The Lee Dellon Interview

Season 4, Episode 7.  Chuck and Chris gather in Las Vegas during the AAOS meeting and spend some catching up.  The bulk of this podcast is Chris' interview with Lee Dellon, who has retired and is living in Las Vegas.  Dr. Dellon has done a great deal to advance the field of nerve surgery - authoring numerous publication, training many of today's nerve experts, and helping to establish key nerve related groups.  He shares his thoughts on various nerve topics including cubital tunnel syndrome

https://en.wikipedia.org/wiki/A._Lee_Dellon

Dr Dellon also references a new book: https://www.amazon.com/Prosector-Lee-Dellon-MD/dp/B0B2TBHX4H

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.

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Transcript

Charles Goldfarb: 0:03

Welcome to the Upper Hand Podcast where Chuck and Chris talk Hansard.

Chris Dy: 0:07

We are two hand surgeons at Washington University in St. Louis here to talk about all things hand surgery related from technical to personal.

Charles Goldfarb: 0:15

Please subscribe, wherever you get your podcasts.

Chris Dy: 0:18

And thank you in advance for leaving a review and leaving a rating wherever you get your podcast.

Charles Goldfarb: 0:24

Oh, hey, Chris.

Chris Dy: 0:25

Hey, Chuck, how are you? I'm great. This is we're actually sitting across the table from each other with microphones and everything. It's kind of like it's January 2020.

Charles Goldfarb: 0:33

It is exactly three years today, since the pandemic was declared.

Chris Dy: 0:38

Are you serious? Wow. Okay. All right. Well, you know, so we are in person because we are, of course, meeting in person that takes us a trip to Las Vegas.

Charles Goldfarb: 0:47

It is a little odd is a little odd, but it is nice to see you

Chris Dy: 0:51

there. Well, I agree. And there are a number of times where I've had to go out of town to meet with people that are from St. Louis. So most recently, I met with Dr. MacKinnon when we were both in Miami for the ASPS and just because it was easier. We're not you know, pulled in different directions usually.

Charles Goldfarb: 1:06

Yeah, it is crazy. It is crazy. And speaking of crazy, Vegas is crazy.

Chris Dy: 1:10

He gets this weird. It is it is a weird place. You know, first off, it's, I guess my third day in Vegas now. And I'm finally used to walk in the strip again, trying to figure out like the ins and outs of it because you look at you know, point to point on a map going from point A to point B it should not be maybe a long walk but it shouldn't be that challenging. But rightfully so they have closed a lot of pedestrian intersections. So you have to navigate all these bridges, and you don't always get it right.

Charles Goldfarb: 1:36

No and you know this town for I'm sure many of our listeners know this down. But if you don't know this town, it is designed with one goal in mind for you never to leave your hotel. And from the you know, the murals on the ceiling that make it look like it's light outside. It's really incredible. The number the operational excellence of these massive hotels is mind boggling.

Chris Dy: 2:00

You know, they, they really have it down to a science. They get you to stay where where they want you to stay in. It's amazing how much money they make. I was talking to somebody who lives in Las Vegas, and they're saying even during the pandemic, they made a lot of money. They just made less money.

Charles Goldfarb: 2:15

I can't I can't even relate what I can relate to. And you and I briefly talked about this is because the time change, I got up super early and went and worked out which was delightful. And I jumped on the peloton and I had to ask your experienced advice because I set a PR and I didn't feel that great. What I blew away most of the yarn. I just didn't understand her. All bikes created equal.

Chris Dy: 2:38

Some bikes. Some bikes are rigged. So they're the people that have these bikes, I swear and I've talked to Tony Loggly you're listening. You're you were at Mayo, and we talked about this, I think you're doing you're wrapping up your fellowship now. But we talked about this, there are certain bikes that are rigged that are far from being calibrated correctly. And I'm not saying that I'm like very skilled at that this whole thing, but there's some people that have outputs that are absolutely insane. So yes, I think there are some bikes that are not calibrated properly. And probably the hotel bike isn't calibrated perfectly. But that being said, congrats. You were feeling good. You got a PR, you know, don't you didn't you didn't set out to rig the system, so it's okay,

Charles Goldfarb: 3:15

no, and I got my workout and I'm gonna walk away with positive vibes about my hotel, which maybe that was the goal.

