{"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":15.72,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.33,"endTime":15.72,"body":"to personal. Please"},{"speaker":"Charles Goldfarb","startTime":15.72,"endTime":18.0,"body":"subscribe,"},{"speaker":"Charles Goldfarb","startTime":15.72,"endTime":18.0,"body":"wherever you get your podcasts."},{"speaker":"Charles Goldfarb","startTime":18.93,"endTime":19.17,"body":"And"},{"speaker":"Chris Dy","startTime":19.17,"endTime":21.57,"body":"thank you in advance"},{"speaker":"Chris Dy","startTime":19.17,"endTime":21.57,"body":"for leaving a review and leaving"},{"speaker":"Chris Dy","startTime":21.57,"endTime":24.45,"body":"a rating wherever you get your"},{"speaker":"Chris Dy","startTime":21.57,"endTime":24.45,"body":"podcasts. Oh,"},{"speaker":"Charles Goldfarb","startTime":24.45,"endTime":25.23,"body":"hey, Chris."},{"speaker":"Chris Dy","startTime":25.44,"endTime":26.37,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":25.44,"endTime":26.37,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":26.91,"endTime":28.32,"body":"I'm great. How"},{"speaker":"Charles Goldfarb","startTime":26.91,"endTime":28.32,"body":"are you?"},{"speaker":"Chris Dy","startTime":29.04,"endTime":32.52,"body":"I'm great. You seem to"},{"speaker":"Chris Dy","startTime":29.04,"endTime":32.52,"body":"be pretty busy nowadays. You"},{"speaker":"Chris Dy","startTime":32.52,"endTime":35.16,"body":"know, obviously, you've got your"},{"speaker":"Chris Dy","startTime":32.52,"endTime":35.16,"body":"full time job. And you've also"},{"speaker":"Chris Dy","startTime":35.16,"endTime":39.54,"body":"got your your Billy Madison hat."},{"speaker":"Chris Dy","startTime":35.16,"endTime":39.54,"body":"You're going back to school?"},{"speaker":"Charles Goldfarb","startTime":39.87,"endTime":43.11,"body":"Yeah, yeah,"},{"speaker":"Charles Goldfarb","startTime":39.87,"endTime":43.11,"body":"this was a B School weekend. So"},{"speaker":"Charles Goldfarb","startTime":43.11,"endTime":46.17,"body":"that for that. It's Thursday,"},{"speaker":"Charles Goldfarb","startTime":43.11,"endTime":46.17,"body":"all day, Friday, all day,"},{"speaker":"Charles Goldfarb","startTime":46.17,"endTime":50.07,"body":"Saturday all day. So I we're"},{"speaker":"Charles Goldfarb","startTime":46.17,"endTime":50.07,"body":"recording on Sunday the 29th."},{"speaker":"Charles Goldfarb","startTime":50.07,"endTime":53.82,"body":"And we'll be dropping this"},{"speaker":"Charles Goldfarb","startTime":50.07,"endTime":53.82,"body":"episode in a couple of weeks."},{"speaker":"Charles Goldfarb","startTime":53.82,"endTime":56.16,"body":"But yes, schools really great."},{"speaker":"Chris Dy","startTime":56.7,"endTime":60.3,"body":"So as to people in the"},{"speaker":"Chris Dy","startTime":56.7,"endTime":60.3,"body":"Executive MBA program actually"},{"speaker":"Chris Dy","startTime":60.3,"endTime":63.39,"body":"call it an EMBA. Because people"},{"speaker":"Chris Dy","startTime":60.3,"endTime":63.39,"body":"have told me that Chuck is going"},{"speaker":"Chris Dy","startTime":63.39,"endTime":64.68,"body":"after his EMBA. I'm like,"},{"speaker":"Charles Goldfarb","startTime":66.27,"endTime":69.27,"body":"it's funny."},{"speaker":"Charles Goldfarb","startTime":66.27,"endTime":69.27,"body":"You asked the question. They do"},{"speaker":"Charles Goldfarb","startTime":69.27,"endTime":72.78,"body":"call it the m bar, which I never"},{"speaker":"Charles Goldfarb","startTime":69.27,"endTime":72.78,"body":"I always call it an executive"},{"speaker":"Charles Goldfarb","startTime":72.78,"endTime":76.44,"body":"MBA. But I guess that's too much"},{"speaker":"Charles Goldfarb","startTime":72.78,"endTime":76.44,"body":"too much of a mouthful. So they"},{"speaker":"Charles Goldfarb","startTime":76.44,"endTime":77.73,"body":"call it the EMBA. Well, I"},{"speaker":"Chris Dy","startTime":77.73,"endTime":80.31,"body":"mean, I give some of"},{"speaker":"Chris Dy","startTime":77.73,"endTime":80.31,"body":"our trainees a hard time if they"},{"speaker":"Chris Dy","startTime":80.31,"endTime":92.91,"body":"come in saying \"ORIF\" . FOOSH is"},{"speaker":"Chris Dy","startTime":80.31,"endTime":92.91,"body":"the other one. I am not a fan of"},{"speaker":"Chris Dy","startTime":92.91,"endTime":94.56,"body":"FOOSH. That's actually one of"},{"speaker":"Chris Dy","startTime":92.91,"endTime":94.56,"body":"the things you can't say my"},{"speaker":"Chris Dy","startTime":94.56,"endTime":97.2,"body":"clinic there are a few phrases,"},{"speaker":"Chris Dy","startTime":94.56,"endTime":97.2,"body":"some of which I can't say on"},{"speaker":"Chris Dy","startTime":97.2,"endTime":100.89,"body":"air, that you're not allowed to"},{"speaker":"Chris Dy","startTime":97.2,"endTime":100.89,"body":"say in my clinic. futian over if"},{"speaker":"Chris Dy","startTime":100.89,"endTime":101.49,"body":"are two of them."},{"speaker":"Charles Goldfarb","startTime":101.91,"endTime":103.41,"body":"I have a"},{"speaker":"Charles Goldfarb","startTime":101.91,"endTime":103.41,"body":"feeling that this is gonna"},{"speaker":"Charles Goldfarb","startTime":103.41,"endTime":107.37,"body":"resonate with some listeners."},{"speaker":"Charles Goldfarb","startTime":103.41,"endTime":107.37,"body":"Yeah, I am not an ORiF, or ORIF"},{"speaker":"Charles Goldfarb","startTime":107.43,"endTime":111.33,"body":"or FOOSH. I don't like those"},{"speaker":"Charles Goldfarb","startTime":107.43,"endTime":111.33,"body":"things. I mean, I don't know why"},{"speaker":"Charles Goldfarb","startTime":111.72,"endTime":113.85,"body":"O.R.I.F is better, but it is,"},{"speaker":"Charles Goldfarb","startTime":111.72,"endTime":113.85,"body":"it's clearly better."},{"speaker":"Chris Dy","startTime":114.54,"endTime":118.17,"body":"I thought you'd have"},{"speaker":"Chris Dy","startTime":114.54,"endTime":118.17,"body":"feelings about this. We're"},{"speaker":"Chris Dy","startTime":118.17,"endTime":120.48,"body":"either going to people, it's"},{"speaker":"Chris Dy","startTime":118.17,"endTime":120.48,"body":"gonna be polarizing, they're"},{"speaker":"Chris Dy","startTime":120.48,"endTime":124.35,"body":"gonna be with us or against us."},{"speaker":"Chris Dy","startTime":120.48,"endTime":124.35,"body":"It's fine. Sorry, you're wrong."},{"speaker":"Chris Dy","startTime":124.38,"endTime":125.31,"body":"If you actually say."},{"speaker":"Charles Goldfarb","startTime":127.56,"endTime":130.86,"body":"Yes, this is"},{"speaker":"Charles Goldfarb","startTime":127.56,"endTime":130.86,"body":"schools. It's kind of crazy, as"},{"speaker":"Charles Goldfarb","startTime":130.89,"endTime":133.5,"body":"I think I don't know if we"},{"speaker":"Charles Goldfarb","startTime":130.89,"endTime":133.5,"body":"talked about on the air. But"},{"speaker":"Charles Goldfarb","startTime":133.53,"endTime":137.37,"body":"I've wanted to do this forever."},{"speaker":"Charles Goldfarb","startTime":133.53,"endTime":137.37,"body":"So I am a little bit older. I'm"},{"speaker":"Charles Goldfarb","startTime":137.37,"endTime":141.3,"body":"not the oldest, but I'm older"},{"speaker":"Charles Goldfarb","startTime":137.37,"endTime":141.3,"body":"and in the class, but it's"},{"speaker":"Charles Goldfarb","startTime":141.3,"endTime":144.75,"body":"great. So this these last three"},{"speaker":"Charles Goldfarb","startTime":141.3,"endTime":144.75,"body":"days, basically, the way it"},{"speaker":"Charles Goldfarb","startTime":144.75,"endTime":148.05,"body":"works here at Wash U Olin School"},{"speaker":"Charles Goldfarb","startTime":144.75,"endTime":148.05,"body":"of Business is you have a"},{"speaker":"Charles Goldfarb","startTime":148.05,"endTime":150.21,"body":"foreign half hour class in the"},{"speaker":"Charles Goldfarb","startTime":148.05,"endTime":150.21,"body":"morning and a four and a half"},{"speaker":"Charles Goldfarb","startTime":150.21,"endTime":153.24,"body":"hour class in the afternoon. You"},{"speaker":"Charles Goldfarb","startTime":150.21,"endTime":153.24,"body":"do that for three days. And they"},{"speaker":"Charles Goldfarb","startTime":153.24,"endTime":157.5,"body":"go beyond one weekend. So this"},{"speaker":"Charles Goldfarb","startTime":153.24,"endTime":157.5,"body":"weekend, we did accounting. And"},{"speaker":"Charles Goldfarb","startTime":157.5,"endTime":162.72,"body":"we also did business analytics,"},{"speaker":"Charles Goldfarb","startTime":157.5,"endTime":162.72,"body":"which is really looking at HBr"},{"speaker":"Charles Goldfarb","startTime":162.72,"endTime":168.78,"body":"cases, and learning how to know"},{"speaker":"Charles Goldfarb","startTime":162.72,"endTime":168.78,"body":"what to analyze, and then how to"},{"speaker":"Charles Goldfarb","startTime":168.78,"endTime":173.76,"body":"do the analysis. The hard part"},{"speaker":"Charles Goldfarb","startTime":168.78,"endTime":173.76,"body":"is not doing the analysis is"},{"speaker":"Charles Goldfarb","startTime":173.76,"endTime":177.21,"body":"figuring out what to analyze and"},{"speaker":"Charles Goldfarb","startTime":173.76,"endTime":177.21,"body":"how to gather disparate pieces"},{"speaker":"Charles Goldfarb","startTime":177.21,"endTime":179.67,"body":"of information and bring them"},{"speaker":"Charles Goldfarb","startTime":177.21,"endTime":179.67,"body":"together for a statistical"},{"speaker":"Charles Goldfarb","startTime":179.67,"endTime":181.38,"body":"assessment. It's very cool."},{"speaker":"Chris Dy","startTime":181.89,"endTime":184.98,"body":"Now is your NBI. One"},{"speaker":"Chris Dy","startTime":181.89,"endTime":184.98,"body":"that has a specific focus like a"},{"speaker":"Chris Dy","startTime":184.98,"endTime":187.56,"body":"healthcare focus, or is it any"},{"speaker":"Chris Dy","startTime":184.98,"endTime":187.56,"body":"more generalized? You know?"},{"speaker":"Chris Dy","startTime":188.22,"endTime":189.36,"body":"You're You're shaking your head?"},{"speaker":"Chris Dy","startTime":188.22,"endTime":189.36,"body":"No."},{"speaker":"Charles Goldfarb","startTime":189.78,"endTime":191.37,"body":"Yeah. Well, I"},{"speaker":"Charles Goldfarb","startTime":189.78,"endTime":191.37,"body":"was gonna verbalize that too."},{"speaker":"Charles Goldfarb","startTime":191.37,"endTime":195.42,"body":"Yeah. I did not want to"},{"speaker":"Charles Goldfarb","startTime":191.37,"endTime":195.42,"body":"healthcare focus, I wanted the"},{"speaker":"Charles Goldfarb","startTime":195.45,"endTime":197.88,"body":"kind of the whole thing. And so"},{"speaker":"Charles Goldfarb","startTime":195.45,"endTime":197.88,"body":"this fall, it's those two"},{"speaker":"Charles Goldfarb","startTime":197.88,"endTime":205.02,"body":"classes, its marketing, and"},{"speaker":"Charles Goldfarb","startTime":197.88,"endTime":205.02,"body":"marketing, accounting, business"},{"speaker":"Charles Goldfarb","startTime":205.02,"endTime":208.62,"body":"analytics. Yeah, those those"},{"speaker":"Charles Goldfarb","startTime":205.02,"endTime":208.62,"body":"three classes for the fall. And"},{"speaker":"Charles Goldfarb","startTime":208.8,"endTime":210.87,"body":"so far, it's been been really"},{"speaker":"Charles Goldfarb","startTime":208.8,"endTime":210.87,"body":"awesome."},{"speaker":"Chris Dy","startTime":211.41,"endTime":215.25,"body":"And they have you"},{"speaker":"Chris Dy","startTime":211.41,"endTime":215.25,"body":"found it hard to, to get into"},{"speaker":"Chris Dy","startTime":215.25,"endTime":217.68,"body":"the assignments, given that they"},{"speaker":"Chris Dy","startTime":215.25,"endTime":217.68,"body":"don't have a healthcare focus. I"},{"speaker":"Chris Dy","startTime":217.68,"endTime":219.96,"body":"mean, because obviously, we're"},{"speaker":"Chris Dy","startTime":217.68,"endTime":219.96,"body":"talking about industries and"},{"speaker":"Chris Dy","startTime":219.96,"endTime":223.68,"body":"spaces that you have not had a"},{"speaker":"Chris Dy","startTime":219.96,"endTime":223.68,"body":"particular professional interest"},{"speaker":"Chris Dy","startTime":223.68,"endTime":223.89,"body":"in."},{"speaker":"Charles Goldfarb","startTime":224.91,"endTime":227.52,"body":"Yeah, they so"},{"speaker":"Charles Goldfarb","startTime":224.91,"endTime":227.52,"body":"far, they're all 100%"},{"speaker":"Charles Goldfarb","startTime":227.52,"endTime":231.18,"body":"applicable, like marketing is"},{"speaker":"Charles Goldfarb","startTime":227.52,"endTime":231.18,"body":"obviously applicable accounting"},{"speaker":"Charles Goldfarb","startTime":231.18,"endTime":235.29,"body":"clearly. And then the business"},{"speaker":"Charles Goldfarb","startTime":231.18,"endTime":235.29,"body":"analytics is really, you know,"},{"speaker":"Charles Goldfarb","startTime":235.32,"endTime":238.02,"body":"obviously, we're not you and I"},{"speaker":"Charles Goldfarb","startTime":235.32,"endTime":238.02,"body":"aren't reading HBr articles at"},{"speaker":"Charles Goldfarb","startTime":238.02,"endTime":242.19,"body":"work, but the concepts of kind"},{"speaker":"Charles Goldfarb","startTime":238.02,"endTime":242.19,"body":"of how to think about things,"},{"speaker":"Charles Goldfarb","startTime":242.19,"endTime":245.34,"body":"how to apply mathematical"},{"speaker":"Charles Goldfarb","startTime":242.19,"endTime":245.34,"body":"assessments, and then how to"},{"speaker":"Charles Goldfarb","startTime":245.34,"endTime":248.73,"body":"take what you find and present"},{"speaker":"Charles Goldfarb","startTime":245.34,"endTime":248.73,"body":"it and share it and convince"},{"speaker":"Charles Goldfarb","startTime":248.73,"endTime":254.07,"body":"people is really great. And so I"},{"speaker":"Charles Goldfarb","startTime":248.73,"endTime":254.07,"body":"think that everything I do will"},{"speaker":"Charles Goldfarb","startTime":254.07,"endTime":257.76,"body":"be applicable. And, you know,"},{"speaker":"Charles Goldfarb","startTime":254.07,"endTime":257.76,"body":"it's just, it's just interesting"},{"speaker":"Charles Goldfarb","startTime":257.76,"endTime":258.69,"body":"stuff to me."},{"speaker":"Chris Dy","startTime":259.62,"endTime":262.53,"body":"Are you the only"},{"speaker":"Chris Dy","startTime":259.62,"endTime":262.53,"body":"clinician in the program? No,"},{"speaker":"Charles Goldfarb","startTime":262.56,"endTime":267.21,"body":"I am not."},{"speaker":"Charles Goldfarb","startTime":262.56,"endTime":267.21,"body":"There are two other two other"},{"speaker":"Charles Goldfarb","startTime":267.21,"endTime":272.25,"body":"full time conditions, one"},{"speaker":"Charles Goldfarb","startTime":267.21,"endTime":272.25,"body":"neurosurgeon at Wash U. And one"},{"speaker":"Charles Goldfarb","startTime":272.25,"endTime":275.55,"body":"plastic surgeon, there's a"},{"speaker":"Charles Goldfarb","startTime":272.25,"endTime":275.55,"body":"internal medicine doctor does a"},{"speaker":"Charles Goldfarb","startTime":275.55,"endTime":281.94,"body":"lot of research. And there is a"},{"speaker":"Charles Goldfarb","startTime":275.55,"endTime":281.94,"body":"two full time PhD like research"},{"speaker":"Charles Goldfarb","startTime":281.94,"endTime":286.65,"body":"folks. There's some clinical"},{"speaker":"Charles Goldfarb","startTime":281.94,"endTime":286.65,"body":"grant managers and so there's"},{"speaker":"Charles Goldfarb","startTime":286.65,"endTime":291.69,"body":"probably probably a quarter of"},{"speaker":"Charles Goldfarb","startTime":286.65,"endTime":291.69,"body":"the class is about 3033 34"},{"speaker":"Charles Goldfarb","startTime":291.69,"endTime":294.93,"body":"people in the class and about a"},{"speaker":"Charles Goldfarb","startTime":291.69,"endTime":294.93,"body":"quarter of the class. Maybe a"},{"speaker":"Charles Goldfarb","startTime":294.93,"endTime":297.87,"body":"little less has some type of"},{"speaker":"Charles Goldfarb","startTime":294.93,"endTime":297.87,"body":"medical tie. Then"},{"speaker":"Chris Dy","startTime":297.87,"endTime":301.62,"body":"of the I guess maybe"},{"speaker":"Chris Dy","startTime":297.87,"endTime":301.62,"body":"the surgeons , what's the timing"},{"speaker":"Chris Dy","startTime":301.62,"endTime":303.69,"body":"of this and their careers and"},{"speaker":"Chris Dy","startTime":301.62,"endTime":303.69,"body":"kind of their overall"},{"speaker":"Chris Dy","startTime":303.69,"endTime":306.06,"body":"intentions? Don't obviously"},{"speaker":"Chris Dy","startTime":303.69,"endTime":306.06,"body":"don't say names, but you know,"},{"speaker":"Chris Dy","startTime":306.54,"endTime":307.95,"body":"what's their? What's their goal?"},{"speaker":"Charles Goldfarb","startTime":308.19,"endTime":309.54,"body":"They're"},{"speaker":"Charles Goldfarb","startTime":308.19,"endTime":309.54,"body":"definitely younger. I think"},{"speaker":"Charles Goldfarb","startTime":309.54,"endTime":316.62,"body":"they're both in their early 40s."},{"speaker":"Charles Goldfarb","startTime":309.54,"endTime":316.62,"body":"I think it's kind of a, it's a"},{"speaker":"Charles Goldfarb","startTime":316.62,"endTime":319.44,"body":"source of interest. I don't know"},{"speaker":"Charles Goldfarb","startTime":316.62,"endTime":319.44,"body":"that either of them have"},{"speaker":"Charles Goldfarb","startTime":319.44,"endTime":321.81,"body":"specifically stated that they"},{"speaker":"Charles Goldfarb","startTime":319.44,"endTime":321.81,"body":"thought this would take their"},{"speaker":"Charles Goldfarb","startTime":321.81,"endTime":325.56,"body":"career in a different direction."