Tag Archives: health risk

Arteries and Calcium Supplements


Dr. Pradip Jamnadas, MD has researched and discovered that calcium supplements may not be for you. Check out his video below.

DO YOU SUFFER FROM HIGH BLOOD PRESSURE? SODIUM, IT’S IN EVERYTHING…


If you are suffering from High Blood Pressure the culprit could be sodium.

Have you been reading the labels lately?

I had stopped reading the labels for a couple of years knowing I had read the labels for the items I had chosen. I was shocked to see the changes. Today it seems all products contain some sort of sodium. If you are reading your labels as you shop you will notice SODIUM even when it says “NO ADDED SALT, LOW SALT and LOW SODIUM”.

For optimal heart-health, the American Heart Association recommends consuming no more than 1,500 milligrams of sodium daily. Too much salt, says Dr. Pollak from MAYO Clinic, can increase your blood pressure, in turn, increasing your risk for a heart attack or stroke.

As you can see in the chart below the changes are constant. Today one slice of white bread has 130mg of sodium. Bottled Water has Calcium Chloride, Sodium Bicarbonate which equals to 5mg per 1 cup. More and more products are hiking up the sodium count so watch your labels.

What shocked me the most was milk and water!!!

I didn’t realize no matter what type of organic, fancy expensive or regular cheap cow milk the sodium levels were no less than 120mg of sodium in a one cup serving. WOW, I searched every label in the dairy section just to find that some milks went even higher.

Water, really!!! Adding sodium to every bottled water. Not only sodium, flavoring and natural minerals. Natural minerals, already known to be in water. Minerals are removed when reverse osmosis takes place to filter out the harmful additives. This is no joke. Next time you buy water check it out.

I always shy away from processed meats, processed cheeses and spreads, canned soups and frozen food as much as possible. These are products that can contain thousands of milligrams of sodium. The manufactures use sodium as a natural preservative. It is widely used in all foods.

ideal blood pressure chart 70

You can no longer trust the same brand to continue to have the same ingredients as weeks and months go by. It had only been 1 year since I had last read the labels on some of the staple products I buy each week. Big changes in those foods happened and I wasn’t paying attention. I was intaking so much sodium I had 6 heart attacks in 4 days thinking it was heart burn. Yeah it was heart burn alright. I thought I was doing my healthy life style eating habits but I slipped up and stopped paying attention.

So Remember… READ YOUR LABELS

KETO DIET… Not all Hype


Keto Diet

The ketogenic diet is all about eating the right foods in the right proportions. When you get it right, it’ll trigger your body to start burning stored fat.

Is it a Diet or is it a Lifestyle change? That’s the question… Are you seeking to medically repair an illness or weight loss permantely.

In the 1920’s it was medically introduced to treat epilepsy in children. Today it helps diabetics regulate their blood sugar levels. It’s also being introduced to cancer patients for weight control.

Yes, you can use it as a diet method and loose the weight you need and go back to the same old lifestyle. But, by returning to sugar and yeast you are creating a YO-YO diet lifestyle. It’s better to try and balance a nutrious diet.

What foods can you eat?

Ewoldt says:

  • nuts
  • seeds
  • full-fat cheese and other dairy products
  • plain Greek yogurt
  • non-starchy and fibrous vegetables
  • oils
  • along with smaller amounts of meats, eggs and fish, become keto diet mainstays.


You’ll need to sharply limit carbohydrates

  • bread and baked goods
  • sweets
  • pasta
  • breakfast cereals
  • starchy vegetables like potatoes, sweet potatoes
  • corn and peas
  • beans
  • fruit
  • beer

Does it really work for weight loss?

Yes — but that answer comes with a qualifier. It takes two to three weeks on the diet to start fat burning (ketosis) in the body. So, don’t expect instant results. Some studies have shown that adhering to low- or very-low-carbohydrate ketogenic diets helps people lose weight. However, long term there is little difference between a ketogenic diet and a higher carbohydrate diet.

Ketogenic diet for Epilepsy

The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control epilepsy in children and now for adults.

The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function.

However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source.

An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.

Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.

Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.

CANCER: LUNG


SOURCE: Mayo Clinic

Lung Cancer

Diagnosis

Testing healthy people for lung cancer

People with an increased risk of lung cancer may consider annual lung cancer screening using low-dose CT scans. Lung cancer screening is generally offered to people 55 and older who smoked heavily for many years and are otherwise healthy.

Discuss your lung cancer risk with your doctor. Together you can decide whether lung cancer screening is right for you.

Tests to diagnose lung cancer

If there’s reason to think that you may have lung cancer, your doctor can order a number of tests to look for cancerous cells and to rule out other conditions.

Tests may include:

  • Imaging tests. An X-ray image of your lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in your lungs that might not be detected on an X-ray.
  • Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.
  • Tissue sample (biopsy). A sample of abnormal cells may be removed in a procedure called a biopsy. Your doctor can perform a biopsy in a number of ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted tube that’s passed down your throat and into your lungs; mediastinoscopy, in which an incision is made at the base of your neck and surgical tools are inserted behind your breastbone to take tissue samples from lymph nodes; and needle biopsy, in which your doctor uses X-ray or CT images to guide a needle through your chest wall and into the lung tissue to collect suspicious cells. A biopsy sample may also be taken from lymph nodes or other areas where cancer has spread, such as your liver.

Careful analysis of your cancer cells in a lab will reveal what type of lung cancer you have. Results of sophisticated testing can tell your doctor the specific characteristics of your cells that can help determine your prognosis and guide your treatment.

Tests to determine the extent of the cancer

Once your lung cancer has been diagnosed, your doctor will work to determine the extent (stage) of your cancer. Your cancer’s stage helps you and your doctor decide what treatment is most appropriate.

Staging tests may include imaging procedures that allow your doctor to look for evidence that cancer has spread beyond your lungs. These tests include CT, MRI, positron emission tomography (PET) and bone scans. Not every test is appropriate for every person, so talk with your doctor about which procedures are right for you.

The stages of lung cancer are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to the lung. By stage IV, the cancer is considered advanced and has spread to other areas of the body.

