{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.77,"endTime":13.35,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.77,"endTime":13.35,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.35,"endTime":14.49,"body":"Chris talk Hand Surgery."},{"speaker":"Chris Dy","startTime":14.79,"endTime":16.56,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.79,"endTime":16.56,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.62,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.62,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.62,"endTime":21.48,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.62,"endTime":21.48,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.33,"endTime":25.23,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.66,"endTime":28.17,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.38,"endTime":29.25,"body":"Oh, Hey,"},{"speaker":"Charles Goldfarb","startTime":28.38,"endTime":29.25,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.64,"endTime":30.72,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.64,"endTime":30.72,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.23,"endTime":32.97,"body":"I'm pretty"},{"speaker":"Charles Goldfarb","startTime":31.23,"endTime":32.97,"body":"fair. How are you today?"},{"speaker":"Chris Dy","startTime":33.96,"endTime":36.78,"body":"I'm doing well. You"},{"speaker":"Chris Dy","startTime":33.96,"endTime":36.78,"body":"know, I'm excited. You've given"},{"speaker":"Chris Dy","startTime":36.78,"endTime":39.69,"body":"me a nice holiday treat. I'm"},{"speaker":"Chris Dy","startTime":36.78,"endTime":39.69,"body":"going to tell everybody, we're"},{"speaker":"Chris Dy","startTime":39.69,"endTime":42.45,"body":"doing an episode about nerve. So"},{"speaker":"Chris Dy","startTime":39.69,"endTime":42.45,"body":"I'm very, very excited. Thank"},{"speaker":"Chris Dy","startTime":42.45,"endTime":44.76,"body":"you, Dr. Goldfarb for my holiday"},{"speaker":"Chris Dy","startTime":42.45,"endTime":44.76,"body":"gift."},{"speaker":"Charles Goldfarb","startTime":44.88,"endTime":47.4,"body":"Yes, I will. I"},{"speaker":"Charles Goldfarb","startTime":44.88,"endTime":47.4,"body":"will stumble through this"},{"speaker":"Charles Goldfarb","startTime":47.4,"endTime":51.81,"body":"episode, but it is it is in"},{"speaker":"Charles Goldfarb","startTime":47.4,"endTime":51.81,"body":"response to an overwhelming"},{"speaker":"Charles Goldfarb","startTime":51.81,"endTime":54.24,"body":"demand. So I have to respect the"},{"speaker":"Charles Goldfarb","startTime":51.81,"endTime":54.24,"body":"listeners."},{"speaker":"Chris Dy","startTime":54.87,"endTime":58.44,"body":"You know, to quote a"},{"speaker":"Chris Dy","startTime":54.87,"endTime":58.44,"body":"highbrow comedian named Will"},{"speaker":"Chris Dy","startTime":58.44,"endTime":61.83,"body":"Ferrell, it gets the people"},{"speaker":"Chris Dy","startTime":58.44,"endTime":61.83,"body":"going, give them what they want."},{"speaker":"Charles Goldfarb","startTime":62.4,"endTime":65.58,"body":"It must. I"},{"speaker":"Charles Goldfarb","startTime":62.4,"endTime":65.58,"body":"hope it does. I think it's"},{"speaker":"Charles Goldfarb","startTime":65.58,"endTime":68.61,"body":"pretty funny. That we're"},{"speaker":"Charles Goldfarb","startTime":65.58,"endTime":68.61,"body":"recording early on Saturday"},{"speaker":"Charles Goldfarb","startTime":68.61,"endTime":71.61,"body":"morning, the day before this"},{"speaker":"Charles Goldfarb","startTime":68.61,"endTime":71.61,"body":"podcast releases. I'm hiding out"},{"speaker":"Charles Goldfarb","startTime":71.61,"endTime":76.47,"body":"in my basement to not awaken my"},{"speaker":"Charles Goldfarb","startTime":71.61,"endTime":76.47,"body":"family. And you just got off the"},{"speaker":"Charles Goldfarb","startTime":76.47,"endTime":78.0,"body":"bike and you're in a dark room."},{"speaker":"Chris Dy","startTime":79.86,"endTime":83.46,"body":"I'm also hiding from"},{"speaker":"Chris Dy","startTime":79.86,"endTime":83.46,"body":"my family. And to help, to help"},{"speaker":"Chris Dy","startTime":83.46,"endTime":87.51,"body":"you out I actually plugged into"},{"speaker":"Chris Dy","startTime":83.46,"endTime":87.51,"body":"my to my Ethernet box just to"},{"speaker":"Chris Dy","startTime":87.51,"endTime":89.19,"body":"make the connection that much"},{"speaker":"Chris Dy","startTime":87.51,"endTime":89.19,"body":"better."},{"speaker":"Charles Goldfarb","startTime":89.4,"endTime":92.31,"body":"Thank you."},{"speaker":"Charles Goldfarb","startTime":89.4,"endTime":92.31,"body":"That is huge. Thank you."},{"speaker":"Chris Dy","startTime":92.52,"endTime":94.26,"body":"Well I'm realizing"},{"speaker":"Chris Dy","startTime":92.52,"endTime":94.26,"body":"that it's, you know, I was"},{"speaker":"Chris Dy","startTime":94.26,"endTime":96.69,"body":"really upset with my internet"},{"speaker":"Chris Dy","startTime":94.26,"endTime":96.69,"body":"provider. And then I realized"},{"speaker":"Chris Dy","startTime":96.69,"endTime":99.6,"body":"it's actually just the very"},{"speaker":"Chris Dy","startTime":96.69,"endTime":99.6,"body":"thick plaster walls and our 100"},{"speaker":"Chris Dy","startTime":99.63,"endTime":102.93,"body":"year old house. Really throttles"},{"speaker":"Chris Dy","startTime":99.63,"endTime":102.93,"body":"your wireless connection."},{"speaker":"Charles Goldfarb","startTime":103.41,"endTime":105.54,"body":"You and I both"},{"speaker":"Charles Goldfarb","startTime":103.41,"endTime":105.54,"body":"have that issue. One of the"},{"speaker":"Charles Goldfarb","startTime":105.54,"endTime":108.6,"body":"beauties of St. Louis, lots of"},{"speaker":"Charles Goldfarb","startTime":105.54,"endTime":108.6,"body":"great old homes. But the"},{"speaker":"Charles Goldfarb","startTime":108.6,"endTime":110.7,"body":"challenge is those thick plaster"},{"speaker":"Charles Goldfarb","startTime":108.6,"endTime":110.7,"body":"walls."},{"speaker":"Chris Dy","startTime":110.73,"endTime":112.92,"body":"Yeah, it only it only"},{"speaker":"Chris Dy","startTime":110.73,"endTime":112.92,"body":"took me eight months into the"},{"speaker":"Chris Dy","startTime":112.92,"endTime":114.12,"body":"pandemic to figure that out."},{"speaker":"Charles Goldfarb","startTime":114.57,"endTime":118.92,"body":"Well done,"},{"speaker":"Charles Goldfarb","startTime":114.57,"endTime":118.92,"body":"well done. Alright, so two"},{"speaker":"Charles Goldfarb","startTime":118.95,"endTime":123.15,"body":"announcements. The first is a"},{"speaker":"Charles Goldfarb","startTime":118.95,"endTime":123.15,"body":"request. I'm not sure how many"},{"speaker":"Charles Goldfarb","startTime":123.15,"endTime":127.2,"body":"of our listeners actually"},{"speaker":"Charles Goldfarb","startTime":123.15,"endTime":127.2,"body":"subscribe to our podcast versus"},{"speaker":"Charles Goldfarb","startTime":127.26,"endTime":131.16,"body":"download it intermittently. It"},{"speaker":"Charles Goldfarb","startTime":127.26,"endTime":131.16,"body":"seems like subscriptions are a"},{"speaker":"Charles Goldfarb","startTime":131.16,"endTime":134.76,"body":"big deal. And so we would love"},{"speaker":"Charles Goldfarb","startTime":131.16,"endTime":134.76,"body":"it. If you guys would consider"},{"speaker":"Charles Goldfarb","startTime":134.76,"endTime":136.62,"body":"actually subscribing to the"},{"speaker":"Charles Goldfarb","startTime":134.76,"endTime":136.62,"body":"podcast."},{"speaker":"Chris Dy","startTime":137.14,"endTime":138.67,"body":"That would be great."},{"speaker":"Chris Dy","startTime":137.14,"endTime":138.67,"body":"And if you could do that, that"},{"speaker":"Chris Dy","startTime":138.67,"endTime":141.67,"body":"would basically be Dr."},{"speaker":"Chris Dy","startTime":138.67,"endTime":141.67,"body":"Goldfarb's holiday gift. So if"},{"speaker":"Chris Dy","startTime":141.67,"endTime":144.64,"body":"you could get Chuck a gift by"},{"speaker":"Chris Dy","startTime":141.67,"endTime":144.64,"body":"subscribing, that will help all"},{"speaker":"Chris Dy","startTime":144.64,"endTime":147.76,"body":"of us out. It'd be like a return"},{"speaker":"Chris Dy","startTime":144.64,"endTime":147.76,"body":"for this nice little gem of a"},{"speaker":"Chris Dy","startTime":147.76,"endTime":148.66,"body":"nerve episode."},{"speaker":"Charles Goldfarb","startTime":149.26,"endTime":152.29,"body":"Please, that"},{"speaker":"Charles Goldfarb","startTime":149.26,"endTime":152.29,"body":"would be awesome. And then the"},{"speaker":"Charles Goldfarb","startTime":152.29,"endTime":155.83,"body":"other thing is we're gonna take"},{"speaker":"Charles Goldfarb","startTime":152.29,"endTime":155.83,"body":"a holiday break."},{"speaker":"Chris Dy","startTime":156.34,"endTime":159.61,"body":"Yes, I don't think"},{"speaker":"Chris Dy","startTime":156.34,"endTime":159.61,"body":"I've ever heard Chuck announce"},{"speaker":"Chris Dy","startTime":159.61,"endTime":162.79,"body":"that he was taking time off"},{"speaker":"Chris Dy","startTime":159.61,"endTime":162.79,"body":"publicly. We're gonna take two"},{"speaker":"Chris Dy","startTime":162.79,"endTime":166.54,"body":"weeks off, to spend some"},{"speaker":"Chris Dy","startTime":162.79,"endTime":166.54,"body":"additional time with our"},{"speaker":"Chris Dy","startTime":166.72,"endTime":171.79,"body":"families, reflect and come back"},{"speaker":"Chris Dy","startTime":166.72,"endTime":171.79,"body":"super strong in 2021. And that"},{"speaker":"Chris Dy","startTime":171.79,"endTime":177.04,"body":"episode will be coming out on"},{"speaker":"Chris Dy","startTime":171.79,"endTime":177.04,"body":"January 10. So we look forward"},{"speaker":"Chris Dy","startTime":177.04,"endTime":180.22,"body":"to spending some time with our,"},{"speaker":"Chris Dy","startTime":177.04,"endTime":180.22,"body":"with our families this holiday"},{"speaker":"Chris Dy","startTime":180.22,"endTime":184.84,"body":"and at least a little more time."},{"speaker":"Chris Dy","startTime":180.22,"endTime":184.84,"body":"And we'll see you guys in 2021."},{"speaker":"Chris Dy","startTime":185.02,"endTime":187.93,"body":"But before we do that, we should"},{"speaker":"Chris Dy","startTime":185.02,"endTime":187.93,"body":"do the episode. So let's talk a"},{"speaker":"Chris Dy","startTime":187.93,"endTime":191.56,"body":"little bit about what's been"},{"speaker":"Chris Dy","startTime":187.93,"endTime":191.56,"body":"going on in your world. With"},{"speaker":"Chris Dy","startTime":191.56,"endTime":193.15,"body":"everything COVID wise."},{"speaker":"Charles Goldfarb","startTime":193.81,"endTime":197.29,"body":"Um, yeah,"},{"speaker":"Charles Goldfarb","startTime":193.81,"endTime":197.29,"body":"we've been struggling through I"},{"speaker":"Charles Goldfarb","startTime":197.29,"endTime":199.81,"body":"guess it's probably the best way"},{"speaker":"Charles Goldfarb","startTime":197.29,"endTime":199.81,"body":"to say it getting cases done"},{"speaker":"Charles Goldfarb","startTime":199.81,"endTime":202.12,"body":"here and there and everywhere."},{"speaker":"Charles Goldfarb","startTime":199.81,"endTime":202.12,"body":"It's made for a poor quality of"},{"speaker":"Charles Goldfarb","startTime":202.12,"endTime":207.43,"body":"life. It's made for struggles of"},{"speaker":"Charles Goldfarb","startTime":202.12,"endTime":207.43,"body":"my team, and frustration with my"},{"speaker":"Charles Goldfarb","startTime":207.43,"endTime":211.3,"body":"family. But I feel this, as we"},{"speaker":"Charles Goldfarb","startTime":207.43,"endTime":211.3,"body":"all do I'm sure, this strong"},{"speaker":"Charles Goldfarb","startTime":211.3,"endTime":214.27,"body":"sense of obligation to help our"},{"speaker":"Charles Goldfarb","startTime":211.3,"endTime":214.27,"body":"patients, which sounds kind of"},{"speaker":"Charles Goldfarb","startTime":214.27,"endTime":216.85,"body":"corny, but it's real. And"},{"speaker":"Charles Goldfarb","startTime":214.27,"endTime":216.85,"body":"sometimes we're helping them"},{"speaker":"Charles Goldfarb","startTime":216.85,"endTime":218.98,"body":"because they have a year end"},{"speaker":"Charles Goldfarb","startTime":216.85,"endTime":218.98,"body":"deductible that they want to"},{"speaker":"Charles Goldfarb","startTime":218.98,"endTime":222.34,"body":"meet. And sometimes, obviously,"},{"speaker":"Charles Goldfarb","startTime":218.98,"endTime":222.34,"body":"it's more pressing concerns. But"},{"speaker":"Charles Goldfarb","startTime":222.46,"endTime":224.89,"body":"it's been a tough, it's been a"},{"speaker":"Charles Goldfarb","startTime":222.46,"endTime":224.89,"body":"tough four to six weeks for me."},{"speaker":"Charles Goldfarb","startTime":224.92,"endTime":225.4,"body":"What about you?"},{"speaker":"Chris Dy","startTime":226.17,"endTime":228.03,"body":"Well, I mean, the fact"},{"speaker":"Chris Dy","startTime":226.17,"endTime":228.03,"body":"that I'm operating at four"},{"speaker":"Chris Dy","startTime":228.03,"endTime":231.15,"body":"different facilities in the span"},{"speaker":"Chris Dy","startTime":228.03,"endTime":231.15,"body":"of one week, tells you that we"},{"speaker":"Chris Dy","startTime":231.15,"endTime":235.83,"body":"are scrambling. But you know, I"},{"speaker":"Chris Dy","startTime":231.15,"endTime":235.83,"body":"guess from the pandemic, and"},{"speaker":"Chris Dy","startTime":235.83,"endTime":239.61,"body":"from necessity, breeds"},{"speaker":"Chris Dy","startTime":235.83,"endTime":239.61,"body":"ingenuity. And so we've tried to"},{"speaker":"Chris Dy","startTime":239.61,"endTime":242.13,"body":"come up with solutions. And, you"},{"speaker":"Chris Dy","startTime":239.61,"endTime":242.13,"body":"know, we've talked about this on"},{"speaker":"Chris Dy","startTime":242.13,"endTime":244.83,"body":"the on the wide awake episode"},{"speaker":"Chris Dy","startTime":242.13,"endTime":244.83,"body":"with Sam, but we've actually"},{"speaker":"Chris Dy","startTime":244.83,"endTime":248.58,"body":"found a way at least"},{"speaker":"Chris Dy","startTime":244.83,"endTime":248.58,"body":"temporarily, to move some of"},{"speaker":"Chris Dy","startTime":248.58,"endTime":252.99,"body":"these WALANT surgeries into the"},{"speaker":"Chris Dy","startTime":248.58,"endTime":252.99,"body":"office. And it's been an"},{"speaker":"Chris Dy","startTime":252.99,"endTime":256.89,"body":"incredibly fun process. I won't"},{"speaker":"Chris Dy","startTime":252.99,"endTime":256.89,"body":"say experiment, because a lot of"},{"speaker":"Chris Dy","startTime":256.89,"endTime":260.73,"body":"thought and work went into it."},{"speaker":"Chris Dy","startTime":256.89,"endTime":260.73,"body":"We even did a dress rehearsal,"},{"speaker":"Chris Dy","startTime":260.73,"endTime":262.2,"body":"and I convinced you to come do"},{"speaker":"Chris Dy","startTime":260.73,"endTime":262.2,"body":"that."},{"speaker":"Charles Goldfarb","startTime":263.07,"endTime":266.64,"body":"I was so I"},{"speaker":"Charles Goldfarb","startTime":263.07,"endTime":266.64,"body":"don't know what the right word"},{"speaker":"Charles Goldfarb","startTime":266.64,"endTime":269.76,"body":"is. I was like, seriously, you"},{"speaker":"Charles Goldfarb","startTime":266.64,"endTime":269.76,"body":"want to do a dress rehearsal? I"},{"speaker":"Charles Goldfarb","startTime":269.76,"endTime":273.27,"body":"got a list of 18 things to do."},{"speaker":"Charles Goldfarb","startTime":269.76,"endTime":273.27,"body":"But you know what? As with many"},{"speaker":"Charles Goldfarb","startTime":273.27,"endTime":276.18,"body":"things, you were absolutely"},{"speaker":"Charles Goldfarb","startTime":273.27,"endTime":276.18,"body":"right. It was worth the time."},{"speaker":"Charles Goldfarb","startTime":276.42,"endTime":279.03,"body":"And we had a whole team of"},{"speaker":"Charles Goldfarb","startTime":276.42,"endTime":279.03,"body":"people there talking through"},{"speaker":"Charles Goldfarb","startTime":279.06,"endTime":283.02,"body":"each step in the process. And it"},{"speaker":"Charles Goldfarb","startTime":279.06,"endTime":283.02,"body":"just made sense so thank you."},{"speaker":"Chris Dy","startTime":283.87,"endTime":285.64,"body":"Yeah, so it's it's"},{"speaker":"Chris Dy","startTime":283.87,"endTime":285.64,"body":"been a lot of fun. I mean, I"},{"speaker":"Chris Dy","startTime":285.64,"endTime":287.59,"body":"don't know if I'm right about"},{"speaker":"Chris Dy","startTime":285.64,"endTime":287.59,"body":"many things. But this one I felt"},{"speaker":"Chris Dy","startTime":287.59,"endTime":291.1,"body":"very strongly about it mainly"},{"speaker":"Chris Dy","startTime":287.59,"endTime":291.1,"body":"because Jennifer Wolff when she"},{"speaker":"Chris Dy","startTime":291.1,"endTime":294.19,"body":"gave a presentation to our"},{"speaker":"Chris Dy","startTime":291.1,"endTime":294.19,"body":"traveling, hand club, shout out"},{"speaker":"Chris Dy","startTime":294.19,"endTime":298.09,"body":"hashtag hand club. She talked"},{"speaker":"Chris Dy","startTime":294.19,"endTime":298.09,"body":"about the importance of doing"},{"speaker":"Chris Dy","startTime":298.09,"endTime":301.18,"body":"that kind of rehearsal, and"},{"speaker":"Chris Dy","startTime":298.09,"endTime":301.18,"body":"we've now successfully done"},{"speaker":"Chris Dy","startTime":301.87,"endTime":305.77,"body":"those cases on two separate days"},{"speaker":"Chris Dy","startTime":301.87,"endTime":305.77,"body":"and a total of six cases of"},{"speaker":"Chris Dy","startTime":306.37,"endTime":310.45,"body":"different variety. And it's gone"},{"speaker":"Chris Dy","startTime":306.37,"endTime":310.45,"body":"really, really well. Patients"},{"speaker":"Chris Dy","startTime":310.45,"endTime":314.14,"body":"are in and out within an hour."},{"speaker":"Chris Dy","startTime":310.45,"endTime":314.14,"body":"They've loved it, the staff has"},{"speaker":"Chris Dy","startTime":314.14,"endTime":317.83,"body":"loved it. And honestly, a lot of"},{"speaker":"Chris Dy","startTime":314.14,"endTime":317.83,"body":"credit goes to staff that have"},{"speaker":"Chris Dy","startTime":317.83,"endTime":320.5,"body":"put in the time to make it work"},{"speaker":"Chris Dy","startTime":317.83,"endTime":320.5,"body":"on the back end in terms of"},{"speaker":"Chris Dy","startTime":320.5,"endTime":325.6,"body":"authorization, billing, etc. and"},{"speaker":"Chris Dy","startTime":320.5,"endTime":325.6,"body":"helping us with getting things"},{"speaker":"Chris Dy","startTime":325.6,"endTime":328.81,"body":"like supplies, and then our"},{"speaker":"Chris Dy","startTime":325.6,"endTime":328.81,"body":"fellow I will shout her out"},{"speaker":"Chris Dy","startTime":328.81,"endTime":331.54,"body":"specifically, Jocelyn Compton"},{"speaker":"Chris Dy","startTime":328.81,"endTime":331.54,"body":"has done an amazing job, because"},{"speaker":"Chris Dy","startTime":331.54,"endTime":334.78,"body":"essentially, she's acting as a"},{"speaker":"Chris Dy","startTime":331.54,"endTime":334.78,"body":"scrub tech, which I think has"},{"speaker":"Chris Dy","startTime":334.78,"endTime":337.87,"body":"had some very nice hidden"},{"speaker":"Chris Dy","startTime":334.78,"endTime":337.87,"body":"educational value for all of us,"},{"speaker":"Chris Dy","startTime":338.11,"endTime":342.34,"body":"makes us appreciate our OR staff"},{"speaker":"Chris Dy","startTime":338.11,"endTime":342.34,"body":"even more. But then also, you"},{"speaker":"Chris Dy","startTime":342.34,"endTime":344.41,"body":"know, we need to know our way"},{"speaker":"Chris Dy","startTime":342.34,"endTime":344.41,"body":"around the trays need to know"},{"speaker":"Chris Dy","startTime":344.41,"endTime":347.98,"body":"how to, to set things up and do"},{"speaker":"Chris Dy","startTime":344.41,"endTime":347.98,"body":"the case, you know,"},{"speaker":"Chris Dy","startTime":348.01,"endTime":348.67,"body":"independently."},{"speaker":"Charles Goldfarb","startTime":349.74,"endTime":351.51,"body":"I think it's"},{"speaker":"Charles Goldfarb","startTime":349.74,"endTime":351.51,"body":"super interesting as well. And I"},{"speaker":"Charles Goldfarb","startTime":351.51,"endTime":354.06,"body":"would add that one of the things"},{"speaker":"Charles Goldfarb","startTime":351.51,"endTime":354.06,"body":"that Chris and I are struggling"},{"speaker":"Charles Goldfarb","startTime":354.06,"endTime":357.63,"body":"with, that maybe our listeners"},{"speaker":"Charles Goldfarb","startTime":354.06,"endTime":357.63,"body":"could help us we've surveyed a"},{"speaker":"Charles Goldfarb","startTime":357.63,"endTime":361.38,"body":"few people across the country,"},{"speaker":"Charles Goldfarb","startTime":357.63,"endTime":361.38,"body":"is the idea of truly doing this"},{"speaker":"Charles Goldfarb","startTime":361.38,"endTime":365.25,"body":"in the office in the United"},{"speaker":"Charles Goldfarb","startTime":361.38,"endTime":365.25,"body":"States is tough. It's not the"},{"speaker":"Charles Goldfarb","startTime":365.25,"endTime":367.65,"body":"technical part, because we can"},{"speaker":"Charles Goldfarb","startTime":365.25,"endTime":367.65,"body":"figure that out, which Chris"},{"speaker":"Charles Goldfarb","startTime":367.65,"endTime":371.76,"body":"just said we have, it's dealing"},{"speaker":"Charles Goldfarb","startTime":367.65,"endTime":371.76,"body":"with the payers, because despite"},{"speaker":"Charles Goldfarb","startTime":371.76,"endTime":374.01,"body":"the fact that doing in the"},{"speaker":"Charles Goldfarb","startTime":371.76,"endTime":374.01,"body":"office is the right thing for"},{"speaker":"Charles Goldfarb","startTime":374.01,"endTime":377.73,"body":"the patient, and saves"},{"speaker":"Charles Goldfarb","startTime":374.01,"endTime":377.73,"body":"significant money for the for"},{"speaker":"Charles Goldfarb","startTime":377.73,"endTime":381.6,"body":"the payer and for the system."