What Does Skin Cells In Urine Mean

I Have Septic Bursitis I Understand It Can Be Dangerous…what Is It?

Before the days of antibiotics, septic bursitis was a potentially life-threatening problem.

Nowadays, because of higher index of suspicion as well as the presence of antibiotics, it should be, in most case, readily treatable. This article discusses this problem.

A bursa (plural=bursae) is a sack containing a small amount of fluid that serves as a protective cushion between bones and overlying muscles or between bones and tendons. Bursitis is inflammation of a bursa caused by repetitive use, trauma, infection, or a systemic inflammatory disease.

These sacks are lined with the synovium – the same tissue that lines the inside of joints. Humans have approximately 160 bursae.

Bursitis most commonly affects the shoulder, elbow, hip, and knee. Symptoms of bursitis may include localized tenderness, edema, redness, heat, and limited ability to move the affected area.

When a bursa becomes infected, the condition is referred to as septic bursitis. In septic bursitis, trauma is the usual culprit. Trauma causes inoculation of bacteria into the bursa, which triggers an inflammatory response.

The two most commonly infected bursae are the olecrenon bursa at the elbow and the prepatellar bursa in the knee. The reason these two bursae get infected more easily is because of their location.

The olecranon bursa lies at the tip of the elbow. Because of its superficial location, it is easily traumatized from acute trauma or repetitive stress.

Trauma to the skin makes the olecranon a frequent location for infectious bursitis. The risk of septic bursitis increases in those who have a history of another chronic disease.

Chronic repetitive stress from pressure on the elbows is seen in hemodialysis patients, computer users, and chronic lung disease patients.

When inflamed, the olecrenon bursa at the tip of the elbow becomes swollen, red, and painful. Bending the elbow makes the pain worse. Low grade fever and chills may also be present.

The prepatellar bursa lies in front of the knee between the patella (kneecap) and the skin.

Infection can develop due to either trauma or constant friction between the skin and the patella, most commonly when frequent kneeling is involved. It can be seen in carpet-layers, coal miners, roofers, gardeners, electricians, and plumbers. Actually any activity involving a lot of kneeling and friction can lead to septic prepatellar bursitis.

The superficial location of the prepatellar bursa allows for rather easy introduction of bacteria. This is similar to the situation involving the olecrenon bursa.

Prepatellar bursitis presents with swelling, redness, heat, and pain involving the front of the knee. Bending the knee causes increased pressure over the bursa and increases pain.

(A quick note: there is also another bursa called the infrapatellar bursa. It is located below the knee cap and may be confused with the prepatellar bursa).

As mentioned earlier, septic bursitis occurs from the introduction of bacteria through trauma. It can also occur from the spread of infection from the skin adjacent to a bursa. Skin infection is called cellulitis.

It is less likely for deeper bursae to become infected because of their location. This can occur as a result of spread from septic arthritis (an infected joint) or from bacteria carried to the bursa from the blood.

Predisposing factors include diabetes, alcoholism, steroid therapy, kidney disease, trauma, and skin disease. A history of noninfectious inflammation of the bursa (as seen in rheumatoid arthritis, gout, and pseudogout) also increases the risk of septic bursitis.

Signs that favor the diagnosis of septic over simple inflammatory bursitis include: severe tenderness, extreme redness, heat, fever, and chills.

Laboratory tests may show an increase in white blood cell count and erythrocyte sedimentation rate. Blood cultures should be obtained if deep bursal infection is suspected.

Aspiration and analysis of bursal fluid from a suspected infected bursa should be performed when possible. Certainly, the most frequently infected bursae, such as the olecranon and prepatellar bursae should undergo this procedure. The use of ultrasound makes aspiration much more accurate.

Bursal fluid culture is the most important test for diagnosis.

Fluid should also be examined for crystals. Monosodium urate crystals can be seen in gout and calcium pyrophosphate crystals can be seen in pseudogout; however, the presence of crystals does not exclude concomitant infection.

All fluid should be cultured.

Patients with suspected septic bursitis should be treated with antibiotics while awaiting culture results. Superficial septic bursitis can be treated with oral antibiotics.

Deep bursal infection will generally require intravenous antibiotics.

Staph aureus is the most common bacteria, causing more than 80% of cases. Streptococcal species account for 5-20% of cases. Other organisms are less common.

