{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.769,"endTime":13.349,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.769,"endTime":13.349,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.349,"endTime":14.459,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.78,"endTime":16.55,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.78,"endTime":16.55,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.55,"endTime":19.64,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.55,"endTime":19.64,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.64,"endTime":21.47,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.64,"endTime":21.47,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.049,"endTime":24.329,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.049,"endTime":24.329,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.329,"endTime":25.229,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.439,"endTime":27.659,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.439,"endTime":27.659,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.659,"endTime":28.169,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.32,"endTime":29.28,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.32,"endTime":29.28,"body":"Chris."},{"speaker":"Chris Dy","startTime":30.059,"endTime":31.019,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":30.059,"endTime":31.019,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.24,"endTime":33.19,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":31.24,"endTime":33.19,"body":"great. It's a beautiful day in"},{"speaker":"Charles Goldfarb","startTime":33.19,"endTime":36.16,"body":"St. Louis, you know, recording a"},{"speaker":"Charles Goldfarb","startTime":33.19,"endTime":36.16,"body":"podcast, what could be better."},{"speaker":"Chris Dy","startTime":36.55,"endTime":38.5,"body":"It is at the very"},{"speaker":"Chris Dy","startTime":36.55,"endTime":38.5,"body":"least, I mean, we're doing it"},{"speaker":"Chris Dy","startTime":38.5,"endTime":41.26,"body":"inside. But both of us have"},{"speaker":"Chris Dy","startTime":38.5,"endTime":41.26,"body":"sunlight in the background,"},{"speaker":"Chris Dy","startTime":41.26,"endTime":44.38,"body":"which is awesome. So that's,"},{"speaker":"Chris Dy","startTime":41.26,"endTime":44.38,"body":"that's a win. That's a win."},{"speaker":"Charles Goldfarb","startTime":44.78,"endTime":46.97,"body":"Yeah, it won't"},{"speaker":"Charles Goldfarb","startTime":44.78,"endTime":46.97,"body":"be the case at 5pm when it's"},{"speaker":"Charles Goldfarb","startTime":46.97,"endTime":49.46,"body":"pitch black out, but we'll enjoy"},{"speaker":"Charles Goldfarb","startTime":46.97,"endTime":49.46,"body":"it while it lasts."},{"speaker":"Chris Dy","startTime":49.679,"endTime":51.719,"body":"That's okay. I'll take"},{"speaker":"Chris Dy","startTime":49.679,"endTime":51.719,"body":"that. I mean, you know, so in"},{"speaker":"Chris Dy","startTime":51.719,"endTime":54.779,"body":"the new neighborhood now, we go"},{"speaker":"Chris Dy","startTime":51.719,"endTime":54.779,"body":"to the same church we went"},{"speaker":"Chris Dy","startTime":54.779,"endTime":56.849,"body":"through before, but now we're"},{"speaker":"Chris Dy","startTime":54.779,"endTime":56.849,"body":"able to walk to the church. So"},{"speaker":"Chris Dy","startTime":56.849,"endTime":60.389,"body":"that was our morning time out to"},{"speaker":"Chris Dy","startTime":56.849,"endTime":60.389,"body":"the outside time in the morning,"},{"speaker":"Chris Dy","startTime":60.779,"endTime":63.599,"body":"my son's got a a soccer game"},{"speaker":"Chris Dy","startTime":60.779,"endTime":63.599,"body":"coming up in about an hour and a"},{"speaker":"Chris Dy","startTime":63.599,"endTime":67.109,"body":"half. So I'll be outside as"},{"speaker":"Chris Dy","startTime":63.599,"endTime":67.109,"body":"well. It's a beautiful 60"},{"speaker":"Chris Dy","startTime":67.109,"endTime":70.079,"body":"degrees here in St. Louis, and"},{"speaker":"Chris Dy","startTime":67.109,"endTime":70.079,"body":"sunny. And it's amazing."},{"speaker":"Charles Goldfarb","startTime":70.589,"endTime":72.659,"body":"That is"},{"speaker":"Charles Goldfarb","startTime":70.589,"endTime":72.659,"body":"awesome. Although if I'm"},{"speaker":"Charles Goldfarb","startTime":72.659,"endTime":75.209,"body":"remembering correctly, it's"},{"speaker":"Charles Goldfarb","startTime":72.659,"endTime":75.209,"body":"pretty much straight uphill to"},{"speaker":"Charles Goldfarb","startTime":75.209,"endTime":78.119,"body":"get to church, I imagine the"},{"speaker":"Charles Goldfarb","startTime":75.209,"endTime":78.119,"body":"walk home is a little more"},{"speaker":"Charles Goldfarb","startTime":78.119,"endTime":78.659,"body":"enjoyable."},{"speaker":"Chris Dy","startTime":79.47,"endTime":81.54,"body":"Oh, it's not that"},{"speaker":"Chris Dy","startTime":79.47,"endTime":81.54,"body":"long. I mean, you know, so we"},{"speaker":"Chris Dy","startTime":81.54,"endTime":87.36,"body":"have this mantra in our family"},{"speaker":"Chris Dy","startTime":81.54,"endTime":87.36,"body":"that's at your, at your urging,"},{"speaker":"Chris Dy","startTime":87.36,"endTime":89.79,"body":"I read that book that Clayton"},{"speaker":"Chris Dy","startTime":87.36,"endTime":89.79,"body":"Christensen book, how you"},{"speaker":"Chris Dy","startTime":89.79,"endTime":92.16,"body":"measure your life, and he talks"},{"speaker":"Chris Dy","startTime":89.79,"endTime":92.16,"body":"about mantras. So we developed a"},{"speaker":"Chris Dy","startTime":92.16,"endTime":95.22,"body":"mantra about two years ago,"},{"speaker":"Chris Dy","startTime":92.16,"endTime":95.22,"body":"whatever, a year and a half ago,"},{"speaker":"Chris Dy","startTime":95.22,"endTime":99.27,"body":"that's we are kind patient and"},{"speaker":"Chris Dy","startTime":95.22,"endTime":99.27,"body":"respectful in our family and the"},{"speaker":"Chris Dy","startTime":99.27,"endTime":101.64,"body":"number of times that the kids"},{"speaker":"Chris Dy","startTime":99.27,"endTime":101.64,"body":"have heard us say that. And I"},{"speaker":"Chris Dy","startTime":101.64,"endTime":104.52,"body":"honestly have to remind myself"},{"speaker":"Chris Dy","startTime":101.64,"endTime":104.52,"body":"that when I'm having a tough"},{"speaker":"Chris Dy","startTime":104.52,"endTime":107.88,"body":"time at work, that I am kind"},{"speaker":"Chris Dy","startTime":104.52,"endTime":107.88,"body":"patient and respectful as part"},{"speaker":"Chris Dy","startTime":107.88,"endTime":111.45,"body":"of this family. But you know, we"},{"speaker":"Chris Dy","startTime":107.88,"endTime":111.45,"body":"were doing something yesterday,"},{"speaker":"Chris Dy","startTime":111.48,"endTime":114.9,"body":"and Rafi didn't want to do"},{"speaker":"Chris Dy","startTime":111.48,"endTime":114.9,"body":"something because it was hard."},{"speaker":"Chris Dy","startTime":114.9,"endTime":117.9,"body":"And my wife was like, you know,"},{"speaker":"Chris Dy","startTime":114.9,"endTime":117.9,"body":"we do hard things in this"},{"speaker":"Chris Dy","startTime":117.9,"endTime":120.36,"body":"family. She's like, maybe we"},{"speaker":"Chris Dy","startTime":117.9,"endTime":120.36,"body":"should add that to the mantra."},{"speaker":"Chris Dy","startTime":120.54,"endTime":122.85,"body":"So we are kind patient"},{"speaker":"Chris Dy","startTime":120.54,"endTime":122.85,"body":"respectful, and we do hard"},{"speaker":"Chris Dy","startTime":122.85,"endTime":126.21,"body":"things. I don't know if we can"},{"speaker":"Chris Dy","startTime":122.85,"endTime":126.21,"body":"change the sign that our nanny"},{"speaker":"Chris Dy","startTime":126.21,"endTime":127.11,"body":"last year made us."},{"speaker":"Charles Goldfarb","startTime":127.68,"endTime":129.96,"body":"That is really"},{"speaker":"Charles Goldfarb","startTime":127.68,"endTime":129.96,"body":"funny. Bring in a little"},{"speaker":"Charles Goldfarb","startTime":129.96,"endTime":131.13,"body":"Peleton."},{"speaker":"Chris Dy","startTime":131.58,"endTime":133.38,"body":"You know, I guess"},{"speaker":"Chris Dy","startTime":131.58,"endTime":133.38,"body":"that's where it came from. It's"},{"speaker":"Chris Dy","startTime":133.38,"endTime":137.52,"body":"got to have come from there. But"},{"speaker":"Chris Dy","startTime":133.38,"endTime":137.52,"body":"yeah, so the walk uphill is not"},{"speaker":"Chris Dy","startTime":137.52,"endTime":140.37,"body":"bad. It was a beautiful day. I"},{"speaker":"Chris Dy","startTime":137.52,"endTime":140.37,"body":"actually was thinking on the way"},{"speaker":"Chris Dy","startTime":140.37,"endTime":143.49,"body":"home, I was like this might be"},{"speaker":"Chris Dy","startTime":140.37,"endTime":143.49,"body":"kind of painful. Come February,"},{"speaker":"Chris Dy","startTime":143.49,"endTime":146.88,"body":"if there's ice and snow. I was"},{"speaker":"Chris Dy","startTime":143.49,"endTime":146.88,"body":"like maybe will drive then, but"},{"speaker":"Chris Dy","startTime":146.88,"endTime":149.04,"body":"it really isn't very far. So"},{"speaker":"Chris Dy","startTime":146.88,"endTime":149.04,"body":"it's nice."},{"speaker":"Charles Goldfarb","startTime":149.34,"endTime":151.2,"body":"I love it. I"},{"speaker":"Charles Goldfarb","startTime":149.34,"endTime":151.2,"body":"love it. I'm glad you're"},{"speaker":"Charles Goldfarb","startTime":151.23,"endTime":154.14,"body":"settling into the new hood and"},{"speaker":"Charles Goldfarb","startTime":151.23,"endTime":154.14,"body":"hopefully met some neighbors and"},{"speaker":"Charles Goldfarb","startTime":154.14,"endTime":154.92,"body":"the like. And."},{"speaker":"Chris Dy","startTime":155.11,"endTime":158.89,"body":"Yeah, Halloween was"},{"speaker":"Chris Dy","startTime":155.11,"endTime":158.89,"body":"great for that. They do it big"},{"speaker":"Chris Dy","startTime":158.89,"endTime":161.71,"body":"here. I mean, I had never seen"},{"speaker":"Chris Dy","startTime":158.89,"endTime":161.71,"body":"anything like it in terms of you"},{"speaker":"Chris Dy","startTime":161.71,"endTime":165.37,"body":"know, everybody out with fire"},{"speaker":"Chris Dy","startTime":161.71,"endTime":165.37,"body":"pits. And you know, that whole"},{"speaker":"Chris Dy","startTime":165.37,"endTime":168.19,"body":"deal, which was nice and"},{"speaker":"Chris Dy","startTime":165.37,"endTime":168.19,"body":"welcoming. And you know, the"},{"speaker":"Chris Dy","startTime":168.19,"endTime":172.84,"body":"kids really enjoyed Halloween."},{"speaker":"Chris Dy","startTime":168.19,"endTime":172.84,"body":"They obviously our three year"},{"speaker":"Chris Dy","startTime":172.84,"endTime":176.53,"body":"old really took to running"},{"speaker":"Chris Dy","startTime":172.84,"endTime":176.53,"body":"everywhere to get candy. She"},{"speaker":"Chris Dy","startTime":176.53,"endTime":180.34,"body":"tired out after about 40"},{"speaker":"Chris Dy","startTime":176.53,"endTime":180.34,"body":"minutes. But you know, the first"},{"speaker":"Chris Dy","startTime":180.37,"endTime":183.94,"body":"30 minutes she was sprinting to"},{"speaker":"Chris Dy","startTime":180.37,"endTime":183.94,"body":"every door just yelling Candy,"},{"speaker":"Chris Dy","startTime":183.94,"endTime":186.4,"body":"candy candy. It was cute."},{"speaker":"Charles Goldfarb","startTime":187.81,"endTime":188.44,"body":"For a while."},{"speaker":"Chris Dy","startTime":188.47,"endTime":191.17,"body":"We had to remind her"},{"speaker":"Chris Dy","startTime":188.47,"endTime":191.17,"body":"about her manners a couple of"},{"speaker":"Chris Dy","startTime":191.17,"endTime":191.89,"body":"times. But."},{"speaker":"Charles Goldfarb","startTime":192.49,"endTime":194.53,"body":"That is good."},{"speaker":"Charles Goldfarb","startTime":192.49,"endTime":194.53,"body":"I do have to say most listeners,"},{"speaker":"Charles Goldfarb","startTime":194.56,"endTime":197.17,"body":"this will not resonate. But I do"},{"speaker":"Charles Goldfarb","startTime":194.56,"endTime":197.17,"body":"love the St. Louis tradition"},{"speaker":"Charles Goldfarb","startTime":197.17,"endTime":201.37,"body":"where you just don't go get"},{"speaker":"Charles Goldfarb","startTime":197.17,"endTime":201.37,"body":"candy in St. Louis, you have to"},{"speaker":"Charles Goldfarb","startTime":201.43,"endTime":205.72,"body":"typically tell a joke, which is"},{"speaker":"Charles Goldfarb","startTime":201.43,"endTime":205.72,"body":"there's nothing better than five"},{"speaker":"Charles Goldfarb","startTime":205.72,"endTime":208.57,"body":"year olds or 10 year olds"},{"speaker":"Charles Goldfarb","startTime":205.72,"endTime":208.57,"body":"telling jokes and Knock Knocks."},{"speaker":"Charles Goldfarb","startTime":208.57,"endTime":211.75,"body":"And I think it's a great"},{"speaker":"Charles Goldfarb","startTime":208.57,"endTime":211.75,"body":"tradition. I think it's great."},{"speaker":"Chris Dy","startTime":211.75,"endTime":215.23,"body":"Yeah, I had never seen"},{"speaker":"Chris Dy","startTime":211.75,"endTime":215.23,"body":"that until coming here. So our"},{"speaker":"Chris Dy","startTime":215.23,"endTime":219.94,"body":"daughter took our son's joke."