startTime":1228.889,"endTime":1232.549,"body":"couple of times, I don't think"},{"speaker":"Chris Dy","startTime":1232.549,"endTime":1235.729,"body":"it actually has borne out in my"},{"speaker":"Chris Dy","startTime":1232.549,"endTime":1235.729,"body":"limited series. So I think"},{"speaker":"Chris Dy","startTime":1235.729,"endTime":1237.139,"body":"that's one consideration I have."},{"speaker":"Charles Goldfarb","startTime":1237.95,"endTime":1239.6,"body":"I think the"},{"speaker":"Charles Goldfarb","startTime":1237.95,"endTime":1239.6,"body":"only thing I suppose college"},{"speaker":"Charles Goldfarb","startTime":1239.6,"endTime":1243.41,"body":"does is create bulk, whether"},{"speaker":"Charles Goldfarb","startTime":1239.6,"endTime":1243.41,"body":"it's head of a proximal phalanx"},{"speaker":"Charles Goldfarb","startTime":1243.41,"endTime":1247.22,"body":"or distal phalanx or head of a"},{"speaker":"Charles Goldfarb","startTime":1243.41,"endTime":1247.22,"body":"metacarpal. So when I do take"},{"speaker":"Charles Goldfarb","startTime":1247.22,"endTime":1252.53,"body":"cartilage, I do it without"},{"speaker":"Charles Goldfarb","startTime":1247.22,"endTime":1252.53,"body":"thoughts about the impact on"},{"speaker":"Charles Goldfarb","startTime":1252.53,"endTime":1254.57,"body":"infection, because I don't think"},{"speaker":"Charles Goldfarb","startTime":1252.53,"endTime":1254.57,"body":"it has a role either."},{"speaker":"Chris Dy","startTime":1256.76,"endTime":1258.92,"body":"And then do you do"},{"speaker":"Chris Dy","startTime":1256.76,"endTime":1258.92,"body":"anything special? This is my"},{"speaker":"Chris Dy","startTime":1258.92,"endTime":1261.8,"body":"nerve portion. Do you do"},{"speaker":"Chris Dy","startTime":1258.92,"endTime":1261.8,"body":"anything special for the nerves"},{"speaker":"Chris Dy","startTime":1261.8,"endTime":1263.75,"body":"traction direct to me, is there"},{"speaker":"Chris Dy","startTime":1261.8,"endTime":1263.75,"body":"anything else?"},{"speaker":"Charles Goldfarb","startTime":1265.94,"endTime":1269.18,"body":"So with"},{"speaker":"Charles Goldfarb","startTime":1265.94,"endTime":1269.18,"body":"initial operation, I do traction"},{"speaker":"Charles Goldfarb","startTime":1269.18,"endTime":1274.16,"body":"direct dummies. And I'm very"},{"speaker":"Charles Goldfarb","startTime":1269.18,"endTime":1274.16,"body":"curious as to what you do. And"},{"speaker":"Charles Goldfarb","startTime":1274.22,"endTime":1277.88,"body":"there is a limited handful of"},{"speaker":"Charles Goldfarb","startTime":1274.22,"endTime":1277.88,"body":"patients, as we all know, that"},{"speaker":"Charles Goldfarb","startTime":1277.88,"endTime":1282.83,"body":"will not be happy and will have"},{"speaker":"Charles Goldfarb","startTime":1277.88,"endTime":1282.83,"body":"nerve pain, it does absolutely"},{"speaker":"Charles Goldfarb","startTime":1282.83,"endTime":1287.51,"body":"tend to happen more commonly in"},{"speaker":"Charles Goldfarb","startTime":1282.83,"endTime":1287.51,"body":"the worker, and not accusing"},{"speaker":"Charles Goldfarb","startTime":1287.51,"endTime":1291.02,"body":"anyone of secondary gain issues,"},{"speaker":"Charles Goldfarb","startTime":1287.51,"endTime":1291.02,"body":"but and I think is legit, it can"},{"speaker":"Charles Goldfarb","startTime":1291.02,"endTime":1294.83,"body":"absolutely be legit. So it's"},{"speaker":"Charles Goldfarb","startTime":1291.02,"endTime":1294.83,"body":"very tricky. But the initial for"},{"speaker":"Charles Goldfarb","startTime":1294.83,"endTime":1300.14,"body":"me is attraction neurectomy,"},{"speaker":"Charles Goldfarb","startTime":1294.83,"endTime":1300.14,"body":"sharp cut with a 15 blade done"},{"speaker":"Charles Goldfarb","startTime":1300.14,"endTime":1303.77,"body":"carefully. But that's my"},{"speaker":"Charles Goldfarb","startTime":1300.14,"endTime":1303.77,"body":"approach, what's your approach?"},{"speaker":"Chris Dy","startTime":1304.489,"endTime":1306.979,"body":"And pretty similar,"},{"speaker":"Chris Dy","startTime":1304.489,"endTime":1306.979,"body":"I'll add the crush injury"},{"speaker":"Chris Dy","startTime":1306.979,"endTime":1311.149,"body":"proximal to the neurectomy site."},{"speaker":"Chris Dy","startTime":1306.979,"endTime":1311.149,"body":"You know, to order it basically"},{"speaker":"Chris Dy","startTime":1311.599,"endTime":1315.439,"body":"enable a level four crush injury"},{"speaker":"Chris Dy","startTime":1311.599,"endTime":1315.439,"body":"proximal to your level five"},{"speaker":"Chris Dy","startTime":1315.439,"endTime":1318.679,"body":"neuro medic injury in the hopes"},{"speaker":"Chris Dy","startTime":1315.439,"endTime":1318.679,"body":"that it won't even regenerate"},{"speaker":"Chris Dy","startTime":1318.679,"endTime":1321.559,"body":"past the level four if it does"},{"speaker":"Chris Dy","startTime":1318.679,"endTime":1321.559,"body":"get to the level five so that it"},{"speaker":"Chris Dy","startTime":1321.559,"endTime":1325.489,"body":"will become symptomatic. But you"},{"speaker":"Chris Dy","startTime":1321.559,"endTime":1325.489,"body":"know, I think there's a lot of"},{"speaker":"Chris Dy","startTime":1325.489,"endTime":1327.769,"body":"different ways to do and don't"},{"speaker":"Chris Dy","startTime":1325.489,"endTime":1327.769,"body":"do anything special beyond that"},{"speaker":"Chris Dy","startTime":1327.769,"endTime":1330.589,"body":"in terms of my primary surgery."