0:10

Welcome to the

0:10

upper hand, where Chuck and

0:13

Chris talk hand surgery.

0:14

We are two hand surgeons at Washington University in St. Louis here to

0:16

talk about all aspects of hand

0:19

surgery from technical to personal.

0:22

Thank you for

0:22

subscribing wherever you get

0:24

your podcasts.

0:25

And be sure to leave a

0:25

review that helps us get the

0:27

word out.

0:28

Oh, hey, Chris.

0:30

Hey Chuck, how are you?

0:31

I'm fantastic. How are you?

0:33

I am well, it's a it's

0:33

a nice Sunday here in St. Louis.

0:37

You know, have had a nice full

0:37

day so far. Had a little washed

0:41

out in the morning with our

0:41

fantastic fellow Elizabeth Wall,

0:46

who, oddly enough, she did

0:46

mention how you mentioned your

0:51

fellow by name. And I have not

0:51

yet mentioned my fellow by name,

0:56

probably rotating, so. Elspeth

0:56

got a shout out last time

0:59

Harrison has gotten a shout out

0:59

before and of course, last but

1:03

not least Dr. Elizabeth Wall.

1:03

Welcome to our fellowship.

1:06

Well done.

1:06

Yeah, podcast jealousy. Who knew

1:10

who knew there was such a thing?

1:11

Oh, but it's good. It's a good day in the house. I've got this wonderful pork

1:13

shoulder roasting in the oven.

1:16

I'm very excited to bite into

1:16

that later. And it's kind of how

1:20

I build my Sundays now is around

1:20

food. So

1:22

That is one

1:22

thing I will never, that'll

1:25

never come out of my mouth. I've

1:25

got a wonderful, wonderful pork

1:28

shoulder roasting in the oven.

1:32

Well, you were kind

1:32

enough to come by the house

1:35

yesterday. So you know, you saw

1:35

our kitchen and everything. And

1:40

you did mention that you are

1:40

always pushing for, you know, a

1:42

bigger range.

1:44

It's funny

1:44

because Chris now lives within

1:47

walking distance. To me, it's

1:47

not the shortest walks. But it's

1:50

also not the longest, I don't

1:50

know how much maybe half mile or

1:53

something. And so Talia and I

1:53

walked over and my wife was

1:56

completely completely humiliated

1:56

by me. Once again, I had a bunch

1:59

of stuff added bring over to

1:59

Chris and a housewarming gift.

2:02

And so I had a backpack and all

2:02

this stuff. And I was carrying

2:05

this plant. It was she wanted to

2:05

get off the main roads as

2:08

quickly as possible. But we were

2:08

we love your new home.

2:11

Congratulations. And then you're

2:11

gonna have many happy years in

2:13

it.

2:14

Thank you. I'm

2:14

currently sitting in the

2:16

basement in the gym, because it

2:16

is the closest to the internet

2:20

router. So I am doing my

2:20

absolute best to improve the

2:24

quality on my end.

2:25

It is working.

2:25

So two things about the about

2:28

generally about the pod. The

2:28

first is and you you throw this

2:31

out there on Twitter, we haven't

2:31

we have some new swag out there.

2:36

Yes, absolutely. You

2:36

mentioned it at the end of last

2:38

week's episode. But for those of

2:38

you that are wondering what the

2:42

swag is, it's essentially some

2:42

croakies that you could use for

2:46

your loupes or your glasses or

2:46

sunglasses to hang them around

2:50

your neck. And I remember always

2:50

trying to find the right pair of

2:53

croakies for for my loupes. When

2:53

I was starting out and I finally

2:57

switched them. I did my first

2:57

case today with the new upper

3:00

hand croakies. And if you catch

3:00

me at the ASSH meeting in San

3:04

Francisco, or at the ASHT

3:04

meeting here in St. Louis, I

3:09

will have a bunch of them in my

3:09

bag and I am looking forward to

3:12

giving them away.

3:13

I love it

3:13

Chris is gonna be like the most

3:15

popular person at the meetings,

3:15

handing out swag cuz there's

3:19

nothing much swag to be gotten

3:19

anymore at these meetings.

3:21

There's I'm just gonna start throwing it from the podium. It's gonna be awesome.

3:23

But speaking of the ASSH

3:26

meeting, I just had a very brief

3:26

text conversation with our

3:31

sometime guests, longtime

3:31

listener and of course, friend,

3:33

Sam Moghtaderi over in

3:33

Washington, DC. And he told me

3:38

that he listened to the episode

3:38

and he is on the fence now about

3:42

coming to the meeting in person.

3:42

He still obviously has to, you

3:45

know, make some logistical

3:45

arrangements. And yeah, for a

3:49

lot of us the COVID concerns

3:49

linger. But he's now thinking

3:53

about it based on the stellar

3:53

job that that Amy and John did

3:57

last week of telling us how

3:57

great the meeting is going to

3:59

be.

4:00

Hey, if one

4:00

person who wasn't going to be

4:02

there comes that I will consider

4:02

that podcast a success.

4:06

And one more thing he

4:06

did mentioned before the episode

4:09

even ended, he ordered a Maui

4:09

Jim sunglass case to put his two

4:14

five loupes in based on some

4:14

sage wisdom that he received.

