{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.77,"endTime":13.35,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.77,"endTime":13.35,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.35,"endTime":14.46,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.7,"endTime":16.56,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.7,"endTime":16.56,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.62,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.62,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.62,"endTime":21.48,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.62,"endTime":21.48,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"subscribing, wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.33,"endTime":25.23,"body":"your podcasts"},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.66,"endTime":28.2,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.32,"endTime":29.34,"body":"Oh hey, Chris."},{"speaker":"Chris Dy","startTime":29.82,"endTime":30.78,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.82,"endTime":30.78,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.23,"endTime":33.69,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":31.23,"endTime":33.69,"body":"really well. How are you?"},{"speaker":"Chris Dy","startTime":34.08,"endTime":37.74,"body":"I am good. I am in"},{"speaker":"Chris Dy","startTime":34.08,"endTime":37.74,"body":"full training mode. It is the"},{"speaker":"Chris Dy","startTime":37.74,"endTime":42.63,"body":"day before the surgeons versus"},{"speaker":"Chris Dy","startTime":37.74,"endTime":42.63,"body":"chef pumpkin war for St. Louis"},{"speaker":"Chris Dy","startTime":42.63,"endTime":43.26,"body":"magazine."},{"speaker":"Charles Goldfarb","startTime":43.739,"endTime":46.589,"body":"You know, I am"},{"speaker":"Charles Goldfarb","startTime":43.739,"endTime":46.589,"body":"a veteran or an alum of that"},{"speaker":"Charles Goldfarb","startTime":46.589,"endTime":52.379,"body":"competition. And I went in a"},{"speaker":"Charles Goldfarb","startTime":46.589,"endTime":52.379,"body":"little naive in my expectations."},{"speaker":"Charles Goldfarb","startTime":52.439,"endTime":55.259,"body":"And I don't mean to have you"},{"speaker":"Charles Goldfarb","startTime":52.439,"endTime":55.259,"body":"lose sleep. But this is a"},{"speaker":"Charles Goldfarb","startTime":55.259,"endTime":56.579,"body":"serious competition."},{"speaker":"Chris Dy","startTime":57.59,"endTime":59.72,"body":"Good. Well, you know,"},{"speaker":"Chris Dy","startTime":57.59,"endTime":59.72,"body":"commensurate with the amount of"},{"speaker":"Chris Dy","startTime":59.72,"endTime":63.68,"body":"days I've given, been given to"},{"speaker":"Chris Dy","startTime":59.72,"endTime":63.68,"body":"prepare. I'm sure I'm going to"},{"speaker":"Chris Dy","startTime":63.68,"endTime":66.65,"body":"do exceedingly well. So what's"},{"speaker":"Chris Dy","startTime":63.68,"endTime":66.65,"body":"the key here? How do you do"},{"speaker":"Chris Dy","startTime":66.65,"endTime":69.35,"body":"well, at this competition, given"},{"speaker":"Chris Dy","startTime":66.65,"endTime":69.35,"body":"that I haven't carved a pumpkin"},{"speaker":"Chris Dy","startTime":69.35,"endTime":69.89,"body":"in 13 years."},{"speaker":"Charles Goldfarb","startTime":69.92,"endTime":72.71,"body":"Well, that's"},{"speaker":"Charles Goldfarb","startTime":69.92,"endTime":72.71,"body":"that's not a good Harbinger for"},{"speaker":"Charles Goldfarb","startTime":72.71,"endTime":78.29,"body":"success. Those who do well here"},{"speaker":"Charles Goldfarb","startTime":72.71,"endTime":78.29,"body":"have a multitude of tools such"},{"speaker":"Charles Goldfarb","startTime":78.29,"endTime":82.28,"body":"as the standard pumpkin carving"},{"speaker":"Charles Goldfarb","startTime":78.29,"endTime":82.28,"body":"tools, but they also typically"},{"speaker":"Charles Goldfarb","startTime":82.28,"endTime":86.87,"body":"bring Dremel tools. And it's"},{"speaker":"Charles Goldfarb","startTime":82.28,"endTime":86.87,"body":"it's really a it's more than"},{"speaker":"Charles Goldfarb","startTime":86.87,"endTime":90.32,"body":"this simplistic pumpkin as you"},{"speaker":"Charles Goldfarb","startTime":86.87,"endTime":90.32,"body":"might expect. I went with an"},{"speaker":"Charles Goldfarb","startTime":90.32,"endTime":95.54,"body":"emoji approach, which got some"},{"speaker":"Charles Goldfarb","startTime":90.32,"endTime":95.54,"body":"appreciation, but was so"},{"speaker":"Charles Goldfarb","startTime":95.57,"endTime":100.85,"body":"simplistic compared to those who"},{"speaker":"Charles Goldfarb","startTime":95.57,"endTime":100.85,"body":"both carved a pumpkin and had"},{"speaker":"Charles Goldfarb","startTime":100.85,"endTime":105.26,"body":"the various colors using the"},{"speaker":"Charles Goldfarb","startTime":100.85,"endTime":105.26,"body":"Dremel tool. Some went with just"},{"speaker":"Charles Goldfarb","startTime":105.26,"endTime":110.54,"body":"a pumpkin face. My year there"},{"speaker":"Charles Goldfarb","startTime":105.26,"endTime":110.54,"body":"was a ob, for example, who had a"},{"speaker":"Charles Goldfarb","startTime":110.54,"endTime":115.85,"body":"whole pumpkin with a fetus"},{"speaker":"Charles Goldfarb","startTime":110.54,"endTime":115.85,"body":"inside a uterus. So it's not"},{"speaker":"Charles Goldfarb","startTime":115.85,"endTime":117.08,"body":"just pumpkin faces."},{"speaker":"Chris Dy","startTime":117.11,"endTime":121.1,"body":"That's special. Okay."},{"speaker":"Chris Dy","startTime":117.11,"endTime":121.1,"body":"Yeah, so I've gotten some design"},{"speaker":"Chris Dy","startTime":121.1,"endTime":125.0,"body":"inspiration scrambling during"},{"speaker":"Chris Dy","startTime":121.1,"endTime":125.0,"body":"clinic yesterday, our fantastic"},{"speaker":"Chris Dy","startTime":125.0,"endTime":128.42,"body":"hand therapist showed me several"},{"speaker":"Chris Dy","startTime":125.0,"endTime":128.42,"body":"designs, you know, kind of"},{"speaker":"Chris Dy","startTime":128.42,"endTime":132.41,"body":"played to my strengths as a hand"},{"speaker":"Chris Dy","startTime":128.42,"endTime":132.41,"body":"surgeon. I'm hoping that the"},{"speaker":"Chris Dy","startTime":132.41,"endTime":137.12,"body":"carpus Does, does us an honor"},{"speaker":"Chris Dy","startTime":132.41,"endTime":137.12,"body":"here. But you know, I'm excited."},{"speaker":"Chris Dy","startTime":137.15,"endTime":139.55,"body":"I went out and purchased some"},{"speaker":"Chris Dy","startTime":137.15,"endTime":139.55,"body":"tools got some practice,"},{"speaker":"Chris Dy","startTime":139.55,"endTime":143.27,"body":"pumpkins have turned it into a"},{"speaker":"Chris Dy","startTime":139.55,"endTime":143.27,"body":"father son event. So you know,"},{"speaker":"Chris Dy","startTime":143.3,"endTime":145.91,"body":"zoom has given us a lot of"},{"speaker":"Chris Dy","startTime":143.3,"endTime":145.91,"body":"freedom here. So you're, I'm"},{"speaker":"Chris Dy","startTime":145.91,"endTime":148.91,"body":"sure people are gonna be seeing"},{"speaker":"Chris Dy","startTime":145.91,"endTime":148.91,"body":"the Dy family on display"},{"speaker":"Chris Dy","startTime":148.91,"endTime":149.36,"body":"tomorrow."},{"speaker":"Charles Goldfarb","startTime":149.79,"endTime":151.5,"body":"Yeah, it is"},{"speaker":"Charles Goldfarb","startTime":149.79,"endTime":151.5,"body":"interesting. Doing it by zoom is"},{"speaker":"Charles Goldfarb","startTime":151.5,"endTime":154.05,"body":"both better and worse, it was"},{"speaker":"Charles Goldfarb","startTime":151.5,"endTime":154.05,"body":"fun in person, but it was a"},{"speaker":"Charles Goldfarb","startTime":154.05,"endTime":157.2,"body":"little more stressful. And I"},{"speaker":"Charles Goldfarb","startTime":154.05,"endTime":157.2,"body":"think that if your kids are part"},{"speaker":"Charles Goldfarb","startTime":157.2,"endTime":160.35,"body":"of your Prop, then you could"},{"speaker":"Charles Goldfarb","startTime":157.2,"endTime":160.35,"body":"win. Because they're pretty"},{"speaker":"Charles Goldfarb","startTime":160.35,"endTime":160.71,"body":"cute."},{"speaker":"Chris Dy","startTime":161.17,"endTime":163.72,"body":"Well, you know, it"},{"speaker":"Chris Dy","startTime":161.17,"endTime":163.72,"body":"sounds like, you know, the bar"},{"speaker":"Chris Dy","startTime":163.72,"endTime":167.65,"body":"is quite low for the orthopedic"},{"speaker":"Chris Dy","startTime":163.72,"endTime":167.65,"body":"hand team in the past. So I"},{"speaker":"Chris Dy","startTime":167.65,"endTime":170.98,"body":"appreciate that. We are not"},{"speaker":"Chris Dy","startTime":167.65,"endTime":170.98,"body":"going to go with just a face. So"},{"speaker":"Chris Dy","startTime":170.98,"endTime":174.1,"body":"we'll see what happens I will"},{"speaker":"Chris Dy","startTime":170.98,"endTime":174.1,"body":"probably take this opportunity"},{"speaker":"Chris Dy","startTime":174.1,"endTime":176.65,"body":"to fail publicly, like I have"},{"speaker":"Chris Dy","startTime":174.1,"endTime":176.65,"body":"with many other things. So"},{"speaker":"Charles Goldfarb","startTime":177.01,"endTime":179.98,"body":"I welcome"},{"speaker":"Charles Goldfarb","startTime":177.01,"endTime":179.98,"body":"that. And I know that you'll"},{"speaker":"Charles Goldfarb","startTime":179.98,"endTime":183.31,"body":"fail on Twitter, indeed. So I"},{"speaker":"Charles Goldfarb","startTime":179.98,"endTime":183.31,"body":"look forward to seeing your"},{"speaker":"Charles Goldfarb","startTime":183.31,"endTime":185.05,"body":"pumpkin shared with all"},{"speaker":"Chris Dy","startTime":185.17,"endTime":187.09,"body":"Listen, if I'm gonna"},{"speaker":"Chris Dy","startTime":185.17,"endTime":187.09,"body":"fail, everybody's gonna see it."},{"speaker":"Chris Dy","startTime":188.32,"endTime":192.58,"body":"So the question people have been"},{"speaker":"Chris Dy","startTime":188.32,"endTime":192.58,"body":"dying to know the answer to,"},{"speaker":"Chris Dy","startTime":193.06,"endTime":197.23,"body":"Chuck, how do they get a hand?"},{"speaker":"Chris Dy","startTime":193.06,"endTime":197.23,"body":"Oh, that's a good pun. How did"},{"speaker":"Chris Dy","startTime":197.23,"endTime":199.96,"body":"they get their hands on one of"},{"speaker":"Chris Dy","startTime":197.23,"endTime":199.96,"body":"the sweet upper hand coffee"},{"speaker":"Chris Dy","startTime":199.96,"endTime":200.47,"body":"mugs?"},{"speaker":"Charles Goldfarb","startTime":200.82,"endTime":204.33,"body":"Well, these"},{"speaker":"Charles Goldfarb","startTime":200.82,"endTime":204.33,"body":"are limited edition. We've only"},{"speaker":"Charles Goldfarb","startTime":204.33,"endTime":208.47,"body":"done one mug printing. And I"},{"speaker":"Charles Goldfarb","startTime":204.33,"endTime":208.47,"body":"think they're stored in both my"},{"speaker":"Charles Goldfarb","startTime":208.47,"endTime":214.62,"body":"basement and yours. And they're"},{"speaker":"Charles Goldfarb","startTime":208.47,"endTime":214.62,"body":"sweet, I have to say. And we've"},{"speaker":"Charles Goldfarb","startTime":214.62,"endTime":218.1,"body":"struggled with the best way to"},{"speaker":"Charles Goldfarb","startTime":214.62,"endTime":218.1,"body":"share these mugs. And I think"},{"speaker":"Charles Goldfarb","startTime":218.1,"endTime":222.33,"body":"we've come up with a really good"},{"speaker":"Charles Goldfarb","startTime":218.1,"endTime":222.33,"body":"win win. What do you think?"},{"speaker":"Chris Dy","startTime":223.2,"endTime":225.24,"body":"I think so. Um, so"},{"speaker":"Chris Dy","startTime":223.2,"endTime":225.24,"body":"what we've done is we've"},{"speaker":"Chris Dy","startTime":225.24,"endTime":229.95,"body":"established a listener survey,"},{"speaker":"Chris Dy","startTime":225.24,"endTime":229.95,"body":"which will help us make sure"},{"speaker":"Chris Dy","startTime":229.95,"endTime":233.04,"body":"that we're talking about what"},{"speaker":"Chris Dy","startTime":229.95,"endTime":233.04,"body":"everybody wants us to talk"},{"speaker":"Chris Dy","startTime":233.04,"endTime":237.15,"body":"about. You know we try to"},{"speaker":"Chris Dy","startTime":233.04,"endTime":237.15,"body":"predict what what would be, you"},{"speaker":"Chris Dy","startTime":237.15,"endTime":240.18,"body":"know, good episode topics and"},{"speaker":"Chris Dy","startTime":237.15,"endTime":240.18,"body":"format things. But we're"},{"speaker":"Chris Dy","startTime":240.18,"endTime":244.02,"body":"certainly open to suggestions."},{"speaker":"Chris Dy","startTime":240.18,"endTime":244.02,"body":"So this is a great way for, for"},{"speaker":"Chris Dy","startTime":244.02,"endTime":246.0,"body":"listeners to give us"},{"speaker":"Chris Dy","startTime":244.02,"endTime":246.0,"body":"suggestions. So how do they"},{"speaker":"Chris Dy","startTime":246.0,"endTime":249.0,"body":"access the listener survey"},{"speaker":"Chris Dy","startTime":246.0,"endTime":249.0,"body":"Chuck,"},{"speaker":"Charles Goldfarb","startTime":249.54,"endTime":251.97,"body":"it will be a"},{"speaker":"Charles Goldfarb","startTime":249.54,"endTime":251.97,"body":"link and we will put it in the"},{"speaker":"Charles Goldfarb","startTime":251.97,"endTime":255.51,"body":"show notes for this episode. And"},{"speaker":"Charles Goldfarb","startTime":251.97,"endTime":255.51,"body":"we're going to leave the survey"},{"speaker":"Charles Goldfarb","startTime":255.51,"endTime":258.57,"body":"the initial plans to leave the"},{"speaker":"Charles Goldfarb","startTime":255.51,"endTime":258.57,"body":"survey open for one month, and"},{"speaker":"Charles Goldfarb","startTime":258.57,"endTime":262.5,"body":"then tabulate the results we'll"},{"speaker":"Charles Goldfarb","startTime":258.57,"endTime":262.5,"body":"share the results as well. And"},{"speaker":"Charles Goldfarb","startTime":262.53,"endTime":267.54,"body":"our goal will be to to award a"},{"speaker":"Charles Goldfarb","startTime":262.53,"endTime":267.54,"body":"mug a month. And so we're gonna"},{"speaker":"Charles Goldfarb","startTime":267.54,"endTime":270.66,"body":"have to think about exactly how"},{"speaker":"Charles Goldfarb","startTime":267.54,"endTime":270.66,"body":"to do that. Certainly emails"},{"speaker":"Charles Goldfarb","startTime":270.66,"endTime":274.95,"body":"with show ideas are still"},{"speaker":"Charles Goldfarb","startTime":270.66,"endTime":274.95,"body":"welcome. We would love to have"},{"speaker":"Charles Goldfarb","startTime":274.95,"endTime":278.13,"body":"your reviews. So there's"},{"speaker":"Charles Goldfarb","startTime":274.95,"endTime":278.13,"body":"multiple ways to get in good"},{"speaker":"Charles Goldfarb","startTime":278.13,"endTime":282.87,"body":"with the creators and"},{"speaker":"Charles Goldfarb","startTime":278.13,"endTime":282.87,"body":"proprietors of the upperhand"},{"speaker":"Charles Goldfarb","startTime":282.87,"endTime":284.49,"body":"podcast. it's a limited group."},{"speaker":"Chris Dy","startTime":285.5,"endTime":288.8,"body":"I feel like you made"},{"speaker":"Chris Dy","startTime":285.5,"endTime":288.8,"body":"it transparent, but it's also"},{"speaker":"Chris Dy","startTime":288.8,"endTime":293.12,"body":"transparent that this is a very"},{"speaker":"Chris Dy","startTime":288.8,"endTime":293.12,"body":"opaque process. So"},{"speaker":"Chris Dy","startTime":293.12,"endTime":298.19,"body":"handpodcast@gmail.com for show"},{"speaker":"Chris Dy","startTime":293.12,"endTime":298.19,"body":"ideas, please leave a review."},{"speaker":"Chris Dy","startTime":298.94,"endTime":301.25,"body":"Apparently that's gonna grease"},{"speaker":"Chris Dy","startTime":298.94,"endTime":301.25,"body":"the wheel for Chuck when he is"},{"speaker":"Chris Dy","startTime":301.25,"endTime":304.58,"body":"doing the blind drawing. But"},{"speaker":"Chris Dy","startTime":301.25,"endTime":304.58,"body":"then also take a look in the"},{"speaker":"Chris Dy","startTime":304.58,"endTime":306.32,"body":"show notes for the listener"},{"speaker":"Chris Dy","startTime":304.58,"endTime":306.32,"body":"survey."},{"speaker":"Charles Goldfarb","startTime":306.899,"endTime":309.809,"body":"Well, I'm not"},{"speaker":"Charles Goldfarb","startTime":306.899,"endTime":309.809,"body":"just suggesting that only good"},{"speaker":"Charles Goldfarb","startTime":309.809,"endTime":313.349,"body":"reviews and good comments have a"},{"speaker":"Charles Goldfarb","startTime":309.809,"endTime":313.349,"body":"chance to win I, we want honest"},{"speaker":"Charles Goldfarb","startTime":313.349,"endTime":315.689,"body":"feedback, we want to know what"},{"speaker":"Charles Goldfarb","startTime":313.349,"endTime":315.689,"body":"we can do better."},{"speaker":"Chris Dy","startTime":316.41,"endTime":319.2,"body":"100%. And you know, if"},{"speaker":"Chris Dy","startTime":316.41,"endTime":319.2,"body":"you if you take a picture of"},{"speaker":"Chris Dy","startTime":319.2,"endTime":321.93,"body":"yourself listening to the upper"},{"speaker":"Chris Dy","startTime":319.2,"endTime":321.93,"body":"hand or telling a colleague"},{"speaker":"Chris Dy","startTime":321.93,"endTime":324.72,"body":"about the upper hand in a"},{"speaker":"Chris Dy","startTime":321.93,"endTime":324.72,"body":"creative way, I think that may"},{"speaker":"Chris Dy","startTime":324.72,"endTime":326.16,"body":"deserve a mug too. We'll see."},{"speaker":"Charles Goldfarb","startTime":326.58,"endTime":328.41,"body":"Yeah, listen,"},{"speaker":"Charles Goldfarb","startTime":326.58,"endTime":328.41,"body":"Chris just wants to hand out"},{"speaker":"Charles Goldfarb","startTime":328.41,"endTime":331.2,"body":"mugs to everybody. I'm trying to"},{"speaker":"Charles Goldfarb","startTime":328.41,"endTime":331.2,"body":"be a little responsible with"},{"speaker":"Charles Goldfarb","startTime":331.2,"endTime":333.87,"body":"this process. So we'll see what"},{"speaker":"Charles Goldfarb","startTime":331.2,"endTime":333.87,"body":"happens."},{"speaker":"Chris Dy","startTime":335.1,"endTime":338.55,"body":"So we have, I got some"},{"speaker":"Chris Dy","startTime":335.1,"endTime":338.55,"body":"fantastic feedback. I didn't"},{"speaker":"Chris Dy","startTime":338.55,"endTime":342.39,"body":"explicitly ask this trainee if I"},{"speaker":"Chris Dy","startTime":338.55,"endTime":342.39,"body":"could read it. So I will not"},{"speaker":"Chris Dy","startTime":342.63,"endTime":347.1,"body":"divulge their name. But a"},{"speaker":"Chris Dy","startTime":342.63,"endTime":347.1,"body":"plastic surgery resident who is"},{"speaker":"Chris Dy","startTime":347.1,"endTime":350.79,"body":"hand fellowship bound, who is"},{"speaker":"Chris Dy","startTime":347.1,"endTime":350.79,"body":"currently in studying for their"},{"speaker":"Chris Dy","startTime":350.79,"endTime":354.69,"body":"boards, they mentioned that they"},{"speaker":"Chris Dy","startTime":350.79,"endTime":354.69,"body":"are in full exam study mode"},{"speaker":"Chris Dy","startTime":354.69,"endTime":358.23,"body":"these days, and your podcast has"},{"speaker":"Chris Dy","startTime":354.69,"endTime":358.23,"body":"been a great resource. So thank"},{"speaker":"Chris Dy","startTime":358.23,"endTime":361.44,"body":"you, you know who you are. And"},{"speaker":"Chris Dy","startTime":358.23,"endTime":361.44,"body":"thank you to every all the"},{"speaker":"Chris Dy","startTime":361.44,"endTime":364.98,"body":"trainees who are listening in,"},{"speaker":"Chris Dy","startTime":361.44,"endTime":364.98,"body":"we hope that we're a great"},{"speaker":"Chris Dy","startTime":364.98,"endTime":368.16,"body":"resource, we hope we're staying"},{"speaker":"Chris Dy","startTime":364.98,"endTime":368.16,"body":"close to the board answers, you"},{"speaker":"Chris Dy","startTime":368.16,"endTime":369.54,"body":"know, and not veering too far"},{"speaker":"Chris Dy","startTime":368.16,"endTime":369.54,"body":"from them."