{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.62,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.62,"body":"upper hand where Chuck and Chris"},{"speaker":"Charles Goldfarb","startTime":13.62,"endTime":14.49,"body":"talk hand surgery."},{"speaker":"Chris Dy","startTime":14.7,"endTime":16.56,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.7,"endTime":16.56,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.65,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.65,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.65,"endTime":21.45,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.65,"endTime":21.45,"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":27.87,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.38,"endTime":29.22,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.38,"endTime":29.22,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.52,"endTime":30.63,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.52,"endTime":30.63,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":30.87,"endTime":32.85,"body":"I'm doing very"},{"speaker":"Charles Goldfarb","startTime":30.87,"endTime":32.85,"body":"well. How are you today?"},{"speaker":"Chris Dy","startTime":33.03,"endTime":36.51,"body":"I am fine. We are on"},{"speaker":"Chris Dy","startTime":33.03,"endTime":36.51,"body":"Instagram Live. Hello, Instagram"},{"speaker":"Chris Dy","startTime":36.51,"endTime":40.08,"body":"Live and we're also doing a"},{"speaker":"Chris Dy","startTime":36.51,"endTime":40.08,"body":"podcast. You know, it's gonna be"},{"speaker":"Chris Dy","startTime":40.08,"endTime":42.63,"body":"a fun day. Let's see how this"},{"speaker":"Chris Dy","startTime":40.08,"endTime":42.63,"body":"goes. I sprung this on you at"},{"speaker":"Chris Dy","startTime":42.63,"endTime":43.26,"body":"the last second."},{"speaker":"Charles Goldfarb","startTime":43.71,"endTime":46.02,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":43.71,"endTime":46.02,"body":"keeping me young man. I didn't"},{"speaker":"Charles Goldfarb","startTime":46.02,"endTime":50.1,"body":"know you could multi zoom."},{"speaker":"Charles Goldfarb","startTime":46.02,"endTime":50.1,"body":"Instagram podcast. Awesome."},{"speaker":"Chris Dy","startTime":50.49,"endTime":52.17,"body":"I'm not sure we might"},{"speaker":"Chris Dy","startTime":50.49,"endTime":52.17,"body":"break this. So"},{"speaker":"Charles Goldfarb","startTime":53.5,"endTime":55.39,"body":"Who broke the"},{"speaker":"Charles Goldfarb","startTime":53.5,"endTime":55.39,"body":"internet? I don't know."},{"speaker":"Chris Dy","startTime":55.96,"endTime":58.39,"body":"Yeah, those those two"},{"speaker":"Chris Dy","startTime":55.96,"endTime":58.39,"body":"hand surgeons with five people"},{"speaker":"Chris Dy","startTime":58.39,"endTime":61.06,"body":"watching. So anyway, it looks"},{"speaker":"Chris Dy","startTime":58.39,"endTime":61.06,"body":"like we've got you know,"},{"speaker":"Chris Dy","startTime":61.06,"endTime":65.38,"body":"obviously our number one guy,"},{"speaker":"Chris Dy","startTime":61.06,"endTime":65.38,"body":"Dr. Sam Moghtaderi on there,"},{"speaker":"Chris Dy","startTime":65.38,"endTime":68.17,"body":"former guests for WALANT. And"},{"speaker":"Chris Dy","startTime":65.38,"endTime":68.17,"body":"Sam, we're gonna talk a little"},{"speaker":"Chris Dy","startTime":68.17,"endTime":72.34,"body":"bit about some of the WALANT"},{"speaker":"Chris Dy","startTime":68.17,"endTime":72.34,"body":"issues on the podcast. So"},{"speaker":"Chris Dy","startTime":72.58,"endTime":74.29,"body":"anyway, Chuck what's going on in"},{"speaker":"Chris Dy","startTime":72.58,"endTime":74.29,"body":"your world today?"},{"speaker":"Charles Goldfarb","startTime":76.12,"endTime":78.37,"body":"You know, it's"},{"speaker":"Charles Goldfarb","startTime":76.12,"endTime":78.37,"body":"one of those days it's an admin"},{"speaker":"Charles Goldfarb","startTime":78.46,"endTime":81.58,"body":"academic day, which"},{"speaker":"Charles Goldfarb","startTime":78.46,"endTime":81.58,"body":"unfortunately becomes more admin"},{"speaker":"Charles Goldfarb","startTime":81.58,"endTime":86.89,"body":"and less academic. But no, good"},{"speaker":"Charles Goldfarb","startTime":81.58,"endTime":86.89,"body":"day, a lot to catch up on and"},{"speaker":"Charles Goldfarb","startTime":87.55,"endTime":89.56,"body":"looking forward to getting some"},{"speaker":"Charles Goldfarb","startTime":87.55,"endTime":89.56,"body":"stuff accomplished."},{"speaker":"Chris Dy","startTime":90.13,"endTime":92.77,"body":"You know, I had some"},{"speaker":"Chris Dy","startTime":90.13,"endTime":92.77,"body":"academic time yesterday, and it"},{"speaker":"Chris Dy","startTime":92.77,"endTime":94.93,"body":"was the first time in a while"},{"speaker":"Chris Dy","startTime":92.77,"endTime":94.93,"body":"that I actually had time to"},{"speaker":"Chris Dy","startTime":94.93,"endTime":96.1,"body":"think, that was awesome."},{"speaker":"Charles Goldfarb","startTime":96.3,"endTime":100.08,"body":"It's so easy"},{"speaker":"Charles Goldfarb","startTime":96.3,"endTime":100.08,"body":"to get caught up in checking the"},{"speaker":"Charles Goldfarb","startTime":100.08,"endTime":104.25,"body":"boxes. And you know, we love"},{"speaker":"Charles Goldfarb","startTime":100.08,"endTime":104.25,"body":"seeing the patients, but man, it"},{"speaker":"Charles Goldfarb","startTime":104.25,"endTime":108.87,"body":"is setting aside time to think"},{"speaker":"Charles Goldfarb","startTime":104.25,"endTime":108.87,"body":"is a prerequisite for the real"},{"speaker":"Charles Goldfarb","startTime":108.87,"endTime":114.33,"body":"world for CEOs of all varieties."},{"speaker":"Charles Goldfarb","startTime":108.87,"endTime":114.33,"body":"And we you know, we don't we"},{"speaker":"Charles Goldfarb","startTime":114.33,"endTime":118.5,"body":"don't set aside that time. And I"},{"speaker":"Charles Goldfarb","startTime":114.33,"endTime":118.5,"body":"think for big ideas, and for do"},{"speaker":"Charles Goldfarb","startTime":118.5,"endTime":121.38,"body":"things, doing things for"},{"speaker":"Charles Goldfarb","startTime":118.5,"endTime":121.38,"body":"ourselves or to advance the"},{"speaker":"Charles Goldfarb","startTime":121.38,"endTime":123.6,"body":"field. You have to have that"},{"speaker":"Charles Goldfarb","startTime":121.38,"endTime":123.6,"body":"time."},{"speaker":"Chris Dy","startTime":124.5,"endTime":126.78,"body":"Yeah, and I think one"},{"speaker":"Chris Dy","startTime":124.5,"endTime":126.78,"body":"thing that I probably could get"},{"speaker":"Chris Dy","startTime":126.78,"endTime":130.17,"body":"better at is actually just"},{"speaker":"Chris Dy","startTime":126.78,"endTime":130.17,"body":"reading. No, I think that the"},{"speaker":"Chris Dy","startTime":130.17,"endTime":132.78,"body":"temptation naturally is to"},{"speaker":"Chris Dy","startTime":130.17,"endTime":132.78,"body":"figure out how you can do more."},{"speaker":"Chris Dy","startTime":133.59,"endTime":137.64,"body":"But I think many, many clinician"},{"speaker":"Chris Dy","startTime":133.59,"endTime":137.64,"body":"scientists have told me that you"},{"speaker":"Chris Dy","startTime":137.64,"endTime":140.1,"body":"can save yourself four years by"},{"speaker":"Chris Dy","startTime":137.64,"endTime":140.1,"body":"spending four hours in the"},{"speaker":"Chris Dy","startTime":140.1,"endTime":140.58,"body":"library."},{"speaker":"Charles Goldfarb","startTime":141.36,"endTime":145.98,"body":"Wow, that is"},{"speaker":"Charles Goldfarb","startTime":141.36,"endTime":145.98,"body":"strong. Yes."},{"speaker":"Chris Dy","startTime":146.38,"endTime":149.26,"body":"So do we have any"},{"speaker":"Chris Dy","startTime":146.38,"endTime":149.26,"body":"actually I think we have a new"},{"speaker":"Chris Dy","startTime":149.26,"endTime":152.74,"body":"review. iTunes five stars the"},{"speaker":"Chris Dy","startTime":149.26,"endTime":152.74,"body":"only option if you're putting a"},{"speaker":"Chris Dy","startTime":152.74,"endTime":157.45,"body":"rating on iTunes. So this is"},{"speaker":"Chris Dy","startTime":152.74,"endTime":157.45,"body":"from ET calverts from April 29."},{"speaker":"Chris Dy","startTime":157.48,"endTime":161.23,"body":"Thank you for the review two"},{"speaker":"Chris Dy","startTime":157.48,"endTime":161.23,"body":"thumbs up. Great. Chuck, good."},{"speaker":"Chris Dy","startTime":161.23,"endTime":162.76,"body":"Did you give her one of those"},{"speaker":"Chris Dy","startTime":161.23,"endTime":162.76,"body":"thumbs?"},{"speaker":"Charles Goldfarb","startTime":163.21,"endTime":165.97,"body":"Well, I would"},{"speaker":"Charles Goldfarb","startTime":163.21,"endTime":165.97,"body":"be happy to I will, I will do"},{"speaker":"Charles Goldfarb","startTime":165.97,"endTime":166.84,"body":"anything I can."},{"speaker":"Chris Dy","startTime":166.0,"endTime":169.3,"body":"It's such a great idea"},{"speaker":"Chris Dy","startTime":166.0,"endTime":169.3,"body":"to listen and learn with a"},{"speaker":"Chris Dy","startTime":169.3,"endTime":172.51,"body":"conversational tone and totally"},{"speaker":"Chris Dy","startTime":169.3,"endTime":172.51,"body":"entertaining. So thank you for"},{"speaker":"Chris Dy","startTime":172.51,"endTime":175.48,"body":"that review. We really"},{"speaker":"Chris Dy","startTime":172.51,"endTime":175.48,"body":"appreciate it again, go on the"},{"speaker":"Chris Dy","startTime":175.48,"endTime":179.8,"body":"iTunes and leave us a five star"},{"speaker":"Chris Dy","startTime":175.48,"endTime":179.8,"body":"review. And nobody has actually"},{"speaker":"Chris Dy","startTime":179.8,"endTime":182.86,"body":"taken us up on this Chuck will"},{"speaker":"Chris Dy","startTime":179.8,"endTime":182.86,"body":"answer anything that you write"},{"speaker":"Chris Dy","startTime":182.89,"endTime":186.64,"body":"as a question in there. So"},{"speaker":"Chris Dy","startTime":182.89,"endTime":186.64,"body":"please, please leave a question."},{"speaker":"Chris Dy","startTime":187.15,"endTime":190.39,"body":"Let's incorporate from the"},{"speaker":"Chris Dy","startTime":187.15,"endTime":190.39,"body":"Instagram Live. Dr. Sam says the"},{"speaker":"Chris Dy","startTime":190.39,"endTime":193.39,"body":"problem is that when I take my"},{"speaker":"Chris Dy","startTime":190.39,"endTime":193.39,"body":"academic time to think I fall"},{"speaker":"Chris Dy","startTime":193.39,"endTime":197.05,"body":"behind on my charts, that's pain"},{"speaker":"Chris Dy","startTime":193.39,"endTime":197.05,"body":"that we all feel, so."},{"speaker":"Charles Goldfarb","startTime":197.41,"endTime":200.11,"body":"That, there is"},{"speaker":"Charles Goldfarb","startTime":197.41,"endTime":200.11,"body":"no doubt there is truth there. I"},{"speaker":"Charles Goldfarb","startTime":200.11,"endTime":203.92,"body":"do want to take a second to"},{"speaker":"Charles Goldfarb","startTime":200.11,"endTime":203.92,"body":"thank our partners QXMD with the"},{"speaker":"Charles Goldfarb","startTime":203.92,"endTime":208.51,"body":"read app. I continue to use this"},{"speaker":"Charles Goldfarb","startTime":203.92,"endTime":208.51,"body":"app it's really interesting that"},{"speaker":"Charles Goldfarb","startTime":208.51,"endTime":212.23,"body":"I I try to stay up with the"},{"speaker":"Charles Goldfarb","startTime":208.51,"endTime":212.23,"body":"literature and with publications"},{"speaker":"Charles Goldfarb","startTime":212.23,"endTime":215.5,"body":"in different ways. Google"},{"speaker":"Charles Goldfarb","startTime":212.23,"endTime":215.5,"body":"Scholar does it for me, I get"},{"speaker":"Charles Goldfarb","startTime":215.5,"endTime":219.97,"body":"emails about publications. But"},{"speaker":"Charles Goldfarb","startTime":215.5,"endTime":219.97,"body":"the read app is really helpful"},{"speaker":"Charles Goldfarb","startTime":219.97,"endTime":222.43,"body":"because I get a once or twice a"},{"speaker":"Charles Goldfarb","startTime":219.97,"endTime":222.43,"body":"week, I think you can set it"},{"speaker":"Charles Goldfarb","startTime":222.43,"endTime":224.68,"body":"however you want. I get an"},{"speaker":"Charles Goldfarb","startTime":222.43,"endTime":224.68,"body":"update on what's been published"},{"speaker":"Charles Goldfarb","startTime":224.83,"endTime":227.86,"body":"in the fields that I have"},{"speaker":"Charles Goldfarb","startTime":224.83,"endTime":227.86,"body":"requested on whether that be"},{"speaker":"Charles Goldfarb","startTime":228.04,"endTime":232.63,"body":"cleft hand or OCD of the"},{"speaker":"Charles Goldfarb","startTime":228.04,"endTime":232.63,"body":"capitellum or the best hand"},{"speaker":"Charles Goldfarb","startTime":232.63,"endTime":235.42,"body":"podcast out there. I get the"},{"speaker":"Charles Goldfarb","startTime":232.63,"endTime":235.42,"body":"updates every week, Chris."},{"speaker":"Chris Dy","startTime":235.6,"endTime":237.31,"body":"It's easy to be the"},{"speaker":"Chris Dy","startTime":235.6,"endTime":237.31,"body":"best when you're the only"},{"speaker":"Chris Dy","startTime":239.17,"endTime":242.05,"body":"actually the only hand surgery"},{"speaker":"Chris Dy","startTime":239.17,"endTime":242.05,"body":"podcast shout out to hand"},{"speaker":"Chris Dy","startTime":242.05,"endTime":246.73,"body":"therapy heroes, hand therapy"},{"speaker":"Chris Dy","startTime":242.05,"endTime":246.73,"body":"podcast, colleagues. So um, you"},{"speaker":"Chris Dy","startTime":246.73,"endTime":251.35,"body":"know, funny story about the QX"},{"speaker":"Chris Dy","startTime":246.73,"endTime":251.35,"body":"MD thing I was chatting with"},{"speaker":"Chris Dy","startTime":251.53,"endTime":255.52,"body":"Micah Sinclair, a pediatric"},{"speaker":"Chris Dy","startTime":251.53,"endTime":255.52,"body":"focused hand surgeon over in"},{"speaker":"Chris Dy","startTime":255.52,"endTime":258.43,"body":"Kansas City. And she asked me"},{"speaker":"Chris Dy","startTime":255.52,"endTime":258.43,"body":"she's like yeah, do you remember"},{"speaker":"Chris Dy","startTime":258.43,"endTime":261.37,"body":"you said something about how"},{"speaker":"Chris Dy","startTime":258.43,"endTime":261.37,"body":"what you use to help keep your"},{"speaker":"Chris Dy","startTime":261.37,"endTime":263.98,"body":"journal articles so you can read"},{"speaker":"Chris Dy","startTime":261.37,"endTime":263.98,"body":"them? Like, I don't remember"},{"speaker":"Chris Dy","startTime":263.98,"endTime":266.47,"body":"ever having that conversation in"},{"speaker":"Chris Dy","startTime":263.98,"endTime":266.47,"body":"person, but I'm pretty sure we"},{"speaker":"Chris Dy","startTime":266.47,"endTime":270.61,"body":"had it on the podcast. And I"},{"speaker":"Chris Dy","startTime":266.47,"endTime":270.61,"body":"can't keep track on what I say"},{"speaker":"Chris Dy","startTime":270.61,"endTime":273.01,"body":"in various modes of my life."},{"speaker":"Chris Dy","startTime":270.61,"endTime":273.01,"body":"Whether it's email,"},{"speaker":"Chris Dy","startTime":273.25,"endTime":275.92,"body":"conversation, zoom, or podcast."},{"speaker":"Charles Goldfarb","startTime":276.0,"endTime":278.34,"body":"No, that is"},{"speaker":"Charles Goldfarb","startTime":276.0,"endTime":278.34,"body":"true. The podcast confuses me"},{"speaker":"Charles Goldfarb","startTime":278.34,"endTime":281.97,"body":"even more, much less Instagram"},{"speaker":"Charles Goldfarb","startTime":278.34,"endTime":281.97,"body":"Live, what is gonna happen?"},{"speaker":"Charles Goldfarb","startTime":281.97,"endTime":284.55,"body":"We're gonna we're gonna implode"},{"speaker":"Charles Goldfarb","startTime":281.97,"endTime":284.55,"body":"i think i think that's the only"},{"speaker":"Charles Goldfarb","startTime":284.55,"endTime":285.75,"body":"future I see for us."},{"speaker":"Chris Dy","startTime":286.05,"endTime":288.87,"body":"Well, you know, to"},{"speaker":"Chris Dy","startTime":286.05,"endTime":288.87,"body":"keep us going if anybody wants"},{"speaker":"Chris Dy","startTime":288.87,"endTime":292.23,"body":"to sponsor us, give us money."