Ergonomically Correct Garden Tools - Your Back Will Thank You

!±8± Ergonomically Correct Garden Tools - Your Back Will Thank You

In most endeavors, a person will opt for the easiest, most comfortable manner by which to accomplish his chosen task. An artist painting a magnificent sunset , shimmering delicately over a lake, will use the best quality artist's brush made of camel hair, not a house painter's 3" wide, synthetically bristled brush. In the kitchen, why chop vegetables until your hands are in considerable pain when there is a food processor waiting to do the job, freeing you from the tedium, and the additional back pain that comes from standing interminably at the kitchen counter, wondering to yourself if your recipe really needs a full cup of finely diced celery? And why would anybody use a manual typewriter that has absolutely no features to boast about, other than causing carpal tunnel syndrome or muscle spasms, that come from the repetitive motion of striking the keys with force when, in the other room, sits a state-of-the-art computer with all the bells and whistles, capable of doing practically everything for you but actually compose the text that you want? I do not think I could begin to be sufficiently proficient (more like bumbling) if I had to worry about setting margins and spacing, and trying to figure out where to put that *%@# "e" inadvertently missing in cheese [sic] without destroying any semblance to proper space placement.

The same thing is true with gardening. You do not use a shovel when a much lighter weight spade will do. And you do not spend an hour, bent over a flower bed, without causing grievous pain to your back and shoulders, when you could be using an ergonomically designed kneeler pad specifically crafted to keep your knees on speaking terms with the rest of your body.

Any gardener, beginner or professional, needs a basic set of tools. As is the case with any job or pastime requiring specialized tools or paraphernalia, to garden you must amass for yourself a set of good quality tools which will not fall apart with the slightest provocation. Plus, you owe it to yourself to obtain the most comfortable tools within your budget. It is better to buy just a few of the basics before you start salivating at the sight of "designer" garden tools. At this point, more is not necessarily better. Pick wisely.

The first category of ergonomically designed garden tools includes SPADES, TROWELS, CULTIVATORS, and SHOVELS. A SPADE is used for digging or cutting the ground. It has a sharp-edged metal blade and a long handle. A TROWEL is basically a small spade, used for lifting plants or soil. A CULTIVATOR is used to prepare the soil for a garden.

A STANDARD or GARDEN TROWEL, a very versatile hand tool, can do many jobs such as digging and shaping holes, hollowing or leveling out soil, and close-up weeding. A TRANSPLANTING TROWEL, with its narrow design, is the ideal tool for digging deep and/or narrow holes for planting seedlings. It is also excellent for removing root balls easily, with no damage to the plant or neighboring areas. Some transplanting trowels have measurements marked on the trowel so the gardener can dig to the correct depth for planting seeds. An extremely versatile tool, the CULTIVATOR , with its three elongated prongs, is perfect for many tasks. It can be used to loosen and prepare soil, extract immature weeds, amend the soil with compost or fertilizer, and to aerate the soil to make watering more efficient. A long-handled ROUND POINT SHOVEL can make or break your garden. You can accomplish anything and everything with this kind of shovel. It is ideal for turning ground or scooping soil, as well as for creating planting holes, filling in holes, and for carting away dirt loosened by another tool.

The next group of gardening tools includes PRUNERS, SHEARS, and LOPPERS. HAND PRUNERS are quite useful. They are perfectly suited for removing dead or damaged branches from rose bushes and shrubs, and they can cut through thin branches. Other uses can include cutting back perennials, and collecting herbs and flowers. I have found, from personal experience, to keep the blades clean and sharpened, or else you will find yourself with an armful of mangled rose stems, hanging half on and half off the bush. Not a pretty sight. I'm very territorial about my rose pruners and really do not like sharing them with others. If the pruner fits...

There are various styles of SHEARS available. Generally speaking, shears are large clipping or cutting instruments shaped like scissors. GRASS SHEARS are designed to get into areas difficult to be trimmed by the lawn mower, such as around tree trunks and flower beds, and to trim the lawn's edges. HEDGE SHEARS and grass shears are alike, but the hedge shears have longer blades. This tool is good when trimming hedges and shrubs. In the Fall, it comes in quite handy when cutting back perennials and also when clipping off dead flower heads.

LOPPERS have long handles in order to prune back or cut off branches from a tree or other such woody plants. They are able to cut through branches up to 2 inched in diameter.

Another important grouping of garden tools is made up of WEEDERS and EDGERS. WEEDERS do just that; they dig up weeds. A weeder consists of a long metal handle ending in finger like projections or scrapers that have been sharpened to facilitate piercing the earth and pulling up long, straggling weeds up and away by cutting them off below the surface. It rather looks like a BBQ fork. EDGERS are used to keep flower beds and bushes maintained in their proper contours. Basically, an edger will help delineate the garden borders by loosening up grass impinging onto sidewalks, stepping stones, flower beds, and around the circular space surrounding the diameter of a tree.

