{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":1.8,"endTime":2.73,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":1.8,"endTime":2.73,"body":"Chris."},{"speaker":"Chris Dy","startTime":3.0,"endTime":4.23,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":3.0,"endTime":4.23,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":4.5,"endTime":6.72,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":4.5,"endTime":6.72,"body":"really well. It's a fine morning"},{"speaker":"Charles Goldfarb","startTime":6.72,"endTime":7.83,"body":"here in St. Louis."},{"speaker":"Chris Dy","startTime":8.039,"endTime":11.519,"body":"It is it is a good"},{"speaker":"Chris Dy","startTime":8.039,"endTime":11.519,"body":"one. It's so good to be back. I"},{"speaker":"Chris Dy","startTime":12.059,"endTime":14.999,"body":"feel like we haven't recorded in"},{"speaker":"Chris Dy","startTime":12.059,"endTime":14.999,"body":"a while. This my first episode"},{"speaker":"Chris Dy","startTime":14.999,"endTime":17.369,"body":"back since coming from Houston."},{"speaker":"Chris Dy","startTime":14.999,"endTime":17.369,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":17.4,"endTime":19.8,"body":"I know. I kind"},{"speaker":"Charles Goldfarb","startTime":17.4,"endTime":19.8,"body":"of have missed it. Maybe missed"},{"speaker":"Charles Goldfarb","startTime":19.8,"endTime":20.91,"body":"you even a little bit."},{"speaker":"Chris Dy","startTime":21.149,"endTime":23.129,"body":"Yeah, right, right."},{"speaker":"Chris Dy","startTime":21.149,"endTime":23.129,"body":"Sure. You would have called if"},{"speaker":"Chris Dy","startTime":23.129,"endTime":25.679,"body":"you actually missed me, you"},{"speaker":"Chris Dy","startTime":23.129,"endTime":25.679,"body":"probably just missed the podcast"},{"speaker":"Chris Dy","startTime":26.069,"endTime":26.999,"body":"experience."},{"speaker":"Charles Goldfarb","startTime":27.27,"endTime":29.61,"body":"I thought"},{"speaker":"Charles Goldfarb","startTime":27.27,"endTime":29.61,"body":"about you all the time. Right."},{"speaker":"Chris Dy","startTime":29.64,"endTime":32.94,"body":"Right. Well, that was"},{"speaker":"Chris Dy","startTime":29.64,"endTime":32.94,"body":"really great having you know, we"},{"speaker":"Chris Dy","startTime":32.94,"endTime":36.0,"body":"had a couple of guests recently,"},{"speaker":"Chris Dy","startTime":32.94,"endTime":36.0,"body":"we had Macy, and Jeff and Steve."},{"speaker":"Chris Dy","startTime":36.0,"endTime":40.32,"body":"And we hope that those will be"},{"speaker":"Chris Dy","startTime":36.0,"endTime":40.32,"body":"recurring episodes or, you know,"},{"speaker":"Chris Dy","startTime":40.77,"endTime":43.5,"body":"types of episodes. And we hope"},{"speaker":"Chris Dy","startTime":40.77,"endTime":43.5,"body":"that everybody enjoyed them."},{"speaker":"Chris Dy","startTime":44.43,"endTime":46.95,"body":"Chuck, we have a couple of great"},{"speaker":"Chris Dy","startTime":44.43,"endTime":46.95,"body":"reviews that were recently"},{"speaker":"Chris Dy","startTime":46.95,"endTime":51.99,"body":"posted. Here's the first one."},{"speaker":"Chris Dy","startTime":46.95,"endTime":51.99,"body":"It's from a listener named"},{"speaker":"Chris Dy","startTime":51.99,"endTime":55.44,"body":"Andrew. It's five star review."},{"speaker":"Chris Dy","startTime":51.99,"endTime":55.44,"body":"Only kind you're allowed to"},{"speaker":"Chris Dy","startTime":55.44,"endTime":60.33,"body":"leave. informative and fun is"},{"speaker":"Chris Dy","startTime":55.44,"endTime":60.33,"body":"the subject line. Perfect. Dr."},{"speaker":"Chris Dy","startTime":60.33,"endTime":63.96,"body":"Goldfarb, and dr. D, aka Chuck"},{"speaker":"Chris Dy","startTime":60.33,"endTime":63.96,"body":"and Chris, please, thank you for"},{"speaker":"Chris Dy","startTime":63.96,"endTime":66.75,"body":"your awesome podcast. It's both"},{"speaker":"Chris Dy","startTime":63.96,"endTime":66.75,"body":"educational and fun. I"},{"speaker":"Chris Dy","startTime":66.75,"endTime":69.51,"body":"appreciate that you cover topics"},{"speaker":"Chris Dy","startTime":66.75,"endTime":69.51,"body":"from patient evaluation to"},{"speaker":"Chris Dy","startTime":69.54,"endTime":72.42,"body":"operative pearls to practice"},{"speaker":"Chris Dy","startTime":69.54,"endTime":72.42,"body":"development. Thank you for your"},{"speaker":"Chris Dy","startTime":72.42,"endTime":75.93,"body":"time and effort. Andrew, thank"},{"speaker":"Chris Dy","startTime":72.42,"endTime":75.93,"body":"you for leaving that review. We"},{"speaker":"Chris Dy","startTime":75.93,"endTime":78.81,"body":"certainly appreciate it. And we"},{"speaker":"Chris Dy","startTime":75.93,"endTime":78.81,"body":"love our listener community. And"},{"speaker":"Chris Dy","startTime":78.81,"endTime":82.35,"body":"thank you to all of you for"},{"speaker":"Chris Dy","startTime":78.81,"endTime":82.35,"body":"going on the iTunes page,"},{"speaker":"Chris Dy","startTime":82.44,"endTime":85.08,"body":"clicking five stars leaving a"},{"speaker":"Chris Dy","startTime":82.44,"endTime":85.08,"body":"review and maybe leaving a"},{"speaker":"Chris Dy","startTime":85.08,"endTime":85.95,"body":"question for Chuck."},{"speaker":"Charles Goldfarb","startTime":86.76,"endTime":88.35,"body":"I love that."},{"speaker":"Charles Goldfarb","startTime":86.76,"endTime":88.35,"body":"Thank you. Thank you for"},{"speaker":"Charles Goldfarb","startTime":88.35,"endTime":91.02,"body":"sharing. And you know, it is"},{"speaker":"Charles Goldfarb","startTime":88.35,"endTime":91.02,"body":"interesting whenever I think"},{"speaker":"Charles Goldfarb","startTime":91.02,"endTime":93.96,"body":"that I mean, I'm proud of our"},{"speaker":"Charles Goldfarb","startTime":91.02,"endTime":93.96,"body":"listeners, you know, we have a"},{"speaker":"Charles Goldfarb","startTime":93.96,"endTime":97.17,"body":"large number of listeners that"},{"speaker":"Charles Goldfarb","startTime":93.96,"endTime":97.17,"body":"does seem to be continuing to"},{"speaker":"Charles Goldfarb","startTime":97.17,"endTime":101.4,"body":"inch up. And there are a lot you"},{"speaker":"Charles Goldfarb","startTime":97.17,"endTime":101.4,"body":"know, it's always interesting me"},{"speaker":"Charles Goldfarb","startTime":101.4,"endTime":103.98,"body":"that there are a number of hand"},{"speaker":"Charles Goldfarb","startTime":101.4,"endTime":103.98,"body":"surgeons, I would recently went"},{"speaker":"Charles Goldfarb","startTime":103.98,"endTime":107.25,"body":"to a fellowship reunion. And I"},{"speaker":"Charles Goldfarb","startTime":103.98,"endTime":107.25,"body":"would say three quarters of the"},{"speaker":"Charles Goldfarb","startTime":107.25,"endTime":111.24,"body":"room had no idea I did a"},{"speaker":"Charles Goldfarb","startTime":107.25,"endTime":111.24,"body":"podcast, which Why would they I"},{"speaker":"Charles Goldfarb","startTime":111.24,"endTime":113.82,"body":"guess if they're not podcast"},{"speaker":"Charles Goldfarb","startTime":111.24,"endTime":113.82,"body":"people and I they're all good"},{"speaker":"Charles Goldfarb","startTime":113.82,"endTime":116.82,"body":"friends, but I don't see them on"},{"speaker":"Charles Goldfarb","startTime":113.82,"endTime":116.82,"body":"a daily basis. So it's super"},{"speaker":"Charles Goldfarb","startTime":116.82,"endTime":120.15,"body":"interesting. So you know, if"},{"speaker":"Charles Goldfarb","startTime":116.82,"endTime":120.15,"body":"this is useful, please tell a"},{"speaker":"Charles Goldfarb","startTime":120.15,"endTime":120.54,"body":"friend."},{"speaker":"Chris Dy","startTime":120.96,"endTime":124.11,"body":"So wait, hold on, what"},{"speaker":"Chris Dy","startTime":120.96,"endTime":124.11,"body":"about the quarter that did know"},{"speaker":"Chris Dy","startTime":124.11,"endTime":125.43,"body":"that you did a podcast,"},{"speaker":"Charles Goldfarb","startTime":125.7,"endTime":130.59,"body":"I knew we did"},{"speaker":"Charles Goldfarb","startTime":125.7,"endTime":130.59,"body":"a podcast and didn't necessarily"},{"speaker":"Charles Goldfarb","startTime":130.59,"endTime":133.26,"body":"listen regularly. And there was"},{"speaker":"Charles Goldfarb","startTime":130.59,"endTime":133.26,"body":"a core group of listeners who"},{"speaker":"Charles Goldfarb","startTime":133.26,"endTime":135.36,"body":"really seem to enjoy it. Listen,"},{"speaker":"Charles Goldfarb","startTime":133.26,"endTime":135.36,"body":"if"},{"speaker":"Chris Dy","startTime":135.36,"endTime":138.15,"body":"one out of four hand"},{"speaker":"Chris Dy","startTime":135.36,"endTime":138.15,"body":"surgeons read any paper that I"},{"speaker":"Chris Dy","startTime":138.15,"endTime":141.87,"body":"wrote, I'd be thrilled. So take"},{"speaker":"Chris Dy","startTime":138.15,"endTime":141.87,"body":"what we've got going here. And"},{"speaker":"Chris Dy","startTime":141.87,"endTime":143.67,"body":"hopefully we can continue to"},{"speaker":"Chris Dy","startTime":141.87,"endTime":143.67,"body":"grow it."},{"speaker":"Charles Goldfarb","startTime":143.82,"endTime":147.6,"body":"That is fair."},{"speaker":"Charles Goldfarb","startTime":143.82,"endTime":147.6,"body":"That is fair. So let's hold"},{"speaker":"Charles Goldfarb","startTime":147.6,"endTime":149.94,"body":"maybe the second review, because"},{"speaker":"Charles Goldfarb","startTime":147.6,"endTime":149.94,"body":"I don't know if I can handle too"},{"speaker":"Charles Goldfarb","startTime":149.94,"endTime":153.69,"body":"much positivity this early in"},{"speaker":"Charles Goldfarb","startTime":149.94,"endTime":153.69,"body":"the morning. And maybe you had a"},{"speaker":"Charles Goldfarb","startTime":153.69,"endTime":157.26,"body":"great idea for a recurring"},{"speaker":"Charles Goldfarb","startTime":153.69,"endTime":157.26,"body":"segment trying to give structure"},{"speaker":"Charles Goldfarb","startTime":157.26,"endTime":158.31,"body":"to our podcast."},{"speaker":"Chris Dy","startTime":158.34,"endTime":160.59,"body":"Yes, structure is"},{"speaker":"Chris Dy","startTime":158.34,"endTime":160.59,"body":"nice. I'm amazed that you and I"},{"speaker":"Chris Dy","startTime":160.59,"endTime":163.53,"body":"made it about 18 months without"},{"speaker":"Chris Dy","startTime":160.59,"endTime":163.53,"body":"structure, given our"},{"speaker":"Chris Dy","startTime":163.53,"endTime":166.68,"body":"personalities, maybe this is the"},{"speaker":"Chris Dy","startTime":163.53,"endTime":166.68,"body":"only unstructured space in our"},{"speaker":"Chris Dy","startTime":166.68,"endTime":170.67,"body":"lives. But I thought it'd be"},{"speaker":"Chris Dy","startTime":166.68,"endTime":170.67,"body":"really fun to talk about our"},{"speaker":"Chris Dy","startTime":170.67,"endTime":175.23,"body":"hardest cases, you know, of"},{"speaker":"Chris Dy","startTime":170.67,"endTime":175.23,"body":"recent memory. So what about if"},{"speaker":"Chris Dy","startTime":175.23,"endTime":179.1,"body":"we asked, you know, and also be"},{"speaker":"Chris Dy","startTime":175.23,"endTime":179.1,"body":"great if listeners wanted to"},{"speaker":"Chris Dy","startTime":179.1,"endTime":182.91,"body":"send in their hard cases. And if"},{"speaker":"Chris Dy","startTime":179.1,"endTime":182.91,"body":"there's any kind of obviously"},{"speaker":"Chris Dy","startTime":182.91,"endTime":185.28,"body":"HIPAA compliant way to talk"},{"speaker":"Chris Dy","startTime":182.91,"endTime":185.28,"body":"about it, we'd love to kind of"},{"speaker":"Chris Dy","startTime":185.28,"endTime":188.1,"body":"talk through a case. But Chuck,"},{"speaker":"Chris Dy","startTime":185.28,"endTime":188.1,"body":"have you had anything"},{"speaker":"Chris Dy","startTime":188.1,"endTime":190.56,"body":"interesting come your way or"},{"speaker":"Chris Dy","startTime":188.1,"endTime":190.56,"body":"something that became"},{"speaker":"Chris Dy","startTime":190.56,"endTime":191.13,"body":"interesting?"},{"speaker":"Charles Goldfarb","startTime":191.429,"endTime":193.109,"body":"Yeah, I"},{"speaker":"Charles Goldfarb","startTime":191.429,"endTime":193.109,"body":"thought of when we discussed"},{"speaker":"Charles Goldfarb","startTime":193.109,"endTime":197.009,"body":"this segment, I was, you know,"},{"speaker":"Charles Goldfarb","startTime":193.109,"endTime":197.009,"body":"merely thinking about cases that"},{"speaker":"Charles Goldfarb","startTime":197.009,"endTime":200.999,"body":"would be appropriate to discuss"},{"speaker":"Charles Goldfarb","startTime":197.009,"endTime":200.999,"body":"and a couple came to mind but,"},{"speaker":"Charles Goldfarb","startTime":201.269,"endTime":204.089,"body":"you know, given your interest in"},{"speaker":"Charles Goldfarb","startTime":201.269,"endTime":204.089,"body":"nerve and apparently the"},{"speaker":"Charles Goldfarb","startTime":204.089,"endTime":208.169,"body":"listeners enjoy her. I'm not"},{"speaker":"Charles Goldfarb","startTime":204.089,"endTime":208.169,"body":"really sure why. I thought a"},{"speaker":"Charles Goldfarb","startTime":208.169,"endTime":211.799,"body":"good challenging nerve case"},{"speaker":"Charles Goldfarb","startTime":208.169,"endTime":211.799,"body":"would be a nice place to start."},{"speaker":"Charles Goldfarb","startTime":212.219,"endTime":213.149,"body":"All right, well,"},{"speaker":"Chris Dy","startTime":213.659,"endTime":215.759,"body":"put me on the hot seat"},{"speaker":"Chris Dy","startTime":213.659,"endTime":215.759,"body":"here. So okay, for the"},{"speaker":"Chris Dy","startTime":215.759,"endTime":218.999,"body":"listeners, I have no idea what"},{"speaker":"Chris Dy","startTime":215.759,"endTime":218.999,"body":"Chuck is about to present. Let's"},{"speaker":"Chris Dy","startTime":218.999,"endTime":220.379,"body":"see what see what he's got."},{"speaker":"Charles Goldfarb","startTime":220.63,"endTime":223.75,"body":"Alright, so"},{"speaker":"Charles Goldfarb","startTime":220.63,"endTime":223.75,"body":"here's the background. I have a"},{"speaker":"Charles Goldfarb","startTime":223.78,"endTime":231.22,"body":"33 year old injured worker with"},{"speaker":"Charles Goldfarb","startTime":223.78,"endTime":231.22,"body":"cubital Tunnel Syndrome. I"},{"speaker":"Charles Goldfarb","startTime":231.22,"endTime":237.07,"body":"treated this patient seven years"},{"speaker":"Charles Goldfarb","startTime":231.22,"endTime":237.07,"body":"ago with a subcutaneous ulnar"},{"speaker":"Charles Goldfarb","startTime":237.07,"endTime":241.39,"body":"nerve transposition. And she did"},{"speaker":"Charles Goldfarb","startTime":237.07,"endTime":241.39,"body":"really well her preoperative"},{"speaker":"Charles Goldfarb","startTime":241.39,"endTime":245.68,"body":"symptoms at that time, were"},{"speaker":"Charles Goldfarb","startTime":241.39,"endTime":245.68,"body":"relatively classic. She had"},{"speaker":"Charles Goldfarb","startTime":245.68,"endTime":249.46,"body":"discomfort at the medial elbow,"},{"speaker":"Charles Goldfarb","startTime":245.68,"endTime":249.46,"body":"she actually had an unstable"},{"speaker":"Charles Goldfarb","startTime":249.46,"endTime":252.79,"body":"nerve and she intermittently had"},{"speaker":"Charles Goldfarb","startTime":249.46,"endTime":252.79,"body":"numbness and tingling in her"},{"speaker":"Charles Goldfarb","startTime":252.79,"endTime":255.88,"body":"fingers. She failed conservative"},{"speaker":"Charles Goldfarb","startTime":252.79,"endTime":255.88,"body":"treatment. We did a"},{"speaker":"Charles Goldfarb","startTime":255.88,"endTime":261.01,"body":"transposition she did well and"},{"speaker":"Charles Goldfarb","startTime":255.88,"endTime":261.01,"body":"disappeared. She has continued"},{"speaker":"Charles Goldfarb","startTime":261.01,"endTime":267.7,"body":"to work in the same occupation."