{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":6.0,"endTime":7.53,"body":"and Chris talk Hand Surgery."},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":17.43,"endTime":18.0,"body":"podcasts."},{"speaker":"Chris Dy","startTime":18.93,"endTime":21.3,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":18.93,"endTime":21.3,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.58,"body":"leaving a rating wherever you"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.58,"body":"get your podcasts."},{"speaker":"Charles Goldfarb","startTime":24.15,"endTime":24.96,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":24.15,"endTime":24.96,"body":"Chris."},{"speaker":"Chris Dy","startTime":25.38,"endTime":26.4,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":25.38,"endTime":26.4,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":27.18,"endTime":30.48,"body":"I'm good. I"},{"speaker":"Charles Goldfarb","startTime":27.18,"endTime":30.48,"body":"feel like you and I we've seen"},{"speaker":"Charles Goldfarb","startTime":30.48,"endTime":34.14,"body":"each other a bit lately, but not"},{"speaker":"Charles Goldfarb","startTime":30.48,"endTime":34.14,"body":"in the confines of our own homes"},{"speaker":"Charles Goldfarb","startTime":34.14,"endTime":35.91,"body":"and during a podcast taping,"},{"speaker":"Chris Dy","startTime":36.36,"endTime":38.79,"body":"yeah, we've had a fair"},{"speaker":"Chris Dy","startTime":36.36,"endTime":38.79,"body":"bit of interaction. It's that"},{"speaker":"Chris Dy","startTime":38.79,"endTime":41.97,"body":"kind of year. I mean, that time"},{"speaker":"Chris Dy","startTime":38.79,"endTime":41.97,"body":"of the year where, you know,"},{"speaker":"Chris Dy","startTime":42.0,"endTime":47.13,"body":"graduation season, you know, all"},{"speaker":"Chris Dy","startTime":42.0,"endTime":47.13,"body":"the all the fun memories and the"},{"speaker":"Chris Dy","startTime":47.19,"endTime":49.86,"body":"the welcome wings and goodbyes"},{"speaker":"Chris Dy","startTime":47.19,"endTime":49.86,"body":"are in the air."},{"speaker":"Charles Goldfarb","startTime":50.4,"endTime":53.19,"body":"Absolutely. We"},{"speaker":"Charles Goldfarb","startTime":50.4,"endTime":53.19,"body":"had a wonderful graduation"},{"speaker":"Charles Goldfarb","startTime":53.19,"endTime":58.32,"body":"ceremony and graduation speaker,"},{"speaker":"Charles Goldfarb","startTime":53.19,"endTime":58.32,"body":"Val Lewis from MD Anderson came"},{"speaker":"Charles Goldfarb","startTime":58.32,"endTime":60.96,"body":"up to spend the really the"},{"speaker":"Charles Goldfarb","startTime":58.32,"endTime":60.96,"body":"weekend with us. And she was"},{"speaker":"Charles Goldfarb","startTime":60.96,"endTime":64.32,"body":"wonderful as a speaker and was"},{"speaker":"Charles Goldfarb","startTime":60.96,"endTime":64.32,"body":"there for our graduation"},{"speaker":"Charles Goldfarb","startTime":64.32,"endTime":68.13,"body":"ceremonies last night, at which"},{"speaker":"Charles Goldfarb","startTime":64.32,"endTime":68.13,"body":"time you were awarded quite a"},{"speaker":"Charles Goldfarb","startTime":68.13,"endTime":70.23,"body":"special award."},{"speaker":"Chris Dy","startTime":71.55,"endTime":75.03,"body":"It was a it was quite"},{"speaker":"Chris Dy","startTime":71.55,"endTime":75.03,"body":"surprising, to be honest with"},{"speaker":"Chris Dy","startTime":75.03,"endTime":78.69,"body":"you. I don't know a terrible"},{"speaker":"Chris Dy","startTime":75.03,"endTime":78.69,"body":"amount about the award, except I"},{"speaker":"Chris Dy","startTime":78.69,"endTime":81.69,"body":"know that there are some great"},{"speaker":"Chris Dy","startTime":78.69,"endTime":81.69,"body":"people that I admire"},{"speaker":"Chris Dy","startTime":81.69,"endTime":84.42,"body":"tremendously who have received"},{"speaker":"Chris Dy","startTime":81.69,"endTime":84.42,"body":"it in the past but it's the I"},{"speaker":"Chris Dy","startTime":84.42,"endTime":86.73,"body":"don't know if I'm gonna say this"},{"speaker":"Chris Dy","startTime":84.42,"endTime":86.73,"body":"properly. But the Palma"},{"speaker":"Chris Dy","startTime":86.73,"endTime":88.38,"body":"Chrironis."},{"speaker":"Charles Goldfarb","startTime":88.65,"endTime":91.5,"body":"I've always"},{"speaker":"Charles Goldfarb","startTime":88.65,"endTime":91.5,"body":"said Palma Chrironis. But"},{"speaker":"Charles Goldfarb","startTime":91.5,"endTime":96.18,"body":"basically it's yeah, it's"},{"speaker":"Charles Goldfarb","startTime":91.5,"endTime":96.18,"body":"basically Teacher of the Year in"},{"speaker":"Charles Goldfarb","startTime":96.18,"endTime":99.33,"body":"the sense of it. And that's,"},{"speaker":"Charles Goldfarb","startTime":96.18,"endTime":99.33,"body":"that's a simplistic way of"},{"speaker":"Charles Goldfarb","startTime":99.33,"endTime":103.14,"body":"saying it, but get faculty"},{"speaker":"Charles Goldfarb","startTime":99.33,"endTime":103.14,"body":"member with the greatest impact"},{"speaker":"Charles Goldfarb","startTime":103.14,"endTime":109.38,"body":"on the education of the chiefs."},{"speaker":"Charles Goldfarb","startTime":103.14,"endTime":109.38,"body":"And it is it's a really, it"},{"speaker":"Charles Goldfarb","startTime":109.38,"endTime":111.42,"body":"really is a great honor. So"},{"speaker":"Charles Goldfarb","startTime":109.38,"endTime":111.42,"body":"that's awesome."},{"speaker":"Chris Dy","startTime":111.9,"endTime":115.74,"body":"Things that I learned"},{"speaker":"Chris Dy","startTime":111.9,"endTime":115.74,"body":"in being awarded is apparently I"},{"speaker":"Chris Dy","startTime":115.74,"endTime":120.3,"body":"sigh quite a bit. And I also"},{"speaker":"Chris Dy","startTime":115.74,"endTime":120.3,"body":"make our trainees, especially"},{"speaker":"Chris Dy","startTime":120.3,"endTime":123.06,"body":"this class of chiefs apparently"},{"speaker":"Chris Dy","startTime":120.3,"endTime":123.06,"body":"draw the brachial plexus. So I"},{"speaker":"Chris Dy","startTime":123.06,"endTime":127.08,"body":"think that two of my mentors,"},{"speaker":"Chris Dy","startTime":123.06,"endTime":127.08,"body":"Marty Boyer and Scott wolf have"},{"speaker":"Chris Dy","startTime":127.08,"endTime":131.64,"body":"had a an outsize impact on how I"},{"speaker":"Chris Dy","startTime":127.08,"endTime":131.64,"body":"educate in terms of sighing and"},{"speaker":"Chris Dy","startTime":131.64,"endTime":133.05,"body":"dropping the brachial plexus."},{"speaker":"Charles Goldfarb","startTime":133.23,"endTime":135.63,"body":"Marty is the"},{"speaker":"Charles Goldfarb","startTime":133.23,"endTime":135.63,"body":"king of the sigh and Scott must"},{"speaker":"Charles Goldfarb","startTime":135.63,"endTime":138.3,"body":"be the king of the drawing of"},{"speaker":"Charles Goldfarb","startTime":135.63,"endTime":138.3,"body":"the brachial plexus. But that is"},{"speaker":"Charles Goldfarb","startTime":138.3,"endTime":143.16,"body":"very funny. And it absolutely"},{"speaker":"Charles Goldfarb","startTime":138.3,"endTime":143.16,"body":"was cited in your award"},{"speaker":"Charles Goldfarb","startTime":143.31,"endTime":148.5,"body":"recognition speech. You've been"},{"speaker":"Charles Goldfarb","startTime":143.31,"endTime":148.5,"body":"traveling. Where have you been"},{"speaker":"Charles Goldfarb","startTime":148.5,"endTime":149.07,"body":"lately?"},{"speaker":"Chris Dy","startTime":149.94,"endTime":152.04,"body":"Well, we you heard we"},{"speaker":"Chris Dy","startTime":149.94,"endTime":152.04,"body":"did the Live episode from"},{"speaker":"Chris Dy","startTime":152.04,"endTime":156.48,"body":"Singapore and, and then we I was"},{"speaker":"Chris Dy","startTime":152.04,"endTime":156.48,"body":"at the AOA, the American"},{"speaker":"Chris Dy","startTime":156.48,"endTime":159.54,"body":"orthopedic Association meeting"},{"speaker":"Chris Dy","startTime":156.48,"endTime":159.54,"body":"in Salt Lake City in which you"},{"speaker":"Chris Dy","startTime":159.54,"endTime":162.03,"body":"as the Program Chair put"},{"speaker":"Chris Dy","startTime":159.54,"endTime":162.03,"body":"together a fantastic program. So"},{"speaker":"Chris Dy","startTime":162.03,"endTime":165.51,"body":"I was just about to ask you to"},{"speaker":"Chris Dy","startTime":162.03,"endTime":165.51,"body":"tell us about that experience"},{"speaker":"Chris Dy","startTime":165.51,"endTime":169.56,"body":"and congratulate you, you know,"},{"speaker":"Chris Dy","startTime":165.51,"endTime":169.56,"body":"by all accounts, just like the"},{"speaker":"Chris Dy","startTime":169.56,"endTime":172.92,"body":"congenital meeting that you put"},{"speaker":"Chris Dy","startTime":169.56,"endTime":172.92,"body":"together with, with Anne Van"},{"speaker":"Chris Dy","startTime":172.92,"endTime":177.12,"body":"Heest and, and Michelle, this"},{"speaker":"Chris Dy","startTime":172.92,"endTime":177.12,"body":"was also a great success."},{"speaker":"Charles Goldfarb","startTime":177.6,"endTime":180.72,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":177.6,"endTime":180.72,"body":"great that it's over. I think it"},{"speaker":"Charles Goldfarb","startTime":180.72,"endTime":183.81,"body":"was I was pleased with the"},{"speaker":"Charles Goldfarb","startTime":180.72,"endTime":183.81,"body":"meeting. And we had some great"},{"speaker":"Charles Goldfarb","startTime":183.81,"endTime":189.75,"body":"content. I will say that, for"},{"speaker":"Charles Goldfarb","startTime":183.81,"endTime":189.75,"body":"me, the highlight was, you know,"},{"speaker":"Charles Goldfarb","startTime":189.78,"endTime":194.88,"body":"for those who aren't aware,"},{"speaker":"Charles Goldfarb","startTime":189.78,"endTime":194.88,"body":"Preston Phillips was killed in"},{"speaker":"Charles Goldfarb","startTime":194.88,"endTime":199.38,"body":"clinic a little more than a year"},{"speaker":"Charles Goldfarb","startTime":194.88,"endTime":199.38,"body":"ago in Tulsa, Oklahoma, Preston"},{"speaker":"Charles Goldfarb","startTime":199.38,"endTime":204.69,"body":"was an impactful, ala member,"},{"speaker":"Charles Goldfarb","startTime":199.38,"endTime":204.69,"body":"member of multiple different"},{"speaker":"Charles Goldfarb","startTime":204.69,"endTime":209.88,"body":"societies. African American"},{"speaker":"Charles Goldfarb","startTime":204.69,"endTime":209.88,"body":"orthopedic surgeon, of which"},{"speaker":"Charles Goldfarb","startTime":209.88,"endTime":214.74,"body":"there are far too few. And when"},{"speaker":"Charles Goldfarb","startTime":209.88,"endTime":214.74,"body":"he was shot in clinic and"},{"speaker":"Charles Goldfarb","startTime":214.74,"endTime":219.6,"body":"killed, it really was not that"},{"speaker":"Charles Goldfarb","startTime":214.74,"endTime":219.6,"body":"we needed a wake up, but a"},{"speaker":"Charles Goldfarb","startTime":219.6,"endTime":223.47,"body":"little bit of a wake up on the"},{"speaker":"Charles Goldfarb","startTime":219.6,"endTime":223.47,"body":"role of the orthopedic surgeon"},{"speaker":"Charles Goldfarb","startTime":223.86,"endTime":229.29,"body":"in advocacy around gun violence."},{"speaker":"Charles Goldfarb","startTime":223.86,"endTime":229.29,"body":"And it is highly controversial."},{"speaker":"Charles Goldfarb","startTime":229.62,"endTime":232.32,"body":"And there are plenty of members"},{"speaker":"Charles Goldfarb","startTime":229.62,"endTime":232.32,"body":"of the American Academy of"},{"speaker":"Charles Goldfarb","startTime":232.32,"endTime":234.54,"body":"Orthopedic surgeons who want"},{"speaker":"Charles Goldfarb","startTime":232.32,"endTime":234.54,"body":"nothing to do with this. And in"},{"speaker":"Charles Goldfarb","startTime":234.54,"endTime":238.17,"body":"fact, I think we should, quote"},{"speaker":"Charles Goldfarb","startTime":234.54,"endTime":238.17,"body":"unquote, stay in our lane. So"},{"speaker":"Charles Goldfarb","startTime":238.17,"endTime":242.55,"body":"anyways, as a result of that, we"},{"speaker":"Charles Goldfarb","startTime":238.17,"endTime":242.55,"body":"put a symposium on about gun"},{"speaker":"Charles Goldfarb","startTime":242.55,"endTime":247.8,"body":"violence, and it was really,"},{"speaker":"Charles Goldfarb","startTime":242.55,"endTime":247.8,"body":"really good. And Anna Miller"},{"speaker":"Charles Goldfarb","startTime":247.8,"endTime":251.31,"body":"from St. Louis really used the"},{"speaker":"Charles Goldfarb","startTime":247.8,"endTime":251.31,"body":"city of St. Louis and some of"},{"speaker":"Charles Goldfarb","startTime":251.31,"endTime":255.03,"body":"our challenges as a case study,"},{"speaker":"Charles Goldfarb","startTime":251.31,"endTime":255.03,"body":"which also was an impactful part"},{"speaker":"Charles Goldfarb","startTime":255.03,"endTime":257.91,"body":"of it. So I love that one. I"},{"speaker":"Charles Goldfarb","startTime":255.03,"endTime":257.91,"body":"love them all. But that"},{"speaker":"Charles Goldfarb","startTime":257.91,"endTime":260.91,"body":"symposium for me was perhaps"},{"speaker":"Charles Goldfarb","startTime":257.91,"endTime":260.91,"body":"most impactful."},{"speaker":"Chris Dy","startTime":262.26,"endTime":267.3,"body":"Yeah, it's it's very"},{"speaker":"Chris Dy","startTime":262.26,"endTime":267.3,"body":"sad state of affairs in, in the"},{"speaker":"Chris Dy","startTime":267.3,"endTime":270.45,"body":"US with regards to the epidemic"},{"speaker":"Chris Dy","startTime":267.3,"endTime":270.45,"body":"of gun violence, and, you know,"},{"speaker":"Chris Dy","startTime":270.45,"endTime":273.33,"body":"our listeners in us know that"},{"speaker":"Chris Dy","startTime":270.45,"endTime":273.33,"body":"and those that are listening and"},{"speaker":"Chris Dy","startTime":273.33,"endTime":276.54,"body":"have kind of viewed the US from"},{"speaker":"Chris Dy","startTime":273.33,"endTime":276.54,"body":"outside clearly know that it's"},{"speaker":"Chris Dy","startTime":276.54,"endTime":279.18,"body":"very different here than it is"},{"speaker":"Chris Dy","startTime":276.54,"endTime":279.18,"body":"everywhere else in the world."},{"speaker":"Chris Dy","startTime":280.23,"endTime":283.62,"body":"That being said, you know, it is"},{"speaker":"Chris Dy","startTime":280.23,"endTime":283.62,"body":"it is a huge problem. And, you"},{"speaker":"Chris Dy","startTime":283.62,"endTime":285.66,"body":"know, I think that the"},{"speaker":"Chris Dy","startTime":283.62,"endTime":285.66,"body":"challenges that we face is that,"},{"speaker":"Chris Dy","startTime":285.66,"endTime":288.72,"body":"you know, orthopedic surgeons,"},{"speaker":"Chris Dy","startTime":285.66,"endTime":288.72,"body":"traditionally both, you know,"},{"speaker":"Chris Dy","startTime":289.32,"endTime":292.56,"body":"you know individually but also"},{"speaker":"Chris Dy","startTime":289.32,"endTime":292.56,"body":"as as a group have shied away"},{"speaker":"Chris Dy","startTime":292.56,"endTime":295.83,"body":"from this, you know, one of the"},{"speaker":"Chris Dy","startTime":292.56,"endTime":295.83,"body":"issues to be very frank that"},{"speaker":"Chris Dy","startTime":295.83,"endTime":299.67,"body":"I've had with working on"},{"speaker":"Chris Dy","startTime":295.83,"endTime":299.67,"body":"advocacy through the through the"},{"speaker":"Chris Dy","startTime":299.7,"endTime":303.0,"body":"AAOS which I've done in the"},{"speaker":"Chris Dy","startTime":299.7,"endTime":303.0,"body":"past, as, you know, doing"},{"speaker":"Chris Dy","startTime":303.0,"endTime":305.73,"body":"lobbying, doing Washington"},{"speaker":"Chris Dy","startTime":303.0,"endTime":305.73,"body":"policy fellowship, being a"},{"speaker":"Chris Dy","startTime":305.76,"endTime":307.68,"body":"Government Affairs Committee"},{"speaker":"Chris Dy","startTime":305.76,"endTime":307.68,"body":"Chair for the hand society"},{"speaker":"Chris Dy","startTime":307.68,"endTime":310.71,"body":"interacting with ALS is that"},{"speaker":"Chris Dy","startTime":307.68,"endTime":310.71,"body":"they've really stayed away from"},{"speaker":"Chris Dy","startTime":310.71,"endTime":313.77,"body":"this because they're the"},{"speaker":"Chris Dy","startTime":310.71,"endTime":313.77,"body":"membership of the ALS has wanted"},{"speaker":"Chris Dy","startTime":313.77,"endTime":318.0,"body":"to kind of stay in our lane. As"},{"speaker":"Chris Dy","startTime":313.77,"endTime":318.0,"body":"a comparison, the American"},{"speaker":"Chris Dy","startTime":318.0,"endTime":321.93,"body":"College of Surgeons has jumped"},{"speaker":"Chris Dy","startTime":318.0,"endTime":321.93,"body":"in on this, which I do admire"},{"speaker":"Chris Dy","startTime":321.93,"endTime":324.84,"body":"tremendously. So hopefully,"},{"speaker":"Chris Dy","startTime":321.93,"endTime":324.84,"body":"there'll be, you know, a sea"},{"speaker":"Chris Dy","startTime":324.84,"endTime":327.48,"body":"change. And, you know,"},{"speaker":"Chris Dy","startTime":324.84,"endTime":327.48,"body":"obviously, the tragic events"},{"speaker":"Chris Dy","startTime":327.48,"endTime":330.63,"body":"that happened to Dr. Phillips"},{"speaker":"Chris Dy","startTime":327.48,"endTime":330.63,"body":"may be contributing to that"},{"speaker":"Chris Dy","startTime":330.63,"endTime":332.88,"body":"change in opinion, but it's"},{"speaker":"Chris Dy","startTime":330.63,"endTime":332.88,"body":"something that needs to be"},{"speaker":"Chris Dy","startTime":332.88,"endTime":335.76,"body":"addressed. You know, we've done"},{"speaker":"Chris Dy","startTime":332.88,"endTime":335.76,"body":"some research here, our lab has"},{"speaker":"Chris Dy","startTime":335.76,"endTime":338.61,"body":"done some work on, you know, the"},{"speaker":"Chris Dy","startTime":335.76,"endTime":338.61,"body":"epidemic of gun violence,"},{"speaker":"Chris Dy","startTime":338.61,"endTime":342.09,"body":"especially during the pandemic."},{"speaker":"Chris Dy","startTime":338.61,"endTime":342.09,"body":"And I'm sure Anna showed some of"},{"speaker":"Chris Dy","startTime":342.09,"endTime":344.79,"body":"those slides. And it's actually"},{"speaker":"Chris Dy","startTime":342.09,"endTime":344.79,"body":"an area of research that we're"},{"speaker":"Chris Dy","startTime":345.15,"endTime":348.15,"body":"looking into doing some grants"},{"speaker":"Chris Dy","startTime":345.15,"endTime":348.15,"body":"and everything for looking at"},{"speaker":"Chris Dy","startTime":348.15,"endTime":350.52,"body":"gun violence and how it relates"},{"speaker":"Chris Dy","startTime":348.15,"endTime":350.52,"body":"to nerve injuries and upper"},{"speaker":"Chris Dy","startTime":350.52,"endTime":354.57,"body":"extremity trauma in general. So,"},{"speaker":"Chris Dy","startTime":350.52,"endTime":354.57,"body":"yeah, that was a very impactful"},{"speaker":"Chris Dy","startTime":354.66,"endTime":358.08,"body":"symposium for sure. And I think"},{"speaker":"Chris Dy","startTime":354.66,"endTime":358.08,"body":"it'll, you know, stimulated a"},{"speaker":"Chris Dy","startTime":358.08,"endTime":359.28,"body":"lot of future discussion."