Well, Christmas is over and although I preach to relax, enjoy, destress and take time for yourself. I did none of those and today at work, I am a zombie. Talk about tired! I had a wonderful holiday starting with going to Jamestown for my husband's side of the family and having a Swedish Christmas which is the first Christmas since his mom passed that we celebrated and tried to make it a true Swedish Christmas. I must say we did well all things considered. I made enough rice pudding for the third world countries and everyone got some to go home with. We then traveled up to Rochester and after a short talk we hit the bed to be awoken by a precious 3 year old that SANTA had come so that we the start of our day. We shared the holiday at my son's home with his in-laws and children and it was great and then back on the road about 2 and heading to PA. We made one stop in Westfield, NY to potty dogs and to see Ron's brother and dad again and got home and had our own Christmas. We laughed as it was dark, and we were tired and it felt like Christmas morning as I fed them pancakes and sausage for dinner ( something fast). The only problem was that the sun did not come up and it didn't get any lighter. Oh well, it was lovely and we beat the storm that will be hitting us today with up to 16 inches. I am looking forward to seeing a couple new movies that are out, enjoying my daughter that is home and maybe just a little veg time tonight. So, again I say, do as I say and not as I do and relaz, enjoy, destress, and take time for yourself. We are the survivors! Making it a great day. S
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I will be the first to say Merry Christmas to you all. I will not apologize for saying that too. I won't say Happy Holidays but I do respect everyone's right to enjoy the holiday as they see fit. This is all about love and redemption and renewal and I for one believe in and need it all. I need to share my love and I need to receive love. I make mistakes and I try harder and I ask for forgiveness and hope for a better me and a better world. We all need renewal as our lives are short circuiting from too much input, too many crossed wires and too much that is not good being focused on. So for all of you out there, Merry Christmas and I send you my love and hope for a better tomorrow and contin
Now that is a strange word and one that we have not often heard but if you are going through Chemo, it may be a word that you start to hear. Why? Well the reason is that Chemo can cause white blood cells to fall through the floor to levels that compromise your health and make you very vulnerable to infection. This is what neutropenia is and it refers to White Blood Cells which are the infection fighters in our blood stream. If our counts are too low we are prone to life threatening infections that might not otherwise hurt a person with normal amounts of white blood cells. It is also important to you receiving chemo as if they drop too low, it may not allow you to remain on schedule for your next chemo.
It is very important to report any signs of infection, chills, and aches as welll as fever and that doesn't mean that you wait a day or two to see what happens or that I will tell them on Monday when I go back in as I don't want to bother them on the weekend. That is exactly why there is someone on call to deal with those issues and don't let it wait. Too often, Monday morning comes and someone has had a problem over the weekend and waited till Monday to come in and then we are scrambling to try to help correct the situation. Your doctor may prescribe a medication that will increase your white blood cells. In the meantime, you as a patient- remember to wash your hands, stay away from sick people, and avoid those situations that may increase your risk of infection and always make it a good day. S Disclaimer: This website is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of any medical institution. Alot has been happening in my life lately and that of my families here at work and at home. I often talk the talk about reducing stress but am somewhat like the preachers kid, I hear it but can't seem to do it. My book club even gave me a bag of wonderful goodies for my birthday to help me relax so I guess it is showing.