},{"speaker":"Chris Dy","startTime":1327.769,"endTime":1330.589,"body":"Now if it becomes a secondary"},{"speaker":"Chris Dy","startTime":1330.589,"endTime":1333.619,"body":"surgery, and then I start to"},{"speaker":"Chris Dy","startTime":1330.589,"endTime":1333.619,"body":"pull out some of the tricks, but"},{"speaker":"Charles Goldfarb","startTime":1334.519,"endTime":1336.139,"body":"I will tell me"},{"speaker":"Charles Goldfarb","startTime":1334.519,"endTime":1336.139,"body":"some of the tricks"},{"speaker":"Chris Dy","startTime":1337.58,"endTime":1340.52,"body":"I've used, I don't I"},{"speaker":"Chris Dy","startTime":1337.58,"endTime":1340.52,"body":"think central central coaptation"},{"speaker":"Chris Dy","startTime":1340.52,"endTime":1343.1,"body":"is an interesting technique. I"},{"speaker":"Chris Dy","startTime":1340.52,"endTime":1343.1,"body":"think that cortically that's"},{"speaker":"Chris Dy","startTime":1343.1,"endTime":1347.18,"body":"probably pretty confusing. To be"},{"speaker":"Chris Dy","startTime":1343.1,"endTime":1347.18,"body":"honest with you. I've, if you"},{"speaker":"Chris Dy","startTime":1347.18,"endTime":1349.88,"body":"can do it in a way where it"},{"speaker":"Chris Dy","startTime":1347.18,"endTime":1349.88,"body":"doesn't create a point of"},{"speaker":"Charles Goldfarb","startTime":1349.91,"endTime":1351.74,"body":"corruption."},{"speaker":"Charles Goldfarb","startTime":1349.91,"endTime":1351.74,"body":"You're just talking about sewing"},{"speaker":"Charles Goldfarb","startTime":1351.74,"endTime":1353.84,"body":"that Irvin's together, correct."},{"speaker":"Charles Goldfarb","startTime":1351.74,"endTime":1353.84,"body":"Okay."},{"speaker":"Chris Dy","startTime":1354.68,"endTime":1357.522,"body":"Correct. And then I"},{"speaker":"Chris Dy","startTime":1354.68,"endTime":1357.522,"body":"think the other technique you"},{"speaker":"Chris Dy","startTime":1357.58,"endTime":1360.887,"body":"could use potentially is"},{"speaker":"Chris Dy","startTime":1357.58,"endTime":1360.887,"body":"implanting it in some muscle, or"},{"speaker":"Chris Dy","startTime":1360.945,"endTime":1364.31,"body":"in some bone bone is tricky,"},{"speaker":"Chris Dy","startTime":1360.945,"endTime":1364.31,"body":"just because you can create a"},{"speaker":"Chris Dy","startTime":1364.368,"endTime":1367.733,"body":"point of constriction. But if"},{"speaker":"Chris Dy","startTime":1364.368,"endTime":1367.733,"body":"you do have an open canal in"},{"speaker":"Chris Dy","startTime":1367.791,"endTime":1371.504,"body":"there, and you can tuck it away"},{"speaker":"Chris Dy","startTime":1367.791,"endTime":1371.504,"body":"nicely, that's an easy way to do"},{"speaker":"Chris Dy","startTime":1371.562,"endTime":1375.102,"body":"it. That's much it's facilitated"},{"speaker":"Chris Dy","startTime":1371.562,"endTime":1375.102,"body":"if you use something like an"},{"speaker":"Chris Dy","startTime":1375.16,"endTime":1378.757,"body":"alga graft as an extension cord,"},{"speaker":"Chris Dy","startTime":1375.16,"endTime":1378.757,"body":"essentially. I've done TMR in"},{"speaker":"Chris Dy","startTime":1378.815,"endTime":1381.715,"body":"some of these situations,"},{"speaker":"Chris Dy","startTime":1378.815,"endTime":1381.715,"body":"because if you've got an"},{"speaker":"Chris Dy","startTime":1381.773,"endTime":1384.906,"body":"expendable lumbar call or"},{"speaker":"Chris Dy","startTime":1381.773,"endTime":1384.906,"body":"something like that, and you"},{"speaker":"Chris Dy","startTime":1384.964,"endTime":1388.677,"body":"find a nice branch, that's been"},{"speaker":"Chris Dy","startTime":1384.964,"endTime":1388.677,"body":"nice. I've done that in the hand"},{"speaker":"Chris Dy","startTime":1388.736,"endTime":1392.275,"body":"occasionally and then once in a"},{"speaker":"Chris Dy","startTime":1388.736,"endTime":1392.275,"body":"foot after a recurring Morton"},{"speaker":"Chris Dy","startTime":1392.333,"endTime":1396.046,"body":"neuroma. And that worked really"},{"speaker":"Chris Dy","startTime":1392.333,"endTime":1396.046,"body":"well. I'm trying to think of any"},{"speaker":"Chris Dy","startTime":1396.104,"endTime":1399.527,"body":"other tricks. I haven't done the"},{"speaker":"Chris Dy","startTime":1396.104,"endTime":1399.527,"body":"full on starfish, that our"},{"speaker":"Chris Dy","startTime":1399.585,"endTime":1403.182,"body":"friends, Glenn Gaston and Brian"},{"speaker":"Chris Dy","startTime":1399.585,"endTime":1403.182,"body":"Lofleur and OrthoCarolina have"},{"speaker":"Chris Dy","startTime":1403.24,"endTime":1406.779,"body":"described that's obviously a for"},{"speaker":"Chris Dy","startTime":1403.24,"endTime":1406.779,"body":"a much more extensive injury"},{"speaker":"Chris Dy","startTime":1406.837,"endTime":1409.1,"body":"than a single, single digit amputation."},{"speaker":"Charles Goldfarb","startTime":1410.12,"endTime":1413.72,"body":"Yeah, I really"},{"speaker":"Charles Goldfarb","startTime":1410.12,"endTime":1413.72,"body":"like just the resection traction"},{"speaker":"Charles Goldfarb","startTime":1415.82,"endTime":1419.57,"body":"resection, I agree with"},{"speaker":"Charles Goldfarb","startTime":1415.82,"endTime":1419.57,"body":"implantation and muscle."