},{"speaker":"Charles Goldfarb","startTime":360.45,"endTime":364.2,"body":"Yeah, well"},{"speaker":"Charles Goldfarb","startTime":360.45,"endTime":364.2,"body":"said and great AOA meeting, I"},{"speaker":"Charles Goldfarb","startTime":364.2,"endTime":368.1,"body":"was privileged to be Wayne"},{"speaker":"Charles Goldfarb","startTime":364.2,"endTime":368.1,"body":"Sebastiannelli's program chair"},{"speaker":"Charles Goldfarb","startTime":368.1,"endTime":371.82,"body":"and happy that it went. So well."},{"speaker":"Charles Goldfarb","startTime":368.1,"endTime":371.82,"body":"I'll segue from that to saying"},{"speaker":"Charles Goldfarb","startTime":371.82,"endTime":375.63,"body":"that it's interesting, because,"},{"speaker":"Charles Goldfarb","startTime":371.82,"endTime":375.63,"body":"you know, when I was a resident"},{"speaker":"Charles Goldfarb","startTime":375.63,"endTime":379.38,"body":"all those years ago, yes, there"},{"speaker":"Charles Goldfarb","startTime":375.63,"endTime":379.38,"body":"were cars and much of our level"},{"speaker":"Charles Goldfarb","startTime":379.38,"endTime":384.12,"body":"one trauma center work was based"},{"speaker":"Charles Goldfarb","startTime":379.38,"endTime":384.12,"body":"around, you know, motor vehicle"},{"speaker":"Charles Goldfarb","startTime":384.12,"endTime":388.02,"body":"crashes, motorcycle, and"},{"speaker":"Charles Goldfarb","startTime":384.12,"endTime":388.02,"body":"occasionally other stuff."},{"speaker":"Charles Goldfarb","startTime":388.02,"endTime":391.47,"body":"Certainly some gun violence, but"},{"speaker":"Charles Goldfarb","startTime":388.02,"endTime":391.47,"body":"not much. Today, I would say."},{"speaker":"Charles Goldfarb","startTime":392.28,"endTime":395.82,"body":"While we still have those,"},{"speaker":"Charles Goldfarb","startTime":392.28,"endTime":395.82,"body":"thankfully, in a weird way, we"},{"speaker":"Charles Goldfarb","startTime":395.82,"endTime":399.6,"body":"have a lot of gun gunshot wounds"},{"speaker":"Charles Goldfarb","startTime":395.82,"endTime":399.6,"body":"to deal with as an orthopedic"},{"speaker":"Charles Goldfarb","startTime":399.6,"endTime":403.74,"body":"service. And we also have a lot"},{"speaker":"Charles Goldfarb","startTime":399.6,"endTime":403.74,"body":"of infections related to drug"},{"speaker":"Charles Goldfarb","startTime":403.74,"endTime":408.96,"body":"abuse. I was fortunate recently"},{"speaker":"Charles Goldfarb","startTime":403.74,"endTime":408.96,"body":"to be the graduation speaker for"},{"speaker":"Charles Goldfarb","startTime":408.96,"endTime":412.38,"body":"University of Florida. And we"},{"speaker":"Charles Goldfarb","startTime":408.96,"endTime":412.38,"body":"learned a little bit I learned a"},{"speaker":"Charles Goldfarb","startTime":412.38,"endTime":417.48,"body":"little bit about a new, I guess,"},{"speaker":"Charles Goldfarb","startTime":412.38,"endTime":417.48,"body":"drug combination, which is"},{"speaker":"Charles Goldfarb","startTime":417.48,"endTime":422.04,"body":"wreaking havoc, and I'm not sure"},{"speaker":"Charles Goldfarb","startTime":417.48,"endTime":422.04,"body":"if you've heard of this. It's a"},{"speaker":"Charles Goldfarb","startTime":422.07,"endTime":427.29,"body":"animal tranquilizer, known as"},{"speaker":"Charles Goldfarb","startTime":422.07,"endTime":427.29,"body":"it's called xylazine. And then"},{"speaker":"Charles Goldfarb","startTime":427.38,"endTime":430.83,"body":"affectionately is wrong word"},{"speaker":"Charles Goldfarb","startTime":427.38,"endTime":430.83,"body":"affectionately known as tranq."},{"speaker":"Charles Goldfarb","startTime":431.07,"endTime":434.58,"body":"But tranq is mixed with"},{"speaker":"Charles Goldfarb","startTime":431.07,"endTime":434.58,"body":"Bentonville because fentanyl"},{"speaker":"Charles Goldfarb","startTime":434.58,"endTime":441.24,"body":"alone apparently does not give"},{"speaker":"Charles Goldfarb","startTime":434.58,"endTime":441.24,"body":"the desired high. Or maybe it's"},{"speaker":"Charles Goldfarb","startTime":441.24,"endTime":443.31,"body":"just a little different. So if"},{"speaker":"Charles Goldfarb","startTime":441.24,"endTime":443.31,"body":"you mix the two together, the"},{"speaker":"Charles Goldfarb","startTime":443.31,"endTime":447.54,"body":"high is different or better"},{"speaker":"Charles Goldfarb","startTime":443.31,"endTime":447.54,"body":"bits. Frank is unbelievably"},{"speaker":"Charles Goldfarb","startTime":447.54,"endTime":451.83,"body":"brutal on the extremities, and"},{"speaker":"Charles Goldfarb","startTime":447.54,"endTime":451.83,"body":"often leads to a ton of dead"},{"speaker":"Charles Goldfarb","startTime":451.83,"endTime":454.92,"body":"tissue and amputations. Have you"},{"speaker":"Charles Goldfarb","startTime":451.83,"endTime":454.92,"body":"had any experience with Trank?"},{"speaker":"Chris Dy","startTime":455.85,"endTime":460.47,"body":"Not in any capacity?"},{"speaker":"Chris Dy","startTime":455.85,"endTime":460.47,"body":"If you're wondering, but so no,"},{"speaker":"Chris Dy","startTime":460.47,"endTime":463.17,"body":"I've only deal I've heard of"},{"speaker":"Chris Dy","startTime":460.47,"endTime":463.17,"body":"this, just you know, kind of"},{"speaker":"Chris Dy","startTime":463.17,"endTime":466.65,"body":"listening to the general news on"},{"speaker":"Chris Dy","startTime":463.17,"endTime":466.65,"body":"podcasts and everything to it's"},{"speaker":"Chris Dy","startTime":466.65,"endTime":472.2,"body":"terrible. You know, and it's,"},{"speaker":"Chris Dy","startTime":466.65,"endTime":472.2,"body":"it's it. It's really sad that"},{"speaker":"Chris Dy","startTime":472.2,"endTime":475.56,"body":"kind of we're going through this"},{"speaker":"Chris Dy","startTime":472.2,"endTime":475.56,"body":"and you know, I think the the"},{"speaker":"Chris Dy","startTime":475.59,"endTime":478.53,"body":"etiology of injuries has"},{"speaker":"Chris Dy","startTime":475.59,"endTime":478.53,"body":"certainly changed from when you"},{"speaker":"Chris Dy","startTime":478.53,"endTime":481.56,"body":"were a resident in the 90s to"},{"speaker":"Chris Dy","startTime":478.53,"endTime":481.56,"body":"where we are now. I'm just going"},{"speaker":"Chris Dy","startTime":481.56,"endTime":487.77,"body":"to put that out there you are"},{"speaker":"Chris Dy","startTime":481.56,"endTime":487.77,"body":"resident in the 90s. The 90s. In"},{"speaker":"Chris Dy","startTime":487.77,"endTime":491.01,"body":"practice longer, longer than"},{"speaker":"Chris Dy","startTime":487.77,"endTime":491.01,"body":"most people who listen to this"},{"speaker":"Chris Dy","startTime":491.01,"endTime":497.46,"body":"podcast have been alive. But"},{"speaker":"Chris Dy","startTime":491.01,"endTime":497.46,"body":"yeah, it's it's it's awful. I"},{"speaker":"Chris Dy","startTime":497.46,"endTime":501.57,"body":"think that you know, it's going"},{"speaker":"Chris Dy","startTime":497.46,"endTime":501.57,"body":"to continue to change. I can't"},{"speaker":"Chris Dy","startTime":501.57,"endTime":504.03,"body":"see things getting better"},{"speaker":"Chris Dy","startTime":501.57,"endTime":504.03,"body":"appreciably, but we should"},{"speaker":"Chris Dy","startTime":504.03,"endTime":506.46,"body":"probably talk about something a"},{"speaker":"Chris Dy","startTime":504.03,"endTime":506.46,"body":"little more lighthearted on this"},{"speaker":"Chris Dy","startTime":506.46,"endTime":507.51,"body":"podcast,"},{"speaker":"Charles Goldfarb","startTime":508.11,"endTime":510.0,"body":"for sure. But"},{"speaker":"Charles Goldfarb","startTime":508.11,"endTime":510.0,"body":"I also think it's something we"},{"speaker":"Charles Goldfarb","startTime":510.0,"endTime":513.6,"body":"see. And yeah, I'm not looking"},{"speaker":"Charles Goldfarb","startTime":510.0,"endTime":513.6,"body":"to solve the drug epidemic and"},{"speaker":"Charles Goldfarb","startTime":513.6,"endTime":517.86,"body":"the gun violence epidemic today"},{"speaker":"Charles Goldfarb","startTime":513.6,"endTime":517.86,"body":"with you. So let's talk about"},{"speaker":"Charles Goldfarb","startTime":517.86,"endTime":519.75,"body":"something more fun. What do you"},{"speaker":"Charles Goldfarb","startTime":517.86,"endTime":519.75,"body":"got up your sleeve?"},{"speaker":"Chris Dy","startTime":520.11,"endTime":521.97,"body":"Well, I will. So I'm"},{"speaker":"Chris Dy","startTime":520.11,"endTime":521.97,"body":"going to I want to make this"},{"speaker":"Chris Dy","startTime":521.97,"endTime":525.54,"body":"brief because we've got some"},{"speaker":"Chris Dy","startTime":521.97,"endTime":525.54,"body":"good cases to talk about. We are"},{"speaker":"Chris Dy","startTime":525.54,"endTime":529.68,"body":"currently in the midst in this"},{"speaker":"Chris Dy","startTime":525.54,"endTime":529.68,"body":"household of planning, our first"},{"speaker":"Chris Dy","startTime":529.68,"endTime":533.1,"body":"camping trip, and no my wife is"},{"speaker":"Chris Dy","startTime":529.68,"endTime":533.1,"body":"not coming because she doesn't"},{"speaker":"Chris Dy","startTime":533.1,"endTime":536.4,"body":"get down with that. So it is a"},{"speaker":"Chris Dy","startTime":533.1,"endTime":536.4,"body":"father son trip, a couple of"},{"speaker":"Chris Dy","startTime":536.4,"endTime":541.62,"body":"families. Dr. Wall's son and her"},{"speaker":"Chris Dy","startTime":536.4,"endTime":541.62,"body":"husband are coming and he's got"},{"speaker":"Chris Dy","startTime":541.62,"endTime":544.74,"body":"all the gear which is good, but"},{"speaker":"Chris Dy","startTime":541.62,"endTime":544.74,"body":"I just want to put a quick plug"},{"speaker":"Chris Dy","startTime":544.74,"endTime":548.07,"body":"out there. If anybody has any"},{"speaker":"Chris Dy","startTime":544.74,"endTime":548.07,"body":"camping tips, please feel free"},{"speaker":"Chris Dy","startTime":548.07,"endTime":550.8,"body":"to share them because we're"},{"speaker":"Chris Dy","startTime":548.07,"endTime":550.8,"body":"about to embark on quite the"},{"speaker":"Chris Dy","startTime":550.8,"endTime":554.76,"body":"adventure. Is this July 4"},{"speaker":"Chris Dy","startTime":550.8,"endTime":554.76,"body":"weekend camping trip though it's"},{"speaker":"Chris Dy","startTime":554.76,"endTime":558.06,"body":"the weekend afterwards. Wow. So"},{"speaker":"Chris Dy","startTime":554.76,"endTime":558.06,"body":"you are really"},{"speaker":"Charles Goldfarb","startTime":558.06,"endTime":560.25,"body":"good. You have"},{"speaker":"Charles Goldfarb","startTime":558.06,"endTime":560.25,"body":"the father's on fishing trip"},{"speaker":"Charles Goldfarb","startTime":560.28,"endTime":565.2,"body":"with Dr. Berks. And now I assume"},{"speaker":"Charles Goldfarb","startTime":560.28,"endTime":565.2,"body":"Dr. Berkes is going to join for"},{"speaker":"Charles Goldfarb","startTime":565.2,"endTime":570.6,"body":"the campaign along with Dr."},{"speaker":"Charles Goldfarb","startTime":565.2,"endTime":570.6,"body":"Wall's family. Wow. It's"},{"speaker":"Chris Dy","startTime":570.63,"endTime":574.41,"body":"it's gonna be quite"},{"speaker":"Chris Dy","startTime":570.63,"endTime":574.41,"body":"the quite the trip. I think that"},{"speaker":"Chris Dy","startTime":574.41,"endTime":577.89,"body":"my son has been watching too"},{"speaker":"Chris Dy","startTime":574.41,"endTime":577.89,"body":"much outdoor boys YouTube"},{"speaker":"Chris Dy","startTime":577.89,"endTime":581.28,"body":"channel because he knows all the"},{"speaker":"Chris Dy","startTime":577.89,"endTime":581.28,"body":"product, product blogs that they"},{"speaker":"Chris Dy","startTime":581.28,"endTime":586.56,"body":"have. And he wants to go to Bass"},{"speaker":"Chris Dy","startTime":581.28,"endTime":586.56,"body":"Pro and just go nuts. That is"},{"speaker":"Chris Dy","startTime":587.64,"endTime":591.06,"body":"the most expensive camping trip"},{"speaker":"Chris Dy","startTime":587.64,"endTime":591.06,"body":"in history. But if anybody has"},{"speaker":"Chris Dy","startTime":591.06,"endTime":594.54,"body":"any tips, let us know. And then"},{"speaker":"Chris Dy","startTime":591.06,"endTime":594.54,"body":"please feel free to email me"},{"speaker":"Chris Dy","startTime":594.54,"endTime":597.63,"body":"directly with those. But we"},{"speaker":"Chris Dy","startTime":594.54,"endTime":597.63,"body":"should probably shout out our"},{"speaker":"Chris Dy","startTime":597.63,"endTime":599.88,"body":"sponsor practice link before we"},{"speaker":"Chris Dy","startTime":597.63,"endTime":599.88,"body":"get in these cases."},{"speaker":"Charles Goldfarb","startTime":599.97,"endTime":601.77,"body":"The upper hand"},{"speaker":"Charles Goldfarb","startTime":599.97,"endTime":601.77,"body":"is sponsored by practice"},{"speaker":"Charles Goldfarb","startTime":601.8,"endTime":605.52,"body":"link.com The most widely used"},{"speaker":"Charles Goldfarb","startTime":601.8,"endTime":605.52,"body":"position job search and career"},{"speaker":"Charles Goldfarb","startTime":605.55,"endTime":607.23,"body":"advancement resource."},{"speaker":"Chris Dy","startTime":607.74,"endTime":610.14,"body":"Becoming a physician"},{"speaker":"Chris Dy","startTime":607.74,"endTime":610.14,"body":"is hard finding the right job"},{"speaker":"Chris Dy","startTime":610.14,"endTime":613.2,"body":"doesn't have to be joined"},{"speaker":"Chris Dy","startTime":610.14,"endTime":613.2,"body":"practice link for free today at"},{"speaker":"Chris Dy","startTime":613.2,"endTime":617.85,"body":"www dot practice length.com/the"},{"speaker":"Chris Dy","startTime":613.2,"endTime":617.85,"body":"upper hand."},{"speaker":"Chris Dy","startTime":618.33,"endTime":619.08,"body":"Hey, Chris."},{"speaker":"Chris Dy","startTime":620.1,"endTime":620.67,"body":"Hey, Chuck,"},{"speaker":"Charles Goldfarb","startTime":621.15,"endTime":623.52,"body":"do you have"},{"speaker":"Charles Goldfarb","startTime":621.15,"endTime":623.52,"body":"any reviews to share?"},{"speaker":"Chris Dy","startTime":623.78,"endTime":626.99,"body":"I do actually. We have"},{"speaker":"Chris Dy","startTime":623.78,"endTime":626.99,"body":"some great reviews to share. So"},{"speaker":"Chris Dy","startTime":627.29,"endTime":629.99,"body":"we've had a couple that have"},{"speaker":"Chris Dy","startTime":627.29,"endTime":629.99,"body":"come in recently, we are still"},{"speaker":"Chris Dy","startTime":629.99,"endTime":633.71,"body":"at 4.9 out of five. So somebody"},{"speaker":"Chris Dy","startTime":629.99,"endTime":633.71,"body":"gave us one star somebody gave"},{"speaker":"Chris Dy","startTime":633.71,"endTime":636.83,"body":"us two stars. So we did more"},{"speaker":"Chris Dy","startTime":633.71,"endTime":636.83,"body":"five star reviews to try and"},{"speaker":"Chris Dy","startTime":636.83,"endTime":639.14,"body":"drag that average up. I don't"},{"speaker":"Chris Dy","startTime":636.83,"endTime":639.14,"body":"know how the iTunes systems"},{"speaker":"Chris Dy","startTime":639.14,"endTime":644.12,"body":"works in terms of rounding up."},{"speaker":"Chris Dy","startTime":639.14,"endTime":644.12,"body":"But we recently got one from"},{"speaker":"Chris Dy","startTime":644.12,"endTime":649.07,"body":"skating lady that says five"},{"speaker":"Chris Dy","startTime":644.12,"endTime":649.07,"body":"stars great for want to bch Ts."},{"speaker":"Chris Dy","startTime":649.31,"endTime":652.79,"body":"I'm an OT, practicing in hand"},{"speaker":"Chris Dy","startTime":649.31,"endTime":652.79,"body":"upper extremity rehab, preparing"},{"speaker":"Chris Dy","startTime":652.79,"endTime":656.12,"body":"for the CHT I really enjoy this"},{"speaker":"Chris Dy","startTime":652.79,"endTime":656.12,"body":"podcast as it gives great"},{"speaker":"Chris Dy","startTime":656.12,"endTime":659.72,"body":"insight and detail into the"},{"speaker":"Chris Dy","startTime":656.12,"endTime":659.72,"body":"surgical procedures I treat. She"},{"speaker":"Chris Dy","startTime":659.72,"endTime":664.04,"body":"appreciates how we have we"},{"speaker":"Chris Dy","startTime":659.72,"endTime":664.04,"body":"respect and appreciate our our"},{"speaker":"Chris Dy","startTime":664.04,"endTime":667.46,"body":"therapy colleagues. And so thank"},{"speaker":"Chris Dy","startTime":664.04,"endTime":667.46,"body":"you skating lady for that"},{"speaker":"Chris Dy","startTime":667.46,"endTime":667.76,"body":"review."},{"speaker":"Charles Goldfarb","startTime":668.33,"endTime":670.43,"body":"Yea, thank you"},{"speaker":"Charles Goldfarb","startTime":668.33,"endTime":670.43,"body":"so much. We are a little bit on"},{"speaker":"Charles Goldfarb","startTime":670.43,"endTime":675.14,"body":"a therapist hiatus, given the"},{"speaker":"Charles Goldfarb","startTime":670.43,"endTime":675.14,"body":"maternity leave of one of our"},{"speaker":"Charles Goldfarb","startTime":675.32,"endTime":678.53,"body":"our wonderful therapists, but we"},{"speaker":"Charles Goldfarb","startTime":675.32,"endTime":678.53,"body":"need to get back to it."},{"speaker":"Chris Dy","startTime":679.07,"endTime":682.19,"body":"We certainly do. I"},{"speaker":"Chris Dy","startTime":679.07,"endTime":682.19,"body":"think that, you know those,"},{"speaker":"Chris Dy","startTime":682.31,"endTime":686.06,"body":"those episodes are always big"},{"speaker":"Chris Dy","startTime":682.31,"endTime":686.06,"body":"favorites. So I look forward to"},{"speaker":"Chris Dy","startTime":686.06,"endTime":688.61,"body":"having having Macy come back on"},{"speaker":"Chris Dy","startTime":686.06,"endTime":688.61,"body":"and maybe even some other"},{"speaker":"Chris Dy","startTime":688.61,"endTime":693.47,"body":"therapists. So the last, the"},{"speaker":"Chris Dy","startTime":688.61,"endTime":693.47,"body":"next review is from pod enthused"},{"speaker":"Chris Dy","startTime":693.71,"endTime":697.88,"body":"five stars and says lovely for"},{"speaker":"Chris Dy","startTime":693.71,"endTime":697.88,"body":"trainees. I'm a PGY2 in ortho"},{"speaker":"Chris Dy","startTime":697.88,"endTime":700.55,"body":"hoping to be a hand surgeon."