{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.08,"body":"Chuck, welcome"},{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.08,"body":"to the Upper Hand Podcast where"},{"speaker":"Charles Goldfarb","startTime":7.08,"endTime":8.85,"body":"Chuck and Chris talk hand"},{"speaker":"Charles Goldfarb","startTime":7.08,"endTime":8.85,"body":"surgery."},{"speaker":"Chris Dy","startTime":9.51,"endTime":11.43,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":9.51,"endTime":11.43,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":11.43,"endTime":14.37,"body":"University in St Louis, here to"},{"speaker":"Chris Dy","startTime":11.43,"endTime":14.37,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":14.37,"endTime":16.59,"body":"surgery related, from technical"},{"speaker":"Chris Dy","startTime":14.37,"endTime":16.59,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":17.13,"endTime":19.02,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":17.13,"endTime":19.02,"body":"subscribe wherever you get your"},{"speaker":"Charles Goldfarb","startTime":19.02,"endTime":20.82,"body":"podcasts, and thank"},{"speaker":"Chris Dy","startTime":20.82,"endTime":23.58,"body":"you in advance for"},{"speaker":"Chris Dy","startTime":20.82,"endTime":23.58,"body":"leaving a review and rating that"},{"speaker":"Chris Dy","startTime":23.58,"endTime":26.01,"body":"helps us get the word out. You"},{"speaker":"Chris Dy","startTime":23.58,"endTime":26.01,"body":"can email us at"},{"speaker":"Chris Dy","startTime":26.04,"endTime":29.46,"body":"handpodcast@gmail.com so let's"},{"speaker":"Chris Dy","startTime":26.04,"endTime":29.46,"body":"get to the episode."},{"speaker":"Charles Goldfarb","startTime":30.24,"endTime":31.08,"body":"Oh hey Chris,"},{"speaker":"Chris Dy","startTime":31.34,"endTime":32.24,"body":"Hey Chuck. How are"},{"speaker":"Chris Dy","startTime":31.34,"endTime":32.24,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":32.84,"endTime":35.18,"body":"I'm fantastic."},{"speaker":"Charles Goldfarb","startTime":32.84,"endTime":35.18,"body":"I'm at the office on the"},{"speaker":"Charles Goldfarb","startTime":35.18,"endTime":36.68,"body":"Saturday morning. What could be"},{"speaker":"Charles Goldfarb","startTime":35.18,"endTime":36.68,"body":"better?"},{"speaker":"Chris Dy","startTime":36.8,"endTime":38.54,"body":"Oh, yeah, absolutely."},{"speaker":"Chris Dy","startTime":36.8,"endTime":38.54,"body":"It sounds like you must have"},{"speaker":"Chris Dy","startTime":38.54,"endTime":39.44,"body":"been rounding then"},{"speaker":"Charles Goldfarb","startTime":40.58,"endTime":43.24,"body":"I was"},{"speaker":"Charles Goldfarb","startTime":40.58,"endTime":43.24,"body":"rounding, but my day started. I"},{"speaker":"Charles Goldfarb","startTime":43.24,"endTime":46.18,"body":"woke up a little too early, and"},{"speaker":"Charles Goldfarb","startTime":43.24,"endTime":46.18,"body":"I happened to wake up just"},{"speaker":"Charles Goldfarb","startTime":46.18,"endTime":49.78,"body":"before I got a text from Emily"},{"speaker":"Charles Goldfarb","startTime":46.18,"endTime":49.78,"body":"zoldos, who's winding down her"},{"speaker":"Charles Goldfarb","startTime":49.78,"endTime":54.4,"body":"fellowship. And she said, just"},{"speaker":"Charles Goldfarb","startTime":49.78,"endTime":54.4,"body":"wanna let you know there's a"},{"speaker":"Charles Goldfarb","startTime":54.4,"endTime":59.68,"body":"flexor tuna syntheta. So I'm"},{"speaker":"Charles Goldfarb","startTime":54.4,"endTime":59.68,"body":"like, I'm there, so I was gonna"},{"speaker":"Charles Goldfarb","startTime":59.68,"endTime":64.2,"body":"come in anyways around, as you"},{"speaker":"Charles Goldfarb","startTime":59.68,"endTime":64.2,"body":"said, and I rode early on my"},{"speaker":"Charles Goldfarb","startTime":64.2,"endTime":67.98,"body":"bike through the park, which"},{"speaker":"Charles Goldfarb","startTime":64.2,"endTime":67.98,"body":"gives me a little trepidation"},{"speaker":"Charles Goldfarb","startTime":67.98,"endTime":72.54,"body":"when it's pitch black. And the"},{"speaker":"Charles Goldfarb","startTime":67.98,"endTime":72.54,"body":"only weird part about it was"},{"speaker":"Charles Goldfarb","startTime":72.6,"endTime":76.32,"body":"those kind of swampy areas in"},{"speaker":"Charles Goldfarb","startTime":72.6,"endTime":76.32,"body":"the park, whether it's still"},{"speaker":"Charles Goldfarb","startTime":76.32,"endTime":79.68,"body":"water, I felt like I wrote it"},{"speaker":"Charles Goldfarb","startTime":76.32,"endTime":79.68,"body":"was like I was driving a car"},{"speaker":"Charles Goldfarb","startTime":79.68,"endTime":85.22,"body":"through a bunch of bugs. Oh, it"},{"speaker":"Charles Goldfarb","startTime":79.68,"endTime":85.22,"body":"was disgusting. But I mean, one"},{"speaker":"Chris Dy","startTime":85.22,"endTime":87.92,"body":"of the things, one of"},{"speaker":"Chris Dy","startTime":85.22,"endTime":87.92,"body":"the things that you know as as"},{"speaker":"Chris Dy","startTime":87.92,"endTime":91.34,"body":"well pubs publicized. Now, I'm"},{"speaker":"Chris Dy","startTime":87.92,"endTime":91.34,"body":"more of an indoor warrior in"},{"speaker":"Chris Dy","startTime":91.34,"endTime":94.16,"body":"terms of working out, just"},{"speaker":"Chris Dy","startTime":91.34,"endTime":94.16,"body":"because I like the"},{"speaker":"Chris Dy","startTime":94.16,"endTime":97.76,"body":"predictability of the conditions"},{"speaker":"Chris Dy","startTime":94.16,"endTime":97.76,"body":"and but occasionally I will go"},{"speaker":"Chris Dy","startTime":97.76,"endTime":100.48,"body":"for runs when it's super nice"},{"speaker":"Chris Dy","startTime":97.76,"endTime":100.48,"body":"outside, or when I'm traveling."},{"speaker":"Chris Dy","startTime":100.48,"endTime":103.96,"body":"That's mainly when I run. And,"},{"speaker":"Chris Dy","startTime":100.48,"endTime":103.96,"body":"you know, I remember running in"},{"speaker":"Chris Dy","startTime":103.96,"endTime":108.28,"body":"Forest Park last summer and just"},{"speaker":"Chris Dy","startTime":103.96,"endTime":108.28,"body":"being like, did I swallow a bug"},{"speaker":"Chris Dy","startTime":108.34,"endTime":113.2,"body":"like and I can only imagine how"},{"speaker":"Chris Dy","startTime":108.34,"endTime":113.2,"body":"it is magnified in so many ways"},{"speaker":"Chris Dy","startTime":113.2,"endTime":115.24,"body":"when you are on a bike, on"},{"speaker":"Charles Goldfarb","startTime":115.24,"endTime":117.52,"body":"a bike, riding"},{"speaker":"Charles Goldfarb","startTime":115.24,"endTime":117.52,"body":"as fast as I I ride. I mean,"},{"speaker":"Charles Goldfarb","startTime":117.52,"endTime":120.3,"body":"come on. And I was kind of doing"},{"speaker":"Charles Goldfarb","startTime":117.52,"endTime":120.3,"body":"the bullfrog through the Bug,"},{"speaker":"Charles Goldfarb","startTime":120.3,"endTime":121.5,"body":"bug storm. It"},{"speaker":"Chris Dy","startTime":124.08,"endTime":126.3,"body":"was funny. So I was"},{"speaker":"Chris Dy","startTime":124.08,"endTime":126.3,"body":"talking with one of our"},{"speaker":"Chris Dy","startTime":126.3,"endTime":131.34,"body":"partners, David Brogan, who is"},{"speaker":"Chris Dy","startTime":126.3,"endTime":131.34,"body":"an accomplished runner and just"},{"speaker":"Chris Dy","startTime":131.34,"endTime":134.16,"body":"recently qualified for the"},{"speaker":"Chris Dy","startTime":131.34,"endTime":134.16,"body":"Boston Marathon. So congrats to"},{"speaker":"Chris Dy","startTime":134.16,"endTime":136.86,"body":"him. And he was talking about"},{"speaker":"Chris Dy","startTime":134.16,"endTime":136.86,"body":"one of the races he'll be doing"},{"speaker":"Chris Dy","startTime":136.86,"endTime":139.38,"body":"next year as a bit of a tune it"},{"speaker":"Chris Dy","startTime":136.86,"endTime":139.38,"body":"up for Boston. It was trying to"},{"speaker":"Chris Dy","startTime":139.38,"endTime":141.98,"body":"get me to do it with him, and"},{"speaker":"Chris Dy","startTime":139.38,"endTime":141.98,"body":"I'm very well might. It's the"},{"speaker":"Chris Dy","startTime":141.98,"endTime":144.62,"body":"the Napa half marathon, you"},{"speaker":"Chris Dy","startTime":141.98,"endTime":144.62,"body":"know? And this is going to sound"},{"speaker":"Chris Dy","startTime":144.62,"endTime":147.26,"body":"ridiculous to many listening,"},{"speaker":"Chris Dy","startTime":144.62,"endTime":147.26,"body":"but my baseline fitness goal is"},{"speaker":"Chris Dy","startTime":147.26,"endTime":150.26,"body":"to always be able to run a half"},{"speaker":"Chris Dy","startTime":147.26,"endTime":150.26,"body":"marathon without training, which"},{"speaker":"Chris Dy","startTime":150.26,"endTime":153.26,"body":"I had I'm there, like, you know,"},{"speaker":"Chris Dy","startTime":150.26,"endTime":153.26,"body":"I've done occasionally, just"},{"speaker":"Chris Dy","startTime":153.26,"endTime":157.04,"body":"like, kept running sometimes,"},{"speaker":"Chris Dy","startTime":153.26,"endTime":157.04,"body":"like, Forrest, Gump, there's one"},{"speaker":"Chris Dy","startTime":157.04,"endTime":160.3,"body":"time I'd I was running and as it"},{"speaker":"Chris Dy","startTime":157.04,"endTime":160.3,"body":"was a, kind of like a six mile"},{"speaker":"Chris Dy","startTime":160.3,"endTime":163.06,"body":"loop. And I said, I'm going to"},{"speaker":"Chris Dy","startTime":160.3,"endTime":163.06,"body":"do it one more time, just to"},{"speaker":"Chris Dy","startTime":163.06,"endTime":166.36,"body":"text David that I did it. And I"},{"speaker":"Chris Dy","startTime":163.06,"endTime":166.36,"body":"did and it's fine. So I was"},{"speaker":"Chris Dy","startTime":166.36,"endTime":168.76,"body":"thinking about running that. And"},{"speaker":"Chris Dy","startTime":166.36,"endTime":168.76,"body":"then I was like, You know what,"},{"speaker":"Chris Dy","startTime":168.76,"endTime":171.16,"body":"David, like, you probably are"},{"speaker":"Chris Dy","startTime":168.76,"endTime":171.16,"body":"going to be a triathlon guy."},{"speaker":"Chris Dy","startTime":171.22,"endTime":173.14,"body":"He's like, You should too. I was"},{"speaker":"Chris Dy","startTime":171.22,"endTime":173.14,"body":"like, yeah, the swimming"},{"speaker":"Chris Dy","startTime":173.14,"endTime":175.54,"body":"terrifies me. I was like, the"},{"speaker":"Chris Dy","startTime":173.14,"endTime":175.54,"body":"biking really terrifies me,"},{"speaker":"Chris Dy","startTime":175.54,"endTime":179.38,"body":"because the number of people"},{"speaker":"Chris Dy","startTime":175.54,"endTime":179.38,"body":"that I see then you two who have"},{"speaker":"Chris Dy","startTime":179.38,"endTime":185.58,"body":"had very bad injuries biking,"},{"speaker":"Chris Dy","startTime":179.38,"endTime":185.58,"body":"you know, interactions with cars"},{"speaker":"Chris Dy","startTime":185.58,"endTime":189.24,"body":"or just falls or, yeah, it"},{"speaker":"Chris Dy","startTime":185.58,"endTime":189.24,"body":"scares me. And I'm just, I think"},{"speaker":"Chris Dy","startTime":189.24,"endTime":195.0,"body":"I'm too chicken now at my my"},{"speaker":"Chris Dy","startTime":189.24,"endTime":195.0,"body":"wise age, No, it's true. Take"},{"speaker":"Chris Dy","startTime":195.0,"endTime":196.08,"body":"that up. It's true. I"},{"speaker":"Charles Goldfarb","startTime":196.08,"endTime":197.58,"body":"don't think"},{"speaker":"Charles Goldfarb","startTime":196.08,"endTime":197.58,"body":"I've ever had that infinite"},{"speaker":"Charles Goldfarb","startTime":197.58,"endTime":202.1,"body":"capacity. My brother kind of is"},{"speaker":"Charles Goldfarb","startTime":197.58,"endTime":202.1,"body":"really fit, and when he was in"},{"speaker":"Charles Goldfarb","startTime":202.1,"endTime":204.86,"body":"his early 50s, just went around"},{"speaker":"Charles Goldfarb","startTime":202.1,"endTime":204.86,"body":"the New York Marathon, which was"},{"speaker":"Charles Goldfarb","startTime":204.86,"endTime":208.76,"body":"insane to me. He couldn't walk"},{"speaker":"Charles Goldfarb","startTime":204.86,"endTime":208.76,"body":"for a couple of days, but he was"},{"speaker":"Charles Goldfarb","startTime":208.76,"endTime":212.84,"body":"able to do it. That's That's not"},{"speaker":"Charles Goldfarb","startTime":208.76,"endTime":212.84,"body":"in my DNA, but I will say both"},{"speaker":"Charles Goldfarb","startTime":212.84,"endTime":215.66,"body":"joy and pain this morning, so I"},{"speaker":"Charles Goldfarb","startTime":212.84,"endTime":215.66,"body":"came in early, worked with one"},{"speaker":"Charles Goldfarb","startTime":215.66,"endTime":221.14,"body":"of the overnight scrubs at Big"},{"speaker":"Charles Goldfarb","startTime":215.66,"endTime":221.14,"body":"Barnes hospital, and someone I"},{"speaker":"Charles Goldfarb","startTime":221.14,"endTime":225.46,"body":"hadn't seen in like, 10 years."},{"speaker":"Charles Goldfarb","startTime":221.14,"endTime":225.46,"body":"Wow. And his first question was,"},{"speaker":"Charles Goldfarb","startTime":225.46,"endTime":229.06,"body":"you still play a ball? No,"},{"speaker":"Chris Dy","startTime":229.12,"endTime":233.2,"body":"I'm not. Oh, that's,"},{"speaker":"Chris Dy","startTime":229.12,"endTime":233.2,"body":"that's so Oh, man, yeah, that"},{"speaker":"Chris Dy","startTime":233.8,"endTime":236.86,"body":"must be tough for you not to,"},{"speaker":"Chris Dy","startTime":233.8,"endTime":236.86,"body":"not to play ball anymore. It"},{"speaker":"Charles Goldfarb","startTime":236.86,"endTime":238.9,"body":"is. I'm just"},{"speaker":"Charles Goldfarb","startTime":236.86,"endTime":238.9,"body":"happy to put one foot in front"},{"speaker":"Charles Goldfarb","startTime":239.02,"endTime":239.56,"body":"of her."},{"speaker":"Chris Dy","startTime":241.18,"endTime":243.24,"body":"Well, you know, I"},{"speaker":"Chris Dy","startTime":241.18,"endTime":243.24,"body":"don't know what it was yesterday"},{"speaker":"Chris Dy","startTime":243.24,"endTime":245.58,"body":"I woke up this morning just"},{"speaker":"Chris Dy","startTime":243.24,"endTime":245.58,"body":"feeling a little more sore. And"},{"speaker":"Chris Dy","startTime":245.58,"endTime":247.5,"body":"I don't know if it's because I"},{"speaker":"Chris Dy","startTime":245.58,"endTime":247.5,"body":"did a, you know, bit of a"},{"speaker":"Chris Dy","startTime":247.5,"endTime":250.26,"body":"different workout yesterday, or"},{"speaker":"Chris Dy","startTime":247.5,"endTime":250.26,"body":"because we were in an all day"},{"speaker":"Chris Dy","startTime":250.26,"endTime":252.84,"body":"Plexus. I'm not sure which one"},{"speaker":"Chris Dy","startTime":250.26,"endTime":252.84,"body":"it was, but it's probably a"},{"speaker":"Chris Dy","startTime":252.84,"endTime":253.56,"body":"combination of"},{"speaker":"Charles Goldfarb","startTime":253.56,"endTime":255.24,"body":"the two."},{"speaker":"Charles Goldfarb","startTime":253.56,"endTime":255.24,"body":"Exactly, right? It's probably a"},{"speaker":"Charles Goldfarb","startTime":255.24,"endTime":258.54,"body":"combination. When we're done"},{"speaker":"Charles Goldfarb","startTime":255.24,"endTime":258.54,"body":"with the pod, my daughter, the"},{"speaker":"Charles Goldfarb","startTime":258.54,"endTime":261.98,"body":"runner, is going to go run eight"},{"speaker":"Charles Goldfarb","startTime":258.54,"endTime":261.98,"body":"or 10, or whatever she's going"},{"speaker":"Charles Goldfarb","startTime":262.04,"endTime":265.22,"body":"to do. And then we're actually"},{"speaker":"Charles Goldfarb","startTime":262.04,"endTime":265.22,"body":"going to dedication of the new"},{"speaker":"Charles Goldfarb","startTime":265.22,"endTime":267.68,"body":"basketball courts in Forest"},{"speaker":"Charles Goldfarb","startTime":265.22,"endTime":267.68,"body":"Park. This my day is Forest"},{"speaker":"Charles Goldfarb","startTime":267.68,"endTime":270.26,"body":"Park, and so I'm going to meet"},{"speaker":"Charles Goldfarb","startTime":267.68,"endTime":270.26,"body":"her halfway, and I can't run"},{"speaker":"Charles Goldfarb","startTime":270.26,"endTime":272.96,"body":"with her, so I'm going to bike"},{"speaker":"Charles Goldfarb","startTime":270.26,"endTime":272.96,"body":"with her, and then and then go"},{"speaker":"Charles Goldfarb","startTime":272.96,"endTime":274.52,"body":"to this. So it'll be a nice day,"},{"speaker":"Chris Dy","startTime":274.7,"endTime":278.3,"body":"very cool. Now, is"},{"speaker":"Chris Dy","startTime":274.7,"endTime":278.3,"body":"running a goal again, or, like"},{"speaker":"Chris Dy","startTime":278.3,"endTime":280.72,"body":"running again? Is that a goal"},{"speaker":"Chris Dy","startTime":278.3,"endTime":280.72,"body":"for you, or is that something"},{"speaker":"Chris Dy","startTime":280.72,"endTime":282.22,"body":"that you just decided you're"},{"speaker":"Chris Dy","startTime":280.72,"endTime":282.22,"body":"going to"},{"speaker":"Charles Goldfarb","startTime":282.22,"endTime":283.9,"body":"shelf I'm"},{"speaker":"Charles Goldfarb","startTime":282.22,"endTime":283.9,"body":"going to choose my words"},{"speaker":"Charles Goldfarb","startTime":283.9,"endTime":287.74,"body":"carefully. Jogging is a goal"},{"speaker":"Charles Goldfarb","startTime":283.9,"endTime":287.74,"body":"again. I've been assured I can."},{"speaker":"Charles Goldfarb","startTime":287.74,"endTime":290.26,"body":"The only thing that makes me a"},{"speaker":"Charles Goldfarb","startTime":287.74,"endTime":290.26,"body":"little worried is for getting to"},{"speaker":"Charles Goldfarb","startTime":290.26,"endTime":294.7,"body":"that six month mark after my"},{"speaker":"Charles Goldfarb","startTime":290.26,"endTime":294.7,"body":"knee replacement, and I'm not"},{"speaker":"Charles Goldfarb","startTime":294.7,"endTime":297.4,"body":"ready to run or jog. So we'll"},{"speaker":"Charles Goldfarb","startTime":294.7,"endTime":297.4,"body":"see."},{"speaker":"Chris Dy","startTime":298.3,"endTime":300.9,"body":"I'll be seeing your"},{"speaker":"Chris Dy","startTime":298.3,"endTime":300.9,"body":"your knee. Sir. This afternoon"},{"speaker":"Chris Dy","startTime":300.9,"endTime":304.56,"body":"for a family gathering. So I"},{"speaker":"Chris Dy","startTime":300.9,"endTime":304.56,"body":"will, I'll prod him a bit,"},{"speaker":"Charles Goldfarb","startTime":305.16,"endTime":307.92,"body":"yeah, tell him"},{"speaker":"Charles Goldfarb","startTime":305.16,"endTime":307.92,"body":"school farms not making you look"},{"speaker":"Charles Goldfarb","startTime":307.92,"endTime":308.7,"body":"good living around the"},{"speaker":"Chris Dy","startTime":309.42,"endTime":311.64,"body":"hospital and"},{"speaker":"Chris Dy","startTime":309.42,"endTime":311.64,"body":"publicizing it on the podcast."},{"speaker":"Chris Dy","startTime":312.84,"endTime":316.14,"body":"So before I wanted to get into"},{"speaker":"Chris Dy","startTime":312.84,"endTime":316.14,"body":"we have couple topics to talk"},{"speaker":"Chris Dy","startTime":316.14,"endTime":318.72,"body":"about today. We do have some,"},{"speaker":"Chris Dy","startTime":316.14,"endTime":318.72,"body":"you know, some time of the year"},{"speaker":"Chris Dy","startTime":318.72,"endTime":321.74,"body":"for fellowship graduation. But"},{"speaker":"Chris Dy","startTime":318.72,"endTime":321.74,"body":"before we get into that, I"},{"speaker":"Chris Dy","startTime":321.74,"endTime":324.62,"body":"wanted to thank our friends at"},{"speaker":"Chris Dy","startTime":321.74,"endTime":324.62,"body":"practice. Link, the upper hand"},{"speaker":"Chris Dy","startTime":324.62,"endTime":326.78,"body":"is sponsored by"},{"speaker":"Chris Dy","startTime":324.62,"endTime":326.78,"body":"practicelink.com, the most"},{"speaker":"Chris Dy","startTime":326.78,"endTime":330.2,"body":"widely used physician job search"},{"speaker":"Chris Dy","startTime":326.78,"endTime":330.2,"body":"and career advancement resource."},{"speaker":"Chris Dy","startTime":330.44,"endTime":330.92,"body":"Becoming"},{"speaker":"Charles Goldfarb","startTime":330.92,"endTime":333.08,"body":"a physician is"},{"speaker":"Charles Goldfarb","startTime":330.92,"endTime":333.08,"body":"hard. Finding the right job"},{"speaker":"Charles Goldfarb","startTime":333.08,"endTime":335.66,"body":"doesn't have to be join practice"},{"speaker":"Charles Goldfarb","startTime":333.08,"endTime":335.66,"body":"link, for free"},{"speaker":"Charles Goldfarb","startTime":335.66,"endTime":340.72,"body":"today@www.practicelink.com"},{"speaker":"Charles Goldfarb","startTime":335.66,"endTime":340.72,"body":"backslash the upper hand. I"},{"speaker":"Charles Goldfarb","startTime":340.72,"endTime":343.96,"body":"think you're the topics are"},{"speaker":"Charles Goldfarb","startTime":340.72,"endTime":343.96,"body":"great. We had talked about a"},{"speaker":"Charles Goldfarb","startTime":343.96,"endTime":346.42,"body":"couple different clinical"},{"speaker":"Charles Goldfarb","startTime":343.96,"endTime":346.42,"body":"topics. I'm not sure which one"},{"speaker":"Charles Goldfarb","startTime":346.42,"endTime":350.98,"body":"we landed on, but the fellow"},{"speaker":"Charles Goldfarb","startTime":346.42,"endTime":350.98,"body":"graduation theme, I think, is"},{"speaker":"Charles Goldfarb","startTime":350.98,"endTime":351.58,"body":"always fun."