},{"speaker":"Charles Goldfarb","startTime":1420.02,"endTime":1423.44,"body":"Probably as my next step,"},{"speaker":"Charles Goldfarb","startTime":1420.02,"endTime":1423.44,"body":"depending on the level, I have"},{"speaker":"Charles Goldfarb","startTime":1423.44,"endTime":1427.34,"body":"done digital nerve to digital"},{"speaker":"Charles Goldfarb","startTime":1423.44,"endTime":1427.34,"body":"nerve coaptation. And I have to"},{"speaker":"Charles Goldfarb","startTime":1427.34,"endTime":1432.86,"body":"say it's generally worked. I do"},{"speaker":"Charles Goldfarb","startTime":1427.34,"endTime":1432.86,"body":"think it's silly to just think"},{"speaker":"Charles Goldfarb","startTime":1432.86,"endTime":1436.28,"body":"you can keep coming back further"},{"speaker":"Charles Goldfarb","startTime":1432.86,"endTime":1436.28,"body":"and further with attraction"},{"speaker":"Charles Goldfarb","startTime":1437.03,"endTime":1441.2,"body":"neurectomy Because that's I"},{"speaker":"Charles Goldfarb","startTime":1437.03,"endTime":1441.2,"body":"think, in the patients that have"},{"speaker":"Charles Goldfarb","startTime":1441.2,"endTime":1444.83,"body":"this happen, is going to likely"},{"speaker":"Charles Goldfarb","startTime":1441.2,"endTime":1444.83,"body":"or potentially keep happening."},{"speaker":"Charles Goldfarb","startTime":1445.1,"endTime":1446.78,"body":"And thankfully, it's just not"},{"speaker":"Charles Goldfarb","startTime":1445.1,"endTime":1446.78,"body":"everyone."},{"speaker":"Chris Dy","startTime":1447.08,"endTime":1448.88,"body":"So let me get your"},{"speaker":"Chris Dy","startTime":1447.08,"endTime":1448.88,"body":"thoughts on a slightly different"},{"speaker":"Chris Dy","startTime":1448.88,"endTime":1452.9,"body":"case. Yeah, so this there's a"},{"speaker":"Chris Dy","startTime":1448.88,"endTime":1452.9,"body":"patient who I treated them and"},{"speaker":"Chris Dy","startTime":1452.9,"endTime":1456.56,"body":"as scleroderma, very bad"},{"speaker":"Chris Dy","startTime":1452.9,"endTime":1456.56,"body":"scleroderma and it's failed all"},{"speaker":"Chris Dy","startTime":1456.56,"endTime":1458.99,"body":"medical management. And a few"},{"speaker":"Chris Dy","startTime":1456.56,"endTime":1458.99,"body":"years ago, it got to the point"},{"speaker":"Chris Dy","startTime":1458.99,"endTime":1462.23,"body":"where we tried salvage kind of"},{"speaker":"Chris Dy","startTime":1458.99,"endTime":1462.23,"body":"procedures, meaning we tried to"},{"speaker":"Chris Dy","startTime":1462.23,"endTime":1467.66,"body":"do pretty extensive, you know,"},{"speaker":"Chris Dy","startTime":1462.23,"endTime":1467.66,"body":"digital sympathectomy, ease and,"},{"speaker":"Chris Dy","startTime":1468.32,"endTime":1470.75,"body":"and then did the arch and did"},{"speaker":"Chris Dy","startTime":1468.32,"endTime":1470.75,"body":"the radial ulnar artery all"},{"speaker":"Chris Dy","startTime":1470.75,"endTime":1473.33,"body":"under the microscope to save a"},{"speaker":"Chris Dy","startTime":1470.75,"endTime":1473.33,"body":"finger and ultimately ended up"},{"speaker":"Chris Dy","startTime":1473.33,"endTime":1476.96,"body":"losing a finger. And then a"},{"speaker":"Chris Dy","startTime":1473.33,"endTime":1476.96,"body":"couple years goes, I mean, the"},{"speaker":"Chris Dy","startTime":1476.96,"endTime":1480.41,"body":"guy is really happy with the end"},{"speaker":"Chris Dy","startTime":1476.96,"endTime":1480.41,"body":"result. Couple years goes by and"},{"speaker":"Chris Dy","startTime":1480.41,"endTime":1482.63,"body":"he comes in, I see his name on"},{"speaker":"Chris Dy","startTime":1480.41,"endTime":1482.63,"body":"the schedule, I'm worried about"},{"speaker":"Chris Dy","startTime":1482.63,"endTime":1486.08,"body":"what's going on. And it's his"},{"speaker":"Chris Dy","startTime":1482.63,"endTime":1486.08,"body":"other side. And he's got the"},{"speaker":"Chris Dy","startTime":1486.11,"endTime":1490.64,"body":"ulcerations going on and middle"},{"speaker":"Chris Dy","startTime":1486.11,"endTime":1490.64,"body":"fingertip. And you know, I tried"},{"speaker":"Chris Dy","startTime":1490.64,"endTime":1493.52,"body":"to Doppler him in the clinic and"},{"speaker":"Chris Dy","startTime":1490.64,"endTime":1493.52,"body":"see what kind of flow we have"},{"speaker":"Chris Dy","startTime":1493.52,"endTime":1495.95,"body":"and I'm not quite sure what's"},{"speaker":"Chris Dy","startTime":1493.52,"endTime":1495.95,"body":"going on in the finger. So I"},{"speaker":"Chris Dy","startTime":1495.95,"endTime":1500.69,"body":"sent him for arterial studies,"},{"speaker":"Chris Dy","startTime":1495.95,"endTime":1500.69,"body":"just to get a much more detailed"},{"speaker":"Chris Dy","startTime":1500.69,"endTime":1505.46,"body":"and objective view of the flow"},{"speaker":"Chris Dy","startTime":1500.69,"endTime":1505.46,"body":"to the finger. And the studies"},{"speaker":"Chris Dy","startTime":1505.49,"endTime":1508.52,"body":"actually come back showing that"},{"speaker":"Chris Dy","startTime":1505.49,"endTime":1508.52,"body":"there is something reasonable in"},{"speaker":"Chris Dy","startTime":1508.52,"endTime":1512.42,"body":"terms of the are the brachial"},{"speaker":"Chris Dy","startTime":1508.52,"endTime":1512.42,"body":"index, or the digit index going"},{"speaker":"Chris Dy","startTime":1512.42,"endTime":1515.54,"body":"to the finger. So I haven't come"},{"speaker":"Chris Dy","startTime":1512.42,"endTime":1515.54,"body":"back to discuss those, like,"},{"speaker":"Chris