{"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 podcast."},{"speaker":"Charles Goldfarb","startTime":24.09,"endTime":24.96,"body":"Oh, Hi, Chris."},{"speaker":"Chris Dy","startTime":25.469,"endTime":26.489,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":25.469,"endTime":26.489,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":26.94,"endTime":28.26,"body":"Fantastic. How"},{"speaker":"Charles Goldfarb","startTime":26.94,"endTime":28.26,"body":"are you?"},{"speaker":"Chris Dy","startTime":28.92,"endTime":31.2,"body":"I'm good. It seems"},{"speaker":"Chris Dy","startTime":28.92,"endTime":31.2,"body":"like you're probably recovering"},{"speaker":"Chris Dy","startTime":31.2,"endTime":33.75,"body":"from what was probably a very"},{"speaker":"Chris Dy","startTime":31.2,"endTime":33.75,"body":"busy holiday weekend."},{"speaker":"Charles Goldfarb","startTime":34.56,"endTime":36.81,"body":"You know, it's"},{"speaker":"Charles Goldfarb","startTime":34.56,"endTime":36.81,"body":"funny, because we discussed"},{"speaker":"Charles Goldfarb","startTime":36.81,"endTime":40.02,"body":"recording this episode last"},{"speaker":"Charles Goldfarb","startTime":36.81,"endTime":40.02,"body":"night, which would have been"},{"speaker":"Charles Goldfarb","startTime":40.02,"endTime":44.73,"body":"July 5. And I'm like, I'm too"},{"speaker":"Charles Goldfarb","startTime":40.02,"endTime":44.73,"body":"tired. I'm bold. I'm recovering."},{"speaker":"Charles Goldfarb","startTime":44.73,"endTime":48.24,"body":"Let's do it. This morning, which"},{"speaker":"Charles Goldfarb","startTime":44.73,"endTime":48.24,"body":"is early in the morning of July"},{"speaker":"Charles Goldfarb","startTime":48.24,"endTime":53.67,"body":"6. So Thursday, two days after"},{"speaker":"Charles Goldfarb","startTime":48.24,"endTime":53.67,"body":"Fourth of July. And I woke up"},{"speaker":"Charles Goldfarb","startTime":55.29,"endTime":57.81,"body":"that I wasn't sure I made the"},{"speaker":"Charles Goldfarb","startTime":55.29,"endTime":57.81,"body":"right decision. I always wake up"},{"speaker":"Charles Goldfarb","startTime":57.81,"endTime":60.24,"body":"before my alarm. And then my"},{"speaker":"Charles Goldfarb","startTime":57.81,"endTime":60.24,"body":"alarm goes off. And there's one"},{"speaker":"Charles Goldfarb","startTime":60.24,"endTime":62.61,"body":"of those I don't know where I"},{"speaker":"Charles Goldfarb","startTime":60.24,"endTime":62.61,"body":"am. I don't know who I am. You"},{"speaker":"Charles Goldfarb","startTime":62.61,"endTime":64.47,"body":"know, this experiences. It was"},{"speaker":"Charles Goldfarb","startTime":62.61,"endTime":64.47,"body":"crazy."},{"speaker":"Chris Dy","startTime":65.88,"endTime":68.19,"body":"Yes, I'm sure and I"},{"speaker":"Chris Dy","startTime":65.88,"endTime":68.19,"body":"think we're going to talk a"},{"speaker":"Chris Dy","startTime":68.19,"endTime":71.49,"body":"little bit about your Fourth of"},{"speaker":"Chris Dy","startTime":68.19,"endTime":71.49,"body":"July weekend here in St. Louis."},{"speaker":"Chris Dy","startTime":71.52,"endTime":75.93,"body":"We were actually a way and I had"},{"speaker":"Chris Dy","startTime":71.52,"endTime":75.93,"body":"a similar experience in well,"},{"speaker":"Chris Dy","startTime":75.93,"endTime":78.24,"body":"similar but very different"},{"speaker":"Chris Dy","startTime":75.93,"endTime":78.24,"body":"experience yesterday when I woke"},{"speaker":"Chris Dy","startTime":78.24,"endTime":81.69,"body":"up in my own bed on Wednesday"},{"speaker":"Chris Dy","startTime":78.24,"endTime":81.69,"body":"morning not knowing exactly"},{"speaker":"Chris Dy","startTime":81.69,"endTime":84.72,"body":"where it was because I was so"},{"speaker":"Chris Dy","startTime":81.69,"endTime":84.72,"body":"used to sleeping in the bed at"},{"speaker":"Chris Dy","startTime":84.72,"endTime":88.53,"body":"the vacation home we were at in"},{"speaker":"Chris Dy","startTime":84.72,"endTime":88.53,"body":"Georgia. So it's very different"},{"speaker":"Chris Dy","startTime":88.53,"endTime":90.96,"body":"experience of disconcerting"},{"speaker":"Chris Dy","startTime":88.53,"endTime":90.96,"body":"nonetheless,"},{"speaker":"Charles Goldfarb","startTime":91.17,"endTime":94.86,"body":"yeah. So you"},{"speaker":"Charles Goldfarb","startTime":91.17,"endTime":94.86,"body":"Was this just you and your wife"},{"speaker":"Charles Goldfarb","startTime":94.86,"endTime":96.0,"body":"or was the whole family."},{"speaker":"Chris Dy","startTime":97.2,"endTime":100.8,"body":"Family, whole family"},{"speaker":"Chris Dy","startTime":97.2,"endTime":100.8,"body":"took the weekend off? My wife is"},{"speaker":"Chris Dy","startTime":100.8,"endTime":103.14,"body":"I think my mate mentioned this"},{"speaker":"Chris Dy","startTime":100.8,"endTime":103.14,"body":"on the pod in the past but my"},{"speaker":"Chris Dy","startTime":103.14,"endTime":105.81,"body":"wife is on the 50 states with"},{"speaker":"Chris Dy","startTime":103.14,"endTime":105.81,"body":"the kids before they're out of"},{"speaker":"Chris Dy","startTime":105.81,"endTime":109.68,"body":"the house. Band. So you know"},{"speaker":"Chris Dy","startTime":105.81,"endTime":109.68,"body":"right now I think that was"},{"speaker":"Chris Dy","startTime":109.68,"endTime":112.62,"body":"number 16 That we checked off"},{"speaker":"Chris Dy","startTime":109.68,"endTime":112.62,"body":"the list going to St. Simons"},{"speaker":"Chris Dy","startTime":112.62,"endTime":116.94,"body":"Island off the coast of Georgia,"},{"speaker":"Chris Dy","startTime":112.62,"endTime":116.94,"body":"flew into Jacksonville and drove"},{"speaker":"Chris Dy","startTime":116.94,"endTime":119.16,"body":"an hour and we had a great time"},{"speaker":"Chris Dy","startTime":116.94,"endTime":119.16,"body":"it was really fun."},{"speaker":"Charles Goldfarb","startTime":119.549,"endTime":122.039,"body":"That counts"},{"speaker":"Charles Goldfarb","startTime":119.549,"endTime":122.039,"body":"for Georgia. That is so not"},{"speaker":"Charles Goldfarb","startTime":122.039,"endTime":125.159,"body":"Georgia. You're just like this"},{"speaker":"Charles Goldfarb","startTime":122.039,"endTime":125.159,"body":"letter of the law."},{"speaker":"Chris Dy","startTime":125.22,"endTime":128.97,"body":"It was very Georgia"},{"speaker":"Chris Dy","startTime":125.22,"endTime":128.97,"body":"tell you that. I'm gonna leave"},{"speaker":"Chris Dy","startTime":128.97,"endTime":130.68,"body":"it at that but it was very"},{"speaker":"Chris Dy","startTime":128.97,"endTime":130.68,"body":"Georgia."},{"speaker":"Charles Goldfarb","startTime":130.889,"endTime":132.689,"body":"You know, be"},{"speaker":"Charles Goldfarb","startTime":130.889,"endTime":132.689,"body":"careful. I'm an Alabama boy."},{"speaker":"Chris Dy","startTime":133.14,"endTime":135.33,"body":"I was it was more"},{"speaker":"Chris Dy","startTime":133.14,"endTime":135.33,"body":"Georgia than many would say"},{"speaker":"Chris Dy","startTime":135.33,"endTime":136.02,"body":"Atlanta is."},{"speaker":"Charles Goldfarb","startTime":137.04,"endTime":140.64,"body":"Well, that is"},{"speaker":"Charles Goldfarb","startTime":137.04,"endTime":140.64,"body":"true. That is very true. Well"},{"speaker":"Charles Goldfarb","startTime":140.64,"endTime":143.4,"body":"good. I'm glad I'm glad it was a"},{"speaker":"Charles Goldfarb","startTime":140.64,"endTime":143.4,"body":"good trip. I do want to mention"},{"speaker":"Charles Goldfarb","startTime":143.43,"endTime":148.08,"body":"I'm on a new kick. Before I tell"},{"speaker":"Charles Goldfarb","startTime":143.43,"endTime":148.08,"body":"you what is overnight oats which"},{"speaker":"Charles Goldfarb","startTime":148.11,"endTime":154.89,"body":"I am not new in fact I am very"},{"speaker":"Charles Goldfarb","startTime":148.11,"endTime":154.89,"body":"late to it is so good. I don't"},{"speaker":"Charles Goldfarb","startTime":154.89,"endTime":157.08,"body":"know what took me 10 years it's"},{"speaker":"Charles Goldfarb","startTime":154.89,"endTime":157.08,"body":"so good."},{"speaker":"Chris Dy","startTime":157.11,"endTime":161.28,"body":"It's probably Jessica"},{"speaker":"Chris Dy","startTime":157.11,"endTime":161.28,"body":"Billy rotating on your on your"},{"speaker":"Chris Dy","startTime":161.28,"endTime":164.55,"body":"service with all of her"},{"speaker":"Chris Dy","startTime":161.28,"endTime":164.55,"body":"overnight oats that I think"},{"speaker":"Chris Dy","startTime":164.58,"endTime":168.72,"body":"already Boyer would would gently"},{"speaker":"Chris Dy","startTime":164.58,"endTime":168.72,"body":"tease her is her mush"},{"speaker":"Charles Goldfarb","startTime":169.41,"endTime":172.38,"body":"it I look I"},{"speaker":"Charles Goldfarb","startTime":169.41,"endTime":172.38,"body":"was looking for a new breakfast"},{"speaker":"Charles Goldfarb","startTime":172.38,"endTime":176.76,"body":"that filled me up and this is"},{"speaker":"Charles Goldfarb","startTime":172.38,"endTime":176.76,"body":"awesome. So for all those What"},{"speaker":"Charles Goldfarb","startTime":176.76,"endTime":180.81,"body":"is this socially disconnected"},{"speaker":"Charles Goldfarb","startTime":176.76,"endTime":180.81,"body":"people like me? overnight oats"},{"speaker":"Charles Goldfarb","startTime":180.81,"endTime":181.47,"body":"is awesome."},{"speaker":"Chris Dy","startTime":181.95,"endTime":184.2,"body":"So is this like you're"},{"speaker":"Chris Dy","startTime":181.95,"endTime":184.2,"body":"one of those guys that does like"},{"speaker":"Chris Dy","startTime":184.2,"endTime":186.33,"body":"the batch prep like for the"},{"speaker":"Chris Dy","startTime":184.2,"endTime":186.33,"body":"whole week or you like"},{"speaker":"Chris Dy","startTime":186.33,"endTime":188.4,"body":"definitely set it the night"},{"speaker":"Chris Dy","startTime":186.33,"endTime":188.4,"body":"before and then"},{"speaker":"Charles Goldfarb","startTime":189.12,"endTime":193.38,"body":"yeah, night"},{"speaker":"Charles Goldfarb","startTime":189.12,"endTime":193.38,"body":"before my milk, my Chia my oats"},{"speaker":"Charles Goldfarb","startTime":193.38,"endTime":195.66,"body":"and add a little sweetener in"},{"speaker":"Charles Goldfarb","startTime":193.38,"endTime":195.66,"body":"the morning little fruit maybe"},{"speaker":"Charles Goldfarb","startTime":195.72,"endTime":197.85,"body":"Ah, my God, it's good stuff."},{"speaker":"Chris Dy","startTime":198.33,"endTime":202.29,"body":"I will say as a"},{"speaker":"Chris Dy","startTime":198.33,"endTime":202.29,"body":"texture guy. overnight oats has"},{"speaker":"Chris Dy","startTime":202.29,"endTime":206.61,"body":"fantastic texture. I just have"},{"speaker":"Chris Dy","startTime":202.29,"endTime":206.61,"body":"never gotten there. Maybe one"},{"speaker":"Chris Dy","startTime":206.61,"endTime":207.42,"body":"day, maybe one day."},{"speaker":"Charles Goldfarb","startTime":207.84,"endTime":209.52,"body":"Well, I"},{"speaker":"Charles Goldfarb","startTime":207.84,"endTime":209.52,"body":"realized you had gotten there"},{"speaker":"Charles Goldfarb","startTime":209.52,"endTime":211.77,"body":"because I haven't seen it on"},{"speaker":"Charles Goldfarb","startTime":209.52,"endTime":211.77,"body":"Instagram. So if it's not"},{"speaker":"Chris Dy","startTime":214.77,"endTime":217.17,"body":"there already"},{"speaker":"Chris Dy","startTime":214.77,"endTime":217.17,"body":"overnight oats enthusiasts are"},{"speaker":"Chris Dy","startTime":217.17,"endTime":220.62,"body":"overnight. It's makers that want"},{"speaker":"Chris Dy","startTime":217.17,"endTime":220.62,"body":"to sponsor us let us know"},{"speaker":"Chris Dy","startTime":220.62,"endTime":222.66,"body":"because apparently Chuck is"},{"speaker":"Chris Dy","startTime":220.62,"endTime":222.66,"body":"going to be on the date,"},{"speaker":"Charles Goldfarb","startTime":223.11,"endTime":225.63,"body":"at least for"},{"speaker":"Charles Goldfarb","startTime":223.11,"endTime":225.63,"body":"the next week, at least"},{"speaker":"Chris Dy","startTime":226.379,"endTime":228.659,"body":"Fourth of July call"},{"speaker":"Chris Dy","startTime":226.379,"endTime":228.659,"body":"what does that like? Certainly,"},{"speaker":"Chris Dy","startTime":228.659,"endTime":232.619,"body":"as we talked about, and maybe a"},{"speaker":"Chris Dy","startTime":228.659,"endTime":232.619,"body":"little less, lighthearted way,"},{"speaker":"Chris Dy","startTime":232.649,"endTime":235.019,"body":"on the last episode, we see a"},{"speaker":"Chris Dy","startTime":232.649,"endTime":235.019,"body":"lot of ballistic injuries here"},{"speaker":"Chris Dy","startTime":235.019,"endTime":237.389,"body":"in St. Louis, this is certainly"},{"speaker":"Chris Dy","startTime":235.019,"endTime":237.389,"body":"ballistic injury of a different"},{"speaker":"Chris Dy","startTime":237.389,"endTime":239.009,"body":"sort that is quite seasonal."},{"speaker":"Charles Goldfarb","startTime":239.999,"endTime":241.919,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":239.999,"endTime":241.919,"body":"first of all, I like how we do"},{"speaker":"Charles Goldfarb","startTime":241.919,"endTime":245.699,"body":"our call. So in other words, our"},{"speaker":"Charles Goldfarb","startTime":241.919,"endTime":245.699,"body":"goal with call on these long"},{"speaker":"Charles Goldfarb","startTime":245.699,"endTime":248.249,"body":"weekends is to give everyone"},{"speaker":"Charles Goldfarb","startTime":245.699,"endTime":248.249,"body":"except for the person on call"},{"speaker":"Charles Goldfarb","startTime":248.249,"endTime":253.259,"body":"time to do what they would like"},{"speaker":"Charles Goldfarb","startTime":248.249,"endTime":253.259,"body":"with so I was on call from June"},{"speaker":"Charles Goldfarb","startTime":253.259,"endTime":257.129,"body":"30 through July 5, which is"},{"speaker":"Charles Goldfarb","startTime":253.259,"endTime":257.129,"body":"great. And I'm being very"},{"speaker":"Charles Goldfarb","startTime":257.129,"endTime":260.279,"body":"serious when I say that because"},{"speaker":"Charles Goldfarb","startTime":257.129,"endTime":260.279,"body":"it really does give every other"},{"speaker":"Charles Goldfarb","startTime":260.279,"endTime":264.839,"body":"person time although Monday was"},{"speaker":"Charles Goldfarb","startTime":260.279,"endTime":264.839,"body":"a normal workday. So you know,"},{"speaker":"Charles Goldfarb","startTime":264.839,"endTime":269.099,"body":"in quotes because not much of"},{"speaker":"Charles Goldfarb","startTime":264.839,"endTime":269.099,"body":"the department was working. But"},{"speaker":"Charles Goldfarb","startTime":269.099,"endTime":271.769,"body":"it's getting us nice get away"},{"speaker":"Charles Goldfarb","startTime":269.099,"endTime":271.769,"body":"you know, it really is a nice"},{"speaker":"Charles Goldfarb","startTime":271.769,"endTime":275.159,"body":"opportunity, so called Thank"},{"speaker":"Charles Goldfarb","startTime":271.769,"endTime":275.159,"body":"goodness for David Wright, who"},{"speaker":"Charles Goldfarb","startTime":275.159,"endTime":280.739,"body":"is one of our remarkable fellows"},{"speaker":"Charles Goldfarb","startTime":275.159,"endTime":280.739,"body":"who was incredibly good. We did"},{"speaker":"Charles Goldfarb","startTime":280.739,"endTime":285.239,"body":"not get absolutely obliterated"},{"speaker":"Charles Goldfarb","startTime":280.739,"endTime":285.239,"body":"with firework trauma, but we had"},{"speaker":"Charles Goldfarb","startTime":285.239,"endTime":291.299,"body":"enough to you know, keep it"},{"speaker":"Charles Goldfarb","startTime":285.239,"endTime":291.299,"body":"interesting. The I have to say"},{"speaker":"Charles Goldfarb","startTime":292.379,"endTime":297.029,"body":"Marty Boyer usually does the"},{"speaker":"Charles Goldfarb","startTime":292.379,"endTime":297.029,"body":"Fourth of July or likes to and"},{"speaker":"Charles Goldfarb","startTime":297.029,"endTime":301.079,"body":"he likes all hands on deck"},{"speaker":"Charles Goldfarb","startTime":297.029,"endTime":301.079,"body":"everyone around you It was just"},{"speaker":"Charles Goldfarb","startTime":301.079,"endTime":304.289,"body":"a normal call weekend for us."},{"speaker":"Charles Goldfarb","startTime":301.079,"endTime":304.289,"body":"And we didn't know extra fellows"},{"speaker":"Charles Goldfarb","startTime":304.289,"endTime":308.699,"body":"were called in. But all firework"},{"speaker":"Charles Goldfarb","startTime":304.289,"endTime":308.699,"body":"injuries are kind of the same to"},{"speaker":"Charles Goldfarb","startTime":308.699,"endTime":314.519,"body":"me. They the pictures look"},{"speaker":"Charles Goldfarb","startTime":308.699,"endTime":314.519,"body":"terrible. And the reality is in"},{"speaker":"Charles Goldfarb","startTime":314.519,"endTime":320.159,"body":"the ER, there's usually not all"},{"speaker":"Charles Goldfarb","startTime":314.519,"endTime":320.159,"body":"that much to do. And it's a"},{"speaker":"Charles Goldfarb","startTime":320.159,"endTime":323.729,"body":"matter of typically the first"},{"speaker":"Charles Goldfarb","startTime":320.159,"endTime":323.729,"body":"webspace often gets blown apart,"},{"speaker":"Charles Goldfarb","startTime":324.599,"endTime":328.409,"body":"maybe some distal amps,"},{"speaker":"Charles Goldfarb","startTime":324.599,"endTime":328.409,"body":"depending on the size of the"},{"speaker":"Charles Goldfarb","startTime":328.649,"endTime":333.599,"body":"explosives, and often some"},{"speaker":"Charles Goldfarb","startTime":328.649,"endTime":333.599,"body":"burns. Ophthalmology is usually"},{"speaker":"Charles Goldfarb","startTime":333.599,"endTime":337.409,"body":"involved before we can go the or"},{"speaker":"Charles Goldfarb","startTime":333.599,"endTime":337.409,"body":"so interesting, but we you know,"},{"speaker":"Charles Goldfarb","startTime":337.409,"endTime":340.799,"body":"we had three or four of those to"},{"speaker":"Charles Goldfarb","startTime":337.409,"endTime":340.799,"body":"a significant degree and, and"},{"speaker":"Charles Goldfarb","startTime":340.799,"endTime":343.199,"body":"thankfully, all came together"},{"speaker":"Charles Goldfarb","startTime":340.799,"endTime":343.199,"body":"nicely."