4:19

That is awesome. The other thing we're working on the podcast is maybe

4:21

a little premature, but hey,

4:24

it's coming. Chris and I have

4:24

gotten questions about some type

4:28

of more, I guess, more formal or

4:28

more structured communication.

4:34

So we're thinking about an email

4:34

newsletter, which would be

4:38

infrequent maybe once a month,

4:38

we're going to try it with just

4:41

important information whether it

4:41

would be Chris and I's favorite

4:44

journal articles, what's

4:44

happening in the world of hand

4:47

surgery. Opinion opinions for

4:47

sure because we're full of them.

4:52

But we if you look at the if you

4:52

look in the show notes for

4:56

episodes going forward, there'll

4:56

be a link to sign up for the

4:58

newsletter or if you Just want

4:58

to reach out to us on any of our

5:02

platforms and share your email

5:02

address, we will include you.

5:05

And we'd love to have you join us.

5:07

And this note

5:07

[email protected]. We would

5:11

love to hear from you get on the

5:11

list and then also send in

5:14

questions. Remember, Chuck will

5:14

literally answer anything that

5:16

you asked him on on air. And I

5:16

will surprise him with it

5:20

because I checked the email

5:20

address more than he does.

5:23

Yeah, way more

5:23

than I do. That is true. I have

5:25

a case. Can I share a case?

5:27

Sure.

5:28

All right, this is one, you know, I have this, I have this thing where I

5:30

really try to be good about

5:33

taking pictures. And when I

5:33

don't do it, and it was

5:37

something that should have been

5:37

photographed. It literally kills

5:39

me It drives me crazy after

5:39

separate the whole case and for

5:42

several days later. But we had a

5:42

super interesting case that I

5:45

did with Dr. Elspeth Hill, the

5:45

and fellow and it was a gunshot

5:51

wound. They were the entry was

5:51

near the pisiform. And the exit

5:58

was dorsally through the thumb

5:58

metacarpal. And it was pretty

6:05

impressive. In the exit wound

6:05

was large The metacarpal was

6:09

destroyed, the trapezium was

6:09

injured and the exam

6:13

preoperatively was not very

6:13

helpful. And so we'd like to to

6:17

proceed to the operating room to

6:17

do an acute carpal tunnel

6:19

release because of the concerns

6:19

of numbness into explore both

6:22

the distal ulnar tunnel and the

6:22

median nerve. So we get to the

6:28

or we open things up and the

6:28

ulnar artery was clotted, but

6:34

there was good blood flow to the

6:34

finger. So we weren't overly

6:36

concerned by that the ulnar

6:36

nerve was intact. And the median

6:41

nerve was 90%. Lacerated is the

6:41

wrong word, but 90% not in

6:48

continuity. And then we dealt

6:48

with a metacarpal. My question

6:53

to you Dr. Dy as a nerve expert

6:53

is what do you do now we have a

6:57

patient who is a victim of

6:57

violence. who, you know, I don't

7:03

I don't like to make assumptions

7:03

about who will or who will not

7:05

come back to the office. But I'm

7:05

not sure if this person could be

7:09

counted on for long term follow

7:09

up. What do you do in the OR

7:13

that day before I tell you what we did?

7:15

So you said the ulnar

7:15

nerve is structurally intact you

7:18

don't know about a concussive

7:18

type injury. As we've mentioned,

7:21

on the prior episode, you know,

7:21

the different kinds of injuries

7:24

you can have to a nerve. So I

7:24

would not do anything else for

7:27

the ulnar nerve other than a

7:27

comprehensive release of the

7:30

distal ulnar tunnel, the

7:30

hypothenar fascia for zone two,

7:34

it's interesting what you could

7:34

do for the median nerve at that

7:37

level. So I'm assuming your 90%

7:37

transection of the nerve is at

7:41

the level of the carpal tunnel?

7:43

It is in the

7:43

middle of the carpal tunnel, and

7:45

there is no evidence visually,

7:45

both by loop and microscope of a

7:53

visual zone of injury on either

7:53

side of the discontinuity.

7:58

And you're there

7:58

within 24, 48, 72 hours of the

8:03

injury?

8:03

For sure, probably 18 hours of the injury, you know, the next morning, we

8:05

got time and took them the OR.

8:07

So, I think old

8:07

school, you close and you call

8:09

So I'm going to flip it around.

8:09

Now that I've exposed myself and

8:11

it a day and you have them come

8:11

back to the office, you know two

8:14

weeks later and plan for going

8:14

to the OR after the zone of

8:17

injury on the nerve has

8:17

theoretically declared itself

8:20

within probably three or four

8:20

weeks and then you proceed with

8:22

nerve grafting. I think that it

8:22

would be acceptable to me if you

8:27

had consented the patient for an

8:27

autograft which you may or may

8:31

not have to proceed with an

8:31

autograft. And what I would

8:34

probably do is try to isolate if

8:34

I could, where the recurrent

8:39

motor branch had come off of the

8:39

median nerve. Now it sounds lik

8:42

that'd be really hard jus

8:42

because of the location in whic

8:46

your transection is it'

8:46

probably right where you know

8:50

most recurrent motor branche

8:50

are coming off. But you coul

8:57

tease apart the recurrent moto

8:57

branch if you can still see i

8:59

going to the thenars and th

8:59

n graft preferentially into th

9:02

t really funnel things into th

9:02

re. After going back being a li

9:06

tle more aggressive on your zo

9:06

e of injury, or you know, yo

9:10

r resection proximally I don

9:10

t know if that all makes sen

9:13

e. And then after that, I mea

9:13

, I think that you could if you

9:16

visually saw an area of tra

9:16

sition resect back a little mor

9:20

and go for the go for the com

9:20

lete grafting at time zero. Now

9:24

hat's wading into contr

9:24

versy. And I think there are a

9:26

lot of people who would say N

9:26

way, why would you do that?