},{"speaker":"Chris Dy","startTime":352.42,"endTime":356.38,"body":"It is. It's a it's"},{"speaker":"Chris Dy","startTime":352.42,"endTime":356.38,"body":"like, it's a great time of the"},{"speaker":"Chris Dy","startTime":356.38,"endTime":358.78,"body":"year. And then, as if, as"},{"speaker":"Chris Dy","startTime":356.38,"endTime":358.78,"body":"faculty, you're like, Wow, here"},{"speaker":"Chris Dy","startTime":358.78,"endTime":360.96,"body":"we go again. Like, you know,"},{"speaker":"Chris Dy","startTime":358.78,"endTime":360.96,"body":"we've got to start this whole"},{"speaker":"Chris Dy","startTime":360.96,"endTime":363.72,"body":"process again. It is great to"},{"speaker":"Chris Dy","startTime":360.96,"endTime":363.72,"body":"see how our fellows, at least in"},{"speaker":"Chris Dy","startTime":363.72,"endTime":367.02,"body":"our microcosm, our fellows, have"},{"speaker":"Chris Dy","startTime":363.72,"endTime":367.02,"body":"grown tremendously over the"},{"speaker":"Chris Dy","startTime":367.02,"endTime":372.42,"body":"year. You know, as I was doing"},{"speaker":"Chris Dy","startTime":367.02,"endTime":372.42,"body":"the the plexus yesterday, I"},{"speaker":"Chris Dy","startTime":372.42,"endTime":376.08,"body":"popped over and was watching"},{"speaker":"Chris Dy","startTime":372.42,"endTime":376.08,"body":"them, one of them operate. And"},{"speaker":"Chris Dy","startTime":376.08,"endTime":379.92,"body":"it was, it was just nice to just"},{"speaker":"Chris Dy","startTime":376.08,"endTime":379.92,"body":"see the decision making and the"},{"speaker":"Chris Dy","startTime":379.92,"endTime":382.46,"body":"X rays. And like, yeah, you"},{"speaker":"Chris Dy","startTime":379.92,"endTime":382.46,"body":"know, you guys have come a long"},{"speaker":"Chris Dy","startTime":382.46,"endTime":385.22,"body":"way, and you were great to"},{"speaker":"Chris Dy","startTime":382.46,"endTime":385.22,"body":"start, and now you're this is, I"},{"speaker":"Chris Dy","startTime":385.22,"endTime":388.64,"body":"like to think of our fellowship"},{"speaker":"Chris Dy","startTime":385.22,"endTime":388.64,"body":"as a finishing school, because"},{"speaker":"Chris Dy","startTime":388.76,"endTime":391.76,"body":"we are fortunate enough to get"},{"speaker":"Chris Dy","startTime":388.76,"endTime":391.76,"body":"incredibly talented fellows."},{"speaker":"Chris Dy","startTime":392.12,"endTime":394.76,"body":"When they walk into the door,"},{"speaker":"Chris Dy","startTime":392.12,"endTime":394.76,"body":"they have different strengths in"},{"speaker":"Chris Dy","startTime":394.76,"endTime":398.3,"body":"different domains of hand"},{"speaker":"Chris Dy","startTime":394.76,"endTime":398.3,"body":"surgery, and then we just get"},{"speaker":"Chris Dy","startTime":398.3,"endTime":401.26,"body":"them all to the, you know, to"},{"speaker":"Chris Dy","startTime":398.3,"endTime":401.26,"body":"the same point by the end of it,"},{"speaker":"Chris Dy","startTime":401.26,"endTime":403.0,"body":"and it's just great to see the"},{"speaker":"Chris Dy","startTime":401.26,"endTime":403.0,"body":"evolution."},{"speaker":"Charles Goldfarb","startTime":403.78,"endTime":406.42,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":403.78,"endTime":406.42,"body":"there's a couple of all of that"},{"speaker":"Charles Goldfarb","startTime":406.42,"endTime":410.62,"body":"is certainly true. And every"},{"speaker":"Charles Goldfarb","startTime":406.42,"endTime":410.62,"body":"fellow has his his or her own"},{"speaker":"Charles Goldfarb","startTime":410.62,"endTime":413.38,"body":"path. They come with different"},{"speaker":"Charles Goldfarb","startTime":410.62,"endTime":413.38,"body":"skill sets, they come with"},{"speaker":"Charles Goldfarb","startTime":413.38,"endTime":416.44,"body":"different knowledge bases, but"},{"speaker":"Charles Goldfarb","startTime":413.38,"endTime":416.44,"body":"they do really end up in"},{"speaker":"Charles Goldfarb","startTime":416.44,"endTime":419.02,"body":"essentially the same spot. And"},{"speaker":"Charles Goldfarb","startTime":416.44,"endTime":419.02,"body":"so it's just super fun to watch."},{"speaker":"Charles Goldfarb","startTime":419.02,"endTime":423.66,"body":"It's gratifying to watch. Is fun"},{"speaker":"Charles Goldfarb","startTime":419.02,"endTime":423.66,"body":"to watch, and they are, you"},{"speaker":"Charles Goldfarb","startTime":423.66,"endTime":426.78,"body":"know, we were talking yesterday,"},{"speaker":"Charles Goldfarb","startTime":423.66,"endTime":426.78,"body":"I was in our COH clinic. And"},{"speaker":"Charles Goldfarb","startTime":426.78,"endTime":432.66,"body":"then, you know, doing at least"},{"speaker":"Charles Goldfarb","startTime":426.78,"endTime":432.66,"body":"one case, and just the joy of"},{"speaker":"Charles Goldfarb","startTime":432.96,"endTime":436.32,"body":"obviously approaching fellowship"},{"speaker":"Charles Goldfarb","startTime":432.96,"endTime":436.32,"body":"graduation is one thing, but you"},{"speaker":"Charles Goldfarb","startTime":436.32,"endTime":439.86,"body":"start to see how meaningful they"},{"speaker":"Charles Goldfarb","startTime":436.32,"endTime":439.86,"body":"are to each other, and working"},{"speaker":"Charles Goldfarb","startTime":439.86,"endTime":443.36,"body":"together is something that you"},{"speaker":"Charles Goldfarb","startTime":439.86,"endTime":443.36,"body":"know, you and David get to do on"},{"speaker":"Charles Goldfarb","startTime":443.36,"endTime":446.9,"body":"occasion, and I get to do with"},{"speaker":"Charles Goldfarb","startTime":443.36,"endTime":446.9,"body":"Lindley, but it's not something"},{"speaker":"Charles Goldfarb","startTime":446.9,"endTime":449.84,"body":"every hand surgeon has the"},{"speaker":"Charles Goldfarb","startTime":446.9,"endTime":449.84,"body":"opportunity to do all the time,"},{"speaker":"Charles Goldfarb","startTime":450.02,"endTime":453.14,"body":"and it really is super fun. So"},{"speaker":"Charles Goldfarb","startTime":450.02,"endTime":453.14,"body":"for those listening who have"},{"speaker":"Charles Goldfarb","startTime":453.14,"endTime":455.72,"body":"that opportunity to don't take"},{"speaker":"Charles Goldfarb","startTime":453.14,"endTime":455.72,"body":"advantage of it. You should."},{"speaker":"Charles Goldfarb","startTime":456.26,"endTime":459.74,"body":"It's revitalizing. It's fun. But"},{"speaker":"Charles Goldfarb","startTime":456.26,"endTime":459.74,"body":"the fellows get to do it some,"},{"speaker":"Charles Goldfarb","startTime":459.74,"endTime":460.46,"body":"and they love it."},{"speaker":"Chris Dy","startTime":460.88,"endTime":463.3,"body":"Yeah, no, I think"},{"speaker":"Chris Dy","startTime":460.88,"endTime":463.3,"body":"it's, it's fun to do every time"},{"speaker":"Chris Dy","startTime":463.3,"endTime":466.66,"body":"that So David and I have a"},{"speaker":"Chris Dy","startTime":463.3,"endTime":466.66,"body":"dedicated Plexus or day once a"},{"speaker":"Chris Dy","startTime":466.66,"endTime":470.44,"body":"month. And I was describing it"},{"speaker":"Chris Dy","startTime":466.66,"endTime":470.44,"body":"to our new micro fellow as"},{"speaker":"Chris Dy","startTime":470.44,"endTime":473.2,"body":"operating like operating with"},{"speaker":"Chris Dy","startTime":470.44,"endTime":473.2,"body":"your annoying cousin that you"},{"speaker":"Chris Dy","startTime":473.2,"endTime":478.96,"body":"love. Or I was gonna go big"},{"speaker":"Chris Dy","startTime":473.2,"endTime":478.96,"body":"brother, little brother, but I"},{"speaker":"Chris Dy","startTime":478.96,"endTime":483.12,"body":"couldn't decide who was who in"},{"speaker":"Chris Dy","startTime":478.96,"endTime":483.12,"body":"that scenario. But, yeah, it's a"},{"speaker":"Chris Dy","startTime":483.12,"endTime":487.44,"body":"fun time, and it is. It"},{"speaker":"Chris Dy","startTime":483.12,"endTime":487.44,"body":"definitely brings out the best"},{"speaker":"Chris Dy","startTime":487.44,"endTime":490.92,"body":"in each of you as surgeons, and"},{"speaker":"Chris Dy","startTime":487.44,"endTime":490.92,"body":"it's great for patient care. It"},{"speaker":"Chris Dy","startTime":490.92,"endTime":493.98,"body":"moves cases along, makes"},{"speaker":"Chris Dy","startTime":490.92,"endTime":493.98,"body":"decision making better and less"},{"speaker":"Chris Dy","startTime":493.98,"endTime":497.4,"body":"stressful. So is that advice"},{"speaker":"Chris Dy","startTime":493.98,"endTime":497.4,"body":"number one that you would give,"},{"speaker":"Chris Dy","startTime":497.7,"endTime":500.78,"body":"you know, graduating fellows? Is"},{"speaker":"Chris Dy","startTime":497.7,"endTime":500.78,"body":"it you know, for if you're"},{"speaker":"Chris Dy","startTime":500.78,"endTime":503.96,"body":"tackling big cases, do it with"},{"speaker":"Chris Dy","startTime":500.78,"endTime":503.96,"body":"somebody else, or work with a"},{"speaker":"Chris Dy","startTime":503.96,"endTime":505.4,"body":"senior partner, or something"},{"speaker":"Chris Dy","startTime":503.96,"endTime":505.4,"body":"like that."},{"speaker":"Charles Goldfarb","startTime":505.46,"endTime":507.32,"body":"Yeah. So I'm"},{"speaker":"Charles Goldfarb","startTime":505.46,"endTime":507.32,"body":"gonna put us both on the spot"},{"speaker":"Charles Goldfarb","startTime":507.32,"endTime":509.48,"body":"and say that we're gonna give"},{"speaker":"Charles Goldfarb","startTime":507.32,"endTime":509.48,"body":"seven pieces of advice,"},{"speaker":"Chris Dy","startTime":511.16,"endTime":516.32,"body":"seven each, like seven"},{"speaker":"Chris Dy","startTime":511.16,"endTime":516.32,"body":"total. Nobody's counting. So"},{"speaker":"Chris Dy","startTime":516.32,"endTime":517.1,"body":"that's number one."},{"speaker":"Charles Goldfarb","startTime":517.64,"endTime":519.56,"body":"That's number"},{"speaker":"Charles Goldfarb","startTime":517.64,"endTime":519.56,"body":"one. It wasn't a planned one. I"},{"speaker":"Charles Goldfarb","startTime":519.56,"endTime":521.68,"body":"don't know that I have three in"},{"speaker":"Charles Goldfarb","startTime":519.56,"endTime":521.68,"body":"my head, but we'll get there."},{"speaker":"Charles Goldfarb","startTime":522.58,"endTime":526.36,"body":"Yes, I think. And then, as I"},{"speaker":"Charles Goldfarb","startTime":522.58,"endTime":526.36,"body":"mentioned, Linley and I get to"},{"speaker":"Charles Goldfarb","startTime":526.36,"endTime":531.52,"body":"operate almost every week. But"},{"speaker":"Charles Goldfarb","startTime":526.36,"endTime":531.52,"body":"for example, next week we have a"},{"speaker":"Charles Goldfarb","startTime":531.52,"endTime":534.76,"body":"politicization and a hypoplastic"},{"speaker":"Charles Goldfarb","startTime":531.52,"endTime":534.76,"body":"thumb reconstruction, two"},{"speaker":"Charles Goldfarb","startTime":534.76,"endTime":538.06,"body":"different cases, and those are"},{"speaker":"Charles Goldfarb","startTime":534.76,"endTime":538.06,"body":"cases we do together. We don't"},{"speaker":"Charles Goldfarb","startTime":538.36,"endTime":541.32,"body":"we're in the same spot. We don't"},{"speaker":"Charles Goldfarb","startTime":538.36,"endTime":541.32,"body":"always operate together, but it"},{"speaker":"Charles Goldfarb","startTime":541.32,"endTime":546.54,"body":"does bring so many advantages to"},{"speaker":"Charles Goldfarb","startTime":541.32,"endTime":546.54,"body":"ourselves, to the patient. It"},{"speaker":"Charles Goldfarb","startTime":546.54,"endTime":550.92,"body":"moves the case along. I think"},{"speaker":"Charles Goldfarb","startTime":546.54,"endTime":550.92,"body":"results are better, but it does."},{"speaker":"Charles Goldfarb","startTime":550.92,"endTime":556.74,"body":"You know, operating in isolation"},{"speaker":"Charles Goldfarb","startTime":550.92,"endTime":556.74,"body":"is fine, but you you miss"},{"speaker":"Charles Goldfarb","startTime":556.74,"endTime":559.56,"body":"something, you lose something,"},{"speaker":"Charles Goldfarb","startTime":556.74,"endTime":559.56,"body":"and so bringing that partner in,"},{"speaker":"Charles Goldfarb","startTime":559.56,"endTime":563.9,"body":"or it could be, I guess, a very"},{"speaker":"Charles Goldfarb","startTime":559.56,"endTime":563.9,"body":"close surgical assistant could"},{"speaker":"Charles Goldfarb","startTime":563.9,"endTime":566.84,"body":"bring the same level of"},{"speaker":"Charles Goldfarb","startTime":563.9,"endTime":566.84,"body":"satisfaction and joy, I guess."},{"speaker":"Charles Goldfarb","startTime":566.84,"endTime":569.6,"body":"But I think operating with a"},{"speaker":"Charles Goldfarb","startTime":566.84,"endTime":569.6,"body":"partner is a whole different"},{"speaker":"Charles Goldfarb","startTime":569.6,"endTime":569.9,"body":"level,"},{"speaker":"Chris Dy","startTime":570.08,"endTime":572.06,"body":"yeah. And I think, you"},{"speaker":"Chris Dy","startTime":570.08,"endTime":572.06,"body":"know, it's obviously not a"},{"speaker":"Chris Dy","startTime":572.06,"endTime":575.0,"body":"viable thing for the vast"},{"speaker":"Chris Dy","startTime":572.06,"endTime":575.0,"body":"majority of cases, but you know,"},{"speaker":"Chris Dy","startTime":575.0,"endTime":578.18,"body":"especially early on, I think if"},{"speaker":"Chris Dy","startTime":575.0,"endTime":578.18,"body":"you're tackling a complex case,"},{"speaker":"Chris Dy","startTime":578.72,"endTime":581.54,"body":"it could be like a one off kind"},{"speaker":"Chris Dy","startTime":578.72,"endTime":581.54,"body":"of thing. But if it's case where"},{"speaker":"Chris Dy","startTime":582.26,"endTime":585.7,"body":"you are either not feeling as"},{"speaker":"Chris Dy","startTime":582.26,"endTime":585.7,"body":"comfortable and you want to"},{"speaker":"Chris Dy","startTime":585.7,"endTime":589.84,"body":"bounce decision making off of"},{"speaker":"Chris Dy","startTime":585.7,"endTime":589.84,"body":"or, you know, you just need"},{"speaker":"Chris Dy","startTime":589.9,"endTime":592.36,"body":"somebody else to help keep the"},{"speaker":"Chris Dy","startTime":589.9,"endTime":592.36,"body":"case moving along. If it's like"},{"speaker":"Chris Dy","startTime":592.36,"endTime":595.06,"body":"a multi step kind of thing that"},{"speaker":"Chris Dy","startTime":592.36,"endTime":595.06,"body":"involves, like, nerve grafting"},{"speaker":"Chris Dy","startTime":595.06,"endTime":597.28,"body":"and somebody harvesting"},{"speaker":"Chris Dy","startTime":595.06,"endTime":597.28,"body":"something else, I mean, it's"},{"speaker":"Chris Dy","startTime":597.28,"endTime":599.8,"body":"just it makes sense, and I think"},{"speaker":"Chris Dy","startTime":597.28,"endTime":599.8,"body":"as a partner, I'd be happy in"},{"speaker":"Chris Dy","startTime":599.8,"endTime":603.06,"body":"it. You know, relieved that a"},{"speaker":"Chris Dy","startTime":599.8,"endTime":603.06,"body":"junior person who was starting"},{"speaker":"Chris Dy","startTime":603.06,"endTime":607.98,"body":"was reaching out. Because, you"},{"speaker":"Chris Dy","startTime":603.06,"endTime":607.98,"body":"know, the hard, I think the the"},{"speaker":"Chris Dy","startTime":607.98,"endTime":611.1,"body":"confidence as a surgeon, as a"},{"speaker":"Chris Dy","startTime":607.98,"endTime":611.1,"body":"surgeon starting out is a very"},{"speaker":"Chris Dy","startTime":611.1,"endTime":614.1,"body":"challenging thing, because you"},{"speaker":"Chris Dy","startTime":611.1,"endTime":614.1,"body":"want to come across as confident"},{"speaker":"Chris Dy","startTime":614.1,"endTime":617.58,"body":"and capable. But the, you know,"},{"speaker":"Chris Dy","startTime":614.1,"endTime":617.58,"body":"Achilles heel for a surgeon is"},{"speaker":"Chris Dy","startTime":617.58,"endTime":618.54,"body":"overconfidence."},{"speaker":"Charles Goldfarb","startTime":619.32,"endTime":622.04,"body":"That's well"},{"speaker":"Charles Goldfarb","startTime":619.32,"endTime":622.04,"body":"said, and I it is a it is a"},{"speaker":"Charles Goldfarb","startTime":622.04,"endTime":625.04,"body":"little bit of a balance, as one"},{"speaker":"Charles Goldfarb","startTime":622.04,"endTime":625.04,"body":"is starting a new practice to"},{"speaker":"Charles Goldfarb","startTime":625.22,"endTime":628.76,"body":"engage his or her partners show"},{"speaker":"Charles Goldfarb","startTime":625.22,"endTime":628.76,"body":"the appropriate amount of"},{"speaker":"Charles Goldfarb","startTime":628.76,"endTime":632.54,"body":"independence without the"},{"speaker":"Charles Goldfarb","startTime":628.76,"endTime":632.54,"body":"perceptions of overconfidence."},{"speaker":"Charles Goldfarb","startTime":633.14,"endTime":635.66,"body":"It can be very tricky, and you"},{"speaker":"Charles Goldfarb","startTime":633.14,"endTime":635.66,"body":"have to sort of read the room,"},{"speaker":"Charles Goldfarb","startTime":635.66,"endTime":638.24,"body":"because you're sort of trying to"},{"speaker":"Charles Goldfarb","startTime":635.66,"endTime":638.24,"body":"thread the needle. And then"},{"speaker":"Charles Goldfarb","startTime":638.24,"endTime":643.84,"body":"there's the inevitable. Why is"},{"speaker":"Charles Goldfarb","startTime":638.24,"endTime":643.84,"body":"new surgeon Joe taking so long"},{"speaker":"Charles Goldfarb","startTime":643.84,"endTime":648.76,"body":"to do his carpal tunnels? And"},{"speaker":"Charles Goldfarb","startTime":643.84,"endTime":648.76,"body":"you know there most people for"},{"speaker":"Charles Goldfarb","startTime":648.76,"endTime":651.58,"body":"carpal tunnel will be just fine,"},{"speaker":"Charles Goldfarb","startTime":648.76,"endTime":651.58,"body":"but in bigger cases and"},{"speaker":"Charles Goldfarb","startTime":651.58,"endTime":654.82,"body":"complicated distro radius is one"},{"speaker":"Charles Goldfarb","startTime":651.58,"endTime":654.82,"body":"example, it may take you a"},{"speaker":"Charles Goldfarb","startTime":654.82,"endTime":658.12,"body":"little longer as a new fellow"},{"speaker":"Charles Goldfarb","startTime":654.82,"endTime":658.12,"body":"graduate, compared to a partner"},{"speaker":"Charles Goldfarb","startTime":658.12,"endTime":661.02,"body":"who's been around for 10 years."},{"speaker":"Charles Goldfarb","startTime":658.12,"endTime":661.02,"body":"But people shouldn't give you"},{"speaker":"Charles Goldfarb","startTime":661.02,"endTime":663.9,"body":"grief for that. You take as long"},{"speaker":"Charles Goldfarb","startTime":661.02,"endTime":663.9,"body":"as you need to take you over"},{"speaker":"Charles Goldfarb","startTime":663.9,"endTime":665.76,"body":"schedule, which is point number"},{"speaker":"Charles Goldfarb","startTime":663.9,"endTime":665.76,"body":"two,"},{"speaker":"Chris Dy","startTime":668.52,"endTime":671.22,"body":"that's my that was my"},{"speaker":"Chris Dy","startTime":668.52,"endTime":671.22,"body":"next one, perfect. But"},{"speaker":"Charles Goldfarb","startTime":671.22,"endTime":673.08,"body":"take, yeah,"},{"speaker":"Charles Goldfarb","startTime":671.22,"endTime":673.08,"body":"but take the time that's"},{"speaker":"Charles Goldfarb","startTime":673.08,"endTime":677.1,"body":"required to do a great job for"},{"speaker":"Charles Goldfarb","startTime":673.08,"endTime":677.1,"body":"the patient, but to the to the"},{"speaker":"Charles Goldfarb","startTime":677.1,"endTime":681.8,"body":"point of advice, over schedule,"},{"speaker":"Charles Goldfarb","startTime":677.1,"endTime":681.8,"body":"not ridiculously, but over"},{"speaker":"Charles Goldfarb","startTime":681.8,"endTime":685.28,"body":"schedule, because it takes some"},{"speaker":"Charles Goldfarb","startTime":681.8,"endTime":685.28,"body":"stress off yourself, and the"},{"speaker":"Charles Goldfarb","startTime":685.28,"endTime":691.28,"body":"perception that you're slow will"},{"speaker":"Charles Goldfarb","startTime":685.28,"endTime":691.28,"body":"be diminished by the fact that"},{"speaker":"Charles Goldfarb","startTime":691.28,"endTime":693.5,"body":"you're just scheduling"},{"speaker":"Charles Goldfarb","startTime":691.28,"endTime":693.5,"body":"accurately. Yeah,"},{"speaker":"Chris Dy","startTime":693.56,"endTime":696.92,"body":"I think that's"},{"speaker":"Chris Dy","startTime":693.56,"endTime":696.92,"body":"completely valid advice and"},{"speaker":"Chris Dy","startTime":696.98,"endTime":701.2,"body":"advice that you gave me starting"},{"speaker":"Chris Dy","startTime":696.98,"endTime":701.2,"body":"out and and I used, and I'm now"},{"speaker":"Chris Dy","startTime":701.2,"endTime":705.34,"body":"kind of at that point of"},{"speaker":"Chris Dy","startTime":701.2,"endTime":705.34,"body":"figuring out the balance between"},{"speaker":"Chris Dy","startTime":705.4,"endTime":708.46,"body":"over scheduling versus under"},{"speaker":"Chris Dy","startTime":705.4,"endTime":708.46,"body":"scheduling in order to get just"},{"speaker":"Chris Dy","startTime":708.46,"endTime":711.52,"body":"enough cases on but then also"},{"speaker":"Chris Dy","startTime":708.46,"endTime":711.52,"body":"make sure that the next patients"},{"speaker":"Chris Dy","startTime":711.52,"endTime":715.06,"body":"are arriving on time without"},{"speaker":"Chris Dy","startTime":711.52,"endTime":715.06,"body":"creating a Yeah, it is a very"},{"speaker":"Chris Dy","startTime":715.06,"endTime":720.16,"body":"fine line. So chuck all the"},{"speaker":"Chris Dy","startTime":715.06,"endTime":720.16,"body":"dashboards. My scheduling"},{"speaker":"Chris Dy","startTime":720.64,"endTime":724.32,"body":"accuracy is some of it's really"},{"speaker":"Chris Dy","startTime":720.64,"endTime":724.32,"body":"under, really over scheduled."