There are two basic types of RAKES: the BOW RAKE and the LEAF RAKE. The BOW RAKE is a basic in any garden. Solidly built with sturdy steel tines, it is used to move and smooth soil. It is also useful for drawing up raised flower or vegetable beds or mounding soil around plants. It is indispensable to "catch and toss" garden debris. LEAF RAKES have flexible plastic or aluminum tines. It is not as heavy as the bow rake but is perfect for gathering scattered leafs, grass clippings, and so forth. Both rakes have long handles so no bending is involved.

Do not forget to select a WATERING CAN, a HOSE with a HOSE REEL and NOZZLE, a ROLLING GARDEN CART/SEAT and a KNEELER. A WATERING CAN has a long spout, enabling you to water your flowers and shrubs from a short distance away while still standing. They do tend to feel quite heavy - water weighs 8-1/3 lbs. per gallon - so try to find a watering can that is made of lighter weight materials, such as aluminum or a sturdy plastic, that is well constructed. A good quality HOSE is essential for your garden and your sanity, unless you are particularly fond of lugging that heavy watering can around to water your lawn. Do not pinch pennies on a hose; buy the best quality hose you can find so you will not be spending your weekends giving first aid to all those holes and leaks that seem to announce themselves the minute you look away. A hose made of rubber should be your best bet. Some are even reinforced from the inside with a material meant to flex with the hose. You will need a NOZZLE of plastic or metal; metal will definitely last longer and frustrate you less. A HOSE REEL will make your life so much simpler. How many times have you tripped over a hose that has been carelessly dropped in serpentine tangles all over the driveway? Try to buy a hose that is of sufficient length to reach from the spigot to the point furthest away on your property where you might need water.

Last, but certainly not least, are the GARDENING STOOL and the KNEELER. These two accessories are designed for those of us who are not quite as mobile as we once were. The GARDENING STOOL helps eliminate back and knee pain by providing a surface upon which to sit while doing gardening chores that generally require standing in one place and/or bending. The stool usually is equipped with wheels and a storage space for your tools, and even has a holder for your water bottle. There is another type of gardening stool resembling a round hassock but it is mounted on a spring mechanism that allows the gardener to sit and reach in all directions without having to get up to reposition the stool. Unfortunately, this second type of stool tends to be very expensive.

The KNEELER, a padded surface in the shape of a rigid swing seat, is designed to take the ground's hardness away from your poor aching knees. A variation of the kneeler is as described above but with grab bars on either side of the cushion to facilitate standing up when you have finished working in that part of your garden. Both models ease pressure on the knees, especially helpful for arthritics.

Probably one of the most effective items, ergonomically speaking, is the ADD-ON HANDLE. It structurally modifies conventionally designed garden tools in a manner that gives the tool an ergonomic grip. It can be used with hand tools such as trowels and spades, rakes, hoes, and brooms. An arm support cuff for increased control and leverage is also available. Both the handle and the cuff are removable and can be used on the tools mentioned above. There are also long reach cultivators for those who must work from a seated position, particularly wheelchair users.

A few final thoughts:You must treat your body as a shrine. Bending incorrectly is the same as taking a sledge hammer to your shrine. Both are destructive. It is easy to make a quick move without thinking. I cannot count the number of times my doctor has fussed at me for just that reason. When RAKING or HOEING, try to keep the tools close to your body. Keep your back straight. Use your arms and NEVER twist your trunk (my doctor's very bone of contention - I still feel guilty when he catches me). If you are short, use long-handled tools in scale with your height. The same is true for tall individuals. Do not consider bending from the waist. This is where the KNEELER or the KNEELER WITH GRAB BARS come in mighty handy. When WEEDING, use long-handled tools to ease the strain on your back, legs, and knees. Forget about bending over to TROWEL; consider squatting or sitting on the ground. When SHOVELING or DIGGING, step on the top of the blade as you vertically insert the head of the shovel in the ground. Lift only small loads, bending at the knees. Never involve your back when lifting. Again, avoid twisting your trunk. This will become your mantra. Use as small of a shovel as possible to adequately complete your task. Again, match your shovel to your body size. Do not push your physical limits when lifting or carrying. Bend from the knees, but not your back and keep the load close to your body. Avoid twisting or reaching. Sound familiar? Get as close as possible to your work. Do not force your reach beyond your comfort zone. More importantly, do not stretch beyond your stable footing! On a personal note, stretching can be deleterious to your health if you have not arranged your footing to your best advantage. To preface this cautionary tale, due to having Degenerative Disc Disease for many years, my chief mode of transportation is my trusty wheelchair. I also wear bilateral leg braces which give me some support when standing. A few summers ago, I thought it would be nice to raid my rose garden to dress up the dining room table as we were expecting dinner guests that evening. Nobody else was at home. Like a fool, I went out to my rose garden, armed with my favorite pruning shears, thinking I would like to cut at least a dozen beautiful roses (we have over 50 bushes). I was wearing rather baggy shorts that billowed in the breeze. Both my legs were ensconced in their braces. Espying a particularly delightful rose, I reached forward toward the bush. I thought my feet were firmly planted atop the redwood chips surrounding the bushes. Boy, was I wrong! As I reached for the stem to be clipped, each foot went in an opposite direction, propelling me toward all those thousands of deadly thorns. With extreme accuracy, I was thrust directly onto the bush. Correction. I was impaled upon the rose bush, imprisoned by those menacing thorns in a bent-over, face-in-the-bush position. Doomed by my thorn-snagged shorts, I was literally immobilized. My neighbor and his brother came trotting across the street to untangle me. Talk about humiliation, not to mention the blood oozing out from the zillion thorn holes on my body. I was the picture of sophistication, not. I thanked them for their help and red-facedly slunk back into the house. I can honestly say that from that point on, I stop to consider all options before even approaching anything in my garden. I had definitely learned my lesson and hope this tale will remind you to plan ahead whenever your body mechanics are involved.