I routinely do massage for some other health issues and have now been told that my massage therapist of 7 years is no longer able to do it so now I have another person to establish a rapport and understanding with, I hope. I was out Sunday doing a presentation to a church group through the Ribbons of Faith and had wonderful interaction and an interesting afternoon. I came home and since Ron was watching football, I curled up with a book and read the book that is actually to be discussed at book club tonight. I did finish it but had my mind wandering at times and lost some data along the way and hoped I could pick it up in the next chapter. I have one out of five coming home for Christmas so although I am elated, I will surely be missing the rest. In fact our Christmas eve could be quite interesting as I work that day and yet we are to be at Ron's Dad by two to eat and my daughter and I are making the desserts and I figure we might make it there in time for dessert. In order to see another of my brood we may drive to their place from Dad's or back home and restart on Christmas day depending on weather since it is a little bit of a jaunt and of course we need to take the two dogs rather than leave them home for an undetermined length of time. So here we start with two dogs, the two desserts for 25 and overnight cases just in case and Christmas packages, etc. You get the drift. What with Ron's beard and an overstuffed car, we might be mistaken for Mr. and Mrs. Claus and my redheaded daughter may be the elf as well. I find it hard to have the Christmas spirit with what is in the news and where our world is but I also know there is good out there and so I look for the good in each moment and each day. The stress thing is there and although I try to give it up to God, I don't always feel the shift from my shoulders to his. This year there are less presents under the tree and less running around trying to find something for everyone. My husband and I have both determined that we have everything we need and actually are looking for less and what we want we go out and buy it. As far as other family member, they are in the same position as us and their children I rarely see and I have no clue what they have or don't have so money fits. We also make several large donations to charities and have that in honor of our families where the money can be used to help others and isn't that what really need and want, to help those in need. I have ordered some cookies and bought supplies so my daughter can mess up the kitchen and do her baking and I did actually bake a few myself. I even sent a few cards out which I haven't done for years. I started a Christmas letter and stopped as there just has been too much in the past year and things that are still waiting for answers. It was more of an, "I love you and am thinking of you" kind of deal this year or at least that is what I hope they got from receiving a card from me and not thinking that I was nearing the end and just wanted to touch base, haha. Life goes so awfully fast and I have turned past the point where I have lived as much as I hope to live in the future. I am on the other side and I know how I want to spend the rest of those years, I just hope I can afford to do it and my health will allow me to do it and I hope and pray it is with my special man by my side. As we are now empty nesters and we have but one living parent left between us, we have two dogs that dominate our life and we both laugh and think why did we do this as we could be free wheeling right now but I see Ron often call them out the door and to the car to run an errand. Pepper, the Golden Doodle is often on his lap while he attempts to read the paper and in this weather we have been having recently you will see us traveling with the dog out the sun roof and Ron with a stocking cap on and me with a blanket and the heat fully raring so the pup can enjoy the ride. We all have stress, we all deal with it differently but remember to laugh along the way, especially if we pass you with a big dog hanging out the sun roof and two older adults in the front seat bundled up and shivering so he can do that. Merry Christmas to all and making it a great day! S For those of you that don't eat, breathe, and live Breast Cancer, this Symposium is a biggie and packed with lots of information so I am going to cut down information bit by bit so you don't use this as a sleeping pill. I am procssing this information to you from CURE magazine and written by Debu Tripathy written on December 6, 2012. There was a study done known as ATLAS and what it was working with was Tamoxifen therapy which is normally used after your other treatment in postmenopausal women and you take one pill daily for 5 years. So now comes the news, The study ahs shown that taking the Tamoxifen for more than 5 years has shown a drop of 3% in mortality rate and about 3-4% drop in recurrence rate and that it is a delayed effect.
