Chat with us, powered by LiveChat
We have moved to 5555, suite 200, Westminster Road in Cote Saint Luc. Stay up to date by following us on Facebook and Instagram!

Flu and cold season is happening now! Let’s talk about your cough and the use of antibiotics.

 

Unnecessary antibiotic use is a direct contributor to antimicrobial resistance, a serious health threat facing Canadians today. It is estimated that 30-50% of written antibiotic prescriptions are completely unecessary. Wide use of antibiotics breeds ‘superbugs’, which become harder, and sometimes impossible, to treat.

Antibiotics kill bacteria, not viruses. Antibiotics fight infections caused by bacteria, but most respiratory infections are caused by viruses.

Viruses cause:
All colds and flu.
Almost all sinus infections.
Most bronchitis (chest colds).
Most sore throats, especially with a cough, runny nose, hoarse voice, or mouth sores.

Antibiotics have risks, such as;
They upset the body’s natural balance of good and bad bacteria.
Nausea, vomiting, and severe diarrhea.
Vaginal infections.
Nerve damage.
Torn tendons.
Life-threatening allergic reactions

Do not take antibiotics for a bronchitis or sore throat unless advised by a Doctor or Nurse and make sure to get immunized if you can – the pneumonia shot and the flu shot help prevent bacterial bronchitis and pneumonia.

 

Travelers’ Diarrhea – Oh No! I Gotta Go!

So diarrhea may not be the most pleasant thing to talk about when planning a vacation, but every traveler should be informed and prepared  for it.

Travelers’ diarrhea can affect all travelers.  It is an unfortunate fact  but no one is safe!

Travelers’ diarrhea is the most common travel related illness.

Bacterial diarrhea lasts three to seven days. Viral diarrhea lasts two to three days. Protozoal diarrhea can last months without treatment.

Everyone is at risk as bacterias, viruses and parasites can be found everywhere, even all inclusive luxurious resorts Canadians are flocking to as Spring Break is upon us!

As a registered nurse with over 5 years experience working in Travel Medicine I can offer helpful tips for preventing and treating traveler’s diarrhea.

How To Avoid Traveler’s  Diarrhea From  Ruining Your Trip?

  • Use bottled water for drinking and brushing teeth. If you don’t have access to bottled water, you can treat your own water by boiling it for a few minutes, OR using a water purification system. (Pristine)
  • Wash your hands regularly and practice good hygiene.
  • Keep your mouth closed while showering.
  • Avoid raw or undercooked meat or seafood.
  • Be cautious with salads, fruits, and vegetables that may have been washed with contaminated water. Stick to fruits that you can peel yourself, and well cooked vegetables.
  • Avoid unpasteurized milk and dairy products.
  • Avoid food from street vendors.
  • Eat foods that are freshly cooked and served hot.
  • Don’t use ice cubes.
  • Probiotics – before, during and after your trip.
  • Dukorol Vaccine – at least 2 weeks prior to travelling

How Do I Know if I have Traveler’s Diarrhea?

  • Abrupt onset of diarrhea and the urgent need to use the toilet
  • Fever
  • Nausea and vomiting
  • Bloating/Gas/Cramps
  • Weakness and discomfort
  • Loss of appetite

How Do I Treat and Manage My Symptoms of Traveler’s Diarrhea?

  • Oral Rehydration Tablets: Known as oral rehydration salts such as Gastrolyte/ Pedialyte.
  • Antibiotics : To be prescribed prior to travel  and varies by destination.To be used in severe – 3 or more loose stools in an 8 hour period.
  • Anti-Motility Medications: Lomotil, Imodium , Bepto -Bismol

I hope this glimpse into the unglamorous side of travel helps to prepare and manage your upcoming trips.

Safe Travels!

 

Small tips to stay healthy

Being healthy is not as simple as some people make it seem online. It’s not easy to find time to do the “simple” two hour long workout that your favorite blogger recommends or to find the twenty-three ingredients needed for the health smoothie that a celebrity loves. Therefore, this list is a compilation of the four easiest and simplest tips to help you live your best and healthiest life.