},{"speaker":"Chris Dy","startTime":215.23,"endTime":219.94,"body":"And she got to the point where"},{"speaker":"Chris Dy","startTime":219.94,"endTime":222.88,"body":"she was so excited. We had to"},{"speaker":"Chris Dy","startTime":219.94,"endTime":222.88,"body":"remind her about the joke thing."},{"speaker":"Chris Dy","startTime":223.12,"endTime":225.73,"body":"She'd run to the door while"},{"speaker":"Chris Dy","startTime":223.12,"endTime":225.73,"body":"yelling candy. As soon as she"},{"speaker":"Chris Dy","startTime":225.73,"endTime":228.73,"body":"got to the people, she would"},{"speaker":"Chris Dy","startTime":225.73,"endTime":228.73,"body":"just blurt out the joke"},{"speaker":"Chris Dy","startTime":228.79,"endTime":231.91,"body":"immediately without being"},{"speaker":"Chris Dy","startTime":228.79,"endTime":231.91,"body":"prompted. No pause for the"},{"speaker":"Chris Dy","startTime":231.91,"endTime":235.33,"body":"punchline, that kind of thing."},{"speaker":"Chris Dy","startTime":231.91,"endTime":235.33,"body":"And just hold out her bag. And"},{"speaker":"Chris Dy","startTime":235.33,"endTime":236.89,"body":"I'm like, well, at least you"},{"speaker":"Chris Dy","startTime":235.33,"endTime":236.89,"body":"told the joke."},{"speaker":"Charles Goldfarb","startTime":238.75,"endTime":241.33,"body":"That's part of"},{"speaker":"Charles Goldfarb","startTime":238.75,"endTime":241.33,"body":"the joy, part of the joy. All"},{"speaker":"Charles Goldfarb","startTime":241.33,"endTime":243.01,"body":"right, what do we got lined up"},{"speaker":"Charles Goldfarb","startTime":241.33,"endTime":243.01,"body":"for the show."},{"speaker":"Chris Dy","startTime":243.55,"endTime":246.04,"body":"Well, we're going to"},{"speaker":"Chris Dy","startTime":243.55,"endTime":246.04,"body":"talk about some articles from"},{"speaker":"Chris Dy","startTime":246.04,"endTime":248.32,"body":"our recent journal club, you"},{"speaker":"Chris Dy","startTime":246.04,"endTime":248.32,"body":"know, so those of you that"},{"speaker":"Chris Dy","startTime":248.32,"endTime":250.66,"body":"follow us on YouTube, we've"},{"speaker":"Chris Dy","startTime":248.32,"endTime":250.66,"body":"noticed that the journal club"},{"speaker":"Chris Dy","startTime":250.75,"endTime":255.01,"body":"sessions have gotten a lot of"},{"speaker":"Chris Dy","startTime":250.75,"endTime":255.01,"body":"traction and have been very well"},{"speaker":"Chris Dy","startTime":255.01,"endTime":258.64,"body":"reviewed. So we're gonna bring"},{"speaker":"Chris Dy","startTime":255.01,"endTime":258.64,"body":"that back, and would love to"},{"speaker":"Chris Dy","startTime":258.64,"endTime":260.98,"body":"hear some feedback from"},{"speaker":"Chris Dy","startTime":258.64,"endTime":260.98,"body":"listeners, whether you think"},{"speaker":"Chris Dy","startTime":260.98,"endTime":263.56,"body":"that's a useful thing. I mean,"},{"speaker":"Chris Dy","startTime":260.98,"endTime":263.56,"body":"we won't make it strictly about"},{"speaker":"Chris Dy","startTime":263.56,"endTime":266.89,"body":"the articles will include kind"},{"speaker":"Chris Dy","startTime":263.56,"endTime":266.89,"body":"of the context and how it may"},{"speaker":"Chris Dy","startTime":266.89,"endTime":270.16,"body":"inform or not inform our"},{"speaker":"Chris Dy","startTime":266.89,"endTime":270.16,"body":"practice. So hopefully, you'll"},{"speaker":"Chris Dy","startTime":270.16,"endTime":272.26,"body":"tell us if it's useful. Send us"},{"speaker":"Chris Dy","startTime":270.16,"endTime":272.26,"body":"your feedback"},{"speaker":"Chris Dy","startTime":272.29,"endTime":277.21,"body":"handpodcast@gmail.com or"},{"speaker":"Chris Dy","startTime":272.29,"endTime":277.21,"body":"@handpodcast on Twitter. And I"},{"speaker":"Chris Dy","startTime":277.21,"endTime":280.6,"body":"wanted to read an email that was"},{"speaker":"Chris Dy","startTime":277.21,"endTime":280.6,"body":"sent to us by Brittany Mitchell."},{"speaker":"Chris Dy","startTime":281.02,"endTime":286.09,"body":"She is a working towards her CHT"},{"speaker":"Chris Dy","startTime":281.02,"endTime":286.09,"body":"and she is a hand therapist in"},{"speaker":"Chris Dy","startTime":286.09,"endTime":290.38,"body":"Salem, Virginia. And she gave us"},{"speaker":"Chris Dy","startTime":286.09,"endTime":290.38,"body":"a bunch of questions and great"},{"speaker":"Chris Dy","startTime":290.38,"endTime":292.93,"body":"feedback and I want us to just"},{"speaker":"Chris Dy","startTime":290.38,"endTime":292.93,"body":"take a piece of what Brittany"},{"speaker":"Chris Dy","startTime":292.93,"endTime":297.37,"body":"had told us or asked us. So"},{"speaker":"Chris Dy","startTime":292.93,"endTime":297.37,"body":"here's one steps taken for"},{"speaker":"Chris Dy","startTime":297.37,"endTime":300.49,"body":"assessment and treatment of the"},{"speaker":"Chris Dy","startTime":297.37,"endTime":300.49,"body":"arthritic patient How do you"},{"speaker":"Chris Dy","startTime":300.49,"endTime":303.79,"body":"know when to perform surgery"},{"speaker":"Chris Dy","startTime":300.49,"endTime":303.79,"body":"versus conservative management?"},{"speaker":"Chris Dy","startTime":303.82,"endTime":306.55,"body":"And do you prescribe therapy"},{"speaker":"Chris Dy","startTime":303.82,"endTime":306.55,"body":"first? Or does it depend on"},{"speaker":"Chris Dy","startTime":306.55,"endTime":309.55,"body":"severity of arthritis? Now,"},{"speaker":"Chris Dy","startTime":306.55,"endTime":309.55,"body":"Chuck, these questions are"},{"speaker":"Chris Dy","startTime":309.55,"endTime":313.54,"body":"usually for you, because you're"},{"speaker":"Chris Dy","startTime":309.55,"endTime":313.54,"body":"the OG, you're the, you've got"},{"speaker":"Chris Dy","startTime":313.54,"endTime":315.31,"body":"all the wisdom. So I want you to"},{"speaker":"Chris Dy","startTime":313.54,"endTime":315.31,"body":"take a stab at these."},{"speaker":"Charles Goldfarb","startTime":317.59,"endTime":320.32,"body":"Well, for"},{"speaker":"Charles Goldfarb","startTime":317.59,"endTime":320.32,"body":"better or worse, in my practice,"},{"speaker":"Charles Goldfarb","startTime":320.32,"endTime":323.47,"body":"much of this is patient driven."},{"speaker":"Charles Goldfarb","startTime":320.32,"endTime":323.47,"body":"And I think most of the"},{"speaker":"Charles Goldfarb","startTime":323.47,"endTime":328.03,"body":"listeners can appreciate that."},{"speaker":"Charles Goldfarb","startTime":323.47,"endTime":328.03,"body":"That is different, necessarily"},{"speaker":"Charles Goldfarb","startTime":328.03,"endTime":330.61,"body":"than the rest of the world. And"},{"speaker":"Charles Goldfarb","startTime":328.03,"endTime":330.61,"body":"patients do drive their care"},{"speaker":"Charles Goldfarb","startTime":330.61,"endTime":333.43,"body":"here, which of course, important"},{"speaker":"Charles Goldfarb","startTime":330.61,"endTime":333.43,"body":"they should, although I think"},{"speaker":"Charles Goldfarb","startTime":333.43,"endTime":337.21,"body":"it's our responsibility to guide"},{"speaker":"Charles Goldfarb","startTime":333.43,"endTime":337.21,"body":"them to, you know, the concept"},{"speaker":"Charles Goldfarb","startTime":337.21,"endTime":341.44,"body":"of value based care and really,"},{"speaker":"Charles Goldfarb","startTime":337.21,"endTime":341.44,"body":"the best care and certainly"},{"speaker":"Charles Goldfarb","startTime":341.44,"endTime":346.33,"body":"jumping to surgery is not"},{"speaker":"Charles Goldfarb","startTime":341.44,"endTime":346.33,"body":"typically what we do. The value"},{"speaker":"Charles Goldfarb","startTime":346.33,"endTime":350.29,"body":"of things like therapy, honestly"},{"speaker":"Charles Goldfarb","startTime":346.33,"endTime":350.29,"body":"just simply hasn't been proven,"},{"speaker":"Charles Goldfarb","startTime":350.47,"endTime":354.46,"body":"especially for diagnosis like"},{"speaker":"Charles Goldfarb","startTime":350.47,"endTime":354.46,"body":"arthritis, there are a couple of"},{"speaker":"Charles Goldfarb","startTime":354.46,"endTime":359.2,"body":"good manuscripts looking at the"},{"speaker":"Charles Goldfarb","startTime":354.46,"endTime":359.2,"body":"role of therapy and CMC"},{"speaker":"Charles Goldfarb","startTime":359.2,"endTime":362.17,"body":"arthritis with some pretty good"},{"speaker":"Charles Goldfarb","startTime":359.2,"endTime":362.17,"body":"results. And I do share that"},{"speaker":"Charles Goldfarb","startTime":362.17,"endTime":365.74,"body":"with patients, and absolutely"},{"speaker":"Charles Goldfarb","startTime":362.17,"endTime":365.74,"body":"make that an option for"},{"speaker":"Charles Goldfarb","startTime":365.74,"endTime":370.66,"body":"patients, especially earlier in"},{"speaker":"Charles Goldfarb","startTime":365.74,"endTime":370.66,"body":"the arthritic process. And my"},{"speaker":"Charles Goldfarb","startTime":370.66,"endTime":373.45,"body":"experience wants you to go down"},{"speaker":"Charles Goldfarb","startTime":370.66,"endTime":373.45,"body":"the path of using steroid"},{"speaker":"Charles Goldfarb","startTime":373.45,"endTime":378.97,"body":"injections to modify symptoms"},{"speaker":"Charles Goldfarb","startTime":373.45,"endTime":378.97,"body":"from arthritis. At that point"},{"speaker":"Charles Goldfarb","startTime":378.97,"endTime":381.52,"body":"therapy is typically less"},{"speaker":"Charles Goldfarb","startTime":378.97,"endTime":381.52,"body":"helpful, and then it becomes"},{"speaker":"Charles Goldfarb","startTime":381.52,"endTime":385.54,"body":"purely a patient driven"},{"speaker":"Charles Goldfarb","startTime":381.52,"endTime":385.54,"body":"decision. It is almost never."},{"speaker":"Charles Goldfarb","startTime":385.75,"endTime":388.09,"body":"And I can think of a few"},{"speaker":"Charles Goldfarb","startTime":385.75,"endTime":388.09,"body":"exceptions, but almost never do"},{"speaker":"Charles Goldfarb","startTime":388.09,"endTime":392.53,"body":"I push for surgery in situations"},{"speaker":"Charles Goldfarb","startTime":388.09,"endTime":392.53,"body":"for arthritis. And I you know,"},{"speaker":"Charles Goldfarb","startTime":392.53,"endTime":395.11,"body":"we've talked about this, I don't"},{"speaker":"Charles Goldfarb","startTime":392.53,"endTime":395.11,"body":"know if I captured well, your"},{"speaker":"Charles Goldfarb","startTime":395.11,"endTime":397.18,"body":"thoughts on the topic, but"},{"speaker":"Charles Goldfarb","startTime":395.11,"endTime":397.18,"body":"that's where I stand."},{"speaker":"Chris Dy","startTime":398.38,"endTime":400.93,"body":"Yeah, I think duration"},{"speaker":"Chris Dy","startTime":398.38,"endTime":400.93,"body":"of symptoms. And, you know,"},{"speaker":"Chris Dy","startTime":400.93,"endTime":403.15,"body":"attempts that other treatment"},{"speaker":"Chris Dy","startTime":400.93,"endTime":403.15,"body":"are what drive me towards"},{"speaker":"Chris Dy","startTime":403.15,"endTime":405.73,"body":"surgery for a lot of my"},{"speaker":"Chris Dy","startTime":403.15,"endTime":405.73,"body":"patients. I don't use"},{"speaker":"Chris Dy","startTime":405.73,"endTime":410.05,"body":"radiographs as much, mainly"},{"speaker":"Chris Dy","startTime":405.73,"endTime":410.05,"body":"because we see it routinely that"},{"speaker":"Chris Dy","startTime":410.05,"endTime":413.05,"body":"not only in the thumb, but also"},{"speaker":"Chris Dy","startTime":410.05,"endTime":413.05,"body":"in the knee and the hip. For"},{"speaker":"Chris Dy","startTime":413.05,"endTime":416.17,"body":"those of you that are"},{"speaker":"Chris Dy","startTime":413.05,"endTime":416.17,"body":"orthopedics trained, the X rays"},{"speaker":"Chris Dy","startTime":416.17,"endTime":419.92,"body":"don't correlate with symptoms."},{"speaker":"Chris Dy","startTime":416.17,"endTime":419.92,"body":"I've seen awful X rays in"},{"speaker":"Chris Dy","startTime":419.92,"endTime":423.61,"body":"patients who aren't bothered at"},{"speaker":"Chris Dy","startTime":419.92,"endTime":423.61,"body":"all. And I've seen pristine X"},{"speaker":"Chris Dy","startTime":423.61,"endTime":426.31,"body":"rays and patients who have"},{"speaker":"Chris Dy","startTime":423.61,"endTime":426.31,"body":"terrible symptoms. So I don't"},{"speaker":"Chris Dy","startTime":426.31,"endTime":429.64,"body":"use that to drive my management."},{"speaker":"Chris Dy","startTime":426.31,"endTime":429.64,"body":"One thing I do make a point of"},{"speaker":"Chris Dy","startTime":429.64,"endTime":432.85,"body":"is eventually if I do get X"},{"speaker":"Chris Dy","startTime":429.64,"endTime":432.85,"body":"rays, and I don't get X rays"},{"speaker":"Chris Dy","startTime":432.85,"endTime":435.07,"body":"initially on many of these"},{"speaker":"Chris Dy","startTime":432.85,"endTime":435.07,"body":"patients, I usually get X rays"},{"speaker":"Chris Dy","startTime":435.07,"endTime":437.41,"body":"only if we're kind of heading"},{"speaker":"Chris Dy","startTime":435.07,"endTime":437.41,"body":"towards surgery, mainly for"},{"speaker":"Chris Dy","startTime":437.41,"endTime":440.65,"body":"surgical planning, and also to"},{"speaker":"Chris Dy","startTime":437.41,"endTime":440.65,"body":"show patients their X rays. I"},{"speaker":"Chris Dy","startTime":440.65,"endTime":444.67,"body":"think that's very illustrative"},{"speaker":"Chris Dy","startTime":440.65,"endTime":444.67,"body":"and helpful thing. I tell the"},{"speaker":"Chris Dy","startTime":444.67,"endTime":448.18,"body":"trainees this, you know, I try"},{"speaker":"Chris Dy","startTime":444.67,"endTime":448.18,"body":"not to I try not to indicate"},{"speaker":"Chris Dy","startTime":448.18,"endTime":451.21,"body":"surgery on the first visit. Now"},{"speaker":"Chris Dy","startTime":448.18,"endTime":451.21,"body":"there are exceptions to that if"},{"speaker":"Chris Dy","startTime":451.21,"endTime":453.34,"body":"somebody is, you know, had a"},{"speaker":"Chris Dy","startTime":451.21,"endTime":453.34,"body":"treatment for a long time, for"},{"speaker":"Chris Dy","startTime":453.34,"endTime":456.52,"body":"example, I see some of Dr."