},{"speaker":"Chris Dy","startTime":697.88,"endTime":700.55,"body":"These episodes have been hugely"},{"speaker":"Chris Dy","startTime":700.55,"endTime":703.19,"body":"helpful for the nuances of"},{"speaker":"Chris Dy","startTime":700.55,"endTime":703.19,"body":"surgical techniques that there"},{"speaker":"Chris Dy","startTime":703.19,"endTime":706.52,"body":"simply isn't enough time to"},{"speaker":"Chris Dy","startTime":703.19,"endTime":706.52,"body":"discuss any or also enjoys our"},{"speaker":"Chris Dy","startTime":706.52,"endTime":709.73,"body":"discussion about patient factors"},{"speaker":"Chris Dy","startTime":706.52,"endTime":709.73,"body":"and indications. So thank you."},{"speaker":"Chris Dy","startTime":710.36,"endTime":712.91,"body":"Thank you to pot enthuse for"},{"speaker":"Chris Dy","startTime":710.36,"endTime":712.91,"body":"listening and for leaving a"},{"speaker":"Chris Dy","startTime":712.91,"endTime":716.15,"body":"review and make sure that you"},{"speaker":"Chris Dy","startTime":712.91,"endTime":716.15,"body":"get on there and leave a review."},{"speaker":"Chris Dy","startTime":716.15,"endTime":718.73,"body":"You can even sneak a question"},{"speaker":"Chris Dy","startTime":716.15,"endTime":718.73,"body":"for Chuck in there about all of"},{"speaker":"Chris Dy","startTime":718.73,"endTime":721.67,"body":"his fancy athlete work and all"},{"speaker":"Chris Dy","startTime":718.73,"endTime":721.67,"body":"that kind of thing."},{"speaker":"Charles Goldfarb","startTime":722.33,"endTime":725.12,"body":"Yes, please,"},{"speaker":"Charles Goldfarb","startTime":722.33,"endTime":725.12,"body":"please, please do. And we had a"},{"speaker":"Charles Goldfarb","startTime":725.12,"endTime":730.82,"body":"great email from one of our"},{"speaker":"Charles Goldfarb","startTime":725.12,"endTime":730.82,"body":"listeners, Joe Rosenbaum, who"},{"speaker":"Charles Goldfarb","startTime":730.82,"endTime":735.89,"body":"shared with us that he was"},{"speaker":"Charles Goldfarb","startTime":730.82,"endTime":735.89,"body":"thrilled to hear us discuss"},{"speaker":"Charles Goldfarb","startTime":736.1,"endTime":740.9,"body":"Israeli baseball because Joe, I"},{"speaker":"Charles Goldfarb","startTime":736.1,"endTime":740.9,"body":"guess, was professional, or semi"},{"speaker":"Charles Goldfarb","startTime":740.9,"endTime":742.97,"body":"professional. I don't want to"},{"speaker":"Charles Goldfarb","startTime":740.9,"endTime":742.97,"body":"offend them by the wrong"},{"speaker":"Charles Goldfarb","startTime":742.97,"endTime":746.45,"body":"terminology. But I'm impressed"},{"speaker":"Charles Goldfarb","startTime":742.97,"endTime":746.45,"body":"that he played that high level"},{"speaker":"Charles Goldfarb","startTime":746.45,"endTime":749.24,"body":"baseball. It wasn't in the"},{"speaker":"Charles Goldfarb","startTime":746.45,"endTime":749.24,"body":"United States."},{"speaker":"Chris Dy","startTime":750.05,"endTime":753.5,"body":"That was really"},{"speaker":"Chris Dy","startTime":750.05,"endTime":753.5,"body":"impressive. You know, baseball"},{"speaker":"Chris Dy","startTime":753.5,"endTime":757.1,"body":"is baseball is hard. I've"},{"speaker":"Chris Dy","startTime":753.5,"endTime":757.1,"body":"learned. You know, I think I"},{"speaker":"Chris Dy","startTime":757.1,"endTime":759.47,"body":"talked about this in one of the"},{"speaker":"Chris Dy","startTime":757.1,"endTime":759.47,"body":"other podcasts when I was"},{"speaker":"Chris Dy","startTime":759.5,"endTime":764.63,"body":"coached pitching for my son's"},{"speaker":"Chris Dy","startTime":759.5,"endTime":764.63,"body":"first grade Baseball, baseball"},{"speaker":"Chris Dy","startTime":764.63,"endTime":769.19,"body":"games. And I definitely, I"},{"speaker":"Chris Dy","startTime":764.63,"endTime":769.19,"body":"definitely threw the ball in a"},{"speaker":"Chris Dy","startTime":769.19,"endTime":772.79,"body":"manner in which there were some"},{"speaker":"Chris Dy","startTime":769.19,"endTime":772.79,"body":"children that were hit. Now I"},{"speaker":"Chris Dy","startTime":772.79,"endTime":776.45,"body":"spread it out among all of the"},{"speaker":"Chris Dy","startTime":772.79,"endTime":776.45,"body":"children on our team that got"},{"speaker":"Chris Dy","startTime":776.45,"endTime":780.65,"body":"beaned by the coach, but I have"},{"speaker":"Chris Dy","startTime":776.45,"endTime":780.65,"body":"a greater appreciation for for"},{"speaker":"Chris Dy","startTime":780.65,"endTime":781.25,"body":"baseball now."},{"speaker":"Charles Goldfarb","startTime":781.88,"endTime":784.7,"body":"Baseball is"},{"speaker":"Charles Goldfarb","startTime":781.88,"endTime":784.7,"body":"hard. There is no doubt. And"},{"speaker":"Charles Goldfarb","startTime":784.7,"endTime":788.09,"body":"baseball's better this year,"},{"speaker":"Charles Goldfarb","startTime":784.7,"endTime":788.09,"body":"it's the pace is faster. It's a"},{"speaker":"Charles Goldfarb","startTime":788.09,"endTime":792.38,"body":"little more exciting. So that's"},{"speaker":"Charles Goldfarb","startTime":788.09,"endTime":792.38,"body":"good news. All right. Should we"},{"speaker":"Charles Goldfarb","startTime":792.44,"endTime":796.37,"body":"talk about maybe talking about"},{"speaker":"Charles Goldfarb","startTime":792.44,"endTime":796.37,"body":"some current trends in"},{"speaker":"Charles Goldfarb","startTime":797.3,"endTime":801.62,"body":"orthopedics and medicine using"},{"speaker":"Charles Goldfarb","startTime":797.3,"endTime":801.62,"body":"some journal club articles to"},{"speaker":"Charles Goldfarb","startTime":801.65,"endTime":802.64,"body":"further discuss,"},{"speaker":"Chris Dy","startTime":802.7,"endTime":804.41,"body":"yeah, we should do the"},{"speaker":"Chris Dy","startTime":802.7,"endTime":804.41,"body":"journal club articles. I want to"},{"speaker":"Chris Dy","startTime":804.41,"endTime":806.21,"body":"talk about a case because we"},{"speaker":"Chris Dy","startTime":804.41,"endTime":806.21,"body":"haven't talked about a case in a"},{"speaker":"Chris Dy","startTime":806.21,"endTime":808.79,"body":"while. And I think this one kind"},{"speaker":"Chris Dy","startTime":806.21,"endTime":808.79,"body":"of piggybacks on our last"},{"speaker":"Chris Dy","startTime":808.79,"endTime":812.51,"body":"discussion about age. So I've"},{"speaker":"Chris Dy","startTime":808.79,"endTime":812.51,"body":"been following a patient for"},{"speaker":"Chris Dy","startTime":812.51,"endTime":817.82,"body":"probably about three or four"},{"speaker":"Chris Dy","startTime":812.51,"endTime":817.82,"body":"months now, who is you know,"},{"speaker":"Chris Dy","startTime":818.15,"endTime":823.37,"body":"somewhere between 55 and 65. You"},{"speaker":"Chris Dy","startTime":818.15,"endTime":823.37,"body":"know, and it's somebody who uses"},{"speaker":"Chris Dy","startTime":823.46,"endTime":827.12,"body":"his hands quite a bit, a young"},{"speaker":"Chris Dy","startTime":823.46,"endTime":827.12,"body":"man, a young a young strapping"},{"speaker":"Chris Dy","startTime":827.12,"endTime":834.08,"body":"lad, thank you, non Medicare"},{"speaker":"Chris Dy","startTime":827.12,"endTime":834.08,"body":"eligible. So under 65, but uses"},{"speaker":"Chris Dy","startTime":834.08,"endTime":838.55,"body":"his hands quite a bit. And"},{"speaker":"Chris Dy","startTime":834.08,"endTime":838.55,"body":"doesn't like to does it cannot"},{"speaker":"Chris Dy","startTime":838.55,"endTime":842.72,"body":"stomach the thought of prolonged"},{"speaker":"Chris Dy","startTime":838.55,"endTime":842.72,"body":"immobilization. So when I first"},{"speaker":"Chris Dy","startTime":842.72,"endTime":847.52,"body":"meet him, he comes in and he had"},{"speaker":"Chris Dy","startTime":842.72,"endTime":847.52,"body":"a fall into his wrist and has a"},{"speaker":"Chris Dy","startTime":847.52,"endTime":851.99,"body":"skateboard waist fracture that"},{"speaker":"Chris Dy","startTime":847.52,"endTime":851.99,"body":"is displaced but not severely"},{"speaker":"Chris Dy","startTime":851.99,"endTime":854.33,"body":"angulated. You know, kind of"},{"speaker":"Chris Dy","startTime":851.99,"endTime":854.33,"body":"well aligned, if you gave it a"},{"speaker":"Chris Dy","startTime":854.33,"endTime":857.06,"body":"chance to heal in a cast, it"},{"speaker":"Chris Dy","startTime":854.33,"endTime":857.06,"body":"probably would heal in the cast,"},{"speaker":"Chris Dy","startTime":858.2,"endTime":860.81,"body":"and doesn't have any arthritic"},{"speaker":"Chris Dy","startTime":858.2,"endTime":860.81,"body":"change or anything like that. So"},{"speaker":"Chris Dy","startTime":860.81,"endTime":864.23,"body":"it's a recent injury. And we"},{"speaker":"Chris Dy","startTime":860.81,"endTime":864.23,"body":"talked about treatment options"},{"speaker":"Chris Dy","startTime":864.23,"endTime":868.58,"body":"and given that he uses his hands"},{"speaker":"Chris Dy","startTime":864.23,"endTime":868.58,"body":"quite a bit, you know, even if"},{"speaker":"Chris Dy","startTime":868.58,"endTime":872.42,"body":"he even though he was not, you"},{"speaker":"Chris Dy","startTime":868.58,"endTime":872.42,"body":"know, a very young person, I"},{"speaker":"Chris Dy","startTime":872.42,"endTime":874.79,"body":"thought it'd be very reasonable"},{"speaker":"Chris Dy","startTime":872.42,"endTime":874.79,"body":"to discuss surgery."},{"speaker":"Charles Goldfarb","startTime":875.21,"endTime":878.6,"body":"In today's"},{"speaker":"Charles Goldfarb","startTime":875.21,"endTime":878.6,"body":"society. The speed at which we"},{"speaker":"Charles Goldfarb","startTime":878.6,"endTime":881.27,"body":"can get patients back to"},{"speaker":"Charles Goldfarb","startTime":878.6,"endTime":881.27,"body":"activities is really important"},{"speaker":"Charles Goldfarb","startTime":881.27,"endTime":886.61,"body":"to them. And so I think it's"},{"speaker":"Charles Goldfarb","startTime":881.27,"endTime":886.61,"body":"fair to discuss surgery now. I"},{"speaker":"Charles Goldfarb","startTime":886.61,"endTime":888.92,"body":"will quibble with one thing you"},{"speaker":"Charles Goldfarb","startTime":886.61,"endTime":888.92,"body":"said or maybe it's just how it"},{"speaker":"Charles Goldfarb","startTime":888.92,"endTime":892.58,"body":"came out. You said it was a"},{"speaker":"Charles Goldfarb","startTime":888.92,"endTime":892.58,"body":"displaced fracture, at least"},{"speaker":"Charles Goldfarb","startTime":892.58,"endTime":896.45,"body":"minimally and for me that"},{"speaker":"Charles Goldfarb","startTime":892.58,"endTime":896.45,"body":"displaced fracture that one can"},{"speaker":"Charles Goldfarb","startTime":896.45,"endTime":900.83,"body":"determine on X ray really does"},{"speaker":"Charles Goldfarb","startTime":896.45,"endTime":900.83,"body":"mean it is just placed and that"},{"speaker":"Charles Goldfarb","startTime":900.83,"endTime":904.25,"body":"does decrease the chance of"},{"speaker":"Charles Goldfarb","startTime":900.83,"endTime":904.25,"body":"healing, which is in my mind yet"},{"speaker":"Charles Goldfarb","startTime":904.25,"endTime":905.36,"body":"another reason for surgery."},{"speaker":"Chris Dy","startTime":905.75,"endTime":908.03,"body":"Right, right. So I"},{"speaker":"Chris Dy","startTime":905.75,"endTime":908.03,"body":"think that, you know, the amount"},{"speaker":"Chris Dy","startTime":908.03,"endTime":912.26,"body":"of displacement, especially for"},{"speaker":"Chris Dy","startTime":908.03,"endTime":912.26,"body":"a skateboard fracture, you know,"},{"speaker":"Chris Dy","startTime":912.86,"endTime":916.7,"body":"I think that we all kind of"},{"speaker":"Chris Dy","startTime":912.86,"endTime":916.7,"body":"debate about how much could heal"},{"speaker":"Chris Dy","startTime":916.7,"endTime":919.82,"body":"versus you know, not heal. With"},{"speaker":"Chris Dy","startTime":916.7,"endTime":919.82,"body":"a cast versus surgery, I think,"},{"speaker":"Chris Dy","startTime":919.82,"endTime":921.71,"body":"especially for escape points"},{"speaker":"Chris Dy","startTime":919.82,"endTime":921.71,"body":"definitely tilts you towards"},{"speaker":"Chris Dy","startTime":921.71,"endTime":926.3,"body":"surgery. Do you think that for"},{"speaker":"Chris Dy","startTime":921.71,"endTime":926.3,"body":"skateboards in particular,"},{"speaker":"Chris Dy","startTime":927.95,"endTime":931.07,"body":"surgery speeds the recovery that"},{"speaker":"Chris Dy","startTime":927.95,"endTime":931.07,"body":"much we know that, you know,"},{"speaker":"Chris Dy","startTime":931.07,"endTime":933.83,"body":"surgery will shave off a lot of"},{"speaker":"Chris Dy","startTime":931.07,"endTime":933.83,"body":"time on recovery for distal"},{"speaker":"Chris Dy","startTime":933.83,"endTime":935.57,"body":"radius fractures. And we'll talk"},{"speaker":"Chris Dy","startTime":933.83,"endTime":935.57,"body":"about that in some of the"},{"speaker":"Chris Dy","startTime":935.57,"endTime":938.12,"body":"articles we discussed. But do"},{"speaker":"Chris Dy","startTime":935.57,"endTime":938.12,"body":"you think that scaffolds you"},{"speaker":"Chris Dy","startTime":938.12,"endTime":938.96,"body":"save a ton of time?"},{"speaker":"Charles Goldfarb","startTime":940.58,"endTime":942.86,"body":"I think it"},{"speaker":"Charles Goldfarb","startTime":940.58,"endTime":942.86,"body":"depends on how you define time."},{"speaker":"Charles Goldfarb","startTime":942.86,"endTime":950.54,"body":"So I do believe it will decrease"},{"speaker":"Charles Goldfarb","startTime":942.86,"endTime":950.54,"body":"the amount of immobilization or"},{"speaker":"Charles Goldfarb","startTime":950.54,"endTime":953.42,"body":"the time duration of"},{"speaker":"Charles Goldfarb","startTime":950.54,"endTime":953.42,"body":"immobilization. And the only"},{"speaker":"Charles Goldfarb","startTime":953.42,"endTime":956.48,"body":"article I know of, and if a"},{"speaker":"Charles Goldfarb","startTime":953.42,"endTime":956.48,"body":"listener knows of another"},{"speaker":"Charles Goldfarb","startTime":956.48,"endTime":959.15,"body":"article chrisser. Obviously, if"},{"speaker":"Charles Goldfarb","startTime":956.48,"endTime":959.15,"body":"you don't have another article,"},{"speaker":"Charles Goldfarb","startTime":959.15,"endTime":963.08,"body":"let us know. But you know, way"},{"speaker":"Charles Goldfarb","startTime":959.15,"endTime":963.08,"body":"back, the shin article bond is"},{"speaker":"Charles Goldfarb","startTime":963.08,"endTime":967.73,"body":"the first author shinza second"},{"speaker":"Charles Goldfarb","startTime":963.08,"endTime":967.73,"body":"author compared or f versus cast"},{"speaker":"Charles Goldfarb","startTime":967.73,"endTime":970.91,"body":"immobilization, and basically"},{"speaker":"Charles Goldfarb","startTime":967.73,"endTime":970.91,"body":"show that it's shaped a week to"},{"speaker":"Charles Goldfarb","startTime":970.91,"endTime":975.47,"body":"a week and a half off of the"},{"speaker":"Charles Goldfarb","startTime":970.91,"endTime":975.47,"body":"healing time. And so to me,"},{"speaker":"Charles Goldfarb","startTime":975.47,"endTime":978.08,"body":"that's not a great deal. If"},{"speaker":"Charles Goldfarb","startTime":975.47,"endTime":978.08,"body":"you're living in a gas for a"},{"speaker":"Charles Goldfarb","startTime":978.08,"endTime":980.93,"body":"while, I think you probably"},{"speaker":"Charles Goldfarb","startTime":978.08,"endTime":980.93,"body":"think it's a helpful amount of"},{"speaker":"Charles Goldfarb","startTime":980.93,"endTime":985.16,"body":"time. But I don't think it saves"},{"speaker":"Charles Goldfarb","startTime":980.93,"endTime":985.16,"body":"a ton of time for the overall"},{"speaker":"Charles Goldfarb","startTime":985.16,"endTime":987.86,"body":"healing. But it does just get"},{"speaker":"Charles Goldfarb","startTime":985.16,"endTime":987.86,"body":"you going faster, so that the"},{"speaker":"Charles Goldfarb","startTime":987.86,"endTime":992.81,"body":"way I say this to my patients"},{"speaker":"Charles Goldfarb","startTime":987.86,"endTime":992.81,"body":"is, if we can start your rehab"},{"speaker":"Charles Goldfarb","startTime":992.81,"endTime":997.19,"body":"starts your therapy safely,"},{"speaker":"Charles Goldfarb","startTime":992.81,"endTime":997.19,"body":"sooner. While it may not"},{"speaker":"Charles Goldfarb","startTime":997.22,"endTime":1001.12,"body":"dramatically change the time to"},{"speaker":"Charles Goldfarb","startTime":997.22,"endTime":1001.12,"body":"bony union, it'll decrease the"},{"speaker":"Charles Goldfarb","startTime":1001.12,"endTime":1005.95,"body":"time of overall recovery because"},{"speaker":"Charles Goldfarb","startTime":1001.12,"endTime":1005.95,"body":"you're healing and working on"},{"speaker":"Charles Goldfarb","startTime":1005.95,"endTime":1006.88,"body":"motion at the same time."},{"speaker":"Chris Dy","startTime":1007.93,"endTime":1009.88,"body":"Yeah, I agree with"},{"speaker":"Chris Dy","startTime":1007.93,"endTime":1009.88,"body":"that. I think that you know, the"},{"speaker":"Chris Dy","startTime":1009.88,"endTime":1012.55,"body":"numbers that I was taught, I"},{"speaker":"Chris Dy","startTime":1009.88,"endTime":1012.55,"body":"remember Dr. Gelberman in"},{"speaker":"Chris Dy","startTime":1012.55,"endTime":1015.73,"body":"clinic, talking to patients and"},{"speaker":"Chris Dy","startTime":1012.55,"endTime":1015.73,"body":"you know, telling patients that,"},{"speaker":"Chris Dy","startTime":1015.73,"endTime":1018.22,"body":"you know, after fixation, you"},{"speaker":"Chris Dy","startTime":1015.73,"endTime":1018.22,"body":"know, screw fixation, you're"},{"speaker":"Chris Dy","startTime":1018.22,"endTime":1020.5,"body":"still looking at six, eight"},{"speaker":"Chris Dy","startTime":1018.22,"endTime":1020.5,"body":"weeks of immobilization before"},{"speaker":"Chris Dy","startTime":1020.5,"endTime":1023.77,"body":"he felt comfortable moving the"},{"speaker":"Chris Dy","startTime":1020.5,"endTime":1023.77,"body":"patient to the next step of"},{"speaker":"Chris Dy","startTime":1023.77,"endTime":1027.97,"body":"motion. And, you know, with with"},{"speaker":"Chris Dy","startTime":1023.77,"endTime":1027.97,"body":"a, you know, a minimally"},{"speaker":"Chris Dy","startTime":1027.97,"endTime":1030.1,"body":"displaced fracture and treating"},{"speaker":"Chris Dy","startTime":1027.97,"endTime":1030.1,"body":"it in the cast, you're looking"},{"speaker":"Chris Dy","startTime":1030.1,"endTime":1032.86,"body":"at 10 to 12 weeks for that bone"},{"speaker":"Chris Dy","startTime":1030.1,"endTime":1032.86,"body":"to heal, which is much longer"},{"speaker":"Chris Dy","startTime":1032.89,"endTime":1036.31,"body":"than you know, the standard six"},{"speaker":"Chris Dy","startTime":1032.89,"endTime":1036.31,"body":"weeks or orthopedic unit you"},{"speaker":"Chris Dy","startTime":1036.31,"endTime":1041.05,"body":"would get for any other bone. I"},{"speaker":"Chris Dy","startTime":1036.31,"endTime":1041.05,"body":"think that the where you can"},{"speaker":"Chris Dy","startTime":1041.05,"endTime":1044.47,"body":"save time in terms of"},{"speaker":"Chris Dy","startTime":1041.05,"endTime":1044.47,"body":"immobilization really depends on"},{"speaker":"Chris Dy","startTime":1044.47,"endTime":1049.18,"body":"the surgeon's threshold for"},{"speaker":"Chris Dy","startTime":1044.47,"endTime":1049.18,"body":"allowing discontinuation of"},{"speaker":"Chris Dy","startTime":1049.18,"endTime":1051.73,"body":"immobilization, that's a very"},{"speaker":"Chris Dy","startTime":1049.18,"endTime":1051.73,"body":"wordy way of saying it, but when"},{"speaker":"Chris Dy","startTime":1051.73,"endTime":1055.27,"body":"do you feel comfortable? If"},{"speaker":"Chris Dy","startTime":1051.73,"endTime":1055.27,"body":"you've got solid fixation? When"},{"speaker":"Chris Dy","startTime":1055.27,"endTime":1059.05,"body":"do you feel comfortable letting"},{"speaker":"Chris Dy","startTime":1055.27,"endTime":1059.05,"body":"letting the patient start"},{"speaker":"Chris Dy","startTime":1059.05,"endTime":1059.47,"body":"motion?"