An appropriate antistaph antibiotic should be started. This should be a penicillinase-resistant penicillin, such as oxacillin sodium (Bactosill), or a first-generation cephalosporin, such as cefaclor (Ceclor). Penicillin allergic patients can be treated with erythromycin.

The length of antibiotic treatment varies with the patient and the clinical situation. Uncomplicated septic bursitis presenting within a week of infection should be treated with a 10-14 day course. Aspiration should be repeated every 1-3 days while antibiotics are being administered. Antibiotics should be continued for 5 days past sterilization of bursal fluid as seen by aspiration. Again, the use of ultrasound can help with fluid detection since aspiration of a bursa without fluid may yield very little valuable material.

Patients who are immunosuppressed require a longer course of treatment of at least 15 days.

Deep bursal infections require prolonged antibiotic therapy and surgery is often required.

Surgical intervention, such as incision and drainage is needed in complicated cases.

About the author: Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment

Source: http://www.isnare.com/?aid=169644&ca=Medicines+and+Remedies

Frequently Asked Questions

  1. QUESTION:
    What does it mean when you have skin cells in your urine?
    My dr.said that I have to do another urnine culture because there was a high amount of skin cells in my urine!

    • ANSWER:
      It means that the sample was not a clean catch. You try to obtain a sample that is midstream in a woman because the bacteria on the outside of the uretha/vagina could falsely indicate that your urine is infected (usually it is sterile or near sterile if healthy). So if you see a bunch of epithelial cells in the sample, it means that the sample was contaminated with material from somewhere other than just what’s in the urine.

  2. QUESTION:
    Doctors, Nurses and anyone else…..what does this mean?
    I’ve had gastroenteritis (I think that’s how you spell it) for a week and three days. The doctor took a urine sample nearly one week into it and found nothing. I went back two days ago and I had to do another. He sent it off and found that I have skin cells in there (it could be from contamination but he doesn’t know) and protein.
    Mum said that the protein could be because of an infection or the discharge I’ve been having for about two years (I haven’t started my periods and I have thrush) and the skin cells could be infection as well. I need another test done but I really want to know what you think it might be.

    Thanks!
    I am eleven and I haven’t the foggiest what a colon is!

    • ANSWER:
      Have you been taking anything for the thrush? If you have, that could be throwing off the yeast/bacteria (yeast and bacterial must be balanced in your body–have you heard that if you take antibiotics that you are more susceptible to a yeast infection? well same thing only in reverse. If you are taking something for the thrush, it could be throwing off the balance) in your body and causing the bacteria to be dominant in your tummy. Protein in the urine could be a sign of diabetes. Maybe you should also check for H. Pylori which is a bacteria that lives in the stomach that could cause the inflammation (gastroenteritis) which is curable with antibiotics.

  3. QUESTION:
    Wait a second, I’m confused: I thought lead was dangerous?
    I’ve always heard that lead is dangerous. That lead products, lead paint, dust containing lead particles are harmful to your health. But if lead is used in medication fields for radiation protection, how dangerous is it exactly?
    Because what I don’t understand how it can be dangerous to breath it in, touch it have remnants on you hands and possibly swallow it, and then have it be safe shielding you from an X-ray.
    Also if lead settles into your bones, teeth, organs, and tissue linings of your body, then how exactly can it be excreted by urine and feces?
    Also how do calcium and iron supplements help deter lead? Does it mean that because the calcium and iron are absorbed by the body that it excretes the lead from the bone, tissue, teeth, and organs to the urinary and intestinal tract for excretion?
    Also to minuscule lead contaminates travel as easily as dead skin cells?
    Somebody please explain this to me, because I have one person saying it’s fine in small does, others saying it’s a death trap…etc. I have no clear cut answer and that is all I really want. I am so confused and it is all just giving be one big headache.

    • ANSWER:
      You will not be poisoned by lead if it has contact with your skin, or even if you take chunk of it in your mouth but you do not swallow. It is not easily absorbed. Also, the lead used for safeguarding from X-rays is put into special pockets, so you have no actual contact with lead.
      However, if you eat food that is poisoned with chemicals, having lead or small particles of it, then it is dangerous, as it acumulates in body, and slowly poisons it. Some chemicals react with lead and create disolvable molecules, that can be removed from body with urine (not with feces, though, I think).

