{"version":"1.0.0","segments":[{"speaker":"Charles A. Goldfarb","startTime":3.63,"endTime":5.61,"body":"Welcome to"},{"speaker":"Charles A. Goldfarb","startTime":3.63,"endTime":5.61,"body":"the upper hand podcast where"},{"speaker":"Charles A. Goldfarb","startTime":5.61,"endTime":7.59,"body":"Chuck and Chris talk Hand"},{"speaker":"Charles A. Goldfarb","startTime":5.61,"endTime":7.59,"body":"Surgery."},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.72,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.72,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.72,"endTime":12.33,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.72,"endTime":12.33,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.67,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.67,"body":"to personal."},{"speaker":"Charles A. Goldfarb","startTime":15.329,"endTime":17.429,"body":"Please"},{"speaker":"Charles A. Goldfarb","startTime":15.329,"endTime":17.429,"body":"subscribe, wherever you get your"},{"speaker":"Charles A. Goldfarb","startTime":17.429,"endTime":18.179,"body":"podcasts."},{"speaker":"Chris Dy","startTime":18.929,"endTime":21.299,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":18.929,"endTime":21.299,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":21.299,"endTime":23.579,"body":"leaving a rating wherever you"},{"speaker":"Chris Dy","startTime":21.299,"endTime":23.579,"body":"get your podcasts."},{"speaker":"Charles A. Goldfarb","startTime":25.079,"endTime":26.339,"body":"Oh, hey,"},{"speaker":"Charles A. Goldfarb","startTime":25.079,"endTime":26.339,"body":"Chris."},{"speaker":"Chris Dy","startTime":26.43,"endTime":27.69,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":26.43,"endTime":27.69,"body":"ya?"},{"speaker":"Charles A. Goldfarb","startTime":28.05,"endTime":30.3,"body":"Fantastic."},{"speaker":"Charles A. Goldfarb","startTime":28.05,"endTime":30.3,"body":"I'm excited to be recording"},{"speaker":"Charles A. Goldfarb","startTime":30.3,"endTime":31.29,"body":"another pod with you."},{"speaker":"Chris Dy","startTime":31.649,"endTime":36.209,"body":"Me too. I'm sitting in"},{"speaker":"Chris Dy","startTime":31.649,"endTime":36.209,"body":"our study right now. Because"},{"speaker":"Chris Dy","startTime":36.209,"endTime":38.789,"body":"nobody's home and it's the only"},{"speaker":"Chris Dy","startTime":36.209,"endTime":38.789,"body":"time I could sit in here. My"},{"speaker":"Chris Dy","startTime":38.789,"endTime":41.489,"body":"wife refuses to put a door on"},{"speaker":"Chris Dy","startTime":38.789,"endTime":41.489,"body":"this study because it says it'll"},{"speaker":"Chris Dy","startTime":41.489,"endTime":42.779,"body":"make the room look smaller."},{"speaker":"Charles A. Goldfarb","startTime":43.8,"endTime":46.71,"body":"Well, super"},{"speaker":"Charles A. Goldfarb","startTime":43.8,"endTime":46.71,"body":"interesting. I have to say as a"},{"speaker":"Charles A. Goldfarb","startTime":46.71,"endTime":52.62,"body":"as a parent of young children."},{"speaker":"Charles A. Goldfarb","startTime":46.71,"endTime":52.62,"body":"There cannot be many times when"},{"speaker":"Charles A. Goldfarb","startTime":52.62,"endTime":53.43,"body":"you are home alone."},{"speaker":"Chris Dy","startTime":54.27,"endTime":56.82,"body":"Yes, it's it's"},{"speaker":"Chris Dy","startTime":54.27,"endTime":56.82,"body":"actually kind of neat. So yes,"},{"speaker":"Chris Dy","startTime":56.82,"endTime":59.22,"body":"I'm supposed to be out of town"},{"speaker":"Chris Dy","startTime":56.82,"endTime":59.22,"body":"right now. But I'm not took the"},{"speaker":"Chris Dy","startTime":59.22,"endTime":63.18,"body":"kids to school today. Drop them"},{"speaker":"Chris Dy","startTime":59.22,"endTime":63.18,"body":"off, came back home raced home"},{"speaker":"Chris Dy","startTime":63.18,"endTime":67.02,"body":"to meet with you and do the"},{"speaker":"Chris Dy","startTime":63.18,"endTime":67.02,"body":"podcast episode. You know, I"},{"speaker":"Chris Dy","startTime":67.02,"endTime":69.87,"body":"already worked out this morning."},{"speaker":"Chris Dy","startTime":67.02,"endTime":69.87,"body":"I might do a two day today just"},{"speaker":"Chris Dy","startTime":69.87,"endTime":73.35,"body":"because I love doing it. And you"},{"speaker":"Chris Dy","startTime":69.87,"endTime":73.35,"body":"know, I may put on some virtual"},{"speaker":"Chris Dy","startTime":73.35,"endTime":76.89,"body":"content from the meeting. Just"},{"speaker":"Chris Dy","startTime":73.35,"endTime":76.89,"body":"kind of pedal along. That's"},{"speaker":"Chris Dy","startTime":76.92,"endTime":80.73,"body":"honestly, people joke about"},{"speaker":"Chris Dy","startTime":76.92,"endTime":80.73,"body":"this. But like, if I'm on my"},{"speaker":"Chris Dy","startTime":80.73,"endTime":83.01,"body":"peloton, when we're when we're"},{"speaker":"Chris Dy","startTime":80.73,"endTime":83.01,"body":"meeting it means I'm actually"},{"speaker":"Chris Dy","startTime":83.01,"endTime":85.5,"body":"trying to pay attention to you."},{"speaker":"Chris Dy","startTime":83.01,"endTime":85.5,"body":"Because otherwise I'm doing"},{"speaker":"Chris Dy","startTime":85.5,"endTime":88.11,"body":"emails or checking social or"},{"speaker":"Chris Dy","startTime":85.5,"endTime":88.11,"body":"anything else."},{"speaker":"Charles A. Goldfarb","startTime":88.589,"endTime":90.239,"body":"Right."},{"speaker":"Charles A. Goldfarb","startTime":88.589,"endTime":90.239,"body":"That's so interesting. So what's"},{"speaker":"Charles A. 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Prior to the"},{"speaker":"Chris Dy","startTime":104.399,"endTime":107.189,"body":"pandemic, I used to do a"},{"speaker":"Chris Dy","startTime":107.189,"endTime":111.449,"body":"treadmill based bootcamp class."},{"speaker":"Chris Dy","startTime":107.189,"endTime":111.449,"body":"But I don't know it's kind of"},{"speaker":"Chris Dy","startTime":111.449,"endTime":114.119,"body":"hard to drag myself down there"},{"speaker":"Chris Dy","startTime":111.449,"endTime":114.119,"body":"to run I get on the bike for"},{"speaker":"Chris Dy","startTime":114.119,"endTime":116.219,"body":"some reason. But the running is"},{"speaker":"Chris Dy","startTime":114.119,"endTime":116.219,"body":"seems harder to me"},{"speaker":"Charles A. Goldfarb","startTime":116.82,"endTime":119.85,"body":"is super"},{"speaker":"Charles A. Goldfarb","startTime":116.82,"endTime":119.85,"body":"interesting. Yeah, I just try to"},{"speaker":"Charles A. Goldfarb","startTime":119.85,"endTime":123.03,"body":"mix it up. And you know, when"},{"speaker":"Charles A. Goldfarb","startTime":119.85,"endTime":123.03,"body":"you get old at, everything gets"},{"speaker":"Charles A. Goldfarb","startTime":123.03,"endTime":123.6,"body":"a little harder."},{"speaker":"Chris Dy","startTime":124.77,"endTime":126.96,"body":"But yes, I'm actually,"},{"speaker":"Chris Dy","startTime":124.77,"endTime":126.96,"body":"you know, after the cycling"},{"speaker":"Chris Dy","startTime":126.96,"endTime":129.84,"body":"stuff I've tried, I'm trying the"},{"speaker":"Chris Dy","startTime":126.96,"endTime":129.84,"body":"boxing program right now. And"},{"speaker":"Chris Dy","startTime":129.9,"endTime":133.38,"body":"it's very humbling, because I"},{"speaker":"Chris Dy","startTime":129.9,"endTime":133.38,"body":"realize how uncoordinated I am"},{"speaker":"Chris Dy","startTime":133.38,"endTime":134.13,"body":"for boxing."},{"speaker":"Charles A. Goldfarb","startTime":135.24,"endTime":137.43,"body":"I grew up"},{"speaker":"Charles A. Goldfarb","startTime":135.24,"endTime":137.43,"body":"doing a little of that. And I"},{"speaker":"Charles A. Goldfarb","startTime":137.43,"endTime":141.45,"body":"have a heavy bag at home and I"},{"speaker":"Charles A. Goldfarb","startTime":137.43,"endTime":141.45,"body":"have a speed bag at home. And"},{"speaker":"Charles A. Goldfarb","startTime":141.45,"endTime":143.28,"body":"they're super fun, for sure."},{"speaker":"Chris Dy","startTime":144.09,"endTime":145.29,"body":"And how often do they"},{"speaker":"Chris Dy","startTime":144.09,"endTime":145.29,"body":"get"},{"speaker":"Charles A. Goldfarb","startTime":145.29,"endTime":148.92,"body":"used very"},{"speaker":"Charles A. Goldfarb","startTime":145.29,"endTime":148.92,"body":"often not like they should."},{"speaker":"Chris Dy","startTime":149.47,"endTime":152.02,"body":"I'd like theboxing"},{"speaker":"Chris Dy","startTime":149.47,"endTime":152.02,"body":"thing and the thing that I'm"},{"speaker":"Chris Dy","startTime":152.02,"endTime":154.69,"body":"doing now is all kind of shadow"},{"speaker":"Chris Dy","startTime":152.02,"endTime":154.69,"body":"boxing stuff and learning"},{"speaker":"Chris Dy","startTime":154.69,"endTime":157.87,"body":"technique, I could definitely"},{"speaker":"Chris Dy","startTime":154.69,"endTime":157.87,"body":"see the merits of having a heavy"},{"speaker":"Chris Dy","startTime":157.87,"endTime":159.13,"body":"bag in a speed bag at home."},{"speaker":"Charles A. Goldfarb","startTime":159.82,"endTime":161.98,"body":"There is no"},{"speaker":"Charles A. Goldfarb","startTime":159.82,"endTime":161.98,"body":"workout like a boxing workout,"},{"speaker":"Charles A. Goldfarb","startTime":161.98,"endTime":164.89,"body":"which is why as we all know,"},{"speaker":"Charles A. Goldfarb","startTime":161.98,"endTime":164.89,"body":"there's all kinds of gyms around"},{"speaker":"Charles A. Goldfarb","startTime":164.89,"endTime":167.95,"body":"that. You can go to a boxing"},{"speaker":"Charles A. Goldfarb","startTime":164.89,"endTime":167.95,"body":"workout because it's It's"},{"speaker":"Charles A. Goldfarb","startTime":167.98,"endTime":169.96,"body":"impressive how much you can get"},{"speaker":"Charles A. Goldfarb","startTime":167.98,"endTime":169.96,"body":"you."},{"speaker":"Chris Dy","startTime":170.8,"endTime":173.2,"body":"So we're talking about"},{"speaker":"Chris Dy","startTime":170.8,"endTime":173.2,"body":"health right now, which is a"},{"speaker":"Chris Dy","startTime":173.2,"endTime":179.68,"body":"great segway it's a new year. So"},{"speaker":"Chris Dy","startTime":173.2,"endTime":179.68,"body":"it's 2022. And we're back for"},{"speaker":"Chris Dy","startTime":179.92,"endTime":184.06,"body":"for a third season of the"},{"speaker":"Chris Dy","startTime":179.92,"endTime":184.06,"body":"podcast. Now, I was thinking it"},{"speaker":"Chris Dy","startTime":184.06,"endTime":186.19,"body":"might be good to kick this"},{"speaker":"Chris Dy","startTime":184.06,"endTime":186.19,"body":"episode off with maybe some"},{"speaker":"Chris Dy","startTime":186.19,"endTime":188.98,"body":"resolutions. I mean, everybody"},{"speaker":"Chris Dy","startTime":186.19,"endTime":188.98,"body":"loves resolutions, and everybody"},{"speaker":"Chris Dy","startTime":188.98,"endTime":192.52,"body":"loves mocking people who don't"},{"speaker":"Chris Dy","startTime":188.98,"endTime":192.52,"body":"keep them. So let's start with"},{"speaker":"Chris Dy","startTime":192.82,"endTime":196.18,"body":"maybe one personal resolution"},{"speaker":"Chris Dy","startTime":192.82,"endTime":196.18,"body":"and one practice resolution or a"},{"speaker":"Chris Dy","startTime":196.18,"endTime":197.47,"body":"professional resolution."