Coffee Date

Well, hello! It has been entirely too long since I have jumped on here. My website was my first creative outlet for sportsdrmorgan and I miss it! There is something said for letting my mind wander and sharing in a larger way than good ‘ole instagram.  Alas, you have asked some questions recently and I thought tackling them on this forum would be a great way to ease back in to writing on the regular. 

Let’s have a little coffee date, shall we? 

How’s motherhood? (The most frequently asked…) 

In a nutshell, it is all of the things people say. It’s a blend of all encompassing love and this intrinsic force deep inside that you didn’t know you had. It’s exhausting and beautiful. The days are truly long and go by too fast. We live far from family and haven’t had any outside help which has made this mama a little strung out at times. But I am eternally grateful I get to be with her everyday and to watch her learning and grow.  We are really learning and growing together really. And the responsibility of nurturing another human is not lost on me, especially in the world today. She is such a tiny wonder. I can’t wait to see who she becomes.

Did you finish your closet clean out?

Ugh. Yes, and no. I tried on everything single piece of clothing I own and tossed out a ton of stuff- 4 giant bags full. You will see it in an upcoming Reel I have yet to edit (did I mention motherhood is also very time consuming)?  Still, every time I walk into my closet I feel at a loss. I tossed another pile out just yesterday. The shift from clinical medicine during a pandemic with the added new mother component and geez… Stella is still trying to get her groove back.

What spring trends are you loving?

On that same note… spring is here! Well, at least in Phoenix it is. And I am dying for a sundress and some color. Bright, floral, pastel or bold, you name it as long as it’s happy. I think for the same reasons above I am really pushing for fun style this year. Classics will never die… but I want to amp it up in a unique way. I feel like getting dressed everyday should be a celebration right now! Anyone else? 

What’s next for SportsDrMorgan? 

Well, team, this is a loaded question. For those of you reading for the first time, I quit clinical medicine about a year and a half ago. Quit meaning… a pandemic relocation mediated an extended maternity leave that has led to more questions than answers. When I walked away from a prestigious academic medicine career I was really happy and also confused. When you are on one path your whole life switching to another can be a little bit (okay a lot a bit) frightening. That said, sportsdrmorgan has exciting things in store. Stay tuned on Instagram to see an awesome opportunity I have upcoming. I am still full of content ideas and as always I will continue to strive to share my knowledge in a fun accessible way, while mixing in a lot of who I am; clothes, mothering, doctoring and hopefully one day soon some travel. I always say I might be a great doctor but I am better at people. And I want to reach as many of you as I can. As always, if you have anything I can help with send it my way. 

Anyway…. Nap time is over and I gotta run. Let’s make this coffee date a regular thing, shall we? 

– Dr M

Our Birth Story

I meant to get this posted near her birth! But the 4th trimester has been wild! … more on that another day. Alas, here we are, and it is finally time for a catch up! If you had been following along you know pregnancy was going well. (And I’ll share my 3rd trimester update eventually…) Due to my age we were candidates for induction at 39 weeks. My doctor and I had made this the tentative plan. I wasn’t super into a ‘birth plan’ per se, but I am type A and like to have some semblance of a strategy in place! But baby girl evidently did not feel this was a good plan… we discovered she was breech, and for a first pregnancy this would mean you cannot have a vaginal delivery due to safety reasons.  If she did not flip to the appropriate direction (ie: head down versus up), I would need a caesarean.  Spoiler alert: she stayed breech. Google “spinning babies” if you want a laugh thinking of me laying upside down while very, very pregnant in a feeble attempt to turn this strong-willed little lady.  We also tried an external cephalic version (ECV) where my doctor attempted to rotate by pushing on my belly.  Yes, it looks as barbaric as it sounds.  It was tolerable pain (nothing compared to what was to come…) but, sadly not successful. Baby girl was showing her stubborn streak. I blame her dad.

Speaking of the hubs… he had a work trip leaving 4 days before our planned induction/now possible c-section. The day before his departure his parents were flying in to stay with me while he was away and help once baby arrived. They were somewhere mid-flight when I went in for one last OB visit before he heads out of town. You know, just in case…

At the doctor I reported the standard late pregnancy symptoms of feeling tired and uncomfortable but overall, feeling well. I had been having mild intermittent belly tightening, and a few episodes of tightening that were more intense but random and rare, nothing too crazy to me or that would signify labor was near. My doctor checked me, and we found out those pains were actually contractions! I was dilated in early labor. The best laid plans, am I right? Since baby girl was breech, suddenly time was not on our side. If we waited I could further into labor and need an emergency c-section. Not ideal. Instead, we opted for a more controlled urgent one. This meant… we were having our baby that day. What! We left the doctor’s office at 10 am. Drove home. Francis got a potty break (of course) and I grabbed my hospital bag. (I almost took it to the doctor appointment that day but was thinking what a rookie move that would be… go figure!) We were back at the hospital and in the operating room by noon. We attempted one last ECV after my spinal (numbing me from the waist down for surgery) … but again she wasn’t willing to flip. 