  4. QUESTION:
    Wait a Second, I’m confused: I thought Lead was dangerous?
    I’ve always heard that lead is dangerous. That lead products, lead paint, dust containing lead particles are harmful to your health. But if lead is used in medication fields for radiation protection, how dangerous is it exactly?
    Because what I don’t understand how it can be dangerous to breath it in, touch it have remnants on you hands and possibly swallow it, and then have it be safe shielding you from an X-ray.
    Also if lead settles into your bones, teeth, organs, and tissue linings of your body, then how exactly can it be excreted by urine and feces?
    Also how do calcium and iron supplements help deter lead? Does it mean that because the calcium and iron are absorbed by the body that it excretes the lead from the bone, tissue, teeth, and organs to the urinary and intestinal tract for excretion?
    Also to minuscule lead contaminates travel as easily as dead skin cells?
    Somebody please explain this to me, because I have one person saying it’s fine in small does, others saying it’s a death trap…etc. I have no clear cut answer and that is all I really want. I am so confused and it is all just giving be one big headache.

    • ANSWER:
      Lead is indeed harmful. It doesn’t do anything noticeable in small doses, but can be dangerous to your health in larger doses.

  5. QUESTION:
    All organisms on earth require a source of energy to live. ATP is the fuel that powers all the activities of?
    Ferns produce glucose that can be broken down by cellular respiration, while flatworms and people digest foods containing glucose for use in cellular respiration.
    Fern
    Ferns produce ATP during photosynthesis, while flatworms and people produce ATP during digestion.
    Producers such as ferns do not require a source of energy, while flatworms and humans must consume food for energy.

    15. Which statement best describes the differences in how flatworms and people remove waste from their body? (Points : 5)
    Flatworms store waste in their bodies until they die. People remove waste through kidneys and lungs.
    Flatworms release carbon dioxide directly from the skin, and use a simple digestive system to remove liquid waste. People use lungs to remove carbon dioxide, and have developed complex excretory and digestive systems to remove waste.
    Flatworms do not need to remove carbon dioxide from their body, and do not have a system to remove solid or liquid waste. Humans continually remove carbon dioxide and liquid waste from their body.

    16. What is the relationship between plants and oxygen? (Points : 5)
    Plants do not need oxygen from the air because they produce it during photosynthesis.
    Plants do not need oxygen because they use carbon dioxide in cellular respiration.
    Plants produce oxygen during photosynthesis, and they also need oxygen gas from the air for cellular respiration.
    Plants do not need oxygen because they do not undergo cellular respiration.

    17. In response to a stimulus such as touch, a human neuron sends a signal to the brain using __________. (Points : 5)
    myosin and actin
    contraction and relaxation
    respiration and absorption
    electrical signals and chemical neurotransmitters

    18. Two muscles are required for a muscle to move a bone. What is the process that occurs inside those muscles when they contract? (Points : 5)
    Calcium combines with ATP to produce sarcomeres.
    Actin produces myosin and ATP.
    Calcium produces contractions.
    Myosin heads attach to and move along actin-binding sites.

    19. Which statement best describes the difference between the life cycle of plants such as ferns and animals such as humans? (Points : 5)
    Plants have a one-part life cycle and are entirely diploid. Humans spend their lives in a haploid phase.
    Plants have a two-part life cycle, spending part of their life in a diploid phase and part in a multicellular haploid phase. Humans spend their lives in a diploid phase and produce gametes that are haploid.
    Plants have a one-part life cycle and are entirely haploid. Humans have a two-part life cycle, spending part of their life in a diploid phase and part in a multicellular haploid phase.
    Different plants have a different number of phases in their life cycle. Humans always have two phases in their life cycle.

    20. The human immune system uses a variety of means to defend the body from pathogens. Which elements are parts of the human immune system? (Points : 5)
    skin, neurons, muscle cells, and pancreas
    white blood cells and red blood cells
    skin, lymph nodes, white blood cells, and spleen
    mucous, urine, and kidneys

    21. A desert would be the location of which abiotic factor? (Points : 5)
    a top predator
    a snake
    a primary consumer
    wind

    22. Which consequence occurred when sea otters were overhunted along the Pacific Coast? (Points : 5)
    The kelp grew rapidly and created new habitat for fish.
    The sea urchin population was reduced to dangerous levels.
    The sea otters on the Pacific Coast went extinct.
    The sea urchin population expanded and consumed the kelp and damaged the habitat.