By the way, I never did get the roses cut for that evening. Sigh...

Ergonomically Correct Garden Tools - Your Back Will Thank You

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Cirrhosis: Risk of Liver Damage

!±8± Cirrhosis: Risk of Liver Damage

Liver is one of the very important organs of body that participates in carrying out many important functions to sustain life of an individual. It can be affected with any disease or disorder and one of the commonest one includes cirrhosis. Cirrhosis is a type of chronic liver disease where the liver tissue is being replaced by fibrosis, scar tissue and regenerative nodules that result in loss of proper functioning of this vital organ. Alcoholism, fatty liver, hepatitis B and C are the major factors that are responsible for this chronic liver disease but other factors may also play minor role for example, viral infection, accumulation of toxic metals like iron and copper due to genetic disease and autoimmune disease. Some idiopathic factors also contribute to liver cirrhosis. Poor quality of life with increased risk of infection is basically responsible for the appearance of one of the most common complication of this disease identified as ascites. Hepatic encephalopathy and esophageal varices are other complications associated with cirrhosis. This chronic condition is generally irreversible and in advanced cases liver transplant is the only solution. The term cirrhosis actually originated from a Greek word meaning diseased liver. René Laennec gave the term cirrhosis in 1819 while carrying out his work.

Liver is a very essential organ of human body as it carries out many critical functions out of which two are very important for example, it participates in the clotting of proteins in order to stop bleeding and it also aids in the removal of toxic materials like drugs that may be harmful for the human body. It also partakes in regulating the regular supply of body fuels namely glucose and lipids. In order to perform these essential functions the liver cells must work properly and must be able establish a close connection with blood so that substances can be easily transported as well as removed from blood via liver. The relationship of liver with blood is a unique one. Arteries supply a very small amount of blood to the liver. Major blood supply of liver actually comes from the intestinal veins as the blood returns to heart. The main vein that returns to heart from intestine is the portal vein. As this portal vein passes through liver it breaks up into smaller and smaller veins. The smallest veins are in close intimacy with the liver cells. This close relationship between the liver cells and the veins helps in addition as well as removal of materials from blood. The liver cells also line up along the whole length of the sinusoids and when the blood passes through these sinusoids blood is collected in larger veins that collectively combine and form a larger single vain known as the hepatic vein that in turn finally returns to the heart.

In liver cirrhosis this intimate relationship between liver cells and blood is destroyed. The liver cells that survive or are newly formed may be able to add or remove substances to blood but their normal functioning is hampered so they no longer are able to maintain the close relationship with blood. Formation of scars also hampers the regular blood flow from liver to the liver cells as result the pressure in the portal vein increases and the condition is known as portal hypertension. The second major problem caused by cirrhosis is disturbance in the relationship between the liver cells and the channels through which the bile flows. Bile is a fluid that is produced by the liver cells and it has two important functions for example, it helps in digestion as well as removal and elimination of toxic substances. The bile produced by the liver cells is secreted into very tiny channels that run between the liver cells and also line the sinusoids known as canaliculi. These canaliculi empty into smaller ducts that open into larger ducts. Finally all these ducts open into a single duct that opens in the intestine. So in this way the bile entering the intestine aids in digestion. At the same time the toxic substances present in the bile also enter intestine and are eliminated out from the body through feces. In cirrhosis, the canaliculi become abnormal and the relationship between the liver cells and these canaliculi is destroyed so the liver cells are not able to eliminate the toxic substance out from the body and they keep on accumulating inside the body. Digestion of food in the intestine is affected but on minor scale.