},{"speaker":"Charles Goldfarb","startTime":321.81,"endTime":325.56,"body":"maybe help them in their current"},{"speaker":"Charles Goldfarb","startTime":325.56,"endTime":329.16,"body":"status, maybe give them"},{"speaker":"Charles Goldfarb","startTime":325.56,"endTime":329.16,"body":"something to reengage with?"},{"speaker":"Charles Goldfarb","startTime":330.18,"endTime":333.3,"body":"Yeah, I actually haven't asked"},{"speaker":"Charles Goldfarb","startTime":330.18,"endTime":333.3,"body":"that specific question. That"},{"speaker":"Charles Goldfarb","startTime":333.3,"endTime":336.03,"body":"question gets asked to me all"},{"speaker":"Charles Goldfarb","startTime":333.3,"endTime":336.03,"body":"the time. But I haven't"},{"speaker":"Charles Goldfarb","startTime":336.06,"endTime":339.84,"body":"specifically asked that"},{"speaker":"Charles Goldfarb","startTime":336.06,"endTime":339.84,"body":"question. But it's, it's really"},{"speaker":"Charles Goldfarb","startTime":339.84,"endTime":343.68,"body":"an interesting thing, I don't"},{"speaker":"Charles Goldfarb","startTime":339.84,"endTime":343.68,"body":"think. And I'll know more as I"},{"speaker":"Charles Goldfarb","startTime":343.68,"endTime":345.84,"body":"go along or develop stronger"},{"speaker":"Charles Goldfarb","startTime":343.68,"endTime":345.84,"body":"feelings. I don't think an MBA"},{"speaker":"Charles Goldfarb","startTime":345.84,"endTime":351.21,"body":"is for every doctor, obviously."},{"speaker":"Charles Goldfarb","startTime":345.84,"endTime":351.21,"body":"But just the learning process."},{"speaker":"Charles Goldfarb","startTime":351.45,"endTime":354.9,"body":"At my age, you know, when you"},{"speaker":"Charles Goldfarb","startTime":351.45,"endTime":354.9,"body":"get old, is fantastic. Like,"},{"speaker":"Charles Goldfarb","startTime":354.9,"endTime":357.81,"body":"it's, it's amazing. It's really"},{"speaker":"Charles Goldfarb","startTime":354.9,"endTime":357.81,"body":"great. Sounds"},{"speaker":"Chris Dy","startTime":357.81,"endTime":360.45,"body":"fun. I always joke"},{"speaker":"Chris Dy","startTime":357.81,"endTime":360.45,"body":"about wanting to do it. And"},{"speaker":"Chris Dy","startTime":360.45,"endTime":365.4,"body":"Tiffany, you better not actually"},{"speaker":"Chris Dy","startTime":360.45,"endTime":365.4,"body":"do this. Just you wait. But is"},{"speaker":"Chris Dy","startTime":365.4,"endTime":367.47,"body":"there anything in particular"},{"speaker":"Chris Dy","startTime":365.4,"endTime":367.47,"body":"that you thought about in terms"},{"speaker":"Chris Dy","startTime":367.47,"endTime":370.71,"body":"of timing? You know, I don't"},{"speaker":"Chris Dy","startTime":367.47,"endTime":370.71,"body":"know whether it was more of"},{"speaker":"Chris Dy","startTime":370.89,"endTime":373.89,"body":"where you were professionally,"},{"speaker":"Chris Dy","startTime":370.89,"endTime":373.89,"body":"or kind of the, you know, the"},{"speaker":"Chris Dy","startTime":373.92,"endTime":376.74,"body":"situation with your kids, or?"},{"speaker":"Chris Dy","startTime":373.92,"endTime":376.74,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":376.74,"endTime":378.84,"body":"it all sort of"},{"speaker":"Charles Goldfarb","startTime":376.74,"endTime":378.84,"body":"came together. I've been looking"},{"speaker":"Charles Goldfarb","startTime":378.84,"endTime":383.22,"body":"at this particular program,"},{"speaker":"Charles Goldfarb","startTime":378.84,"endTime":383.22,"body":"probably for five or six years."},{"speaker":"Charles Goldfarb","startTime":383.61,"endTime":386.76,"body":"And it just felt like I couldn't"},{"speaker":"Charles Goldfarb","startTime":383.61,"endTime":386.76,"body":"pull it off in the past I, I'm"},{"speaker":"Charles Goldfarb","startTime":386.76,"endTime":390.06,"body":"an empty nester. Now, as we"},{"speaker":"Charles Goldfarb","startTime":386.76,"endTime":390.06,"body":"talked about, that definitely"},{"speaker":"Charles Goldfarb","startTime":390.06,"endTime":394.17,"body":"helps. My wife was in agreement"},{"speaker":"Charles Goldfarb","startTime":390.06,"endTime":394.17,"body":"for a lot of reasons. So that"},{"speaker":"Charles Goldfarb","startTime":394.17,"endTime":401.85,"body":"helps. I honestly think, mid to"},{"speaker":"Charles Goldfarb","startTime":394.17,"endTime":401.85,"body":"late ish. 40s is probably the"},{"speaker":"Charles Goldfarb","startTime":401.85,"endTime":404.22,"body":"right age, which is older than a"},{"speaker":"Charles Goldfarb","startTime":401.85,"endTime":404.22,"body":"lot of my classmates, I'm"},{"speaker":"Charles Goldfarb","startTime":404.22,"endTime":405.9,"body":"certainly not trying to say"},{"speaker":"Charles Goldfarb","startTime":404.22,"endTime":405.9,"body":"anything negative of my"},{"speaker":"Charles Goldfarb","startTime":405.9,"endTime":408.9,"body":"classmates. But there is for"},{"speaker":"Charles Goldfarb","startTime":405.9,"endTime":408.9,"body":"this particular program, the"},{"speaker":"Charles Goldfarb","startTime":408.9,"endTime":413.46,"body":"executive program, there is a"},{"speaker":"Charles Goldfarb","startTime":408.9,"endTime":413.46,"body":"critical life experience that I"},{"speaker":"Charles Goldfarb","startTime":413.46,"endTime":418.08,"body":"would that brings a lot to the"},{"speaker":"Charles Goldfarb","startTime":413.46,"endTime":418.08,"body":"class. And you know, hearing"},{"speaker":"Charles Goldfarb","startTime":418.11,"endTime":421.11,"body":"different people in different"},{"speaker":"Charles Goldfarb","startTime":418.11,"endTime":421.11,"body":"industries, talk about their"},{"speaker":"Charles Goldfarb","startTime":421.26,"endTime":424.41,"body":"challenges, their opportunities,"},{"speaker":"Charles Goldfarb","startTime":421.26,"endTime":424.41,"body":"their competition, is part of"},{"speaker":"Charles Goldfarb","startTime":424.41,"endTime":429.39,"body":"the great, vino, what's so"},{"speaker":"Charles Goldfarb","startTime":424.41,"endTime":429.39,"body":"interesting about it. And so I"},{"speaker":"Charles Goldfarb","startTime":429.39,"endTime":432.15,"body":"think you got to have done"},{"speaker":"Charles Goldfarb","startTime":429.39,"endTime":432.15,"body":"enough to know the problems of"},{"speaker":"Charles Goldfarb","startTime":432.15,"endTime":435.57,"body":"your industry, and to know what"},{"speaker":"Charles Goldfarb","startTime":432.15,"endTime":435.57,"body":"you want to accomplish to really"},{"speaker":"Charles Goldfarb","startTime":435.57,"endTime":436.44,"body":"get the most out of it."},{"speaker":"Chris Dy","startTime":438.09,"endTime":440.01,"body":"Well, it sounds like"},{"speaker":"Chris Dy","startTime":438.09,"endTime":440.01,"body":"an amazing experience, I look"},{"speaker":"Chris Dy","startTime":440.01,"endTime":443.46,"body":"forward to seeing you go through"},{"speaker":"Chris Dy","startTime":440.01,"endTime":443.46,"body":"this journey and hearing your"},{"speaker":"Chris Dy","startTime":443.46,"endTime":446.49,"body":"reflections on it. You know,"},{"speaker":"Chris Dy","startTime":443.46,"endTime":446.49,"body":"it's going to it's going to be a"},{"speaker":"Chris Dy","startTime":446.49,"endTime":446.88,"body":"lot of fun."},{"speaker":"Charles Goldfarb","startTime":447.75,"endTime":451.17,"body":"Yeah, I have a"},{"speaker":"Charles Goldfarb","startTime":447.75,"endTime":451.17,"body":"big accounting test that I need"},{"speaker":"Charles Goldfarb","startTime":451.17,"endTime":454.47,"body":"to get done. It's, it's it's"},{"speaker":"Charles Goldfarb","startTime":451.17,"endTime":454.47,"body":"open book. Because you know,"},{"speaker":"Charles Goldfarb","startTime":454.47,"endTime":458.82,"body":"individual, there's an honor"},{"speaker":"Charles Goldfarb","startTime":454.47,"endTime":458.82,"body":"code, the professor estimated 15"},{"speaker":"Charles Goldfarb","startTime":458.82,"endTime":461.85,"body":"plus hours to get that done that"},{"speaker":"Charles Goldfarb","startTime":458.82,"endTime":461.85,"body":"that's the test and you know,"},{"speaker":"Charles Goldfarb","startTime":461.85,"endTime":464.58,"body":"there's homework and there's a"},{"speaker":"Charles Goldfarb","startTime":461.85,"endTime":464.58,"body":"marketing assignment. So it's"},{"speaker":"Charles Goldfarb","startTime":464.58,"endTime":467.04,"body":"gonna keep me occupied, which I"},{"speaker":"Charles Goldfarb","startTime":464.58,"endTime":467.04,"body":"guess is good."},{"speaker":"Chris Dy","startTime":468.99,"endTime":471.63,"body":"15 plus hours, or 15"},{"speaker":"Chris Dy","startTime":468.99,"endTime":471.63,"body":"hours for you is probably the"},{"speaker":"Chris Dy","startTime":471.63,"endTime":475.41,"body":"assignments 15 hours for you."},{"speaker":"Chris Dy","startTime":471.63,"endTime":475.41,"body":"That's probably what, six hours"},{"speaker":"Chris Dy","startTime":475.41,"endTime":477.87,"body":"you know, between running two"},{"speaker":"Chris Dy","startTime":475.41,"endTime":477.87,"body":"rooms and having me"},{"speaker":"Charles Goldfarb","startTime":478.92,"endTime":482.61,"body":"It's funny, I"},{"speaker":"Charles Goldfarb","startTime":478.92,"endTime":482.61,"body":"don't know, I think an average"},{"speaker":"Charles Goldfarb","startTime":482.61,"endTime":485.4,"body":"accounting students. So it'll be"},{"speaker":"Charles Goldfarb","startTime":482.61,"endTime":485.4,"body":"really interesting to see,"},{"speaker":"Chris Dy","startTime":485.46,"endTime":487.74,"body":"I don't think you've"},{"speaker":"Chris Dy","startTime":485.46,"endTime":487.74,"body":"ever been average in any Chuck's"},{"speaker":"Chris Dy","startTime":488.1,"endTime":489.51,"body":"for a while here,"},{"speaker":"Charles Goldfarb","startTime":489.54,"endTime":492.12,"body":"here's one for"},{"speaker":"Charles Goldfarb","startTime":489.54,"endTime":492.12,"body":"you. And I've been given advice"},{"speaker":"Charles Goldfarb","startTime":492.18,"endTime":496.26,"body":"on this. So for this particular"},{"speaker":"Charles Goldfarb","startTime":492.18,"endTime":496.26,"body":"test, there's part of the test,"},{"speaker":"Charles Goldfarb","startTime":496.26,"endTime":499.26,"body":"which is to go for a pass this"},{"speaker":"Charles Goldfarb","startTime":496.26,"endTime":499.26,"body":"pass fail, which is the right"},{"speaker":"Charles Goldfarb","startTime":499.29,"endTime":504.81,"body":"way it should be pass fail. So"},{"speaker":"Charles Goldfarb","startTime":499.29,"endTime":504.81,"body":"you can do 80% of the test and"},{"speaker":"Charles Goldfarb","startTime":504.81,"endTime":509.91,"body":"get a pass. Or you can go for a"},{"speaker":"Charles Goldfarb","startTime":504.81,"endTime":509.91,"body":"high pass. There's no honors or"},{"speaker":"Charles Goldfarb","startTime":509.91,"endTime":513.42,"body":"anything. So it's just pass,"},{"speaker":"Charles Goldfarb","startTime":509.91,"endTime":513.42,"body":"high pass low pass, you can go"},{"speaker":"Charles Goldfarb","startTime":513.42,"endTime":517.2,"body":"for a high pass and do"},{"speaker":"Charles Goldfarb","startTime":513.42,"endTime":517.2,"body":"significantly more work another"},{"speaker":"Charles Goldfarb","startTime":517.2,"endTime":521.16,"body":"five to 10 hours. And"},{"speaker":"Charles Goldfarb","startTime":517.2,"endTime":521.16,"body":"intrinsically, I'm like, of"},{"speaker":"Charles Goldfarb","startTime":521.16,"endTime":525.78,"body":"course, of course, I'm gonna go"},{"speaker":"Charles Goldfarb","startTime":521.16,"endTime":525.78,"body":"for the high pass. And the"},{"speaker":"Charles Goldfarb","startTime":525.78,"endTime":531.18,"body":"practicality is need to modulate"},{"speaker":"Charles Goldfarb","startTime":525.78,"endTime":531.18,"body":"reality. And I don't think I can"},{"speaker":"Charles Goldfarb","startTime":531.18,"endTime":534.42,"body":"do it. I'm still toying with it,"},{"speaker":"Charles Goldfarb","startTime":531.18,"endTime":534.42,"body":"because it feels wrong not to."},{"speaker":"Charles Goldfarb","startTime":535.08,"endTime":538.86,"body":"But that's really interesting."},{"speaker":"Charles Goldfarb","startTime":535.08,"endTime":538.86,"body":"Like, it's kind of it's not who"},{"speaker":"Charles Goldfarb","startTime":538.86,"endTime":540.33,"body":"I am. Well,"},{"speaker":"Chris Dy","startTime":540.33,"endTime":541.86,"body":"I don't know, if it's"},{"speaker":"Chris Dy","startTime":540.33,"endTime":541.86,"body":"one of those things where you"},{"speaker":"Chris Dy","startTime":541.86,"endTime":544.8,"body":"know, the the people who get who"},{"speaker":"Chris Dy","startTime":541.86,"endTime":544.8,"body":"get the high pass, maybe their"},{"speaker":"Chris Dy","startTime":544.8,"endTime":547.71,"body":"names get passed on to other"},{"speaker":"Chris Dy","startTime":544.8,"endTime":547.71,"body":"employer, you know, like, if you"},{"speaker":"Chris Dy","startTime":547.71,"endTime":550.83,"body":"were maybe not somebody who was"},{"speaker":"Chris Dy","startTime":547.71,"endTime":550.83,"body":"in the position you're in, and"},{"speaker":"Chris Dy","startTime":550.83,"endTime":554.64,"body":"it might matter, like, you know,"},{"speaker":"Chris Dy","startTime":550.83,"endTime":554.64,"body":"but I guess P equals m, but at"},{"speaker":"Chris Dy","startTime":554.64,"endTime":556.41,"body":"the end of the day, right?"},{"speaker":"Chris Dy","startTime":554.64,"endTime":556.41,"body":"That's"},{"speaker":"Charles Goldfarb","startTime":556.41,"endTime":559.14,"body":"true. But as"},{"speaker":"Charles Goldfarb","startTime":556.41,"endTime":559.14,"body":"you know, I've talked about it"},{"speaker":"Charles Goldfarb","startTime":559.14,"endTime":563.07,"body":"and I know you're not suggesting"},{"speaker":"Charles Goldfarb","startTime":559.14,"endTime":563.07,"body":"otherwise it is. It's not just"},{"speaker":"Charles Goldfarb","startTime":563.07,"endTime":565.92,"body":"about the letters right, I am"},{"speaker":"Charles Goldfarb","startTime":563.07,"endTime":565.92,"body":"doing this because I am super"},{"speaker":"Charles Goldfarb","startTime":565.92,"endTime":568.59,"body":"interested in there's no doubt"},{"speaker":"Charles Goldfarb","startTime":565.92,"endTime":568.59,"body":"that the exercise of doing the"},{"speaker":"Charles Goldfarb","startTime":568.59,"endTime":572.22,"body":"work makes you better. And then"},{"speaker":"Charles Goldfarb","startTime":568.59,"endTime":572.22,"body":"there's the cognitive"},{"speaker":"Charles Goldfarb","startTime":572.22,"endTime":574.14,"body":"dissonance. I think that's the"},{"speaker":"Charles Goldfarb","startTime":572.22,"endTime":574.14,"body":"right expression in which I'm"},{"speaker":"Charles Goldfarb","startTime":574.14,"endTime":577.83,"body":"feeling by even thinking about"},{"speaker":"Charles Goldfarb","startTime":574.14,"endTime":577.83,"body":"not doing it and judge me if you"},{"speaker":"Charles Goldfarb","startTime":577.83,"endTime":580.68,"body":"will, listeners that's that's"},{"speaker":"Charles Goldfarb","startTime":577.83,"endTime":580.68,"body":"just reality. But"},{"speaker":"Chris Dy","startTime":580.68,"endTime":583.71,"body":"I guess we'll check in"},{"speaker":"Chris Dy","startTime":580.68,"endTime":583.71,"body":"and see which one you got. Which"},{"speaker":"Chris Dy","startTime":583.71,"endTime":587.52,"body":"assignment you completed. Before"},{"speaker":"Chris Dy","startTime":583.71,"endTime":587.52,"body":"we were gonna do with details"},{"speaker":"Chris Dy","startTime":587.52,"endTime":589.65,"body":"episode today about a topic that"},{"speaker":"Chris Dy","startTime":587.52,"endTime":589.65,"body":"I think a lot of people have"},{"speaker":"Chris Dy","startTime":589.65,"endTime":591.9,"body":"encountered. But before we do"},{"speaker":"Chris Dy","startTime":589.65,"endTime":591.9,"body":"that, why don't we jump in and"},{"speaker":"Chris Dy","startTime":591.9,"endTime":593.97,"body":"thank our sponsors at practice,"},{"speaker":"Chris Dy","startTime":591.9,"endTime":593.97,"body":"like"},{"speaker":"Charles Goldfarb","startTime":594.33,"endTime":596.88,"body":"the upper hand"},{"speaker":"Charles Goldfarb","startTime":594.33,"endTime":596.88,"body":"is sponsored by practicelink.com"},{"speaker":"Charles Goldfarb","startTime":596.91,"endTime":600.06,"body":"The most widely used position"},{"speaker":"Charles Goldfarb","startTime":596.91,"endTime":600.06,"body":"job search and career advice"},{"speaker":"Charles Goldfarb","startTime":600.06,"endTime":601.86,"body":"estimate resource. Becoming"},{"speaker":"Chris Dy","startTime":601.86,"endTime":604.05,"body":"a physician is hard"},{"speaker":"Chris Dy","startTime":601.86,"endTime":604.05,"body":"finding the right job doesn't"},{"speaker":"Chris Dy","startTime":604.05,"endTime":606.69,"body":"have to be joined practice link"},{"speaker":"Chris Dy","startTime":604.05,"endTime":606.69,"body":"for free today at"},{"speaker":"Chris Dy","startTime":609.69,"endTime":610.71,"body":"www.practicelink.com/theupperhand."