Two Peds in a Pod®

Books for Helping Children Through Bereavement

Our guest blogger today is Mrs. Beverly Keegan, Librarian at Millcreek Elementry School, Bucks County Pennsylvania . A teacher for over thirteen years and a school librarian for the past nine years, Mrs. Keegan suggests books which may help a grieving child. She writes:

The loss of a loved one is difficult for anyone, but it can be especially confusing for young people. There are many ways to help children better understand death, but perhaps the least threatening approach is to expose them to a character feeling their same emotions in a fictional book. Reading a book either independently or together can be a good way to start a conversation about tough feelings. Below, I have created a list of books that might be helpful for various types of grief. I tried to choose more titles that would be most likely found in a school or library setting.

Loss of a Pet:
Cat Heaven or Dog Heaven by Cynthia Rylant (all ages): Beautiful verse and vibrant illustrations highlight the possible afterlife of both of our most beloved animal friends.

I’ll Always Love You by Hans Wilhelm (grades K-2): A boy loses his longtime companion in this beautiful picture book.

The 10^th Good Thing About Barney by Judith Viorst (all ages): A tender picture book that deals with the loss of the main character’s cat.

Loss of a Mother or Loss of a Teacher:
Remembering Mrs. Rossi by Amy Hest (grades 3-6): Annie deals with the sudden death of her mother, who was also a popular 6^th grade teacher.

Loss of a Parent:

Everett Anderson’s Goodbye (grades K-3) by Lucille Clifton: A boy struggles with the death of his father.

The Memory String (grades 2-4) by Eve Bunting: A girl grieves for her mother while trying to accept a new stepmother. She remembers her mom by counting a string of memory beads.

Loss of a Friend:
If Nathan Were Here (grades 1-3) by Mary Bahr: A young boy deals with the loss of his best friend. It is simple, yet poignant.

Water Bugs and Dragonflies (grades 1-3): a simple animal fable about loss.

Loss of a Sibling:
Kira-Kira (grades 5 and up)—This Newbery Award winner tackles the tough subject of a sister who becomes terminally ill. As her illness worsens, Katie does her best to remember Lynn’s “kira-kira,” which means her bright, shining ways.

Getting Near to Baby (grades 4 and up): In this Newbery medal winner, two sisters move into their aunt’s house. As, the story unfolds, the reader discovers that their infant sister has died. The book deals with the girls’ confusion about their mother’s feelings and their own sense of loss.

Loss of a Relative:
Missing May (grades 4 and up): In this Newbery Award winner, Summer loses her Aunt May. It is a story of how to start to live again after a sharp loss.

Each Little Bird That Sings (grades 4 and up): The main character is used to death, as her family owns the town funeral parlor. However, when her own dear uncle dies, she gets a whole new perspective on sorrow.

For adults and children:
Tear Soup: A parable about a woman who has lost an unnamed loved one. She mixes up a batch of tear soup, made of memories and experiences. This beautiful book could be applied to many different types of grief.

Mrs. Keegan has her own blog and website at www1.cbsd.org/schools/millcreek/library
©2010 Two Peds in a Pod

April 29, 2010 by twopedsinapod

The Tall Tales of Teething: What you should know about teething symptoms

This truth we know for certain: teething causes teeth.

We all can picture our babies chewing on their fingers and toys and drooling before getting their first tooth. But what other symptoms do incoming primary teeth cause?

Nearly everything in the past has been blamed on teething, including seizures, meningitis, and tetanus. According to an article in Pediatrics in Review (April 2009), teething was listed as the official cause of death in about five thousand infants in England in the early 1800s. In France from 1600 to 1900, fifty percent of all infant deaths were blamed on teething!

Numerous studies have tried to identify which symptoms coincide with tooth eruption. Two such studies: http://pediatrics.aappublications.org/cgi/content/abstract/106/6/1374 and http://pediatrics.aappublications.org/cgi/content/abstract/105/4/747 involved parents and/or daycare teachers. They kept daily checklists of symptoms such as runny nose, diaper rash, crankiness, diarrhea, and fever. Every day caretakers checked for new teeth. Guess what those researchers found? They found little correlation between any single illness symptom and a new tooth.

Despite scientific evidence to the contrary, people still blame teething for numerous maladies.

