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Ask Our Bladder Cancer Experts - Oct. 12-16.

By Cancerwise Blogger on October 13, 2009 4:37 PM | Comments (0) | Trackbacks (0)
Questionmark.jpgBecause a cancer diagnosis spurs a raft of questions for patients and caregivers, Anderson Network has arranged week-long online sessions with many of our experts in specific types of cancer.   

The current forum addresses bladder cancer, its new treatment options and results. The fourth most common type of cancer in men and the eighth most common in women, it is diagnosed in 38,000 men and 15,000 women in the United States every year.

Find out more about bladder cancer Oct. 12-16 from three of M. D. Anderson's experts: Colin Dinney, M.D., professor; Barton Grossman, M.D., professor; and Ashish Kamat, M.D., associate professor, Department of Urology.

Visit www.mdanderson.org/andersonnetwork to submit questions or e-mail andersonnetwork@mdanderson.org for more information.

Parents With Cancer Can Help Children Cope

By Cancerwise Blogger on September 28, 2009 3:21 PM | Comments (0) | Trackbacks (0)
By Dawn Dorsey, Staff Writer

ClimbGraphic.jpgCancer affects every member of the family. Children whose parents or other relatives have cancer may face emotional upheaval, doubt and anxiety.

At M. D. Anderson, the CLIMB® (Children's Lives Include Moments of Bravery) program helps children identify and express their emotions when a parent has cancer.

Marisa Minor, a social worker in the Department of Social Work and one of the program's facilitators, says children experience stressful situations differently than adults.

Tips help parents communicate
"In most cases, children aren't yet equipped with the coping tools to help them verbalize questions and seek help when they are worried or scared about what is happening to their parent and to their family," she says.

To help cancer patients guide children through the tough times, Minor recommends these tips:
•    Use the three "C's"
     o    It's called Cancer
     o    The patient or child did not Cause the cancer
     o    Children cannot Catch cancer like a cold or flu
•    Be honest but don't overshare; use age-appropriate information
•    Reassure them there's a plan for their welfare and you will keep them informed
•    Check in frequently; they may have questions even if they don't ask
•    Ask the medical team or social worker for advice about talking to your children
•    Look for resources, such as books, to help children cope

Children can develop tools
Minor says learning age-appropriate and healthy ways to cope with a parent's cancer early in the process can prepare children to:

•    Normalize their feelings
•    Communicate their concerns
•    Identify personal strengths

"Working together as a family helps children become better equipped to express and manage their feelings," she says. "They can develop tools to help them cope with other life challenges that may come their way."

Program brings children together
Through guided conversations and art, CLIMB meetings allow children to bond with other children who are having similar experiences. They find ways to cope with and express sadness and anger. A concurrent parent support group also takes place.
CLIMB was developed by The Children's Treehouse Foundation, a nonprofit organization dedicated to the emotional support of children whose parents have cancer.

Partial funding support for CLIMB is provided by M. D. Anderson's Volunteer Endowment for Patient Support and the Department of Social Work.For more information about the program, contact Minor at 713-792-6826.

M. D. Anderson resources:
CLIMB Support Program

CLIMB Program Helps Children Whose Relatives Have Cancer (M. D. Anderson News Release)


Additional resources:
Children's Treehouse Foundation

Helping Children When A Family Member Has Cancer: Dealing With A Parent's Terminal Illness (American Cancer Society)

When Your Parent Has Cancer: A Guide for Teens


The Emotions of Caregiving for Cancer

By Phyddy Tacchi on September 22, 2009 10:03 AM | Comments (0) | Trackbacks (0)
tacchi0909.jpgToday, let's discuss the fluctuating emotional aspects of caregiving. Below are a few examples of typical things that I hear from caregivers.

"My loved one is so irritable with me and I'm working as hard as I can to help. All I want to do is go home."

"I don't have time to take care of myself. Even if I did, I don't know where to go or what to do."

"I just want things to return to normal, to the way things used to be."

"Sometimes, I just have to get away."

Sound familiar? Sometimes caregivers feel as if their mood changes in relationship to managing the fluctuating nature of day-to-day medical circumstances.

"Help! I'm on an emotional roller coaster and I can't get off."

"Sometimes at night, I just lay there waiting for the next earthquake."

"If I don't sleep at night, I end up crying the next day."

