{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":4.05,"endTime":5.94,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":4.05,"endTime":5.94,"body":"upper hand podcasts where Chuck"},{"speaker":"Charles Goldfarb","startTime":5.94,"endTime":7.2,"body":"and Chris talk Hand Surgery."},{"speaker":"Chris Dy","startTime":7.44,"endTime":8.91,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.44,"endTime":8.91,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":8.91,"endTime":11.01,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":8.91,"endTime":11.01,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":11.01,"endTime":12.42,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":11.01,"endTime":12.42,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":13.38,"endTime":15.09,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":13.38,"endTime":15.09,"body":"subscribe wherever you get your"},{"speaker":"Charles Goldfarb","startTime":15.09,"endTime":15.57,"body":"podcasts."},{"speaker":"Chris Dy","startTime":16.259,"endTime":18.179,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":16.259,"endTime":18.179,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":18.179,"endTime":22.109,"body":"leaving a rating wherever you"},{"speaker":"Chris Dy","startTime":18.179,"endTime":22.109,"body":"get your podcast. Okay, Chris."},{"speaker":"Chris Dy","startTime":22.199,"endTime":23.039,"body":"Hey, Chuck, how are you?"},{"speaker":"Charles Goldfarb","startTime":23.4,"endTime":24.78,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":23.4,"endTime":24.78,"body":"pretty well. How are you?"},{"speaker":"Chris Dy","startTime":25.05,"endTime":26.82,"body":"I'm good. It's a"},{"speaker":"Chris Dy","startTime":25.05,"endTime":26.82,"body":"beautiful weekend in St. Louis."},{"speaker":"Chris Dy","startTime":26.82,"endTime":29.01,"body":"Well, it was until it wasn't"},{"speaker":"Chris Dy","startTime":26.82,"endTime":29.01,"body":"last night."},{"speaker":"Charles Goldfarb","startTime":29.36,"endTime":31.01,"body":"It has the"},{"speaker":"Charles Goldfarb","startTime":29.36,"endTime":31.01,"body":"weather has been fantastic. And"},{"speaker":"Charles Goldfarb","startTime":31.01,"endTime":32.99,"body":"then all hell broke loose. Oh,"},{"speaker":"Charles Goldfarb","startTime":31.01,"endTime":32.99,"body":"my God, you weren't going to"},{"speaker":"Charles Goldfarb","startTime":32.99,"endTime":33.8,"body":"that soccer game where you?"},{"speaker":"Chris Dy","startTime":34.04,"endTime":35.93,"body":"I didn't that made it"},{"speaker":"Chris Dy","startTime":34.04,"endTime":35.93,"body":"to the cards game and the Cards"},{"speaker":"Chris Dy","startTime":35.93,"endTime":38.24,"body":"game was great. And then we were"},{"speaker":"Chris Dy","startTime":35.93,"endTime":38.24,"body":"doing some stuff in the"},{"speaker":"Chris Dy","startTime":38.24,"endTime":40.61,"body":"afternoon and we slowly watched"},{"speaker":"Chris Dy","startTime":38.24,"endTime":40.61,"body":"the weather just deteriorate."},{"speaker":"Chris Dy","startTime":40.73,"endTime":43.49,"body":"It's pretty, pretty rapid and"},{"speaker":"Chris Dy","startTime":40.73,"endTime":43.49,"body":"went from a beautiful day and"},{"speaker":"Chris Dy","startTime":43.49,"endTime":45.08,"body":"the 60s to hail."},{"speaker":"Charles Goldfarb","startTime":45.59,"endTime":47.51,"body":"Yeah, you were"},{"speaker":"Charles Goldfarb","startTime":45.59,"endTime":47.51,"body":"kind enough to share tickets for"},{"speaker":"Charles Goldfarb","startTime":47.51,"endTime":49.31,"body":"the soccer game with one of the"},{"speaker":"Charles Goldfarb","startTime":47.51,"endTime":49.31,"body":"residents and he was so"},{"speaker":"Charles Goldfarb","startTime":49.31,"endTime":52.55,"body":"grateful. But it turned into"},{"speaker":"Charles Goldfarb","startTime":49.31,"endTime":52.55,"body":"just like a good start time was"},{"speaker":"Charles Goldfarb","startTime":52.55,"endTime":54.74,"body":"delayed two hours, but they got"},{"speaker":"Charles Goldfarb","startTime":52.55,"endTime":54.74,"body":"the Win St Louis City."},{"speaker":"Chris Dy","startTime":54.89,"endTime":56.72,"body":"Yes, I know. I saw"},{"speaker":"Chris Dy","startTime":54.89,"endTime":56.72,"body":"that. You know, it's uh,"},{"speaker":"Chris Dy","startTime":56.78,"endTime":58.46,"body":"they're, they're pretty"},{"speaker":"Chris Dy","startTime":56.78,"endTime":58.46,"body":"impressive. You know, they're"},{"speaker":"Chris Dy","startTime":58.46,"endTime":59.66,"body":"certainly doing better than the"},{"speaker":"Chris Dy","startTime":58.46,"endTime":59.66,"body":"cards."},{"speaker":"Charles Goldfarb","startTime":60.62,"endTime":63.32,"body":"Yeah. So we"},{"speaker":"Charles Goldfarb","startTime":60.62,"endTime":63.32,"body":"have a special episode. This is"},{"speaker":"Charles Goldfarb","startTime":63.8,"endTime":66.8,"body":"a joint episode with the British"},{"speaker":"Charles Goldfarb","startTime":63.8,"endTime":66.8,"body":"Society for Surgery the Hand and"},{"speaker":"Charles Goldfarb","startTime":66.8,"endTime":69.26,"body":"we have some great guests. Do"},{"speaker":"Charles Goldfarb","startTime":66.8,"endTime":69.26,"body":"you want to give the audience"},{"speaker":"Charles Goldfarb","startTime":69.41,"endTime":69.92,"body":"intro?"},{"speaker":"Chris Dy","startTime":70.4,"endTime":72.83,"body":"Yeah. So this segment"},{"speaker":"Chris Dy","startTime":70.4,"endTime":72.83,"body":"we did one a few a few months"},{"speaker":"Chris Dy","startTime":72.83,"endTime":75.08,"body":"back and you know, at some great"},{"speaker":"Chris Dy","startTime":72.83,"endTime":75.08,"body":"guests, Dominic Power and Amy"},{"speaker":"Chris Dy","startTime":75.08,"endTime":78.2,"body":"Moore. And you know, there was"},{"speaker":"Chris Dy","startTime":75.08,"endTime":78.2,"body":"clearly a high download hit"},{"speaker":"Chris Dy","startTime":78.2,"endTime":80.27,"body":"rate. So people were pretty"},{"speaker":"Chris Dy","startTime":78.2,"endTime":80.27,"body":"excited about it. So it's really"},{"speaker":"Chris Dy","startTime":80.27,"endTime":82.85,"body":"fun to collaborate with this"},{"speaker":"Chris Dy","startTime":80.27,"endTime":82.85,"body":"group. You know, so we're gonna"},{"speaker":"Chris Dy","startTime":82.88,"endTime":85.67,"body":"we're gonna have two guests"},{"speaker":"Chris Dy","startTime":82.88,"endTime":85.67,"body":"joining us. And we're going to"},{"speaker":"Chris Dy","startTime":85.67,"endTime":89.15,"body":"talk about CMC and Kienbocks . I"},{"speaker":"Chris Dy","startTime":85.67,"endTime":89.15,"body":"think it's going to be fun."},{"speaker":"Chris Dy","startTime":89.75,"endTime":92.0,"body":"Mareia Esplugas is going to join"},{"speaker":"Chris Dy","startTime":89.75,"endTime":92.0,"body":"us and we can formally introduce"},{"speaker":"Chris Dy","startTime":92.0,"endTime":93.95,"body":"her when she joins us. And David"},{"speaker":"Chris Dy","startTime":92.0,"endTime":93.95,"body":"McCombe is going to join us. So"},{"speaker":"Chris Dy","startTime":93.95,"endTime":96.86,"body":"we're crossing continents here"},{"speaker":"Chris Dy","startTime":93.95,"endTime":96.86,"body":"we've got Mireia is from"},{"speaker":"Chris Dy","startTime":96.89,"endTime":100.85,"body":"Barcelona, and David's from,"},{"speaker":"Chris Dy","startTime":96.89,"endTime":100.85,"body":"from down under. So this will be"},{"speaker":"Chris Dy","startTime":100.85,"endTime":101.3,"body":"really fun."},{"speaker":"Charles Goldfarb","startTime":101.51,"endTime":102.71,"body":"Yeah, David's"},{"speaker":"Charles Goldfarb","startTime":101.51,"endTime":102.71,"body":"from Melbourne. And he was the"},{"speaker":"Charles Goldfarb","startTime":102.71,"endTime":107.18,"body":"guest editor for this European"},{"speaker":"Charles Goldfarb","startTime":102.71,"endTime":107.18,"body":"journal in hand surgery volume,"},{"speaker":"Charles Goldfarb","startTime":107.18,"endTime":109.85,"body":"which was entitled Unsolved"},{"speaker":"Charles Goldfarb","startTime":107.18,"endTime":109.85,"body":"Problems in Hand Surgery. It's"},{"speaker":"Charles Goldfarb","startTime":109.85,"endTime":113.03,"body":"really good. We picked a couple"},{"speaker":"Charles Goldfarb","startTime":109.85,"endTime":113.03,"body":"of them to focus on. But really"},{"speaker":"Charles Goldfarb","startTime":113.06,"endTime":115.76,"body":"everything that you and I talked"},{"speaker":"Charles Goldfarb","startTime":113.06,"endTime":115.76,"body":"about and stress about is hid in"},{"speaker":"Charles Goldfarb","startTime":115.76,"endTime":118.22,"body":"this really interesting"},{"speaker":"Charles Goldfarb","startTime":115.76,"endTime":118.22,"body":"addition, I guess you'd call it."},{"speaker":"Chris Dy","startTime":118.49,"endTime":120.86,"body":"Yes, I love I love"},{"speaker":"Chris Dy","startTime":118.49,"endTime":120.86,"body":"when journals take the time to"},{"speaker":"Chris Dy","startTime":120.86,"endTime":124.61,"body":"do special editions and we don't"},{"speaker":"Chris Dy","startTime":120.86,"endTime":124.61,"body":"see it enough, I think. But it's"},{"speaker":"Chris Dy","startTime":124.61,"endTime":127.13,"body":"a nice way to get some topics"},{"speaker":"Chris Dy","startTime":124.61,"endTime":127.13,"body":"out there. And honestly, for"},{"speaker":"Chris Dy","startTime":127.13,"endTime":129.47,"body":"people that are looking for"},{"speaker":"Chris Dy","startTime":127.13,"endTime":129.47,"body":"things to study, it's a great"},{"speaker":"Chris Dy","startTime":129.47,"endTime":131.33,"body":"way to pick up some new ideas"},{"speaker":"Chris Dy","startTime":129.47,"endTime":131.33,"body":"just kind of like what's new"},{"speaker":"Chris Dy","startTime":131.33,"endTime":133.13,"body":"enhancer is always a fun one."},{"speaker":"Chris Dy","startTime":131.33,"endTime":133.13,"body":"Just be like, Oh yeah, that"},{"speaker":"Chris Dy","startTime":133.13,"endTime":136.91,"body":"would be an interesting thing to"},{"speaker":"Chris Dy","startTime":133.13,"endTime":136.91,"body":"study. We should thank our"},{"speaker":"Chris Dy","startTime":136.91,"endTime":139.85,"body":"friends that I practice like you"},{"speaker":"Chris Dy","startTime":136.91,"endTime":139.85,"body":"said that I provided tickets for"},{"speaker":"Chris Dy","startTime":139.85,"endTime":141.65,"body":"Andrew to go to the soccer game"},{"speaker":"Chris Dy","startTime":139.85,"endTime":141.65,"body":"it was on me it was actually"},{"speaker":"Chris Dy","startTime":141.65,"endTime":145.61,"body":"practice link. So the upper hand"},{"speaker":"Chris Dy","startTime":141.65,"endTime":145.61,"body":"is sponsored by practicelink.com"},{"speaker":"Chris Dy","startTime":145.61,"endTime":147.74,"body":"The most widely used physician"},{"speaker":"Chris Dy","startTime":145.61,"endTime":147.74,"body":"job search and career"},{"speaker":"Chris Dy","startTime":147.74,"endTime":148.76,"body":"advancement resource."},{"speaker":"Charles Goldfarb","startTime":149.38,"endTime":150.97,"body":"Becoming a"},{"speaker":"Charles Goldfarb","startTime":149.38,"endTime":150.97,"body":"physician is hard finding the"},{"speaker":"Charles Goldfarb","startTime":150.97,"endTime":153.88,"body":"right job doesn't have to be"},{"speaker":"Charles Goldfarb","startTime":150.97,"endTime":153.88,"body":"joint practice link for free"},{"speaker":"Charles Goldfarb","startTime":153.88,"endTime":156.79,"body":"today at"},{"speaker":"Charles Goldfarb","startTime":153.88,"endTime":156.79,"body":"www.practicelink.com/the"},{"speaker":"Charles Goldfarb","startTime":156.82,"endTime":159.34,"body":"upperhand. All right, I'm super"},{"speaker":"Charles Goldfarb","startTime":156.82,"endTime":159.34,"body":"excited."},{"speaker":"Chris Dy","startTime":159.43,"endTime":161.59,"body":"Yes, thank you"},{"speaker":"Chris Dy","startTime":159.43,"endTime":161.59,"body":"practice link for sponsoring us"},{"speaker":"Chris Dy","startTime":161.59,"endTime":164.62,"body":"and thank you British Society"},{"speaker":"Chris Dy","startTime":161.59,"endTime":164.62,"body":"for Surgery the hand and the"},{"speaker":"Chris Dy","startTime":164.62,"endTime":168.25,"body":"team at JHS Europe for this"},{"speaker":"Chris Dy","startTime":164.62,"endTime":168.25,"body":"opportunity to have some fun to"},{"speaker":"Chris Dy","startTime":168.25,"endTime":170.89,"body":"interview folks from Barcelona"},{"speaker":"Chris Dy","startTime":168.25,"endTime":170.89,"body":"and Australia. So without"},{"speaker":"Chris Dy","startTime":170.89,"endTime":171.88,"body":"further ado, why don't we jump"},{"speaker":"Chris Dy","startTime":170.89,"endTime":171.88,"body":"in?"},{"speaker":"Chris Dy","startTime":171.0,"endTime":177.3,"body":"Well Chuck, here we are. We are"},{"speaker":"Chris Dy","startTime":171.0,"endTime":177.3,"body":"joined by two fantastic guests I"},{"speaker":"Chris Dy","startTime":177.3,"endTime":182.1,"body":"wanted to welcome them First off"},{"speaker":"Chris Dy","startTime":177.3,"endTime":182.1,"body":"we have Dr. Mireia Esplugas is a"},{"speaker":"Chris Dy","startTime":182.28,"endTime":185.1,"body":"has spent 25 years at a hand in"},{"speaker":"Chris Dy","startTime":182.28,"endTime":185.1,"body":"research and so making me feel"},{"speaker":"Chris Dy","startTime":185.1,"endTime":188.31,"body":"very young. Thank you. Mireia as"},{"speaker":"Chris Dy","startTime":185.1,"endTime":188.31,"body":"a member of the Spanish Society"},{"speaker":"Chris Dy","startTime":188.31,"endTime":191.34,"body":"for Surgery behind the European"},{"speaker":"Chris Dy","startTime":188.31,"endTime":191.34,"body":"Wrist Arthroscopy Society and"},{"speaker":"Chris Dy","startTime":191.73,"endTime":194.91,"body":"FESSH, friends of us friends of"},{"speaker":"Chris Dy","startTime":191.73,"endTime":194.91,"body":"ours on the podcast. So welcome"},{"speaker":"Chris Dy","startTime":194.91,"endTime":196.26,"body":"and thank you for joining us"},{"speaker":"Chris Dy","startTime":194.91,"endTime":196.26,"body":"from Barcelona."