},{"speaker":"Charles Goldfarb","startTime":377.73,"endTime":381.6,"body":"And potentially for the patient"},{"speaker":"Charles Goldfarb","startTime":381.75,"endTime":387.6,"body":"who doesn't have a big facility"},{"speaker":"Charles Goldfarb","startTime":381.75,"endTime":387.6,"body":"fee or something like that. It's"},{"speaker":"Charles Goldfarb","startTime":387.6,"endTime":392.28,"body":"tough, because there is no fluff"},{"speaker":"Charles Goldfarb","startTime":387.6,"endTime":392.28,"body":"built into the system to allow"},{"speaker":"Charles Goldfarb","startTime":392.28,"endTime":395.97,"body":"any type of assistance with the"},{"speaker":"Charles Goldfarb","startTime":392.28,"endTime":395.97,"body":"cost of doing this outside of"},{"speaker":"Charles Goldfarb","startTime":395.97,"endTime":396.69,"body":"the operating room."},{"speaker":"Chris Dy","startTime":397.35,"endTime":399.12,"body":"Yeah, essentially, we"},{"speaker":"Chris Dy","startTime":397.35,"endTime":399.12,"body":"would need to find a way to"},{"speaker":"Chris Dy","startTime":399.12,"endTime":403.38,"body":"build in a facility fee that"},{"speaker":"Chris Dy","startTime":399.12,"endTime":403.38,"body":"covers at least the base cost of"},{"speaker":"Chris Dy","startTime":403.41,"endTime":406.89,"body":"the instruments, the packs, all"},{"speaker":"Chris Dy","startTime":403.41,"endTime":406.89,"body":"that kind of stuff. And you"},{"speaker":"Chris Dy","startTime":406.89,"endTime":409.02,"body":"know, that facility fee, I"},{"speaker":"Chris Dy","startTime":406.89,"endTime":409.02,"body":"guarantee you is going to be"},{"speaker":"Chris Dy","startTime":409.02,"endTime":413.52,"body":"substantially leaner than what a"},{"speaker":"Chris Dy","startTime":409.02,"endTime":413.52,"body":"facility fee that you know, an"},{"speaker":"Chris Dy","startTime":413.52,"endTime":417.45,"body":"ASC or an outpatient hospital"},{"speaker":"Chris Dy","startTime":413.52,"endTime":417.45,"body":"department would charge. I mean"},{"speaker":"Chris Dy","startTime":417.45,"endTime":420.27,"body":"honestly, I've started to ask"},{"speaker":"Chris Dy","startTime":417.45,"endTime":420.27,"body":"patients about what their out of"},{"speaker":"Chris Dy","startTime":420.27,"endTime":423.66,"body":"pocket is and what the their"},{"speaker":"Chris Dy","startTime":420.27,"endTime":423.66,"body":"bill for the facility was. And"},{"speaker":"Chris Dy","startTime":423.66,"endTime":426.87,"body":"it's staggering. I mean, it's in"},{"speaker":"Chris Dy","startTime":423.66,"endTime":426.87,"body":"multiple 1000s of dollars for"},{"speaker":"Chris Dy","startTime":427.32,"endTime":431.64,"body":"one case I did recently was 10"},{"speaker":"Chris Dy","startTime":427.32,"endTime":431.64,"body":"minutes under local, and it was"},{"speaker":"Chris Dy","startTime":431.67,"endTime":436.71,"body":"a $6,000 charge to the payer for"},{"speaker":"Chris Dy","startTime":431.67,"endTime":436.71,"body":"facility and she had 1200 out of"},{"speaker":"Chris Dy","startTime":436.71,"endTime":441.24,"body":"pocket, which, you know, it"},{"speaker":"Chris Dy","startTime":436.71,"endTime":441.24,"body":"really shows you that I think"},{"speaker":"Chris Dy","startTime":441.24,"endTime":443.94,"body":"this is the right thing to do."},{"speaker":"Chris Dy","startTime":441.24,"endTime":443.94,"body":"And we'll find a way to make it"},{"speaker":"Chris Dy","startTime":443.94,"endTime":445.74,"body":"work, obviously, in the best"},{"speaker":"Chris Dy","startTime":443.94,"endTime":445.74,"body":"interest of the patient."},{"speaker":"Charles Goldfarb","startTime":446.5,"endTime":448.0,"body":"Yeah it's a"},{"speaker":"Charles Goldfarb","startTime":446.5,"endTime":448.0,"body":"really interesting thing again,"},{"speaker":"Charles Goldfarb","startTime":448.0,"endTime":451.84,"body":"all of us, I think every single"},{"speaker":"Charles Goldfarb","startTime":448.0,"endTime":451.84,"body":"person listening recognizes that"},{"speaker":"Charles Goldfarb","startTime":451.84,"endTime":455.5,"body":"our system, our payer system has"},{"speaker":"Charles Goldfarb","startTime":451.84,"endTime":455.5,"body":"challenges. I think the deeper"},{"speaker":"Charles Goldfarb","startTime":455.5,"endTime":458.83,"body":"into the weeds you get often the"},{"speaker":"Charles Goldfarb","startTime":455.5,"endTime":458.83,"body":"more the more challenges you"},{"speaker":"Charles Goldfarb","startTime":458.83,"endTime":461.23,"body":"realize, but we're not here"},{"speaker":"Charles Goldfarb","startTime":458.83,"endTime":461.23,"body":"really to talk about that. We're"},{"speaker":"Charles Goldfarb","startTime":461.23,"endTime":464.41,"body":"here to say that, I think with"},{"speaker":"Charles Goldfarb","startTime":461.23,"endTime":464.41,"body":"Chris's leadership, you know,"},{"speaker":"Charles Goldfarb","startTime":464.41,"endTime":468.43,"body":"doing the WALANT or local only"},{"speaker":"Charles Goldfarb","startTime":464.41,"endTime":468.43,"body":"cases in the OR is a win, don't"},{"speaker":"Charles Goldfarb","startTime":468.43,"endTime":472.06,"body":"get me wrong, that is absolutely"},{"speaker":"Charles Goldfarb","startTime":468.43,"endTime":472.06,"body":"a win. But taking them"},{"speaker":"Charles Goldfarb","startTime":472.09,"endTime":474.79,"body":"completely out of your"},{"speaker":"Charles Goldfarb","startTime":472.09,"endTime":474.79,"body":"environment brings its own set"},{"speaker":"Charles Goldfarb","startTime":474.79,"endTime":478.18,"body":"of challenges. And I'm happy to"},{"speaker":"Charles Goldfarb","startTime":474.79,"endTime":478.18,"body":"say that due to the pandemic, at"},{"speaker":"Charles Goldfarb","startTime":478.18,"endTime":480.07,"body":"least for the foreseeable"},{"speaker":"Charles Goldfarb","startTime":478.18,"endTime":480.07,"body":"future, we're going to keep"},{"speaker":"Charles Goldfarb","startTime":480.07,"endTime":481.0,"body":"doing these in the clinic."},{"speaker":"Chris Dy","startTime":481.56,"endTime":484.05,"body":"And and the other take"},{"speaker":"Chris Dy","startTime":481.56,"endTime":484.05,"body":"home is that our listeners from"},{"speaker":"Chris Dy","startTime":484.05,"endTime":486.63,"body":"outside the United States will"},{"speaker":"Chris Dy","startTime":484.05,"endTime":486.63,"body":"probably continue to think that"},{"speaker":"Chris Dy","startTime":486.63,"endTime":488.85,"body":"our health care system is"},{"speaker":"Chris Dy","startTime":486.63,"endTime":488.85,"body":"absolutely bonkers. And they're"},{"speaker":"Chris Dy","startTime":488.85,"endTime":489.24,"body":"right."},{"speaker":"Charles Goldfarb","startTime":490.23,"endTime":492.27,"body":"Hopefully they"},{"speaker":"Charles Goldfarb","startTime":490.23,"endTime":492.27,"body":"just hit the fast forward button"},{"speaker":"Charles Goldfarb","startTime":492.27,"endTime":495.33,"body":"they didn't shut off the"},{"speaker":"Charles Goldfarb","startTime":492.27,"endTime":495.33,"body":"podcasts because of this."},{"speaker":"Chris Dy","startTime":495.42,"endTime":497.7,"body":"With all the American"},{"speaker":"Chris Dy","startTime":495.42,"endTime":497.7,"body":"exceptionalism so why don't we"},{"speaker":"Chris Dy","startTime":497.88,"endTime":500.13,"body":"launch into we've had some"},{"speaker":"Chris Dy","startTime":497.88,"endTime":500.13,"body":"really good feedback and some"},{"speaker":"Chris Dy","startTime":500.13,"endTime":501.03,"body":"reviews recently."},{"speaker":"Charles Goldfarb","startTime":501.66,"endTime":505.23,"body":"Yes, yes, we"},{"speaker":"Charles Goldfarb","startTime":501.66,"endTime":505.23,"body":"absolutely have. I liked this"},{"speaker":"Charles Goldfarb","startTime":505.23,"endTime":508.29,"body":"one. But I thoroughly enjoyed"},{"speaker":"Charles Goldfarb","startTime":505.23,"endTime":508.29,"body":"the radial sided wrist pain part"},{"speaker":"Charles Goldfarb","startTime":508.29,"endTime":511.89,"body":"one and two episodes. There was"},{"speaker":"Charles Goldfarb","startTime":508.29,"endTime":511.89,"body":"such great information and"},{"speaker":"Charles Goldfarb","startTime":511.89,"endTime":514.92,"body":"differential diagnosis"},{"speaker":"Charles Goldfarb","startTime":511.89,"endTime":514.92,"body":"rationale, but it was such an"},{"speaker":"Charles Goldfarb","startTime":514.92,"endTime":518.73,"body":"enjoyable listen, I even caught"},{"speaker":"Charles Goldfarb","startTime":514.92,"endTime":518.73,"body":"myself laughing. Probably at us,"},{"speaker":"Charles Goldfarb","startTime":518.73,"endTime":521.76,"body":"Chris but but I shouldn't"},{"speaker":"Charles Goldfarb","startTime":518.73,"endTime":521.76,"body":"editorialize. I cau- I even"},{"speaker":"Charles Goldfarb","startTime":521.76,"endTime":524.1,"body":"caught myself laughing"},{"speaker":"Charles Goldfarb","startTime":521.76,"endTime":524.1,"body":"especially when discussing the"},{"speaker":"Charles Goldfarb","startTime":524.1,"endTime":528.18,"body":"intersection syndrome. I am an"},{"speaker":"Charles Goldfarb","startTime":524.1,"endTime":528.18,"body":"OT beginning to study for and"},{"speaker":"Charles Goldfarb","startTime":528.18,"endTime":531.78,"body":"then it kind of tapers off. But"},{"speaker":"Charles Goldfarb","startTime":528.18,"endTime":531.78,"body":"thank you for that kind review."},{"speaker":"Chris Dy","startTime":532.89,"endTime":537.57,"body":"Probably about the the"},{"speaker":"Chris Dy","startTime":532.89,"endTime":537.57,"body":"footsteps on freshly fallen sn"},{"speaker":"Chris Dy","startTime":537.57,"endTime":540.06,"body":"w. But that was from"},{"speaker":"Charles Goldfarb","startTime":540.33,"endTime":542.76,"body":"Thank you. It"},{"speaker":"Charles Goldfarb","startTime":540.33,"endTime":542.76,"body":"is interesting. We were debating"},{"speaker":"Charles Goldfarb","startTime":542.76,"endTime":545.49,"body":"whether to do that podcast and I"},{"speaker":"Charles Goldfarb","startTime":542.76,"endTime":545.49,"body":"think it worked out well. I"},{"speaker":"Charles Goldfarb","startTime":545.49,"endTime":548.43,"body":"think we're gonna have to try to"},{"speaker":"Charles Goldfarb","startTime":545.49,"endTime":548.43,"body":"think of some different angles"},{"speaker":"Charles Goldfarb","startTime":548.43,"endTime":550.35,"body":"like that. And I'm glad it was"},{"speaker":"Charles Goldfarb","startTime":548.43,"endTime":550.35,"body":"enjoyable at least"},{"speaker":"Chris Dy","startTime":550.35,"endTime":552.6,"body":"It was one that you"},{"speaker":"Chris Dy","startTime":550.35,"endTime":552.6,"body":"you wanted to do. And I said, I"},{"speaker":"Chris Dy","startTime":552.6,"endTime":554.85,"body":"don't know about that. And"},{"speaker":"Chris Dy","startTime":552.6,"endTime":554.85,"body":"you've also wanted to do some"},{"speaker":"Chris Dy","startTime":554.85,"endTime":559.47,"body":"similar episodes on elbow pain."},{"speaker":"Chris Dy","startTime":554.85,"endTime":559.47,"body":"So that's coming in 2021 because"},{"speaker":"Chris Dy","startTime":559.47,"endTime":561.12,"body":"you were right about that one"},{"speaker":"Chris Dy","startTime":559.47,"endTime":561.12,"body":"for sure."},{"speaker":"Charles Goldfarb","startTime":561.18,"endTime":562.86,"body":"It's a trade"},{"speaker":"Charles Goldfarb","startTime":561.18,"endTime":562.86,"body":"we're gonna do more nerve. We're"},{"speaker":"Charles Goldfarb","startTime":562.86,"endTime":565.92,"body":"also gonna do some elbow. Do you"},{"speaker":"Charles Goldfarb","startTime":562.86,"endTime":565.92,"body":"want to share the next one,"},{"speaker":"Charles Goldfarb","startTime":565.92,"endTime":567.06,"body":"which I also loved?"},{"speaker":"Chris Dy","startTime":567.24,"endTime":570.36,"body":"This is a really cool"},{"speaker":"Chris Dy","startTime":567.24,"endTime":570.36,"body":"follow up. And we appreciate"},{"speaker":"Chris Dy","startTime":570.36,"endTime":574.95,"body":"getting it from Sina Babazaday"},{"speaker":"Chris Dy","startTime":570.36,"endTime":574.95,"body":"in Melbourne. Remember we talked"},{"speaker":"Chris Dy","startTime":574.95,"endTime":578.88,"body":"about the six week orthopedic"},{"speaker":"Chris Dy","startTime":574.95,"endTime":578.88,"body":"unit. And Sina actually informed"},{"speaker":"Chris Dy","startTime":578.88,"endTime":581.94,"body":"us that when they're visiting"},{"speaker":"Chris Dy","startTime":578.88,"endTime":581.94,"body":"the UK A few years ago, one of"},{"speaker":"Chris Dy","startTime":581.94,"endTime":585.72,"body":"the older surgeons commented in"},{"speaker":"Chris Dy","startTime":581.94,"endTime":585.72,"body":"that in the 19th century,"},{"speaker":"Chris Dy","startTime":586.14,"endTime":588.75,"body":"orthopedic surgeons would travel"},{"speaker":"Chris Dy","startTime":586.14,"endTime":588.75,"body":"around the country to consult,"},{"speaker":"Chris Dy","startTime":588.78,"endTime":591.42,"body":"they would travel intermittently"},{"speaker":"Chris Dy","startTime":588.78,"endTime":591.42,"body":"to a number of rural locations,"},{"speaker":"Chris Dy","startTime":591.42,"endTime":593.61,"body":"the average time it would take"},{"speaker":"Chris Dy","startTime":591.42,"endTime":593.61,"body":"them to visit the same rural"},{"speaker":"Chris Dy","startTime":593.61,"endTime":597.0,"body":"destination again was six weeks."},{"speaker":"Chris Dy","startTime":593.61,"endTime":597.0,"body":"So hence most things were"},{"speaker":"Chris Dy","startTime":597.0,"endTime":599.76,"body":"treated in six week blocks and"},{"speaker":"Chris Dy","startTime":597.0,"endTime":599.76,"body":"according to him, this is where"},{"speaker":"Chris Dy","startTime":599.76,"endTime":602.91,"body":"the six week orthopedic time"},{"speaker":"Chris Dy","startTime":599.76,"endTime":602.91,"body":"unit came from. So we're"},{"speaker":"Chris Dy","startTime":602.91,"endTime":606.69,"body":"appreciating maybe it is an old"},{"speaker":"Chris Dy","startTime":602.91,"endTime":606.69,"body":"wives tale, but I do like having"},{"speaker":"Chris Dy","startTime":606.69,"endTime":610.65,"body":"a reason to, to do things. So"},{"speaker":"Chris Dy","startTime":606.69,"endTime":610.65,"body":"I'll count this as one."},{"speaker":"Charles Goldfarb","startTime":611.07,"endTime":612.99,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":611.07,"endTime":612.99,"body":"awesome. And I think it's"},{"speaker":"Charles Goldfarb","startTime":612.99,"endTime":615.81,"body":"hilarious. And I'm a fan of"},{"speaker":"Charles Goldfarb","startTime":612.99,"endTime":615.81,"body":"everything historical. So it's"},{"speaker":"Charles Goldfarb","startTime":615.81,"endTime":618.03,"body":"really super interesting. I'm"},{"speaker":"Charles Goldfarb","startTime":615.81,"endTime":618.03,"body":"grateful that we're not"},{"speaker":"Charles Goldfarb","startTime":618.03,"endTime":621.39,"body":"traveling around too much. We're"},{"speaker":"Charles Goldfarb","startTime":618.03,"endTime":621.39,"body":"doing it virtually now with"},{"speaker":"Charles Goldfarb","startTime":621.39,"endTime":624.15,"body":"telehealth but not physically."},{"speaker":"Charles Goldfarb","startTime":621.39,"endTime":624.15,"body":"So that's good news."},{"speaker":"Chris Dy","startTime":624.36,"endTime":627.24,"body":"One more quick thing."},{"speaker":"Chris Dy","startTime":624.36,"endTime":627.24,"body":"I know that one of our listeners"},{"speaker":"Chris Dy","startTime":627.24,"endTime":631.08,"body":"and friends Rob gray in Chicago,"},{"speaker":"Chris Dy","startTime":627.24,"endTime":631.08,"body":"you were catching up on podcast"},{"speaker":"Chris Dy","startTime":631.08,"endTime":633.9,"body":"episodes recently. So Chuck why"},{"speaker":"Chris Dy","startTime":631.08,"endTime":633.9,"body":"don't you read this, this little"},{"speaker":"Chris Dy","startTime":633.9,"endTime":635.73,"body":"anecdote from from Rob."},{"speaker":"Charles Goldfarb","startTime":635.91,"endTime":637.56,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":635.91,"endTime":637.56,"body":"this made Rob laugh. And it"},{"speaker":"Charles Goldfarb","startTime":637.56,"endTime":640.77,"body":"definitely made Chris and I"},{"speaker":"Charles Goldfarb","startTime":637.56,"endTime":640.77,"body":"laugh, it says, and Rob gave us"},{"speaker":"Charles Goldfarb","startTime":640.77,"endTime":643.17,"body":"permission to share this. It"},{"speaker":"Charles Goldfarb","startTime":640.77,"endTime":643.17,"body":"says I'm in the lounge at my"},{"speaker":"Charles Goldfarb","startTime":643.17,"endTime":646.02,"body":"surgery center the other week,"},{"speaker":"Charles Goldfarb","startTime":643.17,"endTime":646.02,"body":"and a rep comes in and asked if"},{"speaker":"Charles Goldfarb","startTime":646.02,"endTime":650.04,"body":"I'm Dr. Gray, she heard a Dr."},{"speaker":"Charles Goldfarb","startTime":646.02,"endTime":650.04,"body":"Gray from Chicago mentioned on"},{"speaker":"Charles Goldfarb","startTime":650.04,"endTime":653.88,"body":"your podcast, and was more than"},{"speaker":"Charles Goldfarb","startTime":650.04,"endTime":653.88,"body":"a little impressed. I have now"},{"speaker":"Charles Goldfarb","startTime":653.88,"endTime":657.81,"body":"reached peak hand surgery fame."},{"speaker":"Charles Goldfarb","startTime":653.88,"endTime":657.81,"body":"Bravo, bravo."},{"speaker":"Chris Dy","startTime":659.43,"endTime":662.97,"body":"So shout out to the"},{"speaker":"Chris Dy","startTime":659.43,"endTime":662.97,"body":"rep from the, in Chicago who"},{"speaker":"Chris Dy","startTime":663.63,"endTime":666.72,"body":"called him Rob Gray for the"},{"speaker":"Chris Dy","startTime":663.63,"endTime":666.72,"body":"podcast. That is awesome. So"},{"speaker":"Chris Dy","startTime":666.72,"endTime":668.34,"body":"thank you for listening, both of"},{"speaker":"Chris Dy","startTime":666.72,"endTime":668.34,"body":"you."},{"speaker":"Charles Goldfarb","startTime":668.58,"endTime":672.36,"body":"That is all"},{"speaker":"Charles Goldfarb","startTime":668.58,"endTime":672.36,"body":"right. Before we jump into our"},{"speaker":"Charles Goldfarb","startTime":672.36,"endTime":676.59,"body":"episode, I do want to say this"},{"speaker":"Charles Goldfarb","startTime":672.36,"endTime":676.59,"body":"partnership with QX md is"},{"speaker":"Charles Goldfarb","startTime":676.59,"endTime":680.85,"body":"interesting. And Chris, and I"},{"speaker":"Charles Goldfarb","startTime":676.59,"endTime":680.85,"body":"weren't sure you know about the"},{"speaker":"Charles Goldfarb","startTime":680.85,"endTime":683.64,"body":"product and weren't sure if kind"},{"speaker":"Charles Goldfarb","startTime":680.85,"endTime":683.64,"body":"of this relationship made sense."},{"speaker":"Charles Goldfarb","startTime":683.82,"endTime":686.1,"body":"It actually has the data is"},{"speaker":"Charles Goldfarb","startTime":683.82,"endTime":686.1,"body":"pretty interesting. They've been"},{"speaker":"Charles Goldfarb","startTime":686.1,"endTime":689.55,"body":"sharing data with us. So I"},{"speaker":"Charles Goldfarb","startTime":686.1,"endTime":689.55,"body":"continue to use the app to"},{"speaker":"Charles Goldfarb","startTime":689.55,"endTime":694.89,"body":"access articles online. And so"},{"speaker":"Charles Goldfarb","startTime":689.55,"endTime":694.89,"body":"our relationship with qx MD has"},{"speaker":"Charles Goldfarb","startTime":694.89,"endTime":698.97,"body":"been really good. And I I"},{"speaker":"Charles Goldfarb","startTime":694.89,"endTime":698.97,"body":"recommend checking out their"},{"speaker":"Charles Goldfarb","startTime":698.97,"endTime":701.34,"body":"product. And again, we're not"},{"speaker":"Charles Goldfarb","startTime":698.97,"endTime":701.34,"body":"paid for saying that I just"},{"speaker":"Charles Goldfarb","startTime":701.34,"endTime":705.27,"body":"think it's a it's a relationship"},{"speaker":"Charles Goldfarb","startTime":701.34,"endTime":705.27,"body":"that has been mutually"},{"speaker":"Charles Goldfarb","startTime":705.27,"endTime":705.84,"body":"beneficial."