},{"speaker":"Charles Goldfarb","startTime":370.05,"endTime":371.67,"body":"Well, that's"},{"speaker":"Charles Goldfarb","startTime":370.05,"endTime":371.67,"body":"great, because you know, study"},{"speaker":"Charles Goldfarb","startTime":371.67,"endTime":378.51,"body":"time is got to be really deeply"},{"speaker":"Charles Goldfarb","startTime":371.67,"endTime":378.51,"body":"valuable. In other words, if"},{"speaker":"Charles Goldfarb","startTime":378.51,"endTime":382.05,"body":"we're giving out one pearl for"},{"speaker":"Charles Goldfarb","startTime":378.51,"endTime":382.05,"body":"every hour of listening, it's"},{"speaker":"Charles Goldfarb","startTime":382.05,"endTime":385.17,"body":"probably not worth your time. So"},{"speaker":"Charles Goldfarb","startTime":382.05,"endTime":385.17,"body":"hopefully, we are, you know,"},{"speaker":"Charles Goldfarb","startTime":385.17,"endTime":388.5,"body":"really discussing topics in a"},{"speaker":"Charles Goldfarb","startTime":385.17,"endTime":388.5,"body":"way which can be helpful. So"},{"speaker":"Charles Goldfarb","startTime":388.77,"endTime":391.47,"body":"that really is a generous"},{"speaker":"Charles Goldfarb","startTime":388.77,"endTime":391.47,"body":"review, for sure. Thank you."},{"speaker":"Chris Dy","startTime":392.59,"endTime":394.18,"body":"So Chuck any good"},{"speaker":"Chris Dy","startTime":392.59,"endTime":394.18,"body":"cases recently?"},{"speaker":"Charles Goldfarb","startTime":394.66,"endTime":396.28,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":394.66,"endTime":396.28,"body":"did have a good case recently,"},{"speaker":"Charles Goldfarb","startTime":396.28,"endTime":399.43,"body":"which was unusual, and that's"},{"speaker":"Charles Goldfarb","startTime":396.28,"endTime":399.43,"body":"why I'd like to share it and so"},{"speaker":"Charles Goldfarb","startTime":399.79,"endTime":407.2,"body":"I had a referral in which the"},{"speaker":"Charles Goldfarb","startTime":399.79,"endTime":407.2,"body":"patient had relatively normal"},{"speaker":"Charles Goldfarb","startTime":407.2,"endTime":410.53,"body":"looking x rays, but something"},{"speaker":"Charles Goldfarb","startTime":407.2,"endTime":410.53,"body":"just didn't look right with the"},{"speaker":"Charles Goldfarb","startTime":410.53,"endTime":415.15,"body":"scaphoid. So we got a CT scan,"},{"speaker":"Charles Goldfarb","startTime":410.53,"endTime":415.15,"body":"and the CT scan showed a"},{"speaker":"Charles Goldfarb","startTime":415.15,"endTime":418.75,"body":"markedly displaced scaphoid"},{"speaker":"Charles Goldfarb","startTime":415.15,"endTime":418.75,"body":"fracture, but displaced in a way"},{"speaker":"Charles Goldfarb","startTime":418.75,"endTime":423.91,"body":"that on the PA and the oblique"},{"speaker":"Charles Goldfarb","startTime":418.75,"endTime":423.91,"body":"you could kind of make it out on"},{"speaker":"Charles Goldfarb","startTime":423.91,"endTime":426.94,"body":"the lateral a good lateral would"},{"speaker":"Charles Goldfarb","startTime":423.91,"endTime":426.94,"body":"have shown it but it was that"},{"speaker":"Charles Goldfarb","startTime":426.94,"endTime":429.46,"body":"classic situation where the"},{"speaker":"Charles Goldfarb","startTime":426.94,"endTime":429.46,"body":"lateral wasn't good, I didn't"},{"speaker":"Charles Goldfarb","startTime":429.46,"endTime":433.33,"body":"repeat it, I still would have"},{"speaker":"Charles Goldfarb","startTime":429.46,"endTime":433.33,"body":"gotten a CT scan. So no regrets"},{"speaker":"Charles Goldfarb","startTime":433.33,"endTime":435.97,"body":"but it does emphasize to me the"},{"speaker":"Charles Goldfarb","startTime":433.33,"endTime":435.97,"body":"need to have standardized"},{"speaker":"Charles Goldfarb","startTime":435.97,"endTime":438.01,"body":"radiographs. These were outside"},{"speaker":"Charles Goldfarb","startTime":435.97,"endTime":438.01,"body":"radiographs, you and I've"},{"speaker":"Charles Goldfarb","startTime":438.01,"endTime":442.18,"body":"discussed how we're fortunate to"},{"speaker":"Charles Goldfarb","startTime":438.01,"endTime":442.18,"body":"have wonderful radiography, you"},{"speaker":"Charles Goldfarb","startTime":442.18,"endTime":446.02,"body":"know, access. So I got the CT"},{"speaker":"Charles Goldfarb","startTime":442.18,"endTime":446.02,"body":"scan, and it showed a widely"},{"speaker":"Charles Goldfarb","startTime":446.02,"endTime":449.56,"body":"displaced scaphoid fracture with"},{"speaker":"Charles Goldfarb","startTime":446.02,"endTime":449.56,"body":"the distal fragment displaced"},{"speaker":"Charles Goldfarb","startTime":449.59,"endTime":455.59,"body":"volarly. And it just struck me"},{"speaker":"Charles Goldfarb","startTime":449.59,"endTime":455.59,"body":"as odd. And there was a couple"},{"speaker":"Charles Goldfarb","startTime":455.59,"endTime":460.39,"body":"of fragments in the capitolunate"},{"speaker":"Charles Goldfarb","startTime":455.59,"endTime":460.39,"body":"joint, and the capitolunate"},{"speaker":"Charles Goldfarb","startTime":460.39,"endTime":463.0,"body":"joint didn't look quite right"},{"speaker":"Charles Goldfarb","startTime":460.39,"endTime":463.0,"body":"either. But everything else"},{"speaker":"Charles Goldfarb","startTime":463.0,"endTime":467.56,"body":"looked great. So normally, I"},{"speaker":"Charles Goldfarb","startTime":463.0,"endTime":467.56,"body":"would simply approach that with"},{"speaker":"Charles Goldfarb","startTime":467.62,"endTime":472.84,"body":"an open volar. And it was a"},{"speaker":"Charles Goldfarb","startTime":467.62,"endTime":472.84,"body":"waste an open volar approach and"},{"speaker":"Charles Goldfarb","startTime":472.87,"endTime":478.12,"body":"fixation. But I decided to"},{"speaker":"Charles Goldfarb","startTime":472.87,"endTime":478.12,"body":"approach this arthroscopically"},{"speaker":"Charles Goldfarb","startTime":478.72,"endTime":481.03,"body":"because I thought there was a"},{"speaker":"Charles Goldfarb","startTime":478.72,"endTime":481.03,"body":"chance I could reduce the"},{"speaker":"Charles Goldfarb","startTime":481.03,"endTime":483.61,"body":"scaphoid arthroscopically and"},{"speaker":"Charles Goldfarb","startTime":481.03,"endTime":483.61,"body":"put a screw in from dorsally."},{"speaker":"Charles Goldfarb","startTime":483.76,"endTime":488.23,"body":"And also just had a little sense"},{"speaker":"Charles Goldfarb","startTime":483.76,"endTime":488.23,"body":"that something wasn't right. And"},{"speaker":"Charles Goldfarb","startTime":488.71,"endTime":490.75,"body":"one of the things I think is"},{"speaker":"Charles Goldfarb","startTime":488.71,"endTime":490.75,"body":"interesting for all of us to"},{"speaker":"Charles Goldfarb","startTime":490.75,"endTime":495.64,"body":"consider is I did not put that"},{"speaker":"Charles Goldfarb","startTime":490.75,"endTime":495.64,"body":"that case on my busy day."},{"speaker":"Charles Goldfarb","startTime":496.03,"endTime":498.76,"body":"Because cases like that are"},{"speaker":"Charles Goldfarb","startTime":496.03,"endTime":498.76,"body":"tough, you can't predict how"},{"speaker":"Charles Goldfarb","startTime":498.76,"endTime":501.97,"body":"long they're gonna take, I might"},{"speaker":"Charles Goldfarb","startTime":498.76,"endTime":501.97,"body":"have been too quick to pull the"},{"speaker":"Charles Goldfarb","startTime":502.03,"endTime":504.7,"body":"pull the trigger to get rid of"},{"speaker":"Charles Goldfarb","startTime":502.03,"endTime":504.7,"body":"the scope and bring in the open"},{"speaker":"Charles Goldfarb","startTime":504.7,"endTime":508.39,"body":"part of the surgery. And so"},{"speaker":"Charles Goldfarb","startTime":504.7,"endTime":508.39,"body":"those cases, for me are best"},{"speaker":"Charles Goldfarb","startTime":508.39,"endTime":512.44,"body":"done on my non busy surgical"},{"speaker":"Charles Goldfarb","startTime":508.39,"endTime":512.44,"body":"day. And I don't do that very"},{"speaker":"Charles Goldfarb","startTime":512.44,"endTime":516.16,"body":"often. And you do more of it. So"},{"speaker":"Charles Goldfarb","startTime":512.44,"endTime":516.16,"body":"I'll stop there. How do you"},{"speaker":"Charles Goldfarb","startTime":516.16,"endTime":520.27,"body":"approach that? I mean, do you"},{"speaker":"Charles Goldfarb","startTime":516.16,"endTime":520.27,"body":"try to do uncertain cases in a"},{"speaker":"Charles Goldfarb","startTime":520.27,"endTime":522.46,"body":"day where you're running back"},{"speaker":"Charles Goldfarb","startTime":520.27,"endTime":522.46,"body":"and forth doing lots of surgery?"},{"speaker":"Charles Goldfarb","startTime":522.46,"endTime":525.43,"body":"Or do you reserve those type of"},{"speaker":"Charles Goldfarb","startTime":522.46,"endTime":525.43,"body":"cases for different days?"},{"speaker":"Chris Dy","startTime":526.35,"endTime":528.21,"body":"Well, there is, um,"},{"speaker":"Chris Dy","startTime":526.35,"endTime":528.21,"body":"for example, you know, the"},{"speaker":"Chris Dy","startTime":528.21,"endTime":530.91,"body":"Plexus stuff, you have a sense"},{"speaker":"Chris Dy","startTime":528.21,"endTime":530.91,"body":"of what you're going to do when"},{"speaker":"Chris Dy","startTime":530.91,"endTime":534.03,"body":"you go into it. And I've gotten"},{"speaker":"Chris Dy","startTime":530.91,"endTime":534.03,"body":"pretty facile with it, I kind of"},{"speaker":"Chris Dy","startTime":534.03,"endTime":535.95,"body":"know how long it's gonna take me"},{"speaker":"Chris Dy","startTime":534.03,"endTime":535.95,"body":"to do a lot of this stuff,"},{"speaker":"Chris Dy","startTime":535.95,"endTime":539.04,"body":"especially if I'm not exploring"},{"speaker":"Chris Dy","startTime":535.95,"endTime":539.04,"body":"to Plexus and I'm going directly"},{"speaker":"Chris Dy","startTime":539.04,"endTime":542.82,"body":"to distal nerve transfers. And I"},{"speaker":"Chris Dy","startTime":539.04,"endTime":542.82,"body":"had a couple of months ago, I"},{"speaker":"Chris Dy","startTime":542.82,"endTime":546.33,"body":"had two weeks where I had back"},{"speaker":"Chris Dy","startTime":542.82,"endTime":546.33,"body":"to back spinal accessory to"},{"speaker":"Chris Dy","startTime":546.33,"endTime":549.36,"body":"Super SCAP and triceps to"},{"speaker":"Chris Dy","startTime":546.33,"endTime":549.36,"body":"axillary nerve transfers, and I"},{"speaker":"Chris Dy","startTime":549.36,"endTime":551.73,"body":"was going to do them posteriorly"},{"speaker":"Chris Dy","startTime":549.36,"endTime":551.73,"body":"and, you know, be out of the"},{"speaker":"Chris Dy","startTime":551.73,"endTime":555.45,"body":"zone of injury. And I could have"},{"speaker":"Chris Dy","startTime":551.73,"endTime":555.45,"body":"done both of them in one day."},{"speaker":"Chris Dy","startTime":555.48,"endTime":558.3,"body":"But I also knew that emotionally"},{"speaker":"Chris Dy","startTime":555.48,"endTime":558.3,"body":"for me, that would have been a"},{"speaker":"Chris Dy","startTime":558.3,"endTime":562.05,"body":"whole lot just because you never"},{"speaker":"Chris Dy","startTime":558.3,"endTime":562.05,"body":"know. And I don't want to feel"},{"speaker":"Chris Dy","startTime":562.05,"endTime":564.63,"body":"like I'm rushing at all. And I"},{"speaker":"Chris Dy","startTime":562.05,"endTime":564.63,"body":"finished both of them before"},{"speaker":"Chris Dy","startTime":564.63,"endTime":569.01,"body":"noon and had some time to do"},{"speaker":"Chris Dy","startTime":564.63,"endTime":569.01,"body":"other things. But I told the"},{"speaker":"Chris Dy","startTime":569.01,"endTime":571.35,"body":"resident that I was with, I"},{"speaker":"Chris Dy","startTime":569.01,"endTime":571.35,"body":"said, look, I think we could"},{"speaker":"Chris Dy","startTime":571.35,"endTime":574.62,"body":"probably knock both of these out"},{"speaker":"Chris Dy","startTime":571.35,"endTime":574.62,"body":"in one day. But I think you"},{"speaker":"Chris Dy","startTime":574.62,"endTime":577.32,"body":"never quite know and it's not"},{"speaker":"Chris Dy","startTime":574.62,"endTime":577.32,"body":"the case you want to rush on not"},{"speaker":"Chris Dy","startTime":577.32,"endTime":579.72,"body":"that you want to rush on any"},{"speaker":"Chris Dy","startTime":577.32,"endTime":579.72,"body":"surgery. But there are some"},{"speaker":"Chris Dy","startTime":579.72,"endTime":581.79,"body":"cases where you know, there's"},{"speaker":"Chris Dy","startTime":579.72,"endTime":581.79,"body":"gonna be you're gonna need a lot"},{"speaker":"Chris Dy","startTime":581.79,"endTime":584.52,"body":"more headspace on and you're"},{"speaker":"Chris Dy","startTime":581.79,"endTime":584.52,"body":"gonna need a lot more emotional"},{"speaker":"Chris Dy","startTime":584.52,"endTime":586.95,"body":"reserve just in case things are"},{"speaker":"Chris Dy","startTime":584.52,"endTime":586.95,"body":"a little trickier than you"},{"speaker":"Chris Dy","startTime":586.95,"endTime":587.46,"body":"expect."},{"speaker":"Charles Goldfarb","startTime":588.2,"endTime":590.9,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":588.2,"endTime":590.9,"body":"well said for me on my busy"},{"speaker":"Charles Goldfarb","startTime":590.9,"endTime":594.53,"body":"surgical day. I spend actually a"},{"speaker":"Charles Goldfarb","startTime":590.9,"endTime":594.53,"body":"fair amount of time designing"},{"speaker":"Charles Goldfarb","startTime":594.53,"endTime":598.76,"body":"the day. I run two rooms, I"},{"speaker":"Charles Goldfarb","startTime":594.53,"endTime":598.76,"body":"overlap cases but I am"},{"speaker":"Charles Goldfarb","startTime":598.76,"endTime":602.81,"body":"physically present for Almost"},{"speaker":"Charles Goldfarb","startTime":598.76,"endTime":602.81,"body":"the entirety of every case, and"},{"speaker":"Charles Goldfarb","startTime":602.81,"endTime":606.92,"body":"it works and the surgery center"},{"speaker":"Charles Goldfarb","startTime":602.81,"endTime":606.92,"body":"trust me, because I do spend"},{"speaker":"Charles Goldfarb","startTime":606.92,"endTime":609.98,"body":"time thinking about this and I"},{"speaker":"Charles Goldfarb","startTime":606.92,"endTime":609.98,"body":"have a lot of goodwill built it,"},{"speaker":"Charles Goldfarb","startTime":610.01,"endTime":613.7,"body":"you know, built up, but a case"},{"speaker":"Charles Goldfarb","startTime":610.01,"endTime":613.7,"body":"like this can wreck it. And so I"},{"speaker":"Charles Goldfarb","startTime":613.7,"endTime":615.62,"body":"did it on a different day. And"},{"speaker":"Charles Goldfarb","startTime":613.7,"endTime":615.62,"body":"I'll tell you briefly I don't"},{"speaker":"Charles Goldfarb","startTime":615.62,"endTime":618.38,"body":"want to go into too much detail."},{"speaker":"Charles Goldfarb","startTime":615.62,"endTime":618.38,"body":"But there was cap there was"},{"speaker":"Charles Goldfarb","startTime":618.38,"endTime":624.14,"body":"severe capitolunate arthrosis."},{"speaker":"Charles Goldfarb","startTime":618.38,"endTime":624.14,"body":"There was not a complete but"},{"speaker":"Charles Goldfarb","startTime":624.14,"endTime":630.71,"body":"there was probably a Geisler"},{"speaker":"Charles Goldfarb","startTime":624.14,"endTime":630.71,"body":"grade three LT tear and this"},{"speaker":"Charles Goldfarb","startTime":630.71,"endTime":635.75,"body":"widely displaced scaphoid, so I"},{"speaker":"Charles Goldfarb","startTime":630.71,"endTime":635.75,"body":"don't really know what was going"},{"speaker":"Charles Goldfarb","startTime":635.75,"endTime":640.64,"body":"on. I do think the scaphoid was"},{"speaker":"Charles Goldfarb","startTime":635.75,"endTime":640.64,"body":"likely acute, but it felt more"},{"speaker":"Charles Goldfarb","startTime":640.64,"endTime":643.67,"body":"like a perilunate situation."},{"speaker":"Charles Goldfarb","startTime":640.64,"endTime":643.67,"body":"Although the mechanism didn't"},{"speaker":"Charles Goldfarb","startTime":643.67,"endTime":647.45,"body":"fit, he punched a punched a wall"},{"speaker":"Charles Goldfarb","startTime":643.67,"endTime":647.45,"body":"and unfortunately, the wall"},{"speaker":"Charles Goldfarb","startTime":647.48,"endTime":650.66,"body":"where he punched it had a stud"},{"speaker":"Charles Goldfarb","startTime":647.48,"endTime":650.66,"body":"behind it. And so it wasn't"},{"speaker":"Charles Goldfarb","startTime":650.66,"endTime":653.84,"body":"ideal for him. So it was just a"},{"speaker":"Charles Goldfarb","startTime":650.66,"endTime":653.84,"body":"very unusual situation. I was"},{"speaker":"Charles Goldfarb","startTime":653.87,"endTime":658.37,"body":"unable to reduce the scaphoid"},{"speaker":"Charles Goldfarb","startTime":653.87,"endTime":658.37,"body":"arthroscopically so I did end up"},{"speaker":"Charles Goldfarb","startTime":658.37,"endTime":661.76,"body":"having to open it, which was"},{"speaker":"Charles Goldfarb","startTime":658.37,"endTime":661.76,"body":"fine. Just a really interesting"},{"speaker":"Charles Goldfarb","startTime":661.76,"endTime":664.34,"body":"case for me. And it reiterated a"},{"speaker":"Charles Goldfarb","startTime":661.76,"endTime":664.34,"body":"couple of the points we've we've"},{"speaker":"Charles Goldfarb","startTime":664.34,"endTime":664.7,"body":"hit on."},{"speaker":"Chris Dy","startTime":665.23,"endTime":669.1,"body":"So why why- How did"},{"speaker":"Chris Dy","startTime":665.23,"endTime":669.1,"body":"you how are you going to proceed"},{"speaker":"Chris Dy","startTime":669.1,"endTime":672.58,"body":"in terms of you know, the"},{"speaker":"Chris Dy","startTime":669.1,"endTime":672.58,"body":"capitolunate issues and"},{"speaker":"Chris Dy","startTime":672.58,"endTime":675.49,"body":"lunotriquetral issues going"},{"speaker":"Chris Dy","startTime":672.58,"endTime":675.49,"body":"forward? Obviously, you fixed"},{"speaker":"Chris Dy","startTime":675.49,"endTime":676.48,"body":"the scaphoid now."