},{"speaker":"Mireia Esplugas","startTime":197.01,"endTime":198.75,"body":"Thank you very"},{"speaker":"Mireia Esplugas","startTime":197.01,"endTime":198.75,"body":"much. I'm very happy to be with"},{"speaker":"Mireia Esplugas","startTime":198.75,"endTime":199.98,"body":"you today here."},{"speaker":"Chris Dy","startTime":200.55,"endTime":201.93,"body":"Very excited as we are"},{"speaker":"Chris Dy","startTime":200.55,"endTime":201.93,"body":"to"},{"speaker":"Charles Goldfarb","startTime":202.11,"endTime":204.15,"body":"Yes. And David"},{"speaker":"Charles Goldfarb","startTime":202.11,"endTime":204.15,"body":"McCombe is our other guests who"},{"speaker":"Charles Goldfarb","startTime":204.15,"endTime":207.84,"body":"actually is the was the guest"},{"speaker":"Charles Goldfarb","startTime":204.15,"endTime":207.84,"body":"editor of the particular journal"},{"speaker":"Charles Goldfarb","startTime":207.84,"endTime":209.97,"body":"Hand Surgery European that we're"},{"speaker":"Charles Goldfarb","startTime":207.84,"endTime":209.97,"body":"talking about today. We have"},{"speaker":"Charles Goldfarb","startTime":209.97,"endTime":213.39,"body":"picked a couple of articles, but"},{"speaker":"Charles Goldfarb","startTime":209.97,"endTime":213.39,"body":"the entire journal is excellent."},{"speaker":"Charles Goldfarb","startTime":213.39,"endTime":215.49,"body":"It's looking at unsolved"},{"speaker":"Charles Goldfarb","startTime":213.39,"endTime":215.49,"body":"problems at hand surgery. And"},{"speaker":"Charles Goldfarb","startTime":215.49,"endTime":219.51,"body":"David is works in Melbourne at"},{"speaker":"Charles Goldfarb","startTime":215.49,"endTime":219.51,"body":"St Vincent's Hospital and the"},{"speaker":"Charles Goldfarb","startTime":219.51,"endTime":221.94,"body":"Melbourne Royal Children's"},{"speaker":"Charles Goldfarb","startTime":219.51,"endTime":221.94,"body":"Hospital. He's in private"},{"speaker":"Charles Goldfarb","startTime":221.94,"endTime":224.85,"body":"practice with Victorian Hand"},{"speaker":"Charles Goldfarb","startTime":221.94,"endTime":224.85,"body":"Surgery Associates and his"},{"speaker":"Charles Goldfarb","startTime":224.85,"endTime":226.77,"body":"clinical interest are adult and"},{"speaker":"Charles Goldfarb","startTime":224.85,"endTime":226.77,"body":"children's hands surgery and"},{"speaker":"Charles Goldfarb","startTime":226.77,"endTime":228.72,"body":"that's where our pads have"},{"speaker":"Charles Goldfarb","startTime":226.77,"endTime":228.72,"body":"overlapped with the treatment of"},{"speaker":"Charles Goldfarb","startTime":228.72,"endTime":231.39,"body":"the kids as well as peripheral"},{"speaker":"Charles Goldfarb","startTime":228.72,"endTime":231.39,"body":"nerve and brachial plexus which"},{"speaker":"Charles Goldfarb","startTime":231.39,"endTime":234.21,"body":"is exciting for Chris and"},{"speaker":"Charles Goldfarb","startTime":231.39,"endTime":234.21,"body":"reconstructive microsurgery. So"},{"speaker":"Charles Goldfarb","startTime":234.3,"endTime":236.52,"body":"we are super excited. Welcome to"},{"speaker":"Charles Goldfarb","startTime":234.3,"endTime":236.52,"body":"both of you."},{"speaker":"David McCombe","startTime":237.63,"endTime":239.64,"body":"Thanks. Thanks,"},{"speaker":"David McCombe","startTime":237.63,"endTime":239.64,"body":"Chuck. It's great. Great to be"},{"speaker":"David McCombe","startTime":239.64,"endTime":242.88,"body":"here and very honored to be"},{"speaker":"David McCombe","startTime":239.64,"endTime":242.88,"body":"asked to participate."},{"speaker":"Chris Dy","startTime":244.08,"endTime":245.94,"body":"Well, we'd like to"},{"speaker":"Chris Dy","startTime":244.08,"endTime":245.94,"body":"have some fun on these episodes."},{"speaker":"Chris Dy","startTime":246.03,"endTime":249.06,"body":"The last one that we did with"},{"speaker":"Chris Dy","startTime":246.03,"endTime":249.06,"body":"Amy more and Dominic power was a"},{"speaker":"Chris Dy","startTime":249.06,"endTime":252.12,"body":"well received and was a nice"},{"speaker":"Chris Dy","startTime":249.06,"endTime":252.12,"body":"conversation. I would love to"},{"speaker":"Chris Dy","startTime":252.12,"endTime":254.88,"body":"start with the keen box article."},{"speaker":"Chris Dy","startTime":252.12,"endTime":254.88,"body":"And today I'd like to say that I"},{"speaker":"Chris Dy","startTime":254.88,"endTime":259.17,"body":"think this was an incredibly"},{"speaker":"Chris Dy","startTime":254.88,"endTime":259.17,"body":"nicely written article very much"},{"speaker":"Chris Dy","startTime":259.17,"endTime":262.8,"body":"laid out the evidence of or the"},{"speaker":"Chris Dy","startTime":259.17,"endTime":262.8,"body":"lack thereof, in terms of what"},{"speaker":"Chris Dy","startTime":262.8,"endTime":265.2,"body":"we know and what we do not know"},{"speaker":"Chris Dy","startTime":262.8,"endTime":265.2,"body":"about cane box disease. So"},{"speaker":"Chris Dy","startTime":265.2,"endTime":267.96,"body":"congratulations to you and your"},{"speaker":"Chris Dy","startTime":265.2,"endTime":267.96,"body":"co authors for writing such a"},{"speaker":"Chris Dy","startTime":267.96,"endTime":269.19,"body":"nice comprehensive article."},{"speaker":"Mireia Esplugas","startTime":269.94,"endTime":272.61,"body":"Thank you very"},{"speaker":"Mireia Esplugas","startTime":269.94,"endTime":272.61,"body":"much. It was a struggling to to"},{"speaker":"Mireia Esplugas","startTime":272.61,"endTime":276.54,"body":"write it, but we enjoyed it. And"},{"speaker":"Mireia Esplugas","startTime":272.61,"endTime":276.54,"body":"we enjoyed that you have enjoyed"},{"speaker":"Mireia Esplugas","startTime":276.57,"endTime":277.77,"body":"the article. Thank you very"},{"speaker":"Mireia Esplugas","startTime":276.57,"endTime":277.77,"body":"much."},{"speaker":"Chris Dy","startTime":278.49,"endTime":280.29,"body":"There was only one"},{"speaker":"Chris Dy","startTime":278.49,"endTime":280.29,"body":"thing that I would have added"},{"speaker":"Chris Dy","startTime":280.32,"endTime":283.53,"body":"and I probably would have cited"},{"speaker":"Chris Dy","startTime":280.32,"endTime":283.53,"body":"Dr. Goldfarb stature, on the"},{"speaker":"Chris Dy","startTime":283.53,"endTime":286.17,"body":"staging of gearbox disease. But"},{"speaker":"Chris Dy","startTime":283.53,"endTime":286.17,"body":"otherwise, I think that it was"},{"speaker":"Chris Dy","startTime":286.17,"endTime":288.81,"body":"an incredibly comprehensive and"},{"speaker":"Chris Dy","startTime":286.17,"endTime":288.81,"body":"it made me think a lot because I"},{"speaker":"Chris Dy","startTime":288.84,"endTime":291.24,"body":"struggle with this condition and"},{"speaker":"Chris Dy","startTime":288.84,"endTime":291.24,"body":"maybe Chuck and David can share"},{"speaker":"Chris Dy","startTime":291.24,"endTime":293.49,"body":"their thoughts too, but the"},{"speaker":"Chris Dy","startTime":291.24,"endTime":293.49,"body":"early stage cane box disease,"},{"speaker":"Chris Dy","startTime":293.67,"endTime":295.62,"body":"knowing what to do and how to"},{"speaker":"Chris Dy","startTime":293.67,"endTime":295.62,"body":"counsel patients it's a lot"},{"speaker":"Chris Dy","startTime":295.62,"endTime":298.98,"body":"easier once you get to the"},{"speaker":"Chris Dy","startTime":295.62,"endTime":298.98,"body":"salvage procedures. But you"},{"speaker":"Chris Dy","startTime":298.98,"endTime":300.84,"body":"know, I don't make any money off"},{"speaker":"Chris Dy","startTime":298.98,"endTime":300.84,"body":"could start with your thoughts."},{"speaker":"Chris Dy","startTime":300.84,"endTime":303.54,"body":"I mean, you know when in your"},{"speaker":"Chris Dy","startTime":300.84,"endTime":303.54,"body":"practice when you see a patient"},{"speaker":"Chris Dy","startTime":303.54,"endTime":307.23,"body":"who's got an earlier stage"},{"speaker":"Chris Dy","startTime":303.54,"endTime":307.23,"body":"disease, what is the role for"},{"speaker":"Chris Dy","startTime":307.26,"endTime":309.99,"body":"purely a metaphyseal core"},{"speaker":"Chris Dy","startTime":307.26,"endTime":309.99,"body":"decompression of the distal"},{"speaker":"Chris Dy","startTime":309.99,"endTime":310.44,"body":"radius?"},{"speaker":"Mireia Esplugas","startTime":311.73,"endTime":313.98,"body":"The program"},{"speaker":"Mireia Esplugas","startTime":311.73,"endTime":313.98,"body":"that we keep of diseases that we"},{"speaker":"Mireia Esplugas","startTime":313.98,"endTime":316.89,"body":"don't really know what will"},{"speaker":"Mireia Esplugas","startTime":313.98,"endTime":316.89,"body":"happen in the future. And we"},{"speaker":"Mireia Esplugas","startTime":316.89,"endTime":320.19,"body":"don't really know if this"},{"speaker":"Mireia Esplugas","startTime":316.89,"endTime":320.19,"body":"radiological funding that we"},{"speaker":"Mireia Esplugas","startTime":320.19,"endTime":325.32,"body":"found is only a moment in, in"},{"speaker":"Mireia Esplugas","startTime":320.19,"endTime":325.32,"body":"the in the timeline of the"},{"speaker":"Mireia Esplugas","startTime":325.32,"endTime":330.66,"body":"disease, or it will be in this"},{"speaker":"Mireia Esplugas","startTime":325.32,"endTime":330.66,"body":"way, for many, many times. So I"},{"speaker":"Mireia Esplugas","startTime":330.66,"endTime":335.13,"body":"think this is the most important"},{"speaker":"Mireia Esplugas","startTime":330.66,"endTime":335.13,"body":"aspect of the article. Because"},{"speaker":"Mireia Esplugas","startTime":335.13,"endTime":339.78,"body":"we don't really know if whatever"},{"speaker":"Mireia Esplugas","startTime":335.13,"endTime":339.78,"body":"we plan to do to the patient"},{"speaker":"Mireia Esplugas","startTime":339.78,"endTime":344.64,"body":"will improve the disease, or the"},{"speaker":"Mireia Esplugas","startTime":339.78,"endTime":344.64,"body":"disease would improve by itself"},{"speaker":"Mireia Esplugas","startTime":344.7,"endTime":349.29,"body":"alone. And the patient would be"},{"speaker":"Mireia Esplugas","startTime":344.7,"endTime":349.29,"body":"clinically correctly for many,"},{"speaker":"Mireia Esplugas","startTime":349.29,"endTime":357.39,"body":"many years. So we, we think that"},{"speaker":"Mireia Esplugas","startTime":349.29,"endTime":357.39,"body":"we must avoid any treatment as"},{"speaker":"Mireia Esplugas","startTime":357.39,"endTime":361.65,"body":"much time as possible. If this"},{"speaker":"Mireia Esplugas","startTime":357.39,"endTime":361.65,"body":"is able to live, the patient is"},{"speaker":"Mireia Esplugas","startTime":361.65,"endTime":368.31,"body":"able to wear a good life with"},{"speaker":"Mireia Esplugas","startTime":361.65,"endTime":368.31,"body":"his disease. And if we cannot"},{"speaker":"Mireia Esplugas","startTime":368.31,"endTime":375.84,"body":"control his symptoms, and we"},{"speaker":"Mireia Esplugas","startTime":368.31,"endTime":375.84,"body":"plan, a surgical treatment, we"},{"speaker":"Mireia Esplugas","startTime":375.87,"endTime":382.74,"body":"really like to do the less"},{"speaker":"Mireia Esplugas","startTime":375.87,"endTime":382.74,"body":"aggressive as possible. And the"},{"speaker":"Mireia Esplugas","startTime":382.74,"endTime":388.89,"body":"decompression is an extra"},{"speaker":"Mireia Esplugas","startTime":382.74,"endTime":388.89,"body":"tickler easy to perform an easy"},{"speaker":"Mireia Esplugas","startTime":388.89,"endTime":394.77,"body":"to recover, procedure. And then"},{"speaker":"Mireia Esplugas","startTime":388.89,"endTime":394.77,"body":"if you see the meter, you can"},{"speaker":"Mireia Esplugas","startTime":394.77,"endTime":399.09,"body":"find good results, good clinical"},{"speaker":"Mireia Esplugas","startTime":394.77,"endTime":399.09,"body":"results, which is not perhaps"},{"speaker":"Mireia Esplugas","startTime":399.66,"endTime":403.62,"body":"good radiological results. But"},{"speaker":"Mireia Esplugas","startTime":399.66,"endTime":403.62,"body":"if the patient is good, is good"},{"speaker":"Mireia Esplugas","startTime":403.71,"endTime":406.86,"body":"with its disease and can have a"},{"speaker":"Mireia Esplugas","startTime":403.71,"endTime":406.86,"body":"good life, this is a good"},{"speaker":"Mireia Esplugas","startTime":406.86,"endTime":408.96,"body":"treatment for him. This is our"},{"speaker":"Mireia Esplugas","startTime":406.86,"endTime":408.96,"body":"idea."},{"speaker":"Charles Goldfarb","startTime":410.19,"endTime":413.91,"body":"I like that."},{"speaker":"Charles Goldfarb","startTime":410.19,"endTime":413.91,"body":"David, maybe in a similar way to"},{"speaker":"Charles Goldfarb","startTime":413.94,"endTime":416.52,"body":"Maria, What's your general"},{"speaker":"Charles Goldfarb","startTime":413.94,"endTime":416.52,"body":"principles as you think about"},{"speaker":"Charles Goldfarb","startTime":416.52,"endTime":419.22,"body":"key box? And we can maybe maybe"},{"speaker":"Charles Goldfarb","startTime":416.52,"endTime":419.22,"body":"Chris, and I'll present a case"},{"speaker":"Charles Goldfarb","startTime":419.22,"endTime":421.62,"body":"and hear what each of you think"},{"speaker":"Charles Goldfarb","startTime":419.22,"endTime":421.62,"body":"about, but what are you how do"},{"speaker":"Charles Goldfarb","startTime":421.62,"endTime":423.09,"body":"you think about Kienbocks in"},{"speaker":"Charles Goldfarb","startTime":421.62,"endTime":423.09,"body":"general?"