Chris Dy: 3:20

Exactly, exactly. Well, so my hotel unlike when we were in Boston for the association doesn't have the peloton setup but they do have two different gyms. Okay, so they have a gym that's open from 6am to 6pm. And then they have the 24 hour gym, which of course isn't a separate tower. And you have to walk cross the casino floor to get to it. So I'm walking around at 430 in the morning, like that, because of the time difference. And it's just so interesting. You've got a couple of people that are up getting coffee getting ready for the day, probably because they're east coasters. And then you've got people that are still out still having a good time the bar had a few people in it and you know Saygus Yeah, it

Charles Goldfarb: 3:56

is. It is something there were some there are some dancing and celebrating going on in the casino at 5am. And I admire the people who have that kind of endurance. Yes, yes. And money.

Chris Dy: 4:07

Exactly. So you know, Las Vegas has been interesting. I got to spend a an afternoon with Dr. Lee Dellon, who was kind enough to be interviewed for the podcast.

Charles Goldfarb: 4:16

That is incredible. I know Dr. Dellon shared some wisdom and shared some perspective. And I'm guessing he has strong opinions about things which I would welcome and look forward to hearing. Yeah, so

Chris Dy: 4:27

you know, the rest of the episode is going to be going to be focused on on my time with Dr. Dellon. I will say that I hung out with him, you know, for an hour or so before the the interview and it was super interesting, really fun. And then after the interview, he was kind enough to drive me back back to the strip. So I'm in I was sitting in Lee Dellon, You know, blue Thunderbird top down, come to back to the strip. It's unreal. Live in the Vegas dream. But before I introduce Dr. Dellon, we probably should acknowledge our our kind sponsors from practice like

Charles Goldfarb: 4:59

absolute The upper hand is sponsored by practice link.com, the most widely used physician job search and career advancement resource.

Chris Dy: 5:07

Becoming a physician is hard. But finding a job doesn't have to be joined practice link today for free www.practicelink.com/ theupperhand. Excellent.

Charles Goldfarb: 5:18

Lets jump into the interview.

Chris Dy: 5:20

Yes, so I want to introduce Dr. Dellon. He's originally from the Bronx and then found his way to do his undergraduate studies at Johns Hopkins and Baltimore. Some of you may have heard of it, especially the medical school where he did his MD, spent some time in the, in the Public Health Service and did two years of research at the NIH, and he has some great stories about his Primate Research at the NIH. He subsequently was the first fellow at the Curtis National Hand Center, and then went on to complete his plastics residency at Hopkins, and then has been in private practice at the Dellon Peripheral Nerve Institute for quite quite a long time and recently retired. So Lee shared a fantastic set of opinions about a range of topics and also talked about his newest retirement project at the end. So you'll hear a little bit about what surgeons do when they retire.

Charles Goldfarb: 6:12

Looking forward to it. Let's jump in. So

Chris Dy: 6:15

Dr. Dellon, you are you have an incredible legacy in peripheral nerve and you continue to contribute to our literature. One of our most popular topics is something that maybe is a little more mainstream, but I wanted to get your thoughts on how you approach a patient currently with cubital tunnel syndrome.