},{"speaker":"Charles Goldfarb","startTime":261.01,"endTime":267.7,"body":"And she was at work, and she"},{"speaker":"Charles Goldfarb","startTime":267.7,"endTime":271.84,"body":"does a physical job and was"},{"speaker":"Charles Goldfarb","startTime":267.7,"endTime":271.84,"body":"struck in the anterior medial"},{"speaker":"Charles Goldfarb","startTime":271.87,"endTime":278.62,"body":"elbow about six months ago. And"},{"speaker":"Charles Goldfarb","startTime":271.87,"endTime":278.62,"body":"since that time, has had really"},{"speaker":"Charles Goldfarb","startTime":278.62,"endTime":283.69,"body":"intense nerve type pain, burning"},{"speaker":"Charles Goldfarb","startTime":278.62,"endTime":283.69,"body":"pain, primarily at the elbow,"},{"speaker":"Charles Goldfarb","startTime":283.72,"endTime":287.95,"body":"but radiating to the fingers."},{"speaker":"Charles Goldfarb","startTime":283.72,"endTime":287.95,"body":"And so that's what she presented"},{"speaker":"Charles Goldfarb","startTime":287.95,"endTime":291.7,"body":"with when she came back to the"},{"speaker":"Charles Goldfarb","startTime":287.95,"endTime":291.7,"body":"office say six months ago. So I"},{"speaker":"Charles Goldfarb","startTime":291.7,"endTime":296.05,"body":"guess I would stop there and"},{"speaker":"Charles Goldfarb","startTime":291.7,"endTime":296.05,"body":"maybe ask how you process this"},{"speaker":"Charles Goldfarb","startTime":296.05,"endTime":298.99,"body":"and what your examination might"},{"speaker":"Charles Goldfarb","startTime":296.05,"endTime":298.99,"body":"look like for a patient such as"},{"speaker":"Charles Goldfarb","startTime":298.99,"endTime":299.35,"body":"this."},{"speaker":"Chris Dy","startTime":300.33,"endTime":302.28,"body":"So I mean, this is the"},{"speaker":"Chris Dy","startTime":300.33,"endTime":302.28,"body":"thing about a subcutaneous"},{"speaker":"Chris Dy","startTime":302.28,"endTime":305.28,"body":"transposition, it takes the"},{"speaker":"Chris Dy","startTime":302.28,"endTime":305.28,"body":"subcutaneous layer nerve and"},{"speaker":"Chris Dy","startTime":305.28,"endTime":308.04,"body":"just moves it to a different"},{"speaker":"Chris Dy","startTime":305.28,"endTime":308.04,"body":"subcutaneous position, perhaps"},{"speaker":"Chris Dy","startTime":308.04,"endTime":312.33,"body":"now when it's anteriorly,"},{"speaker":"Chris Dy","startTime":308.04,"endTime":312.33,"body":"transposed, it's still it's less"},{"speaker":"Chris Dy","startTime":312.33,"endTime":315.72,"body":"vulnerable to the, to the"},{"speaker":"Chris Dy","startTime":312.33,"endTime":315.72,"body":"traction across the medial"},{"speaker":"Chris Dy","startTime":315.72,"endTime":318.9,"body":"epicondyle aisle and is less"},{"speaker":"Chris Dy","startTime":315.72,"endTime":318.9,"body":"prone to ergonomic issues as it"},{"speaker":"Chris Dy","startTime":318.9,"endTime":323.79,"body":"sits kind of where people rest"},{"speaker":"Chris Dy","startTime":318.9,"endTime":323.79,"body":"their their arm. But it's still"},{"speaker":"Chris Dy","startTime":323.79,"endTime":327.57,"body":"prone to trauma, it's not, you"},{"speaker":"Chris Dy","startTime":323.79,"endTime":327.57,"body":"know, deeply positioned, and"},{"speaker":"Chris Dy","startTime":327.57,"endTime":332.34,"body":"then the setting of something"},{"speaker":"Chris Dy","startTime":327.57,"endTime":332.34,"body":"like a known traumatic event, I"},{"speaker":"Chris Dy","startTime":332.34,"endTime":335.43,"body":"guess you have to try the things"},{"speaker":"Chris Dy","startTime":332.34,"endTime":335.43,"body":"that we all want to try first."},{"speaker":"Chris Dy","startTime":335.85,"endTime":339.6,"body":"So if it's more of a pain"},{"speaker":"Chris Dy","startTime":335.85,"endTime":339.6,"body":"component, I would consider"},{"speaker":"Chris Dy","startTime":339.6,"endTime":343.71,"body":"starting something like"},{"speaker":"Chris Dy","startTime":339.6,"endTime":343.71,"body":"gabapentin or pregabalin."},{"speaker":"Chris Dy","startTime":344.4,"endTime":347.22,"body":"Although I recognize those"},{"speaker":"Chris Dy","startTime":344.4,"endTime":347.22,"body":"medications are no fun for"},{"speaker":"Chris Dy","startTime":347.22,"endTime":351.96,"body":"patients. In a from a personal"},{"speaker":"Chris Dy","startTime":347.22,"endTime":351.96,"body":"perspective, once my mother in"},{"speaker":"Chris Dy","startTime":351.96,"endTime":355.02,"body":"law started gabapentin and I"},{"speaker":"Chris Dy","startTime":351.96,"endTime":355.02,"body":"heard about the side effects, my"},{"speaker":"Chris Dy","startTime":355.02,"endTime":357.81,"body":"honest honestly my prescribing"},{"speaker":"Chris Dy","startTime":355.02,"endTime":357.81,"body":"patterns changed a little bit."},{"speaker":"Chris Dy","startTime":358.17,"endTime":360.45,"body":"It's it's a tough medicine to"},{"speaker":"Chris Dy","startTime":358.17,"endTime":360.45,"body":"titrate up, it's a tough"},{"speaker":"Chris Dy","startTime":360.45,"endTime":362.64,"body":"medicine for a patient to"},{"speaker":"Chris Dy","startTime":360.45,"endTime":362.64,"body":"titrate some people fly through"},{"speaker":"Chris Dy","startTime":362.64,"endTime":364.53,"body":"it have no problem, but you"},{"speaker":"Chris Dy","startTime":362.64,"endTime":364.53,"body":"definitely have to tell them"},{"speaker":"Chris Dy","startTime":364.53,"endTime":368.04,"body":"about the side effects,"},{"speaker":"Chris Dy","startTime":364.53,"endTime":368.04,"body":"particularly the somnolence just"},{"speaker":"Chris Dy","startTime":368.04,"endTime":371.97,"body":"the abnormal way that they feel."},{"speaker":"Chris Dy","startTime":368.04,"endTime":371.97,"body":"pregabalin is a good"},{"speaker":"Chris Dy","startTime":371.97,"endTime":374.43,"body":"alternative. I know that you"},{"speaker":"Chris Dy","startTime":371.97,"endTime":374.43,"body":"know other people who like"},{"speaker":"Chris Dy","startTime":374.43,"endTime":377.79,"body":"nerves like Dr. McKinnon, that's"},{"speaker":"Chris Dy","startTime":374.43,"endTime":377.79,"body":"one of our go to medications. It"},{"speaker":"Chris Dy","startTime":377.79,"endTime":381.39,"body":"used to be super expensive. I"},{"speaker":"Chris Dy","startTime":377.79,"endTime":381.39,"body":"believe it's generic now, you"},{"speaker":"Chris Dy","startTime":381.39,"endTime":385.56,"body":"know, so that does change things"},{"speaker":"Chris Dy","startTime":381.39,"endTime":385.56,"body":"a bit. But I typically would"},{"speaker":"Chris Dy","startTime":385.56,"endTime":389.16,"body":"start with that, and then also"},{"speaker":"Chris Dy","startTime":385.56,"endTime":389.16,"body":"with a visit to one of our"},{"speaker":"Chris Dy","startTime":389.16,"endTime":390.39,"body":"expert therapists."},{"speaker":"Charles Goldfarb","startTime":391.05,"endTime":393.54,"body":"Okay, so a"},{"speaker":"Charles Goldfarb","startTime":391.05,"endTime":393.54,"body":"bunch of questions. Or let's"},{"speaker":"Charles Goldfarb","startTime":393.54,"endTime":396.45,"body":"start with what you said last,"},{"speaker":"Charles Goldfarb","startTime":393.54,"endTime":396.45,"body":"so what would you ask from the"},{"speaker":"Charles Goldfarb","startTime":396.45,"endTime":399.87,"body":"therapist? And what is your goal"},{"speaker":"Charles Goldfarb","startTime":396.45,"endTime":399.87,"body":"with therapy? Are you buying"},{"speaker":"Charles Goldfarb","startTime":399.87,"endTime":403.32,"body":"time? Or do you honestly think"},{"speaker":"Charles Goldfarb","startTime":399.87,"endTime":403.32,"body":"therapy is going to make this"},{"speaker":"Charles Goldfarb","startTime":403.32,"endTime":403.95,"body":"patient better?"},{"speaker":"Chris Dy","startTime":404.43,"endTime":407.43,"body":"I think that the risk"},{"speaker":"Chris Dy","startTime":404.43,"endTime":407.43,"body":"benefit ratio in therapy is is"},{"speaker":"Chris Dy","startTime":407.43,"endTime":410.19,"body":"fantastic. You know, so if"},{"speaker":"Chris Dy","startTime":407.43,"endTime":410.19,"body":"therapy, if the time that the"},{"speaker":"Chris Dy","startTime":410.19,"endTime":412.44,"body":"therapist spends with the"},{"speaker":"Chris Dy","startTime":410.19,"endTime":412.44,"body":"patient's aides is an extra set"},{"speaker":"Chris Dy","startTime":412.44,"endTime":415.86,"body":"of eyes and ears and a situation"},{"speaker":"Chris Dy","startTime":412.44,"endTime":415.86,"body":"that is not normal, be the"},{"speaker":"Chris Dy","startTime":415.86,"endTime":418.83,"body":"expertise they can provide and"},{"speaker":"Chris Dy","startTime":415.86,"endTime":418.83,"body":"helping to quiet down that nerve"},{"speaker":"Chris Dy","startTime":418.86,"endTime":423.6,"body":"through local modalities,"},{"speaker":"Chris Dy","startTime":418.86,"endTime":423.6,"body":"stretches, you know, honestly, a"},{"speaker":"Chris Dy","startTime":423.6,"endTime":427.38,"body":"hand to hold sometimes is also"},{"speaker":"Chris Dy","startTime":423.6,"endTime":427.38,"body":"really helpful. And then the"},{"speaker":"Chris Dy","startTime":427.38,"endTime":429.87,"body":"other thing I would do is"},{"speaker":"Chris Dy","startTime":427.38,"endTime":429.87,"body":"probably limit some of the work"},{"speaker":"Chris Dy","startTime":429.87,"endTime":432.57,"body":"related activities if it's"},{"speaker":"Chris Dy","startTime":429.87,"endTime":432.57,"body":"possible. And this is where you"},{"speaker":"Chris Dy","startTime":432.57,"endTime":434.79,"body":"have more much more expertise"},{"speaker":"Chris Dy","startTime":432.57,"endTime":434.79,"body":"than I do in terms of how to"},{"speaker":"Chris Dy","startTime":434.79,"endTime":437.79,"body":"handle this situation in the"},{"speaker":"Chris Dy","startTime":434.79,"endTime":437.79,"body":"context of work comp."},{"speaker":"Charles Goldfarb","startTime":438.57,"endTime":440.4,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":438.57,"endTime":440.4,"body":"that that's a great point, I"},{"speaker":"Charles Goldfarb","startTime":440.4,"endTime":443.58,"body":"would, I would say a couple"},{"speaker":"Charles Goldfarb","startTime":440.4,"endTime":443.58,"body":"things, you know, I've been"},{"speaker":"Charles Goldfarb","startTime":444.0,"endTime":448.35,"body":"taking care of injured workers"},{"speaker":"Charles Goldfarb","startTime":444.0,"endTime":448.35,"body":"for my entire career. And there"},{"speaker":"Charles Goldfarb","startTime":448.35,"endTime":453.09,"body":"has been some evolution, but"},{"speaker":"Charles Goldfarb","startTime":448.35,"endTime":453.09,"body":"patience is not often part of"},{"speaker":"Charles Goldfarb","startTime":453.09,"endTime":457.8,"body":"the equation from the work from"},{"speaker":"Charles Goldfarb","startTime":453.09,"endTime":457.8,"body":"the, you know, the workers comp"},{"speaker":"Charles Goldfarb","startTime":457.8,"endTime":462.99,"body":"side. And so a long duration of"},{"speaker":"Charles Goldfarb","startTime":457.8,"endTime":462.99,"body":"therapy? Probably not okay, I"},{"speaker":"Charles Goldfarb","startTime":462.99,"endTime":466.53,"body":"think it would be reasonable for"},{"speaker":"Charles Goldfarb","startTime":462.99,"endTime":466.53,"body":"the first month or so I follow"},{"speaker":"Charles Goldfarb","startTime":466.53,"endTime":469.38,"body":"these patients monthly to try"},{"speaker":"Charles Goldfarb","startTime":466.53,"endTime":469.38,"body":"some therapy. I don't think that"},{"speaker":"Charles Goldfarb","startTime":469.38,"endTime":473.73,"body":"would be shot down necessarily."},{"speaker":"Charles Goldfarb","startTime":469.38,"endTime":473.73,"body":"But I don't think we could"},{"speaker":"Charles Goldfarb","startTime":473.73,"endTime":477.42,"body":"expect a long duration of"},{"speaker":"Charles Goldfarb","startTime":473.73,"endTime":477.42,"body":"therapy. And you're right, you"},{"speaker":"Charles Goldfarb","startTime":477.42,"endTime":480.69,"body":"could put some restrictions on"},{"speaker":"Charles Goldfarb","startTime":477.42,"endTime":480.69,"body":"for sure. But once again, how"},{"speaker":"Charles Goldfarb","startTime":480.69,"endTime":484.08,"body":"long that will be tolerated by"},{"speaker":"Charles Goldfarb","startTime":480.69,"endTime":484.08,"body":"the employer? I don't know. The"},{"speaker":"Charles Goldfarb","startTime":484.08,"endTime":486.75,"body":"second thing I would say. So"},{"speaker":"Charles Goldfarb","startTime":484.08,"endTime":486.75,"body":"interestingly, this patient had"},{"speaker":"Charles Goldfarb","startTime":486.75,"endTime":491.04,"body":"experience with gabapentin, and"},{"speaker":"Charles Goldfarb","startTime":486.75,"endTime":491.04,"body":"it was not a good experience and"},{"speaker":"Charles Goldfarb","startTime":491.04,"endTime":494.94,"body":"refuse to consider that"},{"speaker":"Charles Goldfarb","startTime":491.04,"endTime":494.94,"body":"medication. I'm not a huge"},{"speaker":"Charles Goldfarb","startTime":494.94,"endTime":497.13,"body":"believer for the reasons you"},{"speaker":"Charles Goldfarb","startTime":494.94,"endTime":497.13,"body":"said I've had some patients with"},{"speaker":"Charles Goldfarb","startTime":497.13,"endTime":501.48,"body":"adverse events, what is the role"},{"speaker":"Charles Goldfarb","startTime":497.13,"endTime":501.48,"body":"if any of steroid medication,"},{"speaker":"Chris Dy","startTime":502.62,"endTime":505.8,"body":"um, you know, I for"},{"speaker":"Chris Dy","startTime":502.62,"endTime":505.8,"body":"this particular situation, I do"},{"speaker":"Chris Dy","startTime":505.8,"endTime":509.61,"body":"not like a steroid injection."