},{"speaker":"Chris Dy","startTime":706.32,"endTime":709.11,"body":"Shout out qx MD and"},{"speaker":"Chris Dy","startTime":706.32,"endTime":709.11,"body":"then if anybody else wants to"},{"speaker":"Chris Dy","startTime":709.11,"endTime":711.54,"body":"actually pay us, please, please"},{"speaker":"Chris Dy","startTime":709.11,"endTime":711.54,"body":"reach out."},{"speaker":"Charles Goldfarb","startTime":712.23,"endTime":714.06,"body":"We're"},{"speaker":"Charles Goldfarb","startTime":712.23,"endTime":714.06,"body":"desperately seeking our first"},{"speaker":"Charles Goldfarb","startTime":714.36,"endTime":716.01,"body":"actual sponsor."},{"speaker":"Chris Dy","startTime":716.31,"endTime":718.68,"body":"If we get a sponsor, I"},{"speaker":"Chris Dy","startTime":716.31,"endTime":718.68,"body":"guarantee you more mugs will be"},{"speaker":"Chris Dy","startTime":718.68,"endTime":719.46,"body":"flowing out."},{"speaker":"Charles Goldfarb","startTime":720.06,"endTime":720.87,"body":"That's true."},{"speaker":"Chris Dy","startTime":721.14,"endTime":724.17,"body":"Find us a sponsor. So"},{"speaker":"Chris Dy","startTime":721.14,"endTime":724.17,"body":"Chuck, one of the things that"},{"speaker":"Chris Dy","startTime":724.17,"endTime":727.83,"body":"came about in the listener"},{"speaker":"Chris Dy","startTime":724.17,"endTime":727.83,"body":"survey was a request for A. more"},{"speaker":"Chris Dy","startTime":727.83,"endTime":733.23,"body":"nerve and B. more technical"},{"speaker":"Chris Dy","startTime":727.83,"endTime":733.23,"body":"episodes. So let's get into just"},{"speaker":"Chris Dy","startTime":733.23,"endTime":735.99,"body":"the details of nerve repair."},{"speaker":"Charles Goldfarb","startTime":736.38,"endTime":739.41,"body":"Yeah I think,"},{"speaker":"Charles Goldfarb","startTime":736.38,"endTime":739.41,"body":"I'm sorry to interrupt, I was"},{"speaker":"Charles Goldfarb","startTime":739.41,"endTime":742.68,"body":"gonna say I think this is"},{"speaker":"Charles Goldfarb","startTime":739.41,"endTime":742.68,"body":"helpful, because Chris, and I"},{"speaker":"Charles Goldfarb","startTime":743.85,"endTime":747.42,"body":"likely think about some of this"},{"speaker":"Charles Goldfarb","startTime":743.85,"endTime":747.42,"body":"differently. We're obviously"},{"speaker":"Charles Goldfarb","startTime":747.42,"endTime":751.74,"body":"both fellowship trained hand"},{"speaker":"Charles Goldfarb","startTime":747.42,"endTime":751.74,"body":"surgeons. Chris is dedicating"},{"speaker":"Charles Goldfarb","startTime":751.95,"endTime":754.77,"body":"much of his career. I don't want"},{"speaker":"Charles Goldfarb","startTime":751.95,"endTime":754.77,"body":"to overstate it, but nerve is a"},{"speaker":"Charles Goldfarb","startTime":754.77,"endTime":760.02,"body":"passion of his. And for me nerve"},{"speaker":"Charles Goldfarb","startTime":754.77,"endTime":760.02,"body":"is part of what I do. And I have"},{"speaker":"Charles Goldfarb","startTime":760.02,"endTime":763.62,"body":"other passions, like kids and"},{"speaker":"Charles Goldfarb","startTime":760.02,"endTime":763.62,"body":"sports, and I certainly take"},{"speaker":"Charles Goldfarb","startTime":763.62,"endTime":767.43,"body":"care of routine hand surgery. I"},{"speaker":"Charles Goldfarb","startTime":763.62,"endTime":767.43,"body":"don't do plexus, but we have a"},{"speaker":"Charles Goldfarb","startTime":767.43,"endTime":771.09,"body":"very different mindset when it"},{"speaker":"Charles Goldfarb","startTime":767.43,"endTime":771.09,"body":"comes to nerve. And so I'm never"},{"speaker":"Charles Goldfarb","startTime":771.09,"endTime":773.55,"body":"going to suggest that I'm right."},{"speaker":"Charles Goldfarb","startTime":771.09,"endTime":773.55,"body":"And Chris is wrong. But I think"},{"speaker":"Charles Goldfarb","startTime":773.61,"endTime":777.03,"body":"when the literature is gray, we"},{"speaker":"Charles Goldfarb","startTime":773.61,"endTime":777.03,"body":"may differ on how we approach"},{"speaker":"Charles Goldfarb","startTime":777.03,"endTime":779.01,"body":"things. So hopefully, that'll be"},{"speaker":"Charles Goldfarb","startTime":777.03,"endTime":779.01,"body":"helpful for the listeners."},{"speaker":"Chris Dy","startTime":779.21,"endTime":782.06,"body":"Yeah, and actually,"},{"speaker":"Chris Dy","startTime":779.21,"endTime":782.06,"body":"one thing I kind of forgot was"},{"speaker":"Chris Dy","startTime":782.06,"endTime":785.72,"body":"that before I started my"},{"speaker":"Chris Dy","startTime":782.06,"endTime":785.72,"body":"practice, there wasn't a lot of"},{"speaker":"Chris Dy","startTime":785.75,"endTime":790.49,"body":"nerve going on in, you know, our"},{"speaker":"Chris Dy","startTime":785.75,"endTime":790.49,"body":"division, because it had just"},{"speaker":"Chris Dy","startTime":790.49,"endTime":794.6,"body":"not been a focus of anybody on"},{"speaker":"Chris Dy","startTime":790.49,"endTime":794.6,"body":"the orthopedic side. And I was"},{"speaker":"Chris Dy","startTime":794.6,"endTime":798.59,"body":"reminded of that when I got an"},{"speaker":"Chris Dy","startTime":794.6,"endTime":798.59,"body":"email from a former washu fellow"},{"speaker":"Chris Dy","startTime":798.59,"endTime":801.59,"body":"who actually was a fellow the"},{"speaker":"Chris Dy","startTime":798.59,"endTime":801.59,"body":"year before me, shout out June."},{"speaker":"Chris Dy","startTime":801.89,"endTime":805.4,"body":"And she had asked for advice on"},{"speaker":"Chris Dy","startTime":801.89,"endTime":805.4,"body":"the case. And I gave her some"},{"speaker":"Chris Dy","startTime":805.4,"endTime":807.41,"body":"advice. And I just kind of"},{"speaker":"Chris Dy","startTime":805.4,"endTime":807.41,"body":"casually said, or you can just"},{"speaker":"Chris Dy","startTime":807.41,"endTime":811.22,"body":"do a nerve transfer. And then in"},{"speaker":"Chris Dy","startTime":807.41,"endTime":811.22,"body":"her response, she had mentioned"},{"speaker":"Chris Dy","startTime":811.22,"endTime":813.71,"body":"that, you know, that just wasn't"},{"speaker":"Chris Dy","startTime":811.22,"endTime":813.71,"body":"part of her training. And I'd"},{"speaker":"Chris Dy","startTime":813.71,"endTime":817.4,"body":"forgotten that before. You know,"},{"speaker":"Chris Dy","startTime":813.71,"endTime":817.4,"body":"the last five years, we just"},{"speaker":"Chris Dy","startTime":817.4,"endTime":819.47,"body":"didn't do a lot of nerve"},{"speaker":"Chris Dy","startTime":817.4,"endTime":819.47,"body":"transfers. So I'm happy to say"},{"speaker":"Chris Dy","startTime":819.47,"endTime":822.05,"body":"that I think that it complements"},{"speaker":"Chris Dy","startTime":819.47,"endTime":822.05,"body":"the fellowship, it doesn't"},{"speaker":"Chris Dy","startTime":822.08,"endTime":825.02,"body":"overrun it. But it is a big"},{"speaker":"Chris Dy","startTime":822.08,"endTime":825.02,"body":"part. And I think a lot of"},{"speaker":"Chris Dy","startTime":825.02,"endTime":827.81,"body":"people, you know, when they come"},{"speaker":"Chris Dy","startTime":825.02,"endTime":827.81,"body":"out into the job market"},{"speaker":"Chris Dy","startTime":828.08,"endTime":831.08,"body":"practices want to hire somebody,"},{"speaker":"Chris Dy","startTime":828.08,"endTime":831.08,"body":"who know how, who knows nerve"},{"speaker":"Chris Dy","startTime":831.08,"endTime":833.84,"body":"and knows how to do nerve"},{"speaker":"Chris Dy","startTime":831.08,"endTime":833.84,"body":"transfers. And to have that in"},{"speaker":"Chris Dy","startTime":833.84,"endTime":836.66,"body":"your back pocket is really"},{"speaker":"Chris Dy","startTime":833.84,"endTime":836.66,"body":"helpful, even if it's not a big"},{"speaker":"Chris Dy","startTime":836.66,"endTime":837.92,"body":"part of your practice."},{"speaker":"Charles Goldfarb","startTime":838.53,"endTime":841.32,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":838.53,"endTime":841.32,"body":"well said, I am going to diverge"},{"speaker":"Charles Goldfarb","startTime":841.32,"endTime":845.13,"body":"a little bit for one quick"},{"speaker":"Charles Goldfarb","startTime":841.32,"endTime":845.13,"body":"story. So I also do a podcast"},{"speaker":"Charles Goldfarb","startTime":845.13,"endTime":849.24,"body":"for the AOA with Alexander"},{"speaker":"Charles Goldfarb","startTime":845.13,"endTime":849.24,"body":"Aleem. And there's a we had a"},{"speaker":"Charles Goldfarb","startTime":849.24,"endTime":852.78,"body":"special guest on this podcast"},{"speaker":"Charles Goldfarb","startTime":849.24,"endTime":852.78,"body":"will drop in a couple weeks."},{"speaker":"Charles Goldfarb","startTime":852.99,"endTime":855.78,"body":"Again, by the AOA, we do"},{"speaker":"Charles Goldfarb","startTime":852.99,"endTime":855.78,"body":"different things for that one,"},{"speaker":"Charles Goldfarb","startTime":855.78,"endTime":858.42,"body":"it's very different than this."},{"speaker":"Charles Goldfarb","startTime":855.78,"endTime":858.42,"body":"But for this one, we had a"},{"speaker":"Charles Goldfarb","startTime":858.48,"endTime":863.31,"body":"guest, Megan Conti Mica who"},{"speaker":"Charles Goldfarb","startTime":858.48,"endTime":863.31,"body":"Chris has a very close"},{"speaker":"Charles Goldfarb","startTime":863.31,"endTime":866.31,"body":"relationship with his side job."},{"speaker":"Charles Goldfarb","startTime":863.31,"endTime":866.31,"body":"I mean, this is both of our"},{"speaker":"Charles Goldfarb","startTime":866.31,"endTime":870.9,"body":"primary focus. This podcast is"},{"speaker":"Charles Goldfarb","startTime":866.31,"endTime":870.9,"body":"the one but Chris does a"},{"speaker":"Charles Goldfarb","startTime":870.9,"endTime":874.86,"body":"wonderful podcast with the hand"},{"speaker":"Charles Goldfarb","startTime":870.9,"endTime":874.86,"body":"society and with Megan, and she"},{"speaker":"Charles Goldfarb","startTime":874.86,"endTime":879.0,"body":"was on as a younger surgeon, I"},{"speaker":"Charles Goldfarb","startTime":874.86,"endTime":879.0,"body":"think she's been in practice"},{"speaker":"Charles Goldfarb","startTime":879.0,"endTime":882.3,"body":"five or six years, and talking"},{"speaker":"Charles Goldfarb","startTime":879.0,"endTime":882.3,"body":"about the challenges of starting"},{"speaker":"Charles Goldfarb","startTime":882.3,"endTime":886.32,"body":"a practice. And the reason I it,"},{"speaker":"Charles Goldfarb","startTime":882.3,"endTime":886.32,"body":"I think it was really great. It"},{"speaker":"Charles Goldfarb","startTime":886.32,"endTime":888.57,"body":"was really fun and understand"},{"speaker":"Charles Goldfarb","startTime":886.32,"endTime":888.57,"body":"why Chris and Megan have such a"},{"speaker":"Charles Goldfarb","startTime":888.57,"endTime":893.76,"body":"good rapport. She's an easy"},{"speaker":"Charles Goldfarb","startTime":888.57,"endTime":893.76,"body":"interview. But the reason I"},{"speaker":"Charles Goldfarb","startTime":893.76,"endTime":896.4,"body":"brought up, I'm bringing it up"},{"speaker":"Charles Goldfarb","startTime":893.76,"endTime":896.4,"body":"now is that I do respect what"},{"speaker":"Charles Goldfarb","startTime":896.4,"endTime":899.55,"body":"Chris has done. And so for those"},{"speaker":"Charles Goldfarb","startTime":896.4,"endTime":899.55,"body":"of you who are residents, or"},{"speaker":"Charles Goldfarb","startTime":899.55,"endTime":903.24,"body":"maybe even students or fellows"},{"speaker":"Charles Goldfarb","startTime":899.55,"endTime":903.24,"body":"going into practice, you know,"},{"speaker":"Charles Goldfarb","startTime":903.24,"endTime":905.73,"body":"there's different ways to think"},{"speaker":"Charles Goldfarb","startTime":903.24,"endTime":905.73,"body":"about how one starts his or her"},{"speaker":"Charles Goldfarb","startTime":905.73,"endTime":909.81,"body":"practice, you can go in and be a"},{"speaker":"Charles Goldfarb","startTime":905.73,"endTime":909.81,"body":"hand surgeon abroad, hand"},{"speaker":"Charles Goldfarb","startTime":909.81,"endTime":911.82,"body":"surgeon, your bread and butter"},{"speaker":"Charles Goldfarb","startTime":909.81,"endTime":911.82,"body":"hand surgeon and do what comes"},{"speaker":"Charles Goldfarb","startTime":911.82,"endTime":914.28,"body":"your way. And that's fine. And"},{"speaker":"Charles Goldfarb","startTime":911.82,"endTime":914.28,"body":"to some extent, no matter who"},{"speaker":"Charles Goldfarb","startTime":914.28,"endTime":917.49,"body":"you are, where you practice, you"},{"speaker":"Charles Goldfarb","startTime":914.28,"endTime":917.49,"body":"have to do some of that. But"},{"speaker":"Charles Goldfarb","startTime":917.49,"endTime":920.34,"body":"then you can find a passion. And"},{"speaker":"Charles Goldfarb","startTime":917.49,"endTime":920.34,"body":"I think when Chris came here, I"},{"speaker":"Charles Goldfarb","startTime":920.34,"endTime":925.95,"body":"don't know that Marty Boyer and"},{"speaker":"Charles Goldfarb","startTime":920.34,"endTime":925.95,"body":"I were super optimistic that he"},{"speaker":"Charles Goldfarb","startTime":925.95,"endTime":930.51,"body":"could carve out a robust nerve"},{"speaker":"Charles Goldfarb","startTime":925.95,"endTime":930.51,"body":"practice. And I think he has, he"},{"speaker":"Charles Goldfarb","startTime":930.51,"endTime":933.36,"body":"has done that. And it is"},{"speaker":"Charles Goldfarb","startTime":930.51,"endTime":933.36,"body":"growing, you know, week by week"},{"speaker":"Charles Goldfarb","startTime":933.36,"endTime":936.24,"body":"and month by month. But there"},{"speaker":"Charles Goldfarb","startTime":933.36,"endTime":936.24,"body":"were challenges in our system"},{"speaker":"Charles Goldfarb","startTime":936.66,"endTime":940.89,"body":"for Chris to be able to do that."},{"speaker":"Charles Goldfarb","startTime":936.66,"endTime":940.89,"body":"But yet, he stuck to his guns,"},{"speaker":"Charles Goldfarb","startTime":940.98,"endTime":944.28,"body":"he understood that it would take"},{"speaker":"Charles Goldfarb","startTime":940.98,"endTime":944.28,"body":"time. And it's been really fun"},{"speaker":"Charles Goldfarb","startTime":944.28,"endTime":946.68,"body":"to watch. And he's done it and"},{"speaker":"Charles Goldfarb","startTime":944.28,"endTime":946.68,"body":"succeeded in many different"},{"speaker":"Charles Goldfarb","startTime":946.68,"endTime":948.45,"body":"ways. And maybe that's a whole"},{"speaker":"Charles Goldfarb","startTime":946.68,"endTime":948.45,"body":"separate episode, because I"},{"speaker":"Charles Goldfarb","startTime":948.45,"endTime":953.1,"body":"think it's awesome what you've"},{"speaker":"Charles Goldfarb","startTime":948.45,"endTime":953.1,"body":"done. Anyways, I'll stop there."},{"speaker":"Chris Dy","startTime":953.96,"endTime":956.48,"body":"Is that the second"},{"speaker":"Chris Dy","startTime":953.96,"endTime":956.48,"body":"part of my Christmas gift? Thank"},{"speaker":"Chris Dy","startTime":956.48,"endTime":960.41,"body":"you, Chuck. That was really nice"},{"speaker":"Chris Dy","startTime":956.48,"endTime":960.41,"body":"of you to say. So let's talk"},{"speaker":"Chris Dy","startTime":960.41,"endTime":964.64,"body":"about a case. So you've got a 32"},{"speaker":"Chris Dy","startTime":960.41,"endTime":964.64,"body":"year old laborer, who had a"},{"speaker":"Chris Dy","startTime":964.64,"endTime":970.07,"body":"crush injury at work. And there"},{"speaker":"Chris Dy","startTime":964.64,"endTime":970.07,"body":"is a median nerve deficit. And"},{"speaker":"Chris Dy","startTime":970.07,"endTime":973.94,"body":"it's a high median nerve"},{"speaker":"Chris Dy","startTime":970.07,"endTime":973.94,"body":"deficit. So you have a loss of"},{"speaker":"Chris Dy","startTime":973.97,"endTime":977.42,"body":"AIN function, and you obviously"},{"speaker":"Chris Dy","startTime":973.97,"endTime":977.42,"body":"have a loss of thenar function,"},{"speaker":"Chris Dy","startTime":977.48,"endTime":981.47,"body":"and you've got a median nerve"},{"speaker":"Chris Dy","startTime":977.48,"endTime":981.47,"body":"deficit, it's a crush injury."},{"speaker":"Chris Dy","startTime":982.01,"endTime":985.43,"body":"How do you think about when you"},{"speaker":"Chris Dy","startTime":982.01,"endTime":985.43,"body":"intervene on that patient? Like"},{"speaker":"Chris Dy","startTime":985.43,"endTime":987.89,"body":"how, you know, very briefly, how"},{"speaker":"Chris Dy","startTime":985.43,"endTime":987.89,"body":"do you think about when the"},{"speaker":"Chris Dy","startTime":987.89,"endTime":990.56,"body":"nerve injury has declared kind"},{"speaker":"Chris Dy","startTime":987.89,"endTime":990.56,"body":"of its prognosis?"},{"speaker":"Charles Goldfarb","startTime":991.49,"endTime":993.47,"body":"Well, I'd like"},{"speaker":"Charles Goldfarb","startTime":991.49,"endTime":993.47,"body":"to say thank you for tossing me"},{"speaker":"Charles Goldfarb","startTime":993.47,"endTime":998.33,"body":"a softball to get this nerve"},{"speaker":"Charles Goldfarb","startTime":993.47,"endTime":998.33,"body":"discussion started. The first"},{"speaker":"Charles Goldfarb","startTime":998.33,"endTime":1001.06,"body":"thing I would do is find Chris's"},{"speaker":"Charles Goldfarb","startTime":998.33,"endTime":1001.06,"body":"number and send the patient"},{"speaker":"Charles Goldfarb","startTime":1001.06,"endTime":1006.43,"body":"over. No, I think, you know,"},{"speaker":"Charles Goldfarb","startTime":1001.06,"endTime":1006.43,"body":"first, obviously, I would try to"},{"speaker":"Charles Goldfarb","startTime":1006.43,"endTime":1009.07,"body":"understand exactly where the"},{"speaker":"Charles Goldfarb","startTime":1006.43,"endTime":1009.07,"body":"crush injury occurred. So for"},{"speaker":"Charles Goldfarb","startTime":1009.07,"endTime":1011.74,"body":"the purposes of this discussion,"},{"speaker":"Charles Goldfarb","startTime":1009.07,"endTime":1011.74,"body":"I hope it's okay, I would assume"},{"speaker":"Charles Goldfarb","startTime":1011.74,"endTime":1017.98,"body":"it's proximal forearm. So you"},{"speaker":"Charles Goldfarb","startTime":1011.74,"endTime":1017.98,"body":"know, if there is even a lot of"},{"speaker":"Charles Goldfarb","startTime":1017.98,"endTime":1020.35,"body":"times in these real crush"},{"speaker":"Charles Goldfarb","startTime":1017.98,"endTime":1020.35,"body":"injuries, industrial crush"},{"speaker":"Charles Goldfarb","startTime":1020.38,"endTime":1023.32,"body":"injuries, there will be a soft"},{"speaker":"Charles Goldfarb","startTime":1020.38,"endTime":1023.32,"body":"tissue component, in addition to"},{"speaker":"Charles Goldfarb","startTime":1023.32,"endTime":1026.59,"body":"the nerve. And depending on what"},{"speaker":"Charles Goldfarb","startTime":1023.32,"endTime":1026.59,"body":"that looks like, I may give that"},{"speaker":"Charles Goldfarb","startTime":1026.59,"endTime":1030.79,"body":"time to heal. But if in, if it"},{"speaker":"Charles Goldfarb","startTime":1026.59,"endTime":1030.79,"body":"is the case, like it might be"},{"speaker":"Charles Goldfarb","startTime":1030.79,"endTime":1034.66,"body":"often I would have the patient."},{"speaker":"Charles Goldfarb","startTime":1030.79,"endTime":1034.66,"body":"If it's been at least three or"},{"speaker":"Charles Goldfarb","startTime":1034.66,"endTime":1037.45,"body":"four weeks, I would send the"},{"speaker":"Charles Goldfarb","startTime":1034.66,"endTime":1037.45,"body":"patient for a nerve study, after"},{"speaker":"Charles Goldfarb","startTime":1037.45,"endTime":1040.57,"body":"a thorough exam, and I'm one of"},{"speaker":"Charles Goldfarb","startTime":1037.45,"endTime":1040.57,"body":"these hand surgeons, and not all"},{"speaker":"Charles Goldfarb","startTime":1040.57,"endTime":1044.5,"body":"of us are like, I like detail. I"},{"speaker":"Charles Goldfarb","startTime":1040.57,"endTime":1044.5,"body":"like minutiae, I like numbers."},{"speaker":"Charles Goldfarb","startTime":1044.5,"endTime":1048.07,"body":"And so I get as much of that"},{"speaker":"Charles Goldfarb","startTime":1044.5,"endTime":1048.07,"body":"done as I can in the office, and"},{"speaker":"Charles Goldfarb","startTime":1048.1,"endTime":1051.49,"body":"have a real discussion with the"},{"speaker":"Charles Goldfarb","startTime":1048.1,"endTime":1051.49,"body":"patient about expectations,"},{"speaker":"Charles Goldfarb","startTime":1051.49,"endTime":1054.7,"body":"crush injuries can be difficult,"},{"speaker":"Charles Goldfarb","startTime":1051.49,"endTime":1054.7,"body":"depending on the ultimate"},{"speaker":"Charles Goldfarb","startTime":1054.7,"endTime":1057.61,"body":"grading, but I send the patient"},{"speaker":"Charles Goldfarb","startTime":1054.7,"endTime":1057.61,"body":"for a nerve study at that first"},{"speaker":"Charles Goldfarb","startTime":1057.61,"endTime":1059.56,"body":"visit, ideally, and you?"