There was such a mix of emotions this day. I felt like I had done everything the best I could during pregnancy and still ended up having a c-section which I really did not want. I was scared. I know too much medical stuff. But not enough at the same time, if that makes sense? The nurse with me saw my fear. While wheeling me back to the operating room she paused the bed and told me a story about my baby girl. She gave me breathing techniques and promised to stay with me throughout. And then we were on our way again. At this point it all happened so fast. There was a mirror overhead and I watched my doctor working. I remember squeezing my husband’s hand in pulses to focus on something other than the fear. I watched as baby girl arrived and heard her little cries. My fear now mixed with a whirlwind of other emotions. It was one of the most overwhelming moments in my life. As they brought her over and placed her on my chest, I knew nothing would ever be the same.  Welcome to the world Everette Hazel. You represent the hope and dream of your parents. And we can’t wait to get to know you.

Photo: Stephanie Honikel Photography

All you need to know: Cortisone.

In orthopedic offices cortisone shots are offered to patients every day. What exactly is a cortisone shot and who needs it? What are the risks and benefits? 

Let’s start at the beginning.  Cortisone is the name used to describe a group of steroid medications we inject into the body. In orthopedics a cortisone shot is given into your knee, shoulder, finger etc… basically any joint space or area. Other names you may hear are methylprednisolone (Depo-Medrol), Triamcinolone (Kenalog) and betamethasone (Celestone). 

I describe these injections to my patients as strong anti-inflammatory medications that are injected into (as one example) your knee.  They work similar to anti-inflammatory medicines you take by mouth (like Advil or ibuprofen) by decreasing inflammation.  However, the mechanism of how it works is different. Also, since we are directly injecting them into the area sometimes they are more effective. 

What does the cortisone actually do? I want to make this super clear- a cortisone injection does one thing only- decrease pain. Cortisone does not fix the injury, repair the joint it is injected into, grow back cartilage or any other magic. Just pain relief. 

How is the shot usually given? Most often cortisone is mixed with a standard numbing medication and injected using a syringe and needle. The numbing medication helps short-term with the pain (just like going to the dentist and getting numb before they pull a tooth) and it also helps distribute the cortisone evenly. My standard recipe is 40 mg of Kenalog and 4 mL of 1% lidocaine in the knee.  Another doctor’s recipes may differ based on their preferences and experience. 

When are cortisone shots needed? That is a difficult question without knowing the specifics of your injury or problem.  That said, the most common thing injected with cortisone are the things that cause us pain. Makes sense, right?  But also keep in mind all things that cause pain do not get a cortisone shot.  One very common use for cortisone is in the treatment of osteoarthritis. Osteoarthritis is the degenerative breakdown of cartilage (a whole topic we will discuss another day) but simply put it is wear and tear on a joint surface.   When someone has pain from osteoarthritis cortisone is often the first go-to for relief. Cortisone also can help with pain associated with meniscal tears, labral tears, bursitis, and several other conditions. Be mindful that there are certain areas of the body, such as tendons, ligaments or soft tissues spaces that either should not have cortisone injected at all or it is at best questionable to do so. 

Who needs one? That is a great discussion for you to have with your doctor!  I would ask the following: What are the goals of the injection? How can I optimize the pain relief to make it better long term?  What are the risks, side effects or alternatives? Remember although very well tolerated any medication we give isn’t a free pass and has risks and side effects. You need to know these ahead of time.  

Here are some of the ways I answer the above. First, how to optimize the pain relief?  I optimize the pain relief after giving a cortisone shot by focusing on the overall function of the body.  If you have a shoulder problem, I want your shoulder to be functioning as close to a normal shoulder as possible.  This is often hard to do! Your shoulder moves differently when you have pain.  Without guidance it is nearly impossible to fix.  Also, with a shoulder problem you are limited in your ability to use that arm normally which can affect other body parts.  This is called compensation.  It can include how you hold your arm, the alignment of your neck or back, and even how you move the other arm. We need to break this cycle for your pain to go away for good!  Cortisone can help with the pain but if the movement pattern is not improved it isn’t a long-term solution. Why? Your body has gotten accustomed to moving the injured way.  If you get cortisone and are having less pain, this is a great time to try to optimize the shoulder movement to keep the pain away. I often recommend physical therapy for this.  Also please note- physical therapy can be fantastic even without a cortisone shot. 