},{"speaker":"Chris Dy","startTime":453.34,"endTime":456.52,"body":"Gelberman's old patients now who"},{"speaker":"Chris Dy","startTime":456.52,"endTime":459.25,"body":"have had lots of therapy and"},{"speaker":"Chris Dy","startTime":456.52,"endTime":459.25,"body":"lots of injections, and they're"},{"speaker":"Chris Dy","startTime":459.25,"endTime":463.54,"body":"ready. And then I also, you"},{"speaker":"Chris Dy","startTime":459.25,"endTime":463.54,"body":"know, I think I'm probably in"},{"speaker":"Chris Dy","startTime":463.54,"endTime":466.0,"body":"the minority on this, I try not"},{"speaker":"Chris Dy","startTime":463.54,"endTime":466.0,"body":"to put needles in people on the"},{"speaker":"Chris Dy","startTime":466.0,"endTime":472.18,"body":"first visit. It's silly, but the"},{"speaker":"Chris Dy","startTime":466.0,"endTime":472.18,"body":"needles hurt. And I don't want"},{"speaker":"Chris Dy","startTime":472.18,"endTime":474.46,"body":"that to be their first"},{"speaker":"Chris Dy","startTime":472.18,"endTime":474.46,"body":"impression of me. That being"},{"speaker":"Chris Dy","startTime":474.46,"endTime":477.61,"body":"said, if they're in misery and"},{"speaker":"Chris Dy","startTime":474.46,"endTime":477.61,"body":"lots of pain, I will offer the"},{"speaker":"Chris Dy","startTime":477.61,"endTime":481.69,"body":"injection. But, you know,"},{"speaker":"Chris Dy","startTime":477.61,"endTime":481.69,"body":"usually we have the privilege of"},{"speaker":"Chris Dy","startTime":481.69,"endTime":485.02,"body":"having therapists, colleagues in"},{"speaker":"Chris Dy","startTime":481.69,"endTime":485.02,"body":"our clinics most of the time. So"},{"speaker":"Chris Dy","startTime":485.02,"endTime":488.92,"body":"that's one entree into therapy."},{"speaker":"Chris Dy","startTime":485.02,"endTime":488.92,"body":"And sometimes they've seen the"},{"speaker":"Chris Dy","startTime":488.92,"endTime":491.98,"body":"patient before me and kind of"},{"speaker":"Chris Dy","startTime":488.92,"endTime":491.98,"body":"told me yeah, they're there."},{"speaker":"Chris Dy","startTime":492.01,"endTime":494.86,"body":"They're ready to person for an"},{"speaker":"Chris Dy","startTime":492.01,"endTime":494.86,"body":"injection, or they want to do"},{"speaker":"Chris Dy","startTime":494.86,"endTime":495.94,"body":"some form of therapy."},{"speaker":"Charles Goldfarb","startTime":496.589,"endTime":498.329,"body":"Yeah, like"},{"speaker":"Charles Goldfarb","startTime":496.589,"endTime":498.329,"body":"everything you said, it's"},{"speaker":"Charles Goldfarb","startTime":498.329,"endTime":501.779,"body":"interesting. So earlier, and"},{"speaker":"Charles Goldfarb","startTime":498.329,"endTime":501.779,"body":"definitely more than 10 years"},{"speaker":"Charles Goldfarb","startTime":501.779,"endTime":504.809,"body":"ago, I was involved in a"},{"speaker":"Charles Goldfarb","startTime":501.779,"endTime":504.809,"body":"clinical practice guideline"},{"speaker":"Charles Goldfarb","startTime":504.809,"endTime":508.559,"body":"development process for the"},{"speaker":"Charles Goldfarb","startTime":504.809,"endTime":508.559,"body":"Academy on CMC arthritis. And"},{"speaker":"Charles Goldfarb","startTime":508.559,"endTime":511.859,"body":"you might think yourself, that's"},{"speaker":"Charles Goldfarb","startTime":508.559,"endTime":511.859,"body":"Chuck, I missed that one. And"},{"speaker":"Charles Goldfarb","startTime":511.859,"endTime":515.849,"body":"that would be because it never,"},{"speaker":"Charles Goldfarb","startTime":511.859,"endTime":515.849,"body":"it never was completed. I think"},{"speaker":"Charles Goldfarb","startTime":515.849,"endTime":518.369,"body":"likely because there was so"},{"speaker":"Charles Goldfarb","startTime":515.849,"endTime":518.369,"body":"little literature to guide us."},{"speaker":"Charles Goldfarb","startTime":518.369,"endTime":520.799,"body":"But I remember sitting in this"},{"speaker":"Charles Goldfarb","startTime":518.369,"endTime":520.799,"body":"conference room being on the"},{"speaker":"Charles Goldfarb","startTime":520.799,"endTime":524.699,"body":"younger side, way back then, and"},{"speaker":"Charles Goldfarb","startTime":520.799,"endTime":524.699,"body":"listen to a couple of the older"},{"speaker":"Charles Goldfarb","startTime":524.699,"endTime":528.269,"body":"hand surgeons say, well, we"},{"speaker":"Charles Goldfarb","startTime":524.699,"endTime":528.269,"body":"don't even get our we don't even"},{"speaker":"Charles Goldfarb","startTime":528.269,"endTime":531.329,"body":"get X rays. You don't need X"},{"speaker":"Charles Goldfarb","startTime":528.269,"endTime":531.329,"body":"rays is a clinical diagnosis. X"},{"speaker":"Charles Goldfarb","startTime":531.329,"endTime":533.849,"body":"rays don't help you in any way."},{"speaker":"Charles Goldfarb","startTime":531.329,"endTime":533.849,"body":"And I'm thinking to myself, but"},{"speaker":"Charles Goldfarb","startTime":534.269,"endTime":537.299,"body":"of course you have to get X"},{"speaker":"Charles Goldfarb","startTime":534.269,"endTime":537.299,"body":"rays. And now I'm like X rays"},{"speaker":"Charles Goldfarb","startTime":537.299,"endTime":541.379,"body":"don't help me at all. It is a"},{"speaker":"Charles Goldfarb","startTime":537.299,"endTime":541.379,"body":"clinical diagnosis. It is easily"},{"speaker":"Charles Goldfarb","startTime":541.379,"endTime":544.619,"body":"reproducible. In almost every"},{"speaker":"Charles Goldfarb","startTime":541.379,"endTime":544.619,"body":"case, there are exceptions, but"},{"speaker":"Charles Goldfarb","startTime":544.619,"endTime":546.839,"body":"almost every case, you know the"},{"speaker":"Charles Goldfarb","startTime":544.619,"endTime":546.839,"body":"diagnosis, you can see the"},{"speaker":"Charles Goldfarb","startTime":546.839,"endTime":549.809,"body":"pathology, whether there's a"},{"speaker":"Charles Goldfarb","startTime":546.839,"endTime":549.809,"body":"contraction of the CMC joint or,"},{"speaker":"Charles Goldfarb","startTime":549.989,"endTime":555.569,"body":"or just pain, and it was an"},{"speaker":"Charles Goldfarb","startTime":549.989,"endTime":555.569,"body":"evolution and and I don't, I"},{"speaker":"Charles Goldfarb","startTime":555.569,"endTime":559.409,"body":"don't get X rays along the way,"},{"speaker":"Charles Goldfarb","startTime":555.569,"endTime":559.409,"body":"unless like you said, I need"},{"speaker":"Charles Goldfarb","startTime":559.409,"endTime":561.899,"body":"them to talk to the patient. Or"},{"speaker":"Charles Goldfarb","startTime":559.409,"endTime":561.899,"body":"sometimes when I'm considering"},{"speaker":"Charles Goldfarb","startTime":561.899,"endTime":564.389,"body":"surgery, I'll get X rays, but"},{"speaker":"Charles Goldfarb","startTime":561.899,"endTime":564.389,"body":"it's not a priority."},{"speaker":"Chris Dy","startTime":565.38,"endTime":569.55,"body":"It's interesting."},{"speaker":"Chris Dy","startTime":565.38,"endTime":569.55,"body":"There are some times where it's"},{"speaker":"Chris Dy","startTime":569.55,"endTime":572.73,"body":"totally patient dependent and"},{"speaker":"Chris Dy","startTime":569.55,"endTime":572.73,"body":"even you know, we've gotten our"},{"speaker":"Chris Dy","startTime":572.73,"endTime":576.84,"body":"Press Ganey patient satisfaction"},{"speaker":"Chris Dy","startTime":572.73,"endTime":576.84,"body":"surveys back recently. And I"},{"speaker":"Chris Dy","startTime":576.84,"endTime":579.6,"body":"admit I'm not perfect, and there"},{"speaker":"Chris Dy","startTime":576.84,"endTime":579.6,"body":"are times where patients are"},{"speaker":"Chris Dy","startTime":579.6,"endTime":581.79,"body":"unhappy and usually the patients"},{"speaker":"Chris Dy","startTime":579.6,"endTime":581.79,"body":"that are unhappy that are the"},{"speaker":"Chris Dy","startTime":581.79,"endTime":586.14,"body":"ones that are more vocal and"},{"speaker":"Chris Dy","startTime":581.79,"endTime":586.14,"body":"have more apt to leave comments."},{"speaker":"Chris Dy","startTime":586.68,"endTime":589.11,"body":"And one of the comments I got"},{"speaker":"Chris Dy","startTime":586.68,"endTime":589.11,"body":"was he didn't even get the X"},{"speaker":"Chris Dy","startTime":589.11,"endTime":593.64,"body":"rays. And I'm like, Listen, I"},{"speaker":"Chris Dy","startTime":589.11,"endTime":593.64,"body":"don't expect the patient"},{"speaker":"Chris Dy","startTime":593.64,"endTime":597.06,"body":"understand that that's not you"},{"speaker":"Chris Dy","startTime":593.64,"endTime":597.06,"body":"know, you know, that test is not"},{"speaker":"Chris Dy","startTime":597.06,"endTime":599.58,"body":"going to change my management"},{"speaker":"Chris Dy","startTime":597.06,"endTime":599.58,"body":"but I feel like sometimes there"},{"speaker":"Chris Dy","startTime":599.58,"endTime":605.04,"body":"is a fear pubic components, you"},{"speaker":"Chris Dy","startTime":599.58,"endTime":605.04,"body":"know, to getting an x ray in"},{"speaker":"Chris Dy","startTime":605.04,"endTime":608.13,"body":"terms of having not necessarily"},{"speaker":"Chris Dy","startTime":605.04,"endTime":608.13,"body":"going through the X ray with"},{"speaker":"Chris Dy","startTime":608.13,"endTime":611.79,"body":"them, but knowing that you cared"},{"speaker":"Chris Dy","startTime":608.13,"endTime":611.79,"body":"enough to get an x ray for them."},{"speaker":"Charles Goldfarb","startTime":613.23,"endTime":616.2,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":613.23,"endTime":616.2,"body":"really interesting. And clearly"},{"speaker":"Charles Goldfarb","startTime":616.2,"endTime":619.08,"body":"communication wasn't ideal. And"},{"speaker":"Charles Goldfarb","startTime":616.2,"endTime":619.08,"body":"often find that sometimes I'll"},{"speaker":"Charles Goldfarb","startTime":619.08,"endTime":621.69,"body":"go ahead and suggest X rays"},{"speaker":"Charles Goldfarb","startTime":619.08,"endTime":621.69,"body":"because you just see the patient"},{"speaker":"Charles Goldfarb","startTime":621.69,"endTime":626.76,"body":"may not say it, but you just see"},{"speaker":"Charles Goldfarb","startTime":621.69,"endTime":626.76,"body":"that they want something more in"},{"speaker":"Charles Goldfarb","startTime":626.76,"endTime":631.92,"body":"the X rays can be that something"},{"speaker":"Charles Goldfarb","startTime":626.76,"endTime":631.92,"body":"more. And you're right sometimes"},{"speaker":"Charles Goldfarb","startTime":631.95,"endTime":636.15,"body":"is just a almost necessity for"},{"speaker":"Charles Goldfarb","startTime":631.95,"endTime":636.15,"body":"the patient to leave your office"},{"speaker":"Charles Goldfarb","startTime":636.15,"endTime":640.23,"body":"satisfied that you did what you"},{"speaker":"Charles Goldfarb","startTime":636.15,"endTime":640.23,"body":"need to do. It's also the the"},{"speaker":"Charles Goldfarb","startTime":640.23,"endTime":643.44,"body":"other mantra of they like to"},{"speaker":"Charles Goldfarb","startTime":640.23,"endTime":643.44,"body":"leave with something, leave with"},{"speaker":"Charles Goldfarb","startTime":643.44,"endTime":648.06,"body":"advice, or leave with a handout"},{"speaker":"Charles Goldfarb","startTime":643.44,"endTime":648.06,"body":"or leave with a link of I think"},{"speaker":"Charles Goldfarb","startTime":648.06,"endTime":651.06,"body":"that really matters to some"},{"speaker":"Charles Goldfarb","startTime":648.06,"endTime":651.06,"body":"patients, but which patients and"},{"speaker":"Charles Goldfarb","startTime":651.09,"endTime":652.2,"body":"is always the tricky part."},{"speaker":"Chris Dy","startTime":653.02,"endTime":657.07,"body":"Let's just say in my,"},{"speaker":"Chris Dy","startTime":653.02,"endTime":657.07,"body":"in my practice, or my clinic, we"},{"speaker":"Chris Dy","startTime":657.07,"endTime":659.44,"body":"have a whiteboard in which I"},{"speaker":"Chris Dy","startTime":657.07,"endTime":659.44,"body":"write kind of everything that I"},{"speaker":"Chris Dy","startTime":659.44,"endTime":664.18,"body":"asked our team to do. The term x"},{"speaker":"Chris Dy","startTime":659.44,"endTime":664.18,"body":"ray, OWO meeting X ray on the"},{"speaker":"Chris Dy","startTime":664.18,"endTime":668.38,"body":"way out, and not coming back, as"},{"speaker":"Chris Dy","startTime":664.18,"endTime":668.38,"body":"become much more frequent than"},{"speaker":"Chris Dy","startTime":668.38,"endTime":671.89,"body":"the last year. Because it's just"},{"speaker":"Chris Dy","startTime":668.38,"endTime":671.89,"body":"easier honestly, to send them"},{"speaker":"Chris Dy","startTime":671.89,"endTime":674.95,"body":"for X rays to have them"},{"speaker":"Chris Dy","startTime":671.89,"endTime":674.95,"body":"understand that we did it for"},{"speaker":"Chris Dy","startTime":674.95,"endTime":677.47,"body":"them. I review it and I'll call"},{"speaker":"Chris Dy","startTime":674.95,"endTime":677.47,"body":"them if there's any issues or"},{"speaker":"Chris Dy","startTime":677.47,"endTime":680.23,"body":"anything like that. But again,"},{"speaker":"Chris Dy","startTime":677.47,"endTime":680.23,"body":"you get the sense some people"},{"speaker":"Chris Dy","startTime":680.23,"endTime":682.51,"body":"just want something to leave"},{"speaker":"Chris Dy","startTime":680.23,"endTime":682.51,"body":"with."