},{"speaker":"Chris Dy","startTime":505.8,"endTime":509.61,"body":"And I've talked, I think it was"},{"speaker":"Chris Dy","startTime":509.61,"endTime":511.95,"body":"some of our trainees in the past"},{"speaker":"Chris Dy","startTime":509.61,"endTime":511.95,"body":"about why we don't use steroids"},{"speaker":"Chris Dy","startTime":511.95,"endTime":515.46,"body":"in general for cubital tunnel,"},{"speaker":"Chris Dy","startTime":511.95,"endTime":515.46,"body":"while the we may use it for"},{"speaker":"Chris Dy","startTime":515.49,"endTime":518.64,"body":"carpal tunnel, there are"},{"speaker":"Chris Dy","startTime":515.49,"endTime":518.64,"body":"different disease processes. You"},{"speaker":"Chris Dy","startTime":518.64,"endTime":521.43,"body":"know, in carpal tunnel, there's"},{"speaker":"Chris Dy","startTime":518.64,"endTime":521.43,"body":"swelling within the carpal"},{"speaker":"Chris Dy","startTime":521.43,"endTime":525.03,"body":"tunnel instructors like tendons,"},{"speaker":"Chris Dy","startTime":521.43,"endTime":525.03,"body":"and your goal is to try to quiet"},{"speaker":"Chris Dy","startTime":525.03,"endTime":529.29,"body":"the swelling in that in that"},{"speaker":"Chris Dy","startTime":525.03,"endTime":529.29,"body":"small confined space. Whereas in"},{"speaker":"Chris Dy","startTime":529.29,"endTime":532.86,"body":"cubital tunnel, say the nerve is"},{"speaker":"Chris Dy","startTime":529.29,"endTime":532.86,"body":"actually inside too. There's not"},{"speaker":"Chris Dy","startTime":532.86,"endTime":536.1,"body":"a swollen structure, you know,"},{"speaker":"Chris Dy","startTime":532.86,"endTime":536.1,"body":"the the nerve is experiencing"},{"speaker":"Chris Dy","startTime":536.1,"endTime":540.15,"body":"traction as it as the elbow"},{"speaker":"Chris Dy","startTime":536.1,"endTime":540.15,"body":"flexes. So it's traction and"},{"speaker":"Chris Dy","startTime":540.15,"endTime":543.96,"body":"compression. And, you know, the"},{"speaker":"Chris Dy","startTime":540.15,"endTime":543.96,"body":"nerve itself is swelling. And I"},{"speaker":"Chris Dy","startTime":543.96,"endTime":546.45,"body":"don't love the idea of putting a"},{"speaker":"Chris Dy","startTime":543.96,"endTime":546.45,"body":"ton of steroids or local"},{"speaker":"Chris Dy","startTime":546.45,"endTime":550.35,"body":"anesthetic around nerves in"},{"speaker":"Chris Dy","startTime":546.45,"endTime":550.35,"body":"general. And then for the"},{"speaker":"Chris Dy","startTime":550.35,"endTime":553.86,"body":"transpose nerve, this would not"},{"speaker":"Chris Dy","startTime":550.35,"endTime":553.86,"body":"I don't think it would provide a"},{"speaker":"Chris Dy","startTime":553.86,"endTime":557.34,"body":"long term relief. I guess you"},{"speaker":"Chris Dy","startTime":553.86,"endTime":557.34,"body":"could make an argument maybe to"},{"speaker":"Chris Dy","startTime":557.34,"endTime":560.97,"body":"try it once. But to me, it's not"},{"speaker":"Chris Dy","startTime":557.34,"endTime":560.97,"body":"going to be something where"},{"speaker":"Chris Dy","startTime":561.0,"endTime":563.25,"body":"that's going to be the thing"},{"speaker":"Chris Dy","startTime":561.0,"endTime":563.25,"body":"that secures her it gets her"},{"speaker":"Chris Dy","startTime":563.25,"endTime":565.95,"body":"back to work and keeps her out"},{"speaker":"Chris Dy","startTime":563.25,"endTime":565.95,"body":"of your office. You know, going"},{"speaker":"Chris Dy","startTime":565.95,"endTime":566.4,"body":"forward."},{"speaker":"Charles Goldfarb","startTime":569.25,"endTime":572.37,"body":"You did."},{"speaker":"Charles Goldfarb","startTime":569.25,"endTime":572.37,"body":"Perfect. So you have taught me"},{"speaker":"Charles Goldfarb","startTime":572.37,"endTime":577.44,"body":"well. I did not offer steroids."},{"speaker":"Charles Goldfarb","startTime":572.37,"endTime":577.44,"body":"I did offer their modulating"},{"speaker":"Charles Goldfarb","startTime":577.44,"endTime":581.52,"body":"medication which patient did not"},{"speaker":"Charles Goldfarb","startTime":577.44,"endTime":581.52,"body":"want and we sent her to therapy"},{"speaker":"Charles Goldfarb","startTime":581.52,"endTime":584.85,"body":"with some mild activity"},{"speaker":"Charles Goldfarb","startTime":581.52,"endTime":584.85,"body":"restrictions. She comes back a"},{"speaker":"Charles Goldfarb","startTime":584.85,"endTime":588.93,"body":"month later, not better."},{"speaker":"Charles Goldfarb","startTime":584.85,"endTime":588.93,"body":"honestly probably a little"},{"speaker":"Charles Goldfarb","startTime":588.93,"endTime":595.62,"body":"worse. With continued pain, as I"},{"speaker":"Charles Goldfarb","startTime":588.93,"endTime":595.62,"body":"guess I would say the primary"},{"speaker":"Charles Goldfarb","startTime":595.62,"endTime":598.83,"body":"complaint with secondary"},{"speaker":"Charles Goldfarb","startTime":595.62,"endTime":598.83,"body":"complaints of numbness and"},{"speaker":"Charles Goldfarb","startTime":598.83,"endTime":603.78,"body":"tingling in the fingers."},{"speaker":"Charles Goldfarb","startTime":598.83,"endTime":603.78,"body":"weakness on exam. Two point"},{"speaker":"Charles Goldfarb","startTime":603.78,"endTime":606.69,"body":"discrimination and this is"},{"speaker":"Charles Goldfarb","startTime":603.78,"endTime":606.69,"body":"static two point which is my"},{"speaker":"Charles Goldfarb","startTime":606.69,"endTime":611.28,"body":"preferred modality was five"},{"speaker":"Charles Goldfarb","startTime":606.69,"endTime":611.28,"body":"millimeters diffusely intrinsic"},{"speaker":"Charles Goldfarb","startTime":611.28,"endTime":616.92,"body":"hand strength was good. The"},{"speaker":"Charles Goldfarb","startTime":611.28,"endTime":616.92,"body":"nerve was clearly highly"},{"speaker":"Charles Goldfarb","startTime":617.04,"endTime":621.9,"body":"irritated on my examination. So"},{"speaker":"Charles Goldfarb","startTime":617.04,"endTime":621.9,"body":"we're now about, let's say 10"},{"speaker":"Charles Goldfarb","startTime":621.9,"endTime":627.09,"body":"weeks after this trauma, have"},{"speaker":"Charles Goldfarb","startTime":621.9,"endTime":627.09,"body":"failed four weeks of therapy and"},{"speaker":"Charles Goldfarb","startTime":627.09,"endTime":630.66,"body":"anti inflammatories. And now she"},{"speaker":"Charles Goldfarb","startTime":627.09,"endTime":630.66,"body":"is back in your office. What's"},{"speaker":"Charles Goldfarb","startTime":630.66,"endTime":631.14,"body":"next?"},{"speaker":"Chris Dy","startTime":631.47,"endTime":633.69,"body":"So I mean, I guess to"},{"speaker":"Chris Dy","startTime":631.47,"endTime":633.69,"body":"summarize the way I would think"},{"speaker":"Chris Dy","startTime":633.69,"endTime":637.86,"body":"about this is a mechanical,"},{"speaker":"Chris Dy","startTime":633.69,"endTime":637.86,"body":"irritated, likely swollen nerve"},{"speaker":"Chris Dy","startTime":637.92,"endTime":642.96,"body":"without any advanced signs of,"},{"speaker":"Chris Dy","startTime":637.92,"endTime":642.96,"body":"of ulnar neuropathy on"},{"speaker":"Chris Dy","startTime":642.96,"endTime":645.78,"body":"examination in terms of motor"},{"speaker":"Chris Dy","startTime":642.96,"endTime":645.78,"body":"and sensory, but the fact that"},{"speaker":"Chris Dy","startTime":645.78,"endTime":649.8,"body":"the nerve is highly sensitive"},{"speaker":"Chris Dy","startTime":645.78,"endTime":649.8,"body":"and irritable kind of pushes us"},{"speaker":"Chris Dy","startTime":649.8,"endTime":653.25,"body":"towards considering operative"},{"speaker":"Chris Dy","startTime":649.8,"endTime":653.25,"body":"treatment. You know, some"},{"speaker":"Chris Dy","startTime":653.25,"endTime":655.02,"body":"listeners would have probably"},{"speaker":"Chris Dy","startTime":653.25,"endTime":655.02,"body":"said, Why don't you get a nerf"},{"speaker":"Chris Dy","startTime":655.02,"endTime":657.6,"body":"study from the get go? I think"},{"speaker":"Chris Dy","startTime":655.02,"endTime":657.6,"body":"that'd be fine. To get a nerf"},{"speaker":"Chris Dy","startTime":657.6,"endTime":659.46,"body":"study from the get go, I think"},{"speaker":"Chris Dy","startTime":657.6,"endTime":659.46,"body":"it's probably time to get it"},{"speaker":"Chris Dy","startTime":659.46,"endTime":659.88,"body":"now."},{"speaker":"Charles Goldfarb","startTime":660.83,"endTime":664.4,"body":"Okay. Thank"},{"speaker":"Charles Goldfarb","startTime":660.83,"endTime":664.4,"body":"you. And that's exactly what we"},{"speaker":"Charles Goldfarb","startTime":664.4,"endTime":667.76,"body":"did. And I would like to know"},{"speaker":"Charles Goldfarb","startTime":664.4,"endTime":667.76,"body":"what you do routinely in these"},{"speaker":"Charles Goldfarb","startTime":667.76,"endTime":671.75,"body":"situations, because it might be"},{"speaker":"Charles Goldfarb","startTime":667.76,"endTime":671.75,"body":"somewhat different. I, you know,"},{"speaker":"Charles Goldfarb","startTime":671.9,"endTime":675.41,"body":"ordered a nerve conduction study"},{"speaker":"Charles Goldfarb","startTime":671.9,"endTime":675.41,"body":"with an EMG. And we also got an"},{"speaker":"Charles Goldfarb","startTime":675.41,"endTime":679.34,"body":"ultrasound I do not always get"},{"speaker":"Charles Goldfarb","startTime":675.41,"endTime":679.34,"body":"ultrasound.  Ultrasound was"},{"speaker":"Charles Goldfarb","startTime":679.34,"endTime":682.13,"body":"helpful in this case. But do you"},{"speaker":"Charles Goldfarb","startTime":679.34,"endTime":682.13,"body":"feel that ultrasound is now in"},{"speaker":"Charles Goldfarb","startTime":682.13,"endTime":685.1,"body":"your practice, essentially"},{"speaker":"Charles Goldfarb","startTime":682.13,"endTime":685.1,"body":"always indicated?"},{"speaker":"Chris Dy","startTime":685.92,"endTime":688.92,"body":"I think so. I mean,"},{"speaker":"Chris Dy","startTime":685.92,"endTime":688.92,"body":"some of it is me learning when"},{"speaker":"Chris Dy","startTime":688.92,"endTime":692.46,"body":"to use ultrasound, and it is in"},{"speaker":"Chris Dy","startTime":688.92,"endTime":692.46,"body":"the non revision setting in the"},{"speaker":"Chris Dy","startTime":692.46,"endTime":695.91,"body":"primary owner neuritis, cubital"},{"speaker":"Chris Dy","startTime":692.46,"endTime":695.91,"body":"tunnel setting, I think it is"},{"speaker":"Chris Dy","startTime":695.91,"endTime":699.3,"body":"useful because it can help"},{"speaker":"Chris Dy","startTime":695.91,"endTime":699.3,"body":"provide some clarity to two"},{"speaker":"Chris Dy","startTime":699.3,"endTime":704.19,"body":"things for the quote, electrode"},{"speaker":"Chris Dy","startTime":699.3,"endTime":704.19,"body":"diagnostically negative cubital"},{"speaker":"Chris Dy","startTime":704.19,"endTime":706.95,"body":"Tunnel Syndrome, but there is"},{"speaker":"Chris Dy","startTime":704.19,"endTime":706.95,"body":"some swelling in the nerve. I"},{"speaker":"Chris Dy","startTime":706.95,"endTime":709.95,"body":"think there's something to be"},{"speaker":"Chris Dy","startTime":706.95,"endTime":709.95,"body":"said about that. Because perhaps"},{"speaker":"Chris Dy","startTime":709.95,"endTime":714.27,"body":"enough of the nerve, quote"},{"speaker":"Chris Dy","startTime":709.95,"endTime":714.27,"body":"fibers are working. So that the"},{"speaker":"Chris Dy","startTime":714.27,"endTime":716.76,"body":"nerve study comes back normal,"},{"speaker":"Chris Dy","startTime":714.27,"endTime":716.76,"body":"at least on the conduction"},{"speaker":"Chris Dy","startTime":716.76,"endTime":719.16,"body":"velocities and likely on the"},{"speaker":"Chris Dy","startTime":716.76,"endTime":719.16,"body":"amplitude and for that early"},{"speaker":"Chris Dy","startTime":719.16,"endTime":721.8,"body":"stage kind of disease, there"},{"speaker":"Chris Dy","startTime":719.16,"endTime":721.8,"body":"probably aren't going to be any"},{"speaker":"Chris Dy","startTime":721.8,"endTime":724.35,"body":"signs of deactivation on the"},{"speaker":"Chris Dy","startTime":721.8,"endTime":724.35,"body":"EMG. And the ultrasound may show"},{"speaker":"Chris Dy","startTime":724.35,"endTime":727.26,"body":"some swelling. The second thing,"},{"speaker":"Chris Dy","startTime":724.35,"endTime":727.26,"body":"as we've talked about in the"},{"speaker":"Chris Dy","startTime":727.26,"endTime":731.16,"body":"past, with it being for it being"},{"speaker":"Chris Dy","startTime":727.26,"endTime":731.16,"body":"useful is you know, the fact"},{"speaker":"Chris Dy","startTime":731.16,"endTime":734.46,"body":"that it can help you in terms of"},{"speaker":"Chris Dy","startTime":731.16,"endTime":734.46,"body":"accurately diagnosing"},{"speaker":"Chris Dy","startTime":734.58,"endTime":739.47,"body":"subluxation of the nerve now in"},{"speaker":"Chris Dy","startTime":734.58,"endTime":739.47,"body":"the setting. And that's why for"},{"speaker":"Chris Dy","startTime":739.47,"endTime":743.43,"body":"those two reasons. That's why I"},{"speaker":"Chris Dy","startTime":739.47,"endTime":743.43,"body":"pretty much always if it's"},{"speaker":"Chris Dy","startTime":743.43,"endTime":747.9,"body":"available through the you know,"},{"speaker":"Chris Dy","startTime":743.43,"endTime":747.9,"body":"through the physiatrist, or"},{"speaker":"Chris Dy","startTime":747.9,"endTime":750.27,"body":"electro diagnostician who's"},{"speaker":"Chris Dy","startTime":747.9,"endTime":750.27,"body":"doing the exam will get an"},{"speaker":"Chris Dy","startTime":750.27,"endTime":753.99,"body":"ultrasound. Some could make the"},{"speaker":"Chris Dy","startTime":750.27,"endTime":753.99,"body":"argument, why don't you just"},{"speaker":"Chris Dy","startTime":753.99,"endTime":756.15,"body":"transition only to ultrasound."},{"speaker":"Chris Dy","startTime":753.99,"endTime":756.15,"body":"And that's a whole different"},{"speaker":"Chris Dy","startTime":756.15,"endTime":760.86,"body":"topic. In this setting, it is"},{"speaker":"Chris Dy","startTime":756.15,"endTime":760.86,"body":"incredibly helpful to have the"},{"speaker":"Chris Dy","startTime":760.86,"endTime":765.18,"body":"information as to how swollen"},{"speaker":"Chris Dy","startTime":760.86,"endTime":765.18,"body":"the nerve potentially is. And"},{"speaker":"Chris Dy","startTime":765.21,"endTime":768.39,"body":"honestly, in some cases, and not"},{"speaker":"Chris Dy","startTime":765.21,"endTime":768.39,"body":"in this case, because I know"},{"speaker":"Chris Dy","startTime":768.39,"endTime":771.06,"body":"that you did the first surgery,"},{"speaker":"Chris Dy","startTime":768.39,"endTime":771.06,"body":"but sometimes you want to make"},{"speaker":"Chris Dy","startTime":771.06,"endTime":773.46,"body":"sure the nerve is actually been"},{"speaker":"Chris Dy","startTime":771.06,"endTime":773.46,"body":"transposed. That is not always"},{"speaker":"Chris Dy","startTime":773.46,"endTime":777.3,"body":"the case. And I've I've been"},{"speaker":"Chris Dy","startTime":773.46,"endTime":777.3,"body":"told by patients that they had"},{"speaker":"Chris Dy","startTime":777.3,"endTime":779.19,"body":"their nerve transpose I've"},{"speaker":"Chris Dy","startTime":777.3,"endTime":779.19,"body":"looked at their incisions and"},{"speaker":"Chris Dy","startTime":779.19,"endTime":782.1,"body":"said, That's way too small, and"},{"speaker":"Chris Dy","startTime":779.19,"endTime":782.1,"body":"the nerve is actually not"},{"speaker":"Chris Dy","startTime":782.1,"endTime":782.7,"body":"transposed."},{"speaker":"Charles Goldfarb","startTime":783.72,"endTime":786.72,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":783.72,"endTime":786.72,"body":"fair. And I am. I'm a real"},{"speaker":"Charles Goldfarb","startTime":786.72,"endTime":791.13,"body":"believer in really small"},{"speaker":"Charles Goldfarb","startTime":786.72,"endTime":791.13,"body":"incisions. But I'm going to"},{"speaker":"Charles Goldfarb","startTime":791.13,"endTime":794.19,"body":"repeat that because I didn't I'm"},{"speaker":"Charles Goldfarb","startTime":791.13,"endTime":794.19,"body":"a believer in really small"},{"speaker":"Charles Goldfarb","startTime":794.19,"endTime":797.58,"body":"incisions. But this is one"},{"speaker":"Charles Goldfarb","startTime":794.19,"endTime":797.58,"body":"surgery where a little bit"},{"speaker":"Charles Goldfarb","startTime":797.58,"endTime":800.46,"body":"longer incision makes a lot of"},{"speaker":"Charles Goldfarb","startTime":797.58,"endTime":800.46,"body":"sense, because what I really"},{"speaker":"Charles Goldfarb","startTime":800.46,"endTime":805.23,"body":"want to avoid, is the nerve not"},{"speaker":"Charles Goldfarb","startTime":800.46,"endTime":805.23,"body":"running the straightest course"},{"speaker":"Charles Goldfarb","startTime":805.26,"endTime":808.89,"body":"possible. And so I agree with"},{"speaker":"Charles Goldfarb","startTime":805.26,"endTime":808.89,"body":"you, I think understanding what"},{"speaker":"Charles Goldfarb","startTime":808.89,"endTime":811.14,"body":"was truly done in a first"},{"speaker":"Charles Goldfarb","startTime":808.89,"endTime":811.14,"body":"surgery matters."