Next, what are the risks? Every medication has risk. I always remind patients every needle stick has a risk of bleeding and infection. The skin is your safety barrier and sticking a hole in it means breaking that barrier.  When sticking a needle into the skin there are structures below the surface.  Depending on where the needle is headed (more for certain injections than others) we need to be aware of blood vessels to avoid bleeding.  These are both very small risks but depending on the person getting the injection.  Another important risk I always discuss applies to patients with diabetes.  We know cortisone injections can transiently increase blood sugar for about two weeks after the injection.  If you are a well-controlled diabetic you can likely still have the injection, but your physician should have you monitor your sugars closely and report any issues. Unfortunately, if your sugars are out of control before the injection it may not be safe to proceed.

How long does the pain relief last?  That is highly variable.  I tell my patients the medication effect lasts a few months. That is how long the medication itself is altering the insides of joint.  However, if you do more (refer back to the above about PT and shoulder pain), then it may last much longer.   Another possible and important ‘risk’ to be clear on is sometimes cortisone does not provide any pain relief at all. 

What if I need to get several cortisone injections to maintain pain relief? This again is variable but could be a concern.  Let’s revisit the knee example for osteoarthritis.  You as my patient have had one the injection every few years and otherwise have done well!  You are able maintain your exercise program, stay at a healthy weight and are maintaining cardiovascular fitness… to me, this is great! Those benefits clearly outweigh the occasional injection.  However, if you notice that you are having repeat injections and the time between them is getting shorter to maintain pain control this may not be the best solution any longer.  There is some data that suggests repeated cortisone injections may advance breakdown of the tissue faster than normal.  So, we must proceed with caution.  

Overall injections of cortisone are safe and well-tolerated in many and can be extremely helpful in alleviating pain. If you have questions about cortisone or whether you are a candidate for one it may be time for an educated discussion with your orthopedic physician.

2nd Trimester Recap.

Ah, the second trimester. The time when you (usually) start to feel a little more normal. For me, this rang true. At about 14 weeks the fog finally started to clear. It wasn’t a quick process. I did not wake up one morning and say “whew I made it.” But over a few days to a few weeks, I noticed improvement. And wow after the first trimester it was great to break through. 

To start, my fatigue dissipated, and my daily nap was no longer required to survive the day. I also felt like getting back to my ‘normal’ foods again including salads and smoothies. Although, my craving for avocado toast certainly did remain… My motivation to exercise also improved, as did my ability to make it happen. This was a welcome gift! It felt great to finally be able to move my body to keep myself and baby healthy knowing how important it is to get regular exercise in pregnancy. (SEE my post here) I changed my walks to my usual jogging and I was able to get back to 2 miles at a comfortable pace.  I started to take longer hikes with my husband, but still could not keep up with him… I also restarted a strength program focusing on short full body circuits to get my muscles going again. 

With my overall renewed energy, I made it a priority to break some of my first trimester habits and remove the crutches I no longer needed. Sadly yes, this meant I said goodbye to my daily bagel and purse stash of crackers. Feeling better overall allowed me to eat and move better, and in doing so (you guessed it) that I felt even better making these healthy choices. 

The biggest surprise of this trimester was my crazy dreams and insomnia. Some nights I would wake up in a full panic over a dream. I also would wake up with full on tears streaming down my face over something that happened in the dream! This was so wild. The insomnia nights were equally crazy.  I could be wide awake for no reason until 3-4 am or fall asleep normally then wake up at 3 am ready for the day. There was no use fighting it. I had the urge to do something productive during these times, (3am laundry anyone?), but instead finished a book on my iPad. The night feels very long when you are awake! Something tells me I will learn this more after baby is here… maybe this was just preparation.

I had hoped my renewed sense of energy would mean more normalcy in my day-to-day life. Unfortunately, this trimester coincided with a peak in COVID-19 in our area. Given pregnancy is a high-risk condition, I continued my time staying safer at home. It was a huge bummer to think I was wasting some of my best days of the pregnancy stuck at home. The emotional toll of being pregnant during this pandemic is something I will write on another day. Bottom line, it is really sad, and I know I am not along in feeling that it has made this already crazy adventure very tough for pregnant women. I feel a lonely and fearful and grieve the ‘normal’ experiences I should be having like registry shopping and babymoons and baby showers. I know most importantly I am safe and healthy, but still sad for losing the first-time mom pregnancy experiences.  