},{"speaker":"Chris Dy","startTime":724.32,"endTime":726.84,"body":"And, you know, I'm happy because"},{"speaker":"Chris Dy","startTime":724.32,"endTime":726.84,"body":"it actually ends up finding a"},{"speaker":"Chris Dy","startTime":726.84,"endTime":729.6,"body":"balance. But, you know, so that"},{"speaker":"Chris Dy","startTime":726.84,"endTime":729.6,"body":"I think that's great advice."},{"speaker":"Chris Dy","startTime":730.02,"endTime":733.74,"body":"Other advice, I'd say, is that,"},{"speaker":"Chris Dy","startTime":730.02,"endTime":733.74,"body":"at the beginning, be very"},{"speaker":"Chris Dy","startTime":734.16,"endTime":738.12,"body":"micromanaging with regards to"},{"speaker":"Chris Dy","startTime":734.16,"endTime":738.12,"body":"how the or is, you know, set up"},{"speaker":"Chris Dy","startTime":738.12,"endTime":741.5,"body":"in terms of, you know, implants"},{"speaker":"Chris Dy","startTime":738.12,"endTime":741.5,"body":"that you might need and the"},{"speaker":"Chris Dy","startTime":741.5,"endTime":744.32,"body":"availability of reps, if you"},{"speaker":"Chris Dy","startTime":741.5,"endTime":744.32,"body":"would like to have reps there,"},{"speaker":"Chris Dy","startTime":744.98,"endTime":748.22,"body":"because those are things that"},{"speaker":"Chris Dy","startTime":744.98,"endTime":748.22,"body":"either you can directly control"},{"speaker":"Chris Dy","startTime":748.22,"endTime":751.58,"body":"and make sure that they're done"},{"speaker":"Chris Dy","startTime":748.22,"endTime":751.58,"body":"correctly, or you have to make"},{"speaker":"Chris Dy","startTime":751.58,"endTime":754.76,"body":"sure that the person who's doing"},{"speaker":"Chris Dy","startTime":751.58,"endTime":754.76,"body":"it knows your preferences and"},{"speaker":"Chris Dy","startTime":754.76,"endTime":757.16,"body":"just touch base with them"},{"speaker":"Chris Dy","startTime":754.76,"endTime":757.16,"body":"regularly. Because even, as"},{"speaker":"Chris Dy","startTime":757.16,"endTime":759.32,"body":"we've learned, you know, even"},{"speaker":"Chris Dy","startTime":757.16,"endTime":759.32,"body":"far out into practice, some of"},{"speaker":"Chris Dy","startTime":759.32,"endTime":761.48,"body":"that stuff can slip through the"},{"speaker":"Chris Dy","startTime":759.32,"endTime":761.48,"body":"cracks and really affect"},{"speaker":"Charles Goldfarb","startTime":762.2,"endTime":764.26,"body":"a day. Yeah,"},{"speaker":"Charles Goldfarb","startTime":762.2,"endTime":764.26,"body":"and it's easier once you're"},{"speaker":"Charles Goldfarb","startTime":764.26,"endTime":769.42,"body":"experienced to sort of pivot and"},{"speaker":"Charles Goldfarb","startTime":764.26,"endTime":769.42,"body":"switch it up and figure things"},{"speaker":"Charles Goldfarb","startTime":769.42,"endTime":772.0,"body":"out. You don't want to be doing"},{"speaker":"Charles Goldfarb","startTime":769.42,"endTime":772.0,"body":"a lot of that early in practice"},{"speaker":"Charles Goldfarb","startTime":772.06,"endTime":776.68,"body":"because of an oversight by you"},{"speaker":"Charles Goldfarb","startTime":772.06,"endTime":776.68,"body":"or by anyone where the correct"},{"speaker":"Charles Goldfarb","startTime":776.68,"endTime":779.5,"body":"equipment wasn't there. So I"},{"speaker":"Charles Goldfarb","startTime":776.68,"endTime":779.5,"body":"agree, be very careful about"},{"speaker":"Charles Goldfarb","startTime":779.5,"endTime":783.18,"body":"that. Talk through it a lot. You"},{"speaker":"Charles Goldfarb","startTime":779.5,"endTime":783.18,"body":"know, find the person you trust"},{"speaker":"Charles Goldfarb","startTime":783.18,"endTime":785.7,"body":"in your new or to make sure you"},{"speaker":"Charles Goldfarb","startTime":783.18,"endTime":785.7,"body":"have what you need. I think"},{"speaker":"Charles Goldfarb","startTime":785.7,"endTime":790.08,"body":"that's great advice. Number"},{"speaker":"Charles Goldfarb","startTime":785.7,"endTime":790.08,"body":"four, I would say, is, you know,"},{"speaker":"Charles Goldfarb","startTime":790.08,"endTime":796.14,"body":"outside of the or developing a"},{"speaker":"Charles Goldfarb","startTime":790.08,"endTime":796.14,"body":"team is incredibly important,"},{"speaker":"Charles Goldfarb","startTime":796.68,"endTime":803.24,"body":"because you are one part of a"},{"speaker":"Charles Goldfarb","startTime":796.68,"endTime":803.24,"body":"team, and your nurse, your ma,"},{"speaker":"Charles Goldfarb","startTime":803.24,"endTime":806.66,"body":"your athletic trainer, whoever"},{"speaker":"Charles Goldfarb","startTime":803.24,"endTime":806.66,"body":"it may be is, I would say,"},{"speaker":"Charles Goldfarb","startTime":806.72,"endTime":811.52,"body":"equally as critical to what you"},{"speaker":"Charles Goldfarb","startTime":806.72,"endTime":811.52,"body":"put forth in your community, how"},{"speaker":"Charles Goldfarb","startTime":811.52,"endTime":815.72,"body":"people see you and your"},{"speaker":"Charles Goldfarb","startTime":811.52,"endTime":815.72,"body":"practice, and hopefully you had"},{"speaker":"Charles Goldfarb","startTime":815.72,"endTime":820.3,"body":"a hand in hiring the person. And"},{"speaker":"Charles Goldfarb","startTime":815.72,"endTime":820.3,"body":"you certainly need to work"},{"speaker":"Charles Goldfarb","startTime":820.3,"endTime":824.74,"body":"together to figure it out, but"},{"speaker":"Charles Goldfarb","startTime":820.3,"endTime":824.74,"body":"getting the right person is"},{"speaker":"Charles Goldfarb","startTime":824.74,"endTime":826.18,"body":"incredibly important."},{"speaker":"Chris Dy","startTime":826.48,"endTime":828.46,"body":"Yeah, I think that's"},{"speaker":"Chris Dy","startTime":826.48,"endTime":828.46,"body":"key. I mean, I've just gone"},{"speaker":"Chris Dy","startTime":828.46,"endTime":832.06,"body":"through a transition recently,"},{"speaker":"Chris Dy","startTime":828.46,"endTime":832.06,"body":"and have been fortunate that the"},{"speaker":"Chris Dy","startTime":832.36,"endTime":836.68,"body":"person that we've hired is"},{"speaker":"Chris Dy","startTime":832.36,"endTime":836.68,"body":"fantastic, and I'm on my best"},{"speaker":"Chris Dy","startTime":836.68,"endTime":842.34,"body":"behavior to hope that that she"},{"speaker":"Chris Dy","startTime":836.68,"endTime":842.34,"body":"stays for quite a while. I was"},{"speaker":"Chris Dy","startTime":842.34,"endTime":846.0,"body":"fortunate enough to have my"},{"speaker":"Chris Dy","startTime":842.34,"endTime":846.0,"body":"first Ma was with me since I"},{"speaker":"Chris Dy","startTime":846.0,"endTime":849.6,"body":"started, and was with me for"},{"speaker":"Chris Dy","startTime":846.0,"endTime":849.6,"body":"almost nine, oh, maybe around"},{"speaker":"Chris Dy","startTime":849.6,"endTime":854.28,"body":"nine years. So that was a great"},{"speaker":"Chris Dy","startTime":849.6,"endTime":854.28,"body":"run. And she kind of our"},{"speaker":"Chris Dy","startTime":854.28,"endTime":857.04,"body":"relationship and our working,"},{"speaker":"Chris Dy","startTime":854.28,"endTime":857.04,"body":"you know, our ability to work"},{"speaker":"Chris Dy","startTime":857.04,"endTime":860.24,"body":"together just kind of grew so"},{"speaker":"Chris Dy","startTime":857.04,"endTime":860.24,"body":"she probably took on more than"},{"speaker":"Chris Dy","startTime":860.24,"endTime":863.36,"body":"she should have been, just"},{"speaker":"Chris Dy","startTime":860.24,"endTime":863.36,"body":"because she kind of was there,"},{"speaker":"Chris Dy","startTime":863.36,"endTime":867.56,"body":"kind of watching it ramp up. So"},{"speaker":"Chris Dy","startTime":863.36,"endTime":867.56,"body":"it's a lot to walk into, but I"},{"speaker":"Chris Dy","startTime":867.56,"endTime":872.24,"body":"think taking care of that"},{"speaker":"Chris Dy","startTime":867.56,"endTime":872.24,"body":"relationship being a leader, but"},{"speaker":"Chris Dy","startTime":872.24,"endTime":874.7,"body":"also leading from the front, in"},{"speaker":"Chris Dy","startTime":872.24,"endTime":874.7,"body":"terms of being willing to do"},{"speaker":"Chris Dy","startTime":874.7,"endTime":877.34,"body":"everything that needs to be"},{"speaker":"Chris Dy","startTime":874.7,"endTime":877.34,"body":"done, to get a clinic together,"},{"speaker":"Chris Dy","startTime":877.34,"endTime":879.86,"body":"and making it like a team and"},{"speaker":"Chris Dy","startTime":877.34,"endTime":879.86,"body":"less of a hierarchy is really"},{"speaker":"Chris Dy","startTime":879.86,"endTime":885.16,"body":"important. Yep, I guess at point"},{"speaker":"Chris Dy","startTime":879.86,"endTime":885.16,"body":"number five would be to develop"},{"speaker":"Chris Dy","startTime":885.16,"endTime":889.24,"body":"a relationship in the community"},{"speaker":"Chris Dy","startTime":885.16,"endTime":889.24,"body":"with the therapy groups, you"},{"speaker":"Chris Dy","startTime":889.24,"endTime":892.54,"body":"know, establish yourself in ways"},{"speaker":"Chris Dy","startTime":889.24,"endTime":892.54,"body":"that as much as possible. And we"},{"speaker":"Chris Dy","startTime":892.54,"endTime":896.98,"body":"talked before in our marketing"},{"speaker":"Chris Dy","startTime":892.54,"endTime":896.98,"body":"podcast with with Amanda about,"},{"speaker":"Chris Dy","startTime":896.98,"endTime":900.36,"body":"you know, going and visiting"},{"speaker":"Chris Dy","startTime":896.98,"endTime":900.36,"body":"physician practices. But. Think"},{"speaker":"Chris Dy","startTime":900.6,"endTime":903.96,"body":"finding ways to make inroads"},{"speaker":"Chris Dy","startTime":900.6,"endTime":903.96,"body":"with the various therapy groups"},{"speaker":"Chris Dy","startTime":903.96,"endTime":906.48,"body":"in your communities is very"},{"speaker":"Chris Dy","startTime":903.96,"endTime":906.48,"body":"helpful, and I've found that to"},{"speaker":"Chris Dy","startTime":906.48,"endTime":909.36,"body":"be an incredibly helpful"},{"speaker":"Chris Dy","startTime":906.48,"endTime":909.36,"body":"resource in terms of doing kind"},{"speaker":"Chris Dy","startTime":909.36,"endTime":912.3,"body":"of lunch and learn, or kind of"},{"speaker":"Chris Dy","startTime":909.36,"endTime":912.3,"body":"after after clinic sessions"},{"speaker":"Chris Dy","startTime":912.3,"endTime":915.06,"body":"where you just go and talk about"},{"speaker":"Chris Dy","startTime":912.3,"endTime":915.06,"body":"a topic and get to know them."},{"speaker":"Charles Goldfarb","startTime":915.6,"endTime":917.82,"body":"Yeah, a good"},{"speaker":"Charles Goldfarb","startTime":915.6,"endTime":917.82,"body":"use of your time. And along"},{"speaker":"Charles Goldfarb","startTime":917.82,"endTime":920.96,"body":"those same lines, if you have"},{"speaker":"Charles Goldfarb","startTime":917.82,"endTime":920.96,"body":"partners that might benefit from"},{"speaker":"Charles Goldfarb","startTime":920.96,"endTime":923.78,"body":"your help, whether your sports"},{"speaker":"Charles Goldfarb","startTime":920.96,"endTime":923.78,"body":"partner is doing certain cases"},{"speaker":"Charles Goldfarb","startTime":924.02,"endTime":926.72,"body":"those relationships are you just"},{"speaker":"Charles Goldfarb","startTime":924.02,"endTime":926.72,"body":"have to develop them. They have"},{"speaker":"Charles Goldfarb","startTime":926.72,"endTime":932.48,"body":"to grow to trust you. My number"},{"speaker":"Charles Goldfarb","startTime":926.72,"endTime":932.48,"body":"six is, most of us start with a"},{"speaker":"Charles Goldfarb","startTime":932.48,"endTime":936.02,"body":"practice that's a little slow,"},{"speaker":"Charles Goldfarb","startTime":932.48,"endTime":936.02,"body":"that can be frustrating. So you"},{"speaker":"Charles Goldfarb","startTime":936.02,"endTime":939.86,"body":"can use your time, as Chris just"},{"speaker":"Charles Goldfarb","startTime":936.02,"endTime":939.86,"body":"said, but try to find a way to"},{"speaker":"Charles Goldfarb","startTime":939.86,"endTime":943.06,"body":"enjoy that time, and don't just"},{"speaker":"Charles Goldfarb","startTime":939.86,"endTime":943.06,"body":"lament that you're not busier,"},{"speaker":"Charles Goldfarb","startTime":943.06,"endTime":947.68,"body":"because you will presumably get"},{"speaker":"Charles Goldfarb","startTime":943.06,"endTime":947.68,"body":"busy quickly enough, and then"},{"speaker":"Charles Goldfarb","startTime":947.68,"endTime":951.4,"body":"you'll miss that time. So do"},{"speaker":"Charles Goldfarb","startTime":947.68,"endTime":951.4,"body":"things in that time which you"},{"speaker":"Charles Goldfarb","startTime":951.4,"endTime":954.7,"body":"will not have the opportunity to"},{"speaker":"Charles Goldfarb","startTime":951.4,"endTime":954.7,"body":"do later, whether that's"},{"speaker":"Charles Goldfarb","startTime":954.7,"endTime":957.52,"body":"spending more time with your"},{"speaker":"Charles Goldfarb","startTime":954.7,"endTime":957.52,"body":"family. You don't want to be"},{"speaker":"Charles Goldfarb","startTime":957.52,"endTime":960.84,"body":"seen as not in the office and"},{"speaker":"Charles Goldfarb","startTime":957.52,"endTime":960.84,"body":"not being around, but spending"},{"speaker":"Charles Goldfarb","startTime":960.84,"endTime":963.48,"body":"time with the family, developing"},{"speaker":"Charles Goldfarb","startTime":960.84,"endTime":963.48,"body":"your practice reading, the"},{"speaker":"Charles Goldfarb","startTime":964.08,"endTime":966.96,"body":"reading and the preparation"},{"speaker":"Charles Goldfarb","startTime":964.08,"endTime":966.96,"body":"shouldn't stop. In fact, I don't"},{"speaker":"Charles Goldfarb","startTime":966.96,"endTime":971.52,"body":"think I ever read as much as I"},{"speaker":"Charles Goldfarb","startTime":966.96,"endTime":971.52,"body":"did during my first year, I over"},{"speaker":"Charles Goldfarb","startTime":971.52,"endTime":973.56,"body":"prepared for every case, and"},{"speaker":"Charles Goldfarb","startTime":971.52,"endTime":973.56,"body":"that's critical."},{"speaker":"Chris Dy","startTime":973.92,"endTime":975.78,"body":"I think, in the first"},{"speaker":"Chris Dy","startTime":973.92,"endTime":975.78,"body":"five years, I read for every"},{"speaker":"Chris Dy","startTime":975.78,"endTime":979.5,"body":"case, whether it was carpal"},{"speaker":"Chris Dy","startTime":975.78,"endTime":979.5,"body":"tunnel, trigger finger, I just"},{"speaker":"Chris Dy","startTime":979.5,"endTime":982.04,"body":"looked at the notes that I had."},{"speaker":"Chris Dy","startTime":979.5,"endTime":982.04,"body":"And then this kind of goes back"},{"speaker":"Chris Dy","startTime":982.04,"endTime":985.1,"body":"to the people that are in"},{"speaker":"Chris Dy","startTime":982.04,"endTime":985.1,"body":"training now. I mean, develop"},{"speaker":"Chris Dy","startTime":985.1,"endTime":988.22,"body":"your note taking system. I was"},{"speaker":"Chris Dy","startTime":985.1,"endTime":988.22,"body":"just talking with one of our PGY"},{"speaker":"Chris Dy","startTime":988.22,"endTime":990.38,"body":"threes. Trey is fantastic. And"},{"speaker":"Chris Dy","startTime":988.22,"endTime":990.38,"body":"we were talking about the"},{"speaker":"Chris Dy","startTime":990.74,"endTime":993.62,"body":"hardest transition between being"},{"speaker":"Chris Dy","startTime":990.74,"endTime":993.62,"body":"a two and a three. And I talked"},{"speaker":"Chris Dy","startTime":993.62,"endTime":996.26,"body":"about this with Dr Aline to our"},{"speaker":"Chris Dy","startTime":993.62,"endTime":996.26,"body":"residency director. Two, you're"},{"speaker":"Chris Dy","startTime":996.68,"endTime":999.26,"body":"just trying to figure out where"},{"speaker":"Chris Dy","startTime":996.68,"endTime":999.26,"body":"your hands are. Three, you're"},{"speaker":"Chris Dy","startTime":999.26,"endTime":1003.24,"body":"actually tasked with being a"},{"speaker":"Chris Dy","startTime":999.26,"endTime":1003.24,"body":"primary surgeon in so many ways,"},{"speaker":"Chris Dy","startTime":1003.78,"endTime":1007.74,"body":"and that jump is big, and the"},{"speaker":"Chris Dy","startTime":1003.78,"endTime":1007.74,"body":"preparation needed to get there"},{"speaker":"Chris Dy","startTime":1007.74,"endTime":1010.68,"body":"is big. And I remember"},{"speaker":"Chris Dy","startTime":1007.74,"endTime":1010.68,"body":"struggling, and everybody does"},{"speaker":"Chris Dy","startTime":1010.68,"endTime":1013.56,"body":"as a mid level resident, trying"},{"speaker":"Chris Dy","startTime":1010.68,"endTime":1013.56,"body":"to figure out what your note"},{"speaker":"Chris Dy","startTime":1013.56,"endTime":1016.08,"body":"taking system and you know, for"},{"speaker":"Chris Dy","startTime":1013.56,"endTime":1016.08,"body":"those that are graduating,"},{"speaker":"Chris Dy","startTime":1016.08,"endTime":1018.78,"body":"you've probably figured out your"},{"speaker":"Chris Dy","startTime":1016.08,"endTime":1018.78,"body":"note taking system, but continue"},{"speaker":"Chris Dy","startTime":1018.78,"endTime":1020.72,"body":"to fall back on those notes,"},{"speaker":"Chris Dy","startTime":1018.78,"endTime":1020.72,"body":"because those the same notes"},{"speaker":"Chris Dy","startTime":1020.72,"endTime":1023.18,"body":"you're going to use for board"},{"speaker":"Chris Dy","startTime":1020.72,"endTime":1023.18,"body":"preparation when you're going to"},{"speaker":"Chris Dy","startTime":1023.18,"endTime":1027.14,"body":"take your boards. So, you know,"},{"speaker":"Chris Dy","startTime":1023.18,"endTime":1027.14,"body":"I think that that's a critical"},{"speaker":"Chris Dy","startTime":1027.14,"endTime":1029.66,"body":"thing, is read for every case,"},{"speaker":"Chris Dy","startTime":1027.14,"endTime":1029.66,"body":"even if it's just looking"},{"speaker":"Chris Dy","startTime":1029.66,"endTime":1032.36,"body":"through your old notes. So"},{"speaker":"Chris Dy","startTime":1029.66,"endTime":1032.36,"body":"you're always prepared."},{"speaker":"Chris Dy","startTime":1033.08,"endTime":1036.8,"body":"Yesterday, in the plexus, I was"},{"speaker":"Chris Dy","startTime":1033.08,"endTime":1036.8,"body":"talking with David, and we were"},{"speaker":"Chris Dy","startTime":1036.8,"endTime":1040.78,"body":"saying, how, you know it"},{"speaker":"Chris Dy","startTime":1036.8,"endTime":1040.78,"body":"sometimes a carpal tunnel is"},{"speaker":"Chris Dy","startTime":1040.78,"endTime":1044.56,"body":"more stressful than a plexus in"},{"speaker":"Chris Dy","startTime":1040.78,"endTime":1044.56,"body":"the way that if something"},{"speaker":"Chris Dy","startTime":1044.56,"endTime":1047.14,"body":"doesn't go perfect in a plexus,"},{"speaker":"Chris Dy","startTime":1044.56,"endTime":1047.14,"body":"there's so many things you could"},{"speaker":"Chris Dy","startTime":1047.14,"endTime":1050.32,"body":"say, well, you know, bad injury."},{"speaker":"Chris Dy","startTime":1047.14,"endTime":1050.32,"body":"There are only a certain number"},{"speaker":"Chris Dy","startTime":1050.32,"endTime":1053.26,"body":"of people in the country or the"},{"speaker":"Chris Dy","startTime":1050.32,"endTime":1053.26,"body":"world that do this, and you"},{"speaker":"Chris Dy","startTime":1053.26,"endTime":1056.32,"body":"know, they understand how"},{"speaker":"Chris Dy","startTime":1053.26,"endTime":1056.32,"body":"challenging this is. But a"},{"speaker":"Chris Dy","startTime":1056.32,"endTime":1059.68,"body":"carpal tunnel, there's no room"},{"speaker":"Chris Dy","startTime":1056.32,"endTime":1059.68,"body":"for error in a carpal tunnel."