},{"speaker":"Chris Dy","startTime":344.55,"endTime":346.47,"body":"Two things. Classic,"},{"speaker":"Chris Dy","startTime":344.55,"endTime":346.47,"body":"nice,"},{"speaker":"Charles Goldfarb","startTime":346.47,"endTime":347.34,"body":"nice, nice,"},{"speaker":"Chris Dy","startTime":347.37,"endTime":349.23,"body":"I thought I thought"},{"speaker":"Chris Dy","startTime":347.37,"endTime":349.23,"body":"the first thing you're gonna say"},{"speaker":"Chris Dy","startTime":349.23,"endTime":351.39,"body":"about how you like how we do"},{"speaker":"Chris Dy","startTime":349.23,"endTime":351.39,"body":"calls that we split it with"},{"speaker":"Chris Dy","startTime":351.39,"endTime":357.96,"body":"plastics. But as your partner, I"},{"speaker":"Chris Dy","startTime":351.39,"endTime":357.96,"body":"appreciate what you said about"},{"speaker":"Chris Dy","startTime":357.96,"endTime":360.27,"body":"how we've done our call"},{"speaker":"Chris Dy","startTime":357.96,"endTime":360.27,"body":"schedule, I think much more"},{"speaker":"Chris Dy","startTime":360.27,"endTime":362.58,"body":"thought has gone into it in"},{"speaker":"Chris Dy","startTime":360.27,"endTime":362.58,"body":"recent years in terms of making"},{"speaker":"Chris Dy","startTime":362.58,"endTime":366.21,"body":"sure to rotate the calls in a"},{"speaker":"Chris Dy","startTime":362.58,"endTime":366.21,"body":"way that works for everybody."},{"speaker":"Chris Dy","startTime":366.57,"endTime":370.83,"body":"And you know that that's clearly"},{"speaker":"Chris Dy","startTime":366.57,"endTime":370.83,"body":"helps with families and people"},{"speaker":"Chris Dy","startTime":370.83,"endTime":373.05,"body":"with young kids. So as your as"},{"speaker":"Chris Dy","startTime":370.83,"endTime":373.05,"body":"your junior partner, I"},{"speaker":"Chris Dy","startTime":373.05,"endTime":375.24,"body":"appreciate that. So thank you"},{"speaker":"Chris Dy","startTime":373.05,"endTime":375.24,"body":"for taking Fourth of July call"},{"speaker":"Chris Dy","startTime":375.27,"endTime":379.8,"body":"my son's birthday is on July 8."},{"speaker":"Chris Dy","startTime":375.27,"endTime":379.8,"body":"So every year, we're typically"},{"speaker":"Chris Dy","startTime":379.8,"endTime":384.63,"body":"out of town. I'm sure I'll in my"},{"speaker":"Chris Dy","startTime":379.8,"endTime":384.63,"body":"when I get to my my queue every"},{"speaker":"Chris Dy","startTime":384.63,"endTime":388.11,"body":"seven years for Fourth of July,"},{"speaker":"Chris Dy","startTime":384.63,"endTime":388.11,"body":"it'll be off to my son, we're"},{"speaker":"Chris Dy","startTime":388.11,"endTime":393.87,"body":"staying in town. But my second"},{"speaker":"Chris Dy","startTime":388.11,"endTime":393.87,"body":"thing is, you know, asking, Does"},{"speaker":"Chris Dy","startTime":393.87,"endTime":399.09,"body":"your threshold for replantation"},{"speaker":"Chris Dy","startTime":393.87,"endTime":399.09,"body":"change with this kind of injury"},{"speaker":"Chris Dy","startTime":399.09,"endTime":403.41,"body":"versus mono, say this standard"},{"speaker":"Chris Dy","startTime":399.09,"endTime":403.41,"body":"kind of tablesaw industrial"},{"speaker":"Chris Dy","startTime":403.41,"endTime":407.76,"body":"accident? Not An avulsion. But"},{"speaker":"Chris Dy","startTime":403.41,"endTime":407.76,"body":"does it change it all over this"},{"speaker":"Chris Dy","startTime":407.76,"endTime":408.21,"body":"weekend?"},{"speaker":"Charles Goldfarb","startTime":409.319,"endTime":411.749,"body":"In response to"},{"speaker":"Charles Goldfarb","startTime":409.319,"endTime":411.749,"body":"your two points? I'll give you"},{"speaker":"Charles Goldfarb","startTime":411.749,"endTime":412.379,"body":"two back?"},{"speaker":"Chris Dy","startTime":413.009,"endTime":415.409,"body":"Of course, of course."},{"speaker":"Chris Dy","startTime":413.009,"endTime":415.409,"body":"Very Own branded?"},{"speaker":"Charles Goldfarb","startTime":415.589,"endTime":419.339,"body":"Yes. Number"},{"speaker":"Charles Goldfarb","startTime":415.589,"endTime":419.339,"body":"one, I don't, I think these are"},{"speaker":"Charles Goldfarb","startTime":419.339,"endTime":422.489,"body":"almost never replaceable. And"},{"speaker":"Charles Goldfarb","startTime":419.339,"endTime":422.489,"body":"there can be An avulsion type"},{"speaker":"Charles Goldfarb","startTime":422.519,"endTime":428.249,"body":"injury, which there certainly"},{"speaker":"Charles Goldfarb","startTime":422.519,"endTime":428.249,"body":"was for us in these cases. So"},{"speaker":"Charles Goldfarb","startTime":428.249,"endTime":430.409,"body":"one of the patients, you"},{"speaker":"Charles Goldfarb","startTime":428.249,"endTime":430.409,"body":"actually may be seeing at some"},{"speaker":"Charles Goldfarb","startTime":430.409,"endTime":433.889,"body":"point who Avulsed we save the"},{"speaker":"Charles Goldfarb","startTime":430.409,"endTime":433.889,"body":"thumb, but the digital nerves"},{"speaker":"Charles Goldfarb","startTime":433.889,"endTime":437.009,"body":"are both evolves proximately."},{"speaker":"Charles Goldfarb","startTime":433.889,"endTime":437.009,"body":"Not that there's anything you"},{"speaker":"Charles Goldfarb","startTime":437.009,"endTime":441.629,"body":"can do for it, but you can be"},{"speaker":"Charles Goldfarb","startTime":437.009,"endTime":441.629,"body":"creative. And so I think"},{"speaker":"Charles Goldfarb","startTime":441.629,"endTime":446.309,"body":"replants are almost never the"},{"speaker":"Charles Goldfarb","startTime":441.629,"endTime":446.309,"body":"situation, I can't think of ever"},{"speaker":"Charles Goldfarb","startTime":446.309,"endTime":449.249,"body":"having done a replant. And in"},{"speaker":"Charles Goldfarb","startTime":446.309,"endTime":449.249,"body":"these situations, for me,"},{"speaker":"Charles Goldfarb","startTime":449.249,"endTime":451.559,"body":"probably the single most"},{"speaker":"Charles Goldfarb","startTime":449.249,"endTime":451.559,"body":"important technical"},{"speaker":"Charles Goldfarb","startTime":451.559,"endTime":454.709,"body":"consideration is the first"},{"speaker":"Charles Goldfarb","startTime":451.559,"endTime":454.709,"body":"webspace. And so if someone's"},{"speaker":"Charles Goldfarb","startTime":454.709,"endTime":458.699,"body":"holding the firework, if it's a"},{"speaker":"Charles Goldfarb","startTime":454.709,"endTime":458.699,"body":"Roman candle, it's a little"},{"speaker":"Charles Goldfarb","startTime":458.699,"endTime":461.459,"body":"bigger, those usually are more"},{"speaker":"Charles Goldfarb","startTime":458.699,"endTime":461.459,"body":"burns than explosions. But"},{"speaker":"Charles Goldfarb","startTime":461.459,"endTime":463.949,"body":"obviously, our fireworks"},{"speaker":"Charles Goldfarb","startTime":461.459,"endTime":463.949,"body":"industry is not regulated. So"},{"speaker":"Charles Goldfarb","startTime":463.949,"endTime":467.279,"body":"those can be explosions as well."},{"speaker":"Charles Goldfarb","startTime":463.949,"endTime":467.279,"body":"With the first webspace gets"},{"speaker":"Charles Goldfarb","startTime":467.279,"endTime":470.249,"body":"blown apart. And I think the"},{"speaker":"Charles Goldfarb","startTime":467.279,"endTime":470.249,"body":"temptation is just to close it,"},{"speaker":"Charles Goldfarb","startTime":470.249,"endTime":473.129,"body":"you know, everything close,"},{"speaker":"Charles Goldfarb","startTime":470.249,"endTime":473.129,"body":"close it down. And what happens"},{"speaker":"Charles Goldfarb","startTime":473.129,"endTime":475.769,"body":"is you have a markedly"},{"speaker":"Charles Goldfarb","startTime":473.129,"endTime":475.769,"body":"contracted first webspace and no"},{"speaker":"Charles Goldfarb","startTime":475.769,"endTime":478.559,"body":"one's happy. And so we do a lot"},{"speaker":"Charles Goldfarb","startTime":475.769,"endTime":478.559,"body":"of painting of the first"},{"speaker":"Charles Goldfarb","startTime":478.559,"endTime":481.259,"body":"webspace I don't think this is"},{"speaker":"Charles Goldfarb","startTime":478.559,"endTime":481.259,"body":"particularly novel, but we do"},{"speaker":"Charles Goldfarb","startTime":481.259,"endTime":484.199,"body":"that. But I think it's really"},{"speaker":"Charles Goldfarb","startTime":481.259,"endTime":484.199,"body":"important that we do that one of"},{"speaker":"Charles Goldfarb","startTime":484.199,"endTime":488.579,"body":"our patients had a CMC fracture"},{"speaker":"Charles Goldfarb","startTime":484.199,"endTime":488.579,"body":"dislocation. And so we pin that,"},{"speaker":"Charles Goldfarb","startTime":488.669,"endTime":493.469,"body":"and the first webspace to let"},{"speaker":"Charles Goldfarb","startTime":488.669,"endTime":493.469,"body":"the soft tissues heal. So yeah,"},{"speaker":"Charles Goldfarb","startTime":493.469,"endTime":496.679,"body":"it's a lot of that just soft"},{"speaker":"Charles Goldfarb","startTime":493.469,"endTime":496.679,"body":"tissue work, which is fine. And,"},{"speaker":"Charles Goldfarb","startTime":496.889,"endTime":498.869,"body":"you know, got to monitor people"},{"speaker":"Charles Goldfarb","startTime":496.889,"endTime":498.869,"body":"as they heal."},{"speaker":"Chris Dy","startTime":499.98,"endTime":504.09,"body":"So I think you're"},{"speaker":"Chris Dy","startTime":499.98,"endTime":504.09,"body":"probably downplaying your"},{"speaker":"Chris Dy","startTime":504.12,"endTime":506.4,"body":"expertise in this area with"},{"speaker":"Chris Dy","startTime":504.12,"endTime":506.4,"body":"regards to the first webspace."},{"speaker":"Chris Dy","startTime":506.4,"endTime":509.85,"body":"I've learned a lot from you"},{"speaker":"Chris Dy","startTime":506.4,"endTime":509.85,"body":"along the years in how to"},{"speaker":"Chris Dy","startTime":509.88,"endTime":514.59,"body":"evaluate and treat, you know,"},{"speaker":"Chris Dy","startTime":509.88,"endTime":514.59,"body":"that part of the injury. Do you"},{"speaker":"Chris Dy","startTime":514.59,"endTime":517.29,"body":"have any technical pearls about"},{"speaker":"Chris Dy","startTime":514.59,"endTime":517.29,"body":"you know, the pinning itself?"},{"speaker":"Chris Dy","startTime":517.29,"endTime":519.81,"body":"Like what size pins to use? How"},{"speaker":"Chris Dy","startTime":517.29,"endTime":519.81,"body":"many pins What's your in, like,"},{"speaker":"Chris Dy","startTime":519.81,"endTime":523.41,"body":"what's your configuration? And"},{"speaker":"Chris Dy","startTime":519.81,"endTime":523.41,"body":"then also, you know, in terms of"},{"speaker":"Chris Dy","startTime":523.41,"endTime":526.59,"body":"coverage, are you doing any"},{"speaker":"Chris Dy","startTime":523.41,"endTime":526.59,"body":"rotational flaps at the time to"},{"speaker":"Chris Dy","startTime":526.59,"endTime":528.81,"body":"bring in some local tissue,"},{"speaker":"Chris Dy","startTime":526.59,"endTime":528.81,"body":"whether it's, you know, pedicle"},{"speaker":"Chris Dy","startTime":528.81,"endTime":533.22,"body":"to random pattern to try and get"},{"speaker":"Chris Dy","startTime":528.81,"endTime":533.22,"body":"some kind of tissue in that"},{"speaker":"Chris Dy","startTime":533.22,"endTime":536.01,"body":"void? Or are you setting things"},{"speaker":"Chris Dy","startTime":533.22,"endTime":536.01,"body":"up for later reconstruction?"},{"speaker":"Charles Goldfarb","startTime":537.78,"endTime":541.47,"body":"Thank you kind"},{"speaker":"Charles Goldfarb","startTime":537.78,"endTime":541.47,"body":"words. I would say that no"},{"speaker":"Charles Goldfarb","startTime":541.5,"endTime":547.14,"body":"immediate, soft tissue, you"},{"speaker":"Charles Goldfarb","startTime":541.5,"endTime":547.14,"body":"know, rotational flaps, etc. I'm"},{"speaker":"Charles Goldfarb","startTime":547.14,"endTime":551.55,"body":"a big fan of dorsal advancement"},{"speaker":"Charles Goldfarb","startTime":547.14,"endTime":551.55,"body":"flaps. That's because of my"},{"speaker":"Charles Goldfarb","startTime":551.55,"endTime":556.95,"body":"congenital bias. If those are if"},{"speaker":"Charles Goldfarb","startTime":551.55,"endTime":556.95,"body":"the dorsal soft tissues are"},{"speaker":"Charles Goldfarb","startTime":556.95,"endTime":560.85,"body":"unaffected by the blast injury,"},{"speaker":"Charles Goldfarb","startTime":556.95,"endTime":560.85,"body":"that certainly can be an"},{"speaker":"Charles Goldfarb","startTime":560.85,"endTime":563.22,"body":"effective way to deepen the"},{"speaker":"Charles Goldfarb","startTime":560.85,"endTime":563.22,"body":"first sweat face if it does"},{"speaker":"Charles Goldfarb","startTime":563.22,"endTime":566.52,"body":"contract. But honestly, I think"},{"speaker":"Charles Goldfarb","startTime":563.22,"endTime":566.52,"body":"if he needs skin and support, I"},{"speaker":"Charles Goldfarb","startTime":566.52,"endTime":570.15,"body":"think you're looking at either a"},{"speaker":"Charles Goldfarb","startTime":566.52,"endTime":570.15,"body":"groin flap or a forum flap of"},{"speaker":"Charles Goldfarb","startTime":570.15,"endTime":576.18,"body":"some variety. So in these cases,"},{"speaker":"Charles Goldfarb","startTime":570.15,"endTime":576.18,"body":"it was simply primary closure."},{"speaker":"Charles Goldfarb","startTime":577.35,"endTime":582.15,"body":"And then we'll see what happens."},{"speaker":"Charles Goldfarb","startTime":577.35,"endTime":582.15,"body":"You know, thankfully, infection"},{"speaker":"Charles Goldfarb","startTime":582.15,"endTime":584.73,"body":"in my experience has not been a"},{"speaker":"Charles Goldfarb","startTime":582.15,"endTime":584.73,"body":"common issue here, but I think"},{"speaker":"Charles Goldfarb","startTime":584.73,"endTime":586.71,"body":"we just want to get through the"},{"speaker":"Charles Goldfarb","startTime":584.73,"endTime":586.71,"body":"initial trauma and then"},{"speaker":"Charles Goldfarb","startTime":586.71,"endTime":590.49,"body":"reevaluate and as far as penny"},{"speaker":"Charles Goldfarb","startTime":586.71,"endTime":590.49,"body":"goes, I go big on these pens."},{"speaker":"Charles Goldfarb","startTime":591.51,"endTime":595.2,"body":"For five at a minimum, but"},{"speaker":"Charles Goldfarb","startTime":591.51,"endTime":595.2,"body":"typically six to I placed my"},{"speaker":"Charles Goldfarb","startTime":595.2,"endTime":599.67,"body":"pens proximately at the between"},{"speaker":"Charles Goldfarb","startTime":595.2,"endTime":599.67,"body":"the first and second metacarpals"},{"speaker":"Charles Goldfarb","startTime":599.91,"endTime":603.3,"body":"I Um, and I think if he plays it"},{"speaker":"Charles Goldfarb","startTime":599.91,"endTime":603.3,"body":"dislike, it just creates more"},{"speaker":"Charles Goldfarb","startTime":603.3,"endTime":608.1,"body":"scarring potentially. So"},{"speaker":"Charles Goldfarb","startTime":603.3,"endTime":608.1,"body":"proximately and one of the"},{"speaker":"Charles Goldfarb","startTime":608.13,"endTime":611.7,"body":"pearls and anyone who's done"},{"speaker":"Charles Goldfarb","startTime":608.13,"endTime":611.7,"body":"enough hand surgery, knows if"},{"speaker":"Charles Goldfarb","startTime":611.7,"endTime":615.75,"body":"you take a six to k where, and,"},{"speaker":"Charles Goldfarb","startTime":611.7,"endTime":615.75,"body":"and keep firing and keep"},{"speaker":"Charles Goldfarb","startTime":615.75,"endTime":620.31,"body":"missing, and I will say it's not"},{"speaker":"Charles Goldfarb","startTime":615.75,"endTime":620.31,"body":"easy to go from the first"},{"speaker":"Charles Goldfarb","startTime":620.31,"endTime":623.61,"body":"metacarpal to the second"},{"speaker":"Charles Goldfarb","startTime":620.31,"endTime":623.61,"body":"metacarpal. His sounds crazy,"},{"speaker":"Charles Goldfarb","startTime":623.82,"endTime":626.67,"body":"even if the wound is open, it"},{"speaker":"Charles Goldfarb","startTime":623.82,"endTime":626.67,"body":"can be a tricky thing to do."},{"speaker":"Charles Goldfarb","startTime":627.0,"endTime":629.7,"body":"Similarly, going from the fifth"},{"speaker":"Charles Goldfarb","startTime":627.0,"endTime":629.7,"body":"metacarpal to the fourth"},{"speaker":"Charles Goldfarb","startTime":629.7,"endTime":633.18,"body":"metacarpal for say, if that CMC"},{"speaker":"Charles Goldfarb","startTime":629.7,"endTime":633.18,"body":"fracture dislocation can also be"},{"speaker":"Charles Goldfarb","startTime":633.18,"endTime":637.29,"body":"tricky, and you cannot fire and"},{"speaker":"Charles Goldfarb","startTime":633.18,"endTime":637.29,"body":"fire and fire and all of a"},{"speaker":"Charles Goldfarb","startTime":637.29,"endTime":640.23,"body":"sudden you've you've perforated"},{"speaker":"Charles Goldfarb","startTime":637.29,"endTime":640.23,"body":"or postage stamped the"},{"speaker":"Charles Goldfarb","startTime":640.23,"endTime":643.53,"body":"metacarpal. And it can break"},{"speaker":"Charles Goldfarb","startTime":640.23,"endTime":643.53,"body":"later. And I've seen it. So"},{"speaker":"Charles Goldfarb","startTime":643.53,"endTime":646.38,"body":"that's the only technical"},{"speaker":"Charles Goldfarb","startTime":643.53,"endTime":646.38,"body":"consideration or worry that I"},{"speaker":"Charles Goldfarb","startTime":646.38,"endTime":647.31,"body":"have with that technique."},{"speaker":"Chris Dy","startTime":647.91,"endTime":650.88,"body":"So postage stamp, many"},{"speaker":"Chris Dy","startTime":647.91,"endTime":650.88,"body":"of our younger listeners may"},{"speaker":"Chris Dy","startTime":650.88,"endTime":654.24,"body":"have never handled the postage"},{"speaker":"Chris Dy","startTime":650.88,"endTime":654.24,"body":"stamp. But I think you're"},{"speaker":"Chris Dy","startTime":654.24,"endTime":657.3,"body":"talking about perforations"},{"speaker":"Chris Dy","startTime":654.24,"endTime":657.3,"body":"around the entire periphery, is"},{"speaker":"Chris Dy","startTime":657.3,"endTime":658.02,"body":"that correct?"