Remarkably Deer-Resistant Evergreen

Every home needs foundation plants – usually a combination of evergreens, deciduous shrubs and small trees. Evergreens offer year-round color and a beautiful backdrop for more seasonal plantings. For some folks with shade and persistent deer problems,

finding a low-growing evergreen can be very difficult. This week we are

featuring one that will solve this problem – a low-growing form of the Japanese

Plum Yew – Cephalotaxus harringtonia ‘Prostrata’.

Award Winning Addition to Your Garden

While the regular Cephalotaxus is a tree, the prostrate form of the Plum Yew is the winner of both the Georgia and Pennsylvania Horticultural Society Gold Medals, primarily because of its neat compact habit. Because demand always exceeds supply and

because prostrate Cephalotaxus is difficult to propagate and slow growing, it is

always scarce and hard to find. We are thrilled to be able to offer it to our

customers this coming spring.

Native to Japan, Korea and eastern China, Prostrate Plum Yew is a low-growing evergreen that prefers light to moderate shade and is extremely deer-resistant. (Do not confuse with regular yews which deer love and which cannot be grown south of Zone 7). It will mature at about three feet tall and about four to five feet wide. Prostrate Plum Yew is a slow grower (about four inches per year) and should require little pruning – although it can be easily pruned in early spring before the new growth

begins. Year-round, Cephalotaxus has glossy, deep green needles borne on slightly arching branches, which give it a graceful appearance.

Cephalotaxus will grow in full sun, although the needle color will be lighter green. As with many evergreens, cold winter wind and strong winter sun will cause temporary

bronzing of the foliage. Its texture and neat habit will make a grouping the focal point in your garden, especially at the edge of a woodland, surrounding a patio, along a walkway or as part of a foundation planting.

Planting and Care

• Plant in compost-enriched, moisture-retentive, well-drained soil. Good drainage is important.
• Once established, Cephalotaxus is quite drought tolerant.
• Space five feet apart
• Fertilize with Cottonseed Meal and Kelp Meal in early spring and late fall
• Hardy in Zones 6-9

Click here to view

Cephalotaxus harringtonia ‘Prostrata’ on the Carroll Gardens website.

More info about Prostate yew:

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Native to Japan, Korea and eastern China, Prostrate Plum Yew is a low-growing evergreen that prefers light to moderate shade and is extremely deer-resistant. (Do not confuse with regular yews which deer love and which cannot be grown …

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Description and planting and care instructions for the Japanese Plum Yew – Cephalotaxus harringtonia ‘Prostrata’ â?? a deer-resistant evergreen.

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Your doctor should check for cardiovascular health (blood pressure, leg pulses), obesity (body mass index and abdominal obesity), nerve function (sensation in fingers and toes), and abnormalities of the prostate and genitals. Blood tests are also important. … And the most important thing men can do to prevent the problem is to stay healthy. But if that fails, it’s certainly nice to know that many effective treatments are available. Posted by Teik Yew at 11:47 AM …

Yew / Taxus Brevifolia / Pacific Yew / Vital Yew

Yew helps prevent cancer, and supports the immune system, lungs, sinuses, breathing, and used externally as a salve for cuts, scrapes and skin irritations.

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Cancer of prostate develops in the prostate gland and typically develops slowly. Advanced prostate cancer could extend to the brain or other body parts. The brain is one of the most common sites of metastasis from solid tumors.

When symptoms of metastatic cancer take place, the type and frequency of the symptoms will rely on the size and location of the metastasis. For instance, cancer that extends to the bones is probable to lead to pain and can cause bone fractures. Cancer that extends to the brain can lead to various symptoms including headaches, seizures and unsteadiness. Shortness of breath might be a sign of lung involvement.

Prostate cancer typically causes no symptoms until it achieves an advanced stage. Sometimes, symptoms close to those of benign prostatic hyperplasia (BPH) develop, including difficulty urinating and a necessity to urinate recurrently or urgently. However, these symptoms do not enlarge until after the cancer develops large enough to compress the urethra and partly block the flow of urine. Afterward, the cancer might lead to bloody urine or a sudden incapability to urinate.

In a number of men, symptoms of prostate cancer develop simply after it spreads (metastasizes). The areas most frequently affected by cancer spread are bone and the kidneys. Bone cancer has a tendency to be painful and might deteriorate the bone enough for it to easily fracture. Cancer of prostate could also spread to the brain, which ultimately leads to seizures, confusion, weakness, headaches, or other neurologic symptoms. After the cancer spreads, anemia is common.

If suspected that prostate cancer spread to the brain or spinal cord, CT or MRI of those organs is done. Brain tumors could directly damage brain cells, or they might indirectly destroy cells by producing inflammation, compressing other parts of the brain because the tumor grows, inducing brain swelling, and causing increased pressure in the skull.