},{"speaker":"Chris Dy","startTime":1060.4,"endTime":1063.9,"body":"You've got to be perfect every"},{"speaker":"Chris Dy","startTime":1060.4,"endTime":1063.9,"body":"time. So that's the bar. So you"},{"speaker":"Chris Dy","startTime":1063.9,"endTime":1065.22,"body":"got to prepare as such."},{"speaker":"Charles Goldfarb","startTime":1066.12,"endTime":1068.52,"body":"Yeah, I really"},{"speaker":"Charles Goldfarb","startTime":1066.12,"endTime":1068.52,"body":"like that. And I also like your"},{"speaker":"Charles Goldfarb","startTime":1068.58,"endTime":1074.04,"body":"point. You know, every level,"},{"speaker":"Charles Goldfarb","startTime":1068.58,"endTime":1074.04,"body":"from intern, maybe, from medical"},{"speaker":"Charles Goldfarb","startTime":1074.04,"endTime":1078.54,"body":"student to intern to residency"},{"speaker":"Charles Goldfarb","startTime":1074.04,"endTime":1078.54,"body":"stages to fellowship to faculty,"},{"speaker":"Charles Goldfarb","startTime":1079.44,"endTime":1081.92,"body":"you're seeing things"},{"speaker":"Charles Goldfarb","startTime":1079.44,"endTime":1081.92,"body":"differently, and you're getting"},{"speaker":"Charles Goldfarb","startTime":1081.92,"endTime":1087.2,"body":"different things out of the"},{"speaker":"Charles Goldfarb","startTime":1081.92,"endTime":1087.2,"body":"case. And so that's part of the"},{"speaker":"Charles Goldfarb","startTime":1087.2,"endTime":1089.96,"body":"challenge. That's why it's so"},{"speaker":"Charles Goldfarb","startTime":1087.2,"endTime":1089.96,"body":"nice. When we do operate with"},{"speaker":"Charles Goldfarb","startTime":1089.96,"endTime":1092.36,"body":"our fellows in the middle of the"},{"speaker":"Charles Goldfarb","startTime":1089.96,"endTime":1092.36,"body":"night, even if we don't need to"},{"speaker":"Charles Goldfarb","startTime":1092.36,"endTime":1096.14,"body":"be there, for example, a flexor"},{"speaker":"Charles Goldfarb","startTime":1092.36,"endTime":1096.14,"body":"tendonitis, they acknowledge"},{"speaker":"Charles Goldfarb","startTime":1096.14,"endTime":1098.54,"body":"they get something out of it"},{"speaker":"Charles Goldfarb","startTime":1096.14,"endTime":1098.54,"body":"when we're there with them, and"},{"speaker":"Charles Goldfarb","startTime":1098.54,"endTime":1100.84,"body":"I think I still get something"},{"speaker":"Charles Goldfarb","startTime":1098.54,"endTime":1100.84,"body":"out of it. Maybe it's more"},{"speaker":"Charles Goldfarb","startTime":1100.84,"endTime":1103.84,"body":"enjoyment or or the moment,"},{"speaker":"Charles Goldfarb","startTime":1100.84,"endTime":1103.84,"body":"rather than something technical."},{"speaker":"Charles Goldfarb","startTime":1103.84,"endTime":1107.92,"body":"But I think every step you kind"},{"speaker":"Charles Goldfarb","startTime":1103.84,"endTime":1107.92,"body":"of reconsider, when you're a two"},{"speaker":"Charles Goldfarb","startTime":1107.92,"endTime":1111.76,"body":"versus a three versus a chief,"},{"speaker":"Charles Goldfarb","startTime":1107.92,"endTime":1111.76,"body":"it's just a really, really fun"},{"speaker":"Charles Goldfarb","startTime":1112.36,"endTime":1113.44,"body":"development process."},{"speaker":"Chris Dy","startTime":1113.92,"endTime":1116.14,"body":"That's the joy of"},{"speaker":"Chris Dy","startTime":1113.92,"endTime":1116.14,"body":"surgery, right? You know, it's"},{"speaker":"Chris Dy","startTime":1116.26,"endTime":1120.18,"body":"the being able to see the"},{"speaker":"Chris Dy","startTime":1116.26,"endTime":1120.18,"body":"differences in each case and"},{"speaker":"Chris Dy","startTime":1120.18,"endTime":1123.96,"body":"what you take out of it, for"},{"speaker":"Chris Dy","startTime":1120.18,"endTime":1123.96,"body":"sure. Do you have any final"},{"speaker":"Chris Dy","startTime":1124.14,"endTime":1127.68,"body":"points of wisdom? I will defer"},{"speaker":"Chris Dy","startTime":1124.14,"endTime":1127.68,"body":"to you as the this, the more"},{"speaker":"Chris Dy","startTime":1127.68,"endTime":1131.04,"body":"senior member of this team to"},{"speaker":"Chris Dy","startTime":1127.68,"endTime":1131.04,"body":"close us out,"},{"speaker":"Charles Goldfarb","startTime":1132.3,"endTime":1134.46,"body":"yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1132.3,"endTime":1134.46,"body":"the if we have a point number"},{"speaker":"Charles Goldfarb","startTime":1134.46,"endTime":1138.18,"body":"seven is you're never on an"},{"speaker":"Charles Goldfarb","startTime":1134.46,"endTime":1138.18,"body":"island, whether that's local"},{"speaker":"Charles Goldfarb","startTime":1138.18,"endTime":1141.32,"body":"help or, you know, we get both."},{"speaker":"Charles Goldfarb","startTime":1138.18,"endTime":1141.32,"body":"Get joy out of the"},{"speaker":"Charles Goldfarb","startTime":1141.32,"endTime":1145.1,"body":"communications regarding case"},{"speaker":"Charles Goldfarb","startTime":1141.32,"endTime":1145.1,"body":"questions and case preparation"},{"speaker":"Charles Goldfarb","startTime":1145.1,"endTime":1149.6,"body":"from fellows at from you know,"},{"speaker":"Charles Goldfarb","startTime":1145.1,"endTime":1149.6,"body":"last year's fellows, 10 year"},{"speaker":"Charles Goldfarb","startTime":1149.6,"endTime":1152.9,"body":"ago, fellows, I still text"},{"speaker":"Charles Goldfarb","startTime":1149.6,"endTime":1152.9,"body":"regularly with two fellows that"},{"speaker":"Charles Goldfarb","startTime":1152.9,"endTime":1157.04,"body":"do a lot of sports that were 15"},{"speaker":"Charles Goldfarb","startTime":1152.9,"endTime":1157.04,"body":"plus years out. And that's more"},{"speaker":"Charles Goldfarb","startTime":1157.04,"endTime":1161.62,"body":"of a we all chime in equally,"},{"speaker":"Charles Goldfarb","startTime":1157.04,"endTime":1161.62,"body":"rather than, you know, looking"},{"speaker":"Charles Goldfarb","startTime":1161.62,"endTime":1165.04,"body":"for advice from one of the one"},{"speaker":"Charles Goldfarb","startTime":1161.62,"endTime":1165.04,"body":"of our attendings. But I think"},{"speaker":"Charles Goldfarb","startTime":1165.04,"endTime":1168.28,"body":"you're never on an island, and"},{"speaker":"Charles Goldfarb","startTime":1165.04,"endTime":1168.28,"body":"the key to that is, you know,"},{"speaker":"Charles Goldfarb","startTime":1168.28,"endTime":1172.42,"body":"don't be shy. Maybe share the"},{"speaker":"Charles Goldfarb","startTime":1168.28,"endTime":1172.42,"body":"wealth. Don't, don't text or"},{"speaker":"Charles Goldfarb","startTime":1172.42,"endTime":1176.02,"body":"email the same person over and"},{"speaker":"Charles Goldfarb","startTime":1172.42,"endTime":1176.02,"body":"over and over. But don't be shy,"},{"speaker":"Charles Goldfarb","startTime":1176.02,"endTime":1178.48,"body":"because that's what your"},{"speaker":"Charles Goldfarb","startTime":1176.02,"endTime":1178.48,"body":"fellowship mentors are there"},{"speaker":"Charles Goldfarb","startTime":1178.48,"endTime":1178.78,"body":"for."},{"speaker":"Chris Dy","startTime":1179.14,"endTime":1181.5,"body":"Yeah, I'm doing a"},{"speaker":"Chris Dy","startTime":1179.14,"endTime":1181.5,"body":"meeting later today, with one of"},{"speaker":"Chris Dy","startTime":1181.5,"endTime":1184.14,"body":"our fellowship graduates from a"},{"speaker":"Chris Dy","startTime":1181.5,"endTime":1184.14,"body":"couple years ago, Lauren Wessel,"},{"speaker":"Chris Dy","startTime":1184.14,"endTime":1186.54,"body":"who's been on the podcast, we're"},{"speaker":"Chris Dy","startTime":1184.14,"endTime":1186.54,"body":"going to talk about a case, as"},{"speaker":"Chris Dy","startTime":1186.54,"endTime":1190.68,"body":"well as talk about just kind of"},{"speaker":"Chris Dy","startTime":1186.54,"endTime":1190.68,"body":"how, how interactions with"},{"speaker":"Chris Dy","startTime":1190.68,"endTime":1193.68,"body":"residents and medical students"},{"speaker":"Chris Dy","startTime":1190.68,"endTime":1193.68,"body":"for research, and how to, you"},{"speaker":"Chris Dy","startTime":1193.68,"endTime":1197.46,"body":"know, work with that. So, yeah,"},{"speaker":"Chris Dy","startTime":1193.68,"endTime":1197.46,"body":"you're never on an island. Your"},{"speaker":"Chris Dy","startTime":1197.46,"endTime":1200.72,"body":"fellowship doesn't end after one"},{"speaker":"Chris Dy","startTime":1197.46,"endTime":1200.72,"body":"year. Clearly. The relationship"},{"speaker":"Chris Dy","startTime":1200.72,"endTime":1205.16,"body":"changes, but don't be a"},{"speaker":"Chris Dy","startTime":1200.72,"endTime":1205.16,"body":"stranger. So hopefully, you know"},{"speaker":"Chris Dy","startTime":1205.34,"endTime":1208.04,"body":"that's helpful to those that are"},{"speaker":"Chris Dy","startTime":1205.34,"endTime":1208.04,"body":"graduating. Congratulations on"},{"speaker":"Chris Dy","startTime":1208.04,"endTime":1211.1,"body":"finishing what is likely the"},{"speaker":"Chris Dy","startTime":1208.04,"endTime":1211.1,"body":"last aspect of your training."},{"speaker":"Chris Dy","startTime":1212.3,"endTime":1216.32,"body":"And you know, make sure to"},{"speaker":"Chris Dy","startTime":1212.3,"endTime":1216.32,"body":"acknowledge your mentors as you"},{"speaker":"Chris Dy","startTime":1216.32,"endTime":1219.5,"body":"go through the process, or have"},{"speaker":"Chris Dy","startTime":1216.32,"endTime":1219.5,"body":"a little graduation dinner for"},{"speaker":"Chris Dy","startTime":1219.5,"endTime":1223.72,"body":"our graduating fellows, in which"},{"speaker":"Chris Dy","startTime":1219.5,"endTime":1223.72,"body":"they have selected a faculty"},{"speaker":"Chris Dy","startTime":1223.72,"endTime":1228.46,"body":"mentor to give a few words. The"},{"speaker":"Chris Dy","startTime":1223.72,"endTime":1228.46,"body":"question came up during the"},{"speaker":"Chris Dy","startTime":1228.46,"endTime":1232.06,"body":"plexus yesterday, whether this"},{"speaker":"Chris Dy","startTime":1228.46,"endTime":1232.06,"body":"is a, you know, more of a roast,"},{"speaker":"Chris Dy","startTime":1232.06,"endTime":1238.42,"body":"or more of a speech? And the"},{"speaker":"Chris Dy","startTime":1232.06,"endTime":1238.42,"body":"answer was, yes, we'll see"},{"speaker":"Chris Dy","startTime":1238.66,"endTime":1241.02,"body":"you've been entrusted with us"},{"speaker":"Chris Dy","startTime":1238.66,"endTime":1241.02,"body":"speaking for one of our"},{"speaker":"Chris Dy","startTime":1241.02,"endTime":1243.0,"body":"graduates. So we'll see what you"},{"speaker":"Chris Dy","startTime":1241.02,"endTime":1243.0,"body":"come up with. Chuck,"},{"speaker":"Charles Goldfarb","startTime":1243.48,"endTime":1244.98,"body":"yeah, it's"},{"speaker":"Charles Goldfarb","startTime":1243.48,"endTime":1244.98,"body":"been low key in the past. I'm"},{"speaker":"Charles Goldfarb","startTime":1244.98,"endTime":1249.0,"body":"not gonna roast anybody. Others"},{"speaker":"Charles Goldfarb","startTime":1244.98,"endTime":1249.0,"body":"might. Yeah, I actually, I have"},{"speaker":"Charles Goldfarb","startTime":1249.0,"endTime":1253.98,"body":"an idea of how to roast Adam. So"},{"speaker":"Charles Goldfarb","startTime":1249.0,"endTime":1253.98,"body":"we'll see. Maybe, before we turn"},{"speaker":"Charles Goldfarb","startTime":1253.98,"endTime":1256.98,"body":"clinical, I'd like to thank"},{"speaker":"Charles Goldfarb","startTime":1253.98,"endTime":1256.98,"body":"checkpoint surgical that is"},{"speaker":"Charles Goldfarb","startTime":1256.98,"endTime":1261.56,"body":"continuing to expand their"},{"speaker":"Charles Goldfarb","startTime":1256.98,"endTime":1261.56,"body":"biomaterial portfolio portfolio"},{"speaker":"Charles Goldfarb","startTime":1261.98,"endTime":1266.36,"body":"with the launch of ACM shield,"},{"speaker":"Charles Goldfarb","startTime":1261.98,"endTime":1266.36,"body":"soft tissue barrier. ACM shield"},{"speaker":"Charles Goldfarb","startTime":1266.36,"endTime":1271.34,"body":"is a is a dehydrated placental"},{"speaker":"Charles Goldfarb","startTime":1266.36,"endTime":1271.34,"body":"membrane allograft for use as a"},{"speaker":"Charles Goldfarb","startTime":1271.34,"endTime":1275.36,"body":"protective barrier in surgical"},{"speaker":"Charles Goldfarb","startTime":1271.34,"endTime":1275.36,"body":"applications, comprised"},{"speaker":"Chris Dy","startTime":1275.36,"endTime":1278.12,"body":"of the complete intact"},{"speaker":"Chris Dy","startTime":1275.36,"endTime":1278.12,"body":"layers of amniotic tissue and"},{"speaker":"Chris Dy","startTime":1278.12,"endTime":1280.84,"body":"minimally processed to preserve"},{"speaker":"Chris Dy","startTime":1278.12,"endTime":1280.84,"body":"the native structure of the"},{"speaker":"Chris Dy","startTime":1280.84,"endTime":1284.14,"body":"tissue. ACM shield is an ideal"},{"speaker":"Chris Dy","startTime":1280.84,"endTime":1284.14,"body":"protective barrier and"},{"speaker":"Chris Dy","startTime":1284.14,"endTime":1287.68,"body":"extracellular matrix scaffold"},{"speaker":"Chris Dy","startTime":1284.14,"endTime":1287.68,"body":"for use in a variety of surgical"},{"speaker":"Chris Dy","startTime":1287.68,"endTime":1292.12,"body":"applications, such as nerve and"},{"speaker":"Chris Dy","startTime":1287.68,"endTime":1292.12,"body":"tendon repair. To learn more,"},{"speaker":"Chris Dy","startTime":1292.18,"endTime":1293.98,"body":"visit checkpointsurgical.com"},{"speaker":"Charles Goldfarb","startTime":1295.18,"endTime":1297.16,"body":"I might be"},{"speaker":"Charles Goldfarb","startTime":1295.18,"endTime":1297.16,"body":"visiting to learn more about"},{"speaker":"Charles Goldfarb","startTime":1297.16,"endTime":1299.38,"body":"this product. It's a little over"},{"speaker":"Charles Goldfarb","startTime":1297.16,"endTime":1299.38,"body":"my head."},{"speaker":"Chris Dy","startTime":1299.68,"endTime":1302.16,"body":"It is. It's, you know,"},{"speaker":"Chris Dy","startTime":1299.68,"endTime":1302.16,"body":"it's a little bit of a, you"},{"speaker":"Chris Dy","startTime":1302.16,"endTime":1304.14,"body":"know, a new thing for"},{"speaker":"Chris Dy","startTime":1302.16,"endTime":1304.14,"body":"checkpoints. So we'll see, we'll"},{"speaker":"Chris Dy","startTime":1304.14,"endTime":1307.08,"body":"see how they do with it. It's"},{"speaker":"Chris Dy","startTime":1304.14,"endTime":1307.08,"body":"funny every time that. So when"},{"speaker":"Chris Dy","startTime":1307.08,"endTime":1311.34,"body":"we do our Plexus or days, we"},{"speaker":"Chris Dy","startTime":1307.08,"endTime":1311.34,"body":"oftentimes will call for nerve"},{"speaker":"Chris Dy","startTime":1311.34,"endTime":1315.36,"body":"stimulators. And both Dr Brogan"},{"speaker":"Chris Dy","startTime":1311.34,"endTime":1315.36,"body":"and I have to disclose our"},{"speaker":"Chris Dy","startTime":1315.36,"endTime":1318.96,"body":"conflicts of interest as we as"},{"speaker":"Chris Dy","startTime":1315.36,"endTime":1318.96,"body":"we call for said stimulators,"},{"speaker":"Chris Dy","startTime":1319.32,"endTime":1322.58,"body":"you know. And David, David"},{"speaker":"Chris Dy","startTime":1319.32,"endTime":1322.58,"body":"occasionally listens to the"},{"speaker":"Chris Dy","startTime":1322.58,"endTime":1325.46,"body":"podcast, I think, not by choice,"},{"speaker":"Chris Dy","startTime":1322.58,"endTime":1325.46,"body":"because I think it comes up on"},{"speaker":"Chris Dy","startTime":1325.46,"endTime":1328.58,"body":"his queue when, when he's"},{"speaker":"Chris Dy","startTime":1325.46,"endTime":1328.58,"body":"running and for many hours and"},{"speaker":"Chris Dy","startTime":1328.58,"endTime":1331.94,"body":"doesn't have the ability to"},{"speaker":"Chris Dy","startTime":1328.58,"endTime":1331.94,"body":"readily change it. So"},{"speaker":"Chris Dy","startTime":1331.94,"endTime":1334.94,"body":"occasionally he listens to us"},{"speaker":"Chris Dy","startTime":1331.94,"endTime":1334.94,"body":"and provide some, I'll say,"},{"speaker":"Chris Dy","startTime":1335.0,"endTime":1338.72,"body":"feedback to us about the the"},{"speaker":"Chris Dy","startTime":1335.0,"endTime":1338.72,"body":"podcast during these long cases."},{"speaker":"Chris Dy","startTime":1338.72,"endTime":1339.32,"body":"So yeah,"},{"speaker":"Charles Goldfarb","startTime":1339.74,"endTime":1341.2,"body":"that's funny."},{"speaker":"Charles Goldfarb","startTime":1339.74,"endTime":1341.2,"body":"Yeah, I haven't heard any"},{"speaker":"Charles Goldfarb","startTime":1341.2,"endTime":1343.3,"body":"feedback, but you guys spend"},{"speaker":"Charles Goldfarb","startTime":1341.2,"endTime":1343.3,"body":"more time together. That's"},{"speaker":"Charles Goldfarb","startTime":1343.3,"endTime":1345.58,"body":"funny. So I think we talked"},{"speaker":"Charles Goldfarb","startTime":1343.3,"endTime":1345.58,"body":"about two different clinical"},{"speaker":"Charles Goldfarb","startTime":1345.58,"endTime":1348.28,"body":"topics. Do you have a choice of"},{"speaker":"Charles Goldfarb","startTime":1345.58,"endTime":1348.28,"body":"which one we will pursue?"},{"speaker":"Chris Dy","startTime":1348.76,"endTime":1351.94,"body":"Well, it's summertime."},{"speaker":"Chris Dy","startTime":1348.76,"endTime":1351.94,"body":"So you know summertime typically"},{"speaker":"Chris Dy","startTime":1351.94,"endTime":1355.06,"body":"means of hot and heavy call with"},{"speaker":"Chris Dy","startTime":1351.94,"endTime":1355.06,"body":"high high energy trauma, at"},{"speaker":"Chris Dy","startTime":1355.06,"endTime":1358.72,"body":"least in St Louis. And I'm"},{"speaker":"Chris Dy","startTime":1355.06,"endTime":1358.72,"body":"realizing more and more that I"},{"speaker":"Chris Dy","startTime":1358.72,"endTime":1362.04,"body":"think in St Louis we see some"},{"speaker":"Chris Dy","startTime":1358.72,"endTime":1362.04,"body":"real stuff. Like, you see real"},{"speaker":"Chris Dy","startTime":1362.04,"endTime":1364.68,"body":"stuff here, of all varieties. I"},{"speaker":"Chris Dy","startTime":1362.04,"endTime":1364.68,"body":"mean, I remember moving here,"},{"speaker":"Chris Dy","startTime":1364.92,"endTime":1368.46,"body":"graduating residency from"},{"speaker":"Chris Dy","startTime":1364.92,"endTime":1368.46,"body":"Manhattan, and coming here and"},{"speaker":"Chris Dy","startTime":1368.46,"endTime":1371.28,"body":"saying, I don't even know what"},{"speaker":"Chris Dy","startTime":1368.46,"endTime":1371.28,"body":"these mechanisms of injury are"},{"speaker":"Chris Dy","startTime":1371.34,"endTime":1373.86,"body":"like. I had to Google what an"},{"speaker":"Chris Dy","startTime":1371.34,"endTime":1373.86,"body":"auger was, because I, you know,"},{"speaker":"Chris Dy","startTime":1373.86,"endTime":1376.32,"body":"I It's not how I grew up, like,"},{"speaker":"Chris Dy","startTime":1373.86,"endTime":1376.32,"body":"you know, it's nothing that I"},{"speaker":"Chris Dy","startTime":1376.32,"endTime":1380.72,"body":"would have seen in Manhattan or"},{"speaker":"Chris Dy","startTime":1376.32,"endTime":1380.72,"body":"Miami. So, you know, you see"},{"speaker":"Chris Dy","startTime":1380.72,"endTime":1383.12,"body":"some real stuff. Here you see"},{"speaker":"Chris Dy","startTime":1380.72,"endTime":1383.12,"body":"high velocity stuff. I was"},{"speaker":"Chris Dy","startTime":1383.12,"endTime":1385.34,"body":"talking to one of our trauma"},{"speaker":"Chris Dy","startTime":1383.12,"endTime":1385.34,"body":"surgeons, which OB yesterday."},{"speaker":"Chris Dy","startTime":1385.34,"endTime":1388.34,"body":"He's like, Yeah, you know, this"},{"speaker":"Chris Dy","startTime":1385.34,"endTime":1388.34,"body":"is this place is it's the real"},{"speaker":"Chris Dy","startTime":1388.34,"endTime":1392.0,"body":"deal in terms of mechanism of"},{"speaker":"Chris Dy","startTime":1388.34,"endTime":1392.0,"body":"injury. So I remember a bad case"},{"speaker":"Chris Dy","startTime":1392.0,"endTime":1394.7,"body":"when I was a fellow, a patient,"},{"speaker":"Chris Dy","startTime":1392.0,"endTime":1394.7,"body":"we actually ended"},{"speaker":"Charles Goldfarb","startTime":1394.7,"endTime":1396.62,"body":"up wait before"},{"speaker":"Charles Goldfarb","startTime":1394.7,"endTime":1396.62,"body":"your case. So let's talk about"},{"speaker":"Charles Goldfarb","startTime":1396.62,"endTime":1399.14,"body":"some of those mechanisms. This"},{"speaker":"Charles Goldfarb","startTime":1396.62,"endTime":1399.14,"body":"is, this is good. This is good"},{"speaker":"Charles Goldfarb","startTime":1399.14,"endTime":1403.3,"body":"stuff. So we have the"},{"speaker":"Charles Goldfarb","startTime":1399.14,"endTime":1403.3,"body":"traditional city trauma, which"},{"speaker":"Charles Goldfarb","startTime":1403.3,"endTime":1408.4,"body":"is MVCs, obviously, in St Louis,"},{"speaker":"Charles Goldfarb","startTime":1403.3,"endTime":1408.4,"body":"we have gunshot wounds, we have"},{"speaker":"Charles Goldfarb","startTime":1408.4,"endTime":1411.34,"body":"stabbings, all that stuff."