Join a Team

As someone who hates working out and tries their best to avoid it, the best way for me to actually exercise is by joining a team. Being part of a team means there is a group of people depending on you, making it easier to go to practices and play games. If competitive sports aren’t your niche, there are several teams or just training groups you can join. According to Psychology Today, being around other people regularly increases self-esteem, increases productivity and lowers the risk of dementia.

Get Enough Sleep

Between Netflix and all the games on your phone, it’s easy to lose track of time. One minute you’re watching reruns of Friends and the next thing you know, it’s 2 am and you need to be up at 6:30. Lack of sleep can negatively impact both mental and physical health. Not sleeping enough can be the root of high blood pressure, a variety of heart problems, weight gain and more, Healthline states. So, if you know you’re one to get distracted, program an alarm on your phone or set your wifi to turn off at a certain time. Sleepfoundation.org recommends 9 to 11 hours of sleep for children, 8 to 10 hours for teenagers, 7 to 9 hours for adults and 7 to 8 hours for adults over the age of 65.

Pack Your Lunch When You’re Full

I love carbs and everything not healthy therefore if I have to buy my lunch when I’m hungry, I would definitely pick pasta over a healthy salad. When I pack my lunch beforehand, I find it’s easier to pick healthy foods because I’m thinking from a non-hungry point of view. This is not to say that you can’t or shouldn’t eat unhealthy food just that it’s better for you if unhealthy meals are spaced out throughout the week. Having more energy throughout the day, better heart health and improved brain function are all results of eating healthier according to Medical News Today.

Avoid Stressful Situations

Stress is a constant of life: whether it’s an upcoming deadline or a late bus. As per WebMD, stress can ruin your teeth, cause insomnia and weaken your immune system. In some cases we can’t avoid stress but in others we can. Try choosing an outfit or packing your food the day before if you’re always late and stressed in the morning. Don’t take on extra projects and/or commitments if you’re already struggling with what you have.

 

Troyer, Angela K. “The Health Benefits of Socializing.” Psychology Today, Sussex       Publishers, 30 June 2016, www.psychologytoday.com/us/blog/living-mild-cognitive-impairment/201606/the-health-benefits-socializing

“11 Effects of Sleep Deprivation on Your Body.” Healthline, Healthline Media, www.healthline.com/health/sleep-deprivation/effects-on-body#1

“How Much Sleep Do We Really Need?” National Sleep Foundation,

https://sleepfoundation.org/excessivesleepiness/content/how-much-sleep-do-we-really-need-0

Crichton-Stuart, Cathleen. “The Top 10 Benefits of Eating Healthy.” Medical News      Today, MediLexicon International, 26 June 2018, www.medicalnewstoday.com/articles/322268.php.

Karriem-Norwood, Varnada. “Stress Symptoms.” WebMD, WebMD, 11 July 2017, www.webmd.com/balance/stress-management/stress-symptoms-effects_of-stress-on-the-body#1.

“Use the 95:5 Rule To Forever Ignore All Further Healthy Living Advice.” Weighty Matters, 23 June 2015, www.weightymatters.ca/2015/06/use-955-rule-to-forever-ignore-all.html

The reasons why Santé Kildare will not become a “Superclinic” any time soon

 

The Montreal Gazette recently published an exposé on “Quebec’s super clinics and their side-effects.”  It’s hard to escape the hype with near weekly announcements by the Minister of Health touting these “new” establishments as a solution to ER overcrowding.  Proponents call them the long-overdue solution to a chronic problem.  Opponents call them “all smoke and mirrors.”  I prefer the term “McMedicine” – Be wary of the adverse complications of Supersizing.

1.     Superclinic ≠ Supercare

What’s in a name?  Superclinics sounds spectacular – nurses with capes, doctors with superpowers.  The Avengers the Primary Care!

However, we have to question who provides the care.  This does not mean that superclinics don’t have super-doctors or super-nurses, but excellent care really emanates from a nurtured doctor-patient relationship.  “Supercare” is delivered by the health team that knows you.

As Dr. Premji laments in healthydebate.ca – “We promote convenience over continuity.”  In fact, “relational continuity” is associated with better care outcomes than speed.

2.     We perpetuate myths about ER use

No doubt our ERs operate above capacity, but do superclinics solve the problem?  As the Gazette correctly points out, ERs continue to work beyond recommended limits even with the weekly openings of new superclinics.