Lee Dellon: 6:37

Okay, that's a very common problem and enhanced surgery. And when I started doing my hand fellowship, I would of course, see my my teachers that Curtis Hand Center, and they would palpate or tap over the ulnar nerve and the cubital tunnel is the operation they would do was a classic operation where the flexor pronator muscle mass was taken from the bone and then sutured back into place for an anterior so muscular transposition, if the nerve was pretty bad back then very few people were just doing insight to decompressions when I did the hand fellowship, the journal hand had just started. And early in their I think their first or second volume was born wrote his, his paper and prior to that, older nerve compression used to be called Post Traumatic owner, neuritis. And many people that had older nerve problems came because the orthopedic surgeons were not as good in either the elbow dislocations or fractures in and around the elbow. So when people had an older palsy, it was felt to be due to trauma, usually after an injury and usually after orthopedic work. So when I was born, operated on people who had not had trauma, he found this thin band that was going across the ulnar nerve near the medial umur, upper condyle. And in between when he after his writing in that article, which I think was maybe 1970 or 71 in the journal hand, not the Journal of hand surgery, the British Journal, it became called the Osborne's ligament. And he had a classification of degree of how bad the nerve was impaired. And he would insist that even if people had almost no two point discrimination or muscle wasting, he could get a good result by just decompressing the nerve and dividing that ban. But pretty much throughout my training, if people had muscle wasting and no two point discrimination, the nerve was felt to be too far advanced to just release Osbornes bans and the nerve was moved anteriorly. And when I watched my teachers do that operation, they had to bend the wrist down and flex the elbow to really get the flexor pronator muscle mass to in a position where they could reattach it to the bone. And then in the post operative period, they would slowly stretch out the elbow and stretch out the wrist. And to me that just seemed to be not the best way to do that. And so I came up with the idea. Enhanced surgery we know very well about doing Z plastic isn't primarily for tendon lengthening, lengthening and I thought why not lengthen the flexion pronator muscle mass and there was an old operation that was done for the cerebral palsy children where it was a complete flexor pronator muscle slide there was even a CPT code for a muscle slide. So I thought huh, but all the muscles that we are going to lengthen in the flexor pronator muscle mass have secondary origins usually in the interosseous membrane or on the bone. And so I could do the lengthening and the flexor pronator muscle mass itself. and not have a great loss of strength in the patient after surgery. And so I introduced the flexor pronator, or muscles slide, Z plasty lengthening, whichever you'd like to call it, and I made an actual Z. And Susan MacKinnon became our hand fellow in 1981, to 82. And she learned that procedure for me, and she's modified it slightly with the shape of her incision. But that was essentially my excuse me approach. And at the time I did this. People trying to write the results of ulnar nerve surgery, just would lump all owner nerve patients together. And so my paper in 1985 was the first what we would now call a systematic or meta analysis, I took every paper written on the owner nerve, and tried to classify each patient according to the degree of a nerve compression. And even at that time, we just did it to minimal, moderate and severe, the severe course would be the muscle wasting at no two point discrimination. And the minimum one would be um, symptoms without any objective other findings, but all with a positive tonnelle sign. And so I took those older nerve papers, broke each one each patient group down where I could, and then did what today we call a meta analysis that was never called that back then. But you could look at that and then see what to expect from doing an anterior subcutaneous or some muscular or an insight to decompression for minimal, moderate or severe degree. And that was my involvement with that early in my hand surgery career.

Chris Dy: 11:50

That's incredible to hear how that's evolved, because I think so many of us have learned that surgery especially with with Dr. McKinnon's videos and the reach that her education efforts have had, so it's great to hear how that has evolved. One question for you. Do you think that that patient with severe compression with the atrophy and the loss of two point can that can that nerve be salvaged?

Unknown: 12:18

I don't mean to say it this way, but I don't think you meant can the nerve be salvaged?

Chris Dy: 12:21

Okay, can can there be restoration of muscle strength? Or can there be restoration of meaningful sensibility?