More Information

Treatment

  • Lung cancer surgery

You and your doctor choose a cancer treatment plan based on a number of factors, such as your overall health, the type and stage of your cancer, and your preferences.

In some cases, you may choose not to undergo treatment. For instance, you may feel that the side effects of treatment will outweigh the potential benefits. When that’s the case, your doctor may suggest comfort care to treat only the symptoms the cancer is causing, such as pain or shortness of breath.

Surgery

During surgery your surgeon works to remove the lung cancer and a margin of healthy tissue. Procedures to remove lung cancer include:

  • Wedge resection to remove a small section of lung that contains the tumor along with a margin of healthy tissue
  • Segmental resection to remove a larger portion of lung, but not an entire lobe
  • Lobectomy to remove the entire lobe of one lung
  • Pneumonectomy to remove an entire lung

If you undergo surgery, your surgeon may also remove lymph nodes from your chest in order to check them for signs of cancer.

Surgery may be an option if your cancer is confined to the lungs. If you have a larger lung cancer, your doctor may recommend chemotherapy or radiation therapy before surgery in order to shrink the cancer. If there’s a risk that cancer cells were left behind after surgery or that your cancer may recur, your doctor may recommend chemotherapy or radiation therapy after surgery.

Radiation therapy

Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing radiation to precise points on your body.

For people with locally advanced lung cancer, radiation may be used before surgery or after surgery. It’s often combined with chemotherapy treatments. If surgery isn’t an option, combined chemotherapy and radiation therapy may be your primary treatment.

For advanced lung cancers and those that have spread to other areas of the body, radiation therapy may help relieve symptoms, such as pain.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that you can recover.

Chemotherapy is often used after surgery to kill any cancer cells that may remain. It can be used alone or combined with radiation therapy. Chemotherapy may also be used before surgery to shrink cancers and make them easier to remove.

In people with advanced lung cancer, chemotherapy can be used to relieve pain and other symptoms.

Radiosurgery

Stereotactic body radiotherapy, also known as radiosurgery, is an intense radiation treatment that aims many beams of radiation from many angles at the cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments.

Radiosurgery may be an option for people with small lung cancers who can’t undergo surgery. It may also be used to treat lung cancer that spreads to other parts of the body, including the brain.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Many targeted therapy drugs are used to treat lung cancer, though most are reserved for people with advanced or recurrent cancer.

Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy treatments are generally reserved for people with advanced lung cancer.

Palliative care

People with lung cancer often experience signs and symptoms of the cancer, as well as side effects of treatment. Supportive care, also known as palliative care, is a specialty area of medicine that involves working with a doctor to minimize your signs and symptoms.

Your doctor may recommend that you meet with a palliative care team soon after your diagnosis to ensure that you’re comfortable during and after your cancer treatment.

In one study, people with advanced non-small cell lung cancer who began receiving supportive care soon after their diagnosis lived longer than those who continued with treatments, such as chemotherapy and radiation. Those receiving supportive care reported improved mood and quality of life. They survived, on average, almost three months longer than did those receiving standard care.

American Heart Association… 10 MYTHS Of HEART DISEASE


Top 10 Myths About Cardiovascular Disease

  • “I’m too young to worry about heart disease.” How you live now affects your risk for cardiovascular diseases later in life. As early as childhood and adolescence, plaque can start accumulating in the arteries and later lead to clogged arteries. One in three Americans has cardiovascular disease, but not all of them are senior citizens. Even young and middle-aged people can develop heart problems – especially now that obesity, type 2 diabetes and other risk factors are becoming more common at a younger age.
  • “I’d know if I had high blood pressure because there would be warning signs.” High blood pressure is called the “silent killer” because you don’t usually know you have it. You may never experience symptoms, so don’t wait for your body to alert you that there’s a problem. The way to know if you have high blood pressure is to check your numbers with a simple blood pressure test. Early treatment of high blood pressure is critical because, if left untreated, it can cause heart attack, stroke, kidney damage and other serious health problems. Learn how high blood pressure is diagnosed.
  • “I’ll know when I’m having a heart attack because I’ll have chest pain.” Not necessarily. Although it’s common to have chest pain or discomfort, a heart attack may cause subtle symptoms. These include shortness of breath, nausea, feeling lightheaded, and pain or discomfort in one or both arms, the jaw, neck or back. Even if you’re not sure it’s a heart attack, call 911 immediately. Learn you risk of heart attack today!
  • “Diabetes won’t threaten my heart as long as I take my medication.” Treating diabetes can help reduce your risk for or delay the development of cardiovascular diseases. But even when blood sugar levels are under control, you’re still at increased risk for heart disease and stroke. That’s because the risk factors that contribute to diabetes onset also make you more likely to develop cardiovascular disease. These overlapping risk factors include high blood pressure, overweight and obesity, physical inactivity and smoking.
  • “Heart disease runs in my family, so there’s nothing I can do to prevent it.” Although people with a family history of heart disease are at higher risk, you can take steps to dramatically reduce your risk. Create an action plan to keep your heart healthy by tackling these to-dos: get active; control cholesterol; eat better; manage blood pressure; maintain a healthy weight; control blood sugar; and stop smoking.
  • “I don’t need to have my cholesterol checked until I’m middle-aged.” The American Heart Association recommends you start getting your cholesterol checked every 5 years starting at age 20. It’s a good idea to start having a cholesterol test even earlier if your family has a history of heart disease. Children in these families can have high cholesterol levels, putting them at increased risk for developing heart disease as adults. You can help yourself and your family by eating a healthy diet and exercising regularly.
  • “Heart failure means the heart stops beating.” The heart suddenly stops beating during cardiac arrest, not heart failure. With heart failure, the heart keeps working, but it doesn’t pump blood as well as it should. It can cause shortness of breath, swelling in the feet and ankles or persistent coughing and wheezing. During cardiac arrest, a person loses consciousness and stops normal breathing.
  • “This pain in my legs must be a sign of aging. I’m sure it has nothing to do with my heart.” Leg pain felt in the muscles could be a sign of a condition called peripheral artery disease. PAD results from blocked arteries in the legs caused by plaque buildup. The risk for heart attack or stroke increases for people with PAD.
  • “My heart is beating really fast. I must be having a heart attack.” Some variation in your heart rate is normal. Your heart rate speeds up during exercise or when you get excited, and slows down when you’re sleeping. Most of the time, a change in your heartbeat is nothing to worry about. But sometimes, it can be a sign of arrhythmia, an abnormal or irregular heartbeat. Most arrhythmias are harmless, but some can last long enough to impact how well the heart works and require treatment.
  • “I should avoid exercise after having a heart attack.” No! As soon as possible, get moving with a plan approved for you! Research shows that heart attack survivors who are regularly physically active and make other heart-healthy changes live longer than those who don’t. People with chronic conditions typically find that moderate-intensity activity is safe and beneficial. The American Heart Association recommends at least two and a half hours of moderate intensity physical activity each week For Overall Cardiovascular Health. Find the help you need by joining a cardiac rehabilitation program, but first consult your healthcare provider for advice on developing a physical activity plan tailored to your needs.