Metastatic brain tumors are classified relying on the precise site of the tumor in the brain, kind of tissue involved, original site of the tumor, and other factors. Rarely, a tumor could extend to the brain, yet the original location or site of the tumor is unknown. This is named cancer of unknown primary (CUP) origin.

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Remarkably Deer-Resistant Evergreen

Every home needs foundation plants – usually a combination of evergreens, deciduous shrubs and small trees. Evergreens offer year-round color and a beautiful backdrop for more seasonal plantings. For some folks with shade and persistent deer problems,

finding a low-growing evergreen can be very difficult. This week we are

featuring one that will solve this problem – a low-growing form of the Japanese

Plum Yew – Cephalotaxus harringtonia ‘Prostrata’.

Award Winning Addition to Your Garden

While the regular Cephalotaxus is a tree, the prostrate form of the Plum Yew is the winner of both the Georgia and Pennsylvania Horticultural Society Gold Medals, primarily because of its neat compact habit. Because demand always exceeds supply and

because prostrate Cephalotaxus is difficult to propagate and slow growing, it is

always scarce and hard to find. We are thrilled to be able to offer it to our

customers this coming spring.

Native to Japan, Korea and eastern China, Prostrate Plum Yew is a low-growing evergreen that prefers light to moderate shade and is extremely deer-resistant. (Do not confuse with regular yews which deer love and which cannot be grown south of Zone 7). It will mature at about three feet tall and about four to five feet wide. Prostrate Plum Yew is a slow grower (about four inches per year) and should require little pruning – although it can be easily pruned in early spring before the new growth

begins. Year-round, Cephalotaxus has glossy, deep green needles borne on slightly arching branches, which give it a graceful appearance.

Cephalotaxus will grow in full sun, although the needle color will be lighter green. As with many evergreens, cold winter wind and strong winter sun will cause temporary

bronzing of the foliage. Its texture and neat habit will make a grouping the focal point in your garden, especially at the edge of a woodland, surrounding a patio, along a walkway or as part of a foundation planting.

Planting and Care

• Plant in compost-enriched, moisture-retentive, well-drained soil. Good drainage is important.
• Once established, Cephalotaxus is quite drought tolerant.
• Space five feet apart
• Fertilize with Cottonseed Meal and Kelp Meal in early spring and late fall
• Hardy in Zones 6-9

Click here to view

Cephalotaxus harringtonia ‘Prostrata’ on the Carroll Gardens website.

More info about Prostrate japanese plum yew:

Spreading Japanese Plum Yew (Cephalotaxus harringtonia …

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TSEED Blog: Seed List B-C

Bellardiera sp. prostrate. Bellardiera variifolia blue. Betula alba (B. pendula) Betula albo-sinensis (Chinese Paper Birch) Betula alleghaniesis (Yellow Birch) Betula costata. Betula davurica (Asian Black Birch) … Celtis sinensis ( Japanese Hackberry) Cephalantus occidentalis (Butterbush) Cephalotaxus fortnei (Fortne’s Plum Yew) Cephalotaxus sinensis (Chinese Plum Yew) Ceratonia siliqua. Katsura672.JPG Cercidiphyllum japonicum (Katsura Tree) ã?«ã??ã?© …

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He sprang to our women; next Easter or

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Remarkably Deer-Resistant Evergreen

Every home needs foundation plants – usually a combination of evergreens, deciduous shrubs and small trees. Evergreens offer year-round color and a beautiful backdrop for more seasonal plantings. For some folks with shade and persistent deer problems,

finding a low-growing evergreen can be very difficult. This week we are

featuring one that will solve this problem – a low-growing form of the Japanese

Plum Yew – Cephalotaxus harringtonia ‘Prostrata’.

Award Winning Addition to Your Garden

While the regular Cephalotaxus is a tree, the prostrate form of the Plum Yew is the winner of both the Georgia and Pennsylvania Horticultural Society Gold Medals, primarily because of its neat compact habit. Because demand always exceeds supply and

because prostrate Cephalotaxus is difficult to propagate and slow growing, it is

always scarce and hard to find. We are thrilled to be able to offer it to our

customers this coming spring.

Native to Japan, Korea and eastern China, Prostrate Plum Yew is a low-growing evergreen that prefers light to moderate shade and is extremely deer-resistant. (Do not confuse with regular yews which deer love and which cannot be grown south of Zone 7). It will mature at about three feet tall and about four to five feet wide. Prostrate Plum Yew is a slow grower (about four inches per year) and should require little pruning – although it can be easily pruned in early spring before the new growth

begins. Year-round, Cephalotaxus has glossy, deep green needles borne on slightly arching branches, which give it a graceful appearance.

Cephalotaxus will grow in full sun, although the needle color will be lighter green. As with many evergreens, cold winter wind and strong winter sun will cause temporary

bronzing of the foliage. Its texture and neat habit will make a grouping the focal point in your garden, especially at the edge of a woodland, surrounding a patio, along a walkway or as part of a foundation planting.