},{"speaker":"Chris Dy","startTime":288.87,"endTime":292.23,"body":"Let us know. This has been a"},{"speaker":"Chris Dy","startTime":292.23,"endTime":294.99,"body":"wonderful experience with the"},{"speaker":"Chris Dy","startTime":292.23,"endTime":294.99,"body":"podcast and you know, we have a"},{"speaker":"Chris Dy","startTime":294.99,"endTime":299.7,"body":"lot of people that listen every"},{"speaker":"Chris Dy","startTime":294.99,"endTime":299.7,"body":"week. So we're we're trending in"},{"speaker":"Chris Dy","startTime":299.7,"endTime":303.6,"body":"terms of downloads. So get it on"},{"speaker":"Chris Dy","startTime":299.7,"endTime":303.6,"body":"the ground floor. I mean, you"},{"speaker":"Chris Dy","startTime":303.6,"endTime":304.41,"body":"know, get in early."},{"speaker":"Charles Goldfarb","startTime":304.9,"endTime":306.37,"body":"It is"},{"speaker":"Charles Goldfarb","startTime":304.9,"endTime":306.37,"body":"interesting to watch our"},{"speaker":"Charles Goldfarb","startTime":306.37,"endTime":309.52,"body":"numbers. The numbers are"},{"speaker":"Charles Goldfarb","startTime":306.37,"endTime":309.52,"body":"stunning. And we are so grateful"},{"speaker":"Charles Goldfarb","startTime":309.52,"endTime":312.64,"body":"for those who download and"},{"speaker":"Charles Goldfarb","startTime":309.52,"endTime":312.64,"body":"listen in every week where, you"},{"speaker":"Charles Goldfarb","startTime":312.64,"endTime":317.86,"body":"know, it's around 1200 expected"},{"speaker":"Charles Goldfarb","startTime":312.64,"endTime":317.86,"body":"downloads and listens a week,"},{"speaker":"Charles Goldfarb","startTime":317.89,"endTime":321.73,"body":"which the great thing is that"},{"speaker":"Charles Goldfarb","startTime":317.89,"endTime":321.73,"body":"number continues to elevate"},{"speaker":"Charles Goldfarb","startTime":321.73,"endTime":324.82,"body":"every week and it really is"},{"speaker":"Charles Goldfarb","startTime":321.73,"endTime":324.82,"body":"remarkable, remarkable to see."},{"speaker":"Charles Goldfarb","startTime":324.97,"endTime":330.67,"body":"So, we were talking earlier"},{"speaker":"Charles Goldfarb","startTime":324.97,"endTime":330.67,"body":"about our lack of time and I do"},{"speaker":"Charles Goldfarb","startTime":330.67,"endTime":334.51,"body":"enjoy other podcasts but it's"},{"speaker":"Charles Goldfarb","startTime":330.67,"endTime":334.51,"body":"difficult to find time to listen"},{"speaker":"Charles Goldfarb","startTime":334.51,"endTime":337.63,"body":"to other podcasts. I was"},{"speaker":"Charles Goldfarb","startTime":334.51,"endTime":337.63,"body":"listening to one of my favorites"},{"speaker":"Charles Goldfarb","startTime":337.63,"endTime":341.98,"body":"which is called the old man and"},{"speaker":"Charles Goldfarb","startTime":337.63,"endTime":341.98,"body":"the three which is JJ Reddick's,"},{"speaker":"Charles Goldfarb","startTime":342.07,"endTime":349.27,"body":"I that resonates on a number of"},{"speaker":"Charles Goldfarb","startTime":342.07,"endTime":349.27,"body":"levels to me. It is really good."},{"speaker":"Charles Goldfarb","startTime":349.9,"endTime":353.56,"body":"And it's really funny and they"},{"speaker":"Charles Goldfarb","startTime":349.9,"endTime":353.56,"body":"had Duncan, JJ Reddick had"},{"speaker":"Charles Goldfarb","startTime":353.56,"endTime":357.67,"body":"Duncan Robinson on who is a"},{"speaker":"Charles Goldfarb","startTime":353.56,"endTime":357.67,"body":"really excellent long range"},{"speaker":"Charles Goldfarb","startTime":357.67,"endTime":358.81,"body":"shooter also."},{"speaker":"Chris Dy","startTime":359.08,"endTime":361.66,"body":"Is this the white guys"},{"speaker":"Chris Dy","startTime":359.08,"endTime":361.66,"body":"who shoot threes podcast?"},{"speaker":"Charles Goldfarb","startTime":363.04,"endTime":365.71,"body":"There may be"},{"speaker":"Charles Goldfarb","startTime":363.04,"endTime":365.71,"body":"something to that, but Duncan"},{"speaker":"Charles Goldfarb","startTime":365.71,"endTime":369.97,"body":"Robinson is best known, despite"},{"speaker":"Charles Goldfarb","startTime":365.71,"endTime":369.97,"body":"his NBA career and estimated new"},{"speaker":"Charles Goldfarb","startTime":369.97,"endTime":373.87,"body":"contract he was undrafted three"},{"speaker":"Charles Goldfarb","startTime":369.97,"endTime":373.87,"body":"years ago, and he's estimated to"},{"speaker":"Charles Goldfarb","startTime":373.87,"endTime":377.62,"body":"sign a five year $80 million"},{"speaker":"Charles Goldfarb","startTime":373.87,"endTime":377.62,"body":"contract coming up which is"},{"speaker":"Charles Goldfarb","startTime":377.62,"endTime":381.28,"body":"really stunning. But he went to"},{"speaker":"Charles Goldfarb","startTime":377.62,"endTime":381.28,"body":"Williams College for one year."},{"speaker":"Chris Dy","startTime":381.28,"endTime":382.93,"body":"I was going to say,"},{"speaker":"Chris Dy","startTime":381.28,"endTime":382.93,"body":"played ball at Williams right?"},{"speaker":"Charles Goldfarb","startTime":382.93,"endTime":385.42,"body":"He did it's a"},{"speaker":"Charles Goldfarb","startTime":382.93,"endTime":385.42,"body":"pathway to success."},{"speaker":"Chris Dy","startTime":385.5,"endTime":387.72,"body":"I mean, that's"},{"speaker":"Chris Dy","startTime":385.5,"endTime":387.72,"body":"basically Jake Goldfarb coming"},{"speaker":"Chris Dy","startTime":387.72,"endTime":388.41,"body":"your way, right?"},{"speaker":"Charles Goldfarb","startTime":388.69,"endTime":391.75,"body":"If only if"},{"speaker":"Charles Goldfarb","startTime":388.69,"endTime":391.75,"body":"only but what i what i took away"},{"speaker":"Charles Goldfarb","startTime":391.75,"endTime":394.87,"body":"was they have a segment about"},{"speaker":"Charles Goldfarb","startTime":391.75,"endTime":394.87,"body":"kind of, they were talking about"},{"speaker":"Charles Goldfarb","startTime":394.87,"endTime":398.14,"body":"being a fanboy of different"},{"speaker":"Charles Goldfarb","startTime":394.87,"endTime":398.14,"body":"people and different things. So"},{"speaker":"Charles Goldfarb","startTime":398.14,"endTime":403.54,"body":"I was thinking that I wanted to"},{"speaker":"Charles Goldfarb","startTime":398.14,"endTime":403.54,"body":"ask you know Who? Who and, and I"},{"speaker":"Charles Goldfarb","startTime":403.54,"endTime":408.04,"body":"can go first if you want but who"},{"speaker":"Charles Goldfarb","startTime":403.54,"endTime":408.04,"body":"in hand surgery, have you met"},{"speaker":"Charles Goldfarb","startTime":408.07,"endTime":412.12,"body":"hand surgery, hand therapy, the"},{"speaker":"Charles Goldfarb","startTime":408.07,"endTime":412.12,"body":"greater world of academic"},{"speaker":"Charles Goldfarb","startTime":412.12,"endTime":416.14,"body":"medicine. Who have you met that"},{"speaker":"Charles Goldfarb","startTime":412.12,"endTime":416.14,"body":"really made you feel like a"},{"speaker":"Charles Goldfarb","startTime":416.14,"endTime":419.59,"body":"fanboy and wanted to like get"},{"speaker":"Charles Goldfarb","startTime":416.14,"endTime":419.59,"body":"their autograph, or, or"},{"speaker":"Charles Goldfarb","startTime":419.59,"endTime":422.08,"body":"whatever, like, just talk"},{"speaker":"Charles Goldfarb","startTime":419.59,"endTime":422.08,"body":"through that if you have any one"},{"speaker":"Charles Goldfarb","startTime":422.08,"endTime":424.45,"body":"that comes to mind? If not, we"},{"speaker":"Charles Goldfarb","startTime":422.08,"endTime":424.45,"body":"can stall and I'll give you one."},{"speaker":"Chris Dy","startTime":425.26,"endTime":427.39,"body":"I don't have anybody"},{"speaker":"Chris Dy","startTime":425.26,"endTime":427.39,"body":"that comes to mind. The only"},{"speaker":"Chris Dy","startTime":427.39,"endTime":429.82,"body":"time that I've asked for an"},{"speaker":"Chris Dy","startTime":427.39,"endTime":429.82,"body":"autograph was when you turned me"},{"speaker":"Chris Dy","startTime":429.82,"endTime":433.48,"body":"down. When I asked for you to"},{"speaker":"Chris Dy","startTime":429.82,"endTime":433.48,"body":"autograph my book. But you know,"},{"speaker":"Chris Dy","startTime":433.48,"endTime":436.78,"body":"that's that's fine. Actually, I"},{"speaker":"Chris Dy","startTime":433.48,"endTime":436.78,"body":"do want to hear your fanboy"},{"speaker":"Chris Dy","startTime":436.78,"endTime":439.99,"body":"story. But shout out to Shobhit"},{"speaker":"Chris Dy","startTime":436.78,"endTime":439.99,"body":"Minhas one of our current"},{"speaker":"Chris Dy","startTime":439.99,"endTime":444.01,"body":"fellows who is a podcast"},{"speaker":"Chris Dy","startTime":439.99,"endTime":444.01,"body":"listener has been since prior to"},{"speaker":"Chris Dy","startTime":444.01,"endTime":446.83,"body":"his fellowship, I see that"},{"speaker":"Chris Dy","startTime":444.01,"endTime":446.83,"body":"Harrison is actually on"},{"speaker":"Chris Dy","startTime":446.83,"endTime":449.44,"body":"Instagram Live. So Harrison is"},{"speaker":"Chris Dy","startTime":446.83,"endTime":449.44,"body":"coming to join us from Los"},{"speaker":"Chris Dy","startTime":449.44,"endTime":452.53,"body":"Angeles next year. Anyway,"},{"speaker":"Chris Dy","startTime":449.44,"endTime":452.53,"body":"Shohbit had this great idea,"},{"speaker":"Chris Dy","startTime":452.65,"endTime":455.77,"body":"which maybe we'll play this out"},{"speaker":"Chris Dy","startTime":452.65,"endTime":455.77,"body":"over a series of episodes of who"},{"speaker":"Chris Dy","startTime":455.77,"endTime":459.04,"body":"would you put on the Mount"},{"speaker":"Chris Dy","startTime":455.77,"endTime":459.04,"body":"Rushmore of hand surgery. So I"},{"speaker":"Chris Dy","startTime":459.04,"endTime":461.89,"body":"want to plant that seed. And"},{"speaker":"Chris Dy","startTime":459.04,"endTime":461.89,"body":"then we'll get back to this"},{"speaker":"Chris Dy","startTime":461.89,"endTime":466.09,"body":"maybe in another episode, but I"},{"speaker":"Chris Dy","startTime":461.89,"endTime":466.09,"body":"don't have a automatic fanboy"},{"speaker":"Chris Dy","startTime":466.09,"endTime":468.97,"body":"moment. Because I guess"},{"speaker":"Chris Dy","startTime":466.09,"endTime":468.97,"body":"fortunately, I've been around,"},{"speaker":"Chris Dy","startTime":469.0,"endTime":471.4,"body":"you know, some of the people"},{"speaker":"Chris Dy","startTime":469.0,"endTime":471.4,"body":"that I admire the most in terms"},{"speaker":"Chris Dy","startTime":471.4,"endTime":474.52,"body":"of, you know, legends in hand"},{"speaker":"Chris Dy","startTime":471.4,"endTime":474.52,"body":"surgery, even here at WashU. So"},{"speaker":"Chris Dy","startTime":474.52,"endTime":478.09,"body":"somebody like Richard Gelberman,"},{"speaker":"Chris Dy","startTime":474.52,"endTime":478.09,"body":"Susan MacKinnon. So I've gotten"},{"speaker":"Chris Dy","startTime":478.09,"endTime":481.0,"body":"to know them and perhaps, you"},{"speaker":"Chris Dy","startTime":478.09,"endTime":481.0,"body":"know, those are people that I"},{"speaker":"Chris Dy","startTime":481.0,"endTime":484.63,"body":"would have thought of as"},{"speaker":"Chris Dy","startTime":481.0,"endTime":484.63,"body":"thinking of as a fanboy type"},{"speaker":"Chris Dy","startTime":485.23,"endTime":486.82,"body":"affair. What about you?"},{"speaker":"Charles Goldfarb","startTime":487.11,"endTime":489.3,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":487.11,"endTime":489.3,"body":"that's true at our world is"},{"speaker":"Charles Goldfarb","startTime":489.3,"endTime":492.18,"body":"accessible at least I like to"},{"speaker":"Charles Goldfarb","startTime":489.3,"endTime":492.18,"body":"think it's accessible. Most"},{"speaker":"Charles Goldfarb","startTime":492.18,"endTime":496.29,"body":"people don't stand on airs or,"},{"speaker":"Charles Goldfarb","startTime":492.18,"endTime":496.29,"body":"or have expect some differential"},{"speaker":"Charles Goldfarb","startTime":496.29,"endTime":500.22,"body":"treatment. And so part of it for"},{"speaker":"Charles Goldfarb","startTime":496.29,"endTime":500.22,"body":"me was not being familiar with"},{"speaker":"Charles Goldfarb","startTime":500.22,"endTime":503.19,"body":"this person. But I the one"},{"speaker":"Charles Goldfarb","startTime":500.22,"endTime":503.19,"body":"experience I've had that most"},{"speaker":"Charles Goldfarb","startTime":503.19,"endTime":508.14,"body":"felt like a fanboy experience"},{"speaker":"Charles Goldfarb","startTime":503.19,"endTime":508.14,"body":"was with Adrian Flat. So Adrian"},{"speaker":"Charles Goldfarb","startTime":508.14,"endTime":511.71,"body":"Flat for those of you who don't"},{"speaker":"Charles Goldfarb","startTime":508.14,"endTime":511.71,"body":"really know the name, was a"},{"speaker":"Charles Goldfarb","startTime":511.74,"endTime":517.98,"body":"Brit, who tells the stories of"},{"speaker":"Charles Goldfarb","startTime":511.74,"endTime":517.98,"body":"surviving the the German raids"},{"speaker":"Charles Goldfarb","startTime":518.43,"endTime":524.25,"body":"in the you know, 39 and 40. You"},{"speaker":"Charles Goldfarb","startTime":518.43,"endTime":524.25,"body":"know, how hiding in the subway"},{"speaker":"Charles Goldfarb","startTime":524.25,"endTime":527.67,"body":"really remarkable stories. He"},{"speaker":"Charles Goldfarb","startTime":524.25,"endTime":527.67,"body":"became one of the fathers of"},{"speaker":"Charles Goldfarb","startTime":527.67,"endTime":531.06,"body":"congenital hand surgery in this"},{"speaker":"Charles Goldfarb","startTime":527.67,"endTime":531.06,"body":"country for sure, was in Iowa"},{"speaker":"Charles Goldfarb","startTime":531.06,"endTime":534.27,"body":"for many years, and then ended"},{"speaker":"Charles Goldfarb","startTime":531.06,"endTime":534.27,"body":"his career working, and really"},{"speaker":"Charles Goldfarb","startTime":534.27,"endTime":537.33,"body":"advising down in Dallas, Texas"},{"speaker":"Charles Goldfarb","startTime":534.27,"endTime":537.33,"body":"Scottish Rite. So I spent some"},{"speaker":"Charles Goldfarb","startTime":537.33,"endTime":540.75,"body":"time down in Dallas with"},{"speaker":"Charles Goldfarb","startTime":537.33,"endTime":540.75,"body":"Marybeth Ezaki and Scott Oishi"},{"speaker":"Charles Goldfarb","startTime":541.47,"endTime":543.87,"body":"learning a bit and I had lunch"},{"speaker":"Charles Goldfarb","startTime":541.47,"endTime":543.87,"body":"with Adrian Flat one day kind of"},{"speaker":"Charles Goldfarb","startTime":543.87,"endTime":547.53,"body":"out of the blue. And he was he"},{"speaker":"Charles Goldfarb","startTime":543.87,"endTime":547.53,"body":"just felt like a larger than"},{"speaker":"Charles Goldfarb","startTime":547.53,"endTime":551.16,"body":"life figure and he has written"},{"speaker":"Charles Goldfarb","startTime":547.53,"endTime":551.16,"body":"one of the one of the books that"},{"speaker":"Charles Goldfarb","startTime":551.79,"endTime":554.64,"body":"one of the books in congenital"},{"speaker":"Charles Goldfarb","startTime":551.79,"endTime":554.64,"body":"hand surgery, the care of the"},{"speaker":"Charles Goldfarb","startTime":554.64,"endTime":558.27,"body":"congenital hand which has been"},{"speaker":"Charles Goldfarb","startTime":554.64,"endTime":558.27,"body":"gone through several editions,"},{"speaker":"Charles Goldfarb","startTime":558.36,"endTime":561.96,"body":"and Marybeth actually just"},{"speaker":"Charles Goldfarb","startTime":558.36,"endTime":561.96,"body":"rewrote it to update it for"},{"speaker":"Charles Goldfarb","startTime":561.96,"endTime":566.4,"body":"modern times. So meeting Adrian"},{"speaker":"Charles Goldfarb","startTime":561.96,"endTime":566.4,"body":"Flat, who passed away, not in"},{"speaker":"Charles Goldfarb","startTime":566.4,"endTime":569.49,"body":"the not too distant past was"},{"speaker":"Charles Goldfarb","startTime":566.4,"endTime":569.49,"body":"really one of those moments for"},{"speaker":"Charles Goldfarb","startTime":569.49,"endTime":571.26,"body":"me, which was just really"},{"speaker":"Charles Goldfarb","startTime":569.49,"endTime":571.26,"body":"exciting."},{"speaker":"Chris Dy","startTime":571.92,"endTime":574.83,"body":"So there is photo"},{"speaker":"Chris Dy","startTime":571.92,"endTime":574.83,"body":"evidence of that lunch of you"},{"speaker":"Chris Dy","startTime":574.83,"endTime":578.73,"body":"and Adrian Flat that gets shown"},{"speaker":"Chris Dy","startTime":574.83,"endTime":578.73,"body":"pretty much at every resident"},{"speaker":"Chris Dy","startTime":578.73,"endTime":581.85,"body":"fellows conference, which is the"},{"speaker":"Chris Dy","startTime":578.73,"endTime":581.85,"body":"fittingly the Adrian Flat"},{"speaker":"Chris Dy","startTime":581.85,"endTime":585.81,"body":"resident fellows conference at"},{"speaker":"Chris Dy","startTime":581.85,"endTime":585.81,"body":"ASSH meeting. And when they"},{"speaker":"Chris Dy","startTime":585.81,"endTime":589.71,"body":"introduce they show the picture"},{"speaker":"Chris Dy","startTime":585.81,"endTime":589.71,"body":"of you and you had a just a"},{"speaker":"Chris Dy","startTime":590.16,"endTime":591.87,"body":"little different haircut back"},{"speaker":"Chris Dy","startTime":590.16,"endTime":591.87,"body":"then."