Unknown: 12:29

Okay, so a wasted muscle, even if it doesn't regain bulk can regain strength. But it's limited. I'll never be back to what it was. But you can take someone who has a muscle that's wasting that's a year or two with that. And you can get some strength back in it but it but it isn't good. It doesn't ever get back to M fiver and make it back to M three plus or maybe an M four but it's certainly worth doing the decompression

Chris Dy: 13:02

and is your approach to doing a transposition the same now you know if you were to have done this surgery recently

Unknown: 13:10

what I what I did change was I would I want to mention Leonard Goldner who is chief of Orthopedic Surgery at Duke and one of the American Society for Surgery, the hand meetings I gave an instructional course on older nerve surgery, and I talked primarily about the anterior semicircular transposition with the musculo tendon lengthening. And Dr. Goldner got up and said that he never had to do had to do that he would, but when he did have to do it, he would save it for previous failed cases. And I made the point that Dr. Goldner has never forgiven me for bless his name. He got up and said Dr. Goldner, I tried to do the best operation the first time, so that I would do an anterior muscular transposition, which had, it has some more morbidity than an insight to that the patients are often bruised and they have to wait two or three weeks till they can really start to use strengthen their hand. But then you know that every possible compression sign along the course of that nerve has been decompressed. And the way I'm finally modified, my algorithm was the person who was a piano player or guitar string instrument player, or of course a hand surgeon, where the musculotendinous unit and strength and reflexes are so critical to what they do. I would do an insight to decompression if they didn't have loss of two point discrimination or muscle wasting, but I would tell them that there was a 5050 chance they might have to come back for me to move the nerve but I would Do the less invasive operation first.

Chris Dy: 15:03

That's, that's refreshing. Because I think that, you know, this is a popular topic among the people that that listen to us. We have a lot of therapists as well that listen, on top of practicing surgeons and trainees. And that's a continued debate, so to say, You've done an incredible amount of work in your career. And I think one of the latest arcs that you've had is to really look at joint innovation, and its role in our treatment of things like arthritis. Can you speak a little bit about how that evolved over time?

Unknown: 15:32

Yes, but before I answer that, since you mentioned therapists, I think for the person who has really advanced ulnar nerve compression at the elbow, where you're concerned about whether the muscle will come back, you have the same type of argument you can make with regard to the radial nerve, should you do some tendon work in terms of tendon transfers, or, as Dr. McKinnon's group would do the emphasized taking the anterior interosseous nerve and transferring it into the distal owner motor in addition to trying to do the proximal decompression. So you do have that today that we didn't used to be able to do if that's the correct grammatical way to say

Chris Dy: 16:20

is that is that a surgery that you have considered adding to mattereum?

Unknown: 16:24

I have to say I've only done for anterior interosseous nerves distally transferred into the distal owner nerve, and they haven't really worked well in my hands. But I know, Tommy Tong and Susan's group have several published papers about it. And sometimes it does work, but it didn't work very well, in my limited experience. It is

Chris Dy: 16:45

something that is all the rage nowadays. So yes, it we'll see how things shake out over time with that with that transfer.

Unknown: 16:51

Oh, I do want to say, one 110, an operation I invented that is not well understood or well known or popularized, but it's really easy to do for the advanced older nerve patient where the little finger remains abducted, sort of like the Wartenberg sign, you can just make a cut over the extensor mechanism over the MP joint and take the extensor, digitally minimis and move it from the radial. From the there.

Chris Dy: 17:24

I'm filming Lee right now

Unknown: 17:27

the older side of the little finger to the radial side of the little finger. You can just cut the tendon and move it from the older side of the little finger to the radial side of the little finger extensor hood and tape the two fingers together like buddy splinting, and the patient will immediately have that Wartenberg problem corrected. And when I wrote that paper, a letter to the editor came in and said if I would just move the tendon under the new metatarsal ligament, I could also correct calling with the same transfer. And I would recommend that to you because it's just one incision over the dorsal aspect of the little finger, disconnecting the extensor, digitally minime and moving it to the radial side. It's very easy to do with very little morbidity for the patient.

Chris Dy: 18:17

I love that transfer. By the way. I think that's a great one. Do you do you think that you could do that in the wide awake manner? And do you think they'd be able to correct that right away? Yes. I love that.

Unknown: 18:28

So joint innovation, yes.

Chris Dy: 18:30

Let's talk about joint innovation.