},{"speaker":"Charles Goldfarb","startTime":611.37,"endTime":614.76,"body":"All right, I"},{"speaker":"Charles Goldfarb","startTime":611.37,"endTime":614.76,"body":"think we have a great case to"},{"speaker":"Charles Goldfarb","startTime":614.76,"endTime":615.57,"body":"discuss"},{"speaker":"Chris Dy","startTime":615.75,"endTime":617.61,"body":"Well, yeah, no, I"},{"speaker":"Chris Dy","startTime":615.75,"endTime":617.61,"body":"think the case is good because"},{"speaker":"Chris Dy","startTime":617.61,"endTime":619.89,"body":"it leads into a pretty good"},{"speaker":"Chris Dy","startTime":617.61,"endTime":619.89,"body":"details type episode. I know"},{"speaker":"Chris Dy","startTime":619.89,"endTime":623.67,"body":"that when I, when we saw people"},{"speaker":"Chris Dy","startTime":619.89,"endTime":623.67,"body":"in Toronto, people have asked"},{"speaker":"Chris Dy","startTime":623.67,"endTime":625.77,"body":"for more kind of technical"},{"speaker":"Chris Dy","startTime":623.67,"endTime":625.77,"body":"detail episodes, and I think"},{"speaker":"Chris Dy","startTime":625.77,"endTime":629.73,"body":"this one is chock full of them."},{"speaker":"Chris Dy","startTime":625.77,"endTime":629.73,"body":"So this is somebody who's, you"},{"speaker":"Chris Dy","startTime":629.73,"endTime":633.99,"body":"know, somebody who is in their"},{"speaker":"Chris Dy","startTime":629.73,"endTime":633.99,"body":"kind of, let's say, 30s, or 40s,"},{"speaker":"Chris Dy","startTime":634.5,"endTime":639.57,"body":"had a very large piece of glass,"},{"speaker":"Chris Dy","startTime":634.5,"endTime":639.57,"body":"you know, come down on their"},{"speaker":"Chris Dy","startTime":639.57,"endTime":643.5,"body":"forearm, and you've got a"},{"speaker":"Chris Dy","startTime":639.57,"endTime":643.5,"body":"laceration that's five"},{"speaker":"Chris Dy","startTime":643.5,"endTime":647.85,"body":"centimeters proximal to the"},{"speaker":"Chris Dy","startTime":643.5,"endTime":647.85,"body":"wrist crease, transverse stays"},{"speaker":"Chris Dy","startTime":647.85,"endTime":651.36,"body":"on the volar side doesn't go"},{"speaker":"Chris Dy","startTime":647.85,"endTime":651.36,"body":"anything dorsally no fracture"},{"speaker":"Chris Dy","startTime":651.36,"endTime":656.1,"body":"remarkably on X ray, and"},{"speaker":"Chris Dy","startTime":651.36,"endTime":656.1,"body":"lacerated everything and the"},{"speaker":"Chris Dy","startTime":656.1,"endTime":659.55,"body":"volar aspect of the forearm,"},{"speaker":"Chris Dy","startTime":656.1,"endTime":659.55,"body":"every tendon, including the"},{"speaker":"Chris Dy","startTime":659.55,"endTime":664.05,"body":"palmaris, which was present. And"},{"speaker":"Chris Dy","startTime":659.55,"endTime":664.05,"body":"then, you know, for the purposes"},{"speaker":"Chris Dy","startTime":664.05,"endTime":667.11,"body":"of this case, you know, it was"},{"speaker":"Chris Dy","startTime":664.05,"endTime":667.11,"body":"patient actually had a"},{"speaker":"Chris Dy","startTime":667.11,"endTime":672.03,"body":"revascularisation at an outside"},{"speaker":"Chris Dy","startTime":667.11,"endTime":672.03,"body":"facility, and then ended up with"},{"speaker":"Chris Dy","startTime":672.03,"endTime":676.65,"body":"me. So that's one wrinkle we"},{"speaker":"Chris Dy","startTime":672.03,"endTime":676.65,"body":"could talk about. But, you know,"},{"speaker":"Chris Dy","startTime":676.65,"endTime":679.47,"body":"fortunately the fingers are"},{"speaker":"Chris Dy","startTime":676.65,"endTime":679.47,"body":"perfused has a good attitude,"},{"speaker":"Chris Dy","startTime":679.53,"endTime":683.31,"body":"good support. How do you kind of"},{"speaker":"Chris Dy","startTime":679.53,"endTime":683.31,"body":"think about this? Well, we call"},{"speaker":"Chris Dy","startTime":683.31,"endTime":685.92,"body":"it America spaghetti wrist and"},{"speaker":"Chris Dy","startTime":683.31,"endTime":685.92,"body":"when I'm told you call an India,"},{"speaker":"Chris Dy","startTime":685.92,"endTime":689.73,"body":"a full house, from my experience"},{"speaker":"Chris Dy","startTime":685.92,"endTime":689.73,"body":"there. How do you think about"},{"speaker":"Chris Dy","startTime":689.73,"endTime":692.52,"body":"this injury as you see this"},{"speaker":"Chris Dy","startTime":689.73,"endTime":692.52,"body":"patient either if you were to"},{"speaker":"Chris Dy","startTime":692.55,"endTime":694.95,"body":"get called from the ER or"},{"speaker":"Chris Dy","startTime":692.55,"endTime":694.95,"body":"whether it's, you know, this"},{"speaker":"Chris Dy","startTime":694.95,"endTime":697.5,"body":"patient never comes to the"},{"speaker":"Chris Dy","startTime":694.95,"endTime":697.5,"body":"office, but this time actually"},{"speaker":"Chris Dy","startTime":697.5,"endTime":699.06,"body":"came to the office? Yeah,"},{"speaker":"Charles Goldfarb","startTime":699.09,"endTime":701.917,"body":"well, that was"},{"speaker":"Charles Goldfarb","startTime":699.09,"endTime":701.917,"body":"gonna be my first point is I"},{"speaker":"Charles Goldfarb","startTime":701.983,"endTime":705.402,"body":"It's interesting what"},{"speaker":"Charles Goldfarb","startTime":701.983,"endTime":705.402,"body":"occasionally, we do electively"},{"speaker":"Charles Goldfarb","startTime":705.468,"endTime":709.282,"body":"but the vast, vast majority of"},{"speaker":"Charles Goldfarb","startTime":705.468,"endTime":709.282,"body":"the time is not an elective"},{"speaker":"Charles Goldfarb","startTime":709.347,"endTime":712.964,"body":"procedure. And this one"},{"speaker":"Charles Goldfarb","startTime":709.347,"endTime":712.964,"body":"certainly fits that category. I"},{"speaker":"Charles Goldfarb","startTime":713.03,"endTime":717.106,"body":"recently did a pair illuminate"},{"speaker":"Charles Goldfarb","startTime":713.03,"endTime":717.106,"body":"electively that was reduced and"},{"speaker":"Charles Goldfarb","startTime":717.172,"endTime":720.986,"body":"an outside hospital came to see"},{"speaker":"Charles Goldfarb","startTime":717.172,"endTime":720.986,"body":"me like 10 days later. And"},{"speaker":"Charles Goldfarb","startTime":721.052,"endTime":724.997,"body":"that's that obviously is done"},{"speaker":"Charles Goldfarb","startTime":721.052,"endTime":724.997,"body":"electively if the reduction is"},{"speaker":"Charles Goldfarb","startTime":725.063,"endTime":726.51,"body":"accomplished in the ED"},{"speaker":"Chris Dy","startTime":726.51,"endTime":727.59,"body":"did it stay reduced,"},{"speaker":"Charles Goldfarb","startTime":727.59,"endTime":729.658,"body":"it stayed"},{"speaker":"Charles Goldfarb","startTime":727.59,"endTime":729.658,"body":"reduced. Yeah, well, they"},{"speaker":"Charles Goldfarb","startTime":729.717,"endTime":733.38,"body":"reduced it actually, what was"},{"speaker":"Charles Goldfarb","startTime":729.717,"endTime":733.38,"body":"interesting about that case, not"},{"speaker":"Charles Goldfarb","startTime":733.439,"endTime":737.043,"body":"to go on a tangent. But what's"},{"speaker":"Charles Goldfarb","startTime":733.439,"endTime":737.043,"body":"interesting about that case is"},{"speaker":"Charles Goldfarb","startTime":737.102,"endTime":740.943,"body":"it was more so I got to it about"},{"speaker":"Charles Goldfarb","startTime":737.102,"endTime":740.943,"body":"two, two and a half weeks later,"},{"speaker":"Charles Goldfarb","startTime":741.002,"endTime":744.666,"body":"it was challenging to get this"},{"speaker":"Charles Goldfarb","startTime":741.002,"endTime":744.666,"body":"case limited reduction, where I"},{"speaker":"Charles Goldfarb","startTime":744.725,"endTime":748.211,"body":"wanted, it wasn't a simple"},{"speaker":"Charles Goldfarb","startTime":744.725,"endTime":748.211,"body":"maneuver. So that felt like more"},{"speaker":"Charles Goldfarb","startTime":748.27,"endTime":751.933,"body":"work than I would typically have"},{"speaker":"Charles Goldfarb","startTime":748.27,"endTime":751.933,"body":"seen. But otherwise, look, it"},{"speaker":"Charles Goldfarb","startTime":751.992,"endTime":755.833,"body":"was nice doing it electively for"},{"speaker":"Charles Goldfarb","startTime":751.992,"endTime":755.833,"body":"sure. So this is fascinating. So"},{"speaker":"Charles Goldfarb","startTime":755.892,"endTime":759.437,"body":"it sounds like probably not a"},{"speaker":"Charles Goldfarb","startTime":755.892,"endTime":759.437,"body":"hand surgeon, maybe a vascular"},{"speaker":"Charles Goldfarb","startTime":759.496,"endTime":763.101,"body":"surgeon at a smaller emergency"},{"speaker":"Charles Goldfarb","startTime":759.496,"endTime":763.101,"body":"department may have taken care"},{"speaker":"Charles Goldfarb","startTime":763.16,"endTime":766.882,"body":"of this and done the revamp, ask"},{"speaker":"Charles Goldfarb","startTime":763.16,"endTime":766.882,"body":"and that brings a whole nother"},{"speaker":"Charles Goldfarb","startTime":766.941,"endTime":770.605,"body":"bag of worms, I guess because"},{"speaker":"Charles Goldfarb","startTime":766.941,"endTime":770.605,"body":"you really have to make sure you"},{"speaker":"Charles Goldfarb","startTime":770.664,"endTime":774.327,"body":"take care of that. Obviously,"},{"speaker":"Charles Goldfarb","startTime":770.664,"endTime":774.327,"body":"you're going to but but that has"},{"speaker":"Charles Goldfarb","startTime":774.386,"endTime":778.05,"body":"to be priority number one, not"},{"speaker":"Charles Goldfarb","startTime":774.386,"endTime":778.05,"body":"that you can't redo the repair."},{"speaker":"Charles Goldfarb","startTime":778.109,"endTime":780.059,"body":"But, but that's really important."},{"speaker":"Chris Dy","startTime":780.659,"endTime":783.119,"body":"Yeah, so you know,"},{"speaker":"Chris Dy","startTime":780.659,"endTime":783.119,"body":"this patient had"},{"speaker":"Chris Dy","startTime":783.539,"endTime":787.769,"body":"revascularisation, radial and"},{"speaker":"Chris Dy","startTime":783.539,"endTime":787.769,"body":"ulnar arteries, both with"},{"speaker":"Chris Dy","startTime":787.769,"endTime":793.799,"body":"interpose saphenous vein graft,"},{"speaker":"Chris Dy","startTime":787.769,"endTime":793.799,"body":"and it looked great. Certainly"},{"speaker":"Chris Dy","startTime":793.799,"endTime":798.659,"body":"was more stressful to dance"},{"speaker":"Chris Dy","startTime":793.799,"endTime":798.659,"body":"around that. And I opted to not"},{"speaker":"Chris Dy","startTime":798.659,"endTime":801.899,"body":"use a tourniquet just out of an"},{"speaker":"Chris Dy","startTime":798.659,"endTime":801.899,"body":"abundance of caution, which"},{"speaker":"Chris Dy","startTime":801.899,"endTime":805.499,"body":"added another element to this"},{"speaker":"Chris Dy","startTime":801.899,"endTime":805.499,"body":"case. You know, so if that was"},{"speaker":"Chris Dy","startTime":805.499,"endTime":808.919,"body":"not in the picture, say this"},{"speaker":"Chris Dy","startTime":805.499,"endTime":808.919,"body":"hand, it was, you know, say the"},{"speaker":"Chris Dy","startTime":808.919,"endTime":812.609,"body":"hand is vascularized. Your"},{"speaker":"Chris Dy","startTime":808.919,"endTime":812.609,"body":"fingers look good in terms of"},{"speaker":"Chris Dy","startTime":813.209,"endTime":817.349,"body":"their pink, they refill? Well,"},{"speaker":"Chris Dy","startTime":813.209,"endTime":817.349,"body":"what's your timing on this is if"},{"speaker":"Chris Dy","startTime":817.349,"endTime":820.709,"body":"this is an ER, and the hand is"},{"speaker":"Chris Dy","startTime":817.349,"endTime":820.709,"body":"perfused, maybe one arteries"},{"speaker":"Chris Dy","startTime":820.709,"endTime":825.089,"body":"out? Maybe the radials out the"},{"speaker":"Chris Dy","startTime":820.709,"endTime":825.089,"body":"owners it or vice versa? Is this"},{"speaker":"Chris Dy","startTime":825.119,"endTime":827.159,"body":"something that you're just"},{"speaker":"Chris Dy","startTime":825.119,"endTime":827.159,"body":"taking right away to the ER? Are"},{"speaker":"Chris Dy","startTime":827.159,"endTime":828.869,"body":"you waiting until your next"},{"speaker":"Chris Dy","startTime":827.159,"endTime":828.869,"body":"elective day?"},{"speaker":"Charles Goldfarb","startTime":829.56,"endTime":831.9,"body":"So really"},{"speaker":"Charles Goldfarb","startTime":829.56,"endTime":831.9,"body":"interesting. So first of all, I"},{"speaker":"Charles Goldfarb","startTime":831.9,"endTime":835.65,"body":"would say I don't recall the"},{"speaker":"Charles Goldfarb","startTime":831.9,"endTime":835.65,"body":"last time I had a spaghetti"},{"speaker":"Charles Goldfarb","startTime":835.65,"endTime":841.02,"body":"wrist or a full house, I love"},{"speaker":"Charles Goldfarb","startTime":835.65,"endTime":841.02,"body":"that. That was complete, meaning"},{"speaker":"Charles Goldfarb","startTime":841.11,"endTime":846.78,"body":"everything vole early, and far"},{"speaker":"Charles Goldfarb","startTime":841.11,"endTime":846.78,"body":"more commonly it is one of the"},{"speaker":"Charles Goldfarb","startTime":846.78,"endTime":851.07,"body":"vessels is intact. And so if one"},{"speaker":"Charles Goldfarb","startTime":846.78,"endTime":851.07,"body":"of the vessels is intact, and"},{"speaker":"Charles Goldfarb","startTime":851.07,"endTime":855.57,"body":"it's a clean knife, or glass"},{"speaker":"Charles Goldfarb","startTime":851.07,"endTime":855.57,"body":"type cut, I typically will"},{"speaker":"Charles Goldfarb","startTime":855.57,"endTime":859.08,"body":"repair the other vessel. But I"},{"speaker":"Charles Goldfarb","startTime":855.57,"endTime":859.08,"body":"certainly don't think is"},{"speaker":"Charles Goldfarb","startTime":859.08,"endTime":863.76,"body":"mandatory if there's there's"},{"speaker":"Charles Goldfarb","startTime":859.08,"endTime":863.76,"body":"good capillary refill. I think"},{"speaker":"Charles Goldfarb","startTime":863.76,"endTime":869.13,"body":"that was to your to your point."},{"speaker":"Charles Goldfarb","startTime":863.76,"endTime":869.13,"body":"And timing. I have always done"},{"speaker":"Charles Goldfarb","startTime":869.13,"endTime":874.38,"body":"these acutely, either that night"},{"speaker":"Charles Goldfarb","startTime":869.13,"endTime":874.38,"body":"or the next day. But there's no"},{"speaker":"Charles Goldfarb","startTime":874.38,"endTime":876.27,"body":"reason it needs to be acute. I"},{"speaker":"Charles Goldfarb","startTime":874.38,"endTime":876.27,"body":"mean, you don't want the most"},{"speaker":"Charles Goldfarb","startTime":876.3,"endTime":877.92,"body":"you don't want to wait three"},{"speaker":"Charles Goldfarb","startTime":876.3,"endTime":877.92,"body":"weeks I don't think because you"},{"speaker":"Charles Goldfarb","startTime":877.92,"endTime":880.71,"body":"don't want too much retraction."},{"speaker":"Charles Goldfarb","startTime":877.92,"endTime":880.71,"body":"You know, it's interesting I was"},{"speaker":"Charles Goldfarb","startTime":880.71,"endTime":882.66,"body":"as you were talking I was"},{"speaker":"Charles Goldfarb","startTime":880.71,"endTime":882.66,"body":"thinking you know, where do"},{"speaker":"Charles Goldfarb","startTime":882.66,"endTime":885.96,"body":"these happen like where proximal"},{"speaker":"Charles Goldfarb","startTime":882.66,"endTime":885.96,"body":"distal wise to these happen?"},{"speaker":"Charles Goldfarb","startTime":886.44,"endTime":890.04,"body":"They they happen in a relatively"},{"speaker":"Charles Goldfarb","startTime":886.44,"endTime":890.04,"body":"narrow range and I guess it's"},{"speaker":"Charles Goldfarb","startTime":890.04,"endTime":893.67,"body":"just the the nature of our"},{"speaker":"Charles Goldfarb","startTime":890.04,"endTime":893.67,"body":"anatomy and the our"},{"speaker":"Charles Goldfarb","startTime":893.67,"endTime":896.73,"body":"susceptibility of trauma. But"},{"speaker":"Charles Goldfarb","startTime":893.67,"endTime":896.73,"body":"yeah, they're happening sort of"},{"speaker":"Charles Goldfarb","startTime":896.73,"endTime":900.75,"body":"and I'm for those on YouTube."},{"speaker":"Charles Goldfarb","startTime":896.73,"endTime":900.75,"body":"You can see But it's kind of"},{"speaker":"Charles Goldfarb","startTime":900.75,"endTime":903.81,"body":"distal one quarter from the"},{"speaker":"Charles Goldfarb","startTime":900.75,"endTime":903.81,"body":"wrist crease a little"},{"speaker":"Charles Goldfarb","startTime":903.81,"endTime":906.51,"body":"approximately, you know, maybe"},{"speaker":"Charles Goldfarb","startTime":903.81,"endTime":906.51,"body":"three or four centimeters."},{"speaker":"Charles Goldfarb","startTime":906.51,"endTime":908.4,"body":"That's where they all happen in"},{"speaker":"Charles Goldfarb","startTime":906.51,"endTime":908.4,"body":"my experience."