Physically I started to have a very tiny bump and at 16.5 weeks felt my first flutters of movements. It honestly gave me butterflies.  Such a strange sensation! And although I don’t automatically feel attached to them in a ‘oh hi there’s a human in there’ sort of way, (I am way too practical for that) it definitely hits on the mystical magical spiritual process that is occurring on a deep level. 

Logistically we hit our regular appointments with our OB, had our anatomy scan and the glucose tolerance test. I added in a visit to the dentist for a much overdue cleaning- dental care is super important during pregnancy! Poor dental health can lead to worse outcomes including things like preterm labor. I started my registry- if anyone is interested in what I picked and what I passed on a future post could be devoted to that as well.  I read every website known to womankind as I prepared it, and often went down unnecessary hour-long rabbit holes to learn more about all the things… I guess that is how my Type A pregnancy brain + staying at home passed the time and rationalized what might be ahead in this grand adventure. 

Overall, this trimester has been pretty good. I hate to complain with any negatives as I know how lucky I am, but the reality is everyday still isn’t roses. I still did have days when fatigue would hit or dinner wasn’t happening due to my stomach discomfort. The fullness in my stomach has been one consistency throughout and it is still wild to me that so much more growth still has to happen.  I can’t decide if everything is flying by our creeping along… Even though I am a doctor somedays I just feel in the dark about what is going on with my body and realize my control is gone. Again, likely preparing me for the future with a baby, I guess!  Nothing to do but wait it out, stay as healthy as I can, and allow nature to do its magic.  

See you in the 3rd Trimester! Ah!

My Starting 5 – April 2021

I was supposed to have this published on the fifth of the month, but instead of working over the weekend we took some much needed time off! A mini babymoon night was just what the doctor ordered. It was great to be able to just relax and spend a few moments away to ourselves after such a hectic year. Just wish it was a longer trip!

I am back on my game plan and writing in real time so that I can get you my Starting 5 for the month of April.  As a reminder, the Starting 5 is my list of the top of items or tips/tricks that I am loving and would share with you over the water cooler at work or over wine with my BFFs. There was a great response to last month’s list… (Here!) hoping you find some gems in this one as well. 

Without further ado… the April Starting 5. 

Hypervolt

Hpyerice Hypervolt in gray and black shown zoomed in
Hypervolt with Bluetooth Percussion
  • 2 words: Game Changer. I have experience with these devices as a team doctor and know they can be great. I was trying to come up with a fun Christmas gift for my husband this year and came across an advertisement. I thought he might love it as he gets a little stiff from his workouts mixed with long days standing over the operating room table. So yes, this was actually a gift I bought for him knowing full well I might use it too… #marriage Come to find out, it is a total game changer for me in this pregnancy! I have been using it daily on my hips, low back, glutes etc. My SI joints have been a hot mess since the second trimester and this little nugget has been worth every penny. Note that I did get it on sale for the holiday… so keep an eye out for a deal but knowing how much we both use it I would absolutely pay full price. 

Be Well By Kelly Protein Powder

Be Well By Kelly Protein Powder
  • If you follow me on Instagram (which I hope you do! @sportsdrmorgan) it is no secret I love Kelly Leveque and her nutrition concepts. When she launched her brand of protein powder I needed to test it out. Prior to this, I have used several whey and plant-based powders. Some I still love (Tone it up Peanut Butter is delicious!) but wanted something less processed to use during pregnancy. Enter BWBK Protein. It is extracted in a chemical free manner, is made from grass-fed beef and contains collagen. I choose the vanilla flavor and have been loving it in my morning smoothie. Also, hot tip- you can mix a small amount in almost anything to up the protein. Another current go to: mix a half scoop in all natural PB and spread on an apple as a balanced snack. 

Hatch Belly Oil

Hatch Belly Oil
  • Staying with the pregnancy theme I splurged on the luxurious Hatch Belly Oil. I have been slathering on all the balms and oils and creams I can find to aid in the stretch as my belly grows. Nothing truly prevents stretch marks according to the science, but it sure doesn’t hurt to keep the skin hydrated. The Hatch Belly Oil is pricey, but it lives up to the hype! The smell is soft and pleasant and it dries super fast. I also love applying it because it feels like a little dose of luxury. And in the times of COVID, while pregnant, staying home all the time… there is something to be said for feeling a little luxury in my post-shower routine. 