9:36

say, Well, why so we did not

9:36

have consent for an autograft?

9:40

We talked about allograft but

9:40

decided that an allograft was

9:43

not appropriate in this

9:43

situation. And so why would you

9:49

not what do you have to lose?

9:49

What does the patient have to

9:51

lose by a resection of a

9:51

presumed zone of injury and

9:56

repair if it's able to be

9:56

primarily repaired?

9:59

No, I like it. I guess I hadn't

9:59

mentioned that or thought about

10:02

that, because I had assumed that

10:02

the zone of injury was

10:05

relatively wide. And you

10:05

wouldn't be able to get it

10:07

together primarily without

10:07

tension. But I've actually done

10:10

that with all nerves at the same

10:10

level. And there's you know,

10:16

there's some case series out

10:16

there about ulnar nerve injuries

10:19

from distal both bone forearm

10:19

fractures with the ulnar nerve

10:23

being injured in the distal

10:23

forearm kind of just proximal to

10:25

the wrist crease. And I have

10:25

primarily repaired those because

10:29

of that very reliable

10:29

topographical relationship of

10:32

the motor and sensory

10:32

components. I've repaired them

10:35

primarily. And I will admit, I

10:35

have flexed the wrist in order

10:38

to get that to you know it to

10:38

come together. But then I will

10:43

check it with the wrist of

10:43

neutral to make sure it's not

10:46

gapping. And I'm comfortable

10:46

with it, it's a very fine line.

10:49

And I think you'll find many old

10:49

school surgeons who would shake

10:52

their heads at that. But then

10:52

that the key there is in making

10:57

sure that you keep the wrist

10:57

flexed, and the dorsal blocking

11:00

splint of sorts, and then

11:00

gradually, progressively bring

11:05

the wrist out into a more

11:05

neutral and then eventually

11:08

slightly extended posture. And

11:08

the way I've done that in the

11:11

past is to monitor it with

11:11

ultrasound. So obviously it

11:14

takes the right patient because

11:14

the ability to come in for those

11:17

kinds of serial monitoring exams

11:17

can be a little challenging.

11:22

I love

11:22

everything you said. I have a

11:24

comment and a question. My

11:24

comment is, it's nice. Well, let

11:29

me just back up for historical

11:29

reasons. You know, it used to be

11:33

that in orthopedics, we would

11:33

treat patients with a wrist

11:36

flexed posture for certain

11:36

fractures, that I think is the

11:39

so called cotton loader position

11:39

distal radius fractures, which

11:43

is a really effective technique

11:43

to obtain a distal radius

11:46

reduction. But it doesn't work

11:46

out well in the end, because of

11:50

the increased pressures inside

11:50

the carpal tunnel with extreme

11:53

wrist flexion or extension. So

11:53

we don't do that anymore. But in

11:56

this case, we've released the

11:56

carpal tunnel. So we're not so

12:01

worried about the pressures. And

12:01

so we were quite comfortable

12:04

with flexing the wrist to

12:04

minimize the tension. My

12:09

question is, is there any role

12:09

for a slightly larger suture to

12:14

detention, the repair of 5-0, or

12:14

something like that epineurial

12:19

stitch crossing over to

12:19

de-tension a bit on the repair

12:23

site? Is that something you'd

12:23

have done or advocate for or

12:27

against?

12:28

I haven't done I

12:28

wouldn't advocate for it. I know

12:31

that there have been some groups

12:31

that have tried to study it,

12:34

including our own Dr. David

12:34

Brogan, using not that exact

12:38

technique, but looking at ways

12:38

to splinter repair, and the

12:41

experiments never quite got off

12:41

the ground. You know, at the end

12:45

of the day, if you don't have

12:45

tension on your repair, then you

12:48

should be in good shape if it

12:48

kind of depends on the caliber

12:52

of suture that you were to use.

12:52

So an 8-0 nylon suture, which

12:55

you know, classically in the

12:55

literature, we talk about the

12:57

8-0, nylon test? There's a

12:57

really nice paper, I think it

13:00

was from Jeff Greenberg's group

13:00

that looked at the

13:02

characteristics of 8-0, nylon

13:02

versus 9-0, nylon versus the

13:06

relative normal strain and a

13:06

nerve. 8-0, nylon, you can get

13:09

away with having a little more

13:09

attention than the native

13:12

tension in a nerve occasionally,

13:12

whereas a 9-0, nylon will not

13:17

let you do that. So for me, if

13:17

it comes together with a 9-0,

13:20

nylon, I feel comfortable

13:20

knowing that it's not going to

13:24

be under excessive tension

13:24

provided that the wrist doesn't

13:26

get fully extended violently.