Unknown: 18:32

Okay, so you liked this because involves an orthopedic surgeon. When I was the chief resident in plastic surgery at Johns Hopkins and I was running the burn unit. GALEN cron was an orthopedic resident rotating on our service. And I was helping him do what I thought was a recurrent dorsal root ganglion. And I instructed him at the beginning, we're going to follow this down into the dorsal wrist capsule, and so on, and we're doing the dissection and the mass did not go into the dorsal wrist capsule when distally and proximally. And I said this looks like an aroma. But of course, there are no nerves on the dorsal aspect of the wrist, maybe it's an injured tendon, we counted all the tendons, they were all there, that added and we took it out in the pathology came back into Roma. And so based on that work, in 1978, I went back to the anatomy lab, where the Hopkins medical students as most other medical students never really thoroughly dissected cadavers. And they had 50 cadavers. And I found that the terminal branch or the posterior interosseous nerve, after innovating the thumb extensor muscles, continued on the interosseous membrane and went through the radial side of the fourth extensor compartment, the innervates, the dorsal root capsule, and I took pictures and I showed them to Dr. Curtis, who's Of course, I was his first hand fell with the hand center in 1977. I'd finished my hand fellowship then, and he said, Lee, that's the reason why people have Pain over their dorsal wrist. And we could ever find anything and a year later they come back with a ganglion, the mass is pushing on that nerve as it goes through the risk capsule. And then it suddenly pops through the extensor tendons and we see it. And so that gave me the idea that wrist pain could come from a nerve. Because in every single anatomy book today, you cannot find a single nerve to any joint in the human body, except as I go puffins, you'll join in the spinal column, where pain management, doctors just use the X ray name, their radiofrequency ablation needle, and a very successful D innervating. A joint. But there's no other nerve to a joint in any anatomy book. And so based on that experience, I was pretty excited about being able to help painful joints. And then when Dr. McKenna did her hand fellowship from 81 to 82. She had a patient in a car accident, whose Volvo Ariston hit the steering wheel, the patient was a piano player at Peabody, and the patient had volar wrist pain. And so I stopped that case. And we in fact found a volar wrist ganglion, which when we took out under the histology, there was a small nerve there. And we had a patient who had had a shotgun injury to their wrist that had been fused, and had vulgaris pain in a fuse joint. And when we explored that, we found a piece of shotgun wadding next to a small nerve. And then we had a patient whose upper arm had been Avulsed with some kind of trench digging equipment, and the arm having been cut in so many places was not replaceable. And we were able to take the volar forearm and take the interior and roseus nerve and follow it through the pronator quadratus into the lower risk capsule with serial histology and therefore we identified the ATR and we identified the anterior interosseous nerve innervating, the volar risk capsule, and published that in 1984 in the Journal of hand surgery, so that meant that we could begin to take care of anterior and posterior wrist pain. And that's what I began to do so the paper on the VOR wrist was an ad for in the paper on partial dorsal wrist innovation was 85. And now to step back in Germany when I finished my hand fellowship, in the first issue of the Journal of hand surgery, Dr. Buck Ramco, from Germany had published a paper on the German speaking people's experience with 300 RISD innovations, but the German approach was to wipe out the entire population of nerves to the wrist joint, they removed 10 separate branches from seven nerves utilizing three or four separate incisions. But when you carefully analyze the yearbook Graham COEs results, only about 20% of his patients really had had all those branches removed. And he got just the same results and people who had had less removed than all the nerves removed. And I decided to call the approach that I use partial joint denervation instead of total wrist and innovation. And of course, the way you decide how many nerves would be removed would be with a nerve blocks. So the failures in the German speaking people's experience were patients who had wrist instability. And so that when I began to do the work with partial dorsal and partial volar, wrist innervation and exclusion criteria was joint instability however, you wanted to find a joint instability. So the German experience was about 60%, good or excellent results, but they had increasing failures due to progressive instability, but people using their wrists that was unstable to begin with. And we had much better success. We had like 80% success if the nerve block was successful. And then that went on to my moving to the knee. And just as their CRPS described for the hand, an orthopedic surgeon in Baltimore, named Dave Hungerford had described CRPS of the knee after people had total knee arthroplasty. And for him, that meant that the skin around the knee joint couldn't be touched as well as people having deep pain in the knee joint. And I had met Dr. Hungerford in 1993, at actually a pain clinic at a Christmas party and I asked him if he had problems with the pain. He told me he has three clinics a week of people with knee pain. I told him that if he sent me his first round draft choice for the summer research residents, I would solve the pain for him. And that summer grateful Winder knocked on my door and told me, Dr. Hungerford had sent him. And I said, Well, Greg, what do you want to do? Greg said, I'm going to become a famous orthopedic sports medicine doctor. And I said, Well, why is that? He said, Well, I was a football player. I had a great GPA, and I was tight end on the football team. And that's what I want to do. So I said, Well, Greg, what What project are you going to do with Dr. Hungerford? He said, Well, we built an apparatus about three meters high. We're going to drop cinder blocks on the knee and study Kandra Malaysia fracture patterns. As a G Greg, that's great. But you know, if you really want to be famous, we should figure out why people with Kandra Malaysia fracture patterns would have paid pain. I don't want to work on nerves. Dr. dellon, what do you mean by pain? So Greg and I went down and we dissected 45 Knees together, we identified the nerves to the knee joint. And on the first cadaver dissection, Greg said, Well, how do you know it's a nerve and not attended Dr. Doe? Then I said, Well, if you pull on it, and the joint moves, it's attended. And if you pull out of the joint doesn't move hits, could it be a nerve, and I left him alone for a while and came back and he said, Doctor down and I found a nerve coming from the sciatic onto the biceps tendon right into the lateral aspect of the, of the knee joint. And that was the start of that. We published it in clinical orthopedics and related research in 1994. Greg got to do an orthopedic residency UCLA. And about six years later, he called me up and he said, Dr. dellon, do you remember me? I said, yeah. So well, I want to be a hand surgeon. I want you to write a letter for me. Previously, when he was a medical student, and he went for orthopedic interviews, he'd come back and he would say, Dr. Delon, are you a plastic surgeon? I said, Yes. Well, why would I go for my orthopedic interviews? Does everybody know you? And I said, well, a lot of hand surgeons are orthopedic surgeons, and I've written a lot of papers in the hand surgery literature. So he asked me and I wrote him a letter and he did his hand fellowship at Mass General Jesse Jupiter. And he's very successful hand surgeon in California now. And at the American Society for Surgery, the hand meetings when I give an instructional course on joint innovation, Greg sits in the background waves to me and smiles.

