From the News section of the Tuesday, January 29, 2008, Toronto Star, page A4, an article about the link between air pollution and heart problems:
TAKING AIR QUALITY TO HEART
Fine particulate pollution is causing cardiac disease, expert says as Ontario fails to meet standards
Joseph Hall
Health Reporter
There is growing evidence that chronic exposure to air pollution levels common in places such as Toronto may be causing heart disease in otherwise healthy people, a top cardiac researcher said yesterday.
While the harmful effects of air pollution on people with pre-existing heart conditions has been well documented, persistent exposure to bad air may be causing cardiac diseases in those with no other risk factors, University of Michigan cardiologist Robert Brook says.
Brook, one of the first researchers to link air pollution with cardiac deaths, was speaking after a Canadian Heart and Stroke Foundation news conference in Toronto, during which the group gave Ontario a failing grade in a new report card on pollution and heart health.
Ontario joined Quebec and parts of the British Columbia interior as the three areas in Canada where fine particle pollution perodically exceeded acceptable air quality levels over a three-year period.
Air pollution, especially fine particulate exhaust from factories and cars, is believed to cause some 6,000 deaths in Canada each year, with about 70 per cent of those linked to existing cardiovascular diseases.
But Brook, who spoke as a pollution expert at the conference, said there is growing evidence dirty air may be having long-term heart effects on young, fit people.
"There are studies ... that show that there may be a cumulative long-term effect of being exposed over a lifetime or over many years," he said in an interview.
Indeed, one major study of women in several American cities published last year showed pollution may increase the risk of heart disease in healthy people by as much as 76 per cent, Brook says.
He says animal studies have also shown that exposure to pollution can cause hardening of the arteries, high blood pressure and diabetes, all of which are risk factors for heart disease and stroke.
As well, Brook says, several studies have recently linked atherosclerosis - hardening of the arteries - in humans to high pollution levels.
"We need to see if air pollution is not only acting like a trigger to (kill) people who would have died in the next few days, or the next few years or weeks, but is shifting the risk of dying for the whole population."
Dr. Beth Abramson, a national foundation spokesperson, warned that high pollution levels were in no way confined to the industralized or heavily trafficked areas where the dirty air is generated.
She says the fine particle pollution that is most worrisome to heart specialists can travel as far as 8000 kilometres from its source.
"Air pollution is a pervasive and unavoidable health risk for heart disease that all Canadians face," Abramson says. "Most are unaware of its short- and long-term impact."
Abramson urged governments to make concerted efforts to cut pollution levels, through such things as better urban planning and increased public transit funding. She also urged people to forgo the car and walk or bike to work and other destinations as often as possible.
Those with known heart conditions, however, should keep an eye on daily air quality reports and avoid outside exercise when pollution levels are high.
The foundation also unveiled a new poll that showed only 13 per cent of Canadians have made the connection between pollution and cardiovascular disease.
In grading the various provinces and areas in Canada, the foundation looked at recorded levels of fine particulate matter that was 2.5 micrometres in diameter- about one fiftieth the diameter of a human hair- or smaller.
Particles this size, known as PM 2.5, can enter your lungs and blood stream, where their inflammatory effect on arterial walls may be responsible for aggravating or causing heart conditions.
Any province that recorded average PM 2.5 levels about 30 on any given day in a year, were given an F grade by the foundation.
Environment Canada has set a PM 2.5 level of 30 or lower as the standard for acceptable air quality.
Tuesday, February 19, 2008
Saturday, February 9, 2008
Trash as a Health and Environmental Hazard
In Naples, Italy, the way trash has been dealt with has caused health hazards - increased cancer rates - in people who live there, and an unpleasant smell for residents and tourists to deal with. From the World & Comment section, Toronto Star, Friday, January 18, 2008, pages AA, AA3:
TRASH LINKED TO HIGH CANCER RATE IN NAPLES' 'TRIANGLE OF DEATH'
Residents in the southern Italian city say years of illegal dumping and burning is poisoning them
Robin Pomeroy and Laura Viggiano
Reuters News Agency
Naples - Piles of trash building up in Naples have filled the air with a putrid stench and spoiled the view for tourists, but the city's waste crisis is also blamed in some deaths.
