Welcome to the upper hand, where Chuck and Chris talk hand surgery.
Chris Dy :We are two hand surgeons at Washington University in St. Louis here to talk about all aspects of hand surgery from technical to personal.
Charles Goldfarb :Thank you for subscribing. Wherever you get your podcasts
Chris Dy :And be sure to leave a review that helps us get the word out.
Charles Goldfarb :Oh, hey, Chris.
Chris Dy :Hey, Chuck, how are you?
Charles Goldfarb :I'm good. How are you?
Chris Dy :I'm good. I'm camped out in your basement. It looks like the Dy family has moved in down here.
Charles Goldfarb :Perfect. And well, that's what we got it for. We've got toys that are 20 years old that are getting rejuvenation.
Chris Dy :You know, he's really into them right now. So you've been kind enough to let us crash here for a little bit so that we can use your pool. And you know, it's nice to have friends with the pool, so
Charles Goldfarb :and it's nice to have the pool used.
Chris Dy :Fantastic. Well, thank you again, I feel bad that we're occupying your space.
Charles Goldfarb :Not at all. I would love to share a review that is-it's a good review, but it also and this is a hint to the audience. It also shares some suggestions for topics and so it's titled "Love! Love this podcast, super helpful. I had two suggestions or topics if you are in need. One tightrope surgeries. I've seen one for the thumb anchored in the second metacarpal. When do you call for it? Number two, do you use the Burton Pellegrini method for CMC arthroplasties question mark comparing Burton Pellegrini versus other types of CMC arthroplasty surgery methods, and number three CRPS and distal radius fracture, mostly conservative, but occasionally post surgical." Those are outstanding suggestions. And I think we can speak to them.
Chris Dy :Did you plant that review because I believe you are the PI on a randomized controlled trial comparing a suture tape internal brace technique versus the classic LRTI for thumb, CMC. And I think you wrote the paper on CRPS type two after distal radius fractures.
Charles Goldfarb :It's not a plant, but both of your statements are true. And we're actually with the help of one of my outstanding-our outstanding partners, Dr. Wall are working on another crps paper related to distal radiu fractures as well. So good stuff,
Chris Dy :you get the you heard it here first the Wash U expert on CRPS.
Charles Goldfarb :And that is not a cry for referrals. Not at all.
Chris Dy :But that this is actually - CRPS has been a suggested episode. So maybe that'd be a great one to do with one of our upcoming therapists guest. So we'll keep that in mind for sure.
Charles Goldfarb :Absolutely. Any any interesting cases this week or recently?
Chris Dy :Well, you know, we just recently did our first case at our South County facility with a revamped and streamlined local only pack. So for carpal tunnel release and trigger finger we're using a new pack that cuts costs by about $60. So that's fantastic from a cost perspective, but even more important from a waste perspective. And it is a much leaner pack with hopefully less of an environmental footprint. And it was really spearheaded by one of our medical students, Kathryn Velicki,, applying for residency right now anybody that's listening, she did a great job with that. And she came to me at the beginning stages of the pandemic, when the medical students were asked to hold off on clinical activities. And they were all asked to do quality improvement projects. So this, it's pretty impressive that her quality improvement project has actually come to fruition within four months. And pretty much will change what we do at least down in South County for for local only surgery.
Charles Goldfarb :I love it, you know that I love it. I'm all about efficiency and about the environment. And so many reasons I love this. I can promise you one thing, it won't stay in South County, I will be begging to import that to one of our other sites for sure.
Chris Dy :Well, the supplier already has the card for it. So we can definitely get that up to where you work.
Charles Goldfarb :I love that. And let's talk about one other thing. We we've had an interesting conversation with an app called Read, which they are going to market our podcast. And we agreed because we like it to talk about their app. And we're not going to spend long talking about it. But it is an app which essentially allows you to sign up for A) different journals that interests you and B) different topics that interest you. And you get updates. And depending on your current, you know your situation, whether you're affiliated with university and have library access for us, we can get these articles that we like pushed to our cell phone, which is really helpful. And so I've enjoyed the app, it's actually made my life a little easier and makes the way I interact with the literature a little different. So I've enjoyed it.