As Dr. Premji explains, we have to address and solve the underlying problems for ER overcrowding – such as overflowing inpatient wards, too few long-term care beds and an inadequate supply of home care services.

3.     “All smoke and mirrors”

Superclinics did not apparate out of thin air.  They are an extension of the pre-existing Clinique Reseau (CR) model established by Minister of Health Couillard more than a decade ago.  Like superclinics, CRs were open on weekends and evenings with on-site access to radiology, labs and specialists.  The difference – 4 hours on Saturday and Sunday.

 

Again the Gazette exposes the less-than-impressive truth: new superclinics may offer at least 40,000 consultations for walk-in patients each year (using the Pierre Boucher superclinic as an example), but the previously named Pierre Boucher Family Medicine Group had already surpassed that goal in 2016, reporting 47,000 consultations for walk-in patients that year!

4.     It’s the PREMs!

If the acronyms CLSC, CSSS, CIUSSS, GMF, GMF-R, UMF are not confusing enough – consider the punitive PREMs.  The Plans régionaux d’effectifs médicaux or PREMs, is a system the Ministry created to determine how many family doctors can practise in a specific area.

Sometimes access has nothing to do with hours – but with hiring adequate staff to meet the need.

As Dr. Mark Roper, Director of the superclinic at the Queen Elizabeth Health Complex comments: “We have doctors applying to work with us, but they are not permitted to work with us because of the government restrictions.”

The Gazette writes: “The PREMs, Roper argues, have tended to favor the outlying regions to the detriment of Montreal. Montreal doctors treat both local residents and those from the off-island suburbs who commute to the city, yet both Liberal and PQ governments have resisted allocating more permits to what is known bureaucratically as Region 6. Politically, more votes are up for grabs off island than in Montreal.”

5.     Who is your clientele?

A big source of confusion remains who is responsible for care.  Family Medicine Groups (GMFs) meet the needs of its defined, rostered population.  Superclinics offer appointments to anyone.  In an ideal world, superclinics bridge the gap between GMFs and ERs, but in reality, the system is contradictory, unnecessarily complex, and at times, adversarial.

Family doctors are financially penalized when their patients seek care elsewhere yet an aggressive advertising campaign for superclinics literally entice and lure patients away from their family doctors.

Combined with the fact that superclinics are also GMFs, the primary care equation becomes unrecognizable.  Solve this formula: GMFs need 80% of its registered patients to see GMF doctors exclusively AND the same GMF-R (aka superclinic) is mandated to book non-registered patients 80% of the time!  Care seems more paradoxical than complimentary.

6.     Shuffling the deck

With PREMs limiting physician movement, who staffs the new wunderclinics?  You guessed it – the same doctors from the GMFs, former CRs and even the ERs.  As one family doctor commented to the Gazette – “I’m thinking of going to work in a super clinic, but that’s just a reshuffling of the cards, isn’t it?”

Other clinics (often the former CRs) are caught in GMF/GMF-R purgatory – too big for one yet small enough for the other.  Funding is threatened and operators fear the demise of their services.  One doctor notes, “It makes no sense.  Since we want to create these super clinics, we’re in the process of hollowing out clinics that used to function well, clinics like mine.”

In the end, GMF Santé Kildare remains committed to providing supercare to our super-patients.  We are fortunate to have a super-team committed to your health and wellbeing.

 

10% effective? No – the flu vaccine is an EXCELLENT match!!

According to recent data from the Public Agency of Canada, 583 influenza viruses have been identified. The quadivalent vaccine that we gave children last Fall (Flulaval Tetra) covers 98.2% of these viruses.

The trivalent vaccine (Agriflu and Fluviral) covers 99.8% of the Influenza A viruses (including H3N2 and H1N1).

So why are so many people getting sick with the flu?

Regrettably, unlike the quadrivalent vaccine, the trivalent version does not vaccinate against the vast majority of the Influenza B viruses. Even so, the trivalent vaccine is a match against 62.3% of all indentified flu viruses this year.

Articles like the one below, published in December, warned about strains in Australia and Western Canada and speculated on their potential impact.

In reality, the flu vaccine is an excellent match – or in the words of the National Microbiology Laboratory – the circulating influenza viruses are “antigenically similar to components in the 2017-2018 Northern Hemisphere vaccine.”