Standing in the barricades erected by local people to stop the authorities from reopening an old landfill in the Pianura neighbourhood, Salvatore Mele, whose son died of cancer, believes the illness was caused by pollution from trash. "I lost him when he was 21,"Mele said.
Besides fouling the port city's image and adding to risks to the Mediterranean from sewage and pollution, the waste in some are associated with higher death rates and certain types of cancer, studies have shown.
A government-appointed former police chief has been given army backup for a four-month quest to end the crisis, but local residents say years of illegal dumping is poisoning them.
"My mum got sick in 2004. We just had time to find what was wrong before she died, 15 days later, of a breast cancer. My father's sister died of the same thing a year later," said Pina Mangiapia, a 38-year-old housewife on the Pianura barricades.
Mangiapia blames the waste dump for three cancer deaths in the familiy, for the melanoma her husband had removed from his leg, and for her four-year-old son's chronic dermatitis.
Scientists say it can be difficult to assess the extent to which pollution is to blame for illnesses also provoked by genetic, soci-economic and lifestyle factors.
But there is proof that parts of Naples and its hinterland, in the shadow of the volcano Mount Vesuvius, have been steadily contaminated by decades of illegal waste dumping and burning.
Medical journal Lancet Oncology in 2004 dubbed part of the Campania region, of which Naples is the capital, "the triangle of death" because the air, soil and water are polluted by high levels of cancer-causing toxins believed to have come from waste.
Research released last year by Italy's National Research Council found that among people living closest to the least-regulated waste-disposal sites - where trash is dumped in fields or burned without any controls - the mortality rate was 12 percent greater than the norm for 2o men and 9 per cent greater for men.
Fatal liver cancers were much more common - up 29 per cent for women and 19 per cent for men in the most at-risk areas - and there were huge increases in congenital malformations of the nervous and urinary systems.
While more than half the places studied in the area did not show abnormal health problems, the study implies a significant health risk for those living in the worst areas.
"First we need to make the dumps safe, close them off, properly gather the bio-gas and control the runoff," said Fabrizio Bianchi, who conducted the research. "We have to get out of this crisis."
Naples' failure to deal with its household waste hit crisis point at the end of December when all rufuse collection stopped as waste dumps had reached capacity, leaving people with no choice but to throw it onto the streets.
Like many in and around the "triangle of death," those in Pianura say their council-run landfill was not properly managed and became a tipping site for hazardous waste.
But an even bigger source of pollution is the Camorra, the Naples organized crime syndicate that runs lucrative line in dumping and burning rubbish illegally.
Mre than domestic trash, the Camorra focuses on disposal of industrial waste which it brings to Campania from Italy's rich north - one of a string of crimes against the environment earning the mafia estimated $9 billion a year.
"The Camorra continues to control the cycle of industrial waste that comes from the north of Italy,"said Michele Buonomo of Legambiente, a campaign group which closely monitors the Camorra.
TRASH LINKED TO HIGH CANCER RATE IN NAPLES' 'TRIANGLE OF DEATH'
Residents in the southern Italian city say years of illegal dumping and burning is poisoning them
Robin Pomeroy and Laura Viggiano
Reuters News Agency
Naples - Piles of trash building up in Naples have filled the air with a putrid stench and spoiled the view for tourists, but the city's waste crisis is also blamed in some deaths.
Standing in the barricades erected by local people to stop the authorities from reopening an old landfill in the Pianura neighbourhood, Salvatore Mele, whose son died of cancer, believes the illness was caused by pollution from trash. "I lost him when he was 21,"Mele said.
Besides fouling the port city's image and adding to risks to the Mediterranean from sewage and pollution, the waste in some are associated with higher death rates and certain types of cancer, studies have shown.
A government-appointed former police chief has been given army backup for a four-month quest to end the crisis, but local residents say years of illegal dumping is poisoning them.
"My mum got sick in 2004. We just had time to find what was wrong before she died, 15 days later, of a breast cancer. My father's sister died of the same thing a year later," said Pina Mangiapia, a 38-year-old housewife on the Pianura barricades.
Mangiapia blames the waste dump for three cancer deaths in the familiy, for the melanoma her husband had removed from his leg, and for her four-year-old son's chronic dermatitis.
Scientists say it can be difficult to assess the extent to which pollution is to blame for illnesses also provoked by genetic, soci-economic and lifestyle factors.