Influenza Season Has Arrived…


Flu is caused by influenza virus of Class A, B and C. Flu spreads directly or indirectly from airborne droplets produced during sneezing or coughing.

Following are the symptoms of flu:

  • Fever
  • Malaise
  • Headache
  • Runny nose
  • Postnasal drip
  • Sneezing
  • Reduced sense of smell
  • Metallic taste in mouth
  • Chills
  • Cough
  • Body pain or muscle pain
  • Sore throat

Take Three Actions to Protect Against Flu

  1. Get Vaccinated
  2. Take preventive steps
  3. Get Treatment

Preventive Steps You Can Take NOW

  • Try to avoid close contact with sick people.
  • While sick, limit contact with others as much as possible to keep from infecting them.
  • If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of a fever-reducing medicine.)
  • Cover your nose and mouth with a tissue when you cough or sneeze. After using a tissue, throw it in the trash and wash your hands.
  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid touching your eyes, nose and mouth. Germs spread this way.
  • Clean and disinfect surfaces and objects that may be contaminated with germs like flu.

Treatments

Most of the time flu goes away without treatment. Taking medication can help relieve symptoms. Bed rest will help in faster recovery. Medication

Self care

  • Drink plenty of fluids
  • Take complete rest
  • Eat healthy foods
  • Practice good hygiene

170.3 million doses of flu vaccine have been distributed.

Happy Holidays and Stay Healthy!!!

Protecting your Skin … Cleansing your pores…Fire… Smoke and Ash Fallout. What to Do.


BY: ORGNAT LIFE

MOST IMPORTANTLY: KEEP YOUR FACE, HANDS and EYES COVERED.

Always wash your hands and change clothes as soon as you get home.

Try and keep the contamination to one area.

If you are one of the few that come home to one of the burnt out neighborhoods make sure you exercise caution while out in the elements.

That means anytime you are outside make sure you follow these simple emergency instructions to cleansing your body.

  • You do not want to inhale any of the elements that is on fire or has been burnt out.
  • Respiratory infections and many other illness can be blamed on large burn out fires as these.
  • Think about how many toxic products that are in our homes. Make sure if moving one of these items you are prepared with emergency protection gear.
  • Refrigerator, microwaves, cars, carpet, wood flooring that has been treated and those are just a few things that every home may have.

Your home and residing in the neighborhood: Set up an area that you can seal off. If you have a separate hall way that you can close off with plastic or a separate entry, perhaps through the side garage door(not a big one)with door to house. Handy to change contaminated clothes.

Even though your area may not have flames crawling up your street or that you can actually see, remember embers and ash can float through the air. It will glide until it gets caught on a branch or something to cling onto.

Make sure you bath each night before you go to bed.

Open your pores with warm water and use a good scrubby or washcloth with loads of soap. Soap up really good. Use cold water after to wash the soap off and close your pores.

Keep all of your smoke clothes in a plastic bag in your sealed area until you wash them. You don’t want to spread the smell or contaminate any other area.

If you are in close vicinity of the devastated areas: Do Not run any fans or air conditioning that has a connetion to outdoors. Close all doors, windows and vents. Close blinds and curtains to keep sun out and temperatures down in the house.

PETS, VOLCANO AND YOU


A volcano eruption can put many animals at risk.

Nothing, No-one, nor any animal or wild life is exempt from the vapors and / or ashes. Who ever is in the path of the downfall will be severally burned and death is usually imminent.

Animals who inhale or ingest volcanic ash are at risk for fluoride poisoning. This could cause internal bleeding, long-term bone damage and teeth loss.

Cows, sheep, goats and horses should be rounded up and put in a closed barn, provided with hay and clean water until the ash dissipated.

Birds were also affected by the volcano. The ponds became heavy with mud and they were unable to fly because their wings were covered with ash.

Guidelines for pet owners concerning animal health after a volcano:

  • if you notice any symptoms or smell sulfur, rotten eggs or a strong acidic smell take reasonable action to protect your pets by limiting their time outdoors
  • any pets with respiratory problems should be well protected from the atmosphere
  • cover outdoor aviaries to protect birds
  • find suitable shelter for any pets that usually live outdoors.

“Pet owners should limit the amount of time that they and their animals spend outside if they detect the ash and consult a vet if they have any concerns about the health of their pets.”

Make sure that you bathe your pet often in Luke warm. Keep any wounds covered and dry. Change bandages everyday for any wounds.

Fine Glass textured ash can cut the lungs if inhaled. Keep all pets in doors or completely covered and out of the elements as well as possible.

 

I know that the ASPCA steps up during all Natural Disasters to rescue all animals. I have witnessed that first hand during a volcano eruption 15 miles from my home. They came and rescued trapped animals with trucks, trailers and by helicopter. Please help this organization that really does their job…

Please Help and Donate Today.

ASPCA NEEDS OUR HELP.. Please DONATE TODAY
ASPCA logo. (PRNewsfoto/ASPCA)

Clean Water??? PUNA


WHO”S MINDING THE WATER QUALITY

DURING THIS CRISIS???

