{"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 Talk Hand"},{"speaker":"Charles Goldfarb","startTime":6.0,"endTime":7.53,"body":"Surgery."},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":17.43,"endTime":19.17,"body":"podcasts. 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":23.58,"body":"a rating wherever you get your"},{"speaker":"Chris Dy","startTime":21.57,"endTime":23.58,"body":"podcast."},{"speaker":"Charles Goldfarb","startTime":25.38,"endTime":26.43,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":25.38,"endTime":26.43,"body":"Chris."},{"speaker":"Chris Dy","startTime":26.61,"endTime":27.54,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":26.61,"endTime":27.54,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":28.11,"endTime":30.57,"body":"If fantastic,"},{"speaker":"Charles Goldfarb","startTime":28.11,"endTime":30.57,"body":"here we are again."},{"speaker":"Chris Dy","startTime":30.78,"endTime":32.49,"body":"I didn't realize we"},{"speaker":"Chris Dy","startTime":30.78,"endTime":32.49,"body":"were dressing up for the"},{"speaker":"Chris Dy","startTime":32.49,"endTime":36.69,"body":"podcast. I'm here in a nice long"},{"speaker":"Chris Dy","startTime":32.49,"endTime":36.69,"body":"sleeve tee. You know, but some"},{"speaker":"Chris Dy","startTime":36.69,"endTime":38.07,"body":"of us are wearing ties,"},{"speaker":"Chris Dy","startTime":36.69,"endTime":38.07,"body":"apparently."},{"speaker":"Charles Goldfarb","startTime":38.25,"endTime":40.35,"body":"Well, I'm"},{"speaker":"Charles Goldfarb","startTime":38.25,"endTime":40.35,"body":"trying to up our game. You know,"},{"speaker":"Charles Goldfarb","startTime":40.35,"endTime":44.04,"body":"if we can't do it verbally, we"},{"speaker":"Charles Goldfarb","startTime":40.35,"endTime":44.04,"body":"got to do YouTube, apparently."},{"speaker":"Charles Goldfarb","startTime":44.04,"endTime":44.61,"body":"Exactly."},{"speaker":"Chris Dy","startTime":44.64,"endTime":46.5,"body":"But I guess we're on"},{"speaker":"Chris Dy","startTime":44.64,"endTime":46.5,"body":"YouTube. So I keep forgetting"},{"speaker":"Chris Dy","startTime":46.5,"endTime":48.93,"body":"that. I told you how my son"},{"speaker":"Chris Dy","startTime":46.5,"endTime":48.93,"body":"asked about Yeah, I think we"},{"speaker":"Chris Dy","startTime":48.93,"endTime":51.51,"body":"talked about this a few episodes"},{"speaker":"Chris Dy","startTime":48.93,"endTime":51.51,"body":"ago about finding me on YouTube."},{"speaker":"Chris Dy","startTime":51.51,"endTime":57.18,"body":"And he had another fellow a"},{"speaker":"Chris Dy","startTime":51.51,"endTime":57.18,"body":"fellow dad at his school Pull me"},{"speaker":"Chris Dy","startTime":57.18,"endTime":59.85,"body":"up just to confirm that it was"},{"speaker":"Chris Dy","startTime":57.18,"endTime":59.85,"body":"indeed on YouTube."},{"speaker":"Charles Goldfarb","startTime":61.08,"endTime":63.09,"body":"Well, he needs"},{"speaker":"Charles Goldfarb","startTime":61.08,"endTime":63.09,"body":"verification, he can just"},{"speaker":"Charles Goldfarb","startTime":63.09,"endTime":64.35,"body":"believe you. Yeah,"},{"speaker":"Chris Dy","startTime":64.349,"endTime":66.179,"body":"he also told me he"},{"speaker":"Chris Dy","startTime":64.349,"endTime":66.179,"body":"wants to be a YouTuber when he"},{"speaker":"Chris Dy","startTime":66.179,"endTime":69.059,"body":"grows up. So I'm not sure we're"},{"speaker":"Chris Dy","startTime":66.179,"endTime":69.059,"body":"going down the right path."},{"speaker":"Charles Goldfarb","startTime":69.18,"endTime":71.31,"body":"Hey I think"},{"speaker":"Charles Goldfarb","startTime":69.18,"endTime":71.31,"body":"he's probably smart. It's funny."},{"speaker":"Charles Goldfarb","startTime":71.31,"endTime":74.37,"body":"I you know, you I'm sure you get"},{"speaker":"Charles Goldfarb","startTime":71.31,"endTime":74.37,"body":"the same email. Those are all"},{"speaker":"Charles Goldfarb","startTime":74.37,"endTime":76.56,"body":"our listeners get the same"},{"speaker":"Charles Goldfarb","startTime":74.37,"endTime":76.56,"body":"emails about different things."},{"speaker":"Charles Goldfarb","startTime":76.56,"endTime":79.83,"body":"But Chris, and I get a lot of"},{"speaker":"Charles Goldfarb","startTime":76.56,"endTime":79.83,"body":"podcast emails, saying you know,"},{"speaker":"Charles Goldfarb","startTime":79.83,"endTime":82.89,"body":"we can help you optimize the"},{"speaker":"Charles Goldfarb","startTime":79.83,"endTime":82.89,"body":"ones about how to optimize"},{"speaker":"Charles Goldfarb","startTime":82.89,"endTime":86.22,"body":"YouTube always catch my eye I"},{"speaker":"Charles Goldfarb","startTime":82.89,"endTime":86.22,"body":"have yet to click on them feels"},{"speaker":"Charles Goldfarb","startTime":86.22,"endTime":87.27,"body":"like clickbait. But"},{"speaker":"Chris Dy","startTime":87.27,"endTime":89.52,"body":"yeah, absolutely. You"},{"speaker":"Chris Dy","startTime":87.27,"endTime":89.52,"body":"know, I think we put out a call"},{"speaker":"Chris Dy","startTime":89.52,"endTime":92.4,"body":"to the WashU undergraduates, but"},{"speaker":"Chris Dy","startTime":89.52,"endTime":92.4,"body":"if there's anybody that wants to"},{"speaker":"Chris Dy","startTime":92.4,"endTime":95.4,"body":"be a marketing, social media"},{"speaker":"Chris Dy","startTime":92.4,"endTime":95.4,"body":"intern for the upper hand,"},{"speaker":"Chris Dy","startTime":95.4,"endTime":97.86,"body":"please step up. Or if you know,"},{"speaker":"Chris Dy","startTime":95.4,"endTime":97.86,"body":"pre med who might be interested,"},{"speaker":"Chris Dy","startTime":97.86,"endTime":98.46,"body":"let us know."},{"speaker":"Charles Goldfarb","startTime":98.82,"endTime":101.1,"body":"Yeah, that is"},{"speaker":"Charles Goldfarb","startTime":98.82,"endTime":101.1,"body":"true. We did have an intern for"},{"speaker":"Charles Goldfarb","startTime":101.1,"endTime":102.45,"body":"a while was that year, too?"},{"speaker":"Chris Dy","startTime":102.6,"endTime":104.76,"body":"Yeah, that was year"},{"speaker":"Chris Dy","startTime":102.6,"endTime":104.76,"body":"two, that was back in the day."},{"speaker":"Chris Dy","startTime":105.33,"endTime":107.1,"body":"So why are you so dressed up?"},{"speaker":"Charles Goldfarb","startTime":107.58,"endTime":111.21,"body":"So I was I"},{"speaker":"Charles Goldfarb","startTime":107.58,"endTime":111.21,"body":"don't think it's top secret. I"},{"speaker":"Charles Goldfarb","startTime":111.21,"endTime":116.46,"body":"was the dean. You know, it's"},{"speaker":"Charles Goldfarb","startTime":111.21,"endTime":116.46,"body":"interesting. I feel a little old"},{"speaker":"Charles Goldfarb","startTime":116.46,"endTime":118.77,"body":"school because first of all, I"},{"speaker":"Charles Goldfarb","startTime":116.46,"endTime":118.77,"body":"don't I don't usually dress up"},{"speaker":"Charles Goldfarb","startTime":118.8,"endTime":121.95,"body":"anymore at all. And, you know,"},{"speaker":"Charles Goldfarb","startTime":118.8,"endTime":121.95,"body":"when the Dean asked you to do"},{"speaker":"Charles Goldfarb","startTime":121.95,"endTime":126.33,"body":"something, you do it. And here"},{"speaker":"Charles Goldfarb","startTime":121.95,"endTime":126.33,"body":"at Washington men, and as the"},{"speaker":"Charles Goldfarb","startTime":126.33,"endTime":130.35,"body":"dean asked me to be part of a"},{"speaker":"Charles Goldfarb","startTime":126.33,"endTime":130.35,"body":"small group, in a chair"},{"speaker":"Charles Goldfarb","startTime":130.38,"endTime":133.32,"body":"Evaluation Session. So what the"},{"speaker":"Charles Goldfarb","startTime":130.38,"endTime":133.32,"body":"way it works at Wash U as it"},{"speaker":"Charles Goldfarb","startTime":133.32,"endTime":136.77,"body":"works in many academic academic"},{"speaker":"Charles Goldfarb","startTime":133.32,"endTime":136.77,"body":"institutions is every five"},{"speaker":"Charles Goldfarb","startTime":136.77,"endTime":140.28,"body":"years, a department is reviewed."},{"speaker":"Charles Goldfarb","startTime":136.77,"endTime":140.28,"body":"And in doing so you review the"},{"speaker":"Charles Goldfarb","startTime":140.28,"endTime":144.51,"body":"chair. And it's very, very"},{"speaker":"Charles Goldfarb","startTime":140.28,"endTime":144.51,"body":"informative. And there's usually"},{"speaker":"Charles Goldfarb","startTime":144.51,"endTime":148.26,"body":"a few visiting chairs from other"},{"speaker":"Charles Goldfarb","startTime":144.51,"endTime":148.26,"body":"departments. And so I won't give"},{"speaker":"Charles Goldfarb","startTime":148.26,"endTime":151.17,"body":"too much information about this"},{"speaker":"Charles Goldfarb","startTime":148.26,"endTime":151.17,"body":"because so I dressed up, I wore"},{"speaker":"Charles Goldfarb","startTime":151.17,"endTime":154.32,"body":"suit yesterday, and I dressed up"},{"speaker":"Charles Goldfarb","startTime":151.17,"endTime":154.32,"body":"today, it was fascinating"},{"speaker":"Charles Goldfarb","startTime":154.32,"endTime":157.65,"body":"process, you really learn a ton"},{"speaker":"Charles Goldfarb","startTime":154.32,"endTime":157.65,"body":"about your own institution, and"},{"speaker":"Charles Goldfarb","startTime":157.65,"endTime":161.25,"body":"about this process. So I liked"},{"speaker":"Charles Goldfarb","startTime":157.65,"endTime":161.25,"body":"it. And I was laughing because I"},{"speaker":"Charles Goldfarb","startTime":161.25,"endTime":164.13,"body":"got I got there this morning."},{"speaker":"Charles Goldfarb","startTime":161.25,"endTime":164.13,"body":"Yesterday, I wore suit. And I"},{"speaker":"Charles Goldfarb","startTime":164.13,"endTime":166.62,"body":"had to prepare the night before"},{"speaker":"Charles Goldfarb","startTime":164.13,"endTime":166.62,"body":"because you know, I'm sneaking"},{"speaker":"Charles Goldfarb","startTime":166.62,"endTime":169.8,"body":"out of the bedroom. Try not to"},{"speaker":"Charles Goldfarb","startTime":166.62,"endTime":169.8,"body":"wake my wife. And so this"},{"speaker":"Charles Goldfarb","startTime":169.8,"endTime":172.95,"body":"morning, I was less prepared. I"},{"speaker":"Charles Goldfarb","startTime":169.8,"endTime":172.95,"body":"got in the car and realized I"},{"speaker":"Charles Goldfarb","startTime":172.95,"endTime":176.4,"body":"didn't have a belt. It wasn't"},{"speaker":"Charles Goldfarb","startTime":172.95,"endTime":176.4,"body":"the shoes I intended to wear."},{"speaker":"Chris Dy","startTime":177.57,"endTime":179.49,"body":"Did you at least have"},{"speaker":"Chris Dy","startTime":177.57,"endTime":179.49,"body":"matching shoes, because that's"},{"speaker":"Chris Dy","startTime":179.49,"endTime":180.36,"body":"happened to some people."},{"speaker":"Charles Goldfarb","startTime":181.62,"endTime":183.99,"body":"I wasn't it"},{"speaker":"Charles Goldfarb","startTime":181.62,"endTime":183.99,"body":"wasn't terrible. I was laughing"},{"speaker":"Charles Goldfarb","startTime":183.99,"endTime":186.36,"body":"to myself. So others joined him."},{"speaker":"Charles Goldfarb","startTime":183.99,"endTime":186.36,"body":"But I don't know that anyone"},{"speaker":"Charles Goldfarb","startTime":186.36,"endTime":188.1,"body":"would have noticed that I hadn't"},{"speaker":"Charles Goldfarb","startTime":186.36,"endTime":188.1,"body":"said anything."},{"speaker":"Chris Dy","startTime":188.4,"endTime":192.06,"body":"Oh my gosh, there was"},{"speaker":"Chris Dy","startTime":188.4,"endTime":192.06,"body":"one day when I was a fellow. I"},{"speaker":"Chris Dy","startTime":192.06,"endTime":196.05,"body":"always kept a spare set of"},{"speaker":"Chris Dy","startTime":192.06,"endTime":196.05,"body":"clothes in the car. Because you"},{"speaker":"Chris Dy","startTime":196.05,"endTime":199.56,"body":"never know on call. You never"},{"speaker":"Chris Dy","startTime":196.05,"endTime":199.56,"body":"know what's gonna happen. So I"},{"speaker":"Chris Dy","startTime":199.56,"endTime":202.74,"body":"thought I had it ready to go."},{"speaker":"Chris Dy","startTime":199.56,"endTime":202.74,"body":"And I had to do a case"},{"speaker":"Chris Dy","startTime":202.74,"endTime":207.03,"body":"overnight. And I had clinic with"},{"speaker":"Chris Dy","startTime":202.74,"endTime":207.03,"body":"Dr. gelderman the next day. Oh,"},{"speaker":"Chris Dy","startTime":207.36,"endTime":212.76,"body":"and I had to close didn't have"},{"speaker":"Chris Dy","startTime":207.36,"endTime":212.76,"body":"the shoes. So then it all the"},{"speaker":"Chris Dy","startTime":212.76,"endTime":216.27,"body":"entire clinic was about how I"},{"speaker":"Chris Dy","startTime":212.76,"endTime":216.27,"body":"was wearing joggers in the"},{"speaker":"Chris Dy","startTime":216.27,"endTime":219.24,"body":"clinic. I mean, I just And if"},{"speaker":"Chris Dy","startTime":216.27,"endTime":219.24,"body":"you've ever been in clinic with"},{"speaker":"Chris Dy","startTime":219.24,"endTime":221.46,"body":"Dr. Gelberman, and you know that"},{"speaker":"Chris Dy","startTime":219.24,"endTime":221.46,"body":"he knows how to push those"},{"speaker":"Chris Dy","startTime":221.46,"endTime":226.86,"body":"buttons. You can push him. Dr."},{"speaker":"Chris Dy","startTime":221.46,"endTime":226.86,"body":"Gelberman. It was his medical"},{"speaker":"Chris Dy","startTime":226.86,"endTime":230.1,"body":"assistant at the time, just kind"},{"speaker":"Chris Dy","startTime":226.86,"endTime":230.1,"body":"of and she still reminds me to"},{"speaker":"Chris Dy","startTime":230.1,"endTime":234.48,"body":"this day about about that"},{"speaker":"Chris Dy","startTime":230.1,"endTime":234.48,"body":"experience. So yeah, you want to"},{"speaker":"Chris Dy","startTime":234.48,"endTime":235.89,"body":"make sure you have everything"},{"speaker":"Chris Dy","startTime":234.48,"endTime":235.89,"body":"laid out."},{"speaker":"Charles Goldfarb","startTime":236.64,"endTime":239.82,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":236.64,"endTime":239.82,"body":"think a lot about this, and"},{"speaker":"Charles Goldfarb","startTime":239.82,"endTime":242.79,"body":"hopefully talked about it but"},{"speaker":"Charles Goldfarb","startTime":239.82,"endTime":242.79,"body":"doesn't really matter. You know,"},{"speaker":"Charles Goldfarb","startTime":242.82,"endTime":248.7,"body":"there is something to dressing"},{"speaker":"Charles Goldfarb","startTime":242.82,"endTime":248.7,"body":"the part. And if wearing scrubs"},{"speaker":"Charles Goldfarb","startTime":248.7,"endTime":251.61,"body":"is dressing the part then I"},{"speaker":"Charles Goldfarb","startTime":248.7,"endTime":251.61,"body":"dress the part. But if it's if"},{"speaker":"Charles Goldfarb","startTime":251.64,"endTime":255.3,"body":"if that doesn't qualify for"},{"speaker":"Charles Goldfarb","startTime":251.64,"endTime":255.3,"body":"administrative roles, I just"},{"speaker":"Charles Goldfarb","startTime":255.3,"endTime":259.44,"body":"don't dress the part and there"},{"speaker":"Charles Goldfarb","startTime":255.3,"endTime":259.44,"body":"is no doubt when I dress nicely."},{"speaker":"Charles Goldfarb","startTime":259.86,"endTime":263.1,"body":"It's different. It makes you"},{"speaker":"Charles Goldfarb","startTime":259.86,"endTime":263.1,"body":"feel different, I think interact"},{"speaker":"Charles Goldfarb","startTime":263.1,"endTime":265.68,"body":"a little differently. There's"},{"speaker":"Charles Goldfarb","startTime":263.1,"endTime":265.68,"body":"something to it. Yeah,"},{"speaker":"Chris Dy","startTime":265.68,"endTime":268.08,"body":"absolutely. And, you"},{"speaker":"Chris Dy","startTime":265.68,"endTime":268.08,"body":"know, I think I still have"},{"speaker":"Chris Dy","startTime":268.11,"endTime":272.25,"body":"trainees who come to clinic in"},{"speaker":"Chris Dy","startTime":268.11,"endTime":272.25,"body":"between cases and they're like,"},{"speaker":"Chris Dy","startTime":272.25,"endTime":274.83,"body":"is it okay, if I'm not dressed"},{"speaker":"Chris Dy","startTime":272.25,"endTime":274.83,"body":"up? I say it's totally fine, you"},{"speaker":"Chris Dy","startTime":274.83,"endTime":277.68,"body":"know, but that would not fly"},{"speaker":"Chris Dy","startTime":274.83,"endTime":277.68,"body":"with other attendees. And if so"},{"speaker":"Chris Dy","startTime":277.68,"endTime":279.51,"body":"when I say it's totally fine, I"},{"speaker":"Chris Dy","startTime":277.68,"endTime":279.51,"body":"totally mean it's fine."},{"speaker":"Chris Dy","startTime":280.05,"endTime":281.37,"body":"Gentlemen, I'm just happier"},{"speaker":"Chris Dy","startTime":280.05,"endTime":281.37,"body":"there."},{"speaker":"Charles Goldfarb","startTime":281.85,"endTime":283.83,"body":"Yeah, I"},{"speaker":"Charles Goldfarb","startTime":281.85,"endTime":283.83,"body":"totally agree. And then, you"},{"speaker":"Charles Goldfarb","startTime":283.83,"endTime":287.88,"body":"know, but the flip side of that"},{"speaker":"Charles Goldfarb","startTime":283.83,"endTime":287.88,"body":"is we can't complain about the"},{"speaker":"Charles Goldfarb","startTime":288.24,"endTime":292.38,"body":"casualisation if that's a word"},{"speaker":"Charles Goldfarb","startTime":288.24,"endTime":292.38,"body":"of our field. You know, I know"},{"speaker":"Charles Goldfarb","startTime":292.38,"endTime":295.38,"body":"they're, you know, there's a"},{"speaker":"Charles Goldfarb","startTime":292.38,"endTime":295.38,"body":"little taboo around ties and"},{"speaker":"Charles Goldfarb","startTime":295.38,"endTime":299.25,"body":"infection and stuff but we can't"},{"speaker":"Charles Goldfarb","startTime":295.38,"endTime":299.25,"body":"make it okay, which I agree with"},{"speaker":"Charles Goldfarb","startTime":299.25,"endTime":301.86,"body":"you I do as well. Well, and then"},{"speaker":"Charles Goldfarb","startTime":299.25,"endTime":301.86,"body":"complain about the lack of"},{"speaker":"Charles Goldfarb","startTime":301.86,"endTime":304.68,"body":"formality and some of the things"},{"speaker":"Charles Goldfarb","startTime":301.86,"endTime":304.68,"body":"that we're seeing because some"},{"speaker":"Charles Goldfarb","startTime":304.68,"endTime":308.58,"body":"of those other things bother me."},{"speaker":"Charles Goldfarb","startTime":304.68,"endTime":308.58,"body":"But you kind of take it all or"},{"speaker":"Charles Goldfarb","startTime":308.58,"endTime":311.04,"body":"take it or go back to the olden"},{"speaker":"Charles Goldfarb","startTime":308.58,"endTime":311.04,"body":"days,"},{"speaker":"Chris Dy","startTime":311.28,"endTime":314.76,"body":"times are changing. So"},{"speaker":"Chris Dy","startTime":311.28,"endTime":314.76,"body":"have you been pretty busy?"},{"speaker":"Chris Dy","startTime":314.76,"endTime":317.64,"body":"Otherwise? I've had quite the"},{"speaker":"Chris Dy","startTime":314.76,"endTime":317.64,"body":"week to be honest with you."