},{"speaker":"David McCombe","startTime":423.69,"endTime":427.74,"body":"I agree that we"},{"speaker":"David McCombe","startTime":423.69,"endTime":427.74,"body":"are operating in a sort of"},{"speaker":"David McCombe","startTime":428.04,"endTime":433.83,"body":"relatively evidence for his own"},{"speaker":"David McCombe","startTime":428.04,"endTime":433.83,"body":"in terms of progression. But"},{"speaker":"David McCombe","startTime":433.83,"endTime":436.92,"body":"yeah, we see we capture the"},{"speaker":"David McCombe","startTime":433.83,"endTime":436.92,"body":"patients, either when they're"},{"speaker":"David McCombe","startTime":438.06,"endTime":440.94,"body":"way down the track, and it's too"},{"speaker":"David McCombe","startTime":438.06,"endTime":440.94,"body":"late for anything or else, you"},{"speaker":"David McCombe","startTime":440.94,"endTime":446.1,"body":"know, often it's this group that"},{"speaker":"David McCombe","startTime":440.94,"endTime":446.1,"body":"have got this the pain and some"},{"speaker":"David McCombe","startTime":446.1,"endTime":448.41,"body":"restriction relationship inside"},{"speaker":"David McCombe","startTime":446.1,"endTime":448.41,"body":"of artists and, and but still"},{"speaker":"David McCombe","startTime":448.41,"endTime":453.03,"body":"have a salvageable or have an"},{"speaker":"David McCombe","startTime":448.41,"endTime":453.03,"body":"intact Lunate. There. They're"},{"speaker":"David McCombe","startTime":453.03,"endTime":455.52,"body":"the uncommon ones, in our"},{"speaker":"David McCombe","startTime":453.03,"endTime":455.52,"body":"experience, you know, we see our"},{"speaker":"David McCombe","startTime":455.52,"endTime":457.83,"body":"patients often they've got a"},{"speaker":"David McCombe","startTime":455.52,"endTime":457.83,"body":"fracture through the night,"},{"speaker":"David McCombe","startTime":457.83,"endTime":462.15,"body":"they're too far gone. And so"},{"speaker":"David McCombe","startTime":457.83,"endTime":462.15,"body":"when, when you see them, it's"},{"speaker":"David McCombe","startTime":462.15,"endTime":466.35,"body":"tempting to want to, because"},{"speaker":"David McCombe","startTime":462.15,"endTime":466.35,"body":"you're familiar with what we"},{"speaker":"David McCombe","startTime":466.47,"endTime":471.42,"body":"perhaps believe is the long term"},{"speaker":"David McCombe","startTime":466.47,"endTime":471.42,"body":"result of deterioration. You"},{"speaker":"David McCombe","startTime":471.42,"endTime":473.73,"body":"want to avoid that because it's"},{"speaker":"David McCombe","startTime":471.42,"endTime":473.73,"body":"difficult, you know, there's not"},{"speaker":"David McCombe","startTime":473.79,"endTime":477.36,"body":"not a lot of great solutions for"},{"speaker":"David McCombe","startTime":473.79,"endTime":477.36,"body":"the bad back end loss event,"},{"speaker":"David McCombe","startTime":477.36,"endTime":481.05,"body":"stage three, threes and fours."},{"speaker":"David McCombe","startTime":477.36,"endTime":481.05,"body":"So it's tempting to try and do"},{"speaker":"David McCombe","startTime":481.05,"endTime":484.38,"body":"something active. But I agree"},{"speaker":"David McCombe","startTime":481.05,"endTime":484.38,"body":"that doing articular procedures,"},{"speaker":"David McCombe","startTime":484.89,"endTime":487.59,"body":"is going to stiffen the wrist,"},{"speaker":"David McCombe","startTime":484.89,"endTime":487.59,"body":"it's tempting to want to put a"},{"speaker":"David McCombe","startTime":487.59,"endTime":491.1,"body":"escolares graft in because,"},{"speaker":"David McCombe","startTime":487.59,"endTime":491.1,"body":"yeah, that makes some sense to"},{"speaker":"David McCombe","startTime":491.13,"endTime":495.87,"body":"correct the problem. But I guess"},{"speaker":"David McCombe","startTime":491.13,"endTime":495.87,"body":"I will be doing shortening"},{"speaker":"David McCombe","startTime":495.87,"endTime":498.63,"body":"osteotomy is I haven't got a lot"},{"speaker":"David McCombe","startTime":495.87,"endTime":498.63,"body":"of experience with just the"},{"speaker":"David McCombe","startTime":498.66,"endTime":502.77,"body":"metaphyseal decompression. But"},{"speaker":"David McCombe","startTime":498.66,"endTime":502.77,"body":"can I get an arthroscopy? I'm"},{"speaker":"David McCombe","startTime":502.77,"endTime":507.66,"body":"not exactly sure that I know, a"},{"speaker":"David McCombe","startTime":502.77,"endTime":507.66,"body":"great plains and a good friend"},{"speaker":"David McCombe","startTime":507.66,"endTime":512.82,"body":"and colleague, and he's written"},{"speaker":"David McCombe","startTime":507.66,"endTime":512.82,"body":"extensively on this and the"},{"speaker":"David McCombe","startTime":512.85,"endTime":514.98,"body":"assessment of the integrity of"},{"speaker":"David McCombe","startTime":512.85,"endTime":514.98,"body":"articular cartilage, I think"},{"speaker":"David McCombe","startTime":514.98,"endTime":517.53,"body":"it's a really difficult problem."},{"speaker":"David McCombe","startTime":514.98,"endTime":517.53,"body":"And I think we, you know, when"},{"speaker":"David McCombe","startTime":517.53,"endTime":520.38,"body":"it's bad, it's bad. But there's"},{"speaker":"David McCombe","startTime":517.53,"endTime":520.38,"body":"a big gray zone where we're not"},{"speaker":"David McCombe","startTime":520.53,"endTime":523.8,"body":"quite so sure what we're dealing"},{"speaker":"David McCombe","startTime":520.53,"endTime":523.8,"body":"with. So I think the principles"},{"speaker":"David McCombe","startTime":523.8,"endTime":527.19,"body":"of trying not to do harm, it's"},{"speaker":"David McCombe","startTime":523.8,"endTime":527.19,"body":"makes a lot of sense, an extra"},{"speaker":"David McCombe","startTime":527.19,"endTime":530.52,"body":"articular procedure,"},{"speaker":"David McCombe","startTime":527.19,"endTime":530.52,"body":"particularly shortening of the"},{"speaker":"David McCombe","startTime":530.52,"endTime":533.31,"body":"radius, if that's feasible. I"},{"speaker":"David McCombe","startTime":530.52,"endTime":533.31,"body":"haven't got a lot of experience"},{"speaker":"David McCombe","startTime":533.31,"endTime":537.93,"body":"with the wedge for the neutral"},{"speaker":"David McCombe","startTime":533.31,"endTime":537.93,"body":"variance. But yeah, I think it's"},{"speaker":"David McCombe","startTime":537.93,"endTime":541.14,"body":"hard. That's why That's why we"},{"speaker":"David McCombe","startTime":537.93,"endTime":541.14,"body":"chose it as a topic because this"},{"speaker":"David McCombe","startTime":541.29,"endTime":547.62,"body":"dilemma is how hard you go. How"},{"speaker":"David McCombe","startTime":541.29,"endTime":547.62,"body":"aggressive should you be? Are we"},{"speaker":"David McCombe","startTime":547.62,"endTime":551.64,"body":"really changing people's"},{"speaker":"David McCombe","startTime":547.62,"endTime":551.64,"body":"outcomes by doing whatever"},{"speaker":"David McCombe","startTime":551.64,"endTime":555.57,"body":"intervention we're planning to"},{"speaker":"David McCombe","startTime":551.64,"endTime":555.57,"body":"do? So there was no I really"},{"speaker":"David McCombe","startTime":555.57,"endTime":560.04,"body":"appreciate Maria's and her"},{"speaker":"David McCombe","startTime":555.57,"endTime":560.04,"body":"colleagues, Alex genkos"},{"speaker":"David McCombe","startTime":560.19,"endTime":563.61,"body":"contribution to that addition."},{"speaker":"David McCombe","startTime":560.19,"endTime":563.61,"body":"So I thought was really good as"},{"speaker":"David McCombe","startTime":563.61,"endTime":568.65,"body":"well. So that doesn't give you"},{"speaker":"David McCombe","startTime":563.61,"endTime":568.65,"body":"any air today, Chuck, but I"},{"speaker":"David McCombe","startTime":568.65,"endTime":571.32,"body":"guess we're all you know, to a"},{"speaker":"David McCombe","startTime":568.65,"endTime":571.32,"body":"degree, gives you a bit of"},{"speaker":"David McCombe","startTime":571.32,"endTime":574.05,"body":"flexibility and you can sort of"},{"speaker":"David McCombe","startTime":571.32,"endTime":574.05,"body":"do provide and you don't do a"},{"speaker":"David McCombe","startTime":574.05,"endTime":577.44,"body":"lot of harm. You may be doing"},{"speaker":"David McCombe","startTime":574.05,"endTime":577.44,"body":"what everyone else is doing."},{"speaker":"David McCombe","startTime":577.44,"endTime":577.8,"body":"Perhaps"},{"speaker":"Chris Dy","startTime":578.04,"endTime":580.17,"body":"I am scared yet"},{"speaker":"Chris Dy","startTime":578.04,"endTime":580.17,"body":"reassured that we are operating"},{"speaker":"Chris Dy","startTime":580.17,"endTime":584.07,"body":"in an evidence free zone as the"},{"speaker":"Chris Dy","startTime":580.17,"endTime":584.07,"body":"state the question that I wanted"},{"speaker":"Chris Dy","startTime":584.07,"endTime":586.35,"body":"to ask each of you and get your"},{"speaker":"Chris Dy","startTime":584.07,"endTime":586.35,"body":"thoughts and I think, Chuck, I'd"},{"speaker":"Chris Dy","startTime":586.35,"endTime":589.08,"body":"love your thoughts on this too."},{"speaker":"Chris Dy","startTime":586.35,"endTime":589.08,"body":"Are there any radiographic"},{"speaker":"Chris Dy","startTime":589.08,"endTime":593.19,"body":"findings? For you to say, I"},{"speaker":"Chris Dy","startTime":589.08,"endTime":593.19,"body":"can't salvage or we have to go"},{"speaker":"Chris Dy","startTime":593.19,"endTime":596.28,"body":"to a salvage procedure. I cannot"},{"speaker":"Chris Dy","startTime":593.19,"endTime":596.28,"body":"save this lunate anymore. Maybe"},{"speaker":"Chris Dy","startTime":596.28,"endTime":599.37,"body":"start with Mireia your thoughts?"},{"speaker":"Chris Dy","startTime":596.28,"endTime":599.37,"body":"When do you say we can't do"},{"speaker":"Chris Dy","startTime":599.64,"endTime":601.89,"body":"anything In like an extra"},{"speaker":"Chris Dy","startTime":599.64,"endTime":601.89,"body":"particular procedure like a core"},{"speaker":"Chris Dy","startTime":601.89,"endTime":604.56,"body":"decompression, we cannot do an"},{"speaker":"Chris Dy","startTime":601.89,"endTime":604.56,"body":"osteotomy we cannot do a"},{"speaker":"Chris Dy","startTime":604.59,"endTime":607.05,"body":"dennervation we can this lunate"},{"speaker":"Chris Dy","startTime":604.59,"endTime":607.05,"body":"needs to go."},{"speaker":"Mireia Esplugas","startTime":609.78,"endTime":614.46,"body":"I think that"},{"speaker":"Mireia Esplugas","startTime":609.78,"endTime":614.46,"body":"perhaps the most useful way to"},{"speaker":"Mireia Esplugas","startTime":614.46,"endTime":618.78,"body":"decide this should be to have"},{"speaker":"Mireia Esplugas","startTime":614.46,"endTime":618.78,"body":"different controls in time. And"},{"speaker":"Mireia Esplugas","startTime":618.78,"endTime":625.11,"body":"to check if it ever, ever"},{"speaker":"Mireia Esplugas","startTime":618.78,"endTime":625.11,"body":"evaluates quickly if he or if he"},{"speaker":"Mireia Esplugas","startTime":625.11,"endTime":629.52,"body":"doesn't, or if he's become an"},{"speaker":"Mireia Esplugas","startTime":625.11,"endTime":629.52,"body":"unstable or he's having a"},{"speaker":"Mireia Esplugas","startTime":629.52,"endTime":636.18,"body":"perhaps we should not only focus"},{"speaker":"Mireia Esplugas","startTime":629.52,"endTime":636.18,"body":"on static explorations, but also"},{"speaker":"Mireia Esplugas","startTime":636.18,"endTime":640.53,"body":"dynamic explorations. And if you"},{"speaker":"Mireia Esplugas","startTime":636.18,"endTime":640.53,"body":"see that, the carpark kinematics"},{"speaker":"Mireia Esplugas","startTime":640.53,"endTime":644.55,"body":"is changing because of the"},{"speaker":"Mireia Esplugas","startTime":640.53,"endTime":644.55,"body":"lunate is, is changing his"},{"speaker":"Mireia Esplugas","startTime":644.55,"endTime":650.07,"body":"shape. Perhaps this would be the"},{"speaker":"Mireia Esplugas","startTime":644.55,"endTime":650.07,"body":"moment to decide that it's the"},{"speaker":"Mireia Esplugas","startTime":650.07,"endTime":653.82,"body":"time to take aggressive or more"},{"speaker":"Mireia Esplugas","startTime":650.07,"endTime":653.82,"body":"aggressive surgical procedure."},{"speaker":"Chris Dy","startTime":655.41,"endTime":657.15,"body":"Thank you for that."