Managing Arthritis Pain

        

Not only are there over 100 types of arthritis, but the disease affects nearly 1 out of every 5 adults. Pain from arthritis can get in the way of your everyday life, but the good news is there are ways to manage arthritis pain. The most important tool for relieving arthritis pain, sometimes even referred to as the "Arthritis pain reliever," is exercise. It used to be thought that people suffering with arthritis should just rest their joints and even avoid physical activity. Including exercise, here are some important methods for managing arthritis pain:

  • Moderate-intensity, low-impact exercises such as walking or swimming
  • Cold and heat therapies
  • Massage
  • Relaxation techniques
  • In some cases, surgery

The bottom line is this: arthritis pain doesn't have to to get in the way of you living your life. There are ways to manage the pain and continue with your normal daily activities. For more information on arthritis, and living with arthritis, check out this article in our health library. You can also visit us online or call our free Consult-A-Nurse® service at 1-888-741-5119 for health information and physician referrals.

Related Posts:
5 Steps to Overcome Chronic Pain
Injectable Treatments for Arthritis

Category Categories: How to be Healthy | Tag Tags: , , , , , , , | Comments 0 Comments and Reactions

Summer Sun Safety: Top Tips

As summer break approaches, it’s time to start thinking about sun safety. May is National Melanoma/Skin Cancer Detection and Prevention Month. Learn how to enjoy summer without worrying about the damaging effects of the sun on your skin. Discover the top tips for lowering your family’s risk of developing skin cancer.

Always apply sunscreen
The CDC reports that the sun can damage your skin in as little as 15 minutes. Use sunscreen with an SPF of at least 15 every day, whether it’s rainy, cloudy or sunny. If you have sensitive skin or you’re applying sunscreen on small children, read labels carefully. You may prefer unscented mineral sunscreen for kids. Reapply often if you’re staying outside, sweating or swimming.

Wear protective clothing
According to the CDC, a typical T-shirt has an SPF rating lower than 15. This means your average shirt isn’t going to offer you adequate protection from the sun, especially during peak times. If you’re going to be spending time outdoors, outfit children in clothing that offers UV protection and SPF greater than 15. Look for long-sleeved bathing suit shirts that cover kids well when swimming.

Wear a hat
You and your kids should wear hats when outdoors. Look into wide-brimmed hats with a safe chin strap for younger kids. Remember, even when wearing a hat, it’s important to apply sunscreen to the face, neck and ears.

Seek shade
Try to stay under the protection of shade whenever possible. Consider bringing a portable tent to beaches and parks. Choose playgrounds with sunshades and tree-filled areas that offer plenty of shady areas for kids to play outdoors. While shade helps reduce your risk of skin cancer, it is not a substitute for wearing sunscreen.

Stay out of the sun
This probably seems obvious, but the best way to avoid sun damage is to stay out of the sun. You don’t need to become a vampire, but you should try to avoid the sun during the peak hours of 10 a.m. to 2 p.m. This is when the sun’s rays are most harmful.

Visit your dermatologist
Make an appointment to visit your dermatologist once a year. It’s important to keep an eye on moles and skin discolorations on your own, but only a professional can gauge potentially cancerous growths. Try not to fret if you need a mole shaved for a biopsy. It’s quick and nearly painless.

To learn more about staying safe in the sun this summer, call our free Consult-A-Nurse® Service 24 hours a day at 1-888-741-5119 to speak to a nurse. For more information on melanoma, visit us online.

Related posts:
More than Just a Cut

Work Healthy Habits into Your Schedule
What You Should Know About Afib!

Category Categories: How to be Healthy | Tag Tags: , , , , , , | Comments 0 Comments and Reactions

Heartburn & GERD: What’s the Difference?

You probably hear the term "heartburn" all the time. On television commercials, the radio, in magazine ads and on billboards. Chances are you have also heard a mention or two about GERD or GastroEsophageal Reflux Disease. The two can become confusing, because they are often depicted very similarly. And in fact, they are very similar. GERD is simply a more serious or severe form of acid reflux that can lead to complications down the road, such as esophagitis, narrowing of the esophagus or Barrett’s esophagus.

Regional Medical Center's Dr. Dilip Ghanekar explains the differences below:

It may be better to first talk about the underlying cause, namely acid reflux. Acid reflux is when acid, which is normally present in the stomach, backs up into the esophagus. The esophagus is the muscular tube that takes food from the mouth to the stomach.