By Chad Rhodes 6/3/2018 3:30 pm

I am no longer getting my drinking water from Pahoa side. Now going Keaau side. If the methane gas is present who’s to say it has not already penetrated the water table in Pahoa. Where is that water table in Pahoa. Feast your pretty eyes on this. This is why I have brought up these issues. I have not heard any one mention the water source for the Puna District.

Kilauea Aquifer Sector Area Hawaii County

KILAUEA AQUIFER SECTOR AREA

SECTOR AREA PROFILE

General

The Kilauea Aquifer Sector Area (ASEA) includes the Pahoa [80801], Kalapana [80802], Hilina[80803], and Keaiwa [80804] Aquifer System Areas (ASYA).  It captures most of the Puna District and the southeastern portion of the Kau District, and extends along most of the island’s southeastern coastline as far south as Kuhua Bay outside Punaluu. The sector area includes most of the Kilauea Crater and Hawaii Volcanoes National Park.

Economy and Population

Economy

Agriculture is the primary economic function in the Puna District.  Vegetables / Papayas in the Kapoho area, flowers in the Pahoa and Kapoho areas, and bananas are the principal products.  Truck farming in the Volcano area is also significant.  The majority of the State’s papayas and bananas are grown in Puna. Several Marijuana growers due to the sunny, hot, humid days.

The Puna Geothermal Venture (PGV) plant located outside of Kapoho generates 30-MW of electricity using three geothermal wells.  Plans were already under way to expand the facility to double its output, but Pele put a stop to that we hope..  PGV had employed 30 people.

Population

Nearly all of the population contributing to the demands from the Kilauea ASEA is within the Puna District.  The rate of growth of Puna’s population has slowed in the past few years., but still ranks as the island’s highest.  The growth can be attributed to the affordability of residences outside of Hilo and the job opportunities in Hilo.  Puna’s status as a “bedroom community” for Hilo is evident from much slower growth in employment, and the worsening traffic on its roads leading into Hilo.

Ok, you have a little better understanding why I have concern. Lager Population, PGV Leaking into Aquifer, Fertilizers used by farmers, cars and other contaminants. Now look at the map and tell me that the Aquifer could not be at risk.

Click on Picture to enlarge image and read complete

So you ask Who’s in Charge

Hawaii County Water Supply

Address: 345 Kekuanaoa St #20, Hilo, HI 96720

Phone: (808) 961-8050

Call and ask when the last test on the Water Spigot locations in the KILAUEA AQUIFER SECTOR AREA was.

The Vog Measurement and Prediction Project – VMAP.. Healthy Weather???


The Vog Measurement and Prediction Project (VMAP) provides real-time vog forecasts. With the help of our project collaborators vog forecasts are available to the public through this web site. Comments and inquiries can be directed to the appropriate contact. We welcome constructive comments from all VMAP users, and strive to provide the best possible service consistent with our mission and resources. Inquiries into actual measured values and concerns regarding hazardous conditions should be directed to the appropriate agency such as the Hawaii State Department of Health. The VMAP website is intended to be complementary to the data provided by other state and federal agencies.

Vog is primarily a mixture of sulfur dioxide (SO2) gas and sulfate (SO4) aerosol. SO2 (invisible) reacts with oxygen and moisture in the air to produce SO4 aerosol (visible). SO2 is expected to be the main problem in areas near the vent (Hawai`i Volcanoes National Park, Pahala, Na`alehu, Hawaiian Ocean View Estates) and SO4 aerosol is expected to be the main problem at locations far from the vent (Kona and farther north and west). For more information on vog visit the FAQ page here.

Vog and Your Health

The links and material on this page are provided to summarize findings about the effects of vog on health.

Health Effects

How vog affects human health is the topic of active research. Children and those with pre-existing lung conditions are the most vulnerable to its effects. Some studies show that children and those with pre-existing respiratory problems are more likely to visit a medical clinic or emergency room during vog episodes. Although vog exposure has not been shown to cause childhood asthma, it has been shown to aggravate asthma in those already diagnosed with the condition.

When exposed to vog, some people report eye, nose, throat, and/or skin irritation, coughing and/or phlegm, chest tightness and/or shortness of breath, headache, and increased susceptibility to respiratory ailments. Some people also report fatigue and/or dizziness. One researcher also found vog is associated with high blood pressure. Another researcher found a link to anxiety. More detail on the health effects on vog can be found in the References section, or by visiting the International Volcanic Health Hazard Network.

Disclaimer: The information contained in the VMAP website is for general information purposes only. While we endeavor to keep the information accurate and up-to-date, we make no representations, warranties, or guarantees about the completeness, accuracy, reliability, suitability, or availability with respect to the VMAP website or the information, products, services, or related graphics contained on the VMAP website for any purpose. Although every effort is made to avoid interruptions to VMAP access, any reliance upon any information presented is strictly at your own risk. In no event will the University of Hawaii at Manoa, the UH-M Department of Atmospheric Sciences, the VMAP team, or any personnel or collaborator associated with VMAP be liable for any losses or damages (direct or indirect) without limitation whatsoever in connection with the use of the VMAP website. The general public is welcome to use the VMAP at this time and by its use implicitly agrees to the terms of this disclaimer.

CLICK HERE FOR VMAP

 

THE HEALTH HAZARDS OF VOLCANIC ASH (part 6 Precautions for Children)


THE HEALTH HAZARDS OF VOLCANIC ASH

A guide for the public

This   document   has   been   prepared   by   the International  Volcanic  Health  Hazard  Network (IVHHN), Cities and Volcanoes Commission, GNS Science and the United States Geological Survey (USGS)  to  promote  the  safety  of  those  who experience volcanic ashfall. This guide explains the potential health effects of volcanic ash and gives details on how to protect yourself and your family in the event of a volcanic ash fall.