},{"speaker":"Charles Goldfarb","startTime":1059.89,"endTime":1062.08,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1059.89,"endTime":1062.08,"body":"exactly right. And there is no"},{"speaker":"Charles Goldfarb","startTime":1062.08,"endTime":1066.4,"body":"literature to guide us on this"},{"speaker":"Charles Goldfarb","startTime":1062.08,"endTime":1066.4,"body":"whatsoever. And so the there's a"},{"speaker":"Charles Goldfarb","startTime":1066.4,"endTime":1069.31,"body":"big difference in healing time"},{"speaker":"Charles Goldfarb","startTime":1066.4,"endTime":1069.31,"body":"between proximal pole waist and"},{"speaker":"Charles Goldfarb","startTime":1069.31,"endTime":1072.19,"body":"distal pole. And my"},{"speaker":"Charles Goldfarb","startTime":1069.31,"endTime":1072.19,"body":"interpretation literature which"},{"speaker":"Charles Goldfarb","startTime":1072.19,"endTime":1075.01,"body":"supplements what you said about"},{"speaker":"Charles Goldfarb","startTime":1072.19,"endTime":1075.01,"body":"Dr. Gelberman's protocol,"},{"speaker":"Charles Goldfarb","startTime":1075.01,"endTime":1078.13,"body":"essentially, a proximal pole"},{"speaker":"Charles Goldfarb","startTime":1075.01,"endTime":1078.13,"body":"nonsurgically has tended to our"},{"speaker":"Charles Goldfarb","startTime":1078.13,"endTime":1083.38,"body":"weeks, sometimes 14 weeks. Waist"},{"speaker":"Charles Goldfarb","startTime":1078.13,"endTime":1083.38,"body":"to me is eight to 10 is what I"},{"speaker":"Charles Goldfarb","startTime":1083.38,"endTime":1086.59,"body":"call it patients and six to"},{"speaker":"Charles Goldfarb","startTime":1083.38,"endTime":1086.59,"body":"eight for for distal kind of"},{"speaker":"Charles Goldfarb","startTime":1086.59,"endTime":1091.54,"body":"pole or just a waist. I have a"},{"speaker":"Charles Goldfarb","startTime":1086.59,"endTime":1091.54,"body":"pretty firm protocol post"},{"speaker":"Charles Goldfarb","startTime":1091.54,"endTime":1094.99,"body":"surgically, whether it be"},{"speaker":"Charles Goldfarb","startTime":1091.54,"endTime":1094.99,"body":"proximal pole or waste of about"},{"speaker":"Charles Goldfarb","startTime":1094.99,"endTime":1100.39,"body":"five to six weeks in a cast. And"},{"speaker":"Charles Goldfarb","startTime":1094.99,"endTime":1100.39,"body":"then I shift to therapy with a"},{"speaker":"Charles Goldfarb","startTime":1100.39,"endTime":1104.83,"body":"custom fabricated some spike IP"},{"speaker":"Charles Goldfarb","startTime":1100.39,"endTime":1104.83,"body":"free splint and early motion"},{"speaker":"Charles Goldfarb","startTime":1104.86,"endTime":1108.04,"body":"initially active and gentle,"},{"speaker":"Charles Goldfarb","startTime":1104.86,"endTime":1108.04,"body":"passive progressing from there."},{"speaker":"Charles Goldfarb","startTime":1108.37,"endTime":1109.48,"body":"What do you do?"},{"speaker":"Chris Dy","startTime":1110.26,"endTime":1113.41,"body":"Pretty similar. You"},{"speaker":"Chris Dy","startTime":1110.26,"endTime":1113.41,"body":"know, we know that when you do"},{"speaker":"Chris Dy","startTime":1113.41,"endTime":1119.35,"body":"motion for for wrist is it you"},{"speaker":"Chris Dy","startTime":1113.41,"endTime":1119.35,"body":"said active only no passive? Do"},{"speaker":"Chris Dy","startTime":1119.35,"endTime":1121.9,"body":"you we know that the dart"},{"speaker":"Chris Dy","startTime":1119.35,"endTime":1121.9,"body":"throwers motion is good for the"},{"speaker":"Chris Dy","startTime":1121.9,"endTime":1125.29,"body":"SL ligament Do you think that"},{"speaker":"Chris Dy","startTime":1121.9,"endTime":1125.29,"body":"can be extrapolated to less"},{"speaker":"Chris Dy","startTime":1125.29,"endTime":1126.94,"body":"stress on the scaphoid bone"},{"speaker":"Chris Dy","startTime":1125.29,"endTime":1126.94,"body":"itself?"},{"speaker":"Charles Goldfarb","startTime":1127.63,"endTime":1129.67,"body":"I don't I"},{"speaker":"Charles Goldfarb","startTime":1127.63,"endTime":1129.67,"body":"don't know that to be a fact."},{"speaker":"Charles Goldfarb","startTime":1129.67,"endTime":1134.65,"body":"But I do to be very clear"},{"speaker":"Charles Goldfarb","startTime":1129.67,"endTime":1134.65,"body":"instructions to the therapist."},{"speaker":"Charles Goldfarb","startTime":1134.65,"endTime":1137.35,"body":"And again, when you have a trust"},{"speaker":"Charles Goldfarb","startTime":1134.65,"endTime":1137.35,"body":"level with a therapist, it"},{"speaker":"Charles Goldfarb","startTime":1137.35,"endTime":1140.38,"body":"really is helpful, so active for"},{"speaker":"Charles Goldfarb","startTime":1137.35,"endTime":1140.38,"body":"sure. And I'm okay with some"},{"speaker":"Charles Goldfarb","startTime":1140.38,"endTime":1143.56,"body":"gentle passive motion to start,"},{"speaker":"Charles Goldfarb","startTime":1140.38,"endTime":1143.56,"body":"especially if they're doing"},{"speaker":"Charles Goldfarb","startTime":1143.56,"endTime":1146.56,"body":"therapy in the system that I"},{"speaker":"Charles Goldfarb","startTime":1143.56,"endTime":1146.56,"body":"know if they're at an outline"},{"speaker":"Charles Goldfarb","startTime":1146.56,"endTime":1148.93,"body":"therapist who I don't know them"},{"speaker":"Charles Goldfarb","startTime":1146.56,"endTime":1148.93,"body":"a little more hesitant and may"},{"speaker":"Charles Goldfarb","startTime":1148.93,"endTime":1150.1,"body":"do active only."},{"speaker":"Chris Dy","startTime":1150.61,"endTime":1153.16,"body":"Right, right. And then"},{"speaker":"Chris Dy","startTime":1150.61,"endTime":1153.16,"body":"I guess the you said there was"},{"speaker":"Chris Dy","startTime":1153.16,"endTime":1155.71,"body":"no literature to guys, I agree."},{"speaker":"Chris Dy","startTime":1153.16,"endTime":1155.71,"body":"There's no good clinical"},{"speaker":"Chris Dy","startTime":1155.98,"endTime":1160.12,"body":"literature, I think the paper"},{"speaker":"Chris Dy","startTime":1155.98,"endTime":1160.12,"body":"that I go back to a lot is more"},{"speaker":"Chris Dy","startTime":1160.12,"endTime":1163.54,"body":"of a mechanical biomechanical"},{"speaker":"Chris Dy","startTime":1160.12,"endTime":1163.54,"body":"one, in terms of looking at"},{"speaker":"Chris Dy","startTime":1163.54,"endTime":1167.35,"body":"loads of failure on a scaphoid,"},{"speaker":"Chris Dy","startTime":1163.54,"endTime":1167.35,"body":"you know, the intact scaphoid"},{"speaker":"Chris Dy","startTime":1167.35,"endTime":1171.91,"body":"versus one that's got an"},{"speaker":"Chris Dy","startTime":1167.35,"endTime":1171.91,"body":"osteotomy line of you know, you"},{"speaker":"Chris Dy","startTime":1171.91,"endTime":1176.2,"body":"know, 50% and 75% 25%. And then"},{"speaker":"Chris Dy","startTime":1171.91,"endTime":1176.2,"body":"with or without screw fixation,"},{"speaker":"Chris Dy","startTime":1176.65,"endTime":1179.65,"body":"and I think that the threshold"},{"speaker":"Chris Dy","startTime":1176.65,"endTime":1179.65,"body":"for me is if I've appreciate,"},{"speaker":"Chris Dy","startTime":1179.68,"endTime":1183.85,"body":"you know, probably about 50% of"},{"speaker":"Chris Dy","startTime":1179.68,"endTime":1183.85,"body":"bony healing with a screw in"},{"speaker":"Chris Dy","startTime":1183.85,"endTime":1186.73,"body":"place, and I'm more comfortable"},{"speaker":"Chris Dy","startTime":1183.85,"endTime":1186.73,"body":"treating it as if it was healed,"},{"speaker":"Chris Dy","startTime":1187.84,"endTime":1190.15,"body":"even without full bony"},{"speaker":"Chris Dy","startTime":1187.84,"endTime":1190.15,"body":"consolidation."},{"speaker":"Charles Goldfarb","startTime":1190.99,"endTime":1193.15,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1190.99,"endTime":1193.15,"body":"a really important point and,"},{"speaker":"Charles Goldfarb","startTime":1193.21,"endTime":1196.45,"body":"and number one, you got to get a"},{"speaker":"Charles Goldfarb","startTime":1193.21,"endTime":1196.45,"body":"CT scan to be able to quantify"},{"speaker":"Charles Goldfarb","startTime":1196.45,"endTime":1200.05,"body":"healing, and I've actually even"},{"speaker":"Charles Goldfarb","startTime":1196.45,"endTime":1200.05,"body":"dropped that number a little"},{"speaker":"Charles Goldfarb","startTime":1200.05,"endTime":1202.63,"body":"lower I think occasionally"},{"speaker":"Charles Goldfarb","startTime":1200.05,"endTime":1202.63,"body":"you'll see like 10%. To me,"},{"speaker":"Charles Goldfarb","startTime":1202.63,"endTime":1206.5,"body":"that's not enough. 20% probably"},{"speaker":"Charles Goldfarb","startTime":1202.63,"endTime":1206.5,"body":"not enough. But once you get"},{"speaker":"Charles Goldfarb","startTime":1206.53,"endTime":1211.66,"body":"past 30 to certainly 40% with a"},{"speaker":"Charles Goldfarb","startTime":1206.53,"endTime":1211.66,"body":"screw, I'll let them go and"},{"speaker":"Charles Goldfarb","startTime":1211.66,"endTime":1212.98,"body":"knock on wood I've never"},{"speaker":"Charles Goldfarb","startTime":1211.66,"endTime":1212.98,"body":"regretted."},{"speaker":"Chris Dy","startTime":1213.76,"endTime":1216.4,"body":"Yeah, I think that a"},{"speaker":"Chris Dy","startTime":1213.76,"endTime":1216.4,"body":"lot of times, some of our"},{"speaker":"Chris Dy","startTime":1216.4,"endTime":1219.04,"body":"radiology, radiology colleagues"},{"speaker":"Chris Dy","startTime":1216.4,"endTime":1219.04,"body":"don't appreciate what we're"},{"speaker":"Chris Dy","startTime":1219.04,"endTime":1222.64,"body":"trying to do, and we get this CT"},{"speaker":"Chris Dy","startTime":1219.04,"endTime":1222.64,"body":"scan, and they just, they tell"},{"speaker":"Chris Dy","startTime":1222.64,"endTime":1225.04,"body":"us that the bone isn't healed"},{"speaker":"Chris Dy","startTime":1222.64,"endTime":1225.04,"body":"yet. And that so I tend to"},{"speaker":"Chris Dy","startTime":1225.04,"endTime":1227.65,"body":"scrutinize these and see what I"},{"speaker":"Chris Dy","startTime":1225.04,"endTime":1227.65,"body":"feel comfortable getting away"},{"speaker":"Chris Dy","startTime":1227.65,"endTime":1230.8,"body":"with, I'm certainly not the best"},{"speaker":"Chris Dy","startTime":1227.65,"endTime":1230.8,"body":"at quantifying these things. And"},{"speaker":"Chris Dy","startTime":1230.8,"endTime":1232.75,"body":"there's probably room for"},{"speaker":"Chris Dy","startTime":1230.8,"endTime":1232.75,"body":"improvement in our communication"},{"speaker":"Chris Dy","startTime":1232.75,"endTime":1235.45,"body":"with the radiology team. But,"},{"speaker":"Chris Dy","startTime":1232.75,"endTime":1235.45,"body":"you know, I've really looked at"},{"speaker":"Chris Dy","startTime":1235.45,"endTime":1238.99,"body":"it and if I got to feel"},{"speaker":"Chris Dy","startTime":1235.45,"endTime":1238.99,"body":"comfortable knowing that this is"},{"speaker":"Chris Dy","startTime":1238.99,"endTime":1242.62,"body":"well on its way to healing. So"},{"speaker":"Chris Dy","startTime":1238.99,"endTime":1242.62,"body":"yeah, that those are the"},{"speaker":"Chris Dy","startTime":1242.62,"endTime":1246.37,"body":"concerns I have. But to bring it"},{"speaker":"Chris Dy","startTime":1242.62,"endTime":1246.37,"body":"back to this case, I actually"},{"speaker":"Chris Dy","startTime":1246.37,"endTime":1252.52,"body":"did recommend surgery for this"},{"speaker":"Chris Dy","startTime":1246.37,"endTime":1252.52,"body":"patient. And he declined. So"},{"speaker":"Chris Dy","startTime":1252.52,"endTime":1255.46,"body":"then we tried cast"},{"speaker":"Chris Dy","startTime":1252.52,"endTime":1255.46,"body":"immobilization, which the"},{"speaker":"Chris Dy","startTime":1255.46,"endTime":1261.16,"body":"patient did not comply with. So"},{"speaker":"Chris Dy","startTime":1255.46,"endTime":1261.16,"body":"you know, we decided at some"},{"speaker":"Chris Dy","startTime":1261.16,"endTime":1264.46,"body":"point to say, alright, if"},{"speaker":"Chris Dy","startTime":1261.16,"endTime":1264.46,"body":"you're, you don't want to wear a"},{"speaker":"Chris Dy","startTime":1264.46,"endTime":1267.52,"body":"cast, or do any immobilization,"},{"speaker":"Chris Dy","startTime":1264.46,"endTime":1267.52,"body":"and I'm certainly not going to"},{"speaker":"Chris Dy","startTime":1267.52,"endTime":1270.1,"body":"operate on you if you're not"},{"speaker":"Chris Dy","startTime":1267.52,"endTime":1270.1,"body":"going to be okay with"},{"speaker":"Chris Dy","startTime":1270.1,"endTime":1273.31,"body":"immobilization. So we're just"},{"speaker":"Chris Dy","startTime":1270.1,"endTime":1273.31,"body":"gonna let this ride. And you"},{"speaker":"Chris Dy","startTime":1273.31,"endTime":1275.98,"body":"know, at that age, are you okay"},{"speaker":"Chris Dy","startTime":1273.31,"endTime":1275.98,"body":"with saying, all right, you get"},{"speaker":"Chris Dy","startTime":1275.98,"endTime":1277.63,"body":"a snack rest when you get a"},{"speaker":"Chris Dy","startTime":1275.98,"endTime":1277.63,"body":"snack rest?"},{"speaker":"Charles Goldfarb","startTime":1278.59,"endTime":1280.03,"body":"Well, I was"},{"speaker":"Charles Goldfarb","startTime":1278.59,"endTime":1280.03,"body":"gonna say this is sort of a"},{"speaker":"Charles Goldfarb","startTime":1280.03,"endTime":1282.85,"body":"natural history study, because"},{"speaker":"Charles Goldfarb","startTime":1280.03,"endTime":1282.85,"body":"we have the we have some natural"},{"speaker":"Charles Goldfarb","startTime":1282.85,"endTime":1286.93,"body":"history knowledge from way back"},{"speaker":"Charles Goldfarb","startTime":1282.85,"endTime":1286.93,"body":"when it'd be great if you could"},{"speaker":"Charles Goldfarb","startTime":1286.96,"endTime":1290.29,"body":"keep us we went to podcasts is"},{"speaker":"Charles Goldfarb","startTime":1286.96,"endTime":1290.29,"body":"still going on and 10 years,"},{"speaker":"Charles Goldfarb","startTime":1290.29,"endTime":1291.76,"body":"it'd be great for an update."},{"speaker":"Chris Dy","startTime":1292.93,"endTime":1294.64,"body":"I don't know why. What"},{"speaker":"Chris Dy","startTime":1292.93,"endTime":1294.64,"body":"do you think this one, do you"},{"speaker":"Chris Dy","startTime":1294.64,"endTime":1297.28,"body":"think this maybe it's different"},{"speaker":"Chris Dy","startTime":1294.64,"endTime":1297.28,"body":"than a SLAC risk? Maybe it's"},{"speaker":"Chris Dy","startTime":1297.28,"endTime":1299.65,"body":"different. So escape would"},{"speaker":"Chris Dy","startTime":1297.28,"endTime":1299.65,"body":"escape for lunate ligament"},{"speaker":"Chris Dy","startTime":1299.68,"endTime":1301.96,"body":"injuries, leading to post"},{"speaker":"Chris Dy","startTime":1299.68,"endTime":1301.96,"body":"traumatic arthritis versus"},{"speaker":"Chris Dy","startTime":1301.96,"endTime":1304.66,"body":"escape with non union? You know,"},{"speaker":"Chris Dy","startTime":1301.96,"endTime":1304.66,"body":"there's the paper, I believe the"},{"speaker":"Chris Dy","startTime":1304.66,"endTime":1308.5,"body":"first author was Mack that"},{"speaker":"Chris Dy","startTime":1304.66,"endTime":1308.5,"body":"described as progression to"},{"speaker":"Chris Dy","startTime":1308.5,"endTime":1312.79,"body":"arthritis. But I think the what"},{"speaker":"Chris Dy","startTime":1308.5,"endTime":1312.79,"body":"we still don't know is how long"},{"speaker":"Chris Dy","startTime":1312.79,"endTime":1315.73,"body":"exactly it takes to get there."},{"speaker":"Chris Dy","startTime":1312.79,"endTime":1315.73,"body":"We know it's going to happen. At"},{"speaker":"Chris Dy","startTime":1315.73,"endTime":1318.7,"body":"some point, it seems to be the"},{"speaker":"Chris Dy","startTime":1315.73,"endTime":1318.7,"body":"progression to arthritis, to"},{"speaker":"Chris Dy","startTime":1318.7,"endTime":1322.54,"body":"post traumatic arthritis is"},{"speaker":"Chris Dy","startTime":1318.7,"endTime":1322.54,"body":"highly variable. And most"},{"speaker":"Chris Dy","startTime":1322.54,"endTime":1325.27,"body":"patients eventually do get"},{"speaker":"Chris Dy","startTime":1322.54,"endTime":1325.27,"body":"there. But you know, I don't"},{"speaker":"Chris Dy","startTime":1325.27,"endTime":1327.34,"body":"know what that timeline is. How"},{"speaker":"Chris Dy","startTime":1325.27,"endTime":1327.34,"body":"do you counsel patients about"},{"speaker":"Chris Dy","startTime":1327.34,"endTime":1327.64,"body":"that?"},{"speaker":"Charles Goldfarb","startTime":1328.36,"endTime":1331.6,"body":"Well, just to"},{"speaker":"Charles Goldfarb","startTime":1328.36,"endTime":1331.6,"body":"follow up once you said it was"},{"speaker":"Charles Goldfarb","startTime":1331.6,"endTime":1335.44,"body":"Mack it was Mack and Gelberman."},{"speaker":"Charles Goldfarb","startTime":1331.6,"endTime":1335.44,"body":"And to make us all feel really"},{"speaker":"Charles Goldfarb","startTime":1335.44,"endTime":1340.21,"body":"old, or at least me it was 1984."