},{"speaker":"Charles Goldfarb","startTime":676.84,"endTime":678.91,"body":"Yeah, so we"},{"speaker":"Charles Goldfarb","startTime":676.84,"endTime":678.91,"body":"use the the arthroscopic"},{"speaker":"Charles Goldfarb","startTime":678.91,"endTime":683.62,"body":"assistance to debride and pin"},{"speaker":"Charles Goldfarb","startTime":678.91,"endTime":683.62,"body":"the LT. And that was you know,"},{"speaker":"Charles Goldfarb","startTime":683.62,"endTime":686.29,"body":"pretty straightforward. We"},{"speaker":"Charles Goldfarb","startTime":683.62,"endTime":686.29,"body":"cleaned up the capitolunate"},{"speaker":"Charles Goldfarb","startTime":686.29,"endTime":691.6,"body":"joint, but did not do anything"},{"speaker":"Charles Goldfarb","startTime":686.29,"endTime":691.6,"body":"with it. And then we fix the"},{"speaker":"Charles Goldfarb","startTime":691.6,"endTime":695.59,"body":"scaphoid. And my thought process"},{"speaker":"Charles Goldfarb","startTime":691.6,"endTime":695.59,"body":"was the capitolunate has to be"},{"speaker":"Charles Goldfarb","startTime":695.59,"endTime":698.68,"body":"chronic. And so let's see what"},{"speaker":"Charles Goldfarb","startTime":695.59,"endTime":698.68,"body":"happens over time."},{"speaker":"Chris Dy","startTime":699.58,"endTime":702.52,"body":"As I'm reminded of"},{"speaker":"Chris Dy","startTime":699.58,"endTime":702.52,"body":"King George in the wonderful"},{"speaker":"Chris Dy","startTime":702.52,"endTime":704.83,"body":"musical, Hamilton, you'll be"},{"speaker":"Chris Dy","startTime":702.52,"endTime":704.83,"body":"back."},{"speaker":"Charles Goldfarb","startTime":708.16,"endTime":711.19,"body":"Oh Lord, that"},{"speaker":"Charles Goldfarb","startTime":708.16,"endTime":711.19,"body":"that reference would have been"},{"speaker":"Charles Goldfarb","startTime":711.19,"endTime":714.76,"body":"well well received by my family"},{"speaker":"Charles Goldfarb","startTime":711.19,"endTime":714.76,"body":"but I have not seen it."},{"speaker":"Chris Dy","startTime":715.32,"endTime":717.63,"body":"Oh, well people"},{"speaker":"Chris Dy","startTime":715.32,"endTime":717.63,"body":"listening are gonna judge both"},{"speaker":"Chris Dy","startTime":717.63,"endTime":719.85,"body":"of us for what just happened,"},{"speaker":"Chris Dy","startTime":717.63,"endTime":719.85,"body":"you for not watching Hamilton,"},{"speaker":"Chris Dy","startTime":719.85,"endTime":720.72,"body":"me for quoting it"},{"speaker":"Charles Goldfarb","startTime":721.77,"endTime":724.17,"body":"Exactly right."},{"speaker":"Charles Goldfarb","startTime":721.77,"endTime":724.17,"body":"If you have to take sides you'll"},{"speaker":"Charles Goldfarb","startTime":724.17,"endTime":725.4,"body":"know which side to take now."},{"speaker":"Chris Dy","startTime":726.8,"endTime":729.32,"body":"Alright, so we enjoy"},{"speaker":"Chris Dy","startTime":726.8,"endTime":729.32,"body":"our reader grab bag. And that's"},{"speaker":"Chris Dy","startTime":729.32,"endTime":732.29,"body":"actually the source of today's"},{"speaker":"Chris Dy","startTime":729.32,"endTime":732.29,"body":"topic. So thank you to everybody"},{"speaker":"Chris Dy","startTime":732.29,"endTime":737.57,"body":"who has left questions for us"},{"speaker":"Chris Dy","startTime":732.29,"endTime":737.57,"body":"and episode suggestions. And"},{"speaker":"Chris Dy","startTime":737.57,"endTime":740.24,"body":"we're happy to answer any"},{"speaker":"Chris Dy","startTime":737.57,"endTime":740.24,"body":"questions feel free to leave"},{"speaker":"Chris Dy","startTime":740.24,"endTime":743.06,"body":"them for us in hand"},{"speaker":"Chris Dy","startTime":740.24,"endTime":743.06,"body":"podcast@gmail.com send them over"},{"speaker":"Chris Dy","startTime":743.06,"endTime":747.35,"body":"Twitter or send them over in the"},{"speaker":"Chris Dy","startTime":743.06,"endTime":747.35,"body":"reviews. And we will consider"},{"speaker":"Chris Dy","startTime":747.35,"endTime":750.35,"body":"them as topics for episodes or"},{"speaker":"Chris Dy","startTime":747.35,"endTime":750.35,"body":"even just answer the question"},{"speaker":"Chris Dy","startTime":750.35,"endTime":753.74,"body":"one off like we've been doing"},{"speaker":"Chris Dy","startTime":750.35,"endTime":753.74,"body":"the last few weeks. So today's"},{"speaker":"Chris Dy","startTime":753.74,"endTime":756.98,"body":"topic is about a topic that is"},{"speaker":"Chris Dy","startTime":753.74,"endTime":756.98,"body":"near and dear to many surgeon's"},{"speaker":"Chris Dy","startTime":756.98,"endTime":761.81,"body":"hearts complex regional pain"},{"speaker":"Chris Dy","startTime":756.98,"endTime":761.81,"body":"syndrome. And many surgeons will"},{"speaker":"Chris Dy","startTime":761.81,"endTime":765.71,"body":"treat this issue but joke that"},{"speaker":"Chris Dy","startTime":761.81,"endTime":765.71,"body":"they don't like to publish about"},{"speaker":"Chris Dy","startTime":765.71,"endTime":768.53,"body":"it. And because patients tend to"},{"speaker":"Chris Dy","startTime":765.71,"endTime":768.53,"body":"find them and not always ones"},{"speaker":"Chris Dy","startTime":768.53,"endTime":771.89,"body":"that they can help. Now Chuck"},{"speaker":"Chris Dy","startTime":768.53,"endTime":771.89,"body":"has published on this topic"},{"speaker":"Chris Dy","startTime":771.89,"endTime":774.98,"body":"extensively, or at least has the"},{"speaker":"Chris Dy","startTime":771.89,"endTime":774.98,"body":"landmark paper in the hand"},{"speaker":"Chris Dy","startTime":774.98,"endTime":778.37,"body":"surgery literature, and now has"},{"speaker":"Chris Dy","startTime":774.98,"endTime":778.37,"body":"a podcast episode about it. So I"},{"speaker":"Chris Dy","startTime":778.37,"endTime":781.28,"body":"think this is a twofer for you."},{"speaker":"Chris Dy","startTime":778.37,"endTime":781.28,"body":"So congratulations."},{"speaker":"Charles Goldfarb","startTime":781.94,"endTime":784.79,"body":"Listen, I"},{"speaker":"Charles Goldfarb","startTime":781.94,"endTime":784.79,"body":"think it's an interesting topic."},{"speaker":"Charles Goldfarb","startTime":784.79,"endTime":788.09,"body":"And I actually it's not all doom"},{"speaker":"Charles Goldfarb","startTime":784.79,"endTime":788.09,"body":"and gloom for my future because"},{"speaker":"Charles Goldfarb","startTime":788.09,"endTime":790.94,"body":"our partner Lindley Wall has"},{"speaker":"Charles Goldfarb","startTime":788.09,"endTime":790.94,"body":"shown interest as well. And"},{"speaker":"Charles Goldfarb","startTime":790.94,"endTime":795.62,"body":"she's looking into carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":790.94,"endTime":795.62,"body":"slash crps in the setting of"},{"speaker":"Charles Goldfarb","startTime":795.62,"endTime":798.44,"body":"distal radius fractures, which"},{"speaker":"Charles Goldfarb","startTime":795.62,"endTime":798.44,"body":"is a super interesting topic."},{"speaker":"Charles Goldfarb","startTime":798.44,"endTime":802.01,"body":"And I mean that legitimately. So"},{"speaker":"Charles Goldfarb","startTime":798.44,"endTime":802.01,"body":"more to come in that area. Let's"},{"speaker":"Charles Goldfarb","startTime":802.04,"endTime":806.9,"body":"Why don't we start with a few"},{"speaker":"Charles Goldfarb","startTime":802.04,"endTime":806.9,"body":"definitions. So I'll go first."},{"speaker":"Charles Goldfarb","startTime":806.93,"endTime":810.23,"body":"So complex regional pain"},{"speaker":"Charles Goldfarb","startTime":806.93,"endTime":810.23,"body":"syndrome is the quote unquote,"},{"speaker":"Charles Goldfarb","startTime":810.23,"endTime":814.82,"body":"newer diagnosis. And there's two"},{"speaker":"Charles Goldfarb","startTime":810.23,"endTime":814.82,"body":"types. There's, there's type one"},{"speaker":"Charles Goldfarb","startTime":814.82,"endTime":818.84,"body":"and there's type two. And so"},{"speaker":"Charles Goldfarb","startTime":814.82,"endTime":818.84,"body":"type one used to be known as"},{"speaker":"Charles Goldfarb","startTime":818.93,"endTime":824.66,"body":"reflex sympathetic dystrophy or"},{"speaker":"Charles Goldfarb","startTime":818.93,"endTime":824.66,"body":"RSD. And essentially, it is a"},{"speaker":"Charles Goldfarb","startTime":825.14,"endTime":829.22,"body":"pain syndrome of unknown"},{"speaker":"Charles Goldfarb","startTime":825.14,"endTime":829.22,"body":"etiology. I think most of us"},{"speaker":"Charles Goldfarb","startTime":829.25,"endTime":832.79,"body":"believe that it is mediated by"},{"speaker":"Charles Goldfarb","startTime":829.25,"endTime":832.79,"body":"small nerve fibers, perhaps c"},{"speaker":"Charles Goldfarb","startTime":832.79,"endTime":837.8,"body":"fibers, but there's no major"},{"speaker":"Charles Goldfarb","startTime":832.79,"endTime":837.8,"body":"nerve injury major or minor"},{"speaker":"Charles Goldfarb","startTime":837.8,"endTime":842.03,"body":"nerve identified as being"},{"speaker":"Charles Goldfarb","startTime":837.8,"endTime":842.03,"body":"injured. And so that's the one"},{"speaker":"Charles Goldfarb","startTime":842.21,"endTime":846.02,"body":"that a hand surgeon likely is"},{"speaker":"Charles Goldfarb","startTime":842.21,"endTime":846.02,"body":"unable to be of help for"},{"speaker":"Charles Goldfarb","startTime":846.02,"endTime":850.13,"body":"treating what is in your mind"},{"speaker":"Charles Goldfarb","startTime":846.02,"endTime":850.13,"body":"crps type two."},{"speaker":"Chris Dy","startTime":850.87,"endTime":854.26,"body":"So crps type two, in"},{"speaker":"Chris Dy","startTime":850.87,"endTime":854.26,"body":"my opinion, or at least from my"},{"speaker":"Chris Dy","startTime":854.26,"endTime":856.96,"body":"understanding of it is"},{"speaker":"Chris Dy","startTime":854.26,"endTime":856.96,"body":"neuropathic pain or nerve"},{"speaker":"Chris Dy","startTime":856.96,"endTime":862.27,"body":"related pain that emanates along"},{"speaker":"Chris Dy","startTime":856.96,"endTime":862.27,"body":"a specific and identifiable"},{"speaker":"Chris Dy","startTime":862.27,"endTime":865.18,"body":"peripheral nerve distribution."},{"speaker":"Chris Dy","startTime":862.27,"endTime":865.18,"body":"Now, that may not necessarily be"},{"speaker":"Chris Dy","startTime":865.18,"endTime":867.79,"body":"for example, the median nerve,"},{"speaker":"Chris Dy","startTime":865.18,"endTime":867.79,"body":"it could be something like the"},{"speaker":"Chris Dy","startTime":867.79,"endTime":870.85,"body":"medial cord of the brachial"},{"speaker":"Chris Dy","startTime":867.79,"endTime":870.85,"body":"plexus, but it follows an"},{"speaker":"Chris Dy","startTime":870.85,"endTime":875.71,"body":"anatomic distribution. And it"},{"speaker":"Chris Dy","startTime":870.85,"endTime":875.71,"body":"makes sense to us as hand"},{"speaker":"Chris Dy","startTime":875.71,"endTime":878.98,"body":"surgeons and peripheral nerve"},{"speaker":"Chris Dy","startTime":875.71,"endTime":878.98,"body":"surgeons to to be able to help"},{"speaker":"Chris Dy","startTime":878.98,"endTime":882.46,"body":"these people because they are"},{"speaker":"Chris Dy","startTime":878.98,"endTime":882.46,"body":"suffering and unfortunately, a"},{"speaker":"Chris Dy","startTime":882.46,"endTime":887.35,"body":"lot of patients with crps or"},{"speaker":"Chris Dy","startTime":882.46,"endTime":887.35,"body":"formerly known as RSD causalgia."},{"speaker":"Chris Dy","startTime":887.89,"endTime":892.27,"body":"They get lumped into the you"},{"speaker":"Chris Dy","startTime":887.89,"endTime":892.27,"body":"know, difficult patient category"},{"speaker":"Chris Dy","startTime":892.39,"endTime":895.75,"body":"and they get bounced around a"},{"speaker":"Chris Dy","startTime":892.39,"endTime":895.75,"body":"lot. And you know, I think that,"},{"speaker":"Chris Dy","startTime":896.23,"endTime":900.04,"body":"as well intentioned as many of"},{"speaker":"Chris Dy","startTime":896.23,"endTime":900.04,"body":"us are both on the surgery side"},{"speaker":"Chris Dy","startTime":900.04,"endTime":903.85,"body":"and the therapy side, these"},{"speaker":"Chris Dy","startTime":900.04,"endTime":903.85,"body":"patients often are neglected."},{"speaker":"Chris Dy","startTime":904.99,"endTime":907.99,"body":"And it's difficult to"},{"speaker":"Chris Dy","startTime":904.99,"endTime":907.99,"body":"differentiate who you can help"},{"speaker":"Chris Dy","startTime":907.99,"endTime":911.23,"body":"and who you don't think you can"},{"speaker":"Chris Dy","startTime":907.99,"endTime":911.23,"body":"help even within that crps type"},{"speaker":"Chris Dy","startTime":911.23,"endTime":911.95,"body":"two category."},{"speaker":"Charles Goldfarb","startTime":913.259,"endTime":916.439,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":913.259,"endTime":916.439,"body":"right. And All right, so let's,"},{"speaker":"Charles Goldfarb","startTime":916.769,"endTime":921.119,"body":"let's, I guess, talk through how"},{"speaker":"Charles Goldfarb","startTime":916.769,"endTime":921.119,"body":"we think about the diagnosis,"},{"speaker":"Charles Goldfarb","startTime":921.359,"endTime":925.709,"body":"and how we use therapy, how we"},{"speaker":"Charles Goldfarb","startTime":921.359,"endTime":925.709,"body":"may use additional studies to"},{"speaker":"Charles Goldfarb","startTime":925.709,"endTime":930.299,"body":"confirm a diagnosis, and how we"},{"speaker":"Charles Goldfarb","startTime":925.709,"endTime":930.299,"body":"think about treatment. So, first"},{"speaker":"Charles Goldfarb","startTime":930.299,"endTime":935.399,"body":"of all, etiology in my mind, we"},{"speaker":"Charles Goldfarb","startTime":930.299,"endTime":935.399,"body":"don't always know the etiology,"},{"speaker":"Charles Goldfarb","startTime":935.579,"endTime":939.539,"body":"it can be a surgery, and there's"},{"speaker":"Charles Goldfarb","startTime":935.579,"endTime":939.539,"body":"some crazy stats that suggest up"},{"speaker":"Charles Goldfarb","startTime":939.539,"endTime":943.739,"body":"to 1% of surgeries can be"},{"speaker":"Charles Goldfarb","startTime":939.539,"endTime":943.739,"body":"associated with crps. That seems"},{"speaker":"Charles Goldfarb","startTime":943.889,"endTime":947.309,"body":"way too high to me. But there is"},{"speaker":"Charles Goldfarb","startTime":943.889,"endTime":947.309,"body":"no doubt that a certain"},{"speaker":"Charles Goldfarb","startTime":947.309,"endTime":950.099,"body":"percentage of patients with"},{"speaker":"Charles Goldfarb","startTime":947.309,"endTime":950.099,"body":"surgery run the risk of"},{"speaker":"Charles Goldfarb","startTime":950.099,"endTime":951.479,"body":"developing crps."},{"speaker":"Chris Dy","startTime":952.26,"endTime":954.09,"body":"And I think you're"},{"speaker":"Chris Dy","startTime":952.26,"endTime":954.09,"body":"right about that. And, you know,"},{"speaker":"Chris Dy","startTime":954.09,"endTime":958.17,"body":"I think that's why many of us"},{"speaker":"Chris Dy","startTime":954.09,"endTime":958.17,"body":"are extraordinarily particular"},{"speaker":"Chris Dy","startTime":958.2,"endTime":962.19,"body":"about protection of cutaneous"},{"speaker":"Chris Dy","startTime":958.2,"endTime":962.19,"body":"nerves, the ones that are, you"},{"speaker":"Chris Dy","startTime":962.19,"endTime":965.49,"body":"know, so called causalgic. So,"},{"speaker":"Chris Dy","startTime":962.19,"endTime":965.49,"body":"for example, if you're doing any"},{"speaker":"Chris Dy","startTime":965.49,"endTime":968.19,"body":"surgery on the medial side of"},{"speaker":"Chris Dy","startTime":965.49,"endTime":968.19,"body":"the elbow, or the forearm, being"},{"speaker":"Chris Dy","startTime":968.19,"endTime":970.47,"body":"concerned about the medial and"},{"speaker":"Chris Dy","startTime":968.19,"endTime":970.47,"body":"tuberculoid cutaneous nerve,"},{"speaker":"Chris Dy","startTime":970.98,"endTime":974.04,"body":"doing any bicep surgery being"},{"speaker":"Chris Dy","startTime":970.98,"endTime":974.04,"body":"concerned about the lateral"},{"speaker":"Chris Dy","startTime":974.04,"endTime":976.41,"body":"inter brachial cutaneous nerve,"},{"speaker":"Chris Dy","startTime":974.04,"endTime":976.41,"body":"there's an incidence of about"},{"speaker":"Chris Dy","startTime":976.41,"endTime":981.87,"body":"17% for LIBC issues after distal"},{"speaker":"Chris Dy","startTime":976.41,"endTime":981.87,"body":"biceps repair. So that's real."},{"speaker":"Chris Dy","startTime":982.41,"endTime":984.75,"body":"It's just a matter honestly,"},{"speaker":"Chris Dy","startTime":982.41,"endTime":984.75,"body":"whether you're looking for them"},{"speaker":"Chris Dy","startTime":984.75,"endTime":989.61,"body":"as a surgeon, or as a therapist,"},{"speaker":"Chris Dy","startTime":984.75,"endTime":989.61,"body":"and then, you know, I think the"},{"speaker":"Chris Dy","startTime":989.61,"endTime":992.13,"body":"palmar cutaneous branch and the"},{"speaker":"Chris Dy","startTime":989.61,"endTime":992.13,"body":"superficial radial nerve are the"},{"speaker":"Chris Dy","startTime":992.13,"endTime":995.07,"body":"other ones that get a rap for"},{"speaker":"Chris Dy","startTime":992.13,"endTime":995.07,"body":"being causalgic nerves and you"},{"speaker":"Chris Dy","startTime":995.07,"endTime":997.02,"body":"know, we've sparred with our"},{"speaker":"Chris Dy","startTime":995.07,"endTime":997.02,"body":"partners on some of this and I"},{"speaker":"Chris Dy","startTime":997.02,"endTime":999.63,"body":"think you and I fall on the same"},{"speaker":"Chris Dy","startTime":997.02,"endTime":999.63,"body":"side of the aisle on this one,"},{"speaker":"Chris Dy","startTime":1000.14,"endTime":1003.47,"body":"you know, quote, they're just"},{"speaker":"Chris Dy","startTime":1000.14,"endTime":1003.47,"body":"skin nerves. And maybe we're a"},{"speaker":"Chris Dy","startTime":1003.47,"endTime":1008.24,"body":"little too paranoid about"},{"speaker":"Chris Dy","startTime":1003.47,"endTime":1008.24,"body":"dissecting and protecting etc."},{"speaker":"Chris Dy","startTime":1008.66,"endTime":1009.62,"body":"but all it takes is one."},{"speaker":"Charles Goldfarb","startTime":1010.86,"endTime":1015.27,"body":"Yeah, it's if"},{"speaker":"Charles Goldfarb","startTime":1010.86,"endTime":1015.27,"body":"you if you, for example, don't"},{"speaker":"Charles Goldfarb","startTime":1015.27,"endTime":1018.27,"body":"take proper care of the medial,"},{"speaker":"Charles Goldfarb","startTime":1015.27,"endTime":1018.27,"body":"brachial or antebrachial"},{"speaker":"Charles Goldfarb","startTime":1018.27,"endTime":1022.11,"body":"cutaneous nerves in the approach"},{"speaker":"Charles Goldfarb","startTime":1018.27,"endTime":1022.11,"body":"for treatment of cubital tunnel,"},{"speaker":"Charles Goldfarb","startTime":1022.68,"endTime":1025.77,"body":"the patient may be fine, and"},{"speaker":"Charles Goldfarb","startTime":1022.68,"endTime":1025.77,"body":"maybe that patient's fine 19 out"},{"speaker":"Charles Goldfarb","startTime":1025.77,"endTime":1030.03,"body":"of 20 times. But if you have one"},{"speaker":"Charles Goldfarb","startTime":1025.77,"endTime":1030.03,"body":"patient that develops a severe"},{"speaker":"Charles Goldfarb","startTime":1030.03,"endTime":1033.27,"body":"pain after a surgery like that,"},{"speaker":"Charles Goldfarb","startTime":1030.03,"endTime":1033.27,"body":"that's one too many. And that's"},{"speaker":"Charles Goldfarb","startTime":1033.27,"endTime":1036.03,"body":"why I take as much care as"},{"speaker":"Charles Goldfarb","startTime":1033.27,"endTime":1036.03,"body":"possible in preventing injury to"},{"speaker":"Charles Goldfarb","startTime":1036.03,"endTime":1040.08,"body":"those nerves. So, alright, so"},{"speaker":"Charles Goldfarb","startTime":1036.03,"endTime":1040.08,"body":"surgery is definitely a risk"},{"speaker":"Charles Goldfarb","startTime":1040.08,"endTime":1045.99,"body":"factor. trauma, be it big or"},{"speaker":"Charles Goldfarb","startTime":1040.08,"endTime":1045.99,"body":"small paper cut can lead to"},{"speaker":"Charles Goldfarb","startTime":1046.74,"endTime":1052.26,"body":"crps, or major trauma can lead"},{"speaker":"Charles Goldfarb","startTime":1046.74,"endTime":1052.26,"body":"to crps. Those are kind of the"},{"speaker":"Charles Goldfarb","startTime":1052.26,"endTime":1054.99,"body":"two groups I think about but it"},{"speaker":"Charles Goldfarb","startTime":1052.26,"endTime":1054.99,"body":"really can be anything."