Planting and Care

• Plant in compost-enriched, moisture-retentive, well-drained soil. Good drainage is important.
• Once established, Cephalotaxus is quite drought tolerant.
• Space five feet apart
• Fertilize with Cottonseed Meal and Kelp Meal in early spring and late fall
• Hardy in Zones 6-9

Click here to view

Cephalotaxus harringtonia ‘Prostrata’ on the Carroll Gardens website.

More info about Prostate plum yew:

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Prostate Japanese Plum Yew: Height: 3-6′ Width: 3-6′ Zone: 6: This slow-growing dwarf conifer has a wide, rounded crown and narrowly furrowed, partially peeling …

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Catalog

Upright Plum Yew. 1 Gal $ 8.00. Upright Plum Yew (Display) 3 Gal … Rosemary Prostate. Sage. 4 Salad Burnet. 4 Scented Geraniums – Rose – Lemon. Stevia. 4 …

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One of the biggest keys to restoring hair in men is to target DHT. DHT is a hormone known for taking out men’s hair fast by binding to healthy hair follicle cells. There are several products out there to choose from that can aid in this, but the most effective ones are the ones containing saw palmetto.

You may be familiar with saw palmetto because it is also the herb many doctors recommend men take over age 40 to maintain healthy prostates. It appears that saw palmetto can aid in stopping hair loss since it blocks the formation of the hormone DHT.

You can easily head over to your local nutrition center or herb shop and purchase a bottle of saw palmetto. Taking it daily will effectively help to control the amount of hair that you’re losing on a daily basis.

Products such as Provillus and Procerin are readily available online and are known for their nutritional values. Both contain high amounts of saw palmetto to help you get full control over how much hair you’re losing. They also contain various other ingredients that can boost hair growth.

Not long ago the company Nioxin who is known for their line of hair loss treatments, came out with a product called follicle booster. Nioxin’s follicle booster is a topical treatment that contains ingredients such as saw palmetto and others that can treat thinning hair fast.

If you want to stop losing hair it’s just a matter of knowing what nutrients to get into your body as well as apply to your scalp for added benefits.

Be careful when jumping from one product to the next. It can be a disaster, which is why I’m giving away my fifteen page report revealing how to truly regrow hair naturally without the hassles. Article Source: http://EzineArticles.com/?expert=Christopher_Litmon

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New Study Reveals Proprietary Saw Palmetto Extract (SPET-085 …

BPH, also known as an enlarged prostate, is the most common benign proliferative disorder in men, affecting more than 50 percent of men over the age of 70. Symptoms include urinary hesitancy, weak urine stream, nocturia, … It revealed that SPET-085 can effectively inhibit the enzyme linked to BPH, at a lower dose as compared to hexane extracts of saw palmetto, currently regarded as the most clinically effective saw palmetto, but unavailable in the United States. …

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Impotence is a lot more common than most people think, with the condition being more prevalent among men over the age of forty. For those uncomfortable about speaking to the family doctor about impotence, there are plenty of natural … Maca – aphrodisiac used to treat male impotence; Muira puama – may increase sexual desire, improve impotence; Saw palmetto – improves impotence, increases sex drive; Tribulus terrestris – Ayurvedic medicinal treatment for impotence …

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Description A Complete Multivitamin and Mineral Formula with Lycopene and Saw Palmetto for Prostate Health. Created especially for the rigorous. … An estimated 50% of men over the age of 50 are said to have prostate issues. Fortunately, science has discovered that there are powerful herbs and herbal extracts that can assist in soothing the prostate. The natural applications have also been shown to promote reproductive and urinary tract health. …

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If, as we saw palmetto Berry products and lycopene may help to improve naturally enlarged prostate. The difference now is that we have a culture of advanced nutritional supplements have Product learned more and more natural we eat in the achievement and … health of the prostate is a concern for people of all ages and increases with age. A healthy thyroid is essential for proper sexual function, while most men take the health of his prostate cancer very seriously. …

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Top 5 Miami Pest Control Nightmares BigNews.biz (press release) The palmetto bug, also known as the American cockroach or water-bug, is a familiar sight to anyone who has spent time in Miami-Dade. …

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saw palmetto: Definition from Answers.com

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â??Dawgs by Decades: One Manâ??s Odyssey as a Georgia Bulldogs Fan

â??Dawgs by Decades: One Manâ??s Odyssey as a Georgia Bulldogs Fan ( Authorâ??s Note I: Originally, I had intended to publish this posting on Sunday, but, because I inadvertently touched off a small controversy in the meantime, I decided to delay this posting, out of fear that it would not be well receive …

Saw palmetto, saw palmetto photos, Serenoa repens photos, Serenoa …

by Steven Foster © 2009 If you’re a male, or have a man in your life, when age creeps up over 40, as mine did this year, you begin to think …

Cleanse Weight | Attached Generation

Powerful antioxidants and male-friendly ingredients such as Saw Palmetto and Zinc have been included. Meanwhile, a unique and soothing fiber matrix will gently cleanse your colon and promote regularity.* Feel Brand New! …

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The Prostate Problem

If you’re a man who has ever gotten a prostate-specific antigen (PSA) screening, you know it’s a “must-have” test for guys over 50. But there’s a debate that’s been raging for years over the test’s ability to save lives. And now, two opposing studies have muddied the waters on the value of this routine test even more – leaving American men wondering if the test is really worth taking.

