Question for the medical guys here

Phylodog

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My wife took me and our boys to Pigeon Forge so we could hit the indoor skydiving place. Had a blast but the suit they gave me had no ability to cinch the wrist openings down. This was the result:

P1040780.jpg


Not sure what I need to do with it. I washed both wounds with antibacterial soap as soon as I got the suit off and I've washed them several times since. I covered them with gauze and tape last night, mainly to keep the seeping gunk off of our sheets. When I got up this morning the gauze was pretty well stuck to the wounds so peeling it off was not a lot of fun.

Do I need to keep them covered or leave them open to the air? I was hoping they would scab over but there was no sign of that happening when I taped them up last night. I just don't want to end up with a nasty infection, I suspect the suit that caused it hadn't been laundered in a few years.
 

tiNdvenTFHwMdqKW

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Re: Question for the medical guys here

I'm no medical guy, but I would put lots of anti-bacterial ointment like polysporin that has a greasy component to it over them and then cover loosely with gauze (no-stick kind is better) and tape.

The grease will keep the gauze from sticking.
 

longebow

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Re: Question for the medical guys here

Keep these sites clean and dry. Cover during the daytime for "protection." A "nonadherent" dressing is only slightly better than a dry one (2x2, 4x4), as the seepage/weeping/exudate fluid will stick and dry to them). Soaking under flowing tepid water in the sink should make it easier/gentler to remove. Would leave them open to the air at bedtime, or very lightly wrapped with kerlix/gauze to keep the bedsheets cleaner (but not to worry, sheets wash out just fine). If your immune system is intact/normal, don't worry about an infection. Would not waste money on bacitracin/antibiotic ointment. Some feel that it slows down the healing process. Would seek medical attention if you have the following: spreading redness (erythema), red streaking, fever or chills. There are different opinions about wound care, so don't get excited if you get other advice. This was mine, and the price was right...

Hope this helps.
 

KillShot

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Re: Question for the medical guys here

PBinWA has it right. I had to do the same thing for a severe, and I mean SEVERE sun burn. Keep a burn ointment/cream on it and if you use gauze, be sure to wrap it loosely.
 

Phylodog

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Re: Question for the medical guys here

Thanks guys. We had a blast but it's amazing how quickly some flapping fabric can wreck your skin.

P1040746.jpg
 

jcfd2201

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Re: Question for the medical guys here

It's a dermal abrasion and needs to be exposed to the air to heal.
Follow Longebow's advice as he is spot on.
 

FltMed13

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Re: Question for the medical guys here

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: longebow</div><div class="ubbcode-body">Keep these sites clean and dry. Cover during the daytime for "protection." A "nonadherent" dressing is only slightly better than a dry one (2x2, 4x4), as the seepage/weeping/exudate fluid will stick and dry to them). Soaking under flowing tepid water in the sink should make it easier/gentler to remove. Would leave them open to the air at bedtime, or very lightly wrapped with kerlix/gauze to keep the bedsheets cleaner (but not to worry, sheets wash out just fine). If your immune system is intact/normal, don't worry about an infection. Would not waste money on bacitracin/antibiotic ointment. Some feel that it slows down the healing process. Would seek medical attention if you have the following: spreading redness (erythema), red streaking, fever or chills. There are different opinions about wound care, so don't get excited if you get other advice. This was mine, and the price was right...

Hope this helps.</div></div>

Yup yup! He's spot on.
 

Sean the Nailer

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    Re: Question for the medical guys here

    Or, you can take the 'opposing' suggestion and cut it all off, at the nearest joint. To prevent, of course, anything from getting worse. It's the thing to do. And remember, if it saves just one child, it's worth it!!!!

    Right?

    Merry Christmas!!!
     

    smokshwn

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    Re: Question for the medical guys here

    So we have a guy who admittedly has no background answering a question that specifically asked for a reply from someone with training and knowledge and another one agreeing with him......The InterWebs are AWESOME!