Chris Dy: 27:12

So it all that all started from a pain service holiday Christmas party

Unknown: 27:17

had said that was exactly it. And so then I asked Dr. Hungerford to send me total knee pain. patients who've got total knee arthroplasty who stood still had pain. He sent me 20 patients, and he didn't he and Michael Martin who was with him, the American Society for the MER, the knee surgery, society's total active range of motion and pain score for the knee, and it innovated the patients. And he they did their post operative evaluations. And that was presented at the American Academy of Orthopedic Surgery, around 1994. And that was published in 1995, or D innervation. of total knee arthroplasty patients. In the following year, we had extended that to, um, young athletes or people who were too young to have total knee arthroplasties like people doing martial arts. And we were able to deactivate them and successfully get them back to activities and could extend those to people who had such an unhappy experience with one knee that even though they were bone on bone on the other knee, we could deactivate them. They still had their osteoarthritis, but they didn't have pain in their knee. And we distinguish between joint efference and the saphenous nerve, which is a cutaneous afferent and the medial cutaneous nerve of the thigh which goes to patellar skin. So if it's pre patellar skin, they also have an aroma of the saphenous if it's patellar skin, which is why Dr. Hungerford thought there was CRPS. They have the neuroma, the medial cutaneous nerve of the thigh, and insulin Scott, which was the main orthopedic knee surgery textbook. In the year 2000. We had about 300 of these patients that we have listed in the results section. And then when Frank Noyes wrote his book on knee surgery a few years ago, he asked me to write a paper on knee pain of neuro origin. And we included the lateral femoral cutaneous nerve, as well as other nerves and so we went from doing wrist innervation to need the innovation.