},{"speaker":"Chris Dy","startTime":909.15,"endTime":910.68,"body":"Right? Yeah, I mean,"},{"speaker":"Chris Dy","startTime":909.15,"endTime":910.68,"body":"because at that point, that's"},{"speaker":"Chris Dy","startTime":910.68,"endTime":912.78,"body":"when you're dealing with actual"},{"speaker":"Chris Dy","startTime":910.68,"endTime":912.78,"body":"tendons, right? Like you get a"},{"speaker":"Chris Dy","startTime":912.78,"endTime":914.79,"body":"little more proximal, that"},{"speaker":"Chris Dy","startTime":912.78,"endTime":914.79,"body":"you're dealing with musculo"},{"speaker":"Chris Dy","startTime":915.33,"endTime":917.97,"body":"musculotendinous junction or"},{"speaker":"Chris Dy","startTime":915.33,"endTime":917.97,"body":"actual muscle injuries, which,"},{"speaker":"Chris Dy","startTime":918.45,"endTime":921.03,"body":"for some reason, don't ever end"},{"speaker":"Chris Dy","startTime":918.45,"endTime":921.03,"body":"up either happening there don't"},{"speaker":"Chris Dy","startTime":921.03,"endTime":925.86,"body":"end up being as complete, so to"},{"speaker":"Chris Dy","startTime":921.03,"endTime":925.86,"body":"say. So yeah, no, I agree with"},{"speaker":"Chris Dy","startTime":925.86,"endTime":927.81,"body":"you. For some reason, they all"},{"speaker":"Chris Dy","startTime":925.86,"endTime":927.81,"body":"end up being in this kind of"},{"speaker":"Chris Dy","startTime":927.81,"endTime":931.32,"body":"distal quarter of the of the"},{"speaker":"Chris Dy","startTime":927.81,"endTime":931.32,"body":"form. And yeah, and I can't"},{"speaker":"Chris Dy","startTime":931.32,"endTime":934.08,"body":"remember the last time I"},{"speaker":"Chris Dy","startTime":931.32,"endTime":934.08,"body":"actually had everything out, you"},{"speaker":"Chris Dy","startTime":934.08,"endTime":935.25,"body":"know, as it was, in this case,"},{"speaker":"Charles Goldfarb","startTime":935.73,"endTime":940.8,"body":"it is since"},{"speaker":"Charles Goldfarb","startTime":935.73,"endTime":940.8,"body":"why vein grafts were chosen. I"},{"speaker":"Charles Goldfarb","startTime":940.8,"endTime":945.99,"body":"don't think that would be my"},{"speaker":"Charles Goldfarb","startTime":940.8,"endTime":945.99,"body":"initial, you know, plan unless I"},{"speaker":"Charles Goldfarb","startTime":945.99,"endTime":949.41,"body":"encountered difficulties with"},{"speaker":"Charles Goldfarb","startTime":945.99,"endTime":949.41,"body":"vessel we approximation. Yeah,"},{"speaker":"Chris Dy","startTime":949.409,"endTime":951.329,"body":"I mean, looking at the"},{"speaker":"Chris Dy","startTime":949.409,"endTime":951.329,"body":"you know, I guess we'll get into"},{"speaker":"Chris Dy","startTime":951.329,"endTime":954.719,"body":"the details. But looking at all"},{"speaker":"Chris Dy","startTime":951.329,"endTime":954.719,"body":"this, this is the case where if"},{"speaker":"Chris Dy","startTime":954.719,"endTime":957.329,"body":"I was feeling a little gutsy, I"},{"speaker":"Chris Dy","startTime":954.719,"endTime":957.329,"body":"probably might have been able to"},{"speaker":"Chris Dy","startTime":957.329,"endTime":961.559,"body":"primarily repair the nerves. But"},{"speaker":"Chris Dy","startTime":957.329,"endTime":961.559,"body":"Adam an abundance of caution in"},{"speaker":"Chris Dy","startTime":961.559,"endTime":964.379,"body":"the fact that the other"},{"speaker":"Chris Dy","startTime":961.559,"endTime":964.379,"body":"considerations for rehab, I"},{"speaker":"Chris Dy","startTime":964.379,"endTime":969.419,"body":"ended up using nerve autograft."},{"speaker":"Chris Dy","startTime":964.379,"endTime":969.419,"body":"But I think he did us whoever"},{"speaker":"Chris Dy","startTime":969.419,"endTime":973.799,"body":"the surgeon was, they did us a"},{"speaker":"Chris Dy","startTime":969.419,"endTime":973.799,"body":"favor, by making sure that there"},{"speaker":"Chris Dy","startTime":973.799,"endTime":976.889,"body":"was some redundancy in their"},{"speaker":"Chris Dy","startTime":973.799,"endTime":976.889,"body":"vascular reconstruction. Because"},{"speaker":"Chris Dy","startTime":976.889,"endTime":979.469,"body":"perhaps if they had, you know,"},{"speaker":"Chris Dy","startTime":976.889,"endTime":979.469,"body":"really mobilized everything and"},{"speaker":"Chris Dy","startTime":979.469,"endTime":982.229,"body":"got those the arteries together,"},{"speaker":"Chris Dy","startTime":979.469,"endTime":982.229,"body":"but they were a little tight"},{"speaker":"Chris Dy","startTime":982.229,"endTime":984.209,"body":"that might have limited what I"},{"speaker":"Chris Dy","startTime":982.229,"endTime":984.209,"body":"could have done in terms of"},{"speaker":"Chris Dy","startTime":984.209,"endTime":987.629,"body":"motion afterwards. And I'm not"},{"speaker":"Chris Dy","startTime":984.209,"endTime":987.629,"body":"sure what the decision making"},{"speaker":"Chris Dy","startTime":987.629,"endTime":990.569,"body":"process was, I don't know if I,"},{"speaker":"Chris Dy","startTime":987.629,"endTime":990.569,"body":"I guess I would have thought to"},{"speaker":"Chris Dy","startTime":990.569,"endTime":994.949,"body":"prep the leg for for Searl. But"},{"speaker":"Chris Dy","startTime":990.569,"endTime":994.949,"body":"I again, it wouldn't have been"},{"speaker":"Chris Dy","startTime":994.949,"endTime":998.159,"body":"my thought to prep the leg for"},{"speaker":"Chris Dy","startTime":994.949,"endTime":998.159,"body":"saphenous. Like in the thigh"},{"speaker":"Chris Dy","startTime":998.159,"endTime":998.909,"body":"saphenous."},{"speaker":"Charles Goldfarb","startTime":999.24,"endTime":1001.7,"body":"Right, right."},{"speaker":"Charles Goldfarb","startTime":999.24,"endTime":1001.7,"body":"Right. What about how did you"},{"speaker":"Charles Goldfarb","startTime":1001.7,"endTime":1005.84,"body":"decide where to do it? Would you"},{"speaker":"Charles Goldfarb","startTime":1001.7,"endTime":1005.84,"body":"have done this as an outpatient?"},{"speaker":"Charles Goldfarb","startTime":1005.84,"endTime":1008.45,"body":"Did you feel like you had to be"},{"speaker":"Charles Goldfarb","startTime":1005.84,"endTime":1008.45,"body":"in the hospital or outpatient"},{"speaker":"Charles Goldfarb","startTime":1008.45,"endTime":1011.63,"body":"with microscope availability?"},{"speaker":"Charles Goldfarb","startTime":1008.45,"endTime":1011.63,"body":"What's your thought for"},{"speaker":"Charles Goldfarb","startTime":1011.69,"endTime":1012.62,"body":"spaghetti wrist?"},{"speaker":"Chris Dy","startTime":1013.16,"endTime":1016.28,"body":"So, for me, it's just"},{"speaker":"Chris Dy","startTime":1013.16,"endTime":1016.28,"body":"microscope availability, I think"},{"speaker":"Chris Dy","startTime":1016.28,"endTime":1019.28,"body":"it's fine to do as an"},{"speaker":"Chris Dy","startTime":1016.28,"endTime":1019.28,"body":"outpatient. I think this never"},{"speaker":"Chris Dy","startTime":1019.28,"endTime":1021.62,"body":"comes up as an outpatient. I"},{"speaker":"Chris Dy","startTime":1019.28,"endTime":1021.62,"body":"think it's a unicorn that I saw"},{"speaker":"Chris Dy","startTime":1021.62,"endTime":1024.98,"body":"here. You know, I think there"},{"speaker":"Chris Dy","startTime":1021.62,"endTime":1024.98,"body":"was an expectation that the"},{"speaker":"Chris Dy","startTime":1024.98,"endTime":1028.58,"body":"patient had, that was kind of"},{"speaker":"Chris Dy","startTime":1024.98,"endTime":1028.58,"body":"relayed to them that there was"},{"speaker":"Chris Dy","startTime":1028.58,"endTime":1032.48,"body":"some urgency to this, which is"},{"speaker":"Chris Dy","startTime":1028.58,"endTime":1032.48,"body":"not wrong. But they were in fact"},{"speaker":"Chris Dy","startTime":1032.48,"endTime":1035.12,"body":"traveling from quite a distance."},{"speaker":"Chris Dy","startTime":1032.48,"endTime":1035.12,"body":"And we were able to pull"},{"speaker":"Chris Dy","startTime":1035.12,"endTime":1037.76,"body":"something off where we're able"},{"speaker":"Chris Dy","startTime":1035.12,"endTime":1037.76,"body":"to do it on an outpatient basis."},{"speaker":"Chris Dy","startTime":1038.72,"endTime":1041.96,"body":"But at a play at a facility that"},{"speaker":"Chris Dy","startTime":1038.72,"endTime":1041.96,"body":"had a microscope. To me, I think"},{"speaker":"Chris Dy","startTime":1041.96,"endTime":1045.08,"body":"I'm personally I would prefer"},{"speaker":"Chris Dy","startTime":1041.96,"endTime":1045.08,"body":"microscope, although I think"},{"speaker":"Chris Dy","startTime":1045.08,"endTime":1048.32,"body":"certainly this could be done"},{"speaker":"Chris Dy","startTime":1045.08,"endTime":1048.32,"body":"without one. You know, should"},{"speaker":"Chris Dy","startTime":1048.35,"endTime":1052.28,"body":"should you feel so inclined, in"},{"speaker":"Chris Dy","startTime":1048.35,"endTime":1052.28,"body":"terms of your magnification with"},{"speaker":"Chris Dy","startTime":1052.28,"endTime":1055.16,"body":"loops. But I do like this under"},{"speaker":"Chris Dy","startTime":1052.28,"endTime":1055.16,"body":"a microscope much better."},{"speaker":"Charles Goldfarb","startTime":1055.55,"endTime":1058.82,"body":"So two other"},{"speaker":"Charles Goldfarb","startTime":1055.55,"endTime":1058.82,"body":"questions. Number one, when you"},{"speaker":"Charles Goldfarb","startTime":1058.82,"endTime":1061.46,"body":"got to the operating room, how"},{"speaker":"Charles Goldfarb","startTime":1058.82,"endTime":1061.46,"body":"many days? Was it? postinjury?"},{"speaker":"Charles Goldfarb","startTime":1061.46,"endTime":1062.03,"body":"Roughly?"},{"speaker":"Chris Dy","startTime":1062.84,"endTime":1063.35,"body":"Six."},{"speaker":"Charles Goldfarb","startTime":1063.71,"endTime":1066.83,"body":"Okay. And then"},{"speaker":"Charles Goldfarb","startTime":1063.71,"endTime":1066.83,"body":"my second question is, What did"},{"speaker":"Charles Goldfarb","startTime":1066.83,"endTime":1072.74,"body":"you ask for? To have available?"},{"speaker":"Charles Goldfarb","startTime":1066.83,"endTime":1072.74,"body":"So you said microscope? And did"},{"speaker":"Charles Goldfarb","startTime":1072.74,"endTime":1075.47,"body":"you know before you went in that"},{"speaker":"Charles Goldfarb","startTime":1072.74,"endTime":1075.47,"body":"you are going to be doing a"},{"speaker":"Charles Goldfarb","startTime":1075.47,"endTime":1080.57,"body":"nerve graft? And how did you"},{"speaker":"Charles Goldfarb","startTime":1075.47,"endTime":1080.57,"body":"know that? And then the last"},{"speaker":"Charles Goldfarb","startTime":1080.57,"endTime":1082.58,"body":"question is, what type of suture"},{"speaker":"Charles Goldfarb","startTime":1080.57,"endTime":1082.58,"body":"Do you ask for in these"},{"speaker":"Charles Goldfarb","startTime":1082.58,"endTime":1083.27,"body":"situations?"},{"speaker":"Chris Dy","startTime":1083.78,"endTime":1085.31,"body":"Yeah, so my"},{"speaker":"Chris Dy","startTime":1083.78,"endTime":1085.31,"body":"inclination was that we're gonna"},{"speaker":"Chris Dy","startTime":1085.31,"endTime":1087.95,"body":"have to do an earth raft mainly"},{"speaker":"Chris Dy","startTime":1085.31,"endTime":1087.95,"body":"because we're, it's not, you"},{"speaker":"Chris Dy","startTime":1087.95,"endTime":1090.98,"body":"know, times zero, or, you know,"},{"speaker":"Chris Dy","startTime":1087.95,"endTime":1090.98,"body":"Day Zero Day One after the"},{"speaker":"Chris Dy","startTime":1090.98,"endTime":1094.1,"body":"injury. So, my sense was that"},{"speaker":"Chris Dy","startTime":1090.98,"endTime":1094.1,"body":"there probably was going to be"},{"speaker":"Chris Dy","startTime":1094.1,"endTime":1097.97,"body":"some retraction of the median"},{"speaker":"Chris Dy","startTime":1094.1,"endTime":1097.97,"body":"and ulnar nerves, which would"},{"speaker":"Chris Dy","startTime":1097.97,"endTime":1104.06,"body":"make it difficult to to get them"},{"speaker":"Chris Dy","startTime":1097.97,"endTime":1104.06,"body":"primarily repaired and collapsed"},{"speaker":"Chris Dy","startTime":1104.06,"endTime":1107.54,"body":"to the floor, I'd be comfortable"},{"speaker":"Chris Dy","startTime":1104.06,"endTime":1107.54,"body":"moving the fingers and having"},{"speaker":"Chris Dy","startTime":1107.54,"endTime":1110.81,"body":"something glide past the fingers"},{"speaker":"Chris Dy","startTime":1107.54,"endTime":1110.81,"body":"and thinking in the future, you"},{"speaker":"Chris Dy","startTime":1110.81,"endTime":1113.24,"body":"know, in the first six weeks"},{"speaker":"Chris Dy","startTime":1110.81,"endTime":1113.24,"body":"about wanting to get some tDCS"},{"speaker":"Chris Dy","startTime":1113.24,"endTime":1116.27,"body":"going for the fingers. Because I"},{"speaker":"Chris Dy","startTime":1113.24,"endTime":1116.27,"body":"didn't have any of the"},{"speaker":"Chris Dy","startTime":1116.3,"endTime":1119.42,"body":"components of this injury, the"},{"speaker":"Chris Dy","startTime":1116.3,"endTime":1119.42,"body":"fingers are probably the most"},{"speaker":"Chris Dy","startTime":1119.42,"endTime":1123.8,"body":"predictable ones. And although I"},{"speaker":"Chris Dy","startTime":1119.42,"endTime":1123.8,"body":"like to prioritize the nerve"},{"speaker":"Chris Dy","startTime":1123.8,"endTime":1127.13,"body":"stuff, just because of what I"},{"speaker":"Chris Dy","startTime":1123.8,"endTime":1127.13,"body":"do, the nerves still have more"},{"speaker":"Chris Dy","startTime":1127.13,"endTime":1131.57,"body":"guarded prognosis. And at the"},{"speaker":"Chris Dy","startTime":1127.13,"endTime":1131.57,"body":"very least, you don't want to"},{"speaker":"Chris Dy","startTime":1131.57,"endTime":1136.46,"body":"compromise what you do with your"},{"speaker":"Chris Dy","startTime":1131.57,"endTime":1136.46,"body":"fingers in order to don't want"},{"speaker":"Chris Dy","startTime":1136.46,"endTime":1138.71,"body":"to compromise the outcome I can"},{"speaker":"Chris Dy","startTime":1136.46,"endTime":1138.71,"body":"get with composite flexion from"},{"speaker":"Chris Dy","startTime":1138.71,"endTime":1141.38,"body":"the flexor tendons, because I'm"},{"speaker":"Chris Dy","startTime":1138.71,"endTime":1141.38,"body":"trying to protect the nerves,"},{"speaker":"Chris Dy","startTime":1141.83,"endTime":1145.61,"body":"because the nerves still are,"},{"speaker":"Chris Dy","startTime":1141.83,"endTime":1145.61,"body":"it's less consistent. I don't"},{"speaker":"Chris Dy","startTime":1145.61,"endTime":1147.92,"body":"know if that's a mouthful, and"},{"speaker":"Chris Dy","startTime":1145.61,"endTime":1147.92,"body":"there's a lot to unpack there."},{"speaker":"Chris Dy","startTime":1147.92,"endTime":1149.27,"body":"But that's at least how I think"},{"speaker":"Chris Dy","startTime":1147.92,"endTime":1149.27,"body":"about it."},{"speaker":"Charles Goldfarb","startTime":1149.9,"endTime":1153.41,"body":"So well, we"},{"speaker":"Charles Goldfarb","startTime":1149.9,"endTime":1153.41,"body":"can Well, we can jump into"},{"speaker":"Charles Goldfarb","startTime":1153.41,"endTime":1157.64,"body":"expectation. So for those who"},{"speaker":"Charles Goldfarb","startTime":1153.41,"endTime":1157.64,"body":"don't do a lot of tendon"},{"speaker":"Charles Goldfarb","startTime":1157.64,"endTime":1160.1,"body":"repairs, and certainly a therapy"},{"speaker":"Charles Goldfarb","startTime":1157.64,"endTime":1160.1,"body":"perspective here would be"},{"speaker":"Charles Goldfarb","startTime":1160.1,"endTime":1164.48,"body":"fascinating. You know, spaghetti"},{"speaker":"Charles Goldfarb","startTime":1160.1,"endTime":1164.48,"body":"wrist or while they can be at"},{"speaker":"Charles Goldfarb","startTime":1164.48,"endTime":1167.81,"body":"the wrong time of day, that is"},{"speaker":"Charles Goldfarb","startTime":1164.48,"endTime":1167.81,"body":"middle of the night, and it can"},{"speaker":"Charles Goldfarb","startTime":1167.81,"endTime":1170.51,"body":"take a while to do all the"},{"speaker":"Charles Goldfarb","startTime":1167.81,"endTime":1170.51,"body":"things that Chris is going to"},{"speaker":"Charles Goldfarb","startTime":1170.51,"endTime":1174.23,"body":"share with us. I think they do"},{"speaker":"Charles Goldfarb","startTime":1170.51,"endTime":1174.23,"body":"pretty well from a nerve. I'm"},{"speaker":"Charles Goldfarb","startTime":1174.23,"endTime":1178.28,"body":"sorry, from a tendon standpoint,"},{"speaker":"Charles Goldfarb","startTime":1174.23,"endTime":1178.28,"body":"what are we so meaning I would"},{"speaker":"Charles Goldfarb","startTime":1178.28,"endTime":1182.0,"body":"hope wrist and finger motion are"},{"speaker":"Charles Goldfarb","startTime":1178.28,"endTime":1182.0,"body":"are close to full, I wouldn't"},{"speaker":"Charles Goldfarb","startTime":1182.0,"endTime":1184.88,"body":"expect completely full there"},{"speaker":"Charles Goldfarb","startTime":1182.0,"endTime":1184.88,"body":"will be some strength issues."},{"speaker":"Charles Goldfarb","startTime":1185.33,"endTime":1188.66,"body":"Likely What's your expectation"},{"speaker":"Charles Goldfarb","startTime":1185.33,"endTime":1188.66,"body":"with your nerve repair? So you"},{"speaker":"Charles Goldfarb","startTime":1188.66,"endTime":1192.77,"body":"were you were going to address"},{"speaker":"Charles Goldfarb","startTime":1188.66,"endTime":1192.77,"body":"presumably the median nerve and"},{"speaker":"Charles Goldfarb","startTime":1192.77,"endTime":1195.95,"body":"the older nerve plus minus"},{"speaker":"Charles Goldfarb","startTime":1192.77,"endTime":1195.95,"body":"superficial branches radioulnar"},{"speaker":"Chris Dy","startTime":1196.76,"endTime":1199.13,"body":"right. So that's our"},{"speaker":"Chris Dy","startTime":1196.76,"endTime":1199.13,"body":"end is intact, which actually"},{"speaker":"Chris Dy","startTime":1199.31,"endTime":1202.58,"body":"plays into the ring construction"},{"speaker":"Chris Dy","startTime":1199.31,"endTime":1202.58,"body":"plan for me, which is a nice"},{"speaker":"Chris Dy","startTime":1202.58,"endTime":1206.51,"body":"thing. But Palmer cutaneous is"},{"speaker":"Chris Dy","startTime":1202.58,"endTime":1206.51,"body":"out of it was not visible"},{"speaker":"Chris Dy","startTime":1206.51,"endTime":1210.77,"body":"anywhere in the wound. And it's"},{"speaker":"Chris Dy","startTime":1206.51,"endTime":1210.77,"body":"interesting to talk about"},{"speaker":"Chris Dy","startTime":1210.77,"endTime":1213.62,"body":"therapy component because in"},{"speaker":"Chris Dy","startTime":1210.77,"endTime":1213.62,"body":"preparation for this episode, I"},{"speaker":"Chris Dy","startTime":1213.62,"endTime":1217.22,"body":"dug out an email from my"},{"speaker":"Chris Dy","startTime":1213.62,"endTime":1217.22,"body":"fellowship year, that wow, I"},{"speaker":"Chris Dy","startTime":1217.22,"endTime":1220.7,"body":"spent, I spent some time with"},{"speaker":"Chris Dy","startTime":1217.22,"endTime":1220.7,"body":"our head therapists. And I would"},{"speaker":"Chris Dy","startTime":1220.73,"endTime":1223.34,"body":"you know, when I would do cases,"},{"speaker":"Chris Dy","startTime":1220.73,"endTime":1223.34,"body":"as a fellow, I would often ask"},{"speaker":"Chris Dy","startTime":1223.34,"endTime":1227.6,"body":"for their input about, you know,"},{"speaker":"Chris Dy","startTime":1223.34,"endTime":1227.6,"body":"rehab. So I dug out an email"},{"speaker":"Chris Dy","startTime":1227.6,"endTime":1230.87,"body":"from a now retired ham"},{"speaker":"Chris Dy","startTime":1227.6,"endTime":1230.87,"body":"therapist, spent a lot of time"},{"speaker":"Chris Dy","startTime":1230.87,"endTime":1234.92,"body":"in our division. And she emailed"},{"speaker":"Chris Dy","startTime":1230.87,"endTime":1234.92,"body":"me back, say, Hey, Chris, I know"},{"speaker":"Chris Dy","startTime":1234.92,"endTime":1236.84,"body":"there's next to nothing in the"},{"speaker":"Chris Dy","startTime":1234.92,"endTime":1236.84,"body":"literature on the rehab"},{"speaker":"Chris Dy","startTime":1236.84,"endTime":1239.42,"body":"perspective for spaghetti risk."