The bottom line – get the Flu vaccine.

Health care with no heart

Sadly – these cuts will not be the exception – they will become the norm.

Please understand that this IS the Minister of Health’s plan. His focus is reorganization, cost-saving and “efficiency” – NOT care – and definitely not care for all.

Remember Bill 10? In its own words: “This bill modifies the organization and governance of the health and social services network…in order to facilitate and simplify public access to services, improve the quality and safety of health care and make the network more efficient and effective.”

“The bill establishes a new system of governance for the regional and supraregional institutions by specifying, among other elements, the composition of their boards of directors… appointed by the Minister of Health and Social Services.”

“The Minister is granted new powers…in particular the power to prescribe rules relating to their organizational structure and management and the power to work with the general management in cases of actions incompatible with the rules of sound management….”

Bill 10 passed in February 2015, abolishing the Board of Directors of individual health institutions and organizations (including the Jewish General, Mount Sinai, Mackay, etc). They were replaced by the CIUSSS, a supraregional agency, led by a team handpicked by the Minister of Health.

In the words of former Liberal MNA, Clifford Lincoln: “It’s such a huge reorganization of the health system that it buries the individual, it buries the client, it buries the patient, it buries the individual institutions and their boards into one, big, mega-reorganized system.”

This is why it should come as no surprise that Francine Dupuis, associate CEO of the CIUSSS West-Central Montreal, justifies the cuts because Miriam Home and Services has “not properly managing its day program for years.”

How has the Miriam Home failed? After all, its purpose is “to ensure that persons with intellectual disabilities be seen and treated as persons, experience love and friendship, experience continuity in their lives, be afforded personal security, be adaptively cared for, be treated with respect and dignity, have access to opportunities to make choices and exercise their rights, learn skills, be given means to compensate for their deficiencies and disabilities, have a decent and appropriate place to live, have a meaningful employment or occupation and have life-long opportunities for growth.”

Apparently not anymore. Dr. Barrette now determines every institution’s purpose – and to quote Francine Dupuis, the “Ministry of Health and Social Services has made it very clear it will no longer allow Miriam Home to provide rehabilitation services to clients whose condition can’t improve.”

The CIUSSS does NOT share the same vision as Miriam Home. The CIUSSS aims to “ensure real integration of services provided to the population.” Its “values” include: commitment to our clientele, collaboration, transparency, courage, respect and innovation.” The list does NOT include Miriam Home qualities like respect, dignity, access, meaning or growth.

Regrettably, we have a health system that promotes efficiency over care and selects services based on risk–return tradeoff. Today we are cutting services for apparently “babysitting” adults with intellectual and developmental deficits. After all, the CIUSSS had determined that they “take too many medications.” Apparently, quality of life, maintaining care, choices, personal security, don’t matter anymore.

Who can we cut next? Children with disabilities? Frail elderly? Palliative patients? Drug addicts? Alcoholics? Do they have good prospects for improvement? What is their cost-benefit?

We have a commitment to care for all. No one said health care was cheap – but common sense and dignity are still free!

 

New Flu Information for 2017-2018 from cdc

flu2017b

New Flu Information for 2017-2018 from cdc.gov/flu

Getting an annual flu vaccine is the first and best way to protect yourself and your family from the flu. Flu vaccination can reduce flu illnesses, doctors’ visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations.

What’s new this flu season?

A few things are new this season:

  • The recommendation to not use the nasal spray flu vaccine (LAIV) was renewed for the 2017-2018 season. Only injectable flu shots are recommended for use again this season.
  • Flu vaccines have been updated to better match circulating viruses (the influenza A(H1N1) component was updated).
  • Pregnant women may receive the flu vaccine

What flu vaccines are recommended this season?

This season, only injectable flu vaccines (flu shots) are recommended. Some flu shots protect against three flu viruses and some protect against four flu viruses.

Live attenuated influenza vaccine (LAIV) – or the nasal spray vaccine – is not recommended for use during the 2017-2018 season because of concerns about its effectiveness.

What viruses will the 2017-2018 flu vaccines protect against?