},{"speaker":"Chris Dy","startTime":1055.62,"endTime":1057.9,"body":"Yeah, no, I mean,"},{"speaker":"Chris Dy","startTime":1055.62,"endTime":1057.9,"body":"those are the types of patients"},{"speaker":"Chris Dy","startTime":1057.9,"endTime":1060.63,"body":"that come in for us, you know,"},{"speaker":"Chris Dy","startTime":1057.9,"endTime":1060.63,"body":"either the acute traumas, you"},{"speaker":"Chris Dy","startTime":1060.63,"endTime":1065.73,"body":"know, the big, the high"},{"speaker":"Chris Dy","startTime":1060.63,"endTime":1065.73,"body":"mechanism, fractures that are"},{"speaker":"Chris Dy","startTime":1065.73,"endTime":1069.33,"body":"associated with nerve injuries."},{"speaker":"Chris Dy","startTime":1065.73,"endTime":1069.33,"body":"But even you know, honestly,"},{"speaker":"Chris Dy","startTime":1069.33,"endTime":1072.48,"body":"standing level falls can have"},{"speaker":"Chris Dy","startTime":1069.33,"endTime":1072.48,"body":"distal radius fractures that"},{"speaker":"Chris Dy","startTime":1072.48,"endTime":1074.61,"body":"have, you know, acute carpal"},{"speaker":"Chris Dy","startTime":1072.48,"endTime":1074.61,"body":"tunnel syndrome that you would"},{"speaker":"Chris Dy","startTime":1074.61,"endTime":1077.58,"body":"not expect. And sometimes these"},{"speaker":"Chris Dy","startTime":1074.61,"endTime":1077.58,"body":"are nerves that are have been"},{"speaker":"Chris Dy","startTime":1077.58,"endTime":1079.89,"body":"chronically affected, and"},{"speaker":"Chris Dy","startTime":1077.58,"endTime":1079.89,"body":"probably just get kind of tipped"},{"speaker":"Chris Dy","startTime":1079.89,"endTime":1083.22,"body":"over. I don't think anybody"},{"speaker":"Chris Dy","startTime":1079.89,"endTime":1083.22,"body":"knows the true, you know,"},{"speaker":"Chris Dy","startTime":1083.52,"endTime":1087.09,"body":"whether that's truly a risk"},{"speaker":"Chris Dy","startTime":1083.52,"endTime":1087.09,"body":"factor or not. But I think that"},{"speaker":"Chris Dy","startTime":1088.05,"endTime":1090.66,"body":"we don't really see many other"},{"speaker":"Chris Dy","startTime":1088.05,"endTime":1090.66,"body":"patients. You know, in my"},{"speaker":"Chris Dy","startTime":1090.66,"endTime":1093.6,"body":"clinic, I see occasionally, you"},{"speaker":"Chris Dy","startTime":1090.66,"endTime":1093.6,"body":"know, there's always that"},{"speaker":"Chris Dy","startTime":1094.11,"endTime":1096.3,"body":"Parsonage-Turner category, which"},{"speaker":"Chris Dy","startTime":1094.11,"endTime":1096.3,"body":"is separate from this topic, we"},{"speaker":"Chris Dy","startTime":1096.3,"endTime":1098.61,"body":"can talk about it a different"},{"speaker":"Chris Dy","startTime":1096.3,"endTime":1098.61,"body":"time. There are all sorts of"},{"speaker":"Chris Dy","startTime":1098.61,"endTime":1100.95,"body":"weird etiologies that are"},{"speaker":"Chris Dy","startTime":1098.61,"endTime":1100.95,"body":"proposed for that one, too."},{"speaker":"Charles Goldfarb","startTime":1102.18,"endTime":1104.04,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1102.18,"endTime":1104.04,"body":"right. I think that's right. And"},{"speaker":"Charles Goldfarb","startTime":1104.04,"endTime":1109.26,"body":"that does fit in at least some"},{"speaker":"Charles Goldfarb","startTime":1104.04,"endTime":1109.26,"body":"of our black boxes. And I think"},{"speaker":"Charles Goldfarb","startTime":1109.26,"endTime":1111.69,"body":"what will be helpful is we"},{"speaker":"Charles Goldfarb","startTime":1109.26,"endTime":1111.69,"body":"present a few patients"},{"speaker":"Charles Goldfarb","startTime":1111.69,"endTime":1114.96,"body":"scenarios, but let's go through"},{"speaker":"Charles Goldfarb","startTime":1111.69,"endTime":1114.96,"body":"some basics. So if I were to"},{"speaker":"Charles Goldfarb","startTime":1114.96,"endTime":1120.03,"body":"think about a patient with"},{"speaker":"Charles Goldfarb","startTime":1114.96,"endTime":1120.03,"body":"potential crps, what type of"},{"speaker":"Charles Goldfarb","startTime":1120.03,"endTime":1123.45,"body":"studies do you consider in"},{"speaker":"Charles Goldfarb","startTime":1120.03,"endTime":1123.45,"body":"affirming the diagnosis?"},{"speaker":"Chris Dy","startTime":1124.29,"endTime":1126.78,"body":"Well, I mean, you"},{"speaker":"Chris Dy","startTime":1124.29,"endTime":1126.78,"body":"know, by and large, almost like"},{"speaker":"Chris Dy","startTime":1126.78,"endTime":1129.9,"body":"a nine to one ratio, the people"},{"speaker":"Chris Dy","startTime":1126.78,"endTime":1129.9,"body":"that come into my office are in"},{"speaker":"Chris Dy","startTime":1129.9,"endTime":1134.28,"body":"that type two versus type one"},{"speaker":"Chris Dy","startTime":1129.9,"endTime":1134.28,"body":"category. Because you know,"},{"speaker":"Chris Dy","startTime":1134.28,"endTime":1137.13,"body":"those are the people that that"},{"speaker":"Chris Dy","startTime":1134.28,"endTime":1137.13,"body":"get get in honestly, there's a"},{"speaker":"Chris Dy","startTime":1137.13,"endTime":1141.12,"body":"lot of bias in how we screen"},{"speaker":"Chris Dy","startTime":1137.13,"endTime":1141.12,"body":"patients coming in, or screen"},{"speaker":"Chris Dy","startTime":1141.12,"endTime":1144.21,"body":"themselves and how they're"},{"speaker":"Chris Dy","startTime":1141.12,"endTime":1144.21,"body":"referred. But the physical exam"},{"speaker":"Chris Dy","startTime":1144.21,"endTime":1146.85,"body":"is so critical. I mean, it's"},{"speaker":"Chris Dy","startTime":1144.21,"endTime":1146.85,"body":"looking for the subtleties and"},{"speaker":"Chris Dy","startTime":1146.85,"endTime":1149.37,"body":"we talked about this before on"},{"speaker":"Chris Dy","startTime":1146.85,"endTime":1149.37,"body":"our prior episodes, but the"},{"speaker":"Chris Dy","startTime":1149.37,"endTime":1154.95,"body":"subtleties of the exam, you"},{"speaker":"Chris Dy","startTime":1149.37,"endTime":1154.95,"body":"know, being very in tune to what"},{"speaker":"Chris Dy","startTime":1154.95,"endTime":1157.62,"body":"normal is in terms of strength"},{"speaker":"Chris Dy","startTime":1154.95,"endTime":1157.62,"body":"but you know, specifically"},{"speaker":"Chris Dy","startTime":1157.62,"endTime":1160.29,"body":"sensation obviously two point"},{"speaker":"Chris Dy","startTime":1157.62,"endTime":1160.29,"body":"discrimination is a mainstay,"},{"speaker":"Chris Dy","startTime":1160.74,"endTime":1163.95,"body":"but comparing side to side"},{"speaker":"Chris Dy","startTime":1160.74,"endTime":1163.95,"body":"sensibility, to light touch,"},{"speaker":"Chris Dy","startTime":1164.07,"endTime":1167.7,"body":"sometimes that's all it takes."},{"speaker":"Chris Dy","startTime":1164.07,"endTime":1167.7,"body":"It's uncommon, but occasionally"},{"speaker":"Chris Dy","startTime":1167.7,"endTime":1171.0,"body":"the patient with the, you know,"},{"speaker":"Chris Dy","startTime":1167.7,"endTime":1171.0,"body":"the, the classic appearance of"},{"speaker":"Chris Dy","startTime":1171.0,"endTime":1173.28,"body":"the trophic patterns on their"},{"speaker":"Chris Dy","startTime":1171.0,"endTime":1173.28,"body":"hand, the abnormal sweat"},{"speaker":"Chris Dy","startTime":1173.28,"endTime":1175.92,"body":"patterns, all that stuff, those,"},{"speaker":"Chris Dy","startTime":1173.28,"endTime":1175.92,"body":"you know, those are classic"},{"speaker":"Chris Dy","startTime":1175.92,"endTime":1178.89,"body":"cases, which are worthy of"},{"speaker":"Chris Dy","startTime":1175.92,"endTime":1178.89,"body":"noting, but it doesn't always"},{"speaker":"Chris Dy","startTime":1179.37,"endTime":1182.94,"body":"come across that way. And then"},{"speaker":"Chris Dy","startTime":1179.37,"endTime":1182.94,"body":"very sensitive cutaneous"},{"speaker":"Chris Dy","startTime":1182.94,"endTime":1184.56,"body":"distribution. So the allodynia"},{"speaker":"Charles Goldfarb","startTime":1184.96,"endTime":1187.39,"body":"First of all,"},{"speaker":"Charles Goldfarb","startTime":1184.96,"endTime":1187.39,"body":"we should clarify that this is a"},{"speaker":"Charles Goldfarb","startTime":1187.39,"endTime":1192.04,"body":"subjective diagnosis. And so"},{"speaker":"Charles Goldfarb","startTime":1187.39,"endTime":1192.04,"body":"making the diagnosis is there"},{"speaker":"Charles Goldfarb","startTime":1192.04,"endTime":1195.19,"body":"are criteria out there but"},{"speaker":"Charles Goldfarb","startTime":1192.04,"endTime":1195.19,"body":"honestly, those are not terribly"},{"speaker":"Charles Goldfarb","startTime":1195.19,"endTime":1198.22,"body":"helpful for me. And so it is"},{"speaker":"Charles Goldfarb","startTime":1195.19,"endTime":1198.22,"body":"based on talking to the patient,"},{"speaker":"Charles Goldfarb","startTime":1198.22,"endTime":1201.07,"body":"examining the patient and"},{"speaker":"Charles Goldfarb","startTime":1198.22,"endTime":1201.07,"body":"potentially A few studies which"},{"speaker":"Charles Goldfarb","startTime":1201.07,"endTime":1204.19,"body":"we'll get to, I like what you"},{"speaker":"Charles Goldfarb","startTime":1201.07,"endTime":1204.19,"body":"said, I agree with what you"},{"speaker":"Charles Goldfarb","startTime":1204.19,"endTime":1209.2,"body":"said, I would categorize it as"},{"speaker":"Charles Goldfarb","startTime":1204.19,"endTime":1209.2,"body":"additionally, pain out of"},{"speaker":"Charles Goldfarb","startTime":1209.2,"endTime":1213.04,"body":"proportion to what we would"},{"speaker":"Charles Goldfarb","startTime":1209.2,"endTime":1213.04,"body":"expect, and clinical findings"},{"speaker":"Charles Goldfarb","startTime":1213.07,"endTime":1216.1,"body":"out of proportion to what we'd"},{"speaker":"Charles Goldfarb","startTime":1213.07,"endTime":1216.1,"body":"expect decreased motion,"},{"speaker":"Charles Goldfarb","startTime":1216.25,"endTime":1221.26,"body":"hypersensitivity, swelling,"},{"speaker":"Charles Goldfarb","startTime":1216.25,"endTime":1221.26,"body":"discoloration, extra sweat, not"},{"speaker":"Chris Dy","startTime":1221.05,"endTime":1222.97,"body":"You know, even with"},{"speaker":"Chris Dy","startTime":1221.05,"endTime":1222.97,"body":"the patients that come in with,"},{"speaker":"Chris Dy","startTime":1221.26,"endTime":1223.51,"body":"enough sweat, any of those"},{"speaker":"Chris Dy","startTime":1221.26,"endTime":1223.51,"body":"things that just don't make"},{"speaker":"Chris Dy","startTime":1222.97,"endTime":1225.85,"body":"for example, distal radius"},{"speaker":"Chris Dy","startTime":1222.97,"endTime":1225.85,"body":"fractures, or other hand crush"},{"speaker":"Chris Dy","startTime":1223.51,"endTime":1227.17,"body":"sense. And the more objective"},{"speaker":"Chris Dy","startTime":1223.51,"endTime":1227.17,"body":"findings that are there, rather"},{"speaker":"Chris Dy","startTime":1225.85,"endTime":1228.85,"body":"injuries, like crush injuries,"},{"speaker":"Chris Dy","startTime":1225.85,"endTime":1228.85,"body":"in particular, are like the crps"},{"speaker":"Chris Dy","startTime":1227.17,"endTime":1231.67,"body":"than just complaints, the easier"},{"speaker":"Chris Dy","startTime":1227.17,"endTime":1231.67,"body":"it is, for me to be comfortable"},{"speaker":"Chris Dy","startTime":1228.85,"endTime":1232.54,"body":"type one diagnosis that I see"},{"speaker":"Chris Dy","startTime":1228.85,"endTime":1232.54,"body":"the most. And I'm sure you know,"},{"speaker":"Chris Dy","startTime":1231.67,"endTime":1232.84,"body":"making a diagnosis."},{"speaker":"Chris Dy","startTime":1232.54,"endTime":1235.42,"body":"that comprises a large part of"},{"speaker":"Chris Dy","startTime":1232.54,"endTime":1235.42,"body":"what you see too, but it's the"},{"speaker":"Chris Dy","startTime":1235.42,"endTime":1238.18,"body":"hand that just doesn't look"},{"speaker":"Chris Dy","startTime":1235.42,"endTime":1238.18,"body":"right after a couple of visits,"},{"speaker":"Chris Dy","startTime":1238.51,"endTime":1241.39,"body":"you can tell it's, it's a little"},{"speaker":"Chris Dy","startTime":1238.51,"endTime":1241.39,"body":"too swollen, it doesn't have the"},{"speaker":"Chris Dy","startTime":1241.39,"endTime":1245.74,"body":"right feel to it, the patients"},{"speaker":"Chris Dy","startTime":1241.39,"endTime":1245.74,"body":"are guarding a lot. And that's"},{"speaker":"Chris Dy","startTime":1245.74,"endTime":1248.56,"body":"when you know, if I recognize"},{"speaker":"Chris Dy","startTime":1245.74,"endTime":1248.56,"body":"as soon as we recognize that,"},{"speaker":"Chris Dy","startTime":1248.56,"endTime":1251.62,"body":"nd sometimes that's at their"},{"speaker":"Chris Dy","startTime":1248.56,"endTime":1251.62,"body":"first visit, we go up to ther- I"},{"speaker":"Chris Dy","startTime":1251.62,"endTime":1254.41,"body":"send them to therapy right"},{"speaker":"Chris Dy","startTime":1251.62,"endTime":1254.41,"body":"way, because this is something t"},{"speaker":"Chris Dy","startTime":1254.41,"endTime":1258.34,"body":"at I want our therapists to g"},{"speaker":"Chris Dy","startTime":1254.41,"endTime":1258.34,"body":"t on top of, and to start devel"},{"speaker":"Chris Dy","startTime":1258.34,"endTime":1261.07,"body":"ping an alliance with the pat"},{"speaker":"Chris Dy","startTime":1258.34,"endTime":1261.07,"body":"ent, because I don't want to s"},{"speaker":"Chris Dy","startTime":1261.07,"endTime":1261.46,"body":"t on that"},{"speaker":"Charles Goldfarb","startTime":1274.7,"endTime":1277.37,"body":"Totally agree."},{"speaker":"Charles Goldfarb","startTime":1274.7,"endTime":1277.37,"body":"And and I do want to circle back"},{"speaker":"Charles Goldfarb","startTime":1277.37,"endTime":1280.7,"body":"to therapy just to finish the"},{"speaker":"Charles Goldfarb","startTime":1277.37,"endTime":1280.7,"body":"train of thought. The other test"},{"speaker":"Charles Goldfarb","startTime":1280.7,"endTime":1284.24,"body":"I consider, which can be"},{"speaker":"Charles Goldfarb","startTime":1280.7,"endTime":1284.24,"body":"helpful. And I would say can"},{"speaker":"Charles Goldfarb","startTime":1284.24,"endTime":1286.79,"body":"being the key word in that"},{"speaker":"Charles Goldfarb","startTime":1284.24,"endTime":1286.79,"body":"sentence would be nerve studies,"},{"speaker":"Charles Goldfarb","startTime":1287.09,"endTime":1291.32,"body":"it would include three phase"},{"speaker":"Charles Goldfarb","startTime":1287.09,"endTime":1291.32,"body":"bone scans, which honestly I"},{"speaker":"Charles Goldfarb","startTime":1291.32,"endTime":1295.49,"body":"don't use very often. advanced"},{"speaker":"Charles Goldfarb","startTime":1291.32,"endTime":1295.49,"body":"imaging can sometimes be"},{"speaker":"Charles Goldfarb","startTime":1295.49,"endTime":1299.45,"body":"helpful. But again, I'll go back"},{"speaker":"Charles Goldfarb","startTime":1295.49,"endTime":1299.45,"body":"to what we both have said is the"},{"speaker":"Charles Goldfarb","startTime":1299.48,"endTime":1302.72,"body":"history of physical, which are"},{"speaker":"Charles Goldfarb","startTime":1299.48,"endTime":1302.72,"body":"most helpful for us."},{"speaker":"Chris Dy","startTime":1302.81,"endTime":1304.97,"body":"I'll be honest, I'm"},{"speaker":"Chris Dy","startTime":1302.81,"endTime":1304.97,"body":"not, I'm usually not getting"},{"speaker":"Chris Dy","startTime":1304.97,"endTime":1308.12,"body":"those studies, you know, I have"},{"speaker":"Chris Dy","startTime":1304.97,"endTime":1308.12,"body":"not found them to be"},{"speaker":"Chris Dy","startTime":1308.12,"endTime":1311.24,"body":"tremendously helpful in"},{"speaker":"Chris Dy","startTime":1308.12,"endTime":1311.24,"body":"establishing a diagnosis. Let's"},{"speaker":"Chris Dy","startTime":1311.24,"endTime":1314.12,"body":"be clear, you and I are not pain"},{"speaker":"Chris Dy","startTime":1311.24,"endTime":1314.12,"body":"management specialists. And I"},{"speaker":"Chris Dy","startTime":1314.12,"endTime":1317.6,"body":"think anybody listening who has"},{"speaker":"Chris Dy","startTime":1314.12,"endTime":1317.6,"body":"more experience in that area is"},{"speaker":"Chris Dy","startTime":1317.75,"endTime":1320.63,"body":"probably going to think that"},{"speaker":"Chris Dy","startTime":1317.75,"endTime":1320.63,"body":"we're overly simplistically"},{"speaker":"Chris Dy","startTime":1320.63,"endTime":1322.97,"body":"looking at this, because there's"},{"speaker":"Chris Dy","startTime":1320.63,"endTime":1322.97,"body":"a lot of sophisticated and"},{"speaker":"Chris Dy","startTime":1322.97,"endTime":1327.47,"body":"rigorous research going on in"},{"speaker":"Chris Dy","startTime":1322.97,"endTime":1327.47,"body":"this area. But you know, this is"},{"speaker":"Chris Dy","startTime":1327.47,"endTime":1331.58,"body":"this is what we see in practice."},{"speaker":"Chris Dy","startTime":1327.47,"endTime":1331.58,"body":"And even if a nerve study comes"},{"speaker":"Chris Dy","startTime":1331.58,"endTime":1335.3,"body":"back, normal, I'm not convinced"},{"speaker":"Chris Dy","startTime":1331.58,"endTime":1335.3,"body":"that that patient, you know, I'm"},{"speaker":"Chris Dy","startTime":1335.3,"endTime":1338.33,"body":"not going to change what I do,"},{"speaker":"Chris Dy","startTime":1335.3,"endTime":1338.33,"body":"because, as you mentioned, it's"},{"speaker":"Chris Dy","startTime":1338.36,"endTime":1342.02,"body":"those smaller pain fibers that"},{"speaker":"Chris Dy","startTime":1338.36,"endTime":1342.02,"body":"are the ones that are, you know,"},{"speaker":"Chris Dy","startTime":1342.05,"endTime":1346.64,"body":"being irritated, in, you know,"},{"speaker":"Chris Dy","startTime":1342.05,"endTime":1346.64,"body":"crps type two, and those pain"},{"speaker":"Chris Dy","startTime":1346.64,"endTime":1349.64,"body":"fibers are not the ones that are"},{"speaker":"Chris Dy","startTime":1346.64,"endTime":1349.64,"body":"going to show up the most on,"},{"speaker":"Chris Dy","startTime":1349.67,"endTime":1353.27,"body":"you know, easily on a nerve"},{"speaker":"Chris Dy","startTime":1349.67,"endTime":1353.27,"body":"conduction study, because the"},{"speaker":"Chris Dy","startTime":1353.27,"endTime":1356.93,"body":"nerve conduction study will pick"},{"speaker":"Chris Dy","startTime":1353.27,"endTime":1356.93,"body":"up those larger and myelinated"},{"speaker":"Chris Dy","startTime":1356.93,"endTime":1359.69,"body":"fibers, whereas the nerve, those"},{"speaker":"Chris Dy","startTime":1356.93,"endTime":1359.69,"body":"pain fibers tend to be smaller"},{"speaker":"Chris Dy","startTime":1359.69,"endTime":1363.77,"body":"and non myelinated. So, you"},{"speaker":"Chris Dy","startTime":1359.69,"endTime":1363.77,"body":"know, while I, honestly I"},{"speaker":"Chris Dy","startTime":1363.77,"endTime":1366.68,"body":"wouldn't even, I wouldn't rely"},{"speaker":"Chris Dy","startTime":1363.77,"endTime":1366.68,"body":"on it. And in for example, if we"},{"speaker":"Chris Dy","startTime":1366.68,"endTime":1369.53,"body":"had a case of a patient with a"},{"speaker":"Chris Dy","startTime":1366.68,"endTime":1369.53,"body":"distal radius fracture who we"},{"speaker":"Chris Dy","startTime":1369.53,"endTime":1372.89,"body":"were suspicious of type two"},{"speaker":"Chris Dy","startTime":1369.53,"endTime":1372.89,"body":"crps, I probably wouldn't get"},{"speaker":"Chris Dy","startTime":1372.89,"endTime":1373.91,"body":"the study to be honest with you."