},{"speaker":"Chris Dy","startTime":1236.84,"endTime":1239.42,"body":"But I love this diagnosis."},{"speaker":"Chris Dy","startTime":1239.42,"endTime":1242.54,"body":"Because it's one, it's one where"},{"speaker":"Chris Dy","startTime":1239.42,"endTime":1242.54,"body":"doing the right things early"},{"speaker":"Chris Dy","startTime":1242.54,"endTime":1245.63,"body":"almost always means a happy"},{"speaker":"Chris Dy","startTime":1242.54,"endTime":1245.63,"body":"outcome. And waiting too late to"},{"speaker":"Chris Dy","startTime":1245.63,"endTime":1248.72,"body":"start can cause a little extra"},{"speaker":"Chris Dy","startTime":1245.63,"endTime":1248.72,"body":"misery. Since we're not in Zone"},{"speaker":"Chris Dy","startTime":1248.72,"endTime":1252.02,"body":"Two, early active motion isn't"},{"speaker":"Chris Dy","startTime":1248.72,"endTime":1252.02,"body":"as critical. However, if nerves"},{"speaker":"Chris Dy","startTime":1252.02,"endTime":1254.6,"body":"are cut, it's almost always"},{"speaker":"Chris Dy","startTime":1252.02,"endTime":1254.6,"body":"essential to start early digit"},{"speaker":"Chris Dy","startTime":1254.6,"endTime":1256.73,"body":"active range of motion to"},{"speaker":"Chris Dy","startTime":1254.6,"endTime":1256.73,"body":"preserve as much of the brain"},{"speaker":"Chris Dy","startTime":1256.73,"endTime":1259.88,"body":"handling as possible. So that's"},{"speaker":"Chris Dy","startTime":1256.73,"endTime":1259.88,"body":"just the beginning of email. And"},{"speaker":"Chris Dy","startTime":1259.88,"endTime":1262.58,"body":"I still go back to the female"},{"speaker":"Chris Dy","startTime":1259.88,"endTime":1262.58,"body":"because it's actually how I base"},{"speaker":"Chris Dy","startTime":1262.58,"endTime":1266.84,"body":"my protocol for for spaghetti"},{"speaker":"Chris Dy","startTime":1262.58,"endTime":1266.84,"body":"risk with or without nerve. So I"},{"speaker":"Chris Dy","startTime":1266.84,"endTime":1269.87,"body":"just chuckled, because that was,"},{"speaker":"Chris Dy","startTime":1266.84,"endTime":1269.87,"body":"you know, almost 10 years ago"},{"speaker":"Chris Dy","startTime":1269.87,"endTime":1271.34,"body":"now. That"},{"speaker":"Charles Goldfarb","startTime":1271.34,"endTime":1273.65,"body":"is awesome."},{"speaker":"Charles Goldfarb","startTime":1271.34,"endTime":1273.65,"body":"And if we were a little more"},{"speaker":"Charles Goldfarb","startTime":1273.65,"endTime":1278.09,"body":"sophisticated podcast people,"},{"speaker":"Charles Goldfarb","startTime":1273.65,"endTime":1278.09,"body":"and that that's on me, not you,"},{"speaker":"Charles Goldfarb","startTime":1278.12,"endTime":1281.09,"body":"there would be a little ding"},{"speaker":"Charles Goldfarb","startTime":1278.12,"endTime":1281.09,"body":"that would happen. So imagine"},{"speaker":"Charles Goldfarb","startTime":1281.12,"endTime":1285.44,"body":"our musical like, wake up and"},{"speaker":"Charles Goldfarb","startTime":1281.12,"endTime":1285.44,"body":"listen for a second, if you are"},{"speaker":"Charles Goldfarb","startTime":1285.44,"endTime":1289.28,"body":"a fellow or even a resident, you"},{"speaker":"Charles Goldfarb","startTime":1285.44,"endTime":1289.28,"body":"know, and I don't care if it's"},{"speaker":"Charles Goldfarb","startTime":1289.28,"endTime":1293.33,"body":"hand or sports, have a"},{"speaker":"Charles Goldfarb","startTime":1289.28,"endTime":1293.33,"body":"relationship with therapists you"},{"speaker":"Charles Goldfarb","startTime":1293.33,"endTime":1297.14,"body":"trust and during your training"},{"speaker":"Charles Goldfarb","startTime":1293.33,"endTime":1297.14,"body":"year, during your specialization"},{"speaker":"Charles Goldfarb","startTime":1297.14,"endTime":1300.86,"body":"year, it's not just surgical"},{"speaker":"Charles Goldfarb","startTime":1297.14,"endTime":1300.86,"body":"indications. It's not just"},{"speaker":"Charles Goldfarb","startTime":1300.86,"endTime":1303.95,"body":"surgical techniques. It is"},{"speaker":"Charles Goldfarb","startTime":1300.86,"endTime":1303.95,"body":"understanding what the therapist"},{"speaker":"Charles Goldfarb","startTime":1303.95,"endTime":1305.9,"body":"can bring to the table."},{"speaker":"Charles Goldfarb","startTime":1303.95,"endTime":1305.9,"body":"Absolutely."},{"speaker":"Chris Dy","startTime":1305.9,"endTime":1308.03,"body":"I mean, it's funny all"},{"speaker":"Chris Dy","startTime":1305.9,"endTime":1308.03,"body":"the all the the fellows seem"},{"speaker":"Chris Dy","startTime":1308.03,"endTime":1310.97,"body":"that the end of the year are"},{"speaker":"Chris Dy","startTime":1308.03,"endTime":1310.97,"body":"scrambling for all the protocol,"},{"speaker":"Chris Dy","startTime":1311.72,"endTime":1314.78,"body":"various conditions, which I can"},{"speaker":"Chris Dy","startTime":1311.72,"endTime":1314.78,"body":"say I was heavily involved in"},{"speaker":"Chris Dy","startTime":1314.78,"endTime":1318.02,"body":"developing some of my protocols,"},{"speaker":"Chris Dy","startTime":1314.78,"endTime":1318.02,"body":"because I work with, you know,"},{"speaker":"Chris Dy","startTime":1318.02,"endTime":1320.24,"body":"Athletica, more than then the"},{"speaker":"Chris Dy","startTime":1318.02,"endTime":1320.24,"body":"Milliken Hand Center just"},{"speaker":"Chris Dy","startTime":1320.24,"endTime":1323.12,"body":"because of the nature of my"},{"speaker":"Chris Dy","startTime":1320.24,"endTime":1323.12,"body":"practice, which was very good"},{"speaker":"Chris Dy","startTime":1323.12,"endTime":1326.03,"body":"for me to learn about kind of"},{"speaker":"Chris Dy","startTime":1323.12,"endTime":1326.03,"body":"how to make these decisions. And"},{"speaker":"Chris Dy","startTime":1326.03,"endTime":1329.33,"body":"I have not thought about them as"},{"speaker":"Chris Dy","startTime":1326.03,"endTime":1329.33,"body":"much because my partners in"},{"speaker":"Chris Dy","startTime":1329.33,"endTime":1331.91,"body":"therapy are so skilled and"},{"speaker":"Chris Dy","startTime":1329.33,"endTime":1331.91,"body":"communicate so well that I don't"},{"speaker":"Chris Dy","startTime":1331.91,"endTime":1334.61,"body":"have to like sit there and think"},{"speaker":"Chris Dy","startTime":1331.91,"endTime":1334.61,"body":"about a protocol that often."},{"speaker":"Chris Dy","startTime":1335.36,"endTime":1335.75,"body":"Yes,"},{"speaker":"Charles Goldfarb","startTime":1335.75,"endTime":1338.69,"body":"and I had to,"},{"speaker":"Charles Goldfarb","startTime":1335.75,"endTime":1338.69,"body":"you know, I've written a book"},{"speaker":"Charles Goldfarb","startTime":1338.69,"endTime":1342.68,"body":"about therapy protocols for"},{"speaker":"Charles Goldfarb","startTime":1338.69,"endTime":1342.68,"body":"congenital, I haven't thought"},{"speaker":"Charles Goldfarb","startTime":1342.68,"endTime":1346.97,"body":"about sports protocols, but did"},{"speaker":"Charles Goldfarb","startTime":1342.68,"endTime":1346.97,"body":"end up having to write some"},{"speaker":"Charles Goldfarb","startTime":1346.97,"endTime":1349.16,"body":"which thankfully had been"},{"speaker":"Charles Goldfarb","startTime":1346.97,"endTime":1349.16,"body":"adopted, it's just easier when"},{"speaker":"Charles Goldfarb","startTime":1349.16,"endTime":1351.14,"body":"we all think about the same way."},{"speaker":"Charles Goldfarb","startTime":1349.16,"endTime":1351.14,"body":"And we've had those"},{"speaker":"Charles Goldfarb","startTime":1351.14,"endTime":1354.83,"body":"conversations that as a group of"},{"speaker":"Charles Goldfarb","startTime":1351.14,"endTime":1354.83,"body":"seven, we hopefully we're pretty"},{"speaker":"Charles Goldfarb","startTime":1354.83,"endTime":1357.41,"body":"aligned on how we handle"},{"speaker":"Charles Goldfarb","startTime":1354.83,"endTime":1357.41,"body":"therapy, just because it's"},{"speaker":"Charles Goldfarb","startTime":1357.41,"endTime":1360.08,"body":"better for the patient and for"},{"speaker":"Charles Goldfarb","startTime":1357.41,"endTime":1360.08,"body":"uniform better for therapy. And,"},{"speaker":"Charles Goldfarb","startTime":1360.35,"endTime":1363.08,"body":"and I think we we as a group had"},{"speaker":"Charles Goldfarb","startTime":1360.35,"endTime":1363.08,"body":"been been pretty good about"},{"speaker":"Charles Goldfarb","startTime":1363.08,"endTime":1364.73,"body":"doing that. Yeah,"},{"speaker":"Chris Dy","startTime":1364.73,"endTime":1366.83,"body":"absolutely. So I mean,"},{"speaker":"Chris Dy","startTime":1364.73,"endTime":1366.83,"body":"to that point about the tendons,"},{"speaker":"Chris Dy","startTime":1367.22,"endTime":1371.24,"body":"you know, it is one where I do"},{"speaker":"Chris Dy","startTime":1367.22,"endTime":1371.24,"body":"want to get some, some passive"},{"speaker":"Chris Dy","startTime":1371.24,"endTime":1375.11,"body":"motion on those fingers ASAP."},{"speaker":"Chris Dy","startTime":1371.24,"endTime":1375.11,"body":"And then your your question"},{"speaker":"Chris Dy","startTime":1375.11,"endTime":1378.14,"body":"about expectations for the"},{"speaker":"Chris Dy","startTime":1375.11,"endTime":1378.14,"body":"nerve. I think in general,"},{"speaker":"Chris Dy","startTime":1378.14,"endTime":1381.17,"body":"anytime you're involving a nerve"},{"speaker":"Chris Dy","startTime":1378.14,"endTime":1381.17,"body":"graft, you probably have about"},{"speaker":"Chris Dy","startTime":1381.47,"endTime":1384.53,"body":"based on literature, somewhere"},{"speaker":"Chris Dy","startTime":1381.47,"endTime":1384.53,"body":"between 70 and 80% chance at"},{"speaker":"Chris Dy","startTime":1384.53,"endTime":1386.9,"body":"getting meaningful clinical"},{"speaker":"Chris Dy","startTime":1384.53,"endTime":1386.9,"body":"recovery. And typically, that's"},{"speaker":"Chris Dy","startTime":1386.9,"endTime":1389.48,"body":"motor, but for obviously, these"},{"speaker":"Chris Dy","startTime":1386.9,"endTime":1389.48,"body":"nerves, this is both motor and"},{"speaker":"Chris Dy","startTime":1389.48,"endTime":1393.32,"body":"sensory. So that's a general"},{"speaker":"Chris Dy","startTime":1389.48,"endTime":1393.32,"body":"broad number that I use for"},{"speaker":"Chris Dy","startTime":1393.32,"endTime":1396.74,"body":"patients, I think it sets"},{"speaker":"Chris Dy","startTime":1393.32,"endTime":1396.74,"body":"appropriate expectations, this"},{"speaker":"Chris Dy","startTime":1396.74,"endTime":1398.78,"body":"page was actually very upfront"},{"speaker":"Chris Dy","startTime":1396.74,"endTime":1398.78,"body":"with what they were looking to"},{"speaker":"Chris Dy","startTime":1398.78,"endTime":1401.66,"body":"do in terms of their future, I"},{"speaker":"Chris Dy","startTime":1398.78,"endTime":1401.66,"body":"won't say specifically what it"},{"speaker":"Chris Dy","startTime":1401.66,"endTime":1404.84,"body":"is, for obvious reasons. But you"},{"speaker":"Chris Dy","startTime":1401.66,"endTime":1404.84,"body":"know, they were more concerned"},{"speaker":"Chris Dy","startTime":1404.84,"endTime":1408.86,"body":"about, you know, being able to"},{"speaker":"Chris Dy","startTime":1404.84,"endTime":1408.86,"body":"grip and grab as opposed to, you"},{"speaker":"Chris Dy","startTime":1408.86,"endTime":1412.76,"body":"know, in their mind kind of a"},{"speaker":"Chris Dy","startTime":1408.86,"endTime":1412.76,"body":"sensation aspects to it. And"},{"speaker":"Chris Dy","startTime":1412.76,"endTime":1415.1,"body":"then the dexterity part of it,"},{"speaker":"Chris Dy","startTime":1412.76,"endTime":1415.1,"body":"which obviously, fortunately,"},{"speaker":"Chris Dy","startTime":1415.1,"endTime":1418.79,"body":"this is their non dominant hand."},{"speaker":"Chris Dy","startTime":1415.1,"endTime":1418.79,"body":"But I know they haven't, the"},{"speaker":"Chris Dy","startTime":1418.79,"endTime":1421.4,"body":"patient has no idea how"},{"speaker":"Chris Dy","startTime":1418.79,"endTime":1421.4,"body":"devastating this injury is going"},{"speaker":"Chris Dy","startTime":1421.4,"endTime":1425.54,"body":"to be to the use of their hand."},{"speaker":"Chris Dy","startTime":1421.4,"endTime":1425.54,"body":"So I'm trying to paint a picture"},{"speaker":"Chris Dy","startTime":1425.54,"endTime":1429.32,"body":"of what a you know, a hand"},{"speaker":"Chris Dy","startTime":1425.54,"endTime":1429.32,"body":"without the good phenol and good"},{"speaker":"Chris Dy","startTime":1429.32,"endTime":1432.95,"body":"intrinsic owner function looks"},{"speaker":"Chris Dy","startTime":1429.32,"endTime":1432.95,"body":"like for that patient. But you"},{"speaker":"Chris Dy","startTime":1432.95,"endTime":1435.89,"body":"obviously don't want to be too"},{"speaker":"Chris Dy","startTime":1432.95,"endTime":1435.89,"body":"much doom and gloom. So I think"},{"speaker":"Chris Dy","startTime":1435.89,"endTime":1439.43,"body":"it is definitely a very"},{"speaker":"Chris Dy","startTime":1435.89,"endTime":1439.43,"body":"challenging situation to counsel"},{"speaker":"Chris Dy","startTime":1439.43,"endTime":1440.93,"body":"somebody in. Oh,"},{"speaker":"Charles Goldfarb","startTime":1440.93,"endTime":1443.18,"body":"for sure."},{"speaker":"Charles Goldfarb","startTime":1440.93,"endTime":1443.18,"body":"Alright, so I want to know, how"},{"speaker":"Charles Goldfarb","startTime":1443.18,"endTime":1445.49,"body":"long have you booked the case"},{"speaker":"Charles Goldfarb","startTime":1443.18,"endTime":1445.49,"body":"for? And I want to know what"},{"speaker":"Charles Goldfarb","startTime":1445.52,"endTime":1449.24,"body":"suture you asked for both for"},{"speaker":"Charles Goldfarb","startTime":1445.52,"endTime":1449.24,"body":"the nerve and the tendons. So"},{"speaker":"Chris Dy","startTime":1449.24,"endTime":1451.79,"body":"I committed the sin of"},{"speaker":"Chris Dy","startTime":1449.24,"endTime":1451.79,"body":"booking it for as long as they"},{"speaker":"Chris Dy","startTime":1451.79,"endTime":1452.21,"body":"had"},{"speaker":"Charles Goldfarb","startTime":1456.74,"endTime":1458.96,"body":"well done. I"},{"speaker":"Chris Dy","startTime":1458.96,"endTime":1462.92,"body":"needed to get the case"},{"speaker":"Chris Dy","startTime":1458.96,"endTime":1462.92,"body":"done. And but yeah, so I I"},{"speaker":"Chris Dy","startTime":1462.92,"endTime":1466.04,"body":"booked the case as two and a"},{"speaker":"Chris Dy","startTime":1462.92,"endTime":1466.04,"body":"half hours. And it probably took"},{"speaker":"Chris Dy","startTime":1466.04,"endTime":1468.86,"body":"a little longer than that. But I"},{"speaker":"Chris Dy","startTime":1466.04,"endTime":1468.86,"body":"think you know, this is a this"},{"speaker":"Chris Dy","startTime":1468.86,"endTime":1471.53,"body":"was a place where that she"},{"speaker":"Chris Dy","startTime":1468.86,"endTime":1471.53,"body":"already had overtime for me set"},{"speaker":"Chris Dy","startTime":1471.53,"endTime":1473.78,"body":"aside and for whatever reason"},{"speaker":"Chris Dy","startTime":1471.53,"endTime":1473.78,"body":"that different case cancelled"},{"speaker":"Chris Dy","startTime":1473.78,"endTime":1476.15,"body":"and I was planning on going to"},{"speaker":"Chris Dy","startTime":1473.78,"endTime":1476.15,"body":"that facility anyway. So they"},{"speaker":"Chris Dy","startTime":1476.15,"endTime":1480.56,"body":"were happy that I use the time."},{"speaker":"Chris Dy","startTime":1476.15,"endTime":1480.56,"body":"And it took a little longer than"},{"speaker":"Chris Dy","startTime":1480.56,"endTime":1482.78,"body":"expected to get in the room and"},{"speaker":"Chris Dy","startTime":1480.56,"endTime":1482.78,"body":"get started because I don't work"},{"speaker":"Chris Dy","startTime":1482.78,"endTime":1485.54,"body":"there all the time. But, you"},{"speaker":"Chris Dy","startTime":1482.78,"endTime":1485.54,"body":"know, they they were great when"},{"speaker":"Chris Dy","startTime":1485.54,"endTime":1490.04,"body":"I got there. They were very,"},{"speaker":"Chris Dy","startTime":1485.54,"endTime":1490.04,"body":"very helpful, wonderful team."