Chris Dy: 29:25

You know more about orthopedic knee pain than many of us who are listening right now. So thank you for sharing that. The dashi segues us into one of the closer to things. The last one we'll talk about what's on your right over there, but then before that, you've mentored so many young people. What do you enjoy the most about all the mentorship?

Unknown: 29:50

I would like to say just two minutes about the tennis elbow. Because as a hand surgeon in Baltimore, I didn't see many tennis elbow patients. I saw mainly failures when people had done the classic orthopedic approach to persistent lateral humeral epicondylitis. And when I would operate on those patients, I would find a nerve in the incision, and it was the posterior cutaneous nerve of the forearm, there was actually an aroma, which is why that incision would often hurt and was often mistaken for failed treatment of the epicondylitis. And when I took that nerve and falling approximately to the radial nerve, I found small branches coming off to the lateral humeral HEPA condyle that gave us gave me the idea that we could deactivate it tennis elbow when they had failed treatment by conservative methods, counterforce bracing, and steroid injections. And so I began that work first with a group of Southern Illinois University with Robert Russell. And then with Nick Rose, who was president of the Southern California hand surgery society trained with David Green. And we have an orthopedic sports medicine physician there who was captain of the UCLA water polo team, whose email is Dr. Sunshine at Dr. Sunshine and taken my book pain solutions. And he had read about that. And he wrote to me and asked if I would come out and work in his clinic, and he loaded up a day with pain patients, so I could help him figure out who was crazy and who really had a peripheral nerve problem. And his pa had bilateral counterforce braces on her arm, and I blocked her to the lateral the nerve to her upper condyle. And she consented to surgery on one arm the next day, and we operated on her. And so our paper in the Journal of hand surgery on treatment of persistent lateral humeral epicondylitis describes that experience and in 2019, for those of you who'd like to learn to do this, I wrote the book, joint innovation, which is available from Springer, nature, the same publishers of Dr. Guys great book on peripheral nerve problems related to orthopedic surgery.

Chris Dy: 32:03

I love that that will thank you. And I love that, that procedure. I love the procedure that she described for for recurrent persistent lateral epicondylitis pain, and oftentimes point our trainees to your paper on how to do that surgery. So the

Unknown: 32:18

thing with the mentors that I am, one thing I really enjoy is watching the discovery in the people's faces and experience usually very experienced people, for example, generals, people have finished general surgery and are doing plastic surgery, when they learn that the pain in a hernia scar can be from a peripheral nerve and not a recurrent hernia. And they see the ilioinguinal nerve and W hypogastric nervous surgery and hurting they can just open the external oblique disconnect these two nerves and treat groin pain, they're half a million hernia repairs a year and 10 to 12% have disabling groin pain. So even that simple mentoring is so much fun to see an experienced surgeon see a small nerve and realize it's the source of these horrible problems. And that was a relatively we should never say an operation simple but with a relatively relatively simple operation can help that person in pain and then later when they've left the fellowship. And they write back and describe the patients that they're helping and the happiness they have in their practice and their personal life was relieving people's pain has been the most encouraging for me.

Chris Dy: 33:35

There are so many people that look to you as a as a mentor and somebody that has shaped their careers. And one thing that I've learned after our conversations where you've hosted me at your lovely home here is that you have done a lot of things that most Academic Surgeons have not done. And I'd like to hear about the pro sector because that is definitely outside of what you wouldn't expect a well known academic plastic hand surgeon to have done.

Unknown: 34:02

What you're referring to is I've published my first novel, and there have been a few surgeons in the past like Silas Weir Mitchell who's most famous as a neurologist, but he of course, was a doctor of looking at nerve injuries and people following the Civil War. He wrote several short stories. And of course, Sherlock Holmes was written by our A Conan Doyle, who is a medical doctor. And we have Michael Crighton, who studied medicine at Harvard who never took care of a single patient but wrote Jurassic Park, Congo and dromeda strain and I decided that I wanted to write something that would be a novel that people could try to understand some of the problems that I faced over these years as a peripheral nerve surgeon.