Caregivers often work overtime to provide care to their loved ones. This has its pitfalls and blessings. It's often a job requiring 24/7 attention with many physical and emotional demands, filled with highs and lows. The most common complaints of caregivers are emotional and physical fatigue, exhaustion and sleep deprivation. The time and effort it takes to care for your loved one each day can, over time, become very stressful with a gradual wearing down of energy.

There's a high correlation between fatigue and depression in caregivers. When you're under such tremendous chronic stress, you can experience many emotional ups and downs on any given day. One minute you feel as if you have it all together and the next minute it seems like you're falling apart. Not only is physical fatigue a factor, but emotional overload is as well.

The Volcanic Feelings of Caregivers: Emotions to the Max

"My feelings bounce around all over the place. Sometimes they are positive and sometimes they are so painful I don't think I can stand it."

Sometimes you may feel like a virtual volcano when pressure builds without relief. Today may seem too difficult and tomorrow too uncertain. Where are you today on this spectrum of feelings?

Calm............................................................Scared
Happy..........................................................Sad
Relieved.......................................................Nervous
Contented.....................................................Angry
Confident......................................................Worried


The "Forbidden" Feelings of Caregivers

"Sometimes, I can't talk to anyone about how I feel. I don't want to burden them or take away the hope of my loved one. No one understands what this is really like unless they've been through it."

It's not unusual for caregivers to have intense feelings that they're hesitant to talk about, especially to their patient as caregivers may wish to protect their loved one from hearing about their distress. These feelings can be strong and seemingly in conflict with what you're trying to do. Although others may tell you to "think positive or be optimistic," there are times when this just doesn't seem possible.

Which of these "forbidden" feelings can you identify with?

•    Yearning for "normal"
•    Doubt
•    Resentment
•    Anger
•    Guilt, feeling trapped
•    Fear
•    Hopelessness
•    Helplessness
•    Worry
•    Sorrow
•    Grief
•    Loneliness


Reflections on the Vocabulary of Medicine

By Michael Fisch M.D. on September 18, 2009 1:19 PM | Comments (0) | Trackbacks (0)
What I noticed the First Time I Saw Patients on Rounds as a Medical Student

MFisch.BayArea_clinic.jpgOn a rainy weekend, I spent a few minutes looking through an old photo album with my kids. Tucked away in a folder within one album were letters that I shared with my parents during medical school. My mom, who died of lung cancer in 2006, had saved these letters.

One letter was written to a wonderful physician and mentor who allowed me to go on infectious disease rounds with him on a Saturday morning for the very first time, during my first month in medical school when everything was about book learning. I found a "thank you" letter to my mentor, Dr. Barry Farr, dated Oct. 27, 1986. In the second paragraph of my letter, I wrote:

I want to share with you some of the things that I learned on Saturday that I otherwise would not have known. I think that this may be interesting for you because it seems that physicians (and other medical students) do not always remember exactly what they did and didn't know when they were first-year students.

In the ensuing paragraphs, I listed seven categories of my observations. Topic six was about vocabulary:

I realized that my ability to understand what was going on hinged on my familiarity with the vocabulary. One way to categorize the vocabulary might be as follows:
a) Anatomical vocabulary (i.e. fourth metatarsal)
b) Vocabulary of disease (i.e. osteomyelitis)
c) Vocabulary of clinical medicine (i.e. nosocomial, iatrogenic)
d) Current jargon (i.e. "LCM," "PTC")

As you may recall, I think that one of Yogi Berra's quotes may apply here (if adapted to medicine). He said something to the effect that "Half of baseball is 50% mental." This can be adapted to read "Half of medicine is 50% vocabulary."

The following week after finding this old letter, a colleague, Dr. Daniel Epner, shared with me his correspondence with Dr. John Mendelsohn, M. D. Anderson's president, regarding his reflections on health care reform. Dr. Epner wrote:

... Many challenges that we face on a daily basis that we think of as biomedical, technical or logistical issues are essentially communication issues. For instance, I hypothesize that we can improve care tremendously and avoid uncomfortable and futile interventions at the end of life by implementing improved communication protocols and procedures that focus on discussions of goals of care throughout the spectrum of illness. ...