},{"speaker":"Chris Dy","startTime":1490.04,"endTime":1492.65,"body":"It's always hard when you're"},{"speaker":"Chris Dy","startTime":1490.04,"endTime":1492.65,"body":"doing a big case with the team"},{"speaker":"Chris Dy","startTime":1492.65,"endTime":1495.65,"body":"you've never worked with, but"},{"speaker":"Chris Dy","startTime":1492.65,"endTime":1495.65,"body":"they were incredible. So then,"},{"speaker":"Chris Dy","startTime":1495.65,"endTime":1498.05,"body":"you know in terms of I booked it"},{"speaker":"Chris Dy","startTime":1495.65,"endTime":1498.05,"body":"for two and a half I probably"},{"speaker":"Chris Dy","startTime":1498.05,"endTime":1501.05,"body":"should have booked it for three"},{"speaker":"Chris Dy","startTime":1498.05,"endTime":1501.05,"body":"days. Knowing I didn't have to"},{"speaker":"Chris Dy","startTime":1501.05,"endTime":1503.72,"body":"do arteries was really helpful"},{"speaker":"Chris Dy","startTime":1501.05,"endTime":1503.72,"body":"or not anticipating having to"},{"speaker":"Chris Dy","startTime":1503.72,"endTime":1507.05,"body":"redo the vascular part was"},{"speaker":"Chris Dy","startTime":1503.72,"endTime":1507.05,"body":"helpful. You know, I asked to"},{"speaker":"Chris Dy","startTime":1507.05,"endTime":1510.65,"body":"prep the leg because I"},{"speaker":"Chris Dy","startTime":1507.05,"endTime":1510.65,"body":"anticipated harvesting Searl. So"},{"speaker":"Chris Dy","startTime":1510.65,"endTime":1512.78,"body":"in terms of positioning bump out"},{"speaker":"Chris Dy","startTime":1510.65,"endTime":1512.78,"body":"of the hip nonsterile"},{"speaker":"Chris Dy","startTime":1512.78,"endTime":1515.57,"body":"tourniquets, and I did not put a"},{"speaker":"Chris Dy","startTime":1512.78,"endTime":1515.57,"body":"tourniquet on the arm because I"},{"speaker":"Chris Dy","startTime":1515.57,"endTime":1518.3,"body":"didn't want to be tempted to use"},{"speaker":"Chris Dy","startTime":1515.57,"endTime":1518.3,"body":"it, just given how fresh the"},{"speaker":"Chris Dy","startTime":1518.3,"endTime":1521.06,"body":"vascular reconstruction was. And"},{"speaker":"Chris Dy","startTime":1518.3,"endTime":1521.06,"body":"there's really no evidence"},{"speaker":"Chris Dy","startTime":1521.06,"endTime":1523.4,"body":"actually did it search quickly"},{"speaker":"Chris Dy","startTime":1521.06,"endTime":1523.4,"body":"trying to figure out if it was"},{"speaker":"Chris Dy","startTime":1523.4,"endTime":1526.91,"body":"okay or not, because it would"},{"speaker":"Chris Dy","startTime":1523.4,"endTime":1526.91,"body":"move the case along faster. But,"},{"speaker":"Chris Dy","startTime":1527.39,"endTime":1530.99,"body":"you know, I also asked for some"},{"speaker":"Chris Dy","startTime":1527.39,"endTime":1530.99,"body":"lidocaine with B to get through"},{"speaker":"Chris Dy","startTime":1530.99,"endTime":1533.48,"body":"some of the skin parts of it."},{"speaker":"Chris Dy","startTime":1530.99,"endTime":1533.48,"body":"And then knowing I was going to"},{"speaker":"Chris Dy","startTime":1533.48,"endTime":1536.06,"body":"have to do a carpal tunnel"},{"speaker":"Chris Dy","startTime":1533.48,"endTime":1536.06,"body":"release and Qian canal release."},{"speaker":"Chris Dy","startTime":1536.6,"endTime":1539.36,"body":"I just went ahead and put that"},{"speaker":"Chris Dy","startTime":1536.6,"endTime":1539.36,"body":"LIDAR without being for that"},{"speaker":"Chris Dy","startTime":1539.36,"endTime":1542.93,"body":"part of it right away in terms"},{"speaker":"Chris Dy","startTime":1539.36,"endTime":1542.93,"body":"of just to make the initial"},{"speaker":"Chris Dy","startTime":1542.93,"endTime":1546.38,"body":"approach a little bit easier."},{"speaker":"Chris Dy","startTime":1542.93,"endTime":1546.38,"body":"And I asked for a bunch of"},{"speaker":"Chris Dy","startTime":1546.38,"endTime":1549.29,"body":"sutures. So for me depending on"},{"speaker":"Chris Dy","startTime":1546.38,"endTime":1549.29,"body":"where that is, it's going to be"},{"speaker":"Chris Dy","startTime":1549.29,"endTime":1552.89,"body":"either a three or a three Oh,"},{"speaker":"Chris Dy","startTime":1549.29,"endTime":1552.89,"body":"braided nonabsorbable suture."},{"speaker":"Chris Dy","startTime":1554.69,"endTime":1559.19,"body":"Oh, caliber of the same variety."},{"speaker":"Chris Dy","startTime":1554.69,"endTime":1559.19,"body":"Then I asked for my standard"},{"speaker":"Chris Dy","startTime":1559.19,"endTime":1566.48,"body":"micro sutures, which for me are"},{"speaker":"Chris Dy","startTime":1559.19,"endTime":1566.48,"body":"nano nano monofilament. And I"},{"speaker":"Chris Dy","startTime":1566.48,"endTime":1570.71,"body":"also asked for some fibrin glue,"},{"speaker":"Chris Dy","startTime":1566.48,"endTime":1570.71,"body":"which is off label for those"},{"speaker":"Chris Dy","startTime":1570.71,"endTime":1573.05,"body":"listening for use and nerve"},{"speaker":"Chris Dy","startTime":1570.71,"endTime":1573.05,"body":"computations. But I think it's a"},{"speaker":"Chris Dy","startTime":1573.05,"endTime":1574.94,"body":"common practice. Okay,"},{"speaker":"Charles Goldfarb","startTime":1575.09,"endTime":1577.55,"body":"so before we"},{"speaker":"Charles Goldfarb","startTime":1575.09,"endTime":1577.55,"body":"jump in on the technical which"},{"speaker":"Charles Goldfarb","startTime":1577.55,"endTime":1580.82,"body":"will include order of"},{"speaker":"Charles Goldfarb","startTime":1577.55,"endTime":1580.82,"body":"operations, I'd love to hear how"},{"speaker":"Charles Goldfarb","startTime":1580.82,"endTime":1584.33,"body":"many strands you know you"},{"speaker":"Charles Goldfarb","startTime":1580.82,"endTime":1584.33,"body":"consider for your tendons, how"},{"speaker":"Charles Goldfarb","startTime":1584.33,"endTime":1587.0,"body":"you think about that in the"},{"speaker":"Charles Goldfarb","startTime":1584.33,"endTime":1587.0,"body":"forearm, and then exactly what"},{"speaker":"Charles Goldfarb","startTime":1587.0,"endTime":1590.78,"body":"you did with your nerves but"},{"speaker":"Charles Goldfarb","startTime":1587.0,"endTime":1590.78,"body":"let's think checkpoint surgical."},{"speaker":"Chris Dy","startTime":1592.34,"endTime":1593.81,"body":"So the upper hand is"},{"speaker":"Chris Dy","startTime":1592.34,"endTime":1593.81,"body":"sponsored by checkpoint"},{"speaker":"Chris Dy","startTime":1593.81,"endTime":1596.18,"body":"surgical, a provider of"},{"speaker":"Chris Dy","startTime":1593.81,"endTime":1596.18,"body":"innovative solutions for"},{"speaker":"Chris Dy","startTime":1596.18,"endTime":1598.61,"body":"peripheral nerve surgery."},{"speaker":"Chris Dy","startTime":1596.18,"endTime":1598.61,"body":"Checkpoint surgical is always"},{"speaker":"Chris Dy","startTime":1598.61,"endTime":1601.07,"body":"striving to elevate the clinical"},{"speaker":"Chris Dy","startTime":1598.61,"endTime":1601.07,"body":"practice of peripheral nerve"},{"speaker":"Chris Dy","startTime":1601.07,"endTime":1603.92,"body":"surgery by providing surgeons"},{"speaker":"Chris Dy","startTime":1601.07,"endTime":1603.92,"body":"with new technologies to help"},{"speaker":"Chris Dy","startTime":1603.92,"endTime":1606.47,"body":"improve patient outcomes."},{"speaker":"Chris Dy","startTime":1603.92,"endTime":1606.47,"body":"Checkpoint"},{"speaker":"Charles Goldfarb","startTime":1605.93,"endTime":1608.331,"body":"surgicals"},{"speaker":"Charles Goldfarb","startTime":1605.93,"endTime":1608.331,"body":"newest intraoperative nerve"},{"speaker":"Charles Goldfarb","startTime":1608.395,"endTime":1612.419,"body":"stimulator the Gemini bipolar"},{"speaker":"Charles Goldfarb","startTime":1608.395,"endTime":1612.419,"body":"nerve stimulator does just that."},{"speaker":"Charles Goldfarb","startTime":1612.484,"endTime":1615.923,"body":"With a bipolar stimulation pro"},{"speaker":"Charles Goldfarb","startTime":1612.484,"endTime":1615.923,"body":"Gemini provides finely"},{"speaker":"Charles Goldfarb","startTime":1615.988,"endTime":1619.752,"body":"controlled stimulation even at"},{"speaker":"Charles Goldfarb","startTime":1615.988,"endTime":1619.752,"body":"the secular level, allowing"},{"speaker":"Charles Goldfarb","startTime":1619.817,"endTime":1623.84,"body":"surgeons to take actions based"},{"speaker":"Charles Goldfarb","startTime":1619.817,"endTime":1623.84,"body":"on the most precise information"},{"speaker":"Charles Goldfarb","startTime":1623.905,"endTime":1627.669,"body":"available to learn more visit"},{"speaker":"Charles Goldfarb","startTime":1623.905,"endTime":1627.669,"body":"www.checkpoint surgical.com."},{"speaker":"Charles Goldfarb","startTime":1627.734,"endTime":1631.433,"body":"Checkpoint surgical driving"},{"speaker":"Charles Goldfarb","startTime":1627.734,"endTime":1631.433,"body":"innovation and nerve surgery."},{"speaker":"Charles Goldfarb","startTime":1631.498,"endTime":1633.38,"body":"Wow, that is good copy. Yeah."},{"speaker":"Chris Dy","startTime":1635.18,"endTime":1637.1,"body":"They have been very"},{"speaker":"Chris Dy","startTime":1635.18,"endTime":1637.1,"body":"great about providing us the"},{"speaker":"Chris Dy","startTime":1637.1,"endTime":1639.65,"body":"coffee that they would like. So"},{"speaker":"Chris Dy","startTime":1637.1,"endTime":1639.65,"body":"thank you to the checkpointing"},{"speaker":"Chris Dy","startTime":1639.65,"endTime":1642.71,"body":"for that. The nice thing about"},{"speaker":"Chris Dy","startTime":1639.65,"endTime":1642.71,"body":"the Gemini is that you don't,"},{"speaker":"Chris Dy","startTime":1642.77,"endTime":1644.93,"body":"there's no chance of stabbing"},{"speaker":"Chris Dy","startTime":1642.77,"endTime":1644.93,"body":"yourself by putting in that"},{"speaker":"Chris Dy","startTime":1644.93,"endTime":1648.53,"body":"grounding needle. But it does"},{"speaker":"Chris Dy","startTime":1644.93,"endTime":1648.53,"body":"have and this is not an episode"},{"speaker":"Chris Dy","startTime":1648.53,"endTime":1651.53,"body":"about the Gemini. But it does"},{"speaker":"Chris Dy","startTime":1648.53,"endTime":1651.53,"body":"have different features that"},{"speaker":"Chris Dy","startTime":1651.53,"endTime":1653.75,"body":"make it very helpful. And I do"},{"speaker":"Chris Dy","startTime":1651.53,"endTime":1653.75,"body":"like using it for for the"},{"speaker":"Chris Dy","startTime":1653.75,"endTime":1656.39,"body":"different features and less risk"},{"speaker":"Chris Dy","startTime":1653.75,"endTime":1656.39,"body":"of stabbing yourself or somebody"},{"speaker":"Chris Dy","startTime":1656.39,"endTime":1656.72,"body":"else"},{"speaker":"Charles Goldfarb","startTime":1656.78,"endTime":1659.57,"body":"I need. I need"},{"speaker":"Charles Goldfarb","startTime":1656.78,"endTime":1659.57,"body":"all that I actually was doing. I"},{"speaker":"Charles Goldfarb","startTime":1659.57,"endTime":1662.33,"body":"do a fair number of sciatic"},{"speaker":"Charles Goldfarb","startTime":1659.57,"endTime":1662.33,"body":"nerve decompressions for chronic"},{"speaker":"Charles Goldfarb","startTime":1662.36,"endTime":1665.42,"body":"hamstring avulsions with my"},{"speaker":"Charles Goldfarb","startTime":1662.36,"endTime":1665.42,"body":"sports partners, and I had a six"},{"speaker":"Charles Goldfarb","startTime":1665.42,"endTime":1671.48,"body":"month old one and I actually"},{"speaker":"Charles Goldfarb","startTime":1665.42,"endTime":1671.48,"body":"considered asking for the"},{"speaker":"Charles Goldfarb","startTime":1671.48,"endTime":1674.96,"body":"checkpoint, but it ended up"},{"speaker":"Charles Goldfarb","startTime":1671.48,"endTime":1674.96,"body":"being fine. So I don't use it"},{"speaker":"Charles Goldfarb","startTime":1675.32,"endTime":1678.86,"body":"with any regularity once a year"},{"speaker":"Charles Goldfarb","startTime":1675.32,"endTime":1678.86,"body":"maybe but I know it's important"},{"speaker":"Charles Goldfarb","startTime":1678.86,"endTime":1680.18,"body":"for your practice, okay."},{"speaker":"Chris Dy","startTime":1680.66,"endTime":1683.21,"body":"But you didn't use a"},{"speaker":"Chris Dy","startTime":1680.66,"endTime":1683.21,"body":"thing that our sponsor."},{"speaker":"Charles Goldfarb","startTime":1684.23,"endTime":1687.71,"body":"I'm not a"},{"speaker":"Charles Goldfarb","startTime":1684.23,"endTime":1687.71,"body":"nerve guy. I do nerves, I use"},{"speaker":"Charles Goldfarb","startTime":1687.71,"endTime":1691.4,"body":"it. And when I use it, I enjoy"},{"speaker":"Charles Goldfarb","startTime":1687.71,"endTime":1691.4,"body":"it. But I'm being real here, Dr."},{"speaker":"Charles Goldfarb","startTime":1691.4,"endTime":1691.85,"body":"D."},{"speaker":"Chris Dy","startTime":1691.94,"endTime":1694.49,"body":"That's great. Yeah,"},{"speaker":"Chris Dy","startTime":1691.94,"endTime":1694.49,"body":"but this, this was not a case in"},{"speaker":"Chris Dy","startTime":1694.49,"endTime":1698.45,"body":"which I used that device. It'd"},{"speaker":"Chris Dy","startTime":1694.49,"endTime":1698.45,"body":"be interesting to use a"},{"speaker":"Chris Dy","startTime":1698.45,"endTime":1702.17,"body":"stimulant handheld stimulator"},{"speaker":"Chris Dy","startTime":1698.45,"endTime":1702.17,"body":"really early on after the injury"},{"speaker":"Chris Dy","startTime":1702.17,"endTime":1707.27,"body":"to see if you can separate some"},{"speaker":"Chris Dy","startTime":1702.17,"endTime":1707.27,"body":"of your stimulate your distal"},{"speaker":"Chris Dy","startTime":1707.27,"endTime":1710.66,"body":"side before valerian"},{"speaker":"Chris Dy","startTime":1707.27,"endTime":1710.66,"body":"degeneration hits. And I've done"},{"speaker":"Chris Dy","startTime":1710.66,"endTime":1713.21,"body":"that for Super acute injuries"},{"speaker":"Chris Dy","startTime":1710.66,"endTime":1713.21,"body":"because it's helpful if you're"},{"speaker":"Chris Dy","startTime":1713.21,"endTime":1717.98,"body":"trying to differentiate motor"},{"speaker":"Chris Dy","startTime":1713.21,"endTime":1717.98,"body":"sensory parts. So that anyway,"},{"speaker":"Chris Dy","startTime":1718.01,"endTime":1722.15,"body":"that's an aside, but yeah, so"},{"speaker":"Chris Dy","startTime":1718.01,"endTime":1722.15,"body":"for me, and I'd love to hear"},{"speaker":"Chris Dy","startTime":1722.15,"endTime":1725.93,"body":"your thoughts, you know, what"},{"speaker":"Chris Dy","startTime":1722.15,"endTime":1725.93,"body":"the order of operations are"},{"speaker":"Chris Dy","startTime":1726.2,"endTime":1730.1,"body":"exposed what you can see right"},{"speaker":"Chris Dy","startTime":1726.2,"endTime":1730.1,"body":"away and for I needed to I"},{"speaker":"Chris Dy","startTime":1730.1,"endTime":1732.53,"body":"actually ended up doing the"},{"speaker":"Chris Dy","startTime":1730.1,"endTime":1732.53,"body":"carpal tunnel release pretty"},{"speaker":"Chris Dy","startTime":1732.53,"endTime":1735.38,"body":"quickly because it was clear to"},{"speaker":"Chris Dy","startTime":1732.53,"endTime":1735.38,"body":"me that somehow these tendons"},{"speaker":"Chris Dy","startTime":1735.38,"endTime":1738.74,"body":"were cutting and retracted back"},{"speaker":"Chris Dy","startTime":1735.38,"endTime":1738.74,"body":"into the carpal tunnel, at least"},{"speaker":"Chris Dy","startTime":1738.74,"endTime":1742.28,"body":"the the FDS is in the FTPS and"},{"speaker":"Chris Dy","startTime":1738.74,"endTime":1742.28,"body":"it was it was kind of a"},{"speaker":"Chris Dy","startTime":1742.28,"endTime":1747.08,"body":"challenging, kind of weaving the"},{"speaker":"Chris Dy","startTime":1742.28,"endTime":1747.08,"body":"tendons back back and forth. But"},{"speaker":"Chris Dy","startTime":1747.14,"endTime":1750.23,"body":"the way it generally approach it"},{"speaker":"Chris Dy","startTime":1747.14,"endTime":1750.23,"body":"is you know, I had to expose"},{"speaker":"Chris Dy","startTime":1750.23,"endTime":1752.9,"body":"these arteries protect both of"},{"speaker":"Chris Dy","startTime":1750.23,"endTime":1752.9,"body":"the arteries get a sense of what"},{"speaker":"Chris Dy","startTime":1752.9,"endTime":1757.07,"body":"that reconstruction look like."},{"speaker":"Chris Dy","startTime":1752.9,"endTime":1757.07,"body":"And then, you know, wanted to"},{"speaker":"Chris Dy","startTime":1757.07,"endTime":1759.44,"body":"get a sense of the tendons and"},{"speaker":"Chris Dy","startTime":1757.07,"endTime":1759.44,"body":"where the nerves were and what I"},{"speaker":"Chris Dy","startTime":1759.44,"endTime":1761.87,"body":"was gonna have to do so that as"},{"speaker":"Chris Dy","startTime":1759.44,"endTime":1761.87,"body":"soon as I could, I'm fortunate"},{"speaker":"Chris Dy","startTime":1761.87,"endTime":1764.39,"body":"enough to work in an academic"},{"speaker":"Chris Dy","startTime":1761.87,"endTime":1764.39,"body":"place like you are where I have"},{"speaker":"Chris Dy","startTime":1764.39,"endTime":1767.18,"body":"an assistant that I can send"},{"speaker":"Chris Dy","startTime":1764.39,"endTime":1767.18,"body":"down to the leg start harvesting"},{"speaker":"Chris Dy","startTime":1767.42,"endTime":1771.23,"body":"circle, which was nice so as"},{"speaker":"Chris Dy","startTime":1767.42,"endTime":1771.23,"body":"soon as we got the tendons"},{"speaker":"Chris Dy","startTime":1771.23,"endTime":1773.84,"body":"sorted out, you know and we were"},{"speaker":"Chris Dy","startTime":1771.23,"endTime":1773.84,"body":"in a good place for it was just"},{"speaker":"Chris Dy","startTime":1773.84,"endTime":1778.43,"body":"kind of sewing tendons sewing"},{"speaker":"Chris Dy","startTime":1773.84,"endTime":1778.43,"body":"tendons, asked our fantastic"},{"speaker":"Chris Dy","startTime":1778.43,"endTime":1782.27,"body":"resident to go down to the leg."