},{"speaker":"Charles Goldfarb","startTime":683.11,"endTime":684.88,"body":"Yeah, couldn't"},{"speaker":"Charles Goldfarb","startTime":683.11,"endTime":684.88,"body":"agree more. Couldn't agree more."},{"speaker":"Charles Goldfarb","startTime":684.88,"endTime":688.21,"body":"That's a great, great"},{"speaker":"Charles Goldfarb","startTime":684.88,"endTime":688.21,"body":"conversation piece this, the"},{"speaker":"Charles Goldfarb","startTime":688.21,"endTime":688.72,"body":"questions."},{"speaker":"Chris Dy","startTime":688.75,"endTime":691.51,"body":"So yeah, Brittany,"},{"speaker":"Chris Dy","startTime":688.75,"endTime":691.51,"body":"thank you for the fantastic"},{"speaker":"Chris Dy","startTime":691.54,"endTime":694.69,"body":"email, we will get some more of"},{"speaker":"Chris Dy","startTime":691.54,"endTime":694.69,"body":"your questions. And I know that"},{"speaker":"Chris Dy","startTime":694.69,"endTime":698.38,"body":"you wanted to come to the to the"},{"speaker":"Chris Dy","startTime":694.69,"endTime":698.38,"body":"ASHT meeting, but couldn't,"},{"speaker":"Chris Dy","startTime":698.89,"endTime":702.16,"body":"you're busy, you got two very"},{"speaker":"Chris Dy","startTime":698.89,"endTime":702.16,"body":"young kids, we certainly will"},{"speaker":"Chris Dy","startTime":702.16,"endTime":705.19,"body":"send you something in terms of"},{"speaker":"Chris Dy","startTime":702.16,"endTime":705.19,"body":"swag, because of your great"},{"speaker":"Chris Dy","startTime":705.19,"endTime":708.4,"body":"questions and engagement. And,"},{"speaker":"Chris Dy","startTime":705.19,"endTime":708.4,"body":"you know, thank you for"},{"speaker":"Chris Dy","startTime":708.4,"endTime":711.19,"body":"listening. And again, if anybody"},{"speaker":"Chris Dy","startTime":708.4,"endTime":711.19,"body":"has questions, please submit"},{"speaker":"Chris Dy","startTime":711.19,"endTime":714.67,"body":"them through the through the"},{"speaker":"Chris Dy","startTime":711.19,"endTime":714.67,"body":"email account, and let us know."},{"speaker":"Chris Dy","startTime":715.0,"endTime":718.9,"body":"And then also sign up for the"},{"speaker":"Chris Dy","startTime":715.0,"endTime":718.9,"body":"upcoming it's been upcoming for"},{"speaker":"Chris Dy","startTime":718.9,"endTime":721.3,"body":"a while but the upcoming"},{"speaker":"Chris Dy","startTime":718.9,"endTime":721.3,"body":"newsletter, and in this"},{"speaker":"Chris Dy","startTime":721.3,"endTime":725.08,"body":"newsletter, we will also include"},{"speaker":"Chris Dy","startTime":721.3,"endTime":725.08,"body":"links and details about the"},{"speaker":"Chris Dy","startTime":725.08,"endTime":726.43,"body":"articles that we're going to"},{"speaker":"Chris Dy","startTime":725.08,"endTime":726.43,"body":"talk about now."},{"speaker":"Chris Dy","startTime":726.0,"endTime":736.86,"body":"So Chuck, what does the number"},{"speaker":"Chris Dy","startTime":726.0,"endTime":736.86,"body":"2000 mean to you?"},{"speaker":"Charles Goldfarb","startTime":726.24,"endTime":729.12,"body":"Yes, we have"},{"speaker":"Charles Goldfarb","startTime":726.24,"endTime":729.12,"body":"about 200 people signed up for"},{"speaker":"Charles Goldfarb","startTime":729.12,"endTime":733.53,"body":"the newsletter. Granted, we have"},{"speaker":"Charles Goldfarb","startTime":729.12,"endTime":733.53,"body":"about 1200. And growing it's"},{"speaker":"Charles Goldfarb","startTime":733.53,"endTime":736.2,"body":"really super satisfying, we"},{"speaker":"Charles Goldfarb","startTime":733.53,"endTime":736.2,"body":"continue to get about 1200"},{"speaker":"Charles Goldfarb","startTime":736.2,"endTime":740.16,"body":"regular listeners, but 150 of"},{"speaker":"Charles Goldfarb","startTime":736.2,"endTime":740.16,"body":"you have signed up for the"},{"speaker":"Charles Goldfarb","startTime":736.86,"endTime":741.21,"body":"Number 2000."},{"speaker":"Charles Goldfarb","startTime":740.16,"endTime":744.09,"body":"newsletter. And hopefully that"},{"speaker":"Charles Goldfarb","startTime":740.16,"endTime":744.09,"body":"momentum grows. So we're close"},{"speaker":"Charles Goldfarb","startTime":741.78,"endTime":774.9,"body":"In the year 2000? No, no Conan"},{"speaker":"Charles Goldfarb","startTime":741.78,"endTime":774.9,"body":"O'Brien fans?"},{"speaker":"Charles Goldfarb","startTime":744.6,"endTime":747.75,"body":"it's on my list of things to g"},{"speaker":"Charles Goldfarb","startTime":744.6,"endTime":747.75,"body":"t done. I hope it gets done th"},{"speaker":"Charles Goldfarb","startTime":747.75,"endTime":751.86,"body":"s week. And I do think it'll ma"},{"speaker":"Charles Goldfarb","startTime":747.75,"endTime":751.86,"body":"e for an interesting forum f"},{"speaker":"Charles Goldfarb","startTime":751.98,"endTime":754.77,"body":"r discussion. And we again, we'"},{"speaker":"Charles Goldfarb","startTime":751.98,"endTime":754.77,"body":"e never looking for one w"},{"speaker":"Charles Goldfarb","startTime":754.77,"endTime":759.51,"body":"y discussion despite our choice"},{"speaker":"Charles Goldfarb","startTime":754.77,"endTime":759.51,"body":"f podcast format. So we lo"},{"speaker":"Charles Goldfarb","startTime":759.51,"endTime":762.96,"body":"k forward to feedback, of cour"},{"speaker":"Charles Goldfarb","startTime":759.51,"endTime":762.96,"body":"e on this and other things that"},{"speaker":"Charles Goldfarb","startTime":762.96,"endTime":763.17,"body":"e d"},{"speaker":"Charles Goldfarb","startTime":775.41,"endTime":780.24,"body":"Yeah, that didn't help me. Tell"},{"speaker":"Charles Goldfarb","startTime":775.41,"endTime":780.24,"body":"me what should it mean?"},{"speaker":"Chris Dy","startTime":780.75,"endTime":784.5,"body":"So we have over 2000"},{"speaker":"Chris Dy","startTime":780.75,"endTime":784.5,"body":"downloads a week for the"},{"speaker":"Chris Dy","startTime":784.5,"endTime":787.44,"body":"podcast. So thank you,"},{"speaker":"Chris Dy","startTime":784.5,"endTime":787.44,"body":"everybody, for checking us out."},{"speaker":"Chris Dy","startTime":787.68,"endTime":790.77,"body":"Telling your colleagues um, you"},{"speaker":"Chris Dy","startTime":787.68,"endTime":790.77,"body":"know, it's a, it's something"},{"speaker":"Chris Dy","startTime":790.77,"endTime":794.1,"body":"that we're very proud of, I had"},{"speaker":"Chris Dy","startTime":790.77,"endTime":794.1,"body":"to update a an educator"},{"speaker":"Chris Dy","startTime":794.1,"endTime":798.06,"body":"portfolio recently. And I did it"},{"speaker":"Chris Dy","startTime":794.1,"endTime":798.06,"body":"one time before promotion, and"},{"speaker":"Chris Dy","startTime":798.09,"endTime":800.79,"body":"had to do at one time since"},{"speaker":"Chris Dy","startTime":798.09,"endTime":800.79,"body":"then. And it was very nice to"},{"speaker":"Chris Dy","startTime":800.79,"endTime":804.27,"body":"change the number from over 1300"},{"speaker":"Chris Dy","startTime":800.79,"endTime":804.27,"body":"downloads a week to over 2000"},{"speaker":"Chris Dy","startTime":804.27,"endTime":806.13,"body":"downloads a week. So thank you,"},{"speaker":"Chris Dy","startTime":804.27,"endTime":806.13,"body":"everybody."},{"speaker":"Charles Goldfarb","startTime":806.55,"endTime":808.71,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":806.55,"endTime":808.71,"body":"fantastic. Yeah, it means the"},{"speaker":"Charles Goldfarb","startTime":808.71,"endTime":811.08,"body":"world and it's why you and I are"},{"speaker":"Charles Goldfarb","startTime":808.71,"endTime":811.08,"body":"sitting here on a Sunday"},{"speaker":"Charles Goldfarb","startTime":811.08,"endTime":812.88,"body":"afternoon talking to each other."},{"speaker":"Chris Dy","startTime":813.54,"endTime":816.09,"body":"Well, let's, let's"},{"speaker":"Chris Dy","startTime":813.54,"endTime":816.09,"body":"jump in. So we should probably"},{"speaker":"Chris Dy","startTime":816.09,"endTime":818.91,"body":"should tackle the intimidating"},{"speaker":"Chris Dy","startTime":816.09,"endTime":818.91,"body":"article first, that basic"},{"speaker":"Chris Dy","startTime":818.91,"endTime":824.43,"body":"science article that amazes me,"},{"speaker":"Chris Dy","startTime":818.91,"endTime":824.43,"body":"but also is very, in some ways"},{"speaker":"Chris Dy","startTime":824.43,"endTime":829.11,"body":"difficult to interpret. So this"},{"speaker":"Chris Dy","startTime":824.43,"endTime":829.11,"body":"is a from the group, Yamanaka et"},{"speaker":"Chris Dy","startTime":829.11,"endTime":834.33,"body":"al. and out of out of Japan. And"},{"speaker":"Chris Dy","startTime":829.11,"endTime":834.33,"body":"this is in the in the October 6"},{"speaker":"Chris Dy","startTime":834.36,"endTime":837.54,"body":"edition of jbjs. So it's"},{"speaker":"Chris Dy","startTime":834.36,"endTime":837.54,"body":"molecular and clinical"},{"speaker":"Chris Dy","startTime":837.54,"endTime":841.32,"body":"elucidation of the mechanism of"},{"speaker":"Chris Dy","startTime":837.54,"endTime":841.32,"body":"action of steroids in idiopathic"},{"speaker":"Chris Dy","startTime":841.32,"endTime":845.88,"body":"carpal tunnel syndrome. That's a"},{"speaker":"Chris Dy","startTime":841.32,"endTime":845.88,"body":"mouthful, but how does steroids"},{"speaker":"Chris Dy","startTime":845.88,"endTime":848.58,"body":"work? For carpal tunnel? So"},{"speaker":"Chris Dy","startTime":845.88,"endTime":848.58,"body":"Chuck, before you read this,"},{"speaker":"Chris Dy","startTime":848.61,"endTime":852.0,"body":"what was your thought of how"},{"speaker":"Chris Dy","startTime":848.61,"endTime":852.0,"body":"steroids work in those who you"},{"speaker":"Chris Dy","startTime":852.0,"endTime":854.04,"body":"choose? chose to give steroids"},{"speaker":"Chris Dy","startTime":852.0,"endTime":854.04,"body":"to?"},{"speaker":"Charles Goldfarb","startTime":854.64,"endTime":858.87,"body":"Yeah, I would"},{"speaker":"Charles Goldfarb","startTime":854.64,"endTime":858.87,"body":"completely buy into how I think"},{"speaker":"Charles Goldfarb","startTime":858.87,"endTime":862.14,"body":"steroids work everywhere as an"},{"speaker":"Charles Goldfarb","startTime":858.87,"endTime":862.14,"body":"anti inflammatory period and"},{"speaker":"Charles Goldfarb","startTime":862.14,"endTime":865.74,"body":"kind of end of story. It's it's"},{"speaker":"Charles Goldfarb","startTime":862.14,"endTime":865.74,"body":"the explanation I give for the"},{"speaker":"Charles Goldfarb","startTime":865.74,"endTime":868.53,"body":"wrist when we're doing you know"},{"speaker":"Charles Goldfarb","startTime":865.74,"endTime":868.53,"body":"what, potentially with the TFCC"},{"speaker":"Charles Goldfarb","startTime":868.53,"endTime":872.37,"body":"tear, but it's absolutely how I"},{"speaker":"Charles Goldfarb","startTime":868.53,"endTime":872.37,"body":"conceived of steroids working"},{"speaker":"Charles Goldfarb","startTime":872.58,"endTime":876.72,"body":"for carpal tunnel syndrome."},{"speaker":"Charles Goldfarb","startTime":872.58,"endTime":876.72,"body":"about you is that it was your"},{"speaker":"Charles Goldfarb","startTime":876.72,"endTime":877.62,"body":"impression as well."},{"speaker":"Chris Dy","startTime":878.01,"endTime":880.5,"body":"Yeah, my normal shtick"},{"speaker":"Chris Dy","startTime":878.01,"endTime":880.5,"body":"is you know, when you have"},{"speaker":"Chris Dy","startTime":880.5,"endTime":882.84,"body":"carpal tunnel, there's some"},{"speaker":"Chris Dy","startTime":880.5,"endTime":882.84,"body":"swelling in the carpal tunnel it"},{"speaker":"Chris Dy","startTime":882.84,"endTime":885.72,"body":"presses on the media nerve cuts"},{"speaker":"Chris Dy","startTime":882.84,"endTime":885.72,"body":"off the blood supply to the"},{"speaker":"Chris Dy","startTime":885.72,"endTime":888.63,"body":"median nerve because it's a"},{"speaker":"Chris Dy","startTime":885.72,"endTime":888.63,"body":"confined space, and the nerve"},{"speaker":"Chris Dy","startTime":888.63,"endTime":892.2,"body":"starts to get aggravated and"},{"speaker":"Chris Dy","startTime":888.63,"endTime":892.2,"body":"irritated. And when it goes"},{"speaker":"Chris Dy","startTime":892.2,"endTime":895.02,"body":"through this kind of dynamic"},{"speaker":"Chris Dy","startTime":892.2,"endTime":895.02,"body":"ischemia, that's when you start"},{"speaker":"Chris Dy","startTime":895.02,"endTime":897.69,"body":"to get the pain and paraesthesia"},{"speaker":"Chris Dy","startTime":895.02,"endTime":897.69,"body":"as then, you know, this is kind"},{"speaker":"Chris Dy","startTime":897.69,"endTime":901.68,"body":"of on the earlier side of the"},{"speaker":"Chris Dy","startTime":897.69,"endTime":901.68,"body":"Earlier side of the condition,"},{"speaker":"Chris Dy","startTime":901.68,"endTime":904.44,"body":"so yeah, the same impression"},{"speaker":"Chris Dy","startTime":901.68,"endTime":904.44,"body":"that you injected there in in"},{"speaker":"Chris Dy","startTime":904.44,"endTime":907.17,"body":"the carpal tunnel, you would cut"},{"speaker":"Chris Dy","startTime":904.44,"endTime":907.17,"body":"the swelling presumably from the"},{"speaker":"Chris Dy","startTime":907.17,"endTime":910.29,"body":"synovial, surrounding the flexor"},{"speaker":"Chris Dy","startTime":907.17,"endTime":910.29,"body":"tendons. And as you cut that"},{"speaker":"Chris Dy","startTime":910.29,"endTime":914.94,"body":"swelling, the nerve would have,"},{"speaker":"Chris Dy","startTime":910.29,"endTime":914.94,"body":"quote, more room to breathe. I"},{"speaker":"Chris Dy","startTime":914.94,"endTime":917.61,"body":"didn't think it was swelling in"},{"speaker":"Chris Dy","startTime":914.94,"endTime":917.61,"body":"the nerve itself, though, but I"},{"speaker":"Chris Dy","startTime":917.61,"endTime":919.53,"body":"thought it was swelling in that"},{"speaker":"Chris Dy","startTime":917.61,"endTime":919.53,"body":"confined space."