},{"speaker":"Chris Dy","startTime":655.41,"endTime":657.15,"body":"David, I'd love your thoughts,"},{"speaker":"Chris Dy","startTime":657.15,"endTime":659.58,"body":"you know, when can you no longer"},{"speaker":"Chris Dy","startTime":657.15,"endTime":659.58,"body":"do any sort of graft or flap or"},{"speaker":"Chris Dy","startTime":659.58,"endTime":662.43,"body":"anything like that? When is the"},{"speaker":"Chris Dy","startTime":659.58,"endTime":662.43,"body":"lineage done? Well, I"},{"speaker":"David McCombe","startTime":662.43,"endTime":665.13,"body":"think once you"},{"speaker":"David McCombe","startTime":662.43,"endTime":665.13,"body":"that once there's a coronal"},{"speaker":"David McCombe","startTime":665.13,"endTime":668.07,"body":"plane fracture, I think that's"},{"speaker":"David McCombe","startTime":665.13,"endTime":668.07,"body":"difficult. It's very hard to,"},{"speaker":"David McCombe","startTime":668.67,"endTime":674.85,"body":"to, if you were to contemplate"},{"speaker":"David McCombe","startTime":668.67,"endTime":674.85,"body":"bone grafting the night once"},{"speaker":"David McCombe","startTime":674.85,"endTime":676.41,"body":"it's quite applied fracture, I"},{"speaker":"David McCombe","startTime":674.85,"endTime":676.41,"body":"think that's pretty hard to"},{"speaker":"David McCombe","startTime":676.41,"endTime":680.04,"body":"capture the brunt of it, try and"},{"speaker":"David McCombe","startTime":676.41,"endTime":680.04,"body":"unite the bowler component to"},{"speaker":"David McCombe","startTime":680.04,"endTime":684.24,"body":"that. I think, you know, the"},{"speaker":"David McCombe","startTime":680.04,"endTime":684.24,"body":"concept of the intra articular"},{"speaker":"David McCombe","startTime":684.24,"endTime":688.14,"body":"procedures. So they're trying to"},{"speaker":"David McCombe","startTime":684.24,"endTime":688.14,"body":"salvage the night that's already"},{"speaker":"David McCombe","startTime":688.17,"endTime":691.8,"body":"lost, its high. If you're trying"},{"speaker":"David McCombe","startTime":688.17,"endTime":691.8,"body":"to expand that back, or if"},{"speaker":"David McCombe","startTime":691.8,"endTime":694.05,"body":"you're trying to fit a bone"},{"speaker":"David McCombe","startTime":691.8,"endTime":694.05,"body":"graft, it's actually got some"},{"speaker":"David McCombe","startTime":694.05,"endTime":697.86,"body":"sort of blood supply still in"},{"speaker":"David McCombe","startTime":694.05,"endTime":697.86,"body":"it, and you're trying to squeeze"},{"speaker":"David McCombe","startTime":697.86,"endTime":702.15,"body":"it into a low note that's"},{"speaker":"David McCombe","startTime":697.86,"endTime":702.15,"body":"reduced its proximal, distal"},{"speaker":"David McCombe","startTime":702.15,"endTime":704.88,"body":"high. That's pretty challenging."},{"speaker":"David McCombe","startTime":702.15,"endTime":704.88,"body":"It's a it's not a very big bar."},{"speaker":"David McCombe","startTime":704.91,"endTime":707.85,"body":"There's a lot of real estate in"},{"speaker":"David McCombe","startTime":704.91,"endTime":707.85,"body":"that Luminate at the best of"},{"speaker":"David McCombe","startTime":707.85,"endTime":710.73,"body":"times, let alone if it's already"},{"speaker":"David McCombe","startTime":707.85,"endTime":710.73,"body":"started to collapse. I think you"},{"speaker":"David McCombe","startTime":710.73,"endTime":713.13,"body":"can still do procedures like"},{"speaker":"David McCombe","startTime":710.73,"endTime":713.13,"body":"derivations and I think you can"},{"speaker":"David McCombe","startTime":713.13,"endTime":716.88,"body":"still do even if the illuminate"},{"speaker":"David McCombe","startTime":713.13,"endTime":716.88,"body":"this non salvageable. I think"},{"speaker":"David McCombe","startTime":716.88,"endTime":719.28,"body":"you can deactivate a wrist, I"},{"speaker":"David McCombe","startTime":716.88,"endTime":719.28,"body":"think that's a reasonable thing"},{"speaker":"David McCombe","startTime":719.28,"endTime":722.61,"body":"to do. It's, you know, it can"},{"speaker":"David McCombe","startTime":719.28,"endTime":722.61,"body":"provide some relief and it's not"},{"speaker":"David McCombe","startTime":722.61,"endTime":727.56,"body":"doing harm. Whether it for that"},{"speaker":"David McCombe","startTime":722.61,"endTime":727.56,"body":"loon I'm doing a leveling"},{"speaker":"David McCombe","startTime":727.56,"endTime":732.51,"body":"procedure is worthwhile,"},{"speaker":"David McCombe","startTime":727.56,"endTime":732.51,"body":"perhaps. But I think once you've"},{"speaker":"David McCombe","startTime":732.51,"endTime":735.0,"body":"got that those changes in the"},{"speaker":"David McCombe","startTime":732.51,"endTime":735.0,"body":"winnowed structure, I'm not sure"},{"speaker":"David McCombe","startTime":735.0,"endTime":738.9,"body":"he can say that. I know people"},{"speaker":"David McCombe","startTime":735.0,"endTime":738.9,"body":"have tried to unite and Jim"},{"speaker":"David McCombe","startTime":738.9,"endTime":744.09,"body":"Higgins with his MFT is trying"},{"speaker":"David McCombe","startTime":738.9,"endTime":744.09,"body":"to rebuild Illinois from"},{"speaker":"David McCombe","startTime":744.09,"endTime":747.06,"body":"scratch. I've not got a lot of"},{"speaker":"David McCombe","startTime":744.09,"endTime":747.06,"body":"experience with that. I use the"},{"speaker":"David McCombe","startTime":747.06,"endTime":750.87,"body":"MFT for skateboards, but I"},{"speaker":"David McCombe","startTime":747.06,"endTime":750.87,"body":"haven't been courageous enough"},{"speaker":"David McCombe","startTime":750.87,"endTime":752.88,"body":"to tackle the night with one of"},{"speaker":"David McCombe","startTime":750.87,"endTime":752.88,"body":"those yet."},{"speaker":"Charles Goldfarb","startTime":754.82,"endTime":758.84,"body":"That's very"},{"speaker":"Charles Goldfarb","startTime":754.82,"endTime":758.84,"body":"helpful. I would agree. I really"},{"speaker":"Charles Goldfarb","startTime":758.84,"endTime":762.74,"body":"liked what Mireia said about the"},{"speaker":"Charles Goldfarb","startTime":758.84,"endTime":762.74,"body":"kinematics and the motion. It's"},{"speaker":"Charles Goldfarb","startTime":762.74,"endTime":765.23,"body":"very important to think that"},{"speaker":"Charles Goldfarb","startTime":762.74,"endTime":765.23,"body":"way, there's not always a"},{"speaker":"Charles Goldfarb","startTime":765.23,"endTime":770.51,"body":"simplistic evaluation tool of"},{"speaker":"Charles Goldfarb","startTime":765.23,"endTime":770.51,"body":"the loonie. But the coronal"},{"speaker":"Charles Goldfarb","startTime":770.51,"endTime":774.38,"body":"plane fractures are difficult."},{"speaker":"Charles Goldfarb","startTime":770.51,"endTime":774.38,"body":"And there is literature to"},{"speaker":"Charles Goldfarb","startTime":774.38,"endTime":777.41,"body":"suggest that one can fix those"},{"speaker":"Charles Goldfarb","startTime":774.38,"endTime":777.41,"body":"with a small screw and get them"},{"speaker":"Charles Goldfarb","startTime":777.41,"endTime":781.22,"body":"to heal. And I have certainly"},{"speaker":"Charles Goldfarb","startTime":777.41,"endTime":781.22,"body":"tried, but I don't believe I"},{"speaker":"Charles Goldfarb","startTime":781.22,"endTime":784.67,"body":"have been routinely successful."},{"speaker":"Charles Goldfarb","startTime":781.22,"endTime":784.67,"body":"So I really appreciate that that"},{"speaker":"Charles Goldfarb","startTime":784.67,"endTime":789.11,"body":"comment, maybe Chris, if it's"},{"speaker":"Charles Goldfarb","startTime":784.67,"endTime":789.11,"body":"okay, let's let's do a very"},{"speaker":"Charles Goldfarb","startTime":789.11,"endTime":793.34,"body":"quick case scenario and just ask"},{"speaker":"Charles Goldfarb","startTime":789.11,"endTime":793.34,"body":"how each of you would approach"},{"speaker":"Charles Goldfarb","startTime":793.34,"endTime":795.98,"body":"it and then we can switch our"},{"speaker":"Charles Goldfarb","startTime":793.34,"endTime":795.98,"body":"topics if that sounds alright to"},{"speaker":"Charles Goldfarb","startTime":795.98,"endTime":799.91,"body":"everyone. Okay. So, go ahead."},{"speaker":"Mireia Esplugas","startTime":800.45,"endTime":803.63,"body":"today something"},{"speaker":"Mireia Esplugas","startTime":800.45,"endTime":803.63,"body":"because of this current"},{"speaker":"Mireia Esplugas","startTime":804.08,"endTime":810.71,"body":"fractures are very difficult to"},{"speaker":"Mireia Esplugas","startTime":804.08,"endTime":810.71,"body":"really treat. In fact, we are we"},{"speaker":"Mireia Esplugas","startTime":810.71,"endTime":815.63,"body":"are moving to think that"},{"speaker":"Mireia Esplugas","startTime":810.71,"endTime":815.63,"body":"perhaps, we should substitute"},{"speaker":"Mireia Esplugas","startTime":815.63,"endTime":823.1,"body":"this this unit to, to read re"},{"speaker":"Mireia Esplugas","startTime":815.63,"endTime":823.1,"body":"return to the normality, the"},{"speaker":"Mireia Esplugas","startTime":823.1,"endTime":831.65,"body":"carpal kinematics and we are"},{"speaker":"Mireia Esplugas","startTime":823.1,"endTime":831.65,"body":"moving to try to to substitute"},{"speaker":"Mireia Esplugas","startTime":831.65,"endTime":836.45,"body":"it, for instance by 3d printed"},{"speaker":"Mireia Esplugas","startTime":831.65,"endTime":836.45,"body":"to donate. And we are focusing"},{"speaker":"Mireia Esplugas","startTime":836.45,"endTime":840.92,"body":"there, how to stabilize it. And"},{"speaker":"Mireia Esplugas","startTime":836.45,"endTime":840.92,"body":"we are we are engaged. We are"},{"speaker":"Mireia Esplugas","startTime":840.92,"endTime":845.3,"body":"starting many projects and this"},{"speaker":"Mireia Esplugas","startTime":840.92,"endTime":845.3,"body":"in this way. And because perhaps"},{"speaker":"Mireia Esplugas","startTime":845.3,"endTime":848.12,"body":"the most important thing is to"},{"speaker":"Mireia Esplugas","startTime":845.3,"endTime":848.12,"body":"restore the carpal kinematics"},{"speaker":"Mireia Esplugas","startTime":848.12,"endTime":855.35,"body":"and kinetics not to try to to"},{"speaker":"Mireia Esplugas","startTime":848.12,"endTime":855.35,"body":"get healthier to donate with a"},{"speaker":"Mireia Esplugas","startTime":855.35,"endTime":855.95,"body":"good shape."},{"speaker":"Charles Goldfarb","startTime":857.3,"endTime":859.22,"body":"Thank you."},{"speaker":"Charles Goldfarb","startTime":857.3,"endTime":859.22,"body":"Well, we all will look forward"},{"speaker":"Charles Goldfarb","startTime":859.22,"endTime":865.13,"body":"to your reports. Not an easy"},{"speaker":"Charles Goldfarb","startTime":859.22,"endTime":865.13,"body":"problem, for sure. So here's a"},{"speaker":"Charles Goldfarb","startTime":865.13,"endTime":868.82,"body":"case for everyone's"},{"speaker":"Charles Goldfarb","startTime":865.13,"endTime":868.82,"body":"consideration. A 35 year old"},{"speaker":"Charles Goldfarb","startTime":869.09,"endTime":874.97,"body":"male laborer who has had central"},{"speaker":"Charles Goldfarb","startTime":869.09,"endTime":874.97,"body":"wrist pain for five years. You"},{"speaker":"Charles Goldfarb","startTime":874.97,"endTime":879.29,"body":"have been following him for two"},{"speaker":"Charles Goldfarb","startTime":874.97,"endTime":879.29,"body":"years. And the illuminate by X"},{"speaker":"Charles Goldfarb","startTime":879.29,"endTime":884.21,"body":"ray and an MRI was obtained is"},{"speaker":"Charles Goldfarb","startTime":879.29,"endTime":884.21,"body":"basically a stage to illuminate"},{"speaker":"Charles Goldfarb","startTime":884.45,"endTime":890.84,"body":"so it's not truly collapsed. The"},{"speaker":"Charles Goldfarb","startTime":884.45,"endTime":890.84,"body":"older variance is slightly"},{"speaker":"Charles Goldfarb","startTime":890.84,"endTime":895.1,"body":"negative, and he is frustrated"},{"speaker":"Charles Goldfarb","startTime":890.84,"endTime":895.1,"body":"with his wrist pain. He has"},{"speaker":"Charles Goldfarb","startTime":895.1,"endTime":899.18,"body":"failed conservative care and"},{"speaker":"Charles Goldfarb","startTime":895.1,"endTime":899.18,"body":"wants something done. So David,"},{"speaker":"Charles Goldfarb","startTime":899.18,"endTime":901.97,"body":"maybe we'll start with You, how"},{"speaker":"Charles Goldfarb","startTime":899.18,"endTime":901.97,"body":"do you think about this patient?"},{"speaker":"Charles Goldfarb","startTime":901.97,"endTime":903.8,"body":"And what would you consider"},{"speaker":"Charles Goldfarb","startTime":901.97,"endTime":903.8,"body":"offering him?"},{"speaker":"David McCombe","startTime":904.85,"endTime":908.84,"body":"So I think he, I"},{"speaker":"David McCombe","startTime":904.85,"endTime":908.84,"body":"think a joint leveling"},{"speaker":"David McCombe","startTime":908.84,"endTime":912.32,"body":"procedure, if he has gotten at"},{"speaker":"David McCombe","startTime":908.84,"endTime":912.32,"body":"variance to a degree, I think"},{"speaker":"David McCombe","startTime":912.32,"endTime":916.73,"body":"that that's a good operation."