},{"speaker":"Charles Goldfarb","startTime":1375.07,"endTime":1377.02,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1375.07,"endTime":1377.02,"body":"very fair. And those are those"},{"speaker":"Charles Goldfarb","startTime":1377.02,"endTime":1380.08,"body":"are really important thoughts."},{"speaker":"Charles Goldfarb","startTime":1377.02,"endTime":1380.08,"body":"So let's talk about a couple of"},{"speaker":"Charles Goldfarb","startTime":1380.08,"endTime":1384.61,"body":"cases. And we can talk about how"},{"speaker":"Charles Goldfarb","startTime":1380.08,"endTime":1384.61,"body":"we think about patients, how we"},{"speaker":"Charles Goldfarb","startTime":1384.73,"endTime":1388.81,"body":"conceive of the role of therapy"},{"speaker":"Charles Goldfarb","startTime":1384.73,"endTime":1388.81,"body":"versus surgery, and when the"},{"speaker":"Charles Goldfarb","startTime":1388.81,"endTime":1393.07,"body":"time comes to not be the"},{"speaker":"Charles Goldfarb","startTime":1388.81,"endTime":1393.07,"body":"patient's primary provider and"},{"speaker":"Charles Goldfarb","startTime":1393.07,"endTime":1398.23,"body":"send the patient on. So let's"},{"speaker":"Charles Goldfarb","startTime":1393.07,"endTime":1398.23,"body":"talk about a but go back to what"},{"speaker":"Charles Goldfarb","startTime":1398.23,"endTime":1403.51,"body":"you said before. So we have a 47"},{"speaker":"Charles Goldfarb","startTime":1398.23,"endTime":1403.51,"body":"year old female who comes with,"},{"speaker":"Charles Goldfarb","startTime":1403.63,"endTime":1407.17,"body":"comes in with a distal radius"},{"speaker":"Charles Goldfarb","startTime":1403.63,"endTime":1407.17,"body":"fracture she's been seen in the"},{"speaker":"Charles Goldfarb","startTime":1407.2,"endTime":1411.34,"body":"ER, reduced, comes to see you"},{"speaker":"Charles Goldfarb","startTime":1407.2,"endTime":1411.34,"body":"and has a mildly displaced"},{"speaker":"Charles Goldfarb","startTime":1411.34,"endTime":1415.54,"body":"distal radius fracture by"},{"speaker":"Charles Goldfarb","startTime":1411.34,"endTime":1415.54,"body":"radiograph. She's in her er"},{"speaker":"Charles Goldfarb","startTime":1415.54,"endTime":1420.64,"body":"placed splint, which is a sugar"},{"speaker":"Charles Goldfarb","startTime":1415.54,"endTime":1420.64,"body":"tongs splint. And on"},{"speaker":"Charles Goldfarb","startTime":1420.64,"endTime":1424.51,"body":"examination, well in discussion"},{"speaker":"Charles Goldfarb","startTime":1420.64,"endTime":1424.51,"body":"first, she's in a lot of pain."},{"speaker":"Charles Goldfarb","startTime":1424.69,"endTime":1427.84,"body":"It's been seven days since her"},{"speaker":"Charles Goldfarb","startTime":1424.69,"endTime":1427.84,"body":"injury, she's in more pain than"},{"speaker":"Charles Goldfarb","startTime":1427.84,"endTime":1431.95,"body":"we would expect the dressings"},{"speaker":"Charles Goldfarb","startTime":1427.84,"endTime":1431.95,"body":"not too tight. And so how do you"},{"speaker":"Charles Goldfarb","startTime":1432.04,"endTime":1435.07,"body":"what do you do exam wise? What"},{"speaker":"Charles Goldfarb","startTime":1432.04,"endTime":1435.07,"body":"do you do and then just kind of"},{"speaker":"Charles Goldfarb","startTime":1435.07,"endTime":1435.76,"body":"talk me through it?"},{"speaker":"Chris Dy","startTime":1436.3,"endTime":1437.68,"body":"Well, you know,"},{"speaker":"Chris Dy","startTime":1436.3,"endTime":1437.68,"body":"usually in that setting, when"},{"speaker":"Chris Dy","startTime":1437.68,"endTime":1440.8,"body":"they're in that much pain, the"},{"speaker":"Chris Dy","startTime":1437.68,"endTime":1440.8,"body":"splint is much more egregiously"},{"speaker":"Chris Dy","startTime":1440.8,"endTime":1443.32,"body":"wrong than what you described."},{"speaker":"Chris Dy","startTime":1440.8,"endTime":1443.32,"body":"It's the splint that goes out"},{"speaker":"Chris Dy","startTime":1443.32,"endTime":1446.53,"body":"all the way to the tips of the"},{"speaker":"Chris Dy","startTime":1443.32,"endTime":1446.53,"body":"fingers, not to knock our ER"},{"speaker":"Chris Dy","startTime":1446.53,"endTime":1450.04,"body":"colleagues but I just see this"},{"speaker":"Chris Dy","startTime":1446.53,"endTime":1450.04,"body":"enough where people come in from"},{"speaker":"Chris Dy","startTime":1451.0,"endTime":1454.72,"body":"non orthopedic providers who are"},{"speaker":"Chris Dy","startTime":1451.0,"endTime":1454.72,"body":"well intentioned want to"},{"speaker":"Chris Dy","startTime":1454.72,"endTime":1457.12,"body":"immobilize a fracture but just"},{"speaker":"Chris Dy","startTime":1454.72,"endTime":1457.12,"body":"don't have the training or the"},{"speaker":"Chris Dy","startTime":1457.12,"endTime":1459.22,"body":"wherewithal to know that they"},{"speaker":"Chris Dy","startTime":1457.12,"endTime":1459.22,"body":"need to leave the fingers free"},{"speaker":"Chris Dy","startTime":1459.22,"endTime":1462.7,"body":"so their fingers have not been"},{"speaker":"Chris Dy","startTime":1459.22,"endTime":1462.7,"body":"moving for a while. You know,"},{"speaker":"Chris Dy","startTime":1462.7,"endTime":1465.79,"body":"even in sometimes it is to tight"},{"speaker":"Chris Dy","startTime":1462.7,"endTime":1465.79,"body":"and the patients had to unwrap"},{"speaker":"Chris Dy","startTime":1465.79,"endTime":1468.61,"body":"and rewrap it themselves and"},{"speaker":"Chris Dy","startTime":1465.79,"endTime":1468.61,"body":"then you get get the splint off."},{"speaker":"Chris Dy","startTime":1468.61,"endTime":1471.73,"body":"That's the first part and then"},{"speaker":"Chris Dy","startTime":1468.61,"endTime":1471.73,"body":"just get a sense of the"},{"speaker":"Chris Dy","startTime":1471.73,"endTime":1475.45,"body":"character of the extremity. And"},{"speaker":"Chris Dy","startTime":1471.73,"endTime":1475.45,"body":"that sounds soft and squishy."},{"speaker":"Chris Dy","startTime":1475.45,"endTime":1477.82,"body":"But I think that's you know,"},{"speaker":"Chris Dy","startTime":1475.45,"endTime":1477.82,"body":"honestly, that'll tell the story"},{"speaker":"Chris Dy","startTime":1477.82,"endTime":1480.73,"body":"you can tell the patient is"},{"speaker":"Chris Dy","startTime":1477.82,"endTime":1480.73,"body":"going to be miserable, and"},{"speaker":"Chris Dy","startTime":1480.73,"endTime":1482.95,"body":"they're not going to do well,"},{"speaker":"Chris Dy","startTime":1480.73,"endTime":1482.95,"body":"regardless of what the"},{"speaker":"Chris Dy","startTime":1482.95,"endTime":1485.26,"body":"radiographs look like purely"},{"speaker":"Chris Dy","startTime":1482.95,"endTime":1485.26,"body":"based on the appearance of the"},{"speaker":"Chris Dy","startTime":1485.26,"endTime":1486.1,"body":"hand in my opinion."},{"speaker":"Charles Goldfarb","startTime":1487.12,"endTime":1489.73,"body":"I love that so"},{"speaker":"Charles Goldfarb","startTime":1487.12,"endTime":1489.73,"body":"taking the splint off almost"},{"speaker":"Charles Goldfarb","startTime":1489.73,"endTime":1492.52,"body":"consequences be damned because"},{"speaker":"Charles Goldfarb","startTime":1489.73,"endTime":1492.52,"body":"leaving the splint on in that"},{"speaker":"Charles Goldfarb","startTime":1492.52,"endTime":1496.03,"body":"setting. Yeah, you may maintain"},{"speaker":"Charles Goldfarb","startTime":1492.52,"endTime":1496.03,"body":"the reduction that was obtained,"},{"speaker":"Charles Goldfarb","startTime":1496.3,"endTime":1500.56,"body":"but at what cost and so taking"},{"speaker":"Charles Goldfarb","startTime":1496.3,"endTime":1500.56,"body":"the splint off. Examine the"},{"speaker":"Charles Goldfarb","startTime":1500.56,"endTime":1503.47,"body":"patient getting a sense of"},{"speaker":"Charles Goldfarb","startTime":1500.56,"endTime":1503.47,"body":"swelling, getting a sense of"},{"speaker":"Charles Goldfarb","startTime":1503.47,"endTime":1506.74,"body":"motion, getting a sense of nerve"},{"speaker":"Charles Goldfarb","startTime":1503.47,"endTime":1506.74,"body":"function with two point and"},{"speaker":"Charles Goldfarb","startTime":1506.74,"endTime":1510.13,"body":"maybe muscle function even, all"},{"speaker":"Charles Goldfarb","startTime":1506.74,"endTime":1510.13,"body":"are critical steps."},{"speaker":"Chris Dy","startTime":1510.57,"endTime":1513.45,"body":"Yea muscle function is"},{"speaker":"Chris Dy","startTime":1510.57,"endTime":1513.45,"body":"often hard in this setting, you"},{"speaker":"Chris Dy","startTime":1513.45,"endTime":1516.33,"body":"know, honestly, in a setting of"},{"speaker":"Chris Dy","startTime":1513.45,"endTime":1516.33,"body":"a recent fracture, all I'm"},{"speaker":"Chris Dy","startTime":1516.33,"endTime":1519.3,"body":"looking for are the thenars"},{"speaker":"Chris Dy","startTime":1516.33,"endTime":1519.3,"body":"firing or not, because I really"},{"speaker":"Chris Dy","startTime":1519.3,"endTime":1522.15,"body":"can't push on him too much. And"},{"speaker":"Chris Dy","startTime":1519.3,"endTime":1522.15,"body":"that's where you rely a lot on"},{"speaker":"Chris Dy","startTime":1522.15,"endTime":1525.45,"body":"your sens-you know sensibility"},{"speaker":"Chris Dy","startTime":1522.15,"endTime":1525.45,"body":"exam. And, you know, I'll be"},{"speaker":"Chris Dy","startTime":1525.45,"endTime":1529.08,"body":"honest, because of efficiency"},{"speaker":"Chris Dy","startTime":1525.45,"endTime":1529.08,"body":"considerations, I'm not doing"},{"speaker":"Chris Dy","startTime":1529.08,"endTime":1531.72,"body":"Semmes-Weinstein's, I will do"},{"speaker":"Chris Dy","startTime":1529.08,"endTime":1531.72,"body":"two points. You know, I think"},{"speaker":"Chris Dy","startTime":1531.72,"endTime":1533.76,"body":"you can do that pretty"},{"speaker":"Chris Dy","startTime":1531.72,"endTime":1533.76,"body":"efficiently. And effectively, as"},{"speaker":"Chris Dy","startTime":1533.76,"endTime":1536.28,"body":"long as the patient cognitively"},{"speaker":"Chris Dy","startTime":1533.76,"endTime":1536.28,"body":"understands the test. And I"},{"speaker":"Chris Dy","startTime":1536.28,"endTime":1538.41,"body":"always check against the"},{"speaker":"Chris Dy","startTime":1536.28,"endTime":1538.41,"body":"opposite side and make sure that"},{"speaker":"Chris Dy","startTime":1538.41,"endTime":1541.23,"body":"they get what we're asking,"},{"speaker":"Chris Dy","startTime":1538.41,"endTime":1541.23,"body":"because guessing does not help"},{"speaker":"Chris Dy","startTime":1541.23,"endTime":1541.98,"body":"in that situation."},{"speaker":"Charles Goldfarb","startTime":1542.65,"endTime":1545.05,"body":"Totally agree."},{"speaker":"Charles Goldfarb","startTime":1542.65,"endTime":1545.05,"body":"And I am a fan of data, whether"},{"speaker":"Charles Goldfarb","startTime":1545.05,"endTime":1547.78,"body":"that'd be grip strength, in"},{"speaker":"Charles Goldfarb","startTime":1545.05,"endTime":1547.78,"body":"other patients two point,"},{"speaker":"Charles Goldfarb","startTime":1548.14,"endTime":1552.61,"body":"whatever I can get, I will say"},{"speaker":"Charles Goldfarb","startTime":1548.14,"endTime":1552.61,"body":"without a doubt, in any patient,"},{"speaker":"Charles Goldfarb","startTime":1552.85,"endTime":1555.76,"body":"the one thing I look for any"},{"speaker":"Charles Goldfarb","startTime":1552.85,"endTime":1555.76,"body":"patient with a distal radius"},{"speaker":"Charles Goldfarb","startTime":1555.76,"endTime":1558.46,"body":"fracture who comes in a week"},{"speaker":"Charles Goldfarb","startTime":1555.76,"endTime":1558.46,"body":"later, the most important"},{"speaker":"Charles Goldfarb","startTime":1558.46,"endTime":1561.52,"body":"physical exam finding for me is"},{"speaker":"Charles Goldfarb","startTime":1558.46,"endTime":1561.52,"body":"finger motion. And it's not even"},{"speaker":"Charles Goldfarb","startTime":1561.52,"endTime":1564.28,"body":"close. Because if that patient"},{"speaker":"Charles Goldfarb","startTime":1561.52,"endTime":1564.28,"body":"comes in with good finger"},{"speaker":"Charles Goldfarb","startTime":1564.28,"endTime":1569.44,"body":"motion, despite a fracture,"},{"speaker":"Charles Goldfarb","startTime":1564.28,"endTime":1569.44,"body":"which could be severe, in my, in"},{"speaker":"Charles Goldfarb","startTime":1569.44,"endTime":1572.26,"body":"my experience, they will do"},{"speaker":"Charles Goldfarb","startTime":1569.44,"endTime":1572.26,"body":"well, they may need surgery to"},{"speaker":"Charles Goldfarb","startTime":1572.26,"endTime":1576.01,"body":"get things realigned, but those"},{"speaker":"Charles Goldfarb","startTime":1572.26,"endTime":1576.01,"body":"patients do well. If a patient"},{"speaker":"Charles Goldfarb","startTime":1576.01,"endTime":1579.46,"body":"comes in that won't move their"},{"speaker":"Charles Goldfarb","startTime":1576.01,"endTime":1579.46,"body":"fingers just one of these like"},{"speaker":"Charles Goldfarb","startTime":1579.55,"endTime":1582.37,"body":"little twitch when you ask them"},{"speaker":"Charles Goldfarb","startTime":1579.55,"endTime":1582.37,"body":"to make a fist, I'm immediately"},{"speaker":"Charles Goldfarb","startTime":1582.37,"endTime":1587.47,"body":"concerned. And so those patients"},{"speaker":"Charles Goldfarb","startTime":1582.37,"endTime":1587.47,"body":"get a careful nerve exam, they"},{"speaker":"Charles Goldfarb","startTime":1587.47,"endTime":1589.96,"body":"absolutely get sent to therapy,"},{"speaker":"Charles Goldfarb","startTime":1587.47,"endTime":1589.96,"body":"even if surgery is being"},{"speaker":"Charles Goldfarb","startTime":1589.96,"endTime":1593.92,"body":"planned. And I'm worried"},{"speaker":"Charles Goldfarb","startTime":1589.96,"endTime":1593.92,"body":"Honestly, I'm worried I do my"},{"speaker":"Charles Goldfarb","startTime":1593.92,"endTime":1597.85,"body":"best stern discussion with the"},{"speaker":"Charles Goldfarb","startTime":1593.92,"endTime":1597.85,"body":"patient how important it is to"},{"speaker":"Charles Goldfarb","startTime":1597.85,"endTime":1600.85,"body":"work on motion, I kind of I warn"},{"speaker":"Charles Goldfarb","startTime":1597.85,"endTime":1600.85,"body":"them, I may sound like a jerk."},{"speaker":"Charles Goldfarb","startTime":1600.85,"endTime":1604.36,"body":"But this is really important."},{"speaker":"Charles Goldfarb","startTime":1600.85,"endTime":1604.36,"body":"And I try my best to emphasize"},{"speaker":"Charles Goldfarb","startTime":1604.36,"endTime":1607.48,"body":"to them just in case, they're"},{"speaker":"Charles Goldfarb","startTime":1604.36,"endTime":1607.48,"body":"not trying to move their fingers"},{"speaker":"Charles Goldfarb","startTime":1607.63,"endTime":1609.7,"body":"that they need to understand how"},{"speaker":"Charles Goldfarb","startTime":1607.63,"endTime":1609.7,"body":"important that is."},{"speaker":"Chris Dy","startTime":1610.63,"endTime":1613.24,"body":"What's your threshold"},{"speaker":"Chris Dy","startTime":1610.63,"endTime":1613.24,"body":"to send for additional studies"},{"speaker":"Chris Dy","startTime":1613.24,"endTime":1616.75,"body":"at this point, either a nerve"},{"speaker":"Chris Dy","startTime":1613.24,"endTime":1616.75,"body":"study or even to go to surgery"},{"speaker":"Chris Dy","startTime":1616.75,"endTime":1621.25,"body":"for in this example, a displaced"},{"speaker":"Chris Dy","startTime":1616.75,"endTime":1621.25,"body":"distal radius fracture with a"},{"speaker":"Chris Dy","startTime":1621.25,"endTime":1623.83,"body":"reasonable reduction, but a hand"},{"speaker":"Chris Dy","startTime":1621.25,"endTime":1623.83,"body":"that doesn't quite look right,"},{"speaker":"Chris Dy","startTime":1623.83,"endTime":1626.56,"body":"and maybe some altered"},{"speaker":"Chris Dy","startTime":1623.83,"endTime":1626.56,"body":"sensibility findings and"},{"speaker":"Chris Dy","startTime":1626.56,"endTime":1628.15,"body":"paresthesias in the median"},{"speaker":"Chris Dy","startTime":1626.56,"endTime":1628.15,"body":"distribution."},{"speaker":"Charles Goldfarb","startTime":1629.38,"endTime":1632.59,"body":"Right, so my"},{"speaker":"Charles Goldfarb","startTime":1629.38,"endTime":1632.59,"body":"threshold, I do not need nerve"},{"speaker":"Charles Goldfarb","startTime":1632.59,"endTime":1635.98,"body":"studies, I don't want that to"},{"speaker":"Charles Goldfarb","startTime":1632.59,"endTime":1635.98,"body":"slow down the time to surgery, I"},{"speaker":"Charles Goldfarb","startTime":1635.98,"endTime":1639.67,"body":"will absolutely do a carpal"},{"speaker":"Charles Goldfarb","startTime":1635.98,"endTime":1639.67,"body":"tunnel release for me, and that"},{"speaker":"Charles Goldfarb","startTime":1639.67,"endTime":1642.76,"body":"this may differ between us and"},{"speaker":"Charles Goldfarb","startTime":1639.67,"endTime":1642.76,"body":"it probably differs with some of"},{"speaker":"Charles Goldfarb","startTime":1642.76,"endTime":1646.87,"body":"our partners, the degree of"},{"speaker":"Charles Goldfarb","startTime":1642.76,"endTime":1646.87,"body":"swelling doesn't necessarily"},{"speaker":"Charles Goldfarb","startTime":1646.9,"endTime":1649.99,"body":"push me to do a carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":1646.9,"endTime":1649.99,"body":"release at the time of treatment"},{"speaker":"Charles Goldfarb","startTime":1649.99,"endTime":1652.42,"body":"of distal radius fracture,"},{"speaker":"Charles Goldfarb","startTime":1649.99,"endTime":1652.42,"body":"although it does a lot of"},{"speaker":"Charles Goldfarb","startTime":1652.42,"endTime":1655.39,"body":"swelling does raise my concern"},{"speaker":"Charles Goldfarb","startTime":1652.42,"endTime":1655.39,"body":"for needing a carpal tunnel."