},{"speaker":"Charles Goldfarb","startTime":919.96,"endTime":921.97,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":919.96,"endTime":921.97,"body":"absolutely. And the authors here"},{"speaker":"Charles Goldfarb","startTime":921.97,"endTime":925.0,"body":"kind of did really did two"},{"speaker":"Charles Goldfarb","startTime":921.97,"endTime":925.0,"body":"studies in one and I don't know"},{"speaker":"Charles Goldfarb","startTime":925.0,"endTime":928.84,"body":"if this was related to feedback"},{"speaker":"Charles Goldfarb","startTime":925.0,"endTime":928.84,"body":"they got during the editorial"},{"speaker":"Charles Goldfarb","startTime":928.84,"endTime":931.99,"body":"process, I actually didn't think"},{"speaker":"Charles Goldfarb","startTime":928.84,"endTime":931.99,"body":"it was necessary. They kind of"},{"speaker":"Charles Goldfarb","startTime":931.99,"endTime":934.93,"body":"looked at, you know, outcomes"},{"speaker":"Charles Goldfarb","startTime":931.99,"endTime":934.93,"body":"with steroid injections in a"},{"speaker":"Charles Goldfarb","startTime":934.93,"endTime":937.33,"body":"group of patients. But that's"},{"speaker":"Charles Goldfarb","startTime":934.93,"endTime":937.33,"body":"not what you and I are focused"},{"speaker":"Charles Goldfarb","startTime":937.33,"endTime":941.14,"body":"on, we're really focused on the"},{"speaker":"Charles Goldfarb","startTime":937.33,"endTime":941.14,"body":"part where they it's really"},{"speaker":"Charles Goldfarb","startTime":941.14,"endTime":946.36,"body":"interesting, they, they"},{"speaker":"Charles Goldfarb","startTime":941.14,"endTime":946.36,"body":"collected fibroblasts, from the"},{"speaker":"Charles Goldfarb","startTime":946.36,"endTime":952.09,"body":"sub synovial connective tissues,"},{"speaker":"Charles Goldfarb","startTime":946.36,"endTime":952.09,"body":"during carpal tunnel release for"},{"speaker":"Charles Goldfarb","startTime":952.09,"endTime":955.21,"body":"patients with idiopathic carpal"},{"speaker":"Charles Goldfarb","startTime":952.09,"endTime":955.21,"body":"tunnel, and they incubated them"},{"speaker":"Charles Goldfarb","startTime":955.21,"endTime":959.32,"body":"with or without triamcinolone"},{"speaker":"Charles Goldfarb","startTime":955.21,"endTime":959.32,"body":"for for one, three or seven"},{"speaker":"Charles Goldfarb","startTime":959.32,"endTime":963.01,"body":"days. And then they looked at"},{"speaker":"Charles Goldfarb","startTime":959.32,"endTime":963.01,"body":"expression of fibrosis related"},{"speaker":"Charles Goldfarb","startTime":963.01,"endTime":966.79,"body":"genes and expression of"},{"speaker":"Charles Goldfarb","startTime":963.01,"endTime":966.79,"body":"inflammatory cytokines, which is"},{"speaker":"Charles Goldfarb","startTime":966.79,"endTime":971.71,"body":"just a super interesting thing"},{"speaker":"Charles Goldfarb","startTime":966.79,"endTime":971.71,"body":"to do. So kudos for thinking"},{"speaker":"Charles Goldfarb","startTime":971.71,"endTime":976.21,"body":"about an age old question in a"},{"speaker":"Charles Goldfarb","startTime":971.71,"endTime":976.21,"body":"very 2021 kind of way."},{"speaker":"Chris Dy","startTime":977.37,"endTime":978.87,"body":"Yeah, I think it's"},{"speaker":"Chris Dy","startTime":977.37,"endTime":978.87,"body":"interesting. So for the"},{"speaker":"Chris Dy","startTime":978.87,"endTime":982.35,"body":"listeners that, you know, my"},{"speaker":"Chris Dy","startTime":978.87,"endTime":982.35,"body":"simplistic understanding of the"},{"speaker":"Chris Dy","startTime":982.35,"endTime":984.93,"body":"basic science of carpal tunnel"},{"speaker":"Chris Dy","startTime":982.35,"endTime":984.93,"body":"syndrome is that initially, you"},{"speaker":"Chris Dy","startTime":984.93,"endTime":988.53,"body":"will have some inflammation. And"},{"speaker":"Chris Dy","startTime":984.93,"endTime":988.53,"body":"as the process goes from this"},{"speaker":"Chris Dy","startTime":988.53,"endTime":991.68,"body":"dynamic ischemia and becomes"},{"speaker":"Chris Dy","startTime":988.53,"endTime":991.68,"body":"more of a sustained and"},{"speaker":"Chris Dy","startTime":991.68,"endTime":995.28,"body":"prolonged compression of the"},{"speaker":"Chris Dy","startTime":991.68,"endTime":995.28,"body":"median nerve, there will then be"},{"speaker":"Chris Dy","startTime":996.36,"endTime":1000.05,"body":"fibrosis within the nerve, that"},{"speaker":"Chris Dy","startTime":996.36,"endTime":1000.05,"body":"can lead to some of the longer"},{"speaker":"Chris Dy","startTime":1000.05,"endTime":1002.87,"body":"term findings that you see the"},{"speaker":"Chris Dy","startTime":1000.05,"endTime":1002.87,"body":"more advanced findings. Now,"},{"speaker":"Chris Dy","startTime":1002.87,"endTime":1005.9,"body":"they were not studying the nerve"},{"speaker":"Chris Dy","startTime":1002.87,"endTime":1005.9,"body":"itself. So they did not sample"},{"speaker":"Chris Dy","startTime":1005.9,"endTime":1008.45,"body":"the nerve, but they studied the"},{"speaker":"Chris Dy","startTime":1005.9,"endTime":1008.45,"body":"tissue immediately surrounding"},{"speaker":"Chris Dy","startTime":1008.45,"endTime":1012.5,"body":"the nerve. So what they found"},{"speaker":"Chris Dy","startTime":1008.45,"endTime":1012.5,"body":"was interesting enough is that"},{"speaker":"Chris Dy","startTime":1012.5,"endTime":1017.09,"body":"when you incubated, you know,"},{"speaker":"Chris Dy","startTime":1012.5,"endTime":1017.09,"body":"the, the sub synovial tissue"},{"speaker":"Chris Dy","startTime":1017.51,"endTime":1021.2,"body":"with the steroid is that it"},{"speaker":"Chris Dy","startTime":1017.51,"endTime":1021.2,"body":"wasn't really the inflammation"},{"speaker":"Chris Dy","startTime":1021.2,"endTime":1026.45,"body":"that was cut, it was an effect"},{"speaker":"Chris Dy","startTime":1021.2,"endTime":1026.45,"body":"on fibrosis related genes. So"},{"speaker":"Chris Dy","startTime":1026.45,"endTime":1029.36,"body":"you know, this was super"},{"speaker":"Chris Dy","startTime":1026.45,"endTime":1029.36,"body":"interesting, and way beyond me"},{"speaker":"Chris Dy","startTime":1029.36,"endTime":1032.48,"body":"in terms of the basic science,"},{"speaker":"Chris Dy","startTime":1029.36,"endTime":1032.48,"body":"but I thought it was interesting"},{"speaker":"Chris Dy","startTime":1032.48,"endTime":1035.54,"body":"that it was more about the"},{"speaker":"Chris Dy","startTime":1032.48,"endTime":1035.54,"body":"steroid working on the fibrosis"},{"speaker":"Chris Dy","startTime":1035.54,"endTime":1038.06,"body":"as opposed to the steroid"},{"speaker":"Chris Dy","startTime":1035.54,"endTime":1038.06,"body":"working on the inflammatory"},{"speaker":"Chris Dy","startTime":1038.06,"endTime":1038.78,"body":"components."},{"speaker":"Charles Goldfarb","startTime":1039.14,"endTime":1040.73,"body":"Yeah, I mean,"},{"speaker":"Charles Goldfarb","startTime":1039.14,"endTime":1040.73,"body":"I think you're pointed, this is"},{"speaker":"Charles Goldfarb","startTime":1040.73,"endTime":1042.98,"body":"not the nerve, this is the"},{"speaker":"Charles Goldfarb","startTime":1040.73,"endTime":1042.98,"body":"surrounding tissues is"},{"speaker":"Charles Goldfarb","startTime":1042.98,"endTime":1046.58,"body":"important. But it's really"},{"speaker":"Charles Goldfarb","startTime":1042.98,"endTime":1046.58,"body":"dramatic findings that really"},{"speaker":"Charles Goldfarb","startTime":1046.61,"endTime":1049.1,"body":"change how I think about this."},{"speaker":"Charles Goldfarb","startTime":1046.61,"endTime":1049.1,"body":"And the next paper, we're going"},{"speaker":"Charles Goldfarb","startTime":1049.1,"endTime":1052.25,"body":"to talk about clinical outcomes"},{"speaker":"Charles Goldfarb","startTime":1049.1,"endTime":1052.25,"body":"from steroid injection, which"},{"speaker":"Charles Goldfarb","startTime":1052.25,"endTime":1055.76,"body":"again, I think is more is, is"},{"speaker":"Charles Goldfarb","startTime":1052.25,"endTime":1055.76,"body":"better done than then what they"},{"speaker":"Charles Goldfarb","startTime":1055.76,"endTime":1059.6,"body":"did in this paper. But it's an"},{"speaker":"Charles Goldfarb","startTime":1055.76,"endTime":1059.6,"body":"important thing for us to"},{"speaker":"Charles Goldfarb","startTime":1059.6,"endTime":1063.23,"body":"process, it's important probably"},{"speaker":"Charles Goldfarb","startTime":1059.6,"endTime":1063.23,"body":"to share with the sophisticated"},{"speaker":"Charles Goldfarb","startTime":1063.23,"endTime":1066.65,"body":"patient. And really, I think"},{"speaker":"Charles Goldfarb","startTime":1063.23,"endTime":1066.65,"body":"it's important for us to"},{"speaker":"Charles Goldfarb","startTime":1066.65,"endTime":1069.02,"body":"consider, you know, think about"},{"speaker":"Charles Goldfarb","startTime":1066.65,"endTime":1069.02,"body":"this as we move forward with"},{"speaker":"Charles Goldfarb","startTime":1069.02,"endTime":1070.46,"body":"additional investigations."},{"speaker":"Chris Dy","startTime":1071.14,"endTime":1073.45,"body":"So for me, I mean, I"},{"speaker":"Chris Dy","startTime":1071.14,"endTime":1073.45,"body":"don't know it doesn't, it"},{"speaker":"Chris Dy","startTime":1073.45,"endTime":1076.27,"body":"changes a little bit how I think"},{"speaker":"Chris Dy","startTime":1073.45,"endTime":1076.27,"body":"about does not change what I do,"},{"speaker":"Chris Dy","startTime":1076.66,"endTime":1079.93,"body":"because we know that the steroid"},{"speaker":"Chris Dy","startTime":1076.66,"endTime":1079.93,"body":"injections in that patient in"},{"speaker":"Chris Dy","startTime":1080.26,"endTime":1083.86,"body":"the certain population will"},{"speaker":"Chris Dy","startTime":1080.26,"endTime":1083.86,"body":"work. Now the longevity is what"},{"speaker":"Chris Dy","startTime":1083.86,"endTime":1085.81,"body":"we'll get into it in the next"},{"speaker":"Chris Dy","startTime":1083.86,"endTime":1085.81,"body":"article, and whether it makes"},{"speaker":"Chris Dy","startTime":1085.81,"endTime":1089.14,"body":"the true difference, but it will"},{"speaker":"Chris Dy","startTime":1085.81,"endTime":1089.14,"body":"work temporarily. It doesn't"},{"speaker":"Chris Dy","startTime":1089.14,"endTime":1092.17,"body":"change what I offer patients, I"},{"speaker":"Chris Dy","startTime":1089.14,"endTime":1092.17,"body":"guess I've changed how I talk to"},{"speaker":"Chris Dy","startTime":1092.17,"endTime":1095.47,"body":"patients about it, I kind of go"},{"speaker":"Chris Dy","startTime":1092.17,"endTime":1095.47,"body":"back on the whether it cuts"},{"speaker":"Chris Dy","startTime":1095.47,"endTime":1098.56,"body":"inflammation around there. I"},{"speaker":"Chris Dy","startTime":1095.47,"endTime":1098.56,"body":"think it may have some really"},{"speaker":"Chris Dy","startTime":1098.56,"endTime":1101.08,"body":"interesting applications in the"},{"speaker":"Chris Dy","startTime":1098.56,"endTime":1101.08,"body":"future. Say for example, we did"},{"speaker":"Chris Dy","startTime":1101.08,"endTime":1104.53,"body":"gene based therapy for carpal"},{"speaker":"Chris Dy","startTime":1101.08,"endTime":1104.53,"body":"tunnel syndrome. Now we know"},{"speaker":"Chris Dy","startTime":1104.53,"endTime":1108.55,"body":"where to really target. But that"},{"speaker":"Chris Dy","startTime":1104.53,"endTime":1108.55,"body":"is, you know, far away from"},{"speaker":"Chris Dy","startTime":1108.55,"endTime":1111.19,"body":"where we are right now. And far"},{"speaker":"Chris Dy","startTime":1108.55,"endTime":1111.19,"body":"away from what we do is hand"},{"speaker":"Chris Dy","startTime":1111.19,"endTime":1112.0,"body":"surgeons I think."