},{"speaker":"Charles Goldfarb","startTime":658.74,"endTime":662.13,"body":"So that was a"},{"speaker":"Charles Goldfarb","startTime":658.74,"endTime":662.13,"body":"new term to me, when I use"},{"speaker":"Charles Goldfarb","startTime":662.13,"endTime":666.24,"body":"potions, stamping, you know, the"},{"speaker":"Charles Goldfarb","startTime":662.13,"endTime":666.24,"body":"little dots when I do most of my"},{"speaker":"Charles Goldfarb","startTime":666.24,"endTime":669.72,"body":"osteotomies. And so I'll take a"},{"speaker":"Charles Goldfarb","startTime":666.24,"endTime":669.72,"body":"K wire, and I prefer to cortex"},{"speaker":"Charles Goldfarb","startTime":669.72,"endTime":672.18,"body":"and then use an osteotome to"},{"speaker":"Charles Goldfarb","startTime":669.72,"endTime":672.18,"body":"complete the osteotomy to"},{"speaker":"Charles Goldfarb","startTime":672.18,"endTime":677.88,"body":"minimize heat to maximize"},{"speaker":"Charles Goldfarb","startTime":672.18,"endTime":677.88,"body":"healing. But yes, if you're if"},{"speaker":"Charles Goldfarb","startTime":677.88,"endTime":681.21,"body":"you're multiple perforating a"},{"speaker":"Charles Goldfarb","startTime":677.88,"endTime":681.21,"body":"bone, you weaken it, obviously."},{"speaker":"Charles Goldfarb","startTime":681.21,"endTime":684.03,"body":"And that's the intent when"},{"speaker":"Charles Goldfarb","startTime":681.21,"endTime":684.03,"body":"you're performing an osteotomy."},{"speaker":"Charles Goldfarb","startTime":684.03,"endTime":687.09,"body":"It's not the intent when you're"},{"speaker":"Charles Goldfarb","startTime":684.03,"endTime":687.09,"body":"performing a painting. It's"},{"speaker":"Charles Goldfarb","startTime":687.09,"endTime":689.58,"body":"funny, though, along those"},{"speaker":"Charles Goldfarb","startTime":687.09,"endTime":689.58,"body":"lines, we were talking the other"},{"speaker":"Charles Goldfarb","startTime":689.58,"endTime":692.07,"body":"day about a couple you know, a"},{"speaker":"Charles Goldfarb","startTime":689.58,"endTime":692.07,"body":"bunch of old people were sitting"},{"speaker":"Charles Goldfarb","startTime":692.07,"endTime":695.79,"body":"around the table talking about"},{"speaker":"Charles Goldfarb","startTime":692.07,"endTime":695.79,"body":"generational gaps, and someone"},{"speaker":"Charles Goldfarb","startTime":696.21,"endTime":699.48,"body":"made the motion of rolling down"},{"speaker":"Charles Goldfarb","startTime":696.21,"endTime":699.48,"body":"their window with a manual"},{"speaker":"Charles Goldfarb","startTime":699.48,"endTime":701.88,"body":"roller. You may not even"},{"speaker":"Charles Goldfarb","startTime":699.48,"endTime":701.88,"body":"remember what that"},{"speaker":"Chris Dy","startTime":702.72,"endTime":703.98,"body":"oh, yeah, remember"},{"speaker":"Chris Dy","startTime":702.72,"endTime":703.98,"body":"that?"},{"speaker":"Charles Goldfarb","startTime":704.82,"endTime":706.8,"body":"And know what"},{"speaker":"Charles Goldfarb","startTime":704.82,"endTime":706.8,"body":"you're talking about? Yep."},{"speaker":"Chris Dy","startTime":706.86,"endTime":708.66,"body":"But still up. It's"},{"speaker":"Chris Dy","startTime":706.86,"endTime":708.66,"body":"still people get the thing with"},{"speaker":"Chris Dy","startTime":708.66,"endTime":711.21,"body":"the phone. When you put your"},{"speaker":"Chris Dy","startTime":708.66,"endTime":711.21,"body":"like you're, you're someone"},{"speaker":"Chris Dy","startTime":711.21,"endTime":713.85,"body":"you're thinking, even though"},{"speaker":"Chris Dy","startTime":711.21,"endTime":713.85,"body":"many people have never held the"},{"speaker":"Chris Dy","startTime":713.85,"endTime":714.66,"body":"phone in that way."},{"speaker":"Charles Goldfarb","startTime":715.5,"endTime":717.45,"body":"That's true."},{"speaker":"Charles Goldfarb","startTime":715.5,"endTime":717.45,"body":"That'd be I don't know that all"},{"speaker":"Charles Goldfarb","startTime":717.45,"endTime":720.12,"body":"kids do. Like I asked my kids"},{"speaker":"Charles Goldfarb","startTime":717.45,"endTime":720.12,"body":"that very question. It was for"},{"speaker":"Charles Goldfarb","startTime":720.12,"endTime":722.76,"body":"me, it was more of this, like,"},{"speaker":"Charles Goldfarb","startTime":720.12,"endTime":722.76,"body":"what's this? And it was kind of"},{"speaker":"Charles Goldfarb","startTime":722.76,"endTime":724.59,"body":"like, what are you holding your"},{"speaker":"Charles Goldfarb","startTime":722.76,"endTime":724.59,"body":"fist up to"},{"speaker":"Chris Dy","startTime":725.61,"endTime":728.58,"body":"see those of you that"},{"speaker":"Chris Dy","startTime":725.61,"endTime":728.58,"body":"are only listening on audio and"},{"speaker":"Chris Dy","startTime":728.58,"endTime":731.7,"body":"are missing the live the YouTube"},{"speaker":"Chris Dy","startTime":728.58,"endTime":731.7,"body":"feed are missing all these"},{"speaker":"Chris Dy","startTime":731.73,"endTime":734.28,"body":"wonderful gestures that Chuck"},{"speaker":"Chris Dy","startTime":731.73,"endTime":734.28,"body":"has made us all is him scarfing"},{"speaker":"Chris Dy","startTime":734.28,"endTime":737.22,"body":"down these overnight oats."},{"speaker":"Chris Dy","startTime":734.28,"endTime":737.22,"body":"Before we move on, I want to ask"},{"speaker":"Chris Dy","startTime":737.22,"endTime":740.25,"body":"you, so it's two pins, are they"},{"speaker":"Chris Dy","startTime":737.22,"endTime":740.25,"body":"largely oriented in the"},{"speaker":"Chris Dy","startTime":740.25,"endTime":745.53,"body":"transverse manner? Yes. And then"},{"speaker":"Chris Dy","startTime":740.25,"endTime":745.53,"body":"how do you position the thumb in"},{"speaker":"Chris Dy","startTime":745.53,"endTime":747.99,"body":"terms of where it is relative to"},{"speaker":"Chris Dy","startTime":745.53,"endTime":747.99,"body":"the plane of the palm?"},{"speaker":"Charles Goldfarb","startTime":748.679,"endTime":752.429,"body":"Yeah, so I"},{"speaker":"Charles Goldfarb","startTime":748.679,"endTime":752.429,"body":"prefer a Well, I think antic"},{"speaker":"Charles Goldfarb","startTime":752.429,"endTime":756.209,"body":"position with maximum radial and"},{"speaker":"Charles Goldfarb","startTime":752.429,"endTime":756.209,"body":"Palmer abduction is one way to"},{"speaker":"Charles Goldfarb","startTime":756.209,"endTime":760.169,"body":"do it. And certainly that's"},{"speaker":"Charles Goldfarb","startTime":756.209,"endTime":760.169,"body":"appropriate. I don't mind if"},{"speaker":"Charles Goldfarb","startTime":760.169,"endTime":763.469,"body":"it's just radially abducted"},{"speaker":"Charles Goldfarb","startTime":760.169,"endTime":763.469,"body":"either. So in the plane of the"},{"speaker":"Charles Goldfarb","startTime":763.469,"endTime":766.199,"body":"fingers, I think is okay, as"},{"speaker":"Charles Goldfarb","startTime":763.469,"endTime":766.199,"body":"long as we're putting the skin"},{"speaker":"Charles Goldfarb","startTime":766.199,"endTime":769.109,"body":"on tension, and you actually put"},{"speaker":"Charles Goldfarb","startTime":766.199,"endTime":769.109,"body":"it a little more tension, I"},{"speaker":"Charles Goldfarb","startTime":769.109,"endTime":771.689,"body":"think when you're maximally"},{"speaker":"Charles Goldfarb","startTime":769.109,"endTime":771.689,"body":"radially abducted."},{"speaker":"Chris Dy","startTime":773.549,"endTime":777.629,"body":"And I think one point"},{"speaker":"Chris Dy","startTime":773.549,"endTime":777.629,"body":"that you mentioned, and you"},{"speaker":"Chris Dy","startTime":777.629,"endTime":779.969,"body":"know, should be reinforced is"},{"speaker":"Chris Dy","startTime":777.629,"endTime":779.969,"body":"the importance of debridement."},{"speaker":"Chris Dy","startTime":780.839,"endTime":783.689,"body":"Yeah, I think getting a really"},{"speaker":"Chris Dy","startTime":780.839,"endTime":783.689,"body":"good to breed mentor, as Marty"},{"speaker":"Chris Dy","startTime":783.689,"endTime":787.439,"body":"would say, to breed mount is"},{"speaker":"Chris Dy","startTime":783.689,"endTime":787.439,"body":"critical with this, because, you"},{"speaker":"Chris Dy","startTime":787.439,"endTime":789.989,"body":"know, I think the last thing we"},{"speaker":"Chris Dy","startTime":787.439,"endTime":789.989,"body":"want to do is leave a night just"},{"speaker":"Chris Dy","startTime":789.989,"endTime":793.829,"body":"for infection. You know, and"},{"speaker":"Chris Dy","startTime":789.989,"endTime":793.829,"body":"unfortunately, a lot of my"},{"speaker":"Chris Dy","startTime":793.829,"endTime":796.349,"body":"experience with firework"},{"speaker":"Chris Dy","startTime":793.829,"endTime":796.349,"body":"injuries is that not all of them"},{"speaker":"Chris Dy","startTime":796.529,"endTime":799.319,"body":"have the ability to follow up"},{"speaker":"Chris Dy","startTime":796.529,"endTime":799.319,"body":"locally. Since, you know, given"},{"speaker":"Chris Dy","startTime":799.319,"endTime":801.599,"body":"the nature of our center, we see"},{"speaker":"Chris Dy","startTime":799.319,"endTime":801.599,"body":"a lot of people that are"},{"speaker":"Chris Dy","startTime":801.629,"endTime":805.319,"body":"transported in sometimes"},{"speaker":"Chris Dy","startTime":801.629,"endTime":805.319,"body":"unnecessarily flown in for a"},{"speaker":"Chris Dy","startTime":805.319,"endTime":808.199,"body":"revision amputation. Because"},{"speaker":"Chris Dy","startTime":805.319,"endTime":808.199,"body":"nobody knows what to do with"},{"speaker":"Chris Dy","startTime":808.199,"endTime":810.269,"body":"these. And they're very"},{"speaker":"Chris Dy","startTime":808.199,"endTime":810.269,"body":"intimidating based on the"},{"speaker":"Chris Dy","startTime":810.269,"endTime":812.999,"body":"pictures, as you alluded to,"},{"speaker":"Chris Dy","startTime":810.269,"endTime":812.999,"body":"everybody has this kind of shock"},{"speaker":"Chris Dy","startTime":812.999,"endTime":817.409,"body":"factor. I remember Fourth of"},{"speaker":"Chris Dy","startTime":812.999,"endTime":817.409,"body":"July as a fellow just, you know,"},{"speaker":"Chris Dy","startTime":817.859,"endTime":821.429,"body":"having a nice day. And then it"},{"speaker":"Chris Dy","startTime":817.859,"endTime":821.429,"body":"started like in Italy in the"},{"speaker":"Chris Dy","startTime":821.429,"endTime":824.969,"body":"late afternoon and I got to the"},{"speaker":"Chris Dy","startTime":821.429,"endTime":824.969,"body":"hospital, I didn't, I hope"},{"speaker":"Chris Dy","startTime":824.969,"endTime":827.879,"body":"nobody from the ACGME is"},{"speaker":"Chris Dy","startTime":824.969,"endTime":827.879,"body":"listening. But you know, I"},{"speaker":"Chris Dy","startTime":827.879,"endTime":830.819,"body":"didn't leave the hospital for a"},{"speaker":"Chris Dy","startTime":827.879,"endTime":830.819,"body":"solid 30 hours, because there"},{"speaker":"Chris Dy","startTime":830.819,"endTime":835.919,"body":"was so much work to do it so we"},{"speaker":"Chris Dy","startTime":830.819,"endTime":835.919,"body":"had to, it was just a busy time."},{"speaker":"Chris Dy","startTime":835.949,"endTime":838.979,"body":"But a lot of there were a lot of"},{"speaker":"Chris Dy","startTime":835.949,"endTime":838.979,"body":"transfer calls. And you know,"},{"speaker":"Chris Dy","startTime":839.069,"endTime":841.319,"body":"triaging those can be"},{"speaker":"Chris Dy","startTime":839.069,"endTime":841.319,"body":"challenging, because it's very"},{"speaker":"Chris Dy","startTime":841.319,"endTime":843.899,"body":"intimidating, you know, if"},{"speaker":"Chris Dy","startTime":841.319,"endTime":843.899,"body":"you're already doing, we were"},{"speaker":"Chris Dy","startTime":843.899,"endTime":846.779,"body":"doing some microvascular work at"},{"speaker":"Chris Dy","startTime":843.899,"endTime":846.779,"body":"that time, and you know whether"},{"speaker":"Chris Dy","startTime":846.779,"endTime":849.869,"body":"to accept something when you're"},{"speaker":"Chris Dy","startTime":846.779,"endTime":849.869,"body":"already doing a Micro Case is"},{"speaker":"Chris Dy","startTime":849.869,"endTime":853.049,"body":"one thing, and that's probably a"},{"speaker":"Chris Dy","startTime":849.869,"endTime":853.049,"body":"topic for another day. But then"},{"speaker":"Chris Dy","startTime":853.049,"endTime":856.259,"body":"also just moving through the"},{"speaker":"Chris Dy","startTime":853.049,"endTime":856.259,"body":"line of revision amputations"},{"speaker":"Chris Dy","startTime":856.259,"endTime":858.239,"body":"trying to ferret what could be"},{"speaker":"Chris Dy","startTime":856.259,"endTime":858.239,"body":"done in the IDI what needed to"},{"speaker":"Chris Dy","startTime":858.239,"endTime":860.369,"body":"be done in the ER because of the"},{"speaker":"Chris Dy","startTime":858.239,"endTime":860.369,"body":"treatments, all that kind of"},{"speaker":"Chris Dy","startTime":860.369,"endTime":860.699,"body":"stuff."},{"speaker":"Charles Goldfarb","startTime":861.179,"endTime":862.919,"body":"Yeah, all"},{"speaker":"Charles Goldfarb","startTime":861.179,"endTime":862.919,"body":"really good points. And it goes"},{"speaker":"Charles Goldfarb","startTime":862.919,"endTime":867.269,"body":"back to your previous question"},{"speaker":"Charles Goldfarb","startTime":862.919,"endTime":867.269,"body":"slash point you made about, you"},{"speaker":"Charles Goldfarb","startTime":867.269,"endTime":869.249,"body":"know, what do you do immediately"},{"speaker":"Charles Goldfarb","startTime":867.269,"endTime":869.249,"body":"versus what do you do in a"},{"speaker":"Charles Goldfarb","startTime":869.249,"endTime":872.519,"body":"delayed fashion and you know, we"},{"speaker":"Charles Goldfarb","startTime":869.249,"endTime":872.519,"body":"want to do the right thing for"},{"speaker":"Charles Goldfarb","startTime":872.519,"endTime":875.729,"body":"the patient, but a patient who"},{"speaker":"Charles Goldfarb","startTime":872.519,"endTime":875.729,"body":"has trouble traveling and may"},{"speaker":"Charles Goldfarb","startTime":875.729,"endTime":878.519,"body":"not be able to come back for"},{"speaker":"Charles Goldfarb","startTime":875.729,"endTime":878.519,"body":"follow ups in St. Louis. That's"},{"speaker":"Charles Goldfarb","startTime":878.519,"endTime":881.609,"body":"a real trick and should we be"},{"speaker":"Charles Goldfarb","startTime":878.519,"endTime":881.609,"body":"more aggressive with immediate"},{"speaker":"Charles Goldfarb","startTime":881.609,"endTime":885.659,"body":"flaps if potentially necessary?"},{"speaker":"Charles Goldfarb","startTime":881.609,"endTime":885.659,"body":"And that's it's a fair question."},{"speaker":"Charles Goldfarb","startTime":885.659,"endTime":887.939,"body":"I don't think there's a right or"},{"speaker":"Charles Goldfarb","startTime":885.659,"endTime":887.939,"body":"wrong answer personally."},{"speaker":"Chris Dy","startTime":888.78,"endTime":890.49,"body":"Absolutely. We should"},{"speaker":"Chris Dy","startTime":888.78,"endTime":890.49,"body":"have an episode some point"},{"speaker":"Chris Dy","startTime":890.49,"endTime":893.16,"body":"about, you know, non"},{"speaker":"Chris Dy","startTime":890.49,"endTime":893.16,"body":"microsurgical flaps that hand"},{"speaker":"Chris Dy","startTime":893.16,"endTime":895.89,"body":"surgeons can do including that"},{"speaker":"Chris Dy","startTime":893.16,"endTime":895.89,"body":"growing flap, which is a nice,"},{"speaker":"Chris Dy","startTime":896.31,"endTime":898.41,"body":"nice technique to pull out of"},{"speaker":"Chris Dy","startTime":896.31,"endTime":898.41,"body":"the bag every now and then"},{"speaker":"Chris Dy","startTime":898.41,"endTime":902.22,"body":"certainly one that is A little"},{"speaker":"Chris Dy","startTime":898.41,"endTime":902.22,"body":"bit of a shock to patients if"},{"speaker":"Chris Dy","startTime":902.22,"endTime":905.7,"body":"they wake up with their hand"},{"speaker":"Chris Dy","startTime":902.22,"endTime":905.7,"body":"sewn to their crotch, but we"},{"speaker":"Chris Dy","startTime":905.7,"endTime":907.5,"body":"should talk about that in a day."},{"speaker":"Chris Dy","startTime":905.7,"endTime":907.5,"body":"I'm sure there are a lot of"},{"speaker":"Chris Dy","startTime":907.5,"endTime":910.62,"body":"guests we could have on to talk"},{"speaker":"Chris Dy","startTime":907.5,"endTime":910.62,"body":"about that. We should think we"},{"speaker":"Chris Dy","startTime":910.62,"endTime":911.91,"body":"should thank our sponsors."},{"speaker":"Charles Goldfarb","startTime":912.539,"endTime":914.609,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":912.539,"endTime":914.609,"body":"The upper hand is sponsored by"},{"speaker":"Charles Goldfarb","startTime":914.609,"endTime":917.909,"body":"practice link.com, the most"},{"speaker":"Charles Goldfarb","startTime":914.609,"endTime":917.909,"body":"widely used physician job search"},{"speaker":"Charles Goldfarb","startTime":917.909,"endTime":920.249,"body":"and career advancement resource."},{"speaker":"Chris Dy","startTime":920.82,"endTime":923.07,"body":"Becoming a physician"},{"speaker":"Chris Dy","startTime":920.82,"endTime":923.07,"body":"is hard finding the right job"},{"speaker":"Chris Dy","startTime":923.07,"endTime":925.98,"body":"doesn't have to be joint"},{"speaker":"Chris Dy","startTime":923.07,"endTime":925.98,"body":"practice link for free today at"},{"speaker":"Chris Dy","startTime":925.98,"endTime":932.28,"body":"www.practicing.com/the. upper"},{"speaker":"Chris Dy","startTime":925.98,"endTime":932.28,"body":"hand. So I wanted to thank all"},{"speaker":"Chris Dy","startTime":932.28,"endTime":936.51,"body":"the listeners for for writing in"},{"speaker":"Chris Dy","startTime":932.28,"endTime":936.51,"body":"we've had some fantastic emails"},{"speaker":"Chris Dy","startTime":936.51,"endTime":939.87,"body":"come in about prior episodes a"},{"speaker":"Chris Dy","startTime":936.51,"endTime":939.87,"body":"lot about the FTL reconstruction"},{"speaker":"Chris Dy","startTime":939.87,"endTime":943.14,"body":"episode, great pointers. I do"},{"speaker":"Chris Dy","startTime":939.87,"endTime":943.14,"body":"want to save those for another"},{"speaker":"Chris Dy","startTime":943.14,"endTime":947.67,"body":"episode, we've had a great email"},{"speaker":"Chris Dy","startTime":943.14,"endTime":947.67,"body":"about our scaphoid discussion"},{"speaker":"Chris Dy","startTime":947.85,"endTime":953.4,"body":"from from our last episode with"},{"speaker":"Chris Dy","startTime":947.85,"endTime":953.4,"body":"with a little bit of contention,"},{"speaker":"Chris Dy","startTime":953.43,"endTime":957.06,"body":"which is great good to discuss."