},{"speaker":"David McCombe","startTime":912.32,"endTime":916.73,"body":"And that can form a component of"},{"speaker":"David McCombe","startTime":916.73,"endTime":921.17,"body":"your plan that he's going to end"},{"speaker":"David McCombe","startTime":916.73,"endTime":921.17,"body":"up having a scope and having"},{"speaker":"David McCombe","startTime":921.17,"endTime":924.29,"body":"these articular surfaces"},{"speaker":"David McCombe","startTime":921.17,"endTime":924.29,"body":"examined and make sure he hasn't"},{"speaker":"David McCombe","startTime":924.29,"endTime":926.87,"body":"got that sort of shifting,"},{"speaker":"David McCombe","startTime":924.29,"endTime":926.87,"body":"shifting sand type of"},{"speaker":"David McCombe","startTime":926.96,"endTime":929.39,"body":"osteochondral fragment that's"},{"speaker":"David McCombe","startTime":926.96,"endTime":929.39,"body":"just loose on the surface. I"},{"speaker":"David McCombe","startTime":929.39,"endTime":933.29,"body":"think that would be a poor"},{"speaker":"David McCombe","startTime":929.39,"endTime":933.29,"body":"prognostic sign. The question, I"},{"speaker":"David McCombe","startTime":933.29,"endTime":936.5,"body":"guess, here is whether you"},{"speaker":"David McCombe","startTime":933.29,"endTime":936.5,"body":"believe that doing a four or"},{"speaker":"David McCombe","startTime":936.5,"endTime":940.58,"body":"five draft and plugging it into"},{"speaker":"David McCombe","startTime":936.5,"endTime":940.58,"body":"the back of his lemonade, and"},{"speaker":"David McCombe","startTime":940.58,"endTime":942.68,"body":"this is the situation I was"},{"speaker":"David McCombe","startTime":940.58,"endTime":942.68,"body":"talking about before this, this"},{"speaker":"David McCombe","startTime":942.68,"endTime":945.68,"body":"is the guy who's 35, it's a"},{"speaker":"David McCombe","startTime":942.68,"endTime":945.68,"body":"laborer he needs, he's got"},{"speaker":"David McCombe","startTime":945.74,"endTime":948.62,"body":"another 20 years of manual work"},{"speaker":"David McCombe","startTime":945.74,"endTime":948.62,"body":"in front of him, he's not going"},{"speaker":"David McCombe","startTime":948.62,"endTime":953.0,"body":"to be as good at that if his"},{"speaker":"David McCombe","startTime":948.62,"endTime":953.0,"body":"wrist is poor. If he ends up"},{"speaker":"David McCombe","startTime":953.0,"endTime":956.72,"body":"with a partial total risk"},{"speaker":"David McCombe","startTime":953.0,"endTime":956.72,"body":"fusion, so yeah, he might be the"},{"speaker":"David McCombe","startTime":956.72,"endTime":961.58,"body":"one that I would do. The trouble"},{"speaker":"David McCombe","startTime":956.72,"endTime":961.58,"body":"is, I think that that guy, he's"},{"speaker":"David McCombe","startTime":961.58,"endTime":965.75,"body":"the minority. So to build up a"},{"speaker":"David McCombe","startTime":961.58,"endTime":965.75,"body":"feeling as to whether you're"},{"speaker":"David McCombe","startTime":965.75,"endTime":968.84,"body":"doing the right thing by these"},{"speaker":"David McCombe","startTime":965.75,"endTime":968.84,"body":"patients, you really need to"},{"speaker":"David McCombe","startTime":968.9,"endTime":971.12,"body":"aggregate a lot of experience"},{"speaker":"David McCombe","startTime":968.9,"endTime":971.12,"body":"with that, I think, because"},{"speaker":"David McCombe","startTime":971.12,"endTime":974.54,"body":"it's, it's not an easy"},{"speaker":"David McCombe","startTime":971.12,"endTime":974.54,"body":"operation. And, you know, if you"},{"speaker":"David McCombe","startTime":974.54,"endTime":977.51,"body":"have a bad result, is it the"},{"speaker":"David McCombe","startTime":974.54,"endTime":977.51,"body":"technique? Is it the principle"},{"speaker":"David McCombe","startTime":977.51,"endTime":981.53,"body":"the surgery, that doesn't work?"},{"speaker":"David McCombe","startTime":977.51,"endTime":981.53,"body":"As well as a we not? We may be"},{"speaker":"David McCombe","startTime":981.53,"endTime":984.65,"body":"reversed lysing the bone but are"},{"speaker":"David McCombe","startTime":981.53,"endTime":984.65,"body":"we restoring the height and"},{"speaker":"David McCombe","startTime":984.65,"endTime":989.69,"body":"maintaining kinematics and, and"},{"speaker":"David McCombe","startTime":984.65,"endTime":989.69,"body":"normal mechanics? So, but you"},{"speaker":"David McCombe","startTime":989.69,"endTime":992.39,"body":"asked me the question, and my"},{"speaker":"David McCombe","startTime":989.69,"endTime":992.39,"body":"answer is I probably would, he"},{"speaker":"David McCombe","startTime":992.39,"endTime":994.64,"body":"would be the guy that I might do"},{"speaker":"David McCombe","startTime":992.39,"endTime":994.64,"body":"this for. So I'd shortened him."},{"speaker":"David McCombe","startTime":994.97,"endTime":997.76,"body":"And I'd take the full five"},{"speaker":"David McCombe","startTime":994.97,"endTime":997.76,"body":"graft, and then do the osteotomy"},{"speaker":"David McCombe","startTime":997.76,"endTime":1001.75,"body":"through that donor site, bring"},{"speaker":"David McCombe","startTime":997.76,"endTime":1001.75,"body":"that down a little bit. And I"},{"speaker":"David McCombe","startTime":1001.75,"endTime":1006.34,"body":"would just carve out a little"},{"speaker":"David McCombe","startTime":1001.75,"endTime":1006.34,"body":"carve out my slot in the back of"},{"speaker":"David McCombe","startTime":1006.34,"endTime":1009.49,"body":"the lunate and plug it in there."},{"speaker":"David McCombe","startTime":1006.34,"endTime":1009.49,"body":"Perfect. And then I would then I"},{"speaker":"David McCombe","startTime":1009.49,"endTime":1011.05,"body":"would, I would wait."},{"speaker":"Charles Goldfarb","startTime":1013.06,"endTime":1014.53,"body":"Thank you."},{"speaker":"Charles Goldfarb","startTime":1013.06,"endTime":1014.53,"body":"That's how well this every"},{"speaker":"Charles Goldfarb","startTime":1014.53,"endTime":1018.28,"body":"before I turned to  Mireia, does"},{"speaker":"Charles Goldfarb","startTime":1014.53,"endTime":1018.28,"body":"every patient get an arthroscopy"},{"speaker":"Charles Goldfarb","startTime":1018.28,"endTime":1020.68,"body":"as part of the procedure to"},{"speaker":"Charles Goldfarb","startTime":1018.28,"endTime":1020.68,"body":"assess the articular cartilage?"},{"speaker":"David McCombe","startTime":1021.76,"endTime":1025.84,"body":"I think if it's a"},{"speaker":"David McCombe","startTime":1021.76,"endTime":1025.84,"body":"stage two, if he's, if they're"},{"speaker":"David McCombe","startTime":1025.84,"endTime":1029.38,"body":"not just having a splint, and"},{"speaker":"David McCombe","startTime":1025.84,"endTime":1029.38,"body":"resting and observation, if"},{"speaker":"David McCombe","startTime":1029.38,"endTime":1031.96,"body":"they're, if I'm contemplating"},{"speaker":"David McCombe","startTime":1029.38,"endTime":1031.96,"body":"doing something, I want to have"},{"speaker":"David McCombe","startTime":1031.96,"endTime":1035.11,"body":"a scope, I want to scope it. And"},{"speaker":"David McCombe","startTime":1031.96,"endTime":1035.11,"body":"part of that diagnostic part of"},{"speaker":"David McCombe","startTime":1035.11,"endTime":1040.06,"body":"that is gaining experience, it's"},{"speaker":"David McCombe","startTime":1035.11,"endTime":1040.06,"body":"you're trying to learn what the"},{"speaker":"David McCombe","startTime":1040.06,"endTime":1043.42,"body":"MRI finding really, really means"},{"speaker":"David McCombe","startTime":1040.06,"endTime":1043.42,"body":"I think it's we're learning with"},{"speaker":"David McCombe","startTime":1043.84,"endTime":1047.14,"body":"the arthroscopic distal radius"},{"speaker":"David McCombe","startTime":1043.84,"endTime":1047.14,"body":"fixation and arthroscopic"},{"speaker":"David McCombe","startTime":1047.89,"endTime":1050.77,"body":"Skyforge fixation, everything"},{"speaker":"David McCombe","startTime":1047.89,"endTime":1050.77,"body":"else now that we're the scope,"},{"speaker":"David McCombe","startTime":1050.8,"endTime":1055.66,"body":"the scope is really just part of"},{"speaker":"David McCombe","startTime":1050.8,"endTime":1055.66,"body":"the diagnostic sort of algorithm"},{"speaker":"David McCombe","startTime":1055.66,"endTime":1058.51,"body":"really, rather than necessarily"},{"speaker":"David McCombe","startTime":1055.66,"endTime":1058.51,"body":"being an operation itself."},{"speaker":"Charles Goldfarb","startTime":1059.17,"endTime":1060.31,"body":"Perfect."},{"speaker":"Charles Goldfarb","startTime":1059.17,"endTime":1060.31,"body":"Mireia."},{"speaker":"Mireia Esplugas","startTime":1061.36,"endTime":1063.46,"body":"I think that"},{"speaker":"Mireia Esplugas","startTime":1061.36,"endTime":1063.46,"body":"the arthroscopy is not the only"},{"speaker":"Mireia Esplugas","startTime":1063.85,"endTime":1067.48,"body":"good valuating tool, but also,"},{"speaker":"Mireia Esplugas","startTime":1063.85,"endTime":1067.48,"body":"it's good for the patient,"},{"speaker":"Mireia Esplugas","startTime":1067.48,"endTime":1071.14,"body":"because you always find a sign"},{"speaker":"Mireia Esplugas","startTime":1067.48,"endTime":1071.14,"body":"of it, it's there, which is"},{"speaker":"Mireia Esplugas","startTime":1071.17,"endTime":1075.55,"body":"perhaps the one of the reasons"},{"speaker":"Mireia Esplugas","startTime":1071.17,"endTime":1075.55,"body":"of his central pain, you'll find"},{"speaker":"Mireia Esplugas","startTime":1075.55,"endTime":1081.37,"body":"the cartilage flaps that you can"},{"speaker":"Mireia Esplugas","startTime":1075.55,"endTime":1081.37,"body":"you can the bride and this may"},{"speaker":"Mireia Esplugas","startTime":1081.37,"endTime":1086.62,"body":"also be at the source of"},{"speaker":"Mireia Esplugas","startTime":1081.37,"endTime":1086.62,"body":"patient's pain. So, yes, I think"},{"speaker":"Mireia Esplugas","startTime":1086.62,"endTime":1092.05,"body":"that we should always scope a"},{"speaker":"Mireia Esplugas","startTime":1086.62,"endTime":1092.05,"body":"keen book mixing it with other"},{"speaker":"Mireia Esplugas","startTime":1092.05,"endTime":1094.87,"body":"treatments. And in this"},{"speaker":"Mireia Esplugas","startTime":1092.05,"endTime":1094.87,"body":"particular case that you have"},{"speaker":"Mireia Esplugas","startTime":1095.17,"endTime":1099.85,"body":"explained, I would scope I would"},{"speaker":"Mireia Esplugas","startTime":1095.17,"endTime":1099.85,"body":"evaluate and treat"},{"speaker":"Mireia Esplugas","startTime":1099.85,"endTime":1102.94,"body":"intraarticular as in the"},{"speaker":"Mireia Esplugas","startTime":1099.85,"endTime":1102.94,"body":"radiocarpal as inter metacarpal."},{"speaker":"Mireia Esplugas","startTime":1103.27,"endTime":1107.23,"body":"And then I would add, but would"},{"speaker":"Mireia Esplugas","startTime":1103.27,"endTime":1107.23,"body":"ask I would add an extra"},{"speaker":"Mireia Esplugas","startTime":1107.23,"endTime":1114.37,"body":"articular osteotomy. Because"},{"speaker":"Mireia Esplugas","startTime":1107.23,"endTime":1114.37,"body":"many patients with only with the"},{"speaker":"Mireia Esplugas","startTime":1114.43,"endTime":1119.86,"body":"osteotomy get better with their"},{"speaker":"Mireia Esplugas","startTime":1114.43,"endTime":1119.86,"body":"pain, you do not perhaps modify"},{"speaker":"Mireia Esplugas","startTime":1120.34,"endTime":1127.87,"body":"the disease evolution, but the"},{"speaker":"Mireia Esplugas","startTime":1120.34,"endTime":1127.87,"body":"patient is is better. And I"},{"speaker":"Mireia Esplugas","startTime":1127.87,"endTime":1130.48,"body":"think that if in this particular"},{"speaker":"Mireia Esplugas","startTime":1127.87,"endTime":1130.48,"body":"case, which is a manual labor,"},{"speaker":"Mireia Esplugas","startTime":1130.48,"endTime":1134.53,"body":"which is certified, which is"},{"speaker":"Mireia Esplugas","startTime":1130.48,"endTime":1134.53,"body":"which the only thing that he"},{"speaker":"Mireia Esplugas","startTime":1134.53,"endTime":1140.29,"body":"wants is to have less pain, and"},{"speaker":"Mireia Esplugas","startTime":1134.53,"endTime":1140.29,"body":"without interfering in his"},{"speaker":"Mireia Esplugas","startTime":1140.32,"endTime":1145.0,"body":"mobility because he has to have"},{"speaker":"Mireia Esplugas","startTime":1140.32,"endTime":1145.0,"body":"a good wrist. Only with this,"},{"speaker":"Mireia Esplugas","startTime":1145.03,"endTime":1149.17,"body":"you can improve him and wait, if"},{"speaker":"Mireia Esplugas","startTime":1145.03,"endTime":1149.17,"body":"in the future, there are more"},{"speaker":"Mireia Esplugas","startTime":1150.25,"endTime":1154.0,"body":"benefits to offer to him"},{"speaker":"Mireia Esplugas","startTime":1150.25,"endTime":1154.0,"body":"surgically. You can."},{"speaker":"Charles Goldfarb","startTime":1155.29,"endTime":1157.3,"body":"Thank you."},{"speaker":"Charles Goldfarb","startTime":1155.29,"endTime":1157.3,"body":"Thank you. Alright, Chris, I'd"},{"speaker":"Charles Goldfarb","startTime":1157.3,"endTime":1160.21,"body":"love to hear your thoughts. And"},{"speaker":"Charles Goldfarb","startTime":1157.3,"endTime":1160.21,"body":"see if you would approach this"},{"speaker":"Charles Goldfarb","startTime":1160.21,"endTime":1160.78,"body":"any differently."