Heartburn is a burning sensation in the chest behind the breast bone. It is caused by acid reflux. It can be accompanied by burning in the throat or sour fluid in the throat. This can cause coughing or a raspy voice. Acid reflux can also cause stomach or chest pain.

Patients are felt to have GERD or GastroEsophageal Reflux Disease when they have symptoms or complications of acid reflux. To a certain extent, the two terms are interchangeable.

The biggest cause for acid reflux is felt to be obesity or being overweight. The reasons may be due to increased pressure on the stomach from the excess fatty tissue in the abdomen. It is also possible that people who are obese are more likely to have lifestyles that increase the chance of getting acid reflux (eating too fast, eating large meals, and eating high-calorie foods). Heartburn is felt by many people in the United States. Twenty-five percent of Americans have heartburn or regurgitation at least once a month.

Possible Complications of GERD
Chronic GERD that is untreated can lead to serious complications in some people. Acid reflux can damage the lining of the esophagus over time, which may cause ulcers and bleeding and is referred to as esophagitis. Damage from continuous acid reflux can create scars that over time lead to a narrowing of the esophagus, which makes swallowing more difficult. And in rare cares an individual may develop Barrett's esophagus, a complication in which cells of the esophageal lining change in shape and color — these cells can then lead to esophageal cancer.

Because of the complications that GERD can lead to, it is important to speak to your doctor if you feel you are experiencing chronic acid reflux. If GERD is diagnosed early on, it can be properly treated and monitored by a physician before further complications arise. To learn more about heartburn and GERD, visit us online at Regional Medical Center Bayonet Point or call our Consult-A-Nurse® service at 1-888-741-5119 for health information and physician referrals.

Category Categories: Signs and Symptoms | Tag Tags: , , , , , , , , | Comments 0 Comments and Reactions

Tips to Help Your Children Form Healthy Habits for Life

Healthy habits start early. If your children learn good habits from a young age, they’ll be likely to stick with them throughout their lives. Give your kids the best start you can.

Healthy Hygiene: Make proper hand-washing a family tradition. Frequent hand-washing prevents the spread of germs that can lead to cold, flu, and other illnesses. Proper hand-washing includes soap and warm water for at least 20 seconds, scrubbing fronts, backs, and in between fingers followed by a clean rinse and drying on a clean towel. Don’t forget proper tooth-brushing at least twice a day as well.

The spread of germs can also be curbed by sneezing into an elbow or using a tissue then properly disposing of it. Also, teach kids to close the lid before flushing to keep microscopic germs from settling on kids or other surfaces when the water swirls.

Healthy Nutrition: Start early with a healthy diet. Kids should have 3 meals a day and 2 nutritious snacks. A diet full of fruits, vegetables, lean protein, whole grains, and low-fat dairy is nutritious and delicious.

Healthy Exercise: Kids should get thirty minutes to an hour of exercise or rigorous play each day. Make family fun time that involves playing a sport, riding bikes, going for a walk, swimming, or just running around in the yard. If the whole family gets involved, exercise is fun and becomes a regular habit.      

Healthy Imagination: Getting away from the TV and other entertainment offered by technology is important. Unplugged play will stimulate your child’s imagination and creativity. Encourage your kids to build a spaceship from an old box or act out their favorite storybook.

Healthy Communication: Get involved in your child’s life each and every day. The more you talk about topics from friends, to safety, to making good choices, the better informed your child will be. Establishing regular and open communication will be essential when it comes time to discuss smoking, drugs, alcohol, and sexual activity. Open the door to communication from the start and always be willing to listen.  

Regional Medical Center Bayonet Po has a great online resource for raising healthy kids. Call our Consult-a-Nurse service 24 hours a day, 7 days a week for more information on healthy living!

Related Posts
Choose a Healthy Lifestyle Over Dieting

The Importance of Family: Family Health History

Splash Safely: Keeping Kids Safe around Water

Category Categories: Health for Children | Tag Tags: , , , , , , , , , , , , , | Comments 0 Comments and Reactions

Back Pain from Lumbar Spinal Stenosis

An aching back is no fun. Lumbar Spinal Stenosis may be the cause of your pain, if it’s in your lower back. Over time, our spines naturally change. Life takes its toll and the spinal canal can narrow. This leads to pain referred to as spinal stenosis.