While an elevated PSA reading may indicate a life-threatening cancer, it may also detect slower-moving tumors that would never cause death. Because doctors can’t yet tell the difference, treatments are often ordered that can impair men’s quality of life – causing many experts to worry that the PSA test is overused.

The Problem With PSA

If you’ve never had a PSA screening, here’s the 411 on this popular prostate test. The prostate produces a substance known as Prostate Specific Antigen (PSA). A small amount of this antigen continuously leaks into the bloodstream, and levels can be easily measured. Since high levels of PSA can be associated with prostate cancer, most doctors rely on this test, combined with a rectal exam, to screen their patients for prostate cancer.

Routinely measuring PSA levels as a way to spot potential prostate cancer began in the early 1990s and quickly gained status as the “gold standard.” The logic behind the simple blood test was that the earlier you could spot prostate cancer, the better the chance of survival. It’s a belief most doctors still subscribe to.

On the other hand, the American Cancer Society does not currently recommend routine PSA screening for all men. Here’s why: Raised PSA levels simply indicate there’s a problem with your prostate. While that could mean cancer, it could also be a sign of a prostate infection or an enlarged prostate. Or it could mean nothing at all since PSA levels also go up after some medical procedures, particularly after a digital rectal exam. Smoking, your diet, weight changes, and the use of calcium supplements an also cause unreliable PSA readings.

Unfortunately, too many doctors automatically schedule a biopsy based on just one PSA screening. This is totally unnecessary. PSA levels, like your blood pressure, can go up and down based on a variety of factors. Scientists at the University of Texas found that men who are overweight or obese typically have lower PSA counts – even if cancer is present. Bladder infections can also upset PSA levels. Certain medications, like the hair loss drug finasteride, can lower your PSA level, while stress can raise it. And something as simple as changing your diet can impact your PSA.

To get the whole picture, several PSA screenings should be done before more radical measures are taken. And that’s where these two studies come in.

Study Stupor

While both studies appeared in a recent issue of the New England Journal of Medicine, that’s where the similarities end. The first study, which followed more than 76,000 American men for seven years, found that getting regular PSA screenings did not reduce prostate cancer deaths. But the other study, which included 182,000 European men, found that getting tested reduced the risk of dying from prostate cancer by 20 percent.

So which study is right? Who knows? What I can say is this: The never-ending debate over the virtues of PSA screenings is enough to make any man crazy! But there are some guidelines that can help you decide if you really need to get tested. The most important is family history. You have a higher risk of developing prostate cancer if the men in your family had the disease, especially if they were diagnosed before they turned 55. If your father or brother developed prostate cancer, your risk is doubled.

Race can also be a risk factor. More African-American men are struck by prostate cancer than their Asian counterparts. Blacks also have a higher risk of dying of the malignancy. If you have either of these risk factors, you should definitely schedule a PSA test by the time you celebrate your 45th birthday.

What if you’re an older man? Some cancer experts say that, if you have had normal PSA readings in the past, you can stop testing at age 70. But, if previous tests show rising PSA levels, keep getting screened at least annually. If you’re eventually diagnosed with prostate cancer, be aware that most prostate cancers are confined to the prostate itself and grow very slowly. If you’re over 75, consider “watchful waiting” – a situation where your doctor keeps very close tabs on the cancer’s progression. It can be a good alternative to aggressive treatment, which can carry the risk of incontinence and impotence.

Pro-Active Protection

In the midst of all this confusion, there is some good news. Mother Nature has provided men with an arsenal of tools to protect against prostate cancer. Here are three of the most effective:

Vitamin D:  A growing number of studies link the “sunshine” vitamin to a lower risk of prostate cancer. One observational study of 19,000 men found that those with the lowest levels of vitamin D have a 70 percent higher risk of developing prostate cancer than those men who got enough of this nutrient. Without enough vitamin D, prostate cells can multiply too quickly and promote both prostate enlargement and cancerous tumors. Yet between 20 and 80 percent of all Americans have low enough levels to classify them as vitamin D deficient. Make sure you’re getting enough by taking 1,000 IU of supplemental vitamin D per day to help prevent cancer.

Lycopene:  This nutrient is a powerful antioxidant and the source of the red coloring in tomatoes. In a study of over 40,000 health professionals, Harvard researchers found that lycopene slashed the risk of prostate cancer by 35 percent. In another study, researchers discovered that the risk of developing prostate cancer – especially aggressive cancer – decreased in men taking 50 mg. of supplemental lycopene daily. They also noted that a high level of lycopene in the blood was associated with low PSA levels. To boost your lycopene levels, take at least 6.5 mg. per day.