The symptoms of cirrhosis either develop due to the chronic liver disease or are the result of complications of cirrhosis. Many symptoms crop up which have no relation with cirrhosis. The chief symptoms include spider angiomata where vascular lesions develop that can be identified by a central arteriole surrounding many smaller vessels. This condition crops up because of higher secretion of estradiol. Palmer erythrema is another symptom where altered sex hormone metabolism results in speckled mottling of palm. Changes in the nail structure also appear for example, Muehrcke's lines identified by paired horizontal lines that are separated by normal color and this condition crops up due to hypoalbuminemia. Apart from this symptom the proximal two-thirds of the nail plates become white with one third portion red in color and this is also due to hypoalbuminemia. This condition is known as Terry's nails. Clubbing nails may also result where the angle between the nail plate and the proximal nail fold is greater than 180. Chronic proliferative periostitis of the long bones result in severe pain and the clinical condition is given the term hypertrophic osteoarthropathy. Dupuytren's contracture can be characterized by thickening and shortening of the palmar facia resulting in the deformities of fingers. This symptom is very common in 33% patients of liver cirrhosis. Benign proliferation of the tissue male of male breasts can also occur due to excessive secretion of estradiol known as gynecomastia and is common in 66% cases.

Hypogonadism characterized by impotence, infertility, loss of sexual drive and testicular atrophy may also occur due to suppression of the pituitary function. Liver may be enlarged, normal or shrunken. Portal hypertension results in splenomegaly where the size of spleen is becomes very large than the normal. Accumulation of fluid in the peritoneal cavity results in the formation of ascites. In the portal hypertension the umbilical vein may be open and abnormality may result in a condition known as caput medusa. Fetor hepaticus may also appear where a musty odor is observed in the breath due to the increased concentration of dimethyl sulphide. Jaundice may also arise in later cases. Fatigue, weakness, loss of appetite, itching and bruising is other symptoms associated with cirrhosis. As the disease advances complications begin to appear and in some individuals they are the first signs of disease. As the disease advances signals are sent to the kidneys to retain salt and water in the body. The excess salt and water first begin to accumulate in the tissue just beneath the ankles and legs due to the effect of gravity. This fluid accumulation is known as edema or pitting edema. The condition of the patient worsens during the day time as intense swelling occurs while standing and sitting but swelling lessens during night while lying down. These changes are orientated by the effect of gravity. When cirrhosis worsens the fluid begins to accumulate in the abdominal cavity just beneath the abdominal wall and the abdominal organs. This results in abdominal swelling, abdominal discomfort and excessive weight gain.

Fluid present in the abdominal cavity provides a favorable condition for the bacteria to grow. In normal conditions very small amount of fluid is present in the abdominal cavity that is capable of resisting infection and the bacteria may be killed in the abdominal cavity or if they enter the portal vein or liver are ultimately killed by liver cells. In cirrhosis the fluid that collects n the abdominal cavity is unable to resist infection. The bacteria find their way from intestine into the ascites and therefore, this infection is known as spontaneous bacterial peritonitis or SBP and it may terminate fatally. Some patients with this complication may not symptoms but others suffer from fever, chills, abdominal pain, diarrhea and tenderness. The scar formed in the cirrhotic liver blocks the path of blood returning from the intestines to the heart and this result in increased pressure in the portal vein and the condition is known as portal hypertension. When the pressure becomes very high then the blood flows with lower pressure towards heart. The increased pressure in the veins of lower esophagus and upper stomach expand resulting in varices. The higher portal pressure results in intense bleeding from these varices in advanced stage. Bleeding in severe cases may terminate fatally if left untreated. The symptoms of bleeding varices may include vomiting blood, passage of black stools and orthostatic dizziness. Bleeding from varices may also occur through the intestines for example form the colon but this is very rare.

Some of the protein also escapes digestion and absorption and is utilized by the bacteria that normally inhabit the intestine. The proteins utilized by these bacteria for their own purpose results in the release of some of the substances in the intestine that can be absorbed in the body. Some of these substances namely, ammonia has an adverse effect over brain function. In general, these toxic substances are removed from the body the intimate relationship of the liver cells with blood. When these toxic substances accumulate in brain in sufficient amounts the brain function is impaired and the condition is known as hepatic encephalopathy. One of the earliest symptoms of hepatic encephalopathy is that the individual falls asleep during the day time rather than night. Other symptoms include irritability, inability to perform calculations, loss of memory, confusion, depressed levels of consciousness and in severe cases coma followed by death. Accumulation of toxic substances in brain also makes the patients sensitive to drugs that are normally removed from the body by the activity of the liver cells. Advanced cases of cirrhosis may also develop hepatorenal syndrome where the normal function of kidneys is altered. Kidneys are not damaged physically but there are changes in the blood flow within the kidneys. Hepatorenal syndrome is characterized by progressive failure of kidney function where they are unable to form adequate amount of urine although the salt and water retention function is normally maintained. If liver function is brought back to normal then this syndrome diminishes. This clearly indicates that loss in the activity of liver cells adversely affects kidney function.