What is Lumbar Spinal Stenosis?
Over time the soft tissue and bone in your spine can harden or become overgrown. This leads to a narrowing in the space around the spinal cord. Due to this narrowing, pressure is put on the cord and nerve roots. In the lower back, this may result in pain or numbness. You may also experience leg weakness. By age 50, approximately 95% of people will have some deterioration of the spine. Most cases of spinal stenosis are seen in people over age 60. Women are more likely to have problematic symptoms that require treatment. On the other hand, congenital spinal stenosis, due to back problems at birth, is more likely to affect men and onset occurs as early as age 30.   

Arthritis and Lumbar Spinal Stenosis
Arthritis often leads to lumbar spinal stenosis. When joints degenerate, the disks in your spine lose water content. This leads to dry and weak disks that are likely to settle or collapse leading to diminished disk space height.

Symptoms

  • Back pain (may not be severe if arthritis is not present)
  • Nerve pain that feels like burning in buttocks or legs (sciatica)
  • Tingling or numb buttocks or leg
  • Weakness in the legs
  • Foot drop: when it feels as though your foot is slapping the ground when walking
  • Pain that is strong when standing or walking and can be reduced when sitting and leaning forward

Diagnosis
If you have any symptoms, your doctor will take a medical history and examine your back to pinpoint areas of pain. A diagnosis may also require an X-ray to look for loss of disk height or bone spurs. An MRI can give images of soft tissue. You may also need a CT scan to get a cross section image of the spine.

Treatment
Non-surgical treatments:

  • Physical therapy to manage symptoms
  • Lumbar traction (not proven effective for many)
  • Anti-inflammatory medication
  • Steroid injections
  • Acupuncture

Surgery: for patients with diminished quality of life due to severe symptoms.

  • Laminectomy: removal of bone, bone spurs, or ligaments to create more space in the spinal area
  • Spinal fusion: decompresses and stabilizes the spine by fusing vertebrae together

Regional Medical Center will hold a special presentation on Lumbar Spinal Stenosis on Thursday, April 19, 2012 from 3 – pm. This free event will be held at the Regional Medical Center Bayonet Point Conference Center located at 14000 Fivay Road, Hudson, FL 34667. Space is limited so make reservations by calling 727-869-5498 or 1-888-663-7746. Come for the information and light refreshments. We hope to see you there.

Related Posts
5 Steps to Overcome Chronic Pain

Getting “Back” Your Life: Getting Rid of Lower Back Pain

Injectable Treatments for Arthritis

Category Categories: Signs and Symptoms | Tag Tags: , , , , , , , , , , , , , , | Comments 0 Comments and Reactions

FDA’s New SPF Rules–What Do They Mean?

FDA. SPF. Are they secret codes? Nope. The FDA is the Food and Drug Administration, which enforces safety laws to protect consumers like you. SPF is sun protection factor and refers to the number on a bottle of sunscreen. The FDA has established new rules about displaying SPF to better inform the public about sun protection.

New Testing
There are new, rigorous tests that sunscreen products must now undergo before they can hit the shelves at your local shop. Accurate results regarding safety and effectiveness of the various types of sunscreens must be achieved during the testing.

New Labels
The common promises on bottles of sunscreen read: sunblock, waterproof, and prevents skin cancer. These phrases and others are no longer allowed as they may be misleading. Previous labeling rules applied to sunburn protection from rays in the UVB spectrum. The UVA spectrum contributes to cancer development and early skin aging but claims regarding UVA protection were not carefully monitored. The new "Broad Spectrum" test will measure effectiveness against both UVA and UVB rays. Products with the label Broad Spectrum SPF 15 (or more) will be proven to protect against cancer and early skin aging in addition to sunburn.

Old Bottles
The new SPF labeling laws have been in the works since summer 2011 and are expected to be fully established and enforced by summer 2012. That means after that time, all sunscreen sold in stores should be accurately labeled. If you have sunscreen from before these changes, it does not mean it is not safe or effective. You do not need to throw these bottles away, according to the FDA. All it means is the labels that promise both UVB and UVA protection may not be as accurate as possible.

