{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.35,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.35,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.35,"endTime":13.86,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.71,"endTime":16.54,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.71,"endTime":16.54,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.54,"endTime":19.63,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.54,"endTime":19.63,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.63,"endTime":21.49,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.63,"endTime":21.49,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.06,"endTime":24.31,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.06,"endTime":24.31,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.31,"endTime":25.24,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.45,"endTime":27.64,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.45,"endTime":27.64,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.64,"endTime":28.18,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.409,"endTime":29.249,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.409,"endTime":29.249,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.729,"endTime":30.479,"body":"Hey, Chuck,"},{"speaker":"Charles Goldfarb","startTime":30.72,"endTime":31.77,"body":"How are you"},{"speaker":"Charles Goldfarb","startTime":30.72,"endTime":31.77,"body":"today?"},{"speaker":"Chris Dy","startTime":32.1,"endTime":34.59,"body":"Oh, you know, I've you"},{"speaker":"Chris Dy","startTime":32.1,"endTime":34.59,"body":"know, I said this with a bunch"},{"speaker":"Chris Dy","startTime":34.59,"endTime":38.07,"body":"of patients today. I'm fine. All"},{"speaker":"Chris Dy","startTime":34.59,"endTime":38.07,"body":"things considered. I've stopped"},{"speaker":"Chris Dy","startTime":38.07,"endTime":40.14,"body":"just saying things are good"},{"speaker":"Chris Dy","startTime":38.07,"endTime":40.14,"body":"things are fine. I mean, I think"},{"speaker":"Chris Dy","startTime":40.14,"endTime":42.9,"body":"that everybody is really feeling"},{"speaker":"Chris Dy","startTime":40.14,"endTime":42.9,"body":"it, especially here in St."},{"speaker":"Chris Dy","startTime":42.9,"endTime":46.62,"body":"Louis. Things are getting even"},{"speaker":"Chris Dy","startTime":42.9,"endTime":46.62,"body":"crazier with this. I don't know"},{"speaker":"Chris Dy","startTime":46.62,"endTime":49.02,"body":"if it's a second wave, third"},{"speaker":"Chris Dy","startTime":46.62,"endTime":49.02,"body":"wave, fourth wave, whatever it"},{"speaker":"Chris Dy","startTime":49.02,"endTime":49.59,"body":"is."},{"speaker":"Charles Goldfarb","startTime":50.2,"endTime":53.26,"body":"Yeah, my line"},{"speaker":"Charles Goldfarb","startTime":50.2,"endTime":53.26,"body":"is I'm okay. That's about as"},{"speaker":"Charles Goldfarb","startTime":53.26,"endTime":55.0,"body":"well as I do these days. I'm"},{"speaker":"Charles Goldfarb","startTime":53.26,"endTime":55.0,"body":"okay."},{"speaker":"Chris Dy","startTime":55.78,"endTime":58.48,"body":"Well, some good news."},{"speaker":"Chris Dy","startTime":55.78,"endTime":58.48,"body":"I mean, last week, we hit a"},{"speaker":"Chris Dy","startTime":58.48,"endTime":63.01,"body":"really great milestone with the"},{"speaker":"Chris Dy","startTime":58.48,"endTime":63.01,"body":"podcast our our guest podcast"},{"speaker":"Chris Dy","startTime":63.01,"endTime":66.1,"body":"with Asif was our fiftieth"},{"speaker":"Chris Dy","startTime":63.01,"endTime":66.1,"body":"episode released."},{"speaker":"Charles Goldfarb","startTime":66.64,"endTime":68.26,"body":"It's really"},{"speaker":"Charles Goldfarb","startTime":66.64,"endTime":68.26,"body":"something I was trying to do the"},{"speaker":"Charles Goldfarb","startTime":68.29,"endTime":72.16,"body":"math, I could have sworn we"},{"speaker":"Charles Goldfarb","startTime":68.29,"endTime":72.16,"body":"started like in February, right"},{"speaker":"Charles Goldfarb","startTime":72.19,"endTime":75.55,"body":"pre pandemic. And we did a"},{"speaker":"Charles Goldfarb","startTime":72.19,"endTime":75.55,"body":"couple of extra episodes, I"},{"speaker":"Charles Goldfarb","startTime":75.55,"endTime":77.23,"body":"guess we did enough that we"},{"speaker":"Charles Goldfarb","startTime":75.55,"endTime":77.23,"body":"already hit 50."},{"speaker":"Chris Dy","startTime":77.65,"endTime":80.17,"body":"Yeah, we had a couple"},{"speaker":"Chris Dy","startTime":77.65,"endTime":80.17,"body":"of Beyonce style, you know, drop"},{"speaker":"Chris Dy","startTime":80.17,"endTime":82.48,"body":"three episodes in one day kind"},{"speaker":"Chris Dy","startTime":80.17,"endTime":82.48,"body":"of launch. So"},{"speaker":"Charles Goldfarb","startTime":83.68,"endTime":85.27,"body":"Those don't"},{"speaker":"Charles Goldfarb","startTime":83.68,"endTime":85.27,"body":"happen anymore."},{"speaker":"Chris Dy","startTime":87.4,"endTime":90.55,"body":"No, they don't. But"},{"speaker":"Chris Dy","startTime":87.4,"endTime":90.55,"body":"we've had some fantastic"},{"speaker":"Chris Dy","startTime":90.55,"endTime":93.19,"body":"feedback from everybody who's"},{"speaker":"Chris Dy","startTime":90.55,"endTime":93.19,"body":"listening. And for those of you"},{"speaker":"Chris Dy","startTime":93.19,"endTime":96.94,"body":"that have filled out the survey,"},{"speaker":"Chris Dy","startTime":93.19,"endTime":96.94,"body":"all 55 of you, thank you so"},{"speaker":"Chris Dy","startTime":96.94,"endTime":102.28,"body":"much, we really do appreciate"},{"speaker":"Chris Dy","startTime":96.94,"endTime":102.28,"body":"it. Please go on and login on"},{"speaker":"Chris Dy","startTime":104.41,"endTime":110.02,"body":"theupperhand.buzzsprout.com or"},{"speaker":"Chris Dy","startTime":104.41,"endTime":110.02,"body":"theupperhandpodcast.wustl.edu."},{"speaker":"Chris Dy","startTime":110.02,"endTime":113.8,"body":"And fill out the survey. We"},{"speaker":"Chris Dy","startTime":110.02,"endTime":113.8,"body":"really appreciate hearing from"},{"speaker":"Chris Dy","startTime":113.8,"endTime":114.43,"body":"everybody."},{"speaker":"Charles Goldfarb","startTime":115.24,"endTime":118.3,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":115.24,"endTime":118.3,"body":"Hey, Chris, did you have,"},{"speaker":"Charles Goldfarb","startTime":118.69,"endTime":120.88,"body":"there's a couple of reviews that"},{"speaker":"Charles Goldfarb","startTime":118.69,"endTime":120.88,"body":"have come in that. We haven't"},{"speaker":"Charles Goldfarb","startTime":120.88,"endTime":123.4,"body":"really talked about it. Have you"},{"speaker":"Charles Goldfarb","startTime":120.88,"endTime":123.4,"body":"had a good or seen a good review"},{"speaker":"Charles Goldfarb","startTime":123.4,"endTime":123.79,"body":"lately."},{"speaker":"Chris Dy","startTime":124.24,"endTime":127.15,"body":"I saw some great"},{"speaker":"Chris Dy","startTime":124.24,"endTime":127.15,"body":"feedback on the survey. So this"},{"speaker":"Chris Dy","startTime":127.15,"endTime":131.62,"body":"is from a current fellow and,"},{"speaker":"Chris Dy","startTime":127.15,"endTime":131.62,"body":"they wrote here I'm a current"},{"speaker":"Chris Dy","startTime":131.62,"endTime":134.11,"body":"Fellow at I won't say which"},{"speaker":"Chris Dy","startTime":131.62,"endTime":134.11,"body":"program because I'm not sure if"},{"speaker":"Chris Dy","startTime":134.11,"endTime":136.87,"body":"you wanted us to reading that on"},{"speaker":"Chris Dy","startTime":134.11,"endTime":136.87,"body":"but I have been listening to"},{"speaker":"Chris Dy","startTime":136.87,"endTime":139.33,"body":"your podcast since finding out"},{"speaker":"Chris Dy","startTime":136.87,"endTime":139.33,"body":"about it through the hand"},{"speaker":"Chris Dy","startTime":139.33,"endTime":142.93,"body":"society email lists in early"},{"speaker":"Chris Dy","startTime":139.33,"endTime":142.93,"body":"spring, I've incorporated a lot"},{"speaker":"Chris Dy","startTime":142.93,"endTime":145.78,"body":"of what I've learned listening"},{"speaker":"Chris Dy","startTime":142.93,"endTime":145.78,"body":"to your podcast into my own"},{"speaker":"Chris Dy","startTime":145.78,"endTime":149.32,"body":"personal fellow clinic. I've"},{"speaker":"Chris Dy","startTime":145.78,"endTime":149.32,"body":"also got half of the residency"},{"speaker":"Chris Dy","startTime":149.32,"endTime":151.69,"body":"listening to it as well. So"},{"speaker":"Chris Dy","startTime":149.32,"endTime":151.69,"body":"thank you, and I look forward to"},{"speaker":"Chris Dy","startTime":151.69,"endTime":155.44,"body":"more episodes. Thank you to the"},{"speaker":"Chris Dy","startTime":151.69,"endTime":155.44,"body":"fellow who wrote that we really,"},{"speaker":"Chris Dy","startTime":155.47,"endTime":156.52,"body":"really appreciate it."},{"speaker":"Charles Goldfarb","startTime":157.03,"endTime":158.56,"body":"Yeah, thank"},{"speaker":"Charles Goldfarb","startTime":157.03,"endTime":158.56,"body":"you and get the other half of"},{"speaker":"Charles Goldfarb","startTime":158.56,"endTime":160.09,"body":"the residency listening, come"},{"speaker":"Charles Goldfarb","startTime":158.56,"endTime":160.09,"body":"on."},{"speaker":"Chris Dy","startTime":161.62,"endTime":163.6,"body":"So Chuck, is somebody"},{"speaker":"Chris Dy","startTime":161.62,"endTime":163.6,"body":"gonna win a mug this month?"},{"speaker":"Charles Goldfarb","startTime":163.69,"endTime":166.78,"body":"Someone needs"},{"speaker":"Charles Goldfarb","startTime":163.69,"endTime":166.78,"body":"to win a mug. I mean, we we sent"},{"speaker":"Charles Goldfarb","startTime":166.78,"endTime":170.56,"body":"one mug across the world to"},{"speaker":"Charles Goldfarb","startTime":166.78,"endTime":170.56,"body":"Brazil, kind of hoping the next"},{"speaker":"Charles Goldfarb","startTime":170.56,"endTime":172.63,"body":"winner is a little more local."},{"speaker":"Chris Dy","startTime":172.84,"endTime":174.82,"body":"Alright, Chuck your"},{"speaker":"Chris Dy","startTime":172.84,"endTime":174.82,"body":"turn to pick a number one"},{"speaker":"Chris Dy","startTime":174.82,"endTime":180.79,"body":"through 53. And it cannot be the"},{"speaker":"Chris Dy","startTime":174.82,"endTime":180.79,"body":"one that we picked before. And I"},{"speaker":"Chris Dy","startTime":180.79,"endTime":183.79,"body":"can't remember which which"},{"speaker":"Chris Dy","startTime":180.79,"endTime":183.79,"body":"number that will make the later"},{"speaker":"Chris Dy","startTime":183.79,"endTime":184.06,"body":"one."},{"speaker":"Charles Goldfarb","startTime":184.24,"endTime":187.54,"body":"Yeah, 43."},{"speaker":"Chris Dy","startTime":188.52,"endTime":192.72,"body":"All right, whoever you"},{"speaker":"Chris Dy","startTime":188.52,"endTime":192.72,"body":"are D Baron 222. And I'll leave"},{"speaker":"Chris Dy","startTime":192.72,"endTime":196.47,"body":"the rest of it off. But whoever"},{"speaker":"Chris Dy","startTime":192.72,"endTime":196.47,"body":"you are, congratulations, you"},{"speaker":"Chris Dy","startTime":196.47,"endTime":200.97,"body":"are the winner of an upper hand"},{"speaker":"Chris Dy","startTime":196.47,"endTime":200.97,"body":"coffee mug. And just from a cost"},{"speaker":"Chris Dy","startTime":200.97,"endTime":203.46,"body":"perspective from our shoestring"},{"speaker":"Chris Dy","startTime":200.97,"endTime":203.46,"body":"budget, I hope you live in the"},{"speaker":"Chris Dy","startTime":203.46,"endTime":207.87,"body":"US. But we still welcome anybody"},{"speaker":"Chris Dy","startTime":203.46,"endTime":207.87,"body":"from from abroad filling out the"},{"speaker":"Chris Dy","startTime":207.87,"endTime":208.38,"body":"survey."},{"speaker":"Charles Goldfarb","startTime":209.14,"endTime":211.33,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":209.14,"endTime":211.33,"body":"You know, international"},{"speaker":"Charles Goldfarb","startTime":211.33,"endTime":213.67,"body":"shipping, my wife runs a"},{"speaker":"Charles Goldfarb","startTime":211.33,"endTime":213.67,"body":"business which is helpful in"},{"speaker":"Charles Goldfarb","startTime":213.67,"endTime":215.62,"body":"these situations. For sure."},{"speaker":"Chris Dy","startTime":216.43,"endTime":218.08,"body":"So, we have a bit of a"},{"speaker":"Chris Dy","startTime":216.43,"endTime":218.08,"body":"treat today, don't we?"},{"speaker":"Charles Goldfarb","startTime":218.3,"endTime":221.15,"body":"Oh my God, we"},{"speaker":"Charles Goldfarb","startTime":218.3,"endTime":221.15,"body":"are lucky to welcome back a"},{"speaker":"Charles Goldfarb","startTime":221.15,"endTime":225.59,"body":"therapist who really has gotten"},{"speaker":"Charles Goldfarb","startTime":221.15,"endTime":225.59,"body":"a lot of accolades locally just"},{"speaker":"Charles Goldfarb","startTime":225.59,"endTime":227.84,"body":"for the care she provides. But"},{"speaker":"Charles Goldfarb","startTime":225.59,"endTime":227.84,"body":"I've loved having her on our"},{"speaker":"Charles Goldfarb","startTime":227.84,"endTime":228.68,"body":"show previously."},{"speaker":"Chris Dy","startTime":229.17,"endTime":231.48,"body":"Well, you know, we're"},{"speaker":"Chris Dy","startTime":229.17,"endTime":231.48,"body":"lucky to be joined by Dr. Macy"},{"speaker":"Chris Dy","startTime":231.48,"endTime":234.72,"body":"Stonner. All right, Chuck. So"},{"speaker":"Chris Dy","startTime":231.48,"endTime":234.72,"body":"let's launch into a case"},{"speaker":"Chris Dy","startTime":235.14,"endTime":239.82,"body":"recently had a case 60 year old"},{"speaker":"Chris Dy","startTime":235.14,"endTime":239.82,"body":"woman with a metaphyseal distal"},{"speaker":"Chris Dy","startTime":239.82,"endTime":243.24,"body":"radius fracture had your"},{"speaker":"Chris Dy","startTime":239.82,"endTime":243.24,"body":"standard dorsal displacement. We"},{"speaker":"Chris Dy","startTime":243.24,"endTime":246.12,"body":"had the conversation about"},{"speaker":"Chris Dy","startTime":243.24,"endTime":246.12,"body":"options and we opted for"},{"speaker":"Chris Dy","startTime":246.12,"endTime":249.66,"body":"surgery. And this is one where a"},{"speaker":"Chris Dy","startTime":246.12,"endTime":249.66,"body":"standard volar plate was used."},{"speaker":"Chris Dy","startTime":250.89,"endTime":253.86,"body":"And how would you approach"},{"speaker":"Chris Dy","startTime":250.89,"endTime":253.86,"body":"therapy at this point? What's"},{"speaker":"Chris Dy","startTime":253.86,"endTime":256.2,"body":"your post op protocol? assuming"},{"speaker":"Chris Dy","startTime":253.86,"endTime":256.2,"body":"everything went smoothly with"},{"speaker":"Chris Dy","startTime":256.2,"endTime":258.54,"body":"the plate? You love the position"},{"speaker":"Chris Dy","startTime":256.2,"endTime":258.54,"body":"of the plate? You love the"},{"speaker":"Chris Dy","startTime":258.75,"endTime":260.37,"body":"reduction? Where do you go from"},{"speaker":"Chris Dy","startTime":258.75,"endTime":260.37,"body":"here?"},{"speaker":"Charles Goldfarb","startTime":260.64,"endTime":262.86,"body":"Yes, it's a"},{"speaker":"Charles Goldfarb","startTime":260.64,"endTime":262.86,"body":"super interesting conversation."},{"speaker":"Charles Goldfarb","startTime":262.86,"endTime":266.58,"body":"I'll start by saying I try not"},{"speaker":"Charles Goldfarb","startTime":262.86,"endTime":266.58,"body":"to tell the patient this bit of"},{"speaker":"Charles Goldfarb","startTime":266.58,"endTime":270.39,"body":"information until they've made"},{"speaker":"Charles Goldfarb","startTime":266.58,"endTime":270.39,"body":"their decision. Because any"},{"speaker":"Charles Goldfarb","startTime":270.39,"endTime":274.29,"body":"rational patient who hears this"},{"speaker":"Charles Goldfarb","startTime":270.39,"endTime":274.29,"body":"is going to choose surgery"},{"speaker":"Charles Goldfarb","startTime":274.29,"endTime":276.72,"body":"meaning, if you're if you're if"},{"speaker":"Charles Goldfarb","startTime":274.29,"endTime":276.72,"body":"you really have a choice,"},{"speaker":"Charles Goldfarb","startTime":276.72,"endTime":278.76,"body":"between nonoperative care and"},{"speaker":"Charles Goldfarb","startTime":276.72,"endTime":278.76,"body":"operative care and you learn"},{"speaker":"Charles Goldfarb","startTime":278.76,"endTime":281.34,"body":"that you can go to therapy and"},{"speaker":"Charles Goldfarb","startTime":278.76,"endTime":281.34,"body":"be in a splint and start early"},{"speaker":"Charles Goldfarb","startTime":281.34,"endTime":286.11,"body":"motion. It's like it sounds like"},{"speaker":"Charles Goldfarb","startTime":281.34,"endTime":286.11,"body":"a dream come true. So going back"},{"speaker":"Charles Goldfarb","startTime":286.11,"endTime":291.06,"body":"to your question, I if I do this"},{"speaker":"Charles Goldfarb","startTime":286.11,"endTime":291.06,"body":"surgery, I have them see our"},{"speaker":"Charles Goldfarb","startTime":291.06,"endTime":297.75,"body":"therapist at about five days and"},{"speaker":"Charles Goldfarb","startTime":291.06,"endTime":297.75,"body":"and my request is a resting"},{"speaker":"Charles Goldfarb","startTime":297.75,"endTime":302.34,"body":"splint to be removed as You"},{"speaker":"Charles Goldfarb","startTime":297.75,"endTime":302.34,"body":"know, as comfortable. I let them"},{"speaker":"Charles Goldfarb","startTime":302.34,"endTime":306.84,"body":"shower at five days. And I start"},{"speaker":"Charles Goldfarb","startTime":302.34,"endTime":306.84,"body":"early active motion and maybe"},{"speaker":"Charles Goldfarb","startTime":306.84,"endTime":310.14,"body":"even some gentle passive motion."