},{"speaker":"Charles A. Goldfarb","startTime":198.27,"endTime":200.55,"body":"Okay, I can"},{"speaker":"Charles A. Goldfarb","startTime":198.27,"endTime":200.55,"body":"go first with the personal, you"},{"speaker":"Charles A. Goldfarb","startTime":200.55,"endTime":205.95,"body":"know, it really is parenthood is"},{"speaker":"Charles A. Goldfarb","startTime":200.55,"endTime":205.95,"body":"a super interesting thing,"},{"speaker":"Charles A. Goldfarb","startTime":205.98,"endTime":211.11,"body":"because of its demands on our"},{"speaker":"Charles A. Goldfarb","startTime":205.98,"endTime":211.11,"body":"time, in a world where we're"},{"speaker":"Charles A. Goldfarb","startTime":211.11,"endTime":215.25,"body":"already super busy with work and"},{"speaker":"Charles A. Goldfarb","startTime":211.11,"endTime":215.25,"body":"so making the time to take care"},{"speaker":"Charles A. Goldfarb","startTime":215.25,"endTime":219.03,"body":"of oneself, you do a good job at"},{"speaker":"Charles A. Goldfarb","startTime":215.25,"endTime":219.03,"body":"it. And honestly, I think it's"},{"speaker":"Charles A. Goldfarb","startTime":219.03,"endTime":221.31,"body":"the right approach because if"},{"speaker":"Charles A. Goldfarb","startTime":219.03,"endTime":221.31,"body":"you take care of yourself, you"},{"speaker":"Charles A. Goldfarb","startTime":221.31,"endTime":225.69,"body":"can do all your other duties to"},{"speaker":"Charles A. Goldfarb","startTime":221.31,"endTime":225.69,"body":"to a better degree, life gets a"},{"speaker":"Charles A. Goldfarb","startTime":225.69,"endTime":229.29,"body":"little less complicated as kids"},{"speaker":"Charles A. Goldfarb","startTime":225.69,"endTime":229.29,"body":"start leaving home. And so"},{"speaker":"Charles A. Goldfarb","startTime":230.01,"endTime":234.66,"body":"especially when your third child"},{"speaker":"Charles A. Goldfarb","startTime":230.01,"endTime":234.66,"body":"is also rarely home my Macy's my"},{"speaker":"Charles A. Goldfarb","startTime":234.66,"endTime":237.81,"body":"youngest and she is in 11th"},{"speaker":"Charles A. Goldfarb","startTime":234.66,"endTime":237.81,"body":"grade and she's very social and"},{"speaker":"Charles A. Goldfarb","startTime":237.81,"endTime":242.37,"body":"so she's not home as much and I"},{"speaker":"Charles A. Goldfarb","startTime":237.81,"endTime":242.37,"body":"do try to be careful not to you"},{"speaker":"Charles A. Goldfarb","startTime":242.37,"endTime":247.14,"body":"know, I'm not home enough to I"},{"speaker":"Charles A. Goldfarb","startTime":242.37,"endTime":247.14,"body":"just have to be very careful"},{"speaker":"Charles A. Goldfarb","startTime":247.14,"endTime":249.18,"body":"about how I spend my time at"},{"speaker":"Charles A. Goldfarb","startTime":247.14,"endTime":249.18,"body":"home but I've been able to"},{"speaker":"Charles A. Goldfarb","startTime":249.18,"endTime":253.2,"body":"exercise more and that is my"},{"speaker":"Charles A. Goldfarb","startTime":249.18,"endTime":253.2,"body":"goal for 2022 is to continue"},{"speaker":"Charles A. Goldfarb","startTime":254.1,"endTime":258.39,"body":"this kind of reborn interest in"},{"speaker":"Charles A. Goldfarb","startTime":254.1,"endTime":258.39,"body":"working out on a regular basis"},{"speaker":"Charles A. Goldfarb","startTime":258.39,"endTime":260.94,"body":"and multi training and all those"},{"speaker":"Charles A. Goldfarb","startTime":258.39,"endTime":260.94,"body":"kind of things so I'm super"},{"speaker":"Charles A. Goldfarb","startTime":260.94,"endTime":263.79,"body":"excited about it and looking"},{"speaker":"Charles A. Goldfarb","startTime":260.94,"endTime":263.79,"body":"forward to it being a great"},{"speaker":"Charles A. Goldfarb","startTime":263.79,"endTime":264.06,"body":"year."},{"speaker":"Chris Dy","startTime":264.9,"endTime":268.68,"body":"Now, how do you"},{"speaker":"Chris Dy","startTime":264.9,"endTime":268.68,"body":"envision kind of keeping track"},{"speaker":"Chris Dy","startTime":268.68,"endTime":272.19,"body":"of this or you know, because"},{"speaker":"Chris Dy","startTime":268.68,"endTime":272.19,"body":"usually people's resolutions in"},{"speaker":"Chris Dy","startTime":272.19,"endTime":276.27,"body":"January come down to health"},{"speaker":"Chris Dy","startTime":272.19,"endTime":276.27,"body":"stuff is there a strategy is"},{"speaker":"Chris Dy","startTime":276.27,"endTime":278.64,"body":"there a you know an"},{"speaker":"Chris Dy","startTime":276.27,"endTime":278.64,"body":"accountability partner is there"},{"speaker":"Chris Dy","startTime":278.64,"endTime":281.97,"body":"all sorts of stuff or is just"},{"speaker":"Chris Dy","startTime":278.64,"endTime":281.97,"body":"standard Chuck Goldfarb put your"},{"speaker":"Chris Dy","startTime":281.97,"endTime":283.08,"body":"head down do the work."},{"speaker":"Charles A. Goldfarb","startTime":283.53,"endTime":285.48,"body":"I don't"},{"speaker":"Charles A. Goldfarb","startTime":283.53,"endTime":285.48,"body":"believe in all that junk I was"},{"speaker":"Charles A. Goldfarb","startTime":285.48,"endTime":290.25,"body":"just gonna work out and it"},{"speaker":"Charles A. Goldfarb","startTime":285.48,"endTime":290.25,"body":"honestly it started and I've got"},{"speaker":"Charles A. Goldfarb","startTime":290.31,"endTime":293.28,"body":"I've been pretty good over the"},{"speaker":"Charles A. Goldfarb","startTime":290.31,"endTime":293.28,"body":"last couple years actually but I"},{"speaker":"Charles A. Goldfarb","startTime":293.28,"endTime":297.09,"body":"if I can, and you may laugh at"},{"speaker":"Charles A. Goldfarb","startTime":293.28,"endTime":297.09,"body":"this as being less than ideal,"},{"speaker":"Charles A. Goldfarb","startTime":297.09,"endTime":299.49,"body":"but if I can get four to five"},{"speaker":"Charles A. Goldfarb","startTime":297.09,"endTime":299.49,"body":"days a weekend it's a huge"},{"speaker":"Charles A. Goldfarb","startTime":299.49,"endTime":304.74,"body":"accomplishment weekends are"},{"speaker":"Charles A. Goldfarb","startTime":299.49,"endTime":304.74,"body":"easy. And usually, sometimes on"},{"speaker":"Charles A. Goldfarb","startTime":304.74,"endTime":307.14,"body":"Fridays I can escape. I have a"},{"speaker":"Charles A. Goldfarb","startTime":304.74,"endTime":307.14,"body":"hard time getting up early to"},{"speaker":"Charles A. Goldfarb","startTime":307.14,"endTime":309.57,"body":"work out occasionally I can do"},{"speaker":"Charles A. Goldfarb","startTime":307.14,"endTime":309.57,"body":"that. But I think from various"},{"speaker":"Charles A. Goldfarb","startTime":309.57,"endTime":312.51,"body":"different ways I can. I think I"},{"speaker":"Charles A. Goldfarb","startTime":309.57,"endTime":312.51,"body":"can get four to five days a week"},{"speaker":"Charles A. Goldfarb","startTime":312.51,"endTime":315.06,"body":"and doing different things"},{"speaker":"Charles A. Goldfarb","startTime":312.51,"endTime":315.06,"body":"whether it's running biking,"},{"speaker":"Charles A. Goldfarb","startTime":315.63,"endTime":320.16,"body":"peloton, or even using the rower"},{"speaker":"Charles A. Goldfarb","startTime":315.63,"endTime":320.16,"body":"or the heavy bag in the"},{"speaker":"Charles A. Goldfarb","startTime":320.16,"endTime":320.58,"body":"basement."},{"speaker":"Chris Dy","startTime":321.33,"endTime":326.49,"body":"Oh, man row, I love"},{"speaker":"Chris Dy","startTime":321.33,"endTime":326.49,"body":"rower. So, whenever I feel back"},{"speaker":"Chris Dy","startTime":326.49,"endTime":330.45,"body":"into pre pandemic, when he would"},{"speaker":"Chris Dy","startTime":326.49,"endTime":330.45,"body":"travel to a meeting, and the"},{"speaker":"Chris Dy","startTime":330.45,"endTime":332.82,"body":"hotel had a rower, I was always"},{"speaker":"Chris Dy","startTime":330.45,"endTime":332.82,"body":"so excited."},{"speaker":"Charles A. Goldfarb","startTime":333.78,"endTime":336.54,"body":"Yeah, I"},{"speaker":"Charles A. Goldfarb","startTime":333.78,"endTime":336.54,"body":"like it is quite a workout. And"},{"speaker":"Charles A. Goldfarb","startTime":336.54,"endTime":339.54,"body":"the other thing I've been doing,"},{"speaker":"Charles A. Goldfarb","startTime":336.54,"endTime":339.54,"body":"and this is going to feed into"},{"speaker":"Charles A. Goldfarb","startTime":339.6,"endTime":343.29,"body":"the second part of this pod is"},{"speaker":"Charles A. Goldfarb","startTime":339.6,"endTime":343.29,"body":"that I've been doing a lot of"},{"speaker":"Charles A. Goldfarb","startTime":343.29,"endTime":348.18,"body":"push ups. And so we had a heavy"},{"speaker":"Charles A. Goldfarb","startTime":343.29,"endTime":348.18,"body":"interview day recently where we"},{"speaker":"Charles A. Goldfarb","startTime":348.18,"endTime":353.82,"body":"interviewed 38 outstanding"},{"speaker":"Charles A. Goldfarb","startTime":348.18,"endTime":353.82,"body":"resident applicants. And I made"},{"speaker":"Charles A. Goldfarb","startTime":353.82,"endTime":357.84,"body":"a point that five times during"},{"speaker":"Charles A. Goldfarb","startTime":353.82,"endTime":357.84,"body":"the day I broke out did push ups"},{"speaker":"Charles A. Goldfarb","startTime":357.84,"endTime":361.08,"body":"between interviews, and it was a"},{"speaker":"Charles A. Goldfarb","startTime":357.84,"endTime":361.08,"body":"great way to both get a workout"},{"speaker":"Charles A. Goldfarb","startTime":361.08,"endTime":364.38,"body":"and stay awake and stay, you"},{"speaker":"Charles A. Goldfarb","startTime":361.08,"endTime":364.38,"body":"know, engaged."},{"speaker":"Chris Dy","startTime":364.77,"endTime":366.66,"body":"Oh, man, I'm totally"},{"speaker":"Chris Dy","startTime":364.77,"endTime":366.66,"body":"gonna hold you to that during"},{"speaker":"Chris Dy","startTime":366.66,"endTime":370.02,"body":"our fellowship interviews."},{"speaker":"Chris Dy","startTime":366.66,"endTime":370.02,"body":"That's awesome. It was good. No,"},{"speaker":"Chris Dy","startTime":370.02,"endTime":374.4,"body":"you know, who's a sneaky"},{"speaker":"Chris Dy","startTime":370.02,"endTime":374.4,"body":"sneakily, really incredibly fit"},{"speaker":"Chris Dy","startTime":374.4,"endTime":376.68,"body":"person. Ryan Calfee?"},{"speaker":"Charles A. Goldfarb","startTime":377.07,"endTime":378.84,"body":"Oh, I know"},{"speaker":"Charles A. Goldfarb","startTime":377.07,"endTime":378.84,"body":"he is. Yeah,"},{"speaker":"Chris Dy","startTime":378.84,"endTime":382.32,"body":"I guess it's not"},{"speaker":"Chris Dy","startTime":378.84,"endTime":382.32,"body":"sneaky, then. But, you know, in"},{"speaker":"Chris Dy","startTime":382.32,"endTime":385.77,"body":"his clinic, he seems to sneak in"},{"speaker":"Chris Dy","startTime":382.32,"endTime":385.77,"body":"some feats of strength with our"},{"speaker":"Chris Dy","startTime":385.77,"endTime":386.46,"body":"trainees."},{"speaker":"Charles A. Goldfarb","startTime":386.64,"endTime":389.31,"body":"Yeah, they"},{"speaker":"Charles A. Goldfarb","startTime":386.64,"endTime":389.31,"body":"are all engaged in the nurses"},{"speaker":"Charles A. Goldfarb","startTime":389.31,"endTime":393.72,"body":"and Ma's as well. All right,"},{"speaker":"Charles A. Goldfarb","startTime":389.31,"endTime":393.72,"body":"what's your resolution?"},{"speaker":"Chris Dy","startTime":394.95,"endTime":397.74,"body":"You know, my, my"},{"speaker":"Chris Dy","startTime":394.95,"endTime":397.74,"body":"resolution is, and I can have a"},{"speaker":"Chris Dy","startTime":397.8,"endTime":401.64,"body":"separate professional one too."},{"speaker":"Chris Dy","startTime":397.8,"endTime":401.64,"body":"But I think, you know, personal"},{"speaker":"Chris Dy","startTime":401.64,"endTime":404.16,"body":"and professional kind of blend"},{"speaker":"Chris Dy","startTime":401.64,"endTime":404.16,"body":"together in this one, I noticed"},{"speaker":"Chris Dy","startTime":404.16,"endTime":408.12,"body":"that, you know, in times where I"},{"speaker":"Chris Dy","startTime":404.16,"endTime":408.12,"body":"get a little bit stressed, I'm"},{"speaker":"Chris Dy","startTime":408.12,"endTime":413.19,"body":"not the best at treating people"},{"speaker":"Chris Dy","startTime":408.12,"endTime":413.19,"body":"like people, and really"},{"speaker":"Chris Dy","startTime":413.19,"endTime":416.85,"body":"understanding kind of where"},{"speaker":"Chris Dy","startTime":413.19,"endTime":416.85,"body":"everybody's coming from, and I"},{"speaker":"Chris Dy","startTime":416.85,"endTime":420.75,"body":"can get a little transactional."},{"speaker":"Chris Dy","startTime":416.85,"endTime":420.75,"body":"And I certainly don't want I"},{"speaker":"Chris Dy","startTime":420.75,"endTime":424.86,"body":"think that's honestly, it's a"},{"speaker":"Chris Dy","startTime":420.75,"endTime":424.86,"body":"it's a generational thing. But I"},{"speaker":"Chris Dy","startTime":424.86,"endTime":427.71,"body":"don't want to put blame on that."},{"speaker":"Chris Dy","startTime":424.86,"endTime":427.71,"body":"I think it's my personality of"},{"speaker":"Chris Dy","startTime":427.74,"endTime":430.92,"body":"always trying to kind of like"},{"speaker":"Chris Dy","startTime":427.74,"endTime":430.92,"body":"move to the next thing. I don't"},{"speaker":"Chris Dy","startTime":430.92,"endTime":434.4,"body":"think everybody sees the world"},{"speaker":"Chris Dy","startTime":430.92,"endTime":434.4,"body":"the same way that I do. And I"},{"speaker":"Chris Dy","startTime":434.4,"endTime":437.7,"body":"tend to get trapped in just"},{"speaker":"Chris Dy","startTime":434.4,"endTime":437.7,"body":"this, like, you know, how can"},{"speaker":"Chris Dy","startTime":437.73,"endTime":441.6,"body":"you do your job so that I can"},{"speaker":"Chris Dy","startTime":437.73,"endTime":441.6,"body":"continue to do my job thing. And"},{"speaker":"Chris Dy","startTime":441.6,"endTime":443.79,"body":"I need to get better at that I"},{"speaker":"Chris Dy","startTime":441.6,"endTime":443.79,"body":"need to understand where people"},{"speaker":"Chris Dy","startTime":443.79,"endTime":446.85,"body":"are coming from their"},{"speaker":"Chris Dy","startTime":443.79,"endTime":446.85,"body":"perspectives that you're gonna"},{"speaker":"Chris Dy","startTime":446.85,"endTime":449.55,"body":"laugh at this, that not"},{"speaker":"Chris Dy","startTime":446.85,"endTime":449.55,"body":"everybody is there to help me"},{"speaker":"Chris Dy","startTime":449.55,"endTime":454.44,"body":"achieve what I want to do. Which"},{"speaker":"Chris Dy","startTime":449.55,"endTime":454.44,"body":"is so so hard as a surgeon?"