},{"speaker":"Chris Dy","startTime":1059.0,"endTime":1064.34,"body":"Yah, I like, like many"},{"speaker":"Chris Dy","startTime":1059.0,"endTime":1064.34,"body":"hand surgeons, I will say, I"},{"speaker":"Chris Dy","startTime":1064.34,"endTime":1067.94,"body":"like data. And I think a lot of"},{"speaker":"Chris Dy","startTime":1064.34,"endTime":1067.94,"body":"us have this attention to detail"},{"speaker":"Chris Dy","startTime":1067.94,"endTime":1071.24,"body":"complex. And it's probably the"},{"speaker":"Chris Dy","startTime":1067.94,"endTime":1071.24,"body":"exception, the hand surgeon that"},{"speaker":"Chris Dy","startTime":1071.24,"endTime":1074.99,"body":"doesn't, I will get a six week"},{"speaker":"Chris Dy","startTime":1071.24,"endTime":1074.99,"body":"study if I can, unless it's a"},{"speaker":"Chris Dy","startTime":1074.99,"endTime":1077.18,"body":"self pay kind of situation,"},{"speaker":"Chris Dy","startTime":1074.99,"endTime":1077.18,"body":"which, you know, unfortunately,"},{"speaker":"Chris Dy","startTime":1077.18,"endTime":1080.63,"body":"it comes up a reasonable amount."},{"speaker":"Chris Dy","startTime":1077.18,"endTime":1080.63,"body":"Because I want to be able to"},{"speaker":"Chris Dy","startTime":1080.63,"endTime":1083.57,"body":"compare something, have another"},{"speaker":"Chris Dy","startTime":1080.63,"endTime":1083.57,"body":"data point to triangulate with"},{"speaker":"Chris Dy","startTime":1083.57,"endTime":1087.59,"body":"the examination. And then I will"},{"speaker":"Chris Dy","startTime":1083.57,"endTime":1087.59,"body":"typically get a three month"},{"speaker":"Chris Dy","startTime":1087.59,"endTime":1089.78,"body":"exam, you know, there are a"},{"speaker":"Chris Dy","startTime":1087.59,"endTime":1089.78,"body":"couple of things that might"},{"speaker":"Chris Dy","startTime":1089.78,"endTime":1093.38,"body":"change and accelerate that"},{"speaker":"Chris Dy","startTime":1089.78,"endTime":1093.38,"body":"treatment algorithm if you know,"},{"speaker":"Chris Dy","startTime":1093.38,"endTime":1096.53,"body":"somebody has explored the nerve,"},{"speaker":"Chris Dy","startTime":1093.38,"endTime":1096.53,"body":"and it's told me that it is, you"},{"speaker":"Chris Dy","startTime":1096.53,"endTime":1099.29,"body":"know, not intact, that just"},{"speaker":"Chris Dy","startTime":1096.53,"endTime":1099.29,"body":"speeds things up and makes my"},{"speaker":"Chris Dy","startTime":1099.29,"endTime":1103.61,"body":"life a lot easier. But in this"},{"speaker":"Chris Dy","startTime":1099.29,"endTime":1103.61,"body":"particular situation, say it's a"},{"speaker":"Chris Dy","startTime":1103.97,"endTime":1107.39,"body":"crush injury with a reasonable"},{"speaker":"Chris Dy","startTime":1103.97,"endTime":1107.39,"body":"soft tissue envelope, and nobody"},{"speaker":"Chris Dy","startTime":1107.39,"endTime":1110.12,"body":"has intervened. I will wait, get"},{"speaker":"Chris Dy","startTime":1107.39,"endTime":1110.12,"body":"a six week study and usually get"},{"speaker":"Chris Dy","startTime":1110.12,"endTime":1112.55,"body":"a three month study, of course"},{"speaker":"Chris Dy","startTime":1110.12,"endTime":1112.55,"body":"doing an exam the whole time."},{"speaker":"Charles Goldfarb","startTime":1113.21,"endTime":1115.85,"body":"A couple"},{"speaker":"Charles Goldfarb","startTime":1113.21,"endTime":1115.85,"body":"questions. Tell me whether this"},{"speaker":"Charles Goldfarb","startTime":1115.85,"endTime":1119.09,"body":"is dogma, or this is fact. But"},{"speaker":"Charles Goldfarb","startTime":1115.85,"endTime":1119.09,"body":"you said a six week study, not a"},{"speaker":"Charles Goldfarb","startTime":1119.09,"endTime":1123.32,"body":"three week study. So there is"},{"speaker":"Charles Goldfarb","startTime":1119.09,"endTime":1123.32,"body":"dogma, I think it's dogma that"},{"speaker":"Charles Goldfarb","startTime":1123.32,"endTime":1125.72,"body":"says three weeks is a good time"},{"speaker":"Charles Goldfarb","startTime":1123.32,"endTime":1125.72,"body":"to get a study. And I think"},{"speaker":"Charles Goldfarb","startTime":1125.72,"endTime":1128.72,"body":"there are some some real reasons"},{"speaker":"Charles Goldfarb","startTime":1125.72,"endTime":1128.72,"body":"for that. But tell us why you"},{"speaker":"Charles Goldfarb","startTime":1128.72,"endTime":1129.68,"body":"said six weeks."},{"speaker":"Chris Dy","startTime":1130.32,"endTime":1131.97,"body":"Um, because I don't"},{"speaker":"Chris Dy","startTime":1130.32,"endTime":1131.97,"body":"think a three week study is"},{"speaker":"Chris Dy","startTime":1131.97,"endTime":1136.68,"body":"going to help you that much."},{"speaker":"Chris Dy","startTime":1131.97,"endTime":1136.68,"body":"Because I'm not I can, I am"},{"speaker":"Chris Dy","startTime":1136.68,"endTime":1139.77,"body":"fairly confident and many of our"},{"speaker":"Chris Dy","startTime":1136.68,"endTime":1139.77,"body":"listeners can do the same thing,"},{"speaker":"Chris Dy","startTime":1140.13,"endTime":1144.18,"body":"make the diagnosis purely on"},{"speaker":"Chris Dy","startTime":1140.13,"endTime":1144.18,"body":"clinical exam. So I'm not"},{"speaker":"Chris Dy","startTime":1144.18,"endTime":1147.45,"body":"looking to make a diagnosis of a"},{"speaker":"Chris Dy","startTime":1144.18,"endTime":1147.45,"body":"nerve injury. I'm trying to"},{"speaker":"Chris Dy","startTime":1147.45,"endTime":1151.11,"body":"prognosticate. And a three week"},{"speaker":"Chris Dy","startTime":1147.45,"endTime":1151.11,"body":"study gives me nothing in terms"},{"speaker":"Chris Dy","startTime":1151.11,"endTime":1156.93,"body":"of prognosis, a six week study"},{"speaker":"Chris Dy","startTime":1151.11,"endTime":1156.93,"body":"will. And it's really the three"},{"speaker":"Chris Dy","startTime":1156.93,"endTime":1159.99,"body":"month study that I think will"},{"speaker":"Chris Dy","startTime":1156.93,"endTime":1159.99,"body":"tell the story. You know, again,"},{"speaker":"Chris Dy","startTime":1159.99,"endTime":1162.36,"body":"we're not talking about Plexus."},{"speaker":"Chris Dy","startTime":1159.99,"endTime":1162.36,"body":"Plexus is a different kind of"},{"speaker":"Chris Dy","startTime":1162.36,"endTime":1164.31,"body":"deal in terms of avulsion"},{"speaker":"Chris Dy","startTime":1162.36,"endTime":1164.31,"body":"injuries, that kind of thing,"},{"speaker":"Chris Dy","startTime":1164.31,"endTime":1169.26,"body":"but a branch type peripheral"},{"speaker":"Chris Dy","startTime":1164.31,"endTime":1169.26,"body":"nerve injury. The six week study"},{"speaker":"Chris Dy","startTime":1169.26,"endTime":1172.89,"body":"is helpful not required the"},{"speaker":"Chris Dy","startTime":1169.26,"endTime":1172.89,"body":"three month studie is where I"},{"speaker":"Chris Dy","startTime":1172.89,"endTime":1175.83,"body":"think the biggest difference is"},{"speaker":"Chris Dy","startTime":1172.89,"endTime":1175.83,"body":"made. And most people will say"},{"speaker":"Chris Dy","startTime":1175.83,"endTime":1179.31,"body":"if you have some kind of motor"},{"speaker":"Chris Dy","startTime":1175.83,"endTime":1179.31,"body":"units present on the EMG part by"},{"speaker":"Chris Dy","startTime":1179.31,"endTime":1182.43,"body":"the three month study that you"},{"speaker":"Chris Dy","startTime":1179.31,"endTime":1182.43,"body":"should have a reasonable"},{"speaker":"Chris Dy","startTime":1182.43,"endTime":1185.88,"body":"outcome. It's really hard to"},{"speaker":"Chris Dy","startTime":1182.43,"endTime":1185.88,"body":"find the literature that"},{"speaker":"Chris Dy","startTime":1185.88,"endTime":1188.61,"body":"supports that. I'm actually"},{"speaker":"Chris Dy","startTime":1185.88,"endTime":1188.61,"body":"writing a review article right"},{"speaker":"Chris Dy","startTime":1188.61,"endTime":1191.58,"body":"now and I'm getting a lot of"},{"speaker":"Chris Dy","startTime":1188.61,"endTime":1191.58,"body":"pushback on you know, the fact"},{"speaker":"Chris Dy","startTime":1191.58,"endTime":1195.51,"body":"that this is dogma, the three"},{"speaker":"Chris Dy","startTime":1191.58,"endTime":1195.51,"body":"month motor unit. And if anybody"},{"speaker":"Chris Dy","startTime":1195.51,"endTime":1197.97,"body":"has an actual citation, it would"},{"speaker":"Chris Dy","startTime":1195.51,"endTime":1197.97,"body":"be really helpful because right"},{"speaker":"Chris Dy","startTime":1197.97,"endTime":1199.92,"body":"now I'm digging in textbooks"},{"speaker":"Chris Dy","startTime":1197.97,"endTime":1199.92,"body":"trying to find it."},{"speaker":"Charles Goldfarb","startTime":1200.61,"endTime":1204.03,"body":"I love it. So"},{"speaker":"Charles Goldfarb","startTime":1200.61,"endTime":1204.03,"body":"a couple other just, not"},{"speaker":"Charles Goldfarb","startTime":1204.03,"endTime":1209.13,"body":"technical, but practical"},{"speaker":"Charles Goldfarb","startTime":1204.03,"endTime":1209.13,"body":"questions. Number one, I assume"},{"speaker":"Charles Goldfarb","startTime":1209.13,"endTime":1212.85,"body":"you tried to have the same"},{"speaker":"Charles Goldfarb","startTime":1209.13,"endTime":1212.85,"body":"person perform the nerve study"},{"speaker":"Charles Goldfarb","startTime":1212.94,"endTime":1214.89,"body":"at six weeks and three months,"},{"speaker":"Charles Goldfarb","startTime":1212.94,"endTime":1214.89,"body":"is that correct?"},{"speaker":"Chris Dy","startTime":1215.57,"endTime":1218.36,"body":"Yes, I try to. And"},{"speaker":"Chris Dy","startTime":1215.57,"endTime":1218.36,"body":"then, you know, usually by the"},{"speaker":"Chris Dy","startTime":1218.36,"endTime":1221.69,"body":"three month mark, I'll also be"},{"speaker":"Chris Dy","startTime":1218.36,"endTime":1221.69,"body":"including some potential donors"},{"speaker":"Chris Dy","startTime":1221.69,"endTime":1224.09,"body":"for nerve transfers. And so if"},{"speaker":"Chris Dy","startTime":1221.69,"endTime":1224.09,"body":"I'm thinking about that in my"},{"speaker":"Chris Dy","startTime":1224.09,"endTime":1226.61,"body":"algorithm, and I have I write on"},{"speaker":"Chris Dy","startTime":1224.09,"endTime":1226.61,"body":"there, specifically potential"},{"speaker":"Chris Dy","startTime":1226.61,"endTime":1229.97,"body":"donor, because even though the"},{"speaker":"Chris Dy","startTime":1226.61,"endTime":1229.97,"body":"person that's doing my studies,"},{"speaker":"Chris Dy","startTime":1230.93,"endTime":1233.6,"body":"is pretty good, and knows what"},{"speaker":"Chris Dy","startTime":1230.93,"endTime":1233.6,"body":"I'm thinking about, you just"},{"speaker":"Chris Dy","startTime":1233.6,"endTime":1236.03,"body":"don't want somebody to not check"},{"speaker":"Chris Dy","startTime":1233.6,"endTime":1236.03,"body":"something because it doesn't"},{"speaker":"Chris Dy","startTime":1236.03,"endTime":1239.93,"body":"help them make the diagnosis."},{"speaker":"Chris Dy","startTime":1236.03,"endTime":1239.93,"body":"Again, we wait, the people that"},{"speaker":"Chris Dy","startTime":1239.93,"endTime":1242.57,"body":"are, you know, most hand"},{"speaker":"Chris Dy","startTime":1239.93,"endTime":1242.57,"body":"surgeons are advanced users of"},{"speaker":"Chris Dy","startTime":1242.57,"endTime":1244.67,"body":"the nerve study, they're not"},{"speaker":"Chris Dy","startTime":1242.57,"endTime":1244.67,"body":"looking to make a diagnosis,"},{"speaker":"Chris Dy","startTime":1244.67,"endTime":1247.73,"body":"they're looking to prognosticate"},{"speaker":"Chris Dy","startTime":1244.67,"endTime":1247.73,"body":"and help figure out what to do"},{"speaker":"Chris Dy","startTime":1247.73,"endTime":1248.33,"body":"for the patient."},{"speaker":"Charles Goldfarb","startTime":1249.05,"endTime":1252.62,"body":"Okay, and then"},{"speaker":"Charles Goldfarb","startTime":1249.05,"endTime":1252.62,"body":"tell us between the six week,"},{"speaker":"Charles Goldfarb","startTime":1252.62,"endTime":1254.15,"body":"and we don't want to get too"},{"speaker":"Charles Goldfarb","startTime":1252.62,"endTime":1254.15,"body":"much on nerve studies, we would"},{"speaker":"Charles Goldfarb","startTime":1254.15,"endTime":1256.4,"body":"probably do an episode on nerve"},{"speaker":"Charles Goldfarb","startTime":1254.15,"endTime":1256.4,"body":"studies. But between the six"},{"speaker":"Charles Goldfarb","startTime":1256.4,"endTime":1259.22,"body":"weeks and three months, what do"},{"speaker":"Charles Goldfarb","startTime":1256.4,"endTime":1259.22,"body":"you see at three months, that"},{"speaker":"Charles Goldfarb","startTime":1259.22,"endTime":1262.73,"body":"screams Wait, things are going"},{"speaker":"Charles Goldfarb","startTime":1259.22,"endTime":1262.73,"body":"to be okay, versus what do you"},{"speaker":"Charles Goldfarb","startTime":1262.73,"endTime":1265.04,"body":"see at three months, that says,"},{"speaker":"Charles Goldfarb","startTime":1262.73,"endTime":1265.04,"body":"Okay, it's time to operate."},{"speaker":"Chris Dy","startTime":1265.69,"endTime":1268.48,"body":"So the complete"},{"speaker":"Chris Dy","startTime":1265.69,"endTime":1268.48,"body":"absence of a motor unit on the"},{"speaker":"Chris Dy","startTime":1268.51,"endTime":1274.48,"body":"EMG for the the muscle that"},{"speaker":"Chris Dy","startTime":1268.51,"endTime":1274.48,"body":"you're trying to, to assess. If"},{"speaker":"Chris Dy","startTime":1274.48,"endTime":1276.88,"body":"there's nothing by three months,"},{"speaker":"Chris Dy","startTime":1274.48,"endTime":1276.88,"body":"I think most of us would say you"},{"speaker":"Chris Dy","startTime":1276.88,"endTime":1279.25,"body":"could probably intervene at that"},{"speaker":"Chris Dy","startTime":1276.88,"endTime":1279.25,"body":"point. There's some controversy"},{"speaker":"Chris Dy","startTime":1279.25,"endTime":1281.89,"body":"there with gunshot wounds, that"},{"speaker":"Chris Dy","startTime":1279.25,"endTime":1281.89,"body":"kind of thing with the classic"},{"speaker":"Chris Dy","startTime":1281.89,"endTime":1286.06,"body":"literature from Omer saying to"},{"speaker":"Chris Dy","startTime":1281.89,"endTime":1286.06,"body":"wait a lot longer. I'm"},{"speaker":"Chris Dy","startTime":1286.06,"endTime":1288.16,"body":"questioning some of that now."},{"speaker":"Chris Dy","startTime":1286.06,"endTime":1288.16,"body":"And I think a lot of people are"},{"speaker":"Chris Dy","startTime":1288.16,"endTime":1293.02,"body":"too. But you know, if if you see"},{"speaker":"Chris Dy","startTime":1288.16,"endTime":1293.02,"body":"one to two motor units at three"},{"speaker":"Chris Dy","startTime":1293.02,"endTime":1297.13,"body":"months, you know, maybe wait a"},{"speaker":"Chris Dy","startTime":1293.02,"endTime":1297.13,"body":"little longer, the single motor"},{"speaker":"Chris Dy","startTime":1297.13,"endTime":1300.97,"body":"unit, I think is not helpful at"},{"speaker":"Chris Dy","startTime":1297.13,"endTime":1300.97,"body":"all. But if you see two to"},{"speaker":"Chris Dy","startTime":1300.97,"endTime":1303.13,"body":"three, that kind of thing. And"},{"speaker":"Chris Dy","startTime":1300.97,"endTime":1303.13,"body":"also it's remember, remember,"},{"speaker":"Chris Dy","startTime":1303.13,"endTime":1305.77,"body":"the EMG is a qualitative"},{"speaker":"Chris Dy","startTime":1303.13,"endTime":1305.77,"body":"assessment of the muscle most of"},{"speaker":"Chris Dy","startTime":1305.77,"endTime":1309.07,"body":"the time, so you have to talk to"},{"speaker":"Chris Dy","startTime":1305.77,"endTime":1309.07,"body":"the person doing the study. And"},{"speaker":"Chris Dy","startTime":1309.1,"endTime":1310.81,"body":"usually they have a pretty good"},{"speaker":"Chris Dy","startTime":1309.1,"endTime":1310.81,"body":"sense of what's going to get"},{"speaker":"Chris Dy","startTime":1310.81,"endTime":1312.85,"body":"better, what's not going to get"},{"speaker":"Chris Dy","startTime":1310.81,"endTime":1312.85,"body":"better, at least from their end."},{"speaker":"Chris Dy","startTime":1313.09,"endTime":1314.02,"body":"How do you think about it?"},{"speaker":"Charles Goldfarb","startTime":1315.2,"endTime":1317.09,"body":"Nothing more"},{"speaker":"Charles Goldfarb","startTime":1315.2,"endTime":1317.09,"body":"sophisticated than that, that's"},{"speaker":"Charles Goldfarb","startTime":1317.09,"endTime":1320.33,"body":"for darn sure. I am looking for"},{"speaker":"Charles Goldfarb","startTime":1317.09,"endTime":1320.33,"body":"the same things you just"},{"speaker":"Charles Goldfarb","startTime":1320.33,"endTime":1323.99,"body":"mentioned. And I'm looking for"},{"speaker":"Charles Goldfarb","startTime":1320.33,"endTime":1323.99,"body":"just improvement in general."},{"speaker":"Charles Goldfarb","startTime":1324.17,"endTime":1327.89,"body":"And, you know, a traumatic"},{"speaker":"Charles Goldfarb","startTime":1324.17,"endTime":1327.89,"body":"injury is certainly different"},{"speaker":"Charles Goldfarb","startTime":1327.89,"endTime":1332.63,"body":"from you know, goes without"},{"speaker":"Charles Goldfarb","startTime":1327.89,"endTime":1332.63,"body":"saying that a traumatic injury"},{"speaker":"Charles Goldfarb","startTime":1332.63,"endTime":1336.32,"body":"is different from a different"},{"speaker":"Charles Goldfarb","startTime":1332.63,"endTime":1336.32,"body":"type of pathology, but I'm"},{"speaker":"Charles Goldfarb","startTime":1336.32,"endTime":1338.36,"body":"looking for the motor units."},{"speaker":"Charles Goldfarb","startTime":1336.32,"endTime":1338.36,"body":"That's what I focus on, for"},{"speaker":"Charles Goldfarb","startTime":1338.36,"endTime":1338.72,"body":"sure."},{"speaker":"Chris Dy","startTime":1339.14,"endTime":1341.54,"body":"So say you're at three"},{"speaker":"Chris Dy","startTime":1339.14,"endTime":1341.54,"body":"months, and you've decided to"},{"speaker":"Chris Dy","startTime":1341.54,"endTime":1346.58,"body":"intervene. And you're exploring"},{"speaker":"Chris Dy","startTime":1341.54,"endTime":1346.58,"body":"the nerve. This is, again, where"},{"speaker":"Chris Dy","startTime":1346.58,"endTime":1350.06,"body":"a lot of dogma and imperfection"},{"speaker":"Chris Dy","startTime":1346.58,"endTime":1350.06,"body":"comes in. How do you assess that"},{"speaker":"Chris Dy","startTime":1350.06,"endTime":1352.7,"body":"nerve? Once you're exposing it?"},{"speaker":"Chris Dy","startTime":1350.06,"endTime":1352.7,"body":"How do you decide? Is it good?"},{"speaker":"Chris Dy","startTime":1352.7,"endTime":1353.39,"body":"Is it not good?"},{"speaker":"Charles Goldfarb","startTime":1354.35,"endTime":1356.96,"body":"What what I'm"},{"speaker":"Charles Goldfarb","startTime":1354.35,"endTime":1356.96,"body":"hoping for. And again, I think"},{"speaker":"Charles Goldfarb","startTime":1356.96,"endTime":1360.86,"body":"this goes without saying is a"},{"speaker":"Charles Goldfarb","startTime":1356.96,"endTime":1360.86,"body":"visual, visual cues on kind of"},{"speaker":"Charles Goldfarb","startTime":1360.86,"endTime":1366.98,"body":"where the pathology exactly is."},{"speaker":"Charles Goldfarb","startTime":1360.86,"endTime":1366.98,"body":"and use those visual cues to"},{"speaker":"Charles Goldfarb","startTime":1366.98,"endTime":1374.81,"body":"help me intervene. I think, for"},{"speaker":"Charles Goldfarb","startTime":1366.98,"endTime":1374.81,"body":"many years that has been, at"},{"speaker":"Charles Goldfarb","startTime":1374.81,"endTime":1377.42,"body":"least in my practice, the way"},{"speaker":"Charles Goldfarb","startTime":1374.81,"endTime":1377.42,"body":"I've handled it, although we do"},{"speaker":"Charles Goldfarb","startTime":1377.42,"endTime":1381.11,"body":"have actual tools in the O R,"},{"speaker":"Charles Goldfarb","startTime":1377.42,"endTime":1381.11,"body":"which can be helpful. So what"},{"speaker":"Charles Goldfarb","startTime":1381.11,"endTime":1384.29,"body":"what do you think about as far"},{"speaker":"Charles Goldfarb","startTime":1381.11,"endTime":1384.29,"body":"as using tools in additional to"},{"speaker":"Charles Goldfarb","startTime":1384.29,"endTime":1385.19,"body":"visual inspection?"},{"speaker":"Chris Dy","startTime":1385.69,"endTime":1388.51,"body":"I mean, it's crazy how"},{"speaker":"Chris Dy","startTime":1385.69,"endTime":1388.51,"body":"we're in 2020, we've been doing"},{"speaker":"Chris Dy","startTime":1388.51,"endTime":1392.86,"body":"microsurgery for 40 or 50 years"},{"speaker":"Chris Dy","startTime":1388.51,"endTime":1392.86,"body":"now. And it's still the look and"},{"speaker":"Chris Dy","startTime":1392.86,"endTime":1396.55,"body":"the feel of the nerve. And, you"},{"speaker":"Chris Dy","startTime":1392.86,"endTime":1396.55,"body":"know, we try to do things like"},{"speaker":"Chris Dy","startTime":1396.55,"endTime":1400.57,"body":"I've used interoperative nerve"},{"speaker":"Chris Dy","startTime":1396.55,"endTime":1400.57,"body":"studies, nerve to nerve action"},{"speaker":"Chris Dy","startTime":1400.57,"endTime":1402.88,"body":"potentials, that kind of thing."