},{"speaker":"Charles Goldfarb","startTime":306.84,"endTime":310.14,"body":"But I'm, I feel fortunate, I"},{"speaker":"Charles Goldfarb","startTime":310.14,"endTime":312.54,"body":"leave that in the hands of our"},{"speaker":"Charles Goldfarb","startTime":310.14,"endTime":312.54,"body":"wonderful therapist."},{"speaker":"Chris Dy","startTime":312.6,"endTime":314.79,"body":"What's with the five"},{"speaker":"Chris Dy","startTime":312.6,"endTime":314.79,"body":"days? Is that just how it works"},{"speaker":"Chris Dy","startTime":314.79,"endTime":318.24,"body":"with your your OR schedule and"},{"speaker":"Chris Dy","startTime":314.79,"endTime":318.24,"body":"where patients can come in?"},{"speaker":"Charles Goldfarb","startTime":319.08,"endTime":322.14,"body":"It honestly"},{"speaker":"Charles Goldfarb","startTime":319.08,"endTime":322.14,"body":"is, it's a number of"},{"speaker":"Charles Goldfarb","startTime":322.14,"endTime":326.13,"body":"convenience. I operate mostly"},{"speaker":"Charles Goldfarb","startTime":322.14,"endTime":326.13,"body":"these cases on Wednesdays, and I"},{"speaker":"Charles Goldfarb","startTime":326.13,"endTime":330.24,"body":"haven't started therapy on"},{"speaker":"Charles Goldfarb","startTime":326.13,"endTime":330.24,"body":"Monday. But before we get to our"},{"speaker":"Charles Goldfarb","startTime":330.24,"endTime":333.66,"body":"wonderful therapist who's going"},{"speaker":"Charles Goldfarb","startTime":330.24,"endTime":333.66,"body":"to enlighten us all, what do you"},{"speaker":"Charles Goldfarb","startTime":333.69,"endTime":336.51,"body":"What's your basic general"},{"speaker":"Charles Goldfarb","startTime":333.69,"endTime":336.51,"body":"protocol, Chris?"},{"speaker":"Chris Dy","startTime":337.35,"endTime":340.08,"body":"So the patients who"},{"speaker":"Chris Dy","startTime":337.35,"endTime":340.08,"body":"are the straightforward ones,"},{"speaker":"Chris Dy","startTime":340.08,"endTime":343.11,"body":"like we're describing here, I"},{"speaker":"Chris Dy","startTime":340.08,"endTime":343.11,"body":"actually go three days, because"},{"speaker":"Chris Dy","startTime":343.11,"endTime":345.48,"body":"I typically will do these on a"},{"speaker":"Chris Dy","startTime":343.11,"endTime":345.48,"body":"Tuesday and get them to therapy"},{"speaker":"Chris Dy","startTime":345.48,"endTime":348.63,"body":"on a Friday for the very"},{"speaker":"Chris Dy","startTime":345.48,"endTime":348.63,"body":"straightforward ones and follow"},{"speaker":"Chris Dy","startTime":348.63,"endTime":351.72,"body":"something very similar to what"},{"speaker":"Chris Dy","startTime":348.63,"endTime":351.72,"body":"you've described. So once"},{"speaker":"Chris Dy","startTime":351.72,"endTime":355.26,"body":"they're in the hands of our"},{"speaker":"Chris Dy","startTime":351.72,"endTime":355.26,"body":"capable therapists, and they go"},{"speaker":"Chris Dy","startTime":355.29,"endTime":358.17,"body":"upstairs across the hall"},{"speaker":"Chris Dy","startTime":355.29,"endTime":358.17,"body":"downstairs, wherever it is,"},{"speaker":"Chris Dy","startTime":358.65,"endTime":361.38,"body":"Macy, welcome back. How do you"},{"speaker":"Chris Dy","startTime":358.65,"endTime":361.38,"body":"approach that patient?"},{"speaker":"Macy Stonner","startTime":363.37,"endTime":366.13,"body":"Hi, everybody,"},{"speaker":"Macy Stonner","startTime":363.37,"endTime":366.13,"body":"thanks for having me. So one of"},{"speaker":"Macy Stonner","startTime":366.13,"endTime":370.12,"body":"these types of patients is among"},{"speaker":"Macy Stonner","startTime":366.13,"endTime":370.12,"body":"my favorites. Just because I"},{"speaker":"Macy Stonner","startTime":370.12,"endTime":373.45,"body":"have orders that say, active"},{"speaker":"Macy Stonner","startTime":370.12,"endTime":373.45,"body":"motion three to five days post"},{"speaker":"Macy Stonner","startTime":373.45,"endTime":376.36,"body":"op doesn't always mean that I do"},{"speaker":"Macy Stonner","startTime":373.45,"endTime":376.36,"body":"that, I'll assess that motion."},{"speaker":"Macy Stonner","startTime":376.36,"endTime":380.86,"body":"But sometimes people are just"},{"speaker":"Macy Stonner","startTime":376.36,"endTime":380.86,"body":"too sore, and too painful to do"},{"speaker":"Macy Stonner","startTime":380.86,"endTime":383.8,"body":"that. So I'll just measure their"},{"speaker":"Macy Stonner","startTime":380.86,"endTime":383.8,"body":"motion and see how they're"},{"speaker":"Macy Stonner","startTime":383.8,"endTime":387.61,"body":"feeling more often than not, I"},{"speaker":"Macy Stonner","startTime":383.8,"endTime":387.61,"body":"will initiate motion, because"},{"speaker":"Macy Stonner","startTime":387.61,"endTime":390.67,"body":"they're excited to to get"},{"speaker":"Macy Stonner","startTime":387.61,"endTime":390.67,"body":"moving. But that doesn't mean"},{"speaker":"Macy Stonner","startTime":390.67,"endTime":394.42,"body":"that I do it all the time. The"},{"speaker":"Macy Stonner","startTime":390.67,"endTime":394.42,"body":"biggest factor for me is finger"},{"speaker":"Macy Stonner","startTime":394.42,"endTime":398.2,"body":"motion, honestly. So finger"},{"speaker":"Macy Stonner","startTime":394.42,"endTime":398.2,"body":"mobility is key in the"},{"speaker":"Macy Stonner","startTime":398.2,"endTime":402.85,"body":"beginning. So I always make that"},{"speaker":"Macy Stonner","startTime":398.2,"endTime":402.85,"body":"the priority exercise along with"},{"speaker":"Macy Stonner","startTime":403.18,"endTime":407.29,"body":"edema reduction. And then I make"},{"speaker":"Macy Stonner","startTime":403.18,"endTime":407.29,"body":"wrist motion secondary."},{"speaker":"Chris Dy","startTime":408.16,"endTime":410.74,"body":"So how do you, so for"},{"speaker":"Chris Dy","startTime":408.16,"endTime":410.74,"body":"those of us that are surgeons"},{"speaker":"Chris Dy","startTime":410.74,"endTime":413.89,"body":"and haven't spent a lot of time"},{"speaker":"Chris Dy","startTime":410.74,"endTime":413.89,"body":"in a therapy suite? What do you"},{"speaker":"Chris Dy","startTime":413.95,"endTime":417.01,"body":"do with the patients with"},{"speaker":"Chris Dy","startTime":413.95,"endTime":417.01,"body":"regards to edema control and"},{"speaker":"Chris Dy","startTime":417.01,"endTime":419.17,"body":"finger motion? What happens"},{"speaker":"Chris Dy","startTime":417.01,"endTime":419.17,"body":"behind the curtain?"},{"speaker":"Macy Stonner","startTime":419.95,"endTime":422.89,"body":"Sure. So we have a"},{"speaker":"Macy Stonner","startTime":419.95,"endTime":422.89,"body":"bunch of educational materials"},{"speaker":"Macy Stonner","startTime":422.89,"endTime":426.58,"body":"for patients and we go through"},{"speaker":"Macy Stonner","startTime":422.89,"endTime":426.58,"body":"education on what is edema? What"},{"speaker":"Macy Stonner","startTime":426.58,"endTime":429.37,"body":"is that fluid buildup in your"},{"speaker":"Macy Stonner","startTime":426.58,"endTime":429.37,"body":"hand? And what can it turn into,"},{"speaker":"Macy Stonner","startTime":429.73,"endTime":432.58,"body":"we want to avoid it from turning"},{"speaker":"Macy Stonner","startTime":429.73,"endTime":432.58,"body":"into scar tissue and getting"},{"speaker":"Macy Stonner","startTime":432.58,"endTime":436.66,"body":"sticky and getting stiffness in"},{"speaker":"Macy Stonner","startTime":432.58,"endTime":436.66,"body":"your fingers and wrists. And so"},{"speaker":"Macy Stonner","startTime":436.66,"endTime":439.42,"body":"we go over methods including"},{"speaker":"Macy Stonner","startTime":436.66,"endTime":439.42,"body":"positioning at night while"},{"speaker":"Macy Stonner","startTime":439.45,"endTime":444.58,"body":"sleeping, elevation, compression"},{"speaker":"Macy Stonner","startTime":439.45,"endTime":444.58,"body":"garments, specific exercises and"},{"speaker":"Macy Stonner","startTime":444.67,"endTime":445.96,"body":"massage techniques."},{"speaker":"Charles Goldfarb","startTime":447.19,"endTime":450.04,"body":"So go a little"},{"speaker":"Charles Goldfarb","startTime":447.19,"endTime":450.04,"body":"deeper there. When you say"},{"speaker":"Charles Goldfarb","startTime":450.04,"endTime":454.12,"body":"compression garments. Everybody"},{"speaker":"Charles Goldfarb","startTime":450.04,"endTime":454.12,"body":"doesn't get something like that,"},{"speaker":"Charles Goldfarb","startTime":454.12,"endTime":456.7,"body":"do they? I mean, maybe someone"},{"speaker":"Charles Goldfarb","startTime":454.12,"endTime":456.7,"body":"gets an isotoner glove if"},{"speaker":"Charles Goldfarb","startTime":456.7,"endTime":460.69,"body":"they're really struggling with"},{"speaker":"Charles Goldfarb","startTime":456.7,"endTime":460.69,"body":"finger swelling. What is a run"},{"speaker":"Charles Goldfarb","startTime":460.69,"endTime":464.05,"body":"of the mill patient get as far"},{"speaker":"Charles Goldfarb","startTime":460.69,"endTime":464.05,"body":"as instruction regarding edema?"},{"speaker":"Macy Stonner","startTime":464.89,"endTime":468.04,"body":"I would say the"},{"speaker":"Macy Stonner","startTime":464.89,"endTime":468.04,"body":"importance of positioning,"},{"speaker":"Macy Stonner","startTime":468.1,"endTime":472.3,"body":"elevation, and motion. And then"},{"speaker":"Macy Stonner","startTime":468.1,"endTime":472.3,"body":"it's a subjective decision"},{"speaker":"Macy Stonner","startTime":472.3,"endTime":474.88,"body":"whether or not to issue a"},{"speaker":"Macy Stonner","startTime":472.3,"endTime":474.88,"body":"compression garment just based"},{"speaker":"Macy Stonner","startTime":474.88,"endTime":478.45,"body":"on their hand. There's no"},{"speaker":"Macy Stonner","startTime":474.88,"endTime":478.45,"body":"protocol for it. But if you see"},{"speaker":"Macy Stonner","startTime":478.45,"endTime":480.58,"body":"that their hand looks like a"},{"speaker":"Macy Stonner","startTime":478.45,"endTime":480.58,"body":"balloon, or you can't see their"},{"speaker":"Macy Stonner","startTime":480.58,"endTime":483.37,"body":"joint creases of their fingers."},{"speaker":"Macy Stonner","startTime":480.58,"endTime":483.37,"body":"They're getting an isotoner"},{"speaker":"Macy Stonner","startTime":483.37,"endTime":483.76,"body":"glove."},{"speaker":"Chris Dy","startTime":484.54,"endTime":488.17,"body":"So before we dive too"},{"speaker":"Chris Dy","startTime":484.54,"endTime":488.17,"body":"far into the details of therapy,"},{"speaker":"Chris Dy","startTime":488.2,"endTime":491.47,"body":"what are some of the you know,"},{"speaker":"Chris Dy","startTime":488.2,"endTime":491.47,"body":"not from of course, Dr. Goldfarb"},{"speaker":"Chris Dy","startTime":491.47,"endTime":495.1,"body":"or any of his partners who, who"},{"speaker":"Chris Dy","startTime":491.47,"endTime":495.1,"body":"send you patients, but what are"},{"speaker":"Chris Dy","startTime":495.1,"endTime":498.79,"body":"the common hiccups that surgeons"},{"speaker":"Chris Dy","startTime":495.1,"endTime":498.79,"body":"have, in terms of either what we"},{"speaker":"Chris Dy","startTime":498.79,"endTime":501.67,"body":"write on our prescriptions, or"},{"speaker":"Chris Dy","startTime":498.79,"endTime":501.67,"body":"what we tell patients that you"},{"speaker":"Chris Dy","startTime":501.67,"endTime":502.54,"body":"have to course correct."},{"speaker":"Macy Stonner","startTime":503.2,"endTime":504.85,"body":"For this"},{"speaker":"Macy Stonner","startTime":503.2,"endTime":504.85,"body":"particular diagnosis, I actually"},{"speaker":"Macy Stonner","startTime":504.85,"endTime":507.67,"body":"don't have that problem very"},{"speaker":"Macy Stonner","startTime":504.85,"endTime":507.67,"body":"much, because it's a pretty"},{"speaker":"Macy Stonner","startTime":507.7,"endTime":511.9,"body":"typical condition we treat and"},{"speaker":"Macy Stonner","startTime":507.7,"endTime":511.9,"body":"enjoy treating, but I would say"},{"speaker":"Macy Stonner","startTime":511.9,"endTime":515.62,"body":"when the script says aggressive"},{"speaker":"Macy Stonner","startTime":511.9,"endTime":515.62,"body":"range of motion, and the patient"},{"speaker":"Macy Stonner","startTime":515.62,"endTime":518.86,"body":"might see that that word scares"},{"speaker":"Macy Stonner","startTime":515.62,"endTime":518.86,"body":"them. And they're like,"},{"speaker":"Macy Stonner","startTime":518.89,"endTime":522.46,"body":"aggressive, what does that mean?"},{"speaker":"Macy Stonner","startTime":518.89,"endTime":522.46,"body":"Am I not progressing? Are you"},{"speaker":"Macy Stonner","startTime":522.46,"endTime":525.58,"body":"gonna crank on my wrist, you"},{"speaker":"Macy Stonner","startTime":522.46,"endTime":525.58,"body":"know, that term scares them and"},{"speaker":"Macy Stonner","startTime":525.58,"endTime":530.2,"body":"so to prevent something like"},{"speaker":"Macy Stonner","startTime":525.58,"endTime":530.2,"body":"complex regional pain syndrome"},{"speaker":"Macy Stonner","startTime":530.2,"endTime":534.19,"body":"from developing, I try to avoid"},{"speaker":"Macy Stonner","startTime":530.2,"endTime":534.19,"body":"inflicting too much pain. I"},{"speaker":"Macy Stonner","startTime":534.19,"endTime":537.73,"body":"don't want patients to associate"},{"speaker":"Macy Stonner","startTime":534.19,"endTime":537.73,"body":"therapy with like, you know,"},{"speaker":"Macy Stonner","startTime":537.76,"endTime":542.26,"body":"torture, so I try to not to"},{"speaker":"Macy Stonner","startTime":537.76,"endTime":542.26,"body":"inflict too much pain on them."},{"speaker":"Charles Goldfarb","startTime":542.75,"endTime":545.03,"body":"So I really"},{"speaker":"Charles Goldfarb","startTime":542.75,"endTime":545.03,"body":"liked what you said earlier"},{"speaker":"Charles Goldfarb","startTime":545.03,"endTime":547.52,"body":"about finger motion, but you may"},{"speaker":"Charles Goldfarb","startTime":545.03,"endTime":547.52,"body":"have said it in a way that's"},{"speaker":"Charles Goldfarb","startTime":547.52,"endTime":551.33,"body":"slightly different than how I"},{"speaker":"Charles Goldfarb","startTime":547.52,"endTime":551.33,"body":"think about it. So for me, when"},{"speaker":"Charles Goldfarb","startTime":551.33,"endTime":555.5,"body":"I see the patient with a distal"},{"speaker":"Charles Goldfarb","startTime":551.33,"endTime":555.5,"body":"radius fracture in clinic, maybe"},{"speaker":"Charles Goldfarb","startTime":555.5,"endTime":557.99,"body":"five days after they were seen"},{"speaker":"Charles Goldfarb","startTime":555.5,"endTime":557.99,"body":"in the emergency department,"},{"speaker":"Charles Goldfarb","startTime":557.99,"endTime":562.34,"body":"maybe they've had a reduction,"},{"speaker":"Charles Goldfarb","startTime":557.99,"endTime":562.34,"body":"maybe they haven't. If they have"},{"speaker":"Charles Goldfarb","startTime":562.34,"endTime":566.09,"body":"great finger motion, I feel like"},{"speaker":"Charles Goldfarb","startTime":562.34,"endTime":566.09,"body":"everything's gonna work out,"},{"speaker":"Charles Goldfarb","startTime":566.12,"endTime":569.9,"body":"everything's gonna be fine. If"},{"speaker":"Charles Goldfarb","startTime":566.12,"endTime":569.9,"body":"they come in, and they don't"},{"speaker":"Charles Goldfarb","startTime":569.9,"endTime":573.11,"body":"they have either swollen fingers"},{"speaker":"Charles Goldfarb","startTime":569.9,"endTime":573.11,"body":"or stiff fingers. To me, that's"},{"speaker":"Charles Goldfarb","startTime":573.11,"endTime":576.68,"body":"the first red flag. But I don't"},{"speaker":"Charles Goldfarb","startTime":573.11,"endTime":576.68,"body":"think that's what you indicated."},{"speaker":"Charles Goldfarb","startTime":576.95,"endTime":579.62,"body":"That's what, that's not exactly"},{"speaker":"Charles Goldfarb","startTime":576.95,"endTime":579.62,"body":"what you were saying when we"},{"speaker":"Charles Goldfarb","startTime":579.62,"endTime":582.65,"body":"first started this conversation."},{"speaker":"Charles Goldfarb","startTime":579.62,"endTime":582.65,"body":"I think you were saying your"},{"speaker":"Charles Goldfarb","startTime":582.65,"endTime":587.36,"body":"first priority with therapy"},{"speaker":"Charles Goldfarb","startTime":582.65,"endTime":587.36,"body":"after ORIF of a distal radius"},{"speaker":"Charles Goldfarb","startTime":587.36,"endTime":590.54,"body":"fracture is to control the edema"},{"speaker":"Charles Goldfarb","startTime":587.36,"endTime":590.54,"body":"and to get the fingers moving."},{"speaker":"Macy Stonner","startTime":590.9,"endTime":592.73,"body":"Correct. So those"},{"speaker":"Macy Stonner","startTime":590.9,"endTime":592.73,"body":"two things because I don't have"},{"speaker":"Macy Stonner","startTime":592.73,"endTime":595.52,"body":"the opportunity to meet them as"},{"speaker":"Macy Stonner","startTime":592.73,"endTime":595.52,"body":"early as you do. So I meet them"},{"speaker":"Macy Stonner","startTime":595.52,"endTime":600.65,"body":"after surgery. And my comment is"},{"speaker":"Macy Stonner","startTime":595.52,"endTime":600.65,"body":"always okay, you broke your"},{"speaker":"Macy Stonner","startTime":600.65,"endTime":603.08,"body":"wrist with the wrist fracture,"},{"speaker":"Macy Stonner","startTime":600.65,"endTime":603.08,"body":"we know that you're going to"},{"speaker":"Macy Stonner","startTime":603.08,"endTime":605.93,"body":"have some stiffness, however,"},{"speaker":"Macy Stonner","startTime":603.08,"endTime":605.93,"body":"you didn't break your fingers."