Chris Dy: 34:50

So tell us a little bit about the book and what maybe give us a you know, a quick answer for it and then how we can get it.

Unknown: 34:57

Very good An example is my attempting to do joint innovations. Other doctors, surgeons, lawyers will say how can you deactivate a joint when there's no nerve that goes to a joint? And I began to wonder, really not long after my fellowship, why I believed certain things were true. And other doctors, including my teachers didn't think those same things were true. So the question is, what is truth to, at least to me to a peripheral nerve surgeon. But truth to me is anatomy. And the name of the book, The Pro sector describes that a pro section is an excellent on the section and when we try to teach in anatomy, we try to demonstrate something with our dissection. And in surgery, we are doing a pro section. It's so for me the truth of I found nerves innervated the joints and I could remove them and relieve pain. That was truthy. And if other people didn't believe me, or they doubted my results, they just hadn't seen the same things. So in the pro sector, I did not want it to be an autobiographical book. I wrote it with a woman as the protagonist. It's historic fiction. It's a lot of fun. It's full of great surgery history stories. It's set in 1910. And as you and probably many people listening know, women could not go to medical school in Europe, or in the United States. But when Johns Hopkins opened as a medical school, its first class had 10% of its students, a B women. And this story, the pro sector is about a woman who could not go to medical school in Europe, she was born in Munich. So a good bit of the story occurs there. And in order to get painted to the story, and her uncle who worked in the chemical industry, which was very big in Munich to the first three Nobel Prizes in chemistry went to people in Munich, her uncle burns his hand, his wrist working in the chemistry lab, and has a third or fourth degree, burn, and she grows up only being able to hold onto her uncle's other hand. And that's her motivation to try to find a way to solve pain. And her uncle has a story and another backstory where he trains toward anatomy to try to understand. And he had the idea that nerves crossed these areas by seeing the dissection of Harriet Cole. And I would encourage all of you to type in Harriet CLE, into your web browser. She was a person who was a janitor, cleaning the anatomy lab in medical school in Philadelphia, and donated her body to Rufus Weaver, the chief of anatomy to a special procession, and her entire nervous system has been preserved and still hangs today in Philadelphia. And that plays a role in the story in this book. And by having a be a woman in 1910. At Hopkins, she has Hallstatt as her teacher, Cushing as her teacher, and John stage Davis who started plastic surgery as her teacher. And then she has the controversies between men and women in surgery between a peripheral nerve surgery and orthopedic surgeons with fixing bones in the legs and compartment syndrome, which is in here. And it gets into my work with getting sensation back in diabetic feet, and how she comes to do this. So the book throughout is about peripheral nerve research in the setting of a woman surgeon and the controversies involved with her. The book is called The Pro sector and is available on Amazon. And I hope you'll take a chance to read it. I think it's very inspiring, especially for those interested in nerve research and women going into surgery.

Chris Dy: 38:57

Lee, thank you for that congrats on the book. And obviously, thank you for being such an inspiration and a guiding light to so many young surgeons and many of us interested in in hands. So thank you again for your time.

Unknown: 39:11

Thank you for interviewing me, you did a great job.

Charles Goldfarb: 39:16

Hey, Chris, that was fun. Let's do it again real soon.

Chris Dy: 39:19

Sounds good. Well, be sure to check us out on Twitter at hand podcast. Hey, Chuck, what's your Twitter handle?

Charles Goldfarb: 39:24

Mine is at congenital hand. What about you?

Chris Dy: 39:27

Mine is at Chris de MD spelled dy. And if you'd like to email us, you can reach us at hand podcast@gmail.com.

Charles Goldfarb: 39:35

And remember, please subscribe wherever you get your podcast

Chris Dy: 39:38

and be sure to leave a review that helps us get the word out.

Charles Goldfarb: 39:41

Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next time