Blog - Page 7 of 9 - Active Healthcare

All About Asthma Month

Lisa Feierstein Asthma, Breathe EZ Leave a comment  

Every May, the U.S. Environmental Protection Agency (EPA) unites organizations across the U.S. in raising asthma awareness, working to get asthma under control, and improving asthmatics’ quality of life. Over 300 million people worldwide have asthma, and 15 million die each year from asthma-related complications or early death, according to the National Institutes of Health.

Asthma Month also reminds us to be aware of common asthma triggers and to be conscientious of how our behavior can affect asthmatics. Tobacco smoke is a well-known trigger, but irritants like strong perfumes and cleaning chemicals can even trigger an asthma attack. NIH-supported scientists are researching and developing a better understanding of how asthma is affected by exposure to allergens (asthma triggers), pollution and microbes. This type of research will help asthmatics better understand which triggers affect them, and how to improve their asthma management plans.

Many communities are also hosting Asthma Month events, like World Asthma Day and Happy Food Allergy Awareness Week. This year’s theme for World Asthma Day is “You can control your asthma,” and organizations are participating in the event by hosting Twitter chats with doctors, promoting educational materials about asthma triggers and management plans, and providing tools to share information about asthma.

Interested in local Asthma Month information and activities? Check out the North Carolina Asthma Program for resources about asthma triggers in residential environments, information for coaches about how asthma affects athletic performance, and more.

Additional Resources:


This Musician Can Soothe Your Asthma Blues

Lisa Feierstein Asthma, Breathe EZ, Children's Health Leave a comment  

Al Keith doesn’t want you down and out with the “asthma blues.” In fact, he’s so concerned about respiratory health, he produced a jazz and blues CD called “Asthma Blues” to educate asthmatics, their families and caregivers about how to have a successful asthma management plan. Al is a respiratory therapist based out of Chicago who understands that music is a powerful educational tool. He created CTK Clinical Consultants, LLC in 2002 as a way to build an “educational bridge between patients and physicians.”

Al’s songs were written based on the National Asthma Education and Prevention Program (NAEPP) guidelines. He sings about important components of an asthma management plan like how to identify asthma triggers, how to use a peak flow meter, and why it’s important to have a written asthma action plan. You can download Al’s album on iTunes, or on the Asthma Blues website, and enjoy songs like “Breathin’ Right,” Get Your Peak Flow On,” and “You Need an Action Plan.”

Additional Resources:

 


More Cases of Diabetes Diagnosed Since Expansion of Medicaid Program

Lisa Feierstein Diabetes Leave a comment  

Medicaid access expanded in 26 states in January 2014 and diagnosed cases of diabetes have also increased significantly in those states. Diagnosed diabetes cases among Medicaid recipients grew 23% in the states that increased their Medicaid programs under the Affordable Care Act. In the 24 states that didn’t expand Medicaid programs, the increase was only 0.4%.

Early detection of diabetes decreases the risk of complications related to the condition; undiagnosed diabetes can result in major medical problems like kidney failure, stroke, heart disease, blindness, and leg and feet amputations. The financial cost of diabetes is also high; total medical costs and the price of lost work and wages amounted to $245 billion in 2014, according to the Center for Disease Control (CDC). Quest Diagnostics funded the research on the increase of diabetes cases related to Medicaid expansion, and found a greater uptick in diagnoses among men and older individuals aged 50 to 64.

At least one in three people will develop diabetes, according to the CDC. Both type 1 and type 2 diabetes can develop at any age, but unlike type 1, most cases of type 2 can be prevented. Combining medication with proper diet and exercise can make a big difference in the success of diabetes management plans. For more information on how to manage your diabetes, check out this infographic, “A Snapshot: Diabetes in the United States” by the CDC.


The Striking Truth about Thunderstorm Asthma

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment  

Thunder doesn’t just signal that lightning is coming—it can also trigger asthma attacks. We usually think the rain will help our allergies by washing away pollen, but on rare occasions, thunderstorms can actually make allergies worse. During thunderstorms, the low barometric pressure can stir up mold and pollen that can be an irritant to individuals with allergies and asthma. Some researchers believe the thunderstorm’s electrical charge can make mold and pollen particles more likely to stick to the lungs, and asthma-related emergency room visits actually increase during and after some thunderstorms.