But there is proof that parts of Naples and its hinterland, in the shadow of the volcano Mount Vesuvius, have been steadily contaminated by decades of illegal waste dumping and burning.
Medical journal Lancet Oncology in 2004 dubbed part of the Campania region, of which Naples is the capital, "the triangle of death" because the air, soil and water are polluted by high levels of cancer-causing toxins believed to have come from waste.
Research released last year by Italy's National Research Council found that among people living closest to the least-regulated waste-disposal sites - where trash is dumped in fields or burned without any controls - the mortality rate was 12 percent greater than the norm for 2o men and 9 per cent greater for men.
Fatal liver cancers were much more common - up 29 per cent for women and 19 per cent for men in the most at-risk areas - and there were huge increases in congenital malformations of the nervous and urinary systems.
While more than half the places studied in the area did not show abnormal health problems, the study implies a significant health risk for those living in the worst areas.
"First we need to make the dumps safe, close them off, properly gather the bio-gas and control the runoff," said Fabrizio Bianchi, who conducted the research. "We have to get out of this crisis."
Naples' failure to deal with its household waste hit crisis point at the end of December when all rufuse collection stopped as waste dumps had reached capacity, leaving people with no choice but to throw it onto the streets.
Like many in and around the "triangle of death," those in Pianura say their council-run landfill was not properly managed and became a tipping site for hazardous waste.
But an even bigger source of pollution is the Camorra, the Naples organized crime syndicate that runs lucrative line in dumping and burning rubbish illegally.
Mre than domestic trash, the Camorra focuses on disposal of industrial waste which it brings to Campania from Italy's rich north - one of a string of crimes against the environment earning the mafia estimated $9 billion a year.
"The Camorra continues to control the cycle of industrial waste that comes from the north of Italy,"said Michele Buonomo of Legambiente, a campaign group which closely monitors the Camorra.
Friday, February 8, 2008
Cosmetics and Cellphones
From the Toronto Star, Living section, Tuesday, January 15, 2008, pages L, L2, an article about the underlying health risks and environmental causes of cancer.
Cancer-Causing Agents
SUSPECTS AT LARGE
What do cosmetics have in common with cellphones? They both worry a leading cancer scientist about their potential as health risks
Nancy J. White
Living Reporter
First off, Devra Davis won't do the interview on her cellphone.
Call me back on the land line, she instructs. It's not the money she's concerned about. It's the microwaves.
She's also concerned about drinking diet pop, wearing a lot of cosmetics and eating non-organic red meat.
But make no mistake: she's not some trendy health-scare type. She's a blue-chip cancer epidemiologist, director of the Center for Environmental Oncology at the University of Pittsburgh Cancer Institute with a Grade A scientific pedigree: a PhD from the University of Chicago, a decade at the National Academy of Sciences, an author of more than 170 published articles.
And she's worried about her environmental exposure to cancer.
"Everyone has to start where they're comfortable, taking control of their own homes," says Davis, who will be the keynote speakter at Women's College Hospital's health forum Friday. "Then they have to make sure they vote for politicians who understand the importance of this issue."
This issue is how we've let modern life, from the air we breathe to the products we use, poison our bodies.
"We've made remarkable progress in treating some forms of cancer," says Davis, 61. "But if we only improve our ability to find and treat the disease, without dealing with the underlying causes, we will not have made enough progress."
In her newest book, The Secret History of the War on Cancer, Davis argues that the long march against cancer has been misled too often by corporate interests and sidetracked by missed opportunities.
In 1936, more than 200 of the world's top cancer scientists convened in Brussels, a gathering of the best minds to create a new way forward in understanding and fighting the disease. When Davis unearthed the transcripts of those meetings, she was stunned to read how much those scientists knew about cancer's social and environmental causes.
Many widely used agents of the time, including ionizing and solar radiation, arsenic, benzene, asbestos, synthetic dyes and hormones, were recognized as cancerous in humans, she writes.
This knowledge came from researchers combining autopsies with medical, personal and workplace histories of cancer victims and conducting animal lab studies.
However, she says, these finds didn't seep into the mainstream medical practice of the day, due, in part, to the scant media coverage given scientific meetings back then. But mainly it was the timing, the brink of World War II. "The world had very different priorities," says Davis.
"Cancer is the ultimate long-term disease. To be concerned about cancer implies a certain optimism in the future."