},{"speaker":"Chris Dy","startTime":455.61,"endTime":459.18,"body":"Because you just assume that"},{"speaker":"Chris Dy","startTime":455.61,"endTime":459.18,"body":"everybody has your interests in"},{"speaker":"Chris Dy","startTime":459.18,"endTime":461.76,"body":"mind, which is not always the"},{"speaker":"Chris Dy","startTime":459.18,"endTime":461.76,"body":"case."},{"speaker":"Charles A. Goldfarb","startTime":462.48,"endTime":464.76,"body":"Well,"},{"speaker":"Charles A. Goldfarb","startTime":462.48,"endTime":464.76,"body":"that's it's really well said,"},{"speaker":"Charles A. Goldfarb","startTime":464.76,"endTime":467.82,"body":"and I think all of us can do"},{"speaker":"Charles A. Goldfarb","startTime":464.76,"endTime":467.82,"body":"better. You know, what, what the"},{"speaker":"Charles A. Goldfarb","startTime":467.82,"endTime":472.02,"body":"pandemic and the pandemic or"},{"speaker":"Charles A. Goldfarb","startTime":467.82,"endTime":472.02,"body":"related challenges of our"},{"speaker":"Charles A. Goldfarb","startTime":472.02,"endTime":477.75,"body":"workforce have shown me is that,"},{"speaker":"Charles A. Goldfarb","startTime":472.02,"endTime":477.75,"body":"you know, we have to be aware of"},{"speaker":"Charles A. Goldfarb","startTime":477.78,"endTime":483.0,"body":"different people's priorities,"},{"speaker":"Charles A. Goldfarb","startTime":477.78,"endTime":483.0,"body":"different people's goals, and"},{"speaker":"Charles A. Goldfarb","startTime":483.03,"endTime":486.6,"body":"trying to engage our nurses and"},{"speaker":"Charles A. Goldfarb","startTime":483.03,"endTime":486.6,"body":"amaze, in particular for"},{"speaker":"Charles A. Goldfarb","startTime":486.6,"endTime":490.83,"body":"outpatient care and our nurses"},{"speaker":"Charles A. Goldfarb","startTime":486.6,"endTime":490.83,"body":"for surgical care. And, you"},{"speaker":"Charles A. Goldfarb","startTime":490.83,"endTime":494.97,"body":"know, our workforce is"},{"speaker":"Charles A. Goldfarb","startTime":490.83,"endTime":494.97,"body":"suffering. So it's just"},{"speaker":"Charles A. Goldfarb","startTime":494.97,"endTime":497.16,"body":"incredibly important. We're, I"},{"speaker":"Charles A. Goldfarb","startTime":494.97,"endTime":497.16,"body":"don't think we're ever going to"},{"speaker":"Charles A. Goldfarb","startTime":497.16,"endTime":499.92,"body":"lose sight of that in the"},{"speaker":"Charles A. Goldfarb","startTime":497.16,"endTime":499.92,"body":"future. But I think we've taken"},{"speaker":"Charles A. Goldfarb","startTime":499.92,"endTime":501.51,"body":"that for granted for too many"},{"speaker":"Charles A. Goldfarb","startTime":499.92,"endTime":501.51,"body":"years."},{"speaker":"Chris Dy","startTime":502.29,"endTime":505.41,"body":"Yeah, absolutely. And,"},{"speaker":"Chris Dy","startTime":502.29,"endTime":505.41,"body":"you know, I think that the way"},{"speaker":"Chris Dy","startTime":505.41,"endTime":508.38,"body":"that I'm going to try to"},{"speaker":"Chris Dy","startTime":505.41,"endTime":508.38,"body":"operationalize this resolution"},{"speaker":"Chris Dy","startTime":508.38,"endTime":513.33,"body":"is to actually try to talk to"},{"speaker":"Chris Dy","startTime":508.38,"endTime":513.33,"body":"people more and slow down a"},{"speaker":"Chris Dy","startTime":513.33,"endTime":516.78,"body":"little bit. And really, because"},{"speaker":"Chris Dy","startTime":513.33,"endTime":516.78,"body":"I, you know, for example, like"},{"speaker":"Chris Dy","startTime":516.78,"endTime":519.12,"body":"the our team that I work with"},{"speaker":"Chris Dy","startTime":516.78,"endTime":519.12,"body":"the Street Bridge routinely, I"},{"speaker":"Chris Dy","startTime":519.12,"endTime":521.43,"body":"mean, I kind of know what's"},{"speaker":"Chris Dy","startTime":519.12,"endTime":521.43,"body":"going on, I kind of know them,"},{"speaker":"Chris Dy","startTime":521.43,"endTime":525.39,"body":"but I actually want to get to"},{"speaker":"Chris Dy","startTime":521.43,"endTime":525.39,"body":"know them as people because I"},{"speaker":"Chris Dy","startTime":525.39,"endTime":528.21,"body":"think that's the the temptation"},{"speaker":"Chris Dy","startTime":525.39,"endTime":528.21,"body":"especially as a young surgeon,"},{"speaker":"Chris Dy","startTime":528.21,"endTime":531.15,"body":"trying to be busy and trying to"},{"speaker":"Chris Dy","startTime":528.21,"endTime":531.15,"body":"get things done and, and"},{"speaker":"Chris Dy","startTime":531.15,"endTime":536.22,"body":"rightfully so at times focused"},{"speaker":"Chris Dy","startTime":531.15,"endTime":536.22,"body":"on patient care and cases, I"},{"speaker":"Chris Dy","startTime":536.22,"endTime":538.86,"body":"don't really get to know people"},{"speaker":"Chris Dy","startTime":536.22,"endTime":538.86,"body":"as well. And I think that's my"},{"speaker":"Chris Dy","startTime":538.95,"endTime":542.67,"body":"personality. That's, that's"},{"speaker":"Chris Dy","startTime":538.95,"endTime":542.67,"body":"something that I need to work"},{"speaker":"Chris Dy","startTime":542.67,"endTime":545.49,"body":"on. So I'm going to try to get"},{"speaker":"Chris Dy","startTime":542.67,"endTime":545.49,"body":"to talk to you more to get to"},{"speaker":"Chris Dy","startTime":545.49,"endTime":550.77,"body":"know people more, you know, who"},{"speaker":"Chris Dy","startTime":545.49,"endTime":550.77,"body":"worked with me. And so maybe you"},{"speaker":"Chris Dy","startTime":550.77,"endTime":552.99,"body":"can check in with me and make"},{"speaker":"Chris Dy","startTime":550.77,"endTime":552.99,"body":"sure I'm doing a good job on"},{"speaker":"Chris Dy","startTime":552.99,"endTime":553.35,"body":"that one."},{"speaker":"Charles A. Goldfarb","startTime":553.589,"endTime":555.329,"body":"I"},{"speaker":"Charles A. Goldfarb","startTime":553.589,"endTime":555.329,"body":"definitely well, I like that."},{"speaker":"Charles A. Goldfarb","startTime":555.629,"endTime":558.779,"body":"All right, come back with one"},{"speaker":"Charles A. Goldfarb","startTime":555.629,"endTime":558.779,"body":"work resolution."},{"speaker":"Chris Dy","startTime":560.4,"endTime":563.13,"body":"Um, I went well, I"},{"speaker":"Chris Dy","startTime":560.4,"endTime":563.13,"body":"mean, this is gonna sound bad,"},{"speaker":"Chris Dy","startTime":563.13,"endTime":566.31,"body":"but I want to get more efficient"},{"speaker":"Chris Dy","startTime":563.13,"endTime":566.31,"body":"with my motion during surgery. I"},{"speaker":"Chris Dy","startTime":566.31,"endTime":570.0,"body":"feel like there's still some"},{"speaker":"Chris Dy","startTime":566.31,"endTime":570.0,"body":"wasted motion and I want to be"},{"speaker":"Chris Dy","startTime":570.03,"endTime":576.06,"body":"as efficient as I can and try to"},{"speaker":"Chris Dy","startTime":570.03,"endTime":576.06,"body":"be better about engaging the"},{"speaker":"Chris Dy","startTime":576.06,"endTime":580.26,"body":"trainees about their efficiency."},{"speaker":"Chris Dy","startTime":576.06,"endTime":580.26,"body":"I tried to show wasted motion I"},{"speaker":"Chris Dy","startTime":580.26,"endTime":582.93,"body":"tried to show point out to them"},{"speaker":"Chris Dy","startTime":580.26,"endTime":582.93,"body":"when there is wasted motion but"},{"speaker":"Chris Dy","startTime":582.93,"endTime":588.99,"body":"I think that I'm not as good at"},{"speaker":"Chris Dy","startTime":582.93,"endTime":588.99,"body":"that myself. Like I've I've kind"},{"speaker":"Chris Dy","startTime":588.99,"endTime":591.36,"body":"of like the the way that I do"},{"speaker":"Chris Dy","startTime":588.99,"endTime":591.36,"body":"things but I think there's"},{"speaker":"Chris Dy","startTime":591.36,"endTime":594.63,"body":"definitely room for improvement."},{"speaker":"Chris Dy","startTime":591.36,"endTime":594.63,"body":"So I during cases I want to say"},{"speaker":"Chris Dy","startTime":594.63,"endTime":597.6,"body":"how could I have done this case"},{"speaker":"Chris Dy","startTime":594.63,"endTime":597.6,"body":"even just a little bit faster,"},{"speaker":"Chris Dy","startTime":597.63,"endTime":600.54,"body":"or a little more efficiently and"},{"speaker":"Chris Dy","startTime":597.63,"endTime":600.54,"body":"maybe even better."},{"speaker":"Charles A. Goldfarb","startTime":602.01,"endTime":604.5,"body":"I like"},{"speaker":"Charles A. Goldfarb","startTime":602.01,"endTime":604.5,"body":"that. And I know you know,"},{"speaker":"Charles A. Goldfarb","startTime":604.5,"endTime":607.71,"body":"teaching surgical technique is"},{"speaker":"Charles A. Goldfarb","startTime":604.5,"endTime":607.71,"body":"always a very interesting"},{"speaker":"Charles A. Goldfarb","startTime":607.71,"endTime":610.68,"body":"proposition it, you know, you"},{"speaker":"Charles A. Goldfarb","startTime":607.71,"endTime":610.68,"body":"have to feel very comfortable"},{"speaker":"Charles A. Goldfarb","startTime":610.68,"endTime":613.5,"body":"with your own technique before"},{"speaker":"Charles A. Goldfarb","startTime":610.68,"endTime":613.5,"body":"you're going to feel comfortable"},{"speaker":"Charles A. Goldfarb","startTime":613.5,"endTime":618.72,"body":"with teaching technique. But"},{"speaker":"Charles A. Goldfarb","startTime":613.5,"endTime":618.72,"body":"it's, you know, it's, it's what"},{"speaker":"Charles A. Goldfarb","startTime":618.72,"endTime":621.12,"body":"we need to do. And we have to do"},{"speaker":"Charles A. Goldfarb","startTime":618.72,"endTime":621.12,"body":"it at a high level. And"},{"speaker":"Charles A. Goldfarb","startTime":621.12,"endTime":624.99,"body":"therefore, self examination of"},{"speaker":"Charles A. Goldfarb","startTime":621.12,"endTime":624.99,"body":"how we get through cases is"},{"speaker":"Charles A. Goldfarb","startTime":624.99,"endTime":627.63,"body":"incredibly important. So I love"},{"speaker":"Charles A. Goldfarb","startTime":624.99,"endTime":627.63,"body":"that. Love that."},{"speaker":"Chris Dy","startTime":628.5,"endTime":631.77,"body":"Now, is there anything"},{"speaker":"Chris Dy","startTime":628.5,"endTime":631.77,"body":"that your your practice and you"},{"speaker":"Chris Dy","startTime":631.77,"endTime":635.46,"body":"know, is probably a well oiled,"},{"speaker":"Chris Dy","startTime":631.77,"endTime":635.46,"body":"finely tuned machine at this"},{"speaker":"Chris Dy","startTime":635.46,"endTime":638.34,"body":"point? Everything's on cruise"},{"speaker":"Chris Dy","startTime":635.46,"endTime":638.34,"body":"control? Is there anything"},{"speaker":"Chris Dy","startTime":638.34,"endTime":640.5,"body":"you're trying to make a little"},{"speaker":"Chris Dy","startTime":638.34,"endTime":640.5,"body":"better either in the practice"},{"speaker":"Chris Dy","startTime":640.5,"endTime":642.66,"body":"realm or the admin leadership"},{"speaker":"Chris Dy","startTime":640.5,"endTime":642.66,"body":"realm?"},{"speaker":"Charles A. Goldfarb","startTime":643.589,"endTime":646.199,"body":"There's too"},{"speaker":"Charles A. Goldfarb","startTime":643.589,"endTime":646.199,"body":"many things to mention, I think,"},{"speaker":"Charles A. Goldfarb","startTime":648.089,"endTime":651.659,"body":"what I need to do a better job"},{"speaker":"Charles A. Goldfarb","startTime":648.089,"endTime":651.659,"body":"of and yeah, I know you do this?"