Beta-Sitosterol:  This compound is found in a wide variety of plants, including prostate-friendly herbs like saw palmetto, pumpkin seed, and Pygeum africanum. A study of malignant prostate tumors showed that beta-sitosterol decreased cancer cell growth by 24 percent and boosted the rate that the cancer cells died fourfold. The researchers concluded that beta-sitosterol worked both directly and indirectly to halt the growth and spread of prostate cancer cells. To get the most protection possible, take 130 mg. of beta-sitosterol daily. Just be aware that plant sterols can interfere with beta-carotene and vitamin E absorption. Make sure to take a multivitamin to avoid a deficiency.

One Last Thing

If you do decide to get a PSA screening, it’s also smart to have some idea what the results mean. What’s high? What’s low? The National Cancer Institute has created the following four categories to help your doctor determine your risk of prostate cancer.

Normal   0-4 ng/ml

Slightly Elevated  4-10 ng/ml

Moderately Elevated  10-20 ng/ml

Highly Elevated  20+ ng/ml

ng/ml = nanograms per milliliter

If your levels are elevated, don’t panic! And don’t let your doctor automatically schedule a biopsy. As I mentioned earlier, there are a lot of reasons your PSA may be higher than normal.

A higher-than-normal PSA reading simply means that two things need to happen. First, if your doctor hasn’t done so, make sure he conducts a digital rectal exam (DRE). During a DRE, your doctor inserts a lubricated, gloved finger into the rectum and feels the prostate for hard, lumpy, or abnormal areas. Pressure may be applied with the doctor’s other hand to the pelvic area so that he can feel for tenderness or abnormalities such as enlargement or growths. There can be some mild discomfort or pain during a DRE, since the doctor must press firmly on the prostate. This pressure can also make you feel like you need to urinate. But, even though it may not be on your “Top 10″ list of fun things to do this year, it beats the heck out of getting a biopsy, which can be painful, risky, and potentially unnecessary.

The second thing you need to do is to request at least one more PSA screening before proceeding to more aggressive testing. Since prostate cancer is a slow-growing cancer, most men with higher than average levels can afford to take at least one additional test, preferably a few weeks after the original screening. Overall, PSA is fairly reliable over time, and both you and your doctor can get a much better picture of what’s really happening inside your prostate if several PSA tests can be compared.

While you’re waiting for your next screening, there are a number of things you can do to improve a troubled prostate. Start by cleaning up your diet. Avoid dairy and highly processed foods, and opt for healthy whole foods. You can also begin to take the supplements mentioned above.

Research Brief

Recently I told you how lutein can protect against age-related macular degeneration. Well, it turns out that this eye-friendly antioxidant can also tackle more mundane problems. A new study from China shows that taking lutein for 12 weeks protected computer users’ eyes from becoming sensitive to long-term exposure to the light from computer monitors.

This is great news for folks like me who spend hours in front of their computers. But, to get this protection, the study found that you need higher-than-average amounts of lutein – six to 12 mg. daily. Along with taking a lutein supplement, you can increase your levels by eating more green, leafy vegetables and egg yolks.

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It’s 10 pm. Severe pain in your belly. You are in ER. Previous day you had a nice party with your friends. Then pain started around your umbilicus (navel). You thought first: aha, probably you ate something bad, it will go away. But it doesn’t. You have vomited once and lost appetite. Pain did not improve but worsened. After a day of suffering you decided to visit the hospital. Long taxi trip. Pain is shooting every time the car bumps into a pot. Nurses ask you bunch of questions and place in an available room. There is a confused 90 something years old women in the neighbor room. She mumbles something incomprehensibly. The woman has come from a nursing home. She suffers Alzheimer disease and yells every night for the past 7 years. She has history of multiple medical problems. They brought her in the ER after she developed fever. Nurses draw your blood. You pain is getting gradually worse. Change your position, pull your legs. Pain doesn’t go away. When the … doctor comes? At last ER physician sees you. He writes H+P and ER orders. A stretcher is rolled in. They take you to a radiology department and put into a big machine looking like a gate. Everybody leaves you and the machine drives you into the big metal doughnut. They bring you back into the ER.

Surgical intern comes. He did not rest since 5 AM. He asks bunch of the same questions again and pokes your belly. A tired resident comes. He pokes your belly again. You still wait, become bored, complain on delay, call your relatives. It’s already 2 AM. At last the resident discuss your symptoms with attending over the phone. He tells you that you have appendicitis and CT scan confirmed it. History and physicals are written. Admission orders are written. Pre-op orders are written. Antibiotics are prescribed. IV fluid is running 80 ml an hour. You sign consent for operation. Transporting guys take you upstairs – depending on severity of your symptoms – straight to or to the floor. Attending will operate you first thing in the morning.