13:26

8-0 nylon is still kind of

13:31

wonder. So I guess the question

13:31

about you know, whether what

13:34

caliber suture to use for your

13:34

cooptation is probably different

13:37

than what you're describing

13:37

about using a de-tensioning

13:42

stitch. I haven't don't have any

13:42

experience with that. And

13:44

actually, Elspeth I think has

13:44

asked me about that before when

13:46

we were having one of our

13:46

sessions and I told her, I was

13:49

not an advocate for it.

13:50

Yeah, she may

13:50

try to bend your ear a little

13:53

bit on that technique. So bottom

13:53

line is relatively small caliber

13:58

bullet, relatively narrow area

13:58

of discontinuity with visual

14:05

injury, not that huge. So we

14:05

excise the what we consider the

14:11

injured segment, and then a

14:11

little bit more. And we were

14:15

able to primarily we approximate

14:15

without a de-tensioning suture,

14:19

but we added a detension suture

14:19

and we flexed the wrist. And you

14:22

know, my opinion here is we

14:22

didn't lose anything. If he does

14:26

not get recovery, we can come

14:26

back and graft, if he gets

14:29

recovery. We're all going to be happy. We approached it this way.

14:32

So you removed the 10%

14:32

that was intact, right?

14:36

Structurally intact.

14:37

We did and it

14:37

was a it was a very posterior

14:39

and ulnar 10% which didn't worry

14:39

me much.

14:44

Now, how do you know.

14:44

How do you judge taking a little

14:48

bit more than the visually

14:48

injured zone segment? Like

14:52

what's the what's the.

14:53

Yeah, well,

14:53

this is a classic paper that's

14:55

not been written yet Dr. Dy. We

14:55

use two millimeters more than

14:58

the injured visibles segment on

14:58

each side.

15:01

That said with such

15:01

confidence, you know wonderful I

15:05

can't wait to read that paper

15:05

when it's finally written. And

15:08

then we'll call it then we'll call it a classic there's there's Chuck Goldfarb again a

15:10

workman just hammering nails.

15:13

That's right

15:13

in my in my chosen field of

15:15

nerve repair.

15:17

Did you voluntarily

15:17

present a nerve case? That's

15:19

amazing.

15:20

I knew you'd be excited about it. That's another reason I was frustrated.

15:21

I didn't have a picture.

15:24

I love it. I love it.

15:24

Well, why don't we jump into

15:27

this week's topic, apropos to

15:27

our theme last week of the ASSH

15:31

annual meeting, I actually got a

15:31

couple of emails from the HBR,

15:36

the Harvard Business Review

15:36

listserv that talked about how

15:39

to give a great presentation.

15:39

And there were two, I think,

15:41

really good articles in that

15:41

set. One was from January 6

15:48

2020, by Carmine Gallo called

15:48

what it takes to give a great

15:53

presentation. And the other one

15:53

is actually a little bit older.

15:55

It's from how to give a killer

15:55

presentation by Chris Anderson,

15:58

which is June 2013. And I like

15:58

the the Gallo went a little bit

16:03

more just because it gives you

16:03

breaks down very easily, but how

16:07

to give a great talk. And it was

16:07

top of the mind for me, because

16:10

I feel like we're getting closer

16:10

to normal. Although we're also

16:13

really hesitant about Delta,

16:13

I've, I'm going to be giving a

16:17

couple of talks at the ORS, ORIF

16:17

clinician scientist development

16:21

program this week, then I've got

16:21

the hand society a couple weeks

16:24

later, as do you with some

16:24

presentations. And we have the

16:27

ASHT meeting the week after

16:27

that. So I'm in talk mode. And

16:30

then I also just get grand

16:30

rounds for our department a few

16:33

weeks back. So all this has been

16:33

top of the mind for me in terms

16:36

of thinking about how to sharpen

16:36

my presentation skills.

16:39

You know, it's

16:39

something that I always am

16:41

interested in reading about. One

16:41

of the things I struggle with

16:44

are these type of discussions

16:44

are tough, because it's really,

16:47

they're really not discussions

16:47

about medical presentations. And

16:51

so there's there's certainly

16:51

takeaway messages that are

16:54

important. But it's not as if

16:54

you can give a talk like they

16:57

described or perhaps like Steve

16:57

Jobs used to give, because we

17:00

have, we have to do things

17:00

somewhat differently. But we

17:03

absolutely can learn from these

17:03

type of discussions. And I will

17:06

say that Chris Anderson, I think

17:06

is one of my favorite thinkers.

17:10

You know, he Chris was the I'm

17:10

on a first name basis with him,

17:13

apparently, was the prior editor

17:13

of Wired Magazine, which I know,

17:18

you know, is one of my

17:18

favorites. And he wrote the

17:21

concept of the long tail, which

17:21

I think we've talked about in

17:25

this forum. If we haven't, we

17:25

will one day. And I think he

17:29

really, really, really did a

17:29

great job in this article as

17:32

well.

17:33

But let's jump into

17:33

one of the articles. And they

17:37

The first tip that they give is

17:37

great presenters use fewer

17:43

slides and fewer words. Now

17:43

we'll talk about this a little

17:47

bit when we gave, we had a

17:47

podcast episode about virtual

17:50

talks. But it's a your your just

17:50

talks in general. I mean, how do

17:54

you construct your slides,

17:54

because I remember towards the

17:58

end of his teaching career, Dr.