Some patients with very advances cirrhosis may develop hepatopulmonary syndrome but its incidence is very rare. The patients with this syndrome generally experience difficulty in breathing due to the excessive secretion of hormones that cause impairment of lung function. The major problem associated with lung function is decrease in the blood flow in the small vessels that pass through the alveoli of the lungs. Due to the decreased blood supply the alveoli are unable to pick up sufficient amounts of oxygen that result in breathing problem. Spleen normally acts as a filter for the removal of older red blood cells, white blood cells and the platelets. The blood that drains from spleen joins the blood in the portal vein from the intestine. As the pressure in the portal vein is very the blood supply to the spleen is blocked. Due to this the size of spleen increases and this condition is known as splenomegaly. Sometimes the spleen swells so intensely that it causes severe abdominal pain. As the size of the spleen enlarges it draws out more and more blood cells and platelets that their number reduces in the blood. The total count of red blood cells, white blood cells and the platelets is reduced and the condition is known as hypersplenism. Anemia causes weakness, leucopenia leads to infections and thrombocytopenia results in loss of blood clotting and causes prolonged bleeding. Cirrhosis also increases the risk of primary liver cancer. Primary indicates that a tumor arises in liver that becomes cancerous later on and secondary condition is that the cancerous growth occurs somewhere else in the body that later spreads in liver also. Most common symptoms of primary liver cancer are abdominal pain, swelling, enlarged liver, weight loss and fever. Liver cancer can also cause increased red blood cell count, low blood sugar and high blood calcium levels.

A number of factors are responsible for this chronic liver disease and more than one cause is present in the same patient. In the western world alcoholism and Hepatitis C are the chief factors which are generally responsible for cirrhosis of liver. The amount and regularity of alcohol intake are responsible for cirrhosis development. Very high consumption of alcohol generally damages the liver cells. Individuals who drink daily with an amount ranging between 8-16 ounces per day are generally at a higher risk of liver damage. Alcoholism is also responsible for the development of fatty liver. Nonalcoholic fatty liver disease (NAFLD) is a group of liver diseases like alcoholic liver disease, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) to cirrhosis. All these diseases are identified by heavy accumulation of fat in the liver cells. The term nonalcoholic is used because this condition crops up in those individuals who do not consume alcohol but if the liver cells are examined microscopically then the symptoms resemble with those present in the liver of those individuals who consume alcohol. NAFLD is associated with insulin resistance, metabolic syndrome and diabetes type 2 and obesity can be considered as a prime factor associated with these clinical symptoms. In the United States about 24% cases with liver cirrhosis undergo liver transplants and NAFLD is responsible for cirrhosis. Cryptogenic cirrhosis is another symptom which is responsible for liver transplant. This issue was earlier debatable among the doctors but now the debate has been solved and nonalcoholic steatohepatitis (NASH) is the major cause. Chronic viral hepatitis is a condition where hepatitis B and hepatitis C virus affect the functioning of liver for many years. Most of the patients with viral hepatitis generally do not develop chronic hepatitis and cirrhosis. Patients suffering from hepatitis generally recover within weeks without the development of cirrhosis but in case of hepatitis B and C in severe cases chronic liver infection and sometimes liver cancer may develop.

Inherited disorders can also result in accumulation of the toxic substances within the liver cells which in turn cause chronic liver disease the common example is abnormal accumulation of copper and iron inside the liver cells. In hemochromatosis patients develop an abnormal tendency of absorbing higher levels of iron from food. Excessive accumulation in the body cells is responsible for cirrhosis, arthritis, heart muscle damage leading to heart failure and testicular dysfunction that causes loss of sexual drive. Treatment is basically focused on removal of excess iron amounts from body by bloodletting. In Wilson disease there is abnormal accumulation of copper in eyes, liver and brain. Cirrhosis, neurological disturbances and tremors make their appearance if this condition is not treated. Generally oral medication is given which aims at removal of copper from the body through urine. Primary biliary cirrhosis (PBC) is a liver disease caused by abnormality of the immune system and is chiefly found in females. In this disease inflammation and destruction of small bile ducts take place within the liver. Bile ducts are the passages through which the bile travels from liver to the intestines. Bile is a fluid produced by the liver which contains substances responsible for the digestion and absorption of fats in the intestine and also contains some waste products like bilirubin. In PBC destruction of the small bile ducts causes blockage of flow of bile from liver to the intestine. As the hepatocytes or liver cells are damaged fibrosis makes its appearance and finally cirrhosis occurs.