Chris Dy :Yeah, no, I think it's nice. I mean, yeah, one of the things that it does is that it serves as an aggregator app for literature. So taking current ways that we consume media, like for example, your Twitter feed, whatever shows up on your Instagram, taking that style and using it for journals and being able to pick what you like. So almost like if you had a news app, and you say, I want to follow these kinds of channels, this will allow you to get pushes from journals. And it's obviously we're all used to scrolling through our phones and finding things that we like and ignoring the stuff we don't like. So I've liked it so far. One of the big advantages I see is being able to access things off campus when you're not at the Medical School.
Charles Goldfarb :Yeah, love it. All right, why don't we jump into our topic for the day?
Chris Dy :Well, Chuck, I think we have a treat today. Not only do we have one special guest, we have two special guests. So who did you ask to join us today?
Charles Goldfarb :Who did we wrangle in and bribe to join us?
Chris Dy :I mean, I mean, who did we pull off of the waiting list? I mean there are people dying to get into this club.
Charles Goldfarb :I know, I know. I don't know if these two guests even know that there's a special thank you coming their way. for participating. We're going to keep that as surprise. A beautiful Upper Hand Coffee Mug. But but that's that's
Chris Dy :not a surprise, come on.
Charles Goldfarb :All right. So first of all, we have a returning guest. This is our first repeat guest because she was so outstanding the first time. And that is Macy Stonner, who is a therapist here with us in St. Louis, at the Milliken Hand center at Washington University. Macy, Welcome back.
Macy Stonner :Hey, y'all, thank you so much for having me again.
Charles Goldfarb :Thank you. And our special special guest from Dallas, Texas. I is Amy Lake, who's a therapist extraordinary for the pediatric patient especially, I first met Amy in 2002. Not to die-not to date either of us. I was I was a young physician at that time. And I went down to hang out in Texas Scottish Rite, for six weeks or so and, and met Amy then and we've stayed in contact over the last 18 years. Welcome.
Amy Lake :Thank you so much. I'm so honored to be here. 18 years. Wow. You know, I've been at Scottish Rite 19. So that was really only a year after I joined the team at Scottish Rite. So we've known each other for a long time. Chuck
Charles Goldfarb :It is crazy. Well, Welcome to you both, we have a great, a great plan for today, we're really going to get to the heart of relationships, I think and this and that is Doctor therapist and therapist, patient and doctor patient. Chris, do you want to get us going?
Chris Dy :Here. So one of one of the things I think is unique, maybe not unique, but I think special about hand surgery is that there's an entire field of doctors and surgeons dedicated to this. And there's an entire field of therapists dedicated to this. So everybody who potentially is doing any of the kind of outside of the run of the mill hand surgery has done extra training for the hand. So why is it? I mean, I guess I'll start with Macy. Why do you think the hand is so special and unique? Why can't you just help people with hand therapy issues if you've completed your standard PT or ot training?
Macy Stonner :Well, the hand as you know, as a surgeon is incredibly complex. And it's beyond the scope of what you get in a generalist, PT or OT schooling. And so you really have to specialize in it. And so that's why we rely so heavily on us, either the certified hand therapist or just somebody who has experience in hands to really know the details of the surgery know, the rehab guidelines following that surgery and just the appropriate care that patients need.
Charles Goldfarb :And Amy, certainly, dealing with kids takes it one step. I don't want to say further but one step in a different direction. What are your thoughts? Big Picture?
Amy Lake :Yeah, you know, it's interesting, because I worked with adults for 10 years before I entered Scottish Rite and have been working with pediatrics for the last 19 years. So it is it's real different. You know, I think it's very important to know your anatomy. I think that's key, I think Macy hit on some really great points. I mean, the hand is very complex, there's a lot of things you need to know about the hand and obviously, learning some of those techniques that you need to know to treat the hand is very important. And then you deal with pediatrics who have abnormal anatomy, right? So you have this normal anatomy and an injury related therapy that you have to to you know, give your patients as adults but then you add in the abnormal anatomy and how kids are born without some things and and how to treat that and it is a kind of a it's a it's a next step kind of thing and, and how to really specialize and learn the ins and outs of that can be real tricky.
