Dr. Maldonado Live Connect Q&A << Back to Blog Some questions were not able to be answered during the live connect/were asked after the live event was closed. Answers to those questions will be completed within the next 2-3 business days and posted below: Bob asked: “Many years ago, I lifted lots of boxes and felt a pain in my back…to this day I have a stabbing pain that goes down thru my leg….my Chiropractor has been trying to remedy the pain with adjustments…but I continue to ice it each day and have learned to live with it…any thoughts on possible treatment? I really would like to avoid the surgery route if at all possible…thank you” Dr. Maldonado’s ANSWER: Back pain that radiates to the leg and that persist for more than 6weeks should be evaluate in more depth with a detailed musculo-skeletal evaluation and further imaging studies. Definitely, there are other alternatives to avoid surgery if not required. Huston asked: “I’m currently flying back and forth from Chicago three times a week for my job. Do you have any recommendations to products or supplements to help ease the tension on my joints from flying? I have some arthritis starting to develop.” Dr. Maldonado’s ANSWER: Good question. There are supplements available that seems that help certain population and is not detrimental to your body. I will recommend to keep a balance diet since this supplements can be included through a good diet. Combination of diet with exercises consisting of flexibility and strengthening would be the best option. If you still have concerns about a specific joint, you should get an evaluation in order to sort out your problem. Jennifer asked: “Hello Dr. Maldonado. I am considering training for my first Flying Pig Marathon next spring and am concerned about getting injured from overtraining. Do you have any tips for a first time marathon runner that will help keep me injury free?” Dr. Maldonado’s ANSWER: You should start assess first what is your baseline endurance and experience in order to set up a training plan. There are many options. If no experience at all you should start 3 days a week with 2-3 miles and every week increasing 10-15% of your distance. You can increase the running days up to 5 and alternates the other days with free weights and or pool exercises in order to avoid overuse injuries. Megan asked: “I’m having some pain in my hip from running. I’ve been resting it for a week now. How long should I wait before getting an xray? A friend suggested it could be a stress fracture.” Dr. Maldonado’s ANSWER: Good question. In the case of stress fracture, the main focus is in the history of your pain. Usually a stress injury is cause with over-training with no rest. Start with pain at the end of a run that with time progress to the beginning of the run and even at rest. If that is your case you should get an evaluation for treatment and/or prevention. Lauren75 asked: “My very active 81-year old grandmother just had a total knee replacement surgery. Up until her surgery she had been walking 3 miles per day. She is convinced her exercising days are over. Are there any exercises you suggest for your older patients and at what point would you say walking (as exercise) would be okay to return to, if ever?” Dr. Maldonado’s ANSWER: Good question. Walking is an impact activity that put pressure in the joints especially in the knee. I am sure that your grandmother would be able to get back to her usual walking days however it would depend upon her tolerance. I will recommend to work first on her flexibility, range of motion, and being pain free before transition to her long walks. She should try short distance and avoid uneven surfaces just to start. Usually few physical therapy sessions would help with this transition that would take few months. Kamisha asked: “Does back pain run in families?” Dr. Maldonado’s ANSWER: Excellent question. I can’t scientifically prove it but definitely I have seen a trend of back problem in relatives of the same families. Whether is due to anatomic vs social factors or not, I am not completely sure. Many factors are involved in this premise. JV asked: “My back bothers me on long car rides. I’m heading to Ga in a few weeks for Christmas. What can I do to decrease my back pain while I’m traveling?” Dr. Maldonado’s ANSWER: I will recommend to divide your trip in segments and stop for stretching. I will recommend to look for a lumbar spine flexibility home exercise program and tried over the counter anti-inflammatories as needed. Try to keep a good posture for all your activities including driving. Landon asked: “What is your opinion on dry needling? My massage therapist recommended it to me as a potential option for my lower back issues…” Dr. Maldonado’s ANSWER: Excellent question. Dry needling is one of the modalities used in physical therapy. The science behind it is to break the chronic fibrosis of the tendons and muscles by provide a small amount of