Researchers have had a difficult time fully understanding thunderstorm asthma since it is a rare, localized occurrence. Thunderstorms generally don’t last very long, so it can be hard to determine if an asthma attack was caused by the thunderstorm or something else. Plus, different asthma sufferers have different sensitivities, so not everyone with asthma is at risk of experiencing a thunderstorm-related asthma attack. However, researchers believe the increase in ER visits due to thunderstorm asthma could be because individuals with mild asthma might not have a rescue inhaler on hand. Scientists are concerned that cases of thunderstorm asthma could increase due to climate change that would increase the amount of pollen in the air and lead to stronger thunderstorms. If you have asthma, make sure you have rescue inhalers on hand in case you are susceptible to thunderstorm asthma.

Sources


Temporary Tattoo Painlessly Tests Blood Sugar

Lisa Feierstein Diabetes 3 Comments

Tattoos aren’t just a fashion statement anymore—nanoengineers have developed a temporary tattoo that can test blood sugar levels. This technology is promising for diabetics since their current option for testing blood sugar levels is by taking fingertip pricks several times a day. Using a temporary tattoo instead would be a much more comfortable and convenient way to test blood sugar levels.

Amay Bandodkar, graduate student and colleagues in Professor Joseph Wang’s laboratory at the NanoEngineering Department and Center for Wearable Sensors at the Jacobs School of Engineering at the University of California, San Diego, developed the sensors in the temporary tattoo. The sensors emit a mild electrical current that measures glucose levels. The electrodes are printed on tattoo paper that gives the user a painless way to test their blood sugar. The tattoos last a day and only cost a few cents.

A closer look at the temporary tattoo that measures glucose levels.

A closer look at the temporary tattoo that measures glucose levels.

The tattoo was tested on seven healthy male patients that do not have diabetes. Although the tattoo recorded a change in their glucose levels, scientists had to remove the tattoo in order to collect data because it doesn’t currently provide the patient with a way to read or monitor their own glucose level. In the future, the tattoos will connect with Bluetooth so data collected by the tattoo can be transmitted to the patient’s doctor or stored in the cloud. The technology used in the tattoo could eventually be used for other medical purposes, like delivering medicine or identifying important metabolites.

 

 

 

Additional Resources:

 

Photo credit: Jacobs School of Engineering/UC San Diego


Your Job Could Be Bad for Your Lungs

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment  

Some jobs, like construction and manufacturing, put workers at a greater risk of experiencing a serious accident. However, there are many other professions that pose a less obvious threat. Some common occupations can actually put your lungs at risk for conditions like asthma, fibrosis, cancer, COPD and infections.

Jobs like construction and manufacturing are often thought of as dangerous because of the risk of equipment-related accidents. However, these jobs also expose workers to asbestos, volatile organic compounds (VOCs), dust from demolitions, or to the risk of inhaling microscopic fibers and metals. These risk factors can contribute to conditions like asthma, lung cancer, and mesothelioma (another type of cancer). Firefighters can also be exposed to harmful building materials, but can reduce their risk of exposure by using a “self-contained breathing apparatus” (SCBA).

Housekeepers are regularly exposed to cleaning chemicals, which can also emit VOCs. These VOCs can cause allergic reactions and lead to long-lasting breathing problems. While cleaning, housekeepers can run fans and open windows in an effort to improve ventilation in the area. Cleaning with vinegar, baking soda and water are effective alternatives to commercial cleaners, and are less irritating to the lungs.

Hair stylists are also regularly exposed to chemicals, but from hair-coloring and straightening products instead of from cleaners. Hair-coloring products can cause asthma, and hair-straightening products contain formaldehyde, a carcinogen. Health care workers with a sensitivity to latex can experience asthma-like symptoms, but latex-free synthetic gloves can be an effective alternative.

For workers with work conditions that can damage their lungs, it’s important to wear protective gear like masks and special breathing apparatuses. Working in well ventilated areas can also make a positive difference. Managers and employees should make an effort to understand job-related health risks, and utilize equipment that protects them from harmful chemicals and dust.