},{"speaker":"Chris Dy","startTime":1161.29,"endTime":1163.48,"body":"Well, I'm gonna bring"},{"speaker":"Chris Dy","startTime":1161.29,"endTime":1163.48,"body":"some sanity to this discussion"},{"speaker":"Chris Dy","startTime":1163.51,"endTime":1169.42,"body":"as somebody who's not. I'm happy"},{"speaker":"Chris Dy","startTime":1163.51,"endTime":1169.42,"body":"that this is a liquid stage two,"},{"speaker":"Chris Dy","startTime":1169.54,"endTime":1172.63,"body":"which means our unit is still in"},{"speaker":"Chris Dy","startTime":1169.54,"endTime":1172.63,"body":"reasonable shape. I'm going to"},{"speaker":"Chris Dy","startTime":1172.63,"endTime":1175.39,"body":"stay out of this gentleman's"},{"speaker":"Chris Dy","startTime":1172.63,"endTime":1175.39,"body":"wrist and leave that for when I"},{"speaker":"Chris Dy","startTime":1175.39,"endTime":1177.31,"body":"have to inevitably come back"},{"speaker":"Chris Dy","startTime":1175.39,"endTime":1177.31,"body":"because we will all be coming"},{"speaker":"Chris Dy","startTime":1177.31,"endTime":1179.98,"body":"back for this patient for future"},{"speaker":"Chris Dy","startTime":1177.31,"endTime":1179.98,"body":"surgery. So I'm going to leave"},{"speaker":"Chris Dy","startTime":1179.98,"endTime":1180.58,"body":"the risk of I've"},{"speaker":"David McCombe","startTime":1182.14,"endTime":1183.82,"body":"The vascularized"},{"speaker":"David McCombe","startTime":1182.14,"endTime":1183.82,"body":"bone graft cures the problem,"},{"speaker":"David McCombe","startTime":1183.97,"endTime":1184.24,"body":"right"},{"speaker":"Chris Dy","startTime":1184.51,"endTime":1186.94,"body":"now because according"},{"speaker":"Chris Dy","startTime":1184.51,"endTime":1186.94,"body":"to the evidence or lack thereof,"},{"speaker":"Chris Dy","startTime":1186.97,"endTime":1189.16,"body":"a joint leveling procedure into"},{"speaker":"Chris Dy","startTime":1186.97,"endTime":1189.16,"body":"denervation will do very well"},{"speaker":"Chris Dy","startTime":1189.16,"endTime":1190.9,"body":"for this patient. So that's all"},{"speaker":"Chris Dy","startTime":1189.16,"endTime":1190.9,"body":"I'm going to offer this"},{"speaker":"Chris Dy","startTime":1190.9,"endTime":1193.72,"body":"question. Do a leveling"},{"speaker":"Chris Dy","startTime":1190.9,"endTime":1193.72,"body":"procedure from the volar side,"},{"speaker":"Chris Dy","startTime":1193.72,"endTime":1195.97,"body":"do the deviation from the volar"},{"speaker":"Chris Dy","startTime":1193.72,"endTime":1195.97,"body":"approach that we already have"},{"speaker":"Chris Dy","startTime":1196.0,"endTime":1198.76,"body":"leave the dorsum of the risk"},{"speaker":"Chris Dy","startTime":1196.0,"endTime":1198.76,"body":"completely intact? So I'm going"},{"speaker":"Chris Dy","startTime":1198.76,"endTime":1201.79,"body":"to close it there Just so that"},{"speaker":"Chris Dy","startTime":1198.76,"endTime":1201.79,"body":"you can't disagree with me and"},{"speaker":"Chris Dy","startTime":1201.79,"endTime":1205.18,"body":"then we can talk about our next"},{"speaker":"Chris Dy","startTime":1201.79,"endTime":1205.18,"body":"topic. David, you authored a"},{"speaker":"Chris Dy","startTime":1205.21,"endTime":1208.09,"body":"really great review article for"},{"speaker":"Chris Dy","startTime":1205.21,"endTime":1208.09,"body":"treatment of early stage thumb,"},{"speaker":"Chris Dy","startTime":1208.09,"endTime":1211.84,"body":"CMC arthrosis. And I, again"},{"speaker":"Chris Dy","startTime":1208.09,"endTime":1211.84,"body":"enjoyed this thoroughly because"},{"speaker":"Chris Dy","startTime":1211.84,"endTime":1215.11,"body":"it really walked us through all"},{"speaker":"Chris Dy","startTime":1211.84,"endTime":1215.11,"body":"the issues, you know, for for"},{"speaker":"Chris Dy","startTime":1215.11,"endTime":1219.46,"body":"you, when, when is early stage"},{"speaker":"Chris Dy","startTime":1215.11,"endTime":1219.46,"body":"truly early stage? Is it purely"},{"speaker":"Chris Dy","startTime":1219.46,"endTime":1221.5,"body":"radiographic? Because we know"},{"speaker":"Chris Dy","startTime":1219.46,"endTime":1221.5,"body":"that sometimes the radiographic"},{"speaker":"Chris Dy","startTime":1221.5,"endTime":1223.33,"body":"findings don't correlate with"},{"speaker":"Chris Dy","startTime":1221.5,"endTime":1223.33,"body":"you know, patients actual"},{"speaker":"Chris Dy","startTime":1223.33,"endTime":1223.87,"body":"symptoms?"},{"speaker":"David McCombe","startTime":1224.89,"endTime":1227.92,"body":"Well, I think the"},{"speaker":"David McCombe","startTime":1224.89,"endTime":1227.92,"body":"focus of this was really the"},{"speaker":"David McCombe","startTime":1228.13,"endTime":1233.77,"body":"that troubling group where you"},{"speaker":"David McCombe","startTime":1228.13,"endTime":1233.77,"body":"you don't want to proceed down"},{"speaker":"David McCombe","startTime":1233.77,"endTime":1237.55,"body":"the road of trapezium, traverse"},{"speaker":"David McCombe","startTime":1233.77,"endTime":1237.55,"body":"ectomy or with whatever"},{"speaker":"David McCombe","startTime":1237.55,"endTime":1240.52,"body":"variation of stabilization we're"},{"speaker":"David McCombe","startTime":1237.55,"endTime":1240.52,"body":"doing, because this is the 40"},{"speaker":"David McCombe","startTime":1240.52,"endTime":1244.24,"body":"year old patient and the"},{"speaker":"David McCombe","startTime":1240.52,"endTime":1244.24,"body":"prospect of a suspension plasti"},{"speaker":"David McCombe","startTime":1244.24,"endTime":1248.11,"body":"or sorry to drop his ectomy"},{"speaker":"David McCombe","startTime":1244.24,"endTime":1248.11,"body":"lasting, another 40 years is"},{"speaker":"David McCombe","startTime":1248.11,"endTime":1253.09,"body":"daunting. So this this work was"},{"speaker":"David McCombe","startTime":1248.11,"endTime":1253.09,"body":"done by a lot of this was done"},{"speaker":"David McCombe","startTime":1253.09,"endTime":1256.48,"body":"by my colleague, Steve Tam,"},{"speaker":"David McCombe","startTime":1253.09,"endTime":1256.48,"body":"who's worked with me and he has"},{"speaker":"David McCombe","startTime":1256.48,"endTime":1262.51,"body":"done a lot on basal thumb."},{"speaker":"David McCombe","startTime":1256.48,"endTime":1262.51,"body":"Kinematics and, and this problem"},{"speaker":"David McCombe","startTime":1262.51,"endTime":1266.83,"body":"with the early patient with the"},{"speaker":"David McCombe","startTime":1262.51,"endTime":1266.83,"body":"idea of that subluxation if you"},{"speaker":"David McCombe","startTime":1266.83,"endTime":1271.99,"body":"truly can identify it. And I"},{"speaker":"David McCombe","startTime":1266.83,"endTime":1271.99,"body":"think in the article this is"},{"speaker":"David McCombe","startTime":1272.86,"endTime":1276.91,"body":"described the role of CT scan in"},{"speaker":"David McCombe","startTime":1272.86,"endTime":1276.91,"body":"accurately defining what is and"},{"speaker":"David McCombe","startTime":1276.91,"endTime":1279.97,"body":"is not subluxed, then there's a"},{"speaker":"David McCombe","startTime":1276.91,"endTime":1279.97,"body":"role for stabilizing it is"},{"speaker":"David McCombe","startTime":1279.97,"endTime":1282.55,"body":"provided the majority of the"},{"speaker":"David McCombe","startTime":1279.97,"endTime":1282.55,"body":"articular cartilage is intact."},{"speaker":"David McCombe","startTime":1282.97,"endTime":1286.36,"body":"So, again, a little bit like we"},{"speaker":"David McCombe","startTime":1282.97,"endTime":1286.36,"body":"were talking about before with"},{"speaker":"David McCombe","startTime":1286.36,"endTime":1288.79,"body":"the keybox. In the role of"},{"speaker":"David McCombe","startTime":1286.36,"endTime":1288.79,"body":"arthroscopy, there's again,"},{"speaker":"David McCombe","startTime":1288.79,"endTime":1291.28,"body":"there's a role for actually"},{"speaker":"David McCombe","startTime":1288.79,"endTime":1291.28,"body":"visualizing that cartilage and"},{"speaker":"David McCombe","startTime":1291.28,"endTime":1296.71,"body":"you can be pretty things that"},{"speaker":"David McCombe","startTime":1291.28,"endTime":1296.71,"body":"look okay, on X ray can be"},{"speaker":"David McCombe","startTime":1297.49,"endTime":1300.31,"body":"somewhat disappointing when you"},{"speaker":"David McCombe","startTime":1297.49,"endTime":1300.31,"body":"actually visualize the articular"},{"speaker":"David McCombe","startTime":1300.31,"endTime":1303.64,"body":"cartilage itself, you see, can"},{"speaker":"David McCombe","startTime":1300.31,"endTime":1303.64,"body":"see be bare areas on the on the"},{"speaker":"David McCombe","startTime":1303.64,"endTime":1307.66,"body":"base and metacarpal and"},{"speaker":"David McCombe","startTime":1303.64,"endTime":1307.66,"body":"trapezium. So they do sort of"},{"speaker":"David McCombe","startTime":1307.69,"endTime":1310.06,"body":"that's a very long winded way of"},{"speaker":"David McCombe","startTime":1307.69,"endTime":1310.06,"body":"not really answering your"},{"speaker":"David McCombe","startTime":1310.06,"endTime":1314.29,"body":"question, Chris. But patients"},{"speaker":"David McCombe","startTime":1310.06,"endTime":1314.29,"body":"with persistent pain, don't"},{"speaker":"David McCombe","startTime":1314.29,"endTime":1318.22,"body":"settle down with simple"},{"speaker":"David McCombe","startTime":1314.29,"endTime":1318.22,"body":"splinting. And those those"},{"speaker":"David McCombe","startTime":1318.25,"endTime":1323.86,"body":"treatments, we all use cortisone"},{"speaker":"David McCombe","startTime":1318.25,"endTime":1323.86,"body":"injection maybe. And then it's"},{"speaker":"David McCombe","startTime":1323.92,"endTime":1326.08,"body":"an ongoing disability for them,"},{"speaker":"David McCombe","startTime":1323.92,"endTime":1326.08,"body":"they've got pain at rest,"},{"speaker":"David McCombe","startTime":1326.08,"endTime":1329.08,"body":"payment, mental activity, then"},{"speaker":"David McCombe","startTime":1326.08,"endTime":1329.08,"body":"they that sort of triggers the"},{"speaker":"David McCombe","startTime":1329.5,"endTime":1335.65,"body":"investigation with the CT and"},{"speaker":"David McCombe","startTime":1329.5,"endTime":1335.65,"body":"then scope plus minus ligament"},{"speaker":"David McCombe","startTime":1335.65,"endTime":1338.68,"body":"reconstruction if you if you're"},{"speaker":"David McCombe","startTime":1335.65,"endTime":1338.68,"body":"confident that you actually have"},{"speaker":"David McCombe","startTime":1338.68,"endTime":1341.83,"body":"true and true subluxation it"},{"speaker":"David McCombe","startTime":1338.68,"endTime":1341.83,"body":"sounds like such a little bit of"},{"speaker":"David McCombe","startTime":1341.83,"endTime":1344.29,"body":"a difficult thing clinically,"},{"speaker":"David McCombe","startTime":1341.83,"endTime":1344.29,"body":"it's a hard thing to see if I"},{"speaker":"David McCombe","startTime":1344.29,"endTime":1347.62,"body":"think you know, a lot of people"},{"speaker":"David McCombe","startTime":1344.29,"endTime":1347.62,"body":"who are a little hyper mobile"},{"speaker":"David McCombe","startTime":1347.62,"endTime":1352.93,"body":"can comes around and have pretty"},{"speaker":"David McCombe","startTime":1347.62,"endTime":1352.93,"body":"significant range. So trying to"},{"speaker":"David McCombe","startTime":1352.93,"endTime":1355.57,"body":"be accurate about what you"},{"speaker":"David McCombe","startTime":1352.93,"endTime":1355.57,"body":"define as subblocks I think it's"},{"speaker":"David McCombe","startTime":1355.57,"endTime":1356.41,"body":"important is"},{"speaker":"Chris Dy","startTime":1357.19,"endTime":1359.65,"body":"I have not used I love"},{"speaker":"Chris Dy","startTime":1357.19,"endTime":1359.65,"body":"those comments and I obviously"},{"speaker":"Chris Dy","startTime":1359.65,"endTime":1362.89,"body":"thought about this quite a bit."},{"speaker":"Chris Dy","startTime":1359.65,"endTime":1362.89,"body":"I have not used a CT scan in my"},{"speaker":"Chris Dy","startTime":1362.89,"endTime":1366.64,"body":"early stage patients, perhaps"},{"speaker":"Chris Dy","startTime":1362.89,"endTime":1366.64,"body":"because I have not thought about"},{"speaker":"Chris Dy","startTime":1366.64,"endTime":1368.77,"body":"going to more of a soft tissue"},{"speaker":"Chris Dy","startTime":1366.64,"endTime":1368.77,"body":"based or you know,"},{"speaker":"Chris Dy","startTime":1369.1,"endTime":1371.38,"body":"reconstructive type surgery in"},{"speaker":"Chris Dy","startTime":1369.1,"endTime":1371.38,"body":"that particular population."},{"speaker":"Chris Dy","startTime":1372.07,"endTime":1375.25,"body":"Mireia are you using a CT scans"},{"speaker":"Chris Dy","startTime":1372.07,"endTime":1375.25,"body":"to evaluate your thumb CMC"},{"speaker":"Chris Dy","startTime":1375.25,"endTime":1375.91,"body":"patients at all?"},{"speaker":"Mireia Esplugas","startTime":1377.92,"endTime":1382.78,"body":"I usually use"},{"speaker":"Mireia Esplugas","startTime":1377.92,"endTime":1382.78,"body":"ultrasound we why because I have"},{"speaker":"Mireia Esplugas","startTime":1382.78,"endTime":1387.04,"body":"an ultrasound equipment in my"},{"speaker":"Mireia Esplugas","startTime":1382.78,"endTime":1387.04,"body":"consultation. And because it"},{"speaker":"Mireia Esplugas","startTime":1387.07,"endTime":1394.0,"body":"helps me to check if there is"},{"speaker":"Mireia Esplugas","startTime":1387.07,"endTime":1394.0,"body":"any joint effusion you can also"},{"speaker":"Mireia Esplugas","startTime":1394.0,"endTime":1401.02,"body":"see the loose bodies. And I come"},{"speaker":"Mireia Esplugas","startTime":1394.0,"endTime":1401.02,"body":"back to two, two dynamic"},{"speaker":"Mireia Esplugas","startTime":1401.02,"endTime":1407.56,"body":"pathology has to keep up before"},{"speaker":"Mireia Esplugas","startTime":1401.02,"endTime":1407.56,"body":"I think that early CMC disease"},{"speaker":"Mireia Esplugas","startTime":1407.71,"endTime":1413.38,"body":"is a Synovial disease is a sign"},{"speaker":"Mireia Esplugas","startTime":1407.71,"endTime":1413.38,"body":"of disease, which can be which"},{"speaker":"Mireia Esplugas","startTime":1413.38,"endTime":1417.31,"body":"can have mechanical or"},{"speaker":"Mireia Esplugas","startTime":1413.38,"endTime":1417.31,"body":"biomechanical basis during grip."},{"speaker":"Mireia Esplugas","startTime":1417.43,"endTime":1422.23,"body":"So, with my ultrasound, I put my"},{"speaker":"Mireia Esplugas","startTime":1417.43,"endTime":1422.23,"body":"proper underwater aspect of the"},{"speaker":"Mireia Esplugas","startTime":1422.23,"endTime":1428.2,"body":"joint and I asked the patient to"},{"speaker":"Mireia Esplugas","startTime":1422.23,"endTime":1428.2,"body":"pinch and to grip and and I can"},{"speaker":"Mireia Esplugas","startTime":1428.2,"endTime":1432.58,"body":"compare with the other time and"},{"speaker":"Mireia Esplugas","startTime":1428.2,"endTime":1432.58,"body":"I see if it's too hypermobile or"},{"speaker":"Mireia Esplugas","startTime":1432.58,"endTime":1437.83,"body":"if he compresses too much, oh he"},{"speaker":"Mireia Esplugas","startTime":1432.58,"endTime":1437.83,"body":"or or if there is an any"},{"speaker":"Mireia Esplugas","startTime":1437.83,"endTime":1441.49,"body":"effusion there or if the"},{"speaker":"Mireia Esplugas","startTime":1437.83,"endTime":1441.49,"body":"metacarpal bone dorsally"},{"speaker":"Mireia Esplugas","startTime":1442.33,"endTime":1446.86,"body":"subluxated during the pinch,"},{"speaker":"Mireia Esplugas","startTime":1442.33,"endTime":1446.86,"body":"and, and this for me this is a"},{"speaker":"Mireia Esplugas","startTime":1446.86,"endTime":1450.49,"body":"definition of the early stage of"},{"speaker":"Mireia Esplugas","startTime":1446.86,"endTime":1450.49,"body":"a CMC pathology."