Primary sclerosing cholangitis (PSC) is a rare disease found in patients with ulcerative colitis. In this condition the bile ducts present outside liver become inflamed, narrowed and obstructed. Obstruction is responsible for the infection of bile ducts, jaundice and finally cirrhosis occurs. In some patients damage to the bile ducts can directly lead to liver cirrhosis. Autoimmune hepatitis is another liver disease where the immune system becomes abnormal and cirrhosis occurs but this disease is very common among women. Progressive inflammation and destruction of hepatocytes are the primary symptoms that ultimately result in cirrhosis. Biliary atresia is a condition where the infants are born without bile ducts so cirrhosis occurs. Other infanst may be lacking vital enzymes responsible for the cleavage of sugars so abnormal sugar accumulation takes place so cirrhosis develops. In rare cases, the loss of a specific enzyme can cause alpha 1 antitrypsin deficiency. Liver plays a vital role in synthesis of proteins, detoxification and storage. It also participates in the metabolism of lipids and carbohydrates. Cirrhosis is often preceded by hepatitis and fatty liver. The hallmark of cirrhosis is the development of a scar tissue that replaces the normal parenchyma, blocks the portal flow of blood through liver and finally disturbs its normal functioning. According to the recent research, stellate cell that normally stores vitamin A plays a pivotal role in the development of liver cirrhosis. Damage of the liver parenchyma results in the activation of this stellate cell and finally the portal supply of blood is obstructed. Stellate cell also secretes the TGF-?1 which is responsible for the fibrotic response causing proliferation of the connective tissue. It also secretes TIMP 1 and 2 which prevents the matrix metalloproteinases from breaking within the matrix. Spleen becomes enlarged causing hypersplenism and increased sequestration of platelets. Portal hypertension is highly responsible for the appearance of symptoms of cirrhosis.

Liver biopsy carried out through percutaneous, transjuglar and laparoscopic approaches are considered very effective which searching for cirrhosis. If clinical, laboratory and radiologic data predict about cirrhosis then biopsy is not needed. A number of clinical trials in the laboratory can be carried out which assure about the presence of cirrhosis for example, the levels of aminotransferases, alkaline phosphatase, gamma-glutamyl transferase are elevated. The levels of bilirubin are also elevated. Albumin levels fall and prothrombin time also increases. Globulin, serum sodium levels are increased. Ultrasound is chiefly used for the diagnosis of the cirrhosis as it shows a small nodular liver but in advanced stages echogenicity becomes prominent. Ultrasound also screens for hepatocellular carcinoma, portal hypertension and Budd-Chiari syndrome. Fibrscan is a newly invented device that uses elastic waves to check out the stiffness of liver which can be read with the help of METAVIR scale. This device generates the image of liver along with pressure reading. This test is very fast than biopsy and is painless. It shows reasonable relation with severity of cirrhosis. Other tests include abdominal CT and liver or bile duct MRI. Gastroscopy is performed in patients with established cirrhosis in order to exclude the possibilities of esophageal varices. If they are found then prophylactic local therapy and beta blocker treatment is suggested.

In general, macroscopically the liver becomes enlarged but with advancement of disease the size of the liver shrinks to small. The surface of liver becomes irregular and it acquires yellowish colouration. Three types of macroscopic nodules namely, macronodular, micronodular and mixed cirrhosis are identified. In micronodular form the nodules are less than 3 mm in size while in macronodular form nodules are larger than 3 mm in size. The mixed cirrhosis consists of mixed nodules of different sizes. A number of microscopical pathological features are identified for cirrhosis for example, presence of regenerating nodules in hepatocytes, presence of fibrosis. Fibrosis is responsible for the destruction of other normal structures like sinusoids, space of Disse, portal hypertension, damage of other vascular structures. A number of other entities may also be responsible for the development of cirrhosis. In chronic hepatitis B there is infiltration of liver parenchyma along with the lymphocytes however, in cardiac cirrhosis, the amount of erythrocytes increase and fibrosis occurs in the hepatic veins. In primary biliary cirrhosis, fibrosis occurs around the bile duct, granulomas and pooling of bile can be identified, in alcoholic cirrhosis there is infiltration of liver along with neutrophils. The severity of cirrhosis is classified on the basis of Child-Pugh Score. The score makes use of bilirubin, albumin, INR, presence and severity of ascites and encephalopathy and the patients are then kept in A, B and C classes. Class A individuals have a favorable prognosis while those belonging to class C are at the risk of death. The score was first given by Child and Turcotte in 1964 and was modified by Pugh et al., in 1973.

According to a study carried out in the United States in 2001, about 27,000 people die every year due to cirrhosis and chronic liver disease. Treatment of cirrhosis can be accomplished in four ways namely, prevention of further damage to liver, treatment of complications of cirrhosis, prevention of liver cancer and its early detection and finally liver transplantation. Consumption of a balanced diet with daily intake of a multivitamin can prevent further damage to liver. Patients with primary biliary cirrhosis require additional doses of vitamin D and K. avoidance of drugs that damage liver cells and well as alcohol quitting can protect liver from damage. Avoidance of non-steroidal anti-inflammatory drugs, eradication of virus of hepatitis B and C, removal of blood from the patients with hemochromatosis to get rid of excessive iron, oral medication for removal of excessive copper through urine can also prevent further damage of liver cells. Retention of salt and water can cause swelling of legs and ankles (edema) or abdomen (ascites) especially in the patients with cirrhosis. Doctors advise these patients to restrict the dietary use of sodium. The amount of salt intake is restricted to 2 grams per day and fluid intake must not exceed 1.2 liters in a day. Diuretic medications are often suggested by the health experts so that excessive salt and water may leave the body through urine. The blood urea and creatinine levels of kidneys must be monitored regularly while using diuretics.