irritation that would generate an inflammatory cascade followed by a healing process, that aide with physical therapy, would end in a better muscle/tendon fiber structure. Mary asked: “Is there any seasonality to back pain? I fell my old injuries flare up in the winter.” Dr. Maldonado’s ANSWER: I am still looking for a clear answer to that question but I have seen the following patterns. During winter, or cold days, most of us become sedentary and the amount of exercises decrease considerably. In addition, while engage in an exercises activity our bodies tend to take longer to warm up. Jacqui asked: “Many years ago a doctor told me to foam roll my lower back should any post-workout pain develop. Is that still a proven method of relief?” Dr. Maldonado’s ANSWER: Foam roll exercises are good for low back problems and other flexibility issues. However, muscle, tendons and ligaments tend to create resistance to routine exercises/stretches and the best approach is to add different ones and extend to adjacent body parts. Eric asked: “I feel pain in my shoulder when I perform certain moves in the gym but no other time. Is it a strength issue or should I avoid those movements?” Dr. Maldonado’s ANSWER: Your shoulder pain could be coming from both. I would recommend to get an evaluation to sort out where the deficit is coming from. In the meantime, I would avoid those exercises and try a course of anti-inflammatory. Vicki asked: “I’ve researched the pain I experience in my left foot and it looks like I have something called Plantar Fasciitis at what point should I seek professional medical treatment for something like this?” Dr. Maldonado’s ANSWER: Excellent question. I always recommend to be active but not in pain. At this point you should look for further evaluation. Plantar fasciitis is a common pathology but occasionally overlap other syndromes like arthritis, pes planus, posterior tibialis insufficiency, etc. Getting an evaluation would be my best recommendations. JD asked: “I was diagnosed with fibromyalgia earlier this year. I have a number of spots on my back that I have trigger pointed by my therapist every couple of weeks. Do you have a supplement you recommend to help with my back flare ups?” Dr. Maldonado’s ANSWER: Fibromyalgia is a challenging diagnosis and varies from person to person. I am not sure that there is a specific supplement available for this condition. The treatment is a multidisciplinary approach focus on each individual deficits. In your case, trigger points can be treated with acupressure therapy, deep tissue massage, flexibility exercises, anti-inflammatory, myofascial trigger points injections, dry needling, balance diet and sleep hygiene. La Tonya asked: “I have had swelling g in and around my left knee and thigh, It began a month ago and since then I’ve been wearing a knee brace. It helps my knee not to buckle but I’m concerned it could be something else. Any idea of what it could be or suggestions on what to do?” Dr. Maldonado’s ANSWER: Excellent question. Knee swelling could be coming from inside or outside the joint. Further medical evaluation should be seek when is coming from inside the joint. You should seek further evaluation in order to find out where the swelling is coming. Knee buckling is also a sign of knee instability that need further assessment. I recommend to continue with the brace until you get an evaluation. Jessica asked: “Dr Maldonado, I have had back pain for approx 20 yrs. I am an RN and I recently injured my back. A MRI showed a partially protruding disc. I was pregnant when this occurred, so no one wanted to do anything, but have since delivered. My lower back is still bothering me. Are there any stretches/exercises for my lower back that will help strengthen my back and take away the pain?” Dr. Maldonado’s ANSWER: Good question. There are many exercises that you can perform to help your back pain. Search online for lumbar spine home exercises program. There is a free application for your smartphone called Get Set, sponsored by the International Olympic Committee, which you might find useful. If that fails then you should look for a re-evaluation of your lumbar spine. Steve asked: “I’m 52 and been active in sports most of my life – swimming throughout and did an Ironman 5 years ago. I recently have constant pain in my ankle – my older siblings have a history of arthritis. If it is, could a Cortisone shot be advised and how long could it last?” Dr. Maldonado’s ANSWER: Excellent question. Congratulations on performing an Ironman. Ankle pain could be related to arthritis, but overlapping syndromes can confuse the clinical presentation like injuries to ligament, tendon, nerves or cartilage. A cortisone injection could be advice depending on where the source of your pain is coming from. Clint asked: “Dr M, Any time I attempt to do cardio (running, walking, elliptical) , I end up with severe ankle/foot pain. It happens off and