Additional Resources:


Nascar Driver Teams Up With American Diabetes Association

Lisa Feierstein Diabetes Leave a comment  

Elite athletes have strict fitness routines and carefully calculated diets, and although Nascar drivers are more stationary, they still have to be in top physical condition. Drivers face strong G-forces and have to quickly manually shift so it’s important that they regularly do intensive cardiovascular, upper body, core and leg exercises. A Nascar driver’s overall health makes a big difference on their success on the track, but driver Ryan Reed recently faced a health challenge that threatened to end his Nascar career.

Ryan Reed started racing at a young age and won the Kid’s Kart Track Championship at only four-years old. In 2010, he was named Rookie of the Year in the Super Late Model Division at Toyota Speedway at Irwindale, but in 2011 he received news that his career may already be over. Reed was diagnosed with type 1 diabetes and told he could no longer race. By working with doctors, his personal trainer, and support systems like his pit crew, Reed has been able to continue driving and also successfully manage his diabetes. He later founded Ryan’s Mission, a non-profit focused on encouraging diabetics and raising awareness about diabetes.

Reed’s story exemplifies how important it is for diabetics to have a strong treatment management plan for their condition. He saw his condition as an opportunity instead of an obstacle; Reed is now the driver of the No. 16 American Diabetes Association Drive to Stop Diabetes presented by Lilly Diabetes Ford Mustang. How does your story compare to Reed’s? Did you overcome an obstacle by implementing a better diabetes management plan? Share your story in our comment section!

 


Indoor Allergies Could Increase Risk of Childhood Asthma

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment  

Parents know that the safety and health of their children will have an impact on their children’s development and health as an adult. Research has shown us that childhood obesity, for example, could be linked to an increased risk of diabetes; heart attacks; cancers; and in the immediate term, it could negatively affect academic performance. A new study revealed another children’s health risk parents should keep in mind, and it involves the relationship between childhood allergies in toddlers and preschoolers and the development of asthma later in childhood.

Researchers studied about 500 children from Cincinnati at ages 1, 2, 3 and 4, and administered skin prick allergy tests for common indoor allergies to cats, dogs, cockroaches and dust mites. Children in the study were tested for asthma at age 7, and researchers found that those with a year-to-year positive test for cat and dust mite allergies and an increased risk of having asthma. Although there’s a link between these specific allergens and an increased risk of developing asthma, more research is needed to determine if these allergens cause asthma since there are other factors that be at play.

Curious about other childhood conditions that increase the risk of asthma development? Check out our post on the link between childhood eczema and asthma.

 

 


Hand Washing Dishes Could Reduce Asthma Risk for Children

Lisa Feierstein Allergies, Asthma, Breathe EZ, Children's Health Leave a comment  

Washing Hands with soapDishwashers are not only a wonderful timesaving luxury, but they also give us the reassurance that our dishes are exceptionally clean. A new study revealed that there could be a downside to dishwashers making dishes “too clean”; the study found that hand washing dishes instead could lower your children’s risk of developing allergic conditions like asthma or eczema.

Researchers at Queen Silvia Children’s Hospital in Sweden quizzed parents of approximately 1,000 Swedish children, all 7 or 8 years old, about the children’s history of asthma, eczema and seasonal allergies. 12% of the families in the study hand washed dishes, and the children in those families had nearly half the risk of developing allergic conditions in comparison to children in families that used a dishwasher.

Hand washing dishes exposes children to more bacteria, which could actually be beneficial in strengthening their immune system, and could be the reason why they have a reduced risk of developing an allergic condition.


Spring Cleaning Without the Sneezing

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment  

Quite a few cultures practice spring cleaning—the Chinese, for example, clean their homes to get ready for the new year. They clean as a way to rid the home of bad luck and invite good fortune in the coming year. In the past, families of many cultures kept their homes tightly sealed from the elements, but heating their homes with coal, oil and wood made dwellings dingy by the time spring rolled around. When spring finally sprung, families hauled everything out of the house to give furniture and clothes a thorough cleaning. Spring cleaning is a refreshing way to give old man winter the boot, and welcome warmer weather with a clean home.

If you have asthma, just the thought of stirring up dust, pet dander, and mold while spring cleaning is enough to make you sneeze. However, you can take a few precautions to prevent a flare up while cleaning.