Getting Dressed

  • Speaking of little luxuries… getting dressed while pregnant isn’t one of them. Nor is getting dressed during a pandemic! Anyone else switched to a 100% sweats and yoga pant wardrobe? Then one day I got dressed. Nothing fancy, just something that made me feel good to wear. I also put on my engagement ring and a splash of makeup. I don’t usually wear my ring when I am home since the majority of the day I find myself doing chores like laundry or washing dishes. That day I noticed immediately I felt better. Putting a small amount of effort can make a huge improvement in your mental wellbeing. Hopefully this is something I can remember to do postpartum as well!  Funny story one day I did ‘full makeup’ for a photo I was taking and when I walked into the bathroom I caught my own reflection in the mirror and literally jumped. I scared myself because I didn’t recognize my own reflection. Haha. Definitely time to step up my day-to-day game for no one except me and my own mental wellbeing. 

Outlet Shopping

  • It is no secret I love a bargain. I needed new bedding for our a new California King size bed. (bed linked here  … I love it!) But I also didn’t want to spend a fortune on the linens. Bedding is important for sleep yes, but my 28lb Frenchie sheds on it. I also needed a few furniture items for our nursey but didn’t want to break the bank.  Baby stuff adds up and is expensive! I will do another post on what we bought for the babe, spoiler alert, you don’t need as much as the registry folks want you to think you do. 
  • After ogling a few of the duvets online from Restoration Hardware I serendipitously found an RH outlet nearby. I did the same for Pottery Barn when hunting for a glider and crib. Here’s the tip. Look for an outlet version of these stores. They sometimes carry ‘scratch and dent’ products, but they also sometimes have perfect returns that cannot be resold. 
  • While in the RH Outlet I stumbled across a pair of Cal king sheets that matched my aesthetic, but no duvets.  I didn’t go to buy sheets. Ugh. I decided to pull them out of the packaging to be sure I didn’t also ‘need’ to buy sheets even though we had just bought two sets… and low and behold it was a DUVET! I was ecstatic. I continued my hunt by searching for shams… but couldn’t find 2 that matched and were the appropriate size. That is until I again opened a package that had been mislabeled. No way, right!  The sales lady was laughing with me by the time I finished. She said the product comes in on large pallets and they cannot look through each in detail. So, if you do venture to find a bargain don’t be afraid to ask to look inside the packaging!
  • While on my Pottery Barn Outlet shopping trip I had another great experience. I had started my search for nursery furniture online, but to my dismay every glider that I did not find hideous was backordered or special order and wouldn’t arrive until months after our due date. Did you know some of these chairs take like 10-20 weeks to produce, let alone ship? The gestation on the chair is as long as on the actual baby. A friend told me to try the PB Outlet as I could take the pieces home the day I purchased. I found the perfect glider in a neutral gray fabric… and while there saw a crib that would work too. We had initially intended on the cheapest crib possible and had considered one from Ikea. But those looked flimsy in person and I was concerned about function.  I also did a deep dive into crib and nursery safety one afternoon (working from home = lots of deep dives into the internet baby space) and I found out about Greengold Certification and the chemical free nature of the products from PB. This was a win win. We got our glider and crib, and I grabbed a stuffed lamb toy to add to the mix. All in all, we saved money and were able to get them set up in the nursery in plenty of time. 

Ski Season.

The cold winter air on your face, fresh powder under your feet, stillness of the wilderness… Whether you tackle the slope on skis or a snowboard nothing quite compares to the feeling of that first run of the day. But as with all sports, injuries can ruin what started as the perfect alpine morning.  Read on to learn about the most common issues snow seekers face and what can be done to stay as safe as possible. 

Common Injuries

For winter sports enthusiasts of the skiing type, the most prevalent injury is in the knee.  With the feet and ankles locked in a hard sided ski boot, the force is directed to the knees means when you fall on the slope.  This force can cause a variety of knee issues, one of the most feared is the ACL Tear (which I wrote about in depth here… LINK), but you can also injure other areas including ligaments such as the MCL or LCL, the menisci, or even the bones (femur/tibia) as they join at the knee.  

For snowboarders, knee injuries can also occur. However, given the orientation of the board on the slope and the single-sled positioning (feet both fixed to the same board), the most common area injured is the wrist. When a snowboarder starts to fall, they instinctively reach for the ground causing injuries ranging from minor sprains to fractures of the wrist bones. 