},{"speaker":"Charles Goldfarb","startTime":1335.44,"endTime":1340.21,"body":"And so you know that that's a"},{"speaker":"Charles Goldfarb","startTime":1340.21,"endTime":1345.85,"body":"lot, and I honestly think is 10"},{"speaker":"Charles Goldfarb","startTime":1340.21,"endTime":1345.85,"body":"to 20 years. But I don't know,"},{"speaker":"Charles Goldfarb","startTime":1345.88,"endTime":1348.67,"body":"you know, thankfully, at least"},{"speaker":"Charles Goldfarb","startTime":1345.88,"endTime":1348.67,"body":"in my part patient population,"},{"speaker":"Charles Goldfarb","startTime":1348.67,"endTime":1352.9,"body":"most would choose proactive"},{"speaker":"Charles Goldfarb","startTime":1348.67,"endTime":1352.9,"body":"surgery. But I think it's a"},{"speaker":"Charles Goldfarb","startTime":1352.9,"endTime":1358.96,"body":"while and so, you know, 55 is? I"},{"speaker":"Charles Goldfarb","startTime":1352.9,"endTime":1358.96,"body":"think he says 55 is is not"},{"speaker":"Charles Goldfarb","startTime":1361.36,"endTime":1365.5,"body":"I'm not there yet, but it is"},{"speaker":"Charles Goldfarb","startTime":1361.36,"endTime":1365.5,"body":"young. Oh, so yeah, I think it's"},{"speaker":"Charles Goldfarb","startTime":1365.5,"endTime":1367.9,"body":"fine. And look, he's made his"},{"speaker":"Charles Goldfarb","startTime":1365.5,"endTime":1367.9,"body":"choice. And so we'll see what"},{"speaker":"Charles Goldfarb","startTime":1367.9,"endTime":1370.96,"body":"happens. And then if let's say"},{"speaker":"Charles Goldfarb","startTime":1367.9,"endTime":1370.96,"body":"he does come back and he's"},{"speaker":"Charles Goldfarb","startTime":1370.96,"endTime":1373.69,"body":"having pain, you know, be could"},{"speaker":"Charles Goldfarb","startTime":1370.96,"endTime":1373.69,"body":"be a candidate for distal pole"},{"speaker":"Charles Goldfarb","startTime":1373.69,"endTime":1377.5,"body":"excision only without doing a"},{"speaker":"Charles Goldfarb","startTime":1373.69,"endTime":1377.5,"body":"more significant operation."},{"speaker":"Chris Dy","startTime":1377.989,"endTime":1382.069,"body":"So he comes back. He's"},{"speaker":"Chris Dy","startTime":1377.989,"endTime":1382.069,"body":"already back because he fell"},{"speaker":"Chris Dy","startTime":1382.069,"endTime":1387.979,"body":"again. And his skateboard"},{"speaker":"Chris Dy","startTime":1382.069,"endTime":1387.979,"body":"fracture is still displaced, but"},{"speaker":"Chris Dy","startTime":1387.979,"endTime":1392.659,"body":"not angulated in the sagittal."},{"speaker":"Chris Dy","startTime":1387.979,"endTime":1392.659,"body":"Plane. Do you have the same"},{"speaker":"Chris Dy","startTime":1392.659,"endTime":1396.949,"body":"conversation again? Now his"},{"speaker":"Chris Dy","startTime":1392.659,"endTime":1396.949,"body":"wife's with him? She's, she's"},{"speaker":"Chris Dy","startTime":1396.949,"endTime":1400.639,"body":"there to cajole him and talk to"},{"speaker":"Chris Dy","startTime":1396.949,"endTime":1400.639,"body":"him about you know, what the"},{"speaker":"Chris Dy","startTime":1400.639,"endTime":1404.359,"body":"options are? How do you counsel"},{"speaker":"Chris Dy","startTime":1400.639,"endTime":1404.359,"body":"this patient? Now? He does. And"},{"speaker":"Chris Dy","startTime":1404.359,"endTime":1406.399,"body":"he's not developed any"},{"speaker":"Chris Dy","startTime":1404.359,"endTime":1406.399,"body":"arthritis, which of course, you"},{"speaker":"Chris Dy","startTime":1406.399,"endTime":1408.349,"body":"wouldn't expect in such a short"},{"speaker":"Chris Dy","startTime":1406.399,"endTime":1408.349,"body":"amount of time. But that is an"},{"speaker":"Chris Dy","startTime":1408.349,"endTime":1412.309,"body":"important thing. He doesn't have"},{"speaker":"Chris Dy","startTime":1408.349,"endTime":1412.309,"body":"any beekley at his styloid. He's"},{"speaker":"Chris Dy","startTime":1412.549,"endTime":1414.499,"body":"basically got a scaphoid"},{"speaker":"Chris Dy","startTime":1412.549,"endTime":1414.499,"body":"fracture that hasn't healed it's"},{"speaker":"Chris Dy","startTime":1414.499,"endTime":1415.249,"body":"got a nonunion"},{"speaker":"Charles Goldfarb","startTime":1416.03,"endTime":1418.22,"body":"when you think"},{"speaker":"Charles Goldfarb","startTime":1416.03,"endTime":1418.22,"body":"he came back, because somehow or"},{"speaker":"Charles Goldfarb","startTime":1418.22,"endTime":1421.76,"body":"another with the fall, he"},{"speaker":"Charles Goldfarb","startTime":1418.22,"endTime":1421.76,"body":"irritated the servant? Yeah."},{"speaker":"Charles Goldfarb","startTime":1423.59,"endTime":1428.84,"body":"Yes, because his wife is with"},{"speaker":"Charles Goldfarb","startTime":1423.59,"endTime":1428.84,"body":"him. I give them the talk again,"},{"speaker":"Charles Goldfarb","startTime":1428.84,"endTime":1431.96,"body":"and I don't probably hold back"},{"speaker":"Charles Goldfarb","startTime":1428.84,"endTime":1431.96,"body":"too much. I would say that when"},{"speaker":"Charles Goldfarb","startTime":1431.96,"endTime":1434.6,"body":"we spoke before I recommended"},{"speaker":"Charles Goldfarb","startTime":1431.96,"endTime":1434.6,"body":"surgical intervention, because"},{"speaker":"Charles Goldfarb","startTime":1434.6,"endTime":1437.48,"body":"I'm concerned, you're not going"},{"speaker":"Charles Goldfarb","startTime":1434.6,"endTime":1437.48,"body":"to heal and that will"},{"speaker":"Charles Goldfarb","startTime":1437.48,"endTime":1440.18,"body":"indefinite, that will certainly"},{"speaker":"Charles Goldfarb","startTime":1437.48,"endTime":1440.18,"body":"lead to arthritis. I just don't"},{"speaker":"Charles Goldfarb","startTime":1440.18,"endTime":1442.85,"body":"know when. And then if he and"},{"speaker":"Charles Goldfarb","startTime":1440.18,"endTime":1442.85,"body":"his wife agree, they still don't"},{"speaker":"Charles Goldfarb","startTime":1442.85,"endTime":1446.6,"body":"want to do anything then. And"},{"speaker":"Charles Goldfarb","startTime":1442.85,"endTime":1446.6,"body":"they can go away again, I guess."},{"speaker":"Chris Dy","startTime":1446.96,"endTime":1449.63,"body":"So in this situation,"},{"speaker":"Chris Dy","startTime":1446.96,"endTime":1449.63,"body":"do you if you offer surgery and"},{"speaker":"Chris Dy","startTime":1449.63,"endTime":1452.84,"body":"you're counseling them? How long"},{"speaker":"Chris Dy","startTime":1449.63,"endTime":1452.84,"body":"do you tell them that they've"},{"speaker":"Chris Dy","startTime":1452.84,"endTime":1455.45,"body":"got to really back off on"},{"speaker":"Chris Dy","startTime":1452.84,"endTime":1455.45,"body":"activities, so not just the"},{"speaker":"Chris Dy","startTime":1455.45,"endTime":1458.33,"body":"mobilization but like know,"},{"speaker":"Chris Dy","startTime":1455.45,"endTime":1458.33,"body":"doing all the things around the"},{"speaker":"Chris Dy","startTime":1458.33,"endTime":1460.82,"body":"house and the yard and"},{"speaker":"Chris Dy","startTime":1458.33,"endTime":1460.82,"body":"everything that you know, he"},{"speaker":"Chris Dy","startTime":1460.82,"endTime":1461.48,"body":"wants to do?"},{"speaker":"Charles Goldfarb","startTime":1462.11,"endTime":1464.36,"body":"So at this"},{"speaker":"Charles Goldfarb","startTime":1462.11,"endTime":1464.36,"body":"point, he has a skateboard waist"},{"speaker":"Charles Goldfarb","startTime":1464.36,"endTime":1468.38,"body":"fracture, which is minimally"},{"speaker":"Charles Goldfarb","startTime":1464.36,"endTime":1468.38,"body":"displaced, but is a clear non"},{"speaker":"Charles Goldfarb","startTime":1468.38,"endTime":1469.01,"body":"union,"},{"speaker":"Chris Dy","startTime":1469.34,"endTime":1471.92,"body":"not like FDA"},{"speaker":"Chris Dy","startTime":1469.34,"endTime":1471.92,"body":"definition of non union, but"},{"speaker":"Chris Dy","startTime":1471.92,"endTime":1475.04,"body":"it's a non union. Yeah. And you"},{"speaker":"Chris Dy","startTime":1471.92,"endTime":1475.04,"body":"can actually see a little bit of"},{"speaker":"Chris Dy","startTime":1475.46,"endTime":1477.17,"body":"sclerosis on the X ray."},{"speaker":"Charles Goldfarb","startTime":1477.77,"endTime":1479.09,"body":"I would"},{"speaker":"Charles Goldfarb","startTime":1477.77,"endTime":1479.09,"body":"probably put the three month"},{"speaker":"Charles Goldfarb","startTime":1479.09,"endTime":1482.15,"body":"number out there because I while"},{"speaker":"Charles Goldfarb","startTime":1479.09,"endTime":1482.15,"body":"out and I think there's a chance"},{"speaker":"Charles Goldfarb","startTime":1482.39,"endTime":1486.08,"body":"there'll be healed or healing at"},{"speaker":"Charles Goldfarb","startTime":1482.39,"endTime":1486.08,"body":"eight weeks and I can tell you"},{"speaker":"Charles Goldfarb","startTime":1486.08,"endTime":1488.6,"body":"how I think about doing the"},{"speaker":"Charles Goldfarb","startTime":1486.08,"endTime":1488.6,"body":"surgery, but I'd love to hear"},{"speaker":"Charles Goldfarb","startTime":1488.6,"endTime":1491.03,"body":"what you might have done. But I"},{"speaker":"Charles Goldfarb","startTime":1488.6,"endTime":1491.03,"body":"would say three months that"},{"speaker":"Charles Goldfarb","startTime":1491.03,"endTime":1493.43,"body":"would be my answer, even though"},{"speaker":"Charles Goldfarb","startTime":1491.03,"endTime":1493.43,"body":"I hope it will be shorter."},{"speaker":"Chris Dy","startTime":1493.97,"endTime":1496.19,"body":"Good. Well, I've been"},{"speaker":"Chris Dy","startTime":1493.97,"endTime":1496.19,"body":"trained well, because I told I"},{"speaker":"Chris Dy","startTime":1496.19,"endTime":1499.7,"body":"told them three months. Backing"},{"speaker":"Chris Dy","startTime":1496.19,"endTime":1499.7,"body":"off on all activities. I told"},{"speaker":"Chris Dy","startTime":1499.7,"endTime":1501.59,"body":"him to look He had the better"},{"speaker":"Chris Dy","startTime":1499.7,"endTime":1501.59,"body":"part of two months, if not"},{"speaker":"Chris Dy","startTime":1501.59,"endTime":1506.72,"body":"longer for immobilization. And,"},{"speaker":"Chris Dy","startTime":1501.59,"endTime":1506.72,"body":"you know, it's interesting, his"},{"speaker":"Chris Dy","startTime":1506.72,"endTime":1509.99,"body":"wife quoted that number back to"},{"speaker":"Chris Dy","startTime":1506.72,"endTime":1509.99,"body":"me. And when I was talking to"},{"speaker":"Chris Dy","startTime":1509.99,"endTime":1512.66,"body":"her after surgery saying,"},{"speaker":"Chris Dy","startTime":1509.99,"endTime":1512.66,"body":"remember three months, tell him"},{"speaker":"Chris Dy","startTime":1512.66,"endTime":1514.85,"body":"three months, I was like, Okay,"},{"speaker":"Chris Dy","startTime":1512.66,"endTime":1514.85,"body":"you tell them three months?"},{"speaker":"Chris Dy","startTime":1517.88,"endTime":1520.19,"body":"Well, I mean, so I wanted to"},{"speaker":"Chris Dy","startTime":1517.88,"endTime":1520.19,"body":"make sure that it wasn't a"},{"speaker":"Chris Dy","startTime":1520.19,"endTime":1523.13,"body":"proximal pole, it was a waste."},{"speaker":"Chris Dy","startTime":1520.19,"endTime":1523.13,"body":"But you know, just to make very"},{"speaker":"Chris Dy","startTime":1523.13,"endTime":1526.16,"body":"sure I got some advanced"},{"speaker":"Chris Dy","startTime":1523.13,"endTime":1526.16,"body":"imaging, because I wanted to"},{"speaker":"Chris Dy","startTime":1526.19,"endTime":1531.53,"body":"ensure the viability of the"},{"speaker":"Chris Dy","startTime":1526.19,"endTime":1531.53,"body":"proximal pole. So for me, that's"},{"speaker":"Chris Dy","startTime":1531.53,"endTime":1533.9,"body":"an MRI, although I think you"},{"speaker":"Chris Dy","startTime":1531.53,"endTime":1533.9,"body":"could get a lot of that"},{"speaker":"Chris Dy","startTime":1533.9,"endTime":1537.29,"body":"information on the CT, I wasn't"},{"speaker":"Chris Dy","startTime":1533.9,"endTime":1537.29,"body":"as worried about pre op planning"},{"speaker":"Chris Dy","startTime":1537.29,"endTime":1540.38,"body":"for bony alignment, because it"},{"speaker":"Chris Dy","startTime":1537.29,"endTime":1540.38,"body":"was not angulated, there was no"},{"speaker":"Chris Dy","startTime":1540.38,"endTime":1543.11,"body":"humpback deformity. So I don't"},{"speaker":"Chris Dy","startTime":1540.38,"endTime":1543.11,"body":"think a CT was going to add a"},{"speaker":"Chris Dy","startTime":1543.11,"endTime":1546.95,"body":"whole lot in that respect. So I"},{"speaker":"Chris Dy","startTime":1543.11,"endTime":1546.95,"body":"got an MRI. And I don't know if"},{"speaker":"Chris Dy","startTime":1546.95,"endTime":1549.17,"body":"you would have gotten any other"},{"speaker":"Chris Dy","startTime":1546.95,"endTime":1549.17,"body":"imaging or just gone off with"},{"speaker":"Chris Dy","startTime":1549.17,"endTime":1551.54,"body":"the X rays, or whether you would"},{"speaker":"Chris Dy","startTime":1549.17,"endTime":1551.54,"body":"have gotten a CT, but the"},{"speaker":"Chris Dy","startTime":1551.54,"endTime":1552.68,"body":"proximal pole was viable."},{"speaker":"Charles Goldfarb","startTime":1553.61,"endTime":1555.35,"body":"Yeah, so I"},{"speaker":"Charles Goldfarb","startTime":1553.61,"endTime":1555.35,"body":"would not have gotten any other"},{"speaker":"Charles Goldfarb","startTime":1555.35,"endTime":1559.82,"body":"imaging. And I would approach"},{"speaker":"Charles Goldfarb","startTime":1555.35,"endTime":1559.82,"body":"this dorsally with a small"},{"speaker":"Charles Goldfarb","startTime":1559.82,"endTime":1565.58,"body":"incision. And if I don't have to"},{"speaker":"Charles Goldfarb","startTime":1559.82,"endTime":1565.58,"body":"do any reduction, or minimal"},{"speaker":"Charles Goldfarb","startTime":1565.58,"endTime":1568.7,"body":"reduction, then I would have a"},{"speaker":"Charles Goldfarb","startTime":1565.58,"endTime":1568.7,"body":"very small one to two cent range"},{"speaker":"Charles Goldfarb","startTime":1568.7,"endTime":1571.73,"body":"decision. And I'd use some just"},{"speaker":"Charles Goldfarb","startTime":1568.7,"endTime":1571.73,"body":"raise bone graft down the drill"},{"speaker":"Charles Goldfarb","startTime":1571.73,"endTime":1572.06,"body":"hole."},{"speaker":"Chris Dy","startTime":1573.23,"endTime":1576.98,"body":"What do you take down"},{"speaker":"Chris Dy","startTime":1573.23,"endTime":1576.98,"body":"the non union and evolution site"},{"speaker":"Charles Goldfarb","startTime":1577.49,"endTime":1579.38,"body":"and that"},{"speaker":"Charles Goldfarb","startTime":1577.49,"endTime":1579.38,"body":"typically do not it would have"},{"speaker":"Charles Goldfarb","startTime":1579.38,"endTime":1584.87,"body":"to be fit was displaced to a"},{"speaker":"Charles Goldfarb","startTime":1579.38,"endTime":1584.87,"body":"visible degree than I would have"},{"speaker":"Charles Goldfarb","startTime":1584.87,"endTime":1588.29,"body":"to do that. And I still think"},{"speaker":"Charles Goldfarb","startTime":1584.87,"endTime":1588.29,"body":"you can go dorsally as long as"},{"speaker":"Charles Goldfarb","startTime":1588.29,"endTime":1592.97,"body":"you're proximal to the dorsal"},{"speaker":"Charles Goldfarb","startTime":1588.29,"endTime":1592.97,"body":"ridge with the blood supply. But"},{"speaker":"Charles Goldfarb","startTime":1592.97,"endTime":1595.94,"body":"if it's pretty close to"},{"speaker":"Charles Goldfarb","startTime":1592.97,"endTime":1595.94,"body":"anatomical or minimally"},{"speaker":"Charles Goldfarb","startTime":1595.94,"endTime":1598.61,"body":"displaced, or if I can"},{"speaker":"Charles Goldfarb","startTime":1595.94,"endTime":1598.61,"body":"manipulate it, then I would not"},{"speaker":"Charles Goldfarb","startTime":1598.61,"endTime":1599.18,"body":"take it down."},{"speaker":"Chris Dy","startTime":1599.539,"endTime":1602.509,"body":"The interesting this"},{"speaker":"Chris Dy","startTime":1599.539,"endTime":1602.509,"body":"one was not there was not a lot"},{"speaker":"Chris Dy","startTime":1602.509,"endTime":1607.099,"body":"of reduction, but it was gapped."},{"speaker":"Chris Dy","startTime":1602.509,"endTime":1607.099,"body":"So there was a pretty clear non"},{"speaker":"Chris Dy","startTime":1607.099,"endTime":1611.419,"body":"union gap. You know, and you"},{"speaker":"Chris Dy","startTime":1607.099,"endTime":1611.419,"body":"know, I guess I veered from the"},{"speaker":"Chris Dy","startTime":1611.419,"endTime":1614.569,"body":"wonderful training that you gave"},{"speaker":"Chris Dy","startTime":1611.419,"endTime":1614.569,"body":"me and made a real incision"},{"speaker":"Chris Dy","startTime":1615.259,"endTime":1617.569,"body":"because I was going to harvest"},{"speaker":"Chris Dy","startTime":1615.259,"endTime":1617.569,"body":"distal radius through the same"},{"speaker":"Chris Dy","startTime":1617.569,"endTime":1619.549,"body":"incision distal radius"},{"speaker":"Chris Dy","startTime":1617.569,"endTime":1619.549,"body":"cancellous autograft through the"},{"speaker":"Chris Dy","startTime":1619.549,"endTime":1622.969,"body":"same incision, you know, in the"},{"speaker":"Chris Dy","startTime":1619.549,"endTime":1622.969,"body":"absence of any you know, lack of"},{"speaker":"Chris Dy","startTime":1622.969,"endTime":1625.579,"body":"viability, the question of"},{"speaker":"Chris Dy","startTime":1622.969,"endTime":1625.579,"body":"viability for the proximal well"},{"speaker":"Chris Dy","startTime":1625.579,"endTime":1628.669,"body":"I did not think doing something"},{"speaker":"Chris Dy","startTime":1625.579,"endTime":1628.669,"body":"vascularized either paddock gold"},{"speaker":"Chris Dy","startTime":1628.669,"endTime":1631.699,"body":"or something crazy and then that"},{"speaker":"Chris Dy","startTime":1628.669,"endTime":1631.699,"body":"was necessary. I think there are"},{"speaker":"Chris Dy","startTime":1631.699,"endTime":1635.599,"body":"a lot of papers demonstrating"},{"speaker":"Chris Dy","startTime":1631.699,"endTime":1635.599,"body":"now that you can heal many"},{"speaker":"Chris Dy","startTime":1635.599,"endTime":1639.739,"body":"things with good carpentry and"},{"speaker":"Chris Dy","startTime":1635.599,"endTime":1639.739,"body":"and you know, not using paddock"},{"speaker":"Chris Dy","startTime":1639.739,"endTime":1644.329,"body":"gold or vascularized graft. So"},{"speaker":"Chris Dy","startTime":1639.739,"endTime":1644.329,"body":"this was, you know, can you tell"},{"speaker":"Chris Dy","startTime":1644.329,"endTime":1646.999,"body":"us autographed harvested from"},{"speaker":"Chris Dy","startTime":1644.329,"endTime":1646.999,"body":"the metathesis of the distal"},{"speaker":"Chris Dy","startTime":1646.999,"endTime":1647.509,"body":"radius."},{"speaker":"Charles Goldfarb","startTime":1648.41,"endTime":1650.21,"body":"I love it."