  • If your asthma management plan has been successful, you have a better chance of avoiding an asthma attack while cleaning. If cleaning in the past has irritated your asthma, keep rescue inhalers on hand.
  • Wear a mask while cleaning to shield your nose from cleaning product chemicals. Also consider using more natural products like baking soda and vinegar, which will fight mold without irritating your lungs.
  • Start by cleaning the bedroom since that’s where we spend a lot of time. Wash bedding on the hot cycle; wipe down surfaces with soapy water; and dust items like lamps, fans and blinds.
  • Try to schedule your cleaning early enough in the day so you can spend a few hours out of the house afterward. That will give your lungs a break while dust settles and odors from cleaning products dissipates.

 

Are you on an asthma treatment plan, but need a refresher on how to get the most out of your medicine? Check out our asthma resources page for equipment instructions, educational videos, and other asthma resources.


An Asthma Diagnosis Didn’t Stop These Top Athletes

Lisa Feierstein Asthma, Breathe EZ Leave a comment  

It’s easy to put famous athletes on a pedestal—their toned physiques and ability to obliterate fitness boundaries makes them seem superhuman. We also hear stories about famous athletes that overcame physical challenges like the loss of a limb, a chronic illness, or even partial loss of sight. A new study’s results should be encouraging for asthmatics worried about their ability to exercise—John Dickinson from Kent University discovered that 70% of 33 swimmers on the British Swimming Squad have some type of asthma. He also found that 30% of the cyclists from Team Sky have asthma.

A number of well-known American athletes have also had successful careers despite having asthma. Former NFL football player Jerome Bettis was diagnosed with asthma at age 15 and worried that diagnosis would end his athletic career. However, he stuck with his asthma treatment plan and went on to play for the Los Angeles Rams, the Pittsburgh Steelers and win a Super Bowl championship. Olympic swimmer and six-time gold medalist Amy Van Dyken is another example of an athlete with a successful career despite an asthma diagnosis. Dyken was diagnosed with severe asthma as a child and her doctors recommended participation in sports as a way to make her lungs stronger and prevent against future asthma attacks.

The success stories of these athletes is an inspiration to asthmatics that are concerned that their condition will be a roadblock to an active lifestyle. Their stories also relay the importance of working with your doctor to develop an effective asthma treatment plan. If you need help adjusting to new equipment, check out our asthma instructional videos to enhance your treatment plan.


NBA Hall of Famer Launches Diabetes Dream Team

Lisa Feierstein Diabetes Leave a comment  

March Madness will be heating up soon, sparking an annual heated rivalry among fans and players alike. One former basketball player has created his own “team” in the hopes of unifying a diverse group with a common goal. NBA Hall of Famer Dominique Wilkins launched a Diabetes Dream Team in 2014, and the Team’s goal is to help adults with type 2 diabetes improve their ability to manage the condition. Dominique’s Diabetes Dream Team stresses three important tools to a successful diabetes management plan: diet, exercise and proper medication. Dominique’s own team is comprised of his physicians, a diabetes educator, a nutritionist and a fitness expert, who together offer him guidance on daily diabetes management.

Wlikins said he realized that small changes can make a big impact in treating his diabetes, and he wants to encourage others to “think differently about managing their diabetes.” Diabetics can download Dominique’s “Diabetes Coaches’ Clipboard” for tips on diabetes management from Dominique and his team of experts.

Are you looking for additional support and ideas in how to better manage your diabetes? Download our free diabetes management resources and join our free diabetes newsletter!

 

 


How to Treat Asthma When Your Pet is a Pest

Lisa Feierstein Allergies, Asthma, Breathe EZ 1

Smile Cute Dog Love Boy Puppy Playful Kid

Many pet owners view their furry or feathered friend as a part of the family. But what happens when you’re allergic to that furry family member? If you’re allergic to your pet but can’t imagine life without Fido, you can take a few precautions to reduce the impact your pet has on triggering asthma attacks.

One common pet allergy myth is that people are allergic to the pet’s fur. Pet dander and saliva are the real culprits triggering allergies, so trimming the pet’s fur won’t necessarily make a difference in reducing asthma attacks. If you have a bird, their feathers aren’t the problem, the dander they generate and the mites in the feathers are what triggers an allergic reaction.