},{"speaker":"Chris Dy","startTime":811.379,"endTime":814.619,"body":"So let's be honest, so"},{"speaker":"Chris Dy","startTime":811.379,"endTime":814.619,"body":"we all know that the the skin"},{"speaker":"Chris Dy","startTime":814.649,"endTime":819.299,"body":"around the around the medial"},{"speaker":"Chris Dy","startTime":814.649,"endTime":819.299,"body":"elbow is very compliant. There's"},{"speaker":"Chris Dy","startTime":819.299,"endTime":822.629,"body":"a lot of pliability within that"},{"speaker":"Chris Dy","startTime":819.299,"endTime":822.629,"body":"and yes, you can. Technically"},{"speaker":"Chris Dy","startTime":822.869,"endTime":825.719,"body":"you can transpose the ulnar"},{"speaker":"Chris Dy","startTime":822.869,"endTime":825.719,"body":"nerve to a really small"},{"speaker":"Chris Dy","startTime":825.719,"endTime":829.259,"body":"incision. But what happens when"},{"speaker":"Chris Dy","startTime":825.719,"endTime":829.259,"body":"you do that is exactly what you"},{"speaker":"Chris Dy","startTime":829.259,"endTime":831.749,"body":"stated is that you do not get"},{"speaker":"Chris Dy","startTime":829.259,"endTime":831.749,"body":"the nerve going in the"},{"speaker":"Chris Dy","startTime":831.749,"endTime":834.299,"body":"straightest line possible, you"},{"speaker":"Chris Dy","startTime":831.749,"endTime":834.299,"body":"end up getting kind of an Omega"},{"speaker":"Chris Dy","startTime":834.299,"endTime":837.119,"body":"sign on that nerve. I think"},{"speaker":"Chris Dy","startTime":834.299,"endTime":837.119,"body":"that's john Isaacs that told me"},{"speaker":"Chris Dy","startTime":837.119,"endTime":840.479,"body":"that term, or as the sign is, I"},{"speaker":"Chris Dy","startTime":837.119,"endTime":840.479,"body":"think Dr. McKinnon calls it"},{"speaker":"Chris Dy","startTime":841.139,"endTime":843.479,"body":"where the nerve will be"},{"speaker":"Chris Dy","startTime":841.139,"endTime":843.479,"body":"transposed to the front of the"},{"speaker":"Chris Dy","startTime":843.479,"endTime":847.439,"body":"elbow, but then as you get as it"},{"speaker":"Chris Dy","startTime":843.479,"endTime":847.439,"body":"comes back down or comes back"},{"speaker":"Chris Dy","startTime":847.709,"endTime":851.639,"body":"posteriorly towards that fascia"},{"speaker":"Chris Dy","startTime":847.709,"endTime":851.639,"body":"around the intersection of the"},{"speaker":"Chris Dy","startTime":851.639,"endTime":854.999,"body":"FCU and the remainder of the"},{"speaker":"Chris Dy","startTime":851.639,"endTime":854.999,"body":"flexor pronator fascia. It kinks"},{"speaker":"Chris Dy","startTime":854.999,"endTime":859.499,"body":"right there. And that's my issue"},{"speaker":"Chris Dy","startTime":854.999,"endTime":859.499,"body":"with small incision ulnar nerve"},{"speaker":"Chris Dy","startTime":859.499,"endTime":860.369,"body":"transpositions."},{"speaker":"Charles Goldfarb","startTime":861.21,"endTime":862.56,"body":"I totally"},{"speaker":"Charles Goldfarb","startTime":861.21,"endTime":862.56,"body":"agree with you. I didn't know"},{"speaker":"Charles Goldfarb","startTime":862.56,"endTime":865.83,"body":"that. You know, I'm not as nerdy"},{"speaker":"Charles Goldfarb","startTime":862.56,"endTime":865.83,"body":"in the nerve world as you are. I"},{"speaker":"Charles Goldfarb","startTime":865.83,"endTime":869.01,"body":"don't mean that offensively. I"},{"speaker":"Charles Goldfarb","startTime":865.83,"endTime":869.01,"body":"mean that. Yes, yes. Yes."},{"speaker":"Charles Goldfarb","startTime":871.98,"endTime":872.67,"body":"Complimentary way"},{"speaker":"Chris Dy","startTime":872.03,"endTime":874.7,"body":"18 months of"},{"speaker":"Chris Dy","startTime":872.03,"endTime":874.7,"body":"podcasting, become bulletproof"},{"speaker":"Chris Dy","startTime":874.73,"endTime":875.57,"body":"to the nerve hating."},{"speaker":"Charles Goldfarb","startTime":876.05,"endTime":880.49,"body":"So I like the"},{"speaker":"Charles Goldfarb","startTime":876.05,"endTime":880.49,"body":"term omega nerve, or whatever"},{"speaker":"Charles Goldfarb","startTime":880.49,"endTime":883.31,"body":"you said from Jonathan Isaacs,"},{"speaker":"Charles Goldfarb","startTime":880.49,"endTime":883.31,"body":"because it really you know, I"},{"speaker":"Charles Goldfarb","startTime":883.31,"endTime":887.69,"body":"don't know all the Greek"},{"speaker":"Charles Goldfarb","startTime":883.31,"endTime":887.69,"body":"letters. But I do know what an"},{"speaker":"Charles Goldfarb","startTime":887.69,"endTime":891.38,"body":"Omega looks like. I don't know"},{"speaker":"Charles Goldfarb","startTime":887.69,"endTime":891.38,"body":"all the fraternity letters"},{"speaker":"Charles Goldfarb","startTime":891.38,"endTime":894.38,"body":"either, but I know what an Omega"},{"speaker":"Charles Goldfarb","startTime":891.38,"endTime":894.38,"body":"looks like so I can see it."},{"speaker":"Charles Goldfarb","startTime":894.41,"endTime":895.79,"body":"Thank you for sharing that."},{"speaker":"Chris Dy","startTime":896.06,"endTime":898.19,"body":"I'm so glad we've"},{"speaker":"Chris Dy","startTime":896.06,"endTime":898.19,"body":"added something to your"},{"speaker":"Chris Dy","startTime":898.19,"endTime":900.41,"body":"knowledge base today, Dr."},{"speaker":"Chris Dy","startTime":898.19,"endTime":900.41,"body":"Goldfarb."},{"speaker":"Charles Goldfarb","startTime":901.02,"endTime":904.26,"body":"You have I"},{"speaker":"Charles Goldfarb","startTime":901.02,"endTime":904.26,"body":"love it. I use it every day now."},{"speaker":"Charles Goldfarb","startTime":905.52,"endTime":910.32,"body":"Alright, let me share the nerve"},{"speaker":"Charles Goldfarb","startTime":905.52,"endTime":910.32,"body":"study results with you. So the"},{"speaker":"Charles Goldfarb","startTime":910.32,"endTime":914.7,"body":"nerve conduction study findings,"},{"speaker":"Charles Goldfarb","startTime":910.32,"endTime":914.7,"body":"I'll just hit a few highlights"},{"speaker":"Charles Goldfarb","startTime":915.57,"endTime":921.51,"body":"showed that there was normal"},{"speaker":"Charles Goldfarb","startTime":915.57,"endTime":921.51,"body":"distal onset latency, amplitude"},{"speaker":"Charles Goldfarb","startTime":921.9,"endTime":927.06,"body":"and conduction velocity, except"},{"speaker":"Charles Goldfarb","startTime":921.9,"endTime":927.06,"body":"for a decrease conduction"},{"speaker":"Charles Goldfarb","startTime":927.06,"endTime":930.33,"body":"velocity at 40 meters per second"},{"speaker":"Charles Goldfarb","startTime":927.06,"endTime":930.33,"body":"across the elbow."},{"speaker":"Chris Dy","startTime":931.5,"endTime":933.87,"body":"Now, so I'm assuming"},{"speaker":"Chris Dy","startTime":931.5,"endTime":933.87,"body":"this, you know, I don't put a"},{"speaker":"Chris Dy","startTime":933.87,"endTime":935.64,"body":"lot of stock in sensor"},{"speaker":"Chris Dy","startTime":933.87,"endTime":935.64,"body":"amplitudes because they're"},{"speaker":"Chris Dy","startTime":935.64,"endTime":938.25,"body":"technically so variable, I'm"},{"speaker":"Chris Dy","startTime":935.64,"endTime":938.25,"body":"assuming those came back as"},{"speaker":"Chris Dy","startTime":938.25,"endTime":943.77,"body":"normal to for the ulnar nerve."},{"speaker":"Chris Dy","startTime":938.25,"endTime":943.77,"body":"They did. And on the EMG part,"},{"speaker":"Chris Dy","startTime":943.8,"endTime":947.13,"body":"are there any deactivation"},{"speaker":"Chris Dy","startTime":943.8,"endTime":947.13,"body":"findings on the FDI? Or the ADM"},{"speaker":"Chris Dy","startTime":947.13,"endTime":949.92,"body":"or any owner if they don't if"},{"speaker":"Chris Dy","startTime":947.13,"endTime":949.92,"body":"they checked the other extrinsic"},{"speaker":"Chris Dy","startTime":949.92,"endTime":954.33,"body":"musculature? They did not. But"},{"speaker":"Chris Dy","startTime":949.92,"endTime":954.33,"body":"they did note that the first"},{"speaker":"Chris Dy","startTime":954.33,"endTime":958.47,"body":"dorsal enter osseous muscle"},{"speaker":"Chris Dy","startTime":954.33,"endTime":958.47,"body":"showed increased motor unit"},{"speaker":"Chris Dy","startTime":958.53,"endTime":962.79,"body":"amplitude. Okay, got it. Are"},{"speaker":"Chris Dy","startTime":958.53,"endTime":962.79,"body":"there any fibrillation or sharp"},{"speaker":"Chris Dy","startTime":962.79,"endTime":966.78,"body":"waves listed? there? We're not."},{"speaker":"Chris Dy","startTime":962.79,"endTime":966.78,"body":"Okay. And then is on the"},{"speaker":"Chris Dy","startTime":966.78,"endTime":971.28,"body":"recruitment pattern like that"},{"speaker":"Chris Dy","startTime":966.78,"endTime":971.28,"body":"far right column on the EMG. any"},{"speaker":"Chris Dy","startTime":971.31,"endTime":973.62,"body":"abnormalities listed in the"},{"speaker":"Chris Dy","startTime":971.31,"endTime":973.62,"body":"recruitment pattern for the"},{"speaker":"Chris Dy","startTime":973.62,"endTime":975.3,"body":"motor units? The MEPs?"},{"speaker":"Charles Goldfarb","startTime":977.07,"endTime":983.97,"body":"Hold on, let"},{"speaker":"Charles Goldfarb","startTime":977.07,"endTime":983.97,"body":"me look. So there are no"},{"speaker":"Charles Goldfarb","startTime":984.0,"endTime":987.57,"body":"recruitment pattern"},{"speaker":"Charles Goldfarb","startTime":984.0,"endTime":987.57,"body":"abnormalities demonstrated."},{"speaker":"Chris Dy","startTime":988.38,"endTime":990.81,"body":"So I mean, to me,"},{"speaker":"Chris Dy","startTime":988.38,"endTime":990.81,"body":"based on what you've described,"},{"speaker":"Chris Dy","startTime":990.81,"endTime":994.05,"body":"it sounds more like a chronic,"},{"speaker":"Chris Dy","startTime":990.81,"endTime":994.05,"body":"the footprint of chronic"},{"speaker":"Chris Dy","startTime":994.05,"endTime":997.65,"body":"changes, but nothing acute. So"},{"speaker":"Chris Dy","startTime":994.05,"endTime":997.65,"body":"I'm not sure how it was"},{"speaker":"Chris Dy","startTime":997.86,"endTime":1001.1,"body":"interpreted by the electrode"},{"speaker":"Chris Dy","startTime":997.86,"endTime":1001.1,"body":"diagnostician, but that's based"},{"speaker":"Chris Dy","startTime":1001.1,"endTime":1002.3,"body":"on what you've told me. That's"},{"speaker":"Chris Dy","startTime":1001.1,"endTime":1002.3,"body":"what I would say."},{"speaker":"Charles Goldfarb","startTime":1002.78,"endTime":1005.18,"body":"So as"},{"speaker":"Charles Goldfarb","startTime":1002.78,"endTime":1005.18,"body":"expected, you are right on the"},{"speaker":"Charles Goldfarb","startTime":1005.18,"endTime":1008.3,"body":"money, you are an expert in this"},{"speaker":"Charles Goldfarb","startTime":1005.18,"endTime":1008.3,"body":"field, it was interpreted as a"},{"speaker":"Charles Goldfarb","startTime":1008.3,"endTime":1014.0,"body":"chronic older neuropathy at the"},{"speaker":"Charles Goldfarb","startTime":1008.3,"endTime":1014.0,"body":"elbow. And it was noted by"},{"speaker":"Charles Goldfarb","startTime":1014.03,"endTime":1018.68,"body":"ultrasound that the nerve was"},{"speaker":"Charles Goldfarb","startTime":1014.03,"endTime":1018.68,"body":"indeed subcutaneous. The maximum"},{"speaker":"Charles Goldfarb","startTime":1018.68,"endTime":1024.5,"body":"cross sectional area of her"},{"speaker":"Charles Goldfarb","startTime":1018.68,"endTime":1024.5,"body":"nerve was 15 millimeters squared"},{"speaker":"Charles Goldfarb","startTime":1024.65,"endTime":1029.39,"body":"versus 10. Okay, as the normal"},{"speaker":"Charles Goldfarb","startTime":1024.65,"endTime":1029.39,"body":"Okay, so we have as you"},{"speaker":"Charles Goldfarb","startTime":1029.39,"endTime":1033.02,"body":"predicted a large swollen nerve"},{"speaker":"Charles Goldfarb","startTime":1029.39,"endTime":1033.02,"body":"without any really exciting new"},{"speaker":"Charles Goldfarb","startTime":1033.02,"endTime":1036.44,"body":"findings, but with a chronic"},{"speaker":"Charles Goldfarb","startTime":1033.02,"endTime":1036.44,"body":"pattern identified. And so"},{"speaker":"Chris Dy","startTime":1036.44,"endTime":1038.39,"body":"let me ask you one"},{"speaker":"Chris Dy","startTime":1036.44,"endTime":1038.39,"body":"more question, because I know"},{"speaker":"Chris Dy","startTime":1038.39,"endTime":1041.06,"body":"that it's going to come up. So"},{"speaker":"Chris Dy","startTime":1038.39,"endTime":1041.06,"body":"on your examination, were there"},{"speaker":"Chris Dy","startTime":1041.06,"endTime":1043.55,"body":"any signs of compression at"},{"speaker":"Chris Dy","startTime":1041.06,"endTime":1043.55,"body":"guiones? canal?"},{"speaker":"Charles Goldfarb","startTime":1044.27,"endTime":1047.63,"body":"There were not"},{"speaker":"Charles Goldfarb","startTime":1044.27,"endTime":1047.63,"body":"and i i am not the world's"},{"speaker":"Charles Goldfarb","startTime":1047.63,"endTime":1051.5,"body":"greatest believer in the"},{"speaker":"Charles Goldfarb","startTime":1047.63,"endTime":1051.5,"body":"existence of Guyons problem in"},{"speaker":"Charles Goldfarb","startTime":1051.5,"endTime":1055.19,"body":"this situation, or distal ulnar"},{"speaker":"Charles Goldfarb","startTime":1051.5,"endTime":1055.19,"body":"tunnel as I often call it as"},{"speaker":"Charles Goldfarb","startTime":1055.19,"endTime":1059.51,"body":"influenced by Doctor Gelberman."},{"speaker":"Charles Goldfarb","startTime":1055.19,"endTime":1059.51,"body":"There were not negative Tinels"},{"speaker":"Charles Goldfarb","startTime":1059.54,"endTime":1061.52,"body":"no type of compressive findings,"},{"speaker":"Charles Goldfarb","startTime":1059.54,"endTime":1061.52,"body":"nothing."},{"speaker":"Chris Dy","startTime":1062.03,"endTime":1064.52,"body":"Okay, cuz I know that"},{"speaker":"Chris Dy","startTime":1062.03,"endTime":1064.52,"body":"there are some listeners shout"},{"speaker":"Chris Dy","startTime":1064.52,"endTime":1068.75,"body":"out Dr. Rob Gray, who believe"},{"speaker":"Chris Dy","startTime":1064.52,"endTime":1068.75,"body":"that releasing Dion's in every"},{"speaker":"Chris Dy","startTime":1068.75,"endTime":1071.63,"body":"case is the way to go. I can't"},{"speaker":"Chris Dy","startTime":1068.75,"endTime":1071.63,"body":"remember which forum we learned"},{"speaker":"Chris Dy","startTime":1071.63,"endTime":1071.84,"body":"that."},{"speaker":"Charles Goldfarb","startTime":1072.74,"endTime":1075.62,"body":"But But here's"},{"speaker":"Charles Goldfarb","startTime":1072.74,"endTime":1075.62,"body":"the question, is it and I"},{"speaker":"Charles Goldfarb","startTime":1075.62,"endTime":1080.3,"body":"understand that is it about"},{"speaker":"Charles Goldfarb","startTime":1075.62,"endTime":1080.3,"body":"releasing a current possible"},{"speaker":"Charles Goldfarb","startTime":1080.3,"endTime":1085.04,"body":"construction site? Or is it"},{"speaker":"Charles Goldfarb","startTime":1080.3,"endTime":1085.04,"body":"about releasing in advance of"},{"speaker":"Charles Goldfarb","startTime":1085.04,"endTime":1088.34,"body":"nerves swelling, quote, unquote,"},{"speaker":"Charles Goldfarb","startTime":1085.04,"endTime":1088.34,"body":"during the recovery?"