},{"speaker":"Charles Goldfarb","startTime":592.14,"endTime":594.66,"body":"I was waiting."},{"speaker":"Charles Goldfarb","startTime":592.14,"endTime":594.66,"body":"I didn't know that picture was"},{"speaker":"Charles Goldfarb","startTime":594.66,"endTime":596.82,"body":"shown but I do know that I look-"},{"speaker":"Chris Dy","startTime":596.82,"endTime":597.9,"body":"Every year, every"},{"speaker":"Chris Dy","startTime":596.82,"endTime":597.9,"body":"year."},{"speaker":"Charles Goldfarb","startTime":598.98,"endTime":600.69,"body":"Well, it was"},{"speaker":"Charles Goldfarb","startTime":598.98,"endTime":600.69,"body":"something I I still remember"},{"speaker":"Charles Goldfarb","startTime":600.69,"endTime":602.58,"body":"that that lunch. So it was"},{"speaker":"Charles Goldfarb","startTime":600.69,"endTime":602.58,"body":"pretty, pretty neat."},{"speaker":"Chris Dy","startTime":603.0,"endTime":605.67,"body":"I guess maybe a more"},{"speaker":"Chris Dy","startTime":603.0,"endTime":605.67,"body":"practical fanboy ish moment is I"},{"speaker":"Chris Dy","startTime":605.67,"endTime":608.67,"body":"remember when I was a resident"},{"speaker":"Chris Dy","startTime":605.67,"endTime":608.67,"body":"at special surgery. And I had"},{"speaker":"Chris Dy","startTime":608.67,"endTime":613.17,"body":"never worked with Michelle"},{"speaker":"Chris Dy","startTime":608.67,"endTime":613.17,"body":"Carlsen before in a case. And it"},{"speaker":"Chris Dy","startTime":613.17,"endTime":615.3,"body":"was one of the things where I"},{"speaker":"Chris Dy","startTime":613.17,"endTime":615.3,"body":"was about to apply for hand"},{"speaker":"Chris Dy","startTime":615.3,"endTime":617.88,"body":"surgery fellowship. So I needed"},{"speaker":"Chris Dy","startTime":615.3,"endTime":617.88,"body":"all of the faculty to know who I"},{"speaker":"Chris Dy","startTime":617.88,"endTime":622.53,"body":"was, and hopefully know that I"},{"speaker":"Chris Dy","startTime":617.88,"endTime":622.53,"body":"could operate. And I'd worked"},{"speaker":"Chris Dy","startTime":622.53,"endTime":626.07,"body":"with Michelle a lot in research,"},{"speaker":"Chris Dy","startTime":622.53,"endTime":626.07,"body":"but never in the OR or in the"},{"speaker":"Chris Dy","startTime":626.07,"endTime":628.77,"body":"clinic. And I remember scrubbing"},{"speaker":"Chris Dy","startTime":626.07,"endTime":628.77,"body":"a case with her and my hand just"},{"speaker":"Chris Dy","startTime":628.77,"endTime":633.06,"body":"started shaking. Like I couldn't"},{"speaker":"Chris Dy","startTime":628.77,"endTime":633.06,"body":"like, it was almost like a Ricky"},{"speaker":"Chris Dy","startTime":633.06,"endTime":637.38,"body":"Bobby moment, where my hands"},{"speaker":"Chris Dy","startTime":633.06,"endTime":637.38,"body":"just the loops felt all out of"},{"speaker":"Chris Dy","startTime":637.38,"endTime":640.29,"body":"focus, but fortunately, I think"},{"speaker":"Chris Dy","startTime":637.38,"endTime":640.29,"body":"I got it together. But I'm"},{"speaker":"Chris Dy","startTime":640.29,"endTime":642.42,"body":"pretty sure she thought was"},{"speaker":"Chris Dy","startTime":640.29,"endTime":642.42,"body":"pretty weird shout out Alison"},{"speaker":"Chris Dy","startTime":642.45,"endTime":646.38,"body":"Kitay, a former HSS resident who"},{"speaker":"Chris Dy","startTime":642.45,"endTime":646.38,"body":"is seeing us on the Instagram"},{"speaker":"Chris Dy","startTime":646.38,"endTime":649.35,"body":"Live. But we're doing a podcast"},{"speaker":"Chris Dy","startTime":646.38,"endTime":649.35,"body":"recording right now."},{"speaker":"Charles Goldfarb","startTime":649.68,"endTime":652.5,"body":"We are. So"},{"speaker":"Charles Goldfarb","startTime":649.68,"endTime":652.5,"body":"just, I just was talking to"},{"speaker":"Charles Goldfarb","startTime":652.5,"endTime":655.44,"body":"Michelle, we you know, she and I"},{"speaker":"Charles Goldfarb","startTime":652.5,"endTime":655.44,"body":"share the strong interest in the"},{"speaker":"Charles Goldfarb","startTime":655.44,"endTime":658.56,"body":"care of the professional"},{"speaker":"Charles Goldfarb","startTime":655.44,"endTime":658.56,"body":"athlete. And she has built"},{"speaker":"Charles Goldfarb","startTime":658.56,"endTime":662.67,"body":"really a thriving, remarkable"},{"speaker":"Charles Goldfarb","startTime":658.56,"endTime":662.67,"body":"practice treating that"},{"speaker":"Charles Goldfarb","startTime":662.67,"endTime":665.25,"body":"population and for good reason."},{"speaker":"Charles Goldfarb","startTime":662.67,"endTime":665.25,"body":"She does a wonderful job with"},{"speaker":"Charles Goldfarb","startTime":665.25,"endTime":669.18,"body":"it. So we were just catching up"},{"speaker":"Charles Goldfarb","startTime":665.25,"endTime":669.18,"body":"about an athlete this week, but"},{"speaker":"Charles Goldfarb","startTime":669.21,"endTime":673.08,"body":"I really admire what she has"},{"speaker":"Charles Goldfarb","startTime":669.21,"endTime":673.08,"body":"built at HSS. For the care of"},{"speaker":"Chris Dy","startTime":673.0,"endTime":676.96,"body":"This is what happens"},{"speaker":"Chris Dy","startTime":673.0,"endTime":676.96,"body":"on the deep interwebs of the"},{"speaker":"Chris Dy","startTime":673.08,"endTime":673.86,"body":"these athletes."},{"speaker":"Chris Dy","startTime":676.96,"endTime":682.12,"body":"professional athlete, hand"},{"speaker":"Chris Dy","startTime":676.96,"endTime":682.12,"body":"surgery. Are you guys like"},{"speaker":"Chris Dy","startTime":682.12,"endTime":685.27,"body":"Illuminati? Like you know, there"},{"speaker":"Chris Dy","startTime":682.12,"endTime":685.27,"body":"are only a few of you. It's like"},{"speaker":"Chris Dy","startTime":685.27,"endTime":687.64,"body":"you, Michelle and Steve Shin,"},{"speaker":"Chris Dy","startTime":685.27,"endTime":687.64,"body":"just, you know, talking about"},{"speaker":"Chris Dy","startTime":687.64,"endTime":688.21,"body":"cases."},{"speaker":"Charles Goldfarb","startTime":688.24,"endTime":690.61,"body":"Well it is"},{"speaker":"Charles Goldfarb","startTime":688.24,"endTime":690.61,"body":"interesting how people ascend in"},{"speaker":"Charles Goldfarb","startTime":690.61,"endTime":694.51,"body":"this world, and I think not to"},{"speaker":"Charles Goldfarb","startTime":690.61,"endTime":694.51,"body":"get too personal or too direct."},{"speaker":"Charles Goldfarb","startTime":694.51,"endTime":698.38,"body":"But you know, what has hampered"},{"speaker":"Charles Goldfarb","startTime":694.51,"endTime":698.38,"body":"my growth in this field is the"},{"speaker":"Charles Goldfarb","startTime":698.38,"endTime":702.34,"body":"fact that the St. Louis Rams are"},{"speaker":"Charles Goldfarb","startTime":698.38,"endTime":702.34,"body":"no longer in St. Louis. The NFL"},{"speaker":"Charles Goldfarb","startTime":702.34,"endTime":705.28,"body":"is so dominant in so many"},{"speaker":"Charles Goldfarb","startTime":702.34,"endTime":705.28,"body":"different ways. And while each"},{"speaker":"Charles Goldfarb","startTime":705.28,"endTime":709.03,"body":"league is different in different"},{"speaker":"Charles Goldfarb","startTime":705.28,"endTime":709.03,"body":"physicians may specialize. When"},{"speaker":"Charles Goldfarb","startTime":709.03,"endTime":711.91,"body":"the Rams left St. Louis, I think"},{"speaker":"Charles Goldfarb","startTime":709.03,"endTime":711.91,"body":"I was feeling really good about"},{"speaker":"Charles Goldfarb","startTime":711.91,"endTime":715.66,"body":"where I was. And I had a good"},{"speaker":"Charles Goldfarb","startTime":711.91,"endTime":715.66,"body":"network of agents I worked with,"},{"speaker":"Charles Goldfarb","startTime":715.87,"endTime":718.96,"body":"and that has really diminished."},{"speaker":"Charles Goldfarb","startTime":715.87,"endTime":718.96,"body":"And so well, I do have the"},{"speaker":"Charles Goldfarb","startTime":718.96,"endTime":721.3,"body":"opportunity to care for many"},{"speaker":"Charles Goldfarb","startTime":718.96,"endTime":721.3,"body":"professional athletes, I think"},{"speaker":"Charles Goldfarb","startTime":721.3,"endTime":725.71,"body":"in St. Louis without an NFL team"},{"speaker":"Charles Goldfarb","startTime":721.3,"endTime":725.71,"body":"has really hampered my growth in"},{"speaker":"Charles Goldfarb","startTime":725.71,"endTime":730.18,"body":"that field, while Steve Shin in"},{"speaker":"Charles Goldfarb","startTime":725.71,"endTime":730.18,"body":"LA has taken off, and he seems"},{"speaker":"Charles Goldfarb","startTime":730.18,"endTime":733.09,"body":"to be the name that's mentioned"},{"speaker":"Charles Goldfarb","startTime":730.18,"endTime":733.09,"body":"as much as any, if not more than"},{"speaker":"Charles Goldfarb","startTime":733.09,"endTime":735.52,"body":"any. And five years ago, that"},{"speaker":"Charles Goldfarb","startTime":733.09,"endTime":735.52,"body":"just wasn't the case."},{"speaker":"Chris Dy","startTime":735.989,"endTime":738.389,"body":"Don't follow the Rams"},{"speaker":"Chris Dy","startTime":735.989,"endTime":738.389,"body":"Chuck, stay here in St. Louis."},{"speaker":"Charles Goldfarb","startTime":738.45,"endTime":741.63,"body":"And don't"},{"speaker":"Charles Goldfarb","startTime":738.45,"endTime":741.63,"body":"worry. Don't worry. It's"},{"speaker":"Charles Goldfarb","startTime":741.63,"endTime":743.67,"body":"interesting watching what's"},{"speaker":"Charles Goldfarb","startTime":741.63,"endTime":743.67,"body":"happened with the English"},{"speaker":"Charles Goldfarb","startTime":743.67,"endTime":747.72,"body":"Premier League. Speaking of rams"},{"speaker":"Charles Goldfarb","startTime":743.67,"endTime":747.72,"body":"and Rams owners. You know, the"},{"speaker":"Charles Goldfarb","startTime":747.72,"endTime":751.35,"body":"three American owners of Premier"},{"speaker":"Charles Goldfarb","startTime":747.72,"endTime":751.35,"body":"League soccer teams, and they"},{"speaker":"Charles Goldfarb","startTime":751.35,"endTime":754.86,"body":"are under a lot of heat because"},{"speaker":"Charles Goldfarb","startTime":751.35,"endTime":754.86,"body":"of the attempted exit for the"},{"speaker":"Charles Goldfarb","startTime":754.86,"endTime":755.43,"body":"Super League."},{"speaker":"Chris Dy","startTime":756.12,"endTime":758.22,"body":"Apparently, it's not a"},{"speaker":"Chris Dy","startTime":756.12,"endTime":758.22,"body":"good idea to follow the money"},{"speaker":"Chris Dy","startTime":758.25,"endTime":760.71,"body":"that typically doesn't always"},{"speaker":"Chris Dy","startTime":758.25,"endTime":760.71,"body":"pan out."},{"speaker":"Charles Goldfarb","startTime":760.93,"endTime":763.48,"body":"Apparently"},{"speaker":"Charles Goldfarb","startTime":760.93,"endTime":763.48,"body":"not, you and I are proof of"},{"speaker":"Charles Goldfarb","startTime":763.48,"endTime":764.41,"body":"concept there."},{"speaker":"Chris Dy","startTime":764.41,"endTime":766.21,"body":"Yeah, we are not"},{"speaker":"Chris Dy","startTime":764.41,"endTime":766.21,"body":"following the money right now"},{"speaker":"Chris Dy","startTime":766.21,"endTime":771.37,"body":"with a podcast. So staying in"},{"speaker":"Chris Dy","startTime":766.21,"endTime":771.37,"body":"the realm of sports. The"},{"speaker":"Chris Dy","startTime":771.4,"endTime":775.78,"body":"detailed deep dive segment that"},{"speaker":"Chris Dy","startTime":771.4,"endTime":775.78,"body":"we did a couple of weeks ago was"},{"speaker":"Chris Dy","startTime":775.78,"endTime":779.29,"body":"pretty popular. And Shohbit, I"},{"speaker":"Chris Dy","startTime":775.78,"endTime":779.29,"body":"was actually surprised that you"},{"speaker":"Chris Dy","startTime":779.29,"endTime":781.93,"body":"had never watched an episode of"},{"speaker":"Chris Dy","startTime":779.29,"endTime":781.93,"body":"Detail given how much of a"},{"speaker":"Chris Dy","startTime":781.93,"endTime":785.26,"body":"basketball nut you are. So"},{"speaker":"Chris Dy","startTime":781.93,"endTime":785.26,"body":"perhaps we'll have to sit down"},{"speaker":"Chris Dy","startTime":785.26,"endTime":786.52,"body":"and put on one of those."},{"speaker":"Charles Goldfarb","startTime":786.87,"endTime":789.48,"body":"That would be"},{"speaker":"Charles Goldfarb","startTime":786.87,"endTime":789.48,"body":"fun, my son texted me last night"},{"speaker":"Charles Goldfarb","startTime":789.48,"endTime":792.69,"body":"and said, because I always talk"},{"speaker":"Charles Goldfarb","startTime":789.48,"endTime":792.69,"body":"about all these subscriptions we"},{"speaker":"Charles Goldfarb","startTime":792.69,"endTime":795.81,"body":"have and all these different"},{"speaker":"Charles Goldfarb","startTime":792.69,"endTime":795.81,"body":"polls on our time as we've been"},{"speaker":"Charles Goldfarb","startTime":795.81,"endTime":799.38,"body":"talking about. And we subscribe"},{"speaker":"Charles Goldfarb","startTime":795.81,"endTime":799.38,"body":"to NBA Live or NBA, whatever"},{"speaker":"Charles Goldfarb","startTime":799.38,"endTime":805.11,"body":"it's called the I get every game"},{"speaker":"Charles Goldfarb","startTime":799.38,"endTime":805.11,"body":"at home and this year pandemic"},{"speaker":"Charles Goldfarb","startTime":805.11,"endTime":808.05,"body":"year, we have watched a ton of"},{"speaker":"Charles Goldfarb","startTime":805.11,"endTime":808.05,"body":"NBA, but I need to watch this"},{"speaker":"Charles Goldfarb","startTime":808.05,"endTime":811.89,"body":"segment of Details and we need"},{"speaker":"Charles Goldfarb","startTime":808.05,"endTime":811.89,"body":"to talk about another segment."},{"speaker":"Chris Dy","startTime":812.52,"endTime":815.1,"body":"So let's I think we've"},{"speaker":"Chris Dy","startTime":812.52,"endTime":815.1,"body":"covered some of this in some of"},{"speaker":"Chris Dy","startTime":815.1,"endTime":817.59,"body":"the prior episodes. But clearly"},{"speaker":"Chris Dy","startTime":815.1,"endTime":817.59,"body":"some of our thinking may have"},{"speaker":"Chris Dy","startTime":817.59,"endTime":820.53,"body":"changed since we recorded the"},{"speaker":"Chris Dy","startTime":817.59,"endTime":820.53,"body":"initial cubital tunnel episodes"},{"speaker":"Chris Dy","startTime":820.53,"endTime":823.17,"body":"because that was honestly I"},{"speaker":"Chris Dy","startTime":820.53,"endTime":823.17,"body":"think it was one of the first"},{"speaker":"Chris Dy","startTime":823.29,"endTime":827.34,"body":"episodes that we dropped. But"},{"speaker":"Chris Dy","startTime":823.29,"endTime":827.34,"body":"let's talk about the detail on"},{"speaker":"Chris Dy","startTime":827.4,"endTime":831.15,"body":"an in situ ulnar nerve"},{"speaker":"Chris Dy","startTime":827.4,"endTime":831.15,"body":"decompression. So skip"},{"speaker":"Chris Dy","startTime":831.15,"endTime":834.63,"body":"indications say you decided you"},{"speaker":"Chris Dy","startTime":831.15,"endTime":834.63,"body":"are doing an in situ ulnar nerve"},{"speaker":"Chris Dy","startTime":834.63,"endTime":837.87,"body":"decompression. And before I"},{"speaker":"Chris Dy","startTime":834.63,"endTime":837.87,"body":"asked you to get into that, I"},{"speaker":"Chris Dy","startTime":837.87,"endTime":840.84,"body":"will say if anybody is on"},{"speaker":"Chris Dy","startTime":837.87,"endTime":840.84,"body":"Instagram Live and wants to, you"},{"speaker":"Chris Dy","startTime":840.84,"endTime":844.38,"body":"know, text some comments on how"},{"speaker":"Chris Dy","startTime":840.84,"endTime":844.38,"body":"you do it. We'll try to roll"},{"speaker":"Chris Dy","startTime":844.38,"endTime":849.27,"body":"that in as well. So, Chuck, um,"},{"speaker":"Chris Dy","startTime":844.38,"endTime":849.27,"body":"how big is your incision, I'm"},{"speaker":"Chris Dy","startTime":849.27,"endTime":851.67,"body":"actually going to get out a"},{"speaker":"Chris Dy","startTime":849.27,"endTime":851.67,"body":"ruler this time and measure my"},{"speaker":"Chris Dy","startTime":851.67,"endTime":852.45,"body":"incision."