To reduce the impact pets have on your asthma, keep pets out of the bedroom and vacuum frequently. Try to mop hardwood and tile floors weekly. If you have a bird, a family member without a pet allergy should be in charge of cleaning the cage since this is where most of the dander and dust mites will gather. HEPA filters – both in your home and in your vacuum cleaner – can reduce the number of allergens in your home up to 98%. These precautions won’t completely alleviate your allergy symptoms, so talk to your doctor about medications and additional steps to take. To learn more about pet allergies and asthma, check our asthma education page.

 

 


Treating Asthma for a Happy Heart

Lisa Feierstein Asthma, Breathe EZ Leave a comment  

We know that treating asthma will make you breathe easier, but managing your asthma will also make your heart happy. A recent Mayo Clinic study found that asthmatics with active asthma have a 70% higher risk of heart attack than individuals without asthma. Dr. Young Juhn, the lead researcher of the study, stressed the importance of properly controlling asthma to reduce the risk of a heart attack.

Inflammation could be the reason for the link between asthma and heart disease. Inflammation results with the immune system’s response to infection and injuries, and asthma and heart disease are associated with higher levels of inflammation. Periodic inflammation isn’t necessarily problematic, but chronic inflammation can lead to permanent bodily damage.

Managing your asthma is important for your heart health, but it’s also a good idea to look at other heart attack risk factors that you should address. Talk to your doctor about whether or not you have other heart disease risk factors like high blood pressure, obesity, diabetes, smoking and high cholesterol, and what you can do to manage these conditions.


North Carolinians Hit Hard by Harsh Flu Season

Lisa Feierstein Asthma, Breathe EZ, Diabetes Leave a comment  

The NC Department of Health and Human Services released new figures about the total flu-related deaths in NC – the count has increased to 114, with 15 new deaths during the week of Jan. 11. Adults 65 and older have taken the hardest hit this flu season; doctors recommend everyone get the flu shot, especially children, elder adults, and those with asthma.

This year’s strain, H3N2, is particularly dangerous, and a mutation of the strain has limited the effectiveness of the flu shot. However, doctors still recommend the flu shot because it can make a difference in many cases. Common complications caused by the flu are sinusitis, bronchitis and pneumonia. The flu can cause inflammation around the heart, dehydration, and can worsen medical conditions like asthma and diabetes.

If you have a chronic medical condition like asthma or diabetes, talk to your doctor about preventative care, like the flu shot, and also about a management plan if you contract the flu. The CDC recommends influenza antiviral drugs for high-risk patients; antiviral drugs can lessen symptoms, reduce the amount of time you have the flu by up to two days, and can prevent complications like pneumonia. Antiviral drugs are most effective when administered within two days of getting sick, but using them later can still be beneficial. In addition to getting a flu shot, take other precautions like washing your hands frequently, and sanitizing common areas and office workstations with disinfectants.  If you do contract the flu, it’s best to stay home to avoid spreading the illness to others.


The Dilemma of Diabetes for Low-Income Patients

Lisa Feierstein Diabetes Leave a comment  

Patients with diabetes know that managing their condition is a daily challenge of monitoring and medicating their condition. Some diabetics face an added hurdle because they face daily food insecurity; low-income diabetics wrestle with being able to afford medication and healthy food. A recent study looked at a group of Boston-based Type 2 diabetics of varying financial status. The group with food insecurity that also tried to cut back on their medication was half as likely as the more financially secure group to manage their diabetes.

Patients with food insecurity were 97 percent more likely to have high blood sugar and high levels of “bad” cholesterol, which indicates that their diabetes was not under control. Researchers determined that addressing access to both medication and food could play a role in improving patients’ ability to manage diabetes. Patients and doctors need to look at the whole picture and identify if a patient’s basic needs are being met in addition to having access to medication.


Put Down that Perfume! An Asthmatic Will Thank You

Lisa Feierstein Allergies, Asthma, Breathe EZ 1

Have you ever experienced sensory overload? You may be able to recall a moment when a stranger walked by and your nose scrunched up in response to their overpowering perfume. Or maybe you had to leave a cosmetics store because the scented lotions and perfumes were too strong. For some, a strong scent can be more than an annoyance. It can cause headaches, dizziness, sneezing, wheezing and difficulty breathing, or even hives.