},{"speaker":"Chris Dy","startTime":953.43,"endTime":957.06,"body":"So I think there's a lot of good"},{"speaker":"Chris Dy","startTime":957.06,"endTime":959.64,"body":"stuff in there. There's a nice P"},{"speaker":"Chris Dy","startTime":957.06,"endTime":959.64,"body":"IP case. So we'll save those for"},{"speaker":"Chris Dy","startTime":959.64,"endTime":962.22,"body":"another day. But I do want to"},{"speaker":"Chris Dy","startTime":959.64,"endTime":962.22,"body":"thank everybody for writing in."},{"speaker":"Chris Dy","startTime":962.43,"endTime":965.43,"body":"We get them we get the emails we"},{"speaker":"Chris Dy","startTime":962.43,"endTime":965.43,"body":"love. It gives us great stuff to"},{"speaker":"Chris Dy","startTime":965.43,"endTime":969.0,"body":"talk about. So if you have any"},{"speaker":"Chris Dy","startTime":965.43,"endTime":969.0,"body":"questions, suggestions, cases,"},{"speaker":"Chris Dy","startTime":969.0,"endTime":971.79,"body":"etc. Hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":973.2,"endTime":977.58,"body":"Yes, love it."},{"speaker":"Charles Goldfarb","startTime":973.2,"endTime":977.58,"body":"And really, it's so helpful to"},{"speaker":"Charles Goldfarb","startTime":977.58,"endTime":981.03,"body":"have that fodder for discussion,"},{"speaker":"Charles Goldfarb","startTime":977.58,"endTime":981.03,"body":"because it means that people are"},{"speaker":"Charles Goldfarb","startTime":981.03,"endTime":984.54,"body":"interested and engaged in"},{"speaker":"Charles Goldfarb","startTime":981.03,"endTime":984.54,"body":"there's really good topics. And"},{"speaker":"Charles Goldfarb","startTime":984.6,"endTime":986.7,"body":"yes, you and I discussed the"},{"speaker":"Charles Goldfarb","startTime":984.6,"endTime":986.7,"body":"head to discuss this morning."},{"speaker":"Charles Goldfarb","startTime":986.7,"endTime":990.66,"body":"Where do we start? But we're"},{"speaker":"Charles Goldfarb","startTime":986.7,"endTime":990.66,"body":"starting with a little journal"},{"speaker":"Charles Goldfarb","startTime":990.66,"endTime":991.65,"body":"club. Yes,"},{"speaker":"Chris Dy","startTime":991.65,"endTime":994.14,"body":"we did talk at the end"},{"speaker":"Chris Dy","startTime":991.65,"endTime":994.14,"body":"of the last episode about how we"},{"speaker":"Chris Dy","startTime":994.14,"endTime":996.12,"body":"wanted to do journal, we got"},{"speaker":"Chris Dy","startTime":994.14,"endTime":996.12,"body":"kind of caught up in that"},{"speaker":"Chris Dy","startTime":996.12,"endTime":999.54,"body":"skateboard case. So speaking of"},{"speaker":"Chris Dy","startTime":996.12,"endTime":999.54,"body":"skateboards, there was a really"},{"speaker":"Chris Dy","startTime":999.54,"endTime":1003.32,"body":"interesting article from the"},{"speaker":"Chris Dy","startTime":999.54,"endTime":1003.32,"body":"Machine Learning Consortium,"},{"speaker":"Chris Dy","startTime":1003.35,"endTime":1006.26,"body":"which is, you know, all over the"},{"speaker":"Chris Dy","startTime":1003.35,"endTime":1006.26,"body":"place, but really headquartered"},{"speaker":"Chris Dy","startTime":1006.26,"endTime":1012.62,"body":"in the, in the Netherlands and"},{"speaker":"Chris Dy","startTime":1006.26,"endTime":1012.62,"body":"Australia. So, machine learning"},{"speaker":"Chris Dy","startTime":1012.62,"endTime":1015.05,"body":"for scaphoid fractures. So you"},{"speaker":"Chris Dy","startTime":1012.62,"endTime":1015.05,"body":"know, there's that always that"},{"speaker":"Chris Dy","startTime":1015.05,"endTime":1018.02,"body":"clinical conundrum about, you"},{"speaker":"Chris Dy","startTime":1015.05,"endTime":1018.02,"body":"know, the occult, scaphoid"},{"speaker":"Chris Dy","startTime":1018.02,"endTime":1021.44,"body":"fracture. And in this this the"},{"speaker":"Chris Dy","startTime":1018.02,"endTime":1021.44,"body":"first article, the first author"},{"speaker":"Chris Dy","startTime":1021.44,"endTime":1024.47,"body":"on this article was last name"},{"speaker":"Chris Dy","startTime":1021.44,"endTime":1024.47,"body":"Bill strap, and this was in the"},{"speaker":"Chris Dy","startTime":1024.47,"endTime":1029.3,"body":"journal a hand surgery, the"},{"speaker":"Chris Dy","startTime":1024.47,"endTime":1029.3,"body":"American edition last month. So,"},{"speaker":"Chris Dy","startTime":1029.33,"endTime":1031.82,"body":"Chuck, what did you take home"},{"speaker":"Chris Dy","startTime":1029.33,"endTime":1031.82,"body":"from this? I mean, you know,"},{"speaker":"Chris Dy","startTime":1031.82,"endTime":1037.52,"body":"they looked at 117 fractures"},{"speaker":"Chris Dy","startTime":1031.82,"endTime":1037.52,"body":"that were confirmed on CT scan"},{"speaker":"Chris Dy","startTime":1037.52,"endTime":1042.17,"body":"MRI, and on X ray, you know,"},{"speaker":"Chris Dy","startTime":1037.52,"endTime":1042.17,"body":"among 422 patients with radial"},{"speaker":"Chris Dy","startTime":1042.17,"endTime":1045.38,"body":"wrist pain after I recited"},{"speaker":"Chris Dy","startTime":1042.17,"endTime":1045.38,"body":"trauma, and then use machine"},{"speaker":"Chris Dy","startTime":1045.38,"endTime":1048.53,"body":"learning algorithms, which they"},{"speaker":"Chris Dy","startTime":1045.38,"endTime":1048.53,"body":"did not disclose the algorithms"},{"speaker":"Chris Dy","startTime":1048.53,"endTime":1053.69,"body":"because I think they're still"},{"speaker":"Chris Dy","startTime":1048.53,"endTime":1053.69,"body":"being refined, so to say, but"},{"speaker":"Chris Dy","startTime":1053.72,"endTime":1057.14,"body":"interestingly enough, you know,"},{"speaker":"Chris Dy","startTime":1053.72,"endTime":1057.14,"body":"I think they're getting closer"},{"speaker":"Chris Dy","startTime":1057.14,"endTime":1061.1,"body":"to trying to find some kind of"},{"speaker":"Chris Dy","startTime":1057.14,"endTime":1061.1,"body":"decision aid for the occult,"},{"speaker":"Chris Dy","startTime":1061.1,"endTime":1061.91,"body":"scaphoid fracture."},{"speaker":"Charles Goldfarb","startTime":1062.9,"endTime":1065.78,"body":"Yeah, and you"},{"speaker":"Charles Goldfarb","startTime":1062.9,"endTime":1065.78,"body":"and I have discussed on the pod"},{"speaker":"Charles Goldfarb","startTime":1065.81,"endTime":1069.98,"body":"the how we each approach these"},{"speaker":"Charles Goldfarb","startTime":1065.81,"endTime":1069.98,"body":"in the sense that, you know,"},{"speaker":"Charles Goldfarb","startTime":1069.98,"endTime":1073.7,"body":"when do you immobilize, when do"},{"speaker":"Charles Goldfarb","startTime":1069.98,"endTime":1073.7,"body":"you get advanced imaging, etc,"},{"speaker":"Charles Goldfarb","startTime":1073.7,"endTime":1077.78,"body":"etc. So the point of this study"},{"speaker":"Charles Goldfarb","startTime":1073.7,"endTime":1077.78,"body":"is, can we accurately predict"},{"speaker":"Charles Goldfarb","startTime":1077.93,"endTime":1081.5,"body":"the probability of a fracture?"},{"speaker":"Charles Goldfarb","startTime":1077.93,"endTime":1081.5,"body":"And can we decrease the number"},{"speaker":"Charles Goldfarb","startTime":1081.8,"endTime":1086.15,"body":"of patients who have advanced"},{"speaker":"Charles Goldfarb","startTime":1081.8,"endTime":1086.15,"body":"imaging to rule out scaphoid"},{"speaker":"Charles Goldfarb","startTime":1086.15,"endTime":1090.17,"body":"fracture? And I have to say, I"},{"speaker":"Charles Goldfarb","startTime":1086.15,"endTime":1090.17,"body":"don't know that, you know, in"},{"speaker":"Charles Goldfarb","startTime":1090.17,"endTime":1092.84,"body":"any way, this changes our"},{"speaker":"Charles Goldfarb","startTime":1090.17,"endTime":1092.84,"body":"current treatment, it has the"},{"speaker":"Charles Goldfarb","startTime":1092.84,"endTime":1096.35,"body":"potential to change our future"},{"speaker":"Charles Goldfarb","startTime":1092.84,"endTime":1096.35,"body":"treatment, but it is pertinent"},{"speaker":"Charles Goldfarb","startTime":1096.38,"endTime":1101.69,"body":"because machine learning is all"},{"speaker":"Charles Goldfarb","startTime":1096.38,"endTime":1101.69,"body":"over the place. And I think this"},{"speaker":"Charles Goldfarb","startTime":1101.69,"endTime":1105.86,"body":"is coming as an adjunct to our"},{"speaker":"Charles Goldfarb","startTime":1101.69,"endTime":1105.86,"body":"clinical acumen, and it will"},{"speaker":"Charles Goldfarb","startTime":1105.86,"endTime":1111.17,"body":"make all of us a little bit"},{"speaker":"Charles Goldfarb","startTime":1105.86,"endTime":1111.17,"body":"better. Because we, you know,"},{"speaker":"Charles Goldfarb","startTime":1111.17,"endTime":1114.23,"body":"this just makes every decision a"},{"speaker":"Charles Goldfarb","startTime":1111.17,"endTime":1114.23,"body":"little more scientific, or I"},{"speaker":"Charles Goldfarb","startTime":1114.23,"endTime":1116.51,"body":"should say, it will make every"},{"speaker":"Charles Goldfarb","startTime":1114.23,"endTime":1116.51,"body":"decision a little more"},{"speaker":"Charles Goldfarb","startTime":1116.51,"endTime":1117.14,"body":"scientific."},{"speaker":"Chris Dy","startTime":1117.41,"endTime":1119.15,"body":"Yeah, no, I think it's"},{"speaker":"Chris Dy","startTime":1117.41,"endTime":1119.15,"body":"interesting, because, you know,"},{"speaker":"Chris Dy","startTime":1119.15,"endTime":1123.68,"body":"when I think of machine learning"},{"speaker":"Chris Dy","startTime":1119.15,"endTime":1123.68,"body":"in this context, I think about,"},{"speaker":"Chris Dy","startTime":1123.68,"endTime":1128.09,"body":"you know, a lot has been said"},{"speaker":"Chris Dy","startTime":1123.68,"endTime":1128.09,"body":"about the potential for machine"},{"speaker":"Chris Dy","startTime":1128.09,"endTime":1131.36,"body":"learning and quote, AI in a very"},{"speaker":"Chris Dy","startTime":1128.09,"endTime":1131.36,"body":"kind of broad term about"},{"speaker":"Chris Dy","startTime":1131.36,"endTime":1134.42,"body":"replacing radiologists in many"},{"speaker":"Chris Dy","startTime":1131.36,"endTime":1134.42,"body":"ways, in terms of pattern"},{"speaker":"Chris Dy","startTime":1134.42,"endTime":1136.91,"body":"recognition on imaging. So this"},{"speaker":"Chris Dy","startTime":1134.42,"endTime":1136.91,"body":"I think, is interesting because"},{"speaker":"Chris Dy","startTime":1136.91,"endTime":1140.21,"body":"it goes beyond just the"},{"speaker":"Chris Dy","startTime":1136.91,"endTime":1140.21,"body":"radiographs and looks at some of"},{"speaker":"Chris Dy","startTime":1140.21,"endTime":1142.64,"body":"the clinical factors, you know,"},{"speaker":"Chris Dy","startTime":1140.21,"endTime":1142.64,"body":"in terms of locations of"},{"speaker":"Chris Dy","startTime":1142.64,"endTime":1145.97,"body":"tenderness, age, mechanism of"},{"speaker":"Chris Dy","startTime":1142.64,"endTime":1145.97,"body":"injury, that kind of thing, and"},{"speaker":"Chris Dy","startTime":1145.97,"endTime":1149.03,"body":"factors in essentially doing a"},{"speaker":"Chris Dy","startTime":1145.97,"endTime":1149.03,"body":"moderate version of something"},{"speaker":"Chris Dy","startTime":1149.03,"endTime":1151.43,"body":"like the audible ankle rules,"},{"speaker":"Chris Dy","startTime":1149.03,"endTime":1151.43,"body":"like you know, the rules for"},{"speaker":"Chris Dy","startTime":1151.43,"endTime":1154.22,"body":"like a decision, you know,"},{"speaker":"Chris Dy","startTime":1151.43,"endTime":1154.22,"body":"simple score for like, if you"},{"speaker":"Chris Dy","startTime":1154.25,"endTime":1156.89,"body":"come in with ankle pain, and"},{"speaker":"Chris Dy","startTime":1154.25,"endTime":1156.89,"body":"whether you have an ankle sprain"},{"speaker":"Chris Dy","startTime":1156.89,"endTime":1159.98,"body":"whether you should get X rays or"},{"speaker":"Chris Dy","startTime":1156.89,"endTime":1159.98,"body":"not to look for a fracture. Now,"},{"speaker":"Chris Dy","startTime":1159.98,"endTime":1162.5,"body":"clearly, you know, sending"},{"speaker":"Chris Dy","startTime":1159.98,"endTime":1162.5,"body":"somebody for a CT scan or an"},{"speaker":"Chris Dy","startTime":1162.5,"endTime":1165.11,"body":"MRI, you know, one of the"},{"speaker":"Chris Dy","startTime":1162.5,"endTime":1165.11,"body":"advanced imaging modalities is"},{"speaker":"Chris Dy","startTime":1165.11,"endTime":1168.95,"body":"much bigger deal than getting X"},{"speaker":"Chris Dy","startTime":1165.11,"endTime":1168.95,"body":"rays, you know, so this"},{"speaker":"Chris Dy","startTime":1168.95,"endTime":1173.15,"body":"algorithm was able to cut down"},{"speaker":"Chris Dy","startTime":1168.95,"endTime":1173.15,"body":"had 100% sensitivity, although,"},{"speaker":"Chris Dy","startTime":1173.18,"endTime":1175.58,"body":"you know, which is good because"},{"speaker":"Chris Dy","startTime":1173.18,"endTime":1175.58,"body":"it didn't miss a fracture, but"},{"speaker":"Chris Dy","startTime":1175.58,"endTime":1179.72,"body":"it probably over called some"},{"speaker":"Chris Dy","startTime":1175.58,"endTime":1179.72,"body":"because their specificity was"},{"speaker":"Chris Dy","startTime":1179.72,"endTime":1182.51,"body":"quite low. And they said that"},{"speaker":"Chris Dy","startTime":1179.72,"endTime":1182.51,"body":"they were able to cut down"},{"speaker":"Chris Dy","startTime":1182.51,"endTime":1185.81,"body":"advanced imaging by 36%. So"},{"speaker":"Chris Dy","startTime":1182.51,"endTime":1185.81,"body":"within the confines of a, you"},{"speaker":"Chris Dy","startTime":1185.81,"endTime":1188.9,"body":"know, a system in which you have"},{"speaker":"Chris Dy","startTime":1185.81,"endTime":1188.9,"body":"finite resources, which all"},{"speaker":"Chris Dy","startTime":1188.9,"endTime":1191.57,"body":"healthcare systems do, and we're"},{"speaker":"Chris Dy","startTime":1188.9,"endTime":1191.57,"body":"trying to be good stewards of"},{"speaker":"Chris Dy","startTime":1191.57,"endTime":1195.56,"body":"this. This has the potential to"},{"speaker":"Chris Dy","startTime":1191.57,"endTime":1195.56,"body":"really help cut costs and drive"},{"speaker":"Chris Dy","startTime":1195.56,"endTime":1200.63,"body":"value. The discussion that we"},{"speaker":"Chris Dy","startTime":1195.56,"endTime":1200.63,"body":"had in our in our Hands service"},{"speaker":"Chris Dy","startTime":1200.63,"endTime":1203.27,"body":"conference on Journal Club was"},{"speaker":"Chris Dy","startTime":1200.63,"endTime":1203.27,"body":"really derived from Where's"},{"speaker":"Chris Dy","startTime":1203.27,"endTime":1205.82,"body":"machine learning going to go."},{"speaker":"Chris Dy","startTime":1203.27,"endTime":1205.82,"body":"And I think what's going to"},{"speaker":"Chris Dy","startTime":1205.82,"endTime":1207.92,"body":"happen is that you're going to"},{"speaker":"Chris Dy","startTime":1205.82,"endTime":1207.92,"body":"see some of these, you know,"},{"speaker":"Chris Dy","startTime":1207.92,"endTime":1211.82,"body":"machine learning algorithms get"},{"speaker":"Chris Dy","startTime":1207.92,"endTime":1211.82,"body":"in the hands of, of insurance"},{"speaker":"Chris Dy","startTime":1211.82,"endTime":1216.26,"body":"companies and payers, and it"},{"speaker":"Chris Dy","startTime":1211.82,"endTime":1216.26,"body":"really drive, you know, the"},{"speaker":"Chris Dy","startTime":1216.26,"endTime":1219.44,"body":"prior authorization processes,"},{"speaker":"Chris Dy","startTime":1216.26,"endTime":1219.44,"body":"essentially. And I think that"},{"speaker":"Chris Dy","startTime":1219.44,"endTime":1222.05,"body":"can be a bit I worry about where"},{"speaker":"Chris Dy","startTime":1219.44,"endTime":1222.05,"body":"that's gonna go."},{"speaker":"Charles Goldfarb","startTime":1223.43,"endTime":1226.1,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1223.43,"endTime":1226.1,"body":"that's well said. And the other"},{"speaker":"Charles Goldfarb","startTime":1226.13,"endTime":1229.22,"body":"factor is, you know, what"},{"speaker":"Charles Goldfarb","startTime":1226.13,"endTime":1229.22,"body":"mattered to their algorithm to"},{"speaker":"Charles Goldfarb","startTime":1229.22,"endTime":1232.25,"body":"their, the ability of the"},{"speaker":"Charles Goldfarb","startTime":1229.22,"endTime":1232.25,"body":"machine learning algorithm to"},{"speaker":"Charles Goldfarb","startTime":1232.25,"endTime":1236.54,"body":"predict things and, you know,"},{"speaker":"Charles Goldfarb","startTime":1232.25,"endTime":1236.54,"body":"male sex, the previous talks"},{"speaker":"Charles Goldfarb","startTime":1236.54,"endTime":1241.01,"body":"about sex and age and mechanism"},{"speaker":"Charles Goldfarb","startTime":1236.54,"endTime":1241.01,"body":"and areas of tenderness. And so"},{"speaker":"Charles Goldfarb","startTime":1241.94,"endTime":1244.97,"body":"I think they did a good job of"},{"speaker":"Charles Goldfarb","startTime":1241.94,"endTime":1244.97,"body":"trying to simplify the number of"},{"speaker":"Charles Goldfarb","startTime":1244.97,"endTime":1250.64,"body":"factors that actually mattered."},{"speaker":"Charles Goldfarb","startTime":1244.97,"endTime":1250.64,"body":"So I think, look, we're gonna"},{"speaker":"Charles Goldfarb","startTime":1250.64,"endTime":1253.46,"body":"see a lot more of this as we"},{"speaker":"Charles Goldfarb","startTime":1250.64,"endTime":1253.46,"body":"should, and it is going to"},{"speaker":"Charles Goldfarb","startTime":1253.46,"endTime":1256.4,"body":"affect how we care for patients."},{"speaker":"Charles Goldfarb","startTime":1253.46,"endTime":1256.4,"body":"I don't think it's there yet."},{"speaker":"Charles Goldfarb","startTime":1256.76,"endTime":1258.14,"body":"But it's not far away."