},{"speaker":"Chris Dy","startTime":1090.11,"endTime":1092.96,"body":"To speak for those who"},{"speaker":"Chris Dy","startTime":1090.11,"endTime":1092.96,"body":"believe in it? The answer would"},{"speaker":"Chris Dy","startTime":1092.96,"endTime":1095.69,"body":"be? Yes. As Dr. Boyer would"},{"speaker":"Charles Goldfarb","startTime":1098.06,"endTime":1100.07,"body":"love it. Yes,"},{"speaker":"Charles Goldfarb","startTime":1098.06,"endTime":1100.07,"body":"it would be. Well, I"},{"speaker":"Chris Dy","startTime":1100.07,"endTime":1103.58,"body":"mean, I think that"},{"speaker":"Chris Dy","startTime":1100.07,"endTime":1103.58,"body":"this comes into like where the"},{"speaker":"Chris Dy","startTime":1103.61,"endTime":1106.52,"body":"to me work comp kind of comes"},{"speaker":"Chris Dy","startTime":1103.61,"endTime":1106.52,"body":"into the picture here, right. So"},{"speaker":"Chris Dy","startTime":1106.52,"endTime":1110.0,"body":"you want to do I think, at least"},{"speaker":"Chris Dy","startTime":1106.52,"endTime":1110.0,"body":"the way that I interpret the"},{"speaker":"Chris Dy","startTime":1110.0,"endTime":1112.22,"body":"care of the injured worker is"},{"speaker":"Chris Dy","startTime":1110.0,"endTime":1112.22,"body":"you want to consider doing"},{"speaker":"Chris Dy","startTime":1112.22,"endTime":1117.11,"body":"everything possible for these"},{"speaker":"Chris Dy","startTime":1112.22,"endTime":1117.11,"body":"patients from jump. So to me,"},{"speaker":"Chris Dy","startTime":1117.11,"endTime":1120.29,"body":"this patient looks like they're"},{"speaker":"Chris Dy","startTime":1117.11,"endTime":1120.29,"body":"heading towards a revision ulnar"},{"speaker":"Chris Dy","startTime":1120.29,"endTime":1123.38,"body":"nerve transposition. And then"},{"speaker":"Chris Dy","startTime":1120.29,"endTime":1123.38,"body":"you could make the argument I"},{"speaker":"Chris Dy","startTime":1123.38,"endTime":1129.38,"body":"think, with reasonable, new with"},{"speaker":"Chris Dy","startTime":1123.38,"endTime":1129.38,"body":"some good justification to"},{"speaker":"Chris Dy","startTime":1129.41,"endTime":1133.49,"body":"consider releasing the distal"},{"speaker":"Chris Dy","startTime":1129.41,"endTime":1133.49,"body":"ulnar tunnel. Now one thing"},{"speaker":"Chris Dy","startTime":1133.49,"endTime":1136.37,"body":"that, you know, for those that"},{"speaker":"Chris Dy","startTime":1133.49,"endTime":1136.37,"body":"are listening in, if you're"},{"speaker":"Chris Dy","startTime":1136.37,"endTime":1140.3,"body":"ordering your nerf studies, it's"},{"speaker":"Chris Dy","startTime":1136.37,"endTime":1140.3,"body":"really hard to diagnose with"},{"speaker":"Chris Dy","startTime":1140.33,"endTime":1144.62,"body":"accuracy, distal owner tunnel"},{"speaker":"Chris Dy","startTime":1140.33,"endTime":1144.62,"body":"compression on a nerve study,"},{"speaker":"Chris Dy","startTime":1144.92,"endTime":1149.51,"body":"because you're relying a lot on"},{"speaker":"Chris Dy","startTime":1144.92,"endTime":1149.51,"body":"the, on the sensory component of"},{"speaker":"Chris Dy","startTime":1149.51,"endTime":1152.75,"body":"the nerve conduction studies. So"},{"speaker":"Chris Dy","startTime":1149.51,"endTime":1152.75,"body":"oftentimes, if you really want"},{"speaker":"Chris Dy","startTime":1152.75,"endTime":1157.01,"body":"to get a lot electrodiagnostic,"},{"speaker":"Chris Dy","startTime":1152.75,"endTime":1157.01,"body":"quote, evidence, compression at"},{"speaker":"Chris Dy","startTime":1157.01,"endTime":1161.57,"body":"the dishonor tunnel requesting a"},{"speaker":"Chris Dy","startTime":1157.01,"endTime":1161.57,"body":"contralateral assessment of that"},{"speaker":"Chris Dy","startTime":1161.57,"endTime":1164.27,"body":"particular component can be"},{"speaker":"Chris Dy","startTime":1161.57,"endTime":1164.27,"body":"useful. Now, obviously, you"},{"speaker":"Chris Dy","startTime":1164.27,"endTime":1166.07,"body":"don't want to do more to the"},{"speaker":"Chris Dy","startTime":1164.27,"endTime":1166.07,"body":"patient than you have to but if"},{"speaker":"Chris Dy","startTime":1166.07,"endTime":1168.59,"body":"you're trying to dial in on that"},{"speaker":"Chris Dy","startTime":1166.07,"endTime":1168.59,"body":"on your nerve study that is"},{"speaker":"Chris Dy","startTime":1168.59,"endTime":1172.1,"body":"useful. I would still argue that"},{"speaker":"Chris Dy","startTime":1168.59,"endTime":1172.1,"body":"that is more of a clinical"},{"speaker":"Chris Dy","startTime":1172.1,"endTime":1176.27,"body":"diagnosis, and maybe a"},{"speaker":"Chris Dy","startTime":1172.1,"endTime":1176.27,"body":"sonographic diagnosis that"},{"speaker":"Chris Dy","startTime":1176.27,"endTime":1179.84,"body":"electrodiagnostic one, but there"},{"speaker":"Chris Dy","startTime":1176.27,"endTime":1179.84,"body":"are a lot of camps or a lot of"},{"speaker":"Chris Dy","startTime":1179.84,"endTime":1183.05,"body":"thought out there as to whether"},{"speaker":"Chris Dy","startTime":1179.84,"endTime":1183.05,"body":"we're making too big of a deal"},{"speaker":"Chris Dy","startTime":1183.05,"endTime":1186.38,"body":"of releasing a nerve"},{"speaker":"Chris Dy","startTime":1183.05,"endTime":1186.38,"body":"prophylactically in whether the"},{"speaker":"Chris Dy","startTime":1186.38,"endTime":1187.97,"body":"nerve is actively compressed or"},{"speaker":"Chris Dy","startTime":1186.38,"endTime":1187.97,"body":"not."},{"speaker":"Charles Goldfarb","startTime":1188.96,"endTime":1190.43,"body":"I like that"},{"speaker":"Charles Goldfarb","startTime":1188.96,"endTime":1190.43,"body":"that's very helpful. And let's"},{"speaker":"Charles Goldfarb","startTime":1190.43,"endTime":1194.57,"body":"be very clear, this is the"},{"speaker":"Charles Goldfarb","startTime":1190.43,"endTime":1194.57,"body":"concept of performing a distal"},{"speaker":"Charles Goldfarb","startTime":1194.57,"endTime":1198.92,"body":"ulnar tunnel decompression is"},{"speaker":"Charles Goldfarb","startTime":1194.57,"endTime":1198.92,"body":"level five evidence but from you"},{"speaker":"Charles Goldfarb","startTime":1198.92,"endTime":1205.25,"body":"know, a number of Really good,"},{"speaker":"Charles Goldfarb","startTime":1198.92,"endTime":1205.25,"body":"highly thought of surgeons, but"},{"speaker":"Charles Goldfarb","startTime":1205.25,"endTime":1207.8,"body":"the science doesn't guide us"},{"speaker":"Charles Goldfarb","startTime":1205.25,"endTime":1207.8,"body":"now. I think the science would"},{"speaker":"Charles Goldfarb","startTime":1207.8,"endTime":1210.53,"body":"be hard pressed to guide us"},{"speaker":"Charles Goldfarb","startTime":1207.8,"endTime":1210.53,"body":"here. Is that your take?"},{"speaker":"Chris Dy","startTime":1210.77,"endTime":1213.41,"body":"Well, I mean, we're"},{"speaker":"Chris Dy","startTime":1210.77,"endTime":1213.41,"body":"kind of diverging from your case"},{"speaker":"Chris Dy","startTime":1213.41,"endTime":1216.74,"body":"here. But you know, I think that"},{"speaker":"Chris Dy","startTime":1213.41,"endTime":1216.74,"body":"the concept of a an injured"},{"speaker":"Chris Dy","startTime":1216.74,"endTime":1221.78,"body":"nerve swelling downstream is"},{"speaker":"Chris Dy","startTime":1216.74,"endTime":1221.78,"body":"based in a lot of really good"},{"speaker":"Chris Dy","startTime":1221.78,"endTime":1226.49,"body":"lab based science. It occurs in"},{"speaker":"Chris Dy","startTime":1221.78,"endTime":1226.49,"body":"rats. Now you make the argument,"},{"speaker":"Chris Dy","startTime":1226.64,"endTime":1229.16,"body":"right, that perhaps what happens"},{"speaker":"Chris Dy","startTime":1226.64,"endTime":1229.16,"body":"in rats doesn't happen in"},{"speaker":"Chris Dy","startTime":1229.16,"endTime":1233.0,"body":"humans. But I think that it does"},{"speaker":"Chris Dy","startTime":1229.16,"endTime":1233.0,"body":"occur. Now whether it reaches"},{"speaker":"Chris Dy","startTime":1233.0,"endTime":1236.18,"body":"the tipping point of actually"},{"speaker":"Chris Dy","startTime":1233.0,"endTime":1236.18,"body":"becoming clinically an issue is"},{"speaker":"Chris Dy","startTime":1236.18,"endTime":1239.15,"body":"a different argument. Now, if"},{"speaker":"Chris Dy","startTime":1236.18,"endTime":1239.15,"body":"you look at the literature in"},{"speaker":"Chris Dy","startTime":1239.15,"endTime":1241.82,"body":"humans for this particular"},{"speaker":"Chris Dy","startTime":1239.15,"endTime":1241.82,"body":"question that you're asking in"},{"speaker":"Chris Dy","startTime":1241.82,"endTime":1245.57,"body":"the setting of ulnar neuropathy,"},{"speaker":"Chris Dy","startTime":1241.82,"endTime":1245.57,"body":"something at the elbow, there"},{"speaker":"Chris Dy","startTime":1245.57,"endTime":1248.54,"body":"isn't great evidence for it."},{"speaker":"Chris Dy","startTime":1245.57,"endTime":1248.54,"body":"There are a couple of case"},{"speaker":"Chris Dy","startTime":1248.54,"endTime":1251.42,"body":"series. So I'd argue we're"},{"speaker":"Chris Dy","startTime":1248.54,"endTime":1251.42,"body":"pushing into level four evidence"},{"speaker":"Chris Dy","startTime":1251.87,"endTime":1256.55,"body":"for the comp supporting the"},{"speaker":"Chris Dy","startTime":1251.87,"endTime":1256.55,"body":"concept of distal decompression"},{"speaker":"Chris Dy","startTime":1256.55,"endTime":1259.55,"body":"helping in the setting of a"},{"speaker":"Chris Dy","startTime":1256.55,"endTime":1259.55,"body":"recovering nerve injury. And the"},{"speaker":"Chris Dy","startTime":1259.55,"endTime":1263.57,"body":"two case series I remember are"},{"speaker":"Chris Dy","startTime":1259.55,"endTime":1263.57,"body":"kind of a hodgepodge of various"},{"speaker":"Chris Dy","startTime":1263.57,"endTime":1266.57,"body":"peripheral nerves. So there's"},{"speaker":"Chris Dy","startTime":1263.57,"endTime":1266.57,"body":"nothing truly dialing in on this"},{"speaker":"Chris Dy","startTime":1266.57,"endTime":1270.86,"body":"question of ulnar nerves. So"},{"speaker":"Chris Dy","startTime":1266.57,"endTime":1270.86,"body":"like much in the literature, if"},{"speaker":"Chris Dy","startTime":1270.86,"endTime":1273.17,"body":"you believe in a concept and"},{"speaker":"Chris Dy","startTime":1270.86,"endTime":1273.17,"body":"want to believe that you can"},{"speaker":"Chris Dy","startTime":1273.17,"endTime":1276.92,"body":"find a paper to support what you"},{"speaker":"Chris Dy","startTime":1273.17,"endTime":1276.92,"body":"believe, if you don't believe in"},{"speaker":"Chris Dy","startTime":1276.92,"endTime":1279.86,"body":"the concept you can hate on the"},{"speaker":"Chris Dy","startTime":1276.92,"endTime":1279.86,"body":"literature and say there's not"},{"speaker":"Chris Dy","startTime":1279.86,"endTime":1282.95,"body":"enough evidence to support it."},{"speaker":"Chris Dy","startTime":1279.86,"endTime":1282.95,"body":"Just like you know, all those"},{"speaker":"Chris Dy","startTime":1282.95,"endTime":1285.89,"body":"papers that have been published"},{"speaker":"Chris Dy","startTime":1282.95,"endTime":1285.89,"body":"recently jbjs about whether or"},{"speaker":"Chris Dy","startTime":1285.89,"endTime":1288.68,"body":"not to fix this radius fracture,"},{"speaker":"Chris Dy","startTime":1285.89,"endTime":1288.68,"body":"so you can find an RCT to"},{"speaker":"Chris Dy","startTime":1288.68,"endTime":1289.4,"body":"support what you want."},{"speaker":"Charles Goldfarb","startTime":1290.06,"endTime":1293.66,"body":"For sure. So"},{"speaker":"Charles Goldfarb","startTime":1290.06,"endTime":1293.66,"body":"before I tell you what I did,"},{"speaker":"Charles Goldfarb","startTime":1293.69,"endTime":1295.91,"body":"I'm here if I'm hearing you"},{"speaker":"Charles Goldfarb","startTime":1293.69,"endTime":1295.91,"body":"correctly, and this injured"},{"speaker":"Charles Goldfarb","startTime":1295.91,"endTime":1298.64,"body":"worker and I'm saying this a"},{"speaker":"Charles Goldfarb","startTime":1295.91,"endTime":1298.64,"body":"little tongue in cheek, you're"},{"speaker":"Charles Goldfarb","startTime":1298.64,"endTime":1301.76,"body":"going to throw the kitchen sink"},{"speaker":"Charles Goldfarb","startTime":1298.64,"endTime":1301.76,"body":"at this patient. And so you are"},{"speaker":"Charles Goldfarb","startTime":1301.76,"endTime":1306.11,"body":"going to perform a submuscular a"},{"speaker":"Charles Goldfarb","startTime":1301.76,"endTime":1306.11,"body":"revision ulnar nerve"},{"speaker":"Charles Goldfarb","startTime":1306.11,"endTime":1310.07,"body":"transposition, you are likely"},{"speaker":"Charles Goldfarb","startTime":1306.11,"endTime":1310.07,"body":"going to perform a distal honor"},{"speaker":"Charles Goldfarb","startTime":1310.07,"endTime":1313.28,"body":"tunnel decompression. And are"},{"speaker":"Charles Goldfarb","startTime":1310.07,"endTime":1313.28,"body":"you going to also supercharge"},{"speaker":"Charles Goldfarb","startTime":1313.28,"endTime":1314.39,"body":"that nerve? Dr Dy?"},{"speaker":"Chris Dy","startTime":1314.78,"endTime":1318.32,"body":"100%. No on the"},{"speaker":"Chris Dy","startTime":1314.78,"endTime":1318.32,"body":"supercharge. You know, so base."},{"speaker":"Chris Dy","startTime":1318.56,"endTime":1322.4,"body":"This is the beef I have with"},{"speaker":"Chris Dy","startTime":1318.56,"endTime":1322.4,"body":"some of the supercharging fever"},{"speaker":"Chris Dy","startTime":1322.82,"endTime":1327.5,"body":"is I don't think that is"},{"speaker":"Chris Dy","startTime":1322.82,"endTime":1327.5,"body":"completely rooted in in the"},{"speaker":"Chris Dy","startTime":1327.5,"endTime":1330.98,"body":"indications that were originally"},{"speaker":"Chris Dy","startTime":1327.5,"endTime":1330.98,"body":"described. So some of the"},{"speaker":"Chris Dy","startTime":1330.98,"endTime":1333.8,"body":"prerequisites as I understand"},{"speaker":"Chris Dy","startTime":1330.98,"endTime":1333.8,"body":"them, and I think I've been"},{"speaker":"Chris Dy","startTime":1333.8,"endTime":1337.64,"body":"taught by Dr. McKinnon on this,"},{"speaker":"Chris Dy","startTime":1333.8,"endTime":1337.64,"body":"that, you know, you need to have"},{"speaker":"Chris Dy","startTime":1337.85,"endTime":1342.14,"body":"a nerve that is actively crying"},{"speaker":"Chris Dy","startTime":1337.85,"endTime":1342.14,"body":"or muscles supplied by that"},{"speaker":"Chris Dy","startTime":1342.14,"endTime":1345.14,"body":"nerve that are actively crying"},{"speaker":"Chris Dy","startTime":1342.14,"endTime":1345.14,"body":"for re innervation. So you need"},{"speaker":"Chris Dy","startTime":1345.14,"endTime":1348.62,"body":"something that's acutely Diener"},{"speaker":"Chris Dy","startTime":1345.14,"endTime":1348.62,"body":"rated. So you know you just the"},{"speaker":"Chris Dy","startTime":1348.62,"endTime":1350.48,"body":"way you describe the nerve"},{"speaker":"Chris Dy","startTime":1348.62,"endTime":1350.48,"body":"studies when I asked you are"},{"speaker":"Chris Dy","startTime":1350.48,"endTime":1353.27,"body":"there fibs in sharp waves, there"},{"speaker":"Chris Dy","startTime":1350.48,"endTime":1353.27,"body":"are no fibs and sharp waves"},{"speaker":"Chris Dy","startTime":1353.27,"endTime":1356.51,"body":"here. So this is not an acutely"},{"speaker":"Chris Dy","startTime":1353.27,"endTime":1356.51,"body":"denervated nerve. So"},{"speaker":"Chris Dy","startTime":1356.51,"endTime":1359.9,"body":"supercharging, this, that"},{"speaker":"Chris Dy","startTime":1356.51,"endTime":1359.9,"body":"whatever gets to the to the"},{"speaker":"Chris Dy","startTime":1359.9,"endTime":1362.81,"body":"distal on their motor component,"},{"speaker":"Chris Dy","startTime":1359.9,"endTime":1362.81,"body":"the distal on their motor"},{"speaker":"Chris Dy","startTime":1362.81,"endTime":1366.08,"body":"component is not asking for"},{"speaker":"Chris Dy","startTime":1362.81,"endTime":1366.08,"body":"help. Clinically, the muscles"},{"speaker":"Chris Dy","startTime":1366.08,"endTime":1368.81,"body":"are great. You've described that"},{"speaker":"Chris Dy","startTime":1366.08,"endTime":1368.81,"body":"the intrinsic strength is good."