For all alpine lovers, injuries to the shoulder can also occur.  During a fall you can easily land on your shoulder or outstretched arm causing injuries to the tendons, muscles, or ligamentous structures in and around the shoulder. Shoulders can stretch out of place (subluxate), dislocate, or break with this mechanism. 

Other areas of the body are also prone to injury from a fall on the slope including the hips, spine, and chest wall. 

The most traumatic snow sport related injuries are those to the head or neck. For experienced and novice skiers alike, barreling down a slippery slope can be hazardous. Conditions that make this worse are crowded areas and other obstacles like trees or rocks.  Hitting another person or a tree can have devastating consequences as can your head on the hard packed snow.  Injuries can range in severity from concussion  to bleeding or fractures to severe traumatic brain or spinal cord injuries.

How to stay safe

Staying safe on the slopes makes for a much better day then ending a run with an injury.  

My recommendations: 

1- know your limits and the trail maps

2- train before you ski

3- save the alcohol for the après

4- wear a helmet, always

1. Know your limits

Staying safe on the slopes requires a level of understanding of what you are getting yourself into as well as a knowledge your ability. If you are a beginner or novice, look at the trail map ahead of time and stick with the runs appropriate for your skill level. You are not competing for a spot on the Olympic team… Even if you are more advanced, remember to avoid putting yourself in a position where you feel out of control.  The number one reason I see patients in the office with an injury is getting themselves into an uncomfortable position.  If you end up in this scenario, it is best to stop and ask for help. Ski patrol is always available to keep you safe.  They would much rather help you down the slope than find you injured. 

Another great tip is to take a lesson. No matter how advanced of a skier you are, lessons can be extremely helpful! During my last ski trip, I took a lesson, and it was worth every penny. The instructor was a true gem, helping me (more novice) and my husband (more intermediate) at the same time by challenging each one of our levels safely.  He was so great that when he ran into us the next day while skiing with his daughter, he skied with us for a bit for follow up tips.  These instructors live for skiing, know the terrain, and know how to teach you to be better. Everyone can learn!

2. Train before you go

If you were going to run a half marathon you wouldn’t just show up race day and expect to finish without problems.  Same goes for snow sports. Even if you are in great physical shape at baseline, some activity specific training can be beneficial.  Skiing and snowboarding are physically demanding sports. You need strong legs, great control of your upper and lower body, and stamina to survive the day.  I can’t count the number of patients who describe their injury as something like, “I was tired, out of control and crashed but can’t remember what actually happened.” Don’t be that person. 

3. Save the Après

Ah yes, the time-honored tradition of that first amazing post-ski après beverage at the lodge. It may be my favorite part of the ski day.  However, studies have shown that alcohol increases the risk of injury for both skiers and snowboarders. (As does any illicit/mind-altering substance use). Save the après festivities for after you are done skiing for the day. 

4. Wear a helmet, always

This one cannot be stressed enough. Head injury can be a devastating outcome of a crash on the slopes. No matter how well you ski, a fall can still happen. It is sort of like driving, even if you drive perfectly, someone else can hit you or cause you to crash. So, we were seatbelts, right? Wear a helmet every time you ski or snowboard. Protect your skull and brain and decrease your risk of tragic outcomes. 

If an injury occurs

Ski patrol is always available for injured skiers. They are all over the mountain and at the base, and most resorts employ trained medical staff. Some even have physicians available. Every ski town I have been to has a local urgent care as well with a team that is used to seeing slope related injuries. If you need follow up after a day on the slopes for a bone, muscle or joint problem seek out your local sports medicine orthopedist. It is always helpful to bring any images (Xray’s, MRI’s, etc…) that were taken on the slopes or after.

And of course, enjoy the snow!

Orthopaedic Injuries of Pregnancy

It is no secret that pregnancy comes with a host of changes for your body. These changes allow you to accommodate making a new life but also can put you at risk for musculoskeletal issues along the way.  This is often because of some combination of loosening of ligaments due to hormones, changes in the center of gravity due to your new “bump”, added weight in general, and increases in overall body stress.

Most common Issues I see in practice:

#1 Injuries from a Fall:

As a specialist, I usually see a patient when they hurt something that needs further investigation.  Injuries happen to even the healthiest of pregnant patients.  One of the most common I see is an ankle sprain (see my full post here on all things ankle sprains) Pregnant patients often feel unbalanced.  A movement as simple as stepping off a curb awkwardly can lead to an ankle injury. The great news is the treatment for ankle sprains during pregnancy is very similar to the average patient, and most do very well without long term issues. 