17:58

Gelberman, giving talks and just

18:02

being mesmerized by the quality

18:02

of the pictures he would have in

18:06

his talks. Now granted, the

18:06

department had a photographer at

18:09

that point, which enabled it.

18:09

But I thought those were

18:14

incredibly powerful slides.

18:16

Yeah, I think we should be clear, you know, if you are giving a scientific

18:18

presentation, a five minute

18:22

podium, talk about your

18:22

research, that's different. If

18:25

you're giving a bigger picture

18:25

discussion on nerves, or

18:28

congenital or sports or

18:28

whatever, I think you can do a

18:32

little more, you can work with

18:32

these techniques a little more,

18:35

and there is no doubt that Dr.

18:35

Gelberman as his career

18:38

advanced, use fewer words, fewer

18:38

bullet points, nice visuals, and

18:43

more talking. But let's be

18:43

honest, that requires a lot more

18:47

preparation, you know, none of

18:47

us, I would hope would go up

18:50

there read the bullet points,

18:50

because we know that's just just

18:52

not that helpful, but sometimes

18:52

require bullet points. And I

18:57

just recorded a presentation for

18:57

the hand society. And I didn't

19:02

want to use bullet points. But I

19:02

found that it was just it

19:04

doesn't convey the message when

19:04

you're kind of working through

19:06

research without them. And so I

19:06

love this concept. fewer words,

19:12

more pictures, more verbal, I

19:12

guess depth to each slide.

19:17

You know, I think that

19:17

your point is is right on about

19:20

you know, two to five minutes

19:20

scientific paper presentation

19:24

has to be very tightly scripted.

19:24

Not that you're reading off of

19:28

off of the slides. But it has to

19:28

be tied to scripts. It has to be

19:31

formatted in a certain way. It

19:31

can't be the beautiful. Here's a

19:33

picture of a nerve kind of talk.

19:33

I actually just met with one of

19:37

our one of our former students

19:37

that I've been working with who

19:40

is now a resident at SLU Alexa

19:40

Powers and she's giving a talk

19:44

at the resident fellows meeting

19:44

in a couple of weeks right

19:47

before the hands society.

19:47

They've got two minutes. So I

19:51

told her I was like look like

19:51

you've got to be tightly

19:53

scripted. Got to practice it a

19:53

bunch so it doesn't sound like

19:55

you're reading. But there's

19:55

really no room for error because

19:59

you don't want to be that that

19:59

runs over and throws off the

20:02

whole program. I noticed that

20:02

the talks that I gave every year

20:07

in terms of the you know,

20:07

Introduction or overview of

20:10

Plexus or nerve or nerve

20:10

studies, as I've go back every

20:14

year, I take more words out. And

20:14

that's also me becoming more

20:18

comfortable with my ability to

20:18

remember the things to hit on

20:21

the slides. Now, I'll admit, in

20:21

kind of the speaker notes

20:25

section, I will just remove the

20:25

text that was on the slide and

20:27

drop it in there. So I remember

20:27

if I have presenter mode

20:30

available, what points to hit.

20:30

But I think that the point in

20:34

this, you know, that they make

20:34

in here is that, you know,

20:36

people remember pictures more,

20:36

you know, they remember, they

20:42

remember, they remember less

20:42

about the words that you're that

20:46

you're saying and more about

20:46

stories that you're telling and

20:48

the points that you make when a

20:48

picture is on the screen. And I

20:53

you know, the second point is,

20:53

you know, great presenters don't

20:55

use bullet points, I agree with

20:55

you, I think that in our field

20:58

in our world, unless you have a

20:58

picture on the screen, you have

21:01

to use, you have to use some

21:01

bullet points, some kind of

21:03

texts.

21:04

Yep, exactly.

21:04

But I should look, I would never

21:08

consider myself a great orator.

21:08

Hopefully I get my message

21:12

across, it's something I think

21:12

I've gotten better at and

21:16

hopefully will continue to get

21:16

better at, I hope content really

21:19

matters to the audience. But you

21:19

know, you want to make it easy

21:22

on the eyes and easy on the

21:22

ears. And just it's a it's a

21:26

it's really an acquired skill,

21:26

which gets to the third point of

21:30

this Gallo article, which is the

21:30

great presenters enhance their

21:34

vocal delivery. And so you know,

21:34

regardless of the political

21:38

spectrum, I think most would

21:38

agree that Obama was a great is

21:42

a great orator. And I'm never

21:42

going to present like he

21:47

presents. But it practice helps.

21:47

Having a even a non medically

21:54

involved person listening to

21:54

your talks helps. It is a skill

21:58

set, though.

21:59

And this kind of gets into the stuff that's in the Chris Anderson article. But I

22:01

mean, it's connecting, and so

22:03

your, your intonations, and the

22:03

way that you talk, are gonna

22:07

vary if you can connect with

22:07

people in the audience. So so

22:09

one of the suggestions that his

22:09

his article was to find five or

22:12

six people in the audience and

22:12

constantly make eye contact so

22:16

that, you know, you can connect

22:16

with somebody and see that

22:20

they're following along and

22:20

helps you understand when people

22:23

are engaged and not engaged.