Chris Dy :One of the things Amy that you wanted us to talk about was the importance of the doctor therapist relationship. Clearly, you know, there are certain ways that this can work well, and some ways in which it can not work well. So can you give me kind of a best case worst case example?
Amy Lake :Yeah, I think it is so important. And my first 10 years working with adults, I didn't really have a real good relationship with any of the doctors that were referring patients to us, it was just kind of a challenge to really make that connection and make that relationship really work. And I feel so blessed when I when I started at Scottish Rite, to have that really unique opportunity to work hand in hand with a doctor and, and clinic with a doctor and be able to observe what they're doing what they're telling their patients, watch some surgeries on occasion. And I think that's so rich, for therapists to really learn what the doctor is doing, what they're teaching their patients. And I think in turn, it's really cool because I'm clinicing right there, my office is right there, they can pop in to where I'm treating these patients at any time. They can watch the splints I'm building and fabricating, and they can see what I'm telling the patients. And I think it's just a really rich and important, important opportunity to really learn from each other. And I think as doctors learn what therapists are doing, and therapists learn what doctors are doing, it really makes that unique experience. And makes the patient really feel special and feel known and feel taken care of when they know that their doctor and their therapist are really communicating with one another.
Charles Goldfarb :I think that's great. And I definitely want to hear from Macy on the same topic. I would say the reward comes for all of us, right? It I know you guys, many therapists enjoy it. I'll say right now because of the pandemic, we're not working as closely with the hand therapists that as we typically have in the past, so often, well, the Shriners is working pretty much like it always has. And that's similar to the Texas Scottish Rite model where we have therapists in clinic and exactly as you described in, in, in our, in our Washington University clinics, we often have hand therapists with us. And it's the same relationship. And it's fantastic. And I think patient loves it, doctor, therapist love it. And I miss it right now, because I don't have a therapist with me in clinic and I have spoken to a therapist, and I believe it when she says that she misses it too. Maybe she's just told me that. But I think it's incredible. Macy.
Macy Stonner :Yes, with COVID I definitely miss being the physician clinic just to have that true, you know, multidisciplinary team. Like you said, it's win win win for all three of the triad. And I was just gonna chime in earlier and say that the patients talk about how much they love the fact that when they come from one of the doctors offices and straight to me, I already know everything that happened. I already know what the X rays look like, I know what the referral says, I know what the return to work restrictions are. And that was four minutes before they walked in. And they're like, Oh, well, Dr. Goldfarb told me to tell you, and I'm like, Oh I already know and I could spit it out. And they're like, that was so fast. That was so great. And so I'm very spoiled. This was my first job outside of school. So that's all I've ever known and hope that's all I will ever know. So again, it's it's a win win win. And I'm very thankful to be a part of it.
Chris Dy :So what's an example of the worst order set you ever received from a referring surgeon? We can start with Amy, since I know all of Macy's orders coming from Dr. Goldfarb are fantastic.
Macy Stonner :I think the worst order is wrist pain, I don't know about you may see, but I just feel like um, when you get an order and it says wrist pain. There's that can be like a million different diagnoses, a million different scenarios. And they don't give you any any ideas of what to do or precautions or what their long term goal is. What their surgical ideas possibly could be or when they're even coming back to the doctor. So wrist pain is my ultimate, I think downfall.
Charles Goldfarb :Yeah, and I'm sure Macy's got one. But you know how this happens, don't you Amy. So here's what here's what's going on in our head. If we have a really tough patient. And we have no idea what to do. I probably shouldn't disclose this, but I'm going to say it Chris may tell me to edit this out later. But oh my god, I don't know what's going on. Let's see, am I gonna order an MRI or I'm gonna send the patient to therapy and say wrist pain. So sometimes therapy wins.
Chris Dy :That's the point when I actually just say refer to Dr. Goldfarb.
Charles Goldfarb :Gotta do something. Alright, Macy, you tell us one.