Another common injury from a fall is a broken kneecap (patella).  Again, these tend to happen because of being a little off balance.  With a slip or fall, you can land directly on the knee causing the patella to break. This is painful! The injury is not usually subtle and makes it difficult to stand or walk.  X-rays will show us the problem, and sometimes the problem needs to have surgery to fix, but often you can get better with a period of resting your leg in a straight position. Though keeping your leg fully straight for weeks is not easy while pregnant… something I appreciate even more now that I am pregnant! But my patients have made it through, and you will too! 

Other broken bones can also happen during pregnancy from falls. The second most common fracture in my practice is a broken wrist. When you start to fall you naturally reach for the ground to brace yourself. Unfortunately with this motion, you can land on your outstretched hand break a bone in your wrist called the distal radius. Again, sometimes these need to be fixed with surgery. The ones that do not are treated in a cast for several weeks. Being in a wrist cast while pregnant also seems absolutely no fun, but it is achievable and safe.  Keep in mind these things can happen in pregnancy (just like outside of it), and orthopedic doctors are trained to do what is best to make sure your bones heal well, and your pregnancy stays safe. It is key to let your OB know if you have had a fall or are seeking care with another doctor. This allows us to all work together to be sure we are optimally treating you and keeping everything as pregnancy safe as possible.

#2 Aches and Pains

Ah yes, the joys of pregnancy…  Sometimes if feels like everything hurts whether you move or sit still! Joint pains, achy muscles, and stiffness all over are very common.  Muscle imbalance mixed with a growing belly often leads to a very common complaint, back pain.  It is estimated that 50-80% of patients experience back pain during pregnancy (2). Other super common areas of pain are the hips/pelvic girdle, knee, and neck. Most of this can again be attributed to the normal changes that occur during pregnancy, and keeping active throughout is the absolute best way to keep these issues at bay.  

#3 Wrist and Hand issues

Again attributed to the changes of pregnancy, wrist and hand pain is also very common. One specific condition that plagues pregnant patients is carpal tunnel syndrome.  This condition usually experienced as hand numbness and tingling in the thumb, index and middle fingers and has been estimated to occur in up to 62% of women who are pregnant (1). Great news, this most often resolves on its own after delivery. Until then, stretches and braces for the wrist usually help relieve the symptoms. 

How to stay safe:

First and foremost, listen to your body! The changes of pregnancy alter so much about your function and physiology. You should avoid risky activities where falling could occur, be careful on wet ground and ice, and always be extra vigilant of where you are walking. Stepping off a curb requires attention as does hurrying across a street or walking on a dirt road/path. Be careful! 

Another great tool is a daily body “check in” to see how you are feeling. Is your back tighter today? How do those hips feel? If you can catch an ache or pain early before it becomes severe, you can likely fix it faster. Add in stretches or targeted exercises for your problem areas, and keep moving throughout pregnancy.  Another tip is to remember to take a break if you are sitting for a prolonged period. This helps keep your body from becoming stiff.  It is important to avoid heavy lifting, and be sure you are using proper techniques to lift with your legs (not your back) to stave off further back pains and injuries.  Avoid reaching far away from your body as much as possible to keep your center of gravity stable.  Sadly, since your balance is a little off, retiring your high heels short term is the safest thing to do. 

As always on this website I preach an overall healthy, active lifestyle. In pregnancy this doesn’t change! If anything, it means more focus on these techniques to keep you fit as everything changes. Daily stretching, strengthening, and cardiovascular exercise help keep your body healthy and strong all pregnancy long. This helps you avoid injuries, keeps a better mind-body connection to avoid falls, and keeps aches and pains away.

Finally, what to do if you have pain or get hurt:

First, think about the severity (how bad is it?). If on your daily body check you noticed some general soreness and aches and pains, start with easy-to-do changes at home. Sit in a more proper position while working, remember to take standing breaks, and be sure you are getting proper exercise and stretching.  Always keep in mind your daily routine and that you may need to change something if your body is aggravated by these activities. Also, as always, talk to your OB! Bring up these concerns at appointments or even before if you feel they are significant.  Many small aches and pains are common and not a big deal, but you should always discuss with your doctor to be sure something further doesn’t need to be evaluated. Also know that even for general aches and pains, sometimes braces or other supports can be used to ease the discomfort.  Sometimes your doctor may recommend a pregnancy-safe medication such as Tylenol or even refer you to physical therapy to aid in your recovery.