Asthmatics with a fragrance sensitivity react to strong scents in a similar way that they would react to allergens. Strong fragrances can act as irritants that worsen asthma symptoms and make it difficult to breathe. Perfumes aren’t the only culprits; detergents, soaps, candles and cleaning products can also trigger a reaction. Identifying which scents are “safe” can take a little trial and error. Start by trying unscented or fragrance-free cleaning and cosmetic products. If you notice that a coworker wears a perfume that causes you to sneeze, wheeze, or run for cover, talk to your supervisor about educating the office on fragrance sensitivities. An air purifier or fan could also help lessen the scent. If all else fails, see if you can move to a different space in the office or alter your work schedule so you spend less time in contact with the problematic perfume.


How Asthmatics Can Manage Indoor Air Quality in the Winter

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment  

North Carolina has famously high humidity levels and high humidity can lead to mold, mildew and dust mites in the home. High humidity can also make breathing more difficult for those with allergies. The drier, less humid winter months bring a new set of challenges for managing asthma symptoms affected by indoor air quality.

Year round, the target humidity level indoors is 35 to 55 percent. It may seem intuitive to counteract the drier air by using humidifiers, but that can create condensation and mold in days when the temperature dips below 30 degrees. While high humidity can cause mold, low humidity can make the house feel too cold and you’ll be inclined to increase the heat. Low humidity can also dry out hard wood floors and building materials. If you notice growing gaps in floorboards, that could be a sign of low humidity levels.

The first step to managing indoor humidity levels is to monitor these levels either with a portable weather station or the controls on your HVAC system. Newer thermostats, like Sensi, provide humidity readings and thermostat schedules that can be adjusted through a smartphone app. Your HVAC system or portable weather station may provide both indoor and outdoor readings to help you make comparisons. By monitoring and comparing humidity levels, you’ll have a better starting point for deciding whether or not to add or reduce humidity levels in the home. Finding the right humidity level is an important step in helping you breathe easier indoors, especially if you have asthma or allergies. For additional help managing humidity and indoor air quality, contact your HVAC technician or an indoor air quality specialist.


Implantable Pump Could Reduce Diabetes Treatments

Lisa Feierstein Diabetes Leave a comment  

Consistently taking medication and monitoring blood-sugar levels can be a big challenge for diabetics. A new implantable pump could make a big difference in the treatment plan for many individuals with diabetes. Intarcia Therapeutics Inc. is a Boston-based startup that has developed a pump, about the size of a matchstick, that can be implanted into the patient’s abdomen. The pump continually delivers a small amount of exenatide, which controls blood-sugar levels, for up to a year. The results of a study of 520 patients using the pump and oral medicines showed promising results by significantly lower blood sugar.

The pump is called the ITCA 650, and only requires a five-minute procedure to insert the device. Intarcia Therapeutics Inc. is receiving some funding support from Servier, a French pharmaceutical company. Regulators will review the device in early 2016 before it can go to market.


What Asthmatics Need to Know About the Flu

Lisa Feierstein Asthma, Breathe EZ Leave a comment  

It’s the most wonderful time of the year…until you get the flu. The downside to the Holidays is that it coincides with flu season, and some unlucky individuals will have to skip some of the festivities in order to recuperate. The flu can cause more complications for the very young or old, and for individuals with diabetes, heart disease or asthma. If you have asthma, you’re at a higher risk of experiencing respiratory problems associated with the flu.

Individuals with asthma should get the flu shot each year as a preventative measure. Some people argue that the flu shot can make you sick or that the effectiveness of the flu shot is a gamble. Some individuals do experience short-term flu-like side effects like aches or a low-grad fever, but it could be their body building antibodies against the flu. It’s also possible that they were already coming down with the flu when they got the shot. Researchers track global flu viruses during the year to identify what will be the most effective combination of vaccines. Although researchers are thorough about developing the vaccine, there isn’t one vaccine they can develop that will work for everyone. But, doctors still recommend a flu shot as the best preventative measure against the flu.

If you do come down with the flu, call your doctor about how to manage your asthma symptoms so they don’t get worse. Your doctor may prescribe an antiviral medicine that will reduce your flu symptoms, and they may alter your asthma action plan to compensate.


  • Have a question or comment?
     
    You can contact us via email button below or submit an online contact form

    Contact

css.php