},{"speaker":"Charles Goldfarb","startTime":1655.63,"endTime":1659.2,"body":"It's about any complaints of"},{"speaker":"Charles Goldfarb","startTime":1655.63,"endTime":1659.2,"body":"numbness or tingling, anything"},{"speaker":"Charles Goldfarb","startTime":1659.2,"endTime":1661.72,"body":"that sounds or looks fishy,"},{"speaker":"Charles Goldfarb","startTime":1659.2,"endTime":1661.72,"body":"that's when I think about doing"},{"speaker":"Charles Goldfarb","startTime":1661.72,"endTime":1664.81,"body":"a carpal tunnel release, I don't"},{"speaker":"Charles Goldfarb","startTime":1661.72,"endTime":1664.81,"body":"think it adds much to risk of"},{"speaker":"Charles Goldfarb","startTime":1664.81,"endTime":1668.11,"body":"surgery, it is safe, it is"},{"speaker":"Charles Goldfarb","startTime":1664.81,"endTime":1668.11,"body":"quick, and it can be a game"},{"speaker":"Charles Goldfarb","startTime":1668.11,"endTime":1671.05,"body":"changer to have done it rather"},{"speaker":"Charles Goldfarb","startTime":1668.11,"endTime":1671.05,"body":"than to have not done it."},{"speaker":"Chris Dy","startTime":1672.17,"endTime":1675.11,"body":"Yeah, I think it's one"},{"speaker":"Chris Dy","startTime":1672.17,"endTime":1675.11,"body":"of those, you know, your"},{"speaker":"Chris Dy","startTime":1675.23,"endTime":1678.23,"body":"personal comfort with the"},{"speaker":"Chris Dy","startTime":1675.23,"endTime":1678.23,"body":"procedure you're offering will"},{"speaker":"Chris Dy","startTime":1678.23,"endTime":1682.82,"body":"affect your threshold to offer"},{"speaker":"Chris Dy","startTime":1678.23,"endTime":1682.82,"body":"it. So it's out there, you know,"},{"speaker":"Chris Dy","startTime":1682.82,"endTime":1685.97,"body":"the literature demonstrates that"},{"speaker":"Chris Dy","startTime":1682.82,"endTime":1685.97,"body":"trauma surgeons are less likely"},{"speaker":"Chris Dy","startTime":1685.97,"endTime":1689.18,"body":"to do carpal tunnel releases"},{"speaker":"Chris Dy","startTime":1685.97,"endTime":1689.18,"body":"compared to hand surgeons. And"},{"speaker":"Chris Dy","startTime":1689.18,"endTime":1691.19,"body":"that's probably is due to"},{"speaker":"Chris Dy","startTime":1689.18,"endTime":1691.19,"body":"familiarity. I mean, you know,"},{"speaker":"Chris Dy","startTime":1691.43,"endTime":1694.01,"body":"at the institution where I"},{"speaker":"Chris Dy","startTime":1691.43,"endTime":1694.01,"body":"trained all of the, for"},{"speaker":"Chris Dy","startTime":1694.01,"endTime":1696.92,"body":"residency, all of the acute"},{"speaker":"Chris Dy","startTime":1694.01,"endTime":1696.92,"body":"distal radius fractures were"},{"speaker":"Chris Dy","startTime":1696.92,"endTime":1698.99,"body":"being fixed by the trauma"},{"speaker":"Chris Dy","startTime":1696.92,"endTime":1698.99,"body":"service, and I didn't release"},{"speaker":"Chris Dy","startTime":1698.99,"endTime":1701.6,"body":"one carpal tunnel, you know in"},{"speaker":"Chris Dy","startTime":1698.99,"endTime":1701.6,"body":"all of that, and, and there"},{"speaker":"Chris Dy","startTime":1701.6,"endTime":1704.66,"body":"probably were some patients who"},{"speaker":"Chris Dy","startTime":1701.6,"endTime":1704.66,"body":"probably could have benefited"},{"speaker":"Chris Dy","startTime":1704.66,"endTime":1710.21,"body":"from it. But, you know, we never"},{"speaker":"Chris Dy","startTime":1704.66,"endTime":1710.21,"body":"did one. And in terms of in a"},{"speaker":"Chris Dy","startTime":1710.21,"endTime":1712.1,"body":"setting where I'm a little"},{"speaker":"Chris Dy","startTime":1710.21,"endTime":1712.1,"body":"worried, but the patient doesn't"},{"speaker":"Chris Dy","startTime":1712.1,"endTime":1715.82,"body":"have a physical exam that purely"},{"speaker":"Chris Dy","startTime":1712.1,"endTime":1715.82,"body":"corroborates that, you know, it"},{"speaker":"Chris Dy","startTime":1715.82,"endTime":1718.1,"body":"kind of depends on the fracture"},{"speaker":"Chris Dy","startTime":1715.82,"endTime":1718.1,"body":"characteristics, you know, the"},{"speaker":"Chris Dy","startTime":1718.1,"endTime":1721.82,"body":"volar lunate facet fragment,"},{"speaker":"Chris Dy","startTime":1718.1,"endTime":1721.82,"body":"because I'm typically using a"},{"speaker":"Chris Dy","startTime":1721.82,"endTime":1725.36,"body":"fragment specific approach. And"},{"speaker":"Chris Dy","startTime":1721.82,"endTime":1725.36,"body":"I can do that through an"},{"speaker":"Chris Dy","startTime":1725.36,"endTime":1728.6,"body":"extended carpal tunnel type"},{"speaker":"Chris Dy","startTime":1725.36,"endTime":1728.6,"body":"approach, I'm going to release"},{"speaker":"Chris Dy","startTime":1728.6,"endTime":1731.0,"body":"the carpal tunnel, because that"},{"speaker":"Chris Dy","startTime":1728.6,"endTime":1731.0,"body":"could just be a one incision"},{"speaker":"Chris Dy","startTime":1731.0,"endTime":1734.15,"body":"kind of surgery, as opposed to"},{"speaker":"Chris Dy","startTime":1731.0,"endTime":1734.15,"body":"if I'm it's a fracture, where if"},{"speaker":"Chris Dy","startTime":1734.15,"endTime":1737.48,"body":"I was to fix it, it would be"},{"speaker":"Chris Dy","startTime":1734.15,"endTime":1737.48,"body":"with the volar plate. That tends"},{"speaker":"Chris Dy","startTime":1737.48,"endTime":1740.09,"body":"to be a two incision surgery,"},{"speaker":"Chris Dy","startTime":1737.48,"endTime":1740.09,"body":"and I'm not as concerned about"},{"speaker":"Chris Dy","startTime":1740.09,"endTime":1743.78,"body":"swelling right underneath the"},{"speaker":"Chris Dy","startTime":1740.09,"endTime":1743.78,"body":"median nerve, you know, if I'm"},{"speaker":"Chris Dy","startTime":1743.78,"endTime":1745.64,"body":"not fixing a volar lunate facet"},{"speaker":"Chris Dy","startTime":1743.78,"endTime":1745.64,"body":"fragment."},{"speaker":"Charles Goldfarb","startTime":1747.59,"endTime":1751.67,"body":"So let's say"},{"speaker":"Charles Goldfarb","startTime":1747.59,"endTime":1751.67,"body":"you see the patient, the pain's,"},{"speaker":"Charles Goldfarb","startTime":1751.67,"endTime":1754.22,"body":"a little out of proportion,"},{"speaker":"Charles Goldfarb","startTime":1751.67,"endTime":1754.22,"body":"finger motions a little bit"},{"speaker":"Charles Goldfarb","startTime":1754.22,"endTime":1757.88,"body":"lousy, but there's no clear"},{"speaker":"Charles Goldfarb","startTime":1754.22,"endTime":1757.88,"body":"evidence of nerve pathology on"},{"speaker":"Charles Goldfarb","startTime":1757.88,"endTime":1761.9,"body":"your exam. So you take them to"},{"speaker":"Charles Goldfarb","startTime":1757.88,"endTime":1761.9,"body":"the OR you treat their fracture,"},{"speaker":"Charles Goldfarb","startTime":1762.11,"endTime":1764.9,"body":"and they come back to see you"},{"speaker":"Charles Goldfarb","startTime":1762.11,"endTime":1764.9,"body":"seven days later, and their"},{"speaker":"Charles Goldfarb","startTime":1764.9,"endTime":1769.7,"body":"fingers are still not moving."},{"speaker":"Charles Goldfarb","startTime":1764.9,"endTime":1769.7,"body":"And you're a little bit"},{"speaker":"Charles Goldfarb","startTime":1769.7,"endTime":1773.39,"body":"uncomfortable with that. I"},{"speaker":"Charles Goldfarb","startTime":1769.7,"endTime":1773.39,"body":"assume that you send them to"},{"speaker":"Charles Goldfarb","startTime":1773.39,"endTime":1776.3,"body":"therapy. Do you order any"},{"speaker":"Charles Goldfarb","startTime":1773.39,"endTime":1776.3,"body":"testing at that point?"},{"speaker":"Chris Dy","startTime":1778.01,"endTime":1780.56,"body":"Probably not because"},{"speaker":"Chris Dy","startTime":1778.01,"endTime":1780.56,"body":"of that. I'll be honest with you"},{"speaker":"Chris Dy","startTime":1780.56,"endTime":1784.25,"body":"in the demographic that we're"},{"speaker":"Chris Dy","startTime":1780.56,"endTime":1784.25,"body":"talking about, in the you know,"},{"speaker":"Chris Dy","startTime":1784.28,"endTime":1790.85,"body":"it isn't a patient of kind of"},{"speaker":"Chris Dy","startTime":1784.28,"endTime":1790.85,"body":"moderate to advanced age. I'm"},{"speaker":"Chris Dy","startTime":1790.85,"endTime":1793.67,"body":"gonna offer them a carpal tunnel"},{"speaker":"Chris Dy","startTime":1790.85,"endTime":1793.67,"body":"under local anyway and my"},{"speaker":"Chris Dy","startTime":1793.67,"endTime":1797.33,"body":"threshold to offer that surgery"},{"speaker":"Chris Dy","startTime":1793.67,"endTime":1797.33,"body":"is lower than before when I was"},{"speaker":"Chris Dy","startTime":1797.33,"endTime":1800.03,"body":"doing it under anesthesia, so"},{"speaker":"Chris Dy","startTime":1797.33,"endTime":1800.03,"body":"I'm probably going to offer them"},{"speaker":"Chris Dy","startTime":1800.03,"endTime":1801.86,"body":"surgery, if I think that that's"},{"speaker":"Chris Dy","startTime":1800.03,"endTime":1801.86,"body":"going to be helpful, there are"},{"speaker":"Chris Dy","startTime":1801.86,"endTime":1804.14,"body":"some patients where I don't"},{"speaker":"Chris Dy","startTime":1801.86,"endTime":1804.14,"body":"think a carpal tunnel release is"},{"speaker":"Chris Dy","startTime":1804.14,"endTime":1806.78,"body":"going to be helpful. Because,"},{"speaker":"Chris Dy","startTime":1804.14,"endTime":1806.78,"body":"you know, if they have crps type"},{"speaker":"Chris Dy","startTime":1806.78,"endTime":1808.01,"body":"one, it's not going to help."},{"speaker":"Charles Goldfarb","startTime":1808.37,"endTime":1810.29,"body":"Well, people"},{"speaker":"Charles Goldfarb","startTime":1808.37,"endTime":1810.29,"body":"have asked for disagreement, and"},{"speaker":"Charles Goldfarb","startTime":1810.29,"endTime":1814.61,"body":"I'm going to give you some, I"},{"speaker":"Charles Goldfarb","startTime":1810.29,"endTime":1814.61,"body":"would not proceed directly to"},{"speaker":"Charles Goldfarb","startTime":1814.61,"endTime":1819.32,"body":"surgery, even with the option of"},{"speaker":"Charles Goldfarb","startTime":1814.61,"endTime":1819.32,"body":"a local only, unless I was darn"},{"speaker":"Charles Goldfarb","startTime":1819.32,"endTime":1823.07,"body":"sure that it was acting as an"},{"speaker":"Charles Goldfarb","startTime":1819.32,"endTime":1823.07,"body":"acute carpal tunnel. So I"},{"speaker":"Charles Goldfarb","startTime":1823.07,"endTime":1826.7,"body":"probably in this situation,"},{"speaker":"Charles Goldfarb","startTime":1823.07,"endTime":1826.7,"body":"would order nerve studies, or"},{"speaker":"Charles Goldfarb","startTime":1826.7,"endTime":1831.56,"body":"would consider the option of a"},{"speaker":"Charles Goldfarb","startTime":1826.7,"endTime":1831.56,"body":"steroid injection. But I"},{"speaker":"Charles Goldfarb","startTime":1831.56,"endTime":1835.79,"body":"understand your rationale, and"},{"speaker":"Charles Goldfarb","startTime":1831.56,"endTime":1835.79,"body":"it does make some sense. Now, in"},{"speaker":"Charles Goldfarb","startTime":1835.79,"endTime":1839.48,"body":"a patient who may not have"},{"speaker":"Charles Goldfarb","startTime":1835.79,"endTime":1839.48,"body":"worsening of symptoms, what's"},{"speaker":"Charles Goldfarb","startTime":1839.48,"endTime":1840.8,"body":"the role of therapy"},{"speaker":"Chris Dy","startTime":1841.71,"endTime":1844.5,"body":"Our therapy colleagues"},{"speaker":"Chris Dy","startTime":1841.71,"endTime":1844.5,"body":"are so incredibly helpful with"},{"speaker":"Chris Dy","startTime":1844.5,"endTime":1846.93,"body":"modalities such as you know, and"},{"speaker":"Chris Dy","startTime":1844.5,"endTime":1846.93,"body":"techniques such as graded motor"},{"speaker":"Chris Dy","startTime":1846.93,"endTime":1850.89,"body":"imagery, and a lot of the, you"},{"speaker":"Chris Dy","startTime":1846.93,"endTime":1850.89,"body":"know, even apps that you can use"},{"speaker":"Chris Dy","startTime":1850.89,"endTime":1855.15,"body":"now, to help with that process."},{"speaker":"Chris Dy","startTime":1850.89,"endTime":1855.15,"body":"And meter box and things like"},{"speaker":"Chris Dy","startTime":1855.15,"endTime":1855.48,"body":"that."},{"speaker":"Charles Goldfarb","startTime":1856.26,"endTime":1858.24,"body":"Yeah, and"},{"speaker":"Charles Goldfarb","startTime":1856.26,"endTime":1858.24,"body":"loading that they do in the"},{"speaker":"Charles Goldfarb","startTime":1858.24,"endTime":1860.97,"body":"therapy clinic in different, you"},{"speaker":"Charles Goldfarb","startTime":1858.24,"endTime":1860.97,"body":"know, working hard on motion,"},{"speaker":"Charles Goldfarb","startTime":1860.97,"endTime":1864.45,"body":"obviously, hard on edema"},{"speaker":"Charles Goldfarb","startTime":1860.97,"endTime":1864.45,"body":"control, stress loading, when"},{"speaker":"Charles Goldfarb","startTime":1864.45,"endTime":1867.51,"body":"it's appropriate, all are"},{"speaker":"Charles Goldfarb","startTime":1864.45,"endTime":1867.51,"body":"important. I mean, for me, they"},{"speaker":"Charles Goldfarb","startTime":1867.51,"endTime":1871.38,"body":"have to have some clinical"},{"speaker":"Charles Goldfarb","startTime":1867.51,"endTime":1871.38,"body":"evidence of nerve pathology, to"},{"speaker":"Charles Goldfarb","startTime":1871.38,"endTime":1874.02,"body":"think about going and doing a"},{"speaker":"Charles Goldfarb","startTime":1871.38,"endTime":1874.02,"body":"carpal tunnel release, if they"},{"speaker":"Charles Goldfarb","startTime":1874.02,"endTime":1877.11,"body":"have no clinical evidence."},{"speaker":"Charles Goldfarb","startTime":1874.02,"endTime":1877.11,"body":"You're right, you're kind of"},{"speaker":"Charles Goldfarb","startTime":1877.11,"endTime":1879.3,"body":"between a rock and a hard place."},{"speaker":"Charles Goldfarb","startTime":1877.11,"endTime":1879.3,"body":"And we depend on our therapy"},{"speaker":"Charles Goldfarb","startTime":1879.3,"endTime":1884.01,"body":"colleagues. And sometimes I've"},{"speaker":"Charles Goldfarb","startTime":1879.3,"endTime":1884.01,"body":"found that there is a later"},{"speaker":"Charles Goldfarb","startTime":1884.07,"endTime":1887.1,"body":"presentation of carpal tunnel,"},{"speaker":"Charles Goldfarb","startTime":1884.07,"endTime":1887.1,"body":"which can be found. So just"},{"speaker":"Charles Goldfarb","startTime":1887.1,"endTime":1890.31,"body":"because pre op or first visit"},{"speaker":"Charles Goldfarb","startTime":1887.1,"endTime":1890.31,"body":"post op, there's no clear"},{"speaker":"Charles Goldfarb","startTime":1890.31,"endTime":1892.86,"body":"evidence of pathology, it can"},{"speaker":"Charles Goldfarb","startTime":1890.31,"endTime":1892.86,"body":"show up later. And I think we"},{"speaker":"Charles Goldfarb","startTime":1892.86,"endTime":1897.93,"body":"have to be aware, based on a"},{"speaker":"Charles Goldfarb","startTime":1892.86,"endTime":1897.93,"body":"lousy overall clinical exam."},{"speaker":"Chris Dy","startTime":1898.62,"endTime":1901.74,"body":"So for those trainees"},{"speaker":"Chris Dy","startTime":1898.62,"endTime":1901.74,"body":"and surgeons that are listening,"},{"speaker":"Chris Dy","startTime":1901.74,"endTime":1903.87,"body":"you know and I was joking"},{"speaker":"Chris Dy","startTime":1901.74,"endTime":1903.87,"body":"earlier, but you know, Chuck"},{"speaker":"Chris Dy","startTime":1903.87,"endTime":1908.22,"body":"really did write the paper on"},{"speaker":"Chris Dy","startTime":1903.87,"endTime":1908.22,"body":"crps type two in the setting of"},{"speaker":"Chris Dy","startTime":1908.67,"endTime":1911.52,"body":"distal radius fractures in the"},{"speaker":"Chris Dy","startTime":1908.67,"endTime":1911.52,"body":"utilization of a carpal tunnel"},{"speaker":"Chris Dy","startTime":1911.52,"endTime":1915.45,"body":"release, which I think has been"},{"speaker":"Chris Dy","startTime":1911.52,"endTime":1915.45,"body":"incredibly influential, you"},{"speaker":"Chris Dy","startTime":1915.45,"endTime":1918.39,"body":"know, in helping a lot of"},{"speaker":"Chris Dy","startTime":1915.45,"endTime":1918.39,"body":"patients in terms of, you know,"},{"speaker":"Chris Dy","startTime":1918.6,"endTime":1921.24,"body":"giving surgeons leeway to say,"},{"speaker":"Chris Dy","startTime":1918.6,"endTime":1921.24,"body":"Hey, this is what's going to"},{"speaker":"Chris Dy","startTime":1921.24,"endTime":1924.27,"body":"work. You know, Chuck, do you"},{"speaker":"Chris Dy","startTime":1921.24,"endTime":1924.27,"body":"have any thoughts on that paper?"},{"speaker":"Charles Goldfarb","startTime":1925.38,"endTime":1928.62,"body":"Well, I think"},{"speaker":"Charles Goldfarb","startTime":1925.38,"endTime":1928.62,"body":"the beauty of that paper, it was"},{"speaker":"Charles Goldfarb","startTime":1928.62,"endTime":1931.5,"body":"a paper written with Dr."},{"speaker":"Charles Goldfarb","startTime":1928.62,"endTime":1931.5,"body":"Gelberman, it was his kind of"},{"speaker":"Charles Goldfarb","startTime":1931.5,"endTime":1934.68,"body":"initial idea. And I couldn't"},{"speaker":"Charles Goldfarb","startTime":1931.5,"endTime":1934.68,"body":"understand why he was so eager"},{"speaker":"Charles Goldfarb","startTime":1934.68,"endTime":1937.29,"body":"for me to be first author. And"},{"speaker":"Charles Goldfarb","startTime":1934.68,"endTime":1937.29,"body":"granted, I did most of the"},{"speaker":"Charles Goldfarb","startTime":1937.29,"endTime":1941.13,"body":"writing. I was younger. And I"},{"speaker":"Charles Goldfarb","startTime":1937.29,"endTime":1941.13,"body":"was like, Okay, great. We joked"},{"speaker":"Charles Goldfarb","startTime":1941.13,"endTime":1944.43,"body":"about it afterwards. I think the"},{"speaker":"Charles Goldfarb","startTime":1941.13,"endTime":1944.43,"body":"lesson is simple. And I think"},{"speaker":"Charles Goldfarb","startTime":1944.43,"endTime":1947.22,"body":"about this lesson in light of"},{"speaker":"Charles Goldfarb","startTime":1944.43,"endTime":1947.22,"body":"even a couple other examples,"},{"speaker":"Charles Goldfarb","startTime":1947.22,"endTime":1951.27,"body":"but the lesson is simple. carpal"},{"speaker":"Charles Goldfarb","startTime":1947.22,"endTime":1951.27,"body":"tunnel release is never going to"},{"speaker":"Charles Goldfarb","startTime":1951.27,"endTime":1955.77,"body":"be the problem. And there was"},{"speaker":"Charles Goldfarb","startTime":1951.27,"endTime":1955.77,"body":"some dogma, hitting back to a"},{"speaker":"Charles Goldfarb","startTime":1955.77,"endTime":1959.04,"body":"previous episode, or urban"},{"speaker":"Charles Goldfarb","startTime":1955.77,"endTime":1959.04,"body":"legend that doing a carpal"},{"speaker":"Charles Goldfarb","startTime":1959.04,"endTime":1962.16,"body":"tunnel release in certain"},{"speaker":"Charles Goldfarb","startTime":1959.04,"endTime":1962.16,"body":"situations can make it worse. I"},{"speaker":"Charles Goldfarb","startTime":1962.16,"endTime":1964.53,"body":"think the lesson for me from"},{"speaker":"Charles Goldfarb","startTime":1962.16,"endTime":1964.53,"body":"that paper is carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":1964.53,"endTime":1969.09,"body":"surgery, or whatever nerve"},{"speaker":"Charles Goldfarb","startTime":1964.53,"endTime":1969.09,"body":"surgery is part of the answer."