on in both feet/ankles. Usually doesn’t appear until the next day, and I wake up with really swollen foot/ankle and can barely bare any weight. I have been to multiple doc (never ortho) and I now have insoles that don’t help. Some recommended a few stretches, like rolling foot across can and calf stretches, but these only help temporarily. I have had x-rays that show no breaks. One doc recommended to stop doing things that bother me, which include walking so not realistic. What else can I do to fix this problem?” Dr. Maldonado’s ANSWER: Good question. Severe exertional pain that persists should have further evaluation. In your case, I would focused on assessing where the pain is coming from. Is coming from ligaments, tendons, nerves, bone or vascular problems. The treatment approach would be tailor depending where the pain is coming from. Physical therapy vs further imaging are few of these options. Anonymous asked: “I fell on my knee several days ago and initially my knee was very swollen and was painful particularly when going up and down stairs, could not bear full weight on that leg, now swelling is down and pain in knee is gone, but having pain in calf right below my knee, do you think it could be a pulled muscle or sprain?” Dr. Maldonado’s ANSWER: Good question. After landing on your knees from a fall, swelling can build up and migrate down due to gravity. This inflammation and fluid can cause pressure and mimic other injuries. However, I would still consider a possible pulled muscle, tendon, or ligament. If the problem persists, I will recommend further assessment for medical advice. Mamaw L. asked: “Many years ago, due to an MVA, I suffered numerous injuries, including the loss of my right patella and the attached ligaments and tendons. Thankfully, I can walk, but have no extension mechanism. Have there been any new advancements in sports medicine that would enable these structures to be replaced and function well enough for me to jog?” Dr. Maldonado’s ANSWER: Good question. Sorry to hear about your injury. There are new advancement that potentially work to certain degree but would depend on the length of the injury, tissue quality, strength of the surrounding structures, etc. I would recommend for you to sit we one of our knee specialist and discuss in details the pro and cons. Stephanie asked: “If I have been diagnosed with arthritis in my three lower discs at base of spine and a disc buldge…. Can I do activities that cause extreme pain without injuring my spine more?” Dr. Maldonado’s ANSWER: Excellent question. I would definitely encourage against pursuing activity that cause extreme pain. There are many options that can be used to treat this pain including oral meds, physical therapy, injections and/or surgery. Further assessment is warranted. Renee asked: “My 6-1/2 year old niece has very noticeable knock knee. It seems like it has gotten worse the older she gets. Is there any treatment or therapy to help correct this problem. Everything I read suggest it will get better by age six. She’ll be going on seven years old next April.” Dr. Maldonado’s ANSWER: Good question. Surgery before growth plates are closed in children is usually avoid unless necessary. Further evaluation to sort out the reason for her problem is warrant in order to select the best treatment approach. Brad asked: “I have suffered with lower back pain for years basically I’m treated with medication and pain management I’m costly told I’m not a candidate for surgery that would mess up my back even more because of the number of locations What determines who is going to be helped by surgery and who is not?” Dr. Maldonado’s ANSWER: Good question. It all depends on the type of back pain, the source of your pain, the severity, distribution, functional deficits and the length. The first step is to find out where the pain is coming from: lumbar joint, disc, vertebra, nerve root, spinal cord. Once that problem is identified we would be able to sort out what would be the best surgical approach and estimate your outcomes. Anonymous asked: “What should I do with my lower back pain and sharp pain tightness in my lower back?” Dr. Maldonado’s ANSWER: Good question. Low back pain could present due to multiple etiologies. Pain can come from lumbar joint, disc, vertebra, nerve root, spinal cord, or muscle/ligament. First approach is to avoid exacerbating activity, trial of anti-inflammatory, muscle relaxers, home exercises program vs physical therapy. If that does not improve your symptoms further medical assessment is warrant in order to sort out the triggering structure. Julie asked: “My 14 year old suffered an ischial tuberosity avulsion fracture 12 weeks ago in a soccer game, a recent xray this week shows that the bone is healed. We are slowly starting up with sports activities-jogging, PT and limited select soccer practices (no full sprinting). My question primary question is, since he is still