},{"speaker":"Macy Stonner","startTime":605.99,"endTime":609.29,"body":"And if you have stiffness in"},{"speaker":"Macy Stonner","startTime":605.99,"endTime":609.29,"body":"your fingers too [you're going"},{"speaker":"Macy Stonner","startTime":609.29,"endTime":612.71,"body":"to be] living your life a whole"},{"speaker":"Macy Stonner","startTime":609.29,"endTime":612.71,"body":"lot harder, and then they kind"},{"speaker":"Macy Stonner","startTime":612.71,"endTime":615.44,"body":"of get that and go from there."},{"speaker":"Charles Goldfarb","startTime":616.04,"endTime":619.76,"body":"So do you"},{"speaker":"Charles Goldfarb","startTime":616.04,"endTime":619.76,"body":"agree with my oversimplification"},{"speaker":"Charles Goldfarb","startTime":619.79,"endTime":622.13,"body":"of good finger motion equals"},{"speaker":"Charles Goldfarb","startTime":619.79,"endTime":622.13,"body":"good outcome?"},{"speaker":"Macy Stonner","startTime":622.52,"endTime":624.14,"body":"You're talking"},{"speaker":"Macy Stonner","startTime":622.52,"endTime":624.14,"body":"about preoperatively?"},{"speaker":"Charles Goldfarb","startTime":624.5,"endTime":626.99,"body":"Preoperativel"},{"speaker":"Charles Goldfarb","startTime":624.5,"endTime":626.99,"body":"yeah, or postoperatively? Just."},{"speaker":"Macy Stonner","startTime":627.02,"endTime":627.74,"body":"For sure."},{"speaker":"Charles Goldfarb","startTime":628.02,"endTime":628.41,"body":"Okay."},{"speaker":"Macy Stonner","startTime":628.68,"endTime":630.39,"body":"Yeah, I totally, I"},{"speaker":"Macy Stonner","startTime":628.68,"endTime":630.39,"body":"totally agree with that. I think"},{"speaker":"Macy Stonner","startTime":630.39,"endTime":632.46,"body":"that that can make a much bigger"},{"speaker":"Macy Stonner","startTime":630.39,"endTime":632.46,"body":"difference in many other"},{"speaker":"Macy Stonner","startTime":632.46,"endTime":633.33,"body":"factors."},{"speaker":"Charles Goldfarb","startTime":634.41,"endTime":636.54,"body":"All right, so"},{"speaker":"Charles Goldfarb","startTime":634.41,"endTime":636.54,"body":"let's say you see Chris's"},{"speaker":"Charles Goldfarb","startTime":636.54,"endTime":640.02,"body":"patient at three days, or my"},{"speaker":"Charles Goldfarb","startTime":636.54,"endTime":640.02,"body":"patient at five days, you make"},{"speaker":"Charles Goldfarb","startTime":640.02,"endTime":642.81,"body":"them one of your beautiful"},{"speaker":"Charles Goldfarb","startTime":640.02,"endTime":642.81,"body":"splints. What do you tell them"},{"speaker":"Charles Goldfarb","startTime":642.81,"endTime":645.9,"body":"about the splint? Do you tell"},{"speaker":"Charles Goldfarb","startTime":642.81,"endTime":645.9,"body":"them to wear it 24/7, except for"},{"speaker":"Charles Goldfarb","startTime":645.9,"endTime":648.93,"body":"showers and very careful motion?"},{"speaker":"Charles Goldfarb","startTime":645.9,"endTime":648.93,"body":"What's your instruction on a"},{"speaker":"Charles Goldfarb","startTime":649.17,"endTime":651.27,"body":"really well done, ORIF?"},{"speaker":"Macy Stonner","startTime":651.93,"endTime":655.32,"body":"So if it's that"},{"speaker":"Macy Stonner","startTime":651.93,"endTime":655.32,"body":"first post op visit, I will tell"},{"speaker":"Macy Stonner","startTime":655.32,"endTime":660.57,"body":"them to wear it all the time,"},{"speaker":"Macy Stonner","startTime":655.32,"endTime":660.57,"body":"except for exercises and"},{"speaker":"Macy Stonner","startTime":660.57,"endTime":664.71,"body":"showers. And if they're sitting"},{"speaker":"Macy Stonner","startTime":660.57,"endTime":664.71,"body":"down watching Netflix, they can"},{"speaker":"Macy Stonner","startTime":664.71,"endTime":669.03,"body":"take it off, breathe a little"},{"speaker":"Macy Stonner","startTime":664.71,"endTime":669.03,"body":"bit, do some edema massage, get"},{"speaker":"Macy Stonner","startTime":669.03,"endTime":671.4,"body":"to know their hand because it"},{"speaker":"Macy Stonner","startTime":669.03,"endTime":671.4,"body":"sounds crazy but sometimes these"},{"speaker":"Macy Stonner","startTime":671.4,"endTime":674.82,"body":"patients are so freaked out by"},{"speaker":"Macy Stonner","startTime":671.4,"endTime":674.82,"body":"their swollen hand that can't"},{"speaker":"Macy Stonner","startTime":674.82,"endTime":679.44,"body":"move that if they wear their"},{"speaker":"Macy Stonner","startTime":674.82,"endTime":679.44,"body":"brace too much. I think that"},{"speaker":"Macy Stonner","startTime":679.74,"endTime":683.43,"body":"they kind of dissociate"},{"speaker":"Macy Stonner","startTime":679.74,"endTime":683.43,"body":"themselves with their hand. So I"},{"speaker":"Macy Stonner","startTime":683.43,"endTime":686.94,"body":"don't always have them wear it"},{"speaker":"Macy Stonner","startTime":683.43,"endTime":686.94,"body":"all the time, particularly when"},{"speaker":"Macy Stonner","startTime":686.94,"endTime":689.19,"body":"they're seated watching TV at"},{"speaker":"Macy Stonner","startTime":686.94,"endTime":689.19,"body":"the end of the day."},{"speaker":"Chris Dy","startTime":689.55,"endTime":692.97,"body":"Now Chuck, I have a"},{"speaker":"Chris Dy","startTime":689.55,"endTime":692.97,"body":"question for you maybe? Who are,"},{"speaker":"Chris Dy","startTime":693.0,"endTime":696.48,"body":"are there certain, not the"},{"speaker":"Chris Dy","startTime":693.0,"endTime":696.48,"body":"fracture characteristics but are"},{"speaker":"Chris Dy","startTime":696.48,"endTime":698.67,"body":"there certain patient"},{"speaker":"Chris Dy","startTime":696.48,"endTime":698.67,"body":"characteristics that make you a"},{"speaker":"Chris Dy","startTime":698.67,"endTime":701.67,"body":"little nervous about this"},{"speaker":"Chris Dy","startTime":698.67,"endTime":701.67,"body":"protocol? You know, is there"},{"speaker":"Chris Dy","startTime":701.67,"endTime":706.29,"body":"something about, do you not"},{"speaker":"Chris Dy","startTime":701.67,"endTime":706.29,"body":"trust certain age groups are you"},{"speaker":"Charles Goldfarb","startTime":706.14,"endTime":709.65,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":706.14,"endTime":709.65,"body":"oversimplify my my way of"},{"speaker":"Charles Goldfarb","startTime":706.29,"endTime":706.62,"body":"know."},{"speaker":"Charles Goldfarb","startTime":709.65,"endTime":713.97,"body":"thinking for sure. But for me,"},{"speaker":"Charles Goldfarb","startTime":709.65,"endTime":713.97,"body":"it really comes down to two"},{"speaker":"Charles Goldfarb","startTime":713.97,"endTime":717.57,"body":"groups, those that start therapy"},{"speaker":"Charles Goldfarb","startTime":713.97,"endTime":717.57,"body":"at five days, and those that"},{"speaker":"Charles Goldfarb","startTime":717.57,"endTime":721.98,"body":"start therapy at five weeks. And"},{"speaker":"Charles Goldfarb","startTime":717.57,"endTime":721.98,"body":"for me, that's generally"},{"speaker":"Charles Goldfarb","startTime":721.98,"endTime":727.47,"body":"fracture characteristics or my"},{"speaker":"Charles Goldfarb","startTime":721.98,"endTime":727.47,"body":"ability to obtain and really"},{"speaker":"Charles Goldfarb","startTime":727.5,"endTime":731.55,"body":"maintain a good reduction in the"},{"speaker":"Charles Goldfarb","startTime":727.5,"endTime":731.55,"body":"operating room. But I had this"},{"speaker":"Charles Goldfarb","startTime":731.55,"endTime":736.35,"body":"wonderful luxury that Macy"},{"speaker":"Charles Goldfarb","startTime":731.55,"endTime":736.35,"body":"provides that I know I can trust"},{"speaker":"Charles Goldfarb","startTime":736.35,"endTime":741.78,"body":"the therapist, so that I don't"},{"speaker":"Charles Goldfarb","startTime":736.35,"endTime":741.78,"body":"have to be overly granular about"},{"speaker":"Charles Goldfarb","startTime":741.78,"endTime":744.6,"body":"how aggressive to be. Because I"},{"speaker":"Charles Goldfarb","startTime":741.78,"endTime":744.6,"body":"know that if I have a good"},{"speaker":"Charles Goldfarb","startTime":744.6,"endTime":749.94,"body":"fixation, patients aren't going"},{"speaker":"Charles Goldfarb","startTime":744.6,"endTime":749.94,"body":"to disrupt a well positioned"},{"speaker":"Charles Goldfarb","startTime":749.94,"endTime":753.0,"body":"plate with good screws, that's"},{"speaker":"Charles Goldfarb","startTime":749.94,"endTime":753.0,"body":"not going to happen. You know,"},{"speaker":"Charles Goldfarb","startTime":753.0,"endTime":755.7,"body":"if they fall, that's one thing,"},{"speaker":"Charles Goldfarb","startTime":753.0,"endTime":755.7,"body":"but doing other exercises, I"},{"speaker":"Charles Goldfarb","startTime":755.7,"endTime":758.79,"body":"feel really comfortable with it."},{"speaker":"Charles Goldfarb","startTime":755.7,"endTime":758.79,"body":"So it's really just the early"},{"speaker":"Charles Goldfarb","startTime":758.79,"endTime":762.87,"body":"group and the late group, in my"},{"speaker":"Charles Goldfarb","startTime":758.79,"endTime":762.87,"body":"mind Macy is that too ov"},{"speaker":"Charles Goldfarb","startTime":762.87,"endTime":763.83,"body":"rsimplified?"},{"speaker":"Macy Stonner","startTime":765.0,"endTime":768.0,"body":"No, I totally can"},{"speaker":"Macy Stonner","startTime":765.0,"endTime":768.0,"body":"appreciate that comment as well."},{"speaker":"Macy Stonner","startTime":768.12,"endTime":768.69,"body":"I see that."},{"speaker":"Chris Dy","startTime":769.47,"endTime":772.38,"body":"So say they they have"},{"speaker":"Chris Dy","startTime":769.47,"endTime":772.38,"body":"they've started this protocol,"},{"speaker":"Chris Dy","startTime":772.47,"endTime":775.59,"body":"they now come back for a first"},{"speaker":"Chris Dy","startTime":772.47,"endTime":775.59,"body":"post op visit with you, Chuck,"},{"speaker":"Chris Dy","startTime":775.59,"endTime":778.83,"body":"when would that be typically?"},{"speaker":"Chris Dy","startTime":775.59,"endTime":778.83,"body":"And what's the conversation what"},{"speaker":"Chris Dy","startTime":778.83,"endTime":779.49,"body":"happens then?"},{"speaker":"Charles Goldfarb","startTime":780.74,"endTime":784.73,"body":"So to me that,"},{"speaker":"Charles Goldfarb","startTime":780.74,"endTime":784.73,"body":"for me, that's 12 days, again, a"},{"speaker":"Charles Goldfarb","startTime":784.73,"endTime":789.08,"body":"number of convenience. And if"},{"speaker":"Charles Goldfarb","startTime":784.73,"endTime":789.08,"body":"I've put in nylon stitches, they"},{"speaker":"Charles Goldfarb","startTime":789.08,"endTime":793.25,"body":"come out, I get a sense of how"},{"speaker":"Charles Goldfarb","startTime":789.08,"endTime":793.25,"body":"they're moving fingers, A1"},{"speaker":"Charles Goldfarb","startTime":793.25,"endTime":795.8,"body":"number, you know, most"},{"speaker":"Charles Goldfarb","startTime":793.25,"endTime":795.8,"body":"important, and then their"},{"speaker":"Charles Goldfarb","startTime":795.8,"endTime":798.59,"body":"forearm and the wrist. And"},{"speaker":"Charles Goldfarb","startTime":795.8,"endTime":798.59,"body":"there's nothing that makes me"},{"speaker":"Charles Goldfarb","startTime":798.59,"endTime":801.65,"body":"happier when a patient comes in"},{"speaker":"Charles Goldfarb","startTime":798.59,"endTime":801.65,"body":"and they can already supinate"},{"speaker":"Charles Goldfarb","startTime":802.13,"endTime":804.5,"body":"you know, they can all I'm you"},{"speaker":"Charles Goldfarb","startTime":802.13,"endTime":804.5,"body":"know, pronation is usually not a"},{"speaker":"Charles Goldfarb","startTime":804.5,"endTime":808.07,"body":"challenge. Sometimes it is but"},{"speaker":"Charles Goldfarb","startTime":804.5,"endTime":808.07,"body":"they can already supinate even"},{"speaker":"Charles Goldfarb","startTime":808.07,"endTime":810.8,"body":"if their wrist motion isn't"},{"speaker":"Charles Goldfarb","startTime":808.07,"endTime":810.8,"body":"great, I feel so good. And I"},{"speaker":"Charles Goldfarb","startTime":810.8,"endTime":814.97,"body":"feel the need to say to the"},{"speaker":"Charles Goldfarb","startTime":810.8,"endTime":814.97,"body":"patient, you don't understand"},{"speaker":"Charles Goldfarb","startTime":814.97,"endTime":819.08,"body":"how wonderfully you're doing. I"},{"speaker":"Charles Goldfarb","startTime":814.97,"endTime":819.08,"body":"just I just feel the need to"},{"speaker":"Charles Goldfarb","startTime":819.08,"endTime":822.86,"body":"contextualize it because it's"},{"speaker":"Charles Goldfarb","startTime":819.08,"endTime":822.86,"body":"just, it's just still amazing to"},{"speaker":"Charles Goldfarb","startTime":822.86,"endTime":823.1,"body":"me."},{"speaker":"Chris Dy","startTime":823.26,"endTime":826.11,"body":"What is it about"},{"speaker":"Chris Dy","startTime":823.26,"endTime":826.11,"body":"supination that, you know,"},{"speaker":"Chris Dy","startTime":826.11,"endTime":829.68,"body":"seeing that restoration of"},{"speaker":"Chris Dy","startTime":826.11,"endTime":829.68,"body":"supination so quickly, for those"},{"speaker":"Chris Dy","startTime":829.68,"endTime":832.5,"body":"of us that don't have as much"},{"speaker":"Chris Dy","startTime":829.68,"endTime":832.5,"body":"experience as you and maybe have"},{"speaker":"Chris Dy","startTime":832.5,"endTime":833.04,"body":"more hair?"},{"speaker":"Charles Goldfarb","startTime":834.14,"endTime":836.51,"body":"Well, and I'd"},{"speaker":"Charles Goldfarb","startTime":834.14,"endTime":836.51,"body":"love Macy's thoughts, I think"},{"speaker":"Charles Goldfarb","startTime":836.51,"endTime":840.95,"body":"it's generally well accepted"},{"speaker":"Charles Goldfarb","startTime":836.51,"endTime":840.95,"body":"that supination is one of the"},{"speaker":"Charles Goldfarb","startTime":840.95,"endTime":845.0,"body":"hardest, if not the hardest"},{"speaker":"Charles Goldfarb","startTime":840.95,"endTime":845.0,"body":"motion to regain. And wrist"},{"speaker":"Charles Goldfarb","startTime":845.0,"endTime":848.36,"body":"flexion is really hard to"},{"speaker":"Charles Goldfarb","startTime":845.0,"endTime":848.36,"body":"regain. Now, of all the you"},{"speaker":"Charles Goldfarb","startTime":848.36,"endTime":850.97,"body":"know, if we consider the four"},{"speaker":"Charles Goldfarb","startTime":848.36,"endTime":850.97,"body":"motion, supination, pronation,"},{"speaker":"Charles Goldfarb","startTime":850.97,"endTime":853.49,"body":"wrist extension and wrist"},{"speaker":"Charles Goldfarb","startTime":850.97,"endTime":853.49,"body":"flexion. The two that I would"},{"speaker":"Charles Goldfarb","startTime":853.49,"endTime":857.36,"body":"deprioritize would be supination"},{"speaker":"Charles Goldfarb","startTime":853.49,"endTime":857.36,"body":"and flexion. From a from a"},{"speaker":"Charles Goldfarb","startTime":857.36,"endTime":860.36,"body":"functional standpoint, right?"},{"speaker":"Charles Goldfarb","startTime":857.36,"endTime":860.36,"body":"I'd rather have good pronation."},{"speaker":"Charles Goldfarb","startTime":860.48,"endTime":863.84,"body":"And I'd rather have good wrist"},{"speaker":"Charles Goldfarb","startTime":860.48,"endTime":863.84,"body":"extension. But being greedy I"},{"speaker":"Charles Goldfarb","startTime":863.84,"endTime":868.04,"body":"want it all so you know if they"},{"speaker":"Charles Goldfarb","startTime":863.84,"endTime":868.04,"body":"have good supination really"},{"speaker":"Charles Goldfarb","startTime":868.07,"endTime":871.37,"body":"early again, it's just like"},{"speaker":"Charles Goldfarb","startTime":868.07,"endTime":871.37,"body":"having good finger motion right"},{"speaker":"Charles Goldfarb","startTime":871.37,"endTime":874.73,"body":"after you break your your wrist."},{"speaker":"Charles Goldfarb","startTime":871.37,"endTime":874.73,"body":"I just feel good about it. Macy"},{"speaker":"Charles Goldfarb","startTime":874.73,"endTime":876.62,"body":"again, am I making this too"},{"speaker":"Charles Goldfarb","startTime":874.73,"endTime":876.62,"body":"simple?"},{"speaker":"Macy Stonner","startTime":876.98,"endTime":880.34,"body":"No, I agree with"},{"speaker":"Macy Stonner","startTime":876.98,"endTime":880.34,"body":"that completely. I think that"},{"speaker":"Macy Stonner","startTime":880.34,"endTime":884.03,"body":"finger motion again is number"},{"speaker":"Macy Stonner","startTime":880.34,"endTime":884.03,"body":"one. So if they can make a full"},{"speaker":"Macy Stonner","startTime":884.03,"endTime":886.37,"body":"fist, I'm like you're doing"},{"speaker":"Macy Stonner","startTime":884.03,"endTime":886.37,"body":"amazing, even though they"},{"speaker":"Macy Stonner","startTime":886.37,"endTime":889.79,"body":"subjectively feel like their"},{"speaker":"Macy Stonner","startTime":886.37,"endTime":889.79,"body":"world has been turned around"},{"speaker":"Macy Stonner","startTime":889.79,"endTime":893.12,"body":"because they can't do the things"},{"speaker":"Macy Stonner","startTime":889.79,"endTime":893.12,"body":"that they normally do. And I"},{"speaker":"Macy Stonner","startTime":893.12,"endTime":895.58,"body":"always have to rest assured,"},{"speaker":"Macy Stonner","startTime":893.12,"endTime":895.58,"body":"hey, you're doing great, you"},{"speaker":"Macy Stonner","startTime":895.58,"endTime":899.03,"body":"know, give them that confidence."