Here are symptoms which are NOT caused by teething that parents should be aware of:

· Teething does not cause fever over 101 degrees F. Fever of this height or higher indicates infection somewhere. Maybe a simple viral infection such as a cold, or a more severe infection such as pneumonia, but parents should NOT assume that their baby’s fever over 101 F is caused by teething. These babies could be contagious. Parents should not expose them to others with the false sense of security that they are not spreading germs.

· Teething does not cause diarrhea severe enough to cause dehydration. If a child has severe diarrhea, then he most likely has a severe stomach virus or another medical issue.

· Teething does not cause a cough severe enough to cause increased work of breathing. Babies make more saliva around four months of age and this increased production does result in an occasional cough. But babies never have breathing problems or a severe cough as a result of teething. Instead, suspect a cough virus or other causes of cough such as asthma.

· Teething does not cause pain severe enough to cause a change in mental state.

Some children get crankier as their teeth erupt and cause their gums to swell and redden. But, if parents cannot console their crying/screaming child, the child likely has another, perhaps more serious, cause of pain and needs an evaluation by his or her health care provider.

Just from a logic standpoint, if teething causes symptoms as babies get their primary teeth, shouldn’t incoming permanent teeth cause the same symptoms? Yet I’ve never heard a parent blame teething for a runny nose, rash, cough, fever, or general bad mood in an eight, nine, or ten year old child who is growing permanent teeth.

Maybe these parents are too busy bemoaning the cost of early orthodontal work.

Julie Kardos, MD
©2010 Two Peds in a Pod

April 25, 2010 by twopedsinapod

AH-CHOO! Coping with seasonal allergies

It’s only 3 p.m. on a Saturday and one of my children is in the shower for the second time today washing off the pollen which has turned her face into a puffy, slimy raspberry. It’s that beautiful time of year when the blooming flowers trigger allergic symptoms such as runny noses and red itchy eyes.

In addition to washing pollen off your child’s body, you can make some changes in your child’s environment to help decrease allergic reactions to the “great” outdoors. For one, turn on the air conditioner and close the windows to limit the outdoors from entering your child’s bedroom. Also, have your child wash her hands as soon as she comes in from playing outside to decrease the chances of her rubbing allergens into her eyes and nose.

Many kinds of medications can help allergy symptoms. The most commonly used oral medications are the antihistamines. These medicines work by limiting the “histamines” your body makes in response to allergies. Histamine causes itchy skin, red eyes, and runny noses. Examples of antihistamines are diphenhydramine (brand name Benedryl), loratadine (brand name Claritin), cetirizine (brand name Zyrtec) and fexofenadine (brand name Allegra). The most common side effect of antihistamines is drowsiness, especially with older antihistamines such as diphenhydramine. Most antihistimines are now available over the counter.

Allergy eye drops and nose sprays act topically on the eyes or nose to combat allergy symptoms. Some prescription nose sprays contain topical steroids or antihistamines. Eye drops may contain antihistamines or mast cell stabilizers (more cells which cause allergy symptoms!).

Another allergy medicine heavily advertised is Singulair. This medicine is a leukotriene inhibitor which prevents the body from releasing another type of substance (leukotrienes) that causes allergy symptoms.

Decongestants such as phenylephrine or pseudoephedrine can help decrease nasal stuffiness. This is the “D” in “Claritin D” or “Allegra D.” However, they are discouraged in young children because of potential side effects such as rapid heart rate, increased blood pressure, and sleep disturbances.

Some of the above mentioned medicines can be taken together and SOME CAN NOT. Parents may inadvertently give more than one oral antihistamine simultaneously. Read the labels carefully for the active ingredients and do NOT give more than one oral antihistamine at a time. In contrast, most antihistamine eye drops and nose sprays can be given together with oral antihistamines.

Please consult your child’s health care provider to determine which allergy medications will best help your child this allergy season. A carefully thought out allergy plan can go a long way to helping your child’s allergy symptoms.

Sure beats taking five showers a day or having your nose removed for allergy season!

Naline Lai MD and Julie Kardos, MD

April 20, 2010 by twopedsinapod

We are patting our non-technological backs

Our Face Book fan page was stagnant until now… we’ve finally figured out how to get our posts out to our fans. Become our fan on Face Book and tell parents about us . Fan page is called Two Peds in a Pod .What’s the use of an advice blog if no one is listening?

We’re determined to grow baby step by baby step.