},{"speaker":"Charles A. Goldfarb","startTime":651.659,"endTime":655.109,"body":"Well, because we've talked about"},{"speaker":"Charles A. Goldfarb","startTime":651.659,"endTime":655.109,"body":"it a five year plan or, or kind"},{"speaker":"Charles A. Goldfarb","startTime":655.109,"endTime":659.819,"body":"of a longer range planning. I"},{"speaker":"Charles A. Goldfarb","startTime":655.109,"endTime":659.819,"body":"think, for me, it's about that I"},{"speaker":"Charles A. Goldfarb","startTime":659.819,"endTime":662.339,"body":"need to do a better job of"},{"speaker":"Charles A. Goldfarb","startTime":659.819,"endTime":662.339,"body":"sitting down with my wife and"},{"speaker":"Charles A. Goldfarb","startTime":662.339,"endTime":669.209,"body":"talking through things, as well"},{"speaker":"Charles A. Goldfarb","startTime":662.339,"endTime":669.209,"body":"as you know, really kind of re"},{"speaker":"Charles A. Goldfarb","startTime":669.209,"endTime":672.239,"body":"examining my goals, I'm at that"},{"speaker":"Charles A. Goldfarb","startTime":669.209,"endTime":672.239,"body":"point in their career where I"},{"speaker":"Charles A. Goldfarb","startTime":672.239,"endTime":675.989,"body":"need to understand what I want"},{"speaker":"Charles A. Goldfarb","startTime":672.239,"endTime":675.989,"body":"out of the rest of my career"},{"speaker":"Charles A. Goldfarb","startTime":675.989,"endTime":679.799,"body":"instead of as, as we joke, kind"},{"speaker":"Charles A. Goldfarb","startTime":675.989,"endTime":679.799,"body":"of just putting my head down"},{"speaker":"Charles A. Goldfarb","startTime":679.799,"endTime":683.129,"body":"and, and continuing what I'm"},{"speaker":"Charles A. Goldfarb","startTime":679.799,"endTime":683.129,"body":"doing, which is very rewarding,"},{"speaker":"Charles A. Goldfarb","startTime":683.129,"endTime":686.579,"body":"and you know, all good, but I"},{"speaker":"Charles A. Goldfarb","startTime":683.129,"endTime":686.579,"body":"think I need to be a little self"},{"speaker":"Charles A. Goldfarb","startTime":686.579,"endTime":689.399,"body":"reflective, I've never had a"},{"speaker":"Charles A. Goldfarb","startTime":686.579,"endTime":689.399,"body":"coach, I don't think I want to"},{"speaker":"Charles A. Goldfarb","startTime":689.399,"endTime":694.169,"body":"get a coach, but sort of have"},{"speaker":"Charles A. Goldfarb","startTime":689.399,"endTime":694.169,"body":"that conversation. My wife is my"},{"speaker":"Charles A. Goldfarb","startTime":694.169,"endTime":697.439,"body":"wife is a social worker and, and"},{"speaker":"Charles A. Goldfarb","startTime":694.169,"endTime":697.439,"body":"specializes in counseling, and"},{"speaker":"Charles A. Goldfarb","startTime":697.439,"endTime":700.289,"body":"is really good. So I think we'll"},{"speaker":"Charles A. Goldfarb","startTime":697.439,"endTime":700.289,"body":"have to sit down and have some"},{"speaker":"Charles A. Goldfarb","startTime":700.289,"endTime":702.509,"body":"conversations, which will be"},{"speaker":"Charles A. Goldfarb","startTime":700.289,"endTime":702.509,"body":"important."},{"speaker":"Chris Dy","startTime":703.469,"endTime":706.049,"body":"Interesting, you say"},{"speaker":"Chris Dy","startTime":703.469,"endTime":706.049,"body":"that about, you know, not"},{"speaker":"Chris Dy","startTime":706.049,"endTime":709.169,"body":"wanting a coach, I kind of think"},{"speaker":"Chris Dy","startTime":706.049,"endTime":709.169,"body":"I want to coach, you know, in"},{"speaker":"Chris Dy","startTime":709.169,"endTime":712.139,"body":"terms of talking. So I when I"},{"speaker":"Chris Dy","startTime":709.169,"endTime":712.139,"body":"was at one of the, you know,"},{"speaker":"Chris Dy","startTime":712.139,"endTime":716.489,"body":"seminars, workshops that I was"},{"speaker":"Chris Dy","startTime":712.139,"endTime":716.489,"body":"helping with on clinician"},{"speaker":"Chris Dy","startTime":716.489,"endTime":720.599,"body":"scientists, several of the"},{"speaker":"Chris Dy","startTime":716.489,"endTime":720.599,"body":"faculty members were talking"},{"speaker":"Chris Dy","startTime":720.599,"endTime":724.139,"body":"about how important it was to"},{"speaker":"Chris Dy","startTime":720.599,"endTime":724.139,"body":"have a leadership coach. And,"},{"speaker":"Chris Dy","startTime":724.649,"endTime":727.259,"body":"you know, that's something that"},{"speaker":"Chris Dy","startTime":724.649,"endTime":727.259,"body":"I don't think is typically"},{"speaker":"Chris Dy","startTime":727.259,"endTime":729.809,"body":"available through our"},{"speaker":"Chris Dy","startTime":727.259,"endTime":729.809,"body":"institution, for people that"},{"speaker":"Chris Dy","startTime":729.809,"endTime":733.409,"body":"aren't chairs. But I think at"},{"speaker":"Chris Dy","startTime":729.809,"endTime":733.409,"body":"other places is more widely"},{"speaker":"Chris Dy","startTime":733.409,"endTime":733.949,"body":"available."},{"speaker":"Charles A. Goldfarb","startTime":735.72,"endTime":739.02,"body":"But let me"},{"speaker":"Charles A. Goldfarb","startTime":735.72,"endTime":739.02,"body":"be very clear, I in no way would"},{"speaker":"Charles A. Goldfarb","startTime":739.02,"endTime":743.13,"body":"judge ever anyone with a coach"},{"speaker":"Charles A. Goldfarb","startTime":739.02,"endTime":743.13,"body":"and a negative light. In fact, I"},{"speaker":"Charles A. Goldfarb","startTime":743.13,"endTime":746.91,"body":"appreciate it. And maybe that's"},{"speaker":"Charles A. Goldfarb","startTime":743.13,"endTime":746.91,"body":"why I said that. I'm just, it"},{"speaker":"Charles A. Goldfarb","startTime":746.91,"endTime":749.1,"body":"would have to be exactly the"},{"speaker":"Charles A. Goldfarb","startTime":746.91,"endTime":749.1,"body":"right person. And that's what"},{"speaker":"Charles A. Goldfarb","startTime":749.1,"endTime":753.48,"body":"makes me nervous. Right, right."},{"speaker":"Charles A. Goldfarb","startTime":749.1,"endTime":753.48,"body":"And how do you figure that out?"},{"speaker":"Charles A. Goldfarb","startTime":753.48,"endTime":756.42,"body":"I don't know. Cuz I don't think"},{"speaker":"Charles A. Goldfarb","startTime":753.48,"endTime":756.42,"body":"it's something you can interview"},{"speaker":"Charles A. Goldfarb","startTime":756.42,"endTime":760.5,"body":"someone for. I think it's a"},{"speaker":"Charles A. Goldfarb","startTime":756.42,"endTime":760.5,"body":"relationship thing. And maybe"},{"speaker":"Charles A. Goldfarb","startTime":760.5,"endTime":761.28,"body":"it'll happen one day."},{"speaker":"Chris Dy","startTime":761.91,"endTime":763.92,"body":"Yeah. I'm not"},{"speaker":"Chris Dy","startTime":761.91,"endTime":763.92,"body":"surprised that Chuck Goldfarb is"},{"speaker":"Chris Dy","startTime":763.92,"endTime":766.92,"body":"very specific with how he wants"},{"speaker":"Chris Dy","startTime":763.92,"endTime":766.92,"body":"to be coached. I'm not I'm not"},{"speaker":"Chris Dy","startTime":766.92,"endTime":769.32,"body":"surprised. Do you? Maybe Maybe,"},{"speaker":"Chris Dy","startTime":766.92,"endTime":769.32,"body":"I don't know, as a basketball"},{"speaker":"Chris Dy","startTime":769.32,"endTime":772.02,"body":"player. Were you hard to coach?"},{"speaker":"Chris Dy","startTime":769.32,"endTime":772.02,"body":"Were you that specific back"},{"speaker":"Chris Dy","startTime":772.02,"endTime":772.35,"body":"then?"},{"speaker":"Charles A. Goldfarb","startTime":773.52,"endTime":775.23,"body":"I think I"},{"speaker":"Charles A. Goldfarb","startTime":773.52,"endTime":775.23,"body":"was very hard to coach as a"},{"speaker":"Charles A. Goldfarb","startTime":775.23,"endTime":778.26,"body":"child simply because I was"},{"speaker":"Charles A. Goldfarb","startTime":775.23,"endTime":778.26,"body":"headstrong and didn't do a great"},{"speaker":"Charles A. Goldfarb","startTime":778.26,"endTime":781.68,"body":"job listening. Hopefully, those"},{"speaker":"Charles A. Goldfarb","startTime":778.26,"endTime":781.68,"body":"those things have changed. Maybe"},{"speaker":"Charles A. Goldfarb","startTime":781.68,"endTime":782.04,"body":"not."},{"speaker":"Chris Dy","startTime":782.91,"endTime":786.78,"body":"I did I do know a"},{"speaker":"Chris Dy","startTime":782.91,"endTime":786.78,"body":"couple of people in the kind of"},{"speaker":"Chris Dy","startTime":786.78,"endTime":790.14,"body":"orthopedic leadership room who"},{"speaker":"Chris Dy","startTime":786.78,"endTime":790.14,"body":"are very Chuck Goldfarb like"},{"speaker":"Chris Dy","startTime":790.14,"endTime":793.2,"body":"that do have coaches so they can"},{"speaker":"Chris Dy","startTime":790.14,"endTime":793.2,"body":"exist, it's just a matter of"},{"speaker":"Chris Dy","startTime":793.2,"endTime":793.8,"body":"finding them."},{"speaker":"Charles A. Goldfarb","startTime":794.01,"endTime":796.23,"body":"I think"},{"speaker":"Charles A. Goldfarb","startTime":794.01,"endTime":796.23,"body":"that is well said. Well said."},{"speaker":"Charles A. Goldfarb","startTime":796.47,"endTime":800.46,"body":"All right. I have a case for"},{"speaker":"Charles A. Goldfarb","startTime":796.47,"endTime":800.46,"body":"you. Okay, okay. I have a middle"},{"speaker":"Charles A. Goldfarb","startTime":800.46,"endTime":809.1,"body":"aged well, you know, what's"},{"speaker":"Charles A. Goldfarb","startTime":800.46,"endTime":809.1,"body":"crazy is, the patient is me is"},{"speaker":"Charles A. Goldfarb","startTime":809.1,"endTime":811.29,"body":"and we'll get to, but I'm"},{"speaker":"Charles A. Goldfarb","startTime":809.1,"endTime":811.29,"body":"sitting in clinic yesterday, and"},{"speaker":"Charles A. Goldfarb","startTime":811.29,"endTime":818.16,"body":"I take this adorable little 17"},{"speaker":"Charles A. Goldfarb","startTime":811.29,"endTime":818.16,"body":"month old child to get a mini"},{"speaker":"Charles A. Goldfarb","startTime":818.16,"endTime":822.78,"body":"CRM, and I have to enter their"},{"speaker":"Charles A. Goldfarb","startTime":818.16,"endTime":822.78,"body":"date of birth and their medical"},{"speaker":"Charles A. Goldfarb","startTime":822.78,"endTime":831.27,"body":"record number. And their date of"},{"speaker":"Charles A. Goldfarb","startTime":822.78,"endTime":831.27,"body":"birth was July 24. Night. Damn,"},{"speaker":"Charles A. Goldfarb","startTime":831.27,"endTime":837.12,"body":"sorry, July 24 2019. Is that"},{"speaker":"Charles A. Goldfarb","startTime":831.27,"endTime":837.12,"body":"right? Now? 2020. So the child"},{"speaker":"Charles A. Goldfarb","startTime":837.12,"endTime":847.41,"body":"is 17 months old. And exactly 50"},{"speaker":"Charles A. Goldfarb","startTime":837.12,"endTime":847.41,"body":"years younger than me, and I was"},{"speaker":"Charles A. Goldfarb","startTime":847.41,"endTime":851.79,"body":"like, Oh my God, for some reason"},{"speaker":"Charles A. Goldfarb","startTime":847.41,"endTime":851.79,"body":"that like hit me like a hammer."},{"speaker":"Charles A. Goldfarb","startTime":855.09,"endTime":857.46,"body":"Okay, so I mean, 50 years"},{"speaker":"Charles A. Goldfarb","startTime":855.09,"endTime":857.46,"body":"younger than me."},{"speaker":"Chris Dy","startTime":859.68,"endTime":861.96,"body":"The math just works."},{"speaker":"Chris Dy","startTime":859.68,"endTime":861.96,"body":"Somehow chuck the math just"},{"speaker":"Chris Dy","startTime":861.96,"endTime":862.41,"body":"works."},{"speaker":"Charles A. Goldfarb","startTime":862.68,"endTime":864.18,"body":"So the"},{"speaker":"Charles A. Goldfarb","startTime":862.68,"endTime":864.18,"body":"parents are sitting there I kind"},{"speaker":"Charles A. Goldfarb","startTime":864.18,"endTime":867.09,"body":"of pause. They're like, look at"},{"speaker":"Charles A. Goldfarb","startTime":864.18,"endTime":867.09,"body":"me, like what's going on? And I"},{"speaker":"Charles A. Goldfarb","startTime":867.09,"endTime":869.37,"body":"was like, I'm having an"},{"speaker":"Charles A. Goldfarb","startTime":867.09,"endTime":869.37,"body":"existential crisis. I'm sorry,"},{"speaker":"Charles A. Goldfarb","startTime":869.37,"endTime":871.05,"body":"excuse me for 30 seconds."},{"speaker":"Chris Dy","startTime":871.08,"endTime":873.24,"body":"They're like this old"},{"speaker":"Chris Dy","startTime":871.08,"endTime":873.24,"body":"man just have a stroke like."},{"speaker":"Charles A. Goldfarb","startTime":875.46,"endTime":877.92,"body":"So,"},{"speaker":"Charles A. Goldfarb","startTime":875.46,"endTime":877.92,"body":"alright, I told you about in a"},{"speaker":"Charles A. Goldfarb","startTime":877.92,"endTime":883.05,"body":"lot of push ups. Not that anyone"},{"speaker":"Charles A. Goldfarb","startTime":877.92,"endTime":883.05,"body":"would notice. But it may or may"},{"speaker":"Charles A. Goldfarb","startTime":883.05,"endTime":887.31,"body":"not be related to my newest"},{"speaker":"Charles A. Goldfarb","startTime":883.05,"endTime":887.31,"body":"symptom, which is I have no"},{"speaker":"Charles A. Goldfarb","startTime":887.31,"endTime":891.27,"body":"constant numbness or tingling in"},{"speaker":"Charles A. Goldfarb","startTime":887.31,"endTime":891.27,"body":"my fingers. I have no"},{"speaker":"Charles A. Goldfarb","startTime":891.27,"endTime":896.61,"body":"provocative peripheral nerve"},{"speaker":"Charles A. Goldfarb","startTime":891.27,"endTime":896.61,"body":"signs. But occasionally, when I"},{"speaker":"Charles A. Goldfarb","startTime":896.61,"endTime":902.13,"body":"reach for something, and it's"},{"speaker":"Charles A. Goldfarb","startTime":896.61,"endTime":902.13,"body":"not necessarily Ford is not only"},{"speaker":"Charles A. Goldfarb","startTime":902.13,"endTime":906.06,"body":"said abduction of the shoulder,"},{"speaker":"Charles A. Goldfarb","startTime":902.13,"endTime":906.06,"body":"but I'll go to bed and reach for"},{"speaker":"Charles A. Goldfarb","startTime":906.06,"endTime":911.79,"body":"something. And I will get a"},{"speaker":"Charles A. Goldfarb","startTime":906.06,"endTime":911.79,"body":"clear, sharp nerve pain to my"},{"speaker":"Charles A. Goldfarb","startTime":911.79,"endTime":916.98,"body":"index finger, period, end of"},{"speaker":"Charles A. Goldfarb","startTime":911.79,"endTime":916.98,"body":"story. And if it's an impressive"},{"speaker":"Charles A. Goldfarb","startTime":916.98,"endTime":922.47,"body":"enough reach that can linger for"},{"speaker":"Charles A. Goldfarb","startTime":916.98,"endTime":922.47,"body":"five minutes or so. And it's the"},{"speaker":"Charles A. Goldfarb","startTime":922.47,"endTime":924.99,"body":"tip of the finger in the dorsal"},{"speaker":"Charles A. Goldfarb","startTime":922.47,"endTime":924.99,"body":"aspect of the finger, I have no"},{"speaker":"Charles A. Goldfarb","startTime":924.99,"endTime":930.06,"body":"neck symptoms whatsoever. What"},{"speaker":"Charles A. Goldfarb","startTime":924.99,"endTime":930.06,"body":"do you think?"