},{"speaker":"Macy Stonner","startTime":895.58,"endTime":899.03,"body":"But I would agree. I don't know"},{"speaker":"Macy Stonner","startTime":899.03,"endTime":902.84,"body":"if I think it's supination vs"},{"speaker":"Macy Stonner","startTime":899.03,"endTime":902.84,"body":"wrist extension, but those are"},{"speaker":"Macy Stonner","startTime":902.84,"endTime":906.38,"body":"the two typically that I find to"},{"speaker":"Macy Stonner","startTime":902.84,"endTime":906.38,"body":"be the most challenging to get"},{"speaker":"Macy Stonner","startTime":906.38,"endTime":909.65,"body":"back. And so supination wrist"},{"speaker":"Macy Stonner","startTime":906.38,"endTime":909.65,"body":"extension, yeah, are the key for"},{"speaker":"Macy Stonner","startTime":909.65,"endTime":914.45,"body":"me. pronation, not typically a"},{"speaker":"Macy Stonner","startTime":909.65,"endTime":914.45,"body":"huge issue. Wrist flexion, I'm"},{"speaker":"Macy Stonner","startTime":914.45,"endTime":916.49,"body":"not too worried about"},{"speaker":"Macy Stonner","startTime":914.45,"endTime":916.49,"body":"functionally and it comes,"},{"speaker":"Chris Dy","startTime":916.55,"endTime":918.77,"body":"it's not so much that"},{"speaker":"Chris Dy","startTime":916.55,"endTime":918.77,"body":"supination helps you from a"},{"speaker":"Chris Dy","startTime":918.77,"endTime":921.17,"body":"functional perspective, it's"},{"speaker":"Chris Dy","startTime":918.77,"endTime":921.17,"body":"just more of a marker of how you"},{"speaker":"Chris Dy","startTime":921.17,"endTime":922.79,"body":"think the patient is going to do"},{"speaker":"Chris Dy","startTime":921.17,"endTime":922.79,"body":"overall,"},{"speaker":"Macy Stonner","startTime":923.15,"endTime":925.19,"body":"I think both, for"},{"speaker":"Macy Stonner","startTime":923.15,"endTime":925.19,"body":"sure. Supination people have a"},{"speaker":"Macy Stonner","startTime":925.19,"endTime":928.76,"body":"hard time washing their face and"},{"speaker":"Macy Stonner","startTime":925.19,"endTime":928.76,"body":"opening doors and things like"},{"speaker":"Macy Stonner","startTime":928.76,"endTime":929.9,"body":"that. So I think it's both."},{"speaker":"Charles Goldfarb","startTime":930.14,"endTime":932.42,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":930.14,"endTime":932.42,"body":"that's well said. All right. So"},{"speaker":"Charles Goldfarb","startTime":932.42,"endTime":936.05,"body":"let's take the patient Macy"},{"speaker":"Charles Goldfarb","startTime":932.42,"endTime":936.05,"body":"who's doing well. You know, you"},{"speaker":"Charles Goldfarb","startTime":936.05,"endTime":939.11,"body":"see him at five days I see him"},{"speaker":"Charles Goldfarb","startTime":936.05,"endTime":939.11,"body":"at 12 days. How often do you"},{"speaker":"Charles Goldfarb","startTime":939.11,"endTime":942.62,"body":"think you need to see him in the"},{"speaker":"Charles Goldfarb","startTime":939.11,"endTime":942.62,"body":"clinic? I'm sorry, in your"},{"speaker":"Charles Goldfarb","startTime":942.62,"endTime":946.1,"body":"therapy clinic? for that patient"},{"speaker":"Charles Goldfarb","startTime":942.62,"endTime":946.1,"body":"who's really almost on"},{"speaker":"Charles Goldfarb","startTime":946.1,"endTime":948.83,"body":"autopilot? Is this a once a week"},{"speaker":"Charles Goldfarb","startTime":946.1,"endTime":948.83,"body":"thing? I know it varies from"},{"speaker":"Charles Goldfarb","startTime":948.83,"endTime":952.13,"body":"patient to patient, but just"},{"speaker":"Charles Goldfarb","startTime":948.83,"endTime":952.13,"body":"generally, the simplest patient"},{"speaker":"Charles Goldfarb","startTime":952.13,"endTime":955.22,"body":"the patient is doing as well as"},{"speaker":"Charles Goldfarb","startTime":952.13,"endTime":955.22,"body":"can be expected. What How do you"},{"speaker":"Charles Goldfarb","startTime":955.22,"endTime":956.54,"body":"think about those patients"},{"speaker":"Macy Stonner","startTime":956.78,"endTime":960.8,"body":"once a week, if"},{"speaker":"Macy Stonner","startTime":956.78,"endTime":960.8,"body":"their edema isn't too bad, they"},{"speaker":"Macy Stonner","startTime":960.8,"endTime":964.28,"body":"have decent motion and not too"},{"speaker":"Macy Stonner","startTime":960.8,"endTime":964.28,"body":"much pain, I think once a week"},{"speaker":"Macy Stonner","startTime":964.28,"endTime":969.47,"body":"is incredibly reasonable. Um, if"},{"speaker":"Macy Stonner","startTime":964.28,"endTime":969.47,"body":"they are really swollen, fingers"},{"speaker":"Macy Stonner","startTime":969.47,"endTime":974.21,"body":"are stiff, can't move their"},{"speaker":"Macy Stonner","startTime":969.47,"endTime":974.21,"body":"wrist, twice a week for sure."},{"speaker":"Macy Stonner","startTime":974.24,"endTime":976.7,"body":"Sometimes that those patients"},{"speaker":"Macy Stonner","startTime":974.24,"endTime":976.7,"body":"are just like I said earlier,"},{"speaker":"Macy Stonner","startTime":976.7,"endTime":980.03,"body":"just kind of freaked out. And"},{"speaker":"Macy Stonner","startTime":976.7,"endTime":980.03,"body":"they need that formal"},{"speaker":"Macy Stonner","startTime":980.03,"endTime":983.66,"body":"instruction, encouragement."},{"speaker":"Macy Stonner","startTime":980.03,"endTime":983.66,"body":"Every, you know."},{"speaker":"Chris Dy","startTime":983.48,"endTime":986.6,"body":"So, just a quick"},{"speaker":"Chris Dy","startTime":983.48,"endTime":986.6,"body":"question, given the era that"},{"speaker":"Chris Dy","startTime":986.6,"endTime":990.5,"body":"we're recording this podcast in"},{"speaker":"Chris Dy","startTime":986.6,"endTime":990.5,"body":"would, for that cruise control"},{"speaker":"Chris Dy","startTime":990.5,"endTime":993.05,"body":"patients, that once a week"},{"speaker":"Chris Dy","startTime":990.5,"endTime":993.05,"body":"patient, would a telemedicine"},{"speaker":"Chris Dy","startTime":993.05,"endTime":993.89,"body":"visit be enough?"},{"speaker":"Macy Stonner","startTime":994.44,"endTime":997.32,"body":"Yes, I totally"},{"speaker":"Macy Stonner","startTime":994.44,"endTime":997.32,"body":"think so. That happened a lot"},{"speaker":"Macy Stonner","startTime":997.32,"endTime":1000.02,"body":"during April and May during the"},{"speaker":"Macy Stonner","startTime":997.32,"endTime":1000.02,"body":"height of COVID, where there"},{"speaker":"Macy Stonner","startTime":1000.02,"endTime":1004.91,"body":"would be those traumatic"},{"speaker":"Macy Stonner","startTime":1000.02,"endTime":1004.91,"body":"patients that we had to see. And"},{"speaker":"Macy Stonner","startTime":1004.94,"endTime":1007.31,"body":"you would do their initial"},{"speaker":"Macy Stonner","startTime":1004.94,"endTime":1007.31,"body":"instruction with the splint and"},{"speaker":"Macy Stonner","startTime":1007.31,"endTime":1010.1,"body":"start them on motion. And I"},{"speaker":"Macy Stonner","startTime":1007.31,"endTime":1010.1,"body":"would see them once a week or"},{"speaker":"Macy Stonner","startTime":1010.1,"endTime":1013.19,"body":"every other week through zoom"},{"speaker":"Macy Stonner","startTime":1010.1,"endTime":1013.19,"body":"and email them pictures of"},{"speaker":"Macy Stonner","startTime":1013.19,"endTime":1015.8,"body":"handouts and measure them"},{"speaker":"Macy Stonner","startTime":1013.19,"endTime":1015.8,"body":"through my camera and make sure"},{"speaker":"Macy Stonner","startTime":1015.8,"endTime":1018.26,"body":"they're progressing"},{"speaker":"Macy Stonner","startTime":1015.8,"endTime":1018.26,"body":"appropriately. They did great."},{"speaker":"Charles Goldfarb","startTime":1018.54,"endTime":1021.36,"body":"So the"},{"speaker":"Charles Goldfarb","startTime":1018.54,"endTime":1021.36,"body":"terminology I use again, maybe"},{"speaker":"Charles Goldfarb","startTime":1021.36,"endTime":1023.85,"body":"still focusing mainly on that"},{"speaker":"Charles Goldfarb","startTime":1021.36,"endTime":1023.85,"body":"patient who's doing well, I"},{"speaker":"Charles Goldfarb","startTime":1023.85,"endTime":1026.01,"body":"think we should kind of come"},{"speaker":"Charles Goldfarb","startTime":1023.85,"endTime":1026.01,"body":"back and revisit the patient"},{"speaker":"Charles Goldfarb","startTime":1026.01,"endTime":1028.41,"body":"who's struggling, but thinking"},{"speaker":"Charles Goldfarb","startTime":1026.01,"endTime":1028.41,"body":"about the patient who's doing"},{"speaker":"Charles Goldfarb","startTime":1028.41,"endTime":1031.98,"body":"reasonably well. The three terms"},{"speaker":"Charles Goldfarb","startTime":1028.41,"endTime":1031.98,"body":"I use, and you may tell me, I'm"},{"speaker":"Charles Goldfarb","startTime":1032.01,"endTime":1034.8,"body":"doing it all wrong. And you"},{"speaker":"Charles Goldfarb","startTime":1032.01,"endTime":1034.8,"body":"just, you know, don't want to"},{"speaker":"Charles Goldfarb","startTime":1034.8,"endTime":1037.86,"body":"embarrass me but I'm gonna"},{"speaker":"Charles Goldfarb","startTime":1034.8,"endTime":1037.86,"body":"embarrass myself perhaps, I talk"},{"speaker":"Charles Goldfarb","startTime":1037.86,"endTime":1041.31,"body":"about active motion. I talk"},{"speaker":"Charles Goldfarb","startTime":1037.86,"endTime":1041.31,"body":"about gentle passive motion and"},{"speaker":"Charles Goldfarb","startTime":1041.31,"endTime":1044.31,"body":"I talk about you know, you don't"},{"speaker":"Charles Goldfarb","startTime":1041.31,"endTime":1044.31,"body":"like this word aggressive"},{"speaker":"Charles Goldfarb","startTime":1044.31,"endTime":1047.37,"body":"passive motion. So what what"},{"speaker":"Charles Goldfarb","startTime":1044.31,"endTime":1047.37,"body":"should I be saying?"},{"speaker":"Chris Dy","startTime":1047.4,"endTime":1049.47,"body":"Not passive"},{"speaker":"Chris Dy","startTime":1047.4,"endTime":1049.47,"body":"aggressive, but aggressive"},{"speaker":"Chris Dy","startTime":1049.47,"endTime":1049.95,"body":"passive."},{"speaker":"Macy Stonner","startTime":1050.52,"endTime":1053.88,"body":"Those are fine"},{"speaker":"Macy Stonner","startTime":1050.52,"endTime":1053.88,"body":"ways to look at it. And by you"},{"speaker":"Macy Stonner","startTime":1053.88,"endTime":1056.82,"body":"saying aggressive passive"},{"speaker":"Macy Stonner","startTime":1053.88,"endTime":1056.82,"body":"motion. I know Dr. Goldfarb is"},{"speaker":"Macy Stonner","startTime":1056.82,"endTime":1059.37,"body":"not pleased with their motion"},{"speaker":"Macy Stonner","startTime":1056.82,"endTime":1059.37,"body":"right now. And I need to get"},{"speaker":"Macy Stonner","startTime":1059.37,"endTime":1062.64,"body":"them moving. But I'm not going"},{"speaker":"Macy Stonner","startTime":1059.37,"endTime":1062.64,"body":"to tell the patient you have to"},{"speaker":"Macy Stonner","startTime":1062.64,"endTime":1064.56,"body":"be aggressive on your wrist or"},{"speaker":"Macy Stonner","startTime":1062.64,"endTime":1064.56,"body":"we're, you're never gonna get"},{"speaker":"Macy Stonner","startTime":1064.56,"endTime":1067.92,"body":"your your function back. That's"},{"speaker":"Macy Stonner","startTime":1064.56,"endTime":1067.92,"body":"more of a little sign to me that"},{"speaker":"Macy Stonner","startTime":1067.92,"endTime":1070.71,"body":"hey, Macy, like I feel good"},{"speaker":"Macy Stonner","startTime":1067.92,"endTime":1070.71,"body":"about this fixation. Their"},{"speaker":"Macy Stonner","startTime":1070.71,"endTime":1074.34,"body":"motion isn't where I want it to"},{"speaker":"Macy Stonner","startTime":1070.71,"endTime":1074.34,"body":"be. Do whatever you want, give"},{"speaker":"Macy Stonner","startTime":1074.34,"endTime":1076.86,"body":"them the kitchen sink, but make"},{"speaker":"Macy Stonner","startTime":1074.34,"endTime":1076.86,"body":"sure that they're stretching?"},{"speaker":"Charles Goldfarb","startTime":1077.43,"endTime":1080.43,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1077.43,"endTime":1080.43,"body":"I think, again, we've worked"},{"speaker":"Charles Goldfarb","startTime":1080.43,"endTime":1083.19,"body":"together on and off for a long"},{"speaker":"Charles Goldfarb","startTime":1080.43,"endTime":1083.19,"body":"time. So I think that is how I"},{"speaker":"Charles Goldfarb","startTime":1083.19,"endTime":1088.53,"body":"mean it. For sure. I guess I"},{"speaker":"Charles Goldfarb","startTime":1083.19,"endTime":1088.53,"body":"also would be hesitant to say"},{"speaker":"Charles Goldfarb","startTime":1088.53,"endTime":1092.73,"body":"aggressive, passive motion at 12"},{"speaker":"Charles Goldfarb","startTime":1088.53,"endTime":1092.73,"body":"days. I shouldn't be."},{"speaker":"Macy Stonner","startTime":1093.78,"endTime":1096.87,"body":"No, I would be, I"},{"speaker":"Macy Stonner","startTime":1093.78,"endTime":1096.87,"body":"would not administer aggressive"},{"speaker":"Macy Stonner","startTime":1096.87,"endTime":1099.36,"body":"passive motion at 12 days, I"},{"speaker":"Macy Stonner","startTime":1096.87,"endTime":1099.36,"body":"probably would not."},{"speaker":"Chris Dy","startTime":1099.45,"endTime":1101.25,"body":"How about for somebody"},{"speaker":"Chris Dy","startTime":1099.45,"endTime":1101.25,"body":"who doesn't work with the two of"},{"speaker":"Chris Dy","startTime":1101.25,"endTime":1105.12,"body":"you routinely. So what is the"},{"speaker":"Chris Dy","startTime":1101.25,"endTime":1105.12,"body":"difference in terms of what you"},{"speaker":"Chris Dy","startTime":1105.12,"endTime":1109.44,"body":"do Macy when you see gentle"},{"speaker":"Chris Dy","startTime":1105.12,"endTime":1109.44,"body":"passive and quote, aggressive"},{"speaker":"Chris Dy","startTime":1109.44,"endTime":1113.34,"body":"passive, how what? How hard are"},{"speaker":"Chris Dy","startTime":1109.44,"endTime":1113.34,"body":"you pushing on the patient or"},{"speaker":"Chris Dy","startTime":1113.34,"endTime":1114.54,"body":"having the patient push."},{"speaker":"Macy Stonner","startTime":1114.84,"endTime":1118.14,"body":"So I always use"},{"speaker":"Macy Stonner","startTime":1114.84,"endTime":1118.14,"body":"the same spiel that my coworkers"},{"speaker":"Macy Stonner","startTime":1118.14,"endTime":1121.74,"body":"will laugh at, because they hear"},{"speaker":"Macy Stonner","startTime":1118.14,"endTime":1121.74,"body":"me say it all the time, that I"},{"speaker":"Macy Stonner","startTime":1121.74,"endTime":1124.41,"body":"want you to gently push with"},{"speaker":"Macy Stonner","startTime":1121.74,"endTime":1124.41,"body":"your, I don't want your pain"},{"speaker":"Macy Stonner","startTime":1124.41,"endTime":1127.53,"body":"levels to exceed a two to a"},{"speaker":"Macy Stonner","startTime":1124.41,"endTime":1127.53,"body":"three out of 10. And everybody's"},{"speaker":"Macy Stonner","startTime":1127.53,"endTime":1130.44,"body":"two to a three out of 10 may be"},{"speaker":"Macy Stonner","startTime":1127.53,"endTime":1130.44,"body":"different. But I just want you"},{"speaker":"Macy Stonner","startTime":1130.44,"endTime":1133.47,"body":"to understand that you're not"},{"speaker":"Macy Stonner","startTime":1130.44,"endTime":1133.47,"body":"cranking on this, it shouldn't"},{"speaker":"Macy Stonner","startTime":1133.47,"endTime":1135.75,"body":"be hard enough to where you have"},{"speaker":"Macy Stonner","startTime":1133.47,"endTime":1135.75,"body":"to go take pain medication, but"},{"speaker":"Macy Stonner","startTime":1135.75,"endTime":1138.72,"body":"I want you to feel a good"},{"speaker":"Macy Stonner","startTime":1135.75,"endTime":1138.72,"body":"stretch, a two to a three out of"},{"speaker":"Macy Stonner","startTime":1138.72,"endTime":1143.61,"body":"10 is appropriate. And that's"},{"speaker":"Macy Stonner","startTime":1138.72,"endTime":1143.61,"body":"how I explain gentle passive."},{"speaker":"Charles Goldfarb","startTime":1144.09,"endTime":1145.83,"body":"That's"},{"speaker":"Charles Goldfarb","startTime":1144.09,"endTime":1145.83,"body":"interesting. I would have"},{"speaker":"Charles Goldfarb","startTime":1145.83,"endTime":1148.08,"body":"thought gentle passive was a"},{"speaker":"Charles Goldfarb","startTime":1145.83,"endTime":1148.08,"body":"five."},{"speaker":"Chris Dy","startTime":1150.39,"endTime":1151.62,"body":"What does that say"},{"speaker":"Chris Dy","startTime":1150.39,"endTime":1151.62,"body":"about you?"},{"speaker":"Macy Stonner","startTime":1153.24,"endTime":1155.64,"body":"A five is pretty"},{"speaker":"Macy Stonner","startTime":1153.24,"endTime":1155.64,"body":"intense, like where you need to"},{"speaker":"Macy Stonner","startTime":1155.64,"endTime":1158.58,"body":"go get some meds. But again,"},{"speaker":"Macy Stonner","startTime":1155.64,"endTime":1158.58,"body":"it's such a subjective scale. I"},{"speaker":"Macy Stonner","startTime":1158.58,"endTime":1159.06,"body":"don't know."},{"speaker":"Charles Goldfarb","startTime":1159.27,"endTime":1161.67,"body":"No, I think"},{"speaker":"Charles Goldfarb","startTime":1159.27,"endTime":1161.67,"body":"your message is clear. I think"},{"speaker":"Charles Goldfarb","startTime":1161.67,"endTime":1164.04,"body":"it's a really important message."},{"speaker":"Charles Goldfarb","startTime":1161.67,"endTime":1164.04,"body":"And I think that's actually good"},{"speaker":"Charles Goldfarb","startTime":1164.04,"endTime":1165.24,"body":"for me to hear as well."},{"speaker":"Chris Dy","startTime":1166.89,"endTime":1169.32,"body":"So, is it the"},{"speaker":"Chris Dy","startTime":1166.89,"endTime":1169.32,"body":"therapist applying the passive"},{"speaker":"Chris Dy","startTime":1169.32,"endTime":1172.23,"body":"motion? Or is it the patient"},{"speaker":"Chris Dy","startTime":1169.32,"endTime":1172.23,"body":"self applying the passive"},{"speaker":"Chris Dy","startTime":1172.23,"endTime":1175.74,"body":"motion? I mean, is that where's"},{"speaker":"Chris Dy","startTime":1172.23,"endTime":1175.74,"body":"the line between active assist"},{"speaker":"Chris Dy","startTime":1175.92,"endTime":1176.46,"body":"by the patient?"