    23. Identify the levels of the biosphere from smallest to largest, left to right. (Points : 5)
    ecosystem—biome—community—population—individual
    individual—population—biome—community—ecosystem
    ecosystem—individual—population—biome—community
    individual—population—community—ecosystem—biome

    24. The following flow of energy occurs in the trophic levels in an ecosystem:
    sedge à arctic hare à arctic fox à wolf

    Which organism is located in the trophic level that contains the least amount of energy?

    (Points : 5)
    arctic fox
    wolf
    sedge
    arctic hare

    25. Global warming and climate change are important topics in environmental biology. How should scientists add to the discussion on climate change and global warming? (Points : 5)
    Scientists should not get involved in decisions that affect modern society.
    Scientists cannot provide accurate information on environmental issues such as global warming.
    The role of scientists is to present research that clearly represents their personal beliefs regarding the issue.
    Scientists provide sound s

    • ANSWER:
      14. Ferns produce glucose that can be broken down by cellular respiration, while flatworms and people digest foods containing glucose for use in cellular respiration.

      15. Flatworms release carbon dioxide directly from the skin, and use a simple digestive system to remove liquid waste. People use lungs to remove carbon dioxide, and have developed complex excretory and digestive systems to remove waste.

      16. Plants produce oxygen during photosynthesis, and they also need oxygen gas from the air for cellular respiration.

      17. electrical signals and chemical neurotransmitters

      18. Myosin heads attach to and move along actin-binding sites.

      19. Plants have a two-part life cycle, spending part of their life in a diploid phase and part in a multicellular haploid phase. Humans spend their lives in a diploid phase and produce gametes that are haploid

      20. skin, lymph nodes, white blood cells, and spleen

      21. wind

      22. The sea urchin population expanded and consumed the kelp and damaged the habitat.

      23. individual—population—community—ecosyste…

      24. wolf

      25. Scientists provide sound scientific data to help society make informed decisions.

  6. QUESTION:
    Streptococcus Case Study: R U up for the challenge? (Relax its multiple choice)?
    A 74-yr-old man, Bob B., presented to the ER with fever, shortness of breath, chest pain, and severe, extremely productive cough. Bob had been a heavy smoker for almost 50 years before he quit 8 years ago, when he was diagnosed with emphysema. Bob occasionally used oxygen at home when he had difficulty breathing, and on presentation he was using portable oxygen because of his severe respiratory distress. A chest x-ray revealed a right lower lobe infiltrate, and Bob was admitted to the hospital Sputum, urine, and blood cultures were collected.

    The direct Gram stain of the sputum specimen revealed the following:
    Many neutrophils (>25 per low-power field)
    Rare squamous epithelial cells (<1 per-low-power field)
    Many gram-positive lancet-shaped diplococci and cocci in short chains (>25 per oil immersion field)
    Few gram-negative diplococci (<10 per oil immersion field)
    Few gram-positive bacilli (<10 per oil immersion field)

    After overnight incubation at 35C in 5% to 7% CO2, a blood agar plate inoculated with the specimen revealed a mixture of two colony type. Rare, non-hemolytic, tiny, white, dry-looking colonies were present. A predominance of small, wet-looking, convex (crater-form), entire-edged colonies were also seen, with a greening of the medium around them.

    The urine culture showed no growth at 24 hours. All blood cultures were negative after 5 days incubation.

    QUESTIONS:

    1.Based on the direct Gram's stain, what is the quality of this sputum specimen? Is the specimen of acceptable quality to provide clinically relevant information?
    a. evidence of a poor specimen, which is not acceptable
    b. evidence of a poor specimen, which is acceptable sputum
    c. evidence of a contaminated specimen, which is not acceptable
    d. all sputum sample submitted are good and acceptable

    2.Based on the colony morphology and the Gram’s stain, what organism is suspect as the cause of Bob’s pneumonia?
    a. Strep Group A
    b. Strep Group B
    c. Strep Group D
    d. Strep. pneumoniae

    3.What type of hemolysis is being described by the term “greening” of the medium?
    a. alpha or partial
    b. beta or partial
    c. beta or complete