growing-and this injury occurred on a growth plate-how likely is it to re-occur? We are very nervous about the upcoming spring soccer & track seasons…but he loves both & wants to participate. Thank You!” Dr. Maldonado’s ANSWER: Excellent question. You are doing the right treatment. There is always concerns with re-injury, but that usually happen due to overtraining syndrome. In other words, lack of rest and persistent participation doing the same activities. This injury can be prevented with good exercise program that consists in flexibility, conditioning and strengthening, but keeping in mind that rest is necessary. Clinically, if there is pain in the same location that was healed, he should be evaluated quickly instead of waiting until the pain stop him from performing his usual activities. Here are the Q&A results from the live event: Beacon Orthopaedics and Sports Medicine Live Connect with Dr. Maldonado (11/30/2017) Close 9:07 Beacon Orthopaedics: The Live Connect with Dr. Maldonado is now open to receive questions, which will be answered beginning at 12pm. Thank you! Thursday November 30, 2017 9:07 Beacon Orthopaedics 11:57 [Comment From AbbyAbby: ] My son plays soccer for King’s Hammer in addition to his school’s team. After long, weekend tournaments, he often complains about his back being tight. What types of stretches or treatments would you recommend? Thursday November 30, 2017 11:57 Abby Dr. Maldonado: Abby. That’s a great question. First we want to stretch the hamstrings and low back muscles. I found an application sponsored by the Olympic team called Get Set that would be an excellent tool. Dr. Maldonado 12:00 [Comment From ScarlettScarlett: ] I love to run outside all year round, but in colder months I have a lot of problems with my joints cracking post run. I’m a healthy 27 year old with a two year-old- daughter. Is the popping of my back and hips something to be concerned about yet? Thursday November 30, 2017 12:00 Scarlett Dr. Maldonado: Scarlett. Good question. Yes, the “cracking” and “popping” is a common issue in my patients. My advice, I will be worry if it is painful. First start with a good dynamic stretching before starting your run. If is painful you should get an evaluation to look for the source of your pain. Dr. Maldonado 12:04 [Comment From WalterWalter: ] Dr. M, I wrestled back in my high school days, 30 years ago. I have a bunch of scar tissue in my shoulder from an injury. As I’m getting older, my shoulder doesn’t move like it used to. Is there any supplement that you recommend to help with mobility? Thursday November 30, 2017 12:04 Walter Dr. Maldonado: Walter. Excellent questions. Supplements can be used for slowing the degeneration of the joints. However, for your shoulder pain it would be necessary to identify if is a muscle, cartilage, ligament, bone or tendon injury in order to sort out the best approach to your problem. Dr. Maldonado 12:05 [Comment From EmmaEmma: ] At what age do you recommend that it is safe in my son’s development to begin weight training? He keeps telling me that I need to get him some weights for Christmas. Thursday November 30, 2017 12:05 Emma Dr. Maldonado: Emma. That is an excellent question. The answer had changed with recent research studies. Before, it was contraindicated, but now it is allowed for kids to engage in weight lifting if it is a supervised program adequate for your son’s age, sports, and tolerance. Dr. Maldonado 12:11 [Comment From JosephineJosephine: ] I’m skeptical about taking pain killers with all of the publicity recently, what are some natural remedies to cure joint pain? Thursday November 30, 2017 12:11 Josephine Dr. Maldonado: Josephine. Good question. Yes, pain killers have shown to help for acute and chronic pain but side effects can sometimes interfere with your daily life. There are many alternatives depending of what joint is affected and the degree of injury. Starting from anti-inflammatory, therapy, massages, flexibility program, injections, etc. I would recommend an evaluation in order to sort out how we can help you. Dr. Maldonado 12:13 [Comment From RaquelRaquel: ] My boss wants us all to purchase standing desks, what do you think? Thursday November 30, 2017 12:13 Raquel Dr. Maldonado: Raquel. Good question. Standing desks are alternatives to help your back stress from prolonged sitting. However, a combination of changing positions and performing flexibility exercises would be helpful in order to keep good back health. Dr. Maldonado 12:15 [Comment From Bob BBob B: ] I’ve got lots of lower back pain and need to ice my back on an hourly basis. The only relief I get is from stretching. My buddy goes to a chiropractor weekly for relief. What do you recommend? Thursday November 30, 2017 12:15 Bob B Dr. Maldonado: Bob. Excellent question. I agree with keeping the stretching exercises. Chiropractors are excellent helping with back pain. Yoga and physical therapy have been shown to be