In 1971, U.S. President Richard Nixon declared war on cancer, reflecting the idea that the type of ingenuity that built the A-bomb and put a man on the moon could wipe out cancer within the decade.
Rocket engineers from NASA held meetings ith medical researchers, setting up charts with overlapping diagrams and lots of arrows, mapping out how the war on cancer should be conducted, writes Davis. Most serious researchers viewed the idea of a single cure as preposterous, a political fuss, she says.
The war did not take aim at any of the known or suspected carcinogrens. Not even tobacco smoking, which the U.S. surgon general had declared a cause of cancer in 1953.
"There were very close ties between the tobacco industry and, later the chemical industry, and the development of the war on cancer," she says.
Today, the emphasis is not so much on declaring war aginst cancer as it is dealing with a chronic condition, says Davis. "We need to make changes in the infrastructures of our lives that will hep reduce the risks."
She's most worried about air pollution, such as emissions from coal-fired plants and growing vehicle traffic, that's distributed across the population. "It's important for people to understand tht the burning of fossil fuels that's warming the Earth is the same process increasing our health risks, including cancer in the long term.
There are several other issues that concern her, particularly because health officals aren't paying much attention to them:
Cellphones - New data from Sweden, she says, shows that people using cellphones for 10 years or more double the risk of brain cancer. She's worried about kids under 16 glued to their cellphones. "Would you let your child play Russian roulette?" she asks.
Aspartame - The artificial sweetener's negative effects in animal studies occurred in the last third of the creatures' lives, which corresponds to human beings in their 60s to 80s. Again, she is especially concerned about children consuming the product over many decades.
The doses that induced cancer in animals, she says, were not especially high: about two cans of diet pop, two yogurts and a couple of sticks of gum a day.
Diagnostic radiation - The medical community is becoming increasingly concerned about unnecessary Computed Tomography scans of children, she writes. A CT scan of a child's stomach can be equivalent to 600 chest X-rays and one of an infant's head may equal a few thousand.
While a CT scan may well be warranted in a medical emergency, she says, repeated follow-up scans may not be a wise idea.
Ritalin - Several papers have indicated that Ritalin, valuable for treating Attention Deficit Disorder, might pose a risk to the user's genetic makeup, says Davis. In one study researchers tested the blood of a dozen children before and after they were put on the drug, she writes, and found chromosome damage after three months' use.
Davis cautions that the numbers tested were small, no direct link to Ritalin was found and genetic damage and repair happens all the time. But given the widespread use of the drug in children, she says, governments and the private sector need to further investigate.
Overall, Davis believes the growing awareness of global climate change is sparking more concern about environmental health.
'The connection is obvious," she says.
"We only have one planet."
Cancer-Causing Agents
SUSPECTS AT LARGE
What do cosmetics have in common with cellphones? They both worry a leading cancer scientist about their potential as health risks
Nancy J. White
Living Reporter
First off, Devra Davis won't do the interview on her cellphone.
Call me back on the land line, she instructs. It's not the money she's concerned about. It's the microwaves.
She's also concerned about drinking diet pop, wearing a lot of cosmetics and eating non-organic red meat.
But make no mistake: she's not some trendy health-scare type. She's a blue-chip cancer epidemiologist, director of the Center for Environmental Oncology at the University of Pittsburgh Cancer Institute with a Grade A scientific pedigree: a PhD from the University of Chicago, a decade at the National Academy of Sciences, an author of more than 170 published articles.
And she's worried about her environmental exposure to cancer.
"Everyone has to start where they're comfortable, taking control of their own homes," says Davis, who will be the keynote speakter at Women's College Hospital's health forum Friday. "Then they have to make sure they vote for politicians who understand the importance of this issue."
This issue is how we've let modern life, from the air we breathe to the products we use, poison our bodies.
"We've made remarkable progress in treating some forms of cancer," says Davis, 61. "But if we only improve our ability to find and treat the disease, without dealing with the underlying causes, we will not have made enough progress."
In her newest book, The Secret History of the War on Cancer, Davis argues that the long march against cancer has been misled too often by corporate interests and sidetracked by missed opportunities.
In 1936, more than 200 of the world's top cancer scientists convened in Brussels, a gathering of the best minds to create a new way forward in understanding and fighting the disease. When Davis unearthed the transcripts of those meetings, she was stunned to read how much those scientists knew about cancer's social and environmental causes.