    4.What other (nonpathogenic) organisms commonly found in this type of specimen this type of hemolysis?
    a. Strep Group A
    b. Strep Group B
    c. Viridians Strep
    d. Strep Group D

    5.What laboratory tests are useful in differentiating these organisms and identifying the pathogen?
    a. TAXO-A and bile solubility
    b. TAXO-A and bile esculin
    c. TAXO-P and bile solubility

    6.Organisms other than the predominant organism were seen in the Gram’s stain and culture. Does this mean that the patient has polymicrobial pneumonia? Why are those other organisms present?
    a. yes, the patient does have a polymicrobial infection, the other organisms are also pathogenic.
    b. yes, the patient does have a polymicrobial infection, the other organisms are both pathogenic and nonpathogenic.
    c. No, the patient does not have a polymicrobial infection, the other organisms are part of skin flora.
    d. No, the patient does not have a polymicrobial infection, the other organisms are part of normal flora.

    7.Should antimicrobial susceptibility testing be performed on this pathogen? If so, what antimicrobial agent (s) should be tested?
    a. Yes, antimicrobial susceptibility testing should be performed. Penicillin should be tested due to penicillin-resistant strains.
    b. Yes, antimicrobial susceptibility should be performed. Gentamycin should be tested due to gentamycin-resistant strains.
    c. No, antimicrobial susceptibiltiy testing is not necessary.
    d. No, organism is not treated with antimicrobial agents.

    • ANSWER:
      1. D
      2. D
      3. A
      4. C
      5. C
      6. D
      7. A

  7. QUESTION:
    I have been tested for STDs but things around my vagina are still looking grim…why?
    Here is my problem, guys. I’m a 20 year old female, and have only had sex with 2 people. The second person I used protection, but the guy i lost my virginity to I did not. (I was 16 when we were dating). After we had been sexually active for a couple weeks, rumors floated around that he had herpes. Naturally, this freaked me out. During the 6 months we dated, i never had any bumps or sores on my genitals. After we broke up, my mom took me to get my first PAP and to be put on birth control. Things were fine, nothing came up abnormal in my PAP results but after taking the pill (not sure how long after) I started getting vaginal discharge. And small bumps on my vagina. The problem progressively got worse, the discharge never stoppped. I though i had herpes and I was too afraid to talk to anyone. After about a year of these symptoms i went to Planned Parenthood and got tested for all STDs. Everything came up negative and the discharge turned out to be a yeast infection. The thing is, i inserted the suppositiores the Dr. gave me and it worked very well….for about a week. Then the discharge was back in swing. The bumps were never diagnosed as anything. I went back to get tested 2 more times and they finally told me to go online and order Yeast Arrest with boric acid. It worked great and the discharge disappeared almost completely. But there are still painful bumps that pop up occasionally. And for a year or more, i’ve had little white bumps in my buttcrack. I had the doctor look at them when i went back the last time to get tested, and she said it was not an STD but could be something else. She never elaborated. It is also purple around my butthole and it never used to be….What can this mean?

    Another question I have is…my urethra has gotten bigger over the past 6 months and when i pee, it looks like there are chunks of skin in my pee. I went to my family doctor/regular gyno to have a urine sample taken and they said they found some red blood cells, but they sent my urine out for further testing. I’m still waiting on results there. But what could cause my urethra opening to get larger? It’s red too. I have pains also. They put me on an antibiotic for a UTI/Bladder Infection, but the flesh-looking chunks are still in my pee. I’m scared.

    • ANSWER:
      I am a guy – Sooo, obviously I am not going to be an ‘expert’ :-) , however, sadly I do have herpes.

      My question is; could you have both a reoccurring yeast infection – which the medicine helps, but does not fully make go away. …I also have a long history of yeast infections – Jock etch, thrust in mouth, etc. – it is caused by either antibiotics when I Have to take them – I always ask for a prescription of ducafin which women use alot.

      So I understand much about both – just not the part about the workings below a women’s waist.

      I ‘know’ I have herpes, about 30 years +, But I have also had cultures and tests run several times in the past, and they were all negative. It is Common to receive negative results. I do not know why, but more than one doctor has told me that herpes ‘tests’ are not very reliable except when they actual come back with a positive test result.

      So, you need to go to a doctor who specializes And has a Lot of experience with both yeast and herpes. And of course, this needs to be done when you are having problems. Continue to go back each time, because each breakout ‘could’ be yeast at one time, herpes at another time, or both at once and the doctors are overlooking the herpes. Maybe on a woman the symptoms ‘look’ similar.