},{"speaker":"Chris Dy","startTime":931.8,"endTime":933.96,"body":"So, dorsal aspect"},{"speaker":"Chris Dy","startTime":931.8,"endTime":933.96,"body":"only."},{"speaker":"Charles A. Goldfarb","startTime":934.56,"endTime":938.1,"body":"It feels"},{"speaker":"Charles A. Goldfarb","startTime":934.56,"endTime":938.1,"body":"more dorsal, but I think it is"},{"speaker":"Charles A. Goldfarb","startTime":938.1,"endTime":940.53,"body":"pulp and kind of radiating some"},{"speaker":"Charles A. Goldfarb","startTime":938.1,"endTime":940.53,"body":"dorsally"},{"speaker":"Chris Dy","startTime":940.89,"endTime":945.33,"body":"terrible patient,"},{"speaker":"Chris Dy","startTime":940.89,"endTime":945.33,"body":"terrible patient. Terrible. So,"},{"speaker":"Chris Dy","startTime":945.57,"endTime":948.99,"body":"you know, I guarantee you"},{"speaker":"Chris Dy","startTime":945.57,"endTime":948.99,"body":"there's a therapist or various"},{"speaker":"Chris Dy","startTime":948.99,"endTime":952.14,"body":"students, hand surgeon listeners"},{"speaker":"Chris Dy","startTime":948.99,"endTime":952.14,"body":"probably gonna nail this before"},{"speaker":"Chris Dy","startTime":952.14,"endTime":956.04,"body":"I do. But you know, I think that"},{"speaker":"Chris Dy","startTime":952.14,"endTime":956.04,"body":"a lot of times patients can have"},{"speaker":"Chris Dy","startTime":956.04,"endTime":959.88,"body":"symptoms that are related to"},{"speaker":"Chris Dy","startTime":956.04,"endTime":959.88,"body":"their cervical spine, even if"},{"speaker":"Chris Dy","startTime":959.88,"endTime":963.06,"body":"they don't have Frank radiating"},{"speaker":"Chris Dy","startTime":959.88,"endTime":963.06,"body":"radicular type symptoms. So"},{"speaker":"Chris Dy","startTime":963.06,"endTime":966.84,"body":"that's probably the first thing"},{"speaker":"Chris Dy","startTime":963.06,"endTime":966.84,"body":"I would think of, you know, is"},{"speaker":"Chris Dy","startTime":966.84,"endTime":970.71,"body":"just some irritation of one of"},{"speaker":"Chris Dy","startTime":966.84,"endTime":970.71,"body":"your nerve roots. Probably see"},{"speaker":"Chris Dy","startTime":970.71,"endTime":973.77,"body":"six based on the way you're"},{"speaker":"Chris Dy","startTime":970.71,"endTime":973.77,"body":"describing it. You if you're"},{"speaker":"Chris Dy","startTime":973.77,"endTime":976.35,"body":"saying it's more dorsal than"},{"speaker":"Chris Dy","startTime":973.77,"endTime":976.35,"body":"anything else, and you know,"},{"speaker":"Chris Dy","startTime":976.35,"endTime":978.54,"body":"maybe it's some irritation of"},{"speaker":"Chris Dy","startTime":976.35,"endTime":978.54,"body":"the radial nerve, but I think"},{"speaker":"Chris Dy","startTime":978.54,"endTime":980.73,"body":"that's highly unlikely to be"},{"speaker":"Chris Dy","startTime":978.54,"endTime":980.73,"body":"honest with you, I would"},{"speaker":"Chris Dy","startTime":980.73,"endTime":983.46,"body":"suspect, more cervical"},{"speaker":"Chris Dy","startTime":980.73,"endTime":983.46,"body":"irritation before I would"},{"speaker":"Chris Dy","startTime":983.46,"endTime":986.79,"body":"suspect anything involving the"},{"speaker":"Chris Dy","startTime":983.46,"endTime":986.79,"body":"radial nerve. When you said"},{"speaker":"Chris Dy","startTime":986.79,"endTime":991.32,"body":"index, I was starting to think"},{"speaker":"Chris Dy","startTime":986.79,"endTime":991.32,"body":"kind of lateral cord, you know,"},{"speaker":"Chris Dy","startTime":991.32,"endTime":994.83,"body":"contributing to the median nerve"},{"speaker":"Chris Dy","startTime":991.32,"endTime":994.83,"body":"but it's kind of unlikely to"},{"speaker":"Chris Dy","startTime":994.83,"endTime":998.67,"body":"pick just that off. So I think"},{"speaker":"Chris Dy","startTime":994.83,"endTime":998.67,"body":"common things being common, I"},{"speaker":"Chris Dy","startTime":998.67,"endTime":1001.34,"body":"would probably peg it more"},{"speaker":"Chris Dy","startTime":998.67,"endTime":1001.34,"body":"towards the neck. But this is"},{"speaker":"Chris Dy","startTime":1001.34,"endTime":1004.01,"body":"the challenge right is trying to"},{"speaker":"Chris Dy","startTime":1001.34,"endTime":1004.01,"body":"figure out kind of where things"},{"speaker":"Chris Dy","startTime":1004.01,"endTime":1007.64,"body":"are coming from and then finding"},{"speaker":"Chris Dy","startTime":1004.01,"endTime":1007.64,"body":"weakness. And you know, I've"},{"speaker":"Chris Dy","startTime":1007.64,"endTime":1010.4,"body":"diagnosed a few people in my"},{"speaker":"Chris Dy","startTime":1007.64,"endTime":1010.4,"body":"clinic have come in for rollout"},{"speaker":"Chris Dy","startTime":1010.4,"endTime":1013.7,"body":"carpal tunnel, etc, with you"},{"speaker":"Chris Dy","startTime":1010.4,"endTime":1013.7,"body":"know, C six and stuff in it and"},{"speaker":"Chris Dy","startTime":1013.7,"endTime":1016.46,"body":"there is some subtle weakness"},{"speaker":"Chris Dy","startTime":1013.7,"endTime":1016.46,"body":"and things like elbow flexion"},{"speaker":"Chris Dy","startTime":1016.46,"endTime":1018.53,"body":"when you really push on people"},{"speaker":"Chris Dy","startTime":1016.46,"endTime":1018.53,"body":"now you're not going to find it"},{"speaker":"Chris Dy","startTime":1018.53,"endTime":1021.65,"body":"if you're doing a cursory"},{"speaker":"Chris Dy","startTime":1018.53,"endTime":1021.65,"body":"examination. But you know, one"},{"speaker":"Chris Dy","startTime":1021.65,"endTime":1024.02,"body":"of the things that I learned"},{"speaker":"Chris Dy","startTime":1021.65,"endTime":1024.02,"body":"from Elizabeth Hoggart was you,"},{"speaker":"Chris Dy","startTime":1024.2,"endTime":1027.41,"body":"you really got to push on"},{"speaker":"Chris Dy","startTime":1024.2,"endTime":1027.41,"body":"people. You know, and I think"},{"speaker":"Chris Dy","startTime":1027.41,"endTime":1030.89,"body":"people are surprised with how,"},{"speaker":"Chris Dy","startTime":1027.41,"endTime":1030.89,"body":"how vigorously I will examine"},{"speaker":"Chris Dy","startTime":1030.89,"endTime":1035.15,"body":"some patients. But, yeah,"},{"speaker":"Chris Dy","startTime":1030.89,"endTime":1035.15,"body":"sometimes you'll you'll find"},{"speaker":"Chris Dy","startTime":1035.15,"endTime":1038.06,"body":"some cervical stuff. I don't"},{"speaker":"Chris Dy","startTime":1035.15,"endTime":1038.06,"body":"know, what do you think?"},{"speaker":"Charles A. Goldfarb","startTime":1038.479,"endTime":1040.669,"body":"Well, I"},{"speaker":"Charles A. Goldfarb","startTime":1038.479,"endTime":1040.669,"body":"certainly that's why I was"},{"speaker":"Charles A. Goldfarb","startTime":1040.669,"endTime":1044.599,"body":"trying to do a self furlings and"},{"speaker":"Charles A. Goldfarb","startTime":1040.669,"endTime":1044.599,"body":"all the, you know, cervical"},{"speaker":"Charles A. Goldfarb","startTime":1044.599,"endTime":1045.799,"body":"assessments, for sure."},{"speaker":"Chris Dy","startTime":1046.08,"endTime":1048.09,"body":"I hope there's a video"},{"speaker":"Chris Dy","startTime":1046.08,"endTime":1048.09,"body":"of you trying to do a self"},{"speaker":"Chris Dy","startTime":1048.09,"endTime":1053.58,"body":"Spurling, so I'm not gonna do it"},{"speaker":"Chris Dy","startTime":1048.09,"endTime":1053.58,"body":"here. Anybody who's not watching"},{"speaker":"Chris Dy","startTime":1053.58,"endTime":1056.37,"body":"the YouTube channel, Chuck, this"},{"speaker":"Chris Dy","startTime":1053.58,"endTime":1056.37,"body":"tried to Spurling himself, and"},{"speaker":"Chris Dy","startTime":1056.37,"endTime":1058.14,"body":"he looked like somebody in a"},{"speaker":"Chris Dy","startTime":1056.37,"endTime":1058.14,"body":"headlock."},{"speaker":"Charles A. Goldfarb","startTime":1058.56,"endTime":1061.89,"body":"It's true."},{"speaker":"Charles A. Goldfarb","startTime":1058.56,"endTime":1061.89,"body":"So in a patient like this, do"},{"speaker":"Charles A. Goldfarb","startTime":1061.89,"endTime":1066.06,"body":"you start with who's minorly"},{"speaker":"Charles A. Goldfarb","startTime":1061.89,"endTime":1066.06,"body":"impacted? Couple times a day"},{"speaker":"Charles A. Goldfarb","startTime":1066.09,"endTime":1069.24,"body":"feels a symptom like this, and"},{"speaker":"Charles A. Goldfarb","startTime":1066.09,"endTime":1069.24,"body":"maybe as part of the patient"},{"speaker":"Charles A. Goldfarb","startTime":1069.24,"endTime":1073.14,"body":"centered care, but do you start"},{"speaker":"Charles A. Goldfarb","startTime":1069.24,"endTime":1073.14,"body":"with sending them to therapy and"},{"speaker":"Charles A. Goldfarb","startTime":1073.14,"endTime":1077.04,"body":"work on nerve glides and"},{"speaker":"Charles A. Goldfarb","startTime":1073.14,"endTime":1077.04,"body":"stretching? Or do you start with"},{"speaker":"Charles A. Goldfarb","startTime":1078.45,"endTime":1082.26,"body":"either a nerve study or, or a"},{"speaker":"Charles A. Goldfarb","startTime":1078.45,"endTime":1082.26,"body":"referral to someone else?"},{"speaker":"Chris Dy","startTime":1082.89,"endTime":1086.49,"body":"I probably wouldn't"},{"speaker":"Chris Dy","startTime":1082.89,"endTime":1086.49,"body":"start with, with, with getting"},{"speaker":"Chris Dy","startTime":1086.49,"endTime":1089.64,"body":"any testing at this point, it's"},{"speaker":"Chris Dy","startTime":1086.49,"endTime":1089.64,"body":"still early on. If I was able to"},{"speaker":"Chris Dy","startTime":1089.64,"endTime":1092.73,"body":"find some other finding that"},{"speaker":"Chris Dy","startTime":1089.64,"endTime":1092.73,"body":"would corroborate suspicion for"},{"speaker":"Chris Dy","startTime":1092.73,"endTime":1096.99,"body":"cervical spine, I honestly would"},{"speaker":"Chris Dy","startTime":1092.73,"endTime":1096.99,"body":"probably just start you on, you"},{"speaker":"Chris Dy","startTime":1096.99,"endTime":1100.74,"body":"know, either, you know, some"},{"speaker":"Chris Dy","startTime":1096.99,"endTime":1100.74,"body":"oral anti inflammatories, if"},{"speaker":"Chris Dy","startTime":1100.74,"endTime":1103.47,"body":"you're able to do that, or a"},{"speaker":"Chris Dy","startTime":1100.74,"endTime":1103.47,"body":"short course of an oral steroid,"},{"speaker":"Chris Dy","startTime":1103.47,"endTime":1106.53,"body":"which can sometimes just wipe"},{"speaker":"Chris Dy","startTime":1103.47,"endTime":1106.53,"body":"things out entirely. But it's"},{"speaker":"Chris Dy","startTime":1106.53,"endTime":1110.43,"body":"probably more time than anything"},{"speaker":"Chris Dy","startTime":1106.53,"endTime":1110.43,"body":"else. If symptoms become a"},{"speaker":"Chris Dy","startTime":1110.43,"endTime":1113.49,"body":"little more frequent and"},{"speaker":"Chris Dy","startTime":1110.43,"endTime":1113.49,"body":"bothersome, then I think that of"},{"speaker":"Chris Dy","startTime":1113.49,"endTime":1117.21,"body":"course of therapy can be very"},{"speaker":"Chris Dy","startTime":1113.49,"endTime":1117.21,"body":"useful."},{"speaker":"Charles A. Goldfarb","startTime":1118.02,"endTime":1121.74,"body":"When you"},{"speaker":"Charles A. Goldfarb","startTime":1118.02,"endTime":1121.74,"body":"think about nerve glides, I've"},{"speaker":"Charles A. Goldfarb","startTime":1121.74,"endTime":1124.65,"body":"always wondered, does that make"},{"speaker":"Charles A. Goldfarb","startTime":1121.74,"endTime":1124.65,"body":"any sense at all? And maybe we"},{"speaker":"Charles A. Goldfarb","startTime":1124.65,"endTime":1128.64,"body":"should invite our therapist"},{"speaker":"Charles A. Goldfarb","startTime":1124.65,"endTime":1128.64,"body":"superstar Macy back. But when"},{"speaker":"Charles A. Goldfarb","startTime":1128.64,"endTime":1132.27,"body":"you think about nerve glides,"},{"speaker":"Charles A. Goldfarb","startTime":1128.64,"endTime":1132.27,"body":"what how do those work? And what"},{"speaker":"Charles A. Goldfarb","startTime":1132.27,"endTime":1133.65,"body":"how do you think about nerve"},{"speaker":"Charles A. Goldfarb","startTime":1132.27,"endTime":1133.65,"body":"glides?"