Many widely used agents of the time, including ionizing and solar radiation, arsenic, benzene, asbestos, synthetic dyes and hormones, were recognized as cancerous in humans, she writes.
This knowledge came from researchers combining autopsies with medical, personal and workplace histories of cancer victims and conducting animal lab studies.
However, she says, these finds didn't seep into the mainstream medical practice of the day, due, in part, to the scant media coverage given scientific meetings back then. But mainly it was the timing, the brink of World War II. "The world had very different priorities," says Davis.
"Cancer is the ultimate long-term disease. To be concerned about cancer implies a certain optimism in the future."
In 1971, U.S. President Richard Nixon declared war on cancer, reflecting the idea that the type of ingenuity that built the A-bomb and put a man on the moon could wipe out cancer within the decade.
Rocket engineers from NASA held meetings ith medical researchers, setting up charts with overlapping diagrams and lots of arrows, mapping out how the war on cancer should be conducted, writes Davis. Most serious researchers viewed the idea of a single cure as preposterous, a political fuss, she says.
The war did not take aim at any of the known or suspected carcinogrens. Not even tobacco smoking, which the U.S. surgon general had declared a cause of cancer in 1953.
"There were very close ties between the tobacco industry and, later the chemical industry, and the development of the war on cancer," she says.
Today, the emphasis is not so much on declaring war aginst cancer as it is dealing with a chronic condition, says Davis. "We need to make changes in the infrastructures of our lives that will hep reduce the risks."
She's most worried about air pollution, such as emissions from coal-fired plants and growing vehicle traffic, that's distributed across the population. "It's important for people to understand tht the burning of fossil fuels that's warming the Earth is the same process increasing our health risks, including cancer in the long term.
There are several other issues that concern her, particularly because health officals aren't paying much attention to them:
Cellphones - New data from Sweden, she says, shows that people using cellphones for 10 years or more double the risk of brain cancer. She's worried about kids under 16 glued to their cellphones. "Would you let your child play Russian roulette?" she asks.
Aspartame - The artificial sweetener's negative effects in animal studies occurred in the last third of the creatures' lives, which corresponds to human beings in their 60s to 80s. Again, she is especially concerned about children consuming the product over many decades.
The doses that induced cancer in animals, she says, were not especially high: about two cans of diet pop, two yogurts and a couple of sticks of gum a day.
Diagnostic radiation - The medical community is becoming increasingly concerned about unnecessary Computed Tomography scans of children, she writes. A CT scan of a child's stomach can be equivalent to 600 chest X-rays and one of an infant's head may equal a few thousand.
While a CT scan may well be warranted in a medical emergency, she says, repeated follow-up scans may not be a wise idea.
Ritalin - Several papers have indicated that Ritalin, valuable for treating Attention Deficit Disorder, might pose a risk to the user's genetic makeup, says Davis. In one study researchers tested the blood of a dozen children before and after they were put on the drug, she writes, and found chromosome damage after three months' use.
Davis cautions that the numbers tested were small, no direct link to Ritalin was found and genetic damage and repair happens all the time. But given the widespread use of the drug in children, she says, governments and the private sector need to further investigate.
Overall, Davis believes the growing awareness of global climate change is sparking more concern about environmental health.
'The connection is obvious," she says.
"We only have one planet."
Saturday, February 2, 2008
Reyes Syndrome and Avoiding Giving ASA (Aspirin) to Children, Teenagers & Young Adults
From the Health Canada website, http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/reye_e.html, information about Reyes Syndrome and the necessity of refraining from giving ASA (aspirin) to children, teenagers and young adults as ASA is linked to Reyes Syndrome for these groups:
The Issue
Reye's Syndrome (RS) is a rare disease that affects mainly children or teenagers during a viral illness, such as chicken pox or influenza. It can be fatal. The use of ASA (Acetylsalicylic Acid) has been strongly linked with the development of RS.
Symptoms - What to do
The symptoms of RS may include:
- Lingering or returning symptoms of the original illness
- Personality changes such as hyperactivity, aggression, confusion and anxiety
- Frequent vomiting and/or dry-heaving, convulsions and delirium, possibly leading to a coma
If your child gets any of these symptoms, call your doctor immediately or go to your hospital's emergency department. RS is fatal in 20 to 30 percent of all cases, and can cause permanent brain damage in those who survive.