},{"speaker":"Chris Dy","startTime":1400.57,"endTime":1402.88,"body":"When it works, it's really"},{"speaker":"Chris Dy","startTime":1402.88,"endTime":1405.94,"body":"helpful, but it doesn't always"},{"speaker":"Chris Dy","startTime":1402.88,"endTime":1405.94,"body":"work. And there's a highly"},{"speaker":"Chris Dy","startTime":1405.94,"endTime":1409.66,"body":"variable technical component to"},{"speaker":"Chris Dy","startTime":1405.94,"endTime":1409.66,"body":"it, where some places like Mayo"},{"speaker":"Chris Dy","startTime":1409.66,"endTime":1412.84,"body":"and LSU have made it work really"},{"speaker":"Chris Dy","startTime":1409.66,"endTime":1412.84,"body":"well. It just doesn't work"},{"speaker":"Chris Dy","startTime":1412.84,"endTime":1416.77,"body":"reliably for me. I'll still use"},{"speaker":"Chris Dy","startTime":1412.84,"endTime":1416.77,"body":"it. I'd also use a handheld"},{"speaker":"Chris Dy","startTime":1416.77,"endTime":1419.47,"body":"nerve stimulator. You know,"},{"speaker":"Chris Dy","startTime":1416.77,"endTime":1419.47,"body":"there are obviously"},{"speaker":"Chris Dy","startTime":1419.47,"endTime":1422.8,"body":"considerations in the extremity."},{"speaker":"Chris Dy","startTime":1419.47,"endTime":1422.8,"body":"We like to use a tourniquet and"},{"speaker":"Chris Dy","startTime":1422.8,"endTime":1425.08,"body":"you know, you have a limitation"},{"speaker":"Chris Dy","startTime":1422.8,"endTime":1425.08,"body":"before you get tourniquet"},{"speaker":"Chris Dy","startTime":1425.08,"endTime":1427.75,"body":"related ischemia and your nerve"},{"speaker":"Chris Dy","startTime":1425.08,"endTime":1427.75,"body":"stimulator is not particularly"},{"speaker":"Chris Dy","startTime":1427.75,"endTime":1431.92,"body":"helpful. So when I'm planning"},{"speaker":"Chris Dy","startTime":1427.75,"endTime":1431.92,"body":"out my case, and I'm"},{"speaker":"Chris Dy","startTime":1431.92,"endTime":1435.19,"body":"orchestrating it in my head, I"},{"speaker":"Chris Dy","startTime":1431.92,"endTime":1435.19,"body":"like to plan out the steps where"},{"speaker":"Chris Dy","startTime":1435.19,"endTime":1439.06,"body":"I have to use a nerve"},{"speaker":"Chris Dy","startTime":1435.19,"endTime":1439.06,"body":"stimulator, if I'm going to. And"},{"speaker":"Chris Dy","startTime":1439.06,"endTime":1441.46,"body":"that happens pretty quickly."},{"speaker":"Chris Dy","startTime":1439.06,"endTime":1441.46,"body":"Early on in the case, we think"},{"speaker":"Chris Dy","startTime":1441.46,"endTime":1444.55,"body":"it's probably 30 minutes, maybe"},{"speaker":"Chris Dy","startTime":1441.46,"endTime":1444.55,"body":"45 minutes before that ischemia"},{"speaker":"Chris Dy","startTime":1444.55,"endTime":1448.42,"body":"kicks in. But again, its look"},{"speaker":"Chris Dy","startTime":1444.55,"endTime":1448.42,"body":"and feel of the nerve, and then"},{"speaker":"Chris Dy","startTime":1448.42,"endTime":1449.83,"body":"eventually you got to cut into"},{"speaker":"Chris Dy","startTime":1448.42,"endTime":1449.83,"body":"it."},{"speaker":"Charles Goldfarb","startTime":1450.71,"endTime":1453.92,"body":"So do you have"},{"speaker":"Charles Goldfarb","startTime":1450.71,"endTime":1453.92,"body":"a preferred nerve stimulator?"},{"speaker":"Charles Goldfarb","startTime":1453.92,"endTime":1455.87,"body":"And I know you don't have"},{"speaker":"Charles Goldfarb","startTime":1453.92,"endTime":1455.87,"body":"relationships with any of these"},{"speaker":"Charles Goldfarb","startTime":1455.87,"endTime":1457.73,"body":"companies? Or do you think it"},{"speaker":"Charles Goldfarb","startTime":1455.87,"endTime":1457.73,"body":"matters?"},{"speaker":"Chris Dy","startTime":1458.51,"endTime":1460.43,"body":"I think it does"},{"speaker":"Chris Dy","startTime":1458.51,"endTime":1460.43,"body":"matter. I do like the checkpoint"},{"speaker":"Chris Dy","startTime":1460.43,"endTime":1463.58,"body":"product. And I don't have a"},{"speaker":"Chris Dy","startTime":1460.43,"endTime":1463.58,"body":"relationship yet. But we are"},{"speaker":"Chris Dy","startTime":1463.58,"endTime":1465.89,"body":"actually going to do some funded"},{"speaker":"Chris Dy","startTime":1463.58,"endTime":1465.89,"body":"research for checkpoint"},{"speaker":"Chris Dy","startTime":1465.89,"endTime":1469.4,"body":"specifically on the question of"},{"speaker":"Chris Dy","startTime":1465.89,"endTime":1469.4,"body":"tourniquet related ischemia. So"},{"speaker":"Chris Dy","startTime":1469.4,"endTime":1472.16,"body":"that disclosure is actually I"},{"speaker":"Chris Dy","startTime":1469.4,"endTime":1472.16,"body":"think it's going to be David's,"},{"speaker":"Chris Dy","startTime":1472.49,"endTime":1476.78,"body":"but I will be a co investigator"},{"speaker":"Chris Dy","startTime":1472.49,"endTime":1476.78,"body":"on that but but, you know, I've"},{"speaker":"Chris Dy","startTime":1476.78,"endTime":1479.48,"body":"tried the other stimulators and"},{"speaker":"Chris Dy","startTime":1476.78,"endTime":1479.48,"body":"have not found them to be as"},{"speaker":"Chris Dy","startTime":1479.48,"endTime":1481.85,"body":"helpful and I've heard others"},{"speaker":"Chris Dy","startTime":1479.48,"endTime":1481.85,"body":"say the same thing."},{"speaker":"Charles Goldfarb","startTime":1482.44,"endTime":1484.42,"body":"That's"},{"speaker":"Charles Goldfarb","startTime":1482.44,"endTime":1484.42,"body":"awesome. And I don't again, have"},{"speaker":"Charles Goldfarb","startTime":1484.42,"endTime":1486.7,"body":"near the volume that you do in"},{"speaker":"Charles Goldfarb","startTime":1484.42,"endTime":1486.7,"body":"this in this realm, but I've"},{"speaker":"Charles Goldfarb","startTime":1486.7,"endTime":1489.7,"body":"used the same and been happy"},{"speaker":"Charles Goldfarb","startTime":1486.7,"endTime":1489.7,"body":"with it, but also, again, being"},{"speaker":"Charles Goldfarb","startTime":1489.7,"endTime":1492.94,"body":"a less experienced nerve person."},{"speaker":"Charles Goldfarb","startTime":1489.7,"endTime":1492.94,"body":"I probably have experienced even"},{"speaker":"Charles Goldfarb","startTime":1492.94,"endTime":1496.09,"body":"more frustration around, you"},{"speaker":"Charles Goldfarb","startTime":1492.94,"endTime":1496.09,"body":"know, this thing isn't working."},{"speaker":"Charles Goldfarb","startTime":1496.12,"endTime":1498.25,"body":"What the heck's going on, you"},{"speaker":"Charles Goldfarb","startTime":1496.12,"endTime":1498.25,"body":"know, that kind of thing, which"},{"speaker":"Charles Goldfarb","startTime":1498.49,"endTime":1502.24,"body":"probably is user. At least to"},{"speaker":"Charles Goldfarb","startTime":1498.49,"endTime":1502.24,"body":"some degree, but but that's"},{"speaker":"Charles Goldfarb","startTime":1502.24,"endTime":1502.87,"body":"reality."},{"speaker":"Chris Dy","startTime":1503.23,"endTime":1505.57,"body":"You know, one thing"},{"speaker":"Chris Dy","startTime":1503.23,"endTime":1505.57,"body":"that I've realized is that when"},{"speaker":"Chris Dy","startTime":1505.57,"endTime":1508.84,"body":"the trainees come in, they often"},{"speaker":"Chris Dy","startTime":1505.57,"endTime":1508.84,"body":"pretend like they know how to"},{"speaker":"Chris Dy","startTime":1508.84,"endTime":1511.33,"body":"use nerve stimulator and how it"},{"speaker":"Chris Dy","startTime":1508.84,"endTime":1511.33,"body":"works. And they usually don't"},{"speaker":"Chris Dy","startTime":1511.33,"endTime":1514.06,"body":"know completely. So I tried to"},{"speaker":"Chris Dy","startTime":1511.33,"endTime":1514.06,"body":"make a point, especially with"},{"speaker":"Chris Dy","startTime":1514.06,"endTime":1516.7,"body":"the residents to show them to"},{"speaker":"Chris Dy","startTime":1514.06,"endTime":1516.7,"body":"make sure they know how you know"},{"speaker":"Chris Dy","startTime":1516.7,"endTime":1518.86,"body":"what light's supposed to be"},{"speaker":"Chris Dy","startTime":1516.7,"endTime":1518.86,"body":"blinking, when you know, it's"},{"speaker":"Chris Dy","startTime":1518.86,"endTime":1521.86,"body":"stimulating and the different"},{"speaker":"Chris Dy","startTime":1518.86,"endTime":1521.86,"body":"components of it and how to"},{"speaker":"Chris Dy","startTime":1521.86,"endTime":1524.74,"body":"troubleshoot it, that kind of"},{"speaker":"Chris Dy","startTime":1521.86,"endTime":1524.74,"body":"thing. Because, again, like"},{"speaker":"Chris Dy","startTime":1524.74,"endTime":1527.56,"body":"that's that stuff that like"},{"speaker":"Chris Dy","startTime":1524.74,"endTime":1527.56,"body":"nobody ever teaches you unless"},{"speaker":"Chris Dy","startTime":1527.56,"endTime":1529.75,"body":"you sit down and read the"},{"speaker":"Chris Dy","startTime":1527.56,"endTime":1529.75,"body":"manual, which not everybody"},{"speaker":"Chris Dy","startTime":1529.75,"endTime":1530.11,"body":"will,"},{"speaker":"Charles Goldfarb","startTime":1530.39,"endTime":1532.67,"body":"yeah, it's"},{"speaker":"Charles Goldfarb","startTime":1530.39,"endTime":1532.67,"body":"super easy to get a trainee to"},{"speaker":"Charles Goldfarb","startTime":1532.67,"endTime":1535.82,"body":"read the manual for an ulnar"},{"speaker":"Charles Goldfarb","startTime":1532.67,"endTime":1535.82,"body":"shortening osteotomy it is less"},{"speaker":"Charles Goldfarb","startTime":1535.82,"endTime":1539.12,"body":"easy to get the this kind of"},{"speaker":"Charles Goldfarb","startTime":1535.82,"endTime":1539.12,"body":"manual read."},{"speaker":"Chris Dy","startTime":1539.12,"endTime":1541.49,"body":"Well, they're usually"},{"speaker":"Chris Dy","startTime":1539.12,"endTime":1541.49,"body":"reading different things when"},{"speaker":"Chris Dy","startTime":1541.49,"endTime":1543.38,"body":"they're prepping for a nerve"},{"speaker":"Chris Dy","startTime":1541.49,"endTime":1543.38,"body":"case with me, I'll tell you"},{"speaker":"Chris Dy","startTime":1543.44,"endTime":1543.89,"body":"that."},{"speaker":"Charles Goldfarb","startTime":1544.1,"endTime":1547.58,"body":"Yes, agreed."},{"speaker":"Charles Goldfarb","startTime":1544.1,"endTime":1547.58,"body":"All right. So let's just say we"},{"speaker":"Charles Goldfarb","startTime":1547.58,"endTime":1550.52,"body":"find the area that's and what"},{"speaker":"Charles Goldfarb","startTime":1547.58,"endTime":1550.52,"body":"are you looking for feel? Is it"},{"speaker":"Charles Goldfarb","startTime":1550.52,"endTime":1555.14,"body":"woodiness? Whatever that means?"},{"speaker":"Charles Goldfarb","startTime":1550.52,"endTime":1555.14,"body":"Is it lack of just the softness?"},{"speaker":"Charles Goldfarb","startTime":1555.14,"endTime":1559.13,"body":"And the Yeah, what are the words"},{"speaker":"Charles Goldfarb","startTime":1555.14,"endTime":1559.13,"body":"you use or the what kind of"},{"speaker":"Charles Goldfarb","startTime":1559.13,"endTime":1559.52,"body":"visual?"},{"speaker":"Chris Dy","startTime":1559.54,"endTime":1562.27,"body":"Yeah, I mean, it's all"},{"speaker":"Chris Dy","startTime":1559.54,"endTime":1562.27,"body":"it's all of that. So you know,"},{"speaker":"Chris Dy","startTime":1562.33,"endTime":1565.45,"body":"obviously, you're exposing"},{"speaker":"Chris Dy","startTime":1562.33,"endTime":1565.45,"body":"healthy nerve as well. So that"},{"speaker":"Chris Dy","startTime":1565.45,"endTime":1567.79,"body":"gives you a good sense. And when"},{"speaker":"Chris Dy","startTime":1565.45,"endTime":1567.79,"body":"you can feel that transition"},{"speaker":"Chris Dy","startTime":1567.79,"endTime":1570.49,"body":"point. And again, because it's"},{"speaker":"Chris Dy","startTime":1567.79,"endTime":1570.49,"body":"such a subjective thing, I make"},{"speaker":"Chris Dy","startTime":1570.49,"endTime":1575.14,"body":"sure the trainee feels it too."},{"speaker":"Chris Dy","startTime":1570.49,"endTime":1575.14,"body":"And you will typically feel that"},{"speaker":"Chris Dy","startTime":1575.2,"endTime":1578.89,"body":"the transition point and, and"},{"speaker":"Chris Dy","startTime":1575.2,"endTime":1578.89,"body":"honestly, that's when you just"},{"speaker":"Chris Dy","startTime":1578.89,"endTime":1583.33,"body":"start cutting, because there are"},{"speaker":"Chris Dy","startTime":1578.89,"endTime":1583.33,"body":"some cases in which you can do a"},{"speaker":"Chris Dy","startTime":1583.33,"endTime":1586.51,"body":"very elegant, internal"},{"speaker":"Chris Dy","startTime":1583.33,"endTime":1586.51,"body":"neurolysis and fascicular"},{"speaker":"Chris Dy","startTime":1586.51,"endTime":1592.45,"body":"dissection. But those cases are"},{"speaker":"Chris Dy","startTime":1586.51,"endTime":1592.45,"body":"few and far in between. But"},{"speaker":"Chris Dy","startTime":1592.45,"endTime":1595.03,"body":"sometimes I'll do that, you"},{"speaker":"Chris Dy","startTime":1592.45,"endTime":1595.03,"body":"know, particularly if I know"},{"speaker":"Chris Dy","startTime":1595.03,"endTime":1600.31,"body":"it's a neuroma incontinuity. And"},{"speaker":"Chris Dy","startTime":1595.03,"endTime":1600.31,"body":"I maybe can just leave some of"},{"speaker":"Chris Dy","startTime":1600.31,"endTime":1605.26,"body":"those fascicles intact. But once"},{"speaker":"Chris Dy","startTime":1600.31,"endTime":1605.26,"body":"you start doing your unblock"},{"speaker":"Chris Dy","startTime":1605.8,"endTime":1609.46,"body":"resection, I think you'll have a"},{"speaker":"Chris Dy","startTime":1605.8,"endTime":1609.46,"body":"better sense. And I think you"},{"speaker":"Chris Dy","startTime":1609.46,"endTime":1612.31,"body":"have to cut into the nerve to"},{"speaker":"Chris Dy","startTime":1609.46,"endTime":1612.31,"body":"really know, some of one of our"},{"speaker":"Chris Dy","startTime":1612.31,"endTime":1615.79,"body":"partners David Brogan is doing a"},{"speaker":"Chris Dy","startTime":1612.31,"endTime":1615.79,"body":"lot of work on interoperative"},{"speaker":"Chris Dy","startTime":1615.79,"endTime":1619.03,"body":"nerve assessments. But you know,"},{"speaker":"Chris Dy","startTime":1615.79,"endTime":1619.03,"body":"those assessments are, you know,"},{"speaker":"Chris Dy","startTime":1619.03,"endTime":1621.76,"body":"going to be off probably another"},{"speaker":"Chris Dy","startTime":1619.03,"endTime":1621.76,"body":"5-10 years."},{"speaker":"Charles Goldfarb","startTime":1622.3,"endTime":1623.77,"body":"Objective"},{"speaker":"Charles Goldfarb","startTime":1622.3,"endTime":1623.77,"body":"assessments"},{"speaker":"Chris Dy","startTime":1624.07,"endTime":1626.23,"body":"Objective assessments"},{"speaker":"Chris Dy","startTime":1624.07,"endTime":1626.23,"body":"using some really interesting"},{"speaker":"Chris Dy","startTime":1626.68,"endTime":1630.01,"body":"imaging techniques, and, you"},{"speaker":"Chris Dy","startTime":1626.68,"endTime":1630.01,"body":"know, really cool stuff that"},{"speaker":"Chris Dy","startTime":1630.46,"endTime":1632.17,"body":"he'll probably start to publish"},{"speaker":"Chris Dy","startTime":1630.46,"endTime":1632.17,"body":"in a couple years."},{"speaker":"Charles Goldfarb","startTime":1632.41,"endTime":1634.33,"body":"Yeah, I agree."},{"speaker":"Charles Goldfarb","startTime":1632.41,"endTime":1634.33,"body":"It's really, really interesting"},{"speaker":"Charles Goldfarb","startTime":1634.9,"endTime":1638.95,"body":"information. So all right. So"},{"speaker":"Charles Goldfarb","startTime":1634.9,"endTime":1638.95,"body":"you know, to me, someone says"},{"speaker":"Charles Goldfarb","startTime":1638.95,"endTime":1641.68,"body":"cut the nerve. So I ask for my"},{"speaker":"Charles Goldfarb","startTime":1638.95,"endTime":1641.68,"body":"big mayo scissors. Is that the"},{"speaker":"Charles Goldfarb","startTime":1641.68,"endTime":1642.4,"body":"right approach?"},{"speaker":"Chris Dy","startTime":1643.29,"endTime":1646.98,"body":"It depends, are you"},{"speaker":"Chris Dy","startTime":1643.29,"endTime":1646.98,"body":"going to cut it again? So you"},{"speaker":"Chris Dy","startTime":1646.98,"endTime":1650.52,"body":"know, one of our partners, Marty"},{"speaker":"Chris Dy","startTime":1646.98,"endTime":1650.52,"body":"likes to discuss how scissors"},{"speaker":"Chris Dy","startTime":1650.52,"endTime":1654.15,"body":"are designed to crush tissue."},{"speaker":"Chris Dy","startTime":1650.52,"endTime":1654.15,"body":"That's how scissors work, right?"},{"speaker":"Chris Dy","startTime":1654.45,"endTime":1657.3,"body":"So you know, yeah, I'll cut a"},{"speaker":"Chris Dy","startTime":1654.45,"endTime":1657.3,"body":"nerve with scissors, but then"},{"speaker":"Chris Dy","startTime":1657.36,"endTime":1662.07,"body":"I'll re cut the nerve with a"},{"speaker":"Chris Dy","startTime":1657.36,"endTime":1662.07,"body":"blade. So I personally, you"},{"speaker":"Chris Dy","startTime":1662.07,"endTime":1665.1,"body":"know, sometimes it is a matter"},{"speaker":"Chris Dy","startTime":1662.07,"endTime":1665.1,"body":"of expediency to cut with"},{"speaker":"Chris Dy","startTime":1665.1,"endTime":1668.64,"body":"scissors. It kind of depends on"},{"speaker":"Chris Dy","startTime":1665.1,"endTime":1668.64,"body":"the situation, I won't say that"},{"speaker":"Chris Dy","startTime":1668.64,"endTime":1672.9,"body":"it's wrong, but it's not ideal."},{"speaker":"Chris Dy","startTime":1668.64,"endTime":1672.9,"body":"And I prefer the old school"},{"speaker":"Chris Dy","startTime":1672.9,"endTime":1675.81,"body":"tongue depressor, you know,"},{"speaker":"Chris Dy","startTime":1672.9,"endTime":1675.81,"body":"obviously wet the tongue"},{"speaker":"Chris Dy","startTime":1675.81,"endTime":1679.56,"body":"depressor. So the nerve tissue"},{"speaker":"Chris Dy","startTime":1675.81,"endTime":1679.56,"body":"doesn't stick on it. And I like"},{"speaker":"Chris Dy","startTime":1679.56,"endTime":1684.51,"body":"a 10 blade to cut it back with a"},{"speaker":"Chris Dy","startTime":1679.56,"endTime":1684.51,"body":"single, single smooth motion"},{"speaker":"Chris Dy","startTime":1684.51,"endTime":1685.8,"body":"like Dr. Gelberman taught me."},{"speaker":"Charles Goldfarb","startTime":1686.55,"endTime":1689.01,"body":"So this is, I"},{"speaker":"Charles Goldfarb","startTime":1686.55,"endTime":1689.01,"body":"love everything you said, and"},{"speaker":"Charles Goldfarb","startTime":1689.01,"endTime":1695.04,"body":"the details absolutely matter."},{"speaker":"Charles Goldfarb","startTime":1689.01,"endTime":1695.04,"body":"So are you, is it a rocking"},{"speaker":"Charles Goldfarb","startTime":1695.04,"endTime":1699.66,"body":"motion on the nerve? Is it a"},{"speaker":"Charles Goldfarb","startTime":1695.04,"endTime":1699.66,"body":"single, downward directed"},{"speaker":"Charles Goldfarb","startTime":1699.69,"endTime":1702.69,"body":"pressure? How do you cut the"},{"speaker":"Charles Goldfarb","startTime":1699.69,"endTime":1702.69,"body":"nerve with that template."},{"speaker":"Chris Dy","startTime":1703.2,"endTime":1706.59,"body":"So you know, I like to"},{"speaker":"Chris Dy","startTime":1703.2,"endTime":1706.59,"body":"do it where if I already have it"},{"speaker":"Chris Dy","startTime":1706.59,"endTime":1709.92,"body":"cut, and I'm re cutting it to"},{"speaker":"Chris Dy","startTime":1706.59,"endTime":1709.92,"body":"just kind of get a final pre"},{"speaker":"Chris Dy","startTime":1709.92,"endTime":1715.02,"body":"repair, cut, I will have"},{"speaker":"Chris Dy","startTime":1709.92,"endTime":1715.02,"body":"somebody pull traction on it"},{"speaker":"Chris Dy","startTime":1715.05,"endTime":1718.41,"body":"with a gentle traction, of"},{"speaker":"Chris Dy","startTime":1715.05,"endTime":1718.41,"body":"course, with a tooth forcep to"},{"speaker":"Chris Dy","startTime":1718.41,"endTime":1721.95,"body":"provide steady counter, you have"},{"speaker":"Chris Dy","startTime":1718.41,"endTime":1721.95,"body":"the tongue depressor underneath"},{"speaker":"Chris Dy","startTime":1721.95,"endTime":1724.68,"body":"it. And then you take the tip of"},{"speaker":"Chris Dy","startTime":1721.95,"endTime":1724.68,"body":"the 10 blade and like you're"},{"speaker":"Chris Dy","startTime":1724.68,"endTime":1727.5,"body":"saying you rock it back. So you"},{"speaker":"Chris Dy","startTime":1724.68,"endTime":1727.5,"body":"start to tip on the far end of"},{"speaker":"Chris Dy","startTime":1727.5,"endTime":1730.74,"body":"the nerve. And then you rock the"},{"speaker":"Chris Dy","startTime":1727.5,"endTime":1730.74,"body":"belly of the blade back. So this"},{"speaker":"Chris Dy","startTime":1730.74,"endTime":1733.59,"body":"matters, you're not cutting with"},{"speaker":"Chris Dy","startTime":1730.74,"endTime":1733.59,"body":"the tip, you're using the belly,"},{"speaker":"Chris Dy","startTime":1733.59,"endTime":1736.38,"body":"the wide belly of a 10 blade or"},{"speaker":"Chris Dy","startTime":1733.59,"endTime":1736.38,"body":"a 15 depending on the size of"},{"speaker":"Chris Dy","startTime":1736.38,"endTime":1739.26,"body":"the nerve. And it's one smooth"},{"speaker":"Chris Dy","startTime":1736.38,"endTime":1739.26,"body":"motion, it's really important"},{"speaker":"Chris Dy","startTime":1739.26,"endTime":1742.29,"body":"that that person is holding good"},{"speaker":"Chris Dy","startTime":1739.26,"endTime":1742.29,"body":"steady counter, you've got firm"},{"speaker":"Chris Dy","startTime":1742.29,"endTime":1745.56,"body":"support underneath the tongue"},{"speaker":"Chris Dy","startTime":1742.29,"endTime":1745.56,"body":"depressor so that it's a single"},{"speaker":"Chris Dy","startTime":1745.59,"endTime":1749.28,"body":"smooth cut. And once you start"},{"speaker":"Chris Dy","startTime":1745.59,"endTime":1749.28,"body":"cutting it multiple times and"},{"speaker":"Chris Dy","startTime":1749.28,"endTime":1751.89,"body":"rocking back and forth and"},{"speaker":"Chris Dy","startTime":1749.28,"endTime":1751.89,"body":"cutting down you know, it's it"},{"speaker":"Chris Dy","startTime":1751.89,"endTime":1756.12,"body":"becomes really challenging to"},{"speaker":"Chris Dy","startTime":1751.89,"endTime":1756.12,"body":"get a clean atraumatic cut on"},{"speaker":"Chris Dy","startTime":1756.12,"endTime":1756.57,"body":"the nerve."