22:25

Absolutely,

22:25

absolutely. Well said. Do you

22:29

consciously think about how you

22:29

the tone of your voice, the

22:34

cadence of your delivery, the

22:34

volume of delivery? I mean,

22:38

clearly, for some people, that

22:38

just comes naturally, if it

22:43

doesn't, do you think about

22:43

those things?

22:46

I, I don't know. If it

22:46

came naturally to me, I think I

22:50

worry less about it, I became

22:50

more comfortable speaking in

22:54

public, for whatever reason, I

22:54

think there were things that I

22:57

did growing up in terms of

22:57

activities that helped. I wasn't

23:01

like a debate or anything like

23:01

that. But I did do a lot of like

23:04

Performing Arts, which I think

23:04

helped my ability to feel

23:08

comfortable speaking in public,

23:08

by no means am I an expert, and

23:12

I'm not the orator of the year.

23:12

But I do feel comfortable with

23:16

that. And I'll be honest with

23:16

you, the podcast has helped a

23:19

lot in terms of just being able

23:19

to think on the fly and to talk

23:22

and, and to work through things

23:22

and to remain confident and

23:25

conversational about things. So

23:25

we were talking before about

23:28

benefits of the podcast, that's

23:28

probably one that had thought

23:30

about a lot before. But I do

23:30

feel more comfortable in a lot

23:33

of venues because of just the

23:33

you know, we put ourselves out

23:35

there every week.

23:37

It is it is

23:37

really true. That I think my

23:41

next live symposium where

23:41

there's multiple different

23:45

people giving their opinions, I

23:45

will be so much more comfortable

23:49

than I would have been pre

23:49

podcast. So what Chris and I are

23:51

saying is we hope some of you out there, start your own podcast and jump into the game

23:53

we were not afraid of

23:56

competition. The more the

23:56

merrier. We're kind of like Elon

23:59

Musk, you know, if you want to

23:59

build a electric car go right

24:01

ahead. But I don't know if

24:01

you're gonna overtake the Tesla

24:04

here.

24:05

Are you bragging right now Chuck?

24:08

Definitely

24:08

not. We want you out there. We

24:11

want more people in this space.

24:13

So they it one of the

24:13

last points in the Gallo article

24:16

is about rehearsing. And I admit

24:16

I do not rehearse as much as I

24:22

should. But I you know, for

24:22

example, the Grand Rounds I was

24:26

asked to give for our department

24:26

I practiced that one. Because

24:30

that talk meant a lot more to me

24:30

than many other of the

24:34

presentations that you know,

24:34

I've given recently. So I do

24:39

think that rehearsing helps. We

24:39

don't always put in the time I

24:42

tend to kind of take my

24:42

rehearsing time and really just

24:46

refine my slides and think to

24:46

myself what I'm going to say,

24:49

but sometimes it is super

24:49

important to time yourself and

24:52

just to get the words out to

24:52

know the right things to say at

24:57

the right moments.

24:58

Well, I think

24:58

is a really The important point

25:01

and Gallo cites Martin Luther

25:01

King Jr., who comes across as

25:05

one of those spontaneous

25:05

speakers that could say anything

25:08

and make it sound beautiful. But

25:08

there was much practice that was

25:11

behind that I Have a Dream

25:11

speech, etc. I'll tell you my

25:15

personal story of when I learned

25:15

to practice to focus my

25:19

delivery. And if there's any of

25:19

our current residents listening,

25:23

hopefully, a touch of this will

25:23

resonate. But when I was so when

25:27

I was a fourth year and a fifth

25:27

year resident, I was fortunate

25:31

enough to do the hand rotation,

25:31

by a fluke of need in the in the

25:34

department, I volunteered to do

25:34

it twice. And that was back in

25:37

the day, there was a little more

25:37

heat and a little more

25:40

expectation for our anatomy

25:40

sessions. And it was a 100% from

25:45

memory, and had better be Word

25:45

Perfect. And I spent hours

25:50

preparing each of those. And

25:50

they were, every week, we had an

25:54

we had an anatomy session. And I

25:54

practiced and practice in the

25:59

shower in front of my wife, I

25:59

mean, not in a shower and in

26:02

front of my wife, but in the

26:02

shower, or my wife. I was

26:05

constantly practicing, it was

26:05

something and I got better.

26:10

Well, I mean, I think

26:10

that, you know, when, when the

26:13

stakes are high, you know, I've

26:13

we've talked a little bit about

26:16

my feelings about the

26:16

fellowship, and I got the much

26:20

softer end of things. And when,

26:20

when you're in training, the

26:24

stakes, right, the expectations

26:24

are high. And you don't want to

26:27

you don't want to get it wrong.