Classically appendicitis starts as a pain that began in the periumbilical region (around navel – you belly pot). Then pain moves to the right lower quadrant of the abdomen. Nausea and vomiting often present after the onset of the pain. Classically, patient has low grade fever (this means around 37-38 C or 101-102 F), positive psoas sign (you stretch your leg and this movement increases your pain), positive Rovsing sign (Doctor pokes in your left lower quadrant of the abdomen, and you fill the pain in you right lower quadrant), Leukocytosis. Leukocytes are the white blood cells – WBC. Usually there are around 4000-9000 white cells per micro liter of you blood. When you have inflammation in you body the count goes up.

Your pain during appendicitis classically localizes in Mc Burney’s point. That is one third between your umbilicus and anterior superior iliac spine (this is the bony point that is sticking most prominently from your pelvis – you can palpate it yourself on the side of your belly). For confirmation a doctor also may try to elicit obturator sign – he will ask you to bend you knee and bring your heel to your groin – this manoeuver increases the pain during appendicitis. Similar test is the raising of the leg while you lie on the stretcher. That movement also increases your pain.

Appendicitis is the inflammation of appendix supposedly due to narrowing of this lumen. That narrowing may be caused by hyperplasia of appendix (means too big growth, overgrowth of the tissue) . That variant happens in children mostly. Another variant – is fecalith (small stony fecal material) that impacts into the appendix lumen. That is seen in young adults mostly.

Appendix itself is a small part of gut . It is pencil-size sticking out gut. Gut is a continuos tube. Mouth is entry. Anus is exit. Appendix sticks out from the wall and ends blindly. It has only one entrance. Appendix is attached to the Caecum (part of gut – literally means blind colon in Latin). Appendix of ruminating animals (animals that chew grass, like cow) is very long and big. Appendix in humans is reduced to the pencil-size. However it doesn’t disappear. There is a theory that appendix plays role in immune response. The walls of appendix are actually filled with lymphatic tissue containing lymphocytes (those are subtype of White Blood Cells). Lymphatics is responsible for immunity.

The removal of appendix doesn’t really change immunity significantly. Nonetheless, it is not something redundant. Unless it is inflamed there is no good reason to remove it .

Now, acute appendicitis is the acute inflammation of appendix. Suffix “-itis” means inflammation in Latin. Appendicitis is also the most common cause of acute abdomen. Acute abdomen in surgery is a condition in abdomen that requires urgent actions, usually surgical.

To diagnose appendicitis you need to have right lower quadrant pain.

The pain should be present together with either appropriate history (all those classical signs and lack of appetite) or Leukocytosis (increase in white blood cells in the blood).

Patients often ask questions: Can I avoid surgery? Can you treat me with antibiotics alone? You told me that it is possible to treat the appendicitis with antibiotics alone. Please, I do not want surgery, my mother (father, brother, fiancee) said that I can avoid surgery.

The answer is: you can try to avoid it probably, but the odds of death are much higher if you treat appendicitis without surgery. Untreated appendicitis may lead to perforation in less than a day. Sun rises. Sun sets. Appendix bursts. So, the prompt surgical intervention is the main solution. On occasion, the surgeon may even find a normal-appearing appendix and no other problem explaining the symptoms. He may remove the appendix anyway because it is better to remove a normal-appearing appendix than to miss mild case of appendicitis.

To cool down the infection before surgery doctors use antibiotics. Antibiotics may convert acute appendicitis into more chronic type. However the removal of the appendix is the choice.

With modern technology it becomes much easier to distinguish appendicitis and other causes of pain in right lower quadrant. Yet there is no 100% proof diagnostics. Sometime doctors treat with antibiotics alone, when they are not sure. Though, modern CT-scan shows appendicitis almost close to 100%.

What would happen if you miss the appendicitis and appendix bursts? You will get one of the most dreaded surgical complication – peritonitis. Again, “-itis” equals inflammation. Peritoneum means the peritoneal cavity.

It is difficult to describe the shape of the peritoneal cavity . That shape is very complex. Simple explanation: peritoneal cavity is like a closed bag. It is completely closed in males

Female have small holes in the peritoneum. Oocytes (future babies) go from ovaries first to peritoneal cavity. The holes in the peritoneum allow oocyte to go into Fallopian tubes. Fallopian tubes lead into the uterus (womb in English or hyster in Latin or uterus in Greek). Organs that are covered by peritoneal cavity linings are named intra-peritoneal. There are also melo-peritoneal, extra-peritoneal or retro-peritoneal organs that covered partially or not covered at all. It looks like the main function of peritoneum (peritoneal cavity) is to give some lubrication to your guts. Though there are other functions as well.