},{"speaker":"Charles Goldfarb","startTime":1408.4,"endTime":1411.34,"body":"That's kind of the"},{"speaker":"Chris Dy","startTime":1411.34,"endTime":1413.32,"body":"America's a very nice"},{"speaker":"Chris Dy","startTime":1411.34,"endTime":1413.32,"body":"place all of you that are"},{"speaker":"Chris Dy","startTime":1413.32,"endTime":1413.68,"body":"listening,"},{"speaker":"Charles Goldfarb","startTime":1415.06,"endTime":1419.86,"body":"yes, yeah. And"},{"speaker":"Charles Goldfarb","startTime":1415.06,"endTime":1419.86,"body":"then we have sort of outdoor"},{"speaker":"Charles Goldfarb","startTime":1419.86,"endTime":1423.36,"body":"activities. So we have our share"},{"speaker":"Charles Goldfarb","startTime":1419.86,"endTime":1423.36,"body":"of bike injuries and scooter"},{"speaker":"Charles Goldfarb","startTime":1423.36,"endTime":1427.86,"body":"injuries and all 10 vehicles,"},{"speaker":"Charles Goldfarb","startTime":1423.36,"endTime":1427.86,"body":"four wheelers, side by sides,"},{"speaker":"Charles Goldfarb","startTime":1427.86,"endTime":1431.88,"body":"which is sort of an ATV, if you"},{"speaker":"Charles Goldfarb","startTime":1427.86,"endTime":1431.88,"body":"ask me, all"},{"speaker":"Chris Dy","startTime":1431.88,"endTime":1433.74,"body":"activities that my"},{"speaker":"Chris Dy","startTime":1431.88,"endTime":1433.74,"body":"children will not be"},{"speaker":"Chris Dy","startTime":1433.74,"endTime":1436.98,"body":"participating in. With my"},{"speaker":"Chris Dy","startTime":1433.74,"endTime":1436.98,"body":"knowledge, based on everyone"},{"speaker":"Chris Dy","startTime":1436.98,"endTime":1440.48,"body":"listening to me like that, dude"},{"speaker":"Chris Dy","startTime":1436.98,"endTime":1440.48,"body":"is like such a wuss. Doesn't"},{"speaker":"Chris Dy","startTime":1440.48,"endTime":1441.8,"body":"bike, he doesn't swim."},{"speaker":"Charles Goldfarb","startTime":1442.46,"endTime":1444.38,"body":"You can only"},{"speaker":"Charles Goldfarb","startTime":1442.46,"endTime":1444.38,"body":"minimize risk to a certain"},{"speaker":"Charles Goldfarb","startTime":1444.38,"endTime":1448.7,"body":"degree. Yeah, I think it's the"},{"speaker":"Charles Goldfarb","startTime":1444.38,"endTime":1448.7,"body":"mixture of the city and the"},{"speaker":"Charles Goldfarb","startTime":1449.06,"endTime":1452.9,"body":"rural engagements, and we get it"},{"speaker":"Charles Goldfarb","startTime":1449.06,"endTime":1452.9,"body":"all. Which is, which is"},{"speaker":"Charles Goldfarb","startTime":1452.9,"endTime":1453.44,"body":"interesting."},{"speaker":"Chris Dy","startTime":1453.62,"endTime":1455.66,"body":"Yeah. I mean,"},{"speaker":"Chris Dy","startTime":1453.62,"endTime":1455.66,"body":"honestly, in our multicenter"},{"speaker":"Chris Dy","startTime":1455.66,"endTime":1459.08,"body":"Plexus study, you know, the"},{"speaker":"Chris Dy","startTime":1455.66,"endTime":1459.08,"body":"number of people that are hurt"},{"speaker":"Chris Dy","startTime":1459.08,"endTime":1463.0,"body":"by falling trees in Missouri is"},{"speaker":"Chris Dy","startTime":1459.08,"endTime":1463.0,"body":"pretty ridiculous. So we had a"},{"speaker":"Chris Dy","startTime":1463.0,"endTime":1466.96,"body":"role. Like, I said, like, four"},{"speaker":"Chris Dy","startTime":1463.0,"endTime":1466.96,"body":"or five people within the span"},{"speaker":"Chris Dy","startTime":1466.96,"endTime":1470.8,"body":"of six months were hurt by"},{"speaker":"Chris Dy","startTime":1466.96,"endTime":1470.8,"body":"falling trees. Now, part of that"},{"speaker":"Chris Dy","startTime":1470.8,"endTime":1473.62,"body":"is because they were cutting the"},{"speaker":"Chris Dy","startTime":1470.8,"endTime":1473.62,"body":"trees down for work or whatever."},{"speaker":"Chris Dy","startTime":1473.62,"endTime":1476.86,"body":"But, I mean, that's terrifying,"},{"speaker":"Chris Dy","startTime":1473.62,"endTime":1476.86,"body":"like, you know, well, so we'll"},{"speaker":"Chris Dy","startTime":1476.86,"endTime":1480.84,"body":"also see industrial type"},{"speaker":"Chris Dy","startTime":1476.86,"endTime":1480.84,"body":"injuries, you know, I remember"},{"speaker":"Chris Dy","startTime":1480.84,"endTime":1485.28,"body":"one Plexus was from a conveyor"},{"speaker":"Chris Dy","startTime":1480.84,"endTime":1485.28,"body":"belt horseback riding, which is"},{"speaker":"Chris Dy","startTime":1485.28,"endTime":1487.62,"body":"where this other case that I was"},{"speaker":"Chris Dy","startTime":1485.28,"endTime":1487.62,"body":"about to mention comes in"},{"speaker":"Chris Dy","startTime":1487.8,"endTime":1489.12,"body":"barges. We are"},{"speaker":"Charles Goldfarb","startTime":1489.12,"endTime":1492.18,"body":"on the barge."},{"speaker":"Charles Goldfarb","startTime":1489.12,"endTime":1492.18,"body":"Oh, I've had a lot of barge"},{"speaker":"Charles Goldfarb","startTime":1492.18,"endTime":1493.08,"body":"injuries. Yeah,"},{"speaker":"Chris Dy","startTime":1493.14,"endTime":1496.38,"body":"yeah, railroad."},{"speaker":"Chris Dy","startTime":1493.14,"endTime":1496.38,"body":"There's one of our Plexus"},{"speaker":"Chris Dy","startTime":1496.38,"endTime":1499.68,"body":"patients came off of a had a"},{"speaker":"Chris Dy","startTime":1496.38,"endTime":1499.68,"body":"railroad accident, a real bad"},{"speaker":"Chris Dy","startTime":1499.68,"endTime":1504.8,"body":"one. And then, yeah, the auger I"},{"speaker":"Chris Dy","startTime":1499.68,"endTime":1504.8,"body":"mentioned, that's a farming"},{"speaker":"Chris Dy","startTime":1505.22,"endTime":1510.92,"body":"instrument or a farming machine."},{"speaker":"Chris Dy","startTime":1505.22,"endTime":1510.92,"body":"I believe it's used for corn I'm"},{"speaker":"Chris Dy","startTime":1510.92,"endTime":1512.12,"body":"gonna get."},{"speaker":"Charles Goldfarb","startTime":1513.14,"endTime":1516.14,"body":"And then one"},{"speaker":"Charles Goldfarb","startTime":1513.14,"endTime":1516.14,"body":"of the ones, which I did grow up"},{"speaker":"Charles Goldfarb","startTime":1516.14,"endTime":1520.46,"body":"in Alabama, not terribly rural,"},{"speaker":"Charles Goldfarb","startTime":1516.14,"endTime":1520.46,"body":"but I didn't have exposure to"},{"speaker":"Charles Goldfarb","startTime":1520.46,"endTime":1523.72,"body":"wood splitters. Wood splitters"},{"speaker":"Charles Goldfarb","startTime":1520.46,"endTime":1523.72,"body":"are one of the worst mechanisms"},{"speaker":"Charles Goldfarb","startTime":1523.72,"endTime":1526.06,"body":"of injury, and for those of you"},{"speaker":"Charles Goldfarb","startTime":1523.72,"endTime":1526.06,"body":"hadn't seen it, it's worth a"},{"speaker":"Charles Goldfarb","startTime":1526.06,"endTime":1529.18,"body":"Google or YouTube. And"},{"speaker":"Charles Goldfarb","startTime":1526.06,"endTime":1529.18,"body":"essentially, you put the wood in"},{"speaker":"Charles Goldfarb","startTime":1529.18,"endTime":1533.26,"body":"this machine that sucks it in"},{"speaker":"Charles Goldfarb","startTime":1529.18,"endTime":1533.26,"body":"and splits it with a very sharp"},{"speaker":"Charles Goldfarb","startTime":1533.26,"endTime":1536.44,"body":"device, and hands and wood"},{"speaker":"Charles Goldfarb","startTime":1533.26,"endTime":1536.44,"body":"splitters do not go well"},{"speaker":"Charles Goldfarb","startTime":1536.44,"endTime":1536.92,"body":"together."},{"speaker":"Chris Dy","startTime":1537.16,"endTime":1540.04,"body":"Yeah, and then I'm"},{"speaker":"Chris Dy","startTime":1537.16,"endTime":1540.04,"body":"just a classic. Oh, it's nice"},{"speaker":"Chris Dy","startTime":1540.04,"endTime":1542.28,"body":"spring or fall weather. I'm"},{"speaker":"Chris Dy","startTime":1540.04,"endTime":1542.28,"body":"going to get to the wood shop."},{"speaker":"Chris Dy","startTime":1542.28,"endTime":1545.22,"body":"So there's a circular saw the"},{"speaker":"Chris Dy","startTime":1542.28,"endTime":1545.22,"body":"table saw the standard kind of"},{"speaker":"Chris Dy","startTime":1545.22,"endTime":1549.06,"body":"stuff with that. So yes, that's"},{"speaker":"Chris Dy","startTime":1545.22,"endTime":1549.06,"body":"the mechanisms of injury that at"},{"speaker":"Chris Dy","startTime":1549.06,"endTime":1553.56,"body":"least we see here in the good"},{"speaker":"Chris Dy","startTime":1549.06,"endTime":1553.56,"body":"old son, Louis. So anyway, this"},{"speaker":"Chris Dy","startTime":1553.56,"endTime":1558.3,"body":"patient, when I was a when I was"},{"speaker":"Chris Dy","startTime":1553.56,"endTime":1558.3,"body":"a fellow, she had a very bad"},{"speaker":"Chris Dy","startTime":1558.66,"endTime":1564.02,"body":"radio carpal fracture"},{"speaker":"Chris Dy","startTime":1558.66,"endTime":1564.02,"body":"dislocation. So the fracture"},{"speaker":"Chris Dy","startTime":1564.02,"endTime":1567.86,"body":"action was largely on the distal"},{"speaker":"Chris Dy","startTime":1564.02,"endTime":1567.86,"body":"radius. So the carpus itself was"},{"speaker":"Chris Dy","startTime":1567.86,"endTime":1571.52,"body":"not fractured, but the carpus"},{"speaker":"Chris Dy","startTime":1567.86,"endTime":1571.52,"body":"was completely dislocated. Fell"},{"speaker":"Chris Dy","startTime":1571.52,"endTime":1575.48,"body":"off on the radial side, so and"},{"speaker":"Chris Dy","startTime":1571.52,"endTime":1575.48,"body":"then was completely dislocated"},{"speaker":"Chris Dy","startTime":1575.48,"endTime":1582.04,"body":"dorsally as well. And so she was"},{"speaker":"Chris Dy","startTime":1575.48,"endTime":1582.04,"body":"horseback riding, was having"},{"speaker":"Chris Dy","startTime":1582.04,"endTime":1586.72,"body":"media, nerve paresthesias. So"},{"speaker":"Chris Dy","startTime":1582.04,"endTime":1586.72,"body":"this was a case where, you know,"},{"speaker":"Chris Dy","startTime":1586.78,"endTime":1589.66,"body":"what do you think about trying"},{"speaker":"Chris Dy","startTime":1586.78,"endTime":1589.66,"body":"close reduction in the emergency"},{"speaker":"Chris Dy","startTime":1589.66,"endTime":1593.86,"body":"room? Is there a role for that?"},{"speaker":"Chris Dy","startTime":1589.66,"endTime":1593.86,"body":"And what's your sense of timing"},{"speaker":"Chris Dy","startTime":1593.86,"endTime":1596.26,"body":"on this? Is this, if you get a"},{"speaker":"Chris Dy","startTime":1593.86,"endTime":1596.26,"body":"good close reduction, you send"},{"speaker":"Chris Dy","startTime":1596.26,"endTime":1599.5,"body":"her out, or is this something"},{"speaker":"Chris Dy","startTime":1596.26,"endTime":1599.5,"body":"that you probably should go more"},{"speaker":"Chris Dy","startTime":1599.5,"endTime":1600.78,"body":"urgently? Yeah,"},{"speaker":"Charles Goldfarb","startTime":1600.78,"endTime":1602.76,"body":"great, great"},{"speaker":"Charles Goldfarb","startTime":1600.78,"endTime":1602.76,"body":"points. I would say a couple"},{"speaker":"Charles Goldfarb","startTime":1602.76,"endTime":1607.92,"body":"things. First, typically, hey, I"},{"speaker":"Charles Goldfarb","startTime":1602.76,"endTime":1607.92,"body":"can say this, they're open"},{"speaker":"Charles Goldfarb","startTime":1607.92,"endTime":1611.94,"body":"injuries. And if it's that big"},{"speaker":"Charles Goldfarb","startTime":1607.92,"endTime":1611.94,"body":"of a trauma and that big of a"},{"speaker":"Charles Goldfarb","startTime":1612.0,"endTime":1616.08,"body":"radiocarbon or severe enough"},{"speaker":"Charles Goldfarb","startTime":1612.0,"endTime":1616.08,"body":"disc radius fracture"},{"speaker":"Charles Goldfarb","startTime":1616.32,"endTime":1619.98,"body":"dislocation, they're often open"},{"speaker":"Charles Goldfarb","startTime":1616.32,"endTime":1619.98,"body":"injuries. And so that does"},{"speaker":"Charles Goldfarb","startTime":1619.98,"endTime":1622.64,"body":"affect your timing a little bit."},{"speaker":"Charles Goldfarb","startTime":1619.98,"endTime":1622.64,"body":"I will say we had this"},{"speaker":"Charles Goldfarb","startTime":1622.64,"endTime":1626.78,"body":"discussion yesterday. Not every"},{"speaker":"Charles Goldfarb","startTime":1622.64,"endTime":1626.78,"body":"open distur radius fracture"},{"speaker":"Charles Goldfarb","startTime":1626.84,"endTime":1629.72,"body":"needs to go to the operating"},{"speaker":"Charles Goldfarb","startTime":1626.84,"endTime":1629.72,"body":"room, you know, but the bigger"},{"speaker":"Charles Goldfarb","startTime":1629.72,"endTime":1633.2,"body":"ones with more trauma, a"},{"speaker":"Charles Goldfarb","startTime":1629.72,"endTime":1633.2,"body":"probably need to go to operating"},{"speaker":"Charles Goldfarb","startTime":1633.2,"endTime":1637.4,"body":"room and B, a closed reduction"},{"speaker":"Charles Goldfarb","startTime":1633.2,"endTime":1637.4,"body":"is almost always a good idea."},{"speaker":"Charles Goldfarb","startTime":1637.46,"endTime":1639.92,"body":"You don't want to slow down"},{"speaker":"Charles Goldfarb","startTime":1637.46,"endTime":1639.92,"body":"things that the operating room"},{"speaker":"Charles Goldfarb","startTime":1639.92,"endTime":1643.24,"body":"happens to be open, and you can"},{"speaker":"Charles Goldfarb","startTime":1639.92,"endTime":1643.24,"body":"get there, but you'd like to get"},{"speaker":"Charles Goldfarb","startTime":1643.24,"endTime":1647.14,"body":"things at least better aligned,"},{"speaker":"Charles Goldfarb","startTime":1643.24,"endTime":1647.14,"body":"to take some soft tissue tension"},{"speaker":"Charles Goldfarb","startTime":1647.14,"endTime":1650.86,"body":"away, decrease the immediate"},{"speaker":"Charles Goldfarb","startTime":1647.14,"endTime":1650.86,"body":"swelling that might happen, take"},{"speaker":"Charles Goldfarb","startTime":1650.86,"endTime":1654.22,"body":"pressure off the median nerve."},{"speaker":"Charles Goldfarb","startTime":1650.86,"endTime":1654.22,"body":"All of those are, in my mind,"},{"speaker":"Charles Goldfarb","startTime":1654.22,"endTime":1656.32,"body":"good reasons to likely do a"},{"speaker":"Charles Goldfarb","startTime":1654.22,"endTime":1656.32,"body":"closed"},{"speaker":"Chris Dy","startTime":1656.32,"endTime":1658.18,"body":"reduction. Yeah, and"},{"speaker":"Chris Dy","startTime":1656.32,"endTime":1658.18,"body":"for pain, I mean, you know,"},{"speaker":"Chris Dy","startTime":1658.18,"endTime":1661.56,"body":"honestly, like with your with"},{"speaker":"Chris Dy","startTime":1658.18,"endTime":1661.56,"body":"your hands sitting sideways. You"},{"speaker":"Chris Dy","startTime":1661.56,"endTime":1665.04,"body":"know that, you know, that hurts."},{"speaker":"Chris Dy","startTime":1661.56,"endTime":1665.04,"body":"So, you know, when I've seen"},{"speaker":"Chris Dy","startTime":1665.04,"endTime":1669.06,"body":"this, it's been kind of, you"},{"speaker":"Chris Dy","startTime":1665.04,"endTime":1669.06,"body":"know, a type one, sometimes for"},{"speaker":"Chris Dy","startTime":1669.06,"endTime":1671.52,"body":"the ulna from that pressure on"},{"speaker":"Chris Dy","startTime":1669.06,"endTime":1671.52,"body":"the ulnar side of the skin, with"},{"speaker":"Chris Dy","startTime":1671.52,"endTime":1674.76,"body":"everything falling radially, and"},{"speaker":"Chris Dy","startTime":1671.52,"endTime":1674.76,"body":"other times for the radius"},{"speaker":"Chris Dy","startTime":1674.76,"endTime":1678.66,"body":"itself, sometimes accompanied by"},{"speaker":"Chris Dy","startTime":1674.76,"endTime":1678.66,"body":"a styloid fracture. And we"},{"speaker":"Chris Dy","startTime":1678.66,"endTime":1681.68,"body":"should probably differentiate,"},{"speaker":"Chris Dy","startTime":1678.66,"endTime":1681.68,"body":"you know, and be careful, you"},{"speaker":"Chris Dy","startTime":1681.68,"endTime":1684.56,"body":"know. So there are distal radius"},{"speaker":"Chris Dy","startTime":1681.68,"endTime":1684.56,"body":"fractures with intra articular"},{"speaker":"Chris Dy","startTime":1684.56,"endTime":1687.26,"body":"extension, in which you will"},{"speaker":"Chris Dy","startTime":1684.56,"endTime":1687.26,"body":"have kind of a very violent"},{"speaker":"Chris Dy","startTime":1687.26,"endTime":1691.1,"body":"injury that will displace the"},{"speaker":"Chris Dy","startTime":1687.26,"endTime":1691.1,"body":"carpus and the distal fragment"},{"speaker":"Chris Dy","startTime":1691.4,"endTime":1694.88,"body":"in a radial direction. Then"},{"speaker":"Chris Dy","startTime":1691.4,"endTime":1694.88,"body":"there's like a true radiocarpal"},{"speaker":"Chris Dy","startTime":1694.88,"endTime":1697.58,"body":"dislocation, which is slightly"},{"speaker":"Chris Dy","startTime":1694.88,"endTime":1697.58,"body":"different beast. But if I guess,"},{"speaker":"Chris Dy","startTime":1697.58,"endTime":1700.84,"body":"for this, I'm talking more about"},{"speaker":"Chris Dy","startTime":1697.58,"endTime":1700.84,"body":"a bad distal radius fracture in"},{"speaker":"Chris Dy","startTime":1700.84,"endTime":1702.88,"body":"which the carpus goes with the"},{"speaker":"Chris Dy","startTime":1700.84,"endTime":1702.88,"body":"distal fragment."},{"speaker":"Charles Goldfarb","startTime":1703.18,"endTime":1705.1,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1703.18,"endTime":1705.1,"body":"that's a really important point."},{"speaker":"Charles Goldfarb","startTime":1705.4,"endTime":1709.9,"body":"Radial carpal dislocations are"},{"speaker":"Charles Goldfarb","startTime":1705.4,"endTime":1709.9,"body":"rare. They definitely happen,"},{"speaker":"Charles Goldfarb","startTime":1709.9,"endTime":1715.84,"body":"but they're rare. More likely is"},{"speaker":"Charles Goldfarb","startTime":1709.9,"endTime":1715.84,"body":"a severe distal radius fracture"},{"speaker":"Charles Goldfarb","startTime":1716.02,"endTime":1718.6,"body":"where you sort of have the"},{"speaker":"Charles Goldfarb","startTime":1716.02,"endTime":1718.6,"body":"articular surface going with the"},{"speaker":"Charles Goldfarb","startTime":1718.6,"endTime":1724.8,"body":"carpus, which is 100% displaced"},{"speaker":"Charles Goldfarb","startTime":1718.6,"endTime":1724.8,"body":"and almost by definition, you"},{"speaker":"Charles Goldfarb","startTime":1724.8,"endTime":1728.04,"body":"have a TFCC tear. Now, that"},{"speaker":"Charles Goldfarb","startTime":1724.8,"endTime":1728.04,"body":"could be a soft tissue only TFCC"},{"speaker":"Charles Goldfarb","startTime":1728.04,"endTime":1731.34,"body":"tear, or that could be a ulna"},{"speaker":"Charles Goldfarb","startTime":1728.04,"endTime":1731.34,"body":"styloid that's large and, you"},{"speaker":"Charles Goldfarb","startTime":1731.34,"endTime":1734.16,"body":"know, but, but I think that is"},{"speaker":"Charles Goldfarb","startTime":1731.34,"endTime":1734.16,"body":"what we're talking about. Thanks"},{"speaker":"Charles Goldfarb","startTime":1734.16,"endTime":1736.98,"body":"for clarifying, and that's what"},{"speaker":"Charles Goldfarb","startTime":1734.16,"endTime":1736.98,"body":"we're sort of going to problem"},{"speaker":"Charles Goldfarb","startTime":1736.98,"endTime":1737.22,"body":"solve."},{"speaker":"Chris Dy","startTime":1737.88,"endTime":1739.98,"body":"Yeah, so, I mean, so"},{"speaker":"Chris Dy","startTime":1737.88,"endTime":1739.98,"body":"we've done a closed reduction."},{"speaker":"Chris Dy","startTime":1739.98,"endTime":1743.12,"body":"It's reasonable. Do you get a CT"},{"speaker":"Chris Dy","startTime":1739.98,"endTime":1743.12,"body":"scan? I've had people ask this,"},{"speaker":"Chris Dy","startTime":1743.12,"endTime":1745.64,"body":"and I don't feel strongly about"},{"speaker":"Chris Dy","startTime":1743.12,"endTime":1745.64,"body":"it, because, honestly, it's not"},{"speaker":"Chris Dy","startTime":1745.64,"endTime":1748.16,"body":"going to change a whole lot of"},{"speaker":"Chris Dy","startTime":1745.64,"endTime":1748.16,"body":"what we do, but sometimes it can"},{"speaker":"Chris Dy","startTime":1748.16,"endTime":1751.34,"body":"be helpful, if you're bold"},{"speaker":"Chris Dy","startTime":1748.16,"endTime":1751.34,"body":"enough to go for fracture"},{"speaker":"Chris Dy","startTime":1751.34,"endTime":1753.32,"body":"fixation right away."},{"speaker":"Charles Goldfarb","startTime":1753.86,"endTime":1757.16,"body":"Yeah, I'm"},{"speaker":"Charles Goldfarb","startTime":1753.86,"endTime":1757.16,"body":"never against it. I think for"},{"speaker":"Charles Goldfarb","startTime":1757.16,"endTime":1760.9,"body":"fellows entering practice is"},{"speaker":"Charles Goldfarb","startTime":1757.16,"endTime":1760.9,"body":"probably not a bad idea. If"},{"speaker":"Charles Goldfarb","startTime":1760.9,"endTime":1766.0,"body":"you're not 100% comfortable with"},{"speaker":"Charles Goldfarb","startTime":1760.9,"endTime":1766.0,"body":"the bony status, I usually don't"},{"speaker":"Charles Goldfarb","startTime":1766.0,"endTime":1767.62,"body":"get a CT scan this situation."