Often, victims get RS just as they appear to be recovering from the original illness. The use of ASA to treat the original illness is strongly connected to the development of RS. However, in rare cases, RS occurs without ASA being taken. We don't know how ASA triggers RS, nor why it primarily affects children, teenagers and young adults.
Protecting Against Reye's Syndrome
Both government and manufacturers have taken action to educate the public about RS. Regulations under the Food and Drugs Act now require manufacturers to label all over-the-counter products that have ASA with a warning about the dangers of giving ASA to a child or teenagers. ASA products are given to children only for relief of pain and not for fever.
The Food and Drugs Act regulations do not allow products containing ASA to be advertised for use by children or teenagers.
Minimizing the Risk of Reye's Syndrome
If your child has a fever, there are other things you can do to bring down the temperature.
- Give your child plenty of liquids to drink, preferably water, flat ginger ale, diluted apple juice or other sugared drinks.
- Avoid milk, carbonated drinks and tart drinks such as orange, cranberry and grapefruit juice. They might upset the child's stomach.
- Remove any extra covers and clothing and keep the room temperature around 18 degrees Celsius (about 64 degrees Fahrenheit).
- Bathe or sponge the child with lukewarm water.
- Use other drugs that help relieve fever, such as acetaminophen.
- If the fever does not come down, consult your family doctor.
- Never try to treat a feverish child under a year old without the advice of your doctor.
- Never give any drug containing ASA to a child, particularly if he or she has the flu or chicken pox, before consulting your doctor.
- Make sure that teenagers are also aware of the dangers of RS and how to prevent it.
The most important thing to remember is that some common symptoms are signs of more serious illnesses. If any symptoms last for more than two days or become worse, call your doctor.
Date Modified: 2006-12-07
The Issue
Reye's Syndrome (RS) is a rare disease that affects mainly children or teenagers during a viral illness, such as chicken pox or influenza. It can be fatal. The use of ASA (Acetylsalicylic Acid) has been strongly linked with the development of RS.
Symptoms - What to do
The symptoms of RS may include:
- Lingering or returning symptoms of the original illness
- Personality changes such as hyperactivity, aggression, confusion and anxiety
- Frequent vomiting and/or dry-heaving, convulsions and delirium, possibly leading to a coma
If your child gets any of these symptoms, call your doctor immediately or go to your hospital's emergency department. RS is fatal in 20 to 30 percent of all cases, and can cause permanent brain damage in those who survive.
Often, victims get RS just as they appear to be recovering from the original illness. The use of ASA to treat the original illness is strongly connected to the development of RS. However, in rare cases, RS occurs without ASA being taken. We don't know how ASA triggers RS, nor why it primarily affects children, teenagers and young adults.
Protecting Against Reye's Syndrome
Both government and manufacturers have taken action to educate the public about RS. Regulations under the Food and Drugs Act now require manufacturers to label all over-the-counter products that have ASA with a warning about the dangers of giving ASA to a child or teenagers. ASA products are given to children only for relief of pain and not for fever.
The Food and Drugs Act regulations do not allow products containing ASA to be advertised for use by children or teenagers.
Minimizing the Risk of Reye's Syndrome
If your child has a fever, there are other things you can do to bring down the temperature.
- Give your child plenty of liquids to drink, preferably water, flat ginger ale, diluted apple juice or other sugared drinks.
- Avoid milk, carbonated drinks and tart drinks such as orange, cranberry and grapefruit juice. They might upset the child's stomach.
- Remove any extra covers and clothing and keep the room temperature around 18 degrees Celsius (about 64 degrees Fahrenheit).
- Bathe or sponge the child with lukewarm water.
- Use other drugs that help relieve fever, such as acetaminophen.
- If the fever does not come down, consult your family doctor.
- Never try to treat a feverish child under a year old without the advice of your doctor.
- Never give any drug containing ASA to a child, particularly if he or she has the flu or chicken pox, before consulting your doctor.
- Make sure that teenagers are also aware of the dangers of RS and how to prevent it.
The most important thing to remember is that some common symptoms are signs of more serious illnesses. If any symptoms last for more than two days or become worse, call your doctor.
Date Modified: 2006-12-07
Subscribe to:
Posts (Atom)