The key point from Dr. Epner is the focus on goals of care and attention to the topic of physician-patient communication. Nevertheless, the vocabulary of medicine itself is one part of the challenge in communication, and it is all too easy to forget when we, in health care, didn't understand all of these words (as I noted to Dr. Farr after my very first rounds).


Head Chatter Management: A Cancer Survivor Must

By Bill Baun on September 14, 2009 12:00 PM | Comments (0) | Trackbacks (0)
Flash back three years to a urology examination room where my wife and I are sitting and my physician has just told us that I have a very aggressive prostate cancer. My wife immediately starts bawling, not crying, but bawling. I'm still not sure what he said after that. What I remember is taking my wife home and trying my best to calm her down. At some point, she fell asleep and I took a long walk outside and finally began to process the news.  

Most of us, at an intellectual level, understand that stress is our reaction to the external environment. We decide, based on many different things, how we react. My wife's parents are alive, while I was raised in a family in which my mother died of cancer when I was just starting college and my dad died of prostate cancer in his late 70s. When I look back at that day in the exam room, I realize that I'd been preparing for the diagnosis all my life.

During my long walk I immediately became angry and then felt a grief I had not felt for a long time. But at some point on that very gray day, my body-mind connection linked up with my spirit -- a spirit forged by my parents' DNA and my life experience with them.

In his book, "Achieving the Mind-Body-Spirit Connection," Luke Seward, Ph.D., suggests that it's the spirit that allows us to find the calming space we all seek. Without the connection to spirit, the body-mind connection acts like a teenager who's always self-absorbed. Immediately, I realized my life path had changed but it was mine, and like my parents I needed to find the strength to live it "well."  

You can't experience that calm space unless you find a way to shut off the head chatter or self-talk that continually runs through our minds. Most of what we say to ourselves we would never say to anyone else. It can be fear-based or at times it's what gives us the necessary motivation to take a step forward.  

How do you quiet it or at least turn the volume down? Or turn it into a positive guide?  

•    Exercise
Maybe it's a walk or a regular exercise routine that helps you focus and turn your self-talk into a positive guide. 

•    Reading
Many read what I call the "little books," like Joan Lunden's "Wake-Up Calls" or Greg Anderson's "Cancer: 50 Essential Things to Do." These books help turn our negative self-talk into positive guides. 

•    Music
I have good friends who find it helpful to listen to slow jazz, classical music or good old church hymns. 

•    Mediation/Prayer
Early morning and evening prayers are a form of meditation. If you add some short prayer/meditation sessions to your days, you'll immediately notice a change in the volume and guidance of your head chatter. The Patient/Family Library at M. D. Anderson has many books that can help you set up a regular daily meditation practice.  

It doesn't matter if you're newly diagnosed, in treatment or now call yourself a cancer survivor. Managing your head chatter is critical to a "well" life.

Flu vs. Cancer: M. D. Anderson Blood Supply Affected by Oncoming Flu Season

By Julie Penne on September 10, 2009 12:42 PM | Comments (0) | Trackbacks (0)
There's another community consequence to the oncoming flu season besides lost time at work, more school absences and jammed doctors' offices. It means there are fewer healthy blood donors and decreased blood supplies for M. D. Anderson Cancer Center patients who so desperately need transfusions and platelets.

Already this school year, one Houston-area high school canceled a drive, one that was projected to yield up to 120 units of blood. Because that drive was canceled and others could be in the coming weeks, the M. D. Anderson Blood Bank needs your help to replenish its supply.  

M. D. Anderson, the largest blood transfusion center in the world, relies heavily on blood drives at high schools and universities, especially during the fall and winter. The students are generous givers and because of their youth, they're rarely turned away for health reasons. That is until flu season strikes.

M. D. Anderson transfuses more than 190,000 units of blood and platelets per year. To keep the coffers well stocked for hundreds of children and adults who are undergoing chemotherapy, stem cell transplantation and major surgery, about 400 units of blood need to be collected daily.

If you live in the Houston area, please visit M. D. Anderson Blood Bank donation sites at 2555 Holly Hall or M. D. Anderson's Clinical Care Center in the Bay Area at 18100 St. John Drive, on the campus of CHRISTUS St. John Hospital. There is free and accessible parking at both sites. There also is a donation site at M. D. Anderson at the Mays Clinic on the second floor near The Tree Sculpture.