},{"speaker":"Charles Goldfarb","startTime":318.0,"endTime":319.68,"body":"Yeah. Tell me"},{"speaker":"Charles Goldfarb","startTime":318.0,"endTime":319.68,"body":"about your week. And then I'll"},{"speaker":"Charles Goldfarb","startTime":319.68,"endTime":322.2,"body":"fill you in. I know you have, I"},{"speaker":"Charles Goldfarb","startTime":319.68,"endTime":322.2,"body":"think there was a flight"},{"speaker":"Charles Goldfarb","startTime":322.2,"endTime":325.08,"body":"cancellation somewhere in there"},{"speaker":"Charles Goldfarb","startTime":322.2,"endTime":325.08,"body":"and you had to make on board"},{"speaker":"Chris Dy","startTime":325.109,"endTime":327.869,"body":"last two weeks were a"},{"speaker":"Chris Dy","startTime":325.109,"endTime":327.869,"body":"little tough. You know, I loved"},{"speaker":"Chris Dy","startTime":327.869,"endTime":331.589,"body":"going to the American Society"},{"speaker":"Chris Dy","startTime":327.869,"endTime":331.589,"body":"peripheral nerve meeting, which"},{"speaker":"Chris Dy","startTime":331.589,"endTime":335.849,"body":"was in Nassau this year. And it"},{"speaker":"Chris Dy","startTime":331.589,"endTime":335.849,"body":"was great meeting had a great"},{"speaker":"Chris Dy","startTime":335.849,"endTime":338.969,"body":"time connecting with everybody"},{"speaker":"Chris Dy","startTime":335.849,"endTime":338.969,"body":"gave some talks, the lab"},{"speaker":"Chris Dy","startTime":338.969,"endTime":341.099,"body":"presented some research, I"},{"speaker":"Chris Dy","startTime":338.969,"endTime":341.099,"body":"really impressed with what our"},{"speaker":"Chris Dy","startTime":341.099,"endTime":344.129,"body":"partner David Brogan has done in"},{"speaker":"Chris Dy","startTime":341.099,"endTime":344.129,"body":"terms of getting the lab off the"},{"speaker":"Chris Dy","startTime":344.129,"endTime":346.439,"body":"ground, and then on our side,"},{"speaker":"Chris Dy","startTime":344.129,"endTime":346.439,"body":"doing some great clinical"},{"speaker":"Chris Dy","startTime":346.439,"endTime":349.379,"body":"research multicenter stuff, much"},{"speaker":"Chris Dy","startTime":346.439,"endTime":349.379,"body":"along the lines of what you've"},{"speaker":"Chris Dy","startTime":349.379,"endTime":353.009,"body":"done with good. So it was"},{"speaker":"Chris Dy","startTime":349.379,"endTime":353.009,"body":"awesome, great time, got some"},{"speaker":"Chris Dy","startTime":353.009,"endTime":355.229,"body":"time to hang with the kids and"},{"speaker":"Chris Dy","startTime":353.009,"endTime":355.229,"body":"everything, which was really"},{"speaker":"Chris Dy","startTime":355.229,"endTime":358.919,"body":"fun. And we were super excited"},{"speaker":"Chris Dy","startTime":355.229,"endTime":358.919,"body":"to come back on Monday MLK Day,"},{"speaker":"Chris Dy","startTime":358.919,"endTime":362.639,"body":"which was a holiday, at least"},{"speaker":"Chris Dy","startTime":358.919,"endTime":362.639,"body":"for the clinics. And then that"},{"speaker":"Chris Dy","startTime":362.639,"endTime":365.069,"body":"winter storm, I can't remem The"},{"speaker":"Chris Dy","startTime":362.639,"endTime":365.069,"body":"name was a winter storm Heather,"},{"speaker":"Chris Dy","startTime":365.759,"endTime":369.539,"body":"or whatever the name was totally"},{"speaker":"Chris Dy","startTime":365.759,"endTime":369.539,"body":"hosed us in terms of getting"},{"speaker":"Chris Dy","startTime":369.539,"endTime":372.569,"body":"back. You know, I was supposed"},{"speaker":"Chris Dy","startTime":369.539,"endTime":372.569,"body":"to come back and have a two room"},{"speaker":"Chris Dy","startTime":372.569,"endTime":377.789,"body":"our day on the day after MLK"},{"speaker":"Chris Dy","startTime":372.569,"endTime":377.789,"body":"Day. That got cancelled because"},{"speaker":"Chris Dy","startTime":377.789,"endTime":381.089,"body":"I could not come back. And it's"},{"speaker":"Chris Dy","startTime":377.789,"endTime":381.089,"body":"really fun calling patients from"},{"speaker":"Chris Dy","startTime":381.089,"endTime":383.699,"body":"an airport on Monday night"},{"speaker":"Chris Dy","startTime":381.089,"endTime":383.699,"body":"saying your surgery on Tuesdays"},{"speaker":"Chris Dy","startTime":383.699,"endTime":386.669,"body":"canceled, some of which were"},{"speaker":"Chris Dy","startTime":383.699,"endTime":386.669,"body":"super understanding and said,"},{"speaker":"Chris Dy","startTime":386.669,"endTime":389.759,"body":"yeah, just get home safe doc."},{"speaker":"Chris Dy","startTime":386.669,"endTime":389.759,"body":"Others were saying, So when are"},{"speaker":"Chris Dy","startTime":389.759,"endTime":394.469,"body":"we going to do it? You know, it"},{"speaker":"Chris Dy","startTime":389.759,"endTime":394.469,"body":"all worked out. You know,"},{"speaker":"Chris Dy","startTime":394.469,"endTime":398.399,"body":"fortunately, there was some"},{"speaker":"Chris Dy","startTime":394.469,"endTime":398.399,"body":"time, you know, this this week,"},{"speaker":"Chris Dy","startTime":398.399,"endTime":401.969,"body":"which is the following week. But"},{"speaker":"Chris Dy","startTime":398.399,"endTime":401.969,"body":"that added to some stress"},{"speaker":"Chris Dy","startTime":401.969,"endTime":405.569,"body":"levels. And then there was this"},{"speaker":"Chris Dy","startTime":401.969,"endTime":405.569,"body":"ice storm that happened, at"},{"speaker":"Chris Dy","startTime":405.569,"endTime":409.049,"body":"least in St. Louis on Sunday"},{"speaker":"Chris Dy","startTime":405.569,"endTime":409.049,"body":"night going into Monday morning,"},{"speaker":"Chris Dy","startTime":409.049,"endTime":413.519,"body":"which and I happen to be the"},{"speaker":"Chris Dy","startTime":409.049,"endTime":413.519,"body":"lucky chap on call with our"},{"speaker":"Chris Dy","startTime":413.519,"endTime":416.669,"body":"fearless hand fellow Adam Mosa,"},{"speaker":"Chris Dy","startTime":413.519,"endTime":416.669,"body":"who is just sitting there"},{"speaker":"Chris Dy","startTime":416.669,"endTime":419.429,"body":"triaging all of the distal"},{"speaker":"Chris Dy","startTime":416.669,"endTime":419.429,"body":"radius fractures that were"},{"speaker":"Chris Dy","startTime":419.429,"endTime":423.179,"body":"pouring in on Monday night. So"},{"speaker":"Chris Dy","startTime":419.429,"endTime":423.179,"body":"yeah, we you know, like the"},{"speaker":"Chris Dy","startTime":423.179,"endTime":425.999,"body":"clinics, at least in St. Louis,"},{"speaker":"Chris Dy","startTime":423.179,"endTime":425.999,"body":"when you have ice clinics, you"},{"speaker":"Chris Dy","startTime":425.999,"endTime":429.359,"body":"never know who's gonna show he"},{"speaker":"Chris Dy","startTime":425.999,"endTime":429.359,"body":"start with a certain number, you"},{"speaker":"Chris Dy","startTime":429.359,"endTime":432.179,"body":"end up probably about 20% lower"},{"speaker":"Chris Dy","startTime":429.359,"endTime":432.179,"body":"than that, and a bunch of"},{"speaker":"Chris Dy","startTime":432.749,"endTime":435.209,"body":"rescheduling things. And so"},{"speaker":"Chris Dy","startTime":432.749,"endTime":435.209,"body":"anyway, that was the start of"},{"speaker":"Chris Dy","startTime":435.209,"endTime":438.419,"body":"the week. I can go into it more"},{"speaker":"Chris Dy","startTime":435.209,"endTime":438.419,"body":"but it was it's been a week."},{"speaker":"Charles Goldfarb","startTime":438.78,"endTime":441.57,"body":"Yeah. So it is"},{"speaker":"Charles Goldfarb","startTime":438.78,"endTime":441.57,"body":"interesting. So it was it was a"},{"speaker":"Charles Goldfarb","startTime":441.57,"endTime":447.33,"body":"real it was a real ice ice event"},{"speaker":"Charles Goldfarb","startTime":441.57,"endTime":447.33,"body":"and I was up early I'd clinic"},{"speaker":"Charles Goldfarb","startTime":447.33,"endTime":451.83,"body":"that day. And I was up early."},{"speaker":"Charles Goldfarb","startTime":447.33,"endTime":451.83,"body":"I'm a Southerner I make gives me"},{"speaker":"Charles Goldfarb","startTime":451.83,"endTime":455.43,"body":"a little anxiety. My wife laughs"},{"speaker":"Charles Goldfarb","startTime":451.83,"endTime":455.43,"body":"at me being a Yankee. But I got"},{"speaker":"Charles Goldfarb","startTime":455.43,"endTime":458.85,"body":"up early. And you know, my"},{"speaker":"Charles Goldfarb","startTime":455.43,"endTime":458.85,"body":"driveway was a sheet of ice. And"},{"speaker":"Charles Goldfarb","startTime":458.85,"endTime":461.49,"body":"it was absolutely the classic"},{"speaker":"Charles Goldfarb","startTime":458.85,"endTime":461.49,"body":"black ice, you couldn't see it."},{"speaker":"Charles Goldfarb","startTime":461.67,"endTime":463.95,"body":"So I'm like, I know what's going"},{"speaker":"Charles Goldfarb","startTime":461.67,"endTime":463.95,"body":"to happen later today. I made it"},{"speaker":"Charles Goldfarb","startTime":463.95,"endTime":467.88,"body":"into work. And I had 60 some odd"},{"speaker":"Charles Goldfarb","startTime":463.95,"endTime":467.88,"body":"patients on it a little more"},{"speaker":"Charles Goldfarb","startTime":467.88,"endTime":472.17,"body":"than half made it at the half"},{"speaker":"Charles Goldfarb","startTime":467.88,"endTime":472.17,"body":"that made it super grateful. And"},{"speaker":"Charles Goldfarb","startTime":472.17,"endTime":476.43,"body":"it really is the effort you"},{"speaker":"Charles Goldfarb","startTime":472.17,"endTime":476.43,"body":"know, to go to work that day"},{"speaker":"Charles Goldfarb","startTime":476.43,"endTime":478.92,"body":"rather than staying home it"},{"speaker":"Charles Goldfarb","startTime":476.43,"endTime":478.92,"body":"means something and the patients"},{"speaker":"Charles Goldfarb","startTime":478.92,"endTime":481.86,"body":"that were there I connected with"},{"speaker":"Charles Goldfarb","startTime":478.92,"endTime":481.86,"body":"felt felt really good. I don't"},{"speaker":"Charles Goldfarb","startTime":481.86,"endTime":485.61,"body":"like being that slow but felt"},{"speaker":"Charles Goldfarb","startTime":481.86,"endTime":485.61,"body":"good. I I did overhear my my"},{"speaker":"Charles Goldfarb","startTime":485.61,"endTime":490.86,"body":"neighbors clinic where one of"},{"speaker":"Charles Goldfarb","startTime":485.61,"endTime":490.86,"body":"the patients was just berating"},{"speaker":"Charles Goldfarb","startTime":490.86,"endTime":495.03,"body":"the poor medical assistant about"},{"speaker":"Charles Goldfarb","startTime":490.86,"endTime":495.03,"body":"the other doctor not being able"},{"speaker":"Charles Goldfarb","startTime":495.03,"endTime":498.81,"body":"to get in because he couldn't"},{"speaker":"Charles Goldfarb","startTime":495.03,"endTime":498.81,"body":"get in. And it's just it's like"},{"speaker":"Charles Goldfarb","startTime":498.81,"endTime":501.72,"body":"I get it. You know, it's these"},{"speaker":"Charles Goldfarb","startTime":498.81,"endTime":501.72,"body":"appointments are hard to come by"},{"speaker":"Charles Goldfarb","startTime":501.72,"endTime":505.44,"body":"and, and it's a big deal to come"},{"speaker":"Charles Goldfarb","startTime":501.72,"endTime":505.44,"body":"in to the doctor. But you also"},{"speaker":"Charles Goldfarb","startTime":505.44,"endTime":509.28,"body":"got to be saved. But I think you"},{"speaker":"Charles Goldfarb","startTime":505.44,"endTime":509.28,"body":"were you were super busy. It"},{"speaker":"Charles Goldfarb","startTime":509.28,"endTime":510.0,"body":"sounds like"},{"speaker":"Chris Dy","startTime":510.06,"endTime":512.76,"body":"yeah, so that rolled"},{"speaker":"Chris Dy","startTime":510.06,"endTime":512.76,"body":"into Tuesday, which is the to"},{"speaker":"Chris Dy","startTime":512.76,"endTime":516.69,"body":"room or day and then Wednesday"},{"speaker":"Chris Dy","startTime":512.76,"endTime":516.69,"body":"was a makeup to room or a day,"},{"speaker":"Chris Dy","startTime":516.87,"endTime":520.95,"body":"which included some of those"},{"speaker":"Chris Dy","startTime":516.87,"endTime":520.95,"body":"fractures. I've now we had to"},{"speaker":"Chris Dy","startTime":520.98,"endTime":524.4,"body":"destroy these osteotomies on the"},{"speaker":"Chris Dy","startTime":520.98,"endTime":524.4,"body":"books for one last week and one"},{"speaker":"Chris Dy","startTime":524.4,"endTime":526.95,"body":"this week, which is uncommon. He"},{"speaker":"Chris Dy","startTime":524.4,"endTime":526.95,"body":"and do one every few months or"},{"speaker":"Chris Dy","startTime":526.95,"endTime":529.47,"body":"whatever. And then on top of"},{"speaker":"Chris Dy","startTime":526.95,"endTime":529.47,"body":"that we had seven acute"},{"speaker":"Chris Dy","startTime":529.47,"endTime":533.88,"body":"fractures. Next, that just"},{"speaker":"Chris Dy","startTime":529.47,"endTime":533.88,"body":"rocking and rolling. So we were"},{"speaker":"Chris Dy","startTime":533.88,"endTime":536.07,"body":"like, do we have enough plates,"},{"speaker":"Chris Dy","startTime":533.88,"endTime":536.07,"body":"I was like, Let me spread these"},{"speaker":"Chris Dy","startTime":536.07,"endTime":538.83,"body":"cases out so that the poor rep"},{"speaker":"Chris Dy","startTime":536.07,"endTime":538.83,"body":"has a little breathing room."},{"speaker":"Charles Goldfarb","startTime":538.98,"endTime":541.41,"body":"The poor, the"},{"speaker":"Charles Goldfarb","startTime":538.98,"endTime":541.41,"body":"rep was having the best day of"},{"speaker":"Charles Goldfarb","startTime":541.41,"endTime":543.27,"body":"his or her life. Yeah,"},{"speaker":"Chris Dy","startTime":543.0,"endTime":545.28,"body":"I don't know about"},{"speaker":"Chris Dy","startTime":543.0,"endTime":545.28,"body":"that. It's a contracted plate."},{"speaker":"Chris Dy","startTime":545.28,"endTime":546.24,"body":"So it's not that great."},{"speaker":"Charles Goldfarb","startTime":547.83,"endTime":550.44,"body":"It is, you"},{"speaker":"Charles Goldfarb","startTime":547.83,"endTime":550.44,"body":"know, like we all you know,"},{"speaker":"Charles Goldfarb","startTime":550.44,"endTime":553.92,"body":"hopefully we all have an"},{"speaker":"Charles Goldfarb","startTime":550.44,"endTime":553.92,"body":"internal barometer that says"},{"speaker":"Charles Goldfarb","startTime":553.92,"endTime":557.61,"body":"with this fracture, I operate or"},{"speaker":"Charles Goldfarb","startTime":553.92,"endTime":557.61,"body":"I don't operate, but there's a"},{"speaker":"Charles Goldfarb","startTime":557.61,"endTime":561.54,"body":"little gray area and my guess is"},{"speaker":"Charles Goldfarb","startTime":557.61,"endTime":561.54,"body":"you were probably searching for"},{"speaker":"Charles Goldfarb","startTime":561.54,"endTime":564.99,"body":"reasons not to operate rather"},{"speaker":"Charles Goldfarb","startTime":561.54,"endTime":564.99,"body":"than do 10 or 12 fractures."},{"speaker":"Chris Dy","startTime":565.02,"endTime":569.22,"body":"I sure tried to triage"},{"speaker":"Chris Dy","startTime":565.02,"endTime":569.22,"body":"and tell you that. Yeah, it's"},{"speaker":"Chris Dy","startTime":569.22,"endTime":572.55,"body":"been busy. But, you know, it's"},{"speaker":"Chris Dy","startTime":569.22,"endTime":572.55,"body":"not a sustainable pace. But it's"},{"speaker":"Chris Dy","startTime":572.55,"endTime":575.25,"body":"sometimes you got blips that you"},{"speaker":"Chris Dy","startTime":572.55,"endTime":575.25,"body":"just got to get through. And I'm"},{"speaker":"Chris Dy","startTime":575.25,"endTime":577.53,"body":"excited actually, you know, I've"},{"speaker":"Chris Dy","startTime":575.25,"endTime":577.53,"body":"been really excited about some"},{"speaker":"Chris Dy","startTime":577.53,"endTime":581.07,"body":"of the research stuff that we're"},{"speaker":"Chris Dy","startTime":577.53,"endTime":581.07,"body":"doing. Oddly enough, there was"},{"speaker":"Chris Dy","startTime":581.07,"endTime":583.95,"body":"one weekend one morning this"},{"speaker":"Chris Dy","startTime":581.07,"endTime":583.95,"body":"weekend where I woke up wanting"},{"speaker":"Chris Dy","startTime":583.95,"endTime":585.66,"body":"to write a grant, which"},{"speaker":"Charles Goldfarb","startTime":586.02,"endTime":588.99,"body":"I exactly"},{"speaker":"Charles Goldfarb","startTime":586.02,"endTime":588.99,"body":"can't say that's ever happened"},{"speaker":"Charles Goldfarb","startTime":588.99,"endTime":589.56,"body":"to me. The"},{"speaker":"Chris Dy","startTime":589.56,"endTime":591.78,"body":"clinical work this"},{"speaker":"Chris Dy","startTime":589.56,"endTime":591.78,"body":"week surely cured me of that"},{"speaker":"Chris Dy","startTime":592.23,"endTime":595.98,"body":"need right now but I've got some"},{"speaker":"Chris Dy","startTime":592.23,"endTime":595.98,"body":"work carved out for the coming"},{"speaker":"Chris Dy","startTime":595.98,"endTime":599.28,"body":"week. So anyway, we should get"},{"speaker":"Chris Dy","startTime":595.98,"endTime":599.28,"body":"in the episode before we do"},{"speaker":"Chris Dy","startTime":599.28,"endTime":602.67,"body":"probably should think Get our"},{"speaker":"Chris Dy","startTime":599.28,"endTime":602.67,"body":"first sponsor. Absolutely."},{"speaker":"Charles Goldfarb","startTime":602.67,"endTime":603.96,"body":"The Upperhand"},{"speaker":"Charles Goldfarb","startTime":602.67,"endTime":603.96,"body":"is sponsored by"},{"speaker":"Charles Goldfarb","startTime":603.99,"endTime":607.47,"body":"Practicelink.com, the most"},{"speaker":"Charles Goldfarb","startTime":603.99,"endTime":607.47,"body":"widely used physician job search"},{"speaker":"Charles Goldfarb","startTime":607.62,"endTime":610.23,"body":"and career advancement resource."},{"speaker":"Chris Dy","startTime":610.77,"endTime":613.17,"body":"Becoming a physician"},{"speaker":"Chris Dy","startTime":610.77,"endTime":613.17,"body":"is hard finding the right job"},{"speaker":"Chris Dy","startTime":613.17,"endTime":616.02,"body":"doesn't have to be joined"},{"speaker":"Chris Dy","startTime":613.17,"endTime":616.02,"body":"practicing for free today at"},{"speaker":"Chris Dy","startTime":616.02,"endTime":619.53,"body":"www.practising.com/the. upper"},{"speaker":"Chris Dy","startTime":616.02,"endTime":619.53,"body":"hand."},{"speaker":"Charles Goldfarb","startTime":619.98,"endTime":623.4,"body":"So we love it"},{"speaker":"Charles Goldfarb","startTime":619.98,"endTime":623.4,"body":"when you the listener write in"},{"speaker":"Charles Goldfarb","startTime":623.43,"endTime":628.29,"body":"to us. And we've got a number of"},{"speaker":"Charles Goldfarb","startTime":623.43,"endTime":628.29,"body":"super interesting questions,"},{"speaker":"Charles Goldfarb","startTime":628.71,"endTime":632.01,"body":"clinical questions that we'd"},{"speaker":"Charles Goldfarb","startTime":628.71,"endTime":632.01,"body":"like to respond to expand upon."},{"speaker":"Charles Goldfarb","startTime":632.61,"endTime":637.29,"body":"So please email us anytime. And"},{"speaker":"Charles Goldfarb","startTime":632.61,"endTime":637.29,"body":"Chris is gonna tell you the"},{"speaker":"Charles Goldfarb","startTime":637.29,"endTime":638.22,"body":"email address"},{"speaker":"Chris Dy","startTime":638.46,"endTime":642.18,"body":"Its not hard.  Its"},{"speaker":"Chris Dy","startTime":638.46,"endTime":642.18,"body":"handpodcast@gmail.com. But yeah,"},{"speaker":"Chris Dy","startTime":642.18,"endTime":644.64,"body":"the let the mailbag stuff is"},{"speaker":"Chris Dy","startTime":642.18,"endTime":644.64,"body":"super interesting all that Chuck"},{"speaker":"Chris Dy","startTime":644.64,"endTime":647.52,"body":"kind of lead off with the first"},{"speaker":"Chris Dy","startTime":644.64,"endTime":647.52,"body":"one, because it does pertain to"},{"speaker":"Chris Dy","startTime":647.52,"endTime":649.5,"body":"a paper in which he was the"},{"speaker":"Chris Dy","startTime":647.52,"endTime":649.5,"body":"senior author."