Dy","startTime":1515.54,"endTime":1517.64,"body":"look like we could try to save"},{"speaker":"Chris Dy","startTime":1515.54,"endTime":1517.64,"body":"your finger. Like, I think"},{"speaker":"Chris Dy","startTime":1517.64,"endTime":1519.98,"body":"there's a chance here, you know,"},{"speaker":"Chris Dy","startTime":1517.64,"endTime":1519.98,"body":"we could do the sympathectomy,"},{"speaker":"Chris Dy","startTime":1520.01,"endTime":1525.29,"body":"etc. And then he says no, like,"},{"speaker":"Chris Dy","startTime":1520.01,"endTime":1525.29,"body":"this is just going to end up the"},{"speaker":"Chris Dy","startTime":1525.29,"endTime":1527.84,"body":"way that the other one ended up,"},{"speaker":"Chris Dy","startTime":1525.29,"endTime":1527.84,"body":"just take it now and it's his"},{"speaker":"Chris Dy","startTime":1527.84,"endTime":1530.72,"body":"middle finger. So what would you"},{"speaker":"Chris Dy","startTime":1527.84,"endTime":1530.72,"body":"do in that situation?"},{"speaker":"Charles Goldfarb","startTime":1531.98,"endTime":1534.26,"body":"So that is"},{"speaker":"Charles Goldfarb","startTime":1531.98,"endTime":1534.26,"body":"clearly a very different"},{"speaker":"Charles Goldfarb","startTime":1534.26,"endTime":1538.31,"body":"situation, I would be grateful"},{"speaker":"Charles Goldfarb","startTime":1534.26,"endTime":1538.31,"body":"for this patient's perspective,"},{"speaker":"Charles Goldfarb","startTime":1538.61,"endTime":1541.52,"body":"because I would agree with it."},{"speaker":"Charles Goldfarb","startTime":1538.61,"endTime":1541.52,"body":"And while you could certainly"},{"speaker":"Charles Goldfarb","startTime":1541.52,"endTime":1546.38,"body":"try something more heroic, I"},{"speaker":"Charles Goldfarb","startTime":1541.52,"endTime":1546.38,"body":"think his approach is very"},{"speaker":"Charles Goldfarb","startTime":1546.38,"endTime":1550.19,"body":"practical. And I would say I"},{"speaker":"Charles Goldfarb","startTime":1546.38,"endTime":1550.19,"body":"would do the amputation, you"},{"speaker":"Charles Goldfarb","startTime":1550.19,"endTime":1553.52,"body":"know, this would be without a"},{"speaker":"Charles Goldfarb","startTime":1550.19,"endTime":1553.52,"body":"tourniquet, it would not be true"},{"speaker":"Charles Goldfarb","startTime":1553.52,"endTime":1556.79,"body":"a lot in this situation, I think"},{"speaker":"Charles Goldfarb","startTime":1553.52,"endTime":1556.79,"body":"it's dangerous if you're going"},{"speaker":"Charles Goldfarb","startTime":1556.79,"endTime":1561.5,"body":"to use epinephrine in lidocaine"},{"speaker":"Charles Goldfarb","startTime":1556.79,"endTime":1561.5,"body":"in a patient who's avascular"},{"speaker":"Charles Goldfarb","startTime":1561.5,"endTime":1564.41,"body":"path. And so that could be a"},{"speaker":"Charles Goldfarb","startTime":1561.5,"endTime":1564.41,"body":"situation where you do the"},{"speaker":"Charles Goldfarb","startTime":1564.41,"endTime":1568.16,"body":"injection, and you could lose"},{"speaker":"Charles Goldfarb","startTime":1564.41,"endTime":1568.16,"body":"tissue. So it would be straight"},{"speaker":"Charles Goldfarb","startTime":1568.16,"endTime":1573.83,"body":"lidocaine. And I would simply"},{"speaker":"Charles Goldfarb","startTime":1568.16,"endTime":1573.83,"body":"try to take the finger is to"},{"speaker":"Charles Goldfarb","startTime":1573.83,"endTime":1578.0,"body":"keep the finger as distal as"},{"speaker":"Charles Goldfarb","startTime":1573.83,"endTime":1578.0,"body":"possible, and wait till I had"},{"speaker":"Charles Goldfarb","startTime":1578.0,"endTime":1580.31,"body":"some type of blood flow to"},{"speaker":"Charles Goldfarb","startTime":1578.0,"endTime":1580.31,"body":"confirm that we could get the"},{"speaker":"Charles Goldfarb","startTime":1580.31,"endTime":1583.73,"body":"skin edges to heal what is or"},{"speaker":"Charles Goldfarb","startTime":1580.31,"endTime":1583.73,"body":"was your approach."},{"speaker":"Chris Dy","startTime":1584.72,"endTime":1587.45,"body":"So I, I used a"},{"speaker":"Chris Dy","startTime":1584.72,"endTime":1587.45,"body":"tourniquet, but I use it very"},{"speaker":"Chris Dy","startTime":1587.45,"endTime":1590.81,"body":"low. You know, because I thought"},{"speaker":"Chris Dy","startTime":1587.45,"endTime":1590.81,"body":"that the surgery would go much"},{"speaker":"Chris Dy","startTime":1590.81,"endTime":1593.18,"body":"faster and more efficiently with"},{"speaker":"Chris Dy","startTime":1590.81,"endTime":1593.18,"body":"it on and honestly, we had done"},{"speaker":"Chris Dy","startTime":1593.18,"endTime":1596.69,"body":"it on his other side, and it"},{"speaker":"Chris Dy","startTime":1593.18,"endTime":1596.69,"body":"turned out fine. So you know, so"},{"speaker":"Chris Dy","startTime":1596.69,"endTime":1600.41,"body":"I took the, you know, I'd love"},{"speaker":"Chris Dy","startTime":1596.69,"endTime":1600.41,"body":"your thoughts on this. But you"},{"speaker":"Chris Dy","startTime":1600.41,"endTime":1602.87,"body":"know, we did a re resection at"},{"speaker":"Chris Dy","startTime":1600.41,"endTime":1602.87,"body":"the level of kind of mid"},{"speaker":"Chris Dy","startTime":1602.87,"endTime":1607.76,"body":"metacarpal. But in doing so we"},{"speaker":"Chris Dy","startTime":1602.87,"endTime":1607.76,"body":"were also very careful to do as"},{"speaker":"Chris Dy","startTime":1607.76,"endTime":1610.64,"body":"much as we could