Drs. Lai and Kardos

April 19, 2010 by

When your child’s friend moves away

This sign now sits on my friend’s lawn. I still remember four years ago when I pulled my big blue minivan up in front of their house after the moving van left. A mommy sat on the stoop with her children. “How old are they? I hollered out. The ages of the children matched my children’s and I was delighted. Indeed they became good friends. And now, there’s the “For Sale” sign.

It’s nearing the end of the school year, and “For Sale” signs dot lawns all over the United States. Chances are, one of them belongs to your child’s friend. Just as the child who moves will have to adjust to a new environment, your child will have to adjust to a world without a friend who was part of his daily routine.

Much has been written about how to transition the child who moves into a new environment, but how can you help your child when his close friend moves away?

Your child may experience a sense of loss and feel that he was “left behind.” Some children perseverate over the new hole in their world. Others take the change in stride.

In the late 1960’s, psychiatrist Elisabeth Kubler-Ross described “the five stages of grief.” The stages were initially applied to people suffering from terminal illness, but later they were applied to any type of deep loss such as your child’s friend moving. The first stage is denial: “I don’t believe he moved.” Anger follows in the second stage: “Why me? That’s not fair!” Your child may then transition into the third stage and bargain: “If I’m good maybe he will hate it there and come back.” The fourth stage is sadness: “ I really miss my friend,” or, “Why make friends when they end up moving away?” The final stage is acceptance: “Everything is going to be okay. We will remain friends even if he doesn’t live here.”

Some pass through all stages quickly and some skip stages altogether. The process is personal and chastising your child to “just get over it” will not expedite the process. However, there are ways to smooth the journey:

· Reassure your child that feeling sad or angry is common. Parents need to know that sad children may not show obvious signs of sadness such as crying. Instead, rocky sleep patterns, alterations in eating, disinterest in activities or a drop in the quality of school work can be signs that a child feels sad. If feelings of depression in your child last more than a month or if your child shows a desire to hurt himself, consult your child’s health care provider.

· When you discuss the move with your child, keep in mind your child’s developmental stage. For instance, preschool children are concrete and tend to be okay with things being “out of sight, out of mind.” Talking endlessly about the move only conveys to the child that something is wrong. Children around third or fourth grade can take the move hard. They are old enough to feel loss, yet not old enough to understand that friendships can transcend distance. For teens, who are heavily influenced by their peers, a friend’s moving away can cause a great deal of disruption. Acknowledge the negative emotions and reassure your child that each day will get better. Reassure him that despite the distance, he is still friends with the child who moved.

· Prior to the move, don’t be surprised if arguments break out between the friends. Anger can be a self defense mechanism employed subconsciously to substitute for sadness.

· Set a reunion time. Plan a vacation with the family who moved or plan a trip to their new home.

· After the move, send a care package and write/ help write a letter with your child.

· Answer a question with a question when you are not sure what a child wants to know. For example if he asks,” Will we always be friends?” Counter with “What do you think will happen?”

· Share stories about how you coped with a best friend moving when you were a child.

As for my children, when I told one of my kids that I will sign her up for soccer, she squealed with delight, “Oh, that’s the league Kelly belongs to.”

My heart sank. I said as gently as I could, “She’s moving- she won’t be here for soccer season.”

And so we begin the process…

Naline Lai, MD

April 18, 2010 by twopedsinapod

“Ya gotta have heart!” Heart murmurs explained.

When the Tin Man was a child in Oz, I’m sure his pediatrician never told his parents, “Has anyone ever said your child has a heart murmur? I hear one today.”

I know that when I tell parents about a heart murmur in their child, their hearts skip and jump. But not all heart murmurs are bad.

A heart murmur is an extra sound that we pediatricians hear when we listen to a child’s heart with a stethoscope. A normal heart beat sounds like this: “lub, dub. lub, dub. lub, dub.” A heart murmur adds a whooshing sound. So what we hear instead is “lub, whoosh, dub” or “lub, dub, whoosh.”

The “whoosh” is usually caused by blood flowing through a relatively narrow opening somewhere in or around the heart. Think of your blood vessels and heart like a garden hose. If you run the water (blood) very hard, or put a kink or cut a hole in the hose, the whoosh of the water grows louder in those locations.