Precautions for Children

Children face the same hazards from the suspension of ash as other age groups, but their exposure may be increased because
they are physically smaller and are less likely to adopt reasonable, prudent, preventive measures to avoid unnecessary
exposure to ash. While evidence suggests that ingestion of small amounts of ash is not hazardous, we recommend that you take
the following precautions.
  • Keep children indoors if possible.
  • Children should be advised against strenuous play or running when ash is in the air, since exertion leads to heavier breathing, drawing small particles more deeply into the lungs.
  • Communities in heavy ash fall areas may wish to organize day-care programs to free parents for clean-up tasks.
  • If children must be outdoors when ash is present in the air, they should wear a mask (preferably one approved by IVHHN). Many masks, however, are designed to fit adults rather than children.
  • Take particular care to prevent children playing in areas where ash is deep on the ground or piled up.
  • Long Pants, Long Sleeve Shirts, mask, goggles, Hats and gloves.

Reduce the exposure to ash:

The most effective way to reduce exposure, especially for people with particular susceptibilities (e.g., children and infants, older people and those with existing respiratory (lung) or cardiovascular (heart and blood vessels) disease) is to shelter somewhere which is not ashy, ideally inside a building where you can stay indoors for some time, if necessary. If you are very concerned about your health, take advice from a health professional.

Take steps to keep ash out of your indoor environment:

  • Close doors and windows, where possible.
  • If possible, seal up large gaps and spaces to the outdoors. For example, you could use tape and plastic sheeting, or rolled-up towels.
  • Try to set up a single entry/exit point for the building. Leave ashy clothes/shoes outside
  • Do not use any appliances (e.g., air conditioners) which suck in air from the outside. If the indoor environment is ashy, try to gently clean away the ash (e.g., using damp cloths)
  • Don’t use vacuum cleaners as they can blow out fine ash, back into the indoor space.

If you are staying indoors for a long time:

  • Make sure that the indoor environment does not get too hot. If it gets too hot, consider evacuating.
  • Don’t use cooking and heating stoves, or other appliances, which produce smoke.
  • Do not smoke cigarettes or other products.
  • Do not use un-fluted gas heaters, or outdoor appliances such as gas patio heaters or barbecues, indoors, due to risk of carbon monoxide poisoning.

Once the ash has settled, it important to remove it through clean-up activities, using water to dampen it first. You must wear a face mask if you are cleaning up settled ash.

When should I use respiratory protection?

If you cannot remove yourself from the ash, you may wish to use some sort of respiratory protection (e.g., face mask), or may be advised to do so by governmental or humanitarian agencies. Masks may be worn when:

1) you are outdoors and there is ash in the air (either during ash fall or afterwards, when it may be remobilized by wind, vehicles and human activities);

2) ash is being mobilized indoors or outdoors by activities such as removal/cleaning-up.

Masks can be worn during waking hours. It is not recommended to wear a face mask while sleeping as it will probably not stay fitted to the face, and it is harder to breathe with a face mask on.

Who can wear respiratory protection?

People with existing respiratory or cardiovascular disease should talk to a health professional about whether facemasks are suitable. Care should be taken to ensure that it is not harder to breathe when using any form of respiratory protection.

Masks are not usually designed to fit children’s faces (although some manufacturers are now producing small masks aimed at children but not infants). Exposure for children and infants should be reduced by staying in a non-ashy (indoor) environment wherever possible. If you do give a mask to a child, show the child how to fit it well, and be very careful it does not make breathing difficult.

What types of respiratory protection are most effective?

The following information will help you decide on which type of respiratory protection to use, but other factors, such as the cost and availability of the protective products, may also need to be taken into account.

When you wear respiratory protection, the effectiveness depends particularly on two factors:

1) how effective the mask or material is at filtering particles (stopping the ash from passing through the material);

2) the fit of the mask or material to the face (preventing particles from entering around the edges).

  • The most effective respiratory protection for adults is to wear a well-fitting, industry-certified face mask such as an N95 mask (also called P2, FFP2 or DS2 in different parts of the world). The certification will be printed on the mask. Such masks are usually disposable.
    • These are highly-efficient at filtering ash and are also usually designed to fit adult faces well, but may be too big for children.
    • Due to their tight fit, they may feel uncomfortable.
    • Using highly-effective masks can make breathing harder; if you have existing respiratory or cardiovascular disease, talk to a health professional about whether such masks are suitable for you.
    • These masks come in many different shapes and sizes. Some fold out into a mask shape and some have a ready-made cup-shape. Some have a valve on the front to improve comfort by letting hot, humid air out. All of these masks will be highly-effective at filtering ash, if worn properly.
  • Some non-certified face masks state that they are designed to filter ‘PM2.5’ (small particles less than 2.5 micrometres in diameter), which is likely to be the most harmful fraction of the ash.
    • These are probably highly-efficient at filtering ash but are often not designed to fit well to the face and so may not be very effective.
  • A standard, pleated surgical mask will be good at filtering ash as long as it fits well to the face. If it does not, it will provide less protection than an industry-certified face mask.
  • Simple healthcare masks (rectangular, non-pleated) do not filter ash well and also do not have ways to make a good seal to the face.
  • Hard-cup (also called nuisance-dust), ‘fashion’ and scooter masks are less effective at filtering ash compared to industry-certified and surgical masks, and may not fit well to the face.
  • Cloth materials (e.g., bandanas, t-shirts, veils, handkerchiefs) worn over the nose and mouth are less effective at filtering ash than most masks, so will offer less protection and they also tend not to fit well.
    • Increasing the number of layers of cloth improves the ability to filter ash but will still be less effective at filtering ash than most face masks.
  • Wetting materials does not improve the ability of masks or cloth to filter volcanic ash.

How should I put on a face mask?

  • With clean hands, take the mask out of the packaging. Avoid contaminating the inside of the mask with ash.
  • Open up any flaps and prepare the straps/loops for tying around the head or ears.
  • Fit the mask over the nose and mouth.
  • Fit the straps to the head:
    • If the mask has elasticated, adjustable straps, put them over your head with the top strap above your ears, around the top of your head, and the lower strap below your ears, towards the bottom of your head. Tighten the straps until the mask makes a seal around your face and is comfortable.
    • If the mask has non-adjustable straps, tie them snuggly around the head.
    • If the mask has ear loops, you may need to use the loops to tighten the mask (you could tie a knot in the loops if the mask is baggy on your face).
  • With both hands, gently press the nose clip over the nose so that it fits well across the nose and onto the face below the eyes. Do not pinch the clip.
  • Press the edges of the mask onto your face (around the cheeks and chin).
  • Once you have fitted the mask, cover the mask with both hands, being careful not to change the fit. If you are using a mask without a valve, breathe out sharply. If you are using a mask with a valve, cover the valve with your hand before breathing out, or breathe in sharply, instead. You should not be able to feel any air escaping/entering around the edges of the mask. Readjust the fit until the seal is tight.
  • If you cannot get the mask to fit, try to find a different mask which fits your face better.