If large varices develop in esophagus and upper part of stomach then the patient may experience excessive bleeding that may terminate fatally. Propranolol is an effective beta blocker commonly used for stopping the bleeding. Patients with abnormal sleep cycle, impaired thinking, odd behavior or other signs of hepatic encephalopathy should be treated with a low protein diet and oral lactulose. Dietary protein is restricted as it can be responsible for the formation of toxic substances responsible for hepatic encephalopathy. Lactulose is a liquid that traps toxic compounds in colon and therefore these cannot be absorbed back in the blood stream to cause encephalopathy. The filtration of blood by an enlarged spleen normally results in mild reduction of red blood cells, white blood cells and platelets that in general do not require treatment. Severe anemia requires transfusions or hormone therapy to stimulate red blood cell production. If the number of white blood cells declines then a hormone identified as granulocyte-colony stimulating factor is used. No approved medication is yet available to increase the number of platelets. Patients suffering from spontaneous bacterial peritonitis usually undergo paracentesis. Several types of liver diseases are associated with increased risk of cancer especially hepatitis B and C and early liver transplant only can save the life of the patient. Cirrhosis is irreversible and in patients where all other possible ways fail to give the desired result, liver transplantation is the only hope. On an average about 80% of the patients who have undergone liver transplantation live for about five years after transplantation.

Research is going on to trace out the exact mechanism underlying scar formation and how it can be stopped and reversed. Better treatments are being searched for the viral liver diseases so the progression of liver cirrhosis may be stopped.

Cirrhosis: Risk of Liver Damage

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A Follower Of What's-His-Name?

!±8± A Follower Of What's-His-Name?

The more I read and listen to others who are wading the House Church pool, sadly, the more I see well-meaning Christians inadvertently lifting up the leaders of various "networks" within the movement.

Once again, Dissension appears to be trying to rear its ugly head.

Each House Church group and network seems to have their own philosophy with each placing greater emphasis on one thing or another. One places a strong emphasis on the Lord's Supper while another stresses that any "layman" can start a church in their home. Another group emphasizes signs and wonders while another emphasizes the "Saturation Church" concept. Many groups are merely taking the "big church" format and reducing it to living room scale, while other groups are, unfortunately, becoming elitist and even divisive as they nurture an "Us against Them" mindset against the traditional, or "legacy" churches.

As usual, it doesn't take a Christian very long to revert back to the "holy place of meeting" mentality while giving lip service to the "We are the Church" mantra. But where actual House Church gatherings are concerned, like snowflakes, no two groups will ever be alike.

OUR SURVEY SAYS...

According to a 2006 survey on the movement, researcher/sociologist George Barna compiled the following breakdown of house churches in America today. Which describes YOUR House Church?

The average length of a House Church gathering is 1-1/2 hours. Only 6% of House Churches meet for 3 hours or more.

29% meet on Wednesday, 25% Sunday. For most participants, House Church appears to function as an addendum to their Sunday attendance

60% always follow the same routine.

91% are little more than Bible Studies.

A group's average size: 15 people. 5 Children.

One third (32%) have no children involved.

50% separate kids and adults; 19% have separate and combined; 22% always have kids and adults together.

Other Activities (Shown are the % of House Churches which Practice each)

Video 41%

Offering 43%

Communion 53%

Music 65%

Prophecy 71%

Discussion 75%

Teaching 80%

Sharing needs 83%

Prayer 87%

Eat/talk 8%

Bible Study 91%

Serving 94%

72% of house church participants said they were satisfied with the sense of community they were experiencing. But we can't expect any one House Church to last forever. According to author Frank Viola, 6 months to 2 years is about the maximum lifespan of a House Church.

LEAD ME TO YOUR TAKER

It must be the Adamic nature of man that causes people who confess that the literal presence of God Himself indwells their very being to act in a manner that is contrary to that declaration. We are no different than the elders of Israel who, although they had the prophet Samuel living among them, a man through whom God spoke, insisted upon having a king like all the other nations. Despite God's warning that a king would TAKE their sons off to war, TAKE their daughters for his Kingdom work and TAKE their taxes, the elders persisted. King Saul was given to them, one of the worst kings ever. The rest is history.

So, here we are, this mighty army-on-bivouac called The Church, endued with the same Spirit that raised Jesus from the dead, still insisting that somebody "lead us" around spiritually. Now, when we gather, some may teach us, but that doesn't make them our leaders. Others may prophecy, but the words they speak forth had better confirm what the REAL leader - Jesus - is already saying to us. Another who is gifted musically might lead us in songs of worship (Those of who cannot carry a note in a bucket say "let them!"). The common tendency, however, is to look to an individual HUMAN's leadership rather than trusting the Holy Spirit to guide His family.

Romans 8:14 tells us, "All who are led by the Spirit of God are sons of God."

Led? Wasn't Jesus "led" by the Holy Spirit into the wilderness to be tested by the devil (Luke 4:1-2)?