Macy Stonner :Well, the wrist pain doesn't bother me when it just says evaluate and treat for wrist pain. I'm like, okay, the doctor has no idea what to do. So I'm going to just figure it out and make up something like that. That doesn't bug me as much as it says like, De Quervain's please work on strengthening, stretching, stuff like that. And I'm like, I'm not gonna strengthen this De Quervain's I think that's gonna really hurt them. So if it's just an order with specifics that I may not clinically agree with. It's like I want to do what the doctor says. But I also want to do what I believe is best for the patient. So then I'm kind of stuck between a rock and a hard place. So that kind of thing is challenging for me. I think that brings up the I think the idea of how important it is to have that good working relationship with your doctor and your therapist, you know, because then you can call him and say, What are you thinking? Or, you know, let's talk through some protocols. Let's let's think through what's in the literature, what's, you know, what's, what is going on? With my colleagues, and what's going on in the world, and what are other people doing and talk through protocols talk through different scenarios of how you might treat that patient.
Charles Goldfarb :Yeah. And that is also the development of the trust to know that if I send the patient to Macy, for example, and say that I think the patient has this, and I know that Macy will take it from there. And if she gets to a point where she's not sure, then we communicate again, it's a really great thing. And there are lots of wonderful therapists in our community, as I'm sure there are in Dallas. But with some I just don't have the same level of relationship. And I think it doesn't allow optimal patient care, it can be good patient care. But when challenges arise, it's just it's just a little harder to get over the hump.
Chris Dy :I love getting emails from therapists with updates on patients, it makes me know that they want to communicate, and that I have another set of eyes out there. I think it's probably the biggest thing about the relationship.
Charles Goldfarb :Yeah, we that's a great point. And I try to make that really clear. And I do have therapists that email regularly, some that text, which is fine, too. But, but email's a little easier and a little more confidential. But great point. Great point.
Chris Dy :So Chuck, do you routinely send patients over with their op notes, you know, for, you know, for certain for certain post op protocols. I mean, I don't routinely do that with the exception of, you know, a big nerve transfer case or complex fracture, that kind of thing. And I think the therapists that at least I work with routinely, at Athletico, they understand when I'm sending over an op note it's something special?
Charles Goldfarb :Well, I, you know, again, I'm spoiled. And I know that if I send a patient to Macy, Macy's already gonna have read the OP note. And so much of what I do is, although it may not be routine in the hand surgery world, that kind of complicated TFCC, repairs and some of the congenital stuff, it has become routine in our office. And so I think when I really emphasize the op note or the hand trauma cases with tendon and nerve, etc, and just something that's even weird for us, and Macy is that a fair assumption that you've,
Macy Stonner :For sure. So we're again, very fortunate to have the same electronic medical record system. So I can read all of your notes in your op notes, and so it's wonderful. So I feel like a big part of my job is when you send a patient over to Milliken, you know, it's all local in St. Louis, but the patient may not follow up with therapy in St. Louis, because they live two hours away. So I do a lot of care coordination, where I help find a legit therapist where they live, I print their op note for them, I really outline precautions, and some ideas for nerve transfer training or appropriate appropriate set of training, just give the therapist an idea. I don't know a lot about what that therapist has treated in the past. And so I often help coordinate that care elsewhere.
Charles Goldfarb :Amy, anything to add on this one? But if not, I have a question for you.
Macy Stonner :I know I agree with Macy on this, I think, you know, we get a lot of patients from all over the state of Texas, and now kind of all over the US. And a lot of times they do have to go to therapists that are more local. And so having that communication and and the ability to talk with that therapist and see if they're comfortable treating that patient, I think is so important.
Chris Dy :One thing that I've noticed in, you know, Chuck, I'm gonna bring this back to nerve, at least in the nerve world, is that there is an incredible amount of variability in nerve transfer post-op protocols. And without the type of communication that Macy and Amy were describing, it's really hard for a therapist to find a protocol and take over somebody's care without the assistance of, you know, centers that have expertise in this area. And as much as Chuck and I and all of our partners offer expertise. Our therapist colleagues offer a tremendous amount of expertise and are huge resources for everybody in the community.