},{"speaker":"Chris Dy","startTime":1768.52,"endTime":1771.7,"body":"So timing wise, if the"},{"speaker":"Chris Dy","startTime":1768.52,"endTime":1771.7,"body":"patient's paresthesias are"},{"speaker":"Chris Dy","startTime":1772.12,"endTime":1776.2,"body":"stable or potentially resolving"},{"speaker":"Chris Dy","startTime":1772.12,"endTime":1776.2,"body":"with the after the close"},{"speaker":"Chris Dy","startTime":1776.2,"endTime":1779.14,"body":"reduction and they're feeling"},{"speaker":"Chris Dy","startTime":1776.2,"endTime":1779.14,"body":"better, What's your general and"},{"speaker":"Chris Dy","startTime":1779.14,"endTime":1781.36,"body":"there's no other poly trauma"},{"speaker":"Chris Dy","startTime":1779.14,"endTime":1781.36,"body":"kind of issues. This is an"},{"speaker":"Chris Dy","startTime":1781.36,"endTime":1784.32,"body":"isolated injury. So what are you"},{"speaker":"Chris Dy","startTime":1781.36,"endTime":1784.32,"body":"thinking in terms of timing?"},{"speaker":"Charles Goldfarb","startTime":1784.68,"endTime":1786.96,"body":"If it's a"},{"speaker":"Charles Goldfarb","startTime":1784.68,"endTime":1786.96,"body":"closed injury, and if you get"},{"speaker":"Charles Goldfarb","startTime":1786.96,"endTime":1790.5,"body":"reasonable alignment, I think"},{"speaker":"Charles Goldfarb","startTime":1786.96,"endTime":1790.5,"body":"you can do it semi electively,"},{"speaker":"Charles Goldfarb","startTime":1790.5,"endTime":1794.4,"body":"if it's an open injury and you"},{"speaker":"Charles Goldfarb","startTime":1790.5,"endTime":1794.4,"body":"don't have a great reduction, I"},{"speaker":"Charles Goldfarb","startTime":1794.4,"endTime":1797.34,"body":"guess I would say in the first"},{"speaker":"Charles Goldfarb","startTime":1794.4,"endTime":1797.34,"body":"24 hours, ideally, something"},{"speaker":"Charles Goldfarb","startTime":1797.34,"endTime":1799.92,"body":"like that, maybe even a little"},{"speaker":"Charles Goldfarb","startTime":1797.34,"endTime":1799.92,"body":"faster, depending on the size."},{"speaker":"Charles Goldfarb","startTime":1800.0,"endTime":1802.7,"body":"Of the open injury. How do you"},{"speaker":"Charles Goldfarb","startTime":1800.0,"endTime":1802.7,"body":"think about it? I agree."},{"speaker":"Chris Dy","startTime":1802.7,"endTime":1804.8,"body":"I mean, I think if the"},{"speaker":"Chris Dy","startTime":1802.7,"endTime":1804.8,"body":"median nerve paresthesia have"},{"speaker":"Chris Dy","startTime":1804.8,"endTime":1809.96,"body":"not gotten better, that changes"},{"speaker":"Chris Dy","startTime":1804.8,"endTime":1809.96,"body":"my my threshold in terms of"},{"speaker":"Chris Dy","startTime":1809.96,"endTime":1813.86,"body":"timing, I would probably move it"},{"speaker":"Chris Dy","startTime":1809.96,"endTime":1813.86,"body":"more urgently. You know, I think"},{"speaker":"Chris Dy","startTime":1813.86,"endTime":1816.8,"body":"that if you don't have a great"},{"speaker":"Chris Dy","startTime":1813.86,"endTime":1816.8,"body":"reduction, that soft tissue"},{"speaker":"Chris Dy","startTime":1816.8,"endTime":1819.26,"body":"swelling is not going to get any"},{"speaker":"Chris Dy","startTime":1816.8,"endTime":1819.26,"body":"better, and you might as well"},{"speaker":"Chris Dy","startTime":1819.26,"endTime":1819.74,"body":"just, just"},{"speaker":"Charles Goldfarb","startTime":1819.98,"endTime":1823.18,"body":"go one of you"},{"speaker":"Charles Goldfarb","startTime":1819.98,"endTime":1823.18,"body":"know, doing a carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":1823.18,"endTime":1828.64,"body":"release is typically advisable"},{"speaker":"Charles Goldfarb","startTime":1823.18,"endTime":1828.64,"body":"in these situations, even though"},{"speaker":"Charles Goldfarb","startTime":1828.64,"endTime":1833.68,"body":"it might be a bruised median"},{"speaker":"Charles Goldfarb","startTime":1828.64,"endTime":1833.68,"body":"nerve and not truly a hematoma"},{"speaker":"Charles Goldfarb","startTime":1833.68,"endTime":1837.4,"body":"in the carpal tunnel. But what"},{"speaker":"Charles Goldfarb","startTime":1833.68,"endTime":1837.4,"body":"you don't want to have happen is"},{"speaker":"Charles Goldfarb","startTime":1837.4,"endTime":1840.16,"body":"you do a great surgery, you"},{"speaker":"Charles Goldfarb","startTime":1837.4,"endTime":1840.16,"body":"crack, you have great bony"},{"speaker":"Charles Goldfarb","startTime":1840.16,"endTime":1843.72,"body":"alignment, and you the patient"},{"speaker":"Charles Goldfarb","startTime":1840.16,"endTime":1843.72,"body":"wakes up without a carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":1843.72,"endTime":1845.94,"body":"release, and they still have"},{"speaker":"Charles Goldfarb","startTime":1843.72,"endTime":1845.94,"body":"tingling in your fingers, and"},{"speaker":"Charles Goldfarb","startTime":1846.0,"endTime":1849.96,"body":"then you're going to worry about"},{"speaker":"Charles Goldfarb","startTime":1846.0,"endTime":1849.96,"body":"it. And maybe, you know, if"},{"speaker":"Charles Goldfarb","startTime":1849.96,"endTime":1853.2,"body":"there truly was hematoma in the"},{"speaker":"Charles Goldfarb","startTime":1849.96,"endTime":1853.2,"body":"carpal tunnel, you've done the"},{"speaker":"Charles Goldfarb","startTime":1853.2,"endTime":1856.02,"body":"patient a disservice. So I sort"},{"speaker":"Charles Goldfarb","startTime":1853.2,"endTime":1856.02,"body":"of make it a habit to do a"},{"speaker":"Charles Goldfarb","startTime":1856.02,"endTime":1858.66,"body":"carpal tunnel release as part of"},{"speaker":"Charles Goldfarb","startTime":1856.02,"endTime":1858.66,"body":"the procedure. I'm sure you do"},{"speaker":"Charles Goldfarb","startTime":1858.66,"endTime":1859.08,"body":"as well."},{"speaker":"Chris Dy","startTime":1859.32,"endTime":1861.5,"body":"I think so too. I"},{"speaker":"Chris Dy","startTime":1859.32,"endTime":1861.5,"body":"mean, I think that just as hand"},{"speaker":"Chris Dy","startTime":1861.5,"endTime":1863.84,"body":"surgeons were more likely to"},{"speaker":"Chris Dy","startTime":1861.5,"endTime":1863.84,"body":"offer that procedure, you know,"},{"speaker":"Chris Dy","startTime":1863.84,"endTime":1866.78,"body":"so I know that a lot of in a lot"},{"speaker":"Chris Dy","startTime":1863.84,"endTime":1866.78,"body":"of places, general orthopods and"},{"speaker":"Chris Dy","startTime":1866.78,"endTime":1869.48,"body":"trauma surgeons will be doing"},{"speaker":"Chris Dy","startTime":1866.78,"endTime":1869.48,"body":"this, and they're probably just"},{"speaker":"Chris Dy","startTime":1869.48,"endTime":1872.36,"body":"because they're lower comfort"},{"speaker":"Chris Dy","startTime":1869.48,"endTime":1872.36,"body":"level with doing a carpal tunnel"},{"speaker":"Chris Dy","startTime":1872.36,"endTime":1874.76,"body":"release, they are less likely to"},{"speaker":"Chris Dy","startTime":1872.36,"endTime":1874.76,"body":"do it. And I think that's been"},{"speaker":"Chris Dy","startTime":1874.76,"endTime":1878.78,"body":"borne out in the literature. But"},{"speaker":"Chris Dy","startTime":1874.76,"endTime":1878.78,"body":"I think you've you never really"},{"speaker":"Chris Dy","startTime":1878.84,"endTime":1882.64,"body":"regret doing it. And I think"},{"speaker":"Chris Dy","startTime":1878.84,"endTime":1882.64,"body":"this is different than kind of"},{"speaker":"Chris Dy","startTime":1882.64,"endTime":1886.42,"body":"the standard, you know, carpal"},{"speaker":"Chris Dy","startTime":1882.64,"endTime":1886.42,"body":"tunnel syndrome patient, you"},{"speaker":"Chris Dy","startTime":1886.42,"endTime":1891.22,"body":"know, the points of compression,"},{"speaker":"Chris Dy","startTime":1886.42,"endTime":1891.22,"body":"I think are different the it's"},{"speaker":"Chris Dy","startTime":1891.22,"endTime":1895.3,"body":"the volar anti brachial fascia"},{"speaker":"Chris Dy","startTime":1891.22,"endTime":1895.3,"body":"that is right underneath the"},{"speaker":"Chris Dy","startTime":1895.36,"endTime":1898.96,"body":"skin of the wrist crease,"},{"speaker":"Chris Dy","startTime":1895.36,"endTime":1898.96,"body":"vulnerably, that is super tight"},{"speaker":"Chris Dy","startTime":1898.96,"endTime":1902.94,"body":"in these patients. So while I"},{"speaker":"Chris Dy","startTime":1898.96,"endTime":1902.94,"body":"don't connect the incisions, if"},{"speaker":"Chris Dy","startTime":1902.94,"endTime":1906.3,"body":"I have a vulner approach, I will"},{"speaker":"Chris Dy","startTime":1902.94,"endTime":1906.3,"body":"do kind of a separate carpal"},{"speaker":"Chris Dy","startTime":1906.3,"endTime":1910.14,"body":"tunnel incision. I do make sure"},{"speaker":"Chris Dy","startTime":1906.3,"endTime":1910.14,"body":"that I can see that I fully"},{"speaker":"Chris Dy","startTime":1910.14,"endTime":1913.32,"body":"released the vulnerabicial"},{"speaker":"Chris Dy","startTime":1910.14,"endTime":1913.32,"body":"fascia, the proximal aspect of"},{"speaker":"Chris Dy","startTime":1913.32,"endTime":1916.02,"body":"the transverse carpal ligament."},{"speaker":"Chris Dy","startTime":1913.32,"endTime":1916.02,"body":"However you want to think about"},{"speaker":"Chris Dy","startTime":1916.02,"endTime":1919.02,"body":"it directly. And I look and I"},{"speaker":"Chris Dy","startTime":1916.02,"endTime":1919.02,"body":"make sure I pass my tenotomies"},{"speaker":"Chris Dy","startTime":1919.02,"endTime":1922.16,"body":"of another instrument"},{"speaker":"Chris Dy","startTime":1919.02,"endTime":1922.16,"body":"underneath, from the palm"},{"speaker":"Chris Dy","startTime":1922.16,"endTime":1925.16,"body":"incision into the wrist or a"},{"speaker":"Chris Dy","startTime":1922.16,"endTime":1925.16,"body":"forearm incision to make sure,"},{"speaker":"Chris Dy","startTime":1925.16,"endTime":1927.26,"body":"because I've been burned by"},{"speaker":"Chris Dy","startTime":1925.16,"endTime":1927.26,"body":"that, and I think that's the"},{"speaker":"Chris Dy","startTime":1927.26,"endTime":1930.32,"body":"compressive point. And then you"},{"speaker":"Chris Dy","startTime":1927.26,"endTime":1930.32,"body":"can access whatever hematoma is"},{"speaker":"Chris Dy","startTime":1930.32,"endTime":1932.42,"body":"there, although I agree hematoma"},{"speaker":"Chris Dy","startTime":1930.32,"endTime":1932.42,"body":"is relatively rare,"},{"speaker":"Charles Goldfarb","startTime":1933.2,"endTime":1934.82,"body":"yeah. And"},{"speaker":"Charles Goldfarb","startTime":1933.2,"endTime":1934.82,"body":"these are ones where you need to"},{"speaker":"Charles Goldfarb","startTime":1934.82,"endTime":1938.66,"body":"be a little careful and avoid"},{"speaker":"Charles Goldfarb","startTime":1934.82,"endTime":1938.66,"body":"the temptation to ever slide,"},{"speaker":"Charles Goldfarb","startTime":1938.72,"endTime":1943.18,"body":"because the anatomy can be so"},{"speaker":"Charles Goldfarb","startTime":1938.72,"endTime":1943.18,"body":"skewed that you may you know"},{"speaker":"Charles Goldfarb","startTime":1943.18,"endTime":1948.82,"body":"it's just a little riskier, but"},{"speaker":"Charles Goldfarb","startTime":1943.18,"endTime":1948.82,"body":"all good points. So, so you've"},{"speaker":"Charles Goldfarb","startTime":1948.82,"endTime":1951.34,"body":"gotten a reasonable reduction."},{"speaker":"Charles Goldfarb","startTime":1948.82,"endTime":1951.34,"body":"Let's say you get the operating"},{"speaker":"Charles Goldfarb","startTime":1951.34,"endTime":1955.9,"body":"room eight hours later, you do"},{"speaker":"Charles Goldfarb","startTime":1951.34,"endTime":1955.9,"body":"your carpal tunnel release, and"},{"speaker":"Charles Goldfarb","startTime":1955.9,"endTime":1959.74,"body":"you're looking at a very"},{"speaker":"Charles Goldfarb","startTime":1955.9,"endTime":1959.74,"body":"unstable, just a radius"},{"speaker":"Charles Goldfarb","startTime":1959.74,"endTime":1964.68,"body":"fracture. You're looking at a"},{"speaker":"Charles Goldfarb","startTime":1959.74,"endTime":1964.68,"body":"unstable Dr, J, what's your"},{"speaker":"Charles Goldfarb","startTime":1964.68,"endTime":1967.14,"body":"first thought? How do you how do"},{"speaker":"Charles Goldfarb","startTime":1964.68,"endTime":1967.14,"body":"you think about it? Well, I"},{"speaker":"Chris Dy","startTime":1967.14,"endTime":1969.84,"body":"mean, so I would"},{"speaker":"Chris Dy","startTime":1967.14,"endTime":1969.84,"body":"always, for me, I'd call for my"},{"speaker":"Chris Dy","startTime":1969.84,"endTime":1973.44,"body":"standard disadraus fracture set"},{"speaker":"Chris Dy","startTime":1969.84,"endTime":1973.44,"body":"of choice. I'd also call for a"},{"speaker":"Chris Dy","startTime":1973.44,"endTime":1976.32,"body":"mini frag set in case I needed"},{"speaker":"Chris Dy","startTime":1973.44,"endTime":1976.32,"body":"to do a little bit of fragment"},{"speaker":"Chris Dy","startTime":1976.32,"endTime":1978.66,"body":"specific stuff on the fly."},{"speaker":"Chris Dy","startTime":1976.32,"endTime":1978.66,"body":"That's just my choice. I mean,"},{"speaker":"Chris Dy","startTime":1978.66,"endTime":1981.74,"body":"if your disadra set has all"},{"speaker":"Chris Dy","startTime":1978.66,"endTime":1981.74,"body":"fragment specific stuff that you"},{"speaker":"Chris Dy","startTime":1982.52,"endTime":1985.52,"body":"like. And then I would also make"},{"speaker":"Chris Dy","startTime":1982.52,"endTime":1985.52,"body":"sure to call for your spanning"},{"speaker":"Chris Dy","startTime":1985.52,"endTime":1988.34,"body":"plate of choice, because I think"},{"speaker":"Chris Dy","startTime":1985.52,"endTime":1988.34,"body":"that this is one where I have a"},{"speaker":"Chris Dy","startTime":1988.34,"endTime":1990.92,"body":"very low threshold for a"},{"speaker":"Chris Dy","startTime":1988.34,"endTime":1990.92,"body":"spanning plate. Now listen,"},{"speaker":"Chris Dy","startTime":1990.92,"endTime":1994.28,"body":"spanning plates are not a"},{"speaker":"Chris Dy","startTime":1990.92,"endTime":1994.28,"body":"panacea. I think that there was"},{"speaker":"Chris Dy","startTime":1994.28,"endTime":1999.74,"body":"a period of time in the kind of"},{"speaker":"Chris Dy","startTime":1994.28,"endTime":1999.74,"body":"late 2010s where everybody was"},{"speaker":"Chris Dy","startTime":1999.74,"endTime":2002.16,"body":"doing spanning plates because of"},{"speaker":"Chris Dy","startTime":1999.74,"endTime":2002.16,"body":"the literature that was"},{"speaker":"Chris Dy","startTime":2002.16,"endTime":2004.98,"body":"supporting their use. I think"},{"speaker":"Chris Dy","startTime":2002.16,"endTime":2004.98,"body":"things have settled back. I"},{"speaker":"Chris Dy","startTime":2004.98,"endTime":2007.14,"body":"mean, I don't love taking"},{"speaker":"Chris Dy","startTime":2004.98,"endTime":2007.14,"body":"somebody back for that second"},{"speaker":"Chris Dy","startTime":2007.14,"endTime":2010.8,"body":"surgery, but I do think there's"},{"speaker":"Chris Dy","startTime":2007.14,"endTime":2010.8,"body":"a utility, particularly not in"},{"speaker":"Chris Dy","startTime":2010.8,"endTime":2013.68,"body":"this case. You know, this isn't"},{"speaker":"Chris Dy","startTime":2010.8,"endTime":2013.68,"body":"a polytrauma case, but if it's a"},{"speaker":"Chris Dy","startTime":2013.68,"endTime":2015.84,"body":"polytrauma case, and you know"},{"speaker":"Chris Dy","startTime":2013.68,"endTime":2015.84,"body":"they're probably going to be"},{"speaker":"Chris Dy","startTime":2015.84,"endTime":2017.88,"body":"needing you need to do some"},{"speaker":"Chris Dy","startTime":2015.84,"endTime":2017.88,"body":"element of weight bearing"},{"speaker":"Chris Dy","startTime":2018.18,"endTime":2020.84,"body":"through that upper extremity. If"},{"speaker":"Chris Dy","startTime":2018.18,"endTime":2020.84,"body":"they've got a lower extremity"},{"speaker":"Chris Dy","startTime":2020.84,"endTime":2023.18,"body":"injury too. That is very"},{"speaker":"Chris Dy","startTime":2020.84,"endTime":2023.18,"body":"helpful, and that's where it"},{"speaker":"Chris Dy","startTime":2023.18,"endTime":2025.46,"body":"came out of, really an"},{"speaker":"Chris Dy","startTime":2023.18,"endTime":2025.46,"body":"experience in Seattle that Doug"},{"speaker":"Chris Dy","startTime":2025.46,"endTime":2028.1,"body":"Handel published, and I know the"},{"speaker":"Chris Dy","startTime":2025.46,"endTime":2028.1,"body":"Duke Group published about it as"},{"speaker":"Chris Dy","startTime":2028.1,"endTime":2031.28,"body":"well. But, I mean, that's the"},{"speaker":"Chris Dy","startTime":2028.1,"endTime":2031.28,"body":"best use of it, but I think it's"},{"speaker":"Chris Dy","startTime":2031.28,"endTime":2034.76,"body":"been used more and more for"},{"speaker":"Chris Dy","startTime":2031.28,"endTime":2034.76,"body":"isolated risk trauma. And I"},{"speaker":"Chris Dy","startTime":2034.76,"endTime":2037.04,"body":"don't love using it all the"},{"speaker":"Chris Dy","startTime":2034.76,"endTime":2037.04,"body":"time, but I like having it"},{"speaker":"Chris Dy","startTime":2037.04,"endTime":2037.64,"body":"available. Yeah,"},{"speaker":"Charles Goldfarb","startTime":2037.64,"endTime":2039.44,"body":"it was"},{"speaker":"Charles Goldfarb","startTime":2037.64,"endTime":2039.44,"body":"interesting. I wasn't sure if"},{"speaker":"Charles Goldfarb","startTime":2039.44,"endTime":2044.62,"body":"you'd bring up this this point,"},{"speaker":"Charles Goldfarb","startTime":2039.44,"endTime":2044.62,"body":"you can overuse a spanning"},{"speaker":"Charles Goldfarb","startTime":2044.62,"endTime":2049.24,"body":"plate. And I personally believe,"},{"speaker":"Charles Goldfarb","startTime":2044.62,"endTime":2049.24,"body":"I've seen that when patients are"},{"speaker":"Charles Goldfarb","startTime":2049.24,"endTime":2051.94,"body":"treated in another city, or come"},{"speaker":"Charles Goldfarb","startTime":2049.24,"endTime":2051.94,"body":"here for another opinion,"},{"speaker":"Charles Goldfarb","startTime":2051.94,"endTime":2054.94,"body":"they've been treated with a"},{"speaker":"Charles Goldfarb","startTime":2051.94,"endTime":2054.94,"body":"spanning plate. I have sometimes"},{"speaker":"Charles Goldfarb","startTime":2054.94,"endTime":2058.3,"body":"wondered why a spanning plate"},{"speaker":"Charles Goldfarb","startTime":2054.94,"endTime":2058.3,"body":"was utilized. I think in some"},{"speaker":"Charles Goldfarb","startTime":2058.3,"endTime":2062.64,"body":"ways it can be simpler, I think"},{"speaker":"Charles Goldfarb","startTime":2058.3,"endTime":2062.64,"body":"to get and hold a reduction, but"},{"speaker":"Charles Goldfarb","startTime":2062.64,"endTime":2065.58,"body":"I don't know that it's a better"},{"speaker":"Charles Goldfarb","startTime":2062.64,"endTime":2065.58,"body":"treatment, and I'm not sure it's"},{"speaker":"Charles Goldfarb","startTime":2065.58,"endTime":2069.96,"body":"always the right treatment. But"},{"speaker":"Charles Goldfarb","startTime":2065.58,"endTime":2069.96,"body":"in a severe fracture, especially"},{"speaker":"Charles Goldfarb","startTime":2069.96,"endTime":2074.88,"body":"with a very small distal radius"},{"speaker":"Charles Goldfarb","startTime":2069.96,"endTime":2074.88,"body":"articular fragment, I think it's"},{"speaker":"Charles Goldfarb","startTime":2074.88,"endTime":2078.6,"body":"an unbelievable, unbelievably"},{"speaker":"Charles Goldfarb","startTime":2074.88,"endTime":2078.6,"body":"helpful option."},{"speaker":"Chris Dy","startTime":2079.38,"endTime":2081.26,"body":"Yeah, I mean my"},{"speaker":"Chris Dy","startTime":2079.38,"endTime":2081.26,"body":"Honestly, my default in the"},{"speaker":"Chris Dy","startTime":2081.26,"endTime":2084.44,"body":"absence, like a very complex"},{"speaker":"Chris Dy","startTime":2081.26,"endTime":2084.44,"body":"radius that doesn't have a"},{"speaker":"Chris Dy","startTime":2084.44,"endTime":2089.06,"body":"substantial, you know, carpal,"},{"speaker":"Chris Dy","startTime":2084.44,"endTime":2089.06,"body":"carpal sub dislocation type"},{"speaker":"Chris Dy","startTime":2089.06,"endTime":2092.42,"body":"component, I like to fix them."},{"speaker":"Chris Dy","startTime":2089.06,"endTime":2092.42,"body":"And, you know, just, you know,"},{"speaker":"Chris Dy","startTime":2092.42,"endTime":2095.12,"body":"it's not usually, it's usually"},{"speaker":"Chris Dy","startTime":2092.42,"endTime":2095.12,"body":"not just a volar plate. So to"},{"speaker":"Chris Dy","startTime":2095.12,"endTime":2098.24,"body":"say they can be more"},{"speaker":"Chris Dy","startTime":2095.12,"endTime":2098.24,"body":"challenging. But even sometimes"},{"speaker":"Chris Dy","startTime":2098.24,"endTime":2100.84,"body":"with a spanning plate, there are"},{"speaker":"Chris Dy","startTime":2098.24,"endTime":2100.84,"body":"components. Components that are"},{"speaker":"Chris Dy","startTime":2100.84,"endTime":2103.06,"body":"better addressed, I think, with"},{"speaker":"Chris Dy","startTime":2100.84,"endTime":2103.06,"body":"some additional fixation,"},{"speaker":"Chris Dy","startTime":2103.06,"endTime":2106.78,"body":"whether that's through K wires"},{"speaker":"Chris Dy","startTime":2103.06,"endTime":2106.78,"body":"or fragment specific fixation."