New Rules Summary

  • A Broad Spectrum SPF 15 or higher label will indicate sufficient protection from sunburn as well as reduced risk for skin cancer and early skin aging. Any protection under 15 may only claim sunburn prevention.
  • Claims such as water or sweat proof or sunblock are no longer allowed. No sunscreen is effective after more than two hours. All types should be reapplied at least every two hours.
  • Sunscreens that claim to be water resistant must indicate if they are tested effective for 40 or 80 minutes. Any sunscreen that is not water resistant must direct consumers that may swim or sweat to use a water resistant sunscreen.
  • All bottles of sunscreen must feature Drug Facts information on the container.     

Sun Protection Tips

  • Limit your time in the sun and avoid exposure during midday peak hours (10 a.m.- 2 p.m.)
  • Wear light, loose, protective clothing including a wide-brimmed hat.
  • Reapply water resistant sunscreen after swimming or sweating in addition to every two hours.

Regional Medical Center wants you to have safe fun in the sun this summer. Check your sunscreen labels carefully before purchasing. Find out more online about the devastating effects of skin cancer.  You can also learn more about how Regular Sunscreen Use May Reduce the Risk of Melanoma. Next time you step out into the sun, don’t forget your sunscreen with new and improved labels.

Related Posts
Enjoy the Weather Carefully; Skin Care in Florida

Protect Yourself from Skin Cancer This Summer

What You Should Know about Melanoma

Category Categories: How to be Healthy | Tag Tags: , , , , , , , , , , , , , , , , , , | Comments 0 Comments and Reactions

How Alcohol Can Affect Your Health

Pour the champagne and make a toast to a special someone. Alcohol has long been associated with celebrations and festivities. All that fun can make people forget about the dangerous health effects of alcohol. April is National Alcohol Awareness Month. Read on to learn more about how alcohol can affect your health.

Health Effects of Alcohol

  • Liver disease (alcoholic hepatitis and cirrhosis)
  • Dementia and neuropathy
  • Cardiovascular disease (cardiomyopathy, hypertension, arrhythmia, and stroke)
  • Pancreatitis (alcohol use is associated with at least 65% of all cases)
  • Immune system weakness (respiratory infections, pneumonia, and tuberculosis)
  • Increased risk for many cancers
  • Hormonal deficiencies, sexual dysfunction, and infertility
  • Early menopause and menstrual irregularities
  • Abuse of alcohol lead to depression
  • Alcoholism
  • Pregnant women who drink alcohol are likely to cause Fetal Alcohol Effects (FAE) or Fetal Alcohol Syndrome Disorder (FASD) in their babies (read more online at Regional Medical Center).

Other Consequences of Alcohol Use

  • Increased chance for car accidents leading to injury or death
  • Other accidents such as burns or firearm accidents
  • Dependency that can impair your ability to do daily functions
  • Unstable relationships with family, friends, and other loved ones
  • Poor judgment leading to dangerous or illegal behavior
  • Suicide attempts
  • May become a target for crime including physical or sexual abuse 

Warning Sign of Alcohol Abuse

  • Drinking alone
  • Drinking causes tardiness at work
  • Drinking causes worry for family
  • Drinking after you’ve promised yourself you won’t
  • Blackouts or memory loss while drinking
  • Headaches or hangovers after drinking

Tips to Limit your Drinking

  • Keep a count of your drinks.
  • Set a limit before your first drink and stick to it.
  • Avoid places where people will be drinking heavily.
  • Seek medical help and support from loved ones.
  • Do not keep an excessive amount of alcohol in your home.

Safe Alcohol Consumption
The U.S. Department of Health and Human Services published The Dietary Guidelines for Americans which recommends that women do not exceed one drink per day and two drinks per day for men. People who should not consume any alcohol include: those under age 21, those who cannot limit or control drinking, pregnant women, people who will be driving, anyone on medication, those with certain medical conditions, and people recovering from drug or alcohol addiction.

Regional Medical Center can help you or a loved one handle your alcohol use. Visit us online to learn more about Alcohol Abuse. This April, during National Alcohol Awareness Month, begin making smart choices about alcohol that will last you the rest of your life.   

Related Posts
5 Simple Ways to Live a Heart Healthy Life

Keep Your Teens Safe During Homecoming!