There are many different flu viruses and they are constantly changing. The composition of flu vaccines is reviewed annually and updated as needed to match circulating flu viruses. Flu vaccines protect against the three or four viruses (depending on vaccine) that research suggests will be most common. For 2017-2018, three-component vaccines are recommended to contain:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • an A/Hong Kong/4801/2014 (H3N2)-like virus
  • a B/Brisbane/60/2008-like (B/Victoria lineage) virus

Quadrivalent (four-component) vaccines, which protect against a second lineage of B viruses, are recommended to be produced using the same viruses recommended for the trivalent vaccines, as well as a B/Phuket/3073/2013-like (B/Yamagata lineage) virus.

When should I get vaccinated?

You should get a flu vaccine before flu begins spreading in your community. It takes about two weeks after vaccination for antibodies to develop in the body that protect against flu, so make plans to get vaccinated early in fall, before flu season begins. CDC recommends that people get a flu vaccine by the end of October, if possible. Getting vaccinated later, however, can still be beneficial and vaccination should continue to be offered throughout the flu season, even into January or later.

Children who need two doses of vaccine to be protected should start the vaccination process sooner, because the two doses must be given at least four weeks apart.

Can I get a flu vaccine if I am allergic to eggs?

The recommendations for people with egg allergies are the same as last season.

  • People who have experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.
  • People who have symptoms other than hives after exposure to eggs, such as swelling, respiratory distress, or vomiting; or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a health care provider.

Protective Actions

What should I do to protect myself from flu this season?

CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease.

In addition to getting a seasonal flu vaccine, you can take everyday preventive actions like staying away from sick people and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading flu to others. In addition, there are prescription medications called antiviral drugs that can be used to treat influenza illness.

What should I do to protect my loved ones from flu this season?

Encourage your loved ones to get vaccinated.

Do some children require two doses of flu vaccine?

Yes. Some children 6 months through 8 years of age will require two doses of flu vaccine for adequate protection from flu. Children in this age group who are getting vaccinated for the first time will need two doses of flu vaccine, spaced at least 28 days apart. Children who have only received one dose in their lifetime also need two doses.

What can I do to protect children who are too young to get vaccinated?

Children younger than 6 months old are at high risk of serious flu complications, but are too young to get a flu vaccine. Because of this, safeguarding them from flu is especially important. If you live with or care for an infant younger than 6 months old, you should get a flu vaccine to help protect them from flu.

How effective will flu vaccines be this season?

Influenza vaccine effectiveness (VE) can vary from year to year among different age and risk groups and even by vaccine type. How well the vaccine works can depend in part on the match between the vaccine virus used to produce the vaccine and the circulating viruses that season. It’s not possible to predict what viruses will be most predominant during the upcoming season.

Will this season’s flu vaccine be a good match for circulating viruses?

It’s not possible to predict with certainty if the flu vaccine will be a good match for circulating flu viruses. The flu vaccine is made to protect against the flu viruses that research and surveillance indicate will likely be most common during the season. However, experts must pick which flu viruses to include in the flu vaccine many months in advance in order for flu vaccines to be produced and delivered on time. Also flu viruses change constantly (called drift) – they can change from one season to the next or they can even change within the course of one flu season.

How long does a flu vaccine protect me from getting the flu?

Multiple studies conducted over different seasons and across flu vaccine types and influenza virus subtypes have shown that the body’s immunity to influenza viruses (acquired either through natural infection or vaccination) declines over time.

Can the flu vaccine provide protection even if the flu vaccine is not a “good” match?

Yes, antibodies made in response to vaccination with one flu virus can sometimes provide protection against different but related flu viruses. A less than ideal match may result in reduced vaccine effectiveness against the flu virus that is different from what is in the flu vaccine, but it can still provide some protection against flu illness.

In addition, it’s important to remember that the flu vaccine contains three or four flu viruses (depending on the type of vaccine you receive) so that even when there is a less than ideal match or lower effectiveness against one virus, the flu vaccine may protect against the other flu viruses.

Can I get vaccinated and still get the flu?