},{"speaker":"Chris Dy","startTime":2107.68,"endTime":2112.0,"body":"Usually it's the vulnerate facet"},{"speaker":"Chris Dy","startTime":2107.68,"endTime":2112.0,"body":"or that dorsal ulnar corner that"},{"speaker":"Chris Dy","startTime":2112.0,"endTime":2115.18,"body":"can be really well dressed. And"},{"speaker":"Chris Dy","startTime":2112.0,"endTime":2115.18,"body":"sometimes you know that that"},{"speaker":"Chris Dy","startTime":2115.18,"endTime":2118.96,"body":"radial styloid type split can be"},{"speaker":"Chris Dy","startTime":2115.18,"endTime":2118.96,"body":"very nicely addressed through a"},{"speaker":"Chris Dy","startTime":2119.2,"endTime":2122.94,"body":"through a separate fixation. So"},{"speaker":"Chris Dy","startTime":2119.2,"endTime":2122.94,"body":"I like to see how things are"},{"speaker":"Chris Dy","startTime":2122.94,"endTime":2125.7,"body":"lying after the close reduction,"},{"speaker":"Chris Dy","startTime":2122.94,"endTime":2125.7,"body":"and then decide, you know what"},{"speaker":"Chris Dy","startTime":2125.7,"endTime":2128.82,"body":"to do. And if we're just, if"},{"speaker":"Chris Dy","startTime":2125.7,"endTime":2128.82,"body":"things keep falling off, or"},{"speaker":"Chris Dy","startTime":2128.82,"endTime":2131.34,"body":"things don't feel super solid,"},{"speaker":"Chris Dy","startTime":2128.82,"endTime":2131.34,"body":"then I go to the spanning plate."},{"speaker":"Chris Dy","startTime":2131.34,"endTime":2135.24,"body":"But if I can get, you know, for"},{"speaker":"Chris Dy","startTime":2131.34,"endTime":2135.24,"body":"example, by columnar, you know,"},{"speaker":"Chris Dy","startTime":2135.6,"endTime":2139.26,"body":"ideally orthogonal fixation, I"},{"speaker":"Chris Dy","startTime":2135.6,"endTime":2139.26,"body":"think that goes a long way."},{"speaker":"Charles Goldfarb","startTime":2139.98,"endTime":2142.28,"body":"Yeah, and I"},{"speaker":"Charles Goldfarb","startTime":2139.98,"endTime":2142.28,"body":"don't mind going both dorsal and"},{"speaker":"Charles Goldfarb","startTime":2142.28,"endTime":2146.48,"body":"bowler for a dorsal plate,"},{"speaker":"Charles Goldfarb","startTime":2142.28,"endTime":2146.48,"body":"bowler plate, if I think I can"},{"speaker":"Charles Goldfarb","startTime":2146.48,"endTime":2150.8,"body":"get definitive fixation at that"},{"speaker":"Charles Goldfarb","startTime":2146.48,"endTime":2150.8,"body":"first setting. I do think that"},{"speaker":"Charles Goldfarb","startTime":2150.8,"endTime":2154.82,"body":"is less commonly done with the"},{"speaker":"Charles Goldfarb","startTime":2150.8,"endTime":2154.82,"body":"option of the spanning plate. In"},{"speaker":"Charles Goldfarb","startTime":2154.82,"endTime":2157.34,"body":"other words, you get your"},{"speaker":"Charles Goldfarb","startTime":2154.82,"endTime":2157.34,"body":"general stability and alignment"},{"speaker":"Charles Goldfarb","startTime":2157.34,"endTime":2160.24,"body":"with your spanning plate, and"},{"speaker":"Charles Goldfarb","startTime":2157.34,"endTime":2160.24,"body":"then maybe do some more"},{"speaker":"Charles Goldfarb","startTime":2160.24,"endTime":2165.1,"body":"technical moves, either with a"},{"speaker":"Charles Goldfarb","startTime":2160.24,"endTime":2165.1,"body":"volar plate, a volar hook plate,"},{"speaker":"Charles Goldfarb","startTime":2165.52,"endTime":2169.24,"body":"or fragment specific plate, or"},{"speaker":"Charles Goldfarb","startTime":2165.52,"endTime":2169.24,"body":"even k wires. I'm a big fan of"},{"speaker":"Charles Goldfarb","startTime":2169.42,"endTime":2172.48,"body":"getting your major reduction"},{"speaker":"Charles Goldfarb","startTime":2169.42,"endTime":2172.48,"body":"holding with a spanning plate"},{"speaker":"Charles Goldfarb","startTime":2172.48,"endTime":2175.12,"body":"and then using K wires. Yeah,"},{"speaker":"Charles Goldfarb","startTime":2172.48,"endTime":2175.12,"body":"absolutely."},{"speaker":"Chris Dy","startTime":2175.12,"endTime":2177.16,"body":"I mean, you've already"},{"speaker":"Chris Dy","startTime":2175.12,"endTime":2177.16,"body":"paid the penalty for the dorsal"},{"speaker":"Chris Dy","startTime":2177.16,"endTime":2179.44,"body":"approach with, you know, the"},{"speaker":"Chris Dy","startTime":2177.16,"endTime":2179.44,"body":"spanning plate. You're not doing"},{"speaker":"Chris Dy","startTime":2179.44,"endTime":2183.36,"body":"a formal dorsal, you know, intra"},{"speaker":"Chris Dy","startTime":2179.44,"endTime":2183.36,"body":"articular exploration normally"},{"speaker":"Chris Dy","startTime":2183.36,"endTime":2186.06,"body":"when you're doing the spanning"},{"speaker":"Chris Dy","startTime":2183.36,"endTime":2186.06,"body":"plate, but you've already got"},{"speaker":"Chris Dy","startTime":2186.06,"endTime":2188.52,"body":"the swelling and saw in the soft"},{"speaker":"Chris Dy","startTime":2186.06,"endTime":2188.52,"body":"tissues on the dorsal side at"},{"speaker":"Chris Dy","startTime":2188.52,"endTime":2192.24,"body":"that point. But I like the"},{"speaker":"Chris Dy","startTime":2188.52,"endTime":2192.24,"body":"thought about the K wires. So if"},{"speaker":"Chris Dy","startTime":2192.24,"endTime":2195.3,"body":"you come, I'm sorry, I was gonna"},{"speaker":"Chris Dy","startTime":2192.24,"endTime":2195.3,"body":"say, if you come to doing the"},{"speaker":"Chris Dy","startTime":2195.3,"endTime":2198.66,"body":"spanning plate, technically, how"},{"speaker":"Chris Dy","startTime":2195.3,"endTime":2198.66,"body":"do you how do you dress? That"},{"speaker":"Chris Dy","startTime":2199.2,"endTime":2203.06,"body":"is, there one particular type of"},{"speaker":"Chris Dy","startTime":2199.2,"endTime":2203.06,"body":"plate that you use, you know, I"},{"speaker":"Chris Dy","startTime":2203.06,"endTime":2205.46,"body":"know that all the manufacturers"},{"speaker":"Chris Dy","startTime":2203.06,"endTime":2205.46,"body":"now have a spanning plate,"},{"speaker":"Charles Goldfarb","startTime":2205.82,"endTime":2207.32,"body":"yeah, and you"},{"speaker":"Charles Goldfarb","startTime":2205.82,"endTime":2207.32,"body":"know, your choice of the"},{"speaker":"Charles Goldfarb","startTime":2207.32,"endTime":2210.92,"body":"spanning plates, to me, does it"},{"speaker":"Charles Goldfarb","startTime":2207.32,"endTime":2210.92,"body":"go to the second metacarpal or"},{"speaker":"Charles Goldfarb","startTime":2210.92,"endTime":2215.18,"body":"third metacarpal? Does it have a"},{"speaker":"Charles Goldfarb","startTime":2210.92,"endTime":2215.18,"body":"sort of flare mid plate that can"},{"speaker":"Charles Goldfarb","startTime":2215.18,"endTime":2217.82,"body":"allow you to put screws either"},{"speaker":"Charles Goldfarb","startTime":2215.18,"endTime":2217.82,"body":"in a distal radius or the"},{"speaker":"Charles Goldfarb","startTime":2217.82,"endTime":2224.44,"body":"carpus? Or is it just a"},{"speaker":"Charles Goldfarb","startTime":2217.82,"endTime":2224.44,"body":"straight, smallish plate, I will"},{"speaker":"Charles Goldfarb","startTime":2224.44,"endTime":2231.46,"body":"say the I do like a thin,"},{"speaker":"Charles Goldfarb","startTime":2224.44,"endTime":2231.46,"body":"straight plate that you can put"},{"speaker":"Charles Goldfarb","startTime":2231.46,"endTime":2235.66,"body":"in with a couple of small"},{"speaker":"Charles Goldfarb","startTime":2231.46,"endTime":2235.66,"body":"incisions. The benefit is you"},{"speaker":"Charles Goldfarb","startTime":2235.66,"endTime":2239.92,"body":"can take it out with one or two"},{"speaker":"Charles Goldfarb","startTime":2235.66,"endTime":2239.92,"body":"small incisions, rather than"},{"speaker":"Charles Goldfarb","startTime":2239.92,"endTime":2244.74,"body":"having to open the entire dorsal"},{"speaker":"Charles Goldfarb","startTime":2239.92,"endTime":2244.74,"body":"approach. But in certain cases,"},{"speaker":"Charles Goldfarb","startTime":2244.74,"endTime":2249.0,"body":"it is nice to have that flare"},{"speaker":"Charles Goldfarb","startTime":2244.74,"endTime":2249.0,"body":"mid plate to light to put"},{"speaker":"Charles Goldfarb","startTime":2249.0,"endTime":2252.54,"body":"separate screws in. So I don't,"},{"speaker":"Charles Goldfarb","startTime":2249.0,"endTime":2252.54,"body":"I'm not. Wed to a particular"},{"speaker":"Charles Goldfarb","startTime":2252.54,"endTime":2256.5,"body":"manufacturer for this, because I"},{"speaker":"Charles Goldfarb","startTime":2252.54,"endTime":2256.5,"body":"think there's different benefits"},{"speaker":"Charles Goldfarb","startTime":2256.5,"endTime":2257.4,"body":"to different plates."},{"speaker":"Chris Dy","startTime":2257.64,"endTime":2259.74,"body":"Yeah, absolutely. I"},{"speaker":"Chris Dy","startTime":2257.64,"endTime":2259.74,"body":"mean, I tend to use, like a"},{"speaker":"Chris Dy","startTime":2259.74,"endTime":2263.6,"body":"thin, straight, 2427, Combi"},{"speaker":"Chris Dy","startTime":2259.74,"endTime":2263.6,"body":"plate. That just tends to be my"},{"speaker":"Chris Dy","startTime":2263.6,"endTime":2267.2,"body":"go to but I see the benefit"},{"speaker":"Chris Dy","startTime":2263.6,"endTime":2267.2,"body":"potentially I have, not from"},{"speaker":"Chris Dy","startTime":2267.56,"endTime":2271.52,"body":"what I remember taking advantage"},{"speaker":"Chris Dy","startTime":2267.56,"endTime":2271.52,"body":"of the kind of those mid plate"},{"speaker":"Chris Dy","startTime":2271.52,"endTime":2274.64,"body":"opportunities to put some"},{"speaker":"Chris Dy","startTime":2271.52,"endTime":2274.64,"body":"fixation in the distal fragment."},{"speaker":"Chris Dy","startTime":2275.18,"endTime":2278.3,"body":"I tend to use it truly like an"},{"speaker":"Chris Dy","startTime":2275.18,"endTime":2278.3,"body":"internal, external fixator,"},{"speaker":"Chris Dy","startTime":2279.14,"endTime":2279.32,"body":"yeah,"},{"speaker":"Charles Goldfarb","startTime":2279.32,"endTime":2280.78,"body":"and I think"},{"speaker":"Charles Goldfarb","startTime":2279.32,"endTime":2280.78,"body":"that's right, but I think"},{"speaker":"Charles Goldfarb","startTime":2280.78,"endTime":2283.54,"body":"depending on the fracture,"},{"speaker":"Charles Goldfarb","startTime":2280.78,"endTime":2283.54,"body":"sometimes that's helpful. And"},{"speaker":"Charles Goldfarb","startTime":2283.54,"endTime":2286.06,"body":"I'll say that occasionally"},{"speaker":"Charles Goldfarb","startTime":2283.54,"endTime":2286.06,"body":"Putting a screw in the carpus is"},{"speaker":"Charles Goldfarb","startTime":2286.06,"endTime":2290.02,"body":"helpful, if you're just grossly"},{"speaker":"Charles Goldfarb","startTime":2286.06,"endTime":2290.02,"body":"unstable. That has not, not"},{"speaker":"Charles Goldfarb","startTime":2290.02,"endTime":2295.72,"body":"commonly, but has been really"},{"speaker":"Charles Goldfarb","startTime":2290.02,"endTime":2295.72,"body":"helpful to me. So any, I don't"},{"speaker":"Charles Goldfarb","startTime":2295.72,"endTime":2298.36,"body":"think there's any necessary,"},{"speaker":"Charles Goldfarb","startTime":2295.72,"endTime":2298.36,"body":"necessarily, any pearls about"},{"speaker":"Charles Goldfarb","startTime":2298.36,"endTime":2299.92,"body":"how to fixate dorsally?"},{"speaker":"Chris Dy","startTime":2300.52,"endTime":2302.28,"body":"No, I think there are"},{"speaker":"Chris Dy","startTime":2300.52,"endTime":2302.28,"body":"a couple. I mean, you know, I"},{"speaker":"Chris Dy","startTime":2302.28,"endTime":2305.04,"body":"think, how do you decide between"},{"speaker":"Chris Dy","startTime":2302.28,"endTime":2305.04,"body":"second and third? Metacarpal,"},{"speaker":"Chris Dy","startTime":2305.04,"endTime":2305.58,"body":"distally,"},{"speaker":"Charles Goldfarb","startTime":2307.26,"endTime":2310.62,"body":"essentially,"},{"speaker":"Charles Goldfarb","startTime":2307.26,"endTime":2310.62,"body":"without sounding too Cavalier, I"},{"speaker":"Charles Goldfarb","startTime":2310.62,"endTime":2313.08,"body":"almost always go to the third,"},{"speaker":"Charles Goldfarb","startTime":2310.62,"endTime":2313.08,"body":"even though some of them are"},{"speaker":"Charles Goldfarb","startTime":2313.08,"endTime":2315.42,"body":"designed to go to the second. I"},{"speaker":"Charles Goldfarb","startTime":2313.08,"endTime":2315.42,"body":"like to have a little ulnar"},{"speaker":"Charles Goldfarb","startTime":2315.42,"endTime":2320.1,"body":"deviation resting position,"},{"speaker":"Charles Goldfarb","startTime":2315.42,"endTime":2320.1,"body":"which that can be helpful with,"},{"speaker":"Charles Goldfarb","startTime":2320.1,"endTime":2323.3,"body":"you know, putting it on the"},{"speaker":"Charles Goldfarb","startTime":2320.1,"endTime":2323.3,"body":"second but it's just sort of how"},{"speaker":"Charles Goldfarb","startTime":2323.3,"endTime":2325.58,"body":"it sits. To me, I don't know"},{"speaker":"Charles Goldfarb","startTime":2323.3,"endTime":2325.58,"body":"that there's a, I don't have a"},{"speaker":"Charles Goldfarb","startTime":2325.58,"endTime":2328.16,"body":"particular algorithm for that,"},{"speaker":"Charles Goldfarb","startTime":2325.58,"endTime":2328.16,"body":"do you? I don't, I know there"},{"speaker":"Chris Dy","startTime":2328.16,"endTime":2330.26,"body":"have been numerous"},{"speaker":"Chris Dy","startTime":2328.16,"endTime":2330.26,"body":"biomechanical studies trying to"},{"speaker":"Chris Dy","startTime":2330.26,"endTime":2332.42,"body":"look at this. I don't, honestly,"},{"speaker":"Chris Dy","startTime":2330.26,"endTime":2332.42,"body":"I don't get matters that much."},{"speaker":"Chris Dy","startTime":2332.42,"endTime":2335.84,"body":"Not the sound glib, but like it"},{"speaker":"Chris Dy","startTime":2332.42,"endTime":2335.84,"body":"really, I do think trying to get"},{"speaker":"Chris Dy","startTime":2335.84,"endTime":2339.32,"body":"the restoration of radial length"},{"speaker":"Chris Dy","startTime":2335.84,"endTime":2339.32,"body":"is probably the best"},{"speaker":"Chris Dy","startTime":2339.32,"endTime":2342.82,"body":"consideration for me, and I find"},{"speaker":"Chris Dy","startTime":2339.32,"endTime":2342.82,"body":"that's that's more reliable"},{"speaker":"Chris Dy","startTime":2342.82,"endTime":2347.5,"body":"going to the third. And then I"},{"speaker":"Chris Dy","startTime":2342.82,"endTime":2347.5,"body":"think the other technical Pearl"},{"speaker":"Chris Dy","startTime":2348.1,"endTime":2351.16,"body":"is, I remember during"},{"speaker":"Chris Dy","startTime":2348.1,"endTime":2351.16,"body":"fellowship, learning from, I"},{"speaker":"Chris Dy","startTime":2351.16,"endTime":2355.48,"body":"think it was either you or Ryan"},{"speaker":"Chris Dy","startTime":2351.16,"endTime":2355.48,"body":"kalfe that when you're I fixed"},{"speaker":"Chris Dy","startTime":2355.48,"endTime":2358.66,"body":"distally first, and then when"},{"speaker":"Chris Dy","startTime":2355.48,"endTime":2358.66,"body":"you're going to fix proximally,"},{"speaker":"Chris Dy","startTime":2358.72,"endTime":2362.1,"body":"instead of having the hand"},{"speaker":"Chris Dy","startTime":2358.72,"endTime":2362.1,"body":"pronated on the hand table. You"},{"speaker":"Chris Dy","startTime":2362.1,"endTime":2364.74,"body":"know, take it off of the hand"},{"speaker":"Chris Dy","startTime":2362.1,"endTime":2364.74,"body":"table, bend the elbow up and"},{"speaker":"Chris Dy","startTime":2364.74,"endTime":2367.62,"body":"have it in neutral forearm"},{"speaker":"Chris Dy","startTime":2364.74,"endTime":2367.62,"body":"position. Because if you, if you"},{"speaker":"Chris Dy","startTime":2367.62,"endTime":2370.98,"body":"fix proximally with the palm"},{"speaker":"Chris Dy","startTime":2367.62,"endTime":2370.98,"body":"flat, with the forearm pronated,"},{"speaker":"Chris Dy","startTime":2370.98,"endTime":2375.3,"body":"it's going to push you radially,"},{"speaker":"Chris Dy","startTime":2370.98,"endTime":2375.3,"body":"if you put, push the position of"},{"speaker":"Chris Dy","startTime":2375.3,"endTime":2380.24,"body":"the plate radial on the radius."},{"speaker":"Chris Dy","startTime":2375.3,"endTime":2380.24,"body":"And if you supinate, or not"},{"speaker":"Chris Dy","startTime":2380.24,"endTime":2382.76,"body":"supinate, but get them into"},{"speaker":"Chris Dy","startTime":2380.24,"endTime":2382.76,"body":"neutral form, rotation off of"},{"speaker":"Chris Dy","startTime":2382.76,"endTime":2384.8,"body":"the table. And for those of you"},{"speaker":"Chris Dy","startTime":2382.76,"endTime":2384.8,"body":"watching on YouTube, I'm"},{"speaker":"Chris Dy","startTime":2384.8,"endTime":2388.22,"body":"demonstrating that it gets you"},{"speaker":"Chris Dy","startTime":2384.8,"endTime":2388.22,"body":"more centrally on the radius,"},{"speaker":"Chris Dy","startTime":2388.22,"endTime":2390.56,"body":"which I think, if you're just"},{"speaker":"Chris Dy","startTime":2388.22,"endTime":2390.56,"body":"kind of in the weeds and you're"},{"speaker":"Chris Dy","startTime":2390.56,"endTime":2393.14,"body":"not thinking about it, you'll"},{"speaker":"Chris Dy","startTime":2390.56,"endTime":2393.14,"body":"regret it. Yeah, and it's"},{"speaker":"Charles Goldfarb","startTime":2393.14,"endTime":2394.7,"body":"not like you"},{"speaker":"Charles Goldfarb","startTime":2393.14,"endTime":2394.7,"body":"have to do the whole case in"},{"speaker":"Charles Goldfarb","startTime":2394.7,"endTime":2398.3,"body":"that position, but you're right,"},{"speaker":"Charles Goldfarb","startTime":2394.7,"endTime":2398.3,"body":"I think. And in general, a"},{"speaker":"Charles Goldfarb","startTime":2398.3,"endTime":2401.2,"body":"dorsal approach with a pronated"},{"speaker":"Charles Goldfarb","startTime":2398.3,"endTime":2401.2,"body":"disc. Radius can present its own"},{"speaker":"Charles Goldfarb","startTime":2401.2,"endTime":2405.1,"body":"set of challenges. And so that"},{"speaker":"Charles Goldfarb","startTime":2401.2,"endTime":2405.1,"body":"is the benefit of fixating at"},{"speaker":"Charles Goldfarb","startTime":2405.1,"endTime":2409.66,"body":"the metacarpal level. First get"},{"speaker":"Charles Goldfarb","startTime":2405.1,"endTime":2409.66,"body":"a screw in in a neutral rotation"},{"speaker":"Charles Goldfarb","startTime":2409.66,"endTime":2413.26,"body":"posture, and then finish your"},{"speaker":"Charles Goldfarb","startTime":2409.66,"endTime":2413.26,"body":"fixation. And that can be really"},{"speaker":"Charles Goldfarb","startTime":2413.26,"endTime":2416.26,"body":"helpful. And I think there is a"},{"speaker":"Charles Goldfarb","startTime":2413.26,"endTime":2416.26,"body":"fine line you do want to get"},{"speaker":"Charles Goldfarb","startTime":2416.26,"endTime":2419.68,"body":"your length back, ideally,"},{"speaker":"Charles Goldfarb","startTime":2416.26,"endTime":2419.68,"body":"you're not truly distracting the"},{"speaker":"Charles Goldfarb","startTime":2419.68,"endTime":2423.0,"body":"carpus like you might do a"},{"speaker":"Charles Goldfarb","startTime":2419.68,"endTime":2423.0,"body":"little bit with an external"},{"speaker":"Charles Goldfarb","startTime":2423.0,"endTime":2425.52,"body":"fixer, and if you are"},{"speaker":"Charles Goldfarb","startTime":2423.0,"endTime":2425.52,"body":"distracting, it's just a little"},{"speaker":"Charles Goldfarb","startTime":2425.52,"endTime":2428.82,"body":"bit you can over distract these"},{"speaker":"Charles Goldfarb","startTime":2425.52,"endTime":2428.82,"body":"and that has been associated"},{"speaker":"Charles Goldfarb","startTime":2428.82,"endTime":2431.82,"body":"with complex regional pain"},{"speaker":"Charles Goldfarb","startTime":2428.82,"endTime":2431.82,"body":"syndrome. So you do have to be a"},{"speaker":"Charles Goldfarb","startTime":2431.82,"endTime":2432.66,"body":"little bit careful,"},{"speaker":"Chris Dy","startTime":2432.72,"endTime":2435.3,"body":"and you'll pay penalty"},{"speaker":"Chris Dy","startTime":2432.72,"endTime":2435.3,"body":"with wrist motion down the line"},{"speaker":"Chris Dy","startTime":2435.3,"endTime":2439.8,"body":"as well. But the CRPS is the"},{"speaker":"Chris Dy","startTime":2435.3,"endTime":2439.8,"body":"pressing concern for me, so I"},{"speaker":"Chris Dy","startTime":2439.8,"endTime":2442.88,"body":"totally agree with that. I don't"},{"speaker":"Chris Dy","startTime":2439.8,"endTime":2442.88,"body":"know. I mean, if you look at the"},{"speaker":"Chris Dy","startTime":2442.94,"endTime":2446.72,"body":"literature supporting the"},{"speaker":"Chris Dy","startTime":2442.94,"endTime":2446.72,"body":"spanning plate, use the wrist"},{"speaker":"Chris Dy","startTime":2446.72,"endTime":2451.58,"body":"motion is very good at, you"},{"speaker":"Chris Dy","startTime":2446.72,"endTime":2451.58,"body":"know, six, 912, months. I do"},{"speaker":"Chris Dy","startTime":2451.58,"endTime":2453.98,"body":"think they have some more"},{"speaker":"Chris Dy","startTime":2451.58,"endTime":2453.98,"body":"limitations in terms of wrist"},{"speaker":"Chris Dy","startTime":2453.98,"endTime":2456.74,"body":"motion than if you had not use"},{"speaker":"Chris Dy","startTime":2453.98,"endTime":2456.74,"body":"the spanning plate. But also"},{"speaker":"Chris Dy","startTime":2456.74,"endTime":2459.2,"body":"that's, I think it's part of the"},{"speaker":"Chris Dy","startTime":2456.74,"endTime":2459.2,"body":"penalty of having such a bad"},{"speaker":"Chris Dy","startTime":2459.2,"endTime":2462.1,"body":"trauma, too. So I can't say it's"},{"speaker":"Chris Dy","startTime":2459.2,"endTime":2462.1,"body":"the spanning plate itself that's"},{"speaker":"Chris Dy","startTime":2462.1,"endTime":2462.58,"body":"causing that."