},{"speaker":"Charles Goldfarb","startTime":1112.51,"endTime":1114.49,"body":"Yeah, and the"},{"speaker":"Charles Goldfarb","startTime":1112.51,"endTime":1114.49,"body":"other thing, which, you know,"},{"speaker":"Charles Goldfarb","startTime":1114.49,"endTime":1117.91,"body":"resonates with me is another"},{"speaker":"Charles Goldfarb","startTime":1114.49,"endTime":1117.91,"body":"diagnosis, which would be tennis"},{"speaker":"Charles Goldfarb","startTime":1117.91,"endTime":1120.91,"body":"elbow, because we talk about"},{"speaker":"Charles Goldfarb","startTime":1117.91,"endTime":1120.91,"body":"tennis elbow as not being an"},{"speaker":"Charles Goldfarb","startTime":1120.91,"endTime":1125.02,"body":"inflammatory condition. And one"},{"speaker":"Charles Goldfarb","startTime":1120.91,"endTime":1125.02,"body":"of the justifications, some use"},{"speaker":"Charles Goldfarb","startTime":1125.02,"endTime":1130.18,"body":"to avoiding steroid injections"},{"speaker":"Charles Goldfarb","startTime":1125.02,"endTime":1130.18,"body":"is just that. And yet, this"},{"speaker":"Charles Goldfarb","startTime":1130.21,"endTime":1133.81,"body":"article shows that steroids can"},{"speaker":"Charles Goldfarb","startTime":1130.21,"endTime":1133.81,"body":"have an effect even beyond or"},{"speaker":"Charles Goldfarb","startTime":1133.81,"endTime":1136.69,"body":"maybe instead of the anti"},{"speaker":"Charles Goldfarb","startTime":1133.81,"endTime":1136.69,"body":"inflammatory effect. And don't"},{"speaker":"Charles Goldfarb","startTime":1136.69,"endTime":1139.27,"body":"get me wrong. I'm not advocating"},{"speaker":"Charles Goldfarb","startTime":1136.69,"endTime":1139.27,"body":"steroid injections, because"},{"speaker":"Charles Goldfarb","startTime":1139.75,"endTime":1141.94,"body":"while I do use them,"},{"speaker":"Charles Goldfarb","startTime":1139.75,"endTime":1141.94,"body":"occasionally, there is pretty"},{"speaker":"Charles Goldfarb","startTime":1141.94,"endTime":1144.28,"body":"good science out there that"},{"speaker":"Charles Goldfarb","startTime":1141.94,"endTime":1144.28,"body":"they're not the be all end all"},{"speaker":"Charles Goldfarb","startTime":1144.28,"endTime":1146.98,"body":"for tennis elbow, but it just"},{"speaker":"Charles Goldfarb","startTime":1144.28,"endTime":1146.98,"body":"makes me think about that"},{"speaker":"Charles Goldfarb","startTime":1146.98,"endTime":1148.15,"body":"diagnosis as well."},{"speaker":"Chris Dy","startTime":1149.17,"endTime":1151.99,"body":"So let's get into the"},{"speaker":"Chris Dy","startTime":1149.17,"endTime":1151.99,"body":"next article. So this is from"},{"speaker":"Chris Dy","startTime":1151.99,"endTime":1156.13,"body":"Hoffer at all and this was from"},{"speaker":"Chris Dy","startTime":1151.99,"endTime":1156.13,"body":"Lund University in Sweden, and"},{"speaker":"Chris Dy","startTime":1156.13,"endTime":1158.89,"body":"this is extended follow up of"},{"speaker":"Chris Dy","startTime":1156.13,"endTime":1158.89,"body":"local steroid injection for"},{"speaker":"Chris Dy","startTime":1158.89,"endTime":1162.46,"body":"carpal tunnel syndrome and RCT."},{"speaker":"Chris Dy","startTime":1158.89,"endTime":1162.46,"body":"And this was in JAMA Network"},{"speaker":"Chris Dy","startTime":1162.46,"endTime":1165.4,"body":"open and it was published and we"},{"speaker":"Chris Dy","startTime":1162.46,"endTime":1165.4,"body":"look at the publication date,"},{"speaker":"Chris Dy","startTime":1165.43,"endTime":1169.42,"body":"October 22 2021. Again, this"},{"speaker":"Chris Dy","startTime":1165.43,"endTime":1169.42,"body":"will be in the show notes and"},{"speaker":"Chris Dy","startTime":1169.42,"endTime":1174.16,"body":"then in the newsletter. So they"},{"speaker":"Chris Dy","startTime":1169.42,"endTime":1174.16,"body":"did an RCT here, and this was"},{"speaker":"Chris Dy","startTime":1174.16,"endTime":1177.28,"body":"amazing five year follow up"},{"speaker":"Chris Dy","startTime":1174.16,"endTime":1177.28,"body":"after steroid injections. So"},{"speaker":"Chris Dy","startTime":1177.28,"endTime":1180.43,"body":"there's a lower dose of 40"},{"speaker":"Chris Dy","startTime":1177.28,"endTime":1180.43,"body":"milligrams of methyl"},{"speaker":"Chris Dy","startTime":1180.85,"endTime":1184.42,"body":"prednisolone and then double"},{"speaker":"Chris Dy","startTime":1180.85,"endTime":1184.42,"body":"that dose and the second arm of"},{"speaker":"Chris Dy","startTime":1184.42,"endTime":1186.88,"body":"the study, and then a placebo"},{"speaker":"Chris Dy","startTime":1184.42,"endTime":1186.88,"body":"and a third arm."},{"speaker":"Charles Goldfarb","startTime":1188.08,"endTime":1190.33,"body":"Yeah, this is"},{"speaker":"Charles Goldfarb","startTime":1188.08,"endTime":1190.33,"body":"great. And this is actually this"},{"speaker":"Charles Goldfarb","startTime":1190.33,"endTime":1193.27,"body":"paper this. This group of"},{"speaker":"Charles Goldfarb","startTime":1190.33,"endTime":1193.27,"body":"patients has been previously"},{"speaker":"Charles Goldfarb","startTime":1193.27,"endTime":1197.74,"body":"studied and reported on so this"},{"speaker":"Charles Goldfarb","startTime":1193.27,"endTime":1197.74,"body":"is almost a follow up study. But"},{"speaker":"Charles Goldfarb","startTime":1197.74,"endTime":1203.29,"body":"man, this is super well done."},{"speaker":"Charles Goldfarb","startTime":1197.74,"endTime":1203.29,"body":"and really gets to the heart, it"},{"speaker":"Charles Goldfarb","startTime":1203.29,"endTime":1207.01,"body":"is interesting on perspective,"},{"speaker":"Charles Goldfarb","startTime":1203.29,"endTime":1207.01,"body":"it gets to the heart of why we"},{"speaker":"Charles Goldfarb","startTime":1207.01,"endTime":1211.3,"body":"think about injections. And just"},{"speaker":"Charles Goldfarb","startTime":1207.01,"endTime":1211.3,"body":"briefly to summarize, so they"},{"speaker":"Charles Goldfarb","startTime":1211.3,"endTime":1215.38,"body":"had they had more than 100"},{"speaker":"Charles Goldfarb","startTime":1211.3,"endTime":1215.38,"body":"participants. And the bottom"},{"speaker":"Charles Goldfarb","startTime":1215.38,"endTime":1221.23,"body":"line is that steroid injections"},{"speaker":"Charles Goldfarb","startTime":1215.38,"endTime":1221.23,"body":"were effective in the sense that"},{"speaker":"Charles Goldfarb","startTime":1221.23,"endTime":1226.12,"body":"they decreased symptoms for a"},{"speaker":"Charles Goldfarb","startTime":1221.23,"endTime":1226.12,"body":"mean of about six months. And"},{"speaker":"Charles Goldfarb","startTime":1226.12,"endTime":1229.6,"body":"they slightly, but not"},{"speaker":"Charles Goldfarb","startTime":1226.12,"endTime":1229.6,"body":"dramatically, in my mind,"},{"speaker":"Charles Goldfarb","startTime":1229.6,"endTime":1232.45,"body":"decrease the number of patients"},{"speaker":"Charles Goldfarb","startTime":1229.6,"endTime":1232.45,"body":"that went on to carpal tunnel."},{"speaker":"Charles Goldfarb","startTime":1232.51,"endTime":1236.41,"body":"So as a surgeon looking at these"},{"speaker":"Charles Goldfarb","startTime":1232.51,"endTime":1236.41,"body":"data, essentially, it confirmed"},{"speaker":"Charles Goldfarb","startTime":1236.41,"endTime":1240.4,"body":"what I already thought, steroid"},{"speaker":"Charles Goldfarb","startTime":1236.41,"endTime":1240.4,"body":"injections buy you time, but do"},{"speaker":"Charles Goldfarb","startTime":1240.4,"endTime":1244.84,"body":"not fundamentally change the"},{"speaker":"Charles Goldfarb","startTime":1240.4,"endTime":1244.84,"body":"benefits of surgery. And most"},{"speaker":"Charles Goldfarb","startTime":1244.84,"endTime":1247.15,"body":"patients come to surgery. And"},{"speaker":"Charles Goldfarb","startTime":1244.84,"endTime":1247.15,"body":"often it's not very long from"},{"speaker":"Charles Goldfarb","startTime":1247.15,"endTime":1250.42,"body":"now. However, the way the"},{"speaker":"Charles Goldfarb","startTime":1247.15,"endTime":1250.42,"body":"article reads is kind of like,"},{"speaker":"Charles Goldfarb","startTime":1250.42,"endTime":1252.34,"body":"well, steroids are great,"},{"speaker":"Charles Goldfarb","startTime":1250.42,"endTime":1252.34,"body":"they're a great option for"},{"speaker":"Charles Goldfarb","startTime":1252.34,"endTime":1255.64,"body":"patients to consider. It's just"},{"speaker":"Charles Goldfarb","startTime":1252.34,"endTime":1255.64,"body":"not the way I think about it."},{"speaker":"Chris Dy","startTime":1256.36,"endTime":1258.73,"body":"Yeah, I think it's"},{"speaker":"Chris Dy","startTime":1256.36,"endTime":1258.73,"body":"really interesting. So in the"},{"speaker":"Chris Dy","startTime":1258.76,"endTime":1262.99,"body":"plus, let's look at the actual"},{"speaker":"Chris Dy","startTime":1258.76,"endTime":1262.99,"body":"results here in the placebo"},{"speaker":"Chris Dy","startTime":1262.99,"endTime":1266.53,"body":"group, the number of percentage"},{"speaker":"Chris Dy","startTime":1262.99,"endTime":1266.53,"body":"of patients that went on to have"},{"speaker":"Chris Dy","startTime":1266.53,"endTime":1271.36,"body":"surgery was 97%, within five"},{"speaker":"Chris Dy","startTime":1266.53,"endTime":1271.36,"body":"years of the injection, in the"},{"speaker":"Chris Dy","startTime":1271.36,"endTime":1274.6,"body":"low dose steroid injection"},{"speaker":"Chris Dy","startTime":1271.36,"endTime":1274.6,"body":"group, the percentage that went"},{"speaker":"Chris Dy","startTime":1274.6,"endTime":1279.37,"body":"into surgery was 92%. And then"},{"speaker":"Chris Dy","startTime":1274.6,"endTime":1279.37,"body":"in the high dose, it was 84%. So"},{"speaker":"Chris Dy","startTime":1279.4,"endTime":1282.73,"body":"84% of people still want to have"},{"speaker":"Chris Dy","startTime":1279.4,"endTime":1282.73,"body":"surgery. Now that is"},{"speaker":"Chris Dy","startTime":1282.73,"endTime":1287.5,"body":"significantly lower than you"},{"speaker":"Chris Dy","startTime":1282.73,"endTime":1287.5,"body":"know, the 97% of the placebo."},{"speaker":"Chris Dy","startTime":1288.19,"endTime":1292.09,"body":"But again, 84% went on to have"},{"speaker":"Chris Dy","startTime":1288.19,"endTime":1292.09,"body":"surgery. But the way that the"},{"speaker":"Chris Dy","startTime":1292.09,"endTime":1295.03,"body":"conclusions and relevant section"},{"speaker":"Chris Dy","startTime":1292.09,"endTime":1295.03,"body":"of the abstract reads, you would"},{"speaker":"Chris Dy","startTime":1295.03,"endTime":1298.0,"body":"think that an insurance company"},{"speaker":"Chris Dy","startTime":1295.03,"endTime":1298.0,"body":"potentially who may not read the"},{"speaker":"Chris Dy","startTime":1298.0,"endTime":1301.36,"body":"entire article, somebody from an"},{"speaker":"Chris Dy","startTime":1298.0,"endTime":1301.36,"body":"insurance company, may say, you"},{"speaker":"Chris Dy","startTime":1301.36,"endTime":1303.4,"body":"know, what, why are we paying"},{"speaker":"Chris Dy","startTime":1301.36,"endTime":1303.4,"body":"for surgery and all these"},{"speaker":"Chris Dy","startTime":1303.4,"endTime":1303.88,"body":"patients?"},{"speaker":"Charles Goldfarb","startTime":1304.69,"endTime":1306.76,"body":"Yeah, and that"},{"speaker":"Charles Goldfarb","startTime":1304.69,"endTime":1306.76,"body":"would be a huge error. And the"},{"speaker":"Charles Goldfarb","startTime":1306.76,"endTime":1310.9,"body":"other I think, all this is"},{"speaker":"Charles Goldfarb","startTime":1306.76,"endTime":1310.9,"body":"interesting and helpful. To me,"},{"speaker":"Charles Goldfarb","startTime":1311.14,"endTime":1315.07,"body":"the most important take home"},{"speaker":"Charles Goldfarb","startTime":1311.14,"endTime":1315.07,"body":"message is the time to surgery,"},{"speaker":"Charles Goldfarb","startTime":1316.06,"endTime":1321.82,"body":"which is pretty consistent at"},{"speaker":"Charles Goldfarb","startTime":1316.06,"endTime":1321.82,"body":"180 days. So this says, Look, on"},{"speaker":"Charles Goldfarb","startTime":1321.82,"endTime":1325.57,"body":"average, you can expect six"},{"speaker":"Charles Goldfarb","startTime":1321.82,"endTime":1325.57,"body":"months of going down your"},{"speaker":"Charles Goldfarb","startTime":1325.57,"endTime":1328.6,"body":"current course, but then on a"},{"speaker":"Charles Goldfarb","startTime":1325.57,"endTime":1328.6,"body":"you know, on average, that's"},{"speaker":"Charles Goldfarb","startTime":1328.6,"endTime":1330.79,"body":"when you will consider surgery"},{"speaker":"Charles Goldfarb","startTime":1328.6,"endTime":1330.79,"body":"to be the right approach for"},{"speaker":"Charles Goldfarb","startTime":1330.79,"endTime":1332.56,"body":"you, which is pretty"},{"speaker":"Charles Goldfarb","startTime":1330.79,"endTime":1332.56,"body":"disappointing, because that"},{"speaker":"Charles Goldfarb","startTime":1332.56,"endTime":1336.94,"body":"means that if it was six months"},{"speaker":"Charles Goldfarb","startTime":1332.56,"endTime":1336.94,"body":"until surgery, presumably"},{"speaker":"Charles Goldfarb","startTime":1336.94,"endTime":1339.28,"body":"they're thinking about surgery"},{"speaker":"Charles Goldfarb","startTime":1336.94,"endTime":1339.28,"body":"as early as three months after"},{"speaker":"Charles Goldfarb","startTime":1339.28,"endTime":1343.18,"body":"an injection. And so to me, this"},{"speaker":"Charles Goldfarb","startTime":1339.28,"endTime":1343.18,"body":"means that injections again,"},{"speaker":"Charles Goldfarb","startTime":1343.27,"endTime":1346.18,"body":"don't really have a strong role"},{"speaker":"Charles Goldfarb","startTime":1343.27,"endTime":1346.18,"body":"in my practice, unless there's a"},{"speaker":"Charles Goldfarb","startTime":1346.18,"endTime":1350.95,"body":"specific patient driven thought"},{"speaker":"Charles Goldfarb","startTime":1346.18,"endTime":1350.95,"body":"process around delaying an"},{"speaker":"Charles Goldfarb","startTime":1350.95,"endTime":1351.52,"body":"intervention."