},{"speaker":"Chris Dy","startTime":1368.81,"endTime":1372.65,"body":"I'm presuming there's no"},{"speaker":"Chris Dy","startTime":1368.81,"endTime":1372.65,"body":"atrophy. So this is something"},{"speaker":"Chris Dy","startTime":1372.65,"endTime":1374.3,"body":"where I don't think you're going"},{"speaker":"Chris Dy","startTime":1372.65,"endTime":1374.3,"body":"to do a whole lot of good you"},{"speaker":"Chris Dy","startTime":1374.3,"endTime":1377.3,"body":"describe the motor amplitudes of"},{"speaker":"Chris Dy","startTime":1374.3,"endTime":1377.3,"body":"that owner nerve as being"},{"speaker":"Chris Dy","startTime":1377.3,"endTime":1381.08,"body":"normal. This is a healthy nerve,"},{"speaker":"Chris Dy","startTime":1377.3,"endTime":1381.08,"body":"it's just irritated at the elbow"},{"speaker":"Chris Dy","startTime":1381.14,"endTime":1384.08,"body":"and just needs to be put in a"},{"speaker":"Chris Dy","startTime":1381.14,"endTime":1384.08,"body":"place where it's not irritable"},{"speaker":"Chris Dy","startTime":1384.08,"endTime":1384.71,"body":"anymore."},{"speaker":"Charles Goldfarb","startTime":1385.76,"endTime":1390.08,"body":"Perfect,"},{"speaker":"Charles Goldfarb","startTime":1385.76,"endTime":1390.08,"body":"perfect. Okay, so failing time,"},{"speaker":"Charles Goldfarb","startTime":1390.59,"endTime":1394.19,"body":"failing conservative management,"},{"speaker":"Charles Goldfarb","startTime":1390.59,"endTime":1394.19,"body":"including therapy, anti"},{"speaker":"Charles Goldfarb","startTime":1394.19,"endTime":1398.21,"body":"inflammatories, but not the"},{"speaker":"Charles Goldfarb","startTime":1394.19,"endTime":1398.21,"body":"nerve modulators. And with"},{"speaker":"Charles Goldfarb","startTime":1398.21,"endTime":1400.04,"body":"approval from workers"},{"speaker":"Charles Goldfarb","startTime":1398.21,"endTime":1400.04,"body":"compensation, the patient was"},{"speaker":"Charles Goldfarb","startTime":1400.04,"endTime":1403.67,"body":"taken to the operating room, and"},{"speaker":"Charles Goldfarb","startTime":1400.04,"endTime":1403.67,"body":"a sub muscular transposition was"},{"speaker":"Charles Goldfarb","startTime":1403.67,"endTime":1409.28,"body":"performed. This was one of those"},{"speaker":"Charles Goldfarb","startTime":1403.67,"endTime":1409.28,"body":"challenging cases where her scar"},{"speaker":"Charles Goldfarb","startTime":1409.28,"endTime":1414.35,"body":"tissue was overwhelming. And so"},{"speaker":"Charles Goldfarb","startTime":1409.28,"endTime":1414.35,"body":"we use the same incision, I made"},{"speaker":"Charles Goldfarb","startTime":1414.35,"endTime":1417.77,"body":"my incision a little anterior to"},{"speaker":"Charles Goldfarb","startTime":1414.35,"endTime":1417.77,"body":"me like a con dial, we found the"},{"speaker":"Charles Goldfarb","startTime":1417.77,"endTime":1420.41,"body":"nerve, we extended our decision"},{"speaker":"Charles Goldfarb","startTime":1417.77,"endTime":1420.41,"body":"I made a you know, reasonable"},{"speaker":"Charles Goldfarb","startTime":1420.41,"endTime":1422.36,"body":"decision to start, but we made"},{"speaker":"Charles Goldfarb","startTime":1420.41,"endTime":1422.36,"body":"it a bit longer, we found"},{"speaker":"Charles Goldfarb","startTime":1422.36,"endTime":1427.25,"body":"healthy nerve approximately no"},{"speaker":"Charles Goldfarb","startTime":1422.36,"endTime":1427.25,"body":"pathology until we got directly"},{"speaker":"Charles Goldfarb","startTime":1427.28,"endTime":1430.67,"body":"over the flexor pronator mass."},{"speaker":"Charles Goldfarb","startTime":1427.28,"endTime":1430.67,"body":"And then we encountered scar"},{"speaker":"Charles Goldfarb","startTime":1430.67,"endTime":1435.62,"body":"tissue like we all dread,"},{"speaker":"Charles Goldfarb","startTime":1430.67,"endTime":1435.62,"body":"honestly. And we meticulously"},{"speaker":"Charles Goldfarb","startTime":1435.62,"endTime":1440.42,"body":"dissected and freed the nerve,"},{"speaker":"Charles Goldfarb","startTime":1435.62,"endTime":1440.42,"body":"honestly, with a cuff of some"},{"speaker":"Charles Goldfarb","startTime":1440.42,"endTime":1443.93,"body":"tissue, because I didn't feel"},{"speaker":"Charles Goldfarb","startTime":1440.42,"endTime":1443.93,"body":"there was any reason it wasn't"},{"speaker":"Charles Goldfarb","startTime":1443.96,"endTime":1450.2,"body":"circumferential. But we took"},{"speaker":"Charles Goldfarb","startTime":1443.96,"endTime":1450.2,"body":"some circum some of the abnormal"},{"speaker":"Charles Goldfarb","startTime":1450.2,"endTime":1453.47,"body":"scarring with the nerve and"},{"speaker":"Charles Goldfarb","startTime":1450.2,"endTime":1453.47,"body":"performed as the lengthening of"},{"speaker":"Charles Goldfarb","startTime":1453.47,"endTime":1456.8,"body":"the flexor printer mass, which"},{"speaker":"Charles Goldfarb","startTime":1453.47,"endTime":1456.8,"body":"I'd love your thoughts on Place"},{"speaker":"Charles Goldfarb","startTime":1456.8,"endTime":1461.45,"body":"the nerve in a nice position so"},{"speaker":"Charles Goldfarb","startTime":1456.8,"endTime":1461.45,"body":"muscularly and went about our"},{"speaker":"Charles Goldfarb","startTime":1461.45,"endTime":1463.55,"body":"business. So thoughts?"},{"speaker":"Chris Dy","startTime":1464.57,"endTime":1467.27,"body":"Um, well, you have no"},{"speaker":"Chris Dy","startTime":1464.57,"endTime":1467.27,"body":"one else but yourself to blame"},{"speaker":"Chris Dy","startTime":1467.27,"endTime":1468.89,"body":"for that scar. Because you did"},{"speaker":"Chris Dy","startTime":1467.27,"endTime":1468.89,"body":"the first"},{"speaker":"Charles Goldfarb","startTime":1470.03,"endTime":1471.95,"body":"amen, it is so"},{"speaker":"Charles Goldfarb","startTime":1470.03,"endTime":1471.95,"body":"true."},{"speaker":"Chris Dy","startTime":1472.67,"endTime":1476.06,"body":"You know, so I do. I"},{"speaker":"Chris Dy","startTime":1472.67,"endTime":1476.06,"body":"do a lot of revision surgery."},{"speaker":"Chris Dy","startTime":1476.9,"endTime":1479.66,"body":"It's actually funny when I was"},{"speaker":"Chris Dy","startTime":1476.9,"endTime":1479.66,"body":"coming out of training, I was"},{"speaker":"Chris Dy","startTime":1479.66,"endTime":1482.42,"body":"talking to Dr. McKinnon, about"},{"speaker":"Chris Dy","startTime":1479.66,"endTime":1482.42,"body":"the you know, doing all the"},{"speaker":"Chris Dy","startTime":1482.42,"endTime":1484.25,"body":"nerve transposition. So he's"},{"speaker":"Chris Dy","startTime":1482.42,"endTime":1484.25,"body":"like, Oh, yeah, don't worry,"},{"speaker":"Chris Dy","startTime":1484.25,"endTime":1486.59,"body":"Chris. You know, you're not"},{"speaker":"Chris Dy","startTime":1484.25,"endTime":1486.59,"body":"gonna do any revisions until"},{"speaker":"Chris Dy","startTime":1486.59,"endTime":1488.45,"body":"you're well into your practice,"},{"speaker":"Chris Dy","startTime":1486.59,"endTime":1488.45,"body":"you know, you're just going to"},{"speaker":"Chris Dy","startTime":1488.45,"endTime":1490.76,"body":"be doing primary. So here's how"},{"speaker":"Chris Dy","startTime":1488.45,"endTime":1490.76,"body":"you do a really good primary."},{"speaker":"Chris Dy","startTime":1490.76,"endTime":1492.74,"body":"She taught me how to do a great"},{"speaker":"Chris Dy","startTime":1490.76,"endTime":1492.74,"body":"primary ulnar nerve"},{"speaker":"Chris Dy","startTime":1492.74,"endTime":1496.46,"body":"transposition, as that all of"},{"speaker":"Chris Dy","startTime":1492.74,"endTime":1496.46,"body":"the other partners at our"},{"speaker":"Chris Dy","startTime":1496.46,"endTime":1499.82,"body":"orthopedic group, and then in my"},{"speaker":"Chris Dy","startTime":1496.46,"endTime":1499.82,"body":"clinic, the stuff that's coming"},{"speaker":"Chris Dy","startTime":1499.82,"endTime":1502.91,"body":"in revision on their nerve trace"},{"speaker":"Chris Dy","startTime":1499.82,"endTime":1502.91,"body":"positions just like anybody, I"},{"speaker":"Chris Dy","startTime":1502.91,"endTime":1507.32,"body":"guess, in an academic practice"},{"speaker":"Chris Dy","startTime":1502.91,"endTime":1507.32,"body":"with a niche, but I, you know, I"},{"speaker":"Chris Dy","startTime":1507.32,"endTime":1510.83,"body":"do a fair bit of revision on"},{"speaker":"Chris Dy","startTime":1507.32,"endTime":1510.83,"body":"nerve surgery. And it's, it's"},{"speaker":"Chris Dy","startTime":1510.86,"endTime":1513.26,"body":"always something where I look at"},{"speaker":"Chris Dy","startTime":1510.86,"endTime":1513.26,"body":"the trainee with me, I say,"},{"speaker":"Chris Dy","startTime":1513.26,"endTime":1517.88,"body":"look, I do revisions, I just,"},{"speaker":"Chris Dy","startTime":1513.26,"endTime":1517.88,"body":"you know, there's so many small"},{"speaker":"Chris Dy","startTime":1517.88,"endTime":1522.29,"body":"little micro decisions that are"},{"speaker":"Chris Dy","startTime":1517.88,"endTime":1522.29,"body":"made during the portions of"},{"speaker":"Chris Dy","startTime":1522.29,"endTime":1525.23,"body":"these cases where you're trying"},{"speaker":"Chris Dy","startTime":1522.29,"endTime":1525.23,"body":"to free up the nerve, where I"},{"speaker":"Chris Dy","startTime":1525.23,"endTime":1527.9,"body":"know that technically, you can"},{"speaker":"Chris Dy","startTime":1525.23,"endTime":1527.9,"body":"probably do this just as well as"},{"speaker":"Chris Dy","startTime":1527.9,"endTime":1530.48,"body":"I, but I want, I don't want you"},{"speaker":"Chris Dy","startTime":1527.9,"endTime":1530.48,"body":"to have any of the"},{"speaker":"Chris Dy","startTime":1530.48,"endTime":1534.47,"body":"responsibility of this. So or"},{"speaker":"Chris Dy","startTime":1530.48,"endTime":1534.47,"body":"feeling like you know, something"},{"speaker":"Chris Dy","startTime":1534.47,"endTime":1536.84,"body":"didn't go well. So I you know,"},{"speaker":"Chris Dy","startTime":1534.47,"endTime":1536.84,"body":"as much as I try to encourage"},{"speaker":"Chris Dy","startTime":1536.84,"endTime":1540.68,"body":"our trainees to, quote, hold the"},{"speaker":"Chris Dy","startTime":1536.84,"endTime":1540.68,"body":"knife. These are cases that I do"},{"speaker":"Chris Dy","startTime":1540.68,"endTime":1545.21,"body":"myself, at least at this point"},{"speaker":"Chris Dy","startTime":1540.68,"endTime":1545.21,"body":"in my career. And it's a tough"},{"speaker":"Chris Dy","startTime":1545.24,"endTime":1548.72,"body":"dissection. You know, I think"},{"speaker":"Chris Dy","startTime":1545.24,"endTime":1548.72,"body":"that for the trainees, there's a"},{"speaker":"Chris Dy","startTime":1548.72,"endTime":1551.87,"body":"lot to learn by, you know,"},{"speaker":"Chris Dy","startTime":1548.72,"endTime":1551.87,"body":"watching how to dissect and I,"},{"speaker":"Chris Dy","startTime":1552.38,"endTime":1554.66,"body":"at this point, I've evolved to"},{"speaker":"Chris Dy","startTime":1552.38,"endTime":1554.66,"body":"switching between different"},{"speaker":"Chris Dy","startTime":1554.66,"endTime":1557.36,"body":"modalities of dissection for"},{"speaker":"Chris Dy","startTime":1554.66,"endTime":1557.36,"body":"this I love the leaving the"},{"speaker":"Chris Dy","startTime":1557.36,"endTime":1562.34,"body":"cuff. I don't do this all with"},{"speaker":"Chris Dy","startTime":1557.36,"endTime":1562.34,"body":"tsunamis, you know, I use the I"},{"speaker":"Chris Dy","startTime":1562.34,"endTime":1565.07,"body":"love the fissure tsunamis that"},{"speaker":"Chris Dy","startTime":1562.34,"endTime":1565.07,"body":"are out there, they're great."},{"speaker":"Chris Dy","startTime":1565.43,"endTime":1569.27,"body":"Sometimes I take out an iris"},{"speaker":"Chris Dy","startTime":1565.43,"endTime":1569.27,"body":"tenotomy sometimes I use a 15"},{"speaker":"Chris Dy","startTime":1569.27,"endTime":1572.93,"body":"blade, sometimes I use a beaver"},{"speaker":"Chris Dy","startTime":1569.27,"endTime":1572.93,"body":"blade in the unis need to be"},{"speaker":"Chris Dy","startTime":1572.93,"endTime":1575.96,"body":"facile in different ways of"},{"speaker":"Chris Dy","startTime":1572.93,"endTime":1575.96,"body":"dissecting. Now, you know, the"},{"speaker":"Chris Dy","startTime":1575.96,"endTime":1579.29,"body":"concept of just spread, spread"},{"speaker":"Chris Dy","startTime":1575.96,"endTime":1579.29,"body":"spread until things pop open is"},{"speaker":"Chris Dy","startTime":1579.29,"endTime":1581.84,"body":"not the case here because what"},{"speaker":"Chris Dy","startTime":1579.29,"endTime":1581.84,"body":"you don't want to do is piss off"},{"speaker":"Chris Dy","startTime":1581.84,"endTime":1585.38,"body":"that nerve even more. And so"},{"speaker":"Chris Dy","startTime":1581.84,"endTime":1585.38,"body":"wide spreads. You know,"},{"speaker":"Chris Dy","startTime":1585.38,"endTime":1588.41,"body":"spreading quote, like a person"},{"speaker":"Chris Dy","startTime":1585.38,"endTime":1588.41,"body":"like one of our former mentors"},{"speaker":"Chris Dy","startTime":1588.41,"endTime":1592.61,"body":"used to tell us is not helpful"},{"speaker":"Chris Dy","startTime":1588.41,"endTime":1592.61,"body":"in this particular setting. Once"},{"speaker":"Chris Dy","startTime":1592.61,"endTime":1595.79,"body":"you've gotten your subcutaneous"},{"speaker":"Chris Dy","startTime":1592.61,"endTime":1595.79,"body":"tissue exposed, I love starting"},{"speaker":"Chris Dy","startTime":1595.79,"endTime":1598.82,"body":"proximately I love going"},{"speaker":"Chris Dy","startTime":1595.79,"endTime":1598.82,"body":"distally I don't I think"},{"speaker":"Chris Dy","startTime":1598.82,"endTime":1601.61,"body":"sometimes going distally can be"},{"speaker":"Chris Dy","startTime":1598.82,"endTime":1601.61,"body":"a little bit more difficult. I"},{"speaker":"Chris Dy","startTime":1601.61,"endTime":1604.16,"body":"like finding the nerve proximal"},{"speaker":"Chris Dy","startTime":1601.61,"endTime":1604.16,"body":"and finding healthy and then"},{"speaker":"Chris Dy","startTime":1604.16,"endTime":1607.04,"body":"starting rolling with my"},{"speaker":"Chris Dy","startTime":1604.16,"endTime":1607.04,"body":"dissection. Now if I'm starting"},{"speaker":"Chris Dy","startTime":1607.04,"endTime":1611.18,"body":"to meet some, if I'm not making"},{"speaker":"Chris Dy","startTime":1607.04,"endTime":1611.18,"body":"headway in my dissection because"},{"speaker":"Chris Dy","startTime":1611.18,"endTime":1613.82,"body":"I'm cutting scar, then I will"},{"speaker":"Chris Dy","startTime":1611.18,"endTime":1613.82,"body":"pivot and start dissecting out"},{"speaker":"Chris Dy","startTime":1613.82,"endTime":1616.46,"body":"the nerve distally in good"},{"speaker":"Chris Dy","startTime":1613.82,"endTime":1616.46,"body":"tissue just to give myself a way"},{"speaker":"Chris Dy","startTime":1616.46,"endTime":1619.55,"body":"to keep the case moving forward."},{"speaker":"Chris Dy","startTime":1616.46,"endTime":1619.55,"body":"And as you know, once you've"},{"speaker":"Chris Dy","startTime":1619.55,"endTime":1622.37,"body":"gotten that nerve kind of"},{"speaker":"Chris Dy","startTime":1619.55,"endTime":1622.37,"body":"mobilized proximately display"},{"speaker":"Chris Dy","startTime":1622.37,"endTime":1626.24,"body":"unhealthy nerve, so it's easier"},{"speaker":"Chris Dy","startTime":1622.37,"endTime":1626.24,"body":"to see your planes as much as"},{"speaker":"Chris Dy","startTime":1626.24,"endTime":1627.77,"body":"the scar tissue will give you at"},{"speaker":"Chris Dy","startTime":1626.24,"endTime":1627.77,"body":"least"},{"speaker":"Charles Goldfarb","startTime":1629.0,"endTime":1631.64,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1629.0,"endTime":1631.64,"body":"really well said, and certainly"},{"speaker":"Charles Goldfarb","startTime":1631.64,"endTime":1636.47,"body":"how I thought about it, how I"},{"speaker":"Charles Goldfarb","startTime":1631.64,"endTime":1636.47,"body":"approached it and do you this is"},{"speaker":"Charles Goldfarb","startTime":1636.5,"endTime":1639.23,"body":"a little bit of just technical"},{"speaker":"Charles Goldfarb","startTime":1636.5,"endTime":1639.23,"body":"but do you believe in the Z link"},{"speaker":"Charles Goldfarb","startTime":1639.23,"endTime":1641.84,"body":"thing, or do you just simply cut"},{"speaker":"Charles Goldfarb","startTime":1639.23,"endTime":1641.84,"body":"the flexor pronator mass and"},{"speaker":"Charles Goldfarb","startTime":1641.84,"endTime":1642.32,"body":"repair it?"