},{"speaker":"Charles Goldfarb","startTime":1648.41,"endTime":1650.21,"body":"That's that's what I would have"},{"speaker":"Charles Goldfarb","startTime":1650.21,"endTime":1652.82,"body":"done and I'm not I'm not against"},{"speaker":"Charles Goldfarb","startTime":1650.21,"endTime":1652.82,"body":"a larger incision as long as you"},{"speaker":"Charles Goldfarb","startTime":1652.82,"endTime":1655.01,"body":"protect the blood supply, but I"},{"speaker":"Charles Goldfarb","startTime":1652.82,"endTime":1655.01,"body":"think you can get away with all"},{"speaker":"Charles Goldfarb","startTime":1655.01,"endTime":1658.55,"body":"of that through a smaller"},{"speaker":"Charles Goldfarb","startTime":1655.01,"endTime":1658.55,"body":"incision. I will say"},{"speaker":"Chris Dy","startTime":1658.76,"endTime":1660.62,"body":"I want to ask you"},{"speaker":"Chris Dy","startTime":1658.76,"endTime":1660.62,"body":"something, okay, because people"},{"speaker":"Chris Dy","startTime":1660.62,"endTime":1664.52,"body":"love the technical stuff. So"},{"speaker":"Chris Dy","startTime":1660.62,"endTime":1664.52,"body":"we've had some kind of quick"},{"speaker":"Chris Dy","startTime":1664.52,"endTime":1668.06,"body":"conversations in conference"},{"speaker":"Chris Dy","startTime":1664.52,"endTime":1668.06,"body":"about how to harvest just a"},{"speaker":"Chris Dy","startTime":1668.06,"endTime":1670.82,"body":"radius can sell us autographed,"},{"speaker":"Chris Dy","startTime":1668.06,"endTime":1670.82,"body":"I want to know the chuck"},{"speaker":"Chris Dy","startTime":1670.82,"endTime":1674.12,"body":"Goldfarb, a fruit protocol of"},{"speaker":"Chris Dy","startTime":1670.82,"endTime":1674.12,"body":"how you how you harvest the"},{"speaker":"Chris Dy","startTime":1674.12,"endTime":1676.49,"body":"graft. And I can say if I have"},{"speaker":"Chris Dy","startTime":1674.12,"endTime":1676.49,"body":"any differences from that,"},{"speaker":"Charles Goldfarb","startTime":1676.88,"endTime":1678.44,"body":"for sure, I'll"},{"speaker":"Charles Goldfarb","startTime":1676.88,"endTime":1678.44,"body":"give you that and I'll give you"},{"speaker":"Charles Goldfarb","startTime":1678.44,"endTime":1683.36,"body":"a technical Pearl for the screw."},{"speaker":"Charles Goldfarb","startTime":1678.44,"endTime":1683.36,"body":"So I make a very small incision"},{"speaker":"Charles Goldfarb","startTime":1683.36,"endTime":1687.53,"body":"again, one to one and a half"},{"speaker":"Charles Goldfarb","startTime":1683.36,"endTime":1687.53,"body":"centimeters, which is roughly at"},{"speaker":"Charles Goldfarb","startTime":1687.53,"endTime":1691.19,"body":"listeners just owner to listen"},{"speaker":"Charles Goldfarb","startTime":1687.53,"endTime":1691.19,"body":"to the listener so it seems a"},{"speaker":"Charles Goldfarb","startTime":1691.19,"endTime":1694.07,"body":"little proximal and may seem a"},{"speaker":"Charles Goldfarb","startTime":1691.19,"endTime":1694.07,"body":"little older, but when you flex"},{"speaker":"Charles Goldfarb","startTime":1694.07,"endTime":1697.01,"body":"the wrist, it's in exactly the"},{"speaker":"Charles Goldfarb","startTime":1694.07,"endTime":1697.01,"body":"right spot. Now through that"},{"speaker":"Charles Goldfarb","startTime":1697.01,"endTime":1700.97,"body":"incision I can place my que were"},{"speaker":"Charles Goldfarb","startTime":1697.01,"endTime":1700.97,"body":"in place my screw and I can also"},{"speaker":"Charles Goldfarb","startTime":1701.03,"endTime":1704.84,"body":"retract the skin easily to"},{"speaker":"Charles Goldfarb","startTime":1701.03,"endTime":1704.84,"body":"listeners when I harvest can"},{"speaker":"Charles Goldfarb","startTime":1704.84,"endTime":1710.3,"body":"sell us bone grab dorsally I"},{"speaker":"Charles Goldfarb","startTime":1704.84,"endTime":1710.3,"body":"make sure to stay proximal and"},{"speaker":"Charles Goldfarb","startTime":1710.3,"endTime":1714.41,"body":"radio to listeners are kind of"},{"speaker":"Charles Goldfarb","startTime":1710.3,"endTime":1714.41,"body":"right at that proximal radial"},{"speaker":"Charles Goldfarb","startTime":1714.41,"endTime":1717.32,"body":"corner of listers. And the"},{"speaker":"Charles Goldfarb","startTime":1714.41,"endTime":1717.32,"body":"reason I do that is I've seen"},{"speaker":"Charles Goldfarb","startTime":1717.32,"endTime":1721.04,"body":"ruptures of the EPL when that is"},{"speaker":"Charles Goldfarb","startTime":1717.32,"endTime":1721.04,"body":"not respected. So in other"},{"speaker":"Charles Goldfarb","startTime":1721.04,"endTime":1724.61,"body":"words, if you just take arranger"},{"speaker":"Charles Goldfarb","startTime":1721.04,"endTime":1724.61,"body":"and crunch off listers, I think"},{"speaker":"Charles Goldfarb","startTime":1724.61,"endTime":1727.43,"body":"you can create a little bit of a"},{"speaker":"Charles Goldfarb","startTime":1724.61,"endTime":1727.43,"body":"problem with your EPL so I don't"},{"speaker":"Charles Goldfarb","startTime":1727.43,"endTime":1730.82,"body":"do that and knock on wood. I"},{"speaker":"Charles Goldfarb","startTime":1727.43,"endTime":1730.82,"body":"haven't had any problems with"},{"speaker":"Charles Goldfarb","startTime":1730.82,"endTime":1734.36,"body":"attendance and then it's just I"},{"speaker":"Charles Goldfarb","startTime":1730.82,"endTime":1734.36,"body":"use a small carrot as like a"},{"speaker":"Charles Goldfarb","startTime":1734.36,"endTime":1739.04,"body":"drill and then a bigger caret to"},{"speaker":"Charles Goldfarb","startTime":1734.36,"endTime":1739.04,"body":"harvest the bone graft. So"},{"speaker":"Charles Goldfarb","startTime":1739.04,"endTime":1742.49,"body":"that's my bone graft harvest"},{"speaker":"Charles Goldfarb","startTime":1739.04,"endTime":1742.49,"body":"technique. How do you do it?"},{"speaker":"Chris Dy","startTime":1743.45,"endTime":1745.37,"body":"Um, you know, I've"},{"speaker":"Chris Dy","startTime":1743.45,"endTime":1745.37,"body":"heard the cautionary tales from"},{"speaker":"Chris Dy","startTime":1745.37,"endTime":1748.07,"body":"you and Marty and Ryan and"},{"speaker":"Chris Dy","startTime":1745.37,"endTime":1748.07,"body":"conference about you know,"},{"speaker":"Chris Dy","startTime":1748.1,"endTime":1751.25,"body":"potential compromise of the EPL."},{"speaker":"Chris Dy","startTime":1748.1,"endTime":1751.25,"body":"I think it is kind of similar to"},{"speaker":"Chris Dy","startTime":1751.25,"endTime":1753.44,"body":"the attritional rupture that you"},{"speaker":"Chris Dy","startTime":1751.25,"endTime":1753.44,"body":"see after a distal radius"},{"speaker":"Chris Dy","startTime":1753.44,"endTime":1755.99,"body":"fracture, you know, with"},{"speaker":"Chris Dy","startTime":1753.44,"endTime":1755.99,"body":"disruption to the metathesis by"},{"speaker":"Chris Dy","startTime":1755.99,"endTime":1759.44,"body":"listers and potentially a water"},{"speaker":"Chris Dy","startTime":1755.99,"endTime":1759.44,"body":"zone area on the EPO, you know,"},{"speaker":"Chris Dy","startTime":1759.44,"endTime":1763.43,"body":"on the EPL tendon itself. So I"},{"speaker":"Chris Dy","startTime":1759.44,"endTime":1763.43,"body":"actually go under, I make a"},{"speaker":"Chris Dy","startTime":1763.43,"endTime":1766.7,"body":"bigger incision admittedly and"},{"speaker":"Chris Dy","startTime":1763.43,"endTime":1766.7,"body":"or I'll make a separate incision"},{"speaker":"Chris Dy","startTime":1766.7,"endTime":1770.36,"body":"if I'm trying to be cute with"},{"speaker":"Chris Dy","startTime":1766.7,"endTime":1770.36,"body":"the dorsal wrist incision. And I"},{"speaker":"Chris Dy","startTime":1770.36,"endTime":1773.9,"body":"go under the second compartment"},{"speaker":"Chris Dy","startTime":1770.36,"endTime":1773.9,"body":"actually make I look at the EPL"},{"speaker":"Chris Dy","startTime":1773.9,"endTime":1778.55,"body":"course and I stay way radial to"},{"speaker":"Chris Dy","startTime":1773.9,"endTime":1778.55,"body":"it and proximal to it. I look"},{"speaker":"Chris Dy","startTime":1778.55,"endTime":1780.86,"body":"for my second compartment so I'm"},{"speaker":"Chris Dy","startTime":1778.55,"endTime":1780.86,"body":"usually mobilizing my second"},{"speaker":"Chris Dy","startTime":1780.86,"endTime":1783.95,"body":"compartment anyway to get access"},{"speaker":"Chris Dy","startTime":1780.86,"endTime":1783.95,"body":"to my wrist. I go under the"},{"speaker":"Chris Dy","startTime":1783.95,"endTime":1786.89,"body":"second compartment. I actually"},{"speaker":"Chris Dy","startTime":1783.95,"endTime":1786.89,"body":"use K wires to make myself a"},{"speaker":"Chris Dy","startTime":1786.89,"endTime":1793.07,"body":"little window. It turns open up"},{"speaker":"Chris Dy","startTime":1786.89,"endTime":1793.07,"body":"the window. i i I found it to be"},{"speaker":"Chris Dy","startTime":1793.67,"endTime":1796.79,"body":"add extra operative time and be"},{"speaker":"Chris Dy","startTime":1793.67,"endTime":1796.79,"body":"a little frustrating especially"},{"speaker":"Chris Dy","startTime":1796.79,"endTime":1799.55,"body":"if somebody else is doing the"},{"speaker":"Chris Dy","startTime":1796.79,"endTime":1799.55,"body":"scooping and I'm having to watch"},{"speaker":"Chris Dy","startTime":1799.55,"endTime":1804.32,"body":"them screw through a small"},{"speaker":"Chris Dy","startTime":1799.55,"endTime":1804.32,"body":"window, a bigger window, I allow"},{"speaker":"Chris Dy","startTime":1804.32,"endTime":1806.99,"body":"the trainee to harvest as much"},{"speaker":"Chris Dy","startTime":1804.32,"endTime":1806.99,"body":"as I can, they can from their"},{"speaker":"Chris Dy","startTime":1806.99,"endTime":1810.62,"body":"side, I inevitably, because I'm"},{"speaker":"Chris Dy","startTime":1806.99,"endTime":1810.62,"body":"coming from a different angle, I"},{"speaker":"Chris Dy","startTime":1810.62,"endTime":1813.44,"body":"remind them that I'm going to"},{"speaker":"Chris Dy","startTime":1810.62,"endTime":1813.44,"body":"harvest more than they did, and"},{"speaker":"Chris Dy","startTime":1813.8,"endTime":1817.97,"body":"harvest a fair bit. And then I"},{"speaker":"Chris Dy","startTime":1813.8,"endTime":1817.97,"body":"put some gel foam into the into"},{"speaker":"Chris Dy","startTime":1817.97,"endTime":1822.17,"body":"the area where were harvested in"},{"speaker":"Chris Dy","startTime":1817.97,"endTime":1822.17,"body":"the metathesis, mainly for make"},{"speaker":"Chris Dy","startTime":1822.17,"endTime":1824.93,"body":"me feel better potentially about"},{"speaker":"Chris Dy","startTime":1822.17,"endTime":1824.93,"body":"hemostasis that tried to close"},{"speaker":"Chris Dy","startTime":1824.93,"endTime":1828.05,"body":"the cortical trapdoor if I can"},{"speaker":"Chris Dy","startTime":1824.93,"endTime":1828.05,"body":"not close it, but put it back"},{"speaker":"Chris Dy","startTime":1828.05,"endTime":1830.93,"body":"down, although I don't think"},{"speaker":"Chris Dy","startTime":1828.05,"endTime":1830.93,"body":"that's a critical part of it."},{"speaker":"Charles Goldfarb","startTime":1831.23,"endTime":1833.48,"body":"So listeners,"},{"speaker":"Charles Goldfarb","startTime":1831.23,"endTime":1833.48,"body":"this is a fundamental difference"},{"speaker":"Charles Goldfarb","startTime":1833.48,"endTime":1839.06,"body":"between Chris and myself. I go"},{"speaker":"Charles Goldfarb","startTime":1833.48,"endTime":1839.06,"body":"for simple, effective and fast."},{"speaker":"Charles Goldfarb","startTime":1839.15,"endTime":1842.9,"body":"And Chris goes for expensive,"},{"speaker":"Charles Goldfarb","startTime":1839.15,"endTime":1842.9,"body":"time consuming and elegant."},{"speaker":"Chris Dy","startTime":1843.08,"endTime":1845.66,"body":"Yeah, well, I don't"},{"speaker":"Chris Dy","startTime":1843.08,"endTime":1845.66,"body":"think that gel foam was very"},{"speaker":"Chris Dy","startTime":1845.66,"endTime":1847.52,"body":"expensive. And I have no"},{"speaker":"Chris Dy","startTime":1845.66,"endTime":1847.52,"body":"conflict of interest in"},{"speaker":"Chris Dy","startTime":1847.52,"endTime":1850.49,"body":"California. I'm actually not"},{"speaker":"Chris Dy","startTime":1847.52,"endTime":1850.49,"body":"sure what the non, the non"},{"speaker":"Chris Dy","startTime":1850.49,"endTime":1851.84,"body":"training for gel foam is."},{"speaker":"Charles Goldfarb","startTime":1851.99,"endTime":1853.88,"body":"I don't know"},{"speaker":"Charles Goldfarb","startTime":1851.99,"endTime":1853.88,"body":"either. But I do know the cost."},{"speaker":"Charles Goldfarb","startTime":1853.88,"endTime":1856.7,"body":"And you're right, it's far less"},{"speaker":"Charles Goldfarb","startTime":1853.88,"endTime":1856.7,"body":"expensive than I thought. And"},{"speaker":"Charles Goldfarb","startTime":1856.7,"endTime":1859.07,"body":"let's just say so don't get"},{"speaker":"Charles Goldfarb","startTime":1856.7,"endTime":1859.07,"body":"anybody in trouble. It's less"},{"speaker":"Charles Goldfarb","startTime":1859.07,"endTime":1860.75,"body":"than $20. For a small piece, I"},{"speaker":"Chris Dy","startTime":1860.93,"endTime":1863.9,"body":"think it's $17.18,"},{"speaker":"Chris Dy","startTime":1860.93,"endTime":1863.9,"body":"based on the reports that we get"},{"speaker":"Chris Dy","startTime":1863.9,"endTime":1867.56,"body":"something, something along those"},{"speaker":"Chris Dy","startTime":1863.9,"endTime":1867.56,"body":"lines. But you know, so then for"},{"speaker":"Chris Dy","startTime":1867.56,"endTime":1872.36,"body":"the interested why you would"},{"speaker":"Chris Dy","startTime":1867.56,"endTime":1872.36,"body":"only pack through there, put the"},{"speaker":"Chris Dy","startTime":1872.36,"endTime":1875.12,"body":"graph through the screws site,"},{"speaker":"Chris Dy","startTime":1872.36,"endTime":1875.12,"body":"because I find that to be an"},{"speaker":"Chris Dy","startTime":1875.12,"endTime":1878.57,"body":"incredibly frustrating exercise,"},{"speaker":"Chris Dy","startTime":1875.12,"endTime":1878.57,"body":"which I don't know how much"},{"speaker":"Chris Dy","startTime":1878.57,"endTime":1881.48,"body":"actually gets down there. And so"},{"speaker":"Chris Dy","startTime":1878.57,"endTime":1881.48,"body":"while I used to say that I do"},{"speaker":"Chris Dy","startTime":1881.48,"endTime":1884.42,"body":"that, I'd stopped doing that."},{"speaker":"Chris Dy","startTime":1881.48,"endTime":1884.42,"body":"And actually just for this"},{"speaker":"Chris Dy","startTime":1884.42,"endTime":1887.81,"body":"particular case, I packed it"},{"speaker":"Chris Dy","startTime":1884.42,"endTime":1887.81,"body":"into the actual non union site."},{"speaker":"Charles Goldfarb","startTime":1888.29,"endTime":1890.81,"body":"So this is"},{"speaker":"Charles Goldfarb","startTime":1888.29,"endTime":1890.81,"body":"important, did you stop doing it"},{"speaker":"Charles Goldfarb","startTime":1890.81,"endTime":1896.15,"body":"because you had failure for"},{"speaker":"Charles Goldfarb","startTime":1890.81,"endTime":1896.15,"body":"those fractures to heal, or you"},{"speaker":"Charles Goldfarb","startTime":1896.15,"endTime":1899.75,"body":"simply didn't feel good. And I"},{"speaker":"Charles Goldfarb","startTime":1896.15,"endTime":1899.75,"body":"don't mean that in a judgmental"},{"speaker":"Charles Goldfarb","startTime":1899.75,"endTime":1902.63,"body":"way you didn't feel good about"},{"speaker":"Charles Goldfarb","startTime":1899.75,"endTime":1902.63,"body":"the fixation when you pack bone"},{"speaker":"Charles Goldfarb","startTime":1902.63,"endTime":1903.68,"body":"graft down the tunnel."},{"speaker":"Chris Dy","startTime":1904.04,"endTime":1905.66,"body":"It wasn't a fixation."},{"speaker":"Chris Dy","startTime":1904.04,"endTime":1905.66,"body":"I still know how much of the"},{"speaker":"Chris Dy","startTime":1905.66,"endTime":1909.17,"body":"graft actually ended up in the"},{"speaker":"Chris Dy","startTime":1905.66,"endTime":1909.17,"body":"tunnel versus, you know, being"},{"speaker":"Chris Dy","startTime":1909.17,"endTime":1912.35,"body":"extruded into other non"},{"speaker":"Chris Dy","startTime":1909.17,"endTime":1912.35,"body":"skateboard parts of the wound."},{"speaker":"Charles Goldfarb","startTime":1912.59,"endTime":1914.3,"body":"I don't know"},{"speaker":"Charles Goldfarb","startTime":1912.59,"endTime":1914.3,"body":"what to say to that. I think"},{"speaker":"Charles Goldfarb","startTime":1914.3,"endTime":1916.97,"body":"when I look at my eye, first of"},{"speaker":"Charles Goldfarb","startTime":1914.3,"endTime":1916.97,"body":"all, how do you how do you do"},{"speaker":"Charles Goldfarb","startTime":1916.97,"endTime":1919.79,"body":"it? Well, I think the drilling"},{"speaker":"Charles Goldfarb","startTime":1916.97,"endTime":1919.79,"body":"is the main thing you're doing"},{"speaker":"Charles Goldfarb","startTime":1919.79,"endTime":1921.86,"body":"because when you drill and"},{"speaker":"Charles Goldfarb","startTime":1919.79,"endTime":1921.86,"body":"especially there's a cavity,"},{"speaker":"Charles Goldfarb","startTime":1921.89,"endTime":1923.87,"body":"that's the main thing you're"},{"speaker":"Charles Goldfarb","startTime":1921.89,"endTime":1923.87,"body":"doing. And then I think, you"},{"speaker":"Charles Goldfarb","startTime":1923.87,"endTime":1928.49,"body":"know, the the to talk about"},{"speaker":"Charles Goldfarb","startTime":1923.87,"endTime":1928.49,"body":"trade names, acumen and"},{"speaker":"Charles Goldfarb","startTime":1928.49,"endTime":1931.91,"body":"accucheck has a little plunger,"},{"speaker":"Charles Goldfarb","startTime":1928.49,"endTime":1931.91,"body":"which is designed for this. And"},{"speaker":"Charles Goldfarb","startTime":1931.91,"endTime":1935.45,"body":"so when you once you drilled,"},{"speaker":"Charles Goldfarb","startTime":1931.91,"endTime":1935.45,"body":"you pack your cancellous bone"},{"speaker":"Charles Goldfarb","startTime":1935.45,"endTime":1937.76,"body":"graft into the tunnel and use"},{"speaker":"Charles Goldfarb","startTime":1935.45,"endTime":1937.76,"body":"the plunger to push it"},{"speaker":"Charles Goldfarb","startTime":1937.97,"endTime":1940.25,"body":"approximately, you know, to the"},{"speaker":"Charles Goldfarb","startTime":1937.97,"endTime":1940.25,"body":"side of the nonunion. And"},{"speaker":"Charles Goldfarb","startTime":1940.28,"endTime":1943.1,"body":"theoretically, it should expand"},{"speaker":"Charles Goldfarb","startTime":1940.28,"endTime":1943.1,"body":"there. Of course, you're right."