},{"speaker":"Chris Dy","startTime":1778.43,"endTime":1782.27,"body":"It's our harvesting circle. So"},{"speaker":"Charles Goldfarb","startTime":1782.36,"endTime":1785.15,"body":"love that and"},{"speaker":"Charles Goldfarb","startTime":1782.36,"endTime":1785.15,"body":"agree with everything you said I"},{"speaker":"Charles Goldfarb","startTime":1785.15,"endTime":1788.15,"body":"don't routinely release the"},{"speaker":"Charles Goldfarb","startTime":1785.15,"endTime":1788.15,"body":"carpal tunnel although some"},{"speaker":"Charles Goldfarb","startTime":1788.15,"endTime":1792.14,"body":"might advocate for that just I"},{"speaker":"Charles Goldfarb","startTime":1788.15,"endTime":1792.14,"body":"guess with nerve swelling, so to"},{"speaker":"Charles Goldfarb","startTime":1792.14,"endTime":1796.49,"body":"say. But it clearly if you have"},{"speaker":"Charles Goldfarb","startTime":1792.14,"endTime":1796.49,"body":"to release it, you release it no"},{"speaker":"Charles Goldfarb","startTime":1796.49,"endTime":1801.5,"body":"second thoughts. I liked the"},{"speaker":"Charles Goldfarb","startTime":1796.49,"endTime":1801.5,"body":"cons. After putting in a core"},{"speaker":"Charles Goldfarb","startTime":1801.5,"endTime":1803.69,"body":"stitch, not that I think you"},{"speaker":"Charles Goldfarb","startTime":1801.5,"endTime":1803.69,"body":"absolutely have to in this"},{"speaker":"Charles Goldfarb","startTime":1803.69,"endTime":1807.68,"body":"location, and sort of using a"},{"speaker":"Charles Goldfarb","startTime":1803.69,"endTime":1807.68,"body":"tag of some sort to identify the"},{"speaker":"Charles Goldfarb","startTime":1807.68,"endTime":1810.89,"body":"distal and proximal tendons. So"},{"speaker":"Charles Goldfarb","startTime":1807.68,"endTime":1810.89,"body":"that's where the time is spent"},{"speaker":"Charles Goldfarb","startTime":1811.07,"endTime":1814.01,"body":"identifying, doing your best to"},{"speaker":"Charles Goldfarb","startTime":1811.07,"endTime":1814.01,"body":"confirm you have the right"},{"speaker":"Charles Goldfarb","startTime":1814.01,"endTime":1818.15,"body":"tendon and and putting your core"},{"speaker":"Charles Goldfarb","startTime":1814.01,"endTime":1818.15,"body":"stitch in. And then once you"},{"speaker":"Charles Goldfarb","startTime":1818.15,"endTime":1821.75,"body":"have all that, then you're just"},{"speaker":"Charles Goldfarb","startTime":1818.15,"endTime":1821.75,"body":"tying knots. Right."},{"speaker":"Chris Dy","startTime":1821.75,"endTime":1824.48,"body":"So I mean, that's the"},{"speaker":"Chris Dy","startTime":1821.75,"endTime":1824.48,"body":"challenges case is that my, my"},{"speaker":"Chris Dy","startTime":1824.48,"endTime":1827.54,"body":"FPL was pretty apparent that was"},{"speaker":"Chris Dy","startTime":1824.48,"endTime":1827.54,"body":"not hard to to get going. But"},{"speaker":"Chris Dy","startTime":1827.54,"endTime":1831.02,"body":"fcrn FC were out. And you know,"},{"speaker":"Chris Dy","startTime":1827.54,"endTime":1831.02,"body":"I did repair those on the way"},{"speaker":"Chris Dy","startTime":1831.02,"endTime":1833.84,"body":"out, you know, and I'd love to"},{"speaker":"Chris Dy","startTime":1831.02,"endTime":1833.84,"body":"know your thoughts about whether"},{"speaker":"Chris Dy","startTime":1834.23,"endTime":1837.74,"body":"both of those are necessary or"},{"speaker":"Chris Dy","startTime":1834.23,"endTime":1837.74,"body":"not. But I went ahead and did it"},{"speaker":"Chris Dy","startTime":1838.76,"endTime":1841.94,"body":"did not do the Palmeras. But as"},{"speaker":"Chris Dy","startTime":1838.76,"endTime":1841.94,"body":"soon as I could find my FPL,"},{"speaker":"Chris Dy","startTime":1841.94,"endTime":1845.03,"body":"that was the, that was the"},{"speaker":"Chris Dy","startTime":1841.94,"endTime":1845.03,"body":"easiest stuff to find outside of"},{"speaker":"Chris Dy","startTime":1845.03,"endTime":1848.78,"body":"fcrn FCU. But then all of the"},{"speaker":"Chris Dy","startTime":1845.03,"endTime":1848.78,"body":"flexors for the fingers had"},{"speaker":"Chris Dy","startTime":1848.78,"endTime":1851.42,"body":"retracted back into the carpal"},{"speaker":"Chris Dy","startTime":1848.78,"endTime":1851.42,"body":"tunnel, distally, they were"},{"speaker":"Chris Dy","startTime":1851.42,"endTime":1854.24,"body":"pretty apparent proximately It"},{"speaker":"Chris Dy","startTime":1851.42,"endTime":1854.24,"body":"wasn't hard, I saw immediate"},{"speaker":"Chris Dy","startTime":1854.24,"endTime":1857.21,"body":"nerve pretty quickly. And I"},{"speaker":"Chris Dy","startTime":1854.24,"endTime":1857.21,"body":"think one pearl that I was"},{"speaker":"Chris Dy","startTime":1857.21,"endTime":1861.11,"body":"taught and that I was telling"},{"speaker":"Chris Dy","startTime":1857.21,"endTime":1861.11,"body":"our residents was that it's"},{"speaker":"Chris Dy","startTime":1861.11,"endTime":1864.2,"body":"tempting, as soon as you see all"},{"speaker":"Chris Dy","startTime":1861.11,"endTime":1864.2,"body":"the anatomy, you know, kind of"},{"speaker":"Chris Dy","startTime":1864.2,"endTime":1866.78,"body":"cut and hanging out to like"},{"speaker":"Chris Dy","startTime":1864.2,"endTime":1866.78,"body":"dissect it out all nicely and"},{"speaker":"Chris Dy","startTime":1866.78,"endTime":1869.39,"body":"separate it but you can't"},{"speaker":"Chris Dy","startTime":1866.78,"endTime":1869.39,"body":"because you actually need those"},{"speaker":"Chris Dy","startTime":1869.39,"endTime":1873.32,"body":"surface cues of the median nerve"},{"speaker":"Chris Dy","startTime":1869.39,"endTime":1873.32,"body":"at that level is just right"},{"speaker":"Chris Dy","startTime":1873.32,"endTime":1875.69,"body":"underneath the epimedium of the"},{"speaker":"Chris Dy","startTime":1873.32,"endTime":1875.69,"body":"FDS. And that's a super"},{"speaker":"Chris Dy","startTime":1875.69,"endTime":1878.75,"body":"important clues. So you know"},{"speaker":"Chris Dy","startTime":1875.69,"endTime":1878.75,"body":"which ones are FDS is, and which"},{"speaker":"Chris Dy","startTime":1878.75,"endTime":1882.11,"body":"ones are FTPS. And then you're"},{"speaker":"Chris Dy","startTime":1878.75,"endTime":1882.11,"body":"relying at your carpal tunnel"},{"speaker":"Chris Dy","startTime":1882.11,"endTime":1885.68,"body":"level of kind of the classic,"},{"speaker":"Chris Dy","startTime":1882.11,"endTime":1885.68,"body":"you know, where your tendons are"},{"speaker":"Chris Dy","startTime":1885.68,"endTime":1889.16,"body":"lying in the carpal tunnel. So"},{"speaker":"Chris Dy","startTime":1885.68,"endTime":1889.16,"body":"and then obviously, you have the"},{"speaker":"Chris Dy","startTime":1889.16,"endTime":1892.49,"body":"accuser use, like pulling on the"},{"speaker":"Chris Dy","startTime":1889.16,"endTime":1892.49,"body":"individual tendons to see which"},{"speaker":"Chris Dy","startTime":1892.49,"endTime":1896.96,"body":"fingers are moving. But, you"},{"speaker":"Chris Dy","startTime":1892.49,"endTime":1896.96,"body":"know, going crazy and dissecting"},{"speaker":"Chris Dy","startTime":1896.96,"endTime":1899.45,"body":"out everything proximately it"},{"speaker":"Chris Dy","startTime":1896.96,"endTime":1899.45,"body":"will actually hurt you in the"},{"speaker":"Chris Dy","startTime":1899.45,"endTime":1899.69,"body":"end."},{"speaker":"Charles Goldfarb","startTime":1900.29,"endTime":1904.16,"body":"Really, really"},{"speaker":"Charles Goldfarb","startTime":1900.29,"endTime":1904.16,"body":"important point. And then"},{"speaker":"Charles Goldfarb","startTime":1904.16,"endTime":1908.57,"body":"depending on your level, you can"},{"speaker":"Charles Goldfarb","startTime":1904.16,"endTime":1908.57,"body":"choose to repair each of the FTP"},{"speaker":"Charles Goldfarb","startTime":1908.57,"endTime":1913.67,"body":"tenants individually or as a"},{"speaker":"Charles Goldfarb","startTime":1908.57,"endTime":1913.67,"body":"group, given the fact that they"},{"speaker":"Charles Goldfarb","startTime":1913.7,"endTime":1916.31,"body":"typically have one common muscle"},{"speaker":"Charles Goldfarb","startTime":1913.7,"endTime":1916.31,"body":"belly, there are exceptions to"},{"speaker":"Charles Goldfarb","startTime":1916.31,"endTime":1919.31,"body":"that as well. But I think that's"},{"speaker":"Charles Goldfarb","startTime":1916.31,"endTime":1919.31,"body":"right, you don't want to over"},{"speaker":"Charles Goldfarb","startTime":1919.31,"endTime":1923.12,"body":"dissect this. And so that's"},{"speaker":"Charles Goldfarb","startTime":1919.31,"endTime":1923.12,"body":"that's why I like you know, just"},{"speaker":"Charles Goldfarb","startTime":1923.12,"endTime":1926.06,"body":"going in putting your core"},{"speaker":"Charles Goldfarb","startTime":1923.12,"endTime":1926.06,"body":"stitches in and usually, uh, you"},{"speaker":"Charles Goldfarb","startTime":1926.06,"endTime":1928.94,"body":"know, sometimes I use a stereo"},{"speaker":"Charles Goldfarb","startTime":1926.06,"endTime":1928.94,"body":"chip with labels, but whatever"},{"speaker":"Charles Goldfarb","startTime":1928.94,"endTime":1932.33,"body":"you want to do, just try to"},{"speaker":"Charles Goldfarb","startTime":1928.94,"endTime":1932.33,"body":"leave as much as you can alone"},{"speaker":"Charles Goldfarb","startTime":1932.36,"endTime":1936.89,"body":"and then start deep work"},{"speaker":"Charles Goldfarb","startTime":1932.36,"endTime":1936.89,"body":"superficial nerves within that"},{"speaker":"Charles Goldfarb","startTime":1936.89,"endTime":1938.9,"body":"order of operations. Yeah,"},{"speaker":"Chris Dy","startTime":1938.93,"endTime":1942.2,"body":"to me, it's much it."},{"speaker":"Chris Dy","startTime":1938.93,"endTime":1942.2,"body":"It's, I think I remember Jim"},{"speaker":"Chris Dy","startTime":1942.2,"endTime":1945.98,"body":"Chang presenting about this. I"},{"speaker":"Chris Dy","startTime":1942.2,"endTime":1945.98,"body":"do like the nerdy part of me"},{"speaker":"Chris Dy","startTime":1945.98,"endTime":1951.38,"body":"wants to do the labels and all"},{"speaker":"Chris Dy","startTime":1945.98,"endTime":1951.38,"body":"this stuff. Practicality wise"},{"speaker":"Chris Dy","startTime":1951.41,"endTime":1953.81,"body":"repairs you go. If you can"},{"speaker":"Chris Dy","startTime":1951.41,"endTime":1953.81,"body":"repair as you go, like you're"},{"speaker":"Chris Dy","startTime":1953.81,"endTime":1956.3,"body":"saying, putting in your course"},{"speaker":"Chris Dy","startTime":1953.81,"endTime":1956.3,"body":"stitches, at least like that is"},{"speaker":"Chris Dy","startTime":1956.3,"endTime":1958.73,"body":"super helpful. Just get things"},{"speaker":"Chris Dy","startTime":1956.3,"endTime":1958.73,"body":"checked off the list, because"},{"speaker":"Chris Dy","startTime":1958.73,"endTime":1961.91,"body":"this case will take up as much"},{"speaker":"Chris Dy","startTime":1958.73,"endTime":1961.91,"body":"time as you give it. You know,"},{"speaker":"Chris Dy","startTime":1961.91,"endTime":1964.97,"body":"so if you want to move this"},{"speaker":"Chris Dy","startTime":1961.91,"endTime":1964.97,"body":"along efficiently, you need to"},{"speaker":"Chris Dy","startTime":1964.97,"endTime":1967.22,"body":"kind of get things going as"},{"speaker":"Chris Dy","startTime":1964.97,"endTime":1967.22,"body":"quickly as you can in terms of"},{"speaker":"Chris Dy","startTime":1967.22,"endTime":1969.53,"body":"knocking some of the repairs"},{"speaker":"Chris Dy","startTime":1967.22,"endTime":1969.53,"body":"out. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1969.53,"endTime":1971.15,"body":"I liked the"},{"speaker":"Charles Goldfarb","startTime":1969.53,"endTime":1971.15,"body":"way you said that. Because I"},{"speaker":"Charles Goldfarb","startTime":1971.15,"endTime":1974.9,"body":"know that when fellows first"},{"speaker":"Charles Goldfarb","startTime":1971.15,"endTime":1974.9,"body":"encounter this in the middle of"},{"speaker":"Charles Goldfarb","startTime":1974.9,"endTime":1978.86,"body":"the night, it can be a really"},{"speaker":"Charles Goldfarb","startTime":1974.9,"endTime":1978.86,"body":"long case. And this is one where"},{"speaker":"Charles Goldfarb","startTime":1979.01,"endTime":1981.98,"body":"you can do a great job, you can"},{"speaker":"Charles Goldfarb","startTime":1979.01,"endTime":1981.98,"body":"do it efficiently, but you have"},{"speaker":"Charles Goldfarb","startTime":1981.98,"endTime":1986.33,"body":"to really focus and go and so"},{"speaker":"Charles Goldfarb","startTime":1981.98,"endTime":1986.33,"body":"clearly you did that. When you"},{"speaker":"Charles Goldfarb","startTime":1986.33,"endTime":1990.53,"body":"evaluate your nerves, were you"},{"speaker":"Charles Goldfarb","startTime":1986.33,"endTime":1990.53,"body":"it was clearly I mean, it must"},{"speaker":"Charles Goldfarb","startTime":1990.53,"endTime":1993.02,"body":"have been apparent that you"},{"speaker":"Charles Goldfarb","startTime":1990.53,"endTime":1993.02,"body":"needed some some length, how"},{"speaker":"Charles Goldfarb","startTime":1993.02,"endTime":1997.76,"body":"much time how much, how many"},{"speaker":"Charles Goldfarb","startTime":1993.02,"endTime":1997.76,"body":"strands, and how much length did"},{"speaker":"Charles Goldfarb","startTime":1997.76,"endTime":1999.77,"body":"you do for your cable grafting,"},{"speaker":"Chris Dy","startTime":2000.07,"endTime":2002.23,"body":"the challenge of where"},{"speaker":"Chris Dy","startTime":2000.07,"endTime":2002.23,"body":"this nerve was cut is where the"},{"speaker":"Chris Dy","startTime":2002.23,"endTime":2004.78,"body":"median nerve starts to go for"},{"speaker":"Chris Dy","startTime":2002.23,"endTime":2004.78,"body":"more and more tubular structure"},{"speaker":"Chris Dy","startTime":2004.78,"endTime":2009.7,"body":"to start to fan out to a flatter"},{"speaker":"Chris Dy","startTime":2004.78,"endTime":2009.7,"body":"nerve. So this ended up being I"},{"speaker":"Chris Dy","startTime":2009.88,"endTime":2012.76,"body":"could have primarily repair this"},{"speaker":"Chris Dy","startTime":2009.88,"endTime":2012.76,"body":"nerve if I really wanted to keep"},{"speaker":"Chris Dy","startTime":2012.76,"endTime":2015.55,"body":"the wrist a little bit of"},{"speaker":"Chris Dy","startTime":2012.76,"endTime":2015.55,"body":"flexion. But that was not what I"},{"speaker":"Chris Dy","startTime":2015.55,"endTime":2018.07,"body":"wanted to do. Because I wanted"},{"speaker":"Chris Dy","startTime":2015.55,"endTime":2018.07,"body":"to make sure that I could get a"},{"speaker":"Chris Dy","startTime":2018.07,"endTime":2022.06,"body":"get tendons gliding past it and"},{"speaker":"Chris Dy","startTime":2018.07,"endTime":2022.06,"body":"be getting a decent going for"},{"speaker":"Chris Dy","startTime":2022.06,"endTime":2025.54,"body":"the tendons. So actually"},{"speaker":"Chris Dy","startTime":2022.06,"endTime":2025.54,"body":"measured my gap, I turned back"},{"speaker":"Chris Dy","startTime":2025.54,"endTime":2029.05,"body":"to healthy fast skulls measured"},{"speaker":"Chris Dy","startTime":2025.54,"endTime":2029.05,"body":"my gap with the wrist, extended"},{"speaker":"Chris Dy","startTime":2029.05,"endTime":2032.11,"body":"over a bump in the fingers and"},{"speaker":"Chris Dy","startTime":2029.05,"endTime":2032.11,"body":"extension. So I would be super"},{"speaker":"Chris Dy","startTime":2032.11,"endTime":2034.42,"body":"sure to know what my median and"},{"speaker":"Chris Dy","startTime":2032.11,"endTime":2034.42,"body":"ulnar nerve gaps were going to"},{"speaker":"Chris Dy","startTime":2034.42,"endTime":2037.12,"body":"be. An immediate nerve gap was"},{"speaker":"Chris Dy","startTime":2034.42,"endTime":2037.12,"body":"not big and ended up being about"},{"speaker":"Chris Dy","startTime":2037.12,"endTime":2039.13,"body":"a centimeter and a half the"},{"speaker":"Chris Dy","startTime":2037.12,"endTime":2039.13,"body":"owner of gap was about two and a"},{"speaker":"Chris Dy","startTime":2039.13,"endTime":2042.76,"body":"half centimeters. So not huge,"},{"speaker":"Chris Dy","startTime":2039.13,"endTime":2042.76,"body":"but you know, so the ulnar nerve"},{"speaker":"Chris Dy","startTime":2042.76,"endTime":2045.07,"body":"ended up being like a really"},{"speaker":"Chris Dy","startTime":2042.76,"endTime":2045.07,"body":"nice kind of three cable size"},{"speaker":"Chris Dy","startTime":2045.07,"endTime":2048.64,"body":"from several. And the median"},{"speaker":"Chris Dy","startTime":2045.07,"endTime":2048.64,"body":"nerve, just based on the width"},{"speaker":"Chris Dy","startTime":2048.79,"endTime":2052.48,"body":"was five, I could have gotten"},{"speaker":"Chris Dy","startTime":2048.79,"endTime":2052.48,"body":"four, but I liked five, and that"},{"speaker":"Chris Dy","startTime":2052.6,"endTime":2054.91,"body":"that's bigger than I typically"},{"speaker":"Chris Dy","startTime":2052.6,"endTime":2054.91,"body":"would use. But just because the"},{"speaker":"Chris Dy","startTime":2054.91,"endTime":2057.19,"body":"nerve is fanning out at that"},{"speaker":"Chris Dy","startTime":2054.91,"endTime":2057.19,"body":"point, I wanted to provide a lot"},{"speaker":"Chris Dy","startTime":2057.19,"endTime":2061.93,"body":"of tubes for that, for that"},{"speaker":"Chris Dy","startTime":2057.19,"endTime":2061.93,"body":"nerve to grow down. The tricky"},{"speaker":"Chris Dy","startTime":2061.93,"endTime":2064.81,"body":"part about this one is that you"},{"speaker":"Chris Dy","startTime":2061.93,"endTime":2064.81,"body":"know, I did leave the location"},{"speaker":"Chris Dy","startTime":2064.81,"endTime":2070.63,"body":"and laceration was proximal"},{"speaker":"Chris Dy","startTime":2064.81,"endTime":2070.63,"body":"enough where I didn't coincide"},{"speaker":"Chris Dy","startTime":2070.63,"endTime":2073.21,"body":"with my carpal tunnel incision."