},{"speaker":"Charles Goldfarb","startTime":650.01,"endTime":654.51,"body":"yeah, so we a"},{"speaker":"Charles Goldfarb","startTime":650.01,"endTime":654.51,"body":"little background, we had been"},{"speaker":"Charles Goldfarb","startTime":654.51,"endTime":660.45,"body":"using, and I am not aligned with"},{"speaker":"Charles Goldfarb","startTime":654.51,"endTime":660.45,"body":"any of these companies. I have a"},{"speaker":"Charles Goldfarb","startTime":660.45,"endTime":664.35,"body":"distant history of working with"},{"speaker":"Charles Goldfarb","startTime":660.45,"endTime":664.35,"body":"arthritis, but we have been"},{"speaker":"Charles Goldfarb","startTime":664.35,"endTime":670.17,"body":"using the internal brace for as"},{"speaker":"Charles Goldfarb","startTime":664.35,"endTime":670.17,"body":"a suspension plasti for CMC"},{"speaker":"Charles Goldfarb","startTime":670.17,"endTime":676.44,"body":"arthritis, and started doing"},{"speaker":"Charles Goldfarb","startTime":670.17,"endTime":676.44,"body":"that 2017 Maybe, and a lot of a"},{"speaker":"Charles Goldfarb","startTime":676.44,"endTime":679.74,"body":"lot of folks in our group had"},{"speaker":"Charles Goldfarb","startTime":676.44,"endTime":679.74,"body":"been using that same technique."},{"speaker":"Charles Goldfarb","startTime":679.98,"endTime":684.21,"body":"And so we started two projects."},{"speaker":"Charles Goldfarb","startTime":679.98,"endTime":684.21,"body":"One was a retrospective look,"},{"speaker":"Charles Goldfarb","startTime":684.21,"endTime":686.67,"body":"and we started that during"},{"speaker":"Charles Goldfarb","startTime":684.21,"endTime":686.67,"body":"COVID. And the other was a"},{"speaker":"Charles Goldfarb","startTime":686.67,"endTime":691.05,"body":"prospective look, prospective"},{"speaker":"Charles Goldfarb","startTime":686.67,"endTime":691.05,"body":"randomized trial, which you"},{"speaker":"Charles Goldfarb","startTime":691.05,"endTime":694.35,"body":"know, we all know is not very"},{"speaker":"Charles Goldfarb","startTime":691.05,"endTime":694.35,"body":"common in hand surgery, and is"},{"speaker":"Charles Goldfarb","startTime":694.35,"endTime":699.06,"body":"challenging to do. So we"},{"speaker":"Charles Goldfarb","startTime":694.35,"endTime":699.06,"body":"submitted our retrospective look"},{"speaker":"Charles Goldfarb","startTime":699.06,"endTime":704.07,"body":"comparing the two groups that is"},{"speaker":"Charles Goldfarb","startTime":699.06,"endTime":704.07,"body":"standard lrti versus the"},{"speaker":"Charles Goldfarb","startTime":704.67,"endTime":708.21,"body":"trapezius ectomy with"},{"speaker":"Charles Goldfarb","startTime":704.67,"endTime":708.21,"body":"suspension, using the internal"},{"speaker":"Charles Goldfarb","startTime":708.21,"endTime":711.36,"body":"brace. And then we also have"},{"speaker":"Charles Goldfarb","startTime":708.21,"endTime":711.36,"body":"recently submitted our"},{"speaker":"Charles Goldfarb","startTime":711.36,"endTime":714.3,"body":"prospective randomized trial"},{"speaker":"Charles Goldfarb","startTime":711.36,"endTime":714.3,"body":"between the two groups and, and"},{"speaker":"Charles Goldfarb","startTime":714.3,"endTime":720.63,"body":"the first paper was published in"},{"speaker":"Charles Goldfarb","startTime":714.3,"endTime":720.63,"body":"JHS Go,eExcuse me. And you know,"},{"speaker":"Charles Goldfarb","startTime":720.63,"endTime":723.15,"body":"there are flaws in the"},{"speaker":"Charles Goldfarb","startTime":720.63,"endTime":723.15,"body":"manuscript, and I was grateful"},{"speaker":"Charles Goldfarb","startTime":723.15,"endTime":726.66,"body":"It was published in JHS Go, and"},{"speaker":"Charles Goldfarb","startTime":723.15,"endTime":726.66,"body":"there was a good question sent"},{"speaker":"Charles Goldfarb","startTime":726.66,"endTime":726.87,"body":"in."},{"speaker":"Chris Dy","startTime":727.71,"endTime":730.35,"body":"So why don't you if do"},{"speaker":"Chris Dy","startTime":727.71,"endTime":730.35,"body":"you want to talk about the"},{"speaker":"Chris Dy","startTime":730.35,"endTime":732.81,"body":"question first, you want to tell"},{"speaker":"Chris Dy","startTime":730.35,"endTime":732.81,"body":"us kind of a high level summary"},{"speaker":"Chris Dy","startTime":732.81,"endTime":735.96,"body":"of what you what you found in"},{"speaker":"Chris Dy","startTime":732.81,"endTime":735.96,"body":"the paper?"},{"speaker":"Charles Goldfarb","startTime":737.13,"endTime":739.74,"body":"Well, what we"},{"speaker":"Charles Goldfarb","startTime":737.13,"endTime":739.74,"body":"found the paper was there really"},{"speaker":"Charles Goldfarb","startTime":739.74,"endTime":742.98,"body":"weren't fundamental differences"},{"speaker":"Charles Goldfarb","startTime":739.74,"endTime":742.98,"body":"in outcomes between the group"},{"speaker":"Charles Goldfarb","startTime":742.98,"endTime":746.37,"body":"and I think that's a fair"},{"speaker":"Charles Goldfarb","startTime":742.98,"endTime":746.37,"body":"summary. And those of you who"},{"speaker":"Charles Goldfarb","startTime":746.37,"endTime":749.91,"body":"have done or read about CMC"},{"speaker":"Charles Goldfarb","startTime":746.37,"endTime":749.91,"body":"arthroplasty in the various"},{"speaker":"Charles Goldfarb","startTime":749.91,"endTime":753.45,"body":"techniques will not be surprised"},{"speaker":"Charles Goldfarb","startTime":749.91,"endTime":753.45,"body":"by that finding, because it"},{"speaker":"Charles Goldfarb","startTime":753.45,"endTime":757.74,"body":"seems like about everything we"},{"speaker":"Charles Goldfarb","startTime":753.45,"endTime":757.74,"body":"do, provides good outcomes. When"},{"speaker":"Charles Goldfarb","startTime":757.74,"endTime":762.87,"body":"I see a patient today, I give"},{"speaker":"Charles Goldfarb","startTime":757.74,"endTime":762.87,"body":"them the two options, and I say"},{"speaker":"Charles Goldfarb","startTime":762.87,"endTime":767.1,"body":"the lrti and I do a classic"},{"speaker":"Charles Goldfarb","startTime":762.87,"endTime":767.1,"body":"Burton and Pellegrini. lrti"},{"speaker":"Charles Goldfarb","startTime":767.1,"endTime":771.06,"body":"where we obviously fcr, excise"},{"speaker":"Charles Goldfarb","startTime":767.1,"endTime":771.06,"body":"the entire trapezium, use the"},{"speaker":"Charles Goldfarb","startTime":771.06,"endTime":775.38,"body":"entire tendon, through the base,"},{"speaker":"Charles Goldfarb","startTime":771.06,"endTime":775.38,"body":"the metacarpal, to suspend the"},{"speaker":"Charles Goldfarb","startTime":775.38,"endTime":778.02,"body":"thumb metacarpal, and then"},{"speaker":"Charles Goldfarb","startTime":775.38,"endTime":778.02,"body":"create an anchovy or kind of"},{"speaker":"Charles Goldfarb","startTime":778.05,"endTime":781.95,"body":"ball tendon to place where the"},{"speaker":"Charles Goldfarb","startTime":778.05,"endTime":781.95,"body":"trapezium used to be, I give"},{"speaker":"Charles Goldfarb","startTime":781.95,"endTime":784.65,"body":"them that option, and I give"},{"speaker":"Charles Goldfarb","startTime":781.95,"endTime":784.65,"body":"them the suspension plasti. And"},{"speaker":"Charles Goldfarb","startTime":784.68,"endTime":787.14,"body":"the question, I don't know that"},{"speaker":"Charles Goldfarb","startTime":784.68,"endTime":787.14,"body":"we necessarily need to read the"},{"speaker":"Charles Goldfarb","startTime":787.14,"endTime":791.58,"body":"question, but the question was"},{"speaker":"Charles Goldfarb","startTime":787.14,"endTime":791.58,"body":"around that technique we"},{"speaker":"Charles Goldfarb","startTime":791.58,"endTime":796.26,"body":"specifically use with the"},{"speaker":"Charles Goldfarb","startTime":791.58,"endTime":796.26,"body":"suspension plasti with the intro"},{"speaker":"Charles Goldfarb","startTime":796.26,"endTime":801.75,"body":"brace. And so what's interesting"},{"speaker":"Charles Goldfarb","startTime":796.26,"endTime":801.75,"body":"is, as much as I try not to bias"},{"speaker":"Charles Goldfarb","startTime":801.75,"endTime":805.95,"body":"the patient, I think the"},{"speaker":"Charles Goldfarb","startTime":801.75,"endTime":805.95,"body":"conversation biases the patient"},{"speaker":"Charles Goldfarb","startTime":806.01,"endTime":810.15,"body":"and 80% of patients choose the"},{"speaker":"Charles Goldfarb","startTime":806.01,"endTime":810.15,"body":"suspension plasti with the"},{"speaker":"Charles Goldfarb","startTime":810.27,"endTime":814.56,"body":"internal brace. I'm curious as"},{"speaker":"Charles Goldfarb","startTime":810.27,"endTime":814.56,"body":"to your conversation and and do"},{"speaker":"Charles Goldfarb","startTime":814.56,"endTime":815.67,"body":"you even offer an LRT?"},{"speaker":"Chris Dy","startTime":816.81,"endTime":818.52,"body":"Yeah, I mean, I think"},{"speaker":"Chris Dy","startTime":816.81,"endTime":818.52,"body":"well, first off, I'll offer an"},{"speaker":"Chris Dy","startTime":818.52,"endTime":821.07,"body":"allergy, if that's what they've"},{"speaker":"Chris Dy","startTime":818.52,"endTime":821.07,"body":"had on the other side by me, or"},{"speaker":"Chris Dy","startTime":821.1,"endTime":825.3,"body":"more likely somebody else, and"},{"speaker":"Chris Dy","startTime":821.1,"endTime":825.3,"body":"they're happy with it. You know,"},{"speaker":"Chris Dy","startTime":825.3,"endTime":828.57,"body":"I tend to say there are a lot of"},{"speaker":"Chris Dy","startTime":825.3,"endTime":828.57,"body":"different ways to do this. I"},{"speaker":"Chris Dy","startTime":828.57,"endTime":831.27,"body":"give the caveat that some of it"},{"speaker":"Chris Dy","startTime":828.57,"endTime":831.27,"body":"depends on the bone quality and"},{"speaker":"Chris Dy","startTime":831.27,"endTime":834.6,"body":"surgery. I tell them, you know,"},{"speaker":"Chris Dy","startTime":831.27,"endTime":834.6,"body":"sometimes we take a tendon and"},{"speaker":"Chris Dy","startTime":834.6,"endTime":838.8,"body":"use that or we use the suture"},{"speaker":"Chris Dy","startTime":834.6,"endTime":838.8,"body":"tape suspension. And if one for"},{"speaker":"Chris Dy","startTime":838.83,"endTime":842.13,"body":"whatever reason doesn't, you"},{"speaker":"Chris Dy","startTime":838.83,"endTime":842.13,"body":"know, last or we have an issue"},{"speaker":"Chris Dy","startTime":842.13,"endTime":844.65,"body":"in surgery, you always have the"},{"speaker":"Chris Dy","startTime":842.13,"endTime":844.65,"body":"other one as a backup typically."},{"speaker":"Chris Dy","startTime":845.22,"endTime":848.25,"body":"And that that obviously is"},{"speaker":"Chris Dy","startTime":845.22,"endTime":848.25,"body":"making sure that you're mindful"},{"speaker":"Chris Dy","startTime":848.25,"endTime":850.89,"body":"and careful with your fcr as"},{"speaker":"Chris Dy","startTime":848.25,"endTime":850.89,"body":"you're doing your trapezius"},{"speaker":"Chris Dy","startTime":850.89,"endTime":856.35,"body":"activate. So I honestly had they"},{"speaker":"Chris Dy","startTime":850.89,"endTime":856.35,"body":"asked me, you know, what, what I"},{"speaker":"Chris Dy","startTime":856.35,"endTime":859.62,"body":"prefer what I do I tell him, you"},{"speaker":"Chris Dy","startTime":856.35,"endTime":859.62,"body":"know, I think the secret he has"},{"speaker":"Chris Dy","startTime":859.62,"endTime":861.48,"body":"mentioned is faster. I think I"},{"speaker":"Chris Dy","startTime":859.62,"endTime":861.48,"body":"tell him that the results"},{"speaker":"Chris Dy","startTime":861.48,"endTime":864.9,"body":"essentially are the same. But it"},{"speaker":"Chris Dy","startTime":861.48,"endTime":864.9,"body":"is faster in terms of the"},{"speaker":"Chris Dy","startTime":864.9,"endTime":867.24,"body":"aren't. And you know, I think"},{"speaker":"Chris Dy","startTime":864.9,"endTime":867.24,"body":"that if you truly ask people"},{"speaker":"Chris Dy","startTime":867.24,"endTime":870.09,"body":"about harvesting and fcr I don't"},{"speaker":"Chris Dy","startTime":867.24,"endTime":870.09,"body":"think they love it. I think"},{"speaker":"Chris Dy","startTime":870.09,"endTime":872.94,"body":"there is some soreness, some"},{"speaker":"Chris Dy","startTime":870.09,"endTime":872.94,"body":"additional pain in the short"},{"speaker":"Chris Dy","startTime":872.94,"endTime":875.85,"body":"term. And for some people,"},{"speaker":"Chris Dy","startTime":872.94,"endTime":875.85,"body":"that's enough to kind of tip the"},{"speaker":"Chris Dy","startTime":875.85,"endTime":878.64,"body":"balance. I think we have to be"},{"speaker":"Chris Dy","startTime":875.85,"endTime":878.64,"body":"good stewards. And I think cost"},{"speaker":"Chris Dy","startTime":878.64,"endTime":880.86,"body":"is an important part of it."},{"speaker":"Chris Dy","startTime":878.64,"endTime":880.86,"body":"Particularly if you're operating"},{"speaker":"Chris Dy","startTime":880.86,"endTime":883.53,"body":"in a surgery center that is"},{"speaker":"Chris Dy","startTime":880.86,"endTime":883.53,"body":"freestanding and where the"},{"speaker":"Chris Dy","startTime":883.53,"endTime":886.41,"body":"implants are technical coming"},{"speaker":"Chris Dy","startTime":883.53,"endTime":886.41,"body":"out of your overhead. It's"},{"speaker":"Chris Dy","startTime":886.41,"endTime":889.11,"body":"probably a little less directly"},{"speaker":"Chris Dy","startTime":886.41,"endTime":889.11,"body":"influencing the surgeons that"},{"speaker":"Chris Dy","startTime":889.11,"endTime":892.05,"body":"are in a bigger institution with"},{"speaker":"Chris Dy","startTime":889.11,"endTime":892.05,"body":"more of an academic practice."},{"speaker":"Chris Dy","startTime":892.8,"endTime":893.16,"body":"Yeah, and"},{"speaker":"Charles Goldfarb","startTime":893.16,"endTime":895.92,"body":"we get and"},{"speaker":"Charles Goldfarb","startTime":893.16,"endTime":895.92,"body":"then we get into the book, how"},{"speaker":"Charles Goldfarb","startTime":895.92,"endTime":900.0,"body":"you truly calculate costs"},{"speaker":"Charles Goldfarb","startTime":895.92,"endTime":900.0,"body":"because oh our time matters and"},{"speaker":"Charles Goldfarb","startTime":900.0,"endTime":901.89,"body":"then the second issue is"},{"speaker":"Charles Goldfarb","startTime":900.0,"endTime":901.89,"body":"returned to work returned to"},{"speaker":"Charles Goldfarb","startTime":901.89,"endTime":904.41,"body":"activities. And so the"},{"speaker":"Charles Goldfarb","startTime":901.89,"endTime":904.41,"body":"fundamental difference, which"},{"speaker":"Charles Goldfarb","startTime":904.44,"endTime":908.16,"body":"always is the factor that"},{"speaker":"Charles Goldfarb","startTime":904.44,"endTime":908.16,"body":"captures the patient is how"},{"speaker":"Charles Goldfarb","startTime":908.16,"endTime":912.15,"body":"quickly you can get out of a"},{"speaker":"Charles Goldfarb","startTime":908.16,"endTime":912.15,"body":"cast and right or wrong. I cast"},{"speaker":"Charles Goldfarb","startTime":912.15,"endTime":914.97,"body":"patients for four weeks after"},{"speaker":"Charles Goldfarb","startTime":912.15,"endTime":914.97,"body":"lrti. And there's been studies"},{"speaker":"Charles Goldfarb","startTime":914.97,"endTime":917.67,"body":"suggesting that number could be"},{"speaker":"Charles Goldfarb","startTime":914.97,"endTime":917.67,"body":"shorter, and it absolutely could"},{"speaker":"Charles Goldfarb","startTime":917.67,"endTime":923.25,"body":"be. But I cast patients for four"},{"speaker":"Charles Goldfarb","startTime":917.67,"endTime":923.25,"body":"weeks with a seizure tape"},{"speaker":"Charles Goldfarb","startTime":923.25,"endTime":927.03,"body":"suspension plasti. I get"},{"speaker":"Charles Goldfarb","startTime":923.25,"endTime":927.03,"body":"patients in therapy five days"},{"speaker":"Charles Goldfarb","startTime":927.03,"endTime":930.12,"body":"after surgery, they are moving"},{"speaker":"Charles Goldfarb","startTime":927.03,"endTime":930.12,"body":"in using their thumb doesn't"},{"speaker":"Charles Goldfarb","startTime":930.12,"endTime":933.15,"body":"mean all their pain has gone."},{"speaker":"Charles Goldfarb","startTime":930.12,"endTime":933.15,"body":"But they're moving and using"},{"speaker":"Charles Goldfarb","startTime":933.15,"endTime":936.81,"body":"their thumb and taking a shower."},{"speaker":"Charles Goldfarb","startTime":933.15,"endTime":936.81,"body":"And that's that's a really big"},{"speaker":"Charles Goldfarb","startTime":936.81,"endTime":937.5,"body":"selling point."},{"speaker":"Chris Dy","startTime":937.86,"endTime":939.78,"body":"Yeah, absolutely. I"},{"speaker":"Chris Dy","startTime":937.86,"endTime":939.78,"body":"think, you know, in our last"},{"speaker":"Chris Dy","startTime":939.81,"endTime":942.51,"body":"podcast with Macy, we talked"},{"speaker":"Chris Dy","startTime":939.81,"endTime":942.51,"body":"about the post op rehab after"},{"speaker":"Chris Dy","startTime":942.51,"endTime":944.4,"body":"something like a suture tape"},{"speaker":"Chris Dy","startTime":942.51,"endTime":944.4,"body":"suspension. And then she"},{"speaker":"Chris Dy","startTime":944.4,"endTime":946.17,"body":"mentioned like, for all these,"},{"speaker":"Chris Dy","startTime":944.4,"endTime":946.17,"body":"like, you don't want to push it"},{"speaker":"Chris Dy","startTime":946.17,"endTime":950.58,"body":"too much in terms of generating"},{"speaker":"Chris Dy","startTime":946.17,"endTime":950.58,"body":"pain, because this is a surgery"},{"speaker":"Chris Dy","startTime":950.58,"endTime":952.68,"body":"that is largely geared towards"},{"speaker":"Chris Dy","startTime":950.58,"endTime":952.68,"body":"pain, and I feel like she is"},{"speaker":"Chris Dy","startTime":952.68,"endTime":955.08,"body":"probably slowing down our"},{"speaker":"Chris Dy","startTime":952.68,"endTime":955.08,"body":"patients more than they want to,"},{"speaker":"Chris Dy","startTime":955.41,"endTime":957.87,"body":"because she understands the"},{"speaker":"Chris Dy","startTime":955.41,"endTime":957.87,"body":"benefit that we'll have in a"},{"speaker":"Chris Dy","startTime":957.87,"endTime":961.23,"body":"long term for them. I don't"},{"speaker":"Chris Dy","startTime":957.87,"endTime":961.23,"body":"know. I mean, I guess, you know,"},{"speaker":"Chris Dy","startTime":961.29,"endTime":964.29,"body":"one of the limitations of the"},{"speaker":"Chris Dy","startTime":961.29,"endTime":964.29,"body":"work that that you've led for"},{"speaker":"Chris Dy","startTime":964.29,"endTime":967.59,"body":"our group is that, you know,"},{"speaker":"Chris Dy","startTime":964.29,"endTime":967.59,"body":"the, the therapy protocols are"},{"speaker":"Chris Dy","startTime":967.59,"endTime":969.54,"body":"very different for the two and"},{"speaker":"Chris Dy","startTime":967.59,"endTime":969.54,"body":"like you said, you know, there's"},{"speaker":"Chris Dy","startTime":969.54,"endTime":972.27,"body":"been work from other groups"},{"speaker":"Chris Dy","startTime":969.54,"endTime":972.27,"body":"saying that even for an lrti,"},{"speaker":"Chris Dy","startTime":972.3,"endTime":974.91,"body":"you know, the classic Burton"},{"speaker":"Chris Dy","startTime":972.3,"endTime":974.91,"body":"Pellegrini. Like you could go a"},{"speaker":"Chris Dy","startTime":974.91,"endTime":977.07,"body":"little bit faster with the"},{"speaker":"Chris Dy","startTime":974.91,"endTime":977.07,"body":"rehab, but I think that our"},{"speaker":"Chris Dy","startTime":977.07,"endTime":981.78,"body":"group chose not to include that"},{"speaker":"Chris Dy","startTime":977.07,"endTime":981.78,"body":"as you know, an earlier rehab"},{"speaker":"Chris Dy","startTime":981.78,"endTime":984.09,"body":"protocol, because it would vary"},{"speaker":"Chris Dy","startTime":981.78,"endTime":984.09,"body":"from our clinical standard of"},{"speaker":"Chris Dy","startTime":984.09,"endTime":987.63,"body":"care. And ethically, it was kind"},{"speaker":"Chris Dy","startTime":984.09,"endTime":987.63,"body":"of like, you know, we didn't"},{"speaker":"Chris Dy","startTime":987.63,"endTime":990.45,"body":"want to get into that for the"},{"speaker":"Chris Dy","startTime":987.63,"endTime":990.45,"body":"RCT. But I mean, why do you"},{"speaker":"Chris Dy","startTime":990.45,"endTime":992.94,"body":"think that you can move people a"},{"speaker":"Chris Dy","startTime":990.45,"endTime":992.94,"body":"little bit earlier after a"},{"speaker":"Chris Dy","startTime":992.94,"endTime":993.99,"body":"suture tape suspension."