Does that mean our LEADER is the Holy Spirit?

Yes, when the Spirit of God invades the soul of man, a new leader emerges, namely, God. Those who know Him will know His voice. What I've found is that far too few of us actually know Him.

Leave it to mankind, sojourners and aliens, spiritual beings enduring this human experience, to try and get comfortable here. We send Moses up the mountain to hear from God because we're scared spitless. We'll even pay somebody to hear from God on our behalf - even making that his salaried job, complete with a title (pastor, reverend, father, etc.) - so he can report back to us at the next church service. Mankind, made in God's image and intended to be the freest creature in the universe, actually WANTS to be led by someone else. It's crazy!

NOTE: The only thing God NEVER gave mankind dominion over was other people!

REPEAT: The only thing God NEVER gave mankind dominion over was other people!

Those humans whom we allow to take authority over our lives will take our freedoms - including our spiritual freedoms - if only because we surrender them, NOT always because they wrestled them from our grip. They'll take all the power we give them. The word "religion" - according to Funk & Wagnall's - actually means "a return to bondage." Hmmm. Jesus came to set us FREE!

GIVE ME A MAN!

In 1 Samuel 17:10, we read about how Goliath shouted at the Israelites, "Give me a man that we may fight each other!" His taunting rang in their ears, causing paralyzing fear. Even today, many are taunted by that same demonic spirit that simply cannot bear to see Christian people submit directly to God, preferring that we submit to a man instead.

The apostle Paul had to write a letter of correction to the House Churches that were meeting in the Greek city of Corinth. It seems that some who were coming into The Church - specifically, in this case, those who belonged to Chloe's family - were beginning to take a little too much pride in their spiritual pedigrees and becoming a bit cliquish. They had opened the door to a Sectarian Spirit. According to 1 Corinthians 1:12, they were saying things like, "I am a follower of Paul," and "I am a follower of Apollos," and "I am a follower of Peter," along with those who confessed, "I am a follower of Christ."

"I am a follower of Catholicism. I am a follower of the Presbyterians. I am a follower of the Baptists. I'm a follower of (name a preacher, any preacher)."

Jesus said, "I will build MY Church, and the gates of Hell will not prevail against it."

He never told Peter to build his own network of churches. He said "feed MY lambs," not "feed YOUR lambs."

Paul never referred to the churches he planted as "his" churches. Here we read how he pleaded with the Corinthian saints, "Christian brothers, I ask you with all my heart in the name of the Lord Jesus Christ to agree among yourselves. Do not be divided into little groups. Think and act as if you all had the same mind."

In verse 13, Paul adds, "Has Christ been divided? Was Paul put on a cross to die for your sins? Were you baptized in the name of Paul? I am thankful to God that I baptized Crispus and Gaius only. No one can say that you were baptized in the name of Paul...Christ did not send me to baptize. He sent me to preach the Good News."

Good News? Yes, the Good News - the Gospel of the Kingdom that Jesus came to preach about (see Matthew 4;23; 9;35; 24:14; Mark 1:14) that is simply this:

1) There is a King.

2) He has a Kingdom.

3) He loves you and wants you in it with Him so that He can care for your needs.

4) He desires to build that Kingdom with you alongside, working WITH Him as He works THROUGH you.

The Queen of Sheba heard about King Solomon and marveled at how he cared for his subjects. From the fine robes they wore, the food they ate, the wisdom the king possessed...he amazed her. "That was some kinda King!"

When God cared for the wandering Children of Israel, for forty years their clothing never wore out, water came from rocks, manna and quail were provided to eat and they were provided shade by day and fire by night. Even their enemies were destroyed and those bitten by serpents were healed. "That was some kinda King!"

Even King Jesus, when preaching to hungry crowds, provided food. He raised their dead loved ones and healed their sicknesses. "That was some kinda King!"

Now, the same Spirit that raised Him from death and led Him in life desires to lead us. But we must submit to Him. We must decrease so that He can increase and shine through us, illuminating our worlds and telling them about the Good News of the Kingdom of God. They, too, once they experience Him, will declare, "That is some kinda King!

The Spirit exalts Jesus, and abases the flesh. If our flesh is screaming out for human leadership, pridefully declaring that we are followers of so-n-so, and if our lives are not centered around Jesus, I question whether or not He is truly the Lord - "kyrios" in Greek, meaning "owner" - of our lives. If Jesus is not central to what your House Church is all about, question its reason for being. If you find yourself following any human being and NOT the Spirit of Christ, I have a Word from God for you: Repent!

We must fight to keep dissension from entering in among us. Our 30,000 manmade denominations aren't doing a very good job of that, it appears. We have been, despite our good intentions, the #1 cause of atheism on the planet.

They will know we are Christians by our love for one another.

So, let's all decide to love one another.

Jesus is Lord...or He's not. Either we submit to Him alone as Lord of ALL, or He isn't our Lord at all.

A Follower Of What's-His-Name?

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