},{"speaker":"Chris Dy","startTime":1642.8,"endTime":1646.07,"body":"Well, I in principle,"},{"speaker":"Chris Dy","startTime":1642.8,"endTime":1646.07,"body":"I go in every case, to Z,"},{"speaker":"Chris Dy","startTime":1646.07,"endTime":1649.52,"body":"lengthen the flexor pronator"},{"speaker":"Chris Dy","startTime":1646.07,"endTime":1649.52,"body":"mass and then release the flexor"},{"speaker":"Chris Dy","startTime":1649.52,"endTime":1652.91,"body":"pronator or z lengthen the"},{"speaker":"Chris Dy","startTime":1649.52,"endTime":1652.91,"body":"flexor pronator fashion and then"},{"speaker":"Chris Dy","startTime":1652.91,"endTime":1656.93,"body":"release the flexor pronator"},{"speaker":"Chris Dy","startTime":1652.91,"endTime":1656.93,"body":"muscle wherever it seems to make"},{"speaker":"Chris Dy","startTime":1656.93,"endTime":1660.68,"body":"sense for the nerve to lie. Now"},{"speaker":"Chris Dy","startTime":1656.93,"endTime":1660.68,"body":"when you're doing a primary"},{"speaker":"Chris Dy","startTime":1660.68,"endTime":1664.19,"body":"transposition, you you know tend"},{"speaker":"Chris Dy","startTime":1660.68,"endTime":1664.19,"body":"to see where the nerve wants to"},{"speaker":"Chris Dy","startTime":1664.19,"endTime":1666.95,"body":"lie. In a revision case that"},{"speaker":"Chris Dy","startTime":1664.19,"endTime":1666.95,"body":"nerve has been transposed for"},{"speaker":"Chris Dy","startTime":1666.95,"endTime":1670.25,"body":"however long it's it tends to"},{"speaker":"Chris Dy","startTime":1666.95,"endTime":1670.25,"body":"know where it wants to sit. And"},{"speaker":"Chris Dy","startTime":1670.25,"endTime":1674.03,"body":"your job is just just to let it"},{"speaker":"Chris Dy","startTime":1670.25,"endTime":1674.03,"body":"sit deeper. So sometimes I'll"},{"speaker":"Chris Dy","startTime":1674.03,"endTime":1676.94,"body":"release you know, I'll do a"},{"speaker":"Chris Dy","startTime":1674.03,"endTime":1676.94,"body":"lengthening of the fascia in the"},{"speaker":"Chris Dy","startTime":1676.94,"endTime":1680.42,"body":"Z manner. And then on the"},{"speaker":"Chris Dy","startTime":1676.94,"endTime":1680.42,"body":"muscle, I'll take it right off"},{"speaker":"Chris Dy","startTime":1680.42,"endTime":1683.39,"body":"the media because sometimes, or"},{"speaker":"Chris Dy","startTime":1680.42,"endTime":1683.39,"body":"I'll take a just off the media"},{"speaker":"Chris Dy","startTime":1683.39,"endTime":1687.41,"body":"because what I'm trying to avoid"},{"speaker":"Chris Dy","startTime":1683.39,"endTime":1687.41,"body":"now is that that chunk of"},{"speaker":"Chris Dy","startTime":1687.41,"endTime":1689.84,"body":"proximal muscle that's left on"},{"speaker":"Chris Dy","startTime":1687.41,"endTime":1689.84,"body":"the medial epicondyle,"},{"speaker":"Chris Dy","startTime":1689.87,"endTime":1695.57,"body":"potentially acting as an area to"},{"speaker":"Chris Dy","startTime":1689.87,"endTime":1695.57,"body":"create some omega type turns. So"},{"speaker":"Chris Dy","startTime":1695.57,"endTime":1698.9,"body":"I've started more to release it"},{"speaker":"Chris Dy","startTime":1695.57,"endTime":1698.9,"body":"off of the bone itself for the"},{"speaker":"Chris Dy","startTime":1698.9,"endTime":1703.61,"body":"muscle, not for the fascia,"},{"speaker":"Chris Dy","startTime":1698.9,"endTime":1703.61,"body":"obviously being mindful as you"},{"speaker":"Chris Dy","startTime":1703.61,"endTime":1707.54,"body":"had posterior about the medial"},{"speaker":"Chris Dy","startTime":1703.61,"endTime":1707.54,"body":"collateral ligament."},{"speaker":"Charles Goldfarb","startTime":1708.53,"endTime":1711.26,"body":"So I like how"},{"speaker":"Charles Goldfarb","startTime":1708.53,"endTime":1711.26,"body":"you worked at word omega into a"},{"speaker":"Charles Goldfarb","startTime":1711.26,"endTime":1716.93,"body":"really rest for you. Thank you."},{"speaker":"Charles Goldfarb","startTime":1711.26,"endTime":1716.93,"body":"Thank you. And do you always"},{"speaker":"Charles Goldfarb","startTime":1716.93,"endTime":1721.4,"body":"find the median nerve with a sub"},{"speaker":"Charles Goldfarb","startTime":1716.93,"endTime":1721.4,"body":"muscular? And is it your goal to"},{"speaker":"Charles Goldfarb","startTime":1721.4,"endTime":1724.34,"body":"have the ulnar nerve running"},{"speaker":"Charles Goldfarb","startTime":1721.4,"endTime":1724.34,"body":"parallel to the median nerve?"},{"speaker":"Chris Dy","startTime":1724.82,"endTime":1727.85,"body":"So again, to evoke our"},{"speaker":"Chris Dy","startTime":1724.82,"endTime":1727.85,"body":"partner Marnie Boyer, never say"},{"speaker":"Chris Dy","startTime":1727.85,"endTime":1732.35,"body":"never, never say always, I think"},{"speaker":"Chris Dy","startTime":1727.85,"endTime":1732.35,"body":"that's it. But yes, I find a"},{"speaker":"Chris Dy","startTime":1732.35,"endTime":1736.64,"body":"median nerve, I feel better, I"},{"speaker":"Chris Dy","startTime":1732.35,"endTime":1736.64,"body":"listen, nobody's perfect. But"},{"speaker":"Chris Dy","startTime":1736.64,"endTime":1741.56,"body":"given what I do, and who I say I"},{"speaker":"Chris Dy","startTime":1736.64,"endTime":1741.56,"body":"am, I feel like such a jerk if"},{"speaker":"Chris Dy","startTime":1741.56,"endTime":1743.27,"body":"something happened in the"},{"speaker":"Chris Dy","startTime":1741.56,"endTime":1743.27,"body":"meeting nerve, and I didn't at"},{"speaker":"Chris Dy","startTime":1743.27,"endTime":1746.66,"body":"least look at the median nerve"},{"speaker":"Chris Dy","startTime":1743.27,"endTime":1746.66,"body":"during the case, because I know"},{"speaker":"Chris Dy","startTime":1746.66,"endTime":1751.37,"body":"that it is at risk during the"},{"speaker":"Chris Dy","startTime":1746.66,"endTime":1751.37,"body":"muscular release of the for the"},{"speaker":"Chris Dy","startTime":1751.37,"endTime":1754.97,"body":"sub muscular transposition. So"},{"speaker":"Chris Dy","startTime":1751.37,"endTime":1754.97,"body":"you know, let's be honest, you"},{"speaker":"Chris Dy","startTime":1754.97,"endTime":1757.13,"body":"know, some muscular"},{"speaker":"Chris Dy","startTime":1754.97,"endTime":1757.13,"body":"transposition is a surgery that"},{"speaker":"Chris Dy","startTime":1757.13,"endTime":1759.77,"body":"has pretty substantial"},{"speaker":"Chris Dy","startTime":1757.13,"endTime":1759.77,"body":"morbidity. And you know, Ryan"},{"speaker":"Chris Dy","startTime":1759.77,"endTime":1765.71,"body":"shown that in some of his"},{"speaker":"Chris Dy","startTime":1759.77,"endTime":1765.71,"body":"papers, and it hurts, it bleeds"},{"speaker":"Chris Dy","startTime":1765.83,"endTime":1768.11,"body":"and these are things that you"},{"speaker":"Chris Dy","startTime":1765.83,"endTime":1768.11,"body":"know, you need to tell and I"},{"speaker":"Chris Dy","startTime":1768.11,"endTime":1770.66,"body":"know you do, but you need to"},{"speaker":"Chris Dy","startTime":1768.11,"endTime":1770.66,"body":"tell your patients ahead of time"},{"speaker":"Chris Dy","startTime":1770.66,"endTime":1774.26,"body":"when you're deciding what to do."},{"speaker":"Chris Dy","startTime":1770.66,"endTime":1774.26,"body":"To me, you know, I still, you"},{"speaker":"Chris Dy","startTime":1774.26,"endTime":1777.02,"body":"know, the three options for a"},{"speaker":"Chris Dy","startTime":1774.26,"endTime":1777.02,"body":"primary case are an insight to"},{"speaker":"Chris Dy","startTime":1777.26,"endTime":1780.26,"body":"decompression, a subcutaneous"},{"speaker":"Chris Dy","startTime":1777.26,"endTime":1780.26,"body":"transposition and a sub muscular"},{"speaker":"Chris Dy","startTime":1780.26,"endTime":1782.45,"body":"and I tried to guide them"},{"speaker":"Chris Dy","startTime":1780.26,"endTime":1782.45,"body":"through what each of those"},{"speaker":"Chris Dy","startTime":1782.87,"endTime":1785.81,"body":"surgeries will feel like based"},{"speaker":"Chris Dy","startTime":1782.87,"endTime":1785.81,"body":"on what patients have told me,"},{"speaker":"Chris Dy","startTime":1786.05,"endTime":1788.15,"body":"and then I'll tell them what I"},{"speaker":"Chris Dy","startTime":1786.05,"endTime":1788.15,"body":"think they need based on their"},{"speaker":"Chris Dy","startTime":1788.15,"endTime":1793.01,"body":"nerve. So it's not entirely"},{"speaker":"Chris Dy","startTime":1788.15,"endTime":1793.01,"body":"shared decision making, but I do"},{"speaker":"Chris Dy","startTime":1793.04,"endTime":1796.4,"body":"like to emphasize that a sub"},{"speaker":"Chris Dy","startTime":1793.04,"endTime":1796.4,"body":"muscular, while it is the most"},{"speaker":"Chris Dy","startTime":1796.4,"endTime":1799.52,"body":"definitive does carry some"},{"speaker":"Chris Dy","startTime":1796.4,"endTime":1799.52,"body":"morbidity with it."},{"speaker":"Charles Goldfarb","startTime":1800.54,"endTime":1803.39,"body":"Perfect. So as"},{"speaker":"Charles Goldfarb","startTime":1800.54,"endTime":1803.39,"body":"we kind of wrap this up, I have"},{"speaker":"Charles Goldfarb","startTime":1803.39,"endTime":1808.28,"body":"one final question. So you told"},{"speaker":"Charles Goldfarb","startTime":1803.39,"endTime":1808.28,"body":"me that it was my fault that the"},{"speaker":"Charles Goldfarb","startTime":1808.28,"endTime":1811.4,"body":"patient made a lot of scar"},{"speaker":"Charles Goldfarb","startTime":1808.28,"endTime":1811.4,"body":"tissue with the first surgery."},{"speaker":"Charles Goldfarb","startTime":1811.55,"endTime":1815.42,"body":"So how am I going to mitigate"},{"speaker":"Charles Goldfarb","startTime":1811.55,"endTime":1815.42,"body":"that with the second surgery? So"},{"speaker":"Charles Goldfarb","startTime":1816.11,"endTime":1818.78,"body":"when do you start therapy?"},{"speaker":"Charles Goldfarb","startTime":1816.11,"endTime":1818.78,"body":"Because that's the only thing I"},{"speaker":"Charles Goldfarb","startTime":1818.78,"endTime":1821.42,"body":"know to do is get that nerve"},{"speaker":"Charles Goldfarb","startTime":1818.78,"endTime":1821.42,"body":"gliding. How do you approach the"},{"speaker":"Charles Goldfarb","startTime":1821.42,"endTime":1821.69,"body":"post,"},{"speaker":"Chris Dy","startTime":1821.69,"endTime":1824.57,"body":"I said, everybody's"},{"speaker":"Chris Dy","startTime":1821.69,"endTime":1824.57,"body":"nerve scars. You know, the, when"},{"speaker":"Chris Dy","startTime":1824.57,"endTime":1827.51,"body":"I went on my diatribe about"},{"speaker":"Chris Dy","startTime":1824.57,"endTime":1827.51,"body":"starting and doing revision"},{"speaker":"Chris Dy","startTime":1827.51,"endTime":1831.5,"body":"surgery more than primary"},{"speaker":"Chris Dy","startTime":1827.51,"endTime":1831.5,"body":"surgery, my point was, I'm sure"},{"speaker":"Chris Dy","startTime":1831.5,"endTime":1834.17,"body":"I'm going to be revising some of"},{"speaker":"Chris Dy","startTime":1831.5,"endTime":1834.17,"body":"my own surgeries in the next"},{"speaker":"Chris Dy","startTime":1834.17,"endTime":1838.52,"body":"five to 10 years. So you know, I"},{"speaker":"Chris Dy","startTime":1834.17,"endTime":1838.52,"body":"will have nobody but myself to"},{"speaker":"Chris Dy","startTime":1838.52,"endTime":1843.77,"body":"blame for that scar. But be in"},{"speaker":"Chris Dy","startTime":1838.52,"endTime":1843.77,"body":"an effort to mitigate against"},{"speaker":"Chris Dy","startTime":1843.77,"endTime":1847.82,"body":"that all of my patients will"},{"speaker":"Chris Dy","startTime":1843.77,"endTime":1847.82,"body":"start moving in three days. And"},{"speaker":"Chris Dy","startTime":1847.82,"endTime":1852.08,"body":"that's something that, you know,"},{"speaker":"Chris Dy","startTime":1847.82,"endTime":1852.08,"body":"Dr. McKinnon taught me. And I"},{"speaker":"Chris Dy","startTime":1852.08,"endTime":1854.72,"body":"think that getting that nerve"},{"speaker":"Chris Dy","startTime":1852.08,"endTime":1854.72,"body":"gliding is the only way aside"},{"speaker":"Chris Dy","startTime":1854.72,"endTime":1857.12,"body":"from obviously, meticulous"},{"speaker":"Chris Dy","startTime":1854.72,"endTime":1857.12,"body":"surgical technique without"},{"speaker":"Chris Dy","startTime":1857.12,"endTime":1859.64,"body":"beating up the nerve without"},{"speaker":"Chris Dy","startTime":1857.12,"endTime":1859.64,"body":"posting against nerve is easier"},{"speaker":"Chris Dy","startTime":1859.64,"endTime":1862.73,"body":"to anonomys. Without huge, wide"},{"speaker":"Chris Dy","startTime":1859.64,"endTime":1862.73,"body":"spreads, when you don't need"},{"speaker":"Chris Dy","startTime":1862.73,"endTime":1865.28,"body":"huge wide spreads. You know,"},{"speaker":"Chris Dy","startTime":1862.73,"endTime":1865.28,"body":"when you're dissecting on a"},{"speaker":"Chris Dy","startTime":1865.28,"endTime":1869.18,"body":"nerve, to me, and you're trying"},{"speaker":"Chris Dy","startTime":1865.28,"endTime":1869.18,"body":"to free up that external"},{"speaker":"Chris Dy","startTime":1869.18,"endTime":1872.36,"body":"epithelium or the mesoneurium"},{"speaker":"Chris Dy","startTime":1869.18,"endTime":1872.36,"body":"around it, you just need to"},{"speaker":"Chris Dy","startTime":1872.36,"endTime":1874.85,"body":"spread the width of the nerve"},{"speaker":"Chris Dy","startTime":1872.36,"endTime":1874.85,"body":"spread once to see what you need"},{"speaker":"Chris Dy","startTime":1874.85,"endTime":1878.54,"body":"to cut and then cut that tissue."},{"speaker":"Chris Dy","startTime":1874.85,"endTime":1878.54,"body":"And that's when I can tell that"},{"speaker":"Chris Dy","startTime":1878.54,"endTime":1881.57,"body":"our trainees have kind of"},{"speaker":"Chris Dy","startTime":1878.54,"endTime":1881.57,"body":"mastered the cadence is when"},{"speaker":"Chris Dy","startTime":1881.6,"endTime":1884.45,"body":"they're not doing huge wide,"},{"speaker":"Chris Dy","startTime":1881.6,"endTime":1884.45,"body":"spreads two or three times over"},{"speaker":"Chris Dy","startTime":1884.45,"endTime":1886.79,"body":"the nerve. And they're just, you"},{"speaker":"Chris Dy","startTime":1884.45,"endTime":1886.79,"body":"know, spread, small spread,"},{"speaker":"Chris Dy","startTime":1886.79,"endTime":1889.94,"body":"cuts, small spread cut, it makes"},{"speaker":"Chris Dy","startTime":1886.79,"endTime":1889.94,"body":"me feel so good when I see them"},{"speaker":"Chris Dy","startTime":1889.94,"endTime":1892.28,"body":"do that, because I know that"},{"speaker":"Chris Dy","startTime":1889.94,"endTime":1892.28,"body":"they understand, you know, how"},{"speaker":"Chris Dy","startTime":1892.28,"endTime":1896.12,"body":"to be mindful of avoiding kind"},{"speaker":"Chris Dy","startTime":1892.28,"endTime":1896.12,"body":"of those blunt, big moves that"},{"speaker":"Chris Dy","startTime":1896.12,"endTime":1897.02,"body":"are going to cause scarring."