Tips for a Safe Holiday Season

Category Categories: Signs and Symptoms | Tag Tags: , , , , , , , , , , , , , | Comments 0 Comments and Reactions

FAQs About Organ Donation

Donations to the needy come from the heart. Sometimes what a person needs IS a heart. Organ donation is a selfless way to give back to people in need. Over 100,000 Americans could be saved by an organ transplant each year. Unfortunately, the necessary organs are not always available, and thousands of people die annually. If all transplantable organs are donated, one organ donor can potentially save up to 8 people.

Who Benefits from Organ Donation?

  • Thousands of patients waiting for life-saving transplants
  • Your family or friends, who might be in need one day
  • You, after making the choice to become an organ donor you will feel great about your selfless decision to help others if the opportunity arises.

Which Organs can be Donated?

  • Kidneys
  • Heart
  • Lungs
  • Liver
  • Pancreas
  • Intestines

(The above organs cannot be stored and must be transplanted to the new body immediately)

  • Tissue: corneas, the middle ear, skin, heart valves, bone, veins, cartilage, tendons, and ligaments can be donated and stored for future use
  • Stem Cells: bone marrow, peripheral blood stem cells, and umbilical cord blood
  • Blood and Platelets

How do I Become an Organ Donor?
You will need to register in your state to become a donor. Some donations of organs are made upon your death. Some ogran donations, such as kidney donation, can be made while you are alive and healthy. If you wish to look into living kidney donation,  contact a local transplant center to find out more. Even if you have a medical condition, you may be eligible to donate. Minority donations are especially critical. 

Are there Ways to Donate Regularly?
You can donate blood on a regular basis. Donating blood saves many lives. You can find a blood drive or local hospital to make your donation. Arrive with ID and be prepared to answer a few simple medical questions. Regular donors will be issued a donor card to make future donations quick and convenient. The blood collection will take about 10 minutes. You’ll rest and enjoy a snack before you leave. There are often perks associated with donating blood from sponsoring companies such as merchandise or tickets to events.

Regional Medical Center wants to encourage you to make a life-saving donation. Patients in our hospital and around the country are patiently waiting for live-saving organ donations. You can give a little part of yourself to be a part of something special. Whether you donate an organ, tissues, or blood you may just save a life. Visit us online to learn more about Giving the Gift of Life.

Related Posts
Medical Preferences and a Living Will

More than Just a Cut

Category Categories: How to be Healthy | Tag Tags: , , , , , , , , , , , , , | Comments 0 Comments and Reactions

HCA Local Area Hospitals’ Parent Company Selected as One of the World’s Most Ethical Companies

Pasco/Hernando Counties, Florida – (March 20, 2012) For the third year in a row, Hospital Corporation of America (HCA), the parent company of Pasco/Hernando County hospitals, Medical Center of Trinity, Oak Hill Hospital and Regional Medical Center Bayonet Point, has been recognized by the Ethisphere Institute as one of the 2012 World’s Most Ethical Companies.  This is the sixth year Ethisphere, a think-tank dedicated to the creation, advancement and sharing of best practices in business ethics, corporate social responsibility, anti-corruption and sustainability, has published the World’s Most Ethical Companies rankings, which appear in Ethisphere Magazine’s Q1 issue.

HCA’s long-standing, industry-leading ethics and compliance program has served as a model for others. “This recognition from the Ethisphere Institute is particularly meaningful to all of us at HCA because it is based on the totality of our organization’s efforts and performance,” said Alan Yuspeh, HCA’s Senior Vice President and Chief Ethics and Compliance Officer. “It reflects not only an energetic ethics and compliance program, but also our dedication to patients, our support for communities we serve, our generosity of spirit in providing charity care, our focus on sustainability, and our culture of integrity.”

The 2012 list is the largest since the award’s inception in 2007. Through in-depth research and a multi-step analysis, Ethisphere reviewed nominations from companies in more than 100 countries and 36 industries. The methodology for the World’s Most Ethical Companies includes reviewing codes of ethics, litigation and regulatory infraction histories; evaluating the investment in innovation and sustainable business practices; looking at activities designed to improve corporate citizenship; and studying nominations from senior executives, industry peers, suppliers and customers.

“Each year the competition for World’s Most Ethical Companies intensifies as the number of nominations submitted for consideration grows,” said Alex Brigham, Executive Director of Ethisphere. “This year’s winners know that a strong ethics program is a key component to a successful business model, and they continue to scrutinize their ethical standards to keep up with an ever-changing regulatory environment.”