},{"speaker":"Charles Goldfarb","startTime":994.95,"endTime":998.16,"body":"So for me"},{"speaker":"Charles Goldfarb","startTime":994.95,"endTime":998.16,"body":"this, the times zero strength is"},{"speaker":"Charles Goldfarb","startTime":998.16,"endTime":1002.39,"body":"there for the suture tape, and I"},{"speaker":"Charles Goldfarb","startTime":998.16,"endTime":1002.39,"body":"if I'm going to create an"},{"speaker":"Charles Goldfarb","startTime":1002.39,"endTime":1007.19,"body":"analogy to another surgery, it"},{"speaker":"Charles Goldfarb","startTime":1002.39,"endTime":1007.19,"body":"is excision of the trapezium and"},{"speaker":"Charles Goldfarb","startTime":1007.19,"endTime":1010.85,"body":"K wire pinning of the thumb"},{"speaker":"Charles Goldfarb","startTime":1007.19,"endTime":1010.85,"body":"metacarpal to the second"},{"speaker":"Charles Goldfarb","startTime":1010.85,"endTime":1015.17,"body":"metacarpal, which we don't do,"},{"speaker":"Charles Goldfarb","startTime":1010.85,"endTime":1015.17,"body":"because patients hate that pin."},{"speaker":"Charles Goldfarb","startTime":1015.38,"endTime":1017.69,"body":"There are certain patients of"},{"speaker":"Charles Goldfarb","startTime":1015.38,"endTime":1017.69,"body":"instruments or there's certain"},{"speaker":"Charles Goldfarb","startTime":1017.69,"endTime":1021.62,"body":"pins that patients hate. That's"},{"speaker":"Charles Goldfarb","startTime":1017.69,"endTime":1021.62,"body":"one of them and pinning the DOJ"},{"speaker":"Charles Goldfarb","startTime":1021.62,"endTime":1024.41,"body":"is another one. And it's super"},{"speaker":"Charles Goldfarb","startTime":1021.62,"endTime":1024.41,"body":"interesting that not too long"},{"speaker":"Charles Goldfarb","startTime":1024.41,"endTime":1028.61,"body":"ago, one of our partners Marty"},{"speaker":"Charles Goldfarb","startTime":1024.41,"endTime":1028.61,"body":"Boyer went back to the concept"},{"speaker":"Charles Goldfarb","startTime":1028.61,"endTime":1031.76,"body":"of pinning after trapezius"},{"speaker":"Charles Goldfarb","startTime":1028.61,"endTime":1031.76,"body":"ectomy that did not last long,"},{"speaker":"Charles Goldfarb","startTime":1031.82,"endTime":1036.02,"body":"I'll tell ya. And so I think the"},{"speaker":"Charles Goldfarb","startTime":1031.82,"endTime":1036.02,"body":"timezero strength is there for"},{"speaker":"Charles Goldfarb","startTime":1036.02,"endTime":1038.99,"body":"the suture tape suspension"},{"speaker":"Charles Goldfarb","startTime":1036.02,"endTime":1038.99,"body":"plasti, I don't think is there"},{"speaker":"Charles Goldfarb","startTime":1038.99,"endTime":1041.84,"body":"with a tendon. And that's why I"},{"speaker":"Charles Goldfarb","startTime":1038.99,"endTime":1041.84,"body":"tend to mobile I don't think is"},{"speaker":"Charles Goldfarb","startTime":1041.84,"endTime":1044.6,"body":"there for weeks either, to be"},{"speaker":"Charles Goldfarb","startTime":1041.84,"endTime":1044.6,"body":"truly honest, but but I think"},{"speaker":"Charles Goldfarb","startTime":1044.6,"endTime":1047.6,"body":"you're starting to develop scar"},{"speaker":"Charles Goldfarb","startTime":1044.6,"endTime":1047.6,"body":"tissue which, which supports"},{"speaker":"Charles Goldfarb","startTime":1047.6,"endTime":1048.35,"body":"this suspension."},{"speaker":"Chris Dy","startTime":1048.86,"endTime":1051.71,"body":"So the question from"},{"speaker":"Chris Dy","startTime":1048.86,"endTime":1051.71,"body":"our reader, and again, we don't"},{"speaker":"Chris Dy","startTime":1051.71,"endTime":1054.59,"body":"need to read the whole thing."},{"speaker":"Chris Dy","startTime":1051.71,"endTime":1054.59,"body":"Listener excuse me, Colin, Dr."},{"speaker":"Chris Dy","startTime":1054.59,"endTime":1057.68,"body":"Colin Kennedy, out in Las Vegas,"},{"speaker":"Chris Dy","startTime":1054.59,"endTime":1057.68,"body":"had great questions about the"},{"speaker":"Chris Dy","startTime":1057.68,"endTime":1059.48,"body":"technical aspects. So I think"},{"speaker":"Chris Dy","startTime":1057.68,"endTime":1059.48,"body":"there are a couple of different"},{"speaker":"Chris Dy","startTime":1059.48,"endTime":1062.78,"body":"ways that you could do this"},{"speaker":"Chris Dy","startTime":1059.48,"endTime":1062.78,"body":"surgery, if you are using that"},{"speaker":"Chris Dy","startTime":1062.78,"endTime":1067.25,"body":"Arthrex suture tape. So one way"},{"speaker":"Chris Dy","startTime":1062.78,"endTime":1067.25,"body":"would be to insert a swivel lock"},{"speaker":"Chris Dy","startTime":1067.25,"endTime":1069.83,"body":"on the base of the index"},{"speaker":"Chris Dy","startTime":1067.25,"endTime":1069.83,"body":"metacarpal. And the other way"},{"speaker":"Chris Dy","startTime":1069.83,"endTime":1073.58,"body":"would be to use kind of a"},{"speaker":"Chris Dy","startTime":1069.83,"endTime":1073.58,"body":"fibertech all suture anchor into"},{"speaker":"Chris Dy","startTime":1073.58,"endTime":1075.65,"body":"the index metacarpal base. And I"},{"speaker":"Chris Dy","startTime":1073.58,"endTime":1075.65,"body":"actually think there's a third"},{"speaker":"Chris Dy","startTime":1075.65,"endTime":1078.86,"body":"option, which is the kind of"},{"speaker":"Chris Dy","startTime":1075.65,"endTime":1078.86,"body":"metal version of the soul lock,"},{"speaker":"Chris Dy","startTime":1078.86,"endTime":1083.21,"body":"as opposed to, you know, the the"},{"speaker":"Chris Dy","startTime":1078.86,"endTime":1083.21,"body":"plastic bow composite version."},{"speaker":"Chris Dy","startTime":1083.21,"endTime":1086.9,"body":"So why do you which one do you"},{"speaker":"Chris Dy","startTime":1083.21,"endTime":1086.9,"body":"do and why do you do it? And do"},{"speaker":"Chris Dy","startTime":1086.9,"endTime":1089.66,"body":"you typically fix them to the"},{"speaker":"Chris Dy","startTime":1086.9,"endTime":1089.66,"body":"index first? So do you fix it to"},{"speaker":"Chris Dy","startTime":1089.66,"endTime":1090.86,"body":"the thumb metacarpal first,"},{"speaker":"Charles Goldfarb","startTime":1091.07,"endTime":1093.17,"body":"yeah, I mean,"},{"speaker":"Charles Goldfarb","startTime":1091.07,"endTime":1093.17,"body":"our group standardized before"},{"speaker":"Charles Goldfarb","startTime":1093.17,"endTime":1096.26,"body":"our trials, but I'll tell you"},{"speaker":"Charles Goldfarb","startTime":1093.17,"endTime":1096.26,"body":"what I do today, which may or"},{"speaker":"Charles Goldfarb","startTime":1096.26,"endTime":1100.13,"body":"may not be different than what"},{"speaker":"Charles Goldfarb","startTime":1096.26,"endTime":1100.13,"body":"you do today. I put the swivel"},{"speaker":"Charles Goldfarb","startTime":1100.13,"endTime":1102.77,"body":"lock suture anchor into the"},{"speaker":"Charles Goldfarb","startTime":1100.13,"endTime":1102.77,"body":"radial base of the thumb"},{"speaker":"Charles Goldfarb","startTime":1102.77,"endTime":1107.42,"body":"metacarpal first, and I try to"},{"speaker":"Charles Goldfarb","startTime":1102.77,"endTime":1107.42,"body":"align it it's basically halfway"},{"speaker":"Charles Goldfarb","startTime":1107.42,"endTime":1110.42,"body":"dorsal bowler so that that"},{"speaker":"Charles Goldfarb","startTime":1107.42,"endTime":1110.42,"body":"suture lies in a little sulcus,"},{"speaker":"Charles Goldfarb","startTime":1111.44,"endTime":1115.28,"body":"I bring the thumb metacarpal"},{"speaker":"Charles Goldfarb","startTime":1111.44,"endTime":1115.28,"body":"directly adjacent to the index"},{"speaker":"Charles Goldfarb","startTime":1115.28,"endTime":1119.48,"body":"finger metacarpal I distract the"},{"speaker":"Charles Goldfarb","startTime":1115.28,"endTime":1119.48,"body":"thumb metacarpal and I put the"},{"speaker":"Charles Goldfarb","startTime":1119.75,"endTime":1125.18,"body":"second swivel lock, just distal"},{"speaker":"Charles Goldfarb","startTime":1119.75,"endTime":1125.18,"body":"is the articular surface of the"},{"speaker":"Charles Goldfarb","startTime":1126.08,"endTime":1128.21,"body":"second metacarpal. So that's"},{"speaker":"Charles Goldfarb","startTime":1126.08,"endTime":1128.21,"body":"where the second and first"},{"speaker":"Charles Goldfarb","startTime":1128.21,"endTime":1133.58,"body":"articulate. I then often do"},{"speaker":"Charles Goldfarb","startTime":1128.21,"endTime":1133.58,"body":"another step I leave the needle"},{"speaker":"Charles Goldfarb","startTime":1133.61,"endTime":1136.97,"body":"on the suture tape, and I often"},{"speaker":"Charles Goldfarb","startTime":1133.61,"endTime":1136.97,"body":"will put a stitch through the"},{"speaker":"Charles Goldfarb","startTime":1136.97,"endTime":1140.96,"body":"dorsal base of the metacarpal"},{"speaker":"Charles Goldfarb","startTime":1136.97,"endTime":1140.96,"body":"and what that does is it"},{"speaker":"Charles Goldfarb","startTime":1140.96,"endTime":1145.58,"body":"actually brings the metal it"},{"speaker":"Charles Goldfarb","startTime":1140.96,"endTime":1145.58,"body":"basically extends the metacarpal"},{"speaker":"Charles Goldfarb","startTime":1146.48,"endTime":1149.3,"body":"by bringing the proximal"},{"speaker":"Charles Goldfarb","startTime":1146.48,"endTime":1149.3,"body":"metacarpal down it extends the"},{"speaker":"Charles Goldfarb","startTime":1149.3,"endTime":1153.26,"body":"distal metacarpal which can get"},{"speaker":"Charles Goldfarb","startTime":1149.3,"endTime":1153.26,"body":"it helps any problems you may be"},{"speaker":"Charles Goldfarb","startTime":1153.26,"endTime":1156.89,"body":"having at the MP joints. I like"},{"speaker":"Charles Goldfarb","startTime":1153.26,"endTime":1156.89,"body":"that combination and I've been"},{"speaker":"Charles Goldfarb","startTime":1156.89,"endTime":1158.63,"body":"quite pleased with it."},{"speaker":"Chris Dy","startTime":1158.84,"endTime":1160.16,"body":"So we're gonna have"},{"speaker":"Chris Dy","startTime":1158.84,"endTime":1160.16,"body":"like a fulcrum against the"},{"speaker":"Chris Dy","startTime":1160.16,"endTime":1160.76,"body":"shouldering"},{"speaker":"Charles Goldfarb","startTime":1161.54,"endTime":1165.95,"body":"correct and a"},{"speaker":"Charles Goldfarb","startTime":1161.54,"endTime":1165.95,"body":"fulcrum against the shouldering"},{"speaker":"Charles Goldfarb","startTime":1166.1,"endTime":1169.58,"body":"proximately but control the"},{"speaker":"Charles Goldfarb","startTime":1166.1,"endTime":1169.58,"body":"metacarpal head distally"},{"speaker":"Chris Dy","startTime":1169.97,"endTime":1172.85,"body":"right right yeah, no I"},{"speaker":"Chris Dy","startTime":1169.97,"endTime":1172.85,"body":"because I my Oh, ours got"},{"speaker":"Chris Dy","startTime":1172.85,"endTime":1177.44,"body":"switched I was doing my last"},{"speaker":"Chris Dy","startTime":1172.85,"endTime":1177.44,"body":"week so our yesterday at the"},{"speaker":"Chris Dy","startTime":1177.44,"endTime":1180.41,"body":"Orthopedic Center, which is not"},{"speaker":"Chris Dy","startTime":1177.44,"endTime":1180.41,"body":"my home court. So I was all my"},{"speaker":"Chris Dy","startTime":1180.41,"endTime":1184.64,"body":"best favor promisee Thank you,"},{"speaker":"Chris Dy","startTime":1180.41,"endTime":1184.64,"body":"but the the rep there was a"},{"speaker":"Chris Dy","startTime":1184.64,"endTime":1187.91,"body":"different rep that I normally"},{"speaker":"Chris Dy","startTime":1184.64,"endTime":1187.91,"body":"cover and you left the needle on"},{"speaker":"Chris Dy","startTime":1188.42,"endTime":1190.61,"body":"and we were passing it through"},{"speaker":"Chris Dy","startTime":1188.42,"endTime":1190.61,"body":"and I said hey you trying to"},{"speaker":"Chris Dy","startTime":1190.61,"endTime":1193.46,"body":"kill me is needle and he's like"},{"speaker":"Chris Dy","startTime":1190.61,"endTime":1193.46,"body":"others like to leave when I was"},{"speaker":"Chris Dy","startTime":1193.46,"endTime":1199.07,"body":"like I know. I know a guy. So I"},{"speaker":"Chris Dy","startTime":1193.46,"endTime":1199.07,"body":"actually go I've changed so i"},{"speaker":"Chris Dy","startTime":1199.07,"endTime":1201.65,"body":"She think that for Me"},{"speaker":"Chris Dy","startTime":1199.07,"endTime":1201.65,"body":"technically, it's easier and"},{"speaker":"Chris Dy","startTime":1201.65,"endTime":1205.01,"body":"more straightforward to fix into"},{"speaker":"Chris Dy","startTime":1201.65,"endTime":1205.01,"body":"the index metacarpal base first,"},{"speaker":"Chris Dy","startTime":1205.88,"endTime":1208.7,"body":"you know that insertion point is"},{"speaker":"Chris Dy","startTime":1205.88,"endTime":1208.7,"body":"just dorsal to where the SER is"},{"speaker":"Chris Dy","startTime":1208.7,"endTime":1212.51,"body":"kind of running by. I don't you"},{"speaker":"Chris Dy","startTime":1208.7,"endTime":1212.51,"body":"know, I think it's be very clear"},{"speaker":"Chris Dy","startTime":1212.51,"endTime":1215.39,"body":"where it is, I don't necessarily"},{"speaker":"Chris Dy","startTime":1212.51,"endTime":1215.39,"body":"check it on, on imaging unless"},{"speaker":"Chris Dy","startTime":1215.39,"endTime":1217.79,"body":"I'm trying to make a point to"},{"speaker":"Chris Dy","startTime":1215.39,"endTime":1217.79,"body":"the to the learner, that's with"},{"speaker":"Chris Dy","startTime":1217.79,"endTime":1221.96,"body":"me. But can I really making sure"},{"speaker":"Chris Dy","startTime":1217.79,"endTime":1221.96,"body":"and feeling that I'm on, not the"},{"speaker":"Chris Dy","startTime":1221.96,"endTime":1225.77,"body":"trapezoid not, but on the index,"},{"speaker":"Chris Dy","startTime":1221.96,"endTime":1225.77,"body":"metacarpal base and kind of"},{"speaker":"Chris Dy","startTime":1225.77,"endTime":1228.56,"body":"feeling and just kind of giving"},{"speaker":"Chris Dy","startTime":1225.77,"endTime":1228.56,"body":"some push, I think that's the"},{"speaker":"Chris Dy","startTime":1228.56,"endTime":1231.53,"body":"bone theoretically, that has a"},{"speaker":"Chris Dy","startTime":1228.56,"endTime":1231.53,"body":"harder time in terms of bone"},{"speaker":"Chris Dy","startTime":1231.53,"endTime":1234.26,"body":"quality, although I have not"},{"speaker":"Chris Dy","startTime":1231.53,"endTime":1234.26,"body":"truly found that to be the case,"},{"speaker":"Chris Dy","startTime":1234.5,"endTime":1238.55,"body":"based on where I've been putting"},{"speaker":"Chris Dy","startTime":1234.5,"endTime":1238.55,"body":"my swivel lock. But I have kind"},{"speaker":"Chris Dy","startTime":1238.55,"endTime":1241.61,"body":"of asked in the past about if we"},{"speaker":"Chris Dy","startTime":1238.55,"endTime":1241.61,"body":"have any backup options, I know"},{"speaker":"Chris Dy","startTime":1241.61,"endTime":1245.3,"body":"there is a kind of a metal type"},{"speaker":"Chris Dy","startTime":1241.61,"endTime":1245.3,"body":"biocomposite, because I've found"},{"speaker":"Chris Dy","startTime":1245.3,"endTime":1250.16,"body":"with those biocomposite anchors,"},{"speaker":"Chris Dy","startTime":1245.3,"endTime":1250.16,"body":"this swivel lock. I think and I"},{"speaker":"Chris Dy","startTime":1250.16,"endTime":1253.31,"body":"have no ties to Arthrex. So if"},{"speaker":"Chris Dy","startTime":1250.16,"endTime":1253.31,"body":"you're an Arthrex rep, forgive"},{"speaker":"Chris Dy","startTime":1253.31,"endTime":1256.04,"body":"me if I'm getting this wrong, my"},{"speaker":"Chris Dy","startTime":1253.31,"endTime":1256.04,"body":"personal experience is that you"},{"speaker":"Chris Dy","startTime":1256.04,"endTime":1259.79,"body":"have to be 100% Perfect with"},{"speaker":"Chris Dy","startTime":1256.04,"endTime":1259.79,"body":"your, with your trajectory when"},{"speaker":"Chris Dy","startTime":1259.79,"endTime":1264.86,"body":"you're inserting that wire or"},{"speaker":"Chris Dy","startTime":1259.79,"endTime":1264.86,"body":"the foot block. After I after"},{"speaker":"Chris Dy","startTime":1264.86,"endTime":1268.49,"body":"drilling, I actually asked the"},{"speaker":"Chris Dy","startTime":1264.86,"endTime":1268.49,"body":"learner to kind of piston"},{"speaker":"Chris Dy","startTime":1268.49,"endTime":1271.4,"body":"through one or two, once or"},{"speaker":"Chris Dy","startTime":1268.49,"endTime":1271.4,"body":"twice with against the hard stop"},{"speaker":"Chris Dy","startTime":1271.4,"endTime":1274.73,"body":"to really clear that channel of"},{"speaker":"Chris Dy","startTime":1271.4,"endTime":1274.73,"body":"debris. I learned that from a"},{"speaker":"Chris Dy","startTime":1274.73,"endTime":1277.82,"body":"former resident who was going"},{"speaker":"Chris Dy","startTime":1274.73,"endTime":1277.82,"body":"into sports and that's what they"},{"speaker":"Chris Dy","startTime":1277.82,"endTime":1281.72,"body":"would do. Dr. Paul England. And"},{"speaker":"Chris Dy","startTime":1277.82,"endTime":1281.72,"body":"I think that's a good idea. So"},{"speaker":"Chris Dy","startTime":1281.78,"endTime":1285.38,"body":"called out the England maneuver."},{"speaker":"Chris Dy","startTime":1281.78,"endTime":1285.38,"body":"And then I while we're kind of"},{"speaker":"Chris Dy","startTime":1285.38,"endTime":1288.5,"body":"swapping out and before putting"},{"speaker":"Chris Dy","startTime":1285.38,"endTime":1288.5,"body":"in the anchor, which is coming"},{"speaker":"Chris Dy","startTime":1288.5,"endTime":1291.56,"body":"from the back table, I'll take a"},{"speaker":"Chris Dy","startTime":1288.5,"endTime":1291.56,"body":"forceps or free and just kind of"},{"speaker":"Chris Dy","startTime":1291.56,"endTime":1294.35,"body":"pop it into that tunnel so that"},{"speaker":"Chris Dy","startTime":1291.56,"endTime":1294.35,"body":"you know, hey, I can feel it,"},{"speaker":"Chris Dy","startTime":1294.35,"endTime":1298.37,"body":"there's a back end of the bone"},{"speaker":"Chris Dy","startTime":1294.35,"endTime":1298.37,"body":"and be the the person putting in"},{"speaker":"Chris Dy","startTime":1298.37,"endTime":1300.95,"body":"the swivel lock understands the"},{"speaker":"Chris Dy","startTime":1298.37,"endTime":1300.95,"body":"trajectory because you got to be"},{"speaker":"Chris Dy","startTime":1300.95,"endTime":1305.39,"body":"perfect. Got to see that kind of"},{"speaker":"Chris Dy","startTime":1300.95,"endTime":1305.39,"body":"fork parts sit down, and the"},{"speaker":"Chris Dy","startTime":1305.39,"endTime":1308.72,"body":"screw part of it really sitting"},{"speaker":"Chris Dy","startTime":1305.39,"endTime":1308.72,"body":"against the surface of the bone."},{"speaker":"Chris Dy","startTime":1308.72,"endTime":1310.7,"body":"Because otherwise, if you don't"},{"speaker":"Chris Dy","startTime":1308.72,"endTime":1310.7,"body":"have that, and you start"},{"speaker":"Chris Dy","startTime":1310.7,"endTime":1311.84,"body":"turning, it's not going to"},{"speaker":"Chris Dy","startTime":1310.7,"endTime":1311.84,"body":"advance."