helpful as well. Dr. Maldonado 12:18 [Comment From What specific exercises are good for the 50+ crowd especially when outside in the cold exercising or runningWhat specific exercises are good for the 50+ crowd especially when outside in the cold exercising or running: ] What specific exercises are good for the 50+ crowd especially when outside in the cold exercising or running. Thursday November 30, 2017 12:18 What specific exercises are good for the 50+ crowd especially when outside in the cold exercising or running Dr. Maldonado: Stretching exercises are good just start warming up your body before working in cold weather. Depending on what is the affected area stretches would varies. The Olympic team sponsored an application called Get Set that would be useful to sort out stretches depending the part of the body that you want to work on. Dr. Maldonado 12:21 Beacon Orthopaedics: To schedule an appointment, call 513-530-3333 or visit us online at beaconortho.com to schedule an appointment 24/7/365. Thursday November 30, 2017 12:21 Beacon Orthopaedics 12:21 [Comment From JacksonJackson: ] Do you recommend back squatting or front squatting in the weight room? I’ve read studies recently online that says front squatting is more natural. What is your professional recommendation? Thursday November 30, 2017 12:21 Jackson Dr. Maldonado: Jackson. Good question. I agreed with your previous reading and perform the squatting as natural as possible to keep from over-stressing your back. Avoid over flexion and over-extension. Dr. Maldonado 12:24 [Comment From JAMESJAMES: ] How do your protect your achilles playing fast sports like tennis, basketball, pickleball? Thursday November 30, 2017 12:24 JAMES Dr. Maldonado: James. Excellent question. Achilles tendinopathy is very common in high impact sports. Prevention is key with stretching, and eccentric exercises. Dr. Maldonado 12:26 [Comment From CarlCarl: ] My back pops when I foam roll before working out. What exactly causes the “popping” sound? Thursday November 30, 2017 12:26 Carl Dr. Maldonado: Carl. Good question. “Popping” sound is very common. The are many structures as ligaments, tendons, bones, cartilage that can be causing it. I would be concerned if the “popping” is painful and further assessment should be done for your back. Dr. Maldonado 12:27 [Comment From KimKim: ] I know all back pain is different, but what are the most common problems you see in former athletes? Thursday November 30, 2017 12:27 Kim Dr. Maldonado: Kim. Excellent question. Common back pain problems include Lumbar strain/sprain, spondylolisthesis, Herniated disk, arthhritis, radiculopathy, etc Dr. Maldonado 12:30 [Comment From M_MarianiM_Mariani: ] My boyfriends’ shoulder has popped out of its socket several times in the past few years. Just a few weeks ago it happened again, and he went to an urgent care to have it placed. Took the doctor 5 minutes, and he had to leverage his foot onto my boyfriends chest to get it back in. Do you think he’ll need surgery or physical therapy to avoid this happening again? Thursday November 30, 2017 12:30 M_Mariani Dr. Maldonado: Mariani. Excellent question. Sorry, to hear that from your boyfriend. Shoulder subluxations get patient prone to further subluations. Further imaging should be done to evaluate if the is a labrum problem and/or additional problems. From there we should be able to tell you the best approach between surgical vs non surgical and/or therapy vs injections. Dr. Maldonado 12:32 [Comment From BraydenBrayden: ] What daily routines do you personally do to maintain a healthy posture? Thursday November 30, 2017 12:32 Brayden Dr. Maldonado: Brayden. Good question. Good posture is very important. First, evaluation of what muscles are the ones requiring stretching vs the ones needing strengthening would be necessary for better approach. Internet is a good resource. Usually we send our patients for a one time visit with the therapist for a more extensive home exercises program. Dr. Maldonado 12:34 [Comment From KimKim: ] Hello: I’ve been dealing with tennis elbow for a couple of years now, using rest as my only means of healing. How come as soon as it seems to have gone away, it switches elbows? It’s switched elbows 3 time now. Thursday November 30, 2017 12:34 Kim Dr. Maldonado: Kim. Good question. Tennis elbow that resolves with rest is a good sign. However, is always good to find the reason of the problem. Is the problem in the tendon, muscle or bone? There is a specific treatment for each if this structures that can be tailor so the problem does not continue to be recurrent. Dr. Maldonado 12:37 [Comment From GinaGina: ] Do you do soft tissue therapy? This has been recommended to me for tennis elbow, and the little bit of deep tissue rubbing I’ve been doing seems to ease the pain. Thursday November 30, 2017 12:37 Gina Dr. Maldonado: Gina. Excellent question. Yes, I recommend deep tissue massage along with