},{"speaker":"Charles Goldfarb","startTime":1969.33,"endTime":1972.48,"body":"And so no fear if you think"},{"speaker":"Charles Goldfarb","startTime":1969.33,"endTime":1972.48,"body":"there is a compressed or"},{"speaker":"Charles Goldfarb","startTime":1972.48,"endTime":1975.81,"body":"compromised nerve, releasing"},{"speaker":"Charles Goldfarb","startTime":1972.48,"endTime":1975.81,"body":"that nerve makes sense. So for"},{"speaker":"Charles Goldfarb","startTime":1975.81,"endTime":1980.19,"body":"example, Dupuytren's surgery, it"},{"speaker":"Charles Goldfarb","startTime":1975.81,"endTime":1980.19,"body":"used to be forboden to do a"},{"speaker":"Charles Goldfarb","startTime":1980.19,"endTime":1982.17,"body":"carpal tunnel release at the"},{"speaker":"Charles Goldfarb","startTime":1980.19,"endTime":1982.17,"body":"same time as you do a"},{"speaker":"Charles Goldfarb","startTime":1982.17,"endTime":1986.13,"body":"fasciectomy. Well, that's crazy"},{"speaker":"Charles Goldfarb","startTime":1982.17,"endTime":1986.13,"body":"to me. And I do that not to say"},{"speaker":"Charles Goldfarb","startTime":1986.13,"endTime":1988.41,"body":"all the time, because not every"},{"speaker":"Charles Goldfarb","startTime":1986.13,"endTime":1988.41,"body":"Dupuytren's patient needs it."},{"speaker":"Charles Goldfarb","startTime":1988.41,"endTime":1991.47,"body":"But if there's evidence to both"},{"speaker":"Charles Goldfarb","startTime":1988.41,"endTime":1991.47,"body":"diagnoses, I don't hesitate to"},{"speaker":"Charles Goldfarb","startTime":1991.47,"endTime":1993.66,"body":"do a carpal tunnel release at"},{"speaker":"Charles Goldfarb","startTime":1991.47,"endTime":1993.66,"body":"the same time as a fasciectomy."},{"speaker":"Chris Dy","startTime":1993.0,"endTime":1998.28,"body":"I think one important"},{"speaker":"Chris Dy","startTime":1993.0,"endTime":1998.28,"body":"point for anybody listening who"},{"speaker":"Chris Dy","startTime":1998.28,"endTime":2001.43,"body":"does the surgeries. You know, a"},{"speaker":"Chris Dy","startTime":1998.28,"endTime":2001.43,"body":"lot of times these are not"},{"speaker":"Chris Dy","startTime":2001.43,"endTime":2005.24,"body":"patients that had carpal tunnel"},{"speaker":"Chris Dy","startTime":2001.43,"endTime":2005.24,"body":"syndrome ahead of time. So"},{"speaker":"Chris Dy","startTime":2005.66,"endTime":2008.45,"body":"oftentimes, the transverse"},{"speaker":"Chris Dy","startTime":2005.66,"endTime":2008.45,"body":"carpal ligament is not as thick,"},{"speaker":"Chris Dy","startTime":2008.48,"endTime":2012.38,"body":"it's not as \"stenotic\". And as"},{"speaker":"Chris Dy","startTime":2008.48,"endTime":2012.38,"body":"ou're doing the approach for the"},{"speaker":"Chris Dy","startTime":2012.38,"endTime":2014.84,"body":"surgery, that's somethi"},{"speaker":"Chris Dy","startTime":2012.38,"endTime":2014.84,"body":"g to consider because we all kno"},{"speaker":"Chris Dy","startTime":2014.84,"endTime":2017.66,"body":"that that part of the surgery"},{"speaker":"Chris Dy","startTime":2014.84,"endTime":2017.66,"body":"is a tactile part of the surgery"},{"speaker":"Chris Dy","startTime":2017.66,"endTime":2021.32,"body":"where you're really feeling"},{"speaker":"Chris Dy","startTime":2017.66,"endTime":2021.32,"body":"with the tip, or the belly o"},{"speaker":"Chris Dy","startTime":2021.32,"endTime":2025.01,"body":"your blade, however you do it i"},{"speaker":"Chris Dy","startTime":2021.32,"endTime":2025.01,"body":"order to make that initial"},{"speaker":"Chris Dy","startTime":2025.01,"endTime":2028.91,"body":"pass to divide the transve"},{"speaker":"Chris Dy","startTime":2025.01,"endTime":2028.91,"body":"se carpal ligament. So that is"},{"speaker":"Chris Dy","startTime":2029.39,"endTime":2032.12,"body":"one important thing to conside"},{"speaker":"Chris Dy","startTime":2029.39,"endTime":2032.12,"body":". And then for me persona"},{"speaker":"Chris Dy","startTime":2032.12,"endTime":2035.99,"body":"ly, what I've noted in the set"},{"speaker":"Chris Dy","startTime":2032.12,"endTime":2035.99,"body":"ing of a fracture, I do like an"},{"speaker":"Chris Dy","startTime":2035.99,"endTime":2039.5,"body":"extended carpal tunnel release"},{"speaker":"Chris Dy","startTime":2035.99,"endTime":2039.5,"body":"type incision with a Bruner"},{"speaker":"Chris Dy","startTime":2039.53,"endTime":2042.26,"body":"igzag across the wrist crease"},{"speaker":"Chris Dy","startTime":2039.53,"endTime":2042.26,"body":"eading away from the palmar"},{"speaker":"Chris Dy","startTime":2042.26,"endTime":2045.65,"body":"utaneous branch of the median"},{"speaker":"Chris Dy","startTime":2042.26,"endTime":2045.65,"body":"erve. Because in the trauma"},{"speaker":"Chris Dy","startTime":2045.65,"endTime":2048.92,"body":"etting, I've noted that that vo"},{"speaker":"Chris Dy","startTime":2045.65,"endTime":2048.92,"body":"ar antebrachial fascia tends t"},{"speaker":"Chris Dy","startTime":2048.92,"endTime":2053.3,"body":"be super tight. And that is"},{"speaker":"Chris Dy","startTime":2048.92,"endTime":2053.3,"body":"one area where I had one patient"},{"speaker":"Chris Dy","startTime":2053.3,"endTime":2056.12,"body":"where I thought I had done an"},{"speaker":"Chris Dy","startTime":2053.3,"endTime":2056.12,"body":"adequate release, but it was tha"},{"speaker":"Chris Dy","startTime":2056.12,"endTime":2061.37,"body":"just a couple of thick fibers"},{"speaker":"Chris Dy","startTime":2056.12,"endTime":2061.37,"body":"f that fascia that were that we"},{"speaker":"Chris Dy","startTime":2062.12,"endTime":2063.2,"body":"e problematic."},{"speaker":"Charles Goldfarb","startTime":2063.0,"endTime":2065.73,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2063.0,"endTime":2065.73,"body":"fair. And that's an important"},{"speaker":"Charles Goldfarb","startTime":2065.73,"endTime":2069.36,"body":"point. You know, I love the"},{"speaker":"Charles Goldfarb","startTime":2065.73,"endTime":2069.36,"body":"centimeter and a half incision"},{"speaker":"Charles Goldfarb","startTime":2069.36,"endTime":2072.87,"body":"for an elective carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":2069.36,"endTime":2072.87,"body":"release. But when I do a"},{"speaker":"Charles Goldfarb","startTime":2073.05,"endTime":2076.62,"body":"traumatic carpal tunnel release,"},{"speaker":"Charles Goldfarb","startTime":2073.05,"endTime":2076.62,"body":"always cross the wrist crease,"},{"speaker":"Charles Goldfarb","startTime":2076.74,"endTime":2081.3,"body":"but often I do and it's a it's a"},{"speaker":"Charles Goldfarb","startTime":2076.74,"endTime":2081.3,"body":"more significant exposure. I do"},{"speaker":"Charles Goldfarb","startTime":2081.3,"endTime":2084.06,"body":"think we need to emphasize that"},{"speaker":"Charles Goldfarb","startTime":2081.3,"endTime":2084.06,"body":"it's not always the median nerve"},{"speaker":"Charles Goldfarb","startTime":2084.06,"endTime":2087.06,"body":"and it's not always carpal"},{"speaker":"Charles Goldfarb","startTime":2084.06,"endTime":2087.06,"body":"tunnel. I've treated a patient"},{"speaker":"Charles Goldfarb","startTime":2087.06,"endTime":2093.48,"body":"who had a tendon transfer had an"},{"speaker":"Charles Goldfarb","startTime":2087.06,"endTime":2093.48,"body":"EIP opposition transfer for a"},{"speaker":"Charles Goldfarb","startTime":2093.48,"endTime":2097.65,"body":"thumb motion. And in the passing"},{"speaker":"Charles Goldfarb","startTime":2093.48,"endTime":2097.65,"body":"of the tendon transfer, the"},{"speaker":"Charles Goldfarb","startTime":2097.65,"endTime":2100.8,"body":"ulnar nerve was compromised at"},{"speaker":"Charles Goldfarb","startTime":2097.65,"endTime":2100.8,"body":"the wrist and so We had to"},{"speaker":"Charles Goldfarb","startTime":2100.8,"endTime":2104.82,"body":"address that and move the move"},{"speaker":"Charles Goldfarb","startTime":2100.8,"endTime":2104.82,"body":"the tendon that was previously"},{"speaker":"Charles Goldfarb","startTime":2104.82,"endTime":2107.4,"body":"transferred around the nerve."},{"speaker":"Charles Goldfarb","startTime":2104.82,"endTime":2107.4,"body":"And so there's a variety of"},{"speaker":"Charles Goldfarb","startTime":2107.4,"endTime":2110.7,"body":"things that can happen. It's"},{"speaker":"Charles Goldfarb","startTime":2107.4,"endTime":2110.7,"body":"just about being aware and"},{"speaker":"Charles Goldfarb","startTime":2110.7,"endTime":2114.84,"body":"looking for possible ideologies."},{"speaker":"Charles Goldfarb","startTime":2110.7,"endTime":2114.84,"body":"Because the alternative is, we"},{"speaker":"Charles Goldfarb","startTime":2114.84,"endTime":2117.45,"body":"can't help the patient. But"},{"speaker":"Charles Goldfarb","startTime":2114.84,"endTime":2117.45,"body":"that's what I enjoy. You know,"},{"speaker":"Charles Goldfarb","startTime":2117.45,"endTime":2120.99,"body":"if a patient comes in who's had"},{"speaker":"Charles Goldfarb","startTime":2117.45,"endTime":2120.99,"body":"a serious problem for a long"},{"speaker":"Charles Goldfarb","startTime":2120.99,"endTime":2125.52,"body":"time, and I can examine a"},{"speaker":"Charles Goldfarb","startTime":2120.99,"endTime":2125.52,"body":"patient and identify a possibly"},{"speaker":"Charles Goldfarb","startTime":2125.52,"endTime":2128.88,"body":"compromised nerve, and offer"},{"speaker":"Charles Goldfarb","startTime":2125.52,"endTime":2128.88,"body":"treatment, I'm not going to cure"},{"speaker":"Charles Goldfarb","startTime":2128.88,"endTime":2131.7,"body":"that patient with crps, type"},{"speaker":"Charles Goldfarb","startTime":2128.88,"endTime":2131.7,"body":"two, but we can make them"},{"speaker":"Charles Goldfarb","startTime":2131.7,"endTime":2136.74,"body":"significantly better. And the"},{"speaker":"Charles Goldfarb","startTime":2131.7,"endTime":2136.74,"body":"flip side is, if I can't, if I"},{"speaker":"Charles Goldfarb","startTime":2136.74,"endTime":2140.07,"body":"don't identify a compromised"},{"speaker":"Charles Goldfarb","startTime":2136.74,"endTime":2140.07,"body":"nerve, and I can't find"},{"speaker":"Charles Goldfarb","startTime":2140.07,"endTime":2142.44,"body":"something that I can do to help"},{"speaker":"Charles Goldfarb","startTime":2140.07,"endTime":2142.44,"body":"the patient, I'm not going to"},{"speaker":"Charles Goldfarb","startTime":2142.44,"endTime":2145.71,"body":"waste their time, by having them"},{"speaker":"Charles Goldfarb","startTime":2142.44,"endTime":2145.71,"body":"come back repetitively, I'm"},{"speaker":"Charles Goldfarb","startTime":2145.71,"endTime":2148.08,"body":"going to send them on to pain"},{"speaker":"Charles Goldfarb","startTime":2145.71,"endTime":2148.08,"body":"management. And that's my"},{"speaker":"Charles Goldfarb","startTime":2148.08,"endTime":2149.73,"body":"simplistic approach. And I like"},{"speaker":"Charles Goldfarb","startTime":2148.08,"endTime":2149.73,"body":"it."},{"speaker":"Chris Dy","startTime":2150.32,"endTime":2152.24,"body":"Yeah, and I think"},{"speaker":"Chris Dy","startTime":2150.32,"endTime":2152.24,"body":"patients will value getting a"},{"speaker":"Chris Dy","startTime":2152.24,"endTime":2154.31,"body":"diagnosis and being told"},{"speaker":"Chris Dy","startTime":2152.24,"endTime":2154.31,"body":"something, I mean, the number of"},{"speaker":"Chris Dy","startTime":2154.31,"endTime":2158.12,"body":"people that we see being at a"},{"speaker":"Chris Dy","startTime":2154.31,"endTime":2158.12,"body":"referral center, you know who"},{"speaker":"Chris Dy","startTime":2158.12,"endTime":2160.76,"body":"have been run around for a long"},{"speaker":"Chris Dy","startTime":2158.12,"endTime":2160.76,"body":"time, and just want answers,"},{"speaker":"Chris Dy","startTime":2160.76,"endTime":2162.71,"body":"regardless of whether you can"},{"speaker":"Chris Dy","startTime":2160.76,"endTime":2162.71,"body":"help them or not, they just want"},{"speaker":"Chris Dy","startTime":2162.71,"endTime":2164.39,"body":"to be told, here's what you"},{"speaker":"Chris Dy","startTime":2162.71,"endTime":2164.39,"body":"have, here's what to expect,"},{"speaker":"Chris Dy","startTime":2164.39,"endTime":2166.49,"body":"here's what I can do, here's"},{"speaker":"Chris Dy","startTime":2164.39,"endTime":2166.49,"body":"what I don't think I can do for"},{"speaker":"Chris Dy","startTime":2166.49,"endTime":2171.14,"body":"you. Patients really appreciate"},{"speaker":"Chris Dy","startTime":2166.49,"endTime":2171.14,"body":"that. You know, and the other"},{"speaker":"Chris Dy","startTime":2171.14,"endTime":2175.7,"body":"way that crps type two tends to"},{"speaker":"Chris Dy","startTime":2171.14,"endTime":2175.7,"body":"show up in my office, you know,"},{"speaker":"Chris Dy","startTime":2175.7,"endTime":2178.46,"body":"aside from like a traumatic"},{"speaker":"Chris Dy","startTime":2175.7,"endTime":2178.46,"body":"brachial plexus injury would be,"},{"speaker":"Chris Dy","startTime":2178.7,"endTime":2181.34,"body":"you know, nerves that are"},{"speaker":"Chris Dy","startTime":2178.7,"endTime":2181.34,"body":"irritated by surgeries, for"},{"speaker":"Chris Dy","startTime":2181.34,"endTime":2184.04,"body":"example, superficial perineal"},{"speaker":"Chris Dy","startTime":2181.34,"endTime":2184.04,"body":"nerve after an ankle fracture,"},{"speaker":"Chris Dy","startTime":2184.64,"endTime":2186.59,"body":"you know, after a standard"},{"speaker":"Chris Dy","startTime":2184.64,"endTime":2186.59,"body":"lateral approach for an ankle"},{"speaker":"Chris Dy","startTime":2186.59,"endTime":2190.31,"body":"fracture, we talked earlier"},{"speaker":"Chris Dy","startTime":2186.59,"endTime":2190.31,"body":"about the medial antebrachial"},{"speaker":"Chris Dy","startTime":2190.31,"endTime":2192.44,"body":"cutaneous nerve in a setting of"},{"speaker":"Chris Dy","startTime":2190.31,"endTime":2192.44,"body":"medial elbow surgery like"},{"speaker":"Chris Dy","startTime":2192.47,"endTime":2195.56,"body":"cubital tunnel surgery. And"},{"speaker":"Chris Dy","startTime":2192.47,"endTime":2195.56,"body":"those are patients that you can"},{"speaker":"Chris Dy","startTime":2195.56,"endTime":2198.17,"body":"really help and you know, it's a"},{"speaker":"Chris Dy","startTime":2195.56,"endTime":2198.17,"body":"whole lot different episode to"},{"speaker":"Chris Dy","startTime":2198.17,"endTime":2200.24,"body":"talk about, you know,"},{"speaker":"Chris Dy","startTime":2198.17,"endTime":2200.24,"body":"specifically the surgical"},{"speaker":"Chris Dy","startTime":2200.24,"endTime":2203.15,"body":"treatment of pain in that"},{"speaker":"Chris Dy","startTime":2200.24,"endTime":2203.15,"body":"setting. Because there's a lot"},{"speaker":"Chris Dy","startTime":2203.15,"endTime":2205.61,"body":"of different ways we can do it,"},{"speaker":"Chris Dy","startTime":2203.15,"endTime":2205.61,"body":"including targeted muscle"},{"speaker":"Chris Dy","startTime":2205.61,"endTime":2208.55,"body":"reinnervation, regenerate"},{"speaker":"Chris Dy","startTime":2205.61,"endTime":2208.55,"body":"peripheral nerve interfaces, you"},{"speaker":"Chris Dy","startTime":2208.55,"endTime":2211.46,"body":"know, people want more nerve"},{"speaker":"Chris Dy","startTime":2208.55,"endTime":2211.46,"body":"talk, Chuck, so we can hold"},{"speaker":"Chris Dy","startTime":2211.46,"endTime":2215.57,"body":"totally have a big nerve day"},{"speaker":"Chris Dy","startTime":2211.46,"endTime":2215.57,"body":"talking about those things. But"},{"speaker":"Chris Dy","startTime":2215.57,"endTime":2218.27,"body":"you know, those are patients"},{"speaker":"Chris Dy","startTime":2215.57,"endTime":2218.27,"body":"that you can help. And we talked"},{"speaker":"Chris Dy","startTime":2218.27,"endTime":2224.15,"body":"about diagnostic workup earlier."},{"speaker":"Chris Dy","startTime":2218.27,"endTime":2224.15,"body":"And I like doing a diagnostic"},{"speaker":"Chris Dy","startTime":2224.15,"endTime":2227.66,"body":"injection. And I don't do it"},{"speaker":"Chris Dy","startTime":2224.15,"endTime":2227.66,"body":"myself, I have somebody do it on"},{"speaker":"Chris Dy","startTime":2227.66,"endTime":2232.34,"body":"ultrasound guidance for a lot of"},{"speaker":"Chris Dy","startTime":2227.66,"endTime":2232.34,"body":"these for a specific, you know,"},{"speaker":"Chris Dy","startTime":2233.03,"endTime":2235.97,"body":"peripheral nerve that is"},{"speaker":"Chris Dy","startTime":2233.03,"endTime":2235.97,"body":"potentially a culprit for crps"},{"speaker":"Chris Dy","startTime":2235.97,"endTime":2240.92,"body":"type two, because sometimes the"},{"speaker":"Chris Dy","startTime":2235.97,"endTime":2240.92,"body":"treatment does involve resection"},{"speaker":"Chris Dy","startTime":2240.92,"endTime":2243.74,"body":"of the nerve and intramuscular"},{"speaker":"Chris Dy","startTime":2240.92,"endTime":2243.74,"body":"transposition or you know,"},{"speaker":"Chris Dy","startTime":2244.01,"endTime":2248.84,"body":"quote, road to nowhere type"},{"speaker":"Chris Dy","startTime":2244.01,"endTime":2248.84,"body":"surgery, it helps me understand"},{"speaker":"Chris Dy","startTime":2248.84,"endTime":2251.93,"body":"the diagnosis that they have, it"},{"speaker":"Chris Dy","startTime":2248.84,"endTime":2251.93,"body":"helps the patient understand,"},{"speaker":"Chris Dy","startTime":2251.93,"endTime":2255.41,"body":"hey, this really was the problem"},{"speaker":"Chris Dy","startTime":2251.93,"endTime":2255.41,"body":"this you know, nerve. And"},{"speaker":"Chris Dy","startTime":2255.41,"endTime":2258.44,"body":"sometimes we take the drastic"},{"speaker":"Chris Dy","startTime":2255.41,"endTime":2258.44,"body":"step of cutting the nerve and"},{"speaker":"Chris Dy","startTime":2258.44,"endTime":2262.55,"body":"leaving them with expected a"},{"speaker":"Chris Dy","startTime":2258.44,"endTime":2262.55,"body":"known area of numbness. But a"},{"speaker":"Chris Dy","startTime":2262.55,"endTime":2264.68,"body":"lot of times these patients are"},{"speaker":"Chris Dy","startTime":2262.55,"endTime":2264.68,"body":"more than happy to make that"},{"speaker":"Chris Dy","startTime":2264.68,"endTime":2268.28,"body":"trade given how severe and how"},{"speaker":"Chris Dy","startTime":2264.68,"endTime":2268.28,"body":"prolonged their symptoms have"},{"speaker":"Chris Dy","startTime":2268.28,"endTime":2268.61,"body":"been."},{"speaker":"Charles Goldfarb","startTime":2269.89,"endTime":2273.16,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2269.89,"endTime":2273.16,"body":"all well said. And I know that"},{"speaker":"Charles Goldfarb","startTime":2273.16,"endTime":2275.92,"body":"you are clamoring for more"},{"speaker":"Charles Goldfarb","startTime":2273.16,"endTime":2275.92,"body":"nerve, I'm just not convinced"},{"speaker":"Charles Goldfarb","startTime":2275.92,"endTime":2278.35,"body":"that the entire audience wants"},{"speaker":"Charles Goldfarb","startTime":2275.92,"endTime":2278.35,"body":"more nerve discussion, maybe,"},{"speaker":"Charles Goldfarb","startTime":2278.38,"endTime":2278.77,"body":"maybe"},{"speaker":"Chris Dy","startTime":2278.89,"endTime":2280.54,"body":"Check the review"},{"speaker":"Chris Dy","startTime":2278.89,"endTime":2280.54,"body":"buddy, check the review."