},{"speaker":"Charles Goldfarb","startTime":2462.94,"endTime":2467.14,"body":"Yes, I totally"},{"speaker":"Charles Goldfarb","startTime":2462.94,"endTime":2467.14,"body":"agree with that. So my sequence"},{"speaker":"Charles Goldfarb","startTime":2467.14,"endTime":2469.42,"body":"of steps, and I don't, doesn't"},{"speaker":"Charles Goldfarb","startTime":2467.14,"endTime":2469.42,"body":"matter if you do crop total,"},{"speaker":"Charles Goldfarb","startTime":2469.42,"endTime":2471.7,"body":"first or last. I often just do"},{"speaker":"Charles Goldfarb","startTime":2469.42,"endTime":2471.7,"body":"it first to get it out of the"},{"speaker":"Charles Goldfarb","startTime":2471.7,"endTime":2474.22,"body":"way. And I often try to do the"},{"speaker":"Charles Goldfarb","startTime":2471.7,"endTime":2474.22,"body":"smaller surgery. No matter what"},{"speaker":"Charles Goldfarb","startTime":2474.22,"endTime":2477.34,"body":"the combo surgery is, I try to"},{"speaker":"Charles Goldfarb","startTime":2474.22,"endTime":2477.34,"body":"do the smaller surgery first to"},{"speaker":"Charles Goldfarb","startTime":2477.34,"endTime":2481.14,"body":"minimize the risk of forgetting."},{"speaker":"Charles Goldfarb","startTime":2477.34,"endTime":2481.14,"body":"But forgetting? No,"},{"speaker":"Chris Dy","startTime":2481.14,"endTime":2483.42,"body":"it's true. I did a"},{"speaker":"Chris Dy","startTime":2481.14,"endTime":2483.42,"body":"case a couple of weeks I was I"},{"speaker":"Chris Dy","startTime":2483.42,"endTime":2485.88,"body":"looked at everybody room said,"},{"speaker":"Chris Dy","startTime":2483.42,"endTime":2485.88,"body":"do not let us forget to do the"},{"speaker":"Chris Dy","startTime":2485.88,"endTime":2488.82,"body":"carpal tunnel. And I immediately"},{"speaker":"Chris Dy","startTime":2485.88,"endTime":2488.82,"body":"started to do the carpal tunnel"},{"speaker":"Chris Dy","startTime":2488.82,"endTime":2491.22,"body":"first, just, I wouldn't forget."},{"speaker":"Chris Dy","startTime":2488.82,"endTime":2491.22,"body":"So"},{"speaker":"Charles Goldfarb","startTime":2491.22,"endTime":2493.38,"body":"carp tunnel"},{"speaker":"Charles Goldfarb","startTime":2491.22,"endTime":2493.38,"body":"first, spanning plate second."},{"speaker":"Charles Goldfarb","startTime":2494.16,"endTime":2498.0,"body":"However, you need to get extra"},{"speaker":"Charles Goldfarb","startTime":2494.16,"endTime":2498.0,"body":"fixation. We need extra"},{"speaker":"Charles Goldfarb","startTime":2498.0,"endTime":2501.66,"body":"fixation. If you have a bowl or"},{"speaker":"Charles Goldfarb","startTime":2498.0,"endTime":2501.66,"body":"ulnar lunate facet, you want to"},{"speaker":"Charles Goldfarb","startTime":2501.66,"endTime":2504.62,"body":"put a little plate there. If you"},{"speaker":"Charles Goldfarb","startTime":2501.66,"endTime":2504.62,"body":"have a larger styloid fragment,"},{"speaker":"Charles Goldfarb","startTime":2504.62,"endTime":2507.8,"body":"you want to put some K wires."},{"speaker":"Charles Goldfarb","startTime":2504.62,"endTime":2507.8,"body":"That's the next step, for sure."},{"speaker":"Charles Goldfarb","startTime":2508.88,"endTime":2511.52,"body":"And then for me, just in, I'd"},{"speaker":"Charles Goldfarb","startTime":2508.88,"endTime":2511.52,"body":"love your thoughts. And then the"},{"speaker":"Charles Goldfarb","startTime":2511.52,"endTime":2517.82,"body":"last step is, as always, assess"},{"speaker":"Charles Goldfarb","startTime":2511.52,"endTime":2517.82,"body":"your Dr J critically, assess"},{"speaker":"Charles Goldfarb","startTime":2517.82,"endTime":2522.76,"body":"your forearm rotation. And if"},{"speaker":"Charles Goldfarb","startTime":2517.82,"endTime":2522.76,"body":"there's a large ulnar styloid"},{"speaker":"Charles Goldfarb","startTime":2522.76,"endTime":2525.7,"body":"fragment, fix it, and you can"},{"speaker":"Charles Goldfarb","startTime":2522.76,"endTime":2525.7,"body":"fix it with a K wire in these"},{"speaker":"Charles Goldfarb","startTime":2525.7,"endTime":2529.96,"body":"situations. I don't get super"},{"speaker":"Charles Goldfarb","startTime":2525.7,"endTime":2529.96,"body":"aggressive with open TFCC repair"},{"speaker":"Charles Goldfarb","startTime":2529.96,"endTime":2532.9,"body":"or anything like that, but fix"},{"speaker":"Charles Goldfarb","startTime":2529.96,"endTime":2532.9,"body":"your ulna style with a K wire"},{"speaker":"Charles Goldfarb","startTime":2533.02,"endTime":2534.4,"body":"and they can make a big"},{"speaker":"Charles Goldfarb","startTime":2533.02,"endTime":2534.4,"body":"difference."},{"speaker":"Chris Dy","startTime":2534.76,"endTime":2537.04,"body":"Yeah, no, no, I"},{"speaker":"Chris Dy","startTime":2534.76,"endTime":2537.04,"body":"totally agree. I think that"},{"speaker":"Chris Dy","startTime":2537.04,"endTime":2540.04,"body":"assessing that drej At the end"},{"speaker":"Chris Dy","startTime":2537.04,"endTime":2540.04,"body":"is critical. You know, as we"},{"speaker":"Chris Dy","startTime":2540.04,"endTime":2542.7,"body":"wrote in one of our papers that"},{"speaker":"Chris Dy","startTime":2540.04,"endTime":2542.7,"body":"is a critical step of fixing a"},{"speaker":"Chris Dy","startTime":2542.7,"endTime":2545.46,"body":"disarray is fracture, and it's"},{"speaker":"Chris Dy","startTime":2542.7,"endTime":2545.46,"body":"often a step that gets"},{"speaker":"Chris Dy","startTime":2545.46,"endTime":2547.92,"body":"overlooked because I'm assessing"},{"speaker":"Chris Dy","startTime":2545.46,"endTime":2547.92,"body":"that as I'm asking them to bring"},{"speaker":"Chris Dy","startTime":2547.92,"endTime":2550.8,"body":"in the floor for the final"},{"speaker":"Chris Dy","startTime":2547.92,"endTime":2550.8,"body":"films. So I when I'm working"},{"speaker":"Chris Dy","startTime":2550.8,"endTime":2553.14,"body":"with a trainee I haven't worked"},{"speaker":"Chris Dy","startTime":2550.8,"endTime":2553.14,"body":"with before, I tell them this is"},{"speaker":"Chris Dy","startTime":2553.14,"endTime":2555.18,"body":"what I'm doing, as you know."},{"speaker":"Chris Dy","startTime":2553.14,"endTime":2555.18,"body":"Just don't forget to do this"},{"speaker":"Chris Dy","startTime":2555.18,"endTime":2557.94,"body":"when you're out in practice. And"},{"speaker":"Chris Dy","startTime":2555.18,"endTime":2557.94,"body":"then lastly, we talked about"},{"speaker":"Chris Dy","startTime":2557.94,"endTime":2560.4,"body":"doing the carpal tunnel release."},{"speaker":"Chris Dy","startTime":2557.94,"endTime":2560.4,"body":"One advantage of doing the"},{"speaker":"Chris Dy","startTime":2560.4,"endTime":2563.24,"body":"carpal tunnel release is that I"},{"speaker":"Chris Dy","startTime":2560.4,"endTime":2563.24,"body":"have no qualms with them now"},{"speaker":"Chris Dy","startTime":2563.24,"endTime":2566.48,"body":"having a block, which oftentimes"},{"speaker":"Chris Dy","startTime":2563.24,"endTime":2566.48,"body":"is very helpful in terms of pain"},{"speaker":"Chris Dy","startTime":2566.48,"endTime":2569.72,"body":"control now that may or may not"},{"speaker":"Chris Dy","startTime":2566.48,"endTime":2569.72,"body":"be offered at your center, pre"},{"speaker":"Chris Dy","startTime":2569.72,"endTime":2572.9,"body":"op or post op if definitely, if"},{"speaker":"Chris Dy","startTime":2569.72,"endTime":2572.9,"body":"they've had a pre op block, for"},{"speaker":"Chris Dy","startTime":2572.9,"endTime":2575.6,"body":"sure, I'm releasing the carpal"},{"speaker":"Chris Dy","startTime":2572.9,"endTime":2575.6,"body":"tunnel because I have no option"},{"speaker":"Chris Dy","startTime":2575.6,"endTime":2580.18,"body":"of assessing neurostatus"},{"speaker":"Chris Dy","startTime":2575.6,"endTime":2580.18,"body":"afterwards. I still have some"},{"speaker":"Chris Dy","startTime":2580.18,"endTime":2583.48,"body":"fond memories of a case during"},{"speaker":"Chris Dy","startTime":2580.18,"endTime":2583.48,"body":"fellowship in which, you know,"},{"speaker":"Chris Dy","startTime":2583.54,"endTime":2586.42,"body":"the faculty said, go ahead and"},{"speaker":"Chris Dy","startTime":2583.54,"endTime":2586.42,"body":"do a block, and then we didn't"},{"speaker":"Chris Dy","startTime":2586.42,"endTime":2589.54,"body":"do a carpal tunnel release, and"},{"speaker":"Chris Dy","startTime":2586.42,"endTime":2589.54,"body":"I had to have a very awkward"},{"speaker":"Chris Dy","startTime":2589.54,"endTime":2592.78,"body":"conversation of why I couldn't"},{"speaker":"Chris Dy","startTime":2589.54,"endTime":2592.78,"body":"do a thorough neuro exam. It"},{"speaker":"Chris Dy","startTime":2592.78,"endTime":2595.78,"body":"didn't go for a while. You can"},{"speaker":"Chris Dy","startTime":2592.78,"endTime":2595.78,"body":"guess which faculty that was"},{"speaker":"Chris Dy","startTime":2595.84,"endTime":2600.9,"body":"okay, but yeah, so I typically"},{"speaker":"Chris Dy","startTime":2595.84,"endTime":2600.9,"body":"will say, if you're going to, if"},{"speaker":"Chris Dy","startTime":2600.9,"endTime":2603.06,"body":"you're thinking about a block,"},{"speaker":"Chris Dy","startTime":2600.9,"endTime":2603.06,"body":"which I think can be a good"},{"speaker":"Chris Dy","startTime":2603.06,"endTime":2606.24,"body":"thing from a pain control"},{"speaker":"Chris Dy","startTime":2603.06,"endTime":2606.24,"body":"perspective, for sure. Do the"},{"speaker":"Chris Dy","startTime":2606.24,"endTime":2607.2,"body":"carpal tunnel release?"},{"speaker":"Charles Goldfarb","startTime":2607.5,"endTime":2611.16,"body":"Yeah, the only"},{"speaker":"Charles Goldfarb","startTime":2607.5,"endTime":2611.16,"body":"caveat with a block, and I agree"},{"speaker":"Charles Goldfarb","startTime":2611.16,"endTime":2614.22,"body":"completely about the carp"},{"speaker":"Charles Goldfarb","startTime":2611.16,"endTime":2614.22,"body":"tunnel, if it's a even more"},{"speaker":"Charles Goldfarb","startTime":2614.22,"endTime":2616.98,"body":"significant trauma than"},{"speaker":"Charles Goldfarb","startTime":2614.22,"endTime":2616.98,"body":"typically having a compartment"},{"speaker":"Charles Goldfarb","startTime":2616.98,"endTime":2619.14,"body":"syndrome in the back of your"},{"speaker":"Charles Goldfarb","startTime":2616.98,"endTime":2619.14,"body":"mind, that would be the other"},{"speaker":"Charles Goldfarb","startTime":2619.14,"endTime":2622.52,"body":"thing to maybe hesitate. But a"},{"speaker":"Charles Goldfarb","startTime":2619.14,"endTime":2622.52,"body":"block is such a wonderful thing"},{"speaker":"Charles Goldfarb","startTime":2623.0,"endTime":2624.74,"body":"that you'd love to be able to do"},{"speaker":"Charles Goldfarb","startTime":2623.0,"endTime":2624.74,"body":"the block."},{"speaker":"Chris Dy","startTime":2624.74,"endTime":2626.78,"body":"Yeah, absolutely. And"},{"speaker":"Chris Dy","startTime":2624.74,"endTime":2626.78,"body":"I think that's really good point"},{"speaker":"Chris Dy","startTime":2626.78,"endTime":2629.72,"body":"about the compartments. So that"},{"speaker":"Chris Dy","startTime":2626.78,"endTime":2629.72,"body":"was a, you know, hot summertime"},{"speaker":"Chris Dy","startTime":2629.72,"endTime":2632.48,"body":"trauma topic. We have probably"},{"speaker":"Chris Dy","startTime":2629.72,"endTime":2632.48,"body":"another one lined up for the"},{"speaker":"Chris Dy","startTime":2632.48,"endTime":2633.2,"body":"next episode."},{"speaker":"Charles Goldfarb","startTime":2633.5,"endTime":2636.32,"body":"Yeah, last"},{"speaker":"Charles Goldfarb","startTime":2633.5,"endTime":2636.32,"body":"question, yeah. How is your Do"},{"speaker":"Charles Goldfarb","startTime":2636.32,"endTime":2640.48,"body":"you have a standard length of"},{"speaker":"Charles Goldfarb","startTime":2636.32,"endTime":2640.48,"body":"time where the plate stays in"},{"speaker":"Charles Goldfarb","startTime":2640.48,"endTime":2643.12,"body":"before you schedule the surgery"},{"speaker":"Charles Goldfarb","startTime":2640.48,"endTime":2643.12,"body":"to remove the spanning plate."},{"speaker":"Chris Dy","startTime":2643.42,"endTime":2646.96,"body":"So first off, for the"},{"speaker":"Chris Dy","startTime":2643.42,"endTime":2646.96,"body":"fellows that are graduating and"},{"speaker":"Chris Dy","startTime":2646.96,"endTime":2649.48,"body":"you have your conversation"},{"speaker":"Chris Dy","startTime":2646.96,"endTime":2649.48,"body":"beforehand with the patient that"},{"speaker":"Chris Dy","startTime":2649.48,"endTime":2652.78,"body":"we're probably going to use a"},{"speaker":"Chris Dy","startTime":2649.48,"endTime":2652.78,"body":"spanning plate. Make sure you"},{"speaker":"Chris Dy","startTime":2652.78,"endTime":2655.42,"body":"dictate in your operative note,"},{"speaker":"Chris Dy","startTime":2652.78,"endTime":2655.42,"body":"or your progress note that this"},{"speaker":"Chris Dy","startTime":2655.42,"endTime":2657.88,"body":"that the spanning plate will be"},{"speaker":"Chris Dy","startTime":2655.42,"endTime":2657.88,"body":"using. There is a planned second"},{"speaker":"Chris Dy","startTime":2657.88,"endTime":2662.34,"body":"procedure, you know, because you"},{"speaker":"Chris Dy","startTime":2657.88,"endTime":2662.34,"body":"just for so many reasons, it's"},{"speaker":"Chris Dy","startTime":2662.34,"endTime":2666.48,"body":"good to have that in the"},{"speaker":"Chris Dy","startTime":2662.34,"endTime":2666.48,"body":"documentation. And then I"},{"speaker":"Chris Dy","startTime":2666.66,"endTime":2669.6,"body":"typically would say two or three"},{"speaker":"Chris Dy","startTime":2666.66,"endTime":2669.6,"body":"months. I know that in one of"},{"speaker":"Chris Dy","startTime":2669.72,"endTime":2672.3,"body":"the older series, they went four"},{"speaker":"Chris Dy","startTime":2669.72,"endTime":2672.3,"body":"months. I think that's a little"},{"speaker":"Chris Dy","startTime":2672.3,"endTime":2675.0,"body":"bit long to be honest with you,"},{"speaker":"Chris Dy","startTime":2672.3,"endTime":2675.0,"body":"but I'd say probably two or"},{"speaker":"Chris Dy","startTime":2675.0,"endTime":2675.84,"body":"three months. How about"},{"speaker":"Charles Goldfarb","startTime":2676.2,"endTime":2677.94,"body":"you? Yeah,"},{"speaker":"Charles Goldfarb","startTime":2676.2,"endTime":2677.94,"body":"what I tell the patient is three"},{"speaker":"Charles Goldfarb","startTime":2677.94,"endTime":2683.24,"body":"months. And if there's clear"},{"speaker":"Charles Goldfarb","startTime":2677.94,"endTime":2683.24,"body":"bony healing and patients"},{"speaker":"Charles Goldfarb","startTime":2683.24,"endTime":2686.18,"body":"getting antsy two months or two"},{"speaker":"Charles Goldfarb","startTime":2683.24,"endTime":2686.18,"body":"and a half months is fine. The"},{"speaker":"Charles Goldfarb","startTime":2686.18,"endTime":2689.3,"body":"beauty of it, especially if you"},{"speaker":"Charles Goldfarb","startTime":2686.18,"endTime":2689.3,"body":"don't have K wires, is you have"},{"speaker":"Charles Goldfarb","startTime":2689.3,"endTime":2692.0,"body":"been a removable brace shortly"},{"speaker":"Charles Goldfarb","startTime":2689.3,"endTime":2692.0,"body":"after surgery, and so they're"},{"speaker":"Charles Goldfarb","startTime":2692.0,"endTime":2695.18,"body":"showering, and they realize that"},{"speaker":"Charles Goldfarb","startTime":2692.0,"endTime":2695.18,"body":"having a stiff wrist, especially"},{"speaker":"Charles Goldfarb","startTime":2695.18,"endTime":2698.0,"body":"if you can rotate the form"},{"speaker":"Charles Goldfarb","startTime":2695.18,"endTime":2698.0,"body":"fully, having a stiff wrist, is"},{"speaker":"Charles Goldfarb","startTime":2698.0,"endTime":2700.78,"body":"not that big a deal. So most"},{"speaker":"Charles Goldfarb","startTime":2698.0,"endTime":2700.78,"body":"patients. Is work on their"},{"speaker":"Charles Goldfarb","startTime":2700.78,"endTime":2702.76,"body":"fingers, they work on their"},{"speaker":"Charles Goldfarb","startTime":2700.78,"endTime":2702.76,"body":"elbow, they work on their"},{"speaker":"Charles Goldfarb","startTime":2702.76,"endTime":2705.88,"body":"forearm, and they're okay, and"},{"speaker":"Charles Goldfarb","startTime":2702.76,"endTime":2705.88,"body":"they're not killing you about"},{"speaker":"Charles Goldfarb","startTime":2705.88,"endTime":2708.1,"body":"getting the plate out, and then"},{"speaker":"Charles Goldfarb","startTime":2705.88,"endTime":2708.1,"body":"you get the plate out, and they"},{"speaker":"Charles Goldfarb","startTime":2708.1,"endTime":2710.38,"body":"have one thing to worry about,"},{"speaker":"Charles Goldfarb","startTime":2708.1,"endTime":2710.38,"body":"and that's wrist motion,"},{"speaker":"Chris Dy","startTime":2710.68,"endTime":2713.14,"body":"right? Exactly. Do you"},{"speaker":"Chris Dy","startTime":2710.68,"endTime":2713.14,"body":"do a little gentle manip as you"},{"speaker":"Chris Dy","startTime":2713.14,"endTime":2718.3,"body":"take the plate out? Absolutely."},{"speaker":"Chris Dy","startTime":2713.14,"endTime":2718.3,"body":"Yeah, not too not too"},{"speaker":"Chris Dy","startTime":2718.3,"endTime":2718.96,"body":"aggressive, though,"},{"speaker":"Charles Goldfarb","startTime":2719.2,"endTime":2721.26,"body":"not too"},{"speaker":"Charles Goldfarb","startTime":2719.2,"endTime":2721.26,"body":"aggressive. All right, all"},{"speaker":"Charles Goldfarb","startTime":2721.26,"endTime":2722.7,"body":"right. That was fun. That was"},{"speaker":"Chris Dy","startTime":2722.7,"endTime":2724.62,"body":"fun. Well, good luck"},{"speaker":"Chris Dy","startTime":2722.7,"endTime":2724.62,"body":"to all of our graduating"},{"speaker":"Chris Dy","startTime":2724.62,"endTime":2727.32,"body":"fellows, and if there are any"},{"speaker":"Chris Dy","startTime":2724.62,"endTime":2727.32,"body":"other topics you want to discuss"},{"speaker":"Chris Dy","startTime":2727.32,"endTime":2730.62,"body":"as you transition into practice,"},{"speaker":"Chris Dy","startTime":2727.32,"endTime":2730.62,"body":"email us. Handpodcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2732.0,"endTime":2735.66,"body":"love it. Have"},{"speaker":"Charles Goldfarb","startTime":2732.0,"endTime":2735.66,"body":"a good day. You too. Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2735.66,"endTime":2737.76,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2735.66,"endTime":2737.76,"body":"real soon."},{"speaker":"Chris Dy","startTime":2738.3,"endTime":2740.48,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2738.3,"endTime":2740.48,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":2740.48,"endTime":2742.64,"body":"suggestions and feedback, you"},{"speaker":"Chris Dy","startTime":2740.48,"endTime":2742.64,"body":"can reach us at"},{"speaker":"Chris Dy","startTime":2742.64,"endTime":2743.48,"body":"handpodcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2745.22,"endTime":2747.38,"body":"and remember,"},{"speaker":"Charles Goldfarb","startTime":2745.22,"endTime":2747.38,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2747.38,"endTime":2748.34,"body":"get your podcast,"},{"speaker":"Chris Dy","startTime":2748.76,"endTime":2751.64,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2748.76,"endTime":2751.64,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2751.64,"endTime":2753.2,"body":"word out. Special,"},{"speaker":"Charles Goldfarb","startTime":2753.2,"endTime":2755.3,"body":"thanks to"},{"speaker":"Charles Goldfarb","startTime":2753.2,"endTime":2755.3,"body":"Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2755.3,"endTime":2755.72,"body":"music,"},{"speaker":"Chris Dy","startTime":2756.38,"endTime":2758.72,"body":"and remember, keep the"},{"speaker":"Chris Dy","startTime":2756.38,"endTime":2758.72,"body":"upper hand come back next time"},{"speaker":"Chris Dy","startTime":2758.72,"endTime":2758.84,"body":"you"}]}