},{"speaker":"Macy Stonner","startTime":1176.46,"endTime":1179.31,"body":"Yeah so I think"},{"speaker":"Macy Stonner","startTime":1176.46,"endTime":1179.31,"body":"that when you first initiate the"},{"speaker":"Macy Stonner","startTime":1179.31,"endTime":1182.91,"body":"exercise, the therapist does it"},{"speaker":"Macy Stonner","startTime":1179.31,"endTime":1182.91,"body":"to show them the technique, the"},{"speaker":"Macy Stonner","startTime":1182.91,"endTime":1187.65,"body":"intensity, the frequency, and"},{"speaker":"Macy Stonner","startTime":1182.91,"endTime":1187.65,"body":"then you teach them how to do it"},{"speaker":"Macy Stonner","startTime":1187.65,"endTime":1189.63,"body":"self administered, because"},{"speaker":"Macy Stonner","startTime":1187.65,"endTime":1189.63,"body":"that's what matters. You can"},{"speaker":"Macy Stonner","startTime":1189.63,"endTime":1192.0,"body":"come to therapy twice a week and"},{"speaker":"Macy Stonner","startTime":1189.63,"endTime":1192.0,"body":"I can stretch you but that's not"},{"speaker":"Macy Stonner","startTime":1192.0,"endTime":1194.13,"body":"going to make a difference if"},{"speaker":"Macy Stonner","startTime":1192.0,"endTime":1194.13,"body":"you're not doing it every day,"},{"speaker":"Macy Stonner","startTime":1194.13,"endTime":1197.43,"body":"multiple times a day. So then I"},{"speaker":"Macy Stonner","startTime":1194.13,"endTime":1197.43,"body":"check their technique, make sure"},{"speaker":"Macy Stonner","startTime":1197.43,"endTime":1200.67,"body":"they're doing it to themselves"},{"speaker":"Macy Stonner","startTime":1197.43,"endTime":1200.67,"body":"appropriately. Some patients"},{"speaker":"Macy Stonner","startTime":1200.67,"endTime":1203.88,"body":"every time they come in, I'll"},{"speaker":"Macy Stonner","startTime":1200.67,"endTime":1203.88,"body":"manually stretch them, maybe do"},{"speaker":"Macy Stonner","startTime":1203.88,"endTime":1207.3,"body":"some mobes, or some mobilization"},{"speaker":"Macy Stonner","startTime":1203.88,"endTime":1207.3,"body":"techniques, or something like"},{"speaker":"Macy Stonner","startTime":1207.3,"endTime":1210.99,"body":"that if they're really stiff."},{"speaker":"Macy Stonner","startTime":1207.3,"endTime":1210.99,"body":"But sometimes you just have to"},{"speaker":"Macy Stonner","startTime":1210.99,"endTime":1213.21,"body":"teach the patient how to do it"},{"speaker":"Macy Stonner","startTime":1210.99,"endTime":1213.21,"body":"themselves, and they've got it"},{"speaker":"Macy Stonner","startTime":1213.21,"endTime":1216.24,"body":"from there. I think people's"},{"speaker":"Macy Stonner","startTime":1213.21,"endTime":1216.24,"body":"personalities are different,"},{"speaker":"Macy Stonner","startTime":1216.24,"endTime":1219.99,"body":"too. And that can be a indicator"},{"speaker":"Macy Stonner","startTime":1216.24,"endTime":1219.99,"body":"as well."},{"speaker":"Chris Dy","startTime":1220.38,"endTime":1222.78,"body":"So I do want to ask,"},{"speaker":"Chris Dy","startTime":1220.38,"endTime":1222.78,"body":"you know, the next progression"},{"speaker":"Chris Dy","startTime":1222.78,"endTime":1226.26,"body":"in terms of you know, what the"},{"speaker":"Chris Dy","startTime":1222.78,"endTime":1226.26,"body":"next milestone is, but just so I"},{"speaker":"Chris Dy","startTime":1226.26,"endTime":1228.24,"body":"know, and I think maybe some"},{"speaker":"Chris Dy","startTime":1226.26,"endTime":1228.24,"body":"other people would want to know,"},{"speaker":"Chris Dy","startTime":1228.9,"endTime":1232.26,"body":"what happens, and what are the"},{"speaker":"Chris Dy","startTime":1228.9,"endTime":1232.26,"body":"things that you do to stretch"},{"speaker":"Chris Dy","startTime":1232.26,"endTime":1234.6,"body":"them out, you know, there're"},{"speaker":"Chris Dy","startTime":1232.26,"endTime":1234.6,"body":"always these modalities that are"},{"speaker":"Chris Dy","startTime":1234.6,"endTime":1237.27,"body":"going on these things that"},{"speaker":"Chris Dy","startTime":1234.6,"endTime":1237.27,"body":"happen in therapy to get"},{"speaker":"Chris Dy","startTime":1237.27,"endTime":1239.61,"body":"patients warmed up, what are the"},{"speaker":"Chris Dy","startTime":1237.27,"endTime":1239.61,"body":"examples of things that you do,"},{"speaker":"Macy Stonner","startTime":1239.76,"endTime":1242.91,"body":"So I will have"},{"speaker":"Macy Stonner","startTime":1239.76,"endTime":1242.91,"body":"their forearm resting on a"},{"speaker":"Macy Stonner","startTime":1242.91,"endTime":1246.45,"body":"bolster like a support and their"},{"speaker":"Macy Stonner","startTime":1242.91,"endTime":1246.45,"body":"wrist just kind of hanging off"},{"speaker":"Macy Stonner","startTime":1246.45,"endTime":1248.94,"body":"the edge, I'll keep them first,"},{"speaker":"Macy Stonner","startTime":1246.45,"endTime":1248.94,"body":"typically in a little bit of"},{"speaker":"Macy Stonner","startTime":1248.94,"endTime":1253.53,"body":"elevation. So it, you know,"},{"speaker":"Macy Stonner","startTime":1248.94,"endTime":1253.53,"body":"doesn't hurt or increases their"},{"speaker":"Macy Stonner","startTime":1253.53,"endTime":1257.82,"body":"tissue extensibility before we"},{"speaker":"Macy Stonner","startTime":1253.53,"endTime":1257.82,"body":"get going, and then I'll just"},{"speaker":"Macy Stonner","startTime":1257.85,"endTime":1261.72,"body":"manually stretch them into all"},{"speaker":"Macy Stonner","startTime":1257.85,"endTime":1261.72,"body":"four motions, I'll make sure"},{"speaker":"Macy Stonner","startTime":1261.72,"endTime":1263.73,"body":"that they know how to do that."},{"speaker":"Macy Stonner","startTime":1261.72,"endTime":1263.73,"body":"And then I'll incorporate"},{"speaker":"Macy Stonner","startTime":1263.73,"endTime":1269.07,"body":"activity with that to augment"},{"speaker":"Macy Stonner","startTime":1263.73,"endTime":1269.07,"body":"those functions as well. So"},{"speaker":"Macy Stonner","startTime":1269.1,"endTime":1273.03,"body":"replicating, opening a door,"},{"speaker":"Macy Stonner","startTime":1269.1,"endTime":1273.03,"body":"holding a hammer and twisting,"},{"speaker":"Macy Stonner","startTime":1273.78,"endTime":1277.59,"body":"getting back into gentle weight"},{"speaker":"Macy Stonner","startTime":1273.78,"endTime":1277.59,"body":"bearing for missed extension, is"},{"speaker":"Macy Stonner","startTime":1277.59,"endTime":1280.32,"body":"something that I do a lot"},{"speaker":"Macy Stonner","startTime":1277.59,"endTime":1280.32,"body":"because people often talk about"},{"speaker":"Macy Stonner","startTime":1280.95,"endTime":1284.7,"body":"getting back to yoga or push ups"},{"speaker":"Macy Stonner","startTime":1280.95,"endTime":1284.7,"body":"or getting up from the floor. So"},{"speaker":"Macy Stonner","startTime":1284.88,"endTime":1288.57,"body":"working on some weight bearing"},{"speaker":"Macy Stonner","startTime":1284.88,"endTime":1288.57,"body":"type activities, and then slowly"},{"speaker":"Macy Stonner","startTime":1288.57,"endTime":1292.32,"body":"incorporating, like resistance"},{"speaker":"Macy Stonner","startTime":1288.57,"endTime":1292.32,"body":"and some strengthening with"},{"speaker":"Macy Stonner","startTime":1292.32,"endTime":1293.19,"body":"those stretches."},{"speaker":"Charles Goldfarb","startTime":1294.74,"endTime":1296.99,"body":"Perfect. All"},{"speaker":"Charles Goldfarb","startTime":1294.74,"endTime":1296.99,"body":"right, let's go back to our"},{"speaker":"Charles Goldfarb","startTime":1296.99,"endTime":1300.62,"body":"simple patient, our simple"},{"speaker":"Charles Goldfarb","startTime":1296.99,"endTime":1300.62,"body":"patient has been seen a couple"},{"speaker":"Charles Goldfarb","startTime":1300.62,"endTime":1303.77,"body":"times by me, and then they've"},{"speaker":"Charles Goldfarb","startTime":1300.62,"endTime":1303.77,"body":"been seeing you once a week,"},{"speaker":"Charles Goldfarb","startTime":1304.43,"endTime":1307.46,"body":"making reasonable progress, they"},{"speaker":"Charles Goldfarb","startTime":1304.43,"endTime":1307.46,"body":"come back to see me it's roughly"},{"speaker":"Charles Goldfarb","startTime":1307.46,"endTime":1310.64,"body":"six weeks. Honestly, it's"},{"speaker":"Charles Goldfarb","startTime":1307.46,"endTime":1310.64,"body":"probably five weeks for me, they"},{"speaker":"Charles Goldfarb","startTime":1310.64,"endTime":1314.09,"body":"come back. That's my first post"},{"speaker":"Charles Goldfarb","startTime":1310.64,"endTime":1314.09,"body":"operative X ray. Chris, I don't"},{"speaker":"Charles Goldfarb","startTime":1314.09,"endTime":1316.19,"body":"know if you agree or disagree"},{"speaker":"Charles Goldfarb","startTime":1314.09,"endTime":1316.19,"body":"with that, weigh in in a second."},{"speaker":"Charles Goldfarb","startTime":1316.49,"endTime":1319.34,"body":"And then assuming the X ray"},{"speaker":"Charles Goldfarb","startTime":1316.49,"endTime":1319.34,"body":"looks fine, you know, it's not"},{"speaker":"Charles Goldfarb","startTime":1319.37,"endTime":1322.1,"body":"obviously, rarely would it be"},{"speaker":"Charles Goldfarb","startTime":1319.37,"endTime":1322.1,"body":"completely healed. But if things"},{"speaker":"Charles Goldfarb","startTime":1322.1,"endTime":1327.56,"body":"look encouraging, then I with"},{"speaker":"Charles Goldfarb","startTime":1322.1,"endTime":1327.56,"body":"therapy, support and agreement,"},{"speaker":"Charles Goldfarb","startTime":1327.56,"endTime":1330.74,"body":"I encourage weaning of the"},{"speaker":"Charles Goldfarb","startTime":1327.56,"endTime":1330.74,"body":"splintand initiation of"},{"speaker":"Charles Goldfarb","startTime":1330.74,"endTime":1334.4,"body":"strengthening. Is that Chris, A"},{"speaker":"Charles Goldfarb","startTime":1330.74,"endTime":1334.4,"body":"how you see it in Macy, what"},{"speaker":"Charles Goldfarb","startTime":1334.4,"endTime":1335.03,"body":"would you add?"},{"speaker":"Chris Dy","startTime":1336.17,"endTime":1339.32,"body":"Yeah, that's pretty"},{"speaker":"Chris Dy","startTime":1336.17,"endTime":1339.32,"body":"similar protocol. You know, I do"},{"speaker":"Chris Dy","startTime":1339.32,"endTime":1343.13,"body":"get a two week X ray, mainly for"},{"speaker":"Chris Dy","startTime":1339.32,"endTime":1343.13,"body":"a silly reason that where I do"},{"speaker":"Chris Dy","startTime":1343.13,"endTime":1346.76,"body":"the majority of these cases, the"},{"speaker":"Chris Dy","startTime":1343.13,"endTime":1346.76,"body":"interoperative, fluoroscopy,"},{"speaker":"Chris Dy","startTime":1346.76,"endTime":1349.52,"body":"doesn't always send reliably. So"},{"speaker":"Chris Dy","startTime":1346.76,"endTime":1349.52,"body":"I want to have some kind of"},{"speaker":"Chris Dy","startTime":1349.52,"endTime":1351.86,"body":"documentation of the fixation"},{"speaker":"Chris Dy","startTime":1349.52,"endTime":1351.86,"body":"that I have. I mean, I have"},{"speaker":"Chris Dy","startTime":1351.86,"endTime":1354.2,"body":"printouts from the"},{"speaker":"Chris Dy","startTime":1351.86,"endTime":1354.2,"body":"interoperative fluoro. And if I"},{"speaker":"Chris Dy","startTime":1354.2,"endTime":1356.84,"body":"really needed it, I could go"},{"speaker":"Chris Dy","startTime":1354.2,"endTime":1356.84,"body":"find it. But I like to have that"},{"speaker":"Chris Dy","startTime":1356.84,"endTime":1360.41,"body":"documents easier sent over from"},{"speaker":"Chris Dy","startTime":1356.84,"endTime":1360.41,"body":"the clinic. And then yes, I will"},{"speaker":"Chris Dy","startTime":1360.41,"endTime":1362.87,"body":"initiate the same kind of"},{"speaker":"Chris Dy","startTime":1360.41,"endTime":1362.87,"body":"protocol in terms of tapering"},{"speaker":"Chris Dy","startTime":1362.87,"endTime":1366.89,"body":"off the splint, and starting"},{"speaker":"Chris Dy","startTime":1362.87,"endTime":1366.89,"body":"some gentle strengthening, I'd"},{"speaker":"Chris Dy","startTime":1366.89,"endTime":1370.04,"body":"be curious to know what Macy"},{"speaker":"Chris Dy","startTime":1366.89,"endTime":1370.04,"body":"thinks gentle means in terms of"},{"speaker":"Chris Dy","startTime":1370.04,"endTime":1373.16,"body":"the amount and how to tell talk"},{"speaker":"Chris Dy","startTime":1370.04,"endTime":1373.16,"body":"to a patient about that."},{"speaker":"Macy Stonner","startTime":1374.17,"endTime":1378.31,"body":"Sure. So if that's"},{"speaker":"Macy Stonner","startTime":1374.17,"endTime":1378.31,"body":"the patient that's doing well, I"},{"speaker":"Macy Stonner","startTime":1378.31,"endTime":1381.88,"body":"will emphasize strengthening"},{"speaker":"Macy Stonner","startTime":1378.31,"endTime":1381.88,"body":"over motion because their motion"},{"speaker":"Macy Stonner","startTime":1381.88,"endTime":1384.4,"body":"is probably fine. They don't"},{"speaker":"Macy Stonner","startTime":1381.88,"endTime":1384.4,"body":"need to worry about that"},{"speaker":"Macy Stonner","startTime":1384.4,"endTime":1388.27,"body":"anymore. And I'll always start"},{"speaker":"Macy Stonner","startTime":1384.4,"endTime":1388.27,"body":"with grip strength, always"},{"speaker":"Macy Stonner","startTime":1388.27,"endTime":1392.62,"body":"always. And then from there,"},{"speaker":"Macy Stonner","startTime":1388.27,"endTime":1392.62,"body":"I'll start with like wrist"},{"speaker":"Macy Stonner","startTime":1392.62,"endTime":1396.31,"body":"isometrics, either manually or"},{"speaker":"Macy Stonner","startTime":1392.62,"endTime":1396.31,"body":"with a band and then kind of"},{"speaker":"Macy Stonner","startTime":1396.37,"endTime":1399.28,"body":"doing heavier activities around"},{"speaker":"Macy Stonner","startTime":1396.37,"endTime":1399.28,"body":"the clinic as their pain"},{"speaker":"Macy Stonner","startTime":1399.28,"endTime":1403.42,"body":"tolerates. But if they are"},{"speaker":"Macy Stonner","startTime":1399.28,"endTime":1403.42,"body":"stiff, even though I get the"},{"speaker":"Macy Stonner","startTime":1403.42,"endTime":1408.34,"body":"orders for strengthening, and"},{"speaker":"Macy Stonner","startTime":1403.42,"endTime":1408.34,"body":"they have horrible motion, I'm"},{"speaker":"Macy Stonner","startTime":1408.34,"endTime":1410.08,"body":"not going to prioritize"},{"speaker":"Macy Stonner","startTime":1408.34,"endTime":1410.08,"body":"strengthening with them, don't"},{"speaker":"Macy Stonner","startTime":1410.08,"endTime":1413.71,"body":"waste your time on gripping, you"},{"speaker":"Macy Stonner","startTime":1410.08,"endTime":1413.71,"body":"need to be stretching. So that's"},{"speaker":"Macy Stonner","startTime":1413.71,"endTime":1416.23,"body":"kind of something that I have to"},{"speaker":"Macy Stonner","startTime":1413.71,"endTime":1416.23,"body":"talk to patients about if they"},{"speaker":"Macy Stonner","startTime":1416.23,"endTime":1420.16,"body":"are still super stiff, and they"},{"speaker":"Macy Stonner","startTime":1416.23,"endTime":1420.16,"body":"kind of have this as a window,"},{"speaker":"Macy Stonner","startTime":1420.16,"endTime":1423.28,"body":"but just prioritizing them the"},{"speaker":"Macy Stonner","startTime":1420.16,"endTime":1423.28,"body":"flexibility over the strength."},{"speaker":"Charles Goldfarb","startTime":1424.1,"endTime":1425.9,"body":"And when you"},{"speaker":"Charles Goldfarb","startTime":1424.1,"endTime":1425.9,"body":"say working on grip strength,"},{"speaker":"Charles Goldfarb","startTime":1425.9,"endTime":1429.56,"body":"and I certainly feel the same"},{"speaker":"Charles Goldfarb","startTime":1425.9,"endTime":1429.56,"body":"way is that putty or a stress"},{"speaker":"Charles Goldfarb","startTime":1429.56,"endTime":1431.06,"body":"ball? What is grip"},{"speaker":"Charles Goldfarb","startTime":1429.56,"endTime":1431.06,"body":"strengthening."},{"speaker":"Macy Stonner","startTime":1431.36,"endTime":1433.7,"body":"To me, it's putty"},{"speaker":"Macy Stonner","startTime":1431.36,"endTime":1433.7,"body":"because we have different"},{"speaker":"Macy Stonner","startTime":1433.7,"endTime":1436.7,"body":"resistances of putty in the"},{"speaker":"Macy Stonner","startTime":1433.7,"endTime":1436.7,"body":"clinic and we give them to"},{"speaker":"Macy Stonner","startTime":1436.7,"endTime":1441.32,"body":"patients. It's better than a"},{"speaker":"Macy Stonner","startTime":1436.7,"endTime":1441.32,"body":"stress ball because you can"},{"speaker":"Macy Stonner","startTime":1441.53,"endTime":1445.55,"body":"replicate different motions, you"},{"speaker":"Macy Stonner","startTime":1441.53,"endTime":1445.55,"body":"can do weight bearing on it, you"},{"speaker":"Macy Stonner","startTime":1445.55,"endTime":1448.49,"body":"can do grip, you can do hook"},{"speaker":"Macy Stonner","startTime":1445.55,"endTime":1448.49,"body":"fish, you can do pinching, you"},{"speaker":"Macy Stonner","startTime":1448.49,"endTime":1451.82,"body":"can do different types of"},{"speaker":"Macy Stonner","startTime":1448.49,"endTime":1451.82,"body":"pinching, so that putty can mold"},{"speaker":"Macy Stonner","startTime":1451.82,"endTime":1455.24,"body":"into very specific shapes and"},{"speaker":"Macy Stonner","startTime":1451.82,"endTime":1455.24,"body":"can replicate many different"},{"speaker":"Macy Stonner","startTime":1455.54,"endTime":1458.45,"body":"grip patterns and pinch"},{"speaker":"Macy Stonner","startTime":1455.54,"endTime":1458.45,"body":"patterns. Whereas as a nerf ball"},{"speaker":"Macy Stonner","startTime":1458.45,"endTime":1461.33,"body":"or stress ball, it's just kind"},{"speaker":"Macy Stonner","startTime":1458.45,"endTime":1461.33,"body":"of grip release, grip release"},{"speaker":"Macy Stonner","startTime":1461.33,"endTime":1465.77,"body":"into this really meaningless"},{"speaker":"Macy Stonner","startTime":1461.33,"endTime":1465.77,"body":"exercise in my opinion."