26:27

And I remember even as a fellow

26:31

here watching the residents give

26:31

what I call it that point their

26:34

recital, you could tell the ones

26:34

that had put in the time, and

26:38

honestly, at the end of the day,

26:38

I'm sure that they learn the

26:41

material quite well. The next

26:41

step is then learning why it's

26:44

important to memorize those

26:44

things and recite them in a

26:46

certain way. I should say that

26:46

along the way, in my residency

26:51

training, one of the

26:51

expectations was to give a lot

26:54

of presentations, whether that

26:54

was something as routine as

26:57

indications conference, but also

26:57

giving indications without also

27:00

giving say like a 15 minute talk

27:00

on a random topic. And it was

27:05

usually the paid service that

27:05

was the most notorious for

27:08

making you give a talk and it

27:08

was painful at the time. But it

27:11

was super, super helpful because

27:11

you learn how to synthesize

27:13

information, you learn how to

27:13

make slides. And oftentimes,

27:17

like for example, on on our

27:17

trauma service, you would have

27:19

to do kind of the the cases, you

27:19

know, the pre op post Ops, but

27:23

then there was also like a 45

27:23

minute lecture that you had to

27:25

give every month in which you

27:25

truly learned a topic, well

27:29

figured out how you operate as a

27:29

as a speaker, which I think you

27:33

know, was probably not the

27:33

intention of the rotation. But

27:37

it was a certainly a nice benefit.

27:39

I think what

27:39

you said is very true. And I

27:41

think that is really an

27:41

important lesson for all the

27:43

trainees that, yes, these are

27:43

asks in a training program or in

27:47

a fellowship program. But you

27:47

will get benefit from each of

27:51

these efforts in knowledge, in

27:51

skills. And we had to give in my

27:56

fellowship, we had to give a

27:56

presentation every week. And so

28:00

we put together a PowerPoint for

28:00

a presentation every week. And

28:03

yes, it was torture, but it is

28:03

much better. PowerPoint

28:07

presentation builder, much

28:07

faster, much more efficient, and

28:10

can really put things together

28:10

quickly, which has served me

28:12

well for many years. And so

28:12

there's a lot of good to come

28:15

out of it. You want to switch

28:15

over to the Anderson article.

28:20

Sure, yeah, I think we've kind of been sprinkling in some of the Anderson stuff along

28:21

the way. I mean, I think the

28:24

biggest thing I took away from

28:24

the Anderson article is

28:26

something that I've learned

28:26

along the way, in my short

28:30

career is to tell a story. You

28:30

know, and it's it's, you know,

28:34

good talk will make people

28:34

think, and you don't necessarily

28:38

need to have them come to the

28:38

conclusions and that you have

28:41

intended. But telling a story

28:41

will will will allow you to take

28:47

them on the journey. You know,

28:47

if you do it right, it can show

28:51

them kind of why you are for

28:51

example, like I gave the talk on

28:55

brachial plexus and the work

28:55

that we've done. And the first

28:58

portion of that talk was mainly

28:58

about kind of showing a case,

29:03

showing something that I thought

29:03

was an amazing technical

29:05

outcome, and then showing how

29:05

the patient really didn't like

29:08

it, and then launching that

29:08

using that as a segue into kind

29:11

of why we're studying what we're

29:11

studying in our you know,

29:15

brachial plexus clinical

29:15

research lab. And I think that,

29:19

you know, people were able to

29:19

follow along with that I got a

29:21

couple of notes from a lot of

29:21

people that I respect, kind of

29:24

saying how that story worked out

29:24

really well. And I had not

29:28

really used the story a whole

29:28

lot in many presentations. So I

29:32

don't know how often you know,

29:32

you have the opportunity to do

29:35

that with a longer kind of talk

29:35

but it certainly captures

29:38

people's attention and engages

29:38

them a lot more.

29:42

Yeah, all well. First of all, I don't know if I said to you directly, but

29:43

your talk was spectacular. And

29:46

you really achieved your goal of

29:46

telling a story about your

29:49

research while imparting really

29:49

important lessons and so it was

29:53

really really well done. I don't

29:53

know if we I don't know if

29:55

that's on YouTube, but we you

29:55

would. People would love that

29:58

and then certainly there's

29:58

different venues That's another

30:00

story. I think it's harder to do

30:00

over zoom. It's harder to

30:04

connect with your audience. But

30:04

really with it again, not a

30:09

scientific presentation, not

30:09

even some of this symposium type

30:12

presentations, different kinds

30:12

of presentation, to tell, tell a

30:16

story, tell your story. It's

30:16

just an opportunity. I love what

30:20

Anderson said about nerves, no

30:20

matter how good you are at this

30:25

tokay to have nerves, because in

30:25

some ways, it does help you is

30:29

one example of something that

30:29

helps connect you to your

30:31

audience.

30:32

We talked a little bit

30:32

about the Amy Cuddy in the

30:35

episode about the ASHT, upcoming

30:35

meeting and the power posing.

30:40

You know, I think whatever it

30:40

takes for you to feel confident,

30:43

and to manage your own nerves,

30:43

you got to do it. And that's

30:46

different for everybody. But I

30:46

think part of it is

30:49

acknowledging the fact that you're going to be nervous and channel that energy into

30:51

something that'll be productive.

30:54

And unfortunately, it tends to

30:54

be a bit of a trial and error,

30:57

kind of situation.

30:59

Yeah,

30:59

absolutely. Right. I think one

31:02

of the, you know, this is a

31:02

little cliche, and maybe a

31:05

little, not in our field, but I

31:05

love the quote, which reads, a

31:10

successful talk is a little

31:10

miracle people see the world

31:13

differently afterward, which is

31:13

really powerful. And again, he

31:17

was you had many goals in the

31:17

talk that you gave to our

31:20

department. And but part of it

31:20

certainly was telling your

31:23

story. But part of it, I hope,

31:23

and assume was to potentially

31:27

inspire our trainee to see a

31:27

problem, and how to tackle it

31:31

from different angles. And so

31:31

that has just great potential to

31:35

make medicine better, and give

31:35

the residents a little

31:39

something. And so while it's a

31:39

little cliche for our world, it

31:42

can absolutely be true.