},{"speaker":"Chris Dy","startTime":1258.95,"endTime":1261.62,"body":"I haven't finished in"},{"speaker":"Chris Dy","startTime":1258.95,"endTime":1261.62,"body":"one day, you know, with some"},{"speaker":"Chris Dy","startTime":1261.62,"endTime":1265.97,"body":"kind of intake form and use of"},{"speaker":"Chris Dy","startTime":1261.62,"endTime":1265.97,"body":"EMRs. So you know, their figure"},{"speaker":"Chris Dy","startTime":1266.63,"endTime":1269.96,"body":"that they show, figure two in"},{"speaker":"Chris Dy","startTime":1266.63,"endTime":1269.96,"body":"terms of, you know, typing in"},{"speaker":"Chris Dy","startTime":1269.96,"endTime":1273.2,"body":"all the factors and getting your"},{"speaker":"Chris Dy","startTime":1269.96,"endTime":1273.2,"body":"risk of a skateboard fracture is"},{"speaker":"Chris Dy","startTime":1273.2,"endTime":1276.17,"body":"super interesting. It's kind of"},{"speaker":"Chris Dy","startTime":1273.2,"endTime":1276.17,"body":"like, this may have been past"},{"speaker":"Chris Dy","startTime":1276.17,"endTime":1279.62,"body":"your training. But when we use"},{"speaker":"Chris Dy","startTime":1276.17,"endTime":1279.62,"body":"the FRAC score for osteoporotic"},{"speaker":"Chris Dy","startTime":1279.62,"endTime":1281.81,"body":"fractures, and you would go on a"},{"speaker":"Chris Dy","startTime":1279.62,"endTime":1281.81,"body":"website, and you would type in"},{"speaker":"Chris Dy","startTime":1281.81,"endTime":1283.61,"body":"all the demographics, and you"},{"speaker":"Chris Dy","startTime":1281.81,"endTime":1283.61,"body":"would tell the patient their"},{"speaker":"Chris Dy","startTime":1283.61,"endTime":1286.58,"body":"risk for fragility fracture in"},{"speaker":"Chris Dy","startTime":1283.61,"endTime":1286.58,"body":"the next five years, super"},{"speaker":"Chris Dy","startTime":1286.58,"endTime":1288.98,"body":"useful for counseling, so you"},{"speaker":"Chris Dy","startTime":1286.58,"endTime":1288.98,"body":"can type all the factors in for"},{"speaker":"Chris Dy","startTime":1288.98,"endTime":1290.93,"body":"this patient and say, Look, your"},{"speaker":"Chris Dy","startTime":1288.98,"endTime":1290.93,"body":"risk of having a skateboard"},{"speaker":"Chris Dy","startTime":1290.93,"endTime":1294.26,"body":"fracture is not zero, but it's"},{"speaker":"Chris Dy","startTime":1290.93,"endTime":1294.26,"body":"only 20 something percent. So I"},{"speaker":"Chris Dy","startTime":1294.26,"endTime":1297.02,"body":"think us getting imaging at this"},{"speaker":"Chris Dy","startTime":1294.26,"endTime":1297.02,"body":"point is probably advanced"},{"speaker":"Chris Dy","startTime":1297.02,"endTime":1300.2,"body":"imaging is probably overkill."},{"speaker":"Chris Dy","startTime":1297.02,"endTime":1300.2,"body":"But if your number meets a"},{"speaker":"Chris Dy","startTime":1300.2,"endTime":1303.35,"body":"certain threshold, 70 80%, you"},{"speaker":"Chris Dy","startTime":1300.2,"endTime":1303.35,"body":"know, let's go ahead and get the"},{"speaker":"Chris Dy","startTime":1303.35,"endTime":1305.51,"body":"advanced imaging because the"},{"speaker":"Chris Dy","startTime":1303.35,"endTime":1305.51,"body":"numbers show that there's a good"},{"speaker":"Chris Dy","startTime":1305.51,"endTime":1307.82,"body":"chance that the that the"},{"speaker":"Chris Dy","startTime":1305.51,"endTime":1307.82,"body":"fracture is there, some would"},{"speaker":"Chris Dy","startTime":1307.82,"endTime":1309.8,"body":"argue why don't you just treat"},{"speaker":"Chris Dy","startTime":1307.82,"endTime":1309.8,"body":"the fracture, if it's"},{"speaker":"Chris Dy","startTime":1309.8,"endTime":1312.68,"body":"radiographically, occult by just"},{"speaker":"Chris Dy","startTime":1309.8,"endTime":1312.68,"body":"go ahead and putting it into"},{"speaker":"Chris Dy","startTime":1312.68,"endTime":1313.19,"body":"cast?"},{"speaker":"Charles Goldfarb","startTime":1314.06,"endTime":1315.83,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":1314.06,"endTime":1315.83,"body":"really interesting to think"},{"speaker":"Charles Goldfarb","startTime":1315.83,"endTime":1317.45,"body":"about this. And one of the"},{"speaker":"Charles Goldfarb","startTime":1315.83,"endTime":1317.45,"body":"reasons you and I want to"},{"speaker":"Charles Goldfarb","startTime":1317.45,"endTime":1320.81,"body":"discuss this article is how it"},{"speaker":"Charles Goldfarb","startTime":1317.45,"endTime":1320.81,"body":"impacts our clinical care."},{"speaker":"Charles Goldfarb","startTime":1321.08,"endTime":1324.86,"body":"Again, today, not really, when"},{"speaker":"Charles Goldfarb","startTime":1321.08,"endTime":1324.86,"body":"this tomorrow began, I don't"},{"speaker":"Charles Goldfarb","startTime":1324.86,"endTime":1327.14,"body":"know. But, you know, is this"},{"speaker":"Charles Goldfarb","startTime":1324.86,"endTime":1327.14,"body":"gonna be something else we have"},{"speaker":"Charles Goldfarb","startTime":1327.14,"endTime":1330.92,"body":"to pay for as clinicians or as"},{"speaker":"Charles Goldfarb","startTime":1327.14,"endTime":1330.92,"body":"hospital systems to access to"},{"speaker":"Charles Goldfarb","startTime":1331.31,"endTime":1335.48,"body":"these machine learning"},{"speaker":"Charles Goldfarb","startTime":1331.31,"endTime":1335.48,"body":"algorithms. And it is really"},{"speaker":"Charles Goldfarb","startTime":1335.48,"endTime":1337.64,"body":"going to be fascinating to see"},{"speaker":"Charles Goldfarb","startTime":1335.48,"endTime":1337.64,"body":"how it plays out. And all I can"},{"speaker":"Charles Goldfarb","startTime":1337.64,"endTime":1340.79,"body":"say is, I hope that many of us"},{"speaker":"Charles Goldfarb","startTime":1337.64,"endTime":1340.79,"body":"get involved in this type of"},{"speaker":"Charles Goldfarb","startTime":1340.79,"endTime":1343.67,"body":"research, because I think that"},{"speaker":"Charles Goldfarb","startTime":1340.79,"endTime":1343.67,"body":"will, will speed the process,"},{"speaker":"Charles Goldfarb","startTime":1343.67,"endTime":1346.28,"body":"but also make it more accessible"},{"speaker":"Charles Goldfarb","startTime":1343.67,"endTime":1346.28,"body":"to all I would predict."},{"speaker":"Chris Dy","startTime":1347.54,"endTime":1350.21,"body":"Certainly agree, I"},{"speaker":"Chris Dy","startTime":1347.54,"endTime":1350.21,"body":"think it's something that you"},{"speaker":"Chris Dy","startTime":1350.21,"endTime":1354.32,"body":"know, AI is coming in all facets"},{"speaker":"Chris Dy","startTime":1350.21,"endTime":1354.32,"body":"of our lives, as well. You"},{"speaker":"Chris Dy","startTime":1354.32,"endTime":1356.78,"body":"either push the elephant or you"},{"speaker":"Chris Dy","startTime":1354.32,"endTime":1356.78,"body":"ride the elephant is one of the"},{"speaker":"Chris Dy","startTime":1356.78,"endTime":1357.11,"body":"other."},{"speaker":"Charles Goldfarb","startTime":1357.74,"endTime":1360.897,"body":"I did read did"},{"speaker":"Charles Goldfarb","startTime":1357.74,"endTime":1360.897,"body":"read this morning that access to"},{"speaker":"Charles Goldfarb","startTime":1360.964,"endTime":1364.994,"body":"like chat, GPT is down like 50%"},{"speaker":"Charles Goldfarb","startTime":1360.964,"endTime":1364.994,"body":"since it first popped on the"},{"speaker":"Charles Goldfarb","startTime":1365.061,"endTime":1368.89,"body":"scene. And the cynical say,"},{"speaker":"Charles Goldfarb","startTime":1365.061,"endTime":1368.89,"body":"that's just because you know,"},{"speaker":"Charles Goldfarb","startTime":1368.958,"endTime":1372.854,"body":"it's summer, and students are"},{"speaker":"Charles Goldfarb","startTime":1368.958,"endTime":1372.854,"body":"not using Chat GPT for their"},{"speaker":"Charles Goldfarb","startTime":1372.921,"endTime":1376.951,"body":"essays. But I think some of the"},{"speaker":"Charles Goldfarb","startTime":1372.921,"endTime":1376.951,"body":"excitement, of course, wears"},{"speaker":"Charles Goldfarb","startTime":1377.018,"endTime":1379.37,"body":"off. But this isn't going anywhere."},{"speaker":"Chris Dy","startTime":1379.88,"endTime":1382.469,"body":"I read I one of the"},{"speaker":"Chris Dy","startTime":1379.88,"endTime":1382.469,"body":"podcasts I listened to semi"},{"speaker":"Chris Dy","startTime":1382.524,"endTime":1385.996,"body":"regularly is the daily from the"},{"speaker":"Chris Dy","startTime":1382.524,"endTime":1385.996,"body":"New York Times. And some of the"},{"speaker":"Chris Dy","startTime":1386.051,"endTime":1389.578,"body":"topics I mean, they cover stuff"},{"speaker":"Chris Dy","startTime":1386.051,"endTime":1389.578,"body":"incredibly well. And I was drawn"},{"speaker":"Chris Dy","startTime":1389.633,"endTime":1392.994,"body":"to the one recently on chat,"},{"speaker":"Chris Dy","startTime":1389.633,"endTime":1392.994,"body":"GPT, which I think is fantastic."},{"speaker":"Chris Dy","startTime":1393.049,"endTime":1396.41,"body":"And it talks about how students"},{"speaker":"Chris Dy","startTime":1393.049,"endTime":1396.41,"body":"are using it. So I'm using it"},{"speaker":"Chris Dy","startTime":1396.465,"endTime":1400.047,"body":"for a very obvious ways in terms"},{"speaker":"Chris Dy","startTime":1396.465,"endTime":1400.047,"body":"of generating a paper some using"},{"speaker":"Chris Dy","startTime":1400.102,"endTime":1403.518,"body":"it in a very interesting way to"},{"speaker":"Chris Dy","startTime":1400.102,"endTime":1403.518,"body":"do kind of background research"},{"speaker":"Chris Dy","startTime":1403.574,"endTime":1406.99,"body":"and then write on their own or"},{"speaker":"Chris Dy","startTime":1403.574,"endTime":1406.99,"body":"using it in, you know, oh, that"},{"speaker":"Chris Dy","startTime":1407.045,"endTime":1410.076,"body":"doesn't sound like what I would"},{"speaker":"Chris Dy","startTime":1407.045,"endTime":1410.076,"body":"write check. GPT here's"},{"speaker":"Chris Dy","startTime":1410.131,"endTime":1413.492,"body":"something that I wrote make this"},{"speaker":"Chris Dy","startTime":1410.131,"endTime":1413.492,"body":"sound like me. And then they"},{"speaker":"Chris Dy","startTime":1413.547,"endTime":1416.743,"body":"also get the perspective of"},{"speaker":"Chris Dy","startTime":1413.547,"endTime":1416.743,"body":"professor, you know, kind of a"},{"speaker":"Chris Dy","startTime":1416.798,"endTime":1420.159,"body":"Liberal Arts professor who just"},{"speaker":"Chris Dy","startTime":1416.798,"endTime":1420.159,"body":"talks about how it's sad how,"},{"speaker":"Chris Dy","startTime":1420.215,"endTime":1423.521,"body":"you know, his students don't"},{"speaker":"Chris Dy","startTime":1420.215,"endTime":1423.521,"body":"want to write and engage in the"},{"speaker":"Chris Dy","startTime":1423.576,"endTime":1426.937,"body":"same way that he wants them to."},{"speaker":"Chris Dy","startTime":1423.576,"endTime":1426.937,"body":"But realizing the chat GPT is"},{"speaker":"Chris Dy","startTime":1426.992,"endTime":1430.243,"body":"here to stay in this kind of"},{"speaker":"Chris Dy","startTime":1426.992,"endTime":1430.243,"body":"thing is going to be something"},{"speaker":"Chris Dy","startTime":1430.298,"endTime":1433.604,"body":"we have to deal with. It'll be"},{"speaker":"Chris Dy","startTime":1430.298,"endTime":1433.604,"body":"super interesting to see what"},{"speaker":"Chris Dy","startTime":1433.66,"endTime":1436.855,"body":"kind of orthopedic residency"},{"speaker":"Chris Dy","startTime":1433.66,"endTime":1436.855,"body":"essays check GPT generates in"},{"speaker":"Chris Dy","startTime":1436.911,"endTime":1440.217,"body":"the next few years. I think"},{"speaker":"Chris Dy","startTime":1436.911,"endTime":1440.217,"body":"that's, it's coming. And I think"},{"speaker":"Chris Dy","startTime":1440.272,"endTime":1443.358,"body":"we need to be fully aware of"},{"speaker":"Chris Dy","startTime":1440.272,"endTime":1443.358,"body":"because as we all know, the"},{"speaker":"Chris Dy","startTime":1443.413,"endTime":1446.609,"body":"there are very few personal"},{"speaker":"Chris Dy","startTime":1443.413,"endTime":1446.609,"body":"statements that stand out. You"},{"speaker":"Chris Dy","startTime":1446.664,"endTime":1450.025,"body":"want to stand out in the right"},{"speaker":"Chris Dy","startTime":1446.664,"endTime":1450.025,"body":"way, but for most people, it's"},{"speaker":"Chris Dy","startTime":1450.08,"endTime":1452.45,"body":"okay to just have a very average"},{"speaker":"Chris Dy","startTime":1450.08,"endTime":1452.45,"body":"statement."},{"speaker":"Charles Goldfarb","startTime":1453.32,"endTime":1456.59,"body":"Yes, that is"},{"speaker":"Charles Goldfarb","startTime":1453.32,"endTime":1456.59,"body":"true. And and I think there are"},{"speaker":"Charles Goldfarb","startTime":1456.62,"endTime":1461.18,"body":"there are those who can"},{"speaker":"Charles Goldfarb","startTime":1456.62,"endTime":1461.18,"body":"allegedly detect and tools that"},{"speaker":"Charles Goldfarb","startTime":1461.18,"endTime":1466.37,"body":"can help you detect an AI"},{"speaker":"Charles Goldfarb","startTime":1461.18,"endTime":1466.37,"body":"generated essay or, you know,"},{"speaker":"Charles Goldfarb","startTime":1466.37,"endTime":1469.13,"body":"personal statement, but"},{"speaker":"Charles Goldfarb","startTime":1466.37,"endTime":1469.13,"body":"certainly you and I don't have"},{"speaker":"Charles Goldfarb","startTime":1469.13,"endTime":1473.3,"body":"that skill set. I don't think we"},{"speaker":"Charles Goldfarb","startTime":1469.13,"endTime":1473.3,"body":"may detect something feels weird"},{"speaker":"Charles Goldfarb","startTime":1473.3,"endTime":1475.88,"body":"about an essay, but we're not"},{"speaker":"Charles Goldfarb","startTime":1473.3,"endTime":1475.88,"body":"going to be able to say that's"},{"speaker":"Charles Goldfarb","startTime":1476.18,"endTime":1477.08,"body":"generated by"},{"speaker":"Chris Dy","startTime":1477.14,"endTime":1479.84,"body":"I guarantee you one of"},{"speaker":"Chris Dy","startTime":1477.14,"endTime":1479.84,"body":"us has read in AI generated"},{"speaker":"Chris Dy","startTime":1479.84,"endTime":1482.69,"body":"thing at some point in the last"},{"speaker":"Chris Dy","startTime":1479.84,"endTime":1482.69,"body":"year, whether it's an essay for"},{"speaker":"Chris Dy","startTime":1482.99,"endTime":1487.01,"body":"for one of our programs, or even"},{"speaker":"Chris Dy","startTime":1482.99,"endTime":1487.01,"body":"a paper. It's interesting in the"},{"speaker":"Chris Dy","startTime":1487.01,"endTime":1489.77,"body":"last few months now for each"},{"speaker":"Chris Dy","startTime":1487.01,"endTime":1489.77,"body":"journal if submitted to that you"},{"speaker":"Chris Dy","startTime":1489.77,"endTime":1493.01,"body":"have to submit an affirmation if"},{"speaker":"Chris Dy","startTime":1489.77,"endTime":1493.01,"body":"this was not generated by chat"},{"speaker":"Chris Dy","startTime":1493.01,"endTime":1498.89,"body":"GPT the game has changed and it"},{"speaker":"Chris Dy","startTime":1493.01,"endTime":1498.89,"body":"will forever be changed. Why"},{"speaker":"Chris Dy","startTime":1498.89,"endTime":1501.65,"body":"don't we move on maybe squeezing"},{"speaker":"Chris Dy","startTime":1498.89,"endTime":1501.65,"body":"One or two more articles, I'll"},{"speaker":"Chris Dy","startTime":1501.65,"endTime":1503.96,"body":"let you pick I thought the"},{"speaker":"Chris Dy","startTime":1501.65,"endTime":1503.96,"body":"distal radius one was"},{"speaker":"Chris Dy","startTime":1503.96,"endTime":1506.3,"body":"interesting. I always thought"},{"speaker":"Chris Dy","startTime":1503.96,"endTime":1506.3,"body":"the ulnar wrist pain one was"},{"speaker":"Chris Dy","startTime":1506.3,"endTime":1508.07,"body":"interesting to you. So where do"},{"speaker":"Chris Dy","startTime":1506.3,"endTime":1508.07,"body":"you want to go next?"},{"speaker":"Charles Goldfarb","startTime":1508.25,"endTime":1511.62,"body":"Let's do those"},{"speaker":"Charles Goldfarb","startTime":1508.25,"endTime":1511.62,"body":"two. So the distal radius paper"},{"speaker":"Charles Goldfarb","startTime":1511.694,"endTime":1516.017,"body":"first author is Schmidt It's"},{"speaker":"Charles Goldfarb","startTime":1511.694,"endTime":1516.017,"body":"based out of various hospitals"},{"speaker":"Charles Goldfarb","startTime":1516.09,"endTime":1520.634,"body":"in Sweden. It's a prospective."},{"speaker":"Charles Goldfarb","startTime":1516.09,"endTime":1520.634,"body":"One year follow up study of 366"},{"speaker":"Charles Goldfarb","startTime":1520.707,"endTime":1525.177,"body":"patients managed either with"},{"speaker":"Charles Goldfarb","startTime":1520.707,"endTime":1525.177,"body":"reduction in cast immobilization"},{"speaker":"Charles Goldfarb","startTime":1525.25,"endTime":1529.647,"body":"or surgical intervention. And we"},{"speaker":"Charles Goldfarb","startTime":1525.25,"endTime":1529.647,"body":"can talk about what surgery"},{"speaker":"Charles Goldfarb","startTime":1529.72,"endTime":1533.824,"body":"means. And they looked at a"},{"speaker":"Charles Goldfarb","startTime":1529.72,"endTime":1533.824,"body":"variety of different outcome"},{"speaker":"Charles Goldfarb","startTime":1533.897,"endTime":1538.368,"body":"measures, including radiographs,"},{"speaker":"Charles Goldfarb","startTime":1533.897,"endTime":1538.368,"body":"quick dash, range of motion,"},{"speaker":"Charles Goldfarb","startTime":1538.441,"endTime":1540.2,"body":"grip strength, etc. And,"},{"speaker":"Chris Dy","startTime":1540.98,"endTime":1545.06,"body":"This was in the May 12"},{"speaker":"Chris Dy","startTime":1540.98,"endTime":1545.06,"body":"2023 edition of The American"},{"speaker":"Chris Dy","startTime":1545.14,"endTime":1550.26,"body":"Journal of the joint surgery. So"},{"speaker":"Chris Dy","startTime":1545.14,"endTime":1550.26,"body":"jbjs 2023, may, if it did those"},{"speaker":"Chris Dy","startTime":1550.34,"endTime":1551.78,"body":"following at home,"},{"speaker":"Charles Goldfarb","startTime":1552.17,"endTime":1556.61,"body":"yes, perfect,"},{"speaker":"Charles Goldfarb","startTime":1552.17,"endTime":1556.61,"body":"perfect. Thank you. And, you"},{"speaker":"Charles Goldfarb","startTime":1556.61,"endTime":1561.53,"body":"know, I guess I would say, not"},{"speaker":"Charles Goldfarb","startTime":1556.61,"endTime":1561.53,"body":"surprisingly, but demonstrated"},{"speaker":"Charles Goldfarb","startTime":1561.53,"endTime":1565.16,"body":"in a nice way, they really"},{"speaker":"Charles Goldfarb","startTime":1561.53,"endTime":1565.16,"body":"showed to cut to the crux, and"},{"speaker":"Charles Goldfarb","startTime":1565.16,"endTime":1569.21,"body":"we can again, elaborate as you"},{"speaker":"Charles Goldfarb","startTime":1565.16,"endTime":1569.21,"body":"wish, clinical outcomes"},{"speaker":"Charles Goldfarb","startTime":1569.21,"endTime":1574.25,"body":"declined, starting at five"},{"speaker":"Charles Goldfarb","startTime":1569.21,"endTime":1574.25,"body":"degrees of dorsal tilt. But"},{"speaker":"Charles Goldfarb","startTime":1574.25,"endTime":1578.06,"body":"really, it's not until you get"},{"speaker":"Charles Goldfarb","startTime":1574.25,"endTime":1578.06,"body":"to 20 degrees of dorsal tilt,"},{"speaker":"Charles Goldfarb","startTime":1579.14,"endTime":1582.5,"body":"that things really started to"},{"speaker":"Charles Goldfarb","startTime":1579.14,"endTime":1582.5,"body":"matter. So that's my simplistic"},{"speaker":"Charles Goldfarb","startTime":1582.5,"endTime":1585.83,"body":"takeaway. I'm sure you can add"},{"speaker":"Charles Goldfarb","startTime":1582.5,"endTime":1585.83,"body":"some nice flavor to that."