    Phylo...Longebow is dead on. It's gonna be a little uncomfortable for a couple of days. I would add that keeping these clean and dry should involve washing them throughout the day with just soap and water then patting dry. Keeping bacterial counts down in surface wounds is much more about volume of water and mechanical agitation than plastering them with any "goop of the week" that's advertised on tv.
     

    crumpmd

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    Re: Question for the medical guys here

    I will take the other opposing view.
    It is a burn injury, 2degree and the blisters are popped and open.
    Clean as you are doing already. Apply some silvadene creme or polysporin ointment in a thin layer over the raw skin. Cover with dry gauze.
    When the exudate stops, usually in 48 to 72 hours, then leave open to air, but clean it well at least daily.
     

    jcfd2201

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    Re: Question for the medical guys here

    Silvadene creme. Great stuff, not cheap, requires script, and less and less insurance co's seem to want to cover it.
     

    Switchblade

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    I agree with crump, but I would also cover it with a 2x2 and tape for protection. My last trip on the asphalt(last Spring) from a guy in an F350 who merged on top of me whil eon the little Buell had my right knee with pretty much the exact same type of abrasion injury...on top of the huge bruise and swelling. I used basic first aid cream, 4x4, then 2x2 as it healed and now have a nice scar from it. The HAwaiian ALoe and bandage will work and supposedly keep scarring to a minimum as well.
    I have LOTS of expereince with abrasions and burns, especailly on my body. Matter of fact when I was healing that knee injury, I had the nerve and vein mapping for my knee an dwas about ready to use a large bore needle to evacuate the liquid to relive the swelling. Next morning when I awoke, the swelling was gone...good thing, because I was so ready to hit it with that huge ass needle.

    Of course as my boys say, "Dude! Suck it up, Band Aids are for pussies!"...no clue where they got THAT from!
     

    RichardTractorGuy

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    Re: Question for the medical guys here

    Lots of choices for friction injury. Tegaderm works well...easy to put on/remove. It will form a pocket of fluid change it 1-3 times/day. My favorite is to just cover with adaptic (which is nonstick) and gauze to absorb the exhudate and hold in place with Cowrap if you can find it or Coban (tape is irritating to skin in some people). Change the dressing when the gauze becomes too moist. Usually there is no need to put any fancy antibiotics or creams. Wash it with regular soap and water and change dressings until it does not drain anymore.
     

    shibby575

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    Re: Question for the medical guys here

    Rub some dirt in it and walk it off. Or treat it like athletes foot and pee on it. Just a FYI, I don't have any capital letters following my name. Merry Christmas.
     

    UKDslayer

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    Re: Question for the medical guys here

    Why didn't you just PM me? I hope you're ok with "gal" advice but to my knowledge I'm the only one here board certified in the topic...
    When it first happened, I would wash with soap & water, myself personally would do a quick rinse with alcohol on site.
    You CAN actually due a debridment to get rid of dried blood, dead skin cells, and foreign material with hydrogen peroxide, but remember this is NOT for antibacterial purposes, only debridement. and shouldn't be used for more than 3 days because it inhibits wound healing. After that, wash with soap and water each day, and since you are still oozing, you want to use polysporin or silvadene on nonadherent dressing (i.e. Telfa); do not use neosporin, neomycin, or triple antibiotic ointment! Do not use dry
    gauze, because not only will it remove the granulating tissue (new, healing cells) it will also absorb any exudate. Exudate is a healing fluid that wounded skin produces that
    contains proteins and chemicals called cytokines that stimulate fibroblasts and healing
    overall. Wounds should be kept as moist as possible. The ad by neosporin that wounds
    heal quicker with neosporin is not from the neosporin itself, it's from the vehicle that
    keeps it moist. To that end, even Vaseline or aquaphor are better than nothing in a
    pinch.
    After placing the polysporin on telfa pads on wounds, wrap with Coach, hurt-free, or generic equivalent (also known as Coban or medirip) it looks like ace- wrap but sticks to itself. This prevents bandage allergy.
    Last but not least, if not up-to-date get a Tetanus booster.
    If redness is greater than 3 mm around wound, if it suddenly is more painful, see a doc to treat cellulitis.

     

    RichardTractorGuy

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    Re: Question for the medical guys here

    FYI I am a board certified orthopedic surgeon....did my training at the Mayo clinic. I met my wife there, a board certified dermatologist.
     

    UKDslayer

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    Re: Question for the medical guys here

    <div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Richard II</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Click to reveal.. <input type="button" class="form-button" value="Show me!" onclick="toggle_spoiler(this, 'Yikes, my eyes!', 'Show me!')" /></div><div class="ubbcode-body"><div style="display: none;">FYI</div></div></div> I am a board certified orthopedic surgeon....did my training at the Mayo clinic. I met my wife there, a board certified dermatologist.</div></div>

    Tegaderm in a size to cover those wounds is very pricey. Adaptor is great and is used by a lot of wound healing docs because it combines the nonadherent dressing and ointment, but last time I priced one box for my practice it was well over $100. You have to realize MOST folks here do not have ready access to a hospital supply cabinet. Although they are OTC, they are hard to track down in specialty pharmacies only.