},{"speaker":"Charles Goldfarb","startTime":1313.07,"endTime":1314.78,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1313.07,"endTime":1314.78,"body":"well said the other technical"},{"speaker":"Charles Goldfarb","startTime":1314.78,"endTime":1319.7,"body":"Pearl is you want to apply"},{"speaker":"Charles Goldfarb","startTime":1314.78,"endTime":1319.7,"body":"maximum tension to your suture"},{"speaker":"Charles Goldfarb","startTime":1319.7,"endTime":1323.18,"body":"tape. And then you basically"},{"speaker":"Charles Goldfarb","startTime":1319.7,"endTime":1323.18,"body":"line everything up with the two"},{"speaker":"Charles Goldfarb","startTime":1323.18,"endTime":1327.38,"body":"prongs over the suture tape at"},{"speaker":"Charles Goldfarb","startTime":1323.18,"endTime":1327.38,"body":"the entrance to the hole. And as"},{"speaker":"Charles Goldfarb","startTime":1327.38,"endTime":1331.31,"body":"soon as you start to put the"},{"speaker":"Charles Goldfarb","startTime":1327.38,"endTime":1331.31,"body":"anchor into the hole, you"},{"speaker":"Charles Goldfarb","startTime":1331.31,"endTime":1334.43,"body":"release the tension on the"},{"speaker":"Charles Goldfarb","startTime":1331.31,"endTime":1334.43,"body":"suture tape. And you're right,"},{"speaker":"Charles Goldfarb","startTime":1334.43,"endTime":1337.73,"body":"it has to be perfectly aligned."},{"speaker":"Charles Goldfarb","startTime":1334.43,"endTime":1337.73,"body":"I will say that it's not a"},{"speaker":"Charles Goldfarb","startTime":1337.76,"endTime":1342.05,"body":"difficult maneuver. But unless"},{"speaker":"Charles Goldfarb","startTime":1337.76,"endTime":1342.05,"body":"until you do it right a couple"},{"speaker":"Charles Goldfarb","startTime":1342.05,"endTime":1345.95,"body":"of times and actually probably"},{"speaker":"Charles Goldfarb","startTime":1342.05,"endTime":1345.95,"body":"do it wrong once it's easy to"},{"speaker":"Charles Goldfarb","startTime":1345.95,"endTime":1347.36,"body":"screw it up. Yeah,"},{"speaker":"Chris Dy","startTime":1347.36,"endTime":1350.18,"body":"no, I actually find"},{"speaker":"Chris Dy","startTime":1347.36,"endTime":1350.18,"body":"the thumb, at least from I do is"},{"speaker":"Chris Dy","startTime":1350.18,"endTime":1353.12,"body":"from a dorsal approach. I think"},{"speaker":"Chris Dy","startTime":1350.18,"endTime":1353.12,"body":"you also go dorsal, you know, I"},{"speaker":"Chris Dy","startTime":1353.12,"endTime":1359.45,"body":"think doing the that doing the"},{"speaker":"Chris Dy","startTime":1353.12,"endTime":1359.45,"body":"anchor insertion for the thumb"},{"speaker":"Chris Dy","startTime":1359.45,"endTime":1362.03,"body":"metacarpal actually, I think can"},{"speaker":"Chris Dy","startTime":1359.45,"endTime":1362.03,"body":"be a little bit tricky sometimes"},{"speaker":"Chris Dy","startTime":1362.03,"endTime":1364.73,"body":"in terms of getting the exposure"},{"speaker":"Chris Dy","startTime":1362.03,"endTime":1364.73,"body":"and getting the angle because I"},{"speaker":"Chris Dy","startTime":1364.73,"endTime":1369.29,"body":"do that second. And then kind of"},{"speaker":"Chris Dy","startTime":1364.73,"endTime":1369.29,"body":"canting out the thumb metacarpal"},{"speaker":"Chris Dy","startTime":1369.29,"endTime":1373.85,"body":"base radially in order to get"},{"speaker":"Chris Dy","startTime":1369.29,"endTime":1373.85,"body":"the cleat or the fork of that"},{"speaker":"Chris Dy","startTime":1373.85,"endTime":1377.15,"body":"thing lined up and push down."},{"speaker":"Chris Dy","startTime":1373.85,"endTime":1377.15,"body":"And then I'm going in and"},{"speaker":"Chris Dy","startTime":1377.15,"endTime":1379.76,"body":"getting it into the position of"},{"speaker":"Chris Dy","startTime":1377.15,"endTime":1379.76,"body":"you know, traction and at"},{"speaker":"Chris Dy","startTime":1379.76,"endTime":1383.03,"body":"duction, which can make it a"},{"speaker":"Chris Dy","startTime":1379.76,"endTime":1383.03,"body":"little bit harder for the person"},{"speaker":"Chris Dy","startTime":1383.03,"endTime":1386.9,"body":"who's putting in the anchor to"},{"speaker":"Chris Dy","startTime":1383.03,"endTime":1386.9,"body":"follow that move as I'm getting"},{"speaker":"Chris Dy","startTime":1386.9,"endTime":1390.02,"body":"started. And then I move it. And"},{"speaker":"Chris Dy","startTime":1386.9,"endTime":1390.02,"body":"you know, we have to kind of be"},{"speaker":"Chris Dy","startTime":1390.02,"endTime":1392.21,"body":"in sequence which is great"},{"speaker":"Chris Dy","startTime":1390.02,"endTime":1392.21,"body":"towards the end of a rotation."},{"speaker":"Chris Dy","startTime":1393.41,"endTime":1395.21,"body":"The beginning of the rotation"},{"speaker":"Chris Dy","startTime":1393.41,"endTime":1395.21,"body":"I'm putting in it went to the"},{"speaker":"Chris Dy","startTime":1395.21,"endTime":1398.57,"body":"point where our amazing current"},{"speaker":"Chris Dy","startTime":1395.21,"endTime":1398.57,"body":"fellow, Dr. Emily's oldest has"},{"speaker":"Chris Dy","startTime":1398.57,"endTime":1400.67,"body":"said, Alright, it's the other"},{"speaker":"Chris Dy","startTime":1398.57,"endTime":1400.67,"body":"rotation I want to put in that"},{"speaker":"Chris Dy","startTime":1400.67,"endTime":1403.13,"body":"anchor now. And I've let her do"},{"speaker":"Chris Dy","startTime":1400.67,"endTime":1403.13,"body":"it the last couple of times,"},{"speaker":"Chris Dy","startTime":1403.13,"endTime":1405.95,"body":"because she's kind of understood"},{"speaker":"Chris Dy","startTime":1403.13,"endTime":1405.95,"body":"the sequence there. And I think"},{"speaker":"Chris Dy","startTime":1405.95,"endTime":1409.13,"body":"that one can be really finicky"},{"speaker":"Chris Dy","startTime":1405.95,"endTime":1409.13,"body":"in the self tensioning part. You"},{"speaker":"Chris Dy","startTime":1409.13,"endTime":1411.98,"body":"know that anchor is supposed to"},{"speaker":"Chris Dy","startTime":1409.13,"endTime":1411.98,"body":"be self tensioning I have not"},{"speaker":"Chris Dy","startTime":1411.98,"endTime":1415.85,"body":"found it to be a self tensioning"},{"speaker":"Chris Dy","startTime":1411.98,"endTime":1415.85,"body":"as a as it's told to us. So I"},{"speaker":"Chris Dy","startTime":1415.85,"endTime":1418.52,"body":"actually typically will hold"},{"speaker":"Chris Dy","startTime":1415.85,"endTime":1418.52,"body":"attention until it's exactly the"},{"speaker":"Chris Dy","startTime":1418.52,"endTime":1419.27,"body":"time to let go"},{"speaker":"Charles Goldfarb","startTime":1420.02,"endTime":1423.41,"body":"of grief and"},{"speaker":"Charles Goldfarb","startTime":1420.02,"endTime":1423.41,"body":"have nothing to add. So to our"},{"speaker":"Charles Goldfarb","startTime":1423.92,"endTime":1427.25,"body":"you know, question writer, thank"},{"speaker":"Charles Goldfarb","startTime":1423.92,"endTime":1427.25,"body":"you for the for the question."},{"speaker":"Charles Goldfarb","startTime":1427.25,"endTime":1431.09,"body":"Hopefully that provides a little"},{"speaker":"Charles Goldfarb","startTime":1427.25,"endTime":1431.09,"body":"clarity. If it didn't, please"},{"speaker":"Charles Goldfarb","startTime":1431.12,"endTime":1434.03,"body":"follow up with us and we can"},{"speaker":"Charles Goldfarb","startTime":1431.12,"endTime":1434.03,"body":"talk on the phone or something"},{"speaker":"Charles Goldfarb","startTime":1434.66,"endTime":1434.96,"body":"involved"},{"speaker":"Chris Dy","startTime":1434.96,"endTime":1436.4,"body":"one follow up question"},{"speaker":"Chris Dy","startTime":1434.96,"endTime":1436.4,"body":"to bring that the closer look"},{"speaker":"Chris Dy","startTime":1436.4,"endTime":1439.19,"body":"why put you put the thumb"},{"speaker":"Chris Dy","startTime":1436.4,"endTime":1439.19,"body":"metacarpal first, I put the"},{"speaker":"Chris Dy","startTime":1439.19,"endTime":1443.18,"body":"index metacarpal first, so why"},{"speaker":"Chris Dy","startTime":1439.19,"endTime":1443.18,"body":"do you do it that way? And I can"},{"speaker":"Chris Dy","startTime":1443.18,"endTime":1444.29,"body":"tell you why I think I do it my"},{"speaker":"Chris Dy","startTime":1443.18,"endTime":1444.29,"body":"way."},{"speaker":"Charles Goldfarb","startTime":1445.31,"endTime":1447.14,"body":"It's the way"},{"speaker":"Charles Goldfarb","startTime":1445.31,"endTime":1447.14,"body":"I've always done it, which is a"},{"speaker":"Charles Goldfarb","startTime":1447.14,"endTime":1450.77,"body":"lousy answer. I think it's very"},{"speaker":"Charles Goldfarb","startTime":1447.14,"endTime":1450.77,"body":"straightforward. And I've had no"},{"speaker":"Charles Goldfarb","startTime":1450.77,"endTime":1454.07,"body":"troubles doing it that way,"},{"speaker":"Charles Goldfarb","startTime":1450.77,"endTime":1454.07,"body":"which is the main reason I don't"},{"speaker":"Charles Goldfarb","startTime":1454.07,"endTime":1458.09,"body":"see an advantage of switching"},{"speaker":"Charles Goldfarb","startTime":1454.07,"endTime":1458.09,"body":"things up. So I've just got I"},{"speaker":"Charles Goldfarb","startTime":1458.09,"endTime":1459.14,"body":"had no difficulties."},{"speaker":"Chris Dy","startTime":1459.92,"endTime":1462.11,"body":"I just like working"},{"speaker":"Chris Dy","startTime":1459.92,"endTime":1462.11,"body":"from outside in or inside out."},{"speaker":"Chris Dy","startTime":1462.11,"endTime":1466.91,"body":"Excuse me. For services I got to"},{"speaker":"Chris Dy","startTime":1462.11,"endTime":1466.91,"body":"and then so then I can you know"},{"speaker":"Chris Dy","startTime":1466.91,"endTime":1469.97,"body":"I like to see, you know, the"},{"speaker":"Chris Dy","startTime":1466.91,"endTime":1469.97,"body":"very end kind of where things"},{"speaker":"Chris Dy","startTime":1469.97,"endTime":1472.13,"body":"are going but you can do it a"},{"speaker":"Chris Dy","startTime":1469.97,"endTime":1472.13,"body":"lot of different ways. Have you"},{"speaker":"Chris Dy","startTime":1472.13,"endTime":1475.25,"body":"had any experience with using"},{"speaker":"Chris Dy","startTime":1472.13,"endTime":1475.25,"body":"the kind of metal version of the"},{"speaker":"Chris Dy","startTime":1475.25,"endTime":1475.91,"body":"swivel lock?"},{"speaker":"Charles Goldfarb","startTime":1476.36,"endTime":1479.72,"body":"I'm not I've"},{"speaker":"Charles Goldfarb","startTime":1476.36,"endTime":1479.72,"body":"only used the composite and"},{"speaker":"Charles Goldfarb","startTime":1479.84,"endTime":1482.33,"body":"like, like you said they have"},{"speaker":"Charles Goldfarb","startTime":1479.84,"endTime":1482.33,"body":"worked well for me. I've not had"},{"speaker":"Charles Goldfarb","startTime":1482.33,"endTime":1486.23,"body":"an issue with strength, no"},{"speaker":"Charles Goldfarb","startTime":1482.33,"endTime":1486.23,"body":"matter how osteopenic so yeah,"},{"speaker":"Charles Goldfarb","startTime":1486.23,"endTime":1487.13,"body":"but the only the"},{"speaker":"Chris Dy","startTime":1487.13,"endTime":1490.01,"body":"only thing I'd say is"},{"speaker":"Chris Dy","startTime":1487.13,"endTime":1490.01,"body":"you know in terms of osteopenia,"},{"speaker":"Chris Dy","startTime":1490.07,"endTime":1493.97,"body":"I tend to check the bone before"},{"speaker":"Chris Dy","startTime":1490.07,"endTime":1493.97,"body":"we open the kit. There has been"},{"speaker":"Chris Dy","startTime":1493.97,"endTime":1496.25,"body":"a time where we've opened the"},{"speaker":"Chris Dy","startTime":1493.97,"endTime":1496.25,"body":"kit. I've gotten something good"},{"speaker":"Chris Dy","startTime":1496.25,"endTime":1499.43,"body":"in the index and I'm not happy"},{"speaker":"Chris Dy","startTime":1496.25,"endTime":1499.43,"body":"with my thumb metacarpal and"},{"speaker":"Chris Dy","startTime":1499.43,"endTime":1502.76,"body":"I've had to pit it. And I think"},{"speaker":"Chris Dy","startTime":1499.43,"endTime":1502.76,"body":"that it'd be good to know how"},{"speaker":"Chris Dy","startTime":1502.76,"endTime":1504.77,"body":"you would kind of handle that"},{"speaker":"Chris Dy","startTime":1502.76,"endTime":1504.77,"body":"situation. You know, what I've"},{"speaker":"Chris Dy","startTime":1504.77,"endTime":1507.26,"body":"done in the past is that, and"},{"speaker":"Chris Dy","startTime":1504.77,"endTime":1507.26,"body":"you may not have come across"},{"speaker":"Chris Dy","startTime":1507.26,"endTime":1510.8,"body":"this, but I've had to use an"},{"speaker":"Chris Dy","startTime":1507.26,"endTime":1510.8,"body":"interference screw, which has"},{"speaker":"Chris Dy","startTime":1510.8,"endTime":1513.56,"body":"been good to at least know that"},{"speaker":"Chris Dy","startTime":1510.8,"endTime":1513.56,"body":"that's on backup in order to get"},{"speaker":"Chris Dy","startTime":1513.56,"endTime":1516.59,"body":"the suture tape to kind of cinch"},{"speaker":"Chris Dy","startTime":1513.56,"endTime":1516.59,"body":"down because you already"},{"speaker":"Chris Dy","startTime":1516.59,"endTime":1520.01,"body":"drilled, you know, reasonably"},{"speaker":"Chris Dy","startTime":1516.59,"endTime":1520.01,"body":"big hole there. So you need"},{"speaker":"Chris Dy","startTime":1520.01,"endTime":1522.17,"body":"something in there, that's going"},{"speaker":"Chris Dy","startTime":1520.01,"endTime":1522.17,"body":"to hold it if you can't get that"},{"speaker":"Chris Dy","startTime":1522.17,"endTime":1523.16,"body":"swivel lock to sit."},{"speaker":"Charles Goldfarb","startTime":1523.91,"endTime":1526.67,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1523.91,"endTime":1526.67,"body":"that that's a very good option."},{"speaker":"Charles Goldfarb","startTime":1527.18,"endTime":1529.73,"body":"You could also probably, if you"},{"speaker":"Charles Goldfarb","startTime":1527.18,"endTime":1529.73,"body":"left your needle on, you"},{"speaker":"Charles Goldfarb","startTime":1529.73,"endTime":1532.55,"body":"probably could literally put a"},{"speaker":"Charles Goldfarb","startTime":1529.73,"endTime":1532.55,"body":"needle through the bone. It's a"},{"speaker":"Charles Goldfarb","startTime":1532.55,"endTime":1536.09,"body":"big needle. And unless the bone"},{"speaker":"Charles Goldfarb","startTime":1532.55,"endTime":1536.09,"body":"is super wimpy, I think you"},{"speaker":"Charles Goldfarb","startTime":1536.09,"endTime":1538.49,"body":"could make that do and even if"},{"speaker":"Charles Goldfarb","startTime":1536.09,"endTime":1538.49,"body":"you had to go through your hole"},{"speaker":"Charles Goldfarb","startTime":1538.49,"endTime":1541.22,"body":"and out there articular surface"},{"speaker":"Charles Goldfarb","startTime":1538.49,"endTime":1541.22,"body":"and then tie it to itself. I"},{"speaker":"Charles Goldfarb","startTime":1541.22,"endTime":1542.39,"body":"think that would work as well."},{"speaker":"Chris Dy","startTime":1542.57,"endTime":1544.28,"body":"Right? Right. Always"},{"speaker":"Chris Dy","startTime":1542.57,"endTime":1544.28,"body":"nice to have a free needle"},{"speaker":"Chris Dy","startTime":1544.28,"endTime":1547.16,"body":"around too if you've already got"},{"speaker":"Chris Dy","startTime":1544.28,"endTime":1547.16,"body":"it off. So sure. All right, so"},{"speaker":"Chris Dy","startTime":1547.16,"endTime":1550.73,"body":"we beat the topic of technical"},{"speaker":"Chris Dy","startTime":1547.16,"endTime":1550.73,"body":"aspects of suture tape"},{"speaker":"Chris Dy","startTime":1550.73,"endTime":1553.01,"body":"suspension, I think to the point"},{"speaker":"Chris Dy","startTime":1550.73,"endTime":1553.01,"body":"of submission,"},{"speaker":"Charles Goldfarb","startTime":1553.3,"endTime":1555.37,"body":"I think we"},{"speaker":"Charles Goldfarb","startTime":1553.3,"endTime":1555.37,"body":"beat the topic of doing research"},{"speaker":"Charles Goldfarb","startTime":1555.37,"endTime":1559.12,"body":"on the CMC join to submission as"},{"speaker":"Charles Goldfarb","startTime":1555.37,"endTime":1559.12,"body":"well. I think that is my last"},{"speaker":"Charles Goldfarb","startTime":1559.33,"endTime":1561.64,"body":"article about CMC joint of my"},{"speaker":"Charles Goldfarb","startTime":1559.33,"endTime":1561.64,"body":"career,"},{"speaker":"Chris Dy","startTime":1562.0,"endTime":1564.25,"body":"we just had journal"},{"speaker":"Chris Dy","startTime":1562.0,"endTime":1564.25,"body":"club this past week and it was a"},{"speaker":"Chris Dy","startTime":1564.25,"endTime":1570.76,"body":"great article about fat grafting"},{"speaker":"Chris Dy","startTime":1564.25,"endTime":1570.76,"body":"and PRP, CMC surgery research"},{"speaker":"Chris Dy","startTime":1570.76,"endTime":1574.81,"body":"that'll never feasibly get done"},{"speaker":"Chris Dy","startTime":1570.76,"endTime":1574.81,"body":"in the United States. But you"},{"speaker":"Chris Dy","startTime":1574.81,"endTime":1576.94,"body":"never know there's always latest"},{"speaker":"Chris Dy","startTime":1574.81,"endTime":1576.94,"body":"and greatest I'm sure we'll see"},{"speaker":"Chris Dy","startTime":1576.94,"endTime":1579.7,"body":"more and plant arthroplasty"},{"speaker":"Chris Dy","startTime":1576.94,"endTime":1579.7,"body":"stuff come in. You never know"},{"speaker":"Chris Dy","startTime":1579.7,"endTime":1580.36,"body":"what's whatever."},{"speaker":"Charles Goldfarb","startTime":1580.99,"endTime":1583.12,"body":"And as much as"},{"speaker":"Charles Goldfarb","startTime":1580.99,"endTime":1583.12,"body":"I try to keep old people like me"},{"speaker":"Charles Goldfarb","startTime":1583.12,"endTime":1586.57,"body":"out of my own clinic I still"},{"speaker":"Charles Goldfarb","startTime":1583.12,"endTime":1586.57,"body":"they sneak in the door sometimes"},{"speaker":"Charles Goldfarb","startTime":1586.57,"endTime":1588.82,"body":"with CMC arthritis, so they're"},{"speaker":"Charles Goldfarb","startTime":1586.57,"endTime":1588.82,"body":"not going away."},{"speaker":"Chris Dy","startTime":1589.66,"endTime":1593.11,"body":"Oh man So one quick,"},{"speaker":"Chris Dy","startTime":1589.66,"endTime":1593.11,"body":"why don't we go to a nerve"},{"speaker":"Chris Dy","startTime":1593.11,"endTime":1596.38,"body":"related topic. But before we do"},{"speaker":"Chris Dy","startTime":1593.11,"endTime":1596.38,"body":"let's Why don't we talk about"},{"speaker":"Chris Dy","startTime":1596.38,"endTime":1597.88,"body":"our friends over at checkpoint?"},{"speaker":"Charles Goldfarb","startTime":1598.39,"endTime":1601.6,"body":"Oh absolutely."},{"speaker":"Charles Goldfarb","startTime":1598.39,"endTime":1601.6,"body":"The upper hand is sponsored by"},{"speaker":"Charles Goldfarb","startTime":1601.6,"endTime":1604.96,"body":"Checkpoint Surgical a provider"},{"speaker":"Charles Goldfarb","startTime":1601.6,"endTime":1604.96,"body":"of innovative solutions for"},{"speaker":"Charles Goldfarb","startTime":1604.96,"endTime":1606.82,"body":"peripheral nerve surgery."