Make sure your choice of respiratory protection fits to your face!

  • A good face mask may have a flexible metal nose clip, adjustable straps and may also have foam around the edges to help with the seal to your face.
  • When your face mask fits properly, there should be a good seal around your face so that you cannot feel any air coming in around the edges.
  • Make sure that spectacle/goggle frames do not affect the seal between the face mask and your face.
  • If you have facial hair, the face mask will not be as effective, because it cannot make a good seal to your face.
  • You can improve the fit and effectiveness of a face mask by tying a layer of cloth over it, although you are likely to find this less comfortable and you should not tie the cloth so tight that it makes breathing harder.

How long will a face mask last for?

  • Disposable masks are designed for single use (so packaging will often state that they should be disposed of after 8 hours) but they can be worn until you notice that they are clogged and/or breathing becomes harder, or if you notice the mask starting to break.
  • However, you may choose to replace them sooner for hygiene reasons and should check frequently for any degradation or growth of mold.
  • Some industrially-certified face masks have a ‘use-by’ date printed on them. After this date, the manufacturer cannot guarantee the integrity of the mask materials.
  • If supplies are limited, disposable masks can be stored for re-use in a clean bag or box to ensure that dust from the outside does not contaminate them. They should not be hung in a dusty environment.
  • Some manufacturers now make non-disposable masks for community use. These can often be washed, for hygiene reasons, but washing will not remove particles from the filtering layer, so they must also be discarded when they become clogged and/or breathing becomes harder, or if you notice the mask starting to break.For further information on the health hazards of volcanic ash and preparedness for ash fall, please download the IVHHN pamphlets available at: http://www.ivhhn.org/pamphlets.htmlThe above material is reproduced from the NEW IVHHN guidelines on Protection from Breathing Ash. Please visit that page for the source research and references.

 

 

 

 

 

 

 

THE HEALTH HAZARDS OF VOLCANIC ASH (part 2 EYES)


THE HEALTH HAZARDS OF VOLCANIC ASH

A guide for the public

This   document   has   been   prepared   by   the International  Volcanic  Health  Hazard  Network (IVHHN), Cities and Volcanoes Commission, GNS Science and the United States Geological Survey (USGS)  to  promote  the  safety  of  those  who experience volcanic ashfall. This guide explains the potential health effects of volcanic ash and gives details on how to protect yourself and your family in the event of a volcanic ash fall.

Eye Symptoms

Eye irritation is a common health effect as pieces of grit can cause painful scratches in the front of the eye (corneal
abrasions) and conjunctivitis. Contact lens wearers need to be especially aware of this problem and leave out their lenses to
prevent corneal abrasion from occurring.

Common symptoms include:

  • Eyes feeling as though there are foreign particles in
  • them.
  • Eyes becoming painful, itchy or bloodshot.
  • Sticky discharge or tear
  • Corneal abrasions or scratches.
  • Acute conjunctivitis or the inflammation of the conjunctival sac that surrounds the eyeball due to the presence of ash, which leads to redness, burning of the eyes, and photosensitivity.

Eye protection

In fine-ash environments, wear goggles or corrective eyeglasses instead of contact lenses to protect eyes from irritation.

EYE FIRST AID

To minimize potential eye irritation:

  • Wear sunglasses (wrap-around styles are best) or goggles. The best are swimmers goggles that fit tight around the eyes.
  • Stay indoors when pollution levels are at their peak
  • Flush eyes with cool water or eye wash
  • Apply a cool compress to relieve discomfort
  • Lubricating eye drops may help prevent soreness or itching
  • Contact lens wearers should remove their lenses at the first sign of eye irritation and thoroughly clean them in their medicated cleaning solution

If symptoms persist you should seek advice from your doctor or optometry.

 

THE HEALTH HAZARDS OF VOLCANIC ASH (part 3 SKIN)

 

THE HEALTH HAZARDS OF VOLCANIC ASH (part 1 LUNGS)


THE HEALTH HAZARDS OF VOLCANIC ASH

A guide for the public

This   document   has   been   prepared   by   the International  Volcanic  Health  Hazard  Network (IVHHN), Cities and Volcanoes Commission, GNS Science and the United States Geological Survey (USGS)  to  promote  the  safety  of  those  who experience volcanic ashfall. This guide explains the potential health effects of volcanic ash and gives details on how to protect yourself and your family in the event of a volcanic ash fall.

What is volcanic ash?

Volcanic ash is composed of fine particles of fragmented volcanic
rock (less than 2 mm diameter). Volcanic ash is often hot very
close to the volcano but is cool when it falls at greater distances.
It is formed during volcanic explosions, from avalanches of hot
rock that flow down the side of volcanoes, or from red-hot liquid
lava spray. Ash varies in appearance depending upon the type of
volcano and the form of the eruption. Thus, it can range in color
from light grey to black and can vary in size from being like grit
to being as fine as talcum powder. Airborne ash blocks out
sunlight, reducing visibility and sometimes causes complete
darkness during day light.
Large ash deposits can incorporate into existing soils and become the future topsoil of a volcanic region. The fertility of the soils around many volcanoes is due to old ash deposits. This beneficial effect of volcanism outweighs, over time, the hazards.
Eruptions can also generate thunder and lightning from
friction between the fine, airborne particles which can be
localized above the volcano or accompany large ash plumes as
they move downwind from infrequent eruptions, so
fertile volcanic areas are often densely populated.
Freshly fallen ash particles can have acid coatings which may
cause irritation to the lungs and eyes. This acid coating is rapidly
removed by rain, which may then pollute local water supplies.
Acidic ash can also damage vegetation, leading to crop failure.
In most eruptions, volcanic ash causes relatively few health problems, but generates much anxiety. People can be more
fearful of the health hazards of volcanic ash and gases than of the risk of dying from more major hazards, such as pyroclastic
flows. However, ash falls can affect very wide areas around volcanoes and may cause major disruption to normal living.
Medical services can expect an increase in the number of patients
with respiratory and eye symptoms during and after an
ashfall event (see IVHHN guidelines on advice to the medical community).