    Price check: my wholesale price on Tegaderm to cover area is $38.29 for 5 dressings; meaning consumer price $76.58 for 5 dressings.

    So that means your wife can do a joint replacement? Just kidding LOL...I know she actually could practice orthopedics legally.
     

    Phylodog

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    Re: Question for the medical guys here

    I appreciate the advice. About 48 hours out now and the seeping has all but stopped. It hurts like a sum'bitch though. The skin around the burns is getting pink and it's pretty sensitive, hopefully that's not infection setting in.

    IMG_1286.jpg


    IMG_1285.jpg


    My wife brought this home for me, would it be good to use or no?

    IMG_1288.jpg


    IMG_1287.jpg
     

    RichardTractorGuy

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    Re: Question for the medical guys here

    I have not read anything regarding those ingredients. Interestingly I have read (don't remember the journal offhand) that emu oil improves thermal injury when compared to placebo.

    Tegaderm has come down in price... I have 4 kids and keep a couple hundred on hand. It is amazing what can be found on amazon....you can even get lidocaine burn gel which is very inexpensive and provides very good relief

    http://www.amazon.com/Tegaderm-Dressing-...3409&sr=8-3
     

    fx77

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    Re: Question for the medical guys here

    Here is a pearl...Take it or leave it FWIW

    One method of managing this type of burn is the occlusive method which worked very well when I worked on a burn unit (second largest in US at the time)it was taught us by H. Harlan Stone, MD at the Grady Memorial Hospital in Atlanta circa 1974 (I have probably treated >500 such wounds that look like the ones U posted (also works well on Fracture blisters..but that is another story)

    Wrap the burns directly with Kerlex bandage... no grease no salve no silvadene (100%cotton fabric not synthetic or Dacron))
    just like this roll..link:

    http://www.amazon.com/Kendall-Kerlix-Antimicrobial-Dressing-Rolls/dp/B002ZU8OO2

    the bandage has to be about 3/4 to an inch thick..requires a few rolls, snug but not to constrict blood flow or return from the hand. It will wick away the drainage from the wounds. Leave it on for 7-10 days without changing it. Only change it if the outside of the dressing gets wet from the serum seeping from the wound. If the outside layers are dry leave it in place.

    When you unwrap at 7-10 days the skin will be reepithelialized and pink in color. It is a method that takes no effort, no brains, no compliance-- is cheap and works for all superficial and most all deep second degree type burns.

    Good luck
     

    UKDslayer

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    Re: Question for the medical guys here

    I would not trust anything homeopathic that needs to be addressed quickly. Interestingly, one if the ingredients, cantharis, comes from juice of a blister beetle and we use to create blisters on molluscum contagiosum in kids. We have to import from Canada.

    Great pictures above (what camera did you use?)

    Two comments: is the pain worse today than yesterday (increasing). Although it doesn't look like a frank cellulitis, increased pain after the iinitial trauma is one of the biggest clues to infection brewing.
    Notice above I mentioned 3 mm of redness being "ok", that is pushing 4-5mm. 3mm
    can be blown off as a granulating wound edge. If you have increasing pain with advancing wound erythema I have more concern about infection brewing. You are using topical antibiotic correct?
    I disagree about the use of topical lidocaine that can be used for several reasons: you can develop lidocaine toxicity if you apply it frequently enough, and ESP to open areas. Btw lido toxicity can cause seizures and death, should not use more than 5mg/kg adults and yes death from topical lidocaine has been reported; in fact EMLA was recalled and repackaged with strict guidelines after 4 kids died. That's why there is
    a lido. patch (rx) with rigid instructions one patch only 12 hours on, 12 hours off too. If you give advice over the Internet you better warn about potential risks...
    The other reasons I don't like topical lido. is that it masks pain, again pain is one of the
    first signs and clinical clues to infection.
    Topical Benzocaine and lidocaine also have a relatively high risk of causing contact dermatitis.
    I advise you take. Ziploc bag, cut off the glued sides. Place over the area and outline with a sharpie the exact border of redness, date and time bag.
    Again, I assume no fever/chills (and tetanus up to date).
    As much as it may suck to seek care over the weekend/holiday, you may need to if that
    pain I increases further (have you tried RJW's pain regimen)? If that border has advanced by am, or if there is any sign of fever, chills,streaks you may have to hit an urgent care center for some antibiotics. Not optimal in my book, because I really prefer to culture before you start antibiotics, but I think it would be prudent to treat first empirically.
    You have my number, please don't hesitate to call anytime, even holiday.