If you don't live in the Houston area, please consider giving blood at your local blood bank. The flu season affects donations all over the nation and the need for blood never diminishes.

For additional information about making an appointment to donate blood or platelets or making arrangements for a blood drive with your company or organization, please call 713/792-7777 or visit on http://www.mdanderson.org/how-you-can-help/donate-blood/index.html.


M. D. Anderson Resources

Learn more about M. D. Anderson's needs for blood donation.
Cancer Newsline audio podcast - Ways to give without money: Blood Donation

How Do You Face Cancer When It's Chronic?

By Cancerwise Blogger on September 1, 2009 12:41 PM | Comments (0) | Trackbacks (0)
By Bayan Raji, Staff Writer

Fourteen years ago, Julie Gomez had surgery to remove a gastrointestinal carcinoid tumor, her gallbladder, and parts of her liver and small intestine. Since then she's been living with this rare and chronic cancer that is controlled -- but not cured.

Illness affects immunity

Although Gomez, a volunteer in M. D. Anderson's Hospitality Center*, has checkups every six months, there isn't much she or doctors can do to get rid of her cancer or to prevent the tumors from growing.

As with any other chronic illness, Gomez says she's learned to deal with side effects and lifestyle changes. In 2002, she contracted Still's disease, a form of rheumatoid arthritis.

"I went from being perfectly fine to immobile in a matter of weeks," she says. "That experience completely humbled me as far as my immune system goes and made me realize I have to be careful."

Symptoms are life-changing

Fatigue is a constant. Gomez, who spends each Wednesday talking to fellow patients and caregivers at the Hospitality Center, doesn't schedule any outings or appointments for Thursday because she knows she won't have the strength.

"You only have so much energy," she says. "It's important to listen to your body, or you'll end up getting sick."

Everyone needs an outlet

Gomez says it's important to talk about her cancer, and the conversations in the Hospitality Center tend to be uplifting and positive.

"I volunteer once a week and talk about my experience with cancer, and it's almost like therapy," she says. "I think everyone needs to connect with people who've had similar experiences."



Mantra helps her make it

Life with an incurable cancer isn't all doom and gloom, but when a bad day strikes Gomez has a motto to get through it.

"I know there will be a bad day, but there won't be a bad week or month," she says.

*The Hospitality Center, a program of Anderson Network, are on-campus oases hosted by cancer survivors and caregivers where patients and caregivers can relax and enjoy refreshments.

M. D. Anderson resources:

People Profile: From Workaholism to Penguins and Volcanoes

Prevention: Patient Profile

Anderson Network


Additional resources:

Gastrointestinal Carcinoid Tumor (National Cancer Institute)

What Is a Gastrointestinal Carcinoid Tumor? (ACS)


AskMDAnderson Helps Navigate Cancer Journey

By Cancerwise Blogger on August 28, 2009 1:44 PM | Comments (0) | Trackbacks (0)
By Bayan Raji, Staff Writer

Questions about treatment options and resources often accompany a cancer diagnosis, and many people look for answers on the Internet.

While it is home to numerous reliable, informative sites, the Internet also contains misleading or unreliable sources. Sometimes it's difficult to know where to turn for accurate answers to difficult questions.

Service provides reliable information

AskMDAnderson puts the front door of M. D. Anderson only an e-mail or a phone call away. This reliable source of information has helped more than 700,000 people since it was established in 1995.

AskMDAnderson can help prospective patients:

•    Find accurate cancer information
•    Make an appointment
•    Understand treatment options
•    Learn about research studies
•    Navigate M. D. Anderson's Internet site
•    Learn about and use patient resources
•    Locate community cancer resources

Accurate info is key

AskMDAnderson representatives are trained by an oncology educator, and they take part in regular training to keep up to date on treatment options and clinical trials.

"Patients are much more informed when they go into their first appointment than they were 10 or 15 years ago," says Jennifer Kennedy-Stovall, associate director in the Public Education Office at M. D. Anderson and head of askMDAnderson. "We help educate people by being a trustworthy source of information about potential treatments and options."

AskMDA2.jpgAnswers ease treatment

Kennedy-Stovall says the most common question askMDAnderson specialists hear is, "How do I become a patient at M. D. Anderson?"