to preserve the"},{"speaker":"Chris Dy","startTime":1607.76,"endTime":1610.64,"body":"intimate of the deep transverse"},{"speaker":"Chris Dy","startTime":1610.64,"endTime":1615.02,"body":"inter metacarpal ligaments. And"},{"speaker":"Chris Dy","startTime":1610.64,"endTime":1615.02,"body":"I'm curious as to how you manage"},{"speaker":"Chris Dy","startTime":1615.02,"endTime":1618.11,"body":"trying to close that gap between"},{"speaker":"Chris Dy","startTime":1615.02,"endTime":1618.11,"body":"the index and the ring finger"},{"speaker":"Chris Dy","startTime":1618.11,"endTime":1623.06,"body":"metacarpals, so as to keep the"},{"speaker":"Chris Dy","startTime":1618.11,"endTime":1623.06,"body":"you know, the strength of the"},{"speaker":"Chris Dy","startTime":1623.15,"endTime":1627.59,"body":"hand, so to say, and to minimize"},{"speaker":"Chris Dy","startTime":1623.15,"endTime":1627.59,"body":"kind of diastasis at that, at"},{"speaker":"Chris Dy","startTime":1627.59,"endTime":1628.13,"body":"that level?"},{"speaker":"Charles Goldfarb","startTime":1629.09,"endTime":1631.46,"body":"Well, I'll"},{"speaker":"Charles Goldfarb","startTime":1629.09,"endTime":1631.46,"body":"start by saying I love the"},{"speaker":"Charles Goldfarb","startTime":1631.46,"endTime":1635.45,"body":"transposition, I love taking the"},{"speaker":"Charles Goldfarb","startTime":1631.46,"endTime":1635.45,"body":"index finger, and transposing it"},{"speaker":"Charles Goldfarb","startTime":1635.45,"endTime":1638.81,"body":"to the middle finger obviously"},{"speaker":"Charles Goldfarb","startTime":1635.45,"endTime":1638.81,"body":"creates a bigger surgery, with"},{"speaker":"Charles Goldfarb","startTime":1638.81,"endTime":1641.54,"body":"more risk for healing with a"},{"speaker":"Charles Goldfarb","startTime":1638.81,"endTime":1641.54,"body":"patient with poor blood supply."},{"speaker":"Charles Goldfarb","startTime":1641.54,"endTime":1644.93,"body":"But honestly, he would probably"},{"speaker":"Charles Goldfarb","startTime":1641.54,"endTime":1644.93,"body":"heal this. So I love that"},{"speaker":"Charles Goldfarb","startTime":1644.93,"endTime":1649.13,"body":"operation, it does create an"},{"speaker":"Charles Goldfarb","startTime":1644.93,"endTime":1649.13,"body":"arrow. And when I just do a ray"},{"speaker":"Charles Goldfarb","startTime":1649.13,"endTime":1654.47,"body":"resection without any type of"},{"speaker":"Charles Goldfarb","startTime":1649.13,"endTime":1654.47,"body":"transposition. You know, I don't"},{"speaker":"Charles Goldfarb","startTime":1654.5,"endTime":1659.0,"body":"do anything specifically to try"},{"speaker":"Charles Goldfarb","startTime":1654.5,"endTime":1659.0,"body":"to narrow that space, I think"},{"speaker":"Charles Goldfarb","startTime":1659.0,"endTime":1661.88,"body":"it's very hard to accomplish"},{"speaker":"Charles Goldfarb","startTime":1659.0,"endTime":1661.88,"body":"that goal. I've not been"},{"speaker":"Charles Goldfarb","startTime":1661.88,"endTime":1665.87,"body":"successful when I tried, I think"},{"speaker":"Charles Goldfarb","startTime":1661.88,"endTime":1665.87,"body":"you could Imbricate, the"},{"speaker":"Charles Goldfarb","startTime":1665.87,"endTime":1671.18,"body":"transverse metacarpal ligament."},{"speaker":"Charles Goldfarb","startTime":1665.87,"endTime":1671.18,"body":"Or certainly you don't want to"},{"speaker":"Charles Goldfarb","startTime":1671.18,"endTime":1675.05,"body":"divide it inadvertently. But to"},{"speaker":"Charles Goldfarb","startTime":1671.18,"endTime":1675.05,"body":"some degree, you're going to"},{"speaker":"Charles Goldfarb","startTime":1675.05,"endTime":1678.17,"body":"have two ends of it because"},{"speaker":"Charles Goldfarb","startTime":1675.05,"endTime":1678.17,"body":"you're taking out the metacarpal"},{"speaker":"Charles Goldfarb","startTime":1678.17,"endTime":1680.96,"body":"in the middle. So at least"},{"speaker":"Charles Goldfarb","startTime":1678.17,"endTime":1680.96,"body":"repairing it if not trying to"},{"speaker":"Charles Goldfarb","startTime":1680.96,"endTime":1684.14,"body":"tighten it a bit makes a lot of"},{"speaker":"Charles Goldfarb","startTime":1680.96,"endTime":1684.14,"body":"sense. How did you approach it?"},{"speaker":"Chris Dy","startTime":1684.62,"endTime":1686.75,"body":"I imbricated. A bit I"},{"speaker":"Chris Dy","startTime":1684.62,"endTime":1686.75,"body":"don't I agree, I don't think you"},{"speaker":"Chris Dy","startTime":1686.75,"endTime":1690.32,"body":"can really, truly close the gap,"},{"speaker":"Chris Dy","startTime":1686.75,"endTime":1690.32,"body":"you can do your best to stop it"},{"speaker":"Chris Dy","startTime":1690.32,"endTime":1693.2,"body":"from getting bigger. You know,"},{"speaker":"Chris Dy","startTime":1690.32,"endTime":1693.2,"body":"he had we talked about the"},{"speaker":"Chris Dy","startTime":1693.2,"endTime":1695.42,"body":"transposition, interestingly"},{"speaker":"Chris Dy","startTime":1693.2,"endTime":1695.42,"body":"enough for his other side. And"},{"speaker":"Chris Dy","startTime":1695.42,"endTime":1698.15,"body":"he said, Just keep it as simple"},{"speaker":"Chris Dy","startTime":1695.42,"endTime":1698.15,"body":"as you can. And because I had"},{"speaker":"Chris Dy","startTime":1698.15,"endTime":1700.49,"body":"the luxury of knowing how he did"},{"speaker":"Chris Dy","startTime":1698.15,"endTime":1700.49,"body":"on the other side, we just kind"},{"speaker":"Chris Dy","startTime":1700.49,"endTime":1703.67,"body":"of went with that as a template."