},{"speaker":"Chris Dy","startTime":1586.759,"endTime":1588.259,"body":"Well, I mean, I don't"},{"speaker":"Chris Dy","startTime":1586.759,"endTime":1588.259,"body":"think that you know, any of"},{"speaker":"Chris Dy","startTime":1588.259,"endTime":1592.879,"body":"these prospective cohort studies"},{"speaker":"Chris Dy","startTime":1588.259,"endTime":1592.879,"body":"are incredibly difficult to do"},{"speaker":"Chris Dy","startTime":1592.909,"endTime":1596.029,"body":"take a lot of work, you know,"},{"speaker":"Chris Dy","startTime":1592.909,"endTime":1596.029,"body":"both you and I are living this"},{"speaker":"Chris Dy","startTime":1596.029,"endTime":1599.269,"body":"right now with our different"},{"speaker":"Chris Dy","startTime":1596.029,"endTime":1599.269,"body":"prospective cohort slash new aka"},{"speaker":"Chris Dy","startTime":1599.269,"endTime":1601.849,"body":"registry type studies, which not"},{"speaker":"Chris Dy","startTime":1599.269,"endTime":1601.849,"body":"really registries but you know,"},{"speaker":"Chris Dy","startTime":1601.849,"endTime":1604.969,"body":"it's, so it's things where it"},{"speaker":"Chris Dy","startTime":1601.849,"endTime":1604.969,"body":"got a ton of work goes into it,"},{"speaker":"Chris Dy","startTime":1604.969,"endTime":1607.699,"body":"and you kind of have to see"},{"speaker":"Chris Dy","startTime":1604.969,"endTime":1607.699,"body":"where the data takes you, even"},{"speaker":"Chris Dy","startTime":1607.699,"endTime":1610.399,"body":"though you have you heard a"},{"speaker":"Chris Dy","startTime":1607.699,"endTime":1610.399,"body":"priori said kind of hypotheses."},{"speaker":"Chris Dy","startTime":1611.389,"endTime":1613.789,"body":"You know, so a lot of effort"},{"speaker":"Chris Dy","startTime":1611.389,"endTime":1613.789,"body":"goes into this kind of thing I,"},{"speaker":"Chris Dy","startTime":1614.149,"endTime":1618.379,"body":"I struggle with, you know, these"},{"speaker":"Chris Dy","startTime":1614.149,"endTime":1618.379,"body":"continuing distal radius"},{"speaker":"Chris Dy","startTime":1618.379,"endTime":1620.989,"body":"fracture papers, you know, we"},{"speaker":"Chris Dy","startTime":1618.379,"endTime":1620.989,"body":"saw such a rush of it, you know,"},{"speaker":"Chris Dy","startTime":1620.989,"endTime":1624.949,"body":"in the last decade of, you know,"},{"speaker":"Chris Dy","startTime":1620.989,"endTime":1624.949,"body":"do you operate, do you not"},{"speaker":"Chris Dy","startTime":1624.949,"endTime":1627.349,"body":"operate, what kind of surgery,"},{"speaker":"Chris Dy","startTime":1624.949,"endTime":1627.349,"body":"you know, that kind of thing in"},{"speaker":"Chris Dy","startTime":1627.349,"endTime":1629.209,"body":"there, the pendulum keeps"},{"speaker":"Chris Dy","startTime":1627.349,"endTime":1629.209,"body":"swinging back and forth. In"},{"speaker":"Chris Dy","startTime":1629.209,"endTime":1631.879,"body":"terms of non operative"},{"speaker":"Chris Dy","startTime":1629.209,"endTime":1631.879,"body":"management, one of our partners,"},{"speaker":"Chris Dy","startTime":1631.909,"endTime":1635.809,"body":"one of is, quote, aggressively"},{"speaker":"Chris Dy","startTime":1631.909,"endTime":1635.809,"body":"non operative, as one of our"},{"speaker":"Chris Dy","startTime":1635.809,"endTime":1638.599,"body":"residents described, you know,"},{"speaker":"Chris Dy","startTime":1635.809,"endTime":1638.599,"body":"for treating these, and I think"},{"speaker":"Chris Dy","startTime":1638.599,"endTime":1641.989,"body":"others have a lower threshold to"},{"speaker":"Chris Dy","startTime":1638.599,"endTime":1641.989,"body":"offer surgery, I tried to give"},{"speaker":"Chris Dy","startTime":1641.989,"endTime":1647.029,"body":"patients, you know, data driven"},{"speaker":"Chris Dy","startTime":1641.989,"endTime":1647.029,"body":"counseling based on kind of age"},{"speaker":"Chris Dy","startTime":1647.029,"endTime":1650.449,"body":"displacement and what to expect."},{"speaker":"Chris Dy","startTime":1647.029,"endTime":1650.449,"body":"And this lines up very well"},{"speaker":"Chris Dy","startTime":1650.449,"endTime":1653.599,"body":"with, you know, the work that,"},{"speaker":"Chris Dy","startTime":1650.449,"endTime":1653.599,"body":"you know, the McQueen group has"},{"speaker":"Chris Dy","startTime":1653.599,"endTime":1657.439,"body":"done in the UK, in terms of, you"},{"speaker":"Chris Dy","startTime":1653.599,"endTime":1657.439,"body":"know, you look at displacement,"},{"speaker":"Chris Dy","startTime":1657.439,"endTime":1659.569,"body":"and it's stuff like grip"},{"speaker":"Chris Dy","startTime":1657.439,"endTime":1659.569,"body":"strength and a dash, it starts"},{"speaker":"Chris Dy","startTime":1659.569,"endTime":1661.489,"body":"to fall off as you get more"},{"speaker":"Chris Dy","startTime":1659.569,"endTime":1661.489,"body":"dorsal displacement."},{"speaker":"Charles Goldfarb","startTime":1662.06,"endTime":1664.73,"body":"Yeah, all well"},{"speaker":"Charles Goldfarb","startTime":1662.06,"endTime":1664.73,"body":"said, again, another golden"},{"speaker":"Charles Goldfarb","startTime":1664.73,"endTime":1669.41,"body":"opportunity for AI or machine"},{"speaker":"Charles Goldfarb","startTime":1664.73,"endTime":1669.41,"body":"learning to help us because, you"},{"speaker":"Charles Goldfarb","startTime":1669.41,"endTime":1673.13,"body":"know, we bring our own biases to"},{"speaker":"Charles Goldfarb","startTime":1669.41,"endTime":1673.13,"body":"this to this decision making"},{"speaker":"Charles Goldfarb","startTime":1673.13,"endTime":1676.34,"body":"process. And, you know, Linley"},{"speaker":"Charles Goldfarb","startTime":1673.13,"endTime":1676.34,"body":"and others are working on"},{"speaker":"Charles Goldfarb","startTime":1676.34,"endTime":1680.27,"body":"decision aids, which really will"},{"speaker":"Charles Goldfarb","startTime":1676.34,"endTime":1680.27,"body":"help, because it's really not"},{"speaker":"Charles Goldfarb","startTime":1680.3,"endTime":1684.38,"body":"only about our perspective, on"},{"speaker":"Charles Goldfarb","startTime":1680.3,"endTime":1684.38,"body":"what we can expect from a"},{"speaker":"Charles Goldfarb","startTime":1684.38,"endTime":1687.65,"body":"patient focused outcome, it's"},{"speaker":"Charles Goldfarb","startTime":1684.38,"endTime":1687.65,"body":"also about what the patient"},{"speaker":"Charles Goldfarb","startTime":1687.65,"endTime":1690.95,"body":"wants, what their thoughts are"},{"speaker":"Charles Goldfarb","startTime":1687.65,"endTime":1690.95,"body":"on surgery, what their thoughts"},{"speaker":"Charles Goldfarb","startTime":1690.95,"endTime":1694.1,"body":"are on the aesthetics, because"},{"speaker":"Charles Goldfarb","startTime":1690.95,"endTime":1694.1,"body":"that matters a lot to some"},{"speaker":"Charles Goldfarb","startTime":1694.1,"endTime":1697.37,"body":"people. And in a perfect world,"},{"speaker":"Charles Goldfarb","startTime":1694.1,"endTime":1697.37,"body":"we wouldn't think about that"},{"speaker":"Charles Goldfarb","startTime":1697.37,"endTime":1699.53,"body":"kind of stuff, we would just do"},{"speaker":"Charles Goldfarb","startTime":1697.37,"endTime":1699.53,"body":"the best thing for the patient,"},{"speaker":"Charles Goldfarb","startTime":1699.53,"endTime":1702.17,"body":"but all that matters. And so"},{"speaker":"Charles Goldfarb","startTime":1699.53,"endTime":1702.17,"body":"it's, this is a really good"},{"speaker":"Charles Goldfarb","startTime":1702.17,"endTime":1706.01,"body":"paper, this will allow us to"},{"speaker":"Charles Goldfarb","startTime":1702.17,"endTime":1706.01,"body":"counsel patients more"},{"speaker":"Charles Goldfarb","startTime":1706.01,"endTime":1709.37,"body":"appropriately, or at least I"},{"speaker":"Charles Goldfarb","startTime":1706.01,"endTime":1709.37,"body":"believe it will, for me, it"},{"speaker":"Charles Goldfarb","startTime":1709.37,"endTime":1711.62,"body":"doesn't fundamentally change the"},{"speaker":"Charles Goldfarb","startTime":1709.37,"endTime":1711.62,"body":"way I think about things, it"},{"speaker":"Charles Goldfarb","startTime":1711.62,"endTime":1713.96,"body":"does reinforce how I think about"},{"speaker":"Charles Goldfarb","startTime":1711.62,"endTime":1713.96,"body":"things, it doesn't change it."},{"speaker":"Chris Dy","startTime":1714.68,"endTime":1716.36,"body":"It this I think"},{"speaker":"Chris Dy","startTime":1714.68,"endTime":1716.36,"body":"reinforces a lot of the work"},{"speaker":"Chris Dy","startTime":1716.36,"endTime":1718.46,"body":"that's already been out there."},{"speaker":"Chris Dy","startTime":1716.36,"endTime":1718.46,"body":"It's important to have it out"},{"speaker":"Chris Dy","startTime":1718.46,"endTime":1721.16,"body":"there. You know, it's not"},{"speaker":"Chris Dy","startTime":1718.46,"endTime":1721.16,"body":"completely novel, but it's"},{"speaker":"Chris Dy","startTime":1721.16,"endTime":1723.29,"body":"important to demonstrate it. And"},{"speaker":"Chris Dy","startTime":1721.16,"endTime":1723.29,"body":"certainly, I think there are"},{"speaker":"Chris Dy","startTime":1723.29,"endTime":1726.17,"body":"differences in terms of"},{"speaker":"Chris Dy","startTime":1723.29,"endTime":1726.17,"body":"acceptability among different"},{"speaker":"Chris Dy","startTime":1726.17,"endTime":1728.54,"body":"cultures, but it's hard to argue"},{"speaker":"Chris Dy","startTime":1726.17,"endTime":1728.54,"body":"with grip strength and a dash to"},{"speaker":"Chris Dy","startTime":1728.54,"endTime":1730.82,"body":"be honest with you, I think that"},{"speaker":"Chris Dy","startTime":1728.54,"endTime":1730.82,"body":"translates pretty well across"},{"speaker":"Chris Dy","startTime":1730.82,"endTime":1733.76,"body":"cultures. You know, the article"},{"speaker":"Chris Dy","startTime":1730.82,"endTime":1733.76,"body":"that we covered in our journal"},{"speaker":"Chris Dy","startTime":1733.76,"endTime":1736.13,"body":"club that we're not gonna get to"},{"speaker":"Chris Dy","startTime":1733.76,"endTime":1736.13,"body":"discuss today was, was that a"},{"speaker":"Chris Dy","startTime":1736.13,"endTime":1739.16,"body":"Rochester and Warren hammered"},{"speaker":"Chris Dy","startTime":1736.13,"endTime":1739.16,"body":"screw up before he left there?"},{"speaker":"Chris Dy","startTime":1739.49,"endTime":1743.78,"body":"And it was interesting, looking"},{"speaker":"Chris Dy","startTime":1739.49,"endTime":1743.78,"body":"at kind of how they evaluated"},{"speaker":"Chris Dy","startTime":1743.78,"endTime":1746.72,"body":"patient preferences,"},{"speaker":"Chris Dy","startTime":1743.78,"endTime":1746.72,"body":"essentially, I think one thing"},{"speaker":"Chris Dy","startTime":1746.72,"endTime":1750.08,"body":"that, you know, where this could"},{"speaker":"Chris Dy","startTime":1746.72,"endTime":1750.08,"body":"go eventually is, you know, the"},{"speaker":"Chris Dy","startTime":1750.08,"endTime":1755.0,"body":"personalized medicine aspect"},{"speaker":"Chris Dy","startTime":1750.08,"endTime":1755.0,"body":"and, you know, having, having"},{"speaker":"Chris Dy","startTime":1755.0,"endTime":1759.71,"body":"some kind of system where the"},{"speaker":"Chris Dy","startTime":1755.0,"endTime":1759.71,"body":"computer knows your preferences,"},{"speaker":"Chris Dy","startTime":1759.71,"endTime":1763.1,"body":"your personality, and says,"},{"speaker":"Chris Dy","startTime":1759.71,"endTime":1763.1,"body":"Okay, well, you know, Chris is"},{"speaker":"Chris Dy","startTime":1763.1,"endTime":1765.83,"body":"really interested in getting"},{"speaker":"Chris Dy","startTime":1763.1,"endTime":1765.83,"body":"back to X, Y, and Z. And based"},{"speaker":"Chris Dy","startTime":1765.83,"endTime":1769.46,"body":"on his fracture displacement,"},{"speaker":"Chris Dy","startTime":1765.83,"endTime":1769.46,"body":"and his timeline, he should have"},{"speaker":"Chris Dy","startTime":1769.46,"endTime":1773.18,"body":"surgery, or he shouldn't. So I"},{"speaker":"Chris Dy","startTime":1769.46,"endTime":1773.18,"body":"think that that's probably where"},{"speaker":"Chris Dy","startTime":1773.18,"endTime":1775.34,"body":"it's going to go. But I think"},{"speaker":"Chris Dy","startTime":1773.18,"endTime":1775.34,"body":"the patient preferences and the"},{"speaker":"Chris Dy","startTime":1775.34,"endTime":1777.77,"body":"counseling are key, because"},{"speaker":"Chris Dy","startTime":1775.34,"endTime":1777.77,"body":"every patient is different in"},{"speaker":"Chris Dy","startTime":1777.77,"endTime":1780.83,"body":"terms of what they want, what"},{"speaker":"Chris Dy","startTime":1777.77,"endTime":1780.83,"body":"matters to them. I had somebody"},{"speaker":"Chris Dy","startTime":1780.83,"endTime":1783.17,"body":"who had treated with, you know,"},{"speaker":"Chris Dy","startTime":1780.83,"endTime":1783.17,"body":"with case management for distal"},{"speaker":"Chris Dy","startTime":1783.17,"endTime":1785.3,"body":"radius fracture, and her"},{"speaker":"Chris Dy","startTime":1783.17,"endTime":1785.3,"body":"displacement is completely"},{"speaker":"Chris Dy","startTime":1785.3,"endTime":1788.84,"body":"acceptable. radiographically and"},{"speaker":"Chris Dy","startTime":1785.3,"endTime":1788.84,"body":"I told her about the likelihood"},{"speaker":"Chris Dy","startTime":1788.84,"endTime":1792.32,"body":"of having a prominence of her"},{"speaker":"Chris Dy","startTime":1788.84,"endTime":1792.32,"body":"own her head, the bump on the"},{"speaker":"Chris Dy","startTime":1792.32,"endTime":1794.78,"body":"pinky side of your wrist, it's"},{"speaker":"Chris Dy","startTime":1792.32,"endTime":1794.78,"body":"most likely going to be there."},{"speaker":"Chris Dy","startTime":1794.78,"endTime":1798.11,"body":"It's not going to change it's"},{"speaker":"Chris Dy","startTime":1794.78,"endTime":1798.11,"body":"going to be like that. And at"},{"speaker":"Chris Dy","startTime":1798.11,"endTime":1800.99,"body":"every follow up visit, that is"},{"speaker":"Chris Dy","startTime":1798.11,"endTime":1800.99,"body":"what this patient fixates on and"},{"speaker":"Chris Dy","startTime":1800.99,"endTime":1803.93,"body":"I said, I could break your wrist"},{"speaker":"Chris Dy","startTime":1800.99,"endTime":1803.93,"body":"again. And we can put a plate on"},{"speaker":"Chris Dy","startTime":1803.93,"endTime":1807.71,"body":"there and make that better or we"},{"speaker":"Chris Dy","startTime":1803.93,"endTime":1807.71,"body":"can cut up that bone. And that,"},{"speaker":"Chris Dy","startTime":1807.71,"endTime":1809.6,"body":"of course is unacceptable to"},{"speaker":"Chris Dy","startTime":1807.71,"endTime":1809.6,"body":"them. But they don't like the"},{"speaker":"Chris Dy","startTime":1809.6,"endTime":1812.57,"body":"fact they've got a bump on the"},{"speaker":"Chris Dy","startTime":1809.6,"endTime":1812.57,"body":"wrist. So, again, like you said,"},{"speaker":"Chris Dy","startTime":1812.57,"endTime":1815.27,"body":"I think it's all the brothers in"},{"speaker":"Chris Dy","startTime":1812.57,"endTime":1815.27,"body":"the counseling, and I don't"},{"speaker":"Chris Dy","startTime":1815.27,"endTime":1817.82,"body":"think a computer is going to"},{"speaker":"Chris Dy","startTime":1815.27,"endTime":1817.82,"body":"counsel patients for us, but I"},{"speaker":"Chris Dy","startTime":1817.82,"endTime":1820.64,"body":"think a computer can provide"},{"speaker":"Chris Dy","startTime":1817.82,"endTime":1820.64,"body":"data, data driven approach,"},{"speaker":"Chris Dy","startTime":1820.64,"endTime":1822.32,"body":"which will help the right"},{"speaker":"Chris Dy","startTime":1820.64,"endTime":1822.32,"body":"patient."},{"speaker":"Charles Goldfarb","startTime":1823.04,"endTime":1827.06,"body":"Yeah, really"},{"speaker":"Charles Goldfarb","startTime":1823.04,"endTime":1827.06,"body":"well said and and the gap"},{"speaker":"Charles Goldfarb","startTime":1827.06,"endTime":1832.01,"body":"between the counseling that we"},{"speaker":"Charles Goldfarb","startTime":1827.06,"endTime":1832.01,"body":"do, and not what patients hear"},{"speaker":"Charles Goldfarb","startTime":1833.3,"endTime":1835.97,"body":"it, but how they incorporate"},{"speaker":"Charles Goldfarb","startTime":1833.3,"endTime":1835.97,"body":"what we say into the way they"},{"speaker":"Charles Goldfarb","startTime":1835.97,"endTime":1838.85,"body":"think about their issue is"},{"speaker":"Charles Goldfarb","startTime":1835.97,"endTime":1838.85,"body":"really super interesting. And"},{"speaker":"Charles Goldfarb","startTime":1838.91,"endTime":1841.76,"body":"again, every patient does it"},{"speaker":"Charles Goldfarb","startTime":1838.91,"endTime":1841.76,"body":"differently. And I have that"},{"speaker":"Charles Goldfarb","startTime":1841.76,"endTime":1845.15,"body":"same patient that you do that."