This is awesome news and gives us a longer term therapy use in women who are at and still are PRE-MENOPAUSAL. So if you have hit the 5 year mark of taking your Tamoxifen and are still pre-menopausal, check with your physician and see if more hormonl therapy Breast Reconstruction Insurance Coverage The Federal Women's Health and Cancer Rights Act of 1998
The Women's Health and Cancer Rights Act (WHCRA) contains important protections for women with breast cancer who choose to have breast reconstruction after a mastectomy. It was signed into law on October 21, 1998. The US Departments of Labor and Health and Human Services have oversight of this law. WHCRA:
The WHCRA will not allow:
The WHCRA is a complex law. If you have questions or concerns about it, please contact the US Department of Labor's toll-free number at 866-487-2365. You can also call your health plan directly (a number should be listed on your insurance card) or your State Insurance Commissioner's office (a number should be located in your local phone book in the state government section). The following information is intended to provide general guidance on frequently asked questions about the Women's Health Act: I have been diagnosed with breast cancer and plan to have a mastectomy. How will the Women's Health Act affect my benefits? Under the Women's Health Act, group health plans, insurance companies, and HMOs that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. This coverage includes reconstruction of the breast removed by mastectomy, reconstruction of the other breast to produce a symmetrical appearance, breast prostheses, and treatment of physical complications at all stages of the mastectomy, including lymphedema (swelling that sometimes happens after treatment for breast cancer). This law sets a federal floor so that women can obtain breast reconstruction following mastectomy even if they live in states that do not require insurance companies to provide this coverage. Does the Women's Health Act require all group plans, insurance companies, and HMOs to provide reconstructive surgery benefits? Generally, yes, as long as the insurance plan also covers medical and surgical benefits for mastectomies. However, certain church plans and government plans may not be required to pay for reconstructive surgery. If you are insured under a church or government plan, check with your plan administrator about it. Under the Women's Health Act, may insurance providers impose deductibles or co-insurance requirements for reconstructive surgery in connection with a mastectomy? Yes, but only if the deductibles and coinsurance are consistent with those established for other benefits under the plan or coverage. My state requires the coverage for breast reconstruction that is required by the WHCRA and also requires minimum hospital stays for my mastectomy. If I have a mastectomy and breast reconstruction, am I also entitled to the minimum hospital stay? It depends. If you have coverage through your employer and your employer is insured, you would be entitled to the minimum hospital stay required by the state law. If you have coverage through your employer but your coverage is not provided by an insurance company or HMO (that is, your employer self-insures your coverage), then state law does not apply. In that case, only the federal Women’s Health Act applies and it does not require minimum hospital stays. To find out if your group health plan is insured or self-insured, contact your plan administrator. If you obtained your coverage under a private health insurance policy (not through your employer), check with your State Insurance Commissioner’s office to learn if state law applies. Are health plans required to give me notice of WHCRA benefits? Yes. Both health plans and health insurance issuers are required to provide you notice of WHCRA benefits when you enroll and every year after that. The annual notice may be sent by itself or it may be included in almost any written communication by the plan or insurer, such as newsletters, annual reports, policy renewal letters, enrollment notices, and others Enrollment notices may consist of a phone number or Web address from which to get more information about coverage. Does WHCRA affect the amount that my health plan will pay my doctors? No. WHCRA does not prevent a plan or health insurance issuer from negotiating the level and type of payment with doctors. However, the law prohibits insurance plans and issuers from penalizing doctors or providing incentives that would cause a doctor to give care that is inconsistent with WHCRA. Do the WHCRA requirements apply to Medicare or Medicaid? No. The law does not apply to Medicare and Medicaid. Where can I get more information about my rights under WHCRA? The US Department of Labor has published answers to frequently asked questions about WHCRA on its website at http://www.dol.gov/ebsa/Publications/whcra.html. Or you may call the Department of Labor at 866-USA-DOL or 866-487-2365. This information was taken from the American Cancer Society website. Genetic Nondiscrimination Information Act The Genetic Information Nondiscrimination Act (GINA), signed into law on May 21, 2008, is the first federal legislation that will provide protections against discrimination based on an individual’s genetic information in health insurance coverage and employment settings. The health insurance protections