},{"speaker":"Charles Goldfarb","startTime":1465.8,"endTime":1468.11,"body":"And then does"},{"speaker":"Charles Goldfarb","startTime":1465.8,"endTime":1468.11,"body":"every patient at some point get"},{"speaker":"Charles Goldfarb","startTime":1468.11,"endTime":1471.59,"body":"the the bands to work on, you"},{"speaker":"Charles Goldfarb","startTime":1468.11,"endTime":1471.59,"body":"know, wrist extension and"},{"speaker":"Charles Goldfarb","startTime":1471.59,"endTime":1474.65,"body":"flexion strengthening or, or is"},{"speaker":"Charles Goldfarb","startTime":1471.59,"endTime":1474.65,"body":"that just if you feel like the"},{"speaker":"Charles Goldfarb","startTime":1474.65,"endTime":1476.84,"body":"patients needs more"},{"speaker":"Charles Goldfarb","startTime":1474.65,"endTime":1476.84,"body":"strengthening."},{"speaker":"Macy Stonner","startTime":1478.19,"endTime":1480.62,"body":"I think the latter"},{"speaker":"Macy Stonner","startTime":1478.19,"endTime":1480.62,"body":"if they need more strengthening"},{"speaker":"Macy Stonner","startTime":1480.95,"endTime":1483.32,"body":"and some of these patients will"},{"speaker":"Macy Stonner","startTime":1480.95,"endTime":1483.32,"body":"fall off our schedules if they"},{"speaker":"Macy Stonner","startTime":1483.32,"endTime":1487.58,"body":"are six weeks out and they're"},{"speaker":"Macy Stonner","startTime":1483.32,"endTime":1487.58,"body":"pain free full motion back to"},{"speaker":"Macy Stonner","startTime":1487.58,"endTime":1490.46,"body":"work. They don't need therapy"},{"speaker":"Macy Stonner","startTime":1487.58,"endTime":1490.46,"body":"anymore. They cancel because"},{"speaker":"Macy Stonner","startTime":1490.46,"endTime":1492.44,"body":"they're living their life and"},{"speaker":"Macy Stonner","startTime":1490.46,"endTime":1492.44,"body":"doing great and I think that"},{"speaker":"Macy Stonner","startTime":1492.44,"endTime":1496.49,"body":"that's fine. And sometimes they"},{"speaker":"Macy Stonner","startTime":1492.44,"endTime":1496.49,"body":"don't even get you know some of"},{"speaker":"Macy Stonner","startTime":1496.49,"endTime":1498.53,"body":"the exercises that we initiate"},{"speaker":"Macy Stonner","startTime":1496.49,"endTime":1498.53,"body":"because they're already back to"},{"speaker":"Macy Stonner","startTime":1498.53,"endTime":1498.95,"body":"living"},{"speaker":"Charles Goldfarb","startTime":1499.5,"endTime":1501.15,"body":"before we get"},{"speaker":"Charles Goldfarb","startTime":1499.5,"endTime":1501.15,"body":"to the tough patient, I have one"},{"speaker":"Charles Goldfarb","startTime":1501.15,"endTime":1503.88,"body":"final question on the easy"},{"speaker":"Charles Goldfarb","startTime":1501.15,"endTime":1503.88,"body":"patient. Because my experience"},{"speaker":"Charles Goldfarb","startTime":1503.88,"endTime":1507.36,"body":"this is a question for both of"},{"speaker":"Charles Goldfarb","startTime":1503.88,"endTime":1507.36,"body":"you. My experience is this quote"},{"speaker":"Charles Goldfarb","startTime":1507.36,"endTime":1511.71,"body":"unquote, easy patient. fracture"},{"speaker":"Charles Goldfarb","startTime":1507.36,"endTime":1511.71,"body":"heals uneventfully, radial sided"},{"speaker":"Charles Goldfarb","startTime":1511.71,"endTime":1516.0,"body":"pain disappears. It is not"},{"speaker":"Charles Goldfarb","startTime":1511.71,"endTime":1516.0,"body":"uncommon at the 12 week visit"},{"speaker":"Charles Goldfarb","startTime":1516.0,"endTime":1519.54,"body":"and that's usually my next"},{"speaker":"Charles Goldfarb","startTime":1516.0,"endTime":1519.54,"body":"visit, that they still complain"},{"speaker":"Charles Goldfarb","startTime":1519.57,"endTime":1524.25,"body":"of ulnar styloid ish pain. And"},{"speaker":"Charles Goldfarb","startTime":1519.57,"endTime":1524.25,"body":"that's a whole nother"},{"speaker":"Charles Goldfarb","startTime":1524.25,"endTime":1527.61,"body":"conversation. And to me, that's"},{"speaker":"Charles Goldfarb","startTime":1524.25,"endTime":1527.61,"body":"the in most patients that's what"},{"speaker":"Charles Goldfarb","startTime":1527.61,"endTime":1532.02,"body":"lingers far beyond what radial"},{"speaker":"Charles Goldfarb","startTime":1527.61,"endTime":1532.02,"body":"sided discomfort is, Chris, has"},{"speaker":"Charles Goldfarb","startTime":1532.02,"endTime":1535.98,"body":"that been your experience? And"},{"speaker":"Charles Goldfarb","startTime":1532.02,"endTime":1535.98,"body":"how do you counsel patients and"},{"speaker":"Charles Goldfarb","startTime":1535.98,"endTime":1537.45,"body":"work with therapy on that?"},{"speaker":"Chris Dy","startTime":1537.96,"endTime":1540.75,"body":"I try to be good, I"},{"speaker":"Chris Dy","startTime":1537.96,"endTime":1540.75,"body":"agree, I try to be good early on"},{"speaker":"Chris Dy","startTime":1540.75,"endTime":1543.09,"body":"about telling them that, you"},{"speaker":"Chris Dy","startTime":1540.75,"endTime":1543.09,"body":"know, we're going to treat this,"},{"speaker":"Chris Dy","startTime":1543.12,"endTime":1545.34,"body":"you know, this fracture, the"},{"speaker":"Chris Dy","startTime":1543.12,"endTime":1545.34,"body":"radius fracture, if they have an"},{"speaker":"Chris Dy","startTime":1545.34,"endTime":1547.92,"body":"ulnar styloid, it'll try to"},{"speaker":"Chris Dy","startTime":1545.34,"endTime":1547.92,"body":"remember to point it out. I'll"},{"speaker":"Chris Dy","startTime":1547.92,"endTime":1552.15,"body":"try to assess their, their ulnar"},{"speaker":"Chris Dy","startTime":1547.92,"endTime":1552.15,"body":"carpus at six weeks, and, you"},{"speaker":"Chris Dy","startTime":1552.15,"endTime":1554.31,"body":"know, point out to them, Look,"},{"speaker":"Chris Dy","startTime":1552.15,"endTime":1554.31,"body":"it's going to be sore here. But"},{"speaker":"Chris Dy","startTime":1554.34,"endTime":1556.83,"body":"usually they brought it up at"},{"speaker":"Chris Dy","startTime":1554.34,"endTime":1556.83,"body":"that point, even at the six week"},{"speaker":"Chris Dy","startTime":1556.83,"endTime":1560.28,"body":"mark I've seen. So I try to get"},{"speaker":"Chris Dy","startTime":1556.83,"endTime":1560.28,"body":"ahead of the messaging on that."},{"speaker":"Chris Dy","startTime":1560.76,"endTime":1564.18,"body":"And it is the the thing that"},{"speaker":"Chris Dy","startTime":1560.76,"endTime":1564.18,"body":"lingers. And I, you know, I"},{"speaker":"Chris Dy","startTime":1564.18,"endTime":1567.09,"body":"spend more time counseling it"},{"speaker":"Chris Dy","startTime":1564.18,"endTime":1567.09,"body":"away than doing anything else. I"},{"speaker":"Chris Dy","startTime":1567.09,"endTime":1569.94,"body":"think rarely I get to the point"},{"speaker":"Chris Dy","startTime":1567.09,"endTime":1569.94,"body":"where I'm treating it, you know,"},{"speaker":"Chris Dy","startTime":1569.94,"endTime":1574.02,"body":"A of course, unlikely to have"},{"speaker":"Chris Dy","startTime":1569.94,"endTime":1574.02,"body":"any further surgery and B, maybe"},{"speaker":"Chris Dy","startTime":1574.02,"endTime":1574.65,"body":"an injection."},{"speaker":"Charles Goldfarb","startTime":1576.12,"endTime":1578.34,"body":"And yeah, Macy"},{"speaker":"Charles Goldfarb","startTime":1576.12,"endTime":1578.34,"body":"what how do you think about it"},{"speaker":"Charles Goldfarb","startTime":1578.34,"endTime":1581.49,"body":"Macy do you similarly? And is"},{"speaker":"Charles Goldfarb","startTime":1578.34,"endTime":1581.49,"body":"that a problem you see regularly"},{"speaker":"Charles Goldfarb","startTime":1581.49,"endTime":1583.08,"body":"in the clinic that ulnar sided"},{"speaker":"Charles Goldfarb","startTime":1581.49,"endTime":1583.08,"body":"pain"},{"speaker":"Macy Stonner","startTime":1583.75,"endTime":1586.42,"body":"It happens. But"},{"speaker":"Macy Stonner","startTime":1583.75,"endTime":1586.42,"body":"one of the things that I tell"},{"speaker":"Macy Stonner","startTime":1586.42,"endTime":1590.86,"body":"people is very emphatically this"},{"speaker":"Macy Stonner","startTime":1586.42,"endTime":1590.86,"body":"will go away. This is common,"},{"speaker":"Macy Stonner","startTime":1591.13,"endTime":1593.38,"body":"because they think, okay, I"},{"speaker":"Macy Stonner","startTime":1591.13,"endTime":1593.38,"body":"injured the radial side of my"},{"speaker":"Macy Stonner","startTime":1593.38,"endTime":1595.99,"body":"wrist why does  the ulnar side"},{"speaker":"Macy Stonner","startTime":1593.38,"endTime":1595.99,"body":"of my wrist hurt. And I kind of"},{"speaker":"Macy Stonner","startTime":1595.99,"endTime":1599.38,"body":"showed them an anatomy book and"},{"speaker":"Macy Stonner","startTime":1595.99,"endTime":1599.38,"body":"kind of the mechanics of the"},{"speaker":"Macy Stonner","startTime":1599.38,"endTime":1602.23,"body":"wrist. And just very, very"},{"speaker":"Macy Stonner","startTime":1599.38,"endTime":1602.23,"body":"strongly, I look them in the"},{"speaker":"Macy Stonner","startTime":1602.23,"endTime":1605.47,"body":"eyes and say this will get"},{"speaker":"Macy Stonner","startTime":1602.23,"endTime":1605.47,"body":"better. And they are like, okay,"},{"speaker":"Macy Stonner","startTime":1605.53,"endTime":1607.48,"body":"okay, thank you. I just needed"},{"speaker":"Macy Stonner","startTime":1605.53,"endTime":1607.48,"body":"that because they didn't"},{"speaker":"Macy Stonner","startTime":1607.48,"endTime":1612.1,"body":"understand anatomically, why"},{"speaker":"Macy Stonner","startTime":1607.48,"endTime":1612.1,"body":"that hurts. But I found the"},{"speaker":"Macy Stonner","startTime":1612.1,"endTime":1615.88,"body":"wrist widget to be marginally"},{"speaker":"Macy Stonner","startTime":1612.1,"endTime":1615.88,"body":"helpful. Another thing that I do"},{"speaker":"Macy Stonner","startTime":1615.88,"endTime":1619.72,"body":"for this is just simple activity"},{"speaker":"Macy Stonner","startTime":1615.88,"endTime":1619.72,"body":"analysis. Because we use ulnar"},{"speaker":"Macy Stonner","startTime":1619.72,"endTime":1622.72,"body":"deviations so much in our daily"},{"speaker":"Macy Stonner","startTime":1619.72,"endTime":1622.72,"body":"activities, whether it's typing"},{"speaker":"Macy Stonner","startTime":1622.72,"endTime":1626.2,"body":"or lifting weights or writing, I"},{"speaker":"Macy Stonner","startTime":1622.72,"endTime":1626.2,"body":"kind of ask them, what do you do"},{"speaker":"Macy Stonner","startTime":1626.2,"endTime":1628.48,"body":"and kind of show me how you do"},{"speaker":"Macy Stonner","startTime":1626.2,"endTime":1628.48,"body":"it. And people use ulnar"},{"speaker":"Macy Stonner","startTime":1628.48,"endTime":1632.62,"body":"deviation functionally so much"},{"speaker":"Macy Stonner","startTime":1628.48,"endTime":1632.62,"body":"we kind of have to teach them to"},{"speaker":"Macy Stonner","startTime":1632.62,"endTime":1635.68,"body":"stop repetitively, ulnarly"},{"speaker":"Macy Stonner","startTime":1632.62,"endTime":1635.68,"body":"deviating during those tasks,"},{"speaker":"Macy Stonner","startTime":1635.68,"endTime":1638.05,"body":"and that kind of takes some of"},{"speaker":"Macy Stonner","startTime":1635.68,"endTime":1638.05,"body":"the pressure off the tfcc."},{"speaker":"Charles Goldfarb","startTime":1638.75,"endTime":1641.57,"body":"Totally agree."},{"speaker":"Charles Goldfarb","startTime":1638.75,"endTime":1641.57,"body":"Totally agree. All right. I"},{"speaker":"Charles Goldfarb","startTime":1641.57,"endTime":1646.1,"body":"think maybe we'll, we'll kind of"},{"speaker":"Charles Goldfarb","startTime":1641.57,"endTime":1646.1,"body":"hit one more kind of group of"},{"speaker":"Charles Goldfarb","startTime":1646.1,"endTime":1648.86,"body":"questions. Let's take the"},{"speaker":"Charles Goldfarb","startTime":1646.1,"endTime":1648.86,"body":"difficult patient. So this the"},{"speaker":"Charles Goldfarb","startTime":1648.86,"endTime":1651.53,"body":"patient that you've been seeing"},{"speaker":"Charles Goldfarb","startTime":1648.86,"endTime":1651.53,"body":"twice a week Macy, you've been"},{"speaker":"Charles Goldfarb","startTime":1651.53,"endTime":1653.78,"body":"encouraged them along, and"},{"speaker":"Charles Goldfarb","startTime":1651.53,"endTime":1653.78,"body":"hopefully they're making at"},{"speaker":"Charles Goldfarb","startTime":1653.78,"endTime":1657.14,"body":"least slow progress with their"},{"speaker":"Charles Goldfarb","startTime":1653.78,"endTime":1657.14,"body":"edema, and their motion, they"},{"speaker":"Charles Goldfarb","startTime":1657.14,"endTime":1661.79,"body":"come back to see me at five or"},{"speaker":"Charles Goldfarb","startTime":1657.14,"endTime":1661.79,"body":"six weeks, x rays look good. And"},{"speaker":"Charles Goldfarb","startTime":1661.79,"endTime":1666.74,"body":"now I say that inappropriate"},{"speaker":"Charles Goldfarb","startTime":1661.79,"endTime":1666.74,"body":"word get aggressive. So what"},{"speaker":"Charles Goldfarb","startTime":1666.74,"endTime":1669.98,"body":"does that mean to you? And a"},{"speaker":"Charles Goldfarb","startTime":1666.74,"endTime":1669.98,"body":"patient who seems to be healing,"},{"speaker":"Charles Goldfarb","startTime":1669.98,"endTime":1672.77,"body":"but it's still struggling? When"},{"speaker":"Charles Goldfarb","startTime":1669.98,"endTime":1672.77,"body":"do you bring in static,"},{"speaker":"Charles Goldfarb","startTime":1672.77,"endTime":1674.87,"body":"progressive or dynamic"},{"speaker":"Charles Goldfarb","startTime":1672.77,"endTime":1674.87,"body":"splinting? How do you think"},{"speaker":"Charles Goldfarb","startTime":1674.87,"endTime":1677.9,"body":"about the progression for the"},{"speaker":"Charles Goldfarb","startTime":1674.87,"endTime":1677.9,"body":"patient who's struggling, but"},{"speaker":"Charles Goldfarb","startTime":1677.93,"endTime":1679.7,"body":"bony wise is probably doing"},{"speaker":"Charles Goldfarb","startTime":1677.93,"endTime":1679.7,"body":"okay."},{"speaker":"Macy Stonner","startTime":1680.83,"endTime":1684.13,"body":"So I group this"},{"speaker":"Macy Stonner","startTime":1680.83,"endTime":1684.13,"body":"category into this group of"},{"speaker":"Macy Stonner","startTime":1684.13,"endTime":1688.72,"body":"patients into two categories."},{"speaker":"Macy Stonner","startTime":1684.13,"endTime":1688.72,"body":"Are they crps like, or are they"},{"speaker":"Macy Stonner","startTime":1688.72,"endTime":1693.22,"body":"just stiff, and not that"},{"speaker":"Macy Stonner","startTime":1688.72,"endTime":1693.22,"body":"painful, if they are the second"},{"speaker":"Macy Stonner","startTime":1693.22,"endTime":1695.56,"body":"group where they're just really"},{"speaker":"Macy Stonner","startTime":1693.22,"endTime":1695.56,"body":"stiff, I'm fine to get"},{"speaker":"Macy Stonner","startTime":1695.56,"endTime":1698.26,"body":"aggressive, I'm fine for their"},{"speaker":"Macy Stonner","startTime":1695.56,"endTime":1698.26,"body":"pain levels to exceed a four or"},{"speaker":"Macy Stonner","startTime":1698.26,"endTime":1703.6,"body":"a five while they're doing"},{"speaker":"Macy Stonner","startTime":1698.26,"endTime":1703.6,"body":"stretches, and I typically don't"},{"speaker":"Macy Stonner","startTime":1703.6,"endTime":1706.42,"body":"make static progressive splints"},{"speaker":"Macy Stonner","startTime":1703.6,"endTime":1706.42,"body":"for wrist motion, because"},{"speaker":"Macy Stonner","startTime":1706.42,"endTime":1709.51,"body":"they're so large, I would"},{"speaker":"Macy Stonner","startTime":1706.42,"endTime":1709.51,"body":"incorporate like a company to"},{"speaker":"Macy Stonner","startTime":1709.51,"endTime":1715.45,"body":"help like a jazz or a statadyne"},{"speaker":"Macy Stonner","startTime":1709.51,"endTime":1715.45,"body":"type brace, fingers, I'll make"},{"speaker":"Macy Stonner","startTime":1715.51,"endTime":1720.73,"body":"some sort of composite flexion"},{"speaker":"Macy Stonner","startTime":1715.51,"endTime":1720.73,"body":"stretch glove or NP flexion"},{"speaker":"Macy Stonner","startTime":1720.73,"endTime":1725.17,"body":"stretch splint or something like"},{"speaker":"Macy Stonner","startTime":1720.73,"endTime":1725.17,"body":"that. For the patient who I'm"},{"speaker":"Macy Stonner","startTime":1725.17,"endTime":1728.56,"body":"concerned about crps, just by"},{"speaker":"Macy Stonner","startTime":1725.17,"endTime":1728.56,"body":"some comments they might make"},{"speaker":"Macy Stonner","startTime":1728.56,"endTime":1731.86,"body":"like, this hand doesn't feel"},{"speaker":"Macy Stonner","startTime":1728.56,"endTime":1731.86,"body":"like my own or my hand looks"},{"speaker":"Macy Stonner","startTime":1731.86,"endTime":1735.28,"body":"like a glove, I can't use it,"},{"speaker":"Macy Stonner","startTime":1731.86,"endTime":1735.28,"body":"then I'm not going to make them"},{"speaker":"Macy Stonner","startTime":1735.28,"endTime":1738.91,"body":"push through pain as much. I"},{"speaker":"Macy Stonner","startTime":1735.28,"endTime":1738.91,"body":"just want to work more so on"},{"speaker":"Macy Stonner","startTime":1738.91,"endTime":1742.12,"body":"function and get them using"},{"speaker":"Macy Stonner","startTime":1738.91,"endTime":1742.12,"body":"their hands versus the patient"},{"speaker":"Macy Stonner","startTime":1742.15,"endTime":1746.44,"body":"who is not the crps type. I'm"},{"speaker":"Macy Stonner","startTime":1742.15,"endTime":1746.44,"body":"going to focus on rote,"},{"speaker":"Macy Stonner","startTime":1746.44,"endTime":1747.64,"body":"repetitive exercise."