     

    Montaguegp

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    Re: Question for the medical guys here

    <div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: UKDslayer</div><div class="ubbcode-body">Why didn't you just PM me? I hope you're ok with "gal" advice but to my knowledge I'm the only one here board certified in the topic...
    When it first happened, I would wash with soap & water, myself personally would do a quick rinse with alcohol on site.
    You CAN actually due a debridment to get rid of dried blood, dead skin cells, and foreign material with hydrogen peroxide, but remember this is NOT for antibacterial purposes, only debridement. and shouldn't be used for more than 3 days because it inhibits wound healing. After that, wash with soap and water each day, and since you are still oozing, you want to use polysporin or silvadene on nonadherent dressing (i.e. Telfa); do not use neosporin, neomycin, or triple antibiotic ointment! Do not use dry gauze, because not only will it remove the granulating tissue (new, healing cells) it will also absorb any exudate. Exudate is a healing fluid that wounded skin produces that contains proteins and chemicals called cytokines that stimulate fibroblasts and healing overall. Wounds should be kept as moist as possible. The ad by neosporin that wounds heal quicker with neosporin is not from the neosporin itself, it's from the vehicle that keeps it moist. To that end, even Vaseline or aquaphor are better than nothing in a pinch.
    After placing the polysporin on telfa pads on wounds, wrap with Coach, hurt-free, or generic equivalent (also known as Coban or medirip) it looks like ace- wrap but sticks to itself. This prevents bandage allergy.
    Last but not least, if not up-to-date get a Tetanus booster.
    If redness us greater than 3 mm around wound, if it suddenly us more painful, see a doc to treat cellulitis.

    </div></div>
    +1
    Wow. Lots of big fancy words!

    Agree with what you said for the most part, however way to involved!!! I am not starting a fight. Check out Gregory L Henry audio-digest amazing risk management speeches.

    K.I.S.S... Rules to live by
    smile.gif
    "solution to pollution is dilution". Keep posting pics and I am sure one of us will tell you to go get help.

    Hey. What the hell do I know I just work as an Emergency Room provider and combine my years as a corpsman 1/5 STA I have 13+ yrs. of medical knowledge and still learning more everyday. Words I live by..
    “If you can't explain it simply, you don't understand it well enough”. Albert Einstein

    Montague
     

    Phylodog

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    Re: Question for the medical guys here

    <div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Montaguegp</div><div class="ubbcode-body">
    +1
    Wow. Lots of big fancy words!

    Agree with what you said for the most part, however way to involved!!! I am not starting a fight. Check out Gregory L Henry audio-digest amazing risk management speeches.

    K.I.S.S... Rules to live by
    smile.gif
    "solution to pollution is dilution". Keep posting pics and I am sure one of us will tell you to go get help.

    Hey. What the hell do I know I just work as an Emergency Room provider and combine my years as a corpsman 1/5 STA I have 13+ yrs. of medical knowledge and still learning more everyday. Words I live by..
    “If you can't explain it simply, you don't understand it well enough”. Albert Einstein

    Montague
    </div></div>

    Easy there killer. I appreciate your willingness to provide assistance but you should know who you're disagreeing with before getting too offensive in your replies.

    UDKS & others - thank you for the help. The pain is increasing and if it continues down that path I'll see if I can meet up with one of our team Dr's this weekend for some antibiotics.
     

    Montaguegp

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    Re: Question for the medical guys here

    <div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Phylodog</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Montaguegp</div><div class="ubbcode-body">
    +1
    Wow. Lots of big fancy words!

    Agree with what you said for the most part, however way to involved!!! I am not starting a fight. Check out Gregory L Henry audio-digest amazing risk management speeches.

    K.I.S.S... Rules to live by
    smile.gif
    "solution to pollution is dilution". Keep posting pics and I am sure one of us will tell you to go get help.