},{"speaker":"Chris Dy","startTime":1607.72,"endTime":1610.39,"body":"Checkpoints next nerve"},{"speaker":"Chris Dy","startTime":1607.72,"endTime":1610.39,"body":"master education program is"},{"speaker":"Chris Dy","startTime":1610.39,"endTime":1613.3,"body":"titled upper extremity acute"},{"speaker":"Chris Dy","startTime":1610.39,"endTime":1613.3,"body":"nerve injury management"},{"speaker":"Chris Dy","startTime":1613.33,"endTime":1616.69,"body":"cadaveric Course. That's a"},{"speaker":"Chris Dy","startTime":1613.33,"endTime":1616.69,"body":"mouthful, guys. It will be held"},{"speaker":"Chris Dy","startTime":1616.69,"endTime":1620.41,"body":"in Scottsdale, Arizona. Ooh,"},{"speaker":"Chris Dy","startTime":1616.69,"endTime":1620.41,"body":"that's nice. On March 15 and"},{"speaker":"Chris Dy","startTime":1620.41,"endTime":1624.13,"body":"16th where it'll be super warm"},{"speaker":"Chris Dy","startTime":1620.41,"endTime":1624.13,"body":"I'm sure Yeah,"},{"speaker":"Charles Goldfarb","startTime":1624.19,"endTime":1627.22,"body":"wow. I we're"},{"speaker":"Charles Goldfarb","startTime":1624.19,"endTime":1627.22,"body":"learning as we read the course"},{"speaker":"Charles Goldfarb","startTime":1627.22,"endTime":1633.07,"body":"faculty includes Dr. Deanna"},{"speaker":"Charles Goldfarb","startTime":1627.22,"endTime":1633.07,"body":"Mercer, Amber Leis and Brooke"},{"speaker":"Charles Goldfarb","startTime":1633.07,"endTime":1636.34,"body":"Baker. To learn more about this"},{"speaker":"Charles Goldfarb","startTime":1633.07,"endTime":1636.34,"body":"program and to register please"},{"speaker":"Charles Goldfarb","startTime":1636.34,"endTime":1640.87,"body":"visit Nervemaster.com Checkpoint"},{"speaker":"Charles Goldfarb","startTime":1636.34,"endTime":1640.87,"body":"Surgical driving innovation in"},{"speaker":"Charles Goldfarb","startTime":1640.87,"endTime":1643.12,"body":"hand surgery. You don't miss a"},{"speaker":"Charles Goldfarb","startTime":1640.87,"endTime":1643.12,"body":"warm weather meeting?"},{"speaker":"Chris Dy","startTime":1643.3,"endTime":1645.85,"body":"Oh, no, I you know"},{"speaker":"Chris Dy","startTime":1643.3,"endTime":1645.85,"body":"what? I'm actually going to be"},{"speaker":"Chris Dy","startTime":1645.85,"endTime":1648.37,"body":"in Scottsdale this coming"},{"speaker":"Chris Dy","startTime":1645.85,"endTime":1648.37,"body":"weekend for a different warm"},{"speaker":"Chris Dy","startTime":1648.37,"endTime":1650.38,"body":"weather hand surgery meeting. So"},{"speaker":"Chris Dy","startTime":1648.37,"endTime":1650.38,"body":"our travel clubs getting"},{"speaker":"Chris Dy","startTime":1650.38,"endTime":1653.23,"body":"together. So yeah, well, I'm"},{"speaker":"Chris Dy","startTime":1650.38,"endTime":1653.23,"body":"gonna go check out the"},{"speaker":"Chris Dy","startTime":1653.23,"endTime":1655.45,"body":"environment. Make sure it's good"},{"speaker":"Chris Dy","startTime":1653.23,"endTime":1655.45,"body":"for everybody who's going to be"},{"speaker":"Chris Dy","startTime":1655.45,"endTime":1657.52,"body":"going to this awesome meeting"},{"speaker":"Chris Dy","startTime":1655.45,"endTime":1657.52,"body":"from checkpoint?"},{"speaker":"Charles Goldfarb","startTime":1657.79,"endTime":1660.55,"body":"Oh my God. Now"},{"speaker":"Charles Goldfarb","startTime":1657.79,"endTime":1660.55,"body":"this is a family meeting also."},{"speaker":"Chris Dy","startTime":1661.3,"endTime":1663.73,"body":"No, this is a me and"},{"speaker":"Chris Dy","startTime":1661.3,"endTime":1663.73,"body":"my wife are going to this"},{"speaker":"Chris Dy","startTime":1663.73,"endTime":1666.19,"body":"meeting. Her kids are staying at"},{"speaker":"Chris Dy","startTime":1663.73,"endTime":1666.19,"body":"home with my father in law,"},{"speaker":"Chris Dy","startTime":1666.19,"endTime":1669.94,"body":"which will be nice. Yeah, I"},{"speaker":"Chris Dy","startTime":1666.19,"endTime":1669.94,"body":"mean, this course is looking"},{"speaker":"Chris Dy","startTime":1669.94,"endTime":1672.7,"body":"really cool. I saw some other"},{"speaker":"Chris Dy","startTime":1669.94,"endTime":1672.7,"body":"material for it. I think there's"},{"speaker":"Chris Dy","startTime":1672.7,"endTime":1674.65,"body":"gonna have some really cool"},{"speaker":"Chris Dy","startTime":1672.7,"endTime":1674.65,"body":"intraoperative ultrasound stuff"},{"speaker":"Chris Dy","startTime":1674.65,"endTime":1676.99,"body":"to look at zone of nerve injury,"},{"speaker":"Chris Dy","startTime":1674.65,"endTime":1676.99,"body":"which will be fascinating."},{"speaker":"Chris Dy","startTime":1677.5,"endTime":1680.35,"body":"Checkpoints also been kind"},{"speaker":"Chris Dy","startTime":1677.5,"endTime":1680.35,"body":"enough to sponsor our WashU"},{"speaker":"Chris Dy","startTime":1680.35,"endTime":1683.26,"body":"peripheral nerve course which is"},{"speaker":"Chris Dy","startTime":1680.35,"endTime":1683.26,"body":"coming up but not officially"},{"speaker":"Chris Dy","startTime":1683.26,"endTime":1685.84,"body":"part of the copy. But I want to"},{"speaker":"Chris Dy","startTime":1683.26,"endTime":1685.84,"body":"plug the course. It's going to"},{"speaker":"Chris Dy","startTime":1685.84,"endTime":1690.46,"body":"be April 5 to sixth here in good"},{"speaker":"Chris Dy","startTime":1685.84,"endTime":1690.46,"body":"ol St. Louis, in in Missouri in"},{"speaker":"Chris Dy","startTime":1690.46,"endTime":1694.93,"body":"the middle of the US. It's going"},{"speaker":"Chris Dy","startTime":1690.46,"endTime":1694.93,"body":"to have you know, speakers from"},{"speaker":"Chris Dy","startTime":1694.96,"endTime":1697.6,"body":"Washington faculty here right"},{"speaker":"Chris Dy","startTime":1694.96,"endTime":1697.6,"body":"now plastics, orthopedics,"},{"speaker":"Chris Dy","startTime":1697.6,"endTime":1700.6,"body":"neurosurgery, as well as the"},{"speaker":"Chris Dy","startTime":1697.6,"endTime":1700.6,"body":"alumni that have come through"},{"speaker":"Chris Dy","startTime":1700.6,"endTime":1704.41,"body":"this program. So folks like Amy"},{"speaker":"Chris Dy","startTime":1700.6,"endTime":1704.41,"body":"Moore Jana Dengler coming back,"},{"speaker":"Chris Dy","startTime":1704.89,"endTime":1708.01,"body":"it's going to be a fun course."},{"speaker":"Chris Dy","startTime":1704.89,"endTime":1708.01,"body":"It's going to have didactics and"},{"speaker":"Chris Dy","startTime":1708.01,"endTime":1710.68,"body":"cadavers. And you know, if"},{"speaker":"Chris Dy","startTime":1708.01,"endTime":1710.68,"body":"you're registered, now you get a"},{"speaker":"Chris Dy","startTime":1710.68,"endTime":1713.35,"body":"better price. And if you're a"},{"speaker":"Chris Dy","startTime":1710.68,"endTime":1713.35,"body":"trainee, you get any better"},{"speaker":"Chris Dy","startTime":1713.35,"endTime":1716.26,"body":"price. So and the social is"},{"speaker":"Chris Dy","startTime":1713.35,"endTime":1716.26,"body":"going to be at the home of none"},{"speaker":"Chris Dy","startTime":1716.26,"endTime":1718.84,"body":"other than Dr. Susan MacKinnon."},{"speaker":"Chris Dy","startTime":1716.26,"endTime":1718.84,"body":"So you get to see how Dr."},{"speaker":"Chris Dy","startTime":1718.84,"endTime":1719.68,"body":"MacKinnon lives."},{"speaker":"Charles Goldfarb","startTime":1720.19,"endTime":1722.47,"body":"Nice, very"},{"speaker":"Charles Goldfarb","startTime":1720.19,"endTime":1722.47,"body":"nice. And I will say April 5 and"},{"speaker":"Charles Goldfarb","startTime":1722.47,"endTime":1726.79,"body":"sixth in all likelihood is going"},{"speaker":"Charles Goldfarb","startTime":1722.47,"endTime":1726.79,"body":"to be a spectacularly beautiful"},{"speaker":"Charles Goldfarb","startTime":1726.79,"endTime":1729.31,"body":"spring day in St. Louis. Of"},{"speaker":"Charles Goldfarb","startTime":1726.79,"endTime":1729.31,"body":"course our fingers are crossed"},{"speaker":"Charles Goldfarb","startTime":1729.31,"endTime":1733.27,"body":"it. That's true. But Dr."},{"speaker":"Charles Goldfarb","startTime":1729.31,"endTime":1733.27,"body":"Mackinnon knows how to throw a"},{"speaker":"Charles Goldfarb","startTime":1733.48,"endTime":1734.5,"body":"welcome social."},{"speaker":"Chris Dy","startTime":1734.74,"endTime":1737.626,"body":"Yea, I t hink it'll be"},{"speaker":"Chris Dy","startTime":1734.74,"endTime":1737.626,"body":"a good time. So make sure you"},{"speaker":"Chris Dy","startTime":1737.681,"endTime":1741.068,"body":"check that out too. So we got an"},{"speaker":"Chris Dy","startTime":1737.681,"endTime":1741.068,"body":"email an email to to the pod"},{"speaker":"Chris Dy","startTime":1741.123,"endTime":1744.287,"body":"about cubital tunnel surgery."},{"speaker":"Chris Dy","startTime":1741.123,"endTime":1744.287,"body":"And this is from Dr. Archit"},{"speaker":"Chris Dy","startTime":1744.343,"endTime":1747.451,"body":"Patel, who is in in New York"},{"speaker":"Chris Dy","startTime":1744.343,"endTime":1747.451,"body":"State and he said that he's"},{"speaker":"Chris Dy","startTime":1747.507,"endTime":1750.837,"body":"enjoyed listening to us on the"},{"speaker":"Chris Dy","startTime":1747.507,"endTime":1750.837,"body":"podcast. He's saying he was a"},{"speaker":"Chris Dy","startTime":1750.893,"endTime":1754.279,"body":"med student at Wash U. So he"},{"speaker":"Chris Dy","startTime":1750.893,"endTime":1754.279,"body":"must have had a great experience"},{"speaker":"Chris Dy","startTime":1754.334,"endTime":1757.609,"body":"with either you or Marty at some"},{"speaker":"Chris Dy","startTime":1754.334,"endTime":1757.609,"body":"point. or Ryan, maybe. And"},{"speaker":"Chris Dy","startTime":1757.665,"endTime":1761.051,"body":"interestingly, it's because of"},{"speaker":"Chris Dy","startTime":1757.665,"endTime":1761.051,"body":"this stuff that you say versus"},{"speaker":"Chris Dy","startTime":1761.106,"endTime":1764.603,"body":"stuff folks hear. From listening"},{"speaker":"Chris Dy","startTime":1761.106,"endTime":1764.603,"body":"to the podcast. It sounds like"},{"speaker":"Chris Dy","startTime":1764.659,"endTime":1767.545,"body":"you and Dr. Goldfarb leaned away"},{"speaker":"Chris Dy","startTime":1764.659,"endTime":1767.545,"body":"from doing so Bosco"},{"speaker":"Chris Dy","startTime":1767.601,"endTime":1770.709,"body":"transpositions and prefer the"},{"speaker":"Chris Dy","startTime":1767.601,"endTime":1770.709,"body":"insight to or subcutaneous"},{"speaker":"Chris Dy","startTime":1770.765,"endTime":1774.151,"body":"transpositions if needed. Is"},{"speaker":"Chris Dy","startTime":1770.765,"endTime":1774.151,"body":"that your understanding? Is that"},{"speaker":"Chris Dy","startTime":1774.206,"endTime":1777.592,"body":"what you do, Chuck? I mean, I"},{"speaker":"Chris Dy","startTime":1774.206,"endTime":1777.592,"body":"actually emailed back because I"},{"speaker":"Chris Dy","startTime":1777.648,"endTime":1781.09,"body":"actually I think I do things a"},{"speaker":"Chris Dy","startTime":1777.648,"endTime":1781.09,"body":"little bit differently in that."},{"speaker":"Charles Goldfarb","startTime":1781.13,"endTime":1783.523,"body":"Well, first of"},{"speaker":"Charles Goldfarb","startTime":1781.13,"endTime":1783.523,"body":"all, thanks to Archit for"},{"speaker":"Charles Goldfarb","startTime":1783.582,"endTime":1786.694,"body":"writing, and asking us to"},{"speaker":"Charles Goldfarb","startTime":1783.582,"endTime":1786.694,"body":"clarify because clearly we"},{"speaker":"Charles Goldfarb","startTime":1786.753,"endTime":1790.582,"body":"needed to clarify. Here's my you"},{"speaker":"Charles Goldfarb","startTime":1786.753,"endTime":1790.582,"body":"know, and it was funny, we were"},{"speaker":"Charles Goldfarb","startTime":1790.642,"endTime":1794.172,"body":"having our monthly research"},{"speaker":"Charles Goldfarb","startTime":1790.642,"endTime":1794.172,"body":"meeting and we're doing a group"},{"speaker":"Charles Goldfarb","startTime":1794.232,"endTime":1797.941,"body":"project on cubital tunnels. And"},{"speaker":"Charles Goldfarb","startTime":1794.232,"endTime":1797.941,"body":"I don't know about you, Chris,"},{"speaker":"Charles Goldfarb","startTime":1798.001,"endTime":1801.172,"body":"or are listeners. There's a"},{"speaker":"Charles Goldfarb","startTime":1798.001,"endTime":1801.172,"body":"limit to how many cubital"},{"speaker":"Charles Goldfarb","startTime":1801.232,"endTime":1804.822,"body":"tunnels I want to do in the day."},{"speaker":"Charles Goldfarb","startTime":1801.232,"endTime":1804.822,"body":"There's a limited number of"},{"speaker":"Charles Goldfarb","startTime":1804.882,"endTime":1808.651,"body":"carpal tunnels as well, but it's"},{"speaker":"Charles Goldfarb","startTime":1804.882,"endTime":1808.651,"body":"just more because they're just"},{"speaker":"Charles Goldfarb","startTime":1808.711,"endTime":1812.48,"body":"simple and fast. Keeble tunnels"},{"speaker":"Charles Goldfarb","startTime":1808.711,"endTime":1812.48,"body":"are still, hopefully simple and"},{"speaker":"Charles Goldfarb","startTime":1812.54,"endTime":1815.95,"body":"relatively fast. But I have an"},{"speaker":"Charles Goldfarb","startTime":1812.54,"endTime":1815.95,"body":"incredible number of cable"},{"speaker":"Charles Goldfarb","startTime":1816.01,"endTime":1819.659,"body":"tunnels coming up. I think it's"},{"speaker":"Charles Goldfarb","startTime":1816.01,"endTime":1819.659,"body":"for one day and five the next"},{"speaker":"Charles Goldfarb","startTime":1819.719,"endTime":1823.13,"body":"and that's too many for me. So,"},{"speaker":"Charles Goldfarb","startTime":1819.719,"endTime":1823.13,"body":"I've spoken to my nurses."},{"speaker":"Chris Dy","startTime":1823.13,"endTime":1824.54,"body":"I'm sure your nurse is"},{"speaker":"Chris Dy","startTime":1823.13,"endTime":1824.54,"body":"going to be here."},{"speaker":"Charles Goldfarb","startTime":1825.47,"endTime":1828.83,"body":"But anyways,"},{"speaker":"Charles Goldfarb","startTime":1825.47,"endTime":1828.83,"body":"the question the question, my"},{"speaker":"Charles Goldfarb","startTime":1828.83,"endTime":1832.64,"body":"population tends to be"},{"speaker":"Charles Goldfarb","startTime":1828.83,"endTime":1832.64,"body":"adolescent to young adult."},{"speaker":"Charles Goldfarb","startTime":1833.48,"endTime":1837.11,"body":"Rarely do I believe in insight"},{"speaker":"Charles Goldfarb","startTime":1833.48,"endTime":1837.11,"body":"to decompression is the right"},{"speaker":"Charles Goldfarb","startTime":1837.14,"endTime":1843.14,"body":"surgery for that group. If, in a"},{"speaker":"Charles Goldfarb","startTime":1837.14,"endTime":1843.14,"body":"slightly older patient, the"},{"speaker":"Charles Goldfarb","startTime":1843.14,"endTime":1847.01,"body":"nerve is absolutely stable, as"},{"speaker":"Charles Goldfarb","startTime":1843.14,"endTime":1847.01,"body":"demonstrated clinically, by"},{"speaker":"Charles Goldfarb","startTime":1847.01,"endTime":1850.67,"body":"palpation, as well as by"},{"speaker":"Charles Goldfarb","startTime":1847.01,"endTime":1850.67,"body":"ultrasound, as well as intra"},{"speaker":"Charles Goldfarb","startTime":1850.67,"endTime":1854.03,"body":"operatively, I will start out"},{"speaker":"Charles Goldfarb","startTime":1850.67,"endTime":1854.03,"body":"and plan to do a decompression"},{"speaker":"Charles Goldfarb","startTime":1854.03,"endTime":1858.47,"body":"and stop that is less than 10%"},{"speaker":"Charles Goldfarb","startTime":1854.03,"endTime":1858.47,"body":"of my current patients, I would"},{"speaker":"Charles Goldfarb","startTime":1858.47,"endTime":1863.48,"body":"say 80% of my current patients"},{"speaker":"Charles Goldfarb","startTime":1858.47,"endTime":1863.48,"body":"are subcutaneous transpositions."},{"speaker":"Charles Goldfarb","startTime":1863.48,"endTime":1868.58,"body":"With that fasciocutaneous flap,"},{"speaker":"Charles Goldfarb","startTime":1863.48,"endTime":1868.58,"body":"and 10% are sub muscular. I"},{"speaker":"Charles Goldfarb","startTime":1868.61,"endTime":1873.17,"body":"rarely have the older patient"},{"speaker":"Charles Goldfarb","startTime":1868.61,"endTime":1873.17,"body":"with more severe cubital tunnel."},{"speaker":"Charles Goldfarb","startTime":1873.29,"endTime":1876.95,"body":"I have had a couple of recently"},{"speaker":"Charles Goldfarb","startTime":1873.29,"endTime":1876.95,"body":"did a nerve transfer recently"},{"speaker":"Charles Goldfarb","startTime":1876.95,"endTime":1880.22,"body":"for that, but the vast majority"},{"speaker":"Charles Goldfarb","startTime":1876.95,"endTime":1880.22,"body":"of my patients and I look"},{"speaker":"Charles Goldfarb","startTime":1880.22,"endTime":1883.19,"body":"forward to hearing Chris's"},{"speaker":"Charles Goldfarb","startTime":1880.22,"endTime":1883.19,"body":"clarification, the vast majority"},{"speaker":"Charles Goldfarb","startTime":1883.19,"endTime":1886.07,"body":"of my patients are subcutaneous."},{"speaker":"Charles Goldfarb","startTime":1883.19,"endTime":1886.07,"body":"So"},{"speaker":"Chris Dy","startTime":1886.1,"endTime":1890.36,"body":"what's your threshold"},{"speaker":"Chris Dy","startTime":1886.1,"endTime":1890.36,"body":"to get into that 10%, where they"},{"speaker":"Chris Dy","startTime":1890.36,"endTime":1892.79,"body":"get a sub muscular as opposed to"},{"speaker":"Chris Dy","startTime":1890.36,"endTime":1892.79,"body":"a subcutaneous."},{"speaker":"Charles Goldfarb","startTime":1893.54,"endTime":1896.24,"body":"I am a"},{"speaker":"Charles Goldfarb","startTime":1893.54,"endTime":1896.24,"body":"believer in patients with severe"},{"speaker":"Charles Goldfarb","startTime":1896.24,"endTime":1899.99,"body":"cubital tunnel doing everything"},{"speaker":"Charles Goldfarb","startTime":1896.24,"endTime":1899.99,"body":"I possibly can to help the"},{"speaker":"Charles Goldfarb","startTime":1899.99,"endTime":1903.68,"body":"patient. Even though the"},{"speaker":"Charles Goldfarb","startTime":1899.99,"endTime":1903.68,"body":"literature in my reading is not"},{"speaker":"Charles Goldfarb","startTime":1903.68,"endTime":1907.79,"body":"completely clear that"},{"speaker":"Charles Goldfarb","startTime":1903.68,"endTime":1907.79,"body":"submuscular is better. I believe"},{"speaker":"Charles Goldfarb","startTime":1907.79,"endTime":1910.7,"body":"it is I think it is the best"},{"speaker":"Charles Goldfarb","startTime":1907.79,"endTime":1910.7,"body":"operation. But I believe it"},{"speaker":"Charles Goldfarb","startTime":1910.7,"endTime":1913.67,"body":"comes at the highest cost. And"},{"speaker":"Charles Goldfarb","startTime":1910.7,"endTime":1913.67,"body":"it's not. It's not just inter"},{"speaker":"Charles Goldfarb","startTime":1913.67,"endTime":1917.39,"body":"inter operative time. It's not"},{"speaker":"Charles Goldfarb","startTime":1913.67,"endTime":1917.39,"body":"just discomfort or recovery. I"},{"speaker":"Charles Goldfarb","startTime":1917.39,"endTime":1921.14,"body":"just think I don't love that"},{"speaker":"Charles Goldfarb","startTime":1917.39,"endTime":1921.14,"body":"concept of cutting muscle. But"},{"speaker":"Charles Goldfarb","startTime":1921.14,"endTime":1924.5,"body":"if a patient has more severe"},{"speaker":"Charles Goldfarb","startTime":1921.14,"endTime":1924.5,"body":"findings, and certainly if they"},{"speaker":"Charles Goldfarb","startTime":1924.5,"endTime":1928.07,"body":"have atrophy, or static two"},{"speaker":"Charles Goldfarb","startTime":1924.5,"endTime":1928.07,"body":"point discrimination changes."},{"speaker":"Charles Goldfarb","startTime":1928.25,"endTime":1931.52,"body":"For me, that's an indication to"},{"speaker":"Charles Goldfarb","startTime":1928.25,"endTime":1931.52,"body":"really think hard about doing a"},{"speaker":"Charles Goldfarb","startTime":1931.52,"endTime":1932.21,"body":"sub muscular."