"It's important for people to contact us in the very beginning because we can make sure they get to the next step in a timely manner," she says. "We can get them to the right place and answer questions they have along the way. If we don't know the answer to something, then we'll find out."

Prospective patients can call askMDAnderson at 1-877-MDA-6789, Monday through Friday, from 8 a.m. to 5 p.m. Central Standard Time (CST). Questions also can be submitted online and are answered in a timely manner.


M. D. Anderson resources:

askMDAnderson

Frequently Asked Questions

Gateways to Care (Conquest magazine)


The Tough Times: Caregiver Doubts

By Phyddy Tacchi on August 19, 2009 10:10 AM | Comments (0) | Trackbacks (0)
Phyddy_reading.jpg"I work all the time, but still feel like I'm behind."

One of the chief concerns of caregivers is fatigue, both physical and emotional. Many caregivers complain of sleep deprivation. Because of the all-encompassing duties that caregivers must absorb, fatigue and self-doubt may set in. The more tired caregivers begin to feel, the more they may question their ability and self-confidence.

If this fluctuating sense of physical and emotional fatigue has happened with you, don't lose heart. This has been the experience of many caregivers. It's important to take care of yourself during these difficult times, even for small blocks of time.  


Which of the following thoughts of self-doubt can you most identify with?

• Why can't I keep up?
• Why can't I do everything that needs to be done?
• Why can't I get him/her to eat? To drink? To walk?
• Is there something wrong with me because I can't get him/her better?
• Why doesn't he/she talk with me?
• Why can't I control things?
• I'm working as hard as I can and he/she still feels bad.
• I don't have time for anything.
• I feel defeated and burned out.
• My loved one is so irritable with me, I just don't know how to handle it.
• My loved one doesn't want anyone else to care for him/her other than me. I'm getting worn out.
• My loved one won't follow my advice.
• I let picky things get to me.

In my next post, I'll discuss the emotions of caregiving.

If you're visiting M. D. Anderson and you have time, I invite you to join me for our weekly "Caregivers, I've Got Feelings, Too!" support group. It's held on Thursdays, noon-1 p.m., at Place ... of wellness, Main Building. Call 713-794-4700 to reserve a spot. Oh, and we serve lunch.

Help Fight Cancer Despite Difficult Times

By Cancerwise Blogger on August 4, 2009 11:06 AM | Comments (0) | Trackbacks (0)
By Bayan Raji, Staff Writer

Americans are crunching budgets and cutting back on expenses, and millions have lost their jobs in recent months. But, cancer hasn't taken a break because the economy is in a rut.

Want to help but don't have the funds to make a monetary donation? Here's a list of ways to help a stranger, friend or relative with cancer.

For a stranger:

•    Donate blood - Many cancer patients need blood transfusions for different reasons, including surgery or a low blood cell count. Donating is a quick and free way to save a life.

•    Volunteer at a hospital - Extra hands often are needed to run gift shops, assist in outpatient facilities or run errands.

•    Get a haircut - Several non-profit groups, such as Locks of Love  and Pantene Beautiful Lengths , donate hair to people who lose their hair as a result of cancer or cancer treatment.

Some salons may provide a discount or even a free hair-cut, but hair donations must meet specific criteria. Ask a stylist for more details.



•    Make Search to Fight http://www.searchtofight.org/ your Internet homepage - On this search engine, Yahoo contributes portions of advertising revenue to the fight against cancer when users click on contributing sponsor links.

•    Donate an old car - Have an old car you'd like to give away? Donate it to the American Cancer Society Cars for A Cure program and proceeds will fund cancer research or other initiatives to fight the disease.

For a friend or loved one:

•    Offer to keep a blog - Many cancer patients use the Internet to keep others up to date on their condition or treatment. A Web page or blog reduces the number of times they have to repeat the same information. It is important not to provide personal information without obtaining permission first.

•    Clean - Treatments such as chemotherapy or radiation dramatically reduce the energy level of most cancer patients. Lend a hand by offering housekeeping services, such as cleaning the bathroom or vacuuming.

•    Cook - Make a meal at home and drop it off. Don't feel offended if you aren't asked to stay. Entertaining guests may take too much energy.

•    Go shopping - Buying provisions for someone in a financial struggle is a nice gesture if you have the money. Taking time to pick up groceries is just as good. It saves a friend or loved one time and energy and shows you are thinking of them.