Now, take a plastic bag, pour a little bit of water or oil into it and seal. Put one hand on one side of the bag, another hand – on another side of the bag and rub against each other. You can see your hands slide easily. This is the idea of peritoneum – you bowels slide easily against each other even when they are stretched by food and when they are pushing the digested food down. When a bowel is punctured (perforated), the content of the bowel will go into the peritoneal cavity. Colon (lower, bigger bowl) has the fecal material. Fecal material consists of bacteria on 2/3 (yeah, there are so many of them). Now, that small puncture in one part of the gut will cause spillage of the bacteria all around that closed bag of peritoneum.

Guts on inside have several mechanisms protecting from bacteria. Peritoneal cavity doesn’t’ have such a protection.

Small puncture in one part of gut will cause all of you guts be inflamed on outside non-protected side (for the gut it is outside, but for the peritoneal cavity it is the inside). This is the peritonitis (diffuse). This what the surgeons are afraid of. Look at you. You belly is like half of you body. So it is like half of you body is severely inflamed. Eventually it may lead to sepsis, a condition in which bacteria enter the blood and infect other parts of the body. This is life-threatening complication.

Sometime inflammation stays local and seals off forming an abscess. Abscess is the walled off accumulation of pus. Pus is the mixture of dead and alive bacteria, dead white blood cells (leukocytes; leukos = white, cyte = cell) that fought the infection and honorably died, and dead tissue, that was digested partially by bacteria and partially by the stuff from leukocytes. Inflamed peritoneum (the lining of the peritoneal cavity is also named peritoneum) easily adhere to each other and may seal of the infection – there will be local peritonitis. Any adherence may cause problems in the future – guts do not slide easily anymore and food or stool sticks. Blockage of the intestine may occur in acute appendicitis as well. This is partially responsible for the nausea and vomiting. Sometimes, when antibiotics are used, appendicitis goes away without surgical treatment. It happens in elderly patients. The patients may come to the hospital with a lump or a mass in the right lower abdomen looking like tumor.

Diagnostic problem with appendicitis is that some other conditions may mimic it.

Abdominal cavity is packed with different organs. Other sources could cause pain in right lower quadrant. Females may have ovarian torsion or tuboovarian abscess or extrauterine pregnancy (this is why doctors persistently ask: when was your last menstrual period? Are you taking contraceptive hormones? Did you have vaginal bleeding?), etc. They also check your chorionic hormone, trying to find if you are pregnant.

Scrupulous doctor asks your permission to perform rectal exam. Many people refuses to do it. I can understand that. Who would like that somebody sticks fingers into his ass. I wouldn’t. But the rectal exam gives a lot of information. Rectum – is the part of gut that is closest to the back orifice. Back orifice is named anus in Latin or anal canal. Surgeons say that there are only two contra-indications for avoiding rectal exam: 1. patient does not have anus 2. Surgeon does not have fingers.

Rectal exam in appendicitis is usually unremarkable. Maybe you can cause pain by palpating the side wall of the rectum that is close to the appendix. But the rectal exam allows to distinguish other disorders. During the rectal exam you may palpate hemorrhoids, uterus, nodules in prostate or enlarged prostate, you may feel fluid in lower part of peritoneal cavity, etc. You may see blood on the finger telling you about internal bleeding. You may check the stool for small amount of blood (named fecal occult blood test – FOBT – or Guaiac test by the name of the dye that turns blue in the presence of blood. At last rectal exam may help in dis-impaction of rectum. That is when hard stool causes bowel obstruction.

Usually a rectal exam is more or less normal. But every surgeon will tell you a war story about how once in while, once in five years he found something significant on rectal exam, something that every other doctor missed. Just by putting the finger into the butt. I saw how a surgeon put a finger into an old, demented women and pulled out a pessarium. It was an apple-size pink plastic membrane , that should go into vagina, but somebody (at home?) put it (by mistake?) into the rectum of that woman. You really need to push hard to get such big object into the anus. The poor lady suffered bowel obstruction for a week and would probably die if it stayed long enough.

OK, lets return to appendicitis. So, doctors will check you White Blood Cell Count Any infection or inflammation may cause this count to be abnormally high. It is not specific for appendicitis, but it confirms other findings.

Next, doctors check Urinalysis – microscopic examination of the urine. That detects red blood cells, white blood cells and bacteria in the urine. When there is inflammation or stones in the kidneys or bladder, the urinalysis is abnormal. A normal urinalysis is more characteristic to appendicitis.

Next they try to image what is going on in your belly. An abdominal x-ray may detect the fecalith as the cause of appendicitis (5%). Free air due to perforation can might be seen on the plain film.

A barium enema may be used. It is an x-ray test where liquid contrast is used from the anus to fill the colon. Sometimes it show an impression on the colon in the area of inflamed appendix. Barium enema also can exclude other intestinal problems that mimic appendicitis.

Ultrasound shows an enlarged appendix or an abscess. Ultrasound is painless, but the appendix can be seen in only half of patients. Ultrasound also is helpful in excluding the problems with ovaries, fallopian tubes and uterus. Ultrasound machine usually looks like a small thumb on wheels that they bring into your room. Technician puts gelly on and drives the probe over you belly.