},{"speaker":"Chris Dy","startTime":1932.21,"endTime":1934.905,"body":"Yeah, no, I've tried"},{"speaker":"Chris Dy","startTime":1932.21,"endTime":1934.905,"body":"to I think those are, I think"},{"speaker":"Chris Dy","startTime":1934.959,"endTime":1938.302,"body":"that's a great algorithm. And I"},{"speaker":"Chris Dy","startTime":1934.959,"endTime":1938.302,"body":"think a lot of people probably"},{"speaker":"Chris Dy","startTime":1938.356,"endTime":1941.699,"body":"have similar thoughts to you. I"},{"speaker":"Chris Dy","startTime":1938.356,"endTime":1941.699,"body":"mean, you know, the price of a"},{"speaker":"Chris Dy","startTime":1941.753,"endTime":1944.826,"body":"sub muscular is there, I do"},{"speaker":"Chris Dy","startTime":1941.753,"endTime":1944.826,"body":"think that the the additional"},{"speaker":"Chris Dy","startTime":1944.88,"endTime":1948.223,"body":"discomfort of that surgery is"},{"speaker":"Chris Dy","startTime":1944.88,"endTime":1948.223,"body":"substantial. To the point where,"},{"speaker":"Chris Dy","startTime":1948.277,"endTime":1951.404,"body":"you know, people ask me how,"},{"speaker":"Chris Dy","startTime":1948.277,"endTime":1951.404,"body":"what the recovery feels like,"},{"speaker":"Chris Dy","startTime":1951.458,"endTime":1954.909,"body":"you know, I've learned it's kind"},{"speaker":"Chris Dy","startTime":1951.458,"endTime":1954.909,"body":"of to get over the cord cutting"},{"speaker":"Chris Dy","startTime":1954.962,"endTime":1958.197,"body":"and sewing and the surgeries,"},{"speaker":"Chris Dy","startTime":1954.962,"endTime":1958.197,"body":"probably four to six weeks for"},{"speaker":"Chris Dy","startTime":1958.251,"endTime":1961.648,"body":"some muscular, and inside two is"},{"speaker":"Chris Dy","startTime":1958.251,"endTime":1961.648,"body":"much shorter, and subcutaneous"},{"speaker":"Chris Dy","startTime":1961.702,"endTime":1965.045,"body":"is someone in the middle. You"},{"speaker":"Chris Dy","startTime":1961.702,"endTime":1965.045,"body":"know, for me, the algorithm I've"},{"speaker":"Chris Dy","startTime":1965.099,"endTime":1968.388,"body":"come to is that somebody who"},{"speaker":"Chris Dy","startTime":1965.099,"endTime":1968.388,"body":"gets an insight to decompression"},{"speaker":"Chris Dy","startTime":1968.442,"endTime":1971.623,"body":"is somebody who has somebody"},{"speaker":"Chris Dy","startTime":1968.442,"endTime":1971.623,"body":"who's, you know, refractory to"},{"speaker":"Chris Dy","startTime":1971.677,"endTime":1974.966,"body":"conservative measures. Somebody"},{"speaker":"Chris Dy","startTime":1971.677,"endTime":1974.966,"body":"who has a nerve study that is"},{"speaker":"Chris Dy","startTime":1975.02,"endTime":1978.416,"body":"completely clean in terms of no"},{"speaker":"Chris Dy","startTime":1975.02,"endTime":1978.416,"body":"see map amplitude loss, there's"},{"speaker":"Chris Dy","startTime":1978.47,"endTime":1981.436,"body":"a conduction velocity drop"},{"speaker":"Chris Dy","startTime":1978.47,"endTime":1981.436,"body":"across the elbows, one would"},{"speaker":"Chris Dy","startTime":1981.49,"endTime":1984.832,"body":"expect but no deviation changes"},{"speaker":"Chris Dy","startTime":1981.49,"endTime":1984.832,"body":"on the EMG. And the ultrasound"},{"speaker":"Chris Dy","startTime":1984.886,"endTime":1988.229,"body":"has demonstrated the nerve to be"},{"speaker":"Chris Dy","startTime":1984.886,"endTime":1988.229,"body":"stable, because I think there"},{"speaker":"Chris Dy","startTime":1988.283,"endTime":1991.195,"body":"are some studies showing that"},{"speaker":"Chris Dy","startTime":1988.283,"endTime":1991.195,"body":"the ultrasound is better"},{"speaker":"Chris Dy","startTime":1991.248,"endTime":1994.537,"body":"predicting it. And I honestly"},{"speaker":"Chris Dy","startTime":1991.248,"endTime":1994.537,"body":"don't want any surprises in the"},{"speaker":"Chris Dy","startTime":1994.591,"endTime":1997.88,"body":"operating room, I'd rather kind"},{"speaker":"Chris Dy","startTime":1994.591,"endTime":1997.88,"body":"of know exactly how to book a"},{"speaker":"Chris Dy","startTime":1997.934,"endTime":2001.277,"body":"case for and how to counsel the"},{"speaker":"Chris Dy","startTime":1997.934,"endTime":2001.277,"body":"patient. Although every time I"},{"speaker":"Chris Dy","startTime":2001.331,"endTime":2004.782,"body":"talked to him about it inside to"},{"speaker":"Chris Dy","startTime":2001.331,"endTime":2004.782,"body":"talk about the possibility of a"},{"speaker":"Chris Dy","startTime":2004.836,"endTime":2008.34,"body":"transposition that's happened to"},{"speaker":"Chris Dy","startTime":2004.836,"endTime":2008.34,"body":"me twice so far, in terms of not"},{"speaker":"Chris Dy","startTime":2008.394,"endTime":2011.791,"body":"being not being fully prepared."},{"speaker":"Chris Dy","startTime":2008.394,"endTime":2011.791,"body":"But if you have any findings of"},{"speaker":"Chris Dy","startTime":2011.845,"endTime":2014.918,"body":"either an unstable nerve on"},{"speaker":"Chris Dy","startTime":2011.845,"endTime":2014.918,"body":"examination or an ultrasound,"},{"speaker":"Chris Dy","startTime":2014.972,"endTime":2018.099,"body":"then you get a subcutaneous"},{"speaker":"Chris Dy","startTime":2014.972,"endTime":2018.099,"body":"transposition. If you have any"},{"speaker":"Chris Dy","startTime":2018.153,"endTime":2021.011,"body":"advanced findings on clinical"},{"speaker":"Chris Dy","startTime":2018.153,"endTime":2021.011,"body":"examination in terms of"},{"speaker":"Chris Dy","startTime":2021.065,"endTime":2024.3,"body":"weakness, as you're stating,"},{"speaker":"Chris Dy","startTime":2021.065,"endTime":2024.3,"body":"certainly atrophy, elevated two"},{"speaker":"Chris Dy","startTime":2024.353,"endTime":2027.427,"body":"point discrimination, then"},{"speaker":"Chris Dy","startTime":2024.353,"endTime":2027.427,"body":"you're and then on your nerves"},{"speaker":"Chris Dy","startTime":2027.481,"endTime":2030.662,"body":"study, if there's a sea map"},{"speaker":"Chris Dy","startTime":2027.481,"endTime":2030.662,"body":"amplitude loss, that's anything"},{"speaker":"Chris Dy","startTime":2030.716,"endTime":2034.112,"body":"more than you know, you know, a"},{"speaker":"Chris Dy","startTime":2030.716,"endTime":2034.112,"body":"value that's less than about 60"},{"speaker":"Chris Dy","startTime":2034.166,"endTime":2037.024,"body":"to 70% of normal of the same"},{"speaker":"Chris Dy","startTime":2034.166,"endTime":2037.024,"body":"amplitude or there's the"},{"speaker":"Chris Dy","startTime":2037.078,"endTime":2040.043,"body":"innovation findings with"},{"speaker":"Chris Dy","startTime":2037.078,"endTime":2040.043,"body":"abnormal recruitment patterns,"},{"speaker":"Chris Dy","startTime":2040.097,"endTime":2042.685,"body":"then you're getting a sub"},{"speaker":"Chris Dy","startTime":2040.097,"endTime":2042.685,"body":"muscular. So that's my"},{"speaker":"Chris Dy","startTime":2042.739,"endTime":2046.136,"body":"algorithm. And then I think I'll"},{"speaker":"Chris Dy","startTime":2042.739,"endTime":2046.136,"body":"add the nerve transfer part. I"},{"speaker":"Chris Dy","startTime":2046.19,"endTime":2049.317,"body":"mean, I think at the same"},{"speaker":"Chris Dy","startTime":2046.19,"endTime":2049.317,"body":"amplitude value is probably less"},{"speaker":"Chris Dy","startTime":2049.371,"endTime":2052.714,"body":"than 30, or 40% of the normal"},{"speaker":"Chris Dy","startTime":2049.371,"endTime":2052.714,"body":"value for that older, intrinsic,"},{"speaker":"Chris Dy","startTime":2052.768,"endTime":2056.057,"body":"whichever, whether it's the ADM"},{"speaker":"Chris Dy","startTime":2052.768,"endTime":2056.057,"body":"or the FDI. Then I'm thinking"},{"speaker":"Chris Dy","startTime":2056.11,"endTime":2059.076,"body":"long and hard about doing a"},{"speaker":"Chris Dy","startTime":2056.11,"endTime":2059.076,"body":"reverse at the side, quote,"},{"speaker":"Chris Dy","startTime":2059.13,"endTime":2060.64,"body":"supercharged nerve transfer."},{"speaker":"Charles Goldfarb","startTime":2061.72,"endTime":2064.12,"body":"What do you"},{"speaker":"Charles Goldfarb","startTime":2061.72,"endTime":2064.12,"body":"tell patients? Let's take the"},{"speaker":"Charles Goldfarb","startTime":2064.15,"endTime":2068.71,"body":"patient with a an unstable"},{"speaker":"Charles Goldfarb","startTime":2064.15,"endTime":2068.71,"body":"nerve, but a relatively clean"},{"speaker":"Charles Goldfarb","startTime":2068.74,"endTime":2073.21,"body":"nerve steady. What do you tell"},{"speaker":"Charles Goldfarb","startTime":2068.74,"endTime":2073.21,"body":"that patient regarding"},{"speaker":"Charles Goldfarb","startTime":2073.24,"endTime":2077.26,"body":"expectations? How many get a"},{"speaker":"Charles Goldfarb","startTime":2073.24,"endTime":2077.26,"body":"cure what percent good are"},{"speaker":"Charles Goldfarb","startTime":2077.26,"endTime":2081.13,"body":"cured? What percent are"},{"speaker":"Charles Goldfarb","startTime":2077.26,"endTime":2081.13,"body":"improved, but perhaps not cured?"},{"speaker":"Charles Goldfarb","startTime":2081.13,"endTime":2083.83,"body":"And what percent are hopefully"},{"speaker":"Charles Goldfarb","startTime":2081.13,"endTime":2083.83,"body":"neither better nor worse?"},{"speaker":"Chris Dy","startTime":2084.19,"endTime":2086.38,"body":"I actually don't use"},{"speaker":"Chris Dy","startTime":2084.19,"endTime":2086.38,"body":"the word cure. I think ever in"},{"speaker":"Chris Dy","startTime":2086.38,"endTime":2089.02,"body":"my practice, you know, in terms"},{"speaker":"Chris Dy","startTime":2086.38,"endTime":2089.02,"body":"of how I counseled people, I"},{"speaker":"Chris Dy","startTime":2089.02,"endTime":2091.15,"body":"tell people, I think I'm gonna"},{"speaker":"Chris Dy","startTime":2089.02,"endTime":2091.15,"body":"make it a lot better. I tell"},{"speaker":"Chris Dy","startTime":2091.15,"endTime":2093.4,"body":"talk to them about how this is a"},{"speaker":"Chris Dy","startTime":2091.15,"endTime":2093.4,"body":"mechanical thing. The nerve is"},{"speaker":"Chris Dy","startTime":2093.4,"endTime":2096.58,"body":"flipping back and forth or"},{"speaker":"Chris Dy","startTime":2093.4,"endTime":2096.58,"body":"wanting to move out from behind"},{"speaker":"Chris Dy","startTime":2096.58,"endTime":2099.79,"body":"the elbow. And that we're going"},{"speaker":"Chris Dy","startTime":2096.58,"endTime":2099.79,"body":"to talk it and secure it and"},{"speaker":"Chris Dy","startTime":2099.79,"endTime":2102.34,"body":"about To replace in front of the"},{"speaker":"Chris Dy","startTime":2099.79,"endTime":2102.34,"body":"elbow, and you know, those"},{"speaker":"Chris Dy","startTime":2102.34,"endTime":2105.46,"body":"patients who have unstable"},{"speaker":"Chris Dy","startTime":2102.34,"endTime":2105.46,"body":"nerves that are relatively"},{"speaker":"Chris Dy","startTime":2105.46,"endTime":2108.16,"body":"slender, they actually do get a"},{"speaker":"Chris Dy","startTime":2105.46,"endTime":2108.16,"body":"sub muscular as opposed to a"},{"speaker":"Chris Dy","startTime":2108.16,"endTime":2110.92,"body":"subcutaneous, I think our"},{"speaker":"Chris Dy","startTime":2108.16,"endTime":2110.92,"body":"experience in the Midwest is"},{"speaker":"Chris Dy","startTime":2110.92,"endTime":2115.03,"body":"that our patients tend to not"},{"speaker":"Chris Dy","startTime":2110.92,"endTime":2115.03,"body":"lack adiposity. So to say, and,"},{"speaker":"Chris Dy","startTime":2115.03,"endTime":2117.19,"body":"you know, they've, they've got"},{"speaker":"Chris Dy","startTime":2115.03,"endTime":2117.19,"body":"some thickness on that side,"},{"speaker":"Charles Goldfarb","startTime":2117.43,"endTime":2118.18,"body":"possibly."},{"speaker":"Chris Dy","startTime":2120.31,"endTime":2122.44,"body":"They, at least they at"},{"speaker":"Chris Dy","startTime":2120.31,"endTime":2122.44,"body":"least got something to work with"},{"speaker":"Chris Dy","startTime":2122.44,"endTime":2126.19,"body":"there. But yeah, and I tell them"},{"speaker":"Chris Dy","startTime":2122.44,"endTime":2126.19,"body":"that I think this has got a"},{"speaker":"Chris Dy","startTime":2126.19,"endTime":2129.49,"body":"really good chance of, of"},{"speaker":"Chris Dy","startTime":2126.19,"endTime":2129.49,"body":"keeping the nerve for being"},{"speaker":"Chris Dy","startTime":2129.49,"endTime":2132.7,"body":"irritated. I tell them, there's"},{"speaker":"Chris Dy","startTime":2129.49,"endTime":2132.7,"body":"a chance of having to redo the"},{"speaker":"Chris Dy","startTime":2132.7,"endTime":2135.37,"body":"surgery. At some point in the"},{"speaker":"Chris Dy","startTime":2132.7,"endTime":2135.37,"body":"future, I've had one patient who"},{"speaker":"Chris Dy","startTime":2135.37,"endTime":2137.44,"body":"have had to revise their"},{"speaker":"Chris Dy","startTime":2135.37,"endTime":2137.44,"body":"subcutaneous because she had a"},{"speaker":"Chris Dy","startTime":2137.44,"endTime":2140.26,"body":"bad trauma to the medial side of"},{"speaker":"Chris Dy","startTime":2137.44,"endTime":2140.26,"body":"the elbow, and that certainly"},{"speaker":"Chris Dy","startTime":2140.26,"endTime":2143.62,"body":"dislodged her her nerve or at"},{"speaker":"Chris Dy","startTime":2140.26,"endTime":2143.62,"body":"least irritated again, when I"},{"speaker":"Chris Dy","startTime":2143.62,"endTime":2147.4,"body":"went into surgery, it wasn't"},{"speaker":"Chris Dy","startTime":2143.62,"endTime":2147.4,"body":"actually flipping back"},{"speaker":"Chris Dy","startTime":2147.4,"endTime":2150.31,"body":"posterior. But you know, the"},{"speaker":"Chris Dy","startTime":2147.4,"endTime":2150.31,"body":"literature would suggest that"},{"speaker":"Chris Dy","startTime":2150.31,"endTime":2154.42,"body":"there is a risk of revision for"},{"speaker":"Chris Dy","startTime":2150.31,"endTime":2154.42,"body":"subcutaneous. And that's why I"},{"speaker":"Chris Dy","startTime":2154.42,"endTime":2156.46,"body":"think it's important to really"},{"speaker":"Chris Dy","startTime":2154.42,"endTime":2156.46,"body":"take care of that nerve when"},{"speaker":"Chris Dy","startTime":2156.46,"endTime":2157.39,"body":"you're doing a surgery."},{"speaker":"Charles Goldfarb","startTime":2158.14,"endTime":2162.46,"body":"Yeah, I don't"},{"speaker":"Charles Goldfarb","startTime":2158.14,"endTime":2162.46,"body":"I feel really good about how my"},{"speaker":"Charles Goldfarb","startTime":2162.46,"endTime":2167.53,"body":"patients are faring. Recently, I"},{"speaker":"Charles Goldfarb","startTime":2162.46,"endTime":2167.53,"body":"don't think I'm a better"},{"speaker":"Charles Goldfarb","startTime":2167.53,"endTime":2171.07,"body":"surgeon, I think one of two"},{"speaker":"Charles Goldfarb","startTime":2167.53,"endTime":2171.07,"body":"things has happened. One, my"},{"speaker":"Charles Goldfarb","startTime":2171.07,"endTime":2174.82,"body":"population really has veered to"},{"speaker":"Charles Goldfarb","startTime":2171.07,"endTime":2174.82,"body":"the younger patient with an"},{"speaker":"Charles Goldfarb","startTime":2174.82,"endTime":2177.49,"body":"unstable nerve. And those"},{"speaker":"Charles Goldfarb","startTime":2174.82,"endTime":2177.49,"body":"patients typically really do"},{"speaker":"Charles Goldfarb","startTime":2177.49,"endTime":2182.71,"body":"well. Or to this concept of the"},{"speaker":"Charles Goldfarb","startTime":2177.49,"endTime":2182.71,"body":"fascia cutaneous flap, I really"},{"speaker":"Charles Goldfarb","startTime":2182.74,"endTime":2187.36,"body":"do think it's a dramatic"},{"speaker":"Charles Goldfarb","startTime":2182.74,"endTime":2187.36,"body":"improvement compared to an Eaton"},{"speaker":"Charles Goldfarb","startTime":2188.56,"endTime":2193.57,"body":"fascial flap alone, which is"},{"speaker":"Charles Goldfarb","startTime":2188.56,"endTime":2193.57,"body":"what I did for 15 years. And so"},{"speaker":"Charles Goldfarb","startTime":2193.57,"endTime":2198.88,"body":"I am really happy with the ulnar"},{"speaker":"Charles Goldfarb","startTime":2193.57,"endTime":2198.88,"body":"nerve treatment in 2024, I feel"},{"speaker":"Charles Goldfarb","startTime":2198.88,"endTime":2201.64,"body":"really good about it, it's"},{"speaker":"Charles Goldfarb","startTime":2198.88,"endTime":2201.64,"body":"pretty uncommon that I worry"},{"speaker":"Charles Goldfarb","startTime":2201.64,"endTime":2203.41,"body":"about a less than optimal"},{"speaker":"Charles Goldfarb","startTime":2201.64,"endTime":2203.41,"body":"outcome."},{"speaker":"Chris Dy","startTime":2203.98,"endTime":2205.75,"body":"Yeah, and I think it's"},{"speaker":"Chris Dy","startTime":2203.98,"endTime":2205.75,"body":"just about catching the patients"},{"speaker":"Chris Dy","startTime":2205.75,"endTime":2207.94,"body":"at the right time. And then"},{"speaker":"Chris Dy","startTime":2205.75,"endTime":2207.94,"body":"making sure that you're, you"},{"speaker":"Chris Dy","startTime":2207.94,"endTime":2211.18,"body":"know, like you're saying, like,"},{"speaker":"Chris Dy","startTime":2207.94,"endTime":2211.18,"body":"the technical parts of surgery"},{"speaker":"Chris Dy","startTime":2211.18,"endTime":2215.59,"body":"are non negotiable. And that's"},{"speaker":"Chris Dy","startTime":2211.18,"endTime":2215.59,"body":"probably not not what's changed"},{"speaker":"Chris Dy","startTime":2215.59,"endTime":2217.81,"body":"with you, it is more kind of"},{"speaker":"Chris Dy","startTime":2215.59,"endTime":2217.81,"body":"maybe the procedure selection or"},{"speaker":"Chris Dy","startTime":2217.81,"endTime":2220.51,"body":"your ability to counsel"},{"speaker":"Chris Dy","startTime":2217.81,"endTime":2220.51,"body":"patients, or it set expectations"},{"speaker":"Chris Dy","startTime":2220.51,"endTime":2223.87,"body":"or just the fact that your"},{"speaker":"Chris Dy","startTime":2220.51,"endTime":2223.87,"body":"patients are very younger. I do."