Resources
CarePages - Stay connected with family and friends
M. D. Anderson Blood Bank
M. D. Anderson Volunteers

A Day in the Life of a Caregiver

By Phyddy Tacchi on June 18, 2009 12:53 PM | Comments (0) | Trackbacks (0)
"I feel responsible for absolutely everything. I always think I should be leading the patient to do the right thing. I feel I'm becoming such a nag."

Life can change with just one phone call. When the words "your loved one has cancer" are heard, life changes forever for the caregiver. That moment of first hearing the news will likely live on in your memory. Suddenly, life as you knew it is gone. A whole new expansive set of responsibilities appears seemingly overnight and invades every facet of daily life, as you can see from the list below.

What new responsibilities do you now have?

Practical Responsibilities
__Handling finances, working with insurance company, handling legal matters
__Providing for child care, meals
__Taking care of the home, often from a distance, such as paying bills, cleaning, yard, mail, etc.
__Time management

Physical
__Patient symptom management
__Fatigue
__Dealing with your own health concerns

Social
__Managing family relationships
__Managing other relationships, including friends, church, etc.
__Continuing with school and work tasks

Spiritual
__Coming to an understanding of the meaning of your life and death issues
__Tolerating suffering while yearning for control
__Maintaining hope in the face of uncertainty

Emotional
__Becoming aware of and managing anxiety, depression, sleeplessness and loneliness
__Learning new communication skills, including with the treatment team and your patient, who may be irritable
__Learning a different skill set of listening and coping skills

Administrative
__Becoming organized as the record keeper, including research on disease facts
__Tracking and organizing medications
__Scheduling for tests and treatments
__Working with the medical staff, other services, and coordinating appointments and schedules
__Seeking and finding help from others
__Providing transportation to and from appointments, errands, etc.
__Receiving medical training for at-home procedures

Self-concept
__Keeping up a feeling of confidence
__Maintaining a sense of self-worth during a time of great demands and stress
__Establishing and maintaining an overall feeling of competence

How many did you check? Are there additional things that you do that aren't on this list? Given that there are only 24 hours in a day, this scope of things to do can feel overwhelming and at times, exhausting. How do you handle this level of stress?

As I'll continue to mention in future caregiver posts, it's vital that you keep a toe in the water of the so-called normal, healthy world. It's so important to take care of yourself, but we'll discuss that at another time.

Restoring a Sense of Buoyancy

By Michael Fisch M.D. on May 20, 2009 10:45 AM | Comments (0) | Trackbacks (0)
Fisch_explaining.jpgThe patient had been perfectly healthy and now he had this new diagnosis of cancer. Now he is just miserable. And I reflect not only on the details about the disease and treatment, and the facts about treatment goals and prognosis, but I wonder how he can restore a sense of "buoyancy" (that force that keeps one afloat as opposed to sinking)?

I'm a cancer physician, not a pop-psychologist, but nevertheless I find it useful to get my own clear sense of buoyancy -- to understand my patients and to understand myself, too. I've decided that these 10 parameters (specific "floaties") are most important. They're in no particular order, they don't have equal importance, and their contributions to my overall buoyancy vary over time.

  1. Autonomy (freedom to choose). It's good not to be told how to act, dress or do every little thing at work.
  2. Exercise my skill (do my thing). I love being a cancer physician.
  3. Establish and maintain meaningful relationships. This applies for all aspects of my life (work, family, other activities).
  4. Being awake to my present reality. That means knowing that I'm not an astronaut, but also being able to tell when I'm tired or hungry or angry.
  5. Gratitude. The glass must be half full, at some level.  
  6. Courage (managing fear). There's no avoiding fear and doubt.
  7. Appreciation of impermanence. This just means that I "get it," that all things change. I may not relish change in all instances (like my aging body or my changing bank account in this economy), but I can see this truth.
  8. Compassionate mind frame. Empathy with benevolent intent.
  9. Finding and keeping my safety and security. This varies for each person. It might be a religious thing for some, or it could be related to having enough money or living close to family. It's that grab bag of individual stuff.
  10. Answering the question "do I matter?" This could be the ultimate existential question at some level, or it may apply in smaller situations (like "do I matter" on this project, or coaching this kids' soccer team, etc.).

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