},{"speaker":"Chris Dy","startTime":1700.49,"endTime":1703.67,"body":"But I've done the transposition"},{"speaker":"Chris Dy","startTime":1703.67,"endTime":1706.1,"body":"in the past and a couple of"},{"speaker":"Chris Dy","startTime":1703.67,"endTime":1706.1,"body":"patients in which this has come"},{"speaker":"Chris Dy","startTime":1706.1,"endTime":1708.74,"body":"up and you know, they've done"},{"speaker":"Chris Dy","startTime":1706.1,"endTime":1708.74,"body":"really well. So I totally get"},{"speaker":"Chris Dy","startTime":1708.74,"endTime":1711.77,"body":"what you're saying. You know,"},{"speaker":"Chris Dy","startTime":1708.74,"endTime":1711.77,"body":"for those of those listeners"},{"speaker":"Chris Dy","startTime":1711.77,"endTime":1713.9,"body":"that are uninitiated, can you"},{"speaker":"Chris Dy","startTime":1711.77,"endTime":1713.9,"body":"describe a little more"},{"speaker":"Chris Dy","startTime":1713.9,"endTime":1716.45,"body":"technically about what you do"},{"speaker":"Chris Dy","startTime":1713.9,"endTime":1716.45,"body":"when you take the index and move"},{"speaker":"Chris Dy","startTime":1716.45,"endTime":1717.23,"body":"it over to the middle?"},{"speaker":"Charles Goldfarb","startTime":1717.65,"endTime":1720.05,"body":"Yeah, let me"},{"speaker":"Charles Goldfarb","startTime":1717.65,"endTime":1720.05,"body":"say this I one of the things I"},{"speaker":"Charles Goldfarb","startTime":1720.05,"endTime":1724.16,"body":"talk about a lot and whether"},{"speaker":"Charles Goldfarb","startTime":1720.05,"endTime":1724.16,"body":"it's a Monteggia fracture or"},{"speaker":"Charles Goldfarb","startTime":1724.16,"endTime":1727.46,"body":"missed montelucia Whether it's a"},{"speaker":"Charles Goldfarb","startTime":1724.16,"endTime":1727.46,"body":"cleft hand that we're"},{"speaker":"Charles Goldfarb","startTime":1727.46,"endTime":1733.85,"body":"reconstructing, when you try to"},{"speaker":"Charles Goldfarb","startTime":1727.46,"endTime":1733.85,"body":"use soft tissue to make up for"},{"speaker":"Charles Goldfarb","startTime":1733.85,"endTime":1738.83,"body":"bony mal alignment, I think you"},{"speaker":"Charles Goldfarb","startTime":1733.85,"endTime":1738.83,"body":"will fail. And so you can't"},{"speaker":"Charles Goldfarb","startTime":1738.83,"endTime":1743.3,"body":"create a new Alienware ligament"},{"speaker":"Charles Goldfarb","startTime":1738.83,"endTime":1743.3,"body":"to hold the Radiohead in place."},{"speaker":"Charles Goldfarb","startTime":1743.51,"endTime":1746.69,"body":"Even if you can achieve that in"},{"speaker":"Charles Goldfarb","startTime":1743.51,"endTime":1746.69,"body":"the operating room, eventually,"},{"speaker":"Charles Goldfarb","startTime":1746.69,"endTime":1749.36,"body":"that's going to fail. And I"},{"speaker":"Charles Goldfarb","startTime":1746.69,"endTime":1749.36,"body":"would say the exact same thing"},{"speaker":"Charles Goldfarb","startTime":1749.63,"endTime":1753.5,"body":"about a cleft hand or an"},{"speaker":"Charles Goldfarb","startTime":1749.63,"endTime":1753.5,"body":"amputated array, because you"},{"speaker":"Charles Goldfarb","startTime":1753.5,"endTime":1756.65,"body":"have to get the bony alignment,"},{"speaker":"Charles Goldfarb","startTime":1753.5,"endTime":1756.65,"body":"right. And then you don't have"},{"speaker":"Charles Goldfarb","startTime":1756.65,"endTime":1760.94,"body":"to worry about the soft tissues."},{"speaker":"Charles Goldfarb","startTime":1756.65,"endTime":1760.94,"body":"When I and then getting to your"},{"speaker":"Charles Goldfarb","startTime":1760.94,"endTime":1766.28,"body":"question is, you know, this is"},{"speaker":"Charles Goldfarb","startTime":1760.94,"endTime":1766.28,"body":"what I do in kids a lot. If they"},{"speaker":"Charles Goldfarb","startTime":1766.28,"endTime":1770.0,"body":"have a cleft hand, we are"},{"speaker":"Charles Goldfarb","startTime":1766.28,"endTime":1770.0,"body":"constantly moving that index"},{"speaker":"Charles Goldfarb","startTime":1770.0,"endTime":1773.87,"body":"finger over to was hopefully"},{"speaker":"Charles Goldfarb","startTime":1770.0,"endTime":1773.87,"body":"there's a bit of residual middle"},{"speaker":"Charles Goldfarb","startTime":1773.87,"endTime":1778.79,"body":"finger metacarpal to both widen"},{"speaker":"Charles Goldfarb","startTime":1773.87,"endTime":1778.79,"body":"the first webspace and narrow"},{"speaker":"Charles Goldfarb","startTime":1778.79,"endTime":1781.85,"body":"the cleft, which is sort of what"},{"speaker":"Charles Goldfarb","startTime":1778.79,"endTime":1781.85,"body":"you're doing here. And so it's"},{"speaker":"Charles Goldfarb","startTime":1781.85,"endTime":1785.66,"body":"really a great operation, you"},{"speaker":"Charles Goldfarb","startTime":1781.85,"endTime":1785.66,"body":"try to maintain the length, and"},{"speaker":"Charles Goldfarb","startTime":1785.66,"endTime":1789.65,"body":"then you essentially are"},{"speaker":"Charles Goldfarb","startTime":1785.66,"endTime":1789.65,"body":"centralizing that cut metacarpal"},{"speaker":"Charles Goldfarb","startTime":1789.65,"endTime":1793.25,"body":"of the index onto the residual"},{"speaker":"Charles Goldfarb","startTime":1789.65,"endTime":1793.25,"body":"metacarpal of the middle finger,"},{"speaker":"Charles Goldfarb","startTime":1793.46,"endTime":1799.97,"body":"and I fixated with a good two"},{"speaker":"Charles Goldfarb","startTime":1793.46,"endTime":1799.97,"body":"over 2.4 plate and I've been"},{"speaker":"Charles Goldfarb","startTime":1800.0,"endTime":1801.53,"body":"really, really happy with that?"