Charles Goldfarb :Yeah, I think that is that is very well said, The. So I know I'm not gonna say this very well, I don't think but both of you guys have experience in helping younger physicians start their practice. And so how do you break us in because I don't know if I've just been lucky. But the therapists I've worked with have been incredibly patient. Definitely incredibly knowledgeable and incredibly willing to help initiate newer physicians and that would include trainees and we can talk about that as a separate topic. But Amy, what are your strategies to help us get it right?
Macy Stonner :Yeah, so it's really it's a really cool opportunity. We get fellows Come in for six months, from all over the US sometimes over the world, and towards the end of their six month rotation is kind of when I sit down with them, I've, we've gotten to know each other we office together. And so we always have a conversation. Okay, what next? How do I find my therapist? What kind of orders do I need to write? How am I going to navigate the system. And so I think it's such an important opportunity for me to be able to really kind of tell them my thoughts before they go out and conquer the world. And it's been a really rich, I think, experience for both of us. And a lot of times, I'm just telling them, you know, if they're trying to find a therapist, they always ask me, what kind of therapist do I need? Especially if it's if they're going into pediatrics? Right? Do I need a CHT that has no pediatric experience? Do I need a pediatric therapist that is trying to get her CHT? Who do I need to look for, and at the end of the day, I think it's really just who you jive with, and who you really have a good relationship with, who is willing to do the work, who's willing to learn, you know, how to treat these kids. And then if they're going into a situation where there's a veteran therapist that's been there before, sometimes I know that therapist and I can help navigate that, that relationship a little bit for them. But I think it's so important that, that everybody is just open and honest and vulnerable, and say, Hey, this is who I am, this is where I am, this is what I know, I want to know more I want to learn from you. And just really kind of check in egos at the door and just really being open to learn from each other really.
Charles Goldfarb :Macy? I know you have depth to add to that. Not that it wasn't deep enough, but open and honest got me a little nervous over here. vulnerable
Chris Dy :Vulnerable was something that Chuck has never been described as.
Macy Stonner :Well, speaking about the fellows, I love how much like fellows really respect the expertise that we have to the table. And I think that comes from the top. So they see the attendings really valuing what we have, and so they also do the same and so I love it at the end of their fellowship, they're like do you have a card I need to call you once I start my own practice or something and I randomly will get calls or emails from old fellows. And they're saying, you know, I don't have a therapist here, I did the surgery, I have no idea what to tell them to do after surgery. And so I'll kind of help outline them a nice rehab progression, and they really appreciate that. But regarding like new attendings, I think you were asking about I might disagree or just kind of ask, well, what's your plan with this post op patient, for example? And they'll say, oh, x, y, z? And I'll kind of think, Okay, well, in the past, historically, we've done this, and they'll say, Oh, good, that's perfect. Do that do that or I'll say, well, has Dr. Goldfarb does this, okay, cool. Do that. So they're always very, very receptive to historically what we've done and what's worked. And if that doesn't work, then we try something new. And that's kind of the beauty of our relationship.
Charles Goldfarb :Let-let's be really clear, Macy doesn't just do that with new attendings. She does that with me. Here's the plan. And she'll say in her nice way, like she just said, Well, have you ever considered this?
Macy Stonner :I try
Chris Dy :One of the things that, you know, maybe this is somewhat unique to the fellowship set up here at WashU, but, you know, as a fellow, you do have an autonomous clinic, which I think is a huge advantage from an education perspective. And the residents play a big part in that too. And back in the day, when I was a fellow, we were doing our own hand therapy, and it really showed you your vulnerability as a surgeon for post op care, because you have no idea. And you know, you could use, I saw firsthand how much the therapist contributed to the ultimate outcome. So that made me go over and spend time at Milliken saying what the heck actually happens at this place. And I encourage the fellows to do that now. And anybody that's listening, that's a trainee, you should go spend some time at the hand therapy suite and see what happens, you know, behind the curtain there, because that's incredibly informative to you know, when you talk to patients about why they're going to therapy, because some people don't want to go to therapy, they don't realize what they can get out of it.