Yes. It’s possible to get sick with the flu even if you have been vaccinated (although you won’t know for sure unless you get a flu test). This is possible for the following reasons:

  • You may be exposed to a flu virus shortly before getting vaccinated or during the period that it takes the body to gain protection after getting vaccinated. This exposure may result in you becoming ill with flu before the vaccine begins to protect you.
  • You may be exposed to a flu virus that is not included in the seasonal flu vaccine.

    flu2017

Kids need real exercise!

sept5

Last year my children told me that their class had new furniture. I did not understand. When I went for parent-teacher interviews, I fell out of my seat – literally and figuratively! What’s up with the wobble chair?

 
Now I understand that kids fidget and squirm during class. Adults do the same during long meetings as well. I also know that there is scant research that kids with ADHD can benefit from wobble chairs – but we should not treat an entire class as if they have a hyperactivity disorder.

 
The vast majority of children don’t have a medical disorder – they simply lack sufficient physical activity.

 
The World Health Organization (WHO) defines ‘health’ as a state of complete physical, mental and social well-being. Health Canada describes ‘healthy living’ as making choices that promote physical, mental, social and spiritual health. Health Canada notes: “All Canadians need a physically active, healthy lifestyle, beginning in their early years. Unfortunately, poor nutrition, inactivity, childhood obesity and declining fitness are common.”

 

about PA

 

The Canadian Physical Activity Guidelines recommend a MINIMUM of 60 minutes of moderate-vigorous intensity aerobic exercise daily.

 

sed beh

 

Aerobic exercise means activity that increases heart rate and sweat production. It is doubtful that teachers will encourage kids to reach aerobic levels on the wobble chairs.
The proportion of children and youth aged 5 to 17 meeting physical activity guidelines are shocking: According to Statistics Canada, only 13% of boys and 6% of girls are getting an average of at least 60 minutes of moderate-to-vigorous physical activity daily.

chart1

On average, kids are sedentary 700 + minutes (over 11 hours) each day.

chart2

 

What are the barriers and solutions?

 

strategies

 

Simply – not the wobble chair!

 

Sept5,2

Spet5,4

Sept5,3

Recordings in the Office

Aug4

Recording doctor appointments can be beneficial – but certain rules need to be respected. Specifically, the recording’s location – public versus private – has certain implications.
The following are concerns and recommendations of the Canadian Medical Protective Association (CMPA):
Privacy issues in public areas
Patients recording in public areas of a doctor’s office, such as waiting rooms and other common spaces, could possibly capture other people who are not involved in the patient’s healthcare encounter. The recordings could include identifiable information about another patient or staff which could breach a person’s privacy.
Impact on the doctor-patient relationship
A patient may have valid reasons for wanting to record a clinical encounter in a private area such as an examination room. They may want to have an accurate record of the physician’s advice, or to share the information with a family member. However, the recording of a clinical encounter by a patient without the physician’s knowledge can be perceived as reflecting a lack of confidence in the relationship on the part of the patient.
Impact on the medical record
Any recording made at the time of the clinical encounter (i.e. contemporaneously) could be considered part of the medical record.

 

Our Policy
Recordings should only be made in private areas. Patients should avoid taking photos and making video and audio recordings in the waiting room or other public areas in order to protect the privacy of other patients and staff members.
Recordings in private locations should be transparent and obtained with the mutual consent of the patient and physician. A copy should be provided and added to official patient health record. The recorded conversations should never be posted on public websites or on social media without the knowledge and approval of all affected parties. the absence of trust and openness may negatively impact the doctor-patient relationship.

 

Aug4#2

Aug4#3

West Nile Virus

mosquito

 

First, the good news… no human cases reported in Canada so far in 2017.

mapWN

 

graphWN

 

Be vigilant – infected mosquitoes have been detected in Ottawa and Toronto this week.

West Nile Virus spreads through the bites of infected mosquitoes. The “high” season starts in July. Remember, mosquitoes reproduce in stagnant water – even if there is a small amount.

What to do?
Take the follow precautions:

  • Use insect repellent than contains DEET, picaridin or lemon eucalyptus
  • Apply to exposed skin – do not use insect repellent on children < 6 months old
  • If you are outdoors at the end of the day, wear light-coloured long-sleeves shirts and pants
  • Install screens on windows
  • Eliminate water that accumulates outdoors – ie. Buckets and barrels
  • Maintain swimming pools – avoid water collected on covers
    Cover garbage cans.

WNres

WNSM