},{"speaker":"Charles Goldfarb","startTime":853.38,"endTime":855.69,"body":"It's so,"},{"speaker":"Charles Goldfarb","startTime":853.38,"endTime":855.69,"body":"before I jump in, I have to say"},{"speaker":"Charles Goldfarb","startTime":855.69,"endTime":860.04,"body":"that Leo Cho, who was one of my"},{"speaker":"Charles Goldfarb","startTime":855.69,"endTime":860.04,"body":"chief residents texted me"},{"speaker":"Charles Goldfarb","startTime":860.04,"endTime":863.07,"body":"earlier this week asking this"},{"speaker":"Charles Goldfarb","startTime":860.04,"endTime":863.07,"body":"exact question and of course"},{"speaker":"Charles Goldfarb","startTime":863.07,"endTime":866.76,"body":"it's on Leo for not listening to"},{"speaker":"Charles Goldfarb","startTime":863.07,"endTime":866.76,"body":"the podcast but but I will I"},{"speaker":"Charles Goldfarb","startTime":866.76,"endTime":870.18,"body":"will push him on this one. So"},{"speaker":"Charles Goldfarb","startTime":866.76,"endTime":870.18,"body":"you know when I make a carpal"},{"speaker":"Charles Goldfarb","startTime":870.18,"endTime":872.67,"body":"tunnel incision, as we"},{"speaker":"Charles Goldfarb","startTime":870.18,"endTime":872.67,"body":"discussed, my incision is two"},{"speaker":"Charles Goldfarb","startTime":872.67,"endTime":875.13,"body":"centimeters, give or take"},{"speaker":"Charles Goldfarb","startTime":872.67,"endTime":875.13,"body":"depending on the size of the"},{"speaker":"Charles Goldfarb","startTime":875.13,"endTime":878.97,"body":"hand. And so for a standard"},{"speaker":"Charles Goldfarb","startTime":875.13,"endTime":878.97,"body":"cubital tunnel decompression."},{"speaker":"Chris Dy","startTime":880.86,"endTime":882.27,"body":"I did have something"},{"speaker":"Chris Dy","startTime":880.86,"endTime":882.27,"body":"here to scale it."},{"speaker":"Charles Goldfarb","startTime":883.32,"endTime":886.44,"body":"For a standard"},{"speaker":"Charles Goldfarb","startTime":883.32,"endTime":886.44,"body":"cubital tunnel decompression, I"},{"speaker":"Charles Goldfarb","startTime":886.44,"endTime":890.67,"body":"would say it's basically five"},{"speaker":"Charles Goldfarb","startTime":886.44,"endTime":890.67,"body":"centimeters is is my and I make"},{"speaker":"Charles Goldfarb","startTime":890.67,"endTime":893.52,"body":"it in this will be interesting."},{"speaker":"Charles Goldfarb","startTime":890.67,"endTime":893.52,"body":"I make it just anterior to the"},{"speaker":"Charles Goldfarb","startTime":893.52,"endTime":896.79,"body":"medial epicondyle. And the"},{"speaker":"Charles Goldfarb","startTime":893.52,"endTime":896.79,"body":"reason I do that is that people"},{"speaker":"Charles Goldfarb","startTime":896.79,"endTime":899.85,"body":"complain about incisions"},{"speaker":"Charles Goldfarb","startTime":896.79,"endTime":899.85,"body":"posteriorly when they rest their"},{"speaker":"Charles Goldfarb","startTime":899.85,"endTime":904.83,"body":"elbow on the table. So five"},{"speaker":"Charles Goldfarb","startTime":899.85,"endTime":904.83,"body":"centimeters, just anterior the"},{"speaker":"Charles Goldfarb","startTime":904.83,"endTime":908.4,"body":"skin is so mobile it's no"},{"speaker":"Charles Goldfarb","startTime":904.83,"endTime":908.4,"body":"problem getting back to the"},{"speaker":"Charles Goldfarb","startTime":908.4,"endTime":911.91,"body":"cubital tunnel retinaculum. What"},{"speaker":"Charles Goldfarb","startTime":908.4,"endTime":911.91,"body":"size incision do you make? And"},{"speaker":"Charles Goldfarb","startTime":911.91,"endTime":912.78,"body":"where do you make it?"},{"speaker":"Chris Dy","startTime":913.17,"endTime":918.06,"body":"So five centimeters?"},{"speaker":"Chris Dy","startTime":913.17,"endTime":918.06,"body":"Two inches. I think that's about"},{"speaker":"Chris Dy","startTime":918.06,"endTime":921.06,"body":"right. Clearly, I am not good at"},{"speaker":"Chris Dy","startTime":918.06,"endTime":921.06,"body":"understanding how long the"},{"speaker":"Chris Dy","startTime":921.06,"endTime":925.26,"body":"incisions I make are. But you"},{"speaker":"Chris Dy","startTime":921.06,"endTime":925.26,"body":"know, yes, the skin window is"},{"speaker":"Chris Dy","startTime":925.26,"endTime":930.03,"body":"pretty mobile. I agree with you"},{"speaker":"Chris Dy","startTime":925.26,"endTime":930.03,"body":"on the prominence and bothersome"},{"speaker":"Chris Dy","startTime":930.03,"endTime":934.44,"body":"ness of the incision, the healed"},{"speaker":"Chris Dy","startTime":930.03,"endTime":934.44,"body":"incision site if it's posterior."},{"speaker":"Chris Dy","startTime":934.8,"endTime":937.35,"body":"So for an ulnar nerve"},{"speaker":"Chris Dy","startTime":934.8,"endTime":937.35,"body":"transposition, I actually, you"},{"speaker":"Chris Dy","startTime":937.35,"endTime":939.63,"body":"know, move the incision more"},{"speaker":"Chris Dy","startTime":937.35,"endTime":939.63,"body":"anterior because you taught me"},{"speaker":"Chris Dy","startTime":939.63,"endTime":943.29,"body":"that. But honestly, for the"},{"speaker":"Chris Dy","startTime":939.63,"endTime":943.29,"body":"cubital tunnel decompression, I"},{"speaker":"Chris Dy","startTime":943.29,"endTime":946.44,"body":"keep it relatively simple and"},{"speaker":"Chris Dy","startTime":943.29,"endTime":946.44,"body":"keep it essentially over the"},{"speaker":"Chris Dy","startTime":946.5,"endTime":948.57,"body":"area where the nerve is going to"},{"speaker":"Chris Dy","startTime":946.5,"endTime":948.57,"body":"be perhaps that has some"},{"speaker":"Chris Dy","startTime":948.57,"endTime":951.33,"body":"implications for scarring over"},{"speaker":"Chris Dy","startTime":948.57,"endTime":951.33,"body":"the nerve too. But I said a"},{"speaker":"Chris Dy","startTime":951.33,"endTime":954.15,"body":"little more posterior, just, you"},{"speaker":"Chris Dy","startTime":951.33,"endTime":954.15,"body":"know, along the posterior border"},{"speaker":"Chris Dy","startTime":954.15,"endTime":955.14,"body":"of the medial epicondyle."},{"speaker":"Charles Goldfarb","startTime":955.93,"endTime":959.29,"body":"But I think"},{"speaker":"Charles Goldfarb","startTime":955.93,"endTime":959.29,"body":"for those on Instagram Live, and"},{"speaker":"Charles Goldfarb","startTime":959.29,"endTime":961.36,"body":"maybe they'll comment or"},{"speaker":"Charles Goldfarb","startTime":959.29,"endTime":961.36,"body":"certainly for our audience, if"},{"speaker":"Charles Goldfarb","startTime":961.36,"endTime":964.6,"body":"you want to reach out to us,"},{"speaker":"Charles Goldfarb","startTime":961.36,"endTime":964.6,"body":"cubital tunnel decompression for"},{"speaker":"Charles Goldfarb","startTime":964.6,"endTime":969.85,"body":"some people is a good three inch"},{"speaker":"Charles Goldfarb","startTime":964.6,"endTime":969.85,"body":"incision. or bigger, it means"},{"speaker":"Charles Goldfarb","startTime":969.85,"endTime":973.39,"body":"something different to different"},{"speaker":"Charles Goldfarb","startTime":969.85,"endTime":973.39,"body":"people. And so, for me again,"},{"speaker":"Charles Goldfarb","startTime":973.39,"endTime":976.78,"body":"the idea is very simple. I don't"},{"speaker":"Charles Goldfarb","startTime":973.39,"endTime":976.78,"body":"excise the intermuscular septum."},{"speaker":"Charles Goldfarb","startTime":977.59,"endTime":981.01,"body":"All I do is I release the roof"},{"speaker":"Charles Goldfarb","startTime":977.59,"endTime":981.01,"body":"of the tunnel. So the cubital"},{"speaker":"Charles Goldfarb","startTime":981.01,"endTime":983.47,"body":"tunnel retinaculum, Osborne's"},{"speaker":"Charles Goldfarb","startTime":981.01,"endTime":983.47,"body":"ligament, I released the"},{"speaker":"Charles Goldfarb","startTime":983.47,"endTime":987.04,"body":"superficial what I call the deep"},{"speaker":"Charles Goldfarb","startTime":983.47,"endTime":987.04,"body":"fascia of the FCU. And I release"},{"speaker":"Charles Goldfarb","startTime":987.04,"endTime":990.43,"body":"anything obviously constricted"},{"speaker":"Charles Goldfarb","startTime":987.04,"endTime":990.43,"body":"proximately I don't touch the"},{"speaker":"Charles Goldfarb","startTime":990.43,"endTime":991.84,"body":"nerve. And that's all I do."},{"speaker":"Chris Dy","startTime":991.0,"endTime":996.25,"body":"So this is detail. So"},{"speaker":"Chris Dy","startTime":991.0,"endTime":996.25,"body":"let's rewind. So say you've made"},{"speaker":"Chris Dy","startTime":996.25,"endTime":999.73,"body":"your five centimeters. I mean,"},{"speaker":"Chris Dy","startTime":996.25,"endTime":999.73,"body":"you're you said it was five for"},{"speaker":"Chris Dy","startTime":999.73,"endTime":1002.19,"body":"this one, right? Yeah, five"},{"speaker":"Chris Dy","startTime":999.73,"endTime":1002.19,"body":"centimeter incision, just"},{"speaker":"Chris Dy","startTime":1002.19,"endTime":1004.86,"body":"anterior to the medial"},{"speaker":"Chris Dy","startTime":1002.19,"endTime":1004.86,"body":"epicondyle. Well, what do you"},{"speaker":"Chris Dy","startTime":1004.86,"endTime":1007.92,"body":"use to help get down to where"},{"speaker":"Chris Dy","startTime":1004.86,"endTime":1007.92,"body":"you need to go? So is this a"},{"speaker":"Chris Dy","startTime":1007.92,"endTime":1010.86,"body":"couple of senn retractors Are"},{"speaker":"Chris Dy","startTime":1007.92,"endTime":1010.86,"body":"you looking for the M ABC and"},{"speaker":"Chris Dy","startTime":1010.86,"endTime":1015.48,"body":"its branches here are you just"},{"speaker":"Chris Dy","startTime":1010.86,"endTime":1015.48,"body":"if it shows up, it's great, are"},{"speaker":"Chris Dy","startTime":1015.48,"endTime":1018.12,"body":"you going to spend some time you"},{"speaker":"Chris Dy","startTime":1015.48,"endTime":1018.12,"body":"know perseverating over it?"},{"speaker":"Charles Goldfarb","startTime":1018.96,"endTime":1022.74,"body":"Two senn"},{"speaker":"Charles Goldfarb","startTime":1018.96,"endTime":1022.74,"body":"retractors, I do assure that the"},{"speaker":"Charles Goldfarb","startTime":1023.19,"endTime":1028.5,"body":"MABC is not in the field. I pull"},{"speaker":"Charles Goldfarb","startTime":1023.19,"endTime":1028.5,"body":"obviously harder on that"},{"speaker":"Charles Goldfarb","startTime":1028.5,"endTime":1032.88,"body":"posterior senn retractor. And as"},{"speaker":"Charles Goldfarb","startTime":1028.5,"endTime":1032.88,"body":"blunt spreads down to the"},{"speaker":"Charles Goldfarb","startTime":1032.88,"endTime":1036.18,"body":"retinaculum. So I think the"},{"speaker":"Charles Goldfarb","startTime":1032.88,"endTime":1036.18,"body":"approach obviously depends on"},{"speaker":"Charles Goldfarb","startTime":1036.18,"endTime":1039.42,"body":"the body habitus, but the"},{"speaker":"Charles Goldfarb","startTime":1036.18,"endTime":1039.42,"body":"approach is quick. And I'm"},{"speaker":"Charles Goldfarb","startTime":1039.42,"endTime":1040.2,"body":"pretty straightforward."},{"speaker":"Chris Dy","startTime":1041.08,"endTime":1043.84,"body":"So one thing that I"},{"speaker":"Chris Dy","startTime":1041.08,"endTime":1043.84,"body":"like when you know, so in terms"},{"speaker":"Chris Dy","startTime":1043.84,"endTime":1046.87,"body":"of finding the MABC, if it is in"},{"speaker":"Chris Dy","startTime":1043.84,"endTime":1046.87,"body":"your field, it tends to rest"},{"speaker":"Chris Dy","startTime":1046.93,"endTime":1051.37,"body":"right on top of that fascia. So"},{"speaker":"Chris Dy","startTime":1046.93,"endTime":1051.37,"body":"I after the initial blunt"},{"speaker":"Chris Dy","startTime":1051.37,"endTime":1054.7,"body":"dissection with the senns, I"},{"speaker":"Chris Dy","startTime":1051.37,"endTime":1054.7,"body":"will typically take a rag or a"},{"speaker":"Chris Dy","startTime":1054.94,"endTime":1057.4,"body":"raytech and kind of roll it"},{"speaker":"Chris Dy","startTime":1054.94,"endTime":1057.4,"body":"around my thumb and bluntly"},{"speaker":"Chris Dy","startTime":1057.4,"endTime":1061.15,"body":"dissect with my thumb, working"},{"speaker":"Chris Dy","startTime":1057.4,"endTime":1061.15,"body":"over the medial epicondyle to"},{"speaker":"Chris Dy","startTime":1061.15,"endTime":1064.39,"body":"clear all that space off. And"},{"speaker":"Chris Dy","startTime":1061.15,"endTime":1064.39,"body":"typically that will push a"},{"speaker":"Chris Dy","startTime":1064.39,"endTime":1068.98,"body":"branch of the MABC anteriorly."},{"speaker":"Chris Dy","startTime":1064.39,"endTime":1068.98,"body":"And then if I see that branch,"},{"speaker":"Chris Dy","startTime":1068.98,"endTime":1071.71,"body":"and I'll switch that to the"},{"speaker":"Chris Dy","startTime":1068.98,"endTime":1071.71,"body":"blunt end of the retractor, and"},{"speaker":"Chris Dy","startTime":1071.71,"endTime":1076.93,"body":"work from there. So I like to"},{"speaker":"Chris Dy","startTime":1071.71,"endTime":1076.93,"body":"find the nerve proximal to the"},{"speaker":"Chris Dy","startTime":1076.93,"endTime":1080.41,"body":"medial epicondyle. And I do a"},{"speaker":"Chris Dy","startTime":1076.93,"endTime":1080.41,"body":"fair bit of ulnar nerve surgery."},{"speaker":"Chris Dy","startTime":1080.41,"endTime":1082.96,"body":"And I still think especially if"},{"speaker":"Chris Dy","startTime":1080.41,"endTime":1082.96,"body":"you're sitting on the other side"},{"speaker":"Chris Dy","startTime":1082.96,"endTime":1085.6,"body":"of the table, and the trainee is"},{"speaker":"Chris Dy","startTime":1082.96,"endTime":1085.6,"body":"the primary surgeon, this can be"},{"speaker":"Chris Dy","startTime":1085.6,"endTime":1088.03,"body":"a little bit trickier to find"},{"speaker":"Chris Dy","startTime":1085.6,"endTime":1088.03,"body":"that nerve than we give it"},{"speaker":"Chris Dy","startTime":1088.03,"endTime":1090.82,"body":"credit for just because of the"},{"speaker":"Chris Dy","startTime":1088.03,"endTime":1090.82,"body":"angle of the approach. If you"},{"speaker":"Chris Dy","startTime":1090.82,"endTime":1094.18,"body":"have the arm up kind of like"},{"speaker":"Chris Dy","startTime":1090.82,"endTime":1094.18,"body":"this, that person who's sitting"},{"speaker":"Chris Dy","startTime":1094.18,"endTime":1098.65,"body":"in you know, in the driver's"},{"speaker":"Chris Dy","startTime":1094.18,"endTime":1098.65,"body":"seat needs to really understand"},{"speaker":"Chris Dy","startTime":1098.65,"endTime":1101.02,"body":"where that nerve is and where to"},{"speaker":"Chris Dy","startTime":1098.65,"endTime":1101.02,"body":"dissect because you can easily"},{"speaker":"Chris Dy","startTime":1101.02,"endTime":1103.42,"body":"glance over it if you don't go"},{"speaker":"Chris Dy","startTime":1101.02,"endTime":1103.42,"body":"in and behind that medial"},{"speaker":"Chris Dy","startTime":1103.42,"endTime":1104.11,"body":"epicondyle."},{"speaker":"Charles Goldfarb","startTime":1105.31,"endTime":1107.56,"body":"Right. And I"},{"speaker":"Charles Goldfarb","startTime":1105.31,"endTime":1107.56,"body":"think the anatomy is different"},{"speaker":"Charles Goldfarb","startTime":1107.56,"endTime":1111.79,"body":"for each person. And so the"},{"speaker":"Charles Goldfarb","startTime":1107.56,"endTime":1111.79,"body":"depth of the groove varies. And"},{"speaker":"Charles Goldfarb","startTime":1111.79,"endTime":1114.64,"body":"so for some patients, it's very"},{"speaker":"Charles Goldfarb","startTime":1111.79,"endTime":1114.64,"body":"easy to feel the nerve, for"},{"speaker":"Charles Goldfarb","startTime":1114.64,"endTime":1117.7,"body":"others it's not. And obviously"},{"speaker":"Charles Goldfarb","startTime":1114.64,"endTime":1117.7,"body":"that has implications for"},{"speaker":"Charles Goldfarb","startTime":1118.09,"endTime":1121.69,"body":"instability of the nerve, and so"},{"speaker":"Charles Goldfarb","startTime":1118.09,"endTime":1121.69,"body":"theoretically, I guess the way I"},{"speaker":"Charles Goldfarb","startTime":1121.69,"endTime":1125.2,"body":"think about it is if I'm"},{"speaker":"Charles Goldfarb","startTime":1121.69,"endTime":1125.2,"body":"thinking about doing a"},{"speaker":"Charles Goldfarb","startTime":1125.2,"endTime":1128.74,"body":"decompression, it is an"},{"speaker":"Charles Goldfarb","startTime":1125.2,"endTime":1128.74,"body":"absolutely rock stable nerve."