offered by GINA are expected to roll out 12 months after the bill is signed, whereas the employment protections will be fully realized in 18 months. Specifically, the legislation protects against genetic discrimination by health insurers or employers by: * Prohibiting group health insurance plans and issuers offering coverage on the group or individual market from basing eligibility determinations or adjusting premiums or contributions on the basis of an individual’s genetic information. Insurance companies cannot request, require or purchase the results of genetic tests, and they are prohibited from disclosing personal genetic information. * Prohibiting issuers of Medigap policies from adjusting pricing or conditioning eligibility on the basis of genetic information. They cannot request, require or purchase the results of genetic tests, or disclose genetic information. * Prohibiting employers from firing, refusing to hire, or otherwise discriminating with respect to compensation, terms, conditions or privileges of employment. Employers may not request, require or purchase genetic information, and they are also prohibited from disclosing personal genetic information. Similar provisions apply to employment agencies and labor organizations. Adapted from materials taken from the Coalition for Genetic Fairness website. Breast Reconstruction Resources: Insurance Laws by State Insurance Coverage Required for Post-Mastectomy Breast Reconstruction If Mastectomy Is Covered Alabama: Provides that federally funded and publicly funded state programs that provide coverage for mastectomy surgery shall also provide coverage for reconstruction of the breast. [Section 22-6-10] Alaska: Conforms state law to federal standards. Provides that health care insurers providing medical and surgical benefits for mastectomies must comply with 42 U.S.C. 300gg-52 regarding coverage for reconstructive surgery following mastectomies. [Sec. 21.42.400] Arizona: Conforms state law to federal standards. Provides that health care insurers providing medical and surgical benefits for mastectomies must comply with 42 U.S.C. 300gg-52 regarding coverage for reconstructive surgery following mastectomies. Arkansas: Provides that every health benefit plan that provides coverage for mastectomy surgery shall also provide coverage for reconstruction of the breast. [23-99-405] California: Treatment for breast cancer shall include coverage for prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. [10123.8.(d)] Connecticut: Provides benefits for the reasonable costs of reconstructive surgery on each breast on which a mastectomy has been performed, and reconstructive surgery on a non-diseased breast to produce symmetrical appearance. [Sec. 38a-504(c)] Delaware: Coverage available for (1) all stages of reconstruction of the breast on which the mastectomy was performed; (2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and (3) prostheses and physical complications of mastectomy, including lymph edemas. [§3563] Florida: Covers prosthetic devices and reconstructive surgery incident to mastectomy, including surgery to reestablish symmetry; surgery must be in a manner chosen by the treating physician. [627.6417] Illinois: Coverage for breast reconstruction in connection with a mastectomy shall include (1) reconstruction of the breast upon which the mastectomy was performed; (2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and (3) prostheses and treatment for physical complications at all stages of mastectomy, including lymph edemas. [ 215 ILCS 5/356g] Indiana: Covers prosthetic devices and all stages of reconstructive surgery, in the manner determined by the attending physician and patient, including reconstruction of the other breast to produce symmetry. [27-13-7-14] Kansas: Covers breast reconstruction, including surgery of the other breast to produce a symmetrical appearance, prostheses and physical complications, in a manner determined in consultation with the attending physician and the patient. [40-2,166] Kentucky: Provides coverage for breast reconstruction, including surgery of the other breast to produce symmetrical appearance, prostheses and physical complications, in a manner determined in consultation with the attending physician and the patient. [304.18-0983] Louisiana: Includes coverage for reconstruction of the breast on which the mastectomy has been performed, coverage for surgery and reconstruction of the other breast to produce a symmetrical appearance, and coverage for prostheses and physical complications, all stages of mastectomy, including lymph edemas and such coverage shall be in a manner determined in consultation with the attending physician and the patient. [22:250.17] Maine: Provides coverage for reconstruction of the breast on which surgery has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance if the patient elects reconstruction and in the manner chosen by the patient and the physician. [§2837-C(2)] Maryland: Requires coverage for reconstructive surgery resulting from a mastectomy, including surgery performed on a non-diseased breast to establish symmetry. [§15-815] Michigan: Covers breast cancer rehabilitative services, delivered on an inpatient or outpatient basis, including reconstructive plastic surgery and physical therapy. [500.3616] Reconstructive surgery and prosthetic devices are covered after the attending