},{"speaker":"Charles Goldfarb","startTime":2282.28,"endTime":2284.83,"body":"I think about"},{"speaker":"Charles Goldfarb","startTime":2282.28,"endTime":2284.83,"body":"one patient that I had in the"},{"speaker":"Charles Goldfarb","startTime":2284.83,"endTime":2287.56,"body":"work comp system, you know, work"},{"speaker":"Charles Goldfarb","startTime":2284.83,"endTime":2287.56,"body":"comp, patients get labeled very"},{"speaker":"Charles Goldfarb","startTime":2287.56,"endTime":2291.7,"body":"quickly. And they get labeled"},{"speaker":"Charles Goldfarb","startTime":2287.56,"endTime":2291.7,"body":"Mullingar someone who's working"},{"speaker":"Charles Goldfarb","startTime":2291.7,"endTime":2294.94,"body":"the system. And this guy was a"},{"speaker":"Charles Goldfarb","startTime":2291.7,"endTime":2294.94,"body":"really nice guy. And I do fall"},{"speaker":"Charles Goldfarb","startTime":2294.94,"endTime":2298.9,"body":"for, you know, nice patients."},{"speaker":"Charles Goldfarb","startTime":2294.94,"endTime":2298.9,"body":"But he had a superficial branch"},{"speaker":"Charles Goldfarb","startTime":2298.9,"endTime":2303.52,"body":"of the radial nerve that had"},{"speaker":"Charles Goldfarb","startTime":2298.9,"endTime":2303.52,"body":"been traumatized. And I"},{"speaker":"Charles Goldfarb","startTime":2303.52,"endTime":2309.37,"body":"initially found a segment that"},{"speaker":"Charles Goldfarb","startTime":2303.52,"endTime":2309.37,"body":"was injured. And we decided to"},{"speaker":"Charles Goldfarb","startTime":2309.4,"endTime":2313.6,"body":"basically excise the nerve. And"},{"speaker":"Charles Goldfarb","startTime":2309.4,"endTime":2313.6,"body":"he is thrilled. He has a large"},{"speaker":"Charles Goldfarb","startTime":2313.6,"endTime":2316.21,"body":"area of numbness along the"},{"speaker":"Charles Goldfarb","startTime":2313.6,"endTime":2316.21,"body":"dorsal thumb and hand and could"},{"speaker":"Charles Goldfarb","startTime":2316.21,"endTime":2320.02,"body":"care less. His pain, which had"},{"speaker":"Charles Goldfarb","startTime":2316.21,"endTime":2320.02,"body":"been present for nine months is"},{"speaker":"Charles Goldfarb","startTime":2320.02,"endTime":2323.77,"body":"gone. He's back to work. And so"},{"speaker":"Charles Goldfarb","startTime":2320.02,"endTime":2323.77,"body":"it's just about, you know, not"},{"speaker":"Charles Goldfarb","startTime":2323.77,"endTime":2326.8,"body":"having preconceived notions"},{"speaker":"Charles Goldfarb","startTime":2323.77,"endTime":2326.8,"body":"walking into the room, and doing"},{"speaker":"Charles Goldfarb","startTime":2326.83,"endTime":2333.13,"body":"our best as diagnosticians to"},{"speaker":"Charles Goldfarb","startTime":2326.83,"endTime":2333.13,"body":"rule out crps, or rule out nerve"},{"speaker":"Charles Goldfarb","startTime":2333.13,"endTime":2335.74,"body":"mediated pain and do what we can"},{"speaker":"Charles Goldfarb","startTime":2333.13,"endTime":2335.74,"body":"to help those patients."},{"speaker":"Chris Dy","startTime":2335.75,"endTime":2337.91,"body":"And let's be real,"},{"speaker":"Chris Dy","startTime":2335.75,"endTime":2337.91,"body":"it's not all sunshine and roses"},{"speaker":"Chris Dy","startTime":2337.91,"endTime":2339.77,"body":"all the time, when I see these"},{"speaker":"Chris Dy","startTime":2337.91,"endTime":2339.77,"body":"patients, you know, there are"},{"speaker":"Chris Dy","startTime":2339.77,"endTime":2343.61,"body":"patients that I cannot help. And"},{"speaker":"Chris Dy","startTime":2339.77,"endTime":2343.61,"body":"these are the crps type one"},{"speaker":"Chris Dy","startTime":2343.61,"endTime":2347.36,"body":"patients largely, and you know,"},{"speaker":"Chris Dy","startTime":2343.61,"endTime":2347.36,"body":"they come to me because they"},{"speaker":"Chris Dy","startTime":2347.36,"endTime":2349.22,"body":"were told that, you know,"},{"speaker":"Chris Dy","startTime":2347.36,"endTime":2349.22,"body":"they're seeing a nerve surgeon"},{"speaker":"Chris Dy","startTime":2349.22,"endTime":2351.38,"body":"and you know, somebody can help"},{"speaker":"Chris Dy","startTime":2349.22,"endTime":2351.38,"body":"them. And you know, it's"},{"speaker":"Chris Dy","startTime":2351.38,"endTime":2354.23,"body":"frustrating to be able not to"},{"speaker":"Chris Dy","startTime":2351.38,"endTime":2354.23,"body":"help somebody and as much as a"},{"speaker":"Chris Dy","startTime":2354.23,"endTime":2356.78,"body":"lot of patients appreciate you"},{"speaker":"Chris Dy","startTime":2354.23,"endTime":2356.78,"body":"know the Straight Dope and being"},{"speaker":"Chris Dy","startTime":2356.78,"endTime":2359.24,"body":"told what's going on and here's"},{"speaker":"Chris Dy","startTime":2356.78,"endTime":2359.24,"body":"a referral to people that might"},{"speaker":"Chris Dy","startTime":2359.24,"endTime":2361.82,"body":"be able to help you. A lot of"},{"speaker":"Chris Dy","startTime":2359.24,"endTime":2361.82,"body":"times they've seen pain"},{"speaker":"Chris Dy","startTime":2361.82,"endTime":2364.7,"body":"management already. And they've"},{"speaker":"Chris Dy","startTime":2361.82,"endTime":2364.7,"body":"seen probably some inferior pain"},{"speaker":"Chris Dy","startTime":2364.7,"endTime":2366.83,"body":"management doctors for the"},{"speaker":"Chris Dy","startTime":2364.7,"endTime":2366.83,"body":"people that are coming in from"},{"speaker":"Chris Dy","startTime":2366.83,"endTime":2371.27,"body":"outside of our facility. And"},{"speaker":"Chris Dy","startTime":2366.83,"endTime":2371.27,"body":"it's frustrating for them and"},{"speaker":"Chris Dy","startTime":2371.27,"endTime":2375.5,"body":"you know, there are often maybe"},{"speaker":"Chris Dy","startTime":2371.27,"endTime":2375.5,"body":"a patient a month or so that"},{"speaker":"Chris Dy","startTime":2375.5,"endTime":2378.41,"body":"just kind of zaps the energy out"},{"speaker":"Chris Dy","startTime":2375.5,"endTime":2378.41,"body":"of me in clinic and just kind of"},{"speaker":"Chris Dy","startTime":2378.41,"endTime":2381.95,"body":"sets the tone in the wrong way"},{"speaker":"Chris Dy","startTime":2378.41,"endTime":2381.95,"body":"because I can't help them, they"},{"speaker":"Chris Dy","startTime":2381.95,"endTime":2384.89,"body":"don't like that I can help them"},{"speaker":"Chris Dy","startTime":2381.95,"endTime":2384.89,"body":"and they're not shy in venting"},{"speaker":"Chris Dy","startTime":2385.07,"endTime":2386.3,"body":"that I can't help them."},{"speaker":"Charles Goldfarb","startTime":2387.68,"endTime":2392.27,"body":"The I would"},{"speaker":"Charles Goldfarb","startTime":2387.68,"endTime":2392.27,"body":"say that the longer I practice,"},{"speaker":"Charles Goldfarb","startTime":2392.51,"endTime":2396.32,"body":"it has become easier for me to"},{"speaker":"Charles Goldfarb","startTime":2392.51,"endTime":2396.32,"body":"be straightforward and honest"},{"speaker":"Charles Goldfarb","startTime":2396.32,"endTime":2400.43,"body":"with patients and tell those who"},{"speaker":"Charles Goldfarb","startTime":2396.32,"endTime":2400.43,"body":"I can help how I can help them"},{"speaker":"Charles Goldfarb","startTime":2400.64,"endTime":2403.49,"body":"and share with those that I"},{"speaker":"Charles Goldfarb","startTime":2400.64,"endTime":2403.49,"body":"don't have a way to help them"},{"speaker":"Charles Goldfarb","startTime":2403.49,"endTime":2407.21,"body":"that too. And like you said,"},{"speaker":"Charles Goldfarb","startTime":2403.49,"endTime":2407.21,"body":"most people appreciate that, but"},{"speaker":"Charles Goldfarb","startTime":2407.21,"endTime":2410.69,"body":"some don't. And you know what? I"},{"speaker":"Charles Goldfarb","startTime":2407.21,"endTime":2410.69,"body":"think that's just the facts of"},{"speaker":"Charles Goldfarb","startTime":2410.69,"endTime":2413.87,"body":"life with being a doctor."},{"speaker":"Charles Goldfarb","startTime":2410.69,"endTime":2413.87,"body":"Unfortunately, those patients"},{"speaker":"Charles Goldfarb","startTime":2413.87,"endTime":2417.41,"body":"are often the ones that go find"},{"speaker":"Charles Goldfarb","startTime":2413.87,"endTime":2417.41,"body":"review sites and leave negative"},{"speaker":"Charles Goldfarb","startTime":2417.41,"endTime":2420.65,"body":"reviews. But you know that"},{"speaker":"Charles Goldfarb","startTime":2417.41,"endTime":2420.65,"body":"again, that's part of it. And"},{"speaker":"Charles Goldfarb","startTime":2420.71,"endTime":2424.22,"body":"but it is easier, the longer you"},{"speaker":"Charles Goldfarb","startTime":2420.71,"endTime":2424.22,"body":"do this, to be direct with"},{"speaker":"Charles Goldfarb","startTime":2424.22,"endTime":2428.12,"body":"patients, you know, show"},{"speaker":"Charles Goldfarb","startTime":2424.22,"endTime":2428.12,"body":"empathy, show understanding to"},{"speaker":"Charles Goldfarb","startTime":2428.12,"endTime":2431.81,"body":"the best of our abilities, show"},{"speaker":"Charles Goldfarb","startTime":2428.12,"endTime":2431.81,"body":"that you care, but be honest and"},{"speaker":"Charles Goldfarb","startTime":2431.81,"endTime":2435.47,"body":"help them move on or find the"},{"speaker":"Charles Goldfarb","startTime":2431.81,"endTime":2435.47,"body":"right doctor to treat them."},{"speaker":"Chris Dy","startTime":2435.66,"endTime":2437.52,"body":"Absolutely. And before"},{"speaker":"Chris Dy","startTime":2435.66,"endTime":2437.52,"body":"we close, I mean, there are a"},{"speaker":"Chris Dy","startTime":2437.52,"endTime":2440.07,"body":"lot of obviously a lot of other"},{"speaker":"Chris Dy","startTime":2437.52,"endTime":2440.07,"body":"modalities to treat patients"},{"speaker":"Chris Dy","startTime":2440.07,"endTime":2445.29,"body":"with crps. You know, we haven't"},{"speaker":"Chris Dy","startTime":2440.07,"endTime":2445.29,"body":"paid enough attention to some of"},{"speaker":"Chris Dy","startTime":2445.29,"endTime":2447.63,"body":"the therapy modalities and it'd"},{"speaker":"Chris Dy","startTime":2445.29,"endTime":2447.63,"body":"probably be a good episode to"},{"speaker":"Chris Dy","startTime":2447.63,"endTime":2450.33,"body":"have with one of our therapists,"},{"speaker":"Chris Dy","startTime":2447.63,"endTime":2450.33,"body":"and also the pharmacologic"},{"speaker":"Chris Dy","startTime":2450.33,"endTime":2452.43,"body":"treatments, you know,"},{"speaker":"Chris Dy","startTime":2450.33,"endTime":2452.43,"body":"gabapentinoids things like"},{"speaker":"Chris Dy","startTime":2452.43,"endTime":2455.73,"body":"gabapentin, pregabalin, while"},{"speaker":"Chris Dy","startTime":2452.43,"endTime":2455.73,"body":"they are awful medicines to be"},{"speaker":"Chris Dy","startTime":2455.73,"endTime":2459.3,"body":"on, you know, having had a"},{"speaker":"Chris Dy","startTime":2455.73,"endTime":2459.3,"body":"relative on it. And then also"},{"speaker":"Chris Dy","startTime":2459.3,"endTime":2462.78,"body":"having had multiple patients"},{"speaker":"Chris Dy","startTime":2459.3,"endTime":2462.78,"body":"tell me how awful they are to"},{"speaker":"Chris Dy","startTime":2462.78,"endTime":2467.55,"body":"take, they can be useful. And"},{"speaker":"Chris Dy","startTime":2462.78,"endTime":2467.55,"body":"then there are a lot of other"},{"speaker":"Chris Dy","startTime":2467.55,"endTime":2472.35,"body":"medications that can be used off"},{"speaker":"Chris Dy","startTime":2467.55,"endTime":2472.35,"body":"label or as secondary agents to"},{"speaker":"Chris Dy","startTime":2472.35,"endTime":2474.93,"body":"help with nerve related pain. So"},{"speaker":"Chris Dy","startTime":2472.35,"endTime":2474.93,"body":"it's not all therapy, all"},{"speaker":"Chris Dy","startTime":2474.93,"endTime":2478.92,"body":"surgery there. This is a hugely"},{"speaker":"Chris Dy","startTime":2474.93,"endTime":2478.92,"body":"deep topic that we could, that"},{"speaker":"Chris Dy","startTime":2478.92,"endTime":2481.74,"body":"we could spend more time on."},{"speaker":"Chris Dy","startTime":2478.92,"endTime":2481.74,"body":"But, you know, this is at least"},{"speaker":"Chris Dy","startTime":2481.74,"endTime":2482.4,"body":"our perspective."},{"speaker":"Charles Goldfarb","startTime":2482.82,"endTime":2485.04,"body":"Yeah. And you"},{"speaker":"Charles Goldfarb","startTime":2482.82,"endTime":2485.04,"body":"know, spinal cord stimulators,"},{"speaker":"Charles Goldfarb","startTime":2485.04,"endTime":2487.26,"body":"and nerve stimulators, all that"},{"speaker":"Charles Goldfarb","startTime":2485.04,"endTime":2487.26,"body":"stuff, I would say the one"},{"speaker":"Charles Goldfarb","startTime":2487.26,"endTime":2490.8,"body":"important thing for all of us to"},{"speaker":"Charles Goldfarb","startTime":2487.26,"endTime":2490.8,"body":"think about is that if you have"},{"speaker":"Charles Goldfarb","startTime":2490.8,"endTime":2493.23,"body":"a patient and for the sake of"},{"speaker":"Charles Goldfarb","startTime":2490.8,"endTime":2493.23,"body":"continuity, let's say it's that"},{"speaker":"Charles Goldfarb","startTime":2493.23,"endTime":2496.59,"body":"distal radius patient, you know,"},{"speaker":"Charles Goldfarb","startTime":2493.23,"endTime":2496.59,"body":"those are the patients when you"},{"speaker":"Charles Goldfarb","startTime":2496.59,"endTime":2500.34,"body":"take them to the OR it's even"},{"speaker":"Charles Goldfarb","startTime":2496.59,"endTime":2500.34,"body":"more valuable to consider a"},{"speaker":"Charles Goldfarb","startTime":2500.34,"endTime":2503.25,"body":"block from our anesthesia"},{"speaker":"Charles Goldfarb","startTime":2500.34,"endTime":2503.25,"body":"colleagues, and potentially an"},{"speaker":"Charles Goldfarb","startTime":2503.25,"endTime":2506.49,"body":"indwelling catheter in that"},{"speaker":"Charles Goldfarb","startTime":2503.25,"endTime":2506.49,"body":"segment of the population. So I"},{"speaker":"Charles Goldfarb","startTime":2506.49,"endTime":2509.55,"body":"use that even more than I"},{"speaker":"Charles Goldfarb","startTime":2506.49,"endTime":2509.55,"body":"typically would because I think"},{"speaker":"Charles Goldfarb","startTime":2509.55,"endTime":2511.5,"body":"there's long lasting benefit to"},{"speaker":"Charles Goldfarb","startTime":2509.55,"endTime":2511.5,"body":"that approach."},{"speaker":"Chris Dy","startTime":2511.87,"endTime":2514.18,"body":"Agree so everybody,"},{"speaker":"Chris Dy","startTime":2511.87,"endTime":2514.18,"body":"you know your patients with"},{"speaker":"Chris Dy","startTime":2514.18,"endTime":2518.53,"body":"complex regional pain syndrome."},{"speaker":"Chris Dy","startTime":2514.18,"endTime":2518.53,"body":"Send them along to Dr. Goldfarb."},{"speaker":"Chris Dy","startTime":2518.56,"endTime":2521.02,"body":"Actually, I'm just kidding. I do"},{"speaker":"Chris Dy","startTime":2518.56,"endTime":2521.02,"body":"love seeing this patient"},{"speaker":"Chris Dy","startTime":2521.02,"endTime":2524.47,"body":"population, they, as challenging"},{"speaker":"Chris Dy","startTime":2521.02,"endTime":2524.47,"body":"as it can be, they end up being"},{"speaker":"Chris Dy","startTime":2524.47,"endTime":2528.22,"body":"the patients that give you hugs,"},{"speaker":"Chris Dy","startTime":2524.47,"endTime":2528.22,"body":"pre covid, of course, and end up"},{"speaker":"Chris Dy","startTime":2528.25,"endTime":2531.28,"body":"being your satisfied patients"},{"speaker":"Chris Dy","startTime":2528.25,"endTime":2531.28,"body":"who want to help, you know,"},{"speaker":"Chris Dy","startTime":2531.28,"endTime":2533.83,"body":"spread the word, you know,"},{"speaker":"Chris Dy","startTime":2531.28,"endTime":2533.83,"body":"Facebook groups, etc. You know,"},{"speaker":"Chris Dy","startTime":2534.58,"endTime":2539.35,"body":"they're out there. So this is a"},{"speaker":"Chris Dy","startTime":2534.58,"endTime":2539.35,"body":"challenging, but rewarding"},{"speaker":"Chris Dy","startTime":2539.41,"endTime":2540.79,"body":"patient population to treat."},{"speaker":"Charles Goldfarb","startTime":2541.86,"endTime":2544.5,"body":"Absolutely. So"},{"speaker":"Charles Goldfarb","startTime":2541.86,"endTime":2544.5,"body":"in six months, we'll circle back"},{"speaker":"Charles Goldfarb","startTime":2544.5,"endTime":2547.56,"body":"and get another nerve podcast"},{"speaker":"Charles Goldfarb","startTime":2544.5,"endTime":2547.56,"body":"going but until then."},{"speaker":"Chris Dy","startTime":2547.65,"endTime":2549.69,"body":"Wait this didn't count"},{"speaker":"Chris Dy","startTime":2547.65,"endTime":2549.69,"body":"as one of the nerve topics did"},{"speaker":"Chris Dy","startTime":2549.69,"endTime":2549.87,"body":"it?"},{"speaker":"Charles Goldfarb","startTime":2553.47,"endTime":2555.39,"body":"Alright,"},{"speaker":"Charles Goldfarb","startTime":2553.47,"endTime":2555.39,"body":"everyone have a good day, Chris."},{"speaker":"Charles Goldfarb","startTime":2555.39,"endTime":2556.53,"body":"It's been fun, as usual."},{"speaker":"Chris Dy","startTime":2556.68,"endTime":2558.57,"body":"Fill out that listener"},{"speaker":"Chris Dy","startTime":2556.68,"endTime":2558.57,"body":"survey so you can get one of"},{"speaker":"Chris Dy","startTime":2558.57,"endTime":2559.23,"body":"those mugs."},{"speaker":"Charles Goldfarb","startTime":2559.89,"endTime":2563.28,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":2559.89,"endTime":2563.28,"body":"Hey, Chris. That was fun. Let's"},{"speaker":"Charles Goldfarb","startTime":2563.28,"endTime":2564.21,"body":"do it again real soon."},{"speaker":"Chris Dy","startTime":2564.48,"endTime":2567.0,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2564.48,"endTime":2567.0,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2567.24,"endTime":2569.43,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2567.24,"endTime":2569.43,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2569.76,"endTime":2572.61,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2569.76,"endTime":2572.61,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2572.76,"endTime":2576.12,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2572.76,"endTime":2576.12,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2576.12,"endTime":2579.93,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2576.12,"endTime":2579.93,"body":"hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2580.57,"endTime":2582.7,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2580.57,"endTime":2582.7,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2582.7,"endTime":2583.78,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2583.84,"endTime":2586.03,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2583.84,"endTime":2586.03,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2586.03,"endTime":2586.45,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2586.84,"endTime":2589.12,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2586.84,"endTime":2589.12,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2589.12,"endTime":2593.14,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2589.12,"endTime":2593.14,"body":"upper hand. Come back next time."}]}