},{"speaker":"Charles Goldfarb","startTime":1128.77,"endTime":1132.58,"body":"And so theoretically a nerve is"},{"speaker":"Charles Goldfarb","startTime":1128.77,"endTime":1132.58,"body":"sitting a little further in the"},{"speaker":"Charles Goldfarb","startTime":1132.58,"endTime":1135.43,"body":"depths of the groove. But you're"},{"speaker":"Charles Goldfarb","startTime":1132.58,"endTime":1135.43,"body":"right, it seems like it should"},{"speaker":"Charles Goldfarb","startTime":1135.43,"endTime":1138.7,"body":"be 100% easy to find the nerve"},{"speaker":"Charles Goldfarb","startTime":1135.43,"endTime":1138.7,"body":"every single time. And I think"},{"speaker":"Charles Goldfarb","startTime":1138.7,"endTime":1140.98,"body":"it is, but it can be a"},{"speaker":"Charles Goldfarb","startTime":1138.7,"endTime":1140.98,"body":"confusing."},{"speaker":"Chris Dy","startTime":1141.52,"endTime":1144.34,"body":"So do you find the"},{"speaker":"Chris Dy","startTime":1141.52,"endTime":1144.34,"body":"nerve at the medial epicondyle"},{"speaker":"Chris Dy","startTime":1144.34,"endTime":1146.83,"body":"just proximal to it before you"},{"speaker":"Chris Dy","startTime":1144.34,"endTime":1146.83,"body":"proceed distally? Or do you"},{"speaker":"Chris Dy","startTime":1146.83,"endTime":1149.89,"body":"release the FCU fascia and look"},{"speaker":"Chris Dy","startTime":1146.83,"endTime":1149.89,"body":"for it there first?"},{"speaker":"Charles Goldfarb","startTime":1150.08,"endTime":1152.0,"body":"I go right at"},{"speaker":"Charles Goldfarb","startTime":1150.08,"endTime":1152.0,"body":"the cubital tunnel retinaculum"},{"speaker":"Charles Goldfarb","startTime":1153.02,"endTime":1155.6,"body":"right behind the medial"},{"speaker":"Charles Goldfarb","startTime":1153.02,"endTime":1155.6,"body":"epicondyle and I've been happy"},{"speaker":"Charles Goldfarb","startTime":1155.6,"endTime":1158.54,"body":"with that approach. You know,"},{"speaker":"Charles Goldfarb","startTime":1155.6,"endTime":1158.54,"body":"when we do things like De"},{"speaker":"Charles Goldfarb","startTime":1158.54,"endTime":1162.32,"body":"Quervain's decompression, I'd"},{"speaker":"Charles Goldfarb","startTime":1158.54,"endTime":1162.32,"body":"make a big effort to create a"},{"speaker":"Charles Goldfarb","startTime":1162.32,"endTime":1165.98,"body":"flap, which theoretically helps"},{"speaker":"Charles Goldfarb","startTime":1162.32,"endTime":1165.98,"body":"prevent those tendons from"},{"speaker":"Charles Goldfarb","startTime":1165.98,"endTime":1169.4,"body":"subluxating. I don't do anything"},{"speaker":"Charles Goldfarb","startTime":1165.98,"endTime":1169.4,"body":"similar with the elbow, I don't"},{"speaker":"Charles Goldfarb","startTime":1169.4,"endTime":1171.77,"body":"know that I can create a flap"},{"speaker":"Charles Goldfarb","startTime":1169.4,"endTime":1171.77,"body":"strong enough that if I did"},{"speaker":"Charles Goldfarb","startTime":1171.77,"endTime":1174.92,"body":"believe in that, I would incise,"},{"speaker":"Charles Goldfarb","startTime":1171.77,"endTime":1174.92,"body":"the cubital tunnel retinaculum"},{"speaker":"Charles Goldfarb","startTime":1174.92,"endTime":1178.31,"body":"and Osborne's ligament as far"},{"speaker":"Charles Goldfarb","startTime":1174.92,"endTime":1178.31,"body":"posteriorly as possible. That's"},{"speaker":"Charles Goldfarb","startTime":1178.31,"endTime":1181.01,"body":"not been my approach. I don't"},{"speaker":"Charles Goldfarb","startTime":1178.31,"endTime":1181.01,"body":"know if you've if you've taken"},{"speaker":"Charles Goldfarb","startTime":1181.01,"endTime":1181.82,"body":"steps like that."},{"speaker":"Chris Dy","startTime":1182.78,"endTime":1185.15,"body":"I don't take that"},{"speaker":"Chris Dy","startTime":1182.78,"endTime":1185.15,"body":"step. But when we are you'll say"},{"speaker":"Chris Dy","startTime":1185.15,"endTime":1188.0,"body":"we've gotten the ulnar nerve"},{"speaker":"Chris Dy","startTime":1185.15,"endTime":1188.0,"body":"isolated, which to me is the"},{"speaker":"Chris Dy","startTime":1188.0,"endTime":1190.58,"body":"biggest part of the surgery at"},{"speaker":"Chris Dy","startTime":1188.0,"endTime":1190.58,"body":"this point. Once we've gotten a"},{"speaker":"Chris Dy","startTime":1190.67,"endTime":1194.36,"body":"lock and a read on where the"},{"speaker":"Chris Dy","startTime":1190.67,"endTime":1194.36,"body":"ulnar nerve is, I tell the"},{"speaker":"Chris Dy","startTime":1194.36,"endTime":1196.91,"body":"trainee if they're the one"},{"speaker":"Chris Dy","startTime":1194.36,"endTime":1196.91,"body":"primarily doing the dissection"},{"speaker":"Chris Dy","startTime":1196.91,"endTime":1200.39,"body":"that what you don't want to do"},{"speaker":"Chris Dy","startTime":1196.91,"endTime":1200.39,"body":"is destabilize it posteriorly."},{"speaker":"Chris Dy","startTime":1200.69,"endTime":1204.41,"body":"So the more posterior tissue"},{"speaker":"Chris Dy","startTime":1200.69,"endTime":1204.41,"body":"that you take, the more likely"},{"speaker":"Chris Dy","startTime":1204.41,"endTime":1207.08,"body":"it is that that nerve is going"},{"speaker":"Chris Dy","startTime":1204.41,"endTime":1207.08,"body":"to want to drift anterior now"},{"speaker":"Chris Dy","startTime":1207.08,"endTime":1210.17,"body":"like you, if I indicated in"},{"speaker":"Chris Dy","startTime":1207.08,"endTime":1210.17,"body":"situ, it's almost always rock"},{"speaker":"Chris Dy","startTime":1210.17,"endTime":1212.24,"body":"solid going to mean in situ,"},{"speaker":"Chris Dy","startTime":1210.17,"endTime":1212.24,"body":"because I have gotten an"},{"speaker":"Chris Dy","startTime":1212.24,"endTime":1214.49,"body":"ultrasound ahead of time, mainly"},{"speaker":"Chris Dy","startTime":1212.24,"endTime":1214.49,"body":"because I don't want to wreak"},{"speaker":"Chris Dy","startTime":1214.49,"endTime":1216.71,"body":"havoc with my day. And also I"},{"speaker":"Chris Dy","startTime":1214.49,"endTime":1216.71,"body":"want to talk to the patient"},{"speaker":"Chris Dy","startTime":1216.71,"endTime":1219.35,"body":"about counseling because they're"},{"speaker":"Chris Dy","startTime":1216.71,"endTime":1219.35,"body":"very different surgeries to get"},{"speaker":"Chris Dy","startTime":1219.35,"endTime":1221.75,"body":"over, you know, an in situ even"},{"speaker":"Chris Dy","startTime":1219.35,"endTime":1221.75,"body":"versus the subcutaneous"},{"speaker":"Chris Dy","startTime":1221.75,"endTime":1226.4,"body":"transposition. So I typically"},{"speaker":"Chris Dy","startTime":1221.75,"endTime":1226.4,"body":"will have them avoid dissecting"},{"speaker":"Chris Dy","startTime":1226.43,"endTime":1229.52,"body":"excessively posteriorly on the"},{"speaker":"Chris Dy","startTime":1226.43,"endTime":1229.52,"body":"nerve and staying really right"},{"speaker":"Chris Dy","startTime":1229.52,"endTime":1233.21,"body":"on top of the nerve A to avoid"},{"speaker":"Chris Dy","startTime":1229.52,"endTime":1233.21,"body":"the stabilizing the nerve, and B"},{"speaker":"Chris Dy","startTime":1233.21,"endTime":1235.82,"body":"to avoid those FCU branches that"},{"speaker":"Chris Dy","startTime":1233.21,"endTime":1235.82,"body":"start to come off."},{"speaker":"Charles Goldfarb","startTime":1237.02,"endTime":1240.8,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1237.02,"endTime":1240.8,"body":"well said. And then we do have a"},{"speaker":"Charles Goldfarb","startTime":1241.07,"endTime":1243.08,"body":"couple of comments or questions"},{"speaker":"Charles Goldfarb","startTime":1241.07,"endTime":1243.08,"body":"coming in. You're the one who"},{"speaker":"Charles Goldfarb","startTime":1243.08,"endTime":1246.86,"body":"can multitask and deal with the"},{"speaker":"Charles Goldfarb","startTime":1243.08,"endTime":1246.86,"body":"comments from from Instagram."},{"speaker":"Charles Goldfarb","startTime":1246.89,"endTime":1247.88,"body":"I'm struggling,"},{"speaker":"Chris Dy","startTime":1247.91,"endTime":1251.33,"body":"I can read off of my"},{"speaker":"Chris Dy","startTime":1247.91,"endTime":1251.33,"body":"phone, Chuck. Yes, I can. So"},{"speaker":"Chris Dy","startTime":1251.33,"endTime":1255.5,"body":"Sam, podcast friend, former"},{"speaker":"Chris Dy","startTime":1251.33,"endTime":1255.5,"body":"guest how far proximally and"},{"speaker":"Chris Dy","startTime":1255.5,"endTime":1259.22,"body":"distally do you release for an"},{"speaker":"Chris Dy","startTime":1255.5,"endTime":1259.22,"body":"in situ so he says he finds"},{"speaker":"Chris Dy","startTime":1259.22,"endTime":1262.4,"body":"himself going fairly high on the"},{"speaker":"Chris Dy","startTime":1259.22,"endTime":1262.4,"body":"humerus with an Army Navy. And"},{"speaker":"Chris Dy","startTime":1262.64,"endTime":1265.4,"body":"that makes me go more than three"},{"speaker":"Chris Dy","startTime":1262.64,"endTime":1265.4,"body":"inches plus with the incision."},{"speaker":"Chris Dy","startTime":1265.97,"endTime":1269.03,"body":"So Chuck, you mentioned earlier"},{"speaker":"Chris Dy","startTime":1265.97,"endTime":1269.03,"body":"you are not getting the septum"},{"speaker":"Chris Dy","startTime":1269.03,"endTime":1272.12,"body":"out and you know, obviously the"},{"speaker":"Chris Dy","startTime":1269.03,"endTime":1272.12,"body":"septum is not a point of"},{"speaker":"Chris Dy","startTime":1272.12,"endTime":1275.39,"body":"compression unless you transpose"},{"speaker":"Chris Dy","startTime":1272.12,"endTime":1275.39,"body":"the nerve. How far proximately"},{"speaker":"Chris Dy","startTime":1275.39,"endTime":1278.0,"body":"are you dissecting? And then in"},{"speaker":"Chris Dy","startTime":1275.39,"endTime":1278.0,"body":"terms of where your incision is"},{"speaker":"Chris Dy","startTime":1278.0,"endTime":1281.78,"body":"placed? How much of that five"},{"speaker":"Chris Dy","startTime":1278.0,"endTime":1281.78,"body":"centimeter incision is proximal"},{"speaker":"Chris Dy","startTime":1281.78,"endTime":1285.71,"body":"to the medial epicondyle? Or is"},{"speaker":"Chris Dy","startTime":1281.78,"endTime":1285.71,"body":"it mainly all at and distal to"},{"speaker":"Chris Dy","startTime":1285.71,"endTime":1288.2,"body":"the medial epicondyle because"},{"speaker":"Chris Dy","startTime":1285.71,"endTime":1288.2,"body":"that'll tell you how far you can"},{"speaker":"Chris Dy","startTime":1288.2,"endTime":1290.75,"body":"get up without extending your"},{"speaker":"Chris Dy","startTime":1288.2,"endTime":1290.75,"body":"incision."},{"speaker":"Charles Goldfarb","startTime":1291.32,"endTime":1293.33,"body":"Yeah, my"},{"speaker":"Charles Goldfarb","startTime":1291.32,"endTime":1293.33,"body":"incision is just at the medial"},{"speaker":"Charles Goldfarb","startTime":1293.33,"endTime":1297.05,"body":"epicondyle, and I create"},{"speaker":"Charles Goldfarb","startTime":1293.33,"endTime":1297.05,"body":"subcutaneous tunnels and feel my"},{"speaker":"Charles Goldfarb","startTime":1297.05,"endTime":1300.98,"body":"visualization is perfect. So"},{"speaker":"Charles Goldfarb","startTime":1297.05,"endTime":1300.98,"body":"this the length of the incision,"},{"speaker":"Charles Goldfarb","startTime":1300.98,"endTime":1303.59,"body":"I don't think dramatically"},{"speaker":"Charles Goldfarb","startTime":1300.98,"endTime":1303.59,"body":"affects how far I decompress the"},{"speaker":"Charles Goldfarb","startTime":1303.59,"endTime":1308.21,"body":"nerve. And so I can access three"},{"speaker":"Charles Goldfarb","startTime":1303.59,"endTime":1308.21,"body":"four inches above the medial"},{"speaker":"Charles Goldfarb","startTime":1308.21,"endTime":1311.72,"body":"epicondyle and distal to the"},{"speaker":"Charles Goldfarb","startTime":1308.21,"endTime":1311.72,"body":"medial epicondyle, I still split"},{"speaker":"Charles Goldfarb","startTime":1311.72,"endTime":1314.6,"body":"the FCU muscle belly when we're"},{"speaker":"Charles Goldfarb","startTime":1311.72,"endTime":1314.6,"body":"talking about distal to make"},{"speaker":"Charles Goldfarb","startTime":1314.6,"endTime":1318.44,"body":"sure that I decompress that deep"},{"speaker":"Charles Goldfarb","startTime":1314.6,"endTime":1318.44,"body":"fascia. So I feel my access is"},{"speaker":"Charles Goldfarb","startTime":1318.44,"endTime":1321.86,"body":"not limited by the size of the"},{"speaker":"Charles Goldfarb","startTime":1318.44,"endTime":1321.86,"body":"incision, as long as I can get"},{"speaker":"Charles Goldfarb","startTime":1321.86,"endTime":1327.14,"body":"my senn retractors in and"},{"speaker":"Charles Goldfarb","startTime":1321.86,"endTime":1327.14,"body":"mobilize the skin two again max"},{"speaker":"Charles Goldfarb","startTime":1327.14,"endTime":1330.08,"body":"three, three centimeter incision"},{"speaker":"Charles Goldfarb","startTime":1327.14,"endTime":1330.08,"body":"is sufficient for me."},{"speaker":"Chris Dy","startTime":1330.5,"endTime":1333.56,"body":"Do you? Do you believe"},{"speaker":"Chris Dy","startTime":1330.5,"endTime":1333.56,"body":"that the Struthers needs to be"},{"speaker":"Chris Dy","startTime":1333.56,"endTime":1334.07,"body":"released?"},{"speaker":"Charles Goldfarb","startTime":1334.97,"endTime":1339.68,"body":"I do not."},{"speaker":"Charles Goldfarb","startTime":1334.97,"endTime":1339.68,"body":"Unless on preoperative exam."},{"speaker":"Charles Goldfarb","startTime":1339.68,"endTime":1342.95,"body":"There's marked findings"},{"speaker":"Charles Goldfarb","startTime":1339.68,"endTime":1342.95,"body":"clinically there which I don't"},{"speaker":"Charles Goldfarb","startTime":1342.95,"endTime":1346.25,"body":"usually see. I think Struthers"},{"speaker":"Charles Goldfarb","startTime":1342.95,"endTime":1346.25,"body":"and again there we're talking"},{"speaker":"Charles Goldfarb","startTime":1346.25,"endTime":1349.46,"body":"five. I think it's the"},{"speaker":"Charles Goldfarb","startTime":1346.25,"endTime":1349.46,"body":"literature says five inches"},{"speaker":"Charles Goldfarb","startTime":1349.46,"endTime":1351.8,"body":"proximally I don't know, but"},{"speaker":"Charles Goldfarb","startTime":1349.46,"endTime":1351.8,"body":"it's significant."},{"speaker":"Chris Dy","startTime":1352.04,"endTime":1353.27,"body":"We keep switching"},{"speaker":"Chris Dy","startTime":1352.04,"endTime":1353.27,"body":"units."},{"speaker":"Charles Goldfarb","startTime":1354.14,"endTime":1356.78,"body":"So confusing."},{"speaker":"Charles Goldfarb","startTime":1354.14,"endTime":1356.78,"body":"My head hurts. I think it's"},{"speaker":"Charles Goldfarb","startTime":1356.81,"endTime":1359.51,"body":"eight centimeters proximal to"},{"speaker":"Charles Goldfarb","startTime":1356.81,"endTime":1359.51,"body":"the medial epicondyle is where"},{"speaker":"Charles Goldfarb","startTime":1359.51,"endTime":1364.76,"body":"we classically say Struthers is,"},{"speaker":"Charles Goldfarb","startTime":1359.51,"endTime":1364.76,"body":"and if there's dramatic clinical"},{"speaker":"Charles Goldfarb","startTime":1364.76,"endTime":1367.25,"body":"signs preoperatively that I make"},{"speaker":"Charles Goldfarb","startTime":1364.76,"endTime":1367.25,"body":"I probably would consider"},{"speaker":"Charles Goldfarb","startTime":1367.25,"endTime":1371.33,"body":"transposing. But I also think"},{"speaker":"Charles Goldfarb","startTime":1367.25,"endTime":1371.33,"body":"that when you transpose you put"},{"speaker":"Charles Goldfarb","startTime":1371.33,"endTime":1374.87,"body":"more tension on that proximal"},{"speaker":"Charles Goldfarb","startTime":1371.33,"endTime":1374.87,"body":"tether. So I think a"},{"speaker":"Charles Goldfarb","startTime":1374.87,"endTime":1379.25,"body":"decompression really is not"},{"speaker":"Charles Goldfarb","startTime":1374.87,"endTime":1379.25,"body":"necessary to fully release"},{"speaker":"Charles Goldfarb","startTime":1379.43,"endTime":1380.06,"body":"Struthers."