},{"speaker":"Chris Dy","startTime":1748.92,"endTime":1751.23,"body":"Now at this point, is"},{"speaker":"Chris Dy","startTime":1748.92,"endTime":1751.23,"body":"the patient completely tapered"},{"speaker":"Chris Dy","startTime":1751.23,"endTime":1754.98,"body":"off of the orthosis? And are"},{"speaker":"Chris Dy","startTime":1751.23,"endTime":1754.98,"body":"they using any kind of support?"},{"speaker":"Chris Dy","startTime":1755.4,"endTime":1756.51,"body":"Even infrequently?"},{"speaker":"Macy Stonner","startTime":1758.52,"endTime":1760.5,"body":"I would say no"},{"speaker":"Macy Stonner","startTime":1758.52,"endTime":1760.5,"body":"splint, unless they're having"},{"speaker":"Macy Stonner","startTime":1760.53,"endTime":1766.56,"body":"ulnar sided wrist pain, and they"},{"speaker":"Macy Stonner","startTime":1760.53,"endTime":1766.56,"body":"have a little wrap on. But at"},{"speaker":"Macy Stonner","startTime":1766.56,"endTime":1768.0,"body":"this point, yeah, I would say no"},{"speaker":"Macy Stonner","startTime":1766.56,"endTime":1768.0,"body":"splint."},{"speaker":"Chris Dy","startTime":1768.45,"endTime":1771.63,"body":"then say you're behind"},{"speaker":"Chris Dy","startTime":1768.45,"endTime":1771.63,"body":"the game in terms of forearm"},{"speaker":"Chris Dy","startTime":1771.63,"endTime":1774.69,"body":"rotation. You know, like you"},{"speaker":"Chris Dy","startTime":1771.63,"endTime":1774.69,"body":"mentioned earlier using a"},{"speaker":"Chris Dy","startTime":1774.69,"endTime":1779.01,"body":"commercially designed static"},{"speaker":"Chris Dy","startTime":1774.69,"endTime":1779.01,"body":"progressive for flexion. And"},{"speaker":"Chris Dy","startTime":1779.01,"endTime":1781.11,"body":"extensions. Similar for forearm?"},{"speaker":"Macy Stonner","startTime":1782.1,"endTime":1784.53,"body":"Yeah, so those are"},{"speaker":"Macy Stonner","startTime":1782.1,"endTime":1784.53,"body":"commercially available splints"},{"speaker":"Macy Stonner","startTime":1784.53,"endTime":1789.99,"body":"can also help with rotation. And"},{"speaker":"Macy Stonner","startTime":1784.53,"endTime":1789.99,"body":"in clinic here at Milliken. We"},{"speaker":"Macy Stonner","startTime":1789.99,"endTime":1792.93,"body":"have designed or I don't know if"},{"speaker":"Macy Stonner","startTime":1789.99,"endTime":1792.93,"body":"we designed it, but we use it"},{"speaker":"Macy Stonner","startTime":1792.93,"endTime":1795.84,"body":"often. It's called a supination"},{"speaker":"Macy Stonner","startTime":1792.93,"endTime":1795.84,"body":"strap. So if they have a"},{"speaker":"Macy Stonner","startTime":1795.84,"endTime":1799.83,"body":"standard wrist cockup, you can"},{"speaker":"Macy Stonner","startTime":1795.84,"endTime":1799.83,"body":"apply Velcro and a bunch of"},{"speaker":"Macy Stonner","startTime":1799.83,"endTime":1805.2,"body":"neoprene and around the distal"},{"speaker":"Macy Stonner","startTime":1799.83,"endTime":1805.2,"body":"humerus, and it helps stretch"},{"speaker":"Macy Stonner","startTime":1805.2,"endTime":1808.29,"body":"them into supination. A lot"},{"speaker":"Macy Stonner","startTime":1805.2,"endTime":1808.29,"body":"simpler and a whole lot cheaper."},{"speaker":"Charles Goldfarb","startTime":1808.87,"endTime":1812.62,"body":"So, as a"},{"speaker":"Charles Goldfarb","startTime":1808.87,"endTime":1812.62,"body":"basic, my kids would say basic"},{"speaker":"Charles Goldfarb","startTime":1812.62,"endTime":1816.97,"body":"as a basic hand surgeon, is it"},{"speaker":"Charles Goldfarb","startTime":1812.62,"endTime":1816.97,"body":"fair to say this seems like"},{"speaker":"Charles Goldfarb","startTime":1816.97,"endTime":1820.27,"body":"common sense, but I've never"},{"speaker":"Charles Goldfarb","startTime":1816.97,"endTime":1820.27,"body":"read this to be true, that if a"},{"speaker":"Charles Goldfarb","startTime":1820.27,"endTime":1824.02,"body":"patient really is only limited"},{"speaker":"Charles Goldfarb","startTime":1820.27,"endTime":1824.02,"body":"in one of the four motions, so"},{"speaker":"Charles Goldfarb","startTime":1824.02,"endTime":1825.94,"body":"let's say they're lacking"},{"speaker":"Charles Goldfarb","startTime":1824.02,"endTime":1825.94,"body":"supination, but everything else"},{"speaker":"Charles Goldfarb","startTime":1825.94,"endTime":1829.78,"body":"is pretty good, that you would"},{"speaker":"Charles Goldfarb","startTime":1825.94,"endTime":1829.78,"body":"expect that patient to do better"},{"speaker":"Charles Goldfarb","startTime":1829.81,"endTime":1833.98,"body":"with a forearm like statadyne in"},{"speaker":"Charles Goldfarb","startTime":1829.81,"endTime":1833.98,"body":"the forearm, versus a patient"},{"speaker":"Charles Goldfarb","startTime":1833.98,"endTime":1836.29,"body":"who's diffusely stiff, right?"},{"speaker":"Charles Goldfarb","startTime":1833.98,"endTime":1836.29,"body":"That goes without saying, if"},{"speaker":"Charles Goldfarb","startTime":1836.29,"endTime":1839.11,"body":"they have multiple motions,"},{"speaker":"Charles Goldfarb","startTime":1836.29,"endTime":1839.11,"body":"which are limited, your"},{"speaker":"Charles Goldfarb","startTime":1839.11,"endTime":1842.41,"body":"expectations for success of the"},{"speaker":"Charles Goldfarb","startTime":1839.11,"endTime":1842.41,"body":"dynamic or static progressive"},{"speaker":"Charles Goldfarb","startTime":1842.41,"endTime":1843.85,"body":"splint is very different."},{"speaker":"Macy Stonner","startTime":1845.15,"endTime":1846.05,"body":"I would agree with"},{"speaker":"Macy Stonner","startTime":1845.15,"endTime":1846.05,"body":"that."},{"speaker":"Charles Goldfarb","startTime":1846.53,"endTime":1850.79,"body":"Okay. But yet,"},{"speaker":"Charles Goldfarb","startTime":1846.53,"endTime":1850.79,"body":"you still would do those"},{"speaker":"Charles Goldfarb","startTime":1850.79,"endTime":1854.21,"body":"specialized splints, because"},{"speaker":"Charles Goldfarb","startTime":1850.79,"endTime":1854.21,"body":"they still can make a"},{"speaker":"Charles Goldfarb","startTime":1854.21,"endTime":1854.78,"body":"difference?"},{"speaker":"Macy Stonner","startTime":1855.2,"endTime":1857.75,"body":"Correct? I would,"},{"speaker":"Macy Stonner","startTime":1855.2,"endTime":1857.75,"body":"I would just have a schedule for"},{"speaker":"Macy Stonner","startTime":1857.75,"endTime":1860.66,"body":"them and say, you know, for 25"},{"speaker":"Macy Stonner","startTime":1857.75,"endTime":1860.66,"body":"minutes in the morning, I want"},{"speaker":"Macy Stonner","startTime":1860.66,"endTime":1862.73,"body":"you to work on wrist extension,"},{"speaker":"Macy Stonner","startTime":1860.66,"endTime":1862.73,"body":"when you get home from work, I"},{"speaker":"Macy Stonner","startTime":1862.73,"endTime":1865.64,"body":"want you to work on 30 minutes"},{"speaker":"Macy Stonner","startTime":1862.73,"endTime":1865.64,"body":"or, you know, pronation or"},{"speaker":"Macy Stonner","startTime":1865.64,"endTime":1870.02,"body":"something like that. And I would"},{"speaker":"Macy Stonner","startTime":1865.64,"endTime":1870.02,"body":"often ask them, What bugs you"},{"speaker":"Macy Stonner","startTime":1870.02,"endTime":1873.89,"body":"the most? What can't you do"},{"speaker":"Macy Stonner","startTime":1870.02,"endTime":1873.89,"body":"that's so frustrating. And"},{"speaker":"Macy Stonner","startTime":1873.89,"endTime":1877.61,"body":"whatever that activity is,"},{"speaker":"Macy Stonner","startTime":1873.89,"endTime":1877.61,"body":"whether it's washing your face,"},{"speaker":"Macy Stonner","startTime":1877.64,"endTime":1880.37,"body":"okay, I know it's supination."},{"speaker":"Macy Stonner","startTime":1877.64,"endTime":1880.37,"body":"It's typing. Okay, I know, it's"},{"speaker":"Macy Stonner","startTime":1880.37,"endTime":1883.28,"body":"pronation, it's reaching out to"},{"speaker":"Macy Stonner","startTime":1880.37,"endTime":1883.28,"body":"grab your coffee cup. I know"},{"speaker":"Macy Stonner","startTime":1883.28,"endTime":1886.31,"body":"it's wrist extension. So"},{"speaker":"Macy Stonner","startTime":1883.28,"endTime":1886.31,"body":"whatever bugs them the most I'm"},{"speaker":"Macy Stonner","startTime":1886.31,"endTime":1887.75,"body":"going to have them work on that"},{"speaker":"Macy Stonner","startTime":1886.31,"endTime":1887.75,"body":"motion the most."},{"speaker":"Charles Goldfarb","startTime":1888.65,"endTime":1890.6,"body":"So sorry,"},{"speaker":"Charles Goldfarb","startTime":1888.65,"endTime":1890.6,"body":"Chris, I know you have a"},{"speaker":"Charles Goldfarb","startTime":1890.6,"endTime":1899.69,"body":"question. What percentage of my"},{"speaker":"Charles Goldfarb","startTime":1890.6,"endTime":1899.69,"body":"patients versus Chris's need a"},{"speaker":"Charles Goldfarb","startTime":1899.69,"endTime":1902.24,"body":"static progressive splint? I'm"},{"speaker":"Charles Goldfarb","startTime":1899.69,"endTime":1902.24,"body":"just kidding. I'm not comparing."},{"speaker":"Charles Goldfarb","startTime":1902.24,"endTime":1905.63,"body":"But in general, we see the"},{"speaker":"Charles Goldfarb","startTime":1902.24,"endTime":1905.63,"body":"gamut, right? We see easy"},{"speaker":"Charles Goldfarb","startTime":1905.63,"endTime":1907.55,"body":"fractures, we see hard"},{"speaker":"Charles Goldfarb","startTime":1905.63,"endTime":1907.55,"body":"fractures, we certainly get"},{"speaker":"Charles Goldfarb","startTime":1907.55,"endTime":1909.95,"body":"referred in some that are"},{"speaker":"Charles Goldfarb","startTime":1907.55,"endTime":1909.95,"body":"harder. But I think our"},{"speaker":"Charles Goldfarb","startTime":1909.95,"endTime":1912.5,"body":"practices in general, regarding"},{"speaker":"Charles Goldfarb","startTime":1909.95,"endTime":1912.5,"body":"distal radius fractures are"},{"speaker":"Charles Goldfarb","startTime":1912.5,"endTime":1915.8,"body":"probably similar to whoever's"},{"speaker":"Charles Goldfarb","startTime":1912.5,"endTime":1915.8,"body":"listening to this, what percent"},{"speaker":"Charles Goldfarb","startTime":1915.8,"endTime":1919.43,"body":"needs something fancy, like a,"},{"speaker":"Charles Goldfarb","startTime":1915.8,"endTime":1919.43,"body":"you know, a specialized splint."},{"speaker":"Macy Stonner","startTime":1920.65,"endTime":1922.3,"body":"I don't have any"},{"speaker":"Macy Stonner","startTime":1920.65,"endTime":1922.3,"body":"research to back this up. But"},{"speaker":"Macy Stonner","startTime":1922.3,"endTime":1926.65,"body":"anecdotally speaking, I would"},{"speaker":"Macy Stonner","startTime":1922.3,"endTime":1926.65,"body":"say 5% or less. To be honest,"},{"speaker":"Macy Stonner","startTime":1926.68,"endTime":1930.07,"body":"there's a gentleman right now,"},{"speaker":"Macy Stonner","startTime":1926.68,"endTime":1930.07,"body":"who needs one for supination."},{"speaker":"Macy Stonner","startTime":1930.07,"endTime":1934.33,"body":"But the physician, one of your"},{"speaker":"Macy Stonner","startTime":1930.07,"endTime":1934.33,"body":"partners who fixed the fracture"},{"speaker":"Macy Stonner","startTime":1934.33,"endTime":1937.75,"body":"told us this is one of the top"},{"speaker":"Macy Stonner","startTime":1934.33,"endTime":1937.75,"body":"five most challenging distal"},{"speaker":"Macy Stonner","startTime":1937.75,"endTime":1940.63,"body":"radius fractures I've ever"},{"speaker":"Macy Stonner","startTime":1937.75,"endTime":1940.63,"body":"treated. So something a comment"},{"speaker":"Macy Stonner","startTime":1940.63,"endTime":1944.86,"body":"like that we know this person is"},{"speaker":"Macy Stonner","startTime":1940.63,"endTime":1944.86,"body":"going to have a hard time. And a"},{"speaker":"Macy Stonner","startTime":1944.86,"endTime":1948.46,"body":"lot of times a surgeon will say,"},{"speaker":"Macy Stonner","startTime":1944.86,"endTime":1948.46,"body":"hey, this was a tough one. Or in"},{"speaker":"Macy Stonner","startTime":1948.46,"endTime":1952.48,"body":"that comment, I know that"},{"speaker":"Macy Stonner","startTime":1948.46,"endTime":1952.48,"body":"getting that full mobility is"},{"speaker":"Macy Stonner","startTime":1952.48,"endTime":1953.68,"body":"going to be challenging."},{"speaker":"Chris Dy","startTime":1954.86,"endTime":1957.53,"body":"One of the things that"},{"speaker":"Chris Dy","startTime":1954.86,"endTime":1957.53,"body":"I've encountered with a subset"},{"speaker":"Chris Dy","startTime":1957.53,"endTime":1962.09,"body":"of patients is that they focus a"},{"speaker":"Chris Dy","startTime":1957.53,"endTime":1962.09,"body":"lot on the numbers that the"},{"speaker":"Chris Dy","startTime":1962.09,"endTime":1966.83,"body":"therapist is measuring, as"},{"speaker":"Chris Dy","startTime":1962.09,"endTime":1966.83,"body":"opposed to function. And that's"},{"speaker":"Chris Dy","startTime":1966.86,"endTime":1972.71,"body":"tough messaging to, to counter"},{"speaker":"Chris Dy","startTime":1966.86,"endTime":1972.71,"body":"in the office, because if"},{"speaker":"Chris Dy","startTime":1972.71,"endTime":1974.54,"body":"they're doing well, from a"},{"speaker":"Chris Dy","startTime":1972.71,"endTime":1974.54,"body":"functional perspective, some"},{"speaker":"Chris Dy","startTime":1974.54,"endTime":1977.18,"body":"people just have this"},{"speaker":"Chris Dy","startTime":1974.54,"endTime":1977.18,"body":"personality where they feel like"},{"speaker":"Chris Dy","startTime":1977.18,"endTime":1980.15,"body":"they need perfect symmetrical"},{"speaker":"Chris Dy","startTime":1977.18,"endTime":1980.15,"body":"motion, or they need a certain"},{"speaker":"Chris Dy","startTime":1980.15,"endTime":1982.49,"body":"number that I don't know if the"},{"speaker":"Chris Dy","startTime":1980.15,"endTime":1982.49,"body":"therapist isn't putting in their"},{"speaker":"Chris Dy","startTime":1982.49,"endTime":1984.44,"body":"head. I never emphasize numbers"},{"speaker":"Chris Dy","startTime":1982.49,"endTime":1984.44,"body":"in the office."},{"speaker":"Macy Stonner","startTime":1984.48,"endTime":1987.09,"body":"I totally agree."},{"speaker":"Macy Stonner","startTime":1984.48,"endTime":1987.09,"body":"Totally agree. This drives me"},{"speaker":"Macy Stonner","startTime":1987.09,"endTime":1990.57,"body":"crazy. Because they'll ask,"},{"speaker":"Macy Stonner","startTime":1987.09,"endTime":1990.57,"body":"Well, what number am I? And I'm"},{"speaker":"Macy Stonner","startTime":1990.57,"endTime":1993.99,"body":"like, Well, last week, you"},{"speaker":"Macy Stonner","startTime":1990.57,"endTime":1993.99,"body":"couldn't turn the doorknob. This"},{"speaker":"Macy Stonner","startTime":1993.99,"endTime":1995.76,"body":"week could you turn the"},{"speaker":"Macy Stonner","startTime":1993.99,"endTime":1995.76,"body":"doorknob? And they said yes,"},{"speaker":"Macy Stonner","startTime":1995.76,"endTime":1998.55,"body":"like so who cares? I don't know,"},{"speaker":"Macy Stonner","startTime":1995.76,"endTime":1998.55,"body":"I don't feel like sharing this"},{"speaker":"Macy Stonner","startTime":1998.55,"endTime":2001.79,"body":"number with you. I just have"},{"speaker":"Macy Stonner","startTime":1998.55,"endTime":2001.79,"body":"this documentation on my notes,"},{"speaker":"Macy Stonner","startTime":2002.36,"endTime":2007.61,"body":"you know, for insurance, but um,"},{"speaker":"Macy Stonner","startTime":2002.36,"endTime":2007.61,"body":"yeah, if they're getting bogged"},{"speaker":"Macy Stonner","startTime":2007.61,"endTime":2009.65,"body":"down in the numbers often do"},{"speaker":"Macy Stonner","startTime":2007.61,"endTime":2009.65,"body":"something else objective like a"},{"speaker":"Macy Stonner","startTime":2009.65,"endTime":2012.62,"body":"dash score, and show them their"},{"speaker":"Macy Stonner","startTime":2009.65,"endTime":2012.62,"body":"dash score on the first day and"},{"speaker":"Macy Stonner","startTime":2012.62,"endTime":2015.53,"body":"look at your dash score no w"},{"speaker":"Macy Stonner","startTime":2012.62,"endTime":2015.53,"body":"look how much you can do, doing"},{"speaker":"Macy Stonner","startTime":2015.53,"endTime":2018.02,"body":"functional things in the clinic"},{"speaker":"Macy Stonner","startTime":2015.53,"endTime":2018.02,"body":"and just highlighting all the"},{"speaker":"Macy Stonner","startTime":2018.02,"endTime":2022.55,"body":"good, rather than, you know,"},{"speaker":"Macy Stonner","startTime":2018.02,"endTime":2022.55,"body":"numbers that may not be changing"},{"speaker":"Macy Stonner","startTime":2022.55,"endTime":2023.3,"body":"week by week."