The methodology for the WME ranking includes reviewing codes of ethics, litigation and regulatory infraction histories; evaluating the investment in innovation and sustainable business practices; looking at activities designed to improve corporate citizenship; and studying nominations from senior executives, industry peers, suppliers and customers.

Read about the methodology and view the complete list of the 2012 World’s Most Ethical Companies at http://ethisphere.com/wme/.

About Ethisphere Institute
The research-based Ethisphere Institute is a leading international think-tank dedicated to the creation, advancement and sharing of best practices in business ethics, corporate social responsibility, anti-corruption and sustainability. The Institute’s associated membership groups, the Ethisphere Council and Business Ethics Leadership Alliance, are forums for business ethics that includes over 200 leading corporations, universities and institutions. These groups are dedicated to the development and advancement of members through increased efficiency, innovation, tools, mentoring, advice, and unique career opportunities. Ethisphere Magazine, which publishes the globally recognized World’s Most Ethical Companies Ranking™, is the quarterly publication of the Institute. Ethisphere provides the only third-party verifications of compliance programs and ethical cultures, Ethics Inside Certification®, Anti-Corruption Leader Verification and Compliance Program Verification. More information on the Ethisphere Institute, including ranking projects and membership, can be found at http://www.ethisphere.com.

All references to “Company” and “HCA” as used throughout this release refer to HCA Holdings, Inc. and its affiliates.

Category Categories: Press Releases | Tag Tags: , , , , , , | Comments 0 Comments and Reactions

Spring Break Safety Tips for Your Teens

Spring break conjures images of volleyball, sunburns, and all-night parties. When teens plan their spring break adventures, be sure that a talk about safety is on the to-do list. There are many things you can encourage your teen to do to ensure a safe and fun spring break.

Travel
If teens are hitting the road, remind them to always buckle up. Drivers should take turns frequently to avoid an accident due to an exhausted driver. Make sure the car has a safety check before the kids take off. If teens are flying, make sure they have all necessary documentation. Establish regular phone check in times and stick to them. Make sure each parent has a detailed itinerary of the travel plans. Always make copies of all travel documents for backup.

Lodgings
Choose a room between floors 2 and 6 to avoid a break-in and make any potential fire exit safer. Urge teens to use the room safe for their valuables, especially travel documents and money. Choose a safe hotel in the center of the action; hotels on the outskirts can be more dangerous with less security.

Groups
Remind teens to never let a friend go off alone. Whether it’s the restroom, ATM, or any other spot, teens should always travel in pairs or more.

Outdoors
Be cautious in the sun. Apply sunscreen SPF 15 or higher before going out for the day. Re-apply as needed. Remind teens that the heat can intensify effects of partying. Beach-goers should stay hydrated with water throughout the day. When using any boats or recreation equipment, teens should adhere to all safety rules. Swim only in designated and monitored areas and never alone. 

Partying
Have an honest discussion with teens regarding alcohol. It is often readily available to underage partiers, especially in foreign countries. Explain the possible consequences of being caught for underage drinking or public intoxication in the city they will be visiting. Provide teens with these safety tips regarding alcohol:

  • Stick to bottled drinks that have a set amount of alcohol; mixed drinks can be over-mixed, powerful, and hit all at once
  • Always have a designated driver if you plan to go anywhere by car
  • Never leave drinks unattended; they can be drugged or tampered with
  • Do not leave a party with someone you’ve just met, male or female
  • It may seem like everyone is drinking, but it’s okay to be the one who stays sober and gets to remember the party and tell the others about it the next day
  • Sipping from a cup of juice or soda can be just as effective for fitting into the social scene; alcohol isn’t required for spring break to be fun

Spring break can be a great time to cut loose and enjoy sunnier weather. If your teen will be traveling for spring break, don’t let the fun start until you’ve discussed and agreed upon the safety issues above. Regional Medical Center wants your teen to have a safe spring break, so visit us online for tips about talking to your teen about sexually transmitted diseases and binge drinking. Regional Medical Center encourages you to share your concerns with your teen to help him or her make smart choices on spring break.

Related Posts
Alcohol Awareness Month

Keep Your Teens Safe During Homecoming!

Category Categories: How to be Healthy | Tag Tags: , , , , , , , , , , , , | Comments 0 Comments and Reactions