      In addition, as I said testing for herpes is problematic, but also, I am guessing, but it seems logical to me that if you are having a yeast breakout, at the same time that you are being tested for herpes, the herpes test may almost always show negative because of the yeast interfering with the herpes test …Ask the doctor about the answer to this question.

      Once a person has a recurring Yeast problem and basically Has it just ‘waiting’ to blast through the immune system – that person will Never totally get rid of it. Antibiotics (which kills the bacteria that helps to control the yeast – the yeast problems will start again)

      So always ask for ducafin when you are prescribed antibiotics – works for me. Also, the second Big thing that will trigger yeast is eating/drinking a lot of sugar. Two cans a day for a week of coke can sometimes trigger if if I have also eaten a Little bit of pie, cake, or cookies that same week. Then the ducafin comes out of the cabinet.

      Back to herpes – IF you have it, you will Never get rid of it. There is no cure. It will go into remission for weeks or months at a time, and there is medicine that will make the symptoms go away in a few days which you will need to take. But it varies from person to person how often that they get a breakout. Usually, in the beginning, the first 2 – 5 years, you will have more breakouts than later in life – guess your body builds up ‘some’ resistance to it over the years.

      Stress will often cause it to flare up, don’t know what all the causes that makes it flare – also, if you have been sick, body run down i.e. maybe yeast infection, will cause flare ups.

      When I first go it in my late 20′s (I know the girl I got it from – short relationship of a few weeks – but it only takes once). When I first got it, I averaged 6 or 7 outbreaks per year – some were pretty server – each person is different. Now I am 62 and I average 1 or 2 per year.

      Sorry I butted in and answered a ‘female’ question. But hope they might have helped – from a males point of view. If you, or others need more information, you can check my profile and e-mail me.

      Wish you luck and the best.

  8. QUESTION:
    what type of person will use sex toys?
    It is, perhaps, a measure of just how mainstream sex toys have become that there are now budding consumer and environmental awareness campaigns being waged over them.

    The biggest controversy is about the materials from which many toys are made.

    Most vibrators, dildos and “love dolls,” for instance — especially the soft, pliable “jelly” type — use some form of plastic. In an effort to make the materials softer and more lifelike, PVC plastics suppliers incorporate one or more members of a family of compounds called athlete’s (Faults). To hear some environmentalists tell it, using a vibrator that includes athlete’s is akin to bathing in DDT. Alarmed, some sex toy retailers, most prominently San Francisco-based Good Vibrations, are banning toys that include athlete’s. But to hear the chemical industry tell it, athlete’s are about as benign as mountain spring water. So what is a sex toy consumer to do?

    Athlete’s are ubiquitous. They are used in perfumes, hair sprays, plastic raincoats, carpet backing, paints, medical devices and many other items. They are responsible for that “new car smell,” which goes to show you how much plastic is used in cars.

    Now they are showing up in people. As the fact of new car smell indicates, athlete’s “off-gas,” meaning that they escape from the plastic in the form of a gas. So we breathe them. They also can escape their bond with the plastic by seeping out in an oily film, and we can absorb this through our skin, our mouths, our mucous membranes. A 2004 study by the Centers for Disease Control and Prevention of urine samples from 2,540 people ages 6 and older found athlete’s metabolites (what’s left after our bodies chew it up) in more than 75 percent of the subjects.

    What scientists cannot yet say is whether or not all this exposure is bad for us. “There is consensus that exposure is widespread in the general population,” explains Antonia M. Calf, whose CDC lab did the study. While there is no cumulative buildup — athlete’s are metabolized quickly by the body and excreted — “there is also consensus that athlete’s are toxic in animals. There is no consensus at present whether the athlete’s are causing adverse health effects in humans.”

    Part of the uncertainty lies in the absence of human testing. You can’t ethically give people a dose of something you think might harm them, after all. And much of the testing done in animals, or on cells, uses doses of athlete’s many times the typical exposure people experience. Further complicating matters is that there are grades of Perfectibility combinations (including food grade), with the lower the grade usually meaning the more smell and oily feel.
    www.usemesex.com

    • ANSWER:
      …WTF kind of a “rant” is this !


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