},{"speaker":"Chris Dy","startTime":1352.05,"endTime":1354.51,"body":"Yeah, so in the"},{"speaker":"Chris Dy","startTime":1352.05,"endTime":1354.51,"body":"placebo group, they had the"},{"speaker":"Chris Dy","startTime":1354.51,"endTime":1358.02,"body":"meantime to surgeries for"},{"speaker":"Chris Dy","startTime":1354.51,"endTime":1358.02,"body":"months. So you know, like you're"},{"speaker":"Chris Dy","startTime":1358.02,"endTime":1360.96,"body":"saying, I think my take home on"},{"speaker":"Chris Dy","startTime":1358.02,"endTime":1360.96,"body":"this is that it works by the"},{"speaker":"Chris Dy","startTime":1360.96,"endTime":1364.53,"body":"time probably gets you about six"},{"speaker":"Chris Dy","startTime":1360.96,"endTime":1364.53,"body":"months. And I think that, you"},{"speaker":"Chris Dy","startTime":1364.53,"endTime":1367.11,"body":"know, this kind of segues us"},{"speaker":"Chris Dy","startTime":1364.53,"endTime":1367.11,"body":"into the next article, the"},{"speaker":"Chris Dy","startTime":1367.11,"endTime":1371.73,"body":"article from Kazmers, and the"},{"speaker":"Chris Dy","startTime":1367.11,"endTime":1371.73,"body":"group out in Utah, that looks at"},{"speaker":"Chris Dy","startTime":1371.73,"endTime":1374.91,"body":"you know, complications,"},{"speaker":"Chris Dy","startTime":1371.73,"endTime":1374.91,"body":"potentially whether you did this"},{"speaker":"Chris Dy","startTime":1374.91,"endTime":1377.97,"body":"surgery for this is an example"},{"speaker":"Chris Dy","startTime":1374.91,"endTime":1377.97,"body":"of a trigger finger release, but"},{"speaker":"Chris Dy","startTime":1378.63,"endTime":1382.95,"body":"probably very similar findings"},{"speaker":"Chris Dy","startTime":1378.63,"endTime":1382.95,"body":"for carpal tunnel. Nice. So, you"},{"speaker":"Chris Dy","startTime":1382.95,"endTime":1387.63,"body":"know, with for me, the advent of"},{"speaker":"Chris Dy","startTime":1382.95,"endTime":1387.63,"body":"local only surgery without a"},{"speaker":"Chris Dy","startTime":1387.63,"endTime":1391.17,"body":"tourniquet has changed, I think"},{"speaker":"Chris Dy","startTime":1387.63,"endTime":1391.17,"body":"my threshold to indicate"},{"speaker":"Chris Dy","startTime":1391.17,"endTime":1395.7,"body":"surgery, both on a medical basis"},{"speaker":"Chris Dy","startTime":1391.17,"endTime":1395.7,"body":"as well as on a hand surgery"},{"speaker":"Chris Dy","startTime":1395.7,"endTime":1396.12,"body":"basis."},{"speaker":"Charles Goldfarb","startTime":1396.66,"endTime":1401.28,"body":"So Chris, I"},{"speaker":"Charles Goldfarb","startTime":1396.66,"endTime":1401.28,"body":"could not agree more, is just so"},{"speaker":"Charles Goldfarb","startTime":1401.28,"endTime":1405.45,"body":"simple. And I don't want to be a"},{"speaker":"Charles Goldfarb","startTime":1401.28,"endTime":1405.45,"body":"naive and be in come across as"},{"speaker":"Charles Goldfarb","startTime":1405.48,"endTime":1410.46,"body":"unaware of risks, even in a in a"},{"speaker":"Charles Goldfarb","startTime":1405.48,"endTime":1410.46,"body":"local only type procedure. But"},{"speaker":"Charles Goldfarb","startTime":1410.46,"endTime":1414.03,"body":"the local only procedures really"},{"speaker":"Charles Goldfarb","startTime":1410.46,"endTime":1414.03,"body":"are so much less demanding on"},{"speaker":"Charles Goldfarb","startTime":1414.03,"endTime":1418.23,"body":"the patient. There's so much"},{"speaker":"Charles Goldfarb","startTime":1414.03,"endTime":1418.23,"body":"less demanding on the system."},{"speaker":"Charles Goldfarb","startTime":1419.22,"endTime":1424.23,"body":"And they're just easier in every"},{"speaker":"Charles Goldfarb","startTime":1419.22,"endTime":1424.23,"body":"way and less expensive and"},{"speaker":"Charles Goldfarb","startTime":1424.23,"endTime":1427.47,"body":"greener in the sense that, you"},{"speaker":"Charles Goldfarb","startTime":1424.23,"endTime":1427.47,"body":"know, we're saving the world"},{"speaker":"Charles Goldfarb","startTime":1427.47,"endTime":1432.0,"body":"from the all the rigmarole that"},{"speaker":"Charles Goldfarb","startTime":1427.47,"endTime":1432.0,"body":"goes into a or based procedure."},{"speaker":"Charles Goldfarb","startTime":1432.18,"endTime":1435.93,"body":"This study is timely and really"},{"speaker":"Charles Goldfarb","startTime":1432.18,"endTime":1435.93,"body":"is impactful. It took the simple"},{"speaker":"Charles Goldfarb","startTime":1435.93,"endTime":1440.19,"body":"example of triggers. But really,"},{"speaker":"Charles Goldfarb","startTime":1435.93,"endTime":1440.19,"body":"it's it can be extrapolated, as"},{"speaker":"Charles Goldfarb","startTime":1440.19,"endTime":1443.04,"body":"you mentioned, to certainly"},{"speaker":"Charles Goldfarb","startTime":1440.19,"endTime":1443.04,"body":"carpal tunnel, if not further."},{"speaker":"Chris Dy","startTime":1443.72,"endTime":1446.9,"body":"So this is from our"},{"speaker":"Chris Dy","startTime":1443.72,"endTime":1446.9,"body":"WashU residence, the alum, Nick"},{"speaker":"Chris Dy","startTime":1446.9,"endTime":1449.39,"body":"Kazmers, who has been doing"},{"speaker":"Chris Dy","startTime":1446.9,"endTime":1449.39,"body":"amazing things with the group at"},{"speaker":"Chris Dy","startTime":1449.39,"endTime":1456.14,"body":"University of Utah. And so this"},{"speaker":"Chris Dy","startTime":1449.39,"endTime":1456.14,"body":"was published in JHS and the"},{"speaker":"Chris Dy","startTime":1456.26,"endTime":1458.72,"body":"date of publication let me pull"},{"speaker":"Chris Dy","startTime":1456.26,"endTime":1458.72,"body":"this up here. I don't know if so"},{"speaker":"Chris Dy","startTime":1458.72,"endTime":1463.16,"body":"yes, so this was in the October"},{"speaker":"Chris Dy","startTime":1458.72,"endTime":1463.16,"body":"issue of JHS. So the article"},{"speaker":"Chris Dy","startTime":1463.16,"endTime":1465.95,"body":"title is comparison of"},{"speaker":"Chris Dy","startTime":1463.16,"endTime":1465.95,"body":"complication rates following"},{"speaker":"Chris Dy","startTime":1465.95,"endTime":1469.07,"body":"trigger finger release performed"},{"speaker":"Chris Dy","startTime":1465.95,"endTime":1469.07,"body":"in the office versus er,"},{"speaker":"Chris Dy","startTime":1469.43,"endTime":1472.67,"body":"population based assessment. And"},{"speaker":"Chris Dy","startTime":1469.43,"endTime":1472.67,"body":"they actually worked with our"},{"speaker":"Chris Dy","startTime":1472.67,"endTime":1475.34,"body":"administrative data group here"},{"speaker":"Chris Dy","startTime":1472.67,"endTime":1475.34,"body":"at WashU, who I've worked with a"},{"speaker":"Chris Dy","startTime":1475.34,"endTime":1479.09,"body":"lot. So methodologically, I"},{"speaker":"Chris Dy","startTime":1475.34,"endTime":1479.09,"body":"think, among the most rigorous"},{"speaker":"Chris Dy","startTime":1479.09,"endTime":1482.03,"body":"of all of these groups who use"},{"speaker":"Chris Dy","startTime":1479.09,"endTime":1482.03,"body":"administrative data, so I"},{"speaker":"Chris Dy","startTime":1482.03,"endTime":1484.97,"body":"immediately knew that it was a"},{"speaker":"Chris Dy","startTime":1482.03,"endTime":1484.97,"body":"well done study. I actually"},{"speaker":"Chris Dy","startTime":1484.97,"endTime":1488.48,"body":"remember connecting Nick with"},{"speaker":"Chris Dy","startTime":1484.97,"endTime":1488.48,"body":"Margie Olson to do this study,"},{"speaker":"Chris Dy","startTime":1488.48,"endTime":1490.7,"body":"and then forgetting all about it"},{"speaker":"Chris Dy","startTime":1488.48,"endTime":1490.7,"body":"and then reading the study and"},{"speaker":"Chris Dy","startTime":1490.7,"endTime":1494.18,"body":"think oh, so they finally did"},{"speaker":"Chris Dy","startTime":1490.7,"endTime":1494.18,"body":"it. So these MarketScan which is"},{"speaker":"Chris Dy","startTime":1494.18,"endTime":1497.96,"body":"a commercial insurance database,"},{"speaker":"Chris Dy","startTime":1494.18,"endTime":1497.96,"body":"the US to know Medicare and no"},{"speaker":"Chris Dy","startTime":1497.96,"endTime":1502.55,"body":"Medicaid, but just Commercial"},{"speaker":"Chris Dy","startTime":1497.96,"endTime":1502.55,"body":"insurance in the US. And they"},{"speaker":"Chris Dy","startTime":1502.55,"endTime":1508.58,"body":"looked at almost 28 to 38,000"},{"speaker":"Chris Dy","startTime":1502.55,"endTime":1508.58,"body":"cases 7600, which were done in a"},{"speaker":"Chris Dy","startTime":1508.58,"endTime":1512.96,"body":"procedure room and 30,000 that"},{"speaker":"Chris Dy","startTime":1508.58,"endTime":1512.96,"body":"were done in the OR. And they"},{"speaker":"Chris Dy","startTime":1512.96,"endTime":1516.17,"body":"looked at the risk of medical"},{"speaker":"Chris Dy","startTime":1512.96,"endTime":1516.17,"body":"complications, which was"},{"speaker":"Chris Dy","startTime":1516.17,"endTime":1519.77,"body":"significantly lower in the"},{"speaker":"Chris Dy","startTime":1516.17,"endTime":1519.77,"body":"procedure room setting. And they"},{"speaker":"Chris Dy","startTime":1519.77,"endTime":1522.86,"body":"also looked at surgical site"},{"speaker":"Chris Dy","startTime":1519.77,"endTime":1522.86,"body":"complications, which was not"},{"speaker":"Chris Dy","startTime":1522.86,"endTime":1525.65,"body":"significantly different,"},{"speaker":"Chris Dy","startTime":1522.86,"endTime":1525.65,"body":"although they're just those of"},{"speaker":"Chris Dy","startTime":1525.65,"endTime":1527.96,"body":"you that want to know the"},{"speaker":"Chris Dy","startTime":1525.65,"endTime":1527.96,"body":"absolute percentages, there was"},{"speaker":"Chris Dy","startTime":1527.96,"endTime":1532.49,"body":"point six 7% in the procedure"},{"speaker":"Chris Dy","startTime":1527.96,"endTime":1532.49,"body":"room cases and point 8% In the"},{"speaker":"Chris Dy","startTime":1532.49,"endTime":1536.69,"body":"or cases. And there were very"},{"speaker":"Chris Dy","startTime":1532.49,"endTime":1536.69,"body":"few atherogenic complications,"},{"speaker":"Chris Dy","startTime":1536.99,"endTime":1542.15,"body":"you know, less than point oh,"},{"speaker":"Chris Dy","startTime":1536.99,"endTime":1542.15,"body":"7%. And in the, to me, point oh,"},{"speaker":"Chris Dy","startTime":1542.15,"endTime":1546.59,"body":"7%. And procedure room and point"},{"speaker":"Chris Dy","startTime":1542.15,"endTime":1546.59,"body":"oh, 9% in the OR. So, you know,"},{"speaker":"Chris Dy","startTime":1546.59,"endTime":1549.77,"body":"this was really interesting. To"},{"speaker":"Chris Dy","startTime":1546.59,"endTime":1549.77,"body":"me, it showed that procedure"},{"speaker":"Chris Dy","startTime":1549.77,"endTime":1553.46,"body":"room cases can be done quite"},{"speaker":"Chris Dy","startTime":1549.77,"endTime":1553.46,"body":"safely from both the medical"},{"speaker":"Chris Dy","startTime":1553.46,"endTime":1557.81,"body":"perspective as you would expect."},{"speaker":"Chris Dy","startTime":1553.46,"endTime":1557.81,"body":"And from a surgical perspective."},{"speaker":"Charles Goldfarb","startTime":1558.98,"endTime":1561.77,"body":"It is timely"},{"speaker":"Charles Goldfarb","startTime":1558.98,"endTime":1561.77,"body":"in the sense that there is a"},{"speaker":"Charles Goldfarb","startTime":1561.77,"endTime":1565.58,"body":"group of us and I will put"},{"speaker":"Charles Goldfarb","startTime":1561.77,"endTime":1565.58,"body":"myself in that group in the"},{"speaker":"Charles Goldfarb","startTime":1565.58,"endTime":1568.94,"body":"past, but I think I'm a, I'm a"},{"speaker":"Charles Goldfarb","startTime":1565.58,"endTime":1568.94,"body":"convert, but there's a group who"},{"speaker":"Charles Goldfarb","startTime":1568.94,"endTime":1571.82,"body":"says, Look, I don't know about"},{"speaker":"Charles Goldfarb","startTime":1568.94,"endTime":1571.82,"body":"the infection risks. And I don't"},{"speaker":"Charles Goldfarb","startTime":1571.82,"endTime":1574.79,"body":"know about complications, I"},{"speaker":"Charles Goldfarb","startTime":1571.82,"endTime":1574.79,"body":"don't know about lighting. And I"},{"speaker":"Charles Goldfarb","startTime":1574.79,"endTime":1579.41,"body":"don't know about can my can my"},{"speaker":"Charles Goldfarb","startTime":1574.79,"endTime":1579.41,"body":"group handle it? The reality is,"},{"speaker":"Charles Goldfarb","startTime":1579.5,"endTime":1585.02,"body":"you know, local only surgery is"},{"speaker":"Charles Goldfarb","startTime":1579.5,"endTime":1585.02,"body":"a win. And yes, it absolutely"},{"speaker":"Charles Goldfarb","startTime":1585.02,"endTime":1589.52,"body":"requires system based thinking."