},{"speaker":"Chris Dy","startTime":1380.63,"endTime":1384.71,"body":"So then to say we were"},{"speaker":"Chris Dy","startTime":1380.63,"endTime":1384.71,"body":"going distally we've released"},{"speaker":"Chris Dy","startTime":1384.71,"endTime":1387.44,"body":"the cubital retinaculum, which"},{"speaker":"Chris Dy","startTime":1384.71,"endTime":1387.44,"body":"is really the roof of the"},{"speaker":"Chris Dy","startTime":1387.44,"endTime":1389.57,"body":"cubital tunnel and then you're"},{"speaker":"Chris Dy","startTime":1387.44,"endTime":1389.57,"body":"getting towards Osborne's"},{"speaker":"Chris Dy","startTime":1389.57,"endTime":1392.78,"body":"ligament which at least I"},{"speaker":"Chris Dy","startTime":1389.57,"endTime":1392.78,"body":"understand that to be defined as"},{"speaker":"Chris Dy","startTime":1392.78,"endTime":1396.17,"body":"the fascia that connects the"},{"speaker":"Chris Dy","startTime":1392.78,"endTime":1396.17,"body":"proximal aspect of the two FCU"},{"speaker":"Chris Dy","startTime":1396.17,"endTime":1400.01,"body":"heads. And I think that is a"},{"speaker":"Chris Dy","startTime":1396.17,"endTime":1400.01,"body":"distinct structure from the"},{"speaker":"Chris Dy","startTime":1400.01,"endTime":1404.3,"body":"cubital retinaculum. And I will"},{"speaker":"Chris Dy","startTime":1400.01,"endTime":1404.3,"body":"release that. And as we proceed"},{"speaker":"Chris Dy","startTime":1404.3,"endTime":1407.06,"body":"distally How do you manage the"},{"speaker":"Chris Dy","startTime":1404.3,"endTime":1407.06,"body":"FCU muscle belly?"},{"speaker":"Charles Goldfarb","startTime":1408.23,"endTime":1410.3,"body":"So different"},{"speaker":"Charles Goldfarb","startTime":1408.23,"endTime":1410.3,"body":"people do different things?"},{"speaker":"Charles Goldfarb","startTime":1410.3,"endTime":1413.39,"body":"Obviously, it was why you're"},{"speaker":"Charles Goldfarb","startTime":1410.3,"endTime":1413.39,"body":"asking, I actually take the"},{"speaker":"Charles Goldfarb","startTime":1413.39,"endTime":1418.22,"body":"blunt ends of my senn retractors"},{"speaker":"Charles Goldfarb","startTime":1413.39,"endTime":1418.22,"body":"one or both, and I simply pull"},{"speaker":"Charles Goldfarb","startTime":1418.22,"endTime":1421.34,"body":"distally if you're in the right"},{"speaker":"Charles Goldfarb","startTime":1418.22,"endTime":1421.34,"body":"plane, the muscle separates."},{"speaker":"Charles Goldfarb","startTime":1421.37,"endTime":1425.39,"body":"There's nothing to cut. I think"},{"speaker":"Charles Goldfarb","startTime":1421.37,"endTime":1425.39,"body":"it's incredibly safe. So you've"},{"speaker":"Charles Goldfarb","startTime":1425.39,"endTime":1428.66,"body":"released the superficial fascia"},{"speaker":"Charles Goldfarb","startTime":1425.39,"endTime":1428.66,"body":"taking care to avoid any"},{"speaker":"Charles Goldfarb","startTime":1428.66,"endTime":1432.17,"body":"cutaneous nerves. Now you"},{"speaker":"Charles Goldfarb","startTime":1428.66,"endTime":1432.17,"body":"bluntly spread the muscle you're"},{"speaker":"Charles Goldfarb","startTime":1432.17,"endTime":1435.92,"body":"looking at the deep fascia and I"},{"speaker":"Charles Goldfarb","startTime":1432.17,"endTime":1435.92,"body":"use scissors to dissect that"},{"speaker":"Charles Goldfarb","startTime":1435.92,"endTime":1437.66,"body":"deep fascia. How do you do it?"},{"speaker":"Chris Dy","startTime":1438.56,"endTime":1441.89,"body":"So I like to incise"},{"speaker":"Chris Dy","startTime":1438.56,"endTime":1441.89,"body":"the superficial fascia that"},{"speaker":"Chris Dy","startTime":1441.89,"endTime":1446.54,"body":"covers the FCU muscle bellies. I"},{"speaker":"Chris Dy","startTime":1441.89,"endTime":1446.54,"body":"like to look at the individual"},{"speaker":"Chris Dy","startTime":1446.54,"endTime":1450.02,"body":"muscle bellies and I've maybe"},{"speaker":"Chris Dy","startTime":1446.54,"endTime":1450.02,"body":"it's because I like the I like"},{"speaker":"Chris Dy","startTime":1450.02,"endTime":1452.9,"body":"doing it or like torturing our"},{"speaker":"Chris Dy","startTime":1450.02,"endTime":1452.9,"body":"residents and fellows but I like"},{"speaker":"Chris Dy","startTime":1452.9,"endTime":1457.61,"body":"to incise that rafe between the"},{"speaker":"Chris Dy","startTime":1452.9,"endTime":1457.61,"body":"two heads of the FCU with a"},{"speaker":"Chris Dy","startTime":1457.61,"endTime":1461.51,"body":"scalpel initially, you know not"},{"speaker":"Chris Dy","startTime":1457.61,"endTime":1461.51,"body":"just tearing through it like you"},{"speaker":"Chris Dy","startTime":1461.51,"endTime":1461.81,"body":"do."},{"speaker":"Charles Goldfarb","startTime":1464.9,"endTime":1467.06,"body":"It is such a"},{"speaker":"Charles Goldfarb","startTime":1464.9,"endTime":1467.06,"body":"precise movement."},{"speaker":"Chris Dy","startTime":1469.55,"endTime":1473.12,"body":"But I like doing that"},{"speaker":"Chris Dy","startTime":1469.55,"endTime":1473.12,"body":"and then you know as that"},{"speaker":"Chris Dy","startTime":1473.12,"endTime":1476.87,"body":"dissection progresses, taking"},{"speaker":"Chris Dy","startTime":1473.12,"endTime":1476.87,"body":"the blunt and a senn retractor,"},{"speaker":"Chris Dy","startTime":1476.87,"endTime":1479.66,"body":"or even just a ragnell, or a"},{"speaker":"Chris Dy","startTime":1476.87,"endTime":1479.66,"body":"baby Army Navy, depending on the"},{"speaker":"Chris Dy","startTime":1479.66,"endTime":1484.22,"body":"size of the patient, and pushing"},{"speaker":"Chris Dy","startTime":1479.66,"endTime":1484.22,"body":"those FCU heads away. And that"},{"speaker":"Chris Dy","startTime":1484.22,"endTime":1487.46,"body":"gives you free reign on that"},{"speaker":"Chris Dy","startTime":1484.22,"endTime":1487.46,"body":"kind of deeper fascia of the"},{"speaker":"Chris Dy","startTime":1487.46,"endTime":1490.25,"body":"FCU. Kind of almost some people"},{"speaker":"Chris Dy","startTime":1487.46,"endTime":1490.25,"body":"will call it almost like a"},{"speaker":"Chris Dy","startTime":1490.25,"endTime":1494.63,"body":"mesoneurium along the the ulnar"},{"speaker":"Chris Dy","startTime":1490.25,"endTime":1494.63,"body":"nerve itself and releasing that."},{"speaker":"Chris Dy","startTime":1495.02,"endTime":1498.05,"body":"And I don't know if there's a"},{"speaker":"Chris Dy","startTime":1495.02,"endTime":1498.05,"body":"right answer on how distal you"},{"speaker":"Chris Dy","startTime":1498.05,"endTime":1502.28,"body":"go there. It's got to, most"},{"speaker":"Chris Dy","startTime":1498.05,"endTime":1502.28,"body":"people would say about four to"},{"speaker":"Chris Dy","startTime":1502.28,"endTime":1507.29,"body":"six centimeters is maybe even"},{"speaker":"Chris Dy","startTime":1502.28,"endTime":1507.29,"body":"excessive, but that will be sure"},{"speaker":"Chris Dy","startTime":1507.29,"endTime":1508.94,"body":"that you're released. And you"},{"speaker":"Chris Dy","startTime":1507.29,"endTime":1508.94,"body":"can do that through that"},{"speaker":"Chris Dy","startTime":1508.94,"endTime":1511.13,"body":"relatively small incision"},{"speaker":"Chris Dy","startTime":1508.94,"endTime":1511.13,"body":"because you're working through"},{"speaker":"Chris Dy","startTime":1511.13,"endTime":1514.4,"body":"those skin windows, and you're"},{"speaker":"Chris Dy","startTime":1511.13,"endTime":1514.4,"body":"able to work quite distal even"},{"speaker":"Chris Dy","startTime":1514.4,"endTime":1516.32,"body":"with a five centimeter incision."},{"speaker":"Charles Goldfarb","startTime":1517.01,"endTime":1518.78,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1517.01,"endTime":1518.78,"body":"the windowed approach is key you"},{"speaker":"Charles Goldfarb","startTime":1518.78,"endTime":1522.29,"body":"are, you can mobilize so much"},{"speaker":"Charles Goldfarb","startTime":1518.78,"endTime":1522.29,"body":"because you're focusing either"},{"speaker":"Charles Goldfarb","startTime":1522.29,"endTime":1525.86,"body":"directly posted in the medial"},{"speaker":"Charles Goldfarb","startTime":1522.29,"endTime":1525.86,"body":"epicondyle and proximal or"},{"speaker":"Charles Goldfarb","startTime":1525.86,"endTime":1530.36,"body":"distal, but let me be clear,"},{"speaker":"Charles Goldfarb","startTime":1525.86,"endTime":1530.36,"body":"only people who see the world as"},{"speaker":"Charles Goldfarb","startTime":1530.36,"endTime":1535.76,"body":"a nerve centric place would call"},{"speaker":"Charles Goldfarb","startTime":1530.36,"endTime":1535.76,"body":"it a mesoneurium. No one calls"},{"speaker":"Charles Goldfarb","startTime":1535.76,"endTime":1538.94,"body":"it a mesoneurium, except for"},{"speaker":"Charles Goldfarb","startTime":1535.76,"endTime":1538.94,"body":"you. It is the deep fascia of"},{"speaker":"Charles Goldfarb","startTime":1538.94,"endTime":1539.57,"body":"the FCU."},{"speaker":"Chris Dy","startTime":1540.71,"endTime":1545.12,"body":"Sure, sure. Agree to"},{"speaker":"Chris Dy","startTime":1540.71,"endTime":1545.12,"body":"disagree, agree to disagree. And"},{"speaker":"Chris Dy","startTime":1545.12,"endTime":1546.86,"body":"then the biggest thing is, you"},{"speaker":"Chris Dy","startTime":1545.12,"endTime":1546.86,"body":"know, like we talked about"},{"speaker":"Chris Dy","startTime":1546.86,"endTime":1550.67,"body":"earlier, I think of sparing the"},{"speaker":"Chris Dy","startTime":1546.86,"endTime":1550.67,"body":"branches to the FCU, even though"},{"speaker":"Chris Dy","startTime":1550.67,"endTime":1553.67,"body":"you're not trying to transpose"},{"speaker":"Chris Dy","startTime":1550.67,"endTime":1553.67,"body":"this nerve in this setting. I"},{"speaker":"Chris Dy","startTime":1553.67,"endTime":1556.61,"body":"think one anatomic probe that I"},{"speaker":"Chris Dy","startTime":1553.67,"endTime":1556.61,"body":"picked up is, you know, I think"},{"speaker":"Chris Dy","startTime":1556.61,"endTime":1559.85,"body":"it was from trying to remember"},{"speaker":"Chris Dy","startTime":1556.61,"endTime":1559.85,"body":"the classic anatomic textbook"},{"speaker":"Chris Dy","startTime":1560.06,"endTime":1562.52,"body":"that lists every kind of variant"},{"speaker":"Chris Dy","startTime":1560.06,"endTime":1562.52,"body":"that's out there, it's got a"},{"speaker":"Chris Dy","startTime":1562.52,"endTime":1566.36,"body":"maroon cover. But there are some"},{"speaker":"Chris Dy","startTime":1562.52,"endTime":1566.36,"body":"variants in which of those"},{"speaker":"Chris Dy","startTime":1566.36,"endTime":1569.78,"body":"branches to the FCU will come in"},{"speaker":"Chris Dy","startTime":1566.36,"endTime":1569.78,"body":"and supply the FCU and then come"},{"speaker":"Chris Dy","startTime":1569.78,"endTime":1574.13,"body":"back up and supply the FDP to"},{"speaker":"Chris Dy","startTime":1569.78,"endTime":1574.13,"body":"the ring and small side, I like"},{"speaker":"Chris Dy","startTime":1574.13,"endTime":1577.25,"body":"to preserve those as much as I"},{"speaker":"Chris Dy","startTime":1574.13,"endTime":1577.25,"body":"can. I guess that's maybe more"},{"speaker":"Chris Dy","startTime":1577.25,"endTime":1580.85,"body":"relevant to an ulnar nerve"},{"speaker":"Chris Dy","startTime":1577.25,"endTime":1580.85,"body":"transposition. But it's good to"},{"speaker":"Chris Dy","startTime":1580.85,"endTime":1583.43,"body":"know that those branches if you"},{"speaker":"Chris Dy","startTime":1580.85,"endTime":1583.43,"body":"look at the nerve as a tube over"},{"speaker":"Chris Dy","startTime":1583.43,"endTime":1586.22,"body":"here, those branches are coming"},{"speaker":"Chris Dy","startTime":1583.43,"endTime":1586.22,"body":"off of the side. So if you stay"},{"speaker":"Chris Dy","startTime":1586.22,"endTime":1589.07,"body":"right on top of the nerve here,"},{"speaker":"Chris Dy","startTime":1586.22,"endTime":1589.07,"body":"you should be safe."},{"speaker":"Charles Goldfarb","startTime":1590.03,"endTime":1593.54,"body":"Yes, you"},{"speaker":"Charles Goldfarb","startTime":1590.03,"endTime":1593.54,"body":"should. But they're absolutely"},{"speaker":"Charles Goldfarb","startTime":1593.54,"endTime":1596.15,"body":"and you've seen it. There are"},{"speaker":"Charles Goldfarb","startTime":1593.54,"endTime":1596.15,"body":"absolutely times when those"},{"speaker":"Charles Goldfarb","startTime":1596.15,"endTime":1600.62,"body":"motor branches come interior. So"},{"speaker":"Charles Goldfarb","startTime":1596.15,"endTime":1600.62,"body":"I do now preach, be careful and"},{"speaker":"Charles Goldfarb","startTime":1600.62,"endTime":1603.14,"body":"thankfully knock on wood. I"},{"speaker":"Charles Goldfarb","startTime":1600.62,"endTime":1603.14,"body":"don't believe I've injured but"},{"speaker":"Charles Goldfarb","startTime":1603.14,"endTime":1605.78,"body":"when the nerves come in here,"},{"speaker":"Charles Goldfarb","startTime":1603.14,"endTime":1605.78,"body":"you're right. It is it is"},{"speaker":"Charles Goldfarb","startTime":1605.78,"endTime":1607.67,"body":"surprising, but it happens."},{"speaker":"Chris Dy","startTime":1608.0,"endTime":1610.64,"body":"So basic question that"},{"speaker":"Chris Dy","startTime":1608.0,"endTime":1610.64,"body":"might help some early trainees."},{"speaker":"Chris Dy","startTime":1611.48,"endTime":1615.02,"body":"Do you even set up a the setup a"},{"speaker":"Chris Dy","startTime":1611.48,"endTime":1615.02,"body":"bovie or bipolar for this case?"},{"speaker":"Chris Dy","startTime":1615.05,"endTime":1616.4,"body":"And what settings do you use?"},{"speaker":"Charles Goldfarb","startTime":1616.88,"endTime":1619.82,"body":"Interestingly,"},{"speaker":"Charles Goldfarb","startTime":1616.88,"endTime":1619.82,"body":"I do not set up a bovie or"},{"speaker":"Charles Goldfarb","startTime":1619.82,"endTime":1623.78,"body":"bipolar for a carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":1619.82,"endTime":1623.78,"body":"release, I do for cubital tunnel"},{"speaker":"Charles Goldfarb","startTime":1623.81,"endTime":1629.09,"body":"decompression. And it's usually"},{"speaker":"Charles Goldfarb","startTime":1623.81,"endTime":1629.09,"body":"at eight to 10. The one vessel"},{"speaker":"Charles Goldfarb","startTime":1629.21,"endTime":1632.78,"body":"that gives me trouble is the"},{"speaker":"Charles Goldfarb","startTime":1629.21,"endTime":1632.78,"body":"tran- I call it transverse it's"},{"speaker":"Charles Goldfarb","startTime":1632.78,"endTime":1638.63,"body":"really an A to P vessel, right"},{"speaker":"Charles Goldfarb","startTime":1632.78,"endTime":1638.63,"body":"as the nerve enters the FCU. So"},{"speaker":"Charles Goldfarb","startTime":1638.63,"endTime":1641.21,"body":"when you've released that"},{"speaker":"Charles Goldfarb","startTime":1638.63,"endTime":1641.21,"body":"superficial fascia, and you go"},{"speaker":"Charles Goldfarb","startTime":1641.21,"endTime":1643.34,"body":"release that you spread the"},{"speaker":"Charles Goldfarb","startTime":1641.21,"endTime":1643.34,"body":"muscle, you're looking at the"},{"speaker":"Charles Goldfarb","startTime":1643.34,"endTime":1646.79,"body":"deep fashion, there's always"},{"speaker":"Charles Goldfarb","startTime":1643.34,"endTime":1646.79,"body":"that transverse vessel. And if"},{"speaker":"Charles Goldfarb","startTime":1646.79,"endTime":1650.84,"body":"you buzz too hot, the nerve"},{"speaker":"Charles Goldfarb","startTime":1646.79,"endTime":1650.84,"body":"jumps and people like you don't"},{"speaker":"Charles Goldfarb","startTime":1650.84,"endTime":1652.58,"body":"like that don't like it when"},{"speaker":"Charles Goldfarb","startTime":1650.84,"endTime":1652.58,"body":"that happens."},{"speaker":"Chris Dy","startTime":1653.03,"endTime":1654.98,"body":"So do you use a"},{"speaker":"Chris Dy","startTime":1653.03,"endTime":1654.98,"body":"bipolar or bovie?"},{"speaker":"Charles Goldfarb","startTime":1655.67,"endTime":1658.4,"body":"I look I'm not"},{"speaker":"Charles Goldfarb","startTime":1655.67,"endTime":1658.4,"body":"a nerve surgeon. I use a bovie."},{"speaker":"Chris Dy","startTime":1658.52,"endTime":1662.48,"body":"Oh, no, you didn't say"},{"speaker":"Chris Dy","startTime":1658.52,"endTime":1662.48,"body":"that. Alright."},{"speaker":"Charles Goldfarb","startTime":1662.72,"endTime":1664.94,"body":"No, I hear"},{"speaker":"Charles Goldfarb","startTime":1662.72,"endTime":1664.94,"body":"you."},{"speaker":"Chris Dy","startTime":1665.15,"endTime":1666.98,"body":"I like the ulnar"},{"speaker":"Chris Dy","startTime":1665.15,"endTime":1666.98,"body":"nerve. But personally."},{"speaker":"Charles Goldfarb","startTime":1669.05,"endTime":1671.75,"body":"I will use"},{"speaker":"Charles Goldfarb","startTime":1669.05,"endTime":1671.75,"body":"either. I do use a bovie on"},{"speaker":"Charles Goldfarb","startTime":1671.75,"endTime":1675.62,"body":"occasion. But you're right for"},{"speaker":"Charles Goldfarb","startTime":1671.75,"endTime":1675.62,"body":"that particular branch in close"},{"speaker":"Charles Goldfarb","startTime":1675.62,"endTime":1677.87,"body":"proximity to the nerve. I think"},{"speaker":"Charles Goldfarb","startTime":1675.62,"endTime":1677.87,"body":"I'm bipolar makes a lot of"},{"speaker":"Charles Goldfarb","startTime":1677.87,"endTime":1678.08,"body":"sense."