What are the effects of ash on health?

Effects of ash on health may be divided into several categories:

Respiratory effects, eye symptoms, skin irritation and indirect
effects.

Respiratory effects

In some eruptions, ash particles can be so fine that they are
breathed deep into the lungs. With high exposure, even healthy
individuals will experience chest discomfort with increased
coughing and irritation.
Common acute (short-term) symptoms include:
  • Nasal irritation and discharge (runny nose).
  • Throat irritation and sore throat, sometimes accompanied by dry coughing.
  • People with pre-existing chest complaints may develop severe bronchitic symptoms which last some days beyond
  • exposure to ash (for example, hacking cough, production of sputum, wheezing, or shortness of breath).
  • Airway irritation for people with asthma or bronchitis; common complaints of people with asthma include
  • shortness of breath, wheezing and coughing.
  • Breathing becomes uncomfortable.
In rare circumstances, long-term exposure to fine volcanic ash may lead to serious lung diseases. For these diseases to occur, the
ash must be very fine, contain crystalline silica (for the disease silicosis to occur) and the people must be exposed to the ash in
high concentrations over many years. Exposure to crystalline silica in volcanic ash is typically of short duration (days to weeks),
and studies suggest that the recommended exposure limits (similar in most countries) can be exceeded for short periods of
time for the general population.
People suffering from asthma or other lung problems such as bronchitis and emphysema, and severe heart problems are most at risk.

 

Why are people with chronic lung problems at special risk?

The fine ash particles irritate the airways and cause them to
contract, making breathing more difficult in people who already have
lung problems. The fine dust also causes the lining of the airways to
produce more secretions which can cause people to cough and breathe
more heavily. Asthma sufferers, especially children who may be
heavily exposed to the ash when they play, may suffer bouts of
coughing, tightness of the chest and wheezing. Some people who have never knowingly had asthma before, may experience asthma symptoms following an ash fall, especially if they go outdoors in the ash and over-exert themselves.

What factors affect respiratory symptoms?

The development of respiratory symptoms from the inhalation of volcanic ash depends on a number of factors. These include the
concentration of particles in the air, the proportion of fine particles in the ash, the frequency and duration of exposure, the
presence of crystalline silica and volcanic gases or aerosols mixed with the ash, and meteorological conditions. Existing
health conditions and the use of respiratory protective
equipment will also influence the symptoms experienced.

THE HEALTH HAZARDS OF VOLCANIC ASH (part 2 EYES)

THE HEALTH HAZARDS OF VOLCANIC ASH (part 4 Indirect health effects )


THE HEALTH HAZARDS OF VOLCANIC ASH

A guide for the public

This   document   has   been   prepared   by   the International  Volcanic  Health  Hazard  Network (IVHHN), Cities and Volcanoes Commission, GNS Science and the United States Geological Survey (USGS)  to  promote  the  safety  of  those  who experience volcanic ashfall. This guide explains the potential health effects of volcanic ash and gives details on how to protect yourself and your family in the event of a volcanic ash fall.

Indirect Effects of Ash Fall

As well as the short and long term health risks, indirect impacts of large ash falls must also be considered. These mainly arise from the secondary consequences of ash fall.

Effects on roads

The reduction in visibility from airborne ash alone may cause accidents. This danger is compounded by ash
covering roads. Not only are road markings covered up, but thin layers of either wet or dry ash are very
slippery, reducing traction. Thick deposits of ash may make roads impassable, cutting off communities from
basic supplies.

Effects on Power

Ash fall can lead to power cuts. These may have implications for health due to lack of heating
or other infrastructural requirements that depend on electricity. Wet ash is conductive, so it is essential
that safe operating procedures are stringently followed when cleaning power supply equipment.

Effects on water supplies

Ash fall can cause contamination of water or clogging and damage of water supply equipment. Small, open
water supplies such as domestic water tanks with roof drainage are especially vulnerable to volcanic ash fall,
and even small quantities of ash may cause problems for potability. While the risk of toxicity is low, the pH
may be reduced or chlorination inhibited. During and after ash falls, there is also likely to be extra water
demand for clean-up, resulting in water shortages.

Effects on sanitation

(waste water disposal etc).
The temporary disablement of municipal sanitation systems may lead to increased disease in affected areas.

Risk Of Roof Collapse

1) Roofs can collapse from the weight of ash, resulting in injury or death for those underneath.
2) There is a danger of roof collapse whilst clearing ash from roofs due to the increased load of a person on an already overloaded roof.
3) In several eruptions people have died after falling from their roofs while cleaning up ash.

Animal Health

If the ash is coated in hydrofluoric acid, the ash can be very toxic to grazing animals if they ingest ash-covered grass and soil.

THE HEALTH HAZARDS OF VOLCANIC ASH (part 3 SKIN)


THE HEALTH HAZARDS OF VOLCANIC ASH

A guide for the public

This   document   has   been   prepared   by   the International  Volcanic  Health  Hazard  Network (IVHHN), Cities and Volcanoes Commission, GNS Science and the United States Geological Survey (USGS)  to  promote  the  safety  of  those  who experience volcanic ashfall. This guide explains the potential health effects of volcanic ash and gives details on how to protect yourself and your family in the event of a volcanic ash fall.

 

Skin Irritation

While not common, volcanic ash can cause skin irritation for some people, especially if the ash is acidic.

Symptoms include:

  • Irritation and reddening of the skin.
  • Secondary infections due to scratching.

Protective Clothing should be worn when you are outdoors.