},{"speaker":"Charles Goldfarb","startTime":1841.76,"endTime":1845.15,"body":"We've had the discussion 10"},{"speaker":"Charles Goldfarb","startTime":1845.15,"endTime":1848.42,"body":"times, but it doesn't change."},{"speaker":"Charles Goldfarb","startTime":1845.15,"endTime":1848.42,"body":"There are several writing on the"},{"speaker":"Charles Goldfarb","startTime":1848.42,"endTime":1850.16,"body":"particular issue, which was"},{"speaker":"Charles Goldfarb","startTime":1848.42,"endTime":1850.16,"body":"predictable."},{"speaker":"Chris Dy","startTime":1850.76,"endTime":1853.07,"body":"Right, right. So yeah,"},{"speaker":"Chris Dy","startTime":1850.76,"endTime":1853.07,"body":"why don't we move on to our"},{"speaker":"Chris Dy","startTime":1853.07,"endTime":1857.78,"body":"final article? I think this one"},{"speaker":"Chris Dy","startTime":1853.07,"endTime":1857.78,"body":"marries her to Pinterest. So"},{"speaker":"Chris Dy","startTime":1857.78,"endTime":1860.69,"body":"this is what the first article"},{"speaker":"Chris Dy","startTime":1857.78,"endTime":1860.69,"body":"is. The first author is Scott"},{"speaker":"Chris Dy","startTime":1860.69,"endTime":1863.39,"body":"Lowenstein, this is on their"},{"speaker":"Chris Dy","startTime":1860.69,"endTime":1863.39,"body":"wrist innervation articular,"},{"speaker":"Chris Dy","startTime":1863.39,"endTime":1866.12,"body":"branching pattern selective"},{"speaker":"Chris Dy","startTime":1863.39,"endTime":1866.12,"body":"blockade of the dorsal branch of"},{"speaker":"Chris Dy","startTime":1866.12,"endTime":1869.12,"body":"the ulnar nerve. This came out"},{"speaker":"Chris Dy","startTime":1866.12,"endTime":1869.12,"body":"of, you know, consortium of"},{"speaker":"Chris Dy","startTime":1869.12,"endTime":1871.82,"body":"places really out of Wisconsin,"},{"speaker":"Chris Dy","startTime":1869.12,"endTime":1871.82,"body":"but I know this concept has been"},{"speaker":"Chris Dy","startTime":1871.82,"endTime":1875.39,"body":"really driven by Dr. Li Delon,"},{"speaker":"Chris Dy","startTime":1871.82,"endTime":1875.39,"body":"who has been on the podcast"},{"speaker":"Chris Dy","startTime":1875.39,"endTime":1878.21,"body":"before, and his academic"},{"speaker":"Chris Dy","startTime":1875.39,"endTime":1878.21,"body":"appointment is at Johns Hopkins,"},{"speaker":"Chris Dy","startTime":1878.21,"endTime":1881.75,"body":"although I know he is recently"},{"speaker":"Chris Dy","startTime":1878.21,"endTime":1881.75,"body":"retired. And Lee did discuss"},{"speaker":"Chris Dy","startTime":1881.75,"endTime":1885.8,"body":"this with me, you know, when I"},{"speaker":"Chris Dy","startTime":1881.75,"endTime":1885.8,"body":"visited with him, when we had"},{"speaker":"Chris Dy","startTime":1885.8,"endTime":1889.64,"body":"our, our interview, so super"},{"speaker":"Chris Dy","startTime":1885.8,"endTime":1889.64,"body":"interesting article about on the"},{"speaker":"Chris Dy","startTime":1889.64,"endTime":1893.18,"body":"wrist innovation. You know, I"},{"speaker":"Chris Dy","startTime":1889.64,"endTime":1893.18,"body":"think the anatomically, they"},{"speaker":"Chris Dy","startTime":1893.18,"endTime":1895.85,"body":"described kind of a pattern of"},{"speaker":"Chris Dy","startTime":1893.18,"endTime":1895.85,"body":"innovation on the older side of"},{"speaker":"Chris Dy","startTime":1895.85,"endTime":1902.36,"body":"the wrist, and then did a"},{"speaker":"Chris Dy","startTime":1895.85,"endTime":1902.36,"body":"simulated block with staining of"},{"speaker":"Chris Dy","startTime":1902.36,"endTime":1905.09,"body":"that would simulate kind of"},{"speaker":"Chris Dy","startTime":1902.36,"endTime":1905.09,"body":"where lidocaine would go, and"},{"speaker":"Chris Dy","startTime":1905.09,"endTime":1909.8,"body":"how often that would affect the"},{"speaker":"Chris Dy","startTime":1905.09,"endTime":1909.8,"body":"selectively hit the ulnar"},{"speaker":"Chris Dy","startTime":1910.1,"endTime":1913.43,"body":"articular branches and not"},{"speaker":"Chris Dy","startTime":1910.1,"endTime":1913.43,"body":"affect the sensory or motor"},{"speaker":"Chris Dy","startTime":1913.43,"endTime":1917.36,"body":"components of the ulnar nerve."},{"speaker":"Chris Dy","startTime":1913.43,"endTime":1917.36,"body":"So I think this is interesting,"},{"speaker":"Chris Dy","startTime":1917.36,"endTime":1923.51,"body":"because it's, it's not novel in"},{"speaker":"Chris Dy","startTime":1917.36,"endTime":1923.51,"body":"terms of the anatomy. It's not"},{"speaker":"Chris Dy","startTime":1923.51,"endTime":1927.17,"body":"novel in terms of doing a block."},{"speaker":"Chris Dy","startTime":1923.51,"endTime":1927.17,"body":"But the way that they did this,"},{"speaker":"Chris Dy","startTime":1928.01,"endTime":1931.52,"body":"they wrote this paper very well,"},{"speaker":"Chris Dy","startTime":1928.01,"endTime":1931.52,"body":"in terms of positioning it for"},{"speaker":"Chris Dy","startTime":1931.52,"endTime":1933.95,"body":"an engineer so that somebody"},{"speaker":"Chris Dy","startTime":1931.52,"endTime":1933.95,"body":"would be interested in reading"},{"speaker":"Chris Dy","startTime":1933.95,"endTime":1938.57,"body":"it. So I think there's a bit of"},{"speaker":"Chris Dy","startTime":1933.95,"endTime":1938.57,"body":"gamesmanship, that's probably"},{"speaker":"Chris Dy","startTime":1938.57,"endTime":1941.27,"body":"not the right term in your games"},{"speaker":"Chris Dy","startTime":1938.57,"endTime":1941.27,"body":"person ship, in terms of how to"},{"speaker":"Chris Dy","startTime":1941.27,"endTime":1944.12,"body":"write this article and to, to"},{"speaker":"Chris Dy","startTime":1941.27,"endTime":1944.12,"body":"get a paper published."},{"speaker":"Charles Goldfarb","startTime":1946.04,"endTime":1947.33,"body":"Yeah, there's"},{"speaker":"Charles Goldfarb","startTime":1946.04,"endTime":1947.33,"body":"a lot of different ways to go"},{"speaker":"Charles Goldfarb","startTime":1947.33,"endTime":1950.54,"body":"with it. I like how you said"},{"speaker":"Charles Goldfarb","startTime":1947.33,"endTime":1950.54,"body":"that last piece about, there's"},{"speaker":"Charles Goldfarb","startTime":1950.54,"endTime":1952.88,"body":"not a lot of new information"},{"speaker":"Charles Goldfarb","startTime":1950.54,"endTime":1952.88,"body":"here. But it was packaged in a"},{"speaker":"Charles Goldfarb","startTime":1952.88,"endTime":1956.54,"body":"way that is interesting. And,"},{"speaker":"Charles Goldfarb","startTime":1952.88,"endTime":1956.54,"body":"you know, when I when I have"},{"speaker":"Charles Goldfarb","startTime":1956.54,"endTime":1960.95,"body":"papers that maybe don't, aren't"},{"speaker":"Charles Goldfarb","startTime":1956.54,"endTime":1960.95,"body":"accepted to the first journal, I"},{"speaker":"Charles Goldfarb","startTime":1960.95,"endTime":1964.37,"body":"submit them to, and the"},{"speaker":"Charles Goldfarb","startTime":1960.95,"endTime":1964.37,"body":"reviewers make comments,"},{"speaker":"Charles Goldfarb","startTime":1964.4,"endTime":1969.08,"body":"sometimes I wonder how I could"},{"speaker":"Charles Goldfarb","startTime":1964.4,"endTime":1969.08,"body":"have packaged the information"},{"speaker":"Charles Goldfarb","startTime":1969.08,"endTime":1971.45,"body":"differently. And this is just"},{"speaker":"Charles Goldfarb","startTime":1969.08,"endTime":1971.45,"body":"well done. Right. It is"},{"speaker":"Charles Goldfarb","startTime":1971.45,"endTime":1976.4,"body":"interesting, I am glad to have"},{"speaker":"Charles Goldfarb","startTime":1971.45,"endTime":1976.4,"body":"read it. From the technical"},{"speaker":"Charles Goldfarb","startTime":1976.4,"endTime":1980.18,"body":"message, there's nothing new"},{"speaker":"Charles Goldfarb","startTime":1976.4,"endTime":1980.18,"body":"here. But it does make me think"},{"speaker":"Charles Goldfarb","startTime":1980.18,"endTime":1984.68,"body":"about things. So would you"},{"speaker":"Charles Goldfarb","startTime":1980.18,"endTime":1984.68,"body":"consider using the information"},{"speaker":"Charles Goldfarb","startTime":1984.68,"endTime":1989.39,"body":"provided in this manuscript? For"},{"speaker":"Charles Goldfarb","startTime":1984.68,"endTime":1989.39,"body":"potentially considering an"},{"speaker":"Charles Goldfarb","startTime":1989.39,"endTime":1992.03,"body":"innovation procedure for the"},{"speaker":"Charles Goldfarb","startTime":1989.39,"endTime":1992.03,"body":"owners of the wrist? especially"},{"speaker":"Charles Goldfarb","startTime":1992.03,"endTime":1993.98,"body":"focusing on that dorsal sensory"},{"speaker":"Charles Goldfarb","startTime":1992.03,"endTime":1993.98,"body":"branch?"},{"speaker":"Chris Dy","startTime":1994.37,"endTime":1997.28,"body":"Yeah, well, 100%, for"},{"speaker":"Chris Dy","startTime":1994.37,"endTime":1997.28,"body":"sure. And you know, when I think"},{"speaker":"Chris Dy","startTime":1997.28,"endTime":1999.83,"body":"both of us just to make it very"},{"speaker":"Chris Dy","startTime":1997.28,"endTime":1999.83,"body":"clear, when both of us make the"},{"speaker":"Chris Dy","startTime":1999.83,"endTime":2002.29,"body":"comments about packaging of this"},{"speaker":"Chris Dy","startTime":1999.83,"endTime":2002.29,"body":"article, we're not saying that"},{"speaker":"Chris Dy","startTime":2002.29,"endTime":2004.87,"body":"in a negative way. I think"},{"speaker":"Chris Dy","startTime":2002.29,"endTime":2004.87,"body":"that's just reality of getting"},{"speaker":"Chris Dy","startTime":2004.87,"endTime":2006.94,"body":"an article into a journal and"},{"speaker":"Chris Dy","startTime":2004.87,"endTime":2006.94,"body":"doing a project that's"},{"speaker":"Chris Dy","startTime":2006.94,"endTime":2010.03,"body":"interesting. Maybe not"},{"speaker":"Chris Dy","startTime":2006.94,"endTime":2010.03,"body":"necessarily novel, but the way"},{"speaker":"Chris Dy","startTime":2010.03,"endTime":2012.1,"body":"you package is how people are"},{"speaker":"Chris Dy","startTime":2010.03,"endTime":2012.1,"body":"going to interpret into"},{"speaker":"Chris Dy","startTime":2012.1,"endTime":2014.26,"body":"corporate into their clinical"},{"speaker":"Chris Dy","startTime":2012.1,"endTime":2014.26,"body":"practice. So the way this is"},{"speaker":"Chris Dy","startTime":2014.26,"endTime":2017.44,"body":"packaged, made me say, you know,"},{"speaker":"Chris Dy","startTime":2014.26,"endTime":2017.44,"body":"I think this is something I"},{"speaker":"Chris Dy","startTime":2017.44,"endTime":2019.51,"body":"could be interested in doing."},{"speaker":"Chris Dy","startTime":2017.44,"endTime":2019.51,"body":"And I have had that thought in"},{"speaker":"Chris Dy","startTime":2019.51,"endTime":2022.12,"body":"the past, but reading, it kind"},{"speaker":"Chris Dy","startTime":2019.51,"endTime":2022.12,"body":"of makes me feel better about"},{"speaker":"Chris Dy","startTime":2022.12,"endTime":2022.54,"body":"doing it."},{"speaker":"Charles Goldfarb","startTime":2023.05,"endTime":2025.06,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":2023.05,"endTime":2025.06,"body":"definitely not in a negative"},{"speaker":"Charles Goldfarb","startTime":2025.06,"endTime":2027.91,"body":"light, honestly, you know, in a"},{"speaker":"Charles Goldfarb","startTime":2025.06,"endTime":2027.91,"body":"very positive light, because I"},{"speaker":"Charles Goldfarb","startTime":2027.91,"endTime":2029.98,"body":"don't think anyone's doing"},{"speaker":"Charles Goldfarb","startTime":2027.91,"endTime":2029.98,"body":"anything inappropriate. They're"},{"speaker":"Charles Goldfarb","startTime":2029.98,"endTime":2034.36,"body":"just presenting the information"},{"speaker":"Charles Goldfarb","startTime":2029.98,"endTime":2034.36,"body":"in a way that will be most, you"},{"speaker":"Charles Goldfarb","startTime":2034.36,"endTime":2037.84,"body":"know, attention grabbing. We"},{"speaker":"Charles Goldfarb","startTime":2034.36,"endTime":2037.84,"body":"talk about that specific thing"},{"speaker":"Charles Goldfarb","startTime":2037.87,"endTime":2041.95,"body":"all the time when we're"},{"speaker":"Charles Goldfarb","startTime":2037.87,"endTime":2041.95,"body":"submitting abstracts for podium"},{"speaker":"Charles Goldfarb","startTime":2041.95,"endTime":2045.43,"body":"presentation, because for those"},{"speaker":"Charles Goldfarb","startTime":2041.95,"endTime":2045.43,"body":"of you who haven't gone down"},{"speaker":"Charles Goldfarb","startTime":2045.43,"endTime":2049.03,"body":"this road before, you know, if"},{"speaker":"Charles Goldfarb","startTime":2045.43,"endTime":2049.03,"body":"you are a reviewer for a major"},{"speaker":"Charles Goldfarb","startTime":2049.03,"endTime":2053.44,"body":"meeting, you are often reviewing"},{"speaker":"Charles Goldfarb","startTime":2049.03,"endTime":2053.44,"body":"at a minimum 50 and sometimes"},{"speaker":"Charles Goldfarb","startTime":2053.44,"endTime":2057.25,"body":"hundreds of abstracts, depending"},{"speaker":"Charles Goldfarb","startTime":2053.44,"endTime":2057.25,"body":"on your role in the process to"},{"speaker":"Charles Goldfarb","startTime":2057.25,"endTime":2060.1,"body":"decide what is accepted for"},{"speaker":"Charles Goldfarb","startTime":2057.25,"endTime":2060.1,"body":"podium presentation, what might"},{"speaker":"Charles Goldfarb","startTime":2060.1,"endTime":2062.2,"body":"be accepted for poster"},{"speaker":"Charles Goldfarb","startTime":2060.1,"endTime":2062.2,"body":"presentation and what might be"},{"speaker":"Charles Goldfarb","startTime":2062.2,"endTime":2066.16,"body":"rejected. And you have a short"},{"speaker":"Charles Goldfarb","startTime":2062.2,"endTime":2066.16,"body":"amount of space to make your"},{"speaker":"Charles Goldfarb","startTime":2066.16,"endTime":2069.7,"body":"case that you have interesting,"},{"speaker":"Charles Goldfarb","startTime":2066.16,"endTime":2069.7,"body":"compelling information. And we"},{"speaker":"Charles Goldfarb","startTime":2069.7,"endTime":2072.55,"body":"talk about packaging it all the"},{"speaker":"Charles Goldfarb","startTime":2069.7,"endTime":2072.55,"body":"time in that process. We talk"},{"speaker":"Charles Goldfarb","startTime":2072.55,"endTime":2075.43,"body":"about it less for actual"},{"speaker":"Charles Goldfarb","startTime":2072.55,"endTime":2075.43,"body":"scientific manuscripts, but it's"},{"speaker":"Charles Goldfarb","startTime":2075.43,"endTime":2078.43,"body":"the same process so I admire"},{"speaker":"Charles Goldfarb","startTime":2075.43,"endTime":2078.43,"body":"what they've done here and it"},{"speaker":"Charles Goldfarb","startTime":2078.43,"endTime":2082.12,"body":"did grab me absolutely. Now I"},{"speaker":"Charles Goldfarb","startTime":2078.43,"endTime":2082.12,"body":"don't know if I would do it"},{"speaker":"Charles Goldfarb","startTime":2082.87,"endTime":2086.89,"body":"helped me understand one thing."},{"speaker":"Charles Goldfarb","startTime":2082.87,"endTime":2086.89,"body":"If the dorsal sensor branches"},{"speaker":"Charles Goldfarb","startTime":2086.89,"endTime":2090.67,"body":"older nerve is potentially a"},{"speaker":"Charles Goldfarb","startTime":2086.89,"endTime":2090.67,"body":"cause allergy of nerve or nerve"},{"speaker":"Charles Goldfarb","startTime":2090.67,"endTime":2096.43,"body":"that leads to pain if injured."},{"speaker":"Charles Goldfarb","startTime":2090.67,"endTime":2096.43,"body":"How can you just cut it and"},{"speaker":"Charles Goldfarb","startTime":2096.43,"endTime":2100.0,"body":"expect that the wrist pain will"},{"speaker":"Charles Goldfarb","startTime":2096.43,"endTime":2100.0,"body":"go away and there won't be any"},{"speaker":"Charles Goldfarb","startTime":2100.0,"endTime":2101.95,"body":"nerve mediated pain?"},{"speaker":"Chris Dy","startTime":2102.64,"endTime":2106.33,"body":"Great question. So you"},{"speaker":"Chris Dy","startTime":2102.64,"endTime":2106.33,"body":"need to be very selective in"},{"speaker":"Chris Dy","startTime":2106.33,"endTime":2108.82,"body":"which portion that you cut. So"},{"speaker":"Chris Dy","startTime":2106.33,"endTime":2108.82,"body":"they were very clear not to get"},{"speaker":"Chris Dy","startTime":2108.82,"endTime":2111.34,"body":"the sensory component that went"},{"speaker":"Chris Dy","startTime":2108.82,"endTime":2111.34,"body":"to the dorsal owner side of the"},{"speaker":"Chris Dy","startTime":2111.34,"endTime":2114.76,"body":"hand. So that's the call centric"},{"speaker":"Chris Dy","startTime":2111.34,"endTime":2114.76,"body":"nerve that we're always looking"},{"speaker":"Chris Dy","startTime":2114.76,"endTime":2117.67,"body":"for when we do any approach to"},{"speaker":"Chris Dy","startTime":2114.76,"endTime":2117.67,"body":"the other side of the wrist as"},{"speaker":"Chris Dy","startTime":2117.67,"endTime":2119.83,"body":"you get towards the on the"},{"speaker":"Chris Dy","startTime":2117.67,"endTime":2119.83,"body":"carpool reading just because of"},{"speaker":"Chris Dy","startTime":2119.83,"endTime":2124.12,"body":"what you know, the paper that"},{"speaker":"Chris Dy","startTime":2119.83,"endTime":2124.12,"body":"Ryan Calfee wrote, you know, she"},{"speaker":"Chris Dy","startTime":2124.12,"endTime":2128.77,"body":"was cited by many, including at"},{"speaker":"Chris Dy","startTime":2124.12,"endTime":2128.77,"body":"the publisher onis graduation"},{"speaker":"Chris Dy","startTime":2128.77,"endTime":2132.25,"body":"ceremony, which as a quick"},{"speaker":"Chris Dy","startTime":2128.77,"endTime":2132.25,"body":"aside, I will say I acknowledged"},{"speaker":"Chris Dy","startTime":2132.25,"endTime":2134.92,"body":"on the last episode how honored"},{"speaker":"Chris Dy","startTime":2132.25,"endTime":2134.92,"body":"I was to join the group that got"},{"speaker":"Chris Dy","startTime":2134.92,"endTime":2138.34,"body":"it and I realized that you also"},{"speaker":"Chris Dy","startTime":2134.92,"endTime":2138.34,"body":"received it, I thought you had I"},{"speaker":"Chris Dy","startTime":2138.37,"endTime":2141.37,"body":"want to like give it to you if"},{"speaker":"Chris Dy","startTime":2138.37,"endTime":2141.37,"body":"you know, but yes, and trying to"},{"speaker":"Chris Dy","startTime":2141.37,"endTime":2144.46,"body":"Google about like what honestly,"},{"speaker":"Chris Dy","startTime":2141.37,"endTime":2144.46,"body":"the award was and what it means."