},{"speaker":"Chris Dy","startTime":1134.61,"endTime":1136.86,"body":"So in brief, I mean, I"},{"speaker":"Chris Dy","startTime":1134.61,"endTime":1136.86,"body":"think the goal with the nerve"},{"speaker":"Chris Dy","startTime":1136.86,"endTime":1140.85,"body":"glide is to try to I mean, it's"},{"speaker":"Chris Dy","startTime":1136.86,"endTime":1140.85,"body":"in the name, but keep the nerve"},{"speaker":"Chris Dy","startTime":1140.85,"endTime":1144.9,"body":"gliding, and keep the the tissue"},{"speaker":"Chris Dy","startTime":1140.85,"endTime":1144.9,"body":"around the nerve, nice and"},{"speaker":"Chris Dy","startTime":1144.9,"endTime":1150.54,"body":"compliant, so that it's not"},{"speaker":"Chris Dy","startTime":1144.9,"endTime":1150.54,"body":"getting stuck anywhere. The the"},{"speaker":"Chris Dy","startTime":1150.54,"endTime":1154.83,"body":"rub with nerve glides, though,"},{"speaker":"Chris Dy","startTime":1150.54,"endTime":1154.83,"body":"is that there are only as when"},{"speaker":"Chris Dy","startTime":1154.83,"endTime":1158.25,"body":"they're done well. And when"},{"speaker":"Chris Dy","startTime":1154.83,"endTime":1158.25,"body":"they're done to the appropriate"},{"speaker":"Chris Dy","startTime":1158.25,"endTime":1160.8,"body":"duration, they can work very"},{"speaker":"Chris Dy","startTime":1158.25,"endTime":1160.8,"body":"well. I think that the the"},{"speaker":"Chris Dy","startTime":1160.8,"endTime":1164.73,"body":"challenge is getting patients to"},{"speaker":"Chris Dy","startTime":1160.8,"endTime":1164.73,"body":"understand exactly how much they"},{"speaker":"Chris Dy","startTime":1164.73,"endTime":1168.24,"body":"need to push in the amount of"},{"speaker":"Chris Dy","startTime":1164.73,"endTime":1168.24,"body":"discomfort they should be"},{"speaker":"Chris Dy","startTime":1168.24,"endTime":1170.34,"body":"feeling and not to cross that"},{"speaker":"Chris Dy","startTime":1168.24,"endTime":1170.34,"body":"threshold. Because if you have"},{"speaker":"Chris Dy","startTime":1170.34,"endTime":1173.7,"body":"somebody who is an overachiever,"},{"speaker":"Chris Dy","startTime":1170.34,"endTime":1173.7,"body":"and over does it, they can"},{"speaker":"Chris Dy","startTime":1173.7,"endTime":1176.67,"body":"actually be set back by the"},{"speaker":"Chris Dy","startTime":1173.7,"endTime":1176.67,"body":"nerve glides. So I think it's"},{"speaker":"Chris Dy","startTime":1176.7,"endTime":1179.4,"body":"it's something where with the"},{"speaker":"Chris Dy","startTime":1176.7,"endTime":1179.4,"body":"proper instruction, it can work"},{"speaker":"Chris Dy","startTime":1179.4,"endTime":1179.97,"body":"quite well."},{"speaker":"Charles A. Goldfarb","startTime":1180.65,"endTime":1182.84,"body":"Excellent."},{"speaker":"Charles A. Goldfarb","startTime":1180.65,"endTime":1182.84,"body":"Thank you. Thank you for your"},{"speaker":"Charles A. Goldfarb","startTime":1182.84,"endTime":1185.51,"body":"thoughts. Hopefully, I'll not be"},{"speaker":"Charles A. Goldfarb","startTime":1182.84,"endTime":1185.51,"body":"really seeing you as a patient"},{"speaker":"Charles A. Goldfarb","startTime":1185.51,"endTime":1187.4,"body":"but just this informal"},{"speaker":"Charles A. Goldfarb","startTime":1185.51,"endTime":1187.4,"body":"consultation."},{"speaker":"Chris Dy","startTime":1187.76,"endTime":1192.2,"body":"I'm sure I couldn't"},{"speaker":"Chris Dy","startTime":1187.76,"endTime":1192.2,"body":"find some weakness in Utah. So"},{"speaker":"Chris Dy","startTime":1192.23,"endTime":1195.74,"body":"So I have a challenging case"},{"speaker":"Chris Dy","startTime":1192.23,"endTime":1195.74,"body":"last week that reminded me of a"},{"speaker":"Chris Dy","startTime":1195.74,"endTime":1199.4,"body":"prior challenging case I had a"},{"speaker":"Chris Dy","startTime":1195.74,"endTime":1199.4,"body":"couple of years ago. So I had a"},{"speaker":"Chris Dy","startTime":1199.4,"endTime":1204.41,"body":"patient who You know, a few"},{"speaker":"Chris Dy","startTime":1199.4,"endTime":1204.41,"body":"years ago had a PAP fracture"},{"speaker":"Chris Dy","startTime":1204.41,"endTime":1208.31,"body":"dislocation. And the classic"},{"speaker":"Chris Dy","startTime":1204.41,"endTime":1208.31,"body":"pattern, you know, kind of a"},{"speaker":"Chris Dy","startTime":1208.31,"endTime":1211.34,"body":"dorsal dislocation with a small"},{"speaker":"Chris Dy","startTime":1208.31,"endTime":1211.34,"body":"hole or fragment that by"},{"speaker":"Chris Dy","startTime":1211.34,"endTime":1214.94,"body":"definition based on the"},{"speaker":"Chris Dy","startTime":1211.34,"endTime":1214.94,"body":"categorizations, small piece"},{"speaker":"Chris Dy","startTime":1214.94,"endTime":1219.77,"body":"like 10 15%, but just was"},{"speaker":"Chris Dy","startTime":1214.94,"endTime":1219.77,"body":"grossly unstable. I tried to"},{"speaker":"Chris Dy","startTime":1219.77,"endTime":1223.49,"body":"dorsal blocking splint that was"},{"speaker":"Chris Dy","startTime":1219.77,"endTime":1223.49,"body":"not satisfactory, as soon as we"},{"speaker":"Chris Dy","startTime":1223.49,"endTime":1226.61,"body":"took the splint off, even with"},{"speaker":"Chris Dy","startTime":1223.49,"endTime":1226.61,"body":"closely monitoring on X rays by"},{"speaker":"Chris Dy","startTime":1226.64,"endTime":1232.34,"body":"incremental relaxation of the,"},{"speaker":"Chris Dy","startTime":1226.64,"endTime":1232.34,"body":"the blocking was still unstable."},{"speaker":"Chris Dy","startTime":1233.21,"endTime":1236.48,"body":"So I was trying to figure out"},{"speaker":"Chris Dy","startTime":1233.21,"endTime":1236.48,"body":"what to do for this patient."},{"speaker":"Chris Dy","startTime":1237.98,"endTime":1241.22,"body":"What's your next step in that"},{"speaker":"Chris Dy","startTime":1237.98,"endTime":1241.22,"body":"stage? So say you've got a small"},{"speaker":"Chris Dy","startTime":1241.25,"endTime":1244.7,"body":"fragment 10 15% of the volar lip"},{"speaker":"Chris Dy","startTime":1241.25,"endTime":1244.7,"body":"of the base of the middle"},{"speaker":"Chris Dy","startTime":1244.7,"endTime":1249.23,"body":"phalanx, but you have continued"},{"speaker":"Chris Dy","startTime":1244.7,"endTime":1249.23,"body":"subluxation of the joint."},{"speaker":"Charles A. Goldfarb","startTime":1250.01,"endTime":1251.99,"body":"Yeah, those"},{"speaker":"Charles A. Goldfarb","startTime":1250.01,"endTime":1251.99,"body":"cases are interesting, because"},{"speaker":"Charles A. Goldfarb","startTime":1251.99,"endTime":1255.65,"body":"it doesn't really fit, right,"},{"speaker":"Charles A. Goldfarb","startTime":1251.99,"endTime":1255.65,"body":"you think we're about a fragment"},{"speaker":"Charles A. Goldfarb","startTime":1255.65,"endTime":1259.07,"body":"that size? Is that fragment"},{"speaker":"Charles A. Goldfarb","startTime":1255.65,"endTime":1259.07,"body":"really contributing to the"},{"speaker":"Charles A. Goldfarb","startTime":1259.07,"endTime":1262.43,"body":"instability? Or is it more of"},{"speaker":"Charles A. Goldfarb","startTime":1259.07,"endTime":1262.43,"body":"the soft tissue envelopes?"},{"speaker":"Charles A. Goldfarb","startTime":1262.7,"endTime":1266.84,"body":"Nonetheless, eat at the fragment"},{"speaker":"Charles A. Goldfarb","startTime":1262.7,"endTime":1266.84,"body":"may not be the reason this"},{"speaker":"Charles A. Goldfarb","startTime":1266.84,"endTime":1270.8,"body":"patient's unstable fixation of"},{"speaker":"Charles A. Goldfarb","startTime":1266.84,"endTime":1270.8,"body":"that fragment, could be"},{"speaker":"Charles A. Goldfarb","startTime":1270.8,"endTime":1274.52,"body":"considered as a role to"},{"speaker":"Charles A. Goldfarb","startTime":1270.8,"endTime":1274.52,"body":"reconstruct that door that that"},{"speaker":"Charles A. Goldfarb","startTime":1274.52,"endTime":1279.74,"body":"buttress that volar buttress. So"},{"speaker":"Charles A. Goldfarb","startTime":1274.52,"endTime":1279.74,"body":"for me, it would depend on what"},{"speaker":"Charles A. Goldfarb","startTime":1279.74,"endTime":1282.98,"body":"I thought about the fragment."},{"speaker":"Charles A. Goldfarb","startTime":1279.74,"endTime":1282.98,"body":"And if I thought that fixation"},{"speaker":"Charles A. Goldfarb","startTime":1282.98,"endTime":1285.77,"body":"of it would would increase the"},{"speaker":"Charles A. Goldfarb","startTime":1282.98,"endTime":1285.77,"body":"stability, that would be my"},{"speaker":"Charles A. Goldfarb","startTime":1285.77,"endTime":1292.88,"body":"first choice, because I prefer"},{"speaker":"Charles A. Goldfarb","startTime":1285.77,"endTime":1292.88,"body":"that over any type of traction,"},{"speaker":"Charles A. Goldfarb","startTime":1293.39,"endTime":1298.07,"body":"situation, or distraction of the"},{"speaker":"Charles A. Goldfarb","startTime":1293.39,"endTime":1298.07,"body":"tip joint. Others might consider"},{"speaker":"Charles A. Goldfarb","startTime":1298.13,"endTime":1301.34,"body":"placing simply a dorsal block"},{"speaker":"Charles A. Goldfarb","startTime":1298.13,"endTime":1301.34,"body":"splint, I'm sorry, a dorsal"},{"speaker":"Charles A. Goldfarb","startTime":1301.34,"endTime":1305.03,"body":"block pin to function in the"},{"speaker":"Charles A. Goldfarb","startTime":1301.34,"endTime":1305.03,"body":"same way that a splint does, but"},{"speaker":"Charles A. Goldfarb","startTime":1305.27,"endTime":1308.66,"body":"you know, can be a little more"},{"speaker":"Charles A. Goldfarb","startTime":1305.27,"endTime":1308.66,"body":"effective. I don't love that"},{"speaker":"Charles A. Goldfarb","startTime":1308.66,"endTime":1311.33,"body":"treatment. So that's not my"},{"speaker":"Charles A. Goldfarb","startTime":1308.66,"endTime":1311.33,"body":"first line. My first line is if"},{"speaker":"Charles A. Goldfarb","startTime":1311.33,"endTime":1316.34,"body":"I think the fragment is"},{"speaker":"Charles A. Goldfarb","startTime":1311.33,"endTime":1316.34,"body":"reducible, and can hold a screw,"},{"speaker":"Charles A. Goldfarb","startTime":1316.7,"endTime":1319.52,"body":"that would be my first choice"},{"speaker":"Charles A. Goldfarb","startTime":1316.7,"endTime":1319.52,"body":"with a distraction setup as the"},{"speaker":"Charles A. Goldfarb","startTime":1319.52,"endTime":1320.36,"body":"second choice."},{"speaker":"Chris Dy","startTime":1320.72,"endTime":1323.21,"body":"So like 1315 Screw"},{"speaker":"Chris Dy","startTime":1320.72,"endTime":1323.21,"body":"situation."},{"speaker":"Charles A. Goldfarb","startTime":1323.63,"endTime":1327.02,"body":"Yeah,"},{"speaker":"Charles A. Goldfarb","startTime":1323.63,"endTime":1327.02,"body":"absolutely. Where I typically"},{"speaker":"Charles A. Goldfarb","startTime":1327.11,"endTime":1331.52,"body":"release the volar plate from the"},{"speaker":"Charles A. Goldfarb","startTime":1327.11,"endTime":1331.52,"body":"fragment. So we're gonna leave"},{"speaker":"Charles A. Goldfarb","startTime":1331.52,"endTime":1336.26,"body":"the volar plate attached"},{"speaker":"Charles A. Goldfarb","startTime":1331.52,"endTime":1336.26,"body":"proximately. Free, so let me"},{"speaker":"Charles A. Goldfarb","startTime":1336.26,"endTime":1340.1,"body":"back up. So Bruner, type"},{"speaker":"Charles A. Goldfarb","startTime":1336.26,"endTime":1340.1,"body":"incisions, a V shaped incision"},{"speaker":"Charles A. Goldfarb","startTime":1340.1,"endTime":1343.67,"body":"centered on the volar tip joint,"},{"speaker":"Charles A. Goldfarb","startTime":1340.1,"endTime":1343.67,"body":"protect the neurovascular"},{"speaker":"Charles A. Goldfarb","startTime":1343.67,"endTime":1347.21,"body":"bundles on either side, open"},{"speaker":"Charles A. Goldfarb","startTime":1343.67,"endTime":1347.21,"body":"between a two and a four and"},{"speaker":"Charles A. Goldfarb","startTime":1347.21,"endTime":1350.36,"body":"retract the flexor tendons and"},{"speaker":"Charles A. Goldfarb","startTime":1347.21,"endTime":1350.36,"body":"go down to the volar plate"},{"speaker":"Charles A. Goldfarb","startTime":1350.36,"endTime":1352.37,"body":"working a little more distally"},{"speaker":"Charles A. Goldfarb","startTime":1350.36,"endTime":1352.37,"body":"that we typically do, I"},{"speaker":"Charles A. Goldfarb","startTime":1352.37,"endTime":1355.1,"body":"typically approach things from"},{"speaker":"Charles A. Goldfarb","startTime":1352.37,"endTime":1355.1,"body":"proximal, but this is"},{"speaker":"Charles A. Goldfarb","startTime":1355.1,"endTime":1358.34,"body":"approaching it from distal. So"},{"speaker":"Charles A. Goldfarb","startTime":1355.1,"endTime":1358.34,"body":"working on the fragment should"},{"speaker":"Charles A. Goldfarb","startTime":1358.34,"endTime":1362.63,"body":"be easy to identify, elevate the"},{"speaker":"Charles A. Goldfarb","startTime":1358.34,"endTime":1362.63,"body":"volar plate insertion off of"},{"speaker":"Charles A. Goldfarb","startTime":1362.63,"endTime":1366.5,"body":"this bony fragment, and then try"},{"speaker":"Charles A. Goldfarb","startTime":1362.63,"endTime":1366.5,"body":"to reduce it anatomically."