},{"speaker":"Chris Dy","startTime":1802.97,"endTime":1805.58,"body":"And do you do anything"},{"speaker":"Chris Dy","startTime":1802.97,"endTime":1805.58,"body":"in particular for their rehab?"},{"speaker":"Chris Dy","startTime":1805.61,"endTime":1808.16,"body":"Is it? Do you mobilize them at"},{"speaker":"Chris Dy","startTime":1805.61,"endTime":1808.16,"body":"all?"},{"speaker":"Charles Goldfarb","startTime":1810.019,"endTime":1812.269,"body":"Yeah, I go"},{"speaker":"Charles Goldfarb","startTime":1810.019,"endTime":1812.269,"body":"slowly with them. And this"},{"speaker":"Charles Goldfarb","startTime":1812.299,"endTime":1815.419,"body":"again, these should heal."},{"speaker":"Charles Goldfarb","startTime":1812.299,"endTime":1815.419,"body":"Sometimes it takes a while if"},{"speaker":"Charles Goldfarb","startTime":1815.419,"endTime":1819.619,"body":"it's a Metastasio area and"},{"speaker":"Charles Goldfarb","startTime":1815.419,"endTime":1819.619,"body":"again, especially in someone who"},{"speaker":"Charles Goldfarb","startTime":1819.619,"endTime":1822.649,"body":"may be avascular, Pap, it can"},{"speaker":"Charles Goldfarb","startTime":1819.619,"endTime":1822.649,"body":"take a while to heal, but if you"},{"speaker":"Charles Goldfarb","startTime":1822.649,"endTime":1827.509,"body":"have good fixation, it should"},{"speaker":"Charles Goldfarb","startTime":1822.649,"endTime":1827.509,"body":"heal. So good strong plate. And"},{"speaker":"Charles Goldfarb","startTime":1827.779,"endTime":1832.309,"body":"usually, after two weeks of kind"},{"speaker":"Charles Goldfarb","startTime":1827.779,"endTime":1832.309,"body":"of post operative dressing, that"},{"speaker":"Charles Goldfarb","startTime":1832.309,"endTime":1835.489,"body":"I'm usually doing a removable"},{"speaker":"Charles Goldfarb","startTime":1832.309,"endTime":1835.489,"body":"splint to get the MCP joints"},{"speaker":"Charles Goldfarb","startTime":1835.489,"endTime":1838.879,"body":"moving, but really limited to"},{"speaker":"Charles Goldfarb","startTime":1835.489,"endTime":1838.879,"body":"activities until we see healing."},{"speaker":"Chris Dy","startTime":1839.6,"endTime":1842.36,"body":"So then you bring it"},{"speaker":"Chris Dy","startTime":1839.6,"endTime":1842.36,"body":"to a close one thing that I"},{"speaker":"Chris Dy","startTime":1842.36,"endTime":1844.88,"body":"always try to make sure I do is"},{"speaker":"Chris Dy","startTime":1842.36,"endTime":1844.88,"body":"when I make my skin incisions"},{"speaker":"Chris Dy","startTime":1844.88,"endTime":1847.76,"body":"for these, if it's just a ray"},{"speaker":"Chris Dy","startTime":1844.88,"endTime":1847.76,"body":"and not a transposition, making"},{"speaker":"Chris Dy","startTime":1847.76,"endTime":1851.27,"body":"sure that I don't have to make a"},{"speaker":"Chris Dy","startTime":1847.76,"endTime":1851.27,"body":"webspace later. So making sure I"},{"speaker":"Chris Dy","startTime":1851.27,"endTime":1854.51,"body":"mark my incisions after that"},{"speaker":"Chris Dy","startTime":1851.27,"endTime":1854.51,"body":"there's a book that I they were"},{"speaker":"Chris Dy","startTime":1854.51,"endTime":1857.3,"body":"giving it away in the resident"},{"speaker":"Chris Dy","startTime":1854.51,"endTime":1857.3,"body":"at the VA one year they were"},{"speaker":"Chris Dy","startTime":1857.3,"endTime":1860.15,"body":"cleaning out the library when I"},{"speaker":"Chris Dy","startTime":1857.3,"endTime":1860.15,"body":"was in residency, and it's a"},{"speaker":"Chris Dy","startTime":1860.21,"endTime":1864.98,"body":"Atlas of amputations, which has"},{"speaker":"Chris Dy","startTime":1860.21,"endTime":1864.98,"body":"been great for the times where"},{"speaker":"Chris Dy","startTime":1864.98,"endTime":1867.32,"body":"I've had to do an amputation,"},{"speaker":"Chris Dy","startTime":1864.98,"endTime":1867.32,"body":"talks all about skin incision,"},{"speaker":"Chris Dy","startTime":1867.32,"endTime":1869.3,"body":"planning and everything. And I"},{"speaker":"Chris Dy","startTime":1867.32,"endTime":1869.3,"body":"really make sure that I don't"},{"speaker":"Chris Dy","startTime":1869.3,"endTime":1871.88,"body":"have to go in and create a"},{"speaker":"Chris Dy","startTime":1869.3,"endTime":1871.88,"body":"webspace, which I think is can"},{"speaker":"Chris Dy","startTime":1871.88,"endTime":1874.07,"body":"be very challenging for an"},{"speaker":"Chris Dy","startTime":1871.88,"endTime":1874.07,"body":"orthopedic surgeon at least."},{"speaker":"Charles Goldfarb","startTime":1874.13,"endTime":1876.11,"body":"That's exactly"},{"speaker":"Charles Goldfarb","startTime":1874.13,"endTime":1876.11,"body":"right. Plastic Surgeons probably"},{"speaker":"Charles Goldfarb","startTime":1876.11,"endTime":1878.42,"body":"don't struggle with that. But"},{"speaker":"Charles Goldfarb","startTime":1876.11,"endTime":1878.42,"body":"you and I do. And we have to"},{"speaker":"Charles Goldfarb","startTime":1878.42,"endTime":1880.7,"body":"think a lot about it. So if you"},{"speaker":"Charles Goldfarb","startTime":1878.42,"endTime":1880.7,"body":"don't have to do it, you are"},{"speaker":"Charles Goldfarb","startTime":1880.7,"endTime":1885.17,"body":"certainly better off. Awesome."