Often they go straight to CT Scan (computer tomography). Especially if the patient is not pregnant. CT scan gives relatively high irradiation of your body by x-rays. However benefits of prompt diagnose of appendicitis outweigh the risk of radiation. CT scan gives slicing images of your body.

What do they look for? As any inflamation causes edema, the wall of the appendix will be thickened. This is actually a defensive mechanism – by edema the organism try to wall of, to seal off the area of infection and inflamation.

But it is useful for us because we can surely say there is an inflammation. The same goes for ultrasound.

CT scan is expensive – around 1000 dollars in an American hospital, though 40 dollars in Russia.

If the CT scan is taken during the night, CT image may be send to Australia Russia or India.

An American radiologist is paid around 40 dollars to read just an X-ray film. I guess he gets more for reading the CT scan. It is only 5 dollars in India. This is why even such clinics as Harvard and Yale adopt this model of work – they send the CT scans to the cheap labor abroad. Especially during the night. Half an hour later the fax from Australia arrives. “Inflammatory pericecal mass in the right iliac fossa consistent with the diagnosis of severe acute appendicitis.” Any doctor can read an x-ray film or CT scan. Radiologists are doctors who specialize in the reading of the films. They may find what was missed by others.

At this point diagnosis is usually clear. In cases if it is not, there is Laparoscopy. Laparoscopy is a surgical procedure. Small fiberoptic tube with a camera is inserted into the abdomen through a small puncture in abdominal wall.

Yet there is no test that will diagnose appendicitis with 100% certainty.

The position of the appendix may vary. If it is longer than normal, appendix may go deep down into the pelvis. It also may move behind the colon (called a retro-caecal appendix). From one hand it is better because retro-caecal appendix has less chances to burst into peritoneal cavity, from the other it is difficult to diagnose and it is difficult to approach surgically. Inflammation of other organs, for example, female pelvic organs, may resemble inflammation of the appendix. Pregnant women may have appendix pushed up in abdomen by the enlarged uterus. Athletic young adults may tolerate more pain and may have not so obvious symptoms of appendicitis. Old patients may have vague symptoms as well.

Other inflammatory problems may mimic appendicitis. Surgeons often observe patients with suspected appendicitis for a period of time to see if the problem will resolve or suggest appendicitis more strongly versus another condition. Conditions that mimic appendicitis are:

1) Meckel’s diverticulitis. 2) Pelvic inflammatory disease -infection of tube and ovary. It is treated with antibiotics alone 3) Fluids from the right upper abdomen may drip into the lower abdomen and cause inflammation resembling appendicitis. Then, for example, patient has gallbladder disease or liver abscess, but all symptoms suggest acute appendicitis. 4) Diverticulitis that occur on the right side. 5) Inflammation of right kidney. 6) Crohn’s disease or ulcerative colitis 7) Yersinia enterocolitica infection – the bacteria that comes form certain food – like unpasteurized milk. – may cause appendicitis passing kidney stone 9) ectopic pregnancy 10) ovarian cyst rupture. And so on. There are some other conditions.

Appendectomy is performed urgently usually. Thomeo is Latin for dissect or cut. Lapar – is abdomen (belly) in medical Latin. Laparotomy is opening of belly. Appendectomy is cutting of appendix. Laparoscopy is looking (by scope) into belly. Antibiotics almost always are given prior to surgery as soon as appendicitis is suspected.

Few patients have mild “confined appendicitis” localized to a small area. These patients may improve during several days of observation when treated with antibiotics alone. Doctors may or may not removed the appendix later. Chances are you are not one of this patients.

If a person has not seen doctor for many days while appendicitis ruptured (yeah, sometime happens; there are some tough guys), an abscess may form, and the perforation may close. Initially it can be treated with antibiotics; however, that will require drainage later. A drain is guided under ultrasound or CT scan and appendix is removed after the abscess resolves.

In modern days surgeons offer laparoscopic appendectomy. They insert laparoscope (it is like a small telescope with a video camera) and remove appendix with special instruments through small puncture wounds.

If you had this type of surgery, you will probably have four 1-cm size scars and you will go home in one or two days.

But if your case is complicated or there is just no laparoscopy in the hospital, they will do classical appendectomy. Surgeon cuts 10-cm incision in the area of the appendix. Appendix is removed form the right lower abdomen or where it is. Area is checked for other problems. In the case of abscess the purulent stuff will be drained with rubber tubes through the skin. With that kind of surgery you will probably stay for four to seven days. Antibiotics will help to resolve the abscess.

This is why you sign the consent: “laparoscopic appendectomy, possible conversion to an open appendectomy”.

The most common complication of appendectomy is wound infection. If it is severe, the surgeon will postpone incision closure for several days.

Ok, now you have those four small scars or one big scar, you go home and visit that party that you missed.

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