},{"speaker":"Charles Goldfarb","startTime":1943.1,"endTime":1946.46,"body":"I don't know for sure. But when"},{"speaker":"Charles Goldfarb","startTime":1943.1,"endTime":1946.46,"body":"you look at your X rays, if you"},{"speaker":"Charles Goldfarb","startTime":1946.46,"endTime":1950.24,"body":"do have a cystic lesion, and you"},{"speaker":"Charles Goldfarb","startTime":1946.46,"endTime":1950.24,"body":"do this technique, and then you"},{"speaker":"Charles Goldfarb","startTime":1950.24,"endTime":1952.94,"body":"look at your X rays, there's"},{"speaker":"Charles Goldfarb","startTime":1950.24,"endTime":1952.94,"body":"bone graft, which fills that"},{"speaker":"Charles Goldfarb","startTime":1952.94,"endTime":1956.45,"body":"cyst, so I feel pretty good"},{"speaker":"Charles Goldfarb","startTime":1952.94,"endTime":1956.45,"body":"about it. And I don't think"},{"speaker":"Charles Goldfarb","startTime":1956.45,"endTime":1959.72,"body":"there's any relationship between"},{"speaker":"Charles Goldfarb","startTime":1956.45,"endTime":1959.72,"body":"technique and healing of these"},{"speaker":"Charles Goldfarb","startTime":1959.72,"endTime":1962.57,"body":"fractures because honestly, it's"},{"speaker":"Charles Goldfarb","startTime":1959.72,"endTime":1962.57,"body":"typically about putting the"},{"speaker":"Charles Goldfarb","startTime":1962.57,"endTime":1965.81,"body":"screws in the right place. And"},{"speaker":"Charles Goldfarb","startTime":1962.57,"endTime":1965.81,"body":"the kind of stability one"},{"speaker":"Charles Goldfarb","startTime":1965.81,"endTime":1967.85,"body":"achieves as much as the bow grip"},{"speaker":"Charles Goldfarb","startTime":1965.81,"endTime":1967.85,"body":"may add some"},{"speaker":"Chris Dy","startTime":1967.88,"endTime":1970.07,"body":"Yeah, I think it's a"},{"speaker":"Chris Dy","startTime":1967.88,"endTime":1970.07,"body":"carpentry more than anything"},{"speaker":"Chris Dy","startTime":1970.07,"endTime":1972.8,"body":"else. And the fact that you're"},{"speaker":"Chris Dy","startTime":1970.07,"endTime":1972.8,"body":"drilling across a fracture that"},{"speaker":"Chris Dy","startTime":1972.8,"endTime":1974.6,"body":"you know, this particular case,"},{"speaker":"Chris Dy","startTime":1972.8,"endTime":1974.6,"body":"I mean, you think about why"},{"speaker":"Chris Dy","startTime":1974.6,"endTime":1978.86,"body":"things go on to non union kind"},{"speaker":"Chris Dy","startTime":1974.6,"endTime":1978.86,"body":"of basic, bony principles. This"},{"speaker":"Chris Dy","startTime":1978.86,"endTime":1981.53,"body":"was because of lack of"},{"speaker":"Chris Dy","startTime":1978.86,"endTime":1981.53,"body":"immobilization. This wasn't"},{"speaker":"Chris Dy","startTime":1981.53,"endTime":1983.96,"body":"because of lack of biology, you"},{"speaker":"Chris Dy","startTime":1981.53,"endTime":1983.96,"body":"know, kind of roughly when you"},{"speaker":"Chris Dy","startTime":1983.96,"endTime":1988.52,"body":"look at contributors to non"},{"speaker":"Chris Dy","startTime":1983.96,"endTime":1988.52,"body":"union. And that's usually the"},{"speaker":"Chris Dy","startTime":1988.52,"endTime":1990.59,"body":"case for some of these, you"},{"speaker":"Chris Dy","startTime":1988.52,"endTime":1990.59,"body":"know, skateboards that you're"},{"speaker":"Chris Dy","startTime":1990.59,"endTime":1994.04,"body":"treating that haven't healed"},{"speaker":"Chris Dy","startTime":1990.59,"endTime":1994.04,"body":"because of they haven't had"},{"speaker":"Chris Dy","startTime":1994.04,"endTime":1999.44,"body":"adequate stability. do when you"},{"speaker":"Chris Dy","startTime":1994.04,"endTime":1999.44,"body":"have to use that plunger? Do you"},{"speaker":"Chris Dy","startTime":1999.44,"endTime":2001.66,"body":"have to take out your guide"},{"speaker":"Chris Dy","startTime":1999.44,"endTime":2001.66,"body":"where yeah, the guide"},{"speaker":"Charles Goldfarb","startTime":2001.45,"endTime":2002.97,"body":"were is I"},{"speaker":"Charles Goldfarb","startTime":2001.45,"endTime":2002.97,"body":"mean, now, if you have an"},{"speaker":"Charles Goldfarb","startTime":2003.013,"endTime":2005.62,"body":"unstable fracture, then you"},{"speaker":"Charles Goldfarb","startTime":2003.013,"endTime":2005.62,"body":"obviously need a derotation wire"},{"speaker":"Charles Goldfarb","startTime":2005.663,"endTime":2008.487,"body":"to keep the skateboard where you"},{"speaker":"Charles Goldfarb","startTime":2005.663,"endTime":2008.487,"body":"put it, but you take out the guy"},{"speaker":"Charles Goldfarb","startTime":2008.531,"endTime":2011.354,"body":"where and and I jump thankfully,"},{"speaker":"Charles Goldfarb","startTime":2008.531,"endTime":2011.354,"body":"generally don't don't find it to"},{"speaker":"Charles Goldfarb","startTime":2011.398,"endTime":2013.917,"body":"be a problem, especially because"},{"speaker":"Charles Goldfarb","startTime":2011.398,"endTime":2013.917,"body":"you hadn't taken down the"},{"speaker":"Charles Goldfarb","startTime":2013.961,"endTime":2016.09,"body":"nonunions, you don't have"},{"speaker":"Charles Goldfarb","startTime":2013.961,"endTime":2016.09,"body":"rotational instability."},{"speaker":"Chris Dy","startTime":2016.66,"endTime":2019.99,"body":"So this one was gapped"},{"speaker":"Chris Dy","startTime":2016.66,"endTime":2019.99,"body":"it, but it was really kind of"},{"speaker":"Chris Dy","startTime":2020.05,"endTime":2023.62,"body":"almost a plate where it lies if"},{"speaker":"Chris Dy","startTime":2020.05,"endTime":2023.62,"body":"you were able to compress it. So"},{"speaker":"Chris Dy","startTime":2023.65,"endTime":2026.38,"body":"you know, for this one, I"},{"speaker":"Chris Dy","startTime":2023.65,"endTime":2026.38,"body":"actually put an accessory wire"},{"speaker":"Chris Dy","startTime":2026.98,"endTime":2030.25,"body":"outside of the path of where I"},{"speaker":"Chris Dy","startTime":2026.98,"endTime":2030.25,"body":"thought I was going to put my"},{"speaker":"Chris Dy","startTime":2030.25,"endTime":2033.73,"body":"wire from my screw. So it would"},{"speaker":"Chris Dy","startTime":2030.25,"endTime":2033.73,"body":"stay out of the way. And then"},{"speaker":"Chris Dy","startTime":2033.73,"endTime":2036.52,"body":"actually, you know, like, you're"},{"speaker":"Chris Dy","startTime":2033.73,"endTime":2036.52,"body":"saying, I was very careful not"},{"speaker":"Chris Dy","startTime":2036.52,"endTime":2039.46,"body":"to go to the dorsal ridge or"},{"speaker":"Chris Dy","startTime":2036.52,"endTime":2039.46,"body":"just to get onto the radial"},{"speaker":"Chris Dy","startTime":2039.46,"endTime":2043.0,"body":"side. But I localize it on"},{"speaker":"Chris Dy","startTime":2039.46,"endTime":2043.0,"body":"because when you have a non"},{"speaker":"Chris Dy","startTime":2043.0,"endTime":2046.51,"body":"union, it always still looks"},{"speaker":"Chris Dy","startTime":2043.0,"endTime":2046.51,"body":"like bone. But then, you know,"},{"speaker":"Chris Dy","startTime":2046.51,"endTime":2050.86,"body":"if you can I use the flora to"},{"speaker":"Chris Dy","startTime":2046.51,"endTime":2050.86,"body":"localize where to where to start"},{"speaker":"Chris Dy","startTime":2052.69,"endTime":2055.75,"body":"evaluating the non union sites."},{"speaker":"Chris Dy","startTime":2052.69,"endTime":2055.75,"body":"So I was able to find the non"},{"speaker":"Chris Dy","startTime":2055.75,"endTime":2058.42,"body":"union sites. And I actually use"},{"speaker":"Chris Dy","startTime":2055.75,"endTime":2058.42,"body":"the curates and kind of tried to"},{"speaker":"Chris Dy","startTime":2058.42,"endTime":2060.64,"body":"freshen things up, because I"},{"speaker":"Chris Dy","startTime":2058.42,"endTime":2060.64,"body":"knew based on the imaging that I"},{"speaker":"Chris Dy","startTime":2060.64,"endTime":2063.85,"body":"had some sclerosis there, and"},{"speaker":"Chris Dy","startTime":2060.64,"endTime":2063.85,"body":"then being very careful to"},{"speaker":"Chris Dy","startTime":2063.85,"endTime":2067.42,"body":"respect the dorsal ridge. But"},{"speaker":"Chris Dy","startTime":2063.85,"endTime":2067.42,"body":"working underneath from that"},{"speaker":"Chris Dy","startTime":2067.42,"endTime":2070.87,"body":"kind of window that I had to"},{"speaker":"Chris Dy","startTime":2067.42,"endTime":2070.87,"body":"curate as much out as I could on"},{"speaker":"Chris Dy","startTime":2070.87,"endTime":2071.98,"body":"both sides of the fracture."},{"speaker":"Charles Goldfarb","startTime":2072.43,"endTime":2073.84,"body":"And what I"},{"speaker":"Charles Goldfarb","startTime":2072.43,"endTime":2073.84,"body":"think you're saying, correct me"},{"speaker":"Charles Goldfarb","startTime":2073.84,"endTime":2077.02,"body":"if I interpreted incorrectly,"},{"speaker":"Charles Goldfarb","startTime":2073.84,"endTime":2077.02,"body":"when I think you're saying is"},{"speaker":"Charles Goldfarb","startTime":2077.02,"endTime":2080.8,"body":"when you look at the scaphoid"},{"speaker":"Charles Goldfarb","startTime":2077.02,"endTime":2080.8,"body":"you don't see the non union,"},{"speaker":"Charles Goldfarb","startTime":2081.25,"endTime":2084.37,"body":"right, because the cartilage cap"},{"speaker":"Charles Goldfarb","startTime":2081.25,"endTime":2084.37,"body":"is intact. And so you need"},{"speaker":"Charles Goldfarb","startTime":2084.37,"endTime":2089.14,"body":"fluoro to decide where to cut"},{"speaker":"Charles Goldfarb","startTime":2084.37,"endTime":2089.14,"body":"the cartilage. Is that correct?"},{"speaker":"Charles Goldfarb","startTime":2089.53,"endTime":2093.34,"body":"Exactly right. Yeah. And the"},{"speaker":"Charles Goldfarb","startTime":2089.53,"endTime":2093.34,"body":"technical pearls only stated"},{"speaker":"Charles Goldfarb","startTime":2093.34,"endTime":2097.06,"body":"because I've done this"},{"speaker":"Charles Goldfarb","startTime":2093.34,"endTime":2097.06,"body":"incorrectly, is when you think"},{"speaker":"Charles Goldfarb","startTime":2097.06,"endTime":2099.46,"body":"you're going to get compression"},{"speaker":"Charles Goldfarb","startTime":2097.06,"endTime":2099.46,"body":"and whether that be from a"},{"speaker":"Charles Goldfarb","startTime":2099.46,"endTime":2101.71,"body":"vulnerable What's your dorsal"},{"speaker":"Charles Goldfarb","startTime":2099.46,"endTime":2101.71,"body":"approach, you have to be really"},{"speaker":"Charles Goldfarb","startTime":2101.71,"endTime":2106.36,"body":"careful not to place a screw"},{"speaker":"Charles Goldfarb","startTime":2101.71,"endTime":2106.36,"body":"that's too long. Because if you"},{"speaker":"Charles Goldfarb","startTime":2106.36,"endTime":2108.91,"body":"place a screw that's too long"},{"speaker":"Charles Goldfarb","startTime":2106.36,"endTime":2108.91,"body":"and what's considered from a"},{"speaker":"Charles Goldfarb","startTime":2108.91,"endTime":2113.77,"body":"dorsal approach, then your screw"},{"speaker":"Charles Goldfarb","startTime":2108.91,"endTime":2113.77,"body":"can essentially run into the"},{"speaker":"Charles Goldfarb","startTime":2113.77,"endTime":2118.66,"body":"distal cortical bone of the"},{"speaker":"Charles Goldfarb","startTime":2113.77,"endTime":2118.66,"body":"scaphoid. Or go past it if"},{"speaker":"Charles Goldfarb","startTime":2118.66,"endTime":2121.42,"body":"you've drilled through it. And"},{"speaker":"Charles Goldfarb","startTime":2118.66,"endTime":2121.42,"body":"if you do that, you may not get"},{"speaker":"Charles Goldfarb","startTime":2121.42,"endTime":2125.08,"body":"compression. And in fact, you"},{"speaker":"Charles Goldfarb","startTime":2121.42,"endTime":2125.08,"body":"may fix it with a gap. And so"},{"speaker":"Charles Goldfarb","startTime":2125.08,"endTime":2128.62,"body":"it's important that you allow"},{"speaker":"Charles Goldfarb","startTime":2125.08,"endTime":2128.62,"body":"this screw which is compressive"},{"speaker":"Charles Goldfarb","startTime":2128.8,"endTime":2129.76,"body":"to compress the bone."},{"speaker":"Chris Dy","startTime":2130.18,"endTime":2132.61,"body":"Right, I think that's"},{"speaker":"Chris Dy","startTime":2130.18,"endTime":2132.61,"body":"a great point. And you've"},{"speaker":"Chris Dy","startTime":2132.61,"endTime":2135.4,"body":"mentioned before, this is not a"},{"speaker":"Chris Dy","startTime":2132.61,"endTime":2135.4,"body":"screw, typically, where you're,"},{"speaker":"Chris Dy","startTime":2136.33,"endTime":2139.27,"body":"you're obsessed with being"},{"speaker":"Chris Dy","startTime":2136.33,"endTime":2139.27,"body":"center center max distance, the"},{"speaker":"Chris Dy","startTime":2139.27,"endTime":2141.55,"body":"orientation of your screw"},{"speaker":"Chris Dy","startTime":2139.27,"endTime":2141.55,"body":"matters a little bit more. Is"},{"speaker":"Chris Dy","startTime":2141.55,"endTime":2142.0,"body":"that right?"},{"speaker":"Charles Goldfarb","startTime":2142.6,"endTime":2144.13,"body":"I think it"},{"speaker":"Charles Goldfarb","startTime":2142.6,"endTime":2144.13,"body":"does. And I don't know whether,"},{"speaker":"Charles Goldfarb","startTime":2144.13,"endTime":2147.1,"body":"you know, I'd like center center"},{"speaker":"Charles Goldfarb","startTime":2144.13,"endTime":2147.1,"body":"and I like perpendicular"},{"speaker":"Charles Goldfarb","startTime":2147.1,"endTime":2149.8,"body":"fracture line. And if you can"},{"speaker":"Charles Goldfarb","startTime":2147.1,"endTime":2149.8,"body":"get both great, but sometimes"},{"speaker":"Charles Goldfarb","startTime":2149.8,"endTime":2152.47,"body":"you're kind of sort of playing"},{"speaker":"Charles Goldfarb","startTime":2149.8,"endTime":2152.47,"body":"both the same time,"},{"speaker":"Chris Dy","startTime":2152.65,"endTime":2154.24,"body":"right. And I think"},{"speaker":"Chris Dy","startTime":2152.65,"endTime":2154.24,"body":"that which one you think it's"},{"speaker":"Chris Dy","startTime":2154.24,"endTime":2154.75,"body":"more important,"},{"speaker":"Charles Goldfarb","startTime":2155.32,"endTime":2158.5,"body":"I probably say"},{"speaker":"Charles Goldfarb","startTime":2155.32,"endTime":2158.5,"body":"center center, but I'm honestly"},{"speaker":"Charles Goldfarb","startTime":2158.5,"endTime":2160.39,"body":"not positive. We know those"},{"speaker":"Charles Goldfarb","startTime":2158.5,"endTime":2160.39,"body":"oblique fractures are the"},{"speaker":"Charles Goldfarb","startTime":2160.39,"endTime":2164.47,"body":"toughest to get to heal. So it"},{"speaker":"Charles Goldfarb","startTime":2160.39,"endTime":2164.47,"body":"was funny because David Brogan"},{"speaker":"Charles Goldfarb","startTime":2164.47,"endTime":2169.57,"body":"shared with me some images for a"},{"speaker":"Charles Goldfarb","startTime":2164.47,"endTime":2169.57,"body":"talk I gave in his technique"},{"speaker":"Charles Goldfarb","startTime":2169.57,"endTime":2174.88,"body":"when he uses the vascularized"},{"speaker":"Charles Goldfarb","startTime":2169.57,"endTime":2174.88,"body":"graph from the knee. And in"},{"speaker":"Charles Goldfarb","startTime":2174.88,"endTime":2177.19,"body":"those cases, he is absolutely"},{"speaker":"Charles Goldfarb","startTime":2174.88,"endTime":2177.19,"body":"putting his screw in"},{"speaker":"Charles Goldfarb","startTime":2177.19,"endTime":2182.23,"body":"perpendicular with the graft and"},{"speaker":"Charles Goldfarb","startTime":2177.19,"endTime":2182.23,"body":"the skateboard. So it's, I kind"},{"speaker":"Charles Goldfarb","startTime":2182.23,"endTime":2184.66,"body":"of think center centers more"},{"speaker":"Charles Goldfarb","startTime":2182.23,"endTime":2184.66,"body":"important, but I don't know that"},{"speaker":"Charles Goldfarb","startTime":2184.69,"endTime":2185.65,"body":"I don't know that to be true."},{"speaker":"Chris Dy","startTime":2186.76,"endTime":2188.92,"body":"So I mean, I packed in"},{"speaker":"Chris Dy","startTime":2186.76,"endTime":2188.92,"body":"a bunch of the graft through"},{"speaker":"Chris Dy","startTime":2188.92,"endTime":2193.21,"body":"this non union void, while I had"},{"speaker":"Chris Dy","startTime":2188.92,"endTime":2193.21,"body":"my, you know, essentially the"},{"speaker":"Chris Dy","startTime":2193.21,"endTime":2196.9,"body":"rotational stability wire in"},{"speaker":"Chris Dy","startTime":2193.21,"endTime":2196.9,"body":"place, so as to not take"},{"speaker":"Chris Dy","startTime":2196.9,"endTime":2199.12,"body":"something that was stable and"},{"speaker":"Chris Dy","startTime":2196.9,"endTime":2199.12,"body":"make it unstable. That's why"},{"speaker":"Chris Dy","startTime":2199.12,"endTime":2201.19,"body":"that fret, that wire was"},{"speaker":"Chris Dy","startTime":2199.12,"endTime":2201.19,"body":"important, I packed everything"},{"speaker":"Chris Dy","startTime":2201.19,"endTime":2205.54,"body":"in and then put my wire in from"},{"speaker":"Chris Dy","startTime":2201.19,"endTime":2205.54,"body":"my main screw and put my screw"},{"speaker":"Chris Dy","startTime":2205.54,"endTime":2208.9,"body":"across, got it lined up, well,"},{"speaker":"Chris Dy","startTime":2205.54,"endTime":2208.9,"body":"seemed to compress a decent bit."},{"speaker":"Chris Dy","startTime":2210.16,"endTime":2211.27,"body":"Do you ever put two screws in?"},{"speaker":"Charles Goldfarb","startTime":2212.62,"endTime":2214.54,"body":"Oh my God,"},{"speaker":"Charles Goldfarb","startTime":2212.62,"endTime":2214.54,"body":"that's heresy, I would never put"},{"speaker":"Charles Goldfarb","startTime":2214.54,"endTime":2217.06,"body":"two screws in, tell me why you"},{"speaker":"Charles Goldfarb","startTime":2214.54,"endTime":2217.06,"body":"put two screws and this one."