  • Long Sleeve Shirt
  • Long Pants
  • Socks and Shoes
  • Gloves
  • Hat

Depending on the type of volcano Kilauea is a basaltic shield volcano, erupting a type of basalt known as tholeiite. This type of lava is the dominant extrusive during the shield building (the main stage) of hawaiian volcanism and is the dominant basalt type erupted on Earth.

Pele’s hair is a form of lava. It is named after Pele, the Hawaiian goddess of volcanoes. It can be defined as volcanic glass fibers or thin strands of volcanic glass.[1] The strands are formed through the stretching of molten basaltic glass from lava, usually from lava fountains, lava cascades, and vigorous lava flows.

Pele’s hair is extremely light, so the wind often carries the fibers high into the air and to places several kilometers away from the vent. It is common to find fibers of Pele’s hair on high places like top of trees, radio antennas, and electric poles.

Pele’s hair does not only occur in Hawaii. It can be found near other volcanoes around the world, for example in Nicaragua (Masaya), Italy (Etna), Ethiopia (Erta’ Ale), and Iceland, where it is known as “nornahár” (“witches’ hair”).[2] It is usually found in gaps in the ground, mostly near vents, skylights, ocean entry, or in corners where Pele’s hair can accumulate.

It is not recommended to touch Pele’s hair, because it is very brittle and very sharp, and small broken pieces can enter the skin. Gloves should be worn while examining it.

For those of you who have sensitive skin you should avoid skin contact with volcanic ash as it will cause an allergic reaction or also called dermatitis , if the volcanic ash already on your skin you should wash your skin with soap and clean water .

Although skin irritation are not always experienced by all people , but if the volcanic ash was mixed with harmful substances you should be careful , because it could be such a dangerous substance that can irritate your skin .

Some of the symptoms that occur to the skin due to volcanic ash

  • The occurrence of red rash on the skin
  • Incidence of red spots on the skin
  • Experiencing skin hives

Some tips to prevent the bad effects of volcanic ash :

  • Use a mask or wet cloth to cover your nose
  • Use goggles to prevent your eyes from volcanic ash
  • You should not wear contact lenses for a while
  • Use eye drops or the like to clean up your eyes
  • Use long sleeves or long pants so that your skin does not come into direct contact with volcanic ash
  • To clean up volcanic ash should be sprayed with water so as not volcanic ash floating .
  • Use a damp cloth to clean the items exposed to dust
  • Wash your skin is exposed to volcanic ash with water and soap
  • When washing cloth or clothing that has been exposed to volcanic ash should be cleaned first before being mixed with other clothing .

THE HEALTH HAZARDS OF VOLCANIC ASH (part 4 Indirect health effects )

THE HEALTH HAZARDS OF VOLCANIC ASH (part 5 What to do to protect yourself against ash)


THE HEALTH HAZARDS OF VOLCANIC ASH

A guide for the public

This   document   has   been   prepared   by   the International  Volcanic  Health  Hazard  Network (IVHHN), Cities and Volcanoes Commission, GNS Science and the United States Geological Survey (USGS)  to  promote  the  safety  of  those  who experience volcanic ashfall. This guide explains the potential health effects of volcanic ash and gives details on how to protect yourself and your family in the event of a volcanic ash fall.

What to do to Protect Yourself Against Ash

Limit Driving

Immediately after an ash fall, even a light one, driving conditions, visibility and air quality can be dramatically
affected, especially by the resuspension of ash by traffic.
Rainfall has a sudden but temporary effect in improving air quality until the ash dries out again. We recommend that, following an ash fall, you refrain from driving and stay indoors if possible. If you must drive, maintain a large distance from the vehicle in front of
you and drive slowly.

Reduce ash in your house

Keep all doors and windows closed whenever possible.

Eye protection

In fine-ash environments, wear goggles or corrective eyeglasses instead of contact lenses to protect eyes from irritation.

Protection

Those undertaking clean-up operations should always wear effective dust masks (see IVHHN Recommended
Masks document at http://www.ivhhn.org). If no approved mask is available, a fabric mask improvised from cloth
will filter out the larger ash particles which may contribute to throat and eye irritation. Dampening
the fabric with water will improve its effectiveness. People with chronic bronchitis, emphysema or asthma
are advised to stay inside and avoid unnecessary exposure to ash.

Drinking Water

After light ash fall it is usually safe to drink water contaminated with ash, but it is better to filter off the
ash particles before drinking. However, ash increases the chlorine requirement in disinfected surface-collected
water which, therefore, can be microbiologically unsafe to drink. Ash will usually make drinking water
unpalatable (sour, metallic or bitter-tasting) before it presents a health risk. The safest way to ensure your well-being is to stock up on water prior to the event. Collect enough drinking water for at least a week (up to one gallon , or 3-4 litres, per person per day). If you rely on collecting rainwater, cover the tank and disconnect any down pipes before ash fall occurs.

Home-grown food

Ash-covered vegetables grown in fields are safe to eat after washing with clean water

Clean Up

Lightly water down the ash deposits before they are removed by shoveling, being careful not to excessively
wet the deposits on roofs, causing excess loading and danger of collapse. Dry brushing can produce very high
exposure levels and should be avoided. Hosing uses large quantities of water and may cause water
shortages in heavily-populated areas.

PROTECT YOURSELF FROM VOLCANIC ASH…


BIG ISLAND NEEDS HELP WITH THE ANIMALS… PLEASE HELP…


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The Community and the Shelters are overwhelmed and need your help today.

Hawaii Lava Flow Animal Rescue

The Hawaiʻi Lava Flow Animal Rescue Network (HLFARN) was created to serve as an informational hub for those needing assistance with pets and animals on farms during the 2018 eruption of Kilauea on the Big Island of Hawaiʻi. But it has become so much more than that. HLFARN has blossomed from a group of strangers into an Ohana; a family of people whose love for animals has taken them into the path of an erupting volcano to rescue pets and farm animals that have been left behind.

We are a grassroots movement to help the residents displaced from Leilani Estates and lower Puna to evacuate their beloved companions and friends. As a group of volunteers, we have rescued over 200 animals thus far. We continue to help residents, their furry friends, and…

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