},{"speaker":"Charles Goldfarb","startTime":2023.87,"endTime":2025.52,"body":"Or it Macy"},{"speaker":"Charles Goldfarb","startTime":2023.87,"endTime":2025.52,"body":"here's the million dollar"},{"speaker":"Charles Goldfarb","startTime":2025.52,"endTime":2029.96,"body":"question. Does every patient"},{"speaker":"Charles Goldfarb","startTime":2025.52,"endTime":2029.96,"body":"that has surgery for a distal"},{"speaker":"Charles Goldfarb","startTime":2029.96,"endTime":2035.33,"body":"radius fracture, need  your"},{"speaker":"Charles Goldfarb","startTime":2029.96,"endTime":2035.33,"body":"expert expertise? Or can someone"},{"speaker":"Charles Goldfarb","startTime":2035.33,"endTime":2038.81,"body":"get away with an off the shelf"},{"speaker":"Charles Goldfarb","startTime":2035.33,"endTime":2038.81,"body":"brace and on their own therapy,"},{"speaker":"Macy Stonner","startTime":2038.0,"endTime":2042.68,"body":"I would say nine"},{"speaker":"Macy Stonner","startTime":2038.0,"endTime":2042.68,"body":"times out of 10 patients will"},{"speaker":"Macy Stonner","startTime":2042.68,"endTime":2047.78,"body":"likely need at least one visit"},{"speaker":"Macy Stonner","startTime":2042.68,"endTime":2047.78,"body":"whether that include education,"},{"speaker":"Macy Stonner","startTime":2047.81,"endTime":2052.49,"body":"a splint, brief exercises,"},{"speaker":"Macy Stonner","startTime":2047.81,"endTime":2052.49,"body":"expectations, but there's that"},{"speaker":"Macy Stonner","startTime":2052.49,"endTime":2057.38,"body":"occasional patient who could"},{"speaker":"Macy Stonner","startTime":2052.49,"endTime":2057.38,"body":"probably be fine with a pre fab"},{"speaker":"Macy Stonner","startTime":2057.38,"endTime":2060.14,"body":"splint and send them on their"},{"speaker":"Macy Stonner","startTime":2057.38,"endTime":2060.14,"body":"way. They may be a low demand"},{"speaker":"Macy Stonner","startTime":2060.14,"endTime":2064.85,"body":"patient with no swelling, no"},{"speaker":"Macy Stonner","startTime":2060.14,"endTime":2064.85,"body":"pain, no stiffness, and they"},{"speaker":"Macy Stonner","startTime":2064.85,"endTime":2066.89,"body":"should be just fine. But you"},{"speaker":"Macy Stonner","startTime":2064.85,"endTime":2066.89,"body":"kind of have to read the"},{"speaker":"Macy Stonner","startTime":2066.89,"endTime":2067.34,"body":"patient."},{"speaker":"Charles Goldfarb","startTime":2068.06,"endTime":2070.55,"body":"And what"},{"speaker":"Charles Goldfarb","startTime":2068.06,"endTime":2070.55,"body":"percentage of patients that you"},{"speaker":"Charles Goldfarb","startTime":2070.55,"endTime":2076.37,"body":"see, do you really today see"},{"speaker":"Charles Goldfarb","startTime":2070.55,"endTime":2076.37,"body":"only once meaning, you know, do"},{"speaker":"Charles Goldfarb","startTime":2076.37,"endTime":2080.6,"body":"you do that regularly or do most"},{"speaker":"Charles Goldfarb","startTime":2076.37,"endTime":2080.6,"body":"patients leave it in your world"},{"speaker":"Charles Goldfarb","startTime":2080.6,"endTime":2082.22,"body":"need at least one or two follow"},{"speaker":"Charles Goldfarb","startTime":2080.6,"endTime":2082.22,"body":"ups."},{"speaker":"Macy Stonner","startTime":2083.38,"endTime":2086.26,"body":"I would say five"},{"speaker":"Macy Stonner","startTime":2083.38,"endTime":2086.26,"body":"to 10% I might see just once."},{"speaker":"Macy Stonner","startTime":2086.41,"endTime":2088.39,"body":"This happened the other day"},{"speaker":"Macy Stonner","startTime":2086.41,"endTime":2088.39,"body":"actually, but it's typically"},{"speaker":"Macy Stonner","startTime":2088.39,"endTime":2093.01,"body":"related to distance and or"},{"speaker":"Macy Stonner","startTime":2088.39,"endTime":2093.01,"body":"insurance so they might live 45"},{"speaker":"Macy Stonner","startTime":2093.01,"endTime":2096.04,"body":"minutes away with a busy"},{"speaker":"Macy Stonner","startTime":2093.01,"endTime":2096.04,"body":"schedule and coming over to the"},{"speaker":"Macy Stonner","startTime":2096.04,"endTime":2100.18,"body":"city is challenging, or their"},{"speaker":"Macy Stonner","startTime":2096.04,"endTime":2100.18,"body":"insurance authorization is only"},{"speaker":"Macy Stonner","startTime":2100.18,"endTime":2102.76,"body":"for one therapy session, so we"},{"speaker":"Macy Stonner","startTime":2100.18,"endTime":2102.76,"body":"kind of have to get it done in"},{"speaker":"Macy Stonner","startTime":2102.76,"endTime":2106.03,"body":"one session. And I'll just make"},{"speaker":"Macy Stonner","startTime":2102.76,"endTime":2106.03,"body":"that visit longer and more"},{"speaker":"Macy Stonner","startTime":2106.06,"endTime":2106.63,"body":"thorough."},{"speaker":"Charles Goldfarb","startTime":2107.56,"endTime":2109.09,"body":"Yes, it's a"},{"speaker":"Charles Goldfarb","startTime":2107.56,"endTime":2109.09,"body":"super interesting question. I"},{"speaker":"Charles Goldfarb","startTime":2109.09,"endTime":2112.39,"body":"mean, I recognize the expertise"},{"speaker":"Charles Goldfarb","startTime":2109.09,"endTime":2112.39,"body":"that you guys bring. But in this"},{"speaker":"Charles Goldfarb","startTime":2112.39,"endTime":2116.77,"body":"challenging era of insurance and"},{"speaker":"Charles Goldfarb","startTime":2112.39,"endTime":2116.77,"body":"cost controls and trying to"},{"speaker":"Charles Goldfarb","startTime":2116.77,"endTime":2120.94,"body":"provide value, there's clear"},{"speaker":"Charles Goldfarb","startTime":2116.77,"endTime":2120.94,"body":"value for some patients, there's"},{"speaker":"Charles Goldfarb","startTime":2121.18,"endTime":2123.94,"body":"pretty clear value for others."},{"speaker":"Charles Goldfarb","startTime":2121.18,"endTime":2123.94,"body":"But you're right, I think there"},{"speaker":"Charles Goldfarb","startTime":2123.94,"endTime":2127.03,"body":"are the occasional patients that"},{"speaker":"Charles Goldfarb","startTime":2123.94,"endTime":2127.03,"body":"probably will do just fine on"},{"speaker":"Charles Goldfarb","startTime":2127.03,"endTime":2127.42,"body":"their own."},{"speaker":"Macy Stonner","startTime":2127.809,"endTime":2128.619,"body":"I agree."},{"speaker":"Charles Goldfarb","startTime":2129.55,"endTime":2131.74,"body":"When are you"},{"speaker":"Charles Goldfarb","startTime":2129.55,"endTime":2131.74,"body":"done? When is therapy over?"},{"speaker":"Macy Stonner","startTime":2132.35,"endTime":2134.93,"body":"Well, it's a hard"},{"speaker":"Macy Stonner","startTime":2132.35,"endTime":2134.93,"body":"question because it can be four"},{"speaker":"Macy Stonner","startTime":2134.93,"endTime":2138.05,"body":"weeks, it can be five months, it"},{"speaker":"Macy Stonner","startTime":2134.93,"endTime":2138.05,"body":"can be I just had somebody who I"},{"speaker":"Macy Stonner","startTime":2138.05,"endTime":2141.77,"body":"discharged after 14 months, from"},{"speaker":"Macy Stonner","startTime":2138.05,"endTime":2141.77,"body":"a distal radius fracture non op"},{"speaker":"Macy Stonner","startTime":2141.77,"endTime":2144.71,"body":"who had crps. So it's so"},{"speaker":"Macy Stonner","startTime":2141.77,"endTime":2144.71,"body":"different. And I think that the"},{"speaker":"Macy Stonner","startTime":2144.71,"endTime":2146.99,"body":"patient's personality plays a"},{"speaker":"Macy Stonner","startTime":2144.71,"endTime":2146.99,"body":"role into it, because some"},{"speaker":"Macy Stonner","startTime":2146.99,"endTime":2151.13,"body":"people are more independent,"},{"speaker":"Macy Stonner","startTime":2146.99,"endTime":2151.13,"body":"where they say, I got this, I"},{"speaker":"Macy Stonner","startTime":2151.13,"endTime":2153.74,"body":"can do it on my own. I don't"},{"speaker":"Macy Stonner","startTime":2151.13,"endTime":2153.74,"body":"need therapy, and some people"},{"speaker":"Macy Stonner","startTime":2153.74,"endTime":2156.95,"body":"need that formal instruction. So"},{"speaker":"Macy Stonner","startTime":2153.74,"endTime":2156.95,"body":"I don't have an answer for you."},{"speaker":"Macy Stonner","startTime":2156.98,"endTime":2161.18,"body":"It can be so dependent on the"},{"speaker":"Macy Stonner","startTime":2156.98,"endTime":2161.18,"body":"patient's personality, the"},{"speaker":"Macy Stonner","startTime":2161.21,"endTime":2165.59,"body":"rigidity of the fixation, their"},{"speaker":"Macy Stonner","startTime":2161.21,"endTime":2165.59,"body":"function, their motion. It's so"},{"speaker":"Macy Stonner","startTime":2165.59,"endTime":2166.43,"body":"patient dependent."},{"speaker":"Chris Dy","startTime":2166.76,"endTime":2169.64,"body":"Well Chuck, on the"},{"speaker":"Chris Dy","startTime":2166.76,"endTime":2169.64,"body":"prescribing side of things, how"},{"speaker":"Chris Dy","startTime":2169.64,"endTime":2171.95,"body":"much are you steering that"},{"speaker":"Chris Dy","startTime":2169.64,"endTime":2171.95,"body":"conversation? You know,"},{"speaker":"Chris Dy","startTime":2171.95,"endTime":2174.62,"body":"typically, I'll say, do you"},{"speaker":"Chris Dy","startTime":2171.95,"endTime":2174.62,"body":"think that therapy is still"},{"speaker":"Chris Dy","startTime":2174.62,"endTime":2175.16,"body":"helping?"},{"speaker":"Macy Stonner","startTime":2175.4,"endTime":2175.73,"body":"Yeah,"},{"speaker":"Chris Dy","startTime":2176.57,"endTime":2178.73,"body":"I think a lot of it,"},{"speaker":"Chris Dy","startTime":2176.57,"endTime":2178.73,"body":"like Macy said, is a patient"},{"speaker":"Chris Dy","startTime":2178.73,"endTime":2179.57,"body":"personality thing."},{"speaker":"Charles Goldfarb","startTime":2180.5,"endTime":2183.05,"body":"You know, we"},{"speaker":"Charles Goldfarb","startTime":2180.5,"endTime":2183.05,"body":"have this huge built in benefit."},{"speaker":"Charles Goldfarb","startTime":2183.05,"endTime":2186.47,"body":"And I don't know what percentage"},{"speaker":"Charles Goldfarb","startTime":2183.05,"endTime":2186.47,"body":"of hand surgeons have the luxury"},{"speaker":"Charles Goldfarb","startTime":2186.47,"endTime":2189.32,"body":"of really having a close"},{"speaker":"Charles Goldfarb","startTime":2186.47,"endTime":2189.32,"body":"relationship with a therapist,"},{"speaker":"Charles Goldfarb","startTime":2189.32,"endTime":2192.86,"body":"potentially even an office"},{"speaker":"Charles Goldfarb","startTime":2189.32,"endTime":2192.86,"body":"therapist. But my comment is the"},{"speaker":"Charles Goldfarb","startTime":2192.86,"endTime":2195.59,"body":"same to all patients, I"},{"speaker":"Charles Goldfarb","startTime":2192.86,"endTime":2195.59,"body":"absolutely ask if they think"},{"speaker":"Charles Goldfarb","startTime":2195.59,"endTime":2198.2,"body":"therapy is still helping. And"},{"speaker":"Charles Goldfarb","startTime":2195.59,"endTime":2198.2,"body":"then I absolutely try to put"},{"speaker":"Charles Goldfarb","startTime":2198.2,"endTime":2200.57,"body":"myself out of the middle. I"},{"speaker":"Charles Goldfarb","startTime":2198.2,"endTime":2200.57,"body":"don't know if that's not"},{"speaker":"Charles Goldfarb","startTime":2200.57,"endTime":2203.0,"body":"something I'm supposed to say."},{"speaker":"Charles Goldfarb","startTime":2200.57,"endTime":2203.0,"body":"But I try to take myself out of"},{"speaker":"Charles Goldfarb","startTime":2203.0,"endTime":2205.7,"body":"the middle, and let the"},{"speaker":"Charles Goldfarb","startTime":2203.0,"endTime":2205.7,"body":"therapist and the patient"},{"speaker":"Charles Goldfarb","startTime":2205.7,"endTime":2209.33,"body":"decide. But here's the danger."},{"speaker":"Charles Goldfarb","startTime":2205.7,"endTime":2209.33,"body":"If you have a therapist, and I"},{"speaker":"Charles Goldfarb","startTime":2209.33,"endTime":2212.69,"body":"don't know any, but there could"},{"speaker":"Charles Goldfarb","startTime":2209.33,"endTime":2212.69,"body":"be some out there who are just"},{"speaker":"Charles Goldfarb","startTime":2212.69,"endTime":2215.57,"body":"trying to keep the patient in"},{"speaker":"Charles Goldfarb","startTime":2212.69,"endTime":2215.57,"body":"the system. They're going to"},{"speaker":"Charles Goldfarb","startTime":2215.57,"endTime":2219.29,"body":"keep bringing that patient back."},{"speaker":"Charles Goldfarb","startTime":2215.57,"endTime":2219.29,"body":"And I'm sure that happens. I"},{"speaker":"Charles Goldfarb","startTime":2219.29,"endTime":2221.99,"body":"know it doesn't happen for our"},{"speaker":"Charles Goldfarb","startTime":2219.29,"endTime":2221.99,"body":"guys, if anything, you guys let"},{"speaker":"Charles Goldfarb","startTime":2221.99,"endTime":2225.41,"body":"patients go a little sooner than"},{"speaker":"Charles Goldfarb","startTime":2221.99,"endTime":2225.41,"body":"I would rather than the"},{"speaker":"Charles Goldfarb","startTime":2225.41,"endTime":2225.86,"body":"opposite."},{"speaker":"Macy Stonner","startTime":2227.13,"endTime":2230.85,"body":"I agree. We, I"},{"speaker":"Macy Stonner","startTime":2227.13,"endTime":2230.85,"body":"agree. We in our clinic,"},{"speaker":"Macy Stonner","startTime":2230.88,"endTime":2235.8,"body":"probably we don't oversee"},{"speaker":"Macy Stonner","startTime":2230.88,"endTime":2235.8,"body":"patients at all. Because we work"},{"speaker":"Macy Stonner","startTime":2235.86,"endTime":2239.01,"body":"in an urban setting and an"},{"speaker":"Macy Stonner","startTime":2235.86,"endTime":2239.01,"body":"academic institution with a lot"},{"speaker":"Macy Stonner","startTime":2239.01,"endTime":2241.92,"body":"of people and particularly in"},{"speaker":"Macy Stonner","startTime":2239.01,"endTime":2241.92,"body":"COVID I think that it's"},{"speaker":"Macy Stonner","startTime":2241.92,"endTime":2245.46,"body":"inconvenient to be here if they"},{"speaker":"Macy Stonner","startTime":2241.92,"endTime":2245.46,"body":"don't live in the city. And"},{"speaker":"Macy Stonner","startTime":2245.52,"endTime":2248.76,"body":"there's a lot of patients to"},{"speaker":"Macy Stonner","startTime":2245.52,"endTime":2248.76,"body":"interact with during during"},{"speaker":"Macy Stonner","startTime":2248.76,"endTime":2253.92,"body":"COVID. But I guess one of our"},{"speaker":"Macy Stonner","startTime":2248.76,"endTime":2253.92,"body":"mantras here is we teach you how"},{"speaker":"Macy Stonner","startTime":2253.92,"endTime":2256.89,"body":"to be successful to self manage"},{"speaker":"Macy Stonner","startTime":2253.92,"endTime":2256.89,"body":"this condition on your own."},{"speaker":"Macy Stonner","startTime":2256.89,"endTime":2260.7,"body":"We're not here to take your"},{"speaker":"Macy Stonner","startTime":2256.89,"endTime":2260.7,"body":"copay. You know, we just I want"},{"speaker":"Macy Stonner","startTime":2260.7,"endTime":2264.15,"body":"you to come see me as long as"},{"speaker":"Macy Stonner","startTime":2260.7,"endTime":2264.15,"body":"you find me helpful. And I say"},{"speaker":"Macy Stonner","startTime":2264.15,"endTime":2265.98,"body":"that to patients, they will take"},{"speaker":"Macy Stonner","startTime":2264.15,"endTime":2265.98,"body":"that advice."},{"speaker":"Charles Goldfarb","startTime":2267.16,"endTime":2270.49,"body":"I think those"},{"speaker":"Charles Goldfarb","startTime":2267.16,"endTime":2270.49,"body":"are words to leave this podcast"},{"speaker":"Charles Goldfarb","startTime":2270.49,"endTime":2274.66,"body":"on, because that is really well"},{"speaker":"Charles Goldfarb","startTime":2270.49,"endTime":2274.66,"body":"said and and i think you know as"},{"speaker":"Charles Goldfarb","startTime":2274.66,"endTime":2279.16,"body":"important as we surgeons believe"},{"speaker":"Charles Goldfarb","startTime":2274.66,"endTime":2279.16,"body":"we are. I think the therapy"},{"speaker":"Charles Goldfarb","startTime":2279.19,"endTime":2282.58,"body":"relationship post surgical is"},{"speaker":"Charles Goldfarb","startTime":2279.19,"endTime":2282.58,"body":"incredibly important. And having"},{"speaker":"Charles Goldfarb","startTime":2282.58,"endTime":2285.76,"body":"the right therapist really can"},{"speaker":"Charles Goldfarb","startTime":2282.58,"endTime":2285.76,"body":"absolutely be the difference"},{"speaker":"Charles Goldfarb","startTime":2285.76,"endTime":2287.32,"body":"between a good result and a"},{"speaker":"Charles Goldfarb","startTime":2285.76,"endTime":2287.32,"body":"great result."},{"speaker":"Chris Dy","startTime":2288.35,"endTime":2290.72,"body":"Dr. Macy Stonner,"},{"speaker":"Chris Dy","startTime":2288.35,"endTime":2290.72,"body":"thank you for joining us."},{"speaker":"Macy Stonner","startTime":2291.65,"endTime":2292.46,"body":"Thanks for having"},{"speaker":"Macy Stonner","startTime":2291.65,"endTime":2292.46,"body":"me."},{"speaker":"Charles Goldfarb","startTime":2293.66,"endTime":2295.64,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2293.66,"endTime":2295.64,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2295.64,"endTime":2296.18,"body":"real soon."},{"speaker":"Chris Dy","startTime":2296.42,"endTime":2298.94,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2296.42,"endTime":2298.94,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2299.18,"endTime":2301.37,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2299.18,"endTime":2301.37,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2301.7,"endTime":2304.55,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2301.7,"endTime":2304.55,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2304.7,"endTime":2308.09,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2304.7,"endTime":2308.09,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2308.09,"endTime":2311.93,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2308.09,"endTime":2311.93,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2312.52,"endTime":2314.65,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2312.52,"endTime":2314.65,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2314.65,"endTime":2315.73,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2315.79,"endTime":2317.98,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2315.79,"endTime":2317.98,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2317.98,"endTime":2318.4,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2318.76,"endTime":2321.07,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2318.76,"endTime":2321.07,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2321.07,"endTime":2325.06,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2321.07,"endTime":2325.06,"body":"upper hand. Come back next time"}]}