Heart murmurs signal different issues at different ages. In a newborn, some types of heart murmurs are expected. Normal newborn hearts contain extra holes that close up after the first hours or days of birth. One type of murmur occurs as the infant draws in his first breath and holes in the heart, present inside the womb, begin to seal. As the holes get narrower, we sometimes hear the “whoosh” of blood as it flows through the narrowing opening. Then these holes close completely and the murmur goes away.

However, some murmurs in infancy signal “extra holes” in the heart. As pediatricians we experience our own heart palpitations when moms want to leave the hospital early with their infants who are less than 48 hours old. We worry because many infants who have abnormal hearts may not develop their abnormal heart murmurs and other signs of heart failure until the day after birth.

Preschool and early school age children often develop “innocent” heart murmurs. “Innocent” implies that extra blood flows through their hearts, but the hearts are structurally normal. These murmurs are fairly common and can run in families. However, there are heart problems which do not surface until this age. For this reason, remember to schedule those yearly well child checkups.

For teens, during the pre participation sports physical, pediatricians listen carefully for a murmur that may indicate that an over grown heart muscle has developed.

Again, holes are not the only culprit behind a murmur. The whoosh sound can also arise when a person is anemic and blood flows faster than normal. In anemic kids, the blood flows faster because it lacks enough oxygen-carrying red blood cells and the heart needs to move blood faster in order to supply oxygen to the body. The most common cause for anemia is a lack of sufficient iron intake. Subsequently, we hear these flow murmurs in children whose diets lack iron, in teenagers who are growing rapidly and quickly use up their iron stores, and in girls who bleed too much at each period. Replenishing the iron level makes a heart murmur from anemia go away.

Even a simple fever (see our earlier blog posts to learn more about fevers) can cause a heart murmur on physical exam. The murmur goes away when the fever goes away.

Pediatric health care providers can often distinguish between “innocent” heart murmurs and not-so- innocent heart murmurs by the sound of the murmur itself (not all “whooshes” sound alike). If any question exists, your child will be referred for more testing, which could include a chest x-ray, an EKG (electrocardiogram), and ECHO (echocardiogram, or ultrasound of the heart) or evaluation by a pediatric cardiologist.

If your child’s pediatrician tells you that your child has a heart murmur, “take heart”. Many times a murmur comes and goes or just becomes part of your child’s baseline physical exam. Even if your child has a serious heart problem, most cases respond well to medication, surgery, or both. While not all heart problems cause heart murmurs, and while not all murmurs signal heart problems, the presence of a heart murmur in a child can signal that your child needs further testing.

Unless, of course, your child is the Tin Man. In this case, extra sounds indicate that your child needs more oil!

Julie Kardos, MD
©2010 Two Peds in a Pod

April 14, 2010 by twopedsinapod

Hand Held Health Hazards: your kids and their devices

This spotted the other day- tendonitis. In plain English, wrist pain at the base of the thumb from the strain of playing too much Nintendo DS/iPod touch or texting on your phone with your thumbs.

Imagine what the iPad will bring.

Naline Lai, MD 2010

© Two Peds in a Pod

April 13, 2010 by twopedsinapod

Subduing stress: relaxation techniques

As the school year comes barreling to an end, I always find an assortment of students parading through my office with stress related ailments. Struggling to keep up in class can be extremely stressful for a child. Whether the child is college aged or elementary school aged, concerned parents want to know how to prevent their child from internalizing stress. Today, psychologist Dr. Sandy Barbo provides us with relaxation techniques to deflect tension. The mom of two college-aged daughters, Dr. Barbo has worked with children and their families for over twenty years. – Dr. Lai

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Hurry, hurry, hurry!!! Off to soccer practice, or the orthodontist’s office, or swim class, or a scout meeting, or a violin lesson. Don’t forget homework, that spelling test… oh no! Wasn’t there a special poster project due soon? Quick, run into Staples to get that poster board. Oh, and yes, we can’t forget to grab some take-out because with all the rush, who had time to make dinner?

Sound familiar? We tend to live very busy lives these days and our children’s schedules reflect that in all the many activities they engage in. Even our youngest and smallest have schedules!

Busy-ness can lead to stress, but so can a host of other experiences our children live through day to day. Our kids have to juggle performance in school (getting assignments done, managing academic and extracurricular challenges), survival in social groups (peer pressure,bullying, overcoming shyness), and even the occasional external stress that filters down from the adult world (news of a disaster, parental job stress, illness in an extended family member).