},{"speaker":"Charles Goldfarb","startTime":1757.11,"endTime":1759.66,"body":"I love that"},{"speaker":"Charles Goldfarb","startTime":1757.11,"endTime":1759.66,"body":"and your first cut on the nerve."},{"speaker":"Charles Goldfarb","startTime":1759.69,"endTime":1764.13,"body":"Are you looking for that to be"},{"speaker":"Charles Goldfarb","startTime":1759.69,"endTime":1764.13,"body":"the last cut on the nerve? Or do"},{"speaker":"Charles Goldfarb","startTime":1764.13,"endTime":1768.27,"body":"you generally accept that your"},{"speaker":"Charles Goldfarb","startTime":1764.13,"endTime":1768.27,"body":"first cut won't be your last,"},{"speaker":"Charles Goldfarb","startTime":1768.3,"endTime":1771.3,"body":"meaning you'll have to cut back"},{"speaker":"Charles Goldfarb","startTime":1768.3,"endTime":1771.3,"body":"further and tell me what you're"},{"speaker":"Charles Goldfarb","startTime":1771.3,"endTime":1774.99,"body":"looking for to to make that"},{"speaker":"Charles Goldfarb","startTime":1771.3,"endTime":1774.99,"body":"decision that I'm in a good"},{"speaker":"Charles Goldfarb","startTime":1774.99,"endTime":1775.41,"body":"spot."},{"speaker":"Chris Dy","startTime":1776.29,"endTime":1778.87,"body":"Um, you know, I try to"},{"speaker":"Chris Dy","startTime":1776.29,"endTime":1778.87,"body":"plan it so that my first cut is"},{"speaker":"Chris Dy","startTime":1778.87,"endTime":1782.08,"body":"not my last. When you're bread"},{"speaker":"Chris Dy","startTime":1778.87,"endTime":1782.08,"body":"loafing you know, and when"},{"speaker":"Chris Dy","startTime":1782.08,"endTime":1784.15,"body":"you're working in a neuroma and"},{"speaker":"Chris Dy","startTime":1782.08,"endTime":1784.15,"body":"you're trying to figure out, you"},{"speaker":"Chris Dy","startTime":1784.15,"endTime":1788.35,"body":"know, where the healthy nerve"},{"speaker":"Chris Dy","startTime":1784.15,"endTime":1788.35,"body":"is. Remember, you can always cut"},{"speaker":"Chris Dy","startTime":1788.35,"endTime":1791.26,"body":"more, and the more you cut"},{"speaker":"Chris Dy","startTime":1788.35,"endTime":1791.26,"body":"initially it's going to be"},{"speaker":"Chris Dy","startTime":1791.26,"endTime":1795.01,"body":"harder and harder to you're"},{"speaker":"Chris Dy","startTime":1791.26,"endTime":1795.01,"body":"gonna have a longer gap, you"},{"speaker":"Chris Dy","startTime":1795.01,"endTime":1799.18,"body":"know, so you're looking for that"},{"speaker":"Chris Dy","startTime":1795.01,"endTime":1799.18,"body":"fascicular extrusion, you're"},{"speaker":"Chris Dy","startTime":1799.18,"endTime":1802.24,"body":"looking for that healthy"},{"speaker":"Chris Dy","startTime":1799.18,"endTime":1802.24,"body":"pattern, look and feel, you"},{"speaker":"Chris Dy","startTime":1802.24,"endTime":1804.64,"body":"know, you should see the"},{"speaker":"Chris Dy","startTime":1802.24,"endTime":1804.64,"body":"fascicles coming out and"},{"speaker":"Chris Dy","startTime":1804.64,"endTime":1809.14,"body":"looking, you know, trying to"},{"speaker":"Chris Dy","startTime":1804.64,"endTime":1809.14,"body":"emerge. And the tissue on the"},{"speaker":"Chris Dy","startTime":1809.14,"endTime":1812.41,"body":"exterior, the, you know, the"},{"speaker":"Chris Dy","startTime":1809.14,"endTime":1812.41,"body":"mesoneurium or external"},{"speaker":"Chris Dy","startTime":1812.41,"endTime":1815.41,"body":"epineurium, whatever you want to"},{"speaker":"Chris Dy","startTime":1812.41,"endTime":1815.41,"body":"call it, that should just look"},{"speaker":"Chris Dy","startTime":1815.53,"endTime":1818.71,"body":"good. But you really do want to"},{"speaker":"Chris Dy","startTime":1815.53,"endTime":1818.71,"body":"see those extruding fascicles"},{"speaker":"Chris Dy","startTime":1818.71,"endTime":1820.0,"body":"coming from the inside of the"},{"speaker":"Chris Dy","startTime":1818.71,"endTime":1820.0,"body":"nerve."},{"speaker":"Charles Goldfarb","startTime":1820.64,"endTime":1823.94,"body":"Yeah, and I"},{"speaker":"Charles Goldfarb","startTime":1820.64,"endTime":1823.94,"body":"would say, again, based on been"},{"speaker":"Charles Goldfarb","startTime":1823.94,"endTime":1827.42,"body":"doing this a while, my guess is"},{"speaker":"Charles Goldfarb","startTime":1823.94,"endTime":1827.42,"body":"that we go wrong as nerve"},{"speaker":"Charles Goldfarb","startTime":1827.42,"endTime":1831.2,"body":"surgeons, when we may have"},{"speaker":"Charles Goldfarb","startTime":1827.42,"endTime":1831.2,"body":"bulging fascicles. And I do"},{"speaker":"Charles Goldfarb","startTime":1831.2,"endTime":1833.75,"body":"think that's a good expression."},{"speaker":"Charles Goldfarb","startTime":1831.2,"endTime":1833.75,"body":"I don't know if you agree or not"},{"speaker":"Charles Goldfarb","startTime":1833.99,"endTime":1838.07,"body":"on one end, and then we may"},{"speaker":"Charles Goldfarb","startTime":1833.99,"endTime":1838.07,"body":"accept a little less on the"},{"speaker":"Charles Goldfarb","startTime":1838.1,"endTime":1841.4,"body":"other end of the nerve. And"},{"speaker":"Charles Goldfarb","startTime":1838.1,"endTime":1841.4,"body":"whether that's because of"},{"speaker":"Charles Goldfarb","startTime":1841.4,"endTime":1844.91,"body":"expediency and the sense that,"},{"speaker":"Charles Goldfarb","startTime":1841.4,"endTime":1844.91,"body":"oh, it'll be fine, and you put a"},{"speaker":"Charles Goldfarb","startTime":1844.91,"endTime":1849.44,"body":"couple stitches in. But I think"},{"speaker":"Charles Goldfarb","startTime":1844.91,"endTime":1849.44,"body":"more and more, especially with"},{"speaker":"Charles Goldfarb","startTime":1849.44,"endTime":1853.79,"body":"good options to bridge the gap."},{"speaker":"Charles Goldfarb","startTime":1849.44,"endTime":1853.79,"body":"People understand that there's"},{"speaker":"Charles Goldfarb","startTime":1853.79,"endTime":1857.12,"body":"no substitute for having really"},{"speaker":"Charles Goldfarb","startTime":1853.79,"endTime":1857.12,"body":"healthy nerve tissue on either"},{"speaker":"Charles Goldfarb","startTime":1857.12,"endTime":1857.36,"body":"end."},{"speaker":"Chris Dy","startTime":1857.9,"endTime":1861.74,"body":"I agree with that."},{"speaker":"Chris Dy","startTime":1857.9,"endTime":1861.74,"body":"100%. You know, and then"},{"speaker":"Chris Dy","startTime":1861.77,"endTime":1864.47,"body":"oftentimes, you're left with a"},{"speaker":"Chris Dy","startTime":1861.77,"endTime":1864.47,"body":"gap. But say, this is a setting"},{"speaker":"Chris Dy","startTime":1864.47,"endTime":1866.84,"body":"in which you don't have a gap."},{"speaker":"Chris Dy","startTime":1864.47,"endTime":1866.84,"body":"You've mobilized the nerve ends,"},{"speaker":"Chris Dy","startTime":1866.84,"endTime":1868.82,"body":"you've gotten a couple of"},{"speaker":"Chris Dy","startTime":1866.84,"endTime":1868.82,"body":"centimeters from your"},{"speaker":"Chris Dy","startTime":1868.82,"endTime":1872.9,"body":"neurolysis, your decompressions,"},{"speaker":"Chris Dy","startTime":1868.82,"endTime":1872.9,"body":"whatever you do, how do you like"},{"speaker":"Chris Dy","startTime":1872.9,"endTime":1874.85,"body":"to repair, say, a median nerve"},{"speaker":"Chris Dy","startTime":1872.9,"endTime":1874.85,"body":"in the forearm?"},{"speaker":"Charles Goldfarb","startTime":1876.13,"endTime":1878.35,"body":"Yeah, so for a"},{"speaker":"Charles Goldfarb","startTime":1876.13,"endTime":1878.35,"body":"median nerve in the forearm,"},{"speaker":"Charles Goldfarb","startTime":1878.35,"endTime":1884.83,"body":"I'll use an 8-0, nylon"},{"speaker":"Charles Goldfarb","startTime":1878.35,"endTime":1884.83,"body":"epineurial suture. And I'm"},{"speaker":"Charles Goldfarb","startTime":1884.83,"endTime":1887.83,"body":"trying to think I would probably"},{"speaker":"Charles Goldfarb","startTime":1884.83,"endTime":1887.83,"body":"use four sutures would be my"},{"speaker":"Charles Goldfarb","startTime":1887.83,"endTime":1893.02,"body":"guess. And I would not use glue,"},{"speaker":"Charles Goldfarb","startTime":1887.83,"endTime":1893.02,"body":"and I would be done. And I'm"},{"speaker":"Charles Goldfarb","startTime":1893.05,"endTime":1896.08,"body":"wincing a little bit, because"},{"speaker":"Charles Goldfarb","startTime":1893.05,"endTime":1896.08,"body":"Chris is now going to tell you"},{"speaker":"Charles Goldfarb","startTime":1896.14,"endTime":1898.63,"body":"how a nerve surgeon would deal"},{"speaker":"Charles Goldfarb","startTime":1896.14,"endTime":1898.63,"body":"with that same nerve?"},{"speaker":"Chris Dy","startTime":1899.17,"endTime":1901.42,"body":"Well, no, I think 8-0"},{"speaker":"Chris Dy","startTime":1899.17,"endTime":1901.42,"body":"is what a lot of people would"},{"speaker":"Chris Dy","startTime":1901.42,"endTime":1904.27,"body":"do. And I think 8-0 is a very"},{"speaker":"Chris Dy","startTime":1901.42,"endTime":1904.27,"body":"reasonable option. I mean, you"},{"speaker":"Chris Dy","startTime":1904.27,"endTime":1907.78,"body":"know, the dogma on this was, you"},{"speaker":"Chris Dy","startTime":1904.27,"endTime":1907.78,"body":"know, if it comes together with"},{"speaker":"Chris Dy","startTime":1907.78,"endTime":1911.83,"body":"8-0 nylon, there's not too much"},{"speaker":"Chris Dy","startTime":1907.78,"endTime":1911.83,"body":"tension. And then if you look at"},{"speaker":"Chris Dy","startTime":1911.83,"endTime":1914.5,"body":"kind of what you're, you don't"},{"speaker":"Chris Dy","startTime":1911.83,"endTime":1914.5,"body":"want too much tension on the"},{"speaker":"Chris Dy","startTime":1914.5,"endTime":1919.3,"body":"nerve. Because if you have, you"},{"speaker":"Chris Dy","startTime":1914.5,"endTime":1919.3,"body":"know, more than 8% of strain,"},{"speaker":"Chris Dy","startTime":1919.42,"endTime":1922.24,"body":"you know, you're going to have"},{"speaker":"Chris Dy","startTime":1919.42,"endTime":1922.24,"body":"ischemia. And then if you have"},{"speaker":"Chris Dy","startTime":1922.24,"endTime":1926.26,"body":"ischemia, that's going to lead"},{"speaker":"Chris Dy","startTime":1922.24,"endTime":1926.26,"body":"to scar, and your nerve repair"},{"speaker":"Chris Dy","startTime":1926.26,"endTime":1931.27,"body":"is not going to heal ideally. So"},{"speaker":"Chris Dy","startTime":1926.26,"endTime":1931.27,"body":"you want some kind of suture"},{"speaker":"Chris Dy","startTime":1931.27,"endTime":1936.01,"body":"that is going to not give you"},{"speaker":"Chris Dy","startTime":1931.27,"endTime":1936.01,"body":"more than 8%. And you know,"},{"speaker":"Chris Dy","startTime":1936.01,"endTime":1938.29,"body":"there is some interesting work,"},{"speaker":"Chris Dy","startTime":1936.01,"endTime":1938.29,"body":"I think Jeff Greenberg did it,"},{"speaker":"Chris Dy","startTime":1938.59,"endTime":1942.07,"body":"where they checked, you know,"},{"speaker":"Chris Dy","startTime":1938.59,"endTime":1942.07,"body":"8-0 nylon, 9-0 nylon, etc. And"},{"speaker":"Chris Dy","startTime":1942.07,"endTime":1945.88,"body":"9-0 meets all the criteria that"},{"speaker":"Chris Dy","startTime":1942.07,"endTime":1945.88,"body":"you need. So I after reading"},{"speaker":"Chris Dy","startTime":1945.88,"endTime":1950.35,"body":"that paper, I switched to using"},{"speaker":"Chris Dy","startTime":1945.88,"endTime":1950.35,"body":"9-0 as my default. And I agree"},{"speaker":"Chris Dy","startTime":1950.35,"endTime":1953.14,"body":"with you using kind of three or"},{"speaker":"Chris Dy","startTime":1950.35,"endTime":1953.14,"body":"four sutures, it kind of depends"},{"speaker":"Chris Dy","startTime":1953.14,"endTime":1956.77,"body":"on how it lines up, I will use a"},{"speaker":"Chris Dy","startTime":1953.14,"endTime":1956.77,"body":"microscope. Unless you know, for"},{"speaker":"Chris Dy","startTime":1956.77,"endTime":1959.56,"body":"example, if I'm in the tight"},{"speaker":"Chris Dy","startTime":1956.77,"endTime":1959.56,"body":"corner of the neck for a plexus,"},{"speaker":"Chris Dy","startTime":1959.56,"endTime":1962.44,"body":"and the scope is just really"},{"speaker":"Chris Dy","startTime":1959.56,"endTime":1962.44,"body":"hard to get in reliably, I may"},{"speaker":"Chris Dy","startTime":1962.44,"endTime":1965.05,"body":"do it under greater"},{"speaker":"Chris Dy","startTime":1962.44,"endTime":1965.05,"body":"magnification loops, like three"},{"speaker":"Chris Dy","startTime":1965.05,"endTime":1968.74,"body":"fives for a nerve graph, but if"},{"speaker":"Chris Dy","startTime":1965.05,"endTime":1968.74,"body":"I'm out in the extremity and a"},{"speaker":"Chris Dy","startTime":1968.74,"endTime":1972.79,"body":"scope is totally reasonable and"},{"speaker":"Chris Dy","startTime":1968.74,"endTime":1972.79,"body":"helpful and accessible, I will"},{"speaker":"Chris Dy","startTime":1972.79,"endTime":1973.36,"body":"use a scope."},{"speaker":"Charles Goldfarb","startTime":1974.2,"endTime":1976.69,"body":"So let's be"},{"speaker":"Charles Goldfarb","startTime":1974.2,"endTime":1976.69,"body":"clear on that. So great, great"},{"speaker":"Charles Goldfarb","startTime":1976.69,"endTime":1977.11,"body":"info,"},{"speaker":"Chris Dy","startTime":1977.17,"endTime":1979.66,"body":"Oh, and Chuck"},{"speaker":"Chris Dy","startTime":1977.17,"endTime":1979.66,"body":"microscope, not arthroscope."},{"speaker":"Chris Dy","startTime":1979.72,"endTime":1980.08,"body":"Microscope."},{"speaker":"Charles Goldfarb","startTime":1980.11,"endTime":1981.94,"body":"Oh,"},{"speaker":"Charles Goldfarb","startTime":1980.11,"endTime":1981.94,"body":"microscope, I was wondering,"},{"speaker":"Charles Goldfarb","startTime":1981.94,"endTime":1984.43,"body":"well it's going to get very"},{"speaker":"Charles Goldfarb","startTime":1981.94,"endTime":1984.43,"body":"soupy in there very quickly."},{"speaker":"Chris Dy","startTime":1984.58,"endTime":1985.72,"body":"The cool kind of"},{"speaker":"Chris Dy","startTime":1984.58,"endTime":1985.72,"body":"scope."},{"speaker":"Charles Goldfarb","startTime":1987.41,"endTime":1990.92,"body":"I don't know"},{"speaker":"Charles Goldfarb","startTime":1987.41,"endTime":1990.92,"body":"much about the micro scope. So"},{"speaker":"Charles Goldfarb","startTime":1990.92,"endTime":1993.5,"body":"let's be clear, because this"},{"speaker":"Charles Goldfarb","startTime":1990.92,"endTime":1993.5,"body":"will be a source of controversy."},{"speaker":"Charles Goldfarb","startTime":1995.0,"endTime":1999.32,"body":"I would not use a scope there."},{"speaker":"Charles Goldfarb","startTime":1995.0,"endTime":1999.32,"body":"And sometimes people don't use"},{"speaker":"Charles Goldfarb","startTime":1999.32,"endTime":2003.73,"body":"scopes for digital nerves. Is"},{"speaker":"Charles Goldfarb","startTime":1999.32,"endTime":2003.73,"body":"that horrible, horrible care"},{"speaker":"Charles Goldfarb","startTime":2003.73,"endTime":2006.1,"body":"we're providing when we don't"},{"speaker":"Charles Goldfarb","startTime":2003.73,"endTime":2006.1,"body":"use a scope for a digital nerve?"},{"speaker":"Chris Dy","startTime":2006.51,"endTime":2008.58,"body":"No, I don't think so."},{"speaker":"Chris Dy","startTime":2006.51,"endTime":2008.58,"body":"I think that, you know, if you"},{"speaker":"Chris Dy","startTime":2008.58,"endTime":2011.31,"body":"feel confident you can do the"},{"speaker":"Chris Dy","startTime":2008.58,"endTime":2011.31,"body":"repair under the magnification"},{"speaker":"Chris Dy","startTime":2011.31,"endTime":2013.98,"body":"that you have. Great. You know,"},{"speaker":"Chris Dy","startTime":2011.31,"endTime":2013.98,"body":"I mean, you know, there are a"},{"speaker":"Chris Dy","startTime":2013.98,"endTime":2017.79,"body":"lot of surgeons, either plastic"},{"speaker":"Chris Dy","startTime":2013.98,"endTime":2017.79,"body":"neurosurgeons, or orthopedic"},{"speaker":"Chris Dy","startTime":2017.79,"endTime":2019.92,"body":"surgeons that repair nerves"},{"speaker":"Chris Dy","startTime":2017.79,"endTime":2019.92,"body":"without a microscope. And we're"},{"speaker":"Chris Dy","startTime":2019.92,"endTime":2022.62,"body":"learning that because we're"},{"speaker":"Chris Dy","startTime":2019.92,"endTime":2022.62,"body":"participating in a multicenter"},{"speaker":"Chris Dy","startTime":2022.62,"endTime":2025.95,"body":"study on PEG fusion. And they"},{"speaker":"Chris Dy","startTime":2022.62,"endTime":2025.95,"body":"have to specifically say do it"},{"speaker":"Chris Dy","startTime":2025.95,"endTime":2028.26,"body":"under a microscope, and many of"},{"speaker":"Chris Dy","startTime":2025.95,"endTime":2028.26,"body":"the surgeons in the study"},{"speaker":"Chris Dy","startTime":2028.32,"endTime":2033.54,"body":"weren't doing that before. So I"},{"speaker":"Chris Dy","startTime":2028.32,"endTime":2033.54,"body":"think that doing it without a"},{"speaker":"Chris Dy","startTime":2033.54,"endTime":2035.22,"body":"microscope is fine. It's just"},{"speaker":"Chris Dy","startTime":2033.54,"endTime":2035.22,"body":"whatever you're comfortable"},{"speaker":"Chris Dy","startTime":2035.22,"endTime":2038.16,"body":"with, you know, there is some"},{"speaker":"Chris Dy","startTime":2035.22,"endTime":2038.16,"body":"literature to support using a"},{"speaker":"Chris Dy","startTime":2038.16,"endTime":2041.22,"body":"microscope in terms of look, you"},{"speaker":"Chris Dy","startTime":2038.16,"endTime":2041.22,"body":"know, they looked at, you know,"},{"speaker":"Chris Dy","startTime":2041.22,"endTime":2044.82,"body":"repairs done in a cadaver lab"},{"speaker":"Chris Dy","startTime":2041.22,"endTime":2044.82,"body":"and checked quality by multiple"},{"speaker":"Chris Dy","startTime":2044.82,"endTime":2049.62,"body":"assessors, and said that, you"},{"speaker":"Chris Dy","startTime":2044.82,"endTime":2049.62,"body":"know, a microscope-assisted"},{"speaker":"Chris Dy","startTime":2049.62,"endTime":2055.29,"body":"repair was technically higher"},{"speaker":"Chris Dy","startTime":2049.62,"endTime":2055.29,"body":"graded than a loop repair."},{"speaker":"Charles Goldfarb","startTime":2056.71,"endTime":2059.35,"body":"Listen, you"},{"speaker":"Charles Goldfarb","startTime":2056.71,"endTime":2059.35,"body":"know, one of the places I work"},{"speaker":"Charles Goldfarb","startTime":2059.35,"endTime":2061.96,"body":"does not have a microscope and"},{"speaker":"Charles Goldfarb","startTime":2059.35,"endTime":2061.96,"body":"granted, I don't do nerve work"},{"speaker":"Charles Goldfarb","startTime":2061.96,"endTime":2066.94,"body":"there very often, if ever, but"},{"speaker":"Charles Goldfarb","startTime":2061.96,"endTime":2066.94,"body":"when I'm on trauma call for"},{"speaker":"Charles Goldfarb","startTime":2066.94,"endTime":2070.42,"body":"hand, and we have, you know, a"},{"speaker":"Charles Goldfarb","startTime":2066.94,"endTime":2070.42,"body":"significant injury to the hand."},{"speaker":"Charles Goldfarb","startTime":2070.42,"endTime":2072.37,"body":"I'm doing nerve repairs on and I"},{"speaker":"Charles Goldfarb","startTime":2070.42,"endTime":2072.37,"body":"always do it under the"},{"speaker":"Charles Goldfarb","startTime":2072.37,"endTime":2075.43,"body":"microscope, there is no"},{"speaker":"Charles Goldfarb","startTime":2072.37,"endTime":2075.43,"body":"difference. I mean, I'm sorry,"},{"speaker":"Charles Goldfarb","startTime":2075.52,"endTime":2079.33,"body":"there is no question that there"},{"speaker":"Charles Goldfarb","startTime":2075.52,"endTime":2079.33,"body":"is a huge difference in"},{"speaker":"Charles Goldfarb","startTime":2079.33,"endTime":2083.26,"body":"visualization and your ability"},{"speaker":"Charles Goldfarb","startTime":2079.33,"endTime":2083.26,"body":"to assure as anatomical a repair"},{"speaker":"Charles Goldfarb","startTime":2083.26,"endTime":2088.87,"body":"as possible. So, microscopes are"},{"speaker":"Charles Goldfarb","startTime":2083.26,"endTime":2088.87,"body":"amazing. And I will use them"},{"speaker":"Charles Goldfarb","startTime":2088.87,"endTime":2092.98,"body":"every opportunity I get, but"},{"speaker":"Charles Goldfarb","startTime":2088.87,"endTime":2092.98,"body":"flipping that around with high"},{"speaker":"Charles Goldfarb","startTime":2092.98,"endTime":2096.61,"body":"powered loops, I think you can"},{"speaker":"Charles Goldfarb","startTime":2092.98,"endTime":2096.61,"body":"do a very good job with it being"},{"speaker":"Charles Goldfarb","startTime":2096.61,"endTime":2101.47,"body":"more important that you have the"},{"speaker":"Charles Goldfarb","startTime":2096.61,"endTime":2101.47,"body":"nerve ends correct. And less"},{"speaker":"Charles Goldfarb","startTime":2101.47,"endTime":2104.41,"body":"important that your rotation"},{"speaker":"Charles Goldfarb","startTime":2101.47,"endTime":2104.41,"body":"could be off, you know, five"},{"speaker":"Charles Goldfarb","startTime":2104.41,"endTime":2106.6,"body":"degrees or something like that,"},{"speaker":"Charles Goldfarb","startTime":2104.41,"endTime":2106.6,"body":"in my opinion."