},{"speaker":"Charles Goldfarb","startTime":1451.75,"endTime":1455.08,"body":"I know that"},{"speaker":"Charles Goldfarb","startTime":1451.75,"endTime":1455.08,"body":"Chris loves that he has recently"},{"speaker":"Charles Goldfarb","startTime":1455.08,"endTime":1460.03,"body":"become an ultrasound fan I am"},{"speaker":"Charles Goldfarb","startTime":1455.08,"endTime":1460.03,"body":"not very I assume that you share"},{"speaker":"Charles Goldfarb","startTime":1460.03,"endTime":1462.94,"body":"David's thoughts on the benefits"},{"speaker":"Charles Goldfarb","startTime":1460.03,"endTime":1462.94,"body":"of arthroscopy as well."},{"speaker":"Mireia Esplugas","startTime":1463.54,"endTime":1466.45,"body":"Yes, I think"},{"speaker":"Mireia Esplugas","startTime":1463.54,"endTime":1466.45,"body":"that arthroscopy allows you to"},{"speaker":"Mireia Esplugas","startTime":1466.45,"endTime":1469.87,"body":"remove the loose body that you"},{"speaker":"Mireia Esplugas","startTime":1466.45,"endTime":1469.87,"body":"very very often lead found in"},{"speaker":"Mireia Esplugas","startTime":1469.87,"endTime":1474.82,"body":"every aspect of the joint and"},{"speaker":"Mireia Esplugas","startTime":1469.87,"endTime":1474.82,"body":"you can check you can do a sign"},{"speaker":"Mireia Esplugas","startTime":1474.82,"endTime":1477.88,"body":"of a mechanical sign of Atomy"},{"speaker":"Mireia Esplugas","startTime":1474.82,"endTime":1477.88,"body":"which could be compared with the"},{"speaker":"Mireia Esplugas","startTime":1479.14,"endTime":1482.92,"body":"good corticoids injection that"},{"speaker":"Mireia Esplugas","startTime":1479.14,"endTime":1482.92,"body":"you can do under on your"},{"speaker":"Mireia Esplugas","startTime":1482.92,"endTime":1486.52,"body":"ultrasound. And you also see the"},{"speaker":"Mireia Esplugas","startTime":1482.92,"endTime":1486.52,"body":"joint and the surface and the"},{"speaker":"Mireia Esplugas","startTime":1486.97,"endTime":1491.83,"body":"the osteophyte the joint surface"},{"speaker":"Mireia Esplugas","startTime":1486.97,"endTime":1491.83,"body":"and you can act there. I do not"},{"speaker":"Mireia Esplugas","startTime":1491.83,"endTime":1496.93,"body":"recommend the electrocoagulation"},{"speaker":"Mireia Esplugas","startTime":1491.83,"endTime":1496.93,"body":"of the ligaments to tighten them"},{"speaker":"Mireia Esplugas","startTime":1496.93,"endTime":1500.56,"body":"because because I I really think"},{"speaker":"Mireia Esplugas","startTime":1496.93,"endTime":1500.56,"body":"that they can reset There's no"},{"speaker":"Mireia Esplugas","startTime":1500.56,"endTime":1505.99,"body":"proprioception helps in that to"},{"speaker":"Mireia Esplugas","startTime":1500.56,"endTime":1505.99,"body":"stabilize the joint. So, electro"},{"speaker":"Mireia Esplugas","startTime":1506.02,"endTime":1508.57,"body":"electro burning of the Meccano"},{"speaker":"Mireia Esplugas","startTime":1506.02,"endTime":1508.57,"body":"receptors. I don't think that"},{"speaker":"Mireia Esplugas","startTime":1508.57,"endTime":1513.1,"body":"it's a good point to that. But"},{"speaker":"Mireia Esplugas","startTime":1508.57,"endTime":1513.1,"body":"the SAIC I scoped them. And I"},{"speaker":"Mireia Esplugas","startTime":1513.1,"endTime":1514.84,"body":"think it's benefited from the"},{"speaker":"Mireia Esplugas","startTime":1513.1,"endTime":1514.84,"body":"patient."},{"speaker":"David McCombe","startTime":1516.01,"endTime":1518.83,"body":"Can I ask Mariah"},{"speaker":"David McCombe","startTime":1516.01,"endTime":1518.83,"body":"and Chris, how long do you think"},{"speaker":"David McCombe","startTime":1518.83,"endTime":1523.06,"body":"the learning curve for an"},{"speaker":"David McCombe","startTime":1518.83,"endTime":1523.06,"body":"ultrasound to become so"},{"speaker":"David McCombe","startTime":1523.09,"endTime":1525.49,"body":"comfortable that what you're"},{"speaker":"David McCombe","startTime":1523.09,"endTime":1525.49,"body":"seeing is actually pathological"},{"speaker":"David McCombe","startTime":1525.49,"endTime":1528.07,"body":"and not just part of the normal"},{"speaker":"David McCombe","startTime":1525.49,"endTime":1528.07,"body":"variant?"},{"speaker":"Mireia Esplugas","startTime":1528.07,"endTime":1529.9,"body":"I think that"},{"speaker":"Mireia Esplugas","startTime":1528.07,"endTime":1529.9,"body":"you can always compare with the"},{"speaker":"Mireia Esplugas","startTime":1529.9,"endTime":1533.92,"body":"other hand. So it's not yes,"},{"speaker":"Mireia Esplugas","startTime":1529.9,"endTime":1533.92,"body":"it's difficult to learn, but"},{"speaker":"Mireia Esplugas","startTime":1533.92,"endTime":1537.04,"body":"it's not so much difficult. And"},{"speaker":"Mireia Esplugas","startTime":1533.92,"endTime":1537.04,"body":"if you have any depth, you go to"},{"speaker":"Mireia Esplugas","startTime":1537.04,"endTime":1543.88,"body":"the other CMC data and compare,"},{"speaker":"Mireia Esplugas","startTime":1537.04,"endTime":1543.88,"body":"and you can think, realize it do"},{"speaker":"Mireia Esplugas","startTime":1543.88,"endTime":1546.67,"body":"this pathologic or it's normal"},{"speaker":"Mireia Esplugas","startTime":1543.88,"endTime":1546.67,"body":"for the patient."},{"speaker":"Charles Goldfarb","startTime":1549.31,"endTime":1551.53,"body":"Chris, have"},{"speaker":"Charles Goldfarb","startTime":1549.31,"endTime":1551.53,"body":"you used I know, you, you know,"},{"speaker":"Charles Goldfarb","startTime":1551.53,"endTime":1553.93,"body":"everything is nerve nerve nerve"},{"speaker":"Charles Goldfarb","startTime":1551.53,"endTime":1553.93,"body":"and use your ultrasound to"},{"speaker":"Charles Goldfarb","startTime":1553.93,"endTime":1556.42,"body":"assess the nerve? Have you used"},{"speaker":"Charles Goldfarb","startTime":1553.93,"endTime":1556.42,"body":"ultrasound to assess joints?"},{"speaker":"Chris Dy","startTime":1556.69,"endTime":1559.57,"body":"I haven't. I think"},{"speaker":"Chris Dy","startTime":1556.69,"endTime":1559.57,"body":"also I want to make sure I'm the"},{"speaker":"Chris Dy","startTime":1559.57,"endTime":1562.12,"body":"right size Pro for that. But now"},{"speaker":"Chris Dy","startTime":1559.57,"endTime":1562.12,"body":"I'm intrigued, and maybe I will."},{"speaker":"Chris Dy","startTime":1562.96,"endTime":1565.42,"body":"I will say that the limits for"},{"speaker":"Chris Dy","startTime":1562.96,"endTime":1565.42,"body":"me right now are honestly just"},{"speaker":"Chris Dy","startTime":1565.42,"endTime":1569.35,"body":"time in not having that built"},{"speaker":"Chris Dy","startTime":1565.42,"endTime":1569.35,"body":"into my workflow yet. But I'm"},{"speaker":"Chris Dy","startTime":1569.35,"endTime":1573.25,"body":"intrigued and maybe may start to"},{"speaker":"Chris Dy","startTime":1569.35,"endTime":1573.25,"body":"explore this. There was I think,"},{"speaker":"Chris Dy","startTime":1573.25,"endTime":1575.86,"body":"Chuck, you had one question. I"},{"speaker":"Chris Dy","startTime":1573.25,"endTime":1575.86,"body":"will I wanted to piggyback off"},{"speaker":"Chris Dy","startTime":1575.86,"endTime":1579.52,"body":"of Mireia's comment about the"},{"speaker":"Chris Dy","startTime":1575.86,"endTime":1579.52,"body":"thermal capsular fee, and the"},{"speaker":"Chris Dy","startTime":1579.52,"endTime":1582.37,"body":"importance of proprioception. I"},{"speaker":"Chris Dy","startTime":1579.52,"endTime":1582.37,"body":"know that Elizabeth Hoggart has"},{"speaker":"Chris Dy","startTime":1582.37,"endTime":1585.94,"body":"published a bit on the thumb CMC"},{"speaker":"Chris Dy","startTime":1582.37,"endTime":1585.94,"body":"innovation, but there are some"},{"speaker":"Chris Dy","startTime":1585.94,"endTime":1589.21,"body":"proponents for innovation. So I"},{"speaker":"Chris Dy","startTime":1585.94,"endTime":1589.21,"body":"guess I wanted to quick thoughts"},{"speaker":"Chris Dy","startTime":1589.21,"endTime":1591.43,"body":"on that. And then I know Chuck"},{"speaker":"Chris Dy","startTime":1589.21,"endTime":1591.43,"body":"wanted to close with one more"},{"speaker":"Chris Dy","startTime":1591.43,"endTime":1593.08,"body":"question. So today and David,"},{"speaker":"Chris Dy","startTime":1591.43,"endTime":1593.08,"body":"what are your thoughts on"},{"speaker":"Chris Dy","startTime":1593.11,"endTime":1594.31,"body":"dennervation? For thumb, CMC?"},{"speaker":"Mireia Esplugas","startTime":1595.16,"endTime":1597.77,"body":"So I'm doing a"},{"speaker":"Mireia Esplugas","startTime":1595.16,"endTime":1597.77,"body":"revision in advanced CMC joint"},{"speaker":"Mireia Esplugas","startTime":1597.77,"endTime":1602.69,"body":"pathology, I believe that it's a"},{"speaker":"Mireia Esplugas","startTime":1597.77,"endTime":1602.69,"body":"good point to to restore good"},{"speaker":"Mireia Esplugas","startTime":1602.69,"endTime":1609.53,"body":"life for the patient. Because in"},{"speaker":"Mireia Esplugas","startTime":1602.69,"endTime":1609.53,"body":"the in the lab, biomechanical"},{"speaker":"Mireia Esplugas","startTime":1609.53,"endTime":1613.49,"body":"receptors, studies that you"},{"speaker":"Mireia Esplugas","startTime":1609.53,"endTime":1613.49,"body":"refer, we participated in that."},{"speaker":"Mireia Esplugas","startTime":1613.67,"endTime":1618.29,"body":"And we found that with age, the"},{"speaker":"Mireia Esplugas","startTime":1613.67,"endTime":1618.29,"body":"mechanoreceptors, density gets"},{"speaker":"Mireia Esplugas","startTime":1618.29,"endTime":1622.31,"body":"down. So you are not damaging"},{"speaker":"Mireia Esplugas","startTime":1618.29,"endTime":1622.31,"body":"proprioception, if you generate"},{"speaker":"Mireia Esplugas","startTime":1622.31,"endTime":1624.05,"body":"when the patient is not young."},{"speaker":"David McCombe","startTime":1627.08,"endTime":1629.09,"body":"Right, can I ask"},{"speaker":"David McCombe","startTime":1627.08,"endTime":1629.09,"body":"you a question? I'm supposed to"},{"speaker":"David McCombe","startTime":1629.09,"endTime":1634.16,"body":"be answering questions, but I'm"},{"speaker":"David McCombe","startTime":1629.09,"endTime":1634.16,"body":"fascinated that definitely the"},{"speaker":"David McCombe","startTime":1634.19,"endTime":1638.54,"body":"say the 30 year old woman who is"},{"speaker":"David McCombe","startTime":1634.19,"endTime":1638.54,"body":"who's hyper mobile? Do you"},{"speaker":"David McCombe","startTime":1638.54,"endTime":1643.61,"body":"believe you can, by virtue of"},{"speaker":"David McCombe","startTime":1638.54,"endTime":1643.61,"body":"strengthening the thumb with the"},{"speaker":"David McCombe","startTime":1643.61,"endTime":1650.24,"body":"proprioceptive arc intact and"},{"speaker":"David McCombe","startTime":1643.61,"endTime":1650.24,"body":"can use can we stabilize? Can we"},{"speaker":"David McCombe","startTime":1650.24,"endTime":1654.05,"body":"produce a stable thumb CMC"},{"speaker":"David McCombe","startTime":1650.24,"endTime":1654.05,"body":"underload? Or is that"},{"speaker":"David McCombe","startTime":1654.32,"endTime":1658.04,"body":"unrealistic? And do we need to"},{"speaker":"David McCombe","startTime":1654.32,"endTime":1658.04,"body":"be doing reconstructive surgery"},{"speaker":"David McCombe","startTime":1658.04,"endTime":1659.12,"body":"or what what do you think about"},{"speaker":"David McCombe","startTime":1658.04,"endTime":1659.12,"body":"that?"},{"speaker":"Mireia Esplugas","startTime":1659.81,"endTime":1662.54,"body":"So we"},{"speaker":"Mireia Esplugas","startTime":1659.81,"endTime":1662.54,"body":"collaborated with Natalie Merida"},{"speaker":"Mireia Esplugas","startTime":1662.54,"endTime":1667.49,"body":"in the in the article, which"},{"speaker":"Mireia Esplugas","startTime":1662.54,"endTime":1667.49,"body":"provoked pro promotes first loss"},{"speaker":"Mireia Esplugas","startTime":1667.49,"endTime":1669.83,"body":"of interest is strengthening an"},{"speaker":"Mireia Esplugas","startTime":1667.49,"endTime":1669.83,"body":"opponent struggling to stabilize"},{"speaker":"Mireia Esplugas","startTime":1669.83,"endTime":1673.43,"body":"the joint work in the left hand,"},{"speaker":"Mireia Esplugas","startTime":1669.83,"endTime":1673.43,"body":"we really saw that they are the"},{"speaker":"Mireia Esplugas","startTime":1673.43,"endTime":1676.88,"body":"main stabilizers because they're"},{"speaker":"Mireia Esplugas","startTime":1673.43,"endTime":1676.88,"body":"so interested and opponents and"},{"speaker":"Mireia Esplugas","startTime":1676.88,"endTime":1681.59,"body":"in Spain, we do not have hand"},{"speaker":"Mireia Esplugas","startTime":1676.88,"endTime":1681.59,"body":"therapists. We we do not have,"},{"speaker":"Mireia Esplugas","startTime":1681.89,"endTime":1686.81,"body":"we have few friends service. So"},{"speaker":"Mireia Esplugas","startTime":1681.89,"endTime":1686.81,"body":"we, our patients do not have a"},{"speaker":"Mireia Esplugas","startTime":1686.81,"endTime":1691.46,"body":"hand therapist, the team to go,"},{"speaker":"Mireia Esplugas","startTime":1686.81,"endTime":1691.46,"body":"and we learn them how to stand"},{"speaker":"Mireia Esplugas","startTime":1691.46,"endTime":1693.47,"body":"and their first or second"},{"speaker":"Mireia Esplugas","startTime":1691.46,"endTime":1693.47,"body":"interests and their opinions,"},{"speaker":"Mireia Esplugas","startTime":1693.47,"endTime":1697.79,"body":"and we follow the patients. And"},{"speaker":"Mireia Esplugas","startTime":1693.47,"endTime":1697.79,"body":"yes, we see that many. I don't"},{"speaker":"Mireia Esplugas","startTime":1697.79,"endTime":1702.56,"body":"know, I don't know, which is the"},{"speaker":"Mireia Esplugas","startTime":1697.79,"endTime":1702.56,"body":"best advantage. But I feel that"},{"speaker":"Mireia Esplugas","startTime":1702.59,"endTime":1707.0,"body":"patients who really do well,"},{"speaker":"Mireia Esplugas","startTime":1702.59,"endTime":1707.0,"body":"their exercise, many of them get"},{"speaker":"Mireia Esplugas","startTime":1707.03,"endTime":1710.45,"body":"improved. So yes, I would"},{"speaker":"Mireia Esplugas","startTime":1707.03,"endTime":1710.45,"body":"recommend to strengthen"},{"speaker":"Mireia Esplugas","startTime":1710.45,"endTime":1711.32,"body":"photosynthesis."