physician has certified medical necessity. [500.3613] Minnesota: Covers all reconstructive surgery incidental to or following injury, sickness or other diseases of the involved part, or congenital defect for a child. Specifically includes benefits for all stages of reconstruction following mastectomy, including surgery and reconstruction of the other breast to produce a symmetrical appearance and prostheses. Also specifies that limitations on reconstructive surgery do not apply to reconstructive breast surgery following medically necessary mastectomy. [62A.25]. Missouri: Covers prosthetic devices and reconstructive surgery necessary to achieve symmetry, as recommended by the oncologist or primary care physician. [376.1209] Montana: Covers reconstructive surgery following a mastectomy resulting from breast cancer, including all stages of reconstructive surgery on the non-diseased breast to establish symmetry and costs of any prostheses.[33-22-135]. Nebraska: Requires coverage for medical and surgical benefits for mastectomy and for all stages of reconstruction of the breast after a mastectomy has been performed and reconstruction of the other breast to produce a symmetrical appearance. The measure also requires coverage for prostheses and physical complications of mastectomy. [44-797]. Nevada: Covers at least two prosthetic devices and reconstructive surgery incident to mastectomy, including surgery to reestablish symmetry. [NRS 608.157] New Hampshire: Covers breast reconstruction, including surgery and reconstruction of the other breast to produce a symmetrical appearance, in the manner chosen by the patient and physician. [417-D:2-b]. New Jersey: Covers reconstructive breast surgery, including coverage to achieve and restore symmetry, and provides benefits for prostheses. [17B:26-2.1a.] New York: Covers breast reconstruction following mastectomy, including reconstruction on a healthy breast required to achieve reasonable symmetry, in the manner determined by the attending physician and the patient to be appropriate. [§3221]. North Carolina: Provides coverage for reconstructive breast surgery, including all stages and revisions of surgery performed on a non-diseased breast to establish symmetry, and reconstruction of the nipple/areolar complex without regard to the lapse of time between mastectomy and reconstruction, as well as coverage for prostheses and physical complications in all stages of mastectomy, including lymph ademas. [§58-51-62] North Dakota: Specifies that health insurance policies may not be issued or renewed in the state unless they provide the benefit provisions of the 1998 Federal Women's Health and Cancer Rights Act. [26.1-36-09.11] Oklahoma: Covers reconstructive breast surgery performed as a result of a partial or total mastectomy, including all stages of reconstructive surgery performed within 2 years on a non-diseased breast to establish symmetry. [§36-6060.5.(D)] Pennsylvania: Covers prosthetic devices and breast reconstruction, including surgery on the opposite breast to achieve symmetry, within six years of the mastectomy date. Additional legislation adds language consistent with federal law. Rhode Island: Covers prosthetic devices and reconstructive surgery to restore and achieve symmetry incident to a mastectomy. Surgery must be performed within 18 months of the original mastectomy. [§27-18-39] South Carolina: Covers prosthetic devices and breast reconstruction, including the non-diseased breast, if determined medically necessary by the patient and attending physician with the approval of the insurer. [38-71-130] Tennessee: Covers all stages of reconstruction for the diseased breast, including lumpectomy, and procedures to restore and achieve symmetry between the breasts, in the manner chosen by the patient and physician, within five years of the reconstructive surgery on the diseased breast. [56-7-2507] Texas: Covers reconstruction of the breast incident to mastectomy, including procedures to restore and achieve symmetry, for contracts delivered, issued for delivery or renewed on or after Jan. 1, 1998. 1999amendment conforms statute to federal law. [§1357.004] Utah: Follows the example of the federal statute by requiring coverage for medical and surgical benefits for mastectomy and for all stages of reconstruction of the breast after a mastectomy has been performed and reconstruction of the other breast to produce a symmetrical appearance. The measure also requires coverage for prostheses and physical complications of mastectomy. [31A-22-630] Virginia: Covers reconstructive breast surgery performed coincident with a mastectomy performed for breast cancer or following the mastectomy, and surgery performed to reestablish symmetry between the two breasts. [§38.2-3418.4] Washington: Covers reconstructive breast surgery if mastectomy resulted from disease, illness or injury, includes surgery to reestablish symmetry. [48.46.280] West Virginia: Includes coverage for reconstruction of the breast on which mastectomy was performed and the opposite breast for symmetry; also provides coverage for prosthesis and complications as determined in consultation with attending physician and patient. [§33-16-3] Wisconsin: Covers breast reconstruction of the affected tissue incident to mastectomy and specifies that such surgery is not considered cosmetic. [149.14(4)(a)] The information was taken from the American Society of Plastic Surgeons website. Disclaimer: This website is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of any medical institution. 'Chemo Brain' May Occur Before Treatment Begins