},{"speaker":"Chris Dy","startTime":2107.56,"endTime":2109.15,"body":"Yeah, I think that"},{"speaker":"Chris Dy","startTime":2107.56,"endTime":2109.15,"body":"look, you know, when you're"},{"speaker":"Chris Dy","startTime":2109.15,"endTime":2111.34,"body":"really assessing the nerve"},{"speaker":"Chris Dy","startTime":2109.15,"endTime":2111.34,"body":"repair, when you're done, I"},{"speaker":"Chris Dy","startTime":2111.34,"endTime":2113.29,"body":"think that's where the scope is"},{"speaker":"Chris Dy","startTime":2111.34,"endTime":2113.29,"body":"really helpful to make sure you"},{"speaker":"Chris Dy","startTime":2113.29,"endTime":2115.81,"body":"don't have any extruding"},{"speaker":"Chris Dy","startTime":2113.29,"endTime":2115.81,"body":"fascicles coming out of your"},{"speaker":"Chris Dy","startTime":2115.81,"endTime":2120.55,"body":"nerve repair, and that your"},{"speaker":"Chris Dy","startTime":2115.81,"endTime":2120.55,"body":"epineurium is nicely tucked. But"},{"speaker":"Chris Dy","startTime":2120.58,"endTime":2123.16,"body":"you know, it sometimes, like in"},{"speaker":"Chris Dy","startTime":2120.58,"endTime":2123.16,"body":"those trauma cases, if you're"},{"speaker":"Chris Dy","startTime":2123.16,"endTime":2125.86,"body":"doing a spaghetti wrist or a"},{"speaker":"Chris Dy","startTime":2123.16,"endTime":2125.86,"body":"replant or something like that"},{"speaker":"Chris Dy","startTime":2125.86,"endTime":2129.82,"body":"you need to move and, you know,"},{"speaker":"Chris Dy","startTime":2125.86,"endTime":2129.82,"body":"expediency is important there."},{"speaker":"Chris Dy","startTime":2130.66,"endTime":2133.84,"body":"In terms of glue, you mentioned"},{"speaker":"Chris Dy","startTime":2130.66,"endTime":2133.84,"body":"that you don't like glue, what's"},{"speaker":"Chris Dy","startTime":2133.84,"endTime":2134.44,"body":"the deal there?"},{"speaker":"Charles Goldfarb","startTime":2135.309,"endTime":2137.079,"body":"I don't like"},{"speaker":"Charles Goldfarb","startTime":2135.309,"endTime":2137.079,"body":"glue, because I just don't use"},{"speaker":"Charles Goldfarb","startTime":2137.079,"endTime":2139.509,"body":"glue. And I think this is"},{"speaker":"Charles Goldfarb","startTime":2137.079,"endTime":2139.509,"body":"something that you can help me"},{"speaker":"Charles Goldfarb","startTime":2139.509,"endTime":2142.239,"body":"with today and maybe help some"},{"speaker":"Charles Goldfarb","startTime":2139.509,"endTime":2142.239,"body":"of our listeners because I think"},{"speaker":"Charles Goldfarb","startTime":2142.239,"endTime":2145.359,"body":"it gets to what you just said,"},{"speaker":"Charles Goldfarb","startTime":2142.239,"endTime":2145.359,"body":"extrusion and and comfort level"},{"speaker":"Charles Goldfarb","startTime":2145.359,"endTime":2148.419,"body":"with your repair. Tell me why I"},{"speaker":"Charles Goldfarb","startTime":2145.359,"endTime":2148.419,"body":"should be using glue."},{"speaker":"Chris Dy","startTime":2148.0,"endTime":2151.63,"body":"I don't know if you"},{"speaker":"Chris Dy","startTime":2148.0,"endTime":2151.63,"body":"need to use glue. I mean, if"},{"speaker":"Chris Dy","startTime":2151.63,"endTime":2153.49,"body":"you're comfortable with your"},{"speaker":"Chris Dy","startTime":2151.63,"endTime":2153.49,"body":"repair, you've gotten it lined"},{"speaker":"Chris Dy","startTime":2153.49,"endTime":2157.0,"body":"up and it feels good. You know,"},{"speaker":"Chris Dy","startTime":2153.49,"endTime":2157.0,"body":"I think that's fine. I don't"},{"speaker":"Chris Dy","startTime":2157.0,"endTime":2159.58,"body":"think it takes anything away"},{"speaker":"Chris Dy","startTime":2157.0,"endTime":2159.58,"body":"though. What I don't think glue"},{"speaker":"Chris Dy","startTime":2159.58,"endTime":2162.85,"body":"does is replace suture. And"},{"speaker":"Chris Dy","startTime":2159.58,"endTime":2162.85,"body":"there are some surgeons out"},{"speaker":"Chris Dy","startTime":2162.85,"endTime":2165.25,"body":"there particularly in the, I"},{"speaker":"Chris Dy","startTime":2162.85,"endTime":2165.25,"body":"think the pedes Plexus world"},{"speaker":"Chris Dy","startTime":2165.25,"endTime":2168.55,"body":"that will only glue and maybe"},{"speaker":"Chris Dy","startTime":2165.25,"endTime":2168.55,"body":"you can get away with it. But"},{"speaker":"Chris Dy","startTime":2168.55,"endTime":2170.92,"body":"you know, if you're going to"},{"speaker":"Chris Dy","startTime":2168.55,"endTime":2170.92,"body":"spend that much time and effort"},{"speaker":"Chris Dy","startTime":2170.95,"endTime":2173.95,"body":"doing something for, that's my"},{"speaker":"Chris Dy","startTime":2170.95,"endTime":2173.95,"body":"personal bias, if you're gonna"},{"speaker":"Chris Dy","startTime":2173.95,"endTime":2176.05,"body":"spend that much time and effort"},{"speaker":"Chris Dy","startTime":2173.95,"endTime":2176.05,"body":"doing something for a patient."},{"speaker":"Chris Dy","startTime":2176.26,"endTime":2178.63,"body":"This is a high stakes surgery,"},{"speaker":"Chris Dy","startTime":2176.26,"endTime":2178.63,"body":"you're going to do everything"},{"speaker":"Chris Dy","startTime":2178.63,"endTime":2182.17,"body":"you can to make that repair as"},{"speaker":"Chris Dy","startTime":2178.63,"endTime":2182.17,"body":"technically excellent as you"},{"speaker":"Chris Dy","startTime":2182.17,"endTime":2185.5,"body":"can. I like lining it up with"},{"speaker":"Chris Dy","startTime":2182.17,"endTime":2185.5,"body":"the suture. I don't like relying"},{"speaker":"Chris Dy","startTime":2185.5,"endTime":2188.71,"body":"on glue. But if the glue doesn't"},{"speaker":"Chris Dy","startTime":2185.5,"endTime":2188.71,"body":"do any harm, I mean that it"},{"speaker":"Chris Dy","startTime":2188.74,"endTime":2191.89,"body":"essentially acts as an adhesive"},{"speaker":"Chris Dy","startTime":2188.74,"endTime":2191.89,"body":"cylinder that's there for about"},{"speaker":"Chris Dy","startTime":2191.89,"endTime":2197.05,"body":"three weeks. You cannot rely on"},{"speaker":"Chris Dy","startTime":2191.89,"endTime":2197.05,"body":"it to to take tension off of"},{"speaker":"Chris Dy","startTime":2197.05,"endTime":2200.11,"body":"your repair, or anything like"},{"speaker":"Chris Dy","startTime":2197.05,"endTime":2200.11,"body":"that. So an over reliance on"},{"speaker":"Chris Dy","startTime":2200.11,"endTime":2202.3,"body":"glue, I think is is an error."},{"speaker":"Charles Goldfarb","startTime":2202.72,"endTime":2205.3,"body":"All right,"},{"speaker":"Charles Goldfarb","startTime":2202.72,"endTime":2205.3,"body":"talk me through the glue. So"},{"speaker":"Charles Goldfarb","startTime":2205.33,"endTime":2208.84,"body":"you're in the OR you've repaired"},{"speaker":"Charles Goldfarb","startTime":2205.33,"endTime":2208.84,"body":"your median nerve in the forearm"},{"speaker":"Charles Goldfarb","startTime":2208.84,"endTime":2214.93,"body":"and you used four 9-0 nylons."},{"speaker":"Charles Goldfarb","startTime":2208.84,"endTime":2214.93,"body":"You brought the microscope in to"},{"speaker":"Charles Goldfarb","startTime":2214.93,"endTime":2218.59,"body":"assist with your repair and to"},{"speaker":"Charles Goldfarb","startTime":2214.93,"endTime":2218.59,"body":"judge your repair. After you"},{"speaker":"Charles Goldfarb","startTime":2218.59,"endTime":2221.2,"body":"were done. You're thrilled"},{"speaker":"Charles Goldfarb","startTime":2218.59,"endTime":2221.2,"body":"there's, actually you're not"},{"speaker":"Charles Goldfarb","startTime":2221.2,"endTime":2225.73,"body":"there's one bulging fascicle"},{"speaker":"Charles Goldfarb","startTime":2221.2,"endTime":2225.73,"body":"that's extruding from the nerve"},{"speaker":"Charles Goldfarb","startTime":2225.73,"endTime":2228.55,"body":"repair. First, what do you do"},{"speaker":"Charles Goldfarb","startTime":2225.73,"endTime":2228.55,"body":"with that? How do you deal with"},{"speaker":"Charles Goldfarb","startTime":2228.55,"endTime":2233.02,"body":"that fascicle and second, talk"},{"speaker":"Charles Goldfarb","startTime":2228.55,"endTime":2233.02,"body":"me through the real, you know,"},{"speaker":"Charles Goldfarb","startTime":2233.05,"endTime":2235.84,"body":"details on applying the glue."},{"speaker":"Chris Dy","startTime":2236.02,"endTime":2238.57,"body":"So I think you know"},{"speaker":"Chris Dy","startTime":2236.02,"endTime":2238.57,"body":"we're, in this case we're doing"},{"speaker":"Chris Dy","startTime":2238.57,"endTime":2241.72,"body":"an epineural repair. You know,"},{"speaker":"Chris Dy","startTime":2238.57,"endTime":2241.72,"body":"there are if you get really"},{"speaker":"Chris Dy","startTime":2241.72,"endTime":2244.57,"body":"distal, in particular for the"},{"speaker":"Chris Dy","startTime":2241.72,"endTime":2244.57,"body":"ulnar nerve, some people would"},{"speaker":"Chris Dy","startTime":2244.57,"endTime":2247.96,"body":"make an argument to do group"},{"speaker":"Chris Dy","startTime":2244.57,"endTime":2247.96,"body":"fascicular repairs. But in the"},{"speaker":"Chris Dy","startTime":2247.96,"endTime":2250.66,"body":"setting where you have one"},{"speaker":"Chris Dy","startTime":2247.96,"endTime":2250.66,"body":"little extruding fascicle I"},{"speaker":"Chris Dy","startTime":2250.66,"endTime":2254.35,"body":"probably would take out a suture"},{"speaker":"Chris Dy","startTime":2250.66,"endTime":2254.35,"body":"as painful as it is, and try to"},{"speaker":"Chris Dy","startTime":2254.35,"endTime":2258.07,"body":"tuck that fascicle in or even"},{"speaker":"Chris Dy","startTime":2254.35,"endTime":2258.07,"body":"just trim it back and then put a"},{"speaker":"Chris Dy","startTime":2258.07,"endTime":2261.58,"body":"suture in the epineurium over"},{"speaker":"Chris Dy","startTime":2258.07,"endTime":2261.58,"body":"the area where that fascicle was"},{"speaker":"Chris Dy","startTime":2261.58,"endTime":2266.62,"body":"extruding. I think that yeah, so"},{"speaker":"Chris Dy","startTime":2261.58,"endTime":2266.62,"body":"trim it back with with scissors."},{"speaker":"Chris Dy","startTime":2267.7,"endTime":2271.63,"body":"You know, usually it's going to"},{"speaker":"Chris Dy","startTime":2267.7,"endTime":2271.63,"body":"be a micro scissor, a straight"},{"speaker":"Chris Dy","startTime":2271.66,"endTime":2275.47,"body":"serrated micro scissor to help"},{"speaker":"Chris Dy","startTime":2271.66,"endTime":2275.47,"body":"with that cut, not ideal that"},{"speaker":"Chris Dy","startTime":2275.47,"endTime":2277.63,"body":"you're cutting with a scissor."},{"speaker":"Chris Dy","startTime":2275.47,"endTime":2277.63,"body":"But I think in that situation,"},{"speaker":"Chris Dy","startTime":2277.63,"endTime":2279.73,"body":"you're not taking down the whole"},{"speaker":"Chris Dy","startTime":2277.63,"endTime":2279.73,"body":"thing and getting a blade in"},{"speaker":"Chris Dy","startTime":2279.73,"endTime":2283.87,"body":"there. I've seen some people use"},{"speaker":"Chris Dy","startTime":2279.73,"endTime":2283.87,"body":"a beaver blade in that setting."},{"speaker":"Chris Dy","startTime":2283.87,"endTime":2286.24,"body":"And if you can maneuver that in"},{"speaker":"Chris Dy","startTime":2283.87,"endTime":2286.24,"body":"there, go ahead. I like the"},{"speaker":"Chris Dy","startTime":2286.24,"endTime":2290.74,"body":"beaver blade for assisting with"},{"speaker":"Chris Dy","startTime":2286.24,"endTime":2290.74,"body":"the neurolysis part of the case."},{"speaker":"Chris Dy","startTime":2291.52,"endTime":2295.87,"body":"But usually will not do much"},{"speaker":"Chris Dy","startTime":2291.52,"endTime":2295.87,"body":"more with with the Beaver. And"},{"speaker":"Chris Dy","startTime":2295.87,"endTime":2299.14,"body":"then in terms of the glue. So"},{"speaker":"Chris Dy","startTime":2295.87,"endTime":2299.14,"body":"one thing is that you know, just"},{"speaker":"Chris Dy","startTime":2299.14,"endTime":2301.84,"body":"from a expediency perspective,"},{"speaker":"Chris Dy","startTime":2299.14,"endTime":2301.84,"body":"when I asked them to prep the"},{"speaker":"Chris Dy","startTime":2301.84,"endTime":2304.39,"body":"scope, I asked them to get the"},{"speaker":"Chris Dy","startTime":2301.84,"endTime":2304.39,"body":"glue out, because the glue needs"},{"speaker":"Chris Dy","startTime":2304.39,"endTime":2307.15,"body":"time to thaw. And there's"},{"speaker":"Chris Dy","startTime":2304.39,"endTime":2307.15,"body":"nothing worse than finishing a"},{"speaker":"Chris Dy","startTime":2307.15,"endTime":2309.55,"body":"repair and wanting to put the"},{"speaker":"Chris Dy","startTime":2307.15,"endTime":2309.55,"body":"glue on and then them saying"},{"speaker":"Chris Dy","startTime":2309.55,"endTime":2312.13,"body":"well, it has to we have to get"},{"speaker":"Chris Dy","startTime":2309.55,"endTime":2312.13,"body":"it out of the freezer, it has to"},{"speaker":"Chris Dy","startTime":2312.13,"endTime":2315.73,"body":"thaw and you have to wait 5-10"},{"speaker":"Chris Dy","startTime":2312.13,"endTime":2315.73,"body":"minutes that is awful. So"},{"speaker":"Chris Dy","startTime":2315.73,"endTime":2318.19,"body":"basically, the OR staff I work"},{"speaker":"Chris Dy","startTime":2315.73,"endTime":2318.19,"body":"with knows that when they prep"},{"speaker":"Chris Dy","startTime":2318.19,"endTime":2320.26,"body":"the scope they get, when they're"},{"speaker":"Chris Dy","startTime":2318.19,"endTime":2320.26,"body":"prepping the microscope, they"},{"speaker":"Chris Dy","startTime":2320.26,"endTime":2324.49,"body":"get the glue out. And it's you"},{"speaker":"Chris Dy","startTime":2320.26,"endTime":2324.49,"body":"know, I don't do the separate"},{"speaker":"Chris Dy","startTime":2324.49,"endTime":2327.22,"body":"syringes drip drip technique"},{"speaker":"Chris Dy","startTime":2324.49,"endTime":2327.22,"body":"that some people describe, I"},{"speaker":"Chris Dy","startTime":2327.22,"endTime":2329.98,"body":"usually just use what's in the"},{"speaker":"Chris Dy","startTime":2327.22,"endTime":2329.98,"body":"syringe, you know that dual"},{"speaker":"Chris Dy","startTime":2329.98,"endTime":2334.51,"body":"chamber that they have. And I,"},{"speaker":"Chris Dy","startTime":2329.98,"endTime":2334.51,"body":"you have to make sure that it's"},{"speaker":"Chris Dy","startTime":2334.51,"endTime":2337.93,"body":"ready, that it's thawed enough"},{"speaker":"Chris Dy","startTime":2334.51,"endTime":2337.93,"body":"and that it the if you're using"},{"speaker":"Chris Dy","startTime":2337.93,"endTime":2341.02,"body":"it multiple times throughout the"},{"speaker":"Chris Dy","startTime":2337.93,"endTime":2341.02,"body":"case, you just want to check the"},{"speaker":"Chris Dy","startTime":2341.23,"endTime":2346.42,"body":"syringe to make sure that it"},{"speaker":"Chris Dy","startTime":2341.23,"endTime":2346.42,"body":"that it's coming out because"},{"speaker":"Chris Dy","startTime":2346.42,"endTime":2348.7,"body":"sometimes it will get clogged"},{"speaker":"Chris Dy","startTime":2346.42,"endTime":2348.7,"body":"and again nothing worse than"},{"speaker":"Chris Dy","startTime":2348.7,"endTime":2351.04,"body":"going to put on your glue and"},{"speaker":"Chris Dy","startTime":2348.7,"endTime":2351.04,"body":"the damn thing is clogged and"},{"speaker":"Chris Dy","startTime":2351.04,"endTime":2354.7,"body":"you have to get another another"},{"speaker":"Chris Dy","startTime":2351.04,"endTime":2354.7,"body":"syringe tip. So just checking"},{"speaker":"Chris Dy","startTime":2354.7,"endTime":2358.45,"body":"that off the field and making"},{"speaker":"Chris Dy","startTime":2354.7,"endTime":2358.45,"body":"sure and then I don't put an"},{"speaker":"Chris Dy","startTime":2358.45,"endTime":2361.9,"body":"excessive amount of glue I make"},{"speaker":"Chris Dy","startTime":2358.45,"endTime":2361.9,"body":"a joke with the fellows whether"},{"speaker":"Chris Dy","startTime":2361.9,"endTime":2364.15,"body":"they should put a hand surgery"},{"speaker":"Chris Dy","startTime":2361.9,"endTime":2364.15,"body":"amount of glue or neurosurgery"},{"speaker":"Chris Dy","startTime":2364.15,"endTime":2367.36,"body":"amount of glue because I've seen"},{"speaker":"Chris Dy","startTime":2364.15,"endTime":2367.36,"body":"some neurosurgeons just glob the"},{"speaker":"Chris Dy","startTime":2367.36,"endTime":2369.88,"body":"whole thing down and nothing"},{"speaker":"Chris Dy","startTime":2367.36,"endTime":2369.88,"body":"against the neurosurgeons"},{"speaker":"Chris Dy","startTime":2369.88,"endTime":2372.73,"body":"because it honestly doesn't"},{"speaker":"Chris Dy","startTime":2369.88,"endTime":2372.73,"body":"matter. But I usually will try"},{"speaker":"Chris Dy","startTime":2372.73,"endTime":2375.34,"body":"to do that nice little burrito"},{"speaker":"Chris Dy","startTime":2372.73,"endTime":2375.34,"body":"technique in which you put the"},{"speaker":"Chris Dy","startTime":2375.34,"endTime":2379.48,"body":"glue on with the nerve on a"},{"speaker":"Chris Dy","startTime":2375.34,"endTime":2379.48,"body":"background. put the glue on make"},{"speaker":"Chris Dy","startTime":2379.48,"endTime":2384.16,"body":"sure it goes all the way around"},{"speaker":"Chris Dy","startTime":2379.48,"endTime":2384.16,"body":"and then cinch the, cinch the"},{"speaker":"Chris Dy","startTime":2384.79,"endTime":2387.67,"body":"blue background over I guess"},{"speaker":"Chris Dy","startTime":2384.79,"endTime":2387.67,"body":"like a taco more than a burrito"},{"speaker":"Chris Dy","startTime":2388.39,"endTime":2389.56,"body":"to help seal it in."},{"speaker":"Charles Goldfarb","startTime":2390.55,"endTime":2392.02,"body":"And then"},{"speaker":"Charles Goldfarb","startTime":2390.55,"endTime":2392.02,"body":"remove the blue background."},{"speaker":"Chris Dy","startTime":2392.47,"endTime":2394.48,"body":"Of course because"},{"speaker":"Chris Dy","startTime":2392.47,"endTime":2394.48,"body":"otherwise the nurses will get on"},{"speaker":"Chris Dy","startTime":2394.48,"endTime":2396.46,"body":"you about that. Yeah background."},{"speaker":"Charles Goldfarb","startTime":2397.059,"endTime":2398.649,"body":"That's that's"},{"speaker":"Charles Goldfarb","startTime":2397.059,"endTime":2398.649,"body":"very helpful and not to put you"},{"speaker":"Charles Goldfarb","startTime":2398.649,"endTime":2402.279,"body":"on the spot. Are there different"},{"speaker":"Charles Goldfarb","startTime":2398.649,"endTime":2402.279,"body":"glue manufacturers? And do you"},{"speaker":"Charles Goldfarb","startTime":2402.279,"endTime":2403.359,"body":"know how much glue costs?"},{"speaker":"Chris Dy","startTime":2404.38,"endTime":2408.28,"body":"So the only glue"},{"speaker":"Chris Dy","startTime":2404.38,"endTime":2408.28,"body":"manufacturer that I'm aware of"},{"speaker":"Chris Dy","startTime":2408.28,"endTime":2412.21,"body":"for this particular setting is"},{"speaker":"Chris Dy","startTime":2408.28,"endTime":2412.21,"body":"TISSEEL and I'm not sure exactly"},{"speaker":"Chris Dy","startTime":2412.21,"endTime":2416.8,"body":"what the company that"},{"speaker":"Chris Dy","startTime":2412.21,"endTime":2416.8,"body":"manufactures it is. But you"},{"speaker":"Chris Dy","startTime":2416.8,"endTime":2419.62,"body":"know, it should be really"},{"speaker":"Chris Dy","startTime":2416.8,"endTime":2419.62,"body":"clearly noted for technical"},{"speaker":"Chris Dy","startTime":2419.62,"endTime":2423.52,"body":"reasons that this is an off"},{"speaker":"Chris Dy","startTime":2419.62,"endTime":2423.52,"body":"label use of TISSEEL for nerve"},{"speaker":"Chris Dy","startTime":2423.52,"endTime":2430.57,"body":"repair. So while it's widely"},{"speaker":"Chris Dy","startTime":2423.52,"endTime":2430.57,"body":"accepted, it is off label. And I"},{"speaker":"Chris Dy","startTime":2430.57,"endTime":2432.94,"body":"want to say it's a couple of"},{"speaker":"Chris Dy","startTime":2430.57,"endTime":2432.94,"body":"hundred dollars. But we should"},{"speaker":"Chris Dy","startTime":2432.94,"endTime":2435.34,"body":"actually check on that. Because"},{"speaker":"Chris Dy","startTime":2432.94,"endTime":2435.34,"body":"you know, in a cost conscious"},{"speaker":"Chris Dy","startTime":2435.34,"endTime":2438.07,"body":"setting, like we even described"},{"speaker":"Chris Dy","startTime":2435.34,"endTime":2438.07,"body":"earlier in the episode, that"},{"speaker":"Chris Dy","startTime":2438.07,"endTime":2439.72,"body":"doesn't matter. I do think it's"},{"speaker":"Chris Dy","startTime":2438.07,"endTime":2439.72,"body":"worth it, though."},{"speaker":"Charles Goldfarb","startTime":2440.62,"endTime":2442.27,"body":"Okay, that's"},{"speaker":"Charles Goldfarb","startTime":2440.62,"endTime":2442.27,"body":"helpful. I'm learning as I"},{"speaker":"Charles Goldfarb","startTime":2442.27,"endTime":2445.87,"body":"thought I might. Alright, we"},{"speaker":"Charles Goldfarb","startTime":2442.27,"endTime":2445.87,"body":"have a few more minutes to talk."