How do we as parents help inoculate our kids so they can better manage the various stresses and anxieties that come their way? There are many possibilities. Here are a few:

One of the easiest and most effective stress busting strategies you can teach your child (and yourself!) has to do with the deep, diaphragmatic breath. Lie down on the floor with your child or sit upright in a comfortable chair. The trick is to align the chest above the pelvis. Make a diamond shape with your thumbs and index fingers.Show your child how to position the belly button in the middle of the diamond. Now instruct her to slowly take in a deep, filling breath so that the belly starts to raise her hands up as far as they can go. Slowly, exhale and allow the belly to sink back down. When empty, fill up again slowly, but comfortably. For some kids, it helps them to imagine they are filling a balloon with their breath and then letting it all out. When you’ve completed 3 belly breaths you’ve created a “mini”. And “minis” are wonderful as they can be done almost anywhere, anytime, incognito! Remind your child on the way to school, “Let’s do a mini”; or before going into an anxiety provoking situation; or even at the end of the day, in bed to help settle everyone down. The deep breath counters our body’s response to stress and is incompatible with anxiety which provokes shallow chest breathing. Try modeling “minis” for your child and encourage him to practice them at least 3 times each day. When you teach your child how to do “minis”, he’s learned a powerful stress buster that he can put to use whenever or wherever the need arises.

Don’t forget the good old fashioned belly laugh. We know that humor helps us reframe and relieve stress, but the deep belly laugh is also diaphragmatic and forges a healthy mind/body connection. Don’t be bashful. Suggest a tickle fest. Have a book of age-appropriate jokes around that you can share with your kids. Belly laughs are infectious. It almost doesn’t matter what silly idea starts them. Show your kids that the sillies can get the better of you too and laugh all of yourselves to the point of exhaustion.

We tend to hold our tension in our “stress triangle”the area between the shoulders and up towards the neck. Show your kid show to gently press their shoulders up towards their ears, then roll them back and relax along with those wonderful deep breaths they’ve already learned. Also, indulge in massage. Rub between your child’s shoulders. At bedtime, offer a foot massage.

Another helpful de-stressor at bedtime can be a guided imagery exercise. You become your child’s guide. Help her create her imaginary safe, relaxed place by engaging all of the senses. Pick, or have your child pick, her favorite vacation setting. Beach? Be ready to customize your guided tour to her most wonderful fantasies. Have her close her eyes, start deep breaths and use her imagination to picture herself stepping down a series of 10 steps into the setting as you slowly and in your most soothing voice count. For example:

1. You’re at the top of a set of stairs that go down the dunes to the beach. You see the beautiful beach below you.Imagine what you see. Imagine the colors all around you. (Deep breath)

2. You can see the wonderful beach scene before you,the boats on the water, the few wispy clouds in the beautiful blue sky, the gulls that fly over the water. (Deep breath)

3. You can feel the sun on your skin. It’s deliciously warm. (Deep breath)

4. A cool breeze, just the right temperature is gently blowing through your hair. (Deep breath)

5. You can hear the sound of the waves lapping at the shore. The sun is sparkling off the water. Imagine the other sounds you hear on the beach. (Deep breath)

6. You can smell all those wonderful beach smells, the sunscreen, the wet sand. You can almost taste the salty ocean water droplets as they reach your lips. (Deep breath)

7. You feel your toes in the sand. It is just the right warm temperature, soft and comfortable under your feet. (Deep breath)

8. You are at the water now. Just let your toes wiggle and feel the wonderful temperature of the water. As you wriggle your toes you can see the sea foam and the sand make wonderful patterns between your toes. (Deep breath)

9. All around you are the people you love. (Deep breath)

10. You lie down on the beach feeling so relaxed and comfortable, just resting and enjoying the wonderful sounds, smells, feelings,tastes, views of the beach. You are restful and relaxed. You are breathing deep steady breaths. Enjoy this feeling of relaxation in this safe, warm, wonderful place. In a minute, when you are ready, you can gently open your eyes or allow yourself to drift off to sleep.

The above mentioned guided imagery exercise can become a beloved ritual. My daughter’s favorite involved a meadow with a family of unicorns. Each night, I learned to tap all my creative resources to keep the characters on interesting adventures in the meadow all the while engaging my daughter’s sensory system within her fantastic imagination, as she continued to deep breathe and leave the stressors of her day behind.