},{"speaker":"Charles A. Goldfarb","startTime":1366.65,"endTime":1373.04,"body":"Usually what I do is I put a K"},{"speaker":"Charles A. Goldfarb","startTime":1366.65,"endTime":1373.04,"body":"wire in on one side. And"},{"speaker":"Charles A. Goldfarb","startTime":1373.04,"endTime":1378.44,"body":"typically that's a 0.035k wire."},{"speaker":"Charles A. Goldfarb","startTime":1373.04,"endTime":1378.44,"body":"And then on the other side, I've"},{"speaker":"Charles A. Goldfarb","startTime":1378.44,"endTime":1381.47,"body":"gotten the reduction, then I'll"},{"speaker":"Charles A. Goldfarb","startTime":1378.44,"endTime":1381.47,"body":"put a screw in. And then I'll"},{"speaker":"Charles A. Goldfarb","startTime":1381.47,"endTime":1383.9,"body":"remove the K wire and put a"},{"speaker":"Charles A. Goldfarb","startTime":1381.47,"endTime":1383.9,"body":"screw with a K where I used to"},{"speaker":"Charles A. Goldfarb","startTime":1383.9,"endTime":1386.9,"body":"be, again, if the fragment"},{"speaker":"Charles A. Goldfarb","startTime":1383.9,"endTime":1386.9,"body":"allows it. I'm not sure what"},{"speaker":"Charles A. Goldfarb","startTime":1386.9,"endTime":1389.6,"body":"your sense was about that"},{"speaker":"Charles A. Goldfarb","startTime":1386.9,"endTime":1389.6,"body":"fragment? Yeah,"},{"speaker":"Chris Dy","startTime":1389.599,"endTime":1392.539,"body":"I mean, not for this"},{"speaker":"Chris Dy","startTime":1389.599,"endTime":1392.539,"body":"particular case. But having had"},{"speaker":"Chris Dy","startTime":1392.539,"endTime":1396.559,"body":"the, the opportunity to explore"},{"speaker":"Chris Dy","startTime":1392.539,"endTime":1396.559,"body":"small fragments, I find that the"},{"speaker":"Chris Dy","startTime":1396.559,"endTime":1399.889,"body":"more you mess with the fragment,"},{"speaker":"Chris Dy","startTime":1396.559,"endTime":1399.889,"body":"you know, it's diminishing"},{"speaker":"Chris Dy","startTime":1399.889,"endTime":1404.029,"body":"returns. So caution for those"},{"speaker":"Chris Dy","startTime":1399.889,"endTime":1404.029,"body":"that are taking on what Chuck is"},{"speaker":"Chris Dy","startTime":1404.029,"endTime":1406.639,"body":"describing, yeah, if you can get"},{"speaker":"Chris Dy","startTime":1404.029,"endTime":1406.639,"body":"some screws in a fragment and"},{"speaker":"Chris Dy","startTime":1406.639,"endTime":1410.179,"body":"have that act as a proper"},{"speaker":"Chris Dy","startTime":1406.639,"endTime":1410.179,"body":"buttress to joint dislocation or"},{"speaker":"Chris Dy","startTime":1410.179,"endTime":1414.169,"body":"subluxation. Great, but you"},{"speaker":"Chris Dy","startTime":1410.179,"endTime":1414.169,"body":"know, those are one chance pins"},{"speaker":"Chris Dy","startTime":1414.169,"endTime":1415.339,"body":"and one chance screws,"},{"speaker":"Charles A. Goldfarb","startTime":1415.789,"endTime":1417.829,"body":"I think"},{"speaker":"Charles A. Goldfarb","startTime":1415.789,"endTime":1417.829,"body":"that is really well said and"},{"speaker":"Charles A. Goldfarb","startTime":1417.829,"endTime":1423.439,"body":"what we as the surgeon need to"},{"speaker":"Charles A. Goldfarb","startTime":1417.829,"endTime":1423.439,"body":"be super careful of is properly"},{"speaker":"Charles A. Goldfarb","startTime":1423.439,"endTime":1428.689,"body":"identifying those fractures that"},{"speaker":"Charles A. Goldfarb","startTime":1423.439,"endTime":1428.689,"body":"will that will allow this"},{"speaker":"Charles A. Goldfarb","startTime":1428.689,"endTime":1432.859,"body":"because if there is combination"},{"speaker":"Charles A. Goldfarb","startTime":1428.689,"endTime":1432.859,"body":"of the fragment or dorsal to the"},{"speaker":"Charles A. Goldfarb","startTime":1432.859,"endTime":1436.849,"body":"fragment, so further combination"},{"speaker":"Charles A. Goldfarb","startTime":1432.859,"endTime":1436.849,"body":"along the joint line, this will"},{"speaker":"Charles A. Goldfarb","startTime":1436.849,"endTime":1441.019,"body":"not only not succeed, it can"},{"speaker":"Charles A. Goldfarb","startTime":1436.849,"endTime":1441.019,"body":"make a difficult situation more"},{"speaker":"Charles A. Goldfarb","startTime":1441.019,"endTime":1444.679,"body":"difficult. So I you are 100%"},{"speaker":"Charles A. Goldfarb","startTime":1441.019,"endTime":1444.679,"body":"Correct. And I agree with that"},{"speaker":"Charles A. Goldfarb","startTime":1444.709,"endTime":1445.339,"body":"caveat."},{"speaker":"Chris Dy","startTime":1445.849,"endTime":1447.919,"body":"So you know, you're"},{"speaker":"Chris Dy","startTime":1445.849,"endTime":1447.919,"body":"saying if you can't do that your"},{"speaker":"Chris Dy","startTime":1447.919,"endTime":1451.639,"body":"next option would be attraction,"},{"speaker":"Chris Dy","startTime":1447.919,"endTime":1451.639,"body":"dynamic experts kind of thing. I"},{"speaker":"Chris Dy","startTime":1451.639,"endTime":1453.469,"body":"mean, you're there. You've"},{"speaker":"Chris Dy","startTime":1451.639,"endTime":1453.469,"body":"already got the approach. Are"},{"speaker":"Chris Dy","startTime":1453.469,"endTime":1455.929,"body":"you are you doing a little"},{"speaker":"Chris Dy","startTime":1453.469,"endTime":1455.929,"body":"boilerplate advancement, a"},{"speaker":"Chris Dy","startTime":1455.929,"endTime":1458.269,"body":"little boilerplate arthroplasty"},{"speaker":"Chris Dy","startTime":1455.929,"endTime":1458.269,"body":"while you're there? No,"},{"speaker":"Charles A. Goldfarb","startTime":1458.66,"endTime":1462.77,"body":"no, I'm"},{"speaker":"Charles A. Goldfarb","startTime":1458.66,"endTime":1462.77,"body":"not. I guess if they'll be"},{"speaker":"Charles A. Goldfarb","startTime":1462.77,"endTime":1466.34,"body":"exception, so many of our"},{"speaker":"Charles A. Goldfarb","startTime":1462.77,"endTime":1466.34,"body":"listeners will have never seen a"},{"speaker":"Charles A. Goldfarb","startTime":1466.34,"endTime":1469.46,"body":"volar plate arthroplasty. And"},{"speaker":"Charles A. Goldfarb","startTime":1466.34,"endTime":1469.46,"body":"again, not to keep harping back"},{"speaker":"Charles A. Goldfarb","startTime":1469.46,"endTime":1472.67,"body":"to my training where things have"},{"speaker":"Charles A. Goldfarb","startTime":1469.46,"endTime":1472.67,"body":"dramatically changed but"},{"speaker":"Charles A. Goldfarb","startTime":1472.7,"endTime":1477.8,"body":"overplayed arthroplasty used to"},{"speaker":"Charles A. Goldfarb","startTime":1472.7,"endTime":1477.8,"body":"be the treatment for these volar"},{"speaker":"Charles A. Goldfarb","startTime":1477.8,"endTime":1482.48,"body":"fragment volar fractures with"},{"speaker":"Charles A. Goldfarb","startTime":1477.8,"endTime":1482.48,"body":"joint instability and it was"},{"speaker":"Charles A. Goldfarb","startTime":1482.48,"endTime":1485.27,"body":"popularized in New York and I"},{"speaker":"Charles A. Goldfarb","startTime":1482.48,"endTime":1485.27,"body":"think in the right hands can"},{"speaker":"Charles A. Goldfarb","startTime":1485.27,"endTime":1488.69,"body":"still be an effective treatment"},{"speaker":"Charles A. Goldfarb","startTime":1485.27,"endTime":1488.69,"body":"but most of us don't do it well"},{"speaker":"Charles A. Goldfarb","startTime":1488.69,"endTime":1492.5,"body":"and so volar played arthroplasty"},{"speaker":"Charles A. Goldfarb","startTime":1488.69,"endTime":1492.5,"body":"where the vote plays advanced"},{"speaker":"Charles A. Goldfarb","startTime":1492.5,"endTime":1495.77,"body":"into the site of the fracture"},{"speaker":"Charles A. Goldfarb","startTime":1492.5,"endTime":1495.77,"body":"has not been a tool for me."},{"speaker":"Chris Dy","startTime":1496.77,"endTime":1498.99,"body":"I think it's a good"},{"speaker":"Chris Dy","startTime":1496.77,"endTime":1498.99,"body":"surgery and know how to do to"},{"speaker":"Chris Dy","startTime":1498.99,"endTime":1502.29,"body":"bail yourself out If you get"},{"speaker":"Chris Dy","startTime":1498.99,"endTime":1502.29,"body":"into a situation where fixation"},{"speaker":"Chris Dy","startTime":1502.29,"endTime":1505.44,"body":"doesn't work, you maybe have not"},{"speaker":"Chris Dy","startTime":1502.29,"endTime":1505.44,"body":"talked to the patient about a"},{"speaker":"Chris Dy","startTime":1505.44,"endTime":1510.48,"body":"dynamic X fix or in the case of"},{"speaker":"Chris Dy","startTime":1505.44,"endTime":1510.48,"body":"a Hemi hammock gone awry. You"},{"speaker":"Chris Dy","startTime":1510.48,"endTime":1514.14,"body":"know, that is one option. So say"},{"speaker":"Chris Dy","startTime":1510.48,"endTime":1514.14,"body":"you've gone to the dynamic"},{"speaker":"Chris Dy","startTime":1514.14,"endTime":1518.79,"body":"experts. In this particular case"},{"speaker":"Chris Dy","startTime":1514.14,"endTime":1518.79,"body":"that I'm describing from a"},{"speaker":"Chris Dy","startTime":1518.79,"endTime":1522.27,"body":"couple years back, the dynamic"},{"speaker":"Chris Dy","startTime":1518.79,"endTime":1522.27,"body":"exe fix was actually where I"},{"speaker":"Chris Dy","startTime":1522.27,"endTime":1525.15,"body":"went directly. I did not try to"},{"speaker":"Chris Dy","startTime":1522.27,"endTime":1525.15,"body":"fix the fragment, I thought it"},{"speaker":"Chris Dy","startTime":1525.15,"endTime":1527.94,"body":"was too small. And perhaps I was"},{"speaker":"Chris Dy","startTime":1525.15,"endTime":1527.94,"body":"not enlightened by you. And I"},{"speaker":"Chris Dy","startTime":1527.94,"endTime":1530.55,"body":"know that our partner Lindley"},{"speaker":"Chris Dy","startTime":1527.94,"endTime":1530.55,"body":"wall also likes to fix the small"},{"speaker":"Chris Dy","startTime":1530.55,"endTime":1535.32,"body":"fragments. But I went to a"},{"speaker":"Chris Dy","startTime":1530.55,"endTime":1535.32,"body":"dynamic ex fix. They want great"},{"speaker":"Chris Dy","startTime":1535.41,"endTime":1539.61,"body":"patient, it was a little bit"},{"speaker":"Chris Dy","startTime":1535.41,"endTime":1539.61,"body":"awkward on the finger, but it it"},{"speaker":"Chris Dy","startTime":1539.61,"endTime":1542.49,"body":"looked good patient actually"},{"speaker":"Chris Dy","startTime":1539.61,"endTime":1542.49,"body":"moved with it because he was"},{"speaker":"Chris Dy","startTime":1542.49,"endTime":1545.67,"body":"working with this therapist. I"},{"speaker":"Chris Dy","startTime":1542.49,"endTime":1545.67,"body":"know that the the knock on that"},{"speaker":"Chris Dy","startTime":1545.67,"endTime":1548.46,"body":"is, although it's a dynamic ex"},{"speaker":"Chris Dy","startTime":1545.67,"endTime":1548.46,"body":"fix. Patients don't actually"},{"speaker":"Chris Dy","startTime":1548.49,"endTime":1553.53,"body":"move. But yeah, they were they"},{"speaker":"Chris Dy","startTime":1548.49,"endTime":1553.53,"body":"were doing great from that. So"},{"speaker":"Chris Dy","startTime":1553.53,"endTime":1556.17,"body":"we did the dynamic ex fix, and"},{"speaker":"Chris Dy","startTime":1553.53,"endTime":1556.17,"body":"we left it on for I think"},{"speaker":"Chris Dy","startTime":1556.17,"endTime":1559.65,"body":"probably six or eight weeks or"},{"speaker":"Chris Dy","startTime":1556.17,"endTime":1559.65,"body":"something like that. And time"},{"speaker":"Chris Dy","startTime":1559.65,"endTime":1563.49,"body":"came for the ex fix to come off."},{"speaker":"Chris Dy","startTime":1559.65,"endTime":1563.49,"body":"And we were happy with it looked"},{"speaker":"Chris Dy","startTime":1563.49,"endTime":1569.76,"body":"rock solid on the the office"},{"speaker":"Chris Dy","startTime":1563.49,"endTime":1569.76,"body":"floor scan next week, unstable,"},{"speaker":"Chris Dy","startTime":1570.24,"endTime":1574.02,"body":"right back out. Not a good"},{"speaker":"Chris Dy","startTime":1570.24,"endTime":1574.02,"body":"feeling. What do you do now?"