},{"speaker":"Chris Dy","startTime":2144.7,"endTime":2148.33,"body":"Your name came up repeatedly. So"},{"speaker":"Chris Dy","startTime":2144.7,"endTime":2148.33,"body":"congrats to you on your, on your"},{"speaker":"Chris Dy","startTime":2148.33,"endTime":2151.78,"body":"publisher on US residents"},{"speaker":"Chris Dy","startTime":2148.33,"endTime":2151.78,"body":"education and mentoring award."},{"speaker":"Chris Dy","startTime":2152.41,"endTime":2154.9,"body":"But yeah, but getting back to"},{"speaker":"Chris Dy","startTime":2152.41,"endTime":2154.9,"body":"discussion. So yeah, you have to"},{"speaker":"Chris Dy","startTime":2154.9,"endTime":2157.24,"body":"be sure that you're going just"},{"speaker":"Chris Dy","startTime":2154.9,"endTime":2157.24,"body":"for these articular branches and"},{"speaker":"Chris Dy","startTime":2157.24,"endTime":2161.17,"body":"not for the sensory component"},{"speaker":"Chris Dy","startTime":2157.24,"endTime":2161.17,"body":"that comes out at component. You"},{"speaker":"Chris Dy","startTime":2161.17,"endTime":2163.81,"body":"know, so I think that that's"},{"speaker":"Chris Dy","startTime":2161.17,"endTime":2163.81,"body":"where the rub is. But the idea"},{"speaker":"Chris Dy","startTime":2163.81,"endTime":2167.44,"body":"here is that what you can do in"},{"speaker":"Chris Dy","startTime":2163.81,"endTime":2167.44,"body":"the clinic, either clinically,"},{"speaker":"Chris Dy","startTime":2167.44,"endTime":2170.17,"body":"which many people the more than"},{"speaker":"Chris Dy","startTime":2167.44,"endTime":2170.17,"body":"more slender, you can actually"},{"speaker":"Chris Dy","startTime":2170.17,"endTime":2174.49,"body":"palpate or roll that nerve, you"},{"speaker":"Chris Dy","startTime":2170.17,"endTime":2174.49,"body":"know, as it's just proximal to"},{"speaker":"Chris Dy","startTime":2174.49,"endTime":2178.84,"body":"the to the owner neck and block"},{"speaker":"Chris Dy","startTime":2174.49,"endTime":2178.84,"body":"that nerve. And now clearly"},{"speaker":"Chris Dy","startTime":2178.84,"endTime":2181.36,"body":"you're gonna get sensory loss on"},{"speaker":"Chris Dy","startTime":2178.84,"endTime":2181.36,"body":"the on the dorsal ulnar aspect"},{"speaker":"Chris Dy","startTime":2181.36,"endTime":2185.53,"body":"of the hand, probably not on the"},{"speaker":"Chris Dy","startTime":2181.36,"endTime":2185.53,"body":"the owner sensory distribution"},{"speaker":"Chris Dy","startTime":2185.53,"endTime":2187.81,"body":"proper to the ring and small"},{"speaker":"Chris Dy","startTime":2185.53,"endTime":2187.81,"body":"finger and you shouldn't get an"},{"speaker":"Chris Dy","startTime":2187.81,"endTime":2190.81,"body":"older motor block, but just"},{"speaker":"Chris Dy","startTime":2187.81,"endTime":2190.81,"body":"blocking that nerve, if it helps"},{"speaker":"Chris Dy","startTime":2190.81,"endTime":2193.81,"body":"with their owner sided wrist"},{"speaker":"Chris Dy","startTime":2190.81,"endTime":2193.81,"body":"pain. That's I think the point"},{"speaker":"Chris Dy","startTime":2193.81,"endTime":2195.61,"body":"of this article, it says that"},{"speaker":"Chris Dy","startTime":2193.81,"endTime":2195.61,"body":"patient would be a good"},{"speaker":"Chris Dy","startTime":2195.61,"endTime":2198.76,"body":"candidate for generation in"},{"speaker":"Chris Dy","startTime":2195.61,"endTime":2198.76,"body":"which in the actual surgery, you"},{"speaker":"Chris Dy","startTime":2198.76,"endTime":2201.22,"body":"would go for the articular"},{"speaker":"Chris Dy","startTime":2198.76,"endTime":2201.22,"body":"branches alone and leave that"},{"speaker":"Chris Dy","startTime":2201.22,"endTime":2204.25,"body":"dorsal owner sensory branch"},{"speaker":"Chris Dy","startTime":2201.22,"endTime":2204.25,"body":"otherwise alone."},{"speaker":"Charles Goldfarb","startTime":2205.33,"endTime":2207.85,"body":"Yeah, that was"},{"speaker":"Charles Goldfarb","startTime":2205.33,"endTime":2207.85,"body":"my attempt at a softball for you"},{"speaker":"Charles Goldfarb","startTime":2207.85,"endTime":2210.55,"body":"to hit out of the park, which I"},{"speaker":"Charles Goldfarb","startTime":2207.85,"endTime":2210.55,"body":"think you did. And you're right."},{"speaker":"Charles Goldfarb","startTime":2210.55,"endTime":2213.88,"body":"I mean, we just to be again,"},{"speaker":"Charles Goldfarb","startTime":2210.55,"endTime":2213.88,"body":"really clear, which I think you"},{"speaker":"Charles Goldfarb","startTime":2213.88,"endTime":2217.72,"body":"were, we I take great care. I"},{"speaker":"Charles Goldfarb","startTime":2213.88,"endTime":2217.72,"body":"mean, every arthroscopy"},{"speaker":"Charles Goldfarb","startTime":2217.81,"endTime":2219.97,"body":"potentially puts that nerve at"},{"speaker":"Charles Goldfarb","startTime":2217.81,"endTime":2219.97,"body":"risk. And there's often a"},{"speaker":"Charles Goldfarb","startTime":2219.97,"endTime":2222.97,"body":"transverse branch that goes"},{"speaker":"Charles Goldfarb","startTime":2219.97,"endTime":2222.97,"body":"right near my six, our portal"},{"speaker":"Charles Goldfarb","startTime":2223.12,"endTime":2225.43,"body":"that we really don't want to"},{"speaker":"Charles Goldfarb","startTime":2223.12,"endTime":2225.43,"body":"injure. So it's just those"},{"speaker":"Charles Goldfarb","startTime":2225.43,"endTime":2228.37,"body":"articular branches that we don't"},{"speaker":"Charles Goldfarb","startTime":2225.43,"endTime":2228.37,"body":"really talk about that are the"},{"speaker":"Charles Goldfarb","startTime":2228.37,"endTime":2232.03,"body":"goal here, if you were to"},{"speaker":"Charles Goldfarb","startTime":2228.37,"endTime":2232.03,"body":"consider that selective"},{"speaker":"Charles Goldfarb","startTime":2232.39,"endTime":2233.17,"body":"denervation,"},{"speaker":"Chris Dy","startTime":2233.53,"endTime":2235.84,"body":"right, I'm not I'm not"},{"speaker":"Chris Dy","startTime":2233.53,"endTime":2235.84,"body":"an arthroscopy, but I stay away"},{"speaker":"Chris Dy","startTime":2235.84,"endTime":2238.63,"body":"from doing six you for this"},{"speaker":"Chris Dy","startTime":2235.84,"endTime":2238.63,"body":"exact reason of trying to avoid"},{"speaker":"Chris Dy","startTime":2238.63,"endTime":2241.15,"body":"damaging that cause out of nerve"},{"speaker":"Chris Dy","startTime":2238.63,"endTime":2241.15,"body":"and I think that's why many of"},{"speaker":"Chris Dy","startTime":2241.15,"endTime":2247.42,"body":"us, novice arthroscopy will do"},{"speaker":"Chris Dy","startTime":2241.15,"endTime":2247.42,"body":"six are as opposed to going more"},{"speaker":"Chris Dy","startTime":2247.42,"endTime":2249.49,"body":"older, because once you as Ryan"},{"speaker":"Chris Dy","startTime":2247.42,"endTime":2249.49,"body":"showed us, once you get more"},{"speaker":"Chris Dy","startTime":2249.49,"endTime":2252.94,"body":"towards that mid axial portion"},{"speaker":"Chris Dy","startTime":2249.49,"endTime":2252.94,"body":"of the of the other side of the"},{"speaker":"Chris Dy","startTime":2252.94,"endTime":2255.43,"body":"wrist, that's when you're"},{"speaker":"Chris Dy","startTime":2252.94,"endTime":2255.43,"body":"putting the sensory component at"},{"speaker":"Chris Dy","startTime":2255.43,"endTime":2258.34,"body":"risk. You know, I think this is"},{"speaker":"Chris Dy","startTime":2255.43,"endTime":2258.34,"body":"interesting. I think that, you"},{"speaker":"Chris Dy","startTime":2258.34,"endTime":2260.95,"body":"know, my concern still remain"},{"speaker":"Chris Dy","startTime":2258.34,"endTime":2260.95,"body":"with the narration in terms of"},{"speaker":"Chris Dy","startTime":2261.34,"endTime":2264.4,"body":"the proprioceptive loss, I think"},{"speaker":"Chris Dy","startTime":2261.34,"endTime":2264.4,"body":"Elizabeth hoggets group has done"},{"speaker":"Chris Dy","startTime":2264.4,"endTime":2268.63,"body":"a lot of work on that I struggle"},{"speaker":"Chris Dy","startTime":2264.4,"endTime":2268.63,"body":"with, you know, the huge upside"},{"speaker":"Chris Dy","startTime":2268.63,"endTime":2270.91,"body":"is that if you block a patient,"},{"speaker":"Chris Dy","startTime":2268.63,"endTime":2270.91,"body":"and they do well with this, and"},{"speaker":"Chris Dy","startTime":2270.91,"endTime":2273.07,"body":"then you do a degeneration and"},{"speaker":"Chris Dy","startTime":2270.91,"endTime":2273.07,"body":"they do well, they're really"},{"speaker":"Chris Dy","startTime":2273.07,"endTime":2275.86,"body":"happy because you've spared them"},{"speaker":"Chris Dy","startTime":2273.07,"endTime":2275.86,"body":"a surgery, a different kind of"},{"speaker":"Chris Dy","startTime":2275.86,"endTime":2279.37,"body":"surgery, that probably has a"},{"speaker":"Chris Dy","startTime":2275.86,"endTime":2279.37,"body":"longer recovery. And then, you"},{"speaker":"Chris Dy","startTime":2279.37,"endTime":2283.15,"body":"know, particularly like the"},{"speaker":"Chris Dy","startTime":2279.37,"endTime":2283.15,"body":"total wrist innovations that the"},{"speaker":"Chris Dy","startTime":2283.15,"endTime":2286.6,"body":"mayo group has published about,"},{"speaker":"Chris Dy","startTime":2283.15,"endTime":2286.6,"body":"you know, for them, it's done"},{"speaker":"Chris Dy","startTime":2286.6,"endTime":2289.18,"body":"really well for slack and snack"},{"speaker":"Chris Dy","startTime":2286.6,"endTime":2289.18,"body":"riffs, it lasts them a certain"},{"speaker":"Chris Dy","startTime":2289.18,"endTime":2291.94,"body":"period of time, it buys them"},{"speaker":"Chris Dy","startTime":2289.18,"endTime":2291.94,"body":"time before they have to have a"},{"speaker":"Chris Dy","startTime":2291.94,"endTime":2295.69,"body":"more palliative or salvage type"},{"speaker":"Chris Dy","startTime":2291.94,"endTime":2295.69,"body":"surgery. The question is, you"},{"speaker":"Chris Dy","startTime":2295.69,"endTime":2297.73,"body":"know, is your patient the right"},{"speaker":"Chris Dy","startTime":2295.69,"endTime":2297.73,"body":"one he's going to be happy with?"},{"speaker":"Chris Dy","startTime":2298.0,"endTime":2300.58,"body":"Wow, that's great. That got me a"},{"speaker":"Chris Dy","startTime":2298.0,"endTime":2300.58,"body":"year or two before I had to have"},{"speaker":"Chris Dy","startTime":2300.61,"endTime":2302.83,"body":"X y\u0026z procedure with a three"},{"speaker":"Chris Dy","startTime":2300.61,"endTime":2302.83,"body":"month recovery."},{"speaker":"Charles Goldfarb","startTime":2303.73,"endTime":2305.8,"body":"Right? And"},{"speaker":"Charles Goldfarb","startTime":2303.73,"endTime":2305.8,"body":"then what's the effect of the"},{"speaker":"Charles Goldfarb","startTime":2305.83,"endTime":2308.89,"body":"previous generation on the"},{"speaker":"Charles Goldfarb","startTime":2305.83,"endTime":2308.89,"body":"recovery and ultimate function"},{"speaker":"Charles Goldfarb","startTime":2308.92,"endTime":2311.71,"body":"after that secondary procedure?"},{"speaker":"Charles Goldfarb","startTime":2308.92,"endTime":2311.71,"body":"That's the question. I totally"},{"speaker":"Charles Goldfarb","startTime":2311.71,"endTime":2314.74,"body":"agree. And that's why I'm not"},{"speaker":"Charles Goldfarb","startTime":2311.71,"endTime":2314.74,"body":"early to jump on on the"},{"speaker":"Charles Goldfarb","startTime":2314.77,"endTime":2319.03,"body":"denervation. option. But again,"},{"speaker":"Charles Goldfarb","startTime":2314.77,"endTime":2319.03,"body":"we clearly don't have the answer"},{"speaker":"Charles Goldfarb","startTime":2319.03,"endTime":2321.91,"body":"to all the problems. And"},{"speaker":"Charles Goldfarb","startTime":2319.03,"endTime":2321.91,"body":"sometimes our options for"},{"speaker":"Charles Goldfarb","startTime":2321.91,"endTime":2324.97,"body":"patients to consider for big"},{"speaker":"Charles Goldfarb","startTime":2321.91,"endTime":2324.97,"body":"risk problems are big risk"},{"speaker":"Charles Goldfarb","startTime":2324.97,"endTime":2328.63,"body":"surgeries, which are not always"},{"speaker":"Charles Goldfarb","startTime":2324.97,"endTime":2328.63,"body":"exciting for patients to hear."},{"speaker":"Charles Goldfarb","startTime":2328.63,"endTime":2331.9,"body":"So this kind of work is again,"},{"speaker":"Charles Goldfarb","startTime":2328.63,"endTime":2331.9,"body":"very, very important. As much as"},{"speaker":"Charles Goldfarb","startTime":2331.9,"endTime":2335.59,"body":"I hate to praise nerve surgery"},{"speaker":"Charles Goldfarb","startTime":2331.9,"endTime":2335.59,"body":"studies."},{"speaker":"Chris Dy","startTime":2336.129,"endTime":2339.459,"body":"Well, this is the, you"},{"speaker":"Chris Dy","startTime":2336.129,"endTime":2339.459,"body":"know, nerve harming surgery part"},{"speaker":"Chris Dy","startTime":2339.459,"endTime":2342.429,"body":"of it, where you're just going"},{"speaker":"Chris Dy","startTime":2339.459,"endTime":2342.429,"body":"after the innervation. So I"},{"speaker":"Chris Dy","startTime":2342.429,"endTime":2345.159,"body":"think it's interesting, I think"},{"speaker":"Chris Dy","startTime":2342.429,"endTime":2345.159,"body":"it certainly has already"},{"speaker":"Chris Dy","startTime":2345.159,"endTime":2347.499,"body":"influenced how I talk to"},{"speaker":"Chris Dy","startTime":2345.159,"endTime":2347.499,"body":"patients, you know, I've talked"},{"speaker":"Chris Dy","startTime":2347.499,"endTime":2350.289,"body":"to patients about you know,"},{"speaker":"Chris Dy","startTime":2347.499,"endTime":2350.289,"body":"using this kind of approach, and"},{"speaker":"Chris Dy","startTime":2350.289,"endTime":2352.149,"body":"some people are really gung ho"},{"speaker":"Chris Dy","startTime":2350.289,"endTime":2352.149,"body":"about it. I think it's all"},{"speaker":"Chris Dy","startTime":2352.149,"endTime":2356.019,"body":"about, again, patient selection,"},{"speaker":"Chris Dy","startTime":2352.149,"endTime":2356.019,"body":"which is a very, you know, catch"},{"speaker":"Chris Dy","startTime":2356.019,"endTime":2358.989,"body":"all term. But honestly, it's"},{"speaker":"Chris Dy","startTime":2356.019,"endTime":2358.989,"body":"probably one of the harder parts"},{"speaker":"Chris Dy","startTime":2358.989,"endTime":2359.619,"body":"of our job."},{"speaker":"Charles Goldfarb","startTime":2360.49,"endTime":2363.22,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":2360.49,"endTime":2363.22,"body":"All right. I'm off"},{"speaker":"Charles Goldfarb","startTime":2363.76,"endTime":2366.82,"body":"polymerization on the books"},{"speaker":"Charles Goldfarb","startTime":2363.76,"endTime":2366.82,"body":"today, which is exciting. I have"},{"speaker":"Charles Goldfarb","startTime":2366.82,"endTime":2369.76,"body":"another super interesting case"},{"speaker":"Charles Goldfarb","startTime":2366.82,"endTime":2369.76,"body":"as well on a kid that came up"},{"speaker":"Charles Goldfarb","startTime":2369.76,"endTime":2372.04,"body":"from Central America. So good"},{"speaker":"Charles Goldfarb","startTime":2369.76,"endTime":2372.04,"body":"day."},{"speaker":"Chris Dy","startTime":2372.31,"endTime":2373.96,"body":"All right. Well, you"},{"speaker":"Chris Dy","startTime":2372.31,"endTime":2373.96,"body":"have a lot of work to do. I've"},{"speaker":"Chris Dy","startTime":2373.96,"endTime":2376.0,"body":"got some abstract writing to do."},{"speaker":"Chris Dy","startTime":2373.96,"endTime":2376.0,"body":"And then I've gotten out of"},{"speaker":"Chris Dy","startTime":2376.0,"endTime":2379.9,"body":"clinic so very different days,"},{"speaker":"Chris Dy","startTime":2376.0,"endTime":2379.9,"body":"but I'm gonna go package things"},{"speaker":"Chris Dy","startTime":2379.9,"endTime":2382.27,"body":"very well for this. ASP and"},{"speaker":"Chris Dy","startTime":2379.9,"endTime":2382.27,"body":"abstract deadline."},{"speaker":"Charles Goldfarb","startTime":2382.66,"endTime":2385.51,"body":"Awesome. Have"},{"speaker":"Charles Goldfarb","startTime":2382.66,"endTime":2385.51,"body":"a good day. See you later. Hey,"},{"speaker":"Charles Goldfarb","startTime":2385.51,"endTime":2387.82,"body":"Chris. That was fun. Let's do it"},{"speaker":"Charles Goldfarb","startTime":2385.51,"endTime":2387.82,"body":"again real soon."},{"speaker":"Chris Dy","startTime":2388.09,"endTime":2390.541,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2388.09,"endTime":2390.541,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2390.588,"endTime":2393.04,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2390.588,"endTime":2393.04,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2393.04,"endTime":2395.5,"body":"Mine is @congenitalhand."},{"speaker":"Chris Dy","startTime":2395.62,"endTime":2399.043,"body":"What about you? Mine"},{"speaker":"Chris Dy","startTime":2395.62,"endTime":2399.043,"body":"is @ChrisDyMD spelled d-y and if"},{"speaker":"Chris Dy","startTime":2399.108,"endTime":2403.63,"body":"you'd like to eat Email us, you"},{"speaker":"Chris Dy","startTime":2399.108,"endTime":2403.63,"body":"can reach us at handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2404.2,"endTime":2406.33,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2404.2,"endTime":2406.33,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2406.33,"endTime":2407.41,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2407.44,"endTime":2409.66,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2407.44,"endTime":2409.66,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2409.66,"endTime":2411.28,"body":"word out. Special thanks"},{"speaker":"Charles Goldfarb","startTime":2411.28,"endTime":2413.2,"body":"to Peter"},{"speaker":"Charles Goldfarb","startTime":2411.28,"endTime":2413.2,"body":"Martin for the amazing music."},{"speaker":"Charles Goldfarb","startTime":2413.47,"endTime":2419.95,"body":"And remember, keep the upper"},{"speaker":"Charles Goldfarb","startTime":2413.47,"endTime":2419.95,"body":"hand. Come back next week"}]}