other modalities with our physical therapist depending the structure that is affected. Dr. Maldonado 12:41 [Comment From AllisonAllison: ] I’ve been squatting for nearly 25 years without pain, my new trainer tells me to put my knees closer together, and now my knee hurts…? Shouldn’t I squat how I feel most comfortable? Thursday November 30, 2017 12:41 Allison Dr. Maldonado: Allison. Excellent question. Squatting can put a lot of stress on the back through out the years. Right technique is essential. I would recommend to keep your legs opened at the level of your shoulders to keep good body base and balance for you and the muscle in order to be biomechanically adequated. Dr. Maldonado 12:44 [Comment From ChristieChristie: ] I’ve been training with heavy weights for almost my entire life, and now that I’m 35, it seems there’s really no reason for me to lift as heavy as I can if my sole purpose is longevity. In the long run, can lifting super heavy, do more harm on the body than good causing long-term injuries? Thursday November 30, 2017 12:44 Christie Dr. Maldonado: Chrisite. Good question. All depend on your goals. If your are competing and looking to crash some marks then continue with the heavy lifting. But if your goal is to be keep active and good health out of competition, I would recommend to avoid heavy lifting in order to avoid long term injuries. Dr. Maldonado 12:46 [Comment From JoanieJoanie: ] For the past 3 months I have been getting sharp, almost stabbing like pain that comes on suddenly behind my eye (alternates between left and right eye)that lasts maybe 10-15 seconds and then goes away, only to continue happening all day long. I notice this tends to happen on the days I lift weights with my upper body and am wondering if there is possibly some relation between the two, as I have a number of nerve issues in my arms. What do you recommend I start with in terms of getting diagnosed, treatment, etc? Thursday November 30, 2017 12:46 Joanie Dr. Maldonado: Joanie. Good question. Sorry to hear that you are having this problem. I would definitely get an evaluation since there are conditions that can associate the heavy lifting with vascular problems by providing spasms in the vasculature. It would be excellent to seek further evaluation to sort this out. Dr. Maldonado 12:49 Beacon Orthopaedics: Ortho Urgent Care Walk In Clinic is available at Sharonville and Northern Kentucky locations, Open every evening until 9pm and Saturday mornings until noon and closed on Sunday. Thursday November 30, 2017 12:49 Beacon Orthopaedics 12:54 [Comment From PaulaPaula: ] I have been suffering from Golfer’s elbow for the past two years and have gone through physical therapy, soft tissue therapy, ultrasound therapy, and two cortisone shots but still have pain. Are there any additional forms of treatment you can recommend? This injury is so frustrating! Thursday November 30, 2017 12:54 Paula Dr. Maldonado: Paula. Good question. I understand your frustration. I feel that you have done an extensive rehab. My next step would be to evaluated where the problem is. Whether is in the muscle, tendon, or bone and the degree of injury so we can consider think about doing PRP vs stem cells (regenerative options). Dr. Maldonado 12:54 [Comment From KimKim: ] A friend of mine had a procedure on her elbow at Beacon for tennis elbow. Can you please tell me what this procedure is called so I can read about it before making an appointment? Thursday November 30, 2017 12:54 Kim Dr. Maldonado: Kim. I would gladly explain the details of the procedure, but I would need the name of the procedure first. It was a surgical vs injection procedure? Dr. Maldonado 1:04 Beacon Orthopaedics: Thank you for submitting your questions! We will take a short break, but will continue answering them again shortly. Thursday November 30, 2017 1:04 Beacon Orthopaedics 1:50 [Comment From BobBob: ] Many years ago, I lifted lots of boxes and felt a pain in my back…to this day I have a stabbing pain that goes down thru my leg….my Chiropractor has been trying to remedy the pain with adjustments…but I continue to ice it each day and have learned to live with it…any thoughts on possible treatment? I really would like to avoid the surgery route if at all possible…thank you Thursday November 30, 2017 1:50 Bob 1:50 [Comment From HustonHuston: ] I’m currently flying back and forth from Chicago three times a week for my job. Do you have any recommendations to products or supplements to help ease the tension on my joints from flying? I have some arthritis starting to develop. Thursday November 30, 2017 1:50 Huston 2:19 [Comment From Jennifer N.Jennifer N.: ] Hello Dr. Maldonado. I am considering training for my first Flying Pig Marathon next spring and am concerned about getting injured from overtraining. Do you have any tips for a first time marathon runner that will help keep me injury free? Thursday November 30, 2017 2:19 Jennifer N.