},{"speaker":"Chris Dy","startTime":2218.17,"endTime":2222.85,"body":"Honestly, big guy, big"},{"speaker":"Chris Dy","startTime":2218.17,"endTime":2222.85,"body":"scaphoid there was room and, you"},{"speaker":"Chris Dy","startTime":2222.85,"endTime":2225.79,"body":"know, I kind of had this talk"},{"speaker":"Chris Dy","startTime":2222.85,"endTime":2225.79,"body":"with him that you know if this"},{"speaker":"Chris Dy","startTime":2225.79,"endTime":2231.67,"body":"were to go on to not heal. And"},{"speaker":"Chris Dy","startTime":2225.79,"endTime":2231.67,"body":"we're not going back. Because of"},{"speaker":"Chris Dy","startTime":2231.7,"endTime":2234.91,"body":"you know, you take somebody you"},{"speaker":"Chris Dy","startTime":2231.7,"endTime":2234.91,"body":"met you immobilize them for the"},{"speaker":"Chris Dy","startTime":2234.91,"endTime":2237.67,"body":"better part of three months, you"},{"speaker":"Chris Dy","startTime":2234.91,"endTime":2237.67,"body":"know, tell them not to do stuff,"},{"speaker":"Chris Dy","startTime":2238.15,"endTime":2240.49,"body":"even if it's not healing, while"},{"speaker":"Chris Dy","startTime":2238.15,"endTime":2240.49,"body":"you're gonna keep them mobilized"},{"speaker":"Chris Dy","startTime":2240.49,"endTime":2244.54,"body":"a little longer, he probably"},{"speaker":"Chris Dy","startTime":2240.49,"endTime":2244.54,"body":"wouldn't want to go on to, you"},{"speaker":"Chris Dy","startTime":2244.54,"endTime":2247.72,"body":"know, to have revision surgery"},{"speaker":"Chris Dy","startTime":2244.54,"endTime":2247.72,"body":"and prolong you know, basically,"},{"speaker":"Chris Dy","startTime":2247.72,"endTime":2249.82,"body":"it's more time out of their"},{"speaker":"Chris Dy","startTime":2247.72,"endTime":2249.82,"body":"life. And if they're gonna end"},{"speaker":"Chris Dy","startTime":2249.82,"endTime":2254.98,"body":"up getting a snack risk, they'll"},{"speaker":"Chris Dy","startTime":2249.82,"endTime":2254.98,"body":"deal with them. So, you know, I"},{"speaker":"Chris Dy","startTime":2254.98,"endTime":2257.65,"body":"actually said there's room in"},{"speaker":"Chris Dy","startTime":2254.98,"endTime":2257.65,"body":"here and you know, with the"},{"speaker":"Chris Dy","startTime":2257.65,"endTime":2261.07,"body":"screw system I was using, there"},{"speaker":"Chris Dy","startTime":2257.65,"endTime":2261.07,"body":"was adequate range in terms of"},{"speaker":"Chris Dy","startTime":2261.07,"endTime":2263.98,"body":"you know, being able to sneak in"},{"speaker":"Chris Dy","startTime":2261.07,"endTime":2263.98,"body":"a smaller screws. So I put a"},{"speaker":"Chris Dy","startTime":2263.98,"endTime":2266.32,"body":"smaller screw essentially very"},{"speaker":"Chris Dy","startTime":2263.98,"endTime":2266.32,"body":"close to the path of that"},{"speaker":"Chris Dy","startTime":2266.32,"endTime":2267.64,"body":"original D rotational wire."},{"speaker":"Charles Goldfarb","startTime":2267.64,"endTime":2269.838,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":2267.64,"endTime":2269.838,"body":"nice when you get your"},{"speaker":"Charles Goldfarb","startTime":2269.905,"endTime":2273.97,"body":"derotation wire, it is a perfect"},{"speaker":"Charles Goldfarb","startTime":2269.905,"endTime":2273.97,"body":"path for a second screw. And"},{"speaker":"Charles Goldfarb","startTime":2274.036,"endTime":2277.502,"body":"almost always, that's the"},{"speaker":"Charles Goldfarb","startTime":2274.036,"endTime":2277.502,"body":"smaller version. You know,"},{"speaker":"Charles Goldfarb","startTime":2277.568,"endTime":2281.366,"body":"theoretically, it most most"},{"speaker":"Charles Goldfarb","startTime":2277.568,"endTime":2281.366,"body":"systems have three, you know,"},{"speaker":"Charles Goldfarb","startTime":2281.433,"endTime":2285.564,"body":"three sizes. And I typically use"},{"speaker":"Charles Goldfarb","startTime":2281.433,"endTime":2285.564,"body":"the middle size for my escape"},{"speaker":"Charles Goldfarb","startTime":2285.631,"endTime":2289.363,"body":"voids with the possibility of"},{"speaker":"Charles Goldfarb","startTime":2285.631,"endTime":2289.363,"body":"upsizing if there is a non"},{"speaker":"Charles Goldfarb","startTime":2289.429,"endTime":2293.361,"body":"union. But I love the idea of"},{"speaker":"Charles Goldfarb","startTime":2289.429,"endTime":2293.361,"body":"putting a really small one in"},{"speaker":"Charles Goldfarb","startTime":2293.427,"endTime":2295.96,"body":"what many and as your standard screws."},{"speaker":"Chris Dy","startTime":2297.1,"endTime":2299.83,"body":"Yeah, so I mean, you"},{"speaker":"Chris Dy","startTime":2297.1,"endTime":2299.83,"body":"know, that case, you know, went"},{"speaker":"Chris Dy","startTime":2299.83,"endTime":2302.59,"body":"well talk to the wife"},{"speaker":"Chris Dy","startTime":2299.83,"endTime":2302.59,"body":"afterwards. And she was like,"},{"speaker":"Chris Dy","startTime":2302.59,"endTime":2305.2,"body":"you know, make sure you tell him"},{"speaker":"Chris Dy","startTime":2302.59,"endTime":2305.2,"body":"three months, like I said"},{"speaker":"Chris Dy","startTime":2305.2,"endTime":2309.58,"body":"earlier, so interesting. I was I"},{"speaker":"Chris Dy","startTime":2305.2,"endTime":2309.58,"body":"was sharing this case with, with"},{"speaker":"Chris Dy","startTime":2309.58,"endTime":2312.25,"body":"our partner, David, who you just"},{"speaker":"Chris Dy","startTime":2309.58,"endTime":2312.25,"body":"mentioned, because we were doing"},{"speaker":"Chris Dy","startTime":2312.58,"endTime":2316.33,"body":"some other case together. And"},{"speaker":"Chris Dy","startTime":2312.58,"endTime":2316.33,"body":"he's like, Well, I'm gonna make"},{"speaker":"Chris Dy","startTime":2316.33,"endTime":2319.33,"body":"it really hard for that, that"},{"speaker":"Chris Dy","startTime":2316.33,"endTime":2319.33,"body":"MFT I said, Well, there's not"},{"speaker":"Chris Dy","startTime":2319.33,"endTime":2322.99,"body":"going to be an MFT there will be"},{"speaker":"Chris Dy","startTime":2319.33,"endTime":2322.99,"body":"no other depths of fixation. I"},{"speaker":"Chris Dy","startTime":2322.99,"endTime":2328.18,"body":"said, if this doesn't do it,"},{"speaker":"Chris Dy","startTime":2322.99,"endTime":2328.18,"body":"then, you know, that's it. But I"},{"speaker":"Chris Dy","startTime":2328.18,"endTime":2330.97,"body":"honestly, I'll feel good."},{"speaker":"Chris Dy","startTime":2328.18,"endTime":2330.97,"body":"Evaluating him knowing that I've"},{"speaker":"Chris Dy","startTime":2330.97,"endTime":2334.66,"body":"got, you know, really solid"},{"speaker":"Chris Dy","startTime":2330.97,"endTime":2334.66,"body":"fixation. And, you know, we'll"},{"speaker":"Chris Dy","startTime":2334.66,"endTime":2337.36,"body":"obviously get the the CT scan"},{"speaker":"Chris Dy","startTime":2334.66,"endTime":2337.36,"body":"that we had talked about, you"},{"speaker":"Chris Dy","startTime":2337.36,"endTime":2339.16,"body":"know, when do you get that post"},{"speaker":"Chris Dy","startTime":2337.36,"endTime":2339.16,"body":"op CT?"},{"speaker":"Charles Goldfarb","startTime":2339.79,"endTime":2341.44,"body":"Scanning, I"},{"speaker":"Charles Goldfarb","startTime":2339.79,"endTime":2341.44,"body":"just had this conversation,"},{"speaker":"Charles Goldfarb","startTime":2341.44,"endTime":2346.84,"body":"because it's a really important"},{"speaker":"Charles Goldfarb","startTime":2341.44,"endTime":2346.84,"body":"question. And it turns a little"},{"speaker":"Charles Goldfarb","startTime":2346.84,"endTime":2350.86,"body":"bit on the patient, you know, I"},{"speaker":"Charles Goldfarb","startTime":2346.84,"endTime":2350.86,"body":"don't want to, you know, try to"},{"speaker":"Charles Goldfarb","startTime":2350.86,"endTime":2354.07,"body":"be sensitive to cause I don't"},{"speaker":"Charles Goldfarb","startTime":2350.86,"endTime":2354.07,"body":"want to get to CT scans. So I"},{"speaker":"Charles Goldfarb","startTime":2354.07,"endTime":2358.78,"body":"don't want to do it too early."},{"speaker":"Charles Goldfarb","startTime":2354.07,"endTime":2358.78,"body":"But also don't want to wait too"},{"speaker":"Charles Goldfarb","startTime":2358.78,"endTime":2363.67,"body":"long and lose time for the"},{"speaker":"Charles Goldfarb","startTime":2358.78,"endTime":2363.67,"body":"patient. So for most patients is"},{"speaker":"Charles Goldfarb","startTime":2363.67,"endTime":2367.63,"body":"at the eight week mark, there is"},{"speaker":"Charles Goldfarb","startTime":2363.67,"endTime":2367.63,"body":"a great paper from from the"},{"speaker":"Charles Goldfarb","startTime":2367.63,"endTime":2370.54,"body":"European Journal, which"},{"speaker":"Charles Goldfarb","startTime":2367.63,"endTime":2370.54,"body":"described using described a"},{"speaker":"Charles Goldfarb","startTime":2370.54,"endTime":2375.61,"body":"protocol in which non surgical"},{"speaker":"Charles Goldfarb","startTime":2370.54,"endTime":2375.61,"body":"treatment was chosen. And an"},{"speaker":"Charles Goldfarb","startTime":2375.64,"endTime":2379.78,"body":"early CT of 46 Weeks was then"},{"speaker":"Charles Goldfarb","startTime":2375.64,"endTime":2379.78,"body":"obtained and if there wasn't"},{"speaker":"Charles Goldfarb","startTime":2379.78,"endTime":2382.57,"body":"healing, then they did surgery."},{"speaker":"Charles Goldfarb","startTime":2379.78,"endTime":2382.57,"body":"And so lots of ways to think"},{"speaker":"Charles Goldfarb","startTime":2382.57,"endTime":2385.12,"body":"about this, but with a"},{"speaker":"Charles Goldfarb","startTime":2382.57,"endTime":2385.12,"body":"surgically treated patient."},{"speaker":"Charles Goldfarb","startTime":2385.6,"endTime":2388.93,"body":"Eight weeks is sort of my"},{"speaker":"Charles Goldfarb","startTime":2385.6,"endTime":2388.93,"body":"Hallmark give or take. What"},{"speaker":"Charles Goldfarb","startTime":2388.93,"endTime":2389.47,"body":"about Yeah,"},{"speaker":"Chris Dy","startTime":2389.68,"endTime":2391.72,"body":"yeah, I think that"},{"speaker":"Chris Dy","startTime":2389.68,"endTime":2391.72,"body":"that's a very different decision"},{"speaker":"Chris Dy","startTime":2391.72,"endTime":2394.75,"body":"making context. You know, when"},{"speaker":"Chris Dy","startTime":2391.72,"endTime":2394.75,"body":"you've gone initially, the non"},{"speaker":"Chris Dy","startTime":2394.75,"endTime":2397.69,"body":"operative treatment. And you"},{"speaker":"Chris Dy","startTime":2394.75,"endTime":2397.69,"body":"know, certainly like you said,"},{"speaker":"Chris Dy","startTime":2397.69,"endTime":2400.33,"body":"you want to make sure you're"},{"speaker":"Chris Dy","startTime":2397.69,"endTime":2400.33,"body":"avoiding extra costs. Last and"},{"speaker":"Chris Dy","startTime":2400.33,"endTime":2404.74,"body":"radiation, you know, with the"},{"speaker":"Chris Dy","startTime":2400.33,"endTime":2404.74,"body":"extra CT, so I actually I, the"},{"speaker":"Chris Dy","startTime":2404.74,"endTime":2406.75,"body":"number I was gonna put out,"},{"speaker":"Chris Dy","startTime":2404.74,"endTime":2406.75,"body":"there was eight weeks as well,"},{"speaker":"Chris Dy","startTime":2407.32,"endTime":2409.69,"body":"because I usually see them at"},{"speaker":"Chris Dy","startTime":2407.32,"endTime":2409.69,"body":"the six week mark, and I'll"},{"speaker":"Chris Dy","startTime":2409.78,"endTime":2413.95,"body":"order the CT for a couple of"},{"speaker":"Chris Dy","startTime":2409.78,"endTime":2413.95,"body":"weeks later. So that I have a"},{"speaker":"Chris Dy","startTime":2413.95,"endTime":2416.92,"body":"sense, you know, at the six week"},{"speaker":"Chris Dy","startTime":2413.95,"endTime":2416.92,"body":"mark, I'll probably keep them in"},{"speaker":"Chris Dy","startTime":2416.92,"endTime":2420.61,"body":"a cast, do the CT scan into"},{"speaker":"Chris Dy","startTime":2416.92,"endTime":2420.61,"body":"cast, and then call them with"},{"speaker":"Chris Dy","startTime":2420.61,"endTime":2423.94,"body":"the results of the CT. And if it"},{"speaker":"Chris Dy","startTime":2420.61,"endTime":2423.94,"body":"if it looks okay, have them come"},{"speaker":"Chris Dy","startTime":2423.94,"endTime":2426.82,"body":"back and have the cast removed"},{"speaker":"Chris Dy","startTime":2423.94,"endTime":2426.82,"body":"and start therapy. If it doesn't"},{"speaker":"Chris Dy","startTime":2426.82,"endTime":2428.53,"body":"look okay, at least we still"},{"speaker":"Chris Dy","startTime":2426.82,"endTime":2428.53,"body":"have a cast on there."},{"speaker":"Charles Goldfarb","startTime":2429.28,"endTime":2431.68,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2429.28,"endTime":2431.68,"body":"that's, that's, that's very"},{"speaker":"Charles Goldfarb","startTime":2431.68,"endTime":2435.67,"body":"reasonable. And, yeah, and then"},{"speaker":"Charles Goldfarb","startTime":2431.68,"endTime":2435.67,"body":"my goal is, you know, if they're"},{"speaker":"Charles Goldfarb","startTime":2435.67,"endTime":2438.61,"body":"healing, but not healed, then I"},{"speaker":"Charles Goldfarb","startTime":2435.67,"endTime":2438.61,"body":"just get a little more"},{"speaker":"Charles Goldfarb","startTime":2438.61,"endTime":2441.49,"body":"aggressive with therapy. So"},{"speaker":"Charles Goldfarb","startTime":2438.61,"endTime":2441.49,"body":"that, again, we're maximizing"},{"speaker":"Charles Goldfarb","startTime":2441.49,"endTime":2446.14,"body":"motion and even strengthening."},{"speaker":"Charles Goldfarb","startTime":2441.49,"endTime":2446.14,"body":"While you know, fracture healing"},{"speaker":"Charles Goldfarb","startTime":2446.14,"endTime":2450.28,"body":"is making its way. So if we have"},{"speaker":"Charles Goldfarb","startTime":2446.14,"endTime":2450.28,"body":"reasonable healing, say is 25%"},{"speaker":"Charles Goldfarb","startTime":2450.28,"endTime":2454.0,"body":"or something like that, on the"},{"speaker":"Charles Goldfarb","startTime":2450.28,"endTime":2454.0,"body":"CT scan? I don't repeat the CT"},{"speaker":"Charles Goldfarb","startTime":2454.0,"endTime":2457.66,"body":"scan, I just continue to follow"},{"speaker":"Charles Goldfarb","startTime":2454.0,"endTime":2457.66,"body":"one or two more X rays and make"},{"speaker":"Charles Goldfarb","startTime":2457.66,"endTime":2459.64,"body":"sure they're clinically doing"},{"speaker":"Charles Goldfarb","startTime":2457.66,"endTime":2459.64,"body":"well make sure they're"},{"speaker":"Charles Goldfarb","startTime":2459.7,"endTime":2462.55,"body":"functionally doing well. And"},{"speaker":"Charles Goldfarb","startTime":2459.7,"endTime":2462.55,"body":"then I just let them go. Do you"},{"speaker":"Charles Goldfarb","startTime":2462.55,"endTime":2463.42,"body":"repeat the CT?"},{"speaker":"Chris Dy","startTime":2464.23,"endTime":2466.78,"body":"Typically, not if"},{"speaker":"Chris Dy","startTime":2464.23,"endTime":2466.78,"body":"we're if the first one shows,"},{"speaker":"Chris Dy","startTime":2466.78,"endTime":2469.99,"body":"you know that we're well, on our"},{"speaker":"Chris Dy","startTime":2466.78,"endTime":2469.99,"body":"way? I don't know if I've, my"},{"speaker":"Chris Dy","startTime":2469.99,"endTime":2471.88,"body":"threshold is probably a little"},{"speaker":"Chris Dy","startTime":2469.99,"endTime":2471.88,"body":"bit higher in terms of"},{"speaker":"Chris Dy","startTime":2471.88,"endTime":2475.72,"body":"percentage healing than 25%."},{"speaker":"Chris Dy","startTime":2471.88,"endTime":2475.72,"body":"But, you know, in this"},{"speaker":"Chris Dy","startTime":2475.72,"endTime":2478.78,"body":"particular case, I'm sure that"},{"speaker":"Chris Dy","startTime":2475.72,"endTime":2478.78,"body":"fine osseous detail will be"},{"speaker":"Chris Dy","startTime":2478.78,"endTime":2481.51,"body":"obscured by middle artifact,"},{"speaker":"Chris Dy","startTime":2478.78,"endTime":2481.51,"body":"clinical correlation will be"},{"speaker":"Chris Dy","startTime":2481.51,"endTime":2482.11,"body":"recommended,"},{"speaker":"Charles Goldfarb","startTime":2482.38,"endTime":2484.0,"body":"where we're"},{"speaker":"Charles Goldfarb","startTime":2482.38,"endTime":2484.0,"body":"counting on that."},{"speaker":"Chris Dy","startTime":2485.65,"endTime":2487.39,"body":"So yeah, thanks. It's"},{"speaker":"Chris Dy","startTime":2485.65,"endTime":2487.39,"body":"been good discussion. We've"},{"speaker":"Chris Dy","startTime":2487.39,"endTime":2490.93,"body":"covered topics from firearm"},{"speaker":"Chris Dy","startTime":2487.39,"endTime":2490.93,"body":"violence, that Trank to campaign"},{"speaker":"Chris Dy","startTime":2490.93,"endTime":2494.47,"body":"to skateboard on unions are"},{"speaker":"Chris Dy","startTime":2490.93,"endTime":2494.47,"body":"pretty sure we could save the"},{"speaker":"Chris Dy","startTime":2494.47,"endTime":2497.2,"body":"articles for our next episode,"},{"speaker":"Chris Dy","startTime":2494.47,"endTime":2497.2,"body":"because I think that, you know,"},{"speaker":"Chris Dy","startTime":2497.23,"endTime":2500.56,"body":"we probably lost a lot of people"},{"speaker":"Chris Dy","startTime":2497.23,"endTime":2500.56,"body":"on the way this far along. Yeah,"},{"speaker":"Chris Dy","startTime":2500.56,"endTime":2500.62,"body":"I"},{"speaker":"Charles Goldfarb","startTime":2500.62,"endTime":2502.87,"body":"think the I'm"},{"speaker":"Charles Goldfarb","startTime":2500.62,"endTime":2502.87,"body":"looking forward to the articles"},{"speaker":"Charles Goldfarb","startTime":2502.87,"endTime":2506.56,"body":"because I think they are a good"},{"speaker":"Charles Goldfarb","startTime":2502.87,"endTime":2506.56,"body":"segue to a more generalized"},{"speaker":"Charles Goldfarb","startTime":2506.56,"endTime":2510.94,"body":"discussion. So I look forward to"},{"speaker":"Charles Goldfarb","startTime":2506.56,"endTime":2510.94,"body":"that. And thank you. It was fun"},{"speaker":"Charles Goldfarb","startTime":2510.94,"endTime":2511.42,"body":"catching up."},{"speaker":"Chris Dy","startTime":2511.81,"endTime":2513.46,"body":"Absolutely. That"},{"speaker":"Chris Dy","startTime":2511.81,"endTime":2513.46,"body":"wonderful day."},{"speaker":"Charles Goldfarb","startTime":2513.82,"endTime":2517.03,"body":"All right, you"},{"speaker":"Charles Goldfarb","startTime":2513.82,"endTime":2517.03,"body":"too. Hey, Chris. That was fun."},{"speaker":"Charles Goldfarb","startTime":2517.06,"endTime":2518.2,"body":"Let's do it again, real soon."},{"speaker":"Chris Dy","startTime":2518.5,"endTime":2520.937,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2518.5,"endTime":2520.937,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2520.982,"endTime":2523.42,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2520.982,"endTime":2523.42,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2523.75,"endTime":2526.63,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2523.75,"endTime":2526.63,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2526.78,"endTime":2530.325,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2526.78,"endTime":2530.325,"body":"spelled dy. And if you'd like to"},{"speaker":"Chris Dy","startTime":2530.395,"endTime":2534.01,"body":"email us, you can reach us at handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2534.58,"endTime":2536.71,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2534.58,"endTime":2536.71,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2536.71,"endTime":2537.79,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2537.85,"endTime":2540.07,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2537.85,"endTime":2540.07,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2540.07,"endTime":2540.46,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2540.85,"endTime":2543.13,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2540.85,"endTime":2543.13,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2543.13,"endTime":2547.12,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2543.13,"endTime":2547.12,"body":"upper hand. Come back next time"}]}