},{"speaker":"Chris Dy","startTime":2223.9,"endTime":2226.54,"body":"I mean, honestly, by because of"},{"speaker":"Chris Dy","startTime":2223.9,"endTime":2226.54,"body":"what I do, and the population"},{"speaker":"Chris Dy","startTime":2226.54,"endTime":2228.73,"body":"that I see, I get a fair number"},{"speaker":"Chris Dy","startTime":2226.54,"endTime":2228.73,"body":"of these patients who have"},{"speaker":"Chris Dy","startTime":2228.73,"endTime":2232.12,"body":"really burnt out nerves, so to"},{"speaker":"Chris Dy","startTime":2228.73,"endTime":2232.12,"body":"say, kind of the cold burned out"},{"speaker":"Chris Dy","startTime":2232.12,"endTime":2234.94,"body":"nerve. And that's an uphill"},{"speaker":"Chris Dy","startTime":2232.12,"endTime":2234.94,"body":"battle. And the counseling is"},{"speaker":"Chris Dy","startTime":2234.94,"endTime":2238.12,"body":"really hard. I mean, for a"},{"speaker":"Chris Dy","startTime":2234.94,"endTime":2238.12,"body":"patient who's got severe enough,"},{"speaker":"Chris Dy","startTime":2239.29,"endTime":2242.2,"body":"on their neuropathy, where we're"},{"speaker":"Chris Dy","startTime":2239.29,"endTime":2242.2,"body":"talking nerve transfer, and even"},{"speaker":"Chris Dy","startTime":2242.2,"endTime":2244.6,"body":"papers, patients who don't get a"},{"speaker":"Chris Dy","startTime":2242.2,"endTime":2244.6,"body":"nerve transfer, but have you"},{"speaker":"Chris Dy","startTime":2244.6,"endTime":2247.9,"body":"know, quote, severe on their"},{"speaker":"Chris Dy","startTime":2244.6,"endTime":2247.9,"body":"neuropathy, I tell them that,"},{"speaker":"Chris Dy","startTime":2247.93,"endTime":2251.29,"body":"you know, I'm not going to judge"},{"speaker":"Chris Dy","startTime":2247.93,"endTime":2251.29,"body":"the surgery as a success, or not"},{"speaker":"Chris Dy","startTime":2251.29,"endTime":2254.5,"body":"a success until about a year"},{"speaker":"Chris Dy","startTime":2251.29,"endTime":2254.5,"body":"after surgery. I tell them, it's"},{"speaker":"Chris Dy","startTime":2254.5,"endTime":2256.87,"body":"going to take that long for the"},{"speaker":"Chris Dy","startTime":2254.5,"endTime":2256.87,"body":"nerve to mend itself. For things"},{"speaker":"Chris Dy","startTime":2256.87,"endTime":2260.17,"body":"to grow back. You're going to"},{"speaker":"Chris Dy","startTime":2256.87,"endTime":2260.17,"body":"get a fair bit of recovery early"},{"speaker":"Chris Dy","startTime":2260.17,"endTime":2262.33,"body":"on in the first few months. But"},{"speaker":"Chris Dy","startTime":2260.17,"endTime":2262.33,"body":"you know, we're not going to"},{"speaker":"Chris Dy","startTime":2262.33,"endTime":2266.11,"body":"know whether this worked until"},{"speaker":"Chris Dy","startTime":2262.33,"endTime":2266.11,"body":"about a year from surgery. I"},{"speaker":"Charles Goldfarb","startTime":2266.11,"endTime":2269.59,"body":"think that's"},{"speaker":"Charles Goldfarb","startTime":2266.11,"endTime":2269.59,"body":"really, really well said. We're"},{"speaker":"Charles Goldfarb","startTime":2269.62,"endTime":2272.98,"body":"running out of time. But I would"},{"speaker":"Charles Goldfarb","startTime":2269.62,"endTime":2272.98,"body":"like to just briefly touch on"},{"speaker":"Charles Goldfarb","startTime":2272.98,"endTime":2277.39,"body":"the third email that we got, if"},{"speaker":"Charles Goldfarb","startTime":2272.98,"endTime":2277.39,"body":"that's okay with you. Yeah,"},{"speaker":"Charles Goldfarb","startTime":2277.39,"endTime":2282.91,"body":"absolutely. So this is this is"},{"speaker":"Charles Goldfarb","startTime":2277.39,"endTime":2282.91,"body":"again, I emailed the person who"},{"speaker":"Charles Goldfarb","startTime":2282.91,"endTime":2285.19,"body":"wrote us and they did not get"},{"speaker":"Charles Goldfarb","startTime":2282.91,"endTime":2285.19,"body":"back to me. So I don't want to"},{"speaker":"Charles Goldfarb","startTime":2285.19,"endTime":2290.35,"body":"say their name. But essentially,"},{"speaker":"Charles Goldfarb","startTime":2285.19,"endTime":2290.35,"body":"they wrote about a 12 year old"},{"speaker":"Charles Goldfarb","startTime":2291.34,"endTime":2294.55,"body":"female with a history of"},{"speaker":"Charles Goldfarb","startTime":2291.34,"endTime":2294.55,"body":"bilateral medial epicondyle"},{"speaker":"Charles Goldfarb","startTime":2294.55,"endTime":2298.66,"body":"fractures, which I have seen."},{"speaker":"Charles Goldfarb","startTime":2294.55,"endTime":2298.66,"body":"And on one side, everything went"},{"speaker":"Charles Goldfarb","startTime":2298.66,"endTime":2302.2,"body":"great. On the other side, they"},{"speaker":"Charles Goldfarb","startTime":2298.66,"endTime":2302.2,"body":"are left with with with what"},{"speaker":"Charles Goldfarb","startTime":2302.2,"endTime":2306.58,"body":"appears to be a non union, but"},{"speaker":"Charles Goldfarb","startTime":2302.2,"endTime":2306.58,"body":"discomfort and what appears to"},{"speaker":"Charles Goldfarb","startTime":2306.58,"endTime":2309.52,"body":"be co contractions. And that's"},{"speaker":"Charles Goldfarb","startTime":2306.58,"endTime":2309.52,"body":"what we talked about, from the"},{"speaker":"Charles Goldfarb","startTime":2309.52,"endTime":2313.36,"body":"paper that we had written where"},{"speaker":"Charles Goldfarb","startTime":2309.52,"endTime":2313.36,"body":"the older nerve doesn't act like"},{"speaker":"Charles Goldfarb","startTime":2313.36,"endTime":2317.08,"body":"a classic, irritated, older"},{"speaker":"Charles Goldfarb","startTime":2313.36,"endTime":2317.08,"body":"nerve. But in the young patient,"},{"speaker":"Charles Goldfarb","startTime":2317.08,"endTime":2320.89,"body":"they have these contractions"},{"speaker":"Charles Goldfarb","startTime":2317.08,"endTime":2320.89,"body":"where the patient may attempt to"},{"speaker":"Charles Goldfarb","startTime":2320.89,"endTime":2325.18,"body":"flex the elbow and you feel the"},{"speaker":"Charles Goldfarb","startTime":2320.89,"endTime":2325.18,"body":"triceps firing, they may attempt"},{"speaker":"Charles Goldfarb","startTime":2325.18,"endTime":2327.97,"body":"to extend the elbow, you feel"},{"speaker":"Charles Goldfarb","startTime":2325.18,"endTime":2327.97,"body":"the biceps firing, and"},{"speaker":"Charles Goldfarb","startTime":2327.97,"endTime":2331.66,"body":"ultimately, especially in this"},{"speaker":"Charles Goldfarb","startTime":2327.97,"endTime":2331.66,"body":"12 year old female population is"},{"speaker":"Charles Goldfarb","startTime":2331.69,"endTime":2336.1,"body":"often the older nerve. And so I"},{"speaker":"Charles Goldfarb","startTime":2331.69,"endTime":2336.1,"body":"just I can't state strong enough"},{"speaker":"Charles Goldfarb","startTime":2336.1,"endTime":2339.79,"body":"how big a deal this is that we"},{"speaker":"Charles Goldfarb","startTime":2336.1,"endTime":2339.79,"body":"have the thought of the older"},{"speaker":"Charles Goldfarb","startTime":2339.79,"endTime":2344.2,"body":"nerve being the culprit in these"},{"speaker":"Charles Goldfarb","startTime":2339.79,"endTime":2344.2,"body":"patients, and I've been so happy"},{"speaker":"Charles Goldfarb","startTime":2344.32,"endTime":2346.03,"body":"with treatment of those"},{"speaker":"Charles Goldfarb","startTime":2344.32,"endTime":2346.03,"body":"patients."},{"speaker":"Chris Dy","startTime":2346.18,"endTime":2348.01,"body":"So what's your How do"},{"speaker":"Chris Dy","startTime":2346.18,"endTime":2348.01,"body":"you approach this? How do you"},{"speaker":"Chris Dy","startTime":2348.01,"endTime":2350.59,"body":"make the diagnosis of these co"},{"speaker":"Chris Dy","startTime":2348.01,"endTime":2350.59,"body":"contractions is there like kind"},{"speaker":"Chris Dy","startTime":2350.59,"endTime":2353.17,"body":"of buzzwords that they say are"},{"speaker":"Chris Dy","startTime":2350.59,"endTime":2353.17,"body":"things you see on examination?"},{"speaker":"Charles Goldfarb","startTime":2353.17,"endTime":2355.935,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":2353.17,"endTime":2355.935,"body":"it's often accompanied by X rays"},{"speaker":"Charles Goldfarb","startTime":2355.999,"endTime":2359.987,"body":"that aren't that satisfying for"},{"speaker":"Charles Goldfarb","startTime":2355.999,"endTime":2359.987,"body":"being healed. That is, with or"},{"speaker":"Charles Goldfarb","startTime":2360.051,"endTime":2363.782,"body":"without previous surgery, maybe"},{"speaker":"Charles Goldfarb","startTime":2360.051,"endTime":2363.782,"body":"there's an appearance of a"},{"speaker":"Charles Goldfarb","startTime":2363.846,"endTime":2367.705,"body":"medial epicondyle non union said"},{"speaker":"Charles Goldfarb","startTime":2363.846,"endTime":2367.705,"body":"the tendency, especially of"},{"speaker":"Charles Goldfarb","startTime":2367.77,"endTime":2371.243,"body":"Orthopedic Surgeons, is to"},{"speaker":"Charles Goldfarb","startTime":2367.77,"endTime":2371.243,"body":"immediately blame it on the"},{"speaker":"Charles Goldfarb","startTime":2371.307,"endTime":2375.295,"body":"bone. And of course, I hope we"},{"speaker":"Charles Goldfarb","startTime":2371.307,"endTime":2375.295,"body":"all would also assess the ulnar"},{"speaker":"Charles Goldfarb","startTime":2375.359,"endTime":2379.282,"body":"nerve, and it may be irritable,"},{"speaker":"Charles Goldfarb","startTime":2375.359,"endTime":2379.282,"body":"but never classically they're"},{"speaker":"Charles Goldfarb","startTime":2379.347,"endTime":2383.142,"body":"not. It's rare that patients are"},{"speaker":"Charles Goldfarb","startTime":2379.347,"endTime":2383.142,"body":"complaining of numbness or"},{"speaker":"Charles Goldfarb","startTime":2383.206,"endTime":2387.065,"body":"tingling, they don't have any"},{"speaker":"Charles Goldfarb","startTime":2383.206,"endTime":2387.065,"body":"weakness in their hand. If you"},{"speaker":"Charles Goldfarb","startTime":2387.129,"endTime":2390.924,"body":"have bang on the nerve, maybe"},{"speaker":"Charles Goldfarb","startTime":2387.129,"endTime":2390.924,"body":"there's some irritability but"},{"speaker":"Charles Goldfarb","startTime":2390.988,"endTime":2394.912,"body":"it's the complaints are more"},{"speaker":"Charles Goldfarb","startTime":2390.988,"endTime":2394.912,"body":"vey. They typically lack flexion"},{"speaker":"Charles Goldfarb","startTime":2394.976,"endTime":2398.835,"body":"and you really can feel the co-"},{"speaker":"Charles Goldfarb","startTime":2394.976,"endTime":2398.835,"body":"contraction is basically the"},{"speaker":"Charles Goldfarb","startTime":2398.899,"endTime":2402.694,"body":"muscles firing at the wrong"},{"speaker":"Charles Goldfarb","startTime":2398.899,"endTime":2402.694,"body":"time, and it's sometimes that's"},{"speaker":"Charles Goldfarb","startTime":2402.758,"endTime":2406.36,"body":"all it is. There's no more"},{"speaker":"Charles Goldfarb","startTime":2402.758,"endTime":2406.36,"body":"nervous, irritability, signs."},{"speaker":"Charles Goldfarb","startTime":2406.425,"endTime":2410.477,"body":"And then when the patient comes"},{"speaker":"Charles Goldfarb","startTime":2406.425,"endTime":2410.477,"body":"back on post op visit one, they"},{"speaker":"Charles Goldfarb","startTime":2410.541,"endTime":2413.5,"body":"are already better. It's really"},{"speaker":"Charles Goldfarb","startTime":2410.541,"endTime":2413.5,"body":"satisfying. So"},{"speaker":"Chris Dy","startTime":2413.74,"endTime":2416.74,"body":"what is your treatment"},{"speaker":"Chris Dy","startTime":2413.74,"endTime":2416.74,"body":"of this? Is it a transposition"},{"speaker":"Chris Dy","startTime":2416.74,"endTime":2419.53,"body":"as we discussed? Is it a neuro"},{"speaker":"Chris Dy","startTime":2416.74,"endTime":2419.53,"body":"lysis? And leaving a bead, what"},{"speaker":"Chris Dy","startTime":2419.53,"endTime":2419.89,"body":"do you do?"},{"speaker":"Charles Goldfarb","startTime":2420.52,"endTime":2423.52,"body":"Definitely"},{"speaker":"Charles Goldfarb","startTime":2420.52,"endTime":2423.52,"body":"transpose. And I haven't had the"},{"speaker":"Charles Goldfarb","startTime":2423.52,"endTime":2428.05,"body":"courage not to address the"},{"speaker":"Charles Goldfarb","startTime":2423.52,"endTime":2428.05,"body":"medial upper condo, I just I'm"},{"speaker":"Charles Goldfarb","startTime":2428.05,"endTime":2430.66,"body":"going to I'm going to have the"},{"speaker":"Charles Goldfarb","startTime":2428.05,"endTime":2430.66,"body":"courage to not address the"},{"speaker":"Charles Goldfarb","startTime":2430.66,"endTime":2432.34,"body":"middle of a condo because I"},{"speaker":"Charles Goldfarb","startTime":2430.66,"endTime":2432.34,"body":"don't think it has anything to"},{"speaker":"Charles Goldfarb","startTime":2432.34,"endTime":2435.67,"body":"do with anything. I think if the"},{"speaker":"Charles Goldfarb","startTime":2432.34,"endTime":2435.67,"body":"medial epicondyle doesn't heal,"},{"speaker":"Charles Goldfarb","startTime":2435.76,"endTime":2439.6,"body":"it often scars in we have a"},{"speaker":"Charles Goldfarb","startTime":2435.76,"endTime":2439.6,"body":"fibers union, just don't buy"},{"speaker":"Charles Goldfarb","startTime":2439.6,"endTime":2442.03,"body":"that. That's the problem. And"},{"speaker":"Charles Goldfarb","startTime":2439.6,"endTime":2442.03,"body":"most of these patients, and my"},{"speaker":"Charles Goldfarb","startTime":2442.03,"endTime":2445.39,"body":"theory is these painful medial"},{"speaker":"Charles Goldfarb","startTime":2442.03,"endTime":2445.39,"body":"elbows where the X rays don't"},{"speaker":"Charles Goldfarb","startTime":2445.39,"endTime":2448.57,"body":"look perfect. might always be"},{"speaker":"Charles Goldfarb","startTime":2445.39,"endTime":2448.57,"body":"the nerve, and that's a little"},{"speaker":"Charles Goldfarb","startTime":2448.57,"endTime":2451.36,"body":"out there. But I would just say"},{"speaker":"Charles Goldfarb","startTime":2448.57,"endTime":2451.36,"body":"be aware of the nerves."},{"speaker":"Chris Dy","startTime":2451.36,"endTime":2453.538,"body":"We're getting into"},{"speaker":"Chris Dy","startTime":2451.36,"endTime":2453.538,"body":"Qanon unknown territory now."},{"speaker":"Chris Dy","startTime":2453.585,"endTime":2456.505,"body":"Here we go. So is there any way"},{"speaker":"Chris Dy","startTime":2453.585,"endTime":2456.505,"body":"you any way you could test that"},{"speaker":"Chris Dy","startTime":2456.552,"endTime":2459.472,"body":"theory? I mean, could you block"},{"speaker":"Chris Dy","startTime":2456.552,"endTime":2459.472,"body":"the ulnar nerve before surgery?"},{"speaker":"Chris Dy","startTime":2459.519,"endTime":2462.115,"body":"Would that just kind of"},{"speaker":"Chris Dy","startTime":2459.519,"endTime":2462.115,"body":"anesthetize that area too? Would"},{"speaker":"Chris Dy","startTime":2462.161,"endTime":2465.128,"body":"that go? I mean, is that one way"},{"speaker":"Chris Dy","startTime":2462.161,"endTime":2465.128,"body":"to think about how to do it and"},{"speaker":"Chris Dy","startTime":2465.174,"endTime":2468.42,"body":"how quickly does co contraction"},{"speaker":"Chris Dy","startTime":2465.174,"endTime":2468.42,"body":"stop after you've transpose the nerve?"},{"speaker":"Charles Goldfarb","startTime":2470.05,"endTime":2473.56,"body":"Good questions"},{"speaker":"Charles Goldfarb","startTime":2470.05,"endTime":2473.56,"body":"Spoken like a nerve surgeon. I"},{"speaker":"Charles Goldfarb","startTime":2473.56,"endTime":2476.53,"body":"wonder if I mean, this is not"},{"speaker":"Charles Goldfarb","startTime":2473.56,"endTime":2476.53,"body":"the population to anesthetize in"},{"speaker":"Charles Goldfarb","startTime":2476.53,"endTime":2480.1,"body":"clinic, unfortunately. So I"},{"speaker":"Charles Goldfarb","startTime":2476.53,"endTime":2480.1,"body":"don't know that while it's a"},{"speaker":"Charles Goldfarb","startTime":2480.1,"endTime":2484.69,"body":"good idea to lidocaine, you"},{"speaker":"Charles Goldfarb","startTime":2480.1,"endTime":2484.69,"body":"know, around the nerve, I don't"},{"speaker":"Charles Goldfarb","startTime":2484.69,"endTime":2488.47,"body":"think that's probably something"},{"speaker":"Charles Goldfarb","startTime":2484.69,"endTime":2488.47,"body":"I would choose. I do think"},{"speaker":"Charles Goldfarb","startTime":2488.47,"endTime":2490.93,"body":"postoperatively the coca"},{"speaker":"Charles Goldfarb","startTime":2488.47,"endTime":2490.93,"body":"directions are gone at the first"},{"speaker":"Charles Goldfarb","startTime":2490.93,"endTime":2495.55,"body":"visit. So I don't try to"},{"speaker":"Charles Goldfarb","startTime":2490.93,"endTime":2495.55,"body":"mobilize those patients"},{"speaker":"Charles Goldfarb","startTime":2495.55,"endTime":2498.28,"body":"immediately. I tend to just let"},{"speaker":"Charles Goldfarb","startTime":2495.55,"endTime":2498.28,"body":"them rest for two weeks and then"},{"speaker":"Charles Goldfarb","startTime":2498.28,"endTime":2501.43,"body":"come back and start mobilizing,"},{"speaker":"Charles Goldfarb","startTime":2498.28,"endTime":2501.43,"body":"and it's usually immediate"},{"speaker":"Charles Goldfarb","startTime":2501.73,"endTime":2502.72,"body":"improvement in"},{"speaker":"Chris Dy","startTime":2502.72,"endTime":2504.73,"body":"typically a"},{"speaker":"Chris Dy","startTime":2502.72,"endTime":2504.73,"body":"subcutaneous or sub muscular"},{"speaker":"Chris Dy","startTime":2504.73,"endTime":2506.38,"body":"transposition, change the"},{"speaker":"Chris Dy","startTime":2504.73,"endTime":2506.38,"body":"younger group, so"},{"speaker":"Charles Goldfarb","startTime":2506.95,"endTime":2508.84,"body":"I just don't"},{"speaker":"Charles Goldfarb","startTime":2506.95,"endTime":2508.84,"body":"like go and some mastering the"},{"speaker":"Charles Goldfarb","startTime":2508.84,"endTime":2511.51,"body":"younger group, especially"},{"speaker":"Charles Goldfarb","startTime":2508.84,"endTime":2511.51,"body":"without real nerve finding."},{"speaker":"Chris Dy","startTime":2511.72,"endTime":2514.03,"body":"Right, and especially"},{"speaker":"Chris Dy","startTime":2511.72,"endTime":2514.03,"body":"if they're younger, inactive and"},{"speaker":"Chris Dy","startTime":2514.03,"endTime":2517.0,"body":"potentially going to compromise"},{"speaker":"Chris Dy","startTime":2514.03,"endTime":2517.0,"body":"that good old flexor pronator"},{"speaker":"Chris Dy","startTime":2517.0,"endTime":2521.5,"body":"mass. Yeah, well, that was a fun"},{"speaker":"Chris Dy","startTime":2517.0,"endTime":2521.5,"body":"episode. So if anybody made it"},{"speaker":"Chris Dy","startTime":2521.5,"endTime":2523.87,"body":"to the end and wants to submit"},{"speaker":"Chris Dy","startTime":2521.5,"endTime":2523.87,"body":"some questions, happy to do"},{"speaker":"Chris Dy","startTime":2523.87,"endTime":2528.76,"body":"another mailbag episode. So hand"},{"speaker":"Chris Dy","startTime":2523.87,"endTime":2528.76,"body":"podcast@gmail.com And then let"},{"speaker":"Chris Dy","startTime":2528.76,"endTime":2532.24,"body":"us know if if it's cool, we"},{"speaker":"Chris Dy","startTime":2528.76,"endTime":2532.24,"body":"share your your question on the"},{"speaker":"Chris Dy","startTime":2532.24,"endTime":2536.59,"body":"air. And yeah, go leave a rating"},{"speaker":"Chris Dy","startTime":2532.24,"endTime":2536.59,"body":"and a review. Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2536.62,"endTime":2538.09,"body":"that was fun."},{"speaker":"Charles Goldfarb","startTime":2536.62,"endTime":2538.09,"body":"Let's do it again real"},{"speaker":"Chris Dy","startTime":2537.94,"endTime":2540.763,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2537.94,"endTime":2540.763,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2540.816,"endTime":2543.64,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2540.816,"endTime":2543.64,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2543.64,"endTime":2546.82,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2543.64,"endTime":2546.82,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2546.82,"endTime":2550.278,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2546.82,"endTime":2550.278,"body":"spelled d-y. And if you'd like"},{"speaker":"Chris Dy","startTime":2550.348,"endTime":2554.23,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2550.348,"endTime":2554.23,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2554.8,"endTime":2556.93,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2554.8,"endTime":2556.93,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2556.93,"endTime":2558.01,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2558.04,"endTime":2560.26,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2558.04,"endTime":2560.26,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2560.26,"endTime":2562.27,"body":"word out. Special thanks to"},{"speaker":"Chris Dy","startTime":2560.26,"endTime":2562.27,"body":"Peter"},{"speaker":"Charles Goldfarb","startTime":2562.27,"endTime":2564.67,"body":"Martin for the"},{"speaker":"Charles Goldfarb","startTime":2562.27,"endTime":2564.67,"body":"amazing music. And remember,"},{"speaker":"Charles Goldfarb","startTime":2565.18,"endTime":2567.34,"body":"keep the upper hand. Come back"},{"speaker":"Charles Goldfarb","startTime":2565.18,"endTime":2567.34,"body":"next time"}]}