    Hey. What the hell do I know I just work as an Emergency Room provider and combine my years as a corpsman 1/5 STA I have 13+ yrs. of medical knowledge and still learning more everyday. Words I live by..
    “If you can't explain it simply, you don't understand it well enough”. Albert Einstein

    Montague
    </div></div>

    Easy there killer. I appreciate your willingness to provide assistance but you should know who you're disagreeing with before getting too offensive in your replies.

    UDKS & others - thank you for the help. The pain is increasing and if it continues down that path I'll see if I can meet up with one of our team Dr's this weekend for some antibiotics. </div></div>

    Oh. I am not disagreeing. UDKS has helped out lots of people with sound advice. Even correctly calling out other medical people. Ie. Adding bactrim for an infection. I have been reading for some time. My post count is low cause I just don't add my point most of the time.

    I just love to heckle about big fancy "doctor" words.

    Glad you are feeling better. I also read that it sounds like you and UDKS know each other.

    For the courts we have to keep our discharge instruction at a 3rd grade level. Or we can get burned. Sucks I know but people just don't get it. Even my own friends I keep it simple.

    Treat it like your new tattoo is my most used line when talking about abrasions/burns.

    Again. Not starting a fight.

    Montague
     

    fx77

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    Re: Question for the medical guys here

    Pain..rule out infection..fever is esp a sign suually Strep sens to PCN in the first 24 hours. Most open wounds will culture a gram negative bug (most common is pseudomonas)which means they are colonized, but does not necessarily mean an infection.
    Allburns have red around their edges a natural response to the trauma and part of th inflammatory healing process.
    Also elevate the hands abpve heart level squeeze the fists to promote circulation and prevent lymphedema (sewlling), and ice also helps.
     

    UKDslayer

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    Re: Question for the medical guys here

    Fx77 - you are an ortho God but I don't agree on wound cultures (although you may be more used to hospital acquired /iatrogenic infections), and I do more community acquired stuff - most wounds cultured staph followed by strep and lots still sensitive to Keflex; the pseudomonas is usually mixed with E.Coli, though seeing some pathogenic nocardia too. General rules for my empirical antibiotic is to cover for both gram negative &gram positive for hand, lower leg/feet & genital areas and any animal or human bites with bactrim or augmentin; otherwise treat as gram positive until cultures come back. In the context of this op's exposure in a dirty
    Suite I would probably double cover.
     

    The Mechanic

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    Re: Question for the medical guys here

    <div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: crumpmd</div><div class="ubbcode-body">I will take the other opposing view.
    It is a burn injury, 2degree and the blisters are popped and open.
    Clean as you are doing already. Apply some silvadene creme or polysporin ointment in a thin layer over the raw skin. Cover with dry gauze.
    When the exudate stops, usually in 48 to 72 hours, then leave open to air, but clean it well at least daily.</div></div>
    Silvadene is the bomb. My son crashed his Harley and used it on some severe abrasions and it healed in a quarter the time and the scaring was minimal.
     

    shibby575

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    Re: Question for the medical guys here

    I see the piss and dirt is working well. I knew this Internet medical advice would be good!
     

    UKDslayer

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    Re: Question for the medical guys here

    <div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: fx77</div><div class="ubbcode-body">Some very good stuff here....
    May be a bit technical..but Whiskey Tango Foxtrot...
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1471990/</div></div>
    Great link. Remind me of training, I can still hear those screams when we put the patients in the hydrotherapy baths for debridement despite the IV morphine premeditation; that was also how they got pseudomonas since bleach doesn't kill pseudomonas.

    How is the OP today?
     

    Phylodog

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    Re: Question for the medical guys here

    <div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: UKDslayer</div><div class="ubbcode-body">

    How is the OP today? </div></div>

    Holding steady, thank you. Merry Christmas UDKS! In the event my arms should take a turn for the worse, and with the difficulty in obtaining medical treatment today, my wife provided me with a nice gift to make any pain bearable.
    smile.gif


    IMG_1293.jpg
     

    shibby575

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    Re: Question for the medical guys here

    Now it looks like you have the right medicine.
     

    Phylodog

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    Re: Question for the medical guys here

    <div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: The Mechanic</div><div class="ubbcode-body">I just don't see what people like in "O brother where art thou" Maybe that is what the whisky is for.
    smile.gif
    </div></div>

    Utter Blasphemy.