So-called "chemo brain" -- problems with thinking, concentrating and remembering that are associated with receiving chemotherapy -- may actually start to occur before the treatment is initiated, a small new study suggests. In the new study, pre-treatment mental fog and fatigue were associated with thought-process problems (also called "cognitive" problems) that have previously been assumed to be directly related to the treatment. "It's hard not to believe that chemotherapy could damage the brain, but we found evidence of the problems occurring in many women even before the therapy had begun," said lead author Bernadine Cimprich, associate professor emerita at the University of Michigan School of Nursing. The researchers tested 97 women, including 65 who had localized breast cancer and 32 healthy women without cancer. The women with cancer had all had surgery, while 28 were going to receive chemotherapy and 37 were going to receive radiation therapy. Before treatment and a month after treatment was begun, the participants performed a verbal memory task during functional MRI brain imaging and reported on their fatigue levels. Women who underwent chemotherapy performed less accurately on the mental task tests both before treatment and after treatment. They also reported a higher level of fatigue. Why did the women anticipating chemotherapy show a greater incidence of chemo brain than did those who were awaiting radiation therapy? "Anticipation of toxic side effects may increase the burden of distress," Cimprich said. (USNews) I recently had to make a quick trip to NC on a family emergency and am just getting back. So, stay tuned and I will promise some information soon on breast cancer. Making it a great
Extending Tamoxifen Use Saves Lives, Reduces Recurrances
The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care. "Certainly, the advice to stop in five years should not stand," said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium. Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. "We've been waiting for this result," said Dr. Robert W. Carlson, a professor of medicine at Stanford University. "I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen." Dr. Eric P. Winer, chief of women's cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again. In the study group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing nine years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent. About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group. (NY Times) Disclaimer: This website is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of any medical institution. At a recent meeting regarding breast cancer issues, it was brought up the Governmental/ society recommendations for routine mmaographic screeing in women at average risk. Keep in mind, those of us that have had breast cancer are past the average risk range but, yet I found what I was looking at very interesting. The American College of Obstetricians and Gynecologists, the American Medical Association, the American Cancer Society, and the American College of Radiology as well as the National Comprehensive Cancer Network have all stated that frequency of screening should be every year and that initiation of screening should start at 40 and go to over the age of 70 years. Having said that, the US Preventative Services task Force, the Canadian Taks Force on Preventive Health Care, the Advisory Committe on Cancer Prevention in the EU and Tha National Health Service, United Kingdom all state that frequency of screening should be every 2-3 years and most don't want you to start screening till 50 and then on the other side, are suggesting no further need or only screen to age 73-74.
Why am I bringing this up, because it scares the heck out of me! As the breast health educator , I am working everyday with patients facing breast cancer and although the numbers are not in the 50's or 60's each day, the numbers are increasing and in those numbers I am also seeing women in their 30's and women in their 80's and 90's that have been diagnosed with breast cancer. So, I look at those recommendations and wonder, wonder why there are those that think starting to screen at 50 is right and those that say no need to scren after 75 and wondering why those recommendations are what they are and also how these cancers are found if not on screening. All I can say, is that the range is getting wider as I am seeing many younger and many older breast cancers and this can't just be an insurance issue and cost cutting to limit the range of those mammograms. This is about saving lives and finding it early so that there are better outcomes and we can make a difference. For me, I have never been an outwardly policital person but I have found as I get older that these things that are near and dear to my heart make a difference and I am becoming more involved. If we have the tool, we should use it and if it saves a life, we are winning. Hope you can make it a great day! S |
AuthorMy name is Sue Kilburn and I am a clinical nurse breast cancer educator at the Yolanda G. Barco Oncology Institute in Meadville, Pennsylvania. Archives
March 2015
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