},{"speaker":"Chris Dy","startTime":2070.63,"endTime":2073.21,"body":"And also the gowns cannot"},{"speaker":"Chris Dy","startTime":2073.21,"endTime":2077.26,"body":"release. But the you know,"},{"speaker":"Chris Dy","startTime":2073.21,"endTime":2077.26,"body":"there's a skin bridge and of"},{"speaker":"Chris Dy","startTime":2077.26,"endTime":2079.54,"body":"course the tendons had to come"},{"speaker":"Chris Dy","startTime":2077.26,"endTime":2079.54,"body":"underneath the skin bridge,"},{"speaker":"Chris Dy","startTime":2079.54,"endTime":2081.52,"body":"they're attracted back in the"},{"speaker":"Chris Dy","startTime":2079.54,"endTime":2081.52,"body":"carpal tunnel. So I ended up"},{"speaker":"Chris Dy","startTime":2081.82,"endTime":2085.24,"body":"putting some sutures in the"},{"speaker":"Chris Dy","startTime":2081.82,"endTime":2085.24,"body":"tendons where I could find them"},{"speaker":"Chris Dy","startTime":2085.24,"endTime":2087.61,"body":"in the carpal tunnel and then"},{"speaker":"Chris Dy","startTime":2085.24,"endTime":2087.61,"body":"pulling those underneath the"},{"speaker":"Chris Dy","startTime":2087.61,"endTime":2090.94,"body":"skin bridge into the proximal"},{"speaker":"Chris Dy","startTime":2087.61,"endTime":2090.94,"body":"wound in shuttling them and in"},{"speaker":"Chris Dy","startTime":2090.94,"endTime":2093.73,"body":"the process of shuttling them"},{"speaker":"Chris Dy","startTime":2090.94,"endTime":2093.73,"body":"that kind of disrupted the"},{"speaker":"Chris Dy","startTime":2093.73,"endTime":2097.54,"body":"contents of my the topography of"},{"speaker":"Chris Dy","startTime":2093.73,"endTime":2097.54,"body":"my carpal tunnel. So now my"},{"speaker":"Chris Dy","startTime":2097.54,"endTime":2101.38,"body":"median nerve took this like"},{"speaker":"Chris Dy","startTime":2097.54,"endTime":2101.38,"body":"weird turn down Deep. So then I"},{"speaker":"Chris Dy","startTime":2101.38,"endTime":2103.57,"body":"had to do the same thing and"},{"speaker":"Chris Dy","startTime":2101.38,"endTime":2103.57,"body":"essentially reorder the carpal"},{"speaker":"Chris Dy","startTime":2103.57,"endTime":2107.83,"body":"tunnel, so that the median or"},{"speaker":"Chris Dy","startTime":2103.57,"endTime":2107.83,"body":"was sitting was sitting vole"},{"speaker":"Chris Dy","startTime":2107.83,"endTime":2111.25,"body":"early again. So again had to put"},{"speaker":"Chris Dy","startTime":2107.83,"endTime":2111.25,"body":"a put a like a little six"},{"speaker":"Chris Dy","startTime":2111.28,"endTime":2114.49,"body":"Prolene in the epithelium before"},{"speaker":"Chris Dy","startTime":2111.28,"endTime":2114.49,"body":"trimming back, and then"},{"speaker":"Chris Dy","startTime":2114.49,"endTime":2117.07,"body":"shuttling that underneath the"},{"speaker":"Chris Dy","startTime":2114.49,"endTime":2117.07,"body":"skin on top of the tendons that"},{"speaker":"Chris Dy","startTime":2117.07,"endTime":2120.31,"body":"are shuttled through, it was so"},{"speaker":"Chris Dy","startTime":2117.07,"endTime":2120.31,"body":"painful, but in at the end of"},{"speaker":"Chris Dy","startTime":2120.31,"endTime":2122.05,"body":"day, I was happy that taken"},{"speaker":"Chris Dy","startTime":2120.31,"endTime":2122.05,"body":"those little things, because"},{"speaker":"Chris Dy","startTime":2122.05,"endTime":2124.42,"body":"then the nerve has a much"},{"speaker":"Chris Dy","startTime":2122.05,"endTime":2124.42,"body":"smoother course along the way."},{"speaker":"Chris Dy","startTime":2124.66,"endTime":2127.03,"body":"And then repairing attendance,"},{"speaker":"Chris Dy","startTime":2124.66,"endTime":2127.03,"body":"I'd love to know what you do, I"},{"speaker":"Chris Dy","startTime":2127.03,"endTime":2131.05,"body":"was using up being a little bit"},{"speaker":"Chris Dy","startTime":2127.03,"endTime":2131.05,"body":"of a kind of a modified, which"},{"speaker":"Chris Dy","startTime":2131.05,"endTime":2133.48,"body":"was government at that point as"},{"speaker":"Chris Dy","startTime":2131.05,"endTime":2133.48,"body":"being modified casters maybe"},{"speaker":"Chris Dy","startTime":2133.48,"endTime":2135.7,"body":"reinforced with the horizontal"},{"speaker":"Chris Dy","startTime":2133.48,"endTime":2135.7,"body":"mattress, just getting really"},{"speaker":"Chris Dy","startTime":2135.7,"endTime":2137.68,"body":"good stitches, at least four"},{"speaker":"Chris Dy","startTime":2135.7,"endTime":2137.68,"body":"strands, and each of them it's"},{"speaker":"Chris Dy","startTime":2137.68,"endTime":2141.55,"body":"not zoned to, but you still want"},{"speaker":"Chris Dy","startTime":2137.68,"endTime":2141.55,"body":"to get stout repairs."},{"speaker":"Charles Goldfarb","startTime":2142.18,"endTime":2143.41,"body":"Yeah, I agree"},{"speaker":"Charles Goldfarb","startTime":2142.18,"endTime":2143.41,"body":"with everything that you know"},{"speaker":"Charles Goldfarb","startTime":2143.41,"endTime":2146.38,"body":"those tendons can be variable"},{"speaker":"Charles Goldfarb","startTime":2143.41,"endTime":2146.38,"body":"size in that part of the"},{"speaker":"Charles Goldfarb","startTime":2146.38,"endTime":2149.08,"body":"forearm, depending on which team"},{"speaker":"Charles Goldfarb","startTime":2146.38,"endTime":2149.08,"body":"you're talking about. And so I"},{"speaker":"Charles Goldfarb","startTime":2149.08,"endTime":2152.2,"body":"agree it's four to six strands"},{"speaker":"Charles Goldfarb","startTime":2149.08,"endTime":2152.2,"body":"if you can, don't mind it all"},{"speaker":"Charles Goldfarb","startTime":2152.2,"endTime":2154.87,"body":"the external horizontal"},{"speaker":"Charles Goldfarb","startTime":2152.2,"endTime":2154.87,"body":"mattress, I think that's a nice"},{"speaker":"Charles Goldfarb","startTime":2154.87,"endTime":2157.54,"body":"way to get a little more"},{"speaker":"Charles Goldfarb","startTime":2154.87,"endTime":2157.54,"body":"strength. And three over to me"},{"speaker":"Charles Goldfarb","startTime":2157.54,"endTime":2160.87,"body":"feels completely fine. I have to"},{"speaker":"Charles Goldfarb","startTime":2157.54,"endTime":2160.87,"body":"say, I don't know that I would"},{"speaker":"Charles Goldfarb","startTime":2160.87,"endTime":2163.27,"body":"have done any shuttling I"},{"speaker":"Charles Goldfarb","startTime":2160.87,"endTime":2163.27,"body":"probably would have just opened"},{"speaker":"Charles Goldfarb","startTime":2163.27,"endTime":2170.05,"body":"things up. But Bravo. And yeah,"},{"speaker":"Charles Goldfarb","startTime":2163.27,"endTime":2170.05,"body":"it's it's a good case. When When"},{"speaker":"Charles Goldfarb","startTime":2170.05,"endTime":2174.34,"body":"do you and maybe we should close"},{"speaker":"Charles Goldfarb","startTime":2170.05,"endTime":2174.34,"body":"this episode down. But what do"},{"speaker":"Charles Goldfarb","startTime":2174.34,"endTime":2177.97,"body":"you tell the patient six months"},{"speaker":"Charles Goldfarb","startTime":2174.34,"endTime":2177.97,"body":"a year for quote unquote, full"},{"speaker":"Charles Goldfarb","startTime":2177.97,"endTime":2178.57,"body":"recovery?"},{"speaker":"Chris Dy","startTime":2179.5,"endTime":2181.78,"body":"Um, you know, I'd"},{"speaker":"Chris Dy","startTime":2179.5,"endTime":2181.78,"body":"expect to get the attendance"},{"speaker":"Chris Dy","startTime":2181.78,"endTime":2185.2,"body":"kind of where, where they should"},{"speaker":"Chris Dy","startTime":2181.78,"endTime":2185.2,"body":"be by about six to eight weeks."},{"speaker":"Chris Dy","startTime":2185.86,"endTime":2187.78,"body":"You know, that's a little"},{"speaker":"Chris Dy","startTime":2185.86,"endTime":2187.78,"body":"aggressive on the timeline. And"},{"speaker":"Chris Dy","startTime":2187.78,"endTime":2190.78,"body":"then the nerves take, I always"},{"speaker":"Chris Dy","startTime":2187.78,"endTime":2190.78,"body":"tell people just nerves take the"},{"speaker":"Chris Dy","startTime":2190.78,"endTime":2194.17,"body":"better part of a year, just"},{"speaker":"Chris Dy","startTime":2190.78,"endTime":2194.17,"body":"pretty generically. You know, I"},{"speaker":"Chris Dy","startTime":2194.32,"endTime":2196.87,"body":"won't get into these details."},{"speaker":"Chris Dy","startTime":2194.32,"endTime":2196.87,"body":"But I did add a sensory nerve"},{"speaker":"Chris Dy","startTime":2196.87,"endTime":2200.47,"body":"transfer from the radial side,"},{"speaker":"Chris Dy","startTime":2196.87,"endTime":2200.47,"body":"the the radial distribution on"},{"speaker":"Chris Dy","startTime":2200.47,"endTime":2205.21,"body":"the radial side of the index"},{"speaker":"Chris Dy","startTime":2200.47,"endTime":2205.21,"body":"dorsum to the proper index,"},{"speaker":"Chris Dy","startTime":2205.21,"endTime":2208.99,"body":"digital nerve on the radial"},{"speaker":"Chris Dy","startTime":2205.21,"endTime":2208.99,"body":"side, and then for the thumb on"},{"speaker":"Chris Dy","startTime":2208.99,"endTime":2212.38,"body":"the other side, for the dorsal"},{"speaker":"Chris Dy","startTime":2208.99,"endTime":2212.38,"body":"owner thumb to get some pinch"},{"speaker":"Chris Dy","startTime":2212.38,"endTime":2215.83,"body":"surface going. And that I think,"},{"speaker":"Chris Dy","startTime":2212.38,"endTime":2215.83,"body":"is just the way to get things"},{"speaker":"Chris Dy","startTime":2215.83,"endTime":2218.95,"body":"moving earlier, in terms of"},{"speaker":"Chris Dy","startTime":2215.83,"endTime":2218.95,"body":"recovery, because I have really"},{"speaker":"Chris Dy","startTime":2218.95,"endTime":2221.65,"body":"had no options to do nerve"},{"speaker":"Chris Dy","startTime":2218.95,"endTime":2221.65,"body":"transfer stuff for 13 hours or"},{"speaker":"Chris Dy","startTime":2221.65,"endTime":2225.22,"body":"for for the other intrinsics. So"},{"speaker":"Chris Dy","startTime":2221.65,"endTime":2225.22,"body":"I'm relying on the grafts for"},{"speaker":"Chris Dy","startTime":2225.22,"endTime":2228.13,"body":"that. But yeah, overall the"},{"speaker":"Chris Dy","startTime":2225.22,"endTime":2228.13,"body":"nerves I tell them, you know,"},{"speaker":"Chris Dy","startTime":2228.13,"endTime":2230.62,"body":"better part of the year and then"},{"speaker":"Chris Dy","startTime":2228.13,"endTime":2230.62,"body":"hopefully we'll get things"},{"speaker":"Chris Dy","startTime":2230.62,"endTime":2232.93,"body":"moving along with therapy pretty"},{"speaker":"Chris Dy","startTime":2230.62,"endTime":2232.93,"body":"quickly within the first few"},{"speaker":"Chris Dy","startTime":2232.93,"endTime":2234.22,"body":"months. And"},{"speaker":"Charles Goldfarb","startTime":2234.22,"endTime":2236.62,"body":"you send them"},{"speaker":"Charles Goldfarb","startTime":2234.22,"endTime":2236.62,"body":"to therapy, how quickly do you"},{"speaker":"Charles Goldfarb","startTime":2236.62,"endTime":2237.55,"body":"start therapy,"},{"speaker":"Chris Dy","startTime":2238.0,"endTime":2240.67,"body":"I'm going to see him"},{"speaker":"Chris Dy","startTime":2238.0,"endTime":2240.67,"body":"back pretty soon. And we're"},{"speaker":"Chris Dy","startTime":2240.67,"endTime":2243.07,"body":"going to do therapy within the"},{"speaker":"Chris Dy","startTime":2240.67,"endTime":2243.07,"body":"first week for finger range of"},{"speaker":"Chris Dy","startTime":2243.07,"endTime":2246.43,"body":"motion, left DLR and a dorsal"},{"speaker":"Chris Dy","startTime":2243.07,"endTime":2246.43,"body":"blocking splint, you know, for"},{"speaker":"Chris Dy","startTime":2246.43,"endTime":2249.7,"body":"the wrist, forearm based"},{"speaker":"Chris Dy","startTime":2246.43,"endTime":2249.7,"body":"dorsally blocking the wrist and"},{"speaker":"Chris Dy","startTime":2249.85,"endTime":2253.93,"body":"neutral that we did the the"},{"speaker":"Chris Dy","startTime":2249.85,"endTime":2253.93,"body":"nerves in extension. And then"},{"speaker":"Chris Dy","startTime":2253.93,"endTime":2256.42,"body":"also extending with outriggers"},{"speaker":"Chris Dy","startTime":2253.93,"endTime":2256.42,"body":"for the thumb and the fingers"},{"speaker":"Chris Dy","startTime":2256.42,"endTime":2259.72,"body":"just to keep them in a position"},{"speaker":"Chris Dy","startTime":2256.42,"endTime":2259.72,"body":"of comfort. So then we'll start"},{"speaker":"Chris Dy","startTime":2259.72,"endTime":2262.69,"body":"some some passive motion for the"},{"speaker":"Chris Dy","startTime":2259.72,"endTime":2262.69,"body":"fingers pretty soon."},{"speaker":"Charles Goldfarb","startTime":2263.92,"endTime":2267.22,"body":"Love it. Love"},{"speaker":"Charles Goldfarb","startTime":2263.92,"endTime":2267.22,"body":"it. Okay. I'm sure we it's"},{"speaker":"Charles Goldfarb","startTime":2267.22,"endTime":2269.38,"body":"interesting that you and I"},{"speaker":"Charles Goldfarb","startTime":2267.22,"endTime":2269.38,"body":"probably underestimated how much"},{"speaker":"Charles Goldfarb","startTime":2269.38,"endTime":2272.89,"body":"there was to talk about here,"},{"speaker":"Charles Goldfarb","startTime":2269.38,"endTime":2272.89,"body":"but I think we got most of it"},{"speaker":"Charles Goldfarb","startTime":2272.89,"endTime":2275.35,"body":"covered. We could certainly that"},{"speaker":"Charles Goldfarb","startTime":2272.89,"endTime":2275.35,"body":"sensory transfers are"},{"speaker":"Charles Goldfarb","startTime":2275.35,"endTime":2277.75,"body":"interesting, but maybe for"},{"speaker":"Charles Goldfarb","startTime":2275.35,"endTime":2277.75,"body":"another episode. Yeah,"},{"speaker":"Chris Dy","startTime":2277.75,"endTime":2281.62,"body":"it's super nice, super"},{"speaker":"Chris Dy","startTime":2277.75,"endTime":2281.62,"body":"nerdy. We can definitely talk"},{"speaker":"Chris Dy","startTime":2281.62,"endTime":2285.1,"body":"about it all the time. But yeah,"},{"speaker":"Chris Dy","startTime":2281.62,"endTime":2285.1,"body":"and I loved I love this case."},{"speaker":"Chris Dy","startTime":2285.1,"endTime":2288.04,"body":"Yes. Was one things. It's fun to"},{"speaker":"Chris Dy","startTime":2285.1,"endTime":2288.04,"body":"do while you're doing it. You"},{"speaker":"Chris Dy","startTime":2288.04,"endTime":2289.75,"body":"just don't want it to take too"},{"speaker":"Chris Dy","startTime":2288.04,"endTime":2289.75,"body":"long because then it becomes"},{"speaker":"Chris Dy","startTime":2289.75,"endTime":2290.17,"body":"less fun."},{"speaker":"Charles Goldfarb","startTime":2291.04,"endTime":2293.11,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":2291.04,"endTime":2293.11,"body":"exactly right. All right. Well,"},{"speaker":"Charles Goldfarb","startTime":2293.11,"endTime":2296.02,"body":"this has been fun, and I look"},{"speaker":"Charles Goldfarb","startTime":2293.11,"endTime":2296.02,"body":"forward to talking next time."},{"speaker":"Charles Goldfarb","startTime":2296.26,"endTime":2300.31,"body":"All right, catch you next time."},{"speaker":"Charles Goldfarb","startTime":2296.26,"endTime":2300.31,"body":"Hey, Chris, that was fun. Let's"},{"speaker":"Charles Goldfarb","startTime":2300.31,"endTime":2301.24,"body":"do it again real soon."},{"speaker":"Chris Dy","startTime":2301.24,"endTime":2303.81,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2301.24,"endTime":2303.81,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2303.859,"endTime":2306.43,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2303.859,"endTime":2306.43,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2306.43,"endTime":2309.64,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2306.43,"endTime":2309.64,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2309.64,"endTime":2313.098,"body":"Mine is @ChrisDYMD"},{"speaker":"Chris Dy","startTime":2309.64,"endTime":2313.098,"body":"spelled d-y. And if you'd like"},{"speaker":"Chris Dy","startTime":2313.168,"endTime":2317.05,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2313.168,"endTime":2317.05,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2317.59,"endTime":2319.72,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2317.59,"endTime":2319.72,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2319.72,"endTime":2320.83,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2320.86,"endTime":2323.08,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2320.86,"endTime":2323.08,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2323.08,"endTime":2323.47,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2323.86,"endTime":2326.14,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2323.86,"endTime":2326.14,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2326.14,"endTime":2330.13,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2326.14,"endTime":2330.13,"body":"upper hand. Come back next time"}]}