},{"speaker":"Charles Goldfarb","startTime":1713.54,"endTime":1715.704,"body":"Perfect,"},{"speaker":"Charles Goldfarb","startTime":1713.54,"endTime":1715.704,"body":"perfect. Well, where are we?"},{"speaker":"Charles Goldfarb","startTime":1715.763,"endTime":1719.039,"body":"This has been an amazing"},{"speaker":"Charles Goldfarb","startTime":1715.763,"endTime":1719.039,"body":"conversation. I'd like to close"},{"speaker":"Charles Goldfarb","startTime":1719.097,"endTime":1722.725,"body":"with one question or one is a"},{"speaker":"Charles Goldfarb","startTime":1719.097,"endTime":1722.725,"body":"comment. But it is a question as"},{"speaker":"Charles Goldfarb","startTime":1722.783,"endTime":1725.767,"body":"well. So like you, I enjoy"},{"speaker":"Charles Goldfarb","startTime":1722.783,"endTime":1725.767,"body":"arthroscopy anywhere and"},{"speaker":"Charles Goldfarb","startTime":1725.826,"endTime":1729.043,"body":"everywhere. And I believe for"},{"speaker":"Charles Goldfarb","startTime":1725.826,"endTime":1729.043,"body":"early CMC, it can be very"},{"speaker":"Charles Goldfarb","startTime":1729.102,"endTime":1732.437,"body":"helpful. My question is, and"},{"speaker":"Charles Goldfarb","startTime":1729.102,"endTime":1732.437,"body":"this article included it, we"},{"speaker":"Charles Goldfarb","startTime":1732.495,"endTime":1735.947,"body":"always hear that closing wedge"},{"speaker":"Charles Goldfarb","startTime":1732.495,"endTime":1735.947,"body":"osteotomy of the base of the"},{"speaker":"Charles Goldfarb","startTime":1736.005,"endTime":1739.75,"body":"metacarpal can be helpful. And I"},{"speaker":"Charles Goldfarb","startTime":1736.005,"endTime":1739.75,"body":"always look for the opportunity"},{"speaker":"Charles Goldfarb","startTime":1739.808,"endTime":1743.611,"body":"to do that procedure. And I just"},{"speaker":"Charles Goldfarb","startTime":1739.808,"endTime":1743.611,"body":"never find the right patient. So"},{"speaker":"Charles Goldfarb","startTime":1743.669,"endTime":1747.414,"body":"what am I missing? And how often"},{"speaker":"Charles Goldfarb","startTime":1743.669,"endTime":1747.414,"body":"is that closing wedge osteotomy"},{"speaker":"Charles Goldfarb","startTime":1747.472,"endTime":1749.93,"body":"appropriate? Very well, you want"},{"speaker":"Charles Goldfarb","startTime":1747.472,"endTime":1749.93,"body":"to start?"},{"speaker":"Mireia Esplugas","startTime":1750.98,"endTime":1754.771,"body":"I think as you"},{"speaker":"Mireia Esplugas","startTime":1750.98,"endTime":1754.771,"body":"I haven't performed I only have"},{"speaker":"Mireia Esplugas","startTime":1754.853,"endTime":1759.963,"body":"one or two in my life and I have"},{"speaker":"Mireia Esplugas","startTime":1754.853,"endTime":1759.963,"body":"scoped many, many CMC joints,"},{"speaker":"Mireia Esplugas","startTime":1760.045,"endTime":1764.825,"body":"because I really do not know"},{"speaker":"Mireia Esplugas","startTime":1760.045,"endTime":1764.825,"body":"which person the job surfaces"},{"speaker":"Mireia Esplugas","startTime":1764.907,"endTime":1769.77,"body":"the good to indicate a semi"},{"speaker":"Mireia Esplugas","startTime":1764.907,"endTime":1769.77,"body":"permanent a couple of students."},{"speaker":"Mireia Esplugas","startTime":1769.852,"endTime":1772.49,"body":"So I think I am asking you shall"},{"speaker":"Charles Goldfarb","startTime":1772.49,"endTime":1773.48,"body":"David teach us?"},{"speaker":"David McCombe","startTime":1774.41,"endTime":1780.56,"body":"Well, I'd love to"},{"speaker":"David McCombe","startTime":1774.41,"endTime":1780.56,"body":"extract but I I, again, exactly"},{"speaker":"David McCombe","startTime":1780.56,"endTime":1782.72,"body":"the same. I haven't. I haven't"},{"speaker":"David McCombe","startTime":1780.56,"endTime":1782.72,"body":"got much experience with that"},{"speaker":"David McCombe","startTime":1782.72,"endTime":1786.59,"body":"operation. We put it in our"},{"speaker":"David McCombe","startTime":1782.72,"endTime":1786.59,"body":"algorithm of treatment for the"},{"speaker":"David McCombe","startTime":1786.8,"endTime":1790.7,"body":"patient with early arthritis"},{"speaker":"David McCombe","startTime":1786.8,"endTime":1790.7,"body":"without subluxation. But to be"},{"speaker":"David McCombe","startTime":1790.7,"endTime":1795.23,"body":"honest, the group that you see"},{"speaker":"David McCombe","startTime":1790.7,"endTime":1795.23,"body":"they're either too far gone, or"},{"speaker":"David McCombe","startTime":1795.23,"endTime":1797.96,"body":"there is this subset that we"},{"speaker":"David McCombe","startTime":1795.23,"endTime":1797.96,"body":"talked about in our article who"},{"speaker":"David McCombe","startTime":1797.99,"endTime":1801.5,"body":"got the subluxation that Billy"},{"speaker":"David McCombe","startTime":1797.99,"endTime":1801.5,"body":"arthritis symptomatic"},{"speaker":"David McCombe","startTime":1801.5,"endTime":1804.14,"body":"subluxation. And they, they do"},{"speaker":"David McCombe","startTime":1801.5,"endTime":1804.14,"body":"pretty well with the ligament"},{"speaker":"David McCombe","startTime":1804.14,"endTime":1808.28,"body":"reconstruction. And I think in"},{"speaker":"David McCombe","startTime":1804.14,"endTime":1808.28,"body":"part, that's because they get"},{"speaker":"David McCombe","startTime":1808.28,"endTime":1810.8,"body":"stiffer. We're reducing the"},{"speaker":"David McCombe","startTime":1808.28,"endTime":1810.8,"body":"range of motion. And maybe"},{"speaker":"David McCombe","startTime":1810.8,"endTime":1814.37,"body":"that's what, what helps with the"},{"speaker":"David McCombe","startTime":1810.8,"endTime":1814.37,"body":"pain we sort of making the very"},{"speaker":"David McCombe","startTime":1814.46,"endTime":1818.36,"body":"stable. But I haven't got much"},{"speaker":"David McCombe","startTime":1814.46,"endTime":1818.36,"body":"experience with extension"},{"speaker":"David McCombe","startTime":1818.36,"endTime":1822.23,"body":"osteotomy I guess, the tibia for"},{"speaker":"David McCombe","startTime":1818.36,"endTime":1822.23,"body":"the arm, a plastic surgeon and"},{"speaker":"David McCombe","startTime":1822.23,"endTime":1825.56,"body":"the concept of doing a causing"},{"speaker":"David McCombe","startTime":1822.23,"endTime":1825.56,"body":"wedge osteotomy in a tibia for a"},{"speaker":"David McCombe","startTime":1825.56,"endTime":1828.26,"body":"bit of arthritis seems pretty"},{"speaker":"David McCombe","startTime":1825.56,"endTime":1828.26,"body":"terrifying to me. But then I"},{"speaker":"David McCombe","startTime":1828.26,"endTime":1833.06,"body":"guess it's the same. Same idea,"},{"speaker":"David McCombe","startTime":1828.26,"endTime":1833.06,"body":"but I haven't seen that patient."},{"speaker":"David McCombe","startTime":1833.51,"endTime":1836.24,"body":"I see this group of patients"},{"speaker":"David McCombe","startTime":1833.51,"endTime":1836.24,"body":"with the instability, who've got"},{"speaker":"David McCombe","startTime":1836.24,"endTime":1840.98,"body":"pain and severely arthritis. And"},{"speaker":"David McCombe","startTime":1836.24,"endTime":1840.98,"body":"then the next group, the ones"},{"speaker":"David McCombe","startTime":1841.13,"endTime":1843.89,"body":"where it's eaten three and eight"},{"speaker":"David McCombe","startTime":1841.13,"endTime":1843.89,"body":"and four, and they're too far"},{"speaker":"David McCombe","startTime":1843.89,"endTime":1846.5,"body":"gone. And then it's just a"},{"speaker":"David McCombe","startTime":1843.89,"endTime":1846.5,"body":"matter of managing the symptom"},{"speaker":"David McCombe","startTime":1846.5,"endTime":1848.63,"body":"and then doing the operation"},{"speaker":"David McCombe","startTime":1846.5,"endTime":1848.63,"body":"when they're when they're ready."},{"speaker":"David McCombe","startTime":1848.63,"endTime":1852.98,"body":"So yeah, I'm with you. It's the"},{"speaker":"David McCombe","startTime":1848.63,"endTime":1852.98,"body":"unicorn."},{"speaker":"Chris Dy","startTime":1853.64,"endTime":1855.915,"body":"Yes, I've only seen"},{"speaker":"Chris Dy","startTime":1853.64,"endTime":1855.915,"body":"that patient on a test question."},{"speaker":"Chris Dy","startTime":1855.959,"endTime":1858.584,"body":"So in my clinic yet, David,"},{"speaker":"Chris Dy","startTime":1855.959,"endTime":1858.584,"body":"Mireia, thank you for joining us"},{"speaker":"Chris Dy","startTime":1858.628,"endTime":1861.297,"body":"for this great conversation."},{"speaker":"Chris Dy","startTime":1858.628,"endTime":1861.297,"body":"It's it's fascinating that we've"},{"speaker":"Chris Dy","startTime":1861.341,"endTime":1864.054,"body":"had the opportunity to interview"},{"speaker":"Chris Dy","startTime":1861.341,"endTime":1864.054,"body":"you for this you know, David,"},{"speaker":"Chris Dy","startTime":1864.098,"endTime":1866.679,"body":"you being in Australia and"},{"speaker":"Chris Dy","startTime":1864.098,"endTime":1866.679,"body":"Mireia being in Barcelona, thank"},{"speaker":"Chris Dy","startTime":1866.723,"endTime":1869.48,"body":"you to the British Society and"},{"speaker":"Chris Dy","startTime":1866.723,"endTime":1869.48,"body":"the European Journal for the for"},{"speaker":"Chris Dy","startTime":1869.524,"endTime":1872.061,"body":"collaborating with us on this"},{"speaker":"Chris Dy","startTime":1869.524,"endTime":1872.061,"body":"and you know, honestly, this"},{"speaker":"Chris Dy","startTime":1872.105,"endTime":1874.906,"body":"unsolved, unsolved problems and"},{"speaker":"Chris Dy","startTime":1872.105,"endTime":1874.906,"body":"hand surgery. Journal edition is"},{"speaker":"Chris Dy","startTime":1874.949,"endTime":1877.269,"body":"fantastic. So we encourage"},{"speaker":"Chris Dy","startTime":1874.949,"endTime":1877.269,"body":"anybody who's listening to"},{"speaker":"Chris Dy","startTime":1877.312,"endTime":1879.938,"body":"please check it out. So David,"},{"speaker":"Chris Dy","startTime":1877.312,"endTime":1879.938,"body":"Mireia, thank you and we look"},{"speaker":"Chris Dy","startTime":1879.982,"endTime":1882.17,"body":"forward to having you join us"},{"speaker":"Chris Dy","startTime":1879.982,"endTime":1882.17,"body":"again sometime soon."},{"speaker":"Unknown","startTime":1883.08,"endTime":1885.0,"body":"Thanks very much."},{"speaker":"Unknown","startTime":1883.08,"endTime":1885.0,"body":"Thanks, man. Thanks for asking"},{"speaker":"Unknown","startTime":1885.0,"endTime":1885.06,"body":"us."},{"speaker":"Charles Goldfarb","startTime":1886.92,"endTime":1888.51,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":1886.92,"endTime":1888.51,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":1888.51,"endTime":1888.93,"body":"real soon."},{"speaker":"Chris Dy","startTime":1889.11,"endTime":1891.15,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":1889.11,"endTime":1891.15,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":1891.24,"endTime":1893.07,"body":"@Handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":1891.24,"endTime":1893.07,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":1893.31,"endTime":1895.65,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":1893.31,"endTime":1895.65,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":1895.71,"endTime":1898.44,"body":"Mine is @ChrisDYMD"},{"speaker":"Chris Dy","startTime":1895.71,"endTime":1898.44,"body":"spelled d-y. And if you'd like"},{"speaker":"Chris Dy","startTime":1898.44,"endTime":1901.53,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":1898.44,"endTime":1901.53,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":1901.97,"endTime":1903.71,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":1901.97,"endTime":1903.71,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":1903.71,"endTime":1906.32,"body":"get your podcast and be sure to"},{"speaker":"Charles Goldfarb","startTime":1903.71,"endTime":1906.32,"body":"leave a review that helps us get"},{"speaker":"Charles Goldfarb","startTime":1906.32,"endTime":1908.84,"body":"the word out. Special thanks to"},{"speaker":"Charles Goldfarb","startTime":1906.32,"endTime":1908.84,"body":"Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":1908.84,"endTime":1912.05,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":1908.84,"endTime":1912.05,"body":"upper hand. Come back next time"}]}