},{"speaker":"Charles Goldfarb","startTime":2445.87,"endTime":2449.62,"body":"So let's say you sticking with"},{"speaker":"Charles Goldfarb","startTime":2445.87,"endTime":2449.62,"body":"the median nerve case, which I"},{"speaker":"Charles Goldfarb","startTime":2449.62,"endTime":2452.8,"body":"think is a good one, for a lot"},{"speaker":"Charles Goldfarb","startTime":2449.62,"endTime":2452.8,"body":"of reasons. You've done your"},{"speaker":"Charles Goldfarb","startTime":2452.8,"endTime":2456.61,"body":"cutbacks, you have bulging"},{"speaker":"Charles Goldfarb","startTime":2452.8,"endTime":2456.61,"body":"fascicles. And, you know, Chuck"},{"speaker":"Charles Goldfarb","startTime":2456.61,"endTime":2460.33,"body":"here is operating. And I think"},{"speaker":"Charles Goldfarb","startTime":2456.61,"endTime":2460.33,"body":"that if I use a 2-0, nylon, I"},{"speaker":"Charles Goldfarb","startTime":2460.33,"endTime":2463.3,"body":"can re approximate these ends."},{"speaker":"Charles Goldfarb","startTime":2460.33,"endTime":2463.3,"body":"But in the back of my head, I'm"},{"speaker":"Charles Goldfarb","startTime":2463.3,"endTime":2467.5,"body":"hearing Chris talking, he saying"},{"speaker":"Charles Goldfarb","startTime":2463.3,"endTime":2467.5,"body":"8%, what did you say strain or"},{"speaker":"Charles Goldfarb","startTime":2467.5,"endTime":2471.73,"body":"8% tension? And I'm thinking, I"},{"speaker":"Charles Goldfarb","startTime":2467.5,"endTime":2471.73,"body":"think this might be more than"},{"speaker":"Charles Goldfarb","startTime":2472.09,"endTime":2475.45,"body":"8%. So I'm like, Alright, in all"},{"speaker":"Charles Goldfarb","startTime":2472.09,"endTime":2475.45,"body":"seriousness, we can't repair"},{"speaker":"Charles Goldfarb","startTime":2475.45,"endTime":2480.16,"body":"this primarily, what are my"},{"speaker":"Charles Goldfarb","startTime":2475.45,"endTime":2480.16,"body":"options? And so how do you think"},{"speaker":"Charles Goldfarb","startTime":2480.16,"endTime":2483.85,"body":"about that, Chris? Is it a no"},{"speaker":"Charles Goldfarb","startTime":2480.16,"endTime":2483.85,"body":"brainer that you use x, y, or z?"},{"speaker":"Charles Goldfarb","startTime":2483.94,"endTime":2488.17,"body":"How do you think about how to"},{"speaker":"Charles Goldfarb","startTime":2483.94,"endTime":2488.17,"body":"bridge that gap in a 55 year old"},{"speaker":"Charles Goldfarb","startTime":2488.17,"endTime":2491.26,"body":"laborer with a crush injury that"},{"speaker":"Charles Goldfarb","startTime":2488.17,"endTime":2491.26,"body":"now has beautiful, bulging"},{"speaker":"Charles Goldfarb","startTime":2491.26,"endTime":2492.85,"body":"fascicles on each end?"},{"speaker":"Chris Dy","startTime":2493.59,"endTime":2495.72,"body":"You know, I don't"},{"speaker":"Chris Dy","startTime":2493.59,"endTime":2495.72,"body":"think it's a no brainer. I think"},{"speaker":"Chris Dy","startTime":2495.72,"endTime":2498.45,"body":"there's emerging literature to"},{"speaker":"Chris Dy","startTime":2495.72,"endTime":2498.45,"body":"support the use of an allograft."},{"speaker":"Chris Dy","startTime":2498.45,"endTime":2501.48,"body":"But if this is my median nerve,"},{"speaker":"Chris Dy","startTime":2498.45,"endTime":2501.48,"body":"I'm not using an allograft I'm"},{"speaker":"Chris Dy","startTime":2501.48,"endTime":2506.73,"body":"using a sural, cabled sural"},{"speaker":"Chris Dy","startTime":2501.48,"endTime":2506.73,"body":"autograft. And I think that's a"},{"speaker":"Chris Dy","startTime":2506.73,"endTime":2510.72,"body":"topic of debate. I think the"},{"speaker":"Chris Dy","startTime":2506.73,"endTime":2510.72,"body":"good thing, the one good, one of"},{"speaker":"Chris Dy","startTime":2510.72,"endTime":2513.57,"body":"the many good things that, you"},{"speaker":"Chris Dy","startTime":2510.72,"endTime":2513.57,"body":"know, the emergence of nerve"},{"speaker":"Chris Dy","startTime":2513.57,"endTime":2517.05,"body":"allograft has done is really"},{"speaker":"Chris Dy","startTime":2513.57,"endTime":2517.05,"body":"allow us to say, alright, like,"},{"speaker":"Chris Dy","startTime":2517.05,"endTime":2521.91,"body":"we really need to avoid tension"},{"speaker":"Chris Dy","startTime":2517.05,"endTime":2521.91,"body":"on repairs. But I just don't"},{"speaker":"Chris Dy","startTime":2521.91,"endTime":2525.81,"body":"think that the evidence is there"},{"speaker":"Chris Dy","startTime":2521.91,"endTime":2525.81,"body":"yet to support mixed or motor"},{"speaker":"Chris Dy","startTime":2525.81,"endTime":2529.77,"body":"nerves being done with an"},{"speaker":"Chris Dy","startTime":2525.81,"endTime":2529.77,"body":"allograft. You know, I think"},{"speaker":"Chris Dy","startTime":2529.77,"endTime":2532.2,"body":"that the literature is going to"},{"speaker":"Chris Dy","startTime":2529.77,"endTime":2532.2,"body":"evolve, and maybe in about three"},{"speaker":"Chris Dy","startTime":2532.2,"endTime":2535.62,"body":"or four years, we'll have some"},{"speaker":"Chris Dy","startTime":2532.2,"endTime":2535.62,"body":"more support. I always like to"},{"speaker":"Chris Dy","startTime":2535.62,"endTime":2538.11,"body":"be careful about looking at the"},{"speaker":"Chris Dy","startTime":2535.62,"endTime":2538.11,"body":"literature, who's written it,"},{"speaker":"Chris Dy","startTime":2538.14,"endTime":2540.57,"body":"the support they've received"},{"speaker":"Chris Dy","startTime":2538.14,"endTime":2540.57,"body":"that kind of thing, because I"},{"speaker":"Chris Dy","startTime":2540.57,"endTime":2544.44,"body":"think that is important. But I"},{"speaker":"Chris Dy","startTime":2540.57,"endTime":2544.44,"body":"do think that it's good that the"},{"speaker":"Chris Dy","startTime":2544.44,"endTime":2547.41,"body":"industry has moved into"},{"speaker":"Chris Dy","startTime":2544.44,"endTime":2547.41,"body":"supporting research and really"},{"speaker":"Chris Dy","startTime":2547.41,"endTime":2549.96,"body":"tried to elevate the level of"},{"speaker":"Chris Dy","startTime":2547.41,"endTime":2549.96,"body":"evidence because honestly, the"},{"speaker":"Chris Dy","startTime":2549.96,"endTime":2554.46,"body":"level of evidence for all this"},{"speaker":"Chris Dy","startTime":2549.96,"endTime":2554.46,"body":"stuff is quite weak. One thing,"},{"speaker":"Chris Dy","startTime":2554.49,"endTime":2558.57,"body":"you know, we can have a whole"},{"speaker":"Chris Dy","startTime":2554.49,"endTime":2558.57,"body":"kind of technical part of how to"},{"speaker":"Chris Dy","startTime":2558.57,"endTime":2561.78,"body":"do a nerve graft. You know, one"},{"speaker":"Chris Dy","startTime":2558.57,"endTime":2561.78,"body":"thing that we didn't mention"},{"speaker":"Chris Dy","startTime":2561.78,"endTime":2564.03,"body":"earlier was whether to use a"},{"speaker":"Chris Dy","startTime":2561.78,"endTime":2564.03,"body":"nerve cutting device when you're"},{"speaker":"Chris Dy","startTime":2564.03,"endTime":2566.34,"body":"cutting the nerve. And I've"},{"speaker":"Chris Dy","startTime":2564.03,"endTime":2566.34,"body":"found that, you know, I've tried"},{"speaker":"Chris Dy","startTime":2566.34,"endTime":2569.58,"body":"it, and I've found it to be a"},{"speaker":"Chris Dy","startTime":2566.34,"endTime":2569.58,"body":"little bit finicky with that"},{"speaker":"Chris Dy","startTime":2569.58,"endTime":2572.85,"body":"blade that you use for the nerve"},{"speaker":"Chris Dy","startTime":2569.58,"endTime":2572.85,"body":"cutting device. But those nerve"},{"speaker":"Chris Dy","startTime":2572.85,"endTime":2576.0,"body":"cutting device templates, those"},{"speaker":"Chris Dy","startTime":2572.85,"endTime":2576.0,"body":"things that you slide the nerve,"},{"speaker":"Chris Dy","startTime":2576.03,"endTime":2578.58,"body":"around the nerve, those are"},{"speaker":"Chris Dy","startTime":2576.03,"endTime":2578.58,"body":"great for for shaping your nerve"},{"speaker":"Chris Dy","startTime":2578.58,"endTime":2583.74,"body":"graphs, and deciding how many"},{"speaker":"Chris Dy","startTime":2578.58,"endTime":2583.74,"body":"cables that kind of thing. So we"},{"speaker":"Chris Dy","startTime":2583.74,"endTime":2587.01,"body":"can talk about sural nerve"},{"speaker":"Chris Dy","startTime":2583.74,"endTime":2587.01,"body":"harvest in a part two and cable"},{"speaker":"Chris Dy","startTime":2587.01,"endTime":2590.49,"body":"graft formation, all that kind"},{"speaker":"Chris Dy","startTime":2587.01,"endTime":2590.49,"body":"of stuff. I will slide one"},{"speaker":"Chris Dy","startTime":2590.52,"endTime":2593.22,"body":"mention in here for this"},{"speaker":"Chris Dy","startTime":2590.52,"endTime":2593.22,"body":"particular case, in a high"},{"speaker":"Chris Dy","startTime":2593.22,"endTime":2596.46,"body":"median nerve injury. I really"},{"speaker":"Chris Dy","startTime":2593.22,"endTime":2596.46,"body":"like the nerve transfer that"},{"speaker":"Chris Dy","startTime":2596.49,"endTime":2600.09,"body":"Bertelli has described, using a"},{"speaker":"Chris Dy","startTime":2596.49,"endTime":2600.09,"body":"branch of the ulnar nerve going"},{"speaker":"Chris Dy","startTime":2600.09,"endTime":2604.05,"body":"to the ADM as a nerve transfer"},{"speaker":"Chris Dy","startTime":2600.09,"endTime":2604.05,"body":"to the APB or to the recurrent"},{"speaker":"Chris Dy","startTime":2604.05,"endTime":2607.83,"body":"motor branch of the of the"},{"speaker":"Chris Dy","startTime":2604.05,"endTime":2607.83,"body":"median nerve. That takes a lot"},{"speaker":"Chris Dy","startTime":2607.83,"endTime":2610.26,"body":"of pressure off of us as hand"},{"speaker":"Chris Dy","startTime":2607.83,"endTime":2610.26,"body":"surgeons, because if you've got"},{"speaker":"Chris Dy","startTime":2610.26,"endTime":2613.08,"body":"a distal nerve transfer that can"},{"speaker":"Chris Dy","startTime":2610.26,"endTime":2613.08,"body":"get to those thenar muscles in"},{"speaker":"Chris Dy","startTime":2613.08,"endTime":2616.35,"body":"time. Whatever you do up in the"},{"speaker":"Chris Dy","startTime":2613.08,"endTime":2616.35,"body":"forum is gravy in terms of"},{"speaker":"Chris Dy","startTime":2616.35,"endTime":2620.73,"body":"getting median nerve, extrinsic"},{"speaker":"Chris Dy","startTime":2616.35,"endTime":2620.73,"body":"function and sensation back."},{"speaker":"Charles Goldfarb","startTime":2621.63,"endTime":2623.73,"body":"Alright, it"},{"speaker":"Charles Goldfarb","startTime":2621.63,"endTime":2623.73,"body":"pains me to say this, but"},{"speaker":"Charles Goldfarb","startTime":2623.73,"endTime":2627.63,"body":"clearly we need a part two to"},{"speaker":"Charles Goldfarb","startTime":2623.73,"endTime":2627.63,"body":"this episode. And let's just off"},{"speaker":"Charles Goldfarb","startTime":2627.63,"endTime":2629.91,"body":"the top of our heads talk about"},{"speaker":"Charles Goldfarb","startTime":2627.63,"endTime":2629.91,"body":"what we'll cover there just to"},{"speaker":"Charles Goldfarb","startTime":2629.91,"endTime":2633.03,"body":"tease the audience while they're"},{"speaker":"Charles Goldfarb","startTime":2629.91,"endTime":2633.03,"body":"enjoying their holiday break. So"},{"speaker":"Charles Goldfarb","startTime":2633.24,"endTime":2636.93,"body":"we are going to talk about some"},{"speaker":"Charles Goldfarb","startTime":2633.24,"endTime":2636.93,"body":"technical with a sural nerve"},{"speaker":"Charles Goldfarb","startTime":2636.93,"endTime":2640.41,"body":"graft. We can talk about the"},{"speaker":"Charles Goldfarb","startTime":2636.93,"endTime":2640.41,"body":"allograft options, what they're"},{"speaker":"Charles Goldfarb","startTime":2640.41,"endTime":2643.59,"body":"good for what they're not good"},{"speaker":"Charles Goldfarb","startTime":2640.41,"endTime":2643.59,"body":"for what the literature says we"},{"speaker":"Charles Goldfarb","startTime":2643.59,"endTime":2647.67,"body":"can, I'd like to talk some"},{"speaker":"Charles Goldfarb","startTime":2643.59,"endTime":2647.67,"body":"technical and decision making"},{"speaker":"Charles Goldfarb","startTime":2647.67,"endTime":2651.63,"body":"with a digital nerve. How do you"},{"speaker":"Charles Goldfarb","startTime":2647.67,"endTime":2651.63,"body":"think about that? What else"},{"speaker":"Charles Goldfarb","startTime":2651.63,"endTime":2653.04,"body":"would we throw in that park?"},{"speaker":"Chris Dy","startTime":2653.07,"endTime":2655.26,"body":"I think for for the"},{"speaker":"Chris Dy","startTime":2653.07,"endTime":2655.26,"body":"purpose of discussion, we should"},{"speaker":"Chris Dy","startTime":2655.26,"endTime":2658.86,"body":"talk about conduits, and that"},{"speaker":"Chris Dy","startTime":2655.26,"endTime":2658.86,"body":"kind of thing. Although I tech,"},{"speaker":"Chris Dy","startTime":2658.89,"endTime":2661.74,"body":"I personally don't use them. I"},{"speaker":"Chris Dy","startTime":2658.89,"endTime":2661.74,"body":"think that that is something"},{"speaker":"Chris Dy","startTime":2661.74,"endTime":2664.65,"body":"that is often used and we should"},{"speaker":"Chris Dy","startTime":2661.74,"endTime":2664.65,"body":"talk about nerve wraps because"},{"speaker":"Chris Dy","startTime":2664.68,"endTime":2667.23,"body":"again, something that is often"},{"speaker":"Chris Dy","startTime":2664.68,"endTime":2667.23,"body":"used that I don't like"},{"speaker":"Charles Goldfarb","startTime":2667.74,"endTime":2669.57,"body":"Actually, I"},{"speaker":"Charles Goldfarb","startTime":2667.74,"endTime":2669.57,"body":"was gonna ask you about both of"},{"speaker":"Charles Goldfarb","startTime":2669.57,"endTime":2673.2,"body":"those, but I think we'll we'll"},{"speaker":"Charles Goldfarb","startTime":2669.57,"endTime":2673.2,"body":"leave it at that and we'll"},{"speaker":"Charles Goldfarb","startTime":2673.2,"endTime":2675.63,"body":"circle back in a couple weeks."},{"speaker":"Chris Dy","startTime":2675.78,"endTime":2678.09,"body":"I will say the number"},{"speaker":"Chris Dy","startTime":2675.78,"endTime":2678.09,"body":"of times that people have sent"},{"speaker":"Chris Dy","startTime":2678.09,"endTime":2680.43,"body":"me cases saying I did this"},{"speaker":"Chris Dy","startTime":2678.09,"endTime":2680.43,"body":"repair that and that and then I"},{"speaker":"Chris Dy","startTime":2680.43,"endTime":2686.07,"body":"wrapped the nerve and I was like"},{"speaker":"Chris Dy","startTime":2680.43,"endTime":2686.07,"body":"ah. Again, I'm probably in the"},{"speaker":"Chris Dy","startTime":2686.07,"endTime":2688.74,"body":"minority in this opinion in"},{"speaker":"Chris Dy","startTime":2686.07,"endTime":2688.74,"body":"terms of avoiding nerve wraps."},{"speaker":"Chris Dy","startTime":2689.04,"endTime":2691.29,"body":"But you're listening to our"},{"speaker":"Chris Dy","startTime":2689.04,"endTime":2691.29,"body":"podcast, you're gonna get my"},{"speaker":"Chris Dy","startTime":2691.29,"endTime":2691.59,"body":"opinion."},{"speaker":"Charles Goldfarb","startTime":2692.409,"endTime":2695.049,"body":"Yeah, well,"},{"speaker":"Charles Goldfarb","startTime":2692.409,"endTime":2695.049,"body":"listen, there's no doubt your"},{"speaker":"Charles Goldfarb","startTime":2695.049,"endTime":2698.079,"body":"expertise is is worth something."},{"speaker":"Charles Goldfarb","startTime":2695.049,"endTime":2698.079,"body":"I don't know if it's worth"},{"speaker":"Charles Goldfarb","startTime":2698.079,"endTime":2699.459,"body":"everything, but it's worth"},{"speaker":"Charles Goldfarb","startTime":2698.079,"endTime":2699.459,"body":"something"},{"speaker":"Chris Dy","startTime":2700.69,"endTime":2702.4,"body":"I don't know. I don't"},{"speaker":"Chris Dy","startTime":2700.69,"endTime":2702.4,"body":"know if I'd go so far as"},{"speaker":"Chris Dy","startTime":2702.4,"endTime":2703.6,"body":"expertise. We'll call it"},{"speaker":"Chris Dy","startTime":2702.4,"endTime":2703.6,"body":"opinion."},{"speaker":"Charles Goldfarb","startTime":2705.01,"endTime":2706.66,"body":"All right,"},{"speaker":"Charles Goldfarb","startTime":2705.01,"endTime":2706.66,"body":"awesome. This was actually"},{"speaker":"Charles Goldfarb","startTime":2706.66,"endTime":2709.21,"body":"surprisingly funny even though"},{"speaker":"Charles Goldfarb","startTime":2706.66,"endTime":2709.21,"body":"we're talking about nerve. So"},{"speaker":"Chris Dy","startTime":2709.75,"endTime":2712.93,"body":"Surprisingly, I mean,"},{"speaker":"Chris Dy","startTime":2709.75,"endTime":2712.93,"body":"come on. Go Go, you're gonna go"},{"speaker":"Chris Dy","startTime":2712.93,"endTime":2715.87,"body":"enjoy your world. Now you're"},{"speaker":"Chris Dy","startTime":2712.93,"endTime":2715.87,"body":"gonna go do a congenital journal"},{"speaker":"Chris Dy","startTime":2715.87,"endTime":2720.04,"body":"club with our fellows. And"},{"speaker":"Chris Dy","startTime":2715.87,"endTime":2720.04,"body":"that's a fantastic program. And"},{"speaker":"Chris Dy","startTime":2720.31,"endTime":2723.49,"body":"anybody looking at our"},{"speaker":"Chris Dy","startTime":2720.31,"endTime":2723.49,"body":"fellowship, we do have one of"},{"speaker":"Chris Dy","startTime":2723.49,"endTime":2727.3,"body":"those sessions is up on YouTube"},{"speaker":"Chris Dy","startTime":2723.49,"endTime":2727.3,"body":"to check out and Chuck and Lily"},{"speaker":"Chris Dy","startTime":2727.33,"endTime":2730.66,"body":"do a fantastic job with that"},{"speaker":"Chris Dy","startTime":2727.33,"endTime":2730.66,"body":"journal club. So I still have"},{"speaker":"Chris Dy","startTime":2730.66,"endTime":2733.72,"body":"PTSD from it, but I know it's a"},{"speaker":"Chris Dy","startTime":2730.66,"endTime":2733.72,"body":"good educational opportunity."},{"speaker":"Charles Goldfarb","startTime":2734.23,"endTime":2737.5,"body":"You do not"},{"speaker":"Charles Goldfarb","startTime":2734.23,"endTime":2737.5,"body":"have PTSD. It is low key. But"},{"speaker":"Charles Goldfarb","startTime":2737.5,"endTime":2741.13,"body":"today we're talking about"},{"speaker":"Charles Goldfarb","startTime":2737.5,"endTime":2741.13,"body":"polydactyly. Radial, ulnar,"},{"speaker":"Charles Goldfarb","startTime":2741.13,"endTime":2744.13,"body":"central, ulnar dimelia. Yeah, I"},{"speaker":"Charles Goldfarb","startTime":2741.13,"endTime":2744.13,"body":"mean, come on. This is good"},{"speaker":"Charles Goldfarb","startTime":2744.13,"endTime":2744.67,"body":"stuff."},{"speaker":"Chris Dy","startTime":2744.97,"endTime":2748.33,"body":"Oh my god, the look on"},{"speaker":"Chris Dy","startTime":2744.97,"endTime":2748.33,"body":"your face. Go do that."},{"speaker":"Charles Goldfarb","startTime":2748.63,"endTime":2750.1,"body":"I just"},{"speaker":"Charles Goldfarb","startTime":2748.63,"endTime":2750.1,"body":"brightened up didn't I."},{"speaker":"Chris Dy","startTime":2750.43,"endTime":2752.71,"body":"You did, everybody"},{"speaker":"Chris Dy","startTime":2750.43,"endTime":2752.71,"body":"have a wonderful holiday season."},{"speaker":"Chris Dy","startTime":2752.71,"endTime":2753.88,"body":"We'll see you in the new year."},{"speaker":"Charles Goldfarb","startTime":2755.08,"endTime":2757.09,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2755.08,"endTime":2757.09,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2757.09,"endTime":2757.63,"body":"real soon."},{"speaker":"Chris Dy","startTime":2757.87,"endTime":2760.39,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2757.87,"endTime":2760.39,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2760.63,"endTime":2762.82,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2760.63,"endTime":2762.82,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2763.15,"endTime":2766.0,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2763.15,"endTime":2766.0,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2766.15,"endTime":2769.54,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2766.15,"endTime":2769.54,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2769.54,"endTime":2773.38,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2769.54,"endTime":2773.38,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2773.949,"endTime":2776.079,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2773.949,"endTime":2776.079,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2776.079,"endTime":2777.189,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2777.219,"endTime":2779.439,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2777.219,"endTime":2779.439,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2779.439,"endTime":2779.859,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2780.219,"endTime":2782.529,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2780.219,"endTime":2782.529,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2782.529,"endTime":2786.519,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2782.529,"endTime":2786.519,"body":"upper hand. Come back next time."}]}