31:44

I'm working on getting

31:44

that talk up to YouTube, I have

31:48

to find a way to blur out the

31:48

patient face that's on there,

31:51

who, you know, he gave us

31:51

permission to use it locally.

31:54

But before it goes out there, I want to make sure that we're on the up and up with that. But

31:56

yeah, that's you know, I

31:59

remember seeing presentations

31:59

from visiting professors before

32:02

who I got inspired by and you

32:02

know, I listen to a lot of,

32:06

there are a lot of a lot of

32:06

areas in our field in

32:09

orthopedics, plastic surgery,

32:09

hand surgery, neurosurgery,

32:12

nerve surgery, where there are a

32:12

lot of questions that can be

32:16

answered. And all it takes is an

32:16

interesting question. And I

32:19

learned a lot from one of my

32:19

mentors at HSS, Scott Wolfe, who

32:22

was trying to scratch the

32:22

surface on this question about

32:26

how to improve outcomes for

32:26

brachial plexus injury patients.

32:29

And he was kind enough to let me

32:29

run with it. You know, and I

32:32

think some of it is just kind of

32:32

letting the idea grow into being

32:35

your own, you know, seeing it as

32:35

an issue. And I think that if

32:41

there was a trainee that was

32:41

able to pick up on that, and

32:43

think of, you know, well, why don't I approach it this way, maybe that was, you know, a good

32:45

thing for them. And hopefully,

32:49

it resonated so.

32:51

Yeah, and let's be clear, we recognize that many in the audience are

32:53

not going to give big, powerful

32:57

career presentations or anything

32:57

like that. But I would argue

33:00

strongly that if you are

33:00

presenting to the local therapy

33:03

group, or you're presenting to

33:03

high school students, which are

33:07

like, ah, whatever, I'll throw a

33:07

talk together for some high

33:09

school students. But you know,

33:09

what, you may change someone's

33:13

life. And that sounds a little

33:13

corny. But if you're talking

33:16

about your high school students telling you about why you've chosen medicine or hand surgery,

33:18

and what you've been able to

33:21

accomplish, it really is a

33:21

powerful opportunity. So I love

33:25

both of these articles. And they

33:25

were fun to read.

33:29

I mean, to bring it to a close. I mean, I think that, you know, when when we're giving

33:32

presentations on a topic, for

33:35

example, distal radius

33:35

fractures, we all love cases, we

33:38

love cases, more than just, you

33:38

know, cases that will illustrate

33:41

certain points about how to

33:41

evaluate, you know, patients

33:44

radiographs, how to think about

33:44

treatment strategies, as opposed

33:46

to just, you know, here is the

33:46

literature. If you can find a

33:50

way to tie cases, you know,

33:50

together so that you you can

33:55

string together the same points.

33:55

That's a better talk to me. So

33:58

for a lot of times, residents

33:58

will be asked to give a talk on

34:00

say, balloon a for set fractures

34:00

or when to use a door sustaining

34:04

plate, if you can find cases

34:04

that are illustrative that is

34:07

the orthopedic or medical

34:07

version of a story.

34:11

Yeah, that's

34:11

right. And I'll tell you again,

34:13

we should close but I'll tell

34:13

you that when I was a resident,

34:16

we transition from the concept

34:16

of a resident or fellow

34:21

presentation or quote unquote,

34:21

Grand Rounds, which

34:24

traditionally had been a bunch

34:24

of slides which a bunch which

34:27

with a bunch of words, it took

34:27

years for Dr. Gelberman to

34:31

imprint his preference on us.

34:31

That would be case based, and

34:36

have four or five cases on the

34:36

volar lunate facet or some type

34:40

of specialized distal radius

34:40

fracture, it is so much more

34:43

impactful and Gosh, it's true.

34:43

And I like how, what you said

34:47

that that is our surgical world,

34:47

our medical world of the

34:51

powerful presentation.

34:54

Alright, so now everybody's ready to go give a talk or presentation or a case

34:56

series and hope We'll see. You

35:01

guys can share your pointers

35:01

with us and let us know what

35:04

works for you.

35:05

Please do.

35:05

Alright Chris, this was fun.

35:08

See you next week.

35:09

All right.

35:09

Hey, Chris. That was fun. Let's

35:13

do it again real soon.

35:14

Sounds good. Well, be

35:14

sure to check us out on Twitter

35:17

@Handpodcast. Hey, Chuck, what's

35:17

your Twitter handle?

35:19

Mine is

35:19

@congenitalhand. What about you?

35:22

Mine is @ChrisDyMD

35:22

spelled d y. And if you'd like

35:26

to email us, you can reach us at

35:26

hand [email protected].

35:30

And remember,

35:30

please subscribe wherever you

35:32

get your podcast

35:33

and be sure to leave a

35:33

review that helps us get the

35:36

word out.

35:36

Special thanks

35:36

to Peter Martin for the amazing

35:39

music. And remember, keep the

35:39

upper hand. Come back next time.