},{"speaker":"Charles A. Goldfarb","startTime":1575.51,"endTime":1580.28,"body":"And now"},{"speaker":"Charles A. Goldfarb","startTime":1575.51,"endTime":1580.28,"body":"you're in trouble? You know, the"},{"speaker":"Charles A. Goldfarb","startTime":1580.28,"endTime":1584.27,"body":"bailout at this point is I think"},{"speaker":"Charles A. Goldfarb","startTime":1580.28,"endTime":1584.27,"body":"you have to try to understand"},{"speaker":"Charles A. Goldfarb","startTime":1584.3,"endTime":1588.53,"body":"why, you know, obviously, why"},{"speaker":"Charles A. Goldfarb","startTime":1584.3,"endTime":1588.53,"body":"did it fail? Was there something"},{"speaker":"Charles A. Goldfarb","startTime":1588.53,"endTime":1591.26,"body":"about your construct? It doesn't"},{"speaker":"Charles A. Goldfarb","startTime":1588.53,"endTime":1591.26,"body":"sound like it, especially if"},{"speaker":"Charles A. Goldfarb","startTime":1591.26,"endTime":1594.62,"body":"you're getting good motion with"},{"speaker":"Charles A. Goldfarb","startTime":1591.26,"endTime":1594.62,"body":"your fixer is probably not the"},{"speaker":"Charles A. Goldfarb","startTime":1594.62,"endTime":1598.07,"body":"construct? Is there some"},{"speaker":"Charles A. Goldfarb","startTime":1594.62,"endTime":1598.07,"body":"unrecognized additional soft"},{"speaker":"Charles A. Goldfarb","startTime":1598.07,"endTime":1603.47,"body":"tissue injury, which again,"},{"speaker":"Charles A. Goldfarb","startTime":1598.07,"endTime":1603.47,"body":"should have healed? Is the volar"},{"speaker":"Charles A. Goldfarb","startTime":1603.47,"endTime":1607.94,"body":"fragment larger than expected"},{"speaker":"Charles A. Goldfarb","startTime":1603.47,"endTime":1607.94,"body":"and not healed and therefore"},{"speaker":"Charles A. Goldfarb","startTime":1607.94,"endTime":1610.76,"body":"contributing to continued"},{"speaker":"Charles A. Goldfarb","startTime":1607.94,"endTime":1610.76,"body":"instability? I think you have to"},{"speaker":"Charles A. Goldfarb","startTime":1610.76,"endTime":1615.05,"body":"be just carefully examine all"},{"speaker":"Charles A. Goldfarb","startTime":1610.76,"endTime":1615.05,"body":"the variables to see if you can"},{"speaker":"Charles A. Goldfarb","startTime":1615.05,"endTime":1618.29,"body":"identify why it failed. And you"},{"speaker":"Charles A. Goldfarb","startTime":1615.05,"endTime":1618.29,"body":"might not not be able to."},{"speaker":"Chris Dy","startTime":1619.88,"endTime":1621.74,"body":"Yeah, I think we"},{"speaker":"Chris Dy","startTime":1619.88,"endTime":1621.74,"body":"thought pretty critically about"},{"speaker":"Chris Dy","startTime":1621.74,"endTime":1625.4,"body":"it. And to me, it just came down"},{"speaker":"Chris Dy","startTime":1621.74,"endTime":1625.4,"body":"to the fact that it wasn't a"},{"speaker":"Chris Dy","startTime":1625.4,"endTime":1629.87,"body":"strong enough bony buttress. So"},{"speaker":"Chris Dy","startTime":1625.4,"endTime":1629.87,"body":"we went to the next level, and"},{"speaker":"Chris Dy","startTime":1629.9,"endTime":1633.14,"body":"at this point, are you the only"},{"speaker":"Chris Dy","startTime":1629.9,"endTime":1633.14,"body":"other option I'm aware of that"},{"speaker":"Chris Dy","startTime":1633.14,"endTime":1635.3,"body":"would work in this situation is"},{"speaker":"Chris Dy","startTime":1633.14,"endTime":1635.3,"body":"a Hemi Hemi."},{"speaker":"Charles A. Goldfarb","startTime":1636.71,"endTime":1640.49,"body":"So I am a"},{"speaker":"Charles A. Goldfarb","startTime":1636.71,"endTime":1640.49,"body":"fan. Not everyone is as you"},{"speaker":"Charles A. Goldfarb","startTime":1640.49,"endTime":1643.43,"body":"know, one of our partners does"},{"speaker":"Charles A. Goldfarb","startTime":1640.49,"endTime":1643.43,"body":"not like or believe in the Hemi"},{"speaker":"Charles A. Goldfarb","startTime":1643.43,"endTime":1648.11,"body":"handmade because he doesn't"},{"speaker":"Charles A. Goldfarb","startTime":1643.43,"endTime":1648.11,"body":"believe he can make it work. You"},{"speaker":"Charles A. Goldfarb","startTime":1648.11,"endTime":1651.5,"body":"know, I did my training in"},{"speaker":"Charles A. Goldfarb","startTime":1648.11,"endTime":1651.5,"body":"Cincinnati and Cincinnati and"},{"speaker":"Charles A. Goldfarb","startTime":1652.04,"endTime":1656.21,"body":"Indianapolis and Louisville had"},{"speaker":"Charles A. Goldfarb","startTime":1652.04,"endTime":1656.21,"body":"a annual meeting. And in the"},{"speaker":"Charles A. Goldfarb","startTime":1656.21,"endTime":1658.73,"body":"impact of Hill Hastings"},{"speaker":"Charles A. Goldfarb","startTime":1656.21,"endTime":1658.73,"body":"certainly was felt in"},{"speaker":"Charles A. Goldfarb","startTime":1658.73,"endTime":1662.09,"body":"Cincinnati. And there was some"},{"speaker":"Charles A. Goldfarb","startTime":1658.73,"endTime":1662.09,"body":"research done about the MMA"},{"speaker":"Charles A. Goldfarb","startTime":1662.09,"endTime":1665.12,"body":"technique while I was in"},{"speaker":"Charles A. Goldfarb","startTime":1662.09,"endTime":1665.12,"body":"Cincinnati. And I think it would"},{"speaker":"Charles A. Goldfarb","startTime":1665.12,"endTime":1669.23,"body":"be a really good technique. It"},{"speaker":"Charles A. Goldfarb","startTime":1665.12,"endTime":1669.23,"body":"is one of those procedures that"},{"speaker":"Charles A. Goldfarb","startTime":1669.23,"endTime":1675.71,"body":"I do think requires meticulous"},{"speaker":"Charles A. Goldfarb","startTime":1669.23,"endTime":1675.71,"body":"workmanship of the fragment. So"},{"speaker":"Charles A. Goldfarb","startTime":1675.71,"endTime":1679.07,"body":"harvesting the right fragment"},{"speaker":"Charles A. Goldfarb","startTime":1675.71,"endTime":1679.07,"body":"conjoining, the fragment to the"},{"speaker":"Charles A. Goldfarb","startTime":1679.07,"endTime":1683.27,"body":"right specifications and"},{"speaker":"Charles A. Goldfarb","startTime":1679.07,"endTime":1683.27,"body":"satisfactory fixation. So it is"},{"speaker":"Charles A. Goldfarb","startTime":1683.27,"endTime":1686.54,"body":"not a simple slam dunk guarantee"},{"speaker":"Charles A. Goldfarb","startTime":1683.27,"endTime":1686.54,"body":"great outcome, but I think it"},{"speaker":"Charles A. Goldfarb","startTime":1686.54,"endTime":1690.5,"body":"can, it can be really, really"},{"speaker":"Charles A. Goldfarb","startTime":1686.54,"endTime":1690.5,"body":"good."},{"speaker":"Chris Dy","startTime":1692.0,"endTime":1695.21,"body":"Yeah, I agree. I think"},{"speaker":"Chris Dy","startTime":1692.0,"endTime":1695.21,"body":"it's one of the more technically"},{"speaker":"Chris Dy","startTime":1695.3,"endTime":1698.51,"body":"demanding carpentry jobs that we"},{"speaker":"Chris Dy","startTime":1695.3,"endTime":1698.51,"body":"have to do in hand surgery, if"},{"speaker":"Chris Dy","startTime":1698.51,"endTime":1701.33,"body":"not the most, to be honest with"},{"speaker":"Chris Dy","startTime":1698.51,"endTime":1701.33,"body":"you, because I think it's not"},{"speaker":"Chris Dy","startTime":1701.51,"endTime":1706.46,"body":"just harvesting the graft"},{"speaker":"Chris Dy","startTime":1701.51,"endTime":1706.46,"body":"appropriately. But it's also"},{"speaker":"Chris Dy","startTime":1707.84,"endTime":1710.87,"body":"getting your recipient bed ready"},{"speaker":"Chris Dy","startTime":1707.84,"endTime":1710.87,"body":"so that it can receive it"},{"speaker":"Chris Dy","startTime":1710.87,"endTime":1712.85,"body":"appropriately. And I think"},{"speaker":"Chris Dy","startTime":1710.87,"endTime":1712.85,"body":"that's honestly the biggest"},{"speaker":"Chris Dy","startTime":1712.85,"endTime":1716.0,"body":"challenge of that surgery is"},{"speaker":"Chris Dy","startTime":1712.85,"endTime":1716.0,"body":"making sure that your graft is"},{"speaker":"Chris Dy","startTime":1716.0,"endTime":1719.69,"body":"shaped appropriately tilted"},{"speaker":"Chris Dy","startTime":1716.0,"endTime":1719.69,"body":"appropriately, to act as a"},{"speaker":"Chris Dy","startTime":1719.69,"endTime":1722.87,"body":"buttress. And for those"},{"speaker":"Chris Dy","startTime":1719.69,"endTime":1722.87,"body":"listeners that are unfamiliar"},{"speaker":"Chris Dy","startTime":1722.87,"endTime":1727.25,"body":"with this concept, you know, the"},{"speaker":"Chris Dy","startTime":1722.87,"endTime":1727.25,"body":"at the CMC joint, the distal"},{"speaker":"Chris Dy","startTime":1727.25,"endTime":1733.1,"body":"aspect of the handmade, has a"},{"speaker":"Chris Dy","startTime":1727.25,"endTime":1733.1,"body":"very nice articular surface that"},{"speaker":"Chris Dy","startTime":1733.1,"endTime":1737.84,"body":"matches essentially what the"},{"speaker":"Chris Dy","startTime":1733.1,"endTime":1737.84,"body":"base of the middle failings has."},{"speaker":"Chris Dy","startTime":1738.11,"endTime":1741.41,"body":"And it's that kind of where the"},{"speaker":"Chris Dy","startTime":1738.11,"endTime":1741.41,"body":"fourth and fifth metacarpal base"},{"speaker":"Chris Dy","startTime":1741.41,"endTime":1744.5,"body":"articulate with the handmade"},{"speaker":"Chris Dy","startTime":1741.41,"endTime":1744.5,"body":"that's very similar to that"},{"speaker":"Chris Dy","startTime":1744.53,"endTime":1748.28,"body":"condylar ridge that's present at"},{"speaker":"Chris Dy","startTime":1744.53,"endTime":1748.28,"body":"the base of the middle failing."},{"speaker":"Chris Dy","startTime":1748.28,"endTime":1751.37,"body":"So you essentially, look at your"},{"speaker":"Chris Dy","startTime":1748.28,"endTime":1751.37,"body":"defect that you have if you have"},{"speaker":"Chris Dy","startTime":1751.37,"endTime":1756.11,"body":"an irreparable base of middle"},{"speaker":"Chris Dy","startTime":1751.37,"endTime":1756.11,"body":"phalanx fracture, look at your"},{"speaker":"Chris Dy","startTime":1756.11,"endTime":1759.62,"body":"defect, go look at your me hand"},{"speaker":"Chris Dy","startTime":1756.11,"endTime":1759.62,"body":"or your handmade harvest a"},{"speaker":"Chris Dy","startTime":1759.62,"endTime":1762.53,"body":"portion of the handmade with a"},{"speaker":"Chris Dy","startTime":1759.62,"endTime":1762.53,"body":"saw kind of chiseling it out and"},{"speaker":"Chris Dy","startTime":1762.53,"endTime":1766.61,"body":"then bring it on to your to your"},{"speaker":"Chris Dy","startTime":1762.53,"endTime":1766.61,"body":"middle phalanx and then using"},{"speaker":"Chris Dy","startTime":1766.61,"endTime":1770.57,"body":"that to recreate that concavity"},{"speaker":"Chris Dy","startTime":1766.61,"endTime":1770.57,"body":"and that lip of the base of the"},{"speaker":"Chris Dy","startTime":1770.57,"endTime":1771.44,"body":"middle phalanx."},{"speaker":"Charles A. Goldfarb","startTime":1772.369,"endTime":1774.829,"body":"Yeah, well"},{"speaker":"Charles A. Goldfarb","startTime":1772.369,"endTime":1774.829,"body":"said and hopefully the listeners"},{"speaker":"Charles A. Goldfarb","startTime":1774.829,"endTime":1777.259,"body":"can visualize that they are not"},{"speaker":"Charles A. Goldfarb","startTime":1774.829,"endTime":1777.259,"body":"already familiar with the"},{"speaker":"Charles A. Goldfarb","startTime":1777.259,"endTime":1781.669,"body":"technique. It can be a game"},{"speaker":"Charles A. Goldfarb","startTime":1777.259,"endTime":1781.669,"body":"changer, I mean, it can salvage"},{"speaker":"Charles A. Goldfarb","startTime":1781.669,"endTime":1785.419,"body":"that tip joint, you know, when I"},{"speaker":"Charles A. Goldfarb","startTime":1781.669,"endTime":1785.419,"body":"have not always had great"},{"speaker":"Charles A. Goldfarb","startTime":1785.419,"endTime":1789.499,"body":"outcomes, and I think sometimes"},{"speaker":"Charles A. Goldfarb","startTime":1785.419,"endTime":1789.499,"body":"arthritis can set in more"},{"speaker":"Charles A. Goldfarb","startTime":1789.499,"endTime":1792.049,"body":"quickly than we might expect and"},{"speaker":"Charles A. Goldfarb","startTime":1789.499,"endTime":1792.049,"body":"the head of the proximal phalanx"},{"speaker":"Charles A. Goldfarb","startTime":1792.049,"endTime":1796.309,"body":"might not be as good as we hope"},{"speaker":"Charles A. Goldfarb","startTime":1792.049,"endTime":1796.309,"body":"that can be one limitation. And,"},{"speaker":"Charles A. Goldfarb","startTime":1796.549,"endTime":1800.479,"body":"again, as you said, the"},{"speaker":"Charles A. Goldfarb","startTime":1796.549,"endTime":1800.479,"body":"carpentry matters but In the"},{"speaker":"Charles A. Goldfarb","startTime":1800.479,"endTime":1803.179,"body":"right setting, you can take a"},{"speaker":"Charles A. Goldfarb","startTime":1800.479,"endTime":1803.179,"body":"finger, that's not really"},{"speaker":"Charles A. Goldfarb","startTime":1803.179,"endTime":1806.869,"body":"salvageable. And you can get a"},{"speaker":"Charles A. Goldfarb","startTime":1803.179,"endTime":1806.869,"body":"great long term outcome."}]}