},{"speaker":"Chris Dy","startTime":1678.11,"endTime":1679.88,"body":"I think I know the"},{"speaker":"Chris Dy","startTime":1678.11,"endTime":1679.88,"body":"exact branch that you're talking"},{"speaker":"Chris Dy","startTime":1679.88,"endTime":1682.97,"body":"about. And I've even heard Dr."},{"speaker":"Chris Dy","startTime":1679.88,"endTime":1682.97,"body":"McKinnon talk about that as a"},{"speaker":"Chris Dy","startTime":1683.06,"endTime":1686.72,"body":"vessel that almost acts like a"},{"speaker":"Chris Dy","startTime":1683.06,"endTime":1686.72,"body":"bracelet over the nerve. You"},{"speaker":"Chris Dy","startTime":1686.72,"endTime":1688.64,"body":"know, so that one is always"},{"speaker":"Chris Dy","startTime":1686.72,"endTime":1688.64,"body":"there. And that one, if you"},{"speaker":"Chris Dy","startTime":1688.64,"endTime":1691.91,"body":"don't get that can make your"},{"speaker":"Chris Dy","startTime":1688.64,"endTime":1691.91,"body":"life challenging. And maybe not"},{"speaker":"Chris Dy","startTime":1691.91,"endTime":1694.43,"body":"so much for this. But more for"},{"speaker":"Chris Dy","startTime":1691.91,"endTime":1694.43,"body":"transposition, which maybe we'll"},{"speaker":"Chris Dy","startTime":1694.43,"endTime":1699.41,"body":"get into in a subsequent episode"},{"speaker":"Chris Dy","startTime":1694.43,"endTime":1699.41,"body":"is just posterior and hugging"},{"speaker":"Chris Dy","startTime":1699.41,"endTime":1702.62,"body":"almost the floor of the cubital"},{"speaker":"Chris Dy","startTime":1699.41,"endTime":1702.62,"body":"tunnel by the medial epicondyle."},{"speaker":"Chris Dy","startTime":1703.07,"endTime":1707.81,"body":"More posterior than the nerve is"},{"speaker":"Chris Dy","startTime":1703.07,"endTime":1707.81,"body":"this cluster of vessels, that if"},{"speaker":"Chris Dy","startTime":1707.81,"endTime":1711.44,"body":"you don't get it first, it will"},{"speaker":"Chris Dy","startTime":1707.81,"endTime":1711.44,"body":"get you. So that's one thing to"},{"speaker":"Chris Dy","startTime":1711.44,"endTime":1713.51,"body":"keep in mind. Mainly, if you're"},{"speaker":"Chris Dy","startTime":1711.44,"endTime":1713.51,"body":"doing a transposition, I"},{"speaker":"Chris Dy","startTime":1713.51,"endTime":1715.97,"body":"wouldn't be working that"},{"speaker":"Chris Dy","startTime":1713.51,"endTime":1715.97,"body":"posterior if you're doing an"},{"speaker":"Chris Dy","startTime":1715.97,"endTime":1717.26,"body":"insight to decompression alone."},{"speaker":"Charles Goldfarb","startTime":1717.74,"endTime":1720.02,"body":"Yeah, well, we"},{"speaker":"Charles Goldfarb","startTime":1717.74,"endTime":1720.02,"body":"can talk about that. Now that I"},{"speaker":"Charles Goldfarb","startTime":1720.02,"endTime":1722.87,"body":"think that's interesting,"},{"speaker":"Charles Goldfarb","startTime":1720.02,"endTime":1722.87,"body":"because, you know, Paul Mansky,"},{"speaker":"Charles Goldfarb","startTime":1722.87,"endTime":1729.35,"body":"and originally the the Is it the"},{"speaker":"Charles Goldfarb","startTime":1722.87,"endTime":1729.35,"body":"macay monkeys, the study out of"},{"speaker":"Charles Goldfarb","startTime":1729.38,"endTime":1732.8,"body":"Boston, or maybe it was"},{"speaker":"Charles Goldfarb","startTime":1729.38,"endTime":1732.8,"body":"Pittsburgh, where they looked at"},{"speaker":"Charles Goldfarb","startTime":1732.8,"endTime":1738.8,"body":"the lack of vascularity to a"},{"speaker":"Charles Goldfarb","startTime":1732.8,"endTime":1738.8,"body":"transposed nerve. And so the"},{"speaker":"Charles Goldfarb","startTime":1738.8,"endTime":1742.55,"body":"recommendation was, you should"},{"speaker":"Charles Goldfarb","startTime":1738.8,"endTime":1742.55,"body":"bring vascularity with the nerve"},{"speaker":"Charles Goldfarb","startTime":1742.55,"endTime":1745.94,"body":"when you transpose it. And what"},{"speaker":"Charles Goldfarb","startTime":1742.55,"endTime":1745.94,"body":"ultimately gets you are the"},{"speaker":"Charles Goldfarb","startTime":1745.94,"endTime":1748.04,"body":"vessels you're talking about."},{"speaker":"Charles Goldfarb","startTime":1745.94,"endTime":1748.04,"body":"Now, we have beautiful"},{"speaker":"Charles Goldfarb","startTime":1748.04,"endTime":1750.8,"body":"longitudinally running vessels"},{"speaker":"Charles Goldfarb","startTime":1748.04,"endTime":1750.8,"body":"until you get to roughly the"},{"speaker":"Charles Goldfarb","startTime":1750.8,"endTime":1754.46,"body":"medial epicondyle level. And"},{"speaker":"Charles Goldfarb","startTime":1750.8,"endTime":1754.46,"body":"then you get this this sort of"},{"speaker":"Charles Goldfarb","startTime":1754.46,"endTime":1758.87,"body":"plexus, but a bunch of vessels"},{"speaker":"Charles Goldfarb","startTime":1754.46,"endTime":1758.87,"body":"coming together, whatever that's"},{"speaker":"Charles Goldfarb","startTime":1758.87,"endTime":1767.57,"body":"called a flock, a flock of"},{"speaker":"Charles Goldfarb","startTime":1758.87,"endTime":1767.57,"body":"vessels. And you're in trouble,"},{"speaker":"Charles Goldfarb","startTime":1767.57,"endTime":1769.97,"body":"you can no longer take the"},{"speaker":"Charles Goldfarb","startTime":1767.57,"endTime":1769.97,"body":"vessels. And so that's where I"},{"speaker":"Charles Goldfarb","startTime":1769.97,"endTime":1772.07,"body":"use the quarter as vessels for a"},{"speaker":"Charles Goldfarb","startTime":1769.97,"endTime":1772.07,"body":"transposition."},{"speaker":"Chris Dy","startTime":1773.18,"endTime":1776.24,"body":"So Sam is mentioning"},{"speaker":"Chris Dy","startTime":1773.18,"endTime":1776.24,"body":"when he transposes, there are"},{"speaker":"Chris Dy","startTime":1776.24,"endTime":1778.97,"body":"juicy vessels by the septum,"},{"speaker":"Chris Dy","startTime":1776.24,"endTime":1778.97,"body":"perhaps a flock of vessels."},{"speaker":"Chris Dy","startTime":1779.42,"endTime":1781.91,"body":"Those are different than the"},{"speaker":"Chris Dy","startTime":1779.42,"endTime":1781.91,"body":"ones I think we were talking"},{"speaker":"Chris Dy","startTime":1781.91,"endTime":1784.94,"body":"about. So those vessels, I"},{"speaker":"Chris Dy","startTime":1781.91,"endTime":1784.94,"body":"believe, are the ones described"},{"speaker":"Chris Dy","startTime":1785.21,"endTime":1788.93,"body":"by Ken Yamaguchi, when he wrote"},{"speaker":"Chris Dy","startTime":1785.21,"endTime":1788.93,"body":"that paper with Dr. Gelberman."},{"speaker":"Chris Dy","startTime":1789.29,"endTime":1792.14,"body":"In those branches of the"},{"speaker":"Chris Dy","startTime":1789.29,"endTime":1792.14,"body":"inferior ulnar collateral artery"},{"speaker":"Chris Dy","startTime":1792.14,"endTime":1794.87,"body":"are always there by the septum."},{"speaker":"Chris Dy","startTime":1792.14,"endTime":1794.87,"body":"And that's actually the reason"},{"speaker":"Chris Dy","startTime":1794.87,"endTime":1798.59,"body":"why when I do a transposition, I"},{"speaker":"Chris Dy","startTime":1794.87,"endTime":1798.59,"body":"don't have the trainees or"},{"speaker":"Chris Dy","startTime":1798.59,"endTime":1800.96,"body":"myself. I don't take the septum"},{"speaker":"Chris Dy","startTime":1798.59,"endTime":1800.96,"body":"all the way by the medial"},{"speaker":"Chris Dy","startTime":1800.96,"endTime":1803.21,"body":"epicondyle, because that's not"},{"speaker":"Chris Dy","startTime":1800.96,"endTime":1803.21,"body":"the point where you need to take"},{"speaker":"Chris Dy","startTime":1803.21,"endTime":1805.4,"body":"it. And that's where you're"},{"speaker":"Chris Dy","startTime":1803.21,"endTime":1805.4,"body":"going to get into trouble with"},{"speaker":"Chris Dy","startTime":1805.4,"endTime":1808.28,"body":"those vessels. Now, I inevitably"},{"speaker":"Chris Dy","startTime":1805.4,"endTime":1808.28,"body":"end up seeing those vessels in"},{"speaker":"Chris Dy","startTime":1808.28,"endTime":1811.64,"body":"more detail once I you know, as"},{"speaker":"Chris Dy","startTime":1808.28,"endTime":1811.64,"body":"part of my surgery will release"},{"speaker":"Chris Dy","startTime":1811.64,"endTime":1815.0,"body":"the service to find the median"},{"speaker":"Chris Dy","startTime":1811.64,"endTime":1815.0,"body":"nerve and keep it safe and out"},{"speaker":"Chris Dy","startTime":1815.0,"endTime":1817.43,"body":"of the way. So, when I'm doing"},{"speaker":"Chris Dy","startTime":1815.0,"endTime":1817.43,"body":"that, I want to make sure it's"},{"speaker":"Chris Dy","startTime":1817.43,"endTime":1819.77,"body":"not hanging up there. But those"},{"speaker":"Chris Dy","startTime":1817.43,"endTime":1819.77,"body":"are always the vessels that once"},{"speaker":"Chris Dy","startTime":1819.77,"endTime":1824.48,"body":"you get into it, I sigh I get"},{"speaker":"Chris Dy","startTime":1819.77,"endTime":1824.48,"body":"out the bipolar. But I'd rather"},{"speaker":"Chris Dy","startTime":1824.48,"endTime":1825.38,"body":"stay away from them."},{"speaker":"Charles Goldfarb","startTime":1826.01,"endTime":1829.43,"body":"Yeah, and they"},{"speaker":"Charles Goldfarb","startTime":1826.01,"endTime":1829.43,"body":"do vary. And let me apologize,"},{"speaker":"Charles Goldfarb","startTime":1829.43,"endTime":1831.71,"body":"guys, I'm going to correct you"},{"speaker":"Charles Goldfarb","startTime":1829.43,"endTime":1831.71,"body":"is this superior ulnar"},{"speaker":"Charles Goldfarb","startTime":1831.71,"endTime":1836.06,"body":"collateral artery, that pierces"},{"speaker":"Charles Goldfarb","startTime":1831.71,"endTime":1836.06,"body":"the intermuscular septum that"},{"speaker":"Charles Goldfarb","startTime":1836.06,"endTime":1839.54,"body":"does provide vascularity to the"},{"speaker":"Charles Goldfarb","startTime":1836.06,"endTime":1839.54,"body":"nerve. So I do try to protect"},{"speaker":"Charles Goldfarb","startTime":1839.54,"endTime":1842.9,"body":"that vessel as i transpose the"},{"speaker":"Charles Goldfarb","startTime":1839.54,"endTime":1842.9,"body":"nerve. But like you There are"},{"speaker":"Charles Goldfarb","startTime":1842.9,"endTime":1846.89,"body":"times when I get out the bovie"},{"speaker":"Charles Goldfarb","startTime":1842.9,"endTime":1846.89,"body":"and turn it and turn it up to"},{"speaker":"Charles Goldfarb","startTime":1846.89,"endTime":1850.19,"body":"deal with bleeding in that area,"},{"speaker":"Charles Goldfarb","startTime":1846.89,"endTime":1850.19,"body":"because it can bleed for sure."},{"speaker":"Chris Dy","startTime":1850.43,"endTime":1852.44,"body":"Yeah, and with those"},{"speaker":"Chris Dy","startTime":1850.43,"endTime":1852.44,"body":"kind of vessels, I'd rather get"},{"speaker":"Chris Dy","startTime":1852.44,"endTime":1855.17,"body":"ahead of I'd rather get them"},{"speaker":"Chris Dy","startTime":1852.44,"endTime":1855.17,"body":"before they get me I think the"},{"speaker":"Chris Dy","startTime":1855.17,"endTime":1858.32,"body":"points will take in about"},{"speaker":"Chris Dy","startTime":1855.17,"endTime":1858.32,"body":"wanting to preserve vasculature"},{"speaker":"Chris Dy","startTime":1858.32,"endTime":1862.04,"body":"to the ulnar nerve if you're"},{"speaker":"Chris Dy","startTime":1858.32,"endTime":1862.04,"body":"doing a transposition. But you"},{"speaker":"Chris Dy","startTime":1862.04,"endTime":1864.32,"body":"know, there's obviously some"},{"speaker":"Chris Dy","startTime":1862.04,"endTime":1864.32,"body":"more work that's been done"},{"speaker":"Chris Dy","startTime":1864.71,"endTime":1867.41,"body":"recently demonstrated, you can"},{"speaker":"Chris Dy","startTime":1864.71,"endTime":1867.41,"body":"take a substantial amount of"},{"speaker":"Chris Dy","startTime":1867.41,"endTime":1870.11,"body":"that extrinsic blood supply to"},{"speaker":"Chris Dy","startTime":1867.41,"endTime":1870.11,"body":"the ulnar nerve, and it can"},{"speaker":"Chris Dy","startTime":1870.11,"endTime":1874.7,"body":"survive even without a robust"},{"speaker":"Chris Dy","startTime":1870.11,"endTime":1874.7,"body":"extrinsic supply for a long"},{"speaker":"Chris Dy","startTime":1874.7,"endTime":1878.48,"body":"segment. So I think that that"},{"speaker":"Chris Dy","startTime":1874.7,"endTime":1878.48,"body":"is, you know, the literature is"},{"speaker":"Chris Dy","startTime":1878.48,"endTime":1883.55,"body":"such where you can make it fit"},{"speaker":"Chris Dy","startTime":1878.48,"endTime":1883.55,"body":"to whatever your preferences in"},{"speaker":"Chris Dy","startTime":1883.55,"endTime":1886.76,"body":"perhaps we can get into the"},{"speaker":"Chris Dy","startTime":1883.55,"endTime":1886.76,"body":"technical details about ulnar"},{"speaker":"Chris Dy","startTime":1886.76,"endTime":1888.92,"body":"nerve transposition, which"},{"speaker":"Chris Dy","startTime":1886.76,"endTime":1888.92,"body":"probably should do subcutaneous"},{"speaker":"Chris Dy","startTime":1888.92,"endTime":1891.65,"body":"and sub muscular. I know that we"},{"speaker":"Chris Dy","startTime":1888.92,"endTime":1891.65,"body":"have different ways how each of"},{"speaker":"Chris Dy","startTime":1891.65,"endTime":1894.68,"body":"us does a subcutaneous so that"},{"speaker":"Chris Dy","startTime":1891.65,"endTime":1894.68,"body":"would be good to dive into the"},{"speaker":"Chris Dy","startTime":1894.68,"endTime":1895.28,"body":"next episode."},{"speaker":"Charles Goldfarb","startTime":1895.64,"endTime":1897.14,"body":"Yeah, that"},{"speaker":"Charles Goldfarb","startTime":1895.64,"endTime":1897.14,"body":"would be fun. What's been fun"},{"speaker":"Charles Goldfarb","startTime":1897.14,"endTime":1900.32,"body":"about the Instagram Live is I"},{"speaker":"Charles Goldfarb","startTime":1897.14,"endTime":1900.32,"body":"see people come and go, like,"},{"speaker":"Charles Goldfarb","startTime":1900.5,"endTime":1904.28,"body":"Dr. Tarabadkar and Dr. Galvez"},{"speaker":"Charles Goldfarb","startTime":1900.5,"endTime":1904.28,"body":"and, and I don't know, whether"},{"speaker":"Charles Goldfarb","startTime":1904.28,"endTime":1906.26,"body":"they're like in the middle of a"},{"speaker":"Charles Goldfarb","startTime":1904.28,"endTime":1906.26,"body":"busy clinic, and they just"},{"speaker":"Charles Goldfarb","startTime":1906.26,"endTime":1909.29,"body":"flipped open Instagram, and they"},{"speaker":"Charles Goldfarb","startTime":1906.26,"endTime":1909.29,"body":"like, what's this going on? Or"},{"speaker":"Charles Goldfarb","startTime":1909.29,"endTime":1911.51,"body":"if they turned us on? They're"},{"speaker":"Charles Goldfarb","startTime":1909.29,"endTime":1911.51,"body":"like, Oh, God, I don't want to"},{"speaker":"Charles Goldfarb","startTime":1911.51,"endTime":1913.7,"body":"hear Dy and Goldfarb again. I"},{"speaker":"Charles Goldfarb","startTime":1911.51,"endTime":1913.7,"body":"gotta get out of here."},{"speaker":"Chris Dy","startTime":1914.39,"endTime":1916.22,"body":"I think they all"},{"speaker":"Chris Dy","startTime":1914.39,"endTime":1916.22,"body":"recognize what's going on here."},{"speaker":"Chris Dy","startTime":1916.22,"endTime":1919.04,"body":"And they cannot be a part of it."},{"speaker":"Chris Dy","startTime":1916.22,"endTime":1919.04,"body":"You're either with us or against"},{"speaker":"Chris Dy","startTime":1919.04,"endTime":1924.74,"body":"us. So thank you to our hand"},{"speaker":"Chris Dy","startTime":1919.04,"endTime":1924.74,"body":"surgery fellow from Chile. Who"},{"speaker":"Chris Dy","startTime":1924.74,"endTime":1927.14,"body":"has a question. So let's wrap up"},{"speaker":"Chris Dy","startTime":1924.74,"endTime":1927.14,"body":"with a question."},{"speaker":"Charles Goldfarb","startTime":1927.26,"endTime":1927.65,"body":"Perfect."},{"speaker":"Chris Dy","startTime":1928.07,"endTime":1930.56,"body":"Wants to ask when do"},{"speaker":"Chris Dy","startTime":1928.07,"endTime":1930.56,"body":"you decide to release or"},{"speaker":"Chris Dy","startTime":1930.56,"endTime":1933.56,"body":"transpose an ulnar nerve? Now"},{"speaker":"Chris Dy","startTime":1930.56,"endTime":1933.56,"body":"the easy thing is to say go"},{"speaker":"Chris Dy","startTime":1933.56,"endTime":1939.17,"body":"listen to episodes two, three"},{"speaker":"Chris Dy","startTime":1933.56,"endTime":1939.17,"body":"and four. For me, oh, Niel's in"},{"speaker":"Chris Dy","startTime":1939.17,"endTime":1942.5,"body":"clinic by the way. And so for me"},{"speaker":"Chris Dy","startTime":1939.17,"endTime":1942.5,"body":"an in situ decompression-"},{"speaker":"Charles Goldfarb","startTime":1942.5,"endTime":1944.66,"body":"Busy clinic,"},{"speaker":"Charles Goldfarb","startTime":1942.5,"endTime":1944.66,"body":"busy clinic Tarababkar."