},{"speaker":"Charles Goldfarb","startTime":1897.889,"endTime":1900.139,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1897.889,"endTime":1900.139,"body":"really well said, and and I"},{"speaker":"Charles Goldfarb","startTime":1900.139,"endTime":1904.999,"body":"worked with a younger resident"},{"speaker":"Charles Goldfarb","startTime":1900.139,"endTime":1904.999,"body":"yesterday. And, you know, it is"},{"speaker":"Charles Goldfarb","startTime":1904.999,"endTime":1908.179,"body":"a matter of applying your"},{"speaker":"Charles Goldfarb","startTime":1904.999,"endTime":1908.179,"body":"centerbrook technique in the"},{"speaker":"Charles Goldfarb","startTime":1908.179,"endTime":1910.789,"body":"right context. And I think"},{"speaker":"Charles Goldfarb","startTime":1908.179,"endTime":1910.789,"body":"that's what residents and all"},{"speaker":"Charles Goldfarb","startTime":1910.789,"endTime":1913.339,"body":"trainees learn, and you know,"},{"speaker":"Charles Goldfarb","startTime":1910.789,"endTime":1913.339,"body":"through the course of their"},{"speaker":"Charles Goldfarb","startTime":1913.339,"endTime":1915.949,"body":"training, and so, wide spreads"},{"speaker":"Charles Goldfarb","startTime":1913.339,"endTime":1915.949,"body":"are appropriate in certain"},{"speaker":"Charles Goldfarb","startTime":1915.949,"endTime":1919.549,"body":"locations. Very, very meticulous"},{"speaker":"Charles Goldfarb","startTime":1915.949,"endTime":1919.549,"body":"spreads are appropriate in other"},{"speaker":"Charles Goldfarb","startTime":1919.549,"endTime":1923.179,"body":"locations. So I think you said"},{"speaker":"Charles Goldfarb","startTime":1919.549,"endTime":1923.179,"body":"that really, really well. So"},{"speaker":"Charles Goldfarb","startTime":1923.179,"endTime":1926.149,"body":"just be clear, when do you send"},{"speaker":"Charles Goldfarb","startTime":1923.179,"endTime":1926.149,"body":"the patient to start their"},{"speaker":"Charles Goldfarb","startTime":1926.149,"endTime":1926.719,"body":"therapy?"},{"speaker":"Chris Dy","startTime":1927.53,"endTime":1930.68,"body":"Three days. So my"},{"speaker":"Chris Dy","startTime":1927.53,"endTime":1930.68,"body":"protocol for these is I leave a"},{"speaker":"Chris Dy","startTime":1930.68,"endTime":1934.34,"body":"drain, especially revision, they"},{"speaker":"Chris Dy","startTime":1930.68,"endTime":1934.34,"body":"come back in three days to see"},{"speaker":"Chris Dy","startTime":1934.34,"endTime":1938.54,"body":"me in the office, we've removed"},{"speaker":"Chris Dy","startTime":1934.34,"endTime":1938.54,"body":"the drain, and we send them to"},{"speaker":"Chris Dy","startTime":1938.54,"endTime":1941.6,"body":"therapy, fortunate enough to"},{"speaker":"Chris Dy","startTime":1938.54,"endTime":1941.6,"body":"have great therapy partners who"},{"speaker":"Chris Dy","startTime":1941.6,"endTime":1946.49,"body":"are in office, who can fabricate"},{"speaker":"Chris Dy","startTime":1941.6,"endTime":1946.49,"body":"splints, and start them moving"},{"speaker":"Chris Dy","startTime":1946.52,"endTime":1949.85,"body":"in gently initially, but just"},{"speaker":"Chris Dy","startTime":1946.52,"endTime":1949.85,"body":"getting that nerve moving. And"},{"speaker":"Chris Dy","startTime":1949.85,"endTime":1952.7,"body":"then I will see them back in"},{"speaker":"Chris Dy","startTime":1949.85,"endTime":1952.7,"body":"three weeks. The sutures will"},{"speaker":"Chris Dy","startTime":1952.7,"endTime":1955.55,"body":"typically come out at the"},{"speaker":"Chris Dy","startTime":1952.7,"endTime":1955.55,"body":"therapist office, if it's with a"},{"speaker":"Chris Dy","startTime":1955.55,"endTime":1958.82,"body":"therapist that I work with"},{"speaker":"Chris Dy","startTime":1955.55,"endTime":1958.82,"body":"routinely, which I've got, I'm"},{"speaker":"Chris Dy","startTime":1958.82,"endTime":1961.88,"body":"fortunate enough to have that"},{"speaker":"Chris Dy","startTime":1958.82,"endTime":1961.88,"body":"relationship. And that's just to"},{"speaker":"Chris Dy","startTime":1961.88,"endTime":1965.06,"body":"make things more efficient in"},{"speaker":"Chris Dy","startTime":1961.88,"endTime":1965.06,"body":"terms of office flow. How about"},{"speaker":"Chris Dy","startTime":1965.06,"endTime":1965.84,"body":"what's your protocol?"},{"speaker":"Charles Goldfarb","startTime":1966.44,"endTime":1968.42,"body":"Yeah, I don't,"},{"speaker":"Charles Goldfarb","startTime":1966.44,"endTime":1968.42,"body":"I'm not sure anyone cares. They"},{"speaker":"Charles Goldfarb","startTime":1968.42,"endTime":1970.61,"body":"just want your protocol. But"},{"speaker":"Charles Goldfarb","startTime":1968.42,"endTime":1970.61,"body":"I'll share my protocol, and I'll"},{"speaker":"Charles Goldfarb","startTime":1970.61,"endTime":1976.55,"body":"share a pearl. So my protocol is"},{"speaker":"Charles Goldfarb","startTime":1970.61,"endTime":1976.55,"body":"they my patients see therapy, at"},{"speaker":"Charles Goldfarb","startTime":1976.55,"endTime":1980.3,"body":"five to seven days, there is no"},{"speaker":"Charles Goldfarb","startTime":1976.55,"endTime":1980.3,"body":"drain, although I deflate the"},{"speaker":"Charles Goldfarb","startTime":1980.3,"endTime":1983.21,"body":"tourniquet prior to final skin"},{"speaker":"Charles Goldfarb","startTime":1980.3,"endTime":1983.21,"body":"closure to minimize risks there"},{"speaker":"Charles Goldfarb","startTime":1983.21,"endTime":1986.27,"body":"and knock on wood have not had a"},{"speaker":"Charles Goldfarb","startTime":1983.21,"endTime":1986.27,"body":"major issue. I see them back in"},{"speaker":"Charles Goldfarb","startTime":1986.27,"endTime":1990.14,"body":"12 days to take out stitches, if"},{"speaker":"Charles Goldfarb","startTime":1986.27,"endTime":1990.14,"body":"I put in removable stitches and"},{"speaker":"Charles Goldfarb","startTime":1990.14,"endTime":1993.41,"body":"go from there. My pearl is for"},{"speaker":"Charles Goldfarb","startTime":1990.14,"endTime":1993.41,"body":"those of you who are starting a"},{"speaker":"Charles Goldfarb","startTime":1993.41,"endTime":1996.14,"body":"practice or considering a"},{"speaker":"Charles Goldfarb","startTime":1993.41,"endTime":1996.14,"body":"practice, whether it be nerve or"},{"speaker":"Charles Goldfarb","startTime":1996.17,"endTime":1999.8,"body":"anything, I think Chris has"},{"speaker":"Charles Goldfarb","startTime":1996.17,"endTime":1999.8,"body":"really done a few really smart"},{"speaker":"Charles Goldfarb","startTime":1999.8,"endTime":2003.94,"body":"things. And the main issue is we"},{"speaker":"Charles Goldfarb","startTime":1999.8,"endTime":2003.94,"body":"all want to build a practice"},{"speaker":"Charles Goldfarb","startTime":2004.03,"endTime":2007.24,"body":"that, you know, well. Many of us"},{"speaker":"Charles Goldfarb","startTime":2004.03,"endTime":2007.24,"body":"want to build a practice that"},{"speaker":"Charles Goldfarb","startTime":2007.24,"endTime":2011.47,"body":"has a niche component, something"},{"speaker":"Charles Goldfarb","startTime":2007.24,"endTime":2011.47,"body":"that really interests you. And"},{"speaker":"Charles Goldfarb","startTime":2011.47,"endTime":2014.89,"body":"whether that's congenital or"},{"speaker":"Charles Goldfarb","startTime":2011.47,"endTime":2014.89,"body":"sports or nerve or whatever. And"},{"speaker":"Charles Goldfarb","startTime":2014.89,"endTime":2017.32,"body":"I think what Chris has done"},{"speaker":"Charles Goldfarb","startTime":2014.89,"endTime":2017.32,"body":"really well as he has just said"},{"speaker":"Charles Goldfarb","startTime":2017.32,"endTime":2022.48,"body":"yes to all referrals. And so,"},{"speaker":"Charles Goldfarb","startTime":2017.32,"endTime":2022.48,"body":"you know, I'm sure Chris has no"},{"speaker":"Charles Goldfarb","startTime":2022.48,"endTime":2024.7,"body":"desire to see some of the"},{"speaker":"Charles Goldfarb","startTime":2022.48,"endTime":2024.7,"body":"patients I sent to him. But he's"},{"speaker":"Charles Goldfarb","startTime":2024.7,"endTime":2027.97,"body":"made it very clear that he will"},{"speaker":"Charles Goldfarb","startTime":2024.7,"endTime":2027.97,"body":"see anything and everything"},{"speaker":"Charles Goldfarb","startTime":2027.97,"endTime":2030.79,"body":"that's potentially nerve"},{"speaker":"Charles Goldfarb","startTime":2027.97,"endTime":2030.79,"body":"related. And that opens the"},{"speaker":"Charles Goldfarb","startTime":2030.79,"endTime":2034.72,"body":"door, it makes me really want to"},{"speaker":"Charles Goldfarb","startTime":2030.79,"endTime":2034.72,"body":"send him all patients, just like"},{"speaker":"Charles Goldfarb","startTime":2034.72,"endTime":2037.84,"body":"I know other people in the"},{"speaker":"Charles Goldfarb","startTime":2034.72,"endTime":2037.84,"body":"community feel the same way. And"},{"speaker":"Charles Goldfarb","startTime":2037.84,"endTime":2041.41,"body":"so if you're building a"},{"speaker":"Charles Goldfarb","startTime":2037.84,"endTime":2041.41,"body":"practice, you can't be super"},{"speaker":"Charles Goldfarb","startTime":2041.41,"endTime":2044.68,"body":"selective to start. And I think"},{"speaker":"Charles Goldfarb","startTime":2041.41,"endTime":2044.68,"body":"Chris, you've done it that"},{"speaker":"Charles Goldfarb","startTime":2044.68,"endTime":2047.26,"body":"really well. And that's why you"},{"speaker":"Charles Goldfarb","startTime":2044.68,"endTime":2047.26,"body":"have a thriving nursing practice"},{"speaker":"Charles Goldfarb","startTime":2047.29,"endTime":2047.74,"body":"already."},{"speaker":"Chris Dy","startTime":2048.25,"endTime":2051.16,"body":"I appreciate you"},{"speaker":"Chris Dy","startTime":2048.25,"endTime":2051.16,"body":"saying that. You know, I guess"},{"speaker":"Chris Dy","startTime":2051.19,"endTime":2055.78,"body":"one example of that is, you"},{"speaker":"Chris Dy","startTime":2051.19,"endTime":2055.78,"body":"know, just a very small"},{"speaker":"Chris Dy","startTime":2056.29,"endTime":2059.86,"body":"component is Thoracic Outlet"},{"speaker":"Chris Dy","startTime":2056.29,"endTime":2059.86,"body":"Syndrome. I believe a lot of"},{"speaker":"Chris Dy","startTime":2059.86,"endTime":2062.74,"body":"Thoracic Outlet Syndrome is"},{"speaker":"Chris Dy","startTime":2059.86,"endTime":2062.74,"body":"treated non operatively. A"},{"speaker":"Chris Dy","startTime":2062.74,"endTime":2066.4,"body":"Thoracic Outlet Syndrome is over"},{"speaker":"Chris Dy","startTime":2062.74,"endTime":2066.4,"body":"diagnosed, or perhaps over"},{"speaker":"Chris Dy","startTime":2066.4,"endTime":2070.06,"body":"treated in a surgical manner in"},{"speaker":"Chris Dy","startTime":2066.4,"endTime":2070.06,"body":"my opinion. Do I love seeing"},{"speaker":"Chris Dy","startTime":2070.06,"endTime":2072.7,"body":"Thoracic Outlet Syndrome"},{"speaker":"Chris Dy","startTime":2070.06,"endTime":2072.7,"body":"patients not particular, it"},{"speaker":"Chris Dy","startTime":2072.7,"endTime":2076.03,"body":"doesn't really bring me joy. You"},{"speaker":"Chris Dy","startTime":2072.7,"endTime":2076.03,"body":"know, I like I like honing my"},{"speaker":"Chris Dy","startTime":2076.03,"endTime":2079.93,"body":"exam. But it is something that"},{"speaker":"Chris Dy","startTime":2076.03,"endTime":2079.93,"body":"in terms of if you look at it"},{"speaker":"Chris Dy","startTime":2079.93,"endTime":2084.79,"body":"purely as a, you know, case to"},{"speaker":"Chris Dy","startTime":2079.93,"endTime":2084.79,"body":"new patient evaluation ratio"},{"speaker":"Chris Dy","startTime":2084.79,"endTime":2087.49,"body":"payoff, not good. Because I"},{"speaker":"Chris Dy","startTime":2084.79,"endTime":2087.49,"body":"don't operate a lot on these"},{"speaker":"Chris Dy","startTime":2087.49,"endTime":2090.43,"body":"people. They end up doing really"},{"speaker":"Chris Dy","startTime":2087.49,"endTime":2090.43,"body":"well with their therapy"},{"speaker":"Chris Dy","startTime":2090.43,"endTime":2094.21,"body":"colleagues. But I'll take the"},{"speaker":"Chris Dy","startTime":2090.43,"endTime":2094.21,"body":"TOS referral because it'll get"},{"speaker":"Chris Dy","startTime":2094.21,"endTime":2097.93,"body":"me the Plexus referral. And I'm"},{"speaker":"Chris Dy","startTime":2094.21,"endTime":2097.93,"body":"okay with that. And I feel like"},{"speaker":"Chris Dy","startTime":2097.93,"endTime":2100.42,"body":"that's been the case because"},{"speaker":"Chris Dy","startTime":2097.93,"endTime":2100.42,"body":"I've had some referring Um,"},{"speaker":"Chris Dy","startTime":2100.45,"endTime":2103.48,"body":"physicians, you know, from two"},{"speaker":"Chris Dy","startTime":2100.45,"endTime":2103.48,"body":"or three hours away who have"},{"speaker":"Chris Dy","startTime":2103.48,"endTime":2106.36,"body":"sent me to us case and then send"},{"speaker":"Chris Dy","startTime":2103.48,"endTime":2106.36,"body":"me a Plexus injury. So I will"},{"speaker":"Chris Dy","startTime":2106.36,"endTime":2109.3,"body":"take all of those TLS cases just"},{"speaker":"Chris Dy","startTime":2106.36,"endTime":2109.3,"body":"because I want to do the Plexus"},{"speaker":"Chris Dy","startTime":2109.3,"endTime":2109.66,"body":"stuff."},{"speaker":"Charles Goldfarb","startTime":2109.75,"endTime":2112.24,"body":"So,"},{"speaker":"Charles Goldfarb","startTime":2109.75,"endTime":2112.24,"body":"absolutely. Well said Well said."},{"speaker":"Charles Goldfarb","startTime":2112.39,"endTime":2117.85,"body":"any final comments as we close"},{"speaker":"Charles Goldfarb","startTime":2112.39,"endTime":2117.85,"body":"our first my hardest recent case"},{"speaker":"Charles Goldfarb","startTime":2117.85,"endTime":2118.9,"body":"to segment?"},{"speaker":"Chris Dy","startTime":2119.05,"endTime":2122.47,"body":"Well, I you know, as"},{"speaker":"Chris Dy","startTime":2119.05,"endTime":2122.47,"body":"they say, and many podiums,"},{"speaker":"Chris Dy","startTime":2122.47,"endTime":2126.22,"body":"nothing ruins a good surgery,"},{"speaker":"Chris Dy","startTime":2122.47,"endTime":2126.22,"body":"like follow up. So I want to see"},{"speaker":"Chris Dy","startTime":2126.22,"endTime":2129.52,"body":"how this patient does over time,"},{"speaker":"Chris Dy","startTime":2126.22,"endTime":2129.52,"body":"whenever you can safely tell us,"},{"speaker":"Chris Dy","startTime":2130.54,"endTime":2133.57,"body":"you know, that'd be great to do"},{"speaker":"Chris Dy","startTime":2130.54,"endTime":2133.57,"body":"an update. Maybe if we remind"},{"speaker":"Chris Dy","startTime":2133.57,"endTime":2135.97,"body":"each other we can update each"},{"speaker":"Chris Dy","startTime":2133.57,"endTime":2135.97,"body":"other on the cases. So next"},{"speaker":"Chris Dy","startTime":2135.97,"endTime":2138.58,"body":"time, I'm on the hot seat for a"},{"speaker":"Chris Dy","startTime":2135.97,"endTime":2138.58,"body":"hard case. So I'm looking"},{"speaker":"Chris Dy","startTime":2138.58,"endTime":2139.39,"body":"forward to doing that."},{"speaker":"Charles Goldfarb","startTime":2140.02,"endTime":2141.52,"body":"Outstanding."},{"speaker":"Charles Goldfarb","startTime":2140.02,"endTime":2141.52,"body":"Well have a great day. This was"},{"speaker":"Charles Goldfarb","startTime":2141.52,"endTime":2143.62,"body":"fun, and I look forward to the"},{"speaker":"Charles Goldfarb","startTime":2141.52,"endTime":2143.62,"body":"next recording."},{"speaker":"Chris Dy","startTime":2143.8,"endTime":2145.66,"body":"You too. Take care."},{"speaker":"Chris Dy","startTime":2143.8,"endTime":2145.66,"body":"Bye bye."}]}