},{"speaker":"Charles Goldfarb","startTime":1585.02,"endTime":1589.52,"body":"It requires coming together on"},{"speaker":"Charles Goldfarb","startTime":1589.52,"endTime":1592.7,"body":"processes and doing things"},{"speaker":"Charles Goldfarb","startTime":1589.52,"endTime":1592.7,"body":"differently. Now, let's be"},{"speaker":"Charles Goldfarb","startTime":1592.7,"endTime":1596.36,"body":"honest, you and I are still on"},{"speaker":"Charles Goldfarb","startTime":1592.7,"endTime":1596.36,"body":"that path to figuring out how to"},{"speaker":"Charles Goldfarb","startTime":1596.36,"endTime":1600.71,"body":"do this efficiently, safely and"},{"speaker":"Charles Goldfarb","startTime":1596.36,"endTime":1600.71,"body":"effectively. But this is the"},{"speaker":"Charles Goldfarb","startTime":1600.71,"endTime":1605.09,"body":"future. It's just it's not it's"},{"speaker":"Charles Goldfarb","startTime":1600.71,"endTime":1605.09,"body":"right in every domain. So why"},{"speaker":"Charles Goldfarb","startTime":1605.09,"endTime":1606.02,"body":"aren't we doing more of it?"},{"speaker":"Chris Dy","startTime":1606.71,"endTime":1608.93,"body":"One would argue that"},{"speaker":"Chris Dy","startTime":1606.71,"endTime":1608.93,"body":"it's not the future, and perhaps"},{"speaker":"Chris Dy","startTime":1608.93,"endTime":1611.99,"body":"we are behind, because clearly,"},{"speaker":"Chris Dy","startTime":1608.93,"endTime":1611.99,"body":"you know, this is happening in a"},{"speaker":"Chris Dy","startTime":1612.74,"endTime":1616.67,"body":"substantial number of trigger"},{"speaker":"Chris Dy","startTime":1612.74,"endTime":1616.67,"body":"finger cases. So you know, 7600"},{"speaker":"Chris Dy","startTime":1616.67,"endTime":1622.64,"body":"out of 38,000 cases, you know,"},{"speaker":"Chris Dy","startTime":1616.67,"endTime":1622.64,"body":"that are going on. So, you know,"},{"speaker":"Chris Dy","startTime":1622.91,"endTime":1627.02,"body":"we should be doing this more."},{"speaker":"Chris Dy","startTime":1622.91,"endTime":1627.02,"body":"One thing, you know, I this is a"},{"speaker":"Chris Dy","startTime":1627.02,"endTime":1630.11,"body":"fantastic article. One thing I"},{"speaker":"Chris Dy","startTime":1627.02,"endTime":1630.11,"body":"wish that Nick and the group had"},{"speaker":"Chris Dy","startTime":1630.11,"endTime":1633.41,"body":"compared were the local the"},{"speaker":"Chris Dy","startTime":1630.11,"endTime":1633.41,"body":"procedure in cases with the"},{"speaker":"Chris Dy","startTime":1633.44,"endTime":1637.1,"body":"local only in the OR cases."},{"speaker":"Chris Dy","startTime":1633.44,"endTime":1637.1,"body":"Because I thought that would be"},{"speaker":"Chris Dy","startTime":1637.1,"endTime":1639.14,"body":"an interesting comparison. And"},{"speaker":"Chris Dy","startTime":1637.1,"endTime":1639.14,"body":"I'm sure there there were"},{"speaker":"Chris Dy","startTime":1639.14,"endTime":1643.7,"body":"reasons why they didn't do it."},{"speaker":"Chris Dy","startTime":1639.14,"endTime":1643.7,"body":"But I, I think that that would"},{"speaker":"Chris Dy","startTime":1643.7,"endTime":1647.18,"body":"give me a better sense of the"},{"speaker":"Chris Dy","startTime":1643.7,"endTime":1647.18,"body":"complication risk, more apples"},{"speaker":"Chris Dy","startTime":1647.18,"endTime":1647.87,"body":"to apples."},{"speaker":"Charles Goldfarb","startTime":1648.68,"endTime":1652.91,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1648.68,"endTime":1652.91,"body":"a great point. It is a nice"},{"speaker":"Charles Goldfarb","startTime":1653.15,"endTime":1658.46,"body":"segue. It's a nice intermediate"},{"speaker":"Charles Goldfarb","startTime":1653.15,"endTime":1658.46,"body":"step to go from traditional hand"},{"speaker":"Charles Goldfarb","startTime":1658.46,"endTime":1663.83,"body":"surgery to local only in the OR"},{"speaker":"Charles Goldfarb","startTime":1658.46,"endTime":1663.83,"body":"to local only in the clinic. And"},{"speaker":"Charles Goldfarb","startTime":1663.83,"endTime":1669.14,"body":"I think you and I are sort of on"},{"speaker":"Charles Goldfarb","startTime":1663.83,"endTime":1669.14,"body":"that spectrum of more the middle"},{"speaker":"Charles Goldfarb","startTime":1669.14,"endTime":1672.14,"body":"group and growing local only"},{"speaker":"Charles Goldfarb","startTime":1669.14,"endTime":1672.14,"body":"group."},{"speaker":"Chris Dy","startTime":1672.95,"endTime":1675.98,"body":"Yeah, we we've talked"},{"speaker":"Chris Dy","startTime":1672.95,"endTime":1675.98,"body":"about it on the pod in the past,"},{"speaker":"Chris Dy","startTime":1675.98,"endTime":1679.67,"body":"but when we had our second wave"},{"speaker":"Chris Dy","startTime":1675.98,"endTime":1679.67,"body":"of our closures back in December"},{"speaker":"Chris Dy","startTime":1679.67,"endTime":1684.14,"body":"of 20, you know, when they"},{"speaker":"Chris Dy","startTime":1679.67,"endTime":1684.14,"body":"closed our ambulatory centers,"},{"speaker":"Chris Dy","startTime":1684.71,"endTime":1688.61,"body":"you know, I did, I think 20"},{"speaker":"Chris Dy","startTime":1684.71,"endTime":1688.61,"body":"cases in the office triggers and"},{"speaker":"Chris Dy","startTime":1688.61,"endTime":1692.27,"body":"carpal tunnels and the queer"},{"speaker":"Chris Dy","startTime":1688.61,"endTime":1692.27,"body":"veins. And you know, we"},{"speaker":"Chris Dy","startTime":1692.27,"endTime":1695.09,"body":"informally administered a"},{"speaker":"Chris Dy","startTime":1692.27,"endTime":1695.09,"body":"survey, and now we're waiting"},{"speaker":"Chris Dy","startTime":1695.09,"endTime":1699.95,"body":"for it's in peer review at a QA"},{"speaker":"Chris Dy","startTime":1695.09,"endTime":1699.95,"body":"journal. But the patients"},{"speaker":"Chris Dy","startTime":1699.95,"endTime":1702.89,"body":"overall were incredibly happy"},{"speaker":"Chris Dy","startTime":1699.95,"endTime":1702.89,"body":"and knock on wood. I mean, I"},{"speaker":"Chris Dy","startTime":1702.89,"endTime":1706.64,"body":"think I'm out of the window of"},{"speaker":"Chris Dy","startTime":1702.89,"endTime":1706.64,"body":"complications from those cases,"},{"speaker":"Chris Dy","startTime":1706.88,"endTime":1709.13,"body":"at least the ones that you worry"},{"speaker":"Chris Dy","startTime":1706.88,"endTime":1709.13,"body":"about the most, and, you know,"},{"speaker":"Chris Dy","startTime":1709.13,"endTime":1712.37,"body":"patients did really well. Now,"},{"speaker":"Chris Dy","startTime":1709.13,"endTime":1712.37,"body":"again, like he said, it took a"},{"speaker":"Chris Dy","startTime":1712.37,"endTime":1716.36,"body":"lot of work to make that happen."},{"speaker":"Chris Dy","startTime":1712.37,"endTime":1716.36,"body":"But I think that's the way that"},{"speaker":"Chris Dy","startTime":1716.36,"endTime":1717.38,"body":"we're gonna end up going."},{"speaker":"Charles Goldfarb","startTime":1718.04,"endTime":1720.38,"body":"Yeah, it"},{"speaker":"Charles Goldfarb","startTime":1718.04,"endTime":1720.38,"body":"you're right, it is the future,"},{"speaker":"Charles Goldfarb","startTime":1720.38,"endTime":1723.56,"body":"but it is now and you are you"},{"speaker":"Charles Goldfarb","startTime":1720.38,"endTime":1723.56,"body":"and I have to catch up with"},{"speaker":"Charles Goldfarb","startTime":1723.56,"endTime":1724.01,"body":"jackets."},{"speaker":"Chris Dy","startTime":1724.01,"endTime":1725.69,"body":"Again, it's not the"},{"speaker":"Chris Dy","startTime":1724.01,"endTime":1725.69,"body":"future, we're just behind."},{"speaker":"Charles Goldfarb","startTime":1727.91,"endTime":1729.65,"body":"Alright, well,"},{"speaker":"Charles Goldfarb","startTime":1727.91,"endTime":1729.65,"body":"I loved all three of these"},{"speaker":"Charles Goldfarb","startTime":1729.65,"endTime":1734.39,"body":"articles. I think they're all"},{"speaker":"Charles Goldfarb","startTime":1729.65,"endTime":1734.39,"body":"impactful. And we'll be cited in"},{"speaker":"Charles Goldfarb","startTime":1734.39,"endTime":1736.64,"body":"years to come. So it was fun"},{"speaker":"Charles Goldfarb","startTime":1734.39,"endTime":1736.64,"body":"reviewing and but you?"},{"speaker":"Chris Dy","startTime":1737.09,"endTime":1739.4,"body":"Yeah, absolutely. I"},{"speaker":"Chris Dy","startTime":1737.09,"endTime":1739.4,"body":"mean, so it is, you know, I have"},{"speaker":"Chris Dy","startTime":1739.4,"endTime":1742.04,"body":"to put on my fellowship director"},{"speaker":"Chris Dy","startTime":1739.4,"endTime":1742.04,"body":"hat and say that, you know, this"},{"speaker":"Chris Dy","startTime":1742.04,"endTime":1743.93,"body":"is the kind of stuff that you're"},{"speaker":"Chris Dy","startTime":1742.04,"endTime":1743.93,"body":"going to get if you were to"},{"speaker":"Chris Dy","startTime":1743.93,"endTime":1746.15,"body":"check out our fellowship"},{"speaker":"Chris Dy","startTime":1743.93,"endTime":1746.15,"body":"program, you know, applications"},{"speaker":"Chris Dy","startTime":1746.15,"endTime":1748.76,"body":"throughout right now, Marty and"},{"speaker":"Chris Dy","startTime":1746.15,"endTime":1748.76,"body":"I actually did our first ask me"},{"speaker":"Chris Dy","startTime":1748.76,"endTime":1753.08,"body":"anything. session yesterday, it"},{"speaker":"Chris Dy","startTime":1748.76,"endTime":1753.08,"body":"was incredibly well attended for"},{"speaker":"Chris Dy","startTime":1753.08,"endTime":1755.63,"body":"being this far away from"},{"speaker":"Chris Dy","startTime":1753.08,"endTime":1755.63,"body":"interviews. So we had 15 people"},{"speaker":"Chris Dy","startTime":1755.63,"endTime":1760.61,"body":"on including some PGY threes and"},{"speaker":"Chris Dy","startTime":1755.63,"endTime":1760.61,"body":"that aren't even applying yet,"},{"speaker":"Chris Dy","startTime":1760.61,"endTime":1764.12,"body":"which was really cool to see. So"},{"speaker":"Chris Dy","startTime":1760.61,"endTime":1764.12,"body":"we're really thankful for"},{"speaker":"Chris Dy","startTime":1764.12,"endTime":1766.52,"body":"everybody that participates. I'm"},{"speaker":"Chris Dy","startTime":1764.12,"endTime":1766.52,"body":"sure some of you also listen to"},{"speaker":"Chris Dy","startTime":1766.52,"endTime":1769.76,"body":"the pod as well. And my son made"},{"speaker":"Chris Dy","startTime":1766.52,"endTime":1769.76,"body":"a guest appearance and insisted"},{"speaker":"Chris Dy","startTime":1769.97,"endTime":1772.73,"body":"that I use a zoom background"},{"speaker":"Chris Dy","startTime":1769.97,"endTime":1772.73,"body":"that was a tiger, which was a"},{"speaker":"Chris Dy","startTime":1772.73,"endTime":1774.98,"body":"little bit weird when he like"},{"speaker":"Chris Dy","startTime":1772.73,"endTime":1774.98,"body":"actually stepped away and I had"},{"speaker":"Chris Dy","startTime":1774.98,"endTime":1777.44,"body":"this like Tiger King thing in"},{"speaker":"Chris Dy","startTime":1774.98,"endTime":1777.44,"body":"the background. But anyway."},{"speaker":"Charles Goldfarb","startTime":1777.74,"endTime":1779.48,"body":"Yeah, a little"},{"speaker":"Charles Goldfarb","startTime":1777.74,"endTime":1779.48,"body":"weird, little weird."},{"speaker":"Chris Dy","startTime":1780.59,"endTime":1783.98,"body":"Well, I enjoy the rest"},{"speaker":"Chris Dy","startTime":1780.59,"endTime":1783.98,"body":"of your day. And Chuck, thanks"},{"speaker":"Chris Dy","startTime":1783.98,"endTime":1787.37,"body":"for chatting about these"},{"speaker":"Chris Dy","startTime":1783.98,"endTime":1787.37,"body":"articles, and we look forward to"},{"speaker":"Chris Dy","startTime":1787.37,"endTime":1788.06,"body":"the next pod."},{"speaker":"Charles Goldfarb","startTime":1788.27,"endTime":1789.41,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":1788.27,"endTime":1789.41,"body":"Have a great day."},{"speaker":"Chris Dy","startTime":1789.92,"endTime":1790.28,"body":"You too."},{"speaker":"Charles Goldfarb","startTime":1791.27,"endTime":1793.25,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":1791.27,"endTime":1793.25,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":1793.25,"endTime":1793.73,"body":"real soon."},{"speaker":"Chris Dy","startTime":1794.0,"endTime":1796.52,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":1794.0,"endTime":1796.52,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":1796.73,"endTime":1798.98,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":1796.73,"endTime":1798.98,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":1799.28,"endTime":1802.13,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":1799.28,"endTime":1802.13,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":1802.28,"endTime":1805.76,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":1802.28,"endTime":1805.76,"body":"spelled dy. If you'd like to"},{"speaker":"Chris Dy","startTime":1805.76,"endTime":1809.51,"body":"email us, you can reach us at"},{"speaker":"Chris Dy","startTime":1805.76,"endTime":1809.51,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":1810.08,"endTime":1812.24,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":1810.08,"endTime":1812.24,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":1812.24,"endTime":1813.32,"body":"get your podcast."},{"speaker":"Chris Dy","startTime":1813.38,"endTime":1815.57,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":1813.38,"endTime":1815.57,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":1815.57,"endTime":1815.99,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":1816.38,"endTime":1818.66,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":1816.38,"endTime":1818.66,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":1818.66,"endTime":1822.56,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":1818.66,"endTime":1822.56,"body":"upper hand come back next"}]}