Charles Goldfarb :We, you know, we, Chris and I take pride in developing relationships with our patients, you know, hand surgeons are known fairly or unfairly, and I'm guilty as charged of having high volume practices where we see and treat a lot of patients in a short period of time. And our goal, typically with the majority of our patients is get them through an episode of X, Y, or Z. So getting through an episode or De Quervian's since it has been mentioned then having them go on about their way. So we don't always develop deep relationships with patients, but the ones we do are the ones with more challenging issues, some of the congenital issues. But whatever we do in our practice you do in spades in yours, because while I may spend five minutes or a really deep clinic visit 10 minutes with a patient, you guys spend 30 minutes with the patient. So tell us a little about that.
Macy Stonner :Yeah, I you know, it's interesting that when I work with adults, it would be it would be a span of 30 to 60 minutes, you know, for 12 weeks, maybe or eight weeks, however long it took. And now with my pediatrics, it's a span of 18 years, you know, so I really get to know my patients, especially those congenital kids that come back time after time. But I think it's such a neat experience to get to know the person, I think as you get to know the person you're treating and, and what goals they really have, you know, to get back to, you know, is it a mom wanting to get back to, you know, you know, taking care of our kids, is it an athlete wanting to get back to a sport, is it a worker that wants to get back to work? Or is it a kid that just wants to go out and play you know, whatever that is, you really get to hone in and, and learn about what makes that person tick. And I think having those those opportunities to be able to do goal directed therapy, and really guide that patient to get back can help motivate that patient to work harder, maybe for you for therapy. And, and I love that, you know, especially when you have that opportunity to have a good relationship with a doctor, you're talking back and forth. So that patient doesn't have the opportunity to really slide through and not do the home exercise program, you know, or, or, you know, if they're not doing what they're supposed to do or not following their precautions, you know, you've got that doctor there that you can call and, hey, I'm going to I'm going to tell Dr. Goldfarb that you're not doing your exercises, and you know, he's going to know that when you go back to his next doctor's visit. So I think all those kind of play into into how we treat our patients. I agree with all that I don't have a ton to add. Other than that, you know, typically we see people for 45 to 60 minutes, sometimes, sometimes twice a week, it's a lot, and most of the time, I like that. But it's funny, because if they have a small amount of time at the physician, and that short visit there might, it might show that, hey, I'm doing pretty good pain's fine, I'm alright. And then they come over to our clinic and you realize they are not alright, they are really being vulnerable with us, you get to know them in a private room, and you see them a lot and you realize, they start to realize, oh my gosh, I can't do anything. And so you get to know them well, and you really get to know their needs. And it helps you not only, you know, hone in on the science piece of it, but really the personal, the psychological kind of everything all comes together.
Amy Lake :And one more thing I'd love to add to that, too. That's so true Macey, and then sometimes it'll go to the doctor, and the doctor will spend five or 10 minutes with them, tell them all the things and then they get to us and they go, I have no idea what the doctor just said. And so you you need to know what your what the doctor probably said to that patient in order to regurgitate back to them, in more layman's terms, maybe of what the doctor said, and really what the goals are, you know, of that patient?
Charles Goldfarb :Yeah, I mean, you guys do a great job of covering our warts, and making us look good, at least I hope and think that's what's going on. That's exactly right. I mean, you add depth to our visits. And again, it's the beauty of the relationship. We briefly talked about why we love having you guys in clinic. But the other thing I really like is when younger therapists come hang out with us for a day or a week or whatever. I think that is really a neat opportunity to show a couple things show how, obviously the routine clinical practice works, but also to show again, how we value this relationship. Chris, have you had that experience? I mean, have you had your therapists come just hang out and see how you do things?
Chris Dy :Yeah, it's been fantastic. And especially when I, you know, depends on you know, obviously, there's a ton of paperwork to make that happen. But getting therapists into the OR has been really, really helpful, because then they get to see what what happens in the operating room. And whether they're in training, that's one thing, but if they're also in practice, the wide awake surgery has been fantastic. When the therapist is present, it's helpful for everybody involved. And I think one thing that my patients have told me that they really appreciate is the team approach. So knowing that, you know, I'm on the same team as my therapists that they see that they feel that and it just makes them feel comforted that everybody is on the same page.