If you have a larger amount of pain related muscle or joints or if you have had a sudden injury, an urgent/emergency evaluation is the way to go. You should also absolutely reach out to your OB as they can work with your orthopedic team to be sure you are optimally treated as a whole by coordinating specific recommendations based on pregnancy. If you need an X-ray, don’t panic. You can use a shield, and the doctor will do everything possible to keep you safe by only taking x-rays that are necessary to treat you properly. Trust your doctor, and ask questions along the way. I never feel bad when a pregnant patient asks about the necessity of a test or treatment. 

Sources:

1. https://pubmed.ncbi.nlm.nih.gov/19753825/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306025/

3. https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/back-pain-during-pregnancy.html

My Starting 5 – March 2021

I enjoy reading ‘Things I love’ posts from bloggers, but they sometimes feel overly sponsored and materialistic. That said, I love seeing the true gems others find. Enter: My Starting 5. These are the 5 things this month that I am totally into. They might be items I love, but I also want to focus on fun experiences or useful tips.   Think of it as the former chats about the latest gadget with a coworker or the tip your BFF gave you over dinner.

It also goes without saying none of this is sponsored because well, no one sponsors me. If that ever changes I will update accordingly. 

Without further ado, the March Starting 5!

Breville Smart Oven Air

Our new Toaster Oven
  • Let me back up… I contemplated adding a toaster to our wedding registry.  The one we used I swear my husband had in college! After reading some reviews I was drawn to the idea a toaster oven instead.  Basically, why have a toaster that literally is an appliance for 1 thing- toast bread?  The toaster oven which does all sorts of things. Right before we made the move to Phoenix I saw this little gem on sale. And when I thought about turning a real oven on to cook in the 115 degree desert heat it seemed worth trying. Let me say, it may be my favorite adult purchase EVER.  Seriously this thing is genius. It toasts, roasts, air fries, bakes and the convection feature makes it heat up so fast without heating the whole house. Literally almost zero preheat time. I think I lived here a month before I even had to turn the real oven on… and that was Thanksgiving when I was using BOTH the toaster oven and real oven.  Simply genius. 

Simple Modern Tumblers

Best Tumbler
  • I mentioned in my 1st trimester post (linked here) that I really had to focus on upping my hydration game during pregnancy. These cups made it happen. I love the neutral colors and size.  I filled it with extra cold water (which it keeps maintains temperature on very well) and thanks to the nifty straw I can chug it down easily. Bonus tip for staying hydrated- every time you take a drink think about 10 big gulps. Boom, you are on your way to hydration.  I use a free app on my phone to track the volume I drink (Water Llama) and know if by noon I am 2-3 fill-ups in I am on track.  I bought my first one at Target… and also they have them on Amazon. 

New Planner

My new 2021 Planner
  • Ah Amazon how I hate to love you so much.  At the start of 2021 I was looking for a simple monthly calendar to help keep this website and instagram on track. Everyone says you need a content calendar (still learning all these things…) but being a visual person I hoped it would help me see everything together.  Most calendars I used before were too busy and had too much space for things I didn’t need (birthdays and to-do’s, etc-  I keep those on my online calendar). Enter this planner from Amazon.  It is thin and simple has just enough space to layout my ideas for the weeks and months ahead.  I have never felt more organized in my content planning. Now time to execute! 

 Podcast Walks

  • That first trimester is a doozy! Nearly all my exercise came from walks in the neighborhood. I have always loved podcasts but found a new appreciation for them while on these walks, and also while working from home and needing a source of stimuli other than my computer screen. Or Francis snoring on the couch. I have been catching up on Oprah’s super soul, re-listening to old favorites from How I Built This, for a short burst I enjoy The angry therapist, and recently have following Be well by Kelly. 

Sunday Pizza Night

  • The Sunday pizza night tradition started in LA when I first moved in with my husband.   And it is one of my favorite easy traditions we have maintained.  It works for several reason.  First, who doesn’t love pizza?  Second, I love having one night a week I never have to think about what to make for dinner.  Our routine is to order a giant salad to split and pizza to share.  After relocating to Phoenix we found ourselves deep in the largest pizza scene I have ever seen (Thrillist Best Pizza Phoenix) . And although I miss my beloved Manhattan Beach Pizza in Southbay— the fact that we can find a wood fire/artisan/special pizza place on every corner certainly helps.  We have tried a new one almost each week! I don’t see this tradition ending any time soon. If you want to try one but don’t live locally… goodbelly.com actually delivers Pizza Bianco nationally. Crazy, right.  If you end up in Phoenix we also love Cibo, The Parlor, and Base Pizzeria.