},{"speaker":"Chris Dy","startTime":1944.69,"endTime":1946.76,"body":"Hey man, you know,"},{"speaker":"Chris Dy","startTime":1944.69,"endTime":1946.76,"body":"those those people in private"},{"speaker":"Chris Dy","startTime":1946.76,"endTime":1949.07,"body":"practice, he's probably got 80"},{"speaker":"Chris Dy","startTime":1946.76,"endTime":1949.07,"body":"people lined up to see him right"},{"speaker":"Chris Dy","startTime":1949.07,"endTime":1951.8,"body":"now. And they're all probably"},{"speaker":"Chris Dy","startTime":1949.07,"endTime":1951.8,"body":"listening to us talk about him,"},{"speaker":"Chris Dy","startTime":1951.8,"endTime":1955.79,"body":"he's probably walking in and out"},{"speaker":"Chris Dy","startTime":1951.8,"endTime":1955.79,"body":"of rooms. Anyway, so for me an"},{"speaker":"Chris Dy","startTime":1955.79,"endTime":1959.0,"body":"in situ decompression is a"},{"speaker":"Chris Dy","startTime":1955.79,"endTime":1959.0,"body":"patient who does not have any"},{"speaker":"Chris Dy","startTime":1959.0,"endTime":1962.81,"body":"advanced motor or sensory"},{"speaker":"Chris Dy","startTime":1959.0,"endTime":1962.81,"body":"findings on clinical exam, so no"},{"speaker":"Chris Dy","startTime":1962.81,"endTime":1966.8,"body":"atrophy, no elevated two point"},{"speaker":"Chris Dy","startTime":1962.81,"endTime":1966.8,"body":"discrimination. They've gotten a"},{"speaker":"Chris Dy","startTime":1966.8,"endTime":1969.98,"body":"nerve study that does not"},{"speaker":"Chris Dy","startTime":1966.8,"endTime":1969.98,"body":"demonstrate any EMG findings in"},{"speaker":"Chris Dy","startTime":1969.98,"endTime":1974.3,"body":"terms of denervation and does"},{"speaker":"Chris Dy","startTime":1969.98,"endTime":1974.3,"body":"not have any, I will say notable"},{"speaker":"Chris Dy","startTime":1974.33,"endTime":1977.81,"body":"loss in motor amplitudes on the"},{"speaker":"Chris Dy","startTime":1974.33,"endTime":1977.81,"body":"motor portion of the study, they"},{"speaker":"Chris Dy","startTime":1977.81,"endTime":1980.84,"body":"typically will have a conduction"},{"speaker":"Chris Dy","startTime":1977.81,"endTime":1980.84,"body":"velocity drop across the elbow."},{"speaker":"Chris Dy","startTime":1981.41,"endTime":1983.69,"body":"And then I will get an"},{"speaker":"Chris Dy","startTime":1981.41,"endTime":1983.69,"body":"ultrasound at the same time as"},{"speaker":"Chris Dy","startTime":1983.69,"endTime":1986.63,"body":"that nerve study to demonstrate"},{"speaker":"Chris Dy","startTime":1983.69,"endTime":1986.63,"body":"that it does not subluxation."},{"speaker":"Chris Dy","startTime":1986.69,"endTime":1988.79,"body":"And again, mainly that's so I"},{"speaker":"Chris Dy","startTime":1986.69,"endTime":1988.79,"body":"can counsel the patient about"},{"speaker":"Chris Dy","startTime":1988.79,"endTime":1992.24,"body":"what to expect in terms of which"},{"speaker":"Chris Dy","startTime":1988.79,"endTime":1992.24,"body":"surgery and the recovery. What"},{"speaker":"Chris Dy","startTime":1992.24,"endTime":1992.75,"body":"about you, Chuck?"},{"speaker":"Charles Goldfarb","startTime":1993.56,"endTime":1997.28,"body":"Yeah, that is"},{"speaker":"Charles Goldfarb","startTime":1993.56,"endTime":1997.28,"body":"a very detailed and good kind of"},{"speaker":"Charles Goldfarb","startTime":1997.28,"endTime":2000.01,"body":"plan, I do think each of us have"},{"speaker":"Charles Goldfarb","startTime":1997.28,"endTime":2000.01,"body":"to have our own indication. So"},{"speaker":"Charles Goldfarb","startTime":2000.01,"endTime":2003.16,"body":"that will be a little different"},{"speaker":"Charles Goldfarb","startTime":2000.01,"endTime":2003.16,"body":"for each of us. I agree with a"},{"speaker":"Charles Goldfarb","startTime":2003.16,"endTime":2005.56,"body":"nerve study. So if a patient"},{"speaker":"Charles Goldfarb","startTime":2003.16,"endTime":2005.56,"body":"despite the fact that the"},{"speaker":"Charles Goldfarb","startTime":2005.56,"endTime":2009.88,"body":"literature says and this is"},{"speaker":"Charles Goldfarb","startTime":2005.56,"endTime":2009.88,"body":"neurosurgery, early literature,"},{"speaker":"Charles Goldfarb","startTime":2009.91,"endTime":2013.48,"body":"the neurosurgery literature says"},{"speaker":"Charles Goldfarb","startTime":2009.91,"endTime":2013.48,"body":"that you can decompress"},{"speaker":"Charles Goldfarb","startTime":2013.48,"endTime":2018.67,"body":"successfully with an advanced"},{"speaker":"Charles Goldfarb","startTime":2013.48,"endTime":2018.67,"body":"digital nerve that has caused"},{"speaker":"Charles Goldfarb","startTime":2018.67,"endTime":2023.02,"body":"some EMG findings. But my"},{"speaker":"Charles Goldfarb","startTime":2018.67,"endTime":2023.02,"body":"personal belief is early cubital"},{"speaker":"Charles Goldfarb","startTime":2023.02,"endTime":2026.11,"body":"tunnel that is failed"},{"speaker":"Charles Goldfarb","startTime":2023.02,"endTime":2026.11,"body":"conservative treatment with an"},{"speaker":"Charles Goldfarb","startTime":2026.11,"endTime":2030.94,"body":"absolutely stable nerve is the"},{"speaker":"Charles Goldfarb","startTime":2026.11,"endTime":2030.94,"body":"perfect indication. Now, do you"},{"speaker":"Charles Goldfarb","startTime":2030.94,"endTime":2034.09,"body":"have to have an ultrasound to"},{"speaker":"Charles Goldfarb","startTime":2030.94,"endTime":2034.09,"body":"assess nerve stability? I would"},{"speaker":"Charles Goldfarb","startTime":2034.09,"endTime":2038.02,"body":"say no. And maybe I'm"},{"speaker":"Charles Goldfarb","startTime":2034.09,"endTime":2038.02,"body":"overestimating my abilities. And"},{"speaker":"Charles Goldfarb","startTime":2038.02,"endTime":2040.48,"body":"maybe that's a study Chris and I"},{"speaker":"Charles Goldfarb","startTime":2038.02,"endTime":2040.48,"body":"need to do we've talked about"},{"speaker":"Charles Goldfarb","startTime":2040.48,"endTime":2040.66,"body":"it."},{"speaker":"Chris Dy","startTime":2041.23,"endTime":2042.19,"body":"Already been done."},{"speaker":"Charles Goldfarb","startTime":2042.88,"endTime":2045.76,"body":"To assess my"},{"speaker":"Charles Goldfarb","startTime":2042.88,"endTime":2045.76,"body":"no one's assessed my ability."},{"speaker":"Chris Dy","startTime":2046.09,"endTime":2048.94,"body":"Maybe not your"},{"speaker":"Chris Dy","startTime":2046.09,"endTime":2048.94,"body":"ability, but the Royal ability."},{"speaker":"Chris Dy","startTime":2048.94,"endTime":2050.2,"body":"Somebody's already done that."},{"speaker":"Charles Goldfarb","startTime":2050.23,"endTime":2052.24,"body":"And is it and"},{"speaker":"Charles Goldfarb","startTime":2050.23,"endTime":2052.24,"body":"what were the findings?"},{"speaker":"Chris Dy","startTime":2052.87,"endTime":2056.32,"body":"We are only about 30%"},{"speaker":"Chris Dy","startTime":2052.87,"endTime":2056.32,"body":"accurate when we assess things"},{"speaker":"Chris Dy","startTime":2056.32,"endTime":2060.13,"body":"before surgery, and an"},{"speaker":"Chris Dy","startTime":2056.32,"endTime":2060.13,"body":"ultrasound is over 95% accurate"},{"speaker":"Chris Dy","startTime":2060.13,"endTime":2062.47,"body":"compared to interoperative"},{"speaker":"Chris Dy","startTime":2060.13,"endTime":2062.47,"body":"inspection after a"},{"speaker":"Chris Dy","startTime":2062.47,"endTime":2063.16,"body":"decompression."},{"speaker":"Charles Goldfarb","startTime":2063.58,"endTime":2064.69,"body":"Let me tell"},{"speaker":"Charles Goldfarb","startTime":2063.58,"endTime":2064.69,"body":"you how I do."},{"speaker":"Chris Dy","startTime":2066.46,"endTime":2067.66,"body":"Evidence be damned."},{"speaker":"Charles Goldfarb","startTime":2069.58,"endTime":2071.17,"body":"Here's how I"},{"speaker":"Charles Goldfarb","startTime":2069.58,"endTime":2071.17,"body":"do it for those of you who might"},{"speaker":"Charles Goldfarb","startTime":2071.17,"endTime":2074.62,"body":"not have access to ultrasound,"},{"speaker":"Charles Goldfarb","startTime":2071.17,"endTime":2074.62,"body":"how about that. So I am"},{"speaker":"Charles Goldfarb","startTime":2074.62,"endTime":2077.5,"body":"increasingly using ultrasound By"},{"speaker":"Charles Goldfarb","startTime":2074.62,"endTime":2077.5,"body":"the way, but I what I do is I"},{"speaker":"Charles Goldfarb","startTime":2077.5,"endTime":2082.15,"body":"flex the elbow all the way up. I"},{"speaker":"Charles Goldfarb","startTime":2077.5,"endTime":2082.15,"body":"put my finger on the most poster"},{"speaker":"Charles Goldfarb","startTime":2082.15,"endTime":2085.81,"body":"aspect of the medial epicondyle"},{"speaker":"Charles Goldfarb","startTime":2082.15,"endTime":2085.81,"body":"and I try to extend the elbow."},{"speaker":"Charles Goldfarb","startTime":2086.08,"endTime":2089.68,"body":"If the nerve is perched that is"},{"speaker":"Charles Goldfarb","startTime":2086.08,"endTime":2089.68,"body":"lying on the medial epicondyle,"},{"speaker":"Charles Goldfarb","startTime":2089.77,"endTime":2093.46,"body":"I'll feel it under my finger. If"},{"speaker":"Charles Goldfarb","startTime":2089.77,"endTime":2093.46,"body":"it's anterior to me, so maybe"},{"speaker":"Charles Goldfarb","startTime":2093.46,"endTime":2097.51,"body":"not even truly subluxated but"},{"speaker":"Charles Goldfarb","startTime":2093.46,"endTime":2097.51,"body":"anterior to my posterior finger,"},{"speaker":"Charles Goldfarb","startTime":2097.63,"endTime":2102.13,"body":"then I trap it anteriorly and I"},{"speaker":"Charles Goldfarb","startTime":2097.63,"endTime":2102.13,"body":"feel it So I feel comfortable"},{"speaker":"Charles Goldfarb","startTime":2102.13,"endTime":2103.75,"body":"with my abilities. But I"},{"speaker":"Charles Goldfarb","startTime":2102.13,"endTime":2103.75,"body":"wouldn't argue with the"},{"speaker":"Charles Goldfarb","startTime":2103.75,"endTime":2106.03,"body":"literature. If we're not good at"},{"speaker":"Charles Goldfarb","startTime":2103.75,"endTime":2106.03,"body":"it. We're not good at it. And"},{"speaker":"Charles Goldfarb","startTime":2106.03,"endTime":2109.21,"body":"that's part of the problem. It's"},{"speaker":"Charles Goldfarb","startTime":2106.03,"endTime":2109.21,"body":"why you always have to be ready"},{"speaker":"Charles Goldfarb","startTime":2109.21,"endTime":2112.93,"body":"to transpose in case your"},{"speaker":"Charles Goldfarb","startTime":2109.21,"endTime":2112.93,"body":"decompression creates an or"},{"speaker":"Charles Goldfarb","startTime":2112.96,"endTime":2114.55,"body":"magnifies an unstable nerve."},{"speaker":"Chris Dy","startTime":2115.12,"endTime":2117.94,"body":"Yeah, and I think that"},{"speaker":"Chris Dy","startTime":2115.12,"endTime":2117.94,"body":"one thing to note is that"},{"speaker":"Chris Dy","startTime":2117.97,"endTime":2121.63,"body":"subluxation and instability is a"},{"speaker":"Chris Dy","startTime":2117.97,"endTime":2121.63,"body":"physiologic variant. You know,"},{"speaker":"Chris Dy","startTime":2121.63,"endTime":2124.12,"body":"some people have that, you know,"},{"speaker":"Chris Dy","startTime":2121.63,"endTime":2124.12,"body":"and some of the studies out of"},{"speaker":"Chris Dy","startTime":2124.12,"endTime":2127.12,"body":"here, you know, one of Ryan's"},{"speaker":"Chris Dy","startTime":2124.12,"endTime":2127.12,"body":"paper shows it's about 30%, or"},{"speaker":"Chris Dy","startTime":2127.36,"endTime":2130.06,"body":"1/3 of people have that, at"},{"speaker":"Chris Dy","startTime":2127.36,"endTime":2130.06,"body":"least in our population here in"},{"speaker":"Chris Dy","startTime":2130.06,"endTime":2133.48,"body":"St. Louis. So that's something"},{"speaker":"Chris Dy","startTime":2130.06,"endTime":2133.48,"body":"to keep in mind and clearly will"},{"speaker":"Chris Dy","startTime":2133.48,"endTime":2138.58,"body":"have implications on how you"},{"speaker":"Chris Dy","startTime":2133.48,"endTime":2138.58,"body":"plan surgery. So this was fun. I"},{"speaker":"Chris Dy","startTime":2138.58,"endTime":2141.7,"body":"enjoyed it. Thank you to the"},{"speaker":"Chris Dy","startTime":2138.58,"endTime":2141.7,"body":"five people who have hung out"},{"speaker":"Chris Dy","startTime":2141.7,"endTime":2146.74,"body":"the whole time. Live we have had"},{"speaker":"Chris Dy","startTime":2141.7,"endTime":2146.74,"body":"a lot of people come and go, but"},{"speaker":"Chris Dy","startTime":2146.86,"endTime":2150.88,"body":"this will be archived and you"},{"speaker":"Chris Dy","startTime":2146.86,"endTime":2150.88,"body":"know, we'll we'll make sure to"},{"speaker":"Chris Dy","startTime":2150.88,"endTime":2153.37,"body":"save it for everybody as well as"},{"speaker":"Chris Dy","startTime":2150.88,"endTime":2153.37,"body":"the podcast episode."},{"speaker":"Charles Goldfarb","startTime":2153.88,"endTime":2154.21,"body":"Perfect."},{"speaker":"Chris Dy","startTime":2154.21,"endTime":2157.57,"body":"So one more I saw"},{"speaker":"Chris Dy","startTime":2154.21,"endTime":2157.57,"body":"here. Sam, however accurate the"},{"speaker":"Chris Dy","startTime":2157.57,"endTime":2159.97,"body":"ultrasound I feel like I really"},{"speaker":"Chris Dy","startTime":2157.57,"endTime":2159.97,"body":"care about the stability of the"},{"speaker":"Chris Dy","startTime":2159.97,"endTime":2162.85,"body":"in situ released nerve, not the"},{"speaker":"Chris Dy","startTime":2159.97,"endTime":2162.85,"body":"pre-op nerve. Amen. I agree with"},{"speaker":"Chris Dy","startTime":2162.85,"endTime":2164.41,"body":"you on that. That you always got"},{"speaker":"Chris Dy","startTime":2162.85,"endTime":2164.41,"body":"to check."},{"speaker":"Charles Goldfarb","startTime":2164.56,"endTime":2166.99,"body":"That is very"},{"speaker":"Charles Goldfarb","startTime":2164.56,"endTime":2166.99,"body":"true. Alright, have a great day."},{"speaker":"Charles Goldfarb","startTime":2166.99,"endTime":2170.05,"body":"Good to see you. This was fun,"},{"speaker":"Charles Goldfarb","startTime":2166.99,"endTime":2170.05,"body":"with Instagram, contributing to"},{"speaker":"Charles Goldfarb","startTime":2170.05,"endTime":2170.83,"body":"the craziness."},{"speaker":"Chris Dy","startTime":2171.58,"endTime":2172.69,"body":"Alright, have a"},{"speaker":"Chris Dy","startTime":2171.58,"endTime":2172.69,"body":"wonderful day."},{"speaker":"Charles Goldfarb","startTime":2173.71,"endTime":2175.72,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2173.71,"endTime":2175.72,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2175.72,"endTime":2176.23,"body":"real soon."},{"speaker":"Chris Dy","startTime":2176.5,"endTime":2179.02,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2176.5,"endTime":2179.02,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2179.26,"endTime":2181.42,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2179.26,"endTime":2181.42,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2181.78,"endTime":2184.63,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2181.78,"endTime":2184.63,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2184.78,"endTime":2188.17,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2184.78,"endTime":2188.17,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2188.17,"endTime":2191.95,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2188.17,"endTime":2191.95,"body":"hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2192.58,"endTime":2194.74,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2192.58,"endTime":2194.74,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2194.74,"endTime":2195.82,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2195.85,"endTime":2198.07,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2195.85,"endTime":2198.07,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2198.07,"endTime":2198.49,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2198.88,"endTime":2201.16,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2198.88,"endTime":2201.16,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2201.16,"endTime":2205.12,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2201.16,"endTime":2205.12,"body":"upper hand. Come back next time"}]}