},{"speaker":"Charles Goldfarb","startTime":1880.7,"endTime":1885.17,"body":"Well, this was fun. Yeah, you"},{"speaker":"Chris Dy","startTime":1885.17,"endTime":1887.36,"body":"know, it's never fun"},{"speaker":"Chris Dy","startTime":1885.17,"endTime":1887.36,"body":"to talk about cutting stuff off"},{"speaker":"Chris Dy","startTime":1887.36,"endTime":1889.91,"body":"that you spend hours trying to"},{"speaker":"Chris Dy","startTime":1887.36,"endTime":1889.91,"body":"put back on and other"},{"speaker":"Chris Dy","startTime":1889.91,"endTime":1892.22,"body":"situations. But, you know,"},{"speaker":"Chris Dy","startTime":1889.91,"endTime":1892.22,"body":"again, if that's what the"},{"speaker":"Chris Dy","startTime":1892.22,"endTime":1895.07,"body":"patient wants, especially if"},{"speaker":"Chris Dy","startTime":1892.22,"endTime":1895.07,"body":"they come requesting it, it can"},{"speaker":"Chris Dy","startTime":1895.07,"endTime":1897.23,"body":"be a very straightforward"},{"speaker":"Chris Dy","startTime":1895.07,"endTime":1897.23,"body":"solution and make everybody's"},{"speaker":"Chris Dy","startTime":1897.23,"endTime":1899.27,"body":"lives better. As we"},{"speaker":"Charles Goldfarb","startTime":1899.27,"endTime":1903.17,"body":"close, I will"},{"speaker":"Charles Goldfarb","startTime":1899.27,"endTime":1903.17,"body":"say that. Earlier this year, the"},{"speaker":"Charles Goldfarb","startTime":1903.17,"endTime":1908.93,"body":"fellows convinced me to replant"},{"speaker":"Charles Goldfarb","startTime":1903.17,"endTime":1908.93,"body":"an ablest thumb, which in a work"},{"speaker":"Charles Goldfarb","startTime":1908.96,"endTime":1911.81,"body":"or an injured worker, and I was"},{"speaker":"Charles Goldfarb","startTime":1908.96,"endTime":1911.81,"body":"like this is never going to"},{"speaker":"Charles Goldfarb","startTime":1911.81,"endTime":1915.92,"body":"work. And the patient is happy"},{"speaker":"Charles Goldfarb","startTime":1911.81,"endTime":1915.92,"body":"as a clam, the thumb is alive."},{"speaker":"Charles Goldfarb","startTime":1916.79,"endTime":1919.79,"body":"Sensation might be an issue for"},{"speaker":"Charles Goldfarb","startTime":1916.79,"endTime":1919.79,"body":"the patient, which we may be"},{"speaker":"Charles Goldfarb","startTime":1919.79,"endTime":1923.51,"body":"consulting you on. But, you"},{"speaker":"Charles Goldfarb","startTime":1919.79,"endTime":1923.51,"body":"know, these are super"},{"speaker":"Charles Goldfarb","startTime":1923.51,"endTime":1926.63,"body":"interesting injuries. And"},{"speaker":"Charles Goldfarb","startTime":1923.51,"endTime":1926.63,"body":"really, the work we do either in"},{"speaker":"Charles Goldfarb","startTime":1926.63,"endTime":1928.94,"body":"the middle of the night or six"},{"speaker":"Charles Goldfarb","startTime":1926.63,"endTime":1928.94,"body":"weeks later can be really"},{"speaker":"Charles Goldfarb","startTime":1928.94,"endTime":1929.54,"body":"impactful."},{"speaker":"Chris Dy","startTime":1930.02,"endTime":1933.11,"body":"No two are alike. That"},{"speaker":"Chris Dy","startTime":1930.02,"endTime":1933.11,"body":"is for sure. All right. Have a"},{"speaker":"Chris Dy","startTime":1933.11,"endTime":1934.46,"body":"great day. You too."},{"speaker":"Charles Goldfarb","startTime":1935.51,"endTime":1937.49,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":1935.51,"endTime":1937.49,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":1937.49,"endTime":1939.05,"body":"real soon. Sounds good."},{"speaker":"Chris Dy","startTime":1939.11,"endTime":1941.27,"body":"Well, be sure to check"},{"speaker":"Chris Dy","startTime":1939.11,"endTime":1941.27,"body":"us out on Twitter at Han"},{"speaker":"Chris Dy","startTime":1941.27,"endTime":1943.22,"body":"podcast. Hey, Chuck, what's your"},{"speaker":"Chris Dy","startTime":1941.27,"endTime":1943.22,"body":"Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":1943.55,"endTime":1946.4,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":1943.55,"endTime":1946.4,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":1946.55,"endTime":1949.938,"body":"Mine is @ChrisDYMD"},{"speaker":"Chris Dy","startTime":1946.55,"endTime":1949.938,"body":"spelled d- y and if you'd like"},{"speaker":"Chris Dy","startTime":1950.007,"endTime":1953.81,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":1950.007,"endTime":1953.81,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":1954.35,"endTime":1956.51,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":1954.35,"endTime":1956.51,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":1956.51,"endTime":1957.59,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":1957.62,"endTime":1959.84,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":1957.62,"endTime":1959.84,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":1959.84,"endTime":1961.58,"body":"word out. Special thanks to"},{"speaker":"Charles Goldfarb","startTime":1961.58,"endTime":1963.83,"body":"Peter Martin"},{"speaker":"Charles Goldfarb","startTime":1961.58,"endTime":1963.83,"body":"for the amazing music. And"},{"speaker":"Charles Goldfarb","startTime":1963.83,"endTime":1966.89,"body":"remember, keep the upper hand."},{"speaker":"Charles Goldfarb","startTime":1963.83,"endTime":1966.89,"body":"Come back next time"}]}