Invite your kids to share when they’ve used their stress busters during the day. Model for them how to take a “mini” to manage some aggravation that comes your way. With just a little bit of practice, your child can start to use these stress-busting strategies, when challenged, to reestablish a sense of calm. It’s truly a gift that keeps on giving over and over again.

Sandy Barbo, Ph.D.

Dr. Barbo is a licensed psychologist and the mom of two college-aged daughters. She has been working with children, parents and families for over 20 years. In addition to providing psychotherapy for anxiety, depression, trauma, Dr. Barbo has developed sub-specialties in infertility, pre and post-adoption, and ADHD. Contact her at: drsandybarbo@comcast.net or P.O. Box 196, New Hope, PA 18938 telephone (215)297-5092

April 8, 2010 by twopedsinapod

Managing Munchies: More healthy weight ideas

Standing in line at a fast food restaurant off an East coast highway during spring break, I overheard the cashier greet the family in front of me by name. I cringed. Was the family a regular customer at the chain? Hopefully, they were just friends with the cashier.

Most of us, including me, are not always health food angels. However, a family who is a regular customer at a fast food restaurant may simply not know how to break the habit. For those who still need to get those healthy eating New Year’s resolutions rolling, our February podcast, “Helping the Overweight Child,” gave the 5-4-3-2-1-0 rules for healthy eating. This post gives more hints:

BMI, or Body Mass Index (weight in kg divided by height in meters squared) is a number which indicates whether your child’s weight is normal for his or her height and age. Normal weight school aged kids DO look a bit scrawny.Children’s bellies should NOT hang over their pants. On the other hand, normal weight toddlers do look a bit pudgy. The Centers for Disease Control and Prevention has a nice BMI calculator.

Snacks aren’t needed at sports games which last only an hour. Supply water bottles and forget the snack.

Don’t feed your younger child snacks to keep him occupied during an older sibling’s event. Bring books, paper and crayons, a doll, or a matchbox car instead.

Make a stack of peanut butter and jelly or cheese sandwiches and keep them wrapped, ready to go, in the fridge. Keep some washed apple slices or carrot sticks along side the sandwiches and this stash can be your “fast food” at those times you need to feed your family “on the run”.

Don’t give your children a junky snack in order to carry them over until dinner. If your kids come home from school STARVING!!, give them a REAL dinner, and then give them a fruit or vegetable when the entire family later sits down.

A holiday is one day, Halloween is October 31^st. ^.Why eat the candy for days and weeks afterwards?

Don’t keep junk food in your home. This will avoid arguments about what to eat.

Have your children ask you if they can have something to eat, rather than allowing “free access” to your pantry/refrigerator. That allows you decide if it is too close to mealtime to have a snack (remember from the Picky Eaters blog post,“hunger is the best sauce”) and will allow you to choose an appropriate snack and portion size. If kids inherently knew healthy choices and portion sizes, they wouldn’t need parents! Also this allows you to determine if the child is truly hungry, bored, or attention seeking.

Now back to the the fast food establishment I find myself in with my family. “Maybe this restaurant chain should offer a Two Peds in a Pod kid’s lunch box,” I mused as my family finished up their greasy, salty meal. Everyone’s curiosity was piqued. My husband and I began to hypothesize what kind of food would be inside a Two Peds box.

“What do you think?” I asked the kids.

“We’re actually more interested in what kind of prize would you would offer,” they said.

Gotta love my regular customers.

Naline Lai, MD and Julie Kardos, MD

April 4, 2010 by twopedsinapod

H1N1: More vaccine info

For all the kids who received separate seasonal and 2009 H1N1 (Swine flu) vaccines last year, there is good news from Kimberly Parnell, PhD, our favorite flu vaccine vigilant-scientist-mom (see the last H1N1 vaccine blog post). The World Health Organization, who meets on a yearly basis in February to decide on the strains for the upcoming fall’s “flu shot” has decided to roll the new/novel H1N1 into this year’s Northern Hemisphere vaccine.

Winter flu season … it’s only nine months away !

For more detailed information:

http://www.who.int/csr/disease/influenza/recommendations2010_11north/en/index.html

Naline Lai, MD

March 31, 2010 by twopedsinapod