Amy Lake :Can I come watch you do a wide awake surgery sometime. I don't know if we'll be doing them anytime soon. But Dr. Lalonde came to visit our hospital and I've heard him speak a bunch of times. And man, I would love to observe one of those.
Chris Dy :I would love to have you visit anytime
Charles Goldfarb :It is changing our practices, Chris is a little more daring than I am, as far as how much he will do. But even for simple things. It's really and for me, a lot of those patients actually never go to therapy because it is the simpler diagnoses. But it has been a real practice changer. The other practice changer is when we've had episodes about dupuytren's and needle aponeurotomies and those patients going to therapy is a very different thing. It takes - what is really almost an impossible diagnosis to treat the post operative fasciectomy patients with massive hand wounds and simplify that so I would think that Macy's happy about that maybe, maybe not. Maybe she likes those - hands that have, you know, huge scars and the unhappy patients for for six months. So Macy putting you on the spot. Have you ever been to the OR and hung out? I don't think you've come to OR with me.
Macy Stonner :No, I have never been to any OR in my life and I would love to.
Charles Goldfarb :Alright, that is a promise we will find a way to get you over there. We'll have to pick the right case. What what cases intrigued you most I know you're gonna say something like flexor tendons, which are not my favorites. Don't say nerve transfers, because then Chris will keep talking about that for the next year.
Macy Stonner :I hate to say it, Dr. Goldfarb, but I would love to see a free functional muscle transfer, a patient of mine is going to have one soon. And the thought of seeing that I think would be very awe inspiring. I don't know. I kind of get queasy. So I'm a little nervous just to maybe see something. But I think that would be the coolest.
Chris Dy :Well, the good thing for you is a Dr. Brogan and I do it together and he is an elegant and technically fantastic surgeon so you won't get queasy, don't worry. You may want to clear the day.
Amy Lake :Oh gosh, I love going into the OR I try to do that whenever I can. It's been a while now. But you know, all the girls that I train and or therapists that I've trained, there's been some guys, I always encourage them to go into the OR. It's such a such a rich and fascinating and up close anatomy lesson, I think, especially if the doctor is willing to talk through what he's doing and kind of show you some things. Sometimes they have time to do that. Sometimes you're just watching. We also now have a screen and the OR so you can kind of watch the screen. It's like a video camera. So you can you know, if you can't get up close to the actual surgery, you can watch the screen and kind of see what they're doing. And I love gosh, I love it all. And I really like pollicizations. I mean, again, you have to kind of be in there for a while to do you know to to watch all of that. I think that is so fascinating. I did get to see a long head of the triceps transfer. That was really exciting. And I just think any opportunity I really encourage you, Macy, to get in. I think it's really, really a rich opportunity.
Charles Goldfarb :Well, we will make it happen. Unfortunately, you will not see a free muscle transfer with me. All right. Well, listen, I want to say thank you to both Macy and Amy. This was super fun as we expected. And I hope informative, I think informative. Certainly, once again, I've learned. So thank you. Thanks for being here today.
Macy Stonner :Thank you so much. It was a pleasure and an honor.
Amy Lake :Yes, thank you very much for the opportunity.
Chris Dy :Those are very nice things to say to Dr. Goldfarb. Thank you for joining us. We love having you. And I know that our our listeners appreciate it. A lot of hand therapists in the audience and they have given us fantastic feedback and they've asked for more therapy guests. So thanks for joining us.
Charles Goldfarb :Hey, Chris, that was fun. Let's do it again real soon.
Chris Dy :Sounds good. Well, be sure to check us out on Twitter @hand podcast. Hey, Chuck, what's your Twitter handle?
Charles Goldfarb :Mine is @congenital hand. What about you?
Chris Dy :Mine is @ChrisDy MD spelled d y. And if you'd like to email us, you can reach us at hand podcast@gmail.com.
Charles Goldfarb :And remember, please subscribe wherever you get your podcast
Chris Dy :and be sure to leave a review that helps us get the word out.
Charles Goldfarb :Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand, come back next time.